The 3-Dimensional-Computed Tomography Texture Is Useful to Predict Pancreatic Neuroendocrine Tumor Grading.

OBJECTIVES: The aim of this study is to evaluate the computed tomography texture parameters in predicting grading. METHODS: This study analyzed 68 nonfunctioning pancreatic neuroendocrine neoplasms (Pan-NENs). Clinical and radiological parameters were studied. Four model models were built, including clinical and standard radiologic parameters (model 1), first- and second-order computed tomography features (models 2 and 3), all parameters (model 4). The diagnostic accuracy was reported as area under the curve. A score was computed using the best model and validated to predict progression-free survival. RESULTS: The size of tumors and heterogeneous enhancement were related to the risk of "non-G1" Pan-NENs (coefficients 0.471, P = 0.012, and 1.508, P = 0.027). Four second-order parameters were significantly related to the presence of "non-G1" Pan-NENs: the gray level co-occurrence matrix correlation (6.771; P = 0.011), gray level co-occurrence matrix contrast variance (0.349; P = 0.009), the neighborhood gray-level different matrix contrast (-63.129; P = 0.001), and the gray-level zone length matrix with the low gray-level zone emphasis (-0.151; P = 0.049). Model 4 was the best, with a higher area under the curve (0.912; P = 0.005). The score obtained predicted the progression-free survival. CONCLUSIONS: Computed tomography radiomics signature can be useful in preoperative workup.

Machine learning for predicting pathological complete response in patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy.

For patients with locally advanced rectal cancer (LARC), achieving a pathological complete response (pCR) after neoadjuvant chemoradiotherapy (CRT) provides them with the optimal prognosis. However, no reliable prediction model is presently available. We evaluated the performance of an artificial neural network (ANN) model in pCR prediction in patients with LARC. Predictive accuracy was compared between the ANN, k-nearest neighbor (KNN), support vector machine (SVM), naïve Bayes classifier (NBC), and multiple logistic regression (MLR) models. Data from two hundred seventy patients with LARC were used to compare the efficacy of the forecasting models. We trained the model with an estimation data set and evaluated model performance with a validation data set. The ANN model significantly outperformed the KNN, SVM, NBC, and MLR models in pCR prediction. Our results revealed that the post-CRT carcinoembryonic antigen is the most influential pCR predictor, followed by intervals between CRT and surgery, chemotherapy regimens, clinical nodal stage, and clinical tumor stage. The ANN model was a more accurate pCR predictor than other conventional prediction models. The predictors of pCR can be used to identify which patients with LARC can benefit from watch-and-wait approaches.

Diffusion-weighted MRI for initial staging in Hodgkin`s lymphoma: comparison with FDG PET.

PURPOSE: To evaluate the use of diffusion-weighted MRI (DWI) for initial staging of Hodgkin`s lymphoma and compare it to FDG PET. METHODS: Forty-one patients with Hodgkin`s lymphoma (14 f, 27 m, median age 39 y) were included in this retrospective study. All patients underwent FDG PET/MR for initial staging, including DWI. The Lugano classification was used to describe disease extent. A combination of follow-up imaging and histopathology served as the reference standard. Method agreement was assessed using weighted kappa (κ). The accuracy of the imaging methods was evaluated using ROC curve analysis. RESULTS: Regarding the Lugano stage, DWI and FDG PET had identical results in 34/41 cases (κ = 0.77). Sensitivity and specificity for nodal involvement was 89.9% and 93.8% for DWI, and 93.8% and 86.9% for FDG PET, respectively. In regard to extranodal involvement, sensitivity and specificity were 88.5% and 99.3% for DWI and 92.3% and 92.7% for FDG PET. The accuracy of both methods for nodal (p = 0.06) and extranodal involvement (p = 0.66) did not differ significantly. CONCLUSION: Despite high sensitivity and specificity, DWI in free breathing cannot be currently recommended as an alternative to FDG PET in initial staging of Hodgkin`s lymphoma due to substantial differences in regard to therapy-determining Lugano Stage.

Cost-effectiveness analysis of positron-emission tomography-computed tomography in preoperative staging for nonsmall-cell lung cancer with resected monometastatic disease.

BACKGROUND: The aim of this study was, from the Chinese healthcare perspective, to assess the cost-effectiveness of positron-emission tomography-computed tomography (PET-CT) with F-fluorodeoxyglucose (F-FDG) in preoperation staging for nonsmall-cell lung cancer (NSCLC) with resected monometastatic disease based on a retrospective study. This study was conducted from January 2017 to February 2019 at an academic hospital. METHODS: A Markov model and 3 decision-tree models were designed to calculate the long-term medical costs, outcomes, and incremental cost-effectiveness ratios (ICERs) of the 2 diagnostic strategies (PET-CT and conventional CT). Model robustness was assessed in sensitivity analyses. RESULTS: For the base-case analysis, preoperative PET-CT evaluation for NSCLC with resected monometastatic disease provided an additional 1.475, 2.129, and 2.412 life-years (LYs), in the time horizon of 10-, 20-, and 30-year, respectively, and the ICERs for the PET-CT group compared with the conventional CT group were $1153, $1393, and $1430 per LY, separately. The acceptability curves demonstrated that when the willingness-to-pay (WTP) thresholds ranged from $500 to $3000/LY, the probability of cost-effectiveness changed varied dramatically, and at WTP > $3000, the probability that the PET-CT group achieved cost-effectiveness was 100%. Sensitivity analyses suggested that the models we designed were robust. CONCLUSION: Compared with conventional CT scan, preoperative F-FDG PET-CT evaluation for patients with resected monometastatic NSCLC is cost-effective from the Chinese healthcare perspective. Preoperative F-FDG PET-CT evaluation should be popularized for patients with resected monometastatic NSCLC.

Associação dos ácidos graxos poli-insaturados da série ômega 3 com parâmetros inflamatórios e estresse oxidativo em mulheres com câncer de mama: impacto do estadiamento clínico / Association of omega-3 polyunsaturated fatty acids with inflammatory parameters and oxidative stress in women with breast cancer: impact of tumor staging

Introdução: O câncer de mama (CM) correspondeu a 29,5% das neoplasias femininas em 2018, sendo que fatores relacionados ao estilo de vida, tais como alimentação podem explicar até 35% dessa neoplasia. Embora multicausal, é provável que desequilíbrio entre a ingestão de ácidos graxos ômega-3 e ômega-6 promova aumento na inflamação e estresse oxidativo nas diferentes etapas do processo de carcinogênese. Objetivo: Avaliar o impacto do estadiamento tumoral clínico na associação dos ácidos graxos ômega 3 biodisponíveis no plasma e nas membranas eritrocitárias com o estresse oxidativo e a inflamação em mulheres com câncer de mama. Material e métodos: Estudo caso-controle, observacional e analítico, com 87 mulheres com CM e 100 mulheres controles selecionadas do Hospital Geral de Fortaleza (HGF) no período de 2011/12. As pacientes Caso foram distribuídas, segundo estadiamento clínico (0-IIIc): EC = estadiamento IIa-IIIc. De ambos os grupos, foram obtidos dados demográficos e clínicos, avaliação antropométrica e composição corporal. Os marcadores de inflamação foram compostos pelas citocinas IL-1ß, IL-6, IL-10, TNF-α e MCP-1. Ao nível plasmático avaliou-se adipocinas (leptina e adiponectina), marcadores de estresse oxidativo (TBARS, LDL (-) e 8-OHdG), assim como o conteúdo de ácidos graxos no plasma e nas membranas dos eritrócitos por cromatografia a gás. Realizou-se teste de qui-quadrado, t-student, correlação de Pearson, Mann-Whitney e regressão linear e logística e adotou-se p<0,05 para todos os testes. Resultados: Não houve diferença entre a idade nos grupos Caso e Controle, nem nos parâmetros antropométricos, com exceção da circunferência da cintura que foi maior no grupo Caso (96,2 cm versus 91,2 cm). O tempo de tabagismo nos Casos foi maior que nos Controles (20,4 anos versus 13,5 anos). Nas mulheres com CM houve predominância do subtipo tumoral ductal (79,3%) e não houve diferenças entre receptores de estrógeno, progesterona, marcador HER2 e de proliferação celular Ki67, segundo estadiamento clínico. Os Casos apresentaram maiores valores de TBARS (6,0 versus 4,7 µmol) e anticorpos anti-LDL (-) (4,6 versus 2,5 U/L) e de citocinas inflamatórias MCP-1 (357,8 versus 295,8 ng/mL) e IL-1ß (2,8 versus 1,3 ng/mL). Os controles apresentaram maior concentração de IL-6 (0,9 versus 1,6 ng/mL) e IL-10 (2,8 versus 5,5 ng/mL), porém as razões entre citocinas (MCP-1, IL-1ß, TNF-α, IL-6 com a IL10) dos Casos apresentaram valores maiores que os Controles. Não houve diferença entre concentrações de citocinas nos grupos segundo estadiamento. O Grupo >EC apresentou maior razão n-6/n-3 e menor concentração de DHA e maior razão linoleico/DHA incorporado nas membranas eritrocitárias. O anticorpo anti-LDL (-) se associou negativamente com tamanho tumoral, enquanto a IL-10 positivamente. Elevado conteúdo de DHA (>= 4,3%) se associou com altas concentrações de IL-10, enquanto que o EPA, DHA e a soma desses se associaram com baixa concentração de citocinas inflamatórias. Os ácidos linoleico e araquidônico apresentaram associação com altas concentrações de marcadores inflamatórios plasmáticos. Conclusão: Mulheres com diagnóstico de CM apresentaram concentrações superiores de biomarcadores inflamatórios e de estresse oxidativo quando comparadas às mulheres saudáveis. Pacientes com maior estadiamento clínico apresentaram menores concentrações de ômega-3 e maiores de ômega-6. De modo contrário, esses ácidos graxos poli-insaturados modularam parâmetros inflamatórios e oxidativos

Introduction: Breast cancer (BC) accounted for 29.5% of female neoplasms in 2018, and lifestyle factors such as diet may explain up to 35% of this cancer. Although multicausal, imbalance between omega-3 and omega-6 fatty acid intake is likely to promote increased inflammation and oxidative stress at different stages of the carcinogenesis process. Objective: To evaluate the impact of clinical tumor staging on the association of bioavailable omega 3 fatty acids in plasma and erythrocyte membranes with oxidative stress and inflammation in women with breast cancer. Material and methods: Case-control, observational and analytical study, with 87 women with BC and 100 control women selected from the General Hospital of Fortaleza (HGF) in 2011/12. Case patients were distributed according to clinical staging (0-IIIc): EC = staging IIa-IIIc. From both groups, demographic and clinical data, anthropometric assessment and body composition were obtained. The inflammation markers were composed of cytokines IL-1ß, IL-6, IL-10, TNF-α and MCP-1. At the plasma level, adipokines (leptin and adiponectin), oxidative stress markers (TBARS, LDL (-) and 8-OHdG), as well as fatty acid content in plasma and erythrocyte membranes were evaluated by gas chromatography. Chi-square, t-student, Pearson correlation, Mann-Whitney and linear regression and logistic tests were performed and p <0.05 was adopted for all tests. Results: There was no difference between age in the Case and Control groups, nor in the anthropometric parameters, except for waist circumference which was higher in the Case group (96.2 cm versus 91.2 cm). Smoking time in Cases was longer than in Controls (20.4 years versus 13.5 years). In women with BC there was a predominance of ductal tumor subtype (79.3%) and no differences between estrogen receptors, progesterone, HER2 marker and Ki67 cell proliferation, according to clinical staging. Cases had higher values of TBARS (6.0 versus 4.7 µmol) and anti-LDL (-) antibodies (4.6 versus 2.5 U / L) and inflammatory cytokines MCP-1 (357.8 versus 295 ng / mL) and IL-1ß (2.8 versus 1.3 ng / mL). Controls had a higher concentration of IL-6 (0.9 versus 1.6 ng / mL) and IL-10 (2.8 versus 5.5 ng / mL), but ratios between cytokines (MCP-1, IL-1ß, TNF-α, IL-6 with IL10) shows higher values than Controls. There was no difference between cytokine concentrations in the groups according to staging. Group >EC presented higher n-6 / n-3 ratio and lower DHA concentration and higher linoleic / DHA ratio incorporated in erythrocyte membranes. Anti-LDL antibody (-) was negatively associated with tumor size, while IL-10 was positively associated. High DHA content (≥ 4.3%) was associated with high IL-10 concentrations, while EPA, DHA and their sum were associated with low concentration of inflammatory cytokines. Linoleic and arachidonic acids were associated with high concentrations of plasma inflammatory markers. Conclusion: Women diagnosed with BC had higher concentrations of inflammatory biomarkers and oxidative stress when compared to healthy women. Patients with higher clinical staging had lower omega-3 and higher omega-6 concentrations. Conversely, these polyunsaturated fatty acids modulated inflammatory and oxidative parameters

Breast Lesion Excision System in the diagnosis and treatment of intraductal papillomas - A feasibility study.

OBJECTIVES: This study aims to evaluate the feasibility of Breast Lesion Excision System (BLES) in the treatment of intraductal papillomas. MATERIAL AND METHODS: All patients with a needle biopsy -based suspicion of an intraductal papilloma who consequently underwent a BLES procedure at Helsinki University Hospital between 2011 and 2016 were included in this retrospective study. The purpose of the BLES procedure was either to excise the entire lesion or in few cases to achieve better sampling. RESULTS: In total, 74 patients underwent 80 BLES procedures. Pathological diagnosis after the BLES biopsy confirmed an intraductal papilloma without atypia in 43 lesions, whereas 10 lesions were upgraded to high-risk lesions (HRL) with either atypical ductal hyperplasia or lobular carcinoma in situ. Five cases were upgraded to malignancy, two were invasive ductal carcinomas and three were ductal carcinoma in situ. Additionally, 18 lesions were diagnosed as other benign lesions. Four procedures failed. Complete excision with BLES was achieved in 19 out of 43 intraductal papillomas, 6 out of 10 HRL and two out of five malignant lesions. No major complications occurred. The BLES procedure was adequate in the management of the 71 breast lesions. CONCLUSION: The BLES procedure is an acceptable method for the management of small benign and high-risk breast lesions such as intraductal papillomas in selected patients. Thus, a great amount of diagnostic surgical biopsies can be avoided.

Metas-Chip precisely identifies presence of micrometastasis in live biopsy samples by label free approach.

Detecting the micrometastasis is a major challenge in patients' survival. The small volume of the biopsied tissue results in limited number of histopathological samples and might reduce the rate of accurate diagnosis even by molecular technologies. We introduce a microelectronic biochip (named Metas-Chip) to detect the micrometastasis in unprocessed liquid or solid samples. It works based on the tendency of malignant cells to track single human umbilical vein endothelial cell (HUVEC)-sensing traps. Such cells detach themselves from the biopsied sample and invade the sensing traps by inducing membrane retraction and blebbing, which result in sharp changes in electrical response of the sensing elements. Metas-Chip identified the metastasis in more than 70 breast cancer patients, in less than 5 h. Moreover it detected the metastasis in lymph nodes of nine patients whom were missed by conventional pathological procedure. Multilevel IHC and real-time polymerase chain reaction (RT-PCR) tests confirmed the diagnosis.

La PET/TC con 18F-Colina en la estadificación y recidiva bioquímica de pacientes con cáncer de próstata: cambios en la clasificación y planificación de radioterapia / 18F-Choline PET/CT scan in staging and biochemical recurrence in prostate cancer patients: Changes in classification and radiotherapy planning

Objetivo: Valorar la utilidad de la 18F-Colina PET/TC en la detección de enfermedad a distancia en la estadificación inicial de pacientes con cáncer de próstata de alto riesgo y en pacientes con recidiva bioquímica, con intención de planificación con radioterapia, así como valorar los cambios en el manejo terapéutico influenciados por los resultados de la misma. Material y métodos: Se evaluaron de manera retrospectiva los estudios 18F-Colina PET/TC de pacientes con diagnóstico de adenocarcinoma de próstata, con indicación de estadificación inicial en pacientes de alto riesgo (o con sospecha de afectación a distancia) y/o planificación de radioterapia y en pacientes con recidiva bioquímica con intención de rescate con radioterapia con un seguimiento adecuado durante al menos 9 meses. Se seleccionaron un total de 56 estudios, 33 (58,93%) de estadificación y 23 (41,07%) de planificación de radioterapia. Para el estudio PET/TC se empleó un equipo multimodal PET/TC, la dosis empleada fue de 296-370MBq de 18F-Colina, con un protocolo de adquisición en 2 fases. Resultados: Del total de los 56 estudios, 43 (76,8%) fueron considerados positivos (para enfermedad local, a distancia o ambas) y 13 (23,2%) negativos. En 13 estudios (23,2%) los hallazgos de la 18F-Colina PET/TC modificaron la clasificación NM. En 4 de los 13 estudios (30,7%) bajó la clasificación (descartando afectación a distancia sospechada por otras técnicas) y en 9 (69,3%) detectó enfermedad a distancia no conocida. Conclusiones: La 18F-Colina PET/TC es una técnica útil en la estadificación, recurrencia bioquímica y planificación de radioterapia en el cáncer de próstata para localizar enfermedad a distancia no detectada con pruebas de imagen convencionales, por lo que deberían ampliarse sus indicaciones en las guías de manejo del mismo (AU)

Objective: To evaluate the role of the 18F-Choline PET/CT in prostate cancer management when detecting distant disease in planning radiotherapy and staging and to evaluate the therapy changes guided by PET/TC results. Material and methods: A retrospective evaluation was performed on 18F-Choline PET/CT scans of patients with prostate cancer. Staging and planning radiotherapy scans were selected in patients with at least 9 months follow up. There was a total of 56 studies, 33 (58.93%) for staging, and 23 (41.07%) for planning radiotherapy. All scans were obtained using a hybrid PET/CT scanner. The PET/CT acquisition protocol consisted of a dual-phase procedure after the administration of an intravenous injection of 296-370MBq of 18F-Choline. Results: There were 43 out of 56 (76.8%) scans considered as positive, and 13 (23.2%) were negative. The TNM staging was changed in 13 (23.2%) scans. The PET/CT findings ruled out distant disease in 4 out of 13 scans, and unknown distant disease was detected in 9 (69.3%) scans. Conclusions: 18F-Choline PET/CT is a useful technique for detecting unknown distant disease in prostate cancer when staging and planning radiotherapy. The inclusion of 18F-choline PET/CT should be considered in prostate cancer management protocols (AU)

18F-FDG PET/TC en el manejo clínico de los linfomas / 18F-FDG PET/CT in the clinical management of patients with lymphoma

El objetivo de la presente revisión es actualizar las recomendaciones sobre el papel de la tomografía por emisión de positrones (PET)/tomografía computarizada (TC) en la estadificación y valoración de la respuesta tras quimioterapia y/o trasplante de progenitores hematopoyéticos en pacientes con linfoma de Hodgkin (LH) y linfoma no-Hodgkin (LNH) en la práctica clínica habitual. En la primera reunión internacional sobre PET en linfoma, celebrada en 2009 en Deauville (Francia), se estableció una escala de 5 puntos para la valoración de la respuesta en pacientes con linfoma mediante la 18F-Fluordeoxiglucosa (FDG) PET/TC. Posteriormente, tras celebrarse la 11.a y 12.a Conferencia Internacional sobre Linfomas en Lugano (Suiza) en 2011 y 2013, respectivamente, se alcanzó un acuerdo en cuanto al uso de la PET/TC para la estadificación y se revisaron los criterios de respuesta en linfoma ávidos por la FDG en la práctica clínica y en ensayos clínicos; son los denominados criterios de valoración de respuesta de Lugano. Los principales consensos alcanzados fueron: I) la PET/TC con 18F-FDG fue formalmente incorporada en la estadificación de los linfomas con avidez por la FDG; II) la biopsia de médula ósea ya no está indicada en la estadificación rutinaria de pacientes con LH y en la mayoría de los pacientes con linfoma B difuso de células grandes (LBDCG), y III) la valoración de respuesta al tratamiento se hará mediante la PET/TC usando la escala de 5 puntos y la clasificación de Lugano. Actualmente, con la introducción de terapias basadas en agentes biológicos con mecanismos inmunes, los criterios de Lugano para valoración de la respuesta requieren una flexibilización y modificación, debido a que estos agentes pueden producir cambios en las técnicas de imagen que sugieren progresión de la enfermedad, a pesar de una respuesta clínica evidente (pseudoprogresión o tumor flare). Ello ha llevado a la adopción provisional de los criterios LYRIC (LYmphoma Response to Inmunomodulatory Therapy Criteria), con la introducción del término «respuesta indeterminada» para definir estos cambios hasta que sean confirmados o descartados como progresión de la enfermedad. El uso generalizado de todas estas recomendaciones mejorará la evaluación de pacientes con linfoma y hará posible la comparación de resultados procedentes de ensayos clínicos (AU)

The aim of this work was to review the current recommendations for staging and response assessment of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) in routine clinical practice after chemotherapy and/or stem cell transplantation. A five-point scale (5-PS) from the First International Workshop on PET in Lymphoma in Deauville, France, in 2009, was recommended as the standard tool to score imaging to assess treatment response in patients with lymphoma using 18F-Fluorodeoxyglucose (FDG) PET/CT. Following the recommendations of the 11th and 12th International Conferences on Malignant Lymphoma held in Lugano (Switzerland), in 2011 and 2013, respectively, a consensus (the so-called Lugano Classification) was reached regarding the use of PET/CT for staging and response assessment in FDG-avid lymphomas. As a result, 18F-FDG PET/CT was formally incorporated into standard staging for FDG-avid lymphomas. A bone marrow biopsy is no longer indicated for the routine staging of HL and most diffuse large B-cell lymphomas. PET/CT will be used to assess response in FDG-avid histologies using the 5-point scale. The recent introduction of biological agents with immune mechanisms requires flexibility in interpretations of the Lugano criteria due to tumour flare or a pseudo-progression effect produced by these agents. Provisional criteria have been proposed (Lymphoma Response to Immunomodulatory Therapy Criteria) with the introduction of the term ‘Indeterminate Response’ in order to identify this phenomenon until confirmed as flare/pseudoprogression or true progression. All these recommendations will improve evaluations of patients with lymphoma, and allow comparison of results from clinical practice and trials (AU)

The Adoption of Single-port Laparoscopy for Full Staging of Endometrial Cancer: Surgical and Oncology Outcomes and Evaluation of the Learning Curve.

STUDY OBJECTIVE: To study the safety, feasibility, learning curve, and surgical outcome for single-port laparoscopic full staging of endometrial cancer. DESIGN: A retrospective study (Canadian Task Force classification II-3). SETTING: A university academic hospital. PATIENTS: Women with endometrial cancer undergoing single-port laparoscopic full surgical staging. INTERVENTIONS: This was a single-center, retrospective consecutive study of patients undergoing single-port laparoscopic full staging of endometrial cancer from March 2012 to December 2015. MEASUREMENTS AND MAIN RESULTS: One hundred ten consecutive cases were included in the study. The mean age was 63 years (standard deviation = 14), and the mean body mass index was 34 kg/m2 (standard deviation = 7). Medical comorbidity was noted in 62% (68/110) of patients, and 55% (61/110) of patients had previous abdominal surgery. Preoperative histology included grade 1 (63%), grade 2 (23%), grade 3 (4%), papillary serous (6%), clear cell (3%), and mixed (1%). Postoperatively, 73% of patients were stage I, 2% were stage II, 21% were stage III, and 4% were stage IV. The conversion rate to multiple ports or to laparotomy was 6.3%. The average total surgical time was 186 minutes. Comparing the last 30 cases of our cohort with the first 20, there was a significant improvement in the reduction of the total operative time (191 vs 152 minutes, p = .036), estimated blood loss (389 vs 121 mL, p = .002), conversion rate (20 % vs 0%, p = .02), and rate of surgical complication (10% vs. 0%, p = .03). The readmission rate was 11% (12/110) with 75% of those patients being readmitted for surgical indications and 25% for medical indications. The rate of ventral hernia was 1.8% (2/110) with an average follow-up of 298 days (31-1085 days). CONCLUSION: Single-port laparoscopic staging of endometrial cancer is a safe and feasible technique to introduce into a gynecologic oncology practice that is compatible with other minimally invasive modalities with similar complication rates, discharge timing, and operative times. Drastic improvement in surgical time can be seen after approximately the first 20 cases.

[Value of functional magnetic resonance imaging in predicting outcomes of neoadjuvant chemoradiotherapy in rectal cancer].

Rectal cancer is one of the common cancers which poses a threat to the health of mankind. In recent years. Multi-modality treatment strategies for locally advanced rectal cancer improve the treatment efficiency. Accurate prediction of the treatment response after the neoadjuvant chemoradiotherapy (CRT) can guide more suitable treatment strategy. MERCURY study proved the prognostic value of post-CRT standard morphologic MRI(T2-weighted) assessment of tumor regression grade(TRG), and MRI assessment of circumferential resection margin can guide the definitive surgery. Compared with standard morphologic MRI (T2-weighted), functional MRI, including diffusion weighted imaging (DWI) and dynamic contrast enhanced (DCE) MRI, has shown more promising results for the prediction of therapeutic response in rectal cancer. The addition of diffusion-weighted images to T2-weighted images improves the accuracy of restaging examinations for determination of complete pathologic responders. DCE can reflect the tumor micro-vascular environment, and the change of perfusion in response to treatment. These images have the potential to improve the accuracy of therapeutic response in rectal cancer.

Evaluation of percutaneous vacuum assisted intact specimen breast biopsy device for ultrasound visualized breast lesions: Upstage rates and long term follow-up for high risk lesions and DCIS.

OBJECTIVE: Percutaneous core biopsy of ultrasound visualized breast lesions is standard for diagnosis. Large gauge vacuum-assisted core needles have improved accuracy; but a significant underestimation of malignancy remains. The IntactR device was assessed for upstaging and subsequent malignancy at the biopsy site. METHODS: 469 consecutive ultrasound visualized breast lesions, < 2.0 cm in size, BIRADS 4 or 5, biopsied with IntactR Breast Lesion Excision System, between July 2007 and August 2014, were reviewed. All non-concordant lesions (0.8%), DCIS (1.7%) and invasive cancers (9.8%) were surgically excised. Excision was recommended for all high risk lesions (13.0%). The upstage rate to DCIS or invasive cancer was determined. All patients were followed for a median of 66 months (24-96 months) with serial imaging and exams to determine the incidence of re-biopsy, or malignancy at the original biopsy site. RESULTS: 23 of 61 high risk lesions (37.5%) were not excised, but observed for a median of 66 months. None required re-biopsy. One atypical lesion was upstaged to DCIS on excision. No patient was diagnosed with malignancy at or near the original biopsy site during follow-up. Overall upstage rate was 1.2%. CONCLUSIONS: Percutaneous biopsy of ultrasound visualized lesions was performed accurately using IntactR. Upstaging was much lower with IntactR than with large-gauge core needles. High risk lesions, diagnosed with IntactR, have a very low upstage rate at surgical excision. It may be possible to observe these lesions without surgery when they present as ultrasound findings and undergo IntactR biopsy.

SEOM/SERAM consensus statement on radiological diagnosis, response assessment and follow-up in colorectal cancer

Colorectal cancer (CRC) is one of the world’s most common cancers, and has one of the highest mortality rates. The last few decades have seen great progress in preventing, diagnosing and treating this disease, providing undeniable impact on patients’ prognosis and quality of life. At all these stages of CRC management, imaging techniques play an essential role. This article reviews some important issues concerning the use of various radiological techniques in the screening, diagnosis, staging, assessment of treatment response, and follow-up of patients with CRC. It also includes a number of practical recommendations on indications for use, technical requirements, minimum information required in the radiology report, evaluation criteria for the response to various drugs, and the recommended frequency at which different examinations should be performed. This consensus statement is the result of cooperation between the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Radiology (SERAM) (AU)

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Robotic technology for colorectal surgery : Procedures, current applications, and future innovative challenges.

BACKGROUND: Colorectal cancer is the third most common cancer worldwide. Current treatment approaches are multidisciplinary, including neoadjuvant chemoradiotherapy for rectal cancer. Several studies have reported an improvement in surgical techniques and in new devices facilitating better pre- and intraoperative staging. OBJECTIVES: Since its first application in 2002, robotic surgery has progressed steadily, offering good surgical results and better oncological outcomes. Currently, many studies and reviews have confirmed its safety and feasibility for colorectal cancer. MATERIALS AND METHODS: Robotic technology simplifies surgical maneuvers thanks to the three-dimensional magnification and stable vision, convenient mobility of the robotic arms, endowrist instruments with seven degrees of freedom, ambidextrous capability, tremor filtering, and indocyanine green fluorescence imaging. RESULTS: Regarding the oncological outcome, the robotic technique is equivalent to the laparoscopic approach; however, a lower recurrence rate has been achieved with the robotic approach in extended lymphadenectomy as part of complete mesocolic excision for right colonic cancer and total mesorectal excision for low rectal tumors. CONCLUSION: Colorectal robotic surgery has progressively improved worldwide. Its advantages are related not only to better oncological outcomes, but also to improvements in terms of detection, accurate diagnosis, and staging.

SEOM Clinical Guideline of localized rectal cancer (2016)

Localized rectal adenocarcinoma is a heterogeneous disease and current treatment recommendations are based on a preoperative multidisciplinary evaluation. High-resolution magnetic resonance imaging and endoscopic ultrasound are complementary to do a locoregional accurate staging. Surgery remains the mainstay of treatment and preoperative therapies with chemoradiation (CRT) or short-course radiation (SCRT) must be considered in more locally advanced cases. Novel strategies with induction chemotherapy alone or preceding or after CRT (SCRT) and surgery are in development (AU)

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SEOM clinical guidelines for the management of germ cell testicular cancer (2016)

Testicular cancer represents the most common malignancy in males aged 15-34 years and is considered a model of curable neoplasm. Maintaining success, reducing treatment burden, and focusing on survivorship are then key objectives. Inguinal orchiectomy is the first recommended maneuver that has both diagnostic and therapeutic aims. Most patients are diagnosed with stage I disease (confined to the testicle). Close surveillance and selective, short-course adjuvant chemotherapy are accepted alternatives for these cases. In patients with more advanced disease (stages II and III), 3-4 courses of cisplatin based chemotherapy (according to IGCCCG risk classification) followed by the judicious surgical removal of residual masses represent the cornerstone of therapy. Poor-risk patients and those failing a first-line therapy should be referred to specialized tertiary centers. Paclitaxel-based conventional chemotherapy and high-dose chemotherapy plus autologous hematopoietic support can cure a proportion of patients with relapsing or refractory disease (AU)

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18F-FDG PET/CT in staging and follow-up of adamantinoma / 18F-FDG PET/CT en la estadificación y seguimiento de un adamantinoma

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Tumor trofoblástico del lecho placentario. Presentación de un caso y revisión de la literatura / Placental site trophoblastic tumour: a case report and a review of the literature

El tumor trofoblástico del lecho placentario es un tumor infrecuente ubicado dentro del grupo de la neoplasia trofoblástica gestacional, que comprende un grupo de tumores con capacidad de producir invasión local y metástasis. Presentamos un caso de tumor trofoblástico del lecho placentario en una mujer de 33 años. Macroscópicamente la pared uterina presentaba una tumoración de 3,5 × 2,5 cm de aspecto hemorrágico y blando que ocupaba todo su espesor, con un punto de perforación en el fondo. Histológicamente mostraba infiltración difusa de células grandes y poliédricas con núcleos grandes e irregulares con ocasionales células bi y multinucleadas. Se disponían de manera aislada o en masas, disecando fibras musculares. Inmunohistoquímicamente se demostró positividad para CK AE1/AE3, lactógeno placentario e inhibina, y negatividad para hCG y p63. Presentamos una revisión de la literatura y comentarios sobre una serie de factores pronósticos adversos (AU)

Placental site trophoblastic tumour is rare, being one of the gestational trophoblastic neoplasms that comprises a group of tumours with potential for local invasion and metastases. We report a case of placental site trophoblastic tumour in a 33 year-old woman. Macroscopically the uterine wall showed a 3.5 × 2.5 cm haemorrhagic soft tumour that occupied almost the entire wall with a perforation point in the fundus. Histologically there was diffuse infiltration of large, polyhedral cells with large, irregular nuclei and occasionally bi- and multinucleated cells. They occurred either individually or in sheets dissecting muscle fibres. Immunohistochemistry revealed CK AE1/AE3, placental lactogen and inhibine but not hCG and p63 expression. Adverse prognostic factors are discussed and the relevant literature is reviewed (AU)