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Park K, Kwon JY, Song JM, Pyeon SY, Lee SH, Chung YS, Lee JM. Prognostic impact of suspicious extraabdominal lymph nodes on patient survival in advanced ovarian cancer. PLoS One 2024; 19:e0299205. [PMID: 38805507 PMCID: PMC11132458 DOI: 10.1371/journal.pone.0299205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/07/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To evaluate the clinical impact of suspicious extra-abdominal lymph nodes (EALNs) identified preoperatively on CT and/or PET/CT images in advanced ovarian cancer. METHODS A retrospective study was conducted with 122 patients diagnosed with stage III or IV ovarian cancer with preoperative CT and/or PET/CT images from 2006 to 2022. Imaging studies were evaluated for the presence, size and location of suspicious EALNs. Suspicious lymph node enlargement was defined by a cut-off ≥5mm short-axis dimension on CT and/or lesions with maximum standardized uptake values of ≥2.5 on PET/CT. This study only included patients who did not have their EALNs surgically removed. RESULTS A total 109 patients met the inclusion criteria; 36 (33%) had suspicious EALNs and were categorized as "node-positive". The median overall survival (OS) was 45.73 months for the "node-positive" and 46.50 months for the "node-negative" patients (HR 1.17, 95% CI 0.68-2.00, p = 0.579). In multivariate analysis, after adjusting for other variables selected by process of backward elimination using a significance level of p<0.20, suspicious EALNs still showed no clinical significance on OS (aHR 1.20, 95% CI 0.67-2.13, p = 0.537) as well as progression-free survival (aHR 1.43, 95% CI 0.85-2.41, p = 0.174). Old age (aHR 2.23, 95% CI 1.28-3.89, p = 0.005) and platinum resistance (aHR 1.92, 95% CI 1.10-3.36, p = 0.023) affects adversely on OS. CONCLUSION Suspicious EALNs did not worsen the prognosis of patients with advanced ovarian cancer. However, its impact on survival is not yet clarified. Further investigation is required to assess the clinical significance of suspicious EALNs on preoperative imaging studies.
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Affiliation(s)
- Kena Park
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Department of Medicine, Graduate School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ji Young Kwon
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Department of Medicine, Graduate School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jeong Min Song
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Department of Medicine, Graduate School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung Yeon Pyeon
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Seon Hwa Lee
- Research Institute of Clinical Medicine, Medical Big Data Research Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Young Shin Chung
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jong-Min Lee
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Sørensen SM, Høgdall C, Mosgaard BJ, Dalgaard MIR, Jensen MP, Fuglsang K, Schnack TH. Residual tumor and primary debulking surgery vs interval debulking surgery in stage IV epithelial ovarian cancer. Acta Obstet Gynecol Scand 2022; 101:334-343. [PMID: 35187660 DOI: 10.1111/aogs.14319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION It is debated whether women with FIGO (International Federation of Gynecology and Obstetrics) Stage IV epithelial ovarian cancer should be offered primary debulking surgery (PDS) or interval debulking surgery (IDS). Furthermore, the impact of complete resection of intra-abdominal disease (R0) despite their extra-abdominal metastases is questioned. The objective of this study was to investigate the impact of intra-abdominal residual tumor, Stage IVA vs IVB, the localization and number of metastases defining Stage IV disease on overall survival (OS) comparing PDS and IDS in FIGO Stage IV epithelial ovarian cancer. MATERIAL AND METHODS We included 2091 women registered with Stage IIIC-IV ovarian cancer in the Danish Gynecological Cancer Database during 2009-2016. The impact of residual tumor was evaluated using univariate and multivariate analyses. RESULTS In total, 681 patients had stage IV disease, of whom 26% underwent PDS, 38% IDS, and 36% chemotherapy only. Overall survival for PDS and IDS were similar. Patients achieving R0 at PDS showed a tendency towards a higher OS than patients achieving R0 at IDS, though the difference was non-significant. In women with Stage IVA and IVB disease there was a survival benefit in achieving R0 both when treated with PDS and IDS. Women with Stage IVB disease treated with chemotherapy only had a significantly lower OS than patients achieving R0 at both PDS and IDS. Malignant pleural effusion and having five metastatic sites compared with having one was associated with a poorer OS. CONCLUSIONS Our study shows similar OS in patients with Stage IV disease treated with IDS compared with PDS. Complete intra-abdominal tumor resection improves the prognosis in both PDS and IDS in Stage IV ovarian cancer. Malignant pleural effusion seems to be a negative prognostic factor and should have more focus in future studies.
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Affiliation(s)
- Sarah Mejer Sørensen
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Claus Høgdall
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Berit Jul Mosgaard
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mai Partridge Jensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Katrine Fuglsang
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Tine Henrichsen Schnack
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
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Yang Y, Du J, Wang YS, Kang HY, Zhai K, Shi HZ. Prognostic Impact of Pleural Effusion in Patients with Malignancy: A Systematic Review and Meta-Analysis. Clin Transl Sci 2022; 15:1340-1354. [PMID: 35212454 PMCID: PMC9199884 DOI: 10.1111/cts.13260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/23/2022] [Accepted: 01/30/2022] [Indexed: 11/26/2022] Open
Abstract
The exact role of pleural effusion in the prognosis of cancer patients remains unclear. We aimed to systematically review the prognostic value of pleural effusion in patients with cancer. We performed a systematic review and meta‐analysis with a systematic literature search. All cohort studies with available overall survival (OS) and progression‐free survival (PFS) results for patients with cancer with or without pleural effusion were included. The Mantel–Haenszel method was used to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Heterogeneity and publication bias were examined. Subgroup analysis and sensitivity analysis were performed. A total of 47 studies with 146,117 patients were included in the analysis. For OS, pleural effusion was a prognostic factor associated with a poor prognosis for patients with cancer (HR, 1.58, 95% CI, 1.43–1.75; I2 94.8%). In the subgroup analysis, pleural effusion was a prognostic factor associated with poor survival for patients with lung cancer (HR, 1.44, 95% CI, 1.35–1.54; I2 60.8%), hematological cancer (HR, 2.79, 95% CI, 1.63–4.77; I2 29.4%) and other types of cancer (HR, 2.08, 95% CI, 1.43–3.01; I2 55.1%). For PFS, pleural effusion was a prognostic factor associated with a poor prognosis for patients with cancer (HR, 1.61, 95% CI, 1.28–2.03; I2 42.9%). We also observed that massive pleural effusion was a prognostic factor associated with a poorer prognosis compared to minimal pleural effusion. Pleural effusion had prognostic value in both OS and PFS of patients with cancer, except for patients with malignant pleural mesothelioma, regardless of whether the malignant effusion was confirmed histologically or cytologically. However, future evidence of other pleural effusion characteristics is still needed.
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Affiliation(s)
- Yuan Yang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Juan Du
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yi-Shan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Han-YuJie Kang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Kan Zhai
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
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Yan G, Li H, Bhetuwal A, McClure MA, Li Y, Yang G, Li Y, Zhao L, Fan X. Pleural effusion volume in patients with acute pancreatitis: a retrospective study from three acute pancreatitis centers. Ann Med 2021; 53:2003-2018. [PMID: 34727802 PMCID: PMC8567956 DOI: 10.1080/07853890.2021.1998594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/19/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the value of pleural effusion volume (PEV) quantified on chest computed tomography (CT) in patients with early stage acute pancreatitis (AP). METHODS Data of PEV, and C-reactive protein (CRP) levels as well as Ranson, bedside index of severity in acute pancreatitis (BISAP), Marshall, acute physiology and chronic health evaluation II (APACHE II), CT severity index (CTSI), and extra-pancreatic inflammation on computed tomography (EPIC) scores in patients with AP were collected. Duration of hospitalization, severity of AP, infection, procedure, intensive care unit (ICU) admission, organ failure, or death were included as the outcome parameters. RESULTS In 465 patients, the mean PEV was 98.8 ± 113.2 mL. PEV showed strong and significant correlations with the CRP levels, duration of hospitalization as well as the Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC scores (p < .05). PEV demonstrated significant accuracy in predicting severity, infection, procedure, ICU admission, organ failure, and death (p < .05). CONCLUSION PEV quantified on chest CT positively associated with the duration of hospitalization, CRP levels, Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC scores. It can be a reliable radiologic biomarker in predicting severity and clinical outcomes of AP.KEY MESSAGESPleural effusion is a common chest finding in patients with acute pancreatitis.Pleural effusion volume quantified on chest CT examination positively associated with the duration of hospitalization, CRP level, as well as Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC scoring systems.Pleural effusion volume can be a reliable radiologic biomarker in the prediction of severity and clinical outcomes of acute pancreatitis.
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Affiliation(s)
- Gaowu Yan
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Hongwei Li
- Department of Radiology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Anup Bhetuwal
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Morgan A. McClure
- Department of Radiology and Imaging, Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoqing Yang
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Yong Li
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Linwei Zhao
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Xiaoping Fan
- Department of Radiology, Suining Central Hospital, Suining, China
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Perlepe G, Varsamas C, Petinaki E, Antonopoulos D, Daniil Z, Gourgoulianis KI. Discrimination of Exudative Pleural Effusions Based on Pleural Adenosine Deaminase (ADA)-C-Reactive Protein (CRP) Levels, and Their Combination: An Observational Prospective Study. J Pers Med 2021; 11:jpm11090864. [PMID: 34575641 PMCID: PMC8468238 DOI: 10.3390/jpm11090864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Malignant (MPE), parapneumonic (PPE) and tuberculous (TPE) pleural effusions constitute common causes of pleurisy. Discriminating among them is usually challenging. C-reactive protein (CRP) and adenosine deaminase (ADA) pleural levels (p-CRP, p-ADA) have been used as differentiators in many studies showing promising results. This study aims to evaluate the diagnostic value of p-CRP, p-ADA levels and their combination among the three categories. (2) Methods: A prospective study of 100 patients with MPE (n = 59), PPE (n = 34) and TPE (n = 7) from a single centre was performed. p-CRP levels were evaluated between PPE and non-PPE and between complicated (CPPE) and non-complicated PPE. ADA levels were also measured to classify patients among MPE and non- MPE. Eventually, the combination of p-CRP and p-ADA values was used as a discrimination factor among PPE, MPE and TPE. (3) Results: ROC analysis revealed that p-CRP with a cut-off value: 4.4 mg/dL can successfully differentiate PPE (AUC = 0.998). The cut-off level of 10 mg/dL can predict CPPE with sensitivity: 63%, specificity: 71.4%, positive predictive value (PPV): 89%, and negative predictive value (NPV): 33%. Furthermore, patients with ADA levels ≤ 32 U/L were more likely to belong to the malignant group sensitivity: 93%, specificity: 78%, PPV: 85.9%, and NPV: 88.9%. Discriminant analysis showed that the combination of p-CRP and p-ADA levels can discriminate PPE, MPE and TPE in 93% of cases. (4) Conclusion: This study provides evidence that p-CRP and p-ADA levels could be possibly used in clinal practice in order to establish a diagnosis among MPE, PPE and TPE.
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Affiliation(s)
- Garifallia Perlepe
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece; (C.V.); (Z.D.); (K.I.G.)
- Correspondence: ; Tel.: +30-2413501613
| | - Charalampos Varsamas
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece; (C.V.); (Z.D.); (K.I.G.)
| | - Efthymia Petinaki
- Department of Microbiology, University Hospital of Larissa, 41110 Larissa, Greece;
| | - Dionysios Antonopoulos
- Department of Biochemistry and Biotechnology, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece;
| | - Zoe Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece; (C.V.); (Z.D.); (K.I.G.)
| | - Konstantinos I. Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece; (C.V.); (Z.D.); (K.I.G.)
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Porcel JM, Murata P, Porcel L, Bielsa S, Pardina M, Salud A. Prevalence, clinical characteristics, and outcome of pleural effusions in ovarian cancer. Pleura Peritoneum 2021; 6:75-81. [PMID: 34179341 PMCID: PMC8216844 DOI: 10.1515/pp-2020-0152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/18/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives The prevalence, clinical characteristics and prognosis of pleural effusions (PEs) associated with ovarian cancer (OC) have seldom been addressed systematically, as in the current investigation. Methods All records of consecutive women with a newly diagnosed OC in our institution over a 13-year period were retrospectively reviewed. Features of PEs on CT scans, pleural fluid analyses, need for definitive therapy of PEs, and the influence of PEs on the overall survival (OS) and progression-free survival (PFS) were evaluated. Results PEs were observed in 81 (43%) of 189 women with OC, either at presentation of cancer (55 patients) or during the course of the disease (26 patients). The causes of PEs were malignancy (55.5%), unknown (37%), or surgery-related (7.4%). The sensitivity of the cytologic diagnosis of malignant PEs was 79.1%. Sixty percent of malignant PEs required pleurodesis or indwelling pleural catheters for symptomatic relief. The presence of ascites strongly predicted PE development (odds ratio 43.2). Women with PEs fared much worse compared with those without PEs, in terms of OS (26.7 vs. 90.4 months), PFS (9.8 vs. 55.3 months) and tumor recurrences (86.4 vs. 43%). In multivariate analyses, PE remained as a relevant independent variable associated with poor outcome (hazard ratio 9.73 for OS, and 3.87 for PFS). Notably, PEs small enough to preclude tapping, and thus of unknown origin, had a similar bad prognosis as malignant PEs. Conclusions OC patients with PEs experience decreased survival, including those with trace effusions not amenable to tapping.
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Affiliation(s)
- José M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Hospital Universitari Arnau de Vilanova, IRBLleida, University of Lleida, Lleida, Spain
| | - Paola Murata
- Department of Medical Oncology, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Laura Porcel
- Department of Internal Medicine, Hospital Universitario Principe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Silvia Bielsa
- Pleural Medicine Unit, Department of Internal Medicine, Hospital Universitari Arnau de Vilanova, IRBLleida, University of Lleida, Lleida, Spain
| | - Marina Pardina
- Department of Radiology, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Antonieta Salud
- Department of Medical Oncology, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
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Boerner T, Filippova OT, Chi AJ, Iasonos A, Zhou QC, Long Roche K, Zivanovic O, Park BJ, Huang J, Jones DR, Abu-Rustum NR, Gardner G, Sonoda Y, Chi DS. Video-assisted thoracic surgery in the primary management of advanced ovarian carcinoma with moderate to large pleural effusions: A Memorial Sloan Kettering Cancer Center Team Ovary Study. Gynecol Oncol 2020; 159:66-71. [PMID: 32792282 DOI: 10.1016/j.ygyno.2020.07.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We assessed the utility of video-assisted thoracic surgery (VATS) in defining extent of intrathoracic disease in advanced ovarian carcinoma with moderate-to-large pleural effusions. METHODS Beginning in 2001, VATS was performed on all patients with suspected advanced ovarian carcinoma and moderate-to-large pleural effusions, evaluating for macroscopic intrathoracic disease. The algorithm recommended primary debulking surgery (PDS) for ≤1 cm, neoadjuvant chemotherapy (NACT)/interval debulking surgery (IDS) for >1 cm intrathoracic disease. We reviewed records of patients undergoing VATS from 10/01-01/19. Differences between treatment groups were tested using standard statistical techniques. RESULTS One-hundred patients met eligibility criteria (median age, 60; median CA-125 level, 1158 U/mL; medium serum albumin, 3.8 g/dL). Macroscopic pleural disease was found in 70 (70%). After VATS, 50 (50%) underwent attempted PDS (PDS group), 50 (50%) received NACT (NACT/IDS group). Forty-seven (94%) underwent IDS. Median overall survival (OS) for the entire cohort (n = 100) was 44.5 months (95% CI: 37.8-51.7). The PDS group had significantly longer survival than the NACT/IDS group [45.8 (95% CI: 40.5-87.8) vs. 37.4 months (95% CI: 33.3-45.2); p = .016]. On multivariable analysis, macroscopic intrathoracic disease (HR 2.18, 95% CI: 1.14-4.18; p = .019) and age ≥ 65 (HR 1.98, 95% CI: 1.16-3.40; p = .013) were independently associated with elevated death risk. Patients with the best outcome had no macroscopic disease at VATS and underwent PDS (median OS, 87.8 months). CONCLUSIONS VATS is useful in therapeutic decision-making for PDS vs. NACT/IDS in advanced ovarian cancer with moderate-to-large pleural effusions.
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Affiliation(s)
- Thomas Boerner
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Olga T Filippova
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andrew J Chi
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qin C Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Bernard J Park
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - James Huang
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA; Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Ginger Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA.
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Peng R, Zhang L, Zhang ZM, Wang ZQ, Liu GY, Zhang XM. Chest computed tomography semi-quantitative pleural effusion and pulmonary consolidation are early predictors of acute pancreatitis severity. Quant Imaging Med Surg 2020; 10:451-463. [PMID: 32190570 DOI: 10.21037/qims.2019.12.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background To study the predictive value of semi-quantitative pleural effusion and pulmonary consolidation for acute pancreatitis (AP) severity. Methods Thorax-abdominal computed tomography (CT) examinations were performed on 309 consecutive AP patients in a single center. Among them, 196 were male, and 113 were female, and the average age was 50±16 years. The etiology of AP was biliary in 43.7% (n=135), hyperlipidemia in 22.0% (n=68), alcoholic in 7.4% (n=23), trauma in 0.6% (n=2), and postoperative status in 1.6% (n=5) cases; 24.6% (n=76) of patients did not have specified etiologies. The prevalence of pleural effusion and pulmonary consolidation was noted. The pleural effusion volume was quantitatively derived from a CT volume evaluation software tool. The pulmonary consolidation score was based on the number of lobes involved in AP. Each patient's CT severity index (CTSI), acute physiology and chronic health evaluation II (APACHE II) scoring system, and bedside index for severity in acute pancreatitis (BISAP) scores were obtained. The semi-quantitative pleural effusion and pulmonary consolidation were compared to these scores and clinical outcomes by receiver operator characteristic (ROC) curve and area under the curve (AUC) analysis. Results In the 309 patients, 39.8% had pleural effusion, and 47.9% had pulmonary consolidation. The mean pleural effusion volume was 41.7±38.0 mL. The mean pulmonary consolidation score was 1.0±1.2 points. The mean CTSI was 3.7±1.8 points, the mean APACHE II score was 5.8±5.1 points, and the mean BISAP score was 1.3±1.0 points; 5.5% of patients developed severe AP, and 13.9% of patients developed organ failure. Pleural effusion volume and pulmonary consolidation scores correlated to the scores for the severity of AP. In predicting severe AP, the accuracy (AUC 0.839) of pleural effusion volume was similar to that of the CTSI score (P=0.961), APACHE II score (P=0.757), and BISAP score (P=0.906). The accuracy (AUC 0.805) of the pulmonary consolidation score was also similar to that of the CTSI score (P=0.503), APACHE II score (P=0.343), and BISAP score (P=0.669). In predicting organ failure, the accuracy (AUC 0.783) of pleural effusion volume was similar to that of the CTSI score (P=0.473), APACHE II score (P=0.119), and BISAP score (P=0.980), and the accuracy (AUC 0.808) of the pulmonary consolidation score was also similar to that of the CTSI score (P=0.236), APACHE II score (P=0.293), and BISAP score (P=0.612). Conclusions Pleural effusion and pulmonary consolidation are common in AP and correlated to the severity of AP. Furthermore, the pleural effusion volume and pulmonary consolidation lobes can provide early prediction of severe AP and organ failure.
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Affiliation(s)
- Rong Peng
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Panzhihua 617000, China
| | - Ling Zhang
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Panzhihua 617000, China
| | - Ze-Ming Zhang
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Panzhihua 617000, China
| | - Zhi-Qing Wang
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Panzhihua 617000, China
| | - Guang-Yu Liu
- Department of Radiology, Medical Imaging Center, Panzhihua Central Hospital, Panzhihua 617000, China
| | - Xiao-Ming Zhang
- Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
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Clinical characteristics that portend a positive Xpert Ultra test result in patients with pleural tuberculosis. Afr J Thorac Crit Care Med 2019; 25:10.7196/AJTCCM.2019.v25i2.011. [PMID: 34286247 PMCID: PMC8278986 DOI: 10.7196/ajtccm.2019.v25i2.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The performance of Xpert-MTB/RIF, including the newer Xpert Ultra test, for the diagnosis of pleural TB is poor (~28 - 38%). There are no data on patient characteristics that portend a positive Xpert-Ultra test in pleural fluid. These characteristics could be useful for selecting patients for Xpert-Ultra testing, thus maximising benefits of a positive test, while minimising cost. OBJECTIVES To determine the clinical, radiological, microbiological and biochemical characteristics associated with Xpert-Ultra positivity in patients with suspected pleural tuberculosis. METHODS We performed a subgroup analysis of a prospective observational cohort (N=165 patients with suspected pleural TB) evaluating same-day diagnostic tools for pleural tuberculosis. Forty-nine patients with confirmed pleural tuberculosis (culture and/or histology) were included in the final analysis. RESULTS Of the 49 participants, 17 (35%) were female and 9 (18.4%) were HIV-infected. In the multivariate analysis including demographic, radiological and pleural fluid test characteristics, there were no independent predictors of Xpert-Ultra positivity. However, when pleural fluid test results were excluded, and when only rapidly ascertainable pre-test factors (demographic and radiologic variables) were considered, the multivariable analysis showed that only a chest X-ray (CXR) suggestive of active TB (cavities, consolidation and hilar lymphadenopathy) was associated with Xpert-Ultra positivity (p=0.021). Notably, only 22% (n=11/49) of the participants had a CXR suggestive of active TB and of these, 73% (n=8/11) had a positive Xpert-Ultra result. CONCLUSION CXR features suggestive of active TB are significantly associated with a positive Xpert-Ultra test result on pleural fluid. These data inform clinical practice in resource-poor settings.
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10
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Kang SK, Reinhold C, Atri M, Benson CB, Bhosale PR, Jhingran A, Lakhman Y, Maturen KE, Nicola R, Pandharipande PV, Salazar GM, Shipp TD, Simpson L, Small W, Sussman BL, Uyeda JW, Wall DJ, Whitcomb BP, Zelop CM, Glanc P. ACR Appropriateness Criteria ® Staging and Follow-Up of Ovarian Cancer. J Am Coll Radiol 2019; 15:S198-S207. [PMID: 29724422 DOI: 10.1016/j.jacr.2018.03.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/12/2022]
Abstract
In the management of epithelial ovarian cancers, imaging is used for cancer detection and staging, both before and after initial treatment. The decision of whether to pursue initial cytoreductive surgery for ovarian cancer depends in part on accurate staging. Contrast-enhanced CT of the abdomen and pelvis (and chest where indicated) is the current imaging modality of choice for the initial staging evaluation of ovarian cancer. Fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT and MRI may be appropriate for problem-solving purposes, particularly when lesions are present on CT but considered indeterminate. In patients who achieve remission, clinical suspicion for relapse after treatment prompts imaging evaluation for recurrence. Contrast-enhanced CT is the modality of choice to assess the extent of recurrent disease, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT is also usually appropriate, as small metastatic foci may be identified. If imaging or clinical examination confirms a recurrence, the extent of disease and timing of disease recurrence then determines the choice of treatments, including surgery, chemotherapy, and radiation therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Stella K Kang
- Principal Author, New York University Medical Center, New York, New York.
| | | | - Mostafa Atri
- Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | - Anuja Jhingran
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Refky Nicola
- State University of New York Upstate Medical University, Syracuse, New York
| | | | | | - Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American Congress of Obstetricians and Gynecologists
| | - Lynn Simpson
- Columbia University, New York, New York; American Congress of Obstetricians and Gynecologists
| | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | | | | | - Bradford P Whitcomb
- Tripler Army Medical Center, Honolulu, Hawaii; Society of Gynecologic Oncology
| | - Carolyn M Zelop
- Valley Hospital, Ridgewood, New Jersey, and NYU School of Medicine, New York, New York; American Congress of Obstetricians and Gynecologists
| | - Phyllis Glanc
- Specialty Chair, Sunnybrook Health Sciences Centre Bayview Campus, Toronto, Ontario, Canada
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11
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Sahdev A. CT in ovarian cancer staging: how to review and report with emphasis on abdominal and pelvic disease for surgical planning. Cancer Imaging 2016; 16:19. [PMID: 27484100 PMCID: PMC4971689 DOI: 10.1186/s40644-016-0076-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/27/2016] [Indexed: 11/10/2022] Open
Abstract
CT of the abdomen and pelvis is the first line imaging modality for staging, selecting treatment options and assessing disease response in ovarian cancer. The staging CT provides disease distribution, disease burden and is the imaging surrogate for surgico-pathological FIGO staging. Optimal cyto-reductive surgery offers patients’ the best chance for disease control or cure, but sub-optimal resection confers no advantage over chemotherapy and adversely increases the risk of post surgical complications. Although there is extensive literature comparing performance of CT against laparoscopy and surgery, for the staging abdominal and pelvic CT, there are currently no accepted guidelines for interpretation or routinely used minimum data set templates for reporting these complex CT scans often with extensive radiological findings. This review provides a systematic approach for identifying the important radiological findings and highlighting important sites of disease within the abdomen and pelvis, which may alter or preclude surgery at presentation or after adjuvant chemotherapy. The distribution of sites and volume of disease can be used to categorize patients as suitable, probably suitable or not suitable for optimal cyto-reductive surgery. This categorization can potentially assist oncological surgeons and oncologists as a semi objective assessment tool useful for selecting patient treatment, streamlining multi disciplinary discussion and improving the reproducibility and correlation of CT with surgical findings. The review also highlights sites of disease and complications of ovarian cancer which should be included as part of the radiological report as these may require additional surgical input from non gynaecological surgeons or influence treatment selection.
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Affiliation(s)
- Anju Sahdev
- St Bartholomew's Hospital, Barts Health, West Smithfield, London, EC1A 7BE, UK.
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12
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Role of Video-Assisted Thoracoscopy in Advanced Ovarian Cancer: A Literature Review. Int J Gynecol Cancer 2016; 26:801-6. [DOI: 10.1097/igc.0000000000000680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AbstractTools that accurately predict the presence of metastatic ovarian cancer in the pleura are limited. Thus, we sought to summarize the current literature on video-assisted thoracoscopic surgery (VATS) and its applicability in patients with advanced ovarian cancer. A total of 187 patients with suspected ovarian cancer who underwent the VATS procedure were identified for this analysis. The median patient age was 59.4 years (range, 20.3–83 years). The median operative time for VATS was 32 minutes (range, 5–65 minutes). In 89 patients (48%), VATS revealed macroscopic disease in the pleural cavity. After VATS, 44 patients underwent neoadjuvant chemotherapy, and the remaining 143 patients underwent primary cytoreductive surgery. Video-assisted thoracoscopic surgery led to a change in disease stage or management in 76 patients (41%). Among patients with pleural effusions, VATS revealed pleural disease in 57% of patients, and 73% of patients with positive pleural cytology had evidence of pleural disease at the time of VATS. In addition, 23.5% of patients with negative pleural cytology had evidence of pleural disease at the time of VATS. Prospective trials are needed to accurately evaluate the impact of VATS on disease-free and overall survival in patients with advanced ovarian cancer. Video-assisted thoracoscopic surgery can help determine which patients are ideal candidates for surgical cytoreduction.
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13
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Abstract
This review will make familiar with new concepts in ovarian cancer and their impact on radiological practice. Disseminated peritoneal spread and ascites are typical of the most common (70-80 %) cancer type, high-grade serous ovarian cancer. Other cancer subtypes differ in origin, precursors, and imaging features. Expert sonography allows excellent risk assessment in adnexal masses. Owing to its high specificity, complementary MRI improves characterization of indeterminate lesions. Major changes in the new FIGO staging classification include fusion of fallopian tube and primary ovarian cancer and the subcategory stage IIIA1 for retroperitoneal lymph node metastases only. Inguinal lymph nodes, cardiophrenic lymph nodes, and umbilical metastases are classified as distant metastases (stage IVB). In multidisciplinary conferences (MDC), CT has been used to predict the success of cytoreductive surgery. Resectability criteria have to be specified and agreed on in MDC. Limitations in detection of metastases may be overcome using advanced MRI techniques.
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Affiliation(s)
- Rosemarie Forstner
- />Department of Radiology, Landeskliniken Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020 Salzburg, Austria
| | - Matthias Meissnitzer
- />Department of Radiology, Landeskliniken Salzburg, Paracelsus Medical University, Müllner Hauptstr. 48, 5020 Salzburg, Austria
| | - Teresa Margarida Cunha
- />Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisbon, Portugal
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14
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Abstract
While there is an ongoing debate regarding the timing of the maximal surgical effort in epithelial ovarian cancer, it is well established that patients with suboptimal tumor debulking derive no benefit from the surgical procedure. The amount of residual disease after cytoreductive surgery has been repeatedly identified as a strong predictor of survival, and accordingly, the surgical effort to achieve the goal of complete gross tumor resection has been constantly evolving. Centers that have adopted the concept of radical surgery in patients with advanced ovarian cancer have reported improvements in their patients' survival. In addition to the expected improvements in the pharmacologic treatment of this disease, some of the next challenges in the surgical management of ovarian cancer include the preoperative prediction of suboptimal debulking, improving the drug delivery to the tumor, and increasing access to centers of excellence in ovarian cancer regardless of geographical, financial, or other social barriers. This review will discuss an update on the role of surgery in the treatment of primary epithelial ovarian cancer as it has evolved since the emergence of the concept of surgical cytoreduction.
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15
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Chiao D, Hanley M, Olazagasti JM. CT volumetric analysis of pleural effusions: a comparison with thoracentesis volumes. Acad Radiol 2015; 22:1122-7. [PMID: 26112055 DOI: 10.1016/j.acra.2015.03.015] [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: 10/20/2014] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES The primary objective of this study was to compare computed tomography (CT) volumetric analysis of pleural effusions with thoracentesis volumes. The secondary objective of this study was to compare subjective grading of pleural effusion size with thoracentesis volumes. MATERIALS AND METHODS This was a retrospective study of 67 patients with free-flowing pleural effusions who underwent therapeutic thoracentesis. CT volumetric analysis was performed on all patients; the CT volumes were compared with the thoracentesis volumes. In addition, the subjective grading of pleural effusion size was compared with the thoracentesis volumes. RESULTS The average difference between CT volume and thoracentesis volume was 9.4 mL (1.3%) ± 290 mL (30%); these volumes were not statistically different (P = .79, paired two-tailed Student's t-test). The thoracentesis volume of a "small," "moderate," and "large" pleural effusion, as graded on chest CT, was found to be approximately 410 ± 260 cc, 770 ± 270 mL and 1370 ± 650 mL, respectively; the thoracentesis volume of a "small," "moderate," and "large" pleural effusion, as graded on chest radiograph, was found to be approximately 610 ± 320 mL, 1040 ± 460 mL, and 1530 ± 830 mL, respectively. CONCLUSIONS CT volumetric analysis is an accessible tool that can be used to accurately quantify the size of pleural effusions.
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16
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Ryu JS, Lim JH, Lee JM, Kim WC, Lee KH, Memon A, Lee SK, Yi BR, Kim HJ, Hwang SS. Minimal Pleural Effusion in Small Cell Lung Cancer: Proportion, Mechanisms, and Prognostic Effect. Radiology 2015; 278:593-600. [PMID: 26323029 DOI: 10.1148/radiol.2015142388] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the frequency and investigate possible mechanisms and prognostic relevance of minimal (<10-mm thickness) pleural effusion in patients with small cell lung cancer (SCLC). MATERIALS AND METHODS The single-center retrospective study was approved by the institutional review board of the hospital, and informed consent was waived by the patients. A cohort of 360 consecutive patients diagnosed with SCLC by using histologic analysis was enrolled in this study. Based on the status of pleural effusion on chest computed tomographic (CT) scans at diagnosis, patients were classified into three groups: no pleural effusion, minimal pleural effusion, and malignant pleural effusion. Eighteen variables related to patient, environment, stage, and treatment were included in the final model as potential confounders. RESULTS Minimal pleural effusion was present in 74 patients (20.6%) and malignant pleural effusion in 83 patients (23.0%). Median survival was significantly different in patients with no, minimal, or malignant pleural effusion (median survival, 11.2, 5.93, and 4.83 months, respectively; P < .001, log-rank test). In the fully adjusted final model, patients with minimal pleural effusion had a significantly increased risk of death compared with those with no pleural effusion (adjusted hazard ratio, 1.454 [95% confidence interval: 1.012, 2.090]; P = .001). The prognostic effect was significant in patients with stage I-III disease (adjusted hazard ratio, 2.751 [95% confidence interval: 1.586, 4.773]; P < .001), but it disappeared in stage IV disease. An indirect mechanism representing mediastinal lymphadenopathy was responsible for the accumulation in all but one patient with minimal pleural effusion. CONCLUSIONS Minimal pleural effusion is a common clinical finding in staging SCLC. Its presence is associated with worse survival in patients and should be considered when CT scans are interpreted.
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Affiliation(s)
- Jeong-Seon Ryu
- From the Center for Lung Cancer, Inha University Hospital, Incheon, South Korea (J.S.R., J.H.L., J.M.L., A.M., S.K.L., B.R.Y., H.J.K.); and Departments of Internal Medicine (J.S.R., J.H.L., J.M.L.), Diagnostic Radiology (W.C.K., K.H.L.), and Social and Preventive Medicine (S.S.H.), Inha University College of Medicine, 27 Inhang-Ro, Jung Gu, Incheon 400-103, South Korea
| | - Jun Hyeok Lim
- From the Center for Lung Cancer, Inha University Hospital, Incheon, South Korea (J.S.R., J.H.L., J.M.L., A.M., S.K.L., B.R.Y., H.J.K.); and Departments of Internal Medicine (J.S.R., J.H.L., J.M.L.), Diagnostic Radiology (W.C.K., K.H.L.), and Social and Preventive Medicine (S.S.H.), Inha University College of Medicine, 27 Inhang-Ro, Jung Gu, Incheon 400-103, South Korea
| | - Jeong Min Lee
- From the Center for Lung Cancer, Inha University Hospital, Incheon, South Korea (J.S.R., J.H.L., J.M.L., A.M., S.K.L., B.R.Y., H.J.K.); and Departments of Internal Medicine (J.S.R., J.H.L., J.M.L.), Diagnostic Radiology (W.C.K., K.H.L.), and Social and Preventive Medicine (S.S.H.), Inha University College of Medicine, 27 Inhang-Ro, Jung Gu, Incheon 400-103, South Korea
| | - Woo Chul Kim
- From the Center for Lung Cancer, Inha University Hospital, Incheon, South Korea (J.S.R., J.H.L., J.M.L., A.M., S.K.L., B.R.Y., H.J.K.); and Departments of Internal Medicine (J.S.R., J.H.L., J.M.L.), Diagnostic Radiology (W.C.K., K.H.L.), and Social and Preventive Medicine (S.S.H.), Inha University College of Medicine, 27 Inhang-Ro, Jung Gu, Incheon 400-103, South Korea
| | - Kyung-Hee Lee
- From the Center for Lung Cancer, Inha University Hospital, Incheon, South Korea (J.S.R., J.H.L., J.M.L., A.M., S.K.L., B.R.Y., H.J.K.); and Departments of Internal Medicine (J.S.R., J.H.L., J.M.L.), Diagnostic Radiology (W.C.K., K.H.L.), and Social and Preventive Medicine (S.S.H.), Inha University College of Medicine, 27 Inhang-Ro, Jung Gu, Incheon 400-103, South Korea
| | - Azra Memon
- From the Center for Lung Cancer, Inha University Hospital, Incheon, South Korea (J.S.R., J.H.L., J.M.L., A.M., S.K.L., B.R.Y., H.J.K.); and Departments of Internal Medicine (J.S.R., J.H.L., J.M.L.), Diagnostic Radiology (W.C.K., K.H.L.), and Social and Preventive Medicine (S.S.H.), Inha University College of Medicine, 27 Inhang-Ro, Jung Gu, Incheon 400-103, South Korea
| | - Seul-Ki Lee
- From the Center for Lung Cancer, Inha University Hospital, Incheon, South Korea (J.S.R., J.H.L., J.M.L., A.M., S.K.L., B.R.Y., H.J.K.); and Departments of Internal Medicine (J.S.R., J.H.L., J.M.L.), Diagnostic Radiology (W.C.K., K.H.L.), and Social and Preventive Medicine (S.S.H.), Inha University College of Medicine, 27 Inhang-Ro, Jung Gu, Incheon 400-103, South Korea
| | - Bo-Rim Yi
- From the Center for Lung Cancer, Inha University Hospital, Incheon, South Korea (J.S.R., J.H.L., J.M.L., A.M., S.K.L., B.R.Y., H.J.K.); and Departments of Internal Medicine (J.S.R., J.H.L., J.M.L.), Diagnostic Radiology (W.C.K., K.H.L.), and Social and Preventive Medicine (S.S.H.), Inha University College of Medicine, 27 Inhang-Ro, Jung Gu, Incheon 400-103, South Korea
| | - Hyun-Jung Kim
- From the Center for Lung Cancer, Inha University Hospital, Incheon, South Korea (J.S.R., J.H.L., J.M.L., A.M., S.K.L., B.R.Y., H.J.K.); and Departments of Internal Medicine (J.S.R., J.H.L., J.M.L.), Diagnostic Radiology (W.C.K., K.H.L.), and Social and Preventive Medicine (S.S.H.), Inha University College of Medicine, 27 Inhang-Ro, Jung Gu, Incheon 400-103, South Korea
| | - Seung-Sik Hwang
- From the Center for Lung Cancer, Inha University Hospital, Incheon, South Korea (J.S.R., J.H.L., J.M.L., A.M., S.K.L., B.R.Y., H.J.K.); and Departments of Internal Medicine (J.S.R., J.H.L., J.M.L.), Diagnostic Radiology (W.C.K., K.H.L.), and Social and Preventive Medicine (S.S.H.), Inha University College of Medicine, 27 Inhang-Ro, Jung Gu, Incheon 400-103, South Korea
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17
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The impact of pleural disease on the management of advanced ovarian cancer. Gynecol Oncol 2015; 138:216-20. [PMID: 25969350 DOI: 10.1016/j.ygyno.2015.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/04/2015] [Indexed: 11/20/2022]
Abstract
Malignant pleural effusion is the most common site of stage IV ovarian cancer. A positive cytology is required for a stage IVA diagnosis. Unfortunately, the accuracy rate of pleural cytology remains low. A number of factors have been identified as prognostic for clinical outcomes in patients with epithelial ovarian cancer (EOC), the International Federation of Gynaecology and Obstetrics (FIGO) stage and residual tumor after debulking surgery being the most widely reported. Thereby careful selection of patients is crucially important, yet no preoperative predictor has proven sufficiently reliable to predict surgical outcome. The authors present a review of the literature on stage IV ovarian cancer specifically focusing on prognostic value of FIGO stage, preoperative workup, role of video-assisted thoracic surgery and maximal cytoreductive surgery.
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18
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Does a standardized preoperative algorithm of clinical data improve outcomes in patients with ovarian cancer? A quality improvement project. Int J Gynecol Cancer 2015; 25:798-801. [PMID: 25950127 DOI: 10.1097/igc.0000000000000433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the potential impact of a standardized preoperative algorithm on outcomes of patients with suspected ovarian cancer. METHODS From January 1 to December 31, 2013, patients with suspected ovarian cancer were triaged to primary debulking surgery or neoadjuvant chemotherapy/interval debulking surgery (NACT/IDS) based on a comprehensive review of preoperative clinical data as part of a quality improvement project. Demographics, surgical, and postoperative data were collected. RESULTS A total of 110 patients with newly diagnosed ovarian cancer were identified: 68 (62%) underwent PDS with an 85% optimal debulking rate. The 30-day readmission rate was 14.7% with a 2.9% 60-day mortality rate. Forty-two patients (38%) underwent NACT. Two patients (4.8%) died before receiving NACT. Thirty-five patients have undergone IDS with an 89% optimal debulking rate. The 30-day readmission rate was 8.5% with a 5.7% 60-day mortality rate after IDS. CONCLUSIONS Although it is difficult to predict which patients will undergo optimal debulking at the time of PDS, surgical morbidity and mortality can be decreased by using NACT in select patients. The initiation of a quality improvement project has contributed to an improvement in patient outcomes at our institution.
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Kurta ML, Edwards RP, Moysich KB, McDonough K, Bertolet M, Weissfeld JL, Catov JM, Modugno F, Bunker CH, Ness RB, Diergaarde B. Prognosis and conditional disease-free survival among patients with ovarian cancer. J Clin Oncol 2014; 32:4102-12. [PMID: 25403208 DOI: 10.1200/jco.2014.55.1713] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Traditional disease-free survival (DFS) does not reflect changes in prognosis over time. Conditional DFS accounts for elapsed time since achieving remission and may provide more relevant prognostic information for patients and clinicians. This study aimed to estimate conditional DFS among patients with ovarian cancer and to evaluate the impact of patient characteristics. PATIENTS AND METHODS Patients were recruited as part of the Hormones and Ovarian Cancer Prediction case-control study and were included in the current study if they had achieved remission after a diagnosis of cancer of the ovary, fallopian tube, or peritoneum (N = 404). Demographic and lifestyle information was collected at enrollment; disease, treatment, and outcome information was abstracted from medical records. DFS was calculated using the Kaplan-Meier method. Conditional DFS estimates were computed using cumulative DFS estimates. RESULTS Median DFS was 2.54 years (range, 0.03-9.96 years) and 3-year DFS was 48.2%. The probability of surviving an additional 3 years without recurrence, conditioned on having already survived 1, 2, 3, 4, and 5 years after remission, was 63.8%, 80.5%, 90.4%, 97.0%, and 97.7%, respectively. Initial differences in 3-year DFS at time of remission between age, stage, histology, and grade groups decreased over time. CONCLUSION DFS estimates for patients with ovarian cancer improved dramatically over time, in particular among those with poorer initial prognoses. Conditional DFS is a more relevant measure of prognosis for patients with ovarian cancer who have already achieved a period of remission, and time elapsed since remission should be taken into account when making follow-up care decisions.
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Affiliation(s)
- Michelle L Kurta
- Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Robert P Edwards
- Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Kirsten B Moysich
- Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Kathleen McDonough
- Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Marnie Bertolet
- Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Joel L Weissfeld
- Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Janet M Catov
- Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Francesmary Modugno
- Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Clareann H Bunker
- Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Roberta B Ness
- Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Brenda Diergaarde
- Michelle L. Kurta, Marnie Bertolet, Joel L. Weissfeld, Janet M. Catov, Francesmary Modugno, Clareann H. Bunker, Brenda Diergaarde, Graduate School of Public Health; Marnie Bertolet, Clinical & Translational Science Institute, University of Pittsburgh; Robert P. Edwards, Kathleen McDonough, Joel L. Weissfeld, Brenda Diergaarde, University of Pittsburgh Cancer Institute; Robert P. Edwards, Janet M. Catov, Francesmary Modugno, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine; Robert P. Edwards, Francesmary Modugno, Magee-Womens Research Institute Ovarian Cancer Center of Excellence, Pittsburgh, PA; Kirsten B. Moysich, Roswell Park Cancer Institute, Buffalo, NY; and Roberta B. Ness, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX.
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Sala E. Ovarian cancer: imaging in treatment selection and planning with FIGO update. Cancer Imaging 2014. [PMCID: PMC4242770 DOI: 10.1186/1470-7330-14-s1-o18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ryu JS, Ryu HJ, Lee SN, Memon A, Lee SK, Nam HS, Kim HJ, Lee KH, Cho JH, Hwang SS. Prognostic impact of minimal pleural effusion in non-small-cell lung cancer. J Clin Oncol 2014; 32:960-7. [PMID: 24550423 DOI: 10.1200/jco.2013.50.5453] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Minimal (< 10 mm thick) pleural effusion (PE) may represent an early phase of malignant PE, but its clinical relevance has rarely been studied. Therefore, we examined the proportion of minimal PE in patients with non-small-cell lung cancer (NSCLC) and its impact on survival. We also considered possible accumulation mechanisms in our data set. PATIENTS AND METHODS On the basis of PE status from chest computed tomography scans at diagnosis, 2,061 patients were classified into three groups: no PE, minimal PE, and malignant PE. Twenty-one variables associated with four factors-patient, stage migration, tumor, and treatment-were investigated for correlation with survival. RESULTS Minimal PE presented in 272 patients (13.2%). Of 2,061 patients, the proportion of each stage was the following: 5.2% stage I, 10.9% stage II, 13.2% stage IIIA, 23.8% stage IIIB, and 13.9% stage IV. Minimal PE correlated significantly with shorter survival time than did no PE (median survival time, 7.7 v 17.7 months; log-rank P < .001), even after full adjustment with all variables (adjusted hazard ratio, 1.40; 95% CI, 1.21 to 1.62). Prognostic impact of minimal PE was higher in early versus advanced stages (Pinteraction = .001). In 237 patients (87.8%) with minimal PE, pleural invasion or attachment as a direct mechanism was observed, and it was an independent factor predicting worse survival (P = .03). CONCLUSION Minimal PE is a commonly encountered clinical concern in staging NSCLCs. Its presence is an important prognostic factor of worse survival, especially in early-stage disease.
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Affiliation(s)
- Jeong-Seon Ryu
- Jeong-Seon Ryu, Azra Memon, Seul-Ki Lee, Hae-Seong Nam, Hyun-Jung Kim, and Jae-Hwa Cho, Center for Lung Cancer, Inha University Hospital; Si-Nae Lee, Kyung-Hee Lee, and Seung-Sik Hwang, Inha University Hospital, Incheon, S. Korea; and Hyo Jin Ryu, University of California, Los Angeles, CA
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Hunter BD, Dhakal S, Voci S, Goldstein NPN, Constine LS. Pleural effusions in patients with Hodgkin lymphoma: clinical predictors and associations with outcome. Leuk Lymphoma 2014; 55:1822-6. [PMID: 24237578 DOI: 10.3109/10428194.2013.836599] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pleural effusions are common in Hodgkin lymphoma (HL). However, little is known about their prognostic significance. One hundred and ten patients with HL who presented to the University of Rochester from 1 January 2003 to 12 December 2010 were reviewed. Pleural effusions were evaluated on review of diagnostic-quality computed tomography (CT) scans. Pleural effusions were present in 26/110 patients: 1/7 (14%) stage I, 11/61 (18%) stage II, 3/18 (17%) stage III and 11/24 (46%) stage IV, and 25/91 (27%) patients had mediastinal involvement, 16/38 (42%) patients had extranodal involvement (any) and 5/14 (35%) patients had E lesions (direct extension to extranodal tissue). Unilateral and bilateral pleural effusions were equally prevalent. Survival analysis demonstrated decreased overall survival for patients with pleural effusions of borderline significance for stage I-IV (p = 0.055) but failed to show significance for patients with stage I-III (p = 0.115). Increasing stage, any extranodal involvement and bulky mediastinal disease were each predictive of pleural effusions. The presence of pleural effusion at presentation may be predictive of inferior survival for patients with Hodgkin lymphoma.
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Affiliation(s)
- Bradley D Hunter
- School of Medicine and Dentistry, University of Rochester Medical Center , Rochester, NY , USA
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Mitchell DG, Javitt MC, Glanc P, Bennett GL, Brown DL, Dubinsky T, Harisinghani MG, Harris RD, Horowitz NS, Pandharipande PV, Pannu HK, Podrasky AE, Royal HD, Shipp TD, Siegel CL, Simpson L, Wong-You-Cheong JJ, Zelop CM. ACR Appropriateness Criteria Staging and Follow-up of Ovarian Cancer. J Am Coll Radiol 2013; 10:822-7. [DOI: 10.1016/j.jacr.2013.07.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 01/22/2023]
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The Role of Interventional Radiology in Management of Benign and Malignant Gynecologic Diseases. Obstet Gynecol Surv 2013; 68:691-701. [DOI: 10.1097/ogx.0b013e3182a878c6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abdominopelvic cytoreduction rates and recurrence sites in stage IV ovarian cancer: Is there a case for thoracic cytoreduction? Gynecol Oncol 2013; 131:27-31. [DOI: 10.1016/j.ygyno.2013.07.093] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/11/2013] [Accepted: 07/16/2013] [Indexed: 11/21/2022]
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Moy MP, Levsky JM, Berko NS, Godelman A, Jain VR, Haramati LB. A new, simple method for estimating pleural effusion size on CT scans. Chest 2013; 143:1054-1059. [PMID: 23632863 DOI: 10.1378/chest.12-1292] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is no standardized system to grade pleural effusion size on CT scans. A validated, systematic grading system would improve communication of findings and may help determine the need for imaging guidance for thoracentesis. METHODS CT scans of 34 patients demonstrating a wide range of pleural effusion sizes were measured with a volume segmentation tool and reviewed for qualitative and simple quantitative features related to size. A classification rule was developed using the features that best predicted size and distinguished among small, moderate, and large effusions. Inter-reader agreement for effusion size was assessed on the CT scans for three groups of physicians (radiology residents, pulmonologists, and cardiothoracic radiologists) before and after implementation of the classification rule. RESULTS The CT imaging features found to best classify effusions as small, moderate, or large were anteroposterior (AP) quartile and maximum AP depth measured at the midclavicular line. According to the decision rule, first AP-quartile effusions are small, second AP-quartile effusions are moderate, and third or fourth AP-quartile effusions are large. In borderline cases, AP depth is measured with 3-cm and 10-cm thresholds for the upper limit of small and moderate, respectively. Use of the rule improved interobserver agreement from κ = 0.56 to 0.79 for all physicians, 0.59 to 0.73 for radiology residents, 0.54 to 0.76 for pulmonologists, and 0.74 to 0.85 for cardiothoracic radiologists. CONCLUSIONS A simple, two-step decision rule for sizing pleural effusions on CT scans improves interobserver agreement from moderate to substantial levels.
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Affiliation(s)
- Matthew P Moy
- Department of Radiology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY
| | - Jeffrey M Levsky
- Department of Radiology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY.
| | - Netanel S Berko
- Department of Radiology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY
| | - Alla Godelman
- Department of Radiology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY
| | - Vineet R Jain
- Department of Radiology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY
| | - Linda B Haramati
- Department of Radiology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY; Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY
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Levsky JM, Moy MP, Haramati LB. Basis of Estimating Pleural Effusion Size on CT Scan: Response. Chest 2013; 143:1839-1840. [DOI: 10.1378/chest.13-0569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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PORCEL JOSÉM, DIAZ JOHNP, CHI DENNISS. Clinical implications of pleural effusions in ovarian cancer. Respirology 2012; 17:1060-7. [DOI: 10.1111/j.1440-1843.2012.02177.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Whitworth JM, Schneider KE, Fauci JM, Bryant AS, Cerfolio RJ, Straughn JM. Outcomes of patients with gynecologic malignancies undergoing video-assisted thoracoscopic surgery (VATS) and pleurodesis for malignant pleural effusion. Gynecol Oncol 2012; 125:646-8. [DOI: 10.1016/j.ygyno.2012.02.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 02/13/2012] [Accepted: 02/20/2012] [Indexed: 01/31/2023]
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Mironov O, Sala E, Mironov S, Pannu H, Chi DS, Hricak H. Thoracic metastasis in advanced ovarian cancer: comparison between computed tomography and video-assisted thoracic surgery. J Gynecol Oncol 2011; 22:260-8. [PMID: 22247803 PMCID: PMC3254845 DOI: 10.3802/jgo.2011.22.4.260] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 06/03/2011] [Accepted: 06/28/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine which computed tomography (CT) imaging features predict pleural malignancy in patients with advanced epithelial ovarian carcinoma (EOC) using video-assisted thoracic surgery (VATS), pathology, and cytology findings as the reference standard. METHODS This retrospective study included 44 patients with International Federation of Obstetrics and Gynecology (FIGO) stage III or IV primary or recurrent EOC who had chest CT ≤30 days before VATS. Two radiologists independently reviewed the CT studies and recorded the presence and size of pleural effusions and of ascites; pleural nodules, thickening, enhancement, subdiaphragmatic tumour deposits and supradiaphragmatic, mediastinal, hilar, and retroperitoneal adenopathy; and peritoneal seeding. VATS, pathology, and cytology findings constituted the reference standard. RESULTS In 26/44 (59%) patients, pleural biopsies were malignant. Only the size of left-sided pleural effusion (reader 1: rho=-0.39, p=0.01; reader 2: rho=-0.37, p=0.01) and presence of ascites (reader 1: rho=-0.33, p=0.03; reader 2: rho=-0.35, p=0.03) were significantly associated with solid pleural metastasis. Pleural fluid cytology was malignant in 26/35 (74%) patients. Only the presence (p=0.03 for both readers) and size (reader 1: rho=0.34, p=0.04; reader 2: rho=0.33, p=0.06) of right-sided pleural effusion were associated with malignant pleural effusion. Interobserver agreement was substantial (kappa=0.78) for effusion size and moderate (kappa=0.46) for presence of solid pleural disease. No other CT features were associated with malignancy at biopsy or cytology. CONCLUSION In patients with advanced EOC, ascites and left-sided pleural effusion size were associated with solid pleural metastasis, while the presence and size of right-sided effusion were associated with malignant pleural effusion. No other CT features evaluated were associated with pleural malignancy.
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Affiliation(s)
- Oleg Mironov
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Evis Sala
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Svetlana Mironov
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Harpreet Pannu
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Dennis S. Chi
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, USA
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