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PubMedDate not supplied

Inflammatory pseudotumor of the pancreas resembling pancreatic cancer: clinical, diagnostic and therapeutic considerations.

Pancreatic masses could be malignant or benign. Among these latter inflammatory pseudotumor is an uncommon mass rarely located in the pancreas and it must be considered in differential diagnosis with pancreatic cancer. A case report and literature review of inflammatory pseudotumor were recognized to well known this rare pathology regarding its clinical, diagnostic, therapeutic and histopathological feature. Twenty-one cases of inflammatory pseudotumor in the adult were reviewed from the literature; 10 (47.6%) were female, 11 (52.3%) male; mean age 53.3 years (range 23-73). They were solid single mass in 18 cases, with median size of 5.1 cm (range 1.5-13), cystic mass in one case; 18 were located in the head, 1 in the body. In 2 cases it appeared as a volumetric increase of the pancreas. Diagnosis was possible only histologically and surgical treatment was mandatory in 20 cases; only in one patient a corticosteroid treatment was performed. Pancreatic inflammatory pseudotumor is a rare lesion of the pancreas but it must be distinguished from pancreatic cancer. Pancreatic resectioning is mainly due to the preoperative diagnostic difficulties that must be resolved surely only with histopathological examination of the specimen.

Adult↗
PubMed1981

Clinical studies of a fast homoarginine-sensitive alkaline phosphatase in patients with cancer.

The activity of an isoenzyme of alkaline phosphatase (FHAP) was measured in serum samples obtained from 1692 individual subjects. The median FHAP concentration in patients with untreated or recurrent cancer (2.73 IU/liter) was two-fold higher than in hospitalized control patients with illnesses other than cancer (1.17 IU/liter) and three-fold higher than in healthy control subjects (0.93 IU/liter). Among patients with either breast or colorectal cancer who were clinically disease free following their initial therapy, the median FHAP concentration (1.54 IU/liter) was intermediate between the median FHAP concentration in patients with untreated or recurrent cancer and that of healthy control subjects. In order to illustrate the potential clinical application of FHAP as a diagnostic cancer marker, we have selected a serum FHAP concentration of 2.22 IU/liter as a reference value above which only 3% of healthy control subjects would have a "positive" test. Utilizing this reference value, 58% of the patients in the present study with untreated or recurrent cancer would have a positive FHAP test, whereas only 11%, of hospitalized patients with illnesses other than cancer would have a positive test. These data suggest that FHAP may be equivalent to the carcinoembryonic antigen as a diagnostic cancer marker.

Adult↗
PubMed2006

Preoperative profiling of symptomatic breast cancer by diagnostic core biopsy.

BACKGROUND: Precise preoperative profiling of breast tumors could facilitate fuller consideration of (neo)adjuvant therapies. METHODS: Diagnostic core biopsy (DCB) accuracy in profiling the primary tumor was prospectively studied in 95 patients with operable breast cancer. The histological type and grade (hematoxylin and eosin staining) and membrane receptor status (semiquantitative immunohistochemistry for estrogen [ER] and progesterone [PR] receptors, as well as Her-2 antigen expression) were assigned by the DCB before surgery. These measures were then compared with those of the definitive surgical specimen available after operation. RESULTS: DCB correctly ascribed tumor type and grade and ER, PR, and Her-2 receptor status in most cases (correlating exactly in 97.5%, 77%, 68%, 71%, and 60%, respectively) with at least moderate concordance (weighted kappa, >.41). When miscategorized, DCB consistently tended to upscore the receptor stain intensity compared with the surgical specimen (22%, 19%, and 27% had higher ER, PR, and Her-2 categorical scores, respectively). ER H-scores correlated best in specimens that stained strongly (224.4 +/- 3 vs. 215.5 +/- 5) and were significantly higher on DCB in those that stained either moderately (195.6 +/- 8.2 vs. 156.8 +/- 5.1; P < .0001) or weakly (157.1 +/- 24.8 vs. 81.4 +/- 4; P = .02). DCB accurately identified all tumors with clinically important ER and Her-2 expression. Furthermore, it promoted three patients into the therapeutically significant range of ER (n = 1) or Her-2 (n = 2) expression. ER negativity on DCB (n = 25) indicated a high-grade tumor (88%), although 11 (44%) patients also overexpressed Her-2. Significant Her-2 expression (n = 16) on DCB predicted the tumor as being poorly differentiated (80%) and both ER and PR negative (67%). CONCLUSIONS: DCB accurately profiles clinically relevant measures of primary tumor cell differentiation. It also reliably categorizes patients with regard to (neo)adjuvant therapy before radical surgery is attempted.

Adult↗
PubMed1981

[Oesophageal cancer extension. Diagnostic contribution and effects on therapy of computed tomography. Report on 40 cases (author's transl)].

Based on a homogeneous series of 40 cases of thoracic or abdominal oesophageal cancer, of which 23 had been confirmed by operation, the authors analyse the contribution of the CT scan to the diagnosis of the extension of the cancer, and evaluate the effects on therapy of this technique. Computed tomography supplies much more precise and complete details of possible cancer extension than any other pre-operative investigation. Conducted after radiological and endoscopic examination of the oesophagus, it supplies rapid, perfectly readable, irreplaceable information on local, regional, and metastatic spread of the cancer. This only slightly aggressive examination enables evaluation of the size of the tumour and its direct relationships, effective exploration of the mediastinal and coeliac glands regions, and detection of possible pleural, pulmonary, or hepatic metastases. Its role in the decision to operate is a considerable one: true assessment of of local, regional, or metastatic extension assists the surgeon in his choice of either curative or palliative therapy. Better still, it enables a route of approach to be decided as a function of data concerning possible extension, as well as the best surgical tactic. As a support for radiotherapy or chemotherapy for this type of cancer, computed tomography greatly assists follow-up supervision.

Esophageal Neoplasms↗
PubMed2002

Cancer patients who experienced diagnostic genetic testing for cancer susceptibility: reactions and behavior after the disclosure of a positive test result.

The aim of this prospective study was to evaluate the consequences of the disclosure of a positive genetic test result to patients affected with cancer. Personal repercussions and patients' behavior with the transmission of their results to relatives were considered. We conducted semistructured interviews with 23 cancer patients identified as carriers of a cancer-predisposing mutation for hereditary breast ovarian or nonpolyposis colorectal cancers, 1 month after the disclosure of the test result. Eight patients spontaneously expressed distressed reactions ("you no longer feel cured"), and 14 patients reported at least one negative feeling (dissatisfied, discouraged, unhappy, or worried), despite expecting to be a carrier. Sixteen patients expressed concerns about the risk of developing another cancer, and 18 were concerned for their children's future, in that they may carry the mutation and develop a cancer. Although 8 patients found that disadvantages of knowing their genetic status outweighed the advantages, all but 1 did not regret having undergone genetic testing. All of the patients transmitted their results to at least one close relative. Although 6 of them expressed difficulties in being the only person who could transmit the information and 9 said it was a heavy responsibility, all except 1 did not want someone else to have to inform their families. Our results illustrate the potential negative impact of diagnostic genetic testing in patients with cancer. This includes distressed reactions and difficulties in transmitting their results to relatives. Future large-scale studies are warranted to confirm our findings.

Adaptation, Psychological↗
PubMed1998

[Gammography using Tc 99m MIBI in patients with suspected breast cancer. Proposed diagnostic protocol].

The aim of this work has been to determine whether the joint use of mammography and scintimammography is capable of reducing the number of biopsies required in patients with suspected breast cancer. We have performed scintimammography in 90 patients, 97 lesions, with breast cancer suspicion. In the mammography was evaluated the degree of malignancy suspicion and the size of the lesion. Only 41 of the biopsies revealed the presence of cancer. The sensitivity, specificity, PPV and NPV of scintimammography were 85%, 79%, 74% and 88%. According to the mammography findings 20 lesions (1 breast cancer) were included as low, 31 lesions (4 breast cancer) as indeterminate and 46 lesions (36 breast cancer) as high malignancy suspicion. 14 lesions (2 low, 2 indeterminate and 10 high suspicion) were smaller than 1 cm. The scintimammography was positive in all breast cancer of low and indeterminate suspicion of malignancy and in 30 of high probability. On the basis of this results we propose that a biopsy must be carried out to those lesions with a high suspicion of malignancy, and to lesions with low or indeterminate suspicion that are smaller than 1 cm or that present a positive scintimammography. Following this protocol, only 64 of the 97 biopsies would have been necessary, with a reduction of the 34% in the total number of biopsies and, more important, a 65% of reduction in the number of biopsies carried out in the groups of low and indeterminate suspicion of malignancy. At the same time we would indicate biopsy in all cases of breast cancer.

Adult↗
PubMed2005

An automated data algorithm to distinguish screening and diagnostic colorectal cancer endoscopy exams.

Despite questions about accuracy, automated data are used increasingly for research and quality measurement. The goal of this study was to develop an automated data algorithm designed to distinguish screening and diagnostic endoscopy (sigmoidoscopy and colonoscopy) exams. We assessed the algorithm's ability to correctly classify the exams using paper medical records as the "gold standard." The algorithm used diagnostic codes to identify the indication of the endoscopies. The algorithm's ability to classify the indication varied by endoscopy exam. The sensitivities for identifying diagnostic sigmoidoscopy and colonoscopy were 48.1% and 23.8%, respectively. The algorithm missed most of the diagnostic endoscopies. Conversely, the sensitivities for identifying screening sigmoidoscopy and colonoscopy were high (87.9% and 84.4%, respectively) but were associated with low specificities. Our findings suggest that studies relying solely on automated data overestimate screening rates if indication is not considered. The automated algorithm presented here needs further improvements to better differentiate screening from diagnostic exams.

Aged↗
PubMedDate not supplied

Cytology of lleal conduit urine in bladder cancer patients: diagnostic utility and pitfalls.

OBJECTIVE: To study the cytomorphology of urine obtained from the ileal conduit and to determine its utility and identify the pitfalls. STUDY DESIGN: Urine specimens from 469 cases of suspected or proven bladder cancer received over a period of 5 years were analyzed in the cytology laboratory. In 35 cases, total bladder resection was followed by ileal conduit reconstruction. The follow-up cytologic analysis of these 35 ileal conduit cases formed the basis of this study. RESULTS: There was absence of urothelial cells in all but 2 cases. The smear predominantly showed small, scattered intestinal mucosal cells with pyknotic nuclei, extensive karyorrhexis and numerous bacteria. In 2 cases, cytology proved superior to endoscopy and radiology in detecting recurrent disease. We had 2 false negative cases, and the negativity was attributed to sampling errors. There was 1 false positive case in which 3-dimensional clusters of intestinal columnar cells were erroneously diagnosed as adenocarcinoma. CONCLUSION: Urine obtained from ileal conduit specimens shows a smear picture that is different from that of specimens from the bladder. Thus, it is imperative to understand the difference between the cytomorphology of bladder urine and ileal conduit urine, to minimize the pitfalls and increase diagnostic utility.

Bacteria↗
PubMed1989

[Colorectal cancer: are diagnostic delay, degree of spread and survival related? Clinical analysis of 307 cases followed up for more than 4 years].

It seems logical to think that the longer the interval between the patient's first symptom of colorrectal cancer and operation, the greater the tumoral extension found by the surgeon will be, and the lower the postoperative survival. Nevertheless, there is much evidence to indicate that this may not always be true. We've analyzed the problem in 307 patients operated of colorectal cancer in our service from January 1979 to December 1984 and followed-up until now. We investigated the time interval from the first clinical symptom until operation, and survival. These variables were related to the Duke grade. As regards the preoperative interval, the average (in months) for Duke's grade A was 7.41 (sigma = 16.88), for D it was 7.41 (sigma = 9.47) and for C, 5.13 (sigma = 8.41). There were no statistically significant differences. As for survival, after four years all the grade A patients, 64% of the grade B patients and 35% of the grade C patients followed-up survived. We've found no relation between diagnostic delay and postoperative survival. These results suggest that it is not true that the longer the symptomatic period, the greater the tumoral spread. As such, diagnostic delay is not a good prognostic indicator for predecting tumoral spread or survival.

Colorectal Neoplasms↗
PubMed1995

Medical diagnostic x rays and thyroid cancer.

BACKGROUND: Diagnostic x rays are the largest man-made source of exposure to ionizing radiation for the general population. Whether there are meaningful cancer risks associated with such exposures is unclear. Most previous case-control studies have relied on recalled histories of x rays, and there is concern that completeness and accuracy of recall might differ between cancer case and control subjects. PURPOSE: The present study used information recorded prospectively in hospital charts to address the relationship between medical diagnostic x rays and risk of thyroid cancer. METHODS: The Swedish Cancer Registry and the Uppsala-Orebro Regional Cancer Registry were used to identify persons with papillary or follicular thyroid cancer diagnosed from January 1, 1980, through December 31, 1992, among residents of the Uppsala Health Care Region. After histopathologic review, there were 484 such case subjects available for study. An equal number of age-, sex-, and county of residence-matched control subjects from the general population were randomly selected on the basis of the Swedish Registry of the Total Population. Lifetime residential histories were compiled, and radiology records were searched at all Swedish hospital serving regions where study subjects ever maintained an official residence. Approximate radiation doses to the thyroid gland for specific types of x-ray examinations were assigned on the basis of mean values of measurements made in Sweden in 1973-1975 and in the United States in 1970. Odds ratios were used to evaluate the association between diagnostic radiography and risk of thyroid cancer. RESULTS: A total of 3853 medical diagnostic x rays were ascertained among thyroid cancer case subjects and 4039 among the matched control subjects. There were no tendency for case subjects to have had more of the types of x-ray procedure associated with higher radiation dose to the thyroid gland (i.e., those involving the head or neck area). This finding was true even when analysis was restricted to x rays occurring before 1960, when doses likely were higher than in more recent years, and for examinations occurring in childhood and adolescence, when susceptibility to radiation-induced thyroid cancer is greatest. The relative risk of thyroid cancer was not significantly associated with estimated cumulative dose to the thyroid gland from diagnostic x rays (two-sided P for trend = .80). CONCLUSION: These data indicate that the risk of thyroid cancer due to medical diagnostic x rays, if any, is very small.

Adenocarcinoma, Follicular↗
PubMed1995

Intraoperative tumour classification in papillary thyroid cancer--a diagnostic dilemma.

The objective of the study was to assess surgical strategy of papillary carcinoma of the thyroid based on residual tumour findings after completion thyroidectomy. We investigated the accuracy of intraoperative tumour classification in papillary thyroid cancers (PTC) and its effect on intraoperative decision-making. In a 34-year period, we performed 182 total thyroidectomies for PTC, 69 of which were completion thyroidectomies. The indications for completion thyroidectomy were (1) inaccurate assessment of the size of solitary tumours (n = 28), (2) unilateral (n = 23) and (3) bilateral multicentricity (n = 18). Fifteen patients had residual cancers (22%), which were significantly correlated with the extent of the first procedure. After initial lobectomy, residual tumours were present in 54% of patients, compared to only 3% after initial lobectomy, isthmusectomy and contralateral subtotal lobectomy. We favour lobectomy, isthmusectomy and contralateral subtotal lobectomy in patients with papillary thyroid cancers smaller than 1.5 cm in diameter and a total thyroidectomy in all other cases.

Adolescent↗
PubMed2004

PET/CT using 18F-FDG in suspected lung cancer recurrence: diagnostic value and impact on patient management.

UNLABELLED: The goal of this study was to assess the value of hybrid imaging using a combined PET/CT device with 18F-FDG in the diagnosis and clinical management of suspected recurrent lung cancer. METHODS: Forty-two patients with non-small cell lung cancer (NSCLC) with suspected recurrence due to new clinical, biochemical, and radiologic findings were prospectively evaluated. PET/CT results were compared with PET interpreted with side-by-side CT data. A final diagnosis of recurrence was confirmed by histologic tissue sampling during surgery or biopsy or by further clinical and radiologic work-up. The impact of PET/CT on patient management was assessed. RESULTS: Twenty-four of 27 positive PET/CT studies (89%) were proven to have recurrent disease. Fourteen of 15 negative PET/CT studies (93%) had no evidence of disease. The sensitivity, specificity, and positive and negative predictive values of PET/CT for diagnosis of recurrence were 96%, 82%, 89%, and 93% compared with 96%, 53%, 75%, and 90%, respectively, for PET. PET/CT changed the PET lesion classification in 22 patients (52%), by determining the precise localization of sites of increased 18F-FDG uptake. PET/CT changed the management of 12 patients (29%) by eliminating previously planned diagnostic procedures (5 patients), by initiating a previously unplanned treatment option (4 patients), or by inducing a change in the planned therapeutic approach (3 patients). CONCLUSION: In patients with a suspected recurrence of NSCLC, PET/CT provides a better anatomic localization of suspicious lesions compared with PET interpreted with side-by-side CT data. This improved diagnostic performance of PET/CT has a further impact on the clinical management and treatment planning of the patients.

Adult↗
PubMed1979

Early detection of ductal breast cancer: the diagnostic procedure for pathological discharge from the nipple.

Pathologic discharge from the nipple may be the only symptom of an early stage of carcinoma. Galactography is then the diagnostic method of choice to locate intraductal, nonpalpable lesions. The technique of galactography, the adequate surgical approach of pathologic galactographs (milk-duct segment resection), and the appropriate histological work-up of the surgical specimen are demonstrated. We report on 1918 galactographies in 1363 women with pathological discharge. In only 427 cases was a milk duct segment resection necessary (31.4%). In 8.5%, we found invasive intraductal cancer and in 2.9% ductal carcinomata in situ. Only 1 patient with breast cancer had axillary metastases. Extensive intraductal solid, papillary or adenomatous proliferations were found in 11.9% of the patients with excision. In 46.7% of the patients, papillomas were excised, a definitive treatment for this process. The supposition for success in the early diagnosis of cancer is close teamwork among the radiology, surgery and pathology services: the diagnostic result depends upon this. We attribute our yield of exact diagnosis to a very sophisticated histological work-up. We believe that this is necessary to avoid diagnostic failures.

Biopsy↗
PubMed2001

Professional and community efforts to prevent morbidity and mortality from oral cancer.

BACKGROUND: Oral and pharyngeal cancers cause significant morbidity and mortality, yet there has been little improvement in survival rates in the past 30 years. Because early diagnoses significantly increase survival rates, the authors summarize several approaches to educating and mobilizing the dental profession and the public about this problem. Clinicians are invited to initiate similar programs to catalyze change in their own communities. METHODS: The authors found that many approaches have been used to define the problem and initiate change. These include surveys, focus groups, development of consortia, media programs, flyers, leaflets, prescription pads, legislation and professional endorsements. RESULTS: In Maryland in 1996, only 20 percent of adults reported receiving an oral cancer examination, and most oral cancers were diagnosed at late stages by physicians, not dentists. Results of the public educational campaigns in the regions of New York/New Jersey and Maryland have not been formally evaluated, but there is a developing consensus that oral cancer diagnostic practices in the regions with active educational programs are increasing. CONCLUSIONS: Coalitions or partnerships among individuals and organizations from government, academia, private practice, industry, the general community and the media can affect awareness about oral cancer prevention and early detection on a regional basis. CLINICAL IMPLICATIONS: By increasing awareness of oral cancer among the dental profession and the public, earlier diagnosis of these cancers with consequent improved cure rates is likely. Providing oral cancer diagnostic services as a routine part of an oral examination also may motivate patients to visit the dentist at least once a year.

Adult↗
PubMed2026

Mapping the de-implementation of traditional diagnostic tests in pediatric acute lymphoblastic leukemia.

INTRODUCTION: Advances in cancer diagnostics raise questions about when and how to de-implement traditional approaches; however, these processes remain poorly described. At St. Jude Children's Research Hospital (SJCRH), routine conventional cytogenetics for pediatric acute lymphoblastic leukemia (ALL) diagnosis was de-implemented in 2018 following adoption of clinical genomics. This study aimed to map this process to inform future diagnostic de-implementation initiatives. METHODS: Interviews were conducted with SJCRH staff involved or impacted by cytogenetics de-implementation. Data were analyzed using thematic and rapid qualitative analysis informed by the Consolidated Framework for Implementation Research. Member-checking was used to verify and refine process maps, which were subsequently reviewed by an external expert panel, representing diverse settings, through focus group discussions. RESULTS: Thirteen SJCRH clinicians participated. De-implementation was described as successful, with no negative impact on patient outcomes. Decision-making began with internal correlation studies that demonstrated superior diagnostic performance of clinical genomics. De-implementation was viewed as a natural evolution that improved molecular classification, resource allocation, and workflow efficiency. Perceived risks included loss of cytogenetics competency, delayed turnaround time, and career insecurity, all addressed institutionally. Lessons learned highlighted the importance of deliberate discussion about logic and evidence supporting de-implementation. Fifteen external experts offered suggestions to improve process map generalizability, highlighting institutional- and system-level considerations. CONCLUSION: De-implementation of cytogenetics in ALL in favor of clinical genomics was successful at SJCRH. This study offers an example of diagnostic de-implementation in cancer care and proposes a structured approach to guide future efforts. De-implementation should be considered alongside introduction of novel diagnostic approaches.

cancer diagnostics↗