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At least 757 records · Page 42Linked to original sources
PubMed2003

Chromoscopy might improve diagnostic accuracy in cancer surveillance for ulcerative colitis.

OBJECTIVES: Multiple biopsy has been a recommended procedure for cancer surveillance in patients with ulcerative colitis (UC). The aim of this study was to investigate the accuracy of chromoscopic findings in surveillance for patients with UC. METHODS: During the period 1995-2002, we performed 117 surveillance colonoscopies in 57 patients with pancolitis for more than 5 yr. Multiple biopsy specimens were uniformly obtained from flat mucosa in each segment of the colorectum, and, when necessary, from areas specified by chromoscopy. The specified area was classified as polypoid lesion or visible flat lesion. In each specimen, histology was graded according to the classification of dysplasia. RESULTS: Among 818 specimens, 28 (3.4%) were positive for dysplasia. There were 20 low grade dysplasias and eight high grade dysplasias. Dysplasia was more frequently positive in visible flat lesions (37.1%, p < 0001) and in polypoid lesions (16.9%, p < 0.0001) than in flat mucosa (0.4%, p < 0.0001). Furthermore, it was more frequently positive in visible flat lesions than in polypoid lesions (p < 0.05). High-grade dysplasia was found in 4.4% of polypoid lesions and in 14.8% of visible flat lesions, but it was not detected in flat mucosa. Overall, dysplasia was detected in 12 patients. Positive dysplasia was confined to visible flat lesions in four patients and to flat mucosa in one patient. CONCLUSIONS: Our results suggest that biopsy from flat visible lesions under chromoscopy might improve the accuracy of cancer surveillance in UC.

Adolescent↗
PubMed1991

Influence of "diagnostic delay" upon cancer survival: an analysis of five tumour sites.

STUDY OBJECTIVE: The aim was to assess the relationship between survival, tumour stage, and the interval from first symptom to diagnosis (SDI, or duration of symptoms). DESIGN: This was a retrospective follow up study of a cohort of patients registered in the tumour registry of the Hospital del Mar (Barcelona). SETTING: Hospital based tumour registry, with patients derived mainly from the City of Barcelona. PARTICIPANTS: 1247 cases of lung, breast, stomach, colon, or rectal cancer were analysed using survival curves and Cox proportional hazards regression. Subjects (mean age 63.6 years) were followed for a median length of 12.9 months after diagnosis. At the time of diagnosis one fourth of patients had disseminated disease. MEASUREMENTS AND MAIN RESULTS: Based on clinical records, a physician registered the onset time of the first symptom attributable to cancer (from which the SDI is computed), as well as the tumour stage at diagnosis. Other measurements followed standard tumour registry procedures. Overall, the crude mean SDI was 5.15 months (SD 8.03, median 2.03); only 24.5% of cases had an SDI less than a month. Crude mean SDIs by anatomical site were as follows: lung cancer 3.07 months; breast 7.44; stomach 5.34; colon 5.74; rectum 5.03. Tumour extension did not appear to be significantly influenced by SDI, only breast cancer showing a distinct pattern of increased extension with increasing SDI. As expected, the probability of survival decreased monotonically with increasing stage in all sites. Tumour site was also a significant predictor of survival, which at one year ranged from 93% for breast cancer to 28% for lung cancer. However, a longer SDI tended sometimes to be associated with a better chance of survival, a fact that was most apparent in colon cancer. All Cox proportional hazards models showed a consistent picture: SDI was not a significant predictor of survival (age and sex adjusted hazard ratios ranging from 0.97 to 1.01), neither was sex; age did predict survival, and so did site and stage. CONCLUSIONS: The results provide further evidence of a very weak relationship between SDI and tumour stage at diagnosis (except for breast cancer), and between SDI and survival, thus emphasising some limitations within which early clinical detection operates. They also suggest that in addition to reflecting patient and physician behaviour, as well as the functioning of the health system, SDI may be influenced by the biological behaviour of the tumour.

Adult↗
PubMed1996

Disclosure of diagnostic information to cancer patients in Greece.

Truth-telling to cancer patients is controversial. The aim of the present study was to investigate oncologists', radiotherapists', and palliative care specialists' attitudes and truth-telling practices in Greece. A postal survey of a representative sample of 300 oncologists, radiotherapists, and palliative care specialists was made in February 1993. A total of 228 doctors completed and returned the questionnaires. It appears that withholding the truth from cancer patients remains very common in Greece.

Adult↗
PubMed2004

Diagnostic classification of cancer using DNA microarrays and artificial intelligence.

The application of artificial intelligence (AI) to microarray data has been receiving much attention in recent years because of the possibility of automated diagnosis in the near future. Studies have been published predicting tumor type, estrogen receptor status, and prognosis using a variety of AI algorithms. The performance of intelligent computing decisions based on gene expression signatures is in some cases comparable to or better than the current clinical decision schemas. The goal of these tools is not to make clinicians obsolete, but rather to give clinicians one more tool in their armamentarium to accurately diagnose and hence better treat cancer patients. Several such applications are summarized in this chapter, and some of the common pitfalls are noted.

Artificial Intelligence↗
PubMed2003

Outcome in patients with differentiated thyroid cancer with negative diagnostic whole-body scanning and detectable stimulated thyroglobulin.

BACKGROUND: Management of patients with differentiated thyroid carcinoma with negative diagnostic radioiodide scanning and increased serum thyroglobulin (Tg) concentrations is a widely debated problem. High-dose iodine-131 treatment of patients who have a negative (131)I diagnostic whole-body scan (WBS) is advocated. However, the therapeutic benefit of this "blind" treatment is not clear. OBJECTIVE: To investigate the course of serum Tg during thyroid hormone suppression therapy (Tg-on) and clinical outcome in patients with negative diagnostic (131)I scanning and increased serum Tg concentrations during thyroid hormone withdrawal (Tg-off), after treatment with high-dose (131)I. DESIGN: Retrospective single-center study. METHODS: Fifty-six patients were treated with a blind therapeutic dose of 150 mCi (131)I. Median follow-up from this treatment until the end of observation was 4.2 Years (range 0.5-13.5 Years). RESULTS: The post-treatment WBS revealed (131)I uptake in 28 patients, but none in the remaining 28 patients. In this study the Tg-on values did not change after treatment in either the positive or the negative post-treatment WBS group. During follow-up, 18 of the 28 patients with a positive post-treatment WBS achieved complete remission, compared with 10 of the 28 patients with a negative post-treatment WBS. Nine patients in the negative group died, but no patients died in the positive post-treatment group (P=0.001). CONCLUSIONS: High-dose iodine treatment in diagnostically negative patients who have a negative post-treatment scan seems to confer no additional value for tumor reduction and survival. In patients with a positive post-treatment scan, high-dose iodine treatment can be used as a diagnostic tool to identify tumor location, and a therapeutic effect may be present in individual cases.

Adenoma, Oxyphilic↗
PubMed1997

Laser induced fluorescence in diagnostics of laryngeal cancer.

Differences in autofluorescence between normal and malignant tissues offer new possibilities for detecting and localizing early laryngeal carcinomas. In the present study imaging was performed using a specially designed device that exploits differences in fluorescent properties of normal and cancerous tissues without photodynamic drugs. Fluorescence was induced by helium-cadmium laser, captured by an image-intensified camera and displayed on a video monitor after previous computerization. 40 patients were evaluated, of whom 20 had suspect malignancies. Laryngoscopic appearances during standard microlaryngoscopy, fluorescence images and computerized fluorescence intensities were compared to histopathological findings. The experience from this study shows that autofluorescence laryngoscopy may be a useful complementary method for detecting laryngeal malignancies.

Fluorescence↗