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1.
Bull Cancer ; 107(3): 295-307, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32115178

RESUMO

OBJECTIVES: To evaluate the impact of systematic radiological review by breast specialist radiologist of malignant breast lesion imaging on the therapeutic management of patients. MATERIALS AND METHODS: Data collection was performed for patients with histopathologically proved breast cancer or suspicious breast lesion on imaging realized out of our institution. Patients underwent systematic mammary and axillary ultrasound, imaging review and if necessary complementary mammographic images. We analyzed the number of additional breast biopsies and axillary lymph node fine needle aspiration (FNA) with their histopathological results. We assessed their impact by comparing the final surgical treatment to the one planned before review. RESULTS: Two hundred and seventeen patients were included, with a total of 230 BIRADS 0, 4, 5 or 6 breast lesions. Seventy-six additional breast core biopsies were realized, leading to diagnose 43 additional BIRADS 6 lesions (24 infiltrative carcinomas, 9 DCIS and 10 atypical lesions) in 30 patients (13.82%). Thirty-five additional lymph node FNA were realized with 12 metastatic nodes and 3 false negative samples. Imaging review lead to change surgical treatment in 59 patients (27.19%, P<0.01) with modification in breast surgery in 37 patients, axillary surgery in 8 patients and both sites surgery in 12 patients. CONCLUSION: This study shows an impact of systematic radiological review by breast specialist radiologist in therapeutic management of patients treated for malignant breast lesion.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia , Linfonodos/diagnóstico por imagem , Radiologistas , Adulto , Idoso , Axila , Biópsia por Agulha Fina/estatística & dados numéricos , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Calcinose/diagnóstico por imagem , Quimioterapia Adjuvante/estatística & dados numéricos , Distribuição de Qui-Quadrado , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Mamografia , Mastectomia/estatística & dados numéricos , Mastectomia Simples/estatística & dados numéricos , Pessoa de Meia-Idade , Período Pré-Operatório , Radioterapia (Especialidade) , Estudos Retrospectivos , Estatísticas não Paramétricas , Ultrassonografia Mamária/estatística & dados numéricos
2.
Medicine (Baltimore) ; 99(9): e19314, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118758

RESUMO

BACKGROUND: Ruling out distant metastases, non-small cell lung cancer (NSCLC)treatment depends on the results of mediastinal node staging (N staging). Several diagnostic methods play central roles in mediastinal N staging. This study is intended to evaluate the existing diagnostic methods and report quality, and to search for the best method for staging mediastinal lymph nodes. METHODS: We searched PubMed, Embase, and the Cochrane Library to identify relevant studies, including randomized controlled trials and retrospective studies. These studies report the application of computed tomography, positron emission tomography-computed tomography, magnetic resonance imaging, endobronchial ultrasound, and mediastinoscopy in the diagnosis of mediastinal lymph node staging of NSCLC. The quality of the literature was assessed using the Quality Assessment of Diagnostic Accuracy Study 2. The true positive, false positive, true negative, and false negative of each study was extracted. The corresponding sensitivity, specificity, and other indicators were calculated and the Summary Receiver Operating curve was established. Then, head-to-head and indirect comparison meta-analyses will be conducted. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: This study will provide basis for mediastinal lymph node staging of non-small cell lung cancer. PROSPERO REGISTRATION NUMBER: CRD42019145667.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Diagnóstico por Imagem/normas , Linfonodos/fisiopatologia , Estadiamento de Neoplasias/normas , Idoso , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Protocolos Clínicos , Diagnóstico por Imagem/métodos , Endoscopia/métodos , Endoscopia/normas , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/normas , Masculino , Mediastinoscopia/métodos , Mediastinoscopia/normas , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas , Ultrassonografia/métodos , Ultrassonografia/normas
3.
J Comput Assist Tomogr ; 44(2): 262-268, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32195806

RESUMO

OBJECTIVE: The purpose of this study was to assess the diagnostic performance of multiphasic computed tomography (CT) in the discrimination of metastatic lymph nodes (LNs) of papillary thyroid cancer by using quantitative parameters. METHODS: This study enrolled 272 pathologically proven metastatic and benign LNs. Multiphasic CT was utilized by using nonenhanced, arterial (25-second delay), and venous (80-second delay) phases. Mean tissue attenuation values (MAVs) of metastatic and benign LNs were measured, and normalized MAV (common carotid artery and paraspinal muscle) and wash-in and wash-out percentages were also calculated. RESULTS: The arterial phase showed the highest diagnostic performance in differentiation (area under the curve ± standard error, 0.97 ± 0.02; 95% confidence interval, 0.94-1.0; P < 0.001). Cutoff values for MAVs, normalized MAVs, and wash-in and wash-out percentages to predict metastatic LNs were calculated as 109 HU, 0.33, 1.93, 122.5, and -5.6 (sensitivity: 93.4%, 93.3%, 90.4%, 94.1%, and 97.8%, and specificity: 99.3%, 90.4%, 98.5%, 92.6%, and 99.3%, respectively). CONCLUSIONS: Early-phase enhanced CT and the use of quantitative parameters derived from multiphasic CT improve the detection of cervical lymph node metastasis from papillary thyroid cancer.


Assuntos
Metástase Linfática/diagnóstico por imagem , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Estudos de Avaliação como Assunto , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pescoço , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
4.
Zhonghua Wai Ke Za Zhi ; 58(3): 165-169, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187919

RESUMO

Image-guided percutaneous placement of breast tissue marker clip (breast marker) is mainly used for precisely marking and localizing breast cancer lesion and metastatic axillary lymph node. Until now, there is no clinical guideline in the field worldwide. This consensus established by Chinese Society of Breast Surgery, Chinese Surgical Society of Chinese Medical Association is based on our clinical practice and literature review, and particularly focuses on indications and contraindications, key placement procedures and evaluation methods, complications prevention and treatment, to provide guidance for the safe and standard clinical applications of breast marker.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mama/diagnóstico por imagem , Marcadores Fiduciais , Linfonodos/diagnóstico por imagem , Axila , Consenso , Feminino , Humanos , Instrumentos Cirúrgicos
5.
Br J Radiol ; 93(1108): 20190558, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31957473

RESUMO

OBJECTIVE: To build and validate a CT radiomic model for pre-operatively predicting lymph node metastasis in early cervical carcinoma. METHODS AND MATERIALS: A data set of 150 patients with Stage IB1 to IIA2 cervical carcinoma was retrospectively collected from the Nanfang hospital and separated into a training cohort (n = 104) and test cohort (n = 46). A total of 348 radiomic features were extracted from the delay phase of CT images. Mann-Whitney U test, recursive feature elimination, and backward elimination were used to select key radiomic features. Ridge logistics regression was used to build a radiomic model for prediction of lymph node metastasis (LNM) status by combining radiomic and clinical features. The area under the receiver operating characteristic curve (AUC) and κ test were applied to verify the model. RESULTS: Two radiomic features from delay phase CT images and one clinical feature were associated with LNM status: log-sigma-2-0 mm-3D_glcm_Idn (p = 0.01937), wavelet-HL_firstorder_Median (p = 0.03592), and Stage IB (p = 0.03608). Radiomic model was built consisting of the three features, and the AUCs were 0.80 (95% confidence interval: 0.70 ~ 0.90) and 0.75 (95% confidence intervalI: 0.53 ~ 0.93) in training and test cohorts, respectively. The κ coefficient was 0.84, showing excellent consistency. CONCLUSION: A non-invasive radiomic model, combining two radiomic features and a International Federation of Gynecology and Obstetrics stage, was built for prediction of LNM status in early cervical carcinoma. This model could serve as a pre-operative tool. ADVANCES IN KNOWLEDGE: A noninvasive CT radiomic model, combining two radiomic features and the International Federation of Gynecology and Obstetrics stage, was built for prediction of LNM status in early cervical carcinoma.


Assuntos
Linfonodos/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Neoplasias do Colo do Útero/diagnóstico por imagem , Área Sob a Curva , Intervalos de Confiança , Feminino , Humanos , Modelos Logísticos , Linfonodos/patologia , Pessoa de Meia-Idade , Período Pré-Operatório , Curva ROC , Estudos Retrospectivos , Estatísticas não Paramétricas , Neoplasias do Colo do Útero/patologia
6.
Br J Radiol ; 93(1108): 20190711, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31971817

RESUMO

OBJECTIVE: A number of pre-operative factors predicting nodal burden in females with breast cancer have recently been identified. The aim of this study is to assess if these factors independently influence nodal burden in females with a positive axillary core biopsy. METHODS: All node positive patients detected on axillary core biopsy were identified in our cancer audit database. Mode of presentation, age, core tumour grade, core tumour type, ER and HER2 status were evaluated. Tumours were assessed for ultrasound size, distance of tumour-to-skin, presence of invasion of skin and diffuse skin thickening. Axillary lymph nodes were assessed for cortical thickness and presence of ultrasound replaced nodes. Statistical significance was ascertained using univariate logistic regression. A predictive model was produced following a multiple logistic regression model incorporating cross-validation and assessed using receiving operating characteristic curve. RESULTS: 115 patients' data were analysed. Patients referred because of symptoms (70% vs 38%, p = 0.005), and those with ultrasound skin thickening (87% vs 59%, p = 0.055) have higher nodal burden than those referred from screening or without skin thickening. These factors were significant after multivariate analysis. The final predictive model included mode of presentation, ultrasound tumour size, cortical thickness and presence of ultrasound skin thickening. The area under curve is 0.77. CONCLUSION: We have shown that mode of presentation and ultrasound skin thickening are independent predictors of high nodal burden at surgery. A model has been developed to predict nodal burden pre-operatively, which may lead to avoidance of axillary node clearance in patients with lower nodal burden. ADVANCES IN KNOWLEDGE: Method of presentation and skin involvement/proximity to skin by the primary tumour are known to influence outcome and nodal involvement respectively but have not been studied with regard to nodal burden. We have shown that mode of presentation and skin thickening at ultrasound are independent predictors of high nodal burden at surgery.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Pele/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Axila , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/patologia , Feminino , Humanos , Modelos Logísticos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/estatística & dados numéricos , Linfonodos/patologia , Metástase Linfática/diagnóstico por imagem , Pessoa de Meia-Idade , Período Pré-Operatório , Reprodutibilidade dos Testes , Estudos Retrospectivos , Pele/patologia , Ultrassonografia
7.
Khirurgiia (Mosk) ; (1): 61-66, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994501

RESUMO

OBJECTIVE: To develop a method for analysis of lymphatic drainage pathways from the lobe of the lung affected by non-small cell lung cancer (NSCLC) using infrared fluorescence. MATERIAL AND METHODS: A study enrolled patients with NSCLC who underwent anatomic resection of the lung with systematic lymph node dissection and preliminary intraoperative peritumoral injection of indocyanine green conjugate with human albumin. Registration of fluorescence in regional lymph nodes (LN) was carried out immediately after excision of specimen using the FLUM-808 instrumental system. RESULTS: Infrared fluorescence was observed in 117 hilar and mediastinal lymph nodes from 43 patients (2.7 nodes per a patient). Comparison of localization of fluorescent LN with localization of tumor in various lobes established significant variability of lymphatic drainage pathways. CONCLUSION: The developed method of infrared fluorescent evaluation of lymphatic drainage in patients with NSCLC confirms the necessity of systematic lymph node dissection for adequate staging.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Metástase Linfática/diagnóstico por imagem , Estadiamento de Neoplasias/métodos , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Corantes , Fluorescência , Humanos , Verde de Indocianina , Raios Infravermelhos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo , Linfonodos/diagnóstico por imagem , Linfonodos/fisiopatologia , Linfonodos/cirurgia , Metástase Linfática/fisiopatologia
9.
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
10.
Br J Radiol ; 93(1106): 20190790, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31778314

RESUMO

OBJECTIVE: To assess metastatic involvement of perigastric lymph nodes (PLNs) in patients with T1 gastric cancer by using CT perfusion imaging (CTPI). METHODS: A total of 82 annotated PLNs of 33 patients with T1 gastric cancer confirmed by endoscopic ultrasonography underwent CTPI and portal phase CT scan before operation. The scan data were post-processed to acquire perfusion maps and calculate perfusion parameters including blood flow (BF) and permeability surface (PS). A radiologist measured the short axis diameters and perfusion parameters of PLNs. According to the post-operative pathology result, PLNs were divided into two groups: metastatic and inflammatory LNs. Perfusion parameters values and the size of PLNs between two groups were respectively compared statistically by t-test, and a receiver operating characteristic curve analysis was used to determine the optimal diagnostic cut-off value with sensitivity, specificity and area under the curve. RESULTS: Examined 82 PLNs were metastatic in 45 (54.9%) and inflammatory in 37 (45.1%). The mean values of perfusion parameters and the short axis diameters in metastatic and inflammatory PLNs, respectively, were BF of 97.48 vs 81.21 ml/100 mg /min (p < 0.001), PS of 45.11 vs 36.80 ml/100 mg /min (p < 0.001), and the size of 1.51 cm vs 1.29 cm (p = 0.059). The sensitivity of 84.4%, specificity of 67.6% and area under the curve of 0.826 for BF with cut-off value of 88.89 ml/100 mg /min for differentiating metastatic from inflammatory nodes were higher than those of PS or the size of PLNs (p < 0.001). CONCLUSION: CT perfusion parameters values were different between metastatic and inflammatory PLNs in T1 gastric cancer. BF value may be the most reliable diagnostic marker of metastatic PLNs, and it is helpful for clinicians to choose treatment modality or management plan in T1 gastric cancer patients. ADVANCES IN KNOWLEDGE: CTPI gives information on vascularization of LNs.BF value might be a more effective marker than PS or the size of LNs for differentiating metastatic from inflammatory LNs in patients with T1 gastric cancer.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Junção Esofagogástrica/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão/métodos , Curva ROC , Tomografia Computadorizada por Raios X/métodos
11.
J Cancer Res Clin Oncol ; 146(1): 237-244, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606761

RESUMO

PURPOSE: Subclinical lymph node (LN) metastasis is associated with poor survival outcome in oral cavity squamous cell carcinoma (OCC), which alleges elective neck LN dissection. Preoperative detection of metastatic LNs may improve prognosis and proper management of OCC. We examined the clinical usefulness of fluorine 18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) for the detection of occult neck LN metastasis in OCC patients in comparison with conventional CT/magnetic resonance (MR) imaging. METHODS: A total of 178 OCC patients with negative neck palpation findings were assessed prospectively with 18F-FDG PET/CT and CT/MR imaging. Histopathological analyses of neck dissection samples served as reference. Diagnostic values of 18F-FDG PET/CT versus CT/MR imaging were compared with the McNemar test and logistic regression with generalized estimating equations. RESULTS: Forty-two patients (23.6%) had metastasis in 44 sides and 58 levels of the neck. The sensitivity for detection of occult metastasis was higher for 18F-FDG PET/CT than that for CT/MR imaging on a per-patient (69.1% vs 35.7%), per-side (70.5% vs 36.4%), and per-level (62.1% vs 29.3%) basis (all P ≤ 0.001). However, the specificity for metastatic detection was higher for CT/MR imaging than that for 18F-FDG PET/CT (all P < 0.005). 18F-FDG PET/CT improved detection of occult metastasis up to 33.4% in these patients compared to CT/MR imaging. CONCLUSIONS: 18F-FDG PET/CT can better detect occult neck metastasis than CT/MR imaging, which may potentially impact the clinical management of OCC patients.


Assuntos
Fluordesoxiglucose F18 , Linfonodos/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neoplasias Bucais/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Estudos Prospectivos , Compostos Radiofarmacêuticos , Adulto Jovem
12.
Int J Radiat Oncol Biol Phys ; 106(3): 630-638, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31759076

RESUMO

PURPOSE: Intensity modulated proton therapy (IMPT) of locally advanced prostate cancer can spare the bowel considerably compared with modern photon therapy, but simultaneous treatment of the prostate (p), seminal vesicles (sv), and lymph nodes is challenging owing to day-to-day organ motion and range uncertainties. Our purpose was, therefore, to generate a plan library for use in adaptive IMPT to mitigate these uncertainties. METHODS AND MATERIALS: We retrospectively included 27 patients with a series of computed tomography scans throughout their treatment representing day-to-day variation. In 18 of the patients, target motion was analyzed using rigid shifts of prostate gold markers relative to bony anatomy. A plan library with different p and sv planning target volume (p/sv-PTV) positions was defined from the distribution and direction of these shifts. Delivery of IMPT using plan selection from the library was simulated for image guidance on bony anatomy, in the remaining patients and compared with nonadaptive IMPT. RESULTS: The plan library consisted of 3 small margin p/sv-PTVs: (1) p/sv-PTV shifted 1.5 systematic error (Σ) of the population mean in the anterior and cranial directions, (2) p/sv-PTV shifted 1.5Σ in the posterior and caudal directions, and (3) p/sv-PTV in the planning position. The conventional p/sv-PTV was also available for backup. Plan selection compared with nonadaptive IMPT resulted in a reduction of the rectum volume receiving 60 Gy relative biological effect (RBE) (V60GyRBE) from on average 12 mL to 9 mL. For the bladder the average V45GyRBE was reduced from 36% to 30%. Large and small bowel doses were also reduced, whereas target coverage was comparable or improved compared with nonadaptive IMPT. CONCLUSIONS: Plan selection based on a population model of rigid target motion was feasible for all patients. Compared with conventional IMPT, plan selection resulted in significant dosimetric sparing of rectum and bladder without compromising target coverage.


Assuntos
Movimentos dos Órgãos , Neoplasias da Próstata/radioterapia , Terapia com Prótons/métodos , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada/métodos , Pontos de Referência Anatômicos/diagnóstico por imagem , Marcadores Fiduciais , Ouro , Humanos , Bibliotecas Digitais , Linfonodos/diagnóstico por imagem , Irradiação Linfática/métodos , Masculino , Tratamentos com Preservação do Órgão/métodos , Órgãos em Risco/diagnóstico por imagem , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Reto/diagnóstico por imagem , Estudos Retrospectivos , Glândulas Seminais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Incerteza , Bexiga Urinária/diagnóstico por imagem
14.
Surg Clin North Am ; 100(1): 91-107, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31753118

RESUMO

In this article we provide a critical review of the evidence available for surgical management of the nodal basin in melanoma, with an aim to ensure an understanding of risks and benefits for all lymph node surgery offered to patients, and alternatives to surgical management where appropriate.


Assuntos
Linfonodos/efeitos dos fármacos , Melanoma/patologia , Neoplasias Cutâneas/patologia , Humanos , Linfonodos/diagnóstico por imagem , Metástase Linfática , Melanoma/diagnóstico por imagem , Melanoma/tratamento farmacológico , Melanoma/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/terapia
15.
Orv Hetil ; 161(1): 33-38, 2020 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-31884815

RESUMO

Castleman disease is a rare lymphoproliferative disease the exact cause of which is not known. The diagnosis is based on the adequate histological examination. While in the unifocal form, the disease most commonly affects the chest, and symptoms may resolve as a result of intact excision of the tumour; other treatment methods may be performed in addition to or instead of surgical incision in the case of the multifocal form. We present the case of a patient with Castleman disease who received multidisciplinary treatment. Speech difficulty, dysphagia, and progressive paresis occurred in the upper and lower extremities of the 56-year-old male patient 18 weeks before his check-up examinations. Although the complaints temporarily resolved with plasmapheresis, surgical sampling could not confirm the origin of the mediastinal lymphadenomegaly detected with thoracic CT. The patient was admitted to our department to remove the 5 cm large subcarinal lymph node or to gain a tissue sample from it. On admission, significant atrophy, hypotonia and tetraplegia were seen in the four extremities, and areflexia was detected all over the body. The 5.5 × 3.5 cm large subcarinal lymph node conglomerate was removed from posterolateral thoracotomy. Histology was performed, Castleman disease was confirmed. 3 days after the surgery, the patient was able to move the extremities, and then on the 9th postoperative day, the patient could walk using a walking frame, and he was transferred back to the Department of Neurorehabilitation. At transfer, the muscle strength of the upper extremities was almost intact, and 4/5 muscle strength was detected in the lower extremities. After this, methylprednisolone, vitamin B1, calcium citrate, famotidine therapy was administered, and 2 weeks after his transfer, he was discharged home; at that time, the patient was able to walk safely without a walking frame. The symptoms resolved almost completely 3 months after the surgery. Diagnosis and treatment of Castleman disease are multidisciplinary tasks. If the patient is suitable for surgery, surgical removal has to play a key role in the treatment of unifocal Castleman disease. Orv Hetil. 2020; 161(1): 33-38.


Assuntos
Hiperplasia do Linfonodo Gigante/diagnóstico , Linfonodos/diagnóstico por imagem , Doenças do Mediastino/diagnóstico por imagem , Quadriplegia/complicações , Hiperplasia do Linfonodo Gigante/cirurgia , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Toracotomia , Tomografia Computadorizada por Raios X
17.
Anticancer Res ; 39(12): 6843-6849, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810951

RESUMO

BACKGROUND/AIM: This study examined whether the prognostic nutritional index (PNI) is a useful predictor of pathological lymph node metastasis (pN+) in gastric cancer (GC). PATIENTS AND METHODS: This study retrospectively examined 167 patients with advanced GC (cT2-T4) undergoing curative gastrectomy. The predictive ability of PNI for pN+ was evaluated in comparison with that of clinical lymph node metastasis (cN+) determined by computed tomography (CT). RESULTS: The optimal cut-off value of PNI for predicting pN+ was 46 according to the receiver operating characteristic curve analysis. Multivariate analysis revealed a PNI<46 [odds ratio (OR)=2.905; 95% confidence interval (CI)=1.347-6.638, p=0.006], cN+ (OR=2.323; 95%CI=1.204-4.579, p=0.012), and undifferentiated-type adenocarcinoma (OR=2.032; 95%CI=1.060-3.947, p=0.033) to be independent predictors of pN+. PNI detected pN+ with a higher specificity (84.9%) and positive predictive value (PPV) (75.6%) than cN+ (68.5% and 68.1%, respectively). When the subjects were limited to patients with cN+, the specificity and PPV of a PNI<46 for pN+ became markedly high (91.3% and 90.5%, respectively). CONCLUSION: PNI predicts pN+ with a high specificity in patients with a clinical diagnosis of advanced GC; therefore, PNI may aid in the definitive diagnosis of pN+, especially in combination with CT findings.


Assuntos
Linfonodos/patologia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrectomia , Humanos , Linfonodos/diagnóstico por imagem , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Prognóstico , Curva ROC , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico por imagem , Análise de Sobrevida , Tomografia Computadorizada por Raios X
18.
Einstein (Sao Paulo) ; 17(4): eMD5157, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31826074

RESUMO

Elastography is a widely used procedure in conventional ultrasonography that has recently been incorporated in echoendoscopy. This is an innovative and promising technology that aims to increase the negative predictive value of endoscopic ultrasonography and fine-needle aspiration punctures. It is useful for directing punctures in suspect areas and, consequently, improves diagnostic performance. This is a non-invasive technique, easy to perform, without additional costs or complications. The main indications are the analysis of solid pancreatic masses, lymph nodes, subepithelial lesions, lesions in the left hepatic lobe and in the left adrenal. Negative or inconclusive cases of fine-needle aspiration can be submitted to elastography when there is a strong suspicion of malignancy. Elastography has a high precision for the differential diagnosis of solid masses and in difficult-to-access anatomic sites, as well as in mediastinal lymph nodes and pancreatic tumors. The procedure is based on the degree of tissue elasticity measurement, with a good correlation between the elasticity index and histopathological features. We report the case of four patients evaluated by echoendoscopy and qualitative elastography who had differential diagnoses in mediastinal lymph nodes: sarcoidosis, lymphoma, histoplasmosis and esophageal neoplasia.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Endossonografia/métodos , Linfonodos/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Adulto , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
19.
PLoS Biol ; 17(12): e3000486, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31856185

RESUMO

The conduit network is a hallmark of lymph node microanatomy, but lack of suitable imaging technology has prevented comprehensive investigation of its topology. We employed an extended-volume imaging system to capture the conduit network of an entire murine lymph node (comprising over 280,000 segments). The extensive 3D images provide a comprehensive overview of the regions supplied by conduits, including perivascular sleeves and distinctive "follicular reservoirs" within B cell follicles, surrounding follicular dendritic cells. A 3D topology map of conduits within the T-cell zone showed homogeneous branching, but conduit density was significantly higher in the superficial T-cell zone compared with the deep zone, where distances between segments are sufficient for T cells to lose contact with fibroblastic reticular cells. This topological mapping of the conduit anatomy can now aid modeling of its roles in lymph node function, as we demonstrate by simulating T-cell motility in the different T-cell zones.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Imagem Tridimensional/métodos , Linfonodos/diagnóstico por imagem , Animais , Linfócitos B/imunologia , Movimento Celular , Fibroblastos , Camundongos/imunologia , Linfócitos T/imunologia
20.
Cancer Imaging ; 19(1): 91, 2019 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-31878958

RESUMO

BACKGROUND: In patients who have had axillary nodal metastasis diagnosed prior to neoadjuvant chemotherapy for breast cancer, there is little consensus on how to manage the axilla subsequently. The aim of this study was to explore whether a combination of breast magnetic resonance imaging (MRI) assessed response and primary tumour pathology factors could identify a subset of patients that might be spared axillary node clearance. METHODS: A retrospective data analysis was performed of patients with core biopsy-proven axillary nodal metastasis prior to commencement of neoadjuvant chemotherapy (NAC) who had subsequent axillary node clearance (ANC) at definitive breast surgery. Breast tumour and axillary response at MRI before, during and on completion of NAC, core biopsy tumour grade, tumour type and immunophenotype were correlated with pathological response in the breast and the number of metastatic nodes in the ANC specimens. RESULTS: Of 87 consecutive patients with MRI at baseline, interim and after neoadjuvant chemotherapy who underwent ANC at time of breast surgery, 33 (38%) had no residual macrometastatic axillary disease, 28 (32%) had 1-2 metastatic nodes and 26 (30%) had more than 2 metastatic nodes. Factors that predicted axillary nodal complete response were MRI complete response in the breast (p < 0.0001), HER2 positivity (p = 0.02) and non-lobular tumour type (p = 0.015). CONCLUSION: MRI assessment of breast tumour response to NAC and core biopsy factors are predictive of response in axillary nodes, and can be used to guide decision making regarding appropriate axillary surgery.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Imagem por Ressonância Magnética/normas , Adulto , Idoso , Antineoplásicos/uso terapêutico , Axila/diagnóstico por imagem , Axila/patologia , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática/tratamento farmacológico , Metástase Linfática/patologia , Pessoa de Meia-Idade , Terapia Neoadjuvante
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