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Ursprung S, Zhang ML, Asmundo L, Hesami M, Najmi Z, Cañamaque LG, Shenoy-Bhangle AS, Pierce TT, Mojtahed A, Blake MA, Cochran R, Nikolau K, Harisinghani MG, Catalano OA. An Illustrated Review of the Recent 2019 World Health Organization Classification of Neuroendocrine Neoplasms: A Radiologic and Pathologic Correlation. J Comput Assist Tomogr 2024:00004728-990000000-00293. [PMID: 38438338 DOI: 10.1097/rct.0000000000001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
ABSTRACT Recent advances in molecular pathology and an improved understanding of the etiology of neuroendocrine neoplasms (NENs) have given rise to an updated World Health Organization classification. Since gastroenteropancreatic NENs (GEP-NENs) are the most common forms of NENs and their incidence has been increasing constantly, they will be the focus of our attention. Here, we review the findings at the foundation of the new classification system, discuss how it impacts imaging research and radiological practice, and illustrate typical and atypical imaging and pathological findings. Gastroenteropancreatic NENs have a highly variable clinical course, which existing classification schemes based on proliferation rate were unable to fully capture. While well- and poorly differentiated NENs both express neuroendocrine markers, they are fundamentally different diseases, which may show similar proliferation rates. Genetic alterations specific to well-differentiated neuroendocrine tumors graded 1 to 3 and poorly differentiated neuroendocrine cancers of small cell and large-cell subtype have been identified. The new tumor classification places new demands and creates opportunities for radiologists to continue providing the clinically most relevant report and on researchers to design projects, which continue to be clinically applicable.
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Affiliation(s)
- Stephan Ursprung
- From the Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - M. Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | | | - Mina Hesami
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Zahra Najmi
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | | | | | | | | | - Michael A Blake
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Rory Cochran
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Konstantin Nikolau
- From the Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
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Ferri V, Vicente E, Quijano Y, Duran H, Diaz E, Fabra I, Malave L, Ruiz P, Costantini G, Pizzuti G, Cubillo A, Rubio MC, Cañamaque LG, Alfonsel JN, Caruso R. Light and shadow of watch-and-wait strategy in rectal cancer: oncological result, clinical outcomes, and cost-effectiveness analysis. Int J Colorectal Dis 2023; 38:277. [PMID: 38051359 DOI: 10.1007/s00384-023-04573-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The watch-and-wait (WW) strategy is a potential option for patients with rectal cancer who obtain a complete clinic response after neoadjuvant therapy. The aim of this study is to analyze the long-term oncological outcomes and perform a cost-effectiveness analysis in patients undergoing this strategy for rectal cancer. MATERIAL AND METHODS The data of patients treated with the WW strategy were prospectively collected from January 2015 to January 2020. A control group was created, matched 1:1 from a pool of 480 patients undergoing total mesorectal excision. An independent company carried out the financial analysis. Clinical and oncological outcomes were analyzed in both groups. Outcome parameters included surgical and follow-up costs, quality-adjusted life years (QALYs), and the incremental cost per QALY gained or the incremental cost-effectiveness ratio (ICER). RESULTS Forty patients were included in the WW group, with 40 patients in the surgical group. During a median follow-up period of 36 months, metastasis-free survival (MFS) and overall survival (OS) were similar in the two groups. In the WW group, nine (22%) local regrowths were detected in the first 2 years. The permanent stoma rate was slightly higher after salvage surgery in the WW group compared to the surgical group (48.5% vs 20%, p < 0.01). The cost-effectiveness analysis was slightly better for the WW group, especially for low rectal cancer compared to medium-high rectal cancer (ICER = - 108,642.1 vs ICER = - 42,423). CONCLUSIONS The WW strategy in locally advanced rectal cancer offers similar oncological outcomes with respect to the surgical group and excellent results in quality of life and cost outcomes, especially for low rectal cancer. Nonetheless, the complex surgical field during salvage surgery can lead to a high permanent stoma rate; therefore, the careful selection of patients is mandatory.
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Affiliation(s)
- Valentina Ferri
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, Calle Oña 10, 28050, Madrid, Spain.
| | - Emilio Vicente
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, Calle Oña 10, 28050, Madrid, Spain
| | - Yolanda Quijano
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, Calle Oña 10, 28050, Madrid, Spain
| | - Hipolito Duran
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, Calle Oña 10, 28050, Madrid, Spain
| | - Eduardo Diaz
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, Calle Oña 10, 28050, Madrid, Spain
| | - Isabel Fabra
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, Calle Oña 10, 28050, Madrid, Spain
| | - Luis Malave
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, Calle Oña 10, 28050, Madrid, Spain
| | - Pablo Ruiz
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, Calle Oña 10, 28050, Madrid, Spain
| | | | | | - Antonio Cubillo
- Oncology Department, HM-Sanchinarro University Hospital, Madrid, Spain
| | - Maria Carmen Rubio
- Radiotherapy Department, HM-Sanchinarro University Hospital, Madrid, Spain
| | | | - Javier Nuñez Alfonsel
- Instituto de Validación de La Eficiencia Clínica (IVEC), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Riccardo Caruso
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, Calle Oña 10, 28050, Madrid, Spain
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León Durán D, Garcia Cañamaque L, Fernandez-Friera L. Heart murmur with unusual diagnosis. Heart 2021; 106:1301-1367. [PMID: 32788289 DOI: 10.1136/heartjnl-2020-316736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Diego León Durán
- Unidad de Imagen Cardiaca, Hospital Universitario HM Montepríncipe-CIEC/Hospital Universitario HM Puerta del Sur, Madrid, Spain
| | | | - Leticia Fernandez-Friera
- Unidad de Imagen Cardiaca, Hospital Universitario HM Montepríncipe-CIEC/Hospital Universitario HM Puerta del Sur, Madrid, Spain .,Centro Nacional de Investigaciones Cardiovasculares Carlos III, CNIC, Madrid, Spain
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Suarez-Weiss KE, Herold A, Gervais D, Palmer E, Amorim B, King JD, Weier L, Shahein T, Bernstine H, Domachevsk L, Cañamaque LG, Herrmann K, Umutlu L, Groshar D, Catalano OA. Hybrid imaging of the abdomen and pelvis. Radiologe 2021; 60:80-89. [PMID: 32424463 DOI: 10.1007/s00117-020-00661-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Accurate imaging is crucial for lesion detection in abdominal organs, for the noninvasive characterization of focal and diffuse abnormalities, and for surgical planning. To accomplish these tasks, several imaging modalities such as multidetector computer tomography (MDCT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) are used for abdominal imaging, providing important morphological, functional or metabolic information. More recently, PET/MRI has been gaining attention due to the possibility of combining high-resolution imaging with metabolic imaging. PET/MRI is a novel hybrid imaging technology that in the near future might play a pivotal role in the clinical management of oncologic and inflammatory abdominopelvic diseases. Despite the still limited number of published clinical studies, PET/MRI has been proven to be at least equivalent to PET/CT and to standalone MRI in a variety of oncologic disease. Moreover, in selected and focused clinical studies, it has been proven to outperform current standard of care imaging, for example, in evaluating cholangiocarcinomas, liver metastases, untreated and treated rectal cancer. This has also had an impact on therapeuticmanagement in some studies. Therefore in some institutions, including those of the authors, PET/MRI is becoming the new standard imaging modality in staging treatment-naïve intrahepatic massforming cholangiocarcinomas and prior to complicated hepatic surgery.
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Affiliation(s)
| | | | - Debra Gervais
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Edwin Palmer
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Joseph D King
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Li Weier
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tajmir Shahein
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | | | - Onofrio A Catalano
- Division of Abdominal Radiology, Massachusetts General Hospital, Boston, MA, USA.
- University of Naples Parthenope, Naples, Italy.
- Harvard Medical School, Massachusetts General Hospital, 55 Fruits St, Boston, MA, USA.
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5
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Catalano OA, Lee SI, Parente C, Cauley C, Furtado FS, Striar R, Soricelli A, Salvatore M, Li Y, Umutlu L, Cañamaque LG, Groshar D, Mahmood U, Blaszkowsky LS, Ryan DP, Clark JW, Wo J, Hong TS, Kunitake H, Bordeianou L, Berger D, Ricciardi R, Rosen B. Improving staging of rectal cancer in the pelvis: the role of PET/MRI. Eur J Nucl Med Mol Imaging 2020; 48:1235-1245. [PMID: 33034673 DOI: 10.1007/s00259-020-05036-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The role of positron emission tomography/magnetic resonance (PET/MR) in evaluating the local extent of rectal cancer remains uncertain. This study aimed to investigate the possible role of PET/MR versus magnetic resonance (MR) in clinically staging rectal cancer. METHODS This retrospective two-center cohort study of 62 patients with untreated rectal cancer investigated the possible role of baseline staging PET/MR versus stand-alone MR in determination of clinical stage. Two readers reviewed T and N stage, mesorectal fascia involvement, tumor length, distance from the anal verge, sphincter involvement, and extramural vascular invasion (EMVI). Sigmoidoscopy, digital rectal examination, and follow-up imaging, along with surgery when available, served as the reference standard. RESULTS PET/MR outperformed MR in evaluating tumor size (42.5 ± 21.03 mm per the reference standard, 54 ± 20.45 mm by stand-alone MR, and 44 ± 20 mm by PET/MR, P = 0.004), and in identifying N status (correct by MR in 36/62 patients [58%] and by PET/MR in 49/62 cases [79%]; P = 0.02) and external sphincter infiltration (correct by MR in 6/10 and by PET/MR in 9/10; P = 0.003). No statistically significant differences were observed in relation to any other features. CONCLUSION PET/MR provides a more precise assessment of the local extent of rectal cancers in evaluating cancer length, N status, and external sphincter involvement. PET/MR offers the opportunity to improve clinical decision-making, especially when evaluating low rectal tumors with possible external sphincter involvement.
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Affiliation(s)
- Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA. .,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA. .,Department of Radiology, University of Naples "Parthenope", Naples, Italy.
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA
| | | | - Christy Cauley
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Robin Striar
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Andrea Soricelli
- Department of Radiology, University of Naples "Parthenope", Naples, Italy.,SDN IRCCS, Naples, Italy
| | - Marco Salvatore
- SDN IRCCS, Naples, Italy.,University of Naples Suor Orsola Benincasa, Napoli, NA, Italy
| | - Yan Li
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Lawrence S Blaszkowsky
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Vernon Cancer Center, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA, 02462, USA
| | - David P Ryan
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey W Clark
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - David Berger
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Bruce Rosen
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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6
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Suarez-Weiss KE, Herold A, Gervais D, Palmer E, Amorim B, King JD, Weier L, Shahein T, Bernstine H, Domachevsk L, Cañamaque LG, Umutlu L, Herrmann K, Groshar D, Catalano OA. [Hybrid imaging of the abdomen and pelvis. German version]. Radiologe 2020; 60:394-404. [PMID: 32232543 DOI: 10.1007/s00117-020-00660-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Accurate imaging is crucial for lesion detection in abdominal organs, for the noninvasive characterization of focal and diffuse abnormalities, and for surgical planning. To accomplish these tasks, several imaging modalities such as multidetector computer tomography (MDCT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) are used for abdominal imaging, providing important morphological, functional or metabolic information. More recently, PET/MRI has been gaining attention due to the possibility of combining high-resolution imaging with metabolic imaging. PET/MRI is a novel hybrid imaging technology that in the near future might play a pivotal role in the clinical management of oncologic and inflammatory abdominopelvic diseases. Despite the still limited number of published clinical studies, PET/MRI has been proven to be at least equivalent to PET/CT and to stand-alone MRI in a variety of oncologic disease. Moreover, in selected and focused clinical studies, it has been proven to outperform current standard of care imaging, for example, in evaluating cholangiocarcinomas, liver metastases, untreated and treated rectal cancer. This has also had an impact on therapeutic management in some studies. Therefore in some institutions, including those of the authors, PET/MRI is becoming the new standard imaging modality in staging treatment-naïve intrahepatic mass-forming cholangiocarcinomas and prior to complicated hepatic surgery.
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Affiliation(s)
- Krista Elise Suarez-Weiss
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | | | - Debra Gervais
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | - Edwin Palmer
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | | | - Joseph D King
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | - Li Weier
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | - Tajmir Shahein
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA
| | | | | | | | | | | | | | - Onofrio A Catalano
- Division of Abdominal Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, 02114, Boston MA, USA. .,University of Naples Parthenope, Neapel, Italien.
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