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At least 127 records · Page 7Linked to original sources

Increasing prostate biopsy cores based on volume vs the sextant biopsy: a prospective randomized controlled clinical study on cancer detection rates and morbidity.

OBJECTIVE: To determine if a volume-adjusted increase in the number of biopsy cores could detect more prostate cancers than the standard sextant biopsy alone, without increasing morbidity, and to determine its applicability in Malaysian patients, as a standard sextant biopsy misses 20-25% of prostate malignancies. PATIENTS AND METHODS: In a prospective randomized study of patients undergoing transrectal ultrasonography (TRUS)-guided biopsy for a prostate-specific antigen (PSA) level of 4-20 ng/mL without abnormal digital rectal examination (DRE), the men were divided into five main groups (A-E) with prostate volumes of <20, 20-40, 40-60, 60-80 and >80 mL, respectively. Patients in groups B-E were randomized into sextant (B1 to E1) and increased biopsy-core subgroups, i.e. B2 (eight cores), C2 (10 cores), D2 (12 cores) and E2 (14 cores). The morbidity profile was also evaluated during and after TRUS biopsy, assessing a pain score, rectal bleeding, haematuria, haemospermia and development of fever. In all, 132 patients were recruited (mean age 67.8 years; mean PSA 9.41 ng/mL). RESULTS: The overall cancer detection rate was 24% (32 men). Taking more cores detected 65.5% of cancers, and the sextant biopsy 34.5% (P = 0.0025), but did not increase the overall morbidity. CONCLUSIONS: The volume-adjusted, increased-core regimen significantly increased the positive biopsy rate of TRUS-guided prostate biopsies with no added morbidity.

Aged↗

[End results of gastric cancer detected by mass survey: analysis using the relative survival rate curve].

In the 15-year period 1970 to 1984, the Detection Center of Hokkaido Cancer Society discovered 2,508 gastric cancer cases (1,681 male, 827 female) including 999 cases of early gastric cancers. The survey included 2.01 million people in Hokkaido. Among the cases, 2,508 were diagnosed as stomach cancer, which amounted to 0.12% of the total screened during the period. The proportion of early gastric cancers has been increased over this period. Of those suffering from gastric cancer, 2,287 cases were operable. Mucosal carcinoma accounted for 479 cases, carcinoma with invasion to submucosa accounted for 520 cases. Early gastric cancer numbered 999 cases, or 43.6% of the operable cases. Advanced cancer or cancer with invasion beyond the muscularis propria totalled 1,288 cases, or 56.4% of the operable cases. The relative survival rate was calculated which shows the survival ratio of detected cancer cases to the general population: 67.8% 5-year, 64.0% 10-year and 63.5% 15-year survival rate. These results show that cancer detection leads to a good relative survival rate. The relative survival rate flattens after five years, because the curve of the survival rate of cancer patients decreases gradually, while the expected survival rate of the general population remains constant. If lead time is not considered, the 5-year relative survival rate is satisfactory: if it is considered, however, the 10- or even 15-year survival rate may well be estimated. The 15-year relative survival rate of surgically treated early gastric cancer, advanced gastric cancer and total cancer are 94.0%, 51.0% and 70.7% respectively. These data clearly show that early gastric cancer treated surgically carries an excellent chance for 15-year survival when compared to advanced cancer. One may also note the relatively high survival rate of 63.5% in all gastric cancer patients discovered by this program; this figure reflects a high proportion of early gastric cancer among all cancers. As presented, the mass screening program does have positive effects in reducing gastric cancer deaths by detecting more early gastric cancer cases than among usual clinic patients.

Female↗

Are extended biopsies really necessary to improve prostate cancer detection?

The aim of this study is to understand the value of specific sites in extended peripheral and transition zone biopsy schemes in order to define the optimal systematic biopsy regimen correlated with the percentage of positivity of each single bioptic site. A total of 165 consecutive patients underwent transrectal ultrasonography examination to detect prostate cancer followed by a lesion-directed and systematic 14-step biopsy scheme. The detection rate was examined for the lesion-directed and for each zone region biopsy. The frequency of positive biopsies in the various prostate regions was determined to evaluate the diagnostic yield of each biopsy site. Analysis was stratified for prostate-specific antigen (PSA), free-to-total PSA ratio, age, prostate size and digital rectal examination. The biopsy protocol detected 40% of patients (66/165) as positive and 55.1% (91/165) as negative for cancer. Standard sextant biopsy was expected to detect only 51 cancer on 66, lateral peripheral (PZ), transition (TZ) and central zone (CZ) biopsies only 56 cancer on 66, while the combination of sextant, PZ, TZ and CZ biopsies, for a total of 14 zone biopsies, detected 64 on 66 patients with cancer (97%) at recruitment. Sampling only the eight prostate regions with higher frequency of positive cancer biopsy was expected to detect 61 cancer patients against the 64 found with the 14-step scheme. This eight-biopsy regimen outperforms the conventional sextant regimen in cancer detection rate (93 vs 77%) and has an overall detection rate lower by only 3.1% (36.9 vs 40%) compared to the 14-biopsy regimen. This difference in detection rate is even smaller in patients with PSA values <10 ng/ml, age <70 y and prostate size <50 ml. This eight-biopsy scheme, including sampling in PZ and TZ toward the base, should be considered in an initial biopsy scheme to maintain a similar detection rate of an extensive biopsy scheme reducing the number of biopsies.

Biopsy↗

Use of intensified early cancer detection in high-risk patients with familial breast and ovarian cancer.

A prospective follow-up study was carried out to evaluate the influence of risk and genetic counselling on use of early cancer detection. Five hundred and fifty-six subjects who fulfilled inclusion criteria for a genetic analysis of the BRCA1/2 genes (the high-risk group A) and 205 who did not fulfil the inclusion criteria (the lower risk group B) attended primary consultation in the interdisciplinary cancer genetic clinic. Information about participation in the early cancer detection programme was documented. Information about changes in use after consultation could be evaluated from 349 women (94 group B and 255 group A). Methods such as monthly self-palpation, breast palpation by gynaecologist, ultrasound of the breast, transvaginal ultrasound and pelvic examination had all been commonly used. Consultees at higher risk used mammography less often than women at lower risk. Magnetic resonance imaging of the breast was used rarely. Most methods were used more often at the recommended interval by women at higher risk during the follow-up period. In conclusion, at present intensified early cancer detection programmes for women at risk provide a less invasive option than chemoprevention or prophylactic surgery. Although the methods are used at high frequency it seems feasible to motivate women at risk to participate. This can be done by providing information and counselling in the cancer genetic clinic.

Adult↗

Biomarkers in molecular medicine: cancer detection and diagnosis.

In spite of advances in diagnostics and therapeutics, cancer remains the second leading cause of death in the U.S. Successful cancer treatment depends not only on better therapies but also on improved methods to assess an individual's risk of developing cancer and to detect cancers at early stages when they can be more effectively treated. Current cancer diagnostic imaging methods are labor-intensive and expensive, especially for screening large asymptomatic populations. Effective screening strategies depend on methods that are noninvasive and detect cancers in their early stages of development. There is increasing interest and enthusiasm in molecular markers as tools for cancer detection and prognosis. It is hoped that newly discovered cancer biomarkers and advances in high-throughput technologies would revolutionize cancer therapies by improving cancer risk assessment, early detection, diagnosis, prognosis, and monitoring therapeutic response. These biomarkers will be used either as stand-alone tests or to complement existing imaging methods.

Biomarkers, Tumor↗

Proceedings: the Applications of Bioinformatics in Cancer Detection Workshop.

The Division of Cancer Prevention of the National Cancer Institute sponsored and organized the Applications of Bioinformatics in Cancer Detection Workshop on August 6-7, 2002. The goal of the workshop was to evaluate the state of the science of bioinformatics and determine how it may be used to assist early cancer detection, risk identification, risk assessment, and risk reduction. This paper summarizes the proceedings of this conference and points out future directions for research.

Computational Biology↗

[The Health and Medical Services Law for the elderly and early cancer detection].

Anti-cancer measures in Japan were started in the 1950s, and programs for the early detection of stomach and cervical cancer supported by the National Government were begun in 1966 and 1967, respectively. In 1983 the Health and Medical Services Law for the Elderly was enacted, and under this law nationwide early detection programs for stomach and cervical cancer have been under taken and the number of people screened has been steadily increasing. Accuracy control programs for these cancer detection systems are now being established by prefectural governments. The examination of programs for the early detection of lung cancer and breast cancer will be necessary when suitable methods have been established.

Aged↗

Early colon cancer detected by 18F-FDG PET.

Positron emission tomography (PET) is a noninvasive functional imaging modality that can disclose the presence of a malignant disease. It has recently been reported that PET may be useful to detect primary colorectal cancer (CRC). We present the case of a 47-yr-old man with early colon cancer detected by 18F-fluorodeoxyglucose (FDG) PET. The patient consulted us because of a positive fecal occult blood test and focal FDG uptake in the pelvic cavity detected at a physical check-up. After the usual work up, he was diagnosed as having a sigmoid polyp, 16 mm in diameter. Subsequently, colonoscopic polypectomy was carried out. The surgical specimen was histologically diagnosed as a well-differentiated adenocarcinoma, invading the submucosal layer with lymphatic invasion. Therefore, the involved portion of the sigmoid colon was laparoscopically resected. The FDG PET carried out 1 yr after the operation, showed no abnormal FDG uptake. PET can noninvasively detect an early colon cancer as small as in our patient, as well as other cancers in the whole body. Therefore, we consider it suitable as a screening examination.

Adenocarcinoma↗

Twenty-year follow-up of minimal breast cancer from the Breast Cancer Detection Demonstration Project.

Since the 1960s, the potential benefits of early detection of breast cancer through screening with physical examination and mammography have been studied. In a mass screening study begun in 1973 by the Breast Cancer Detection Demonstration Project (BCDDP), mammography detected 90% of the cancers that were diagnosed. Of the women aged 35 to 74 years from the BCDDP study who were diagnosed with minimal breast cancer, the 20-year cumulative breast cancer survival rates were 95.8% for 469 women with in situ breast cancer and 82.8% for 769 women with invasive breast cancers 1 cm or smaller in size.

Breast Neoplasms↗

Highlights of the evidence of benefit for women aged 40-49 years from the 14-year follow-up of the Breast Cancer Detection Demonstration Project.

Randomized breast cancer screening trials are helpful in establishing evidence of benefit when they yield statistically significant results. The results of individual randomized screening trials can vary greatly depending on the quality of the images, the frequency of screening, compliance, contamination, sample size, and the length and adequacy of follow-up. For women 40-49 years of age at entry the first randomized breast cancer screening trial, the Health Insurance Program of Greater New York (HIP), showed a statistically significant decrease of 24% in breast cancer mortality at 18 years of follow-up, virtually the same as the 23% decrease seen in women 50-59 years of age. At 10-12 years of follow-up, five of seven randomized trials have shown nonstatistical decreases in breast cancer mortality. No trials with fewer than 8 years of follow-up have shown a decrease in mortality for women 40-49 years of age; whereas seven trials have shown a decrease for women older than 50 years of age. The largest study on the screening of women aged 40-49 (93,471) was the Breast Cancer Detection Demonstration Program (BCDDP). This demonstration program was not a randomized trial but has yielded indirect supportive evidence for the screening of women aged 40-49, by comparing age group results. Three highlights of these studies are presented: (1) Mammography in the BCDDP (1970s) was improved greatly compared to that in the HIP study (1960s). Mammography detected 40% of the cancers in women 40-49 years of age in the HIP compared to 90% in the BCDDP. In women 50-59 years of age, mammography detected 60% of cancers in the HIP but 92% in the BCDDP. (2) Using annual two-view mammography plus clinical breast examination after the first screen of women 45 years of age and older, subsequent detection rates were virtually the same for all age groups. The number of women screened annually yields slightly more than two breast cancers per 1000 women, regardless of age group. (3) Similar types, sizes, stage distributions, and survival and case fatality rates were demonstrated in women aged 40-49, 50-59 and 60-69 years.

Adult↗

Teaching early breast cancer detection strategies.

Breast cancer is the most common cancer occurring among women. Currently, breast cancer can be detected early and treated effectively if all asymptomatic women participate in the screening program. Screening strategies include a mammogram, medical examination of the breast, and breast self-examination. This article describes the nurse's role in promoting and decreasing barriers to these strategies for early detection of breast cancer.

Adult↗

Cancer detection and mammogram volume of radiologists in a population-based screening programme.

This study investigates the relationship between the number of screening mammograms read by radiologists and the screening breast cancer detection rate. Cancer detection rates for incident screens (all women aged 40 years) were compared by increasing categories of reader volume using Poisson regression. Data from New South Wales (NSW) for a 2 year period (2000-2001) were obtained from the BreastScreen NSW programme. Cancer detection rates increased with the number of mammograms read in the programme, reaching a plateau of approximately 40 per 10,000 after 1375 mammograms per year. No significant differences in cancer detection were evident above 875 mammograms (compared to below 875 mammograms) per year (RR=0.79, 95% CI 0.63-0.99).

Adult↗

Instrumental variables when evaluating screening trials: estimating the benefit of detecting cancer by screening.

When evaluating the benefit of detecting cancer by screening we try to answer the question, 'what would a screen detected subject's outcome have been if his/her cancer had progressed to clinical detection'. By 'outcome' we mean survival time, cancer size and stage, lead time effects and more. Because only an unethical study can answer it directly, researchers have attempted to answer the question indirectly using data from randomized cancer screening studies (subjects randomized to study (screened) or control (not screened)). Inferences are made by first selecting the cancer cohort (those subjects who are found to have cancer), then comparing subjects having screen detected cancers to subjects having clinically detected cancers. However, there are two difficulties with this approach: (i) because screening (intends to) detect cancers early, at the trial's end the study group contains more cancer cases than the control group and so the cancer cohort has some unidentified control subjects missing (that is, subjects having cancer during the screening period that have not yet been clinically detected); (ii) because screen detected cancers (may) differ from clinically detected cancers, the comparison group should include only a (non-identified) subset of the cancer cohort's control subjects (that is, only those control subjects having cancers that would have been screen detected). Statistical literature acknowledges these difficulties and attempts to solve them separately, but without success; those methods do not yield meaningful causal inferences and admit substantial bias. Recently, Angrist, Imbens and Rubin and Imbens and Rubin provide a framework for instrumental variable methods that we interpret as allowing us to make causal inferences with incompletely identified comparison groups. We apply their framework to evaluating cancer screening trials and find that we may simultaneously accommodate both difficulties while giving a meaningful answer to the question posed above. Using data from a breast cancer screening trial we demonstrate the general method with a variety of outcome measures and extensions.

Adult↗

Prognostic value of morphometry and DNA flow-cytometry features of invasive breast cancers detected by population screening: comparison with control group of hospital patients.

Using the prognostic value of morphometric and flow-cytometric features, a group of patients with invasive breast cancers detected with population screening (PS, n = 70) has been evaluated and compared with a random control group in 2 hospitals (H group, n = 225) diagnosed in the same period. The results show that the PS patients had smaller tumors, less positive lymph nodes, better differentiated tumors with a lower mitotic activity index (MAI) and lower values of the morphometric prognostic index (MPI). Furthermore, the women more frequently had diploid tumors and tumors with small nuclei. The second purpose was to evaluate whether quantitative microscopical features, in comparison with other prognostic features such as size of primary tumor, nodal status and histologic grade, are as strong prognosticators in PS tumors as in H-detected breast cancers. In comparison with H tumors, morphometric and flow-cytometric features, as well as tumor size, had the same prognostic value for the PS tumors. In contrast, nodal status was not significant within the PS group, and the same phenomenon was found in a subgroup of H patients with similar sized tumors. Of all quantitative microscopical features (MPI, MAI, mean nuclear area (MNA) and DNA Index (DI], the MAI had the strongest prognostic value. DI showed additional prognostic value to the MAI for patients with small tumors and with small tumor-cell nuclei, because a diploid pattern in these cases (this combination occurred in 21 patients of the total group = 30%) was correlated with a 95% 10-year survival rate. Histologic grade, although significant within the large H group, was of no prognostic value within the PS group, and also not as in the H sub-group with small tumors. It is concluded from morphometric and DNA flow-cytometric criteria that these prognostic features in invasive breast cancers detected by PS were all more favorable than in randomly detected hospital breast cancers. This may account for the reported better survival rate of PS patients. Furthermore, the prognosis of patients with small invasive breast cancers detected by population screening can be more accurately deduced by quantitative microscopical features than by axillary-lymph-node status.

Aged↗

Needle core length in sextant biopsy influences prostate cancer detection rate.

OBJECTIVES: Prostate cancer detection in biopsies increases with the number of sites and total tissue sampled. Its dependence on needle core fragment length is uncertain. METHODS: We surveyed two consecutive series of sextant needle biopsies from two practices in 1998 to 2000: 251 patients from Pennsylvania (group P) and 1596 from Virginia (group V). We tabulated the gross needle core lengths per sextant site and classified the diagnoses as benign or into four nonbenign categories: high-grade prostatic intraepithelial neoplasia; atypical small acinar proliferation, suspicious; atypical small acinar proliferation, suspicious plus high-grade prostatic intraepithelial neoplasia; and cancer. Logistic regression analysis was used to correlate cancer or a nonbenign diagnosis with the total length (sum of six sites) and, after excluding the sites with more than one core, with the length per single core, and the anatomic site of origin (apex, mid-gland, base). RESULTS: The mean total tissue length sampled was 108 +/- 27 mm (range 30 to 275) in group P and 81 +/- 22 mm (range 30 to 228) in group V. Sextant sites with a single core contained a mean of 12.8 +/- 3.5 mm tissue, with a 3.6-fold variation among the middle 95%. Group V core lengths at the apex averaged 11.8 mm, shorter (P = 0.0001) than mid (13.3 mm) or base (12.7 mm). A predictive value of longer length for a nonbenign diagnosis was noted in four of six sextants (P <0.04), with trend strongest at the apex, for which detection was influenced by abnormal digital rectal examination (P = 0.02) or ultrasound (P = 0.04) findings. CONCLUSIONS: The length of single cores sampled by sextant biopsy can vary more than 3.6-fold and represents a quality assurance consideration. The effect of length on cancer or nonbenign detection was maximal at the prostatic apex where the cores were shortest.

Biopsy, Needle↗

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↗

[Cancer detection with whole-body FDG PET images without attenuation correction].

Whole-body positron emission tomography (PET) using 2-deoxy-2-[18F]fluoro-D-glucose (FDG) has been applied successfully for the detection of cancer. In PET studies, transmission scans for attenuation correction are usually performed. In whole-body PET studies, however, the transmission scans lengthen the acquisition time and are not practical for routine clinical use. Thirty-two patients underwent whole-body PET studies with transmission scans. A total of 106 lesions were true positive on corrected images. At the same time that the corrected images were being reconstructed, uncorrected images were also reconstructed and visually inspected. In a patient with a large breast cancer (11 cm in diameter), the parasternal metastatic lymph node was not identified on the uncorrected image because of image artifacts produced by high FDG accumulation in the breast cancer. In a patient with recurrent colonic cancer, paraaortic metastatic lymph nodes were not well visualized because of attenuation effects. However, 104 out of 106 (98.1%) lesions were recognizable on uncorrected images as well as corrected images. This suggests that uncorrected images can be used for the detection of cancers.

Adult↗

Recent molecular advances in the approach to early lung cancer detection and intervention.

Lung cancer is a major contributor to overall cancer mortality. Detecting lung cancer while it is still a localized process is a long-cherished goal for improving the outcome of this disease. Recent developments suggest that we are approaching this capability. We next have to think about how to implement a change in our approach to lung cancer management to derive the benefit of better detection capability. This is an area in which our growing understanding of lung cancer biology is providing clues on improving the inhibition of cancer progression.

Apoptosis↗