The Value of Preoperative Positron Emission Tomography/Computed Tomography in Node-Negative Endometrial Cancer on Magnetic Resonance Imaging.

OBJECTIVE: The aim of this study was to investigate the value of [18F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in predicting lymph node status in node-negative endometrial cancer on preoperative magnetic resonance imaging (MRI). METHODS: Patients with endometrial cancer who underwent both preoperative MRI and FDG-PET/CT followed by hysterectomy and lymphadenectomy were initially included. We then enrolled patients with MRI-defined node-negative disease (lymph nodes <1 cm in the short-axis diameter, or no visible lymph node). Histologic examination was the gold standard for lymph node metastasis diagnosis. The diagnostic performance of FDG-PET/CT in predicting lymph node metastasis was calculated in patient-by-patient and lymph node station-by-station analyses. RESULTS: On preoperative MRI, 362 patients had no lymph node metastasis. All patients underwent pelvic lymph node dissection and 118 patients underwent further para-aortic lymph node dissection. From 2099 lymph node stations, 10,238 lymph nodes were retrieved. Twenty-seven patients (7.5%) had lymph node metastasis in 49 lymph node stations (2.3%) on pathologic examination. FDG-PET/CT identified lymph node metastasis in five patients (18.5%) and eight lymph node stations (16.3%). The median diameter of false-negative metastatic lymph nodes was 6 mm (range 1-22) in the long axis and 3 mm (range 1-11) in the short axis. For para-aortic lymph nodes, FDG-PET/CT diagnosed 2 of 11 patients (18.1%) with para-aortic lymph node metastasis, and 3 of 12 para-aortic lymph node stations (25%) with metastasis. CONCLUSION: Preoperative FDG-PET/CT has low value in predicting lymph node metastasis in node-negative endometrial cancer on preoperative MRI.

Human Papillomavirus E6/E7-Specific siRNA Potentiates the Effect of Radiotherapy for Cervical Cancer in Vitro and in Vivo.

The functional inactivation of TP53 and Rb tumor suppressor proteins by the HPV-derived E6 and E7 oncoproteins is likely an important step in cervical carcinogenesis. We have previously shown siRNA technology to selectively silence both E6/E7 oncogenes and demonstrated that the synthetic siRNAs could specifically block its expression in HPV-positive cervical cancer cells. Herein, we investigated the potentiality of E6/E7 siRNA candidates as radiosensitizers of radiotherapy for the human cervical carcinomas. HeLa and SiHa cells were transfected with HPV E6/E7 siRNA; the combined cytotoxic effect of E6/E7 siRNA and radiation was assessed by using the cell viability assay, flow cytometric analysis and the senescence-associated ß-galactosidase (SA-ß-Gal) assay. In addition, we also investigated the effect of combined therapy with irradiation and E6/E7 siRNA intravenous injection in an in vivo xenograft model. Combination therapy with siRNA and irradiation efficiently retarded tumor growth in established tumors of human cervical cancer cell xenografted mice. In addition, the chemically-modified HPV16 and 18 E6/E7 pooled siRNA in combination with irradiation strongly inhibited the growth of cervical cancer cells. Our results indicated that simultaneous inhibition of HPV E6/E7 oncogene expression with radiotherapy can promote potent antitumor activity and radiosensitizing activity in human cervical carcinomas.

The value of 15-minute delayed contrast-enhanced CT to differentiate hyperattenuating adrenal masses compared with chemical shift MR imaging.

OBJECTIVES: To investigate the diagnostic performance of 15-min delayed contrast-enhanced computed tomography (15-DECT) compared with that of chemical shift magnetic resonance (CSMR) imaging in differentiating hyperattenuating adrenal masses and to perform subgroup analysis in underlying malignancy and non-malignancy. METHODS: This study included 478 adrenal masses in 453 patients examined with 15-DECT and 235 masses in 217 patients examined with CSMR. Relative percentage washout (RPW) and absolute percentage washout (APW) on 15-DECT, and signal intensity index (SII) and adrenal-to-spleen ratio (ASR) on CSMR were measured. Sensitivity, specificity and accuracy of 15-DECT and CSMR were analysed for characterisation of adrenal adenoma. Subgroup analyses were performed in patients with and without underlying malignancy. Attenuation and size of the masses on unenhanced CT correlated with the risk of non-adenoma. RESULTS: RPW calculated from 15-DECT showed the highest diagnostic performance for characterising hyperattenuating adrenal masses regardless of underlying malignancy, and the sensitivity, specificity and accuracy were 91.7 %, 74.8 % and 88.1 %, respectively in all patients. The risk of non-adenoma increased approximately threefold as mass size increased 1 cm or as its attenuation value increased by 10 Hounsfield units. CONCLUSIONS: 15-DECT was more accurate than CSMR in characterising hyperattenuating adrenal masses regardless of underlying malignancy. KEY POINTS: Delayed contrast-enhanced CT and chemical shift magnetic resonance (CSMR) characterise adrenal lesions. 15-min DECT is more accurate than CSMR in characterising hyperattenuating adrenal masses. Sensitivity of CSMR decreases as the CT attenuation of adenomas increases. Risk of non-adenoma is increased 2.9-fold as size increased by 1 cm. Risk of non-adenoma is increased 2.9-fold as attenuation increased by 10 HU.

Comparison of T2-weighted MRI with and without fat suppression for differentiating renal angiomyolipomas without visible fat from other renal tumors.

OBJECTIVE: The purpose of this study was to retrospectively compare the usefulness of T2-weighted imaging with and without fat suppression for differentiating angiomyolipomas (AMLs) without visible fat from other renal tumors. MATERIALS AND METHODS: MRI was performed in 111 patients (66 men and 46 women; age range, 17-78 years) who had pathologically diagnosed (14 AMLs, 86 renal cell carcinomas [RCCs], and three other tumors) and clinically diagnosed (eight AMLs) renal masses without visible fat or a cystic portion on unenhanced CT. The signal intensity (SI), tumor-to-kidney SI ratio, tumor-to-spleen SI ratio on T2-weighted imaging and fat-suppressed T2-weighted imaging, and tumor-fat subtraction index were measured for each tumor. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic accuracy of SI ratios. RESULTS: The highest area under the ROC curve was 0.886 for tumor-to-kidney SI ratio on fat-suppressed T2-weighted imaging. With a tumor-to-kidney SI ratio of 0.9 on fat-suppressed T2-weighted imaging, the sensitivity, specificity, positive predictive value, and negative predictive value were 90.9%, 71.1%, 43.5%, and 97%, respectively. The highest tumor-to-kidney SI ratio of AMLs without visible fat was 1.09. Ninety-eight percent of renal tumors with a tumor-to-kidney SI ratio greater than 1.09 were RCCs (51/52), especially clear cell RCCs (82.7%, 43/52). CONCLUSION: Fat-suppressed T2-weighted imaging is more useful than T2-weighted imaging for differentiating AMLs without visible fat from non-AMLs. The high SI of solid renal masses on fat-suppressed T2-weighted imaging can be indicative of non-AMLs, especially RCCs.

Diagnostic performance of multidetector computed tomography in the evaluation of perinephric fat invasion in renal cell carcinoma patients.

PURPOSE: This study aimed to evaluate the diagnostic performance of multidetector computed tomography (MDCT) for preoperative evaluation of perinephric fat invasion in patients with renal cell carcinomas (RCCs). METHODS: A total of 408 consecutive patients with surgically confirmed RCC who underwent MDCT were included in this study. Image analysis was first performed with axial-only CT images. A second analysis was then performed with both axial and coronal CT images. A qualitative analysis was then conducted by 2 reviewers who reached consensus. The reference standard was pathologic evaluation. RESULTS: The areas under the curve of the receiver operating characteristic analysis were 0.786 and 0.877 for axial-only images and 0.805 and 0.836 for combined images in both readers. The area under the curve of tumor size was 0.833, a similar value to that of the reviewers. In multivariate analysis, tumor size, a linear-nodular or nodular type of fat infiltration, and an irregular tumor margin were independent predicting factors for perinephric fat invasion. CONCLUSIONS: The MDCT shows relatively high diagnostic performance in detecting perinephric fat invasion of RCC, but suffers from a relatively low positive predictive value. Tumor size, fat infiltration with a nodular appearance, and an irregular tumor margin were predictors for perinephric invasion.

Three-phase, contrast-enhanced, multidetector CT in the evaluation of complicated renal cysts: comparison of the postcontrast phase combination.

BACKGROUND: Multiphasic multidetector computed tomography (MDCT) is widely used for the assessment and diagnosis of complicated renal cysts. PURPOSE: To determine the optimal combination of postcontrast phases of MDCT for the evaluation of complicated renal cysts. MATERIAL AND METHODS: In 164 renal cysts with pathology confirmation or follow-up >2 years, the Bosniak category was recorded by two radiologists in consensus. They reviewed the MDCT images during three interpretation sessions. In the first session, the radiologists evaluated two phases of images (unenhanced and corticomedullary phases), while during the second session, they evaluated two phases of images (unenhanced and parenchymal phases), and in the third session, they evaluated all three phases of images (unenhanced, corticomedullary, and parenchymal phases). The diagnostic accuracy for evaluating renal cysts was compared in each session using receiver-operating characteristics (ROC) analysis. RESULTS: There were 106 benign renal cysts and 58 malignant renal cysts. The areas under the ROC curves (AUCs) of the second and third sessions were greater than that of the first session (P < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of the first session were 74%, 88%, 77%, and 86%, respectively, and those of the second session were 90%, 85%, 77%, and 94%, respectively. The values of the third session were identical to those of the second session. CONCLUSION: Unenhanced and parenchymal phase CT scans are sufficient for differentiating malignant from benign renal cysts and there was no additional value by adding the corticomedullary phase to the combination of unenhanced and parenchymal phase CT.

Clinical significance of tumor volume in endometrial cancer: a Japan-Korea cooperative study.

OBJECTIVE: The aim of this study was to elucidate the significance of tumor volume as a risk factor for predicting lymph node metastasis. METHODS: We applied the tumor volume index to the data that were collected for 327 Korean patients with endometrial cancer who underwent preoperative assessment including magnetic resonance imaging (MRI) and subsequent surgery including systematic lymphadenectomy. The volume index, which we previously reported in the literature, was defined as the product of maximum longitudinal diameter along the uterine axis, maximum anteroposterior diameter in a sagittal section image, and maximum horizontal diameter in a horizontal section image according to MRI data, from 425 Japanese women with endometrial cancer. Relationships between lymph node metastasis and results of preoperative examinations including volume index were analyzed by logistic regression analysis. RESULTS: The prevalence of affected lymph nodes was 14.2%. Multivariate analysis showed that high-grade histology assessed by endometrial biopsy [odds ratio (OR); 2.9, 95% confidence interval (CI): 1.4-6.4], volume index (OR; 2.4, 95% CI: 1.1-5.3), node enlargement assessed by MRI (OR; 4.2, 95% CI: 1.4-13.2), and high serum cancer antigen (CA)125 level (OR; 3.6, 95% CI: 1.6-8.1) were significantly and independently related to lymph node metastasis. When volume index was excluded from the analysis, myoinvasion assessed by MRI was an independent risk factor for lymph node metastasis as well as high-grade histology, node enlargement, and high serum CA125 level. CONCLUSION: Volume index is compatible with myometrial invasion as a factor for predicting lymph node metastasis in endometrial cancer.

Additional value of combined evaluation of tumor size with lymph node size in the detection of lymph node metastases in early-stage cervical cancer patients.

Although tumor size is a prognostic factor in cervical cancer patients, its role in the diagnosis of lymph node metastasis is unclear. We therefore evaluated the diagnostic value of tumor and lymph node size compared with lymph node size alone in the detection of metastatic lymph nodes in patients with early-stage cervical cancer.We retrospectively evaluated 699 patients with International Federation of Obstetrics and Gynecology stage IB1-IIA cervical carcinoma who underwent magnetic resonance imaging before lymphadenectomy involving all visible lymph nodes in the surgical fields. Seven nodal groups were evaluated: para-aortic, both common iliac, both external iliac, and both internal/obturator areas. Pathologic evaluation was the diagnostic standard. The largest short-axis diameter of lymph nodes in each region and the largest tumor diameters were measured in magnetic resonance images. The value of additional information from magnetic resonance images was evaluated by receiver operating characteristic curve analysis.Of the 699 patients, 108 (15.8%) had lymph node metastases. The areas under the curve for measurements of lymph node size, tumor size, and both were (A) 0.635, (B) 0.706, and (C) 0.742, respectively (A vs B, P = 0.006; A vs C P < 0.001; B vs C, P = 0.002).This study illustrates that magnetic resonance imaging measurements of tumor size and tumor size plus lymph node size showed a higher diagnostic performance than lymph node size alone in predicting lymph node metastasis in patients with early-stage cervical cancer.

Radiologic-pathologic correlation of renal cell carcinoma associated with Xp11.2 translocation.

BACKGROUND: The prognosis of translocation RCCs in adult patients is relatively poor compared to that of other subtypes of RCCs. Although there have been several reports regarding radiologic findings of translocation RCC, studies with histologic correlation could help to understand the imaging features. PURPOSE: To explore the correlation between radiologic and pathologic findings in Xp11.2 translocation renal cell carcinoma (RCC) and provide clues for translocation RCC diagnosis. MATERIAL AND METHODS: CT scans of six patients (one man and five women; age range, 8-71 years; mean age, 34 years) with histologically-proven Xp11.2 translocation RCCs were retrospectively evaluated in consensus by two radiologists. Tumor size, presence of necrosis, hemorrhage, fat or calcification, enhancement patterns of the tumor, presence of lymphadenopathy, and distant metastases were evaluated. RESULTS: The average size of the tumors was 6 cm (range, 2.7-12 cm). All six tumors appeared as well-defined masses with areas of low attenuation representing hemorrhage or necrosis. Four tumors contained high attenuating solid portions, compared to the surrounding renal cortex seen on unenhanced images, where representing dense cellular component on microscopic examination. Peripheral rim enhancement pattern that correlated with histologic finding of a fibrous capsule was seen in five cases. In two patients who underwent kidney MR, the masses showed low signal intensity on T2-weighted images. One patient had lymphadenopathy. No distant metastasis was noted in any patient. CONCLUSION: Translocation RCC appeared as a well-defined mass that contain high attenuating solid portions on unenhanced images and low attenuating necrotic or hemorrhagic foci; the tumor also showed gradual peripheral rim enhancement due to a fibrous capsule surrounding the tumor.

Recurrence patterns of bladder transitional cell carcinoma after radical cystectomy.

BACKGROUND: Multidetector computed tomography (MDCT) is widely accepted as an effective imaging modality in monitoring for bladder cancer recurrence after radical cystectomy. Elucidating the pattern of bladder cancer recurrence on CT can increase the diagnostic accuracy. PURPOSE: To evaluate the recurrence patterns of transitional cell carcinoma of the bladder and the factors associated with cancer recurrence. MATERIAL AND METHODS: One hundred and forty-nine consecutive patients (mean age, 66.55 years; range, 32-86 years) who underwent preoperative contrast-enhanced CT and radical cystectomy were included in this study. The presence, site, and time of tumor recurrence were recorded retrospectively by two radiologists in a consensus fashion. The association of tumor recurrence and tumor factors (T stage, lymph node metastasis, nuclear grade, and tumor diameter) were also evaluated using multiple logistic regression analysis and Kaplan-Meier statistics. RESULTS: Tumor recurrence occurred in 60 patients (40.3%) with a mean time of 14 months (range, 1-64 months). The sites of recurrence included the operation site (n = 20), lymph node (n = 20), bone (n = 11), liver (n = 6), lung (n = 5), upper urinary tract (n = 4), colon (n = 3), adrenal gland (n = 2), peritoneum (n = 1), abdominal wall (n = 1), psoas muscle (n = 1), and penile skin (n = 1). Tumor recurrence was found to be associated with advanced T stage (P = 0.002) and lymph node metastasis (P < 0.001). CONCLUSION: Transitional cell carcinomas of the bladder recur more frequently at the operation site and lymph node, and T-stage and lymph node metastasis are closely associated with tumor recurrence.

Sonography of the adrenal glands in the adult.

Although its capability has been overlooked, sonography can be a useful screening tool for adrenal lesion in adults. In this article, we discuss scan technique, patient positioning, and anatomic consideration for adrenal sonography in adults and illustrate sonographic appearance of normal adrenal gland as well as adrenal tumors and tumor-like lesions.

Inter- and intra-observer variability in contouring of the prostate gland on planning computed tomography and cone beam computed tomography.

PURPOSE: To investigate inter-/intra-observer variability in defining the prostate by use of planning computed tomography (PCT) and cone beam CT (CBCT) with magnetic resonance image (MRI) as guidance prior to the introduction of an adaptive radiotherapy for prostate cancer. MATERIAL AND METHODS: We reviewed PCT and firstly acquired CBCT datasets of each ten patients with prostate cancer. Three physicians independently delineated the prostate based on PCT and CBCT with MRI as guidance, allowing determination of inter-physician variability. Two physicians repeated prostate contouring three times in total to investigate intra-physician variability. We compared delineated prostate volumes in terms of the generalized conformity index (CI(gen)), maximum variation ratio (MVR), and center of mass (COM). RESULTS: There were no significant inter-/intra-observer differences in the estimation of prostate volume on both PCT and CBCT. For both inter- and intra-observer variability in contouring the prostate gland, there were no significant differences in MVR between PCT and CBCT. The CI(gen) for inter-observer variability was 0.74 by PCT and 0.69 by CBCT. The CI(gen) for intra-observer variability on PCT and CBCT was 0.84 and 0.81 for observer 2 and 0.76 and 0.73 for observer 3. COM analyses showed that the greatest inter-/intra-observer variability was in the measurement of the prostate apex and base. With respect to CI(gen) and COM analysis for the inter-observer variability, more precise delineation of the prostate was possible on PCT than CBCT. More precise contouring in terms of both CI(gen) and COM was demonstrated by observer 2 than observer 3. CONCLUSIONS: Despite some ambiguity in apex and base level, there was a good consistency in delineating the gland on CBCT plus MRI-guided modification both among/within observer(s), without any significant difference from the consistency in defining the prostate on PCT. This study provides a framework for future studies of CBCT imaging of the prostate.

Value of T2-weighted MR imaging in differentiating low-fat renal angiomyolipomas from other renal tumors.

BACKGROUND: Accurate preoperative diagnosis of fat scanty angiomyolipomas is an important clinical issue. By evaluating the low signal intensity of angiomyolipomas in MR T2-weighted images the diagnostic accuracy can be elevated. PURPOSE: To retrospectively assess the usefulness of T2-weighted MR imaging for differentiating low-fat angiomyolipomas (AMLs) from other renal tumors. MATERIAL AND METHODS: We retrospectively evaluated 71 patients with surgically proven renal masses (10 AMLs, 57 renal cell carcinomas [RCCs], and four oncocytomas), all of which showed no visible fat as well as gradual enhancement patterns on contrast-enhanced CT. Signal intensity was measured in each renal mass and in the spleen on T2-weighted images, and each signal intensity ratio (SIR) was calculated; SIR values were then compared in the AML and non-AML groups. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of the two parameters for differentiating the two groups. RESULTS: The SIR values (77 ± 24% vs. 162 ± 79%, p = 0.002) were significantly lower in the AML than in the non-AML group. The area under the ROC curve was 0.926 for SIR. The sensitivity and specificity in the diagnosis of AMLs were 90% and 90.2%, using SIR cut-off of 92.5%. CONCLUSION: Signal intensity measurements on T2-weighted MR images can differentiate AML from non-AML in the kidney.

Diagnosis of lymph node metastasis in uterine cervical cancer: usefulness of computer-aided diagnosis with comprehensive evaluation of MR images and clinical findings.

BACKGROUND: Lymph node (LN) status is an important parameter for determining the treatment strategy and for predicting the prognosis for patients with uterine cervical cancer. Computer-aided diagnosis (CAD) can be feasible for differentiating metastatic from non-metastatic lymph nodes in patients with uterine cervical cancer. PURPOSE: To determine the usefulness of CAD that comprehensively evaluates MR images and clinical findings for detecting LN metastasis in uterine cervical cancer. MATERIAL AND METHODS: In 680 LNs from 143 patients who underwent radical hysterectomy for uterine cervical cancer, the CAD system using the Bayesian classifier estimated the probability of metastasis based on MR findings and clinical findings. We compared the diagnostic accuracy for detecting metastatic LNs in the CAD and MR findings. RESULTS: Metastasis was diagnosed in 70 (12%) LNs from 34 (24%) patients. The area under ROC curves of CAD (0.924) was greater than those of the mean ADC (0.854), minimum ADC (0.849), maximum ADC (0.827), short-axis diameter (0.856) and long-axis diameter (0.753) (P < 0.05). The specificity and accuracy of the CAD (86%, 86%) were greater than those of the mean ADC (77%, 77%), maximum ADC (77%, 77%), minimum ADC (68%, 70%), and short-axis diameter (65%, 67%) (P < 0.05). CONCLUSION: CAD system can improve the diagnostic performance of MR for detecting metastatic LNs in uterine cervical cancer.

Region-based diagnostic performance of multidetector CT for detecting peritoneal seeding in ovarian cancer patients.

PURPOSE: To determine the accuracy of multi-detector CT (MDCT) compared with the surgical findings, such as peritoneal seeding and metastatic lymph nodes, in ovarian cancer patients. METHODS: Fifty-seven FIGO stage IA-IV ovarian cancer patients, who underwent MDCT before primary surgery, were included in this study. Two radiologists evaluated the following imaging findings in consensus: the presence of nodular, plaque-like or infiltrative soft-tissue lesions in peritoneal fat or on the serosal surface; presence of ascites; parietal peritoneal thickening or enhancement; and small bowel wall thickening or distortion. We also evaluated the presence of lymph node metastases. To allow region-specific comparisons, the peritoneal cavity was divided into 13 regions and retroperitoneal lymph nodes were divided into 3 regions. Descriptive statistical data were thus obtained. RESULTS: The MDCT sensitivity, specificity, positive predictive values, and negative predictive values were 45, 72, 46, and 72%, respectively, for detecting peritoneal seeding and 21, 90, 52, and 69%, respectively, for detecting lymph node metastasis. CONCLUSIONS: MDCT is moderately accurate for detecting peritoneal metastasis and lymph node metastasis in ovarian cancer patients.

Diagnostic performance of computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer: meta-analysis.

We performed a meta-analysis to compare diagnostic performances of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET or PET/CT), for detection of metastatic lymph nodes in patients with cervical cancer. We searched MEDLINE (PubMed), EMBASE and the Cochrane Review database in December 2007. All articles were independently reviewed and selected by three evaluators. We estimated a summary receiver operating characteristic (sROC) curve. The area under the curve (AUC), Q*, and pooled weighted estimates of sensitivity and specificity for each modality by patient-based and region- or node-based data analyses and conducted pair-wise comparisons between modalities using the two-sample Z-test. Forty-one of 768 initially identified studies were included in the meta-analysis. In a patient-based data analysis, PET or PET/CT showed the highest pooled sensitivity (82%) and specificity (95%), while CT showed 50% and 92%; and MRI, 56% and 91%, respectively. The AUC (0.9641) and Q* (0.9106) of PET or PET/CT were significantly higher than those of MRI (AUC = 0.8270; Q* = 0.7599), both P < 0.001. In region- or node-based data analysis, sensitivities of CT (52%) and PET or PET/CT (54%) were higher than that of MRI (38%), P < 0.02 and P < 0.001, respectively, while specificities of MRI (97%) and PET or PET/CT (97%) were higher than that of CT (92%), both P < 0.001. The AUC and Q* showed no significant difference among CT, MRI, and PET or PET/CT. PET or PET/CT had an overall higher diagnostic performance than did CT or MRI in detecting metastatic lymph nodes in patients with cervical cancer.

Differential diagnostic performance of magnetic resonance imaging in the detection of lymph node metastases according to the tumor size in early-stage cervical cancer patients.

OBJECTIVES: The objective of this study was to evaluate the diagnostic performance in managing early-stage cervical cancer according to the International Federation of Gynecology and Obstetrics (FIGO) stage or tumor size. METHODS/MATERIALS: We performed a retrospective review of patients with FIGO stages IB1 to IIA cervical carcinoma who underwent magnetic resonance imaging (MRI) before lymphadenectomy. Lymphadenectomy involved all visible lymph nodes in the surgical fields. We compared the accuracy of MRI for detecting metastatic lymph nodes in the FIGO IB and IIA groups and in the nonbulky (≤ 4 cm) and bulky (>4) tumor groups. χ² analysis was used to compare the accuracy of MRI for detecting metastatic lymph nodes. P ≤ 0.05 was considered statistically significant. RESULTS: Three hundred five patients were included. Lymph node metastases were present in 49 (16.1%) of these patients. The sensitivity, specificity, and positive and negative predictive values were 7%, 99.3%, 31.3%, and 95.8% in the nonbulky tumor group and 43.8%, 97.1%, 70%, and 91.8% in the bulky tumor group (P = 0.001, P = 0.0097, P = 0.0479, and P = 0.0142, respectively). CONCLUSIONS: For predicting lymph node metastasis with MRI in early-stage cervical cancer patients, MRI showed a higher diagnostic performance in the bulky tumor group compared with that in the nonbulky tumor group and had a low value in the nonbulky tumor group, even when accounting for FIGO stage.

Green tea consumption and risk of stomach cancer: a meta-analysis of epidemiologic studies.

This meta-analysis investigated the quantitative association between the consumption of green tea and the risk of stomach cancer in epidemiologic studies using crude data and adjusted data. We searched MEDLINE, EMBASE and the Cochrane Review in August 2007. All the articles searched were independently reviewed and selected by 3 evaluators according to predetermined criteria. A total of 13 epidemiologic studies were included. When all the case-control and cohort studies were pooled, the odds ratios (OR) [corrected] of stomach cancer for the highest level of green tea consumption when compared with the lowest level of consumption were shown to be 1.10 (95% confidence interval (CI), 0.92-1.32) using the crude data and 0.82 (95% CI, 0.70-0.96) using the adjusted data.In the meta-analyses of case-control studies, no significant association was seen between green tea consumption and stomach cancer using the crude data (odds ratio (OR), 0.79; 95% CI, 0.58-1.07) [corrected], but green tea was shown to have a preventive effect on stomach cancer using the adjusted data (OR, 0.73; 95% CI, 0.64-0.83) [corrected]. In the meta-analyses of the recent cohort studies, the highest green tea consumption was shown to significantly increase stomach cancer risk using the crude data (RR, 1.59; 95% CI, 1.16-2.18), but no significant association between them was seen when using the adjusted data (RR, 1.04; 95% CI, 0.93-1.17). Unlike the case-control studies, no preventive effect on stomach cancer was seen for the highest green tea consumption in the meta-analysis of the recent cohort studies. Further clinical trials are needed.

Node-by-node correlation between MR and PET/CT in patients with uterine cervical cancer: diffusion-weighted imaging versus size-based criteria on T2WI.

The purpose of the study was to perform a node-by-node comparison of an ADC-based diagnosis and various size-based criteria on T2-weighted imaging (T2WI) with regard to their correlation with PET/CT findings in patients with uterine cervical cancer. In 163 patients with 339 pelvic lymph nodes (LNs) with short-axis diameter >5 mm, the minimum apparent diffusion coefficient (ADC), mean ADC, short- and long-axis diameters, and ratio of long- to short-axis diameters (L/S ratio) were compared in PET/CT-positive and -negative LNs. On PET/CT, 118 (35%) LNs in 58 patients were positive. The mean value of minimum and mean ADCs, short- and long-axis diameters, and L/S ratio were different in PET/CT-positive (0.6436 x 10(-3) mm(2)/s, 0.756 x 10(-3) mm(2)/s, 10.3 mm, 13.2 mm, 1.32, respectively) and PET/CT-negative LNs (0.8893 x 10(-3) mm(2)/s, 1.019 x 10(-3) mm(2)/s, 7.4 mm, 11.0 mm, 1.49, respectively) (P < 0.05). The Az value of the minimum ADC (0.864) was greater than those of mean ADC (0.836), short-axis diameter (0.764), long-axis diameter (0.640) and L/S ratio (0.652) (P < 0.05). The sensitivity and accuracy of the minimum ADC (86%, 82%) were greater than those of the short-axis diameter (55%, 74%), long-axis diameter (73%, 58%) and L/S ratio (52%, 66%) (P < 0.05). ADC showed superior correlation with PET/CT compared with conventional size-based criteria on T2WI.

Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a meta-analysis.

BACKGROUND: This meta-analysis was performed to investigate the outcome of laparoscopic surgery for endometrial carcinoma compared with laparotomy. METHODS: We searched the MEDLINE (PubMed), EMBASE, and Cochrane Review databases in September 2007. Three independent evaluators selected the articles according to predetermined selection criteria. RESULTS: Thirteen comparative studies (5 prospective and 8 retrospective) that met the selection criteria were included. In a fixed-effects meta-analysis, the overall survival and therecurrence rate showed no significant differences between the laparoscopy and the laparotomy groups, with odds ratios of 0.84 (95% confidence interval, 0.64-1.62) and 0.90 (95% confidence interval, 0.49-1.16), respectively. However, the complication rate was lower in the laparoscopy group than in the laparotomy group with an odds ratio of 0.43 (95% confidence interval, 0.32-0.58). CONCLUSIONS: The survival outcome and recurrence rate after laparoscopic surgery for endometrial carcinoma were similar to those in the laparotomy procedures. However, the complication rate was lower after laparoscopy compared with laparotomy.