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Schreyer AG, Dendl LM, Antoch G, Layer G, Beyer L, Schleder S. Interdisziplinäre Tumorkonferenzen in der radiologischen Routine. Radiologe 2020; 60:737-746. [DOI: 10.1007/s00117-020-00685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zusammenfassung
Ziel
Interdisziplinäre Tumorkonferenzen (Boards) sind regelmäßig stattfindende Konferenzen, bei denen unter medizinischen Experten verschiedener Fachrichtungen versucht wird, einen für den Patienten optimierten Behandlungsplan zu erstellen. Die Anwesenheit eines radiologischen Facharztes ist in nahezu allen relevanten Boards medizinisch unumgänglich. Um die aktuelle Beanspruchung der Radiologie durch derartige Boards systematisch zu evaluieren und auch um aktuelle Zahlen zur möglichen zukünftigen Personalplanung zu liefern, haben wir eine aktuelle Standortbestimmung in der Radiologie in Deutschland durchgeführt.
Material und Methoden
Es erfolgte eine Online-Umfrage. Zur Teilnahme aufgefordert waren alle 33 Lehrstuhlinhaber in der Radiologie sowie nach dem Zufallsprinzip weitere 50 ausgewählte Chefärzte für Radiologie an Krankenhäusern der Schwerpunkt-, oder Maximalversorgung (im Folgenden „Schwerpunktkliniken“ genannt).
Ergebnisse
Es nahmen 26 von 33 radiologischen Instituten (79 %) der Universitätskliniken und 28 von 50 Instituten (56 %) der Schwerpunktkliniken teil. Die Gesamtzahl der durchgeführten Tumorboards beträgt im Durchschnitt 3,3 pro Tag bzw. 16,7 pro Woche an Universitätskliniken und 2,6 pro Tag bzw. 13 pro Woche an Schwerpunktkliniken. Es ergibt sich ein durchschnittlicher zeitlicher Aufwand unter Berücksichtigung der Vorbereitungs- und Durchführungszeit sowie der Durchführungshäufigkeiten von 33,1 h/Woche an Universitätskliniken und 18,2 h/Woche an Schwerpunktkliniken. Dies entspricht bei einer 42-Stunden-Woche an Universitätskliniken 78,8 % und bei einer 40-Stunden-Woche an Schwerpunktkliniken 45,5 % einer Facharztstelle, die für interdisziplinäre Tumorboards notwendig sind.
Schlussfolgerung
Die „sprechende“ Radiologie mit ihren interdisziplinären Tumorboards stellt ein klinisches Selbstverständnis unter aktiver Teilnahme und Moderation durch die Radiologie dar, welches die Patientenversorgung evidenzbasiert verbessert. Dennoch muss bei der in der Medizin vorherrschenden Ressourcenknappheit für künftige Diskussionen bezüglich einer personellen Kompensation die hier erhobene Datengrundlage bzgl. des Personalaufwands der klinischen Radiologie für die Teilnahme an Tumorboards bedacht werden.
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Abstract
CLINICAL ISSUE The intravenous administration of contrast agents increases the contrast between diverse tissues and vessels against their surroundings in both computed tomography (CT) and magnetic resonance imaging (MRI) scans and has been generously used for years. There are only a few scientific publications that have systematically evaluated the impact of this contrast-enhancing technique over noncontrast enhancing techniques. RADIOLOGICAL STANDARD According to these publications and our clinical experiences, there are far more indications to use non-contrast-enhancing techniques as they are used in clinical practice. The most important requirement to renounce the use of a contrast agent is sufficient clinical information and differentiated justified indication. The present review shows useful non-contrast-enhanced examination techniques for neuroradiology, musculoskeletal system, lymphatic system, and thorax, including the hearth, abdomen and breasts. CLINICAL RECOMMENDATIONS Good indications for non-contrast imaging are generally follow-ups. In cerebral related questions, like in traumatic or atraumatic emergencies, transient ischemic attacks, minor stroke diagnostic, dementia and in follow-ups of multiple sclerosis, there is usually no need for contrast agent. Examinations of the musculoskeletal systems and follow-up examinations of the lymphatic system can generally be done without a contrast agent. There is no major loss of value in CT and MRI scans of the thorax by examining without contrast. The value of using a contrast agent in the abdomen is far less than expected. Up to now use of a contrast agent is essential in evaluating questions related to vessels or angiomatous tissue and in breast MRI.
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Affiliation(s)
- G Layer
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum Ludwigshafen gGmbH, 67063, Ludwigshafen, Deutschland.
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Abstract
The transformation of a European guideline (2013/59/Euratom) from 2013 into national law requires adaptation of the national statutory regulations. This year, all areas of protection from ionizing radiation will be subject to the new radiation protection law (StrlSchG). Through this, the German X‑ray and Radiation Protection Acts will be combined to form a higher level of authority. The main parts of the StrlSchG will receive a new classification and will be organized according to the exposure scenario: radiation protection in planned exposure scenarios, radiation protection in emergency exposure scenarios, radiation protection in existing exposure scenarios, and the regulation of overall exposure scenarios. The most important or modified regulated points for radiology are concerned with early recognition, where the application of X‑ray or nuclear radiation is permitted in principle under certain conditions; the consultation of medical physics experts in all diagnostic investigative procedures involving radiation and applications for radiological intervention that are linked to high doses in the person under investigation; teleradiology, another special case of the application of X‑rays in humans that requires approval, now with the "required" technical qualification in radiation protection, formerly with the "full" technical qualification, in addition to research, the simplified approval procedure being substituted with a notification procedure.Furthermore, in contrast to previous regulations, those tasked with radiation protection can contact the regulators directly in the case of conflict, which indicates considerable reinforcement of their authority.The only dose limit that will be considerably reduced is the organ-specific equivalent dose of the eye lens, where the highest value will be reduced from 150 to 20 mSv per year in those who are exposed to radiation professionally.
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Affiliation(s)
- G Layer
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum Ludwigshafen gGmbH, 67063, Ludwigshafen, Deutschland.
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Grünwald F, Layer G, Heidgen FJ, Menzel C, Biersack HJ, Rieker O. 99mTc-MAA-Anreicherung in der Leber bei cavo-portalem Shunt über eine rekanalisierte Vena umbilicalis. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1632299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungBei der Lungenperfusionsszintigraphie einer Patientin mit Vena-cava-superior-Verschluß fand sich eine deutliche MAA-Anreicherung in Teilen der Leber. Als Ursache konnte ein Kollateralkreislauf über Venen der Abdominalwand und eine rekanalisierte Vena umbilicalis ermittelt werden. Unter externer Bestrahlung von Lymphomen des oberen Mediastinums kam es zu einem raschen Rückgang des cavo-portalen Shunt-Volumens.
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Layer G. Befunden – die Grundlage der radiologischen Arbeit. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bazal P, Nastase OA, Vieira MS, Maceira Gonzalez AM, Kowal J, Ramos V, Ozer N, Kammerer I, Von Knobelsdorff F, Castillo E, Olaz F, Alvarez V, Sadaba R, Ciriza M, Arrieta V, Escribano E, Beunza MT, G Solana S, Lopez N, Amzulescu M, Boileu L, Page M, De Meester C, Boulif J, Lazam S, Pouleur AC, Vanoverschelde JL, Gerber BL, Kowallick J, Rafiq I, Chabiniok R, Figueroa A, Carr R, Hussain T, Igual B, Monmeneu JV, Lopez-Lereu P, Garcia MP, Cosin-Sales JV, Bigaj J, Hazik A, Kulisiewicz Z, Slupska M, Bitt J, Silva J, Ferreira N, Bettencourt N, Gama V, Canpolat U, Aytemir K, Hazirolan T, Yorgun H, Oto A, Layer G, Kiessling AH, Sack FU, Hennig P, Menza M, Dieringer MA, Foell D, Jung B, Schulz-Menger J, Maceira A, Llopis A, Velez O, Tebar L. Moderated Posters session: cardiovascular magnetic resonanceP967Simplified segmental calculation of extracellular volume with T1 mapping for evaluation of diffuse interstitial fibrosisP968Diffuse myocardial fibrosis quantification by magnetic resonance imaging in patients with aortic valve diseasesP969Occult anthracycline cardiac injury in adolescents and young adults cancer survivors with normal left ventricular ejection fractionP970Reference values for regional and global myocardial T2 mapping with cardiovascular magnetic resonance at 1.5T vs 3TP971The accuracy of a real-time MR method in the assessment of right ventricular volume and functionP972Can blunted heart rate response to adenosine vasodilator stress have prognostic implications on myocardial perfusion imaging by cardiovascular magnetic resonance?P973Association of vitamin d with left atrial fibrosis in patients with lone AF undergoing cryoablationP974Left ventricular remodelling after mitral valve reconstruction: a 1-year prospective cMRI studyP975Abnormal regional myocardial motion in patients with left ventricular pressure overload detected by MR tissue phase mapping at rest and during stressP976Potential utility of splenic switch-off to improve the diagnostic performance of vasodilator stress cardiac magnetic resonance. Preliminary study. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schreyer AG, Layer G. S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist. ROFO-FORTSCHR RONTG 2015; 187:676-84. [PMID: 26019048 DOI: 10.1055/s-0034-1399526] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED Diverticular disease and diverticulitis represent an increasingly common disease especially in patients with advanced age. The German Society of Digestive and Metabolic Diseases (DGVS) as well as the German Society of General and Visceral Surgery (DGAV) in collaboration with the German Radiology Society (DRG) created and published S2k guidelines regarding this topic. Knowledge of the diagnosis and therapy of this common disease is extremely important for the radiologist for the daily clinical routine. In this article we review and discuss the most important clinical situations and algorithms of this disease focusing on radiological topics. Additionally, we introduce the new CCD (classification of diverticular disease) system regarding radiology. KEY POINTS For the diagnosis of a diverticular disease a sectional imaging method should be performed. First choice should be a "qualified ultrasound examination" followed by CT in uncertain situations or complicated disease. Disease classification should be done according the new CCD (Classification of diverticular disease) algorithm. Based on this new CCD patients can be stratified into outpatient, in-house patient and surgical treatment therapy.
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Affiliation(s)
- A G Schreyer
- Institute of Radiology, University Hospital Regensburg, Germany
| | - G Layer
- Central Institute for Diagnostic and Interventional Radiology, Ludwigshafen Hospital, Germany
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Layer G. Integration von Systemen oder Alles aus einer Hand? ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Layer G. Pankreas: Radiologie. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Layer G, Tombach B, Vestring T, Gaibler T. Ein Jahr Patientenrechtegesetz – eine Zwischenbilanz. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Layer G, Reimer P. Vertragsverhandlungen, Verträge mit und ohne Liquidationsrecht. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Layer G. Brauchen wir mehr strukturierte Screeningprogramme? ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stahl T, Engelhardt F, Layer G. [Rare, but significant complication after BCG instillation therapy after urothelial carcinoma]. ROFO-FORTSCHR RONTG 2013; 185:1199-200. [PMID: 23832635 DOI: 10.1055/s-0033-1335877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Layer G. Radiologische PEG Anlage. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Layer G. Vergütung - Worauf ist zu achten! ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mansel RE, MacNeill F, Horgan K, Goyal A, Britten A, Townson J, Clarke D, Newcombe RG, Keshtgar M, Kissin M, Layer G, Hilson A, Ell P, Wishart G, Brown D, West N. Results of a national training programme in sentinel lymph node biopsy for breast cancer. Br J Surg 2013; 100:654-61. [PMID: 23389843 DOI: 10.1002/bjs.9058] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND New Start, a structured, validated, multidisciplinary training programme in sentinel lymph node biopsy (SLNB), was established to allow the introduction and rapid transfer of appropriate knowledge and technical skills to ensure safe and competent practice across the UK. METHODS Multidisciplinary teams attended a theory/skills laboratory course, following which they performed 30 consecutive SLNBs, either concurrently with their standard axillary staging procedure (training model A) or as stand-alone SLNB (training model B). SLNB was performed according to a standard protocol using the combined technique of isotope ((99m) Tc-labelled albumin colloid) and blue dye. An accredited New Start trainer mentored the first five procedures in the participant's hospital, or all 30 if stand-alone. Validation standards for model A and B were a localization rate of at least 90 per cent. In addition, for model A only, in which a minimum of ten patients were required to be node-positive, a false-negative rate (FNR) of 10 per cent or less was required. RESULTS From October 2004 to December 2008, 210 SLNB-naive surgeons, in 103 centres, performed 6685 SLNB procedures. The overall sentinel lymph node (SLN) localization rate was 98·9 (95 per cent confidence interval 98·6 to 99·1) per cent (6610 of 6685) and the FNR 9·1 (7·9 to 10·5) per cent (160 of 1757). The FNR was related to nodal yield, ranging from 14·8 per cent for one node and declining to 9·7, 6·6, 4·7 and 4·1 per cent for two, three, four and more than four SLNs respectively. No learning curve was identified for localization or FNR. CONCLUSION The programme successfully trained a wide range of UK breast teams to perform safe SLNB and suggested that a standard injection protocol and structured multidisciplinary training can abolish learning curves.
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Affiliation(s)
- R E Mansel
- Department of Surgery, Cardiff University, Cardiff, UK.
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Layer G. Chefarztvertrag - Vergütung - Worauf ist zu achten? ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Layer G. Durchleuchtung Ösophagus, Magen, Kolon: Technik und Durchführung. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Babar MM, Madani R, Jackson P, Irvine T, Layer G, Kissin M. P3-07-28: One Step Nucleic Acid Amplification (OSNA) for Intraoperative Molecular Detection of Lymph Node Metastases and Micro-Metastases in Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-07-28] [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
Introduction: Ideally, intraoperative sentinel lymph node analysis in breast cancer should be automated, concordant with histopathology and practically applicable. One step nucleic acid amplification (OSNA), a highly sensitive intraoperative assay of cytokeratin 19 mRNA, is used for the detection of sentinel lymph node (SLN) macro- and micro-metastases in breast cancer. Guildford adopted the intraoperative OSNA “live” in December 2008 after undertaking a multicentre evaluation of its accuracy and high concordance with histopathology and here we present our two year data since its introduction.
Methods: Data was collected prospectively from 2008–10. All patients eligible for sentinel node biopsy were offered OSNA and operations were performed by five consultant breast surgeons. On detection of micro-metastasis (+) and positive but inhibited metastases a level 1 axillary nodal clearance (ANC) and for a macro-metastasis (++), a level 3 ANC was performed.
Results: 471 patients had 999 SLN analysed, median age being 61. All except one were females. 72% (n=340) had wide local excision, 26% (n=120) underwent mastectomy and 2% (8) SNB alone. Mean tumour size was 18.3 mms. 80% (n=371) of the cases were IDC and 55% (n=256) had grade II tumour. 34% (n=161/471) had positive SLN who had further ANC. Of these, 48% (n=78/161) had macro-metastases, 37% (n=59/161) had micro-metastases and 15% (n=24/161) had positive but inhibited results. 17% (10/59) of the patients with micrometastases had positive non-SLN (NSLN), four (4/59, 6.8%) had four positive nodes (SLN+NSLN) thus receiving adjuvant radiotherapy. 8% (2/24) of those with positive but inhibited results and 39% (30/78) of those with macro-metastases had positive NSLN.
Conclusion: Over a third of patients had OSNA positive SLN and underwent axillary surgery at the same operation. This technique eliminates the need for a second operation in sentinel lymph node positive patients and avoids the anxious wait for results in all, streamlining the patient's cancer journey. OSNA upstages patients with micro-metastases and long term studies are needed to determine the clinical relevance of molecular micro-metastatic disease.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-28.
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Affiliation(s)
- MM Babar
- 1Royal Surrey County Hospital, Guildford, SU, United Kingdom; University of Surrey, Guildford, SU, United Kingdom
| | - R Madani
- 1Royal Surrey County Hospital, Guildford, SU, United Kingdom; University of Surrey, Guildford, SU, United Kingdom
| | - P Jackson
- 1Royal Surrey County Hospital, Guildford, SU, United Kingdom; University of Surrey, Guildford, SU, United Kingdom
| | - T Irvine
- 1Royal Surrey County Hospital, Guildford, SU, United Kingdom; University of Surrey, Guildford, SU, United Kingdom
| | - G Layer
- 1Royal Surrey County Hospital, Guildford, SU, United Kingdom; University of Surrey, Guildford, SU, United Kingdom
| | - M Kissin
- 1Royal Surrey County Hospital, Guildford, SU, United Kingdom; University of Surrey, Guildford, SU, United Kingdom
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Babar M, Madani R, Thwaites L, Jackson P, Chakravorty A, Irvine T, Kissin M, Layer G. 5010 ORAL Intraoperative Molecular Detection of Lymph Node Metastases and Micro-metastases – Results of the First UK Centre Using the One Step Nucleic Acid Amplification Assay. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71452-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Layer G. Divertikelkrankheit. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1278860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mansel R, Goyal A, MacNeill F, Newcombe R, Layer G, Kissin M, Horgan K, Britten A, Hilson A, Clarke D, Townson J, Ell P, Wishart G, Brown D, West N, Keshtgar M. Abstract P1-01-01: Learning Sentinel Node Biopsy in the UK: Results of the NEW START Training Program. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p1-01-01] [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: NEW START-a structured, validated multi-professional surgical training programme, was established to allow rapid transfer of appropriate knowledge and technical skills to ensure safe and competent practice of sentinel lymph node biopsy (SLNB) across the UK.
Methods: Multi-professional teams attended a theory/skills-lab course delivering a standardized educational package, following which they performed SLNB in 30 consecutive patients, either concurrently with their standard axillary staging procedure — mentorship training model-or as stand-alone SLNB — apprenticeship training model. An accredited NEW START trainer mentored the first 5 procedures in the participants’ hospital, or all 30 if stand-alone. Validation standards were a localization rate of ≥90% and in the mentorship program where a minimum of 10 cases were node positive, a false-negative rate of ≥10%. SLNB was performed according to a standardised protocol using the combined technique of isotope (0.05-0.1ml of 99mTc-albumin colloid — Nanocoll®) and blue dye (Patent blue V) injected into the tumour quadrant peri-areolar tissue. Isotope was injected intra-dermally and static scintigraphic images were obtained, blue dye was injected sub-dermally after anaesthetic induction.
Results: From October 2004 to December 2008, 210 SLNB naive surgeons, in 103 centres, performed 6,685 SLNB procedures of which 31% (2,098/6,685) were node positive. The mentorship training model was followed in 87% (5,849/6,685). Scintigraphy identified axillary lymph node drainage in 85% (5,564/6,511) with an overall SLN localization rate of 98.9% (6,610/6,685, 95% CI 98.6% to 99.1%). Node positivity was higher (P<0.001) for failed (58.7%, 44/75) than successful (31.1%, 2054/6610) localizations. The mentorship false negative rate (FNR) was 8.9% (163/1821, 95% CI 7.7% to 10.4%). The median SLN yield was 2.0 (range 1-11).
SLN localization and FNR improved with surgeon caseload so that after 20 procedures the FNR fell below 10% but no statistically significant learning curve was identified. The FNR patients who had one SLN harvested was 14.8%. The FNR rate declined to 9.4%, 6.3%, 4.5% and 4.0% for those patients with 2, 3, 4 and more than 4 SLNs removed.
Conclusion: NEW START demonstrates that a standardized injection protocol and structured multi-professional training can abolish learning curves so ensuring patient safety during national adoption of a new technique. Tumor quadrant injection using both isotope and dye has a high localization rate and low false-negative rate. Failed localization indicates higher probability of axillary nodal involvement. It is not necessary to remove more than 4 SLNs to achieve a FNR of less than 5%.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-01.
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Affiliation(s)
- R Mansel
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - A Goyal
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - F MacNeill
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - R Newcombe
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - G Layer
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - M Kissin
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - K Horgan
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - A Britten
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - A Hilson
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - D Clarke
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - J Townson
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - P Ell
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - G Wishart
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - D Brown
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - N West
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
| | - M. Keshtgar
- Cardiff University, Cardiff; Royal Marsden Hospital, London; Royal Surrey County Hospital, Guildford; Leeds General Infirmary, Leeds; St George's Hospital, London; Royal Free Hospital, London; Warwick Hospital; The Middlesex Hospital, London; Addenbrooke's Hospital, Cambridge; Ninewells Hospital, Dundee
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Madani R, Jafferbhoy S, Thwaites L, Jackson P, Layer G, Irvine T, Kissin M. One-Step Nucleic acid Amplification: An intraoperative test for detection of lymph node metastases in breast cancer patients. Results of the first UK centre. Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Madani R, Jafferbhoy S, Thwaites L, Jackson P, Layer G, Irvine T, Kissin M. One-step nucleic acid amplification in detection of lymph node metastases in breast cancer patients: Are patients being over treated? Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mitra A, Conway C, Walker C, Cook M, Powell B, Lobo S, Chan M, Kissin M, Layer G, Smallwood J, Ottensmeier C, Stanley P, Peach H, Chong H, Elliott F, Iles MM, Nsengimana J, Barrett JH, Bishop DT, Newton-Bishop JA. Melanoma sentinel node biopsy and prediction models for relapse and overall survival. Br J Cancer 2010; 103:1229-36. [PMID: 20859289 PMCID: PMC2967048 DOI: 10.1038/sj.bjc.6605849] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [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] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND To optimise predictive models for sentinal node biopsy (SNB) positivity, relapse and survival, using clinico-pathological characteristics and osteopontin gene expression in primary melanomas. METHODS A comparison of the clinico-pathological characteristics of SNB positive and negative cases was carried out in 561 melanoma patients. In 199 patients, gene expression in formalin-fixed primary tumours was studied using Illumina's DASL assay. A cross validation approach was used to test prognostic predictive models and receiver operating characteristic curves were produced. RESULTS Independent predictors of SNB positivity were Breslow thickness, mitotic count and tumour site. Osteopontin expression best predicted SNB positivity (P=2.4 × 10⁻⁷), remaining significant in multivariable analysis. Osteopontin expression, combined with thickness, mitotic count and site, gave the best area under the curve (AUC) to predict SNB positivity (72.6%). Independent predictors of relapse-free survival were SNB status, thickness, site, ulceration and vessel invasion, whereas only SNB status and thickness predicted overall survival. Using clinico-pathological features (thickness, mitotic count, ulceration, vessel invasion, site, age and sex) gave a better AUC to predict relapse (71.0%) and survival (70.0%) than SNB status alone (57.0, 55.0%). In patients with gene expression data, the SNB status combined with the clinico-pathological features produced the best prediction of relapse (72.7%) and survival (69.0%), which was not increased further with osteopontin expression (72.7, 68.0%). CONCLUSION Use of these models should be tested in other data sets in order to improve predictive and prognostic data for patients.
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Affiliation(s)
- A Mitra
- Section of Epidemiology and Biostatistics, Leeds Institute of Molecular Medicine, St James's University Hospital, Beckett Street, Leeds LS97TF, UK.
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Layer G. Fokale Leberläsionen. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
In Germany approximately 29,000 people died of colorectal carcinoma (CRC) in 2002; the risk of getting CRC is 4-6% in Germany, rising with age from the 50th year of life. About one third of all people over 50 years of age have polyps with the potential for malignant transformation in the colorectum, which is a sufficiently high prevalence rate to justify screening. In contrast to most other cancer diseases, in the case of CRC it is possible to prevent the cancer and not only to detect it at an early stage. Application of the test for occult blood in persons between their 45th and 80th years can reduce the mortality of CRC by 14%. We can assume that already regular sigmoidoscopies with consistent performance of polypectomy when needed could reduce the incidence of CRC by 50-70%. There is no doubt that coloscopy is the technique of choice for secondary prevention, as it unites the possibility of complete diagnosis and treatment with a justifiably low level of risk. The economic advantages of an avoidance strategy compared with the treatment of CRC, which is certainly expensive, have been documented. On the basis of all the data reported, in the case of CRC preventive strategies can be emphatically recommended.
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Affiliation(s)
- G Layer
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum der Stadt Ludwigshafen gGmbH, Akademisches Lehrkrankenhaus der Johannes Gutenberg Universität Mainz, Ludwigshafen, Deutschland.
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Goyal A, MacNeill F, Keshtgar M, Horgan K, Kissin M, Layer G, Wishart G, Brown D, Purusotham A, Mansel RE. Injection of radioactive colloid and blue dye at the peri-areolar edge in the tumor quadrant for sentinel lymph node biopsy in breast cancer: Results of the UK NEW START training program. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sirkis V, Fraiture B, Gass S, Layer G, Zahn R, Senges J, Grau A. [Detection of cardial and extracardial right-to-left shunts in young stroke patients]. Nervenarzt 2008; 79:195-201. [PMID: 17924088 DOI: 10.1007/s00115-007-2346-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND The aim of this study was to determine the frequency of extracardial and particularly pulmonal right-to-left-shunts (RLS) in patients with acute cerebral ischemia of unknown origin. PATIENTS AND METHODS We investigated 52 patients under 60 years of age with cerebral ischemic stroke of unknown origin using transesophageal echocardiography (TEE) with special attention to the late phase of ultrasound contrast medium in the left atrium. Additionally we performed contrast transcranial doppler sonography (TCD). RESULTS In the TEE, 25 patients (48%) showed cardial RLS. In seven patients with normal TEE (13.5%) we found evidence of RLS with contrast TCD (spontaneous RLS n=4, RLS after valsalva n=3). In none of these seven patients did we find late-phase contrast in the left atrium. CONCLUSION The constellation of RLS detection in contrast TCD but not in TEE was frequently found. Particularly in spontaneous RLS, this constellation raises the suspicion of a pulmonary shunt. However our extended TEE protocol did not give additional evidence for a pulmonary location of the shunt.
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Affiliation(s)
- V Sirkis
- Zentrum der Psychiatrie, Klinikum der Johann-Wolfgang-Goethe-Universität, Heinrich-Hoffmann-Strasse 10, Frankfurt am Main, Germany.
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Layer G. MR-Kolographie. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Focal hepatic lesions occur in 5% of the population. The clarification of such common occurrences is of major significance because oncological diseases play an important role with respect to morbidity and mortality of the population. The first part of this review article dealt with the most important aspects of classification, epidemiology and pathology of hepatic tumors for radiologists and the current technical situation with regards to the diagnostic procedure. This second part of the review deals with the significance of radiological procedures for identification and differential diagnosis of hepatic tumors.
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Affiliation(s)
- G Layer
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum der Stadt Ludwigshafen gGmbH, Akademisches Lehrkrankenhaus, Johannes-Gutenberg-Universität Mainz, Bremserstrasse 79, 67063, Ludwigshafen, Germany.
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Abstract
Besides malignant disease, focal liver lesions can also represent benign changes. Among the malignant lesions, in addition to hepatocellular carcinoma, liver metastases should be mentioned. In contrast, benign lesions such as focal nodular hyperplasia and hepatocellular adenoma are rarely encountered. Various radiological procedures are employed for the (differential) diagnosis. The transabdominal ultrasound examination is supplemented by color Doppler procedures, contrast-enhanced or intraoperative ultrasound. Computed tomography (CT) should be performed with native images as well as after using modern nonionic, iodine-containing water-soluble contrast agents; multidetector spiral CT is today's standard. If comparable optimal technology is available on-site, (contrast-enhanced) MRI is preferable. Intra-arterial selective angiography has become less important for detecting and characterizing focal liver changes with the advent of tomographic procedures. The question of whether sonography- or CT-guided biopsy of the liver is needed for further diagnostic work-up, whether a wait-and-see approach is justified, or whether surgery is required to clarify the diagnosis should always be answered on a case-by-case basis.
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Affiliation(s)
- G Layer
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum der Stadt Ludwigshafen gGmbH, Akademisches Lehrkrankenhaus der Johannes Gutenberg Universität Mainz, Bremserstrasse 79, 67063 Ludwigshafen, Deutschland.
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Di Palma S, Collins N, Faulkes C, Ping B, Ferns G, Haagsma B, Layer G, Kissin MW, Cook MG. Chromogenic in situ hybridisation (CISH) should be an accepted method in the routine diagnostic evaluation of HER2 status in breast cancer. J Clin Pathol 2007; 60:1067-8. [PMID: 17293390 PMCID: PMC1972421 DOI: 10.1136/jcp.2006.043356] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
MESH Headings
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/therapeutic use
- Breast Neoplasms/diagnosis
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/genetics
- Chromogenic Compounds
- Female
- Genes, erbB-2
- Humans
- In Situ Hybridization/methods
- Patient Selection
- Trastuzumab
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Affiliation(s)
- S Di Palma
- Histopathology, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK.
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Cornelius BC, Kilkowski A, Scheidt T, Beyer MR, Mark B, Layer G. Tako-Tsubo Kardiomyopathie. Charakteristika in der kardialen MRT unter Verwendung der TIRM-Sequenz, des frühen und des späten Kontrastmittelenhancements. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Layer G. MR-Kolographie. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hartmann D, Bassler B, Pfeifer B, Eickhoff A, Weickert U, Riemann JF, Layer G. Patientenakzeptanz der MR-Kolonographie: Eine prospektive Erhebung im Vergleich zur konventionellen Koloskopie. Dtsch Med Wochenschr 2006; 131:2519-23. [PMID: 17091438 DOI: 10.1055/s-2006-955043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Precondition for establishment of magnetic resonance colonography (MRCG) as a diagnostic tool in secondary prevention of colorectal cancer is not only high diagnostic accuracy but also a good acceptance amongst patients. The aim of this study was to compare post-examination appraisal of patients for MRCG to that of bowel preparation and conventional colonoscopy. PATIENTS AND METHODS 88 patients (24 women, 64 men, mean age 67 +- 17,3 years) were interviewed by a standardized questionnaire regarding pain/discomfort (scale from 1 to 10), overall assessment of difficulties and preference for future tests. After bowel cleansing, MRCG and conventional colonoscopy were performed on the same day. Bowel cleansing consisted of drinking about 5 liters of a polyethylene glycol-electrolyte solution. For MRCG the colon was filled with ca. 2000 ml of tap water. Imaging was performed with a 1.5T MR scanner in the prone position. RESULTS Most unpleasant for the patients was the preceding bowel preparation (70%), followed by colonoscopy (14%) and MRCG (8%). The preferred method was MRCG (58%) followed by colonoscopy (20,5%). The most unpleasant symptoms named by patients were the amount of oral electrolyte solution that had to be drunk (34%), abdominal pressure (25%), nausea (24%) because of bowel preparation, body positioning (25%) and rectal tube (13%) during MRCG, abdominal pressure (19%) and pain (18%) during colonoscopy. CONCLUSION Patients' acceptance of MRCG indicates that it has a potential role as an additional diagnostic tool in secondary prevention of colorectal cancer.
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Affiliation(s)
- D Hartmann
- Medizinische Klinik C, Klinikum der Stadt Ludwigshafen gGmbH, Brenserstrasse 79, 67063 Ludwigshafen am Rhein.
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Baßler B, Hartmann D, Pfeiffer B, Schilling D, Riemann JF, Layer G. Kontrastverstärkte Dark Lumen MR-Kolonographie: Ist die Sensitivität bei der Polypendetektion histologieabhängig? ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cornelius BC, Kilkowski A, Kuoraki K, Scheidt T, Mark B, Layer G. Diagnostischer Stellenwert der MRT des Herzens bei Patienten mit Brustschmerz und invasivem Anschluss einer KHK. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Layer G. MR-Kolonographie. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vossoughi D, Breer H, Gauss I, Delank KW, Layer G. Bedeutung der MRT für die Diagnostik der posttraumatischen Anosmie nach Schädel-Hirn-Trauma (SHT). ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-941138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kirchhoff TD, Rudolph KL, Layer G, Chavan A, Greten TF, Rosenthal H, Kubicka S, Galanski M, Manns MP, Schild H, Gallkowski U. Chemoocclusion vs chemoperfusion for treatment of advanced hepatocellular carcinoma: a randomised trial. Eur J Surg Oncol 2005; 32:201-7. [PMID: 16373084 DOI: 10.1016/j.ejso.2005.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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: 09/30/2005] [Accepted: 11/08/2005] [Indexed: 02/08/2023] Open
Abstract
AIMS Transarterial chemoembolization (TACE) can be associated with considerable toxicity and treatment-associated mortality. Transient transarterial chemoocclusion (TACO) using degradable starch microspheres (DSM) has been proposed as a potentially safer alternative while maintaining anti-tumour efficiency. In a randomised phase II trial TACO was compared to transarterial chemoperfusion without DSM (TACP). METHODS Seventy-four patients with advanced HCC were randomised to two treatment arms: (i) TACO (600-1200 mg DSM) and (ii) TACP. In both arms regional chemotherapy consisted of cisplatin (100 mg/m2) and doxorubicin (60 mg/m2). Both arms were corresponding in terms of age, gender, liver performance state, and tumour-stage. A maximum of six treatment cycles was applied in monthly intervals. Follow-up was performed in terms of tumour response, time to progression, survival and quality of life. RESULTS Tumour response rates did not differ significantly between the two treatment arms, however, there was a tendency towards higher response rates in the TACO arm (TACO vs TACP): partial response: 26 vs 9%, stable disease: 41 vs 55%, progressive disease: 33 vs 36%. Time to tumour progression (32 vs 27 weeks), and overall survival (60 vs 69 weeks) were not significantly different. Grade 4 adverse events were rare in both arms and treatment-associated mortality was not observed. In addition, there was no significant difference in terms of quality of life under therapy (EORTC). CONCLUSION TACO with DSM did not improve response or survival significantly compared to TACP in advanced non-resectable HCC.
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Affiliation(s)
- T D Kirchhoff
- Department of Diagnostic Radiology, Hannover Medical School, OE 8220, D-30625 Hannover, and Department of Radiology, University Hospital, Bonn, Germany.
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Hartmann D, Bassler B, Schilling D, Pfeiffer B, Jakobs R, Eickhoff A, Riemann JF, Layer G. Incomplete conventional colonoscopy: magnetic resonance colonography in the evaluation of the proximal colon. Endoscopy 2005; 37:816-20. [PMID: 16116531 DOI: 10.1055/s-2005-870309] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS The purpose of this study was to evaluate dark-lumen magnetic resonance (MR) colonography prospectively in patients with incomplete conventional colonoscopy. PATIENTS AND METHODS Thirty-two patients with incomplete conventional colonoscopy underwent same-day dark-lumen MR colonography on the basis of a standard protocol. The depiction of colorectal diseases was assessed in the following colon segments: cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. The reasons for incomplete colonoscopy included high-grade stenosis in 26 patients (four with occlusive cancer, 12 with fibrotic stenosis based on recurrent sigmoid diverticulitis, eight with Crohn's-induced stenosis, and two with nonsteroidal anti-inflammatory drug colonopathy), extreme patient intolerance in one patient, and technical challenges associated with an elongated colon in five patients. The results of MR colonography were compared with the findings of the initial conventional colonoscopy, the histopathological outcome, and follow-up colonoscopy when possible. RESULTS All high-grade stenoses were confirmed on MR colonographic data sets. Of the 26 patients with high-grade stenosis, 19 underwent surgery with histopathological confirmation of the initial diagnosis. Follow-up colonoscopy was carried out in 14 patients with surgically treated high-grade stenosis. In six of these 14 patients, nine polyps identified at the initial MR colonography were confirmed and removed during a postoperative conventional colonoscopy. Two polyps (5 mm and 8 mm in diameter) identified on postoperative conventional colonoscopy had not been seen preoperatively at MR colonography. One polyp seen on MR colonography was not identified in the follow-up colonoscopy. CONCLUSION Dark-lumen MR colonography is a feasible and useful method of evaluating the entire colon in patients with incomplete conventional colonoscopy.
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Affiliation(s)
- D Hartmann
- Dept. of Medicine C (Gastroenterology) Ludwigshafen Academic Teaching Hospital, University of Mainz, Bremserstrasse 79, 67063 Ludwigshafen, Germany
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Baßler B, Hartmann D, Pfeifer B, Schilling D, Riemann JF, Layer G. Kontrastverstärkte Dark-lumen-MR-Kolonographie bei adenomatösen versus hyperplastischen kolorektalen Polypen. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-868234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Layer G. Virtuelle MR-Kolonographie. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baßler B, Hartmann D, Pfeifer B, Schilling D, Riemann JF, Layer G. Dark-lumen-MR-Kolonographie bei inkompletter Endoskopie des Dickdarms. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cornelius BC, Mark B, Kilkowski A, Scheidt T, Kouraki K, Zahn R, Layer G. MRT des Herzen bei Troponin-positiven Patienten mit dem klinischen Bild einer akuten Myokarditis. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Weikel W, Hofmann M, Steiner E, Bohrer M, Layer G. [Stereotactic vacuum-assisted breast biopsy - analysis of 166 cases]. ACTA ACUST UNITED AC 2004; 126:87-92. [PMID: 15112135 DOI: 10.1055/s-2004-818774] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Screening mammography (as planned in Germany) will lead to an increasing number of breast biopsies. The purpose of this study was to determine the promise of directional large core biopsy as a patient-protecting therapeutic method. MATERIAL AND METHODS 166 vacuum assisted, X-ray-guided biopsy procedures were analysed. RESULTS Histopathologic examination resulted in 75.8 % benign lesions. Atypical proliferation and noninvasive neoplasia was found in 18.6 %, invasive carcinoma in 5.4 % of the biopsies. Complications were few. Neither skin- or chestwall injuries, nor pain or intraoperative bleeding caused an abortion. Postoperative we found four cases of bleeding, further on in 28.3 % a superficial, in 3 % a larger and deep hematoma, but in total without any operative revision. No infection was diagnosed. In the average 17.2 (8-31) specimens were removed. After excision of 18 probes the definitive histopathologic diagnosis was clear in all cases, also, the microcalcifications were found. The underestimation rate amounted to 3 of 35 cases. CONCLUSIONS This clinical study proves stereotactic vacuum-assisted biopsy as a relieable method for analysing indeterminate mammographically detected breast lesions, which shows lower rates of complications than conventional surgical procedures.
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Baßler BB, Hartmann D, Tiziani B, Schilling D, Breer H, Riemann JF, Layer G. Patientenakzeptanz der Dark Lumen MR-Kolonographie im Vergleich zur Koloskopie in einer prospektiven klinischen Studie. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baßler BB, Hartmann D, Tiziani B, Schilling D, Breer H, Riemann JF, Layer G. Dark Lumen MR-Kolonographie versus Koloskopie bei der Detektion von kolorektalen Polypen: Eine prospektive Doppelblindstudie. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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