Depth Of Invasion In Patients Research Articles

MRI-based radiomics analysis improves preoperative diagnostic performance for the depth of stromal invasion in patients with early stage cervical cancer

BackgroundThe depth of cervical stromal invasion is one of the important prognostic factors affecting decision-making for early stage cervical cancer (CC). This study aimed to develop and validate a T2-weighted imaging (T2WI)-based radiomics model and explore independent risk factors (factors with statistical significance in both univariate and multivariate analyses) of middle or deep stromal invasion in early stage CC.MethodsBetween March 2017 and March 2021, a total of 234 International Federation of Gynecology and Obstetrics IB1-IIA1 CC patients were enrolled and randomly divided into a training cohort (n = 188) and a validation cohort (n = 46). The radiomics features of each patient were extracted from preoperative sagittal T2WI, and key features were selected. After independent risk factors were identified, a combined model and nomogram incorporating radiomics signature and independent risk factors were developed. Diagnostic accuracy of radiologists was also evaluated.ResultsThe maximal tumor diameter (MTD) on magnetic resonance imaging was identified as an independent risk factor. In the validation cohort, the radiomics model, MTD, and combined model showed areas under the curve of 0.879, 0.844, and 0.886. The radiomics model and combined model showed the same sensitivity and specificity of 87.9% and 84.6%, which were better than radiologists (sensitivity, senior = 75.7%, junior = 63.6%; specificity, senior = 69.2%, junior = 53.8%) and MTD (sensitivity = 69.7%, specificity = 76.9%).ConclusionMRI-based radiomics analysis outperformed radiologists for the preoperative diagnosis of middle or deep stromal invasion in early stage CC, and the probability can be individually evaluated by a nomogram.

Evaluation of Tumour Volume as a Prognostic Factor in Carcinoma Buccal Mucosa.

(1) To determine tumor volume by clinical measurement, imaging and histopathological examination in patients with squamouscarcinoma of buccal mucosa. (2) To correlate tumor volume with lymph-node metastasis and loco-regional control. Retrospective Observational Study. Rural tertiary care hospital. 75 Patients undergoing surgery for T2 (68%) and T3 (32%) Oral squamous carcinomas were included in this observational study. Tumor volume-a product of maximum length, breadth and thickness, was determined clinically and by imaging. Tumor volume on histopathology was documented and correlated with lymph-node metastasis. After 13months minimum follow-up, tumor volume was correlated with loco-regional control. Recurrences were analysed with regard to tumor volume, depth of invasion, lymph-node metastasis and resection margins. Average tumor volume was 7.1cm3among T2 and 14.4cm3among T3. 25% of T2 tumors had metastatic lymph-nodes compared to 33.3% in T3. There was positive correlation between tumor volume and lymph-node metastasis. Lymph-node metastasis was absent when tumor volume was < 8cm3. There were 4 local and 2 regional recurrences in this study. Average histopathological tumor volume among patients who had local recurrence was 12.95cm3. Regional recurrences occurred in tumors staged N2b and N3b on histopathology. Average depth of invasion in patients with recurrence was 10.33mm.. Tumor volume represents actual tumor load and correlates with lymph node metastasis and prognosis in oral cancers. Depth of invasion and tumor thicknessinfluence staging and prognosis. Large volume tumors have poor oncological outcome.

Does a history of head and neck cancer affect outcome of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma?

Background and study aims Esophageal squamous cell carcinoma (ESCC) is the most common secondary tumor in patients with head and neck squamous cell cancer (HNSCC). Currently, endoscopic submucosal dissection (ESD) is the preferred approach to manage superficial ESCC, however, it remains to be elucidated whether patients with HNSCC and early ESCC managed by ESD have different outcomes. Patients and methods We retrospectively analyzed esophageal ESD for early ESCC from September 2009 to September 2017 and the following variables: demographics, tumor and specimen size, Paris classification, location, en bloc and R0 resection rates, overall survival (OS) and adverse events (AEs). To reduce selection bias, propensity score matching was applied to compare the results. Results Eighty-nine ESDs were performed in 81 consecutive patients (47 with HNSCC and 34 without HNSCC). Patients with HNSCC who developed superficial ESCC were found to be younger and to refer a more frequent history of alcohol ingestion and smoking. There was no difference in lesion size, number of lesions, procedure time, en bloc resection rate, R0 resection rate, local recurrence and adverse event rate between the two groups. The histological depth of invasion for patients with HNSCC was significantly shallower before ( P = 0.016) and after ( P = 0.047) matching. The overall survival rate was similar in both groups. Conclusions Patients with HNSCC have earlier detection of ESCC, probably due to endoscopic screening. Previous history of chemoradiation and surgery for HNSCC does not affect procedure time, AEs and OS.

Classification for invasion depth of esophageal squamous cell carcinoma using a deep neural network compared with experienced endoscopists

Cancer invasion depth is a critical factor affecting the choice of treatment in patients with superficial squamous cell carcinoma (SCC). However, the diagnosis of invasion depth is currently subjective and liable to interobserver variability. We developed a deep learning-based artificial intelligence (AI) system based on Single Shot MultiBox Detector architecture for the assessment of superficial esophageal SCC. We obtained endoscopic images from patients with superficial esophageal SCC at our facility between December 2005 and December2016. After excluding poor-quality images, 8660 non-magnified endoscopic (non-ME) and 5678 ME images from 804 superficial esophageal SCCs with pathologic proof of cancer invasion depth were used as the training dataset, and 405 non-ME images and 509 ME images from 155 patients were selected for the validation set.Oursystem showed a sensitivity of 90.1%, specificity of 95.8%, positive predictive value of 99.2%, negative predictive value of 63.9%, and an accuracy of 91.0% for differentiating pathologic mucosal and submucosal microinvasive (SM1) cancers from submucosal deep invasive (SM2/3) cancers. Cancer invasion depth was diagnosed by 16 experienced endoscopists using the same validation set, with an overall sensitivity of 89.8%, specificity of 88.3%, positive predictive value of 97.9%, negative predictive value of 65.5%, and an accuracy of 89.6%. This newly developed AI system showed favorable performance for diagnosing invasion depth in patients with superficial esophageal SCC, with comparable performance to experienced endoscopists.

Depth of invasion in patients with early stage oral cancer staged by sentinel node biopsy.

BackgroundTo investigate if depth of invasion (DOI) can predict occult nodal disease in patients with cT1‐2N0 (7th TNM) oral squamous cell carcinoma (OSCC) staged by sentinel lymph node biopsy (SLNB).MethodsIn 199 OSCC patients, DOI measurements and SLNB were performed.ResultsMetastases were found in 64 of 199 patients (32%). Of these 64 patients, the mean DOI was 6.6 mm compared to 4.7 mm in patients without metastases (P = .003). The ROC‐curve showed an area under the curve of 0.65 with a most optimal cutoff point of 3.4 mm DOI (sensitivity 83% and specificity 47%). Regional metastases were found in 15% of patients with DOI ≤ 3.4 mm.ConclusionDOI seems to be a poor predictor for regional metastasis in patients with cT1‐2N0 OSCC. Therefore, staging of the neck using SLNB in patients with early stage oral cancer should also be performed in tumors with limited DOI and probably in T3 (8th TNM) OSCC ≤4 cm diameter.

CT in the Assessment of the Depth of Tumor Invasion of Colon Cancer

Objective: to study the symptoms of tumor lesions of colon and to determine the CT criteria for assessing the depth of tumor invasion in patients with colon cancer.Materials and methods. CT data were analyzed at 121 patients with colon cancer. All patients were fully resected and CT data were compared with data of morphological studies. Staging was performed according to TNM classification 7th ed. (2009).Results.We evaluated CT symptoms of tumor lesions in comparison with the data of pathological category T (pT): type of tumor, its structure, the condition of the external colon contour, the state of paracolon fat and its density, the presence of fat image between the tumor and adjacent organs and tissues, CT signs of invasion of malignant process in the neighboring organs and adjacent structures. For tumors with extraintestinal growth (T3–4 category) are characteristic CT symptoms: tumor heterogeneous structure (p &lt; 0.001) with a fuzzy outer contour of the colon in the affected area (p &lt; 0.05), the presence of changes in the paracolon fat whose density −76,95 HU and more, the invasion into adjacent organs at T4 category. The diagnostic efficiency of CT in determining T3–4 category was as follows: 90.9% accuracy, sensitivity 93.6%, specificity of 81.5%.Conclusions. Computed tomography is a highly informative method for determining extraorgan spread of colon cancer, which allows to determine the amount of preoperative surgical treatment and adjust treatment tactics.

Autofluorescence Bronchoscopy and Endobronchial Ultrasound

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Intratumoral gene expression profile of genes involved in 5-FU metabolism and angiogenesis, comparison with tumor invasion depth in patients with advanced gastric cancer.

56 Background: The biopsy specimen by endoscopy can only show the surface of its gene profiles. We hypothesis whether the biopsy specimen can reflect all part of gene profile or not. We tested how 5-FU related genes and angiogenesis gene expressed in the invasion depth in the primary tumor of the Stage II or III advanced gastric cancer. Methods: Twenty-five patients with stage II or III advanced gastric cancer who underwent gastrectomy were analyzed.Formalin-fixed, paraffin-embedded tumor tissues were dissected from the surface section (mainly mucosa), the middle section (mainly submucossa) and the deep section (the part invaded most deeply) of the primary tumor and the normal gastric mucosa tissue by the laser-captured microdissection technique and were analyzed for target gene expressions using a quantitative real-time polymerase chain reaction.We analyzed for target genes as TS, TP, DPD, ERCC1, EGFR, VEGF and HIF1α. Results: In the primary tumor, TP and HIF1α gene expression in the surface section was significantly higher than in the deep section (p=0.021, p=0.012). These gene expression and the depth of the primary tumor had a correlation coefficient (TP; r=0.29, HIF1α; r=0.33). There was no significantly difference between surface and deep section in the primary tumor in TS, DPD, ERCC1, VEGF, EGFR except TP and HIF1α. There was no significantly difference between surface and middle section in the primary tumor in all gene expression. There was no significantly difference between middle and deep section in the primary tumor in all gene expression. Conclusions: Only TP and HIF1α had tendency that these gene expression became higher as invaded from the surface section to the deep section of primary tumor. These data suggested that biopsy specimens could be predicted gene expression profile from the surface of gastric cancer. But as you know, gastric cancer has a heterogeneity gene profile. We need at least few samples to say whole gene expression of its tumors. This is preliminary data, it will need further study to proof these result.

Elevated C-reactive protein level is associated with the tumor depth of invasion in patients with operable colorectal carcinoma.

There is increasing evidence to show that the presence of raised concentrations of serum C-reactive protein (CRP) is associated with poor survival in patients with colorectal carcinoma. The CRP response with respect to tumor characteristics in colorectal carcinoma was examined to identify factors that might reflect a raised CRP level. One hundred and eighty-one patients who underwent elective colorectal resection were identified for inclusion in this study. Eighteen patients with high CRP levels were compared to a control group of 163 patients without high CRP levels, and the correlation between preoperative CRP level and clinicopathological features in operable colorectal carcinoma was investigated. The analysis of factors with seeming potential to be associated with CRP levels following colorectal surgery, disclosed that only the depth of tumor invasion, serum albumin and lymphovascular invasion were of statistical significance. Multivariate subgroup analysis of the association between these factors and CRP showed that depth of invasion and albumin were independently associated with CRP. Our results suggest that depth of tumor invasion is associated with an increase in CRP levels. CRP is considered an important indicator of advanced local invasion in operable colorectal surgery, if other inflammatory conditions are excluded.

High‐risk human papillomavirus and cervical lymph node metastasis in patients with oropharyngeal cancer

The purpose of this study was to determine the role of high-risk human papillomavirus (HPV) in lymph node metastasis and the depth of invasion in oropharyngeal cancer. The study included patients with 90 oral carcinomas and 66 oropharyngeal carcinomas. High-risk HPV in situ hybridization was performed to detect HPV infection. The positive rate of high-risk HPV in situ hybridization was 15.4% (24 of 156). There was a significant difference in the fraction of positive high-risk HPV between oral (6.7%) and oropharyngeal (27.3%) cancers (p < .000). Significant correlations were found between positive high-risk HPV and cervical lymph node metastasis, tumor depth of invasion in patients with oropharyngeal cancer (p = .002, p = .016, respectively). There was a statistically significant association between high-risk HPV positivity and the disease-specific survival in patients with oropharyngeal cancer (p = .035). High-risk HPV infection was significantly related to cervical lymph node metastasis and depth of invasion in patients with oropharyngeal cancer. © 2011 Wiley Periodicals, Inc. Head Neck, 2012.

Degree of Error of Thin-Section MR in Measuring Extramural Depth of Tumor Invasion in Patients with Rectal Cancer

Degree of Error of Thin-Section MR in Measuring Extramural Depth of Tumor Invasion in Patients with Rectal Cancer

2084: Advantages of 3D sonography in determination of tumor invasion depth in patients with rectal tumors

Objectives: Determination of tumor invasion depth and anal sphincter involvement in patients with rectal tumor is important for therapy choice. Standard transrectal sonography (TS) is obligatory part of TNM-staging in these patients. It allows to visualize five layers of rectal wall, pararectal structures and tumor invasion depth. Investigation goal was to reveal the possibilities of sonography with 3D reconstruction in estimation of invasion depth of rectal and anal cancer.

Prognostic factors for patients with gastric cancer after surgical resection

Summary Background Stomach cancer is the 8 th most common cause of cancer death, with median age of diagnosis 70 years for men and 74 years for women. Surgical resection is still the method of choice and surgical trials are focused on identifying prognostic factors for groups of patients undergoing curative surgery. Aim The aim of our retrospective study was an analysis of prognostic factors in a group of patients with gastric cancer. Materials/Methods We retrospectively analyzed a group of 248 patients with gastric cancer. Clinical and histological parameters were collected and then correlated with each another and with survival time using statistical parametric and nonparametric methods. Survival probability was estimated by Kaplan-Meier method. Statistical significance of prognostic factors depending on survival time was assessed by the Cox nonparametric proportional hazard regression model. Results Univariate analysis showed significance of the following parameters: weight loss of more than 10 kg, tumour size, histological type of tumour, lymph node involvement, stage at the time of diagnosis and type of operation. Multivariate analysis showed that weight loss of more than 10 kg, T2 tumour size, lymph metastases, total gastrectomy and finally curative operation were independent prognostic factors of survival. Conclusions Taking our data together we conclude that: (i) lymph node metastasis is a significant prognostic factor with poor prognosis, (ii) type of operation is a significant prognostic factor of survival, (iii) we confirmed the influence of T2 depth of invasion for patients’ overall survival, (iv) weight loss of more than 10 kg displays a statistical correlation with survival time and worse prognosis, (v) parameters connected with complications after surgical procedures have no infl uence on survival time in the examined group.

Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status.

The current TNM classification system does not consider tumor length or the number of lymph nodes in the staging and classification scheme for patients with esophageal carcinoma. Using data from the National Cancer Institute SEER Program, the authors explored the effect of tumor length and number of positive lymph nodes on survival in patients with esophageal carcinoma. Patients with esophageal adenocarcinoma or squamous cell carcinoma were subgrouped according to historic stage with localized, regional, or distant disease. Demographic factors (age at diagnosis, race, and gender) and tumor characteristics (morphology, histologic grade, tumor length, primary site, depth of invasion, number of positive lymph nodes, proportion of positive lymph nodes dissected, and distant metastatic sites) were examined. Overall factors that were associated with an increased mortality risk included increasing age at diagnosis, black race versus white race, histologic grade, primary tumor site in the lower esophagus and abdomen versus upper regions, and increasing depth of invasion. Among patients with regional disease, the number of positive lymph nodes (>/= 5 vs. < 5) was related to an increasing risk (hazard ratio [HR], 1.29; 95% confidence interval [95%CI], 1.06-1.56). The proportion of positive lymph nodes compared with the number of lymph nodes dissected conferred an increased risk (HR, 1.63; 95%CI, 1.26-2.11). Among patients with distant disease, sites other than distant lymph nodes implied an increased mortality risk (HR, 1.37; 95%CI, 1.37-1.65). Tumor length was an independent predictor of mortality when controlling for depth of invasion in patients with localized disease (HR, 1.15; 95%CI, 1.08-1.21). Tumor length, the number of involved lymph nodes, and the ratio of positive lymph nodes are important prognostic factors for survival in patients with esophageal carcinoma. A revised TNM classification system for patients with esophageal carcinoma might consider adding tumor length and number of positive lymph nodes as two important prognostic factors.

Intraoperative frozen section examination of myometrial invasion depth in patients with endometrial carcinoma.

The objective of this study was to evaluate the accuracy of frozen sections (FS) as a method for estimation of the depth of myometrial invasion in patients with stage I endometrial carcinoma. During a 3-year period (1989-1992), 46 consecutive patients with FIGO stage I endometrial carcinoma were included in this study. The depth of myometrial invasion was estimated by FS examination performed during surgery. The final histologic findings of the surgical specimen were compared to the FS evaluation. The results of this study demonstrate that deep or superficial myometrial invasions were correctly diagnosed by FS in 42 out of 46 cases (91.3%). Three cases (6.6%) with deep myometrial invasion were falsely diagnosed as superficially invasive. One case with superficial invasion (2.1%) was falsely diagnosed as deeply invasive. In conclusion, intraoperative FS examination of depth of myometrial invasion by endometrial carcinoma is a simple and accurate method, providing a good correlation with the final histologic report of the surgical specimen.