Location of pelvic recurrence after 'curative' low anterior resection for rectal cancer.

AIMS: It has been emphasized that the mesorectum is the key to local recurrence after resection for rectal cancer. In view of this we studied the location of recurrences, relative to the bed of the primary tumour, the neorectum and the level of anastomoses, in patients referred for recurrences after low anterior resection (LAR) in the <>. METHODS: The relative level above the anal verge of the primary cancer, the anastomosis and the recurrence was registered by proctoscopy in 46 patients operated on for recurrent cancer after low anterior resection. The origin of the recurrence was determined from the operative specimen. RESULTS: The median level of the primary cancers was 10 cm above the anal verge, with the anastomoses 2 cm lower, the majority being within 2 cm. Most recurrences were within 1 cm of the anastomosis. No rectal cancer occurred more than 3 cm distal to the anastomosis. Seventy to 80% of recurrences started peri-rectally, most invading the anastomosis. CONCLUSIONS: The tumour bed is most often the origin of the recurrence. Recurrences were mostly due to inadequate radial, and in a few cases longitudinal, dissection of the mesorectum. Virtually all recurrences were within reach of the examining finger. At follow-up of rectal cancers most local recurrences can therefore be identified earlier by digital examination than by proctoscopy.

Diagnostic value of ultrasonography in patients with palpable mammographically noncalcified breast tumors.

PURPOSE: To analyze the diagnostic accuracy of mammography, ultrasonography (US), and both methods combined in evaluation of palpable noncalcified breast tumors. MATERIAL AND METHODS: Mammograms and sonograms of 200 patients with palpable noncalcified breast masses were retrospectively analyzed independently by four experienced radiologists in 3 sessions: Mammography or US interpretations in the first two and combined reading in the last session. Nonneoplastic abnormalities and mammographically obvious cancers were excluded. Receiver operating characteristic (ROC) analyses were performed for 115 (60 benign and 55 malignant) tumors and subgroups according to tissue density and tumor size. A single ROC curve for each diagnostic test was obtained by pooling the individual ratings. The area under the ROC curve was used as a measure of diagnostic performance. RESULTS: US revealed significantly higher diagnostic performance than mammography for tumors larger than 2 cm. Combined reading showed significantly higher performance than mammography except for tumors smaller than 2 cm. The performance of all three tests was reduced in dense parenchyma, and significantly so for mammographic and combined interpretation. CONCLUSION: The accuracy of US in patients with palpable mammographically noncalcified and not obviously malignant breast tumors is lower than reported for mixed sample populations. The accuracy of US may be influenced by breast parenchyma density. Combined reading offers the highest diagnostic accuracy.

Variability in the interpretation of ultrasonography in patients with palpable noncalcified breast tumors.

PURPOSE: To analyze interobserver variability of ultrasonography (US) as an adjunct to mammography in patients with palpable noncalcified breast tumors. MATERIAL AND METHODS: Mammographic, US, and combined reading of 200 patients with palpable noncalcified breast masses were performed independently by four experienced radiologists. Nonneoplastic abnormalities and mammographically obvious cancers were excluded. Receiver operating characteristic (ROC) analysis based on 115 tumors was carried out for mammography, US, and both combined for each radiologist. The US diagnoses of the 45 cancers excluded from ROC analysis and the 55 cancers included were compared. RESULTS: One radiologist revealed a significantly higher diagnostic performance with US than with mammography. Combined reading showed the highest performance for all observers, but the improvement as compared with mammography was significant for only two. Higher accuracy on combined reading was mainly caused by correct upgrading of tumors with benign or indeterminate mammographic findings. One radiologist had benefit of US for downgrading of tumors. All four radiologists made a malignant US diagnosis twice as often in mammographically obvious cancers than in mammographically nonconclusive tumors. CONCLUSION: Radiologists differ substantially in interpretation of breast imaging. Combined reading offers the highest diagnostic accuracy mainly by correct upgrading of tumors on US. The role of US for downgrading tumors is operator-dependent.

Visceral obesity and breast cancer risk.

BACKGROUND: The risk for breast cancer and the sex hormone abnormalities noted in breast cancer patients have been demonstrated in women with upper body fat obesity. The objective of this study was to determine if the visceral component of upper body fat obesity was correlated with breast cancer risk. METHODS: A case-control study of 40 consecutively enrolled women with breast cancer and 40 community-based age, weight, and waist circumference-matched control subjects was conducted. The areas of visceral fat, subcutaneous fat, and total fat were measured using computed tomography at the L-4 vertebral body. Calculations of relative risk for breast cancer were based on these fat compartments. RESULTS: Patients with breast cancer had a significantly greater visceral fat area (P = 0.01), visceral-to-total-fat area ratio (VT ratio) (P < 0.001) and significantly lower subcutaneous-to-visceral-fat area ratio (SV ratio) (P < 0.001) compared with the matched controls. The relative risk for breast cancer increased with increasing VT ratio (< or = 0.24 = 1.0; > 0.24 = 9.5) (P < 0.0001) and decreasing SV ratio (> or = 3.64 = 1.0; < 3.64 = 8.5) (P = 0.0002). CONCLUSIONS: Visceral obesity, as assessed by computed tomography, was a significant risk factor for breast cancer in women matched for age, weight, and waist circumference. Comparing the VT ratio for both groups, breast cancer patients had 45% more visceral fat compared with matched control subjects.

Research on nonlinear optical materials: an assessment.

The seven papers making up this assessment are based on the Workshop on Nonlinear Optical Materials held in April 1986.