Tumor Dimension Research Articles

Can Radiographic Tumor Volume of Oral Squamous Cell Carcinoma Help Predict Clinical and Pathological Tumor Features?

Radiographic tumor volume (RTV) of oral squamous cell carcinoma (SCC) is seldom measured in practice. Aims of the study are to estimate RTV of SCC and to investigate its relationship with clinical and pathological stage, tumor margin status, recurrence, and need for chemo/radiation.The design is a retrospective cohort study. The predictor variable is SCC RTV. The primary outcome variables are clinical and pathological tumor size. The secondary outcomes are margin status and postoperative chemo/radiation. Tumor dimensions were measured on preoperative maxillofacial or neck computer tomography images with contrast. Information on patient and tumor characteristics was obtained. Pearson correlation, t test, ANOVA and log rank test were used for statistical analysis. The significance level was set at .05.Thirty-six subjects aged 36 to 86 were included in the study. Positive association was found between clinical T stage and RTV (P = .0003) and between pathologic T stage and RTV (P = .002). Mean value of RTV was significantly higher in the group with positive margins (P = .0004). RTV was significantly higher in cancers requiring adjuvant chemo/radiation (P = .033). Mean RTV for patients with recurrence was 1.86 cm3 as compared to 1.29 cm3 for patients with no recurrence. Higher tumor volumes were more likely to be associated with recurrence.RTV is a variable that is readily available to head and neck surgeons. RTV is associated with clinical and pathological tumor sizes, margin status, need for adjuvant chemo/radiation and tumor recurrence.

The buccal fat pad flap for the reconstruction of intraoral buccal defects following buccal cancer surgery

ObjectiveThere are many reconstruction techniques for the repair of the intraoral buccal defects following oncological resections. The pedicled buccal fat pad (BFP) flap can be used for reconstruction of medium-sized buccal defects. The purpose of this study was to investigate the outcomes of the reconstruction with BFP flap following the resection of buccal tumors and risk factors on BFP flap success. MethodsThis study was designed as a retrospective case series research. Ten patients with squamous cell carcinoma of the buccal mucosa underwent BFP flap reconstruction following tumor resection. The dimensions of the primary tumor and post-resection defect were calculated. The intraoral operation field was evaluated on the postoperative 7th day and in the postoperative 1 st and 6th months. Postoperative flap status, disease recurrence, risk factors for flap success were assessed. ResultsThe mean greatest dimension of the post-resection buccal defect was 41.9 ± 10.3 mm. A partial dehiscence was observed in three patients in the postoperative 7th day. The 6th month-examination revealed no flap complications. The mean greatest dimension of post-resection buccal defect in uncomplicated patients was 42.7 ± 11.4 mm and in patients with partial dehiscence was 40 ± 8.6 mm (p = 0.727). There was no significant difference between uncomplicated patients and patients with partial dehiscence according to body mass index (normal vs overweight, p = 0.667). ConclusionThe BFP flap is a reliable reconstruction method in medium sized buccal defects following oncological resection. It has low complication and donor site morbidity rates and also good anatomical and oncological outcomes.

Conservative (non-radical) surgery for stage IB1 cervical cancer.

There has been lively debate in recent years following the publication of various retrospective case series and small cohort studies that suggest certain women presenting with International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical cancer (pre-2018 revised classification) may be treated by non-radical surgery, either simple hysterectomy or cone biopsy, where fertility preservation is required. A strictly defined histological criterion is necessary for selecting such cases, incorporating tumour dimensions including estimated tumour volume, lympho-vascular space invasion and pelvic lymph node status. Meta-analyses of these studies show that the oncological outcomes are comparable to the excellent results achieved by radical hysterectomy and radical trachelectomy. In addition, the fertility and pregnancy outcomes for cases treated by conisation are superior to cases managed by radical trachelectomy. Multi-centre, ethically approved, prospective studies are currently on-going, which will provide better quality evidence in an attempt to contribute to this debate, with the intention of improving outcomes, including quality of life, in women presenting with small-volume stage IB1 cervical cancer.

The incidence and relevance of non-fatty components in trunk and extremity lipomatous soft tissue masses.

To determine the incidence and diagnostic relevance of non-fatty 'solid appearing' components within lipomatous tumours of the trunk and extremity. Retrospective review of patients referred to a specialist musculoskeletal oncology service over a 12-month period with a lipomatous trunk or extremity soft tissue tumour. The presence and morphology (solitary/multifocal; homogeneous/heterogeneous; well-defined/poorly defined) of non-fatty components was recorded based on MRI and compared with the final histological diagnosis. 213 patients with 217 lipomatous tumours were included, 119 (55.9%) males and 94 (44.1%) females with mean age of 54.6 years (range 7-93 years). Seventy-seven (35.5%) lesions arose superficial to the fascia and 139 (64.1%) deep, while a single case involved both compartments. Mean maximal tumour dimension was 94.9 mm (range 12-288 mm). Non-fatty 'solid appearing' components were identified in 28 (12.9%) cases, of which eight were solitary and 20 were multifocal, six had homogeneous SI and 22 had heterogeneous SI, and eight had well-defined margins, while 20 had poorly defined margins. Histological diagnosis was available in 20 of the tumours containing non-fatty components, 16 of which were benign, two intermediate grade and two malignant (a dedifferentiated liposarcoma and a myxoid liposarcoma). The commonest diagnosis was spindle cell lipoma, which accounted for 10 of 20 (50%) cases with confirmed histology. Non-fatty components are identified in ~13% of trunk and extremity lipomatous tumours. The majority of such lesions are benign lipoma variants, most commonly spindle cell lipoma. Solid non-fatty components are identified in approximately 13% of lipomatous tumours referred to a specialist sarcoma service. Despite the concern that these may represent dedifferentiated liposarcomas, high-grade tumours were seen in only two cases, the commonest diagnosis being a spindle cell lipoma.

Dataset for the reporting of carcinoma of the esophagus in resection specimens: recommendations from the International Collaboration on Cancer Reporting

A standardized data set for esophageal carcinoma pathology reporting was developed based on the approach of the International Collaboration on Cancer Reporting (ICCR) for the purpose of improving cancer patient outcomes and international benchmarking in cancer management. The ICCR convened a multidisciplinary international expert panel to identify the best evidence-based clinical and pathological parameters for inclusion in the data set for esophageal carcinoma. The data set incorporated the current edition of the World Health Organization Classification of Tumours of the Digestive System, and Tumour-Node-Metastasis staging systems. The scope of the data set encompassed resection specimens of the esophagus and esophagogastric junction with tumor epicenter ≤20mm into the proximal stomach. Core reporting elements included information on neoadjuvant therapy, operative procedure used, tumor focality, tumor site, tumor dimensions, distance of tumor to resection margins, histological tumor type, presence and type of dysplasia, tumor grade, extent of invasion in the esophagus, lymphovascular invasion, response to neoadjuvant therapy, status of resection margin, ancillary studies, lymph node status, distant metastases, and pathological staging. Additional non-core elements considered useful to report included clinical information, specimen dimensions, macroscopic appearance of tumor, and coexistent pathology. This is the first international peer-reviewed structured reporting data set for surgically resected specimens of the esophagus. The ICCR carcinoma of the esophagus data set is recommended for routine use globally and is a valuable tool to support standardized reporting, to benefit patient care by providing diagnostic and prognostic best-practice parameters.

Imaging criteria to predict Shamblin group in carotid body tumors - revisited.

This study aims to compare the imaging findings of carotid body tumors on contrast-enhanced computed tomography (CT) with the intraoperative Shamblin grade and to evolve an imaging-based scoring system that can accurately predict the Shamblin grade. Preoperative contrast-enhanced CT scans of 40 patients who underwent surgical excision of carotid body tumors in our institution between 2004 and 2017 were retrospectively reviewed. The angle of contact with the internal carotid artery (ICA), tumor volume, presence of peritumoral tuft of veins, loss of tumor adventitia interface and distance from the skull base were assessed and compared with the intraoperative Shamblin grades of the tumor. Ordinal logistic regression was used to determine which parameters could be predictors of the Shamblin grades. Receiver operator characteristic (ROC) curves were used to score the tumor volumes. Among the 42 tumors evaluated, 6 (14.3%) were surgically classified as Shamblin I, 15 (35.7%) as Shamblin II, and 21 (50%) as Shamblin III tumors. Pairwise comparison between the three Shamblin groups showed a statistically significant difference for angle of contact with ICA, maximum tumor dimension, presence of peritumoral tuft of veins and loss of tumor adventitia interface (p = 0.001, p = 0.001, p = 0.038 and p = 0.003, respectively). However, tumor volumes and distance from skull base were not significantly different between the Shamblin groups (p = 0.136 and p = 0.682). A scoring system, including four of the above mentioned parameters (angle of contact with ICA, tumor volume, presence of peritumoral tuft of veins, and loss of tumor adventitia interface) was developed with a maximum score of 8 and a minimum of 2. A statistically significant difference was found between the final scores among the three Shamblin groups (p < 0.001). Using ROC curves, a final score of ≥6 was found to separate Shamblin grade III tumors from grade I and II tumors (sensitivity, 95.24%; specificity, 71.43%). All patients with documented intraoperative estimated blood loss of >1000 mL had Shamblin grade III tumors. Postoperative complications like stroke, ICA thrombosis and lower cranial nerve palsies were seen only with Shamblin grade II and III tumors. The simple scoring system we have proposed correlates well with the Shamblin grade and helps in identifying patients who have a higher risk of developing complications.

Identification of an optimal prolactin threshold to determine prolactinoma size using receiver operating characteristic analysis

Prolactinomas represent the most common type of secretory pituitary neoplasms, with a therapeutic management that varies considerably based on tumour size and degree of hyperprolactinemia. The aim of the current study was to evaluate the relationship between serum prolactin (PRL) concentrations and prolactinoma size, and to determine a cut-off PRL value that could differentiate micro- from macro-prolactinomas. A retrospective cohort study of 114 patients diagnosed with prolactinomas between 2007 and 2017 was conducted. All patients underwent gadolinium enhanced pituitary MRI and receiver operating characteristic (ROC) analyses were performed. 51.8% of patients in this study were men, with a mean age at the time of diagnosis of 42.32 ± 15.04 years. 48.2% of the total cohort were found to have microadenomas. Baseline serum PRL concentrations were strongly correlated to tumour dimension (r = 0.750, p = 0.001). When performing the ROC curve analysis, the area under the curve was 0.976, indicating an excellent accuracy of the diagnostic method. For a value of 204 μg/L (4338 mU/L), sensitivity and specificity were calculated at 0.932 and 0.891, respectively. When a cut off value of 204 μg/L (4338 mU/L) was used, specificity was 93.2%, and sensitivity 89.1%, acceptable to reliably differentiate between micro- and macro- adenomas.

Genetic Alterations and Clinical Features in Brazilian Patients With Pheochromocytomas and Paragangliomas

Abstract Pheochromocytomas and paragangliomas are tumors derived from chromaffin cells which result from mutations of at least six different genes as autosomal dominant disorders. We evaluated the existence of correlations between genetic alterations and clinical data in 16 patients with pheochromocytomas and/or paragangliomas. From 2007 to 2019, 13 patients with pheochromocytoma [3 men, medium age 39 years (14–61)] and 3 with paraganglioma [1 men, medium age 33 years (22–35)] were evaluated regarding the presence of genetic mutations and possible correlations between the latter and some clinical features. Besides the mutations, tumor size, symptoms and signs present by the time of the diagnosis were studied. Four patients had pathogenic mutations (SDHB deletion encompassing the promoter and exon 1, C98Y in the SDHB gene, N78S in the VHL gene, and C634R in the RET gene) and one subject had a V90M variant in the TMEM127 gene. Two patients did not present mutations and nine had nonpathogenic mutations. Regarding the presence of clinical features before treatment, there was a predominance of arterial hypertension (75.0%), while the prevalence of tachycardia, abdominal pain and headaches was respectively 12.5%, 12.5% and 6.25%. There was no significant difference between the age of patients with pathogenic mutations and that of the other patients (31.2 vs. 38.6 years, p= 0.3952). Moreover, there were no differences regarding the prevalence of pheochromocytoma (p= 0.2143) or clinical features (p: hypertension= 0.6346, tachycardia= 0.4583, abdominal pain= 0.5417, headaches= 0.6875), or tumor dimensions (p= 0.4578) when the two groups were compared. However, the prevalence of paragangliomas was higher in patients with pathogenic mutations (p= 0.0179). In patients with pheochromocytoma and paraganglioma, the absence of correlations between pathogenic mutations and clinical features increases the importance of the genetic studies in the determination of treatment and prognosis of these tumors. Furthermore, subjects with germline mutations associated with pheochromocytoma and paraganglioma should undergo lifelong clinical, biochemical and imaging surveillance and their families should receive genetic counseling.

Giant Prolactinomas: An Experience From South India

Giant prolactinomas are large lactotroph adenomas, defined as those with maximum dimension of >4cm. They constitute <5% of all prolactin secreting tumors, and are more frequently seen in men. They present with features of hyperprolactinemia and hypopitutarism and are responsive to dopamine agonist therapies. In the current study we have shared our experience on management of giant prolactinomas over the last 15 years. We collected clinical data retrospectively from medical records of patients with giant prolactinoma managed at our institute over the last 15 years. This study describes the symptomatology, tumor characteristics and response to therapy. Our study included 21 patients with 15 males and 6 females. The mean age of presentation was 32 ± 10.3 years, ranging between 10 to 53 years. Vision defect was the predominant complaint (57%, 12 patients), followed by headache (52%, 11 patients). Erectile dysfunction was a presenting feature in 13% of men (2 patients) and amenorrhea/galactorrhea in 33% of women (2 patients). Seizure was seen in 10% of the patients (2 patients) and 10% (2 patients) were diagnosed with giant prolactinoma on evaluation for primary infertility. Tumor associated pituitary dysfunction manifested as hypogonadism in 67%, 14 patients, central hypothyroidism in 38%, 8 patients, and hypocortisolism in 1 patient. The median maximum tumor dimension was 4.4 cm with median basal PRL of 7168 ng/ml. Five patients underwent debulking surgery (24% of the patients) prior to endocrinology referral for indications such as apoplexy/raised intracranial tension. All patients received cabergoline and a mean dose of 2.1 ± 1.7 mg/week (range, 1-7 mg/week) was prescribed to attain a median nadir prolactin level of 48 ng/ml over a median period of 4 months (range, 1-40 months). The follow-up MRI data was analysed for 13 patients. Tumor shrinkage of >50% from the baseline was seen in all but 1 patient (92%) and 2 patients had disappearance of radiologically detectable tumor. Although giant prolactinomas have a greater tumor burden than the more common macroprolactinomas, the responsiveness to dopamine agonist therapy is excellent and surgical therapy is reserved for any exceedingly large tumors to relieve compression on vital structures.

Think Outside the Thorax: Doege-Potter Syndrome Presenting as a Retroperitoneal Mass

Introduction: Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome, occurring less commonly than insulinoma. These tumors produce high molecular weight insulin-like growth factor-2 or “big IGF-2”, resulting in hypoglycemia: big IGF-2 decreases glycogenolysis, gluconeogenesis, and glucagon release as well as increases glucose uptake by adipocytes and skeletal muscle. NICTH specifically associated with a solitary fibrous tumor (SFT) is known as Doege-Potter syndrome. Doege-Potter syndrome is seen most with thoracic SFT’s. This case study details the diagnosis and management of Doege-Potter syndrome due to retroperitoneal SFT.Case Description: Our patient is a 68-year-old, white female who initially presented to an outside facility with a 3-week history of episodic neuroglycopenic symptoms temporarily relieved with eating. She reported night sweats but no weight change or fever. Medical history was notable only for hypertension and GERD. She had no personal or family history of diabetes. She was transferred to our facility for further evaluation of an 18.6 cm multilobular mass seen just inferior to the liver on abdominal CT. Whipple’s triad was confirmed with venous glucose sampling while inpatient. C-peptide, free/total insulin, and pro-insulin were collected during permissive hypoglycemia and were low. Morning cortisol and TSH were unremarkable. Additionally, sulfonylurea screen and insulin antibodies were negative. Ultrasound-guided biopsy of the lesion was positive for CD34 and STAT6, consistent with SFT. Refractory hypoglycemia was treated with D5W infusion until surgical resection of the retroperitoneal mass, after which, she had complete resolution of her hypoglycemia.Discussion: This patient’s serum IGF-2 was within normal limits, consistent with reports of feedback inhibition exerted by increased levels of big-IGF-2. Therefore, the IGF-2:IGF-1 ratio is used to determine increased serum levels of big IGF-2, but this test is not widely available. SFT’s can recur within months to years of resection, necessitating surveillance. Recurrence is also more common with extrathoracic tumors. Surgical pathology noted tumor dimensions of 22 cm and 2270 g; mitotic rate was 1 per 10 hpf. Features typical of malignancy include large size (>15 cm) and mitotic rate >4 mitoses per hpf. This patient’s follow-up CT abdomen at 6 weeks did not show any findings to suggest recurrent or metastatic disease.

Advanced Stages and Increased Need for Adjuvant Treatments in Breast Cancer Patients: The Effect of the One-year COVID-19 Pandemic.

The COVID-19 lockdown includes restrictive measures and temporary health system reorganization. Resources were shifted to COVID-19 patients, screening programs were temporary suspended, and oncological care suffered slow-down. The aim of the study was to evaluate the impact of these measures on breast cancer patients. All breast cancer patients referred to our unit from February 21, 2019 to February 21, 2021 were enrolled. Type of treatments and surgery, TNM, tumor diameter, and predictive and prognostic factors were analyzed. Out of 445 patients with a breast cancer diagnosis, 182 (40.9%) were enrolled in the COVID-19 group (from February 21, 2010 to February 21, 2021). These patients were compared with 263 (59.1%) patients pre-COVID-19. Tumor diameters were bigger in the COVID-19 group. Type of surgery and N staging were statistically significantly different. Extreme advanced disease incidence was significantly different between the groups (2.7% COVID-19 group vs. 0 pre-COVID-19 group, p=0.011). Incidence of post-surgical radiation-therapy was higher in the COVID-19 group. Other variables analyzed were comparable without a statistically significant difference. COVID-19 led to increased tumor dimensions, advanced N-staging, and increased need for adjuvant treatments in breast cancer.

Abstract No. 22 Predictors of intrahepatic recurrence of hepatocellular carcinoma following percutaneous microwave ablation of tumors larger than 3 cm

To identify the predictors of local recurrence and distant intrahepatic recurrence following microwave ablation of hepatocellular cancer larger than 3 cm 74 cases of microwave ablations for HCC >3 cm in size were included from a single institution. Data was collected from EMR and PACS. Mean age was 66 (SD 4.2) and the mean maximal tumor dimension was 4.2 cm (SD 1.2 cm). The mean distance of the tumors from diaphragm and the capsule were 2.5 (SD 2.6) and 0.5 (SD 0.9) cm, respectively. In 25 cases (33.7%), the tumor was < 1cm from diaphragm. In 45 cases (60.8%) a large vessel was located within 1 cm from the tumor margin. The mean AFP was 155.5 (224). Mean red cell distribution width was 14.9%. The mean platelet/albumin ratio was 2.8 (1.48). There were 44 (59.4%) cases of total recurrences of which 30 (40.5%) were local recurrences over a mean follow up period of 20 months. Tumors over 3.5 cm had a significantly higher proportion of recurrence (40.7 vs 73.3%, P = 0.03). Both maximal tumor dimension (P = 0.04) and the least distance from diaphragm (0.03) were independent predictors of recurrence on multivariate regression analysis. In HCC over 3 cm, the maximal tumor dimension and the proximity of the tumor to the diaphragm are predictors of recurrence following microwave ablation. Tumors over the size of 3.5 cm have significantly higher rates of recurrence.

Abstract No. 466 Quantitative assessment of the effect of intra-arterial nitroglycerin on hepatocellular carcinoma perfusion using two-dimensional digital subtraction angiography

To evaluate the effects of intra-arterial nitroglycerin on hepatocellular carcinoma perfusion using 2-D perfusion angiography Two-dimensional (2D) perfusion angiograms obtained during planning arteriography for radioembolization of HCCs from September 2019 to February 2020 were retrospectively reviewed. Inclusion criteria included LIRADS-5 lesions and angiographically identifiable tumor and background parenchyma. Exclusion criteria included treated lesions and motion-degraded studies. Tumor and background liver parenchyma 2D perfusion data before and after the administration of intra-arterial nitroglycerin were processed and the area under the curve (AUC) of the time-density curve was calculated. Relative perfusion of HCC to background liver was compared at the 2 time points using a 2-tailed unpaired t-test. Twenty-four arteriograms were reviewed. Twelve were excluded from the analysis due to prior treatment (n = 5), motion degradation (n = 2), and no identifiable background liver (n = 5). Twelve HCCs in 12 patients were included in the final analysis. Mean patient age was 71.7 ± 9.7 years. Ten patients had cirrhosis. Mean maximum tumor dimension was 4.9 ± 2.0 cm. Seven tumors were in the right lobe and 5 in the left lobe. Contrast injection duration was 5 seconds. Mean intra-arterial nitroglycerin dose was 279 ± 69 micrograms. The arteriograms were then analyzed using 2D perfusion software. The ratio of the AUC of HCC to background liver was 2.18 ± 1.11 before intra-arterial nitroglycerin and 3.14 ±1.70 after nitroglycerin administration (P < 0.05). Intra-arterial nitroglycerin significantly increases perfusion to hepatocellular carcinoma when compared to background liver. Further research is needed to determine if nitroglycerin increases the permeability of HCC tumors and thereby increases intra-tumoral dose delivery.

A438079 affects colorectal cancer cell proliferation, migration, apoptosis, and pyroptosis by inhibiting the P2X7 receptor

BackgroundOur previous study identified elevated expression of the P2X7 receptor (P2X7R) in colorectal cancer (CRC) patients, suggesting the receptor is a target for predicting poor disease prognosis. A438079 is a highly selective P2X7R antagonist, however, no studies have identified A438079 effects and mechanisms toward the biological behavior of CRC cells, and its therapeutic in vivo potential in CRC nude mice. MethodsThe CRC cell lines, HCT-116 and SW620 were treated with 10 μM A438079, after which proliferation, migration, invasion, and apoptosis were assessed. SW620 cell xenografted BALB/c nude male mice were randomly divided into control, 5-FU, and A438079 groups. Mouse weight and tumor dimensions were also measured every two days. Furthermore, the expression of apoptosis related indicators (P2X7R, Bcl-2, Bax, caspase9, cleaved caspase9, caspase3, and cleaved caspase3) and pyroptosis related indicators (NLRP3, ASC, cleaved caspase1, and interleukin (IL)-β) were investigated in vitro and in vivo. ResultsA438079 inhibited HCT-116 and SW620 cell proliferation, invasion and migration, and inhibited the growth of CRC xenografts in nude mice. A438079 promoted apoptosis via the Bcl-2/caspase9/caspase3 pathway and inhibited pyroptosis through the NLRP3/caspase1 pathway by inhibiting P2X7R in vitro and in vivo. ConclusionsWe preliminarily confirmed the therapeutic potential of A438079 toward CRC, and we provide a sound theoretical basis for A438079 as a new drug for the clinical treatment of CRC.

Outcome of pituitary hormone deficits after surgical treatment of nonfunctioning pituitary macroadenomas.

Nonfunctionning pituitary macroadenomas (NFPMA) are benign tumors that cause symptoms of mass effects including hypopituitarism. Their primary treatment is transsphenoidal surgery. We aimed to determine the outcome of pituitary hormone deficits after surgical treatment of NFPMA and to identify factors predicting hormonal recovery. We retrospectively included 246 patients with NFPMA diagnosed and operated in one of the two participating centers. All hormonal axes were evaluated except growth hormone (GH). Postoperative improvement of pituitary endocrine function was considered if at least one hormonal deficit had recovered and a lower total number of deficits was observed 1 year after surgery. 80% (n = 197) of patients had one or more pituitary deficits and 28% had complete anterior hypopituitarism. Besides GH, the gonadotropic and thyrotropic axes were the most commonly affected (68% and 62%, respectively). The number of hypopituitary patients dropped significantly to 61% at 1 year (p < 0.001) and a significant improvement was observed for all hormonal axes, except central diabetes insipidus. Among patients with preoperative hypopituitarism, 88/175 (50%) showed improved pituitary function at 1 year. Both hyperprolactinemia at diagnosis and a lower tumor diameter independently predicted favorable endocrine outcome. Hypopituitarism is present in 80% of patients with NFPMA and nearly half of them will benefit from sustained improvement after surgery. Hyperprolactinaemia at diagnosis and lower tumor dimensions are associated with favorable endocrine prognosis. This supports the option of early surgery in NFPMA patients with pituitary deficits independent of the presence of visual disturbances.

A giant right atrial myxoma—The growth rate and multi‐modality imaging

A young and healthy woman presented with progressive dyspnea on exertion. An echocardiogram showed a giant right atrial mass. Cardiac CT angiography provided the most accurate estimate for the tumor size, while 2-D echo, 2-D, and 3-D trans-esophageal echo underestimated the dimensions of the cardiac tumor when referenced by the surgical specimen. We also calculated the growth rate of the right atrial myxoma to be at least 1.2mm per month based on a normal chest CT 54months before her presentation. Surgical pathology confirmed typical features of cardiac myxoma in the right atrium.

An Automatic Framework to Create Patient-specific Eye Models From 3D Magnetic Resonance Images for Treatment Selection in Patients With Uveal Melanoma

PurposeThe optimal treatment strategy for uveal melanoma (UM) relies on many factors, the most important being tumor size and location. Building on recent developments in high-resolution 3D ocular magnetic resonance imaging (MRI), we developed an automatic image-processing framework to create patient-specific eye models and to subsequently determine the full 3D tumor shape and size automatically. Methods and MaterialsFrom 15 patients with UM, 3D inversion-recovery gradient-echo (T1-weighted) and 3D fat-suppressed spin-echo (T2-weighted) images were acquired with a 7T MRI scanner. First, the sclera and cornea were segmented from the T2-weighted image by mesh-fitting. The T1- and T2-weighted images were then coregistered. From the registered T1-weighted image, the lens, vitreous body, retinal detachment, and tumor were segmented. Fuzzy C-means clustering was used to differentiate the tumor from retinal detachments. The tumor model was verified and (if needed) edited by an ophthalmic MRI specialist. Subsequently, the prominence and largest basal diameter of the tumor were measured automatically based on the verified contours. These results were compared with manual assessments on the original images and with ultrasound measurements to show the errors in manual analysis. ResultsThe framework successfully created an eye model fully automatically in 12 cases. In these cases, a Dice similarity coefficient (mean surface distance) of 97.7%±0.84% (0.17±0.11 mm) was achieved for the sclera, 96.8%±1.05% (0.20±0.06 mm) for the vitreous body, 91.6%±4.83% (0.15±0.06 mm) for the lens, and 86.0%±7.4% (0.35±0.27 mm) for the tumor. The manual assessments deviated, on average, 0.39±0.31 mm in prominence and 1.7±1.22 mm in basal diameter from the automatic measurements. ConclusionsThe described framework combined information from T1- and T2-weighted images to accurately determine tumor boundaries in 3D. The proposed process may have a direct effect on clinical workflow, as it enables an accurate 3D assessment of tumor dimensions, which directly influences therapy selection.

Brain Tumor Classification Using Texture Feature Extraction

Medical imaging methods are necessary for tumor treatment. Image processing increases the accuracy, location, efficiency and recognizes tumor in magnetic resonance imaging (MRI) for the human brain. There are three MRI image cases studied consist of one image of a healthy human brain, and two with brain cancer cases to extract tumor size, area, dimension, and location. We presented two steps to extract the texture properties from the three image cases. The first step consists of two methods, used to extract statistical image feature, which is a grey level co-occurrence matrix modified method and the proposed grey level Run-length matrix method. The second step consists of two methods applied to the outputs of step-one to extract the full information. These methods are segmentation based on threshold technique and supervised classification technique based on the parallel pipe. Moreover, there are twelve features studied like the image roughness, uniformity or energy, and local homogeneity extracted to show the quality difference between methods. Image histogram presented to show the small difference between the output of the features. The result shows the segmentation based on threshold technique has efficient output with higher accuracy as well as the presented methods.

The absolute tumor-capsule contact length in the diagnosis of extraprostatic extension of prostate cancer.

Extraprostatic extension (EPE) of prostate cancer is associated with a poor prognosis. The broad-based capsule-tumor interface has been recognized as one of the worrisome imaging features in multiparametric prostate MRI (mpMRI). However, there was significant heterogeneity among the measurement method used in prior studies. This study's objectives were to investigate and compare the accuracy between the curvilinear and linear measurement, find the optimal cut-off contact surface threshold for the diagnosis of EPE, and assess the benefit of the additional contact surface measurement versus visual assessment alone. The status of EPE in mpMRI and the overall PI-RADS were assessed. The tumor's dimensions, the actual tumor-capsule contact length (ACTCL), and the absolute tumor-capsule contact length (ABTCL) were measured. The parameters were analyzed and correlated with the EPE status from prostatectomy specimens. Ninety-five patients who underwent mpMRI followed by prostatectomy were included in the study. High Gleason score (score 8-9), radiologist's impression of EPE, and PI-RADS 5 were significantly correlated with EPE in surgical specimens (p = 0.014, p < 0.001, and p < 0.001, respectively). Both ACTCL and ABTCL of patients with EPE were significantly higher than those without EPE in all imaging sequences (p < 0.001 to p = 0.003). The ABTCL has higher accuracy than the ACTCL. Dynamic contrast enhancement (DCE) was the most accurate sequence to measure the contact interface. The recommended cut-off value of ABTCL was 15.0mm, which had a sensitivity and specificity of 75.86% and 72.09%. Multivariable analysis revealed that the ABTCL > 15mm and the radiologist's impression on visual assessment were the only two independent predictors for the prediction of EPE (p = 0.048 and p = 0.016, respectively). Improvement of diagnostic performance was achieved when the two factors were combined. The ABTCL has better accuracy than the curvilinear measurement in the prediction of EPE. The optimum sequence for the measurement of the contact surface is the DCE. We recommended using 15.0mm as a cut-off point. The addition of the ABTCL measurement showed an increase in diagnostic performance. We encourage radiologists to use the capsular contact measurement in addition to their visual assessment to detect EPE in pre-operative MRI.

Radionecrosis (RN) in patients with brain metastases treated with stereotactic radiosurgery (SRS) and immunotherapy

Objectives Limited data exist regarding radionecrosis (RN) rates when patients receive immunotherapy (IT) and SRS for brain metastases. This study assesses the influence of such treatments on the rate of RN. Methods We retrospectively reviewed 352 lesions from 105 patients with metastatic melanoma or NSCLC treated with SRS and IT from 2012 to 2018. Lesions were excluded from analysis if patients had received WBRT or prior GK to the same lesion, if RN occurred before IT, or if IT had been discontinued >6 months pre-SRS or initiated >1 year post-SRS. IT was delivered concurrently (±30 days of SRS) or sequentially. Overall survival and RN rates were assessed with Kaplan-Meier analysis. Univariate analysis and multivariate analysis were performed to identify characteristics predicting RN. Results Of 195 lesions from 63 patients included in analysis, the median prescription dose, IDL, lesion volume, and maximum tumor dimension (MTD) were 19 Gy, 50%, 0.15 cc and 0.8 cm, respectively. RN rates at 1, 2, and 3 years were 7.3%, 10.4% and 10.4%. On UVA, RN risk increased with, isodose volume (IDV), MTD, and tumor volume (TV) whereas conformity index was associated with a trend toward decreased RN risk. Two-year RN rates increased with TV ≥ 0.3 cc (16% vs 1.1% p = 0.001), MTD ≥ 1.3 cm (19.1% vs 1.8% p < 0.003), and IDV ≥ 1.5 cc (19.6% vs 1.7% p = 0.001). Concurrent vs sequential timing of IT did not predict for RN. Conclusions Patients who received IT and SRS had acceptably low rates of RN. Timing of IT did not predict for RN. Further investigation is warranted to define RN risk with combined SRS and IT.