British Gynaecological Cancer Society Recommendations for Evidence Based, Population Data Derived Quality Performance Indicators for Ovarian Cancer.

Ovarian cancer survival in the UK lags behind comparable countries. Results from the ongoing National Ovarian Cancer Audit feasibility pilot (OCAFP) show that approximately 1 in 4 women with advanced ovarian cancer (Stage 2, 3, 4 and unstaged cancer) do not receive any anticancer treatment and only 51% in England receive international standard of care treatment, i.e., the combination of surgery and chemotherapy. The audit has also demonstrated wide variation in the percentage of women receiving anticancer treatment for advanced ovarian cancer, be it surgery or chemotherapy across the 19 geographical regions for organisation of cancer delivery (Cancer Alliances). Receipt of treatment also correlates with survival: 5 year Cancer survival varies from 28.6% to 49.6% across England. Here, we take a systems wide approach encompassing both diagnostic pathways and cancer treatment, derived from the whole cohort of women with ovarian cancer to set out recommendations and quality performance indicators (QPI). A multidisciplinary panel established by the British Gynaecological Cancer Society carefully identified QPI against criteria: metrics selected were those easily evaluable nationally using routinely available data and where there was a clear evidence base to support interventions. These QPI will be valuable to other taxpayer funded systems with national data collection mechanisms and are to our knowledge the only population level data derived standards in ovarian cancer. We also identify interventions for Best practice and Research recommendations.

Can Cross-Sectional Imaging Reliably Determine Pathological Staging of Right-Sided Colon Cancers and Select Patients for More Radical Surgery or Neo-Adjuvant Treatment?

Purpose and research question Cross-sectional imaging with CT scanning is the most commonly performed imaging modality to stage right-sided colon cancers. There is increasing evidence for the use of neo-adjuvant chemotherapy in selected patients and debate about the role of complete mesocolic excision (CME) and central vascular ligation (CVL) in the management of locally advanced colon cancers. Predicted tumour stage and the presence of nodal metastases by CT are often used to select patients for neo-adjuvant chemotherapy and those that may benefit from CME. This study aims to compare predicted radiological T and N staging with final pathological T and N staging in elective patients having potentially curative surgery for right-sided colon cancer. Methods A retrospective analysis was carried out of a prospectively gathered database of all patients who had undergone (true) right hemicolectomy between 02/01/13 and 21/05/20. Sensitivity, specificity, positive predictive value, and negative predictive value for CT scanning with regards to the pathological nodal metastases were calculated and analysed. Results The sensitivity and specificity of radiology staging for predicting nodal status were 76.4% and 65.5% respectively. The positive predictive value of CT staging for correctly identifying nodal metastases was 55.3%, with a negative predictive value of 77.3%. Conclusions This large series adds further evidence that CT, even when reviewed by expert GI radiologists, has limited accuracy at identifying lymph node metastases in colon cancer.

Does pregnancy affect vascular enhancement in patients undergoing CT pulmonary angiography?

The aim of this study was to evaluate whether pregnancy affects contrast enhancement within the pulmonary arteries during computed tomography pulmonary angiography (CTPA). This was a retrospective analysis of the CTPA examinations of 16 pregnant and 16 non-pregnant female patients, suspected of having an acute pulmonary embolus (PE), during the same time period. Pulmonary vascular enhancement was evaluated by measuring the CT density within the pulmonary arteries. In a blinded evaluation, subjective grading of contrast enhancement within the pulmonary arteries was also performed. There was a significant difference in arterial enhancement between the two groups, with pregnant patients having a mean pulmonary arterial density 112 HU less than patients in the control group [mean attenuation of 259.79 +/- 59.31 HU in pregnant patients versus 371.88 +/- 60.63 HU in non-pregnant patients (p < 0.001)]. The mean subjective pulmonary arterial enhancement score in the pregnant group was 8.19 +/- 2.51 versus 13.69 +/- 3.07 in the control group (p < 0.001). Pregnant women undergoing CTPA have significantly decreased pulmonary arterial enhancement compared to non-pregnant patients, probably due to the increase in cardiac output in pregnancy. We may need to reconsider how we perform CTPA in this group in order to ensure adequate opacification for diagnosis.

Diffusion-weighted MR neurography for the assessment of brachial plexopathy in oncological practice.

BACKGROUND: To evaluate diffusion-weighted MR neurography (DW-MRN) for visualizing the brachial plexus and for the assessment of brachial plexopathy. METHODS: 40 oncological patients with symptoms of brachial plexopathy underwent 1.5 T MRI using conventional MR sequences and unidirectional DW-MRN. The images were independently reviewed by two radiologists. Anatomic visualization of the brachial plexus was scored using a 5 point scale on conventional MR sequences and then combined with DW-MRN. A brachial plexus abnormality was also scored using a 5 point scale and inter-observer agreement determined by kappa statistics. Diagnostic accuracy for brachial plexopathy assessed by conventional MRI alone versus conventional MRI combined with DW-MRN was compared by ROC analysis using reference standards. RESULTS: DW-MRN significantly improved visualization of the brachial plexus compared with conventional MRI alone (P<0.001). When assessing brachial plexopathy, inter-observer agreement was moderate for conventional MRI (kappa=0.48) but good for conventional MRI with DW-MRN (kappa=0.62). DW-MRN combined with conventional MRI significantly improved diagnostic accuracy in one observer (P<0.05) but was similar in the other observer. CONCLUSION: DW-MRN improved visualization of the brachial plexus. Combining DW-MRN with conventional MRI can improve inter-observer agreement and detection of brachial plexopathy in symptomatic oncological patients.

Imaging appearance of sarcomas of the prostate.

Sarcomas of the prostate are rare tumours. Their clinicopathologic features are well described, however, the imaging features of these tumours have rarely been documented. The purpose of this article is to illustrate the imaging findings of prostate sarcomas, with an emphasis on their appearance on magnetic resonance imaging and to identify features that may help to differentiate them from the commoner prostate adenocarcinomas.

High fat food increases gastric residence and thus thresholds for objective symptoms in allergic patients.

SCOPE: We have tested the hypothesis that high fat foods such as chocolate induce reduced rates of gastric emptying in comparison to lower fat foods and that this can impact uptake of allergens and subsequent reactions in allergic patients. METHODS AND RESULTS: In four volunteers, magnetic resonance imaging was used to measure gastric emptying of a series of nine doses of either dark chocolate bars containing 35% fat or a chocolate dessert containing 8% fat. Analysis showed a mean rate of decrease in gastric volume with an 8% fat dessert was 0.33 ± 0.09 mL/min compared to an average rate of increase in gastric volume of 0.09 ± 0.10 mL/min for the chocolate bars. In parallel, eight allergic patients were challenged for either peanut or hazelnut in the same two matrices and doses using a standardized protocol. A statistical analysis of the objective symptoms in the allergic patients showed that the chocolate bars gave a significantly higher threshold for objective symptoms than the dessert. CONCLUSIONS: Chocolate bars induced lower gastric emptying rates and in food challenges with allergic patients gave a higher threshold of elicitation for objective reactions than a dessert.