Pretherapeutic Assessment Research Articles

Frailty und ihre Bedeutung in der Kopf-Hals-Onkologie

Since treatment of elderly patients with head and neck cancer is often challenging due to preexisting comorbidities, continuous efforts are required to raise awareness for frailty, which is a multidimensional state of diminished physiologic reserve resulting in decreased resiliency and increased vulnerability to stressors. Frailty is a predictor of poor clinical outcomes in head and neck cancer patients, but until now there is no standardization of frailty assessment. Pretherapeutic frailty assessment among head and neck cancer patients should be incorporated into routine multidisciplinary management to predict adverse outcomes and tailor a personalized treatment. This article would like to explain the complex syndrome frailty and its importance for head and neck oncology.

Pretherapeutic Assessment of Pancreatic Cancer: Comparison of FDG PET/CT Plus Delayed PET/MR and Contrast-Enhanced CT/MR.

PurposeThis study aims to determine the diagnostic performance of whole-body FDG PET/CT plus delayed abdomen PET/MR imaging in the pretherapeutic assessment of pancreatic cancer in comparison with that of contrast-enhanced (CE)-CT/MR imaging.Materials and MethodsForty patients with pancreatic cancer underwent nonenhanced whole-body FDG PET/CT, delayed abdomen PET/MR imaging, and CE-CT/MR imaging. Two nuclear medicine physicians independently reviewed these images and discussed to reach a consensus, determining tumor resectability according to a 5-point scale, N stage (N0 or N positive), and M stage (M0 or M1). With use of clinical-surgical-pathologic findings as the reference standard, diagnostic performances of the two imaging sets were compared by using the McNemar test.ResultsThe diagnostic performance of FDG PET/CT plus delayed PET/MR imaging was not significantly different from that of CE-CT/MR imaging in the assessment of tumor resectability [area under the receiver operating characteristic curve: 0.927 vs. 0.925 (p = 0.975)], N stage (accuracy: 80% (16 of 20 patients) vs. 55% (11 of 20 patients), p = 0.125), and M stage (accuracy: 100% (40 of 40 patients) vs. 93% (37 of 40 patients), p = 0.250). Moreover, 14 of 40 patients had liver metastases. The number of liver metastases detected by CE-CT/MR imaging, PET/CT, and PET/MR imaging were 33, 18, and 61, respectively. Compared with CE-CT/MR imaging, PET/MR imaging resulted in additional findings of more liver metastases in 9/14 patients, of which 3 patients were upstaged. Compared with PET/CT, PET/MR imaging resulted in additional findings of more liver metastases in 12/14 patients, of which 6 patients were upstaged.ConclusionsAlthough FDG PET/CT plus delayed PET/MR imaging showed a diagnostic performance similar to that of CE-CT/MR imaging in the pretherapeutic assessment of the resectability and staging of pancreatic tumors, it still has potential as the more efficient and reasonable work-up approach for the additional value of metastatic information provided by delayed PET/MR imaging.

High-frequency ultrasound: an essential non-invasive tool for the pre-therapeutic assessment of basal cell carcinoma.

Aim: While histology remains the “gold standard” for cutaneous tumoral pathology, high-frequency ultrasound (HFUS) was shown to play a significant role in the non-invasive, pre-therapeutic assessment of skin tumors. The aim of our study was to determine whether there is a significant correlation between the ultrasound (US) and histological measurements of basal cell carcinoma (BCC) tumor depth. Materials and Methods: The present study retrospectively analyzed clinical, dermoscopy, HFUS and histological examinations of 90 patients (52 men and 38 women) with histologically confirmed BCC, with focus on tumor depth index (DI). Results: On clinical examination, 54 lesions were nodular (32 presented ulcerations) and 36 superficial lesions. Dermoscopy showed suggestive signs of BCC, most frequently “in focus” arborising superficial vessels (n=81), blue-grey ovoid nests (n=48) and specks of brown pigment (n=7). HFUS revealed well-defined (n=88) or poorly defined (n=2) hypoechoic, vascularized lesions, with inhomogeneous structure (n=90) and characteristic hyperechoic dots (n=36). A strong correlation (Pearson’s r=0.92) between the HFUS (mean measured US depth = 1.33 mm) and histological (mean measured histological depth = 1.47 mm) DI of the investigated skin lesions was found, although significant differences (p<0.001 – t-test for paired samples) between the two measurements were observed. Conclusions: HFUS provides reliable information about BCC depth of invasion that cannot be otherwise obtained prior to surgery. In this manner, it completes the preclinical evaluation and can have an impact on the choice of the optimal therapeutic method.

Bone and Intramuscular Hydatid Cysts: A Rare Association

<i>Background:</i> Hydatidosis is a parasitic disease linked to the development of Echinococcus Granulosus larval form in humans. This anthropozoonosis is characterized by many topographical and evolutionary aspects. Musculoskeletal hydatidosis is rare, it represents only 0.9 to 2.5% of all locations. <i>Objective:</i> the aim of this manuscript is to report a rare case of bone and muscle location of hydatid cyst and show the imaging contribution in its positive diagnosis and pre-therapeutic assessment. <i>Method:</i> We report the observation of a 61-year-old man admitted to our training for a right thigh mass, revealing a muscular hydatid cyst with a concomitant iliac bone location. <i>Result:</i> Ultrasound examination shows an intra muscular cystic lesion, of the Sartorius and rectus femoris muscles, with hydatid membranes inside. A simultaneous bone location, at the ipsilateral iliac bone, was fortuitously discovered on CT scan and MRI exploration, which show a multicystic lytic lesion with cystic signal and round daughter cysts on MRI examination. A complementary X-ray of the pelvis shows the classic "honeycomb" appearance of the right iliac bone. A positive hydatid serology confirmed the diagnosis. No concomitant hepatic or pulmonary localization was demonstrated on abdominal ultrasound and chest CT scan. An anthelminthic therapy (Albendazole) was started, and the patient was a candidate for further surgical treatment. <i>Conclusion:</i> Musculoskeletal hydatid cyst location is rare. The Hydatid osteopathy is usually infiltrative, slow and progressive, which makes diagnosis late and compromises the quality of treatment. So, despite its rarity; musculoskeletal hydatid cyst should always be considered in the differential diagnosis of cystic lesions in endemic areas.

Reliability of Medical Imaging in the Pre-Therapeutic Assessment of Acute Intestinal Obstruction at the Centre Hospitalier Universitaire Du Point “G”

Introduction: Acute intestinal obstruction is a serious pathology, a surgical emergency for which medical imaging plays an important role in the management. We initiated this work in order to study the contribution of imaging in the diagnosis of acute intestinal obstruction at the Point-G University Hospital. Patients and Methods: This was a prospective, descriptive and analytical study of 96 patients collected at the radiology and medical imaging department of CHU Point-G from January 2018 to January 2019. Results: The age of our patients varied from 11 to 86 years, with an average of 36 years old. There was a male predominance of 64.6% against 35.4% for women, i.e., a sex ratio of 1.82. Previous surgery was found in 61.5% of our patients. The pain was present in all patients. An unprepared abdominal X-ray was performed in 89.6% of patients. Hydroaerobic levels were found in 96.5% of patients. Abdominopelvic CT scans were performed on 12 patients, all of whom were diagnosed with occlusion. These positive diagnostic findings were consistent with intraoperative findings in 92% of cases. The causes were dominated by bridges in 46 patients and tumors in 9 patients. Signs of severity on CT were dominated by signs of distress of the upstream bile ducts in 8.3%. Exactly 8% of our patients spontaneously resumed transit, 91% received surgical treatment and 1% died before surgery. The outcome was favorable in 80 patients (83.3%) and poor with death in 16 patients (16.7%). Conclusion: Acute intestinal obstruction remains a serious pathology for which the X-ray of the PSA is often the only radiological examination performed in an emergency. However, abdominopelvic CT seems to us to be widely indicated thanks to its contribution both to the positive diagnosis and to the diagnosis of severity and etiology. However, this imaging technique is widely underused in our practice because of its high cost and lack of availability.

Safety and Efficacy of Venetoclax-Based Treatment in Elderly CLL Patients: A Retrospective Study from the Filo Group

Median age at diagnosis of chronic lymphocytic leukemia is 72 years. However, only few patients over 80 years of age are included in clinical trials, even in those devoted to unfit patients. In order to evaluate both efficiency and safety of venetoclax in this category of patients, we conducted a multicentric retrospective study and collected data from 77 CLL patients from 19 FILO centers who started venetoclax after 80 years of age.Median age at venetoclax initiation was 86 years old (81-97). 63% of patients had a history of heart disease, 62% had renal failure (moderate 59% and severe 3%) and 29% had a history of severe infections. Despite their comorbidities and a CIRS greater than 6 in 70% of cases, their autonomy was preserved with a median performans status of 1 (0-4). In this comorbid geriatric population, pretherapeutic geriatric assessment was only performed in a single patient. The median number of prior therapies was 2 (0-6) with an exposure to a BCR inhibitor in 56% of cases. 11q and 17p deletion were found in 39% and 30% of cases respectively, 39% of patients had a complex karyotype and 30% harbored a TP53 mutation. However, in this real life population, these prognostic factors were only performed in half of patients. IGHV mutational status was only available in 11 patients, and 83% of them had unmutated IGHV. At the time of venetoclax initiation, the tumor lysis syndrome (TLS) risk was moderate in 57% of cases and high in 8% of cases. Venetoclax was administered as a single agent (42%) or in association with rituximab (58%). In total, half of the patients were hospitalized at each dose ramp-up, and only 3 patients were treated on outpatient basis. 82% of the cohort was able to reach the daily dose of 400mg. Half of the patients were included in a phone call monitoring program with oncology nurses to pre-emptively manage side effects and foster therapy adherence. The safety study reported 14% of TLS, with 2 discontinuations of treatment within the first month: one of which led to dialysis and the other to death. As in the previously published studies, 25% of patients had infectious complications, and grade 3 haematological and digestive toxicities were reported in 42% and 22% of cases, respectively. The reduction of the daily dose of venetoclax was necessary for 33%. Permanent discontinuation of venetoclax occurred in 40% of subjects, including 29% of early withdrawal (within the first 3 months). Main reasons for discontinuation were intolerance (21%), CLL progression (21%), death (21%) and scheduled treatment discontinuation (10%). The overall response rate was 86%, consisting of 49% of complete response (unconfirmed by bone marrow biopsy) and 37% of partial response. With a median follow-up of 21months, estimated progression free survival and overall survival were 29 and 38 months respectively. Prior exposure to a BCR inhibitor had no impact on progression free survival.To conclude, venetoclax has a manageable safety profile in elderly patients with comorbidities and can induce prolonged responses. Finally, if additional follow-up by oncology nurses seems to be more and more implemented, the pre-therapeutic onco-geriatric evaluation remains underexploited in this population. DisclosuresFerrant: AstraZeneca: Honoraria; AbbVie: Honoraria, Other: Travel, Accommodations, Expenses; Janssen: Other: Travel, Accommodations, Expenses. Feugier: Janssen: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Amgen: Honoraria; Astrazeneca: Consultancy, Honoraria. Laribi: AstraZeneca: Other: Personal Fees; Le Mans Hospital: Research Funding; AbbVie: Other: Personal Fees, Research Funding; Jansen: Research Funding; Novartis: Other: Personal Fees, Research Funding; IQONE: Other: Personal Fees; Astellas Phama, Inc.: Other: Personal Fees; BeiGene: Other: Personal Fees; Takeda: Other: Personal Fees, Research Funding. Tchernonog: JANSSEN: Consultancy; ABBVIE: Consultancy; ASTRAZENECA: Consultancy. Dartigeas: Astra-Zeneca: Membership on an entity's Board of Directors or advisory committees, Other: travel grants/Congress; Abbvie: Membership on an entity's Board of Directors or advisory committees, Other: travel grants/Congress; Janssen: Membership on an entity's Board of Directors or advisory committees, Other: travel grants/Congress. Quinquenel: Abbvie: Honoraria; Janssen: Honoraria; AstraZeneca: Honoraria.

The Role of FDG-PET/CT in Staging of Breast Cancer

Abstract Background Breast cancer is the most common non-skin cancer and the second leading cause of cancer related death in women. Breast cancer strikes women of all ages, races, ethnicities, socioeconomic strata, and geographic locales. Once breast cancer is diagnosed, the tumor stage has to be accurately determined before therapy chosen and the prognosis known. Aim of the Work to highlight the role of PET-CT imaging in staging of patients with breast cancer. Patients and Methods This study was carried out on a total of 51 female patients biopsy-proved to have cancer breast coming to perform PET/CT scans for staging, pre-operative or pre-therapeutic assessment with ages ranging from 27 to 78 years, in specialized private center in Cairo using combined PET-CT machine (Phillips Ingenuity TF PET/CT 128 Slice) from October 2017 to June 2019. Results Combined PET/CT staged 3 patients as stage IA, 10 patients as stage IIA, 6 patients as stage IIB, 2 patients as stage IIIA, 3 patients as stage IIIB, 2 patients as stage IIIC and 25 patients as stage IV. Out of 51 patients, combined PET/CT upgraded the staging of 13 patients compared to initial CT staging. Conclusion PET/CT is the technique of choice and indispensable tool for evaluation of the patients with breast cancer.

Surgical management of recto-vaginal fistula (about 6 cases).

IntroductionRecto-vaginal fistula (RVF) is defined as a pathological epithelialized communication between the posterior wall of the vagina and the anterior wall of the rectum through the recto-vaginal septum. RVFs are rare and represent less than 5% of rectal fistulas. Occurring after childbirth or during a proctological pathology, they create a deep distress for the patients. The aim of our work is to analyze the epidemiological particularities and the risk factors of occurrence of RVF as well as the modalities and results of our therapeutic management.Materials and methodsOur work is retrospective analytic and comparative concerning 6 cases operated in the department of general surgery 3 of the UHC Ibn Rochd of Casablanca for recto vaginal fistula or recidive over a period of 7 years from 2012 to 2018.ResultsThe analysis of the results of our study allowed us to note: A frequency of occurrence of RVF of about 0.48%. The average age at diagnosis was 55 in our patients. The etiologies were dominated by post-radiation (33.33%) and post-operative (16.66%) RVFs. The predominant mode of delivery in our study was vaginal delivery (83.33%). The antecedents were dominated by pelvic irradiation in 50% of patients, and pelvic surgery for cervical cancer and/or rectal cancer (50%). The diagnosis was revealed by a vaginal stool output in all patients. Surgical treatment was performed in all our patients. The surgical technique of choice in our series was drainage by Stenon, in 83.33% of patients. A protective stoma was performed in all our patients studied, a colostomy in 66.66%, and an ileostomy in 33.33% of patients. The immediate postoperative evolution was excellent in all our patients, while the short- and medium-term evolution revealed the occurrence of recurrence in one third of the patients (33.33%). The treatment of choice for recurrence was the interposition of a pedicled fat flap of the labia majora, known as the modified Martius technique. The morbidity, represented mainly by recurrence, was 25%, with a mortality rate of 0%.DiscussionThe occurrence of RVF in all its etiologies seems to be infrequent. However, its real incidence remains poorly documented in the literature, it varies between 0.3% and 15.3%. RVFs are considered simple or complex depending on their size, location and etiology. The high or low location and the etiology of the RVF determine the choice of the approach during surgical management. The diagnosis is most often clinical. The examination will try to find the cause of the RVF and the associated lesions. RVF can be asymptomatic. The importance of the symptoms depends on the topography of the fistula, the diameter of the orifice, and the quality of the intestinal transit. No additional investigations are required to confirm the diagnosis of RVF, since the positive diagnosis is essentially clinical. However, in the case of a high or complex fistula, the clinician can support his or her pre-therapeutic assessment with the exploration of imaging data, especially those of the digestive opacification, MRI and pelvic CT. The causes of RVFs are multiple. However, their proportions are difficult to establish. Post-obstetrical RVFs, those due to Crohn's disease, and post-op are probably the most frequent. The literature describes a variety of surgical approaches and treatment options for RVF. However, there are no treatment recommendations. The available data are vague and do not define an optimal treatment. Medical treatment with antibiotics and sitz baths is often necessary to control the local infection. The surgical management of RVFs is complex and follows several principles. The therapeutic arsenal is very varied and constitutes a real “escalation”, ranging from simple drainage by suture to the radical treatment represented by abdominal-pelvic amputation. The results of the treatment of simple VF are excellent in all studies. The healing rate varies from 75 to 100% depending on the authors.ConclusionThe results of this study confirm the low incidence of RVF, and show that vaginal delivery and a history of pelvic surgery (for rectal or cervical cancer) are the most frequent predictors of RVF. Thus, from a therapeutic point of view, medical treatment is always required, it allows the flow of the fistula to be reduced, which facilitates preparation for the surgical procedure.

Three-dimensional nuclear magnetic resonance spectroscopy: a complementary tool to multiparametric magnetic resonance imaging in the identification of aggressive prostate cancer at 3.0T.

The limitations of the assessment of tumor aggressiveness by Prostate Imaging Reporting and Data System (PI-RADS) and biopsies suggest that the diagnostic algorithm could be improved by quantitative measurements in some chosen indications. We assessed the tumor high-risk predictive performance of 3.0 Tesla (3.0T) multiparametric magnetic resonance imaging (mp-MRI) combined with nuclear magnetic resonance spectroscopic sequences (NMR-S) in order to show that the metabolic analysis could bring out an evocative result for the aggressive form of prostate cancer. We conducted a retrospective study of 26 patients (mean age, 62.4 years) who had surgery for prostate cancer between 2009 and 2016 after pre-therapeutic assessment with 3.0T mp-MRI and NMR-S. Groups within the intermediate range of the D'Amico risk classification were divided into two categories, low risk (n=20) and high risk (n=6), according to the International Society of Urological Pathology (ISUP) 2-3 limit. Histoprognostic discordances within various risk groups were compared with the corresponding predictive MRI values. The performance of predictive models was assessed based on sensitivity, specificity, and the area under the curve (AUC) of receiver operating characteristic (ROC) curves. After prostatectomy, histological analysis reclassified 18 patients as high-risk, including 16 who were T3 MRI grade, of whom 13 (81.3%) were found to be pT3. Among the patients who had cT1 or cT2 digital rectal examinations, the T3 MRI factor multiplied by 8.7 [odds ratio (OR), 8.7; 95% confidence interval (CI), 1.3-56.2; P=0.024] the relative risk of being pT3 and by 5.8 (OR, 5.8; 95% CI, 0.95-35.7; P=0.05) the relative risk of being pGleason (pGS) > GS-prostate biopsy. Spectroscopic data showed that the choline concentration was significantly higher (P=0.001) in aggressive disease. The predictive model of tumor aggressiveness combining mp-MRI plus NMR-S was better than the mp-MRI model alone (AUC, 0.95 vs. 0.86). Information obtained by mp-MRI coupled with spectroscopy may improve the detection of occult aggressive disease, helping in the discrimination of intermediate risks.

Fortuitous discovery of melanomas in the ENT Department - a histopathological and immunohistochemical study.

The melanoma, having its origin in the melanocyte cells, is one of the most aggressive forms of skin cancer in the world with one of the highest rates of brain metastasis. The incidence of cutaneous melanoma in the Mediterranean countries varies from three to five cases/100 000 people/year. Its prognosis is based on an early diagnosis. Sinonasal mucosal melanoma (SNMM) is an extremely rare tumor, accounting for 0.3–2% of all melanomas. The non-specific symptomatology is often delaying the presentation of the patient at the hospital and therefore the diagnosis. The SNMM is a highly aggressive tumor, and the presence of metastasis at the diagnosis usually implies a poor prognosis. The management of the melanomas requires a precise pre-therapeutic assessment and a multidisciplinary approach for the diagnosis, with surgical treatment or radiotherapy required in order to ensure a better a quality of life. In this paper, we retrospectively analyzed two cases of mucosal melanoma and one case of cutaneous melanoma of the nose.

Systemic inflammation and pro-inflammatory cytokine profile predict response to checkpoint inhibitor treatment in NSCLC: a prospective study

Treatment with single agent immune checkpoint inhibitors (ICIs) has tremendously changed second line therapy in NSCLC. However, there are still no reliable biomarkers predicting response and survival in this group of patients. PD-L1 revealed to be a correlating, but no perfect marker. Therefore, we sought to investigate in this prospective study, whether inflammation status and cytokine profile could serve as additional biomarkers guiding treatment decision for single agent ICIs in NSCLC. 29 stage IV NSCLC patients receiving single agent PD-1 checkpoint-inhibitor in second line were prospectively enrolled. Inflammatory scores and cytokine profiles (IL-6, IL-8, IL-10, IFN-γ and TNFα) have been obtained before treatment and at the time of the first staging. Cytokine profiles were correlated with response and survival. Patients with signs of pre-therapeutic inflammation (elevated, NLR, SII, IL-6, IL-8) showed significantly lower response to ICI treatment and reduced PFS. Contrary, elevated levels of IFN-γ revealed to characterize a subgroup of patients, who significantly benefits from ICI treatment. Furthermore, low systemic inflammation and high levels of IFN-γ characterized patients with long term-response to ICI treatment. Pre-therapeutic assessment of inflammation and cytokine profiles has the ability to predict response and survival in NSCLC patients treated with single agent ICIs.

Anti-Tnf Side Effects in the Treatment of Chronic Inflammatory Bowel Disease

IBD is a common, serious and disabling chronic digestive disease, Their different manifestations, whether digestive and extra-digestive, require a multi-professional care adapted to each specific patient. Anti-TNFs are now an essential therapeutic weapon in the management of inflammatory bowel disease (IBD). Their effectiveness in both the short and long term has been demonstrated in various studies. However short and long term anti-tnf results vary from patient to patient which can be explained in many cases by the significant number of discontinued treatment in patients that experience side effects. The purpose of our work is to study the different side effects occurring in patients under biotherapy, the management of these side effects and their prevention. We prospectively analyzed since four years the medical records of 54 IBD patients who received anti-TNF treatment. An exhaustive pre-therapeutic assessment was performed systematically in all patients. A clinical and biological control was carried out systematically before each therapeutic administration to search for undesirable reactions. Side effects were classified into several categories including immediate hypersensitivity reactions, dermatological complications, infectious, neurological, haematological, neoplasic and cardiac complications. During this period, 54 patients were treated with biotherapies, representing 24.2% of all IBD patients. We observed 29 side effects, an incidence of 46% including two severe effects 3.5%, occurring on average after one month of treatment. The hematological undesirable effects were the most frequent appeared in 14 patients (26%), severe infection specifically tuberculosis appeared in 2 patients (3.6%), allergic effects were severe in only one case (anaphylactic shock), finally the secondary cutaneous lesions of Anti-TNF were observed in a single patient (extensive psoriasis). Severe adverse reactions led to permanent discontinuation of Anti-TNF in 24.1% of cases. The use of anti-TNF treatment is likely to generate numerous undesirable effects, hence the advantage of respecting the recommendations relating to the assessment before any treatment with biotherapy and of making regular clinical follow-up during treatment with a meticulous clinical examination as well as biological monitoring in order to prevent the occurrence of these complications, and to manage them correctly once they appear.

Anti-Tnf Side Effects in the Treatment of Chronic Inflammatory Bowel Disease

IBD is a common, serious and disabling chronic digestive disease, Their different manifestations, whether digestive and extra-digestive, require a multi-professional care adapted to each specific patient. Anti-TNFs are now an essential therapeutic weapon in the management of inflammatory bowel disease (IBD). Their effectiveness in both the short and long term has been demonstrated in various studies. However short and long term anti-tnf results vary from patient to patient which can be explained in many cases by the significant number of discontinued treatment in patients that experience side effects. The purpose of our work is to study the different side effects occurring in patients under biotherapy, the management of these side effects and their prevention. We prospectively analyzed since four years the medical records of 54 IBD patients who received anti-TNF treatment. An exhaustive pre-therapeutic assessment was performed systematically in all patients. A clinical and biological control was carried out systematically before each therapeutic administration to search for undesirable reactions. Side effects were classified into several categories including immediate hypersensitivity reactions, dermatological complications, infectious, neurological, haematological, neoplasic and cardiac complications. During this period, 54 patients were treated with biotherapies, representing 24.2% of all IBD patients. We observed 29 side effects, an incidence of 46% including two severe effects 3.5%, occurring on average after one month of treatment. The hematological undesirable effects were the most frequent appeared in 14 patients (26%), severe infection specifically tuberculosis appeared in 2 patients (3.6%), allergic effects were severe in only one case (anaphylactic shock), finally the secondary cutaneous lesions of Anti-TNF were observed in a single patient (extensive psoriasis). Severe adverse reactions led to permanent discontinuation of Anti-TNF in 24.1% of cases. The use of anti-TNF treatment is likely to generate numerous undesirable effects, hence the advantage of respecting the recommendations relating to the assessment before any treatment with biotherapy and of making regular clinical follow-up during treatment with a meticulous clinical examination as well as biological monitoring in order to prevent the occurrence of these complications, and to manage them correctly once they appear.

Reliability and accuracy of time-resolved contrast-enhanced magnetic resonance angiography in hypervascular spinal metastases prior embolization.

Preoperative embolization of hypervascular spinal metastases (HSM) is efficient to reduce perioperative bleeding. However, intra-arterial digital subtraction angiography (IA-DSA) must confirm the hypervascular nature and rule out spinal cord arterial feeders. This study aimed to evaluate the reliability and accuracy of time-resolved contrast-enhanced magnetic resonance angiography (TR-CE-MRA) in assessing HSM prior to embolization. All consecutive patients referred for preoperative embolization of an HSM were prospectively included. TR-CE-MRA sequences and selective IA-DSA were performed prior to embolization. Two readers independently reviewed imaging data to grade tumor vascularity (using a 3-grade and a dichotomized "yes vs no" scale) and identify the arterial supply of the spinal cord. Interobserver and intermodality agreements were estimated using kappa statistics. Thirty patients included between 2016 and 2019 were assessed for 55 levels. Interobserver agreement was moderate (κ = 0.52; 95% CI [0.09-0.81]) for TR-CE-MRA. Intermodality agreement between TR-CE-MRA and IA-DSA was good (κ = 0.74; 95% CI [0.37-1.00]). TR-CE-MRA had a sensitivity of 97.9%, a specificity of 71.4%, a positive predictive value of 95.9%, a negative predictive value of 83.3%, and an overall accuracy of 94.6%, for differentiating hypervascular from non-hypervascular SM. The arterial supply of the spine was assessable in 2/30 (6.7%) cases with no interobserver agreement (κ < 0). TR-CE-MRA can reliably differentiate hypervascular from non-hypervascular SM and thereby avoid futile IA-DSAs. However, TR-CE-MRA was not able to evaluate the vascular supply of the spinal cord at the target levels, thus limiting its scope as a pretherapeutic assessment tool. • TR-CE-MRA aids in distinguishing hypervascular from non-hypervascular spinal metastases. • TR-CE-MRA could avoid one-quarter of patients referred for HSM embolization to undergo futile conventional angiography. • TR-CE-MRA's spatial resolution is insufficient to replace IA-DSA in the pretherapeutic assessment of the spinal cord vascular anatomy.

Pre-therapeutic microglia activation and sex determine therapy effects of chronic immunomodulation.

Modulation of the innate immune system is emerging as a promising therapeutic strategy against Alzheimer's disease (AD). However, determinants of a beneficial therapeutic effect are ill-understood. Thus, we investigated the potential of 18 kDa translocator protein positron-emission-tomography (TSPO-PET) for assessment of microglial activation in mouse brain before and during chronic immunomodulation.Methods: Serial TSPO-PET was performed during five months of chronic microglia modulation by stimulation of the peroxisome proliferator-activated receptor (PPAR)-γ with pioglitazone in two different mouse models of AD (PS2APP, AppNL-G-F). Using mixed statistical models on longitudinal TSPO-PET data, we tested for effects of therapy and sex on treatment response. We tested correlations of baseline with longitudinal measures of TSPO-PET, and correlations between PET results with spatial learning performance and β-amyloid accumulation of individual mice. Immunohistochemistry was used to determine the molecular source of the TSPO-PET signal.Results: Pioglitazone-treated female PS2APP and AppNL-G-F mice showed attenuation of the longitudinal increases in TSPO-PET signal when compared to vehicle controls, whereas treated male AppNL-G-F mice showed the opposite effect. Baseline TSPO-PET strongly predicted changes in microglial activation in treated mice (R = -0.874, p < 0.0001) but not in vehicle controls (R = -0.356, p = 0.081). Reduced TSPO-PET signal upon pharmacological treatment was associated with better spatial learning despite higher fibrillar β-amyloid accumulation. Immunohistochemistry confirmed activated microglia to be the source of the TSPO-PET signal (R = 0.952, p < 0.0001).Conclusion: TSPO-PET represents a sensitive biomarker for monitoring of immunomodulation and closely reflects activated microglia. Sex and pre-therapeutic assessment of baseline microglial activation predict individual immunomodulation effects and may serve for responder stratification.

Evaluation of Pre-Therapeutic Assessment in Endometrial Cancer Staging.

Objective: The aim of this retrospective cohort study is to evaluate the concordance between the preoperative MRI and histology data with the final histopathological examination. Method: This is a retrospective observational study of 183 patients operated for endometrioid cancer between January 2009 and December 2019 in the surgical oncology department of the Lorraine Cancer Institute (ICL) in Vandœuvre-lès-Nancy. The patients included are all women operated on for endometrioid-type endometrial cancer over this period. The exclusion criteria are patients for whom the pre-therapy check-up does not include pelvic MRI and those who have not had first-line surgery. The final anatomopathological results were compared with preoperative imaging data and with endometrial biopsy data. Results: For the myometrial infiltration, the sensitivity of MRI was of 37% and the specificity of 54%. To detect nodal metastases, the sensitivity of MRI was of 21% and the specificity of 93%. We observed an under estimation of the FIGO classification (p = 0.001) with the MRI in 42.7% of cases (n = 76) and an overestimation in 24.2% of cases (n = 43). There was a concordance in 33.1% of cases (n = 59). We had a poor agreement between the MRI and final histopathological examination with an adjusted kappa (κ) of 0.12 [95% IC (0.02; 0.24)]. There was a moderate concordance on the grade between the pretherapeutic biopsy and the final histopathological examination on excised tissue with an adjusted kappa of 0.52 [95% IC 0.42–0.62)]. Endometrial biopsy underestimated the tumor grade in 28.9% of cases (n = 50) (p < 0.001), overestimated the tumor grade in 6.9% of cases (n = 12) and we observed a concordance in 64.2% of cases (n = 111). Conclusion: The pre-operative assessment of endometrial cancer is inconsistent with the results obtained on final histopathological examination. A study with a systematic review should be done to assess the performance of MRI, only in expert centers, in order to consider a a specific care management for endometrial cancer patients: patients who have had an MRI in an outpatient center should have their imaging systematically reviewed, with the possibility of a new examination in case of incomplete sequences, by expert radiologists, and discussed in multidisciplinary concertation meeting in expert centers, before any therapeutic decision. The sentinel node biopsy must be used for low and intermediate risk endometrial cancer.

Value of spectral detector CT for pretherapeutic, locoregional assessment of esophageal cancer

PurposeTo investigate the diagnostic value of spectral detector dual-energy CT-derived low-keV virtual monoenergetic images (VMI) and iodine overlays (IO) for locoregional, pretherapeutic assessment of esophageal cancer. Method74 patients with biopsy-proven esophageal cancer who underwent pre-therapeutic, portal-venous-phase staging examinations of the chest and abdomen were retrospectively included. Quantitative image analysis was performed ROI-based within the tumor, healthy esophageal wall, peri-esophageal lymph nodes, azygos vein, aorta, liver, diaphragm, and mediastinal fat. Two radiologists evaluated delineation of the primary tumor and locoregional lymph nodes, assessment of the celiac trunk and diagnostic certainty regarding tumor infiltration in conventional images (CI), VMI from 40 to 70 keV and IO. Moreover, presence/absence of advanced tumor infiltration (T3/T4) was determined binary using all available images. ResultsVMI40−60keV showed significantly higher attenuation and signal-to-noise ratio compared to CI for all assessed ROIs, peaking at VMI40keV (p < 0.05). Contrast-to-noise ratio of tumor/esophagus (VMI40keV/CI: 7.7 ± 4.7 vs. 2.3 ± 1.5), tumor/diaphragm (VMI40keV/CI: 9.0 ± 5.5 vs. 2.2 ± 1.7) and tumor/liver (4.3 ± 5.5 vs. 1.9 ± 2.1) were all significantly higher compared to CI (p < 0.05). Qualitatively, lymph node delineation and diagnostic certainty regarding tumor infiltration received highest ratings both in IO and VMI40keV, whereas vascular assessment was rated highest in VMI40keV and primary tumor delineation in IO. Sensitivity/Specificity/Accuracy for detecting advanced tumor infiltration using the combination of CI, VMI40−70keV and IO was 42.4 %/82.0 %/56.3 %. ConclusionsIO and VMI40−60keV improve qualitative assessment of the primary tumor and depiction of lymph nodes and vessels at pretherapeutic SDCT of esophageal cancer patients yet do not mitigate the limitations of CT in determining tumor infiltration.

Anatomical variants of the celiac trunk

Determine the anatomical variants of the celiac trunk and describe it in its modal form using a scanner. In total, 200 patients were included in this study. The study was carried out using a multi-detector scanner (SIEMENS Somatom Emotion Excel Edition, 16 bars). The two-dimensional and three-dimensional reconstructions by volume were made with the OSIRIX software. It was a retrospective study. The study had taken into account the result of the abdominal scanners injected carried out from December 15, 2018 to February 15, 2019 i.e. 14 months (1 year 2 months). A predominance of type I of UFLACKER is 93.50% with a rate of change from normal of 6.50%. A vertebral projection of the origin of the celiac trunk at the level of the T12-L1 intervertebral disc was observed in 52.80%. An existence of collateral branches in 7.5% of cases. Other terminal branches apart from the three classics were found in 8.5% of the cases. These variants deserve special attention in the case of a pre-therapeutic vascular assessment for the surgical or interventional management of tumors and trauma of the supra-meso-colic viscera or even for organ transplantation.

Predictive value of suvmax changes between two sequential post-therapeutic FDG-pet in head and neck squamous cell carcinomas

18-flurodesoxyglucose position emission tomography (FDG-PET) with computed tomography (CT) or magnetic resonance imaging (MRI) is a broadly accepted tool for pretherapeutic staging and post-therapeutic assessment of response. The prognostic value of sequential post-therapeutic FDG-PETs and the impact of change in metabolic activity has been scarcely reported so far. We hypothesized that an increase in metabolic activity (as measured by maximum standardized uptake value, SUVmax) would be predictive for recurrence. We retrospectively assessed all oral, oropharyngeal, laryngeal, and hypopharyngeal squamous cell carcinoma patients treated at the Department of Otorhinolaryngology—Head and Neck Surgery, University Hospital Zurich between April 1st, 2010 and September 30th, 2018 (N = 337). After a negative post-treatment FDG-PET at 3 months, we measured the SUVmax of the local tumor area and the regional lymph nodes on follow-up FDG-PET at 9 months. We then correlated SUVmax difference between 9 and 3 months with tumor recurrence using Kaplan Meier analysis. During follow-up, 68 patients (20.2%) had local recurrence and 53 had regional recurrence (15.7%) at a median time of 9.0 (IQR 4.25–14) and 7.0 (IQR 5.25–23) months, respectively. An increase in local and/or regional SUVmax from the 3 months to the 9 months post-therapeutic FDG-PET resulted in a poorer recurrence-free survival (Log rank, P = 0.001, for both). An increase in local SUVmax between 3 and 9 months was associated with a hazard ratio of 4.17 for recurrence (95%CI 1.89–9.2, P = 0.0003). In conclusion, an increase in metabolic activity/SUVmax between two post-therapeutic FDG-PETs requires a histological examination as it is associated with tumor recurrence.

Pre-therapeutic assessment of chronic lymphocytic leukemia: which genetic assessment and why?

Pre-therapeutic assessment of chronic lymphocytic leukemia: which genetic assessment and why?