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1.
Medicine (Baltimore) ; 99(11): e19488, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176086

RESUMO

INTRODUCTION: Dyspnea due to tracheal invasion by malignant tumors is a common oncological emergency that is difficult to manage, and a common cause of death among patients with advanced cancer. Bronchoscopy-guided intervention therapy under conventional ventilation is very risky for patients with severe central airway stenosis. Extracorporeal membrane oxygenation (ECMO) provides strong cardiopulmonary support, but is rarely used in bronchoscopy-guided interventional therapy. PATIENT CONCERNS: The patient had advanced esophageal cancer with metastases to the trachea and left and right main bronchi. Despite several sessions of radiotherapy, chemotherapy, and bronchoscopy-guided intervention therapy, the tumor in the airway became enlarged, the lumen was severely narrow, and the patient experienced respiratory distress. DIAGNOSIS: A thoracic computed tomography scan performed at our hospital revealed invasion of the trachea and opening of the left and right main bronchi by the esophageal cancer, blockage of the stent by the tumor, and severe luminal narrowing. An emergency bronchoscopy showed slit-like stenosis of the middle and lower part of the trachea and the left and right main bronchi, and the tumor was highly vascular. INTERVENTIONS: To reduce the risk of major airway bleeding and asphyxia during bronchoscopy under conventional ventilation, we finally performed argon plasma coagulation with a high frequency electric knife and cryotherapy with ECMO support. OUTCOMES: We successfully cleared the tumor tissue in the airway under ECMO support. The trachea and left and right main bronchi recovered smoothly, and the patient was soon discharged. CONCLUSION: ECMO can meet the oxygenation needs during bronchoscopy-guided intervention therapy. For patients with severe central airway obstruction due to malignant tumors, ECMO should be considered if conventional respiratory support cannot guarantee the safety of surgery.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias da Traqueia/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Broncoscopia , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Diagnóstico Diferencial , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Oxigenação por Membrana Extracorpórea , Fazendeiros , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Tomografia Computadorizada por Raios X , Neoplasias da Traqueia/complicações , Neoplasias da Traqueia/secundário , Neoplasias da Traqueia/cirurgia
2.
Einstein (Sao Paulo) ; 18: eMD5223, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049130

RESUMO

Computed tomography with multiple detectors and the advancement of processors improved rendered images and three-dimensional reconstructions in clinical practice. Traditional axial slices form non-intuitive images because they are seen in only one plane. The three-dimensional reconstructions can show structures details and diseases with complex anatomy in different perspectives. Cinematic rendering is a newly three-dimensional reconstruction technique, already approved for clinical use, which can produce realistic images from traditional computed tomography data. The algorithm used is based on light trajectory methods and the global lighting model, which simulate thousands of images from all possible directions. Thus, the technique shapes the physical propagation of light and generates a realistic three-dimensional image with depth, shadows and more anatomic details. It is a multidimensional rendering acquired through complex lighting effects. The aim of this article was to show the advance of three-dimensional technology with the cinematic rendering in images exams of the thoracic wall.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Imagem Tridimensional/métodos , Sarcoma Sinovial/diagnóstico por imagem , Neoplasias Torácicas/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Adulto , Algoritmos , Humanos , Masculino , Pessoa de Meia-Idade , Sarcoma Sinovial/secundário , Tomografia Computadorizada por Raios X/métodos
3.
Anticancer Res ; 40(1): 271-280, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892576

RESUMO

BACKGROUND/AIM: To investigate whether a radiomic machine learning (ML) approach employing texture-analysis (TA) features extracted from primary tumor lesions (PTLs) is able to predict tumor grade (TG) and nodal status (NS) in patients with oropharyngeal (OP) and oral cavity (OC) squamous-cell carcinoma (SCC). PATIENTS AND METHODS: Contrast-enhanced CT images of 40 patients with OP and OC SCC were post-processed to extract TA features from PTLs. A feature selection method and different ML algorithms were applied to find the most accurate subset of features to predict TG and NS. RESULTS: For the prediction of TG, the best accuracy (92.9%) was achieved by Naïve Bayes (NB), bagging of NB and K Nearest Neighbor (KNN). For the prediction of NS, J48, NB, bagging of NB and boosting of J48 overcame the accuracy of 90%. CONCLUSION: A radiomic ML approach applied to PTLs is able to predict TG and NS in patients with OC and OP SCC.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Linfonodos/patologia , Neoplasias Bucais/diagnóstico por imagem , Neoplasias Bucais/patologia , Neoplasias Orofaríngeas/diagnóstico por imagem , Neoplasias Orofaríngeas/patologia , Idoso , Algoritmos , Humanos , Aprendizado de Máquina , Gradação de Tumores , Tomografia Computadorizada por Raios X
4.
Int J Radiat Oncol Biol Phys ; 106(2): 358-368, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31654783

RESUMO

PURPOSE: There are no established imaging biomarkers that predict response during chemoradiation for patients with locally advanced non-small cell lung carcinoma. At our institution, proton therapy (PT) patients undergo repeat computed tomography (CT) simulations twice during radiation. We hypothesized that tumor regression measured on these scans would separate early and late responders and that early response would translate into better outcomes. METHODS AND MATERIALS: Patients underwent CT simulations before starting PT (CT0) and between weeks 1 to 3 (CT1) and weeks 4 to 7 (CT2) of PT. Primary tumor volume (TVR) and nodal volume (NVR) reduction were calculated at CT1 and CT2. Based on recursive partitioning analysis, early response at CT1 and CT2 was defined as ≥20% and ≥40%, respectively. Locoregional and overall progression-free survival (PFS), distant metastasis-free survival, and overall survival by response status were measured using Kaplan-Meier analysis. RESULTS: Ninety-seven patients with locally advanced non-small cell lung carcinoma underwent definitive PT to a median dose of 66.6 Gy with concurrent chemotherapy. Median TVR and NVR at CT1 were 19% (0-79%) and 19% (0-75%), respectively. At CT2, they were 33% (2-98%) and 35% (0-89%), respectively. With a median follow-up of 25 months, the median overall survival and PFS for the entire cohort was 24.9 and 13.2 months, respectively. Compared with patients with TVR and NVR <20% at T1 and <40% at T2, patients with TVR and NVR ≥20% at CT1 and ≥40% at CT2 had improved median locoregional PFS (27.15 vs 12.97 months for TVR ≥40% vs <40%, P < .01, and 25.67 vs 12.09 months for NVR ≥40% vs <40%, P < .01) and median PFS (22.7 vs 9.2 months, P < .01, and 20.3 vs 7.9 months, P < .01), confirmed on multivariate Cox regression analysis. CONCLUSIONS: Significantly improved outcomes in patients with early responses to therapy, as measured by TVR and NVR, were seen. Further study is warranted to determine whether treatment intensification will improve outcomes in slow-responding patients.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/terapia , Quimiorradioterapia/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/terapia , Terapia com Prótons , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Tomografia Computadorizada Quadridimensional , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Irradiação Linfática , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Dosagem Radioterapêutica , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral
5.
Br J Radiol ; 93(1107): 20190638, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31845816

RESUMO

OBJECTIVE: To evaluate dosimetric consequences of inter-fraction setup variation and anatomical changes in patients receiving multifield optimised (MFO) intensity modulated proton therapy for post-operative oropharyngeal (OPC) and oral cavity (OCC) cancers. METHODS: Six patients receiving MFO for post-operative OPC and OCC were evaluated. Plans were robustly optimised to clinical target volumes (CTVs) using 3 mm setup and 3.5% range uncertainty. Weekly online cone beam CT (CBCT) were performed. Planning CT was deformed to the CBCT to create virtual CTs (vCTs) on which the planned dose was recalculated. vCT plan robustness was evaluated using a setup uncertainty of 1.5 mm and range uncertainty of 3.5%. Target coverage, D95%, and hotspots, D0.03cc, were evaluated for each uncertainty along with the vCT-calculated nominal plan. Mean dose to organs at risk (OARs) for the vCT-calculated nominal plan and relative % change in weight from baseline were evaluated. RESULTS: Robustly optimised plans in post-operative OPC and OCC patients are robust against inter-fraction setup variations and range uncertainty. D0.03cc in the vCT-calculated nominal plans were clinically acceptable across all plans. Across all patients D95% in the vCT-calculated nominal treatment plan was at least 100% of the prescribed dose. No patients lost ≥10% weight from baseline. Mean dose to the OARs and max dose to the spinal cord remained within tolerance. CONCLUSION: MFO plans in post-operative OPC and OCC patients are robust to inter-fraction uncertainties in setup and range when evaluated over multiple CT scans without compromising OAR mean dose. ADVANCES IN KNOWLEDGE: This is the first paper to evaluate inter-fraction MFO plan robustness in post-operative head and neck treatment.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias Bucais/radioterapia , Neoplasias Orofaríngeas/radioterapia , Terapia com Prótons/métodos , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada/métodos , Idoso , Carcinoma de Células Escamosas/diagnóstico por imagem , Fracionamento da Dose de Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/diagnóstico por imagem , Órgãos em Risco/efeitos da radiação , Neoplasias Orofaríngeas/diagnóstico por imagem , Projetos Piloto , Cuidados Pós-Operatórios , Estudos Retrospectivos , Medula Espinal/efeitos da radiação , Incerteza
6.
An Bras Dermatol ; 94(6): 637-657, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31789244

RESUMO

Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.


Assuntos
Dermoscopia/métodos , Ceratose Actínica/diagnóstico por imagem , Ceratose Actínica/terapia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Humanos , Ceratose Actínica/patologia , Fatores de Risco , Índice de Gravidade de Doença , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia
7.
J Craniomaxillofac Surg ; 47(12): 1968-1972, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810847

RESUMO

OBJECTIVES: Routine panendoscopy is used to detect synchronous malignancies of the upper aerodigestive tract in staging of oral squamous cell carcinoma. The goal of this study was to investigate the occurrence of synchronous malignancies at time of diagnosis using panendoscopy. To challenge the role of panendoscopy as inherent part of routine staging procedures, we were especially interested in low risk patients. MATERIALS AND METHODS: Retrospectively, a cohort of 484 patients with pathologically confirmed diagnosis of primary oral and oropharyngeal squamous cell carcinoma was investigated. Electronically recorded findings of in-house conducted panendoscopy were retrieved and evaluated for the occurrence of pathological changes of the mucosa. In case of synchronous malignancies, findings were correlated to preoperative radiographic imaging. Patients were classified as high or low risk. Patients with lacking risk factors (no smoking, no drinking in history) were defined as low risk patients. RESULTS: Overall, we detected three synchronous malignancies of the upper aerodigestive tract (3/484; 0.6%). Two non-small cell lung cancers were detected in patients with a smoking history of 60 pack years. One esophageal carcinoma in situ was detected in a patient with reported alcohol consumption. No synchronous malignancy was detected in patients without risk factors and no malignancy was previously detected by diagnostic imaging. CONCLUSION: Pre-treatment panendoscopy can reveal synchronous malignancies of the upper aerodigestive tract in patients with primary oral squamous cell carcinoma. Risk stratification of patients can avoid unnecessarily conducted panendoscopy in patients without risk factors. This may lead to a higher cost-efficacy in public health system, less treatment-related complications and earlier treatment initiation.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Endoscopia/métodos , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Bucais/cirurgia , Neoplasias Primárias Múltiplas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico por imagem , Endoscopia do Sistema Digestório , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/diagnóstico por imagem , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
Clin Nucl Med ; 44(12): 956-960, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689276

RESUMO

PURPOSE: We sought to distinguish lung adenocarcinoma (ADC) from squamous cell carcinoma using a machine-learning algorithm with PET-based radiomic features. METHODS: A total of 396 patients with 210 ADCs and 186 squamous cell carcinomas who underwent FDG PET/CT prior to treatment were retrospectively analyzed. Four clinical features (age, sex, tumor size, and smoking status) and 40 radiomic features were investigated in terms of lung ADC subtype prediction. Radiomic features were extracted from the PET images of segmented tumors using the LIFEx package. The clinical and radiomic features were ranked, and a subset of useful features was selected based on Gini coefficient scores in terms of associations with histological class. The areas under the receiver operating characteristic curves (AUCs) of classifications afforded by several machine-learning algorithms (random forest, neural network, naive Bayes, logistic regression, and a support vector machine) were compared and validated via random sampling. RESULTS: We developed and validated a PET-based radiomic model predicting the histological subtypes of lung cancer. Sex, SUVmax, gray-level zone length nonuniformity, gray-level nonuniformity for zone, and total lesion glycolysis were the 5 best predictors of lung ADC. The logistic regression model outperformed all other classifiers (AUC = 0.859, accuracy = 0.769, F1 score = 0.774, precision = 0.804, recall = 0.746) followed by the neural network model (AUC = 0.854, accuracy = 0.772, F1 score = 0.777, precision = 0.807, recall = 0.750). CONCLUSIONS: A machine-learning approach successfully identified the histological subtypes of lung cancer. A PET-based radiomic features may help clinicians improve the histopathologic diagnosis in a noninvasive manner.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Aprendizado de Máquina , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Área Sob a Curva , Teorema de Bayes , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
10.
J Craniofac Surg ; 30(8): 2362-2367, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31609941

RESUMO

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is a common type of malignant skin disorder. An uncommon feature is local bony invasion, as can rarely be seen in lesions on the scalp. The optimal treatment strategy in these rare cases is still under debate. OBJECTIVE: The aim of this case report is to present a 1-stage three-dimensional planned surgical resection and reconstruction of a cSCC with bony invasion into the scalp and to discuss the alternative options and potential pitfalls. MATERIALS AND METHODS: A patient diagnosed with rT4N0M0 cSCC of the scalp underwent a cranial resection and reconstruction in 1 stage. With the use of computer-assisted design and computer-assisted manufacturing a patient-specific implant (PSI) of poly (ether ether ketone) was manufactured. After the PSI was inserted, it was covered with a latissimus dorsi muscle and a split-thickness skin graft. RESULTS: Intraoperatively the resection template generated an accurate resection and accurate and fast placement of the PSI. The reconstruction had a clinical satisfactory esthetic result, but was hampered by the development of a small wound dehiscence was observed over the postoperative course. CONCLUSION: Three-dimensional planned resection and reconstruction for composite defects of the skull after resection of a cSCC of the scalp with bony invasion may lead to an accurate and predictable resection and accurate and fast placement of the PSI. However, patient specific characteristics should be considered to assess potential risks and benefits before opting for this one-stage treatment strategy.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Estética Dentária , Humanos , Imagem Tridimensional , Masculino , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Couro Cabeludo/diagnóstico por imagem , Couro Cabeludo/cirurgia , Pele , Neoplasias Cutâneas/cirurgia , Transplante de Pele , Crânio/diagnóstico por imagem , Crânio/cirurgia
11.
Nucl Med Commun ; 40(11): 1138-1147, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31568193

RESUMO

OBJECTIVE: Oral cancer ranks in the top three of all cancers in India, accounting for over 30% of all cancers reported. Elective neck dissection (END) is the mainstay of treatment in early disease. Performing ENDs for node negative (N0) patients can result in significant morbidity with questionable benefit and impair the patients' quality of life. Sentinel Lymph Node Biopsy (SLNB), is an emerging investigation helping in risk stratification of patients with early oral cancer and node negative disease. SLNB is a simple, easy to perform investigation with a high sensitivity and plays a major role in avoiding neck dissection. Studies have compared SLNB-based neck dissection with END in early oral cancers, and also on survival benefit with prophylactic neck dissection at the time of primary surgery as compared to watchful waiting followed by therapeutic neck dissection for nodal relapse, in patients with clinical N0 (cN0) oral squamous cell carcinoma (OSCC) on literature search. AIM: Our primary aim was to determine the effectiveness of lymphoscintigraphy in OSCC in clinically neck node negative (cN0) patients in comparison to gold standard END for nodal metastases identification and secondly to assess the utility of gamma probe in guiding SLNB in this group of patients. MATERIALS AND METHODS: Fifty-eight patients (M:F = 42:16) with histologically confirmed OSCC of T1-3 stage with cN0 and planned for curative intent primary surgical treatment were divided into two arms. All patients underwent sentinel lymph node (SLN) imaging and biopsy. Arm 1 underwent nodal dissection based on SLNB positivity, while all patients in arm 2 had wide neck dissection irrespective of SLNB findings. RESULTS: SLN was detected in all 58 patients, 96.4% patients showed SLN immediately postinjection. More than one SLN was found in 94.3% patients and 6.8% patients showed contralateral SLN also. Higher proportion of nodal metastasis were observed in tongue cancers than in remaining floor of mouth and buccal mucosa cancers (38% vs 12%, P< 0.01). We also found significant association between T size and nodal metastasis in our series. Sensitivity of SLNB was 88.23% with a specificity of 100%, both for SLN imaging and gamma probing localization reflecting the reliability of this technique. Serial step sectioning at 150 micrometre is recommended. SLNB showed positive nodes in 29.3 % patients with cN0 neck. We found that the association between the outcome in both arms was not statistically significant. On follow-up, three patients with T3N0 OSCC of arm 2 had nodal recurrence/lung metastases. One patient of arm 1 had nodal recurrence. Two patients expired within one year. As high as 73% patients (22 negative necks out of 30) had unwarranted neck dissection in arm 2. CONCLUSION: SLNB is an effective method to circumvent unwarranted neck dissection in early OSCC and prevent complications. Gamma probing is a robust and easy tool to identify SLN in T1-3 stages with N0 necks clinically. A positive SLNB is found to be reliable in guiding neck dissection in this small study. Larger studies are warranted to establish its recommendation in routine clinical practice.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Raios gama , Linfocintigrafia , Neoplasias Bucais/diagnóstico por imagem , Esvaziamento Cervical , Linfonodo Sentinela/diagnóstico por imagem , Adulto , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Estadiamento de Neoplasias
12.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570341

RESUMO

A 57-year-old man with a known anterior mediastinal mass presented with abdominal distension, jaundice, and signs of urinary and bowel obstruction. Labs revealed leukocytosis, transaminitis, direct hyperbilirubinaemia and elevated levels of alkaline phosphatase, lactate dehydrogenase and uric acid. Subsequent imaging revealed the anterior mediastinal mass and diffuse liver lesions consistent with metastatic disease. MRI of the spine and brain were negative for metastases. Liver biopsy and immunohistochemistry revealed basaloid squamous cell carcinoma of thymic origin. Treatment with capecitabine was initiated but was complicated by worsening liver and kidney failure. Eventually, due to continued worsening of the patient's condition and minimal treatment response, capecitabine was stopped during cycle 1 and the patient was discharged to inpatient hospice with comfort care. In this case report, we highlight the presenting features, imaging findings and management of a patient with metastatic thymic carcinoma.


Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Hepáticas/secundário , Neoplasias do Mediastino/secundário , Neoplasias do Timo/patologia , Biópsia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/tratamento farmacológico , Progressão da Doença , Evolução Fatal , Humanos , Imuno-Histoquímica , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/tratamento farmacológico , Pessoa de Meia-Idade , Conforto do Paciente , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/tratamento farmacológico
13.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(5): 959-963, 2019 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-31624406

RESUMO

OBJECTIVE: To evaluate the diagnostic performance of a non-invasive, non-radiating, economical and convenient infrared thermal imaging in the detection of oral squamous cell carcinoma (OSCC) cervical lymph node metastasis, and evaluate its applicability via parallel test and series test. METHODS: This study was a prospective clinical study which passed the ethical review by the Biomedical Ethics Committee, Hospital of Stomatology, Peking University, and had been submitted for clinical trial registration. Totally 74 OSCC patients who were to undergo a neck dissection were included in this study. The inclusion criteria were patients who: (1) were pathologically diagnosed as malignant tumors and planned to undergo surgical treatment including neck dissection; (2) agreed to participate in this study. The exclusion criteria were those who: (1) had undergone surgeries at head and neck previously; (2) with a history of systemic tumor adjuvant therapies such as radiotherapy or chemotherapy etc; (3) were unwilling or unable to cooperate. Basal information as well as clinical examination results were collected, such as physical examination and contradictive enhanced CT. Besides, infrared thermal imaging was done ahead of surgery. Analysis of the diagnostic power of infrared thermal imaging followed the principles of diagnostic test. The positive signs of infrared thermal imaging were: (1) asymmetric thermographic pattern including vascular pattern in ROI; (2) thickening image of unilateral facial artery/vein, submental artery/vein or external carotid artery; (3) surface temperature of ROI raised over 1 °C compared with the opposite side; (4) changes of neck profile with abnormal temperature pattern. The gold standard of this diagnostic test was pathology diagnosis of cervical lymph nodes. RESULTS: The sensitivity of infrared thermal imaging was 75.0%, while the specificity was 69.0%, accuracy was 71.6%, positive predictive value was 64.9% and negative predictive value was 78.4%. The sensitivity of parallel test which stood for the combination of infrared thermal imaging and conventional clinical examinations was 87.9% while the specificity of series test was 97.6%. CONCLUSION: Infrared thermal imaging is a promising non-invasive, non-radiating and economical tool in the detection of cervical lymph node metastasis from OSCC when combined with conventional pre-operative examination.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Bucais/diagnóstico por imagem , Testes Diagnósticos de Rotina , Neoplasias de Cabeça e Pescoço , Humanos , Raios Infravermelhos , Linfonodos , Estudos Prospectivos , Sensibilidade e Especificidade
15.
BMC Surg ; 19(1): 105, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395049

RESUMO

BACKGROUND: There is currently no established standard tissue sampling method for hypopharyngeal cancer. The present study aimed to evaluate the feasibility of esophagogastroduodenoscopy (EGD) for the pretreatment evaluation of hypopharyngeal cancer and the safety of EGD-guided forceps biopsy. METHODS: We reviewed nine patients with hypopharyngeal cancer who underwent EGD for the evaluation of tumor extent and tissue biopsy from March 2014 to March 2017 at International St. Mary's Hospital. One experienced endoscopist performed all the EGD procedures in the presence of a head and neck surgeon. The procedure included determining tumor location, extent (presence of pyriform sinus apex involvement), and size, and passing the endoscope through the upper esophageal sphincter. The success rate of tissue sampling was assessed, and procedure-related complications were recorded. RESULTS: All patients were male, with a mean age of 69.9 ± 10.9 years (range 61-69 years). Tissue sampling using biopsy forceps was performed in 6/9 patients (66.7%). No complications related to moderate sedation or biopsy, including post-biopsy bleeding or respiratory distress, were reported. Histologic confirmation was successful in 5/6 patients (83.3%). Upper gastrointestinal lesions were evaluated in 7/9 (77.8%) patients in whom the scope passed through the lesion. CONCLUSIONS: EGD and EGD-guided forceps biopsy may be useful for the evaluation of hypopharyngeal cancer extent and tissue sampling, respectively.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Endoscopia do Sistema Digestório/métodos , Neoplasias Hipofaríngeas/diagnóstico por imagem , Idoso , Carcinoma de Células Escamosas/patologia , Endoscopia do Sistema Digestório/efeitos adversos , Endoscopia do Sistema Digestório/instrumentação , Estudos de Viabilidade , Gastroscópios , Humanos , Neoplasias Hipofaríngeas/patologia , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/instrumentação , Biópsia Guiada por Imagem/métodos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos
16.
World Neurosurg ; 131: e155-e169, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376550

RESUMO

OBJECTIVE: To integrate 3-dimensional (3D) intraoperative ultrasound (iUS) data in spinal navigation. METHODS: In 11 patients with intradural spinal tumors, 3D-iUS was performed before and after tumor resection. Intraoperative computed tomography (iCT) was used for automatic patient registration for spinal navigation; fiducial-based registration was performed in 1 case. The outlines of the vertebra were defined in preoperative image data by automatic mapping; risk and target structures were segmented manually; all these data were rigidly and if necessary non-rigidly registered with iCT. For 3D-iUS acquisition, tracked convex-shaped transducers (contact surface: 29 x 10 mm; scanning frequency: 10-3.8 MHz or 13-5 MHz) were used. RESULTS: Navigated 3D-iUS was successfully implemented in all cases; 3D-iUS datasets were acquired and could be used as 3D image data for further navigation after iUS scanning. The 3D objects defined in preoperative image data, outlining the vertebra, target and risk structures, could be visualized in the 3D-iUS data. Navigated 3D-iUS allowed to reliably evaluate the extent of resection in all cases and updating of navigation, ensuring high navigational accuracy. The target registration error applying iCT-based automatic registration was 0.78 ± 0.23 mm. The effective dose for iCT was 0.11 ± 0.077 mSv for cervical and 1.75 ± 0.72 mSv for thoracic scans. CONCLUSIONS: Using 3D-iUS can be successfully integrated in spinal navigation. Automatic registration applying low-dose iCT and non-linear image registration offers displaying preoperative images in the same orientation as the 3D-iUS scan, as well as visualizing segmented structures in the navigated 3D-iUS data. This greatly facilitates image interpretation. Navigated 3D-iUS provides a possibility for navigation updating and immediate online quality control.


Assuntos
Imagem Tridimensional/métodos , Neoplasias Meníngeas/cirurgia , Neuronavegação/métodos , Neoplasias da Medula Espinal/cirurgia , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Ependimoma/diagnóstico por imagem , Ependimoma/cirurgia , Feminino , Glioma/diagnóstico por imagem , Glioma/cirurgia , Hemangioblastoma/diagnóstico por imagem , Hemangioblastoma/cirurgia , Humanos , Cuidados Intraoperatórios , Neoplasias Pulmonares/patologia , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/secundário , Adulto Jovem
17.
Cancer Invest ; 37(8): 339-354, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31412717

RESUMO

Squamous cell carcinoma (SCC) of skin has no standard treatment regimen, resulting in recurrences/metastasis. Although, doxorubicin (Dox), an anthracycline antibiotic has demonstrated some degree of efficacy. Molecular imaging can help in assessment of treatment response and prognosis of SCCs. MRI data showed that spin-spin relaxation (T2) time was longer (138 ± 2 msec) in Dox treated Test-II and there is no significant difference in spin-lattice relaxation (T1) time with respective controls. These findings further corroborated with the histology, proliferation index, apoptotic index, and HMGA1 protein expression. Thus, MRI may be a useful tool for monitoring treatment response noninvasively for skin tumor prognosis.


Assuntos
Antibióticos Antineoplásicos/farmacologia , Carcinoma de Células Escamosas/tratamento farmacológico , Doxorrubicina/farmacologia , Imagem por Ressonância Magnética , Imagem Molecular/métodos , Neoplasias Cutâneas/tratamento farmacológico , Animais , Apoptose/efeitos dos fármacos , Biomarcadores/metabolismo , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patologia , Proteínas HMGA/genética , Proteínas HMGA/metabolismo , Camundongos , Valor Preditivo dos Testes , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/patologia , Fatores de Tempo , Carga Tumoral/efeitos dos fármacos
18.
Artigo em Chinês | MEDLINE | ID: mdl-31434372

RESUMO

Objective: To analyze the clinical characteristics of two groups(vascular classification declines or not in narrow band imaging (NBI) of patients with advanced hypopharyngeal carcinoma after induced chemotherapy, to follow-up and compare the survival differences between the two groups, and to explore the effect of vascular changes on clinical prognosis after induced chemotherapy in patients with advanced hypopharyngeal carcinoma. Methods: Clinical data of 56 patients with advanced hypopharyngeal carcinoma from August 2014 to September 2016 in Beijing Tongren Hospital, Capital Medical University were collected. The patients were divided into two groups according to NBI vascular classification declines or not after induced chemotherapy. The survival of patients and the impact of different factors on the prognosis were retrospectively analyzed. SPSS 24.0 statistical software was used for analysis. Frequency data were compared between the two groups using χ(2) test. Kaplan-Meier method and Cox regression analysis were employed for survival analysis and Log-Rank test was used for inter-group comparison, P<0.05 was statistically significant. Results: There was significant difference in overall survival rate(OS) between two groups of patients with advanced hypopharyngeal carcinoma after induced chemotherapy (P<0.05). Multivariate analysis showed that NBI vascular classification changes after induced chemotherapy was the impact factor for prognosis of advanced hypopharyngeal carcinoma after induced chemotherapy. Conclusion: In addition to recurrence and metastasis, NBI vascular classification changes is the important impact factor for prognosis of advanced hypopharyngeal carcinoma after induced chemotherapy. Patients with NBI vascular classification declines have significant survival benefit. The patients with advanced hypopharyngeal carcinoma should be checked with NBI examination before and after induced chemotherapy. NBI should be included in the routine screening indicators for prognosis of advanced hypopharyngeal carcinoma.


Assuntos
Antineoplásicos/farmacologia , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias Hipofaríngeas/tratamento farmacológico , Imagem de Banda Estreita , Veias/efeitos dos fármacos , Veias/diagnóstico por imagem , Antineoplásicos/uso terapêutico , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Humanos , Neoplasias Hipofaríngeas/diagnóstico por imagem , Neoplasias Hipofaríngeas/patologia , Quimioterapia de Indução , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
19.
J Cancer Res Ther ; 15(4): 760-765, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31436229

RESUMO

Background: The aim of the study is to evaluate the technique, safety, efficacy, and clinical value of computed tomography (CT)-guided percutaneous coaxial biopsy combined with microwave ablation (MWA) therapy for pulmonary tumors. Materials and Methods: CT-guided percutaneous coaxial biopsy combined with MWA was performed on 27 tumors in 23 patients who received treatment at our hospital from August 2014 to November 2017. The patients were followed up from 2 to 42 months. The outcomes were evaluated with plain and contrast spiral CT scans. Results: After treatment, lower density and lower CT values than baseline values were observed in the ablated area. The positive rate of biopsy was 81.48%. Seventeen patients had complete remission, four had partial remission, and two had progressive disease, with an effective rate of 91.3%. Until February 2018, 14 patients survived. Seven patients with metastatic lung cancer died of primary tumor progression. Two patients with primary lung cancer also died; one died of a lung infection and the other of cerebral hemorrhage. The 1-year local control rate was 88.9%, and the median progression-free survival was 33 months. The 1-, 2-, and 3-year survival rates were 91.3%, 69.6%, and 60.9%, respectively. Conclusion: CT-guided percutaneous coaxial biopsy combined with MWA can improve the quality of life of patients, prolong survival, and improve the survival rate. It is currently one of the most promising interventional treatments.


Assuntos
Adenocarcinoma de Pulmão/cirurgia , Carcinoma de Células Escamosas/cirurgia , Ablação por Cateter/métodos , Biópsia Guiada por Imagem/métodos , Neoplasias Pulmonares/cirurgia , Micro-Ondas , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Adulto , Idoso , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Taxa de Sobrevida , Resultado do Tratamento
20.
J Cancer Res Ther ; 15(4): 842-848, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31436241

RESUMO

Aim: Tongue carcinoma is one of the most common oral and maxillofacial malignant tumors worldwide, maximum standardized uptake value (SUVmax) in 18 F-fluoro-2-deoxyglucose-positron emission tomography/computed tomography (PET/CT) has been widely used in cancer research; however, there are few systematical reports on the relationship between SUVmax and clinicopathological characteristics in tongue squamous cell carcinoma (TSCC). This study aimed to investigate the relationship between them and whether SUV parameters can predict lymph node metastasis. Materials and Methods: PET/CT manifestations and clinicopathological features of 52 patients with TSCC confirmed by pathology were retrospectively analyzed. Single-factor and multiple regression analyses were conducted on possible factors influencing TSCC SUVmax, including sex, age, smoking history, tumor location and size, histological differentiation, and tumor node metastasis (TNM) stages, T stages, and N stages. Diagnostic performance of SUVmax for lymph node metastasis was measured by the area under the receiver operating characteristic curve, and sensitivity and specificity were determined by Youden's J statistic. Results: SUVmax was correlated with sex, tumor location and size, and TNM stages, T stages, and N stages (P < 0.05) but was not correlated with histological differentiation, smoking history, and age (P > 0.05). Sex, tumor location, tumor size, and N stage were influencing factors independent of TSCC SUVmax (P < 0.05). TSCC SUVmax had predictive value for lymph node metastasis. When the cutoff value was 6.57, the diagnostic efficiency was the highest, with the sensitivity being 79.2% and the specificity being 85.7%. Conclusions: SUVmax was higher among male patients with TSCC with posterior tumor location, larger tumor size, and lymph node metastasis, and TSCC SUVmax was important in predicting lymph node metastasis.


Assuntos
Carcinoma de Células Escamosas/patologia , Fluordesoxiglucose F18/metabolismo , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos/metabolismo , Neoplasias da Língua/patologia , Adulto , Idoso , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/metabolismo , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias da Língua/diagnóstico por imagem , Neoplasias da Língua/metabolismo , Adulto Jovem
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