Isolated tumor cells in sentinel lymph nodes of invasive breast cancer: cell displacement or metastasis?

The goal of this study was to determine whether the presence of isolated tumoral cells (ITCs) in sentinel lymph nodes (SLNs) after core needle biopsy (CNB) is related to the time interval between CNB and surgery and to histopathologic features of invasive breast cancer. Data from 633 consecutive patients with no micrometastasis or metastasis on both frozen sections and definitive pathologic examination of SLNs were retrieved from a prospective data base. No association was found between ITCs and the time interval between CNB and SLNB. The association was significant with tumor size, the tumor lymphovascular invasion (LVI) and the histologic type of the tumor. This study adds supplementary data to the association between tumoral LVI and ITCs in SLNs, The time interval between CNB procedure and SLNB was not related to affect presence of ITCs, which might not suggest the iatrogenic origin of these cells.

Concordance between core needle biopsy and surgical excision specimens for tumour hormone receptor profiling according to the 2011 St. Gallen Classification, in clinical practice.

To focus on and compare the tumor hormone receptor profiles on core needle biopsy (CNB) and subsequent surgical excision specimens in a large clinical series of invasive breast carcinoma patients, with regard to guidelines proposed at the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. A total of 993 consecutive patients who had hormone receptors (HR) assays performed on both CNB and subsequent surgical excision specimens of invasive carcinomas were included (1,110 tumors). Concordant tumor HR profiles between CNB and surgical excision specimens were noted in 1,085 of 1,110 tumors (97.75%). Among 138 tumors considered negative on CNB (both HR assays <1%), 10 cases (7.2%) displayed an HR profile positive on surgical excision specimen. Discrepancies between CNBs and surgical excision specimens are very seldom noted. HR assay evaluation on surgical excision specimens should only be considered in patients when both HR assays are negative on CNBs.

Approaches for the optimization of MR protocols in clinical hybrid PET/MRI studies.

Magnetic resonance imaging (MRI) is the examination method of choice for the diagnosis of a variety of diseases. MRI allows us to obtain not only anatomical information but also identification of physiological and functional parameters such as networks in the brain and tumor cellularity, which plays an increasing role in oncologic imaging, as well as blood flow and tissue perfusion. However, in many cases such as in epilepsy, degenerative neurological diseases and oncological processes, additional metabolic and molecular information obtained by PET can provide essential complementary information for better diagnosis. The combined information obtained from MRI and PET acquired in a single imaging session allows a more accurate localization of pathological findings and better assessment of the underlying physiopathology, thus providing a more powerful diagnostic tool. Two hundred and twenty-one patients were scanned from April 2011 to January 2012 on a Philips Ingenuity TF PET/MRI system. The purpose of this review article is to provide an overview of the techniques used for the optimization of different protocols performed in our hospital by specialists in the following fields: neuroradiology, head and neck, breast, and prostate imaging. This paper also discusses the different problems encountered, such as the length of studies, motion artifacts, and accuracy of image fusion including physical and technical aspects, and the proposed solutions.

Role of sonography in the diagnostic workup of ovarian and adnexal masses except in pregnancy and during ovarian stimulation.

The main role of imaging is to provide a description of the appearance, size, and location of adnexal lesions and associated abnormalities. In some circumstances, the aggressive potential of an adnexal lesion may be suggested on the basis of the imaging findings, the age of the patient, and the clinical data.

Is imaging relevant for treatment choice in early stage cervical uterine cancer?

BACKGROUND: Improvement in the selection of patients with early cervical cancer eligible for different therapeutic options is expected from imaging. OBJECTIVE: We examined key tumoral features such as tumor diameter cut-off values of 2 cm or 4 cm in largest dimension, distance between tumor and internal os, outer third stromal cervical invasion, parametrial invasion and lymph node invasion. SEARCH STRATEGY: We conducted a literature search to identify all relevant studies based on imaging that evaluated these parameters. SELECTION CRITERIA: Articles were only considered when data of imaging modalities were compared with histopathological findings of the surgical specimens, considered as the gold standard. DATA COLLECTION AND ANALYSIS: We examined series that included more than 30 patients with primary untreated biopsy-confirmed cervical cancer. When numerous articles were obtained for one investigational modality, only series that included more than fifty patients were taken into account. MAIN RESULTS: Data is lacking for the diagnostic value of imaging for assessing tumor diameter cut-off values of 2 cm or 4 cm, and distance between tumor and internal os. There is a high negative predictive value of MRI for complete stromal invasion. Accurate assessment of lymph node status in patients with early cervical cancer is still lacking. PET-CT role is promising, but the diagnostic value of normal-sized hypermetabolic lymph nodes needs further investigation. CONCLUSION: Based on imaging, accurate selection of patients for treatment choice is still lacking in patients with early cervical cancer.

Non-invasive modalities for predicting lymph node spread in early stage endometrial cancer?

BACKGROUND: Lymph node status in EC determines the staging and has important prognostic and therapeutic implications. OBJECTIVES: We have examined the diagnostic value of preoperative and intraoperative non-invasive methods to determine the lymph node status in endometrial cancer, or, indirectly, for identification of patients at increased risk of lymph node involvement. SEARCH STRATEGY: We conducted a literature search to identify all relevant reports that evaluated lymph node spread in EC. SELECTION CRITERIA: Articles were only considered when data of investigational modalities were compared with histopathological findings of the surgical specimens, considered as the gold standard. DATA COLLECTION AND ANALYSIS: When numerous relevant articles were identified for one investigational modality, only series including more than 50 patients were considered. MAIN RESULTS: Sensitivity of CT and MRI for diagnosis metastatic lymph node is limited. TVS performs as well as MRI in predicting deep myometrial invasion. It is unclear whether intraoperative gross visual examination and frozen section perform better than preoperative methods to predict deep myometrial invasion. There is a limited sensitivity of intraoperative frozen section for predicting poorly differentiated EC. CONCLUSION: Accurate non-invasive assessment of lymph node status in patients with EC remains challenging. SYNOPSIS: Despite imaging advances in the past 20 years, accurate non-invasive assessment of lymph node status in patients with EC remains challenging.

Early-stage cervical cancer: is surgery better than radiotherapy?

Patients with early-stage cervical cancer may be treated appropriately with either radical surgery or radiation therapy. As most patients will be cured of their disease, side-effects of therapy and quality of life become of great importance. Individualization of treatment to reduce therapy-associated morbidity should be the main goal in cervical cancer management. Recent developments in surgical techniques, such as laparoscopy, nerve-sparing radical hysterectomy, sentinel lymph node biopsy, trachelectomy and 'less radical' hysterectomy, have contributed to reduce the morbidity of the surgical treatment. The use of postoperative radiotherapy or chemoradiation leads to more pronounced side effects than after either surgery or irradiation alone. Therefore, prognostic factors should be used to select patients for either surgery or radiotherapy alone to minimize the increased toxicities associated with the combination. The objectives of this review are to discuss the evidence supporting radical surgery, 'less radical' surgery and radiotherapy with regard to complication rate and quality of life.

Magnetic resonance imaging to identify risk of lymph node metastasis in patients with endometrial cancer.

OBJECTIVE: To assess the value of magnetic resonance imaging (MRI) to identify endometrial cancer patients at risk of lymph node metastasis. METHODS: Retrospective review of data from 108 patients with clinical stage I endometrial cancer who underwent preoperative MRI and were treated surgically. Patients at risk of lymph node metastasis were defined as those who had more than 50% myometrial infiltration or cervical invasion. Preoperative MRI reports were compared with final pathologic results. RESULTS: The mean age of the patients was 69.5 years and most patients had endometrioid cancer. On final pathologic analysis, 59 patients had deep myometrial infiltration or cervical invasion. For diagnosis of deep myometrial infiltration, cervical invasion, or both, MRI sensitivity and specificity were 56% and 85%; 47% and 83%; and 67% and 77%, respectively. CONCLUSION: MRI has limited value in identifying patients with endometrial cancer who are at risk of lymph node metastasis. Minimally invasive laparoscopic lymph node staging should be undertaken when it is feasible.

Percutaneous CT-guided multisampling core needle biopsy of thoracic lesions.

OBJECTIVE: The purpose of our study was to evaluate the diagnostic yield and the complication rate of percutaneous CT-guided coaxial 18-gauge (1.25-mm diameter) multisampling (five samples) core needle biopsy (CNB) of suspected thoracic lesions. MATERIALS AND METHODS: The records of 75 consecutive patients (29 women, 46 men; age range, 33-92 years) who underwent percutaneous CT-guided adjustable coaxial 18-gauge multisampling (five samples) CNB of a suspected thoracic lesion (eight mediastinal lesions, two chest wall lesions, two pleural lesions, and 63 intrapulmonary lesions) were reviewed. RESULTS: Ninety-seven percent (73/75) of CNB specimens were considered adequate for a specific diagnosis by the histopathology staff. Diagnostic yield was 97% (95% confidence interval, 91-99%) (72/74) (number of correct diagnoses obtained at CNB / number of definitive diagnoses). There were 61 malignant lesions and 11 benign lesions. There was no false-negative result when CNB was considered adequate for a specific diagnosis by the histopathology staff. Pneumothorax occurred in 19% (12/63 intrapulmonary lesions). One patient required placement of a chest tube. Minor postbiopsy hemoptysis occurred and resolved spontaneously in 11% (7/63) of patients. CONCLUSION: Percutaneous CT-guided coaxial multisampling large CNB of suspected thoracic lesions, in a mainly cancer-based population, is an accurate procedure for a specific histologic diagnosis and has a low rate of complications.

High opacification of hilar pulmonary vessels with a small amount of nonionic contrast medium for general thoracic CT: a prospective study.

OBJECTIVE: The main goal of this study was to determine whether in thoracic helical CT for general indications a high opacification of hilar pulmonary vessels could be obtained using a small amount of nonionic contrast medium. SUBJECTS AND METHODS: Two hundred consecutive patients referred for contrast-enhanced thoracic CT for malignancies or infections prospectively entered the study. They were randomly assigned to one of two simple bolus injection protocols (100 patients in each protocol): 60 mL of a nonionic contrast agent (250 mg I/mL) injected at a 3 mL/sec flow rate, or 80 mL of the same contrast agent injected at a 4 mL/sec flow rate. No saline flush or bolus triggering system was used. Hilar and mediastinal vessel enhancement was qualitatively (using a 4-point scale) and quantitatively (arterial attenuation values) assessed. Perivenous artifacts were also assessed. RESULTS: No extensive perivenous artifacts were noted. No significant difference was noted regarding pulmonary venous enhancement. Excellent opacification of the pulmonary veins was observed in 66% of patients injected at 3 mL/sec and in 56% of patients injected at 4 mL/sec (p > 0.192). A highly significant difference was noted for pulmonary artery enhancement. Excellent opacification of the pulmonary arteries was noted in 83% of patients injected with a 3mL/sec flow rate and in 61% of patients injected with a 4 mL/sec flow rate (p = 0.001). CONCLUSION: A high level of opacification of hilar pulmonary vessels, with no major perivenous artifacts, can be obtained with a small amount of nonionic contrast medium using a simple bolus injection.