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Bogdanski AM, Onnekink AM, Inderson A, Boekestijn B, Bonsing BA, Vasen HFA, van Hooft JE, Boonstra JJ, Mieog JSD, Wasser MNJM, Feshtali S, Potjer TP, Klatte DCF, van Leerdam ME. THE ADDED VALUE OF BLOOD GLUCOSE MONITORING IN HIGH-RISK INDIVIDUALS UNDERGOING PANCREATIC CANCER SURVEILLANCE. Pancreas 2024:00006676-990000000-00147. [PMID: 38598368 DOI: 10.1097/mpa.0000000000002335] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVES The study aimed to investigate the added value of blood glucose monitoring in high-risk individuals (HRIs) participating in pancreatic cancer surveillance. METHODS HRIs with a CDKN2A/p16 germline pathogenic variant (PV) participating in pancreatic cancer surveillance were included in this study. Multivariable logistic regression was performed to assess the relationship between new-onset diabetes (NOD) and pancreatic ductal adenocarcinoma (PDAC). To quantify the diagnostic performance of NOD as a marker for PDAC, receiver operating characteristic curve with area under the curve (AUC) was computed. RESULTS In total, 220 HRIs were included between 2000-2019. Median age was 61 (IQR 53-71) years and 62.7% of participants were female. During the study period, 26 (11.8%) HRIs developed NOD, of whom 5 (19.2%) later developed PDAC. The other 23 (82.1%) PDAC cases remained NOD-free. Multivariable analysis showed no statistically significant relationship between NOD and PDAC (OR 1.21; 95% CI, 0.39-3.78) and four out of five PDAC cases appeared to have NOD within three months before diagnosis. Furthermore, NOD did not differentiate between HRIs with- and without PDAC (AUC 0.54; 95% CI, 0.46-0.61). CONCLUSIONS In this study we found no added value for longitudinal glucose monitoring in CDKN2A PV carriers participating in an imaging-based pancreatic cancer surveillance program.
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Affiliation(s)
- Aleksander M Bogdanski
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anke M Onnekink
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Akin Inderson
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bas Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jurjen J Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Shirin Feshtali
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas P Potjer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Derk C F Klatte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
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2
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Bogdanski AM, van Hooft JE, Boekestijn B, Bonsing BA, Wasser MNJM, Klatte DCF, van Leerdam ME. Aspects and outcomes of surveillance for individuals at high-risk of pancreatic cancer. Fam Cancer 2024:10.1007/s10689-024-00368-1. [PMID: 38619782 DOI: 10.1007/s10689-024-00368-1] [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] [Received: 01/05/2024] [Accepted: 02/24/2024] [Indexed: 04/16/2024]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related deaths and is associated with a poor prognosis. The majority of these cancers are detected at a late stage, contributing to the bad prognosis. This underscores the need for novel, enhanced early detection strategies to improve the outcomes. While population-based screening is not recommended due to the relatively low incidence of PDAC, surveillance is recommended for individuals at high risk for PDAC due to their increased incidence of the disease. However, the outcomes of pancreatic cancer surveillance in high-risk individuals are not sorted out yet. In this review, we will address the identification of individuals at high risk for PDAC, discuss the objectives and targets of surveillance, outline how surveillance programs are organized, summarize the outcomes of high-risk individuals undergoing pancreatic cancer surveillance, and conclude with a future perspective on pancreatic cancer surveillance and novel developments.
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Affiliation(s)
- Aleksander M Bogdanski
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Bas Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Derk C F Klatte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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3
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Klatte DCF, Boekestijn B, Onnekink AM, Dekker FW, van der Geest LG, Wasser MNJM, Feshtali SS, Mieog JSD, Luelmo SAC, Morreau H, Potjer TP, Inderson A, Boonstra JJ, Vasen HFA, van Hooft JE, Bonsing BA, van Leerdam ME. Surveillance for pancreatic cancer in high-risk individuals leads to improved outcomes: a propensity score-matched analysis. Gastroenterology 2023; 164:1223-1231.e4. [PMID: 36889551 DOI: 10.1053/j.gastro.2023.02.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/16/2023] [Accepted: 02/15/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND & AIMS Recent pancreatic cancer surveillance programs of high-risk individuals have reported improved outcomes. This study assessed to what extent outcomes of pancreatic ductal adenocarcinoma (PDAC) in patients with a CDKN2A/p16 pathogenic variant (PV) diagnosed under surveillance are better as compared to PDAC patients diagnosed outside surveillance. METHODS In a propensity score matched cohort using data from the Netherlands Cancer Registry (NCR), we compared resectability, stage and survival between patients diagnosed under surveillance with non-surveillance PDAC patients. Survival analyses were adjusted for potential effects of lead time. RESULTS Between January 2000 and December 2020, 43 762 patients with PDAC were identified from the NCR. Thirty-one patients with PDAC under surveillance were matched in a 1:5 ratio with 155 non-surveillance patients based on age at diagnosis, sex, year of diagnosis, and tumor location. Outside surveillance, 5.8% of the cases had stage I cancer, as compared to 38.7% of surveillance PDAC patients (OR 0.09; 95% CI, 0.04 - 0.19). In total, 18.7% of non-surveillance patients vs. 71.0% of surveillance patients underwent a surgical resection (OR 10.62; 95% CI, 4.56 - 26.63). Patients in surveillance had a better prognosis, reflected by a 5-year survival of 32.4% and a median overall survival (OS) of 26.8 months vs. 4.3% 5-year survival and 5.2 months median OS in non-surveillance patients (HR 0.31, 95% CI 0.19 - 0.50). For all adjusted lead times, survival remained significantly longer in surveillance patients than in non-surveillance patients. CONCLUSION Surveillance for PDAC in carriers of a CDKN2A/p16 PV results in earlier detection, increased resectability and improved survival as compared to non-surveillance PDAC patients.
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Affiliation(s)
- D C F Klatte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - B Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anke M Onnekink
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - F W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands
| | - L G van der Geest
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), The Netherlands
| | - M N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - S Shahbazi Feshtali
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J S D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - S A C Luelmo
- Department of Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - T P Potjer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - A Inderson
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - J J Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - H F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - J E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - B A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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4
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Ibrahim IS, Vasen HFA, Wasser MNJM, Feshtali S, Bonsing BA, Morreau H, Inderson A, de Vos Tot Nederveen Cappel WH, van den Hout WB. Cost-effectiveness of pancreas surveillance: The CDKN2A-p16-Leiden cohort. United European Gastroenterol J 2023; 11:163-170. [PMID: 36785917 PMCID: PMC10039795 DOI: 10.1002/ueg2.12360] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/29/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND CDKN2A-p16-Leiden mutation carriers have a high lifetime risk of developing pancreatic ductal adenocarcinoma (PDAC), with very poor survival. Surveillance may improve prognosis. OBJECTIVE To assess the cost-effectiveness of surveillance, as compared to no surveillance. METHODS In 2000, a surveillance program was initiated at Leiden University Medical Center with annual MRI and optional endoscopic ultrasound. Data were collected on the resection rate of screen-detected tumors and on survival. The Kaplan-Meier method and a parametric cure model were used to analyze and compare survival. Based on the surveillance and survival data from the screening program, a state-transition model was constructed to estimate lifelong outcomes. RESULTS A total of 347 mutation carriers participated in the surveillance program. PDAC was detected in 31 patients (8.9%) and the tumor could be resected in 22 patients (71.0%). Long-term cure among patients with resected PDAC was estimated at 47.1% (p < 0.001). The surveillance program was estimated to reduce mortality from PDAC by 12.1% and increase average life expectancy by 2.10 years. Lifelong costs increased by €13,900 per patient, with a cost-utility ratio of €14,000 per quality-adjusted life year gained. For annual surveillance to have an acceptable cost-effectiveness in other settings, lifetime PDAC risk needs to be 10% or higher. CONCLUSION The tumor could be resected in most patients with a screen-detected PDAC. These patients had considerably better survival and as a result annual surveillance was found to be cost-effective.
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Affiliation(s)
- Isaura S Ibrahim
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans F A Vasen
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Shirin Feshtali
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Akin Inderson
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Wilbert B van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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5
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Klatte DCF, Boekestijn B, Wasser MNJM, Feshtali Shahbazi S, Ibrahim IS, Mieog JSD, Luelmo SAC, Morreau H, Potjer TP, Inderson A, Boonstra JJ, Dekker FW, Vasen HFA, van Hooft JE, Bonsing BA, van Leerdam ME. Pancreatic Cancer Surveillance in Carriers of a Germline CDKN2A Pathogenic Variant: Yield and Outcomes of a 20-Year Prospective Follow-Up. J Clin Oncol 2022; 40:3267-3277. [PMID: 35658523 DOI: 10.1200/jco.22.00194] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Pancreatic cancer surveillance in high-risk individuals may lead to detection of pancreatic ductal adenocarcinoma (PDAC) at an earlier stage and with improved survival. This study evaluated the yield and outcomes of 20 years of prospective surveillance in a large cohort of individuals with germline pathogenic variants (PVs) in CDKN2A. METHODS Prospectively collected data were analyzed from individuals participating in pancreatic cancer surveillance. Surveillance consisted of annual magnetic resonance imaging with magnetic resonance cholangiopancreatography and optional endoscopic ultrasound. RESULTS Three hundred forty-seven germline PV carriers participated in surveillance and were followed for a median of 5.6 (interquartile range 2.3-9.9) years. A total of 36 cases of PDAC were diagnosed in 31 (8.9%) patients at a median age of 60.4 (interquartile range 51.3-64.1) years. The cumulative incidence of primary PDAC was 20.7% by age 70 years. Five carriers (5 of 31; 16.1%) were diagnosed with a second primary PDAC. Thirty (83.3%) of 36 PDACs were considered resectable at the time of imaging. Twelve cases (12 of 36; 33.3%) presented with stage I disease. The median survival after diagnosis of primary PDAC was 26.8 months, and the 5-year survival rate was 32.4% (95% CI, 19.1 to 54.8). Individuals with primary PDAC who underwent resection (22 of 31; 71.0%) had an overall 5-year survival rate of 44.1% (95% CI, 27.2 to 71.3). Nine (2.6%; 9 of 347) individuals underwent surgery for a suspected malignant lesion, which proved to not be PDAC, and this included five lesions with low-grade dysplasia. CONCLUSION This long-term surveillance study demonstrates a high incidence of PDAC in carriers of a PV in CDKN2A. This provides evidence that surveillance in such a high-risk population leads to detection of early-stage PDAC with improved resectability and survival.
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Affiliation(s)
- Derk C F Klatte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bas Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Isaura S Ibrahim
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Saskia A C Luelmo
- Department of Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas P Potjer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Akin Inderson
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jurjen J Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bert A Bonsing
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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6
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Franklin SL, Voormolen N, Bones IK, Korteweg T, Wasser MNJM, Dankers HG, Cohen D, van Stralen M, Bos C, van Osch MJP. Feasibility of Velocity-Selective Arterial Spin Labeling in Breast Cancer Patients for Noncontrast-Enhanced Perfusion Imaging. J Magn Reson Imaging 2021; 54:1282-1291. [PMID: 34121250 PMCID: PMC8518819 DOI: 10.1002/jmri.27781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 12/04/2022] Open
Abstract
Background Dynamic contrast‐enhanced (DCE) MRI is the most sensitive method for detection of breast cancer. However, due to high costs and retention of intravenously injected gadolinium‐based contrast agent, screening with DCE‐MRI is only recommended for patients who are at high risk for developing breast cancer. Thus, a noncontrast‐enhanced alternative to DCE is desirable. Purpose To investigate whether velocity selective arterial spin labeling (VS‐ASL) can be used to identify increased perfusion and vascularity within breast lesions compared to surrounding tissue. Study Type Prospective. Population Eight breast cancer patients. Field Strength/Sequence A 3 T; VS‐ASL with multislice single‐shot gradient‐echo echo‐planar‐imaging readout. Assessment VS‐ASL scans were independently assessed by three radiologists, with 3–25 years of experience in breast radiology. Scans were scored on lesion visibility and artifacts, based on a 3‐point Likert scale. A score of 1 corresponded to “lesions being distinguishable from background” (lesion visibility), and “no or few artifacts visible, artifacts can be distinguished from blood signal” (artifact score). A distinction was made between mass and nonmass lesions (based on BI‐RADS lexicon), as assessed in the standard clinical exam. Statistical Tests Intra‐class correlation coefficient (ICC) for interobserver agreement. Results The ICC was 0.77 for lesion visibility and 0.84 for the artifact score. Overall, mass lesions had a mean score of 1.27 on lesion visibility and 1.53 on the artifact score. Nonmass lesions had a mean score of 2.11 on lesion visibility and 2.11 on the artifact score. Data Conclusion We have demonstrated the technical feasibility of bilateral whole‐breast perfusion imaging using VS‐ASL in breast cancer patients. Evidence Level 1 Technical Efficacy Stage 1
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Affiliation(s)
- Suzanne L Franklin
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Center for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Nora Voormolen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Isabell K Bones
- Center for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Tijmen Korteweg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henrike G Dankers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniele Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marijn van Stralen
- Center for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Clemens Bos
- Center for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Matthias J P van Osch
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
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7
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Tomee SM, Meijer CA, Kies DA, le Cessie S, Wasser MNJM, Golledge J, Hamming JF, Lindeman JHN. Systematic approach towards reliable estimation of abdominal aortic aneurysm size by ultrasound imaging and CT. BJS Open 2021; 5:6073388. [PMID: 33609372 PMCID: PMC7893461 DOI: 10.1093/bjsopen/zraa041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/20/2020] [Indexed: 11/14/2022] Open
Abstract
Background The management of abdominal aortic aneurysm (AAA) is fully dictated by AAA size, but there are no uniform measurement guidelines, and systematic differences exist between ultrasound- and CT-based size estimation. The aim of this study was to devise a uniform ultrasound acquisition and measurement protocol, and to test whether harmonization of ultrasound and CT readings is feasible. Methods A literature review was undertaken to evaluate evidence for ultrasound-based measurement of AAA. A protocol for measuring AAA was then developed, and intraobserver and interobserver reproducibility was tested. Finally, agreement between ultrasound readings and CT-based AAA diameters was evaluated. This was an observational study of patients with a small AAA who participated in two pharmaceutical intervention trials. Results Based on a literature review, an ultrasound acquisition and reading protocol was devised. Evaluation of the protocol showed an intraobserver repeatability of 1.6 mm (2s.d.) and an interobserver intraclass correlation coefficient (ICC) of 0.97. Comparison of protocolled ultrasound readings and local CT readings indicated a good correlation (r = 0.81), but a systematic +4.1-mm difference for CT. Harmonized size readings for ultrasound imaging and CT increased the correlation (r = 0.91) and reduced the systematic difference to +1.8 mm by CT. Interobserver reproducibility of protocolized CT measurements showed an ICC of 0.94 for the inner-to-inner method and 0.96 for the outer-to-outer method. Conclusion The absence of harmonized size acquisition and reading guidelines results in overtreatment and undertreatment of patients with AAA. This can be avoided by the implementation of standardized ultrasound acquisition and a harmonized reading protocol for ultrasound- and CT-based readings.
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Affiliation(s)
- S M Tomee
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - C A Meijer
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Radiology, Martini Hospital, Groningen, the Netherlands
| | - D A Kies
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology, Section of Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Biomedical Datascience, Leiden University Medical Centre, Leiden, the Netherlands
| | - M N J M Wasser
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - J F Hamming
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - J H N Lindeman
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
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8
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van Dam LF, Klok FA, Tushuizen ME, Ageno W, Darwish Murad S, van Haren GR, Huisman MV, Lauw MN, Iglesias Del Sol A, Wasser MNJM, Willink Y, Kroft LJM. Magnetic Resonance Thrombus Imaging to Differentiate Acute from Chronic Portal Vein Thrombosis. TH Open 2020; 4:e224-e230. [PMID: 32984756 PMCID: PMC7511264 DOI: 10.1055/s-0040-1716716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/04/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction
Timely diagnosis and treatment of portal vein thrombosis (PVT) is crucial to prevent morbidity and mortality. However, current imaging tests cannot always accurately differentiate acute from chronic (nonocclusive) PVT. Magnetic resonance noncontrast thrombus imaging (MR-NCTI) has been shown to accurately differentiate acute from chronic venous thrombosis at other locations and may also be of value in the diagnostic management of PVT. This study describes the first phase of the Rhea study (NTR 7061). Our aim was to select and optimize MR-NCTI sequences that would be accurate for differentiation of acute from chronic PVT.
Study Design
The literature was searched for different MRI sequences for portal vein and acute thrombosis imaging. The most promising sequences were tested in a healthy volunteer followed by one patient with acute PVT and two patients with chronic PVT, all diagnosed on (repetitive) contrast-enhanced computed tomography (CT) venography to optimize the MR-NCTI sequences. All images were evaluated by an expert panel.
Results
Several MR-NCTI sequences were identified and tested. Differentiation of acute from chronic PVT was achieved with 3D T1 TFE (three-dimensional T1 turbo field echo) and 3D T1 Dixon FFE (three-dimensional T1 fast field echo) sequences with best image quality. The expert panel was able to confirm the diagnosis of acute PVT on the combined two MR-NCTI sequences and to exclude acute PVT in the two patients with chronic PVT.
Conclusion
Using 3D T1 TFE and 3D T1 Dixon FFE sequences, we were able to distinguish acute from chronic PVT. This clinical relevant finding will be elucidated in clinical studies to establish their test performance.
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Affiliation(s)
- Lisette F van Dam
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Guido R van Haren
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Mandy N Lauw
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ysbrand Willink
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Barnhoorn MC, Wasser MNJM, Roelofs H, Maljaars PWJ, Molendijk I, Bonsing BA, Oosten LEM, Dijkstra G, van der Woude CJ, Roelen DL, Zwaginga JJ, Verspaget HW, Fibbe WE, Hommes DW, Peeters KCMJ, van der Meulen-de Jong AE. Long-term Evaluation of Allogeneic Bone Marrow-derived Mesenchymal Stromal Cell Therapy for Crohn's Disease Perianal Fistulas. J Crohns Colitis 2020; 14:64-70. [PMID: 31197361 PMCID: PMC6930001 DOI: 10.1093/ecco-jcc/jjz116] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The long-term safety and efficacy of allogeneic bone marrow-derived mesenchymal stromal cell [bmMSC] therapy in perianal Crohn's disease [CD] fistulas is unknown. We aimed to provide a 4-year clinical evaluation of allogeneic bmMSC treatment of perianal CD fistulas. METHODS A double-blind dose-finding study for local bmMSC therapy in 21 patients with refractory perianal fistulising Crohn's disease was performed at the Leiden University Medical Center in 2012-2014. All patients treated with bmMSCs [1 x 107 bmMSCs cohort 1, n = 5; 3 × 107 bmMSCs cohort 2, n = 5; 9 × 107 bmMSCs cohort 3, n = 5] were invited for a 4-year evaluation. Clinical events were registered, fistula closure was evaluated, and anti-human leukocyte antigen [HLA] antibodies were assessed. Patients were also asked to undergo a pelvic magnetic resonance imaging [MRI] and rectoscopy. RESULTS Thirteen out of 15 patients [87%] treated with bmMSCs were available for long-term follow-up. Two non-MSC related malignancies were observed. No serious adverse events thought to be related to bmMSC therapy were found. In cohort 2 [n = 4], all fistulas were closed 4 years after bmMSC therapy. In cohort 1 [n = 4] 63%, and in cohort 3 [n = 5] 43%, of the fistulas were closed, respectively. In none of the patients anti-HLA antibodies could be detected 24 weeks and 4 years after therapy. Pelvic MRI showed significantly smaller fistula tracts after 4 years. CONCLUSIONS Allogeneic bmMSC therapy for CD-associated perianal fistulas is also in the long-term a safe therapy. In bmMSC-treated patients, fistulas with closure at Week 24 were still closed after 4 years.
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Affiliation(s)
- Marieke C Barnhoorn
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Helene Roelofs
- Department of Immunohematology and Blood Transfusion, University Medical Center, Leiden, The Netherlands
| | - P W Jeroen Maljaars
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ilse Molendijk
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Liesbeth E M Oosten
- Department of Immunohematology and Blood Transfusion, University Medical Center, Leiden, The Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Dave L Roelen
- Department of Immunohematology and Blood Transfusion, University Medical Center, Leiden, The Netherlands
| | - Jaap-Jan Zwaginga
- Department of Immunohematology and Blood Transfusion, University Medical Center, Leiden, The Netherlands
| | - Hein W Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem E Fibbe
- Department of Immunohematology and Blood Transfusion, University Medical Center, Leiden, The Netherlands
| | - Daniel W Hommes
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrea E van der Meulen-de Jong
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands,Corresponding author: Andrea E. van der Meulen-de Jong, Department of Gastroenterology and Hepatology, Leiden, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. Tel.: +31 71 5262915; fax: +31 71 5248115;
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Wasser MNJM, Welling M, Lamers G, Pauwels EKJ, Nieuwenhuizen W. Effects of an Antifibrin Monoclonal Antibody and Fragments thereof on Some Properties of Fibrin. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1645683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryAntifibrin monoclonal antibody Y22, of IgG1-subclass, has its epitope in the D-domain of fibrin. In a thrombin time assay, Y22 and its F(ab)2 fragments interfere with clotting of citrated plasma. Transmission and scanning electronmicroscopic studies show that clotting of citrated blood or plasma in the presence of Y22 results in formation of thin, short fibrin fibres. The (smaller) Fab fragments of Y22 did not have an anti-clotting effect. This suggests that the anticoagulant effect of Y22 is due to steric hindrance of the association of fibrin monomers. A control antibody and its F(ab)2 and Fab fragments have no effect on fibrin formation.In a parabolic rate assay, Y22 Fab fragments interfered strongly with the fibrin-induced enhancement of the t-PA-catalyzed plasminogen activation, whereas intact Y22 and a control antibody did not. In contrast with their effects on the fibrin assembly, the effects of Y22, Y22-F(ab)2 and Y22-Fab on the capacity of fibrin to act as a rate-enhancer in the plasminogen activation by t-PA appears to decrease with the size of the immunoreactive entity. As is discussed, this may be due to the differential accessibility of sites involved in stimulation and polymerization which are located in the fibrin D-domain.
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Affiliation(s)
- M N J M Wasser
- The Gaubius Institute TNO, Leiden, The Netherlands
- The Department of Diagnostic Radiology, University Hospital Leiden, The Netherlands
| | - M Welling
- The Gaubius Institute TNO, Leiden, The Netherlands
- The Department of Diagnostic Radiology, University Hospital Leiden, The Netherlands
| | - G Lamers
- The Department of Cell Biology, Zoological Faculty, State University Leiden, The Netherlands
| | - E K J Pauwels
- The Department of Diagnostic Radiology, University Hospital Leiden, The Netherlands
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Ibrahim IS, Bonsing BA, Swijnenburg RJ, Welling L, Veenendaal RA, Wasser MNJM, Morreau H, Inderson A, Vasen HFA. Dilemmas in the management of screen-detected lesions in patients at high risk for pancreatic cancer. Fam Cancer 2017; 16:111-115. [PMID: 27406244 PMCID: PMC5243878 DOI: 10.1007/s10689-016-9915-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In 3–5 % of all cases of pancreatic ductal adenocarcinoma (PDAC), hereditary factors influence etiology. While surveillance of high-risk individuals may improve the prognosis, this study describes two very different outcomes in patients with screen-detected lesions. In 2000, a surveillance program of carriers of a CDKN2A/p16-Leiden-mutation consisting of annual MRI was initiated. Patients with a suspected pancreatic lesion undergo CT-scan and Endoscopic Ultrasound, and surgery is offered when a lesion is confirmed. In 2015, two patients with a screen-detected solid lesion were identified. In both patients, lesions were visible on MRI and CT scan, while the EUS was unremarkable. Surgical resection of the head of the pancreas resulted in nearly fatal complications in the first patient. This patient was shown to have a benign lesion. In contrast, timely identification of an early cancer in the second patient was accompanied by an uneventful postoperative course. These cases underline the risks inherent to a PDAC prevention program. All patients should be fully informed about the possible outcomes before joining a surveillance program.
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Affiliation(s)
- Isaura S Ibrahim
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Lieke Welling
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Roeland A Veenendaal
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Akin Inderson
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Hans F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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12
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Molendijk I, Bonsing BA, Roelofs H, Peeters KCMJ, Wasser MNJM, Dijkstra G, van der Woude CJ, Duijvestein M, Veenendaal RA, Zwaginga JJ, Verspaget HW, Fibbe WE, van der Meulen-de Jong AE, Hommes DW. Allogeneic Bone Marrow-Derived Mesenchymal Stromal Cells Promote Healing of Refractory Perianal Fistulas in Patients With Crohn's Disease. Gastroenterology 2015; 149:918-27.e6. [PMID: 26116801 DOI: 10.1053/j.gastro.2015.06.014] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/23/2015] [Accepted: 06/17/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Patients with perianal fistulizing Crohn's disease have a poor prognosis because these lesions do not heal well. We evaluated the effects of local administration of bone marrow-derived mesenchymal stromal cells (MSCs) to these patients from healthy donors in a double-blind, placebo-controlled study. METHODS Twenty-one patients with refractory perianal fistulizing Crohn's disease were randomly assigned to groups given injections of 1 × 10(7) (n = 5, group 1), 3 × 10(7) (n = 5, group 2), or 9 × 10(7) (n = 5, group 3) MSCs, or placebo (solution with no cells, n = 6), into the wall of curettaged fistula, around the trimmed and closed internal opening. The primary outcome, fistula healing, was determined by physical examination 6, 12, and 24 weeks later; healing was defined as absence of discharge and <2 cm of fluid collection-the latter determined by magnetic resonance imaging at week 12. All procedures were performed at Leiden University Medical Center, The Netherlands, from June 2012 through July 2014. RESULTS No adverse events were associated with local injection of any dose of MSCs. Healing at week 6 was observed in 3 patients in group 1 (60.0%), 4 patients in group 2 (80.0%), and 1 patient in group 3 (20.0%), vs 1 patient in the placebo group (16.7%) (P = .08 for group 2 vs placebo). At week 12, healing was observed in 2 patients in group 1 (40.0%), 4 patients in group 2 (80.0%), and 1 patient in group 3 (20.0%), vs 2 patients in the placebo group (33.3%); these effects were maintained until week 24 and even increased to 4 (80.0%) in group 1. At week six, 4 of 9 individual fistulas had healed in group 1 (44.4%), 6 of 7 had healed in group 2 (85.7%), and 2 of 7 had healed in group 3 (28.6%) vs 2 of 9 (22.2%) in the placebo group (P = .04 for group 2 vs placebo). At week twelve, 3 of 9 individual fistulas had healed in group 1 (33.3%), 6 of 7 had healed in group 2 (85.7%), 2 of 7 had healed in group 3 (28.6%), and 3 of 9 had healed in the placebo group (33.3%). These effects were stable through week 24 and even increased to 6 of 9 (66.7%) in group 1 (P = .06 group 2 vs placebo, weeks 12 and 24). CONCLUSIONS Local administration of allogeneic MSCs was not associated with severe adverse events in patients with perianal fistulizing Crohn's disease. Injection of 3 × 10(7) MSCs appeared to promote healing of perianal fistulas. ClinicalTrials.gov ID NCT01144962.
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Affiliation(s)
- Ilse Molendijk
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Helene Roelofs
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerard Dijkstra
- Department Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marjolijn Duijvestein
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roeland A Veenendaal
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap-Jan Zwaginga
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands; The Jon J van Rood Center for Clinical Transfusion Research, Sanquin-Leiden University Medical Center, Leiden, The Netherlands
| | - Hein W Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem E Fibbe
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Daniel W Hommes
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands; Division of Digestive Diseases, University of California Los Angeles, Los Angeles, California
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Schaafsma BE, van de Giessen M, Charehbili A, Smit VTHBM, Kroep JR, Lelieveldt BPF, Liefers GJ, Chan A, Löwik CWGM, Dijkstra J, van de Velde CJH, Wasser MNJM, Vahrmeijer AL. Optical mammography using diffuse optical spectroscopy for monitoring tumor response to neoadjuvant chemotherapy in women with locally advanced breast cancer. Clin Cancer Res 2014; 21:577-84. [PMID: 25473002 DOI: 10.1158/1078-0432.ccr-14-0736] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Diffuse optical spectroscopy (DOS) has the potential to enable monitoring of tumor response during chemotherapy, particularly in the early stages of treatment. This study aims to assess feasibility of DOS for monitoring treatment response in HER2-negative breast cancer patients receiving neoadjuvant chemotherapy (NAC) and compare DOS with tumor response assessment by MRI. EXPERIMENTAL DESIGN Patients received NAC in six cycles of 3 weeks. In addition to standard treatment monitoring by dynamic contrast enhanced MRI (DCE-MRI), DOS scans were acquired after the first, third, and last cycle of chemotherapy. The primary goal was to assess feasibility of DOS for early assessment of tumor response. The predictive value of DOS and DCE-MRI compared with pathologic response was assessed. RESULTS Of the 22 patients, 18 patients had a partial or complete tumor response at pathologic examination, whereas 4 patients were nonresponders. As early as after the first chemotherapy cycle, a significant difference between responders and nonresponders was found using DOS (HbO2 86% ± 25 vs. 136% ± 25, P = 0.023). The differences between responders and nonresponders continued during treatment (halfway treatment, HbO2 68% ± 22 vs. 110% ± 10, P = 0.010). Using DCE-MRI, a difference between responders and nonresponders was found halfway treatment (P = 0.005) using tumor volume measurement calculations. CONCLUSIONS DOS allows for tumor response assessment and is able to differentiate between responders and nonresponders after the first chemotherapy cycle and halfway treatment. In this study, DOS was equally effective in predicting tumor response halfway treatment compared with DCE-MRI. Therefore, DOS may be used as a novel imaging modality for (early) treatment monitoring of NAC.
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Affiliation(s)
| | | | - Ayoub Charehbili
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. Department of Clinical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Vincent T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Judith R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Alan Chan
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. Percuros B.V., Enschede, the Netherlands
| | - Clemens W G M Löwik
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jouke Dijkstra
- Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Meijer CA, Stijnen T, Wasser MNJM, Hamming JF, van Bockel JH, Lindeman JHN. Doxycycline for stabilization of abdominal aortic aneurysms: a randomized trial. Ann Intern Med 2013; 159:815-23. [PMID: 24490266 DOI: 10.7326/0003-4819-159-12-201312170-00007] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Doxycycline inhibits formation and progression of abdominal aortic aneurysms (AAAs) in preclinical models of the disease, but it is unclear whether and how this observation translates to humans. OBJECTIVE To test whether doxycycline inhibits AAA progression in humans. DESIGN Randomized, placebo-controlled, double-blind trial. (Dutch Trial Registry: NTR 1345) SETTING: 14 Dutch hospitals. PATIENTS 286 patients with small AAAs between October 2008 and June 2011. INTERVENTION Daily dose of 100 mg of doxycycline (n = 144) or placebo (n = 142) for 18 months. MEASUREMENTS The primary outcome measure was aneurysm growth at 18 months, as estimated by repeated single-observer ultrasonography. Secondary outcomes included growth at 6 and 12 months and the need for elective surgery. RESULTS Mean aneurysm diameter (approximately 43 mm) and other baseline characteristics were similar in both groups. Doxycycline treatment was associated with increased aneurysm growth (4.1 mm in the doxycycline group vs. 3.3 mm in the placebo group at 18 months; difference, 0.8 mm [95% CI, 0.1 to 1.4 mm]; P = 0.016 mm). Twenty-one patients receiving doxycycline and 22 patients receiving placebo had elective surgical repair (Kaplan–Meier estimates were 16.1% for those receiving doxycycline and 16.5% for those receiving placebo; difference, -0.4% [CI, -9.3% to 8.5%]; P = 0.83). Time to repair was similar in the groups (P = 0.92). LIMITATIONS This study focuses on patients with small AAAs. As such, whether the data can be extrapolated to larger AAAs (>55 mm) is unclear. The high number of elective repairs (n = 43) was unanticipated. Moreover, the study did not follow patients who withdrew because of an adverse effect. CONCLUSION This trial found that 18 months of doxycycline therapy did not reduce aneurysm growth and did not influence the need for AAA repair or time to repair. PRIMARY FUNDING SOURCE The Netherlands Organisation for Health Research and Development, and the NutsOhra Fund.
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Dekker TJA, Charehbili A, Smit VTHBM, Wasser MNJM, Heijns JB, van Warmerdam LJ, Kessels L, Dercksen W, Pepels M, Maartense E, van Laarhoven HWM, Vriens B, Meershoek-Klein Kranenbarg E, van de Velde CJH, Liefers GJ, Nortier HWR, Tollenaar RAEM, Mesker WE, Kroep JR. Abstract P1-06-04: The predictive value of tumor-stroma ratio for radiological and pathological response to neoadjuvant chemotherapy in breast cancer (BC): A Dutch breast cancer trialists’ group (BOOG) side-study. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-06-04] [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: 11/16/2022]
Abstract
Abstract
Background
Intra-tumoral stroma interacts with tumor cells and has a profound effect on tumor behavior. The tumor-stroma ratio (TSR) is of prognostic value in BC and other types of solid tumors. However, the predictive value of this parameter for achieving pathological complete response (pCR) after neoadjuvant chemotherapy is unknown.
Methods
We evaluated the relation between TSR and neoadjuvant treatment response in a retrospective cohort of 69 patients (pts) treated with various regimens of neoadjuvant chemotherapy at our institution who were diagnosed with BC between 1991 and 2007 and of whom radiological response was recorded. The percentage of intra-tumoral stroma was visually estimated on diagnostic sections from primary tumor tissue by two observers. The cut-off point between stroma-rich and stroma-poor tumors was set to 50% (as determined in previous investigations). These results were validated in a cohort from the NEOZOTAC trial: a national, multicenter, randomized study comparing the efficacy of TAC (docetaxel, adriamycin and cyclophosphamide i.v. day 1) chemotherapy with or without zoledronic acid 4 mg i.v., q 3 weeks, 6 times in 250 pts with stage II/III, measurable, HER2-negative BC. Radiological response (complete or partial) was evaluated following RECIST 1.1 criteria. pCR was centrally revised and defined as absence of residual tumor cells in the original tumor bed.
Results
In the retrospective cohort (n = 69) 62.3% of the specimens were classified as stroma-rich. In univariate analysis TSR was significantly associated with radiological response (76.0% stroma-poor vs. 48.8% stroma-rich, P = 0.03). This finding persisted after multivariate analysis for T-status, N-status and ER-status (Odds Ratio [OR] 0.17, 95% C.I.: 0.04-0.78). In the validation set, in which 47.9% of the specimens were stroma-rich (211 cases evaluated), TSR did not predict for radiological response (79.5% stroma-poor vs. 79.2%, P = 0.96). However, when validation data were split on basis of ER-status, TSR was a significant and independent predictor for radiological response in ER-negative pts. (89.5% vs. 50%, P = 0.048, 95% C.I.: 0.01 - 0.98). In the validation set, TSR predicted for pCR with greater pCR rates in stroma-poor tumors (P = 0.03, 22.7% vs 10.3%). Final response results of the pilot and the enlarged sample size of all 250 pts of the validation set will be presented.
Conclusions
TSR might be a marker for radiological and pathological response to neoadjuvant chemotherapy, especially for the ER- tumor subgroup. Considering the simplicity and low cost of TSR assessment, it should be further evaluated and will be prospectively studied in the next neoadjuvant chemotherapy trial of the BOOG.
Contact information:
Dr. J.R. Kroep, M.D., Ph.D., Department of Medical Oncology, email:j.r.kroep@lumc.nl or T.J.A. Dekker, MSc. Department of Surgery and Medical Oncology, email: t.j.a.dekker@lumc.nl or LUMC datacenter, Department of Surgery, phone +31(0)71-5263500, fax +31(0)71-5266744, email: datacenter@lumc.nl, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-06-04.
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Affiliation(s)
- TJA Dekker
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - A Charehbili
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - VTHBM Smit
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - MNJM Wasser
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - JB Heijns
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - LJ van Warmerdam
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - L Kessels
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - W Dercksen
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - M Pepels
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - E Maartense
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - HWM van Laarhoven
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - B Vriens
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - E Meershoek-Klein Kranenbarg
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - CJH van de Velde
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - G-J Liefers
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - HWR Nortier
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - RAEM Tollenaar
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - WE Mesker
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
| | - JR Kroep
- Leiden University Medical Center, Leiden, Netherlands; Amphia Hospital, Breda, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands; Maxima Medical Center, Veldhoven, Netherlands; Elkerliek Hospital, Helmond, Netherlands; Reinier de Graaff Gasthuis, Delft, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; Maastricht University Medical Center, Maastricht, Netherlands
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van den Tillaart SAHM, Srámek A, Wasser MNJM, Trimbos JBMZ. Barrel index of bulky cervical tumours and intrauterine fluid determined by MRI as additional prognostic factors for survival. EUR J GYNAECOL ONCOL 2013; 34:208-212. [PMID: 23967547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE to investigate whether morphologic characteristics determined by magnetic resonance imaging (MRI) can discriminate between bulky cervical tumours with a favourable or worse prognosis. MATERIALS AND METHODS MRI examinations were performed in 24 patients with cervical cancer Stage >or= 1B2. The ratio between tumour width and length (barrel index: BI) and the presence of intrauterine fluid retention were related to survival in a multivariate regression analysis. RESULTS BI and intracavital fluid were predictors of survival, independent from tumour diameter and other known important factors for survival. A cut-off value of 1.40 for the BI proved to be the best prognostic factor with respect to recurrence and death: the hazard ratios of BI > 1.40 as compared to BI <or= 1.40 were 18.9 (95% CI 2.8 to 125.6) for recurrent disease and 16.4 (95% CI 2.9 to 93.9) for death by cervical cancer. The hazard ratios of intracavital fluid retention were 73.6 (95% CI 5.3 to 1,016.4) and 48.1 (95% CI 4.7 to 491.6) for recurrence and death, respectively. CONCLUSION The morphologic characteristic BI and the presence or absence of intracavital fluid as determined by MRI might have predictive value for survival in patients with bulky cervical tumours.
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van de Ven S, Liefers GJ, Putter H, van Warmerdam LJ, Kessels LW, Dercksen W, Pepels MJ, Maartense E, van Laarhoven HWM, Vriens B, Smit VTHBM, Wasser MNJM, Meershoek-Klein KEM, van Leeuwen-Stok E, van de Velde CJH, Nortier JWR, Kroep JR. Abstract PD07-06: NEO-ZOTAC: Toxicity data of a phase III randomized trial with NEOadjuvant chemotherapy (TAC) with or without ZOledronic acid (ZA) for patients with HER2-negative large resectable or locally advanced breast cancer (BC). Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-pd07-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The role of bisphosphonates (BP) when added to the (neo)adjuvant treatment of BC in enhancing the efficacy of therapy is still unknown. NEOZOTAC investigates the efficacy of ZA added to neoadjuvant chemotherapy in patients with HER2-negative BC.
Trial design: NEOZOTAC is a Dutch multicenter study. Patients are 1:1 randomized to 3-weekly TAC (docetaxel 75mg/m2, adriamycin 50 mg/m2 and cyclophosphamide 500 mg/m2 i.v., day 1) chemotherapy supported by pegfilgrastim (6 mg sc), day 2 with or without ZA (4 mg i.v. within 24 hr after chemotherapy) q3 weeks.
Eligibility criteria: Main inclusion criteria: stage II or III, measurable, HER2-negative BC, age ≥18 years, WHO 0–2, adequate bone marrow-, renal-, and liver function, absence of prior BP usage and absence of active dental problems.
Study endpoint: The primary endpoint is the pathologic complete response (pCR) rate. Secondary endpoints are toxicity, clinical response, tumor heterogeneity in core biopsy vs. operation specimen, and (disease free) survival. Optional side studies include fluorescent imaging (SoftScan®), changes in bone markers, single nucleotide polymorphisms and the insulin-like growth factor pathway, circulating tumor and endothelial cells and the false-negative rate of the sentinel node biopsy after neoadjuvant chemotherapy.
Statistical Methods: Using a 5% significance level based on the two-sided Fishers exact test with a power of 80%, 250 patients (125/arm) are needed to show an improvement of the pCR-rate from 17% to 34% in the experimental arm. Randomization was done according to the Pococks minimisation technique stratified by cT, cN, and estrogen receptor status. Toxicity is analyzed using the Exact (2-sided) Chi-Square test.
Results: From July 2010 to April 2012, 250 patients from 25 participating sites were randomized. Toxicity data of 173 patients are currently available and data of all 250 patients will be presented at SABCS. Patient characteristics are presented in table 1.
Hematological and non-hematological toxicities were not significantly different between both treatment arms. Main grade 3/4 NCI-CTCv4 toxicities were neutropenia (8%), followed by febrile neutropenia (7%), fatigue (6%), diarrhea, hypertension, nausea (3%) and vomiting (1.2%). Bone pain, myalgia, and hypocalcemia occurred in one patient in the TAC-ZA arm (0.6%). Osteonecrosis of the jaw was not observed.
Conclusions: Neoadjuvant TAC supported by pegfilgrastim plus ZA is feasible. No significant difference in toxicity are reported compared with the control arm.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD07-06.
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Affiliation(s)
- S van de Ven
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - G-j Liefers
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - H Putter
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - LJ van Warmerdam
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - LW Kessels
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - W Dercksen
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - MJ Pepels
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - E Maartense
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - HWM van Laarhoven
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - B Vriens
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - VTHBM Smit
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - MNJM Wasser
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - Kranenbarg EM Meershoek-Klein
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - E van Leeuwen-Stok
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - CJH van de Velde
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - JWR Nortier
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
| | - JR Kroep
- Leiden University Medical Center (LUMC), Leiden, Netherlands; Catharina Hospital, Eindhoven, Netherlands; Deventer Hospital, Deventer, Netherlands
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Potjer TP, Schot I, Langer P, Heverhagen JT, Wasser MNJM, Slater EP, Klöppel G, Morreau HM, Bonsing BA, de Vos Tot Nederveen Cappel WH, Bargello M, Gress TM, Vasen HFA, Bartsch DK. Variation in precursor lesions of pancreatic cancer among high-risk groups. Clin Cancer Res 2012; 19:442-9. [PMID: 23172884 DOI: 10.1158/1078-0432.ccr-12-2730] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Pancreatic ductal adenocarcinoma (PDAC) surveillance programs are currently offered to high-risk individuals aiming to detect precursor lesions or PDAC at an early stage. We assessed differences in frequency and behavior of precursor lesions and PDAC between two high-risk groups. EXPERIMENTAL DESIGN Individuals with a p16-Leiden germline mutation (N = 116; median age 54 years) and individuals from familial pancreatic cancer (FPC) families (N = 125; median age 47 years) were offered annual surveillance by MRI and magnetic resonance cholangiopancreatography (MRCP) with or without endoscopic ultrasound (EUS) for a median surveillance period of 34 months (0-127 months) or 36 months (0-110 months), respectively. Detailed information was collected on pancreatic cystic lesions detected on MRCP and precursor lesions in surgical specimens of patients who underwent pancreatic surgery. RESULTS Cystic lesions were more common in the FPC cohort (42% vs. 16% in p16-Leiden cohort), whereas PDAC was more common in the p16-Leiden cohort (7% vs. 0.8% in FPC cohort). Intraductal papillary mucinous neoplasm (IPMN) was a common finding in surgical specimens of FPC-individuals, and was only found in two patients of the p16-Leiden cohort. In the p16-Leiden cohort, a substantial proportion of cystic lesions showed growth or malignant transformation during follow-up, whereas in FPC individuals most cystic lesions remain stable. CONCLUSION In p16-Leiden mutation carriers, cystic lesions have a higher malignant potential than in FPC-individuals. On the basis of these findings, a more intensive surveillance program may be considered in this high-risk group.
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Affiliation(s)
- Thomas P Potjer
- Departments of Gastroenterology & Hepatology, Radiology, Pathology, and Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Potjer TP, Schot I, Langer P, Heverhagen JT, Wasser MNJM, Slater EP, Klöppel G, Morreau HM, Bonsing BA, de Vos Tot Nederveen Cappel WH, Bargello M, Gress TM, Vasen HFA, Bartsch DK. Variation in precursor lesions of pancreatic cancer among high-risk groups. Clin Cancer Res 2012. [PMID: 23172884 DOI: 10.1158/1078-0432.ccr- 12-2730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Pancreatic ductal adenocarcinoma (PDAC) surveillance programs are currently offered to high-risk individuals aiming to detect precursor lesions or PDAC at an early stage. We assessed differences in frequency and behavior of precursor lesions and PDAC between two high-risk groups. EXPERIMENTAL DESIGN Individuals with a p16-Leiden germline mutation (N = 116; median age 54 years) and individuals from familial pancreatic cancer (FPC) families (N = 125; median age 47 years) were offered annual surveillance by MRI and magnetic resonance cholangiopancreatography (MRCP) with or without endoscopic ultrasound (EUS) for a median surveillance period of 34 months (0-127 months) or 36 months (0-110 months), respectively. Detailed information was collected on pancreatic cystic lesions detected on MRCP and precursor lesions in surgical specimens of patients who underwent pancreatic surgery. RESULTS Cystic lesions were more common in the FPC cohort (42% vs. 16% in p16-Leiden cohort), whereas PDAC was more common in the p16-Leiden cohort (7% vs. 0.8% in FPC cohort). Intraductal papillary mucinous neoplasm (IPMN) was a common finding in surgical specimens of FPC-individuals, and was only found in two patients of the p16-Leiden cohort. In the p16-Leiden cohort, a substantial proportion of cystic lesions showed growth or malignant transformation during follow-up, whereas in FPC individuals most cystic lesions remain stable. CONCLUSION In p16-Leiden mutation carriers, cystic lesions have a higher malignant potential than in FPC-individuals. On the basis of these findings, a more intensive surveillance program may be considered in this high-risk group.
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Affiliation(s)
- Thomas P Potjer
- Departments of Gastroenterology & Hepatology, Radiology, Pathology, and Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Voorham-van der Zalm PJ, Voorham JC, van den Bos TWL, Ouwerkerk TJ, Putter H, Wasser MNJM, Webb A, DeRuiter MC, Pelger RCM. Reliability and differentiation of pelvic floor muscle electromyography measurements in healthy volunteers using a new device: The multiple array probe leiden (MAPLe). Neurourol Urodyn 2012; 32:341-8. [PMID: 22972554 DOI: 10.1002/nau.22311] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 08/16/2012] [Indexed: 11/06/2022]
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Heijnsdijk EAM, Warner E, Gilbert FJ, Tilanus-Linthorst MMA, Evans G, Causer PA, Eeles RA, Kaas R, Draisma G, Ramsay EA, Warren RML, Hill KA, Hoogerbrugge N, Wasser MNJM, Bergers E, Oosterwijk JC, Hooning MJ, Rutgers EJT, Klijn JGM, Plewes DB, Leach MO, de Koning HJ. Differences in natural history between breast cancers in BRCA1 and BRCA2 mutation carriers and effects of MRI screening-MRISC, MARIBS, and Canadian studies combined. Cancer Epidemiol Biomarkers Prev 2012; 21:1458-68. [PMID: 22744338 DOI: 10.1158/1055-9965.epi-11-1196] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is recommended that BRCA1/2 mutation carriers undergo breast cancer screening using MRI because of their very high cancer risk and the high sensitivity of MRI in detecting invasive cancers. Clinical observations suggest important differences in the natural history between breast cancers due to mutations in BRCA1 and BRCA2, potentially requiring different screening guidelines. METHODS Three studies of mutation carriers using annual MRI and mammography were analyzed. Separate natural history models for BRCA1 and BRCA2 were calibrated to the results of these studies and used to predict the impact of various screening protocols on detection characteristics and mortality. RESULTS BRCA1/2 mutation carriers (N = 1,275) participated in the studies and 124 cancers (99 invasive) were diagnosed. Cancers detected in BRCA2 mutation carriers were smaller [80% ductal carcinoma in situ (DCIS) or ≤10 mm vs. 49% for BRCA1, P < 0.001]. Below the age of 40, one (invasive) cancer of the 25 screen-detected cancers in BRCA1 mutation carriers was detected by mammography alone, compared with seven (three invasive) of 11 screen-detected cancers in BRCA2 (P < 0.0001). In the model, the preclinical period during which cancer is screen-detectable was 1 to 4 years for BRCA1 and 2 to 7 years for BRCA2. The model predicted breast cancer mortality reductions of 42% to 47% for mammography, 48% to 61% for MRI, and 50% to 62% for combined screening. CONCLUSIONS Our studies suggest substantial mortality benefits in using MRI to screen BRCA1/2 mutation carriers aged 25 to 60 years but show important clinical differences in natural history. IMPACT BRCA1 and BRCA2 mutation carriers may benefit from different screening protocols, for example, below the age of 40.
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Obdeijn IMA, Loo CE, Rijnsburger AJ, Wasser MNJM, Bergers E, Kok T, Klijn JGM, Boetes C. Assessment of false-negative cases of breast MR imaging in women with a familial or genetic predisposition. Breast Cancer Res Treat 2009; 119:399-407. [DOI: 10.1007/s10549-009-0607-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 10/15/2009] [Indexed: 11/24/2022]
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Abstract
BACKGROUND AND AIM Intraluminal nutrients stimulate superior mesenteric artery (SMA) blood flow. Of the macronutrients, especially fat affects the magnitude of the SMA blood flow response to a meal. Little is known however on the influence of fat hydrolysis on SMA flow. METHODS We compared in eight healthy volunteers the SMA flow response (Doppler ultrasonography) to continuous intraduodenal fat perfusion (LCT, 240 kCal h(-1)) during conditions with normal hydrolysis (placebo, control), increased hydrolysis (pancreatic enzyme supplementation; 50 kU lipase) and impaired hydrolysis (orlistat 240 mg). RESULTS Intraduodenal LCT significantly (P<0.01) increased SMA flow in all experiments over basal. The SMA flow response to fat during pancreatic enzyme supplementation (1.49 +/- 0.1 l min(-1)) was significantly (P<0.05) higher compared with placebo (1.11 +/- 0.16 l min(-1)). Lipase inhibition with orlistat did not significantly affect fat stimulated SMA flow compared with placebo: 0.89 +/- 0.08 l min(-1) versus 1.11 +/- 0.16 l min(-1). CONCLUSIONS Administration of pancreatic enzymes significantly increases fat stimulated SMA flow. Fat digest products in the intestinal lumen contribute to the regulation of SMA blood flow.
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Affiliation(s)
- T Symersky
- Department of Gastroenterology-Hepatology, Leiden University Medical Canter, Leiden, The Netherlands
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Florie J, Wasser MNJM, Arts-Cieslik K, Akkerman EM, Siersema PD, Stoker J. Dynamic Contrast-Enhanced MRI of the Bowel Wall for Assessment of Disease Activity in Crohn's Disease. AJR Am J Roentgenol 2006; 186:1384-92. [PMID: 16632735 DOI: 10.2214/ajr.04.1454] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the role of contrast-enhanced dynamic MRI in predicting the disease activity of Crohn's disease. MATERIALS AND METHODS Forty-eight patients in two hospitals who had clinically suspected exacerbation of Crohn's disease were included in this study. In three levels of thickened small-bowel wall, axial dynamic T1-weighted sequences were performed every 4-6 sec for a total duration of 2-3 min after contrast administration; static T1-weighted turbo spin-echo sequences were acquired both before and after contrast administration. The slope of enhancement, enhancement ratio, time to enhancement, enhancement time, and thickness of the small-bowel wall were determined. These MRI results were compared with overall clinical grade, Crohn's disease activity index (CDAI), and Van Hees activity index. Clinical grade was based on clinical information, physical findings, laboratory studies, endoscopy, surgery, and other imaging studies. Spearman's correlation coefficient and p values were determined per hospital. Fisher's z-transformation was applied before pooling the correlation coefficients from both hospitals. RESULTS The enhancement ratio based on the static series showed significant correlation with the clinical grade (r = 0.29, p = 0.045), CDAI (r =0.31, p = 0.033), and Van Hees activity index (r = 0.36, p = 0.016). The enhancement ratio based on the dynamic series correlated significantly with the CDAI (r = 0.38, p = 0.016). Wall thickness correlated significantly with clinical grade (r = 0.47, p = 0.003) and Van Hees activity index (r = 0.41, p = 0.007). CONCLUSION These data suggest that the enhancement ratio of bowel wall after IV administration of gadodiamide and bowel wall thickness are weak to moderate indicators of the severity of Crohn's disease.
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Affiliation(s)
- Jasper Florie
- Department of Radiology, Academic Medical Center, G1-211, PO Box 22700, Amsterdam 1100 DE, The Netherlands
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Elzevier HW, Bevers RFM, Wasser MNJM, Pelger RCM. Testis calcification of the tunica albuginea. Eur Radiol 2005; 16:240-1. [PMID: 15988587 DOI: 10.1007/s00330-005-2802-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Accepted: 05/02/2005] [Indexed: 11/26/2022]
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Pijl MEJ, Doornbos J, Wasser MNJM, van Houwelingen HC, Tollenaar RAEM, Bloem JL. Quantitative analysis of focal masses at MR imaging: a plea for standardization. Radiology 2004; 231:737-44. [PMID: 15163813 DOI: 10.1148/radiol.2313030173] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To assess the effects of changing analytic method variables on the signal intensity (SI) difference-to-noise ratios (SDNRs) for the contrast between lesions and background organs depicted on magnetic resonance (MR) images and to propose a standardized analytic method for the quantitative analysis of focal masses seen at MR imaging. MATERIALS AND METHODS The SIs of 48 liver metastases (originating from colorectal cancer) in 20 patients, the surrounding liver parenchyma, and the background noise were measured on T2-weighted MR images. All 2000 and 2001 issues of the American Journal of Roentgenology, the Journal of Magnetic Resonance Imaging, Magnetic Resonance Imaging, and Radiology were searched for articles describing quantitative analyses. SDNRs were calculated by using formulas from these articles and various region-of-interest (ROI) locations to measure metastasis and background noise SIs. The Wilcoxon signed rank test was used to compare the various SDNR calculations. RESULTS In 34 articles in which quantitative analyses of focal masses are described, the reported SDNRs were calculated with four different formulas. The SDNRs for our study material calculated with the four formulas reported in the literature differed grossly in both number and unit. The SDNRs for ROIs encompassing the entire metastasis differed significantly (P =.034) from the SDNRs for ROIs in a homogeneous area of the metastasis margin. Differences in SDNRs between various noise ROI locations were significant (P <.022). CONCLUSION Slight changes in the variables of quantitative analysis of focal masses had marked effects on reported SDNRs. To overcome these effects, the use of a standardized method involving one formula, a lesion ROI in a homogeneous area at the metastasis margin, and a background noise ROI along the phase-encoding axis in the air (including systematic noise) is proposed for the quantitative analysis of findings on magnitude MR images.
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Affiliation(s)
- Milan E J Pijl
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
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Pijl MEJ, Wasser MNJM, Joekes EC, van de Velde CJH, Bloem JL. Metastases of colorectal carcinoma: comparison of soft- and hard-copy helical CT interpretation. Radiology 2003; 227:747-51. [PMID: 12702822 DOI: 10.1148/radiol.2273020006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare soft- and hard-copy computed tomographic (CT) image interpretation with regard to evaluation time and detection rates for hepatic and extrahepatic colorectal metastases in candidates for liver surgery. MATERIALS AND METHODS In 20 patients with a history of colorectal carcinoma, two radiologists independently evaluated CT data sets. Focal hepatic lesions were characterized as benign or malignant by using a five-point scale. In each patient, soft-copy readouts and hard-copy printouts were compared for nonenhanced hepatic, contrast material-enhanced hepatic, and contrast-enhanced extrahepatic data sets. A stopwatch was used to document evaluation time. Ninety-two hepatic metastases and six extrahepatic metastatic recurrences were detected with the standard of reference--surgical, intraoperative ultrasonographic, and histologic findings. RESULTS Both observers evaluated the contrast-enhanced hepatic data set significantly faster (P =.026 and.009) by using soft-copy readouts. The contrast-enhanced extrahepatic data set was also evaluated significantly faster (P =.010 and.006) with soft-copy readouts. Detection of hepatic and extrahepatic tumor with soft-copy readouts is not significantly superior to that with hard copies. Detection rates of hepatic metastases for nonenhanced and contrast-enhanced CT for both observers ranged from 50%-80% (46-74 of 92) for soft-copy readouts and 46%-75% (42-69 of 92) for hard copies. Interobserver agreement was highest for contrast-enhanced soft-copy readouts for hepatic metastases. CONCLUSION Soft-copy readouts of contrast-enhanced CT data sets for the detection of hepatic metastases and extrahepatic metastatic recurrences were evaluated significantly faster than were hard copies, with at least equal sensitivity and with excellent interobserver agreement.
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Affiliation(s)
- Milan E J Pijl
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, C3-Q, 2333 ZA Leiden, The Netherlands.
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van Erkel AR, Pijl MEJ, van den Berg-Huysmans AA, Wasser MNJM, van de Velde CJH, Bloem JL. Hepatic metastases in patients with colorectal cancer: relationship between size of metastases, standard of reference, and detection rates. Radiology 2002; 224:404-9. [PMID: 12147835 DOI: 10.1148/radiol.2242011322] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To determine the relationship between the size of hepatic metastases, the standard of reference, and the reported detection rate in patients with colorectal cancer. MATERIALS AND METHODS With use of a MEDLINE search (January 1994 to January 2001), articles were selected that contained original results on detection of hepatic metastases of colorectal cancer, categorized for size in at least two categories, with use of helical computed tomography (CT), helical CT at arterial portography, or magnetic resonance imaging. Results were compared with the size distribution of hepatic metastases in 47 consecutive patients with colorectal carcinoma, which were detected by using a combination of intraoperative ultrasonography (US) and palpation. RESULTS Seven studies met all predefined criteria. Four studies involved intraoperative US in all patients and demonstrated a significant negative correlation (-0.988) between detection rate and fraction of small metastases. These studies had a higher fraction and lower detection rate of small metastases and a lower overall detection rate. A majority (58% [145 of 252]) of metastases in the study population were smaller than 20 mm. CONCLUSION Few articles adequately describe the standard of reference and size distribution of hepatic lesions. Hepatic metastases of colorectal cancer are frequently smaller than 20 mm. When the standard of reference is suboptimal, many small metastases are excluded from analysis, and detection rates are therefore inflated.
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Affiliation(s)
- Arian R van Erkel
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands.
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