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1.
Virchows Arch ; 2023 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-37957341

RESUMO

Solitary fibrous tumour (SFT) is a mesenchymal neoplasm with variable behaviour, very rarely involving the genitourinary (GU) tract. Most reported cases correspond to isolated case reports. STAT6 immunohistochemistry is a more recent and reliable diagnostic marker. The pathology database of two tertiary institutes was searched for SFTs involving the GU tract. STAT6 strong diffuse nuclear staining confirmed the diagnosis in all four cases, and the NAB2::STAT6 fusion was demonstrated by NGS in one case. Two cases were diagnosed in needle biopsy, one involving the prostate and the other involving the seminal vesicle. One case corresponded to a pelvic mass inseparable from and infiltrating the prostate and bladder. The remainder represented an exceedingly rare involvement of the spermatic cord. Involvement by a SFT should be considered in the differential diagnosis of spindle cell lesions involving GU organs. STAT6 strong diffuse nuclear staining is an important ancillary tool, particularly in a biopsy.

2.
Acta Cytol ; 67(5): 507-518, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37494911

RESUMO

INTRODUCTION: PD-L1 expression is the most widely used predictive marker for immune checkpoint inhibitor (ICI) therapy in patients with lung adenocarcinoma. However, the current understanding of the association between PD-L1 expression and treatment response is suboptimal. A significant percentage of patients have only a cytological specimen available for clinical management. Therefore, it is relevant to examine the impact of molecular features on PD-L1 expression in cytological samples and how it might correlate with a therapeutic response. METHODS: We evaluated patients diagnosed with adenocarcinoma of the lung who had both in-house targeted next-generation sequencing analysis and paired PD-L1 (22C3) immunohistochemical staining performed on the same cell blocks. We explored the association between molecular features and PD-L1 expression. In patients who underwent ICIs therapy, we assessed how a specific gene mutation impacted a therapeutic response. RESULTS: 145 patients with lung adenocarcinoma were included in this study. PD-L1-high expression was found to be more common in pleural fluid than in other sample sites. Regional lymph node samples showed a higher proportion of PD-L1-high expression (29%) compared with lung samples (6%). The predictive value of PD-L1 expression was retained in cytological samples. Mutations in KRAS were also associated with a PD-L1-high expression. However, tumors with TP53 or KRAS mutations showed a lower therapy response rate regardless of the PD-L1 expression. CONCLUSION: Cytological samples maintain a predictive value for PD-L1 expression in patients with lung adenocarcinoma as regards the benefit of ICI treatment. Specific molecular alterations additionally impact PD-L1 expression and its predictive value.


Assuntos
Adenocarcinoma de Pulmão , Antígeno B7-H1 , Inibidores de Checkpoint Imunológico , Neoplasias Pulmonares , Humanos , Adenocarcinoma de Pulmão/tratamento farmacológico , Adenocarcinoma de Pulmão/metabolismo , Adenocarcinoma de Pulmão/patologia , Antígeno B7-H1/genética , Antígeno B7-H1/metabolismo , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Imuno-Histoquímica , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patologia , Proteínas Proto-Oncogênicas p21(ras)/genética , Inibidores de Checkpoint Imunológico/uso terapêutico
3.
Clin Breast Cancer ; 22(1): e123-e133, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34120846

RESUMO

BACKGROUND: Human epidermal growth factor 2 (HER2) amplification and/or overexpression occurs in 12% to 25% of breast cancers. Accurate detection of HER2 is critical in predicting response to HER2-targeted therapy. Both immunohistochemistry (IHC) and in situ hybridization (ISH) are FDA-approved methods for detecting HER2 status because its protein overexpression is largely attributable to gene amplification. However, variable discordant results between IHC and ISH have been reported. METHODS: We determined the frequency of HER2 IHC/ISH discordance in these patients and also performed a pooled literature review analysis. RESULTS: Of the 1125 consecutive primary or metastatic breast cancers with HER2 IHC and ISH performed simultaneously between 2015 and 2020, 84.6% had an unequivocal HER2 status. Discordance was found in 30 cases from 26 patients, including 13 IHC-/ISH+ and 17 IHC+/ISH-, representing 1.6% and 11.9% of IHC- and IHC+ cases, respectively. Review of the literature between 2001 and 2020 identified 46 relevant studies, with a total of 43,468 cases with IHC and ISH performed. The IHC-/ISH+ and IHC+/ISH- discordances were seen in all antibody clones and ISH methods used. The IHC+/ISH- discordance was significantly higher than IHC-/ISH+ (13.8% vs. 3%, P < .0001). The overall discordance constituted 4% of all cases and 5.4% of those with an unequivocal IHC status. Significantly lower incongruities for both IHC-/ISH+ and IHC+/ISH- were found in those published after 2018. The discordances probably reflect altered biology of HER2 oncogene/oncoprotein. Routinely performing both IHC and ISH may uncover such cases to prevent denial of potentially beneficial targeted therapy.


Assuntos
Neoplasias da Mama/metabolismo , Imuno-Histoquímica/normas , Hibridização In Situ/normas , Receptor ErbB-2/metabolismo , Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/patologia , Erros de Diagnóstico , Feminino , Amplificação de Genes , Humanos , Hibridização in Situ Fluorescente/métodos , Variações Dependentes do Observador
4.
J Comput Assist Tomogr ; 44(6): 821-832, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33196594

RESUMO

The most common sarcomas in the thorax are metastasis from an extrathoracic primary malignancy. Primary intrathoracic sarcomas are rare albeit aggressive malignancies that are diagnosed on histopathology. Although a few imaging characteristics have been described that are common to sarcomas, it is still a diagnosis of exclusion as other tumors are much more common. Like elsewhere, primary thoracic sarcomas are also classified according to their histologic features. They are a rare group of tumors that can arise from the mediastinal structures, lung, pleura, or chest wall. On imaging, differentiating these from more common malignancies like lung cancer is difficult and often requires multimodality workup and tissue sampling. A few sarcomas are very specific to their locations, such as angiosarcoma in the right atrium, leiomyosarcoma in the pulmonary artery, where imaging has high accuracy for the diagnosis. Despite being nonspecific in a majority of cases, imaging plays a pivotal role in determining the organ of origin, tumor extent, invasion of adjacent structures, and thus help to assess the surgical resectability. Although sarcomas arising from chest wall are the most common primary sarcomas in the chest, they are excluded from this review to focus only on primary intrathoracic sarcomas. The article provides a comprehensive imaging and pathology review of the rare primary intrathoracic sarcomas, including but not limited to angiosarcoma, Kaposi sarcoma, fibrosarcoma, malignant transformation of fibrous tumor of pleura, sarcomatoid mesothelioma, leiomyosarcoma, and malignant small round blue cell tumors.Key points:Primary intrathoracic sarcomas are rare but clinically important.Imaging helps to determine local extent, invasion, metastases and appropriate site/mode of biopsy.Role of pathology is paramount in diagnosis and guiding treatment based on immunogenetic/molecular typing.


Assuntos
Diagnóstico por Imagem/métodos , Sarcoma/diagnóstico por imagem , Neoplasias Torácicas/diagnóstico por imagem , Diagnóstico Diferencial , Humanos
5.
Hypertension ; 76(3): 614-621, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32683905
6.
Am J Clin Pathol ; 152(1): 27-35, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-30892602

RESUMO

OBJECTIVES: To compare the effects of two methods of formalin-fixed paraffin-embedded (FFPE) tissue harvesting on DNA quality and next-generation sequencing (NGS) quality metrics. METHODS: DNA integrity number (DIN) and NGS quality metrics resulting from DNA extraction and sequencing of 199 sequential samples harvested via the Pinpoint Slide DNA Isolation System and the punch method were compared. RESULTS: DNA extracted from FFPE tissue punches had higher DIN than that extracted from Pinpoint samples (mean ± SD, 6.18 ± 0.83 vs 5.09 ± 0.91; P < .0001), indicating less degradation. Lower DIN correlated with lower-quality metrics of NGS, that is lower percentage of unique on-target reads, average depth of coverage, and percentage of positions with coverage depth greater than or equal to 100×, 400×, and 1,000×. CONCLUSIONS: Our study demonstrated methods to harvest tissue from FFPE blocks may affect quality of DNA, which in turn has an effect on other NGS quality metrics.


Assuntos
DNA de Neoplasias/análise , Sequenciamento de Nucleotídeos em Larga Escala/normas , Humanos , Inclusão em Parafina , Manejo de Espécimes , Fixação de Tecidos
7.
J Am Coll Surg ; 228(4): 474-479, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30582976

RESUMO

BACKGROUND: With the increased use of molecular testing of thyroid fine-needle biopsies, the frequency and extent of thyroid resection for thyroid nodules has changed. Although the role of frozen-section analysis of the thyroid has been reduced markedly in recent years, many surgeons still routinely use it intraoperatively. We sought to determine the utility of frozen section during thyroidectomy in the era of molecular testing. STUDY DESIGN: We reviewed 236 consecutive patients who had thyroidectomy with intraoperative frozen-section analysis at our institution between November 2015 and October 2017. We re-reviewed the preoperative diagnosis, frozen-section diagnosis, final pathology, and whether operative management changed from the initial plan based on frozen section. RESULTS: Mean age of the patients was 55.6 ± 14.1 years, and 83% were female. Of the 236 patients, frozen section did not change the intraoperative management in 225 (95%). Of the 11 patients whose thyroid operation was modified, the operation was either too much or not enough in 6 patients. In only 5 (2.1%) patients, frozen-section analysis correctly changed the extent of thyroidectomy. CONCLUSIONS: Thyroid frozen-section analysis adds cost and time to thyroid operations without notable benefit. In our cohort, only 2.1% of frozen sections accurately changed intraoperative management. We recommend against its routine use.


Assuntos
Secções Congeladas , Cuidados Intraoperatórios/métodos , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Idoso , Biópsia por Agulha Fina , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Estudos Retrospectivos , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia
8.
Oncotarget ; 8(34): 57845-57854, 2017 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-28915716

RESUMO

BACKGROUND: With rapid advances in genomic medicine, the complexity of delivering precision medicine to oncology patients across a university health system demanded the creation of a Molecular Tumor Board (MTB) for patient selection and assessment of treatment options. The objective of this report is to analyze our progress to date and discuss the importance of the MTB in the implementation of personalized medicine. MATERIALS AND METHODS: Patients were reviewed in the MTB for appropriateness for comprehensive next generation sequencing (NGS) cancer gene set testing based on set criteria that were in place. Because profiling of stage IV lung cancer, colon cancer, and melanoma cancers were standard of care, these cancer types were excluded from this process. We subsequently analyzed the types of cases referred for testing and approved with regards to their results. RESULTS: 191 cases were discussed at the MTB and 132 cases were approved for testing. Forty-six cases (34.8%) had driver mutations that were associated with an active targeted therapeutic agent, including BRAF, PIK3CA, IDH1, KRAS, and BRCA1. An additional 56 cases (42.4%) had driver mutations previously reported in some type of cancer. Twenty-two cases (16.7%) did not have any clinically significant mutations. Eight cases did not yield adequate DNA. 15 cases were considered for targeted therapy, 13 of which received targeted therapy. One patient experienced a near complete response. Seven of 13 had stable disease or a partial response. CONCLUSIONS: MTB at University of Alabama-Birmingham is unique because it reviews the appropriateness of NGS testing for patients with recurrent cancer and serves as a forum to educate our physicians about the pathways of precision medicine. Our results suggest that our detection of actionable mutations may be higher due to our careful selection. The application of precision medicine and molecular genetic testing for cancer patients remains a continuous educational process for physicians.

9.
Case Rep Pathol ; 2016: 6898526, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27293940

RESUMO

Adenomatoid tumor is an uncommon benign neoplasm of mesothelial differentiation that distinctively arises in and around the genital organs. In rare instances, it has been described in extragenital locations. There have been only two reports documenting its occurrence in the anterior mediastinum, and no reports documenting its occurrence in the posterior mediastinum. We report the first case of posterior mediastinal adenomatoid tumor. A 37-year-old Caucasian woman presented with symptoms of bronchitis. Imaging studies identified a 2.0 cm posterior mediastinal mass abutting the T9 vertebral body, clinically and radiologically most consistent with schwannoma. Histologic sections revealed a lesion composed of epithelioid cells arranged in cords and luminal profiles embedded in a fibrotic to loose stroma and surrounded by a fibrous pseudocapsule. Lesional cells showed vacuolated eosinophilic cytoplasm and peripherally displaced nuclei with prominent nucleoli. There was focal cytologic atypia but no mitotic figures or necrosis was identified. The lesional cells expressed cytokeratin, calretinin, and nuclear WT1 but were negative for PAX8, TTF1, p53, chromogranin, CD31, and CD34, and Ki67 showed <2% proliferation rate, diagnostic of adenomatoid tumor. Three years after resection, the patient is in good health without tumor recurrence. Thus, our encounter effectively expands the differential diagnosis of posterior mediastinal neoplastic entities.

10.
Ann Thorac Surg ; 99(5): 1814-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25952218

RESUMO

Pulmonary endarterectomy (PEA) can significantly increase long-term survival in patients with chronic thromboembolic pulmonary hypertension; however, the role of PEA for chronic thromboembolic pulmonary hypertension due to pulmonary valve endocarditis is controversial. A critically ill 61-year-old man with intractable right ventricular heart failure was found to have chronic thromboembolic pulmonary hypertension due to Streptococcus bovis pulmonary valve endocarditis and underwent successful pulmonary valve replacement and PEA. The successful outcome in this case suggests that PEA should be considered in patients with this condition.


Assuntos
Endarterectomia , Endocardite Bacteriana/complicações , Hipertensão Pulmonar/etiologia , Embolia Pulmonar/complicações , Embolia Pulmonar/cirurgia , Infecções Estreptocócicas/complicações , Streptococcus bovis , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/microbiologia
11.
Hum Pathol ; 43(1): 121-6, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21733556

RESUMO

Pleomorphic hyalinizing angiectatic tumor of soft parts is a recently recognized, low-grade mesenchymal neoplasm of uncertain lineage. It is characterized by clusters of ectatic, fibrin-lined, thin-walled vessels surrounded by pleomorphic but mitotically inert spindled cells with frequent intranuclear inclusions and a variable inflammatory component. Here, we report a case of recurrent pleomorphic hyalinizing angiectatic tumor in a 37-year-old white woman. Touch imprint cytologic analysis revealed oval and spindled cells with fine chromatin, occasional prominent intranuclear inclusions, and intracytoplasmic pigment. The histologic features of the cells constituting the bulk of tumor were those characteristic of a putative precursor lesion ("early pleomorphic hyalinizing angiectatic tumor") as well as another recently described entity known as hemosiderotic fibrohistiocytic lipomatous lesion. Cytogenetic analysis revealed 2 unbalanced translocations involving chromosomes 1 and 3 and chromosomes 1 and 10, with a karyotype of 45,XX,der(1)t(1;3)(p31;q12),-3,der(10)t(1;10)(p31;q25)[11]/46,XX[4], thus suggesting that this disease is neoplastic. The controversies in classification of these lesions are also discussed.


Assuntos
Mesenquimoma/patologia , Neoplasias de Tecidos Moles/patologia , Cariótipo Anormal , Adulto , Biomarcadores Tumorais/metabolismo , Vasos Sanguíneos/patologia , Cromossomos Humanos Par 1 , Cromossomos Humanos Par 10 , Cromossomos Humanos Par 3 , Terapia Combinada , Análise Citogenética , Grânulos Citoplasmáticos/ultraestrutura , Dilatação Patológica/patologia , Feminino , , Humanos , Hialina/metabolismo , Mesenquimoma/genética , Mesenquimoma/terapia , Recidiva Local de Neoplasia , Neoplasias de Tecidos Moles/genética , Neoplasias de Tecidos Moles/terapia , Translocação Genética
12.
J Thorac Cardiovasc Surg ; 137(3): 605-9, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19258075

RESUMO

OBJECTIVE: The objective was to identify whether repeat positron emission tomography scan after neoadjuvant chemoradiotherapy in patients with esophageal cancer predicted a complete response. METHODS: A retrospective study using a prospective database was performed. Patients had esophageal cancer and underwent neoadjuvant chemoradiotherapy, an initial and repeat positron emission tomography, endoscopic ultrasound with fine-needle aspiration (at the same institution), and Ivor Lewis esophagogastrectomy with lymph node resection. RESULTS: There were 221 patients who underwent Ivor Lewis, 86 of whom had their initial and repeat positron emission tomography scans performed at the same center. Of these, 37 patients (43%) were complete responders. The median maximum standardized uptake value of esophageal cancer decreased by 72% in the 37 patients who were complete responders, by 58% in the 31 patients who were partial responders, and by 37% in the 18 patients who had a minimal pathologic response. When the maximum standardized uptake value decreased by more than 64%, the patient was likely to be a complete responder (P = .003, area under the curve = 0.75). CONCLUSION: When initial and repeat positron emission tomography scans are performed at the same center at least 30 days after the completion of preoperative chemoradiotherapy, the percent change in the maximum standardized uptake value is a predictor of the response to chemoradiotherapy by a patient with esophageal cancer. When the maximum standardized uptake value decreases by 64% or more, it is likely that the patient is a complete responder. These data may help guide neoadjuvant therapy and identify patients for a future randomized study that compares observation with surgical resection in patients with esophageal cancer who appear to be complete responders.


Assuntos
Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/terapia , Tomografia por Emissão de Pósitrons , Adulto , Idoso , Estudos de Coortes , Terapia Combinada , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/estatística & dados numéricos , Indução de Remissão , Estudos Retrospectivos
13.
Am J Clin Pathol ; 130(3): 425-7, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18701416

RESUMO

The effect of using a 30% cutoff for the proportion of HER2+ cells on the interobserver variability in the interpretation of HER2 immunohistochemical results was evaluated. Immunostained sections from 96 cases of breast carcinoma were reviewed by 10 pathologists and scored as positive (3+) when uniform strong membranous staining was identified in at least 10% of tumor cells; the actual percentage of cells with such staining was also estimated. The agreement rates and the kappa values using a 30% cutoff were compared with those using a 10% cutoff. These proved to be higher in 62% and 66% of measurements, respectively, with average interobserver rates and kappa values of 72% and 0.54 using the 30% cutoff and 70% and 0.49 using the 10% cutoff (P=.001 for all comparisons). Using a 30% cutoff for the percentage of HER2+ cells by immunohistochemical analysis modestly decreased interobserver variability in the interpretation of HER2 immunohistochemical results.


Assuntos
Neoplasias da Mama/química , Imuno-Histoquímica/normas , Variações Dependentes do Observador , Receptor ErbB-2/análise , Neoplasias da Mama/patologia , Feminino , Humanos , Reprodutibilidade dos Testes
14.
Ann Diagn Pathol ; 12(4): 293-295, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18620999

RESUMO

Angiomyolipoma is a benign tumor composed of varying proportions of smooth muscle cells, blood vessels, and adipose tissue that most commonly occurs in the kidney. Sporadic lesions and lesions arising in the setting of the tuberous sclerosis complex have been reported in extrarenal sites. We present the case of an incidentally discovered angiomyolipoma in the anterior mediastinum. Thymoma was suspected clinically, and the lesion was composed mainly of spindled-to-epithelioid cells arranged in a histologic pattern reminiscent of hemangiopericytoma, a pattern that has been described in thymoma. Immunohistochemical stains revealed positivity for smooth muscle actin and HMB-45, revealing the expression of smooth muscle and melanocytic markers characteristic of angiomyolipoma and other lesions in the PEComa family.


Assuntos
Angiomiolipoma/patologia , Neoplasias do Mediastino/patologia , Actinas/metabolismo , Antígenos de Neoplasias/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Antígenos Específicos de Melanoma , Pessoa de Meia-Idade , Músculo Liso/patologia , Proteínas de Neoplasias/metabolismo , Timoma/patologia , Neoplasias do Timo/patologia
15.
Ann Thorac Surg ; 83(6): 2201-3, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17532427

RESUMO

This report describes the surgical management of a tumor that filled the left chest of a 58-year-old man. Histopathologic examination showed that this was an angiomyolipoma, a tumor that most commonly occurs in the kidney. The preoperative evaluation and intraoperative management are presented, along with a brief review of this unusual neoplasm.


Assuntos
Angiomiolipoma/cirurgia , Neoplasias Torácicas/cirurgia , Angiomiolipoma/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Torácicas/diagnóstico
16.
Cytojournal ; 3: 27, 2006 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-17156485

RESUMO

BACKGROUND: Diagnosis of pancreatic lesions can be accurately performed by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) with onsite cytopathologists to assess specimen adequacy and to determine a preliminary diagnosis. Considerable time is needed to perform on-site assessments. This takes away work time of cytopathologists and prohibits them from serving remote locations. It is therefore logical to ask if real-time telecytopathology could be used to assess specimen adequacy and if telecytopathology diagnosis has the same level of agreement to the final diagnosis as that of onsite evaluation. In this study, we compare agreement between cytodiagnoses rendered using telecytopathology with onsite and final interpretations. METHOD: 40 Diff-Quik-stained EUS-FNA were re-evaluated retrospectively (patient ages 31-62, 19:21 male:female, 15 non-malignant lesions, 25 malignant lesions as classified by final diagnosis). Each previously assessed by a cytopathologist and finally reviewed by the same or different cytopathologist. Blinded to the final diagnosis, a resident pathologist re-screened all slides for each case, selected a slide and marked the diagnostic cells most representative of the lesion. Blinded to the diagnosis, one cytopathologist assessed the marked cells through a real time remotely operated telecytopathology system (MedMicroscopy). Diagnosis and time spent were recorded. Kappa statistic was used to compare agreements between telecytopathology vs. original onsite vs. final diagnoses. RESULTS: Time spent for prescreening ranged from 1 to 5 minutes (mean 2.6 +/- 1.3 minutes) and time spent for telecytopathology diagnosis ranged from 2-20 minutes (mean 7.5 +/- 4.5 minutes). Kappa statistics, K, was as follows: telecytopathology versus onsite diagnosis K, 95% CI = 0.65, 0.41-0.88, for telecytopathology versus final K, 95% CI = 0.61, 0.37-0.85 and for onsite diagnosis versus final K, 95% CI = 0.79, 0.61-0.98. There is no significant difference in agreement between onsite and telecytopathology diagnoses. Kappa values for telecytopathology were less than onsite evaluation when compared to the final diagnosis; however, the difference was not statistically significant. CONCLUSION: This retrospective study demonstrates the potential use of telecytopathology as a valid substitute for onsite evaluation of pancreatic carcinoma by EUS-FNA.

18.
Echocardiography ; 22(2): 137-43, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15693780

RESUMO

This preliminary study demonstrates the superiority of live three-dimensional transthoracic echocardiography (3D TTE) over two-dimensional (2D) TTE in the assessment of left atrial (LA) tumors in four patients studied by us (three myxomas, one hemangioma, all subsequently pathologically proven). Because of the unique ability of live 3D TTE to systematically section and view the contents of an intracardiac mass, LA myxomas in the three patients studied could be more confidently diagnosed by noting isolated echolucent areas consistent with hemorrhage/necrosis in the tumor mass. On the other hand, a definite echolucent area was found by 2D TTE in only two of the three patients with myxoma. In the fourth patient with a hemangioma, live 3D TTE showed much more extensive and closely packed echolucencies with little solid tissue as compared to a myxoma consistent with a highly vascularized tumor. In contrast, 2D TTE demonstrated only two isolated echolucencies in the tumor suggesting an erroneous diagnosis of myxoma.


Assuntos
Ecocardiografia Tridimensional , Ecocardiografia , Neoplasias Cardíacas/diagnóstico por imagem , Feminino , Átrios do Coração , Hemangioma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/diagnóstico por imagem
20.
Ann Thorac Surg ; 78(6): 1903-9; discussion 1909, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15560998

RESUMO

BACKGROUND: Repeat positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) and chest computed tomography (CT) are used to assess the effectiveness of chemoradiotherapy in patients with non-small cell lung cancer (NSCLC); however, the change in the standardized uptake values (SUV) has not been correlated with the pathologic change of the primary tumor. METHODS: This is a retrospective cohort study of a prospective database of 56 patients who had NSCLC, FDG-PET, and chest CT scans both before and after neoadjuvant therapy, followed by complete resection of their cancer. Maximum SUVs (maxSUV) and tumor size were measured, and the percentage of change was compared with the percentage of nonviable tumor cells. The primary objective was to measure the degree of correlation between these values. RESULTS: The change in the maxSUV has a near linear relationship to the percent of nonviable tumor cells in the resected tumors. FDG-PET's maxSUV is better correlated to pathology than the change in size on CT scan (r2 = 0.75, r2 = 0.03, p < 0.001). When the maxSUV decreased by 80% or more, a complete pathologic response could be predicted with a sensitivity of 90%, specificity of 100%, and accuracy of 96%. CONCLUSIONS: The change in maxSUV on FDG-PET scan after neoadjuvant therapy holds a near linear relationship with pathologic response. It is a more accurate predictor than the change of size on CT scan. When the maxSUV decreases by 80% or more it is likely that the patient is a complete responder irrespective of cell type, neoadjuvant treatment, or the final absolute maxSUV. These findings may help guide treatment strategies.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Fluordesoxiglucose F18/farmacocinética , Neoplasias Pulmonares/diagnóstico por imagem , Adulto , Idoso , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/terapia , Estudos de Coortes , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Tomografia por Emissão de Pósitrons , Prognóstico , Curva ROC , Radioterapia , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
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