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Hemangiopericitoma , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/patología , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/diagnóstico por imagen , Hemangiopericitoma/patología , Hemangiopericitoma/diagnóstico , Hemangiopericitoma/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Anciano , Gastrectomía , Adenocarcinoma/patología , Adenocarcinoma/diagnósticoRESUMEN
BACKGROUND AND OBJECTIVE: Neoadjuvant chemotherapy results in various responses when used to treat locally advanced gastric cancer, we aimed to develop and validate a predictive model of the response to neoadjuvant chemotherapy in patients with gastric cancer. METHODS: A total of 128 patients with locally advanced gastric cancer who underwent pre-treatment computed tomography (CT) scanning followed by neoadjuvant chemoradiotherapy were included (training cohort: n = 64; validation cohort: n = 64). We built a radiomics score combined with laboratory parameters to create a nomogram for predicting the efficacy of neoadjuvant chemotherapy and calculating scores for risk factors. RESULTS: The radiomics score system demonstrated good stability and prediction performance for the response to neoadjuvant chemotherapy, with the area under the curve of the training and validation cohorts being 0.8 and 0.64, respectively. The radiomics score proved to be an independent risk factor affecting the efficacy of neoadjuvant chemotherapy. In addition to the radiomics score, four other risk factors were included in the nomogram, namely the platelet-to-lymphocyte ratio, total bilirubin, ALT/AST, and CA199. The model had a C-index of 0.8. CONCLUSIONS: Our results indicated that radiomics features could be potential biomarkers for the early prediction of the response to neoadjuvant treatment.
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Terapia Neoadyuvante , Nomogramas , Neoplasias Gástricas , Tomografía Computarizada por Rayos X , Humanos , Neoplasias Gástricas/patología , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/terapia , Neoplasias Gástricas/tratamiento farmacológico , Masculino , Femenino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Anciano , Adulto , Estudios Retrospectivos , Factores de Riesgo , Bilirrubina/sangre , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Área Bajo la Curva , Recuento de Plaquetas , Radiómica , Antígenos de Carbohidratos Asociados a TumoresRESUMEN
ANTECEDENTES: En cumplimiento del inciso e, sobre nuestras funciones como UFETS, que dice: "Desarrollar evaluaciones de tecnologías sanitarias, incluyendo medicamentos, dispositivos y equipos médicos, procedimientos médicos o quirúrgicos y sistemas de organización, en forma sistémica y objetiva aplicadas a la salud, basándose en la mejor evidencia científica disponible", realizamos esta revisión rápida sobre la utilidad de la jeringa 10 ml precargada de solución salina (ClNa 0.9%) para la inyección de medios de contraste en tomografía computarizada o resonancia magnética. ESTRATEGIA DE BÚSQUEDA DE INFORMACIÓN: Pregunta Clínica: En pacientes con cáncer de mama, cuello uterino y estómago que requieren inyección de medios de contraste ¿Cuál es la utilidad de la jeringa 10ml precarga de solución salina (NaCl 0.9%) en la realización de una tomografía computarizada o resonancia magnética con contraste? Recolecciòn de los Manuscritos a Revisar: Tipos de estudios: La estrategia de búsqueda sistemática de información científica para el desarrollo del presente informe se realizó siguiendo las recomendaciones de la Pirámide jerárquica de la evidencia propuesta por Haynes y se consideró los siguientes estudios: Sumarios y guías de práctica clínica. Revisiones sistemáticas y/o meta-análisis. Ensayos Controlados Aleatorizados (ECA) Estudios Observacionales (cohortes, caso y control, descriptivos) No hubo limitaciones acerca de la fecha de publicación o el idioma para ningún estudio. Fuentes de información: De acceso libre o Bases de datos: Pubmed y Cochrane Fecha de búsqueda: Desde el inicio de los tiempos hasta la actualidad. Términos de Búsqueda Considerando la pregunta PICO se construyó una estrategia de búsqueda. Sin restricciones en el idioma y año. DISCUSIÓN: Durante la sesión de panel se discutió los artículos encontrados, así como las búsquedas realizadas en las principales agencias de evaluación de tecnologías sanitarias y las guías que reportan información al respecto de jeringas precargadas 10 ml NaCl 0.9%. Con respecto a los estudios encontrados se ha evidenciado que el uso de jeringas precargadas NaCl 0.9% en los 03 estudios ha sido favorable en reducción de infecciones del torrente sanguíneo relacionadas a catéter, disminución en el riesgo de reemplazo del catéter venoso periférico, disminución del riesgo para pacientes y mejoras en la seguridad de los trabajadores de salud y también podría llevar a una reducción en costos asociados. El primer estudio si bien fue realizado en pacientes oncológicos, se realizó en ambientes de quimioterapia y el segundo estudio fue un estudio cuasi experimental que abarco pacientes que acudieron o estaban en diferentes áreas hospitalarias y en el caso del tercer estudio no se logró tener acceso al manuscrito en versión extensa debido a que fue publicado hace menos de un mes y el acceso era limitado. Por ello, se ha planteado que la evidencia obtenida con respecto al uso de jeringas precargadas es indirecta por lo cual es difícil establecer una conclusión con respecto a su uso en un área específica como previo a la realización de tomografía con contraste o una resonancia magnética. CONCLUSIONES: En el Instituto Nacional de Enfermedades Neoplásicas se realizan anualmente aproximadamente 45000 exámenes radiológicos de tipo TC ó RM que requieren el uso de contraste en pacientes con cáncer de mama, estómago o cuello uterino en donde se utilizaría jeringas 10 mL precargadas con solución salina 0.9%. Se realizó una búsqueda sistemática y una búsqueda dirigida de la evidencia para evaluar la utilidad de la jeringa precargada 10 mL con solución salina 0.9% y no se encontró evidencia directa de su uso en la población específica; sin embargo, se han reportado algunos artículos científicos que encuentran evidencia favorable de su uso comparado con la jeringa cargada manualmente. Se encontraron 03 artículos que comparando la tecnología sanitaria "Jeringa 10 mL precargada con NaCl 0.9%" con la jeringa de carga manual, las jeringas precargadas presentan: un menor porcentaje de remoción de jeringa por complicaciones, reducción de la tasa de infección del torrente sanguíneo relacionada con el catéter y reducción de la tasa de fallo de colocación del catéter venoso. Adicionalmente, según informes de contraloría y en base análisis internos de la institución se ha priorizado un presupuesto para la atención del cáncer de mama, cáncer de cuello uterino y cáncer de estómago para el estadiaje y tratamiento que en base al riesgo identificado "contaminación por uso de jeringas cargadas manualmente" se establezca la medida de control "utilizar jeringa precargada previo al examen". Con respecto a la adquisición, está disponible en Latinoamérica y es de fácil adquisición a solicitud. Finalmente, en base a la evidencia encontrada y los documentos revisados a nivel institucional el panel establece la necesidad de que el área de costos realice un análisis de impacto presupuestario que nos permita conocer si la inclusión de la tecnología sanitaria "Jeringa 10 mL precargada con NaCl 0.9%" implicaría una reducción de costos en el área específica en la cual se va a implementar.
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Humanos , Neoplasias Gástricas/diagnóstico por imagen , Jeringas/provisión & distribución , Neoplasias de la Mama/diagnóstico por imagen , Espectroscopía de Resonancia Magnética/instrumentación , Tomografía Computarizada por Rayos X/instrumentación , Neoplasias del Cuello Uterino/diagnóstico por imagen , Solución Salina/administración & dosificación , Análisis Costo-Beneficio/economía , Medios de ContrasteRESUMEN
PURPOSE: To explore the application value of multi-slice spiral CT (MSCT), magnetic resonance imaging (MRI) combined with gastric contrast-enhanced ultrasonography in the diagnosis of T staging of gastric cancer. METHODS: The subjects of study were 109 gastric cancer patients with T stages admitted to our hospital for diagnosis and treatment from December 2016 to December 2018. All the patients were examined with MSCT, MRI and gastric contrast-enhanced ultrasonography before operation to observe corresponding imaging results. T staging of gastric cancer patients was conducted according to the examination results, which was then compared with postoperative pathological staging. It was performed to analyze the accuracy of the three diagnostic methods and combined diagnosis of gastric cancer T staging. RESULTS: The sensitivity of MSCT in the diagnosis of T staging of gastric cancer was 60.00%, 67.74%, 72.22%, 76.47%, the specificity was 95.24%, 88.46%, 86.30%, 94.56% and the diagnostic coincidence rate was 87.16%, 82.57%, 81.65%, 91.74%; the sensitivity of MRI in the diagnosis of T staging of gastric cancer was 68.00%, 70.97%, 77.78%, 76.47%, the specificity was 92.86%, 88.46%, 91.78%, 95.65%, and the diagnostic coincidence rate was 87.16%, 83.49%, 87.16%, 92.66%; the sensitivity of gastric contrast-enhanced ultrasonography in the diagnosis of T staging of gastric cancer was 80.00%, 83.87%, 86.11%, 82.35%, the specificity was 97.62%, 92.31%, 91.78%, 97.83%, and the diagnostic coincidence rate was 93.58%, 89.91%, 89.91%, 95.41%; the sensitivity of combined MSCT, MRI and gastric contrast-enhanced ultrasonography in the diagnosis of T staging of gastric cancer was 88.00%, 93.55%, 97.22%, 94.12%; the specificity was 100%, 97.44%, 95.89%, 98.91%; and the diagnostic coincidence rate was 97.25%, 96.33%, 96.33%, 98.17%, respectively. Statistical analysis revealed that the sensitivity, specificity and diagnostic coincidence rate of combined detection of the three methods were significantly higher than those of single detection (P < 0.05). CONCLUSION: Combined use of MSCT, MRI and gastric contrast-enhanced ultrasonography can significantly improve the diagnostic sensitivity, specificity and diagnostic coincidence rate of T staging of gastric cancer. It may provide a certain reference value for guiding the selection of clinical therapeutic approaches and evaluation of curative effect.
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Imagen por Resonancia Magnética/métodos , Tomografía Computarizada Multidetector/métodos , Neoplasias Gástricas/diagnóstico por imagen , Ultrasonografía/métodos , Adulto , Anciano , Medios de Contraste/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Imagen Multimodal/métodos , Estadificación de Neoplasias/métodos , Sensibilidad y Especificidad , Neoplasias Gástricas/patologíaAsunto(s)
Adenocarcinoma/radioterapia , Neoplasias Gástricas/radioterapia , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Femenino , Hemostáticos/uso terapéutico , Humanos , Persona de Mediana Edad , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Proteína p53 Supresora de TumorRESUMEN
Non-invasive imaging of vascular endothelial growth factor receptor 1 (VEGFR1) remains a great challenge in the early diagnosis of tumors, especially in gastric cancer. Here, we designed and evaluated a novel 111In-DOTA-F56 peptide as a radioactive analogue of F56 (peptide WHSDMEWWYLLG) to bind VEGFR1. It was obtained by radiolabeling DOTA-F56 with 111InCl3 with 98% radiochemical purity and 1.4 ± 0.4 GBq/µmol specific activity. 111In-DOTA-F56 was obtained by the reaction of DOTA-F56 (10 µg) with 111InCl3 in pH 4.0 sodium acetate buffer at 85 °C for 20 min. 111In-DOTA-F56 shows good stability in 0.01 M Phosphate Buffered Saline (PBS) and 5% Human Serum Albumin (HSA). 111In-DOTA-F56 has a high binding affinity for human gastric cancer BGC-823 cells. Bio-distribution studies of 111In-DOTA-F56 were performed in nude mice xenografted with human gastric cancer BGC-823 cells and the results revealed tumor uptake accumulation. A blocking dose of DOTA-F56 significantly reduced the tumor uptake of 111In-DOTA-F56. Tumors were observed with Micro-SPECT images, and the uptake in the tumor increased with time from 4 h to 24 h. The MIP of the Micro-SPECT also showed that the excess DOTA-F56 can specifically block 111In-DOTA-F56 in a mouse tumor model. We successfully synthesized the 111In-DOTA-F56 VEGFR1-targeted peptide as a non-invasive molecule with fine radiochemical properties. Micro-SPECT indicates tumor uptake, which can be further blocked by excess of the F56 peptide, indicating that 111In-DOTA-F56 peptide has potential for early detection of VEGFR1 positive gastric cancer and is worthy of further clinical investigations.
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Compuestos Heterocíclicos con 1 Anillo/química , Oligopéptidos/química , Neoplasias Gástricas/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Receptor 1 de Factores de Crecimiento Endotelial Vascular/análisis , Animales , Línea Celular Tumoral , Relación Dosis-Respuesta a Droga , Compuestos Heterocíclicos con 1 Anillo/farmacocinética , Humanos , Radioisótopos de Indio , Ratones , Estructura Molecular , Neoplasias Experimentales/diagnóstico por imagen , Oligopéptidos/farmacocinética , Relación Estructura-Actividad , Distribución TisularAsunto(s)
Neurilemoma/cirugía , Neoplasias Gástricas/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Femenino , Tumores del Estroma Gastrointestinal , Humanos , Persona de Mediana Edad , Neurilemoma/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , UltrasonografíaRESUMEN
ABSTRACT Background: Papiliotrema laurentii is one of several non-neoformans cryptococci that have rarely been associated with human infection, since it was previously considered saprophyte and thought to be non-pathogenic to humans. Nevertheless, increasing number of reports of human infection have emerged in recent years, mostly in oncologic patients. Aim: To report a case of a female patient with pyloric obstructive cancer with a catheter-related Papiliotrema laurentii blood stream infection and systematically review the available evidence on P. laurentii infection in humans. Methods: Retrieval of studies was based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews and Opengray.eu. There was no language or date of publication restrictions. The reference lists of the studies retrieved were searched manually. Results: The search strategy retrieved 1703 references. In the final analysis, 31 references were included, with the description of 35 cases. Every patient but one had a previous co-morbidity - 48.4 % of patients had a neoplasm. Amphotericin B was the most used treatment and only a single case of resistance to it was reported. Most patients were cured of the infection. Conclusion: P. laurentii infection in humans is usually associated to neoplasia and multiple co-morbidities, and amphotericin B seems to be a reliable agent for treatment.
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Humanos , Femenino , Anciano , Neoplasias Gástricas/diagnóstico por imagen , Infecciones Relacionadas con Catéteres/diagnóstico por imagen , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/terapia , Biopsia , Vancomicina/uso terapéutico , Tomografía Computarizada por Rayos X , Fluconazol/uso terapéutico , Anfotericina B/uso terapéutico , Bacteriemia/microbiología , Cryptococcus/aislamiento & purificación , Infecciones Relacionadas con Catéteres/etiología , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Combinación Piperacilina y Tazobactam/uso terapéutico , Antibacterianos/uso terapéuticoRESUMEN
BACKGROUND: Papiliotrema laurentii is one of several non-neoformans cryptococci that have rarely been associated with human infection, since it was previously considered saprophyte and thought to be non-pathogenic to humans. Nevertheless, increasing number of reports of human infection have emerged in recent years, mostly in oncologic patients. AIM: To report a case of a female patient with pyloric obstructive cancer with a catheter-related Papiliotrema laurentii blood stream infection and systematically review the available evidence on P. laurentii infection in humans. METHODS: Retrieval of studies was based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews and Opengray.eu. There was no language or date of publication restrictions. The reference lists of the studies retrieved were searched manually. RESULTS: The search strategy retrieved 1703 references. In the final analysis, 31 references were included, with the description of 35 cases. Every patient but one had a previous co-morbidity - 48.4 % of patients had a neoplasm. Amphotericin B was the most used treatment and only a single case of resistance to it was reported. Most patients were cured of the infection. CONCLUSION: P. laurentii infection in humans is usually associated to neoplasia and multiple co-morbidities, and amphotericin B seems to be a reliable agent for treatment.
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Infecciones Relacionadas con Catéteres/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico por imagen , Anciano , Anfotericina B/uso terapéutico , Antibacterianos/uso terapéutico , Bacteriemia/microbiología , Biopsia , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/etiología , Infecciones Relacionadas con Catéteres/microbiología , Cryptococcus/aislamiento & purificación , Femenino , Fluconazol/uso terapéutico , Humanos , Combinación Piperacilina y Tazobactam/uso terapéutico , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/terapia , Tomografía Computarizada por Rayos X , Vancomicina/uso terapéuticoRESUMEN
INTRODUCTION: Desmoplastic small round cell tumor is an extremely rare and aggressive cancer that affects mainly adolescents and young adults. Despite multiple therapeutic strategies, most patients have resistant disease with very poor survival rates. CASE PRESENTATION: We present a case of a 10-year-old Caucasian boy with a desmoplastic small round cell tumor refractory to conventional treatment who exhibited a good response to alternative treatment. With use of irinotecan and vincristine in association with radiation therapy, a reduction of 96.9% of the dimensions of the target lesions compared with the initial image was observed. CONCLUSION: This chemotherapy regimen, in association with radiation therapy, demonstrated efficacy for refractory desmoplastic small round cell tumor in our patient, and it is cost-effective.
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Tumor Desmoplásico de Células Pequeñas Redondas/tratamiento farmacológico , Irinotecán/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Vincristina/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica , Niño , Análisis Costo-Beneficio , Tumor Desmoplásico de Células Pequeñas Redondas/diagnóstico por imagen , Tumor Desmoplásico de Células Pequeñas Redondas/patología , Países en Desarrollo , Humanos , Masculino , Radiografía Abdominal , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/patología , Resultado del TratamientoRESUMEN
INTRODUCTION AND AIMS: Neuroendocrine tumors are of great scientific interest, given that they are difficult to diagnose and treat. Despite being relatively rare (< 1/100,000 individuals, 1-2% of the gastrointestinal neoplasias) and indolent, their potential malignancy must not be forgotten. An increase in the number of diagnosed tumors has been observed in recent years. The aim of the present study was to update a published case series of 19 patients suspected of presenting with pancreatic neuroendocrine tumor with 51 current cases, to study and compare the new results with those of the previous case series, as well as with other recent publications from Spain, the United States, China, and India. MATERIALS AND METHODS: A retrospective, multicenter case series was conducted on 70 patients (19 cases published in 2011), whose data has been collected over a period of 23 years. The variables analyzed were: age, sex, symptomatology, tumor size, location, metastasis, final diagnosis, and surgery, among others. RESULTS: Mean patient age was 55 years and 60% of the patients were men. Disease location was the pancreatic head in 28.5% of the patients and the tail in 27.1%, mean tumor size was 3.9cm (0.2-10cm), 71.4% of the patients had non-functioning tumors, 32.8% had metastases (100% to the liver), 74.2% of the patients were operated on, and actuarial survival was 75%. CONCLUSIONS: Differences were observed between the previously published case series and the current results. There was an increase in incidentalomas and non-functioning tumors, but no variation in the overall survival rate. The differences with other case series (age, sex, and tumor location) were dependent on the country where the cases were compiled. The increase in tumors could be related to a higher number of diagnoses made through imaging studies and to the greater sensitivity of the devices employed.
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Neoplasias Intestinales/diagnóstico por imagen , Neoplasias Intestinales/diagnóstico , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/diagnóstico , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/diagnóstico por imagen , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
El cáncer gástrico temprano (CGT) se define como un adenocarcinoma invasivo que alcanza a la submucosa gástrica, con o sin metástasis linfática independientemente del tamaño del tumor (Carter 1984). La incidencia de esta entidad es variable dependiendo de la población, pero se ha observado un aumento en los últimos años a nivel mundial debido a los avances en las técnicas diagnósticas. Los dos factores asociados al pronóstico en el cáncer gástrico temprano son la metástasis linfática y la invasión tumoral, de los cuales la afectación linfática ha demostrado ser un factor pronóstico independiente (Roviello 2006). Los avances en las técnicas de diagnóstico y tratamiento endoscópico han cambiado el paradigma del tratamiento de cáncer gástrico temprano. Sin embargo, a nivel mundial la gastrectomía se mantiene como el tratamiento locoregional definitivo (Montgomery 2013). Los datos globales para el cáncer gástrico lo posicionan en el quinto cáncer en incidencia (952.000 casos en 2012) y como la tercera causa de muerte por cáncer en ambos sexos (GLOBOCAN 2012). Más del 75% de los casos (677.000) ocurre en países en vías de desarrollo (456.000 en hombres y 221.000 en mujeres). La tasa ajustada por edad es dos veces más alta en hombres que en mujeres (Figura 1). A nivel nacional el cáncer gástrico representa la cuarta causa de cáncer en incidencia (15,8 por 100.000) y la segunda en mortalidad por cáncer (13,1 por 100.000) en ambos sexos. En hombres la incidencia ajustada es de 16,6 por 100.000 con una tasa de mortalidad de 13,9 por 100.000, y en mujeres la incidencia es de 15,0 por 100.000 con una tasa mortalidad de 12,4 por 100.000 (Perú - GLOBOCAN 2012). Considerando la importante carga de enfermedad del cáncer gástrico en la población peruana, el Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) de EsSalud ha planteado la necesidad de la realización de una guía de práctica clínica (GPC) basada en la mejor evidencia disponible para el diagnóstico y tratamiento del cáncer gástrico temprano.
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Humanos , Neoplasias Gástricas/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Neoplasias Gástricas/diagnóstico por imagen , Diagnóstico Precoz , Endoscopía , Antibacterianos/uso terapéuticoRESUMEN
OBJECTIVE: This study retrospectively reviewed 46 cases of gastric gastrointestinal stromal tumors treated by endoluminal endoscopic full-thickness resection (EFR) microsurgery in our gastrointestinal endoscopy center. We aimed to evaluate the EFR for the treatment of gastric gastrointestinal stromal tumors originating from the muscularis propria. METHODS: A total of 46 patients with gastric gastrointestinal stromal tumors originated from the muscularis propria layer from January 2012 to June 2015 were treated with EFR. The patients were followed up with gastroscope and computed tomography (CT) for evaluation of therapeutic effect and safety. RESULTS: EFR was successfully accomplished to remove all tumors in 46 patients. The mean procedure time was 82.5±39.8min (56-188min). Except in 3 leiomyomas, pathological examination confirmed gastrointestinal stromal tumor (GIST) in 43 cases. None of the patients had occurred bleeding, peritonitis and other complications after EFR. Thereafter, all patients were followed up with gastro-scope after 1, 6,12 months. CONCLUSIONS: EFR is effective and safe for patients with gastric gastrointestinal stromal tumors originated from muscularis propria layer and has the advantage of less invasive treatment and higher tumor resection rate. It should be considered for further application.
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Resección Endoscópica de la Mucosa/métodos , Gastrectomía/métodos , Mucosa Gástrica/cirugía , Tumores del Estroma Gastrointestinal/cirugía , Leiomioma/cirugía , Neoplasias Gástricas/cirugía , Adulto , Anciano , Femenino , Mucosa Gástrica/patología , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Humanos , Leiomioma/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Gástricas/diagnóstico por imagen , Resultado del Tratamiento , Adulto JovenRESUMEN
Background: The multi-slice computerized tomography (MSCT) is a medical imaging modality that has been used to determine the size and location of the stomach cancer. Additionally, MSCT is considered the best modality for the staging of gastric cancer. One way to assess the type 2 cancer of stomach is by detecting the pathological structure with an image segmentation approach. The tumor segmentation of MSCT gastric cancer images enables the diagnosis of the disease condition, for a given patient, without using an invasive method as surgical intervention. Methods: This approach consists of three stages. The initial stage, an image enhancement, consists of a method for correcting non homogeneities present in the background of MSCT images. Then, a segmentation stage using a clustering method allows to obtain the adenocarcinoma morphology. In the third stage, the pathology region is reconstructed and then visualized with a three-dimensional (3-D) computer graphics procedure based on marching cubes algorithm. In order to validate the segmentations, the Dice score is used as a metric function useful for comparing the segmentations obtained using the proposed method with respect to ground truth volumes traced by a clinician. Results: A total of 8 datasets available for patients diagnosed, from the cancer data collection of the project, Cancer Genome Atlas Stomach Adenocarcinoma (TCGASTAD) is considered in this research. The volume of the type 2 stomach tumor is estimated from the 3-D shape computationally segmented from the each dataset. These 3-D shapes are computationally reconstructed and then used to assess the morphopathology macroscopic features of this cancer. Conclusions: The segmentations obtained are useful for assessing qualitatively and quantitatively the stomach type 2 cancer. In addition, this type of segmentation allows the development of computational models that allow the planning of virtual surgical processes related to type 2 cancer.
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Adenocarcinoma/clasificación , Adenocarcinoma/diagnóstico por imagen , Algoritmos , Neoplasias Gástricas/clasificación , Neoplasias Gástricas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Carga TumoralRESUMEN
SUMMARY OBJECTIVE: This study retrospectively reviewed 46 cases of gastric gastrointestinal stromal tumors treated by endoluminal endoscopic full-thickness resection (EFR) microsurgery in our gastrointestinal endoscopy center. We aimed to evaluate the EFR for the treatment of gastric gastrointestinal stromal tumors originating from the muscularis propria. METHODS: A total of 46 patients with gastric gastrointestinal stromal tumors originated from the muscularis propria layer from January 2012 to June 2015 were treated with EFR. The patients were followed up with gastroscope and computed tomography (CT) for evaluation of therapeutic effect and safety. RESULTS: EFR was successfully accomplished to remove all tumors in 46 patients. The mean procedure time was 82.5±39.8min (56-188min). Except in 3 leiomyomas, pathological examination confirmed gastrointestinal stromal tumor (GIST) in 43 cases. None of the patients had occurred bleeding, peritonitis and other complications after EFR. Thereafter, all patients were followed up with gastro-scope after 1, 6,12 months. CONCLUSIONS: EFR is effective and safe for patients with gastric gastrointestinal stromal tumors originated from muscularis propria layer and has the advantage of less invasive treatment and higher tumor resection rate. It should be considered for further application.
RESUMO OBJETIVO: Este estudo revisou retrospectivamente 46 casos de tumores gástricos estromáticos gastrointestinais tratados por microcirurgia endoluminal endoscópica de ressecção completa (EFR) em nosso centro de endoscopia gastrointestinal. Pretendemos avaliar a EFR para o tratamento de tumores gastrointestinais estromáticos originários da muscularis própria. MÉTODOS: Um total de 46 pacientes com tumores gástricos estromáticos gastrointestinais originários da camada muscular própria, de janeiro de 2012 a junho de 2015, foi tratado com EFR. Os pacientes foram acompanhados com gastroscópio e tomografia computadorizada (TC) para avaliação de efeitos terapêuticos e segurança. RESULTADOS: A EFR foi realizada com sucesso para remover todos os tumores em 46 pacientes. O tempo médio de procedimento foi de 82,5±39,8 min (56-188 min). Exceto em três leiomiomas, exame patológico confirmou tumor estromal gastrointestinal (Gist) em 43 casos. Em nenhum paciente ocorreu sangramento, peritonite e outras complicações após EFR. Posteriormente, todos os pacientes foram acompanhados com gastroscópio após um, seis e 12 meses. CONCLUSÕES: A EFR é eficaz e segura para pacientes com tumores gastrointestinais originários da camada muscular própria e tem a vantagem de ser um tratamento menos invasivo e com maior taxa de ressecção tumoral. Deve ser considerada para posterior aplicação.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Adulto Joven , Neoplasias Gástricas/cirugía , Tumores del Estroma Gastrointestinal/cirugía , Resección Endoscópica de la Mucosa/métodos , Gastrectomía/métodos , Mucosa Gástrica/cirugía , Leiomioma/cirugía , Neoplasias Gástricas/diagnóstico por imagen , Estudios Retrospectivos , Resultado del Tratamiento , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Mucosa Gástrica/patología , Leiomioma/patología , Persona de Mediana EdadRESUMEN
PURPOSE: Gastroenteropancreatic neuroendocrine tumors are a heterogeneous group of low incidence neoplasms characterized by a low proliferative activity and slow growth. Their response to targeted therapies is heterogeneous and often does not lead to tumor shrinkage. Thus, evaluation of the therapeutic response should differ from other kind of tumors. METHODS: To answer relevant questions about which techniques are best in the assessment of progression or treatment response a RAND/UCLA-based consensus process was implemented. Relevant clinical questions were listed followed by a systematic search of the literature. The expert panel answered all questions with recommendations, combining available evidence and expert opinion. Recommendations were validated through a questionnaire and a participatory meeting. RESULTS: Expert recommendations regarding imaging tools for tumor assessment and evaluation of progression were agreed upon. Available imaging techniques were reviewed and recommendations for best patient monitoring practice and the best way to evaluate treatment response were formulated.
Asunto(s)
Neoplasias Intestinales/diagnóstico por imagen , Neoplasias Intestinales/patología , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/patología , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/patología , Diagnóstico por Imagen/métodos , Progresión de la Enfermedad , HumanosRESUMEN
INTRODUCTION AND AIMS: Gastric cancer is one of the main causes of cancer worldwide, but there is currently no global screening strategy for the disease. Endoscopy is the screening method of choice in some Asian countries, but no standardized technique has been recognized. Systematic alphanumeric-coded endoscopy can increase gastric lesion detection. The aim of the present article was to compare the usefulness of systematic alphanumeric-coded endoscopy with conventional endoscopy for the detection of premalignant lesions and early gastric cancer in subjects at average risk for gastric cancer. MATERIALS AND METHODS: A cross-sectional, comparative, prospective, randomized study was conducted on patients at average risk for gastric cancer (40-50 years of age, no history of H. pylori infection, intestinal metaplasia, gastric atrophy, or gastrointestinal surgery). Before undergoing endoscopy, the patients had gastric preparation (200mg of oral acetylcysteine or 50mg of oral dimethicone). Conventional chromoendoscopy was performed with indigo carmine dye for contrast enhancement. RESULTS: Fifty consecutive cases (mean age 44.4 ± 3.34 years, 60% women, BMI 27.6 ± 5.82 kg/m2) were evaluated. Endoscopic imaging quality was satisfactory in all the cases, with no differences between methods (p = 0.817). The detection rate of premalignant lesions and early gastric cancer was 14% (6 cases of intestinal metaplasia and one case of gastric adenocarcinoma). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 100, 95, 80, 100 and 96%, respectively, for systematic alphanumeric-coded endoscopy, and 100, 45, 20, 100, and 52%, respectively, for conventional endoscopy. Lesion detection through systematic alphanumeric-coded endoscopy was superior to that of conventional endoscopy (p = 0.003; OR = 12). CONCLUSION: Both techniques were effective, but systematic alphanumeric-coded endoscopy significantly reduced the false positive rate.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Detección Precoz del Cáncer/métodos , Gastroscopía/métodos , Imagen Óptica/métodos , Lesiones Precancerosas/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico por imagen , Adenocarcinoma/patología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Lesiones Precancerosas/patología , Estudios Prospectivos , Riesgo , Sensibilidad y Especificidad , Neoplasias Gástricas/patologíaRESUMEN
Fundamento: el cáncer gástrico constituye la segunda causa de muerte por cáncer en el mundo. Objetivo: validar el ultrasonido hidrogástrico en el diagnóstico del cáncer gástrico avanzado. Métodos: el ultrasonido hidrogástrico fue realizado por dos observadores independientes a 100 pacientes, 30 con cáncer gástrico avanzado, confirmados por endoscopia y biopsia; y 70 pacientes sin cáncer gástrico. Resultados: por regresión logística se determinó que el engrosamiento de la pared gástrica fue el único signo con valor como predictor de la presencia de CG. La sensibilidad, especificidad, certeza, valor predictivo positivo y valor predictivo negativo del ultrasonido hidrogástrico fueron de 83,3 por ciento; 90, por ciento; 88,0 por ciento; 78,1 por ciento y 92,6 por ciento respectivamente. Conclusiones: el ultrasonido hidrogástrico es una modalidad diagnostica útil en el diagnóstico del cáncer gástrico avanzado(AU)
Background: gastric cancer still remains one of the most common malignancies worldwide. Objective: to validate the Conventional hydrogastric ultrasound in the diagnosis of the advanced gastric cancer. Methods: the hydrogastric ultrasound was carried out by two independent observers 30 with cancer patients with advanced gastric cancer, confirmed by endoscopy and biopsy; and 70 patients without gastric cancer. Results: for logistical regression it was determined that the thickening of the gastric wall was the only sign with value like predictor of the presence of advancedgastric cancer. The sensibility, specificity, certainty, value positive predictive and value negative predictive of the hydrogastric ultrasound in the diagnosis of gastric cancer were of 83,3 percent; 90;0 percent; 88,0 percent; 78,1 percent y 92,6 percent respectively. Conclusions: the Hydrogastric ultrasound is a diagnostic modality useful in the diagnosis of the advanced gastric cancer(AU)