Proven Malignancy Research Articles

A prospective study to assess the quality of life (QOL) in breast cancer patients and factors affecting quality of life

IntroductionBreast cancer is the most prevalent malignancy among women globally, with an incidence rate of 11.7 %, surpassing lung cancer as the most frequently diagnosed cancer. In India, incidence rates begin to increase in the early thirties, peaking between the ages of 50 and 64. Historically, the female population has harbored significant fear towards this particular cancer due to the social stigma associated with the diagnosis. It not only poses a challenge to their self-image but also affects their sexual function, consequently having a negative impact on their psychological well-being. Recent advancements in treatment delivery techniques have decreased breast cancer mortality and enhanced disease-free survival rates. However, ensuring a good quality of life (QOL) remains a challenge. This study was conducted to assess the QOL of breast cancer patients and the factors influencing it. MaterialsPatients with histopathological proven malignancy of breast carcinoma aged above 18 years who were registered in our radiotherapy department were included in this cross-sectional study. Patient related, disease related and treatment related parameters were noted. QOL survey instruments used were EORTC-QLQ-C30 version 3.0, EORTC-QLQ-BR23. ResultsA total of 160 patients registered in our department from November 2019 to November 2022 were included in this study. The young breast (<45 years) cancer patients showed comparable QOL scores with older patients on most symptomatic and functional scales. The patients with an advanced disease had lowest scores on all functional scales but was not statistically significant. Breast conserving surgery (BCS) correlated very well with better functioning scores in our study though it did not achieve statistical significance. Patients undergoing BCS seemed more confident about their future prospectives and had better sexual enjoyment score. People living in urban area scored higher in both scales. ConclusionThis study indicates that QOL of breast cancer patients is closely linked to clinical and sociodemographic factors. Providing financial and psychological support to patients diagnosed with breast cancer may further enhance their QOL.

Mucocutaneous Manifestations among Patients with Malignancies at a Tertiary Care Center in Maharashtra: A Cross-Sectional Study

Abstract Background: Malignant disorders are a leading cause of mortality and morbidity. Cutaneous manifestations may be presenting features of internal malignancies, leading to diagnosis of occult tumors, while others may occur as adverse reactions to therapeutic modalities. Aims and Objectives: To classify cutaneous manifestations among patients with malignant disorders, document their clinical profile, and analyze them with respect to age, gender, type of malignancy, and treatment. Materials and Methods: One hundred twenty patients with proven malignancy presenting with mucocutaneous lesions were enrolled in the cross-sectional study. On the basis of history, clinical examination, investigations and skin biopsy, the lesions were classified as (1) Primary cutaneous malignancy, (2) Cutaneous metastasis, (3) Paraneoplastic syndromes, (4) Mucocutaneous manifestations not related to malignancies, (5) Adverse effects secondary to treatment modalities. Results: One hundred twenty patients comprised 70 females (58.3%) and 50 males (41.7%). They were categorized as primary cutaneous malignancy (20.2%), hematological malignancies (15%), solid organ malignancy (50.9%), and gastrointestinal malignancies (5%). HIV seropositivity was seen in two patients (1.6%). Maximum belonged to Category 5 (60, 50%), of which 52 (86.7%) were adverse effects of chemotherapy with single patient showing radiation dermatitis and one patient in Category 3 (0.8%). Eleven patients showed cutaneous metastasis (9.1%), predominantly carcinoma breast. Clinically, primary cutaneous malignancies often presented as ulceronodular growths with squamous cell carcinoma being the most common histopathological type (30%). Anagen effluvium was the most common (35%) manifestation overall and in solid organ malignancies followed by melanonychia (16, 13.33%), cutaneous xerosis (9, 7.5%), and mucocutaneous hyperpigmentation (23, 19.16%). Conclusions: Mucocutaneous manifestations need prompt attention to facilitate timely diagnosis and improved outcomes.

Clinical safety and efficacy of microwave ablation for small renal masses.

CT-guided MWA is a safe and effective tool that should be utilized in the treatment of small renal masses (SRMs). We aim to clarify the utility of CT-guided MWA by examining patient outcomes such as recurrence, treatment success, changes in renal function, and complications. A retrospective review of consecutive patients with SRMs who underwent same day renal mass biopsy (RMB) and CT-guided MWA between 2015 and 2022 was performed. Treatment safety was assessed by 30-day complications according to the Clavien-Dindo system and change in eGFR >30 days post-procedure. Treatment efficacy was defined by local recurrence and incomplete treatment rates and calculated using the Kaplan-Meier method. A total of 108 renal masses were found in 104 patients. The overall complication rate was 7.4% (8/108), of which 4 were major complications (3.7%). For those with renal function available >30 days post ablation, the median eGFR was 47.2 (IQR: 36.0, 57), compared to 52.3 (IQR: 43.7, 61.5) pre-ablation, p<0.0001. 5-year local recurrence free survival was 86%. Among those with biopsy proven malignancy (n= 66), there were five local recurrences (7.54%) occurring at a median of 25.1 months (IQR 19.9, 36.2) and one case (1.5%) of incomplete treatment. As the medical field continues to evolve towards less invasive interventions, MWA offers a valuable tool in the management of renal masses. With low major complication and recurrence rates, our findings support the utility of CT-guided MWA as a tool for treatment of SRMs.

Probable impact of environmental radiation on thyroid swellings in areas of Eastern Hyderabad and Nalgonda

IntroductionThyroid swellings are prevalent in 4 to 7% of the Indian population and are commonly present in females. Thyroid swelling has been attributed to various causes, such as ingestion of goitrogens and low iodine in the diet in benign, radiation exposure, and genetic in malignancies. Eastern Hyderabad and Nalgonda have a high fluoride content in the ground water, which can potentially disrupt thyroid functioning. Moreover, the region also harbors high uranium content and environmental radiation; hence, a retrospective analysis of the FNAC and histopathology of the thyroid swellings was done to evaluate the paradigm.MethodA retrospective analysis of the patient’s records from February 1, 2022, to January 31, 2023, was conducted considering all the patients who presented with thyroid swelling. The variables taken into consideration were age, gender, and FNAC findings. A correlation was also made with the histopathology of the specimen of operated patients.ResultA total of 88 medical records of the patients were evaluated, and it was determined that there was a preponderance of females with a ratio of 8.77:1. Majority of the swellings were Benign labeled as Bethesda category 2 (n = 61) followed by category 3 (n = 11). To be considered are the cases of malignancies falling into category 6, which comprise 7.95% (n = 7). The majority of the patients were seen between the ages of 31 to 40 (n = 28), followed by 41 to 50 (n = 25).On comparing with the histopathological reports, two cases of category 5 were found to be having papillary thyroid carcinoma and another with follicular thyroid carcinoma making the number of proven malignancies to be 10.22% (n = 9). Other histopathological findings correlated with the results of FNAC.ConclusionThrough this pilot study, we conclude that most thyroid swellings were benign, but there is a higher incidence of thyroid malignancies (10.22%), significantly higher than the country average of 2 to 4%. The higher number of malignant cases can be attributed to many factors, including high fluoride content and environmental radiation. Further studies need to be conducted, taking each element individually.

Comparison the Difference of Thyroid Function Status between 2D &amp; 3D CRT Treatment Technique in HNC Patients

Introduction: Thyroid gland is an important endocrine gland which regulates metabolic activities in our body as well as regulates vital body functions including breathing, heart rate, central and peripheral nervous systems, body weight, menstrual cycle, cholesterol levels and much more. As thyroid gland placed in the same field area treated by radiation therapy of non-thyroid head and neck cancer patient, so it is a challenge to preserve the normal thyroid function after completion of treatment. Objective: To assess the comparison the difference of thyroid function status between 2D &amp; 3D CRT treatment technique in HNC patients. Methods: It was a quasi-experimental study was conducted at National Institute of Cancer Research &amp; Hospital (NICRH), Mohakhali, Dhaka, Bangladesh from November 2016 and ended in October’2017. Total of 60 patients with above mentioned criteria were selected and each arm got 30 patients. Patient with histopathology report proven carcinoma of head and neck receiving radiotherapy were selected from tumor board of NICRH. The present study were carried out on patients with biopsy proven malignancies of head and neck who attended the Radiotherapy Department for radiotherapy and who met the selection criteria of the study. Results: Total study population was 60 among which 30 were in arm A (2D) and 30 were in arm B (3D). Majorities of the patients in arm A were 41-50 years old (46.7%). The mean age of the arm A patients was 52.27 (±7.38) years and that of the arm B was 49.50 (± 13.55) years. Thirty patients of head &amp; neck cancers were included in arm A of the study, i.e. 2D arm. Out of which 21 (70%) were male and rest 9 (30%) were female. Thirty patients of head &amp; neck cancers were included in arm B of the study, i.e. 3D arm. Out of which 23 (76.7%) were male and rest 7 (23.3%) were female. Most of the patients in both arms were farmers (40% in arm A and 60% in arm B). There were 9(30%) oropharyngeal, 8(26.7%) hypopharyngeal and 13(43.3%) ........

First UK experience of apalutamide in metastatic and non-metastatic prostate cancer outside of clinical trials.

106 Background: Apalutamide plus androgen deprivation therapy(ADT) has been approved as a treatment option for castrate resistant non metastatic prostate cancer (nmCRPC) with a high risk of developing metastatic disease. It has also demonstrated benefit in patients with metastatic, castration-sensitive prostate (mHSPC) cancer, with improvement in overall and radiographic progression–free survival. Here we report our first experience of using Apalutamide in real life clinical practice. Methods: A cohort of 108 patients from 5 UK centres were included, among them 68 were metastatic and 40 non metastatic. All patients were treated with Apalutamide 240 mg along with ADT until disease progression. The primary endpoint was objective rate (ORR) and secondary endpoints included treatment duration and safety. Results: The median age for the whole cohort was 71 years (interquartile range 43-91), 73 years for nmCRPC and 69 years for mHSPC respectively. 81% had biopsy proven malignancy. A total of 11.7% with mHSPC had received prior radical treatment (prostatectomy or radiotherapy for localised disease), compared to 92.5% patients in the non-metastatic cohort. PSA reached undetectable levels (&lt;0.04 ng per ml) in 67% of the patients in the metastatic and 60% in non-metastatic subset respectively. In patients with mHSPC, who had radiological assessments performed, the response rates at 6 months were as follows: partial response (24%), stable disease (74%) and progressive disease (4%).39% of the whole cohort, reported grade 2 and above toxicities. The commonest were skin rash, thyroid dysfunction, hypertension, lethargy and hot flushes. Adverse events led to discontinuation in 1 patient and dose reduction in 1 patient. Conclusions: Our experience of using Apalutamide has shown good biochemical and radiological response in both nmCRPC and mHSPC. Treatment was well tolerated with low rates of treatment discontinuation. Further follow up of these patients will guide us in terms of overall survival.

Body fluids: Comparison of liquid based cytology with conventional cytopreparatory technique.

In the diagnosis of malignant tumors, cytological examinations of various body fluids are useful. For the preparation of body fluid, many methods are used till date. The use of liquid-based cytology is new upcoming in the field. To examine the performance of liquid-based cytology on body cavity fluids as compared to conventional cytopreparatory techniques. In the present study, 700 body fluid samples were processed by both liquid- based cytology (BD SurePath™) and conventional cytopreparatory technique (Thick & Thin). The performance of both techniques was compared in terms of "smear quality" and "overall diagnostic test performance." Out of 155 body fluid samples from proven malignancy patients, 32 (20.65%) were reported as Positive for malignancy, 23 (14.84%) as Suspicious of malignancy, and 100 (64.51%) as Negative for malignancy by CS (Thick and Thin). A total of 44 (28.39%) were reported as Positive for malignancy, 12 (7.74%) as Suspicious of malignancy, and 99 (63.87%) as Negative for malignancy by LBC. Liquid-based cytology is advantageous over conventional techniques in cytomorphology of body fluids, but not better in sensitivity and specificity. Also saves cytopathologist's valuable time for screening.

Effects of Light-absorbing Carbons in Intraoperative Molecular Imaging-Guided Lung Cancer Resections.

One of the novel advancements to enhance the visual aspects of lung cancer identification is intraoperative molecular imaging (IMI), which can reliably detect tumors that would otherwise be missed by standard techniques such as tactile and visual feedback, particularly for sub-centimeter or ground-glass nodules. However, there remains a subset of patients who do not benefit from IMI due to excessive background fluorescence secondary to parenchymal light-absorbing carbon deposition. Our goal was to identify the effects of these carbonaceous materials on the quality of IMI-guided lung cancer resections. Between July 2014 and May 2021, a total of 311 patients were included in the study. Patients underwent infusion of the study drug OTL38 or ICG up to 24h prior to VATS for lung cancer. Several factors such as age, tumor subtype, PET SUV, smoking, demographics, chronic lung conditions, patient domicile, and anthracosis were analyzed with respect to lung fluorescence during IMI. P values < 0.05 were considered statistically significant. Variables such as age, sex, and race had no statistical correlation to IMI success. However, smoking status and pack year had a statistically significant correlation with background parenchymal fluorescence and lung inflammation (p < 0.05). MFI of background (lung parenchyma) correlated with smoking history (p < 0.05) which led to decreased tumor-to-background ratio (TBR) measurements for all patients with proven malignancy (p < 0.05). Patients with chronic lung disease appear to have increased background parenchymal fluorescence regardless of smoking history (287 vs. 154, p < 0.01). City dwellers compared to other groups appear to be exposed to higher pollutant load and have higher rates of anthracosis, but living location's impact on fluorescence quantification appears to be not statistically significant. Smokers with greater than 10PPY and those with chronic lung disease appear to have decreased lesion-to-background discrimination, significant anthracosis, and reduced IMI efficacy secondary to light-absorbing carbon deposition.

Correlation of Salivary Lactate Dehydrogenase in Oral Malignancies

INTRODUCTION Diagnostic delays are one of the key reasons behind the poor prognosis and outcomes in oral mailgnancies. The non-invasive technique of saliva collection reduces anxiety and discomfort associated with serum sample collections and simplifies the procurement of repeated samples for longitudinal, long-time monitoring. Progressive increase in Lactate dehydrogenase levels are seen to be positively related to the degree of cellular atypia and can be used as a screening tool in assessing the malignant potential of premalignant lesions. AIMS To study the correlation between increase in salivary Lactate dehydrogenase(LDH) in oral malignant and pre malignant lesions and to study the role of salivary Lactate dehydrogenase as an alternate to conventional biopsy and prognostic tool. MATERIALS AND METHODS All patients with premalignant and proven malignancies were made to give salivary samples before and after surgical intervention. A follow up salivary Lactate dehydrogenase was taken at 6 months, 1 year and 2 year interval for any change in trends and for any rise in levels if recurrences occurred. RESULTS There was a statistically significant (p=0.0001) difference in Lactate dehydrogenase levels pre and post operatively in oral lesions. In cases of recurrence there was a significant rise in LDH levels compared to those without recurrence at similar intervals. CONCLUSION A significantly higher salivary LDH level with a statistically significant fall in the post operative LDH levels(p value= 0.001), This indicates a positive correlation between salivary LDH and presence of dysplastic and malignant cells and can be considered as a non invasive alternative to conventional biopsy with a possible use of salivary LDH as a screening tool to predict recurrence or progression of disease process.

943. Epidemiology of Actinomycosis in a Tertiary Care Cancer Center

BackgroundActinomyces are human commensals with significant pathogenic potential. The aim of this study was to determine the epidemiology of Actinomycosis in a tertiary care cancer center and identify species most commonly associated with invasive disease.MethodsWe retrospectively reviewed all patients referred to our institution with suspected or documented solid or hematological malignancies and positive cultures for Actinomyces species from July 2007 to June 2020 (13 years). Species identification was performed by VITEK® automated system (bioMerieux Inc.). Probable invasive actinomycosis was defined as cases with consistent clinical presentation, suggestive radiographic findings, and a positive culture from a nonsterile site, but lack of histopathological confirmation. Proven invasive actinomycosis was defined as the presence of consistent clinical symptoms, suggestive radiographic findings, a positive culture and histopathological confirmation, or cultures from sterile site without histopathological confirmation. Contaminants were considered positive cultures from sterile or non-sterile site without evidence of disease. ResultsOf 233 cases with positive cultures 194 (83.3%) were considered contaminants and 39 (16.7%) diagnostic of invasive actinomycosis. Of 39 cases of invasive actinomycosis, 64% were documented in patients with solid tumors, 13% in hematological malignancy and 23% among individuals without proven malignancy, 25 (64%) were probable and 14 (36%) proven. Of patients with proven/probable actinomycosis 27 (69%) had polymicrobial growth. Abdominopelvic was the most frequent site of invasive actinomycosis. A. odontolyticus was the most common species isolated (41%) followed by A. meyeri (28%) in patients with invasive disease, and A. odontolyticus (42%) among contaminants. ConclusionThe majority of positive cultures for Actinomyces species were considered contaminants. In our cohort Invasive actinomycosis affected mainly patients with solid tumors. Abdominopelvic was the most common site of invasive disease. Species most commonly associated with invasive actinomycosis were A. odontolyticus followed by A. meyeri with A. israelii isolated less frequently.Disclosures All Authors: No reported disclosures

Determinants of survival in children with cancer in Johannesburg, South Africa

Background: Childhood cancer, although rare, remains an important cause of death worldwide. The outcomes of children with all cancer types in South Africa are not well-documented.Aim: The aim of the article was to determine local childhood cancer survival rates and establish determinants of survival.Setting: The study was conducted at a state and a private hospital in South Africa.Methods: This retrospective cohort study consecutively included all children with a proven malignancy from 01 January 2012 to 31 December 2016. Univariable and multivariable analyses were used to establish which factors significantly impacted overall survival (OS).Results: Of a total of 677 study participants, 71% were black South Africans. The estimated 5-year overall survival (OS) was 57% (95% confidence interval [CI]: 53-61%) and significant determinants of OS on the multivariable analysis included: ethnicity, cancer-type and nutritional status. White and Indian patients had higher OS compared to black patients (hazard ration [HR] (95% CI) 0.46 (0.30-0.69) p = 0.0002 and HR (95%) 0.38 (0.19-0.78) p = 0.0087, respectively). Underweight patients had inferior survival (HR (95% CI) 1.78 (1.28-2.47)) p = 0.0006. Patients with neuroblastoma had an increased risk of dying compared to those with leukaemia (HR [95% CI] 1.78 [1.08-2.94]) p = 0.025. Progression of disease was the most common cause of death, followed by disease relapse.Conclusion: The childhood cancer survival rate obtained in this study can be used as a baseline to facilitate improvement. Non-modifiable prognostic factors included ethnicity and cancer-type whilst modifiable risk factors included undernutrition. Undernutrition should be addressed on a national and local level to improve survival.

Epidemiology of Non-Malignant Oral Lesions in a Rural Population Attending a Tertiary Care Centre in Lucknow, U.P., India

Objective: To describe the epidemiology of non-malignant oral lesions in a rural population attending a tertiary care centre in Lucknow, India. Method: A total of 340 patients presenting with oral lesions for more than 2 weeks were enrolled in the study. Patients with proven malignancy, white patch in the oral cavity which can be scrapped off, e.g. oral candidiasis and urban patients were excluded from the assessment. Demographic profile, adverse oral habits and dietary habits of patients were noted. Data was analyzed using SPSS 21.0 software. Data has been represented as number and percentages. Results: Age of patients enrolled in the study ranged between 18 and 75 years, median age was 32 years and mean age was 33.86±10.65 years. Majority were aged 26-50 years (66.2%), were males (55.3%), were farmers/labourers (58.6%), were illiterate/educated upto primary grade (57.1%). Oral pain and burning sensation was the most common presenting complaint (45%). All the patients have two or more of the following habits – areca nut chewing, tobacco chewing and smoking. A total of 41.5% patients had all the three habits. Alcohol and spicy food consumption were reported by 12.6% and 84.4% patients. On histopathology, a total of 191 (56.18%) cases had premalignant lesions and 149 (43.82%) had benign lesions. Major premalignant types were leukoplakia (n=87; 45.5%), OSMF (n=62; 32.5%) and Erythroplakia (n=18; 9.4%). Aphthous ulcer major (n=74; 49.7%), geographical tongue (n=43; 28.9%) and traumatic ulcer (n=23; 15.4%) were the major benign lesions. Conclusion: In a rural population presenting with non-premalignant oral lesions areca nut, chewing tobacco and smoking were the major etiologies affecting mainly young adults. The high prevalence of premalignant lesions showed a high potential of their transformation to malignant status. Preventive measures with modification of oral habits are recommended. Keywords: Non-malignant oral lesions, Leukoplakia, oral submucous fibrosis, aphthous ulcer major, rural.

Breast and Lung Effusion Survival Score Models: Improving Survival Prediction in Patients With Malignant Pleural Effusion and Metastasis

Evidence-based guidelines recommend management strategies for malignant pleural effusions (MPEs) based on life expectancy. Existent risk-prediction rules do not provide precise individualized survival estimates. Can a newly developed continuous risk-prediction survival model for patients with MPE and known metastatic disease provide precise survival estimates? Single-center retrospective cohort study of patients with proven malignancy, pleural effusion, and known metastatic disease undergoing thoracentesis from 2014 through 2017. The outcome was time from thoracentesis to death. Risk factors were identified using Cox proportional hazards models. Effect-measure modification (EMM) was tested using the Mantel-Cox test and was addressed by using disease-specific models (DSMs) or interaction terms. Three DSMs and a combined model using interactions were generated. Discrimination was evaluated using Harrell's C-statistic. Calibration was assessed by observed-minus-predicted probability graphs at specific time points. Models were validated using patients treated from 2010 through 2013. Using LENT (pleural fluid lactate dehydrogenase, Eastern Cooperative Oncology Group performance score, neutrophil-to-lymphocyte ratio and tumor type) variables, we generated both discrete (LENT-D) and continuous (LENT-C) models, assessing discrete vscontinuous predictors' performances. The development and validation cohort included 562 and 727 patients, respectively. The Mantel-Cox test demonstrated interactions between cancer type and neutrophil to lymphocyte ratio (P< .0001), pleural fluid lactate dehydrogenase (P= .029), and bilateral effusion (P= .002). DSMs for lung, breast, and hematologic malignancies showed C-statistics of 0.72, 0.72, and 0.62, respectively; the combined model's C-statistics was 0.67. LENT-D (C-statistic, 0.60) and LENT-C (C-statistic, 0.65) models underperformed. EMM is present between cancer type and other predictors; thus, DSMs outperformed the models that failed to account for this. Discrete risk-prediction models lacked enough precision to be useful for individual-level predictions.

Clinicopathological study of benign breast diseases a study of 50 cases

Background: Benign breast diseases are a neglected entity in developing countries despite the fact that they involved in the majority of breast complaints. Benign breast disorders can be defined as any non-malignant breast condition and involved wide range of clinical and pathological disorders. Breast diseases present as swellings. It is a symptom/sign for a different lesion varying from developmental abnormality, inflammatory lesions, epithelial and stromal proliferation to malignancy. Patients were studied on the basis of i.e., clinically, and histopathological ultrasound has done. Our purpose of study is to document various benign Brest diseases to study different mode of presentations of diseases and correlation of clinical and pathological diagnosisMethods: The given study was a prospective and observational study, undertaken in the department of general surgery, govt. medical college Surat, during the study period of March 2018 to September 2019.All the female and male patients with breast related disease were included in this study. Female patients with biopsy proven malignancy were excluded from the study.Results: The study comprised of 50 patients with benign breast diseases; the most common is Fibro adenoma which formed 68% then fibrocystic diseases 20%. With most common age group involved in our study is 21-30 years.Conclusions: Benign breast diseases are more common but ignored entity though it carries majority of complaints and occur mainly in young women less than 30 years of age and were mostly fibro adenoma and fibrocystic change.

Perianal Fistula-Associated Carcinoma in Crohn's Disease: A Multicentre Retrospective Case Control Study.

Carcinoma associated with perianal fistula in Crohn's disease is a pending threat for patients. This study aimed to improve understanding and facilitate development of diagnostic and therapeutic strategies. A retrospective case-control study was conducted at four German hospitals. The analysis included 40 patients with proven malignancy associated with perianal Crohn's fistulas and 40 randomly selected controls with fistulizing perianal Crohn's disease. Differences between groups were analysed and multivariate calculations were performed to describe risk factors for oncological outcomes. Histology revealed adenocarcinoma in 33/40 patients and squamous cell carcinoma in 7/40 patients. Compared to fistula patients without carcinoma, patients with malignancies associated with fistula had a diagnosis of Crohn's disease at younger age. Crohn's disease lasted longer in patients with malignancy [25.8 ± 9.0 vs 19.6 ± 10.4; p = 0.006]. Fistula-related findings differed significantly between the two groups. Signs of complicated and severe fistulation including complex anatomy and chronic activity occurred significantly more often in patients with malignancy associated with fistula. Significant multivariate hazard ratios for overall mortality and progression-free survival were shown for histological type of cancer, metastatic disease and R1 resection. Overall survival was 45.1 ± 28.6 months and the 5-year survival rate was 65%. In patients with adenocarcinoma or squamous cell carcinoma associated with perianal fistula in Crohn's disease, fistula characteristics determine the risk of malignancy. Early diagnosis influences outcomes, while treatment of chronic fistula activity may be key to preventing malignancy. Expert multimodal therapy is paramount for successful treatment of perianal fistula-associated malignancies.

Oncologic significance of unexpected osseous foci on FDG-PET without correlative CT abnormalities.

Our purpose was to explore the clinical significance of unexpected osseous foci on 18F-FDG-PET without correlative CT abnormalities (FWCT) in patients referred for oncologic evaluation. The significance of FDG-avid foci without correlative CT abnormalities has been previously explored in tissues such as breast, lung, liver, and prostate; however, osseous foci without correlative CT abnormalities continue to present challenges in diagnostic interpretations. This study is a retrospective review of 120 osseous FWCT, reported in 91 patients, and their corresponding clinical follow-up. We included only patients with at least 6months of clinical follow-up leading to a final diagnosis, reviewing bone biopsy results, follow-up imaging, and clinical notes. We excluded those patients on active chemotherapy at the time of the scan. For reports describing > 3 foci, we only analyzed the one with highest maximum standardized uptake value (SUVmax). As a measure of uptake intensity, we obtained focus-to-liver ratios (F/L) utilizing their SUVmax and corresponding hepatic 3D SUVmean. Of 91 patients, 74 (81%) had biopsy-confirmed primary malignancies and 17 (19%) had suspicious findings on diagnostic imaging, but no proven primary malignancy. 50 of 120 (42%) osseous foci were malignant and 70 (58%) were benign. 49 of 120 (41%) foci were solitary and 71 (59%) were 0 with other foci (non-solitary). Malignancy resulted from 15/49 (31%) solitary foci and 35/71 (49%) non-solitary foci. Malignant lesions had a mean F/L 2.37 ± 0.397 and benign lesions a mean F/L 1.49 ± 0.169. Osseous malignancy correlated with a higher uptake intensity (Spearman = 0.408; P < 0.01) and was significantly associated with F/L ≥ 2.0 (P < 0.001). Osseous FWCT led to restaging and management modification in 12/91 (13%) patients. Osseous FWCT frequently represent early stages of malignancy. A higher index of suspicion is warranted for osseous FWCT associated with underlying myeloproliferative neoplasms, breast and lung cancer, and moderate (F/L 1.0-2.0) or high (F/L > 2.0) uptake intensity. Interpreting physicians encountering these variables can recommend interval follow-up with 18F-FDG-PET/CT or correlation with contrast-enhanced MRI or tissue biopsy. In patients with an altered biodistribution of 18F-FDG in the bone marrow (e.g., recent chemotherapy cycle), follow-up FDG-PET can be obtained at an appropriate time interval following oncologic treatment.

CTRIAL-IE (ICORG) 07-11: Phase II Trial Evaluating Radiobiological Based Reirradiation Strategy for Patients with Malignant Spinal Cord Compression

To prospectively assess the efficacy and toxicity of External Beam Radiotherapy (EBRT) reirradiation in patients (pts) with Malignant Spinal Cord Compression (MSCC) occurring in previously irradiated area and not for surgical decompression. An ICH-GCP compliant prospective Gehan’s two-stage design Phase 2 trial evaluated a radiobiology based EBRT reirradiation strategy for MSCC. The primary endpoint was mobility (Tomita mobility score change at 5 weeks); the secondary endpoints were long-term spinal toxicity & Radiation-Induced Myelopathy (RIM) (RTOG SOMA scale), Quality of Life (EORTC-QLQ-C15 PAL v. 1.0) and non-spinal acute & long-term toxicity (RTOG scale). Eligible pts had a pathological proven malignancy, excluding primary bone tumor, and diagnosed with a treatment naïve MRI documented MSCC, occurring in a previously irradiated spinal area (Spinal dose received ≤ 90 Gy2). Based on radiobiological and retrospective clinical data, pts were classified into 3 RIM risk categories. The reirradiation EBRT schedule aimed to deliver a minimum of 12 Gy in 4 fractions (Maximum: 30 Gy/10), and a cumulative dose to the spine (equal to the BED sum of each radiotherapy courses prescribed doses) of respectively 100 Gy2, if time interval ≤ 6 months between radiotherapy courses, and 130 Gy2, if > 6 months. From 01/2008 to 09/2016, 22 pts were recruited, 16 pts with week 1 acute toxicity data and 11 pts with week 5 efficacy data (Early death: 9, withdrew consent: 2). Baseline population characteristics were: median age: 66 years (24-88), ♀/♂ratio: 6/16, median KPS: 60 (40-100). 16 pts were initially ambulatory and all were within the low risk RIM category. The common pathologies were prostate (36%) and lung cancer (23%). The compression levels were cervical (9.1%), thoracic (68.2%), lumbar (13.6%) and lumbo-sacral (9.1%). The week 5 overall response rate, defined as improved (n = 2) or stable (n = 7) Tomita score, was 81.8 % (95% CI: 52.3-94.9%), largely above the 20% protocol-defined clinical efficacy futility mark, and associated at week 5 with a significant improvement of the EORTC QLQ-C15-PAL pain score (28.6 units, 95% CI 0.8 to 56.3) and a non-significant improvement of Physical Functioning score. The median survival from consent date was 2.2 months (0.9-5.4). Acute toxicity was observed in 9 pts, all grade ≤ 2. Among the 8 pts reaching the 3 month assessment or more, there were 3 grade 1 late-toxicity events (2 intestine and 1 fatigue) and 2 SOMA grade> 2 RIM (diagnosed at 3 & 12 months) , corresponding to an overall cumulative incidence estimated between 9.1 % ( intention to treat) and 25% (actual), exceeding the 3% risk predicted by the radiobiological and clinical models. EBRT reirradiation provides similar response rate than the one reported in our previously reported trial with irradiation naïve MSCC pts, but the observed RIM incidence was higher than predicted, demonstrating the importance of prospective trials.

A Prospective Study to Evaluate the Role of Narrow Band Imaging and Toludine Blue in the Screening of Premalignant and Malignant Lesions of the Oral Cavity in a Tertiary Referral Centre.

In India cancer patients come at a very advanced stage with many of them being crossed the stage of resection. A wide range of non invasive techniques like toludine blue staining, methylene blue staining, Narrow band imaging have been developed for the early detection of malignant and premalignant lesions in the mucosa including oral cavity and gastrointestinal tract. However it is difficult for the clinicians to decide which diagnostic tool is most appropriate and useful for screening, resulting in failure to pick up the lesions at an early stage. Various online journals have been reviewed and no journal was found to support this point. This study here by describes Toludine blue and narrow-band imaging (NBI), diagnostic tools already proven independently as a useful screening method in many fields, and demonstrate its usefulness in the early detection of premalignant and malignant lesions of the oral cavity, as reported by previous studies in the otolaryngologic literature and compare both screening tools which has not been done till now. This study was done in a tertiary referral centre in middle India from March 2018 to August 2019 in order to evaluate the role of different screening tools (NBI and Toludine blue).44 patients with suspicious oral cavity lesions (premalignant and malignant) who had given consent for both NBI and toludine blue screening techniques were selected from the suspected (premalignant and malignant lesions) who had visited the OPD during the study period. Patients with proven malignancy were excluded from the study. A detailed history of the patient taken and standard Ear, nose, throat, oral cavity and neck examination of patient carried out. After subjecting the patients to screening tools like NBI and toludine blue, the efficacy of these techniques in helping us to take a representative biopsy was evaluated. In present study the sensitivity (to correctly identify all patients with disease), specificity (to correctly reject healthy patients without disease) of older technique toludine blue in detecting premalignant lesion was 66.6%, 87.8% while for NBI was 66.6%, 95%. For malignant lesion sensitivity and specificity of toludine blue was 94.3%, 100%, while the same for NBI was 100%, 88.8% respectively. Both NBI and toludine blue staining can be adopted for screening and the accurate detection of biopsy site and in the follow up of premalignant lesions to look for malignant transformation. Time tested is Toludine blue which is cheap and easily available. But being a better tool and having an upper hand in evaluating the lesions, NBI should be made available in all the secondary and tertiary care centres as a screening method.

The Clinically Relevant Breast Imaging Audit.

An audit of a breast imaging practice must be based on data with accepted definitions and rules so that the comparisons between breast imaging facilities and interpretive staff are comparable. The four basic data points for calculating these metrics are true positive (TP), true negative (TN), false positive (FP), and false negative (FN). For mammography, the definition of "true" is the presence of a proven malignancy within a year of the exam. The presence or absence of breast cancer within a year of the exam and an increase in patient mobility between different facilities may render the calculation of sensitivity and specificity difficult for most facilities unless a regional cancer registry is available.Thus, the metrics that can be easily calculated within a facility are recall rate (all the positive interpretations divided by all the exams read), positive predictive value (PPV) 1 = percentage of abnormal screening exams that result in a diagnosis of cancer within a year, PPV2 = percentage of all diagnostic exams recommended for biopsy and cancer discovered within a year, PPV3 = benign tissue diagnosis and no cancer within a year, and the cancer detection rate (the true positive exams per one thousand exams). Intuitively, one may assume that accuracy (TP + TN/TP + FP + TN + FN) is the best metric for an interpreter. However, this can produce spurious results. The most accurate method to determine a reader's skills is the use of the receiver operating characteristic (ROC) curve, which clearly presents, in graphic form, the relationship between the four basic data points.

2DSM vs FFDM: A computeraided diagnosis based comparative study for the early detection of breast cancer

AbstractPurposeAccurate and early detection of breast cancer using effective imaging modalities is an active area of research in medical image analysis. Computeraided diagnosis (CAD) of breast cancer using digital mammograms may help in early diagnosis and can assist in maintaining patient health. The breast imaging reporting and data system (BIRADS) is widely used for risk assessment and classification grading in breast cancer screening. It contains seven different grading systems for breast cancer risk assessment. These range from grade 0 (incomplete) to grade 6 (proven malignancy). All other intermediate stages state the progression of risk.MethodsThe current research results have shown that two‐dimensional synthesized mammogram (2DSM) imaging and conventional full‐field digital mammography (FFDM) are two important imaging modalities which can be used for screening breast cancer. To the best of our knowledge, there is no study which has yet compared the BIRADS discrimination power of 2DSM and FFDM imaging modalities. In this paper we present a novel CAD‐based comparative study, using texton and gist for the characterization of breast cancer with 2DSM and FFDM imagery.ResultsThe developed method achieved an average performance of 92.9% accuracy using a probabilistic neural network classifier for FFDM images with tenfold crossvalidation. Hence, our proposed model showed that FFDM images are more effective than the 2DSM imaging modality in discriminating BIRADS grades.ConclusionThe obtained results confirmed that our method performed well in the early detection of breast cancer. Consequently, it can be used as a distinct system in rural hospitals.