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At least 955 records · Page 53Linked to original sources
PubMed1994

Role of intraoperative assessment of lymph node metastasis and serosal invasion in patients with gastric cancer.

The clinical diagnoses of nodal status (N) and tumor invasion (T) were performed intraoperatively during 1499 consecutive operations for gastric carcinoma and compared with subsequent pathologic diagnoses. An accurate macroscopic diagnosis of N stage was difficult; overall accuracy was only 56.6%. Intraoperative assessment of T stage (particularly of serosal invasion) was correct for 93.2% of early stages of the disease with invasion confined to the mucosa or submucosa (pT1) when the pathologist assessed the T stage in the resected specimen, for 95.6% of advanced tumors invading the serosa (pT3), but for tumors of an intermediate stage with invasion involving the muscularis propria or the subserosa (pT2) in only 41.9% of cases. Macroscopic overestimation occurred in 58.1% of cases with pT2 tumors, which were characterized by carcinomas in the upper third of the stomach, tumors larger than 5 cm, carcinomas of the ulcerating type, differentiated adenocarcinomas, tumors invading the subserosa, and those accompanied by lymph node metastasis or liver metastasis. The overestimated group had a significantly poorer prognosis than the correctly assessed cases (P < 0.05). Since multivariate logistic regression analysis showed that the significant risk factor related to the inaccurate intraoperative assessment of T stage was tumor size, the error in diagnosis may correlate with a greater degree of tumor spread. Surgeons should decide their therapeutic approach at the time of surgery on the basis of their intraoperative assessment of tumor spread. We recommend extensive surgery followed by adequate chemotherapy when serosal invasion is suspected at surgery.

Adenocarcinoma↗
PubMedDate not supplied

Interpretation of time trends in disease rates in the presence of generation effects.

A comparison is made of indices used for assessing trends in mortality rates over time, and results for four types of cancer are used as examples. The approaches contrasted as measures of change over calendar years of time are the use of crude death rates, standardized death rates (both direct and indirect approaches) and period effects estimated from an age-period-cohort model (including and excluding the cohort factor). The use of these indices is also compared with examination of the original age-specific rates. Similar analyses are made of the equivalent indices for examining changes between different birth cohorts over time. Submodels of the age-period-cohort model are shown to be algebraically and empirically related to age-standardized indices. The use of the full model, as contrasted to standardization methods, can result in important modifications to the interpretation in some cases. However, there are difficulties with this approach, as with all models, if applied uncritically. It is a wise precaution to examine the age-specific rates in each instance to ensure that any summary index is appropriate.

Adult↗
PubMed1975

The metastatic spread of "head and neck" tumors in men (an autopsy study of 371 cases).

The investigation was performed by using 371 autopsy records collected by the Department of Pathology at Roswell Park Memorial Institute from 1956 till 1967. Only the "head and neck" tumors were taken into consideration. Two hypotheses were tested, i.e. whether metastases diffuse directly from the primary tumor throughout the body or if the metastatic process takes place in steps, requiring, in other words, that one or more organs be seeded first, before any generalized metastasis occurs. It appeared that the lungs and the lymphnodes of the neck are the two organs responsible for generalized metastases in the cancers of the "head and neck" area. The importance of the neck and lungs metastases in disseminating the disease was discussed in the text. It appeared that when metastases are present in the lymphnodes of the neck, the cancer is already generalized with and without metastatic deposits in the lungs. However, the absence of metastases in the neck is no guarantee that the disease is still localized to the "head and neck" area.

Adenocarcinoma↗
PubMed1993

Radiation-induced cancer risk in radiographic cephalometry.

The carcinogenic risks associated with the cephalometric x-ray techniques customarily used in orthodontics and oral surgery have been estimated. Lateral, posteroanterior, 45 degrees oblique, lateral temporomandibular joint tomography, basilar techniques, and commonly-used combinations were examined. Data reported in a previous article on doses absorbed by pituitary (brain), salivary, and thyroid glands were used to calculate increased risk over normal incidence using the BEIR V model. The findings are expressed in a number of graphs. Tables list the estimated percentage increase in carcinomas for several of the most often used cephalometric procedures, and compare these with the more common complete mouth (periapical) and panoramic surveys. The overall conclusion is that responsible use of cephalometric radiology adds very little to the person's carcinogenic burden.

Absorption↗
PubMed2005

Hui and Walter's latent-class reference-free approach may be more useful in assessing agreement than diagnostic performance.

BACKGROUND AND OBJECTIVE: Hui and Walter developed a latent class approach to assess the accuracy of a diagnostic procedure when no reference test is available. Our objective was to compare sensitivity and specificity estimates obtained with this reference-free approach and standard approaches, and to examine how and why they differed on a computerized tomography (CT) scan case study. STUDY DESIGN AND SETTING: We compared two sets of sensitivity and specificity estimates from four radiologists independently assessing tumoral and lymph node extension of 85 lung cancer patients with preoperative thoracic CT scan, those obtained relative to pathology findings from surgical specimens (reference set), and those derived from Hui and Walter's approach. RESULTS: The two sets of estimates significantly and markedly differed from each other. From simulations, we found that small-sample bias in Hui and Walter's estimates could be a major factor in explaining this difference. Furthermore, errors in pathology findings could account for part of this difference. Finally, our analyses revealed that the latent classes may differ intrinsically from the reference classes as defined from pathology findings and may have a different interpretation. CONCLUSION: Diagnostic parameters estimated with respect to latent classes may be more useful in providing a complete assessment of interobserver agreement than in assessing diagnostic performance.

Carcinoma, Non-Small-Cell Lung↗