Estimated Tumor Volume Research Articles

Weakly supervised segmentation of tumor lesions in PET-CT hybrid imaging.

.Purpose: We introduce and evaluate deep learning methods for weakly supervised segmentation of tumor lesions in whole-body fluorodeoxyglucose-positron emission tomography (FDG-PET) based solely on binary global labels (“tumor” versus “no tumor”).Approach: We propose a three-step approach based on (i) a deep learning framework for image classification, (ii) subsequent generation of class activation maps (CAMs) using different CAM methods (CAM, GradCAM, GradCAM++, ScoreCAM), and (iii) final tumor segmentation based on the aforementioned CAMs. A VGG-based classification neural network was trained to distinguish between PET image slices with and without FDG-avid tumor lesions. Subsequently, the CAMs of this network were used to identify the tumor regions within images. This proposed framework was applied to FDG-PET/CT data of 453 oncological patients with available manually generated ground-truth segmentations. Quantitative segmentation performance was assessed for the different CAM approaches and compared with the manual ground truth segmentation and with supervised segmentation methods. In addition, further biomarkers (MTV and TLG) were extracted from the segmentation masks.Results: A weakly supervised segmentation of tumor lesions was feasible with satisfactory performance [best median Dice score 0.47, interquartile range (IQR) 0.35] compared with a fully supervised U-Net model (median Dice score 0.72, IQR 0.36) and a simple threshold based segmentation (Dice score 0.29, IQR 0.28). CAM, GradCAM++, and ScoreCAM yielded similar results. However, GradCAM led to inferior results (median Dice score: 0.12, IQR 0.21) and was likely to ignore multiple instances within a given slice. CAM, GradCAM++, and ScoreCAM yielded accurate estimates of metabolic tumor volume (MTV) and tumor lesion glycolysis. Again, worse results were observed for GradCAM.Conclusions: This work demonstrated the feasibility of weakly supervised segmentation of tumor lesions and accurate estimation of derived metrics such as MTV and tumor lesion glycolysis.

642 PL02.01 DOES A HIGH MANDARD SCORE REALLY DEFINE A POOR RESPONSE TO CHEMOTHERAPY IN OESOPHAGEAL ADENOCARCINOMA?

Abstract A high Mandard score corresponds to a non-response to chemotherapy in the primary tumour in oesophageal adenocarcinoma. However, some patients experience tumour volume reduction and a nodal downstaging despite a high score. This study compares survival and recurrence patterns in these patients. Methods Clinicopathological factors were analysed using multivariable Cox regression assessing time to death and recurrence. CT estimated tumour volume change was examined in a subgroup of consecutive patients. Mean pre-chemotherapy and post chemotherapy tumour volumes were compared across Mandard groups and nodal responders. Results 555 patients were included. Median survival was 55 months (Mandard 1,2,3) and 21 months (Mandard 4,5). In the Mandard 4,5 group (332 patients), comparison between complete nodal responders and persistent nodal disease showed improved survival (90 vs 18 months), recurrence rates (locoregional 14.75% vs 28.74, systemic 24.59% vs 48.42%) and CRM positivity (22.95% vs 68.11). Complete nodal response independently predicted improved survival (HR 0.34(0.16–0.74). Post-chemotherapy tumour volume reduction was greater in patients with a complete nodal response (−16.3 cm3 vs −7.7 cm3 p 0.033) with no significant difference between Mandard groups. Conclusion: Patients with a complete nodal response to chemotherapy have significantly improved outcomes despite a poor Mandard score. High Mandard score does not correspond with a non-response to chemotherapy in all cases and patients with nodal downstaging may still benefit from adjuvant chemotherapy.

Volume tumor impact on melanoma survival assessed using Breslow density

Volume tumor impact on melanoma survival assessed using Breslow density

Conservative (non-radical) surgery for stage IB1 cervical cancer.

There has been lively debate in recent years following the publication of various retrospective case series and small cohort studies that suggest certain women presenting with International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical cancer (pre-2018 revised classification) may be treated by non-radical surgery, either simple hysterectomy or cone biopsy, where fertility preservation is required. A strictly defined histological criterion is necessary for selecting such cases, incorporating tumour dimensions including estimated tumour volume, lympho-vascular space invasion and pelvic lymph node status. Meta-analyses of these studies show that the oncological outcomes are comparable to the excellent results achieved by radical hysterectomy and radical trachelectomy. In addition, the fertility and pregnancy outcomes for cases treated by conisation are superior to cases managed by radical trachelectomy. Multi-centre, ethically approved, prospective studies are currently on-going, which will provide better quality evidence in an attempt to contribute to this debate, with the intention of improving outcomes, including quality of life, in women presenting with small-volume stage IB1 cervical cancer.

Long-Term Outcomes of Patients with Hydrocephalus Secondary to Tectal Plate Glioma versus Idiopathic Aqueductal Stenosis: Results from a Single Center

Introduction: Tectal plate gliomas (TPG) constitute a distinct entity of benign tumors of the brain stem which show an indolent clinical course. Adequate treatment of secondary hydrocephalus is undoubtedly a major factor in the outcome. However, little is known about to what degree the tumor itself determines the long-term outcome of these patients. Methods: We retrospectively analyzed and compared the clinical and radiological data of 16 pediatric TPG patients with data of 12 pediatric idiopathic aqueductal stenosis (IAS) patients treated in our center from 1988 to 2018. For both groups, we assessed the long-term outcome in terms of hydrocephalus management, and for the TPG group, we assessed tumor growth during follow-up. In a separate prospective part of the study, we performed a neuropsychological evaluation in a subgroup of patients using a standardized testing battery, covering intelligence, learning, memory, executive functions, and an inventory on depression. Results: In the TPG group, the mean clinical and radiological follow-up was 84 and 70 months, respectively. On average, the maximum diameter of the tumor increased by 11% (p = 0.031) and the estimated tumor volume with 35% (p = 0.026) on radiological follow-up. The fronto-occipital horn ratio (FOHR) decreased by 23% on average after treatment. In the IAS group, the mean clinical and radiological follow-up was 117 and 85 months, respectively. In this group, the FOHR decreased by 21% on average. Neurocognitive testing revealed significant higher scores in the TPG group on global intelligence (TPG = 109, IAS = 85.5, U = 3, p < 0.01, z = −2.71), performance (TPG= 100, IAS = 85, U = 7, p = 0.03, z = −2.2), and verbal intelligence (TPG = 122, IAS = 91.5, U = 2, p < 0.00, z = −2.87) as well as working memory (TPG = 109.5, IAS = 77, U = 0.5, p = 0.01, z = −2.46). Conclusion: Our results suggest that the long-term outcome in TPG patients is acceptable and that cognition is substantially better preserved than in patients with IAS. This puts the idea of a significant contribution of the tumoral mass to disease outcome on the long term in question. Adequate and prompt management of hydrocephalus is the most important factor in long-term cognitive outcome.

Protective Effects of Preconditioning Exercise on Skeletal Muscle Strength and Tumor Growth in the Female Tumor‐Bearing Mouse

Background Cancer cachexia, a complex metabolic wasting disease, occurs in up to 80% of cancer patients and results in death in up to one-third of cancer patients. While research in this field is growing, cancer cachexia remains an untreated condition with irreversible effects as there are no clear diagnostic criteria. Therefore, a great need exists to better understand this disease and possible preventative methods. Research has shown that exercise interventions have a positive impact on inhibiting tumor growth and preserving muscle mass. Many questions remain regarding the most effective timing and extent of exercise as a protective measure. Therefore, the purpose of this study was to examine the effects of preconditioning exercise as a protective measure for cancer cachexia. Methods Female LC3 Tg+ and WT mice were randomly separated into four groups, sedentary non-tumor bearing (SED+NT), sedentary tumor bearing (SED+T), treadmill exercise non-tumor bearing (TM+NT), and treadmill exercise tumor bearing (TM+T). Mice underwent an 8-week treadmill exercise training protocol (TM) or remained sedentary (SED). Next, mice were implanted with tumor cells (T group; 1x105 LLC cells in flank) or remained non-tumor (NT) for 4 weeks. To examine the protective effects of exercise on tumor growth and muscle wasting during cancer cachexia, grip strength and tumor growth evaluations were taken at baseline, 8-week, and 12-week time points. At the end of the 12-week study, muscle and tumor tissue was collected and weighed. Results While no differences existed between groups at baseline, exercise trained (TM) mice exhibited modest gains in grip strength compared to SED mice. Following tumor bearing, SED+T mice exhibited a significant (P < 0.05) decline in grip strength compared to SED+NT animals. Additionally, SED+T skeletal muscle mass (gastrocnemius, mixed fiber) was significantly (P < 0.05) less compared to TM+T. Interestingly, TM resulted in a 20-fold decrease in estimated tumor volume (P < 0.05) and a 60% decrease in tumor mass (P < 0.05) compared to SED tumors. Conclusion The analyzed data indicate that preconditioning exercise appears to play an important role in protecting the musculature during cancer cachexia. This is evidenced by exercise's ability to guard against cancer cachexia-mediated declines in both muscle strength and mass. Furthermore, exercise preconditioning significantly stunted tumor growth even when animals did not exercise during the tumor bearing. This information is crucial in understanding the significance of exercise in cancer patients and in elucidating the importance of timing of exercise as a protective measure against the detrimental effects of cancer cachexia.

Towards an Image-Informed Mathematical Model of In Vivo Response to Fractionated Radiation Therapy.

Simple SummaryUsing medical imaging data and computational models, we develop a modeling framework to provide personalized treatment response forecasts to fractionated radiation therapy for individual tumors. We evaluate this approach in an animal model of brain cancer and forecast changes in tumor cellularity and vasculature.Fractionated radiation therapy is central to the treatment of numerous malignancies, including high-grade gliomas where complete surgical resection is often impractical due to its highly invasive nature. Development of approaches to forecast response to fractionated radiation therapy may provide the ability to optimize or adapt treatment plans for radiotherapy. Towards this end, we have developed a family of 18 biologically-based mathematical models describing the response of both tumor and vasculature to fractionated radiation therapy. Importantly, these models can be personalized for individual tumors via quantitative imaging measurements. To evaluate this family of models, rats (n = 7) with U-87 glioblastomas were imaged with magnetic resonance imaging (MRI) before, during, and after treatment with fractionated radiotherapy (with doses of either 2 Gy/day or 4 Gy/day for up to 10 days). Estimates of tumor and blood volume fractions, provided by diffusion-weighted MRI and dynamic contrast-enhanced MRI, respectively, were used to calibrate tumor-specific model parameters. The Akaike Information Criterion was employed to select the most parsimonious model and determine an ensemble averaged model, and the resulting forecasts were evaluated at the global and local level. At the global level, the selected model’s forecast resulted in less than 16.2% error in tumor volume estimates. At the local (voxel) level, the median Pearson correlation coefficient across all prediction time points ranged from 0.57 to 0.87 for all animals. While the ensemble average forecast resulted in increased error (ranging from 4.0% to 1063%) in tumor volume predictions over the selected model, it increased the voxel wise correlation (by greater than 12.3%) for three of the animals. This study demonstrates the feasibility of calibrating a model of response by serial quantitative MRI data collected during fractionated radiotherapy to predict response at the conclusion of treatment.

Nascent Prostate Cancer Heterogeneity Drives Evolution and Resistance to Intense Hormonal Therapy

BackgroundPatients diagnosed with high risk localized prostate cancer have variable outcomes following surgery. Trials of intense neoadjuvant androgen deprivation therapy (NADT) have shown lower rates of recurrence among patients with minimal residual disease after treatment. The molecular features that distinguish exceptional responders from poor responders are not known. ObjectiveTo identify genomic and histologic features associated with treatment resistance at baseline. Design, setting, and participantsTargeted biopsies were obtained from 37 men with intermediate- to high-risk prostate cancer before receiving 6 mo of ADT plus enzalutamide. Biopsy tissues were used for whole-exome sequencing and immunohistochemistry (IHC). Outcome measurements and statistical analysisWe assessed the relationship of molecular features with final pathologic response using a cutpoint of 0.05 cm3 for residual cancer burden to compare exceptional responders to incomplete and nonresponders. We assessed intratumoral heterogeneity at the tissue and genomic level, and compared the volume of residual disease to the Shannon diversity index for each tumor. We generated multivariate models of resistance based on three molecular features and one histologic feature, with and without multiparametric magnetic resonance imaging estimates of baseline tumor volume. Results and limitationsLoss of chromosome 10q (containing PTEN) and alterations to TP53 were predictive of poor response, as were the expression of nuclear ERG on IHC and the presence of intraductal carcinoma of the prostate. Patients with incompletely and nonresponding tumors harbored greater tumor diversity as estimated via phylogenetic tree reconstruction from DNA sequencing and analysis of IHC staining. Our four-factor binary model (area under the receiver operating characteristic curve [AUC] 0.89) to predict poor response correlated with greater diversity in our cohort and a validation cohort of 57 Gleason score 8–10 prostate cancers from The Cancer Genome Atlas. When baseline tumor volume was added to the model, it distinguished poor response to NADT with an AUC of 0.98. Prospective use of this model requires further retrospective validation with biopsies from additional trials. ConclusionsA subset of prostate cancers exhibit greater histologic and genomic diversity at the time of diagnosis, and these localized tumors have greater fitness to resist therapy. Patient summarySome prostate cancer tumors do not respond well to a hormonal treatment called androgen deprivation therapy (ADT). We used tumor volume and four other parameters to develop a model to identify tumors that will not respond well to ADT. Treatments other than ADT should be considered for these patients.

Minimally invasive ethyl cellulose ethanol ablation in domesticated cats with naturally occurring head and neck cancers: Six cats.

It is difficult to retain tumoricidal doses of ethanol in large or unencapsulated tumours without causing intoxication or damaging surrounding tissue. Ethyl cellulose-ethanol ablation (ECEA) overcomes this limitation by trapping ethanol intratumorally. To evaluate the safety of ECEA and to develop a clinically feasible workflow, a single-arm pilot study was performed in cats with lingual/sublingual squamous cell carcinoma (SCC). Six cats underwent intratumoral injection of 6% ethyl cellulose in ethanol. Subjects were observed overnight. There was mild bleeding and transient hyperthermia, and injection site pain and swelling that improved with anti-inflammatory drugs. Serum ethanol was minimally elevated; the mean concentration peaked 1 hour after injection (129 +/- 15.1nM). Cats were rechecked at weeks 1 and 2; booster treatments were given in cats (n=3) with stable quality of life and partial response to therapy. Recheck examinations were then performed monthly. The longest tumour dimension increased in each animal (progressive disease via cRECIST); however, estimated tumour volume was reduced in 3 of 6 cats, within 1 week of ECEA. All cats were euthanized (median survival time 70 days) because of local tumour progression and/or lingual dysfunction that was likely hastened by ECEA. ECEA is not a viable treatment for feline lingual/sublingual SCC; tumour volume was effectively reduced in some cats, but the simultaneous loss of lingual function was poorly tolerated. Further optimization may make ECEA a useful option for SCC at other oral sites in the cat, and for head and neck malignancies in other species.

Automatic three‐dimensional detection and volume estimation of low‐grade gliomas

AbstractBrain tumor segmentation is routinely needed in diagnostic radiology. Automatic volume estimation has been used for diagnosis improvement and treatment process. This article presents a new approach for tumor volume estimation, using a variational level set method. The new adapted representation of intensity allows the method to be efficient in the region of interest identification, regardless the shape, size, and location of the tumor. For the estimation of an optimal bounding box, a fuzzy preference optimization model is used. The proposed approach is suitable for the zero level set initialization as well as for the reduction of the processing area, which ultimately speeds up the curve evolution. Moreover, tumor contours are determined using the hybrid level set technique, which combines the gradient and local phase information as an edge indicator term. Such an approach is robust to attenuation and intensity inhomogeneity. The proposed method is evaluated using a set of real and synthetic images. Our method achieved a performance of 96% accuracy, with an average execution time of 4.75 seconds. The proposed method is fast, accurate, and does not require training data or prior knowledge. With such experimental results, our approach outperforms 18 state‐of‐the‐art methods.

Increased Estimated Tumour Size to Total Liver Volume Ratio is Associated with Worse Survival in Resectable Hepatocellular Carcinoma

Introduction: Tumour diameter is a known prognostic factor for hepatocellar carcinoma but does not fully reflect tumour burden. In this study we aim to explore the relationship between the estimated tumour volume to total liver volume ratio and overall survival. Method: Patients who were diagnosed of hepatocellular carcinoma with computer tomography (CT) liver volumetry performed during the period of November 2009 to November 2019 were included. Patients underwent hepatic resection were included. Estimated tumour volume (ETV) was defined as 2/3 x π x (largest tumour diameter/2)³ TLV was determined by CT volumetry. Statistical analysis with prospectively collected data was performed. Results: 143 patients was included in the study. The median ETV was 220.9cm3 (0.9—4188.8cm3). The median TLV was 1379.2cm3 (541.6—136524.0) and ETV:TLV ranges 0.0007—7.7341. The hazard ratio was 1.138 for diameter of largest tumour (p< 0.001) and was 1.540 for ETV:TLV (p< 0.001). The optimal cut-off value of ETV:TLV was 0.065 by the ROC curve. Survival analysis showed that patients with ETV:TLV < 0.065 had significantly better 5-year overall survival than those with ETV:TLV >/=0.065 (84.7% vs 45.3%; p< 0.001). 5-year disease free survival was also better in patients with ETV:TLV < 0.065 (50.7% vs 20.5%; p< 0.001). Conclusion: An increase in ETV:TLV to over 0.065 is associated with worse survival outcomes. This can be used as a prognostic tool in the management of HCC.

Usefulness of dual-energy computed tomography for oral cancer image.

We aimed to compare dual-energy computed tomography (DECT) virtual monochromatic imaging (VMI) and iodine density imaging (IDI) of oral cancers in terms of visual scoring and tumour volume estimation. Nine patients diagnosed with oral cancer who underwent DECT VMI and IDI were enrolled. One radiation oncologist, one head and neck surgeon and nine oral surgeons evaluated image clarity and quality in each patient in terms of metal artefacts due to dental prosthesis, internal tumour structure, tumour-organ boundary and total quality of images for diagnosis. Tumour volume was estimated using VMI, IDI and magnetic resonance imaging (MRI). The mean score for image artefact was significantly higher for IDI than for VMI in three observers, the mean score for internal structure was significantly higher for IDI than for VMI in five, the mean score for tumour-organ boundary was significantly higher for IDI than for VMI in two and the mean score for total quality of images for diagnosis was significantly higher for IDI than for VMI in five. Standard deviation of estimated tumour volume was not significantly different between VMI and IDI, but that of MRI was significantly lowest in three images. In DECT for oral cancer, IDI has a visual image superior to VMI; thus, we recommend the use of IDI. Clinical trial number: UMIN000038994.

Enhanced Detection of Treatment Effects on Metastatic Colorectal Cancer with Volumetric CT Measurements for Tumor Burden Growth Rate Evaluation.

Mathematical models combined with new imaging technologies could improve clinical oncology studies. To improve detection of therapeutic effect in patients with cancer, we assessed volumetric measurement of target lesions to estimate the rates of exponential tumor growth and regression as treatment is administered. Two completed phase III trials were studied (988 patients) of aflibercept or panitumumab added to standard chemotherapy for advanced colorectal cancer. Retrospectively, radiologists performed semiautomated measurements of all metastatic lesions on CT images. Using exponential growth modeling, tumor regression (d) and growth (g) rates were estimated for each patient's unidimensional and volumetric measurements. Exponential growth modeling of volumetric measurements detected different empiric mechanisms of effect for each drug: panitumumab marginally augmented the decay rate [tumor half-life; d [IQR]: 36.5 days (56.3, 29.0)] of chemotherapy [d: 44.5 days (67.2, 32.1), two-sided Wilcoxon P = 0.016], whereas aflibercept more significantly slowed the growth rate [doubling time; g = 300.8 days (154.0, 572.3)] compared with chemotherapy alone [g = 155.9 days (82.2, 347.0), P ≤ 0.0001]. An association of g with overall survival (OS) was observed. Simulating clinical trials using volumetric or unidimensional tumor measurements, fewer patients were required to detect a treatment effect using a volumetric measurement-based strategy (32-60 patients) than for unidimensional measurement-based strategies (124-184 patients). Combined tumor volume measurement and estimation of tumor regression and growth rate has potential to enhance assessment of treatment effects in clinical studies of colorectal cancer that would not be achieved with conventional, RECIST-based unidimensional measurements.

Gaussian Mixture Model for MRI Image Segmentation to Build a Three-Dimensional Image on Brain Tumor Area

A brain tumor is one of the deadly diseases that attack the central and nervoussystem. The treatment of brain tumor, need high accuracy and precision. Brain tumordetection through Magnetic Resonance Imaging (MRI) has two-dimensional output withthree perspectives, namely sagittal, coronal, and axial. These different perspectives needto be seen one by one to determine the location and size of the tumor. Tosolve the problem, this study constructs the three-dimensional visualization perspective ofMRI images. The tumor area in MRI image is segmented as a region of interest (ROI) byemploying the Gaussian Mixture Model (GMM) with Expectation-Maximization as theoptimization technique. These couple segmentation methods have revealed significant gainas a clear boundary of the tumor area to separate from the healthy part of the brain andan estimated tumor volume from sagittal, coronal, and axial perspectives. Furthermore,these findings have been successfully visualized in 3D construction of the tumor positionon the left side of the patient’s head with an estimated volume of 749mm3.

Intrahepatic cholangiocarcinoma: Introducing the preoperative prediction score based on preoperative imaging

BackgroundIntrahepatic cholangiocarcinoma (ICC) still has a poor long-term outcome, even after complete resection. We investigated different parameters gathered in preoperative imaging and analyzed their influence on resectability, recurrence, and survival. MethodsAll patients who underwent exploration due to ICC between January 2008 and June 2018 were analyzed retrospectively. Kaplan-Meier model, log-rank test and Cox regression were used. ResultsOut of 184 patients, 135 (73.4%) underwent curative intended resection. Median overall survival (OS) was 22.2 months with a consecutive 1-, 3- and 5-year OS of 73%, 29%, and 17%. Median recurrence-free survival (RFS) was 9.3 months with a consecutive 1-, 3- and 5-year RFS of 36%, 15%, and 11%. Site of tumor, parenchymal localization, tumor configuration/dissemination, and estimated tumor volume had significant influence on resectability. Univariate analyses showed that site of tumor, tumor configuration/dissemination, number of nodules, and estimated tumor volume had predictive values for OS and RFS. Together with tumor size the preoperative prediction (POP) score was created showing significance for OS and RFS (all P < 0.001). In multivariate analysis, POP score (HR = 1.779; 95% CI: 1.268-2.495; P = 0.001), T stage (HR = 1.255; 95% CI: 1.040-1.514; P = 0.018) and N stage (HR = 1.334; 95% CI: 1.081-1.645; P = 0.007) were the independent predictors for OS. For RFS, POP score (HR = 1.733; 95% CI: 1.300-2.311; P < 0.001) and M stage (HR = 3.036; 95% CI: 1.376-6.697; P = 0.006) were the independent predictors. ConclusionsThe POP score showed to have a highly significant influence on OS and RFS. The score is easy to assess through preoperative imaging. For patients in the high risk group at least staging laparoscopy or preoperative chemotherapy should be evaluated, because they showed equal outcome compared to the irresectable group.

Orbital Lobe and Palpebral Adenomas of the Lacrimal Gland Behave as Distinct Entities.

To assess whether orbital lobe and palpebral adenomas of the lacrimal gland are biologically similar, based upon a comparison of the age at presentation and at first symptom. The size of the excised tumor in the 2 groups is also examined and considered in relation to age at surgery. Review of clinical details and histopathology reports for patients with biopsy-proven lacrimal gland pleomorphic adenomas, under the care of Moorfields Eye Hospital. The age at presentation and at earliest symptoms were calculated for each patient. Where available, estimates of tumor volume were obtained from the 3 orthogonal measurements taken during histopathological examination. One hundred eighty-seven patients (100 male patients; 53%) presented at an average age of 48 years (median, 46.8; range, 11-88): the average age for 144 patients with orbital lobe tumors (mean, 48 years; median, 47.8; range, 11-88) was similar to that for 43 patients with palpebral tumors (mean, 46 years; median, 46.8; range, 24-81) (p = 0.45). The average age at first symptom(s) in the 2 groups is similar (orbital 45 years, palpebral 44 years; p = 0.63). In contrast, there is a very highly significant difference in estimated tumor volumes, with the mean for orbital lobe pleomorphic adenomas being 5.4 ml (median, 4.9 ml; range, 1.5-13.6) and that for palpebral being 0.91 ml (median, 0.7 5 ml; range 0.11-3.61) (p = 1.42 × 10-25). As expected, excised palpebral adenomas-readily palpable in the eyelid-are very much smaller than orbital lobe tumors, that tend to be impalpable. If pleomorphic adenomas in the 2 locations were biologically identical, they should arise at the same time and have similar growth rates-which would mean that orbital pleomorphic adenomas ([PAs] being, on average, 6 times the size of palpebral PAs) should present several decades later. The age at presentation and age at first symptom are, however, almost identical in the 2 groups. These observations provide incontrovertible evidence that, in their biological behavior, palpebral and orbital PAs are distinct entities-either arising at different ages (with orbital tumors arising much earlier in life) or having different growth rates (palpebral PAs being slower).

Computational Modeling of Interstitial Fluid Pressure and Velocity in Head and Neck Cancer Based on Dynamic Contrast-Enhanced Magnetic Resonance Imaging: Feasibility Analysis.

We developed and tested the feasibility of computational fluid modeling (CFM) based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for quantitative estimation of interstitial fluid pressure (IFP) and velocity (IFV) in patients with head and neck (HN) cancer with locoregional lymph node metastases. Twenty-two patients with HN cancer, with 38 lymph nodes, underwent pretreatment standard MRI, including DCE-MRI, on a 3-Tesla scanner. CFM simulation was performed with the finite element method in COMSOL Multiphysics software. The model consisted of a partial differential equation (PDE) module to generate 3D parametric IFP and IFV maps, using the Darcy equation and values (min−1, estimated from the extended Tofts model) to reflect fluid influx into tissue from the capillary microvasculature. The Spearman correlation (ρ) was calculated between total tumor volumes and CFM estimates of mean tumor IFP and IFV. CFM-estimated tumor IFP and IFV mean ± standard deviation for the neck nodal metastases were 1.73 ± 0.39 (kPa) and 1.82 ± 0.9 × (10−7 m/s), respectively. High IFP estimates corresponds to very low IFV throughout the tumor core, but IFV rises rapidly near the tumor boundary where the drop in IFP is precipitous. A significant correlation was found between pretreatment total tumor volume and CFM estimates of mean tumor IFP (ρ = 0.50, P = 0.004). Future studies can validate these initial findings in larger patients with HN cancer cohorts using CFM of the tumor in concert with DCE characterization, which holds promise in radiation oncology and drug-therapy clinical trials.

Expression of Circulating Microparticles for the Diagnosis of Non-small Cell Lung Cancer: Clinicopathological Correlations and Prognostic Value

Increased values of circulating microparticles (MPs) have been reported in solid tumors including non-small cell lung cancer (NSCLC). We therefore investigated the utility of baseline MPs in the clinical setting of patients with NSCLC. Quantification of MPs in the plasma was performed by flowcytometry. Baseline MP values were correlated with clinical patients' characteristics, estimated tumor volume (ETV) and treatment response. Receiver operating characteristics (ROC) curves were plotted to discriminate between patients and controls in order to determine the diagnostic value of circulating MPs in NSCLC. Our prospective study included 134 NSCLC patients (98 at initial diagnosis, ID and 36 at relapse, R) and 30 healthy individuals. The mean of baseline MP numbers was significantly higher in patients presented either at ID or R than in controls (p<0.0001). Basal MP numbers were inversely correlated with ETV values (p=0.04). In addition, the difference in MP levels at diagnosis was significant according to tumor histology (p=0.02) and primary tumor size (p=0.0007). Using ROC analysis, the optimal cutoff value for baseline MPs was 1307 events/µL with a sensitivity and a specificity of 67.3% and 90.0%, respectively. High MPs expression was significantly associated with low-level smoking degree (p=0.001), non-squamous cell types (p=0.017) and decreased tumor size (p=0.003). Our results suggest that high baseline MP values could be an indicator of tumor growth inhibition in NSSLC. Furthermore, high expression of circulating MPs at diagnosis might predict good prognosis in NSCLC patients.

Manual prostate cancer segmentation in MRI: interreader agreement and volumetric correlation with transperineal template core needle biopsy.

To assess interreader agreement of manual prostate cancer lesion segmentation on multiparametric MR images (mpMRI). The secondary aim was to compare tumor volume estimates between MRI segmentation and transperineal template saturation core needle biopsy (TTSB). We retrospectively reviewed patients who had undergone mpMRI of the prostate at our institution and who had received TTSB within 190days of the examination. Seventy-eight cancer lesions with Gleason score of at least 3 + 4 = 7 were manually segmented in T2-weighted images by 3 radiologists and 1 medical student. Twenty lesions were also segmented in apparent diffusion coefficient (ADC) and dynamic contrast enhanced (DCE) series. First, 20 volumetric similarity scores were computed to quantify interreader agreement. Second, manually segmented cancer lesion volumes were compared with TTSB-derived estimates by Bland-Altman analysis and Wilcoxon testing. Interreader agreement across all readers was only moderate with mean T2 Dice score of 0.57 (95%CI 0.39-0.70), volumetric similarity coefficient of 0.74 (0.48-0.89), and Hausdorff distance of 5.23mm (3.17-9.32mm). Discrepancy of volume estimate between MRI and TTSB was increasing with tumor size. Discrepancy was significantly different between tumors with a Gleason score 3 + 4 vs. higher grade tumors (0.66ml vs. 0.78ml; p = 0.007). There were no significant differences between T2, ADC, and DCE segmentations. We found at best moderate interreader agreement of manual prostate cancer segmentation in mpMRI. Additionally, our study suggests a systematic discrepancy between the tumor volume estimate by MRI segmentation and TTSB core length, especially for large and high-grade tumors. • Manual prostate cancer segmentation in mpMRI shows moderate interreader agreement. • There are no significant differences between T2, ADC, and DCE segmentation agreements. • There is a systematic difference between volume estimates derived from biopsy and MRI.

MP80-19 IS RENAL VOLUME AND FUNCTION COMPROMISED IN ONCOCYTOMA PATIENTS ON ACTIVE SURVEILLANCE?

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III (MP80)1 Apr 2020MP80-19 IS RENAL VOLUME AND FUNCTION COMPROMISED IN ONCOCYTOMA PATIENTS ON ACTIVE SURVEILLANCE? Amandip Cheema*, Arun Menon, Tashionna White, Gaybrielle James, and Eric Kauffman Amandip Cheema*Amandip Cheema* More articles by this author , Arun MenonArun Menon More articles by this author , Tashionna WhiteTashionna White More articles by this author , Gaybrielle JamesGaybrielle James More articles by this author , and Eric KauffmanEric Kauffman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000972.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The oncologic safety of active surveillance in renal oncocytoma is well reported. However concern remains at the hypothetical possibility of renal functional deterioration due to mechanical effects of an enlarging tumor on normal renal parenchyma. Here we tested this hypothesis by evaluating renal functional outcomes of oncocytoma tumors on AS, including 3-dimension (3-D) imaging software to measure ipsilateral renal parenchymal volumetric changes in patients with large and/or actively growing oncocytoma tumors. METHODS: A renal tumor AS database at Roswell Park Comprehensive Cancer Center was queried to identify all renal oncocytoma patients with at least 18 months follow up on AS. Renal functional outcomes (Cr, GFR) were retrospectively reviewed to determine changes during AS. Tumor volume was calculated using the formula 0.5362*x*y*z when 3 dimensions were available and 0.5362*x*y*(x+y/2) when two dimensions were available. Oncocytoma patients with an estimated volume increase on AS of at least 10 cm3 were selected for automated 3-D volumetric assessment of the tumor and ipsilateral renal parenchyma using CT images with Myrian ® software. Ipsilateral renal parenchymal volume and tumor volume were compared between first and last available CT images. RESULTS: Among a total of 32 oncocytoma patients on AS, 22 with at least 18 months follow up were identified (median 33, mean 37.5, range 19-95 months). Median (mean) estimated tumor volume for these 22 patients was 8.5 cm3 (27.3 cm3) at AS initiation compared to 16.8 cm3 (42.73 cm3) at last follow up. Median (mean) Cr and GFR for these 22 patients was 1.02 mg/dl and 70.9 ml/min/1.73m2 (1.0 and 68.6) at AS initiation compared to 0.89 mg/dl and 79.5 ml/min/1.73m2 (0.9 and 74.2) at last follow up. A total of 9 patients were identified with estimated volume increase of at least 10 cc on AS, most of whom had tumor size >5 cm at last follow up. Tumor volumes calculated for these 9 patients using 3-D imaging software (range 11.3-222) correlated well with estimated tumor volumes (range 9.2-232). The median change in 3-D tumor volume on AS was 26.1 cm3 (mean 40.5, range 12.2-108), while the median change in normal renal parenchymal volume was 4.0 cm3 (mean -1.6, range -35-23). 6/9 (67%) tumors had minimal-to-no decrease (10 cm3 or more) in 3-D renal parenchymal volume on AS. CONCLUSIONS: Loss of renal parenchyma and function may be uncommon in oncocytoma patients regardless of tumor growth and size. This result supports the renal functional safety of AS for oncocytoma, however larger studies with longer follow up and larger tumor volume increases are needed. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1233-e1234 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amandip Cheema* More articles by this author Arun Menon More articles by this author Tashionna White More articles by this author Gaybrielle James More articles by this author Eric Kauffman More articles by this author Expand All Advertisement PDF downloadLoading ...