This document discusses guidelines for diagnosing and treating ground glass opacities (GGO) in the lungs. It notes that GGOs are an under-recognized sign of early lung cancer in Asia. CT scans are better than chest x-rays at detecting small nodules and GGOs. The characteristics of GGO lesions on CT scans, such as size and density, can help determine cancer risk and appropriate treatment, which may include limited surgical resection for small, low-density GGOs. Overall treatment outcomes are excellent for resected pure GGO malignant nodules regardless of specific characteristics.
This document discusses various embolization agents used to occlude blood vessels. It begins by defining embolization as introducing substances into circulation to block vessels to arrest or prevent bleeding. The goals are adjuvant, curative, or palliative depending on the condition. Originally, autologous blood clot was used but it recanalizes quickly. Modern agents include gel foam, particles like PVA and embospheres, and coils which can be pushable, injectable, or detachable. The appropriate agent depends on the region and degree of occlusion needed. Liquid agents are also used. Coils are commonly used for aneurysms while particles are used for fibroids and tumors.
Dose to the Dysphagia/Aspiration-Related Structures (DARS) is critical to ensure proper swallowing functions to the patients after IMRT to the head and neck region
Brachytherapy involves placing radioactive sources inside or near a tumor to deliver radiation therapy. It is a type of radiotherapy that allows for a high dose of localized radiation to be administered to the tumor area while sparing surrounding healthy tissues from radiation exposure. Brachytherapy treatments are typically short in duration compared to external beam radiotherapy but require specialized equipment and skilled medical professionals for administration.
This document summarizes Vibha Chaswal's radiation oncology rotation #11, which involved training in total body irradiation (TBI), total skin electron therapy (TSET), and intraoperative radiation therapy (IORT) under the mentorship of Tim Waldron. The key goals, dosimetric parameters, treatment techniques, and safety procedures for TBI and TSET are outlined. TBI is used for immunosuppression and cancer eradication, while TSET treats cutaneous T cell lymphoma; both therapies aim for dose homogeneity and verification.
This presentation includes High-resolution computed tomography (HRCT) of the Chest and Temporal bone.
Objective of HRCT.
Artefacts in HRCT.
Clinical applications of HRCT.
Advantages of HRCT.
Disadvantages of HRCT.
Positioning and Centering.
A CT scan of the liver involves three phases - arterial, portal vein, and delayed phases - following injection of contrast. The arterial phase, 30 seconds after injection, highlights hypervascular lesions near arteries. The portal vein phase, 70-90 seconds after injection, shows hypovascular lesions as hypodense. The delayed phase, 5-10 minutes after injection, further characterizes lesions such as hemangiomas, HCC, and CCC. Each phase provides different information to identify and characterize liver lesions.
This document classifies and describes various skin tumours, including benign tumours like moles, lentigos, and café au lait spots. It also covers premalignant lesions such as actinic keratoses and malignant lesions including basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Key information provided includes the epidemiology, pathogenesis, clinical presentation, management and prognosis of these important skin tumours.
This document discusses various embolization agents used to occlude blood vessels. It begins by defining embolization as introducing substances into circulation to block vessels to arrest or prevent bleeding. The goals are adjuvant, curative, or palliative depending on the condition. Originally, autologous blood clot was used but it recanalizes quickly. Modern agents include gel foam, particles like PVA and embospheres, and coils which can be pushable, injectable, or detachable. The appropriate agent depends on the region and degree of occlusion needed. Liquid agents are also used. Coils are commonly used for aneurysms while particles are used for fibroids and tumors.
Dose to the Dysphagia/Aspiration-Related Structures (DARS) is critical to ensure proper swallowing functions to the patients after IMRT to the head and neck region
Brachytherapy involves placing radioactive sources inside or near a tumor to deliver radiation therapy. It is a type of radiotherapy that allows for a high dose of localized radiation to be administered to the tumor area while sparing surrounding healthy tissues from radiation exposure. Brachytherapy treatments are typically short in duration compared to external beam radiotherapy but require specialized equipment and skilled medical professionals for administration.
This document summarizes Vibha Chaswal's radiation oncology rotation #11, which involved training in total body irradiation (TBI), total skin electron therapy (TSET), and intraoperative radiation therapy (IORT) under the mentorship of Tim Waldron. The key goals, dosimetric parameters, treatment techniques, and safety procedures for TBI and TSET are outlined. TBI is used for immunosuppression and cancer eradication, while TSET treats cutaneous T cell lymphoma; both therapies aim for dose homogeneity and verification.
This presentation includes High-resolution computed tomography (HRCT) of the Chest and Temporal bone.
Objective of HRCT.
Artefacts in HRCT.
Clinical applications of HRCT.
Advantages of HRCT.
Disadvantages of HRCT.
Positioning and Centering.
A CT scan of the liver involves three phases - arterial, portal vein, and delayed phases - following injection of contrast. The arterial phase, 30 seconds after injection, highlights hypervascular lesions near arteries. The portal vein phase, 70-90 seconds after injection, shows hypovascular lesions as hypodense. The delayed phase, 5-10 minutes after injection, further characterizes lesions such as hemangiomas, HCC, and CCC. Each phase provides different information to identify and characterize liver lesions.
This document classifies and describes various skin tumours, including benign tumours like moles, lentigos, and café au lait spots. It also covers premalignant lesions such as actinic keratoses and malignant lesions including basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Key information provided includes the epidemiology, pathogenesis, clinical presentation, management and prognosis of these important skin tumours.
Journal Club : Article by Kim YS, Rhim H, Choi MJ, Lim HK, Choi D. High-intensity focused ultrasound therapy: an overview for radiologists. Korean journal of radiology. 2008 Aug 1;9(4):291-302.
This document discusses imaging of prostate cancer. It begins with an introduction to prostate cancer epidemiology and symptoms. Transrectal ultrasound is described as the primary imaging method for diagnosis and staging, allowing visualization of the prostate zones and measurement of volume. Appearances of normal variants, benign conditions like BPH and prostatitis, and prostate cancer on ultrasound are presented. The role of MRI in accurate staging of extracapsular extension and seminal vesicle invasion is also summarized.
HOLISTIC APPROACH IN WHOLE BRAIN RADIATION IN BRAIN METSKanhu Charan
1. Whole brain radiotherapy is commonly used to treat brain metastases but can cause long-term side effects like memory loss and decreased quality of life.
2. A new study aims to spare structures like the hippocampus, cochlea, and parotid glands using IMRT and VMAT to reduce side effects while maintaining tumor coverage.
3. Dosimetry results found that IMRT and VMAT reduced hippocampal, parotid, and cochlear doses by 45-82% compared to conventional radiotherapy, allowing for improved quality of life.
Learn from our Slideshare about the differences between ultrasound transducers. We also cover tips on how to treat your probes and how to select the right one.
This document provides information about an opposing urethrogram procedure used to evaluate and document urethral strictures. It begins with an introduction to urethral anatomy and then describes the indications, contraindications, equipment, and technique for performing an opposing urethrogram. This involves inserting a suprapubic catheter and Foley catheter, filling the bladder with contrast medium under fluoroscopy, and obtaining images to assess any strictures present in the urethra. Potential complications are noted. The concluding sentences state that an opposing urethrogram is the only x-ray procedure that can accurately access the length of a urethral stricture.
This document discusses radiotherapy and CT simulation procedures. It begins with an introduction to radiotherapy and how it uses radiation to destroy cancer cells. It then describes the linear accelerator machine commonly used to deliver targeted radiation treatments. Finally, it outlines the mould room procedure for creating customized thermoplastic masks to immobilize patients, ensuring accurate radiation delivery to the treatment site.
This document provides information on the management of soft tissue sarcoma. It discusses the clinical presentation, patterns of spread, imaging, histology, grading, staging, prognostic factors and management of soft tissue sarcomas. The key points are:
1) Soft tissue sarcomas most commonly present as painless swellings in the extremities and can invade locally along fascial planes. Imaging like MRI is important for assessing tumor extent.
2) Histologically, the most common subtypes are undifferentiated pleomorphic sarcoma and liposarcoma. Grading systems consider tumor differentiation, mitosis and necrosis.
3) Staging is based on tumor size, depth, nodal status and metastasis
Interventional Radiology : Devices and Embolic Agents that a Resident NEEDS T...Saurabh Joshi
Interventional Radiology is full of various devices and materials. The general radiology resident needs to know these in order to impress the examiner. This file also contains information on various embolic agents.
Prostate biopsy is commonly used to diagnose prostate cancer. Transrectal ultrasound guided biopsy is most common, but transperineal biopsy provides improved sampling. Extended biopsy schemes of 12 cores or more are now standard. Antibiotic prophylaxis and local anesthesia reduce risks of infection and pain. New techniques like MRI-fusion biopsy target suspected cancers more precisely. Overall, prostate biopsy remains a valuable tool but ongoing improvements aim to enhance safety, accuracy and ability to detect clinically significant cancers.
This document discusses digital subtraction angiography (DSA), including its history, equipment, and applications. DSA involves acquiring digital fluoroscopic images before and after injecting contrast material, and using computer subtraction to remove bone structures and leave an image of blood vessels. It originated in the 1970s and allows for real-time angiography with improved vessel contrast compared to conventional techniques. Key components of DSA systems include an x-ray unit, image intensifier, computer, and software for image processing functions like subtraction, enhancement, and roadmapping.
Radiotherapy is an important treatment option for penile carcinoma. It can be used as curative treatment for early stage tumors, as adjuvant treatment after surgery to reduce the risk of recurrence, and for palliation of advanced tumors. The main radiotherapy techniques are external beam radiotherapy and brachytherapy. Brachytherapy involves placing radioactive sources inside or next to the tumor and is often used for small early stage tumors, providing good tumor control rates and organ preservation. External beam radiotherapy uses external radiation beams and can treat larger tumors or be used as adjuvant therapy. Proper patient positioning and immobilization is important for both techniques to precisely target the tumor while sparing surrounding organs. Radiotherapy is generally well-tol
Immobilization devices help maintain a patient's position during radiotherapy to limit movement. Examples include vac-locks, thermoplastics, head rests, breast boards, tilt boards, belly boards, bite blocks, wing boards, and base plates. These devices provide patient comfort and stability while restricting movement to allow for precise, reproducible treatment positioning.
Radioiodine therapy uses radioactive iodine to treat hyperthyroidism and thyroid cancer. Iodine concentrates in the thyroid gland where it delivers radiation to ablate residual or cancerous thyroid tissue. For therapy, patients prepare with a low iodine diet and medication withdrawal before receiving doses ranging from 5-200 mCi orally. Strict radiation safety precautions are required during and after treatment due to iodine excretion. Whole body imaging with 1-5 mCi I-131 or I-123 sodium iodide is performed 48-72 hours later to identify residual thyroid tissue or cancer metastases and guide further treatment. Sources of error include contamination, stunning from prior I-131 doses, and saliv
This document provides an overview of radiation safety training for diagnostic radiology. It covers types of radiation, shielding principles, diagnostic modalities, and general principles for planning x-ray installations. Key factors in determining shielding requirements include the workload, distance from radiation source, and occupancy level of areas. Shielding is designed to reduce worker and public exposure according to regulatory dose limits. Layout recommendations include room dimensions, barrier thicknesses, and placement of equipment and operator consoles. Reference data on shielding materials is also provided for common modalities like radiography, fluoroscopy, CT, and dental x-ray.
High intensity focused ultrasound (HIFU) is an early stage medical technology that is in various stages of development worldwide to treat a range of disorders. The mechanism is similar to using a magnifying glass to focus sunlight. Focused ultrasound uses an acoustic lens to concentrate multiple intersecting beams of ultrasound on a target. Each individual beam passes through tissue with little effect but at the focal point where the beams converge, the energy can have useful thermal or mechanical effects. HIFU is typically performed with real-time imaging via ultrasound or MRI to enable treatment targeting and monitoring (including thermal tracking with MRI).
This document provides information about contrast agents used in CT scans, including intravenous, oral, and rectal contrast. It discusses the four main types of contrast agents and how they work to enhance organs and tissues on CT images. It also addresses potential adverse effects of intravenous contrast agents and recommendations for reducing risks. Safety considerations are outlined for patients with renal insufficiency, diabetes, cardiovascular disease, and other conditions. Guidelines are provided for dosages of oral and intravenous contrast depending on the area of the body being examined.
Luc Rotenberg : US guided vacuum breast biopsy and minimal Invasive Intervent...breastcancerupdatecongress
This document summarizes minimal invasive interventional procedures for breast lesions. It discusses ultrasound-guided breast biopsy procedures and whether they can provide minimal invasive diagnosis and treatment of benign and malignant lesions. Various biopsy methods and devices are reviewed, including vacuum-assisted biopsy. Indications, risks, sample size, and follow up after biopsy are addressed. Underestimation rates of ductal carcinoma in situ and atypical lesions with biopsy are discussed. Radiological-pathological concordance and determining appropriate management of biopsy results is also covered. Radiofrequency ablation is presented as a potential minimal invasive treatment option.
PERCITANEOUS NEPHROSTOMY and HYSTEROSALPIONGOGRAPHYSharmaRajan4
This document provides information about percutaneous nephrostomy and hysterosalpingography radiological procedures. It describes the techniques, indications, contraindications, equipment, and potential complications for each procedure. Percutaneous nephrostomy involves inserting a drainage catheter into the kidney under imaging guidance to relieve urinary obstruction or provide access. Hysterosalpingography uses injected contrast medium and x-ray imaging to evaluate the uterus and fallopian tubes for causes of infertility. Both procedures require careful technique and monitoring of patients due to risks of infection, bleeding, or contrast medium reactions.
This document discusses brachytherapy, a type of radiation therapy where radioactive material is placed directly inside the body near the tumor being treated. It begins by explaining the two major categories of radiation therapy: external-beam therapy where a machine emits radiation from outside the body, and brachytherapy where radioactive sources are placed inside the body. It then provides details on brachytherapy, including how it works from inside the body compared to external beam therapy, common radiation sources used, and the typical procedure involving planning, applicator insertion, treatment delivery, and removal of sources.
This document provides guidelines and recommendations for quality assurance and safety in brachytherapy physics. It summarizes the key aspects of brachytherapy including source calibration, dosimetry, treatment planning, procedures for low-dose rate and high-dose rate treatments, and quality assurance programs. The guidelines aim to ensure safety, accuracy of dose delivery, and consistency in brachytherapy practices.
This document discusses several types of rare head and neck tumors, including extramedullary plasmacytomas, nasopharyngeal angiofibroma, non-lentiginous melanoma, and extracranial meningiomas. It provides details on the epidemiology, clinical presentation, diagnosis, treatment options including radiation therapy techniques, and outcomes for each of these tumor types.
Validity of sentinel node biopsy in early oral and oropharyngeal carcinomaDibya Falgoon Sarkar
This study evaluated the validity of sentinel node biopsy in early oral and oropharyngeal carcinoma to determine if it can help avoid unnecessary elective neck dissections. The study found that sentinel node biopsy identified occult metastases in 12 of 36 patients (33.3%), suggesting that neck dissection may be overtreatment for many patients. Sentinel nodes correctly identified metastases in 14 of 15 cases. While the study was limited by its small size and retrospective design, the results suggest sentinel node biopsy could help reduce overtreatment through more precise staging of early-stage cancers. Larger prospective studies are still needed to establish sentinel node biopsy as a reliable alternative to elective neck dissection.
Journal Club : Article by Kim YS, Rhim H, Choi MJ, Lim HK, Choi D. High-intensity focused ultrasound therapy: an overview for radiologists. Korean journal of radiology. 2008 Aug 1;9(4):291-302.
This document discusses imaging of prostate cancer. It begins with an introduction to prostate cancer epidemiology and symptoms. Transrectal ultrasound is described as the primary imaging method for diagnosis and staging, allowing visualization of the prostate zones and measurement of volume. Appearances of normal variants, benign conditions like BPH and prostatitis, and prostate cancer on ultrasound are presented. The role of MRI in accurate staging of extracapsular extension and seminal vesicle invasion is also summarized.
HOLISTIC APPROACH IN WHOLE BRAIN RADIATION IN BRAIN METSKanhu Charan
1. Whole brain radiotherapy is commonly used to treat brain metastases but can cause long-term side effects like memory loss and decreased quality of life.
2. A new study aims to spare structures like the hippocampus, cochlea, and parotid glands using IMRT and VMAT to reduce side effects while maintaining tumor coverage.
3. Dosimetry results found that IMRT and VMAT reduced hippocampal, parotid, and cochlear doses by 45-82% compared to conventional radiotherapy, allowing for improved quality of life.
Learn from our Slideshare about the differences between ultrasound transducers. We also cover tips on how to treat your probes and how to select the right one.
This document provides information about an opposing urethrogram procedure used to evaluate and document urethral strictures. It begins with an introduction to urethral anatomy and then describes the indications, contraindications, equipment, and technique for performing an opposing urethrogram. This involves inserting a suprapubic catheter and Foley catheter, filling the bladder with contrast medium under fluoroscopy, and obtaining images to assess any strictures present in the urethra. Potential complications are noted. The concluding sentences state that an opposing urethrogram is the only x-ray procedure that can accurately access the length of a urethral stricture.
This document discusses radiotherapy and CT simulation procedures. It begins with an introduction to radiotherapy and how it uses radiation to destroy cancer cells. It then describes the linear accelerator machine commonly used to deliver targeted radiation treatments. Finally, it outlines the mould room procedure for creating customized thermoplastic masks to immobilize patients, ensuring accurate radiation delivery to the treatment site.
This document provides information on the management of soft tissue sarcoma. It discusses the clinical presentation, patterns of spread, imaging, histology, grading, staging, prognostic factors and management of soft tissue sarcomas. The key points are:
1) Soft tissue sarcomas most commonly present as painless swellings in the extremities and can invade locally along fascial planes. Imaging like MRI is important for assessing tumor extent.
2) Histologically, the most common subtypes are undifferentiated pleomorphic sarcoma and liposarcoma. Grading systems consider tumor differentiation, mitosis and necrosis.
3) Staging is based on tumor size, depth, nodal status and metastasis
Interventional Radiology : Devices and Embolic Agents that a Resident NEEDS T...Saurabh Joshi
Interventional Radiology is full of various devices and materials. The general radiology resident needs to know these in order to impress the examiner. This file also contains information on various embolic agents.
Prostate biopsy is commonly used to diagnose prostate cancer. Transrectal ultrasound guided biopsy is most common, but transperineal biopsy provides improved sampling. Extended biopsy schemes of 12 cores or more are now standard. Antibiotic prophylaxis and local anesthesia reduce risks of infection and pain. New techniques like MRI-fusion biopsy target suspected cancers more precisely. Overall, prostate biopsy remains a valuable tool but ongoing improvements aim to enhance safety, accuracy and ability to detect clinically significant cancers.
This document discusses digital subtraction angiography (DSA), including its history, equipment, and applications. DSA involves acquiring digital fluoroscopic images before and after injecting contrast material, and using computer subtraction to remove bone structures and leave an image of blood vessels. It originated in the 1970s and allows for real-time angiography with improved vessel contrast compared to conventional techniques. Key components of DSA systems include an x-ray unit, image intensifier, computer, and software for image processing functions like subtraction, enhancement, and roadmapping.
Radiotherapy is an important treatment option for penile carcinoma. It can be used as curative treatment for early stage tumors, as adjuvant treatment after surgery to reduce the risk of recurrence, and for palliation of advanced tumors. The main radiotherapy techniques are external beam radiotherapy and brachytherapy. Brachytherapy involves placing radioactive sources inside or next to the tumor and is often used for small early stage tumors, providing good tumor control rates and organ preservation. External beam radiotherapy uses external radiation beams and can treat larger tumors or be used as adjuvant therapy. Proper patient positioning and immobilization is important for both techniques to precisely target the tumor while sparing surrounding organs. Radiotherapy is generally well-tol
Immobilization devices help maintain a patient's position during radiotherapy to limit movement. Examples include vac-locks, thermoplastics, head rests, breast boards, tilt boards, belly boards, bite blocks, wing boards, and base plates. These devices provide patient comfort and stability while restricting movement to allow for precise, reproducible treatment positioning.
Radioiodine therapy uses radioactive iodine to treat hyperthyroidism and thyroid cancer. Iodine concentrates in the thyroid gland where it delivers radiation to ablate residual or cancerous thyroid tissue. For therapy, patients prepare with a low iodine diet and medication withdrawal before receiving doses ranging from 5-200 mCi orally. Strict radiation safety precautions are required during and after treatment due to iodine excretion. Whole body imaging with 1-5 mCi I-131 or I-123 sodium iodide is performed 48-72 hours later to identify residual thyroid tissue or cancer metastases and guide further treatment. Sources of error include contamination, stunning from prior I-131 doses, and saliv
This document provides an overview of radiation safety training for diagnostic radiology. It covers types of radiation, shielding principles, diagnostic modalities, and general principles for planning x-ray installations. Key factors in determining shielding requirements include the workload, distance from radiation source, and occupancy level of areas. Shielding is designed to reduce worker and public exposure according to regulatory dose limits. Layout recommendations include room dimensions, barrier thicknesses, and placement of equipment and operator consoles. Reference data on shielding materials is also provided for common modalities like radiography, fluoroscopy, CT, and dental x-ray.
High intensity focused ultrasound (HIFU) is an early stage medical technology that is in various stages of development worldwide to treat a range of disorders. The mechanism is similar to using a magnifying glass to focus sunlight. Focused ultrasound uses an acoustic lens to concentrate multiple intersecting beams of ultrasound on a target. Each individual beam passes through tissue with little effect but at the focal point where the beams converge, the energy can have useful thermal or mechanical effects. HIFU is typically performed with real-time imaging via ultrasound or MRI to enable treatment targeting and monitoring (including thermal tracking with MRI).
This document provides information about contrast agents used in CT scans, including intravenous, oral, and rectal contrast. It discusses the four main types of contrast agents and how they work to enhance organs and tissues on CT images. It also addresses potential adverse effects of intravenous contrast agents and recommendations for reducing risks. Safety considerations are outlined for patients with renal insufficiency, diabetes, cardiovascular disease, and other conditions. Guidelines are provided for dosages of oral and intravenous contrast depending on the area of the body being examined.
Luc Rotenberg : US guided vacuum breast biopsy and minimal Invasive Intervent...breastcancerupdatecongress
This document summarizes minimal invasive interventional procedures for breast lesions. It discusses ultrasound-guided breast biopsy procedures and whether they can provide minimal invasive diagnosis and treatment of benign and malignant lesions. Various biopsy methods and devices are reviewed, including vacuum-assisted biopsy. Indications, risks, sample size, and follow up after biopsy are addressed. Underestimation rates of ductal carcinoma in situ and atypical lesions with biopsy are discussed. Radiological-pathological concordance and determining appropriate management of biopsy results is also covered. Radiofrequency ablation is presented as a potential minimal invasive treatment option.
PERCITANEOUS NEPHROSTOMY and HYSTEROSALPIONGOGRAPHYSharmaRajan4
This document provides information about percutaneous nephrostomy and hysterosalpingography radiological procedures. It describes the techniques, indications, contraindications, equipment, and potential complications for each procedure. Percutaneous nephrostomy involves inserting a drainage catheter into the kidney under imaging guidance to relieve urinary obstruction or provide access. Hysterosalpingography uses injected contrast medium and x-ray imaging to evaluate the uterus and fallopian tubes for causes of infertility. Both procedures require careful technique and monitoring of patients due to risks of infection, bleeding, or contrast medium reactions.
This document discusses brachytherapy, a type of radiation therapy where radioactive material is placed directly inside the body near the tumor being treated. It begins by explaining the two major categories of radiation therapy: external-beam therapy where a machine emits radiation from outside the body, and brachytherapy where radioactive sources are placed inside the body. It then provides details on brachytherapy, including how it works from inside the body compared to external beam therapy, common radiation sources used, and the typical procedure involving planning, applicator insertion, treatment delivery, and removal of sources.
This document provides guidelines and recommendations for quality assurance and safety in brachytherapy physics. It summarizes the key aspects of brachytherapy including source calibration, dosimetry, treatment planning, procedures for low-dose rate and high-dose rate treatments, and quality assurance programs. The guidelines aim to ensure safety, accuracy of dose delivery, and consistency in brachytherapy practices.
This document discusses several types of rare head and neck tumors, including extramedullary plasmacytomas, nasopharyngeal angiofibroma, non-lentiginous melanoma, and extracranial meningiomas. It provides details on the epidemiology, clinical presentation, diagnosis, treatment options including radiation therapy techniques, and outcomes for each of these tumor types.
Validity of sentinel node biopsy in early oral and oropharyngeal carcinomaDibya Falgoon Sarkar
This study evaluated the validity of sentinel node biopsy in early oral and oropharyngeal carcinoma to determine if it can help avoid unnecessary elective neck dissections. The study found that sentinel node biopsy identified occult metastases in 12 of 36 patients (33.3%), suggesting that neck dissection may be overtreatment for many patients. Sentinel nodes correctly identified metastases in 14 of 15 cases. While the study was limited by its small size and retrospective design, the results suggest sentinel node biopsy could help reduce overtreatment through more precise staging of early-stage cancers. Larger prospective studies are still needed to establish sentinel node biopsy as a reliable alternative to elective neck dissection.
This document presents a case of a 21-year-old female who presented with right nasal obstruction and discharge for two years. Imaging showed total opacification of the right sphenoid sinus and a polypoidal mass in the right nasal cavity. The patient underwent endoscopic sinus surgery where the mass was excised. Histopathology revealed secretory carcinoma (SC), previously known as mammary analogue secretory carcinoma (MASC). The patient had a second surgery for clear margins and is currently in remission with regular follow ups. The document then discusses SC/MASC as a rare salivary gland carcinoma that can rarely affect the sinonasal tract, and outlines its clinical features, diagnosis, treatment and prognosis.
REVIEW OF METHODS FOR DIAGNOSIS OF LUNG CANCERswankyshahir
This document discusses the diagnosis of lung cancer. It covers risk factors for lung cancer like smoking and air pollution. Screening methods are discussed, including low-dose CT screening which has been shown to decrease lung cancer mortality by 20% compared to chest x-rays. Diagnostic tools covered include sputum cytology, chest x-rays, CT scans, PET scans, bronchoscopy, biopsy and gene mutations associated with lung cancer like EGFR and KRAS. Early detection through low-dose CT screening and use of various diagnostic imaging and biopsy methods is key to improving outcomes for lung cancer patients.
Current Concept of Management Gastric Carcinomadrmangual1954
This document discusses current concepts in the management of gastric carcinoma. It provides details on the magnitude of the problem, including annual incidence rates worldwide. It describes the changing scenario of gastric cancer, with increasing rates of proximal gastric cancer. The document discusses diagnostic modalities and pre-operative staging, as well as TNM classification. It outlines surgical management objectives and options, including the extent of lymph node dissection and tumor resection status.
S E L E C T I V E A X I L L A R Y D I S S E C T I O N I NAnil Haripriya
This document discusses selective axillary dissection in carcinoma of the breast. It notes that tumor size and axillary lymph node status are important prognostic factors, and that axillary lymph node dissection is an important staging procedure. However, total axillary dissection can cause morbidity. The concept of sentinel node biopsy is explored as a way to select patients who need full axillary dissection versus those who do not by examining the first lymph node(s) that receive metastatic cells from the primary tumor. Studies demonstrating the predictive value and accuracy of sentinel node biopsy in determining axillary node status are summarized.
- Ms. M presented with multiple pulmonary nodules found on CT scan during workup for atypical chest pain
- Differential diagnosis included infection, granulomatosis, rheumatoid arthritis, malignancy
- Follow up imaging showed growth of some nodules, recommending biopsy vs resection
- She underwent left upper lobe resection, pathology found metastatic adenocarcinoma from previous colon cancer
- Given her history, the recommended next step is 6 months of adjuvant chemotherapy despite equivocal data on its benefits
This document summarizes a study that evaluated the efficacy of ultrasonography and computed tomography in diagnosing palpable neck masses. 40 patients with neck masses were examined clinically and underwent ultrasound and CT scans. The results found that ultrasound was useful for characterizing masses as solid or cystic and identifying features like margins, calcifications and necrosis. CT provided additional information on tissue attenuation, extent of lesions, and involvement of surrounding structures or distant spread. The study concluded that ultrasound combined with CT provides valuable information to accurately diagnose neck masses and guide their management.
Literature Review Of Management Of Pineal Region TumourLiew Boon Seng
- Pineal region tumors make up 0.4-1.0% of intracranial tumors in adults and 3.0-8.0% of brain tumors in children, with most children presenting between ages 10-20 years old.
- MRI with gadolinium is used to evaluate pineal region lesions and assess characteristics like size, vascularity and borders, though tumor type cannot be determined reliably from imaging alone.
- Histopathological examination is needed for diagnosis, as germ cell tumors are the most common in children and include germinomas and other tumors derived from totipotential germ cells.
This document discusses olfactory groove meningiomas. It describes their location in the anterior cranial fossa near the olfactory nerves. It outlines their typical presentation with long-standing headaches and anosmia. Imaging shows well-defined enhancing masses. Preoperative embolization is described as a safe option to reduce blood loss during surgery. Complete resection is the goal but recurrence can occur due to direct invasion or incomplete resection. Complications include CSF leakage, vascular injury, and seizures.
Dr Ian Katz, Dermatopathologist, from Southern Sun Skin Cancer Clinic and Southern Sun Pathology, discusses the pro and cons of using shave biopsies in clinical skin cancer practice.
1) The document discusses various radiation techniques for treating cancer of the esophagus including 2D, 3D conformal radiation therapy, IMRT, and IGRT.
2) It covers topics like target volume delineation, field design considerations for different esophageal subsites, and evolution from 2D to 3D treatment planning.
3) While there is no consensus, most contemporary trials use margins of 3-5cm cranially and caudally on the gross tumor with approximately a 2cm radial margin.
Temporal bone tumors staging and radiological assesmenttamer ebaied
The document summarizes temporal bone malignancies (TBMs), which are rare neoplasms originating in the temporal bone. Squamous cell carcinoma is the most common type. The University of Pittsburgh staging system is commonly used to stage TBMs, with higher T stages (T3 and T4) correlating with poorer prognosis. Pre-operative CT and MRI are useful to evaluate tumor spread and plan surgical resection, though MRI may be needed to fully assess soft tissue involvement. Overall, advances in imaging and skull base surgery have improved outcomes for TBMs in recent decades.
The document discusses anal canal carcinoma and its management. It covers the epidemiology, etiology, risk factors, carcinogenesis, morphology, clinical features, classification, screening, diagnosis, staging, treatment and recent advances of anal canal carcinoma. Screening and removing precancerous polyps is important for prevention. Diagnosis involves imaging and biopsy. Treatment depends on staging and may include surgery, chemotherapy and radiation. Ongoing research focuses on improved screening, staging and minimally invasive treatment options.
The document discusses low grade glioma and provides details about a case. It begins with definitions of diffuse infiltrating gliomas and some key facts. It then provides details of a 39-year-old male patient who presented with frontal headache and personality changes. MRI showed a left temporal lesion measuring 6cm without enhancement. The document discusses the imaging protocol and findings in detail. It provides neuropathology findings of diffuse glioma, IDH mutant, and 1p/19q codeletion, consistent with oligodendroglioma grade II. The document discusses surgery details, post-op imaging, and recommendations for adjuvant treatment including radiation, chemotherapy options and dose.
This document discusses ampullary carcinomas, including their epidemiology, clinical manifestations, diagnosis, staging, treatment, and prognosis. It provides details on: the average age of diagnosis being 60-70 years old; the most common histologic subtype being intestinal (47%); obstructive jaundice being the most common presenting symptom (80%); diagnostic tests including ERCP, CT, and tumor markers; the TNM staging system; pancreaticoduodenectomy being the standard treatment for localized disease; and adjuvant therapy options including chemotherapy and chemoradiotherapy for stage IB or higher cancers.
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This document discusses the management of small renal masses (SRMs). Key points include:
1. SRMs are detected more frequently due to increased use of imaging and are usually less than 4cm.
2. Goals for managing early stage renal cell carcinoma include cancer survival, preserving renal function, and avoiding treatment morbidity.
3. Treatment options for SRMs include radical nephrectomy, partial nephrectomy, thermal ablation, and active surveillance. Partial nephrectomy is the gold standard.
4. Cryoablation and radiofrequency ablation are emerging minimally invasive techniques for treating SRMs but long term data on oncologic outcomes is still lacking.
This document provides guidance on managing and treating women with histologically confirmed cervical intraepithelial neoplasia (CIN). It describes excisional and ablative treatment methods, including their characteristics, indications, and potential complications. It recommends local excision is the preferred treatment method to allow full histological assessment. The document also discusses options for monitoring outcomes after treatment and provides specific recommendations for managing CIN in special clinical situations.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
16. 早期肺癌,X光幾乎無法偵測
Breast Ca with Second P
Malignant Pulmonary Lesions:
Breast Ca with Second Primary Lung Ca
Malignant Pulmonary L
Breast Ca with Second Prim
19. Ann Thorac Surg. 2003 May;75(5):1601-5; discussion 1605-6.
Prospective study of thoracoscopic limited resection for ground-glass opacity selected by
computed tomography.
Nakata M, Sawada S, Saeki H, Takashima S, Mogami H, Teramoto N, Eguchi K.
thoracoscopic wedge resection was performed prospectively between June
2000 and December 2001 in 33 patients with pure GGO lesions that were 1
cm or less.
Thoracoscopic wedge resection was completed with complete safety. The
histologic diagnoses of these 33 lesions were adenocarcinoma in 1,
bronchioloalveolar carcinoma (BAC) in 23, and atypical adenomatous
hyperplasia (AAH) in 9.
No patients have had any evidence of tumor recurrence to date.
結果:
治療選擇
GGO < 1cm, 肺腺癌為侵襲性通常較低
20. 96 patients with persistent GGO 2 cm or less in diameter underwent
pulmonary resection from January 1997 to December 2001.
93.0% (53/57) of pure GGO 1 cm or less were BAC or AAH,
whereas
38.5% (15/39) of pure GGO larger than 1 cm or mixed GGO were
adenocarcinoma.
治療選擇
結果:
Ann Thorac Surg. 2008 Feb;85(2):S701-4.
Minimally invasive approach to early, peripheral adenocarcinoma with ground-
glass opacity appearance.
Asamura H.
GGO< 1cm, 肺腺癌為侵襲性通常較低
24. Jpn J Thorac Cardiovasc Surg. 2005 Jan;53(1):22-8.
Pulmonary nodules 10 mm or less in diameter with ground-glass opacity component
detected by high-resolution computed tomography have a high possibility of malignancy.
Yoon HE, Fukuhara K, Michiura T, Takada M, Imakita M, Nonaka K, Iwase K.
By Tumor Size Only
93%of nodules larger than 20 mm,
75% of nodules 10 to 20 mm,
43% of nodules < or =10 mm were malignant.
If Add GGO pattern assess
88% malignant in GGO(+) 30% malignant in GGO(-)
結果:
94 patients with indeterminate peripheral pulmonary
nodules underwent wedge resection by VATS.
研究設計:
對於小於1cm 的肺結節
用 CT 評估 GGO pattern
可有效預測惡性的機率 (明顯提高)
重要訊息
29. Korean J Radiol. 2009 Jan-Feb;10(1):12-20.
Malignant pure pulmonary ground-glass opacity nodules: prognostic implications.
Park JH, Lee KS, Kim JH, Shim YM, Kim J, Choi YS, Yi CA.
CONCLUSION: Prognoses in patients with pure GGO malignant pulmonary nodules are
excellent, and not significantly different in terms of nodule number, size, surgical
method, presence of size change before surgical removal and histopathological
diagnosis.
RESULTS: Of the 58 patients, 40 patients (69%) were confirmed to have a
bronchioloalveolar carcinoma (BAC) and 18 patients (31%) were confirmed to have
an adenocarcinoma with a predominant BAC component.
follow-up period of 24 months (range; 12-65 months).
雖說根據 GGO, size 等 criteria 決定術式, 但最近一項
研究顯示其預後與上述因素 (包括術式) 無關
有人認為,只要是Pure GGO, 治療後預後差不多
49. Hook wire Localization for very early Lung Ca
實際案例
chogram pattern,
olar Carcinoma
Lung Air bronchogram pattern,
Bronchoalveolar Carcinoma
Lung Mass, Adenocarcinoma
腫瘤 0.8公分
52. Hook wire Localization for very early Lung Ca
實際案例
Ca s/p Op with Contralateral
ass Opacity (GGO) on F/U
Carcinoma
GGO
y
/U
VATS
ocalization
LL Lung Ca s/p Lobectomy
Localization
Op with Contralateral
acity (GGO) on F/U
Carcinoma
GGO
VATS
56. Hook wire Localization for very early Lung Ca
實際案例
Prior Lung Ca s/p Op with Ipsil
lesion on F/U (Adhesion was
Post Op F/U
1yr later
Using CT localization
Before Op
Post Op F/U
1yr later
Using CT localization
Before Op
VATS
TB
64. Thorac Surg Clin. 2007 May;17(2):191-201, viii.
Management of the peripheral small ground-glass opacities.
Yoshida J.
Pure ground-glass opacities (GGO) with a small consolidation area are mostly
bronchioloalveolar carcinomas that have not yet become invasive, whereas a minority
represents only inflammatory changes. Even if they are cancers, they are slow-
growing and often remain unchanged for several years. There is no need for
immediate resection of GGO lesions and a watchful waiting strategy is recommended.
It seems that a lower-impact surgery (eg, wedge resection or segmentectomy) is
curative for these lung cancers. Because high-resolution CT seems to predict
noninvasive or minimally invasive GGO lung cancers with high reliability, less invasive
treatments like radiofrequency ablation have greater appeal.
Pure type GGO (type A or B) 使用 lower impact
Of surgery 即足夠
65. Br J Cancer 2005
Sublobular resection= Wedge or Segmentectomy
66. Stage IA Lung Adeno Ca,
Limited Resection vs Lobectomy
1y, 3y survivial 接近,直到5y survival 才稍有diff
68. GGO Lung BACs /Adenocarcinoma:
治療原則
• GGO type A or B, <2cm, Peripheral type:
Wedge resection.
• GGO type C 以上, or >2cm, or Central type:
Segmentectomy or Lobectomy + LN sampling
or dissection.
69. Ann Thorac Cardiovasc Surg. 2009 Apr;15(2):82-8.
Selection of sublobar resection for c-stage IA non-small cell lung cancer based on a
combination of structural imaging by CT and functional imaging by FDG PET.
Yoshioka M, Ichiguchi O.
Four types of data were collected:
(1) tumor size based on HR/TSCT (0-10 mm, 11-20 mm or 21-30 mm);
(2) percentage of ground-glass opacity (GGO) region (GGO type or solid type);
(3) pathological type (invasive cancer [INVC] or non-INVC [NINVC]);
(4) FDG uptake in the tumor (grades 0, 1, and 2).
選擇手術式的考量
70. One of 42 tumors (2.4%) less than 1 cm in size, 29 of 132 tumors (22.0%) 1-2 cm in size, and
25 of 74 tumors (33.8%) 2-3 cm in size were judged to be INVC (p = 0.0002). (size 愈大,
invasive Ca 的機率愈大)
GGO type tumors (2.3%) were less likely to be INVC than
solid type tumors (32.9%) (p <0.0001). (GGO 是 invasive Ca 的機率很低)
None of the 28 GGO tumors less than 1 cm in size was INVC;
however, the possibility of INVC remained in solid type tumors less than 1 cm in size. (GGO
小於1cm 幾乎都是 non-invasive, 但 solid type 就不然)
In tumors whose diameter was more than 1 cm, INVC was possible regardless of their size or
character (GGO or solid). (大於1cm 要小心, 即便是 GGO)
One of 23 (4.3%), 4 of 33 (12.1%) and 14 of 43 tumors (32.6%) whose FDG uptake
showed grades 0, 1, and 2, respectively, microscopically revealed INVC (p = 0.0028).
All tumors whose FDG uptake was grade 0 and whose size was less than 1 cm were NINVC.
All 5 tumors (5.0%) which were found to have lymph node metastasis showed
grade 2 FDG uptake.
71. The criteria for operation for cT1N0M0 NSCLC based on HR/TSCT and FDG PET
findings are the following:
a tumor less than 1 cm in size and either a GGO type or whose PET grade is 0
(wedge resection);
a tumor greater than 1 cm in size and whose PET grade is 0 or 1 (segmentectomy
with lymph node dissection);
a tumor whose PET grade is 2
(lobectomy with systemic lymph node dissection).
結論 不同的情境, 不同的手術式
72. Kyobu Geka. 2009 Apr;62(4):277-80.
Video-assisted thoracic surgery (VATS) for clinical stage I lung cancer in consideration of the
diameters and characteristcs of each tumor and the technical limitations of VATS]
Article in Japanese]
Sugi K, Kobayashi S, Sudou M, Sakano H, Tao H, Matsuda E, Okabe K.
Department Chest Surgery, Yamaguchi-Ube Medical Center, Ube, Japan.
We planned an intervention study to investigate the late outcome of limited surgery for cStage IA
ung cancer by several video-assisted thoracic surgery (VATS) procedures. METHODS: VATS partial
esection was done for non-solid tumors less than 1.5 cm in maximum diameter with non-solid
omponent on high resolution computed tomography (HRCT) [group A]. VATS segmentectomy
with minor thoracotomy with ND1 + alpha lymph node dissection was done for tumors less than
2.0 cm in maximum diameter that was not included in the group A (group B). Tumors of less than
3.0 cm in diameter that did not fit into the other 2 groups were treated by VATS lobectomy with
minor thoracotomy plus ND2 lymph node dissection (group C). RESULTS: A total of 159 patients
were enrolled during the 5-year enrollment period (group A: 21 patients, group B: 43 patients,
group C: 95 patients). The recurrence-free 5-year survival rate was 100% in the group A, 82.8% in
he group B, and 78.4% in the group C, showing no significant differences between the groups.
Twenty-eight % of patients was switched to surgical techniques involving more extensive resection
n the group A and B. while 6% of the patients was switched to thoracotomy overall. The overall
ecurrence rate was 10.7% (n=17), while the locoregional and distant recurrence rate was 5.7%
n=9) and 5.0% (n=8), respectively. CONCLUSIONS: This controlled intervention study suggested
hat limited surgery by VATS approaches for cStage IA lung cancer are acceptable as cancer
operation.
不同的情境, 不同的VATS 術式
77. LIMITED RESECTION FOR LUNG CANCER
I. Inability to tolerate lobectomy because of
pulmonary or other co-morbidities;
II. Small tumors up to 2 cm diameter;
III. Peripheral location of tumor in the lung;
IV. Confirmed stage IA disease only;
V. Predominantly GGO appearance on CT
imaging.
Alan Dart Loon Sihoe 2012
Division of Cardiothoracic Surgery, Department of
Surgery, Li Ka Shing Faculty of Medicine, The University
of Hong Kong, Queen Mary Hospital, Hong Kong, China
78. Tohoku J Exp Med. 2009 Feb;217(2):133-7.
Curative wedge resection for non-invasive bronchioloalveolar carcinoma.
Sagawa M, Higashi K, Usuda K, Aikawa H, Machida Y, Tanaka M, Ueno M, Sakuma T.
The criteria for wedge resection were;
1) clinically no nodal or distant metastasis,
2) the location of the tumor was peripheral enough to undergo wedge resection,
3) the diameter of the shadow was 8-20 mm,
4) GGO% (diameter of GGO area/diameter of whole tumor) was 80% or over,
5) FDG uptake of the tumor was less than that of the mediastinum,
6) the intraoperative pathological diagnosis was non-invasive bronchioloalveolar
carcinoma,
7) informed consent was obtained.
可以使用 Wedge resection 的準則如上
79. <2cm T1N0M0, pure or partial GGO
2015
對於早期GGO
可先考慮使用
保守切除治療的方式
看結果
決定後續治療的策略
86. In conclusion:
(1) patient survival after wedge/sublobar resection of stage I
NSCLC is improving, and is not significantly different
globally for peripheral small-sized tumors;
(2) there are phase III studies comparing lobectomy and
segmentectomy but not wedge resection;
(3) survival probability of wedge resection seems to be
similar to that of SBRT, but SBRT has limitations such as
“no-fly-zone”, irradiation of hilar tumors and associated
complications such as pulmonary fibrosis and hemoptysis;
and
(4) a suitable subgroup of patients for wedge/sublobar
resection may be found based on tumor size, location,
margindistance, M/T ratio, and margin cytology.
87. 非小細胞肺癌 (NSCLC), T4-M
Heart, Great Vessels.
Carina, Trachea.
Vertebrae. 侵犯
T3
T4
M1
M1a
M1b: Distant Metastasis
T4
AJCC 6th Ed
AJCC 7th Ed
Lung NSCLC: AJCC T Stage
7th 與6th Ed 的差異
88. Ann Thorac Surg. 2004 Oct;78(4):1194-9.
Surgical treatments for multiple primary adenocarcinoma of the lung.
Nakata M, Sawada S, Yamashita M, Saeki H, Kurita A, Takashima S, Tanemoto K.
31 / 369 patients (8.4%) were determined multiple primary adenoCa.
26 patients were synchronous and
5 patients were metachronous with a median interval of 59.0 months.
49 /68 (72.1%) of lesions exhibited ground-glass opacity (GGO) on high-
resolution CT (HRCT).
Pathologically well-differentiated adenocarcinoma with mixed bronchioloalveolar
pattern 39.7%
以為Multiple GGO 或 Adeno Ca 就不適合開刀切除,
錯!
89. Taking into consideration pulmonary function, size, location, and HRCT findings of the
lesions the procedures performed were
lobectomy with mediastinal lymph-node dissection for 32 patients, segmentectomy
with hilar node dissection for 8 patients, and
wedge resection for 28 patients.
Of 17 patients with bilateral synchronous cancers, simultaneous bilateral pulmonary
resection was performed in 14 patients including simultaneous bilateral video-
assisted thoracic surgery (VATS) in 11 patients.
After a median follow-up period of 27.7 months,
the 3-year overall survival rate was 92.9% and
the 3-year disease-free survival rates of synchronous cancer and metachronous
cancer were 77.9% and 100%, respectively.
誰說, 外科治療不適用於Multifocal GGO or Adeno Ca?
90. J Thorac Cardiovasc Surg. 2007 Oct;134(4):877-82.
Efficacy of thoracoscopic resection for multifocal bronchioloalveolar carcinoma showing
pure ground-glass opacities of 20 mm or less in diameter.
Mun M, Kohno T.
結論
Video-assisted thoracic surgery management of multifocal bronchioloalveolar
carcinoma yielded satisfactory results.
However, the appearance of new lesions remains a problem.
研究內容
27patients (10 male and 17 female) with a median age of 64 years (range, 41-78 years) had
91 ground-glass opacity lesions on high-resolution computed tomography. Sixteen patients
(59%) were women with no history of smoking. The distribution of bronchioloalveolar
carcinoma lesions was unilateral in 14 patients and bilateral in 13 patients. 10 patients
underwent wedge resection. 17patients underwent single-stage segmentectomy or
lobectomy (alone or with wedge resection) for technical reasons.
結果
The median postoperative observation period was 46 months. All
patients have survived to date, but new lesions have developed in 7 (26%).
(但多為很小 ,3mm lesion 或是low malig)
All patients had N0 disease.
cN0 (for type A,B).