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Shiao JC, Shen X. Contemporary Role of Radiation Therapy in Testicular Cancer. Urol Clin North Am 2024; 51:395-405. [PMID: 38925742 DOI: 10.1016/j.ucl.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Testicular cancer is a rare but curable male malignancy. Seminoma represents the majority of germ cell tumors and is considered radiation sensitive. Radiation treatment plays a role in adjuvant therapy after orchiectomy of stage I, IIA, and IIB seminomas. Radiation dose de-escalation has been effective in preventing tumor recurrences while also limiting acute and long-term toxicities. However, long-term risks, including the prevailing concern of secondary malignancy risk, between adjuvant radiation and chemotherapy play a role in recommendations. Ongoing work continues to be performed to reduce radiation field and dose in combination with chemotherapy while still maintaining excellent outcomes.
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Affiliation(s)
- Jay C Shiao
- Department of Radiation Oncology, University of Kansas Cancer Center, 4001 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Xinglei Shen
- Department of Radiation Oncology, University of Kansas Cancer Center, 4001 Rainbow Boulevard, Kansas City, KS 66160, USA
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Charnalia M, Chopra S, Mulani J, Popat P, Rath S, Thomeer M, Mittal P, Gupta A, Boere I, Gupta S, Nout RA. RECIST 1.1 versus clinico-radiological response assessment for locally advanced cervical cancer: implications on interpreting survival outcomes of future trials. Int J Gynecol Cancer 2024; 34:817-823. [PMID: 38649234 DOI: 10.1136/ijgc-2024-005336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE To investigate differences in standard clinico-radiological evaluation versus Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 for reporting survival outcomes in patients with locally advanced cervical cancer treated with chemoradiation and brachytherapy. METHODS Between November 2017 and March 2020, patients recruited in cervical cancer trials were identified. MRI at diagnosis and at least one follow-up imaging was mandatory. Disease-free survival and progression-free survival were determined using standard evaluation (clinical examination and symptom-directed imaging) and RECIST 1.1. Agreement between criteria was estimated using κ value. Sensitivity analysis was done to test the sensitivity, specificity, and accuracy of RECIST 1.1 in detecting response to treatment. RESULTS Sixty-nine eligible patients had at least one target lesion. Thirty-three patients (47.8%) had pathological lymph nodes. Of these 33 patients, RECIST 1.1 classified only 18% (6/33) as 'target nodal lesions' and the remaining nodes as 'non-target'. There were 6 (8.7%) and 8 (11.6%) patients with disease events using RECIST 1.1 and standard evaluation, respectively. The disease-free survival at 12, 18, and 24 months using RECIST 1.1 was 94.2%, 91.2%, 91.2%, and with standard evaluation was 94.2%, 89.7%, and 88.2%, respectively (p=0.58). Whereas, progression-free survival at 12, 18, and 24 months using RECIST 1.1 and standard evaluation were same (94.2%, 91.2%, and 91.2%, respectively). The κ value was 0.84, showing strong agreement in assessing disease-free survival, although an absolute difference of 3% between endpoint assessment methodologies. RECIST 1.1 had a sensitivity of 75% (95% CI 34.91% to 96.81%), specificity of 100% (95% CI 94.13% to 100%), and accuracy of 97.1% (95% CI 89.92% to 99.65%). CONCLUSIONS The study showed 1.5% and 3% difference in disease-free survival at 18 and 24 months and no difference in progression-free survival between RECIST 1.1 and standard evaluation in a patient cohort with low event rate.
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Affiliation(s)
- Mayuri Charnalia
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, Maharashtra, India
| | - Jaahid Mulani
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, Maharashtra, India
| | - Palak Popat
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sushmita Rath
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Maarten Thomeer
- Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Centre, Rotterdam, Zuid-Holland, Netherlands
| | - Prachi Mittal
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ankita Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, Maharashtra, India
| | - Ingrid Boere
- Department of Medical Oncology, Erasmus MC Cancer Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Sudeep Gupta
- Department of Medical Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, Maharashtra, India
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Centre, Rotterdam, Zuid-Holland, Netherlands
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Green A, Temsah P, Goldfarb L, Sanfolippo K, Knoche E, Muzaffar R, Osman MM. Evaluating appropriateness of 18F-fluciclovine PET/CT relative to standard of care imaging guidelines and the impact of ADT on positivity: a prospective study in 62 Veterans Administration patients at a single institution. Nucl Med Commun 2024; 45:526-535. [PMID: 38517329 DOI: 10.1097/mnm.0000000000001836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND According to the National Comprehensive Cancer Network Guidelines, 18F-fluciclovine PET/CT is considered appropriate after negative standard of care (SOC) imaging. OBJECTIVE To prospectively compare 18F-fluciclovine to SOC imaging, investigate whether it should be done when SOC imaging is (+), and evaluate its detection rate in patients receiving androgen deprivation therapy. METHODS We recruited 57 prostate cancer patients with biochemical recurrence with 18F-fluciclovine PET/CT and SOC imaging within 30 days. Prostate-specific antigen (PSA) level, Gleason score (GS), history of radical prostatectomy (RP), radiation therapy (RT) or hormone therapy (HT) were reviewed. RESULTS The 57 patients had a median PSA of 2.6 and average GS of 7.4; 27 (47.4%) had RP, 28 (49.1%) had RT, 1 (1.75%) had HT and 1 (1.75%) observation only. 18F-fluciclovine identified disease recurrence in 45/57 patients (78.9%), including oligometastasis in 18/45 (40%). SOC imaging identified recurrent disease in 12/57 patients (21.1%) while 18F-fluciclvoine identified additional sites of disease in 11/12 (91.7%). The (+) 18F-fluciclovine studies had a median PSA 2.6 ng/ml compared to 6.0 ng/ml in the (+) SOC studies. CONCLUSION 18F-fluciclovine was superior to SOC imaging for lesion detection, identification of oligometastasis and identification of additional sites of disease.
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Affiliation(s)
- Aileen Green
- Department of Radiology, Saint Louis VA Medical Center, and
| | - Peter Temsah
- Division of Nuclear Medicine, Department of Radiology, Saint Louis University and
| | | | - Kristen Sanfolippo
- Department of Internal Medicine, Saint Louis VA Medical Center, Saint Louis, Missouri, USA
| | - Eric Knoche
- Department of Internal Medicine, Saint Louis VA Medical Center, Saint Louis, Missouri, USA
| | - Razi Muzaffar
- Division of Nuclear Medicine, Department of Radiology, Saint Louis University and
| | - Medhat M Osman
- Department of Radiology, Saint Louis VA Medical Center, and
- Division of Nuclear Medicine, Department of Radiology, Saint Louis University and
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Al‐Zubaidi M, Ong K, Viswambaram P, Bangash H, Boardman G, McCombie SP, Oey O, Swarbrick N, Redfern A, Ong J, Gauci R, Low R, Hayne D. Comparing fluorodeoxyglucose positron emission tomography with computed tomography in staging for nodal and distant metastasis in urothelial/bladder cancer. BJUI COMPASS 2024; 5:473-479. [PMID: 38633828 PMCID: PMC11019246 DOI: 10.1002/bco2.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 04/19/2024] Open
Abstract
Objectives We aim to assess the clinical value of 18F-fluorodeoxyglucose positron (18F-FDG-PET) scan in detecting nodal and distant metastasis compared with computed tomography (CT) scan in patients with urothelial carcinoma or bladder cancer, aiming to improve staging accuracy and thereby better prognosticate and determine therapy. Methods A retrospective review of 75 patients with invasive bladder cancer (≥T1) who were staged with both CT and 18F-FDG-PET within an 8-week interval was performed for the period between 2015 and 2020. Seventy-two per cent (54/75) had formal pelvic lymph node (LN) dissection or biopsy of lesions suspicious for metastases. FDG-PET definitions for positive sites were assessed depending on SUV Max (nodes with SUVmax >4 at any size, SUV > 2 for lymph nodes >8 mm, or any SUV if the lymph node was >10 mm on axial images). For CT scanning, enlarged LN by RECIST 1.1 criteria (>10 mm) as well as qualitative findings suggesting metastasis were considered positive. The analysis was based on the comparison of CT and 18F-FDG-PET findings to histopathology results from LN dissection or biopsies. Results Sensitivity, specificity, positive predictive values (PPV) and negative predictive value (NPV) of CT versus FDG-PET for detecting metastasis, in patients who underwent pelvic LN dissection or biopsy of lesions suspicious of metastases, were 46.6% (95% CI: 21%-70%) versus 60% (95% CI: 32%-84%), 100% (95% CI: 91%-100%) versus 83.78% (95% CI: 69%-94%), 100% (95% CI: 63%-100%) versus 60% (95% CI: 32%-84%), and 82.2% (95% CI: 68%-92%) versus 83.78% (95% CI: 69%-94%), respectively. 7/75 (9.3%) patients avoided cystectomy due to 18F-FDG-PET features of metastases that were not detected by CT. Conclusion FDG-PET may be more sensitive than CT for metastases in the staging of bladder cancer, which resulted in significant avoidance of aggressive local management in cases with occult metastasis.
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Affiliation(s)
- Mohammed Al‐Zubaidi
- Department of UrologyFiona Stanley HospitalMurdochAustralia
- UWA Medical SchoolUniversity of Western AustraliaCrawleyAustralia
| | - Katherine Ong
- Department of UrologyFiona Stanley HospitalMurdochAustralia
| | - Pravin Viswambaram
- Department of UrologyFiona Stanley HospitalMurdochAustralia
- UWA Medical SchoolUniversity of Western AustraliaCrawleyAustralia
| | - Haider Bangash
- Department of UrologyFiona Stanley HospitalMurdochAustralia
| | - Glenn Boardman
- Research Support and Development UnitFiona Stanley HospitalMurdochAustralia
| | - Steve P. McCombie
- Department of UrologyFiona Stanley HospitalMurdochAustralia
- UWA Medical SchoolUniversity of Western AustraliaCrawleyAustralia
| | - Oliver Oey
- UWA Medical SchoolUniversity of Western AustraliaCrawleyAustralia
| | | | - Andrew Redfern
- Department of Medical OncologyFiona Stanley HospitalMurdochAustralia
| | - Jeremy Ong
- Department of Nuclear MedicineFiona Stanley HospitalMurdochAustralia
| | - Richard Gauci
- Department of Nuclear MedicineFiona Stanley HospitalMurdochAustralia
| | - Ronny Low
- Department of RadiologyFiona Stanley HospitalMurdochAustralia
| | - Dickon Hayne
- Department of UrologyFiona Stanley HospitalMurdochAustralia
- UWA Medical SchoolUniversity of Western AustraliaCrawleyAustralia
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Liu J, Miao G, Deng L, Zhou G, Yang C, Rao S, Liu L, Zeng M. Should the Baseline MRI Staging Criteria Differentiate Between Mucinous and Classical Rectal Adenocarcinoma? Acad Radiol 2024; 31:1378-1387. [PMID: 37949701 DOI: 10.1016/j.acra.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/08/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
RATIONALE AND OBJECTIVES To compare baseline MR imaging features for pre-treatment staging between rectal mucinous adenocarcinoma (RMAC) and rectal classical adenocarcinoma (RCAC), and to investigate whether the subtype of mucinous carcinoma influences MRI evaluation criteria and high-risk tumors identifying. METHODS A total of 306 patients who underwent surgical rectal cancer resection were retrospectively reviewed in the study. MR imaging parameters of the primary tumor and lymph nodes (LNs) were compared between two subtypes. Logistic regression and receiver operating characteristic analyses were performed to test significant associations between LN imaging parameters and malignant LN status in RMAC and RCAC, respectively. RESULTS The length of mucinous tumors was larger than RCAC tumors in pT3 and pT4 stage. For pN0 patients, the long and short diameters of the largest LN on MRI were more likely to be larger in RCAC than RMAC. For pN+ patients, the proportion of LNs exhibiting internal heterogeneity in RMAC was obviously greater than that in RCAC. The best cut-off value of the largest short diameter of malignant LNs was 6.05 mm for RMAC and 8.05 mm for RCAC. And the highest AUC for predicting LNs metastases based on the largest short diameter was 0.794 for RMAC using 6 mm size cut-off, and 0.667 for RCAC using 8 mm cut-off. CONCLUSION The imaging features that were associated with LN metastases were different between RMAC and RCAC, and different size criteria of LNs was suggested to distinguish high-risk tumors. Clinicians should stay vigilant of LN status and take histologic subtypes into consideration before assigning clinical strategies.
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Affiliation(s)
- Jingjing Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., L.D., G.Z., C.Y., S.R., L.L., M.Z.); Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., G.Z., C.Y., S.R., L.L., M.Z.); Shanghai Institute of Medical Imaging, Shanghai, China (J.L., G.Z., C.Y., S.R., L.L., M.Z.)
| | - Gengyun Miao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., L.D., G.Z., C.Y., S.R., L.L., M.Z.); Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., G.Z., C.Y., S.R., L.L., M.Z.)
| | - Lamei Deng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., L.D., G.Z., C.Y., S.R., L.L., M.Z.)
| | - Guofeng Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., L.D., G.Z., C.Y., S.R., L.L., M.Z.); Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., G.Z., C.Y., S.R., L.L., M.Z.); Shanghai Institute of Medical Imaging, Shanghai, China (J.L., G.Z., C.Y., S.R., L.L., M.Z.)
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., L.D., G.Z., C.Y., S.R., L.L., M.Z.); Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., G.Z., C.Y., S.R., L.L., M.Z.); Shanghai Institute of Medical Imaging, Shanghai, China (J.L., G.Z., C.Y., S.R., L.L., M.Z.)
| | - Shengxiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., L.D., G.Z., C.Y., S.R., L.L., M.Z.); Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., G.Z., C.Y., S.R., L.L., M.Z.); Shanghai Institute of Medical Imaging, Shanghai, China (J.L., G.Z., C.Y., S.R., L.L., M.Z.)
| | - Liheng Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., L.D., G.Z., C.Y., S.R., L.L., M.Z.); Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., G.Z., C.Y., S.R., L.L., M.Z.); Shanghai Institute of Medical Imaging, Shanghai, China (J.L., G.Z., C.Y., S.R., L.L., M.Z.)
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., L.D., G.Z., C.Y., S.R., L.L., M.Z.); Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China (J.L., G.M., G.Z., C.Y., S.R., L.L., M.Z.); Shanghai Institute of Medical Imaging, Shanghai, China (J.L., G.Z., C.Y., S.R., L.L., M.Z.).
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Bae H, Rha SE, Kim H, Kang J, Shin YR. Predictive Value of Magnetic Resonance Imaging in Risk Stratification and Molecular Classification of Endometrial Cancer. Cancers (Basel) 2024; 16:921. [PMID: 38473283 DOI: 10.3390/cancers16050921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/27/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
This study evaluated the magnetic resonance imaging (MRI) findings of endometrial cancer (EC) patients and identified differences based on risk group and molecular classification. The study involved a total of 175 EC patients. The MRI data were retrospectively reviewed and compared based on the risk of recurrence. Additionally, the associations between imaging phenotypes and genomic signatures were assessed. The low-risk and non-low-risk groups (intermediate, high-intermediate, high, metastatic) showed significant differences in tumor diameter (p < 0.001), signal intensity and heterogeneity on diffusion-weighted imaging (DWI) (p = 0.003), deep myometrial invasion (involvement of more than 50% of the myometrium), cervical invasion (p < 0.001), extrauterine extension (p = 0.002), and lymphadenopathy (p = 0.003). Greater diffusion restriction and more heterogeneity on DWI were exhibited in the non-low-risk group than in the low-risk group. Deep myometrial invasion, cervical invasion, extrauterine extension, lymphadenopathy, recurrence, and stage discrepancy were more common in the non-low-risk group (p < 0.001). A significant difference in microsatellite stability status was observed in the heterogeneity of the contrast-enhanced T1-weighted images (p = 0.027). However, no significant differences were found in MRI parameters related to TP53 mutation. MRI features can be valuable predictors for differentiating risk groups in patients with EC. However, further investigations are needed to explore the imaging markers based on molecular classification.
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Affiliation(s)
- Hanna Bae
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 14662, Republic of Korea
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 14662, Republic of Korea
| | - Hokun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 14662, Republic of Korea
| | - Jun Kang
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 14662, Republic of Korea
| | - Yu Ri Shin
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 14662, Republic of Korea
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Koshkin VS, Kumar V, Kline B, Escobar D, Aslam M, Cooperberg MR, Aggarwal RR, de Kouchkovsky I, Chou J, Meng MV, Friedlander T, Porten S, Hope TA. Initial Experience with 68Ga-FAP-2286 PET Imaging in Patients with Urothelial Cancer. J Nucl Med 2024; 65:199-205. [PMID: 38212070 DOI: 10.2967/jnumed.123.266390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/07/2023] [Indexed: 01/13/2024] Open
Abstract
Improved imaging modalities are needed to accurately stage patients with muscle-invasive bladder cancer (MIBC) and metastatic urothelial carcinoma. Imaging with small-molecule ligands or inhibitors of fibroblast activation protein (FAP) is a promising modality that has demonstrated initial efficacy across a broad range of tumors. We present our experience with the novel FAP-peptide binder 68Ga-FAP-2286 in patients with MIBC. Methods: Patients with histopathologically confirmed bladder cancer who had either localized disease at diagnosis (localized cohort, n = 13) or known metastatic disease (metastatic cohort, n = 8) were imaged with 68Ga-FAP-2286 PET as part of a clinical trial (NCT04621435). The SUVmax of 68Ga-FAP-2286 PET-positive lesions and lesion size were documented. In patients who had available 18F-FDG PET performed within 45 d of 68Ga-FAP-2286 PET (n = 5), uptake on the 2 scans was compared. When there was a discrepancy between imaging modalities on retrospective review, biopsy of suggestive lesions was performed as the standard of care. Results: In the metastatic and localized cohorts, 36 and 18 68Ga-FAP-2286-avid lesions, respectively, were identified across multiple anatomic locations, including lymph nodes, visceral metastases, and bones. Fourteen of 36 lesions in the metastatic cohort and 14 of 18 lesions in the localized cohort were lymph nodes measuring less than 1 cm. Among lesions measuring less than 0.5 cm, 0.5-1 cm, and more than 1 cm, average SUVmax was 5.2 ± 2.6, 9.6 ± 3.7, and 13.0 ± 4.3, respectively, in the metastatic cohort and 10.5 ± 5.1, 10.8 ± 5.7, and 9.9 ± 5.4, respectively, in the localized cohort. Five patients had 18F-FDG PET available for comparison. The average SUVmax for lesions avid on 68Ga-FAP-2286 PET and 18F-FDG PET was 9.9 ± 3.4 versus 4.2 ± 1.9, respectively (n = 16 lesions). For 3 patients in the localized cohort, 68Ga-FAP-2286 PET informed clinical management, including identification of both false-positive findings on 18F-FDG PET and false-negative findings on conventional CT. Conclusion: 68Ga-FAP-2286 imaging is highly sensitive in patients with urothelial cancer and is effective in identifying metastatic lesions across a variety of anatomic sites, including subcentimeter lymph nodes that would not have raised suspicion on conventional scans. This novel imaging modality may inform clinical decision-making in patients with MIBC both by refining local nodal staging and by defining metastatic disease that would otherwise be undetectable on conventional imaging.
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Affiliation(s)
- Vadim S Koshkin
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California;
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
| | - Vipul Kumar
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Brad Kline
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Domenique Escobar
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Maya Aslam
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Matthew R Cooperberg
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Rahul R Aggarwal
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
| | - Ivan de Kouchkovsky
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
| | - Jonathan Chou
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
| | - Maxwell V Meng
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Terence Friedlander
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
| | - Sima Porten
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; and
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Hu Z, Ma L, Ding Y, Zhao X, Shi X, Lu H, Liu K. Enhancing the Accuracy of Lymph-Node-Metastasis Prediction in Gynecologic Malignancies Using Multimodal Federated Learning: Integrating CT, MRI, and PET/CT. Cancers (Basel) 2023; 15:5281. [PMID: 37958454 PMCID: PMC10648189 DOI: 10.3390/cancers15215281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/22/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Gynecological malignancies, particularly lymph node metastasis, have presented a diagnostic challenge, even with traditional imaging techniques such as CT, MRI, and PET/CT. This study was conceived to explore and, subsequently, to bridge this diagnostic gap through a more holistic and innovative approach. By developing a comprehensive framework that integrates both non-image data and detailed MRI image analyses, this study harnessed the capabilities of a multimodal federated-learning model. Employing a composite neural network within a federated-learning environment, this study adeptly merged diverse data sources to enhance prediction accuracy. This was further complemented by a sophisticated deep convolutional neural network with an enhanced U-NET architecture for meticulous MRI image processing. Traditional imaging yielded sensitivities ranging from 32.63% to 57.69%. In contrast, the federated-learning model, without incorporating image data, achieved an impressive sensitivity of approximately 0.9231, which soared to 0.9412 with the integration of MRI data. Such advancements underscore the significant potential of this approach, suggesting that federated learning, especially when combined with MRI assessment data, can revolutionize lymph-node-metastasis detection in gynecological malignancies. This paves the way for more precise patient care, potentially transforming the current diagnostic paradigm and resulting in improved patient outcomes.
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Affiliation(s)
- Zhijun Hu
- Department of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China; (Z.H.); (X.Z.)
| | - Ling Ma
- Library, Shanghai Jiao Tong University, Shanghai 200240, China; (L.M.); (X.S.)
| | - Yue Ding
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China;
| | - Xuanxuan Zhao
- Department of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China; (Z.H.); (X.Z.)
| | - Xiaohua Shi
- Library, Shanghai Jiao Tong University, Shanghai 200240, China; (L.M.); (X.S.)
| | - Hongtao Lu
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China;
| | - Kaijiang Liu
- Department of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China; (Z.H.); (X.Z.)
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Lakhman Y, Aherne EA, Jayaprakasam VS, Nougaret S, Reinhold C. Staging of Cervical Cancer: A Practical Approach Using MRI and FDG PET. AJR Am J Roentgenol 2023; 221:633-648. [PMID: 37459457 PMCID: PMC467038 DOI: 10.2214/ajr.23.29003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
This review provides a practical approach to the imaging evaluation of patients with cervical cancer (CC), from initial diagnosis to restaging of recurrence, focusing on MRI and FDG PET. The primary updates to the International Federation of Gynecology and Obstetrics (FIGO) CC staging system, as well as these updates' relevance to clinical management, are discussed. The recent literature investigating the role of MRI and FDG PET in CC staging and image-guided brachytherapy is summarized. The utility of MRI and FDG PET in response assessment and posttreatment surveillance is described. Important findings on MRI and FDG PET that interpreting radiologists should recognize and report are illustrated. The essential elements of structured reports during various phases of CC management are outlined. Special considerations, including the role of imaging in patients desiring fertility-sparing management, differentiation of CC and endometrial cancer, and unusual CC histologies, are also described. Finally, future research directions including PET/MRI, novel PET tracers, and artificial intelligence applications are highlighted.
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Affiliation(s)
- Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Emily A Aherne
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Vetri Sudar Jayaprakasam
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, Montpellier, France
- Pinkcc Lab, IRCM, Montpellier, France
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
- Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, QC, Canada
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10
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Kaczmarek K, Małkiewicz B, Skonieczna-Żydecka K, Lemiński A. Influence of Neoadjuvant Chemotherapy on Survival Outcomes of Radical Cystectomy in Pathologically Proven Positive and Negative Lymph Nodes. Cancers (Basel) 2023; 15:4901. [PMID: 37835595 PMCID: PMC10571771 DOI: 10.3390/cancers15194901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
Patients receiving neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) typically show better survival outcomes than those undergoing immediate surgery for muscle-invasive bladder cancer. However, most studies have not considered the lymph node (LN) status when evaluating NAC's survival benefits. This study sought to delineate the impact of NAC on patients based on their pathologically determined LN status at the time of RC. We examined data from 1395 patients treated at two departments between 1991 and 2022. Of them, 481 had positive LNs. A comparison of overall survival (OS) outcomes revealed that patients without LN involvement ((y)pN0) benefited from NAC with a hazard ratio (HR) of 0.692 (95% confidence interval [CI] 0.524-0.915). In contrast, patients with (y)pN+ showed no improvement with NAC (HR 0.927, 95%CI 0.713-1.205). Notably, patients treated with NAC for stage
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Affiliation(s)
- Krystian Kaczmarek
- Department of Urology and Urological Oncology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Bartosz Małkiewicz
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Karolina Skonieczna-Żydecka
- Department of Biochemical Sciences, Pomeranian Medical University, Władysława Broniewskiego 24, 71-460 Szczecin, Poland
| | - Artur Lemiński
- Department of Urology and Urological Oncology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
- Department of Biochemical Sciences, Pomeranian Medical University, Władysława Broniewskiego 24, 71-460 Szczecin, Poland
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11
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Lee S, Kassam Z, Baheti AD, Hope TA, Chang KJ, Korngold EK, Taggart MW, Horvat N. Rectal cancer lexicon 2023 revised and updated consensus statement from the Society of Abdominal Radiology Colorectal and Anal Cancer Disease-Focused Panel. Abdom Radiol (NY) 2023; 48:2792-2806. [PMID: 37145311 PMCID: PMC10444656 DOI: 10.1007/s00261-023-03893-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 05/06/2023]
Abstract
The Society of Abdominal Radiology's Colorectal and Anal Cancer Disease-Focused Panel (DFP) first published a rectal cancer lexicon paper in 2019. Since that time, the DFP has published revised initial staging and restaging reporting templates, and a new SAR user guide to accompany the rectal MRI synoptic report (primary staging). This lexicon update summarizes interval developments, while conforming to the original lexicon 2019 format. Emphasis is placed on primary staging, treatment response, anatomic terminology, nodal staging, and the utility of specific sequences in the MRI protocol. A discussion of primary tumor staging reviews updates on tumor morphology and its clinical significance, T1 and T3 subclassifications and their clinical implications, T4a and T4b imaging findings/definitions, terminology updates on the use of MRF over CRM, and the conundrum of the external sphincter. A parallel section on treatment response reviews the clinical significance of near-complete response and introduces the lexicon of "regrowth" versus "recurrence". A review of relevant anatomy incorporates updated definitions and expert consensus of anatomic landmarks, including the NCCN's new definition of rectal upper margin and sigmoid take-off. A detailed review of nodal staging is also included, with attention to tumor location relative to the dentate line and locoregional lymph node designation, a new suggested size threshold for lateral lymph nodes and their indications for use, and imaging criteria used to differentiate tumor deposits from lymph nodes. Finally, new treatment terminologies such as organ preservation, TNT, TAMIS and watch-and-wait management are introduced. This 2023 version aims to serve as a concise set of up-to-date recommendations for radiologists, and discusses terminology, classification systems, MRI and clinical staging, and the evolving concepts in diagnosis and treatment of rectal cancer.
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Affiliation(s)
- Sonia Lee
- Radiological Sciences, University of California, Irvine, Irvine, CA, USA.
- University of California at Irvine, 101 The City Dr. S, Orange, CA, 92868, USA.
| | - Zahra Kassam
- Department of Medical Imaging, Schulich School of Medicine, St Joseph's Hospital, Western University, London, ON, N6A4V2, Canada
| | - Akshay D Baheti
- Department of Radiology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Kevin J Chang
- Department of Radiology, Boston University Medical Center, Boston, MA, USA
| | - Elena K Korngold
- Department of Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Melissa W Taggart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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12
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Zhu M, Zhuo Q, Liu W, Guan C, Zuo Y. Imaging evaluation of para-aortic lymph nodes in cervical cancer. Acta Radiol 2023; 64:2611-2617. [PMID: 37321631 DOI: 10.1177/02841851231179178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND In recent years, much literature has reported the diagnostic value of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT in para-aortic lymph node metastasis of cervical cancer. PURPOSE To compare and analyze the para-aortic lymph node presentations found in cervical cancer on different images in order to determine the best precise imaging method for identifying metastatic lymph nodes. MATERIAL AND METHODS PubMed, Web of Science, MEDLINE, and other databases were searched for the non-invasive detection of metastatic lymph nodes for a comprehensive comparison. RESULTS Positive lymph nodes on CT are significantly related to the following factors: short axis ≥10 mm; and round or central necrosis. Positive lymph nodes on MRI are significantly related to the following factors: short axis ≥8 mm; inhomogeneous signal intensity; morphology: round, irregular edge, extracapsular invasion, central necrosis, loss of lymph node structure, burrs, or lobes; and ADC value decreases, combined with local actuality. On PET-CT examination, when the short axis of the lymph node is >5 mm, the SUV is >2.5, or the FDG uptake is greater than that of the surrounding tissue, it is a metastatic lymph node. CONCLUSION In conclusion, different imaging techniques show metastatic lymph nodes in different ways. Combining the patient's medical history with the symptoms of the aforementioned lymph nodes, together with one or more imaging techniques, is important to diagnose para-aortic lymph nodes in cervical cancer.
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Affiliation(s)
- Minying Zhu
- Department of Gynecological Oncology, Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, PR China
| | - Qingchan Zhuo
- Department of Gynecological Oncology, Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, PR China
| | - Wenci Liu
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, PR China
| | - Chengnong Guan
- Department Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, PR China
| | - Yufang Zuo
- Department of Gynecological Oncology, Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, PR China
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13
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Borgheresi A, Agostini A, Sternardi F, Cesari E, Ventura F, Ottaviani L, Delle Fave RF, Pretore E, Cimadamore A, Filosa A, Galosi AB, Giovagnoni A. Vascular Enlargement as a Predictor of Nodal Involvement in Bladder Cancer. Diagnostics (Basel) 2023; 13:2227. [PMID: 37443621 DOI: 10.3390/diagnostics13132227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
In bladder cancer (BC), the evaluation of lymph node (LN) involvement at preoperative imaging lacks specificity. Since neoangiogenesis is paired with lymphatic involvement, this study aims to evaluate the presence of perivesical venous ectasia as an indirect sign of LN involvement, together with other conventional CT findings. All the patients who underwent radical cystectomy (RC) for BC between January 2017 and December 2019 with available preoperative contrast-enhanced CT (CECT) within 1 month before surgery were included. Patients without available pathological reports (and pTNM stage) or who underwent neoadjuvant treatments and palliative RC were excluded. Two readers in blind assessed the nodal shape and hilum, the short axis, and the contrast enhancement of suspicious pelvic LNs, the Largest Venous Diameter (LVD) efferent to the lesion, and the extravesical tumor invasion. In total, 38 patients (33 males) were included: 17 pT2, 17 pT3, 4 pT4; pN+: 20/38. LN short axis > 5 mm, LN enhancement, and LVD > 3 mm were significantly correlated with N+ at pathology. LVD > 3 mm had a significantly higher sensitivity and specificity (≥90%, AUC = 0.949) and was an independent predictor (p = 0.0016).
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Francesca Sternardi
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Elisa Cesari
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
| | - Fiammetta Ventura
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
| | - Letizia Ottaviani
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| | | | - Eugenio Pretore
- Division of Urology, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Alessia Cimadamore
- Division of Pathology, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Healthcare, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
| | - Alessandra Filosa
- Division of Pathology, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Healthcare, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
| | - Andrea Benedetto Galosi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
- Division of Urology, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Italy
- Department of Radiological Sciences, Azienda Ospedaliero Universitaria delle Marche, Via Conca 71, 60126 Ancona, Italy
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14
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Awiwi MO, Kaur H, Ernst R, Rauch GM, Morani AC, Stanietzky N, Palmquist SM, Salem UI. Restaging MRI of Rectal Adenocarcinoma after Neoadjuvant Chemoradiotherapy: Imaging Findings and Potential Pitfalls. Radiographics 2023; 43:e220135. [PMID: 36927125 DOI: 10.1148/rg.220135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Rectal adenocarcinoma constitutes about one-third of all colorectal adenocarcinoma cases. Rectal MRI has become mandatory for evaluation of patients newly diagnosed with rectal cancer because it can help accurately stage the disease, impact the choice to give neoadjuvant therapy or proceed with up-front surgery, and even direct surgical dissection planes. Better understanding of neoadjuvant chemoradiotherapy effects on rectal tumors and recognition that up to 30% of patients can have a pathologic complete response have opened the door for the nonsurgical "watch-and-wait" management approach for rectal adenocarcinoma. Candidates for this organ-preserving approach should have no evidence of malignancy on all three components of response assessment after neoadjuvant therapy (ie, digital rectal examination, endoscopy, and rectal MRI). Hence, rectal MRI again has a major role in directing patient management and possibly sparing patients from unnecessary surgical morbidity. In this article, the authors discuss the indications for neoadjuvant therapy in management of patients with rectal adenocarcinoma, describe expected imaging appearances of rectal adenocarcinoma after completion of neoadjuvant therapy, and outline the MRI tumor regression grading system. Since pelvic sidewall lymph node dissection is associated with a high risk of permanent genitourinary dysfunction, it is performed for only selected patients who have radiologic evidence of sidewall lymph node involvement. Therefore, the authors review the relevant lymphatic compartments of the pelvis and describe lymph node criteria for determining locoregional nodal spread. Finally, the authors discuss limitations of rectal MRI, describe several potential interpretation pitfalls after neoadjuvant therapy, and emphasize how these pitfalls may be avoided. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Muhammad O Awiwi
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Harmeet Kaur
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Randy Ernst
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Gaiane M Rauch
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Ajaykumar C Morani
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Nir Stanietzky
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Sarah M Palmquist
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Usama I Salem
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
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15
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Pak T, Sadowski E, Patel-Lippmann K. MR Imaging in Cervical Cancer. Radiol Clin North Am 2023; 61:639-649. [PMID: 37169429 DOI: 10.1016/j.rcl.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Cervical cancer remains a significant contributor to morbidity and mortality for women globally despite medical advances in preventative medicine and treatment. The 2018 Internal Federation of Gynecology and Obstetrics committee modified their original 2009 staging scheme to incorporate advanced imaging modalities, where available, to increase the accuracy of staging and to guide evolving treatments. Having a robust understanding of the newest staging iteration, its consequences on treatment pathways, and common imaging pitfalls will aid the radiologist in generating valuable and practical reports to optimize treatment strategies.
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16
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Both radiographical and pathological lymph node statuses are independent predictors for survival following neoadjuvant chemotherapy and radical cystectomy for cT3/4 or cN+ bladder cancer. World J Urol 2023; 41:101-107. [PMID: 36269368 PMCID: PMC9849310 DOI: 10.1007/s00345-022-04187-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/30/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Urothelial bladder cancer (UBC) with clinical suspicion of locally advanced growth or pelvic lymphogenic spread has a high risk of progression and death. PATIENTS AND METHODS Bladder cancer patients with locally advanced (cT3/4) tumor growth or suspected pelvic lymphogenic spread (cN+) were treated with preoperative cisplatin-containing chemotherapy and consolidative cystectomy with pelvic lymphadenectomy. We aimed to identify prognostic factors and describe the patients' oncological outcome. RESULTS A complete dataset including follow-up data was available for 96 patients. In a univariate analysis, we identified cN stage (cN+ vs cN-, HR 2.7, 95% CI 1.3-6.0), response to chemotherapy (HR 0.2, 95% CI 0.1-0.5), ypT stage (ypT0/is/1 vs ypT2-4, HR 3.1, 95% CI 1.4-6.8), ypN stage (ypN + vs ypN-, HR 7.9, 95% CI 3.7-17.0), resection status (HR 4.4, 95% CI HR 1.5-13.0) as significantly associated with cancer-specific survival. In a multivariate regression analysis, both cN and ypN statuses were validated as independent prognostic factors for cancer-specific survival (cN: HR 2.6, 95% CI 1.1-6.1; ypN: HR 5.5, 95% CI 2.0-15.1). DISCUSSION Lymph node status was identified as a prognostic marker in a high-risk cohort of UBC patients treated with inductive chemotherapy and cystectomy. Establishing cN status as a prognosticator underlines the necessity to aggressively treat these patients despite reported impreciseness of imaging procedures in UCB. Patients with histologically positive lymph nodes following preoperative chemotherapy have a very poor prognosis, and thus, the need for adjuvant systemic treatment is emphasized. CONCLUSION Both clinically and pathologically affected lymph nodes convey a poor prognosis in bladder cancer and necessitate aggressive treatment.
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Mori T, Kato H, Kawaguchi M, Kanayama T, Furui T, Noda Y, Hyodo F, Matsuo M. MRI characteristics for predicting histological subtypes in patients with uterine cervical adenocarcinoma. Eur J Radiol 2023; 158:110612. [PMID: 36542931 DOI: 10.1016/j.ejrad.2022.110612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/17/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the magnetic resonance imaging (MRI) findings of uterine cervical adenocarcinoma for predicting different histological subtypes. MATERIALS AND METHODS We retrospectively analyzed MRI findings of 76 consecutive patients with histopathologically-confirmed uterine cervical adenocarcinoma undergoing preoperative MRI examination. An experienced pathologist classified the histological subtypes based on World Health Organization's 2020 classification and into human papillomavirus (HPV)-associated adenocarcinomas (HPVAs, n = 54) (usual type and variants) and HPV-independent adenocarcinomas (HPVIs, n = 22) (gastric type adenocarcinoma (GAS), clear cell type, and other types). Different MRI variables were compared quantitatively and qualitatively between HPVA and HPVI and between GAS and non-GAS tumor types. RESULTS The maximum tumor diameter was significantly greater in HPVIs than HPVAs (41.9 ± 18.6 vs 32.7 ± 15.6 mm; p < 0.05). Heterogeneous enhancement on fat-suppressed gadolinium-enhanced T1-weighted images was more frequently seen in HPVIs than HPVAs (62 % vs 15 %; p < 0.01) and in GASs than non-GASs (78 % vs 16 %; p < 0.01). Also, infiltrative growth pattern (58 % vs 20 %; p < 0.05) and intratumoral cyst formation (83 % vs 47 %) (p < 0.05) were more frequent in GASs than non-GASs. CONCLUSIONS Compared with HPVAs, HPVIs tend to have a larger tumor size with heterogeneous enhancement, of which GASs frequently show infiltrative growth patterns with intratumoral cyst formation and heterogeneous enhancement.
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Affiliation(s)
- Takayuki Mori
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Masaya Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | | | - Tatsuro Furui
- Department of Obstetrics and Gynecology, Gifu University, Gifu, Japan
| | - Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Fuminori Hyodo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Institute for Advanced Study, Gifu University, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
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18
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Multidisciplinary Management and Radiotherapy Recommendations for Clinically and Pathologically Node-positive Bladder Cancer. Semin Radiat Oncol 2023; 33:35-50. [PMID: 36517192 DOI: 10.1016/j.semradonc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are limited data regarding the optimal management of patients with pelvic node-positive, but non-metastatic, bladder cancer. Increasing data demonstrate that this is a distinct clinical entity with outcomes bridging between bladder-confined muscle-invasive bladder cancer and metastatic advanced bladder cancer. Guidelines and staging systems have formalized the need to incorporate the unique considerations of management of pelvic node-positive bladder cancer. However, there remains an absence of a definite standard of care. Treatment options include systemic therapy alone, neoadjuvant chemotherapy followed by radical cystectomy, or bladder-preserving trimodality therapy. Furthermore, ongoing studies aim to determine the benefit of incorporating immunotherapy into these treatment paradigms. In this review article, we will discuss the key considerations for management of patients with pelvic node-positive bladder cancer.
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Radiomics Signature Using Manual Versus Automated Segmentation for Lymph Node Staging of Bladder Cancer. Eur Urol Focus 2023; 9:145-153. [PMID: 36115774 DOI: 10.1016/j.euf.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/26/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bladder cancer (BC) treatment algorithms depend on accurate tumor staging. To date, computed tomography (CT) is recommended for assessment of lymph node (LN) metastatic spread in muscle-invasive and high-risk BC. However, the diagnostic efficacy of radiologist-evaluated CT imaging studies is limited. OBJECTIVE To evaluate the performance of quantitative radiomics signatures for detection of LN metastases in BC. DESIGN, SETTING, AND PARTICIPANTS Of 1354 patients with BC who underwent radical cystectomy (RC) with lymphadenectomy who were screened, 391 with pathological nodal staging (pN0: n = 297; pN+: n = 94) were included and randomized into training (n = 274) and test (n = 117) cohorts. Pelvic LNs were segmented manually and automatically. A total of 1004 radiomics features were extracted from each LN and a machine learning model was trained to assess pN status using histopathology labels as the ground truth. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Radiologist assessment was compared to radiomics-based analysis using manual and automated LN segmentations for detection of LN metastases in BC. Statistical analysis was performed using the receiver operating characteristics curve method and evaluated in terms of sensitivity, specificity, and area under the curve (AUC). RESULTS AND LIMITATIONS In total, 1845 LNs were manually segmented. Automated segmentation correctly located 361/557 LNs in the test cohort. Manual and automatic masks achieved an AUC of 0.80 (95% confidence interval [CI] 0.69-0.91; p = 0.64) and 0.70 (95% CI: 0.58-0.82; p = 0.17), respectively, in the test cohort compared to radiologist assessment, with an AUC of 0.78 (95% CI 0.67-0.89). A combined model of a manually segmented radiomics signature and radiologist assessment reached an AUC of 0.81 (95% CI 0.71-0.92; p = 0.63). CONCLUSIONS A radiomics signature allowed discrimination of nodal status with high diagnostic accuracy. The model based on manual LN segmentation outperformed the fully automated approach. PATIENT SUMMARY For patients with bladder cancer, evaluation of computed tomography (CT) scans before surgery using a computer-based method for image analysis, called radiomics, may help in standardizing and improving the accuracy of assessment of lymph nodes. This could be a valuable tool for optimizing treatment options.
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Yoo GS, Park HC, Yu JI. Clinical implication and management of rectal cancer with clinically suspicious lateral pelvic lymph node metastasis: A radiation oncologist's perspective. Front Oncol 2022; 12:960527. [PMID: 36568216 PMCID: PMC9768025 DOI: 10.3389/fonc.2022.960527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
Rectal cancer is the eighth most common malignancy worldwide. With the introduction of total mesorectal excision (TME) and neoadjuvant chemoradiation (NCRT), intrapelvic local control has been remarkably improved. However, lateral pelvic recurrence remains problematic, especially in patients with clinically suspicious lateral pelvic lymph node (LPLN). LPLN dissection has been applied for the management of LPLN metastasis, mainly in Japan and other Eastern countries, while the role of NCRT is more emphasized and LPLN dissection is performed in very limited cases in Western countries. However, the optimal management strategy for patients with rectal cancer with suspicious LPLN metastasis has not been determined. Herein, we review the latest studies on the optimal management of LPLN metastasis to suggest the most appropriate treatment policies according to current evidence and discuss future research directions.
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Affiliation(s)
| | | | - Jeong Il Yu
- *Correspondence: Jeong Il Yu, ; Hee Chul Park,
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Liu X, Tian J, Wu J, Zhang Y, Wang X, Zhang X, Wang X. Utility of diffusion weighted imaging-based radiomics nomogram to predict pelvic lymph nodes metastasis in prostate cancer. BMC Med Imaging 2022; 22:190. [DOI: 10.1186/s12880-022-00905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Preoperative pelvic lymph node metastasis (PLNM) prediction can help clinicians determine whether to perform pelvic lymph node dissection (PLND). The purpose of this research is to explore the feasibility of diffusion-weighted imaging (DWI)-based radiomics for preoperative PLNM prediction in PCa patients at the nodal level.
Methods
The preoperative MR images of 1116 pathologically confirmed lymph nodes (LNs) from 84 PCa patients were enrolled. The subjects were divided into a primary cohort (67 patients with 192 positive and 716 negative LNs) and a held-out cohort (17 patients with 43 positive and 165 negative LNs) at a 4:1 ratio. Two preoperative pelvic lymph node metastasis (PLNM) prediction models were constructed based on automatic LN segmentation with quantitative radiological LN features alone (Model 1) and combining radiological and radiomics features (Model 2) via multiple logistic regression. The visual assessments of junior (Model 3) and senior (Model 4) radiologists were compared.
Results
No significant difference was found between the area under the curve (AUCs) of Models 1 and 2 (0.89 vs. 0.90; P = 0.573) in the held-out cohort. Model 2 showed the highest AUC (0.83, 95% CI 0.76, 0.89) for PLNM prediction in the LN subgroup with a short diameter ≤ 10 mm compared with Model 1 (0.78, 95% CI 0.70, 0.84), Model 3 (0.66, 95% CI 0.52, 0.77), and Model 4 (0.74, 95% CI 0.66, 0.88). The nomograms of Models 1 and 2 yielded C-index values of 0.804 and 0.910, respectively, in the held-out cohort. The C-index of the nomogram analysis (0.91) and decision curve analysis (DCA) curves confirmed the clinical usefulness and benefit of Model 2.
Conclusions
A DWI-based radiomics nomogram incorporating the LN radiomics signature with quantitative radiological features is promising for PLNM prediction in PCa patients, particularly for normal-sized LNM.
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Glemser PA, Rotkopf LT, Ziener CH, Beuthien-Baumann B, Weru V, Kopp-Schneider A, Schlemmer HP, Dimitrakopoulou-Strauss A, Sachpekidis C. Hybrid imaging with [ 68Ga]PSMA-11 PET-CT and PET-MRI in biochemically recurrent prostate cancer. Cancer Imaging 2022; 22:53. [PMID: 36138437 PMCID: PMC9502876 DOI: 10.1186/s40644-022-00489-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
AIM To compare [68Ga]PSMA-11 PET-CT, [68Ga]PSMA-11 PET-MRI and MRI in a cohort of prostate cancer (PCa) patients in biochemical recurrence after initial curative therapy. MATERIALS AND METHODS Fifty-three patients with biochemically recurrent PCa underwent whole-body [68Ga]PSMA-11 PET-CT 1 hour post-injection (p.i.) followed by [68Ga]PSMA-11 PET-MRI 2.5 hours p.i., including a multiparametric MRI pelvic protocol examination. Imaging data analysis consisted of visual (qualitative) evaluation of the PET-CT, PET-MRI and MRI scans, as well as semi-quantitative and quantitative analyses of the PET and MRI data, including calculation of the parameters standardized uptake value (SUV) and apparent diffusion coefficient (ADC) derived from the PCa lesions. Association analysis was performed between imaging and clinical data, including PSA level and Gleason score. The results were considered significant for p-values less than 0.05 (p < 0.05). RESULTS The hybrid imaging modalities [68Ga]PSMA-11 PET-CT and PET-MRI were positive in more patients than MRI alone. In particular, PET-CT detected lesions suggestive of PCa relapse in 34/53 (64.2%), PET-MRI in 36/53 (67.9%) and MRI in 23/53 patients (43.4%). While no significant differences in lesion detection rate were observed between PET-CT and PET-MRI, the latter was particularly efficient in detection of local recurrences in the prostate bed mainly due to the contribution of the MRI part of the modality. Association analysis revealed a statistically significant increase in the probability of a positive scan with increasing PSA levels for all imaging modalities. Accordingly, there was no significant association between scan positivity rate and Gleason score for any imaging modality. No significant correlation was observed between SUV and ADC values in lymph node metastases. CONCLUSION [68Ga]PSMA-11 PET-CT and PET-MRI provide equally good detection rates for PCa recurrence, both outperforming stand-alone MRI.
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Affiliation(s)
- P A Glemser
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - L T Rotkopf
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty, Ruprecht-Karls-University Heidelberg, 69120, Heidelberg, Germany
| | - C H Ziener
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - B Beuthien-Baumann
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - V Weru
- Department of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Kopp-Schneider
- Department of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H P Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Dimitrakopoulou-Strauss
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69210, Heidelberg, Germany
| | - C Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69210, Heidelberg, Germany.
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Fernandes MC, Nikolovski I, Long Roche K, Lakhman Y. CT of Ovarian Cancer for Primary Treatment Planning: What the Surgeon Needs to Know- Radiology In Training. Radiology 2022; 304:516-526. [PMID: 35608442 PMCID: PMC9434813 DOI: 10.1148/radiol.212737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 11/11/2022]
Abstract
A 60-year-old woman presented with intermittent abdominal pain, an elevated serum CA-125 level, and an abnormal CT examination and was ultimately diagnosed with advanced-stage high-grade serous ovarian cancer. Key tumor locations on CT scans that should be highlighted by the radiologist to guide treatment selection are discussed.
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Affiliation(s)
- Maria Clara Fernandes
- From the Department of Radiology (M.C.F., I.N., Y.L.) and Gynecologic
Service, Department of Surgery (K.L.R.), Memorial Sloan Kettering Cancer Center,
1275 York Ave, New York, NY 10065
| | - Ines Nikolovski
- From the Department of Radiology (M.C.F., I.N., Y.L.) and Gynecologic
Service, Department of Surgery (K.L.R.), Memorial Sloan Kettering Cancer Center,
1275 York Ave, New York, NY 10065
| | - Kara Long Roche
- From the Department of Radiology (M.C.F., I.N., Y.L.) and Gynecologic
Service, Department of Surgery (K.L.R.), Memorial Sloan Kettering Cancer Center,
1275 York Ave, New York, NY 10065
| | - Yulia Lakhman
- From the Department of Radiology (M.C.F., I.N., Y.L.) and Gynecologic
Service, Department of Surgery (K.L.R.), Memorial Sloan Kettering Cancer Center,
1275 York Ave, New York, NY 10065
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The Role of CT in the Staging and Follow-Up of Testicular Tumors: Baseline, Recurrence and Pitfalls. Cancers (Basel) 2022; 14:cancers14163965. [PMID: 36010958 PMCID: PMC9406011 DOI: 10.3390/cancers14163965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Testicular cancer (TC) is an uncommon group of tumors affecting predominantly younger males between 15 and 40 years, and accounting for less than 1% of malignancies in men, albeit in the context of an increasing incidence rate over recent decades. Testicular germ cell tumors (TGCT) are the most frequent (90%), and most cases of TGCT are organ-confined at diagnosis. The majority of patients with TGCT have an excellent prognosis, with a 5-year survival rate greater than 95%, and expect to be cured thanks to different risk-adapted treatments such as cisplatin-based chemotherapy, even at advanced stages. It is for this reason that both initial staging and follow-up are essential for appropriate management in initiating adapted therapy as well as treating cases of recurrence, most frequent during the first 5 years. Abstract Ultrasound imaging of the testis represents the standard-of-care initial imaging for the diagnosis of TGCT, whereas computed tomography (CT) plays an integral role in the initial accurate disease staging (organ-confined, regional lymph nodes, or sites of distant metastases), in monitoring the response to therapy in patients who initially present with non-confined disease, in planning surgical approaches for residual masses, in conducting follow-up surveillance and in determining the extent of recurrence in patients who relapse after treatment completion. CT imaging has also an important place in diagnosing complications of treatments. The aims of this article are to review these different roles of CT in primary TGCT and focus on different pitfalls that radiologists need to be aware of.
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25
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Das JP, Woo S, Ghafoor S, Andrieu PC, Ulaner GA, Donahue TF, Goh AC, Vargas HA. Value of MRI in evaluating urachal carcinoma: A single center retrospective study. Urol Oncol 2022; 40:345.e9-345.e17. [DOI: 10.1016/j.urolonc.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/07/2022] [Accepted: 02/26/2022] [Indexed: 11/25/2022]
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Basso Dias A, Finelli A, Bauman G, Veit-Haibach P, Berlin A, Ortega C, Avery L, Metser U. Impact of 18F-DCFPyL PET on Staging and Treatment of Unfavorable Intermediate or High-Risk Prostate Cancer. Radiology 2022; 304:600-608. [PMID: 35608445 DOI: 10.1148/radiol.211836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Data regarding 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine 3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) PET in primary staging of prostate cancer (PCa) are limited. Purpose To compare the performance of 18F-DCFPyL PET/CT or PET/MRI (PET) with bone scan and CT with or without multiparametric MRI (hereafter, referred to as conventional imaging) in the initial staging of men with unfavorable intermediate or high-risk PCa and to assess treatment change after PET. Materials and Methods This prospective study evaluated men with biopsy-proven, untreated, unfavorable intermediate or high-risk PCa with 0 to four metastases or equivocal for extensive metastases (more than four) who underwent PET between May 2018 and December 2020. The diagnostic performance of PET in detecting pelvic nodal and distant metastases was compared with conventional imaging alone. Metastatic sites at conventional imaging and PET were compared with a composite reference standard including histopathologic analysis, correlative imaging, and/or clinical and biochemical follow-up. The intended treatment before PET was compared with the treatment plan established after performing PET. Detection rate, sensitivity, and specificity of conventional imaging and PET were compared by using McNemar exact test on paired proportions. Results The study consisted of 108 men (median age, 66 years; IQR, 61-73 years) with no metastases (n = 84), with oligometastases (four or fewer metastases; 22 men), or with equivocal findings for extensive metastases (n = 2). Detection rates at PET and conventional imaging for nodal metastases were 34% (37 of 108) and 11% (12 of 108) (P < .001), respectively, and those for distant metastases were 22% (24 of 108) and 10% (11 of 108) (P = .02), respectively. PET altered stage in 43 of 108 (40%) and treatment in 24 of 108 (22%) men. The most frequent treatment change was from systemic to local-regional therapy in 10 of 108 (9%) and from local-regional to systemic therapy in nine of 108 (8%) men. Equivocal findings were encountered less frequently with PET (one of 108; 1%) than with conventional imaging (29 of 108; 27%). Conclusion Initial staging with 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine 3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) PET after conventional imaging (bone scan and CT with or without multiparametric MRI) helped to detect more nodal and distant metastases than conventional imaging alone and changed treatment in 22% of men. Clinical trial registration no. NCT03535831, NCT03718260 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Jadvar in this issue.
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Affiliation(s)
- Adriano Basso Dias
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Antonio Finelli
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Glenn Bauman
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Patrick Veit-Haibach
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Alejandro Berlin
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Claudia Ortega
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Lisa Avery
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
| | - Ur Metser
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, Canada M5G 2M9 (A.B.D., P.V.H., C.O., U.M.); Division of Urology, Department of Surgery (A.F.), Department of Radiation Oncology (A.B.), and Department of Biostatistics (L.A.), Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; and Department of Oncology, Western University, London, Canada (G.B.)
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27
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Schieda N, Oto A, Allen BC, Akin O, Barker SJ, Fulgham PF, Gettle LM, Maranchie JK, Patel BN, Schuster DM, Smith D, Turkbey IB, Lockhart ME. ACR Appropriateness Criteria® Staging and Surveillance of Testicular Cancer: 2021 Update. J Am Coll Radiol 2022; 19:S194-S207. [PMID: 35550802 DOI: 10.1016/j.jacr.2022.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023]
Abstract
The staging and surveillance of testicular cancer is a complex topic, which integrates clinical, biochemical, and imaging components. The use of imaging for staging and surveillance of testicular cancer is individually tailored to each patient by considering tumor histology and prognosis. This document discusses the rationale for use of imaging by imaging modality during the initial staging of testicular seminoma and nonseminoma tumors and during the planned surveillance of stage IA and IB testicular cancer by histological subtype integrating clinical suspicion for disease recurrence in surveillance protocols. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Nicola Schieda
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada.
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Brian C Allen
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York; Director of Body MRI
| | - Samantha J Barker
- University of Minnesota, Minneapolis, Minnesota; Director of Body Ultrasound M Health Fairview
| | - Pat F Fulgham
- Urology Clinics of North Texas, Dallas, Texas; American Urological Association; Chairman of the Department of Urology, Texas Health Presbyterian Hospital of Dallas
| | | | | | - Bhavik N Patel
- Stanford University Medical Center, Stanford, California; Director of AI
| | | | - Dan Smith
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada, Primary care physician
| | - Ismail B Turkbey
- National Institutes of Health, Bethesda, Maryland; Staff Clinician at NIH
| | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama; Chair, ACR Appropriateness Committee
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Borgheresi A, De Muzio F, Agostini A, Ottaviani L, Bruno A, Granata V, Fusco R, Danti G, Flammia F, Grassi R, Grassi F, Bruno F, Palumbo P, Barile A, Miele V, Giovagnoni A. Lymph Nodes Evaluation in Rectal Cancer: Where Do We Stand and Future Perspective. J Clin Med 2022; 11:jcm11092599. [PMID: 35566723 PMCID: PMC9104021 DOI: 10.3390/jcm11092599] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 12/12/2022] Open
Abstract
The assessment of nodal involvement in patients with rectal cancer (RC) is fundamental in disease management. Magnetic Resonance Imaging (MRI) is routinely used for local and nodal staging of RC by using morphological criteria. The actual dimensional and morphological criteria for nodal assessment present several limitations in terms of sensitivity and specificity. For these reasons, several different techniques, such as Diffusion Weighted Imaging (DWI), Intravoxel Incoherent Motion (IVIM), Diffusion Kurtosis Imaging (DKI), and Dynamic Contrast Enhancement (DCE) in MRI have been introduced but still not fully validated. Positron Emission Tomography (PET)/CT plays a pivotal role in the assessment of LNs; more recently PET/MRI has been introduced. The advantages and limitations of these imaging modalities will be provided in this narrative review. The second part of the review includes experimental techniques, such as iron-oxide particles (SPIO), and dual-energy CT (DECT). Radiomics analysis is an active field of research, and the evidence about LNs in RC will be discussed. The review also discusses the different recommendations between the European and North American guidelines for the evaluation of LNs in RC, from anatomical considerations to structured reporting.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
| | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
| | - Letizia Ottaviani
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale IRCCS di Napoli, 80131 Naples, Italy;
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Napoli, Italy
- Correspondence:
| | - Ginevra Danti
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Federica Flammia
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Roberta Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Francesca Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Abruzzo Health Unit 1, Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, 67100 L’Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
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29
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Tuberculosis of abdominal lymph nodes, peritoneum, and GI tract: a malignancy mimic. Abdom Radiol (NY) 2022; 47:1775-1787. [PMID: 35292843 DOI: 10.1007/s00261-022-03472-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The purpose is to discuss abdominal tuberculosis mimicking malignancy involving the lymph nodes, peritoneum, and the GI tract. CONCLUSION Awareness of the pathophysiology and imaging appearance on various modalities of abdominal tuberculosis involving the lymph nodes, peritoneum, and the GI tract that may simulate malignancy can aid differentiation, diagnosis, and therapy, particularly in areas where tuberculosis is endemic.
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30
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Virarkar M, Vulasala SS, Daoud T, Javadi S, Lall C, Bhosale P. Vulvar Cancer: 2021 Revised FIGO Staging System and the Role of Imaging. Cancers (Basel) 2022; 14:2264. [PMID: 35565394 PMCID: PMC9102312 DOI: 10.3390/cancers14092264] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 01/27/2023] Open
Abstract
Vulvar cancer is a rare gynecological malignancy. It constitutes 5-8% of all gynecologic neoplasms, and squamous cell carcinoma is the most common variant. This article aims to review the etiopathogenesis revised 2021 International Federation of Gynecology and Obstetrics (FIGO) classification and emphasize imaging in the staging of vulvar cancer. The staging has been regulated by FIGO since 1969 and is subjected to multiple revisions. Previous 2009 FIGO classification is limited by the prognostic capability, which prompted the 2021 revisions and issue of a new FIGO classification. Although vulvar cancer can be visualized clinically, imaging plays a crucial role in the staging of the tumor, assessing the tumor extent, and planning the management. In addition, sentinel lymph node biopsy facilitates the histopathological staging of the draining lymph node, thus enabling early detection of tumor metastases and better survival rates.
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Affiliation(s)
- Mayur Virarkar
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA; (M.V.); (C.L.)
| | - Sai Swarupa Vulasala
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA; (M.V.); (C.L.)
| | - Taher Daoud
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (T.D.); (S.J.); (P.B.)
| | - Sanaz Javadi
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (T.D.); (S.J.); (P.B.)
| | - Chandana Lall
- Department of Diagnostic Radiology, University of Florida College of Medicine, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL 32209, USA; (M.V.); (C.L.)
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA; (T.D.); (S.J.); (P.B.)
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Starmans MPA, Ho LS, Smits F, Beije N, de Kruijff I, de Jong JJ, Somford DM, Boevé ER, te Slaa E, Cauberg ECC, Klaver S, van der Heijden AG, Wijburg CJ, van de Luijtgaarden ACM, van Melick HHE, Cauffman E, de Vries P, Jacobs R, Niessen WJ, Visser JJ, Klein S, Boormans JL, van der Veldt AAM. Optimization of Preoperative Lymph Node Staging in Patients with Muscle-Invasive Bladder Cancer Using Radiomics on Computed Tomography. J Pers Med 2022; 12:jpm12050726. [PMID: 35629148 PMCID: PMC9147130 DOI: 10.3390/jpm12050726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 12/10/2022] Open
Abstract
Approximately 25% of the patients with muscle-invasive bladder cancer (MIBC) who are clinically node negative have occult lymph node metastases at radical cystectomy (RC) and pelvic lymph node dissection. The aim of this study was to evaluate preoperative CT-based radiomics to differentiate between pN+ and pN0 disease in patients with clinical stage cT2-T4aN0-N1M0 MIBC. Patients with cT2-T4aN0-N1M0 MIBC, of whom preoperative CT scans and pathology reports were available, were included from the prospective, multicenter CirGuidance trial. After manual segmentation of the lymph nodes, 564 radiomics features were extracted. A combination of different machine-learning methods was used to develop various decision models to differentiate between patients with pN+ and pN0 disease. A total of 209 patients (159 pN0; 50 pN+) were included, with a total of 3153 segmented lymph nodes. None of the individual radiomics features showed significant differences between pN+ and pN0 disease, and none of the radiomics models performed substantially better than random guessing. Hence, CT-based radiomics does not contribute to differentiation between pN+ and pN0 disease in patients with cT2-T4aN0-N1M0 MIBC.
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Affiliation(s)
- Martijn P. A. Starmans
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
- Correspondence: ; Tel.: +31-10-704-10-26
| | - Li Shen Ho
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
| | - Fokko Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
| | - Nick Beije
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (N.B.); (I.d.K.)
| | - Inge de Kruijff
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (N.B.); (I.d.K.)
| | - Joep J. de Jong
- Department of Urology, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (J.J.d.J.); (J.L.B.)
| | - Diederik M. Somford
- Department of Urology, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands;
| | - Egbert R. Boevé
- Department of Urology, Franciscus Gasthuis & Vlietland, 3045 PM Rotterdam, The Netherlands;
| | - Ed te Slaa
- Department of Urology, Isala, 8025 AB Zwolle, The Netherlands; (E.t.S.); (E.C.C.C.)
| | | | - Sjoerd Klaver
- Department of Urology, Maasstad, 3079 DZ Rotterdam, The Netherlands;
| | | | - Carl J. Wijburg
- Department of Urology, Rijnstate, 6815 AD Arnhem, The Netherlands;
| | | | - Harm H. E. van Melick
- Department of Urology, St Antonius Ziekenhuis, Nieuwegein, 3543 AZ Utrecht, The Netherlands;
| | - Ella Cauffman
- Department of Urology, Zuyderland, 6162 BG Sittard, The Netherlands; (E.C.); (P.d.V.); (R.J.)
| | - Peter de Vries
- Department of Urology, Zuyderland, 6162 BG Sittard, The Netherlands; (E.C.); (P.d.V.); (R.J.)
| | - Rens Jacobs
- Department of Urology, Zuyderland, 6162 BG Sittard, The Netherlands; (E.C.); (P.d.V.); (R.J.)
| | - Wiro J. Niessen
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
| | - Jacob J. Visser
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
| | - Stefan Klein
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
| | - Joost L. Boormans
- Department of Urology, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (J.J.d.J.); (J.L.B.)
| | - Astrid A. M. van der Veldt
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (L.S.H.); (F.S.); (W.J.N.); (J.J.V.); (S.K.); (A.A.M.v.d.V.)
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (N.B.); (I.d.K.)
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Is there a diagnostic benefit of late-phase abdomino-pelvic PET/CT after urination as part of whole-body 68 Ga-PSMA-11 PET/CT for restaging patients with biochemical recurrence of prostate cancer after radical prostatectomy? EJNMMI Res 2022; 12:12. [PMID: 35244791 PMCID: PMC8897520 DOI: 10.1186/s13550-022-00885-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/15/2022] [Indexed: 12/31/2022] Open
Abstract
Background To assess the diagnostic value of an additional late-phase PET/CT scan after urination as part of 68 Ga-PSMA-11 PET/CT for the restaging of patients with biochemically recurrent prostate cancer (BCR). Methods This retrospective trial included patients with BCR following radical prostatectomy, who underwent standard whole-body early-phase PET/CT performed 105 ± 45 min and an additional late-phase PET/CT performed 159 ± 13 min after injection of 68 Ga-PSMA-11. Late-phase PET/CT covered a body volume from below the liver to the upper thighs and was conducted after patients had used the bathroom to empty their urinary bladder. Early- and late-phase images were evaluated regarding lesion count, type, localisation, and SUVmax. Reference standard was histopathology and/or follow-up imaging. Results Whole-body early-phase PET/CT detected 93 prostate cancer lesions in 33 patients. Late-phase PET/CT detected two additional lesions in two patients, both local recurrences. In total, there were 57 nodal, 28 bone, and 3 lung metastases, and 7 local recurrences. Between early- and late-phase PET/CT, lymph node metastases showed a significant increase of SUVmax from 14.5 ± 11.6 to 21.5 ± 17.6 (p = 0.00007), translating to a factor of + 1.6. Benign lymph nodes in the respective regions showed a significantly lower increase of SUVmax of 1.4 ± 0.5 to 1.7 ± 0.5 (p = 0.0014, factor of + 1.2). Local recurrences and bone metastases had a SUVmax on late-phase PET/CT that was + 1.7 and + 1.1 times higher than the SUVmax on early-phase PET/CT, respectively. Conclusion In patients with BCR following radical prostatectomy, an additional abdomino-pelvic late-phase 68 Ga-PSMA-11 PET/CT scan performed after emptying the urinary bladder may help to detect local recurrences missed on standard whole-body 68 Ga-PSMA-11 PET/CT. Lymph node metastases show a higher SUVmax and a stronger increase of SUVmax than benign lymph nodes on late-phase PET/CT, hence, biphasic 68 Ga-PSMA-11 PET/CT might help to distinguish between malignant and benign nodes. Bone metastases, and especially local recurrences, also demonstrate a metabolic increase over time.
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Restaino S, Buda A, Puppo A, Capozzi VA, Sozzi G, Casarin J, Gallitelli V, Murgia F, Vizzielli G, Baroni A, Corrado G, Pasciuto T, Ferrari D, Novelli A, Berretta R, Legge F, Vizza E, Chiantera V, Ghezzi F, Landoni F, Scambia G, Fanfani F. Anatomical distribution of sentinel lymph nodes in patients with endometrial cancer: a multicenter study. Int J Gynecol Cancer 2022; 32:517-524. [PMID: 35110375 DOI: 10.1136/ijgc-2021-003253] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Sentinel lymph node (SLN) mapping represents the standard approach in uterine confined endometrial cancer patients. The aim of this study was to evaluate the anatomical distribution of SLNs and the most frequent locations of nodal metastasis. METHODS This was an observational retrospective multicenter study involving eight high volume gynecologic cancer centers in Italy. We reviewed 1576 patients with a histologically confirmed diagnosis of endometrial cancer from September 2015 to June 2020. All patients underwent total hysterectomy with salpingo-ophorectomy and SLN mapping. RESULTS A total of 3105 SLNs were mapped and removed, 2809 (90.5%) of these were bilateral and 296 (9.5%) unilateral. The overall detection rate was 93.4% (77.9% bilateral and 15.5% unilateral). The majority of SLNs (80%) and positive SLNs (77.8%) were found at the external iliac and obturator level in both endometrioid and non-endometrioid endometrial cancer. Negative SLNs were more frequent in patients with endometrioid compared with non-endometrioid cancer (91.9% vs 86.1%, p<0.0001). Older patients, a higher body mass index, and non-endometrioid histology were more likely to have 'no mapping' (p<0.0001). Univariate and multivariate analysis showed that higher body mass index and age at surgery were independent predictive factors of empty node packet and fat tissue (p=0.029 and p<0.01, respectively). CONCLUSION The most frequent sites of SLNs and metastases were located in the pelvic area below the iliac vessel bifurcation. Our findings showed that older age, a higher body mass index, and non-endometrioid histology had a negative impact on mapping.
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Affiliation(s)
- Stefano Restaino
- Department of Obstetrics, Gynecology, and Pediatrics, Obstetrics and Gynecology Unit, Udine University Hospital, DAME, Udine, Italy
| | - Alessandro Buda
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.,Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Andrea Puppo
- Clinic of Obstetrics and Gynecology, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | - Giulio Sozzi
- Department of Gynecologic Oncology, Università di Palermo, Palermo, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy
| | | | - Ferdinando Murgia
- Obstetrics and Gynecology Unit, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Giuseppe Vizzielli
- Department of Obstetrics, Gynecology, and Pediatrics, Obstetrics and Gynecology Unit, Udine University Hospital, DAME, Udine, Italy.,Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, Udine, Italy
| | | | | | - Tina Pasciuto
- Research Core Facilty Data Collection G-STeP, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Largo Agostino Gemelli 8, Rome, Italy
| | - Debora Ferrari
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Antonia Novelli
- Department of Gynaecology and Obstetrics, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Roberto Berretta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Legge
- Obstetrics and Gynecology Unit, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Enrico Vizza
- Department of Experimental Clinical Oncology, IRCCS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, Università di Palermo, Palermo, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy
| | - Fabio Landoni
- Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy.,UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Francesco Fanfani
- Department of Obstetrics and Gynecology, University of Insubria, Women's and Children's Del Ponte Hospital, Varese, Italy .,UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
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Sluckin TC, Couwenberg AM, Lambregts DM, Hazen SMJ, Horsthuis K, Meijnen P, Beets-Tan RG, Tanis PJ, Marijnen CA, Kusters M. Lateral lymph nodes in rectal cancer: do we all think the same? A review of multidisciplinary obstacles and treatment recommendations. Clin Colorectal Cancer 2022; 21:80-88. [DOI: 10.1016/j.clcc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/11/2022]
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35
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Mori T, Kato H, Kawaguchi M, Hatano Y, Ishihara T, Noda Y, Hyodo F, Matsuo M, Furui T, Morishige KI. A comparative analysis of MRI findings in endometrial cancer: differentiation between endometrioid adenocarcinoma, serous carcinoma, and clear cell carcinoma. Eur Radiol 2022; 32:4128-4136. [DOI: 10.1007/s00330-021-08512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/19/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022]
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36
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Fuller LD, Dunn A, Huber AR, Vyas M, Gonzalez RS. Clinicopathologic Features of Gynecologic Malignancies Presenting Clinically as Colonic Malignancies. Am J Clin Pathol 2022; 157:82-89. [PMID: 34302332 DOI: 10.1093/ajcp/aqab097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To systematically evaluate gynecologic malignancies (adnexal or uterine) causing gastrointestinal (GI) signs (eg, mass on colonoscopy) or symptoms (eg, bloody stools) clinically mimicking a GI primary malignancy. METHODS The archives of 2 institutions were retrospectively reviewed for gynecologic malignancies clinically manifesting as colonic lesions. For each case, available radiologic, endoscopic, and histologic findings were recorded. RESULTS We identified 16 cases: 13 biopsies and 3 resections. The masses were localized in the rectosigmoid (14 cases [88%]), right (1 case [6%]), and transverse (1 case [6%]) colon. Gastrointestinal-type complaints included abdominal pain, weight loss, hematochezia, and obstruction; 1 case was asymptomatic and found during screening colonoscopy. Nine patients (56%) had no known prior gynecologic malignancy, and in only 2 of these patients was there some clinical suspicion of a noncolonic primary malignancy. Most cases (13 [81%]) were serous carcinoma, usually high-grade adnexal or primary peritoneal. Six cases (38%) directly extended into the colon, and 7 (44%) metastasized; route of spread was unclear in the others. Only 1 case (6%) showed mucosal involvement, and none showed desmoplasia or dirty necrosis. Four of the 13 serous carcinomas (31%) showed psammoma bodies. CONCLUSIONS Advanced gynecologic malignancies, most commonly serous carcinoma, can rarely manifest as GI lesions. Clues to noncolonic origin on biopsy include lack of colonic mucosal involvement/dysplasia, desmoplasia, or dirty necrosis.
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Affiliation(s)
| | - Andrew Dunn
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Aaron R Huber
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Monika Vyas
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Raul S Gonzalez
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Simu P, Jung I, Banias L, Fulop ZZ, Bara T, Simu I, Andone S, Staden RISV, Satala CB, Halmaciu I, Gurzu S. In-House Validated Map of Lymph Node Stations in a Prospective Cohort of Colorectal Cancer: A Tool for a Better Preoperative Staging. JOURNAL OF ONCOLOGY 2022; 2022:1788004. [PMID: 35345517 PMCID: PMC8957432 DOI: 10.1155/2022/1788004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/06/2022] [Accepted: 03/07/2022] [Indexed: 02/05/2023]
Abstract
Preoperative staging of colorectal cancer (CRC) based on imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) is crucial for identification and then removal of the positive lymph nodes (LNs). The aim of this study was to evaluate the correlation between preoperatively seen morphologic criteria (number, size, shape, structure, borders, or enhancement patterns) and histopathological features of LNs using an in-house validated map of nodal stations. A total of 112 patients with CRC that underwent surgery were preoperatively evaluated by CT scans. The locoregional, intermediate, and central LNs were CT-mapped and then removed during open laparotomy and examined under microscope. The analysis of correlations was interpreted using the suspicious-to-positive ratio (SPR) parameter. The greatest correlation was found in tumors located in the sigmoid colon, descending colon and middle rectum; SPR value was 1.12, 1.18, and 1.26, respectively. SPR proved to be 0.59 for cases of the transverse colon. Regarding the enhancement type, the dotted pattern was mostly correlated with metastatic LNs (OR: 7.84; p < 0.0001), while the homogenous pattern proved a reliable indicator of nonmetastatic LNs (OR: 1.99; p < 0.05). A total of 1809 LNs were harvested, with a median value of 15 ± 1.34 LNs/case. Transdisciplinary approach of CRC focused on pre-, intra-, and postoperatively mapping of LNs might increase the accuracy of detecting metastasized nodes for tumors of the distal colon and middle rectum but not for those of the transverse colon. In addition to morphologic criteria, the enhancement pattern of LNs can be used as a predictor of nodal involvement improving the CT-based preoperative staging.
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Affiliation(s)
- Patricia Simu
- 1Department of Radiology and Imaging, Clinical County Emergency Hospital, Targu Mures, Romania
- 2Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Ioan Jung
- 2Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Laura Banias
- 2Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Zsolt Zoltan Fulop
- 3Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
| | - Tivadar Bara
- 3Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
| | - Iunius Simu
- 1Department of Radiology and Imaging, Clinical County Emergency Hospital, Targu Mures, Romania
| | - Sebastian Andone
- 4Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Raluca Ioana Stefan-van Staden
- 5Laboratory of Electrochemistry and PATLAB, National Institute of Research for Electrochemistry and Condensed Matter, Bucharest, Romania
| | - Catalin Bogdan Satala
- 2Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Ioana Halmaciu
- 1Department of Radiology and Imaging, Clinical County Emergency Hospital, Targu Mures, Romania
- 6Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
| | - Simona Gurzu
- 2Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
- 7Research Center of Oncopathology and Transdisciplinary Research, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
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38
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Rockall AG, Barwick TD, Wilson W, Singh N, Bharwani N, Sohaib A, Nobbenhuis M, Warbey V, Miquel M, Koh DM, De Paepe KN, Martin-Hirsch P, Ghaem-Maghami S, Fotopoulou C, Stringfellow H, Sundar S, Manchanda R, Sahdev A, Hackshaw A, Cook GJ. Diagnostic Accuracy of FEC-PET/CT, FDG-PET/CT, and Diffusion-Weighted MRI in Detection of Nodal Metastases in Surgically Treated Endometrial and Cervical Carcinoma. Clin Cancer Res 2021; 27:6457-6466. [PMID: 34526364 PMCID: PMC9401562 DOI: 10.1158/1078-0432.ccr-21-1834] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/14/2021] [Accepted: 09/13/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Preoperative nodal staging is important for planning treatment in cervical cancer and endometrial cancer, but remains challenging. We compare nodal staging accuracy of 18F-ethyl-choline-(FEC)-PET/CT, 18F-fluoro-deoxy-glucose-(FDG)-PET/CT, and diffusion-weighted-MRI (DW-MRI) with conventional morphologic MRI. EXPERIMENTAL DESIGN A prospective, multicenter observational study of diagnostic accuracy for nodal metastases was undertaken in 5 gyne-oncology centers. FEC-PET/CT, FDG-PET/CT, and DW-MRI were compared with nodal size and morphology on MRI. Reference standard was strictly correlated nodal histology. Eligibility included operable cervical cancer stage ≥ 1B1 or endometrial cancer (grade 3 any stage with myometrial invasion or grade 1-2 stage ≥ II). RESULTS Among 162 consenting participants, 136 underwent study DW-MRI and FDG-PET/CT and 60 underwent FEC-PET/CT. In 118 patients, 267 nodal regions were strictly correlated at histology (nodal positivity rate, 25%). Sensitivity per patient (n = 118) for nodal size, morphology, DW-MRI, FDG- and FEC-PET/CT was 40%*, 53%, 53%, 63%*, and 67% for all cases (*, P = 0.016); 10%, 10%, 20%, 30%, and 25% in cervical cancer (n = 40); 65%, 75%, 70%, 80% and 88% in endometrial cancer (n = 78). FDG-PET/CT outperformed nodal size (P = 0.006) and size ratio (P = 0.04) for per-region sensitivity. False positive rates were all <10%. CONCLUSIONS All imaging techniques had low sensitivity for detection of nodal metastases and cannot replace surgical nodal staging. The performance of FEC-PET/CT was not statistically different from other techniques that are more widely available. FDG-PET/CT had higher sensitivity than size in detecting nodal metastases. False positive rates were low across all methods. The low false positive rate demonstrated by FDG-PET/CT may be helpful in arbitration of challenging surgical planning decisions.
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Affiliation(s)
- Andrea G. Rockall
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom.,Corresponding Author: Andrea G. Rockall, Division of Surgery and Cancer, Imperial College London, ICTEM Building, Hammersmith Campus, Du Cane Road, London W12 0NS, United Kingdom. E-mail:
| | - Tara D. Barwick
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - William Wilson
- Cancer Research UK & UCL Cancer Trials Centre, University College London, United Kingdom
| | - Naveena Singh
- Department of Pathology, Barts Health NHS Trust, London, United Kingdom
| | - Nishat Bharwani
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Aslam Sohaib
- Department of Radiology, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Marielle Nobbenhuis
- Department of Gynaeoncology, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Victoria Warbey
- Department of Radiology, Guys and St Thomas' NHS Trust, London, United Kingdom
| | - Marc Miquel
- Clinical Physics, Barts Health NHS Trust, London, United Kingdom.,William Harvey Research Institute, Digital Environment Research Institute, Queen Mary University of London, London, United Kingdom
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Katja N. De Paepe
- Department of Radiology, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Pierre Martin-Hirsch
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Sadaf Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Gynaeoncology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Christina Fotopoulou
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Gynaeoncology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Helen Stringfellow
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Sudha Sundar
- Pan Birmingham Gynaecological Cancer Centre, City Hospital and Insitute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ranjit Manchanda
- Wolfson Institute of Preventive Medicine QMUL, London, United Kingdom.,Department of Gynaecological Oncology, Barts Health NHS Trust, London, United Kingdom.,Department of Health Services Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anju Sahdev
- Department of Radiology, St Bartholomews Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, University College London, United Kingdom
| | - Gary J. Cook
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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Dhamija E, Gulati M, Manchanda S, Singhal S, Sharma D, Kumar S, Bhatla N. Imaging in Carcinoma Cervix and Revised 2018 FIGO Staging System: Implications in Radiology Reporting. Indian J Radiol Imaging 2021; 31:623-634. [PMID: 34790308 PMCID: PMC8590564 DOI: 10.1055/s-0041-1735502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
The International Federation of Gynecology and Obstetrics (FIGO) staging system of carcinoma cervix saw a radical change in 2018 with the inclusion of cross-sectional imaging tools for the assessment of disease extent and staging. One of the major revisions is the inclusion of lymph node status, detected either on imaging or pathological evaluation, in the staging system. The changes were based on long-term patient follow-up and survival rates reported in literature. Thus, it becomes imperative for a radiologist to be well versed with the recent staging system, its limitations, and implications on the patient management.
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Affiliation(s)
- Ekta Dhamija
- Department of Radiodiagnosis, Dr B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Malvika Gulati
- Department of Radiodiagnosis, Dr B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, Dr B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Dayanand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Endometrial cancer from early to advanced-stage disease: an update for radiologists. Abdom Radiol (NY) 2021; 46:5325-5336. [PMID: 34297164 DOI: 10.1007/s00261-021-03220-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/23/2023]
Abstract
The purpose of this article is to review the current molecular classification of endometrial cancer, the imaging findings in early and advanced disease, and the current management strategies, focusing on the new systemic therapies for advanced EC. In recent years, the management of endometrial cancer has significantly changed. The molecular characterization of endometrial cancer has shed new light into the biologic behavior of this disease, the International Federation of Gynecology and Obstetrics staging system was recently revised, and imaging was formally incorporated in the management of endometrial cancer. Recent genomic analysis of endometrial cancer led to the approval of new molecular-targeted therapies and immune checkpoint inhibitors. Imaging allows assessment of myometrial invasion, cervical stromal extension, lymph node involvement and distant metastases, and has a crucial role for treatment planning. Treatment strategies, which include surgery, radiation and systemic therapies are based on accurate staging and risk stratification.
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Is elective inguinal or external iliac irradiation during neoadjuvant (chemo)radiotherapy necessary for locally advanced lower rectal cancer with anal sphincter invasion? Pract Radiat Oncol 2021; 12:125-134. [PMID: 34670136 DOI: 10.1016/j.prro.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/19/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the impact of excluding irradiation of inguinal lymph nodes (ILNs) and external iliac lymph nodes (ELNs) during neoadjuvant (chemo)radiotherapy in a locally advanced lower rectal cancer (LALRC) with anal sphincter invasion. MATERIALS AND METHODS A total of 214 LALRC patients with anal sphincter invasion according to pre-treatment magnetic resonance imaging who underwent neoadjuvant (chemo)radiotherapy followed by surgery between September 2010 and May 2019 were enrolled. ILNs and ELNs were clinically negative pre-treatment and were excluded from irradiation. Failure rates and patterns of ILNs and ELNs and survival were analyzed. Nomograms for predicting ILN and ELN failure risk were also constructed. RESULTS The median follow-up was 53.3 months. The three-year failure rates were 3.7% for ILNs and 3.3% for ELNs. Only one patient developed isolated ILN failure, and no patient experienced isolated ELN failure. Multivariate analyses demonstrated that lower edge of tumors invaded or located below the dentate line (odds ratio [OR] 7.513, P = 0.013), high histological grade (OR 6.892, P = 0.017), and perineural invasion (OR 7.111, P = 0.023) were significantly related to ILN failure. Both perineural invasion (OR 8.923, P = 0.011) and high histological grade (OR 8.129, P = 0.011) showed a strong correlation with ELN failure. The concordance index of nomograms for predicting ILN and ELN failure risk were 0.842 and 0.880, respectively. The three-year local recurrence free survival, disease-free survival, and overall survival were 94.6% (95% confidence interval [CI], 91.3%‒97.9%), 77.7% (95% CI, 71.8%‒83.6%), and 91.9% (95% CI, 87.8%‒96.0%), respectively, for the whole cohort. CONCLUSIONS Excluding ILNs and ELNs from irradiation was associated with an acceptably low failure risk for LALRC invading the anal sphincter. These findings help to refine existing guidelines for clinical target volume delineation of ILNs and ELNs during neoadjuvant (chemo)radiotherapy in rectal cancer.
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Hoffmann P, Balik M, Hoffmannova M, Spacek J, Vanasek J, Rezac A, Dvorak P. Long-term experience with percutaneous biopsies of pelvic lesions using CT guidance. Sci Prog 2021; 104:368504211058555. [PMID: 34918561 PMCID: PMC10450592 DOI: 10.1177/00368504211058555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To evaluate the accuracy, efficiency, complication rate, technical features, and relations among followed parameters of CT-guided percutaneous biopsies of the pelvic lesions. 140 biopsies in 136 patients for tumors, sizes 17-160 mm in largest diameter, were carried out in patients with probable tumorous pelvic process within ten years period. The patients were women in 77 cases and men in 59 cases, aged 21 to 87 years. The lesions´ size varied from 17 mm to 160 mm in largest diameter. In 135 biopsies (96.4%) results were true positive or true negative; only 5 procedures (3.6%) were histologically false negative and had to be verified surgically. Metastatic affection was the most common diagnosis (26.4%). Lymphomas were diagnosed in 25%; serous adenocarcinoma of ovary or uterine tube was verified in 15.7% of cases. Totally 7 complications (5%) were confirmed, all were minor hemorrhages. A statistically significant relation between the complication rate and hypervascular character (p = 0.00004), and between needle gauge and histological accuracy (p = 0.00429) was revealed. Core needle biopsy using percutaneous approach and CT guidance had a high overall accuracy in determining the final histological diagnosis including subtyping. Concurrently, the complication incidence was low.
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Affiliation(s)
- Petr Hoffmann
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Michal Balik
- Department of Urology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Martina Hoffmannova
- Faculty of Education, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jiri Spacek
- Department of Urology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Jiri Vanasek
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Adam Rezac
- Department of Gynecology and Obstetrics, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Petr Dvorak
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
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Tanis JB, Simlett-Moss AB, Ossowksa M, Maddox TW, Guillem J, Lopez-Jimenez C, Polton G, Burrow R, Finotello R. Canine anal sac gland carcinoma with regional lymph node metastases treated with sacculectomy and lymphadenectomy: Outcome and possible prognostic factors. Vet Comp Oncol 2021; 20:276-292. [PMID: 34590408 DOI: 10.1111/vco.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023]
Abstract
The staging system commonly used in canine anal sac gland carcinoma (ASGC) is a revised Tumour-Node-Metastasis (TNM) system published in 2007. This staging system consists in four stages and, for dogs with nodal metastases, the size of the metastatic lymph node (mLN) defines the N stage. However, we hypothesise that (1) the mLN size has no prognostic significance when the mLN can be excised, (2) a high number of mLNs is associated with poorer prognosis and (3) the measurement of the mLN on imaging is not reproducible. To investigate these hypotheses, medical records and diagnostic images of dogs with ASGC and mLN, treated with sacculectomy and lymphadenectomy, with or without chemotherapy, were reviewed. Interobserver variability for mLN measurement was assessed. Prognostic factors including mLN size and number were investigated. Time to documented progression (TDP) and disease-specific survival (DSS) were evaluated. Progression-free interval (PFI) was analysed with interval-censored data analysis. Fifty-seven dogs were included. The median PFI, TDP and DSS were 110 (95%CI 61.5-185.5), 196 (95%CI 162-283) and 340 days (95%CI 321-471), respectively. For measurement of the largest mLN, interobserver agreement was excellent but limits of agreement reached 39.7%. Neither the size of the largest mLN nor the use of adjuvant chemotherapy were associated with outcome. The number of mLNs was associated with outcome and having more than four mLNs was associated with shorter PFI (p < .001), TDP (p = .004) and DSS (p < .001). While mLN size measurement was not consistently reproducible and did not influence outcome in our cohort, number of mLNs did. Further studies are required for development of a revised staging system.
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Affiliation(s)
- Jean-Benoit Tanis
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK
| | - Angharad B Simlett-Moss
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK
| | - Malgorzata Ossowksa
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK
| | - Thomas W Maddox
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK
| | - James Guillem
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK
| | | | - Gerry Polton
- North Downs Specialist Referrals, Bletchingley, UK
| | - Rachel Burrow
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK.,Northwest Veterinary Specialists, Runcorn, UK
| | - Riccardo Finotello
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK
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Oncologic Imaging of the Lymphatic System: Current Perspective with Multi-Modality Imaging and New Horizon. Cancers (Basel) 2021; 13:cancers13184554. [PMID: 34572781 PMCID: PMC8465736 DOI: 10.3390/cancers13184554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
The lymphatic system is an anatomically complex vascular network that is responsible for interstitial fluid homeostasis, transport of large interstitial particles and cells, immunity, and lipid absorption in the gastrointestinal tract. This network of specially adapted vessels and lymphoid tissue provides a major pathway for metastatic spread. Many malignancies produce vascular endothelial factors that induce tumoral and peritumoral lymphangiogenesis, increasing the likelihood for lymphatic spread. Radiologic evaluation for disease staging is the cornerstone of oncologic patient treatment and management. Multiple imaging modalities are available to access both local and distant metastasis. In this manuscript, we review the anatomy, physiology, and imaging of the lymphatic system.
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Li H, Zhu M, Jian L, Bi F, Zhang X, Fang C, Wang Y, Wang J, Wu N, Yu X. Radiomic Score as a Potential Imaging Biomarker for Predicting Survival in Patients With Cervical Cancer. Front Oncol 2021; 11:706043. [PMID: 34485139 PMCID: PMC8415417 DOI: 10.3389/fonc.2021.706043] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/19/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Accurate prediction of prognosis will help adjust or optimize the treatment of cervical cancer and benefit the patients. We aimed to investigate the incremental value of radiomics when added to the FIGO stage in predicting overall survival (OS) in patients with cervical cancer. METHODS This retrospective study included 106 patients with cervical cancer (FIGO stage IB1-IVa) between October 2017 and May 2019. Patients were randomly divided into a training cohort (n = 74) and validation cohort (n = 32). All patients underwent contrast-enhanced computed tomography (CT) prior to treatment. The ITK-SNAP software was used to delineate the region of interest on pre-treatment standard-of-care CT scans. We extracted 792 two-dimensional radiomic features by the Analysis Kit (AK) software. Pearson correlation coefficient analysis and Relief were used to detect the most discriminatory features. The radiomic signature (i.e., Radscore) was constructed via Adaboost with Leave-one-out cross-validation. Prognostic models were built by Cox regression model using Akaike information criterion (AIC) as the stopping rule. A nomogram was established to individually predict the OS of patients. Patients were then stratified into high- and low-risk groups according to the Youden index. Kaplan-Meier curves were used to compare the survival difference between the high- and low-risk groups. RESULTS Six textural features were identified, including one gray-level co-occurrence matrix feature and five gray-level run-length matrix features. Only the FIGO stage and Radscore were independent risk factors associated with OS (p < 0.05). The C-index of the FIGO stage in the training and validation cohorts was 0.703 (95% CI: 0.572-0.834) and 0.700 (95% CI: 0.526-0.874), respectively. Correspondingly, the C-index of Radscore was 0.794 (95% CI: 0.707-0.880) and 0.754 (95% CI: 0.623-0.885). The incorporation of the FIGO stage and Radscore achieved better performance, with a C-index of 0.830 (95% CI: 0.738-0.922) and 0.772 (95% CI: 0.615-0.929), respectively. The nomogram based on the FIGO stage and Radscore could individually predict the OS probability with good discrimination and calibration. The high-risk patients had shorter OS compared with the low-risk patients (p < 0.05). CONCLUSION Radiomics has the potential for noninvasive risk stratification and may improve the prediction of OS in patients with cervical cancer when added to the FIGO stage.
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Affiliation(s)
- Handong Li
- Department of Radiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Miaochen Zhu
- Central Laboratory, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Lian Jian
- Department of Radiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Feng Bi
- Department of Radiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaoye Zhang
- Central Laboratory, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Chao Fang
- Department of Clinical Pharmaceutical Research Institution, Hunan Cancer Hospital, Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
| | - Ying Wang
- Central Laboratory, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jing Wang
- Gynecological Oncology Clinical Research Center, Hunan Cancer Hospital, Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
| | - Nayiyuan Wu
- Central Laboratory, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaoping Yu
- Department of Radiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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Santoro AA, Di Gianfrancesco L, Racioppi M, Pinto F, Palermo G, Sacco E, Campetella M, Scarciglia E, Bientinesi R, Di Paola V, Totaro A. Multiparametric magnetic resonance imaging of the prostate: Lights and shadows. Urologia 2021; 88:280-286. [PMID: 34075837 DOI: 10.1177/03915603211019982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prostate cancer is the second most commonly diagnosed cancer in man. Since the first MRI was performed, enormous progress has been made in diagnosis, treatment, and follow up of PCa, mainly due to multiparametric prostatic MRI (mpMRI). Although mpMRI has become the best imaging tool for identifying PCa, some limitations still exist. Prostate imaging with mpMRI is, to date, the best way to locate suspicious lesions to trigger prostate biopsy, plan active surveillance, or definitive treatment. In case of relapse, mpMRI can help detect local disease and provide specific management. It is well known that there is a subset of patients in whom mpMRI fails to depict csPCa. These missed significant cancers demand great attention. Prostate mpMRI quality depends on several factors related to equipment (including equipment vendor, magnet field and gradient strength, coil set used, software and hardware levels, sequence parameter choices), patient (medications, body habitus, motion, metal implants, rectal gas), and most importantly the radiologic interpretation of images (learning curve effects, subjectivity of observations, interobserver variations, and reporting styles). Inter-reader variability represents a huge current limitation of this method. Therefore, mpMRI remains the best imaging tool available to detect PCa, guiding diagnosis, treatment, and follow up while inter-reader variability represents the best limitation. Radiomics can help identifying imaging biomarkers to help radiologist in detecting significant PCa, reducing examination times, and costs.
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Affiliation(s)
- Agostino Antonio Santoro
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Luca Di Gianfrancesco
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Francesco Pinto
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Giuseppe Palermo
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Marco Campetella
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Eros Scarciglia
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Valerio Di Paola
- Department of Radiology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
| | - Angelo Totaro
- Department of Urology, Catholic University of the Sacred Heart - Fondazione Policlinico Universitario "A. Gemelli" - IRCSS, Rome, Italy
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Causa Andrieu PI, Woo S, Rios-Doria E, Sonoda Y, Ghafoor S. The role of imaging in pelvic exenteration for gynecological cancers. Br J Radiol 2021; 94:20201460. [PMID: 33960814 DOI: 10.1259/bjr.20201460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pelvic exenteration (PE) is one of the most challenging gynecologic oncologic surgeries and is an overriding term for different procedures that entail radical en bloc resection of the female reproductive organs and removal of additional adjacent affected pelvic organs (bladder, rectum, anus, etc.) with concomitant surgical reconstruction to restore bodily functions. Multimodality cross-sectional imaging with MRI, PET/CT, and CT plays an integral part in treatment decision-making, not only for the appropriate patient selection but also for surveillance after surgery. The purpose of this review is to provide a brief background on pelvic exenteration in gynecologic cancers and to familiarize the reader with the critical radiological aspects in the evaluation of patients for this complex procedure. The focus of this review will be on how imaging can aid in treatment planning and guide management.
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Affiliation(s)
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Eric Rios-Doria
- Department of Gynecological Surgery, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Yukio Sonoda
- Department of Gynecological Surgery, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Soleen Ghafoor
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Jeong H, Park KJ, Lee YJ, Kim HD, Kim JH, Yoon S, Hong B, Lee JL. The Prognosis and the Role of Adjuvant Chemotherapy for Node-Positive Bladder Cancer Treated with Neoadjuvant Chemotherapy Followed by Surgery. Cancer Res Treat 2021; 54:226-233. [PMID: 33957019 PMCID: PMC8756114 DOI: 10.4143/crt.2021.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aims to evaluate the prognosis of pathologically node-positive bladder cancer after neoadjuvant chemotherapy, the role of adjuvant chemotherapy in these patients, and the value of preoperative clinical evaluation for lymph node metastases. Materials and Methods Patients who received neoadjuvant chemotherapy followed by partial/radical cystectomy and had pathologically confirmed lymph node metastases between January 2007 and December 2019 were identified and analyzed. Results A total of 53 patients were included in the study. The median age was 61 years (range, 34 to 81 years) with males comprising 86.8%. Among the 52 patients with post-neoadjuvant/pre-operative computed tomography results, only 33 patients (63.5%) were considered positive for lymph node metastasis. Sixteen patients (30.2%) received adjuvant chemotherapy (AC group), and 37 patients did not (no AC group). With the median follow-up duration of 67.7 months, the median recurrence-free survival (RFS) and the median overall survival (OS) was 8.5 months and 16.2 months, respectively. The 2-year RFS and OS rates were 23.3% and 34.6%, respectively. RFS and OS did not differ between the AC group and no AC group (median RFS, 8.8 months vs. 6.8 months, p=0.772; median OS, 16.1 months vs. 16.3 months, p=0.479). Thirty-eight patients (71.7%) experienced recurrence. Distant metastases were the dominant pattern of failure in both the AC group (91.7%) and no AC group (76.9%). Conclusion Patients with lymph node-positive disease after neoadjuvant chemotherapy followed by surgery showed high recurrence rates with limited survival outcomes. Little benefit was observed with the addition of adjuvant chemotherapy.
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Affiliation(s)
- Hyehyun Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kye Jin Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Jun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Internal Medicine Division of Oncology, Haeundae Paik Hospital Cancer Center, Inje University College of Medicine, Busan, Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jwa Hoon Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Division of Oncology/Hematology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Shinkyo Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Lyun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kawaguchi M, Kato H, Hatano Y, Tomita H, Hara A, Miyazaki T, Matsuo M. Magnetic resonance imaging findings of extrauterine high-grade serous carcinoma based on new pathologic criteria for primary site assignment. Acta Radiol 2021; 62:687-694. [PMID: 32576024 DOI: 10.1177/0284185120934474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There has been no study that has reported magnetic resonance imaging (MRI) findings of extrauterine high-grade serous carcinomas (HGSCs) that have been histologically determined by the new criteria. PURPOSE To assess MRI findings of extrauterine HGSCs based on new pathologic criteria. MATERIAL AND METHODS Fifty patients with histopathologically proven extrauterine HGSCs, who underwent pretreatment gadolinium-enhanced MRI, were included in this study. After surgery, the primary sites were histopathologically determined based on new criteria for primary site assignment in extrauterine HGSCs as follows: fallopian tube (n = 34); ovary (n = 9); primary peritoneal HGSC (n = 1); and tubo-ovarian (n = 6). We retrospectively reviewed MR images and compared the MR findings between tubal and ovarian primaries. RESULTS MRI patterns with tubal primaries were classified as ovarian cancer (62%), peritoneal cancer (35%), and fallopian tube cancer (3%). MRI patterns with ovarian primaries were classified as ovarian cancer (78%) and peritoneal cancer (22%). The frequency of the involvement of the fallopian tube, ovary, peritoneum, uterus, and lymph node was not significantly different between the two pathologies. There was no significant difference in the abnormal amount of ascites, hemorrhagic ascites, or characteristics of the ovarian lesions between the two pathologies. CONCLUSION On MR images, tubal primaries almost always exhibited ovarian or peritoneal cancer pattern, but rarely exhibited fallopian tube cancer pattern. MR findings could not accurately differentiate between tubal and ovarian primaries; therefore, histopathologic investigation is essential for determination of the primary site of extrauterine HGSCs.
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Affiliation(s)
| | - Hiroki Kato
- Department of Radiology, Gifu University, Gifu, Japan
| | | | | | - Akira Hara
- Department of Tumor Pathology, Gifu University, Gifu, Japan
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Małkiewicz B, Kiełb P, Gurwin A, Knecht K, Wilk K, Dobruch J, Zdrojowy R. The Usefulness of Lymphadenectomy in Bladder Cancer-Current Status. ACTA ACUST UNITED AC 2021; 57:medicina57050415. [PMID: 33922894 PMCID: PMC8145304 DOI: 10.3390/medicina57050415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 12/13/2022]
Abstract
The purpose of this review is to present the current status of lymph node dissection (LND) during radical cystectomy in patients with bladder cancer (BCa). Despite the growing body of evidence of LND utility at the time of radical cystectomy (RC) in high-risk nonmuscle-invasive and muscle-invasive BCa (MIBC), therapeutic and prognostic value and optimal extent of LND remain unsolved issues. Recently published results of the first prospective, a randomized trial assessing the therapeutic benefit of extended versus limited LND during RC, failed to demonstrate survival improvement with the extended template. Although LND is the most accurate staging procedure, the direct therapeutic effect is still not evident from the current literature, limiting the possibility of establishing clear recommendations. This indicates the need for robust and adequately powered clinical trials.
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Affiliation(s)
- Bartosz Małkiewicz
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
- Correspondence: ; Tel.: +48-506-158-136
| | - Paweł Kiełb
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Adam Gurwin
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Klaudia Knecht
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Karol Wilk
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Jakub Dobruch
- First Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Romuald Zdrojowy
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
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