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Vascular endothelial growth factor expression in airways of patients with lung cancer: a possible diagnostic tool of responsive angiogenic status on the host side.

STUDY OBJECTIVE: We evaluated the expression of vascular endothelial growth factor (VEGF) in airways in patients with lung cancer. METHODS: BAL fluid (BALF) and plasma samples were obtained from 41 patients with primary lung carcinomas and 7 patients with noncancerous diseases, and were analyzed for VEGF by an enzyme-linked immunosorbent assay. After standardization with the albumin protein levels, the relative intensity (VEGF index) was determined as the ratio of VEGF expression on the disease side to that on the healthy side. RESULTS: In all cases, VEGF concentrations in BALF were greater than those in plasma samples. On the healthy side, the mean value of VEGF in BALF was significantly greater in lung cancer patients than in patients with noncancerous diseases (p = 0.0470). While age, gender, location of cancer (right vs left), histology (adenocarcinoma vs squamous cell carcinoma), and T factor (T1/2 vs T3/4) did not affect the VEGF levels in BALF, the VEGF index was inversely associated with distant metastasis and nodal involvement. The VEGF index of patients in stage I was significantly greater than that of patients in stage IV (p = 0.0308). CONCLUSIONS: The VEGF expression in airways is likely to reflect the response to tumor angiogenesis on the host side. Of direct clinical relevance is that the assessment of VEGF concentrations in airways may provide information concerning the dependency of tumor angiogenesis on VEGF, which is variable according to tumor progression.

Adenocarcinoma↗

Minimum prostate-specific antigen (PSA) level diagnostic of prostate cancer.

The PSA levels in benign prostatic hyperplasia (BPH) and prostate adenocarcinoma (PA) overlap, both below and above 4 to 10 ng/mL. There is no known PSA level diagnostic of PA. In this study, data were obtained in 160 consecutive men aged 58 to 87. Prebiopsy PSA levels (PSA-1) were obtained prior to "sextant" gun biopsies in 97 cases diagnosed as noncarcinoma, and in 56 cases diagnosed as PA. Multiple hematoxylin and eosin sections were made of each biopsy, and Gleason scores given the PAs. Cases were followed up to 30 months with repeated PSA levels and additional biopsies. The highest PSA level in NPA in this series was 54.6 ng/mL.

Adenocarcinoma↗

The role of diagnostic laparoscopy in staging of pancreatic cancers.

Authors report elective diagnostic laparoscopy, and the role of this method in evaluating operability of pancreatic cancer. At their department 11 diagnostic laparoscopic procedures of pancreatic cancer were performed during the last 5 years. In 3 cases tumor proved to be resectable despite preoperative imaging results of unresectable condition. On the basis of international literature authors give brief summary of indications, cost and benefit of diagnostic laparoscopy, and its place in the diagnostic algorythm of pancreatic cancer.

Algorithms↗

Surgical strategy for early gastric cancer.

The diagnostic and therapeutic options in early gastric cancer are reviewed. In Japan, the rate of detection of early gastric cancers has increased so that minute gastric cancers can now be identified as a result of advances in diagnostic methods. The results of histopathological staging of a large number of resected specimens have led to three surgical options based on size and depth of the primary lesion, namely classical R2 resection, radical resection with limited lymphadenectomy and endoscopic surgery.

Gastroscopy↗

[Tumor markers in breast cancer: on the diagnostic value of serum determinations in clinical freedom from tumor and manifest disease].

We have analyzed 1301 serum determinations of the tumor markers CA 15-3 and CEA in 405 breast cancer patients. CA 15-3 exhibited a higher accuracy than CEA (sensitivity-specificity diagram). Using cut-off levels of 30 U/ml (CA 15-3) and 5 ng/ml (CEA) we observed a sensitivity of 70.7% versus 61.8% and an approximate specificity of 93.8% versus 83.4%. The sensitivity of the panel of both markers was 80.9%, the specificity 84.5%. The high specificity of both markers caused high positive predictive values. The marker expression was higher in patients with hematogenic metastasis than with local recurrences (the median for CA 15-3 levels was 88.2 U/ml versus 26.6 U/ml; for CEA: 10.0 ng/ml versus 2.5 ng/ml). Less expression of both markers in patients younger than 40 years in comparison to patients older than 40 seems to be remarkable. Early detection of relapse - a marker increase over the cut-off level before clinical proof - was observed in 43.8% (CA 15-3; median of leadtime 6.1 months) of 73 patients; CEA: 24.7%, 7.2 months. Metastasis was predicted 3-6 times more often than local recurrences. Monitoring of the manifest more or less progressed tumor is still the main task of present tumor markers. But the results also suggesting the use of these markers for early detection of metastasis, especially in panels.

Adult↗

[Diagnostic imaging of cancer].

Rapid development of imaging techniques provided much more precise methodology of diagnosis, staging and dynamics of cancer. Nowadays the onco-radiodiagnostic units are able to select the optimal imaging technique based on established international protocols. These protocols provide the basis of cancer diagnosis, therapy control and clinical research. The onco-radiodiagnostic unit is essential part of the oncoteam managing the cancer patients. Follow-up protocols are now equally important compared to those of the diagnosis and staging, requiring a continuous interaction between radiologists and physicians. The comprehensive cancer centers with all the necessary imaging techniques are the optimal organizations where professional and economic priorities both can be considered for the benefit of cancer patients.

Algorithms↗

[Problems in the diagnostic of primary gastric stump cancer and recurrences of gastric cancer. A comparison of X-ray diagnostic and endoscopy (author's transl)].

X-ray findings and gastroscopic findings of patients with primary gastric stump cancer and recurrences of gastric cancer are compared. These findings are compared with the observations of operations. The reasons of false diagnoses and doubtful tentative diagnoses were analyzed. In the analysis of X-ray pictures especially the benign operative caused and the postoperative alterations of the wall and mucosa of the stomach must delimit from infiltrative and polypous increasing tumors. The postoperative control examination may be valuable for the diagnosis, because it gives the possibilities for comparison. Roentgenography in double contrast relieves the diagnosis. Stenosing processes of the cardia and anastomose causes difficulties in differential diagnosis in gastroscopy opposite to scared alterations. The aimed biopsy improves the tumor protection. Both examination techniques shows difficulties in recognition of recurrences, which develop from the duodenal stump. Only a special examination technique leads to an improvement of the results. The instruction and experience of the examiner, the knowledge of tumor diagnostics and of the methods of operations and of the postoperative alterations are for the diagnosis of these processes of decisive importance. X-ray examination and endoscopy are two supplementing examination methods.

Endoscopy↗

Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: new diagnostic method.

This study was designed to evaluate the accuracy of ultrasonography alone and in combination with fine-needle aspiration biopsy (FNAB) for detection of axillary metastases of nonpalpable lymph nodes in breast cancer patients. Ultrasonography was carried out in 150 axillas of 148 patients (mean age 57 years, range 30-80 years); and in 93 axillas lymph nodes were detected. Nodes were described according to their dimension and echo patterns and were compared with histopathologic results. FNAB was carried out in 81 axillas (122 nodes). The sensitivity of ultrasonography was highest (87%) when size (length >5 mm) was used as criterion for malignancy, but the specificity was rather low (56%). When nodes with a malignant pattern (echo-poor or inhomogeneous) were visualized, specificity was 95%. Ultrasound-guided FNAB had a sensitivity of 80% and a specificity of 100% and detected metastases in 63% of node-positive patients. It is concluded that FNAB is an easy, reliable, inexpensive method for identifying patients with positive nodes. In the case of negative findings, other diagnostic procedures to exclude lymph node metastases, such as sentinel node mapping, could be performed.

Axilla↗

Quality of diagnostic services for cancer: a comparison of open access and conventional outpatient clinics.

OBJECTIVE AND STUDY DESIGN: To assess quality of a quick and early diagnosis route (QED) by determining effectiveness and cost-effectiveness of five clinics compared with three conventional outpatient clinics. Prospective economic evaluation. Six-month cohort of all referrals (November 1996-April 1997). SUBJECTS: All referrals for suspected cancers of: upper gastro-intestinal tract; urinary tract, prostate and testis; skin. EFFECTIVENESS: Median days saved between GP referral and date of: diagnostic appointment; consultant decision; intervention. RESULTS: GP referral to diagnostic appointment: QED was effective (median days) for all clinics. Diagnostic appointment to consultant decision: QED was effective for testicular and haematuria clinics. Consultant decision to intervention: QED was effective for haematuria, testicular and melanoma clinics. COST-EFFECTIVENESS: Extra (incremental) NHS cost per patient diagnosed. RESULTS: Less than 5 Pounds per day saved between GP referral and diagnostic appointment for: endoscopy; haematuria; prostate; testicular; melanoma. Less than 3 Pounds per day saved between GP referral and consultant decision for: testicular; haematuria. Less than 3 Pounds per day saved between GP referral and intervention for: endoscopy; haematuria; testicular; melanoma. CONCLUSION: A "quick and early" diagnostic route provides a higher quality service through improved effectiveness and cost-effectiveness compared to conventional outpatients.

Cohort Studies↗

[What to expect from the pathologist in the diagnostics of colorectal cancer? Experience from the clerkships in the US].

Nowadays, surgery still remains the basic treatment modality in the therapy of colorectal cancer. An exact pathological evaluation of the extent of tumour spread and the quality of the resection is also essential for indication of adjuvant therapy and for the assessing prognosis. In the treatment of colorectal cancer, it is precisely this collaboration between the surgeon and pathologist which is fundamental to the multidisciplinary approach. The pathologic examination must concentrate on the macro- and microscopic pathological anatomy, evaluation of lymph node positivity, and presence of micrometastases or other signs of local tumour progression. All these factors can help to establish the prognosis. The standards of pathological examination and methods differ between centres and countries. From personal experience during clerkships in the United States the authors offer an overview of how American pathologists approach examination of colorectal cancer, and which characteristics of the disease are concentrated upon.

Colorectal Neoplasms↗

[Serum determination of CA 19-9 in patients with digestive cancers and its diagnostic evaluation].

The precision of CA 19-9 RIA kit was evaluated by recovery, reproducibility and dilution test with very satisfactory results. The CA 19-9 value in sera from 52 healthy individuals and from 224 patients with gastric intestinal cancer and other benign disease, showed an increased positive rate in several cases of gastric intestinal cancer. For example, the positive rate in pancreatic cancer, bile duct cancer, colo-rectal cancer, gastric cancer, esophagus cancer, primary biliary cirrhosis diabetes mellitus, liver cirrhosis and chronic hepatitis was 60%, 75%, 55.6%, 45.6%, 20%, 28.6%, 22.7%, 13.7% and 1.7% respectively. By contrast, values from patients with acute hepatitis, fulminant hepatitis, fatty liver, gastric duodenal ulcer, pancreatitis, and primary liver cancer were within the normal range. In this study, CA 19-9 RIA were found to be significant as an adjunct in the management of patients with gastrointestinal cancer, especially pancreatic cancer, and bile duct cancer.

Antigens, Neoplasm↗

Assessment of plasma DNA levels, allelic imbalance, and CA 125 as diagnostic tests for cancer.

BACKGROUND: Allelic imbalance (AI), the loss or gain of chromosomal regions, is found in many cancers. AI can be detected in genomic tumor DNA released into the blood after necrosis or apoptosis. We evaluated plasma DNA concentration, allelic status in plasma DNA, and serum CA 125 level as screening tests for ovarian and other cancers. METHODS: Plasma samples were obtained from 330 women (44 normal healthy control individuals, 122 patients with various cancers, and 164 control patients with non-neoplastic diseases). Plasma DNA concentration was determined in all samples. Allelic status was determined by digital single nucleotide polymorphism (SNP) analysis with eight SNP markers in plasma DNA from 54 patients with ovarian cancer and 31 control patients. CA 125 was determined in 63 samples. Receiver-operating characteristic (ROC) curves were plotted, and the areas under the ROC curves--a measure of the overall ability of a diagnostic test with multiple cutoffs to distinguish between diseased and nondiseased individuals--were determined. RESULTS: The area under the ROC curve for plasma DNA concentration was 0.90 for patients with neoplastic disease versus healthy control individuals and 0.74 for patients with neoplastic diseases versus control patients with non-neoplastic diseases. For control subjects given a specificity of 100% (95% confidence interval [CI] = 92% to 100%), the highest sensitivity achieved was 57% (95% CI = 49% to 67%). AI in at least one SNP was found in 87% (95% CI = 60% to 98%) of patients with stage I/II ovarian cancer and 95% (95% CI = 83% to 99%) of patients with stage III/IV ovarian cancer, but AI was not found in 31 patients with non-neoplastic diseases (specificity = 100%, 95% CI = 89% to 100%). The area under the ROC curve assessing AI was 0.95. Combining the serum CA 125 level with the plasma DNA concentration increased the area under the ROC curve from 0.78 (CA 125 alone) to 0.84. CONCLUSION: Plasma DNA concentration may not be sensitive or specific enough for cancer screening or diagnosis, even when combined with CA 125. AI was detected with high specificity in plasma DNA from patients with ovarian cancer and should be studied further as a screening tool.

Adult↗

Prostate cancer: risk assessment and diagnostic approaches.

The successful treatment of prostate cancer relies on detection of the disease at its earliest stages. Although prostate-specific antigen (PSA)-based screening has been a significant advance in the early diagnosis of prostate cancer, identifying specific genetic alterations in a given family or patient will allow more appropriate screening for early disease. Mapping and identification of specific prostate cancer susceptibility genes is slowly becoming a reality. Other prostate cancer risks include a family history, race, and possibly serum markers such as insulin-like growth factor-I (IGF-I). Once a high-risk man is identified, transrectal ultrasound (TRUS)-guided biopsies are the standard to diagnose prostate cancer. Although TRUS is an advance over traditional digitally directed biopsies, it represents a random sampling of the prostate since most lesions cannot be visualized. Newer modalities such as ultrasound contrast agents, pattern recognition, and artificial neural networks (ANNs), applied to TRUS images, may improve diagnostic accuracy. If a man at risk for prostate cancer has undergone a negative TRUS biopsy, the decision for the need for additional biopsies is problematic. Use of PSA derivatives such as free and total PSA and the initial biopsy abnormalities such as atypia or high-grade prostatic intraepithelial neoplasia may define those patients in need of follow-up biopsy.

Journal Article↗

Novel oncogene HCCR: its diagnostic and therapeutic implications for cancer.

Identification of robust diagnostic and therapeutic target molecules for human malignancy is still an important issue. If we identify novel proteins which play a stem-line role for cellular transformation or aggravation of malignancy, it could give us a clue to diagnose a tumor in an earlier stage and to develop more reliable therapeutic tools. For this purpose, we have screened abnormally expressed genes in various human cancers by differential display RT-PCR. One of the overexpressed genes was a human cervical cancer oncogene (HCCR). HCCR was not only identified in cervical cancer tissues, but also found to be overexpressed in various human malignancies such as leukemia/lymphoma, breast, kidney, stomach, colon, liver and ovarian cancer. This molecule appeared to be a negative regulator of p53. In this paper, we discuss the biological functions of HCCR molecules and its implications for early diagnosis and future development of therapeutic devices of cancer.

Animals↗