Pub Date : 2020-04-01DOI: 10.1177/0300891620914165
I. Ewais, A. Awis, Y. Fahim, S. Khodair, H. Gewefel
Background: Imaging of dense breast represents a diagnostic challenge for interpreting radiologists. Tomosynthesis and ultrasound are used as additional imaging tools to compensate the lower sensitivity of 2D mammography when examining a dense breast. This study compares the diagnostic performance of 50° wide-angle digital breast tomosynthesis (wide-angle DBT) to hand-held breast ultrasound (HHUS) in the evaluation of probably benign and malignant breast lesions in dense breast. Patients and Methods: A retrospective review of 131 women with dense breasts (ACR C and D) was conducted during a 12-months period (October 2018 -October 2019). Out of the 131 women; 40 cases (30.5%) were reported to have 64 probably benign and malignant lesions (BI-RADS 3, 4 and 5) detected by combined wide-angle DBT and HHUS. Patients with negative results (BI-RADS 1) or typically benign lesions (BI-RADS 2) were excluded from this study. Median age for the included 40 cases=46.8 years (range =30-67). Women above the age of 40 (n=35, 87%) were examined with combined 2D mammogram + wide-angle DBT and ultrasound. Women below 40 (n=5, 13%) were initially examined by ultrasound and obtained complementary wide-angle DBT mammography based on clinical necessity. Separate BI-RADS were given for each modality and independently correlated with histopathological results for BI-RADS 4 and 5, or routine follow up images for BI-RADS 3. Results: Among the 64 lesions; 10 (15.6%) were pathologically proven malignant in 5 cases (two cases were presenting with multi-focal disease), and 54 (84.4%) benign lesions pathologically proven or followed up in 35 patients. Sensitivity was 100% for wide-angle DBT (10/10) and 80% for ultrasound (8/10). Specificity and positive predictive value for ultrasound was 94.4% (51/54) and 72.7% (8/11), respectively. For wide-angle DBT, specificity was 90.7% (49/54) and positive predictive value was 66.7% (10/15). Despite the high sensitivity, in our study, DBT showed equal diagnostic accuracy to that of breast ultrasound (92.2%, 59/64). Both modalities were not similar in depicting malignant lesions; two more lesions were initially identified at wide-angle DBT images presented as <1cm area of architectural distortion (p=0.07). Other two diagnostic cases presented with acute inflammatory symptoms; they showed architectural distortion in DBT, which were false-positives for the later, yet, ultrasound showed mastitis and abscess formation. Ultrasound significantly identified more benign lesions than DBT mammography (p=0.001). Conclusion: Wide-angle DBT and HHUS are indispensable in identifying probably benign and malignant lesions in dense breasts. Our study showed the role of Wide-angle DBT in detecting small (<1 cm) malignant lesions presenting as architectural distortion. However, the radiologists experience with DBT and the significant clinical information added by ultrasound may impact the diagnostic performance. Therefore, supplemental HHUS to wide-angle DBT
{"title":"The Diagnostic Performance of Wide-Angle Digital Breast Tomosynthesis in Comparison to Hand-Held 2D Ultrasound in the Evaluation of Probably Benign & Malignant Lesions in Dense Breast Parenchyma","authors":"I. Ewais, A. Awis, Y. Fahim, S. Khodair, H. Gewefel","doi":"10.1177/0300891620914165","DOIUrl":"https://doi.org/10.1177/0300891620914165","url":null,"abstract":"Background: Imaging of dense breast represents a diagnostic challenge for interpreting radiologists. Tomosynthesis and ultrasound are used as additional imaging tools to compensate the lower sensitivity of 2D mammography when examining a dense breast. This study compares the diagnostic performance of 50° wide-angle digital breast tomosynthesis (wide-angle DBT) to hand-held breast ultrasound (HHUS) in the evaluation of probably benign and malignant breast lesions in dense breast. Patients and Methods: A retrospective review of 131 women with dense breasts (ACR C and D) was conducted during a 12-months period (October 2018 -October 2019). Out of the 131 women; 40 cases (30.5%) were reported to have 64 probably benign and malignant lesions (BI-RADS 3, 4 and 5) detected by combined wide-angle DBT and HHUS. Patients with negative results (BI-RADS 1) or typically benign lesions (BI-RADS 2) were excluded from this study. Median age for the included 40 cases=46.8 years (range =30-67). Women above the age of 40 (n=35, 87%) were examined with combined 2D mammogram + wide-angle DBT and ultrasound. Women below 40 (n=5, 13%) were initially examined by ultrasound and obtained complementary wide-angle DBT mammography based on clinical necessity. Separate BI-RADS were given for each modality and independently correlated with histopathological results for BI-RADS 4 and 5, or routine follow up images for BI-RADS 3. Results: Among the 64 lesions; 10 (15.6%) were pathologically proven malignant in 5 cases (two cases were presenting with multi-focal disease), and 54 (84.4%) benign lesions pathologically proven or followed up in 35 patients. Sensitivity was 100% for wide-angle DBT (10/10) and 80% for ultrasound (8/10). Specificity and positive predictive value for ultrasound was 94.4% (51/54) and 72.7% (8/11), respectively. For wide-angle DBT, specificity was 90.7% (49/54) and positive predictive value was 66.7% (10/15). Despite the high sensitivity, in our study, DBT showed equal diagnostic accuracy to that of breast ultrasound (92.2%, 59/64). Both modalities were not similar in depicting malignant lesions; two more lesions were initially identified at wide-angle DBT images presented as <1cm area of architectural distortion (p=0.07). Other two diagnostic cases presented with acute inflammatory symptoms; they showed architectural distortion in DBT, which were false-positives for the later, yet, ultrasound showed mastitis and abscess formation. Ultrasound significantly identified more benign lesions than DBT mammography (p=0.001). Conclusion: Wide-angle DBT and HHUS are indispensable in identifying probably benign and malignant lesions in dense breasts. Our study showed the role of Wide-angle DBT in detecting small (<1 cm) malignant lesions presenting as architectural distortion. However, the radiologists experience with DBT and the significant clinical information added by ultrasound may impact the diagnostic performance. Therefore, supplemental HHUS to wide-angle DBT","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"18 1","pages":"33 - 33"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81252247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.1177/0300891620914148
Olabode E. Omotoso, A. Gbadegesin Michael, A. O. Oluwasola Timothy, A. Okolo Clement, O. Ogun Gabriel, O. Oluwasola Abideen
This research study explored the mutations in the exon 3 and exon 4 of the P53 gene in cervical cancer. Genomic DNA was isolated and purified from cervical tissue biopsies obtained from patients reporting at the University College Hospital, Ibadan. The purified genomic DNA was quantified using NanoDropTM 2000 spectrophotometer. The region of interest was amplified using Polymerase Chain Reaction (PCR), this was quantified on a 1.5% agarose gel, and the ethidium bromide stained gel was viewed on a transilluminator. The PCR products were sequenced at Inqaba Biotec, and chromatogram was analyzed using FinchTv and SnapGene Viewer. Nucleotide BLAST was performed on the DNA sequence for sequence identity and retrieval of reference sequence. Multiple Sequence Alignment using T-COFFEE was performed to reveal the polymorphic variations in the samples. The outcome of this study showed nineteen identified polymorphic variants; Missense mutations occurred in 47% of the samples, 32% were silent mutations, 16% were frameshift mutation and 5% nonsense mutation. Sociodemographic characteristics revealed that 60% of the study participants has husbands with multiple sexual partners and that only 23.3% of the participants have ever done pap smear test prior to diagnosis, while 20% of them are unaware of the screening test. The histopathological result, alongside the Multiple Sequence Alignment revealed that with higher severity of cervical carcinoma, the p53 gene tends to accumulate more mutations. Our study also revealed the poor knowledge of Nigerian women to cancer screening, this may be one of the contributory factors to late diagnosis of cervical cancer among the African population. Hence, awareness for uptake of cancer screening and early detection are encouraged.
{"title":"Mutational Analysis Revealed Polymorphic Variants in Exon 3 and Exon 4 Of P53 Gene in Cervical Cancer","authors":"Olabode E. Omotoso, A. Gbadegesin Michael, A. O. Oluwasola Timothy, A. Okolo Clement, O. Ogun Gabriel, O. Oluwasola Abideen","doi":"10.1177/0300891620914148","DOIUrl":"https://doi.org/10.1177/0300891620914148","url":null,"abstract":"This research study explored the mutations in the exon 3 and exon 4 of the P53 gene in cervical cancer. Genomic DNA was isolated and purified from cervical tissue biopsies obtained from patients reporting at the University College Hospital, Ibadan. The purified genomic DNA was quantified using NanoDropTM 2000 spectrophotometer. The region of interest was amplified using Polymerase Chain Reaction (PCR), this was quantified on a 1.5% agarose gel, and the ethidium bromide stained gel was viewed on a transilluminator. The PCR products were sequenced at Inqaba Biotec, and chromatogram was analyzed using FinchTv and SnapGene Viewer. Nucleotide BLAST was performed on the DNA sequence for sequence identity and retrieval of reference sequence. Multiple Sequence Alignment using T-COFFEE was performed to reveal the polymorphic variations in the samples. The outcome of this study showed nineteen identified polymorphic variants; Missense mutations occurred in 47% of the samples, 32% were silent mutations, 16% were frameshift mutation and 5% nonsense mutation. Sociodemographic characteristics revealed that 60% of the study participants has husbands with multiple sexual partners and that only 23.3% of the participants have ever done pap smear test prior to diagnosis, while 20% of them are unaware of the screening test. The histopathological result, alongside the Multiple Sequence Alignment revealed that with higher severity of cervical carcinoma, the p53 gene tends to accumulate more mutations. Our study also revealed the poor knowledge of Nigerian women to cancer screening, this may be one of the contributory factors to late diagnosis of cervical cancer among the African population. Hence, awareness for uptake of cancer screening and early detection are encouraged.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"211 1","pages":"18 - 18"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76492651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.1177/0300891620914161
L. Gertallah, A. Almoregy, T. Baiomy, K. F. Helal, M. F. Abohashim, Rehab Hemeda, Doaa Mandour, Ahmed Embaby, O. Harb
Background: Although lymphadenectomy is advised for accurate surgical endometrial-carcinoma staging, the procedure is not performed regularly worldwide. Most studies on it include few patients and mainly compare pelvic with pelvic/para-aortic lymphadenectomy. Comparing lymphadenectomy with non-lymphadenectomy is rare. The current study examined prognostic significance and survival advantages of pelvic and pelvic/para-aortic lymphadenectomy compared to no lymphadenectomy. Materials and Methods: This was a retrospective cohort analysis of 75 patients with endometrial carcinomas. The patients were divided into 3 treatment groups based on whether or not lymph-node dissection was performed and the extent of the dissections: (1) pelvic lymphadenectomy; (2) pelvic/para-aortic lymphadenectomy; and (3) no lymphadenectomy. Correlations were analyzed among the surgical techniques used for the 3 groups with respect to the need for adjuvant radiotherapy or chemotherapy, recurrences, and survival outcomes. Results: Pelvic and pelvic/para-aortic lymphadenectomy produced more-favorable overall survival (OS) and progression-free survival (PFS) rates than no lymphadenectomy (p = 0.047). A significant difference was noted among the 3 treatment groups for OS rate and disease-free survival rates (p = 0.015 and 0.017, respectively). The recurrence rates were 47.1%, 35.7%, and 68.8% in the pelvic lymphadenectomy, and pelvic/para-aortic lymphadenectomy, and no lymphadenectomy groups, respectively (p = 0.037). Conclusions: This study showed that pelvic and para-aortic lymphadenectomy improved the OS and PFS rates of patients with endometrial cancer.
{"title":"Pelvic Lymphadenectomy and Pelvic and Para-Aortic Lymphadenectomy Versus No Lymphadenectomy for Endometrial Cancer","authors":"L. Gertallah, A. Almoregy, T. Baiomy, K. F. Helal, M. F. Abohashim, Rehab Hemeda, Doaa Mandour, Ahmed Embaby, O. Harb","doi":"10.1177/0300891620914161","DOIUrl":"https://doi.org/10.1177/0300891620914161","url":null,"abstract":"Background: Although lymphadenectomy is advised for accurate surgical endometrial-carcinoma staging, the procedure is not performed regularly worldwide. Most studies on it include few patients and mainly compare pelvic with pelvic/para-aortic lymphadenectomy. Comparing lymphadenectomy with non-lymphadenectomy is rare. The current study examined prognostic significance and survival advantages of pelvic and pelvic/para-aortic lymphadenectomy compared to no lymphadenectomy. Materials and Methods: This was a retrospective cohort analysis of 75 patients with endometrial carcinomas. The patients were divided into 3 treatment groups based on whether or not lymph-node dissection was performed and the extent of the dissections: (1) pelvic lymphadenectomy; (2) pelvic/para-aortic lymphadenectomy; and (3) no lymphadenectomy. Correlations were analyzed among the surgical techniques used for the 3 groups with respect to the need for adjuvant radiotherapy or chemotherapy, recurrences, and survival outcomes. Results: Pelvic and pelvic/para-aortic lymphadenectomy produced more-favorable overall survival (OS) and progression-free survival (PFS) rates than no lymphadenectomy (p = 0.047). A significant difference was noted among the 3 treatment groups for OS rate and disease-free survival rates (p = 0.015 and 0.017, respectively). The recurrence rates were 47.1%, 35.7%, and 68.8% in the pelvic lymphadenectomy, and pelvic/para-aortic lymphadenectomy, and no lymphadenectomy groups, respectively (p = 0.037). Conclusions: This study showed that pelvic and para-aortic lymphadenectomy improved the OS and PFS rates of patients with endometrial cancer.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"95 1","pages":"29 - 29"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73730633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.1177/0300891620914166
E. Saad, K. Elshahat, Sarah Hazem, Nadia Ebrahim, Nada Osama, H. Abdeen, Hussein M. Metwally
Introduction and Objective: In adjuvant radiotherapy for left breast cancer, a significant heart volume may be included in the radiation field leading to long-term cardiac toxicities. Deep inspiratory breath hold technique (DIBH) leads to chest wall separation away from the heart and thus can reduce the heart dose compared to free breathing technique. The aim of this study is to correlate dosimetrically the degree of chest wall expansion measured on planning 4D-CT scan to the heart dose in left breast cancer irradiation using DIBH technique. Materials and Methods: Thirty four patients with left breast cancer planned for adjuvant radiotherapy were included. All patients were scanned by Varian RPM (Real Time Position Managment) respiratory gating system using infrared reflecting markers and a video camera to detect the respiratory motion. IMRT or VMAT plans were done for all patients with a prescribed dose 50Gy/25fr/5w with or without operative bed boost dose 10Gy/5fr/1w. The degree of chest wall expansion was identified by measuring the amplitude of DIBH breathing curve from baseline in planning 4D-CT scan in centimeters. The depth of expansion was correlated dosimetrically with the heart V20, V30, and mean heartdose. Results: The mean distance of chest wall expansion was 2.9cm. The mean left lung dose was 8.6Gy. The mean left lung V20 was 13.8%. The mean heart dose was 1.8Gy. The mean heart V30 was 0.6%. A statistically significant reduction of the mean heart dose and V30 was observed with chest wall expansion of 1.4cm or higher (p<0.05). Conclusion: In DIBH technique, the depth of chest wall expansion in 4DCT planning is dosimetrically correlated with the cardiac dose reduction during adjuvant irradiation of left breast cancer. Further clinical studies are needed to translate this dosimetric advantage into clinical benefit.
{"title":"Dosimetric Correlation Between The Depth of Chest Wall Expansion and Heart Dose in Left Breast Cancer Irradiation Using Deep Inspiratory Breath Hold Technique","authors":"E. Saad, K. Elshahat, Sarah Hazem, Nadia Ebrahim, Nada Osama, H. Abdeen, Hussein M. Metwally","doi":"10.1177/0300891620914166","DOIUrl":"https://doi.org/10.1177/0300891620914166","url":null,"abstract":"Introduction and Objective: In adjuvant radiotherapy for left breast cancer, a significant heart volume may be included in the radiation field leading to long-term cardiac toxicities. Deep inspiratory breath hold technique (DIBH) leads to chest wall separation away from the heart and thus can reduce the heart dose compared to free breathing technique. The aim of this study is to correlate dosimetrically the degree of chest wall expansion measured on planning 4D-CT scan to the heart dose in left breast cancer irradiation using DIBH technique. Materials and Methods: Thirty four patients with left breast cancer planned for adjuvant radiotherapy were included. All patients were scanned by Varian RPM (Real Time Position Managment) respiratory gating system using infrared reflecting markers and a video camera to detect the respiratory motion. IMRT or VMAT plans were done for all patients with a prescribed dose 50Gy/25fr/5w with or without operative bed boost dose 10Gy/5fr/1w. The degree of chest wall expansion was identified by measuring the amplitude of DIBH breathing curve from baseline in planning 4D-CT scan in centimeters. The depth of expansion was correlated dosimetrically with the heart V20, V30, and mean heartdose. Results: The mean distance of chest wall expansion was 2.9cm. The mean left lung dose was 8.6Gy. The mean left lung V20 was 13.8%. The mean heart dose was 1.8Gy. The mean heart V30 was 0.6%. A statistically significant reduction of the mean heart dose and V30 was observed with chest wall expansion of 1.4cm or higher (p<0.05). Conclusion: In DIBH technique, the depth of chest wall expansion in 4DCT planning is dosimetrically correlated with the cardiac dose reduction during adjuvant irradiation of left breast cancer. Further clinical studies are needed to translate this dosimetric advantage into clinical benefit.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"47 1","pages":"34 - 34"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80013151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.1177/0300891620914160
M. Saleh, L. Kassem, Hanaa Atteya, M. Mousa, S. Alsirafy
Background: Social support (SS) has been proven to be associated with improved outcome of early breast cancer. Little is known about the magnitude of social support available for Egyptian breast cancer patient and much less is known about the changes that occur in such support after the diagnosis of breast cancer and starting treatment. Methods: We designed a longitudinal questionnaire based prospective cohort study using the six item form of the Medical Outcomes Study- Social Support Survey (MOS-SSS) questionnaire and included patients with pathologically proven non-metastatic breast cancer 18-70 years of age. Patients completed the self administered questionnaire at 2 time points: at first diagnosis of breast cancer and after 3-6 months of starting treatment. Comparison of the pre and post treatment questionnaires was done using paired sample T test. Results: A total of 48 patients completed the 2 questionnaires. Median age was 48 years (range: 24-65 years). Seventy percent of our patients were married, 67% had more than 2 children and 77.8% were housewives. Around half of the patients (45.2%) had monthly income below 1200 EGP. Patients who had higher education level (p=0.002) and those who were living in Cairo (p=0.033) reported higher SS at baseline. Mean MOS-SSS score at baseline was 64.4 (±24.8) while after treatment was 76.4 (±22.3); p<0.001. The increase in SS was consistent in most of the patient subgroups but was more prominent in illiterate patients compared to educated (p=0.033), those who work a handy job compared to housewife (p=0.04), and those who lived in Upper Egypt compared to Cairo residents (p=0.029). Conclusion: The majority of Egyptian breast cancer patients had a supportive environment after the diagnosis of breast cancer. A special attention should be paid to the at-risk groups with no sufficient SS during that period.
{"title":"Changes in Perceived Social Support after Starting Treatment in Egyptian Patients with Operable Breast Cancer: A Longitudinal Observational Study","authors":"M. Saleh, L. Kassem, Hanaa Atteya, M. Mousa, S. Alsirafy","doi":"10.1177/0300891620914160","DOIUrl":"https://doi.org/10.1177/0300891620914160","url":null,"abstract":"Background: Social support (SS) has been proven to be associated with improved outcome of early breast cancer. Little is known about the magnitude of social support available for Egyptian breast cancer patient and much less is known about the changes that occur in such support after the diagnosis of breast cancer and starting treatment. Methods: We designed a longitudinal questionnaire based prospective cohort study using the six item form of the Medical Outcomes Study- Social Support Survey (MOS-SSS) questionnaire and included patients with pathologically proven non-metastatic breast cancer 18-70 years of age. Patients completed the self administered questionnaire at 2 time points: at first diagnosis of breast cancer and after 3-6 months of starting treatment. Comparison of the pre and post treatment questionnaires was done using paired sample T test. Results: A total of 48 patients completed the 2 questionnaires. Median age was 48 years (range: 24-65 years). Seventy percent of our patients were married, 67% had more than 2 children and 77.8% were housewives. Around half of the patients (45.2%) had monthly income below 1200 EGP. Patients who had higher education level (p=0.002) and those who were living in Cairo (p=0.033) reported higher SS at baseline. Mean MOS-SSS score at baseline was 64.4 (±24.8) while after treatment was 76.4 (±22.3); p<0.001. The increase in SS was consistent in most of the patient subgroups but was more prominent in illiterate patients compared to educated (p=0.033), those who work a handy job compared to housewife (p=0.04), and those who lived in Upper Egypt compared to Cairo residents (p=0.029). Conclusion: The majority of Egyptian breast cancer patients had a supportive environment after the diagnosis of breast cancer. A special attention should be paid to the at-risk groups with no sufficient SS during that period.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"15 1","pages":"28 - 28"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85176379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.1177/0300891620914126
A. Elkholy, A. Awadeen, I.H. Kabeil, A. Sokar
Introduction: Venous thromboembolism (VTE) is the second most common cause of death among patients with breast cancer. In particular, VTE accounted for 20% of deaths after radical mastectomy. Owing to the devastating sequels associated with VTE and its financial impact, the current study was conducted to reveal the possible risk factors of VTE after breast cancer surgeries. Materials and Methods: Extensive systematic literature review, from inception up to 1 October 2019, was performed throughout 12 databases to reveal all clinical studies reported the risk factors of VTE after breast cancer surgeries. Pooled analysis was implemented using Review Manager. Results: This meta-analysis included 8 articles that encompassed an overall 166929 patients. There was no statistically significant difference between patients developed VTE and those not developed such condition regarding Caprini total score (SMD0.5;95%CI-0.58,1.57;P=0.36). Subsequently, patients developed VTE were elder than patients did not develop such complications (MD1.21;95%CI 1.06,1.35;P<0.001). Patients had pre-operative diabetes mellitus (OR 0.69;95%CI0.49,0.98;P=0.04) or pulmonary disease (OR1.43;95%CI1.09,1.88;P=0.01) were more susceptible to experience post-operative VTE, relative to other patients. Besides that, post-operative hospitalization stays were significantly longer among patients experienced VTE, relative to patients did not experience such complications (MD 2.6;95%CI 2.54,2.66;P<0.001). Patients subjected to radical mastectomy and primary reconstruction were more vulnerable to have VTE post-operatively (OR 2.66;95%CI 1.90,3.71;P<0.001). Similarly, patients received concurrent venous catheterization were more susceptible to develop VTE post-operatively (OR 2.13;95%CI 1.22,3.73;P<0.00=0.008). On the contrary, post-operative hormonal therapy, radiotherapy, or chemotherapy were not statistically significant risk factors of VTE after breast cancer surgeries. Conclusions: Elderly patients and those with pre-operative diabetes mellitus or pulmonary diseases and patients subordinated to primary reconstruction after radical mastectomy were more susceptible to develop VTE. Understanding these factors will aid health care providers to optimize the optimal preventive strategies of VTE after breast cancer surgeries.
{"title":"Risk Factors of Venous Thromboembolic Events after Breast Cancer Surgeries; A Meta-Analysis of 166929 Patients","authors":"A. Elkholy, A. Awadeen, I.H. Kabeil, A. Sokar","doi":"10.1177/0300891620914126","DOIUrl":"https://doi.org/10.1177/0300891620914126","url":null,"abstract":"Introduction: Venous thromboembolism (VTE) is the second most common cause of death among patients with breast cancer. In particular, VTE accounted for 20% of deaths after radical mastectomy. Owing to the devastating sequels associated with VTE and its financial impact, the current study was conducted to reveal the possible risk factors of VTE after breast cancer surgeries. Materials and Methods: Extensive systematic literature review, from inception up to 1 October 2019, was performed throughout 12 databases to reveal all clinical studies reported the risk factors of VTE after breast cancer surgeries. Pooled analysis was implemented using Review Manager. Results: This meta-analysis included 8 articles that encompassed an overall 166929 patients. There was no statistically significant difference between patients developed VTE and those not developed such condition regarding Caprini total score (SMD0.5;95%CI-0.58,1.57;P=0.36). Subsequently, patients developed VTE were elder than patients did not develop such complications (MD1.21;95%CI 1.06,1.35;P<0.001). Patients had pre-operative diabetes mellitus (OR 0.69;95%CI0.49,0.98;P=0.04) or pulmonary disease (OR1.43;95%CI1.09,1.88;P=0.01) were more susceptible to experience post-operative VTE, relative to other patients. Besides that, post-operative hospitalization stays were significantly longer among patients experienced VTE, relative to patients did not experience such complications (MD 2.6;95%CI 2.54,2.66;P<0.001). Patients subjected to radical mastectomy and primary reconstruction were more vulnerable to have VTE post-operatively (OR 2.66;95%CI 1.90,3.71;P<0.001). Similarly, patients received concurrent venous catheterization were more susceptible to develop VTE post-operatively (OR 2.13;95%CI 1.22,3.73;P<0.00=0.008). On the contrary, post-operative hormonal therapy, radiotherapy, or chemotherapy were not statistically significant risk factors of VTE after breast cancer surgeries. Conclusions: Elderly patients and those with pre-operative diabetes mellitus or pulmonary diseases and patients subordinated to primary reconstruction after radical mastectomy were more susceptible to develop VTE. Understanding these factors will aid health care providers to optimize the optimal preventive strategies of VTE after breast cancer surgeries.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"20 1","pages":"6 - 6"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74908111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.1177/0300891620914175
HS Mubisi, MM Farouk, I. Zaki, TA El Fayoiem, A. Ismail
Introduction: Triple negative breast cancer (TNBC), defined as lacking the expression of estrogen receptor alpha (ERα), progesterone receptor and human epidermal growth factor receptor is an aggressive breast cancer subtype for which there is a need to identify new therapeutic targets. About 50-80% of TNBC express Estrogen Receptor Beta (ERβ). Given its slight differences from ERα in terms of structure, signaling and its anti-proliferative effects on breast cancer cells, ERβ may be a possible therapeutic target. This study sought to assess the presence of ERβ and its correlation with the clinico-pathological features among the Egyptian females with TNBC. Material and Methods: The study was a retrospective analysis. The following data was retrieved from patient’s files and recorded: age, tumor size, lymph nodes metastasis, and stage. Paraffin blocks for patients confirmed by IHC to be TNBC were subjected to immunohistochemical staining for ERβ, CK5/6, and Ki 67. Results: ERβ was positive in 80% of cases (n=32/40). ERβ significantly correlated with Age (rs = -0.473, P = 0.002, n = 40), Tumor size (rs = -0.471, P = 0.007, n = 40), Lymph nodes (rs = -0.365, P = 0.021, n =40), and Stage (rs = -0.468, P = 0.002, n = 40). There was no correlation between ERβ with Ki-67 and CK5/6 a marker of the basal phenotype. All 8 patients without ERβ had an aggressive disease. 4 received neoadjuvant chemotherapy with minimum or no pathologic complete response in the axillary lymph nodes, 2 presented with upfront metastatic disease while the other 2 were cases of local recurrence with a change in the molecular phenotype of the tumor from luminal subtype to TNBC. Conclusion: This study shows ERβ expression occurs in TNBC. It may have the potential to become a therapeutic target for TNBC.
简介:三阴性乳腺癌(TNBC)被定义为缺乏雌激素受体α (ERα)、孕激素受体和人表皮生长因子受体的表达，是一种侵袭性乳腺癌亚型，需要寻找新的治疗靶点。约50-80%的TNBC表达雌激素受体β (ERβ)。鉴于ERβ在结构、信号传导和对乳腺癌细胞的抗增殖作用方面与ERα略有不同，ERβ可能是一个可能的治疗靶点。本研究旨在评估埃及女性TNBC患者中ERβ的存在及其与临床病理特征的相关性。材料与方法:本研究为回顾性分析。以下数据从患者档案中检索并记录:年龄、肿瘤大小、淋巴结转移和分期。对经免疫组化证实为TNBC的患者石蜡块进行ERβ、CK5/6和Ki 67的免疫组化染色。结果:80%的病例ERβ阳性(n=32/40)。ERβ与年龄(rs = -0.473, P = 0.002, n =40)、肿瘤大小(rs = -0.471, P = 0.007, n =40)、淋巴结(rs = -0.365, P = 0.021, n =40)、分期(rs = -0.468, P = 0.002, n =40)显著相关。ERβ与Ki-67和基础表型标志物CK5/6之间没有相关性。8例无ERβ的患者均为侵袭性疾病。4例接受新辅助化疗，腋窝淋巴结病理完全缓解最小或无完全缓解，2例出现前期转移性疾病，另外2例局部复发，肿瘤分子表型从腔内亚型转变为TNBC。结论:ERβ在TNBC中有表达。它可能有潜力成为TNBC的治疗靶点。
{"title":"Assessment of Estrogen Receptor Beta in Patients with Triple Negative Breast Cancer","authors":"HS Mubisi, MM Farouk, I. Zaki, TA El Fayoiem, A. Ismail","doi":"10.1177/0300891620914175","DOIUrl":"https://doi.org/10.1177/0300891620914175","url":null,"abstract":"Introduction: Triple negative breast cancer (TNBC), defined as lacking the expression of estrogen receptor alpha (ERα), progesterone receptor and human epidermal growth factor receptor is an aggressive breast cancer subtype for which there is a need to identify new therapeutic targets. About 50-80% of TNBC express Estrogen Receptor Beta (ERβ). Given its slight differences from ERα in terms of structure, signaling and its anti-proliferative effects on breast cancer cells, ERβ may be a possible therapeutic target. This study sought to assess the presence of ERβ and its correlation with the clinico-pathological features among the Egyptian females with TNBC. Material and Methods: The study was a retrospective analysis. The following data was retrieved from patient’s files and recorded: age, tumor size, lymph nodes metastasis, and stage. Paraffin blocks for patients confirmed by IHC to be TNBC were subjected to immunohistochemical staining for ERβ, CK5/6, and Ki 67. Results: ERβ was positive in 80% of cases (n=32/40). ERβ significantly correlated with Age (rs = -0.473, P = 0.002, n = 40), Tumor size (rs = -0.471, P = 0.007, n = 40), Lymph nodes (rs = -0.365, P = 0.021, n =40), and Stage (rs = -0.468, P = 0.002, n = 40). There was no correlation between ERβ with Ki-67 and CK5/6 a marker of the basal phenotype. All 8 patients without ERβ had an aggressive disease. 4 received neoadjuvant chemotherapy with minimum or no pathologic complete response in the axillary lymph nodes, 2 presented with upfront metastatic disease while the other 2 were cases of local recurrence with a change in the molecular phenotype of the tumor from luminal subtype to TNBC. Conclusion: This study shows ERβ expression occurs in TNBC. It may have the potential to become a therapeutic target for TNBC.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"21 1","pages":"38 - 38"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82126658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.1177/0300891620914127
Ashraf Sobhy, Mohammed Gamil, O. Youssef, A. Mebed
Background: Non-epithelial cancers of the ovary are uncommon. They include malignancies of germ cell origin, sex cord-stromal cell origin, metastatic carcinomas to the ovary, and a variety of extremely rare ovarian cancers, such as sarcomas and lipoid cell tumors. Nonepithelial malignancies account for about 10% of all ovarian cancers. Objective: To review the management of Non-epithelial ovarian cancer in the NCI Cairo university during a period of 5 years (2005 till 2010). Material and Methods: Retrospective study including 114 patients who were diagnosed and treated with Non-epithelial ovarian cancer (2005 to 2010). Data were collected from the biostatistics and cancer epidemiology department. Results: Out of 114 patients; 25(21.9%) were benign and 25 (21.9%) were borderline malignant; 55 (48.2%) were malignant and 9 (7.89%) of them were unpredicted biologic behavior; the median age of the study population was 49.7 years (range 14_83years). Panhysterectomy was done in 77(67.5%) of the patients; ovariectomy and debulking were done in 22(19.3%; salpingooophorectomy was done in 10(8.8%) 0f patients and cystectomy was done in 3(2.6%) and 2 cases underwent biopsy. Conclusion: Sex cord-stromal tumors and malignant germ cell tumors are the most common nonepithelial ovarian cancers. These tumors often, but not always, present with the sequelae of overproduction of either androgens or estrogens. It is important to diagnose these masses early, as overall prognosis is typically very good for early stage disease in all histological subtypes. Both sex cord-stromal tumors and malignant germ cell tumors of the ovary are treated with initial surgical resection. Fertility sparing surgery can be considered for both sex cord-stromal and malignant germ cell tumors of the ovary. Depending on the pathological diagnosis and disease stage, postoperative management consists of either expectant management or adjuvant chemotherapy. It is recommended that all patients with nonepithelial ovarian cancer be monitored for evidence of disease recurrence on a standardized schedule.
{"title":"Non-Epithelial Ovarian Cancer; NCI Study","authors":"Ashraf Sobhy, Mohammed Gamil, O. Youssef, A. Mebed","doi":"10.1177/0300891620914127","DOIUrl":"https://doi.org/10.1177/0300891620914127","url":null,"abstract":"Background: Non-epithelial cancers of the ovary are uncommon. They include malignancies of germ cell origin, sex cord-stromal cell origin, metastatic carcinomas to the ovary, and a variety of extremely rare ovarian cancers, such as sarcomas and lipoid cell tumors. Nonepithelial malignancies account for about 10% of all ovarian cancers. Objective: To review the management of Non-epithelial ovarian cancer in the NCI Cairo university during a period of 5 years (2005 till 2010). Material and Methods: Retrospective study including 114 patients who were diagnosed and treated with Non-epithelial ovarian cancer (2005 to 2010). Data were collected from the biostatistics and cancer epidemiology department. Results: Out of 114 patients; 25(21.9%) were benign and 25 (21.9%) were borderline malignant; 55 (48.2%) were malignant and 9 (7.89%) of them were unpredicted biologic behavior; the median age of the study population was 49.7 years (range 14_83years). Panhysterectomy was done in 77(67.5%) of the patients; ovariectomy and debulking were done in 22(19.3%; salpingooophorectomy was done in 10(8.8%) 0f patients and cystectomy was done in 3(2.6%) and 2 cases underwent biopsy. Conclusion: Sex cord-stromal tumors and malignant germ cell tumors are the most common nonepithelial ovarian cancers. These tumors often, but not always, present with the sequelae of overproduction of either androgens or estrogens. It is important to diagnose these masses early, as overall prognosis is typically very good for early stage disease in all histological subtypes. Both sex cord-stromal tumors and malignant germ cell tumors of the ovary are treated with initial surgical resection. Fertility sparing surgery can be considered for both sex cord-stromal and malignant germ cell tumors of the ovary. Depending on the pathological diagnosis and disease stage, postoperative management consists of either expectant management or adjuvant chemotherapy. It is recommended that all patients with nonepithelial ovarian cancer be monitored for evidence of disease recurrence on a standardized schedule.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"21 1","pages":"7 - 7"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91307716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.1177/0300891620914173
F. Gharib, Dareen Abd elaziz mohamed, B. Amer
Introduction: Endometrial adenocarcinoma is characterized by a good prognosis. However, the disease response shows a significant heterogeneity. Treatment of endometrial cancer (EC) is still based on clinico-pathological parameters, which have limited role in risk stratification. There is a need for more determinant markers, such as L1 Cell Adhesion Molecule (L1CAM), to identify patients at higher risk of relapse and tailor a more convenient treatment. L1CAM has a capacity to enhance cell motility and promote tumor invasion in different malignancies. In Egypt, the incidence rate of EC is growing over time. Especially in Elgharbiah governorate (home of this study). L1CAM expression and Ki-67 was reported and compared with other clinico-pathological criteria. Method: Seventy-six female patients of endometrial carcinomas were involved in this prospective study. The patients were treated and followed up at Tanta University Hospitals in the period between January 2015 to April 2019. L1CAM expression and Ki-67 was detected by immuno-histochemical exam and compared with other clinico-pathological criteria. Survival was assessed and compared by Kaplan-Meier curves and log-rank test. Results: Positive L1CAM expression was detected in 17 patients (22.4%) and was significantly correlated with unfavorable prognostic factors such as higher stage and grade (P= 0.021 and P =0.001 respectively), lympo-vascular invasion (P <0.001), non-endometroid type (P <0.027) and Ki-67 (P= 0.003). Univariate analysis revealed that: positive L1CAM; higher tumor grade; high stage; and non-endometrioid type were significantly associated with shorter disease-free survival (DFS) but no significant correlation was detected between Ki-67 and DFS. In multivariate analysis, positive L1CAM remained statistically significant with DFS [P =0.045; 95%CI (1.028:11.17); HR=3.38]. Conclusion: Our study indicates that L1CAM expression and Ki-67 are significantly associated with poor tumor characteristics. L1CAM is significantly associated with shorter disease-free survival and may be a helpful tool as a part of a simple clinical molecular classification for EC.
{"title":"Expression of L1CAM and KI-67 in Endometrial Cancer of Egyptian Females: Clinical Impact and Survival","authors":"F. Gharib, Dareen Abd elaziz mohamed, B. Amer","doi":"10.1177/0300891620914173","DOIUrl":"https://doi.org/10.1177/0300891620914173","url":null,"abstract":"Introduction: Endometrial adenocarcinoma is characterized by a good prognosis. However, the disease response shows a significant heterogeneity. Treatment of endometrial cancer (EC) is still based on clinico-pathological parameters, which have limited role in risk stratification. There is a need for more determinant markers, such as L1 Cell Adhesion Molecule (L1CAM), to identify patients at higher risk of relapse and tailor a more convenient treatment. L1CAM has a capacity to enhance cell motility and promote tumor invasion in different malignancies. In Egypt, the incidence rate of EC is growing over time. Especially in Elgharbiah governorate (home of this study). L1CAM expression and Ki-67 was reported and compared with other clinico-pathological criteria. Method: Seventy-six female patients of endometrial carcinomas were involved in this prospective study. The patients were treated and followed up at Tanta University Hospitals in the period between January 2015 to April 2019. L1CAM expression and Ki-67 was detected by immuno-histochemical exam and compared with other clinico-pathological criteria. Survival was assessed and compared by Kaplan-Meier curves and log-rank test. Results: Positive L1CAM expression was detected in 17 patients (22.4%) and was significantly correlated with unfavorable prognostic factors such as higher stage and grade (P= 0.021 and P =0.001 respectively), lympo-vascular invasion (P <0.001), non-endometroid type (P <0.027) and Ki-67 (P= 0.003). Univariate analysis revealed that: positive L1CAM; higher tumor grade; high stage; and non-endometrioid type were significantly associated with shorter disease-free survival (DFS) but no significant correlation was detected between Ki-67 and DFS. In multivariate analysis, positive L1CAM remained statistically significant with DFS [P =0.045; 95%CI (1.028:11.17); HR=3.38]. Conclusion: Our study indicates that L1CAM expression and Ki-67 are significantly associated with poor tumor characteristics. L1CAM is significantly associated with shorter disease-free survival and may be a helpful tool as a part of a simple clinical molecular classification for EC.","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"30 1","pages":"36 - 36"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85785998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-01DOI: 10.1177/0300891619868013
I. Gockel, B. Jansen-Winkeln, L. Haase, S. Niebisch, Y. Moulla, O. Lyros, F. Lordick, K. Schierle, C. Wittekind, R. Thieme
Background: Patients with intestinal cancer (colorectal, appendiceal, and small bowel) with peritoneal metastases (PM) have a poor prognosis. We assessed whether pressurized intraperitoneal aerosol chemotherapy (PIPAC) together with systemic chemotherapy is an effective treatment option for these entities in palliative intent. Methods: Between November 2015 and February 2018, prospective data registry was performed (NCT03100708). Thirteen patients with intestinal cancer (median age 61 years [range 49–77]) underwent 26 PIPAC procedures with a median number of 2 interventions per patient (range 1–6). A chemoaerosol consisting of cisplatin/doxorubicin was administered during standard laparoscopy. Results: The median peritoneal carcinomatosis index according to Sugarbaker before the first PIPAC was 14 (range 2–27), and the median ascites volume was 10 mL (range 0–6300 mL). Six patients who received 2 or more PIPAC procedures had decreased and stable ascites volumes, while only 1 patient displayed increased ascites. The median overall survival was 303 days (range 30–490) after the first PIPAC procedure. Conclusions: PIPAC offers a novel treatment option for patients with PM. Our data show that PIPAC is safe and well-tolerated. Ascites production can be controlled by PIPAC in patients with intestinal cancer. Further studies are required to document the significance of PIPAC within palliative therapy concepts. Trial registration: NCT03100708
{"title":"Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) in patients with peritoneal metastasized colorectal, appendiceal and small bowel cancer","authors":"I. Gockel, B. Jansen-Winkeln, L. Haase, S. Niebisch, Y. Moulla, O. Lyros, F. Lordick, K. Schierle, C. Wittekind, R. Thieme","doi":"10.1177/0300891619868013","DOIUrl":"https://doi.org/10.1177/0300891619868013","url":null,"abstract":"Background: Patients with intestinal cancer (colorectal, appendiceal, and small bowel) with peritoneal metastases (PM) have a poor prognosis. We assessed whether pressurized intraperitoneal aerosol chemotherapy (PIPAC) together with systemic chemotherapy is an effective treatment option for these entities in palliative intent. Methods: Between November 2015 and February 2018, prospective data registry was performed (NCT03100708). Thirteen patients with intestinal cancer (median age 61 years [range 49–77]) underwent 26 PIPAC procedures with a median number of 2 interventions per patient (range 1–6). A chemoaerosol consisting of cisplatin/doxorubicin was administered during standard laparoscopy. Results: The median peritoneal carcinomatosis index according to Sugarbaker before the first PIPAC was 14 (range 2–27), and the median ascites volume was 10 mL (range 0–6300 mL). Six patients who received 2 or more PIPAC procedures had decreased and stable ascites volumes, while only 1 patient displayed increased ascites. The median overall survival was 303 days (range 30–490) after the first PIPAC procedure. Conclusions: PIPAC offers a novel treatment option for patients with PM. Our data show that PIPAC is safe and well-tolerated. Ascites production can be controlled by PIPAC in patients with intestinal cancer. Further studies are required to document the significance of PIPAC within palliative therapy concepts. Trial registration: NCT03100708","PeriodicalId":23450,"journal":{"name":"Tumori Journal","volume":"17 1","pages":"70 - 78"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88880918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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