5-Fluorouracil induced liver toxicity in patients with colorectal cancer: role of computed tomography texture analysis as a potential biomarker.

PURPOSE: To assess if CT texture analysis (TA) can serve as a biomarker of liver toxicity in patients with colorectal cancer treated with 5-fluorouracil (5-FU)-based chemotherapy. METHODS: In this IRB-approved, HIPAA-compliant retrospective study, patients with colorectal cancer treated with 5-FU-based regimens during 2008-2010 were identified from institutional electronic database. Total 43 patients (23 women; mean age 56 years) with normal baseline liver function tests (LFTs), availability of baseline (pre-chemotherapy) and first follow-up CT (median 1.7 months, interquartile range (IQR) 1.5-2.5) performed during chemotherapy were included. Two single-slice ROI of right and left liver lobe were obtained on baseline and first follow-up CT for TA. Texture features [mean, entropy, kurtosis, skewness, mean of positive pixel, standard deviation (SD)] were extracted using a commercially available software (TexRAD; Feedback Medical Ltd, Cambridge, UK). Changes in texture parameters between baseline and follow-up CT were evaluated with Wilcoxon signed-rank test for patients with and without LFT elevation during chemotherapy. RESULTS: Patients with LFT elevation (n = 34; 79%) showed significantly different mean, entropy, skewness, and SD (p values range 0.007-0.047) between baseline and first follow-up CT. No significant changes in features were observed in patients without LFT elevation (n = 9; 21%). In 19 patients (56%), first follow-up CT was performed before elevation of LFTs was observed. CONCLUSIONS: This proof-of-concept study shows that there are early changes in liver texture on first follow-up CT in patients with LFT elevation during 5-FU-based chemotherapy for colorectal cancer. In more than 50% of cases, these changes occur before LFT elevation becomes evident on blood tests.

Lobular breast cancer: patterns of intraabdominal metastatic spread on imaging and prognostic significance.

OBJECTIVE: To retrospectively review the frequency, patterns and intra-abdominal sites of metastatic invasive lobular breast cancer, and to correlate the findings with overall survival. MATERIALS AND METHODS: From a pathology database search revealing 327 patients with metastatic lobular breast cancer at our institution from January 2004 through August 2014, imaging was available in 116 patients (age range, 31-87 years, mean age, 55). Simple descriptive statistics were performed to record and tabulate the abdominal metastatic spread. Prognostic significance of abdominal metastases and individual abdominal metastatic sites was studied using the Log-rank test and construction of Kaplan-Meier curves. RESULTS: The most frequent sites of intra-abdominal metastatic invasive lobular breast cancer were peritoneum (55 patients, 47%), followed by liver (37 patients, 32%), bowel (34 patients, 29%), ovary (33 patients, 28%), retroperitoneum (16 patients, 14%), ureter (16 patients, 14%), and lymph nodes (15 patients, 13%). Bowel obstruction was noted in 15 patients (13%) and hydronephrosis in 25 patients (22%). The median abdominal metastasis-free survival was 76 months (interquartile range: 17-191). The overall survival (OS) was 86 months (interquartile range: 49-188). Patients with abdominal metastases had shorter OS. Patients with hepatic metastases had shorter overall survival than those patients without hepatic metastases (p = 0.02, Log-Rank test). CONCLUSION: Invasive lobular breast cancer has a predilection for metastasizing to both typical (liver) and atypical intra-abdominal sites (peritoneum, GI tract, and adnexa). Presence of intra-abdominal disease and hepatic metastases in patients with ILC negatively affects overall survival.

Construction and validation of an educational technology on human papillomavirus vaccine for adolescents / Construcción y validación de una tecnología educativa sobre la vacuna virus del papiloma humano para adolescentes / Construção e validação de uma tecnologia educativa sobre a vacina papilomavírus humano para adolescentes

ABSTRACT Objective: To construct and validate a comic-type educational technology on the human papillomavirus vaccine. Methods: A methodological study developed based on the manuals, informative notes of the Ministry of Health and with the suggestions of the target audience. Content validation was performed with 11 expert judges and the validation of appearance, with 32 adolescents. For the judges, the Content Validity Index was used and for the target audience the proportion of agreement was considered. Results: The comic book obtained a content validation index total of 0.95, a validation index considered adequate. It was identified a concordance greater than 0.80 in the validation of appearance with the target public, indicating an excellent degree of agreement. Conclusion: The technology was considered valid by the judges and the target audience, and can be used as an educational tool to guide the practice in the acceptability scenario of the vaccine. Implications for practice: The technology may contribute to the stimulation of adhesion to the human papillomavirus vaccine, since, in Brazil, the rates of adhesion to this vaccine are still low.

RESUMEN Objetivo: Construir y validar una tecnología educativa del tipo historietas sobre la vacuna contra el virus del papiloma humano. Métodos: Estudio metodológico desarrollado con base en los manuales, notas informativas del Ministerio de la Salud y con las sugerencias del público objetivo. La validación de contenido fue realizada con 11 jueces especialistas y la validación de la apariencia, con 32 adolescentes. Para los jueces, se utilizó el Índice de Validez de Contenido y para el público objetivo se consideró la proporción de concordancia. Resultados: Las historietas obtuvieran un índice de validación de contenido total de 0,95, índice de validación considerado adecuado. Se identificó concordancia mayor que 0,80 en la validación de la apariencia con el público objetivo, indicando óptimo grado de concordancia. Conclusión: La tecnología fue considerada válida por los jueces y el público objetivo, pudiendo ser utilizada como instrumento educativo para orientar la práctica en el escenario de aceptabilidad de la vacuna. Implicaciones para la práctica: La tecnología puede contribuir con el estímulo a la adhesión a la vacuna contra el virus del papiloma humano, ya que en Brasil los índices de adhesión a esta vacuna todavía son bajos.

RESUMO Objetivo: Construir e validar uma tecnologia educativa do tipo história em quadrinhos sobre a vacina contra o papilomavírus humano. Métodos: Estudo metodológico desenvolvido com base nos manuais, notas informativas do Ministério da Saúde e com as sugestões da população alvo. A validação de conteúdo foi realizada com 11 juízes especialistas e a validação de aparência com 32 adolescentes. Para os juízes foi utilizado o Índice de Validade de Conteúdo e para o público alvo considerou-se a proporção de concordância. Resultados: A história em quadrinhos obteve um índice de validação de conteúdo total de 0,95, índice de validação considerado adequado. Identificou-se concordância maior que 0,80 na validação de aparência com o público alvo, indicando ótimo grau de concordância. Conclusão: A tecnologia foi considerada válida pelos juízes e pela população alvo, podendo ser utilizada como instrumento educativo para orientar a prática no cenário de aceitabilidade da vacina. Implicações para a prática: A tecnologia poderá estimular a adesão à vacina contra o papilomavírus humano, uma vez que, no Brasil, os índices de adesão a essa vacina ainda são baixos.

Somatic Mutations Drive Distinct Imaging Phenotypes in Lung Cancer.

Tumors are characterized by somatic mutations that drive biological processes ultimately reflected in tumor phenotype. With regard to radiographic phenotypes, generally unconnected through present understanding to the presence of specific mutations, artificial intelligence methods can automatically quantify phenotypic characters by using predefined, engineered algorithms or automatic deep-learning methods, a process also known as radiomics. Here we demonstrate how imaging phenotypes can be connected to somatic mutations through an integrated analysis of independent datasets of 763 lung adenocarcinoma patients with somatic mutation testing and engineered CT image analytics. We developed radiomic signatures capable of distinguishing between tumor genotypes in a discovery cohort (n = 353) and verified them in an independent validation cohort (n = 352). All radiomic signatures significantly outperformed conventional radiographic predictors (tumor volume and maximum diameter). We found a radiomic signature related to radiographic heterogeneity that successfully discriminated between EGFR+ and EGFR- cases (AUC = 0.69). Combining this signature with a clinical model of EGFR status (AUC = 0.70) significantly improved prediction accuracy (AUC = 0.75). The highest performing signature was capable of distinguishing between EGFR+ and KRAS+ tumors (AUC = 0.80) and, when combined with a clinical model (AUC = 0.81), substantially improved its performance (AUC = 0.86). A KRAS+/KRAS- radiomic signature also showed significant albeit lower performance (AUC = 0.63) and did not improve the accuracy of a clinical predictor of KRAS status. Our results argue that somatic mutations drive distinct radiographic phenotypes that can be predicted by radiomics. This work has implications for the use of imaging-based biomarkers in the clinic, as applied noninvasively, repeatedly, and at low cost. Cancer Res; 77(14); 3922-30. ©2017 AACR.

Anatomical features of metacarpal heads that simulate bone erosions: cadaveric study using computed tomography scanning and sectional radiography.

OBJECTIVE: The objective of this study was to demonstrate the anatomical features of metacarpal heads that can simulate bone erosions. MATERIALS AND METHODS: After performing computed tomography scanning of 6 cadaveric hand specimens, normal anatomy was identified; the maximum depth, height, and area of the osseous concavities in the ulnar, radial, and intersesamoid aspects of the metacarpal heads were measured. An average value was determined for each of the measurements of the 5 fingers, and statistical analysis was done. RESULTS: Three concavities were identified in the first metacarpal head (intersesamoid, ulnar, and radial) and 2 in the others fingers (ulnar and radial). All of them had sharp regular margins without sclerotic reaction. The measurements of these concavities were done. CONCLUSIONS: We analyzed the normal osseous anatomy of the metacarpal heads. Knowledge of this normal anatomy enables the radiologist to differentiate normal concave regions from bone erosions that accompany a variety of synovial inflammatory diseases.