Multimodal MRI radiomics for preoperative predicting Fuhrman nuclear grade of clear cell renal cell carcinoma / 中华放射学杂志

Objective:To investigate the value of multimodal MRI radiomics in the preoperative prediction of Fuhrman nuclear grade of clear cell renal cell carcinoma (ccRCC).Methods:A total of 129 patients with ccRCC confirmed by pathology from April 2011 to April 2021 in Third Affiliated Hospital of Soochow University were collected, and the imaging and clinicopathological data were retrospectively analyzed. All patients were divided into training set ( n=90) and validation set ( n=39) at the ratio of 7∶3 using random indicator method. According to the postoperative pathological results, Fuhrman grades Ⅰ and Ⅱ were included in the low grade group (96 cases, 65 cases in the training set and 31 cases in the validation set), and Fuhrman grades Ⅲ and Ⅳ were included in the high grade group (33 cases, 25 cases in the training set and 8 cases in the validation set). Two radiologists manually delineated regions of interest (ROI) on T 1WI, T 2WI, Dixon-water, Dixon-fat, susceptibility weighted imaging (SWI), blood oxygen level dependent (BOLD) images, and 396 texture features were extracted from each ROI. In the training set, intra-class correlation coefficient, Mann-Whitney U test, minimum redundancy maximum relevance and least absolute shrinkage and selection operator method were used to reduce the dimension of features to obtain the best texture features. The logistic regression was used to develop the multimodal radiomics model, and the receiver operating characteristic (ROC) curve was used to evaluate the effectiveness of the model in identifying high and low-grade ccRCC in training set and validation set. Results:Four SWI, one T 2WI and one BOLD texture features were selected for modeling. The areas under the ROC curve (95%CI) of the multimodal radiomics model for identifying high and low grade ccRCC in the training and validation sets were 0.859 (0.770-0.923) and 0.883 (0.740-0.964), with the specificity at 95.4% and 87.1%, the sensitivity at 68.0% and 87.5%, the accuracy at 87.8% and 87.2%, respectively. Conclusion:The multimodal MRI radiomics model based on T 2WI, SWI and BOLD images has high effectiveness in preoperative predicting Fuhrman nuclear grade of ccRCC.

The value of IVIM-DWI and multi-phasic enhanced MRI in the classification of clear cell renal cell carcinoma / 实用放射学杂志

Objective To investigate the value of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)and multi-phasic enhanced MRI in the classification of clear cell renal cell carcinoma(ccRCC).Methods The data of 91 patients with pathologically confirmed ccRCC who all underwent multi-phasic enhanced MRI and IVIM-DWI examination were analyzed retrospectively. According to Fuhrman classification criteria,grade Ⅰ - Ⅱ were defined as low-grade group(n=73),grade Ⅲ - Ⅳ were defined as high-grade group(n=18).Mann-Whitney U test,independent sample t test and receiver operating characteristic(ROC)analysis were used for statistical analysis.Results The maximal diameter and pathological stage of ccRCC in the low-grade group were lower than those in the high-grade group,and the differences between the two groups were statistically significant(P<0.001 and P=0.003). The signal intensity and enhancement rate of ccRCC in the high-grade group in corticomedullary phase and parenchyma phase were lower than those in the low-grade group,but there was no significant difference between the two groups(all P>0.05).The ADC and D values of ccRCC in the high-grade group were lower than those in the low-grade group,and the differences between the two groups were statistically significant(P=0.007 and P=0.009).However,there was no significant difference of D *and f between the two groups(P=0.604 and P=0.695).Conclusion Multi-phasic enhanced MRI scanning has a limited value in the classification of ccRCC.IVIM-DWI derived diffusion-related parameters(ADC and D)is of great significance for differentiating between high-grade and low-grade ccRCC.

Analysis on risk factors and prognosis of posterior capsular rupture in phacoemulsification cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract?AIM: To investigate the risk factors and prognosis of posterior capsular rupture in phacoemulsification cataract surgery through analyzing the cataract patients in our hospital.?METHODS:Totally 1825 patients (1912 eyes) treated in our hospital were selected from November 2012 to November 2015. The patients with posterior capsular rupture were as observation group.Control group was randomly selected with a 1: 4 ratio in patients without posterior capsular rupture.All the patient's age, gender, type of cataract, ocular disease history, other medical history, surgical history, preoperative intraocular pressure, the eyes affected, the health situation, visual acuity at 1d before and after surgery and other factors were recorded and analyzed for risk factors and prognosis.?RESULTS: Statistical results showed gender, type of cataract, preoperative intraocular pressure, history of tobacco and alcohol, eyes affected and other factors did not impact on the rupture rate ( P>0.05 ); and type of nucleus, preoperative visual acuity, some eye diseases were the risk factors for posterior capsule rupture ( P<0.05).Postoperative visual acuity of the two groups was all improved, but visual acuity of patients with posterior capsule rupture significantly decreased.?CONCLUSION: With eye disease history ( a history of vitreous hemorrhage, retinal detachment before surgery and preoperative visual acuity <20/200) are more likely to result in intraoperative posterior capsular rupture.Nuclear hardness over grade Ⅳ is also an important risk factor. Before one surgery, it is needed to learn more about the medical history of cataract patients, to conduct a reasonable comprehensive assessment for risk factors, to decrease the risk in the surgery, which are to increase the success rate and to improve the prognosis.

Expression of EphA1 protein in clear cell renal cell carcinomas and its clinical significance / 临床与实验病理学杂志

Purpose To investigate the expression of EphA1 in renal cell carcinomas ( RCC) and to analyze its correlation with clini-copathological parameters in order to explore the clinical significance of EphA1 protein in renal cell carcinomas ( RCC) . Methods The immunocytochemical method was employed to measure the expression of EphA1 in 144 clear cell RCC ( ccRCC) tissues, 18 chro-mophobe RCC tissues and 6 papillary RCC tissues. Correlation between EphA1 protein expression and clinical parameters was evaluated by statistics. Results High level of the expression of EphA1 was observed in all normal renal tubes. The EphA1 protein was negative-ly or weakly expressed in 93 out of 144 ccRCC (64. 6%) and positively expressed in 51 out of 144 ccRCC (35. 4%). Positive expres-sion of EphA1 was observed in all samples of chromophobe RCC and papillary RCC. The high level expression of the EphA1 protein was significantly associated with younger patients (P<0. 001), sex (P=0. 016) and lower nuclear grade (P<0. 001). No significant relation between the expression of EphA1 and tumor diameter was found ( P=0. 316 ) . Conclusion EphA1 protein may be a new marker for the prognosis of ccRCC.

The MRI of ductal carcinoma in situ with pathology grade / 中国癌症杂志

Background and purpose:Histological grade of DCIS is an important factor in the prognosis, high nuclear grade have higher inifltration trend and recurrence rate. This study aimed to evaluate the dynamic and morphological MRI charactristics of ductal carcinoma in situ (DCIS) of the breast, then analyze its relations with nuclear grade. Methods:Of the 94 patients, 97 lesions were proved DCIS by pathology. The morphology, maximum size, time-intensity curve of lesion were recorded or measured. Statistic was performed to identify MR imaging features that optimally discriminated HNG from non-HNG DCIS. Results:There were 49 non mass-like enhancement lesions, and 48 masses enhancement lesions. Among 49 non mass-like lesions, 29 were segmental enhancement (59.18%). Dynamic enhanced performance:50 exhibited plateau curves and 27 were washout curves. BI-RADS categories:22 BI-RADS 4A, 19 BI-RADS 4B, 29 BI-RADS 4C, and 27 BI-RADS 5. HNG lesions exhibited larger mean maximum lesion size (non-mass-like enhancement: P=0.01; mass: P=0.03), time- intensity curve was variable to approach signiifcance (P=0.01), and BI-RADS can help to discriminate the nuclear grade (P=0.02). There were no differences in lesion morphology (P>0.05). Conclusion:The preliminary ifndings suggest that DCE MR imaging features may aid in identifying patients with high risk DCIS.

An unusual case of invasive papillary carcinoma of the breast.

Invasive papillary carcinoma is a rare variant of breast cancer. We report an unusual case of invasive papillary carcinoma of the breast with high nuclear grade, brisk mitosis, necrosis, extensive apocrine differentiation, and intense lymphoplasmacytic infiltrate; additionally triple-negativity for estrogen and progesterone receptors and Her2 neu. The patient underwent modified radical mastectomy and adjuvant chemotherapy. But, it was a node negative breast carcinoma. Increasing the awareness of this clinicopathologic entity would be helpful in avoiding overtreatment of patients with this cancer even if the tumor has negative morphological and immunohistochemical prognosticators.

Heterogeneity of Invasive Ductal Carcinoma: Proposal for a Hypothetical Classification

To investigate what heterogeneity exists in breast cancer, 228 consecutive patients with operable invasive duetal carcinoma (IDC), not otherwise specified, were categorized on the basis of the horizontal progression model of carcinogenesis. Using the reversed Black's nuclear grade (RBNG) in the IDC component and the association of ductal carcinoma in situ (DCIS), the patients were classified into pure IDC (IDC de novo or ab initio) as Group I, non-high grade (RBNG 1 and 2) IDC with DCIS as Group II, and high grade (RBNG 3) IDC with DCIS as Group III. The Groups classified in the present study appeared as a prognostic factor independent of known prognostic and predictive factors in multivariate test. Group I had the worst prognosis among the three groups and was the most non-responsive to tamoxifen. After performing stratifying analyses by group, it was found that metastasis-free survival was statistically associated with the status of hormone receptors estrogen receptor and progesterone receptor and tamoxifen therapy only in Group II. In addition, the status of c-erbB-2 expression had prognostic significance only within the Group III. Our results may be used to frame an alternative hypothetical model for breast cancer evolution and will lead us to reconsider the tailoring of the comprehensive therapeutic modality used at the present time.

The Correlations between the Expression of Cyclin E and Clinical Features of the Primary Breast Cancer

PURPOSE: Cyclin E is a key regulatory protein in the G1-S transition during the cell cycle. The correlations between cyclin E protein and the clinical features of breast cancer were investigated in order to evaluate its clinical utility in invasive breast cancer. METHODS: An immunohistochemical assay for cyclin E was performed in 101 consecutive invasive breast cancers. The correlation between cyclin E expression and the clinicobiological parameters including patient survival was analyzed. RESULTS: Cyclin E expression was observed in 50 patients (49.5%). The scoring of the cyclin E expression level was divided into low (or=25%). In high nuclear grade tumors, cyclin E overexpression was much higher than that in low nuclear grade tumors (P=0.049). In the younger age group (<50 yrs), cyclin E expression was significantly higher than the older age group (P= 0.016). No significant correlation was observed between cyclin E and the tumor size, lymph node status, hormonal receptor status, histological grade, mitotic index and Ki67. In multivariate analysis, only the lymph node status was significantly associated with the patients' outcome (P= 0.002). CONCLUSION: Cyclin E overexpression did not have prognostic impact on the patients' survival rate in invasive breast cancer. In high nuclear grade tumors, the cyclin E expression level was much higher. The definite value of cyclin E as a clinicobiologic marker should be further investigated by prospective studies with other cell regulatory proteins.

Correlation of Clinical Stage and Presumptive Prognostic Factors in Renal Cell Carcinoma

Renal cell carcinoma is the most common primary cancer of the kidney. The tumor stage is a reliable prognostic marker in renal cell carcinoma which is significantly associated with patient survival. But assessment of other prognostic factors has produced varying and often conflicting results. We reevaluated the significance of varied prognostic parameters in 33 cases of renal cell carcinoma; clinical stage, cell type, histologic pattern, DNA ploidy, Ki-67 labeling index, and bcl-2 oncoprotein expression. We could not statistically prove that DNA ploidy and bcl-2 expression were related to any examined parameters. Cell type was not related to clinical stage nor nuclear grade but there was a significant correlation (p=0.002) between cell type and histologic pattern. Nuclear grade (p=0.007) and Ki-67 labeling index (p=0.036) were significantly related to clinical stage, suggesting their value as complementary prognostic markers for renal cell carcinoma.

Correlation of Clinical Stage and Presumptive Prognostic Factors in Renal Cell Carcinoma

Renal cell carcinoma is the most common primary cancer of the kidney. The tumor stage is a reliable prognostic marker in renal cell carcinoma which is significantly associated with patient survival. But assessment of other prognostic factors has produced varying and often conflicting results. We reevaluated the significance of varied prognostic parameters in 33 cases of renal cell carcinoma; clinical stage, cell type, histologic pattern, DNA ploidy, Ki-67 labeling index, and bcl-2 oncoprotein expression. We could not statistically prove that DNA ploidy and bcl-2 expression were related to any examined parameters. Cell type was not related to clinical stage nor nuclear grade but there was a significant correlation (p=0.002) between cell type and histologic pattern. Nuclear grade (p=0.007) and Ki-67 labeling index (p=0.036) were significantly related to clinical stage, suggesting their value as complementary prognostic markers for renal cell carcinoma.

Comparison of Rb and p53 Protein Expression with Stage and Grade as a Prognostic Value in Renal Cell Carcinoma / 대한암학회지

PURPOSE: This study was performed to evaluate prognostic significance of Rb and p53 protein immunostaining in renal cell carcinoma. We investigated correlations between Rb, p53 immunostaining and nuclear grade and stage as prognostic factors of renal cell carcinoma. MATERIALS AND METHODS: Subjects of this study were sixty-nine cases of renal cell carcinoma. We used indirect immunohistochemical methods in the formalin-fixed paraffin- embedded tissue (Rb: Pharmingen, USA; p53: Novocastra, UK). In staging and nuclear grading of the renal cell carcinoma, the American Joint Commitee on Cancer (AJCC) TNM system and Fuhrmans grading system were applied respectively. RESULTS: According to Fuhrmans grading system, four cases were classified grade I, 15 cases were classified grade II, 13 cases were classified grade III, and 37 cases were classified grade IV. By AJCC TNM staging system, 29 cases were grouped stage I, 20 cases were grouped stage II, 15 cases were grouped stage III and five cases were grouped stage IV. In 55 cases (79% of all cases), Rb protein was expressed. Expression of Rb protein did not correlate with nuclear grade nor tumor stage. p53 protein was expressed in 17 cases (24% of all cases). p53 protein expression was frequently detected in high nuclear grade group (p < 0.05), but was not correlated with tumor stage. CONCLUSION: Expression of Rb protein was not conelated with nuclear grade and stage. And expression of p53 protein was not correlated with stage, but it is correlated with nuclear grade. Thus immunohistochemical examinstion of p53 could be a histological prognostic factor.

Correlation between Nuclear Grades and the Numbers of AgNORs and PCNA Labeling Indices in Renal Cell Carcinoma

The author examined the number of AgNORs and PCNA labeling indices by histochemical and immunohistochemical studies in 20 cases of renal cell carcinoma, composed of 5 cases according to the nuclear grades. The results obtained are summarized as follows; 1) Mean number of AgNORs according to the nuclear grades of renal cell carcinoma were 1.38+/-0.40 (mean+/-standard deviation) for Grade I, 2.53+/-0.33 for Grade II, 5.43+/-0.66 for Grade III, and 7.88+/-0.72 for Grade IV. The mean numbers of AgNORs according to the nuclear grades were significantly increased(p=0.0005). 2) PCNA labeling indices (positive nuclear ratio) according to the nuclear grades of renal cell carcinoma were 5.90+/-2.36 for Grade I, 19.30+/-6.71 for Grade II, 45.73+/-8.62 for Grade III, and 61.83+/-6.34 for Grade IV. Also, the PCNA labeling indices according to the nuclear grades were significantly increased(p=0.0008). 3) The mean numbers of AgNORs directly correlated with the PCNA labeling indices (r=0.9861, p<0.001). On the basis of the above results, it was considered that the numbers of AgNORs and PCNA labeling indices as markers of proliferative activity of tumor cells correlate well with the nuclear grades of renal cell carcinoma.

Prognostic Value of Pathological Parameters in Renal Cell Carcinoma / 대한비뇨기과학회지

We conducted a retrospective study of 41 cases of clinically localized renal cell carcinoma (RCC) treated with radical nephrectomy by our department between January 1987 and December 1993. The prognostic pathological parameters considered were tumor extension (pT stage), nuclear grading, histological grading, cell type, histologic growth pattern and tumor size. In the univariate analysis by log-rank test, three parameters showed prognostic significance, including pT stage, nuclear grading and tumor size. However, in the multivariate analysis using Cox's regressional hazard model, only two parameters including pT stage (p0.05). We think that nuclear grading cannot predict the outcome of patients at the same surgical stage. These results suggest that pathological stage of RCC may be the most important prognostic factor and the nuclear grade of tumor may provide additional important prognostic information.

A Pathological Study of Renal Cell Carcinoma

The most common malignant renal neoplasm is renal cell carcinoma. It is estimated that renal cell carcinoma accounts for 1% of all primary malignancies in Korea. Rell cell carcinoma presents diverse clinical courses with gross, histopathologic features. It has been known to be very difficult tumor to predict its clinical prognosis. In Korea, many studies have been reported concerning the clinical aspects of renal cell carcinoma. However, pathological studies of renal cell carcinoma are very few even though studies of nuclear grade have been attempted recently. We reviewed 93 cases of renal cell carcinoma examined in the period from 1978 to 1987 in the department of pathology, Yonsei university college of medicine, Yongdong Severance hospital, Wonju college of medicine and analyzed the histopathologic classification, including nuclear grade according to the Fuhrman's method. We abtained the following results by studying the relationship of the factors which had been known as correlated with the prognosis. 1) The ages of patients ranged from 9 to 74 years with a peak in the 6th decade. 2) The most common symptoms of the patients were hematuria, mass and pain, in that oder, and 7 patients complained to specific symptoms. The incidentally found cases characterized stage I, nuclear grade 2 small tumor size (not more than 4 cm) and clear cell type. 3) The renal cell carcinoma was more frequently located in the left kidney than the right by a ratio of 1.25 : 1. The incidence of intrarenal location was divided to the upper pole, 40% : mid portion, 29% : lower pole, 23% : diffuse involvement, 8%. The tumor shoing diffuse growth pattern had a large size, high nuclear grade and mixed cells. 4) The tumor size averaged 8 cm and there was no significant relationship between the size and stage. Seven cases of neoplasms not more than 3 cm were seen, of which 2 cases revealed an outcome of distant metastasis. 5) The histological pattern showed major solid, 53% : tubular, 11% : mixed, 18% : papillary, 9% and sarcomatoid type 9%. The sarcomatoid type was characterized by grade 4, a larger size(more than 10 cm), advanced stage. 6) There was no special relationship between the stage and grade but mostly grade 2 occupied the stage I. 7) The clear cell type was predominantly noted at grade 2 (65%), at the stage I (63%), granular or mixed cell type at grade 3 (87%), 4 (70%). According to these results, the tumors showing a sarcomatoid histologic pattern, diffuse growth pattern had unfavorable prognostic factors, and are thus estimated to have a poor prognosis. But the case which were incidentally found have favorable prognostic factors and probably a better prognosis. The tumor size alone can not exactly predict the metastasis and is not correlated with the stage. Small renal cell neoplasm (not more than 3 cm) generally has unfavorable prognostic factors and should be considered potentially malignant. The high grade frequently has granular cytoplasm. This represents the relationship between grade and cytoplasm, poor prognosis in the granular cell than the clear. The renal cell carcinoma shows variable prognosis and thus the prognosis should be estimated by all the factors. Nuclear grade can be used as one of the useful prognostic factors.