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Objective: Total mesorectal excision (TME) is the gold standard for surgical treatment of mid-low rectal cancer, but the postoperative incidence of urination and sexual dysfunction is relatively high. Preserving the Denonvilliers fascia (DF) during TME can reduce the postoperative incidence of urination and sexual dysfunction. In this study, high resolution magnetic resonance imaging (MRI) was used to observe the imaging performance and display of DF, so as to determine the value of this technique in preoperative evaluation of the preservation of DF. Methods: A descriptive cohort study was carried out. Clinical data of patients with rectal cancer who underwent TME and received preoperative high-resolution MRI at department of Gastrointestinal Surgery, the Third Affiliated Hospital of Sun Yat-sen University from August 2015 to June 2017 were retrospectively analyzed. The characteristics of DF were examined, and the shortest distance (d) between the anterior edge of tumor and DF was measured on high-resolution MRI. The distance d was compared between patients with stage T1-T2 and those with stage T3. Receiver operating characteristic (ROC) analysis was used to determine the predictive value of d for stage T1-T2 disease. Results: Thirty-two patients were enrolled in the study, including 27 males and 5 females with mean age of (62.9±8.9) years. DF was visualized in 96.9% (31/32) of cases on the T2WI sequence. The mean distance d in patients with stage T1-T2 disease (n=23) was (6.73±2.65) mm, and in those with stage T3 disease (n=9) was (1.30±1.15) mm (t=5.893, P<0.001). A cutoff of d >3 mm yielded specificity and positive predictive value for diagnosing stage T1-T2 disease of both 100%, sensitivity of 95.7% and negative predictive value of 90%. The optimum threshold of d was >3.05 mm, and Youden index was 0.957. Conclusions: High-resolution MRI can show the DF and accurately evaluate the relationship of DF with tumor in rectal cancer patients. Analysis on d value can provide an objective basis for the safe preservation of DF.
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Aged , Female , Humans , Male , Middle Aged , Cohort Studies , Fascia/pathology , Magnetic Resonance Imaging , Neoplasm Staging , Rectal Neoplasms/surgery , Retrospective StudiesABSTRACT
Objective: To retrospectively compare the prognosis between patients with locally advanced T and N stage nasopharyngeal carcinoma (NPC), to provide a reference for the clinical treatment of NPC. Methods: A total of 264 NPC cases from December 2011 to November 2017 visiting The General Hospital of Western Theater Command were pathologically diagnosed and retrospectively analyzed. Of these, 102 and 162 were locally advanced T and N stage, respectively. Results: The two groups 5-year overall survival (OS), progression-free survival (PFS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were compared. These were 82.8% and 75.8% (P=0.271), 73.7% and 62.8% (P=0.043), 87.6% and 91.6% (P=0.646), 87.7% and 79.5% (P=0.066), respectively. Conclusions: The DMFS, OS and PFS decreased in patients with locally advanced N stage NPC, although there was no statistical difference. The significance of systemic and stratified treatment should be emphasized in patients with locally advanced N stage NPC in order to achieve a higher OS rate and reduce distant metastasis.
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Objective: To compare the feasibility of automated breast volume scanner automated breast ultrasound system (ABUS) and the traditional ultrasound (US) in measuring breast cancer size so as to evaluate their value in predicting breast cancer T staging. Methods: We retrospectively recruited 60 women with breast cancer who had received US and ABUS. The maximal tumor diameter was measured as tumor size. Based on the actual postoperative tumor size in pathology, Bland-Altman analysis and intraclass correlation coefficient (ICC) were used to compare the values measured by US and ABUS. Then we made a preliminary study of the accuracy of US and ABUS in predicting breast cancer T staging. Results: The best absolute agreement was shown between US and ABUS in measuring tumor size. Moreover, ABUS showed better agreement with histology than US [average difference (-1.09±3.61)mm vs. (-1.57±4.99)mm] with a higher ICC (0.93 vs. 0.86), especially for tumors which were more than 2 cm. In addition, both US and ABUS could predict breast cancer T staging relatively accurately (82.1% vs. 87.5%). Conclusion: Both US and ABUS showed good agreement with pathology in measuring tumor size. ABUS even outperformed US in assessing tumor size for tumors beyond 2 cm. Therefore, ABUS can be considered as an alternative to US in T staging of breast cancer.
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Objective To set up a living mice colonoscopy platform to establish an orthotopic model of colorectal cancer in mice under direct vision,and to observe its biological behavior such as metastasis.Methods Eighteen-week-old male C57/BL mice were anesthetized,and the intestinal lumen of the mice was examined by a self-developed living mice colonoscopy and Olympus URF-P5 ureteroscopy,respectively.The imaging effects of the two methods were compared.Human colon cancer HT-29 cells were injected into the colonic mucosa of BALB/c-nu mice under direct vision.The colonoscopy was performed on the 3rd,7th and 15th day after the injection to observe the tumor formation in the intestinal lumen.The mice were sacrificed when the body weight decreased significantly or cachexia appeared,and then the abdominal cavity was examined including the tumor formation and metastasis.Results The self-developed living mice colonoscopy platform can provide clear vision of enteric cavity,and no mice died in the colonoscopy examination.In vivo subcutaneous injection of HT-29 cells in mice was performed with a perforation rate of 15％,a mortality rate of 33.3％,a tumor formation rate of 62.5％,an abdominal metastasis rate of 60％,a liver metastasis rate of 25％,and an abdominal wall transfer rate of 25％.Conclusion The self-developed mice colonoscopy platform can be used for the study of colorectum in living mice.The imaging effect is no less than that of Olympus URF-P5 ureteroscopy.In addition,an orthotopic colorectal cancer model can be established by this platform combing with submucosal injection technology.
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Objective To observe the utility value of MR intravoxel incoherent motion (IVIM) in histological grading and muscle invasion of bladder urothelial carcinoma.Methods According to postoperative histologic grade and T staging,60 patients with bladder urothelial carcinoma confirmed by surgery and pathology were divided into low grade (LG) group and high grade (HG) group,as well as muscle-noninvasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC) group.MR IVIM parameters (apparent diffusion coefficient standard [ADCst],true diffusion coefficient [D],pseudodiffusion coefficient [D*] and perfusion fraction [f]) were compared with independent-samples t tests.A binary Logistic regression model was established to evaluate the predicted probability of combined IVIM parameters.ROC curves of IVIM parameters and their combination's predicted probability were drawn,and the diagnostic efficiency was evaluated.Results ADCst,D and f values of HG group were significantly lower than those of LG group (all P＜0.05).Area under ROC curve (AUCs) for ADCst,D and f value to differentiate HG from LG were 0.88,0.86 and 0.72,respectively (all P＜0.01),and AUCs for predicted probability of combined ADCst and D,combined ADCst and f and combined D and f were 0.91,0.90 and 0.88,respectively (all P＜0.0001).ADCst,D and f values of M1BC group were significantly lower than those of NMIBC group (all P＜0.0001).AUCs for ADCst,D and f value to differentiate MIBC from NMIBC were 0.91,0.85 and 0.88,respectively (all P＜0.0001),and all AUCs for predicted probability of combined ADCst and D,combined ADCst and f and combined D and f were both 0.93 (all P＜0.000 1).Conclusion Lower ADCst,D and f values may indicate greater possibility of high grade and muscle invasion of bladder urothelial carcinoma.Combination of IVIM parameters can improve diagnostic efficacy.
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BACKGROUND: Carcinoma of buccal mucosa is the most common cancer of the oral cavity in India. Treatment of oral cancer poses unique reconstructive challenges, owing to the dynamic architecture of the oral cavity. Despite current progress in various treatment modalities, over the past 50 years survival rates have not improved drastically. Although, philosophy on treatment of buccal mucosa carcinoma remains well‑established, due to the relative paucity of reported data, retrospective reviews of institutional experiences are of prime importance. This study provides a detailed insight on this site specific cancer of the oral cavity in the Indian population. AIM: The aim of this study is to analyze our experience with the management of carcinoma of buccal mucosa; associated clinical presentation, outcomes and prognostic factors. SETTINGS AND DESIGN: A retrospective chart review was performed of all cases of primary buccal mucosa carcinoma treated surgically between years 2008 and 2012 in SDM Craniofacial Unit, Karnataka, India. MATERIALS AND METHODS: All cases were analyzed based on patient characteristics, clinical presentation, surgical and adjuvant therapy rendered and treatment outcomes. A retrospective chart review was carried out using the hospital’s data base for the same. STATISTICAL ANALYSIS USED: Kaplan‑Meier methods were used for analyzing disease free survival (DFS). Univariate analysis of prognostic factors was performed with log rank test. RESULTS: The significant variables in univariate analysis were: Overall stage, T‑stage (T1/T2 vs. T3/T4) and nodal status (N0 vs. N+). We found that staging, tumor size and nodal status were significant prognostic factors for DFS. CONCLUSION: The strong influence of overall disease stage, tumor size, nodal status, final histopathological report and habits of tobacco/betel quid chewing, on prognosis; emphasizes the importance of early diagnosis and prevention of carcinoma of buccal mucosa in the Indian population.
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Objective To explore the evaluation of contrast enhanced CT with multi -direction adjusting multi -planar reformation(MPR)on the stomach wall invasion of advanced gastric cancer.Methods 105 cases of advanced gastric cancer proved by pathology after surgery were checked by contrast enhanced CT before surgery.All the images were reconstructed by multi -direction adjusting MPR to show perfectly the lesions of gastric cancer,T stage diagnosed by CT were compared with the T stage diagnosed by pathology.Results T1,T2,T3,T4 stage diag-nosed by pathology were 9 cases,23 cases,46 cases and 27 cases respectively,the accuracy of multi -direction adjus-ting MPR in diagnosing T1,T2,T3,T4 stage were 98.1%,93.3%,86.7%,91.4% respectively.Conclusion Con-trast enhanced CT with multi -direction adjusting MPR can improve the accuracy in diagnosing the T stage of ad-vanced gastric cancer,which can be used to evaluate the staging of advanced gastric cancer.
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PURPOSE: Preoperative staging of gastric cancer is crucial because the treatment modality and the prognosis depend upon the stage of gastric cancer. Current treatment modalities for early gastric cancer have focused on the quality of life. Endoscopic ultrasonography (EUS) and abdominal computed tomography (CT) are commonly used diagnostic tools to evaluate the invasiveness (T stage) of the primary tumor. The purpose of this paper is to evaluate the sensitivity and the specificity of preoperative EUS and CT in comparison with postoperative pathology. MATENRIALS AND METHODS: From October 2001 to October 2002, EUS and abdominal CT were performed simultaneously on 75 patients who underwent radical gastric surgery for the treatment of gastric cancer. Through analyzing the clinical T stage and the pathologic T stage, We evaluated the diagnostic sensitivities and specificities of endoscopic ultrasonography and abdominal computed tomography. RESULTS: The male-to-female sex ratio was 1:0.6 (males:47, females:28). The mean age was 55.4 years in males (range:28~81) and 54.4 years in females (range:23~77). The clinical T stage based on EUS included 22 T1mm, 7 T1sm, 22 T2, and 24 T3. The clinical T stage based on CT included 20 Tx, 23 T2, and 32 T3. The permanent pathologic report confirmed 23 T1mm, 10 T1sm, 17 T2, 24 T3, and 1 T4. The sensitivity and specificity of EUS were 84.2% and 94.7%, respectively. However, the sensitivity and specificity of abdominal CT were 53.3% and 77.0%, respectively. CONCLUSION: Our data suggest that EUS is a very useful diagnostic tool for evaluating the T stage of gastric cancer because EUS has higher specificity than abdominal CT. Therefore, EUS may have a significant role as a preoperative diagnostic modality in patients undergoing minimally invasive surgery.
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Female , Humans , Male , Endosonography , Pathology , Prognosis , Quality of Life , Sensitivity and Specificity , Sex Ratio , Stomach Neoplasms , Minimally Invasive Surgical Procedures , Tomography, X-Ray ComputedABSTRACT
From 1981 to 1987, 91 patients underwent radical nephrectomy for renal cell carcinoma. The regional lymph nodes were resected in 42 patients with disease localized to the kidney. The following results were obtained. 1. 5 year survival rates for patients with stage TlNOMO, T2NOMO and T3aNOMO were 100, 81.8 and 66.4 %, respectively, and for patients with stage T3bNOMO or regional lymph node involvement was 0 %. 2. The incidence of regional lymph node involvement in patients with stage T1, T2 and T3a was 0, 13.0 and 31.8%, respectively. 3. The extended lymphadenectomy for renal cell carcinoma was not proved to be more effective than radical nephrectomy only. 4. Staging was correct with computerized tomography in 71.0% of the lesions but stage T1 was determined correctly by computerized tomography in 100 % of patients. When the efficiency of computerized tomography and the possibility of regional lymph node involvement is considered, and extended lymphadenectomy is not a suggested addition to radical nephrectomy in patients with stage T1 renal cell carcinoma. In the future radioimmunoassay techniques or magnetic resonance imaging techniques may provide additional information in the evaluation of metastatic disease.