Maximum Lesion Size Research Articles

Surgical upgrade rate of breast atypia to malignancy: An academic center's experience and validation of a predictive model.

Atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and lobular carcinoma insitu (LCIS) are commonly seen on breast core needle biopsy (CNB). Many institutions recommend excision of these lesions to exclude malignancy. A retrospective chart review was performed on patients who had ADH, ALH, or LCIS on breast CNB from 1/1/08 to 12/31/10 who subsequently had surgical excision of the biopsy site. Study objectives included determining upgrade to malignancy at surgical excision, identification of predictors of upgrade, and validation of a recently published predictive model. Clinical and demographic factors, pathology, characteristics of the biopsy procedure and visible residual lesion were recorded. T test and chi-squared test were used to identify predictors. Classification tree was used to predict upgrade. 151 patients had mean age of 53years. The mean maximum lesion size on imaging was 11mm. The primary atypia was ADH in 63.6%, ALH in 27.8%, and LCIS in 8.6%. 16.6% of patients had upgrade to malignancy, with 72% DCIS and 28% invasive carcinoma. Risk factors for upgrade included maximum lesion size (P=.002) and radiographic presence of residual lesion (P=.001). A predictive model based on these factors had sensitivity 78%, specificity 80% and AUC=0.88. Validating a published nomogram with our data produced accuracy figures (AUC=0.65) within published CI of 0.63-0.82. In CNB specimens containing ADH, ALH, or LCIS, initial lesion size and presence of residual lesion are predictors of upgrade to malignancy. A validated model may be helpful in developing patient management strategies.

A pilot evaluation of magnetic resonance imaging characteristics seen with solid papillary carcinomas of the breast in 4 patients

BackgroundSolid papillary carcinoma (SPC) is a rare variant of breast papillary carcinoma with unique pathological morphology and biological behavior. There is only one case report on T1-MRI of SPC. In this study, we report our findings on this new category of papillary carcinoma to fill the gap in MRI characterization of SPC.MethodsThis retrospective study included four pathology-confirmed in situ SPC patients. Conventional MRI, diffusion weighted imaging (DWI), and magnetic resonance spectroscopy (MRS) were performed with a 1.5 T whole-body MR scanner before surgical operation. The following characteristics of each lesion were recorded: signal intensity on T2WI/STIR and T1FSPGR, morphology, maximum lesion size, and time intensity curve (TIC) on dynamic contrast enhancement MRI (DCE-MRI), apparent diffusion coefficient (ADC) value from DWI, and Cho peak from MRS.ResultsSignal intensities of all lesions were heterogenous on T2WI/STIR and T1FSPGR. Mass enhancements were observed for all lesions with either oval or irregular shapes on DCE-MRI. The maximum lesion size ranged from 0.8 cm to 3.2 cm. All lesion margins were circumscribed, and internal enhancements were homogeneous or heterogeneous from DCE-MRI. TIC appeared with a rapid increase in initial contrast phases of all lesions. All lesions on DWI (b = 1000s/mm2) were slightly hyperintense with an ADC value range of 1.3 × 10−3 mm2/s to 1.9 × 10−3 mm2/s. Cho peak was absent at 3.2 ppm for all lesions.ConclusionsMRI characteristics of SPC include heterogeneous signal intensity within the lesion on T2WI/STIR and T1FSPGR, mass enhancement with circumscribed margins, either oval or irregular shapes, and a rapid initial enhancement of TIC on DCE-MRI. ADC values and the absence of Cho peak may provide valuable information to distinguish SPC from other invasive breast carcinomas.

Pathogenic Variability within Indian Alternaria brassicae Isolates Using Seed, Cotyledon and Leaf of Brassica Species

AbstractThirty Alternaria brassicae (Berk.) Sacc. isolates from diverse geographical locations of India were studied for pathogenic variability on seed, cotyledon and true leaves of Brassica species. Seed germination was reduced maximum by isolate BAB‐39 in Brassica juncea cultivar Varuna (22.1%), Brassica rapa var. Toria cultivar PT‐303 (12%), Brassica carinata cultivar Kiran (12%), Brassica napus cultivar GSL‐1 (11%) and tolerant source of B. juncea genotype PHR‐2 (7%), although least by isolate BAB‐49. Maximum lesion size on leaf was recorded in B. juncea cultivar Rohini (11.2, 16.5 and 16.8 mm) with isolates BAB‐09 (Pantnagar), BAB‐19 (Bharatpur) and BAB‐39 (Kangra), respectively, and categorized as highly virulent, while minimum lesion size of 3.2, 3.7 and 3.8 mm was observed with isolates BAB‐47 (Tonk), BAB 49 (Jobner) and BAB 04 (Kamroop), respectively, considered the weak isolates. On B. alba, BAB‐09, BAB‐19 and BAB‐39 isolates caused maximum lesion size of 3.7, 3.8 and 3.9 mm, respectively, even though it showed maximum tolerance. In both seed and cotyledon inoculation method, the per cent Alternaria blight severity above 80% was observed with isolate of BAB‐39 (91.5%), BAB‐19 (89.0%), BAB‐09 (85.5%) and least in isolate BAB‐49 (34.0%). Brassica seed, cotyledon and leaf showed the similar positive response for categorizing A. brassicae isolates as virulent and avirulent. This information could be used to the development and assessment of resistant brassica germplasm, especially with A. brassicae populations exhibiting increased virulence.

Apparent diffusion coefficient values may help predict which MRI-detected high-risk breast lesions will upgrade at surgical excision.

To investigate whether diffusion-weighted imaging (DWI) features could assist in determining which high-risk lesions identified on dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and diagnosed on core needle biopsy (CNB) will upgrade to malignancy on surgical excision. This Institutional Review Board (IRB)-approved prospective study included participants with MRI-detected Breast Imaging Reporting and Data System (BI-RADS) 4 or 5 lesions with high-risk pathology on CNB who underwent surgical excision. Twenty-three high-risk lesions detected on 3T breast MRI in 20 women (average age = 54 ± 9 years) were evaluated, of which six lesions (26%) upgraded to malignancy at surgery. DCE, DWI characteristics, and clinical factors were compared between high-risk lesions that upgraded to malignancy on surgical excision and those that did not. Logistic regression modeling was performed to identify features that optimally predicted upgrade to malignancy, with performance described using area under the receiver operating characteristic curve (AUC). High-risk lesions that upgraded on excision demonstrated lower apparent diffusion coefficient (ADC) than those that did not (median, 1.08 × 10-3 mm2 /s vs.1.39 × 10-3 mm2 /s, P = 0.046), and a trend of greater maximum lesion size (median, 24 mm vs. 8 mm, P = 0.053). There were no significant differences in lesion type (mass vs. nonmass enhancement, P = 1.0) or kinetic features (P = 0.78 for peak initial enhancement; P = 1.0 for worst curve type) among the high-risk cohorts. A model incorporating maximum lesion size and ADC provided optimal performance to predict upgrade to malignancy (AUC = 0.89). ADC and maximum lesion size on MRI show promise for predicting which MRI-detected high-risk lesions will upgrade to malignancy at surgical excision. 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1028-1036.

Hill-Sachs lesion classification under arthroscopic findings

The Hill-Sachs lesion (HSL) plays a role in recurrent glenohumeral joint instability. Currently, there are no studies based on the form characteristics of HSL. The purposes of this study were to report the HSL form characteristics and to determine whether they are correlated with number of prior subluxations and dislocations. The study enrolled 134 consecutive patients diagnosed with anterior shoulder instability during an arthroscopic procedure. We classified the arthroscopic findings into 4 types, as follows: type 1, cyst type; type 2, gutter type; type 3, island type; and type 4, wide type. Subsequently, we investigated the correlation between each type and the number of shoulder subluxations and dislocations reported. The following data were analyzed: subluxation and dislocation history, arthroscopic findings, and maximum lesion size. Of the patients evaluated, 18, 32, 30, and 54 were classified as types 1 to 4, respectively. The mean numbers of shoulder dislocations were 3.3, 7.3, 6.0, and 12.0 for types 1 to 4, respectively. The wide type was correlated with more subluxations and dislocations than the other types (P = .001, .046, and .007, respectively). There were significant differences in mean width among all types (P < .0001). HSL width was correlated with lesion type and angle. We classified HSL into 4 types on the basis of visual inspection and found a correlation between lesion type and lesion size. However, HSL width was correlated with lesion type and angle; that is, the number of dislocations and subluxations does not affect HSL width.

Pulmonary radiofrequency ablation in a district general hospital: is it a safe and effective treatment?

To analyse the technical success of ablation therapy and the incidence of complications in patients treated with pulmonary ablation and to assess factors affecting local disease control and patient survival in a subgroup with metastatic colorectal cancer. Technical success and complications in all patients undergoing lung ablation between June 2009 and July 2015 were recorded. Overall survival and local disease control in a subgroup with metastases from a colorectal primary were calculated. Factors influencing outcome were explored. Two hundred and seven pulmonary ablations were performed in 86 patients at 156 attendances. Technical success was achieved in 207/207 (100%). Thirty and 90-day mortality was 0%. The major complication rate was 13/86 (15%). One hundred and one metastases were treated in 46 patients with a colorectal primary. This group had a mean±standard error survival time of 53.58±3.47 months with a 1, 2, 3, 4, and 5-year survival rate of 97.4%, 91.3%, 81.5%, 59.8%, and 48%. There was no statistically significant difference in survival regarding time to development of metastatic disease, the total number of lesions ablated, the initial number of lesions ablated, the maximum size of lesion treated, or unilateral versus bilateral disease. Patients with extrapulmonary disease were found to have a shorter survival from the primary diagnosis. Seventy-eight (77.2%) of the 101 lesions were stable after first RFA. Local relapse was more likely when a metastasis was close to a large (>3mm) vessel. RFA is a safe and effective procedure that can be performed without on-site cardiothoracic support. Good outcomes depend upon careful patient selection. This study supports its use in oligometastatic disease.

Dose-Volume Response Relationship for Brain Metastases Treated with Frameless Single-Fraction Linear Accelerator-Based Stereotactic Radiosurgery.

Background: Our aim was to identify a dose-volume response relationship for brain metastases treated with frameless stereotactic radiosurgery (SRS).Methods: We reviewed patients who underwent frameless single-fraction linear accelerator SRS for brain metastases between 2007 and 2013 from an institutional database. Proportional hazards modeling was used to identify predictors of outcome. A ratio of maximum lesion dose per mm-diameter (Gy/mm) was constructed to establish a dose-volume relationship.Results: There were 316 metastases evaluated in 121 patients (2 - 33 mm in the largest diameter). The median peripheral dose was 18.0 Gy (range: 10.0 – 24.0 Gy). Local control was 84.8% for all lesions and was affected by location, peripheral dose, maximum dose, and lesion size (p values < 0.050). A dose-volume response relationship was constructed using the maximum dose and lesion size. A unit increase in Gy/mm was associated with decreased local failure (p = 0.005). Local control of 80%, 85%, and 90% corresponded to maximum doses per millimeter of 1.67 Gy/mm, 2.86 Gy/mm, and 4.4 Gy/mm, respectively. Toxicity was uncommon and only 1.0% of lesions developed radionecrosis requiring surgery.Conclusions: For brain metastases less than 3 cm, a dose-volume response relationship exists between maximum radiosurgical dose and lesion size, which is predictive of local control.

Does size reliably predict malignancy in soft tissue tumours?

In this retrospective study we examined whether size is a viable marker of tumour malignancy in soft tissue masses (STM) and if the ratio of width and length (RALD) of an STM reflects tumour biology more accurately. Measurements of maximal lesion size and perpendicular diameter were performed in available MRI and ultrasonography studies of 212 patients (mean age 54.4 ± 17.2years, male:female 1:1.12) with a histologically verified diagnosis. Overall, 28.2% of lesions were malignant, 11.1% intermediate, and 58.8% benign. Size alone was a weak predictor of malignancy in STMs (sensitivity 68.8%, specificity 50.3%, positive predictive value [PPV] 44.0%, negative predictive value [NPV] 80.4%). RALD showed better discriminatory power with greater separation between benign and malignant entities and higher values for sensitivity (83.6%), specificity (53.6%), and NPV (89.0%). A weighted combination of size, age and RALD improved diagnostic power, demonstrating higher values for sensitivity (77.0%), specificity (80.1%), PPV (61.0%), and NPV (89.6%). Size should not be used alone to estimate an STM's malignancy. RALD better reflects a lesion's growth pattern and a combination of age, size, and RALD helps to discriminate more accurately between benign, intermediate, and malignant entities. These findings should help to estimate easily whether a newly found STM is benign or malignant prior to further workup. •Size does not reliably differentiate between benign, intermediate, and malignant tumours •The R ALD (ratio of lateral to axial diameter) improves diagnostic confidence •When combined with age and size, STM differentiation was further enhanced •These measurements can aid in earlier detection of sarcomas.

Laparoscopic versus open liver resection for metastatic colorectal cancer

Application of minimally invasive surgery for oncologic liver resection is still limited to expert centers. We describe our experience in laparoscopic liver resection (LLR) for colorectal liver metastases (CLM). Between February 2010 and February 2015, 174 patients underwent resection of CLM. LLR was chosen according to surgeon's preferences. Data was retrieved from the institutes' electronic charts and retrospectively analyzed. LLR was performed in 42 patients (24.5%) and OLR in 132. Increased number of metastases were found in OLR (2.82 ± 2.81 versus 1.78 ± 1.16, P = 0.02), with no difference in maximal lesion size (33.1 ± 22 versus 34.9 ± 27.5 cm, P = 0.7). Altogether 55 patients underwent major hepatectomy, and 50 of the OLR group (37.8%, 37 right hepatectomy and 7 left hepatectomy) (P = 0.02). In 5 patients (11.6%) a conversion to open surgery was indicated. Operative time was longer in LLR. Estimated blood loss was decreased in laparoscopic minor resections. One OLR patient died during the postoperative period (0.7%). Eight patients in the OLR group had major complications, versus 1 in the LLR group (P = 0.0016). Reoperation within 30 days was performed in 4 OLR patients and none in the LLR group. Patients in the LLR group had shorter length of stay (LOS) (6.78 ± 2.75 versus 8.39 ± 5.64 days, P = 0.038). R0 resection was 88% in both groups. In selected patients with CLM, LLR is feasible, safe and may achieve shorter LOS without inferior oncologic outcome.

Effect of Use of Propolis on Serum Levels of Il-17 and Clinical Symptoms and Signs in Patients with Ulcerative Oral Lichen Planus

Background and aims: Ulcerative oral lichen planus is a relatively common symptomatic condition with a potential for malignant transformation. Interleukin-17 is a cytokines, which has attracted the attention of researchers as a factor effective in its etiology. Therefore, recent research in relation to the treatment of inflammatory and immunologic diseases has focused on techniques to decrease and regulate cytokines, especially interleukin-17. Propolis is one of the products of honeybees and has anti inflammatory, antineoplastic and antimicrobial properties and an effect on decreasing IL-17 levels. The aim of the present study was to evaluate the effect of propolis on serum levels of IL-17 and clinical symptoms and signs in patients with ulcerative oral lichen planus. Materials and methods: In this clinical trial, 25 patients with ulcerative lichen planus were included. Blood samples were taken to determine IL-17 serum levels. Then 500-mg capsules of propolis were given for 30 days a capsule daily. After a month, serum levels of IL-17 were determined once again. In addition, pain severity (VAS) and the maximum sizes of lesions before and after administration of propolis were determined. Results: Mean serum levels of IL-17 before and after intervention were 135±16.5 and 127±12 pg/mL, respectively, demonstrating statistically significant differences. In addition, VAS means before and after treatment were 4.2±3.6 and 3.3±2.8, respectively, with statistically significant differences. The means of maximum lesion sizes before and after treatment were 14±7.7and 9.8±7.6 mm, revealing statistically significant differences. Conclusion: Administration of propolis decreased IL-17 serum levels, pain and burning sensation severity (based on VAS) and the maximum of lesion diameters in patients with ulcerative oral lichen planus.

Analysis of radiofrequency lesions in egg whites in vitro produced by application of the Tew electrode for different temperatures and times.

Understanding the size and shape of radiofrequency lesions is important to reduce side effects when applied to patients. To investigate the radiofrequency lesions produced by the application of the Tew electrode for different temperatures and times. The white from a fresh hen's egg was placed in a rectangular glass container and warmed to 37 °C. After immersion of the Tew electrode in the egg white, radiofrequency lesions were produced at 65 °C, 70 °C, 75 °C, 80 °C, 85 °C and 90 °C. For each temperature, photographs were taken at 10 s, 20 s, 30 s, 40 s, 50 s, 60 s, 70 s, 80 s, 90 s, 100 s, 110 s and 120 s. The size of the lesion was measured at each temperature and time. A mixed model was used to analyze the data. The size of the lesion increased with increasing temperature and time. There were statistically significant differences in the size of the internal radius between the 65 °C and 70 °C groups and the 70 °C and 75 °C groups, as well as in the 70 °C and 75 °C groups in the size of the external radius and the 60 °C to 80 °C groups in the size of the distal radius. The maximum lesion size was produced at 90 °C and 120 s, and was 1.06±0.16 mm in internal radius, 0.37±0.15 mm in external radius, 0.39±0.04 mm in distal radius. The Tew electrode produces lesions following the contour of the tip, and the internal radius is larger than the external and distal radius. The best combination of temperature and time for lesioning using the Tew electrode is 80 °C, for 60 s to 90 s.

The interaction between the composition of preinjected fluids and duration of radiofrequency on lesion size.

Clinical recommendations for the duration of radiofrequency (RF) delivery have been based on no-fluid design, which may not be representative of clinical practice where fluid preinjection occurs. The purpose of this study was to examine the interaction between the preinjection of fluids of differing compositions and duration of RF on lesion size. The variability of lesion development under different preinjection conditions was also examined across the RF lesion duration. Monopolar RF was performed with ex vivo chicken samples for 180 seconds without fluid preinjection or with fluid preinjected. Nonionic and ionic fluids were investigated. Lesion size parameters and and power levels were measured every 10 seconds. The surface area and efficiency index were calculated. The preinjection of specific fluid increased the maximum mean surface area. Lesion growth continued throughout the entire lesion cycle. When all groups were considered together, the largest mean surface area occurred at 180 seconds. The preinjection of specific fluids altered the rate of lesion growth and the time required to achieve maximum lesion size in a fluid-specific manner. Significant variability was documented in the rate and amount of lesion growth under each condition. Extending lesioning time resulted in reduced lesion variability. Fluid preinjection alters both final lesion size and the time required to achieve maximum lesion size. Extending the duration of RF lesion cycle beyond 90 seconds when fluid is preinjected allows for lesion size to be maximized while limiting lesion size variability, both of which assist in successfully lesioning a targeted nerve.

A randomized controlled trial of trypsin to treat brown recluse spider bites in Guinea pigs.

Brown recluse spider bites result in necrotic skin lesions for which there is no known antidote. Since venom toxins are proteins, a proteolytic enzyme like trypsin might be effective in reducing toxicity. The aim of this study was to conduct a randomized controlled trial of trypsin to treat brown recluse spider bites in guinea pigs. Subjects were 18 female guinea pigs. Anesthesia for injections was inhaled isoflurane. Analgesia was 0.05mg/kg of buprenorphine twice a day as needed. Intervention was intradermal injection of 30μg of brown recluse venom (Spider Pharm, Yarnell, AZ). Immediately after envenomation, subjects were randomized to two groups of nine: trypsin 10μg in 1mL normal saline and 1mL of normal saline. The primary outcome was lesion area over a 10-day time period. Statistical analysis was performed with repeated measures ANOVA. Mean lesion area was smaller but not statistically different in the placebo group. Maximum lesion size occurred at day 4 in both groups, when lesion area was 76.1 ± 108.2mm(2) in the placebo group and 149.7 ± 127.3mm(2) in the treatment group. P value was 0.15 for placebo vs. treatment. This study did not establish a role for trypsin as a treatment for brown recluse spider bites in a guinea pig model.

Ductal carcinoma in situ diagnosed at US-guided 14-gauge core-needle biopsy for breast mass: Preoperative predictors of invasive breast cancer

ObjectivesTo identify preoperative features that could be used to predict invasive breast cancer in women with a diagnosis of ductal carcinoma in situ (DCIS) at ultrasound (US)-guided 14-gauge core needle biopsy (CNB). MethodsA total of 86 DCIS lesions that were diagnosed at US-guided 14-gauge CNB and excised surgically in 84 women were assessed. We retrospectively reviewed the patients’ medical records, mammography, US, and MR imaging. We compared underestimation rates of DCIS for the collected clinical and radiologic variables and determined the preoperative predictive factors for upstaging to invasive cancer. ResultsTwenty-seven (31.4%) of 86 DCIS lesions were upgraded to invasive cancer. Preoperative features that showed a significantly higher underestimation of DCIS were palpability or nipple discharge (p=0.040), number of core specimens less than 5 (p=0.011), mammographic maximum lesion size of 25mm or larger (p=0.022), mammographic mass size of 40mm or larger (p=0.046), sonographic mass size of 32mm or larger (p=0.009), lesion size of 30mm on MR (p=0.004), lower signal intensity (SI) on fat-saturated T2-weighted MR images (FS-T2WI) (p=0.005), heterogeneous or rim enhancement on MR images (p=0.009), and apparent diffusion coefficient (ADC) values lower than 1.04×10−3mm2/s on diffusion-weighted MR imaging (DWI) (p<0.001). ConclusionClinical symptom of palpability or nipple discharge, number of core specimen, mammographic maximum lesion or mass size, SI on FS-T2WI, heterogeneous or rim enhancement on MR, and ADC value may be helpful in predicting the upgrade to invasive breast cancer for DCIS diagnosed at US-guided 14-gauge CNB.

Target Indices for Clinical Ablation in Atrial Fibrillation

In animal studies of radiofrequency ablation, lesion sizes plateau as the maximum lesion size is reached for an ablation. Lesion parameters are not available in clinical ablations, but preclinical work suggests that these correlate with impedance drop and electrogram attenuation. Characterization of the relationships between catheter contact force, ablation duration, and these surrogate markers of lesion formation may allow us to define targets for effective ablation. Fifteen patients undergoing first-time radiofrequency ablation for nonparoxysmal atrial fibrillation were studied. All were in atrial fibrillation at the time of the procedure. Ablations were performed with an irrigated-tip contact force-sensing catheter in temperature-controlled mode (temperature limited to 48°C, power to 30 W). Included were 285 left atrial static ablations, 247 with additional impedance data. The ablation force time integral (FTI) correlated with the attenuation of the electrogram with ablation (Spearman ρ, -0.14; P=0.02): the relationship plateauing from 500 g·s, a reduction in the electrogram amplitude of 20%. The FTI also correlated with the impedance drop during ablation (Spearman ρ, 0.79; P<0.0005): the relationship was logarithmic, the reduction in the impedance with an increasing FTI also plateauing from 500 g·s, an impedance drop of 7.5%. The ablation duration affected the impedance drop at an FTI if the duration was <10 s. Beyond this time point, the FTI achieved rather than the ablation duration or mean contact force applied determined the impedance drop. During nonparoxysmal atrial fibrillation ablation, an FTI of 500 g·s should be targeted with ablation duration of ≥10 s. Clinical Trials Registration- URL: http://clinicaltrials.gov/. Unique Identifier: NCT01587404.

CT Differentiation of Mucin-Producing Cystic Neoplasms of the Liver From Solitary Bile Duct Cysts

The purpose of this study was to identify the CT features required for differentiating mucin-producing cystic neoplasms of the liver (mucinous cystic neoplasms and cyst-forming intraductal papillary neoplasms of the bile duct) from solitary bile duct cysts. CT images of pathologically confirmed mucinous cystic neoplasms (n = 15), cyst-forming intraductal papillary neoplasms of the bile duct (n = 16), and solitary bile duct cysts (n = 31) were reviewed. Analysis of the CT findings included shape, presence of septa, location of septa (peripheral vs central), thickness of septa (thin vs thick), mosaic pattern, mural nodules, intracystic debris, calcification, upstream bile duct dilatation, downstream bile duct dilatation, and communication between a cystic lesion and the bile duct. The maximum size of a cystic lesion and the maximum size of the largest mural nodule were measured. The presence of septa, central septa, mural nodules, upstream bile duct dilatation, and downstream bile duct dilatation were found to be significant CT findings for differentiating mucinous cystic neoplasms and cyst-forming intraductal papillary neoplasms of the bile duct from solitary bile duct cysts (p < 0.05 for each finding). When two of these five criteria were used in combination, the sensitivity and specificity for diagnosing mucin-producing cystic neoplasms and cyst-forming intraductal papillary neoplasms of the bile duct were 87% (27 of 31) and 87% (27 of 31), respectively. When two of these five criteria were used in combination, the sensitivity and specificity for diagnosing mucinous cystic neoplasms and cyst-forming intraductal papillary neoplasms of the bile duct were 87% (27 of 31) and 87% (27 of 31), respectively [corrected]. With the use of specific CT criteria, mucin-producing cystic neoplasms of the liver can be differentiated from solitary bile duct cysts with a high degree of accuracy.

Recurrent Thyroid Cancer Diagnosis: ROC Study of the Effect of a High-Resolution Head and Neck 18F-FDG PET/CT Scan

(18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) has demonstrated significant value in the evaluation of patients with indication of recurrent thyroid cancer with negative conventional workup. The hypothesis of this study was that the addition of a dedicated, high-resolution head and neck scan (HNS) to the standard whole-body scan (WBS) improves the accuracy of the detection and diagnosis of recurrent thyroid cancer. Forty-three consecutive patients suspected for recurrent thyroid cancer, as indicated by increased tumor markers, prospectively underwent a WBS and a HNS with (18)F-FDG PET/CT. The patients were followed up to establish ground truth. Areceiver operator characteristic (ROC) study with two observers was conducted to evaluate the impact of the additional HNS on the detection and diagnosis of recurrent thyroid cancer. Indices of performance included the area under the ROC curve (AUC), the number of detected abnormal foci, and the size of the detected foci without and with the HNS images. ROC results showed that the addition of the HNS to the standard WBS increased the average AUC index of performance from 0.69 to 0.96, a statistically significant difference with a confidence interval (CI) of -0.33 to -0.19. Diagnosis was also improved with the average AUC increasing from 0.79 to 0.87 but differences were not statistically significant (CI, -0.19 to 0.04). Interreader agreement was "good" in the detection task and "excellent" in the diagnostic task. The addition of the HNS increased the number of detected foci in the positive patients by an average of 37%, whereas false-positive detections in the negative patients increased by an average of 10%. Reported average maximum lesion size also increased with the HNS addition by an average of 11%. The addition of a high-resolution HNS to the standard whole-body PET/CT imaging improves readers' performance in the detection and diagnosis of recurrent thyroid cancer and could greatly benefit patient care.

Public Library of Science

Worldwide there are more than 10,000 reported jellyfish stings annually that can potentially cause local dermatonecrosis and systemic symptoms including cardiovascular instability, respiratory distress, and anaphylaxis. When dermal tissue is exposed to jellyfish venom, there is a significant inflammatory reaction and upregulation of matrix metalloproteinase (MMP) activity. Other than its use as an antibiotic, tetracycline is also an effective metalloproteinase inhibitor but has never been studied as a topical treatment for jellyfish stings. This study investigated the role of MMP activity in dermal toxicity after a sting from the Nemopilema nomurai Scyphozoan jellyfish and the ability of tetracycline to inhibit the clinical sequelae after envenomation. After treating human keratinocyte and mouse fibroblast models with isolated N nomurai jellyfish venom and different concentrations of tetracycline, the investigators measured MMP activity with gelatin zymography, electrophoresis, and Western blot analysis. Additionally, the investigators performed in vivo experiments using envenomated rabbit models treated with lanolin cream alone or containing tetracycline. Finally, the authors analyzed the histological effects of envenomated rabbit skin after treatment with tetracycline. After venom exposure, MMP activity significantly increased but was suppressed in the presence of tetracycline. In the in vivo rabbit models, the maximal skin lesion size was noted after 24 hours and steadily decreased over a period of 48 hours. Topical application of lanolin cream with tetracycline to envenomated areas of skin significantly reduced maximal lesion size at 24 hours. Additionally, histological analysis showed a decreased level of hemorrhage and neutrophilic infiltration for skin treated with tetracycline. This study suggested that tetracycline is able to downregulate MMP activity induced by N nomurai jellyfish venom and can also decrease maximal lesion size when applied topically. The authors conclude that tetracycline creams may be beneficial as a first-aid dermal treatment after jellyfish envenomation. Limitations of the study include applicability to human skin and accessibility to tetracycline cream shortly after jellyfish envenomation. (PLoS One. 2013;8:e57658) C Kang, YB Jin, J Kwak, et al.

Status and symptomatology of early blight (Alternaria solani) of potato (Solanum tuberosum L.) in Kashmir valley

Alternaria leaf blight is one of the most important diseases of potato (Solanum tuberosum L.) worldwide. The disease was prevalent in all the potato growing areas of Kashmir valley surveyed during 2009 and 2010. The overall mean disease incidence and intensity ranged from 24.54 to 28.23% and 13.84 to 15.98%, respectively. The highest disease incidence (39.09%) and intensity (22.54%) was recorded in district Budgam. The lowest level of disease was in district Shopian (14.89 and 8.05%, respectively). The pathogen associated with the disease was identified as Alternaria solani (Ellis and Martin) Jones and Grout. In early stages of disease development, small irregular to circular dark brown spots on lower leaves appear, measuring 0.5 mm in size. Upto fourth week of June concentric rings form as a result of irregular growth patterns by the organism in the leaf tissue giving the lesion a characteristic ‘target spot’ or ‘bulls eye’ appearance. The maximum lesion size 7.4 mm was recorded in the second week of August. Key words: Potato, Alternaria solani, survey, disease incidence, symtomatology.

Final efficacy results of NCIC CTG IND.202: A randomized phase II study of recombinant interleukin-21 (rIL21) in patients with recurrent or metastatic melanoma (MM).

9032 Background: rIL21 is a T-cell derived cytokine with antitumor activity dependent on NK cells or CD8+ T cells through induction of central and effector memory cells. A previous phase II study demonstrated an ORR of 22.5% in previously untreated patients with MM. We conducted a multicentre randomized phase II study of MM evaluating the efficacy, toxicity, pharmacokinetics, immunogenicity, and biomarkers of rIL21 versus dacarbazine (DTIC). Methods: Eligible patients: Recurrent or MM, with either maximum tumour lesion size of &lt; 50 mm or LDH &lt; 2.5 x ULN and prior therapy with BRAF/MEK inhibitors allowed. Patients were treated with either rIL-21, 30 µg /kg/day dose IV daily x 5 days weeks 1, 3, 5 q 8 weeks or dacarbazine (DTIC) 1000 mg/m2 IV q 3 weeks. The primary objective was to compare progression free survival (PFS). The trial was designed to detect a hazard ratio of 1.75 with one-sided alpha of 0.1; 58 progression events were required to provide 80% power. Results: 64 patients were randomized, 32 in the rIL-21 arm and 32 in the DTIC arm. The Table summarizes key demographic and efficacy endpoints. Common rIl21 related adverse events were fatigue, rash, diarrhea, nausea, myalgia and elevated liver enzymes. At least one dose reduction/ interruption or discontinuation occurred in 32 (100%) and 27 (96.4%) of rIL21 and DTIC patients. Conclusions: Despite encouraging efficacy in prior phase I/II studies, the results suggest that rIL-21 is comparable to DTIC in this patient population. Additional biomarker analysis from this study is pending and combination studies are currently ongoing. Clinical trial information: NCT00514085. [Table: see text]