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Objective: To determine the correlation of conventional and diffusion-weighted imaging findings on magnetic resonance imaging (MRI) of the brain, based on Visually AcceSAble Rembrandt Images (VASARI) criteria, with the histopathological grading of gliomas: low-grade or high-grade. Materials and Methods: Preoperative MRI scans of 178 patients with brain gliomas and pathological confirmation were rated by two neuroradiologists for tumor size, location, and tumor morphology, using a standardized imaging feature set based on the VASARI criteria. Results: In the univariate analysis, more than half of the MRI characteristics evaluated showed a significant association with the tumor grade. The characteristics most significantly associated with the tumor grade were hemorrhage; restricted diffusion; pial invasion; enhancement; and a non-contrast-enhancing tumor crossing the midline. In a multivariable regression model, the presence of enhancement and hemorrhage maintained a significant association with high tumor grade. The absence of contrast enhancement and restricted diffusion were associated with the presence of an isocitrate dehydrogenase gene mutation. Conclusion: Our data illustrate that VASARI MRI features, especially intratumoral hemorrhage, contrast enhancement, and multicentricity, correlate strongly with glial tumor grade.
Objetivo: Determinar a correlação dos achados de imagem convencional e de difusão na ressonância magnética (RM) do encéfalo, com base nos critérios Visually AcceSAble Rembrandt Images (VASARI), com a classificação histopatológica de gliomas: gliomas de baixo grau e gliomas de alto grau. Materiais e Métodos: Imagens de RM pré-cirúrgicas de 178 pacientes com gliomas cerebrais e confirmação patológica foram avaliadas por dois neurorradiologistas quanto ao tamanho, localização e morfologia do tumor usando um padrão de imagem baseado nos critérios VASARI. Resultados: Na análise univariada, mais da metade das características avaliadas apresentou associação significativa com o grau do tumor. Hemorragia, restrição à difusão, invasão pial, realce e tumor sem realce cruzando a linha média foram as características com associação mais significativa. No modelo de regressão multivariada, a presença de realce e hemorragia manteve associação significativa com tumores de alto grau. A ausência de realce pelo meio de contraste e a restrição da difusão foram associados à presença da mutação do gene isocitrato desidrogenase. Conclusão: Nossos dados ilustram que as características de RM do VASARI, especialmente hemorragia intratumoral, presença de realce de contraste e multicentricidade, forneceram uma correlação importante com o grau da neoplasia glial.
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OBJECTIVES: To explore diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) for assessing pathological prognostic factors in patients with rectal cancer. MATERIALS AND METHODS: A total of 162 patients (105 males; mean age of 61.8 ± 13.1 years old) scheduled to undergo radical surgery were enrolled in this prospective study. The pathological prognostic factors included histological differentiation, lymph node metastasis (LNM), and extramural vascular invasion (EMVI). The DWI, IVIM, and DKI parameters were obtained and correlated with prognostic factors using univariable and multivariable logistic regression. Their assessment value was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Multivariable logistic regression analyses showed that higher mean kurtosis (MK) (odds ratio (OR) = 194.931, p < 0.001) and lower apparent diffusion coefficient (ADC) (OR = 0.077, p = 0.025) were independently associated with poorer differentiation tumors. Higher perfusion fraction (f) (OR = 575.707, p = 0.023) and higher MK (OR = 173.559, p < 0.001) were independently associated with LNMs. Higher f (OR = 1036.116, p = 0.024), higher MK (OR = 253.629, p < 0.001), lower mean diffusivity (MD) (OR = 0.125, p = 0.038), and lower ADC (OR = 0.094, p = 0.022) were independently associated with EMVI. The area under the ROC curve (AUC) of MK for histological differentiation was significantly higher than ADC (0.771 vs. 0.638, p = 0.035). The AUC of MK for LNM positivity was higher than f (0.770 vs. 0.656, p = 0.048). The AUC of MK combined with MD (0.790) was the highest among f (0.663), MK (0.779), MD (0.617), and ADC (0.610) in assessing EMVI. CONCLUSION: The DKI parameters may be used as imaging biomarkers to assess pathological prognostic factors of rectal cancer before surgery. CLINICAL RELEVANCE STATEMENT: Diffusion kurtosis imaging (DKI) parameters, particularly mean kurtosis (MK), are promising biomarkers for assessing histological differentiation, lymph node metastasis, and extramural vascular invasion of rectal cancer. These findings suggest DKI's potential in the preoperative assessment of rectal cancer. KEY POINTS: Mean kurtosis outperformed the apparent diffusion coefficient in assessing histological differentiation in resectable rectal cancer. Perfusion fraction and mean kurtosis are independent indicators for assessing lymph node metastasis in rectal cancer. Mean kurtosis and mean diffusivity demonstrated superior accuracy in assessing extramural vascular invasion.
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Purpose: To evaluate the efficacy of high b-value diffusion-weighted imaging (DWI) with a continuous-time random-walk (CTRW) diffusion model in determining the pathological grade and variant histology (VH) of bladder cancer (BCa). Methods: A total of 81 patients (median age, 70 years; range, 35-92 years; 18 females; 66 high grades; 30 with VH) with pathologically confirmed bladder urothelial carcinoma were retrospectively enrolled and underwent bladder MRI on a 3.0T MRI scanner. Multi-b-value DWI was performed using 11 b-values. Three CTRW model parameters were obtained: an anomalous diffusion coefficient (D) and two parameters reflecting temporal (α) and spatial (ß) diffusion heterogeneity. The apparent diffusion coefficient (ADC) was calculated using b0 and b800. D, α, ß, and ADC were statistically compared between high- and low-grade BCa, and between pure urothelial cancer (pUC) and VH. Comparisons were made using the Mann-Whitney U test between different pathological states. Receiver operating characteristic curve analysis was used to assess performance in differentiating the pathological states of BCa. Results: ADC, D, and α were significantly lower in high-grade BCa compared to low-grade, and in VH compared to pUC (p < 0.001), while ß showed no significant differences (p > 0.05). The combination of D and α yielded the best performance for determining BCa grade and VH (area under the curves = 0.913, 0.811), significantly outperforming ADC (area under the curves = 0.823, 0.761). Conclusion: The CTRW model effectively discriminated pathological grades and variants in BCa, highlighting its potential as a noninvasive diagnostic tool.
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Background: Multi-parameter imaging technology, which is based on substance separation, helps to predict the pathological grade of tumors. When using dual-layer spectral-detector computed tomography (DLCT) to quantify tumor properties, different methods of placing regions of interest (ROIs) directly impact the measurement of parameters, thus affecting the clinical diagnosis of lesions. Consequently, in this study, we aimed to compare the performance of 2 different ROI plotting methods on DLCT in differentiating the histologic grade of hepatocellular carcinoma (HCC). Methods: This retrospective study included 48 consecutive patients with pathologically confirmed HCC, who underwent DLCT from May 2022 to March 2023. The attenuation value of conventional computed tomography (CT), electron density relative to water (EDW), normalized effective atomic number (NZeff), and normalized iodine density (NID) were measured by 2 radiologists using the conventional planar sketching (PS) method and the volumetric analysis method, respectively. The differences in parameters between the arterial phase (AP) and venous phase (VP) were calculated for each parameter (∆CT, ∆EDW, ∆NZeff, ∆NID). We used 2-sample t-test or Mann-Whitney U test was used to compare the differences in parameters between the 2 methods. Spearman correlation analysis was used to determine the correlation between each parameter and histologic grade. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance. Results: The mean values for the spectral quantitative parameters (CTAP, NZeffAP, NIDAP) and the difference between the arterial phase and venous phase (AP-VP) of parameters (∆CT, ∆EDW, ∆NZeff) measured using the volumetric analysis method were significantly lower than those of the PS method (P<0.05). For the ∆NZeff, the volumetric analysis method achieved the highest area under the curve (AUC) with a value of 0.918 [95% confidence interval (CI): 0.847-0.988], followed by the PS method (AUC =0.853, 95% CI: 0.743-0.963). Conclusions: The spectral parameters of DLCT provide a novel quantitative method for evaluating histological differentiation in patients with HCC, which is worthy of clinical recommendation. Different ROI plotting methods significantly impact the measurement of spectral parameters. Therefore, the whole tumor region should be covered in the parameter measurement of HCC lesions as much as feasible, which is more helpful in predicting the histological grading of tumors before treatment.
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BACKGROUND: In the management of solid tumours, routine concepts are increasingly being transformed into individualized patient treatment. Endocrine surgery is traditionally characterized by resection strategies that are adapted to phenotype and genotype of the underlying disease. As complication rates in surgery correlate with the extent of resection, continuous efforts are made to identify selection criteria in order to limit the extent of surgery without compromising the oncological outcome. The aim is to design risk-stratified precision endocrine surgery. MATERIALS AND METHODS: A search was carried out in PubMed for new and modern strategies and approaches for oncological endocrine surgery. RESULTS: Several developments in surgical technique and technology, molecular pathology, medical therapy, and study data identify the potential to adapt the surgical strategy in all areas of endocrine surgery. CONCLUSION: According to prevalent data, limited extent of resection in thyroid cancer surgery shows a reduction in complication rates while preserving oncological outcome when adequate selection criteria are implemented. New insights and innovative technologies also influence additional areas in oncological endocrine surgery for parathyroid, adrenal, and neuroendocrine neoplasia. However, the broad practice of these new concepts needs to be evaluated with regard to long-term oncological outcome.
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Neoplasias de las Glándulas Endocrinas , Humanos , Neoplasias de las Glándulas Endocrinas/cirugía , Neoplasias de las Glándulas Endocrinas/patología , Procedimientos Quirúrgicos Endocrinos/métodos , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Neoplasias de las Glándulas Suprarrenales/cirugía , Neoplasias de las Glándulas Suprarrenales/patologíaRESUMEN
BACKGROUND: In retrospective analyses, the Pediatric Oncology Group [POG) and the Federation National des Centres de Lutte Contre le Cancer (FNCLCC) histologic grade predict outcome in pediatric non-rhabdomyosarcoma soft tissue sarcoma (NRSTS), but prospective data on grading, clinical features, and outcomes of low-grade NRSTS are limited. METHODS: We analyzed patients less than 30 years of age enrolled on Children's Oncology Group (COG) study ARST0332 (NCT00346164) with POG grade 1 or 2 NRSTS. Low-risk patients were treated with surgery alone. Intermediate-/high-risk patients received ifosfamide/doxorubicin and radiotherapy, with definitive resection either before or after 12 weeks of chemoradiotherapy. RESULTS: Estimated 5-year event-free and overall survival were 90% and 100% low risk (n = 80), 55% and 78% intermediate risk (n = 15), and 25% and 25% high risk (n = 4). In low-risk patients, only local recurrence was seen in 10%; none with margins greater than 1 mm recurred locally. Sixteen of 17 intermediate-/high-risk patients who completed neoadjuvant chemoradiotherapy underwent gross total tumor resection, 80% with negative margins. Intermediate-/high-risk group events included one local and seven metastatic recurrences. Had the FNCLCC grading system been used to direct treatment, 29% of low-risk (surgery alone) patients would have received radiotherapy ± chemotherapy. CONCLUSIONS: Most low-risk patients with completely resected POG low-grade NRSTS are successfully treated with surgery alone, and surgical margins greater than 1 mm may be sufficient to prevent local recurrence. Patients with intermediate- and high-risk low-grade NRSTS have outcomes similar to patients with high-grade histology, and require more effective therapies. Use of the current FNCLCC grading system may result in overtreatment of low-risk NRSTS curable with surgery alone.
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Sarcoma , Humanos , Femenino , Masculino , Niño , Adolescente , Sarcoma/terapia , Sarcoma/patología , Sarcoma/mortalidad , Preescolar , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Adulto Joven , Lactante , Adulto , Tasa de Supervivencia , Clasificación del Tumor , Estudios Retrospectivos , Doxorrubicina/administración & dosificación , Doxorrubicina/uso terapéutico , Estudios de Seguimiento , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/terapia , Ifosfamida/administración & dosificación , Pronóstico , Neoplasias de los Tejidos Blandos/terapia , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/mortalidad , Estudios Prospectivos , Terapia CombinadaRESUMEN
BACKGROUND: Evidence of the association between obesity and renal cell carcinoma progression is contradictory. The effects of renal cell carcinoma on fat distribution are still unknown. OBJECTIVE: The goal of this study was to determine the ability of various forms of fat deposition to predict the Fuhrman nuclear grade of clear cell renal cell carcinoma [ccRCC]. METHODS: This retrospective study included 320 patients with pathologically proven ccRCC [215 men and 105 women; 263 low-grade ccRCC and 57 highgrade ccRCC]. Based on computed tomography scans, adipose tissue in various body regions was classified into the perirenal fat area [PFA], visceral fat area [VFA], total fat area [TFA], subcutaneous fat area [SFA], and hepatic steatosis [HS]. Subsequently, the relative VFA [rVFA] was computed. Age, sex, body mass index, and maximal tumor diameter were also regarded as clinical factors. Univariate and multivariate logistic regression studies were conducted to evaluate whether there was an association between body fat composition and the Fuhrman classification and whether it was related to gender. RESULTS: After correcting for age, males with low-grade ccRCC exhibited higher TFA [257.6 vs. 203.0, p = 0.002], VFA [151.6 vs.115.5, p = 0.007], SFA [106.0 vs. 87.5, p = 0.015], PFA [55.1 vs. 30.4, p < 0.001], and HS [18% vs. 0%, p = 0.031] than those with high-grade ccRCC. There was no significant difference among rVFA in males. In females, there was no significant difference in any of the parameters. VFA and PFA remained independent predictors for high-grade ccRCC in males in both the monovariate [VFA: odds ratio [OR] 0.992, 95% confidence interval [CI] 0.987-0.997, p = 0.004; PFA: OR 0.949, 95% CI 0.930-0.970, p < 0.001] and multivariate [VFA: OR 1.028, 95% CI 1.001-1.074, p < 0.001; PFA: OR 0.878, 95% CI 0.833-0.926, p < 0.001] models. CONCLUSION: Gender-specific adipose tissue in different locations demonstrated varied values for predicting high-grade ccRCC and may be utilized as an independent predictor of high-grade ccRCC in male patients.
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Carcinoma de Células Renales , Grasa Intraabdominal , Neoplasias Renales , Tomografía Computarizada por Rayos X , Humanos , Masculino , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/patología , Femenino , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Neoplasias Renales/clasificación , Persona de Mediana Edad , Grasa Intraabdominal/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Anciano , Factores Sexuales , Adulto , Anciano de 80 o más AñosRESUMEN
Introduction. Papillary urothelial carcinomas are currently graded as either low- or high-grade tumors based on World Health Organization (WHO) 2022 guidelines for genitourinary tumors. However, a minority of tumors are mixed-grade tumors, composed predominantly of low-grade cancer with a minor high-grade component. In the 2022 WHO these cancers are recognized as having outcomes comparable to low-grade cancers, although data to date has been limited. Methods. The pathology records of a large academic institution were searched for mixed-grade, non-muscle invasive papillary carcinomas of the bladder and ureter in order to characterize prognosis of these cancers. Results. Of 136 cancers, the majority (n = 104, 76.5%) were solitary, mixed-grade tumors, while 21 (15.4%) had a concurrent low-grade cancer and 11 (8.1%) had multiple mixed-grade tumors at the time of diagnosis. At follow-up (median 48.3 months, range = 1.3 months-18.1 years), 71 cancers recurred (52.2%): 52 (38.2%) as low- or mixed-grade cancers and 18 (13.2%) as high-grade cancers. There were no instances of stage-progression to >pT2. Conclusions. The clinical outcome of mixed-grade carcinomas was similar to what has been reported for low-grade carcinomas. Based on our results, and prior congruent studies of mixed-grade lesions, these lesions may be regarded as a distinct sub-category with a better prognosis than high-grade tumors.
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Background: This study assesses survival rates among patients with localized extremity bone sarcoma who have undergone amputation, pinpointing subpopulations that are disproportionately affected by amputation-related survival disparities. Methods: Examination of data was conducted using the Surveillance, Epidemiology, and End Results (SEER) program, analyzing records of 3765 patients diagnosed with localized extremity bone sarcoma between 2000 and 2019. Of these, 857 received amputations (Amputation cohort), and 2908 underwent limb-sparing surgeries. Propensity score matching, considering demographic and clinical features, was utilized to ensure a fair comparison. Results: Following propensity score matching, the study focused on 1714 cases. The Amputation cohort was observed to have significantly poorer survival rates (Cancer-Specific Survival [CSS]: Hazard Ratio [HR] = 1.28, 95% Confidence Interval [CI]: 1.05-1.55; Overall Survival [OS]: HR = 1.37, 95% CI: 1.15-1.63). Subsequent subgroup analysis indicated that individuals with tumors exceeding 8 cm in size or those located in the lower limbs were notably at a higher risk of shortened survival (for tumors >8 cm - CSS: HR = 1.32, 95% CI: 1.02-1.71; OS: HR = 1.39, 95% CI: 1.09-1.76; for lower limb tumors - CSS: HR = 1.25, 95% CI: 1.01-1.54; OS: HR = 1.33, 95% CI: 1.11-1.61). Conclusions: Our findings demonstrate that patients diagnosed with localized extremity bone sarcoma undergoing amputation exhibit lower survival rates, especially in cases involving tumors of greater size or those situated in the lower limbs. In patient groups where amputation is inevitable, careful follow-up is required after surgical intervention.
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BACKGROUND: Soft tissue sarcomas are rare malignant tumors with significant heterogeneity. The importance of classifying histological grades is fundamental to defining the treatment approach. OBJECTIVE: To evaluate magnetic resonance imaging (MRI) in predicting the histological grade of soft tissue sarcomas. METHODS: A retrospective observational study included patients over 18 years undergoing MRI and primary tumor surgery at AC Camargo Cancer Center from January 2015 to June 2022. Two radiologists evaluated MRI criteria (size, margin definition, heterogeneity of the T2 signal, high-intensity peritumoral signal on T2, and postperitumoral contrast), and a grading prediction score was calculated. χ2 and logistic regression analyses were conducted. RESULTS: Sixty-eight patients were included (38 men; median: 48 years). Moreover, 52 high-grade and 16 low-grade tumors were observed. The MRI criteria associated with histological grade were peritumoral high-intensity T2-weighted signals (p < 0.001) and peritumoral postcontrast enhancement (p = 0.006). Logistic regression confirmed their significance (odds ratio [OR]: 11.8 and 8.8, respectively). Each score point increment doubled the chance of high-grade tumors (OR: 2.0; p = 0.014). CONCLUSION: MRI effectively predicts histological grades of soft tissue sarcomas. Peritumoral high-intensity T2-weighted signals and peritumoral postcontrast enhancement are valuable indicators of high-grade tumors. This highlights MRI's importance in treatment decision-making for sarcoma patients.
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BACKGROUND/AIM: The purpose of this study was to investigate whether primary tumor resection in patients with bone metastatic breast cancer has an impact on survival using the Surveillance, Epidemiology, and End Results database, considering subtype classification. PATIENTS AND METHODS: We included all female patients with bone metastatic breast cancer at initial presentation between 2010 and 2016 with known hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) statuses. Cases showing unknown cause of death or unknown HR/HER2 status were excluded. Survival analysis was performed using Cox proportional hazards modeling to calculate hazard ratios (HZR). RESULTS: Of the 13,450 patients included in this study, 2,073 patients were HR+/HER2+, 8,597 patients were HR+/HER2-, 797 patients were HR-/HER2+, and 1,182 patients were HR-/HER2- (triple-negative). Five-year overall survival (OS) rate was 34.5% in HR+/HER2+, 26.0% in HR+/HER2-, 29.2% in HR-/HER2+ and 8.0% in triple-negative. Triple-negative patients showed the worsen OS [HR+/HER2+: HZR=2.1, 95% confidence interval (CI)=1.9-2.3; HR+/HER2-: HZR= 2.4, 95%CI=2.2-2.6; HR-/HER2+: HZR=1.5, 95%CI=1.3-1.6]. After excluding patients who died within six months, primary tumor resection prolonged survival in each subtype classification except HR-/HER2+. CONCLUSION: Patients with triple-negative bone metastatic breast cancer showed unfavorable survival. Primary tumor resection prolonged survival in each subtype except for HR-/HER2+.
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Neoplasias Óseas , Neoplasias de la Mama , Humanos , Femenino , Neoplasias de la Mama/metabolismo , Pronóstico , Receptor ErbB-2/metabolismo , Análisis de Supervivencia , Modelos de Riesgos Proporcionales , Neoplasias Óseas/metabolismoRESUMEN
Introduction Cancer of unknown primary (CUP) is a challenging malignancy. The purpose of this study was to investigate the clinical characteristics and prognosis of bone metastatic CUP using the population-based Surveillance, Epidemiology, and End Results (SEER) database. Methods From the SEER database, we identified 1908 patients with bone metastatic CUP at initial presentation between 2010 and 2018. Histology was subdivided following International Classification of Diseases for Oncology codes as Adenocarcinoma, Squamous cell, Neuroendocrine, or Carcinoma not otherwise specified (NOS). Cox proportional hazard modeling was applied using factors of age, sex, ethnicity, histological subtype, and therapeutic intervention. Results Among the 1908 patients, histology was Neuroendocrine in 240 patients, Squamous cell in 201 patients, Adenocarcinoma in 810 patients and NOS in 657 patients. In each subtype, patients tended to be predominantly male and white. Chemotherapy was introduced for 28% of patients and radiation for 34% in the entire cohort. Survival in patients with bone metastatic CUP was unfavorable, with a median survival of 2 months. Among the histological subtypes, Adenocarcinoma showed shorter survival than the other groups. In addition, treatment interventions such as chemotherapy and radiation therapy prolonged survival, particularly for Squamous cell, Adenocarcinoma and NOS, but not for Neuroendocrine. Discussion Bone metastatic CUP showed extremely poor prognosis, but treatment interventions such as chemotherapy and radiation generally offered survival benefits. Further randomized clinical research is needed to confirm the present results (AU)
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Humanos , Neoplasias Óseas/patología , Neoplasias Óseas/terapia , Adenocarcinoma/patología , Adenocarcinoma/terapia , Neoplasias Primarias Desconocidas/patología , Neoplasias Primarias Desconocidas/terapia , Estadificación de Neoplasias , PronósticoRESUMEN
Purpose: The use of MRI-targeted biopsies has led to lower detection of Gleason Grade Group 1 (GG1) prostate cancer and increased detection of GG2 disease. Although this finding is generally attributed to improved sensitivity and specificity of MRI for aggressive cancers, it might also be explained by grade inflation. Our objective was to determine the likelihood of definitive treatment and risk of post-treatment recurrence for patients with GG2 cancer diagnosed using targeted biopsies relative to men with GG1 cancer diagnosed using systematic biopsies. Methods: We performed a retrospective study on a large tertiary centre registry (HUS Acamedic Datalake) to retrieve data on prostate cancer diagnosis, treatment, and cancer recurrence. We included patients with either GG1 with systematic biopsies (3317 men) or GG2 with targeted biopsies (554 men) from 1993 to 2019. We assessed the risk of curative treatment and recurrence after treatment. Kaplan-Meier survival curves were computed to assess treatment- and recurrence-free survival. Cox proportional hazards regression analysis was performed to assess the risk of posttreatment recurrence. Results: Patients with systematic biopsy detected GG1 cancer had a significantly longer median time-to-treatment (31 months) than those with targeted biopsy detected GG2 cancer (4 months, p<0.0001). The risk of recurrence after curative treatment was similar between groups with the upper bound of 95% CI, excluding an important difference (HR: 0.94, 95% CI [0.71-1.25], p=0.7). Conclusion: GG2 cancers detected by MRI-targeted biopsy are treated more aggressively than GG1 cancers detected by systematic biopsy, despite having similar oncologic risk. To prevent further overtreatment related to the MRI pathway, treatment guidelines from the pre-MRI era need to be updated to consider changes in the diagnostic pathway.
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Introducción. El melanoma es la proliferación maligna de melanocitos asociado a un comportamiento agresivo. El objetivo de este estudio fue determinar las variables histológicas del melanoma cutáneo. Métodos. Estudio observacional retrospectivo, transversal descriptivo, realizado con reportes de patologías de pacientes con diagnóstico de melanoma cutáneo en un laboratorio de patología en Cali, Colombia, entre 2016-2021. Se incluyeron las variables edad, sexo, localización, subtipo, espesor de Breslow, ulceración, márgenes, mitosis, invasión linfovascular, neurotrofismo, regresión tumoral, nivel de Clark e infiltración tumoral por linfocitos. Resultados. Se obtuvieron 106 reportes y fueron excluidos 54 por duplicación. Se incluyeron 52 registros, la media de edad fue de 61 años, con una mayor frecuencia de mujeres (55,8 %). De los 33 casos donde se especificó el subtipo histológico, el más frecuente fue el de extensión superficial (66,6 %), seguido del acral lentiginoso (18,1 %) y nodular con (15,2 %). La localización más frecuente fue en extremidades (61,5 %). El espesor de Breslow más común fue IV (34,6 %) y el nivel de Clark más frecuente fue IV (34,6 %). La ulceración estuvo en el 40,4 %. El subtipo nodular fue el de presentación más agresiva, donde el 100 % presentaron espesor de Breslow IV. Conclusiones. El subtipo de melanoma más común en nuestra población fue el de extensión superficial; el segundo en frecuencia fue el subtipo acral lentiginoso, que se localizó siempre en extremidades. Más del 50 % de los melanomas tenían espesor de Breslow mayor o igual a III, lo que impacta en el pronóstico.
Background. Melanoma is the malignant proliferation of melanocytes associated with aggressive behavior. The objective of this study was to determine the histological variables of cutaneous melanoma. Methods. Observational, cross-sectional, descriptive, retrospective study carried out with reports of pathologies with a diagnosis of cutaneous melanoma in a pathology laboratory in Cali between 2016-2021. The variables were age, sex, location, subtype, Breslow thickness, ulceration, margins, mitosis, lymphovascular invasion, neurotropism, tumoral regression, Clark level and tumor infiltration by lymphocytes. Results. One hundred and six reports were obtained and 54 were excluded due to duplication. A descriptive analysis was made on the 52 records that were included, the mean age was 61 years, with a higher frequency in women with 55.8%. Of the 33 cases where the histological subtype was specified, the most frequent was superficial extension with 66.6%, followed by acral lentiginous with 18.1% and nodular with 15.2%. The most frequent location was in the extremities (61.5%); the most common Breslow was IV (34.6%), and the most frequent Clark was IV (34.6%). Ulceration was in 40.4%. The nodular subtype was the most aggressive presentation where 100% presented Breslow IV. Conclusions. The most common subtype of melanoma was that of superficial extension. In our population, the second most frequent was the acral lentiginous subtype, which was always located on the extremities. More than 50% of the melanomas had Breslow greater than or equal to III, which affects the prognosis.
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Humanos , Patología , Melanoma , Estadificación de Neoplasias , Clasificación del Tumor , Histología , MitosisRESUMEN
OBJECTIVE: To establish a prediction model for preoperatively predicting grade 1 and grade 2/3 tumors in patients with pancreatic neuroendocrine tumors (PNETs) based on 68Ga-DOTATATE PET/CT. METHODS: Clinical data of 41 patients with PNETs were included in this study. According to the pathological results, they were divided into grade 1 and grade 2/3. 68Ga-DOTATATE PET/CT images were collected within one month before surgery. The clinical risk factors and significant radiological features were filtered, and a clinical predictive model based on these clinical and radiological features was established. 3D slicer was used to extracted 107 radiomic features from the region of interest (ROI) of 68Ga-dotata PET/CT images. The Pearson correlation coefficient (PCC), recursive feature elimination (REF) based five-fold cross validation were adopted for the radiomic feature selection, and a radiomic score was computed subsequently. The comprehensive model combining the clinical risk factors and the rad-score was established as well as the nomogram. The performance of above clinical model and comprehensive model were evaluated and compared. RESULTS: Adjacent organ invasion, N staging, and M staging were the risk factors for PNET grading (p < 0.05). 12 optimal radiomic features (3 PET radiomic features, 9 CT radiomic features) were screen out. The clinical predictive model achieved an area under the curve (AUC) of 0.785. The comprehensive model has better predictive performance (AUC = 0.953). CONCLUSION: We proposed a comprehensive nomogram model based on 68Ga-DOTATATE PET/CT to predict grade 1 and grade 2/3 of PNETs and assist personalized clinical diagnosis and treatment plans for patients with PNETs.
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Tumores Neuroectodérmicos Primitivos , Tumores Neuroendocrinos , Neoplasias Pancreáticas , Tomografía de Emisión de Positrones , Cintigrafía , Humanos , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tumores Neuroendocrinos/patología , Radioisótopos de Galio , Tomografía Computarizada por Rayos X , Neoplasias Pancreáticas/patologíaRESUMEN
OBJECTIVES: The 2021 World Health Organization (WHO) classification of central nervous system (CNS) tumors prioritizes isocitrate dehydrogenase (IDH) mutation to define tumor types in diffuse gliomas, in contrast to the 2016 classification, which prioritized histological features. Our objective was to investigate the influence of this change in the performance of proton MR spectroscopy (1H-MRS) in segregating high-grade diffuse astrocytoma subgroups. METHODS: Patients with CNS WHO grade 3 and 4 diffuse astrocytoma, known IDH mutation status, and available 1H-MRS were retrospectively retrieved and divided into 4 groups based on IDH mutation status and histological grade. Differences in 1H-MRS between groups were analyzed with the Kruskal-Wallis test. The points on the spectrum that showed the greatest differences were chosen to evaluate the performance of 1H-MRS in discriminating between grades 3 and 4 tumors (WHO 2016 defined), and between IDH-mutant and IDH-wildtype tumors (WHO 2021). ROC curves were constructed with these points, and AUC values were calculated and compared. RESULTS: The study included 223 patients with high-grade diffuse astrocytoma. Discrimination between IDH-mutant and IDH-wildtype tumors showed higher AUC values (highest AUC short TE, 0.943; long TE, 0.864) and more noticeable visual differences than the discrimination between grade 3 and 4 tumors (short TE, 0.885; long TE, 0.838). CONCLUSION: Our findings suggest that 1H-MRS is more applicable to classify high-grade astrocytomas defined with the 2021 criteria. Improved metabolomic robustness and more homogeneous groups yielded better tumor type discrimination by 1H-MRS with the new criteria. CLINICAL RELEVANCE STATEMENT: The 2021 World Health Organization classification of brain tumors empowers molecular criteria to improve tumor characterization. This derives in greater segregation of high-grade diffuse astrocytoma subgroups by MR spectroscopy and warrants further development of brain tumor classification tools with spectroscopy. KEY POINTS: ⢠The new 2021 updated World Health Organization classification of central nervous system tumors maximizes the role of molecular diagnosis in the classification of brain tumors. ⢠Proton MR spectroscopy performs better to segregate high-grade astrocytoma subgroups when defined with the new criteria. ⢠The study provides additional evidence of improved metabolic characterization of brain tumor subgroups with the new criteria.
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Astrocitoma , Neoplasias Encefálicas , Humanos , Protones , Estudios Retrospectivos , Astrocitoma/patología , Neoplasias Encefálicas/genética , Espectroscopía de Resonancia Magnética , Organización Mundial de la Salud , Mutación , Isocitrato Deshidrogenasa/genética , Isocitrato Deshidrogenasa/metabolismoRESUMEN
BACKGROUND: The objectives of this study were to clarify whether localized extremity soft tissue sarcoma (STS) patients who underwent amputation surgery experienced worsened survival and to identify those patients for whom amputation surgery worsened survival. METHODS: Using the Surveillance, Epidemiology, and End Results database, we identified 8897 patients with localized extremity STS between 1983 and 2016. Of these 6431 patients, 733 patients underwent amputation surgery (Amputation group), and 5698 underwent limb-sparing surgery (Limb-sparing group). RESULTS: After adjusting for patient background by propensity score matching, a total of 1346 patients were included. Patients in the Amputation group showed worsened survival (cancer-specific survival (CSS): hazard ratio (HR) = 1.42, 95% confidence interval (CI) 1.15-1.75, overall survival (OS): HR = 1.41, 95%CI 1.20-1.65). In subclass analysis, patients with high-grade STS, spindle cell sarcoma and liposarcoma in the Amputation group showed shortened survival (high-grade-CSS: HR = 1.44, 95%CI 1.16-1.77, OS: HR = 1.38, 95%CI 1.18-1.62; spindle cell sarcoma-CSS: HR = 4.75, 95%CI 1.56-14.4, OS: HR = 2.32, 95%CI 1.45-3.70; liposarcoma-CSS: HR = 2.91, 95%CI 1.54-5.50, OS: HR = 2.32, 95%CI 1.45-3.70). CONCLUSIONS: Survival was shortened in localized extremity STS patients who received amputation surgery.
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Liposarcoma , Sarcoma , Humanos , Resultado del Tratamiento , Extremidades/cirugía , Sarcoma/cirugía , Amputación Quirúrgica , Estudios Retrospectivos , PronósticoRESUMEN
Objective:To evaluate the value of 18F-FDG PET metabolic parameters in predicting histopathological grade of soft tissue sarcoma (STS). Methods:From December 2012 to December 2021, 51 patients (26 males, 25 females, age range: 32-84 years) who underwent 18F-FDG PET/CT imaging before treatment and confirmed STS pathologically in the First Affiliated Hospital of Dalian Medical University were retrospectively collected. 18F-FDG PET metabolic parameters SUV max, metabolic tumor volume (MTV), total lesion glycolysis (TLG) and intertumoral FDG uptake heterogeneity (IFH) were measured. Kruskal-Wallis rank sum test was used to analyze the differences in metabolic parameters among different groups and Spearman rank correlation analysis was used to analyze the correlation of each metabolic parameter and histological grade. Logistic regression was used to screen and construct the prediction model for high-grade STS. ROC curve was plotted and Delong test was used to analyze the differences among AUCs. Results:The metabolic parameters SUV max, MTV, TLG and IFH were significantly different among French Federation of Cancer Centers Sarcoma Group (FNCLCC)Ⅰ( n=8), Ⅱ( n=10) and Ⅲ ( n=33) grade groups ( H values: 16.24, 10.52, 19.29 and 16.99, all P<0.05), and each metabolic parameter was positively correlated with histological grade ( rs values: 0.58, 0.45, 0.52, and 0.62, all P<0.05). Multivariate logistic regression analysis showed that SUV max(odds ratio ( OR)=1.27, 95% CI: 1.06-1.51, P=0.009) and IFH ( OR=6.83, 95% CI: 1.44-32.27, P=0.015) were independent risk indicators for high-grade STS. The prediction model constructed by combining SUV max and IFH had better diagnostic efficacy for differentiating high-grade STS with the AUC of 0.93, and the sensitivity of 93.9%(31/33) and the specificity of 16/18, respectively. The AUC of prediction model was significant different from SUV max, MTV, TLG and IFH (AUCs: 0.81, 0.78, 0.86 and 0.85; z values: 2.69, 2.53, 1.94 and 1.97, all P<0.05). Conclusions:The metabolic parameters SUV max, MTV, TLG and IFH are valuable predictors for histological grade of STS. The combination of SUV max and IFH may be a more meaningful method than using each of the above metabolic parameters alone.
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INTRODUCTION: Cancer of unknown primary (CUP) is a challenging malignancy. The purpose of this study was to investigate the clinical characteristics and prognosis of bone metastatic CUP using the population-based Surveillance, Epidemiology, and End Results (SEER) database. METHODS: From the SEER database, we identified 1908 patients with bone metastatic CUP at initial presentation between 2010 and 2018. Histology was subdivided following International Classification of Diseases for Oncology codes as Adenocarcinoma, Squamous cell, Neuroendocrine, or Carcinoma not otherwise specified (NOS). Cox proportional hazard modeling was applied using factors of age, sex, ethnicity, histological subtype, and therapeutic intervention. RESULTS: Among the 1908 patients, histology was Neuroendocrine in 240 patients, Squamous cell in 201 patients, Adenocarcinoma in 810 patients and NOS in 657 patients. In each subtype, patients tended to be predominantly male and white. Chemotherapy was introduced for 28% of patients and radiation for 34% in the entire cohort. Survival in patients with bone metastatic CUP was unfavorable, with a median survival of 2 months. Among the histological subtypes, Adenocarcinoma showed shorter survival than the other groups. In addition, treatment interventions such as chemotherapy and radiation therapy prolonged survival, particularly for Squamous cell, Adenocarcinoma and NOS, but not for Neuroendocrine. DISCUSSION: Bone metastatic CUP showed extremely poor prognosis, but treatment interventions such as chemotherapy and radiation generally offered survival benefits. Further randomized clinical research is needed to confirm the present results.
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Adenocarcinoma , Neoplasias Óseas , Neoplasias Primarias Desconocidas , Humanos , Masculino , Femenino , Neoplasias Primarias Desconocidas/terapia , Neoplasias Primarias Desconocidas/patología , Pronóstico , Adenocarcinoma/terapia , Adenocarcinoma/patología , Neoplasias Óseas/patología , Estadificación de NeoplasiasRESUMEN
Information available from the New South Wales Cancer Registry (NSWCR) about the aggressiveness of prostate cancer is limited to the summary stage variable 'degree of spread', which contains a high proportion of cases defined as 'unknown'. In this study we demonstrate the feasibility of obtaining and analysing prostate cancer pathology data from stored pathology records. Pathology data were extracted from stored pathology records of incident prostate cancer cases in men participating in the 45 and Up Study, a large Australian prospective cohort study, who were diagnosed between January 2006 and December 2013. Baseline questionnaires from the 45 and Up Study were linked to the NSWCR. Demographic and pathology items were tabulated and associations described. We evaluated the completeness of pathological characteristics by degree of spread of cancer at diagnosis. Among the 123,921 men enrolled in the 45 and Up Study, 5,091 had incident prostate cancer and 5,085 were linked to a pathology record. The most complete variables included grade group of diagnostic (85.8%) and surgical (99.8%) specimens, margin status (98.1%), extraprostatic extension (95.1%) and seminal vesicle invasion (96.8%). Most diagnostic specimens were grade group 1 (26.6%) or 2 (23.5%). Of the 5,085 cases, 30.8% were classified by the NSWCR with unknown degree of spread; a pathology record could be extracted for 99.4% of these. The unknown degree of spread cases had similar levels of completeness and distribution of diagnostic and surgical pathology features to those with a localised degree of spread. This study demonstrated the feasibility of obtaining and analysing data derived from pathology reports from centralised state-based cancer registry notifications. Supplementing degree of spread information with pathology data from diagnosis and surgery will improve both the quality of research and policy aimed at improving the lives of men with prostate cancer.