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Ślusarczyk A, Zapała P, Olszewska-Ślusarczyk Z, Radziszewski P. The prediction of cancer-specific mortality in T1 non-muscle-invasive bladder cancer: comparison of logistic regression and artificial neural network: a SEER population-based study. Int Urol Nephrol 2023; 55:2205-2213. [PMID: 37280316 PMCID: PMC10406653 DOI: 10.1007/s11255-023-03655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/27/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE To identify the risk factors for 5-year cancer-specific (CSS) and overall survival (OS) and to compare the accuracy of logistic regression (LR) and artificial neural network (ANN) in the prediction of survival outcomes in T1 non-muscle-invasive bladder cancer. METHODS This is a population-based analysis using the Surveillance, Epidemiology, and End Results database. Patients with T1 bladder cancer (BC) who underwent transurethral resection of the tumour (TURBT) between 2004 and 2015 were included in the analysis. The predictive abilities of LR and ANN were compared. RESULTS Overall 32,060 patients with T1 BC were randomly assigned to training and validation cohorts in the proportion of 70:30. There were 5691 (17.75%) cancer-specific deaths and 18,485 (57.7%) all-cause deaths within a median of 116 months of follow-up (IQR 80-153). Multivariable analysis with LR revealed that age, race, tumour grade, histology variant, the primary character, location and size of the tumour, marital status, and annual income constitute independent risk factors for CSS. In the validation cohort, LR and ANN yielded 79.5% and 79.4% accuracy in 5-year CSS prediction respectively. The area under the ROC curve for CSS predictions reached 73.4% and 72.5% for LR and ANN respectively. CONCLUSIONS Available risk factors might be useful to estimate the risk of CSS and OS and thus facilitate optimal treatment choice. The accuracy of survival prediction is still moderate. T1 BC with adverse features requires more aggressive treatment after initial TURBT.
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Affiliation(s)
- Aleksander Ślusarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005 Warsaw, Poland
| | - Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005 Warsaw, Poland
| | | | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005 Warsaw, Poland
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Ma XB, Ma HY, Jia XF, Wen FF, Liu CX. Misdiagnosis of an elevated lesion in the esophagus: A case report. World J Clin Cases 2022; 10:9828-9833. [PMID: 36186185 PMCID: PMC9516941 DOI: 10.12998/wjcc.v10.i27.9828] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/30/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Esophageal carcinosarcoma (ECS) is a rare biphasic tumor and a type of esophageal malignancy, which presents as protruding or elevated lesions. ECS patients are often not hospitalized until they have severe dysphagia. ECS is easily misdiagnosed as a benign tumor due to its atypical characteristics under endoscopy. With the popularization of endoscopic treatment, these patients are often referred to endoscopic treatment, such as endoscopic submucosal dissection (ESD). However, there is a lack of consensus on the endoscopic features and therapies for ECS. Here, we report a case of ECS and discuss the value of endoscopic diagnosis and therapeutic strategies.
CASE SUMMARY A 63-year-old man was admitted to the hospital with dysphagia. During the endoscopic examination, an elevated lesion was found with an erosive and hyperemic surface covered with white pseudomembranous inflammation. Endoscopic ultrasonography (EUS), biopsies, and enhanced thoracic computed tomography were performed, suggesting that it was a benign lesion and located within the submucosal layer. This lesion was diagnosed as a fibrovascular polyp with a Paris classification of 0-Ip. The patient was then referred to ESD treatment. However, the post-ESD pathological and immunohistochemical study showed that this lesion was ECS with a vertical positive margin (T1b stage), indicating that we made a misdiagnosis and achieved a noncurative resection. Due to the potential tumor residue, additional open surgery was performed at the patient's request. In the postoperative pathological study, no tumor remnants or metastases were discovered. The patient was followed for 1 year and had no recurrence.
CONCLUSION ECS can be misdiagnosed at the initial endoscopy. EUS can help to identify the tumor stage. Patients with T1b stage ECS cannot be routinely referred to ESD treatment due to the high risk of metastasis and recurrence rate.
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Affiliation(s)
- Xing-Bin Ma
- Department of Gastroenterology and Hepatology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Huai-Yuan Ma
- Department of Gastroenterology and Hepatology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Xing-Fang Jia
- Department of Gastroenterology and Hepatology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Fei-Fei Wen
- Department of Pathology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Cheng-Xia Liu
- Department of Gastroenterology and Hepatology, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
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Nian J, Tao L, Zhou W. Prior endoscopic resection does not affect the outcome of secondary surgery for T1 colorectal cancer, a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:273-81. [PMID: 34716475 DOI: 10.1007/s00384-021-04049-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND It remains unclear the effect of prior endoscopic resection (ER) on the secondary surgery (SS) for T1 colorectal cancer (CRC). This study aimed to compare the short- and long-term outcomes between primary surgery (PS) and ER followed by SS for T1 CRC. METHODS A systematic literature search was performed in PubMed and Ovid for studies comparing PS with ER followed by SS for T1 colorectal cancer. The last search was performed on 18 May 2021. The primary outcomes were surgical parameters and the secondary outcomes were survival indicators. The meta-analysis was performed with Review Manager Software (version 5.3). RESULTS A total of fifteen studies published between 2013 and 2021 with 4349 patients were included in this meta-analysis finally. No significant difference was observed between the two groups for operative time (P = 0.75, WMD = 3.16, 95%CI [-15.88, 22.19], I2 = 64%), blood loss (P = 0.86, WMD = 12.33, 95%CI [-122.99, 147.65], I2 = 95%), and postoperative complications (P = 0.59, OR = 0.93, 95%CI [0.71, 1.22], I2 = 0%). Besides, the two groups showed comparable survival outcomes, including overall recurrence rate (P = 0.15, OR = 0.78, 95%CI [0.56, 1.09], I2 = 23%) and 5-year overall survival (P = 0.76, OR = 0.86, 95%CI [0.33, 2.25], I2 = 0%). In the subgroup analysis for studies with propensity matching score or lesions located in the rectum, the results were not changed. CONCLUSION ER followed by SS is feasible for T1 CRC with high-risk factors. The prior ER would not bring additional adverse effects to the SS. More advanced tools should be developed to improve the diagnostic accuracy for the high-risk factors before treatment for T1 CRC.
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Zhou X, Chen H, Li S, Hua J, Zhang W, Li X, Si X, Zhang G. Treatment Options for T1 Stage Adenocarcinoma of Esophagogastric Junction: A Real-World Retrospective Cohort Study. Cancer Control 2021; 28:10732748211063955. [PMID: 34913741 PMCID: PMC8723737 DOI: 10.1177/10732748211063955] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The number of patients diagnosed with T1 stage adenocarcinoma of
esophagogastric junction (AEGJ) has been increasing. This study was
conducted to investigate the effect of different treatment options (surgery,
chemoradiation, and surgery+chemoradiation) on long-term survival in
patients with T1-stage AEGJ. Methods We searched the Surveillance, Epidemiology, and End Results (SEER) database
to identify the records of patients with T1-stage AEGJ between 2010 and
2018. Patient demographics and cancer parameters were compared among the
three groups. The Kaplan–Meier method and Cox proportional hazard modeling
were used to compare long-term survival. Results Data from 925 T1 stage AEGJ patients (surgery: n=516, surgery+chemoradiation:
n=206, chemoradiation: n=203) were collected. We found that the OS and CSS
rates of three treatment options had significant difference. Besides,
positive nodal status also showed lower OS and CSS rat. Multivariate Cox
regression analysis showed that surgery group has much lower risk of death
compared with chemoradiation group and similar risk of death compared with
surgery+chemoradiation group. Subgroup analysis suggested that in patients
with N1–N3 status had higher OS and CSS rates in surgery+chemoradiation
group. Conclusion Using SEER data, we identified a significant survival advantage with the use
of surgery compared to chemoradiation in patients with T1-stage AEGJ while
the long-term survival of patients after surgery+chemoradiation group was
not significantly different and low risk of death in positive nodal
status.
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Affiliation(s)
- Xiaoying Zhou
- Department of Gastroenterology, 74734First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Han Chen
- Department of Gastroenterology, 74734First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuo Li
- Department of Gastroenterology, 74734First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Hua
- Department of Gastroenterology, 74734First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weifeng Zhang
- Department of Gastroenterology, 74734First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xueliang Li
- Department of Gastroenterology, 74734First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinmin Si
- Department of Gastroenterology, 74734First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guoxin Zhang
- Department of Gastroenterology, 74734First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Tang CT, Guo ZX, Wang P, Chen YX, Zeng CY. Higher LNM rate and poorer prognosis of early-onset compared to late-onset T1 stage colorectal cancer: a large-population based study. Am J Cancer Res 2021; 11:3176-3188. [PMID: 34249453 PMCID: PMC8263633] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/17/2021] [Indexed: 06/13/2023] Open
Abstract
As for T1 stage CRC, there is little knowledge of differences in lymph node metastasis (LNM) and prognosis between early-onset and late-onset CRC. To know that, we included 13,084 patients from the SEER database and 476 patients in T1 stage from our hospital to analyze difference of LNM and prognosis. Univariate and multivariate logistic analyses revealed that early-onset CRC was more likely than late-onset CRC to be positive for LNM. In addition, we found that T1b stage, poor differentiation and lymphatic invasion were risk factors for LNM. Specifically, we found that black race was a risk factor. Before propensity-score matching (PSM), we also found that early-onset CRC patients had better survival, as demonstrated by SEER data. After adjusting for confounding factors by PSM, we found that early onset remained a risk factor for LNM. Moreover, we found that patients diagnosed with early-onset CRC had a poorer prognosis than those diagnosed with late-onset CRC, which was demonstrated by analysis of SEER data and our own data. In conclusion, our study was the first to find that early-onset T1 stage CRC more frequently developed LNM, suggesting that endoscopic submucosal resection should be performed more carefully in these patients. Moreover, early-onset patients in the T1 stage also had poorer survival, suggesting that clinical doctors should pay more attention to early-onset patients.
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Affiliation(s)
- Chao-Tao Tang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University Nanchang, China
| | - Zi-Xiang Guo
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University Nanchang, China
| | - Peng Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University Nanchang, China
| | - You-Xiang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University Nanchang, China
| | - Chun-Yan Zeng
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University Nanchang, China
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Xu M, Tang Q, Li M, Liu Y, Li F. An analysis of Ki-67 expression in stage 1 invasive ductal breast carcinoma using apparent diffusion coefficient histograms. Quant Imaging Med Surg 2021; 11:1518-1531. [PMID: 33816188 DOI: 10.21037/qims-20-615] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background To investigate the value of apparent diffusion coefficient (ADC) histograms in differentiating Ki-67 expression in T1 stage invasive ductal breast carcinoma (IDC). Methods The records of 111 patients with pathologically confirmed T1 stage IDC who underwent magnetic resonance imaging prior to surgery were retrospectively reviewed. The expression of Ki-67 in tumor tissue samples from the patients was assessed using immunohistochemical (IHC) staining, with a cut-off value of 25% for high Ki-67 labeling index (LI). ADC images of the maximum lay of tumors were selected, and the region of interest (ROI) of each lay was delineated using the MaZda software and analyzed by histogram. The correlations between the histogram characteristic parameters and the Ki-67 LI were investigated. Additionally, the histogram characteristic parameters of the high Ki-67 group (n=54) and the low Ki-67 group (n=57) were statistically analyzed to determine the characteristic parameters with significant difference. Receiver operator characteristic (ROC) analyses were further performed for the significant parameters. Results The mean value, and the 1st, 10th, 50th, 90th, and 99th percentiles were found to be negatively correlated with the expression of Ki-67 (all P values <0.001), with a correlation coefficient of -0.624, -0.749, -0.717, -0.621, -0.500, and -0.410, respectively. In the high Ki-67 group, the mean value, and the 1st, 10th, 50th, 90th, and 99th percentiles extracted by the histogram were significantly lower (all P values <0.05) than that of the low Ki-67 group, with areas under the ROC curves ranging from 0.717-0.856. However, the variance, skewness, and kurtosis did not differ between the two groups (all P values >0.05). Conclusions Histogram-derived parameters for ADC images can serve as a reliable tool in the prediction of Ki-67 proliferation status in patients with T1 stage IDC. Among the significant ADC histogram values, the 1st and 10th percentiles showed the best predictive values.
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Affiliation(s)
- Maolin Xu
- Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Tang
- Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Manxiu Li
- Department of Breast Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yulin Liu
- Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Li
- Department of Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Pecoraro A, Palumbo C, Knipper S, Mistretta FA, Rosiello G, Tian Z, St-Hilaire PA, Shariat SF, Saad F, Lavallée L, Briganti A, Kapoor A, Fiori C, Porpiglia F, Karakiewicz PI. Synchronous Metastasis Rates in T1 Renal Cell Carcinoma: A Surveillance, Epidemiology, and End Results Database-based Study. Eur Urol Focus 2020; 7:818-826. [PMID: 32169361 DOI: 10.1016/j.euf.2020.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/20/2019] [Revised: 01/19/2020] [Accepted: 02/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Synchronous metastasis (SM) rates in T1 renal cell carcinoma (RCC) patients relied on historical cohorts and may not take into account the favorable stage migration toward lower tumor size (TS) that occurred in more recent years. OBJECTIVE To investigate SM rates in T1 RCC patients according to histological subtype (HS), tumor grade (TG), and TS. INTERVENTION Partial nephrectomy, radical nephrectomy, focal ablation, and non-interventional management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Within the Surveillance, Epidemiology, and End Results database (2004-2015), 60 640 stage T1 patients were identified. SM rates were tabulated and tested in multivariable logistic regression models. RESULTS AND LIMITATIONS According to HS, average SM rates were 0%, 0.5%, 1.1%, 1.4%, 3.7%, 21.5%, and 36.2% for multilocular cystic, chromophobe, papillary, clear cell TG 1-2, clear cell TG 3-4, collecting duct, and sarcomatoid RCC, respectively. In a multivariate logistic regression model, age, TS, HS, and TG were independent predictors of SM. Bone only was the commonest metastatic site (41.0%), followed by lung only (24.5%), liver only (3.6%), and brain only (3.8%). Of all SM patients, 72.8% harbored a single metastatic site. The major limitations of this study are lack of recurrence and metastatic progression data. CONCLUSIONS Within T1 RCC, it was possible to identify five metastatic risk categories according to SM rates: (1) multilocular cystic RCC (0%), (2) chromophobe RCC (0-2.0%), (3) clear cell TG 1-2 and papillary RCC, (4) clear cell TG 3-4 RCC (1.2-8.9%), and (5) sarcomatoid and collecting duct RCC (7.0-49.1%). The most frequent metastatic location is bone only, followed by lung only, and virtually all SMs are solitary. PATIENT SUMMARY Metastatic rate varies in T1 stage renal cell carcinoma patients according to tumor size, histology, and tumor grade.
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Affiliation(s)
- Angela Pecoraro
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
| | - Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy
| | - Sophie Knipper
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco A Mistretta
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Pierre-Antoine St-Hilaire
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | | | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Luke Lavallée
- Division of Urology, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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Dai W, Mo S, Xiang W, Han L, Li Q, Wang R, Xu Y, Cai G. The Critical Role of Tumor Size in Predicting Prognosis for T1 Colon Cancer. Oncologist 2019; 25:244-251. [PMID: 32162825 DOI: 10.1634/theoncologist.2019-0469] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/14/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The role of horizontal growth index of tumor size in survival prediction is still underappreciated in colon cancer because of the identification of vertical infiltration index reflected by T stage. We sought to reveal the impact of T stage on the prognostic and predictive value of tumor size in colon cancer. MATERIALS AND METHODS Data of patients with stage I-III colon cancer were extracted from Surveillance, Epidemiology, and End Results Program (SEER) and Fudan University Shanghai Cancer Center (FUSCC) databases. Harrell's concordance index (c-index) and time-dependent receiver operating characteristic curve (ROC) were used to analyze the discriminative ability of prognostic factors. RESULTS Stratified analyses based on T stage found that the increase of T stage significantly and negatively repressed the effect of tumor size on death and recurrence risk. In addition, tumor size showed the greatest hazard ratio of cancer-specific death and relapse in T1 colon cancer. Even more importantly, the discriminatory ability of tumor size outperformed any other widely accepted prognostic clinical features in predicting cancer-specific survival (SEER: c-index 0.637, area under the ROC [AUC] 0.649; FUSCC: c-index 0.673, AUC 0.686) and disease-free survival (FUSCC: c-index 0.645, AUC 0.656) in T1 stage colon cancer. CONCLUSION Tumor size is a critical clinical factor with considerable prognostic and predictive value for T1 colon cancer, and it should be selectively incorporated into the current staging system to facilitate prediction of death and recurrence risk. IMPLICATIONS FOR PRACTICE To date, no consensus has been reached about the prognostic and predictive value of tumor size in colon cancer. Although tumor size is an independent prognostic factor for patients with colon cancer, the impact of tumor size on death or recurrence risk decreased notably with the increase of T stage. More importantly, the discriminative ability of tumor size outperformed any other clinical factors including N stage in patients with T1 colon cancer. Therefore, tumor size should be recommended to be incorporated into current staging systems to facilitate prognosis prediction for patients with T1 colon cancer.
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Affiliation(s)
- Weixing Dai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Shaobo Mo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Wenqiang Xiang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Lingyu Han
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Renjie Wang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Guoxiang Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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Wang QH, Ji JL, Li H, He PL, Song LX, Zhao Y, Wang HY, Huang T, Sun XX, Cao YW, Dong Z, Shi BB. [Preoperative Lymphocyte-to-monocyte Ratio Predicts Prognosis in Patients with Stage T1 Non-muscle Invasive Bladder Cancer]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2019; 41:622-629. [PMID: 31699192 DOI: 10.3881/j.issn.1000-503x.11227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective To investigate the clinical value of preoperative lymphocyte-to-monocyte ratio(LMR)in evaluating the prognosis of patients with stage T1 non-muscle invasive bladder cancer(NMIBC).Methods A total of 215 patients with stage T1 NMIBC who underwent transurethral resection of bladder tumor were enrolled.Clinical data were collected.Patients were followed up and their disease-free survival(DFS)and overall survival(OS)were recorded.The receiver operating characteristic(ROC)curve of preoperative LMR in detecting patient prognosis was used to determine the optimal cut-off value for LMR.Patients were divided into low LMR group(LMR <3.86,n=77)and high LMR group(LMR ≥ 3.86,n=138).Kaplan-Meier survival curves were explored to compare cumulative DFS and OS rates in patients with different LMR levels,and COX proportional hazards regression model was used to analyze factors associated with DFS and OS.Results All these 215 patients with T1 stage NMIBC were followed up for 2-92 months,and the DFS rate was 59.07% and OS rate was 65.12%.Kaplan-Meier curves showed that the cumulative DFS rate(χ 2=4.784,P=0.029)and cumulative OS rate(χ 2=7.146, P=0.008)in the low LMR group were significantly lower than those in the high LMR group.Tumor size ≥ 3 cm(HR=1.398,95% CI:1.042-1.875,P=0.025),pathological grade G3(HR=1.266,95% CI:1.026-1.563,P=0.028),and LMR ≥ 3.86(HR=2.347,95% CI:1.080-5.101,P=0.031)were independent factors associated with DFS in patients with stage T1 NMIBC.In addition,tumor size ≥ 3 cm(HR=1.228,95% CI:1.015-1.484,P=0.034),pathological grade G3(HR=1.366,95% CI:1.017-1.834,P=0.038),and LMR<3.86(HR=2.008,95% CI:1.052-3.832,P=0.035)were independent factors associated with OS in patients with T1 stage NMIBC. Conclusion Preoperative LMR is an independent factor associated with patients' prognosis in T1 stage NIMBC.Patients with low LMR tend to have higher risk of NMIBC progression and death.
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Affiliation(s)
- Qing Hai Wang
- Department of Kidney Transplantation,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China
| | - Jian Lei Ji
- Department of Kidney Transplantation,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China
| | - Hong Li
- Department of Kidney Transplantation,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China
| | - Ping Li He
- Department of Kidney Transplantation,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China
| | - Li Xia Song
- Department of Kidney Transplantation,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China
| | - Yang Zhao
- Department of Kidney Transplantation,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China
| | - Hong Yang Wang
- Department of Kidney Transplantation,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China
| | - Tao Huang
- Department of Kidney Transplantation,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China
| | - Xiao Xia Sun
- Department of Kidney Transplantation,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China
| | - Yan Wei Cao
- Department of Kidney Transplantation,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China
| | - Zhen Dong
- Department of Kidney Transplantation,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China
| | - Bing Bing Shi
- Department of Urology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
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10
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Li G, Zhu D, Gao H, Chen H, Li Y, Niu Y. Oncologic outcomes of nephron-sparing surgery in patients with T1 multifocal renal cell carcinoma. Clin Transl Oncol 2018; 21:760-765. [PMID: 30443869 DOI: 10.1007/s12094-018-1984-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/17/2018] [Accepted: 11/09/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This study is performed to explore the pathological characteristics and oncologic outcomes of T1 multifocal renal cell carcinoma (RCC). METHODS The clinical data of 600 patients (442 males and 158 females) between the age of 29 and 73 years, diagnosed with T1 RCC were collected from three hospitals in China, out of which 421 cases had undergone nephron-sparing surgery (NSS) and 179 cases had undergone radical nephrectomy (RN) between December 2010 and January 2015. RESULTS Tumor was identified with multifocality in 32 patients (5.33%), out of which 21 were set to receive NSS, and 11 to receive RN, respectively; 21 cases of clear cell tumor, 8 cases of papillary tumor, 1 case of chromophobe tumor and 2 cases of Xp.11.2 translocation RCC. Among 568 cases of monofocal tumors, 400 patients underwent NSS, and the remaining 168 patients underwent RN, respectively. After a median follow-up of 5 years, 13 patients were found with recurrent tumors out of those who had undergone NSS, 11 with monofocal tumors and 2 with multifocal tumors containing satellite tumor nodules (p = 0.13). Out of the 32 individuals with multifocal RCC, 4 cases were reported to have died of cancer, 2 of NSS and 2 of RN. From these findings, the cancer-specific survival for NSS and RN was estimated to be 90.48% and 81.82%, respectively (p = 0.48). CONCLUSION The findings from the study suggested that there were pathological differences in multifocal renal tumors, and that papillary carcinoma may be more common than clear cell carcinoma. The recurrence rate and survival rate of multifocal RCC were similar to monofocal tumors. Tumor recurrence may be related to satellite tumor nodules, which can only be detected once surgery is performed.
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Affiliation(s)
- G Li
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin Medical University, Tianjin, 300211, China
| | - D Zhu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin Medical University, Tianjin, 300211, China
| | - H Gao
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin Medical University, Tianjin, 300211, China
| | - H Chen
- The Second People's Hospital of Lianyungang, Lian Yungang City, 222000, Jiangsu Province, China
| | - Y Li
- Department of Pathology, The People's Hospital of Liao Cheng, Liao Cheng City, 252000, Shandong Province, China
| | - Y Niu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin Medical University, Tianjin, 300211, China.
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11
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Sun ZQ, Ma S, Zhou QB, Yang SX, Chang Y, Zeng XY, Ren WG, Han FH, Xie X, Zeng FY, Sun XT, Wang GX, Li Z, Zhang ZY, Song JM, Liu JB, Yuan WT. Prognostic value of lymph node metastasis in patients with T1-stage colorectal cancer from multiple centers in China. World J Gastroenterol 2017; 23:8582-8590. [PMID: 29358866 PMCID: PMC5752718 DOI: 10.3748/wjg.v23.i48.8582] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the features and prognostic value of lymph node metastasis in patients with T1-stage colorectal cancer (CRC).
METHODS In all, 321 cases of T1-stage CRC were selected from 10132 patients with CRC who received surgical therapy in six large-scale hospitals in China and were retrospectively analyzed. Univariate and multivariate analyses were performed to analyze the risk factors for lymphatic metastasis. A survival analysis was then performed to analyze the prognostic value of lymph node metastasis.
RESULTS The occurrence rate of T1 stage was 3.17% (321/10132); of these patients, the lymph node metastasis rate was 8.41% (27/321), and the non-lymph node metastasis rate was 91.59% (294/321). Univariate analysis showed that preoperative serum CEA, preoperative serum CA199, preoperative serum CA724, vascular invasion, and degree of differentiation were associated with lymph node metastasis in T1-stage CRC (P < 0.05 for all). Multivariate analysis indicated that preoperative serum CA724, vascular invasion, and degree of differentiation were closely related to lymph node metastasis (P < 0.05 for all). Log-rank survival analysis showed that age, preoperative serum CEA, preoperative serum CA199, vascular invasion, degree of differentiation, and lymph node metastasis (χ2 = 24.180, P < 0.001) were predictors of 5-year overall survival (OS) (P < 0.05 for all). COX regression analysis demonstrated that preoperative serum CA199 and lymph node metastasis (HR = 5.117; P < 0.05; 95%CI: 0.058-0.815) were independent prognostic indicators of 5-year OS in patients with T1-stage CRC (P < 0.05 for both).
CONCLUSION The morbidity of T1-stage CRC was 3.17% for all CRC cases. Preoperative serum CA724, vascular invasion, and degree of differentiation are independent risk factors for lymph node metastasis. Lymph node metastasis is an independent prognostic factor for OS in patients with T1-stage CRC.
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Affiliation(s)
- Zhen-Qiang Sun
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- Department of Gastrointestinal Surgery, the Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Shuai Ma
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Quan-Bo Zhou
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Shuai-Xi Yang
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Yuan Chang
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xiang-Yue Zeng
- Department of Gastrointestinal Surgery, the Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Wei-Guo Ren
- Department of Gastroenterology, the Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Fang-Hai Han
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Xiang Xie
- Department of Coronary Artery Disease, Heart Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Fan-Ye Zeng
- Department of Oncology, the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Xian-Tao Sun
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Gui-Xian Wang
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Zhen Li
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Zhi-Yong Zhang
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Jun-Min Song
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Jin-Bo Liu
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Wei-Tang Yuan
- Department of Anorectal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
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12
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Xiong J, Wang R, Sun Y, Chen H. Lymph node metastasis according to primary tumor location in T1 and T2 stage non-small cell lung cancer patients. Thorac Cancer 2016; 7:304-9. [PMID: 27148415 PMCID: PMC4846618 DOI: 10.1111/1759-7714.12328] [Citation(s) in RCA: 4] [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: 09/15/2015] [Accepted: 11/23/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To evaluate the pattern of lymph node metastasis (LNM) according to primary tumor location in T1 and T2 stage non-small cell lung cancer (NSCLC) patients. METHODS The data of 1916 NSCLC patients with LNM who underwent surgery with systematic nodal resection between November 2008 to December 2014 were included in the study. Analyses of tumor location, pathological T stage, and nodal metastasis were performed. RESULTS In T1a stage patients, superior mediastinum, aortopulmonary, and inferior mediastinum lymph node metastases were observed in primary tumors present in the right upper lobe (RUL), left upper lobe (LUL) and right middle lobe (RML), respectively. In T1b-stage patients, superior mediastinum, aortopulmonary, and inferior mediastinum lymph node metastases were observed in the RML, LUL, and right lower lobe (RLL), respectively. In patients with T2a-stage, superior mediastinum, aortopulmonary and inferior mediastinum lymph node metastases were observed in the RUL, LUL, and RLL, respectively. However, in T2b-stage patients, RUL, LUL and RML locations were associated with superior mediastinum, aortopulmonary, and inferior mediastinum lymph node metastases, respectively. Multivariable logistic regression showed that T stage was significantly associated with mediastinal and intrapulmonary lymph node metastases. In addition, tumor location was significantly associated with N2 station LNM. CONCLUSION LNM varied according to tumor location and T-stage, which are independent factors influencing N2 station LNM.
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Affiliation(s)
- Jian Xiong
- Department of Thoracic Surgery Fudan University Shanghai Cancer Center Shanghai China; Department of Oncology Shanghai Medical College Fudan University Shanghai China
| | - Rui Wang
- Department of Thoracic Surgery Fudan University Shanghai Cancer Center Shanghai China; Department of Oncology Shanghai Medical College Fudan University Shanghai China
| | - Yihua Sun
- Department of Thoracic Surgery Fudan University Shanghai Cancer Center Shanghai China; Department of Oncology Shanghai Medical College Fudan University Shanghai China
| | - Haiquan Chen
- Department of Thoracic Surgery Fudan University Shanghai Cancer Center Shanghai China; Department of Oncology Shanghai Medical College Fudan University Shanghai China
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13
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Ahmad R, Setia N, Schmidt BH, Hong TS, Wo JY, Kwak EL, Rattner DW, Lauwers GY, Mullen JT. Predictors of Lymph Node Metastasis in Western Early Gastric Cancer. J Gastrointest Surg 2016; 20:531-8. [PMID: 26385006 DOI: 10.1007/s11605-015-2945-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/09/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND The application of endoscopic and local resection for early gastric cancer (EGC) is limited by the risk of regional lymph node (LN) metastasis. We sought to determine the incidence and predictors of LN metastasis in a contemporary cohort of Western patients with early gastric cancer. METHODS Sixty-seven patients with pT1 gastric adenocarcinoma underwent radical surgery without neoadjuvant therapy at our institution between 1995 and 2011, and clinicopathologic factors predicting LN metastasis were analyzed. RESULTS LN metastases were present in 15/67 (22 %) pT1 tumors, including 1/23 (4 %) T1a tumors and 14/44 (32 %) T1b tumors. Tumor size, site, degree of differentiation, macroscopic tumor sub-classification, perineural invasion status, and depth of submucosal tumor penetration did not predict LN metastasis. The presence of lymphovascular invasion (LVI) and positive nodal status by endoscopic ultrasound (EUS) were the only factors that predicted LN metastasis on multivariate analysis. T1a tumors without LVI had a 0 % rate of positive LN, whereas T1b tumors with LVI had a 64.3 % rate of positive LN. CONCLUSIONS EGC limited to the mucosa, without evidence of LVI, and N0 on EUS, may be considered for limited resection. However, any EGC with submucosal invasion, LVI, or positive nodes on EUS should undergo radical resection with lymphadenectomy.
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Affiliation(s)
- Rima Ahmad
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Namrata Setia
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin H Schmidt
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Eunice L Kwak
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - David W Rattner
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Gregory Y Lauwers
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA.
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14
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Choi JS, Han BK, Ko EY, Ko ES, Hahn SY, Shin JH, Kim MJ. Comparison between two-dimensional synthetic mammography reconstructed from digital breast tomosynthesis and full-field digital mammography for the detection of T1 breast cancer. Eur Radiol 2015; 26:2538-46. [PMID: 26628063 DOI: 10.1007/s00330-015-4083-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 07/29/2015] [Revised: 10/03/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the interpretative performance of two-dimensional (2D) synthetic mammography (SM) reconstructed from digital breast tomosynthesis (DBT) in the detection of T1-stage invasive breast cancers, compared to 2D full-field digital mammography (FFDM). METHODS This retrospective study enrolled 214 patients. For each patient, FFDM and DBT were performed between January and June 2013, and SM was reconstructed from DBT data. Three radiologists interpreted images and recorded visibility scores and morphologies of cancers. Diagnostic performances of SM and FFDM were compared. Percentages of detected cancers and visibility scores were compared for tumour size, and presence of calcifications for each observer. RESULTS Observer sensitivity showed no difference for detection with SM and FFDM (P > 0.05). One observer showed a higher specificity (P = 0.02) and higher positive predictive value with SM (95 % CI 0.6-16.4), but the differences in the corresponding values between SM and FFDM for the other observers were not statistically significant. In subgroup analyses according to tumour size and presence of calcifications, percentages of detected cancers and visibility scores were not significantly different. CONCLUSIONS Diagnostic performances of SM and FFDM are comparable for detecting T1-stage breast cancers. Therefore, our results indicate that SM may eliminate the need for additional FFDM during DBT-based imaging. KEY POINTS • DBT plus FFDM increases radiation dose compared to FFDM alone. • Detecting T1-stage cancers with only SM is comparable to detection with FFDM. • Two-dimensional SM may replace dose-requiring FFDM in DBT-based imaging.
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Affiliation(s)
- Ji Soo Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, South Korea
| | - Boo-Kyung Han
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, South Korea.
| | - Eun Young Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, South Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, South Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, South Korea
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, South Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
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