Usefulness of FDG PET for assessment of early recurrent epithelial ovarian cancer

OBJECTIVE: The purpose of our study was to evaluate the diagnostic accuracy of FDG positron emission tomography (PET) in comparison with CT in detecting recurrent ovarian carcinoma and its ability to reveal small tumor recurrence. MATERIALS AND METHODS: We reviewed the records of 31 consecutive patients with pathologically proven epithelial carcinoma who underwent FDG PET 1 month before second-look surgery to assess recurrent tumor. Of these 31 patients, 21 patients also underwent CT 1 month before second-look surgery. The diagnostic accuracies of FDG PET (n = 31), CT (n = 21), and combined FDG PET and CT (n = 21) in detecting recurrent tumor were calculated and compared with each other using the Bennett's test in 21 patients who underwent both imaging studies. Detection rates of individual tumors relative to their sizes were compared between FDG PET and CT using the McNemar test. RESULTS: The sensitivity, specificity, and accuracy of FDG PET, CT, and combined FDG PET and CT for revealing recurrent ovarian cancer were 45.3%, 99.7%, 91.0%; 54.5%, 99.6%, 91.7%; 58.2%, 99.6%, 92.4%, respectively. We found no statistically significant difference in the diagnostic accuracy of FDG PET, CT, and combined FDG PET and CT (chi(2) < 5.991). Detection rates of tumor nodules found on CT were significantly greater than those on FDG PET when nodule size was 0.3-0.7 cm (p < 0.05). CONCLUSION: FDG PET did not improve the overall diagnostic accuracy in detecting recurrent ovarian carcinoma compared with CT. Rather, FDG PET was inferior to CT in its ability to reveal small-tumor recurrence.     

Screening for lung cancer

OBJECTIVE: The purpose of our review is to discuss the current state of lung cancer screening using CT in the context of defined criteria for effective screening. CONCLUSION: Although there are hopeful developments in lung cancer screening, a number of unresolved issues must be answered before adopting screening on a large scale. Currently no data exist to suggest that lung cancer screening with CT will result in a decrease in lung cancer mortality.     

Screening for colorectal cancer

Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer deaths in the United States. Fortunately, both the incidence and mortality associated with the disease have declined during the past 2 decades. This is likely due, at least in part, to improved efforts at screening and more aggressive removal of adenomatous polyps. However, colorectal cancer screening is still generally underutilized. This article reviews the current status and future outlook for colorectal cancer screening, including a discussion of risk factors for the disease, its anatomic distribution, proposed mechanisms of development from adenomatous polyps, rationale for screening, and screening options. Published literature concerning the cost-effectiveness of colorectal cancer screening is also summarized. The article concludes with a discussion of the emerging consensus regarding the importance of and approaches to screening.     

Screening for lung cancer

Screening for lung cancer serves to prevent deaths from this disease insofar as earlier resections are associated with higher rates of cure. There is good reason to believe that this is the case: in stage I, the 5-year survival rate with resection is 70%, whereas without resection the corresponding rate is only 10%. Before this evidence emerged, various authoritative organizations and agencies in North America advised against screening for lung cancer on the grounds of the results of several RCTs. As for CXR, I argue that the study results are consistent with up to 40% reduction in the fatality rate. Moreover, modern helical CT screening provides for detecting much smaller tumors than were detected in those studies. It is time to revoke the conclusion that screening for lung cancer does not serve to prevent deaths from this disease, and to quantify the usefulness of CT screening in particular. As for the requisite research, the prevailing orthodoxy has it that RCTs are to be used, but I argue that more meaningful results are obtainable, more rapidly and much less expensively, by the use of noncomparative (and hence unrandomized) studies.     

Technic and results of radiotherapy in early stages of ovarian cancer

By treating eleven patients with an individual large field therapy adapted to the single stage and subsequent chemotherapy (Leukeran), we obtained an average survival time of 42,6 months (living patients) and 37,6 months (patients died), respectively. Late complications of this therapy were not observed, the tolerance was good. In case of recurrence after this treatment, the reserves of bone marrow seem to be too small to allow an aggressive chemotherapy.     

Screening mammography mitigates breast cancer disparities through early detection of triple negative breast cancer

PurposeScreening mammography improves breast cancer survival through early detection, but Triple Negative Breast Cancer (TNBC) is more difficult to detect on mammography and has lower survival compared to non-TNBC, even when detected at early stages. TNBC is twice as common among African American (AA) compared to White American (WA) women, thereby contributing to the 40% higher breast cancer mortality rates observed in AA women. The role of screening mammography in addressing breast cancer disparities is therefore worthy of study.MethodsOutcomes were evaluated for TNBC patients treated in the prospectively-maintained databases of academic cancer programs in two metropolitan cities of the Northeast and Midwest, 1998–2018.ResultsOf 756 TNBC cases, 301 (39.8%) were mammographically screen-detected. 46% of 189 AA and 38.5% of 460 WA patients had screen-detected TNBC (p = 0.16). 25.3% of 257 TNBC cases ≤50 years old had screen-detected disease compared to 47.3% of 499 TNBC cases >50 years old (p < 0.0001).220/301 (73.1%) screen-detected TNBC cases were T1 lesions versus 118/359 (32.9%) non-screen-detected cases (p < 0.0001). Screen-detected TNBC was more likely to be node-negative (51.9% v. 40.4%; p < 0.0001).Five-year overall survival was better in screen-detected TNBC compared to nonscreen-detected TNBC (92.8% v. 81.5%; p < 0.0001) in the entire cohort. The magnitude of this effect was most significant among AA patients (Fig. 1). Screening-related survival patterns were similar among AA and WA patients in both cities.ConclusionData from two different cities demonstrates the value of screening mammography to mitigate breast cancer disparities in AA women through the early detection of TNBC.     

Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers

PURPOSE: To present prevalence screening data from a nonrandomized screening trial by using low-dose computed tomography (CT) and a simple algorithm based on the size and attenuation of detected nodules to guide diagnostic work-up. MATERIALS AND METHODS: Eight hundred seventeen asymptomatic volunteers (age range, 40-78 years; median age, 53 years; median tobacco consumption, 45 pack-years) underwent spiral low-dose CT of the chest without contrast material enhancement. We regarded all noncalcified pulmonary nodules greater than 10 mm in diameter as potentially malignant and recommended histologic examination or follow-up after 3, 6, 12, and 24 months to exclude growth. For noncalcified pulmonary nodules of 10 mm or smaller, repeat low-dose CT was recommended to exclude growth. RESULTS: In 43% (350 of 817) of individuals, 858 noncalcified pulmonary nodules were found. Thirty-two nodules in 29 subjects were larger than 10 mm. Biopsy of 15 lesions revealed lung cancer in 12 lesions in 11 subjects (prevalence for all ages, 1.3% [11 of 817 subjects]; >50 years of age, 2.1% [11 of 519 subjects]; >60 years of age, 3.9% [eight of 206 subjects]), with a high proportion of early tumor stages (seven tumors, stage I; two, stage II; and three, stage III); three lesions were benign. In 17 nodules larger than 10 mm, follow-up with low-dose CT for a minimum of 24 months did not demonstrate growth. CONCLUSION: Lung cancer screening with low-dose CT demonstrated a prevalence of asymptomatic cancers in 1.3% of a smoking population, including a high proportion of early tumor stages and a 20% (three of 15) rate of invasive procedures for benign lesions.     

Screening for breast cancer with mammography

Mammography is generally accepted as a useful problem-solving clinical tool in characterizing known breast lesions, so that appropriate and timely treatment can be given. However, it remains grossly underutilized at what it does best: screening. The major strengths of mammography are a) its ability to detect breast cancer at a smaller, potentially more curable stage than any other examination, and b) its proved efficacy in reducing breast cancer mortality in asymptomatic women aged 40–74. If, as has recently been estimated, screening with mammography and physical examination can be expected to lower breast cancer deaths by 40%–50% among those actually examined (13), then the lives of almost 20,000 U.S. women might be saved each year if screening were to become very widely used. The challenges of the next decade are clear, to mount much more effective campaigns to educate physicians and lay women about the life-saving benefits of breast cancer screening, to devise increasingly effective and lower cost screening strategies, to further improve the current high quality of mammographic imaging despite its increasing proliferation, and to train large numbers of breast imaging specialists to guarantee that the growing case load of screening and problem-solving mammograms is interpreted with a very high level of skill.     

Screening for prostate cancer in military populations

With the widespread use of the prostate-specific antigen (PSA) test, smaller cancers are being detected among younger men and 5-year, cancer-specific, survival rates are on the rise. Although this lead-time effect may not translate into long-term improvement, these changes are a necessary prerequisite to effective screening. For high-risk patients, i.e., men with a family history of the disease and African American men, a strategy consisting of annual PSA blood testing and digital rectal examination for men > or = 40 years of age appears prudent. Many low/average-risk men of age 40 to 49 also request testing, and it is reasonable to offer testing and risk assessment to them. The exact screening threshold for total PSA levels for these men is not known, but 95% have PSA levels of < or = 1.5 to 2.5 ng/mL. PSA velocity (< 20% per year), percentage of free PSA (> 18-25%), and complexed PSA levels may be used to help determine risk. More study of young men is needed.     

Patients with ovarian cancer have elevated (51)Cr-EDTA plasma clearance early post-operatively

Plasma clearance of (51)Cr-EDTA (Clp(EDTA)) is widely used to determine glomerular filtration rate prior to carboplatin based chemotherapy. We have observed that many patients with ovarian cancer have elevated Clp in the early post-operative phase compared to later phases. The purpose of this study was to examine whether this observation reflects a systematic difference. We retrospectively analysed data from 53 patients who had undergone surgery for ovarian cancer. Twenty-six patients had Clp(EDTA) measured early after the operation (mean, 8 days (range, 3-16 days)) (early group), and 27 patients had Clp(EDTA) measured late post-operatively (mean, 32 days (range, 19-48 days)) (late group). Clp(EDTA) values was measured before the first, third and fifth course of chemotherapy. Additionally, age, height, weight, cancer stage, ascites and tumour histology were noted. Mean Clp(EDTA) in the early group was significantly higher than in the late group (104+/-4.4 vs 89+/-3.5 ml.min(-1) per 1.73 m(2); P =0.005). Clp(EDTA) declined significantly in the early group from the first measurement after the operation until measurement before the third course of chemotherapy but remained constant in the late group. Clp(EDTA) was not correlated to ascites, cancer stage or tumour histology. It is concluded that patients with ovarian cancer have significantly higher Clp(EDTA) in the early post-operative phase than similar patients with Clp(EDTA) measured late post-operatively.     

蛋白质芯片技术在矽肺早期血清生物标志物筛选中的应用

目的寻找可对矽肺患者进行早期诊断的血清特异性生物标志物。方法选择接触矽尘未患病者(0组)、接触矽尘有可疑矽肺者(0 组)、接触矽尘后患I期矽肺者(I组)以及未接触矽尘的正常人(正常对照组)各20例,利用表面加强激光解析电离飞行时间质谱(SELDI-TOF-MS)技术检测各组血清蛋白质指纹图谱。结果质荷比(M/Z)为2746、3269、3402、3941、4184、5488、5914、6122、7572、7937的10个标志分子在矽尘暴露人员(0、0 、I组)和正常人的血清中差异表达,相对含量变化具有统计学意义(P<0.05)。其中M/Z为2746的分子在矽尘暴露人员血清中高表达,而在正常人血清中低表达;相反,M/Z为4184、5914和6122的分子在正常人血清中高表达,而在矽尘暴露人员血清中低表达。M/Z为2938、3269、3821、4095、5071、5483、5640的7个标志分子在矽尘暴露人员各组血清中差异表达,相对含量变化具有统计学意义(P<0.05),其中M/Z为5071、5483和5640的分子在矽尘暴露人员0组和0 组中均为低表达,而在I组中高表达。结论M/Z为2746、4184、5914和6122的分子可能成为矽肺患者与正常人的鉴别诊断指标,而M/Z为5071、5483和5640的分子可能成为矽肺的早期诊断指标。     

Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers

The aim of this study was analysis of incidence results in a prospective one-arm feasibility study of lung cancer screening with low-radiation-dose spiral computed tomography in heavy smokers. Eight hundred seventeen smokers (40 years, 20 pack years of smoking history) underwent baseline low-dose CT. Biopsy was recommended in nodules >10 mm with CT morphology suggesting malignancy. In all other lesions follow-up with low-dose CT was recommended. Annual repeat CT was offered to all study participants. Six hundred sixty-eight (81.8%) of the 817 subjects underwent annual repeat CT with a total of 1735 follow-up years. Follow-up of non-calcified nodules present at baseline CT demonstrated growth in 11 of 792 subjects. Biopsy was performed in 8 of 11 growing nodules 7 of which represented lung cancer. Of 174 new nodules, 3 represented lung cancer. The 10 screen-detected lung cancers were all non-small cell cancer (6 stage IA, 1 stage IB, 1 stage IIIA, 2 stage IV). Five symptom-diagnosed cancers (2 small cell lung cancer: 1 limited disease, 1 extensive disease, 3 central/endobronchial non-small cell lung cancer, 2 stage IIIA, 1 stage IIIB) were diagnosed because of symptoms in the 12-month interval between two annual CT scans. Incidence of lung cancer was lower than prevalence, screen-detected cancers were smaller, and stage I was found in 70% (7 of 10) of screen-detected tumors. Only 27% (4 of 15) of invasive procedures was performed for benign lesions; however, 33% (5 of 15) of all cancers diagnosed in the population were symptom-diagnosed cancers (3 central NSCLC, all stage III, 2 SCLC) demonstrating the limitations of CT screening.     

Imaging of ovarian cancer

Cross sectional imaging continues to play an increasingly important role in ovarian cancer diagnosis, staging, and treatment follow-up. Screening for ovarian cancer remains a controversial subject. The combined use of clinical examination, CA-125, and endovaginal ultrasound (US) are being advocated for high risk patients but consensus recommendation for screening awaits further studies. in characterization of an ovarian neoplasm US is indisputedly the primary imaging approach. Only when US is inconclusive are further studies warranted. Magnetic resonance imaging (MRI) is generally preferred to computer tomography (CT). A prospective MRI-CT clinical trial has not been performed as yet. Preoperative staging by imaging is slowly gaining its acceptance. This is mostly due to the awareness of the difficulties and inaccuracy in surgical staging when unsuspected extensive disease is present. Furthermore, in known resectable ovarian cancer, primary chemotherapeutic cytoreduction may be a better treatment option. Accuracy of CT and MRI in staging ovarian cancer is similar. CT, however, is faster, more widely available, and less expensive; these are important attributes that are decisive in this time of health reimbursement constraints.     

Screening for lung cancer by low-dose computed tomography

The primary screening method for lung cancer in Japan is the chest x-ray, although it is not the accepted international standard because its accuracy is lower than that of procedures used to detect other types of cancer. Since the incidence and mortality rate of lung cancer are higher than in many other cancers, more effective screening modalities need to be developed. Lung cancer screening was improved about ten years ago through the introduction of computed tomography (CT) scanning techniques. CT provides a higher level of accuracy in detecting early lung cancers and there have been reports of improvement in the five-year survival rate, although its effect on decreasing the mortality rate has not been demonstrated as yet. There are two significant disadvantages, however, associated with using CT for the detection of lung cancer. First, CT scanning results in a considerably higher level of radiation exposure than chest x-ray. Secondly, CT scanning is so sensitive that it can reveal shadows unrelated to lung cancer, resulting in additional, but unnecessary CT scans being performed for further examination. Accordingly, this report reviews the basic points that should be considered when conducting CT scanning for lung cancer screening purposes.