A multicenter, retrospective archive study of radiological and clinical features of ALK-positive non-small cell lung cancer patients and crizotinib efficacy.

To evaluate radiological and clinical features in metastatic anaplastic lymphoma kinase+ non-small cell lung cancer patients and crizotinib efficacy in different lines. This national, non-interventional, multicenter, retrospective archive screening study evaluated demographic, clinical, and radiological imaging features, and treatment approaches in patients treated between 2013-2017. Totally 367 patients (54.8% males, median age at diagnosis 54 years) were included. Of them, 45.4% were smokers, and 8.7% had a family history of lung cancer. On radiological findings, 55.9% of the tumors were located peripherally, 7.7% of the patients had cavitary lesions, and 42.9% presented with pleural effusion. Pleural effusion was higher in nonsmokers than in smokers (37.3% vs. 25.3%, P = .018). About 47.4% of cases developed distant metastases during treatment, most frequently to the brain (26.2%). Chemotherapy was the first line treatment in 55.0%. Objective response rate was 61.9% (complete response: 7.6%; partial response: 54.2%). The highest complete and partial response rates were observed in patients who received crizotinib as the 2nd line treatment. The median progression-free survival was 14 months (standard error: 1.4, 95% confidence interval: 11.2-16.8 months). Crizotinib treatment lines yielded similar progression-free survival (P = .078). The most frequent treatment-related adverse event was fatigue (14.7%). Adrenal gland metastasis was significantly higher in males and smokers, and pleural involvement and effusion were significantly higher in nonsmokers-a novel finding that has not been reported previously. The radiological and histological characteristics were consistent with the literature data, but several differences in clinical characteristics might be related to population characteristics.

Bone marrow mesenchymal stromal cells support regeneration of intestinal damage in a colitis mouse model, independent of their CXCR4 expression.

Inflammatory bowel disease (IBD) is characterized by a chronically dysregulated immune response in the gastrointestinal tract. Bone marrow multipotent mesenchymal stromal cells have an important immunomodulatory function and support regeneration of inflamed tissue by secretion of soluble factors as well as through direct local differentiation. CXCR4 is the receptor for CXCL12 (SDF-1, stromal-derived factor-1) and has been shown to be the main chemokine receptor, required for homing of MSCs. Increased expression of CXCL12 by inflamed intestinal tissue causes constitutive inflammation by attracting lymphocytes but can also be used to direct MSCs to sites of injury/inflammation. Trypsin is typically used to dissociate MSCs into single-cell suspensions but has also been shown to digest surface CXCR4. Here, we assessed the regenerative effects of CXCR4high and CXCR4low MSCs in an immune-deficient mouse model of DSS-induced colitis. We found that transplantation of MSCs resulted in clinical improvement and histological recovery of intestinal epithelium. In contrary to our expectations, the levels of CXCR4 on transplanted MSCs did not affect their regenerative supporting potential, indicating that paracrine effects of MSCs may be largely responsible for their regenerative/protective effects.

Integrated FDG-PET/CT contribution over cross-sectional imaging in recurrence or progression of pancreaticobiliary neoplasms.

PURPOSE: We aim to compare FDG-PET/CT and cross-sectional imaging (contrastenhanced CT/MRI) diagnostic abilities in detecting recurrence/progression of pancreaticobiliary system tumors and to reveal the clinical impact of integrated FDGPET/CT to CT/MRI on patient management. MATERIALS AND METHODS: FDG-PET/CT and CT/MRI scans of 70 patients from initiation of treatment until proven recurrence/progression were retrospectively evaluated. FDGPET/CT and contrast-enhanced CT/MRI accuracy, sensitivity, specificity, PPV and NPV are compared in terms of overall recurrence/progression diagnosis and sitespecific concern; local disease, local lymph node, and distant organ metastasis. The impact of integrated FDG-PET/CT on patient management is scrutinized. RESULTS: CT/MRI has higher sensitivity than FDG-PET/CT in detecting loco-regional involvement (90% vs 76.7% P: 0.152), local lymph node metastasis (88.9% vs 77.8%, P: 0.380) and distant organ metastasis (96.5% vs 80.7%; P: 0.006) in tumor recurrence/progression. In overall diagnosis, CT/MRI is more sensitive and accurate but less specific than FDG-PET/CT (92.3% vs 87.7%; 87.1% vs 84.2%; 40% vs 20%, respectively). In 8% (6/70) of patients FDG-PET/CT had a major impact on patient management. CONCLUSION: FDG-PET/CT and cross-sectional imaging have different advantages and shortcomings. In recurrence/progression, recognition of early changes is more feasible by CT/MRI. However, inconsistency of morphologic and metabolic findings is important reason of cross-sectional imaging failure. FDG-PET/CT is superior in showing extraabdominal metastases, but missing small-volume lesions and misinterpreting inflammatory changes are still a problem lowering its sensitivity. Nevertheless FDGPET/CT is good option for guiding undetermined imaging findings or clinic-radiologic mismatch.

Percutaneous nephrostomy in infants: a 20-year single-center experience.

PURPOSE: To investigate the safety and efficacy of the imaging-guided percutaneous nephrostomy (PCN) procedure in infants. METHODS: A total of 75 (50 boys; 66.7%) patients with a mean age of 121 days (range, 1-351 days) who underwent PCN over a period of 20 years were included in this retrospective study. For each patient, PCN indications, catheter size, the mean duration of catheterization, complications, and the procedure performed following nephrostomy were recorded. Technical success was determined based on the successful placement of the nephrostomy catheter within the pelvicalyceal system. Clinical success was defined as the complete resolution of hydronephrosis and improvement in renal function tests during follow-up. In patients with urinary leakage, technical and clinical success was determined based on the resolution of leakage. RESULTS: The technical success rate was 100%, and no procedure-related mortality was observed. In 11 patients (14.7%), bilateral PCN was performed. The most frequent indication of PCN was ureteropelvic junction obstruction (n = 41, 54.7%). Procedure-related major complications were encountered in two patients (methemoglobinemia and respiratory arrest caused by the local anesthetic agent in one patient and the development of urinoma caused by urinary leakage from the puncture site in the other). Mild urinary leakage was the only minor complication that occurred and only in one patient. Catheter-related complications were managed through replacement or revision surgery in 16 patients (21.3%). CONCLUSION: Imaging-guided PCN is a feasible and effective procedure with high technical success and low major complication rates, and it is useful for protecting kidney function in infants.

Real-world outcomes of pazopanib in metastatic soft tissue sarcoma: a retrospective Turkish oncology group (TOG) study.

AIM: Description of patient characteristics, effectiveness and safety in Turkish patients treated with pazopanib for metastatic soft tissue sarcoma (STS). PATIENTS AND METHODS: This multicenter study is based on retrospective review of hospital medical records of patients (≥ 18 years) treated with pazopanib for non-adipocytic metastatic STS at 37 Oncology clinics across Turkey. Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) were evaluated with further analysis of data on the three most common histological subtypes (leiomyosarcoma [LMS], undifferentiated pleomorphic sarcoma [UPS], synovial sarcoma [SS]) in the cohort. RESULTS: Data of 552 adults (57.6% women, median age: 52 years) were analyzed. DCR and ORR were 43.1% and 30.8%, respectively. Median PFS was 6.7 months and OS was 13.8 months. For LMS, UPS and SS, median PFSs were 6.1, 5.9 and 7.53 months and median OSs were 15.03, 12.87 and 12.27 months, respectively. ECOG ≥ 2 was associated with poor PFS and OS. Liver metastasis was only a factor for progression. Second-line use of pazopanib (vs. front-line) was associated with better PFS, its use beyond third line predicted worse OS. Adverse events (AE) occurred in 82.7% of patients. Most common AEs were fatigue (58.3%) and anorexia (52.3%) which were graded as ≥ 3 in 8.2% and 7.4% of patients, respectively. CONCLUSION: Pazopanib is effective and well-tolerated in treatment of non-adipocytic metastatic STS. Its earlier use (at second-line), good performance status may result in better outcomes. Worldwide scientific collaborations are important to gain knowledge on rarer STS subtypes by conducting studies in larger patient populations.

Giant pulmonary pseudoaneurysm following balloon dilatation of the pulmonary artery to relieve pulmonary band.

Pulmonary artery pseudoaneurysms are uncommon. They may occur secondary to trauma, infectious diseases, vasculitis syndromes, neoplasms, congenital diseases, and pulmonary hypertension. Due to increasing number of cardiac interventions, iatrogenic complications are among the major causes of pulmonary artery pseudoaneurysms.In this report, we present a 6-month-old patient with pulmonary pseudoaneurysm that occurred following pulmonary balloon angioplasty for the relief of a pulmonary band.

Evaluation of Environmental and Nutritional Aspects of Bee Pollen Samples Collected from East Black Sea Region, Turkey, via Elemental Analysis by ICP-MS.

Honeybee pollens are good food sources in terms of their mineral contents and are specific to the regions they are collected. In addition, they may be used as bioindicators in the assessment of environmental pollution based on their potentially toxic element contents. In the present study, mineral element composition and potentially toxic element levels of honeybee pollen samples collected from various cities in East Black Sea Region of Turkey (18 samples) were determined by inductively coupled plasma mass spectrometry (ICP-MS) after microwave assisted acid digestion. The method validation was performed by using CRM (Certified Reference Material-BCR®279-Sea Lettuce-Ulva lactuca) to evaluate the accuracy and precision. Elemental composition of honeybee pollens were detected within the following ranges (minimum-maximum, mg kg-1 dry pollen); Mn (manganese): 11.579-117.349, Fe (Iron): 34.865-811.043, Zn (zinc): 17.707-56.223, Se (selenium): 0.422-0.722, Cr (chromium): 0.848-6.949, Cu (copper): 7.510-26.344, Mg (magnesium): 549.921-2149.716, Ca (calcium): 726.575-2201.837, Na (sodium): 36.518-120.283, Pb (lead): < 0.005-0.622, Cd (cadmium): 0.039-1.390, Ni (nickel): 2.317-21.710, and As (arsenic): 1.331-2.248. Recommended daily allowance, target hazard quotients, hazard index, and carcinogenic risk values of the pollens were calculated with the help of these results. In considering THQ values, pollens were determined to be safe for the consumption of both genders. Based on the carcinogenic risk calculation, most of the pollens examined in this study were categorized as moderately risky. Monitoring studies can be used to identify new sources of contamination or the origin and spread of a particular element. Hence, bee pollens can also be considered as potential bioindicators of toxic metal pollution. HIGHLIGHTS: • Mineral content and potentially toxic metal levels of 18 honeybee pollens were determined. • Recommended daily allowance (RDA) values were calculated. • The nutritional aspects of honeybee pollen samples were evaluated. • Hazard quotient (HQ), hazard index (HI), and carcinogenic risk (CR) estimation of honeybee pollens were assessed. • The potentiality of honeybee pollens as a bioindicator for pollution was discussed.

Effects of storage media, supplements and cryopreservation methods on quality of stem cells.

Despite a vast amount of different methods, protocols and cryoprotective agents (CPA), stem cells are often frozen using standard protocols that have been optimized for use with cell lines, rather than with stem cells. Relatively few comparative studies have been performed to assess the effects of cryopreservation methods on these stem cells. Dimethyl sulfoxide (DMSO) has been a key agent for the development of cryobiology and has been used universally for cryopreservation. However, the use of DMSO has been associated with in vitro and in vivo toxicity and has been shown to affect many cellular processes due to changes in DNA methylation and dysregulation of gene expression. Despite studies showing that DMSO may affect cell characteristics, DMSO remains the CPA of choice, both in a research setting and in the clinics. However, numerous alternatives to DMSO have been shown to hold promise for use as a CPA and include albumin, trehalose, sucrose, ethylene glycol, polyethylene glycol and many more. Here, we will discuss the use, advantages and disadvantages of these CPAs for cryopreservation of different types of stem cells, including hematopoietic stem cells, mesenchymal stromal/stem cells and induced pluripotent stem cells.

Investigation of Phenolic Content in Five Different Pine Barks Species Grown in Turkey by HPLC-UV and LC-MS.

Investigation of phenolic content from different pine bark species grown in Turkey was performed using a reversed-phase high pressure liquid chromatography with ultraviolet (RP-HPLC-UV) method. All phenolic constituents were separated in <26 min on reversed-phase C18 column with gradient mobile phase that consists of orthophosphoric acid, methanol and acetonitrile. Detections were made on an UV detector at 280 nm and at a flow rate of 1 mL/min. Samples were prepared according to Masqueller's conventional sample preparation method with slight modifications. To avoid the reduction in extraction efficiency the sample preparation step was carried out under argon atmosphere. The linearity of the method was between 0.9994 and 0.9999. The detection limits for the five phenolic constituents ranged from 0122 to 0.324 mg/L. Catechin and taxifolin were found in all pine barks at a concentration of 0.065 ± 0.002-1.454 ± 0.004 and 0.015 ± 0.001-23.164 ± 0.322 mg/g, respectively. Epicatechin was determined in four pine barks between 0.027 ± 0.001 and 0.076 ± 0.002 mg/g, ferulic acid in two pine barks between 0.010 ± 0.001 and 0.022 ± 0.001 mg/g and epicatechin gallate in only one of the pine barks at 0.025 ± 0.001 mg/g. Finally, the total amount of phenolic compounds and antioxidant capacities of the pine barks were found to be very high.

The characteristics of left atrial diverticula in normal sinüs rhythm patients.

PURPOSE: The purpose of this study was to evaluate the prevalence, location, size and morphological characteristics of left atrial diverticula using electrocardiographically gated multi-detector computed tomography in patients with normal sinus rhythm. METHODS: Electrocardiographically gated cardiac multi-detector computed tomography was performed in 93 patients with normal sinus rhythm. The prevalence, number, size, morphological characteristics and location of left atrial diverticula were recorded. RESULTS: A total of 72 left atrial diverticula were diagnosed in 45 (48.4%) of the 93 patients in this study. Of these 72 diverticula, 66 (91.7%) were cystiform and 6 (8.3%) were tubiform. Anterosuperior wall, left lateral wall and septum were the most common locations of these left atrial diverticula (n = 42, 58.3%; n = 22, 15.3% and n = 7, 9.7%, respectively). CONCLUSION: Diverticula are common variations. The discovery of these structures is relatively new and their clinical significance remains unclear. They are generally asymptomatic but although not supported by many studies, in some case reports they are claimed to be associated with arrhythmias and thromboembolism. In addition, it is theoretically reasonable to think that they may cause complications during interventional procedures. Better understanding of these structures has the potential to improve management strategies and reduce potential complications. Therefore, they should be reported during routine cardiac computed tomography.

Clinicopathologic and Prognostic Differences between Three Different Age Groups (Child/Adolescent, Young Adults, and Adults) of Colorectal Cancer Patients: A Multicentre Study.

BACKGROUND: Colorectal cancer (CRC) is a rare disease amongst children and adolescents. Previous studies have reported a number of differences between children/adolescents, young adults, and adult patients with CRC. However, none of these studies compared these age groups according to their clinicopathologic and prognostic characteristics. In the current study, we compare these three age groups. METHODS: A total of 173 (1.1% of 15,654 patients) young CRC patients (≤25 years) were included in the study. As a control group, 237 adult CRC patients (>25 years) were also included. Patients were divided into three age groups: child/adolescent (10-19 years), young adult (20-25 years), and adult (>25 years). RESULTS: Statistical differences amongst the three groups in terms of gender (p = 0.446), family history (p = 0.578), symptoms of presentation (p = 0.306), and interval between initiation of symptoms and diagnosis (p = 0.710) could not be demonstrated. Whilst abdominal pain (p < 0.001) and vomiting (p = 0.002) were less common in young adults than in other groups, rectal bleeding and changes in bowel habits were relatively less common in adolescents than in other groups. Rectal localisation (p = 0.035), mucinous adenocarcinoma (p < 0.001), and a poorly differentiated histologic subtype (p < 0.001) were less common in the adult group than in other groups. The percentage of patients with metastasis and sites of metastasis (e.g., peritoneum and lung) differed between groups. The median overall survival was 32.6 months in the adolescent group, 57.8 months in the young adult group and was not reached in the adult group (p = 0.022). The median event-free survival of the adolescent, young adult, and adult groups was 29.0, 29.9, and 61.6 months, respectively (p = 0.003). CONCLUSIONS: CRC patients of different age groups present different clinicopathologic and prognostic characteristics. Clinicians should be aware of and manage the disease according to these differences.

Comparison of CT methods for determining graft steatosis in living donor liver transplantation.

PURPOSE: To evaluate and compare the diagnostic performance of non-enhanced computed tomography (NECT) and contrast-enhanced CT (CECT) attenuation indices in the assessment of hepatic steatosis by using biopsy as the reference standard. MATERIALS AND METHODS: This retrospective study was approved by our Institutional Review Board. 55 Potential donors who underwent both NECT and triphasic CECT and core liver biopsy, were included the study. Average attenuation measurements that were obtained from multiple regions in liver, spleen, and psoas muscle on both unenhanced and CECT were used for analysis. Hepatic attenuation measurements were analyzed with and without normalization with the spleen and psoas muscle. Linear regression and receiver operating characteristic (ROC) curve analysis were used to evaluate the statistical association between CT indices and steatosis at histology. RESULTS: Linear regression analysis confirmed the strongest correlation between steatosis and normalized measurements of hepatic attenuation with splenic attenuations on hepatic venous phase of CECT scan (R 0.821; R2 0.674 and R 0.816; R2 0.665, respectively). The use of ROC curve analysis also demonstrated that normalized measurements of hepatic attenuation with splenic attenuations on hepatic venous phase of CECT showed high diagnostic performance regarding the qualitative distinction of steatosis (AUC values greater than 0.9). CONCLUSION: Attenuation measurements of liver normalized with spleen on hepatic venous phase may be useful in evaluating steatosis in donor candidates with moderate to severe steatosis who are unacceptable for liver donation. In this manner unnecessary liver biopsy may be avoided in those donor candidates.

Anti-Ri-associated paraneoplastic neurological syndrome: Initial symptom of breast cancer with HER2 overexpression and treatment by dual HER2 blockade.

Paraneoplastic neurological syndrome is associated with anti-Ri antibodies, which are typically present with opsoclonus-myoclonus-ataxia. Human epidermal growth factor receptor 2 (HER2) overexpression is present in 15%-25% of breast cancer and is associated with poor prognosis. There are a few reports of paraneoplastic neurological syndrome associated with HER2-positive breast cancer in the literature, of which most are anti-Yo-associated paraneoplastic neurological syndrome. We present herein the case of a female patient with HER2-positive breast cancer who had atypical anti-Ri antibody associated with opsoclonus-myoclonus paraneoplastic neurological syndrome. Following the diagnosis of paraneoplastic syndrome, chemotherapy with dual HER2 blockade and immunomodulating treatment including intravenous immunoglobulin and oral prednisolone were administered. Although the patient was negative for serum anti-Ri antibodies, there was partial clinical improvement and her neurological deficit persisted. To our knowledge, this is the first case report of female patient with HER2-positive breast cancer who had atypical anti-Ri antibody associated with opsoclonus-myoclonus paraneoplastic neurological syndrome and treated with dual HER2 blockade.

Prognostic factors of patients who received chemotherapy after cranial irradiation for non-small cell lung cancer with brain metastases: A retrospective analysis of multicenter study (Anatolian Society of Medical Oncology).

PURPOSE: Almost half of all patients diagnosed with non-small cell lung cancer (NSCLC) have distant metastases at presentation. One-third of patients with NSCLC will have brain metastases. Without effective treatment, the median survival is only 1 month. However, it is difficult to treat brain metastases with systemic chemotherapy since the agents have difficulty crossing the blood-brain barrier. Therefore, it is important to estimate the patient's survival prognosis. The aim of this study was to analyze prognostic factors for survival in Turkish patients who received chemotherapy after cranial irradiation for NSCLC with brain metastases. METHODS: We retrospectively reviewed 698 patients with brain metastases resulting from NSCLC. Ten potential prognostic variables were chosen for analysis. Univariate and multivariate analyses were conducted to identify prognostic factors associated with overall survival (OS). RESULTS: Among the 10 variables for univariate analysis, six were identified to have prognostic significance; these included sex, smoking history, histology, number of brain metastases, extracranial metastases, and neurosurgical resection. Multivariate analysis by the Cox proportional hazard model showed that a smoking history, extracranial metastases, and neurosurgical resection were independent negative prognostic factors for OS. CONCLUSION: Smoking history, extracranial metastases, and neurosurgical resection were considered independent negative prognostic factors for OS. These findings may facilitate pretreatment prediction of survival and can be used for selecting patients for more appropriate treatment options.

Diffusion-weighted imaging in ectopic pregnancy: ring of restriction sign.

OBJECTIVE: To demonstrate the diffusion-weighted imaging (DWI) findings of ectopic pregnancy (EP) and introduce the "ring of restriction" sign by discussing possible causes. METHODS: Between January 2014 and January 2017, patients with EP and examined by MRI on a 3T scanner were retrospectively evaluated. MRI and DWI findings were recorded. RESULTS: A total of 40 patients were diagnosed with EP at our university hospital, 8 of whom (20%) were evaluated by MRI and DWI. All of them were haemodynamically and clinically stable and could be imaged adequately. Locations were ovary (n = 3, 37.5%), tuba (n = 2, 25%), Caesarean section scar (n = 2, 25%) and parauterine (n = 1, 12.5%). In all eight EPs, the gestational sac diameter was compatible with 7-9 weeks. With DWI, the gestational sac was seen as a thick-walled cyst-like structure. The thick wall showed diffusion restrictions in all patients (ring of restriction sign). CONCLUSIONS: DWI through its cellular and molecular evidence may contribute diagnosis of EP. Advances in knowledge: Being aware of the EP wall shows diffusion restriction (ring of restriction) avoids interpretation errors especially in appropriate clinical setting with no need for contrast material.

Efficacy and safety of cetuximab plus FOLFOX in second-line and third-line therapy in metastatic colorectal cancer.

PURPOSE: To evaluate the efficacy and adverse events with cetuximab plus FOLFOX administered as second- and third-line therapy in metastatic colorectal cancer (mCRC) patients. METHODS: IPatients were administered cetuximab plus FOLFOX as second- and third-line therapy from January 2010 through October 2015. mCRC patients with wild type KRAS were alsï given irinïtecan and/ïr ïxaliplatin cïmbined with fluorïpyrimidine±bevacizumab. Tumor respïnse and survival were evaluated using RECIST and Kaplan-Meier methïd respectively. RESULTS: Sixty patients were included this study. Cetuximab plus FOLFOX was administered to 40 (66.7%) patients as second-line and to 20 (33.3%) as third-line therapy. The majority of the patients had a good ECOG performance status (PS) (0 or 1). Clinical benefit was partial plus stable disease and it was 75.0% for both of these two lines. The median progression free survival (PFS) was 7.1 months (95% CI=3.2-10.9) and 6.0 months (95% CI=2.4-9.6), in the second-and third-line (p=0.484). The median ïverall survival (ÏS) was 14.3 and 9.2 mïnths in secïnd-and third-line therapy respectively (p=0.071). The common toxicities were haematologic and gastrointestinal, mostly grade 1 and 2. CONCLUSION: The addition of cetuximab to FOLFOX was well-tolerated and had antitumor activity both in second- and third-line therapy in patients with mCRC.

Analysis of risk factors affecting coagulopathy after donor hepatectomy in a newly established liver transplant center.

OBJECTIVE: As might be expected, living donor liver surgery is associated with serious morbidity and mortality risks. Coagulopathy after donor hepatectomy is an important risk factor affecting morbidity. In this study, risk factors affecting the development of coagulopathy after donor hepatectomy was evaluated in a newly-established liver transplant center. MATERIAL AND METHODS: A retrospective evaluation of 46 liver donors to whom hepatectomy was applied in Medipol Universty of School of Medicine Department of Organ Transplantation between April 2014 and July 2015 was made. Coagulopathy was defined as prothrombin time ≥15 sec. or platelet count <80000/mm3 on postoperative day 3. Donors were separated into 2 groups as those with (n=24) and without (n=22) coagulopathy. Preoperative, intraoperative and postoperative factors acting on coagulopathy were analyzed. RESULTS: In the intergroup analysis, it was seen that remnant liver volume, remnant liver volume % and remnant liver volume to body weight ratio were factors associated with coagulopathy. The cut-off values for these 3 parameters were calculated as 773.5 cm3, 40.5% and 0.915 cm3/kg, respectively. Only remnant liver volume % was determined as a risk factor for coagulopathy after donor hepatectomy on multiple logistic regression analysis. CONCLUSION: The results of this study showed that the most important risk factors affecting coagulopathy after donor hepatectomy were the parameters associated with remnant liver volume.

Is the necrosis/wall ADC ratio useful for the differentiation of benign and malignant breast lesions?

OBJECTIVE: To determine whether the necrosis/wall apparent diffusion coefficient (ADC) ratio is useful for the malignant-benign differentiation of necrotic breast lesions. METHODS: Breast MRI was performed using a 3-T system. In this retrospective study, calculation of the necrosis/wall ADC ratio was based on ADC values measured from the necrosis and from the wall of malignant and benign breast lesions by diffusion-weighted imaging (DWI). By synchronizing post-contrast T1 weighted images, the separate parts of wall and necrosis were maintained. All the diagnoses were pathologically confirmed. Statistical analyses were conducted using an independent sample t-test and receiver operating characteristic analysis. The intraclass and interclass correlations were evaluated. RESULTS: A total of 66 female patients were enrolled, 38 of whom had necrotic breast carcinomas and 28 of whom had breast abscesses. The ADC values were obtained from both the wall and necrosis. The mean necrosis/wall ADC ratio (± standard deviation) was 1.61 ± 0.51 in carcinomas, and it was 0.65 ± 0.33 in abscesses. The area under the curve values for necrosis ADC, wall ADC and the necrosis/wall ADC ratio were 0.680, 0.068 and 0.942, respectively. A wall/necrosis ADC ratio cut-off value of 1.18 demonstrated a sensitivity of 97%, specificity of 93%, a positive-predictive value of 95%, a negative-predictive value of 96% and an accuracy of 95% in determining the malignant nature of necrotic breast lesions. There was a good intra- and interclass reliability for the ADC values of both necrosis and wall. CONCLUSION: The necrosis/wall ADC ratio appears to be a reliable and promising tool for discriminating breast carcinomas from abscesses using DWI. Advances in knowledge: ADC values of the necrosis obtained by DWI are valuable for malignant-benign differentiation in necrotic breast lesions. The necrosis/wall ADC ratio appears to be a reliable and promising tool in the breast imaging field.

Outcomes of surveillance versus adjuvant chemotherapy for patients with stage IA and IB nonseminomatous testicular germ cell tumors.

BACKGROUND: Currently, it is accepted that risk assessment of clinical stage I (CS I) nonseminomatous germ cell tumors (NSGCT) patient is mainly dependent on the presence of lymphovascular invasion (LVI). Initial active surveillance, adjuvant chemotherapy and retroperitoneal lymph node dissection (RPLND) are acceptable treatment options for these patients, but there is no uniform consensus. The purpose of this study was to compare outcomes of active surveillance with adjuvant chemotherapy. METHODS: A total of 201 patients with CS I NSGCT after orchiectomy were included. Outcomes of active surveillance and adjuvant chemotherapy were retrospectively analyzed. The prognostic significance of risk factors for survival and relapse was evaluated. RESULTS: Of the 201 patients, 110 (54.7%) received adjuvant chemotherapy, while the remaining 91 patients (45.3%) underwent surveillance. Relapses were significantly higher for patients underwent surveillance compared to adjuvant chemotherapy group (18.3 vs. 1.2%, p < 0.001). The 5-year relapse-free survival (RFS) rate for patients who were treated with adjuvant chemotherapy was significantly better than those of patients underwent surveillance (97.6 vs. 80.8%, respectively; p < 0.001). Univariate analysis showed that the presence of LVI (p = 0.01) and treatment option (p < 0.001) were prognostic factors for RFS and pT stage (p = 0.004) and invasion of rete testis (p = 0.004) and the presence of relapse (p < 0.001) were significant prognostic factors for OS. Multivariate analysis revealed that the treatment strategy was an independent prognostic factor for RFS (p < 0.001, HR 0.54). A logistic regression analysis demonstrated that treatment options (p = 0.031), embryonal carcinoma (EC) >50% (p = 0.013) and tumor diameter (p = 0.016) were found to be independent factors for predicting relapse. CONCLUSIONS: Our results indicate that adjuvant chemotherapy is associated with improved RFS compared with surveillance for CS I NSGCT patients. Moreover, the treatment strategy is an important prognostic indicator for RFS and a predictive factor for relapse. Although adjuvant chemotherapy seems to be a suitable treatment for patients with risk factors for relapse, surveillance is still preferred management option.