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Accuracy of computed tomography in nodal staging of colon cancer patients

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World Journal of Gastrointestinal Surgery 2015年第7期7卷 116-122页

作者： Audrey H Choi Rebecca A Nelson Hans F Schoellhammer Won Cho Michelle Ko Amanda Arrington Christopher R Oxner Marwan Fakih Jimmie Wong Stephen M Sentovich Julio Garcia-Aguilar Joseph Kim Department of Surgery City of Hope National Medical Center Department of Biostatistics City of Hope National Medical Center Department of Medical Oncology City of Hope National Medical Center Department of Radiology City of Hope National Medical Center

AIM: To predict node-positive disease in colon cancer using computed tomography(CT).METHODS: American Joint Committee on Cancer stage Ⅰ-Ⅲ colon cancer patients who underwent curavtiveintent colectomy between 2007-2010 were identified at a single comprehensive cancer center. All patients had preoperative CT scans with original radiology reports from referring institutions. CT images underwent blinded secondary review by a surgeon and a dedicated abdominal radiologist at our institution to identify pericolonic lymph nodes(LNs). Comparison of outside CT reports to our independent imaging review was performed in order to highlight differences in detection in actual clinical practice. CT reviews were compared with final pathology. Results of the outside radiologist review, secondary radiologist review, and surgeon review were compared with the final pathologic exam to determine sensitivity, specificity, positive and negative predictive values, false positive and negative rates, and accuracy of each review. Exclusion criteria included evidenceof metastatic disease on CT, rectal or appendiceal involvement, or absence of accompanying imaging from referring ***: From 2007 to 2010, 64 stageⅠ-Ⅲ colon cancer patients met the eligibility criteria of our study. The mean age of the cohort was 68 years, and 26(41%) patients were male and 38(59%) patients were female. On final pathology, 26 of 64(40.6%) patients had nodepositive(LN+) disease and 38 of 64(59.4%) patients had node-negative(LN-) disease. Outside radiologic review demonstrated sensitivity of 54%(14 of 26 patients) and specificity of 66%(25 of 38 patients) in predicting LN+ disease, whereas secondary radiologist review demonstrated 88%(23 of 26) sensitivity and 58%(22 of 38) specificity. On surgeon review, sensitivity was 69%(18 of 26) with 66% specificity(25 of 38). Secondary radiology review demonstrated the highest accuracy(70%) and the lowest false negative rate(12%), compared to the surgeon review a

关键词： Colon cancer Lymph nodes Clinical staging Computed tomography Neoadjuvant therapy

Current methods of staging and restaging of the mediastinal nodes in non-small-cell lung cancer

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World Journal of Respirology 2015年第2期5卷 166-175页

作者： Marcin Zielinski Department of Thoracic Surgery Pulmonary Hospital

To analyze the current methods of primary staging and repeated staging(restaging) of the mediastinal nodes in non-small-cell lung cancer(NSCLC), all methods currently used for staging of NSCLC are analyzed. These methods include imaging techniques [computer tomography(CT), positron emission tomography(PET) combined with CT(PET/CT)], endoscopic/ultrasound techniques(endobronchial ultrasound/transbronchial needle aspiration) and endoscopic ultrasound/fine needle aspiration and surgical techniques [standard cervical mediastinoscopy, video-assisted mediastinoscopy, extended mediastinoscopy, videoassisted mediastinoscopic lymphadenectomy, transcervical extended mediastinal lymphadenectomy, anterior mediastinotomy(Chamberlain procedure) and videoassisted thoracic surgery]. The diagnostic yield of Chest CT is regarded insufficient for both, primary staging and restaging. The PET/CT became a standard imaging technique preceding curative surgery of radical chemoradiotherapy. The issue of intraoperative staging is also described. Finally, the author's proposed algorithm of staging, both for primary staging and restaging after neoadjuvant therapy is presented. Detailed staging of NSCLC enables selection of patients with early stage disease for curative surgical/multimodality treatment and helps to avoid unnecessary surgery in advanced disease.

关键词： Lung cancer staging Endoscopy Surgery Mediastinum

Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy

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World Journal of Gastrointestinal Surgery 2010年第9期2卷 283-290页

作者： Sebastien Gaujoux Peter J Allen Hepatobiliary Service Memorial Sloan-Kettering Cancer Center1275 York AvenueC-887New YorkNY 10021United States

Even after extensive preoperative assessment,staging laparoscopy may allow avoidance of non-therapeutic laparotomy in patients with radiographically occult metastatic or locally unresectable *** laparoscopy is associated with decreased postoperative pain,a shorter hospital stay and a higher likelihood of receiving systemic therapy compared to laparotomy but its yield has decreased with improvements in imaging *** uses of staging laparoscopy include the following:(1) In the staging of pancreatic adenocarcinoma,laparoscopic staging allows for the identif ication of sub-radiographic metastatic disease in locally advanced cancer in approximately 30% of patients and,in radiographically resectable cancer,may identify metastatic disease in 10%-15% of cases;(2) In colorectal liver metastases,selective use of laparoscopic staging in patients with a clinical risk score of over 2 identifies unresectable disease in approximately 20% of patients;(3) In hepatocellular carcinoma,laparoscopic staging could be selectively used in high-risk patients such as those with clinically apparent liver cirrhosis and in patients with major vascular invasion or bilobar tumors;and(4) In biliary tract malignancy,staging laparoscopy may be used in all patients with potentially resectable primary gallbladder cancer and in selected patients with T2/T3 hilar *** of the decreasing yield of SL secondary to improvements in imaging techniques,staging laparoscopy should be used selectively for patients with pancreatic and hepatobiliary malignancy to avoid unnecessary non-therapeutic laparotomy and to improve resource *** individual surgeon should apply his or her threshold as to whether staging laparoscopy is indicated according to the quality of preoperative imaging studies and the availability of resources at their own institution.

关键词： Pancreatic cancer Liver metastasis staging laparoscopy Cholangiocarcinoma Gallbladder cancer Hepatocellular carcinoma

Response to pretransplant downstaging therapy predicts patient outcome after liver transplantation for hepatocellular carcinoma with portal vein tumor thrombus

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Hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 295-298页

作者： Zhe Yang Jing-Qi Sun Shuo Wang Li Zhuang Shu-Sen Zheng Department of Hepatobiliary and Pancreatic Surgery Department of Liver TransplantationShulan(Hangzhou)HospitalZhejiang Shuren University School of MedicineHangzhou 310022China Division of Hepatobiliary Pancreatic Surgery First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China

To the Editor:Downstaging therapy has been confirmed to help patients whose tumors are beyond the liver transplantation (LT) criteria to gain the opportunity for LT with long-term *** et al.[1] recently demonstrated that patients with hepatocellular carcinoma (HCC) beyond the Hangzhou criteria on initial diagnosis without extra hepatic metastasis or vascular invasion have comparative outcomes with those matching Milan criteria after LT if these patients are successfully downstaged to the Hangzhou criteria[1].However,whether the downstaging therapy prolongs the survival time of those with portal vein tumor thrombosis (PVTT) is not *** study was to add some data in this field.

关键词： staging hepatocellular invasion

Factors associated with upstaging in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy

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Cancer Biology & Medicine 2019年第2期16卷 312-318页

作者： Jing Si Benlong Yang Rong Guo Naisi Huang Chenlian Quan Linxiaoxi Ma Bingqiu Xiu Yun Cao Yue Tang Linxiao Shen Jiajian Chen Jiong Wu Department of Breast Surgery Fudan University Shanghai Cancer Center Shanghai 200032 China Department of Oncology Fudan University Shanghai Medical College Shanghai 200032 China Collaborative Innovation Center for Cancer Medicine Shanghai 200032 China

Objective: Patients preoperatively diagnosed with ductal carcinoma in situ(DCIS) by core needle biopsy(CNB) exhibit a significant risk for upstaging on final pathology, which leads to major concerns of whether axillary staging is required at the primary operation. The present study aimed to identify clinicopathological factors associated with upstaging in patients preoperatively diagnosed with DCIS by ***: The present study enrolled 604 patients(cN0 M0) with a preoperative diagnosis of pure DCIS by CNB, who underwent axillary staging between August 2006 and December 2015, at Fudan University Shanghai Cancer Center(Shanghai, China).Predictive factors of upstaging were analyzed ***: Of the 604 patients, 20.03%(n = 121) and 31.95%(n = 193) were upstaged to DCIS with microinvasion(DCISM) and invasive breast cancer(IBC) on final pathology, respectively. Larger tumor size on ultrasonography(> 2 cm) was independently associated with upstaging [odds ratio(OR) 1.558, P = 0.014]. Additionally, patients in lower breast imaging reporting and data system(BI-RADS) categories were less likely to be upstaged(4 B vs. 5: OR 0.435, P = 0.002;4 C vs. 5: OR 0.502, P = 0.001). Overall,axillary metastasis occurred in 6.79%(n = 41) of patients. Among patients with axillary metastasis, 1.38%(4/290), 3.31%(4/121)and 17.10%(33/193) were in the DCIS, DCISM, and IBC groups, ***: For patients initially diagnosed with DCIS by CNB, larger tumor size on ultrasonography(> 2 cm) and higher BIRADS category were independent predictive factors of upstaging on final pathology. Thus, axillary staging in patients with smaller tumor sizes and lower BI-RADS category may be omitted, with little downstream risk for upstaging.

关键词： Ductal carcinoma in situ core needle biopsy axillary staging

Regional location of lymph node metastases predicts survival in patients with de novo metastatic prostate cancer

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Asian Journal of Andrology 2023年第4期25卷 462-467页

作者： Zhi-Peng Wang Jun-Ru Chen Jin-Ge Zhao Sha Zhu Xing-Ming Zhang Jia-Yu Liang Ben He Yu-Chao Ni Guang-Xi Sun Peng-Fei Shen Hao Zeng Department of Urology Institute of UrologyWest China HospitalSichuan UniversityChengdu 610041China Department of Urology The Third People’s Hospital of ChengduChengdu 610031China

To report the regional locations of metastases and to estimate the prognostic value of the pattern of regional metastases inmen with metastatic hormone-sensitive prostate cancer (mHSPC), we retrospectively analyzed 870 mHSPC patients betweenNovember 28, 2009, and February 4, 2021, from West China Hospital in Chengdu, China. The patients were initially classifiedinto 5 subgroups according to metastatic patterns as follows: simple bone metastases (G1), concomitant bone and regional lymphnode (LN) metastases (G2), concomitant bone and nonregional LN (NRLN) metastases (G3), lung metastases (G4), and livermetastases (G5). In addition, patients in the G3 group were subclassified as G3a and G3b based on the LN metastatic plane(below or above the diaphragm, respectively). The associations of different metastatic patterns with castration-resistant prostatecancer-free survival (CFS) and overall survival (OS) were analyzed by univariate and multivariate analyses. The results showedthat patients in G1 and G2 had relatively favorable clinical outcomes, patients in G3a and G4 had intermediate prognoses, andpatients in G3b and G5 had the worst survival outcomes. We observed that patients in G3b had outcomes comparable to those inG5 but had a significantly worse prognosis than patients in G3a (median CFS: 8.2 months vs 14.3 months, P = 0.015;medianOS: 38.1 months vs 45.8 months, P = 0.038). In conclusion, metastatic site can predict the prognosis of patients with mHSPC,and the presence of concomitant bone and NRLN metastases is a valuable prognostic factor. Furthermore, our findings indicatethat the farther the NRLNs are located, the more aggressive the disease is.

关键词： lymph node metastases metastatic hormone-sensitive prostate cancer metastatic pattern metastatic site nonregional lymph node metastases staging

Lag time,high-risk histopathological features,metastasis,and survival interrelation in retinoblastoma:a perspective from lower-middle income country

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International Journal of Ophthalmology(English edition) 2022年第12期15卷 1994-2000页

作者： Purjanto Tepo Utomo Datu Respatika Bambang Ardianto Hanggoro Tri Rinonce Didik Setyo Heriyanto Banu Aji Dibyasakti Irene Titin Darajati Indra Tri Mahayana Agus Supartoto Department of Ophthalmology Faculty of Medicine Public Health and NursingUniversitas Gadjah Mada-Prof.Dr.Sardjito General HospitalYogyakarta 55281Indonesia Department of Child Health Faculty of Medicine Public Health and NursingUniversitas Gadjah Mada-Prof.Dr.Sardjito General HospitalYogyakarta 55281Indonesia Department of Anatomical Pathology Faculty of Medicine Public Health and NursingUniversitas Gadjah Mada-Prof.Dr.Sardjito General HospitalYogyakarta 55281Indonesia

AIM:To investigate the impact of lag time to metastasis and survival rates among patients with ***:This retrospective study was conducted with 52 patients from the Department of Ophthalmology and the Department of Pediatrics of *** General Hospital,between 1^(st) January 2014 and 31^(st) December *** time was defined as the time delay between the first sign of retinoblastoma to the diagnosis of *** subjects with lag time>one year were included in the case group,while the subjects with lag timestaging of retinoblastoma(P=0.005 and P=0.006,respectively).The lag time was also significantly correlated with both metastasis event[odds ratio(OR):5.06,95%Cl:1.56-16.44,P=0.006]and mortality(OR:4.54,95%Cl:1.37-15.07,P=0.011).The follow-up was continued for 32 subjects for 3y after initial *** analysis revealed a significant difference among these two groups(P=0.021).Furthermore,lag time was significantly correlated with survival of retinoblastoma(r=-0.53,P=0.046).CONCLUSION:The study highlights the importance of lag time between the onset of first symptoms and the time of retinoblastoma diagnosis which significantly contribute to metastasis and mortality of patients with *** for the early detection of retinoblastoma should be performed for individuals at-risk to minimize lag time and improve the outcomes.

关键词： retinoblastoma lag time metastasis survival staging laterality

Endoscopic techniques for diagnosis and treatment of gastroentero-pancreatic neuroendocrine neoplasms:Where we are

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World Journal of Gastroenterology 2022年第26期28卷 3258-3273页

作者： Roberta Elisa Rossi Alessandra Elvevi Camilla Gallo Andrea Palermo Pietro Invernizzi Sara Massironi HPB Surgery Hepatology and Liver TransplantationENETS Center of ExcellenceFondazione IRCCS Istituto Nazionale Tumori(INTNational Cancer Institute)Milan 20133Italy Division of Gastroenterology and Center for Autoimmune Liver Diseases Department of Medicine and SurgeryUniversity of Milano-BicoccaMonza 20900Italy

BACKGROUND The correct localization of the primary tumor site and a complete histological diagnosis represent the milestones for the proper management of gastro-enteropancreatic neuroendocrine neoplasms(GEP-NENs).AIM To analyze current evidence on the role of endoscopy in the diagnosis/treatment of *** An extensive bibliographical search was performed in PubMed to identify guidelines and primary literature(retrospective and prospective studies,systematic reviews,case series)published in the last 15 years,using both medical subject heading(MeSH)terms and free-language keywords:gastro-enteropancreatic neuroendocrine neoplasms;endoscopy;ultrasound endoscopy;capsule endoscopy;double-balloon enteroscopy;diagnosis;therapy;*** In the diagnostic setting,endoscopic ultrasonography(EUS)represents the diagnostic gold standard for pancreatic NENs and the technique of choice for the locoregional staging of gastric,duodenal and rectal *** diagnosis of small bowel NENs(sbNENs)has been improved with the advent of video capsule endoscopy and double-balloon enteroscopy,which allow for direct visualization of the entire small bowel;however,data regarding the efficacy/safety of these techniques in the detection of sbNENs are scanty and often *** a therapeutic point of view,endoscopic removal is the treatment of choice for the majority of gastric NENs(type 1/2),for well-differentiated localized nonmetastatic duodenal NENs<1 cm,confined to the submucosa layer and for<10 mm,stage T1–T2,rectal ***-guided pancreatic locoregional ablative treatments have been proposed in recent studies with promising results in order to control symptoms or reduce tumor burden in selected *** Standard axial endoscopy and EUS still play a pivotal role in several *** techniques for increasing the rate of R0 resection should be reserved for high-volume referral centers.

关键词： Gastro-entero-pancreatic neuroendocrine neoplasms Endoscopy Ultrasound endoscopy Capsule endoscopy Double-balloon enteroscopy Diagnosis Therapy staging

Genitourinary melanoma:An overview for the clinician

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Asian Journal of Urology 2022年第4期9卷 407-422页

作者： Danielle K.DePalo Kelly M.Elleson Michael J.Carr Philippe E.Spiess Jonathan S.Zager Department of Cutaneous Oncology Moffitt Cancer CenterTampaFLUSA Department of Surgery University of LouisvilleLouisvilleKYUSA Department of Genitourinary Oncology Moffitt Cancer CenterTampaFLUSA

Genitourinary (GU) melanoma is a rare presentation of melanoma accounting for approximately 0.5% of all *** melanomas include primary melanomas of the vulva,vagina,uterine cervix,ovary,penis,scrotum,urethra,bladder,ureter,and *** melanomas are often diagnosed in advanced stages and stigma is thought to contribute to delays in *** the likely diagnosing provider,it is imperative that dermatologists,urologists,and gynecologists are aware of these uncommon sites of *** there have been major advances in the treatment of melanomas as a whole in the last 10 years,their applications to GU melanomas have often been *** melanomas have not been included in many of the major phase II clinical trials which brought contemporary advanced treatments to market and the prognoses for GU melanomas remain *** to the rarity of GU melanomas,much of the literature provides gener alized recommendations across multiple different organs affected by GU melanomas or omits certain topics,making it difficult to appreciate the funda-mentals of the individual *** review aimed to provide background information on the pathogenesis and epidemiology of the different sites of GU melanomas and categorize data specific to the presentation,staging,treatment,and prognosis of each type of GU melanoma to guide the *** was also meant to encourage a multidisciplinary approach to the management of these patients as it spans the expertise of surgical oncologists,medical oncologists,radiation oncologist,dermatologists,urologists,and gynecologists.

关键词： Genitalia Female Male Melanoma Rare diseases staging Treatment Urinary tract