SMARCA4-deficient non-small cell lung carcinoma: clinicodemographic, computed tomography, and positron emission tomography-computed tomography features.

Background: SMARCA4-deficient non-small cell lung carcinoma (SD-NSCLC) is a relatively rare tumor, which occurs in 5-10% of NSCLC. Based on World Health Organization thoracic tumor classification system, SMARCA4-deficient undifferentiated tumor (SD-UT) is recognized as a separate entity from SD-NSCLC. Differentiation between SD-NSCLC and SD-UT is often difficult due to shared biological continuum, but often required for choosing appropriate treatment regimen. Therefore, the aim of our study was to identify the clinicopathologic, computed tomography (CT), and positron emission tomography (PET)-CT imaging features of SD-NSCLC. Methods: Nine patients of pathologically confirmed SD-NSCLC were included in our analysis. We reviewed electronic medical records for clinical information, demographic features, CT, and PET-CT imaging features were analyzed. Results: Smoking history and male predominance are observed in all patients with SD-NSCLC (n=9). On CT, SD-NSCLC appeared as relatively well-defined masses with lobulated contour (n=8) and peripheral location (n=7). Invasion of adjacent pleura or chest wall (n=7) were frequently observed, regardless of small tumor size. Four cases showed lymph node metastases. Among nine patients, three patients showed multiple bone metastases, and one patient showed lung-to-lung metastases. Conclusions: In patient with SD-NSCLC, there was tendency for male smokers, peripheral location and invasion of adjacent pleural or chest wall invasion regardless of small tumor size, when compared to SD-UT.

Pathological characteristics and risk stratification in patients with stage I endometrial cancer: utility of apparent diffusion coefficient histogram analysis.

OBJECTIVES: Accurate pre-operative prediction of risk stratification using a non-invasive imaging tool is clinically important for planning optimal treatment strategies, particularly in early-stage endometrial cancer (EC). This study aimed to investigate the utility of apparent diffusion coefficient (ADC) histogram analysis in evaluating the pathological characteristics and risk stratification in patients with Stage I EC. METHODS: Between October 2009 and December 2014, a total of 108 patients with surgically proven Stage I EC (endometrioid type = 91; non-endometrioid type = 17) excluding stage ≥II that underwent preoperative 3T-diffusion-weighted imaging without administration of contrast medium were enrolled in this retrospective study. Risk stratification was divided into four risk categories based on the ESMO-ESGO-ESTRO Guidelines: low, intermediate, high-intermediate, and high risk. The ADC histogram parameters (minimum, mean [ADCmean], 10th-90th percentile, and maximum [ADCmax]) of the tumor were generated using an in-house software. The ADC histogram parameters were compared between patients with endometrioid type and non-endometrioid type, between Stage IA and IB, between histological grades, and evaluated for differentiating non-high risk group from high risk group. Inter-reader agreement for tumor ADC measurements was also evaluated. Statistical analyses were performed using the Student's t-test, Mann-Whitney U test, receiver operating characteristics (ROC) analysis, or intraclass correlation coefficient (ICC). RESULTS: In differentiating endometrioid type from non-endometrioid type EC, all ADC histogram parameters were statistically significant (p < 0.05). In differentiating histological grades, 90th percentile ADC and ADCmax showed significantly higher values in tumor Grade III than in tumor Grade I-II (p < 0.05). In differentiating superficial myometrial invasion from deep myometrial invasion, all ADC histogram parameters were statistically significant (p < 0.05), except ADCmax. In differentiating non-high risk group from high risk group, ADCmean, 75th-90th percentile ADC, and ADCmax were statistically significant (p < 0.05). For predicting the high risk group, the area under the ROC curve of ADCmax was 0.628 and the highest among other histogram parameters. All histogram parameters revealed moderate to good inter-reader reliability (ICC = 0.581‒0.769). CONCLUSION: The ADC histogram analysis as reproducible tool may be useful for evaluating the pathological characteristics and risk stratification in patients with early-stage EC. ADVANCES IN KNOWLEDGE: ADC histogram analysis may be useful for evaluating risk stratification in early-stage endometrial cancer patients.

Ureteral cancer: Complete ureteral obstruction on computed tomography urography is associated with periureteral fat invasion.

OBJECTIVE: To determine predictive factors for periureteral fat invasion of ureteral cancer on computed tomography (CT) urography. MATERIALS AND METHODS: Consecutive 77 patients with CT urography and surgically proven ureteral cancer were retrospectively evaluated. Three independent radiologists with different experiences in interpreting CT urography analyzed radiologic findings as follows: (a) periureteral infiltration (absent; equivocal; or present); (b) ureteral obstruction (complete obstruction or not); (c) lesion length; (d) lesion width; (e) hydronephrosis grade; and (f) renal atrophy (present or not). We analyzed univariate and multivariate logistic regression. We assessed sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of significant parameters. RESULTS: Periureteral fat invasion was surgically identified in 33.8 % (26/77). For reader 1, periureteral infiltration (odds ratio [OR] = 3.330), complete ureteral obstruction (OR = 18.965), and renal atrophy (OR = 3.116) were significant in univariate analysis (p < 0.05), while only complete ureteral obstruction was significant in multivariate analysis (OR = 12.779; p = 0.018). For reader 2 (OR = 4.172; p = 0.019) and 3 (OR = 9.459; p = 0.035), only complete ureteral obstruction was significant in univariate analysis. Sensitivity, specificity, PPV, and NPV of complete ureteral obstruction were 96.2 % (25/26), 43.1 % (22/51), 46.3 % (25/54), and 95.7 % (22/23) for reader 1, 84.6 % (22/26), 43.1 % (22/51), 43.1 % (22/51), and 84.6 % (22/26) for reader 2, and 96.2 % (25/26), 27.5 % (14/51), 40.3 % (25/62), and 93.3 % (14/15) for reader 3, respectively. CONCLUSION: Complete ureteral obstruction on CT urography is highly sensitive for extra-ureteral extension of ureteral cancer. Ureteral cancer without complete ureteral obstruction may be less likely to invade periureteral fat.