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PubMed1996

Fluorescence photography as a diagnostic method for oral cancer.

This study was carried out to evaluate the diagnostic utility of autofluorescence photography for oral mucosal lesions. The materials consisted of 15 chemically-induced lesions containing carcinomas in 15 hamsters, and 32 oral lesions in 30 patients. In the animal models, orange fluorescence was detected in all squamous cell carcinomas invading the muscle layer, and the intensity of the fluorescence increased with the progress of the lesions. In the clinical application, orange fluorescence was detected in 14 of 16 malignant tumors and in one of 16 benign lesions. These results suggest that fluorescence photography may be useful for the diagnosis of oral cancer, particularly for squamous cell carcinoma.

9,10-Dimethyl-1,2-benzanthracene↗

PubMed2026

Beyond mutations: epigenetic and fragmentomic landscapes of cfDNA in lung cancer.

INTRODUCTION: Lung cancer is the most frequently diagnosed cancer worldwide and the leading cause of cancer-related mortality. Cell-free DNA (cfDNA) has emerged as a powerful biomarker in cancer detection. Early diagnostics efforts often leverage cancer-associated mutations present in cfDNA, but beyond such mutation-based assays, recent advances have shed light on other non-mutational features. The analysis of cfDNA epigenetic profiles and fragmentation patterns, known as 'fragmentomics,' has revealed a wealth of data to explore in noninvasive lung cancer diagnosis. AREAS COVERED: This review will explore this new narrative, summarizing the current understanding and use of cfDNA epigenetic modifications and fragmentomic patterns, while integrating findings to illustrate their vast potential in early-stage detection and therapeutics. By considering a range of epigenetic and fragmentomic features, cfDNA methylation (5mC, 5hmC), histone modifications, size profiles, and end signatures, this review highlights how the multidimensional integration of such signals shows promise in refining early-stage lung cancer and guiding therapeutic decisions. EXPERT OPINION: cfDNA epigenetic and fragmentomic analyses represent a transformative frontier in lung cancer diagnostics and monitoring. While these approaches demonstrate significant potential, most studies are limited by modest cohort sizes and reports of survival benefits, underscoring the need for large-scale validation and deeper mechanistic understanding.

Humans↗

PubMed2005

Imaging for lung cancer restaging.

Diagnostic imaging plays an important role in the monitoring of tumor response during lung cancer restaging to evaluate the efficacy of chemotherapy and/or radiation therapy during treatment, and in the detection of recurrent or metastatic neoplasm after treatment has been completed. While CT represents the primary imaging modality for lesion evaluation during restaging and for surveillance imaging once therapy has been completed, studies evaluating the role of 18-fluoro-2 deoxyglucose positron emission tomography (FDG-PET) in lung cancer restaging have shown promise regarding the detection of residual and recurrent neoplasm, and in evaluating for early response to first line therapy. With both CT and FDG-PET, residual or recurrent disease should, when possible, be differentiated from therapy-related changes in the lungs. We review the role of imaging in lung cancer restaging with attention to CT and FDG-PET for treatment assessment and the detection of recurrent or metastatic disease.

Fluorodeoxyglucose F18↗

PubMed1989

[High-resolution computed tomography for diagnosing pulmonary complications in patients with lung cancer].

The diagnostic value of high-resolution computed tomography has been assessed in 10 lung cancer patients with pulmonary infiltrates. This method was used to evaluate the radiographic appearance of the new pulmonary disease. The expectorated sputum of each patient was examined for a bacteriologic and cytologic diagnosis. In some patients, the flexible bronchofiberscopy that was accompanied by bronchoalveolar lavage was performed so as to establish the etiologic diagnosis. In conclusion, high-resolution computed tomography was found to be useful in diagnosing pulmonary complications in lung cancer patients.

Adult↗

PubMed2000

New diagnostic techniques and treatments for early breast cancer.

OBJECTIVES: To review diagnostic techniques and treatments for early breast cancer, including radiologic techniques, biomarkers, surgical techniques, radiation therapy, adjuvant chemotherapy regimens, and hormonal therapy. DATA SOURCES: Scientific and review articles, book chapters, and clinical practice. CONCLUSIONS: Breast cancer is a major health problem. The advances in diagnosis and treatment of early breast cancer and the amount of information available make it difficult for patients to make diagnostic and treatment decisions. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need to be knowledgeable in the many advances in diagnostic and treatment techniques for early breast cancer to assist patients with difficult decisions.

Antineoplastic Agents↗

PubMed2002

11C-metomidate PET imaging of adrenocortical cancer.

The diagnostic potential of positron emission tomography (PET) with carbon-11 metomidate in patients with adrenocortical cancer (ACC) was evaluated. Thirteen PET examinations were performed in 11 patients with CT-detected primary tumours or recurrence and/or metastases from a previously histopathologically proven ACC. The findings at PET were compared with those at CT and verified by histopathology. Six studies (group A) were performed in patients who at the time of imaging were free of medication that could interfere with 11beta-hydroxylase activity and thereby tracer uptake at PET, such as adrenal steroid inhibitors or chemotherapy. The remaining seven studies (group B) were carried out in patients who were monitored during treatment with one or a combination of these drugs. PET visualised all viable tumours with high tracer uptake, and revealed two more lesions than were seen on CT. Three necrotic tumours were detected as false negative observations, as confirmed at surgery and histopathological examination. A true negative observation was obtained at PET in the case of a suspected liver metastasis on CT that was found to have fat vacuolation at histopathological examination of an ultrasonically guided core biopsy specimen. Group A showed apparently higher uptake in normal tissues than group B (adrenal, P=0.03; liver, P=0.01). The metomidate uptake was increased in tumour lesions as compared with normal tissues (adrenal, P=0.02; liver, P=0.005). ACC could be clearly visualised with (11)C-metomidate PET except when the tumour was necrotic. Medication with adrenal steroid inhibitors and chemotherapy decreased the tracer uptake.

Adrenal Cortex Neoplasms↗

PubMed2025

Personalizing CA125 Levels Using Tumor Marker Variants: A Case-Control Analysis of Diagnostic Performance for Pancreatic Cancer.

BACKGROUND: Cancer antigen 125 (CA125) is widely recognized as a useful biomarker for the surveillance of patients with ovarian and other cancers. Prior genome-wide association studies have identified variants that influence CA125 levels. We evaluated the utility of stratifying CA125 levels by such variants and evaluated diagnostic performance in control subjects and patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: We measured CA125 levels in 807 control subjects and 450 patients with PDAC and genotyped 10 variants involving four genes (GAL3ST2, MSLN, D2HGDH, and MUC16). We compared CA125 levels in controls by variant and generated variant-defined CA125 cutoffs and then classified cases and controls into functional groups based on their variant profile. We used this variant classification to evaluate the diagnostic performance of CA125 in patients with PDAC. RESULTS: Six variants associated with CA125 levels were used to group controls into one of four groups. Mean CA125 levels in the highest variant group were approximately fourfold higher than in the lowest group. African Americans were more likely to have a variant group associated with low CA125 levels. After setting diagnostic cutoffs by variant group, the diagnostic sensitivity of CA125 for PDAC was 20.2% at 98% specificity (areas under the ROC curve, 0.702), not significantly different from a uniform CA125 diagnostic cutoff (areas under the ROC curve, 0.700). CONCLUSIONS: Gene variants can be used to generate personalized CA125 reference ranges. This approach did not significantly improve CA125's diagnostic performance for pancreatic cancer, but it merits evaluation in other diagnostic settings, such as detecting ovarian cancer. IMPACT: Gene variants can be used to personalize CA125 levels.

Humans↗

PubMed1996

Age-specific differences in the diagnostics and treatment of cancer patients aged 50 years and older in the province of Limburg, The Netherlands.

BACKGROUND: In the Netherlands, 45% of all cancer cases occur in men and women aged 70 years and older. Since the population is ageing and cancer incidence rises with age, the number of new malignancies in the elderly is increasing. It has become apparent that there is a relationship between age at diagnosis and the treatment received. Therefore, age-specific variations in patterns of care for six common forms of cancer in the elderly, are examined. PATIENTS AND METHODS: Patients aged 50 years and older, diagnosed in the period 1988-1992 in Middle and South Limburg with breast, colorectal, lung, ovarian, head and neck cancer and non-Hodgkin lymphoma were included (n = 6911). Data were obtained from the population-based Regional Cancer Registry of the Comprehensive Cancer Centre Limburg. Age-specific differences in diagnostics and treatment were analysed using chi-square analysis (age categories: 50-59, 60-69, 70+). Logistic regression analyses were used to examine the extent to which age increased the chance of not being treated or of receiving less intensive treatment, while controlling for the stage of the disease and the sex of the patient. RESULTS: For all malignancies the stage was unknown in a larger proportion of the patients aged 70 years and older than in the younger patient groups. Compared to their younger counterparts, the diagnosis of elderly breast, colorectal and lung cancer patients was more often based solely on clinical grounds. In the total study population, 16% were not treated. Per age category 50-59 years, 60-69 years and 70+ these percentages were 7%, 12% and 22%, respectively, (P-trend = 0.001). For all malignancies the chance of not receiving treatment increased with increasing age. However, the size and nature of the differences varied with the localisation of the tumour. The proportion of untreated patients was particularly high in the patients with lung cancer and metastatic colorectal and ovarian cancer, and there was an increase with increasing age (P-trend = 0.001). The vast majority of patients with NHL, breast, head and neck and non-metastatic colorectal cancer received treatment, 90%, 94%, 91%, and 99%, respectively. However, elderly patients less often received a combination of treatment modalities. CONCLUSIONS: The diagnostics and choice of treatment for several common types of cancer were dependent on age. This study could not take into account the major problem of co-morbidity which can be a reason to choose for lesser therapy in the elderly. More research is necessary to determine which factors determine the diagnostics and choice of treatment and whether these factors differ between young and elderly patients.

Age Factors↗

PubMed1989

Endoluminal ultrasound for early detection of local recurrence of rectal cancer.

The diagnostic potential of endoluminal (endorectal and endovaginal) ultrasound to detect asymptomatic resectable local recurrence after rectal cancer surgery has been assessed in 120 patients: 17 recurrences (14 per cent) were detected. The method showed 97 per cent accuracy, 94 per cent sensitivity and 98 per cent specificity; the positive predictive value was 85 per cent and the negative predictive value was 99 per cent. A longer follow-up is, however, necessary to confirm these results. Of the 17 patients with local recurrence, six were asymptomatic and underwent reoperative surgery. Of the other 11 patients with symptomatic recurrence, only two underwent reoperative surgery.

Adenocarcinoma↗

PubMed2005

The role of progesterone metabolites in breast cancer: potential for new diagnostics and therapeutics.

Proliferative changes in the normal breast are known to be controlled by female sex steroids. However, only a portion of all breast cancer patients respond to current estrogen based endocrine therapy, and with continued treatment nearly all will become unresponsive and experience relapse. Therefore, ultimately for the majority of breast carcinomas, explanations and treatments based on estrogen are inadequate. Recent observations indicate that 5alpha-pregnane and 4-pregnene progesterone metabolites may serve as regulators of estrogen-responsive as well as unresponsive human breast cancers. The conversion of progesterone to the 5alpha-pregnanes is increased while conversion to the 4-pregnenes is decreased in breast carcinoma tissue, as a result of changes in progesterone metabolizing 5alpha-reductase, 3alpha-hydroxysteroid oxidoreductase (3alpha-HSO) and 20alpha-HSO activities and gene expression. The 5alpha-pregnane, 5alpha-pregnane-3,20-dione (5alphaP) stimulates, whereas the 4-pregnene, 3alpha-hydroxy-4-pregnen-20-one (3alphaHP), inhibits cell proliferation and detachment, by modulation of cytoskeletal and adhesion plaque molecules via the MAP kinase pathway and involving separate and specific plasma membrane-based receptors. The promotion of breast cancer appears to be related to changes in in situ concentrations of cancer-inhibiting and cancer-promoting progesterone metabolites. New diagnostic and therapeutic possibilities for breast cancer are suggested.

20-alpha-Hydroxysteroid Dehydrogenase↗

PubMedDate not supplied

[Fluorescent diagnostics of urinary bladder cancer].

Introduction of optic markers in screening for cancer of the urinary bladder (UB) raises diagnostic significance of UB cystoscopy. Application of intravesical form of 5-aminolevulinic acid (5-ALA), precursor of photodynamically active protoporphirine IX, prevents complications in systemic use of tetracycline or hepatoprophirines. Fluorescent cystoscopy with 5-ALA (n = 59) was made in 51 patients treated in the Research Institute of Urology. UB cancer was detected in 32 patients. This procedure proved highly sensitive and specific (97.0 and 75.6%, respectively, being much more effective than standard cystoscopy and biopsy in the white light (85.1 and 81.4%, respectively). Specificity of fluorescent cystoscopy is much higher in detection of tumors and pretumor lesions (88.4%). Fluorescent diagnosis is expected to become a gold standard in the program of UB cancer detection.

Administration, Intravesical↗

PubMed2001

The T-SCAN technology: electrical impedance as a diagnostic tool for breast cancer detection.

In this paper we present the T-SCAN technology and its use as a diagnostic tool for breast cancer detection. We show, using theoretical models with simplified geometries, that displaying planar two-dimensional maps of the currents detected at the breast's surface relate to the electric field distribution within the breast. This distribution is a manifestation of the bulk spatial inhomogeneities in the complex dielectric constant that represent the various tissue types. These differences may be used to discriminate between various pathological states. We furthermore illustrate a useful classifier, based on admittance data measured up to 2 kHz, and we argue that low frequency impedance measurements can be used successfully in breast cancer diagnosis.

Breast Neoplasms↗

PubMed2006

Diagnostic accuracy in skin cancer clinics: the Australian experience.

BACKGROUND: Australia, with the world's highest incidence of skin cancer, has witnessed the emergence of "open access" skin cancer clinics during the past decade. These clinics are becoming increasingly popular destinations for the diagnosis and treatment of skin cancers, yet little is known about the diagnostic performance of practitioners in this setting. We sought to measure the accuracy of clinical diagnosis in this setting. METHODS: Clinical and histological data were obtained from 199 consecutive patients undergoing biopsy or excision for 287 skin lesions. We measured the sensitivity, specificity and predictive value of the clinical diagnoses compared with histological diagnoses. RESULTS: Of 287 biopsied or excised lesions, the most common were benign nevi (24%) and basal cell carcinomas (22%), followed by actinic keratoses (11%), dysplastic nevi (11%) and squamous cell carcinomas (7%). Sensitivity was highest for diagnosing BCC (0.89, 95%CI 0.78-0.95) and dysplastic nevi (0.80, 95%CI 0.61-0.93), and lowest for actinic keratoses and the group of benign lesions. Specificity was greater than 0.93 for all diagnoses except BCC (0.76, 95%CI 0.70-0.81). Treating clinicians perceived moderate to strong pressure to excise 49% of lesions overall, but in particular for benign nevi (73%). CONCLUSIONS: Australian family practitioners in open access skin cancer clinics diagnose a wide range of skin lesions with high specificity and moderate to high sensitivity. Benign nevi are accurately diagnosed and often excised because of patient pressure.

Australia↗

PubMed2004

Influence of health insurance status on inclusion of HER-2/neu testing in the diagnostic workup of breast cancer patients.

OBJECTIVE: . To assess the prevalence of HER-2/neu testing in a community-based health care system shortly after the approval of several laboratory kits for HER-2/neu testing for diagnostic purposes by the US Food and Drug Administration and to discern the best discriminating variables for inclusion of the test in the diagnostic workup of breast cancer patients. DESIGN: A retrospective cross-sectional study was designed to analyze data for the period beginning 1 January 1999 and ending 31 December 2000. SETTING: Henry Ford Health System, the largest health care system in southeastern Michigan, is a comprehensive, self-contained system. STUDY PARTICIPANTS: Four hundred and fifty-one women diagnosed with primary invasive breast cancers were consecutively sampled from the tumor registry of the Henry Ford Health System. RESULTS: The proportion of women tested for HER-2/neu increased by 2-fold during year 2 of the observation. Absence of estrogen receptors (OR = 1.96, 95% CI 1.15-3.21), physicians with specialty in surgery (OR = 6.21, 95% CI 2.88-13.33, P = 0.0001), and having a capitated insurance (OR = 1.59, 95% CI 1.06-2.44, P = 0.027) were associated with HER-2/neu testing. CONCLUSION: Absence of estrogen receptors was the only pathological characteristic associated with HER-2/neu testing. The effect of specialization in surgery on the increased likelihood of HER-2/neu testing can be explained mostly by the 'patient volume effect'. The observed disparity in the delivery of innovative diagnostic approaches to cancer patients was influenced by the type of health insurance. Implementation of institutional policies can improve in providing universal quality of care for all patients regardless of their health insurance.

Biomarkers, Tumor↗

PubMed2003

Computerized tomography screening for lung cancer: new findings and diagnostic work-up.

On computerized tomography (CT) screening for lung cancer within the Early Lung Cancer Action Project, both at baseline and repeat screening, we found not only solid but also subsolid nodules, which unlike solid ones do not completely obscure the lung parenchyma. We established that subsolid nodules represent approximately 20% of the nodules shown on screening and that they have a higher frequency of malignancy than solid nodules. Although we found growth of solid nodules to be a reliable indicator of malignancy, growth of subsolid nodules was more difficult to assess. On review of our results to date in screening, we have continued to refine our definition of a positive result of screening from that given in our initial publication on screening. We have also provided an updated screening regimen. It starts with the initial, low-dose CT test and for all those with positive results on this initial test, the regimen continues by specifying the work-up needed to rule-in a diagnosis of malignancy. In this regimen, we found growth assessed by high-resolution CT to be a useful indicator of malignancy and have developed image-processing tools to help in this assessment. Once growth is ascertained, we recommend fine-needle aspiration for confirmation of malignancy. It may be that once criteria for definitive growth are established and validated, fine-needle aspiration may become optional. However, in the meantime, in the context of screening, a more cautious approach is warranted.

Humans↗

PubMed1998

Cytology of bronchial biopsy rinse fluid to improve the diagnostic yield for lung cancer.

Sampling techniques are combined during bronchoscopy to increase the diagnostic yield for endobronchial malignant tumours. Bronchial biopsy provides the definitive histological diagnosis in most cases, but accompanying cytological procedures such as washing, brushing, needle aspiration or imprint cytology can increase diagnostic yield. In this prospective study, a different cytological technique, that could enhance the diagnostic yield of bronchoscopy without increasing its time or cost, was tested. Flexible bronchoscopy was performed in 93 patients suspected of having pulmonary neoplasms. Bronchial biopsies were initially placed in a balanced salt solution. When bronchoscopy was finished, all visible tissue fragments were removed and placed in formalin to undergo histopathological examination and the rinse fluid was sent for cytological examination. Washing was performed routinely but no cytological brushing was employed. Eighty-two patients had final diagnoses of malignant neoplasm. In four (4.8%) of these patients, the only positive result came from the cytological examination of the bronchial biopsy rinse fluid. No false-positive results were found. The agreement with the histological results was 81.8%. The addition of bronchial biopsy rinse-fluid examination increased the sensitivity of bronchoscopy from 65.8% to 70.7% (McNemar's p=0.009). The cytological study of bronchial biopsy rinse fluid offers reliable positive results in an additional 4.8% of cases, thus enhancing bronchoscopic diagnostic yield for malignant endobronchial tumours while neither prolonging the procedure nor increasing costs.

Biopsy, Needle↗

PubMed1997

A nurse-managed smoking cessation intervention during diagnostic testing for lung cancer.

PURPOSE/OBJECTIVES: To determine the effectiveness of a nurse-managed smoking cessation intervention. DESIGN: Prospective, descriptive, one-group, pretest/post-test. SETTING: Urban, academic, tertiary-care setting. SAMPLE: Fifteen adult male and female smokers with a suspected diagnosis of lung cancer who were admitted to an inpatient thoracic surgery unit for diagnostic testing. METHODS: Subjects received a nurse-managed smoking cessation intervention during hospitalization with subsequent verification of smoking status at a clinic visit six weeks postintervention. MAIN RESEARCH VARIABLES: Self-reported smoking status and saliva cotinine levels at six weeks postintervention. FINDINGS: Eighty-seven percent of subjects reported an intent to quit smoking within the month. At six weeks postintervention, 93% of the subjects reported at least one cessation attempt, and 40% were confirmed, via saliva cotinine analysis, as abstinent from smoking during the prior week. CONCLUSIONS: A nurse-managed smoking cessation intervention was successful in achieving short-term cessation. IMPLICATIONS FOR NURSING PRACTICE: Hospitalization for diagnostic testing associated with lung cancer may represent an opportunity for nurses to deliver a smoking-cessation intervention.

Adult↗

PubMed1980

[Diagnostic errors in esophageal cancer].

At different stages of examination and treatment in esophageal cancer patients there arise a large number of diagnostic errors, making from 28.3% to 32.7% as shown by our findings. A primary x-ray examination fails to detect tumor in 13.8-19.2% of patients. Most frequently diagnostic errors were due to underestimation of the clinical symptoms (first of all dysphagia and pains in food passage along the esophagus); a long period of time elapsed since patients' referral till roentgenological examination, poor potentialities of the latter in terms of detecting early esophageal cancer. If esophageal cancer is reasonably suspected then esophagoscopy is felt to be mandatory in all cases with negative roentgenological findings. To timely recognize esophageal tumors and lessen the number of diagnostic errors, it seems rational to establish special centers for endoscopic examination (fiberoptic esophagogastroscopy), where this category of patients should be referred to.

Deglutition Disorders↗