Staging CT Scan Research Articles

Is there value in the routine inclusion of chest computed tomography for patients with gastrointestinal stromal tumor?

PurposeNational Comprehensive Cancer Network guidelines suggest chest CT when gastrointestinal stromal tumors are larger than 2 cm. We evaluate the value of screening the chest region during initial and follow-up CT. MethodSingle institution retrospective analysis of GIST cancer registry for patients diagnosed between May 2010 and November 2019 with tumor > 2 cm. We collected the patient demographics and clinical data; reviewed all CT scans of the chest region and recorded the lung nodules. Patients were grouped into lung nodule group and non-nodule group. Categorical variables were compared with the Chi square test and continuous variables with the Mann-Whitney U test. The survival probability was determined from Kaplan-Meier survival analysis and log-rank test for comparing differences. ResultsThe final cohort included 382 patients (median age 61 years-old [interquartile range: 52–71]) and grouped into non-nodule group (n = 284) and lung nodule group (n = 98). The frequency of the CT scan was more in lung nodule group (8 [5–12]) than in non-nodule group (4 [2–9], p < 0.001). The lung nodule group had more CT including the chest region (6 [3–10] vs 3 [1–7], p < 0.001). In progressive lung nodules (8/98 [8 %]), only one patient had confirmed lung metastasis from GIST (1/382 [3 %]). There was no difference in overall survival between nodule groups (p = 0.12). ConclusionsGIST patients with tumors larger than 2 cm have extremely low risk for lung metastasis. Routine inclusion of chest CT scan in staging and follow up is unnecessary.

EP496 - Metastatic Invasive Lobular Carcinoma of the Breast mimicking healed Gastric Ulcer: A Case Report

Abstract Introduction Breast cancer metastasizing to the stomach as a new presentation is highly unusual. We report a 77-year-old female with such presentation. Case Presentation A 77-year-old female investigated for significant weight loss. She denied any upper or lower gastrointestinal symptoms. She had bidirectional scopes. Colonoscopy showed only diverticulosis. Two gastroscopies revealed non-specific stellar shaped areas in the anterior antrum wall mimicking a healed gastric ulcer. Biopsies confirmed metastatic lobular carcinoma of the breast, ER+ve, HER2 negative. On further clinical examination she had large mass upper outer quadrant with palpable enlarged nodes. Staging CT scan showed couple of hyper enhancing foci in the right breast which may be potential candidates for primary tumour and enlarged right axillary nodes. Subsequently she had an ultrasound guided biopsy of the breast lesion confirmed invasive lobular cancer. Patient has been referred to the breast MDT for breast and lymph node biopsy. Discussion The incidence of GI metastatic disease from a primary breast cancer is less than 1%. It is more common to diagnose in patients with prior history and treatment for primary breast malignancy. However, occasionally it can be encountered prior to the diagnosis of the primary tumour. Hence, index of high suspicion is required as the endoscopic findings are non-specific.

Evolving role of staging CT scans during CT-angiography for DIEP flap reconstruction planning

BackgroundPre-operative planning with CTA in DIEP flap reconstruction is an essential preoperative tool. The aim of this study was to describe the management of the incidental findings following introduction and further modification of a combined CTA and CT-staging pre-operative protocol which include chest, abdomen, pelvis and musculoskeletal system. Material, methodA retrospective case series of 292 patients (Group1) with breast cancer who underwent DIEP flap between 2015 and 2019. This was followed by a re-assessment between 2019 and 2021 for 101 patients (Group 2) following modification of the staging-CT protocol for only those patients who received chemotherapy. Group 1 includes both of immediate and delayed reconstruction and, but the Group 2 includes only the high-risk cases of delayed reconstruction. Both groups had CT staging. Result30% of Group 1, most likely who had the delayed reconstruction, had findings which were recommended for further follow-up. This led to a change in staging of high-risk patients only at the end of 2019 to those who underwent chemotherapy who had delayed reconstruction.56.4% of Group 2 demonstrated incidental findings, 42.1% of them necessitated repeat scanning, 7% were referred to other specialties and 47.4% did not require further action There were no cases of occult metastatic breast cancer in either series; however, 1% were diagnosed with de novo primary cancers at non breast sites in the first series only. ConclusionThe screening of asymptomatic breast cancer patients as part of CTA scanning prior to autologous reconstruction is not universally practiced and not supported by NICE guidelines. This unit has changed practice to stop pre-operative staging for low-risk patients at the end of 2019, reserving it for the high-risk patient groups to reduce cost.

633. DOES SARCOPENIA PREDICT NEOADJUVANT CHEMOTHERAPY TOXICITY IN OESOPHAGEAL ADENOCARCINOMA PATIENTS?

Abstract Background Sarcopenia, defined as the loss of muscle mass and function, is associated with a high risk of adverse outcomes in the cancer population. Radiologically defined sarcopenia has been linked to both short- and long-term outcomes after oesophagectomy for cancer. Neoadjuvant treatment plays a crucial role in the treatment of locally advanced oesophagogastric cancer. It is not fully clear whether patients with low muscle mass are more prone to sustaining acute chemotherapy toxicities during neoadjuvant chemotherapy (NAC) prior to oesophagectomy, especially when ECX or FLOT chemotherapy regimens are used. Methods Patients undergoing NAC and oesophagectomy between January 2016 and December 2022 had their skeletal muscle index analysed (SMI) at the time of initial staging. SMI was computed from staging CT scan slices as the lean muscle mass at the level of the third lumbar vertebra and the height of the patient. Patients were then divided into two categories depending on whether their NAC was completed fully (FLOT four cycles, ECX three cycles) or whether NAC treatment was incomplete. The Mann-Whitney U test was used to statistically test the hypothesis of any difference in SMI between these two groups. Results There were 208 patients included in this study. 109 patients had ECX and 90 patients had FLOT. Fourteen patients (6.7%) did not complete NAC treatment fully but progressed to oesophagectomy. The median (IQR) SMI of patients who did not complete NAC treatment was 46.54 cm2/m2 (43.40-51.32) compared to 50.87 cm2/m2 (45.88-57.33) for those who received all prescribed NAC cycles (p=0.026). Conclusion This study demonstrated that patients with higher SMI are better equipped to withstand the side effects of NAC and complete this treatment. It appears that strategies to improve sarcopenia before or during NAC are needed. Prehabilitation might be one of these strategies, and therefore, the effect of various prehabilitation regimens on sarcopenia needs to be further explored.

CT-derived body composition and differential association with age, TNM stage and systemic inflammation in patients with colon cancer

Low skeletal muscle index/density (SMI/SMD) is prevalent in cancer, adversely prognostic and associated with tumour stage and the systemic inflammatory response (SIR). Age and SMI/SMD has not been widely studied. The present study analyses the association between age and SMI/SMD after adjustment for other clinicopathological factors. Patients undergoing resectional surgery for TNM Stage I-III disease within the West of Scotland between 2011 and 2014 were identified. A single CT slice was obtained from each patients staging CT scan. SMI and SMD were stratified normal/abnormal. The SIR was stratified using Systemic Inflammatory Grade (SIG). When stratified by age (< 50/50s/60s/70s/80+), 39%/38%/48%/62%/74% and 27%/48%/64%/82%/92% of patients had a low SMI and SMD respectively (both p < 0.001). Older age (OR 1.47, p < 0.001), female sex (OR 1.32, p = 0.032), lower socioeconomic deprivation (OR 1.15, p = 0.004), higher ASA (OR 1.30, p = 0.019), emergency presentation (OR 1.82, p = 0.003), lower BMI (OR 0.67, p < 0.002) and higher SIG (OR 1.23, p < 0.001) were independently associated with low SMI. Older age (OR 2.28, p < 0.001), female sex (OR 1.38, p = 0.038), higher ASA (OR 1.92, p < 0.001), emergency presentation (OR 1.71, p = 0.023), and higher SIG (OR 1.37, p < 0.001) were independently associated with lower SMD. Tumour factors were not independently associated with either SMI/SMD. Age was a major factor associated with low SMI/SMD in patients with colon cancer. Therefore, in these patients it is likely that this represents largely constitutional body composition as opposed to being a disease mediated effect. Adjustment for age is required when considering the cancer mediated effect on SMI/SMD in patients with colon cancer.

A Phase II Trial of Celecoxib with Neoadjuvant Concurrent Chemoradiation for Patients with Localized Rectal Adenocarcinoma Stage II and III

Abstract Background In recent years, neoadjuvant chemoradiation and subsequent surgical resection with total mesorectal excision has been shown to increase local control with decreased toxicity in comparison to upfront surgical resection followed by adjuvant chemoradiation. Neoadjuvant chemoradiotherapy is the standard treatment for locally advanced rectal cancer. In this study we evaluated the efficacy of adding a selective COX-2 inhibitor to standart neoadjuvant chemoradiation on pathologic response, sphincter preservation and acute toxicity. Materials and Methods Thirty patients with Adenocarcinoma of rectum (up to 15 cm of anal verge) were enrolled in this phase 2 study. Patients undergone full colonoscopy, MRI rectal protocol, abdomino-pelvic and chest CT scan for staging then received neoadjuvant concurrent chemoradiation (capecitabine 825 mg/m2 bid in combination with celecoxib 200 mg bid and radiotherapy (50-50.4Gy/25-28fraction). Surgery was done 5-12 weeks after chemoradiation. Acute complications were scored by common toxicity criteria 5.0 and tumor response was graded according to AJCC and CAP guidelines for rectal adenocarcinoma. Results Of 30 patients, total mesorectal excision was done in 22 patients. Tumor regression grade was reported as: 7 patients (31.8%) had grade 0 or complete response, 7 patients (31.8%) had grade 1 or moderate response, 6 patients (27%) had grade 2 or minimal response and 2 patients (9%) had grade 3 or poor response. Primary tumor down staging was 63% and nodal down staging was 73% with sphincteric preservation rate of 77% among the operated cohort. No patients had hematologic or cardio-vascular toxicity. Conclusion Results indicate celecoxib in combination with neoadjuvant chemoradiation is safe and associated with low toxicity. This combination can promote pathologic complete response, tumor regression grade, sphincteric preservation, T and N down staging in rectal adenocarcinoma.

Hodgkin lymphoma: hypodense lesions in mediastinal masses

Hypodense volumes (HDV) in mediastinal masses can be visualized in a computed tomography scan in Hodgkin lymphoma. We analyzed staging CT scans of 1178 patients with mediastinal involvement from the EuroNet-PHL-C1 trial and explored correlations of HDV with patient characteristics, mediastinal tumor volume and progression-free survival. HDV occurred in 350 of 1178 patients (29.7%), typically in larger mediastinal volumes. There were different patterns in appearance with single lesions found in 243 patients (69.4%), multiple lesions in 107 patients (30.6%). Well delineated lesions were found in 248 cases (70.1%), diffuse lesions were seen in 102 cases (29.1%). Clinically, B symptoms occurred more often in patients with HDV (47.7% compared to 35.0% without HDV (p = 0.039)) and patients with HDV tended to be in higher risk groups. Inadequate overall early-18F-FDG-PET-response was strongly correlated with the occurrence of hypodense lesions (p < 0.001). Patients with total HDV > 40 ml (n = 80) had a 5 year PFS of 79.6% compared to 89.7% (p = 0.01) in patients with HDV < 40 ml or no HDV. This difference in PFS is not caused by treatment group alone. HDV is a common phenomenon in HL with mediastinal involvement.

Scrotal Dermatofibrosarcoma Protuberance: A Case Review at Mankweng Academic Hospital

Background: Dermatofibrosarcoma Protuberance (DFSP) is an uncommon slow-growing soft tissue tumour. The overall incidence of DFSP in the population ranges from 0.3–5 per million and is more common in blacks than whites, males and females are affected equally. The main objective of this case report is to share our experience with Dermatofibrosarcoma Protuberance and give a literature review on the standard of care. Case Presentation: A 28-year-old male presented to the outpatient department with a five-year history of a painless right inguinoscrotal mass. On physical examination the mass was lobulated, fixed to the underlying tissue, it was non-tender measured 8 X 8 cm and there were no inguinal lymph nodes palpable. Ultrasound showed a hypervascular soft tissue tumour not involving the testicle. Wide Local Excision was performed, and histology showed a protuberant ulcerated nodule. A staging CT scan of the chest and abdomen was normal with no features of any metastatic lesions. Conclusion: DFSP is a slow-growing and locally aggressive tumor. Therefore, early diagnosis and complete surgical resection can result in patients being cured. Mohs micrographic surgery is becoming the treatment of choice for DFSP as it results in complete surgical clearance. Imatinib is a novel treatment option for DFSP and is increasingly being used.

Evaluating metrics of circulating tumor DNA response and progression using a high sensitivity tumor-agnostic assay in metastatic HR+/HER2- breast cancer receiving endocrine therapy and a CDK4/6-inhibitor.

1043 Background: CDK4/6-inhibitors (-i) and endocrine therapy (ET) are first-line treatment for HR+/HER2- metastatic breast cancer (mBC). Clinical evaluation and cross-sectional imaging are used for treatment response assessment. The relationship between clinical/radiographic response and ctDNA dynamics using a high sensitivity tumor-agnostic assay is unknown in HR+/HER2- mBC. ctDNA monitoring in mBC may support clinical decision-making, enable new strategies for response assessment in clinical trials, and facilitate enrolment of patients lacking measurable disease (bone-only). Methods: Patients (pts) with HR+/HER2- mBC receiving ET and CDK4/6i were enrolled in a prospective cohort study. Plasma samples were collected at baseline (BL) and regularly on-treatment. Samples were analyzed using Guardant Infinity, a tumor-agnostic genomic and epigenomic platform. ctDNA-response (-R) was defined as a ≥50% decrease (dec) in methylation tumor fraction (mTF) from BL. ctDNA-progression (-P) was defined as a &lt;50% dec in mTF from BL or any subsequent increase in mTF above an absolute mTF of 0.001% (cohort specific definition). Imaging outcomes and dates of treatment discontinuation (TD) were collected. Results: 57 pts with 350 clinical timepoints were evaluated. Median follow up was 28.2m (range: 1.6-66.0m). 42/57 (74%) pts received palbociclib and 40/57 (70%) received an aromatase inhibitor. ctDNA-R/-P was evaluable in 49/57 patients. ctDNA-P identified within the first 90d on CDK4/6i was not prognostic of TD (p=0.7972); when assessed between 90-180d it was prognostic of early TD (med: 6.3m vs. not reached; HR: 5.17, 95%CI: 1.04-25.7; p=0.0003). 156 matched radiographic and ctDNA assessments (blood collected within 30d of CT) were evaluable for ctDNA-R/-P and imaging concordance. Excluding those with clinician-identified sclerotic bone changes suggestive of treatment effect (n=5 events), adjudicated radiographic progression did not occur in the setting of ctDNA-R (NPV: 100%, sensitivity: 100%); no pts had clinical progression in the presence of ctDNA-R. ctDNA rise in the absence of radiographic progression occurred in 13 pts; 7/13 had TD (med: 10.1m, range: 3.0-21.9m) in the follow up period reflecting a molecular lead time. Blood first monitoring, using these metrics, could have avoided 104/150 (69%) staging CT scans in this cohort. Conclusions: ctDNA dynamics are associated with clinical outcomes in HR+/HER2- mBC. The use of a high sensitivity assay permits assessment of response in nearly all patients and suggests the possibility that radiographic surveillance could be reduced in patients with ctDNA-R. Prospective validation of these findings are required. Additional ctDNA-R/-P definitions and relationship with RECIST 1.1 criteria will be presented at the meeting.

Segmentation of mediastinal lymph nodes in CT with anatomical priors

PurposeLymph nodes (LNs) in the chest have a tendency to enlarge due to various pathologies, such as lung cancer or pneumonia. Clinicians routinely measure nodal size to monitor disease progression, confirm metastatic cancer, and assess treatment response. However, variations in their shapes and appearances make it cumbersome to identify LNs, which reside outside of most organs.MethodsWe propose to segment LNs in the mediastinum by leveraging the anatomical priors of 28 different structures (e.g., lung, trachea etc.) generated by the public TotalSegmentator tool. The CT volumes from 89 patients available in the public NIH CT Lymph Node dataset were used to train three 3D off-the-shelf nnUNet models to segment LNs. The public St. Olavs dataset containing 15 patients (out-of-training-distribution) was used to evaluate the segmentation performance.ResultsFor LNs with short axis diameter ≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge $$\\end{document} 8 mm, the 3D cascade nnUNet model obtained the highest Dice score of 67.9 ± 23.4 and lowest Hausdorff distance error of 22.8 ± 20.2. For LNs of all sizes, the Dice score was 58.7 ± 21.3 and this represented a ≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge $$\\end{document}10% improvement over a recently published approach evaluated on the same test dataset.ConclusionTo our knowledge, we are the first to harness 28 distinct anatomical priors to segment mediastinal LNs, and our work can be extended to other nodal zones in the body. The proposed method has the potential for improved patient outcomes through the identification of enlarged nodes in initial staging CT scans.

Impact of FAPI-46/dual-tracer PET/CT imaging on radiotherapeutic management in esophageal cancer

BackgroundFibroblast activation protein (FAP) is expressed in the tumor microenvironment (TME) of various cancers. In our analysis, we describe the impact of dual-tracer imaging with Gallium-68-radiolabeled inhibitors of FAP (FAPI-46-PET/CT) and fluorodeoxy-D-glucose (FDG-PET/CT) on the radiotherapeutic management of primary esophageal cancer (EC).Methods32 patients with EC, who are scheduled for chemoradiation, received FDG and FAPI-46 PET/CT on the same day (dual-tracer protocol, 71%) or on two separate days (29%) We compared functional tumor volumes (FTVs), gross tumor volumes (GTVs) and tumor stages before and after PET-imaging. Changes in treatment were categorized as “minor” (adaption of radiation field) or “major” (change of treatment regimen). Immunohistochemistry (IHC) staining for FAP was performed in all patients with available tissue.ResultsPrimary tumor was detected in all FAPI-46/dual-tracer scans and in 30/32 (93%) of FDG scans. Compared to the initial staging CT scan, 12/32 patients (38%) were upstaged in nodal status after the combination of FDG and FAPI-46 PET scans. Two lymph node metastases were only visible in FAPI-46/dual-tracer. New distant metastasis was observed in 2/32 (6%) patients following FAPI-4 -PET/CT. Our findings led to larger RT fields (“minor change”) in 5/32 patients (16%) and changed treatment regimen (“major change”) in 3/32 patients after FAPI-46/dual-tracer PET/CT. GTVs were larger in FAPI-46/dual-tracer scans compared to FDG-PET/CT (mean 99.0 vs. 80.3 ml, respectively (p < 0.001)) with similar results for nuclear medical FTVs. IHC revealed heterogenous FAP-expression in all specimens (mean H-score: 36.3 (SD 24.6)) without correlation between FAP expression in IHC and FAPI tracer uptake in PET/CT.ConclusionWe report first data on the use of PET with FAPI-46 for patients with EC, who are scheduled to receive RT. Tumor uptake was high and not depending on FAP expression in TME. Further, FAPI-46/dual-tracer PET had relevant impact on management in this setting. Our data calls for prospective evaluation of FAPI-46/dual-tracer PET to improve clinical outcomes of EC.

Quality of Life, Sarcopenia and Nutritional Status in Patients with Esophagogastric Tumors before and after Neoadjuvant Therapy.

(1) Background: Health-related quality of life (HRQoL) gains importance as novel treatment options for individuals with esophagogastric tumors to improve long-term survival. Impaired HRQoL has been shown to be a predictor of overall survival. Sarcopenia is a known prognostic factor for postoperative complications. As the regular control of sarcopenia through CT scans might not always be possible and HRQoL and nutritional scores are easier to obtain, this study aimed to assess the relationship between nutritional scores, HRQoL and skeletal muscle mass in patients undergoing chemotherapy for cancers of the upper gastrointestinal tract. (2) Methods: Eighty patients presenting with tumors of the upper GI tract were included and asked to fill out the standardized HRQoL questionnaire, EORTC's QLQ-C30. Nutritional status was assessed using the MNA, MUST and NRS 2002 scores. Sarcopenia was determined semi-automatically based on the skeletal muscle index at the L3 vertebrae level in staging CT scans. (3) Results: In chemo-naïve patients, HRQoL summary scores correlated significantly with nutritional scores and SMI. SMI and HRQoL prior to neoadjuvant therapy correlated significantly with SMI after treatment. (4) Conclusions: HRQoL is a helpful tool for assessing patients' overall constitution. The correlation of HRQoL summary scores and SMI might allow for a rough assessment of skeletal muscle status through HRQoL assessment in chemo-naïve patients.

Exploring the Diagnostic Dilemma of Indeterminate Pulmonary Nodules in Patients with Primary Sarcoma of Bone.

Bone sarcomas are known to have a predilection for pulmonary metastasis. Surveillance protocols are thus focused on periodic chest imaging, typically with CT scan. Pulmonary nodules can be easily identified with this modality, but smaller nodules are not readily biopsied and may not represent metastatic disease. These are called indeterminate. The natural history of indeterminate nodules in a bone sarcoma population and factors associated with progression to true metastatic disease are not clearly defined. All bone sarcoma patients treated at a single institution from 2010 to 2020 were eligible for inclusion. We treated 327 patients over this period; 119 were excluded for age less than 16 years, 31 were excluded for evident metastatic disease at presentation, and 60 were excluded for incomplete clinical follow-up or CT chest imaging either at staging or in surveillance. We assessed chest CT images for presence of pulmonary nodules and selected variables both at the staging and on surveillance images. Nodules were considered metastatic if proven histologically with a biopsy or by clinical interpretation by the multidisciplinary sarcoma team. Clinical and imaging factors were assessed for the association of indeterminate nodule progression to true metastatic disease. Seventy three of the 117 patients had indeterminate nodules on their staging CT scan; 41.1% of those patients progressed to metastatic disease compared to 43.2% of the patients that did not have indeterminate nodules on staging CT. Fifty eight of the 117 patients developed indeterminate nodules on surveillance chest CT, and 55.2% of those patients progressed to metastatic disease. There were no clinical or imaging factors that predicted the development of metastatic disease in the group that had indeterminate nodules at presentation; however, the number and size of nodules did correlate with progression to metastasis in those that developed indeterminate nodules on surveillance. Indeterminate pulmonary nodules are common on staging CT scans in patients with a bone sarcoma. The presence or absence of these indeterminate nodules was not predictive of progression to true metastatic disease in this cohort. However, the development of indeterminate nodules on surveillance imaging was associated with progression to metastatic disease with the size and number of nodules being important factors.

Pilot study of HER2 targeted 64 Cu-DOTA-tagged PET imaging in gastric cancer patients.

Human epidermal growth factor receptor 2 (HER2) is an important biomarker for targeted gastric cancer (GC) immunotherapy. However, heterogeneous HER2 overexpression in GC, loss of HER2 expression during therapy, and inability to non-invasively identify HER2 overexpressing tumors impede effective targeting therapies. Improved HER2-specific functional imaging can address these challenges. Trastuzumab is a HER2-directed mAb to treat HER2 overexpressing cancers. The 64 Cu-DOTA-trastuzumab radiotracer is used to detect HER2+ metastatic breast cancer. We aimed to develop 64 Cu-DOTA-trastuzumab PET-CT to detect and characterize tumor uptake in HER2+ or - GC patients. We conducted a single-arm phase II pilot study exploring the feasibility of 64 Cu-DOTA-trastuzumab for PET imaging of HER2 overexpressing GC compared to HER2 non-expressing tumors. Eight patients with biopsy-confirmed gastric adenocarcinoma were included. Immunohistochemistry was used to evaluate primary tumor biopsies for HER2 overexpression. Patients were injected with 45 mg of cold trastuzumab followed by 5 mg of 64 Cu-DOTA-trastuzumab. PET-CT scans were performed 24-48 h post radiotracer injection and compared to standard staging CT scans. We observed limited toxicity following 64 Cu-DOTA-trastuzumab injections. While there was uptake of the radiotracer in portions of HER2+ lesions, there was no statistically significant distinction between tumor and background by standardized uptake value analysis. Despite the potential of 64 Cu-DOTA-trastuzumab PET imaging of HER2+ metastatic breast cancer, a 5 mg dose of this radiotracer injected 24-48 h before imaging was insufficient to identify HER2+ GC. These results inform future GC imaging studies to optimize biomarker-targeted therapies based on dosage and timing for more clinically relevant imaging.

1124 Staging CT in the Work Up for Primary Breast Cancer – Indications, Incidentalomas, Metastases and the Impact on Patient Management

Abstract Aim There is considerable variation amongst units in the use of staging CT in breast cancer. The current ABS guidelines advise staging in those with &amp;gt;/ = N2, T3/4 or those with symptoms suspicious for metastatic disease. The aim of this study was to assess the indications for primary breast cancer patients undergoing staging CT scan, and the subsequent detection rate of incidentalomas and metastatic disease. Method This was a retrospective cohort study conducted in a high-volume tertiary referral centre of patients diagnosed with a primary breast cancer between January 2018 and December 2018 who underwent staging CT. Data was assessed for patient demographics, tumour characteristics and findings on CT. Results 714 patients were diagnosed with breast cancer in this 12-month period, of which 120 had a staging CT. Twelve had recurrent disease and were excluded. There was an overall incidentaloma rate of 66.6% and metastases rate of 11.1%. The group was subdivided into those who fulfilled the guidelines and those who did not. 46 patients met the staging criteria, with metastatic and incidentaloma rates of 21.7% and 65.2% respectively. 62 patients did not meet the staging criteria, with metastatic and incidentalomas rates of 3.2% and 67.7% respectively. Conclusions This study demonstrates that the detection of metastatic disease in patients who do not meet the criteria is low with a rate of 3.2%. CT staging in primary breast cancer should be reserved for patients who meet the guidelines in order to better direct resource, avoid over investigation and mitigate patient anxiety.

External validation of biomechanical computed tomography for fracture risk classification in metastatic hormone sensitive prostate cancer.

e24077 Background: For men with metastatic hormone-sensitive prostate cancer (mHSPC) on androgen deprivation therapy (ADT), guidelines recommend dual-energy X-ray absorptiometry (DXA) screening to identify fracture risk and benefit from antiresorptive therapy. However, only 8% of men with mHSPC receive routine DXA screening. Biomechanical computed tomography (BCT) is a radiomic technique that measures bone mineral density (BMD) and bone strength from routine staging and surveillance CT scans but has not been validated in mHSPC. Methods: This retrospective cohort study included 99 patients with incident mHSPC beginning ADT (2013-2020) at one academic (n = 70) and one tertiary VA medical center (n = 29) with CT abdomen/pelvis or PET/CT imaging at baseline (within 1 year prior to ADT initiation) and follow-up (1-2 years after ADT initiation). BCT-assessed BMD T-score and femoral strength were calculated from baseline and follow-up CT scans. We evaluated the association between BCT measures and subsequent pathologic and non-pathologic fractures within 3 years following mHSPC diagnosis. Results: Among 99 patients, mean age was 68 years, 48 (48.5%) were White, and 45 (45.4%) were Black. During median follow-up of 19 months, 23 (24%) developed a pathologic and 15 (15%) a non-pathologic fracture. BCT and DXA-assessed femoral-neck BMD T-score were strongly correlated (R2= 0.94, N = 23). Higher BCT-assessed baseline BMD (Odds Ratio [OR] 0.5, p = 0.03) and bone strength (OR 0.57, p = 0.02) were each associated with decreased pathologic fracture (Table). Neither BMD nor bone strength were significantly associated with non-pathologic fracture. BCT identified 10 (10%) men eligible for antiresorptive therapy by established BMD, strength, or FRAX criteria at ADT initiation, 4 (40%) of whom never received it by the end of follow-up. Between baseline and follow-up, both BMD (-0.27) and bone strength (-0.34) decreased among patients who did not receive antiresorptive therapy (n = 76), with no difference in longitudinal change between ADT alone vs with androgen receptor signaling inhibitors. Conclusions: In this diverse, multicenter cohort of men with mHSPC beginning ADT, BCT BMD assessed from routine CT scans strongly correlated with DXA-assessed BMD. BCT measurements predicted subsequent pathologic fracture and identified additional men who would benefit from antiresorptive therapy. BCT may provide a practical method to assess the role for anti-resorptive therapy in patients with mHSPC. [Table: see text]

Staging CT scans in breast cancer: Are we missing any metastases?

Staging CT scans in breast cancer: Are we missing any metastases?

PD13-07 MULTIPARAMETRIC MRI OF THE BLADDER AS A PREDICTIVE FACTOR OF HISTOPATHOLOGY AT RETUR IN T1GH WITH PRESENCE OF DETRUSOR MUSCLE: COULD IT HAVE A ROLE?

You have accessJournal of UrologyCME1 Apr 2023PD13-07 MULTIPARAMETRIC MRI OF THE BLADDER AS A PREDICTIVE FACTOR OF HISTOPATHOLOGY AT RETUR IN T1GH WITH PRESENCE OF DETRUSOR MUSCLE: COULD IT HAVE A ROLE? Andrea Giordano, Ettore Dalmasso, Eugenio Alessandria, Germano Chiapello, Diego Bernardi, Beatrice Carbonaro, Violino Paolo, and Ivano Morra Andrea GiordanoAndrea Giordano More articles by this author , Ettore DalmassoEttore Dalmasso More articles by this author , Eugenio AlessandriaEugenio Alessandria More articles by this author , Germano ChiapelloGermano Chiapello More articles by this author , Diego BernardiDiego Bernardi More articles by this author , Beatrice CarbonaroBeatrice Carbonaro More articles by this author , Violino PaoloViolino Paolo More articles by this author , and Ivano MorraIvano Morra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003260.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The role of re-TUR in patients with T1 bladder tumor and muscle in TUR specimen remains controversial. Furthermore, re-TUR is an invasive procedure and a non-negligible source of logistic difficulties. On the other hand, the role of multi-parametric magnetic resonance imaging (mpMRI) for bladder cancer is growing, thanks to its high sensibility and specificity in the identification of local invasiveness of the tumor. We analyzed the role of MRI in the setting of repeated transurethral resection (reTUR) to predict absence of residual tumor (T0), persistence or understaging at first resection and we present our experience. METHODS: From April 2021 to September 2022 patients with diagnosis of T1HG bladder cancer and presence of detrusor muscle at first resection underwent a bladder MRI before reTUR, after 4 or 5 weeks from the first procedure. Ethical Committee approval has been obtained. Results were classified as no evidence of residual tumor, its evidence or understaging (according to VI-RADS score). MRI was 1.5 T. Accuracy was determined using histopathology as the reference standard. RESULTS: A total of 85 MRI was performed. 68 (80%) were classified as no residual tumor, 15 (17%) as residual tumor and 2 (3%) as suspected understaging at first resection. Accordancy with histopathology was 88%. Only in 10 (12%) cases MRI did not correctly predict results of reTUR: in 7 cases MRI classified as no residual tumors but histopathology found persistence of disease (of high grade), and 3 cases were classified as residual tumor but reTUR was negative. All 10 cases were intraoperatively macroscopically negative. The 2 cases of understaging were correctly predicted by MRI. Patients’ characteristics, tumor size, focality, site, prior recurrence rate, lymphovascular invasion, histological variants and hydronephrosis at staging CT-scan did not affect MRI accuracy. CONCLUSIONS: MRI is effective for prediction of histopathology at reTUR and could represent an effective tool in stratifying patients with T1HG who need second resection. Better instrumentation (3T-MRI), increasing experience and integration of modern prediction models can improve further our preliminary results, even including accurate cost analysis. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e408 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea Giordano More articles by this author Ettore Dalmasso More articles by this author Eugenio Alessandria More articles by this author Germano Chiapello More articles by this author Diego Bernardi More articles by this author Beatrice Carbonaro More articles by this author Violino Paolo More articles by this author Ivano Morra More articles by this author Expand All Advertisement PDF downloadLoading ...

Multidimensional characterization of early-stage gastric cancer: Preliminary results of MIMETIC trial.

422 Background: Gastric adenocarcinoma (GA) represents a leading cause of cancer death worldwide. For localized and locally advanced (LA) GA, accounting for 30% of new diagnoses, surgery, with or without peri-operative chemotherapy (CTX), remains the cornerstone of treatment. Nevertheless, the cure rate remains unsatisfactory. Genomic biomarkers have been tested to tailor anticancer treatments, but no one is able to guide the treatment choice in GA. Gut microbiota represents an emerging area of investigation in cancer, as a key modulator of host immune response. However, its role in GA on treatment tolerability and outcome is not unraveled. Additionally, radiomics, which can perform massive data mining to increase diagnostic power, and extensive dietary assessment are fast-growing tools. Our aim is to set an innovative approach to mapping the interaction among nutrition, microbiome, genomics, and radiomics and correlate them with clinical outcomes. Methods: We are conducting a prospective observational trial in GA patients (pts), candidates to receive peri-operative CTX or upfront surgery. For each patient, we longitudinally collect blood, fecal and salivary samples, alongside clinical and nutritional information. Additionally, past dietary consumption is measured using the food frequency questionnaire. At baseline, CT scan for staging, radiomic analysis, upper digestive endoscopy with biopsy, and molecular biomarkers are performed. Additional samples are taken from tumor and surrounding normal mucosa (1 to 3 cm) for microbiome analysis. Genomic DNA from stool, buccal and gastric tissue samples will be extracted and subjected to 16S metagenomic sequencing. Taxonomic and functional features within and between anatomical compartments will be correlated with clinical and radiomic data. Results: Here, we are presenting preliminary data of fecal samples from 35 GA pts in comparison with a cohort of healthy subjects (HCs) collected at our Institution. Pts’ characteristics are outlined here. We observed that the structure of the gut microbiota of GA pts is distinct from HCs in terms of beta diversity, and this difference is maintained after CTX. In particular, GA’s microbiota was enriched in S. anginosus, among other taxa. Conclusions: Our preliminary data support the feasibility of the study. The differences in structure and composition of the gut microbiota of GA pts compared to HCs confirm previous reports while providing the rationale for developing gut microbiota profiling into a non-invasive biomarker, to implement early diagnosis and prevention. The study is ongoing and actively recruiting.[Table: see text]

Local Staging Characteristics (T2, T3) of Colorectal Cancer In Multislice Computerized Tomography (MSCT) Imaging

Background: Early determination of the local staging of colorectal cancer is very important to determine the prognostic and optimal management of therapy. The purpose of this study was to determine the local staging characteristics (T2, T3) of colorectal cancer on MSCT imaging. Method: a descriptive design with a retrospective analytical observation approach, namely by evaluating the results of a local staging CT scan (T2, T3) of colorectal cancer. The sample size was 34 cases of colorectal cancer that met the inclusion criteria. Results: 8 cases (23.5%) of colorectal cancer were found with local T2 staging and 26 cases (76.5%) with local T3 staging. The characteristics of local staging T2 are the majority of 100% solid components, 100% clear boundaries, 100% homogeneous enhancement patterns, and 100% not invading surrounding organs. While the characteristics of the local staging of T3 are mostly solid components 61.53%, unclear boundaries 73.07%, irregular margins 96.15%, mass morphology 88.46%, homogeneous enhancement patterns 61.53% and heterogeneous 38.46%, does not invade the surrounding organs 100%. Conclusion: The differences in the characteristics of local T2 and T3 staging lie in the tumor boundaries, tumor shape, and patterns of enhancement.