Radiology and Oncology最新文献

Background: This study investigated the clinical utility of ultrasound in diagnosing sarcopenia in patients with diffuse large B-cell lymphoma (DLBCL), focusing on muscle mass, strength, and physical fitness.

Patients and methods: A prospective analysis was conducted on 167 patients with DLBCL (88 with sarcopenia and 79 without). Muscle thickness (MT), cross-sectional area (CSA), and subcutaneous fat thickness (SFT) were measured using ultrasound at various anatomical sites. Diagnostic efficacy of muscle indices for sarcopenia was assessed using receiver operating characteristic (ROC) curves.

Results: Patients with sarcopenia exhibited significant reductions in MT and CSA across multiple muscle groups, including biceps brachii (BB), vastus intermedius (VI), and rectus femoris (RF) (all p ≤ 0.001). ROC analysis identified RF-CSA as the most effective indicator of sarcopenia, with an area under the curve (AUC) of 0.87, a sensitivity of 86%, and a specificity of 83% at a critical value of 7.08 cm². Multivariate analysis revealed that reduced MT and CSA significantly increased the risk of sarcopenia after adjusting for age, gender, and physical performance.

Conclusions: Ultrasound was a cost-effective and accessible diagnostic tool for identifying sarcopenia in DLBCL patients. Early detection through ultrasound can guide timely interventions and improve clinical outcomes.

Background: Immunohistochemical staining for p16 is used to differentiate precancerous cervical lesions in tissue samples, but the interpretation of patchy p16 expression remains challenging. We performed human papillomavirus (HPV) genotyping and evaluated immunohistochemical expression of HPV E4 protein - a marker for transient infections, stem cell transcription factor NANOG, and transcription factor SOX11 to detect possible high-grade squamous lesions in atypical p16 patchy squamous epithelium.

Materials and methods: We analyzed 24 cervical tissue samples with atypical squamous epithelium and patchy p16 expression along with the following controls: 11 cases of atypical squamous epithelium with null p16 expression, 9 condylomas, 12 cases of cervical intraepithelial neoplasia (CIN) grade 1, 11 cases of CIN2, and 9 cases of CIN3. In addition, HPV genotyping of tissue and related cervical smears from up to two years prior to biopsy was performed. Immunohistochemical staining for Ki67, HPV E4, NANOG, and SOX11 was performed and compared with follow-up data.

Results: High-risk HPV infection was detected in 6/24 cases with patchy p16 expression and HPV E4 was expressed in 1/24 cases with patchy p16, weak NANOG expression was found in 11/24 cases with patchy p16 expression while no SOX11 expression was observed. During 10 months of follow-up, additional CIN1 and two CIN3 were identified, and another CIN1 and CIN3 after 5 and 6 years, accordingly.

Conclusions: Our study showed that atypical squamous epithelium with patchy p16 expression poses a risk for highgrade precancerous lesions, harbouring high-risk HPV infection. Novel markers may hold diagnostic value in other specific contexts.

Background: The Lightning^® software, was added to the Gamma Knife's Leksell GammaPlan^® as a fully automated inverse planner, differently from the prior software, Wizard^®. In this paper we compare their treatment planning capacity and quality.

Materials and methods: Thirty-eight cases were compared under four different planning techniques. First, manual forward planning aided by the Wizard^® optimization tool. Second, inverse planning with Wizard^®. The third and fourth plans used Lightning^® with and without consideration for organs at risk (OAR). They were analysed for: planning time, number of shots, coverage, selectivity, gradient index, bean-on time, and OAR dose. Comparison based on pathology was added due to their idiosyncrasies. For quality comparison, dose-volume histograms (DVH) were compared to plans developed under our treatment standards. Tumor's volume and time to plan were correlated with Pearson's coefficient.

Results: Lightning^® had better coverage (8%) and gradient index (15%) but had 12% decrease in selectivity. Planning and delivery times had a reduction of 57% and 5% respectively, despite having three times the number of shots. Only Lightning^® with protection of OAR met the dose constrains in all plans. DVH showed similar plan qualities.

Conclusions: Lightning^® allowed the planner to explore different optimization parameters to achieve a plan that suits the clinical problem at hand. It took less time to calculate shots placement, OAR protection and the ideal isodose line than the Wizard^®. This can be useful to plan multiple and complex targets at a faster time, increase the patient's tolerance and, may have a radiobiological advantage by impacting intra-fraction repair.

Background: Basal cell carcinoma (BCC) is a cutaneous malignancy that typically appears in sun-exposed areas. We analyzed data from the Insp-ECT registry of all patients affected by BCC in the head and neck region. The aim of this study was to evaluate the safety and efficacy of electrochemotherapy (ECT) on a 5-year basis.

Patients and methods: A cohort of 132 patients was included. They were treated by ECT according to the current Standard Operating Procedures. The median age was 74 years (range 41-93). There was a median of 1 nodule per patient (range 1-7), and the median size of the lesions was 1.4 cm (range 0.5-5.0 cm).

Results: Patients tolerated ECT well, and 96% agreed to repeat it if needed. The side effects were mild and temporary. All patients achieved a complete clinical response after 1 to 3 ECT sessions. During the first year of follow-up, 4 (3%) patients experienced recurrence, which was treated (2 with ECT, 1 with surgery, and 1 with a combination of ECT and surgery), after which they remained free of disease until the end of follow-up at 5 years. Five patients reported recurrence thereafter and were treated according to their condition. At the 5-year follow-up, the disease-free survival (DFS) rate was 92% (95% confidence interval [CI]: 87%-96%). At that time, 3 patients were alive with disease (2%), and 124 patients were free of disease (98%).

Conclusions: This study shows the feasibility and efficacy of ECT treatment in elderly patients with BCC tumors in aesthetically and functionally sensitive areas, with negligible toxicity. Comparable efficacy to other treatment modalities was demonstrated at 1 year and 5 years of follow-up in terms of DFS.

Background: On imaging, malignant breast masses are commonly associated with spicules. To the best of our knowledge, the clinical significance of such spiculae has not been previously studied, and no surgical guidelines are available for the management of mammographically detected spiculations.

Patients and methods: Between April 2018 and December 2019, all consecutive breast-conserving surgery -patients with invasive malignant lesions, who required intraoperative radiological breast specimen assessment with tomosynthesis, were retrospectively included in this analysis. The tumors were classified into two groups: those with spiculated margins as the dominant feature, and those with other distinct morphological characteristics. Spicule visualization, length, and distribution were evaluated in both groups using pre- and intraoperative imaging and compared with the histopathological features of the spicules.

Results: In total, 162 invasive lesions were evaluated. The presence of spicule-associated additional tumor foci was a common finding; 67.6% of the spiculated tumors and 48.9% of the other tumors had additional foci. Most additional tumor foci were within 1 cm of the tumor edge. The mean pathologically measured distance from the main tumor margin to the spicule-associated additional tumor foci was 4.3 ± 2.8 mm. Compared to the maximum spicule length determined from intraoperative images (9.5 ± 5.1 mm), the distance of actual tumor infiltration was much shorter, and a very weak correlation was observed.

Conclusions: Breast tumor spicules harbor additional tumor foci, which may lead to margin positivity and potential reoperation. Additional research is necessary to determine the actual tumor burden and clinical significance of spicules.

Background: We retrospectively assessed volumetric response of myxoid liposarcoma (MLPS) with preoperative radiotherapy (RT) and sought to identify disease and treatment characteristics associated with response.

Patients and methods: We identified all patients with a histologic diagnosis of MLPS who received preoperative RT from 2013 to 2021 at our institution. We used cone beam computed tomography (CBCT) to assess changes in tumor volume and greatest dimension during treatment. Tumors were contoured on CBCT images prior to treatment and at the end of each week of RT. Percentage change in tumor volume and greatest dimension were calculated based on pre-treatment and final week contours. Patients with tumors incompletely visualized on CBCT were excluded from volume analysis but included on greatest dimension analysis. Magnetic resonance imaging (MRI) was used to evaluate pre- and post-RT radiographic features. Surgical pathology was reviewed to record pathologic characteristics.

Results: Twenty patients met inclusion criteria. Most tumors (18/20) were low grade. The most frequent dose/fractionation scheme was 50 Gy in 25 fractions (16/20), with 3 patients receiving 36 Gy in 18 fractions. Median pre-RT volume and greatest dimension were 120 cc (interquartile range [IQR]: 56-399) and 11.2 cm (IQR: 8.4-14.1), respectively. Median percentage change in volume and greatest dimension were -37% (IQR: -57 to -29) and -10% (IQR: -20 to -7). All evaluable tumors decreased in volume during RT. Between pre- and post-RT MRI, most patients had a decrease in intratumoral (16/20) and peritumoral edema (11/20). Sixteen patients exhibited extensive pathologic response. There were no significant associations between radiographic and pathologic features and volumetric change. Local failure at 3 years was 9% (95% confidence interval: 1-59).

Conclusions: We report significant decreases in MLPS tumor size during preoperative RT. There may be a role for adaptive RT planning to reduce target volumes and minimize RT-associated morbidity.

Background: The incidental detection of indeterminate small renal masses (SRMs) has been rising continuously over the last few decades. The aim of our study was to assess selected contrast enhanced computed tomography (CECT) parameters in the characterization of indeterminate SRMs and compare them with selected magnetic resonance imaging (MRI) data.

Patients and methods: Patients with indeterminate SRMs discovered on CECT were included in the study. Selected CECT features have been analyzed as differentiating between clear cell renal cell carcinoma (ccRCC) and other etiologies of SRMs. In 82% of patients, which had available MRI data, a comparison between selected MRI and CECT parameters were performed.

Results: Relative washout in CECT had the best accuracy (76.5%), sensitivity (88.9%), as well as satisfactory specificity (69.7%) in ccRCC prediction. The cut-off point determined in receiver operating analysis using the Youden index for this parameter was 11.54. Multivariable analysis showed that only T1 SI ratio < 0.73 from MRI parameters and relative washout > 11.5 from CECT parameters were independent predictors of ccRCC (OR: 30.86, 95% CI: 1.58-600.26, p = 0.024; OR: 15.36, 95% CI: 1.52-155.16, p = 0.021).

Conclusions: In clinical practice, the use of both CECT and MRI indicators, especially T1 SI ratio < 0.73 for MRI and relative washout > 11.5 for CECT, can support physicians in diagnosing and treating patients effectively.

Background: Sarcopenia is a progressive and generalised skeletal muscle disorder which presents as loss of muscle mass and function and is associated with increased likelihood of adverse outcomes, reduced quality of life and increased mortality. In developed countries, the prevalence of sarcopenia is rising due to increasing life expectancy. Still, in many clinical settings, sarcopenia may be overlooked and undertreated. While several tools are available for assessment of muscle mass and quality, there remains a need for safe, reliable and accurate diagnostic methods which can be implemented for both sarcopenia diagnosis and the evaluation of treatment efficacy.

Conclusions: Ultrasound is an accessible and non-ionizing imaging technique that can potentially be used for that purpose. Several ultrasound parameters have been identified for their utility to provide assessment of muscle mass, quality and/or muscle function. Ultrasound is gaining recognition as an accurate and reproducible method of muscle mass assessment. However, there are still several limitations that preclude the application of ultrasound in routine clinical practice. Implementing a harmonized measurement protocol and conducting large-scale longitudinal studies on both healthy individuals and various patient cohorts could enable the establishment of clearly defined reference values for individual ultrasound parameters and, in turn, potentially reliable differentiation between normal and sarcopenic states.

Background: Radiation-induced lymphopenia (RIL) is associated with an increased risk of death in solid tumors, including rectal cancer. The aim of this study was to determine whether the sequencing of chemotherapy in total neoadjuvant treatment (TNT) for rectal cancer predicts the development of RIL.

Patients and methods: We analyzed acute hematologic toxicity data from 53 patients who underwent TNT for locally or locoregionally advanced rectal cancer between July 2022 and April 2023. Twenty-eight patients received induction chemotherapy with capecitabine and oxaliplatin [CAPOX], and 25 received consolidation chemotherapy (6 cycles of CAPOX in both groups). The chemoradiation protocol consisted of Volumetric Modulated Arc Therapy with Simultaneous Integrated Boost Radiotherapy (VMAT-SIB RT) up to 48.4 Gy in 22 fractions, concomitantly with capecitabine twice a day (lat. bis in die, BID). The Mann-Whitney U test was performed to compare RIL between the two patient groups. Pelvic bone marrow was contoured as a non-limiting organ-at-risk to assess the received dose, and binary logistic regression was used to determine whether RIL depends on V_5Gy~V_42Gy or the planning target volume (PTV) size.

Results: Thirty-four patients (64.2%) developed RIL of any grade, which was not significantly associated with either the induction or consolidation chemotherapy TNT regimen (Wald = 3.159, p = 0.076). No significant differences were found in neutrophil counts or the neutrophil-to-lymphocyte ratio. In the logistic regression model predicting the likelihood of RIL, two variables were statistically significant: V_10Gy (Wald = 4.366, p = 0.037) and V_30Gy (Wald = 6.084, p = 0.014). These results indicate that V_10Gy< 71% and V_30Gy< 26.6% may reduce the likelihood of developing RIL.

Conclusions: In our study, the sequencing of chemotherapy in TNT for rectal cancer did not predict the development of RIL. However, the incidence of RIL may be reduced by applying RT dosimetric constraints to the pelvic bone marrow.

Background: Malignant pleural mesothelioma (MPM) is a global health concern linked to asbestos exposure. In Slovenia, regions with high asbestos exposure rates make MPM a significant public health issue. Although thoracoscopic biopsy is the gold standard for MPM diagnosis, its invasiveness highlights the need for reliable, non-invasive diagnostic biomarkers.

Patients and methods: This prospective study evaluated the diagnostic potential of fibulin-3 as a biomarker for MPM, focusing on its ability to distinguish MPM from other pleural conditions, its association with disease stage and histological subtype, and its prognostic value for survival. Ninety patients, who underwent diagnostic thoracoscopic biopsy from January 2013 to October 2014, were included. Fibulin-3 levels in plasma and pleural effusion were measured using enzyme-linked immunosorbent assay (ELISA), and clinical data were analysed with statistical tests, including receiver operating characteristic (ROC) analysis.

Results: The study cohort comprised 32 patients with MPM, 24 with metastatic pleural carcinoma, and 34 with benign pleural diseases. Plasma fibulin-3 levels were significantly elevated (p = 0.0132) in MPM patients compared to those with benign pleural effusions due to asbestos exposure, with a cut-off of 12.31 ng/mL showing 100% specificity but low sensitivity (39.39%). Elevated fibulin-3 levels in pleural effusion correlated with advanced disease (p = 0.0463) and aggressive histological subtypes (p = 0.0324). No significant survival correlation was observed.

Conclusions: While plasma fibulin-3 is a highly specific biomarker for MPM, its low sensitivity limits its standalone diagnostic utility. Its potential role in risk stratification and early detection of MPM at-risk populations using combination of different and new biomarkers warrants further study.