Assessment Of Tumor Size Research Articles

An Update on the Role of MRI in Treatment Stratification of Patients with Cervical Cancer.

Cervical cancer is the fourth most common cancer in women worldwide and the most common gynaecological malignancy. The FIGO staging system is the most commonly utilised classification system for cervical cancer worldwide. Prior to the most recent update in the FIGO staging in 2018, the staging was dependent upon clinical assessment alone. Concordance between the surgical and clinical FIGO staging decreases rapidly as the tumour becomes more advanced. MRI now plays a central role in patients diagnosed with cervical cancer and enables accurate staging, which is essential to determining the most appropriate treatment. MRI is the best imaging option for the assessment of tumour size, location, and parametrial and sidewall invasion. Notably, the presence of parametrial invasion precludes surgical options, and the patient will be triaged to chemoradiotherapy. As imaging is intrinsic to the new 2018 FIGO staging system, nodal metastases have been included within the classification as stage IIIC disease. The presence of lymph node metastases within the pelvis or abdomen is associated with a poorer prognosis, which previously could not be included in the staging classification as these could not be reliably detected on clinical examination. MRI findings corresponding to the 2018 revised FIGO staging of cervical cancers and their impact on treatment selection will be described.

The Accuracy of Mammogram and Ultrasound in Assessment of Tumour Size and Lymph Node Involvement in Invasive Breast Cancer

The Accuracy of Mammogram and Ultrasound in Assessment of Tumour Size and Lymph Node Involvement in Invasive Breast Cancer

Allogenic Cancellous Bone versus Injectable Bone Substitute for Endoscopic Treatment of Simple Bone Cyst and Intraosseous Lipoma of the Calcaneus and Is Intraosseous Lipoma a Developmental Stage of a Simple Bone Cyst?

Simple bone cysts (SBCs) and intraosseous lipoma (IOL) of the calcaneus are rare tumor entities that are primarily diagnosed due to unspecific heel pain, incidental findings, or rarely due to pathological fractures. Compared to traditional open tumor resections, endoscopic resection of these benign tumors aims to minimize surgical morbidity and maximize surgical efficiency without compromising safety. Grafting is regularly performed to reduce the risk of recurrence and stimulate osseous consolidation of the lytic lesion. As the incidence is low and treatment strategies are heterogeneous, there is no clear consensus for the treatment of simple cysts or intraosseous lipomas of the calcaneus. The objectives of this study are (a) to present medium to long-term results after endoscopic resection and grafting with allogenic cancellous bone or bioresorbable hydroxyapatite and calcium sulfate cement, and (b) to add further evidence to the discussion of whether calcaneal SBC and IOL are the same entity at different developmental stages. Between 2012 and 2019, a total of 25 benign bone tumors consisting of 17 SBCs and 8 IOLs were treated by A.T. with endoscopic resection and grafting, comprising the largest cohort to date. For grafting, 12 patients received allogenic cancellous bone (group A) and 13 patients received injectable bone substitute (group B). Pre- and postoperative imaging using plain X-rays and MRI was retrospectively analyzed with a mean follow-up time of 24.5 months to assess tumor size, osseous consolidation (modified Neer classification), and tumor recurrence. A retrospective chart analysis focusing on adverse intra- and perioperative events and other complications associated with the surgical procedure was performed using the modified Clavien-Dindo classification (CD1-3). A total of 12/13 cases with allogenic bone grafting showed a Neer Type 1 osseous healing of the tumorous lesion after endoscopic resection, whereas only 5/11 cases with injectable bone substitute showed sufficient healing (types 1 and 2). There were three recurrent cysts (Neer 4) and two persistent cysts (Neer 3) after using injectable bone substitute. Two CD1 complications were observed in group A (prolonged wound drainage, sural neuritis) and eight complications were observed in group B (6× CD1, 2× CD3). At least two IOLs diagnosed preoperatively using MRI were ultimately identified as SBCs upon histopathologic examination. Allogenic cancellous bone grafting after endoscopic resection of calcaneal SBC or IOL showed a very low rate of complications and no tumor recurrence in our series. On the other hand, depending on the material used, injectable bone substitute showed a high rate of "white-out" (excessive drainage), resulting in multiple complications such as prolonged wound healing, insufficient permanent defect filling, recurrence, and revision surgery. Over time, calcaneal SBC may transform into IOL, exhibiting distinct features of both entities simultaneously during ossoscopy and histopathological analysis.

The Metastatic Risk of Renal Cell Carcinoma by Primary Tumor Size and Subtype

BackgroundCurrent data on the association between tumor size, subtype, and metastases, and thresholds for intervention, for renal cell carcinoma (RCC), are largely based on single-center nephrectomy registries that may under-represent those presenting with metastatic disease. ObjectiveWe sought to assess tumor size and histologic subtype in relation to metastatic status at presentation for patients with RCC. Design, setting, and participantsUsing Surveillance, Epidemiology and End Results cancer registry data, we identified patients with a diagnosis of RCC made between 2004 and 2019, and a known size of primary tumor. We used nodal and metastatic TNM staging to assess metastatic disease at presentation. Outcome measurements and statistical analysisWe report the proportion of metastatic disease across varying tumor sizes for clear cell (ccRCC), papillary (pRCC), and chromophobe (chRCC) RCC. We also examine sarcomatoid RCC and RCC with sarcomatoid features (sarcRCC). Logistic regression models were used to model the likelihood of metastatic disease for each histologic subtype. Results and limitationsOf 181096 RCC patients included, 23829 had metastatic disease. For any RCC, metastatic rates of 3.6%, 13.1%, 30.3%, and 45.1% were observed for tumors ≤4, 4–≤7, 7–≤10, and >10 cm, respectively. Metastatic rates of chRCC were low at even large sizes, 11.0% at >10 cm. In contrast, sarcRCC had high metastatic rates at all sizes, 27.1% at ≤4 cm. Metastatic rates for ccRCC and pRCC increased steadily above 3 cm. For any RCC and each evaluated subtype, tumor size was found to be associated with metastatic disease on logistic regression (p < 0.001). ConclusionsThe likelihood of a renal mass being metastatic varies greatly with both its subtype and size. We report higher likelihoods of metastatic disease across tumor sizes compared with what has been reported previously. These results may help clinicians pick appropriate thresholds for intervention and candidates for active surveillance. Patient summaryWe find that the metastatic probability of renal cell carcinoma varies greatly with subtype and increases with tumor size.

Nanocarriers for Sirna Delivery Aimed at the Treatment of Melanoma: Systematic Review.

Melanoma is a malignant skin cancer type with a high lethality rate due to active metastasis. Among the risk factors for its development is exposure to ultraviolet radiation (UV) and phenotypical characteristics such as clear skin and eyes. Given the difficulties of the conventional therapy, the high cost of the treatment and the low bioavailability of drugs, it is important to develop new therapeutic methods to circumvent this situation. Nanosystems such as micelles, liposomes and nanoparticles present advantages when compared to conventional treatments. The objective of this paper is to carry out a literature review based on articles that dealt with the use of siRNA-loaded nanosystems for the treatment of melanoma, with trials carried out in vivo to assess tumor size. The search was conducted in the Web of Science and PubMed databases considering the last 5 years, that is, the period between January 2017 to December 2021. The "SiRNA and Drug Delivery Systems and Melanoma" keywords were used in both databases, and the articles were analyzed using the inclusion and exclusion criteria established for this paper. The results obtained indicated that using siRNA transported via nanosystems was capable of silencing the BRAF tumor genes and of reducing tumor size and weight, not presenting in vitro and/or in vivo toxicity. Such being the case, the development of these systems becomes a non-invasive and promising option for the treatment of melanoma.

Hepatic arterial infusion with nanoliposomal irinotecan leads to significant regression of tumor size of colorectal liver metastases in a CC531 rat model.

Long-term therapy for unresectable colorectal liver metastases remains challenging. Intraarterial treatments aim to avoid systemic adverse effects of chemotherapy. Nanoliposomal cytotoxic drugs manage to increase the drug concentration within the tumor while reducing toxicity in healthy tissue. In this study we analyzed the effect of hepatic arterial infusion (HAI) with nanoliposomal irinotecan with or without the combination of embolization particles in a rat model for colorectal liver metastases. For the study 32 WAG/Rij rats received subcapsular tumor implantation with CC531 rat colonic adenocarcinoma cells. After ten days tumor size was assessed via ultrasound and animals underwent HAI. One group served as control receiving NaCl 0.9 % (Sham), the three treatment groups received either nanoliposomal irinotecan (HAI nal iri), Embocept® S (HAI Embo) or Embocept® S and nanoliposomal irinotecan (HAI Embo+nal iri). Three days after treatment animals were sacrificed after assessment of tumor size. As a result all treatment groups showed a significant reduction in tumor growth compared to Sham (p<0.05). Expression of the apoptosis marker caspase-3 was enhanced in HAI nal iri and HAI Embo+nal iri compared to Sham and HAI Embo and even significantly enhanced after HAI Embo+nal iri in comparison to Sham (p<0.05). We were able to show thatHAI with Embocept® S led to significantly reduced tumor growth while HAI with nanoliposomal irinotecan alone or in combination with Embocept® S even led to a reduction of tumor size. Thus, we demonstrate that intraarterial treatment with nanoliposomal irinotecan effectively inhibits tumor growth in a rat model of colorectal liver metastases and demands further investigation.

Downregulating vaccinia-related kinase 1 by luteolin suppresses ovarian cancer cell proliferation by activating the p53 signaling pathway

ObjectivesOvarian cancer constitutes one of the most common causes of cancer-related deaths, and preventing chemotherapy resistance and recurrence in patients with ovarian cancer remains a challenge. Herein, we aimed to identify the effect of luteolin, a novel therapeutic agent targeting vaccinia-related kinase 1 (VRK1), on high-grade serous ovarian cancer (HGSOC). MethodsPhosphokinase array, RNA sequencing, and cell cycle and apoptosis assays were conducted to determine the underlying mechanism of the effect of luteolin on HGSOC cells. The anticancer effects of oral and intraperitoneal luteolin administration were assessed in patient-derived xenograft models via several methods, including the assessment of tumor size and immunohistochemistry of phospho-p53, phosphor-HistoneH3 and cleaved caspase 3. ResultsLuteolin reduced HGSOC cell proliferation and increased apoptosis and cell cycle arrest at G2/M. Compared with controls, several genes were dysregulated in luteolin-treated cells, and luteolin activated the p53 signaling pathway. The human phosphokinase array revealed distinct p53 upregulation in luteolin-treated cells, as confirmed by p53 phosphorylation at ser15 and ser46 using western blot analysis. In patient-derived xenograft models, oral or intraperitoneal luteolin administration substantially suppressed tumor growth. Moreover, combination treatment involving luteolin and cisplatin inhibited tumor cell proliferation, especially in cisplatin-resistant HGSOC cell lines. ConclusionsLuteolin demonstrated considerable anticancer effect on HGSOC cells, reduced VRK1 expression, and activated the p53 signaling pathway, thereby inducing apoptosis and cell cycle arrest in G2/M and inhibiting cell proliferation. Furthermore, luteolin exhibited a synergistic effect with cisplatin both in vivo and in vitro. Thus, luteolin can be considered a promising cotreatment option for HGSOC.

Tumor Size Assessment with Three Breast Imaging Modalities

Background and Objectives: Diagnostic accuracy of breast MR is higher than the routinely used sonomammography and digital mammography. There are mixed reports regarding usefulness of breast MR imaging regarding the tumor size estimation. The objective of this study was to determine which modality can assess the exact tumor dimension in comparison with corresponding tumor dimension at pathologic examinations. Materials and Methods: In a prospective study, 68 patients who came for screening diagnostic mammogram and who had breast lesions of Breast Imaging Reporting and Data System (BIRADS) category 3 and more were evaluated. All patients underwent bilateral digital mammography and targeted high-frequency sonography of the primary lesion. Those patients who were thought to possibly have breast cancer and to be candidates for surgical management were offered bilateral contrast-enhanced breast MRI. Tumor size was evaluated by digital mammography, sonomammography, contrast-enhanced mammography, and compared with histopathology reports. Results: Size of the lesions as measured by DM or SM correlated well with the size determined through breast MR (r = 0.975, P &lt; 0.01). There was a statistically significant difference between the measured sizes of lesions between breast MR and HPE (P = 0.76). Breast MR imaging, true size was overestimated in 28 breasts with range of 0–0.6 cm and underestimated in 25 breasts with range of 0–0.9 cm. Conclusion: Breast MR imaging depicts more accurate dimensions of the tumor and its extensions than digital and sonomammography.

PD40-09 16 YEAR TRENDS IN THE USE OF PARTIAL NEPHRECTOMY: ARE DEMOGRAPHIC DISPARITIES IMPROVING?

You have accessJournal of UrologyCME1 Apr 2023PD40-09 16 YEAR TRENDS IN THE USE OF PARTIAL NEPHRECTOMY: ARE DEMOGRAPHIC DISPARITIES IMPROVING? Steven Monda, Hans Lui, Gabriela Gonzalez, Manolis Pratsinis, and Marc Dall'Era Steven MondaSteven Monda More articles by this author , Hans LuiHans Lui More articles by this author , Gabriela GonzalezGabriela Gonzalez More articles by this author , Manolis PratsinisManolis Pratsinis More articles by this author , and Marc Dall'EraMarc Dall'Era More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003345.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Beginning in the late 1990s partial nephrectomy (PN) became increasingly common for treatment of renal cell carcinoma as an alternative to radical (or total) nephrectomy (RN). Early work established disparities within whom received partial nephrectomy with black, female, and low-income patients less likely to receive partial nephrectomy. Recent trends in the continued adoption and demographic disparities within PN are not known. METHODS: Using 2004-2019 SEER data we identified 131,527 renal cell carcinoma patients with tumors between 1.0 and 10 cm who underwent nephrectomy, PN or RN. We assessed predictors of partial nephrectomy using multivariable logistic regression assessing tumor size, treatment year, income, metropolitan status, race, and ethnicity as independent predictors. We also report proportions of nephrectomies performed by PN within different groups across this period. RESULTS: Between 2004 and 2019 the mean tumor size treated with PN increased from 3.0 cm (95% CI 2.9-3.1) to 3.3 cm (95% CI 3.2-3.3) and the percent of excised T1a tumors, ≤4 cm, treated with PN increased from 37.6% to 70.6% (Figures 1 & 2). While controlling for tumor size and treatment year on multivariable logistic regression, Black, Hispanic, non-metropolitan, and lower income patients were all less likely to receive partial nephrectomy (Odds ratios of 0.82, 0.84, 0.83, and 0.70, all p<0.001). The gap in percentage of patient receiving partial nephrectomy for T1a tumors appeared to be eliminated for female patients, narrow for black patients, but widen for poor and rural patients across the study period (Table 1). CONCLUSIONS: Partial nephrectomy for renal cell carcinoma has become increasingly common over the past 16 years with some plateau over the last 5 years. Despite this, demographic disparities in utilization of partial nephrectomy remain pronounced, particularly for low-income and rural patients. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1055 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven Monda More articles by this author Hans Lui More articles by this author Gabriela Gonzalez More articles by this author Manolis Pratsinis More articles by this author Marc Dall'Era More articles by this author Expand All Advertisement PDF downloadLoading ...

MP64-04 THE METASTATIC POTENTIAL OF RENAL MASSES IS UNDERAPPRECIATED: A SIZE ANALYSIS STRATIFIED BY HISTOLOGY

You have accessJournal of UrologyCME1 Apr 2023MP64-04 THE METASTATIC POTENTIAL OF RENAL MASSES IS UNDERAPPRECIATED: A SIZE ANALYSIS STRATIFIED BY HISTOLOGY Steven Monda, Hans Lui, Manolis Pratsinis, Christopher Evans, and Marc Dall'Era Steven MondaSteven Monda More articles by this author , Hans LuiHans Lui More articles by this author , Manolis PratsinisManolis Pratsinis More articles by this author , Christopher EvansChristopher Evans More articles by this author , and Marc Dall'EraMarc Dall'Era More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current data on the association between tumor size and metastases, and thresholds for intervention, for renal masses are largely based on single center nephrectomy registries. We sought to assess tumor size and metastatic status at presentation for patients with any RCC and for specific histologies using a cancer registry. METHODS: Using SEER data we identified patients with a diagnosis of renal cell carcinoma made between 2004-2019. We assessed nodal and metastatic staging to identify non-localized disease. We performed specific assessments on clear cell (ccRCC), papillary (pRCC), and chromophobe (chrRCC) as well as RCC with sarcomatoid features (sarcRCC). We also assessed grade for ccRCC and pRCC. We report proportion of non-localized disease at various sizes and use logistic regression to establish statistical significance. RESULTS: Of 181,096 patients with RCC included, 23,829 has non-localized disease. For RCC, any histology, 3 to 4 cm, 6 to 7 cm, and 10 to 12 cm tumors had non-localized rates of 4.0%, 16.7%, and 40.3% respectively. For chRCC non-localized rates were low at even large sizes. In contrast, sarcRCC had high non-localized rates at all sizes. ccRCC and pRCC non-localized rates increased steadily across each centimeter evaluated. For any RCC and each evaluated histology, tumor size was found to be associated with non-localized disease on logistic regression while controlling for sex; the odds ratio for each additional centimeter was 1.38, 1.29, 1.24, and 1.12 for ccRCC, pRCC, chRCC, and sarcRCC respectively (p<0.001). CONCLUSIONS: The likelihood of a small renal mass being metastatic varies greatly with both its histology and size. We report roughly twice the likelihood of non-localized disease across all tumor sizes compared to what has been reported previously in nephrectomy registries. These results may help clinicians pick appropriate thresholds for intervention and candidates for active surveillance, especially in those characterized by biopsy. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e881 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven Monda More articles by this author Hans Lui More articles by this author Manolis Pratsinis More articles by this author Christopher Evans More articles by this author Marc Dall'Era More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract P3-04-08: Comparison Of Cone Beam Breast CT And Breast MRI In Preoperative Assessment Of Primary Breast Cancer Tumor Size

Abstract Comparison Of Cone Beam Breast CT And Breast MRI In Preoperative Assessment Of Primary Breast Cancer Tumor Size Yinan Ji＊1, Geyi Liao＊1, Ningbing Luo2, Yi Jiang1, Xiaoming Liao1, Wei Tang1, Huawei Yang 1. 1Department of Breast Surgery, 2Department of Radiology, Guangxi Medical University Tumor Hospital, Nanning, China Correspondence to: Dr. Huawei Yang, Department of Breast Surgery, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China Email: Lordyhw@163.com ＊Contributed equally Background: Breast cancer is the malignant tumor with the highest incidence among women in China, seriously endangering women’s health. After breast cancer is diagnosed, surgery is one of the primary treatments. Assessing the extent of breast cancer is vitally important to formulate the best surgical option, obtain clear margins while minimizing the volume of removed tissue, and improve the treatment outcome and patient’s quality of life. Currently, breast surgery relies heavily on Breast MRI (bMRI) for preoperative assessment. However, bMRI may overestimate the tumor sizes. bMRI is contraindicated in patients with claustrophobia, metal implants, and allergy to gadolinium contrast medium. In addition, bMRI is generally expensive and time-consuming. Some patients find bMRI less favorable for cost and time concerns. Cone Beam Breast CT (CBBCT) is a new modality using Cone Beam CT technology and iodinated contrast media for true 3D high-resolution imaging of the breast. Our previous studies have proved the feasibility of CBBCT in the preoperative assessment of breast cancer. A large-scale study has been done to further examine the clinical significance of CBBCT in pre-operative assessment compared with bMRI. Methods: 273 female primary breast cancer patients were included in this study. The maximal diameters of the tumors were measured in CBBCT and bMRI images by an experienced radiologist. The differences between the image-measured size and surgical pathology size (gold standard) were calculated as ΔDCT and ΔDMR. ΔD ˃ 5mm was considered an overestimation and ΔD ˂-5mm was considered an underestimation. The absolute values of ΔDCT and ΔDMR were also calculated as ΔDCT_abs and ΔDMR_abs. A Student t-test was used to compare the statistical differences between ΔDCT_abs and ΔDMR_abs. Among ΔDCT_abs and ΔDMR_abs, a 5mm cut-off value was used to determine the concordance between image and pathology. The concordance rates of CBBCT-Pathology and bMRI-Pathology were tested with the χ2 method. Factors that may affect the accuracy of tumor size measurement were analyzed. Results: Overall there were no statistically significant differences between ΔDCT_abs and ΔDMR_abs. (0.58±0.68cm vs. 0.65±0.68cm; t=1.653, P=0.100). Using 5mm as the cut-off value of concordance, there was no significant difference in the CBBCT-Pathology and bMRI-Pathology concordance rates (64.8% vs. 60.1%, χ2 =1.320, P=0.251). The overestimation rate of CBBCT was significantly lower than that of bMRI (11.4% vs. 19.4%, χ2=6.810, P=0.009). But there was no significant difference in the underestimation rates (23.8% vs. 20.5%, χ2=0.860, P=0.354). ΔDCT_abs is significantly smaller than ΔDMR_abs among the invasive ductal carcinoma group (P=0.017), the premenopausal group (P=0.004), and the small tumor size (≤2cm) group (P=0.003). ΔDCT_abs and ΔDMR_abs.have no significant differences among the lymph node metastasis group, multi-lesion group, and enhancement type group (P &amp;gt; 0.05). Conclusions: CBBCT is concordant with surgical pathology in breast tumor size measurement and provides more accurate tumor size estimation compared with bMRI. CBBCT can be used as a valuable modality for pre-operative assessment. Citation Format: YINAN JI, Geyi Liao, Ningbing Luo, Yi Jiang, Xiaoming Liao, Wei Tang, Huawei Yang. Comparison Of Cone Beam Breast CT And Breast MRI In Preoperative Assessment Of Primary Breast Cancer Tumor Size [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-04-08.

Three-Dimensional Exoscopic Versus Microscopic Resection of Vestibular Schwannomas: A Comparative Series.

Microsurgical resection of vestibular schwannoma (VS) is highly challenging, especially because surgical treatment nowadays is mainly reserved for larger (Koos grade 3 and 4) tumors. To assess the performance of three-dimensional exoscope use in VS resection in comparison with the operative microscope. Duration of surgery and clinical and radiological results were collected for 13 consecutive exoscopic schwannoma surgeries. Results were compared with 26 preceding microsurgical resections after acknowledging similar surgical complexity between groups by assessment of tumor size (maximum diameter and Koos grade), the presence of meatal extension or cystic components, and preoperative hearing and facial nerve function. Total duration of surgery was comparable between microscopically and exoscopically operated patients (264 minutes ± 92 vs 231 minutes ± 84, respectively; P = .276). However, operative time gradually decreased in consecutive exoscopic cases and in a multiple regression model predicting duration of surgery, and exoscope use was associated with a reduction of 58.5 minutes (95% CI -106.3 to -10.6; P = .018). Tumor size was identified as the main determinant of duration of surgery (regression coefficient = 5.50, 95% CI 3.20-7.80) along meatal extension and the presence of cystic components. No differences in postoperative hearing preservation and facial nerve function were noted between the exoscope and the microscope. Resection of VS using a foot switch-operated three-dimensional exoscope is safe and leads to comparable clinical and radiological results as resection with the operative microscope.

Multiparametric Magnetic Resonance Imaging in Determining Prognostic Factors for Cervical Cancer IB2-IIB Stages after Neoadjuvant Chemotherapy

Background : Comprehensive treatment of locally advanced cervical cancer (CC) requires the use of informative diagnostic methods to assess tumor size, extent of the tumor and other factors that determine prognosis of the disease. Purpose : Determination of diagnostic opportunities of multiparametric magnetic resonance imaging (mpMRI) in the visualization of residual tumor and assessment of the main prognostic factors in patients with stage IB2-IIB cervical cancer (FIGO) after neoadjuvant chemotherapy (NACT). Material and methods : Patients with stage IB2-IIB cervical cancer (n = 120) were prospectively enrolled in the study; they received NACT followed by surgical treatment or chemoradiotherapy (CRT). Patients underwent mpMRI before NACT and not later than 14 days after the 3rd course of NACT. To determine the diagnostic opportunities of mpMRI, MRI-data were compared with pathomorphological results. In the comparative analysis were included the following factors: residual tumor size (maximum diameter), depth of stromal invasion (mm), presence of parametrial invasion. Potential MRI-signs suggestive for lymphovascular invasion (LVI) of the parametrium were also assessed. Results : Obtained MRI-data about the size of the residual tumor and the depth of stromal invasion showed statistically significant correlation with the results of pathomorphological study (p &lt; 0.0001) — R 2 = 0.77 and 0.69, respectively. Difference value in measuring the maximum diameter of the residual tumor was on the average 2.52±6.76 mm. MRI sensitivity in the assessment of parametrial invasion was 71.4 %, specificity — 95.1 %, accuracy — 88.9 %, PVPR — 71.4 %, PVNR — 95.1 %. Potential predictors significantly associated with parametrial LVI were identified: parametrial edema (p = 0.001) and dilatation of parametrial vessels (&gt; 3 mm) (p = 0.015). According to these factors was developed a mathematical model, which predicts the risk of having parametrial LVI before surgery in patients after NACT. Conclusion : Multiparametric MRI is an effective technique in assessing the size of the residual tumor, depth of stromal invasion and parametrial invasion in patients with stage IB2-IIB cervical cancer after NACT. MpMRI makes it possible to assess potential signs, associated with parametrial LVI in patients with locally advanced cervical cancer.

Abstract PR006: Impact of heterogeneity for mismatch repair activity on colon tumor development and therapeutic response

Abstract Four Consensus Molecular Subtypes (CMS) of colorectal cancer (CRC) were recently recognized that distinguish CRC by mutational profile and gene expression signatures. One of the subtypes, CMS1, is enriched for cancers that are deficient for DNA mismatch repair (dMMR). The genetic instability leads to high tumor mutational burden, creating numerous neoantigens on the surface of the tumor that can elicit an immune response. CMS1 cancers with dMMR are the best candidates for immunotherapy as compared to cancers with proficient DNA mismatch repair (pMMR). Early clinical trials revealed that only 30-55% metastatic dMMR CRC responded to immunotherapy. Moreover, many responses were incomplete. If a tumor consists of a mixture of dMMR and pMMR tumor cells, then only some tumor cells may be sensitive to immunotherapy, leading to a partial response or acquired resistance. Conventional preclinical mouse models that are typically used to test treatment regimens fail to accurately predict efficacy for many reasons but foremost they lack intratumoral heterogeneity that is a common feature of human cancers. To better understand how a heterogeneous tumor microenvironment for dMMR impacts tumor development and response to immunotherapy, we have developed a new mouse model that develops tumors with a spectrum of MMR activity. Homotypic dMMR or immunologically ‘hot’ tumors that express green fluorescent protein are predicted to have the best response to immunotherapy. Homotypic pMMR or immunologically ‘cold’ tumors that express red fluorescent protein are predicted to not respond to immunotherapy. Heterotypic tumors with a mixture of dMMR and pMMR cells or immunologically ‘lukewarm’ tumors are predicted to have a partial response to immunotherapy. Surveillance bright field and fluorescent colonoscopies allow us to assess tumor size and proportion of dMMR (green) and pMMR (red) tumor cells in real-time before, during and after treatment and prior to necropsy, ex vivo imaging, and histological analysis. Mixed MMR tumors ranged from as few as 5% dMMR (green) cells to as many as 95%. The tumor response to systemic immunotherapy alone, aPD-L1, was dependent on the tumor composition. Large dMMR tumors following aPD-L1 therapy appeared to have large areas of necrosis in wholemount, whereas pMMR tumors following treatment were indistinguishable from pMMR tumors in controls. Mixed MMR tumor response varied depending on percentage of dMMR cells; tumors with a high percentage of dMMR cells remained small after aPD-L1 whereas tumors with a low percentage of dMMR had an outgrowth of pMMR cells after aPD-L1. Future analysis of histological biomarkers may assist in effectively translating the observed preclinical therapeutic responses into survival benefits for patients with CRC and other tumor types especially those heterogenous for MMR activity. Citation Format: Santina Snow, Dawn Albrecht, Shane Huebner, Maggie Baus, Paul Clark, Jamey Weichert, Zachary Morris, Richard Halberg. Impact of heterogeneity for mismatch repair activity on colon tumor development and therapeutic response [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer; 2022 Oct 1-4; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;82(23 Suppl_1):Abstract nr PR006.

Contrast-Enhanced Spectral Mammography and tumor size assessment: a valuable tool for appropriate surgical management of breast lesions.

To compare the accuracy of Contrast-Enhanced Spectral Mammography (CESM), MG, US, and breast MRI in estimating the size of breast lesions requiring surgery. The postoperative histology size of the lesion was used as the gold standard. Two hundred thirty-three non-benign lesions in 189 patients were included in the analyses. All the selected patients underwent CESM and at least one other conventional diagnostic exam (US, MG, or MRI). Subsequently, all the patients underwent surgery preceded by cytological/histological examination. The largest diameter of the lesion at imaging was measured by a radiologist with more than 10years' experience and then compared with the size of the lesion in the histological sample at the surgery (gold standard). Among the 233 breast lesions, 196 were evaluated with US, 206 with MG and 160 with MRI. We found no statistically significant differences between size measurements using CESM and MRI compared with the measurements at the surgery (p value 0.63 and 0.51), whereas a significant difference was found for MG and US (p < 0.001). CESM is a reliable method for estimating the size of breast lesions: its performance seems superior to US and MG and comparable to MRI.

The Evolving Interplay of SBRT and the Immune System, along with Future Directions in the Field.

Simple SummaryWe provide this commentary of stereotactic body radiotherapy (SBRT), and describe our evolving understanding of this treatment approach, its effects on the immune system, and the ability to stimulate immune cells to further recognize and attack cancer. The aim of this work is to describe our current knowledge of how SBRT effects the environment within the tumor and the immune cells present, whether timing the combination of this treatment with that of immunotherapy may have an impact on the body’s own immune response, and what the latest approaches in the field are in regards to this radiation treatment modality. Among these latest and exciting developments is Personalized Ultrafractionated Stereotactic Adaptive Radiation Therapy, known as PULSAR. This latest approach is described in detail herein, and may represent a leading novel method for adapting radiation treatments to treatment-induced tumor changes over time and stimulating the body’s immune response against tumor cells.In this commentary, we describe the potential of highly ablative doses utilizing Stereotactic Body Radiation Therapy (SBRT) in single or few fractions to enhance immune-responsiveness, how timing of this approach in combination with immune-checkpoint inhibitors may augment treatment-effect, and whether Personalized Ultrafractionated Stereotactic Adaptive Radiation Therapy (PULSAR) is an avenue for future advancement in the continued endeavor to foster a systemic effect of therapy beyond the radiation treatment field. The ablative potential of SBRT may support an increase in tumor-antigen presentation, enhancement of immune-stimulatory components, and an improvement in tumor-microenvironment immune cell infiltration. Furthermore, the latest advancement of ablative radiation delivery is PULSAR-based therapy, whereby ablative doses are delivered in pulses of treatment that may be several weeks apart, combined with adaptive treatment to tumor changes across time. The benefits of this novel approach include the ability to optimize direct tumor control by assessment of tumor size and location via dedicated imaging acquired prior to each delivered pulse, and further potentiation of immune recognition through combination with concurrent immune-checkpoint blockade.

32622 Imaging technologies for presurgical margin assessment of basal cell carcinoma

Basal cell carcinoma (BCC) is the most common skin cancer worldwide. Mohs micrographic surgery is a highly used BCC treatment, involving staged resection of the tumor with complete histologic evaluation of the peripheral margins. A reduction in the number of Mohs stages would significantly improve care and could result in substantial economic benefits, estimated at $36 million USD in savings per annum. Noninvasive imaging modalities can potentially streamline the surgical management of skin cancers by refining presurgical assessments of tumor size.

Accuracy of different sonomammographic imaging modalities in assessment of breast tumor size

BackgroundAccurate breast cancer size is crucial for staging and an important prognostic factor in patient management. Therapeutic decisions heavily depend on tumor size detection by radiological imaging. The purpose of our prospective comparative study is to compare the diagnostic accuracy of different sonomammographic breast imaging modalities, namely DM, DBT, CESM, 2D US and 3D US in the preoperative tumor size measurement.ResultsCESM, 3D US and 2D US achieved moderately strong correlation with the pathological size measurements, while (DM) and (DBT) showed fair correlation with the pathology. CESM showed the highest correlation coefficient (0.789), while (DBT) showed the lowest correlation coefficient (0.411). Regarding the agreement, there was good agreement of the size measured by CESM, 3D US and 2D US with the pathology as the ICC was (0.798), (0.769) and (0.624), respectively. The highest agreement with the pathology was achieved with CESM. The agreement of the size measured by (DM) and (DBT) with the pathology was moderate as the ICC was (0.439) and (0.416), respectively. The lowest agreement was achieved with the size measured by (DBT).ConclusionsCESM and 3D US are more superior to DM, 2D US and DBT regarding preoperative size measurement. 3D US can be used as preoperative noninvasive technique, especially in patients with impaired renal function who cannot tolerate CESM.

Invasive Lobular Carcinoma: A Multimodality Imaging Primer.

HomeRadioGraphicsVol. 42, No. 4 PreviousNext Breast ImagingRadiographics FundamentalsInvasive Lobular Carcinoma: A Multimodality Imaging PrimerPaul Manning, Soudabeh Fazeli, Vivian Lim, William A. Ladd, Mohammad Eghtedari, Alice Chong, Rebecca Rakow-Penner, Haydee Ojeda-Fournier Paul Manning, Soudabeh Fazeli, Vivian Lim, William A. Ladd, Mohammad Eghtedari, Alice Chong, Rebecca Rakow-Penner, Haydee Ojeda-Fournier Author AffiliationsFrom the Department of Radiology, Breast Imaging Division, UC San Diego Health, Koman Family Outpatient Pavilion, 9400 Campus Point Dr, La Jolla, CA 92037.Address correspondence to H.O.F. (e-mail: [email protected]).Paul ManningSoudabeh FazeliVivian LimWilliam A. LaddMohammad EghtedariAlice ChongRebecca Rakow-PennerHaydee Ojeda-Fournier Published Online:Jun 10 2022https://doi.org/10.1148/rg.210058MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractInvasive lobular carcinomas have an atypical clinical manifestation and imaging appearance, and mammographic, US, and MRI findings can help radiologists accurately assess tumor size and evaluate for multicentric, multifocal, and bilateral disease.Suggested ReadingsHa SM, Chae EY, Cha JH, Kim HH, Shin HJ, Choi WJ. Breast MR imaging before surgery: outcomes in patients with invasive lobular carcinoma by using propensity score matching. Radiology 2018;287(3):771–777. Link, Google ScholarLopez JK, Bassett LW. Invasive lobular carcinoma of the breast: spectrum of mammographic, US, and MR imaging findings. RadioGraphics 2009;29(1):165–176. Link, Google ScholarWeinstein SP, Orel SG, Heller R, et al. MR imaging of the breast in patients with invasive lobular carcinoma. AJR Am J Roentgenol 2001;176(2):399–406. Crossref, Medline, Google ScholarArticle HistoryReceived: May 20 2021Revision requested: July 2 2021Revision received: Aug 1 2021Accepted: Aug 4 2021Published online: June 10 2022Published in print: July 2022 FiguresReferencesRelatedDetailsAccompanying This ArticleInvasive Lobular Carcinoma: A Multimodality Imaging PrimerJun 10 2022Default Digital Object SeriesRecommended Articles Nipple-sparing Mastectomy: What the Radiologist Should KnowRadioGraphics2022Volume: 42Issue: 2pp. 321-339American Joint Committee on Cancer’s Staging System for Breast Cancer, Eighth Edition: What the Radiologist Needs to KnowRadioGraphics2018Volume: 38Issue: 7pp. 1921-1933Digital Breast Tomosynthesis: Update on Technology, Evidence, and Clinical PracticeRadioGraphics2021Volume: 41Issue: 2pp. 321-337Case 242: Radiation-induced AngiosarcomaRadiology2017Volume: 283Issue: 3pp. 909-916Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and PitfallsRadioGraphics2018Volume: 38Issue: 2pp. 330-356See More RSNA Education Exhibits Invasive Lobular Carcinoma Multimodality Primer: Pictorial Essay for Residents and FellowsDigital Posters2020Invasive Lobular Carcinoma, the Great Imitator of the Breast: A Practical Multimodality Diagnostic Guide for ResidentsDigital Posters2019Keeping Abreast of Disparities in Screening Mammography: A Primer for Understanding the Needs of Underserved PopulationsDigital Posters2020 RSNA Case Collection Male Breast CancerRSNA Case Collection2021Metastatic Melanoma Presenting as Bilateral Breast MassesRSNA Case Collection2020Locally Advanced Invasive Lobular CarcinomaRSNA Case Collection2022 Vol. 42, No. 4 Slide PresentationAbbreviations Abbreviations: IDC invasive ductal carcinoma ILC invasive lobular carcinoma Metrics Altmetric Score PDF download

MP24-01 RACE BASED EQUATIONS FOR ESTIMATING KIDNEY FUNCTION MAY CONTRIBUTE TO RACIAL DISPARITIES IN PARTIAL NEPHRECTOMY UTILIZATION AMONG BLACK PATIENTS WITH KIDNEY TUMORS

You have accessJournal of UrologyCME1 May 2022MP24-01 RACE BASED EQUATIONS FOR ESTIMATING KIDNEY FUNCTION MAY CONTRIBUTE TO RACIAL DISPARITIES IN PARTIAL NEPHRECTOMY UTILIZATION AMONG BLACK PATIENTS WITH KIDNEY TUMORS Nour Abdallah, Tarik Benidir, Martin Hofmann, Eiftu Haile, Diego Aguilar Palacios, Venkatesh Krishnamurthi, Samuel Haywood, Mohamed Eltemamy, Jihad Kaouk, Robert Abouassaly, Steven Campbell, and Christopher Weight Nour AbdallahNour Abdallah More articles by this author , Tarik BenidirTarik Benidir More articles by this author , Martin HofmannMartin Hofmann More articles by this author , Eiftu HaileEiftu Haile More articles by this author , Diego Aguilar PalaciosDiego Aguilar Palacios More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , Samuel HaywoodSamuel Haywood More articles by this author , Mohamed EltemamyMohamed Eltemamy More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Steven CampbellSteven Campbell More articles by this author , and Christopher WeightChristopher Weight More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002563.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Population based studies have found that black Americans with renal tumors are less likely to undergo a partial nephrectomy (PN) compared to non-black Americans despite their increased risk for chronic kidney disease (CKD). Guidelines suggest assessment of renal function, tumor size and location to determine whether to perform a PN or radical nephrectomy (RN). However, commonly used equations to predict renal function are racialized and estimate a 15-20% higher glomerular filtration rate (eGFR) if the patient is black compared to non-black patients. We hypothesize that these racialized estimates of eGFR may contribute to the lower utilization of PN in blacks. METHODS: From 2005 to 2020, we included 6476 consecutive patients undergoing either PN or RN with known self-reported race and preoperative (preop) creatinine at Cleveland Clinic. Data was dichotomized into Black (n=668) and non-Black patients (n=5808) and compared across preop variables and surgery types. Multivariable regression analysis was used to identify predictors of PN. We also stratified PN rates across CKD stages for blacks and non-blacks. RESULTS: The cohorts’ preop variables are listed in Table 1. Black patients had higher rates of diabetes, hypertension, had higher comorbidity scores and lower baseline eGFR. On multivariable logistic regression analysis, black patients were less likely to be treated via PN (Odds Ratio (OR)=0.75, Confidence interval (CI)=[0.63-0.89], p=0.001), even when controlling for body mass index, age-adjusted Charlson comorbidity index, hypertension, preop eGFR, tumor size and complexity. When comparing PN rates across CKD stages, PN utilization was similar for all stages except stage 1, where the odds of getting a PN were 39% lower for black patients compared to non-blacks (OR 0.61, [0.46-0.82], p=0.01). CONCLUSIONS: Black patients were less likely to undergo PN, despite lower baseline kidney function and higher comorbidity rates. This disparity was most marked in patients with high estimated renal function. Racialized kidney function equations may contribute, along with access and other unknown factors to the disparity seen in the use of kidney preservation strategies for black patients with renal masses. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e392 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nour Abdallah More articles by this author Tarik Benidir More articles by this author Martin Hofmann More articles by this author Eiftu Haile More articles by this author Diego Aguilar Palacios More articles by this author Venkatesh Krishnamurthi More articles by this author Samuel Haywood More articles by this author Mohamed Eltemamy More articles by this author Jihad Kaouk More articles by this author Robert Abouassaly More articles by this author Steven Campbell More articles by this author Christopher Weight More articles by this author Expand All Advertisement PDF downloadLoading ...