Role of imaging in the diagnostic and therapeutic algorithms of breast cancer

Early diagnosis and prevention have the most significant effect on overall disease specific outcome; 90% of all breast cancer cases could be cured if diagnosed early and treated accurately. As for all diagnostic methods the most important requirement for diagnostic imaging is to detect breast cancer in its early stage, and to determine accurate tumor staging, in order to select the appropriate therapy. Its role is to monitor the effectiveness of therapy, to follow up patients reliably for early detection of recurrent disease. The spectrum of radiological imaging methods in breast cancer became broader in the past two decades; imaging that provides functional or metabolic data and whole body information such as CT, MRI and PET-CT are now available besides common X-ray and ultrasound mammography. The MRI is getting more and more important for the detection and characterization of breast cancer. Multimodal imaging techniques provide more accurate analysis, which is confirmed by increasing statistics authentically, but none of the imaging methods was specific enough to provide histological diagnosis. However, imaging-guided biopsies enable precise histological or cytological confirmation.     

Clinical epidemiology of primary lung cancer in Tunisia. 100 cases

BACKGROUND: Lung cancer is frequent and its incidence is increasing inTunisia and in all over the world. Few published Tunisian studies have described epidemiology of lung cancer. AIM: To report the clinical features and outcomes of lung cancer in Tunisia from a retrospective review of 100 consecutive patients seen in F.S.I. hospital in La Marsa. METHODS: a retrospective study was carried out 100 cases of bronchial carcinoma seen in pulmonology department between 2000 and 2004. We analysed diagnosis modalities, histological subtypes, staging of the disease, treatment strategies and survival. Survival rates were calculated using Kaplan-Meier method. RESULTS: mean age was 59.5 years,sex-ratio at 19.92% of patients were smokers; the average of tobacco consumption was 48.5 PY. The diagnosis was histologically proven in 90% of the cases. Specimen were obtained by bronchoscopy (53.4% of cases), fine-needle lung biopsy (30%), metastasis biopsy (7.7%), surgical biopsy (7.7%) and more rarely by thoracoscopy (1.2%). Histologically, 39% were squamous carcinomas, 30% adenocarcinomas and 8.7% small cell carcinomas. 51% of non small cell lung carcinomas were stage IV, 26% stage IIIB, 9% stage IIIA and 14% were stage I or II. 6 of 10 patients with small cell carcinomas were with disseminated disease. 18 of 21 patients with resectable tumors receive surgery. Patients with locally advanced tumors received combined chemotherapy and radiotherapy. 14 of 46 stage IV patients received palliative chemotherapy. Survival rate was 18% at 2 years.     

PET-CT在肺癌诊断与临床分期中的应用

目的：探讨^18F-脱氧葡萄糖正电子发射显像／电子计算机断层扫成像（^18F-FDG PET-CT）在肺癌诊断及其在临床分期方面的价值。方法：75例患者进行了PET-CT检查诊断为肺癌,分析其PET-CT代谢情况与影像学检查结果（薄层增强CT和HIKCT检查结果）进行对照分析。结果：75例患者通过^18F-FDGPET-CT检查,均诊断为肺癌,其中经纤维支气管检查或者穿刺检查有明确病理的49例,经术后病理证实的23例;^18F-FDGPET-CT75例均表现为放射性摄取异常增高,最大SUV值在1．5-18．8之间;30例CT增强扫描病例中,病灶边缘毛糙,明显强化,CT值升高在20-46Hu之间;45例HRCT检查中病灶有明显分叶、毛刺征、血管集束征、胸膜凹陷征及支气管截断现象等。结论：^18F-FDGPET-CT与诊断性CT联合应用,可以对肺癌进行明确诊断与分期。     

肺癌骨转移单光子发射计算机断层显像术放射性核素骨显像特点分析

目的 分析肺癌核素骨显像的影像特征,评估单光子发射计算机断层显像术(SPECT)放射性核素骨显像诊断肺癌骨转移的临床价值.方法 177例确诊为肺癌的患者进行99mTc-MDP骨显像检查,对骨转移的症状、部位、数量与病理类型进行回顾性分析.结果 肺癌骨转移发生率为45.8%(81/177),其中多发性骨转移69例,占骨转移者的85.2%(69/81).腺癌骨转移发生率为69.0%(40/58),鳞癌为41.3%(19/46),小细胞癌为32.5%(13/40),未分化癌为27.3%(9/33),腺癌骨转移发生率与其他类型癌骨转移发生率比较差异有统计学意义(P＜0.05);共发现转移灶526处,部位以胸部为最多,共212处(40.3%),其他依次为脊柱168处(31.9%)、盆腔73处(13.9%)、四肢62处(11.8%)、颅骨11处(2.1%).结论 肺癌骨转移以多发病灶较为常见,部位以胸部、脊柱多发.腺癌骨转移发生率最高.肺癌患者应常规进行放射性核素骨显像,这对疾病的分期、治疗方案的选择、预后评估均有重要意义.     

小细胞肺癌中PTEN的表达及其与凋亡的关系

目的　探讨小细胞肺癌 (SCLC)组织中PTEN的表达及临床意义与细胞凋亡的关系。方法　 4 2例SCLC组织和 16例肺良性病变组织PTEN的表达采用免疫组织化学S -P法检测。 4 2例SCLC组织肿瘤细胞凋亡采用TUNEL法检测。结果　 4 2例SCLC组织PTEN缺失率 73.8%高于 16例肺良性病变 (P <0 .0 1) ,PTEN的缺失与SCLC的临床TNM分期相关 ,与细胞学亚型、性别、年龄无关。PTEN蛋白的缺失与小细胞肺癌癌细胞凋亡无关。结论　SCLC中存在PTEN缺失并对SCLC的发生、发展起着重要作用。     

The value of integrated PET-CT images in 2 lymphoma patients with skeletal localisations

In two women with Hodgkin's disease, 36 and 34 years of age, the PET-scan showed increased FDG-uptake in regions where the CT-scan did not reveal any abnormalities. Integration of the PET-CT images visualised bone marrow localisations in both patients. One patient underwent a CT-guided bone biopsy that confirmed this localisation. In both cases, the results of the integrated PET-CT images altered the therapy that would have been given on the basis ofthe standard staging technique. Both patients underwent radiotherapy. After 6 months, one patient had no visible lesions. The other patient died due to progression ofthe disease. Integrated PET-CT images can play an important role, not only in the precise classification and staging of lymphoma but also at the start of therapy, as an initial scan, in the evaluation of the response to treatment, and in the early detection of recurrence.     

Exposure to crocidolite and the incidence of different histological types of lung cancer.

OBJECTIVES: To estimate the relations between exposure to both tobacco smoke and crocidolite and the incidence of various histological types of lung cancer. METHODS: In 1979 all former workers from the Wittenoom asbestos industry who could be traced were sent a questionnaire on smoking history. Of 2928 questionnaires sent, satisfactory replies were received from 2400 men and 149 women. Of the men, 80% had smoked at some time and 50% still smoked. Occupational exposure to crocidolite was known from employment records and follow up was maintained through death and cancer registries in Australia with histological diagnoses obtained from the relevant State Cancer Registry. Conditional logistic regression was used to estimate the effects of tobacco and asbestos exposure on incidence of different cell types of lung cancer in a nested case-control design. RESULTS: Between 1979 and 1990, 71 cases of lung cancer occurred among men in this cohort: 27% squamous cell carcinoma, 31% adenocarcinoma, 18% small cell carcinoma, 11% large cell carcinoma, and 13% unclassified or indeterminate. Two of the classified cases and one unclassified case had never smoked. The incidence of both squamous and adenocarcinoma types of lung cancer were greatest in ex-smokers and in those subjects with the highest levels of exposure to crocidolite. After adjustment for smoking habit, the increase in incidence of lung cancer with increasing exposure to crocidolite was greater for squamous cell carcinoma than for adenocarcinoma. CONCLUSIONS: The results from this study have shown significant exposure-response effects for exposure to crocidolite, and both adenocarcinoma and squamous cell carcinoma of the lung. They also provide some further evidence against the theory that parenchymal fibrosis induced by asbestos is a necessary precursor to asbestos induced lung cancer.     

Trends in histopathology of lung cancer in Alberta

OBJECTIVE: To describe the trends over calendar period and birth cohort in lung cancer incidence by histopathology and sex, in Alberta. METHODS: Lung cancer data were extracted from the Alberta Cancer Registry for the years 1979 to 1998. Trends in age-standardized rates over calendar period and trends of age-specific rates over birth cohorts are presented. These trends are discussed in relation to historic smoking patterns. RESULTS: Lung cancer incidence is increasing over calendar period in females for all lung cancers and the histological types, adenocarcinoma, squamous cell, and small cell carcinoma. In males, all lung cancer incidence increases until 1988 and then decreases. Adenocarcinoma incidence in males increases over the whole time period, while squamous cell and small cell carcinoma incidence decreases. For females born before 1939, the incidence of all lung cancer and the three histological types increases over birth cohorts for all age groups. For those born after 1939, there is a slight decline. Male lung cancer incidence shows no marked increases over birth cohorts. In males born after 1929, all lung cancer and squamous cell and small cell carcinoma incidence decreases over birth cohorts for all age groups. Incidence of adenocarcinoma increases over all birth cohorts in males. CONCLUSION: In Alberta, incidence of adenocarcinoma of the lung is increasing in both males and females, while squamous cell and small cell carcinoma are decreasing in males, but increasing in females. These trends may reflect changes in smoking habits.     

Occupational lung cancer. A comparison between humans and experimental animals

Many epidemiological and experimental studies have suggested that the respiratory tract is one of the most sensitive organs to environmental carcinogens. Nevertheless there is little evidence to determine the relationship between a specific environmental carcinogen and a cell type of lung cancer, because the cell types of lung cancer and their relative frequencies are highly complex compared with those of other organs and tissues. In the present paper, occupational lung-cancer characteristics, which are the clearest in the relation between cause and effect in human lung cancers, were reviewed in comparison with the results of animal experiments concerned with occupational lung carcinogens. Through accumulation of histopathological examinations of the lung cancer cases, the following relationships between cause and cell type were conjectured: chromium and squamous cell carcinoma; asbestos and adenocarcinoma; nickel and squamous cell carcinoma; beryllium and small cell carcinoma; bis (chloromethyl) ether and small cell carcinoma; mustard gas and squamous cell or small cell carcinoma; vinyl chloride and large cell or adenocarcinoma; radionuclides and small cell carcinoma. The relation pertaining to arsenic, benzotrichloride and tar could not be conjectured because of insufficient cases and information in the histological diagnosis. On the other hand, the carcinogenicity of these substances in occupational exposure has been confirmed by animal experiments administered intratracheally or by inhalation studies under relatively higher concentration. As a result of recent refinements of inhalation study, all-day and life-span exposure to extremely low concentrations, such as microgram/m3 orders, of certain substances has been possible. The characteristics of lung tumors occurring in these animals are rather different from those of human. For example, in mouse, almost all of the malignant lung tumors developed by carcinogens are adenocarcinomas and it is rare to find the squamous cell carcinoma. Moreover, small cell carcinoma and large cell carcinoma have not known to occur in the lungs of rats and mice. Therefore, future research should focus elucidating the specific relationship between cause and cell type of human lung cancer by means of animal experiments on lung cancer that give attention to the specificities of each experimental animal and the origin of the resultant lung tumor.     

肿瘤标记物联合检测在肺癌诊断中的应用价值

目的探讨联合检测血清肿瘤标记物CEA、NSE、CYFRA21-1、TPA、CA15-3、CA242在肺癌临床诊断中的价值。方法应用放射免疫法和酶联免疫法检测108例肺癌病人、40例肺良性病变病人及41例正常健康人的血清中CEA、NSE、CYFRA21-1、TPA、CA15-3、CA242的水平。结果肺癌组血清6项肿瘤标记物含量均高于肺良性病变组及正常组;CEA、CA15-3、CA242在肺腺癌中的水平最高,NSE在肺小细胞癌中的水平最高,CYFRA21-1、TPA在肺鳞癌中的水平最高,6项联合检测肺鳞癌、肺腺癌、肺小细胞癌的阳性率可分别达97.5%、100%、95.8%。结论运用联合检测多种肿瘤标记物可以提高肺癌诊断的敏感性,同时对于确定其临床分期和鉴别病理类型具有一定的意义。     

纤维支气管镜在肺癌228例患者的临床分析

[目的]探讨肺癌纤维支气管镜诊断的镜下特点和临床特征。[方法]回顾性分析了228例经纤维支气管镜诊断的肺癌患者临床资料。[结果]病灶发生于叶支气管者最多,发生于右中叶者发生率(68.75%)。不同发生部位比较差异有统计学意义(P﹤0.05)。组织学类型以鳞癌最为常见,其次是小细胞癌,腺癌、未分型癌和其他类型肺癌。纤支镜镜下特征与肺癌组织学类型相关性差异有统计学意义(P﹤0.05)。肺癌的分型:228例肺癌患者中中央型肺癌164例(71.9%),周围型肺癌64例(28.1%)。纤支镜镜下表现:管内增殖型55例(24.1%)、管外压迫型53例(23.2%)、管壁浸润型51例(22.3%)、混合型81例(35.5%)和正常型12例(5.2%)。[结论]肺癌以中央型多见,纤支镜镜下特点以增生型和混合型为主,组织学类型主要为鳞癌和小细胞癌。     

Effect of occupational air pollutants on various histological types of lung cancer: a population based case-control study.

A population based case-control study was performed in Cracow, Poland, to determine the effect of occupational air pollutants on various histological types of lung cancer. Male cases and controls were identified from the Cracow Death Register. Information was obtained by mailed questionnaire from next of kin on smoking, occupational branch, occupational exposures, and other pertinent variables. Response rates were 73.5% in cases and 72.0% in controls. For cases that underwent a bronchial biopsy or surgical excision the histological diagnosis of the tumour was obtained from clinical records. The case group contained 343 subjects with squamous cell carcinomas, 151 with small cell carcinomas, and 106 with adenocarcinomas. Twenty seven cases showed other histological types (large cell carcinoma and not classifiable). Analysis was performed separately by histological type for occupational exposure variables adjusted for smoking. Long term exposure to mineral dust and metal dust (20 years or more) was found to be a significant risk factor for small cell and squamous cell carcinoma. The effect was more pronounced if the analysis was restricted to those aged less than 70 years. The highest relative risk (RR) due to occupational exposures was found for squamous cell carcinoma and exposure to mineral dust for more than 20 years (RR = 2.45, 95% CI 1.43-4.19). The estimated effect of mineral dust on small cell carcinoma and adenocarcinoma was smaller (RR = 2.29, 95% CI 1.16-4.53 and RR = 2.04, 95% CI 0.89-4.64 respectively). The effect of metal dust and fumes seemed about the same for squamous and small cell carcinoma. No specific agent could be identified as particularly important for a specific histological type; it rather seemed that the effects of the substances considered were similar for lung cancers in general.     

人非小细胞肺癌中FHIT基因突变的研究

目的探讨FHIT基因突变在非小细胞肺癌发生发展中的作用。方法应用PCR-SSCP和DNA序列分析方法对29例人非小细胞肺癌中FHIT基因外显子5及其相邻内含子进行研究,以癌旁组织和7例肺良性病变组织做对照。结果29例肺癌患者中有7例出现FHIT基因变异,阳性率24.1%其中鳞癌28.6%(6/21)腺癌(1/6);而癌旁组织及肺良性病变组中均无变异,肺癌组、癌旁组及肺良性病变组比较差异具有统计学意义(p<0.05)。FHIT基因异常与非小细胞肺癌P-TNM分期、肿瘤组织学类型无明显关系。异常FHIT基因经DNA序列分析显示为内含子两个位点的碱基发生突变:188位插入G,227位T—C。外显子及其与内含子接头位点未发现变异。结论FHIT基因变异与非小细胞肺癌发生发展有关,基因异常发生在内含子,该变异可能是引起FHIT基因RNA异常剪接的主要原因之一。     

非小细胞肺癌中FHIT基因及HER2表达的意义及相关性研究

目的 探讨在非小细胞肺癌中脆性组氨酸三联体(FHIT)基因及人类表皮生长因子受体2(HER2)表达与临床病理的关系,以及二者在非小细胞肺癌中的相关性.方法 用免疫组化法检测50例肺癌组织及21例癌旁非肺癌组织的FHIT基因及HER2阳性表达率.结果 肺癌组织中FHIT蛋白表达阳性率为30.00%,显著低于非肺癌组织的80.95%(P＜0.05),而且FHIT基因的表达与组织类型、淋巴结转移、TNM临床分期有关.肺癌中存在HER2的过度表达,表达率为56.00%,并与淋巴结转移、TNM分期相关.FHIT基因的表达与HER2存在负相关关系,相关系数(r)=-0.38.结论 在肺癌的发生、浸润、转移病变阶段中存在FHIT的表达下调和HER2的过度表达,二者呈负相关.     

PET/CT在肺癌诊断中价值初探

目的：探讨PET/CT在肺癌诊断中的应用价值。方法：回顾性分析98例肺部结节患者的PET/CT检查,结合患者的临床及病理检查判断PET/CT对肺癌诊断符合率。结果：PET/CT诊断结果,恶性病变79例,其中48例有病理诊断,鳞癌18例,腺癌15例,小细胞肺癌14例,类癌1例。肺门、纵隔淋巴结转移34例,肺内转移10例,胸膜转移12例,多发骨转移18例,脑部转移1例,确诊为良性病变19例。PET/CT对肺癌诊断的灵敏度、特异度以及诊断准确率分别为98.7%、94.7%、98.0%。结论：PET/CT能够较准确的诊断肺部疾病,在肺部病灶的良、恶性鉴别和疾病分期有突出的临床实用价值。     

沈阳市31家工厂职工肺癌的流行病学调查研究

目的：对沈阳市1979－1994年31家工厂职工肺癌的流行病学调查研究，结果：肺癌的发病率在19．4／10万＝52．9／10万之间，1990年最高（52．9／10万）；男性高于女性；肺癌死亡率，男性在22．9／10万－58．9／10万之间，1990年最高（58．9／10万）；女性在7．6／10万－28．7／10万之间，1987年最高（28．7／10万）；男性高于女性。肺癌，35，8，10年的存活率分别为8．3％，5．3％，3．2％，1．3％，中心型肺癌居3种部位之首位（67．0％），男性鳞癌居4种组织类型的首位（50．9％），女性腺癌居4种组织类型的首位（67．9％），55－64岁为鳞癌（44．5％），腺癌（47．2％），小细胞癌（50．0％）和大细胞癌（35．7％）的高发病年龄组。     

肺癌肿瘤实性区CT强化程度与肿瘤分期及病理类型的相关性分析

目的：探讨影响肺癌肿瘤实性区的CT强化程度与肿瘤分期及病理类型的相关性分析。方法：回顾性分析2013年1月-2014年6月本院收治的200例行胸部CT增强扫描肺癌患者的临床资料,统计分析肿瘤实性区的CT强化程度与肿瘤T分期（T1/T2/T3/T4）、病理类型（小细胞癌/鳞癌/腺癌）、神经元特异性烯醇化酶（NSE）的关系。结果：200例肺癌肿瘤实性区的CT强化程度的范围为1.652~4.193,平均（2.529±0.592）。T1期31例、T2期60例、T3期39例、T4期70例,平均CT强化程度分别为（2.145±0.334）、（2.288±0.445）、（2.625±0.589）、（2.767±0.659）。T1和T2、T3和T4之间差异无统计学意义（P〉0.05）;T3和T4明显高于T1和T2,差异均有统计学意义（P〈0.05）。小细胞癌42例、鳞癌58例、腺癌100例,平均CT强化程度分别为（2.208±0.484）、（2.567±0.485）、（2.680±0.641）;鳞癌和腺癌比较差异无统计学意义（P〉0.05）,小细胞癌明显低于鳞癌和腺癌,差异有统计学意义（P〈0.05）。NSE水平范围是8.02~109.73 ng/mL,平均（28.423±20.473）ng/mL,经线性相关分析CT强化程度与NSE水平之间无明显相关性（P〉0.05）。结论：随着肿瘤T分期的增高肺癌肿瘤实性区的CT强化程度有逐渐升高的趋势;非小细胞肺癌的CT强化程度高于小细胞肺癌;肺癌肿瘤实性区的CT强化程度与NSE水平无明显相关性。     

内皮素与血管内皮细胞生长因子在非小细胞肺癌中的表达及相关性

目的研究内皮素(endothelin-1,ET-1)与血管内皮细胞生长因子(vascularendothelialgrowthfactor,VEGF)在非小细胞肺癌中的表达及两者的相关性。方法应用免疫组化SABC染色法,检测101例非小细胞肺癌标本中ET-1、VEGF的阳性表达,分别评价ET-1和VEGF与非小细胞肺癌临床病理特征间的关系,并分析ET-1和VEGF表达的相关性。结果 ET-1表达与肿瘤组织学分级、病理分期有关(P0.05),与病理分型无关联;VEGF表达与肿瘤病理分期有关(P0.05),与组织分级、病理分型无关联。ET-1高表达的区域VEGF也呈高表达,两者的表达呈正相关(P0.05)。结论 ET-1和VEGF的表达与非小细胞肺癌的发生发展密切相关,可以作为该病恶性生长的检测指标。ET-1与VEGF可能具有协同作用,促进血管生成。     

Treatment of cervical cancer in Italy: Strategies and their impact on the women

Treatment of cervical cancer greatly varies according to the stage of the disease. Laparoscopic surgical staging is emerging as a valid approach, compared to clinical and imaging staging, to better identify the treatment plan.Minimally invasive surgery plays the greatest role in the treatment of early cervical carcinoma (ECC). Laparoscopically assisted radical vaginal hysterectomy (LARVH) is an alternative surgical strategy in this subset of patients. Interest has been increasing in using conservative fertility-sparing surgery such as laparoscopic vaginal radical trachelectomy (LVRT) or chemo-conization, options to be preferred in selected patients, with early-stage disease and asking for future fertility.Chemoradiotherapy currently represents the gold standard in the treatment of patient with locally advanced cervical cancer (LACC). In Italy, neoadjuvant chemotherapy (NACT) followed by radical surgery is today emerging as a valid alternative to the standard chemoradiation and the paclitaxel, ifosfamide and cisplatin (TIP) regimen is one of the most active neoadjuvant chemotherapeutic treatments.Moreover, the combination of different strategies to maximize local control should be considered. Among different approaches to this issue the use of a three-modality treatment, including radiotherapy, chemotherapy and surgery has been investigated. Our data on a large single-institutional series of LACC patients treated with chemoradiation followed by radical surgery confirm that this three-modality treatment can achieve overall survival (OS) and Disease Free Survival (DFS) rates at least comparable to chemoradiation alone, with an acceptable rate of complications.Tailoring of radical surgery, on the basis of intraoperative findings, such as lympho-nodes status, might play an important role in diminishing the overall rate of complications and eventually improve quality of life (QoL) of these patients. Cervical cancer generally has an aggressive impact on relatively young women and, as we experienced, the relevance of psychosocial aspects in gynaecologic oncology has become a main issue.     

鳞状细胞癌抗原研究进展

鳞状细胞癌抗原对多种肿瘤(宫颈癌、头颈部癌、肝癌、食管癌、肺癌、乳腺癌)的诊断、临床分期、病理分级及对肿瘤的判断预后、指导临床治疗等方面有重要参考价值,是鳞状细胞癌的肿瘤标志物,本研究就以上方面进行综述。