Histological Confirmation Of Cancer Research Articles

The additional diagnostic value of virtual bronchoscopy navigation in patients with pulmonary nodules – The NAVIGATOR study

BackgroundThe number of solitary pulmonary nodules to be evaluated is expected to increase and therefore we need to improve diagnostic and therapeutic tools to approach these nodules. To prevent patients from futile invasive procedures and receiving treatment without histological confirmation of cancer, we evaluated the value of virtual bronchoscopy navigation to obtain a diagnosis of the solitary pulmonary nodule in a real-world clinical setting. MethodsIn the NAVIGATOR single center, prospective, observational cohort study patients underwent a virtual bronchoscopy navigation procedure with or without guide sheet tunnelling to assess a solitary pulmonary nodule. Nodules were considered not accessible if a diagnosis could not be obtained by either by CT-guided transthoracic biopsy or conventional bronchoscopy. ResultsBetween February 2021 and January 2022 35 patients underwent the virtual bronchoscopy navigation procedure. The overall diagnostic yield was 77% and was dependent on size of the nodule and chosen path, with highest yield in lesions with an airway path. Adverse events were few and manageable. ConclusionVirtual bronchoscopy navigation with or without sheet tunnelling is a new technique with a good diagnostic yield, also in patients in whom previously performed procedures failed to establish a diagnosis and/or alternative procedures are considered not feasible based on expected yield and/or safety. Preventing futile or more invasive procedures like surgery or transthoracic punctures with a higher complication rate is beneficial for patients, and allowed treatment adaptation in two-third of the analyzed patient population.

Pancreatic Solid Lesions Accompanied by Large Pseudocysts – How to Obtain a Histological Diagnosis

Background: Pseudocysts accompanying pancreatic solid lesions are rare findings and represent a big hurdle in obtaining a pre-operative histological diagnosis. Although they are usually complications of pancreatitis, pseudocysts can develop as a consequence of compression on the main pancreatic duct of solid masses whose characterization is essential. If the cyst is of moderate-large size, the acoustic effect of the fluid content and also the compression of the cyst itself on the pancreatic parenchima make often impossible to visualize the lesion which is squeezed too far from the probe to be seen. As a result, perfoming endoscopic-ultrasound guided fine needle aspiration/biopsy (EUS-FNA/B) of the solid mass underneath it is usually very challenging. Description of the technique: When there is a suspicion of a solid mass along with a moderate-large size pseudocyst, having a histological confirmation of cancer before surgery is essential and nowadays considered as standard of care. Using a 19G FNA needle to aspirate the cyst to dryness improves dramatically the lesion accessibility which becomes in the end visible and approachable with a standard EUS guided FNA or FNB. The procedure is safe and easy to perform under conscious sedation. Conclusions: EUS guided aspiration of large pseudocysts developed as complication of pancreatic lesions can be a crucial step in facilitating the histological confirmation of potential malignant lesions prior to surgery, allowing their visualization and biopsy.

Evaluation of the Overall 5-Year Survival of Breast Cancer at INO: Data from the 5-Year Prospective Database

Background: Breast cancer is both the most common and deadliest cancer among women in the world. The objective of this study was to assess breast cancer survival rates. Material and Methods: Prospective study conducted at the National Institute of oncology (INO) Sidi Mohamed Ben Abdellah Rabat .diagnosed patients with cancer from 2013 to 2015. The date of inclusion in the study is the date of histological confirmation of cancer. The survival assessment performed by the Kaplan Meier method, and the comparison between the different classes of a variable was performed by the Log Rank test. Results: 931 cases were collected during this study. According to molecular classification 59% of luminal patients, 25% positive human epidermal growth factor receptors (her2 positive) and 16% basal. The percentage of survival at 5 years, for luminal stage I 93%, stage II 92%, stage III 74% and stage IV 25% ;as well as for basal stage I 92%, stage II 80%, stage III 53% and stage IV 10% ; then the her2 positive stage I 100%, stage II 75% and stage III 70%. Conclusion: The discovery of metastatic cancer decreased breast cancer survival rate, hence the importance of Early Detection Awareness.

Does urinary cytology have a role in haematuria investigations?

ObjectivesTo determine the diagnostic accuracy of urinary cytology to diagnose bladder cancer and upper tract urothelial cancer (UTUC) as well as the outcome of patients with a positive urine cytology and normal haematuria investigations in patients in a multicentre prospective observational study of patients investigated for haematuria.Patient and methodsThe DETECT I study (clinicaltrials.gov NCT02676180) recruited patients presenting with haematuria following referral to secondary case at 40 hospitals. All patients had a cystoscopy and upper tract imaging (renal bladder ultrasound [RBUS] and/ or CT urogram [CTU]). Patients, where urine cytology were performed, were sub‐analysed. The reference standard for the diagnosis of bladder cancer and UTUC was histological confirmation of cancer. A positive urine cytology was defined as a urine cytology suspicious for neoplastic cells or atypical cells.ResultsOf the 3 556 patients recruited, urine cytology was performed in 567 (15.9%) patients from nine hospitals. Median time between positive urine cytology and endoscopic tumour resection was 27 (IQR: 21.3–33.8) days. Bladder cancer was diagnosed in 39 (6.9%) patients and UTUC in 8 (1.4%) patients. The accuracy of urinary cytology for the diagnosis of bladder cancer and UTUC was: sensitivity 43.5%, specificity 95.7%, positive predictive value (PPV) 47.6% and negative predictive value (NPV) 94.9%. A total of 21 bladder cancers and 5 UTUC were missed. Bladder cancers missed according to grade and stage were as follows: 4 (19%) were ≥ pT2, 2 (9.5%) were G3 pT1, 10 (47.6%) were G3/2 pTa and 5 (23.8%) were G1 pTa. High‐risk cancer was confirmed in 8 (38%) patients. There was a marginal improvement in sensitivity (57.7%) for high‐risk cancers. When urine cytology was combined with imaging, the diagnostic performance improved with CTU (sensitivity 90.2%, specificity 94.9%) superior to RBUS (sensitivity 66.7%, specificity 96.7%). False positive cytology results were confirmed in 22 patients, of which 12 (54.5%) had further invasive tests and 5 (22.7%) had a repeat cytology. No cancer was identified in these patients during follow‐up.ConclusionsUrine cytology will miss a significant number of muscle‐invasive bladder cancer and high‐risk disease. Our results suggest that urine cytology should not be routinely performed as part of haematuria investigations. The role of urine cytology in select cases should be considered in the context of the impact of a false positive result leading to further potentially invasive tests conducted under general anaesthesia.

A brief instrument to measure health-related quality-of-life in patients with bone metastasis: validation of the German version of Bone Metastases Quality-of-Life-10 (BOMET-QoL-10)

Aims: This prospective, epidemiologic study was designed to translate the original Spanish Bone Metastases Quality-of-Life-10 (BOMET-QoL-10) questionnaire and undertake a validation of the translated German version of BOMET-QoL-10 in Germany to assess health-related quality-of-life (HRQoL) in patients with bone metastases (BM).Methods: The translation process included forward and backward translations, and a linguistic validation. Patients aged ≥18 years with histological confirmation of cancer, diagnosed with BM, life expectancy ≥6 months, and fluency in German were eligible for this study (enrolled consecutively in 33 outpatient centers in Germany). Patients were given the German version of BOMET-QoL-10, together with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire QLQ-C30 and EORTC QLQ-BM22 questionnaires at inclusion, 6 weeks, 3 months, and 6 months after inclusion. A debriefing questionnaire was administered at inclusion to determine patient acceptability and understanding.Results: Data include 364 patients with BM (median age = 68 years; females = 71.7%). The BOMET-QoL-10 is brief and clear (median completion time = 5 minutes; >90% of patients completed the questionnaire without assistance). The BOMET-QoL-10 forms only one overall scale. All 10 items showed a substantial correlation with the first factor (factor loading, range = 0.58–0.86). BOMET-QoL-10 exhibits high internal consistency and reproducibility (Cronbach’s alpha = 0.91; intra-class correlation coefficient = 0.76). BOMET-QoL-10 showed significant correlations (range = 0.69–0.79) both with EORTC QLQ-C30 and EORTC QLQ-BM22 within the functioning (physical, social, interference) and symptom (fatigue, pain) scales, displayed significant sensitivity to change in EORTC QLQ-BM22 scores, and proved the potential ability to detect change in HRQoL in patients with different disease status.Limitations: There was a high proportion of females in this study, which might represent a limitation.Conclusions: The German version of BOMET-QoL-10 is a valid, reliable, brief, and clear instrument able to measure HRQoL in patients with BM.

Optical Coherence Tomography: A Novel Imaging Method for Post-lumpectomy Breast Margin Assessment—A Multi-reader Study

This study aimed to assess whether different breast cancer subspecialty physicians can be trained to distinguish non-suspicious from suspicious areas of post-lumpectomy specimen margin in patients with breast cancer using optical coherence tomography (OCT) images (a near-infrared based imaging technique) with final histology as the reference standard. This institutional review board-exempt, Health Insurance Portability and Accountability Act-compliant study was performed on 63 surgically excised breast specimens from 35 female patients, creating a 90-case atlas containing both non-suspicious and suspicious areas for cancer. OCT images of the specimens were performed, providing 6.5-15 µm resolution with tissue visualization 1-2 mm subsurface. From the 90-case atlas, 40 cases were chosen for training and 40 were randomly selected for reader assessment. Three breast imaging radiologists, two pathologists, two breast surgeons, and one non-clinical reader were trained and assessed for ability to distinguish non-suspicious from suspicious findings blinded to clinical data and corresponding histology slides. Duration of training and assessment, sensitivity, specificity, positive predictive value, negative predictive value, and the area under the curve for each reader were calculated as well as averages by subspecialty. The average training time was 3.4 hours (standard deviation, 1.2). The average assessment time was 1.9 hours (standard deviation, 0.7). The overall average reader sensitivity, specificity, and accuracy for detecting suspicious findings with histologic confirmation of cancer at the surgical margin for all eight readers were 80%, 87%, and 87%, respectively. Radiologists demonstrated the highest average among the disciplines, 85%, 93%, and 94%, followed by pathologists, 79%, 90%, and 84%, and surgeons, 76%, 84%, and 82% respectively. With relatively short training (3.4 hours), readers from different medical specialties were able to distinguish suspicious from non-suspicious OCT imaging findings in ex vivo breast tissue as confirmed by histology. These results support the potential of OCT as a real-time intraoperative tool for post-lumpectomy specimen margin assessment.

PTU-019 Quality of Upper Gastrointestinal Endoscopy Reporting in Suspected Cancer Patients

Introduction Accurate endoscopy reporting is vital for upper gastrointestinal (GI) cancer management decisions. Effects of poor reporting are unknown but they are likely to cause delay in providing definitive treatment plans. Methods The Somerset Upper GI cancer database was used to identify patients between March 2014 and February 2015. Endoscopy report obtained from Endobase, radiological imaging report from PACS and local cancer multi-disciplinary team (MDT) index outcomes were then used to assess reporting quality and draw comparison. Reports were assessed against an expected ideal reporting criteria (anatomic extent of examination and its limitations, tissue samples obtained, description of findings, diagnostic impression and photodocumentation), against which the crucial computed tomography (CT) findings and subsequent MDT decisions could be made. Results A 12 month sample size of 84 confirmed upper GI cancer patients were identified (68% males; median age 70 years). Median time difference between endoscopy and staging CT scan was 7 days (range 0–46 days). In 86% (n = 72) the endoscopist reported the exact tumour location when correlated to CT findings. Only 56% (n = 47) mentioned that biopsies had been taken but of these only 51% (n = 24) mentioned the number of biopsies taken. All the visualised lesions had a reported description of how the lesion appeared i.e. malignant features. In total, 19 (23%) patients were identified having repeat gastroscopies and of these 6 (7%) were felt to be avoidable repeats. Of these, 2 were repeated for clarification of previous endoscopy reports while 4 were required due to insufficient biopsies for adequate histological confirmation of cancer. Overall the delay in organising these avoidable repeat gastroscopies ranged from 14–69 days (median 16.5). Of the 6 index gastroscopies that required repeating, 3 were undertaken by GI consultants (two surgeons, one physician), 1 trainee endoscopist, 1 nurse endoscopist, 1 acute physician consultant endoscopist. Conclusion Poor endoscopy reporting practice can cause significant delays in cancer diagnosis and management. Some technical difficulties are inevitable in clinical practice however attention to details in report is important. We recommend that every endoscopy unit must ensure that regular internal audits on endoscopy reporting are undertaken for quality assurance. Disclosure of Interest None Declared

Guidelines-based diagnostic process does increase hospital delay in a cohort of colorectal cancer patients: a population-based study.

This is an investigation of factors determining hospital delay until treatment in an unrestricted population of colorectal cancer patients in the western part of the Netherlands. All patients with newly diagnosed colon (n=2146) and rectal carcinoma (n=1036) in the period 2006-2008 were included in analyses of inhospital delay (first hospital visit until first treatment >35 days). One-third of all patients were also available for analyses of prehospital delay (enrollment until first hospital visit >7 days). Patient, tumour and process factors predicting delay were examined in logistic regression models. The median prehospital and inhospital time intervals were 2 days [(p25-p75) 0-16] and 32 days (17-49), respectively, for colon cancer patients and 7 days (1-21) and 43 days (33-60) for rectal cancer patients. After adjustment for patient and tumour factors, colon and rectal cancer patients with first hospital visit before histological confirmation of cancer, complete diagnostic assessment or discussed in a multidisciplinary meeting had a higher probability of increased inhospital delay. Furthermore, first hospital visit before histological confirmation of cancer was associated with decreased prehospital delay in colon and rectal cancer patients. A guidelines-based diagnostic process (considered high quality of care) and multidisciplinary collaboration were associated with increased hospital delay in colorectal cancer patients.

In newly diagnosed breast cancer, is a contralateral prophylactic mastectomy necessary following a negative MRI?

627 Background: With more centers using MRI to aid in initial staging, there is apprehension that the highly sensitive MRI exam may lead to “unnecessary” mastectomies. We evaluated whether a negative contralateral MRI could be used to rule out a synchronous contralateral carcinoma and hence avoid a prophylactic contralateral mastectomy (CPM) at initial breast cancer diagnosis. Methods: Data of women with a new diagnosis of breast cancer (invasive or DCIS) from February 2003-November 2007 at our institution were reviewed. Women who had a negative MRI of the contralateral breast and who subsequently underwent CPM were included. A CPM was one in which there was no histological confirmation of cancer in the contralateral breast before surgery. All mastectomy specimens were analyzed pathologically. True negatives were mastectomy samples which contained no cancer following pathologic examination. False negatives were mastectomy samples which were found to have cancer after pathologic review. Results: 538 women were identified. 51 women met the study criteria. Median patient age was 56 years (range, 33–77). Of the 51 women who underwent a CPM, 2 were found to have pathologic confirmation of cancer. One occult cancer was a 0.3 cm grade 1, invasive lobular carcinoma; the second a 0.5 cm, low grade DCIS. The overall prevalence of synchronous occult contralateral cancer after a negative MRI was 3.9% (95% CI 0.5 - 13.5%). The negative predictive value of MRI was 96.1% (95% CI 86.5 - 99.5%). Conclusions: This study provides pathologic data regarding the utility of a negative contralateral breast MRI in women with newly diagnosed breast cancer. The prevalence of a synchronous occult contralateral cancer after a negative MRI in women with newly diagnosed breast cancer is very low. Physicians and patients can be assured that the risk of occult cancer is low in the setting of a normal contralateral MRI, an important fact when considering CPM after a diagnosis of unilateral breast cancer. No significant financial relationships to disclose.

Long-Term Survival in Patients with Non-Small Cell Lung Cancer Treated with Palliative Radiotherapy

The aim of palliative thoracic radiotherapy in patients with advanced non-small cell lung cancer (NSCLC) is to alleviate symptoms. This study was designed to determine whether any patients achieved longterm survival after this treatment. In Edinburgh, between 1974 and 1993, 4531 patients were treated with palliative radiotherapy for NSCLC, receiving ten fractions or fewer. We reviewed the case notes of the long-term survivors.Sixty-one (1.3%; 95% confidence interval (CI) 1.0–1.6) patients survived for more than 5 years; 43 (70%) had histological confirmation of cancer; 28 (46%) had stage Stage I or II, 28 (46%) Stage III and one Stage IV disease; 53 (87%) patients were treated with doses of 30–35 Gy in ten daily fractions, seven (12%) received 20 Gy in five daily fractions and one received a 10 Gy single fraction. Forty- two (69%) patients had a radiological complete response, 16 (26%) a partial response and the remainder stable disease. Clinically significant radiation pneumonitis occurred in one (2%) patient, radiation myelopathy in two (3%) and multiple rib fractures in one (2%). There did not appear to be an association between long-term survival and a radiosensitive phenotype. On univariate analysis, long-term survival was more frequent in patients receiving ten-fraction regimens than in those who underwent a shorter course of radiotherapy (χ2 = 19.5, P < 0.001). Thirty-four (0.8%; 95% CI 0.6–1.0) patients were disease free at death or at last review (median 10 years; range 5–17).We conclude that palliative thoracic radiotherapy produces long-term survival in 1.3% and personal cure in up to 1% of patients with advanced NSCLC.

Epidemiología descriptiva de cáncer en el Instituto Nacional de Cancerología de México

Objective. To analyze the descriptive epidemiology of cancer at the Instituto Nacional de Cancerologia of Mexico, and describe the characteristics of the growing demand for medical care. Material and methods. A review of the 10 year experience of the Hospital Cancer Registry from 1985 to 1994 was done. Results. During the study period a total of 28 591 patients was registered with the histological confirmation of cancer. There were 8 984 (31.4%) men, being ,

Oral cancer and mouthwash use: Evaluation of the epidemiologic evidence

BACKGROUND:An association between mouthwash use and cancer of the oropharynx has been the focus of many epidemiologic studies. PURPOSE:To critically review the methodology of studies of this association. METHODS:Studies were identified through a computerized MEDLINE search of English-language publications from 1976 to 1994. Eligible studies were independently reviewed, and specific criteria were applied to assess issues in the design, analysis, and results of the studies. Methodologic criteria were used that define a case-control study of acceptable epidemiologic quality: (1) histologic confirmation of cancer; (2) use of incident cases; (3) population-based cases; (4) equal exclusions of controls; (5) population-based controls; (6) exposure to mouthwash use before the cancer diagnosis; and (7) adjustments or restrictions for tobacco, alcohol, or both. RESULTS:Seven case-control studies were identified. The odds ratios for these studies ranged from a protective effect (0.82 for any use of mouthwash) to an elevation in risk (2.5 at the highest exposure). Two studies had significant unadjusted odds ratios for the risk of oral cancer. Of the three studies with data on women adjusted for tobacco and alcohol use, one was statistically significant, and none of the three similar studies in men was significant (although one was close). The five studies with data on female nonsmokers, nondrinkers, or both had odds ratios ranging from 1.1 to 3.16 (only one study was significant at the p = 0.05 level), and the four studies with similar data on men were not significant. Two studies met only two of the methodologic criteria, three studies met three, one met four, and one met all seven. CONCLUSIONS:Few of the available studies on mouthwash use and risk of subsequent oropharynx cancer adhere to basic methodologic principles of case-control design. Neither the data for the overall association nor the analysis in patients without other clinical risk factors support a link between mouthwash use and oral cancer. (OTOLARYNGOL HEAD NECK SURG 1995;113:253-61.)

CT of Submucosal and Occult Laryngeal Masses

Computed tomographic examinations were performed on 24 patients with entirely submucosal laryngeal mass lesions. Presenting complaints were hoarseness (17 patients), dysphagia (1 patient), airway obstruction (5 patients), and a cervical nodal metastasis (1 patient). The masses were visible endoscopically as submucosal bulges in 21 patients. Three other patients presenting with hoarseness and vocal cord paresis or paralysis had otherwise negative endoscopy and a mass demonstrated on CT. Thirteen patients were eventually diagnosed as having squamous cell carcinoma, which was the primary working diagnosis following CT in 12 cases. The group of 13 carcinoma patients had a range of two to five endoscopic procedures with one to four negative biopsies and a 6 week to 9 month delay in histologic confirmation of cancer. Other lesions included five laryngoceles, two chondrosarcomas, and one case each of paraganglioma, fibrosarcoma, lymphoma, and tuberculous laryngitis. Computed tomography is an indispensable tool for evaluating submucosal laryngeal masses or otherwise unexplainable symptoms (usually hoarseness) that might herald such a mass. A definite submucosal mass on CT should prompt a deep or wedge biopsy to reach a pathologic diagnosis. This will avoid the delay in diagnosis that frequently occurs in these patients.

Subtotal colectomy in the dimethylhydrazine-treated rat. A surgical model of colorectal cancer.

The effects of subtotal colectomy on the survival of rats with established colon cancer induced by 1,2-dimethylhydrazine (DMH) have been investigated in an attempt to assess whether it might provide a suitable model of surgical treatment of this disease. 40 female Wistar rats received a regimen of DMH injections (40 mg/kg body weight s.c. every 14 days for 10 weeks) known to produce colon cancer. An additional 10 rats received no DMH, serving as controls (group 1). After presenting with signs of colonic disease at 25 weeks, all DMH-treated rats had diagnostic colonoscopy under general anaesthesia, only those with visible neoplasms (n = 34) being included in the study. These were randomised into two groups: group 2 (n = 13) animals were unoperated controls while group 3 (n = 21) animals had a therapeutic subtotal colectomy with histological confirmation of cancer in the resected colon. The animals were observed until death, the postoperative survival and cause of death at necropsy being compared between groups. The results showed that overall survival (p less than 0.013) and survival from death due to colon cancer (p less than 0.001) were significantly increased in the colectomised group 3 animals compared to unoperated controls (group 2). While 91% of the unoperated controls died of colon cancer, only 8% of the colectomised group died of this cause (p less than 0.001), the remainder dying from unrelated causes, predominantly DMH-induced primary extracolonic cancers. Subtotal colectomy in rats with DMH-induced colon cancer reduces mortality from this disease, providing a suitable model of surgical treatment. However, the high incidence of DMH-induced extracolonic cancers may make the model unsuitable for studies of adjuvant therapy.

Recent developments in gastrointestinal endoscopy.

Endoscopic findings can be extremely valuable in directing or altering specific treatment. Endoscopy also has therapeutic applications, such as removal of polyps (gastric or colonic), coagulation of bleeding sites in cases of upper gastrointestinal bleeding, and the removal of foreign objects from the gastrointestinal tract. Laparoscopy is an easily performed procedure with minimal risk. On of its greatest values is in investigating diseases of the liver. Coloscopy has many uses, including evaluation of equivocal x-ray findings and histologic confirmation of cancer. Endoscopic retrograde cholangiopancreatography (ERCP) is a new, highly sophisticated procedure that offers a major advantage in investigating pancreatic disease and evaluating jaundice.

Survival of patients with cancer of thyroid gland.

During the period 1935 to 1951, there were 283 newly diagnosed cases of thyroid cancer among residents of the state of Connecticut. The median survival after diagnosis for the 251 persons with histological confirmation of cancer was three and one-half years. At the end of the 12th month, two-thirds of the patients were still alive, whereas two-thirds of the members of a control group had not yet died by the end of the 12th year. Thyroid cancer progresses five times more rapidly in men than in women. Women with papillary cancer have a considerably better prognosis (median survival nine and one-half years) than women with the non-papillary variety (median survival two years). The survival of men was poor regardless of the histological variety of the neoplasm. For both sexes combined the median survival in localized thyroid cancer was four and one-half years for the nonpapillary types and eight years for the papillary variety.