101
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Naur TMH, Konge L, Nayahangan LJ, Clementsen PF. Training and certification in endobronchial ultrasound-guided transbronchial needle aspiration. J Thorac Dis 2017; 9:2118-2123. [PMID: 28840013 DOI: 10.21037/jtd.2017.06.89] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) plays a key role in the staging of lung cancer, which is crucial for allocation to surgical treatment. EBUS-TBNA is a complicated procedure and simulation-based training is helpful in the first part of the long learning curve prior to performing the procedure on actual patients. New trainees should follow a structured training programme consisting of training on simulators to proficiency as assessed with a validated test followed by supervised practice on patients. The simulation-based training is superior to the traditional apprenticeship model and is recommended in the newest guidelines. EBUS-TBNA and oesophageal ultrasound-guided fine needle aspiration (EUS-FNA or EUS-B-FNA) are complementary to each other and the combined techniques are superior to either technique alone. It is logical to learn and to perform the two techniques in combination, however, for lung cancer staging solely EBUS-TBNA simulators exist, but hopefully in the future simulation-based training in EUS will be possible.
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Affiliation(s)
- Therese Maria Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
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102
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Murakami R, Semba A, Kawahara K, Matsuyama K, Hiraki A, Nagata M, Toya R, Yamashita Y, Oya N, Nakayama H. Concurrent chemoradiotherapy with S-1 in patients with stage III-IV oral squamous cell carcinoma: A retrospective analysis of nodal classification based on the neck node level. Mol Clin Oncol 2017; 7:140-144. [PMID: 28685092 DOI: 10.3892/mco.2017.1276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/13/2017] [Indexed: 12/11/2022] Open
Abstract
The aim of the present study was to retrospectively evaluate the treatment outcomes of concurrent chemoradiotherapy (CCRT) with S-1, an oral fluoropyrimidine anticancer agent, for advanced oral squamous cell carcinoma (SCC). The study population consisted of 47 patients with clinical stage III or IV oral SCC, who underwent CCRT with S-1. Pretreatment variables, including patient age, clinical stage, T classification, midline involvement of the primary tumor and nodal status, were analyzed as predictors of survival. In addition to the N classification (node-positive, multiple and contralateral), the prognostic impact of the level of nodal involvement was assessed. Nodal involvement was mainly observed at levels Ib and II; involvement at levels Ia and III-V was considered to be anterior and inferior extension, respectively, and was recorded as extensive nodal involvement (ENI). The 3-year overall survival (OS) and progression-free survival (PFS) rates were 37 and 27%, respectively. A finding of ENI was a significant factor for OS [hazard ratio (HR)=2.16; 95% confidence interval (CI): 1.03-4.55; P=0.038] and PFS (HR=2.65; 95% CI: 1.32-5.33; P=0.005); the 3-year OS and PFS rates in patients with vs. those without ENI were 23 vs. 50% and 9 vs. 43%, respectively. The other variables were not significant. Therefore, CCRT with S-1 may be an alternative treatment for advanced oral SCC; favorable outcomes are expected in patients without ENI.
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Affiliation(s)
- Ryuji Murakami
- Department of Medical Imaging, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0976, Japan
| | - Akiko Semba
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0976, Japan
| | - Kenta Kawahara
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0976, Japan
| | - Keiya Matsuyama
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0976, Japan
| | - Akimitsu Hiraki
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0976, Japan
| | - Masashi Nagata
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0976, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0976, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0976, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0976, Japan
| | - Hideki Nakayama
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0976, Japan
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103
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Op de Beeck B, Smeets P, Penninckx F, Pattyn P, Silversmit G, Van Eycken E. Accuracy of pre-treatment locoregional rectal cancer staging in a national improvement project. Acta Chir Belg 2017; 117:104-109. [PMID: 27881048 DOI: 10.1080/00015458.2016.1259883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to assess the accuracy, particularly the predictive value, of locoregional clinical rectal cancer staging (cTN) and its variability in a national improvement project. METHODS cTN stages and the distance between tumour and mesorectal fascia (MRF) were compared with histopathological findings in 1168 patients who underwent radical resection without neoadjuvant treatment. Data were registered prospectively from 2006 to 2014. RESULTS Agreement between clinical and histopathological TN stages was 50%, independent of tumour location. Inter-hospital variability was within 99% prediction limits. Magnetic resonance imaging (MRI) was increasingly applied, but staging accuracy did not improve. Stage II-III was correctly predicted in 69% and pStage I was over-staged in 35%. The positive predictive value of endorectal ultrasonography (ERUS) for T1 lesions was 57%. MRI-based distances to MRF correlated poorly with the circumferential resection margin (r = 0.26). A negative resection margin was achieved in 91% when the distance to the MRF was >1 mm. CONCLUSIONS The accuracy of rectal cancer staging in general practice should be improved to avoid under- or overtreatment. Training and expert review of pre-treatment MR imaging could be helpful. A second ERUS is justified when transanal local resection for early lesions is planned.
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Affiliation(s)
| | - Peter Smeets
- Department of Radiology, University Hospital, Gent, Belgium
| | - Freddy Penninckx
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - Piet Pattyn
- Department of Gastrointestinal Surgery, University Hospital, Gent, Belgium
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104
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Duan J, Deng T, Ying G, Zhang H, Zhou L, Bai M, Li H, Ba Y. Prognostic significance of the T2 substage in patients with esophageal squamous cell carcinoma. Dis Esophagus 2017; 30:1-7. [PMID: 28375473 DOI: 10.1093/dote/dow027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Indexed: 12/11/2022]
Abstract
The invasion of the muscularis propria is defined as T2 stage in esophageal squamous cell carcinoma. Evidence is lacking regarding whether the T2 substage based on anatomy may serve as a prognostic indicator. This study aims to confirm the prognostic value of the T2 substage. The clinicopathological characteristics of 120 patients who had pathologically verified T2 tumors between 2006 and 2011 at the Tianjin Medical University Cancer Institute and Hospital were retrospectively studied. Based on the invasion depth, tumors that had penetrated the circular muscle layer were defined as T2a, while T2b disease referred to those that had invaded the longitudinal muscle layer. Factors potentially related to survival were analyzed with univariate and multivariate analyses. The logistic regression model was used to examine the factors associated with lymph node metastasis. To verify the prognostic value of the T2 substage further, patients with T1b and T3 stage disease during the same period were selected for comparisons. The univariate and multivariate analyses demonstrated that the T2 substage and N stage were independent prognostic factors. The T2 substage was highly relevant to lymph node metastasis in the logistic regression model (P = 0.044). When T1b and T3 was considered, the survival of T2a patients was closer to that of T1b patients, while the survival of T2b patients was closer to that of T3 disease (P = 0.000). The T2 substage was an independent prognostic factor. Patients with T2a tumors displayed a favorable survival, while the prognosis of T2b patients was closer to that of T3 patients.
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105
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Abstract
Lung cancer remains a common and deadly disease. Many modalities are available to
the bronchoscopist to evaluate and stage lung cancer. We review the role of
bronchoscopy in the staging of the mediastinum with convex endobronchial
ultrasound (EBUS) and discuss emerging role of esophageal ultrasonography as a
complementary modality. In addition, we discuss advances in scope technology and
elastography. We review the bronchoscopic methods available for the diagnosis of peripheral
lung nodules including radial EBUS and navigational bronchoscopy (NB) with a
consideration of the basic methodologies and diagnostic accuracies. We conclude
with a discussion of the comparison of the various methodologies.
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Affiliation(s)
- Adam R Belanger
- Division of Pulmonary and Critical Care, Section of Interventional Pulmonology, University of North Carolina at Chapel Hill, NC, USA
| | - Jason A Akulian
- Assistant Professor of Medicine, Director, Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, 8007 Burnett Womack Bldg., CB 7219, Chapel Hill, NC 27713, USA
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106
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Grzegółkowski P, Kaczmarek K, Lemiński A, Soczawa M, Gołąb A, Słojewski M. Assessment of the infiltrative character of bladder cancer at the time of transurethral resection: a single center study. Cent European J Urol 2016; 70:22-26. [PMID: 28461983 PMCID: PMC5407325 DOI: 10.5173/ceju.2017.768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/12/2016] [Accepted: 12/04/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Determining the clinical stage of bladder carcinoma before radical cystectomy is characterized by a high inaccuracy rate. The discrepancy in some reports reaches up to 48%. Therefore intraoperative clinical staging of bladder carcinoma is not recommended before radical treatment as it is for prostate cancer. However, the accuracy of clinical assessment of the muscle invasive character of the tumors at the time of transurethral resection has not been studied. In our study we estimate the accuracy of clinical staging during endoscopic treatment. Material and methods 332 patients who had undergone transurethral resection of bladder cancer were studied in this retrospective analysis. Data such as age, gender, presence of hydronephrosis, operator, the results of bimanual bladder examination, TURB report and pathologic report, were collected from each patient. Intraoperative prediction of the muscle invasive nature of the tumor was compared with pathological reports. A logistic regression analysis was used to evaluate the influence of particular variables on upstaging and downstaging. Results Overall accuracy between clinical and histopathology staging was 87.8%. Discrepancy was observed only in 36 patients. Patients with pTa stage were the most numerous group among patients with accurate prediction of the muscle invasiveness character of the tumor. Univariable logistic regression indicated that the presence of a palpable mass in the bimanual examination was a predictor of upstaging, with an OR 11.75 CI95% [2.49–55.32]. Conclusions The study indicated the high accuracy between clinical and pathological reports. Intraoperative evaluation of tumor character should be an indispensable part of treatment, which can be useful for planning in advance the further stages of treatment.
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Affiliation(s)
- Paweł Grzegółkowski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Krystian Kaczmarek
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Artur Lemiński
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Michał Soczawa
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Adam Gołąb
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
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107
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Zhong B, Lin Y, Lai Y, Zheng F, Zheng X, Huang R, Yang W, Chen Z. Relationship of Oct-4 to malignant stage: a meta-analysis based on 502 positive/high Oct-4 cases and 522 negative/low case-free controls. Oncotarget 2016; 7:2143-52. [PMID: 26575328 PMCID: PMC4811523 DOI: 10.18632/oncotarget.5737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/28/2015] [Indexed: 01/07/2023] Open
Abstract
Background Octamer 4 (Oct-4), an important member of the POU domain transcription factor family, has been suggested to function as a master switch during differentiation of human somatic cells and more recently has come to be linked with neoplastic properties. The aim of this study was to evaluate the relationship between Oct-4 and cancer stage using a meta-analysis approach. Materials and Methods Relevant articles published as of May 2015 were retrieved from the following databases: PubMed, ISI Web of Knowledge, Embase, and Chinese National Knowledge Infrastructure (CNKI). The strengths of relationship for outcomes of interest were estimated based on odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of 11 articles on Oct-4 and cancer staging that collectively included 502 positive/high Oct-4 cases and 522 negative/low case-free controls were chosen. Positive/high Oct-4 was significantly associated with cancer stage in several kinds of cancer. Specifically, positive/high Oct-4 was associated with cancer stage III/IV (fixed effects: OR = 1.53, 95% CI = 1.12–2.10), primary tumor (T3–4) (random effects: OR = 1.93, 95% CI = 0.99–3.77), and cancer grade of differentiation (intermediate-poor) (random effects: OR = 3.45, 95% CI = 1.5–7.61). Conclusion These findings suggest that positive/high Oct-4 is more strongly linked to stage III/IV cancer and cancer grade of differentiation, and is correlated with malignant characteristics that lead to poor prognosis in different types of cancer, especially in Asian. Given variability related to ethnicity and differences in cancer types, additional studies are warranted to establish the generalizability of our findings.
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Affiliation(s)
- Beilong Zhong
- Department of Thoracic Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Yan Lin
- Department of Breast Disease, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China
| | - Yingrong Lai
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Fangfang Zheng
- Department of Pediatrics, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Xiaobin Zheng
- Department of Respiratory Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Rijiao Huang
- Department of Clinical Laboratory, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Weilin Yang
- Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Zhenguang Chen
- Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Lung Cancer Research Center of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
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108
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Rice TW, Apperson-Hansen C, DiPaola LM, Semple ME, Lerut TEMR, Orringer MB, Chen LQ, Hofstetter WL, Smithers BM, Rusch VW, Wijnhoven BPL, Chen KN, Davies AR, D’Journo XB, Kesler KA, Luketich JD, Ferguson MK, Räsänen JV, van Hillegersberg R, Fang W, Durand L, Allum WH, Cecconello I, Cerfolio RJ, Pera M, Griffin SM, Burger R, Liu JF, Allen MS, Law S, Watson TJ, Darling GE, Scott WJ, Duranceau A, Denlinger CE, Schipper PH, Ishwaran H, Blackstone EH. Worldwide Esophageal Cancer Collaboration: clinical staging data. Dis Esophagus 2016; 29:707-714. [PMID: 27731549 PMCID: PMC5591441 DOI: 10.1111/dote.12493] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To address uncertainty of whether clinical stage groupings (cTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for clinically staged patients from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5-25 mg/kg2 , 47%), little weight loss (2.4 ± 7.8 kg), 0-1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cN0 (44%), cM0 (95%), and cG2-G3 (89%); most involved the distal esophagus (73%). Non-risk-adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cN0 versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre-treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, and treatment characteristics and should direct 9th edition data collection.
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Affiliation(s)
| | | | | | | | | | | | - L.-Q. Chen
- West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | | | - B. M. Smithers
- University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - V. W. Rusch
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | | | | | | | - K. A. Kesler
- Indiana University Medical Center, Indianapolis, Indiana, USA
| | - J. D. Luketich
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - M. K. Ferguson
- Department of Surgery, The University of Chicago, Chicago, Illinois, USA
| | | | | | - W. Fang
- Shanghai Chest Hospital, Shanghai, China
| | - L. Durand
- Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina
| | - W. H. Allum
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - R. J. Cerfolio
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - M. Pera
- Hospital Universitario del Mar, Barcelona, Spain
| | | | - R. Burger
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - J.-F Liu
- Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | | | - S. Law
- University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
| | - T. J. Watson
- University of Rochester, Rochester, New York, USA
| | | | - W. J. Scott
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - A. Duranceau
- University of Montreal, Montreal, Quebec, Canada
| | - C. E. Denlinger
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - P. H. Schipper
- Oregon Health and Science University, Portland, Oregon, USA
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109
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Rice TW, Chen LQ, Hofstetter WL, Smithers BM, Rusch VW, Wijnhoven BPL, Chen KL, Davies AR, D'Journo XB, Kesler KA, Luketich JD, Ferguson MK, Räsänen JV, van Hillegersberg R, Fang W, Durand L, Cecconello I, Allum WH, Cerfolio RJ, Pera M, Griffin SM, Burger R, Liu JF, Allen MS, Law S, Watson TJ, Darling GE, Scott WJ, Duranceau A, Denlinger CE, Schipper PH, Lerut TEMR, Orringer MB, Ishwaran H, Apperson-Hansen C, DiPaola LM, Semple ME, Blackstone EH. Worldwide Esophageal Cancer Collaboration: pathologic staging data. Dis Esophagus 2016; 29:724-733. [PMID: 27731547 PMCID: PMC5731491 DOI: 10.1111/dote.12520] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/03/2016] [Accepted: 06/04/2016] [Indexed: 02/05/2023]
Abstract
We report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for patients with pathologically staged cancer of the esophagus and esophagogastric junction after resection or ablation with no preoperative therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted de-identified data using standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 13,300 patients, 5,631 had squamous cell carcinoma, 7,558 adenocarcinoma, 85 adenosquamous carcinoma, and 26 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (51%), little weight loss (1.8 kg), 0-2 ECOG performance status (83%), and a history of smoking (70%). Cancers were pT1 (24%), pT2 (15%), pT3 (50%), pN0 (52%), pM0 (93%), and pG2-G3 (78%); most involved distal esophagus (71%). Non-risk-adjusted survival for both squamous cell carcinoma and adenocarcinoma was monotonic and distinctive across pTNM. Survival was more distinctive for adenocarcinoma than squamous cell carcinoma when pT was ordered by pN. Survival for pTis-1 adenocarcinoma was better than for squamous cell carcinoma, although monotonic and distinctive for both. WECC pathologic staging data is improved over that of the 7th edition, with more patients studied and patient and cancer variables collected. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics, and should direct 9th edition data collection. However, the role of pure pathologic staging as the principal point of reference for esophageal cancer staging is waning.
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Affiliation(s)
- T W Rice
- Cleveland Clinic, Cleveland, Ohio, USA.
| | - L-Q Chen
- West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - W L Hofstetter
- University of Texas MD Anderson Hospital, Houston, Texas, USA
| | - B M Smithers
- University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - V W Rusch
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | - K L Chen
- Beijing Cancer Hospital, Beijing, China
| | - A R Davies
- Guy's & St Thomas' Hospitals, London, England
| | | | - K A Kesler
- Indiana University Medical Center, Indianapolis, Indiana, USA
| | - J D Luketich
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - M K Ferguson
- Department of Surgery, The University of Chicago, Chicago, Illinois, USA
| | - J V Räsänen
- Helsinki University Hospital, Helsinki, Finland
| | | | - W Fang
- Shanghai Chest Hospital, Shanghai, China
| | - L Durand
- Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina
| | - I Cecconello
- University of São Paulo School of Medicine, São Paulo, Brazil
| | - W H Allum
- Royal Marsden NHS Foundation Trust, London, UK
| | - R J Cerfolio
- Section of Thoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - M Pera
- Hospital Universitario del Mar, Barcelona, Spain
| | - S M Griffin
- University of Newcastle upon Tyne, Newcastle, United Kingdom
| | - R Burger
- University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - J-F Liu
- Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - M S Allen
- Mayo Clinic, Rochester, Minnesota, USA
| | - S Law
- University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
| | - T J Watson
- University of Rochester, Rochester, New York, USA
| | - G E Darling
- Toronto General Hospital, Toronto, Ontario, Canada
| | - W J Scott
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - A Duranceau
- University of Montreal, Montreal, Quebec, Canada
| | - C E Denlinger
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - P H Schipper
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - M B Orringer
- University of Michigan, Ann Arbor, Michigan, USA
| | - H Ishwaran
- University of Miami, Miami, Florida, USA
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110
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Rice TW, Lerut TEMR, Orringer MB, Chen LQ, Hofstetter WL, Smithers BM, Rusch VW, van Lanschot J, Chen KN, Davies AR, D’Journo XB, Kesler KA, Luketich JD, Ferguson MK, Rasanen JV, van Hillegersberg R, Fang W, Durand L, Allum WH, Cecconello I, Cerfolio RJ, Pera M, Griffin SM, Burger R, Liu JF, Allen MS, Law S, Watson TJ, Darling GE, Scott WJ, Duranceau A, Denlinger CE, Schipper PH, Ishwaran H, Apperson-Hansen C, DiPaola LM, Semple ME, Blackstone EH. Worldwide Esophageal Cancer Collaboration: neoadjuvant pathologic staging data. Dis Esophagus 2016; 29:715-723. [PMID: 27731548 PMCID: PMC5528175 DOI: 10.1111/dote.12513] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023]
Abstract
To address uncertainty of whether pathologic stage groupings after neoadjuvant therapy (ypTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for pathologically staged cancers after neoadjuvant therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 7,773 pathologically staged neoadjuvant patients, 2,045 had squamous cell carcinoma, 5,686 adenocarcinoma, 31 adenosquamous carcinoma, and 11 undifferentiated carcinoma. Patients were older (61 years) men (83%) with normal (40%) or overweight (35%) body mass index, 0-1 Eastern Cooperative Oncology Group performance status (96%), and a history of smoking (69%). Cancers were ypT0 (20%), ypT1 (13%), ypT2 (18%), ypT3 (44%), ypN0 (55%), ypM0 (94%), and G2-G3 (72%); most involved the distal esophagus (80%). Non-risk-adjusted survival for yp categories was unequally depressed, more for earlier categories than later, compared with equivalent categories from prior WECC data for esophagectomy-alone patients. Thus, survival of patients with ypT0-2N0M0 cancers was intermediate and similar regardless of ypT; survival for ypN+ cancers was poor. Because prognoses for ypTNM and pTNM categories are dissimilar, prognostication should be based on separate ypTNM categories and groupings. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics and should direct 9th edition data collection.
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Affiliation(s)
| | | | | | - L.-Q. Chen
- West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | | | - B. M. Smithers
- University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - V. W. Rusch
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | | | | | | | - K. A. Kesler
- Indiana University Medical Center, Indianapolis, Indiana, USA
| | - J. D. Luketich
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - M. K. Ferguson
- Department of Surgery, The University of Chicago, Chicago, Illinois, USA
| | | | | | - W. Fang
- Shanghai Chest Hospital, Shanghai, China
| | - L. Durand
- Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina
| | - W. H. Allum
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - R. J. Cerfolio
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - M. Pera
- Hospital Universitario del Mar, Barcelona, Spain
| | | | - R. Burger
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - J.-F. Liu
- Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | | | - S. Law
- University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
| | - T. J. Watson
- University of Rochester, Rochester, New York, USA
| | | | - W. J. Scott
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - A. Duranceau
- University of Montreal, Montreal, Quebec, Canada
| | - C. E. Denlinger
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - P. H. Schipper
- Oregon Health & Science University, Portland, Oregon, USA
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111
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Howe TE, Khurram SA, Hunter K, Martin LH, Fry AM. Accuracy of staging of oral squamous cell carcinoma of the tongue: should incisional biopsy be done before or after magnetic resonance imaging? Br J Oral Maxillofac Surg 2017; 55:298-9. [PMID: 27682718 DOI: 10.1016/j.bjoms.2016.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/07/2016] [Indexed: 11/22/2022]
Abstract
Accurate staging of oral squamous cell carcinoma (oral SCC) is essential. Some clinicians delay diagnostic biopsy until after magnetic resonance imaging (MRI). We retrospectively studied the clinical records and histopathological databases of 58 patients with SCC of the tongue; 39 had biopsy before MRI and 19 afterwards. In the group who had the biopsy first, eight were up-staged, nine were down-staged, and in 22 the T stage was accurate. In those who had MRI first, the corresponding figures were two, six, and 11, respectively. The time between initial biopsy and excision was significantly longer in the MRI group (43 days), than in the biopsy group (16 days) (p<0.001). Differences in staging between the two groups were not significant. Whether the biopsy was taken before or after MRI does not seem to affect the accuracy of clinical staging, and to delay biopsy until after staging may be unnecessary.
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112
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Savarino E, Ottonello A, Tolone S, Bartolo O, Baeg MK, Farjah F, Kuribayashi S, Shetler KP, Lottrup C, Stein E. Novel insights into esophageal diagnostic procedures. Ann N Y Acad Sci 2016; 1380:162-177. [PMID: 27681220 DOI: 10.1111/nyas.13255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022]
Abstract
The 21st century offers new advances in diagnostic procedures and protocols in the management of esophageal diseases. This review highlights the most recent advances in esophageal diagnostic technologies, including clinical applications of novel endoscopic devices, such as ultrathin endoscopy and confocal laser endomicroscopy for diagnosis and management of Barrett's esophagus; novel parameters and protocols in high-resolution esophageal manometry for the identification and better classification of motility abnormalities; innovative connections between esophageal motility disorder diagnosis and detection of gastroesophageal reflux disease (GERD); impedance-pH testing for detecting the various GERD phenotypes; performance of distensibility testing for better pathophysiological knowledge of the esophagus and other gastrointestinal abnormalities; and a modern view of positron emission tomography scanning in metastatic disease detection in the era of accountability as a model for examining other new technologies. We now have better tools than ever for the detection of esophageal diseases and disorders, and emerging data are helping to define how well these tools change management and provide value to clinicians. This review features novel insights from multidisciplinary perspectives, including both surgical and medical perspectives, into these new tools, and it offers guidance on the use of novel technologies in clinical practice and future directions for research.
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Affiliation(s)
- Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
| | - Andrea Ottonello
- Department of Surgical and Diagnostic Integrated Sciences, University of Genoa, Genoa, Italy
| | - Salvatore Tolone
- Division of General and Bariatric Surgery, Department of Surgery, Second University of Naples, Naples, Italy
| | - Ottavia Bartolo
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Myong Ki Baeg
- Division of Gastroenterology, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, South Korea
| | - Farhood Farjah
- Division of Cardiothoracic Surgery, Surgical Outcomes Research Center, University of Washington, Seattle, Washington
| | - Shiko Kuribayashi
- Department of Gastroenterology and Hepatology, Gunma University Hospital, Maebashi, Japan
| | - Katerina P Shetler
- Division of Gastroenterology, Palo Alto Medical Foundation, Mountain View, California
| | - Christian Lottrup
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark.,Department of Medicine, North Jutland Regional Hospital, Hjørring, Denmark
| | - Ellen Stein
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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113
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Kagedan DJ, Frankul F, El-Sedfy A, McGregor C, Elmi M, Zagorski B, Dixon ME, Mahar AL, Vasilevska-Ristovska J, Helyer L, Rowsell C, Swallow CJ, Law CH, Coburn NG. Negative predictive value of preoperative computed tomography in determining pathologic local invasion, nodal disease, and abdominal metastases in gastric cancer. ACTA ACUST UNITED AC 2016; 23:273-9. [PMID: 27536178 DOI: 10.3747/co.23.3124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Before undergoing curative-intent resection of gastric adenocarcinoma (ga), most patients undergo abdominal computed tomography (ct) imaging to determine contraindications to resection (local invasion, distant metastases). However, the ability to detect contraindications is variable, and the literature is limited to single-institution studies. We sought to assess, on a population level, the clinical relevance of preoperative ct in evaluating the resectability of ga tumours in patients undergoing surgery. METHODS In a provincial cancer registry, 2414 patients with ga diagnosed during 2005-2008 at 116 institutions were identified, and a primary chart review of radiology, operative, and pathology reports was performed for all patients. Preoperative abdominal ct reports were compared with intraoperative findings and final pathology reports (reference standard) to determine the negative predictive value (npv) of ct in assessing local invasion, nodal involvement, and intra-abdominal metastases. RESULTS Among patients undergoing gastrectomy, the npv of ct imaging in detecting local invasion was 86.9% (n = 536). For nodal metastasis, the npv of ct was 43.3% (n = 450). Among patients undergoing surgical exploration, the npv of ct for intra-abdominal metastases was 52.3% (n = 407). CONCLUSIONS Preoperative abdominal ct imaging reported as negative is most accurate in determining local invasion and least accurate in nodal assessment. The poor npv of ct should be taken into account when selecting patients for staging laparoscopy.
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Affiliation(s)
- D J Kagedan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON; Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - F Frankul
- Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON
| | - A El-Sedfy
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, U.S.A
| | - C McGregor
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON
| | - M Elmi
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON; Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - B Zagorski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - M E Dixon
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, U.S.A
| | - A L Mahar
- Department of Public Health Sciences, Queen's University, Kingston, ON
| | | | - L Helyer
- Division of General Surgery, Dalhousie University, Halifax, NS
| | - C Rowsell
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - C J Swallow
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON
| | - C H Law
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON; Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - N G Coburn
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON; Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
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114
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Anyiwe K, Qiao Y, De P, Yoshida EM, Earle CC, Thein HH. Effect of socioeconomic status on hepatocellular carcinoma incidence and stage at diagnosis, a population-based cohort study. Liver Int 2016; 36:902-10. [PMID: 26455359 DOI: 10.1111/liv.12982] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/05/2015] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) incidence is increasing worldwide and cirrhosis is the most important risk factor predominantly caused by chronic viral hepatitis infection. We studied the impact of socioeconomic status (SES) on HCC incidence and stage at diagnosis among viral hepatitis cases. METHODS A population-based retrospective cohort study was conducted through the Ontario Cancer Registry linked data. Incidence rates were calculated using person-time methodology. Association between SES (income quintile) and HCC incidence was assessed using proportional-hazards regression. The impact of SES on HCC stage was investigated using logistic regression. RESULTS Among 11 350 individuals diagnosed with viral hepatitis between 1991 and 2010, a crude HCC incidence rate of 21.4 cases per 1000 person-years was observed. Adjusting for age, gender, urban/rural residence and year of viral hepatitis diagnosis, a significant association was found between SES and HCC incidence, with an increased risk among individuals in the lowest three income quintiles (incidence rate ratio, IRR = 1.235; 95% CI: 1.074-1.420; IRR = 1.183; 95% CI: 1.026-1.364; IRR = 1.158; 95% CI: 1.000-1.340 respectively). No significant association between SES and HCC incidence was found after additionally adjusting for risk factors associated with HCC. However, HCC risk factors such as cirrhosis and HIV are associated with SES. Furthermore, no association was found between SES and HCC stage. CONCLUSIONS The association between SES and HCC incidence is likely because of differences in risk factors across income quintiles. Investigating how SES affects HCC incidence facilitates an understanding of which populations are at elevated risk for HCC.
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Affiliation(s)
- Kika Anyiwe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Yao Qiao
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Prithwish De
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Surveillance and Cancer Registry, Cancer Care Ontario, Toronto, ON, Canada
| | - Eric M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - Craig C Earle
- Ontario Institute for Cancer Research, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Hla-Hla Thein
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Ontario Institute for Cancer Research, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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115
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Bulzico D, de Faria PAS, de Paula MP, Bordallo MAN, Pessoa CHCN, Corbo R, Ferman S, Vaisman M, Neto LV. Recurrence and mortality prognostic factors in childhood adrenocortical tumors: Analysis from the Brazilian National Institute of Cancer experience. Pediatr Hematol Oncol 2016; 33:248-58. [PMID: 27246903 DOI: 10.3109/08880018.2016.1173148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prognostic markers that can help identifying precocious risk of unfavorable outcomes in patients with childhood adrenocortical tumors (ACTs) are still unclear. This observational and retrospective study aimed to identify clinical and pathology prognostic factors of recurrence and death in a tertiary cancer center population. Clinical, pathology, demographic, staging, and therapy data from patients with childhood ACT (median age: 3.6 years) treated at the Brazilian National Institute of Cancer between 1997 and 2015 were assessed. Univariate and bivariate analyses were used to study the association of clinical and pathology characteristics with recurrence and mortality. Recurrence and disease-related mortality were the main outcomes. Twenty-seven patients were included. Complete tumor resection was performed in 21 cases. The median tumor size was 8.2 cm. Mitotane was the most common adjuvant/palliative therapy (n = 13). Recurrence occurred in 6 patients, after a median time of 7.2 months, and was more common among those with larger tumors (P =.008), higher Weiss score (P =.001), and microscopic tumoral necrosis (P =.002). Ten patients died from the disease. Older age (P =.04), larger tumor size (P =.002), metastatic disease (P =.003), previous recurrence (P =.003), incomplete resection (P =.002), intraoperative tumor spillage (P =.005), higher Weiss score (P =.03), microscopic necrosis (P =.005), and capsular invasion (P =.02) were all associated with increased death risk. Even though complete tumor resection was performed in most cases, a considerable number of cases of childhood ACT resulted in recurrence and death. Early identification of unfavorable outcomes is essential to determine ideal therapy and appropriate surveillance.
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Affiliation(s)
- Daniel Bulzico
- a Endocrine Oncology Unit, Brazilian National Institute of Cancer-INCA , Rio de Janeiro, Rio de Janeiro , Brazil.,c Endocrinology Section, Federal Hospital of Lagoa , Rio de Janeiro, Rio de Janeiro , Brazil
| | | | - Marcela Pessoa de Paula
- c Endocrinology Section, Federal Hospital of Lagoa , Rio de Janeiro, Rio de Janeiro , Brazil
| | - Maria Alice Neves Bordallo
- a Endocrine Oncology Unit, Brazilian National Institute of Cancer-INCA , Rio de Janeiro, Rio de Janeiro , Brazil
| | - Cencita H C N Pessoa
- a Endocrine Oncology Unit, Brazilian National Institute of Cancer-INCA , Rio de Janeiro, Rio de Janeiro , Brazil
| | - Rossana Corbo
- a Endocrine Oncology Unit, Brazilian National Institute of Cancer-INCA , Rio de Janeiro, Rio de Janeiro , Brazil.,d Nuclear Medicine Section, Medical School and Clementino Fraga Filho University Hospital, Rio de Janeiro Federal University , Rio de Janeiro, Rio de Janeiro , Brazil
| | - Sima Ferman
- e Department of Pediatric Oncology , Brazilian National Institute of Cancer-INCA , Rio de Janeiro , Rio de Janeiro , Brazil
| | - Mario Vaisman
- f Department of Internal Medicine and Endocrinology Section , Medical School and Clementino Fraga Filho University Hospital, Rio de Janeiro Federal University , Rio de Janeiro, Rio de Janeiro , Brazil
| | - Leonardo Vieira Neto
- c Endocrinology Section, Federal Hospital of Lagoa , Rio de Janeiro, Rio de Janeiro , Brazil.,f Department of Internal Medicine and Endocrinology Section , Medical School and Clementino Fraga Filho University Hospital, Rio de Janeiro Federal University , Rio de Janeiro, Rio de Janeiro , Brazil
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116
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Alcázar JL, Pineda L, Caparrós M, Utrilla-Layna J, Juez L, Mínguez JA, Jurado M. Transvaginal/transrectal ultrasound for preoperative identification of high-risk cases in well- or moderately differentiated endometrioid carcinoma. Ultrasound Obstet Gynecol 2016; 47:374-379. [PMID: 26033568 DOI: 10.1002/uog.14912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/23/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the role of transvaginal/transrectal ultrasound for preoperative identification of high-risk cases among women with well-differentiated (G1) or moderately differentiated (G2) endometrioid carcinoma of the endometrium. METHODS This was a single-center prospective observational cohort study comprising a consecutive series of women with a preoperative diagnosis of G1/G2 endometrioid carcinoma of the endometrium. All women underwent transvaginal or transrectal ultrasound examination by a single examiner. According to the examiner's subjective impression, patients were considered high risk if myometrial infiltration was ≥ 50% and/or involvement of the cervix and/or adnexa was suspected. FIGO surgical staging was performed in all cases. According to definitive histological data regarding myometrial infiltration, cervical involvement and adnexal involvement, women were classified as low risk (no myometrial infiltration, no cervical involvement and no adnexal involvement) or high risk (myometrial infiltration ≥ 50% and/or cervical involvement and/or adnexal involvement). Sensitivity, specificity and positive (LR+) and negative (LR-) likelihood ratios, with 95% CIs, of transvaginal/transrectal ultrasound for detecting stage ≥ IB were calculated. Agreement between risk determined by transvaginal/transrectal ultrasound and postoperative definitive histology was calculated. RESULTS Of 209 eligible women, 169 were included in the study. Mean (± SD) age of the study cohort was 60.7 ± 10.3 years, with a range of 32-91 years. Sensitivity, specificity, LR+ and LR- of transvaginal/transrectal ultrasound identifying high-risk cases according to myometrial infiltration, cervical involvement and adnexal involvement were 78.0% (95% CI, 63.7-88.0%), 89.1% (95% CI, 81.7-93.8%), 7.14 (95% CI, 4.19-12.18) and 0.25 (95% CI, 0.15-0.42), respectively. CONCLUSIONS Preoperative transvaginal/transrectal ultrasound may play a significant role in identifying high-risk cases among those with G1/G2 endometrioid carcinoma of the endometrium according to preoperative biopsy, and could be a useful test in this clinical setting. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J L Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - L Pineda
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Caparrós
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J Utrilla-Layna
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - L Juez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J A Mínguez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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Filson CP, Natarajan S, Margolis DJA, Huang J, Lieu P, Dorey FJ, Reiter RE, Marks LS. Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: The role of systematic and targeted biopsies. Cancer 2016; 122:884-92. [PMID: 26749141 DOI: 10.1002/cncr.29874] [Citation(s) in RCA: 301] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/02/2015] [Accepted: 12/14/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND The current study was conducted to evaluate the performance of magnetic resonance (MR)-ultrasound-guided fusion biopsy in diagnosing clinically significant prostate cancer (csCaP). METHODS A total of 1042 men underwent multiparametric MR imaging (mpMRI) and fusion biopsy consecutively in a prospective trial (2009-2014). An expert reader graded mpMRI regions of interest (ROIs) as 1 to 5 using published protocols. The fusion biopsy device was used to obtain targeted cores from ROIs (when present) followed by a fusion image-guided, 12-core systematic biopsy in all men, even if no suspicious ROI was noted. The primary endpoint of the study was the detection of csCaP (ie, Gleason score ≥ 7). RESULTS Among 825 men with ≥ 1 suspicious ROI of ≥ grade 3, 289 (35%) were found to have csCaP. Powerful predictors of csCaP were ROI grade (grade 5 vs grade 3: odds ratio, 6.5 [P<.01]) and prostate-specific antigen density (each increase of 0.05 ng/mL/cc: odds ratio, 1.4 [P<.01]). Combining systematic and targeted biopsies resulted in the detection of more patients with csCaP (289 patients) than targeting (229 patients) or systematic (199 patients) biopsy alone. Among patients with no suspicious ROI, 35 (16%) were found to have csCaP on systematic biopsy. CONCLUSIONS In this prospective trial, MR-ultrasound fusion biopsy allowed for the detection of csCaP, with a direct relationship noted with ROI grade and prostate-specific antigen density. The combination of targeted and systematic biopsy detected more csCaP than either modality alone; systematic biopsies revealed csCaP in 16% of men with no suspicious MRI target. The advantages of this new biopsy method are apparent, but issues of cost, training, and reliability await resolution before its widespread adoption.
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Affiliation(s)
- Christopher P Filson
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.,Department of Urology, Emory University, Atlanta, Georgia
| | - Shyam Natarajan
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.,Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Daniel J A Margolis
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Jiaoti Huang
- Department of Pathology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Patricia Lieu
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Frederick J Dorey
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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Leddy R, Irshad A, Metcalfe A, Mabalam P, Abid A, Ackerman S, Lewis M. Comparative accuracy of preoperative tumor size assessment on mammography, sonography, and MRI: Is the accuracy affected by breast density or cancer subtype? J Clin Ultrasound 2016; 44:17-25. [PMID: 26294391 DOI: 10.1002/jcu.22290] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/24/2015] [Accepted: 07/21/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE To compare the accuracy of preoperative breast tumor size measurements obtained on three imaging modalities (mammography [MM], sonography [US], and MRI) with those obtained on final pathologic examination for different breast densities and various tumor types. METHODS Records from patients who underwent breast cancer lumpectomy between 2008 and 2012 and in whom tumor was seen on all three imaging modalities were retrospectively reviewed for maximum tumor size measurements. Patients with positive tumor margins and those who had undergone neoadjuvant chemotherapy were excluded. Tumor size measurements obtained on the three imaging modalities were compared for accuracy with those obtained during the final pathologic examination. Differences were analyzed for the whole group and for subgroups according to breast density and tumor type. RESULTS In total, 57 patients were included, in whom wire-localization lumpectomy was performed without neoadjuvant chemotherapy; negative surgical margins for tumor were obtained, and tumor was preoperatively visualized on all three imaging modalities. The mean (± SEM) tumor size measured on MRI was significantly greater than that measured on pathology (p < 0.001), whereas the sizes measured on US and MM were not statistically significantly different from that measured on pathology (p = 0.62 and p = 0.57). Tumor size measured on MRI was greater than that measured on both US and MM (p = 0.003 and p < 0.001). Compared with the measurements obtained on pathology, that obtained on US showed moderate agreement (Lin concordance correlation coefficient [CCC], 0.71; 95% confidence interval [CI], 0.56-0.82); poorer agreement was found for the sizes obtained on MM (CCC, 0.58; 95% CI, 0.38-0.72) and MRI (CCC, 0.50; 95% CI, 0.31-0.65). No difference in comparative accuracy of size measurement was noted between dense and nondense breast tissue. MRI overestimated tumor size in ductal cancers (p < 0.001) and slightly underestimated it in lobular cancers. CONCLUSIONS Preoperative MRI significantly overestimated tumor size. Measurements obtained on US and MM were more accurate irrespective of breast density, with US measurements being slightly more accurate than MM measurements.
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Affiliation(s)
- Rebecca Leddy
- Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, 29425
| | - Abid Irshad
- Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, 29425
| | - Allie Metcalfe
- Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, 29425
| | - Pramod Mabalam
- Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, 29425
| | - Ahad Abid
- Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, 29425
| | - Susan Ackerman
- Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, 29425
| | - Madelene Lewis
- Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, 29425
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Rozman A, Malovrh MM, Adamic K, Subic T, Kovac V, Flezar M. Endobronchial ultrasound elastography strain ratio for mediastinal lymph node diagnosis. Radiol Oncol 2015; 49:334-40. [PMID: 26834519 PMCID: PMC4722923 DOI: 10.1515/raon-2015-0020] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/30/2015] [Indexed: 02/07/2023] Open
Abstract
Background Ultrasound elastography is an imaging procedure that can assess the biomechanical characteristics of different tissues. The aim of this study was to define the diagnostic value of the endobronchial ultrasound (EBUS) elastography strain ratio of mediastinal lymph nodes in patients with a suspicion of lung cancer. The diagnostic values of the strain ratios were compared with the EBUS brightness mode (B-mode) features of selected mediastinal lymph nodes and with their cytological diagnoses. Patients and methods This prospective, single-centre study enrolled patients with an indication for biopsy and mediastinal staging after a non-invasive diagnostic workup of a lung tumour. EBUS with standard B-mode evaluation and elastography with strain ratio measurement were performed before endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Results Thirty-three patients with 80 suspicious mediastinal lymph nodes were included. Malignant infiltration was confirmed in 34 (42.5%) lymph nodes. The area under the receiver operating characteristic curve for the strain ratio was 0.87 (p < 0.0001). At a strain ratio ≥ 8, the accuracy for malignancy prediction was 86.25% (sensitivity 88.24%, specificity 84.78%, positive predictive value [PPV] 81.08%, negative predictive value [NPV] 90.70%). The strain ratio is more accurate than conventional B-mode EBUS modalities for differentiating between malignant and benign lymph nodes. Conclusions EBUS-guided elastography with strain ratio assessment can distinguish malignant from benign mediastinal lymph nodes with greater accuracy than conventional EBUS modalities. This new method may reduce the number of mediastinal EBUS-TBNAs and thus reduce the invasiveness and expense of mediastinal staging in patients with non-small lung cancer (NSCLC).
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Affiliation(s)
- Ales Rozman
- University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia
| | - Mateja Marc Malovrh
- University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia
| | - Katja Adamic
- University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia
| | - Tjasa Subic
- University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia
| | - Viljem Kovac
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Matjaz Flezar
- University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia
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Pei Q, Wang L, Pan J, Ling T, Lv Y, Zou X. Endoscopic ultrasonography for staging depth of invasion in early gastric cancer: A meta-analysis. J Gastroenterol Hepatol 2015; 30:1566-73. [PMID: 26094975 DOI: 10.1111/jgh.13014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 03/29/2015] [Accepted: 05/30/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM Endoscopic ultrasonography (EUS) is a widely used imaging modality for detecting the depth of early gastric cancer (EGC) invasion. However, the studies pertaining to EUS for staging early gastric cancer have reported widely varied sensitivities and specificities. This study was conducted to estimate the overall diagnostic accuracy of EUS for staging the depth in EGCs. METHODS The literatures were identified by searching in PubMed, Embase, and Web of Knowledge databases. Two reviewers independently extracted the information from the literatures for constructing 2 × 2 table. A random-effect model or a fixed-effect model was used to estimate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. A summary receiver operating characteristic curve also was constructed. Meta-regression and subgroup analysis were used to explore the sources of heterogeneity. RESULTS The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of EUS for M staging were 76% (95% confidence interval [CI], 74-78%), 72% (95% CI, 69-75%), 3.67 (95% CI, 2.48-5.44), and 0.31 (95% CI, 0.24-0.40), respectively. For SM staging, these results were 62% (95% CI, 59-66%), 78% (95% CI, 76-80%), 2.99 (95% CI, 2.26-3.96), and 0.43 (95% CI, 0.32-0.57), respectively. For M/SM1 staging, they were 90% (95% CI, 88-92%), 67% (95% CI, 61-72%), 3.14 (95% CI, 2.08-4.73), and 0.12 (95% CI, 0.07-0.22), respectively. The area under the curve for mucosal, submucosal, and mucosal/minimal submucosal invasion staging were 0.85, 0.82, and 0.81, respectively. CONCLUSIONS Endoscopic ultrasonography only has a relatively low accuracy for staging the depth of invasion in EGCs. Accordingly, EUS may be not indispensable in the staging of EGCs.
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Affiliation(s)
- Qingshan Pei
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Lei Wang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
| | - Jianmei Pan
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Tingsheng Ling
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
| | - Ying Lv
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
| | - Xiaoping Zou
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, Nanjing, China
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Abstract
Multiparametric MRI of the prostate consists of T1- and T2-weighted sequences, which provide anatomical information, and one or more 'functional' sequences, that is, diffusion-weighted imaging, dynamic contrast-enhanced sequences and magnetic resonance spectroscopy. Prostate MRI is the most accurate imaging method for local staging of prostate cancer and can also be used for the noninvasive evaluation of tumor aggressiveness. By magnetic resonance-guided prostate biopsy it is possible to target the most cancer-suspicious areas of the gland, especially in patients with a negative transrectal biopsy. In patients with biochemical recurrence after radical treatment, MRI is a valuable tool for the detection of local tumor recurrence and whole-body MRI can be used for the diagnosis of distant metastases.
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Affiliation(s)
- Andreas G Wibmer
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York City, NY 10065, USA
| | - Hebert Alberto Vargas
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York City, NY 10065, USA
| | - Hedvig Hricak
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York City, NY 10065, USA
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Löfgren J, Loft A, Barbosa de Lima VA, Østerlind K, von Benzon E, Højgaard L. Clinical importance of re-interpretation of PET/CT scanning in patients referred to a tertiary care medical centre. Clin Physiol Funct Imaging 2015. [PMID: 26211508 DOI: 10.1111/cpf.12278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate, in a controlled prospective manner with double-blind read, whether there are differences in interpretations of PET/CT scans at our tertiary medical centre, Rigshospitalet, compared to the external hospitals. METHODS Ninety consecutive patients referred to our department who had an external F-18-FDG PET/CT scan were included. Only information that had been available at the time of the initial reading at the external hospital was available at re-interpretation. Teams with one radiologist and one nuclear medicine physician working side by side performed the re-interpretation in consensus. Two oncologists subsequently and independently compared the original reports with the re-interpretation reports. In case of 'major discordance', the oncologists assessed the respective reports validities. RESULTS The interpretations were graded as 'accordant' in 43 patients (48%), 'minor discordance' in 30 patients (33%) and 'major discordance' in 17 patients (19%). In 11 (65%) of the 17 cases graded as 'major discordance', it was possible to determine which report that was most correct. In 9 of these 11 cases (82%), the re-interpretation was most correct; in one case, the original report and in another case, both interpretations were incorrect. CONCLUSIONS Major discordant interpretations were frequent [19% (17 of 90 cases)]. In those cases where follow-up could assess the validity, the re-interpretation at Rigshospitalet was most correct in 9 of 11 cases (82%), indicating that there is a difference in expertise in interpreting PET/CT at a tertiary referral hospital compared to primary local hospitals.
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Affiliation(s)
- Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Kell Østerlind
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eric von Benzon
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Ebrahimi A, Gil Z, Amit M, Yen TC, Liao CT, Chatturvedi P, Agarwal J, Kowalski L, Kreppel M, Cernea C, Brandao J, Bachar G, Villaret AB, Fliss D, Fridman E, Robbins KT, Shah J, Patel S, Clark J. Comparison of the American Joint Committee on Cancer N1 versus N2a nodal categories for predicting survival and recurrence in patients with oral cancer: Time to acknowledge an arbitrary distinction and modify the system. Head Neck 2015; 38:135-9. [PMID: 25227311 DOI: 10.1002/hed.23871] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We hypothesized that pathological N1 (pN1) and N2a (pN2a) nodal disease portend a similar prognosis in patients with oral cancer. METHODS An international multicenter study of 739 oral squamous cell carcinoma (SCC) patients with pN1 or pN2a stage disease was conducted. Multivariable analyses were performed using Cox proportional hazard models to compare locoregional failure, disease-specific survival (DSS), and overall survival (OS). Institutional heterogeneity was assessed using 2-stage random effects meta-analysis techniques. RESULTS Univariate analysis revealed no difference in locoregional failure (p = .184), DSS (p = .761), or OS (p = .475). Similar results were obtained in adjusted multivariable models and no evidence of institutional heterogeneity was demonstrated. CONCLUSION The prognosis of pN2a and pN1 disease is similar in oral SCC suggesting these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy. However, these results may reflect more aggressive treatment of N2a disease; hence, we caution against using these data to deintensify treatment.
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Affiliation(s)
- Ardalan Ebrahimi
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Ziv Gil
- The Laboratory for Applied Cancer Research, the Technion, Israel Institute of Technology, Haifa, Israel.,Department of Otolaryngology, Rambam Medical Center, Rappaport School of Medicine, the Technion, Israel Institute of Technology, Haifa, Israel
| | - Moran Amit
- The Laboratory for Applied Cancer Research, the Technion, Israel Institute of Technology, Haifa, Israel.,Department of Otolaryngology, Rambam Medical Center, Rappaport School of Medicine, the Technion, Israel Institute of Technology, Haifa, Israel
| | | | | | | | | | | | - Matthias Kreppel
- Department of Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Claudio Cernea
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Jose Brandao
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Gideon Bachar
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | | | - Dan Fliss
- Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eran Fridman
- Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - K Thomas Robbins
- Southern Illinois University School of Medicine, Carbondale, Illinois
| | - Jatin Shah
- Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Snehal Patel
- Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jonathan Clark
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
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Husby JA, Reitan BC, Biermann M, Trovik J, Bjørge L, Magnussen IJ, Salvesen ØO, Salvesen HB, Haldorsen IS. Metabolic Tumor Volume on 18F-FDG PET/CT Improves Preoperative Identification of High-Risk Endometrial Carcinoma Patients. J Nucl Med 2015; 56:1191-8. [PMID: 26045311 DOI: 10.2967/jnumed.115.159913] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/20/2015] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED Our objective was to prospectively explore the diagnostic value of (18)F-FDG PET/CT for preoperative staging in endometrial carcinomas and to investigate whether (18)F-FDG PET-specific quantitative tumor parameters reflect clinical and histologic characteristics. METHODS Preoperative (18)F-FDG PET/CT was prospectively performed on 129 consecutive endometrial carcinoma patients. Two physicians who did not know the clinical findings or staging results independently reviewed the images, assessing primary tumor, cervical stroma involvement and metastatic spread, and determining maximum and mean standardized uptake value (SUVmax and SUVmean, respectively) for tumor, metabolic tumor volume (MTV), and total lesion glycolysis (TLG). All parameters were analyzed in relation to histomorphologic and clinical tumor characteristics. Receiver-operating-characteristic curves for identification of deep myometrial invasion and lymph node metastases were generated, and MTV cutoffs for predicting deep myometrial invasion and lymph node metastases were calculated. RESULTS The sensitivity, specificity, and accuracy of (18)F-FDG PET/CT for the detection of lymph node metastases were 77%-85%, 91%-96%, and 89%-93%, respectively. SUVmax, SUVmean, MTV, and TLG were significantly related to deep myometrial invasion, presence of lymph node metastases, and high histologic grade (P < 0.015 for all) and independently predicted deep myometrial invasion (P < 0.015) and lymph node metastases (P < 0.025) after adjustment for preoperative histologic risk (based on subtype and grade) in endometrial biopsies. Optimal cutoffs for MTV in predicting deep myometrial invasion (20 mL) and the presence of lymph node metastases (30 mL) yielded odds ratios of 7.8 (P < 0.001) and 16.5 (P = 0.001), respectively. CONCLUSION (18)F-FDG PET/CT represents a clinically valuable tool for preoperatively evaluating the presence of lymph node metastases in endometrial carcinoma patients. Applying MTV cutoffs for the prediction of deep myometrial invasion and lymph node metastases may increase diagnostic accuracy and aid preoperative identification of high-risk patients, enabling restriction of lymphadenectomy for patients with a low risk of aggressive disease.
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Affiliation(s)
- Jenny A Husby
- Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bernt C Reitan
- Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Martin Biermann
- Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jone Trovik
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway Norway Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; and
| | - Line Bjørge
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway Norway Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; and
| | - Inger J Magnussen
- Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Øyvind O Salvesen
- Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Helga B Salvesen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway Norway Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, Bergen, Norway; and
| | - Ingfrid S Haldorsen
- Center for PET/NM and Department of Radiology, Haukeland University Hospital, Bergen, Norway Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Li Z, Zou X, Xie L, Chen H, Chen Y, Yeung SCJ, Zhang H. Personalizing risk stratification by addition of PAK1 expression to TNM staging: improving the accuracy of clinical decision for gastroesophageal junction adenocarcinoma. Int J Cancer 2015; 136:1636-45. [PMID: 25159681 DOI: 10.1002/ijc.29167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/01/2014] [Accepted: 08/19/2014] [Indexed: 02/05/2023]
Abstract
Gastroesophageal junction adenocarcinoma (GEJA) is an aggressive malignancy with an alarmingly rising incidence. TNM staging is widely used by oncologists to stratify prognosis as well as direct therapeutic strategies. However, inadequate lymphadenectomy is frequently encountered for GEJA and largely confounds prognosis resulting from TNM staging. Thus, a molecular biomarker, which can accurately forecast the risk of nodal metastasis in patients with inadequate lymphadenectomy, is required to guide precisely clinical decision. In this study, bioinformatics and pathological analysis identified that p21 protein-activated kinase 1 (PAK1) is associated with lymph nodal metastasis of GEJA. The PAK1 H-score was lower in the patients with negative lymph nodes than that in patients with positive (metastatic) lymph nodes (6.865 ± 3.376, 9.370 ± 2.530, respectively; p < 0.001). The PAK1 H-score in lymph nodes was positively correlated with that in primary tumors (PTs; p < 0.001; r = 0.475). PAK1 H-scores in PTs had the best performance based on its area under the receiver-operating characteristic (ROC) curve compared with PAK1 H-scores in lymph nodes, histological grade, lymph nodal metastasis status, tumor size, depth of tumor, TNM stage and number of resected lymph nodes. Multivariate Cox proportional hazard and Fine and Gray models showed that histological grade 3, Charlson comorbidity index > 7 and high PAK1 expression in PTs were associated with significantly increased risk of recurrence and cancer-related death. In conclusion, high PAK1 expression in PTs is predictive of node metastasis and can be easily integrated in the clinical decision process for personalized therapeutics of GEJA.
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Affiliation(s)
- Zongtai Li
- Department of Biotherapy and Gastrointestinal Medical Oncology, Affiliated Cancer Hospital of Shantou University Medical College, Shantou, China; Department of Oncological Radiotherapy, The People's Hospital of Gaozhou, Gaozhou, Guangdong, China; Cancer Research Center, Shantou University Medical College, Shantou, China
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Aziz F. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a concise review. Transl Lung Cancer Res 2015; 1:208-13. [PMID: 25806182 DOI: 10.3978/j.issn.2218-6751.2012.09.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 09/17/2012] [Indexed: 11/14/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) offers a minimally invasive alternative to mediastinoscopy with additional access to the hilar nodes, a better safety profile, and it removes the costs and hazards of theatre time and general anesthesia with comparable sensitivity, although the negative predictive value of mediastinoscopy (and sample size) is greater. EBUS- TBNA also obtains larger samples than conventional TBNA, has superior performance and theoretically is safer, allowing real-time sampling under direct vision. It can also have predictive value both in sonographic appearance of the nodes and histological characteristics. EBUS-TBNA is therefore indicated for NSCLC staging, diagnosis of lung cancer when there is no endobronchial lesion, and diagnosis of both benign (especially tuberculosis and sarcoidosis) and malignant mediastinal lesions. The procedure is different than for flexible bronchoscopy, takes longer, and requires more training. EBUS-TBNA is more expensive than conventional TBNA but can save costs by reducing the number of more costly mediastinoscopies. In the future, endobronchial ultrasound may have applications in airways disease and pulmonary vascular disease.
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Affiliation(s)
- Fahad Aziz
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1021, USA
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127
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Kosary CL, Altekruse SF, Ruhl J, Lee R, Dickie L. Clinical and prognostic factors for melanoma of the skin using SEER registries: collaborative stage data collection system, version 1 and version 2. Cancer 2015; 120 Suppl 23:3807-14. [PMID: 25412392 DOI: 10.1002/cncr.29050] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objectives of this article are to assess the completeness of the data collected on site-specific factors (SSFs) as a part of Collaborative Stage (CS) version 2 and the impact of the transition from the American Joint Committee on Cancer's (AJCC) 6th to 7th edition guidelines on stage distribution. METHODS Incidence data for melanomas of the skin from 18 Surveillance, Epidemiology, and End Results (SEER) registries (SEER-18) were analyzed. Percentages of unknown cases for 7 SSFs were examined, along with staging trends from 2004 to 2010 and differences in AJCC 6th and 7th edition stage distributions for 2010 cases. RESULTS Fewer than 10% of cases were coded as unknown for SSFs 1 (measured thickness), 2 (ulceration), and 3 (lymph node metastasis). For the remaining SSFs, 36-81% of cases were coded as unknown. Stage distributions were relatively consistent across time and between the AJCC 6th and 7th editions, with the exception of stage IA and stage INOS (not otherwise specified), for which a shift in cases was observed between the AJCC 6th and 7th edition guidelines fOR 2010 cases. CONCLUSIONS A shift of cases out of stage IA and into stage INOS was observed between the AJCC 6th and 7th edition guidelines for 2010 cases. This was attributed to the high number of cases coded as unknown for SSF7 (primary tumor mitotic count/rate). The percentage of cases coded as unknown varied by SSF. Data completeness presents an issue for SSFs introduced in CS version 2.
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Affiliation(s)
- Carol L Kosary
- National Cancer Institute, Division of Cancer Control and Population Sciences, Rockville, Maryland
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128
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Jamison PM, Altekruse SF, Chang JT, Zahn J, Lee R, Noone AM, Barroilhet L. Site-specific factors for cancer of the corpus uteri from SEER registries: collaborative stage data collection system, version 1 and version 2. Cancer 2015; 120 Suppl 23:3836-45. [PMID: 25412395 DOI: 10.1002/cncr.29054] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/24/2014] [Accepted: 08/05/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Uterine cancer is the fourth leading cancer among US women. Changes in uterine cancer staging were made from the American Joint Committee on Cancer (AJCC) 6th to 7th edition staging manuals, and 8 site-specific factors (SSFs) and 3 histologic schemas were introduced. Carcinomas account for 95% of cases and are the focus of this report. METHODS Distributions of SSF values were examined for 11,601 cases of malignant cancer of the corpus uteri and uterus, NOS (not otherwise specified) diagnosed in Surveillance, Epidemiology, and End Results (SEER) Program registries during 2010. AJCC 6th and 7th edition staging distributions were compared for 11,176 cases using data in both staging systems. AJCC 6th edition staging distributions during 2004-2010 were examined. AJCC 7th edition SSFs required by SEER were International Federation of Gynecology and Obstetrics stage (SSF1), peritoneal cytology (SSF2), number of positive pelvic lymph nodes (SSF3), number of pelvic lymph nodes examined (SSF4), number of positive para-aortic lymph nodes (SSF5), and number of para-aortic lymph nodes examined (SSF6). RESULTS For SSFs related to lymph nodes, a third of cases were classified as "not applicable," reflecting that lymph node dissection is not indicated for cases with stage1A and stage 4 diagnoses. AJCC 7th edition criteria assigned more cases to stage I (72.9%) than AJCC 6th edition criteria (68.7%). Annual counts significantly increased during 2004-2010, as did counts for AJCC 6th edition stages INOS, IA, IB, IC, IIIA, IIIB, IIIC, and IVB. The proportion of cases diagnosed with stage I cancer was stable, whereas stages II and IV decreased and stage III increased. CONCLUSIONS Five SSFs were suitable for analysis: peritoneal cytology results (SSF2), numbers of positive pelvic lymph nodes (SSF3), pelvic lymph nodes examined (SSF4), positive para-aortic lymph nodes (SSF5), and para-aortic lymph nodes examined (SSF6).
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Affiliation(s)
- Patricia M Jamison
- National Cancer Institute, Division of Cancer Control and Population Sciences, Rockville, Maryland
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Uslu L, Donig J, Link M, Rosenberg J, Quon A, Daldrup-Link HE. Value of 18F-FDG PET and PET/CT for evaluation of pediatric malignancies. J Nucl Med 2015; 56:274-86. [PMID: 25572088 DOI: 10.2967/jnumed.114.146290] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Successful management of solid tumors in children requires imaging tests for accurate disease detection, characterization, and treatment monitoring. Technologic developments aim toward the creation of integrated imaging approaches that provide a comprehensive diagnosis with a single visit. These integrated diagnostic tests not only are convenient for young patients but also save direct and indirect health-care costs by streamlining procedures, minimizing hospitalizations, and minimizing lost school or work time for children and their parents. (18)F-FDG PET/CT is a highly sensitive and specific imaging modality for whole-body evaluation of pediatric malignancies. However, recent concerns about ionizing radiation exposure have led to a search for alternative imaging methods, such as whole-body MR imaging and PET/MR. As we develop new approaches for tumor staging, it is important to understand current benchmarks. This review article will synthesize the current literature on (18)F-FDG PET/CT for tumor staging in children, summarizing questions that have been solved and providing an outlook on unsolved avenues.
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Affiliation(s)
- Lebriz Uslu
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Jessica Donig
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Michael Link
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jarrett Rosenberg
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Andrew Quon
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
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Mick CG, James T, Hill JD, Williams P, Perry M. Molecular imaging in oncology: (18)F-sodium fluoride PET imaging of osseous metastatic disease. AJR Am J Roentgenol 2014; 203:263-71. [PMID: 25055258 DOI: 10.2214/AJR.13.12158] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This literature review details the history, pharmacokinetics, and utility of (18)F-sodium fluoride (Na(18)F) PET/CT in detecting osseous metastases compared with the current standard of care, technetium-99m methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy. Additional discussion highlights solutions to impediments for broader implementation of this modality and insight into the complementary roles of (18)F-FDG PET/CT and Na(18)F PET/CT in oncology imaging, including preliminary data for combined Na(18)F and FDG PET/CT. CONCLUSION Na(18)F PET/CT is the most comprehensive imaging modality for the evaluation of osseous metastatic disease. Although further data acquisition is necessary to expand cost-benefit analyses of this imaging agent, emerging data reinforce its diagnostic advantage, suggest methods to mitigate impediments to broader utilization of Na(18)F PET/CT, and introduce a potentially viable technique for single-session combined Na(18)F and FDG PET/CT staging of soft-tissue and osseous disease.
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131
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Lea D, Håland S, Hagland HR, Søreide K. Accuracy of TNM staging in colorectal cancer: a review of current culprits, the modern role of morphology and stepping-stones for improvements in the molecular era. Scand J Gastroenterol 2014; 49:1153-63. [PMID: 25144865 DOI: 10.3109/00365521.2014.950692] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. Survival is largely stage-dependant, guided by the tumor-node-metastases (TNM) system for TNM assessment. Histopathological evaluation, including assessment of lymph node status, is important for correct TNM staging. However, recent updates in the TNM system have resulted in controversy. A continued debate on definitions resulting in potential up- and downstaging of patients, which may obscure survival data, has led the investigators to investigate other or alternative staging tools. Consequently, additional prognostic factors have been searched for using the regular light microscopy. Among the factors evaluated by histopathology include the evaluation of tumor budding and stromal environment, angiogenesis, as well as involvement of the immune system (including the 'Immunoscore'). We review the current role of histopathology, controversies in TNM-staging and suggested alternatives to better predict outcome for CRC patients in the era of genomic medicine.
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Affiliation(s)
- Dordi Lea
- Department of Pathology, Stavanger University Hospital , Stavanger , Norway
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Findlay JM, Middleton MR, Tomlinson I. A systematic review and meta-analysis of somatic and germline DNA sequence biomarkers of esophageal cancer survival, therapy response and stage. Ann Oncol 2014; 26:624-644. [PMID: 25214541 PMCID: PMC4374384 DOI: 10.1093/annonc/mdu449] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Recent advances in next generation sequencing reinforce the potential for DNA sequence markers to guide esophageal cancer management. We report the first systematic review and meta-analysis, identifying 94 markers of outcome and 41 of stage. Overall, evidence was poor. Meta-analyses demonstrated outcome associations for 6 tumor and 9 germline variants: priorities for prospective evaluation. Introduction There is an urgent need for biomarkers to help predict prognosis and guide management of esophageal cancer. This review identifies, evaluates and meta-analyses the evidence for reported somatic and germline DNA sequence biomarkers of outcome and stage. Methods A systematic review was carried out of the PubMed, EMBASE and Cochrane databases (20 August 2014), in conjunction with the ASCO Level of Evidence scale for biomarker research. Meta-analyses were carried out for all reported markers associated with outcome measures by more than one study. Results Four thousand and four articles were identified, 762 retrieved and 182 studies included. There were 65 reported markers of survival or recurrence 12 (18.5%) were excluded due to multiple comparisons. Following meta-analysis, significant associations were seen for six tumor variants (mutant TP53 and PIK3CA, copy number gain of ERBB2/HER2, CCND1 and FGF3, and chromosomal instability/ploidy) and seven germline polymorphisms: ERCC1 rs3212986, ERCC2 rs1799793, TP53 rs1042522, MDM2 rs2279744, TYMS rs34743033, ABCB1 rs1045642 and MTHFR rs1801133. Twelve germline markers of treatment complications were reported; 10 were excluded. Two tumor and 15 germline markers (11 excluded) of chemo (radio)therapy response were reported. Following meta-analysis, associations were demonstrated for mutant TP53, ERCC1 rs11615 and XRCC1 rs25487. There were 41 tumor/germline reported markers of stage; 27 (65.9%) were excluded. Conclusions Numerous DNA markers of outcome and stage have been reported, yet few are backed by high-quality evidence. Despite this, a small number of variants appear reliable. These merit evaluation in prospective trials, within the context of high-throughput sequencing and gene expression.
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Affiliation(s)
- J M Findlay
- Molecular and Population Genetics, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; Oxford OesophagoGastric Centre
| | - M R Middleton
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - I Tomlinson
- Molecular and Population Genetics, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford; NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK.
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Roberts JA, Waters L, Ro JY, Zhai QJ. Smoothelin and caldesmon are reliable markers for distinguishing muscularis propria from desmoplasia: a critical distinction for accurate staging colorectal adenocarcinoma. Int J Clin Exp Pathol 2014; 7:792-796. [PMID: 24551305 PMCID: PMC3925929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 12/30/2013] [Indexed: 06/03/2023]
Abstract
An accurate distinction between deep muscularis propria invasion versus subserosal invasion by colonic adenocarcinoma is essential for the accurate staging of cancer and subsequent optimal patient management. However, problems may arise in pathologic staging when extensive desmoplasia blurs the junction between deep muscularis propria and subserosal fibroadipose tissue. To address this issue, forty-three (43) cases of colonic adenocarcinoma resections from 2007-2009 at The Methodist Hospital in Houston, TX were reviewed. These cases were selected to address possible challenges in differentiating deep muscularis propria invasion from superficial subserosal invasion based on H&E staining alone. Immunohistochemical staining using smooth muscle actin (SMA), smoothelin, and caldesmon were performed on 51 cases: 8 cases of pT1 tumors (used mainly as control); 12 pT2 tumors; and 31 pT3 tumors. All 51 (100%) had diffuse, strong (3+) immunoreactivity for caldesmon and smoothelin in the muscularis propria with a granular cytoplasmic staining pattern. However, the desmoplastic areas of these tumors, composed of spindled fibroblasts and myofibroblasts, showed negative immunostaining for caldesmon and smoothelin (0/35). SMA strongly stained the muscularis propria and weakly (1+) or moderately (2+) stained the spindled fibroblasts in the desmoplastic areas (the latter presumably because of myofibroblastic differentiation). Compared to SMA, caldesmon and smoothelin are more specific stains that allow better delineation of the muscularis propria from the desmoplastic stromal reaction which provides a critical aide for proper staging of colonic adenocarcinoma and subsequent patient care.
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Affiliation(s)
- Jordan A Roberts
- Department of Pathology, Houston Methodist Hospital, Weill College of Medicine, Cornell UniversityHouston, TX
| | - Lindsay Waters
- Department of Pathology, Houston Methodist Hospital, Weill College of Medicine, Cornell UniversityHouston, TX
| | - Jae Y Ro
- Department of Pathology, Houston Methodist Hospital, Weill College of Medicine, Cornell UniversityHouston, TX
| | - Qihui Jim Zhai
- Department of Pathology, Houston Methodist Hospital, Weill College of Medicine, Cornell UniversityHouston, TX
- Department of Lab Medicine and Pathology, Mayo ClinicJacksonville, FL
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Chang MC, Escallon JM, Colgan TJ. Prognostic significance of a positive axillary lymph node fine-needle aspirate in patients with invasive breast carcinoma. Cancer Cytopathol 2013; 122:138-44. [PMID: 24106096 DOI: 10.1002/cncy.21354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/13/2013] [Accepted: 08/15/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Image-guided axillary lymph node fine-needle aspirates (FNAs) correlate well with pathologic lymph node staging in cases of invasive breast carcinoma. The objective of this study was to determine the prognostic significance of a positive lymph node. METHODS Consecutive cases of nonmetastatic (M0) invasive breast carcinoma evaluated by image-guided FNA were identified (4-year period, median follow-up of 51 months). "Positive" and "nonpositive" groups were compared using Kaplan-Meier survival analysis. Multivariate Cox regression was used to correct for clinicopathologic and treatment factors. A total of 142 cases was included, 70 with positive axillary FNA and 72 with a nonpositive result. RESULTS FNA-positive and nonpositive cases did not differ in patient age, tumor subtype, or hormone receptor status. Positive FNA was significantly associated with advanced T and N pathologic stage, and with HER2 (human epidermal growth factor receptor 2) positivity. FNA-positive patients were more likely to undergo mastectomy and to receive chemotherapy. Kaplan-Meier analysis showed that positive FNA is associated with poor prognosis, both with respect to disease-free survival (89% nonpositive versus 73% positive at 5 years, P < .001) and overall survival (94% versus 81%, respectively, at 5 years, P = .01). Multivariate analysis showed that when correcting for other variables, FNA positivity was not independently significant. CONCLUSIONS Positive axillary lymph node FNA is associated with poor prognosis on univariate analysis. By contrast, overall nodal staging is independently significant on multivariate analysis. The prognostic significance of axillary FNA likely results from its ability to predict for nodal status. Axillary FNA has utility as a preoperative staging procedure.
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Affiliation(s)
- Martin C Chang
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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Abstract
The tumor-node-metastasis (TNM) staging system has been the anchor of cancer diagnosis, treatment, and prognosis for many years. For meaningful clinical use, an orderly, progressive condensation of the T and N categories into an overall staging system needs to be defined, usually with respect to a time-to-event outcome. This can be considered as a cutpoint selection problem for a censored response partitioned with respect to two ordered categorical covariates and their interaction. The aim is to select the best grouping of the TN categories. A novel bootstrap cutpoint/model selection method is proposed for this task by maximizing bootstrap estimates of the chosen statistical criteria. The criteria are based on prognostic ability including a landmark measure of the explained variation, the area under the receiver operating characteristic (ROC) curve, and a concordance probability generalized from Harrell's c-index. We illustrate the utility of our method by applying it to the staging of colorectal cancer.
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Affiliation(s)
- Yunzhi Lin
- Department of Statistics, University of Wisconsin-Madison, Madison, WI, USA
| | - Richard Chappell
- Department of Statistics, University of Wisconsin-Madison, Madison, WI, USA Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Haseebuddin M, Dehdashti F, Siegel BA, Liu J, Roth EB, Nepple KG, Siegel CL, Fischer KC, Kibel AS, Andriole GL, Miller TR. 11C-acetate PET/CT before radical prostatectomy: nodal staging and treatment failure prediction. J Nucl Med 2013; 54:699-706. [PMID: 23471311 DOI: 10.2967/jnumed.112.111153] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED Despite early detection programs, many patients with prostate cancer present with intermediate- or high-risk disease. We prospectively investigated whether (11)C-acetate PET/CT predicts lymph node (LN) metastasis and treatment failure in men for whom radical prostatectomy is planned. METHODS 107 men with intermediate- or high-risk localized prostate cancer and negative conventional imaging findings underwent PET/CT with (11)C-acetate. Five underwent LN staging only, and 102 underwent LN staging and prostatectomy. PET/CT findings were correlated with pathologic nodal status. Treatment-failure-free survival was estimated by the Kaplan-Meier method. The ability of PET/CT to predict outcomes was evaluated by multivariate Cox proportional hazards analysis. RESULTS PET/CT was positive for pelvic LN or distant metastasis in 36 of 107 patients (33.6%). LN metastasis was present histopathologically in 25 (23.4%). The sensitivity, specificity, and positive and negative predictive values of PET/CT for detecting LN metastasis were 68.0%, 78.1%, 48.6%, and 88.9%, respectively. Treatment failed in 64 patients: 25 with metastasis, 17 with a persistent postprostatectomy prostate-specific antigen level greater than 0.20 ng/mL, and 22 with biochemical recurrence (prostate-specific antigen level > 0.20 ng/mL after nadir) during follow-up for a median of 44.0 mo. Treatment-failure-free survival was worse in PET-positive than in PET-negative patients (P < 0.0001) and in those with false-positive than in those with true-negative scan results (P < 0.01), suggesting that PET may have demonstrated nodal disease not removed surgically or identified pathologically. PET positivity independently predicted failure in preoperative (hazard ratio, 3.26; P < 0.0001) and postoperative (hazard ratio, 3.07; P = 0.0001) multivariate models. CONCLUSION In patients planned for or completing prostatectomy, (11)C-acetate PET/CT detects LN metastasis not identified by conventional imaging and independently predicts treatment-failure-free survival.
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Affiliation(s)
- Mohammed Haseebuddin
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Aljebreen AM, Azzam NA, Alzubaidi AM, Alsharqawi MS, Altraiki TA, Alharbi OR, Almadi MA. The accuracy of multi-detector row computerized tomography in staging rectal cancer compared to endoscopic ultrasound. Saudi J Gastroenterol 2013; 19:108-12. [PMID: 23680707 PMCID: PMC3709372 DOI: 10.4103/1319-3767.111950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIM Our aim was to evaluate the diagnostic accuracy of multi-detector row computerized tomography (MDCT) in staging of rectal cancer by comparing it to rectal endoscopic ultrasound (EUS). MATERIALS AND METHODS We prospectively included all patients with rectal cancer referred to our gastroenterology unit for staging of rectal cancer from December 2007 until February 2011, 53 patients whose biopsy had proven rectal cancer underwent both MDCT scan of the pelvis and rectal EUS. Both imaging modalities were compared and the agreement between T- and N-staging of the disease was assessed. RESULTS We staged 62 patients with rectal cancer during the study period. Of these, 53 patients met the inclusion criteria and were evaluated (25 women and 28 men). The mean age was 57.79 ± 14.99 years (range 21-87). MDCT had poor accuracy compared with EUS in T-staging with a low degree of agreement (kappa = 0.26), while for N-staging MDCT had a better accuracy and a moderate degree of agreement with EUS (kappa = 0.45). CONCLUSIONS MDCT has a poor accuracy for predicting tumor invasion compared to EUS for T-staging while it has moderate accuracy for N-staging.
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Affiliation(s)
- Abdulrahman M. Aljebreen
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Nahla A. Azzam
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad M. Alzubaidi
- Division of Colorectal Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed S. Alsharqawi
- Division of Radiology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Thamer A. Altraiki
- Division of Colorectal Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Othman R. Alharbi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Majid A. Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia,The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada,Address for correspondence: Dr. Majid A. Almadi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, P.O. Box 2925 (59), Riyadh 11461, Saudi Arabia. E-mail:
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Pauwels EK, Coumou AW, Kostkiewicz M, Kairemo K. [¹⁸F]fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography imaging in oncology: initial staging and evaluation of cancer therapy. Med Princ Pract 2013; 22:427-37. [PMID: 23363934 PMCID: PMC5586772 DOI: 10.1159/000346303] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 12/05/2012] [Indexed: 12/16/2022] Open
Abstract
Positron emission tomography (PET) with [¹⁸F]fluoro-2-deoxy-D-glucose (FDG) has proven to be a valuable diagnostic modality in various diseases. Its accuracy has been improved with the hybrid PET/computed tomography (CT) technique because of precise anatomic location of areas of abnormal FDG accumulation. This integrated PET/CT modality has been widely adopted, particularly in oncology. This paper reviews the role of FDG-PET/CT imaging in breast cancer, non-small-cell lung cancer, colorectal cancer, head and neck cancer as well as lymphoma on the basis of recent key articles. Special attention is paid to preoperative diagnostic workup, evaluation of treatment response and survival prognosis. Experience from specialized centers indicates that there is strong evidence for the clinical effectiveness of FDG-PET/CT in staging, restaging and the prediction of response to therapy in the above-mentioned malignancies. It is concluded that this imaging modality contributes considerably to improved patient management and paves the way to personalize cancer treatment in a cost-effective way.
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Affiliation(s)
- Ernest K.J. Pauwels
- University Medical School Pisa, Pisa, Italy
- Leiden University Medical Center, Leiden, Finland
- *Prof. emer. Ernest K.J. Pauwels, Via di San Gennaro 79B, IT-55010 Capannori (Italy), E-Mail
| | - Annette W. Coumou
- Amsterdam University Medical Center, Amsterdam, The Netherlands, Finland
| | | | - Kalevi Kairemo
- International Comprehensive Cancer Center Docrates, Helsinki, Finland
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Carethers JM. Proteomics, genomics, and molecular biology in the personalized treatment of colorectal cancer. J Gastrointest Surg 2012; 16:1648-50. [PMID: 22760966 PMCID: PMC3424282 DOI: 10.1007/s11605-012-1942-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/15/2012] [Indexed: 01/31/2023]
Abstract
Colorectal cancer develops and progresses from genetic and genomic changes that occur within and transforms the growth behavior of a normal colonic cell. Molecular tools have advanced enough to allow the scientific community to probe deeper into risk alleles within a population as well as into individual patient genetic data that can ascribe such a risk. Detected genetic and genomic changes from colorectal cancer can help determine a patient's prognosis, predict response to chemotherapy, and determine the approach to care with biological therapies. Utilizing stool, blood/plasma, and tumor tissue to obtain genetic, genomic, and pharmacokinetic information contribute to a person's profile to direct specific cancer care.
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Affiliation(s)
- John M. Carethers
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 3901 Taubman Center, SPC 5368, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5368, USA
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Deleuran T, Søgaard M, Frøslev T, Rasmussen TR, Jensen HK, Friis S, Olsen M. Completeness of TNM staging of small-cell and non-small-cell lung cancer in the Danish cancer registry, 2004-2009. Clin Epidemiol 2012; 4 Suppl 2:39-44. [PMID: 22936855 PMCID: PMC3429148 DOI: 10.2147/clep.s33315] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We examined the completeness of TNM staging of small-cell (SCLC) and nonsmall- cell (NSCLC) lung cancer in the national Danish Cancer Registry (DCR) and whether staging varied by year of diagnosis, gender, age, degree of comorbidity, or presence of histopathological diagnosis. METHODS We identified all patients with SCLCs and NSCLCs registered in the DCR during 2004-2009 and examined the completeness of their TNM registrations. Completeness was defined as the number of recorded individuals with TNM divided by the total number of patients. Completeness was calculated for TNM, T, N, and M individually, overall, and by year of diagnosis, gender, age at diagnosis, and comorbidity. Data regarding comorbidity was obtained from the Danish National Patient Register (DNPR). We performed separate analyses for patients with a histopathologically verified diagnosis of NSCLC. Finally, we designed an algorithm to categorize tumors with missing TNM components as limited, extensive, or distant disease. RESULTS Overall TNM staging completeness was 77.5% (95% confidence interval (CI): 76.1%-78.8%) for SCLC and 77.9% (95% CI: 77.3%-78.4%) for NSCLC. Completeness did not vary by gender and increased during the study period. The proportion of staged patients was lower among patients above 80 years of age or with medium to high levels of comorbidity. CONCLUSION Overall TNM completeness for SCLC and NSCLC in the Danish Cancer Registry is high, but decreases with increasing levels of comorbidity and at ages greater than 80 years. Researchers should be aware of these potential sources of bias.
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Affiliation(s)
- Thomas Deleuran
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Novis MI, Baroni RH, Cerri LMDO, Mattedi RL, Buchpiguel CA. Clinically low-risk prostate cancer: evaluation with transrectal doppler ultrasound and functional magnetic resonance imaging. Clinics (Sao Paulo) 2011; 66:27-34. [PMID: 21437432 PMCID: PMC3044567 DOI: 10.1590/s1807-59322011000100006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Accepted: 10/03/2010] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To evaluate transrectal ultrasound, amplitude Doppler ultrasound, conventional T2-weighted magnetic resonance imaging, spectroscopy and dynamic contrast-enhanced magnetic resonance imaging in localizing and locally staging low-risk prostate cancer. INTRODUCTION Prostate cancer has been diagnosed at earlier stages and the most accepted classification for low-risk prostate cancer is based on clinical stage T1c or T2a, Gleason score ≤6, and prostate-specific antigen (PSA) ≤10 ng/ml. METHODS From 2005 to 2006, magnetic resonance imaging was performed in 42 patients, and transrectal ultrasound in 26 of these patients. Seven patients were excluded from the study. Mean patient age was 64.94 years and mean serum PSA was 6.05 ng/ml. The examinations were analyzed for tumor identification and location in prostate sextants, detection of extracapsular extension, and seminal vesicle invasion, using surgical pathology findings as the gold standard. RESULTS Sixteen patients (45.7%) had pathologically proven organ-confined disease, 11 (31.4%) had positive surgical margin, 8 (28.9%) had extracapsular extension, and 3 (8.6%) presented with extracapsular extension and seminal vesicle invasion. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy values for localizing low-risk prostate cancer were 53.1%, 48.3%, 63.4%, 37.8% and 51.3% for transrectal ultrasound; 70.4%, 36.2%, 65.1%, 42.0% and 57.7% for amplitude Doppler ultrasound; 71.5%, 58.9%, 76.6%, 52.4% and 67.1% for magnetic resonance imaging; 70.4%, 58.7%, 78.4%, 48.2% and 66.7% for magnetic resonance spectroscopy; 67.2%, 65.7%, 79.3%, 50.6% and 66.7% for dynamic contrast-enhanced magnetic resonance imaging, respectively. Sensitivity, specificity, PPV, NPV and accuracy values for detecting extracapsular extension were 33.3%, 92%, 14.3%, 97.2% and 89.7% for transrectal ultrasound and 50.0%, 77.6%, 13.7%, 95.6% and 75.7% for magnetic resonance imaging, respectively. For detecting seminal vesicle invasion, these values were 66.7%, 85.7%, 22.2%, 97.7% and 84.6% for transrectal ultrasound and 40.0%, 83.1%, 15.4%, 94.7% and 80.0% for magnetic resonance imaging. CONCLUSION Although preliminary, our results suggest that imaging modalities have limited usefulness in localizing and locally staging clinically low-risk prostate cancer.
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Affiliation(s)
- Maria Inês Novis
- Faculdade de Medicina da Universidade de São Paulo--Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Abstract
Endoscopic ultrasound (EUS) is an increasingly available diagnostic and therapeutic tool used within the U.K. it has wide applications both in the gastrointestinal tract and mediastinum with its current main uses being in the staging of luminal malignancies and assessment of pancreatic and subepithelial lesions. The emergence of linear EUS has opened up new therapeutic avenues with fine needle aspiration, trucut biopsies, coeliac plexus blocks and transmural pseudocyst drainage all now possible. Future developments include localised brachytherapy/chemotherapy and alcohol ablation of unresectable pancreatic malignancies and EUS-guided endoscopic surgery.
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143
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Boscoe FP, Sherman C. On socioeconomic gradients in cancer registry data quality. J Epidemiol Community Health 2006; 60:551. [PMID: 16698989 PMCID: PMC2563948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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144
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Reynolds RK, Burke WM, Advincula AP. Preliminary experience with robot-assisted laparoscopic staging of gynecologic malignancies. JSLS 2005; 9:149-58. [PMID: 15984701 PMCID: PMC3015578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of integrating robot-assisted technology in the performance of laparoscopic staging of gynecologic malignancies. METHODS Seven patients underwent robot-assisted laparoscopic staging procedures for gynecologic cancers. Data were collected and analyzed as a retrospective case series analysis. RESULTS We attempted 7 robot-assisted laparoscopic staging procedures with no conversions to laparotomy. The median lymph node count for lymphadenectomy was 15 (range, 4 to 29). Mean operating time was 257 minutes (range, 174 to 345). The average estimated blood loss was 50 mL. One patient developed sinusitis and required intravenous antibiotics. The median hospital stay was 2 days. CONCLUSION Robot-assisted laparoscopic staging is a feasible technique that may overcome the surgical limitations of conventional laparoscopy.
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Affiliation(s)
- R Kevin Reynolds
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan Medical Center, L 4000 Women's Hospital, 1500 East Medical Center Dr, Ann Arbor, MI 48109-0276, USA.
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