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Abstract
Ultrasound (US) lexicon of the Breast Imaging Reporting and Data System (BI-RADS) defines an echogenic breast mass as a lesion that is hyperechoic in comparison with subcutaneous adipose tissue. However, at sonography, only 0.6 to 5.6% of breast masses are echogenic and the majority of these lesions are benign. approximately, 0.5% of malignant breast lesions appear hyperechoic. The various benign pathologic entities that appear echogenic on US are lipoma, hematoma, seroma, fat necrosis, abscess, pseudoangiomatous stromal hyperplasia, galactocele, etc. The malignant diagnoses that may present as hyperechoic lesions on breast US are invasive ductal carcinoma, invasive lobular carcinoma, metastasis, lymphoma, and angiosarcoma. Echogenic breast masses need to be correlated with mammographic findings and clinical history. Lesions with worrisome features such as a spiculated margin, interval enlargement, interval vascularity, or association with suspicious microcalcifications on mammography require biopsy. In this article, we would like to present a pictorial review of patients who presented to our department with echogenic breast masses and were subsequently found to have various malignant as well as benign etiologies on histopathology.
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Affiliation(s)
- S K Ramani
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Navi Mumbai, Maharashtra, India
| | - Ashita Rastogi
- Department of Radiodiagnosis, Delhi State Cancer Institute, New Delhi, India
| | - Nita Nair
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tanuja M Shet
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Meenakshi H Thakur
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Baid U, Rane SU, Talbar S, Gupta S, Thakur MH, Moiyadi A, Mahajan A. Overall Survival Prediction in Glioblastoma With Radiomic Features Using Machine Learning. Front Comput Neurosci 2020; 14:61. [PMID: 32848682 PMCID: PMC7417437 DOI: 10.3389/fncom.2020.00061] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/27/2020] [Indexed: 02/05/2023] Open
Abstract
Glioblastoma is a WHO grade IV brain tumor, which leads to poor overall survival (OS) of patients. For precise surgical and treatment planning, OS prediction of glioblastoma (GBM) patients is highly desired by clinicians and oncologists. Radiomic research attempts at predicting disease prognosis, thus providing beneficial information for personalized treatment from a variety of imaging features extracted from multiple MR images. In this study, first-order, intensity-based volume and shape-based and textural radiomic features are extracted from fluid-attenuated inversion recovery (FLAIR) and T1ce MRI data. The region of interest is further decomposed with stationary wavelet transform with low-pass and high-pass filtering. Further, radiomic features are extracted on these decomposed images, which helped in acquiring the directional information. The efficiency of the proposed algorithm is evaluated on Brain Tumor Segmentation (BraTS) challenge training, validation, and test datasets. The proposed approach achieved 0.695, 0.571, and 0.558 on BraTS training, validation, and test datasets. The proposed approach secured the third position in BraTS 2018 challenge for the OS prediction task.
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Affiliation(s)
- Ujjwal Baid
- Department of Electronics and Telecommunication Engineering, Shri Guru Gobind Singhji Institute of Engineering and Technology, Nanded, India
| | - Swapnil U Rane
- Department of Pathology, Tata Memorial Centre, ACTREC, HBNI, Navi-Mumbai, India
| | - Sanjay Talbar
- Department of Electronics and Telecommunication Engineering, Shri Guru Gobind Singhji Institute of Engineering and Technology, Nanded, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, ACTREC, HBNI, Navi-Mumbai, India
| | - Meenakshi H Thakur
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Aliasgar Moiyadi
- Department of Neurosurgery Services, Tata Memorial Centre, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Tata Memorial Hospital, HBNI, Mumbai, India
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Baid U, Talbar S, Rane S, Gupta S, Thakur MH, Moiyadi A, Sable N, Akolkar M, Mahajan A. A Novel Approach for Fully Automatic Intra-Tumor Segmentation With 3D U-Net Architecture for Gliomas. Front Comput Neurosci 2020; 14:10. [PMID: 32132913 PMCID: PMC7041417 DOI: 10.3389/fncom.2020.00010] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/27/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose: Gliomas are the most common primary brain malignancies, with varying degrees of aggressiveness and prognosis. Understanding of tumor biology and intra-tumor heterogeneity is necessary for planning personalized therapy and predicting response to therapy. Accurate tumoral and intra-tumoral segmentation on MRI is the first step toward understanding the tumor biology through computational methods. The purpose of this study was to design a segmentation algorithm and evaluate its performance on pre-treatment brain MRIs obtained from patients with gliomas. Materials and Methods: In this study, we have designed a novel 3D U-Net architecture that segments various radiologically identifiable sub-regions like edema, enhancing tumor, and necrosis. Weighted patch extraction scheme from the tumor border regions is proposed to address the problem of class imbalance between tumor and non-tumorous patches. The architecture consists of a contracting path to capture context and the symmetric expanding path that enables precise localization. The Deep Convolutional Neural Network (DCNN) based architecture is trained on 285 patients, validated on 66 patients and tested on 191 patients with Glioma from Brain Tumor Segmentation (BraTS) 2018 challenge dataset. Three dimensional patches are extracted from multi-channel BraTS training dataset to train 3D U-Net architecture. The efficacy of the proposed approach is also tested on an independent dataset of 40 patients with High Grade Glioma from our tertiary cancer center. Segmentation results are assessed in terms of Dice Score, Sensitivity, Specificity, and Hausdorff 95 distance (ITCN intra-tumoral classification network). Result: Our proposed architecture achieved Dice scores of 0.88, 0.83, and 0.75 for the whole tumor, tumor core and enhancing tumor, respectively, on BraTS validation dataset and 0.85, 0.77, 0.67 on test dataset. The results were similar on the independent patients' dataset from our hospital, achieving Dice scores of 0.92, 0.90, and 0.81 for the whole tumor, tumor core and enhancing tumor, respectively. Conclusion: The results of this study show the potential of patch-based 3D U-Net for the accurate intra-tumor segmentation. From experiments, it is observed that the weighted patch-based segmentation approach gives comparable performance with the pixel-based approach when there is a thin boundary between tumor subparts.
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Affiliation(s)
- Ujjwal Baid
- Department of Electronics and Telecommunication Engineering, Shri Guru Gobind Singhji Institute of Engineering and Technology, Nanded, India
| | - Sanjay Talbar
- Department of Electronics and Telecommunication Engineering, Shri Guru Gobind Singhji Institute of Engineering and Technology, Nanded, India
| | - Swapnil Rane
- Department of Pathology, Tata Memorial Centre, Tata Memorial Hospital, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Mumbai, India
| | - Meenakshi H Thakur
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Tata Memorial Hospital, Mumbai, India
| | - Aliasgar Moiyadi
- Department of Neurosurgery Services, Tata Memorial Centre, Tata Memorial Hospital, Mumbai, India
| | - Nilesh Sable
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Tata Memorial Hospital, Mumbai, India
| | - Mayuresh Akolkar
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Tata Memorial Hospital, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Tata Memorial Hospital, Mumbai, India
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Singh S, Ramani SK, Rastogi A, Thakur MH. Incidence of internal mammary node in locally advanced breast cancer and its correlation with metastatic disease: a retrospective observational study. Br J Radiol 2019; 92:20190098. [PMID: 31538515 DOI: 10.1259/bjr.20190098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine incidence of internal mammary nodes (IMN) at baseline CT of locally advanced breast cancer (LABC) and ascertain prognostic implication. METHODS AND MATERIALS Retrospective review of all LABC patients from 1 January 2012 through 31 December 2014 was performed after approval from institutional review board. CTs of 182 patients enrolled were reviewed by two radiologists independently, and IMNs were documented based on size, location and relation with location of breast primary. 3-year follow-up was analysed and incidence of metastases was calculated as overall incidence, incidence in patients with and without discernible IMN at baseline imaging. Results are presented as numbers and percentages. Differences in metastases of two groups were compared using χ2 test. 95% CI was calculated and p < 0.05 was considered significant. RESULTS 77 of 182 had identifiable IMN (42.3% incidence). Majority of identifiable nodes were on ipsilateral side of primary (incidence 90.90%) with higher incidence in patients with upper-outer quadrant tumours (55.9%). Majority were seen in second intercostal space (44.4%). 36 (19.7%) developed distant metastases within 3 years of therapy. Of these, 21 (27.3%) had IMN as compared with 15 (14.3 %) without IMN on baseline imaging. Patients with identifiable IMN on baseline CT had significantly higher incidence of distant metastases (p = 0.0321). CONCLUSION Significant number LABC patients have identifiable IMN on baseline imaging with patients showing IMN on baseline CT showing significantly higher rate of metastatic disease following therapy. ADVANCES IN KNOWLEDGE Many LABC patients have identifiable IMNs on baseline imaging which show higher incidence of subsequent metastatic disease.
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Affiliation(s)
- Somesh Singh
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India
| | - Subhash K Ramani
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India
| | - Ashita Rastogi
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India
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Ramani SK, Rastogi A, Mahajan A, Nair N, Shet T, Thakur MH. Imaging of the treated breast post breast conservation surgery/oncoplasty: Pictorial review. World J Radiol 2017; 9:321-329. [PMID: 28932361 PMCID: PMC5583527 DOI: 10.4329/wjr.v9.i8.321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/01/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
Mammographic appearance of the normal breast is altered in the post-operative setting. It is essential to be aware of the normal findings as well as to identify features of recurrent disease with particular emphasis on radiological-pathological concordance. Digital breast tomosynthesis and volumetric breast density add incremental value in this clinical setting. We present a pictorial review of various cases to illustrate normal post-operative findings as well as mammographic features suspicious for recurrent disease.
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Affiliation(s)
- Subhash K Ramani
- Department of Radiodiagnosis, JJ Hospital, Mumbai 400008, India
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India
| | - Ashita Rastogi
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India
| | - Nita Nair
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai 400012, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Centre, Mumbai 400012, India
| | - Meenakshi H Thakur
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India
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Mahajan A, Rekhi B, Laskar S, Bajpai J, Jayasree L, Thakur MH. Primary pulmonary artery sarcoma masquerading as pulmonary thromboembolism: a rare diagnosis unveiled. Clin Sarcoma Res 2017; 7:13. [PMID: 28680558 PMCID: PMC5496329 DOI: 10.1186/s13569-017-0080-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 06/23/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Primary pulmonary artery sarcomas are rare malignant vascular tumors and carry a very poor prognosis. Due to overlapping clinical and radiological features, the differentiation between pulmonary artery thromboembolism and pulmonary artery sarcoma can be challenging. CASE PRESENTATION We herein present clinical, radiological and pathological features of primary pulmonary artery high grade sarcoma (angiosarcoma) in a 59-year-old male. The patient presented with a history of breathlessness on exertion of 2-months duration and was misdiagnosed as massive pulmonary thromboembolism on initial CT imaging. CONCLUSION Great similarity with significant degree of overlap in clinical and radiologic presentation makes differentiation of pulmonary artery sarcomas and thromboembolism a diagnostic challenge. Even though they are exceptionally rare, one should always consider it as differential diagnosis especially in cases with atypical clinical or imaging presentation.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Tata Memorial Centre, Room No 120, Dr E Borges Road, Parel, Mumbai, Maharashtra 400012 India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra 400012 India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra 400012 India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, 400012 India
| | - Lekshmy Jayasree
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Tata Memorial Centre, Room No 120, Dr E Borges Road, Parel, Mumbai, Maharashtra 400012 India
| | - Meenakshi H Thakur
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Tata Memorial Centre, Room No 120, Dr E Borges Road, Parel, Mumbai, Maharashtra 400012 India
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Mahajan A, Deshpande SS, Thakur MH. Diffusion magnetic resonance imaging: A molecular imaging tool caught between hope, hype and the real world of “personalized oncology”. World J Radiol 2017; 9:253-268. [PMID: 28717412 PMCID: PMC5491653 DOI: 10.4329/wjr.v9.i6.253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/08/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
“Personalized oncology” is a multi-disciplinary science, which requires inputs from various streams for optimal patient management. Humongous progress in the treatment modalities available and the increasing need to provide functional information in addition to the morphological data; has led to leaping progress in the field of imaging. Magnetic resonance imaging has undergone tremendous progress with various newer MR techniques providing vital functional information and is becoming the cornerstone of “radiomics/radiogenomics”. Diffusion-weighted imaging is one such technique which capitalizes on the tendency of water protons to diffuse randomly in a given system. This technique has revolutionized oncological imaging, by giving vital qualitative and quantitative information regarding tumor biology which helps in detection, characterization and post treatment surveillance of the lesions and challenging the notion that “one size fits all”. It has been applied at various sites with different clinical experience. We hereby present a brief review of this novel functional imaging tool, with its application in “personalized oncology”.
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Mahajan A, Sable NP, Popat PB, Bhargava P, Gangadhar K, Thakur MH, Arya S. Magnetic Resonance Imaging of Gynecological Malignancies: Role in Personalized Management. Semin Ultrasound CT MR 2016; 38:231-268. [PMID: 28705370 DOI: 10.1053/j.sult.2016.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Gynecological malignancies are a leading cause of mortality and morbidity in women and pose a significant health problem around the world. Currently used staging systems for management of gynecological malignancies have unresolved issues, the most important being recommendations on the use of imaging. Although not mandatory as per the International Federation of Gynecology and Obstetrics recommendations, preoperative cross-sectional imaging is strongly recommended for adequate and optimal management of patients with gynecological malignancies. Standardized disease-specific magnetic resonance imaging protocols help assess disease spread accurately and avoid pitfalls. Multiparametric imaging holds promise as a roadmap to personalized management in gynecological malignancies. In this review, we will highlight the role of magnetic resonance imaging in cervical, endometrial, and ovarian carcinomas.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Nilesh P Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Palak B Popat
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Kiran Gangadhar
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | | | - Supreeta Arya
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India.
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Affiliation(s)
| | - Mehul Patel
- All authors: Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Nilesh Sable
- All authors: Tata Memorial Centre, Mumbai, Maharashtra, India
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Chaudhari UK, Imran M, Manjramkar DD, Metkari SM, Sable NP, Gavhane DS, Katkam RR, Sachdeva G, Thakur MH, Kholkute SD. Use of ultrasound imaging for the diagnosis of abnormal uterine bleeding in the bonnet macaque ( Macaca radiata). Lab Anim 2016; 51:65-74. [PMID: 26946119 DOI: 10.1177/0023677216637304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ultrasound is a powerful, low-cost, non-invasive medical tool used by laboratory animal veterinarians for diagnostic imaging. Sonohysterography and transvaginal ultrasound are frequently used to assess uterine anomalies in women presenting with abnormal uterine bleeding (AUB). In the present study, we have evaluated the abdominal ultrasound of bonnet monkeys ( n = 8) showing spontaneous ovulatory ( n = 5) and anovulatory ( n = 3) AUB. The ovulatory ( n = 5) macaques showed cyclic AUB for 7-8 days. The anovulatory ( n = 3) macaques had irregular AUB with menstrual cycles of 40-45 days. The B-mode abdominal, colour Doppler and 3D ultrasound scans were performed during the proliferative phase of the menstrual cycle. Ultrasound examination revealed endometrial polyps in five macaques and endometrial hyperplasia in three animals. The width and length of endometrial polyps was around 0.5-1 cm (average 0.51 ± 0.23 cm × 0.96 ± 0.16 cm) with significant increase in endometrial thickness ( P < 0.0002). 3D ultrasound also showed a homogeneous mass in the uterine cavity and colour Doppler ultrasound showed increased vascularity in the endometrial polyps. Endometrial hyperplasia characteristically appeared as a thickened echogenic endometrium ( P < 0.0002). This study demonstrates the use of non-invasive ultrasound techniques in the diagnosis of AUB in macaques.
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Affiliation(s)
- Uddhav K Chaudhari
- 1 Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | - M Imran
- 1 Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | | | | | - Nilesh P Sable
- 3 Department of Radiodiagnosis, Tata Memorial Hospital (TMH), Parel, Mumbai, India
| | | | - Rajendra R Katkam
- 1 Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | - Geetanjali Sachdeva
- 1 Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | - Meenakshi H Thakur
- 3 Department of Radiodiagnosis, Tata Memorial Hospital (TMH), Parel, Mumbai, India
| | - Sanjeeva D Kholkute
- 1 Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
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Mahajan A, Engineer R, Chopra S, Mahanshetty U, Juvekar SL, Shrivastava SK, Desekar N, Thakur MH. Role of 3T multiparametric-MRI with BOLD hypoxia imaging for diagnosis and post therapy response evaluation of postoperative recurrent cervical cancers. Eur J Radiol Open 2015; 3:22-30. [PMID: 27069975 PMCID: PMC4811859 DOI: 10.1016/j.ejro.2015.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/21/2015] [Indexed: 02/08/2023] Open
Abstract
In operated cervix cancer, the accuracy of diagnosing vaginal vault/local recurrent lesions was higher at combined multiparametric MR imaging and conventional MR imaging (100%) than at conventional MR imaging (70%) or multiparametric MR imaging (96.7%) alone. We found a significant correlation between percentage tumor regression and pre-treatment parameters: NEI (p = 0.02), the maximum slope (p = 0.04), mADC value (p = 0.001) and amount of hypoxic fraction present in the pretherapy MRI (p = 0.01). Multiparametric and BOLD hypoxia MR Imaging are feasible and reliable in diagnosing post-operative recurrence in cervical cancer and should be applied when there is clinical suspicion of post-operative recurrence. Quantitative image features obtained at multiparametric-MRI with BOLD hypoxia imaging has potential to be an appropriate and reliable biologic target for radiation dose painting to optimize therapy in future.
Objectives To assess the diagnostic value of multiparametric-MRI (MPMRI) with hypoxia imaging as a functional marker for characterizing and detecting vaginal vault/local recurrence following primary surgery for cervical cancer. Methods With institutional review board approval and written informed consent 30 women (median age: 45 years) from October 2009 to March 2010 with previous operated carcinoma cervix and suspected clinical vaginal vault/local recurrence were examined with 3.0T-MRI. MRI imaging included conventional and MPMRI sequences [dynamic contrast enhanced (DCE), diffusion weighted (DW), 1H-MR spectroscopy (1HMRS), blood oxygen level dependent hypoxia imaging (BOLD)]. Two radiologists, blinded to pathologic findings, independently assessed the pretherapy MRI findings and then correlated it with histopathology findings. Sensitivity, specificity, positive predictive value, negative predictive value and their confidence intervals were calculated. The pre and post therapy conventional and MPMRI parameters were analyzed and correlated with response to therapy. Results Of the 30 patients, there were 24 recurrent tumors and 6 benign lesions. The accuracy of diagnosing recurrent vault lesions was highest at combined MPMRI and conventional MRI (100%) than at conventional-MRI (70%) or MPMRI (96.7%) alone. Significant correlation was seen between percentage tumor regression and pre-treatment parameters such as negative enhancement integral (NEI) (p = 0.02), the maximum slope (p = 0.04), mADC value (p = 0.001) and amount of hypoxic fraction on the pretherapy MRI (p = 0.01). Conclusion Conventional-MR with MPMRI significantly increases the diagnostic accuracy for suspected vaginal vault/local recurrence. Post therapy serial MPMRI with hypoxia imaging follow-up objectively documents the response. MPMRI and BOLD hypoxia imaging provide information regarding tumor biology at the molecular, subcellular, cellular and tissue levels and this information may be used as an appropriate and reliable biologic target for radiation dose painting to optimize therapy in future.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India; Department of Imaging Sciences and Biomedical Engineering, Kings College London, UK
| | - Reena Engineer
- Department of Radiation-Oncology, Tata Memorial Centre, Mumbai 400012, India
| | - Supriya Chopra
- Department of Radiation-Oncology, Tata Memorial Centre, Mumbai 400012, India
| | - Umesh Mahanshetty
- Department of Radiation-Oncology, Tata Memorial Centre, Mumbai 400012, India
| | - S L Juvekar
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India
| | - S K Shrivastava
- Department of Radiation-Oncology, Tata Memorial Centre, Mumbai 400012, India
| | - Naresh Desekar
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India
| | - M H Thakur
- Department of Radiodiagnosis and Imaging, Tata Memorial Centre, Mumbai 400012, India
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Mistry KA, Thakur MH, Kembhavi SA. The effect of chemotherapy on the mammographic appearance of breast cancer and correlation with histopathology. Br J Radiol 2015; 89:20150479. [PMID: 26495873 DOI: 10.1259/bjr.20150479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To document the mammographic changes after neoadjuvant chemotherapy with histopathological correlation, to calculate the accuracy of mammography (MG) in predicting residual tumour size and to measure the interobserver agreement in reading mammograms. METHODS In 446 consecutive cases, the pre- and post-chemotherapy mammograms were retrospectively evaluated by two blinded observers, and consensus findings were compared with reference standard of surgical specimen. The accuracy of MG in predicting residual tumour size was calculated. Kappa statistics were calculated for measuring the interobserver agreement for reading mammograms. The sensitivity, specificity, positive-predictive value and negative-predictive value for the prediction of residual disease were calculated. RESULTS The most common primary abnormalities were mass lesions without and with microcalcifications. After chemotherapy, there was decrease in size of most (95.1%) of the measurable masses, with decrease in the mean tumour size from 4.1 to 2.5 cm. The density of the tumour decreased in 66.6% (241/362) cases with residual disease. There was almost perfect interobserver agreement for describing the primary abnormality in the pre- as well as post-chemotherapy mammograms (k = 0.87 and 0.81, respectively) with substantial agreement for measurement of the mass lesions before and after chemotherapy (k = 0.69 and 0.68, respectively). MG showed accuracy of 60.0%, sensitivity of 94.4%, specificity of 50.0%, positive-predictive value of 91.3% and negative-predictive value of 61.8%. CONCLUSION MG remains a highly sensitive and reproducible investigation for the assessment of residual disease after chemotherapy. ADVANCES IN KNOWLEDGE There is substantial interobserver agreement in characterizing and measuring breast tumours on mammograms.
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Affiliation(s)
- Kunal A Mistry
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai, India
| | - Meenakshi H Thakur
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai, India
| | - Seema A Kembhavi
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai, India
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Mahajan A, Goh V, Basu S, Vaish R, Weeks AJ, Thakur MH, Cook GJ. Bench to bedside molecular functional imaging in translational cancer medicine: to image or to imagine? Clin Radiol 2015; 70:1060-82. [PMID: 26187890 DOI: 10.1016/j.crad.2015.06.082] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 02/05/2023]
Abstract
Ongoing research on malignant and normal cell biology has substantially enhanced the understanding of the biology of cancer and carcinogenesis. This has led to the development of methods to image the evolution of cancer, target specific biological molecules, and study the anti-tumour effects of novel therapeutic agents. At the same time, there has been a paradigm shift in the field of oncological imaging from purely structural or functional imaging to combined multimodal structure-function approaches that enable the assessment of malignancy from all aspects (including molecular and functional level) in a single examination. The evolving molecular functional imaging using specific molecular targets (especially with combined positron-emission tomography [PET] computed tomography [CT] using 2- [(18)F]-fluoro-2-deoxy-D-glucose [FDG] and other novel PET tracers) has great potential in translational research, giving specific quantitative information with regard to tumour activity, and has been of pivotal importance in diagnoses and therapy tailoring. Furthermore, molecular functional imaging has taken a key place in the present era of translational cancer research, producing an important tool to study and evolve newer receptor-targeted therapies, gene therapies, and in cancer stem cell research, which could form the basis to translate these agents into clinical practice, popularly termed "theranostics". Targeted molecular imaging needs to be developed in close association with biotechnology, information technology, and basic translational scientists for its best utility. This article reviews the current role of molecular functional imaging as one of the main pillars of translational research.
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Affiliation(s)
- A Mahajan
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK; Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, 400012, India.
| | - V Goh
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - S Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, 400 012, India
| | - R Vaish
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, 400012, India
| | - A J Weeks
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - M H Thakur
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, 400012, India
| | - G J Cook
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK; Department of Nuclear Medicine, Guy's and St Thomas NHS Foundation Trust Hospital, London, UK
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Deshpande SS, Thakur MH, Dholam K, Mahajan A, Arya S, Juvekar S. Osteoradionecrosis of the mandible: through a radiologist's eyes. Clin Radiol 2014; 70:197-205. [PMID: 25446325 DOI: 10.1016/j.crad.2014.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 09/01/2014] [Accepted: 09/17/2014] [Indexed: 02/08/2023]
Abstract
Head and neck malignancies constitute a major cause of morbidity and mortality all over the world. Radiotherapy plays a pivotal role in the management of these tumours; however, it has associated complications, with mandibular osteoradionecrosis (ORN) being one of the gravest orofacial complications. Early diagnosis, extent evaluation, and detection of complications of ORN are imperative for instituting an appropriate management protocol. ORN can closely mimic tumour recurrence, the differentiation of which has obvious clinical implications. The purpose of the present review is to acquaint the radiologist with the imaging features of mandibular ORN and the ways to differentiate ORN from tumour recurrence.
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Affiliation(s)
- S S Deshpande
- Department of Radiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai 400022, India
| | - M H Thakur
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - K Dholam
- Department of Dental and Prosthetic Surgery, Tata Memorial Hospital, Parel, Mumbai 400012, India.
| | - A Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - S Arya
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - S Juvekar
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, India
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Chaudhari UK, Metkari SM, Manjaramkar DD, Sachdeva G, Katkam R, Bandivdekar AH, Mahajan A, Thakur MH, Kholkute SD. Echography of the cervix and uterus during the proliferative and secretory phases of the menstrual cycle in bonnet monkeys (Macaca radiata). J Am Assoc Lab Anim Sci 2014; 53:18-23. [PMID: 24411775 PMCID: PMC3894643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/03/2013] [Accepted: 07/11/2013] [Indexed: 02/08/2023]
Abstract
We undertook the present study to investigate the echographic characteristics of the uterus and cervix of female bonnet monkeys ( Macaca radiata ) during the proliferative and secretory phases of the menstrual cycle. The cervix was tortuous in shape and measured 2.74 ± 0.30 cm (mean ± SD) in width by 3.10 ± 0.32 cm in length. The cervical lumen contained 2 or 3 colliculi, which projected from the cervical canal. The echogenicity of cervix varied during proliferative and secretory phases. The uterus was pyriform in shape (2.46 ± 0.28 cm × 1.45 ± 0.19 cm) and consisted of serosa, myometrium, and endometrium. The endometrium generated a triple-line pattern; the outer and central lines were hyperechogenic, whereas the inner line was hypoechogenic. The endometrium was significantly thicker during the secretory phase (0.69 ± 0.12 cm) than during the proliferative phase (0.43 ± 0.15 cm). Knowledge of the echogenic changes in the female reproductive organs of bonnet monkeys during a regular menstrual cycle may facilitate understanding of other physiologic and pathophysiologic changes.
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Affiliation(s)
- Uddhav K Chaudhari
- Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India.
| | - Siddnath M Metkari
- Animal House Facility, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | - Dhyananjay D Manjaramkar
- Animal House Facility, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | - Geetanjali Sachdeva
- Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | - Rajendra Katkam
- Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | - Atmaram H Bandivdekar
- Department of Biochemistry, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital (TMH), Parel, Mumbai, India
| | - Meenakshi H Thakur
- Department of Radiodiagnosis, Tata Memorial Hospital (TMH), Parel, Mumbai, India
| | - Sanjiv D Kholkute
- Department of Primate Biology, National Institute for Research in Reproductive Health (NIRRH), Indian Council of Medical Research (ICMR), Parel, Mumbai, India
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Chaudhari UK, Metkari SM, Sachdeva G, Katkam RR, Nimbkar-Joshi S, Manjaramkar DD, Mahajan A, Thakur MH, Kholkute SD. Endometrial polyps associated with endometrial hyperplasia in an obese bonnet monkey (Macaca radiata): a case report. J Med Primatol 2013; 42:333-5. [PMID: 23808706 DOI: 10.1111/jmp.12057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND A 10-year-old, female bonnet monkey (Macaca radiata) showed abnormal menstrual cycle length with heavy menstrual bleeding for 6-8 days. METHODS Uterine ultrasound and histological examinations of endometrium by endometrial biopsy. RESULTS An ultrasound examination of the uterine cavity showed presence of an enlarged polypoid mass. Further endometrial histology confirmed the presence of simple endometrial hyperplasia. CONCLUSIONS We report for the first time that endometrial polyp is associated with endometrial hyperplasia in obese bonnet monkey.
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Affiliation(s)
- U K Chaudhari
- Department of Primate Biology, National Institute for Research in Reproductive Health (ICMR), Mumbai, India
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Kembhavi SA, Choudhary H, Deodhar K, Thakur MH. Reactive intramammary lymph node mimicking recurrence on MRI study in a patient with prior breast conservation therapy. J Cancer Res Ther 2013; 9:111-3. [PMID: 23575088 DOI: 10.4103/0973-1482.110396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Breast conservative therapy (BCT) is a well accepted form of treatment for patients with early stage breast cancer. The incidence of ipsilateral breast tumor recurrence is higher in patients undergoing BCT than in those patients undergoing Modified Radical Mastectomy (MRM) without any adverse effect on survival. Patients treated with BCT are put on active surveillance using clinical breast examination and mammography. The radiologist reading the follow-up mammograms is on high alert and any neo-density is viewed with suspicion. MRI may be used as a problem solving tool. At such a time, an innocuous intra-mammary node can mimic malignancy on MRI. We want to showcase one such typical example with histological proof and highlight that type III curve may be seen in an intramammary node. Our case also reinforces the utility of second look ultrasound which is a faster, cheaper and easier method for localization and biopsy of abnormalities seen on MRI.
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Affiliation(s)
- Seema A Kembhavi
- Department of Radiodiagnosis, Tata Memorial Centre, Parel, Mumbai, India.
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Mahantshetty U, Khanna N, Swamidas J, Engineer R, Thakur MH, Merchant NH, Deshpande DD, Shrivastava S. Trans-abdominal ultrasound (US) and magnetic resonance imaging (MRI) correlation for conformal intracavitary brachytherapy in carcinoma of the uterine cervix. Radiother Oncol 2011; 102:130-4. [PMID: 21885140 DOI: 10.1016/j.radonc.2011.08.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 08/04/2011] [Accepted: 08/05/2011] [Indexed: 12/17/2022]
Abstract
PURPOSE Trans-abdominal ultrasonography (US) is capable of determining size, shape, thickness, and diameter of uterus, cervix and disease at cervix or parametria. To assess the potential value of US for image-guided cervical cancer brachytherapy, we compared US-findings relevant for brachytherapy to the corresponding findings obtained from MR imaging. MATERIALS AND METHODS Twenty patients with biopsy proven cervical cancer undergoing definitive radiotherapy with/without concomitant Cisplatin chemotherapy and suitable for brachytherapy were invited to participate in this study. US and MR were performed in a similar reproducible patient positioning after intracavitary application. US mid-sagittal and axial image at the level of external cervical os was acquired. Reference points D1 to D9 and distances were identified with respect to central tandem and flange, to delineate cervix, central disease, and external surface of the uterus. RESULTS Thirty-two applications using CT/MR compatible applicators were evaluable. The D1 and D3 reference distances which represent anterior surface had a strong correlation with R=0.92 and 0.94 (p<0.01). The D2 and D4 reference distances in contrast, which represent the posterior surface had a moderate (D2) and a strong (D4) correlation with R=0.63 and 0.82 (p<0.01). Of all, D2 reference distance showed the least correlation of MR and US. The D5 reference distance representing the fundal thickness from tandem tip had a correlation of 0.98. The reference distances for D6, D7, D8, and D9 had a correlation of 0.94, 0.82, 0.96, and 0.93, respectively. CONCLUSIONS Our study evaluating the use of US, suggests a reasonably strong correlation with MR in delineating uterus, cervix, and central disease for 3D conformal intracavitary brachytherapy planning.
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Affiliation(s)
- Umesh Mahantshetty
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Mumbai, India.
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Kulkarni S, Kulkarni A, Roy D, Thakur MH. Percutaneous computed tomography-guided core biopsy for the diagnosis of mediastinal masses. Ann Thorac Med 2010; 3:13-7. [PMID: 19561877 PMCID: PMC2700430 DOI: 10.4103/1817-1737.37948] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2007] [Accepted: 11/10/2007] [Indexed: 11/04/2022] Open
Abstract
AIM To describe various approaches of computed tomography (CT)-guided core biopsy and evaluate its ability to obtain adequate tissue for the assessment of mediastinal masses. MATERIALS AND METHODS Between February 2004 and October 2006, 83 percutaneous CT-guided biopsies of mediastinal lesions were performed on 82 patients under local anesthesia. Coaxial needles were used and minimum of 3-4 cores were obtained. Post-biopsy CT scan was performed and patients observed for any complications. Tissue samples were taken to Pathology Department in formalin solution. RESULTS From the 83 biopsies, adequate tissue for histological diagnosis was obtained in 80 (96%), and the biopsy was considered diagnostic. Of the 80 diagnostic biopsies, 74 biopsy samples were definitive for neoplastic pathology and 6 biopsy samples revealed no evidence of malignancy. There were no major complications. Minor complications were recorded in 5 patients. CONCLUSION Percutaneous image-guided core biopsy of mediastinal lesions is an accurate, safe and cost-effective tool for the initial assessment of patients with mediastinal masses.
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Affiliation(s)
- Suyash Kulkarni
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
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Mittra I, Mishra GA, Singh S, Aranke S, Notani P, Badwe R, Miller AB, Daniel EE, Gupta S, Uplap P, Thakur MH, Ramani S, Kerkar R, Ganesh B, Shastri SS. A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening. Int J Cancer 2010; 126:976-84. [PMID: 19697326 DOI: 10.1002/ijc.24840] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cervix and Breast cancers are the most common cancers among women worldwide and extract a large toll in developing countries. In May 1998, supported by a grant from the NCI (US), the Tata Memorial Hospital, Mumbai, India, started a cluster-randomized, controlled, screening-trial for cervix and breast cancer using trained primary health workers to provide health-education, visual-inspection of cervix (with 4% acetic acid-VIA) and clinical breast examination (CBE) in the screening arm, and only health education in the control arm. Four rounds of screening at 2-year intervals will be followed by 8 years of monitoring for incidence and mortality from cervix and breast cancers. The methodology and interim results after three rounds of screening are presented here. Good randomization was achieved between the screening (n = 75360) and control arms (n = 76178). In the screening arm we see: High screening participation rates; Low attrition; Good compliance to diagnostic confirmation; Significant downstaging; Excellent treatment completion rate; Improving case fatality ratios. The ever-screened and never-screened participants in the screening arm show significant differences with reference to the variables religion, language, age, education, occupation, income and health-seeking behavior for gynecological and breast-related complaints. During the same period, in the control arm we see excellent participation rate for health education; Low attrition and a good number of symptomatic referrals for both cervix and breast.
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Roy D, Kulkarni A, Kulkarni S, Thakur MH, Maheshwari A, Tongaonkar HB. Transrectal ultrasound-guided biopsy of recurrent cervical carcinoma. Br J Radiol 2008; 81:902-6. [PMID: 18662963 DOI: 10.1259/bjr/56205669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The objective of this study was to evaluate the feasibility, safety and diagnostic accuracy of transrectal ultrasound (TRUS)-guided core biopsy for recurrent carcinoma of the uterine cervix in patients with non-diagnostic vaginal cytology and transvaginal punch biopsy.17 patients with clinical and imaging suspicion of recurrent carcinoma of the cervix, and with negative cytology and punch biopsy, were referred for TRUS-guided biopsy of a recurrent mass. Data were collected with respect to demography, previous diagnosis, treatment received, size and location of the recurrent lesion, and biopsy results. Adequate samples were obtained for all patients. TRUS-guided biopsy was technically successful in all of the patients and provided histological diagnosis of recurrence in 16 patients. One of the patients had post-radiation fibrosis. There were no procedure-related complications. In conclusion, TRUS-guided biopsy for recurrent cervical cancer is a feasible, safe and accurate method for establishing a histopathological diagnosis. It should be considered in patients with non-diagnostic vaginal cytology and punch biopsy.
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Affiliation(s)
- D Roy
- Department of Radiodiagnosis, Genitourinary and Gynaec Oncology Services, Tata Memorial Hospital, Mumbai, India
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Abstract
Ureal metastases (although an uncommon site of metastatic involvement) are seen with primary tumours of the lung and breast and, very rarely, in other primary tumours. Undescended testis predisposes to malignancy. We present a rare case of choroidal metastasis from a non-seminomatous germ cell tumour arising in an undescended testis, and describe its clinical, ultrasound and MRI findings together with a relevant review of the literature.
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Affiliation(s)
- N C Purandare
- Tata Memorial Hospital, Dr E Borges Marg, Parel, Mumbai 400 012, India
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Shukla PJ, Pandey D, Rao PP, Shrikhande SV, Thakur MH, Arya S, Ramani S, Mehta S, Mohandas KM. Impact of intra-operative ultrasonography in liver surgery. Indian J Gastroenterol 2005; 24:62-5. [PMID: 15879652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVE Intra-operative ultra-sonography (IOUS) during surgery for primary and metastatic hepatic tumors identifies additional lesions and helps in determining the most optimal surgical strategy. We assessed the impact of IOUS in liver surgery at our hospital, a tertiary-care cancer center. METHODS Patients with potentially resectable hepatic tumors underwent surgical exploration. The relationship of the tumor with regard to the intrahepatic vasculature was determined by IOUS. A search was also made for additional lesions not detected by pre-operative imaging modalities. In appropriate cases, IOUS was also used to assist resection and radiofrequency ablation/ethanol injection. RESULTS Between January 2003 and January 2005, 52 patients underwent surgery for primary or secondary hepatic tumors. IOUS was performed in 48 of these patients. It detected additional hepatic lesions in 14 patients (29.2%). IOUS contributed to changing the operative plan in 21 patients (43.8%). It was directly responsible for avoiding resection or ablation in 7 patients (14.6%), 5 of whom had multiple bilobar lesions, 1 had IOUS-guided biopsy that revealed caseating granuloma on frozen section, and 1 patient had no lesion on IOUS. Three patients had extent of resection changed based on IOUS findings. IOUS also guided radiofrequency ablation in 8 patients and ethanol injection in one patient. CONCLUSION IOUS is an essential tool in surgery for hepatic tumors. In addition to accurate staging, it also aids in safe resection and radiofrequency ablation in appropriate cases.
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Affiliation(s)
- Parul J Shukla
- Department of GI Surgical Oncology, Tata Memorial Hospital, Mumbai.
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Abstract
Sarcomas of the seminal vesicle are very rare and poorly documented; as it is not always possible to pinpoint a truly vesicular origin of the pelvic mass due to local spread at the time of presentation. The purpose of the article is to document and characterize a rhabdomyosarcoma of the seminal vesicle of which to the knowledge of the authors there has been no previous report in the English literature.
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Affiliation(s)
- D A Sanghvi
- Department of Radiodiagnosis, Tata Memorial Hospital, Dr Ernest Borges Road, Parel, Mumbai 400 012, India
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Abstract
Prompted by the concern about unnecessary axillary dissections, we prospectively studied the accuracy of clinical examination (CE) and conventional ultrasonography (USG, 7.5 MHz), to diagnose pre-operatively metastatic axillary lymph nodes in 200 operable breast cancer patients. USG had higher specificity (90% vs 77%, P = 0.025) and higher positive predictive value (ppv = 90% vs 76%, P = 0.02) than CE. Together, CE + USG had higher sensitivity (82% vs 58%, P = 0.00005) and higher negative predictive value (npv = 76% vs 58%, P = 0.008) than CE alone. In women < 45 years, CE + USG had higher sensitivity (91% vs 76%, P = 0.037) and npv (89% vs 67%, P = 0.018) than in older women. The sensitivity and npv of CE + USG to detect > 1 positive node were 97% (for both) in women < 45 years compared to 81% and 79% in older women. The high sensitivity of CE + USG (82% for the whole group) is probably due to the higher proportion of young women (median age = 45) in our population. It suggests that using CE + USG to avoid axillary dissection in some patients is feasible.
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Affiliation(s)
- J S Vaidya
- Department of Surgery, Tata Memorial Hospital, Bombay, India
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