Evaluation Of Distant Metastases Research Articles

Risk factors, prognostic factors, and nomograms for distant metastasis in patients with diagnosed duodenal cancer: A population-based study.

Duodenal cancer is one of the most common subtypes of small intestinal cancer, and distant metastasis (DM) in this type of cancer still leads to poor prognosis. Although nomograms have recently been used in tumor areas, no studies have focused on the diagnostic and prognostic evaluation of DM in patients with primary duodenal cancer. To develop and evaluate nomograms for predicting the risk of DM and personalized prognosis in patients with duodenal cancer. Data on duodenal cancer patients diagnosed between 2010 and 2019 were extracted from the Surveillance, Epidemiology, and End Results database. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for DM in patients with duodenal cancer, and univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors in duodenal cancer patients with DM. Two novel nomograms were established, and the results were evaluated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). A total of 2603 patients with duodenal cancer were included, of whom 457 cases (17.56%) had DM at the time of diagnosis. Logistic analysis revealed independent risk factors for DM in duodenal cancer patients, including gender, grade, tumor size, T stage, and N stage (P < 0.05). Univariate and multivariate COX analyses further identified independent prognostic factors for duodenal cancer patients with DM, including age, histological type, T stage, tumor grade, tumor size, bone metastasis, chemotherapy, and surgery (P < 0.05). The accuracy of the nomograms was validated in the training set, validation set, and expanded testing set using ROC curves, calibration curves, and DCA curves. The results of Kaplan-Meier survival curves (P < 0.001) indicated that both nomograms accurately predicted the occurrence and prognosis of DM in patients with duodenal cancer. The two nomograms are expected as effective tools for predicting DM risk in duodenal cancer patients and offering personalized prognosis predictions for those with DM, potentially enhancing clinical decision-making.

Risk factors for distant metastasis of chondrosarcoma: A population-based study.

Chondrosarcoma is the second largest bone malignancy after osteosarcoma and mainly affects middle-aged adults, where patients with distant metastasis (DM) often have a poor prognosis. Although nomograms have been widely used to predict distant tumor metastases, there is a lack of large-scale data studies for the diagnostic evaluation of DM in chondrosarcoma. Data on patients diagnosed with chondrosarcoma from 2004 to 2015 were obtained from the Surveillance, Epidemiology, and End Results database. Independent risk factors for having DM from chondrosarcoma were screened using univariate and multivariate logistics regression analysis. A nomogram was created to predict the probability of DM from the screened independent risk factors. The nomogram was then validated using receiver operating characteristic curves and calibration curves. A total of 1870 chondrosarcoma patients were included in the study after data screening, of which 157 patients (8.40%) had DM at the time of diagnosis. Univariate and multivariate logistic regression analysis screened four independent risk factors, including grade, tumor number, T stage, and N stage. receiver operating characteristic curves and calibration curves showed good accuracy of the nomogram in both training and validation sets. The current study screened for independent risk factors for DM from chondrosarcoma, which will help clinicians evaluate patients.

Papillary thyroid microcarcinoma with multiple pulmonary metastases following lung cancer surgery: a case report.

Distant metastasis is extremely rare for papillary thyroid microcarcinoma (PTMC) without lymph node metastasis or extrathyroidal extension, for which active surveillance (AS) is indicated. The evaluation of distant metastases in low-risk PTMC is controversial. A case of PTMC in which AS would have been performed if chest CT and lung surgery had not been performed is reported. The patient was a 71-year-old woman undergoing follow-up in the Department of Thoracic Surgery at our hospital for multiple frosted glass shadows in both lung fields for one and a half years. To make a definitive diagnosis, thoracoscopic right middle lobectomy and left upper partial lobectomy were performed 4 and 6months earlier, respectively. In both resected specimens, lung adenocarcinoma and small metastasis of papillary thyroid carcinoma (PTC) were found. The patient was transferred to our department for a thorough examination for PTC. Ultrasonography was performed to search for the primary lesion, and it showed an irregular hypoechoic mass of 4mm and 6mm in the middle of the right lobe of the thyroid gland. The patient was diagnosed with PTC. Its clinical stage was T1a (m) N0 M1 (stage IVC). Total thyroidectomy and prophylactic central node dissection were performed. The pathological diagnosis was PTC (typical type) pT1a (m) N0. Postoperatively, she received radioactive iodine therapy. We experienced an extremely rare case and struggled to determine a treatment plan. We might be aware that lung metastases could develop in low-risk PTMC.

The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in oral squamous cell carcinoma: A systematic review

Objective: The aim of this study was to systematically review the literature to assess the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in oral squamous cell carcinoma (OSCC). Materials and Methods: The literature was searched using MEDLINE and ScienceDirect databases. Studies comparing fusion imaging PET/CT with other imaging modalities in the staging, identifying secondary metastasis, treatment response assessment, and follow-up of OSCC, were deemed eligible. Results: Six studies met the inclusion criteria. The average mean was found to be 85.47%, 78.80%, 78.50%, and 89.22% for sensitivity, specificity, positive predictive value (PPV), and negative predictive value, respectively. The risk of bias graph shows that there was 50% low risk of bias in selection of patients, more than 25% low risk of bias in conduct/interpretation of the index test, and > 25% risk of bias in reference standard. 18F-FDG PET/CT is a good prognostic factor for overall and progression-free survival. Conclusion: FDG PET/CT has a good diagnostic accuracy for identifying metastatic nodes, especially subcentimeter metastatic nodes that appear morphologically normal on CT images. PET/CT is promising in the diagnosis and evaluation of distant metastases and for identifying unknown and second primary malignancies. Advances in Knowledge: Fusion imaging is gaining importance with its ability to identify tumor as small as 0.5 mm and provide early diagnosis, thereby increasing quality of life of patients. PET/CT provides valuable information for therapeutic planning, therapeutic assessment, follow-up, and surveillance in the care of patients with OSCC.

Risk Factors, Prognostic Factors, and Nomograms for Distant Metastasis in Patients With Newly Diagnosed Osteosarcoma: A Population-Based Study.

BackgroundOsteosarcoma is the most common bone cancer, mainly occurring in children and adolescents, among which distant metastasis (DM) still leads to a poor prognosis. Although nomogram has recently been used in tumor areas, there are no studies focused on diagnostic and prognostic evaluation of DM in primary osteosarcoma patients.MethodsThe data of osteosarcoma patients diagnosed between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for DM in osteosarcoma patients, and univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors of osteosarcoma patients with DM. We then established two novel nomograms and the results were evaluated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).ResultA total of 1,657 patients with osteosarcoma were included, and 267 patients (16.11%) had DM at the time of diagnosis. The independent risk factors for DM in patients with osteosarcoma include age, grade, T stage, and N stage. The independent prognostic factors for osteosarcoma patients with DM are age, chemotherapy and surgery. The results of ROC curves, calibration, DCA, and Kaplan–Meier (K-M) survival curves in the training, validation, and expanded testing sets, confirmed that two nomograms can precisely predict occurrence and prognosis of DM in osteosarcoma patients.ConclusionTwo nomograms are expected to be effective tools for predicting the risk of DM for osteosarcoma patients and personalized prognosis prediction for patients with DM, which may benefit clinical decision-making.

The Role of Contrast-Enhanced Imaging for Colorectal Cancer Management

Imaging is fundamental in the management of colorectal cancer (CRC). Contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance (CEMR) are the imaging modalities recommended to stage and restage CRC. The aim of this review is to summarize the most relevant studies published on the role of contrast-enhanced imaging for the management of CRC. There are published data demonstrating the accuracy of CECT and CEMR for local staging of both colon and rectal cancer, as well as for the evaluation of distant metastases. Moreover, different aspects of these methods, in particular perfusion techniques, are emerging as prognostic biomarkers. The optimization of contrast media injection protocols is essential to ensure reproducibility and high image quality. Contrast-enhanced imaging is mandatory in the management of CRC both for the evaluation of the primary tumor and of distant metastases.

Abstract P5-02-03: Incidental radiographic findings at the time of breast cancer diagnosis

Abstract Background: Perioperative staging imaging to evaluate for distant metastases is frequently performed in patients with newly diagnosed breast cancer, despite clinical guidelines recommending against their routine use in stage I and II disease. In addition, recent technological advances in imaging have led to increased sensitivity for findings, many of which are unrelated to breast cancer. We assessed whether the presence of incidental findings on staging imaging is associated with a higher risk of breast cancer recurrence. Patients and Methods: A retrospective review of staging imaging for distant metastases was performed in 340 patients with stage II or III invasive breast cancer diagnosed in 2008-2009 at a large academic medical center. Data related to patient demographics, pathology, treatment, and recurrence were abstracted from the electronic medical record. Kaplan Meier curves and Cox proportional hazards models were used to assess the association between the presence of incidental findings and time to disease recurrence. Results: A total of 169 of 340 patients (49.7%) underwent staging evaluation for distant metastases (CT chest, CT abdomen/pelvis, bone scan, and/or PET-CT). Of these, 146 (86.4%) had at least one suspicious or indeterminate radiographic finding. To clarify these findings, 73 (43.2%) patients underwent follow-up imaging or procedures. Nineteen patients were diagnosed with metastatic disease, 18 of whom were initially thought to have stage III disease and one was thought to have stage II disease. In the 127 patients without definite evidence of metastatic disease who underwent staging imaging, 32 were diagnosed with disease recurrence. With median follow-up of 4.9 years, the presence of indeterminate or suspicious findings at diagnosis was not associated with a significant difference in time to disease recurrence, adjusted for stage, hormone receptor status, and HER2 status (HR 1.44, 95% CI 0.51-6.03, p=0.55). Time to Disease Recurrence by Imaging ModalityImaging Modality# With Indeterminate or Suspicious Finding(s)# Without Indeterminate or Suspicious Finding(s)Hazard Ratio95% Confidence Intervalp-valueAll Patients without mets at diagnosis127231.440.51-6.030.55CT Chest83521.890.80-4.460.15CT Abdomen/Pelvis91451.380.63-3.040.43Bone Scan351231.040.44-2.460.93 Time to Disease Recurrence by Type of Radiographic AbnormalityType of Abnormal Finding# With Indeterminate or Suspicious Finding(s)# Without Indeterminate or Suspicious Finding(s)Hazard Ratio95% Confidence Intervalp-valuePulmonary nodules70661.650.76-3.580.20Liver lesions46911.720.83-3.600.15Borderline or enlarged lymph nodes201190.570.17-1.960.37 Conclusions: Staging imaging for distant metastases frequently reveals indeterminate findings, whose presence was not associated with a significant risk of disease recurrence in this analysis. Due to low yield for the diagnosis of metastases, staging imaging should not routinely be performed in stage II breast cancer patients. Citation Format: Brothers JM, Kidwell KM, Brown RK, Henry NL. Incidental radiographic findings at the time of breast cancer diagnosis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-02-03.

3D model-based documentation with the Tumor Therapy Manager (TTM) improves TNM staging of head and neck tumor patients.

Many treatment approaches are available for head and neck cancer (HNC), leading to challenges for a multidisciplinary medical team in matching each patient with an appropriate regimen. In this effort, primary diagnostics and its reliable documentation are indispensable. A three-dimensional (3D) documentation system was developed and tested to determine its influence on interpretation of these data, especially for TNM classification. A total of 42 HNC patient data sets were available, including primary diagnostics such as panendoscopy, performed and evaluated by an experienced head and neck surgeon. In addition to the conventional panendoscopy form and report, a 3D representation was generated with the "Tumor Therapy Manager" (TTM) software. These cases were randomly re-evaluated by 11 experienced otolaryngologists from five hospitals, half with and half without the TTM data. The accuracy of tumor staging was assessed by pre-post comparison of the TNM classification. TNM staging showed no significant differences in tumor classification (T) with and without 3D from TTM. However, there was a significant decrease in standard deviation from 0.86 to 0.63 via TTM ([Formula: see text]). In nodal staging without TTM, the lymph nodes (N) were significantly underestimated with [Formula: see text] classes compared with [Formula: see text] with TTM ([Formula: see text]). Likewise, the standard deviation was reduced from 0.79 to 0.69 ([Formula: see text]). There was no influence of TTM results on the evaluation of distant metastases (M). TNM staging was more reproducible and nodal staging more accurate when 3D documentation of HNC primary data was available to experienced otolaryngologists. The more precise assessment of the tumor classification with TTM should provide improved decision-making concerning therapy, especially within the interdisciplinary tumor board.

Isolated Mediastinal Lymph Node False Positivity of [18F]-Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography in Patients With Cervical Cancer

This study aimed to evaluate the degree of mediastinal involvement in patients with cervical cancer with isolated mediastinal [F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) positivity as verified by histopathologic examination. Two hundred twenty-eight patients with newly diagnosed cervical cancer and who underwent FDG-PET imaging were analyzed. Twenty-nine patients (17%) had disseminated disease detected with PET/computed tomography (CT). Only 10 patients (4%) had increased FDG uptake in mediastinal lymph nodes alone. Of the 10 patients with mediastinal disease, 2 refused surgical mediastinal lymph node biopsy and did not receive any treatment. Patients with suspected paratracheal or subcarinal lymph node metastasis detected on PET/CT underwent mediastinoscopy, and those with hilar metastasis had video-assisted mediastinal lymphadenectomy. Treatment was delivered according to final staging based on histopathologic confirmation of mediastinal lymph node involvement. The mean (SD) maximum standardized uptake values for primary cervical tumor and mediastinal lymph nodes were 19.7 (10.3) and 7.5 (1.6), respectively. Of 8 patients who underwent mediastinal lymph node confirmation, 6 (75%) were tumor free, demonstrating granulomatous changes, and were treated curatively. No patients had residual or recurrent disease at the primary site, and all but 1 were alive without disease. Two patients with confirmed mediastinal lymph node metastasis were treated palliatively and died between 9 and 11 months after diagnosis. Positron emission tomography/CT is an important tool for lymphatic staging and evaluation of distant metastases in cervical cancer. However, PET/CT should be interpreted cautiously for isolated mediastinal involvement; surgical evaluation is required for accurate staging and appropriate treatment decisions to achieve better outcomes.

Cáncer de recto: diagnóstico, estudio y estadificación

Rectal cancer: diagnosis, study and staging Rectal cancer is defi ned as a tumour located between the anal verge and 15 cm within anal verge. In rectal cancer, a precise preoperative staging allows to categorize patients for different available treatments, as well as decide the best surgical treatment. Preoperative staging is performed by several radiological tech- niques. Currently available procedures are endorectal ultrasound (EUS), computed tomography (CT) mag- netic resonance (MRI), positron emission tomography-computed tomography (PET/CT) and intraoperative ultrasound. EUS is a procedure performed by the colorrectal surgeon that allows the evaluation of the depth of tumour invasion as well as lymph node status; nevertheless its main shortcoming is the inability to assess mesorectal fascia involvement. Nowadays, MRI is the best method to assess mesorectal fascia involvement in addition to tumour invasion and lymph nodes involved. CT is a widely available procedure, and its main use is evaluation of distant metastases, with lower accuracy to assess tumour invasion and lymph node status. PET/CT is currently gaining importance, however its role in preoperative staging it's not widely accepted. IOUS allows evaluation of liver metastases during surgery, and therefore determines management and prog- nosis. Consequently, is necessary for surgeons to maintain an up-to-date knowledge of current methods, its advantages and limitations.

Is There a Role for Positron Emission Tomography in Breast Cancer Staging?

Positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (FDG) is a radiotracer imaging method that is used in the care of patients with cancer. We conducted a nonsystematic review of the literature regarding the applicability of this technique in patients with breast cancer, encompassing the impact of FDG-PET on surgical management, including axillary node staging and sentinel lymph node biopsy; the use of FDG-PET in the evaluation of the primary tumor; the role of FDG-PET in the evaluation of distant metastases both at diagnosis and in the investigation of suspected recurrence; and the ability of FDG-PET to predict treatment response. FDG-PET is not sufficiently sensitive to replace histologic surgical staging of the axilla. Although FDG avidity of the primary tumor has been shown to be an unfavorable indicator, there is insufficient information to recommend its routine use for this indication. FDG-PET is more sensitive than conventional imaging in the detection of metastatic or recurrent disease, but the impact of increased sensitivity on patient care and outcome has not been demonstrated. The data regarding prediction of treatment response are insufficient to reach any conclusion. There are a number of prospective, adequately powered clinical trials currently in progress that should provide more definitive answers regarding the role, if any, of this technique in the management of patients with breast cancer.

Synchronous liver metastases of intracystic papillary carcinoma with invasion of the breast

A rare case of intracystic papillary carcinoma (IPC) with invasion had synchronous metastases to the liver at presentation. A 57-year-old postmenopausal woman noticed a right breast tumor 7 months prior to admission. Mammography showed an oval mass measuring 3.1 cm in diameter with no calcification, and ultrasonography showed an intracystic tumor with a papillary growth pattern. Fine-needle aspiration cytology revealed adenocarcinoma. Excisional biopsy revealed intracystic solid papillary carcinoma with invasion. The tumor was a clear-cell type with extracellular mucin. Two months after the initial biopsy, a screening ultrasonographic examination of the liver showed multiple hyperechoic masses. Abdominal contrast-enhanced CT scan and magnetic resonance imaging (MRI) showed multiple hypervascular masses compatible with metastatic tumors. No suspicious lesions were detected on examinations for malignancy in other organs. Distant metastases in cases of IPC with invasion are very rare. The potential of distant metastasis in IPC with invasion and the difficulty of evaluating invasive foci should be recognized. Careful evaluation of distant metastases is recommended.

Fluorine-18 FDG-PET in Detecting Local Recurrence and Distant Metastases in Breast Cancer—Taiwanese Experiences

Fluorine-18 fluorodeonyglucose positron emission tomography (FDG-PET) was used to detect local recurrence, axillary lymph node (LN) involvement and distant metastases in patients with breast cancer. Thirty-six female patients with breast cancer s/p operation underwent FDG-PET studies. Findings were confirmed by histology following surgery and/or biopsy or negative follow-up results over a period of at least one year. In the evaluation of local recurrence, the diagnostic sensitivity, specificity, and accuracy of FDG-PET was 100, 96.8, and 97.2%, respectively. In the evaluation of axillary LN involvement, sensitivity, specificity, and accuracy was 80, 100, and 97.2%, respectively. In the evaluation of distant metastases, the diagnostic sensitivity, specificity, and accuracy was 83.3, 85.2, and 84.4%, respectively. The FDG-PET is a useful diagnostic tool in detecting local recurrence, axillary LN involvement, and distant metastasis.

Detection of metastases from head and neck cancers.

Before treatment for head and neck malignancies is begun, a search for distant metastases (DM) is performed. The first objective of this review was to determine the accuracy of liver function tests (LFT), alkaline phosphatase (AP) tests, and chest radiographs (CXR) in detection of DM. Second, an effort was made to identify tumor characteristics which are associated with a higher incidence of DM and therefore justify the use of more precise screening tools. An analysis of 97 patients with noncutaneous squamous cell carcinomas presenting to the Stanford Head and Neck Tumor Board in 1991 revealed 17 DM in 14 patients. There were 10 pulmonary metastases, 5 bone metastases, and 2 hepatic metastases. CXR had a sensitivity of 50% and a specificity of 94% for detection of pulmonary DM. AP tests showed a sensitivity of 20% and a specificity of 98% for detection of bone DM. LFT had a sensitivity of 50% and an 81% specificity for demonstration of hepatic DM. A separate analysis of 79 patients with known DM from two hospitals showed the incidence of DM to be increased in patients who had tumors of advanced stage, advanced T status, and poor histologic differentiation and to also be increased in the presence of local-regional recurrence. There was little association of DM with N status. The sensitivity of CXR and laboratory tests, which are currently used in evaluation for DM at most cancer centers, is disappointing; these tests should be viewed as gross screening examinations. We recommend a chest computed tomography scan in the event of an abnormal CXR, a bone scan in the event of an elevated AP, and either an ultrasound or computed tomography/magnetic resonance imaging scan of the liver when elevated LFT levels are present, depending on tumor stage and differentiation.

Scintigraphic Evaluation of Patients with Lung Carcinoma

Patients with lung carcinoma can benefit in several ways from radionuclide studies (Table 1). The major role of the studies is to detect the presence or extent of the primary disease, but newer applications also are having an impact on determinations of prognosis and evaluation of therapy. The various scintigraphic approaches include direct evaluation of pulmonary ventilation and perfusion via the lung scan; evaluation of metastatic disease and opportunistic infections by gallium citrate (67Ga) scintigraphy; evaluation for distant metastases by liver, bone, brain, or other organ scans; and additional applications, such as localization of hemoptysis by technetium 99m (99mTc) red blood cell lung imaging or evaluation of cardiac function by gated blood pool studies in patients receiving certain types of cardiotoxic chemotherapy.