Digital mammography: a review of technical development and clinical applications

For detecting and diagnosing breast cancer at its earliest stage, mammography is the most sensitive technique currently available and is therefore the method of choice. Screen-film mammography has been used successfully as a screening test for breast cancer for > 2 decades. However, conventional mammography has substantial limitations and, therefore, digital mammography systems have been developed to improve image quality and overcome the limitations of screen-film technique limitations. Herein we discuss the differences between screen-film and digital mammography systems and the processes related to digital mammography that differ from conventional mammography, including detector technology, digital image formation, image processing, image display, and image archival. Finally, we review the results from currently available clinical trials regarding the performance of digital mammography and discuss clinical implications such as cost-effectiveness.     

Preparation and characterization of a specific monoclonal antibody against a new gene product: URG11

As a new gene, the monoclonal antibody against URG11 protein is not currently available. In this study, one monoclonal antibody (MAb) against URG11 was obtained with standard cell fusion technique and enzymelinked immunosorbent assay (ELISA) screening. The peptide of URG11 used in making the MAb in this study was synthesized as described. One of the newly developed MAbs is named MAb 3D2, the isotype of which is IgG2a. Immunohistochemistry and Western blot showed that MAb 3D2 could recognize URG11 protein in both native and denatured forms. MAb 3D2 will be a useful tool for the functional research of URG11 in future studies.     

Formation en curiethérapie

Treatment technique training needs theoretical and practical knowledge allowing proposing the right treatment for the right patient, but also allowing performing the technical gesture in the best conditions for an optimal result with a maximal security. The evolution of the brachytherapy techniques needs the set up of specific theoretical and practical training sessions. The present article focuses on the importance of the brachytherapy training as well as the different means currently available for the young radiation oncologist community for perfecting their education. National and international trainings are presented. The role of the simulation principle in the frame of brachytherapy is also discussed. Even if brachytherapy is not always an easy technique, its efficacy and its medico-economical impact need to be passed down to motivated students with the implementation of relevant educational means.     

Clinical study of selective intra-arterial infusion chemotherapy using trans-radial arterial approach in 4 cases of advanced breast cancer

We administered neoadjuvant chemotherapy by a selective intra-arterial infusion method using a trans-radial approach in patients with advanced breast cancer (stage III and stage IV). The trans-radial approach uses the arterial flow, based on the Seldinger technique. In this method, the radial artery is cannulated, and epirubucin is infused into the artery that carries blood from the subclavical artery to the breast. We have used this method in 4 cases thus far. Two of the patients received a single intra-arterial infusion of epirubicin. The other 2 patients were catheterized before they received chemotherapy by intra-arterial infusion. This technique decreased the pain or discomfort caused by the catheterizations during chemotherapy in all 4 cases. However, the currently available catheters are not always able to approach the artery flowing into the breast, thus the protocol will need to be refined.     

Techniques Used to Localize Occult Breast Lesions: An Update

With breast cancer screening programs becoming more available worldwide and covering larger age ranges, the prevalence of impalpable breast pathology is increasing. Whilst there is a ‘tried and tested’ technique for localizing occult lesions, the market for alternative methods is increasing and is estimated to pass $1 billion by 2024. In this article, we review the techniques currently available for localization of occult breast lesions and discuss the pros and cons of each.     

尿脱落细胞Lewis X检测诊断膀胱尿路上皮癌的价值

目的探讨Lewis X抗原在膀胱尿路上皮癌非侵袭性诊断中的应用价值.方法采用EnVision免疫细胞化学方法,检测52例膀胱尿路上皮癌和16例非肿瘤患者尿脱落细胞标本中Lewis X抗原的表达情况,并与细胞病理学检测结果相比较.结果尿路上皮癌诊断的敏感性和特异性分别为84.6%和87.5%,其敏感性显著高于细胞病理学.结论尿脱落细胞Lewis X抗原免疫染色,是检测膀胱尿路上皮癌可行的较敏感的非侵袭性方法.     

Current state of treatment for advanced gastric cancer

The radical treatment of gastric cancer is complete resection of the tumor by surgery. For advanced gastric cancer, a multidisciplinary approach has been attempted to improve patient prognosis. Potentially resectable and curable advanced gastric cancer is treated with routine surgery, followed by postoperative adjuvant chemotherapy. For highly advanced gastric cancer, extended radical surgery or preoperative adjuvant chemotherapy have been attempted. Laparoscopic gastrectomy for advanced gastric cancer has not been widely used because of the difficult surgical technique involved, but enhanced magnification in the surgical field is expected to improve the accuracy of the lymph node dissection procedure. In future, the significance of currently available treatments should be investigated. The key treatment for advanced gastric cancer at present is surgery.     

Target coverage in head and neck cancer treated with intensity-modulated radiotherapy: a comparison between conventional and conformal techniques

AIMS AND BACKGROUND: We designed a comparative planning study aimed at quantifying the advantages of intensity-modulated radiotherapy (IMRT) over the conventional 3-field technique (3FT) and a 5-field conformal technique (5FCT) for head and neck (HN) cancer. METHODS: We selected 9 patients treated at our institution with curative radiotherapy for a HN cancer. For all cases 4 plans were generated: 2 plans using the "standard" techniques (3FT and 5FCT), a third plan using IMRT, and a fourth "mixed" plan using IMRT followed by a conventional boost. RESULTS: Our study confirmed literature data on the ability of IMRT to significantly decrease the dose received by organs at risk, compared with previous techniques. Target coverage was systematically better with 5FCT and IMRT than with 3FT. However, the increase in coverage of both PTV2 and PTV1 was only about 3-5% and this was achieved at the price of a similar increase in maximum dose (D1%). Volumetric parameters (V100%, V95%) were much more sensitive in detecting the improvement with IMRT. CONCLUSIONS: The improvement of target coverage attained by IMRT, as compared with conventional and conformal techniques, might be overestimated by data currently available in the medical literature. If treatment with conventional techniques is planned using all tools provided by currently available fully 3-D planning systems, excellent target coverage can be obtained.     

Intercostal artery aneurysms complicating thoracic aortic coarctation: Diagnosis with magnetic resonance angiography

The case report of a 46‐year‐old woman diagnosed with complete aortic coarctation and multiple intercostal artery aneurysms using ‘ultrafast time‐resolved’ multiphase contrast‐enhanced magnetic resonance angiography and conventional single‐phase, high‐resolution breath‐hold contrast‐enhanced magnetic resonance angiogram techniques is presented. A review of intercoastal artery aneurysms occurring in conjunction with aortic coarctation and the various contrast‐enhanced magnetic resonance angiography techniques currently available is provided.     

Magnetic resonance imaging of the exocrine pancreas

The currently available MRI, techniques that are used to perform imaging of the pancreas are reviewed. A basic pancreas examination includes: fat-suppressed breath-hold T1-weighted and respiratory triggered or breath-hold T2-weighted fast sequences The use of dynamic MRI with both extracellular gadolinium chelates and specific contrast agents is stressed in the evaluation of exocrine pancreatic diseases. It is concluded that an "all-in-one" approach including MR angiography of the pancreatic vessels and MR cholangiopancreatography of the biliopancreatic ductal system, confirmed by further studies, is presumably the most cost-effective imaging technique in the evaluation of a vast array of exocrine pancreatic diseases.     

Cytochemistry and ultrastructure in lymphoma and leukemia: utility in the diagnosis of different leukemias and the recognition of subtypes of lymphoproliferative disorders

This review is based on the findings of multiparameter studies performed on cells obtained from over 200 cases of leukemia and illustrates the wide range of laboratory tests currently available for cell phenotype identification. Immunological techniques are not discussed and the review deals mainly with light and electron microscopic cytochemistry, transmission (TEM) and scanning electron microscopy (SEM). The importance of light microscopic cytochemistry is clearly demonstrated. In particular, paranuclear acid phosphatase, non-specific esterase (NSE) and diaminopeptidase staining are recommended as reliable T-cell markers. Ultrastructural identification of unclassified leukemic cells using techniques to detect myeloperoxidase, acid phosphatase, platelet peroxide (PPO) and NSE, is shown to be of great importance in cases of early myelo-monoblastic differentiation with negative light microscopic cytochemistry. SEM is also shown to be a reliable means of distinguishing lymphoid and non-lymphoid leukemia when some degree of differentiation is present. However SEM does not appear to contribute in the diagnosis of unclassified leukemia. The new scanning immunoelectron microscopy (SIEM) technique employing heteroantisera or monoclonal antibodies conjugated to latex microspheres (immunolatex) to detect surface receptors and specific antigens is also illustrated. This technique displays the topography of surface antigens on the cell surface of leukemic cells in 3-dimension and facilitates simultaneous visualization of the surface architecture of the labelled cells.     

Automatic Colorectal Polyp Detection in Colonoscopy Video Frames

Colonoscopy is currently the best technique available for the detection of colon cancer or colorectal polyps or other precursor lesions. Computer aided detection (CAD) is based on very complex pattern recognition. Local binary patterns (LBPs) are strong illumination invariant texture primitives. Histograms of binary patterns computed across regions are used to describe textures. Every pixel is contrasted relative to gray levels of neighbourhood pixels. In this study, colorectal polyp detection was performed with colonoscopy video frames, with classification via J48 and Fuzzy. Features such as color, discrete cosine transform (DCT) and LBP were used in confirming the superiority of the proposed method in colorectal polyp detection. The performance was better than with other current methods.     

Management and supportive treatment of frail patients with metastatic pancreatic cancer

Data regarding management of frail patients with pancreatic ductal adenocarcinoma practice is currently very scarce. Randomized clinical trials usually exclude these subgroup of patients and the majority of the publications only consider chronological age and ECOG performance status for their classification. Therefore, the current available data do not reflect daily clinical practice. Only data from a phase two study (FRAGANCE study), designed to select a tolerable dose-schedule of nab-placitaxel + gemcitabine (Phase one) and to evaluate the efficacy of the selected regimen (Phase two) in patients with ECOG-2 and previously untreated advanced PDAC, are currently available. Management of these particular patients is exceedingly complex and requires collaboration of multidisciplinary teams and intensive support treatment. This article reviews the literature available regarding the management of the so-called frail patients and provide guidance for chemotherapy as well as supportive care treatments.     

Current treatment for colorectal cancer metastatic to the liver.

Surgery is currently the only available treatment option which offers the potential for cure for patients with liver metastases from colorectal cancer. Of those who undergo a potentially curative operation for their primary tumour but subsequently recur, almost 80% will develop evidence of metastatic disease within the liver. Greater experience and improvements in technique in liver surgery, with an increasingly aggressive surgical approach to metastatic colorectal cancer to the liver, has resulted in prolonged disease-free survival with 5-year rates varying from 21% to 48%. In order to increase these numbers further and to treat patients not eligible for surgical therapy, new treatment modalities and strategies have been developed. This review presents an update of the current treatment for colorectal disease metastatic to the liver.     

Proton therapy in lung cancer: clinical outcomes and technical issues. A systematic review.

BACKGROUND AND PURPOSE: To determine whether, according to the currently available literature, proton therapy (PT) has a role in the treatment of non-small-cell lung cancer (NSCLC), to assess its safety and efficacy and to evaluate the main technical issues specifically related to this treatment technique. MATERIALS AND METHODS: During March 2007, two independent researchers conducted a systematic review of the current data on the treatment of NSCLC with PT. RESULTS: In total, 113 reports were retrieved, 17 of which were included in the analysis. There were no prospective trials (randomized or non-randomized). Nine uncontrolled single-arm studies were available from three PT centers, providing clinical outcomes for 214 patients in total. These reports were mainly related to stage I-II tumors, with results comparable to those obtained with surgery, without significant toxicity. In addition, two papers were found that compared photon and proton dose distributions, which showed a potential for dose escalation and/or a sparing of the organ at risk with PT. Finally, six studies analyzed dosimetric and technical issues related with PT, mainly underlining the difficulties in designing dose distributions that are representative of the dose actually delivered during treatment. CONCLUSIONS: Although from a physical point of view PT is a good option for the treatment of NSCLC, limited data are available on its application in the clinical practice. Furthermore, the application of PT to lung cancer does present technical challenges. Because of the small number of institutions involved in the treatment of this disease, number of patients, and methodological weaknesses of the trials it is therefore not possible to draw definitive conclusions about the superiority of PT with respect to the photon techniques currently available for the treatment of NSCLC.     

Aggressive insulinoma with bone metastases

This is the first report of the development of bone metastases in a patient with an insulinoma. Following the development of bone metastases, further chemotherapy with etoposide (VP-16) and cis-platinum was not successful and the patient's condition was rapidly fatal. This case demonstrates the unusually aggressive course and poor response to currently available chemotherapeutic agents of a malignant insulinoma. The clinical and diagnostic features of insulinomas are reviewed.     

Aesthetic and Functional Evaluation of Total Nasal Reconstructions

The loss of a portion or the totality of the nose has great relevance on the perception of the beauty of a face and can result in a catastrophic quality of life impairment. Several surgical techniques are currently available for the reconstruction of the nasal pyramid. However, there are very few nasal reconstruction quality evaluation protocols that allow the surgeon to choose objectively the best technique for each kind of defects. Six total nasal reconstruction performed in University of Sassari Maxillofacial Unit were evaluated with a protocol that investigate objectively and subjectively the surgical aesthetic and functional outcome. Sensitivity recovery on the reconstructive flaps was also assessed. Patients reported a satisfactory nasal reconstruction both functionally and aesthetically. Sensitivity recovery on the forehead flap was always present even after pedicle resection or in case of traumatic section of the infraorbital nerve. The use of a three layer reconstruction has proved a viable technique both aesthetically and functionally. In particular the use of the forehead flap to reconstruct the outer layer of the nose allows to carry a tissue with very similar characteristics to the original with a recovery of the sensitivity almost complete.     

Peptide receptor radionuclide therapy for patients with advanced pancreatic neuroendocrine tumors

¹⁷⁷Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) is now approved for patients with advanced gastroenteropancreatic neuroendocrine tumors (NET), and it is therefore important to understand the efficacy and safety of PRRT in this patient population. PRRT efficacy and safety outcomes have frequently been summarized for patient populations with gastroenteropancreatic NET, but not specifically in patients with pancreatic NET (panNET). The pivotal phase 3 trial of ¹⁷⁷Lu-DOTATATE PRRT in NET was restricted to patients with a midgut primary site. No phase 3 trial data on PRRT treatment outcomes are currently available for the panNET patient population. This review presents the available evidence for panNET treatment outcomes with PRRT and demonstrates that the available data favor PRRT as a modality for this NET primary site. However, several other therapies for advanced panNET are currently available, and the sequencing and combination of PRRT with these other therapies is set to become the big challenge for the future of panNET management. Patient, tumor, and logistical factors (tumor burden, expression of somatostatin receptors, availability of PRRT, patient preferences, and concerns over long-term toxicity) need to be taken into consideration when selecting therapy.     

Stimulation of neo-angiogenesis by combined use of irradiated and vascularized living bone graft for oncological reconstruction

Reconstruction for large bone and osteochondral defects following musculoskeletal tumor excision remains challenging. Mega-prosthesis is clearly a useful reconstructive tool. Because the survival time of tumor patients has been increasing due to better treatment options, the aim of our group is to achieve complete biological reconstruction without using any artificial materials. With this approach, durability would not be a limitation. In the present study, we reviewed the biological reconstructive procedures currently available for large bone defects after tumor excision. Devitalized bone autograft is particularly well suited in the region where allografts are not readily available. However, the complication rate, such as infection and spontaneous bone resorption, was unexpectedly high due to non-viable graft. In an attempt to reduce these complications, we have used irradiated bone autograft in combination with free vascularized viable bone graft. In an experimental study, we demonstrated a neo-vascularization effect of vascularized bone graft with devitalized bone autograft, i.e. to convert dead bone into living bone. Clinically, this technique is best indicated for reconstruction of intercalary bone defect, especially tibial shaft. Some degree of articular change occurs after irradiation and cannot be prevented, even with the combined use of vascularized bone graft. In our experience, secondary procedures such as surface replacement prosthesis are necessary to treat the osteoarthritis in such cases, even if the radiological finding is severe. The rationale for a combined vascularized and irradiated bone autograft is the cumulative advantage provided by the biological properties of the former with the mechanical endurance of the latter.