To evaluate the imaging characteristics of desmoplasia on digital breast tomosynthesis (DBT) and their association with the Ki-67 index.
Seventy-seven malignant spiculated breast masses were analyzed ...in terms of tumor size, length and width of spicules, coverage of tumor margin with spicules, and the number of spicules. The Ki-67 index was obtained from surgically removed tumor specimens.
The average spicule length was significantly negatively associated with a high Ki-67 (P=0.005, odds ratio OR 0.252, 95% confidence interval CI 0.094-0.676), ie, the lesions with longer spicules had a 3.968 times lower odds of having a high Ki-67 than the lesions with shorter spicules. The average spicule width at the base was significantly positively associated with Ki-67 (P=0.004, OR 3.939, 95% CI 1.520-10.209), ie, the lesions with thick spicules had a 3.939 times higher odds of having a high Ki-67 than the lesions with thin spicules. The lesions with more than 20 spicules and those with partially spiculated margins more frequently had a high Ki-67 than those with fewer spicules and fully spiculated margins, but the differences were not significant.
The spiculation analysis could be used as a non-invasive method providing information about malignant lesions. The tumor proliferative activity, and therefore the patient's prognosis, might be predicted before biopsy directly from DBT images.
In this study, we compared the measurement of carotid stenosis by computed tomography angiography (CTA) based on the narrowest diameter
cross sectional area (CSA) with the measurement by color ...Doppler ultrasonography (CDUS) as a reference standard, and analyzed how the application of different statistical methods affected the result. On 113 carotid arteries with ≥50% stenosis, we quantified the level of correlation among the three measurements, sensitivity, specificity, and differences in the estimated stenosis level. Correlation between both CTA measurements was good with Pearson's ρ between 0.87 and 0.91 (p<0.001). Correlation between CDUS and CTA measurements was only modest with Pearson's ρ between 0.2 (p=0.075) and 0.4 (p=0,007) for CDUS CTA (CSA), and between 0.23 (p=0.062) and 0.39 (p=0.008) for CDUS CTA (diameter). Differences in stenosis between CTA (CSA) and CDUS were centered around 0%, and between CTA (diameter) and CDUS around 20%. Sensitivity and specificity for CTA (CSA) method were 81% and 77%, and for CTA (diameter) 23% and 100%, respectively. A good correlation between CSA and diameter measurement just means that these are two related features of stenosis, it does not mean good agreement. CTA (CSA) method better detected surgical stenoses, whereas CTA (diameter) systematically underestimated stenosis level. The study of differences between the measurements indicated agreement better than the calculation of correlation coefficients.
Objectives
To compare the estimation of carotid artery stenosis by computed tomography angiography (CTA) based on cross-sectional area versus the smallest diameter measurement, and test the accuracy ...of both CTA measurements using color Doppler ultrasonography (CDUS) as a reference method.
Methods
For 113 carotid arteries with stenosis ≥50% we analysed the differences in the estimated stenosis level between both CTA methods and CDUS using the Bland-Altman approach. Further, we calculated sensitivity, specificity and plotted receiver operating characteristic (ROC) curves for both CTA methods.
Results
The mean difference between CDUS and CTA (area) measurements was −0.4% (
p
= 0.68); between CDUS and CTA (diameter), 20.7% (
p
< 0.001); and between CTA (area) and CTA (diameter), 21.2% (
p
< 0.001). Sensitivity and specificity for the CTA (area) method were 81% and 77%, and for CTA (diameter) were 23% and 100%. The area under the curve (AUC) for CTA (diameter) was 0.62 (0.57, 0.66), and for CTA (area) 0.79 (0.71–0.87). The equality test for the two AUCs was <0.0001.
Conclusions
CTA (diameter)-based measurements significantly underestimated the degree of carotid stenosis. We recommend the CTA (area) method because of its higher predictive power for a correct stenosis classification and a lack of significant difference in the estimated stenosis level, compared to CDUS.
Main messages
•
Cross-sectional area measurement considers asymmetric shape of the residual vessel lumen.
•
CTA (diameter) method on average significantly underestimates the true level of stenosis.
•
CTA (area) method correctly classifies vessels needing surgical intervention.
Perkutana biopsija širokom iglom minimalno je invazivna metoda koja omogućava preoperativnu histološku dijagnozu promjena u dojci. Kod nepalpabilnih promjena izvodi se pod kontrolom radioloških ...slikovnih
metoda. Neke promjene vidljive tomosintezom nisu uočljive 2D mamografijom i ne mogu se bioptirati konvencionalnom stereotaksijskom metodom. Stoga je 2013. godine u kliničku praksu uvedena biopsija vođena tomosintezom. Ta se metoda služi slojevnim snimkama za definiranje dubine promjene, bez potrebe za dodatnim snimanjem i triangulacijom. Postupak se izvodi s manjim brojem ekspozicija i stoga s nižom ukupnom dozom zračenja te kraće od stereotaksijske biopsije. U Općoj bolnici Karlovac metoda se primjenjuje od kraja 2015. godine, otkad je učinjeno 179 zahvata. Ciljanje i uzimanje uzoraka bili su uspješni kod svih promjena, što je potvrđeno
kontrolnom tomosintezom ili snimanjem uzoraka pri promjenama s kalcifikatima. Patohistološkom analizom dobiveni su 44 (24,6%) maligna nalaza, 13 (7,3%) benignih promjena nesigurnoga malignog potencijala te 122-je (68,2%) benigne promjene. Među malignim nalazima bili su 32 (72,7%) neinvazivna duktalna karcinoma (DCIS) i 12 (27,3%) invazivnih karcinoma. S obzirom na konačnu dijagnozu, nakon kirurškog zahvata imali smo stopu podcijenjenosti DCIS-a od 14,3%, a benignih promjena nesigurnoga malignog potencijala od 25%.
Benigne promjene praćene su tijekom razdoblja od 24 mjeseca. U uzorku sa završenim periodom praćenja stopa lažno negativnih nalaza bila je 2,8%, osjetljivost metode 86,4%, specifičnost 100%, pozitivna prediktivna vrijednost 100%, negativna prediktivna vrijednost 70%, a točnost 89,7%. Za vrijeme postupka i nakon njega nismo imali većih komplikacija. Biopsija dojke vođena tomosintezom nije rezervirana samo za promjene vidljive jedino tomosintezom već se može primijeniti i za vođenje biopsija promjena koje su vidljive 2D mamografijom.
Aim To evaluate the imaging characteristics of desmoplasia on digital breast tomosynthesis (DBT) and their association with the Ki-67 index. Methods Seventy-seven malignant spiculated breast masses ...were analyzed in terms of tumor size, length and width of spicules, coverage of tumor margin with spicules, and the number of spicules. The Ki-67 index was obtained from surgically removed tumor specimens. Results The average spicule length was significantly negatively associated with a high Ki-67 (P = 0.005, odds ratio OR 0.252, 95% confidence interval CI 0.094-0.676), ie, the lesions with longer spicules had a 3.968 times lower odds of having a high Ki-67 than the lesions with shorter spicules. The average spicule width at the base was significantly positively associated with Ki-67 (P = 0.004, OR 3.939, 95% CI 1.520-10.209), ie, the lesions with thick spicules had a 3.939 times higher odds of having a high Ki-67 than the lesions with thin spicules. The lesions with more than 20 spicules and those with partially spiculated margins more frequently had a high Ki-67 than those with fewer spicules and fully spiculated margins, but the differences were not significant. Conclusion The spiculation analysis could be used as a non-invasive method providing information about malignant lesions. The tumor proliferative activity, and therefore the patient's prognosis, might be predicted before biopsy directly from DBT images.
In this study, we compared the measurement of carotid stenosis by computed tomography angiography (CTA) based on the narrowest diameter versus cross sectional area (CSA) with the measurement by color ...Doppler ultrasonography (CDUS) as a reference standard, and analyzed how the application of different statistical methods affected the result. On 113 carotid arteries with >50% stenosis, we quantified the level of correlation among the three measurements, sensitivity, specificity, and differences in the estimated stenosis level. Correlation between both CTA measurements was good with Pearson's p between 0.87 and 0.91 (p<0.001). Correlation between CDUS and CTA measurements was only modest with Pearson's p between 0.2 (p=0.075) and 0.4 (p=0,007) for CDUS CTA (CSA), and between 0.23 (p=0.062) and 0.39 (p=0.008) for CDUS CTA (diameter). Differences in stenosis between CTA (CSA) and CDUS were centered around 0%, and between CTA (diameter) and CDUS around 20%. Sensitivity and specificity for CTA (CSA) method were 81% and 77%, and for CTA (diameter) 23% and 100%, respectively. A good correlation between CSA and diameter measurement just means that these are two related features of stenosis, it does not mean good agreement. CTA (CSA) method better detected surgical stenoses, whereas CTA (diameter) systematically underestimated stenosis level. The study of differences between the measurements indicated agreement better than the calculation of correlation coefficients. Key words: Carotid stenosis; CT angiography; Color Doppler ultrasonography; Statistical data analysis U studiji smo usporedili mjerenje stenoze karotida CT angiografijom (CTA) bazirano na najuzem promjeru ili povrsini presjeka zile s mjerenjem kolor dopler ultrazvukom (CDUS) kao referentnim standardom i analizirali kako primjena razlicitih statistickih metoda utjece na rezultat. Za 113 karotidnih arterija sa stenozom greater than or equal to50% odredili smo stupanj korelacije izmedu tri nacina mjerenja, osjetljivost, specificnost te razlike u procijenjenom stupnju stenoze. Korelacija izmedu oba CTA mjerenja bila je dobra s Pearsonovim p izmedu 0,87 i 0,91 (p<0,001). Korelacija izmedu CDUS i CTA mjerenja bila je skromna s Pearsonovim p izmedu 0,2 (p=0,075) i 0,4 (p=0,007) za CDUS CTA (povrsina) te izmedu 0,23 (p=0,062) i 0,39 (p=0,008) za CDUS CTA (promjer). Razlike u izmjerenoj stenozi izmedu CTA (povrsina) i CDUS bile su centrirane oko 0%, izmedu CTA (promjer) i CDUS oko 20%. Osjetljivost i specificnost za metodu CTA (povrsina) bile su 81% i 77%, a za metodu CTA (promjer) 23% i 100%. Dobra korelacija izmedu mjerenja baziranog na povrsini ili promjeru samo znaci da su promjer i povrsina presjeka zile dvije povezane znacajke stenoze, no ne znaci i dobro slaganje medu metodama. Metoda CTA (povrsina) je bolje otkrivala kirurske stenoze, dok je metoda CTA (promjer) sustavno podcjenjivala stupanj stenoze. Studija razlika izmedu stenoza dobivenih pojedinom metodom mjerenja bolje pokazuje slaganje medu metodama nego izracun koeficijenata korelacije. Kljucne rijeci: Stenoza karotida; CT angiografija; Obojeni Dopplerov ultrazvuk; Statisticka analiza podataka
Small cell lung cancer (SCLC) is an aggressive malignancy characterized by rapid proliferation, early dissemination, acquired therapy resistance, and poor prognosis. Early diagnosis of SCLC is ...crucial since most patients present with advanced/metastatic disease, limiting the potential for curative treatment. While SCLC exhibits initial responsiveness to chemotherapy and radiotherapy, treatment resistance commonly emerges, leading to a five-year overall survival rate of up to 10%. New effective biomarkers, early detection, and advancements in therapeutic strategies are crucial for improving survival rates and reducing the impact of this devastating disease. This review aims to comprehensively summarize current knowledge on diagnostic options, well-known and emerging biomarkers, and SCLC treatment strategies and discuss future perspectives on this aggressive malignancy.
Non-small cell lung cancer (NSCLC) has become the best example of precision oncology's impact on outcomes in everyday clinical practice, significantly changing the expectations of all stakeholders, ...including medical professionals, society, and most importantly, patients. Consequently, the implementation of the precision oncology concept in medical systems, in order to achieve optimal and proven curative effects in NSCLC, is imperative. In this study, we investigated the development, challenges, and results associated with the implementation of precision oncology in NSCLC on a national level in Croatia. We conducted a multicenter, retrospective, cross-sectional analysis on the total population of Croatian patients with metastatic lung cancer, on whose tumors specimen comprehensive genomic profiling (CGP) testing was performed during 2020 and 2021. A total of 48 patients were included in the study. CGP revealed clinically relevant genomic alterations (CRGA) in 37 patients (79%), with a median of 2 (IQR 1-3) CRGA per patient. From the panel of recommended tests,
,
, and
were the most common alterations, detected in 16 (34%), 5 (11%), and 3 (6%) patients, respectively. CGP revealed additional targetable mutations in 29 (60%) patients who would not have been tested (and consequently, whose mutations would not have been detected) according to the existing everyday standard of practice in Croatia. The tumor mutational burden was reported as high (≥10 Muts/Mb) in 19 patients (40%). CGP analysis reported some kind of targeted therapy for 34 patients (72%). CGP revealed other potentially targetable mutations, and it also determined TMB to be high in a significant number of patients. In conclusion, when possible, CGP should be used as an upfront backbone diagnostic and treatment-oriented work-up in patients with NSCLC.
Integrins are heterodimeric cell surface glycoproteins used by cells to bind to the extracellular matrix (ECM) and regulate tumor cell proliferation, migration and survival. A causative relationship ...between integrin expression and resistance to anticancer drugs has been demonstrated in different tumors, including head and neck squamous cell carcinoma. Using a Cal27 tongue squamous cell carcinoma model, we have previously demonstrated that
expression of integrin αVβ3 confers resistance to several anticancer drugs (cisplatin, mitomycin C and doxorubicin) through a mechanism involving downregulation of active Src, increased cell migration and invasion. In the integrin αVβ3 expressing Cal27-derived cell clone 2B1, αVβ5 expression was also increased, but unrelated to drug resistance. To identify the integrin adhesion complex (IAC) components that contribute to the changes in Cal27 and 2B1 cell adhesion and anticancer drug resistance, we isolated IACs from both cell lines. Mass spectrometry (MS)-based proteomics analysis indicated that both cell lines preferentially, but not exclusively, use integrin α6β4, which is classically found in hemidesmosomes. The anticancer drug resistant cell clone 2B1 demonstrated an increased level of α6β4 accompanied with increased deposition of a laminin-332-containing ECM. Immunofluorescence and electron microscopy demonstrated the formation of type II hemidesmosomes by both cell types. Furthermore, suppression of α6β4 expression in both lines conferred resistance to anticancer drugs through a mechanism independent of αVβ3, which implies that the cell clone 2B1 would have been even more resistant had the upregulation of α6β4 not occurred. Taken together, our results identify a key role for α6β4-containing type II hemidesmosomes in regulating anticancer drug sensitivity.
Aim To determine the diagnostic accuracy of pulmonary artery to aorta ratio in screening for pulmonary hypertension in advanced chronic obstructive pulmonary disease (COPD) patients. Methods A ...prospective, diagnostic study was conducted in University Hospital Center Zagreb between January 2015 and March 2018. The study enrolled 100 patients who consecutively underwent chest computed tomography (CT), echocardiographic exam, and right heart catheterization. Two independent observers measured pulmonary artery and ascending aorta diameters. The correlation between the ratio and mean pulmonary artery pressure, measured invasively, was assessed. Patients with echocardiographic signs of moderate systolic or diastolic left ventricular dysfunction were excluded (n = 44). Results Sixty-six patients (55.5% men), with a median age of 6', were identified. Median forced expiratory volume during the first second (FEV1) was 34 + or - 12, FEV1/ forced vital capacity <0.70. Patients with and without pulmonary hypertension had pulmonary artery diameter of 36 + or - 7 mm and 27 + or - 4.6 mm, respectively (P < 0.001). Median pulmonary artery/aorta (PA/A) ratios for patients with and without pulmonary hypertension were 1.05 and 0.81, respectively (P < 0.001). PA/A ratio above 0.95 was an independent predictor of pulmonary hypertension with a specificity of '00% and a sensitivity of 74.51% (area under the curve = 0.882; standard error = 0.041; P < 0.001). Conclusion PA/A ratio as measured on chest CT images can be used as a screening tool instead of echocardiography.
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