Is there any non-invasive marker replace the needle liver biopsy predictive for liver fibrosis, in patients with chronic hepatitis?

BACKGROUND/AIMS: Non-invasive serum markers are being used to determine fibrosis score as an alternative to liver biopsy. The aim of the present study was to evaluate the accuracy and predictive value of the non-invasive markers in identifying the presence or absence of significant fibrosis in patients with chronic viral hepatitis. METHODOLOGY: A total of 557 patients (401 chronic hepatitis B (CHB), 156 chronic hepatitis C (CHC)) were enrolled into the study retrospectively. Liver biopsies were evaluated histopathologically according to the Knodell scoring system. Laboratory values such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), y-glutamyltranspeptidase (GGT) and platelet count (PLT) was tested on the same day of liver biopsy. Using these laboratory values, AST/ALT ratio (AAR), age-platelet index (API) and AST/ PLT ratio index (APRI), GGT/PLT ratio index (GAPI) and AST to GGT ratio (AGR) were calculated. RESULTS: Advanced liver fibrosis including stage 3-4 was observed in 197 (49%) of patients with CHB, 84 (54%) of patients with CHC. Mean age and GGT were higher and PLT was lower in patients with advanced liver fibrosis (stage 3-4) than those in patients with absence of significant fibrosis (stage 0-1) (p < 0.001). But, there was no statistically significant relationship for mean value of AST and ALT between patients with stage 0-1 and stage 3-4. The API and GAPI were found to be significantly associated with the fibrosis score and correlation co-efficient (r) were 0.35 and 0.23, respectively (p < 0.001), while the APRI, AAR and AGR values were not associated with the fibrosis score in all of the patients (p > 0.05). But, APRI has showed correlation with liver fibrosis in patients with CHC contrary to patients with CHB. CONCLUSION: Age, GGT, PLT, API and GAPI are significantly associated with the extent of fibrosis. But these non-invasive markers can not replace liver biopsy.

Integrated PET/CT for the evaluation of para-aortic nodal metastasis in locally advanced cervical cancer patients with negative conventional CT findings.

OBJECTIVE: The aim of this study was to evaluate the usefulness of integrated 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (PET/CT) for the detection of para-aortic nodal status and to test whether PET/CT change management strategy in locally advanced cervical cancer (LACC) patients with negative conventional CT findings. MATERIALS AND METHODS: Sixteen locally advanced (FIGO stage IIB-IVA) cervical squamous cancer patients with negative conventional CT findings were eligible to enter this prospective study. All patients underwent firstly PET/CT scans then extraperitoneal surgical exploration for para-aortic lymphadenectomy. Based on histopathologic confirmation, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the PET/CT for para-aortic lymph node metastasis were estimated. RESULTS: The median age was 48.7 (range 42-67). The accuracy, sensitivity, specificity, PPV and NPV of the PET/CT were 75%, 50%, 83.3%, 50% and 83.3%, respectively. The treatment was modified in four of sixteen (25%) patients; four patients received EFRT in combination with cisplatin chemotherapy instead of standard pelvic field radiotherapy in combination with cisplatin chemotherapy. CONCLUSION: Our results, despite our study group is small, suggest that PET/CT is an effective imaging technique in the evaluation of LACC with negative CT findings. It may help planning the management especially selecting radiation field. However, larger controlled studies are needed to recommend PET/CT as an alternative to pre-treatment surgical staging.

Changes of Ki-67 index in squamous cell carcinoma of the cervix during the early course of radiotherapy and prediction of prognosis.

PURPOSE: To determine whether changes in the Ki-67 index during the early course of radiotherapy could predict the prognosis in squamous cell carcinoma of the uterine cervix and be of value in clinical practice. MATERIALS AND METHODS: Biopsy specimens from 23 cases of histologically confirmed squamous cell carcinoma of the cervix were stained with anti-Ki-67 monoclonal antibody prior to radiotherapy and after 9 Gy. The correlation between the Ki-67 index, local control and distant metastasis was determined by Spearman's correlation test. RESULTS: Median age of the patients was 49. According to the FIGO staging system four patients had Stage IIA, 16 had Stage IIB, one had Stage IIIA and two had Stage IIIB disease. Among the whole group brachytherapy was applied to 17 patients (17/23) and weekly cisplatin (40 mg/m2) was applied to 15 patients (15/23). The mean Ki-67 index prior to radiotherapy and after 9 Gy for the entire group were 58.5% and 46.0%, respectively. The Ki-67 index after 9 Gy decreased in most of the patients (74%). During a median follow-up of 23 months four patients developed local recurrence and four patients developed distant metastasis. No significant correlation was detected among the local control and changes in Ki-67 index after 9 Gy, whereas there was a moderate correlation between distant metastasis and changes in Ki-67 index after 9 Gy (r = 0.51, p = 0.01). CONCLUSION: The Ki-67 index can be used safely as a proliferation marker in cervical carcinomas, and changes in the Ki-67 index during the early course of radiotherapy may predict the metastatic potential. However prospective studies including a large number of patients with long-term follow-up are necessary to confirm the clinical utility of this marker in cervical cancer.

A case report: Leukaemic infiltration and hyperplasia of the prostate.

Leukaemic infiltration of prostate with hyperplasia is a rare manifestation and is usually found in known cases of leukaemia, but it may be the first sign of an undiagnosed leukaemia. In this report, a rare case of leukaemic infiltration of the prostate in a 64-year-old man is represented.

Tumor volume estimation by the percentage carcinoma method in uterine cervix carcinoma.

OBJECTIVE: To assess the capacity of the percentage carcinoma method to predict tumor volume in cervical carcinoma and generate a mathematical equation for calculation of tumor volume. STUDY DESIGN: Thirteen radical hysterectomy specimens were studied. The actual tumor volume was assessed by stereology. A factor was generated by the formula tumor volume = factor x percentage carcinoma x number of blocks. The percentage carcinoma was calculated by the grid method. Then tumor volume was estimated by the same formula. The relationship between actual and estimated tumor volumes was analyzed by Spearman's correlation. RESULTS: Correlation of the tumor volumes assessed by the two methods was excellent (r = .945) and statistically significant (P = .01). CONCLUSION: Percentage carcinoma assessed by the grid ratio method is highly predictive of tumor volume, but care must be taken not to overstate the importance of our results due to the small number of patients. The prediction of outcome in cervical carcinoma by means of percentage carcinoma should be evaluated in large clinical studies.

Increased vascular surface density in ovarian endometriosis.

Our goal in this study was to investigate the presence of angiogenesis-related factors in endometriomas by evaluating their vascular surface densities. Thirty ovarian samples were included in the study. Of these, ten were histologically confirmed endometriomas, ten were ovarian specimens in the follicular phase and ten were ovarian specimens in the luteal phase, serving as controls. Histological specimens were immunostained for von Willebrand factor (vWF: factor VIII-related antigen) and CD34. The area with the highest microvessel density in endometriosis and in the normal ovary was evaluated by using an intercept grid. All microvessels in a specific field (x 100 magnification) were counted and vascular surface density was measured, as 164.01 +/- 21.26 vs. 125.15 +/- 11.28 and 117.44 +/- 9.27 by using vWF, and as 172.97 +/- 25.64 vs. 138.65 +/- 32.21 and 120.34 +/- 18.40 by using CD34 in endometriotic, follicular and luteal ovarian samples, respectively (p < 0.001). The mean vascular surface density was significantly higher in endometriosis than in the ovarian samples of the follicular phase or the luteal phase. No significant difference was seen between normal ovarian samples. Endometriosis was associated with angiogenic properties. Having demonstrated elevated angiogenic factors in endometriotic samples, we concluded that activation of angiogenesis might be a key factor in the pathogenesis of endometriosis.