Neutrophil to Lymphocyte Ratio: A Predictive Marker for Treatment Outcomes in Patients With Rectal Cancer Who Underwent Neoadjuvant Chemoradiation Followed by Surgery.

PURPOSE: In this study, we investigated the role of neutrophil to lymphocyte ratio (NLR) as a predictor of tumor response and as a prognostic factor in patients with rectal cancer who had undergone curative surgery after neoadjuvant chemoradiation therapy (nCRT). METHODS: Between January 2009 and July 2016, we collected 140 consecutive patients who had undergone curative intent surgery after nCRT due to rectal adenocarcinoma. We obtained the pre- and post-nCRT NLR by dividing the neutrophil count by the lymphocyte count. The cutoff value was obtained using receiver operating characteristic analysis for tumor response and using maximally selected rank analysis for recurrence-free survival (RFS). The relationship among NLR, tumor response, and RFS was assessed by adjusting the possible clinico-pathological confounding factors. RESULTS: The possibility of pathologic complete response (pCR) was significantly decreased in high pre- (>2.77) and postnCRT NLR (>3.23) in univariate regression analysis. In multivariate analysis, high post-nCRT NLR was an independent negative predictive factor for pCR (adjusted odds ratio, 0.365; 95% confidence interval [CI], 0.145-0.918). The 5-year RFS of all patients was 74.6% during the median 37 months of follow-up. Patients with higher pre- (>2.66) and post-nCRT NLR (>5.21) showed lower 5-year RFS rates (53.1 vs. 83.3%, P = 0.006) (69.2 vs. 75.7%, P = 0.054). In multivariate Cox analysis, high pre-nCRT NLR was an independent poor prognostic factor for RFS (adjusted hazard ratio, 2.300; 95% CI, 1.061-4.985). CONCLUSION: Elevated NLR was a negative predictive marker for pCR and was independently associated with decreased RFS. For confirmation, a large-scale study with appropriate controls is needed.

Evaluation of radiation doses in patient and medical staff during endoscopic retrograde cholangiopancreatography procedures.

The radiation exposure dose must be optimised because the hazard resulting from an interventional radiology procedure is long term depending on the patient. The aim of this study was to measure the radiation doses received by the patients and medical staff during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Data were collected during 126 ERCP procedures, including the dose-area product (DAP), entrance dose (ED), effective dose (E), fluoroscopy time (T) and number of digital radiographs (F). The medical staff members each wore a personal thermoluminescence dosemeter to monitor exposure during ERCP procedures. The mean DAP, ED, E and T were 47.06 Gy cm(2), 196.06 mGy, 8.93 mSv, 7.65 min and 9.21 images, respectively. The mean dose to the staff was 0.175 mSv and that to the assistant was 0.069 mSv. The dose to the medical staff was minimal when appropriate protective measures were used. The large variation in the patient doses must be further investigated.

Evaluation based on Monte Carlo simulation of lifetime attributable risk of cancer after neck X-ray radiography.

At present, concern regarding radiation exposure is increasing with the prevalence of radiologic examination. As radiation damages the human body, we have evaluated medical radiation dose values and studied the importance of optimizing radiation exposure. We measured entrance surface dose (ESD) values using a RANDO(®) phantom (neck) in 94 randomly selected locations in the central region of Korea. Thyroid and organ doses were calculated using Monte Carlo simulations (PCXMC 2.0.1) based on measured values. In addition, the lifetime attributable risk (LAR) of cancer was calculated for the thyroid, using the method proposed in the biological effects of ionizing radiation VII report. The average measured ESD values obtained using the RANDO(®) phantom (neck) were antero-posterior 1.33 mGy and lateral 1.23 mGy, for a total of 2.56 mGy. Based on the ESD values measured using the phantom, the organ doses were obtained using a Monte Carlo simulation (PCXMC 2.0.1). The thyroid dose was 1.48 mSv on average. In evaluating the LAR of thyroid cancer incidence, a frequency of 0.02 per 100,000 from 2.94 per 100,000 males and a frequency of 0.10 per 100,000 from 16.23 per 100,000 females were found. The risk of cancer was found to be higher when the patient's age was lower, and was also higher in females than in males. It was concluded that beneficial exams in the medical field should not be prohibited because of a statistically small risk, although acknowledgement of the dangers of ionizing radiation is necessary.

Mammographic and sonographic findings of primary breast lymphoma.

The objective of this study was to describe the mammographic and sonographic appearances of primary lymphoma of the breast. We retrospectively reviewed the mammographic and ultrasonographic images of 12 patients with primary lymphoma of the breast. Descriptions of imaging findings were made according to the Breast Imaging Reporting and Data System lexicon by two radiologists. Mammography was performed on 11 patients. Most of the lesions were shown to be oval-shaped (72.7%) and high-density (90.9%) masses on mammography. Ultrasound examination was performed on 8 patients. The lymphomas were commonly single (75%), circumscribed (50%) or microlobulated (37.5%), and oval (50%) masses on sonography. The echo pattern of the mass was hypoechoic in 7 patients (87.5%) but hyperechoic in 1 patient (12.5%). No mass had spiculated margins or calcifications. Ipsilateral axillary lymph node involvement was noted in 1 patient. In conclusion, most primary lymphomas of the breast present as oval-shaped and high-density masses on mammography and as single and hypoechoic masses with circumscribed or microlobulated margins on sonography.

Volume-expanding complications after pneumonectomy: comparison of CT findings.

The purpose of this study was to assess and characterize the computed tomographic (CT) findings of various volume-expanding complications occurring in the postpneumonectomy space. Chest CT scans, obtained in 17 patients in whom plain chest radiographs had revealed shift of the mediastinum away from the surgical side after pneumonectomy for lung cancer, were retrospectively reviewed. Recurrent neoplasm (n=6) appeared as soft-tissue mass projecting into the postpneumonectomy space and/or enlarged mediastinal lymph nodes. Empyema (n=4) was manifested by smooth thickening of the residual pleura with or without thickening of the extrapleural tissues. Hemothorax (n=4) was characterized by amorphous material of high attenuation contained within the postpneumonectomy space. Chylothorax (n=2) presented no abnormal finding except for expansion of the postpneumonectomy space. The remaining one case showed only expansion of the postpneumonectomy space and it was normalized without any treatment, which was supposed to be transient pleural fluid collection of uncertain cause. When mediastinal shift away from the surgical side occurs on plain chest radiography following pneumonectomy, CT can be helpful in differentiating various volume-expanding complications providing characteristic features.

Collecting duct carcinoma of the kidney: CT and pathologic correlation.

PURPOSE: We characterized CT findings of collecting duct carcinoma of the kidney and correlated these with the histopathologic findings. MATERIALS AND METHODS: CT scans of 18 patients with pathologically proven collecting duct carcinoma of the kidney were retrospectively reviewed. We analyzed CT findings of collecting duct carcinoma and also correlated CT findings with the histopathologic findings. RESULTS: The mean size of the tumors was 6.9 cm and all cases were solid. Seventeen (94%) tumors had a medullary location. Nine (69%) and 11 (85%) cases showed weak and heterogeneous enhancement, respectively. A cystic component (50%) was frequently seen within the tumors. Lymphadenopathy and metastasis were noted in 10 (56%) and 6 (33%) cases, respectively. Perinephric stranding and vascular invasion were present in 10 (56%) and 5 (28%) cases, respectively. In 17 (94%) of the 18 cases, involvement of the renal sinus was present. Infiltrative growth (67%) and preservation of the renal contour (61%) were more common than expansile growth (33%) and exophytic configuration (39%), respectively. These CT features were well correlated with the histopathologic findings. CONCLUSION: Medullary location, weak and heterogeneous enhancement, involvement of the renal sinus, infiltrative growth, preserved renal contour, and a cystic component are CT findings frequently seen in patients with collecting duct carcinoma of the kidney. CT findings are nevertheless nonspecific and do not allow collecting duct carcinoma to be easily differentiated from the other subtypes of renal cell carcinoma. However, when CT demonstrates a renal tumor with these findings, collecting duct carcinoma can be considered in the differential diagnosis.

MRI of small cell carcinoma of the uterine cervix with pathologic correlation.

OBJECTIVE: The purpose of this study was to evaluate the MRI features of small cell carcinoma of the uterine cervix and to correlate those features with pathologic findings. CONCLUSION: Small cell carcinoma of the uterine cervix can be characterized by frequent parametrial invasion and extensive lymphadenopathy, although the tumor morphology seems to be nonspecific on MRI.

Small cell carcinoma of the urinary bladder: CT and MR imaging findings.

OBJECTIVE: Primary small cell carcinoma (SCC) is a rare aggressive malignancy of the urinary bladder, with identical histopathology to that of the lung. The treatment and prognosis of bladder SCC are somewhat different from those of more frequent transitional cell carcinoma. The purpose of this study was to analyze the CT and MR imaging findings of bladder SCC. MATERIALS AND METHODS: Six adult patients (five males and one female) with pathologically proven SCC of the urinary bladder who had undergone pelvic CT and/or MR imaging were included in this study. The radiologic findings were retrospectively evaluated in terms of tumor location, texture, calcification, depth of invasion, perivesical extension, lymph node involvement, and local or distant metastasis, by two radiologists, who established a consensus. RESULTS: CT and MR images depicted all tumors as large, ill-defined, relatively well enhancing, broad-based polypoid intramural masses with (n=3) or without (n=3) cystic portions. Their frequent location was posterior and trigonal (n=3). Calcification was found within one tumor, and lymphadenopathy in four. At T2-weighted MR images, the solid portion of the tumor was relatively hypointense. The stage at the time of diagnosis was C in three patients, and D1 in three. Follow-up imaging showed brain metastasis in one patient and liver metastasis in two. CONCLUSION: On CT and MR images, SCC of the urinary bladder appeared as a large, enhancing, broad-based polypoid mass. It was stage C or higher, and lymph nodes and distant metastasis were frequent. T2-weighted MR images showed that the solid portion of the tumor was relatively hypointense. When radiologic examinations demonstrate a bladder tumor of this kind in adults, SCC of the urinary bladder should be included in the differential diagnosis.