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1.
Medicine (Baltimore) ; 99(11): e19251, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176049

RESUMO

Lymph nodes (LN) metastasis differentiation from computed tomography (CT) images is a challenging problem. This study aims to investigate the association between radiomics image parameters and LN metastasis in colorectal mucinous adenocarcinoma (MAC).Clinical records and CT images of 15 patients were included in this study. Among them, 1 patient was confirmed with all metastatic LNs, the other 14 were confirmed with all non-metastatic LNs. The regions of the LNs were manually labeled on each slice by experienced radiologists. A total of 1054 LN regions were obtained. Among them, 164 were from metastatic LNs. One hundred nine image parameters were computed and analyzed using 2-sample t test method and logistic regression classifier.Based on 2 sample t test, image parameters between the metastatic group and the non-metastatic group were compared. A total of 73 parameters were found to be significant (P < .01). The selected shape parameters demonstrate that non-metastatic LNs tend to have smaller sizes and more circle-like shapes than metastatic LNs, which validates the common agreement of LN diagnosis using computational method. Besides, several high order parameters were selected as well, which indicates that the textures vary between non-metastatic LNs and metastatic LNs. The selected parameters of significance were further used to train logistic regression classifier with L1 penalty. Based on receiver operating characteristic (ROC) analysis, large area under curve (AUC) values were achieved over 5-fold cross validation (0.88 ±â€Š0.06). Moreover, high accuracy, specificity, and sensitivity values were observed as well.The results of the study demonstrate that some quantitative image parameters are of significance in differentiating LN metastasis. Logistic regression classifiers showed that the parameters are with predictive values in LN metastasis, which may be used to assist preoperative diagnosis.


Assuntos
Adenocarcinoma Mucinoso/diagnóstico por imagem , Adenocarcinoma Mucinoso/patologia , Neoplasias Colorretais/patologia , Linfonodos/patologia , Metástase Linfática/patologia , Tomografia Computadorizada por Raios X/métodos , Absorciometria de Fóton/métodos , Adenocarcinoma Mucinoso/cirurgia , Adulto , Idoso , Estudos de Coortes , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Modelos Logísticos , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Cuidados Pré-Operatórios , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
2.
Am Surg ; 86(2): 164-170, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167047

RESUMO

Tumor deposits in colon cancer are related to poor prognosis, whereas the prognostic power of tumor deposits in combination with lymph node metastasis (LNM) is controversial. This study aimed to compare the overall survival between LNM alone and LNM in combination with tumor deposits, and to verify whether the number of tumor deposits can be considered LNM in patients with both LNM and tumor deposits in stage III colon cancer by propensity score matching (PSM). Patients carrying resected stage III adenocarcinoma of colon cancer were identified from the Surveillance, Epidemiology, and End Results database (2010-2015). The Kaplan-Meier method, Cox proportional hazard models and PSM were used. On the whole, 23,168 patients (20,451 (88.3%) with only LNM and 2,717 (11.7%) with both LNM and tumor deposits) were selected. After undergoing PSM, patients with both LNM and tumor deposits showed worse overall survival (hazard ratio = 1.33, 95% confidence interval: 1.20-1.47, P < 0.001). After the number of tumor deposits was added with that of positive regional lymph nodes, patients with both LNM and tumor deposits seemed to have prognostic implications similar to those with LNM alone (hazard ratio = 1.02, 95% confidence interval: 0.93-1.12, P = 0.66). The simultaneous presence of LNM and tumor deposits, as compared with the presence of only LNM, had an association with a worse outcome. Tumor deposits should be considered as LNM in patients with both tumor deposits and LNM in stage III colon cancer.


Assuntos
Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Linfonodos/patologia , Metástase Linfática/patologia , Adenocarcinoma/secundário , Idoso , Intervalos de Confiança , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Pontuação de Propensão , Modelos de Riscos Proporcionais , Programa de SEER , Taxa de Sobrevida
3.
Urologe A ; 59(2): 209-218, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32020240

RESUMO

The incidence of penile cancer in central Europe and North America is low, and patients often present at a late stage of the disease. The diagnosis can very often be made by visual examination of the primary tumor. Its morphology, size, and location as well as the inguinal lymph nodes are of clinical interest. The removal of (micro)metastatic lymph nodes is decisive for the prognosis. These cannot be diagnosed clinically or by imaging with sufficient reliability, which makes invasive lymph node staging necessary. Penile cancer can only be cured by surgery in patients with localized cancer and early stage regional lymph node metastasis. The primary tumor, including metastatic lymph nodes, must be completely excised as early as possible. If indicated, organ preservation must be performed with strict adherence of safety margins. Optimal lymph node management is crucial for long-term survival.


Assuntos
Excisão de Linfonodo/métodos , Linfonodos/patologia , Neoplasias Penianas/diagnóstico , Neoplasias Penianas/cirurgia , Intervalo Livre de Doença , Europa (Continente) , Humanos , Metástase Linfática/patologia , Metástase Linfática/prevenção & controle , Masculino , Estadiamento de Neoplasias , Neoplasias Penianas/mortalidade , Neoplasias Penianas/patologia , Pênis/patologia , Prognóstico , Reprodutibilidade dos Testes , Análise de Sobrevida
5.
Medicine (Baltimore) ; 99(2): e18533, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914026

RESUMO

BACKGROUND: Recent studies have shown that long noncoding RNA (lncRNA) H19 is aberrantly expressed in various cancers. However, the prognostic significance of H19 in cancer patients remains to be elucidated. Here, we designed and conducted a meta-analysis to evaluate the prognostic value of this lncRNA for malignant solid neoplasms. METHODS: Relevant publications were collected from PubMed, Cochrane Library, Web of Science, and Embase databases. The relevant survival data of patients with H19-associated cancers were downloaded from The Cancer Genome Atlas (TCGA) project. Statistically significant relationships between H19 expression levels and overall survival were analyzed by hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). RESULTS: A total of 15 studies with 1584 patients were ultimately included for this literature meta-analysis. An elevated level of H19 expression was found to be negatively correlated with the overall survival (OS) (HR = 1.62, 95% CI = 1.36-1.93, P < .001) in various cancers. Abnormal H19 expression was also positively correlated with poor tumor differentiation (P < .0001), more advanced clinical stage (P < .0001), earlier lymph node metastasis (P < .0001), and earlier distant metastasis (P < .05). The relationship between elevated H19 expression and overall survival was further validated by a TCGA dataset consisting of 7462 cancer patients (HR = 1.12, 95% CI = 1.03-1.22, P < .05). CONCLUSION: Our study indicates that H19 expression is closely relevant to clinical outcome and suggests that lncRNA H19 could be a crucial prognostic biomarker for certain carcinoma types.


Assuntos
Neoplasias/genética , Neoplasias/mortalidade , RNA Longo não Codificante/genética , Biomarcadores Tumorais/genética , Carcinoma , Feminino , Humanos , Metástase Linfática/genética , Metástase Linfática/patologia , Masculino , Neoplasias/patologia , Prognóstico , Intervalo Livre de Progressão
6.
Urology ; 135: 50-56, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31669270

RESUMO

OBJECTIVE: To describe and compare the management of WT and oncologic outcomes by patient age using a large national database. METHODS: The National Cancer Database was queried for patients with WT diagnosis from 2004 to 2013. Patients were grouped by age and compared: pediatric (<16 years), young adults (16-35 years) and adult (>35 years). Overall survival (OS) was the primary endpoint. Factors associated with OS were determined using multivariate analysis. RESULTS: The majority of patients were pediatric (n = 2686), followed by young adult (n = 91), and adult (n = 35). Five-year OS was significantly better for children vs young adults or adults (93.1% vs 79.1% vs 78.9%, respectively; P <.001), as was 10-year OS (91.5% vs 52.4% vs 70%; P <.001). On multivariate analysis, OS was significantly better for children vs young adult (HR 3.62; 95% CI 2.25-5.8; P <.001), and adult (HR 3.38; 95% CI, 1.49-7.7; P <.004). Other variables associated with worse OS included bilateral disease (HR 2.06; P = .003), stage II disease (HR 2.92; P = .036), stage IV disease (HR 4.1; P = .004), and positive lymph nodes (HR 1.97-4.90; P = .018). Patients >15 years were less likely to undergo lymph node sampling (OR 0.19; P <.001), radiation therapy (OR 0.62; P = .03), or chemotherapy (OR 0.38; P <.001). CONCLUSION: Adults with WT experience worse 5- and 10-year OS when compared to children with WT. Survival decrements in adults are likely multifactorial including modifiable factors such as inadequate staging due to low rates of lymph node sampling, and underutilization of adjuvant therapies.


Assuntos
Neoplasias Renais/terapia , Metástase Linfática/terapia , Padrões de Prática Médica/estatística & dados numéricos , Tumor de Wilms/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Excisão de Linfonodo/estatística & dados numéricos , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nefrectomia/métodos , Nefrectomia/estatística & dados numéricos , Prognóstico , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologia , Tumor de Wilms/mortalidade , Tumor de Wilms/patologia , Adulto Jovem
7.
J Surg Res ; 246: 160-169, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31586890

RESUMO

BACKGROUND: A major roadblock to reducing the mortality of colorectal cancer (CRC) is prompt detection and treatment, and a simple blood test is likely to have higher compliance than all of the current methods. The purpose of this report is to examine the utility of a mass spectrometry-based blood serum protein biomarker test for detection of CRC. MATERIALS AND METHODS: Blood was drawn from individuals (n = 213) before colonoscopy or from patients with nonmetastatic CRC (n = 50) before surgery. Proteins were isolated from the serum of patients using targeted liquid chromatography-tandem mass spectrometry. We designed a machine-learning statistical model to assess these proteins. RESULTS: When considered individually, over 70% of the selected biomarkers showed significance by Mann-Whitney testing for distinguishing cancer-bearing cases from cancer-free cases. Using machine-learning methods, peptides derived from epidermal growth factor receptor and leucine-rich alpha-2-glycoprotein 1 were consistently identified as highly predictive for detecting CRC from cancer-free cases. A five-marker panel consisting of leucine-rich alpha-2-glycoprotein 1, epidermal growth factor receptor, inter-alpha-trypsin inhibitor heavy-chain family member 4, hemopexin, and superoxide dismutase 3 performed the best with 70% specificity at over 89% sensitivity (area under the curve = 0.86) in the validation set. For distinguishing regional from localized cancers, cross-validation within the training set showed that a panel of four proteins consisting of CD44 molecule, GC-vitamin D-binding protein, C-reactive protein, and inter-alpha-trypsin inhibitor heavy-chain family member 3 yielded the highest performance (area under the curve = 0.75). CONCLUSIONS: The minimally invasive blood biomarker panels identified here could serve as screening/detection alternatives for CRC in a human population and potentially useful for staging of existing cancer.


Assuntos
Biomarcadores Tumorais/sangue , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Metástase Linfática/diagnóstico , Programas de Rastreamento/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia , Colonoscopia , Neoplasias Colorretais/sangue , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Estudos Transversais , Estudos de Viabilidade , Feminino , Humanos , Metástase Linfática/patologia , Masculino , Espectrometria de Massas/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Projetos Piloto , Estudos Prospectivos , Curva ROC
8.
Virchows Arch ; 476(2): 219-230, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31616981

RESUMO

Clinical significance of the pT4 category in colon cancer is increasing with several therapeutic implications. The aim of this study was to evaluate variability in diagnosing pT4a colon cancer. Twelve pathologists classified 66 preselected scanned Hematoxylin/Eosin-stained slides with tumor cells at a distance of 25-1500 µm (n = 22), 0-25 µm (n = 22), or on (n = 22) the peritoneal surface. Inter- and intraobserver variability were calculated using Kappa statistics. For interlaboratory variability, pathology reports of pT3 and pT4a colon cancer were extracted from the Dutch Pathology Registry between 2012 and 2015. The proportion of pT4a (pT4a/(pT3+pT4a)) was compared between 33 laboratories. Potential risk of understaging was assessed by determining the average number of blocks taken from pT3 and pT4a N0-2M0 tumors with metachronous peritoneal metastasis. Interobserver variability among 12 pathologists was 0.50 (95%CI 0.41-0.60; moderate agreement). Intraobserver variability (8 pathologists) was 0.71 (substantial agreement). A total of 7745 reports with pT3 or pT4aN0-2M0 colon cancer from 33 laboratories were included for interlaboratory analysis. Median percentage of pT4a was 15.5% (range 3.2-24.6%). After adjustment for case mix, 8 labs diagnosed pT4a significantly less or more frequently than the median lab. Metachronous peritoneal metastases were histologically verified in 170 of 6629 pT3 and in 129 of 1116 pT4a tumors, with a mean number of blocks of 4.03(SD 1.51) and 4.78 (SD 1.76) taken from the primary tumors, respectively (p < 0.001). A substantial variability in diagnosing pT4a colon cancer exists, both at pathologist and laboratory level. Diagnosis of pT4a stage appears to be challenging and there is a need for standardizing assessment of this pathological entity.


Assuntos
Adenocarcinoma/patologia , Neoplasias do Colo/patologia , Metástase Linfática/patologia , Peritônio/patologia , Adenocarcinoma/diagnóstico , Neoplasias do Colo/diagnóstico , Humanos , Invasividade Neoplásica/patologia , Variações Dependentes do Observador , Prognóstico , Estudos Retrospectivos
9.
J Cancer Res Clin Oncol ; 146(3): 739-748, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31832762

RESUMO

BACKGROUND: It is highly controversial that how to deal with the lateral lymph-node metastasis in patients with rectal cancer. Although lateral lymph node can be detected by preoperative MRI, the metastasis status cannot be accurately determined following standard total mesorectal excision (TME) in low-risk patients. This study was to assess the correlation between preoperative MRI detected lateral lymph-node (LLN) features and prognosis in patients with non-preradiated low recurrence risk rectal cancers. MATERIALS AND METHODS: This retrospective study included 593 low-risk rectal cancers underwent TME without neoadjuvant chemo-radiotherapy from January 2013 to December 2015. The features of the largest LLN were retrospectively reviewed on preoperative MRI. The relationship of MR-LLN features with overall survival, metastasis-free survival, and local relapse-free survival was analyzed. RESULTS: A total of 593 patients including 415 cases of pN0, 86 cases of pN1, and 92 cases of pN2 were enrolled in this study. In pN0 patients, at least one visible LLN was detected in 104 patients on primary MRI. The MR-T staging, postoperative therapy status, the presence of MR-LLN, and short axis (SA) of MR-LLN were significantly correlated with the recurrence in pN0 patients (all p < 0.05). The OS and MFS were significantly lower in patients with MR-LLN SA ≥ 8 mm than SA < 8 mm (p < 0.01, HR = 4.35, 95% CI = 1.48-12.77). The OS and MFS of patients with pN0-LLN(+) and SA ≥ 8 mm were similar to pN2-LLN(-) patients. The location of MR-LLN showed no significant impact on prognosis. CONCLUSION: For low-risk rectal cancers without neoadjuvant chemo-radiotherapy, the presence of MR-LLN is associated with poor prognosis. The pN0-LLN(+) SA ≥ 8 mm patients might be concerned as pN2 patients and receive more intensive neoadjuvant or adjuvant treatment.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Excisão de Linfonodo , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Prognóstico , Neoplasias Retais/mortalidade , Estudos Retrospectivos
10.
Cancer Immunol Immunother ; 69(1): 69-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31786620

RESUMO

Colorectal cancer (CRC) is a leading cause of cancer-related death, partly due to a lack of reliable biomarkers for early diagnosis. To improve the outcome of CRC, it is critical to provide diagnosis at an early stage using promising sensitive/specific marker(s). Using immunohistochemistry and histopathology, IL-38 expression was determined in tissue arrays of CRC with different TNM status and depth of tumour invasion. Data were compared to IL-38 in adjacent non-cancer tissue and correlated with demographic information, including survival. A substantial reduction of IL-38 was detected in the CRC tissue compared to adjacent non-cancer colonic tissue. IL-38 correlated with the extent of tumour differentiation (P < 0.0001); CRC location in the left side of the colon (P < 0.05), and smaller tumour size (≤ 5 cm; P < 0.05). Receiver operating characteristic (ROC) curve analysis demonstrated both high specificity and high sensitivity of IL-38 for the diagnosis of CRC [area under the curve (AUC) = 0.89)]. By sub-group analysis, AUC of IL-38 for the diagnosis of CRC was higher in poorly differentiated, right-sided CRC or tumour size > 5 cm (all AUC > 0.9). Significantly, longer survival was observed for the IL-38high versus the IL-38low groups in CRC patients (P = 0.04). Survival was also longer for IL-38high patients with lymph node metastasis (P = 0.01) and TNM stage III-IV (P = 0.02). Multivariate analysis demonstrated that IL-38 (P = 0.05) and tumour invasion depth (P = 0.04) were independent factors for survival. High IL38 in CRC is an independent prognostic factor for the longer survival of CRC patients. IL-38 signalling may constitute a therapeutic target in CRC.


Assuntos
Adenocarcinoma/diagnóstico , Biomarcadores Tumorais/metabolismo , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Interleucinas/metabolismo , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Feminino , Seguimentos , Humanos , Interleucinas/análise , Estimativa de Kaplan-Meier , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Prognóstico , Sensibilidade e Especificidade , Taxa de Sobrevida , Adulto Jovem
11.
J Surg Res ; 245: 475-482, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31446189

RESUMO

BACKGROUND: The clinical characteristics of stage III colon cancer and the prognostic significance of tumor deposits were investigated, to construct a prognostic nomogram. METHODS: The data of patients were retrieved from the Surveillance, Epidemiology, and End Results database. Patients were randomized to a training or validation cohort. The Kaplan-Meier method was used to analyze survival rates. In the training cohort, a prognostic nomogram was established via Cox regression and then tested in the validation cohort. The accuracy and discrimination of the nomogram were assessed using concordance indices (C-indices) and calibration curves. RESULTS: Of the 9246 patients meeting the inclusion criteria, 1788 (19.3%) had tumor deposits. Patients with tumor deposits only showed similar survival rates to those with lymph node metastases only (P = 0.83). Compared with these, patients with both tumor deposits and lymph node metastases exhibited significantly worse survival (P < 0.01). In the multivariate Cox regression analyses, the following were identified as independent prognostic indicators and adopted to formulate the nomogram: tumor deposits, age, ethnicity, T stage, the number of positive regional lymph nodes, grade, and carcinoembryonic antigen. In the training cohort, the calibration curve showed good consistency, and the concordance index of the nomogram for predicting overall survival reaches 0.727 (95% CI: 0.71524-0.73876), superior to the concordance index of the American Joint Committee on Cancer staging system (0.594, 95% CI: 0.58224-0.60576). These results are supported in the validation cohort. CONCLUSIONS: Tumor deposits may be an independent prognostic factor for patients with stage III colon cancer after colectomy. The nomogram constructed herein accurately predicted overall survival.


Assuntos
Colectomia , Neoplasias do Colo/mortalidade , Nomogramas , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Programa de SEER/estatística & dados numéricos , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
13.
Int Braz J Urol ; 45(6): 1270-1274, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808417

RESUMO

Bladder cancer is a common cancer that may present as superficial, invasive, or metastatic disease. Non-muscle-invasive bladder cancer (NMIBC) represents the majority of bladder cancer diagnoses, but represents a spectrum of disease with a variable clinical course, notably for significant risk of recurrence and potential for progression. NMIBC metastasis to distant organs without local invasion or regional metastasis is a very rare occurrence, so there are limi-ted case reports about early metastasis in the literature.


Assuntos
Carcinoma/secundário , Neoplasias de Cabeça e Pescoço/patologia , Metástase Linfática/patologia , Neoplasias da Bexiga Urinária/patologia , Idoso , Carcinoma/diagnóstico por imagem , Evolução Fatal , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Metástase Linfática/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X , Ultrassonografia , Neoplasias da Bexiga Urinária/diagnóstico por imagem
14.
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
15.
Cancer Imaging ; 19(1): 70, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31685035

RESUMO

BACKGROUND: The aim of this study is to evaluate the microstructure and microcirculation of regional lymph nodes (LNs) in rectal cancer by using non-invasive intravoxel incoherent motion MRI (IVIM-MRI), and to distinguish metastatic from non-metastatic LNs by quantitative parameters. METHODS: All recruited patients underwent IVIM-MRI (b = 0, 5, 10, 20, 30, 40, 60, 80, 100, 150, 200, 400, 600, 1000, 1500 and 2000 s/mm2) on a 3.0 T MRI system. One hundred sixty-eight regional LNs with a short-axis diameter equal to or greater than 5 mm from 116 patients were evaluated by two radiologists independently, including 78 malignant LNs and 90 benign LNs. The following parameters were assessed: the short-axis diameter (S), long-axis diameter (L), short- to long-axis diameter ratio (S/L), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion factor (f). Intraclass correlation coefficients (ICCs) were calculated to assess the interobserver agreement between two readers. Receiver operating characteristic curves were applied for analyzing statistically significant parameters. RESULTS: Interobserver agreement of IVIM-MRI parameters between two readers was excellent (ICCs> 0.75). The metastatic group exhibited higher S, L and D (P < 0.001), but lower f (P < 0.001) than the non-metastatic group. The area under the curve (95% CI, sensitivity, specificity) of the multi-parameter combined equation for D, f and S was 0.811 (0.744~0.868, 62.82%, 87.78%). The diagnostic performance of the multi-parameter model was better than that of an individual parameter (P < 0.05). CONCLUSION: IVIM-MRI parameters provided information about the microstructure and microcirculation of regional LNs in rectal cancer, also improved diagnostic performance in identifying metastatic LNs.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Linfonodos/diagnóstico por imagem , Neoplasias Retais/diagnóstico por imagem , Adulto , Idoso , Imagem de Difusão por Ressonância Magnética/normas , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Neoplasias Retais/patologia
16.
Medicine (Baltimore) ; 98(45): e17859, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702649

RESUMO

BACKGROUND: To investigate the diagnostic performance of cytology (fine-needle aspiration cytology [FNAC]), thyroglobulin (fine-needle aspiration thyroglobulin [FNA-Tg]), and combination of them in the washout of fine-needle aspiration for those patients who have suspicious metastatic lymph nodes of differentiated thyroid cancer. METHODS: Databases, including PubMed, EMbase, Web of Science and Cochrane Library were searched up to June 2019. The quality assessment of diagnostic accuracy scale-2 was used to conduct quality assessments, and publication bias was evaluated using the Deeks funnel plot. STATA version 14.0 was used to perform the meta-analysis. RESULTS: A total of 2257 patients with 2786 samples of suspicious metastatic lymph nodes of differentiated thyroid cancer were included in the meta-analysis. The results showed that the diagnostic value for detecting lymph node metastasis of differentiated thyroid cancer was as follows: combination of FNAC and FNA-Tg > FNA-Tg > FNAC. All differences of superiority among them are statistically significant. The sensitivity of the combination was 0.968 (95% confidence interval [CI]: 0.942-0.983), the specificity was 0.932 (95% CI: 0.856-0.969), the diagnostic score was 6.036 (95% CI: 4.892-7.181), the diagnostic odds ratio was 418.424 (95% CI: 133.167-1314.729), and the score of summary receiver operating characteristic was 0.99 (95% CI: 0.97-0.99). CONCLUSIONS: The combination of FNAC and FNA-Tg is an excellent procedure in diagnosis of lymph nodes metastasis of patients with differentiated thyroid cancer, which should be highly recommended.


Assuntos
Carcinoma Papilar/patologia , Metástase Linfática/patologia , Tireoglobulina/análise , Neoplasias da Glândula Tireoide/patologia , Área Sob a Curva , Biomarcadores Tumorais/análise , Biópsia por Agulha Fina , Humanos , Metástase Linfática/diagnóstico , Valor Preditivo dos Testes
17.
Medicine (Baltimore) ; 98(45): e17876, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702656

RESUMO

Radioiodine refractory (RAIR) is the major cause of thyroid cancer-related death. In order to avoid needless Radioiodine (RAI) therapy, recognizing the RAIR cases in time is important for the patients to obtain more time for the effective therapy.Evaluate the ultrasound features of cervical metastatic lymph node in patients with RAIR differentiated thyroid cancer (DTC).Seventeen adult patients with histologically confirmed locally advanced or metastatic RAIR-DTC were prospectively enrolled. The ultrasound (US) characteristics of cervical lesions in patients with the RAIR-DTC were compared with cervical lymph node metastasis from 59 non RAIR-DTC cases.Among the 17 patients, cervical lymph node metastasis was found in 15 patients (88.3%). The cervical lesions of RAIR-DTC (mean size, 2.0 cm) were larger than that in non RAIR-DTC group (mean size, 1.30 cm). More multiple lesions and more lesions with visible flow were found in the RAIR Group, while fewer hyperechogenic punctuations were found in RAIR group (P < .05). The distant metastasis rates showed that RAIR-DTC led to a poorer prognosis than those of patients in the non RAIR Group (P < .01).Ultrasound can help distinguish metastasized cervical lymph nodes of RAIR-DTC patients from non RAIR-DTC patients. For RAIR-DTC patients, a long-term US evaluation should be performed.


Assuntos
Metástase Linfática/patologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Radioisótopos do Iodo/efeitos adversos , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Câncer Papilífero da Tireoide/dietoterapia , Câncer Papilífero da Tireoide/terapia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/terapia , Ultrassonografia Doppler em Cores
18.
Zhonghua Zhong Liu Za Zhi ; 41(11): 801-804, 2019 Nov 23.
Artigo em Chinês | MEDLINE | ID: mdl-31770845

RESUMO

Internal mammary lymph node (IMLN) metastasis forms the part of the N-staging of breast cancer, and affects the treatment program and prognosis. At present, IMLN metastasis is clinically diagnosed by anatomical imaging, functional imaging and postoperative pathology. Anatomical imaging includes ultrasound, CT and MRI. Functional image includes positron emission computed tomography (PET-CT), PET-MRI, single photon emission computed tomography (SPECT) and SPECT-CT. Because of the special location of the internal mammary region and the complex anatomical structure around it, the imaging diagnosis rate and pathological diagnosis rate of IMLN are often different. Therefore, it is important to identify the relevant factors of IMLN metastasis for guiding the local treatment of internal mammary region, including the scope of surgery and radiotherapy.


Assuntos
Neoplasias da Mama/patologia , Metástase Linfática/patologia , Neoplasias da Mama/diagnóstico por imagem , Humanos , Incidência , Linfonodos/patologia , Metástase Linfática/diagnóstico por imagem , Imagem por Ressonância Magnética , Estadiamento de Neoplasias , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Fatores de Risco , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único
20.
Yonsei Med J ; 60(11): 1005-1012, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31637881

RESUMO

PURPOSE: Identification of lymph node (LN) metastasis in non-small cell lung cancer (NSCLC) is critical for disease staging and selection of therapeutic modalities. Sometimes it is not possible to obtain LN core tissue by endobronchial ultrasound-guided transbronchial needle aspirate (EBUS-TBNA), resulting in low diagnostic yield. MATERIALS AND METHODS: In this study, 138 specimens were collected from 108 patients who underwent EBUS-TBNA under the suspicion of LN metastasis of NSCLC. Diagnostic yields of anti-CD45 and anti-methionyl-tRNA synthetase (MRS), immunofluorescent (IF) staining on cytology specimens were compared with those of conventional cytology and positron emission tomography-computed tomography (PET-CT). RESULTS: MRS was strongly expressed in NSCLC cells metastasized to LNs, but weakly expressed in cells at the periphery of the LN germinal center. The majority of cells were CD20 positive, although a few cells were either CD3 or CD14 positive, indicating that CD45 staining is required for discrimination of non-malignant LN constituent cells from NSCLC cells. When the diagnostic efficacy of MRS/CD45 IF staining was evaluated using 138 LN cellular aspirates from 108 patients through EBUS-TBNA, the sensitivity was 76.7% and specificity was 90.8%, whereas those of conventional cytology test were 71.8% and 100.0%, respectively. Combining the results of conventional cytology testing and those of PET-CT showed a sensitivity and specificity of 71.6% and 100%, and the addition of MRS/CD45 dual IF data to this combination increased sensitivity and specificity to 85.1% and 97.8%, respectively. CONCLUSION: MRS/CD45 dual IF staining showed good diagnostic performance and may be a good tool complementing conventional cytology test for determining LN metastasis of NSCLC.


Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/enzimologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/enzimologia , Metástase Linfática/diagnóstico , Metionina tRNA Ligase/metabolismo , Idoso , Antígenos CD/metabolismo , Carcinoma Pulmonar de Células não Pequenas/patologia , Linhagem Celular Tumoral , Feminino , Humanos , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Curva ROC
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