We aimed to determine the long-term yield of pancreatic cancer surveillance in hereditary predisposed high-risk individuals.
From 2006 to 2019, we prospectively enrolled asymptomatic individuals with ...an estimated 10% or greater lifetime risk of pancreatic ductal adenocarcinoma (PDAC) after obligatory evaluation by a clinical geneticist and genetic testing, and subjected them to annual surveillance with both endoscopic ultrasonography (EUS) and MRI/cholangiopancreatography (MRI/MRCP) at each visit.
366 individuals (201 mutation-negative familial pancreatic cancer (FPC) kindreds and 165 PDAC susceptibility gene mutation carriers; mean age 54 years, SD 9.9) were followed for 63 months on average (SD 43.2). Ten individuals developed PDAC, of which four presented with a symptomatic interval carcinoma and six underwent resection. The cumulative PDAC incidence was 9.3% in the mutation carriers and 0% in the FPC kindreds (p<0.001). Median PDAC survival was 18 months (range 1-32). Surgery was performed in 17 individuals (4.6%), whose pathology revealed 6 PDACs (3 T1N0M0), 7 low-grade precursor lesions, 2 neuroendocrine tumours <2 cm, 1 autoimmune pancreatitis and in 1 individual no abnormality. There was no surgery-related mortality. EUS detected more solid lesions than MRI/MRCP (100% vs 22%, p<0.001), but less cystic lesions (42% vs 83%, p<0.001).
The diagnostic yield of PDAC was substantial in established high-risk mutation carriers, but non-existent in the mutation-negative proven FPC kindreds. Nevertheless, timely identification of resectable lesions proved challenging despite the concurrent use of two imaging modalities, with EUS outperforming MRI/MRCP. Overall, surveillance by imaging yields suboptimal results with a clear need for more sensitive diagnostic markers, including biomarkers.
Purpose
Detection of peritoneal metastases (PM) is key in the staging and management of gastrointestinal and ovarian cancer patients. The purpose of this meta-analysis was to determine the diagnostic ...performance of CT, PET(CT), and (DW)MRI in detecting PM.
Methods
A literature search in Pubmed, Embase (Ovid), and Scopus was performed (January 1997–May 2018) to identify studies reporting on the accuracy of imaging PM in the diagnostic workup of gastrointestinal or ovarian cancers. Inclusion criteria were region-based or patient-based studies comprising > 15 patients, surgery/histology/radiological follow-up as a reference standard, and sufficient data to construct a 2 × 2 contingency table. Two observers performed data extraction. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using a bivariate random-effects model and hierarchical summary operating curves (HSROC) were generated.
Results
Of 3457 citations retrieved, twenty-four articles met all inclusion criteria. Thirty-seven datasets could be extracted for analysis including 20 for CT, 10 for PET(CT), and 7 for (DW)MRI. The pooled sensitivity, specificity, and DOR for the detection of PM for region-based studies for CT were 68% (CI, 46–84%), 88%(CI, 81–93%), and 15.9 (CI, 4.4–58.0) respectively; 80% (CI, 57–92%), 90% (CI, 80–96%), and 36.5 (CI, 6.7–199.5) for PET(CT), respectively; 92% (CI, 84–96%), 85% (CI, 78–91%), 63.3 (CI, 31.5–127.3) for (DW)MRI. In the patient-based group, not enough studies were included to make a pooled analysis for (DW)MRI and PET(CT).
Conclusion
(DW)MRI and PET(CT) showed comparable diagnostic performance for the detection of peritoneal metastases in ovarian and gastrointestinal cancer patients. Since MRI is more widely available than PET(CT) in clinical practice, this potentially is the imaging method of choice in most centers in the future.
Key Points
• Detection of peritoneal metastases plays an important role in the accurate staging of cancer patients, however, there is no accepted reference standard for the imaging of peritoneal metastases
• This meta-analysis shows that (DW)MRI provided the highest sensitivity for the detection of peritoneal metastases in ovarian and gastrointestinal cancer patients
• Although (DW)MRI and PET(CT) show a comparable overall diagnostic performance, (DW)MRI seems to be the imaging method of choice since it is more available in daily practice than PET(CT).
Abstract
H i stacking has proven to be a highly effective tool to statistically analyse average H i properties for samples of galaxies which may or may not be directly detected. With the plethora of ...H i data expected from the various upcoming H i surveys with the SKA Precursor and Pathfinder telescopes, it will be helpful to standardize the way in which stacking analyses are conducted. In this work we present a new python-based package, hiss, designed to stack H i (emission and absorption) spectra in a consistent and reliable manner. As an example, we use hiss to study the H i content in various galaxy sub-samples from the NIBLES survey of SDSS galaxies which were selected to represent their entire range in total stellar mass without a prior colour selection. This allowed us to compare the galaxy colour to average H i content in both detected and non-detected galaxies. Our sample, with a stellar mass range of $10^8 \lt {{ M}}_\star \, (\text{M}_\odot) \lt 10^{12}$, has enabled us to probe the H i-to-stellar mass gas fraction relationship more than half an order of magnitude lower than in previous stacking studies.
Objective
The use of lymph node sampling during staging procedures in clinical early‐stage mucinous ovarian carcinoma (MOC) is an ongoing matter of debate. Furthermore, the incidence of lymph node ...metastases (LNM) in MOC in relation to tumour grade (G) is unknown. We aimed to determine the incidence of LNM in clinical early‐stage MOC per tumour grade.
Design
Retrospective study with data from the Dutch Pathology Registry (PALGA).
Setting
The Netherlands, 2002–2012.
Population or sample
Patients with MOC.
Methods
Histology reports on patients with MOC diagnosed in the Netherlands between 2002 and 2012 were obtained from PALGA. Reports were reviewed for diagnosis, tumour grade and presence of LNM. Clinical data, surgery reports and radiology reports of patients with LNM were retrieved from hospital files.
Main outcome measures
Incidence of LNM, disease‐free survival (DFS).
Results
Of 915 patients with MOC, 426 underwent lymph node sampling. Cytoreductive surgery was performed in 267 patients. The other 222 patients received staging without lymph node sampling. In eight of 426 patients, LNM were discovered by sampling. In four of 190 (2.1%) patients with G1 MOC, LNM were present, compared with one of 115 (0.9%) patients with G2 MOC and three of 22 (13.6%) patients with G3 MOC. Tumour grade was not specified in 99 patients. Patients with clinical early‐stage MOC had no DFS benefit from lymph node sampling.
Conclusions
LNM are rare in early‐stage G1 and G2 MOC without clinical suspicion of LNM. Therefore, lymph node sampling can be omitted in these patients.
Tweetable
Lymph node sampling can be omitted in clinical early‐stage G1 and G2 mucinous ovarian cancer.
Tweetable
Lymph node sampling can be omitted in clinical early‐stage G1 and G2 mucinous ovarian cancer.
► Degradation of bisphenol A polycarbonate under blue light radiation is studied. ► Increasing the exposure time is associated with yellowing. ► Two stages are observed in the yellowing of ...polycarbonate plates. ► Combination of photo-Fries and photo-oxidation leads to yellowing.
In this investigation, the degradation mechanisms of Bisphenol A Polycarbonate (BPA–PC) plates under blue light radiation are studied. The BPA–PC plates are used both in light conversion carriers in LED modules and encapsulantes in LED packages. Optical degradation of the products is mainly due to the degradation of BPA–PC encapsulants under blue light radiation. In this study, BPA–PC plates are irradiated with blue light at elevated temperature of 140°C for a period up to 1920h. Optical and chemical properties of the photo-aged plates were studied using UV–Vis spectrophotometer, FTIR-ATR spectrometer, integrated sphere, and Lambda 950 spectrophotometer. The results show that increasing the exposure time leads to the discoloration, loss of optical properties, decrease of light transmission, decrease in the relative radiant power value, and increase in the yellowing index (YI) of BPA–PC plates. The results also show that there are two stages in the yellowing of polycarbonate plates. The first stage is the so-called induction period in which there is no major change in the value of YI and the rate of yellowing is very slow. This stage takes until 500h, followed by the second yellowing regime, where the yellowing is accelerated and the rate of yellowing is comparatively faster. Both photo-Fries and photo-oxidation products are identified as the mechanisms of photo-degradation, with photo-Fries predominating as ageing time increases.
Background
Perihilar cholangiocarcinoma (pCCA) is a rare tumour that requires complex multidisciplinary management. All known data are almost exclusively derived from expert centres. This study aimed ...to analyse the outcomes of patients with pCCA in a nationwide cohort.
Methods
Data on all patients diagnosed with pCCA in the Netherlands between 2010 and 2018 were obtained from the Netherlands Cancer Registry. Data included type of hospital of diagnosis and the received treatment. Outcomes included the type of treatment and overall survival.
Results
A total of 2031 patients were included and the median overall survival for the overall cohort was 5.2 (95% CI 4.7‐5.7) months. Three‐hundred‐ten (15%) patients underwent surgical resection, 271 (13%) underwent palliative systemic treatment, 21 (1%) palliative local anti‐cancer treatment and 1429 (70%) underwent best supportive care. These treatments resulted in a median overall survival of 29.6 (95% CI 25.2‐34.0), 12.2 (95% CI 11.0‐13.3), 14.5 (95%CI 8.2‐20.8) and 2.9 (95% CI 2.6‐3.2) months respectively. Resection rate was 13% in patients who were diagnosed in non‐academic and 32% in academic centres (P < .001), which resulted in a survival difference in favour of academic centres. Median overall survival was 9.7 (95% CI 7.7‐11.7) months in academic centres compared to 4.9 (95% CI 4.3‐5.4) months in non‐academic centres (P < .001).
Conclusions
In patients with pCCA, resection rate and overall survival were higher for patients who were diagnosed in academic centres. These results show population‐based outcomes of pCCA and highlight the importance of regional collaboration in the treatment of these patients.
Objective
Standard surgical treatment of advanced-stage ovarian carcinoma with electrosurgery cannot always result in complete cytoreductive surgery (CRS), especially when many small metastases are ...found on the mesentery and intestinal surface. We investigated whether adjuvant use of a neutral argon plasma device can help increase the complete cytoreduction rate.
Patients and Methods
327 patients with FIGO stage IIIB–IV epithelial ovarian cancer (EOC) who underwent primary or interval CRS were randomized to either surgery with neutral argon plasma (PlasmaJet) (intervention) or without PlasmaJet (control group). The primary outcome was the percentage of complete CRS. The secondary outcomes were duration of surgery, blood loss, number of bowel resections and colostomies, hospitalization, 30-day morbidity, and quality of life (QoL).
Results
Complete CRS was achieved in 119 patients (75.8%) in the intervention group and 115 patients (67.6%) in the control group (risk difference (RD) 8.2%, 95% confidence interval (CI) –0.021 to 0.181;
P
= 0.131). In a per-protocol analysis excluding patients with unresectable disease, complete CRS was obtained in 85.6% in the intervention group and 71.5% in the control group (RD 14.1%, 95% CI 0.042 to 0.235;
P
= 0.005). Patient-reported QoL at 6 months after surgery differed between groups in favor of PlasmaJet surgery (95% CI 0.455–8.350;
P
= 0.029). Other secondary outcomes did not differ significantly.
Conclusions
Adjuvant use of PlasmaJet during CRS for advanced-stage ovarian cancer resulted in a significantly higher proportion of complete CRS in patients with resectable disease and higher QoL at 6 months after surgery. (Funded by ZonMw, Trial Register NL62035.078.17.)
Trial Registration
Approved by the Medical Ethics Review Board of the Erasmus University Medical Center Rotterdam, the Netherlands, NL62035.078.17 on 20-11-2017. Recruitment started on 30-1-2018.
Abstract
A search has been made for 21 cm H
i
line emission in a total of 350 unique galaxies from two samples whose optical properties indicate they may be massive. The first consists of 241 low ...surface brightness (LSB) galaxies of morphological type Sb and later selected from the HyperLeda database and the second consists of 119 LSB galaxies from the UGC with morphological types Sd-m and later. Of the 350 unique galaxies, 239 were observed at the Nançay Radio Telescope, 161 at the Green Bank Telescope, and 66 at the Arecibo telescope. A total of 295 (84.3%) were detected, of which 253 (72.3%) appear to be uncontaminated by any other galaxies within the telescope beam. Finally, of the total detected, uncontaminated galaxies, at least 31 appear to be massive LSB galaxies, with a total H
i
mass ≥ 10
10
M
⊙
, for
H
0
= 70 kms
−1
Mpc
−1
. If we expand the definition to also include galaxies with significant total (rather than just gas) mass, i.e., those with an inclination-corrected H
i
line width
W
50,cor
> 500 km s
−1
, this brings the total number of massive LSB galaxies to 41. There are no obvious trends between the various measured global galaxy properties, particularly between mean surface brightness and galaxy mass.
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