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At least 955 records · Page 53Linked to original sources
PubMed1979

Lung cancer. Symptoms, signs and diagnostic criteria.

A consecutive hospital series of 1 053 patients treated for lung cancer during the period 1962 through 1971 has been studied. Clinical symptoms were present more often in men than in women and in 42% symptoms had been noted more than 6 months prior to the diagnosis. Peripheral tumours gave less symptoms than central ones. Although in 22% of the patients the tumour was discovered on a chest film in the absence of relevant symptoms, 12% only had been detected by regular mass X-ray screening. More than 40% of the peripherally located tumours were clinically silent. Squamous cell and anaplastic small cell cancers were predominantly centrally located (80 and 90%, respectively) against 65% and 74% for adenocarcinomas and undifferentiated large cell tumours.

Adult↗
PubMed2006

Improved cancer detection using computer-aided detection with diagnostic and screening mammography: prospective study of 104 cancers.

OBJECTIVE: This study prospectively evaluated a computer-aided detection (CAD) device used with diagnostic and screening mammography by assessing cancers detected; tumor sizes, histology, and stage; positive predictive value (PPV) of biopsy recommendation; and recall rates before and after CAD introduction. SUBJECTS AND METHODS: Interpretations of 9,520 consecutive mammograms were recorded without and then with CAD for a 28-month period. Cancer detections based on initial radiologist review and additional detections based on CAD findings were noted. Recall rates, tumor size and histology, and PPV of biopsy recommendation before and after the introduction of CAD were compared. RESULTS: Cancers detected only with CAD assistance were 9.6% of all cancers (10 of 104); screening-detected cancers increased 13.3% with CAD assistance (four in addition to 30 screening-detected cancers). The 95% one-sided confidence boundary using binomial distribution is consistent with at least 5.3% for all cancers and 5.1% for nonpalpable cancers. The greatest impact was on ductal carcinoma in situ, for which CAD increased cancer detection by 14.2% (three added to 21). Similar percentages of cancers were detected only with CAD assistance in both screening (11.4%; 4 of 35) and diagnostic (9.5%; six of 63) studies. Additional cancers were detected using CAD in patients with implants and previous lumpectomy. The additional cancers detected with CAD were smaller (p = 0.01 for all cancers, p = 0.03 for nonpalpable invasive cancer). The screening recall rate increased from 6.2% to 7.8% after CAD, with a decrease in the biopsy rate and a nonsignificant increase in the biopsy PPV from 21.9% to 26.3%. CONCLUSION: CAD resulted in detection of more cancers in screening and diagnostic patients, with an increased recall rate but no deterioration in PPV of biopsy. Additional cancers detected were significantly smaller.

Biopsy↗
PubMed1980

Diagnostic contribution of bladder washing and multiple biopsies in bladder cancers.

The superior diagnostic contribution of bladder washing as compared to routine urinary cytology was demonstrated in a prospective study. Random mucosal biopsies of normal-looking mucosa taken at the time of treatment or of the first control cystoscopy revealed the presence of multiple cancerous or precancerous lesions in a variety of patients. The heterogeneity of bladder cancer had to be recognized for adequate follow-up and treatment.

Biopsy↗
PubMed2006

Real-time reverse transcription PCR and the detection of occult disease in colorectal cancer.

Molecular diagnostics offers the promise of accurately matching patient with treatment, and a resultant significant effect on improved disease outcome. More specifically, the real-time reverse transcription polymerase chain reaction (qRT-PCR), with its combination of conceptual simplicity and technical utility, has the potential to become a valuable analytical tool for the detection of mRNA targets from tissue biopsies and body fluids. Its potential is particularly promising in cancer patients, both as a prognostic assay and for monitoring response to therapy. Colorectal cancer provides an instructive paradigm for this potential as well as the problems associated with its use as a clinical assay. Currently, histopathological staging, which provides a static description of the anatomical extent of tumour spread within a surgical specimen, defines patient prognosis. The detection of lymph node (LN) metastasis constitutes the most important prognostic factor in colorectal cancer and as the primary indicator of systemic disease spread, LN status determines the choice of postoperative adjuvant chemotherapy. However, its limitations are emphasised by the considerable prognostic heterogeneity of patients within a given tumour stage: not all patients with LN-negative cancers are cured and not all patients with LN-positive tumours die from their disease. This has resulted in a search for more accurate staging protocols and has seen the introduction of the concept of "molecular staging", the incorporation of molecular parameters into clinical tumour staging. Quantification of disease-associated mRNA is one such parameter that utilises the qRT-PCR assay's potential for generating quantitative results. These are not only more informative than qualitative data, but contribute to assay standardisation and quality management. This review provides an assessment of the practical value to the clinician of RT-PCR-based molecular diagnostics. It points out reasons for the many contradictory results encountered in the literature and concludes that there is an urgent need for standardisation at every level, starting with pre-assay sample acquisition and template preparation, assay protocols and post-assay analysis.

Biomarkers, Tumor↗
PubMed1990

Familial pancreatic cancer (Part II): Surveillance, diagnostic tests, and surgical strategies.

We have provided a description of the current state of knowledge relevant to familial/hereditary pancreatic cancer. Since the most important clinical ramifications of this disease, whose incidence and mortality are essentially the same, rests upon its earlier detection, we have also characterized available diagnostic tests, surgical strategies, and current knowledge about its pathology. We believe that advances in control of pancreatic cancer will be heavily impacted by progress in the search for new and better diagnostic tests. These could include monoclonal antibodies targeted to pancreatic tumor tissue, and possibly pancreatic site-specific P450's, as well as biomolecular/genetic techniques, particularly when focused on individuals at high risk. Thus, family studies are important in this disease because if an autosomal dominantly inherited form of pancreatic cancer is delineated, one could identify individuals at high risk early in life. Comparison could then be made with individuals in branches of the family where the disease is not segregating. Thus, there would be a greater potential for discovery of methods for early detection with evaluation of sensitivity and specificity in families wherein the predictability for pancreatic cancer occurrence is high.

Adenoma↗
PubMedDate not supplied

[Positron-emission tomography/computed tomography: artifacts and pitfalls in cancer patients].

Diagnostic accuracy and correct initial staging (or restaging) are fundamental in the management of oncological patients and can directly influence therapeutic decisions. The combination of positron-emission tomography (PET) and computed tomography (CT) in a single scanner (PET/TC) represents an important achievement in the fields of oncology, nuclear medicine, and radiology. These scanners allow morphologic images (obtained by CT) to be fused and correlated with metabolic images (obtained by PET) to a high degree of accuracy. In addition to an understanding of the physiopathology of cancer and the behavior of the different types of neoplasms, the correct interpretation of PET/CT images requires in-depth knowledge of the physiological distribution of the F-18 fluorodeoxyglucose molecule (FDG, currently the most widely used marker in oncology), of the frequent physiological variations in its distribution, and of the possible causes of non-malignant pathological FDG uptake. Furthermore, the use of CT data to correct attenuation and reconstruct PET images in PET/CT scanners can generate some characteristic artifacts specific to this new diagnostic tool, and these can lead to misinterpretation with potential therapeutic implications. This article reviews and illustrates some of the most common artifacts and pitfalls that can appear in PET/CT studies. The detection and correct interpretation of these findings are essential for the appropriate management of oncologic patients.

Fluorodeoxyglucose F18↗
PubMed1987

Staging of genitourinary cancers. The role of diagnostic imaging.

Computed tomography (CT) is currently the standard modality for staging of urologic cancer in most institutions. It is used for demonstrating nodal involvement, and for demonstrating invasion of the primary lesion into surrounding fat, muscle, or other tissues or organs. It is also useful for demonstrating hepatic metastases in renal and vesical carcinomas. The problem with computed tomography, however, is that it can only show whether the nodes are large or not; neither can it show the nodal architecture, nor can it detect metastases in normal-sized nodes. Intravesical sonography has been helpful for staging papillary bladder cancer. Transrectal sonography has been somewhat helpful for demonstrating seminal vesicle invasion in patients with prostatic carcinoma. Inferior vena cavography and renal venography can be helpful for demonstrating whether a renal, renal pelvic, or adrenal carcinoma has extended into either vein. Lymphography can show nodal architecture and metastases in normal-sized nodes, and can make possible needle biopsy of abnormal-appearing nodes even if they are normal sized. The examination cannot show very small or microscopic nodal metastases, and it can miss abnormal nodes totally if they have been completely replaced by metastases. It yields false positives when fatty or fibrous infiltration of the nodes has occurred. It is used primarily for staging patients with testis or prostatic carcinoma. Bone scans are essential for staging prostatic carcinoma. Magnetic resonance imaging (MRI) is helpful in some cases of renal cell carcinoma. Multiplanar imaging prevents overstaging. It is also accurate for showing whether the renal vein or inferior vena cava are involved. Enlarged lymph nodes are easily distinguished from vessels. For staging bladder carcinoma involving the fundus or base of the bladder, MRI is better than CT. Microscopic nodal metastases, such as are common in carcinoma of the prostate, currently are not detected by any imaging modality.

Angiography↗
PubMed1985

Preclinical cancer of the cervix: diagnostic pitfalls.

This paper outlines the pitfalls encountered in the diagnosis of 127 preclinical cancers of the cervix. Each patient had cervical cytology, colposcopy, and histology performed within the same institution. Early stromal invasion was diagnosed in 55 patients and occult invasion was diagnosed in 72 patients. For preclinical cancers as a group, the possibility of invasive carcinoma was predicted cytologically in 36% and suspected colposcopically in 41%. However, in over 85% of patients the abnormal transformation zone (TZ) extended into or was totally confined within the endocervical canal and could not be adequately evaluated with the colposcope. A feature of this study was the high incidence of incomplete excision of abnormal tissue by cone biopsy and a high incidence of residual disease at hysterectomy. Cone biopsy was necessary to accurately assess the maximum depth and extent of invasion prior to definitive therapy whenever invasion was suspected colposcopically or on target biopsy. In 10 of 16 such patients, the cone biopsy demonstrated occult invasion. Colposcopy and directed target biopsy alone was adequate for the diagnosis of frank invasive cancer in 22 of the 72 patients in the occult invasion group, enabling definitive therapy to be undertaken without further delay.

Adenocarcinoma↗
PubMed1993

[Occult cervical cancer developing after diagnostic-therapeutic conization of CIN 3].

A case of the so called occult cervical cancer which developed 2 years after the conisation performed in a 45-year old woman on account of CIN 3 has been described. Cancer was detected in the operative specimen of the removed uterus. Hysterectomy was performed on account of the progressive form of the myomas. The multiple colposcopy and cytological follow-up examination after conisation was always negative, just as the histological examination of the tissue specimen of the cervical canal. The hypothetical course of the development of the cancer has been discussed. In connection with the above findings a modification of the conisation technique, especially in older women, is suggested.

Carcinoma in Situ↗
PubMed2006

Selective pretreatment diagnostic imaging for detecting remote metastases in patients with endometrial cancer.

OBJECTIVES: Various diagnostic tests are available to rule out metastases. However, not all of these tests provide significant information. Based on data collected at our institution, we have analyzed the significance of various imaging methods. PATIENTS AND METHODS: In 337 patients with fully staged endometrial carcinoma, the results of chest X-rays, bone scintigraphy, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasonography of the liver, kidneys and abdomen were analyzed. RESULTS: In the 7 patients who showed metastases, the liver was the most frequently affected organ. Hepatic CT is associated with a likelihood ratio (LR) of 9.0, hence representing a valuable technique. In cases with a pretest probability of 1.19% (independent of the disease stage), CT results in a post-test probability of 9.78%, putting into question the usefulness of the method for confirming metastases. With all other analyzed diagnostic modalities, even less information is gained. CONCLUSION: The routine use of the above diagnostic methods, indiscriminate of the disease stage, is not justified. LRs provide an estimate of the information gained by a diagnostic procedure.

Abdominal Neoplasms↗
PubMed1999

Factors involved in diagnostic delay of testicular cancer.

In testicular cancer, which is one of the highly curable cancers, the beneficial effect of early diagnosis on survival has been well accepted for years. This study was planned to determine the probable factors involved in diagnostic delay of testicular cancer. A total of 140 patients with testicular cancer were included in this study. We attempted to find a relationship between the mode of presentation, stage of the tumour, patients' socioeconomic status and the delay in diagnosis. Majority of patients presented with scrotal pain (49.3%). No significant correlation was found between the mode of presentation and stage of the disease (p>0.05). The median time of delay in diagnosis was 5.4 months. The stage at presentation was not influenced by the delay in diagnosis. Similarly the annual income and the educational level of the patients had no significant impact on the delay in diagnosis. No effect of delay in diagnosis on the stage at presentation could be demonstrated in our study. Our results indicate that in this country people are not thoroughly educated about the importance of routine self-examination of the testes. It must also be emphasized that painful testicular masses need to be evaluated carefully to rule out malignancy.

Adolescent↗
PubMedDate not supplied

Distinguishing melanocytic nevi from melanoma by DNA copy number changes: comparative genomic hybridization as a research and diagnostic tool.

Cancer typically results in loosened control over genomic integrity, resulting in alterations of the genome of cancer cells. Comparative genomic hybridization (CGH) is a method that can be used on DNA extracted from routinely fixed tissue to assess the entire genome for the presence of changes in DNA copy number. CGH analysis has revealed that melanoma differs from melanocytic nevi by the presence of frequent chromosomal aberrations. In contrast, melanocytic nevi typically show no chromosomal aberrations, or have a restricted set of alterations with basically no overlap to melanoma. These marked differences between aberration patterns in melanomas and melanocytic nevi can be exploited diagnostically to classify melanocytic tumors that are ambiguous based on histopathologic assessment. In addition to potential diagnostic applications, detailed analyses of recurrent aberrations can lead to the identification of genes relevant in melanocytic neoplasia.

Adult↗
PubMed2004

Detection of K-ras gene mutation in fecal samples from elderly large intestinal cancer patients and its diagnostic significance.

AIM: To study the diagnostic significance of K-ras gene mutations in fecal samples from elderly patients with large intestinal cancer. METHODS: DNA was extracted in the fecal and tissue samples from 23 large intestinal cancer patients, 20 colonic adenomatoid polypus patients and 20 healthy subjects. The K-ras gene mutations at the first and second bases of codon 12 were detected by the allele specific mismatch method. RESULTS: The K-ras gene mutation was 56.52%(13/23) in the large intestinal cancer patients, which was notably higher than that in the normal subjects whose K-ras gene mutation was 5%(1/20) (chi (2)=12.93, P<0.001). There was no significant difference in comparison with that of colonic adenomatoid polypus patients whose K-ras gene mutation was 30%(6/12) (chi (2)=3.05, P>0.05). The K-ras gene mutation at the second base of codon 12 was 92.13%(12/13) in the large intestinal cancer patients. There was no significant difference between the detection rate of K-ras gene mutation in the fecal and tissue samples (chi (2)=9.35, P<0.01). CONCLUSION: Our results indicate that detection of the K-ras gene mutations in fecal samples provides a non-invasive diagnostic method for the elderly large intestinal cancer patients. Its significance in the early diagnosis of large intestinal cancer awaits further studies.

Aged↗
PubMed1995

Sociodemographic factors associated with the diagnostic staging of breast cancer in southern Italy.

BACKGROUND: There are marked regional differences in breast cancer mortality rates in Italy, probably linked to factors such as diagnostic delay, therapeutic strategies, and biologic and sociodemographic differences. To investigate a possible link between sociodemographic factors (e.g. age, education, and residence) and delay in the diagnosis of breast cancer, data were evaluated from all such patients from our Institute living in the Campania Region of Southern Italy for 1991-1993. METHODS: Patients were grouped into Tis-T1/N0-N+ versus T2-4/N0-N+ and the variables examined were age (< 40, 41-50, 51-60, > 60 years), education (< or = 5 vs. > 5 school years) and residence (urban vs. rural). An analysis was made using the Pearson's Chi-square test and the multiple logistic regression. RESULTS: Statistically significant differences were found for both residence (P = 0.04) and education level (P = 0.03) in the older than 60 years age group, but only for residence (P = 0.03) in the 51-60 years age group. The risks according to Mantel-Haenszel were 1.28 for education (P = 0.08) and 1.32 for residence in rural municipalities (P = 0.05). The odds ratio for residence in rural municipalities, adjusted by education and by the education-residence interaction, was 2.26 (95% confidence interval [CI], 1.12-4.54) in the 51-60 years age group and 1.74 (95% CI, 1.01-3.00) in the older than 60 years age group. CONCLUSIONS: These data clearly indicate that residents of rural municipalities, as well as poorly educated subjects, are more likely than their respective counter-parts to have a delayed diagnosis of breast cancer.

Adult↗
PubMed2005

[Diagnostic imaging of lung cancer on multislice CT (MDCT)].

Helical CT, and the newest technological development, multislice CT (multidetector CT: MDCT), have revolutionized the diagnostic approach to diseases of the chest including lung cancer. There are several factors that contribute to the important role of multislice CT scanning of the chest: (1) data acquisition is so rapid that the scanning of the entire lung can be performed during a single breath-hold period; (2) continuous acquisition of thin slices allows the improvement of the image quality of multiplanar reconstruction of thoracic abnormalities; (3) MDCT may help reduce the radiation dose, so that, compared to conventional or single-slice helical CT, the radiation dose is lowered with comparable image quality. The advantages of MDCT include both improved nodule detection and nodule characterization on lung cancer screening programs, because the entire lung can be scanned with thin slice in a single breath-hold without an intersection gap. In the evaluation of lung cancer, MDCT will allow improved detection of pleural dissemination and hilar lymph node adenopathy because of the continuous and narrow scan collimation.

Adenocarcinoma↗
PubMed2002

Application of microarrays to the analysis of gene expression in cancer.

Molecular diagnostics is a rapidly advancing field in which insights into disease mechanisms are being elucidated by use of new gene-based biomarkers. Until recently, diagnostic and prognostic assessment of diseased tissues and tumors relied heavily on indirect indicators that permitted only general classifications into broad histologic or morphologic subtypes and did not take into account the alterations in individual gene expression. Global expression analysis using microarrays now allows for simultaneous interrogation of the expression of thousands of genes in a high-throughput fashion and offers unprecedented opportunities to obtain molecular signatures of the state of activity of diseased cells and patient samples. Microarray analysis may provide invaluable information on disease pathology, progression, resistance to treatment, and response to cellular microenvironments and ultimately may lead to improved early diagnosis and innovative therapeutic approaches for cancer.

Gene Expression Profiling↗