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Konishi T, Shimada Y, Hsu M, Wei IH, Pappou E, Smith JJ, Nash GM, Guillem JG, Paty PB, Garcia-Aguilar J, Cercek A, Yaeger R, Stadler ZK, Segal NH, Varghese A, Saltz LB, Shia J, Vakiani E, Gönen M, Weiser MR. Contemporary Validation of a Nomogram Predicting Colon Cancer Recurrence, Revealing All-Stage Improved Outcomes. JNCI Cancer Spectr 2019; 3:pkz015. [PMID: 31119207 PMCID: PMC6512350 DOI: 10.1093/jncics/pkz015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/28/2019] [Accepted: 03/21/2019] [Indexed: 12/23/2022] Open
Abstract
Background The Memorial Sloan Kettering Cancer Center (MSK) colon cancer recurrence nomogram is a risk calculator that provides patients and clinicians with individualized prediction of recurrence following curative resection of colon cancer. Although validated on multiple separate cohorts, the nomogram requires periodic updating as patient care changes over time. The aim of this study was to evaluate the nomogram’s accuracy in a contemporary cohort and modify the tool to reflect improvements in outcome related to advances in colon cancer therapy. Methods A contemporary patient cohort was compiled, including consecutive colon cancer patients undergoing curative resection for stage I–III colon adenocarcinoma at MSK from 2007 to 2014. The nomogram’s predictive accuracy was assessed by concordance index and calibration plots of predicted vs actual freedom from recurrence at 5 years after surgery. Results Data from a total of 999 eligible patients with complete records were used for validation. Median follow-up among survivors was 37 months. The concordance index was 0.756 (95% confidence interval = 0.707 to 0.805), indicating continued discriminating power, but the calibration plot revealed that the nomogram overestimated recurrence risk. Recalibration of the nomogram by estimating a new baseline freedom-from-recurrence function restored the nomogram’s accuracy. Conclusion The updated nomogram retains the original nomogram’s variables but includes a lower baseline estimation of recurrence risk, reflecting improvements in outcomes for all stages of colon cancer, likely resulting from advances in imaging and integration of multiple treatment modalities.
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Affiliation(s)
- Tsuyoshi Konishi
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshifumi Shimada
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY.,Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Iris H Wei
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emmanouil Pappou
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Joshua Smith
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Garrett M Nash
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| | - José G Guillem
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Philip B Paty
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zsofia K Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil H Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anna Varghese
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leonard B Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin R Weiser
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
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2
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Simulated Dose Reduction for Abdominal CT With Filtered Back Projection Technique: Effect on Liver Lesion Detection and Characterization. AJR Am J Roentgenol 2019; 212:84-93. [DOI: 10.2214/ajr.17.19441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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3
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Muenzel D, Daerr H, Proksa R, Fingerle AA, Kopp FK, Douek P, Herzen J, Pfeiffer F, Rummeny EJ, Noël PB. Simultaneous dual-contrast multi-phase liver imaging using spectral photon-counting computed tomography: a proof-of-concept study. Eur Radiol Exp 2017; 1:25. [PMID: 29708205 PMCID: PMC5909366 DOI: 10.1186/s41747-017-0030-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 11/03/2017] [Indexed: 12/14/2022] Open
Abstract
Background To assess the feasibility of dual-contrast spectral photon-counting computed tomography (SPCCT) for liver imaging. Methods We present an SPCCT in-silico study for simultaneous mapping of the complementary distribution in the liver of two contrast agents (CAs) subsequently intravenously injected: a gadolinium-based contrast agent and an iodine-based contrast agent. Four types of simulated liver lesions with a characteristic arterial and portal venous pattern (haemangioma, hepatocellular carcinoma, cyst, and metastasis) are presented. A material decomposition was performed to reconstruct quantitative iodine and gadolinium maps. Finally, a multi-dimensional classification algorithm for automatic lesion detection is presented. Results Our simulations showed that with a single-scan SPCCT and an adapted contrast injection protocol, it was possible to reconstruct contrast-enhanced images of the liver with arterial distribution of the iodine-based CA and portal venous phase of the gadolinium-based CA. The characteristic patterns of contrast enhancement were visible in all liver lesions. The approach allowed for an automatic detection and classification of liver lesions using a multi-dimensional analysis. Conclusions Dual-contrast SPCCT should be able to visualise the characteristic arterial and portal venous enhancement with a single scan, allowing for an automatic lesion detection and characterisation, with a reduced radiation exposure.
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Affiliation(s)
- Daniela Muenzel
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany
| | - Heiner Daerr
- 2Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Roland Proksa
- 2Philips GmbH Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Alexander A Fingerle
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany
| | - Felix K Kopp
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany
| | - Philippe Douek
- 3Department of Interventional Radiology and Cardio-vascular and Thoracic Diagnostic Imaging, Louis Pradel University Hospital, Bron, France
| | - Julia Herzen
- 4Chair of Biomedical Physics, Department of Physics and School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Franz Pfeiffer
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany.,4Chair of Biomedical Physics, Department of Physics and School of BioEngineering, Technical University of Munich, Garching, Germany.,5Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | - Ernst J Rummeny
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany
| | - Peter B Noël
- 1Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 München, Germany.,4Chair of Biomedical Physics, Department of Physics and School of BioEngineering, Technical University of Munich, Garching, Germany
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Cantisani V, Grazhdani H, Fioravanti C, Rosignuolo M, Calliada F, Messineo D, Bernieri MG, Redler A, Catalano C, D’Ambrosio F. Liver metastases: Contrast-enhanced ultrasound compared with computed tomography and magnetic resonance. World J Gastroenterol 2014; 20:9998-10007. [PMID: 25110428 PMCID: PMC4123379 DOI: 10.3748/wjg.v20.i29.9998] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/23/2013] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound (US) for several applications, especially for the detection of metastases. In particular, contrast enhanced ultrasonography (CEUS) allows the display of the parenchymal microvasculature, enabling the study and visualization of the enhancement patterns of liver lesions in real time and in a continuous manner in all vascular phases, which is similar to contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging. Clinical studies have reported that the use of a contrast agent enables the visualization of more metastases with significantly improved sensitivity and specificity compared to baseline-US. Furthermore, studies have shown that CEUS yields sensitivities comparable to CT. In this review, we describe the state of the art of CEUS for detecting colorectal liver metastases, the imaging features, the literature reports of metastases in CEUS as well as its technique, its clinical role and its potential applications. Additionally, the updated international consensus panel guidelines are reported in this review with the inherent limitations of this technique and best practice experiences.
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Larsen LPS. Role of contrast enhanced ultrasonography in the assessment of hepatic metastases: A review. World J Hepatol 2010; 2:8-15. [PMID: 21160951 PMCID: PMC2998950 DOI: 10.4254/wjh.v2.i1.8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 09/17/2009] [Accepted: 09/24/2009] [Indexed: 02/06/2023] Open
Abstract
Contrast enhanced ultrasonography (CEUS) has improved both the detection and characterization of focal liver lesions. It is now possible to evaluate in real time the perfusion of focal liver lesions in the arterial, portal and late contrast phases, and thus to characterize focal liver lesions with high diagnostic accuracy. As a result, CEUS has taken a central diagnostic role in the evaluation of focal liver lesions that are indeterminate upon computed tomography (CT) and magnetic resonance imaging. The combined use of second generation contrast agents and low mechanical index techniques is essential for the detection of liver metastases, and it now allows the examination of the entire liver in both the portal and late phases. Several studies have shown that using CEUS instead of conventional ultrasonography without contrast agents significantly improves sensitivity in detection of liver metastases. Furthermore, the detection rate with CEUS seems to be similar to that of CT. This review describes the clinical role of CEUS in detecting liver metastases, including details about examination techniques, features of metastases observed with CEUS, and clinical results and guidelines.
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Affiliation(s)
- Lars Peter Skovgaard Larsen
- Lars Peter Skovgaard Larsen, Department of Radiology, Aarhus University Hospital, Noerrebrogade 44, Aarhus 8000 C, Denmark
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Wicherts DA, de Haas RJ, van Kessel CS, Bisschops RHC, Takahara T, van Hillegersberg R, Bipat S, Rinkes IHMB, van Leeuwen MS. Incremental value of arterial and equilibrium phase compared to hepatic venous phase CT in the preoperative staging of colorectal liver metastases: an evaluation with different reference standards. Eur J Radiol 2009; 77:305-11. [PMID: 19695807 DOI: 10.1016/j.ejrad.2009.07.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 07/21/2009] [Accepted: 07/22/2009] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the incremental value of arterial and equilibrium phase compared to hepatic venous phase multidetector row CT (MDCT) in the preoperative staging of colorectal liver metastases (CLM) and to determine the influence of the reference standard. MATERIALS AND METHODS Fifty-three consecutive CLM patients underwent 16 detector row CT in hepatic arterial, venous, and equilibrium phase before surgery between March 2003 and January 2007. Detected lesions were characterized by three independent radiologists. The reference standard consisted of intraoperative palpation and ultrasound of the liver, and histopathological examination of the resected specimen. Additionally, data of follow-up CT was added. Statistical analysis was performed on a per-lesion basis. RESULTS According to the reference standard 251 lesions were present, of which 203 (81%) were malignant (mean size: 29.4 ± 22.5 mm), and 41 (16%) were benign (mean size: 8.3 ± 7.7 mm). Sensitivity rates for CLM were comparable between triphasic and hepatic venous phase CT (P>0.05). Sensitivity for the detection of CLM lowered from 60-77% to 52-68% when follow-up CT was added to the reference standard. CONCLUSION Arterial and equilibrium phase CT have no incremental value compared to hepatic venous phase MDCT in the detection of CLM. Sensitivity rates are, however, influenced by the type of reference standard used.
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Affiliation(s)
- Dennis A Wicherts
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Pauls S, Gabelmann A, Heinz W, Fröhlich E, Juchems MS, Brambs HJ, Schmidt SA. Liver perfusion with dynamic multidetector-row computed tomography as an objective method to evaluate the efficacy of chemotherapy in patients with colorectal cancer. Clin Imaging 2009; 33:289-94. [DOI: 10.1016/j.clinimag.2008.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 10/08/2008] [Indexed: 12/27/2022]
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Konopke R, Bunk A, Kersting S. The role of contrast-enhanced ultrasound for focal liver lesion detection: an overview. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1515-26. [PMID: 17618038 DOI: 10.1016/j.ultrasmedbio.2007.04.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 02/21/2007] [Accepted: 04/18/2007] [Indexed: 05/16/2023]
Abstract
The development of new ultrasound (US) contrast agents and sonographic techniques has considerably improved the possibilities of ultrasound in the assessment of liver tumors. An overview is given on diagnostic potential of contrast-enhanced US (CEUS) and real-time low mechanical index technique in the detection of various focal liver lesions compared with computed tomography, magnetic resonance imaging or intraoperative US. In two of our own studies that included 100 patients each we showed an increase of correct findings in CEUS compared with B-mode US from 64% to 87% and from 67% to 84% as confirmed by intraoperative evaluation of the liver. Especially after chemotherapy and in the case of small metastases, significantly more metastases were correctly detected by CEUS compared with B-mode US. These results and clinical study results in the literature show that CEUS allows tumor detection and direct visualization of the tumor vascularity and put contrast-enhanced sonography among recommended noninvasive imaging methods for focal liver lesions with improvements in diagnostic strategy.
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Affiliation(s)
- R Konopke
- Department of Visceral, Thoracic, and Vascular Surgery, Carl Gustav Carus University Hospital, Dresden University of Technology, Dresden, Germany
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