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PubMed2003

Diagnostic pathology for the cancer patient.

It is necessary to have a cooperative relationship between the clinician and the pathologist, because information from both is critical for determining the best case management and favorable prognosis. The principle roles of the veterinary pathologist are to describe the submitted tissues, to determine the nature of the tumor, and to assess completeness of surgical margins. Recently, the Council of the American College of Veterinary Pathologists (ACVP) appointed an ad hoc committee on oncology to evaluate oncologists' needs by polling members of the Veterinary Cancer Society (VCS). The committee's vision was to review morphologic, immunologic, and molecular techniques so that veterinary pathologists could meet the current and future diagnostic and prognostic needs of oncologic veterinarians. The factors determined to be most important to the VCS members in selecting a diagnostic pathology provider included, in order of importance: (1) reliability of results; (2) short turnaround-time; (3) easy access for consultation; (4) rapport with pathologist; (5) convenience of service; and (6) cost of service. This manuscript will attempt to review improved morphologic, immunologic, and molecular techniques to provide for the future diagnostic and prognostic needs of oncologic veterinarians.

Animals↗
PubMed1992

[Serum selenium level as a diagnostic parameter in breast cancer].

The level of selenium in blood serum was determined in 33 patients with breast cancer, 13 women with verified mastopathy, and 43 healthy subjects from the Zagreb area. In the second and third quartiles the values of selenium obtained from sick subjects (41-58 micrograms/l) and healthy subjects (73-89 micrograms/l) differed significantly (p less than 0.001). In the group of subjects with mastopathy, serum selenium in the same way ranged from 67-70 micrograms/l and did not differ significantly from the group of healthy women, but differed significantly from the patients with breast cancer (p less than 0.001). Such a result leads to the conclusion that determination of selenium in the blood could be used as a noninvasive diagnostic parameter in clinical assessment of malignant breast disease.

Adenocarcinoma↗
PubMed2000

The value of transbronchial lung biopsy in the diagnosis of peripheral lung tumors according to cell type.

BACKGROUND: Transbronchial lung biopsy (TBLB) is a useful diagnostic tool for peripheral lung tumors. However, the success rate is variable. Our study was designed to investigate the value of TBLB without fluoroscopic guidance in the diagnosis of variable cell types of peripheral lung cancers. METHODS: A retrospective study was conducted to investigate a total of 597 patients who had undergone fiberoptic bronchoscopy for lung mass on chest X-ray in Chang Gung Memorial Hospital from January 1996 to December 1998. The lung masses were proven to be malignant by cytology and histology. RESULTS: Of 358 patients (60.0%) proven with malignancy, 107 patients presented with peripheral lung cancer (17.9%), including 59 with adenocarcinoma, 26 with squamous cell carcinoma, 11 with poorly differentiated carcinoma, 3 with small cell carcinoma, and 8 with metastatic cancers. The diagnostic rate of peripheral lung cancer by TBLB reached 54.2%. The sensitivity rates of detection of non-small cell type by TBLB were adenocarcinoma, 50.9%; squamous cell carcinoma, 61.5%; and poorly differentiated carcinoma, 72.7%, while that of small cell carcinoma was 100%. In contrast, the sensitivity rate of TBLB for metastatic cancers was lower (12.5%) than for primary lung cancers. Repeated TBLB of peripheral lung cancers increased the diagnostic rate from 49.5% to 54.2%. CONCLUSION: TBLB is an effective bronchoscopic sampling technique in the diagnosis of peripheral lung tumors without additional risk. The use of TBLB in the clinical routine should be encouraged.

Biopsy, Needle↗
PubMed2007

[Developments in cancer management by innovative genomics. 2006 report of the National Cancer Consortium].

Research on developing molecular diagnostics for hereditary cancers resulted in establishing diagnostic services for familiar polyposis and non-polyposis patients (mutation determination of APC, MYH, STK11, SMAD4, MLH1, MSH2). In familiar testicular cancers the role of gr/gr gene on Y chromosome was identified. Molecular diagnostic tool was established to monitor the progression of follicular lymphoma using Bcl-2/IgH fusion sequences. Molecular diagnostic tools were developed to monitor circulating endothelial precursor cells (CEP) as well and the technique was tested in lung cancer patients. In malignant melanoma we have tested several potential novel markers among which ryanodine receptor seems to be a promising one, while the functional P2X7 receptor may serve as a therapeutic target. We have determined the tyrosine kinase "kinome" profile of HER-2-amplified breast cancers. Furthermore, the "kinome" profile was found to be characteristic for head and neck cancers of various anatomical location. Based on previous studies on the anti-migratory and antimetastatic potential of low-molecular-weight heparins, we have identified short heparin-derived oligosaccharides with maintained antimetastatic- but non-anticoagulant potentials. Pharmacogenomic studies on the role of polymorphism of the serine-hydroxymethyl-transferase (SHMT) gene in the efficacy of 5-FU and FOLFIRI protocols of colorectal cancer patients revealed a significant effect resulting in altered overall survival as well.

Antineoplastic Agents↗
PubMed2001

Three-dimensional power Doppler ultrasound improves the diagnostic accuracy for ovarian cancer prediction.

OBJECTIVE: The goal of this study was to determine if three-dimensional power Doppler ultrasound improves the specificity for ovarian cancer detection as compared with two-dimensional ultrasound. METHODS: Seventy-one women with a known complex pelvic mass were referred for a preoperative ultrasound evaluation with both two-dimensional and three-dimensional gray-scale ultrasonography. The 3D studies were performed with the Kretz Voluson 530D using a mechanized transvaginal probe. Surface rendering and power Doppler imaging were performed by the same gynecologic sonologist, and reassigned to one of four echo patterns: cystic, multicystic, complex, or solid. Sonographic criteria used for diagnosing ovarian cancer were based on a system that included morphological characteristics, histological prediction, and power Doppler imaging. RESULTS: Seventy-one women underwent surgical exploration: 14 (19.7%) had ovarian cancer (2 FIGO stage I, 2 stage II, 7 stage III, and 3 metastatic colon) and 2 had uterine cancer. Two-dimensional gray-scale ultrasound identified 40 masses as suspicious for cancer, including all 14 malignancies, yielding a sensitivity, specificity, and positive predictive value of 100, 54, and 35%, respectively. However, evaluation with 3D power Doppler identified only 28 cases as suspicious (including all 14 cancers), resulting in a sensitivity, specificity, and positive predictive value of 100, 75, and 50%, respectively. CONCLUSIONS: Three-dimensional power Doppler imaging better defines the morphological and vascular characteristics of ovarian lesions. All malignancies were correctly identified by both 2D and 3D imaging; however, the specificity significantly improved with the addition of 3D power Doppler. This improved diagnostic accuracy may promote improved patient care by separating complex benign masses from ovarian cancer, therefore facilitating appropriate physician referral.

Adult↗
PubMed1983

Benign versus malignant hepatic lesions. A diagnostic dilemma with breast cancer patients.

The diagnosis of hepatic metastases heralds a grave prognosis in breast cancer patients. The authors describe seven patients with breast cancer who were found to have hepatic defects that were suspected to present metastatic disease on initial screening and investigations. However, these patients were subsequently shown to have benign hepatic lesions after careful history-taking and supplementary diagnostic techniques, in most cases with the aid of hepatic angiographic examinations. The authors believe that thorough investigation is indicated to elucidate the nature of hepatic defects, especially in cancer patients with no other site of metastatic involvement.

Adult↗
PubMed1988

Determinants of postoperative stay in patients with colorectal cancer. Implications for diagnostic-related groups.

The easiest way to reduce the cost of hospital care for patients is to reduce the length of hospital stay. Multivariate analysis was used to identify potentially alterable factors affecting postoperative length of stay for 320 consecutive colorectal cancer patients undergoing elective surgery during a three-year period. Prolonged postoperative stays were noted for patients over age 69. Significantly longer stays were seen for men than for women (13.9 vs. 11.9 days, P = .012). Operative procedure significantly influenced postoperative stay: left hemicolectomies, anterior resections with colostomy, abdominoperineal resections, and subtotal colectomies were associated with significantly longer stays than right, transverse, sigmoid, and anterior resections without colostomy (P less than .001). Complications increased the mean postoperative stay from 11.4 to 19.7 days (P less than .001) and stay increased progressively with the number of blood transfusions received from 11.1 days for no blood to 21.6 days for more than four units (P less than .001). Severity of disease, as reflected by Dukes' stage, tumor differentiation, and tumor size, was not related to postoperative stay. In the latter half of the study, postoperative stay declined, accompanied by a decline in the use of blood and a shift in the procedures performed for rectal carcinoma away from abdominoperineal resection toward anterior resection without colostomy. Diagnosis-related group (DRG) relative weights for procedure, age, and complications are at variance with these findings.

Age Factors↗
PubMed1980

Diagnostic cytology in breast cancer screening.

In the period 1977-1978, 245 solid or cystic breast tumors and 134 nipple secretions were evaluated cytologically at the Trieste Cancer Institute. The results are discussed in the light of literature reports, and the high incidence of unsatisfactory smears observed in the group of malignant lesions (14,7%) is attributed to incorrect technique in specimen collection. The incidence of false positives and false negatives was 0,2% and 2,9%, respectively. The data reported are insufficient for significant statistical conclusion, but nevertheless confirm further the diagnostic importance of breast cytology whose routine practice in patient study protocols for breast cancer is highly recommended.

Adenocarcinoma, Mucinous↗
PubMed2004

Evaluation of nuclear matrix protein-22 as a clinical diagnostic marker for bladder cancer.

OBJECTIVES: To evaluate prospectively the prognostic power of urinary nuclear matrix protein-22 (NMP-22) for bladder cancer in Taiwanese screening and surveillance settings. METHODS: Single voided urine samples were obtained from 68 healthy individuals, 303 patients with benign urothelial diseases, and 28 patients with urogenital tumors. The NMP-22 levels in the urine samples were measured using enzyme-linked immunosorbent assay methods. RESULTS: The median NMP-22 level in healthy individuals and patients with benign and malignant disease was 5.9, 4.8, and 7.4 U/mL, respectively. The positive NMP-22 rate in healthy individuals and patients with benign and malignant disease was 4.4%, 17.2%, and 50%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value was 50%, 82.8%, 21.2%, and 94.7%, respectively, using 7.5 U/mL as the cutoff value. CONCLUSIONS: Our data demonstrated that NMP-22 is not a good diagnostic tool for screening or follow-up surveillance of bladder cancer owing to its low sensitivity and positive predictive value. Nevertheless, it could be adopted as a tool to rule out the possibility or risk of developing bladder cancer because of its high negative predictive value in our study.

Adolescent↗
PubMed1989

Hospital costs, cancer patients, and gynecology diagnostic related groups.

This study of 115 Medicare gynecology patients in five noncancer-designated gynecology diagnostic related groups (DRGs) demonstrated that patients with a diagnosis of a malignancy (N = 52) had significantly higher hospital resource utilization compared to patients without a malignancy (N = 63) in these gynecology DRGs. Cancer patients had higher total hospital costs (P less than 0.001), longer hospital length of stay (P less than 0.01), significant financial losses under DRGs (P less than 0.01), greater percentage of outliers (P less than 0.05), greater severity of illness, and greater mortality (P less than 0.001) compared to noncancer patients in these same gynecology DRGs. These findings raise the question of whether hospitals will be adequately reimbursed by DRGs for many gynecology cancer patients. Disincentives for hospitals to treat gynecology cancer patients under the current DRG reimbursement system may affect both the access to and the quality of care.

Aged↗
PubMed2004

Position of positron emission tomography and other imaging diagnostic modalities in esophageal cancer.

Positron emission tomography (PET) using the positron emitting glucose analogue 18F-fluorodeoxyglucose (FDG) has emerged as a useful metabolism-based wholebody imaging tool for gastro-esophageal cancer diagnosis and follow up. Most large cancer centers worldwide are now equipped for PET (or even PET-CT). Therefore, there is a growing need for a clear definition of the relative position of PET within the currently available diagnostic modalities. Significant scientific data indicate that FDG-PET adds clinically useful information to the information obtained by standard means (mainly CT and endoscopic ultrasound) throughout the different phases of clinical patient management: 1) at initial diagnosis: PET detects more frequently distant lymph node involvement and organ metastases compared to conventional diagnostics, allowing a more accurate selection of the most appropriate treatment; 2) during chemotherapy: semi-quantitative FDG-PET allows early identification of non-responding patients. Indeed, the metabolic response as measured by serial FDG-PET can be used to predict the clinical and histopathological response. Moreover, the PET-response seems to be related to overall and disease free survival; 3) after a treatment: FDG-PET allows accurate assessment of the residual tumor load; 4) in the follow up: FDG-PET allows accurate detection and restaging of recurrent disease.

Esophageal Neoplasms↗
PubMed2001

Antibody-based diagnostic and therapeutic innovations for human cancer.

As adjuvants, antibody-based diagnostic and therapeutic innovations can potentially decrease morbidity and mortality associated with many human malignancies. Current strategies employing genetically modified constructs may improve tumor penetration and increase versatility.

Antibodies, Monoclonal↗
PubMed1992

The diagnostic value of barium enema in cancer of the corpus uteri.

The diagnostic value of barium enema in staging of carcinomas of the corpus uteri was evaluated in a retrospective study of 218 patients. The primary treatment in all patients was surgical. Barium enema was performed preoperatively in 48 (22%) of the patients and postoperatively in 106 (49%); 64 (29%) of the patients were not subjected to this investigation. Barium enema revealed changes possibly due to tumor in five patients (3%): two patients exhibited stenosis of the sigmoid colon due to a stromal sarcoma (Stages III and IV), and in one patient there was evidence that the primary tumor was in fact a carcinoma of the sigmoid colon. The suspicion of bowel involvement in the two other patients (both at Stage I) proved to be unfounded. These results show that barium enema is unnecessary in carcinoma of the corpus uteri at Stages I and II, and that in Stages III and IV the necessity for this investigation should be considered for each patient on an individual basis.

Adenocarcinoma↗
PubMed1982

[Clinical diagnostic value and diagnostic possibilities of visualization of the thoracic lymphatic duct using 113mIn-coind in cancer patients].

The diagnostic value of lymphoductoscintigraphy for involvement of mediastinal lymph nodes was assessed by intracutaneous injection of 113mIn-coind into interdigital spaces of feet of 82 patients with Hodgkin's disease and tumors of the uterus, breast, lung and testis. Disturbances in lymph flow in mediastinal lymph duct were detected in 39 cases. In 35 out of them, involvement of mediastinal lymph nodes was detected by X-ray examination. In 2 cases, metastatic lesions in lymph nodes were found during surgery, although X-ray examination failed to establish them. Application of 113mIn-coined lymphoductoscintigraphy should be recommended as a diagnostic procedure, because it provides sufficient information, does not interfere with main physiological functions, is simple and can be performed as often as required.

Adolescent↗
PubMed1981

[Diagnostic errors in esophageal cancer].

Cases of esophageal cancer are often admitted to oncological establishments at relatively late stages of tumor process: in 85%, the record of symptoms exceeds three months. The average duration of case histories before admission is 7.4 months. Diagnostic errors were established in the patients who had consulted the doctor during a period of less than 3 months after symptom development. This was due to the frequent appearance (41%) at initial stages of symptoms other than dysphagia which was misleading. However, even if dysphagia was apparent, primary X-ray examination failed to detect esophageal tumors in 20.1% of cases. Therefore, an endoscopic examination must be performed in cases of dysphagia. Whenever dysphagia is a consequence of esophageal burns, patients should undergo examinations at specialized oncological establishments for some years.

Aged↗
PubMed2001

Medical diagnostic X-ray radiation--an evaluation from medical records and dentist cards in a case-control study of thyroid cancer in the northern medical region of Sweden.

The aim of this study was to evaluate the association between thyroid cancer and diagnostic X-ray radiation based on medical records. By using the Swedish Cancer Registry, 187 living cases with thyroid cancer (81%), aged 20-70 years at the time of their diagnosis in 1980-1989 were identified in the Northern Health Care Region of Sweden. Seven cases were reclassified as having a disease other than thyroid cancer and were excluded. The investigation included 180 living cases and 360 controls from the National Population Registry. In 132 cases and 251 controls data from X-ray records on earlier investigations > 5 years prior to diagnosis and corresponding years for the controls were analysed. The mean calculated thyroid dose for the cases was 7.0 mGy (median 1.1) and for the controls 7.4 mGy (median 1.0). This study showed no difference in the total material between calculated absorbed thyroid dose of medical diagnostic X-ray in cases versus controls. In younger women (< or = 50 years at diagnosis) with papillary thyroid cancer an association was found, however it was not significant. The results could be related to selective bias and should be treated with caution. Future studies require analysis of diagnostic medical X-ray investigations involving the thyroid gland including more specific data on sex and age of exposure in the whole study group.

Adult↗
PubMed1978

Cancer of the pancreas: diagnostic accuracy and survival statistics.

We have reviewed the natural history, reliability of diagnosis, and survivorship of 100 patients with adenocarcinoma of the pancreas, in the context of a thorough review of the literature on survival after therapy for adenocarcinoma of the pancreas. There is 40--62.5% error in the histologic confirmation of the diagnosis of pancreatic cancer. The error by inspection and palpation alone at the time of surgery may be as great as 25%. The absolute 5 year survival rate calculated from 61 clinical studies representing approximately 15,000 patients is 0.4%. The best series in the current literature has only 3% 5 year rate based upon the total population of pancreatic cancer patients. 12.3% of 5 year survivors from the world literature did not have curative surgery. This study shows the necessity for standardization of reporting methods. The same patients and survivors should not be used repeatedly in different reports. Some authors who claim the most effective palliation by pancreatic resection have the highest mortality rates.

Adenocarcinoma↗
PubMed2001

Computer-assisted diagnostics: application to prostate cancer.

Artificial neural networks (ANNs) have only recently been applied to solve problems in the diagnosis, staging, and prediction of treatment outcome in prostate cancer. A literature search provided information on 10 published journal articles that were selected for review and analysis. In all but one of the studies that compared the ANN output with logistic regression modeling, the ANN performed better. Specific training issues for neural networks are discussed and examples provided. We conclude that the continued development and refinement of computer-assisted diagnostic methodology are warranted to enhance conventional statistical approaches to the classification and pattern recognition found in data sets from men either suspected of having or known to have prostate cancer.

Diagnosis, Computer-Assisted↗