Second to fourth digit ratio in women with breast cancer / Relación del segundo al cuarto dígito en mujeres con cáncer de mama

SUMMARY: Digit ratio established in utero is positivelly correlated with intrauterine level of estrogen. Since the breast cancer is related to excessive and prolonged exposure to estrogen, digit ratio might be considered as useful marker in breast cancer risk assessment. The aim of the present study was to compare digit ratios in breast cancer patients and healthy controls. The study group consisted of 98 breast cancer patients aged between 29 to 84 years while the control group included 141 healthy women aged between 21 and 67 years. After collecting anamnestic data concerning menopausal status, the length of second and fourth fingers were measured and the digit ratios were calculated for both hands, as well as the difference between right and left digit ratio. Digit ratio was significantly higher on right hand in breast cancer patients compaired to healthy controls (1.003±0.05 vs. 0.990±0.03). Right digit ratio showed better predictive capacity for the breast cancer development then the left (AUC:0.609 vs. 0.541). Negative statistically significant correlation between right digit ratio and the age of breast cancer diagnosis was observed (r=-0.271). Higher values of right digit ratio in women with breast cancer when compared to healthy women suggest their higher prenatal estrogen exposure that confirms the importance of digit ratio determination in breast cancer risk assessment.

La proporción de dígitos establecida en el útero, se correlaciona positivamente con el nivel intrauterino de estrógeno. Dado que el cáncer de mama está relacionado con una exposición excesiva y prolongada a los estrógenos, la proporción de dígitos podría considerarse un marcador útil en la evaluación del riesgo de cáncer de mama. El objetivo del presente estudio fue comparar proporciones de dígitos en pacientes con cáncer de mama y controles sanos. El grupo de estudio consistió en 98 pacientes con cáncer de mama con edades comprendidas entre los 29 y los 84 años, mientras que el grupo de control incluyó a 141 mujeres sanas con edades comprendidas entre los 21 y los 67 años. Después de recopilar datos anamnésticos sobre el estado menopáusico, se midió la longitud de los dedos segundo y anular y se calcularon las proporciones de los dedos para ambas manos, así como la diferencia entre la proporción de los dedos derecho e izquierdo. La proporción de dígitos fue significativamente mayor en la mano derecha en pacientes con cáncer de mama en comparación con controles sanos (1,003 ± 0,05 frente a 0,990 ± 0,03). La proporción del dígito derecho mostró una mejor capacidad predictiva para el desarrollo de cáncer de mama que el izquierdo (AUC: 0.609 vs. 0.541). Se observó una correlación estadísticamente significativa negativa entre la proporción de dígitos derechos y la edad del diagnóstico de cáncer de mama (r=-0,271). Los valores más altos de la proporción de dígitos derechos en mujeres con cáncer de mama en comparación con mujeres sanas sugieren una mayor exposición prenatal a estrógenos que confirma la importancia de la determinación de la proporción de dígitos en la evaluación del riesgo de cáncer de mama.

Research progress in in vitro detection of urinary volatile organic compounds for early cancer diagnosis / 国际生物医学工程杂志

With the further increase of the global cancer burden, various cancers are increasingly challenging human health status and quality of life. Thus, early screening of cancer is crucial. Urinary volatile organic compounds (VOCs) detection techniques have the advantages of easy access to samples, high acceptance of patients, non-invasive, and so on, which have been favored and concerned by researchers. In this paper, existing techniques and methods for cancer diagnosis based on urine VOCs were described, relevant studies on the use of urine VOCs for cancer diagnosis were reviewed, and the barriers and future perspectives of the technique were discussed. This paper can be a reference for researchers working in the direction of urinary VOCs detection, a multidisciplinary field that spans medicine and materials science.

Development of fluorescent- and radio-traceable T1307-polymeric micelles as biomedical agents for cancer diagnosis: biodistribution on 4T1 tumor-bearing mice

Abstract In recent years, nanocarriers have been studied as promising pharmaceutical tools for controlled drug-delivery, treatment-efficacy follow-up and disease imaging. Among them, X-shaped amphiphilic polymeric micelles (Tetronic®, poloxamines) display great potential due to their biocompatibility and non-toxic effects, among others. In the present work, polymeric micelles based on the T1307 copolymer were initially decorated with a 4,4-difluoro-4-bora-3a,4a-diaza-s-indacene (BODIPY)-fluorophore in order to determinate its in vivo biodistribution on 4T1 tumor-bearing mice. However, unfavorable results with this probe led to two different strategies. On the one hand, the BODIPY-micelle-loaded, L-T1307-BODIPY, and on the other hand, the 99mTc-micelle-radiolabeled, L-T1307- 99m Tc, were analyzed separately in vivo. The results indicated that T1307 accumulates mainly in the stomach, the kidneys, the lungs and the tumor, reaching the maximum organ-accumulation 2 hours after intravenous injection. Additionally, and according to the results obtained for L-T1307- 99m Tc, the capture of the polymeric micelles in organs could be observed up to 24 hours after injection. The results obtained in this work were promising towards the development of new radiotracer agents for breast cancer based on X-shaped polymeric micelles.

Biosensor-based assay of exosome biomarker for early diagnosis of cancer / 医学前沿

Cancer imposes a severe threat to people's health and lives, thus pressing a huge medical and economic burden on individuals and communities. Therefore, early diagnosis of cancer is indispensable in the timely prevention and effective treatment for patients. Exosome has recently become an attractive cancer biomarker in noninvasive early diagnosis because of the unique physiology and pathology functions, which reflects remarkable information regarding the cancer microenvironment, and plays an important role in the occurrence and evolution of cancer. Meanwhile, biosensors have gained great attention for the detection of exosomes due to their superior properties, such as convenient operation, real-time readout, high sensitivity, and remarkable specificity, suggesting promising biomedical applications in the early diagnosis of cancer. In this review, the latest advances of biosensors regarding the assay of exosomes were summarized, and the superiorities of exosomes as markers for the early diagnosis of cancer were evaluated. Moreover, the recent challenges and further opportunities of developing effective biosensors for the early diagnosis of cancer were discussed.

Evaluación del impacto de la pandemia COVID-19 en el diagnóstico y tratamiento de pacientes con cáncer de mama tratadas en Clínica Alemana de Santiago / Evaluation of the impact of the COVID-19 pandemic in the diagnosis and treatment of breats cancer patients at Clínica Alemana de Santiago

Resumen Introducción: Debido a la pandemia COVID-19 se ha visto un retraso en diagnósticos de en-fermedades oncológicas, cambio de tratamientos y aumento en mortalidad. Objetivo: Evaluar efectos de la pandemia en pacientes de Clínica Alemana de Santiago con diagnóstico reciente de cáncer de mama, comparadas con igual periodo año 2019. Materiales y Método: Estudio cuantitativo, retrospectivo, tipo descriptivo. Período 1 de abril - 31 de julio de 2020 comparado con igual periodo de año 2019. Revisión de nuestra base de datos, comparando motivo de consulta, estadio y tratamiento. Análisis estadístico con programa STATA, test T student y test exacto de Fisher. Consideramos significativo p < 0,05. Resultados: Total 156 pacientes, 70 (44,87%) consultaron en periodo señalado año 2020 versus 86 (55,13%) en 2019 (p = 0,1). Edad promedio 55 años versus 58 (p = 0,38). Consulta por nódulo palpable de mama, 25 versus 29 (p = 0,86). Hubo diferencias en pacientes que consultaron por antece-dentes familiares de cáncer de mama, 0 versus 6 (p = 0,033), y en pacientes con antecedente personal de cáncer de mama, 0 versus 6 (p = 0,033). Consulta por control imagenológico fue 39 versus 53 (p = 0,5). En época de pandemia hubo más tumores Her 2, 11 versus 2 (p = 0,006). Por estadios, no hubo diferencia. Por tratamiento indicado, cirugía fue de 49 pacientes versus 71 (p = 0,85). Hormonoterapia neoadyuvante 7 versus 1 (p = 0,058). Conclusiones: En periodo de pandemia hubo menor consulta por cáncer de mama. La mayoría por control imagenológico y lesiones palpables, sin diferencia en estos grupos entre ambos periodos. Hubo menos cirugías y más tratamientos con hormonoterapia neoadyuvante.

Introduction: Due to SARS-CoV-2 pandemic there has been a delay in oncological diagnosis and treatments potentially increasing mortality. Aim: To evaluate the effects of the pandemic in patients treated in Clinica Alemana with recent diagnosis of breast cancer, comparing the reason of consultation, stage and treatment to a similar time frame in 2019. Materials and Method: This is a retrospective, descriptive and quantitative study. Analyzing patients registry from April 1st to July 31st, 2020 compared with same time frame of 2019. Retrospective analysis of our database searching for reason of consultation, stage and treatment. Data analysis using STATA, T student test and Fisher exact test, considering significant a p < 0.05. Results: N156, 70 (44.87%) consultations in the 2020-time frame versus 86 (55.13%) in 2019 (p = 0.1). Mean age 55 years versus 58 (p = 0.38). Palpable tumor 25 versus 29 (p = 0.86). There was a difference in patients consulting due to personal breast oncological background, 0 versus 6 (p = 0.033) or familiar breast oncological background 0 versus 6 (p = 0.033). Breast images control 39 versus 53 (p = 0.5). In Pandemic more Her 2 tumors were diagnosed 11 versus 2 (p = 0.006). No differences in stages were observed. Upfront surgical treatment in 49 versus 71 patients (p = 0.85) and neoadjuvant hormonal treatment 7 versus 1 (p = 0.058). Conclusion: In the pandemic time frame there were less consultations due to breast cancer. The majority of the patients came because of a palpable tumor or breast image control without a significant difference compared with a similar time frame in previous year. There were less surgeries and more neoadjuvant hormonal treatments.

Virus del papiloma humano (VPH) y cáncer / Human papillomavirus (HPV) and cancer

Cada año, más de medio millón de mujeres en el mundo son diagnosticadas con cáncer cervical, usualmente asociado a la infección por virus del papiloma humano (VPH) de alto riesgo. Aunque la mayoría de las infecciones por VPH se resuelven dentro de un término menor de 2 años, algunos tipos virales, en particular el VPH16, pueden persistir por décadas y originar diferentes tipos de cáncer, siendo el cervical el más común. La historia natural de la infección por VPH de alto riesgo y el periodo prolongado en que ocurre su progresión, permite la prevención de la enfermedad. La infección por VPH de alto riesgo que evoluciona a cáncer incluye varios procesos como la integración del genoma viral, la división celular incontrolada, y la participación de cambios celulares y epigenéticos. La prueba de citología convencional que se viene practicando para la tamización hace más de 50 años continúa teniendo vigencia, especialmente en países de ingresos bajos y medios, pero está siendo reemplazada por otros métodos como las pruebas moleculares que detectan directamente la presencia del virus, con mayor efectividad como prueba de tamización. En 2014, el Ministerio de Salud y Protección Social de Colombia desarrolló una guía de práctica clínica para la detección y manejo de lesiones premalignas de cuello uterino, en la cual se recomienda la prueba de ADN-VPH para la tamización inicial en las mujeres mayores de 30 años. Hasta el momento se han encontrado resultados positivos con la implementación de la prueba, no obstante, se requieren estudios adicionales que confirmen estos hallazgos, dada su importancia en el control de la morbilidad y mortalidad asociadas a la infección

Each year, more than half a million women in the world are diagnosed with cervical cancer, usually associated with high-risk human papillomavirus (HPV) infection. Although most HPV infections resolve within 2 years, some viral types, particularly HPV16, can persist for decades and cause different types of cancer, being the cervical type the most common. The natural history of high-risk HPV infection and the prolonged period in which its progression occurs, allows for the prevention of the disease. High-risk HPV infection that progresses to cancer includes several processes such as viral genome integration, uncontrolled cell division, and the participation of cellular and epigenetic changes. The conventional Pap smear test that has been practiced as a screening method for more than 50 years continues to be used, especially in low- and middle-income countries, but it is being replaced by other methods such as molecular tests that directly detect the presence of the virus, with greater effectiveness as a screening test. In 2014, the Ministry of Health and Social Protection of Colombia developed a clinical practice guide for the detection and management of premalignant cervical lesions, in which the DNA-HPV test is recommended for initial screening in women over 30 years. So far, positive results have been found with the implementation of the test, however, additional studies are required to confirm these findings given its importance in controlling the morbidity and mortality associated with the infection

Recomendaciones para el diagnóstico, tratamiento y seguimiento del cáncer de mama durante la pandemia de SARS-Cov-2/COVID-19 en Colombia / Recommendations for the diagnosis, treatment and monitoring of breast cancer during the SARS-Cov-2/COVID-19 pandemic in Colombia

Resumen Bajo las nuevas condiciones generadas por la pandemia de COVID-19, los tratamientos para el cáncer de mama requieren algunas reorientaciones y cuidados que se exponen en este artículo. Se consideran aquí las tres fases de gravedad de la pandemia y los respectivos tratamientos que demandan en función de los lineamientos dictados por el Ministerio de Salud y Protección Social de Colombia. Se trata de un conjunto de referencias para orientar las terapias y tratamientos, inspiradas en las políticas de salud regionales, nacionales e institucionales.

Abstract Under the new conditions generated by the COVID-19 pandemic, breast cancer treatments requires some reorientations and cares that are discussed in this article. The three phases of severity of the pandemic and the respective treatments they require -based on the guidelines issued by the Ministry of Health and Social Protection of Colombia- are considered here. It is a set of references to guide therapies and treatments, inspired by regional, national and institutional health policies.

Serum hTERT Level as Sensitive Biomarker With Prognostic Implications in Breast, Lung, Gastric and Liver Cancers

@#Human telomerase reverse transcriptase (hTERT) plays an important role in telomere restitution and gene regulation. Evidences suggest that hTERT is linked with the risk and progression of several types of malignancies. Detection of hTERT mRNA levels, as one of tumor markers, may reflect the tumor burden and the clinical status of the patient. Present paper emphasizes the potency of hTERT mRNA detection in serum as a sensitive tumor biomarker in different types of cancer. Detection of serum hTERT mRNA levels has been found highly sensitive and specific for varied cancers. A number of reports reflect its superiority to other conventional tumor markers including alfa-fetoprotein, EGFR, lens culinaris agglutinin-reactive AFP and Des-gamma carboxy prothrombin. Serum hTERT has been found linked with the risk and progression of different cancer types. hTERT levels in combination with other tumor markers may be used to improve cancer detection, tumor size and level of cancer progression.

Aumento de la capacidad diagnóstica de la ecografía (informada con clasificación t-rads) cuando se agrega una punción aspirativa con aguja fina (informada con sistema bethesda) / Increase of the diagnostic yield of thyroid sonogram (reported with t-rads clasification) when a fine needle aspiration cytology (reported with bethesda system) is added

Cuando un nódulo tiroideo muestra características ecográficas sospechosas de malignidad (informada con clasificación T-RADS) casi no se discute que debe completarse el diagnóstico con una punción aspirativa con aguja fina (PAAF) (informada con sistema Bethesda). Pero cuando la ecografía sólo muestra características consideradas de benignidad, la indicación de PAAF es cuestionable y debe ser justificada. ¿Podrá la clasificación T-RADS determinar eficientemente cuáles nódulos tiroideos requieren una PAAF y cuáles no? Esta decisión está vinculada a determinar si un paciente deberá ser sometido o no a una cirugía tiroidea. Objetivo: Analizar la capacidad de la clasificación T-RADS, con y sin el agregado de sistema Bethesda para optimizar el diagnóstico de patología tiroidea. Material y métodos: se incluyeron 139 nódulos que requirieron cirugía, previamente evaluados con ecografía y con PAAF. Fueron realizadas por un mismo operador las ecografías (SMB), las punciones (OBM) y las cirugías (JLN). Se homogeneizaron las definiciones: T-RADS II-III-IVa y Bethesda II-III: Baja sospecha de malignidad; T-RADS IVb-V-VI y Bethesda IV-V-VI: Alta sospecha de malignidad. Conslusiones: se comprobó que cuando las características ecográficas de un nódulo tienen baja sospecha de malignidad (T-RADS II-III-IVa), indicar una PAAF no aporta al diagnóstico en forma estadísticamente significativa. Cuando la ecografía indica alta sospecha de malignidad (T-RADS IVb-V-VI), la realización de una PAAF incrementa significativamente la certidumbre del diagnóstico (AU)

When a thyroid nodule shows ultrasonographic characteristics of malignancy suspicion (informed with T-RADS classification), almost nobody discusses to complete diagnosis with a fine needle aspiration biopsy (FNAB) (informed with Bethesda system). But when ultrasonography only shows characteristics compatible with benignity, a FNAB indication is questionable and that must be justified. Could T-RADS classification efficiently identify which nodule requires a FNAB and which does not? That decision will linked to which patients should be undergo a thyroid surgery. Objective: to analyze T-RADS capability with and without Bethesda system to optimize the diagnosis of thyroid pathology. Material and methods: a total of 139 nodules which required surgery were included. They were previously evaluated with ultrasonography and FNAB. A same operator classified the T-RADS (SMB), the Bethesda system (OMB) and performed the surgeries (JLN). For this work, definitions were homogenized as follows: T-RADS II-III-IVa and Bethesda II-III: Low suspicion of malignancy; T-RADS IVb-V-VI and Bethesda IV-V-VI: High suspicion of malignancy. Conclusions: the evidence suggested that when a thyroid nodule shows low suspicion of malignancy by ultrasonography (T-RADS II-III-IVa), the indication of a FNAB did not add statistically significant diagnostic benefit. When a thyroid nodule shows high suspicion of malignancy (T-RADS IVb-V-VI), a FNAB added significant diagnostic accuracy (AU)

Disponibilidad de técnicas moleculares para niños con tumores de difícil caracterización. Un problema en la Oncopatología pediátrica. Aplicación y difusión de técnicas de diagnóstico complementarias en el ámbito público / Availability of molecular techniques for children with difficult-to-characterize tumors. A problem in pediatric oncopathology. Application and diffusion of complementary diagnostic techniques in the public setting

La revolución de la biología molecular y el desarrollo de la investigación biomédica básica para el diagnóstico y posterior manejo del cáncer infantil han llevado a la necesidad de organización de grupos interdisciplinarios de profesionales, los cuales se encargan de afrontar los nuevos desafíos diagnósticos y terapéuticos. Los sarcomas indiferenciados pediátricos constituyen un grupo heterogéneo de neoplasias malignas de aspecto primitivo y polifenotípico. La categorización de gran parte de este tipo de tumores es posible gracias a la aplicación de técnicas moleculares complementarias al estudio histopatológico. El objetivo del presente estudio fue recategorizar sarcomas indiferenciados mediante la implementación de una nueva metodología diagnóstica. Se efectuaron técnicas de inmunohistoquimica (IHQ), FISH de interfase y RT-PCR a partir de tejido fijado en formol e incluido en parafina en 144 casos de sarcomas indiferenciados. Se logró la recategorización del 95.1% de los casos, arribando a 24 diagnósticos diferentes. Sólo un 4.9% permanece aún como sarcoma indiferenciado o inclasificable. Los resultados alcanzados por este estudio demuestran la importancia de contar con nuevas herramientas diagnósticas a nivel molecular y recursos humanos especializados que posibiliten su correcta implementación para el diagnóstico de neoplasias de difícil caracterización (AU)

The revolution of molecular biology and the development of basic medical research for the diagnosis and subsequent management of childhood cancer have led to a need to organize interdisciplinary groups of professionals in charge of facing new diagnostic and treatment challenges. Childhood undifferentiated sarcomas are a heterogeneous group of malignant neoplasms that are primitive in appearance and have polyphenotypic features. Categorization of a large part of this type of tumor has become possible with molecular techniques as a complement to histopathological studies. The aim of this study was to categorize undifferentiated sarcomas using new diagnostic tools. Immunohistochemistry (IHC), interfase FISH, and RT-PCR techniques were used on formalin-fixed and paraffin-embedded tissues of 144 cases of undifferentiated sarcomas. Overall, 95.1% of the cases could be recategorized resulting in 24 different diagnoses. In only 4.9% the diagnosis of undifferentiated or unclassifiable sarcoma was maintained. These results emphasize the importance of the availability of new diagnostic tools at the molecular level and specialized human resources enabling adequate implementation for the diagnosis of difficult-to-characterize neoplasms (AU)

Pseudomyxoma peritonei originating from appendix tumors / Pseudomixoma peritoneal com origem em tumores do apêndice

ABSTRACT Background: Appendix tumors represent about 1% of all gastrointestinal neoplasia, in other words they are quite rare. However, there is a specific type of appendiceal neoplasms (mucinous adenocarcinoma) that spreads to the peritoneum and in almost 20% of the cases, resulting in a disease called pseudomyxoma peritonei. Although, it is a very rare condition, it is nonetheless a very severe one and therefore it is crucial to know how to correctly diagnose and treat it. Objective: This study provides updated data on how to diagnose, classify and treat pseudomyxoma peritonei that originates from appendix tumors. Methods: A bibliographic research was performed on PubMed database, including articles published since 2000, as well as, cross-referencing with the initial research. Discussion: In the past, patients diagnosed with pseudomyxoma peritonei would only undergo palliative measures, so their overall survival rate was greatly reduced. Over the years pseudomyxoma peritonei treatment has evolved and patients are now undergoing treatment which is a combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. This new therapy has allowed an increase of survival chances of up to 5 years in those patients with values between 53% and 88%, depending on the type of tumor. Conclusion: Despite the great progress we have witnessed in recent years, which have led to a large increase in survival rates, more research needs to be done, on what to do when the disease is in an unresectable stage. Finding a less aggressive therapy than cytoreductive surgery + hyperthermic intraperitoneal chemotherapy will be an important step forward.

RESUMO Introdução: As neoplasias do apêndice são bastante raras, representando atualmente cerca de 1% de todas as neoplasias gastrointestinais. O adenocarcinoma mucinoso é um dos subtipos de neoplasia do apêndice e caracteriza-se por metastizar para o peritoneu, em 20% dos casos, facto que se manifesta sob a forma de uma doença designada por Pseudomixoma Peritoneal. Apesar de ser uma condição muito rara, a sua extrema gravidade justifica a importância de a saber diagnosticar e tratar corretamente. Métodos: Foi realizada uma pesquisa bibliográfica na base de dados PubMed, incluindo artigos publicados desde 2000 bem como artigos de pesquisa cruzada com os iniciais. Discussão: No passado, os doentes diagnosticados com Pseudomixoma Peritoneal eram apenas submetidos a medidas paliativas, pelo que a sua sobrevida era muito reduzida. Ao longo dos anos o tratamento do Pseudomixoma Peritoneal foi evoluindo sendo agora os doentes submetidos a uma combinação de cirurgia citoredutiva e quimioterapia hipertérmica intraperitoneal. Esta nova terapêutica tem permitido aumentar a sobrevida aos 5 anos destes pacientes para valores entre os 53% e os 88%, dependendo do tipo de tumor. Conclusões: Apesar dos grandes avanços que se têm verificado, e que culminaram com um grande aumento das taxas de sobrevivência, devem ser feitos mais estudos que encontrem novas abordagens para quando o tumor já é diagnosticado num estado irressecável, bem como terapêuticas menos invasivas.

Utilidad diagnóstica de la ecografía tiroidea en la evaluación de nódulos tiroideos en niños y adolescentes / Diagnostic utility of thyroid ultrasound ecografy in thyroid nodules evaluation in children and adolescents

AIM: To evaluate the diagnostic utility of ultrasonography and other antecedents and exams usually availables, in the study of patients with thyroid nodules aged 0-20 years. SUBJECTS AND METHODOLOGY: Cross-sectional analytical observational study. We reviewed the data of patients undergoing FNAP (thyroid puncture with a fine needle) and / or thyroidectomy between January 2007 and December 2013. The ultrasound evaluation was performed by 3 specialists. The surgical biopsy was considered an indicator of benignity or malignancy and, in its absence the FNAP (excluding the Bethesda diagnoses 3 and 4). The association between cancer and the different variables was evaluated through binary logistic regression, with measure of association of odds ratio (OR). With the initially significant variables, a multivariate analysis was carried out and a cut-off score was subsequently defined to allow the diagnosis to be discriminated. RESULTS: 104 nodules are included in the analysis (100 patients), 89♀ / 11♂; age x16 ± 2.8; TSH 2.8 uIU / ml ± 5; lymphocytic thyroiditis 30%; pathological anatomy: benign 46 (44%) cancer 58 (56%). Sonographic findings predictive of malignancy were: hypoechogenicity (OR 2.95 p = 0.008) irregular shape (100% CA) non-smooth edges (OR 8.5 p = 0.000) microcalcifications (OR 39 p = 0.000) thick calcifications (OR 18 p = 0.001) and presence of suspicious adenopathy (100% CA). In the TIRADS classification, cases classified as 4 and 5 corresponded to cancer in 50 and 92%. The presence of thyroiditis did not show an insignificant association with malignancy. From the joint analysis of the significant variables, a score with adequate sensitivity and specificity is obtained. CONCLUSIONS: The usefulness of ultrasound as a fundamental examination in the evaluation of the pediatric patient who consults by thyroid nodule is corroborated. Accurately describing their sonographic characteristics and, above all, analyzing them together, allows us to determine an approximate risk of malignancy and define with greater certainty the indication of performing FNAP

Coloretal cancer in pregnant women / Cancro colorectal na mulher grávida

Abstract Background Colorectal cancer in pregnancy is a rare pathology with limited high-grade evidence available for guidance. The diagnosis of CRC in pregnant women is usually delayed, and once diagnosis is made, challenges exist as treatment options may be limited. Objective The study aims to highlight the importance of early investigation of symptomatic patients during pregnancy, as well as to update treatment and prognosis in CRC. Methods A literature search in PubMed database, including articles from 2006 to 2016 and cross-research articles with the initial research. Results Pregnancy can limit and contraindicate the utilization of standard diagnostic and therapeutic tools, which in particular can hamper the liberal use of colonoscopy and CT. Physical evaluation and abdominal US are first recommended; besides, MRI or CT may be used, only in indicated cases. Surgery is the main stay of treatment but radiotherapy and chemotherapy have significant role in posterior management of tumour. Conclusions Many studies are needed in order to achieve development in CRC pathogenesis during pregnancy as well as in treatment outcomes. The potential curative treatment of the disease should be the main aim of treatment when considering CRC in pregnancy. However, it is crucial to adapt the treatment to each patient, taking into account conscious decision on pregnancy further management.

Resumo Introdução O cancro colorretal na gravidez é uma patologia rara, com limitada evidência científica para orientação terapêutica. O diagnóstico de cancro coloretal em mulheres grávidas é tardio e, quando o diagnóstico é feito, as opções de tratamento podem ser limitadas. Objetivo O objetivo deste estudo é ressalvar a importância da investigação precoce de pacientes sintomáticas durante a gravidez, assim como avaliar os atuais métodos de tratamento e prognóstico no CCR. Métodos A pesquisa bibliográfica foi realizada na base de dados PubMed, incluindo artigos a partir de 2006 até 2016, assim como artigos de pesquisa cruzada com os artigos iniciais. Resultados A gravidez pode limitar e contra-indicar a utilização de ferramentas de diagnóstico e terapêuticas convencionais, assim como dificultar o uso indiscriminado de colonoscopia e tomografia computadorizada. A avaliação física e a ecografia abdominal são a primeira linha para diagnóstico. No entanto, em casos selecionados, a ressonância magnética ou a tomografia computadorizada também podem ser usadas. A cirurgia é o gold-standard mas a radioterapia e a quimioterapia assumem um papel cada vez mais relevante no tratamento multidisciplinar destes tumores. Discussão Como os sintomas abdominais são comuns na gravidez e cancro coloretal pode simulá-los, o diagnóstico diferencial entre estas duas patologias é crucial, já que intervenções precoces podem ser curativas. Após diagnóstico, o seguimento das grávidas deve ser individualizado, dependendo de vários fatores. Porém, já que atualmente o tratamento do cancro é possível na gravidez, a probabilidade de sobrevivência da paciente não deve ser diminuída devido ao diagnóstico tardio. Conclusões Mais estudos são necessários para saber mais acerca da patogénese do cancro coloretal na gravidez, assim como os resultados após tratamento. O potencial objetivo é o tratamento oncológico do cancro coloretal. No entanto, é crucial adaptar o tratamento a cada paciente, tendo em conta a sua decisão consciente acerca da continuação da gravidez.

Development of radioimmunoconjugate for diagnosis and management of head-and-neck subclinical cancer and colorectal carcinoma

ABSTRACT Scientific innovations in diagnostic methods are important drivers of cancer control and prevention. Noninvasive imaging of the epidermal growth factor receptor (EGFR) in head-and-neck squamous, cell carcinoma and colorectal cancer could be valuable to select patients for EGFR-targeted therapy, as well as to monitor the efficacy and occurrence of resistance to immunotherapy. In order to develop the first Brazilian radioimmunoconjugate for diagnosis, Cetuximab has been conjugated to p-SCN-Bn-DTPA chelator and radiolabeled with Indium-111. The conjugation methodology was optimized using different mAb:DTPA molar ratios, time was then reduced for immunoconjugate preparation, besides the protein recovery' percentage increased after purification (m = 83.8 ± 0.91 %). The stability of Cetuximab-DTPA at - 20 oC was evaluated for six months, and its integrity was greater than 90% (m =93.9 ± 1.5%, N = 24). The radioimmunoconjugate with specific activity of 185 MBq/mg showed radiochemical purity above 95% (m=96.8 ± 1.31 %, N = 15). We conclude that the radioimmunoconjugate 111In-DTPA-cetuximab is stable and may be applied to the diagnosis of EGFR-positive tumors.

The study of the value of combined detection of serum tumor markers in the diagnosis of lung cancer / 国际检验医学杂志

Objective To explore the value of combined detection of serum tumor markers in the diagnosis of lung cancer.Meth-ods Electrochemiluminescence immunoassay was used to detect 5 kinds of tumor markers in 86 patients with lung cancer,92 pa-tients with benign lung disease and healthy persons,serum levels of neuron specific enolase(NSE),carcinoembryonic antigen (CEA),squamous cell carcinoma antigen(SCCAg),carbohydrate antigen 125(CA125)and cytokeratin fragment 21-1(CYFRA21-1).The difference of tumor markers in different patients and different pathological types of lung cancer and the difference of single and combined detection of tumor markers in the diagnosis of lung cancer were compared.Results The serum levels of NSE,CEA, SCC,CA125 and CYFRA211 in patients with lung cancer were significantly higher than those in benign lung disease group and healthy control group,and the difference was statistically significant(P<0.05).The average level of NSE in the serum of patients with small cell lung cancer was higher,CEA,CA125 levels in the serum of patients with adenocarcinoma was higher,and the levels of SCC and CYFRA211 in the sera of patients with squamous cell carcinoma were higher.The combined detection of serum tumor markers is more sensitive than that of the single detection,and the combined detection of NCE,CEA and CYFRA211 has relatively high specificity and accuracy.The combined detection of 5 serum indexes has the highest sensitivity,but its specificity is low,only 81.53%.Conclusion The single tumor marker has certain limitation whose sensitivity and specificity have great differences for dif-ferential diagnosis of different pathological types of lung cancer,and combined detection of the serum tumor markers can be mutual-ly complementary,which could have high sensitivity and accuracy.

Transperineal prostate biopsies for diagnosis of prostate cancer are well tolerated: A prospective study using patient-reported outcome measures / 亚洲男科学杂志(英文版)

We aimed to determine short-term patient-reported outcomes in men having general anesthetic transperineal (TP) prostate biopsies. A prospective cohort study was performed in men having a diagnostic TP biopsy. This was done using a validated and adapted questionnaire immediately post-biopsy and at follow-up of between 7 and 14 days across three tertiary referral hospitals with a response rate of 51.6%. Immediately after biopsy 43/201 (21.4%) of men felt light-headed, syncopal, or suffered syncope. Fifty-three percent of men felt discomfort after biopsy (with 95% scoring <5 in a 0-10 scale). Twelve out of 196 men (6.1%) felt pain immediately after the procedure. Despite a high incidence of symptoms (e.g., up to 75% had some hematuria, 47% suffered some pain), it was not a moderate or serious problem for most, apart from hemoejaculate which 31 men suffered. Eleven men needed catheterization (5.5%). There were no inpatient admissions due to complications (hematuria, sepsis). On repeat questioning at a later time point, only 25/199 (12.6%) of men said repeat biopsy would be a significant problem despite a significant and marked reduction in erectile function after the procedure. From this study, we conclude that TP biopsy is well tolerated with similar side effect profiles and attitudes of men to repeat biopsy to men having TRUS biopsies. These data allow informed counseling of men prior to TP biopsy and a benchmark for tolerability with local anesthetic TP biopsies being developed for clinical use.

El signo de Leser-Trélat ¿Un predictor de neoplasias útil en clínica? / The Leser-Trélat sign A useful predictor of neoplasms in clinic?

Propósito: el signo de Leser-Trélat conjuga la presencia simultánea de queratosis seborreica eruptiva con una neoplasia maligna, pero existen publicaciones de pacientes con queratosis con o sin la neoplasia. Se buscó establecer si hay evidencia sobre esta asociación para considerar la potencialidad de la aparición de tales lesiones dermatológicas como un hallazgo precoz de neoplasias malignas. Fuente de datos: revisión sistemática de la literatura ubicada en Medline, Cochrane, Lilacs, Scholar Gloogle e Imbiomed. Selección de estudios: se evaluaron todos los artículos afines a queratosis seborreica eruptiva y cáncer, sin límite en edad, sexo, tipo de artículo o idioma. Extracción de datos: se leyeron de 668 resúmenes y se revisaron 120 artículos completos, 66 utilizados en este informe. Resultados: la evidencia que apoya la asociación entre queratosis seborreica súbita y cáncer es pobre: sólo existen cuatro estudios de casos y controles cuyos resultados no apoyan esta asociación. Conclusiones: la gran mayoría de las publicaciones son producto del hallazgo al azar de las dos entidades y no producto de la búsqueda sistemática de una de ellas cuando aparece la otra, lo que refleja una especie de sesgo de selección a la hora de publicar dichos casos.

Purpose: the sign of Leser-Trélat conjugates the simultaneous presence of eruptive seborrheic keratoses with a malignancy, but there are reports of patients with keratosis with or without neoplasia. The establishment of whether there is evidence for this association to consider the potential for the occurrence of such skin lesions as an early finding of malignant neoplasms was sought. Data Sources: a systematic review of the literature located on Medline, Cochrane, Lilacs, Schoolar Google and Imbiomed. Study Selection: all articles related to eruptive seborrheic keratosis and cancer, with no limit on age, sex, type of article or language were evaluated. Data Extraction: 668 abstracts were read and 120 full articles were reviewed, 66 used in this report. Results: the evidence supporting the association between sudden seborrheic keratosis and cancer is poor: there are only four case-control studies whose results do not support this association. Conclusions: the vast majority of publications are the product of chance finding of the two entities and not the result of a systematic search of one of them when the other appears, reflecting a kind of selection bias in publishing such cases.

A survey of the current situation of pathologists and development of a consultation network using virtual slides / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : To grasp what kind of problems exists in order to solve the shortage of pathologists, we conducted a survey with special focus on the condition of facilities with single pathologists. We also considered whether the use of virtual slide technology is a viable option in mitigating the shortage of pathologists.<br><b>Methods</b> : The survey was conducted at the 58th Autumn Annual Meeting of the Japanese Society of Pathology using questionnaires. Interviews were also obtained with pathologists who use virtual slides<br><b>Results</b> : The percentage of facilities with single pathologists was approximately 30%, and these facilities had the highest rates of using virtual slides for remote pathology consultations. Regardless of the number of pathologist at a facility, outside consultation was often obtained with difficult cases. Although pathologists working alone expressed anxiety over diagnosing cancer, consulting other facilities appeared to be difficult.<br><b>Conclusion</b> : In order to reduce the anxiety of pathologists working alone and to raise the accuracy of cancer diagnoses, a mechanism by which pathologists can consult each other is required. Developing a network for pathologists for such consultations using virtual slides is felt to be important in primary care.

Modelo para la prevención y manejo del cáncer de pulmón en Cuba, 2010 / A form designed to prevent and to manage the lung cancer in Cuba, 2010

Introducción: El cáncer de pulmón es un grave problema sanitario en Cuba y afecta a uno y otro sexos. Su alta incidencia y mortalidad tienen una tendencia al incremento, más ostensible en mujeres. Su diagnóstico se realiza frecuentemente en etapas avanzadas. Objetivos: Estandarizar procederes que permitan, desde el nivel primario de atención, un procedimiento organizado para la prevención y el manejo del cáncer de pulmón, con énfasis en las personas en riesgo, así como contribuir a reducir el diagnóstico tardío de la enfermedad. Métodos: Para la construcción del algoritmo se tuvieron en cuenta los principales factores de riesgo del cáncer de pulmón, y entre ellos el de mayor contribución: el tabaquismo. Se organizó una secuencia estructurada de pasos que incluyó la aplicación de la estrategia de las 3 A (Averiguar, Animar, Asesorar), propuesta por la Organización Mundial de la Salud, adecuada a nuestro contexto y modificada, al ser aplicada por primera vez a fumadores pasivos. El modelo fue sometido a validación según criterios de expertos. Resultados: Fue construido el algoritmo que partió de explorar los principales factores de riesgo del cáncer de pulmón, orientado a sistematizar una conducta preventiva del tabaquismo, así como la sistemática de manejo del individuo en riesgo, con la participación activa del médico y la enfermera de la familia durante todo el proceso de atención. El resultado de la validación fue satisfactorio y se incorporaron las recomendaciones de los expertos. Consideraciones finales: Para el logro del diagnóstico en estadios más tempranos de la enfermedad y de la contribución a la reducción de la morbilidad y mortalidad, retos de la salud pública cubana actual, deberá tenerse en cuenta la propuesta de este modelo de prevención y adecuado manejo del cáncer de pulmón desde el nivel primario de atención

Introduction: The lung cancer is a serious health problem in Cuba affecting both sexes. Its high incidence and mortality have a trend to increase more evident in women. Its diagnosis frequently is made in the advanced stages. Objectives: To standardize procedures allowing from the primary level of care a procedure organized for prevention and management of lung cancer emphasizing the persons in risk, as well as to contribute to reduce the late diagnosis of disease. Methods: To construction of algorithm authors took into account the main risk factors of lung cancer and among them that of great contribution: smoking. A structured sequence of steps was organized including the implementation of "strategy" of three A (to find out, to encourage, to advice) proposed by WHO, suitable for our context and modified when it was applied for the first time in passive smokers. The form was submitted to validation according to the expert criteria. Results: An algorithm was designed from the exploration of main risk factors of lung cancer, directed to systematize a preventive behavior of smoking, as well as the management systematics of individual in risk with the active participation of family physician and nurse over all the care process. The result of validation was satisfactory and the expert recommendations were incorporated. Final considerations: To achieve the diagnosis in earlier stages of disease and of the contribution to reduction of morbility and mortality which are challenges of current Cuban public health, we must to take into account the proposal of this form of prevention and appropriate management of lung cancer from the primary care level

Criterios ante el desafío de la información a los pacientes con cáncer / Approaches before the challenge of the information to cancer patients

Se efectuó un estudio descriptivo y transversal en el Consultorio Médico de la Familia No. 4, perteneciente al Policlínico Docente del poblado El Cristo en el municipio de Santiago de Cuba, durante el 2008, para determinar los criterios acerca de la información deseada por los pacientes con cáncer y algunas de las actitudes de los que supieron cuál era su diagnóstico. En la casuística predominaron las personas con nivel escolar medio superior, partidarias de que se les dijera la verdad sobre su padecimiento; las que preferían permanecer en su domicilio como estancia final para el estadio terminal y las que mostraron tener miedo, principalmente ante el dolor insoportable. Se utilizó la prueba de Ji al cuadrado de homogeneidad para comparar proporciones con una confiabilidad de 95 por ciento

A descriptive and cross-sectional study was carried out in the family doctor's office No. 4, belonging to the Teaching Polyclinic from El Cristo village in Santiago de Cuba, in 2008, to determine the approaches to the information desired by cancer patients and some of the attitudes of those who knew about their diagnosis. People with high school level, those who were in favor of being told the truth about their illness, those who preferred to remain in their home as a final stay for the terminal stage, and those that showed to be afraid, mainly of the unbearable pain, prevailed in the case material. The chi square-test of homogeneity was used to compare proportions with a confidence of 95 per cent