Benign Disease Group Research Articles

Application of serum levels of pro-gastrin releasing peptide, tissue polypeptide specific antigen and neuron specific enolase in therapy monitoring in small cell lung cancer patients

Objective To evaluate the clinical significance of serum levels of ProGRP, TPS and NSE in diagnosis and therapy monitoring in small cell lung cancer patients. Methods The levels of serum ProGRP, TPS and NSE in 51 SCLC patients (SCLC group), 60 benign pulmonary disease patients (benign disease group ) and 60 healthy people (healthy group ) were determined using chemiluminescent immunoassay, ELISA and electrochemiluminescent immunoassay respectively. Blood samples were collected and detected prior to therapy, before the second course of chemotherapy and the third course of chemotherapy consecutively in all the 51 SCLC patients. Results The serum ProGRP, TPS and NSE concentrations prior to chemotherapy in limited stage SCLC (LSCLC) were 136. 9(22.8-631.7)ng/L, 78. 2(56.4-114.6) U/L and 28.1(20.9-46.1)μg/L, respectively; And in extensive stage SCLC patients (ESCLC) were 1 106.6(41.2-2161.1) ng/L, 230. 9( 143.5-259.0) U/L and 81.1 (34.3-140.0)μg/L, respectively. The serum concentrations of the 3 markers in benign disease group were 19. 7 ( 9. 5-29. 1 )ng/L, 48. 7 ( 17.9-95.4) U/L and 12. 1(1.2-13.9) μg/L; and in healthy group were 20.3(10.7-30.6) ng/L, 50.3(19.5-70.7) U/L and 11.7 (1.1-13.4)μg/L, respectively. The Kruskal-Wallis test showed significantly statistical difference in different groups of the 3 tumor markers, Chi-Square were 51. 368,36. 532 and 81. 645( P ＜0. 01 ). Significant statistically differences showed when the concentrations of the 3 marks of the 2 control group were compared with that of the LSCLC group ( U =491, 827, 609 and 476, 831, 585,respectively, P ＜ 0. 05 ). Differences were also statistically significant when the 2 control group compared with that of the ESCLC group ( U = 314,532,456 and 302,553,430, respectively, P ＜ 0. 01 ). The AUC of ProGRP was 0.832 +0.029(95% CI:0.774-0.890). When cutoff value of ProGRP set as 37.7 ng/L, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and Youden's index were 71% (36/51), 97% (116/120), 90% (36/40), 89% ( 116/131 ) and 67%, respectively; show good detection performance. The sensitivity increased to 92%, 86%, 92% and 88%, when combination detection of ProGRP + TPS + NSE, ProGRP + TPS, ProGRP + NSE and TPS + NSE were used, and the specificities were 77%, 77% , 92% and 77% accordingly. The Fridman test showed significantly statistical difference in the 3 tumor markers at different stages of treatment, x2 were 49. 120, 10. 614 and 44. 392, P ＜0. 01. After the first chemotherapy course, all the tumor marker levels except TPS decreased significantly in comparison with the pretreatment concentrations. However, only ProGRP levels showed a progressive drop during the two consecutive courses of therapy, and the median concentrations were 68.0 ( 18. 6-158.4 ) and 21.0( 14. 9-63.5) ng/L (compared to the level before therapy,Z=-4. 889 and -5. 594, P ＜0. 01 ). The median of serum TPS increased slightly to 105.2 (54. 1-181.2 ) U/L after the first chemotherapy course (Z=-1.248, P＞0.05), and decreased significantly to 79.0(48.7-155.3) U/L after the second chemotherapy course (Z=-2.484, P＜0. 05 ). As to the NSE, the median concentration decreased to 11.8(8.0-16.0)μg/L after the first chemotherapy course ( Z= - 5. 568, P ＜ 0. 01 ). However, the median was 10. 6(9.0-12.7)μg/L, which showed no significant decrease after the second chemotherapy course (Z=-1.851, P＞0.05).Forty-six SCLC patients evaluated as clinical remission ( 3 CR and 43 PR) after the second chemotherapy course, among them there were 38 patients (83%) with normal serum ProGRP, TPS and NSE level ( 19 patients) or with only 1 abnormal tumor level ( 19 patients). There were only 2 patients with all abnormal serum ProGRP, TPS and NSE level, and both patients were evaluated as clinical PD. Two patients with 2 abnormal tumors results were classified as SD, the only 1 patient without therapy evaluation also had 2 abnormal tumor marker results. Conclusions The serum ProGRP, TPS and NSE are valuable tumor markers for diagnosis and treat monitoring of SCLC, particularly the ProGRP + NSE shows the highest clinical value. Combing detection of the 3 tumor markers are valuable for therapy monitoring and prognosis in SCLC patients. Key words: Lung neoplasms; Carcinoma, small cell; Peptide fragments; Phoshopyruvate hydratase

The Value of Serum Biomarkers (Bc1, Bc2, Bc3) in the Diagnosis of Early Breast Cancer

Surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF) is an approach to biomarker discovery that combines chromatography and mass spectrometry. We aimed to consider the efficacy of Bc1, Bc2, and Bc3 serum biomarkers on early detection of breast cancer (BC) in this study. In this prospective study, 91 patients who were admitted to our hospital between January 2007 and July 2008 were included. Serum samples from 91 women were stored at -80 °C until use. The cancer group included 27 cases of BC. The benign breast disease group included 24 women with benign breast diseases and control group 37 age-matched apparently healthy women. The data obtained for these three groups of patients was worked out for each serum biomarker (Bc1, Bc2, and Bc3) by using SELDI-TOF individually and compared with each other separately and evaluated statistically. Bc2 possesses the highest individual diagnostic power. Bc2 was statistically significant in comparison between the malignant disease group, control group and benign disease group. Bc1 was statistically significant in the malignant disease group compared to control group as well as in the benign disease group compared to control group. Thus Bc1, rather than showing malignant progression, it shows tumoral progression or inflammatory process. Bc3 was found upregulated in all malignant cases; however, it was not statistically significant compared to the benign disease group or the control group. It has been shown that Bc2 profiles might be useful in clinical practice to improve BC diagnosis. However none of the proteomics reach reasonable AUC values for the discrimination of the BC. Additional confirmation in larger and similarly-designed prospective studies is needed to consider of the efficacy of Bc1 and Bc2 in early diagnosis of the BC.

Diagnosis value of the detection of CYFRA21-1 in non-small cell lung cancer

背景与目的细胞角蛋白19片段（cytokeratin 19 fragment, CYFRA21-1）是血液中的一种可溶性蛋白质，它可能是一种潜在的循环肿瘤标志物。本研究旨在探讨CYFRA21-1在非小细胞肺癌（non-small cell lung cancer, NSCLC）诊断中的应用价值。方法采用酶联免疫吸附法分别检测107例NSCLC患者和51例肺部良性疾病患者外周血中CYFRA21-1含量，应用受试者工作曲线（receiver operaing characteristic curves, ROC）对检测结果进行临床评价。结果NSCLC组织与肺良性疾病组外周血CYFRA21-1水平差别有统计学意义（χ2=47.343, P < 0.001）；以3.3 μg/L为诊断临界点，CYFRA21-1诊断NSCLC的敏感性和特异性分别为74.77%和76.47%，ROC曲线下面积为0.813 9；NSCLC各病理类型之间CYFRA21-1水平差别无有统计学意义（χ2=0.450, P=0.799）；外周血CYFRA21-1在广泛期（Ⅲb、Ⅳ）病例中明显高于局限期（Ⅰ、Ⅱ、Ⅲb）病例（χ2=7.057, P=0.008）。结论CYFRA21-1作为肺癌肿瘤标志物具有相对较高的敏感性和特异性；血浆中CYFRA21-1水平升高提示肺癌患者可能已经发展为广泛期。

Diagnostic value of combined determination of serum CA125,TSGF and DD levels in patients with ovarian cancer

Objective To investigate the clinical value ofcombined detection of the serum levels of CA125,TSGF and DD in the diagnosis of ovarian cancer. Methods The serum CA125 and DD were determined by enzyme linked immunosorbent assay and TSGF was determined by biochemistry shade selection in all 252 patients(including 84 cases of ovarian cancer,84 cases of ovarian benign diseases,84 cases of controls). Results The concentration of CA125,TSGF and DD in the diagnosis of ovarian cancer group were higher than those in ovarian benign diseases group and the controls(all P＜0.05).There was no statistical significance in the concentration of CA 125,TSGF and DD between ovarian benign diseases group and the controls(all P ＞ 0.05).In combined assay of CA 125,TSGF and DD,the sensitivity rate was 94.05%,the specificity rate was 90.48%,and the accuracy rate was 92.26%.Comparing with the single assay,combined analysis had much higher diagnostic sensitivity(all P＜0.05). Conclusion The assay of CA125,TSGF and DD had significant dinical value in diagnosis of breast cancer,combined detection could increase the positive detection of ovarian cancer,and compensate the use of only one tumor marker. Key words: Ovarian Neoplasms; Carbohydrate antigen 125; Tumor specific growth factor; D-dimer

Use of Serum Circulating Ccnb2 in Cancer Surveillance

Cyclin B2 (CCNB2), a member of the cyclin protein family, has been found to be up-regulated in human cancers. To evaluate the potential use of circulating CCNB2 in serum in cancer surveillance, we examined relative expression levels of serum circulating CCNB2 mRNA in 103 cancer patients, 19 normal controls, and 40 benign disease patients using real-time quantitative reverse transcriptase polymerase chain reaction. We found that the relative expression level of circulating CCNB2 mRNA in cancer patients was significantly higher (p<0.0001) than that in normal controls and benign diseases group. Circulating CCNB2 mRNA level was significantly (p<0.001) correlated with cancer stage and metastasis status. Receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.87 and 0.83 (p<0.05) in identifying cancer patients' metastasis status in lung and digestive tract cancer, respectively. Moreover, we observed that expression levels of circulating CCNB2 mRNA in cancer patients significantly decreased (p=0.0084) after their therapeutic treatments. These data suggest that detection of serum circulating CCNB2 mRNA may have potential clinical applications in screening and monitoring of metastasis and therapeutic treatments.

Metabolic profiling of bile in cholangiocarcinoma using in vitro magnetic resonance spectroscopy

ObjectivesCholangiocarcinoma (CCA) has a poor prognosis and its aetiology is inadequately understood. Magnetic resonance spectroscopy (MRS) of bile may provide insights into the pathogenesis of CCA and help identify novel diagnostic biomarkers. The aim of this study was to compare the chemical composition of bile from patients with CCA with that of bile from patients with benign biliary disease. MethodsMagnetic resonance spectra were acquired from the bile of five CCA patients and compared with MRS of control bile from patients with benign biliary disease (seven with gallstones, eight with sphincter of Oddi dysfunction [SOD], five with primary sclerosing cholangitis [PSC]). Metabolic profiles were compared using both univariate and multivariate pattern-recognition analysis. ResultsUnivariate analysis showed that levels of glycine-conjugated bile acids were significantly increased in patients with CCA, compared with the benign disease groups (P= 0.002). 7β primary bile acids were significantly increased (P= 0.030) and biliary phosphatidylcholine (PtC) levels were reduced (P= 0.010) in bile from patients with CCA compared with bile from gallstone patients. These compounds were also of primary importance in the multivariate analysis: the cohorts were differentiated by partial least squares discriminant analysis (PLS-DA). ConclusionsThese preliminary data suggest that altered bile acid and PtC metabolism play an important role in CCA aetiopathogenesis and that specific metabolites may have potential as future biomarkers.

Clinical value of serum TPS, CEA, Pro-GRP and CYFRA21-1 in patients with lung cancer

背景与目的血清肿瘤标志物在肺癌的诊断、疗效、预后判断中起着重要作用。本研究探讨血清组织多肽特异性抗原（tissue polypeptide specifc antigen, TPS）与癌胚抗原（carcinoembryonic antigen, CEA）、胃泌素释放肽前体（precursor of gastrin-releasing peptide, Pro-GRP）和细胞角蛋白19片段（cytokeratin-19-fragments, CYFR21-1）的水平及其在肺癌患者中的临床意义。方法应用ELISA检测82例肺癌患者化疗前及部分患者化疗后4种标志物水平。结果肺癌患者TPS、CEA、Pro-GRP阳性率及水平显著高于肺部良性疾病组和健康对照组。广泛期小细胞肺癌患者TPS阳性率显著高于局限期患者。患者化疗后TPS、CEA、Pro-GRP阳性率及水平均显著下降。非小细胞肺癌患者TPS水平是预后的独立因素。结论TPS在肺癌患者的辅助诊断、疗效观察有较好的临床意义，对非小细胞肺癌的预后判断方面可能有一定价值。

Serum vascular endothelial growth factors C and D in patients with oesophageal cancer☆☆☆

Lymph node metastasis is a characteristic of malignant cancers and is observed more frequently in oesophageal cancer than in other digestive tract cancers, making it one of the most important prognostic factors. Vascular endothelial growth factors C (VEGF-C) and D (VEGF-D) are important lymphangiogenic factors in human cancers and lymphangiogenesis is associated with lymph node metastasis. The aim of the study was to determine the correlation between pre-treatment serum levels of VEGF-C (sVEGF-C) and VEGF-D (sVEGF-D) and clinicopathologic features in patients with oesophageal cancer. Serum VEGF-C and sVEGF-D were measured by enzyme-linked immunoadsorbent assay (ELISA) on 149 patients with oesophageal cancer, 29 patients with benign oesophageal diseases and 30 healthy controls. Serum VEGF-C and sVEGF-D levels were significantly higher in patients with oesophageal carcinoma than in the control group (p<0.001 and p=0.001, respectively) or in the benign oesophageal diseases group (p=0.04 and p=0.03, respectively). Subgroup analysis showed that lymph node metastasis (p=0.001), stage (p=0.001), tumour depth (p=0.006), resectability (p=0.002), tumour size (p=0.01), distant metastases (p=0.01) and histological grading (p=0.04) were correlated with an elevated level of sVEGF-C. Elevated levels of sVEGF-D were associated with tumour depth (p=0.002), stage (p=0.01) and lymph node metastasis (p=0.02). Among the patients (n=83) who underwent potentially curative surgery, the overall survival time (p=0.008) was shorter for patients with a high level (>8667 pg ml(-1)) of sVEGF-C than for those with a low level (<8667 pg ml(-1)), when the cut-off value was determined on the basis of the median value in oesophageal cancer patients. On univariate regression analysis, tumour size, tumour depth, stage, lymph node metastases, distant metastases, resectability and sVEGF-C were found to be significant prognostic factors. These results suggest that pre-treatment levels of sVEGF-C and sVEGF-D reflect lymph node metastases and advanced stage of oesophageal cancer. Serum VEGF-C may be useful in predicting poor outcome for patients undergoing a potentially curative oesophagectomy.

The changes of blood coagulation in surgical patients with lung cancer

背景与目的恶性肿瘤可引起机体高凝血状态, 可能导致血栓栓塞症的发生, 手术创伤则是重要的危险因素。本研究探讨肺癌患者手术前后凝血状态、变化及临床意义。方法采用前瞻性对照研究方法, 选取普胸外科临床有效病例74例, 分为肺癌组和肺良性疾病组。观察患者术前和术后凝血酶原时间(prothrombin time, PT)、活化的部分凝血活酶时间(activated partial thromboplastin time, APTT)、血小板计数(platelet count, PLT)、D二聚体(D-dimer, D-D)及纤维蛋白原(fibrinogen, Fib)等指标反应的凝血功能状态、变化及临床表现, 比较组间组内之间的差别。结果术前肺癌组较肺良性疾病组患者以及肺癌类型中腺癌患者较鳞癌患者术前Fib升高并高于正常值(P < 0.05)。肺癌组患者出现PT在术后第1天-第7天延长, APTT在术后第3天-第7天缩短, Fib在术后第3天-第7天、D-D在术后第1天-第7天升高, PLT在术后第1天、第3天较术前呈下降趋势而术后第5天、第7天有升高趋势, 与术前比较差异有统计学意义(P < 0.05)。肺癌组较肺良性疾病组患者术后第7天PT、D-D升高(P < 0.05)。术后肺癌组出现1例肺血栓栓塞症(pulmonary thromboembolism, PTE), 肺良性疾病组未出现静脉血栓栓塞症(venous thromboembolism, VTE)。结论肺癌患者手术前后易出现高血凝状态并发VTE, 有必要行一定的干预措施避免VTE的发生。

Measurement of exhaled volatile organic compounds in lung cancer patients

to study the characteristics of volatile organic compounds (VOCs) in exhaled breath of lung cancer patients, and therefore to explore its use in the diagnosis of the disease. from February 2007 to September 2009, 55 patients with lung cancer, 21 patients with benign lung diseases and 30 healthy controls were enrolled in our study. The VOCs in exhaled breath were detected by the SPME (solid phase microextraction)-GC (gas chromatography) system. heptanal was detected in 45 patients of the lung cancer group, 1 of the benign lung disease group, and 1 of the healthy control group. The positive rate was higher in the lung cancer group as compared to the benign lung disease group and the healthy group combined (P < 0.05). The detection of heptanal was not related to age, smoking, histological type and staging (P > 0.05). heptanal maybe a useful marker in VOCs from patients with lung cancer.

The Clinical Implication of MAGE Gene Detection in Bronchial Washing Fluid in Routine Practice

Background: Melanoma antigen genes (MAGE) are expressed in many human malignant cells and are silent in normal tissues other than in testis and in placenta. But MAGE expression in benign lung diseases, such as pulmonary tuberculosis or cases with severe inflammation, needs further evaluation to overcome false-positive findings. We evaluated detection rates of the melanoma antigen genes (MAGE) RT-nested PCR in bronchoscopic washing samples from patients with benign lung disease, as well as in patients with malignancies. Methods: Bronchial washing fluid from 122 patients was used for cytological examination and MAGE gene detection using RT-nested-PCR of common A1-6 mRNA. We compared the results from the RT-nested PCR and the pathologic or bacteriologic diagnosis. We also analyzed the expression rate and false positive rate of MAGE gene. Results: Among 122 subjects, lung cancer was diagnosed in 23 patients and benign lung disease was diagnosed in 99 patients. In patients with lung cancer, the positive rate of MAGE expression was 47.8% (11/23) and in benign lung disease group, the expression rate was 14.1% (14/99). Among benign lung disease group, the expression rate of MAGE gene (25.0%) in patients with pulmonary tuberculosis (11/44) was especially high. Conclusion: MAGE A1-6 RT-nested PCR of bronchial washing fluid can be used as a complementary method in lung cancer, but that test results in a high false positive rate in tuberculosis patients.

Early diagnosis value in of serum lysophosphatidic acid and CA-125 detection ovarian cancer

Objective To explore the clinical value of early diagnosis of ovarian cancer by serum lysophosphatidic acid(LPA) and CA-125.Methods 50 patients with ovarian cancer from October 2005 to February 2008 were selected as ovarian cancer group,at the same period selected 44 patients with ovarian benign tumor(ovarian benign disease group),and 50 healthy women as the healthy control group.All patients were diagnosed and confirmed by preoperative blood and pathology.The serum LPA and CA-125 of two groups were detected.Results The serum LPA level and the positive rate in the ovarian cancer group was higher than that of the ovaries benign group or the control group(P＜0.05).The CA-125 level in the ovarian cancer group was similar to that of the ovaries benign group(P＞0.05),while the CA-125 level in the ovarian cancer group or the ovaries benign group was higher than that of the control group(P＜0.05).The specificity of the LPA was better than that of the CA-125 detection.In the early diagnosis of ovarian cancer,the sensitivity of the combination(85.7%) was better than either of them(P＜0.01);the plasma LPA level and positive rate of CA-125 of the phase Ⅱ～Ⅳ ovarian cancer patients were higher than that of phase Ⅰ (P＜0.01);the CA-125 positive rate of the serious cystadenocarcinoma was higher than that of the cystadenocarcinoma(P＜0.01).Conclusion LPA is a sensitive biomarker for the early diagnosis of ovarian cancer,especially combined with CA-125.It should be widely used in clinic. Key words: Ovarian neoplasms; Lysophosholipids; CA-125 antigen

Investigation on the reference range of human serum levels of human epididymis protein 4 hi healthy people

Objective To investigate the reference range of serum human epididymis protein 4 ( HE4 ) . Methods An Enzyme-linked immunosorbent assay ( ELISA) was used to measure the concentrations of HE4. Totally 530 cases of healthy adults and benign disease patients were determined . The impact of age, sex, menopause status and diseases on serum HE4 levels was analyzed. Then the reference range was established in the north of China Results The serum HE4 levels had a positive correlation with age (r=0. 473,P 50 years[ (32. 9 ± 15. 2) pmol/L]. The serum levels of HE4 in the group of female age≤40 years [ (41. 6 ± 10. 4) pmol/L] is lower than that in the group of the female age >40 years[(32. 8 ±13.4) pmol/L]. Serum level of HE4 was higher in benign disease group as compared with that in health group in both gender and all age groups. The upper and 101. 8 pmol/L respectively. The upper limit of reference range for female in the groups of age≤40 years and age > 40 years is 59. 6 pmol/L and 62.4 pmol/L respectively. Conclusions Age and disorder are two important factors which can affect human serum level of HE4. The age should take into consideration for establishment of HE4 reference range. Key words: Epididymis secretory protein; Tumor markers; biological; Reference values

Studies on the value of human epididymis protein 4 in patients with ovarian cancer

Objective To evaluate serum human epididymis protein 4 (HE4) as a biomarker for ovarian cancer. Methods HE4 was determined by ELISA in ovarian cancer patients ( n = 82 ) , benign ovarian disease patients ( n = 26 ) and healthy controls ( n = 40) . Results The level of HE4 was significantly higher in ovarian cancer group(46. 6 pmol/L) than that in benign ovarian disease group(31. 5 pmol/L) and healthy control group(24.0 pmol/L) in premenopausal women ( U = 95. 5 and 100.0, P 3. 5% for premenopausal women and > 12. 5% for postmenopausal women. With the progression of ovarian carcinoma, the levels of HE4 as well as the sensitivity were increased. HE4 concentrations were higher in patients with lymph node metastasis than those without metastasis ( U = 34. 0 and 77. 0 in premenopausal and postmenopausal women, P < 0. 01 , respectively). Changes of HE4 concentrations were correlated with tumor response. Elevated levels of HE4 were found in recurrent disease patient, and the levels were decreased while the patients were sensitive to therapy. Conclusion HE4 determination is helpful in the diagnosis and prognosis of ovarian cancer. Key words: Epididymis secretory protein; Tumor markers; biological; Ovarian neoplasms

The value of tumor markers in monitoring of non-small cell lung cancer

One hundred and four patients with non-small cell lung cancer (NSCLC) and 17 patients with benign lung lesions were enrolled in the study. Carcinoembryonic antigen ( CEA), neural specific enolaee (NSE) and cytokemtin 19 fragment (CYFRA21-1) in serum were detected by dectruchemiluminescence method before and after operation. The serum levels of three markers in preoperative NSCLC patients were significandy higher than those of benign pulmonary diseases group (t = 7. 930, 5.568, 6. 110, P 0.05 ). There were significant differences in serum levels of CEA, NSE and CYFRA21-1 before and after operation in NSCLC group ( t = 5.419, 4.722, 5.779, P 0.05). This study indicates that detection of serum CEA, NSE and CYFRA21-1 is of monitoring value for treatment of non-small cell lung cancer. Key words: Cancinoma, non-small cell lung; Tumor markers,biological

Potential of Dual Time Point FDG-PET Imaging in Differentiating Malignant from Benign Pleural Disease

The aim of this study was to assess the utility of dual time point 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) imaging in differentiating benign from malignant pleural disease. Fifty-five consecutive patients of suspected malignant pleural mesothelioma (MPM) and recurrence of MPM who were referred for the evaluation underwent two sequential 18F-FDG-PET scans (dual time point imaging). The average percent change in the maximum standardized uptake values (Delta%SUVmax) of the lesion/lesions between time point 1 (SUV(max1)) and time point 2 (SUV(max2)) was calculated. All PET results were correlated with the histopathological or cytopathology results. Patients were divided into three principal groups (A = newly diagnosed MPM, B = recurrent MPM, and C = benign pleural disease). The parameters of 18F-FDG uptake (SUV(max) values and its changes over time) were compared among groups. Among the 55 patients who had undergone dual time point 18F-FDG-PET studies, 44 were diagnosed with MPM (28 newly diagnosed and 16 had recurrence). The PET studies demonstrated 229 malignant pleural lesions in these patients. The remaining 11 patients were proven to have benign pleural disease. The mean +/- SD of the SUV(max1), SUV(max2), and the Delta%SUV(max) of the all lesions of each patient in groups A, B, and C were 5.0 +/- 2.2%, 5.8 +/- 2.8%, and 12.8 +/- 8.4%; 4.6 +/- 1.7%, 5.3 +/- 2.0%, 13.8 +/- 9.2%; and 1.6 +/- 0.4%, 1.4 +/- 0.3%, and-9.6 +/- 19.1%, respectively. The mean +/- SD of the SUV(max1), SUV(max2), and Delta%SUV(max) in patients with both newly diagnosed and recurrent MPM were significantly higher than those of benign pleural disease group (p < 0.0001). For each patient, the most intense (hottest) lesion's SUV(max1), SUV(max2), and Delta%SUV(max) were also compared among the aforementioned groups, and these results again confirmed that MPM lesions had significantly higher values than those of benign pleural lesions (p < 0.0001). There is an increasing uptake of (18)F-FDG over time in pleural malignancies, whereas the uptake in benign pleural disease generally stays stable or decreases over time. Therefore, dual time point imaging appears to be an effective approach in differentiating benign from malignant pleural disease, which increases the sensitivity and is also helpful in guiding the biopsy site for a successful diagnosis.

Does autoimmune thyroid disease affect parathyroid autotransplantation and survival?

While the increased risk to parathyroid gland preservation has long been recognized during surgery for thyroid cancer, the effect of different benign pathological conditions on parathyroid preservation has not previously been reported. The aim of this study was to examine parathyroid viability in relation to autoimmune thyroid disease. This is a retrospective cohort study including all patients having an initial total thyroidectomy (TT) performed by this unit during the period 2004-2005. A total of 628 patients underwent TT in the study period. For the Graves' disease cases, 45 (62.5%) required the autotransplantation of one or less parathyroid gland, whereas 27 (37.5%) required two or more glands to be autotransplanted. This was significantly higher than for the benign thyroid disease group in which the respective figures were 242 (77.6%) and 70 (22.4%) (P= 0.01). Of the lymphocytic thyroiditis cases, 61 (65.5%) required the autotransplantation of one or less gland, whereas 32 (34.4%) required the autotransplantation of two or more glands. This was also significantly higher (P= 0.03). Temporary hypocalcaemia was significantly higher when two or more glands were autotransplanted (23 out of 177, 13.2%) than one or less gland autotransplanted (18 out of 451, 4.0%, P < 0.01). However, the overall incidence of permanent hypoparathyroidism was 1.0%, and there was no significant difference between the groups. TT performed for Graves' disease and lymphocytic thyroiditis results in the autotransplantation of more parathyroid glands, leading to a higher incidence of temporary hypocalcaemia post-operatively. Despite this, the incidence of permanent hypoparathyroidism remains low at 1%.

Expression and clinical significance of nuclear matrix protein 22 and cytokeratin 18 in transitional cell carcinoma of the bladder

To evaluate the expression and clinical significance of urinary nuclear matrix protein (NMP22) and cytokeratin 18 (CK18) for transitional cell carcinoma of the bladder. Urinary NMP22 and CK18 levels of 293 patients with transitional cell carcinoma of the bladder, 400 patients with non-transitional cell carcinoma of the bladder, and 105 bladder benign disease were analysed by enzyme-linked-immunosorbent assay (ELISA). The levels of urinary NMP22 and CK18 in the patients with transitional cell carcinoma of the bladder (M = 17.3 U/ml, M(CK18) = 484.2 U/L) were significantly higher than those in the non-transitional cell carcinoma of the bladder (M = 6.8 U/ml, M(CK18) = 156.0 U/L) and the benign disease group (M(NMP22) = 2.3 U/ml, M(CK18) = 66.6 U/L) (P < 0.001). The sensitivity and specificity of urinary NMP22 and CK18 were 79.2%, 88.6% and 78.2%, 82.9%, respectively, for transitional cell carcinoma of the bladder before any treatment. The joint sensitivity of the two markers was 91.7%. The NMP22 and CK18 levels were significantly lower in the recovered patients after surgical operation (P < 0.01), while in patients with recurrence or metastasis the levels of the markers were significantly higher (P < 0.01). There was a significant relationship between NMP22 and CK18, (r = 0.689, P < 0.01). The levels of urinary nmp22 and CK18 were significantly different among pathological grade G1, G2, G3, and stage Ta, T1, T2, T3 (P < 0.01). NMP22 and CK18 are useful tumor marker for diagnosis of transitional cell carcinoma of the bladder and for monitoring the state of illness. The joint use of the two markers can improve the sensitivity of cancer detection. NMP22 and CK18 may become a new class of tumor markers, and to be the basis for development of a new assay with an increased efficacy for the detection and treatment of bladder cancer.

The values of serum human epididymis secretory protein 4 and CA(125) assay in the diagnosis of ovarian malignancy

To evaluate the value of human epididymis secretory protein 4 (HE4) and CA(125) in the diagnosis of ovarian malignancy. HE4 and CA(125) in the serum specimens of malignant ovarian tumor group (30 cases), benign ovarian diseases (110 cases; 45 benign ovarian tumor, 57 endometriotic diseases and 8 pelvic inflammation were included) and healthy women group (137 cases) were assayed double blindly. The levels and the diagnosis efficiency of the HE4 and CA(125) were analyzed. (1) The median levels of HE4 and CA(125) were significantly higher in malignant ovarian tumor group (244 pmol/L and 601 kU/L respectively) than those of the benign ovarian diseases group (32 pmol/L and 22 kU/L respectively) and healthy women group (32 pmol/L and 11 kU/L respectively) (P = 0.000 - 0.029). The median levels of CA(125) were also higher in endometriotic diseases and pelvic inflammation groups (53 and 41 kU/L respectively) than those of benign ovarian tumor group and healthy women group (12 and 11 kU/L respectively; P = 0.000 - 0.031). (2) The positive rate of HE4 was lower than that of CA(125) in malignant ovarian tumor group (P = 0.036). HE4 was negative in benign diseases and healthy women groups. But the positive rates of CA(125) were 56.1% and 5/8 respectively in endometriotic diseases and pelvic inflammation groups and there were significant differences compared with HE4 (P = 0.000). (3) The HE4 assay had advantage over the CA(125) assay in receiver operating characteristic-area under the curve (ROC-AUC) and sensitivity with a specificity of 100% when ovarian malignancy was compared with controls having benign diseases and healthy women, benign tumor or benign diseases groups respectively. The CA(125) assay had advantage over the HE4 assay in ROC-AUC and sensitivity with the same specificity when ovarian cancers were compared with controls having healthy women group. (4) Combined assay of HE4 and CA(125) was better than CA(125) alone when ovarian malignancy was compared with controls having any group. (5) Combined assay was better than HE4 alone in ROC-AUC and sensitivity with the same specificity when ovarian cancers were compared with controls having benign diseases and healthy women or healthy women groups. And combined assay was lower in the ROC-AUC and the sensitivity with specificity of 100% than HE4 when ovarian cancers were compared with controls having benign tumors or benign diseases groups respectively. (6) The diagnosis efficiency of the HE4 assay at the level 86 pmol/L determined in ROC curve with controls having benign diseases and healthy women group and at the 95% reference level 50 pmol/L of healthy women or 150 pmol/L recommended by the kit respectively was compared. The sensitivity of 50 pmol/L was 73% higher than 150 pmol/L and 86 pmol/L, while the specificity and positive predictive value were lower (P = 0.002, P = 0.000). The specificity, accuracy and positive predictive value of HE4 assay at the set point of 150 pmol/L and 86 pmol/L were 100%, 96% and 96%. The set point of 86 pmol/L had advantage over 150 pmol/L at the sensitivity of diagnosis, 70% and 63% respectively. But the positive predictive value was 95% lower than 150 pmol/L, being 100%. There was no significant difference (P = 0.883, P = 0.883). The specificity of HE4 assay is higher than CA(125) assay in the diagnosis of ovarian cancer and HE4 combined with CA(125) assay can improve the diagnoses. The set point of 150 pmol/L is advantageous for the accurate diagnosis, while the set point of 86 pmol/L is advantageous for the screening of malignant ovarian cancer.

Tumor associated antigens identify a high risk benign disease group

Tumor associated antigens identify a high risk benign disease group