Risk factors for residual cancer or lymph node metastasis after endoscopic noncurable resection of early colorectal cancer / 中华肿瘤杂志

Objective: Risk factors related to residual cancer or lymph node metastasis after endoscopic non-curative resection of early colorectal cancer were analyzed to predict the risk of residual cancer or lymph node metastasis, optimize the indications of radical surgical surgery, and avoid excessive additional surgical operations. Methods: Clinical data of 81 patients who received endoscopic treatment for early colorectal cancer in the Department of Endoscopy, Cancer Hospital, Chinese Academy of Medical Sciences from 2009 to 2019 and received additional radical surgical surgery after endoscopic resection with pathological indication of non-curative resection were collected to analyze the relationship between various factors and the risk of residual cancer or lymph node metastasis after endoscopic resection. Results: Of the 81 patients, 17 (21.0%) were positive for residual cancer or lymph node metastasis, while 64 (79.0%) were negative. Among 17 patients with residual cancer or positive lymph node metastasis, 3 patients had only residual cancer (2 patients with positive vertical cutting edge). 11 patients had only lymph node metastasis, and 3 patients had both residual cancer and lymph node metastasis. Lesion location, poorly differentiated cancer, depth of submucosal invasion ≥2 000 μm, venous invasion were associated with residual cancer or lymph node metastasis after endoscopic (P<0.05). Logistic multivariate regression analysis showed that poorly differentiated cancer (OR=5.513, 95% CI: 1.423, 21.352, P=0.013) was an independent risk factor for residual cancer or lymph node metastasis after endoscopic non-curative resection of early colorectal cancer. Conclusions: For early colorectal cancer after endoscopic non-curable resection, residual cancer or lymph node metastasis is associated with poorly differentiated cancer, depth of submucosal invasion ≥2 000 μm, venous invasion and the lesions are located in the descending colon, transverse colon, ascending colon and cecum with the postoperative mucosal pathology result. For early colorectal cancer, poorly differentiated cancer is an independent risk factor for residual cancer or lymph node metastasis after endoscopic non-curative resection, which is suggested that radical surgery should be added after endoscopic treatment.

Application of near infrared fluorescence imaging in detection of residual cancer in oral squamous cell carcinoma / 中华肿瘤杂志

Objective: Local recurrence is the main cause of treatment failure in patients with oral squamous cell carcinoma (OSCC). This study was proposed to investigate the feasibility of near infrared fluorescence (NIF) via indocyanine green (ICG) for monitoring surgical marginal in operation for OSCC patients. Methods: In 35 patients with OSCC treated surgically in the Department of Oral and Maxillofacial Surgery, Nanjing University School of Medicine, from January 2019 to June 2020, ICG (0.75 mg/kg) was administered intravenously via elbow vein at (12±1) hours before surgery, and NIF was performed intraoperatively on the surgical field and the cut edge of the surgically excised specimen, and fluorescence intensity was measured for OSCC tissue and normal oral mucosa, abnormal fluorescence signals were taken and subjected to rapid cryopathological examination. Correlation between NIF tumor boundary grading and pathological tumor boundary grading was analyzed by Spearman correlation analysis. Results: Clear ICG NIF was obtained for tumor lesions in all 35 patients, with a positive rate of 100%. The fluorescence intensity of OSCC tissue was (412.73±146.56) au, which was higher than that of normal oral mucosa tissue [(279.38±82.56) au, P<0.01]. Abnormal fluorescence signals were detected at the tumor bed and the cut edge of the surgical resection specimen in 4 patients, of which 2 cases were pathologically confirmed as cancer cell residue and 2 cases as inflammatory cell infiltration. The rate of positive detection of cut margins using ICG NIF technique in OSCC was 5.7% (2/35). Twenty of the 35 OSCC patients had grade 1, 11 of grade 2, and 4 of grade 3 tumor borders revealed by NIF of surgical resection specimens, which was positively correlated with pathological tumor border (r=0.809, P<0.001). Conclusions: ICG NIF technique can effectively detect the residual cancer cells at the incision margin, which is of great clinical value in reducing local recurrence of OSCC after surgery due to intraoperative cancer residue.

The value of MRI enhancement amplitude in qualitative diagnosis of suspicious enhancement after neoadjuvant therapy in breast cancer / 中华放射学杂志

Objective:To investigate the value of dynamic contrast-enhanced MRI enhancement amplitude for qualitative diagnosis of suspicious residual enhancing lesions after neoadjuvant therapy (NAT) in breast cancer.Methods:In total, 168 suspicious residual enhancing lesions of 168 patients who received NAT at Peking University Cancer Hospital from January 2015 to June 2016 were retrospectively analyzed and divided into non-residual cancer group ( n=59) and residual cancer group ( n=109) according to pathological findings. Then 168 suspicious residual enhancing lesions were stratified according to molecular subtype and baseline enhancing morphology. According to the breast imaging reporting and data system, the morphology of enhancing lesions, the margin of mass-like enhancing lesions, and the distribution of non-mass-like enhancing lesions on MRI before NAT were recorded. The second phase (1 min 45 s-2 min after contrast injection) was used as the early phase, and the fifth phase (5-6 min after contrast injection) was used as the late phase to measure the signal intensity and time-signal intensity curve (TIC) of suspicious residual enhancing lesions, and the signal enhancement ratio (SER) was calculated. Independent sample t-test, Mann-Whitney U test and χ 2 test were used to compare the difference of SER and clinical features between the non-residual and residual cancer groups. The receiver operator characteristic curve was used to analyze the diagnostic efficacy of SER to determine residual cancer. Results:There are statistically significant differences in invasive ductal carcinoma grade, hormone receptor status, the morphology of enhancing lesion on baseline MRI and TIC type between non-residual and residual cancer groups ( P<0.05). The SER values of the non-residual cancer group in the early [31% (23%, 61%)] and late (72%±43%) enhanced phases were significantly lower than those of the residual cancer group [49% (28%, 71%), 88%±38%, Z=-2.26, t=-2.43, P=0.024, 0.016, respectively]. Among suspicious residual enhancing lesions with hormone receptor negative status and single mass-like morphology, the SER values of the non-residual cancer group in the early (33%±16%) and late [64% (42%, 74%)] enhanced phases were significantly lower than those of the residual cancer group [59%±30%, 84% (77%, 106%), t=-2.86, Z=-3.17, P=0.008, 0.001, respectively]. The area under the curve values of SER in differentiating suspicious residual enhancing lesions were statistically different between early and late enhanced phases (0.606 and 0.637, respectively, Z=2.16, P=0.031). Conclusion:For breast cancer after NAT, it is difficult to determine the suspicious residual enhancing lesions on MRI subjectively, especially the hormone receptor negative lesions with single mass, SER can be used as an auxiliary diagnostic method, and it is necessary for the analysis of late enhancement.

Does tumor stroma ratio of breast cancer trucut biopsy determine response to neoadjuvant therapy?

Aims and Objectives: We examined the prognostic value of Tumor stroma ratio (TSR) in breast tumor core biopsy (TCB) specimen to determine response to neoadjuvant therapy (NAT) prior to modified radical mastectomy (MRM). Methods: This was a retrospective analysis of patients with breast cancer who underwent TCB before NAT between August 2016 and July 2018. TSR in TCB was studied independently by 2 pathologists ( VM, VS) defined as stroma rich (TSR?50%) or stroma poor (TSR>50%). MRM specimen of these patients were subsequently studied .Residual cancer burden (RCB) was calculated using the MD Anderson RCB calculator, categorized as complete (0), good (1) Partial (2) and no response (3). Statistical analysis was done to assess correlation of TSR to RCB. Results: A total of 62 patients were analyzed. Mean(SD) age was 48(11) years.Twenty eight (45%) and 34 (55%) patients were stroma rich and stroma poor respectively. Twenty six (42%) patients were responders and 36 (58%) non-responders to NAT. Among stroma rich patients, only 3 (10%) were responders (Class 0 &1)and 25 (90%) non-responders(Class2&3)to NAT, among stroma poor patients 23 (68%) responded well and 11 (32%) did not.TSR had a moderate negative correlation with RCB (-0.6). On univariate analysis, only TSR had a significant effect on RCB class (<0.001). Conclusions: TSR on TCB is a useful prognostic factor to determine response of breast carcinoma patients to neoadjuvant therapy.It is cost effective, simple and quick. Larger multi-centric studies would be useful to study its clinical implications.

Role of short-term follow-up MRI in the detection of postoperative breast residual cancer / 实用放射学杂志

Objective To evaluate the role of short-term follow-up MRI in the detection of postoperative breast residual cancer. Methods A retrospective analysis was performed on 13 patients who were diagnosed as nonmalignant breast lesions by preoperative clinical and ultrasound and mammography examinations and intraoperative frozen pathology.However,these patients were finally confirmed as malignant breast lesions by paraffin pathology and received corresponding second operations.Routine MRI,DCE-MRI and EPI-DWI scan were performed on the 13 patients within one month after the first operation and these MRI features and patholo-gy were comparatively analyzed.Results All the cases showed local mammary architecture distortion both in routine MRI and DCE-MRI.The enhancement characteristics of the 13 cases were as follows:3 cases of stippled enhancement,4 cases of small nodular en-hancement,1 dendritic enhancement,1 network enhancement,1 ring-like enhancement of cystic wall and 3 cases of no abnormal en-hancement.The lesions of 7 cases showed type Ⅰ curve (progressive enhancement pattern)and 6 cases showed type Ⅱ curve (plat-eau pattern).The lesions of 6 cases showed decreased ADC value.In summary,there were 6 cases of tumor residue diagnosed by both MRI and the second pathology,while only 1 case of residual neuroendocrine carcinoma was misdiagnosed by MRI but confirmed by the second pathology.Conclusion Short-term follow-up MRI could be of value in determining postoperative breast residual tumor, and could be helpful for surgeons to make accurate operation plan.

Is Surgical Treatment Necessary after Non-curative Endoscopic Resection for Early Gastric Cancer?

PURPOSE: Additional surgery is commonly recommended in gastric cancer patients who have a high risk of lymph node metastasis or a positive resection margin after endoscopic resection. We conducted this study to determine factors related to residual cancer and to determine the appropriate treatment strategy. MATERIALS AND METHODS: A total of 28 patients who underwent curative gastrectomy due to non-curative endoscopic resection for early gastric cancer between January 2006 and June 2009 were enrolled in this study. Their clinicopathological findings were reviewed retrospectively and analyzed for residual cancer. RESULTS: Of the 28 patients, surgical specimens showed residual cancers in eight cases (28.6%) and lymph node metastasis in one case (3.8%). Based on results of the endoscopic resection method, the rate of residual cancer was significantly different between the en-bloc resection group (17.4%) and the piecemeal resection group (80.0%). The rate of residual cancer was significantly different between the diffuse type group (100%) and the intestinal type group (20%). The rate of residual cancer in the positive lateral margin group (25.0%) was significantly lower than that in the positive vertical margin group (33.3%) or in the positive lateral and vertical margin group (66.7%). CONCLUSIONS: We recommended that patients who were lateral and vertical margin positive, had a diffuse type, or underwent piecemeal endoscopic resection, should be treated by surgery. Minimal invasive procedures can be considered for patients who were lateral margin positive and intestinal type through histopathological examination after en-bloc endoscopic resection.

Is Surgical Treatment Necessary after Non-curative Endoscopic Resection for Early Gastric Cancer?

PURPOSE: Additional surgery is commonly recommended in gastric cancer patients who have a high risk of lymph node metastasis or a positive resection margin after endoscopic resection. We conducted this study to determine factors related to residual cancer and to determine the appropriate treatment strategy. MATERIALS AND METHODS: A total of 28 patients who underwent curative gastrectomy due to non-curative endoscopic resection for early gastric cancer between January 2006 and June 2009 were enrolled in this study. Their clinicopathological findings were reviewed retrospectively and analyzed for residual cancer. RESULTS: Of the 28 patients, surgical specimens showed residual cancers in eight cases (28.6%) and lymph node metastasis in one case (3.8%). Based on results of the endoscopic resection method, the rate of residual cancer was significantly different between the en-bloc resection group (17.4%) and the piecemeal resection group (80.0%). The rate of residual cancer was significantly different between the diffuse type group (100%) and the intestinal type group (20%). The rate of residual cancer in the positive lateral margin group (25.0%) was significantly lower than that in the positive vertical margin group (33.3%) or in the positive lateral and vertical margin group (66.7%). CONCLUSIONS: We recommended that patients who were lateral and vertical margin positive, had a diffuse type, or underwent piecemeal endoscopic resection, should be treated by surgery. Minimal invasive procedures can be considered for patients who were lateral margin positive and intestinal type through histopathological examination after en-bloc endoscopic resection.

A Case of No Residual Cancer in Radical Prostatectomy Specimens Despite Biopsy-proven Prostate Cancer / 대한비뇨기과학회지

In prostate cancer patients without local invasion and metastasis, radical prostatectomy is performed as a rule for the resection of residual cancer. In a few cases, little amount of cancer volume is identified in radical prostatectomy specimens. This finding has been described as 'minimal residual cancer' or 'vanishing cancer phenomenon' and some reports have demonstrated an increase in the incidence of minimal residual prostate cancer. However, only few cases with 'minimal residual cancer' or 'no residual cancer' despite efforts searching for other possibilites have been reported. We report a case of no residual cancer in radical prostatectomy specimens of biopsy-proven prostate cancer.

Clinical analysis and significance of residual tumor rate after local resection of thyroid carcinoma / 中国普通外科杂志

Objective To evaluate the rate of residual tumor after local resection of thyroid carcinoma,and provide theoretical basis to determine the indications for re-operation.Methods The clinical data of 56 patients,who had re-operation in our hospital after local resection of thyroid carcinoma,were summarized.Results As confirmed by pathology,the rate of residual tumor of patients was 42.8% at re-operation.When the tumor was larger than 4 cm,or smaller than 2 cm before the first operation,the residual tumor rate was 80% and 11.1% respectively.The residual tumor rate was 86.3% in patients with tumor invading thyroid capsule,14.7% in patients without capsule invasion,47.6% in patients who had only nodule resection,50% after ipsi-lateral partial lobectomy,and 12.5% after subtotal thyroidectomy.The sensitivity of finding residual tumor by CT and doppler ultrasound examiination before re-operation was 64.0% and 60.0% respectively,and the positive predictive value was 80.0% and 30.0% respectively.Conclusions The rate of residual tumor is high in patients with thyroid cancer operated by local resection.And it′s necessary to re-operation.The condition of tumor before the first operation and CT examination are significant for selection of patients to have re-operation.

Detection and clinical implication of minimal residual cancer cells in patients with solid tumors / 第二军医大学学报

After surgical removal of a primary tumor the minimal residual cancer cells (MRCC) and metastases derived thereof are the actual targets for all theraputic approaches. Due to the great sensitivity and PCR-based detection systems, the molecular characterization of MRCC can provide information about their metastatic potential, availability of drug targets, drug sensitivity and development of therapy resistance, which will close the analytical gap between primary disease and the detection of metastases by conventional methods such as imaging procedures, and this will help therapy selection, monitoring of the treatment effects and predicting of the prognosis. Patients will benefit from a individualized therapy in the end.