The FIGO 2018 staging system was introduced to allow better prognostic differentiation in cervical cancer, causing considerable stage migration and affecting treatment options. We evaluated the ...accuracy of the FIGO 2018 staging in predicting recurrence free (RFS) and overall survival (OS) compared to FIGO 2009 staging in clinically early stage cervical cancer. We conducted a nationwide retrospective cohort study, including 2264 patients with preoperative FIGO (2009) IA1, IA2 and IB1 cervical cancer between 2007–2017. Kaplan–Meier analyses were used to assess survival outcomes. Logistic regression was used to assess risk factors for lymph node metastasis and parametrial invasion. Stage migration occurred in 48% (22% down-staged, 26% up-staged). Survival data of patients down-staged from IB to IA1/2 disease were comparable with FIGO 2009 IA1/2 and better than patients remaining stage IB1. LVSI, invasion depth and parametrial invasion were risk factors for lymph node metastases. LVSI, grade and age were associated with parametrial invasion. In conclusion, the FIGO 2018 staging system accurately reflects prognosis in early stage cervical cancer and is therefore more suitable than the FIGO 2009 staging. However subdivision in IA1 or IA2 based on presence or absence of LVSI instead of depth of invasion would have improved accuracy. For patients down-staged to IA1/2, less radical surgery seems appropriate, although LVSI and histology should be considered when determining the treatment plan.
Objectives
Imaging is increasingly used to assess lymph node involvement in clinically early-stage cervical cancer. This retrospective study aimed to evaluate the diagnostic accuracy of MRI, CT, and
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FFDG-PET-CT.
Methods
Women with International Federation of Gynaecology and Obstetrics (FIGO) 2009 stage IA2-IIA cervical cancer and pretreatment imaging between 2009 and 2017 were selected from the Netherlands Cancer Registry. Patient-based and region-based (i.e. pelvic and common iliac) nodal status was extracted from radiology reports. Pathology results were considered the reference standard for calculating accuracy indices. Multiple imputation was used for missing pathology to limit verification bias risk.
Results
Nodal assessment was performed in 1676 patients with MRI, 926 with CT, and 379 with
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FFDG-PET-CT, with suspicious nodes detected in 17%, 16%, and 48%, respectively.
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FFDG-PET-CT was used to confirm MRI/CT results in 95% of patients. Pathology results were imputed for 30% of patients.
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FFDG-PET-CT outperformed MRI and CT in detecting patient-based nodal metastases with sensitivities of 80%, 48%, and 40%, and AUCs of 0.814, 0.706, and 0.667, respectively, but not in specificity: 79%, 92%, and 92%. Region-based analyses showed similar indices in the pelvic region, but worse performance in the common iliac region with AUCs of 0.575, 0.554, and 0.517, respectively.
Conclusions
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FFDG-PET-CT outperformed MRI and CT in detecting nodal metastases, which may be related to its use as a verification modality. However, MRI and CT had the highest specificity. As MRI is generally performed routinely to assess local and regional spread of cervical cancer,
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FFDG-PET-CT can be used to confirm suspicious nodes.
Critical relevance statement
Accurate assessment of the nodal status in clinically early-stage cervical cancer is essential for tumour staging, treatment decision making and prognosis.
Key points
• The accuracy of MRI, CT or
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FFDG-PET-CT for nodal staging in early cervical cancer is a subject of discussion.
• Overall,
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FFDG-PET-CT outperformed MRI, followed by CT, when used as a verification modality.
• Staging with MRI and the addition of
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FFDG-PET-CT to verify high-risk cases seems to be a good approach.
Graphical Abstract
Design and fabrication of a monolithic, single aperture widely tuneable diode laser emitting around 970 nm is presented. Overgrown sampled grating Bragg reflectors are applied to setup wavelength ...selective mirrors. Wavelength tuning is achieved via the Vernier effect with thermal heaters placed on top of the sampled gratings. The 20 nm quasi-continuous tuning around 970 nm with an optical side mode suppression ratio in excess of 40 dB is demonstrated and an optical output power of more than 30 mW at a pump current of 180 mA is presented.
We report on broad-area distributed Bragg reflector (DBR) lasers with a stripe width of 90 ¿m providing up to 14-W optical power and 50% maximum conversion efficiency. Ninety-five percent of the ...power is included within a wavelength range of less than 1 nm. The wavelength shift between threshold and the maximum output power is less than 3.5 nm. The wavelength stabilization is achieved with a 500-¿m -long DBR containing a sixth-order Bragg grating defined by i-line wafer stepper lithography and fabricated by reactive ion etching.
High-intensity focused ultrasound (HIFU) has been shown to generate lesions that destroy brain tissue while disrupting the blood-brain barrier (BBB) in the periphery of the lesion. BBB opening, ...however, has not been shown without damage, and the mechanisms by which HIFU induces BBB disruption remain unknown. We show that HIFU is capable of reversible, nondestructive, BBB disruption in a targeted region-of-interest (ROI) (29 of 55 applications; 26 of 55 applications showed no effect); this opening reverses after 72 h. Light microscopy demonstrates that HIFU either entirely preserves brain architecture while opening the BBB (18 of 29 applications), or generates tissue damage in a small volume within the region of BBB opening (11 of 29 applications). Electron microscopy supports these observations and suggests that HIFU disrupts the BBB by opening capillary endothelial cell tight junctions, an isolated ultrastructural effect that is different from the mechanisms through which other (untargeted) modalities, such as hyperosmotic solutions, hyperthermia and percussive injury disrupt the BBB. (E-mail: pierre@apl.washington.edu)
We present experimental results about edge-emitting distributed-Bragg-reflector-tapered diode lasers emitting at 980 nm. The investigated lasers show an output power of up to 12 W with a conversion ...efficiency of about 45%. The lasers also exhibit a small vertical divergence <15deg full-width at half maximum (FWHM), a nearly diffraction-limited beam quality, and a narrow spectral linewidth with FWHM smaller than 12 pm. These properties allow efficient single-pass second harmonic generation with power levels of more than 1 W at 488 nm.
As a consequence of the EU Water Framework Directive more focus is now on discharges of hazardous substances from wastewater treatment plants and sewers. Thus, many municipalities in Denmark may have ...to adopt to future advanced treatment technologies. This paper describes a holistic assessment, which includes technical, economical and environmental aspects. The technical and economical assessment is performed on 5 advanced treatment technologies: sand filtration, ozone treatment, UV exclusively for disinfection of pathogenic microorganisms, membrane bioreactor (MBR) and UV in combination with advanced oxidation. The technical assessment is based on 12 hazardous substances comprising heavy metals, organic pollutants, endocrine disruptors as well as pathogenic microorganisms. The environmental assessment is performed by life cycle assessment (LCA) comprising 9 of the specific hazardous substances and three advanced treatment methods; sand filtration, ozone treatment and MBR. The technical and economic assessment showed that UV solely for disinfection purposes or ozone treatment is the most advantageous advanced treatment methods if the demands are restricted to pathogenic microorganisms. In terms of sustainability, sand filtration is the most advantageous method based on the technical and environmental assessment due to the low energy consumption and high efficiency with regards to removal of heavy metals.
Significant environmental improvements can often be achieved by integrating environmental properties as an optimisation parameter in product development together with more traditional values such as ...production costs, functionality, aesthetics etc. This paper presents a professional method intended for managers based on quantitative life cycle assessment to identify environmental ‘hot spots’ in a reference product's life cycle and to select new environmentally optimised solutions for a new product. The paper takes its starting point in traditional procedures for product development (idea, analysis, goal definition, concept development and detail development) and shows step by step how the environmental properties of the new product can be optimised and thus contribute to the overall competitiveness of the new product.
Landslides are responsible for a considerable loss of buildings and infrastructure and often human lives. Although most of the studies concerning landslide disasters are concentrated on landslide ...risk assessment, zoning and monitoring, there are few studies focusing in its vulnerability component, particularly for inhabited areas. This paper explores the applicability of a new methodology for landslide vulnerability assessment that allows for a simplified probabilistic estimation of vulnerability to landslides. This is based on the First-Order Second-Moment (FOSM) approach, which allows for the quantification of uncertainty from the input parameters up to the vulnerability estimates. Results on the application of the method show vulnerability estimates for susceptible categories on structures and people for prescribed study areas. These are given in the form of expected values and ranges of variation, according to uncertainty measures given by intensity and susceptibility parameters. Due to the expert-based nature of the vulnerability methodology, fine judgement is expected to accompany the interpretations of results.
Many European infrastructures dating back to ’50 and ’60 of the last century like bridges and viaducts are approaching the end of their design lifetime. In most European countries costs related to ...maintenance of infrastructures reach a quite high percentage of the construction budget and additional costs in terms of traffic delay are due to downtime related to the inspection and maintenance interventions. In the last 30 years, the rate of deterioration of these infrastructures has increased due to increased traffic loads, climate change related events and man-made hazards. A sustainable approach to infrastructures management over their lifecycle plays a key role in reducing the impact of mobility on safety (over 50 000 fatalities in EU per year) and the impact of greenhouse gases emission related to fossil fuels. The events related to the recent collapse of the Morandi bridge in Italy tragically highlighted the sheer need to improve resilience of aging transport infrastructures, in order to increase the safety for people and goods and to reduce losses of functionality and the related consequences. In this focus Structural Health Monitoring (SHM) is one of the key strategies with a great potential to provide a new approach to performance assessment and maintenance over the life cycle for an efficient, safe, resilient and sustainable management of the infrastructures. In this paper research efforts, needs and challenges in terms of performance monitoring, assessment and standardization are described and discussed.
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