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Olsen EA, Whittaker S, Willemze R, Pinter-Brown L, Foss F, Geskin L, Schwartz L, Horwitz S, Guitart J, Zic J, Kim YH, Wood GS, Duvic M, Ai W, Girardi M, Gru A, Guenova E, Hodak E, Hoppe R, Kempf W, Kim E, Lechowicz MJ, Ortiz-Romero P, Papadavid E, Quaglino P, Pittelkow M, Prince HM, Sanches JA, Sugaya M, Vermeer M, Zain J, Knobler R, Stadler R, Bagot M, Scarisbrick J. Primary cutaneous lymphoma: recommendations for clinical trial design and staging update from the ISCL, USCLC, and EORTC. Blood 2022; 140:419-437. [PMID: 34758074 PMCID: PMC9353153 DOI: 10.1182/blood.2021012057] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
The number of patients with primary cutaneous lymphoma (PCL) relative to other non-Hodgkin lymphomas (NHLs) is small and the number of subtypes large. Although clinical trial guidelines have been published for mycosis fungoides/Sézary syndrome, the most common type of PCL, none exist for the other PCLs. In addition, staging of the PCLs has been evolving based on new data on potential prognostic factors, diagnosis, and assessment methods of both skin and extracutaneous disease and a desire to align the latter with the Lugano guidelines for all NHLs. The International Society for Cutaneous Lymphomas (ISCL), the United States Cutaneous LymphomaConsortium (USCLC), and the Cutaneous Lymphoma Task Force of the European Organization for the Research and Treatment of Cancer (EORTC) now propose updated staging and guidelines for the study design, assessment, endpoints, and response criteria in clinical trials for all the PCLs in alignment with that of the Lugano guidelines. These recommendations provide standardized methodology that should facilitate planning and regulatory approval of new treatments for these lymphomas worldwide, encourage cooperative investigator-initiated trials, and help to assess the comparative efficacy of therapeutic agents tested across sites and studies.
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Affiliation(s)
- Elise A Olsen
- Department of Dermatology and Department of Medicine, Division of Hematologic Malignancies, Duke University Medical Center, Durham, NC
| | - Sean Whittaker
- School of Basic and Medical Biosciences, Kings College London and St. Johns Institute of Dermatology, London, United Kingdom
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lauren Pinter-Brown
- Departments of Medicine and Dermatology, Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA
| | - Francine Foss
- Hematology and Stem Cell Transplantation, Yale University School of Medicine, New Haven, CT
| | - Larisa Geskin
- Department of Dermatology, Columbia University Medical Center, New York, NY
| | - Lawrence Schwartz
- Department of Radiology, Columbia University Medical Center, New York, NY
| | - Steven Horwitz
- Department of Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Joan Guitart
- Departments of Dermatology and Pathology, Northwestern University, Chicago, IL
| | - John Zic
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN
| | - Youn H Kim
- Department of Dermatology, Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA
| | - Gary S Wood
- Department of Dermatology, University of Wisconsin-Madison, Madison, WI
| | - Madeleine Duvic
- University of Texas MD Anderson Cancer Center, Dermatology Unit, Houston, TX
| | - Wei Ai
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, CT
| | - Alejandro Gru
- Divisions of Dermatopathology and Hematopathology, Department of Pathology, Emily Couric Clinical Cancer Center, University of Virginia, Charlottesville, VA
| | - Emmanuella Guenova
- Department of Dermatology, Lausanne University Hospital, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Emmilia Hodak
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Richard Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Werner Kempf
- Department of Dermatology, University Hospital Zurich and Kempf and Pfaltz Histologische Diagnostik, Zurich, Switzerland
| | - Ellen Kim
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mary Jo Lechowicz
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA
| | - Pablo Ortiz-Romero
- Department of Dermatology, Hospital Universitario 12 de Octubre, i+12 Institute, CIBERONC, Medical School, Universidad Complutense, Madrid, Spain
| | - Evangelia Papadavid
- Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Turin, Italy
| | - Mark Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ
| | - H Miles Prince
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Jose Antonio Sanches
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Makoto Sugaya
- Department of Dermatology, International University of Health and Welfare, Chiba, Japan
| | - Maarten Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jasmine Zain
- Department of Hematology and Hematopoetic Stem Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Robert Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Stadler
- University Clinic for Dermatology, Johannes Wesling Medical Centre, University of Bochum, Minden, Germany
| | - Martine Bagot
- Department of Dermatology, Université de Paris, AP-HP, Hôpital Saint-Louis, Paris, France; and
| | - Julia Scarisbrick
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Hodak E. Is lymph node core-needle biopsy an alternative to excisional biopsy for the accurate staging of mycosis fungoides/Sézary syndrome and predicting the survival of patients? Br J Dermatol 2021; 185:251-252. [PMID: 34114213 DOI: 10.1111/bjd.20496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- E Hodak
- Division of Dermatology, Rabin Medical Center, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Israel
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Hodak E, Sherman S, Papadavid E, Bagot M, Querfeld C, Quaglino P, Prince HM, Ortiz-Romero PL, Stadler R, Knobler R, Guenova E, Estrach T, Patsatsi A, Leshem YA, Prague-Naveh H, Berti E, Alberti-Violetti S, Cowan R, Jonak C, Nikolaou V, Mitteldorf C, Akilov O, Geskin L, Matin R, Beylot-Barry M, Vakeva L, Sanches JA, Servitje O, Weatherhead S, Wobser M, Yoo J, Bayne M, Bates A, Dunnill G, Marschalko M, Buschots AM, Wehkamp U, Evison F, Hong E, Amitay-Laish I, Stranzenbach R, Vermeer M, Willemze R, Kempf W, Cerroni L, Whittaker S, Kim YH, Scarisbrick JJ. Should we be imaging lymph nodes at initial diagnosis of early-stage mycosis fungoides? Results from the PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) international study. Br J Dermatol 2021; 184:524-531. [PMID: 32574377 DOI: 10.1111/bjd.19303] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early-stage mycosis fungoides (MF) includes involvement of dermatopathic lymph nodes (LNs) or early lymphomatous LNs. There is a lack of unanimity among current guidelines regarding the indications for initial staging imaging in early-stage presentation of MF in the absence of enlarged palpable LNs. OBJECTIVES To investigate how often imaging is performed in patients with early-stage presentation of MF, to assess the yield of LN imaging, and to determine what disease characteristics promoted imaging. METHODS A review of clinicopathologically confirmed newly diagnosed patients with cutaneous patch/plaque (T1/T2) MF from PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) data. RESULTS PROCLIPI enrolled 375 patients with stage T1/T2 MF: 304 with classical MF and 71 with folliculotropic MF. Imaging was performed in 169 patients (45%): 83 with computed tomography, 18 with positron emission tomography-computed tomography and 68 with ultrasound. Only nine of these (5%) had palpable enlarged (≥ 15 mm) LNs, with an over-representation of plaques, irrespectively of the 10% body surface area cutoff that distinguishes T1 from T2. Folliculotropic MF was not more frequently imaged than classical MF. Radiologically enlarged LNs (≥ 15 mm) were detected in 30 patients (18%); only seven had clinical lymphadenopathy. On multivariate analysis, plaque presentation was the sole parameter significantly associated with radiologically enlarged LNs. Imaging of only clinically enlarged LNs upstaged 4% of patients (seven of 169) to at least IIA, whereas nonselective imaging upstaged another 14% (24 of 169). LN biopsy, performed in eight of 30 patients, identified N3 (extensive lymphomatous involvement) in two and N1 (dermatopathic changes) in six. CONCLUSIONS Physical examination was a poor determinant of LN enlargement or involvement. Presence of plaques was associated with a significant increase in identification of enlarged or involved LNs in patients with early-stage presentation of MF, which may be important when deciding who to image. Imaging increases the detection rate of stage IIA MF, and identifies rare cases of extensive lymphomatous nodes, upstaging them to advanced-stage IVA2.
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Affiliation(s)
- E Hodak
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Sherman
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Papadavid
- Athens University Medical School, Athens, Greece
| | - M Bagot
- Hospital St Louis, Paris, France
| | - C Querfeld
- City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
| | - P Quaglino
- Dermatologic Clinic, University of Turin Medical School, Turin, Italy
| | - H M Prince
- Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - P L Ortiz-Romero
- Department of Dermatology, Hospital 12 de Octubre, Medical School, University Complutense, Madrid, Spain
| | - R Stadler
- Johannes Wesling University Medical Centre, Minden, Germany
| | - R Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - E Guenova
- University Hospital Zurich, Zurich, Switzerland
| | - T Estrach
- Hospital Clinico, University of Barcelona, Barcelona, Spain
| | - A Patsatsi
- Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Y A Leshem
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Prague-Naveh
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Berti
- University of Milan, Milan, Italy
| | | | - R Cowan
- Christie Hospital, Manchester, UK
| | - C Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - V Nikolaou
- Athens University Medical School, Athens, Greece
| | - C Mitteldorf
- HELIOS Klinikum Hildesheim GmbH, University Medical Centre Göttingen, Göttingen, Germany
| | - O Akilov
- University of Pittsburgh School of Medicine, Pennsylvania, PA, USA
| | - L Geskin
- University of Columbia, New York, NY, USA
| | - R Matin
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - L Vakeva
- Helsinki University Central Hospital, Helsinki, Finland
| | - J A Sanches
- University of São Paulo Medical School, São Paulo, SP, Brazil
| | - O Servitje
- Hospital Universatari de Bellvitge, Barcelona, Spain
| | | | - M Wobser
- University Hospital Wuerzburg, Wuerzburg, Germany
| | - J Yoo
- University Hospital Birmingham, Birmingham, UK
| | | | - A Bates
- University Hospital Southampton, Southampton, UK
| | - G Dunnill
- University Hospital Bristol, Bristol, UK
| | | | | | - U Wehkamp
- University Hospital Kiel, Kiel, Germany
| | - F Evison
- University Hospital Birmingham, Birmingham, UK
| | - E Hong
- Stanford University Medical Center, Stanford, CA, USA
| | - I Amitay-Laish
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Stranzenbach
- Johannes Wesling University Medical Centre, Minden, Germany
| | - M Vermeer
- Leiden University Medical Centre, Leiden, the Netherlands
| | - R Willemze
- Leiden University Medical Centre, Leiden, the Netherlands
| | - W Kempf
- Kempf and PFlatz, Histologische Diagnostik, Zurich, Switzerland
| | - L Cerroni
- Department of Dermatology, Research Unit Dermatopathology, Medical University of Graz, Graz, Austria
| | | | - Y H Kim
- Stanford University Medical Center, Stanford, CA, USA
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Calvani J, de Masson A, de Margerie-Mellon C, de Kerviler É, Ram-Wolff C, Gruber A, Meignin V, Brice P, Sadoux A, Mourah S, Bagot M, Battistella M. Image-guided lymph node core-needle biopsy predicts survival in mycosis fungoides and Sézary syndrome. Br J Dermatol 2021; 185:419-427. [PMID: 33400272 DOI: 10.1111/bjd.19796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/07/2020] [Accepted: 12/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prognosis of Sézary syndrome (SS) and mycosis fungoides (MF) depends on lymph node (LN) involvement. The usefulness of LN image-guided core-needle biopsies (CNBs), instead of surgical sampling, has been poorly evaluated. OBJECTIVES To determine the prognostic value of LN CNB in MF/SS. METHODS A retrospective search was conducted to identify all LN biopsy specimens of MF/SS between 2008 and 2019. Biopsies were staged according to the International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer (ISCL/EORTC) criteria. We performed immunolabelling and determined the tumour clone frequency (TCF) by high-throughput sequencing of the T-cell receptor beta locus. RESULTS We included 119 consecutive biopsies from 100 patients, 45 with MF and 55 with SS. N1, N2 and N3 stages were diagnosed in 34 (29%), 26 (22%) and 59 (49%) cases, respectively. The TCF, Ki67 index, and percentage of cells positive for thymocyte selection-associated high mobility group box protein (TOX), programmed cell death protein 1 (PD1), killer cell immunoglobulin-like receptor 3DL2 (KIR3DL2) and cluster of differentiation (CD)30 were all positively correlated with the N stage. Median overall survival (OS) for N1/N2 vs. N3 patients was 42 months (range 26-not reached) vs. 14 months (range 5-30), respectively (P < 0·001). In univariate analyses, an age > 75 years, LN short-axis diameter > 15 mm, N3 stage, presence of large-cell transformation, TOX > 60%, PD1 > 25%, Ki67 > 30%, KIR3DL2 > 15%, CD30 > 10% and TCF > 25% were identified as adverse prognostic factors. In multivariate analyses, only an age > 75 years and Ki67 index > 30% were associated with reduced OS. We developed a new prognostic index associating the N stage and the Ki67 index, which better discriminates N3 patients with poor prognosis. CONCLUSIONS CNB allows an objective assessment of the LN involvement in MF/SS, relevant for staging and prognosis.
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Affiliation(s)
- J Calvani
- Department of, Pathology, Hôpital Saint-Louis APHP, Paris, France
| | - A de Masson
- Department of, Dermatology, Hôpital Saint-Louis APHP, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
| | | | - É de Kerviler
- Department of, Radiology, Hôpital Saint-Louis APHP, Paris, France
| | - C Ram-Wolff
- Department of, Dermatology, Hôpital Saint-Louis APHP, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
| | - A Gruber
- Department of, Solid Tumor Genomics, Hôpital Saint-Louis APHP, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
| | - V Meignin
- Department of, Pathology, Hôpital Saint-Louis APHP, Paris, France
| | - P Brice
- Department of, Hematology, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis APHP, Paris, France
| | - A Sadoux
- Department of, Solid Tumor Genomics, Hôpital Saint-Louis APHP, Paris, France
| | - S Mourah
- Department of, Solid Tumor Genomics, Hôpital Saint-Louis APHP, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
| | - M Bagot
- Department of, Dermatology, Hôpital Saint-Louis APHP, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
| | - M Battistella
- Department of, Pathology, Hôpital Saint-Louis APHP, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
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Vidal D, Alfageme F. Ultrasound-Guided Fine-Needle Aspiration Cytology and Core-Needle Biopsy in Dermatology: A Step Forward. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Vidal D, Alfageme F. Ultrasound-Guided Fine-Needle Aspiration Cytology and Core-Needle Biopsy in Dermatology: A Step Forward. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:707-709. [PMID: 30791969 DOI: 10.1016/j.ad.2018.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 09/24/2018] [Accepted: 09/30/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- D Vidal
- Servicio de Dermatología, Hospital Moisès Broggi de Sant Joan Despí, Sant Joan Despí, Barcelona, España.
| | - F Alfageme
- Servicio de Dermatología, Hospital Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
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7
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Scarisbrick JJ, Hodak E, Bagot M, Stranzenbach R, Stadler R, Ortiz-Romero PL, Papadavid E, Knobler R, Quaglino P, Vermeer M. Developments in the understanding of blood involvement and stage in mycosis fungoides/Sezary syndrome. Eur J Cancer 2018; 101:278-280. [DOI: 10.1016/j.ejca.2018.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 12/19/2022]
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8
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Ikeuchi M, Asahina R, Nishida H, Kamishina H, Kitoh K, Sakai H, Maeda S. Phenotypic analysis of mice xenografted with canine epitheliotropic cutaneous T-cell lymphoma cells. Vet Dermatol 2018; 29:517-e172. [PMID: 30159932 DOI: 10.1111/vde.12650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND In canine epitheliotropic cutaneous T-cell lymphoma (ECTCL), neoplastic cells cause skin lesions and potentially metastasize to lymph nodes, blood and other organs. Murine models are potentially valuable for elucidating the molecular mechanisms responsible for regulation of ECTCL cell migration. HYPOTHESIS/OBJECTIVES To describe a phenotype of mice xenografted with canine ECTCL cells (EO-1 cells). ANIMALS Four NOD.CB17-Prkdcscid /J (NOD SCID) mice were used. METHODS AND MATERIALS EO-1 cells were subcutaneously xenografted into NOD SCID mice. After four weeks, the development of tumour lesions in skin and other organs was investigated. RESULTS Mice developed skin lesions with metastasis to the lymph nodes, spleen, lung, blood and liver. CONCLUSIONS AND CLINICAL IMPORTANCE Mice xenografted with EO-1 cells may be useful for studying the pathogenesis of canine ECTCL.
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Affiliation(s)
- Miho Ikeuchi
- Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
| | - Ryota Asahina
- Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
| | - Hidetaka Nishida
- Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
| | - Hiroaki Kamishina
- Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
| | - Katsuya Kitoh
- Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
| | - Hiroki Sakai
- Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
| | - Sadatoshi Maeda
- Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
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Spencer A, Gazzani P, Gadvi R, Hughes S, Stevens A, Shah F, Scarisbrick J. Computed tomography scanning in mycosis fungoides: optimizing the balance between benefit and harm. Br J Dermatol 2017; 178:563-564. [DOI: 10.1111/bjd.15657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- A. Spencer
- Department of Dermatology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - P. Gazzani
- Department of Dermatology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - R. Gadvi
- Department of Radiology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - S.J. Hughes
- Department of Radiology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - A. Stevens
- Department of Oncology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - F. Shah
- Department of Dermatology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
| | - J. Scarisbrick
- Department of Dermatology; University Hospitals Birmingham; Mindelsohn Way, Edgbaston, Birmingham B15 2GW U.K
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