Radiology and Oncology最新文献

Background: Adrenocortical carcinoma (ACC) is a rare cancer that presents significant diagnostic and therapeutic challenges. We analyzed the management and estimated survival of ACC patients in Slovenia over a 17-year period.

Patients and methods: Patients registered in the National Cancer Registry and treated from 2000 to 2017 were included. The survival and prognostic factors were assessed using the Kaplan-Meier method and Cox regression, respectively.

Results: Forty-eight patients were included in our analysis. At the time of diagnosis, 6%, 42%, 25% and 27% had stage according European Network for the Study of Adrenal Tumors (ENSAT) I, II, III and IV, respectively. Adjuvant treatment with mitotane was assigned to 18 of 34 potentially eligible patients. High-risk patients treated with adjuvant mitotane showed a reduced probability of death, although the difference was not statistically significant. Relapses had numerically higher rate of R1 resection and higher Ki67. Eleven patients underwent first-line therapy with etoposide, doxorubicin, cisplatin and mitotane (EDP-M). Their median progression-free survival was 4.4 months. The median overall survival of entire cohort was 28.9 and the median disease-specific survival (DSS) was 36.2 months. The 5-year DSS rate of ENSAT I, II, III and IV were 100%, 56%, 50% and 0%, respectively. The prognostic value of ENSAT stage and Helsinki score regarding overall survival was confirmed with the multivariate analysis.

Conclusions: The 5-year DSS of our ENSAT II patients was worse than reported in contemporary cohorts. Suboptimal surgery and inconsistent adjuvant therapy with mitotane might have contributed to this outcome. Better outcomes of this rare disease might be accomplished with dedicated teams including various specialties, working towards optimal staging, diagnostic and therapeutic measures.

Background: This study evaluates the contouring variability among observers using MR images reconstructed by different sequences and quantifies the differences of automatic segmentation models for different sequences.

Patients and methods: Eighty-three patients with pelvic tumors underwent T1-weighted image (T1WI), contrast enhanced Dixon T1-weighted (T1dixonc), and T2-weighted image (T2WI) MR imaging on a simulator. Two observers performed manual delineation of the bladder, anal canal, rectum, and femoral heads on all images. Contour differences were used to analyze the interobserver and intersequence variability. A single-sequence automatic segmentation network was established using the U-Net network, and the segmentation results were analyzed.

Results: Variability analysis among observers showed that the bladder, rectum, and left femoral head on T1WI yielded the highest dice similarity coefficient (DSC) and the lowest 95% Hausdorff distance (HD) (all three sequences). Regarding sequence variability analysis for the same observer, the difference between T1WI and T2WI was the smallest. The DSC of the bladder, rectum, and femoral heads exceeded 0.88 for T1WI-T2WI. The differences between automatic segmentations and manual delineations were minimal on T2WI. The averaged DSC of automatic and manual segmentation of all organs on T2WI exceeded 0.81, and the averaged 95% HD value was lower than 7 mm. Similarly, the sequence variability analysis of automatic segmentation indicates that the automatic segmentation differences between T2WI and T1WI are minimal.

Conclusions: T1WI and T2WI yielded better results in manual delineation and automatic segmentation, respectively. The analysis of variability among three sequences indicates that the yielded good similarity outcomes between the T1WI and T2WI cases in manual and automatic segmentation. We infer that the T1WI and T2WI (or their combination) can be used for MR-only radiation therapy.

Background: The study aimed to investigate the reduction of hematoma risk during MRI-guided breast biopsies by evaluating position-dependent intervention parameters and characteristics of the target lesion.

Materials and methods: We retrospectively analyzed 252 percutaneous MRI-guided breast biopsies performed at a single center between January 2013 and December 2023. Two groups were built depending on the severity of relative hematoma formation (using a cut-off ≤ 7.62 cm³ or > 7.62 cm³). Potential influencing variables were assessed, such as patient demographics, interventional parameters related to anatomical landmarks, and lesion characteristics. Fisher's exact test and Mann-Whitney-U-Test were used to calculate the statistical difference between groups of categorical, dichotomous, and continuous variables. Multivariable logistic regression was used to identify the strongest association with relative hematoma formation.

Results: The univariate analysis showed that relatively larger hematoma occurred significantly more frequently when the patients were younger (P = 0.002), the relative distances from the target lesion to the nipple (P = 0.001) as well as alongside the access path (P = 0.001) were greater and when the vacuum-assisted biopsy system was used in contrast to the Spirotome® (P = 0.035). Multivariable logistic regression analysis also showed that these were independently associated with the occurrence of relatively larger hematomas. Epinephrine in the local anesthetic, lesion location classified by specific quadrant, and pathological findings did not influence the extent of the hematoma.

Conclusions: Our findings underscore the importance of strategic procedural planning to minimize hematoma occurrence and enhance patient safety during MRI-guided breast biopsy procedures.

Background: The differential diagnosis of cardiac myxomas (CM), the most common benign primary cardiac tumors, is broad and a thorough diagnostic workup is required to establish accurate diagnosis prior to surgical resection. Transthoracic echocardiography (TTE) is usually the first imaging modality used for diagnosis of suspected CM. In a single tertiary centre study, we sought to determine the accuracy, sensitivity, and specificity of TTE in the diagnosis of CM and to determine echocardiographic characteristics indicative of CM.

Patients and methods: We retrospectively analyzed clinical, echocardiographic, and pathohistological findings of 73 patients consecutively admitted for suspected CM.

Results: After diagnostic workup, 53 (73%) patients were treated surgically at our institution. Based on preoperative TTE, patients were divided into a CM group (n=45, 85%) and non-myxoma (NM) group. Of the 53 pathohistological specimens obtained during surgery, 39 (73%) were CM. The sensitivity and specificity of preoperative echocardiography were 97% and 50%, respectively. The overall accuracy was 85%. All NM tumors were found in an atypical location and 72% of CM were found in a typical position in the left atrium (p < 0.001). Tumors in NM group were significantly smaller than CM (24.3 ± 13.2 mm vs. 37.9 ± 18.3 mm, p = 0.017).

Conclusions: Our study confirms very good accuracy of TTE in the diagnosis of CM. The most important echocardiographic characteristics to differentiate between CM and tumors of different etiology are tumor location and size. Smaller tumors presenting at an atypical location are less likely to be diagnosed as CM, and these require additional imaging modalities for accurate diagnosis.

Background: Breast cancer is one of the most common cancers, increasingly prevalent also among working-age populations. Regardless of age, breast cancer has significant direct and indirect costs on the individuals, families and society. The aim of the research was to provide a comprehensive bibliometric analysis of the financial toxicity of breast cancer, to identify research voids and future research challenges.

Materials and methods: The systematic mapping of literature relied on a multi-method approach, combining bibliometric methods with a standard review/discussion of most important contributions. The analysis employed Bibliometrics in R and VosViewer.

Results: The results highlighted the key authors, journals and research topics in the investigation of the financial toxicity of cancer and stressed the concentration of work around several authors and journals.

Conclusions: The results also revealed a lack of a comprehensive approach in the study of financial toxicity, as the literature often focuses on one or few selected aspects of financial toxicity. In addition, geographic coverage is uneven and differences in the healthcare systems represent a challenge to straightforward comparisons.

Background: This study investigates the association of single nucleotide polymorphism in glutathione S transferase P1 (rs1695 and rs1138272) and phosphatase and TENsin homolog (rs701848 and rs2735343) with the risk of colorectal cancer (CRC).

Patients and methods: In this case-control study, 250 healthy controls and 200 CRC patients were enrolled. All subjects were divided into 3 groups: healthy control, patients, and overall (control + patients). Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The demographic information, including age, gender, location, smoking status, cancer stage, and node involvement, were collected.

Results: The allele frequencies of PTEN rs701848 in overall subjects were 0.78 for C and 0.22 for T. Similarly, in overall individuals, allele frequencies for PTEN rs2735343 were 0.65 and 0.35 for G and C alleles, respectively. The CC genotype or C allele of rs701848 and CG/GG genotype of rs2735343 were observed to be a risk factor for CRC. In overall individuals, a significant (p ≤ 0.05)) association was observed between rs701848 and rs2735343 polymorphisms CRC. Allele frequencies for GSTP1 rs1695 were 0.68 and 0.32 for the A and G alleles, respectively. Allele frequencies for GSTP1 rs1138272 were 0.68 and 0.32 for C and T alleles, respectively. However, a significant (p < 0.05) association was found in males for rs1695, while a non-significant difference was observed for the distribution of any genotypes or alleles at GSTP1 (rs1138272).

Conclusions: Both SNPs of PTEN rs701848 and rs2735343 polymorphisms were significantly associated with CRC. However, in GSTP1, rs1695 was significantly associated with CRC risk in males, and rs1138272 showed a non-significant association with colorectal cancer risk.

Background: Chronic postoperative pain is the most common postoperative complication that impairs quality of life. Postoperative pain gradually develops into neuropathic pain. Multimodal analgesia targets multiple points in the pain pathway and influences the mechanisms of pain chronification.

Patients and methods: We investigated whether a lidocaine patch at the wound site or an infusion of metamizole and tramadol can reduce opioid consumption during laparoscopic colorectal surgery and whether the results are comparable to those of epidural analgesia. Patients were randomly divided into four groups according to the type of postoperative analgesia. Group 1 consisted of 20 patients who received an infusion of piritramide. Group 2 consisted of 21 patients who received an infusion of metamizole and tramadol. Group 3 consisted of 20 patients who received patient-controlled epidural analgesia. Group 4 consisted of 22 patients who received piritramide together with a 5% lidocaine patch on the wound site. The occurrence of neuropathic pain was also investigated.

Results: Piritramide consumption was significantly lowest in group 3 on the day of surgery and on the first and second day after surgery. Group 4 required significantly less piritramide than group 1 on the day of surgery and on the first and second day after surgery. The group with metamizole and tramadol required significantly less piritramide than groups 1 and 4 on the first and second day after surgery. On the day of surgery, this group required the highest amount of piritramide.

Conclusions: Weak opioids such as tramadol in combination with non-opioids such as metamizole were as effective as epidural analgesia in terms of postoperative analgesia and opioid consumption. A lidocaine patch in combination with an infusion of piritramide have been able to reduce opioid consumption.

Background: Bleomycin ElectroScleroTherapy (BEST) is a new approach in the treatment of vascular malformations. After bleomycin is administered to the malformation, electric pulses are applied to the target area to enhance the effectiveness of bleomycin. The mode of action is comparable to the effect of electrochemotherapy on tumour vasculature. For the wider and safer use of BEST in the clinical treatment of low-flow vascular malformations, this Current Operating Procedure (COP) is being prepared. It is a proposal for the clinical standardisation of BEST using the Cliniporator^® as the electrical pulse generator with its associated electrodes. The electrical parameters considered in this protocol are those validated by the European Standard Operating Procedures for Electrochemotherapy (ESOPE) with the Cliniporator^®.

Conclusions: General requirements are proposed, and, depending on the type of lesion, local skills and the availability of radiological equipment, two technical approaches of BEST are described based on ultrasound guided intervention or combined ultrasound and fluoroscopic guided intervention.

Background: In uveal melanoma patients, short-term evaluation of treatment response to hepatic artery infusion chemotherapy (HAIC) using the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria is challenging due to the diffuse metastatic spread. As liver enlargement can frequently be observed, this study aims to compare RECIST 1.1 and liver volumetry (LV) for the evaluation of HAIC treatment response.

Patients and methods: Treatment response was evaluated in 143 patients (mean age 65.1 ± 10.9 years, 54% female) treated by HAIC by RECIST 1.1 and LV on CT imaging performed before and after HAIC. In LV, different increases in liver volume were evaluated to set an effective threshold to distinguish between stable disease (SD) and progressive disease (PD). Overall survival (OS) was calculated as the time from first HAIC to patient death using Kaplan-Meier test and multivariate analysis was performed for RECIST 1.1 and LV.

Results: In the overall population, median OS (mOS) was 13.5 months (95% CI 11.2-15.8 months). In LV, a threshold of 10% increase in liver volume was suited to identify patients with significantly reduced OS (SD: 103/143 patients, mOS 15.9 months; PD: 40/143 patients, 6.6 months; p < 0.001). Compared to RECIST 1.1, LV was the only significant prognostic factor that was able to identify a decreased OS.

Conclusions: In uveal melanoma patients with liver metastases, LV with a threshold for liver volume increase of 10% was suitable to evaluate treatment response and would be able to be used as a valuable add-on or even alternative to RECIST 1.1.

Background: Minimally invasive parathyroidectomy is the treatment of choice in patients with primary hyperparathyroidism (PHP), but it needs a reliable preoperative localization method to detect hyperfunctioning parathyroid tissue. Higher sensitivity and lower radiation exposure was demonstrated for [¹⁸F]fluorocholine PET/CT (FCh-PET/CT) in comparison to [^99mTc]sestamibi (MIBI) scintigraphy. However, data of its efficiency in resource use and patient outcomes is lacking. The aim of our study was to determine the resource efficiency and patient outcomes of FCh-PET/CT in comparison to conventional MIBI scintigraphy.

Patients and methods: A group of 234 patients who underwent surgery after MIBI scintigraphy was compared to a group of 163 patients who underwent surgery after FCh-PET/CT. The whole working process from the implementation of imaging to the completion of surgical treatment was analyzed. The economic burden was expressed in the time needed for the required procedures.

Results: The time needed to perform imaging was reduced by 83% after FCh-PET/CT in comparison to MIBI scintigraphy. The time needed to perform surgery was reduced by 41% when intraoperative parathyroid hormone monitoring was not used. There was no significant difference in the time of surgery between FCh-PET/CT and MIBI scintigraphy.

Conclusions: FCh-PET/CT reduces the time of imaging, the time of surgery and potentially reduces the number of reoperations for persistent disease.