Extent Of Tumor Invasion Research Articles

Diagnostic Values of Ki67, Cox2, CD31, E-cadherin, VEGF, MMP2, and MMP9 Protein Expression in Human Melanoma

Background: Cutaneous melanoma, the most severe form of skin cancer, has an unpredictable behavior and a high mortality rate. Recent research has identified new biomarkers and their associations with certain histopathological features, offering essential insights into diagnosis, prognosis, and therapeutic strategies. Material and method: In this meticulously designed and executed study, we analyzed 85 formalin-fixed, paraffin-embedded (FFPE) tissue samples using the gold standard technique of immunohistochemistry (IHC) to characterize the protein expression profiles. We used a comprehensive panel of Ki67, Cox2, CD31, VEGF, MMP2, MMP9, and E-cadherin antibodies. Clinical stages were meticulously determined according to TNM classification, the thickness of the Breslow depth, and Clark levels. We employed robust statistical methods such as one-way ANOVA and curve estimation regression to analyze the data. The STRING database, a trusted resource, was used to identify protein-protein interactions and related pathways. Results: The results of our study unveiled novel pairwise positive correlations between CD31 and Ki67 (r = 0.72), and between VEGF and Ki67 protein expression (r = 0.63). We also found a significant inverse relationship between the expression of E-cadherin and some biomarkers, such as Ki67, CD31, and VEGF (p < 0.001 for all). Additionally, our findings revealed a strong positive association between the extent of tumor invasion and the expression levels of Ki67, CD31, and VEGF. The overexpression of these proteins was significantly correlated with advanced clinical stages (p < 0.001 for all). Conclusion: Our study suggests that the biomarkers we examined could be reliable potential diagnostic and prognostic biomarkers for cutaneous melanoma. These findings have the potential to significantly impact the diagnosis, prognosis, and treatment of this deadly disease, offering new avenues for improved patient care.

Clinical features and surgical treatment of right cardiac system tumors

A total of 25 patients with right cardiac system tumors in the Department of Cardiac Surgery, Beijing Anzhen Hospital from January 2012 to October 2022 were retrospectively included in the study. The preoperative data, and information of surgical treatment and perioperative management on these patients were analyzed and summarized. One patient developed pulmonary embolism and died before surgery, and the other 24 patients (16 males and 8 females) received surgical treatment, with an average age of (44.7±10.2) years (24-74 years). Nine patients were diagnosed with malignant tumors. Among the 24 patients who received surgical treatment, two patients died during the perioperative period, in-situ tumor recurrence was seen in three patients within about 1 year after surgery (two patients died without surgery, and one patient died 3 months after surgery), two patients had distant metastasis, and 17 patients had a good prognosis. Right cardiac system tumors are rare, with a high malignant rate, and the clinical manifestations vary greatly. Active surgical intervention is found to be effective, and the prognosis is closely related to the pathological type and extent of tumor invasion.

Optimization of the complex treatment of patients with locally disseminated malignant thyroid tumors with invasion or compression of the upper respiratory tract

In recent years, the number of widespread malignant tumors of the thyroid gland with invasion or compression of the upper respiratory tract, most often with medium to low histological differentiation, has been increasing rapidly, which worsens the prognosis for the recovery of patients. The most important prognostic factors in the case of widespread malignant tumors of the thyroid gland are histological differentiation and the extent of tumor invasion. The urgency of the issue of comprehensive treatment of patients with locally disseminated malignant thyroid tumors is due to the lack of a single tactic, the choice of the scope of surgical interventions and resections of the upper respiratory tract is not defined.
 Objective — to determine medical and surgical tactics for improving the complex treatment of patients with locally disseminated malignant thyroid tumors with invasion and compression of the upper respiratory tract (URT), depending on the degree of spread and histological structure of the tumor.
 Materials and methods. In total, 2,300 patients with malignant tumors of the thyroid gland have been treated. The experimental group included 165 patients (7.2%) with T4a‑b category locally disseminated malignant thyroid tumors. The clinical and morphological characteristics of the patients in the general and experimental groups were analyzed and compared. The patients of experimental group demonstrated lower morphological differentiation of tumors, significantly higher number of regional and distant metastases, older patients’ age, that worsened the prognosis for recovery, and prevalence of men over women.
 Results. Most often, the tumor was disseminated in the URT, 55 patients had signs of URT stenosis of the I—III degree. Urgent tracheotomy was performed in 9 patients with pronounced stenosis of the III degree, which turned out to be very difficult, and 3 patients died during the operation or in the early postoperative period. In the case of initially inoperable T4b tumors, we performed neoadjuvant antitumor chemotherapy, the resulting tumor regression allowed for radical surgery in most patients. Various resections of the latter with the application of a tracheostomy or primary anastomosis were performed in patients with invasion of the upper respiratory tract. The effectiveness of various methods was analyzed depending on the prevalence of invasion and morphological differentiation of the tumor. In the experimental group of radically operated patients, the mortality rate was 31.0%, the recurrence rate was 39.3%.
 Conclusions. The prognosis for recovery in the group of locally disseminated malignant thyroid tumors is worse due to the lower morphological differentiation of tumors, older age of patients, and a greater number of regional and distant metastases. In case of URT stenosis, it is advisable to prepare the patient for radical surgery with intraoperative placement of a tracheostomy. In the case of an initially inoperable tumor, it is advisable to carry out neoadjuvant polychemotherapy. Surgical treatment of locally disseminated malignant thyroid tumors should be as radical, «aggressive» as possible, and the choice of the method of resection of the upper respiratory tract depends on the prevalence of invasion and the degree of differentiation of the tumor, and must comply with oncological principles.

Stereotactic DOTATATE Positron Emission Tomography/Computed Tomography–Guided Resection of a Multiply Recurrent World Health Organization Grade 2 Parasagittal Meningioma: A Technical Case Report

BACKGROUND AND IMPORTANCE: Resection of parasagittal meningiomas is challenging due to venous and superior sagittal sinus involvement. Recurrent tumors can be particularly challenging given scar tissue from prior surgery and radiation, which can be difficult to differentiate from active tumor on preoperative MRI. Cu-64-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-octreotate (DOTATATE) is a somatostatin receptor (SSTR) ligand detectable on positron emission tomography (PET) imaging. SSTR is expressed by most meningiomas. While DOTATATE-PET has been investigated for radiotherapy planning, its use in guiding oncological meningioma resection is understudied. Here, we present a case example demonstrating its use in guiding surgical planning and maximizing the extent of resection. CLINICAL PRESENTATION: A 45-year-old man with a World Health Organization grade 2 bilateral parasagittal meningioma presented with recurrence after 2 prior resections, wound infection and washout, and fractionated radiotherapy with boost to residual disease. Preoperative angiography demonstrated an occluded sagittal sinus beyond the extent of the residual tumor. Stereotactic DOTATATE PET-computed tomography (CT) imaging was integrated with the neuro-navigation and used intraoperatively to identify extent of active tumor, differentiating it from scar tissue and gliosis. This was used to facilitate oncological tumor resection with negative pathological margins that correlated with the absence of DOTATATE signal. CONCLUSION: Stereotactic DOTATATE PET-CT is a valuable addition to the neurosurgeon's toolkit, particularly when integrated into the neuro-navigation, for achieving complete resections of recurrent meningiomas, or meningiomas where the extent of tumor invasion can be challenging to define on preoperative MRI.

The Extent of Tumor Invasion and Therapeutic Embolization Are Associated with Recurrent Hemorrhage in Patients with External Carotid Artery Blowout Syndrome

PurposeTo explore the optimal strategies of therapeutic embolization for patients with carotid blowout syndrome in the external carotid artery (ECA), who may also present with arterial tumor invasion or necrosis extending to the internal carotid artery (ICA) or common carotid artery (CCA). Materials and MethodsThe study included 110 patients with ECA blowout between 2005 and 2022. Antecedent cross-sectional imaging features were examined, including tumor size, extent of arterial invasion, and air-containing necrosis. Patients were divided into Groups 1 (n = 53, simultaneous ICA/CCA invasion + ECA therapeutic embolization), 2 (n = 18, simultaneous ICA/CCA invasion + ECA-ICA/CCA therapeutic embolization), and 3 (n = 39, no ICA/CCA invasion + ECA therapeutic embolization). Kaplan-Meier and multivariable Cox regression analyses were performed to evaluate associations of clinical, imaging, and therapeutic embolization characteristics with recurrent bleeding. ResultsMultivariable Cox regression revealed that Group 1 was independently associated with a higher risk of recurrent bleeding than that in Group 2 (adjusted hazard ratio, 6.3; 95% CI, 1.7‒23.4; P = .005) and Group 3 (adjusted hazard ratio, 3.8; 95% CI, 1.8‒8.3; P = .001). In the subgroup with simultaneous ICA/CCA invasion, air-containing necrosis around the ICA/CCA was independently associated with recurrent bleeding after therapeutic embolization of the ECA (adjusted hazard ratio, 5.0; 95% CI, 1.8‒13.6; P = .002). ConclusionsIn patients with ECA blowout treated with therapeutic embolization, there was a lower risk of recurrent bleeding when the extents of arterial invasion and therapeutic embolization were concordant. Air-containing necrosis around the ICA/CCA was associated with recurrent bleeding, so extensive therapeutic embolization to the ICA/CCA should be evaluated in such patients.

DIPG-38. PATIENT-DERIVED THREE-DIMENSIONAL AVATARS REVEAL CELL-AUTONOMOUS MECHANISMS DRIVING INVASION AND METASTATIC PROGRESSION IN DIFFUSE MIDLINE GLIOMAS

Abstract Diffuse midline gliomas H3K27-altered are pediatric tumors associated with dismal survival after diagnosis that are characterized by their ability to infiltrate the entire central nervous system. We show that the extent of tumor invasion and metastatic progression represent critical adverse prognostic factors affecting the survival of DMG patients. Yet, no genetic alterations associate to the tumor progression patterns. We therefore used glioma stem cells collected at diagnosis to create patient-specific 3D avatars. We found that their invasive behaviour faithfully predicts metastatic relapse in patients, thus proving DMG spread is mainly an autonomous ability of tumor cells. This relevant modelling strategy revealed the existence of phenotypic entities associated with distinct migration modalities and capacities. Using transcriptomics of both organoids and primary tumors, we identified the biological programs associated with variable invasiveness. Importantly, we show that Bone Morphogenetic Protein 7 (BMP7) signalling is a crucial tumour-autonomous regulator of DMG invasiveness via the control of a phenotypic switch. We further deciphered effectors downstream of BMP7 stimulation as actionable targets to reduce invasion. These findings have two possible therapeutic applications. First, glioma stem cell 3D models represent a tool for tumor phenotypic stratification to rapidly predict patients with exacerbated invasiveness and increased risk of metastatic progression. This may allow to propose whole-brain or cranio-spinal irradiation within weeks after diagnosis to prevent the appearance of distant foci. Second, targeting autocrine and short-range BMP7-related signalling may become a useful adjunct to the current therapeutics, which are mainly directed to control the disease locally.

Buccinator muscle invasion is a risk factor for cervical lymph node metastasis in squamous cell carcinoma of the buccal mucosa: A retrospective study.

The present study aimed to determine the risk factors associated with cervical lymph node metastasis (CLNM) in patients with buccal mucosa squamous cell carcinoma (BMSCC). This retrospective study included patients with primary BMSCC who underwent surgery at the Department of Oral and Maxillofacial Surgical Oncology of Tokyo Medical and Dental University (Tokyo, Japan) between January 2008 and December 2017. The following data were collected and analyzed: Sex, age, primary lesion subsite, tumor/node/metastasis stage, clinical growth patterns, tumor differentiation, lymphovascular and perineural invasion, mode of invasion, pathological depth of invasion, extent of tumor invasion, and clinical outcome of patients with BMSCC. Multivariate analysis was performed to identify the possible risk factors for CLNM. A total of 75 patients were included in the present study, among whom 30 (40%) were found to have histological CLNM. Of the 33 patients with buccinator muscle infiltration by the tumor, 24 (72.7%) had CLNM. Multiple logistic regression analysis revealed that buccinator muscle invasion was the most significant predictive risk factor for CLNM in BMSCC. The present study found that tumor invasion of the buccinator muscle was the most significant predictive risk factor for CLNM in BMSCC. Therefore, elective neck dissection should be performed if buccinator muscle invasion is identified in patients with BMSCC.

Clinical effect of high-flow revascularization in microsurgery combined with endoscopic endonasal surgery for skull base tumors with intracranial and extracranial involvement.

The objective of the study is to investigate the surgical methods and clinical effects of high-flow revascularization in microsurgery combined with endoscopic endonasal surgery for skull base tumors with intracranial and extracranial involvement. The relationships between skull base tumors and internal carotid artery (ICA), tumor location and size, and the extent of tumor invasion were assessed. Preoperative CT perfusion (CTP), magnetic resonance (MR) perfusion-weighted imaging (PWI) (MR-PWI), and digital subtraction angiography (DSA) were performed to evaluate collateral circulation and brain tissue perfusion. Then craniotomy through the fronto-orbitozygomatic approach was performed, based on which four cases received extended middle skull base approach+Dolenc approach + Fukushima bypass type I, and six cases received extended middle skull base approach+Fukushima bypass type III. After surgery, DSA, CT angiogram (CTA), and CTP/PWI were performed to evaluate the patency of the reconstructed vessels and cerebral perfusion, and contrast-enhanced MRI to evaluate the degree of tumor resection. All patients were followed up for 6-12months. Among the 10 cases investigated, gross total resection was achieved in 8 cases, subtotal resection in 1 case, and partial resection in 1 case, as confirmed by CT and enhanced MRI. The patency of revascularization vessels was observed using fluorescein angiography during the operation in all patients and via DSA and CTA postoperatively in nine patients. One patient underwent ventilator-assisted ventilation because of respiratory failure and failed to undergo DSA and CTA. Regarding postoperative complications, one patient developed watershed cerebral infarction on the operated side but no sequelae after drug treatment, three patients developed facial numbness, which improved after 3months, and two patients experienced worsened diplopia. After 6 to 12months of follow-up on the nine evaluable patients, the Glasgow Outcome Scale (GOS) was 4-5 after surgery. In addition, 6-month follow-up results showed that one patient with clival chondrosarcoma developed recurrence on contrast-enhanced MRI, while no relapse was observed in the other patients. For skull base tumors with intracranial and extracranial invasion and involving the ICA, revascularization might improve the total resection rate and reduce the recurrence rate and risk of intraoperative bleeding and postoperative ischemia.

U-Net Modelling-Based Imaging MAP Score for Tl Stage Nephrectomy: An Exploratory Study.

We evaluate the stability of the clinical application of the MAP scoring system based on anatomical features of renal tumour images, explore the relevance of this scoring system to the choice of surgical procedure for patients with limited renal tumours, and investigate the effectiveness of automated segmentation and reconstruction 3D models of renal tumour images based on U-net for interpretative cognitive navigation during laparoscopy Tl stage radical renal tumour cancer surgery. A total of 5 000 kidney tumour images containing manual annotations were applied to the training set, and a stable and efficient full CNN algorithm model oriented to clinical needs was constructed to regionalism and multistructure and to finely automate segmentation of kidney tumour images, output modelling information in STL format, and apply a tablet computer to intraoperatively display the Tl stage kidney tumour model for cognitive navigation. Based on a training sample of MR images from 201 patients with stage Tl renal tumour cancer, an adaptation of the classical U-net allows individual segmentation of important structures such as renal tumours and 3D visualisation to visualise the structural relationships and the extent of tumour invasion at key surgical sites. The preoperative CT and clinical data of 225 patients with limited renal tumours treated surgically at our hospital from August 2011 to August 2012 were retrospectively analysed by three imaging physicians using the MAP scoring system for the total score and the variables R (maximum diameter), E (exogenous/endogenous), N (distance from the renal sinus), A (ventral/dorsal), L (relationship along the longitudinal axis of the kidney), and h (whether in contact with the renal hilum). The score for each variable (contact with the renal hilum) was statistically compared with each other for the three observers. Patients were divided into three groups according to the total score—low, medium, and high—and according to the surgical procedure—radical and partial resection. The correlation between the total score and the score of each variable and the choice of surgical procedure was analysed. The agreement rate of the total score and the score of each variable for all three observers was over 90% (P ≤ 0.001). The map scoring system based on the anatomical features of renal tumour imaging was well stabilized, and the scores were significantly correlated with the surgical approach.

A Modified T-Stage Classification for Gastric Neuroendocrine Tumors

The eighth edition of the American Joint Committee on Cancer (AJCC) staging manual's TNM staging classification for gastric neuroendocrine tumors has been shown to have poor prognostic discriminability. The aim of present study was to propose a modified T-stage classification, and externally validate its performance in a separate population data registry. A modified T-stage classification with tumor size and extent of tumor invasion was generated from the National Cancer Database between 2004 and 2014 (n=1249). External validation was performed using the Surveillance, Epidemiology, and End Results registry between 1973 and 2013 (n=539). In the National Cancer Database population, using the AJCC T-stage classification, the 5-y survival rates were 85.7%, 80.8%, 64.5%, and 46.1% in T1, T2, T3, and T4 patients respectively (P < 0.001). These rates were more contrasting with the modified T-stage (mT) classification at 87.0%, 78.2%, 59.0%, and 40.3% respectively (P < 0.001). When patients within each of the AJCC T stages were stratified by mT stages, significant survival heterogeneity was observed within each of the AJCC T2 to T4 stages (P < 0.01). Conversely, when mT stages were stratified by AJCC T stage, no survival difference was observed in any of the mT stages (P > 0.05).The same analyses were performed using Surveillance, Epidemiology, and End Results data, and all the observed results were validated. The current AJCC T stage classification categorizes patients into groups with heterogenous prognosis, thus failing to serve as an effective staging tool. A modified T-stage classification demonstrated significantly improved stratification for patients with gastric neuroendocrine tumors.

Preoperative Staging Diagnosis of Colorectal Cancer Based on Multi-Row Spiral CT

Colorectal cancer is a common malignant tumor of digestive tract, and its incidence has increased significantly in recent years. The 5-year survival rate of patients with early local colorectal cancer is more than 90%, with local invasion of about 68%, and distant metastasis of less than 10%. Therefore, early diagnosis and early treatment is an effective means for the prevention and treatment of colorectal cancer. At present, X-ray air-barium double contrast radiography and fiberoptic endoscope are most commonly used in the examination of colorectal tumors in the world. These two methods have the advantages of simple operation, intuition and low cost. However, it is limited to judge the depth of tumor invasion, whether to break through the serosa, lymphatic metastasis, and distant metastasis. In this work, it can be confirmed that the measurement of preoperative tumor vascular volume reconstruction density is feasible in the preoperative evaluation of colorectal cancer, it will provide clinicians with more valuable information about preoperative tumor staging. Besides, multi-slice spiral CT has the advantages of less trauma, high speed, and clear image. It can not only judge the location of the tumor, the depth, and extent of tumor invasion, and show distant organ metastasis, but also has good application value in tumor staging. In this paper, the clinical data and MSCT imaging data of patients with colorectal cancer were analyzed retrospectively, and the value of MSCT in the diagnosis of colorectal cancer was discussed.

SURGICAL AND PROGNOSTIC IMPLICATIONS IN GASTRIC ADENOCARCINOMA BY THE INTEGRATION OF PROTEOMIC MOLECULAR ANALYSIS

Abstract INTRODUCTION Despite a steady decline in the incidence of gastric cancer (GC) over recent decades, the prognosis remains poor with 5-year survival rates of 21.9% in Europe. The AJCC Cancer Staging Manual (8th Edition) establishes the necessity to evaluate personalized survival models. These models would help in the decision-making process. Proteomic and genomic molecular analyses have provided a more in-depth knowledge of GC. MATERIAL AND METHODS 19 patients affected by 21 tumors operated between 2012-2014 were prospectively included. Healthy tissue and tumor samples were taken from each case and deposited in a tissue biobank for subsequent proteomic analysis by Proteomics Department. RESULTS The following histopathological types were identified: (73.69%) intestinal, (10.52%) diffuse, and (15.78%) undetermined, poorly differentiated, and mixed neuroendocrine of the classification WHO. According to the size and extent of tumor invasion, the percentages of the sample were T1 or T2 (26.31%) and T3 or T4 (73.68%). Furthermore, 57.89% of the patients were found to have lymph-node metastases (N 1, 2, 3 +). After the differences in protein intensities in healthy tissue and tumor tissue were analyzed, it was found that in the healthy tissue, EGFR1, MAPK1 and MAPK3 were predictive variables of overall survival when the tumor stage was T3 or T4 CONCLUSIONS It would be convenient to redefine the classification and treatment plan in gastric cancer by integrating the study at a molecular level.

FDG-PET for preoperative evaluation of tumor invasion in ampullary cancer: A retrospective analysis.

Tumor invasion is the most significant prognostic factor in ampullary cancer and is thus a crucial factor in decision making for treatment. Endoscopic ultrasound can be performed to evaluate tumor invasion, but its diagnostic accuracy varies depending on the endoscopist. This study aimed to assess the usefulness of fluorodeoxyglucose positron emission tomography (FDG-PET) for preoperatively predicting tumor invasion in ampullary cancer. We retrospectively evaluated 44 patients with ampullary cancer (adenoma, n = 6; adenocarcinoma, n = 38) who underwent surgical resection. The SUVmax of the ampullary tumor site was assessed using FDG-PET, and the correlation among tumor invasion, lymph node metastasis, and other clinicopathological factors was evaluated. The SUVmax of the ampullary tumor site gradually increased depending on the extent of tumor invasion (p = 0.0075). Moreover, the SUVmax was significantly different between ≤T1a and ≥T1b, which is an indication for endoscopic papillectomy or surgical resection (p = 0.0015). The SUVmax of the ampullary section was significantly correlated with lymph node metastasis (p = 0.035). The SUVmax of the ampullary tumor site is correlated with tumor invasion and lymph node metastasis in ampullary cancer. Thus, FDG-PET can be a useful modality for preoperative staging and treatment strategy.

Esophageal leiomyoma and simultaneous overlying squamous cell carcinoma: a case report and review of the literature

BackgroundSquamous cell carcinoma is the most common epithelial tumor of the esophagus. Upper endoscopy with multiple minimally invasive biopsies should be performed to confirm the diagnosis. Leiomyoma of esophagus is rare, but it’s the most common benign submucosal mesenchymal tumor of the esophagus. The simultaneous occurrence of an overlying epithelial lesion and a mesenchymal lesion is very rare. This study aims to show a case operated due to squamous cell carcinoma of esophagus that was postoperatively diagnosed with coexistent esophageal leiomyoma and give a clear overview of the existing literature on it.Case presentationThe patient was a 41-year-old woman who underwent three field esophagectomy (McKeown). Pathological evaluation was done, and the patient had poorly differentiated squamous cell carcinoma and multiple leiomyomas. A leiomyoma was found with an invading overlying squamous cell carcinoma.ConclusionIt is concluded that esophageal carcinomas may coexist with leiomyomas; preexisting benign tumors may have played an important role in the development of the carcinoma by inducing constant stimulation of the overlying mucosa; endoscopic ultrasonography is recommended to avoid overestimating the extent of tumor invasion and the resultant aggressive radical surgery. As the developing countries had limited equipment, esophageal resection could be the modality of choice in the treatment.

Accuracy of Computed Tomography and Magnetic Resonance Imaging for Detection of Pathologic Risk Factors in Patients Diagnosed with Retinoblastoma

ABSTRACT Aim: To assess and compare the diagnostic accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) for detecting the extent of tumor invasion in eyes with advanced retinoblastoma prior to enucleation using histopathologic analysis as a reference. Methods: A total of 56 patients (68 eyes) enucleated for retinoblastoma were reviewed. Eyes with complete data (CT 28, MRI 16) were included for analysis. Imaging data were reviewed by a pediatric radiologist, blinded to histopathology results. Four high-risk factors which included scleral, choroidal, anterior eye segment invasion, and postlaminar optic nerve invasion were assessed. Results: For CT, the diagnostic odds ratio (DOR), sensitivity, and specificity for detecting postlaminar optic nerve invasion were 1.7%, 25%, and 83.3%. Choroidal invasion was correctly identified in only 2 of 10 eyes (DOR 0.5, sensitivity 20%, specificity 66.7%). For scleral invasion, CT showed a diagnostic ratio of 1.5%, sensitivity 40%, specificity 69.6% whereas for anterior segment invasion DOR was 9.2%, sensitivity 100%, and specificity 65.4%. MRI showed a higher DOR for detecting postlaminar optic nerve invasion of 39%, sensitivity 77.8%, and specificity 100%. Choroidal and scleral invasion on MRI had a DOR of 6.5% (sensitivity 25%, specificity 100%) and 6% (sensitivity 33.3%, specificity 92.3%) respectively while DOR for anterior segment invasion was 1.3% (sensitivity 50%, specificity 57.1%). Conclusion: CT showed a poor diagnostic accuracy for all four high-risk factors in advanced retinoblastoma and therefore may not be a useful tool for assessment of tumor extension. For MRI, detection of postlaminar optic nerve invasion was moderately accurate although less accurate for detection of other risk factors. Decision-making for each child should not be based on any single parameter but rather on consideration of clinical factors in combination with radiologic findings.

Combining Images and T-Staging Information to Improve the Automatic Segmentation of Nasopharyngeal Carcinoma Tumors in MR Images

The accurate and reproducible delineation of tumors from uninvolved tissue is essential for radiation oncology. However, the tumor margin may be challenging to identify from magnetic resonance (MR) images of nasopharyngeal carcinomas (NPCs). Additionally, clinical diagnoses such as T-staging may already provide some information on tumor invasion. To use this information and improve the performance of tumor segmentation, we propose a novel deep learning neural network architecture that can incorporate both T-staging and image information. Based on U-Net, our model adds a T-channel composed of T-staging information and uses the attention mechanism. Since the T-staging information is defined by the extent of tumor invasion, the T-channel using T-staging information can improve the segmentation accuracy at different stages. Additionally, the addition of an attention mechanism allows our model to retain the most valuable pixels of the image, thus further improving the delineation accuracy. In our experiments, the proposed network was trained and validated based on records from 251 clinical patients using 10-fold cross-validation. The dice similarity coefficient (DSC) and average symmetric surface distance (ASSD) were used to evaluate our network's results. The average DSC and ASSD and their standard deviation (SD) values are 0.841 ± 0.011 and 0.747 ± 0.199 mm. The unique T-channel effectively utilizes T-staging information to improve the results. With the combination of the T-channel module and the attention module, we significantly improved NPC tumor delineation performance.

Long‑term outcomes of incidental gallbladder carcinoma without additional resection: A single institution experiment

Incidental gallbladder carcinoma (IGC), defined as unexpected malignancy identified in the surgical gallbladder specimen of a cholecystectomy performed for a benign diagnosis, can be difficult to suspect preoperatively. Furthermore, there are valid clinical reasons to defer reoperation for additional resection, particularly in elderly patients. The present study aimed to determine the long-term outcomes and prognostic factors associated with recurrence in patients with IGC. The medical records of 678 patients who underwent cholecystectomy at Toyooka Hospital between September 2011 and November 2017 were reviewed. The cases identified to be IGC were retrospectively analyzed to determine patient and histopathological characteristics, surgical details, long-term outcomes and factors associated with cancer recurrence. A total of 22 patients were diagnosed with gallbladder carcinoma following cholecystectomy by histopathological examination, and 12 of these were identified to be IGC. The median age was 80 years (range 70-89 years). Although 6 of the 12 patients with IGC had stage pT2 or pT3 tumors, only 1 patient underwent additional resection. Recurrence occurred in 3 of the 8 patients who did not undergo additional resection and were available for long-term follow-up. Recurrence was not associated with the extent of tumor invasion but may be associated with other histopathological findings, preoperative treatment history and risk factors for recurrence. Furthermore, long-term survival was observed in patients with pT2 and pT3 tumors who did not undergo additional resection. Recurrence was not associated with the extent of tumor invasion but may be associated with other histopathological findings, preoperative treatment history, and risk factors for recurrence. Furthermore, long-term survival was observed in patients with pT2 and pT3 tumors who did not undergo additional resection. Even if it is a progressive IGC case, appropriate preoperative treatment or cholecystectomy without persistence of the carcinoma cell, based on a preoperative image evaluation and a postoperative histopathological examination, may greatly influence the long-term prognosis of IGC.

Inferior and Intra-/Peri-Articular Superior Sacroiliac Joint Injection Approaches Under Ultrasound Guidance to Treat Metastasis-Related Posterior Pelvic Bone Pain.

Numerous mechanical and pathologic variables contribute to sacroiliac joint (SIJ) pain. The oncologic population has additional considerations, including tumor burden causing fracture, nerve compression, joint instability, and periosteal inflammation. Post-treatment changes may also restrict joint mobility, causing transitional pain. Currently, fluoroscopically guided SIJ injections, aimed at the inferior one third of the SIJ, are the gold standard for treatment but have only been described in the nononcologic population. Ultrasound (US) guidance may confer several benefits, including positioning, ease of procedure, lower costs, and, importantly, guidance to avoid neovascularization, metastatic disease, and other soft tissue structures. We aim to describe the advantages of US-guided SIJ injections for refractory malignant SIJ pain from extra-articular tumors. We then describe our technique and decision framework for accessing the superior or inferior SIJ in patients with metastatic sacroiliac pain. A retrospective review was performed on 5 patients with refractory malignant SIJ pain who underwent US-guided superior or inferior approach SIJ injection. Using imaging and outcomes, we developed a decision framework. Patients received either inferior or superior approach SIJ injections depending on location of tumor, extent of tumor invasion, and stability of the SIJ as per our framework. All patients reported improvement in pain and function without complications. We propose a decision framework for inferior vs. superior approach US-guided SIJ injections in the oncologic population with SIJ pain from metastases to the pelvis or sacrum. Having multiple techniques to approach the SIJ is important in the oncologic population, in whom metastatic tumor burden poses a technical challenge to performing these injections.

CLINICO PATHOLOGICAL ASSESSMENT OF GASTRIC CANCER IN BIHAR REGION

Gastric cancer has been one of the leading causes of cancer-related mortality over the past century. Today it is the 4th most common cancer in the world. Surgery remains the only major curative option. Majority of these cancers are found to be unresectable on laparotomy. Most gastric cancer patients are diagnosed with advanced disease with the development of distant metastases hence assessment of prognostic markers in these patients should be done. Hence based on above condition the present study was planned for Clinico Pathological Assessment of Gastric Cancer in Bihar Region.&#x0D; The present study was planned in Department of Pathology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India. The present study was planned from duration of June 2018 to December 2018. In the present study 50 cases of adenocarcinoma of stomach were enrolled and evaluated. The patients were diagnosed on clinical, radiological, endoscopic examination with confirmation by histopathological examination of either endoscopic biopsy or the resected specimen. The resected gastrectomy specimens were examined grossly and tumour location, tumour dimensions, extent of tumour invasion, metastasis to lymph nodes, number of lymph nodes involved, abnormality in surrounding mucosa were recorded.&#x0D; Gastric cancer is second most common cancer in male and fifth most common amongst females in East and Central Asia. The incidence of gastric cancer is twice as much in men as in women. Majority of cases had history of tobacco consumption, which clearly indicates the role of tobacco in causation of stomach cancer. Weak relation was seen in alcohol consumption. Screening of asymptomatic people in a high risk area may be useful in early detection of disease. Efforts to detect cancer early in developing countries would go a long way in reducing the disease burden and improving the outcome.&#x0D; Keywords: Gastric cancer, Mucinous adenocarcinoma, Tobacco, Metastasis, etc.

Fiber-tract localized diffusion coefficients highlight patterns of white matter disruption induced by proximity to glioma.

Gliomas account for 26.5% of all primary central nervous system tumors. Recent studies have used diffusion tensor imaging (DTI) to extract white matter fibers and the diffusion coefficients derived from MR processing to provide useful, non-invasive insights into the extent of tumor invasion, axonal integrity, and gross differentiation of glioma from metastasis. Here, we extend this work by examining whether a tract-based analysis can improve non-invasive localization of tumor impact on white matter integrity. This study retrospectively analyzed preoperative magnetic resonance sequences highlighting contrast enhancement and DTI scans of 13 subjects that were biopsy-confirmed to have either high or low-grade glioma. We reconstructed the corticospinal tract and superior longitudinal fasciculus by applying atlas-based regions of interest to fibers derived from whole-brain deterministic streamline tractography. Within-subject comparison of hemispheric diffusion coefficients (e.g., fractional anisotropy and mean diffusivity) indicated higher levels of white matter degradation in the ipsilesional hemisphere. Novel application of along-tract analyses revealed that tracts traversing the tumor region showed significant white matter degradation compared to the contralesional hemisphere and ipsilesional tracts displaced by the tumor.