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PubMed2006

Multi-detector CT in the evaluation of patients with recurrence of rectal cancer.

The advantages of multiplanar reconstruction in rectal cancer recurrence diagnostics using medium resolution multi-detector CT are evaluated. We included 40 patients after a rectal cancer operation in this study. During follow-up ten patients developed a recurrence. All patients received a minimum of two CT-examinations in their follow-up program. A total of 131 CT-scans were evaluated. Each examination was reviewed by two experienced radiologists in respect to recurrence. Each examination was presented in axial reconstruction with a slice thickness of 8mm with an increment of 7 mm and a slice thickness of 3 mm with an increment of 2 mm. The thin slices were used for the multi-planar reconstruction. Multi-planar reconstructions showed better results for the detection of recurrence than axial reconstruction. A reduced slice thickness did not lead to better results in axial reconstruction. Multi-planar reconstruction showed a sensitivity of 0.88, a specificity of 1.0 and an accuracy of 0.97. Our axial reconstruction results were: 0.86, 0.96, and 0.93, respectively. Sensitivity and accuracy showed a significant increase after the first and second examinations. Multi-planar reconstructions allow for better detection of rectal cancer recurrence when compared to axial reconstructions. Thinner axial slice thickness shows no diagnostic advantage.

Adult↗
PubMed2005

Screening women at high risk for breast cancer with mammography and magnetic resonance imaging.

BACKGROUND: The authors compared the performance of screening mammography versus magnetic resonance imaging (MRI) in women at genetically high risk for breast cancer. METHODS: The authors conducted an international prospective study of screening mammography and MRI in asymptomatic, genetically high-risk women age >/= 25 years. Women with a history of breast cancer were eligible for a contralateral screening if they had been diagnosed within 5 years or a bilateral screening if they had been diagnosed > 5 years previously. All examinations (MRI, mammography, and clinical breast examination [CBE]) were performed within 90 days of each other. RESULTS: In total, 390 eligible women were enrolled by 13 sites, and 367 women completed all study examinations. Imaging evaluations recommended 38 biopsies, and 27 biopsies were performed, resulting in 4 cancers diagnosed for an overall 1.1% cancer yield (95% confidence interval [95%CI], 0.3-2.8%). MRI detected all four cancers, whereas mammography detected one cancer. The diagnostic yield of mammography was 0.3% (95%CI, 0.01-1.5%). The yield of cancer by MRI alone was 0.8% (95%CI, - 0.3-2.0%). The biopsy recommendation rates for MRI and mammography were 8.5% (95%CI, 5.8-11.8%) and 2.2% (95%CI, 0.1-4.3%). CONCLUSIONS: Screening MRI in high-risk women was capable of detecting mammographically and clinically occult breast cancer. Screening MRI resulted in 22 of 367 of women (6%) who had negative mammogram and negative CBE examinations undergoing biopsy, resulting in 3 additional cancers detected. MRI also resulted in 19 (5%) false-positive outcomes, which resulted in benign biopsies.

Adult↗
PubMed2003

Pseudomass of the bladder neck after prostatectomy: report of two cases.

The authors reviewed ultrasonographic (US) images, cystoscopic findings, and biopsy results at the vesicourethral anastomosis in two patients suspected of having local recurrence after radical prostatectomy. A focal, masslike bulge was identified with US at the posterior aspect of the bladder neck, just above the anastomosis. This bulge mimicked the appearance of local recurrence of cancer; however, diagnostic studies, biopsy results, and clinical follow-up failed to demonstrate recurrent cancer. A review of the surgical technique led the authors to conclude that a pseudomass at the vesicourethral anastomosis may result from focal infolding of normal bladder mucosa.

Aged↗
PubMed2003

[Diagnostic conization of the uterine cervix and its effect on survival of patients after Wertheim-Meigs hysterectomy].

The aim of this retrospective work was to evaluate the diagnostic conization and its influence on morbidity and survival of patients with cervical cancer IB and IIA stage after radical hysterectomy a modo Wertheim-Meigs. The impact and influence of the irradical conization on the lymph node metastases and prognosis was analyzed. 535 patients in stage IB and IIA were examined for the period of 1990 and 2002. All of them were radically operated by Wertheim-Meigs method. There were 35 patients mainly from the countryside, who were treated by conization priory to radical hysterectomy. The time interval between the conization and the radical hysterectomies was between 5 and 8 weeks. The surgical morbidity and death incidence for patients with prior conization was not significantly different from other patients with directly radical hysterectomies. The survival was not significantly different between the two groups (84% vs 81%, p = 0.21). The Multivariate analysis which we used showed us that the irradical conization is not connected with higher risk of metastases or poor prognosis. We think that in early cervical cancer, the diagnostic conization has no adverse negative effect on the following radical hysterectomy a modo Werheim-Meigs. The irradical conization has no influence on prognosis.

Cervix Uteri↗
PubMed2006

Reported symptoms, diagnostic delay and stage of colorectal cancer: a population-based study in Denmark.

OBJECTIVE: The primary prognostic factor for colorectal cancer (CRC) is stage. Any association between symptoms, diagnostic delay and stage may have implications for the clinical course of the disease. We examined the association between symptoms and diagnostic delay and between symptoms and stage, and assessed whether the associations differed for colon cancer (CC) and rectal cancer (RC). PATIENTS AND METHODS: Population-based prospective observational study based on 733 Danish CRC patients. Diagnostic delay and patients' reported symptoms were determined through questionnaire-interviews. Dukes' stage was obtained from medical records and pathology forms. Diagnostic delay was categorized into three delay groups: < or = 60, 61-150 and > 150 days. Stage was classified into nonadvanced (Dukes' A and B) or advanced (Dukes' C and D) cancers. We calculated the frequency of the most frequently reported initial symptom or symptom complex for CC and RC patients, and evaluated the frequency of patients with different initial symptoms/symptom complexes in the three delay groups. For the most frequent initial symptoms/symptom complexes, we calculated the frequencies according to stage, and estimated the relative risk of having an advanced stage, with 95% confidence intervals. RESULTS: The most frequent initial symptoms/symptom complexes were very vague symptoms for CC and rectal bleeding for RC. For both CC and RC, rectal bleeding was significantly associated with nonadvanced stage. The relative risk of having an advanced cancer was 0.6 for monosymptomatic rectal bleeding and 0.7 for rectal bleeding combined with other symptoms. CONCLUSIONS: Initial symptoms of CC were often very vague, making it difficult to identify a precise start date. The most frequent initial symptom/symptom complex for RC - rectal bleeding - was better defined. Rectal bleeding was significantly associated with nonadvanced CC and RC and a significantly decreased relative risk of having an advanced cancer.

Colonic Neoplasms↗
PubMedDate not supplied

[Computed tomography in the diagnosis of gastric cancer].

The potentialities of x-ray computer-aided tomography (CAT) in the studies of intraparietal blastomatous infiltration are analyzed as shown by examinations of 134 patients with gastric cancer. The diagnostic efficacies of various modifications of CAT (filling of the stomach with liquid, pneumoscanning of the stomach with or without tubes) are assessed. Good diagnostic potentialities of tubal scanning of the stomach in the assessment of intraparietal tumor infiltration are demonstrated. CAT semeiotics of gastric cancer is presented, characterizing the tumors with predominantly intraparietal dissemination of blastomatous infiltration. The existent projection limitations of axial CAT of individual portions of the stomach and high price of the examination imply that the indications to the use of this method in gastrooncology should be clearly defined. At the same time, scrupulous adherance to methodologic requirements aimed at imaging of intraparietal changes in gastric cancer may help to solve a number of differential diagnostic difficulties, primarily those connected with predominantly submucously growing carcinomas.

Aged↗
PubMed1991

Diagnostic utility of oncogenes and their products in human cancer.

The first clear cut association of an oncogene with a specific cancer is the c-abl translocation in chronic myelogenous leukemia and acute lymphocytic leukemia; it has been observed in 90% of CML cases examined. This is the major contributing factor to its being the target of the first oncogene-based FDA-approved diagnostic test. Although the role of the abl translocation in the tumorigenic process is not yet understood, it is clear that somehow it must be causally related to the disease, and thus is an ideal target for a diagnostic test. The association of this oncogene with a specific cancer is the model on which all others may be based in the future. Second generation tests could easily include PCR on mRNA, and/or in situ hybridization, both of which could be performed using blood samples. Both methods would provide a faster means of testing a large number of cells, however, the methodologies must be improved through automation and computer-aided image analysis, respectively, in order to become useful routine tests. Both neu and epidermal growth factor receptor (EGFR) appear to have a close correlation between overexpression of the gene product and outcome of disease in breast cancer; valuable information for prognosis of the disease. And again, although the actual mechanism of action of these molecules and how this relates to the tumorigenic process is not yet known, it is believed from the very nature of the molecules that they must in some way contribute to the progression of the disease. In both cases, the protein products are overexpressed in tissue, and in the case of Neu, it appears as through at least some of the patients have a Neu-related protein in their serum. These molecules present relatively easy targets for the development of diagnostic/prognostic assays, as antibodies are easily made and can be incorporated into a variety of assay formats. Current assays available, an ELISA for Neu and a radio-ligand binding assay for EGFR, are highly sensitive, reproducible and relatively easy to perform. Only the ELISA is commercially available, however, and hence allows for easy comparison between laboratories. An abvious step towards the routine measurement of EGFR then is the development of a comparable commercially available test. An improvement for both types of assay would be the incorporation of an internal control to gauge the cellular component of the tissue samples that are tested. The outcome of the applications of myc and ras to cancer diagnostics is not so easily predictable, with a couple of exceptions.(ABSTRACT TRUNCATED AT 400 WORDS)

Female↗
PubMed1998

[Diagnostic molecular biology in breast cancer].

Studies of molecular genetic changes in breast carcinoma are slowly improving our understanding of the biological process which leads to a normal breast epithelial cell becoming a carcinoma cell with invasive and metastatic properties. Carriers of germ-line mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 are particularly prone to develop breast cancer. Genetic screening and counselling programs have been established to identify individuals at high risk and provide intervention to reduce the suffering and mortality associated with breast cancer. In the future, the identification of specific molecular genetic changes in tumours may be applied as diagnostic and prognostic tools. An improved understanding of the molecular genetic mechanisms underlying the development of breast cancer may eventually yield novel therapeutic strategies, attacking specific genetic changes in the tumour.

Biomarkers, Tumor↗
PubMed2000

Preoperative serum CD26 levels: diagnostic efficiency and predictive value for colorectal cancer.

CD26 is an ectoenzyme with dipeptidyl peptidase IV activity expressed on a variety of cell types. Although the function of the high concentration of serum-soluble CD26 (sCD26) is unknown, it may be related to the cleavage of biologically active polypeptides. As CD26 or enzymatic activity levels were previously associated with cancer, we examined the potential diagnostic and prognostic value of preoperative sCD26 measurements by ELISA in colorectal carcinoma patients. We found a highly significant difference between sCD26 levels in healthy donors (mean 559.7 +/- 125.5 microg l(-1)) and cancer patients (mean 261.7 +/- 138.1 microg l(-1)) (P< 0.001). A cut-off at 410 microg l(-1)gave 90% sensitivity with 90% specificity which means that the diagnostic efficiency of sCD26 is higher than that shown by other markers, particularly in patients at early stages. Moreover, sCD26 as a variable is not related with Dukes' stage classification, age, gender, tumour location or degree of differentiation. With a follow-up of 2 years until recurrence, preliminary data show that sCD26 can be managed as a prognostic variable of early carcinoma patients. In addition, the origin of sCD26 is discussed.

Adult↗
PubMed1998

Can urine bound diagnostic tests replace cystoscopy in the management of bladder cancer?

PURPOSE: We compare the diagnostic value of NMP22 and BTA stat testing, and QUANTICYT computer assisted dual parameter image analysis to cytology and cystoscopy in patients who had symptoms suggestive of transitional cell cancer or were being followed after treatment for that disease. MATERIALS AND METHODS: We prospectively evaluated voided urine and/or barbotage specimens from 291 patients a mean of 65.2 years old. All voided urine samples were evaluated by quick staining and standard cytology, the BTA stat 1-step qualitative assay (which detects a bladder tumor associated antigen) and the NMP22 test (which detects a nuclear mitotic apparatus protein). In addition, barbotage specimens were evaluated by QUANTICYT computer assisted dual parameter image analysis. All patients underwent subsequent cystoscopy and biopsy evaluation of any suspicious lesion. Sensitivity, specificity, and the predictive value of positive and negative results were determined in correlation with endoscopic and histological findings. RESULTS: In 91 patients with histologically proved transitional cell carcinoma overall sensitivity was 48, 57, 58, 59 and 59% for the NMP22 test, the BTA stat test, rapid staining cytology of barbotage samples, rapid staining cytology of voided urine specimens and image analysis, respectively. For histological grades 1 to 3 underlying transitional cell carcinoma sensitivity was 17, 61 and 90% for urinary cytology, 48, 58 and 63% for the BTA stat test, and 52, 45 and 50% for the NMP22 test, respectively. Specificity was 100% for cytology, 93% for image analysis, 70% for the NMP22 test and 68% for the BTA stat test. CONCLUSIONS: Immunological markers are superior to cytological evaluation and image analysis for detecting low grade transitional cell carcinoma but they have low specificity and sensitivity in grade 3 transitional cell carcinoma. Urine bound diagnostic tools cannot replace cystoscopy.

Adolescent↗
PubMed1997

[Colonic cancer: from molecular diagnosis to diagnostic and therapeutic procedure].

Studies of tumour cell genetic alterations have demonstrated the existence of two distinct groups of colorectal cancers. The first one is characterised by the existence of hyperploid tumour cells and frequent loss of heterozygosity. These colorectal cancers are the most common. The second one is characterised by the presence of microsatellite instability. Among the most frequent genetic alterations, the loss of heterozygosity on the short arm of chromosome 17 and the long arm of chromosome 18 seems to be indicators of a pejorative prognosis. In the same way the existence of a p53 mutation in tumour cells has been demonstrated as an independent prognostic factor in colorectal cancer. The indication of an adjuvant chemotherapy on the basis of such genetic alterations remains to be demonstrated by randomised trials.

Chromosome Mapping↗
PubMed1996

Mammography in men with breast cancer: review of the mammographic findings in five cases.

Male breast carcinoma is an uncommon malignancy. The age at diagnosis and tumour stage are more advanced in males than in females. Poor alertness of both men and physicians for this infrequent disease may account for the delay in diagnosis. In this study, we reviewed male breast carcinomas seen within a 3 year period and assessed the mammographic findings. There is limited experience in the diagnosis of breast carcinoma in male patients and this has been considerably influenced by the knowledge of female breast cancer. The diagnostic criteria for the female counterpart cannot always be safely applied to male breast cancer. Mammograms of men with breast cancer usually show an uncalcified subareolar mass, which may mimic or be obscured by gynaecomastia. Occasionally, punctate calcifications may indicate malignant disease in the male breast. Early detection of male breast cancer may prolong the survival rate as in cases of female breast cancer.

Aged↗
PubMed2006

[Serum organochlorines pesticides level of non-occupational exposure women and risk of breast cancer:a case-control study].

OBJECTIVE: To describe exposure level of organochlorines pesticides residues in non-occupational exposure population in China and testify the hypothesis that organochlorine pesticides exposure may be the risk factor to human breast cancer. METHODS: A case-control study based on community was designed. 90 new diagnostic breast cancer patients from the Second Hospital of Sichuan Province, and 136 health women from community, who settled down in the same district as case were enrolled. The risk factors of breast cancer were investigated by a questionnaire. GC-ECD was used to measure the serum level of Organochlorines pesticide residues. The adjusted odds rations (OR) of organochlorines pesticides residues to breast cancer were evaluated by logistic regression model. RESULTS: 8 organochlorines pesticide residues including p, p'-DDT, p, p'-DDE, o, p'-DDT, p, p'-DDD and alpha, beta, gamma, delta-HCHs (hexachlorocyclohexane) could be detected in serum of cases and controls. The detecting rates of beta-HCH, p, p'-DDE and p, p'-DDT respectively were 91.2%, 92.1% and 91.2%. There were no significant differences of serum level of organochlorines pesticides residues between cases and controls (P > 0.05). After adjusting confounding factors, serum p,p'-DDT, p,p'-DDD, and delta-HCH level were positively related to the risk of breast cancer (adjusted OR > 2, P < 0.05) . High serum p,p'-DDT,p,p'-DDD and beta-HCH level were positively correlated to premenopausal women (adjusted ORs respectively were 3.59, 5.70 and 3.06, P < 0.05). CONCLUSION: Organochlorines pesticides resides, including DDTs and HCHs, may increase women's risk of breast cancer, particularly in premenopausal women in China.

Adult↗
PubMed2004

Comparing breast cancer case identification using HMO computerized diagnostic data and SEER data.

OBJECTIVE: To determine the sensitivity and positive predictive value (PPV) of computerized diagnostic data from health maintenance organizations (HMOs) in identifying incident breast cancer cases. STUDY DESIGN: An HMO without a cancer registry developed an algorithm identifying incident breast cancer cases using computerized diagnostic codes. Two other HMO sites with Surveillance, Epidemiology, and End Results (SEER) registries duplicated this case-identification approach. Using the SEER registries as the criterion standard, we determined the sensitivity and PPV of the computerized data. METHODS: Data were collected from HMO computerized data-bases between January 1, 1996, and December 31, 1999. Surveillance, Epidemiology, and End Results data were also used. RESULTS: The overall sensitivity of the HMO databases was between 0.92 (95% confidence interval [CI], 0.91-0.96) and 0.99 (95% CI, 0.98-0.99). Sensitivity was high (range, 0.94-0.98), for the first 3 (of 4) years, dropping slightly (range, 0.81-0.94) in the last year. The overall PPV ranged from 0.34 (95% CI, 0.32-0.35) to 0.44 (95% CI, 0.42-0.46). Positive predictive value rose sharply (range, 0.18-0.20) after the first year to 0.83 and 0.92 in the last year because prevalent cases were excluded. Review of a random sample of 50 cases identified in the computerized data-bases but not by SEER data indicated that, while SEER usually identified the cases, the registry did not associate every case with the health plan. CONCLUSIONS: Health maintenance organization computerized databases were highly sensitive for identifying incident breast cancer cases, but PPV was low in the initial year because the systems did not differentiate between prevalent and incident cases. Health maintenance organizations depending solely on SEER data for cancer case identification will miss a small percentage of cases.

Algorithms↗
PubMed1992

Diagnostic validity of fecal occult blood tests for detecting gastroenterological cancers.

In order to estimate the diagnostic validity of chemical fecal occult blood tests, i.e. orthotolidine (Shionogi A) and guajac (Shionogi B) slides for detecting cancers of the esophagus, stomach and colorectum, the authors followed up all the examinees (n = 3,449) of comprehensive medical check-ups at the Center for Adult Diseases, Osaka, by means of record linkage to the Osaka Cancer Registry's files. Then, diagnostic validity was calculated based on the results of two years' follow-up. Sensitivity for the respective cancers was 20.0%, 11.8% and 62.5% for Shionogi A, and 20.0%, 5.9% and 43.8% for Shionogi B slides. Likelihood ratio for the respective cancers was 1.4, 0.8 and 4.5 for Shionogi A, and 3.3, 1.0 and 7.5 for Shionogi B. Specificity was analogous among the three cancer sites, being 86% for Shionogi A and 94% for Shionogi B. These results suggest that the diagnostic validity of chemical occult blood tests for detecting cancers of the esophagus and the stomach is very poor, and therefore imply that close examinations of these sites for screening positives is unnecessary in mass screenings for colorectal cancer.

Adult↗
PubMed2004

Computer-aided detection in diagnostic mammography: detection of clinically unsuspected cancers.

OBJECTIVE: We had two objectives: to determine the percentage of women presenting with clinical findings whose diagnostic mammogram led to detection of a breast cancer at a site distant from the original clinical complaint and to assess the performance of computer-aided detection (CAD) on diagnostic mammography. MATERIALS AND METHODS: Three institutions contributed consecutive cases in which a mammogram was obtained to evaluate a clinical finding, after which a histologic diagnosis of breast cancer was made. Clinical data and the mammograms were reviewed to determine the nature of the clinical findings and to document the location and characteristics of 212 biopsy-proven cancers in 197 patients who met the study criteria. Standard four-view breast mammograms were then analyzed by a CAD system. RESULTS: The most common clinical finding was a palpable mass (90%, 177/197), with nipple discharge (5%, 9/197), focal tenderness or pain (2%, 5/197), and miscellaneous complaints (3%, 6/197) also noted. Two separate cancers were found in 7.6% (15/197) of the cases. In another 7.6% (15/197) of the cases, the single diagnosed cancer was not at the location of the specific clinical finding. The CAD system correctly marked 87% (26/30) of those cancers that were clinically unsuspected (i.e., not at the location of the clinical finding). CONCLUSION: Breast cancers occurred at locations other than the site of the presenting clinical finding in 15% (30/197) of patients undergoing diagnostic mammography in whom a cancer was detected. CAD identified 87% of these incidentally detected cancers and may therefore be useful as a detection aid to the radiologist when interpreting diagnostic mammograms.

Breast Neoplasms↗
PubMed2004

Incorporating pathologists' criteria of malignancy into the evolutionary model for cancer development.

A wide variety of alterations in cell and tissue structure still form the basis for cancer diagnosis by pathologists. Cancer development is recognized to be an evolutionary process [Foulds, 1954; Cairns, 1975; Nowell, 1976; Sager, 1982; Tomlinson et al., 1996; Cahill et al., 1999; Tomlinson and Bodmer, 1999], but the phenotypic changes diagnostic of cancer (pathologists' "criteria of malignancy") have not been integrated into the existing evolutionary framework. Since phenotypic changes bear an important relationship to the genetic and physiologic changes underlying Darwinian evolution, we propose that diagnostic structural alterations also bear an important and predictable relation to both the cancer genes and the functional alterations active at any particular step in the development of a cancer. Cancer genes are predicted to mediate the acquisition of cellular-level diagnostic criteria and the diagnostic cellular-level structural changes should reflect in a useful manner the altered cell physiology required for the cell to achieve increased "cellular fitness" at any particular step of colonal evolution. Tissue-level criteria of malignancy should relate less directly to specific cancer genes, but tissue-level criteria should still provide essential insight into the interplay of the altered cellular fitness with the constraints imposed by the cells' microenvironment. The evolutionary framework allows tissue-level criteria of malignancy to be expressed in terms of viable hypotheses for the mechanism of clonal expansion at any particular step in cancer development. This approach to conveying the tissue-level criteria of malignancy complements pattern recognition approaches to diagnosis, and establishes common ground between pathology and cell biology. When viewed from this perspective, the functions of cancer genes appear quite different from those predicted by the "Gatekeeper, Caretaker" or "Hallmarks of Cancer" models. Finally, a full evolutionary framework incorporating the criteria of malignancy restores congruity between the histogenetic classification and the emerging molecular classification of cancer.

Cell Transformation, Neoplastic↗
PubMed2005

[Diagnostic value of combined detection of TPS, CA153 and CEA in breast cancer].

OBJECTIVE: To study the diagnostic value of combined detection of the 3 tumor markers, namely tissue polypeptide specific antigen (TPS), cancer antigen 153 (CA153), and carcino embryonic antigen (CEA), in patients with breast cancer. METHODS: The serum levels of TPS, CA153 and CEA were determined by enzyme-linked immumosorbent assay in 90 patients with breast cancer and 30 healthy adults. RESULTS: The serum levels of 3 tumor markers in breast cancer patients were significantly higher than those in the control group (P<0.01). The sensitivity of TPS to breast cancer was 87.7% with specificity of 90.0%. The sensitivity and specificity of CA153 to breast cancer was 55.6% and 93.3%, and those of CEA was 45.8% and 96.7%, respectively. The sensitivity of the 3 tumor markers in combination was 100% in breast cancer diagnosis. CONCLUSION: TPS, CA153 and CEA have diagnostic value in breast cancer and possess obvious complementarity, and their combined detection can significantly improve the sensitivity of breast cancer diagnosis.

Adult↗