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Magnetic nanoparticles-based systems for multifaceted biomedical applications. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bashyam A, Frangieh CJ, Raigani S, Sogo J, Bronson RT, Uygun K, Yeh H, Ausiello DA, Cima MJ. A portable single-sided magnetic-resonance sensor for the grading of liver steatosis and fibrosis. Nat Biomed Eng 2020; 5:240-251. [PMID: 33257853 DOI: 10.1038/s41551-020-00638-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 09/28/2020] [Indexed: 12/19/2022]
Abstract
Low-cost non-invasive diagnostic tools for staging the progression of non-alcoholic chronic liver failure from fatty liver disease to steatohepatitis are unavailable. Here, we describe the development and performance of a portable single-sided magnetic-resonance sensor for grading liver steatosis and fibrosis using diffusion-weighted multicomponent T2 relaxometry. In a diet-induced mouse model of non-alcoholic fatty liver disease, the sensor achieved overall accuracies of 92% (Cohen's kappa, κ = 0.89) and 86% (κ = 0.78) in the ex vivo grading of steatosis and fibrosis, respectively. Localization of the measurements in living mice through frequency-dependent spatial encoding led to an overall accuracy of 87% (κ = 0.81) for the grading of steatosis. In human liver samples, the sensor graded steatosis with an overall accuracy of 93% (κ = 0.88). The use of T2 relaxometry as a sensitive measure in fully automated low-cost magnetic-resonance devices at the point of care would alleviate the accessibility and cost limits of magnetic-resonance imaging for diagnosing liver disease and assessing liver health before liver transplantation.
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Affiliation(s)
- Ashvin Bashyam
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Electrical Engineering & Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Chris J Frangieh
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Electrical Engineering & Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Siavash Raigani
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremy Sogo
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Electrical Engineering & Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Roderick T Bronson
- Department of Microbiology and Immunobiology, Division of Immunology, Harvard Medical School, Boston, MA, USA
| | - Korkut Uygun
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Heidi Yeh
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Dennis A Ausiello
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Center for Assessment Technology and Continuous Health, Massachusetts General Hospital, Boston, MA, USA
| | - Michael J Cima
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
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James J, Kantere D, Enger J, Siarov J, Wennberg AM, Ericson MB. Report on fluorescence lifetime imaging using multiphoton laser scanning microscopy targeting sentinel lymph node diagnostics. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:1-8. [PMID: 32172545 PMCID: PMC7070082 DOI: 10.1117/1.jbo.25.7.071204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/07/2020] [Indexed: 06/10/2023]
Abstract
SIGNIFICANCE Sentinel lymph node (SLN) biopsy is an important method for metastasis staging in, e.g., patients with malignant melanoma. Tools enabling prompt histopathological analysis are expected to facilitate diagnostics; optical technologies are explored for this purpose. AIM The objective of this exploratory study was to investigate the potential of adopting multiphoton laser scanning microscopy (MPM) together with fluorescence lifetime analysis (FLIM) for the examination of lymph node (LN) tissue ex vivo. APPROACH Five LN tissue samples (three metastasis positive and two negative) were acquired from a biobank comprising tissues from melanoma patients. Tissues were deparaffinized and subjected to MPM-FLIM using an experimental MPM set-up equipped with a time correlated single photon counting module enabling FLIM. RESULTS The data confirm that morphological features similar to conventional histology were observed. In addition, FLIM analysis revealed elevated morphological contrast, particularly for discriminating between metastatic cells, lymphocytes, and erythrocytes. CONCLUSIONS Taken together, the results from this investigation show promise for adopting MPM-FLIM in the context of SLN diagnostics and encourage further translational studies on fresh tissue samples.
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Affiliation(s)
- Jeemol James
- University of Gothenburg, Biomedical Photonics Group, Department of Chemistry and Molecular Biology, Gothenburg, Sweden
| | - Despoina Kantere
- University of Gothenburg, Institute of Clinical Sciences, Department of Dermatology and Venereology, Gothenburg, Sweden
| | - Jonas Enger
- University of Gothenburg, Department of Physics, Gothenburg, Sweden
| | - Jan Siarov
- University of Gothenburg, Department of Pathology, Gothenburg, Sweden
| | - Ann Marie Wennberg
- University of Gothenburg, Institute of Clinical Sciences, Department of Dermatology and Venereology, Gothenburg, Sweden
| | - Marica B. Ericson
- University of Gothenburg, Biomedical Photonics Group, Department of Chemistry and Molecular Biology, Gothenburg, Sweden
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Zhu L, Zhou Z, Mao H, Yang L. Magnetic nanoparticles for precision oncology: theranostic magnetic iron oxide nanoparticles for image-guided and targeted cancer therapy. Nanomedicine (Lond) 2016; 12:73-87. [PMID: 27876448 DOI: 10.2217/nnm-2016-0316] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Recent advances in the development of magnetic nanoparticles (MNPs) have shown promise in the development of new personalized therapeutic approaches for clinical management of cancer patients. The unique physicochemical properties of MNPs endow them with novel multifunctional capabilities for imaging, drug delivery and therapy, which are referred to as theranostics. To facilitate the translation of those theranostic MNPs into clinical applications, extensive efforts have been made on designing and improving biocompatibility, stability, safety, drug-loading ability, targeted delivery, imaging signal and thermal- or photodynamic response. In this review, we provide an overview of the physicochemical properties, toxicity and theranostic applications of MNPs with a focus on magnetic iron oxide nanoparticles.
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Affiliation(s)
- Lei Zhu
- Departments of Surgery & Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Zhiyang Zhou
- Departments of Surgery & Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.,Xiangya School of Medicine, Central South University, Changsha, Hunan 410008, China
| | - Hui Mao
- Departments of Surgery & Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Lily Yang
- Departments of Surgery & Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
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Abstract
OBJECTIVE The purpose of this study was to assess regional recurrence rates of patients who underwent sentinel lymph node biopsy (SLNB) using radiocolloid guidance alone. BACKGROUND Isosulfan blue dye is commonly used along with Tc99-labeled radiocolloid localization in SLNB for melanoma. Blue dye has, however, been associated with allergic reactions, long-term staining of skin, and increased cost. We hypothesized that the rate of regional recurrence when SLNB is performed with radiocolloid alone would be comparable to established reports using both radiocolloid and blue dye. METHODS A prospectively collected database was retrospectively queried for patients who underwent SLNB for melanoma during the years 2005 through 2008. Data collected included patient demographics, primary lesion characteristics, operative details, and recurrence. The primary outcome was the rate of recurrence within the biopsied basin after negative SLNB's performed without isosulfan blue dye. RESULTS In 215 patients, 279 nodal basins were identified. All patients underwent successful radiocolloid localization, and positive sentinel nodes were found in 40 patients (18.6%). Six of 175 patients with a negative SLNB developed a regional node recurrence as the first site of metastasis (3.4%). Among all 215 patients, 44 experienced recurrence of any kind (20.5%). Higher mitotic rate and Breslow depth were significantly associated with likelihood of recurrence. CONCLUSIONS Success rates, node positivity rates, and rates of regional recurrence after SLNB for melanoma using radiocolloid alone are acceptable and similar to those of prior reports using blue dye plus radiocolloid.
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Wang D, Fei B, Halig LV, Qin X, Hu Z, Xu H, Wang YA, Chen Z, Kim S, Shin DM, Chen Z(G. Targeted iron-oxide nanoparticle for photodynamic therapy and imaging of head and neck cancer. ACS NANO 2014; 8:6620-32. [PMID: 24923902 PMCID: PMC4155749 DOI: 10.1021/nn501652j] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 06/12/2014] [Indexed: 05/21/2023]
Abstract
Photodynamic therapy (PDT) is a highly specific anticancer treatment modality for various cancers, particularly for recurrent cancers that no longer respond to conventional anticancer therapies. PDT has been under development for decades, but light-associated toxicity limits its clinical applications. To reduce the toxicity of PDT, we recently developed a targeted nanoparticle (NP) platform that combines a second-generation PDT drug, Pc 4, with a cancer targeting ligand, and iron oxide (IO) NPs. Carboxyl functionalized IO NPs were first conjugated with a fibronectin-mimetic peptide (Fmp), which binds integrin β1. Then the PDT drug Pc 4 was successfully encapsulated into the ligand-conjugated IO NPs to generate Fmp-IO-Pc 4. Our study indicated that both nontargeted IO-Pc 4 and targeted Fmp-IO-Pc 4 NPs accumulated in xenograft tumors with higher concentrations than nonformulated Pc 4. As expected, both IO-Pc 4 and Fmp-IO-Pc 4 reduced the size of HNSCC xenograft tumors more effectively than free Pc 4. Using a 10-fold lower dose of Pc 4 than that reported in the literature, the targeted Fmp-IO-Pc 4 NPs demonstrated significantly greater inhibition of tumor growth than nontargeted IO-Pc 4 NPs. These results suggest that the delivery of a PDT agent Pc 4 by IO NPs can enhance treatment efficacy and reduce PDT drug dose. The targeted IO-Pc 4 NPs have great potential to serve as both a magnetic resonance imaging (MRI) agent and PDT drug in the clinic.
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Affiliation(s)
- Dongsheng Wang
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Department of Radiology and Imaging Sciences, and Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, Georgia 30322, United States
| | - Baowei Fei
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Department of Radiology and Imaging Sciences, and Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, Georgia 30322, United States
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia 30322, United States
- Address correspondence to ,
| | - Luma V. Halig
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Department of Radiology and Imaging Sciences, and Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, Georgia 30322, United States
| | - Xulei Qin
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia 30322, United States
| | - Zhongliang Hu
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Department of Radiology and Imaging Sciences, and Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, Georgia 30322, United States
| | - Hong Xu
- Ocean NanoTech LLC, San Diego, California 92126, United States
| | | | - Zhengjia Chen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Department of Radiology and Imaging Sciences, and Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, Georgia 30322, United States
- Biostatistics and Bioinformatics Shared Resource at Winship Cancer Institute, Emory University, Atlanta, Georgia 30322, United States
| | - Sungjin Kim
- Biostatistics and Bioinformatics Shared Resource at Winship Cancer Institute, Emory University, Atlanta, Georgia 30322, United States
| | - Dong M. Shin
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Department of Radiology and Imaging Sciences, and Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, Georgia 30322, United States
| | - Zhuo (Georgia) Chen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Department of Radiology and Imaging Sciences, and Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, Georgia 30322, United States
- Address correspondence to ,
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Satpathy M, Wang L, Zielinski R, Qian W, Lipowska M, Capala J, Lee GY, Xu H, Wang YA, Mao H, Yang L. Active targeting using HER-2-affibody-conjugated nanoparticles enabled sensitive and specific imaging of orthotopic HER-2 positive ovarian tumors. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2014; 10:544-55. [PMID: 24038985 PMCID: PMC3946402 DOI: 10.1002/smll.201301593] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/13/2013] [Indexed: 05/20/2023]
Abstract
Despite advances in cancer diagnosis and treatment, ovarian cancer remains one of the most fatal cancer types. The development of targeted nanoparticle imaging probes and therapeutics offers promising approaches for early detection and effective treatment of ovarian cancer. In this study, HER-2 targeted magnetic iron oxide nanoparticles (IONPs) are developed by conjugating a high affinity and small size HER-2 affibody that is labeled with a unique near infrared dye (NIR-830) to the nanoparticles. Using a clinically relevant orthotopic human ovarian tumor xenograft model, it is shown that HER-2 targeted IONPs are selectively delivered into both primary and disseminated ovarian tumors, enabling non-invasive optical and MR imaging of the tumors as small as 1 mm in the peritoneal cavity. It is determined that HER-2 targeted delivery of the IONPs is essential for specific and sensitive imaging of the HER-2 positive tumor since we are unable to detect the imaging signal in the tumors following systemic delivery of non-targeted IONPs into the mice bearing HER-2 positive SKOV3 tumors. Furthermore, imaging signals and the IONPs are not detected in HER-2 low expressing OVCAR3 tumors after systemic delivery of HER-2 targeted-IONPs. Since HER-2 is expressed in a high percentage of ovarian cancers, the HER-2 targeted dual imaging modality IONPs have potential for the development of novel targeted imaging and therapeutic nanoparticles for ovarian cancer detection, targeted drug delivery, and image-guided therapy and surgery.
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Affiliation(s)
| | - Liya Wang
- Emory University School of Medicine, Atlanta, GA
| | | | - Weiping Qian
- Emory University School of Medicine, Atlanta, GA
| | | | - Jacek Capala
- Radiation Oncology, National Institutes of Health, Bethesda, MD
| | | | - Hong Xu
- Ocean Nanotech, LLC, Springdale, AR
| | | | - Hui Mao
- Emory University School of Medicine, Atlanta, GA
| | - Lily Yang
- Prof. Lily Yang, Department of Surgery, Emory University School of Medicine, Clinic C, Room C-4088, 1365 C Clifton Road, NE, Atlanta, GA 30322. Telephone: 404-778-4269; Fax: 404-778-5530.
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Pourtau L, Oliveira H, Thevenot J, Wan Y, Brisson AR, Sandre O, Miraux S, Thiaudiere E, Lecommandoux S. Antibody-functionalized magnetic polymersomes: in vivo targeting and imaging of bone metastases using high resolution MRI. Adv Healthc Mater 2013; 2:1420-4. [PMID: 23606565 DOI: 10.1002/adhm.201300061] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Indexed: 01/29/2023]
Abstract
Multifunctional polymersomes loaded with maghemite nanoparticles and grafted with an antibody, directed against human endothelial receptor 2, are developed as novel MRI contrast agents for bone metastasis imaging. Upon administration in mice bearing bone tumor grown from human breast cancer cells, MR images show targeting and enhanced retention of antibody-labeled polymersomes at the tumor site.
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Affiliation(s)
- Line Pourtau
- Centre de Résonance Magnétique, des Systèmes Biologiques, UMR 5536, Université Bordeaux Segalen, CNRS, France
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Niziołek A, Murawa D. Diagnostic value of intraoperative histopathological examination of the sentinel nodes in breast cancer and skin melanoma-Preliminary results of single centre retrospective study. Rep Pract Oncol Radiother 2013; 18:245-9. [PMID: 24416560 PMCID: PMC3863217 DOI: 10.1016/j.rpor.2013.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 02/05/2013] [Accepted: 03/24/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Intraoperative histopatological examination of the sentinel nodes enables selection of patients who need dissection of the regional lymphatic system during the same operation. The aim of this study is to evaluate the diagnostic value of intraoperative histopathological examination of the sentinel nodes in breast cancer and skin melanoma. Intraoperative histopathology of the sentinel nodes as a diagnostic method is used in patients with melanoma and breast cancer. Recent studies have proved it to be an effective method for evaluating the nodes in the final histopathology. Intraoperative histopathological examination of the sentinel nodes is not performed routinely and there is no clear position on this issue. In this paper we try to prove that intraoperative test gives patients the simultaneous benefits of removal of regional lymph nodes metastases and earlier initiation of adjuvant therapy. METHODS The study comprises 137 patients with breast cancer and 35 patients with malignant skin melanoma. Sentinel nodes were intraoperatively sectioned and examined by means of the imprint method and frozen section evaluation. The patients with positive sentinel nodes underwent immediate dissection of regional lymph nodes. Those with negative sentinel nodes diagnosed in the intraoperative examination, but positive in final pathologic results, underwent subsequent dissection of regional lymph nodes. RESULTS 60 sentinel lymph nodes were found in 35 patients with skin melanoma. In 3 patients, 3 sentinel lymph nodes were false negative in the intraoperative histopathological examination. No false positive sentinel lymph nodes were found. 249 sentinel lymph nodes were found in the intraoperative histopathological examination in 137 patients with breast cancer. There were no false positive sentinel nodes, but there were 7 false negative sentinel nodes. In this study, only 5 (3.6%) patients with breast cancer and 3 (8.5%) patients with skin melanoma required another regional operation. CONCLUSION The method of intraoperative histopathological evaluation of the sentinel nodes enables identification of metastases in these lymph nodes and gives a possibility to carry out a one-step regional lymphadenectomy and start the adjuvant therapy earlier.
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Affiliation(s)
- Aleksander Niziołek
- 1st Clinic of Surgical Oncology and General Surgery, Greater Poland Cancer Centre, ul. Garbary 15, 61-866 Poznań, Poland
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Lee GY, Qian WP, Wang L, Wang YA, Staley CA, Satpathy M, Nie S, Mao H, Yang L. Theranostic nanoparticles with controlled release of gemcitabine for targeted therapy and MRI of pancreatic cancer. ACS NANO 2013; 7:2078-89. [PMID: 23402593 PMCID: PMC3609912 DOI: 10.1021/nn3043463] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The tumor stroma in human cancers significantly limits the delivery of therapeutic agents into cancer cells. To develop an effective therapeutic approach overcoming the physical barrier of the stroma, we engineered urokinase plasminogen activator receptor (uPAR)-targeted magnetic iron oxide nanoparticles (IONPs) carrying chemotherapy drug gemcitabine (Gem) for targeted delivery into uPAR-expressing tumor and stromal cells. The uPAR-targeted nanoparticle construct, ATF-IONP-Gem, was prepared by conjugating IONPs with the amino-terminal fragment (ATF) peptide of the receptor-binding domain of uPA, a natural ligand of uPAR, and Gem via a lysosomally cleavable tetrapeptide linker. These theranostic nanoparticles enable intracellular release of Gem following receptor-mediated endocytosis of ATF-IONP-Gem into tumor cells and also provide contrast enhancement in magnetic resonance imaging (MRI) of tumors. Our results demonstrated the pH- and lysosomal enzyme-dependent release of gemcitabine, preventing the drug from enzymatic degradation. Systemic administrations of ATF-IONP-Gem significantly inhibited the growth of orthotopic human pancreatic cancer xenografts in nude mice. With MRI contrast enhancement by IONPs, we detected the presence of IONPs in the residual tumors following the treatment, suggesting the possibility of monitoring drug delivery and assessing drug-resistant tumors by MRI. The theranostic ATF-IONP-Gem nanoparticle has great potential for the development of targeted therapeutic and imaging approaches that are capable of overcoming the tumor stromal barrier, thus enhancing the therapeutic effect of nanoparticle drugs on pancreatic cancers.
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Affiliation(s)
- Gee Young Lee
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Department of Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Wei Ping Qian
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Liya Wang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | | | - Charles A. Staley
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Minati Satpathy
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Shuming Nie
- Department of Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Address Correspondence to: Lily Yang, M.D., Ph.D. Department of Surgery, Emory University School of Medicine, 1365-C Clifton Road, NE, Atlanta, GA, 30322, USA. Tel: + 1 404-778-4269, Fax: + 1 404-778-5530, , Or Hui Mao, Ph.D. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, NE Atlanta, GA, 30322, USA. Tel: +1 404-712-0357, Fax: +1 404-712-5948,
| | - Lily Yang
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Address Correspondence to: Lily Yang, M.D., Ph.D. Department of Surgery, Emory University School of Medicine, 1365-C Clifton Road, NE, Atlanta, GA, 30322, USA. Tel: + 1 404-778-4269, Fax: + 1 404-778-5530, , Or Hui Mao, Ph.D. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, NE Atlanta, GA, 30322, USA. Tel: +1 404-712-0357, Fax: +1 404-712-5948,
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Bagaria SP, Faries MB, Morton DL. Sentinel node biopsy in melanoma: technical considerations of the procedure as performed at the John Wayne Cancer Institute. J Surg Oncol 2010; 101:669-76. [PMID: 20512942 DOI: 10.1002/jso.21581] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Since its first description in 1990, sentinel node (SN) biopsy has become the standard for accurate staging of a melanoma-draining regional lymphatic basin. This minimally invasive, multidisciplinary technique can detect occult metastases by selective sampling and focused pathologic analysis of the first nodes on the afferent lymphatic pathway from a primary cutaneous melanoma. An understanding of preoperative lymphoscintigraphy, intraoperative lymphatic mapping, and the definition of SN are critical for surgical expertise with SN biopsy.
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Affiliation(s)
- Sanjay P Bagaria
- John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA
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Abstract
The increased use of sensitive imaging modalities has led to increased identification of the incidental liver mass (ILM). A combination of careful consideration of patient factors and imaging characteristics of the ILM enables clinicians to recommend a safe and efficient course of action. Using an algorithmic approach, this article includes pertinent clinical factors and the specific radiologic criteria of ILMs and discusses the indications for potential procedures. It is the aim of this article to assist with the development of an individualized strategy for each patient with an ILM.
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Affiliation(s)
- Cherif Boutros
- Department of Hepatobiliary and Surgical Oncology, Roger Williams Medical Center, 825 Chalkstone Avenue, Prior 4, Providence, RI 02908, USA
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Detection and characterization of focal liver lesions: a Japanese phase III, multicenter comparison between gadoxetic acid disodium-enhanced magnetic resonance imaging and contrast-enhanced computed tomography predominantly in patients with hepatocellular carcinoma and chronic liver disease. Invest Radiol 2010; 45:133-41. [PMID: 20098330 DOI: 10.1097/rli.0b013e3181caea5b] [Citation(s) in RCA: 191] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To prospectively evaluate the safety and efficacy of combined unenhanced and gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging compared with unenhanced MR imaging and triphasic contrast-enhanced spiral computed tomography (CT) for the detection and characterization of focal liver lesions. MATERIALS AND METHODS The study was reviewed and approved by the institutional review board at each of the 15 centers involved in the study, and informed written consent was given by all patients. In total, 178 patients with suspected focal hepatic lesions (based, in most patients, on CT, tumor marker and ultrasound examinations) underwent combined MR imaging with a single, rapid injection of Gd-EOB-DTPA 0.025 mmol/kg, including T1-weighted dynamic and delayed MR images 20 to 40 minutes postinjection. Triphasic contrast-enhanced CT, the comparator examination, was performed within 4 weeks of MR imaging. Standard of references (SOR) were resection histopathology and intraoperative ultrasonography, or combined CT during arterial portography and CT hepatic arteriography; in cases where, although the major lesions were treated, some lesion(s) were not treated, follow-up superparamagnetic iron oxide-enhanced MR imaging was additionally performed. All images were assessed for differences in lesion detection and characterization (specific lesion type) by on-site readers and 3, blinded (off-site) reviewers. All adverse events (AEs) occurring within 72 hours after Gd-EOB-DTPA administration were reported. RESULTS Overall, 9.6% of patients who received Gd-EOB-DTPA reported 21 drug-related AEs. A total of 151 patients were included in the efficacy analysis. Combined MR imaging showed statistically higher sensitivity in lesion detection (67.5%-79.5%) than unenhanced MR imaging (46.5%-59.1%; P < 0.05 for all). Combined MR imaging also showed higher sensitivity in lesion detection than CT (61.1%-73.0%), with the results being statistically significant (P < 0.05) for on-site readers and 2 of 3 blinded readers. Higher sensitivity in lesion detection with combined MR imaging compared with CT was also clearly demonstrated in the following subgroups: lesions with a diameter <or=20 mm (lesions <or=10 mm: 38.0%-55.4% vs. 26.1%-47.3%, respectively; lesions 10-20 mm: 71.1%-87.3% vs. 65.7%-78.4%, respectively); in cirrhotic patients (64.5%-75.4% vs. 54.5%-70.3%, respectively); and in patients with hepatocellular carcinoma (66.6%-78.6% vs. 59.1%-71.6%, respectively). Combined MR imaging demonstrated a higher proportion of correctly characterized lesions (50.5%-72.1%) than unenhanced MR imaging (30.2%-50.0%; P < 0.05 for all), whereas there were no significant differences compared with CT (49.0%-68.1%), except for one blinded reader (P < 0.05). CONCLUSION In this study, hepatocyte-specific Gd-EOB-DTPA was shown to be safe and to improve the detection and characterization of focal hepatic lesions compared with unenhanced MR imaging. When compared with spiral CT, Gd-EOB-DTPA enhanced MRI seems to be beneficial especially for the detection for smaller lesions or hepatocellular carcinoma underlying cirrhotic liver.
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Zech CJ, Grazioli L, Jonas E, Ekman M, Niebecker R, Gschwend S, Breuer J, Jönsson L, Kienbaum S. Health-economic evaluation of three imaging strategies in patients with suspected colorectal liver metastases: Gd-EOB-DTPA-enhanced MRI vs. extracellular contrast media-enhanced MRI and 3-phase MDCT in Germany, Italy and Sweden. Eur Radiol 2009; 19 Suppl 3:S753-63. [PMID: 19484243 DOI: 10.1007/s00330-009-1432-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to perform an economic evaluation of hepatocyte-specific Gd-EOB-DTPA enhanced MRI (PV-MRI) compared to extracellular contrast-media-enhanced MRI (ECCM-MRI) and three-phase-MDCT as initial modalities in the work-up of patients with metachronous colorectal liver metastases. The economic evaluation was performed with a decision-tree model designed to estimate all aggregated costs depending on the initial investigation. Probabilities on the need for further imaging to come to a treatment decision were collected through interviews with 13 pairs of each a radiologist and a liver surgeon in Germany, Italy and Sweden. The rate of further imaging needed was 8.6% after initial PV-MRI, 18.5% after ECCM-MRI and 23.5% after MDCT. Considering the cost of all diagnostic work-up, intra-operative treatment changes and unnecessary surgery, a strategy starting with PV-MRI with 959 Euro was cost-saving compared to ECCM-MRI (1,123 Euro) and MDCT (1,044 Euro) in Sweden. In Italy and Germany, PV-MRI was cost-saving compared to ECCM-MRI and had total costs similar to MDCT. In conclusion, our results indicate that PV-MRI can lead to cost savings by improving pre-operative planning and decreasing intra-operative changes. The higher cost of imaging with PV-MRI is offset in such a scenario by lower costs for additional imaging and less intra-operative changes.
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Affiliation(s)
- C J Zech
- Institute of Clinical Radiology, University Hospital Munich-Grosshadern, Munich, Germany.
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15
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Yang L, Mao H, Wang YA, Cao Z, Peng X, Wang X, Duan H, Ni C, Yuan Q, Adams G, Smith MQ, Wood WC, Gao X, Nie S. Single chain epidermal growth factor receptor antibody conjugated nanoparticles for in vivo tumor targeting and imaging. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2009; 5:235-43. [PMID: 19089838 PMCID: PMC3626261 DOI: 10.1002/smll.200800714] [Citation(s) in RCA: 206] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Epidermal growth factor receptor (EGFR) targeted nanoparticle are developed by conjugating a single-chain anti-EGFR antibody (ScFvEGFR) to surface functionalized quantum dots (QDs) or magnetic iron oxide (IO) nanoparticles. The results show that ScFvEGFR can be successfully conjugated to the nanoparticles, resulting in compact ScFvEGFR nanoparticles that specifically bind to and are internalized by EGFR-expressing cancer cells, thereby producing a fluorescent signal or magnetic resonance imaging (MRI) contrast. In vivo tumor targeting and uptake of the nanoparticles in human cancer cells is demonstrated after systemic delivery of ScFvEGFR-QDs or ScFvEGFR-IO nanoparticles into an orthotopic pancreatic cancer model. Therefore, ScFvEGFR nanoparticles have potential to be used as a molecular-targeted in vivo tumor imaging agent. Efficient internalization of ScFvEGFR nanoparticles into tumor cells after systemic delivery suggests that the EGFR-targeted nanoparticles can also be used for the targeted delivery of therapeutic agents.
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Affiliation(s)
- Lily Yang
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, 1365 C Clifton Road NE Atlanta, GA 30322 (USA),
| | - Hui Mao
- Department of Radiology, Emory University School of Medicine, EUH AG11, 1364 Clifton Road, Atlanta, GA 30322 (USA)
| | | | - Zehong Cao
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, 1365 C Clifton Road NE Atlanta, GA 30322 (USA)
| | - Xianghong Peng
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, 1365 C Clifton Road NE Atlanta, GA 30322 (USA)
| | - Xiaoxia Wang
- Department of Radiology, Emory University School of Medicine, EUH AG11, 1364 Clifton Road, Atlanta, GA 30322 (USA)
| | - Hongwei Duan
- Department of Biomedical Engineering, Emory University School of Medicine, 101 Woodruff Circle, Suite 2007B, Atlanta, GA 30322 (USA)
| | - Chunchun Ni
- Department of Radiology, Emory University School of Medicine, EUH AG11, 1364 Clifton Road, Atlanta, GA 30322 (USA)
| | - Qingan Yuan
- Fox Chase Cancer Center, Philadelphia, PA 19111 (USA)
| | - Gregory Adams
- Fox Chase Cancer Center, Philadelphia, PA 19111 (USA)
| | - Mark Q. Smith
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, 1365 C Clifton Road NE Atlanta, GA 30322 (USA)
| | - William C. Wood
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, 1365 C Clifton Road NE Atlanta, GA 30322 (USA)
| | - Xiaohu Gao
- Department of Bioengineering, University of Washington, Seattle, WA 98195 (USA)
| | - Shuming Nie
- Department of Biomedical Engineering, Emory University School of Medicine, 101 Woodruff Circle, Suite 2007B, Atlanta, GA 30322 (USA)
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Yang L, Cao Z, Sajja HK, Mao H, Wang L, Geng H, Xu H, Jiang T, Wood WC, Nie S, Wang YA. Development of Receptor Targeted Magnetic Iron Oxide Nanoparticles for Efficient Drug Delivery and Tumor Imaging. J Biomed Nanotechnol 2008; 4:439-449. [PMID: 25152701 DOI: 10.1166/jbn.2008.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The development of multifunctional nanoparticles that have dual capabilities of tumor imaging and delivering therapeutic agents into tumor cells holds great promises for novel approaches for tumor imaging and therapy. We have engineered urokinase plasminogen activator receptor (uPAR) targeted biodegradable nanoparticles using a size uniform and amphiphilic polymer-coated magnetic iron oxide (IO) nanoparticle conjugated with the amino-terminal fragment (ATF) of urokinase plasminogen activator (uPA), which is a high affinity natural ligand for uPAR. We further developed methods to encapsulate hydrophobic chemotherapeutic drugs into the polymer layer on the IO nanoparticles, making these targeted magnetic resonance imaging (MRI) sensitive nanoparticles drug delivery vehicles. Using a fluorescent drug doxorubicin (Dox) as a model system, we showed that this hydrophobic drug can be efficiently encapsulated into the uPAR-targeted IO nanoparticles. This class of Dox-loaded nanoparticles has a compact size and is stable in pH 7.4 buffer. However, encapsulated Doxcan be released from the nanoparticles at pH 4.0 to 5.0 within 2 hrs. In comparison with the effect of equivalent dosage of free drug or non-targeted IO-Dox nanoparticles, uPAR-targeted IO-Dox nanoparticles deliver higher levels of Dox into breast cancer cells and produce a stronger inhibitory effect on tumor cell growth. Importantly, Dox-loaded IO nanoparticles maintain their T2 MRI contrast effect after being internalized into the tumor cells due to their significant susceptibility effect in the cells, indicating that this drug delivery nanoparticle has the potential to be used as targeted therapeutic imaging probes for monitoring the drug delivery using MRI.
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Affiliation(s)
- Lily Yang
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, GA 30322, USA ; Radiology, Emory University School of Medicine, Atlanta, Georgia, GA 30322, USA
| | - Zehong Cao
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, GA 30322, USA
| | - Hari Krishna Sajja
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, GA 30322, USA
| | - Hui Mao
- Radiology, Emory University School of Medicine, Atlanta, Georgia, GA 30322, USA
| | - Liya Wang
- Radiology, Emory University School of Medicine, Atlanta, Georgia, GA 30322, USA
| | - Huaying Geng
- Ocean Nanotech, LLC, 700 Research Center Blvd, 72701, Fayetteville, Arkansas, USA
| | - Hengyi Xu
- Ocean Nanotech, LLC, 700 Research Center Blvd, 72701, Fayetteville, Arkansas, USA
| | - Tieshan Jiang
- Ocean Nanotech, LLC, 700 Research Center Blvd, 72701, Fayetteville, Arkansas, USA
| | - William C Wood
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, GA 30322, USA
| | - Shuming Nie
- Biomedical Engineering, Emory University School of Medicine, Atlanta, Georgia, GA 30322, USA
| | - Y Andrew Wang
- Ocean Nanotech, LLC, 700 Research Center Blvd, 72701, Fayetteville, Arkansas, USA
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Magnetic resonance imaging detects differences in migration between primary and immortalized neural stem cells. Acad Radiol 2008; 15:1269-81. [PMID: 18790399 DOI: 10.1016/j.acra.2008.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 04/29/2008] [Accepted: 05/02/2008] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES The study was performed to evaluate the effect of magnetic resonance imaging (MRI) contrast agent (super paramagnetic iron oxide [SPIO]) on differentiation and migration of primary murine neural stem cells (NSCs) in comparison to a neural stem cell line (C17.2). Because detection of labeled cells depends on the concentration of SPIO particles per imaging voxel, the study was performed at various concentrations of SPIO particles to determine the concentration that could be used for in vivo detection of small clusters of grafted cells. MATERIALS AND METHODS Murine primary NSCs or C17.2 cells were labeled with different concentrations of SPIO particles (0, 25, 100, and 250 microg Fe/mL) and in vitro assays were performed to assess cell differentiation. In vivo MRI was performed 7 weeks after neonatal transplantation of labeled cells to evaluate the difference in migration capability of the two cell populations. RESULTS Both the primary NSCs and the C17.2 cells differentiated to similar number of neurons (Map2ab-positive cells). Similar patterns of engraftment of C17.2 cells were seen in transplanted mice regardless of the SPIO concentration used. In vivo MRI detection of grafted primary and C17.2 cells was only possible when cells were incubated with 100 microg/mL or higher concentration of SPIO. Extensive migration of C17.2 cells throughout the brain was observed, whereas the migration of the primary NSCs was more restricted. CONCLUSIONS Engraftment of primary NSCs can be detected noninvasively by in vivo MRI, and the presence of SPIO particles do not affect the viability, differentiation, or engraftment pattern of the donor cells.
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Goto Y, Ferrone S, Arigami T, Kitago M, Tanemura A, Sunami E, Nguyen SL, Turner RR, Morton DL, Hoon DSB. Human high molecular weight-melanoma-associated antigen: utility for detection of metastatic melanoma in sentinel lymph nodes. Clin Cancer Res 2008; 14:3401-7. [PMID: 18519770 DOI: 10.1158/1078-0432.ccr-07-1842] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Detection of micrometastasis in melanoma-draining lymph nodes is important for staging and prognosis. Immunohistochemical staining (IHC) using S-100p-HMB-45-, and MART-1-specific antibodies is used for detecting metastases in sentinel lymph nodes (SLN). However, improvement in IHC is needed for melanoma micrometastasis detection. EXPERIMENTAL DESIGN Paraffin-embedded archival tissue (PEAT) specimens were obtained from 42 non-SLN macrometastases, 42 SLN metastases, and 16 tumor-negative SLNs of 100 melanoma patients who underwent SLN biopsy. PEAT specimens were assessed by IHC with high molecular weight-melanoma-associated antigen (HMW-MAA)-specific monoclonal antibodies (mAb) and with S-100p-, HMB-45-, and MART-1-specific antibodies. Quantitative real-time reverse-transcriptase PCR assay was used for HMW-MAA and MART-1 mRNA detection. RESULTS Expression frequency and immunostaining intensity were higher for HMW-MAA than MART-1 in nodal macrometastases (P < 0.0001 and P < 0.0001, respectively) and micrometastases (P < 0.0001 and P = 0.004, respectively). All 52 (100%) macrometastases were positive with HMW-MAA-specific mAbs, whereas 43 (83%) were positive with MART-1-specific mAbs. In a comparison analysis, 23 of 23 (100%) micrometastases were HMW-MAA-positive, whereas 21 (91%) and 18 (78%) specimens were S-100p- and HMB-45-positive, respectively. Quantitative real-time reverse-transcriptase PCR analysis of 48 nodal metastases showed HMW-MAA mRNA detection in SLNs with metastases. CONCLUSIONS HMW-MAA is more sensitive and specific than MART-1, S-100p, and HMB-45 for IHC-based detection of SLN micrometastases. SLN PEAT-based detection specificity of melanoma micrometastases can be improved by IHC with HMW-MAA-specific mAbs.
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Affiliation(s)
- Yasufumi Goto
- Department of Molecular Oncology, John Wayne Cancer Institute, 2200 Santa Monica Boulevard, Santa Monica, CA 90404, USA
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Annemans L, Lencioni R, Warie H, Bartolozzi C, Ciceri M, Müller U. Health economic evaluation of ferucarbotran-enhanced MRI in the diagnosis of liver metastases in colorectal cancer patients. Int J Colorectal Dis 2008; 23:77-83. [PMID: 17912536 DOI: 10.1007/s00384-007-0350-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2007] [Indexed: 02/04/2023]
Abstract
PURPOSE The objective of our study was to analyze the health economic impact of ferucarbotran-enhanced magnetic resonance imaging (MRI) in the diagnosis of hepatic colorectal cancer metastases based on observed changes in medical management. MATERIALS AND METHODS A decision tree simulating a patient's medical management was designed, comparing two scenarios: contrast-enhanced spiral computed tomography-based vs ferucarbotran-enhanced MRI-based (Resovist, Bayer Schering Pharma AG, Germany) diagnosis. A clinical trial in patients with presumed liver metastases (n=36) provided data on clinical decisions regarding the medical management options in relation to diagnostic outcomes: resection, chemotherapy, or best supportive care. A "gold standard" was established afterward, combining all the available clinical, imaging, laboratory, and pathology findings. A multidisciplinary panel formed by a hepatologist, a liver surgeon, and an interventional radiologist decided on the recommended medical management for each patient. Costs of medical resources associated with each management option (all expressed in Euro) were obtained from the public health insurance (average European values). Life expectancies for the different options were obtained from literature. RESULTS Despite an initial extra cost of 338 Euro, a significant net saving of 1,443 Euro was obtained with ferucarbotran-enhanced MRI mainly because of avoiding unnecessary surgery. There was no significant difference in the predicted life expectancy between both arms, despite the large difference in medical decision. CONCLUSION In this comparative medical decision analysis, it was shown that ferucarbotran-enhanced MRI has the potential to improve medical management and save health care costs.
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20
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Nomura K, Kadoya M, Ueda K, Fujinaga Y, Miwa S, Miyagawa SI. Detection of hepatic metastases from colorectal carcinoma: comparison of histopathologic features of anatomically resected liver with results of preoperative imaging. J Clin Gastroenterol 2007; 41:789-95. [PMID: 17700429 DOI: 10.1097/01.mcg.0000225676.22218.08] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
GOALS The specificity and sensitivity of intravenous-enhanced multidetector row computed tomography (MDCT), superparamagnetic iron oxide-enhanced magnetic resonance imaging (SPIO-MRI), multidetector row computed tomography with arterioportography combined with multidetector row computed tomography with hepatic arteriography (CTAP/CTHA), and intraoperative ultrasonography (IOUS) for detecting hepatic metastases from colorectal carcinoma were evaluated based on histopathologic examination of resected livers. STUDY MDCT, SPIO-MRI, CTAP/CTHA, and IOUS were performed routinely to determine surgical indications and methods in patients with hepatic metastases from colorectal carcinoma. The resected liver specimens were then cut serially into sections 3 to 5 mm thick for routine histologic examination. RESULTS Fifty metastatic lesions were detected by histopathologic study of a large amount of anatomically resected liver from 8 patients with colorectal liver metastasis. The tumors ranged in size from 3 to 53 mm (mean 13.8 mm) and 26 lesions (52%) were less than 10 mm in diameter. Histopathologic examination of the resected liver specimens showed that CTAP/CTHA was the most sensitive imaging modality, followed in order by IOUS, SPIO-MRI, and MDCT. Among all the tumors detected by CTAP/CTHA, SPIO-MRI overlooked 5, but all of the tumors detected by SPIO-MRI were also detected by CTAP/CTHA. The number of metastatic liver tumors detected differed significantly among MDCT, SPIO-MRI, and histopathologic examination. One false-positive lesion was detected by IOUS. CONCLUSIONS CTAP/CTHA is a useful preoperative imaging modality for detecting small hepatic metastases from colorectal carcinoma.
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Affiliation(s)
- Kazuhiko Nomura
- Department of Gastroenterological Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Nagano, Japan.
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Abstract
During the last 2 decades, the development and wide acceptance of SLN biopsy have affected the management of melanoma profoundly. This technique represents a considerable improvement in the ability to evaluate the tumor status of the regional lymph node basin, which is the most important predictor of survival in patients who have melanoma. Histopathologic and molecular assessment of the SLN has enhanced the detection of clinically occult nodal metastases, thereby distinguishing patients who might benefit from immediate lymphadenectomy from those for whom this procedure is unlikely to be helpful. This technique also identifies patients who would be candidates for clinical trials of adjuvant therapy. Centers can offer SLN biopsy without routine CLND once they reach a level of proficiency that usually corresponds to a learning phase of 55 cases. The role of molecular technology in the identification and analysis of the SLN remains to be established. Although molecular evidence of SLN metastasis has been identified in patients who have early-stage melanoma, its clinical relevance cannot be determined until marker selection is improved. The markers presently under study lack sensitivity and specificity. The role of molecular biomarkers can be validated only through large, multicenter, randomized. controlled trials such as the MSLT-II, a trial that will determine the benefit of multimarker RT-PCR assay in SLN specimens. SLN offers a promising future in staging lymph nodes and will improve the management of patients who have melanoma. Although SLN biopsy has become widely accepted as a minimally invasive technique of staging regional lymph nodes, its use in patients who have melanoma continues to be challenged. The future of SLN biopsy holds promise if prospective multicenter trials confirm a survival benefit for SLN biopsy as compared with watch-and-wait observation.
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Affiliation(s)
- Farin Amersi
- Department of Surgical Oncology and the Roy E. Coats Research Laboratories, John Wayne Cancer Institute, 2200 Santa Monica Blvd., Santa Monica, CA 90404, USA
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22
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Shidham VB, Komorowski R, Neuberg M, Walker A, Campbell BH, Chang CC, Dzwierzynski WW. Prevention of an additional surgery for regional lymphadenectomy in melanoma: rapid intraoperative immunostaining of sentinel lymph node imprint smears. Diagn Pathol 2006; 1:32. [PMID: 16999866 PMCID: PMC1592125 DOI: 10.1186/1746-1596-1-32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 09/25/2006] [Indexed: 02/04/2023] Open
Abstract
Background Sentinel lymph node (SLN) biopsy is performed at many institutions and is considered a standard of care in the management of cutaneous melanoma. The discriminatory immunostaining pattern with the 'MCW Melanoma Cocktail' (a mixture of MART-1 {1:500}, Melan- A {1:100}, and Tyrosinase {1:50} monoclonal antibodies) allows intraoperative immunocytochemical evaluation of imprint smears of SLNs for melanoma metastases. Cohesive cells of benign capsular melanocytic nevi that were also immunoreactive with the cocktail do not exfoliate easily for imprint smear detection. Methods We prospectively evaluated 73 lymph nodes (70 SLN & 3 non-SLN) from 41 cases (mean 1.8, 1 to 4 SLNs/case) of cutaneous melanoma using a rapid 17-minute immunostaining previously published protocol. The results were compared with permanent sections also immunostained with 'the cocktail'. Results 19.5%, 8/41 cases (12%, 9/73 lymph nodes) were positive for melanoma metastases on permanent sections immunostained with the 'MCW melanoma cocktail'. Melanoma metastases in 87.5% (7/8) of these cases were also detected in rapidly immunostained imprint smears, with 100% specificity and 90% sensitivity. None of the 7 SLNs from 7 cases with capsular nevi showed false positive results. Conclusion Melanoma metastases could be detected in imprint smears immunostained with 'MCW Melanoma Cocktail' utilizing a rapid intraoperative protocol. The cohesive cells of the capsular nevi do not readily exfoliate and do not lead to false positive interpretation. In a majority of positive cases, a regional lymphadenectomy could have been completed during the same surgery for SLN biopsy and wide excision of primary melanoma site, potentially eliminating the need for an additional surgery.
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Affiliation(s)
- Vinod B Shidham
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard Komorowski
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marcelle Neuberg
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alonzo Walker
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bruce H Campbell
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chung-Che Chang
- Department of Pathology, The Methodist Hospital, Houston, TX, USA
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Joyner BL, Levin TL, Goyal RK, Newman B. Focal nodular hyperplasia of the liver: a sequela of tumor therapy. Pediatr Radiol 2005; 35:1234-9. [PMID: 16052333 DOI: 10.1007/s00247-005-1558-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 06/26/2005] [Accepted: 07/02/2005] [Indexed: 12/17/2022]
Abstract
Focal nodular hyperplasia (FNH) of the liver occurs with increased frequency in oncology patients after completion of tumor therapy. Its development may be related to the vascular damage induced by such therapy. We present three children who developed FNH after undergoing antineoplastic therapy for non-hepatic primary tumors. Recognition of this association in the appropriate patient population might obviate the need for biopsy.
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Affiliation(s)
- Benny L Joyner
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
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Abstract
Imaging of the liver is undertaken for the detection and characterization of suspected primary or secondary neoplasms, prior to planning a surgery or chemotherapy pump placement, for assessing treatment response, for evaluating biliary pathology, and for screening for liver neoplasms in high-risk groups. In this article, we review the advantages and disadvantages of various imaging modalities in the evaluation of the liver and formulate guidelines for the imaging of common clinical indications. A brief review of imaging findings in focal and diffuse liver disease is also presented.
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Affiliation(s)
- Dushyant V Sahani
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, White 270, 55 Fruit Street, Boston, Massachusetts 02114, USA.
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25
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Shidham VB, Komorowski R, Macias V, Kaul S, Dawson G, Dzwierzynski WW. Optimization of an immunostaining protocol for the rapid intraoperative evaluation of melanoma sentinel lymph node imprint smears with the 'MCW melanoma cocktail'. Cytojournal 2004; 1:2. [PMID: 15500702 PMCID: PMC524024 DOI: 10.1186/1742-6413-1-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Accepted: 08/06/2004] [Indexed: 11/19/2022] Open
Abstract
Background In the management of cutaneous melanoma, it is desirable to complete the regional lymphadenectomy during the initial surgical procedure for wide excision of biopsy site and sentinel lymph node (SLN) biopsy. In this study, we optimized and evaluated a rapid 17 minutes immunostaining protocol. The discriminatory immunostaining pattern associated with the 'MCW Melanoma Cocktail' (mixture of Melan- A, MART- 1, and tyrosinase) facilitated the feasibility of intraoperative evaluation of imprint smears of SLNs for melanoma metastases. Methods Imprint smears of 51 lymph nodes from 25 cases (48 SLNs and 3 non-SLNs, 1 to 4 SLNs/case) of cutaneous melanoma were evaluated. Results Sixteen percent, 8/51 lymph nodes (28%, 7/25 cases) were positive for melanoma metastases in immunostained permanent sections with the 'MCW melanoma cocktail'. All of these melanoma metastases, except 1 SLN from 1 case, were also detected in rapidly immunostained wet-fixed and air-dried smears (rehydrated in saline and postfixed in alcoholic formalin). The cytomorphology was superior in air-dried smears, which were rehydrated in saline and postfixed in alcoholic formalin. Wet-fixed smears frequently showed air-drying artifacts, which lead to the focal loss of immunostaining. None of the 5 SLNs from 5 cases exhibiting capsular nevi showed a false positive result with immunostained imprint smears. Conclusions Melanoma metastases can be detected intraoperatively in both air-dried smears and wet-fixed smears immunostained with the MCW Melanoma cocktail. Air-dried smears rehydrated in saline and postfixed in alcoholic formalin provide superior results and many practical benefits.
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Affiliation(s)
- Vinod B Shidham
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard Komorowski
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Virgilia Macias
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sushma Kaul
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Glen Dawson
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
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Chertow GM, Mason PD, Vaage-Nilsen O, Ahlmén J. On the relative safety of parenteral iron formulations. Nephrol Dial Transplant 2004; 19:1571-5. [PMID: 15150356 DOI: 10.1093/ndt/gfh185] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intravenous iron is usually required to optimize the correction of anaemia in persons with advanced chronic kidney disease and end-stage renal disease. Randomized clinical trials may have insufficient power to detect differences in the safety profiles of specific formulations. METHODS We obtained data from the US Food and Drug Administration on reported adverse drug events (ADEs) related to the provision of three formulations of intravenous iron during 1998-2000. We estimated the relative risks [odds ratios (OR)] of ADEs associated with the use of higher molecular weight iron dextran and sodium ferric gluconate complex compared with lower molecular weight iron dextran using 2 x 2 tables. RESULTS The total number of reported parenteral iron-related ADEs was 1981 among approximately 21,060,000 doses administered, yielding a rate of 9.4 x 10(-5), or approximately 94 per million. Total major ADEs were significantly increased among recipients of higher molecular weight iron dextran (OR 5.5, 95% CI 4.9-6.0) and sodium ferric gluconate complex (OR 6.2, 95% CI 5.4-7.2) compared with recipients of lower molecular weight iron dextran. We observed significantly higher rates of life-threatening ADEs, including death, anaphylactoid reaction, cardiac arrest and respiratory depression among users of higher molecular weight compared with lower molecular weight iron dextran. There was insufficient power to detect differences in life-threatening ADEs when comparing lower molecular weight iron dextran with sodium ferric gluconate complex. CONCLUSIONS Parenteral iron-related ADEs are rare. Using observational data, overall and most specific ADE rates were significantly higher among recipients of higher molecular weight iron dextran and sodium ferric gluconate complex than among recipients of lower molecular weight iron dextran. These data may help to guide clinical practice, as head-to-head clinical trials comparing different formulations of intravenous iron have not been conducted.
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Affiliation(s)
- Glenn M Chertow
- Division of Nephrology, Department of Medicine, University of California San Francisco, 94118-1211, USA.
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Coulam CH, Chan FP, Li KCP. Can a multiphasic contrast-enhanced three-dimensional fast spoiled gradient-recalled echo sequence be sufficient for liver MR imaging? AJR Am J Roentgenol 2002; 178:335-41. [PMID: 11804888 DOI: 10.2214/ajr.178.2.1780335] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the accuracy of a multiphasic gadolinium-enhanced three-dimensional (3D) fast spoiled gradient-recalled echo sequence alone in the detection and characterization of focal liver lesions compared with a comprehensive liver evaluation using multiphasic gadolinium-enhanced 3D fast spoiled gradient-recalled echo, T1-weighted, and fat-suppressed fast spin-echo T2-weighted sequences. MATERIALS AND METHODS A retrospective review of abdominal MR imaging examinations in 61 patients was performed. All MR examinations included unenhanced spin-echo T1-weighted, unenhanced fat-suppressed fast spin-echo T2-weighted, and multiphasic gadolinium-enhanced 3D fast spoiled gradient-recalled echo sequences obtained during successive breath-holds. The liver was evaluated for focal lesions first with the 3D spoiled gradient-recalled echo sequences and then, during a separate sitting, with the T1- and T2-weighted sequences. The usefulness of each sequence in the detection and characterization of lesions was recorded. The gold standard for lesion detection and characterization was all three imaging sequences reviewed together. RESULTS A total of 114 focal liver lesions were identified, 54 of which were simple cysts. The 3D spoiled gradient-recalled echo sequence alone detected 92 (81%) of the 114 lesions, and the T1- and T2-weighted sequences detected 95 (83%) of the 114 lesions. Of the 60 lesions that were not simple cysts, the 3D spoiled gradient-recalled echo sequence alone detected 58 (97%), and T1- and T2-weighted sequences detected 51 (85%). In 24% of the patients with lesions, the T1- and T2-weighted sequences were found to be helpful for the characterization of lesions. CONCLUSION A multiphasic contrast-enhanced 3D fast spoiled gradient-recalled echo sequence alone detects most of the clinically relevant focal liver lesions. Additional liver examination using both unenhanced T1- and T2-weighted sequences is helpful for lesion characterization but increases the detection rate only minimally.
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Affiliation(s)
- Curtis H Coulam
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr., Rm. H1307, Stanford, CA 94305, USA
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Stojadinovic A, Allen PJ, Clary BM, Busam KJ, Coit DG. Value of frozen-section analysis of sentinel lymph nodes for primary cutaneous malignant melanoma. Ann Surg 2002; 235:92-8. [PMID: 11753047 PMCID: PMC1422400 DOI: 10.1097/00000658-200201000-00012] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze a large, single-institution experience with routine frozen section (FS) of the sentinel lymph node (SLN) in patients with primary cutaneous melanoma. SUMMARY BACKGROUND DATA Controversy exists over the utility of intraoperative FS analysis of the SLN in patients with primary cutaneous melanoma. METHODS All patients with clinically node-negative cutaneous melanoma undergoing SLN biopsy from 1991 to 1999 were identified from a prospective database. All SLNs were examined by FS. Step-sectioning and immunohistochemistry of permanent section were performed for SLNs negative by FS. RESULTS At least one SLN was identified in 98% (360/368) of patients. There were 74 (20%) SLNs positive on permanent section; FS was positive in 59% of these. The accuracy, sensitivity, and specificity of FS were 92%, 59%, and 100%. Because isolated recurrence developed in six patients in the nodal basin in which the SLN was negative, the failure rate was 1.7%. The false-negative rate for SLN biopsy was 7.5%. CONCLUSIONS Because the prevalence of metastases within the SLN and sensitivity of FS analysis are low, routine use of FS for all patients undergoing SLN biopsy is not recommended.
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Affiliation(s)
- Alexander Stojadinovic
- Departments of Surgery and Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Mann GN, Marx HF, Lai LL, Wagman LD. Clinical and cost effectiveness of a new hepatocellular MRI contrast agent, mangafodipir trisodium, in the preoperative assessment of liver resectability. Ann Surg Oncol 2001; 8:573-9. [PMID: 11508618 DOI: 10.1007/s10434-001-0573-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Improved preoperative assessment of focal liver disease and tumors could have a potentially significant impact on their treatment. Mangafodipir trisodium (Teslascan; Nycomed Amersham Imaging, Little Chalfont, UK) is a new hepatocellular contrast agent for use with state-of-the-art MR imaging that, in early reports, is accurate in detection and characterization of liver lesions. METHODS Records and diagnostic images of all patients undergoing enhanced Teslascan MRI (T-MRI) at our institution were reviewed. We assessed the relative sensitivities of contrast-enhanced CT scan (CECT) and T-MRI in detecting lesions, as well as the impact of T-MRI in the decision to operate or not on patients. In those patients taken to surgery, the correlation between T-MRI and intraoperative palpation and intraoperative ultrasound (IOUS) was determined. RESULTS Fifty-four patients were noted on CECT to have focal liver lesions and subsequently underwent imaging with T-MRI. The T-MRI correlated with CT findings in 22 patients (41%), upstaged the liver disease in 26, and demonstrated fewer lesions in 6. Only 43 patients were considered operative candidates and T-MRI influenced the operative decision in 32 patients (74%), dissuading operative intervention in 14. In the 25 patients without clear preoperative evidence of unresectability who were taken to the operating room, T-MRI correlated with findings of intraoperative palpation in 19 (76%). In the 20 patients who underwent IOUS, T-MRI correlated with IOUS in 14 patients (70%). IOUS detected an additional nine lesions, all of which were <1 cm. Seventeen patients underwent resection and/or ablation of their liver lesions. Compared with pathology, sensitivities of CECT, T-MRI, and intraoperative evaluation were 61%, 83%, and 93%, respectively. T-MRI failed to predict hepatic-specific unresectability in only one of eight patients, the other seven having extrahepatic disease. CONCLUSIONS These findings suggest that T-MRI is more sensitive than CECT in the preoperative predicting of the resectability of hepatic lesions. Despite T-MRI accurately correlating with intraoperative surgical findings, IOUS should be performed on all patients prior to a final decision to resect or ablate a focal liver lesion.
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Affiliation(s)
- G N Mann
- Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA.
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