Aspergillus species in patients with chronic rhinosinusitis

The aim of this study was to determine the frequency of Aspergillus spp. in the paranasal cavities of 40 patients with suspicion of chronic rhinosinusitis, by standard mycological as well as serological examinations. We found Aspergillus in nine of 37 patients.     

Radiological staging in breast cancer: which asymptomatic patients to image and how

Background:

Approximately 4% of patients diagnosed with early breast cancer have occult metastases at presentation. Current national and international guidelines lack consensus on whom to image and how.

Methods:

We assessed practice in baseline radiological staging against local guidelines for asymptomatic newly diagnosed breast cancer patients presenting to the Cambridge Breast Unit over a 9-year period.

Results:

A total of 2612 patients were eligible for analysis; 91.7% were appropriately investigated. However in the subset of lymph node negative stage II patients, only 269 out of 354 (76.0%) investigations were appropriate. No patients with stage 0 or I disease had metastases; only two patients (0.3%) with stage II and ⩽3 positive lymph nodes had metastases. Conversely, 2.2, 2.6 and 3.8% of these groups had false-positive results. The incidence of occult metastases increased by stage, being present in 6, 13.9 and 57% of patients with stage II (⩾4 positive lymph nodes), III and IV disease, respectively.

Conclusion:

These results prompted us to propose new local guidelines for staging asymptomatic breast cancer patients: only clinical stage III or IV patients require baseline investigation. The high specificity and convenience of computed tomography (chest, abdomen and pelvis) led us to recommend this as the investigation of choice in breast cancer patients requiring radiological staging.     

鼻腔癌临床TNM新分期的研究

目的根据对目前几种主要鼻腔癌临床分期的分析,提出新的临床分期标准。方法运用122例鼻腔癌患者的临床资料,对目前主要的鼻腔癌临床分期进行分析。并结合临床资料,通过计算机优化和筛选,提出新的临床分期。生存分析采用Kaplan-Meier法,多因素分析采用Cox回归模型。结果根据新的临床分期标准,本组122例中,T1期16例,12期32例,13期42例,T4期32例,其5年生存率分别为78．8％,64．6％,49．9％和30．0％;Ⅰ期患者16例,Ⅱ期患者26例,Ⅲ期患者45例,Ⅳ期患者35例,其5年生存率分别为78．8％,68．4％,51．3％和29．0％。全组总的5年生存率为61．6％。新的临床分期标准结合了现代影像学技术,与现有各分期比较,更符合TNM分期的一般原则,各期例数分布均匀,生存曲线有显著差异。结论新的临床分期标准在各项参数上均优于现存的鼻腔癌各临床分期法,值得临床应用和推广。     

Hodgkins disease: Clinical and radiological prognostic factors in a laparotomy series

From July 1979 to June 1988, 62 patients managed at Westmead Hospital underwent a staging laparotomy (LAP) for Hodgkins disease. Fifty-four patients were clinical stage (CS) I or II and eight were CS III. The sensitivities of the imaging modalities of computed tomography (CT), Gallium and bipedal lymphangiogram (LAG) were assessed for their predictive value for abdominal disease in patients who underwent a LAP. The most sensitive combination for predicting a negative laparotomy (78%) was a negative abdominal CT and a negative Gallium scan. Upstaging occurred in two of 16 Stage I patients (13%) and nine of 38 Stage II patients (24%). Of the 11 patients upstaged, the spleen was involved in 10 (91%). Factors which predicted for upstaging in a univariate analysis were: age greater than 40 years (P= 0.02), mixed cellularity or lymphocyte depleted histology (P= 0.02), and more than three sites involved above the diaphragm (P= 0.008). In a multivariate analysis, the only significant predictor was the number of sites of involvement (P= 0.007). Two subgroups who had a low probability of upstaging were favourable histology patients with up to two sites of involvement (0%) and females with up to two sites of involvement (0%). We conclude that abdominal imaging is associated with a high false-negative rate, particularly for CS II disease.     

Comparison of radiological and clinical features of temporal lobe necrosis in nasopharyngeal carcinoma patients treated with 2D radiotherapy or intensity-modulated radiotherapy

Background:

To compare the imaging and clinical features of temporal lobe necrosis (TLN) in nasopharyngeal carcinoma (NPC) patients treated with two-dimensional radiotherapy (2D-RT) or those with intensity-modulated radiotherapy (IMRT).

Methods:

We retrospectively analysed NPC patients who underwent 2D-RT (72 patients, 128 temporal lobes) or IMRT (36 patients, 50 lobes) and developed radiation-induced, MRI-confirmed TLN.

Results:

White-matter lesions (WMLs), contrast-enhanced lesions, cysts and local mass effects were present in 128 out of 128 vs 48 out of 50 (P=0.078), 123 out of 128 vs 47 out of 50 (P=0.688), 10 out of 128 vs 1 out of 50 (P=0.185) and 57 out of 128 vs 13 out of 50 (P=0.023) temporal lobes, respectively, in the 2D-RT and IMRT groups. The WMLs were more extensive in the 2D-RT group (P<0.001). The maximum diameter of contrast-enhanced lesions was greater in the 2D-RT group (P<0.001), and these lesions tended to extend far away from the nasopharynx. The WMLs and enhancement had no impact on cyst development (both P=1). Local mass effects were always accompanied with contrast-enhanced lesions (P=0.024) but were not correlated with WMLs or cysts (P=0.523 and 0.341, respectively). There were no between-group differences in clinical features (all P-values>0.05), whereas the difference in the incidence of severe debility was of marginal significance (18.1% vs 5.6%, P=0.077).

Conclusions:

The IMRT-induced TLN was less extensive and milder than 2D-RT-induced TLN, but both had similar clinical features.     

28例炎性乳腺癌患者的分子分型特点及对预后的影响

目的 探讨炎性乳腺癌(IBC)患者的分子分型特点及对预后的影响.方法 收集28例女性IBC患者的临床资料,分析免疫组化指标ER、PR、HER2、Ki-67的阳性表达率,比较不同分子分型患者的预后.结果 28例IBC患者中,Luminal A型、Luminal B型、HER2过表达型及三阴性所占比例分别为21.4％、17.9％、32.1％、28.6％,5年总生存率分别为75.0％、66.7％、44.4％、25.0％,差异无统计学意义(P﹥0.05).结论 IBC预后较差,尤其是三阴性和HER2过表达型,分子靶向药物的应用有更广阔的前景.     

Predictive and discriminating three-risk-group prognostic scoring system for staging Hodgkin lymphomas

BACKGROUND: Several 3-stage Ann Arbor classification-derived prognostic systems were constructed since 1980 to identify the prognosis of Hodgkin lymphoma (HL). Modern statistical tools were applied to 955 patients treated between 1981 and 1996 to build a 3-stage prognostic scoring system (PSS). METHODS: Each variable associated with 10-year overall survival (10-year OS) was assigned to 2 (0 or 1) or 3 (0, 1 or 3) values. By summing the values attributed to each variable, 3 stages were defined. 10-year OS, 5-year event-free survival (5-year EFS), and freedom from progression (5-year FFP) rates of the PSS and of other existing systems were then compared. RESULTS: Four variables were associated with 10-year OS: age (<40 = 0, >or=40 = 1), number of involved lymphoid areas (1-2 = 0, 3-4 = 1, >or=5 = 2), visceral disease (no = 0, yes = 1), and systemic symptoms (no = 0, yes = 1). Scores 0 and 1, 2 and 3, and >or=4 were attributed to 59.7%, 30.9%, and 9.4% of the patients who had 10-year OS rates of 93.5, 75.7, and 53.4% and 5-year EFS / 5-year FFP rates of 91.2%/90.3%, 78.1%/76.3%, and 54.1%/52.6%, respectively. The discrimination and prediction abilities of the PSS were better than those of the other systems tested; moreover, the PSS adequately identified the few patients with a worse prognosis without resorting to the International Prognostic Score for advanced stages. The PSS was also highly predictive for 489 patients treated between 1997 and 2002. CONCLUSION: PSS is a useful alternative to the existing prognostic systems for evaluating HL patients.     

乳腺原发性印戒细胞癌与乳腺黏液腺癌分子指标及预后的比较

目的 比较乳腺原发性印戒细胞癌与乳腺黏液腺癌的分子特点及预后.方法 对6例乳腺原发性印戒细胞癌患者和25例乳腺黏液腺癌患者的临床病理资料进行回顾性分析,比较其分子分型特点及生存情况.结果 乳腺原发性印戒细胞癌与乳腺黏液腺癌患者在发病年龄、肿瘤大小、TNM分期、雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER2)表达及分子分型方面,差异均无统计学意义(P≥0.05);在淋巴结转移、Ki-67表达方面,差异有统计学意义(P﹤0.05).乳腺原发性印戒细胞癌与乳腺黏液腺癌患者的5年无病生存率分别为66.7%、80.0%.结论 乳腺原发性印戒细胞癌比乳腺黏液腺癌更具侵袭性,淋巴结转移率高,Ki-67表达水平高,预后差.     

Musculoskeletal CPD revision: cases from the New Zealand bone and soft tissue tumour registry

The following case report was selected from the New Zealand Bone and Soft Tissue Tumour Registry to highlight some key concepts and findings in musculoskeletal imaging with radiological-pathological correlation. The presentation follows a question and answer format followed by clinical information, selected images, diagnosis, discussion and teaching points.     

鼻咽癌UICC第7版分期与中国2008分期比较及分期更新建议

目的 比较鼻咽癌UICC第7版分期及中国2008分期, 并对分期的更新提供参考依据。方法 回顾分析2006—2012年病理确诊的初治无远处转移、接受调强适形放疗的鼻咽癌患者767例。以OS、LRFS、DMFS为主要预后指标, 比较两种分期系统T分期、N分期、临床分期对预后的预测价值。Kaplan-Meier法计算各项生存率, 组间差异比较行Logrank检验, Cox法多因素分析。结果 从T分期来看, 中国2008分期在预测OS、LFFS方面优于UICC分期。从N分期来看, 两种分期在预测OS、DMFS方面相当。从临床分期来看, UICC分期在预测OS方面优于中国2008分期。依据统计结果推荐的新分期中T分期、N分期、临床分期对预后均有较好预测价值。结论 鼻咽癌UICC第7版分期与中国2008分期在预测预后方面各有优势。推荐的新分期方案对当前鼻咽癌分期的更新有一定价值。     

Clinical,radiological, pathological and prognostic aspects of intraventricular oligodendroglioma: comparison with central neurocytoma

Studies comparing intraventricular oligodendroglioma (IVO) and central neurocytoma (CN) in terms of their clinical, radiological and pathological features are scarce. We, therefore, investigated the similarities and differences between these types of tumors to get a better understanding of how they may be more properly diagnosed and treated. The clinical manifestations, CT/MRI findings, pathological characteristics and clinical outcomes of 8 cases of IVOs and 12 cases of CNs were analyzed retrospectively. Both IVO and CN occurred most commonly in young adults and manifested with symptoms of increased intracranial pressure secondary to obstructive hydrocephalus. However, they were radiologically different in location (p?=?0.007), diffusion-weighted imaging (p?=?0.001), “scalloping” appearance (p?=?0.006), flow void sign (p?=?0.006) and ventricular wall invasion (p?=?0.000). Histologically, significant differences in mitotic count (p?=?0.008) and parenchymal infiltration (p?=?0.01) were noted. Immunohistochemically, significant differences in the expression of Olig2 (p?=?0.000), Syn (p?=?0.01) and NeuN (p?=?0.000) were observed. In addition, MIB-1 labeling index (p?=?0.035) and case fatality rate (p?=?0.021) of IVO were much higher than those of CN, while survival rate of IVO was much lower than that of CN (p?=?0.028). IVO and CN are similar in onset age and clinical manifestations, but have different imaging and pathological features. Patients with IVOs may have a relatively poorer prognosis compared to those with CNs.     

ORIGINAL ARTICLE: Pilot comparison of 18F-fluorocholine and 18F-fluorodeoxyglucose PET/CT with conventional imaging in prostate cancer

Introduction: Conventional imaging (CI) is known to have limitations with respect to staging of patients with primary or relapsed prostate cancer. Positron emission tomography/computed tomography (PET/CT) with ¹⁸F-flurodeoxyglucose (FDG) is also often suboptimal because of low tracer avidity, but ¹⁸F-fluorocholine (FCH) appears to be a promising alternative molecular imaging probe. We report a prospective pilot study of PET/CT comparing both tracers for staging and restaging of patients with prostate cancer. Methods: Sixteen prostate cancer patients were evaluated (7 for staging and 9 for restaging). All patients also underwent CI, comprising at least an abdominopelvic CT and a bone scan. All imaging results and other relevant data were extracted from the imaging reports and medical charts. Results: Based on all imaging-detected disease sites, both FCH-PET/CT and FDG-PET/CT (79%) were more sensitive than CI (14%), with the highest number of sites of nodal and distant disease on FCH PET/CT. FCH-PET/CT alone would have provided sufficient clinical information to form an appropriate management plan in 88% of cases, as compared with 56% for CI. Conclusion: FCH-PET/CT has the potential to impact on the management of patients with prostate cancer significantly more often than CI.