Dual-energy CT for the evaluation of silicone breast implants.

OBJECTIVE: The evaluation of breast implants for rupture is currently the domain of ultrasound and MRI, while mammography is of very limited diagnostic value. Recently, specific visualisation of silicone has become feasible using dual-energy CT. Our objective was to evaluate whether it is feasible to identify silicone in breast implants by dual-energy CT and to reliably diagnose or rule out ruptures. METHODS: Seven silicone breast implant specimens were examined on dual-source CT at 100- and 140-kV tube potential with a 0.8-mm tin filter (collimation 128 × 0.6 mm, current-time products 165 and 140 mAsref with modulation, rotation time 0.28 s, pitch 0.55). Two patients scheduled for implant removal or replacement were examined with identical parameters. RESULTS: The silicone of the implant specimens showed a strong dual-energy signal. In one patient, both implants were intact, while a rupture was identified in the other patient. Ultrasound, MRI, surgical findings and histology confirmed the dual-energy CT diagnosis. CONCLUSION: Dual-energy CT may serve as an alternative technique for speedy evaluation of silicone breast implants. Specific clinical studies are required to determine the diagnostic accuracy and define indications for this technique.

Pelvimetry revisited: analyzing cephalopelvic disproportion.

The objective of this study was to assess the clinical value of pelvimetry to predict dystocia due to cephalopelvic disproportion. 63 patients who had received an abdominal CT scan postpartum were included. Pelvimetry was performed retrospectively with these datasets on a 3D workstation; there were no CT examinations performed solely for pelvimetry, and there was no radiation exposure for study purposes. Patients were divided into three groups by the course of birth, i.e. normal vaginal delivery (A), dystocia due to cephalopelvic disproportion (B) and other patients (C). Previously described methods were evaluated for their accuracy in diagnosing cephalopelvic disproportion. The pelvimetric parameters did not show significant differences between groups A (n=20) and B (n=20) except for the sagittal mid-pelvic diameter (q) with 12.7+/-0.6 cm vs. 11.9+/-0.6 cm (p=0.0001). The ROC analysis of the previously described methods showed areas under the curve between 0.50 and 0.67. The ROC curves for q had an area of 0.88, providing 85% sensitivity with 85% specificity. In conclusion, the sagittal mid-pelvic diameter shows potential to detect cephalopelvic disproportion with acceptable accuracy. With the information gained on the CT data, a prospective trial based on MR imaging can be set up to validate the diagnostic accuracy.

Long-term follow-up after ovarian borderline tumor: relapse and survival in a large patient cohort.

OBJECTIVES: To assess long-term survival and relapse rate of patients diagnosed with a borderline tumor of the ovary (BOT) with special focus on the influence of primary surgery. STUDY DESIGN: All women diagnosed and treated for BOT between 1983 and 2006 at our institution were included in this retrospective study. Clinical data including operative procedure, stage and histology at first diagnosis as well as follow-up data were analyzed with reference to survival times and relapse rates. RESULTS: Altogether 113 patients could be identified, including 19 women treated with fertility sparing surgery (19.2%). Mean follow-up time was 9.6+/-6.6 years. Relapse occurred during the follow-up period in 10 patients (10.1%) with a mean time to recurrence of 2.0+/-1.7 years. Patients with recurrent disease had a statistically significantly worse survival: 5- and 10-year survival rates were 90.0 and 80.0% compared with 98.9 and 94.4% for those without (p=0.0208), respectively. Relapse rate was 7.1% in early borderline patients (Ia: 4/56) and 14% (>Ia: 6/43) for all others (p=0.436). Patients with invasive implants had a statistically significantly higher relapse rate (p=0.0112). No significant difference in relapse rates or survival was observed between the histological subtypes. Five- and 10-year survival rates of women treated with fertility sparing surgery (n=19) were 100% and thus not worse than those of radically operated patients (5- and 10-year survival 95.1 and 90.1%). Relapse rates in both groups were comparable with 10.5 and 10.0% (p=0.723). The surgical procedure with lymphadenectomy vs. without had no influence on relapse or survival, neither did laparoscopy vs. laparotomy. CONCLUSION: Our findings confirm the good prognosis of BOT in general. Patients with invasive implants have higher relapse rates. Fertility sparing surgery in women at childbearing age can be an adequate treatment option in early stage disease.

Predictive value of CA 125 and CA 72-4 in ovarian borderline tumors.

BACKGROUND: The aim of this study was to assess the prognostic value of cancer antigen (CA) 125 and CA 72-4 in patients with ovarian borderline tumor (BOT). METHODS: All women diagnosed and treated for BOT at our institution between 1981 and 2008 were included into this retrospective study (n=101). Preoperatively collected serum samples were analyzed for CA 125 (Architect, Abbott and Elecsys, Roche) and CA 72-4 (Elecsys, Roche) with reference to clinical data and compared to healthy women (n=109) and ovarian cancer patients (n=130). RESULTS: With a median of 34.7 U/mL (range 18.1-385.0 U/mL) for CA 125 and 2.3 U/mL (range 0.2-277.0 U/mL) for CA 72-4, serum tumor markers in BOT patients were significantly elevated as compared to healthy women with a median CA 125 of 13.5 U/mL (range 4.0-49.7 U/mL) and median CA 72-4 of 0.8 U/mL (range 0.2-20.6 U/mL). In addition, there was a significant difference compared with ovarian cancer patients who showed a median CA 125 of 401.5 U/mL (range 12.5-35,813 U/mL), but no difference was observed for CA 72-4 (median 3.9 U/mL, range 0.3-10,068 U/mL). Patients with a pT1a tumor stage had significantly lower values of CA 125 but not of CA 72-4 compared with individuals with higher tumor stages (median CA 125 29.9 U/mL for pT1a vs. 50.9 U/mL for >pT1a; p=0.014). There was a trend for increased concentrations of CA 125 but not of CA 72-4 in the presence of ascites, endometriosis or peritoneal implants at primary diagnosis. With respect to the prognostic value of CA 125 or CA 72-4, CA 125 was significantly higher at primary diagnosis in patients who later developed recurrence (251.0 U/mL vs. 34.65 U/mL, p=0.012). CONCLUSIONS: Serum CA 125 and CA 72-4 concentrations in BOT patients differ from healthy controls and patients with ovarian cancer. CA 125, but not CA 72-4, at primary diagnosis correlates with tumor stage and tends to be increased in the presence of ascites, endometriosis or peritoneal implants. Moreover, CA 125 at primary diagnosis appears to have prognostic value for recurrence.

PET-CT in recurrent ovarian cancer: impact on treatment planning.

BACKGROUND: Positron emission tomography-computed tomography (PET-CT) is currently not established in the management of recurrent ovarian cancer. Here, its value in diagnosis and therapy planning was evaluated. PATIENTS AND METHODS: Seventy patients received PET-CT for suspicion of recurrent ovarian cancer. PET-CT and surgery were reviewed to analyze the accuracy in the diagnosis of recurrence and prediction of full resectability. RESULTS: PET-CT showed disease relapse in 63 of 70 patients, with full sensitivity and specificity. Thirty cases were operated on. PET-CT indicated full resectability in 24, but in fact only incomplete resection was possible in three cases. Thus sensitivity and specificity for the identification of full resectability were 100% and 66%, respectively. Seven negative results in PET-CT were confirmed by a relapse-free follow-up of 1 year. CONCLUSION: PET-CT offers reliable detection of recurrent ovarian cancer. Although diagnostic accuracy in the prediction of full resectability is limited, surgical planning is improved by identifying sites of intraperitoneal involvement.

Breast cancer and pregnancy: challenges of chemotherapy.

BACKGROUND: Breast cancer is the second most frequently occurring malignancy during pregnancy. As evidence-based data on diagnostics and treatment is lacking, current recommendations mostly derive from nonrandomized experiences. We reviewed the current literature with focus on chemotherapy during pregnancy and lactation. RESULTS: The diagnosis of pregnancy associated breast cancer implies the challenge to balance between a life-saving therapy for the mother's breast cancer and a potentially life-threatening therapy for the fetus. With few limitations, surgery and chemotherapy can be performed during pregnancy, preferably in the second and third trimester, whereas radiotherapy and endocrine or antibody treatment should be postponed until after delivery. CONCLUSION: Breast cancer during pregnancy and lactation remains a therapeutic and ethical multidisciplinary challenge. Close cooperation between all disciplines is inevitable to find an optimal treatment strategy for the mother and her unborn child.

Phyllodes tumour of the breast: clinical follow-up of 33 cases of this rare disease.

OBJECTIVE: The "cystosarcoma phyllodes" of the breast is a rare entity which accounts for 0.5% of all breast neoplasms. The aim of our study was to analyse the clinical management with respect to patient outcome. STUDY DESIGN: The data of 5270 patients with primary breast neoplasms treated in our department between 1984 and 2005 were retrospectively analysed for the histopathologic diagnosis of a cystosarcoma phyllodes. The clinical data was analysed with respect to tumour grading and size, treatment and prognosis. RESULTS: Retrospective analysis of 5270 patients with primary breast neoplasms revealed 33 patients. In the histopathological analysis, tumour grade was classified as benign in 40%, borderline in 27% and malignant in 33% of patients. Breast conserving surgery was conducted in 58% of the patients, mastectomy in 42%. Only one patient was treated with adjuvant radiotherapy after primary surgery. Mean tumour size was 6.9 cm, and no lymph node infiltration was found in the 10 patients who received axillary lymph node dissection. Local recurrence occurred in eight patients (26%). The local recurrence rate was 50% in malignant, 20% in borderline and only 8% in benign tumours. Distant metastases were seen in three patients (9%) with malignant phyllodes tumours. Neither regarding age at primary diagnosis nor in tumour size there was a significant difference between patients with local recurrence or metastatic spread and those without (p=0.284 tumour size; p=0.739 for age; Mann-Whitney U-test). CONCLUSION: Histopathological classification appears to be the strongest prognostic factor in this disease.

Obstetrical and gynecological writing and publishing in Europe.

OBJECTIVE: To assess the number and quality of scientific articles published by authors from the European Union (EU) and Germany in the field of obstetrics and gynecology. STUDY DESIGN: Scientific articles published during the years 1980-2003 covered by the Journal Citation Report (JCR) were considered, with a focus on the impact factor (IF), authors' origin, journal country and publishing language. RESULTS: In 2003, there are 53 journals listed by the JCR for the field category 'obstetrics and gynecology', with altogether 3201 publications listed in the Science Citation Index (SCI). From the year 1980, the total number of publications increased persistently. Looking at the top 20 journals in the field of obstetrics and gynecology, there are 12 journals from the US, 8 from Europe. None of these journals has an IF>10 but 30 journals show an IF>1. Over the last 25 years, a growing importance of the English language as scientific language can be observed. CONCLUSION: These data indicate an important role of European research in the field of obstetrics and gynecology comparable to that of US-American research. The English language is gaining importance as scientific language, displacing other languages and contributing to a loss of impact of non-English journals.

Selectin blockade plus therapy with low-dose sirolimus and cyclosporin a prevent brain death-induced renal allograft dysfunction.

Both antigen-dependent and -independent factors influence long-term organ allograft function and survival. Brain death (BD), a significant antigen-independent, donor-related injury upregulates a variety of inflammatory mediators in peripheral organs. One of the earliest responses to such an insult is the expression of selectins by endothelial cells of the transplanted tissues; these in turn trigger a cascade of nonspecific events, that enhance host alloresponses and which may be worsened by toxic effects of long-term immunosuppression. Using a rat model in which donor BD accentuates subsequent renal allograft injury, we have tested the effects of therapy with recombinant P-selectin glycoprotein ligand (rPSGL-Ig) alone, or in combination with sirolimus (SRL) and cyclosporin A. We found that in contrast to the effects of standard doses of SRL or cyclosporine, rPSGL-Ig decreased inflammation in the early posttransplant period such that lower doses of maintenance immunosuppression were sufficient to maintain long-term graft function.