sensitivity and specificity of ultrasound-guided core-needle biopsy of neck masses

Neck masses are common presentations that often require tissue sampling to guide therapy. While open biopsy is invasive, fine needle aspiration cytology includes a high rate of nondiagnostic samples. We performed a retrospective analysis on 166 ultrasound-guided core-needle biopsies form the necks of 68 patients. The target tissue was correctly sampled in 64 patients, and on revision biopsy it reached to 66 patients [97%]. We experienced 97% success in obtaining high quality histopathologic specimens [66 out of 68 cases]. In these 66 patients the sensitivity and specificity in differentiating benign from malignant lesions was 97.6%, and 100% respectively. We conclude that ultrasound-guided core-needle biopsy is a safe and reliable technique in the diagnosis of neck masses with high diagnostic yield and high tissue quality for histopathology that represents a sufficient alternative to open biopsy, even in diagnosis of lymphoma

Value of preoperative axillary ultrasonography as a useful guide to sentinel LN biopsy in clinically node negative with large sized breast carcinoma

Breast carcinoma is most'y diagnosed beyond stage I in Egyptian patients. Here, we evakiate the use of preoperative ultrasonography to predict axillary lymph nodes involvement. We speculate that preoperative ultrasonographic evaluation may be of paramount importance in the era of sentinel node biopsy. Consecutive 110 clinically node-negative breast carcinomas were ultrasonographically examined for axillary nodes using 10 MHz linear transducer The images were recorded for analysis. Descriptive statistics of morphologic features of the examined lymph node in relation to final pathology were performed. Mean age was 47.5 years. Axillary lymph nodes were pathologically invaded in 80 patients [72.7%] with an average infiltration of 4.2 nodes per axilla. Compared to pathologic find ings, gray sca'e ultrasonography was highly significant in differentiating malignant from benign tumors [p<0.001], Gray sca'e examination had a sensitivity for detecting nodal metastases of 85.0%, specificity of 63.3% and overall accuracy of 79.1%. Surgeon-performed axillary ultrasonography is a helpful adjunct to clinical examination to improve preoperative staging in clinically node negative breast cancer especially in larger-sized tumors. However if sonography is negative sentinel node biopsy should be done due to considerable percentage of false negative results

Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer using an oxaliplatin-containing regimen: a phase II study

The combination of radiation, 5-fluorouracil and oxaliplatin in locally advanced rectal cancer has been shown to be feasible in phase 1 trials. The purpose of this phase II trial was to assess tolerance and efficacy of this regimen in a preoperative setting. Between December 2003 and Jan 2006, 46 patients with locally advanced rectal adenocarcinoma entered the study. Radiotherapy was delivered with a fourfield technique to a dose of 50.4Gy over 5 weeks with a concomitant boost approach. Two cycles of chemotherapy were given synchronously on weeks 1 and 5 [from days 1-5 and 29-33] in the form of oxalipatin 130mg/m[2] on day 1 plus 30 minute infusion of 100mg/m[2] L-folinic acid and continuous infusion of fluorouracil 350mg/m[2] for 5 days. Surgery was planned 6 weeks later. All patient completed treatment without modification except 10/46 patients [21.7%] who experienced grade 3/4 toxicity which necessitates treatment interruption and further dose reduction. Surgery was performed in 44 patients as 2 cases developed metastasis before the time of the planned surgery. An objective response was seen in 31 patients [67.4%]. Sphincter-saving surgery was possible in 27 patients [61.4%]. No postoperative deaths occurred. In 5/44 patients [11.4%] the operative specimen was sterilized and in 2/44 patients [4.5%] only very few residual malignant cells difficult to find microscopically were detected. Pathological downstaging was diagnosed in 70.5% [31 out of 44 patient]. Local and distant progression occurred later in 9 patients and the 2-year event-free and overall survival were 83% and 91% at a median follow up time of 20 months. The median event-free and overall survival durations were 12 and 22.5 months respectively. The event-free duration ranged from 5 to 34 months while the overall survival duration ranged from 13 to 36 months. Such a combined preoperative chemoradiotherapy using an oxaliplatin-containing regimen is well tolerated with no increase in surgical morbidity. The rates of pathological downstaging and sphincter-saving surgery are encouraging. Further phase III studies are needed for better evaluation of the value of such regimen

Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer using an oxaliplatin-containing regimen: a phase II study

The combination of radiation. 5-fluorouracil and oxallplatin in locally advanced rectal cancer has been shown to be feasible in phase 1 trials. The purpose of this phase II trial was to assess tolerance and efficacy of this regimen in a preoperative setting. Between December 2003 and Jan 2006. 46 patients with locally advanced rectal adenocarcinoma entered the study. Radiotherapy was delivered with a four-field technique to a dose of 50.4 Gy over 5 weeks with a concomitant boost approach. Two cycles of chemotherapy were given synchronously on weeks 1 and 5 [from days 1-5 and 29-33] in the form of oxalipatin 130 mg/m[2] on day 1 plus 30 minute infusion of 100 mg/m[2] L-folinic acid and continuous infusion of fluorouracil. 350 mg/m[2] for 5 days. Surgery was planned 6 weeks later. All patient completed treatment without modification except 10/46 patients [21.7%] who experienced grade 3/4 toxicity which necessitates treatment interruption and further dose reduction Surgery was performed in 44 patients as 2 cases developed metastasis before the time of the planned surgery. An objective response was seen in 31 patients [6 7.4%]. Sphincter-saving surgery was possible in 27 patients [61.4%]. No postoperative deaths occurred. In 5/44 patients [11.4%]. the operative specimen was sterilized and in 2/44 patients [4.5%]. only very few residual malignant cells difficult to find microscopically were detected. Pathological down staging was diagnosed in 70.5% [31 out of 44 patients]. Local and distant progression occurred later in 9 patients and the 2- year event-free and overall survival were 83% and 91% at a median follow up time of 20 months. The median event-free and overall survival durations were .12 and 22.5 months respectively. The event-free duration ranged from 5 to 34 months while the overall survival duration ranged from 13 to 36 months. - Such a combined preoperative chemoradiotherapy using an oxaliplatin-containing regimen is well tolerated with no increase in surgical morbidity. The rates of pathological down staging and sphincter saving surgery are encouraging. Further phase III studies are needed for better evaluation of the value of such regimen

Paclitaxel as induction chemotherapy plus radiation for locally advanced sequamous cell carcinoma of the head and neck

The primary objective of this study was to asses the complete response [CR] rate to a new innovative induction regimen plus combined chemoradiation in patients with locally advanced head and neck cancer [LA-HNC]. From April 2003 to March 2005, 66 eligible patients with LA-HNC referred mainly from Oncosurgery Department to Clinical Oncology and Nuclear Medicine Department, Mansoura University Hospital were treated by three cycles of induction chemotherapy [IC] with paclitaxel 175mg/m[2] in 3-h infusion on d1, leucovorin [LV] 200mg/m[2] over 20min immediately followed by fluorouracil [FU] 400mg/m[2] bolus and then 600mg/m[2] as 24h continuous infusion on d1 and 2, cisplatin 75mg/m[2] over 1-h infusion on d2 every 3 weeks. This was followed by radiation [70Gy] am weekly cisplatin 20mg/m[2]. After the completion of IC, 12/66 [18.2%] patient had CR. The CR rate was increased to [53.03%] post concomitant chemoradiotherapy [CCRT]. Hematologic toxicity, alopecia and mucositis were the most common complications of treatment. Median time to progression was 10 months and median survival was 18 months. This novel induction regimen is active, well tolerated and can be successfully followed by CCRT with weekly cisplatin. CCRT should remain standard treatment for patients with LA-HNC