This study examined the diagnostic validity of three swab techniques for identifying chronic wound infection by comparing quantitative cultures from swab specimens to quantitative cultures from tissue specimens. The three swab techniques tested were wound exudate, the Z-technique, and Levine's technique. Of the 83 chronic wounds studied, 30 (36%) were found to be infected based on the tissue culture results. Levine's technique was found to have the highest accuracy at 0.80 when compared to the tissue cultures. A critical threshold of 37,000 organisms per swab using Levine's technique provided a sensitivity of 90% and specificity of 57% for detecting infected wounds. The mean concordance between swab specimens using Levine's technique and tissue specimens was 78%.
This document discusses various factors that impact prognosis for patients with carcinomatosis peritoneal. It discusses factors like transmural invasion, number of lymph nodes analyzed, micrometastases, lymphovascular invasion, residual disease after treatment, histological grade, and the importance of multidisciplinary treatment. It provides references for studies on how each of these factors relates to patient survival outcomes.
Additional value of prenatal genomic array testing in fetuses with isolated structural ultrasound abnormalities and a normal karyotype: a systematic review of the literature
M.C. de Wit, M.I. Srebniak, L.C.P. Govaerts, D. Van Opstal, R.J.H. Galjaard and A.T.J.I. Go
Link to free access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.12575/abstract
The document discusses the evolution of colposcopy terminology and standards. It notes that terminology and techniques vary widely in different settings, making it difficult to compare outcomes and practices. The development of standardized terminology and rigorous training programs, like those in the UK, can help improve colposcopic accuracy and consistency between providers. The document also reviews studies on how factors like lesion size and excision dimensions may impact outcomes. It introduces new terminology for describing findings like the transformation zone type and ridge sign.
This document provides an overview of soft tissue sarcoma (STS):
- STS is a diverse group of rare cancers that arise from mesodermal tissues, accounting for 1% of adult and 15% of pediatric cancers.
- STS can occur anywhere but most commonly in the extremities. Over 50 histologic subtypes exist.
- Risk factors include genetic conditions, radiation exposure, certain chemicals, and lymphedema.
- STS is typically diagnosed based on imaging and biopsy of a mass. Grading and staging integrate tumor characteristics.
- Treatment involves surgery to remove the tumor with clear margins, sometimes combined with radiation and/or chemotherapy. The goal is local control without amputation when possible
Sentinel lymph node biopsy before neoadjuvant chemotherapy for clinical axill...Dr./ Ihab Samy
Ihab S. Fayeka MD; Fouad A. Saleepa MD; Hany F. Habashyb MD; Alfred E. Namourc MD ; Iman G. Farahatd MD ;Magdy Kotbe MD
a: department of surgical oncology - national cancer institute - Cairo university - Egypt.
b: department of surgery - Fayoum university hospital - El Fayoum - Egypt.
c: department of medical oncology - national cancer institute - Cairo university - Egypt.
d: department of surgical pathology - national cancer institute - Cairo university - Egypt.
e: department of nuclear medicine - national cancer institute - Cairo university - Egypt.
For correspondance contact: drihab74@hotmail.com
Kasr el-aini journal of surgery Volume 14, No.1, January 2013
This study examined differences in diagnostic delays between nodular melanoma (NM) and superficial spreading melanoma (SSM). NM accounts for a disproportionate number of melanoma deaths due to its rapid vertical growth. The study found that doctors were more likely to reassure patients with NM that their lesion was benign compared to SSM patients. Patients with NM also had more doctor consultations and were less likely to have their lesion biopsied during the first visit. Addressing earlier diagnosis of NM could significantly impact melanoma mortality through increased physician awareness and lowering the threshold for biopsy of concerning lesions.
CANCER of UNKNOWN PRIMARY (CUP), Dr BÙI ĐẮC CHÍhungnguyenthien
Cancer of unknown primary (CUP) refers to metastatic cancer that has spread to other parts of the body but the original primary site cannot be identified. CUP makes up approximately 2-6% of cancer cases. Conventional methods to identify the primary site include imaging scans, medical history, physical exams, and laboratory tests. Molecular profiling using techniques like immunohistochemistry, gene expression profiling, and next generation sequencing can identify predictive biomarkers and actionable targets in around 80% of CUP cases. Identifying the primary site can help determine the best treatment approach and predict outcomes. Gene expression profiling tests like the Pathwork Tissue of Origin test can determine the likely tissue of origin with 99% certainty when the highest similarity score is above
This study examined the diagnostic validity of three swab techniques for identifying chronic wound infection by comparing quantitative cultures from swab specimens to quantitative cultures from tissue specimens. The three swab techniques tested were wound exudate, the Z-technique, and Levine's technique. Of the 83 chronic wounds studied, 30 (36%) were found to be infected based on the tissue culture results. Levine's technique was found to have the highest accuracy at 0.80 when compared to the tissue cultures. A critical threshold of 37,000 organisms per swab using Levine's technique provided a sensitivity of 90% and specificity of 57% for detecting infected wounds. The mean concordance between swab specimens using Levine's technique and tissue specimens was 78%.
This document discusses various factors that impact prognosis for patients with carcinomatosis peritoneal. It discusses factors like transmural invasion, number of lymph nodes analyzed, micrometastases, lymphovascular invasion, residual disease after treatment, histological grade, and the importance of multidisciplinary treatment. It provides references for studies on how each of these factors relates to patient survival outcomes.
Additional value of prenatal genomic array testing in fetuses with isolated structural ultrasound abnormalities and a normal karyotype: a systematic review of the literature
M.C. de Wit, M.I. Srebniak, L.C.P. Govaerts, D. Van Opstal, R.J.H. Galjaard and A.T.J.I. Go
Link to free access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.12575/abstract
The document discusses the evolution of colposcopy terminology and standards. It notes that terminology and techniques vary widely in different settings, making it difficult to compare outcomes and practices. The development of standardized terminology and rigorous training programs, like those in the UK, can help improve colposcopic accuracy and consistency between providers. The document also reviews studies on how factors like lesion size and excision dimensions may impact outcomes. It introduces new terminology for describing findings like the transformation zone type and ridge sign.
This document provides an overview of soft tissue sarcoma (STS):
- STS is a diverse group of rare cancers that arise from mesodermal tissues, accounting for 1% of adult and 15% of pediatric cancers.
- STS can occur anywhere but most commonly in the extremities. Over 50 histologic subtypes exist.
- Risk factors include genetic conditions, radiation exposure, certain chemicals, and lymphedema.
- STS is typically diagnosed based on imaging and biopsy of a mass. Grading and staging integrate tumor characteristics.
- Treatment involves surgery to remove the tumor with clear margins, sometimes combined with radiation and/or chemotherapy. The goal is local control without amputation when possible
Sentinel lymph node biopsy before neoadjuvant chemotherapy for clinical axill...Dr./ Ihab Samy
Ihab S. Fayeka MD; Fouad A. Saleepa MD; Hany F. Habashyb MD; Alfred E. Namourc MD ; Iman G. Farahatd MD ;Magdy Kotbe MD
a: department of surgical oncology - national cancer institute - Cairo university - Egypt.
b: department of surgery - Fayoum university hospital - El Fayoum - Egypt.
c: department of medical oncology - national cancer institute - Cairo university - Egypt.
d: department of surgical pathology - national cancer institute - Cairo university - Egypt.
e: department of nuclear medicine - national cancer institute - Cairo university - Egypt.
For correspondance contact: drihab74@hotmail.com
Kasr el-aini journal of surgery Volume 14, No.1, January 2013
This study examined differences in diagnostic delays between nodular melanoma (NM) and superficial spreading melanoma (SSM). NM accounts for a disproportionate number of melanoma deaths due to its rapid vertical growth. The study found that doctors were more likely to reassure patients with NM that their lesion was benign compared to SSM patients. Patients with NM also had more doctor consultations and were less likely to have their lesion biopsied during the first visit. Addressing earlier diagnosis of NM could significantly impact melanoma mortality through increased physician awareness and lowering the threshold for biopsy of concerning lesions.
CANCER of UNKNOWN PRIMARY (CUP), Dr BÙI ĐẮC CHÍhungnguyenthien
Cancer of unknown primary (CUP) refers to metastatic cancer that has spread to other parts of the body but the original primary site cannot be identified. CUP makes up approximately 2-6% of cancer cases. Conventional methods to identify the primary site include imaging scans, medical history, physical exams, and laboratory tests. Molecular profiling using techniques like immunohistochemistry, gene expression profiling, and next generation sequencing can identify predictive biomarkers and actionable targets in around 80% of CUP cases. Identifying the primary site can help determine the best treatment approach and predict outcomes. Gene expression profiling tests like the Pathwork Tissue of Origin test can determine the likely tissue of origin with 99% certainty when the highest similarity score is above
1) The document discusses the Halsted and Fisher hypotheses regarding breast cancer treatment. The Halsted hypothesis viewed breast cancer as spreading in an orderly manner from the breast to lymph nodes to distant sites, supporting radical mastectomy. The Fisher hypothesis viewed breast cancer as a systemic disease at diagnosis.
2) Recent evidence from NSABP trials suggests local therapy and local recurrence may affect survival outcomes, challenging the Fisher hypothesis. Patients who experienced local recurrence had higher risks of distant disease and mortality. Improved local control with radiotherapy was associated with decreased breast cancer deaths.
3) The evidence indicates that both local and systemic factors play a role in breast cancer, supporting an approach that considers both.
This document discusses biopsy principles and abdominal tumors in veterinary medicine. It provides guidelines for obtaining biopsy samples, including using the proper technique to procure enough tissue for an accurate diagnosis without increasing the risk of metastasis. Needle biopsy, incisional biopsy, and excisional biopsy are described as common methods. The role of the pathologist in interpreting biopsy results and potential sources of error are also outlined. For abdominal tumors, the document recommends evaluations like radiographs and ultrasound prior to exploration. It states that solitary masses should be explored for diagnosis and possible treatment, while diffuse disease is rarely helped by surgery alone. Factors like tumor stage, site and grade will impact therapy and prognosis.
Our Childhood Cancer Reseach Panel is a targeted gene panel that utilizes 20 ng of FFPE DNA and 10 ng of FFPE RNA in a simple, 3-tube AmpliSeq™ assay suitable for sequencing on the Ion Torrent platform with rapid turn around time (<3 days in lab) and automated report generation that may in the future help improve pediatric cancer diagnosis, identify prognostic features, and detect genomic alterations (including mutations, insertions, deletions, gene amplification and RNA expression levels) that match targeted therapeutic targets.
This document summarizes a research project that aims to define biomarkers for personalized cancer treatment using drug sensitivity data. The project will analyze existing drug sensitivity and molecular profiling data from cell lines and patients to identify biomarkers associated with drug response. Predictive models will be developed and tested to determine the most effective drugs for individual patients based on their tumor biomarkers. The goal is to improve cancer treatment outcomes by selecting treatments that have a higher likelihood of curing individual patients.
L rotenberg, g lenczner premalignant breast lesion imaging jfim hanoi 2015 compLuc ROTENBERG
This document discusses breast premalignant lesions, their imaging appearance, diagnosis, and management. It provides information on lesions such as DCIS, ADH, ALH, and LCIS. Imaging modalities like mammography, ultrasound, and MRI can detect these lesions as masses, calcifications or other abnormalities. Biopsy is often used for diagnosis but may underestimate the lesion. Surgical excision is generally recommended when premalignant lesions are found on biopsy to rule out associated malignancy, though careful radiologic-pathologic correlation in some cases can guide observation over excision. Underestimation rates vary by biopsy method and number of specimens obtained.
Round table #19 at American Society of Cytopathology (Nov 5, 2012, Las Vegas,...vshidham
This document discusses cell blocks for molecular tests and immunocytochemistry applications. It begins with an overview of cell blocks and their role in bridging cytology and histopathology. It then discusses various methods for preparing cell blocks from different specimen types, noting critical issues to consider like specimen cellularity and anticipated ancillary tests. The document also covers immunophenotyping using cell blocks and challenges like antigen loss. It presents an approach called SCIP for immunocytochemistry of effusions. Finally, it indicates there will be a discussion of study cases using cell blocks.
This document discusses treatment approaches for early stage cervical cancer. It notes that for invasive cervical cancers measuring less than 2 cm, removal of the parametrium may be omitted. For some very small tumors, pelvic lymphadenectomy can also be omitted as the risk of lymph node metastasis is limited. It also discusses outcomes from vaginal trachelectomy and laparoscopic pelvic lymphadenectomy for early stage cancers. The document considers conservative treatment approaches for stage IA2-IB1 cancers less than 3 cm in size, including a proposed study design stratifying patients based on tumor diameter.
The clinical application development and validation of cell free dna assays -...Candy Smellie
What is the impact of assay failure in your laboratory and how do you monitor for it?
In cancer patients, cell-free DNA carries tumour-related genetic alterations that are relevant to cancer development, disease progression and response to therapy.
Cell-free DNA detection allows:
Early detection
Frequent sampling
Monitoring of disease progression
Measure response to therapy
Detection of resistance mutation
Non-invasive diagnostic tool development
This document summarizes research on analyzing clinical and molecular cancer data to enable precision cancer medicine. It discusses analyzing tumor heterogeneity, transcriptional subtyping of colorectal cancer, identifying biomarkers of drug response, and exploring these concepts using patient-derived xenograft models. Key findings include identifying microRNAs that antagonize a poor-prognosis colorectal cancer subtype and finding kinase genes that are therapeutic targets in otherwise resistant tumor cells and xenografts.
Natural fluorescence of normal and neoplastic human colonguest2f80ca
This document describes a study that used microspectrofluorometry to analyze and compare the natural fluorescence of normal and neoplastic (cancerous) human colon tissue. The study found:
1) Normal and cancerous colon tissues exhibited different patterns of fluorescence intensity and spectral shape, related to their distinct histological organizations.
2) The most evident spectral differences involved the stromal compartment and were likely due to different fluorochromes, related to the host response to tumors.
3) The nature and extent of autofluorescence modifications between normal and cancerous tissues helped explain previous "in vivo" analysis findings and highlighted the importance of excitation parameters for exploiting autofluorescence in diagnosis.
Field cancerization refers to genetic and molecular alterations that occur in histologically normal tissue surrounding tumors. These alterations predispose the tissue to developing additional new cancers. The document discusses two cases presenting with multiple primary tumors in the oral cavity and larynx as examples of field cancerization. It then reviews the original description of field cancerization from 1953 and various theories for how it occurs. The concept of an "etiologic field effect" is introduced, which broadens the understanding of cancer susceptibility at the molecular, cellular and environmental levels. Several examples of field cancerization are described for different cancer types. Clinical tools for detecting field cancerization like iodine staining and toluidine blue staining are also mentioned.
1) Treatment of rectal cancer involves a multimodal approach combining chemotherapy, radiation therapy, and surgery depending on the stage of disease.
2) For locally advanced stages, preoperative chemoradiation is preferred to improve local control and rates of sphincter preservation compared to postoperative chemoradiation.
3) Short course preoperative radiation is non-inferior to long course chemoradiation in terms of local recurrence rates according to a randomized trial, though the optimal approach remains unclear.
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.
Abstract
OBJECTIVE: Complete surgical resection is the only potentially curative treatment of localized pancreatic neuroendocrine tumors. Unfortunately, a significant proportion of these patients present with unresectable locally advanced tumors or massive metastatic disease. Recently, a new therapeutic approach for this subset of patients has emerged consisting of neoadjuvant therapy followed by surgical exploration in responders.
DESIGN: We searched MEDLINE for the purpose of identifying reports regarding neoadjuvant treatment modalities for advanced pancreatic neuroendocrine tumors.
RESULTS: We identified 12 studies, the vast majority of which were either case reports or small case series. Treatment options included chemotherapy, radiotherapy, peptide receptor radionuclide therapy, biological agents or various combina- tions of them.
CONCLUSIONS: Increasing evidence supports the application of neoadjuvant protocols in advanced pancreatic neuroendocrine tumors aiming at tumor downsizing, thus rendering curative resection feasible. Given that prospective and controlled randomized clini- cal trials from high-volume institutions are not feasible, expert panel consensus is needed to define the optimal treatment algorithm.
El documento explica cómo localizar un libro en la biblioteca del campus de Vicálvaro mediante la consulta del catálogo bibliográfico. Indica que se debe buscar el libro de interés en el catálogo en línea haciendo clic en "Catálogo", y proporciona detalles sobre la información relevante a tener en cuenta como la signatura, tipo de material y localización del libro. También describe los diferentes tipos de signaturas y colecciones especiales, así como el préstamo intercampus para libros ubicados en otras bibliotecas.
LVSC presentation: Building Partnerships for ESF, 8 Maylvscsteve
This document provides an update on European Social Fund (ESF) programmes and partnerships for voluntary and community sector organizations. It discusses the timeline and support available for the Building Better Opportunities (BBO) programme launching in June 2015, including funding of £32.5-35 million in grants rather than contracts. Organizations are encouraged to stay updated on ESF opportunities through the LVSC website and bulletins. The agenda also included time for networking around themes of interest.
Edelweiss Management Consulting GmbH is a German consulting company with offices in Dusseldorf, London, Prague, and Kiev that has been operating successfully since 1997. They provide recruitment services with over 75,000 professionals in their database, an average vacancy closing time of 14 days, no prepayment for services, and a 100-day replacement guarantee at no cost. The document provides information on who they are, their advantages for clients, how they work with clients on vacancies, and contact details.
Blue whales can eat large amounts of krill due to their baleen plates and large gulp size. Sea snakes are ocean reptiles with long bodies that are highly venomous but use venom mainly for defense. Dolphins communicate through various noises, have feelings, and are playful animals that can perform tricks. The document discusses reasons for choosing these three sea animals for a new zoo: blue whales because they are the largest animal, sea snakes because they are unusual snakes that live in water, and dolphins because they are playful and the author has cuddled one before.
Este documento presenta una introducción al tema de las políticas culturales en América Latina. Discute cómo las políticas culturales han sido tradicionalmente vistas como un área no estructurada y ajena a lo político. Sin embargo, en las últimas décadas ha habido un mayor interés en este tema, con la creación de ministerios de cultura y planes nacionales. El documento también analiza cómo los estudios sobre políticas culturales han evolucionado, pasando de simples descripciones burocráticas a enfoques más conceptuales y críticos. Finalmente
Informe de Sostenibilidad Ambiental para el Sector Eléctrico 2015-20Tienda Solar
Informe sobre las estrategia a desempeñar por el Ministerio de Industria, Energía y Turismo de cara a la Sostenibilidad Ambiental del Sector Eléctrico, con un aumento de apoyo a las energías renovables.
1) The document discusses the Halsted and Fisher hypotheses regarding breast cancer treatment. The Halsted hypothesis viewed breast cancer as spreading in an orderly manner from the breast to lymph nodes to distant sites, supporting radical mastectomy. The Fisher hypothesis viewed breast cancer as a systemic disease at diagnosis.
2) Recent evidence from NSABP trials suggests local therapy and local recurrence may affect survival outcomes, challenging the Fisher hypothesis. Patients who experienced local recurrence had higher risks of distant disease and mortality. Improved local control with radiotherapy was associated with decreased breast cancer deaths.
3) The evidence indicates that both local and systemic factors play a role in breast cancer, supporting an approach that considers both.
This document discusses biopsy principles and abdominal tumors in veterinary medicine. It provides guidelines for obtaining biopsy samples, including using the proper technique to procure enough tissue for an accurate diagnosis without increasing the risk of metastasis. Needle biopsy, incisional biopsy, and excisional biopsy are described as common methods. The role of the pathologist in interpreting biopsy results and potential sources of error are also outlined. For abdominal tumors, the document recommends evaluations like radiographs and ultrasound prior to exploration. It states that solitary masses should be explored for diagnosis and possible treatment, while diffuse disease is rarely helped by surgery alone. Factors like tumor stage, site and grade will impact therapy and prognosis.
Our Childhood Cancer Reseach Panel is a targeted gene panel that utilizes 20 ng of FFPE DNA and 10 ng of FFPE RNA in a simple, 3-tube AmpliSeq™ assay suitable for sequencing on the Ion Torrent platform with rapid turn around time (<3 days in lab) and automated report generation that may in the future help improve pediatric cancer diagnosis, identify prognostic features, and detect genomic alterations (including mutations, insertions, deletions, gene amplification and RNA expression levels) that match targeted therapeutic targets.
This document summarizes a research project that aims to define biomarkers for personalized cancer treatment using drug sensitivity data. The project will analyze existing drug sensitivity and molecular profiling data from cell lines and patients to identify biomarkers associated with drug response. Predictive models will be developed and tested to determine the most effective drugs for individual patients based on their tumor biomarkers. The goal is to improve cancer treatment outcomes by selecting treatments that have a higher likelihood of curing individual patients.
L rotenberg, g lenczner premalignant breast lesion imaging jfim hanoi 2015 compLuc ROTENBERG
This document discusses breast premalignant lesions, their imaging appearance, diagnosis, and management. It provides information on lesions such as DCIS, ADH, ALH, and LCIS. Imaging modalities like mammography, ultrasound, and MRI can detect these lesions as masses, calcifications or other abnormalities. Biopsy is often used for diagnosis but may underestimate the lesion. Surgical excision is generally recommended when premalignant lesions are found on biopsy to rule out associated malignancy, though careful radiologic-pathologic correlation in some cases can guide observation over excision. Underestimation rates vary by biopsy method and number of specimens obtained.
Round table #19 at American Society of Cytopathology (Nov 5, 2012, Las Vegas,...vshidham
This document discusses cell blocks for molecular tests and immunocytochemistry applications. It begins with an overview of cell blocks and their role in bridging cytology and histopathology. It then discusses various methods for preparing cell blocks from different specimen types, noting critical issues to consider like specimen cellularity and anticipated ancillary tests. The document also covers immunophenotyping using cell blocks and challenges like antigen loss. It presents an approach called SCIP for immunocytochemistry of effusions. Finally, it indicates there will be a discussion of study cases using cell blocks.
This document discusses treatment approaches for early stage cervical cancer. It notes that for invasive cervical cancers measuring less than 2 cm, removal of the parametrium may be omitted. For some very small tumors, pelvic lymphadenectomy can also be omitted as the risk of lymph node metastasis is limited. It also discusses outcomes from vaginal trachelectomy and laparoscopic pelvic lymphadenectomy for early stage cancers. The document considers conservative treatment approaches for stage IA2-IB1 cancers less than 3 cm in size, including a proposed study design stratifying patients based on tumor diameter.
The clinical application development and validation of cell free dna assays -...Candy Smellie
What is the impact of assay failure in your laboratory and how do you monitor for it?
In cancer patients, cell-free DNA carries tumour-related genetic alterations that are relevant to cancer development, disease progression and response to therapy.
Cell-free DNA detection allows:
Early detection
Frequent sampling
Monitoring of disease progression
Measure response to therapy
Detection of resistance mutation
Non-invasive diagnostic tool development
This document summarizes research on analyzing clinical and molecular cancer data to enable precision cancer medicine. It discusses analyzing tumor heterogeneity, transcriptional subtyping of colorectal cancer, identifying biomarkers of drug response, and exploring these concepts using patient-derived xenograft models. Key findings include identifying microRNAs that antagonize a poor-prognosis colorectal cancer subtype and finding kinase genes that are therapeutic targets in otherwise resistant tumor cells and xenografts.
Natural fluorescence of normal and neoplastic human colonguest2f80ca
This document describes a study that used microspectrofluorometry to analyze and compare the natural fluorescence of normal and neoplastic (cancerous) human colon tissue. The study found:
1) Normal and cancerous colon tissues exhibited different patterns of fluorescence intensity and spectral shape, related to their distinct histological organizations.
2) The most evident spectral differences involved the stromal compartment and were likely due to different fluorochromes, related to the host response to tumors.
3) The nature and extent of autofluorescence modifications between normal and cancerous tissues helped explain previous "in vivo" analysis findings and highlighted the importance of excitation parameters for exploiting autofluorescence in diagnosis.
Field cancerization refers to genetic and molecular alterations that occur in histologically normal tissue surrounding tumors. These alterations predispose the tissue to developing additional new cancers. The document discusses two cases presenting with multiple primary tumors in the oral cavity and larynx as examples of field cancerization. It then reviews the original description of field cancerization from 1953 and various theories for how it occurs. The concept of an "etiologic field effect" is introduced, which broadens the understanding of cancer susceptibility at the molecular, cellular and environmental levels. Several examples of field cancerization are described for different cancer types. Clinical tools for detecting field cancerization like iodine staining and toluidine blue staining are also mentioned.
1) Treatment of rectal cancer involves a multimodal approach combining chemotherapy, radiation therapy, and surgery depending on the stage of disease.
2) For locally advanced stages, preoperative chemoradiation is preferred to improve local control and rates of sphincter preservation compared to postoperative chemoradiation.
3) Short course preoperative radiation is non-inferior to long course chemoradiation in terms of local recurrence rates according to a randomized trial, though the optimal approach remains unclear.
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.
Abstract
OBJECTIVE: Complete surgical resection is the only potentially curative treatment of localized pancreatic neuroendocrine tumors. Unfortunately, a significant proportion of these patients present with unresectable locally advanced tumors or massive metastatic disease. Recently, a new therapeutic approach for this subset of patients has emerged consisting of neoadjuvant therapy followed by surgical exploration in responders.
DESIGN: We searched MEDLINE for the purpose of identifying reports regarding neoadjuvant treatment modalities for advanced pancreatic neuroendocrine tumors.
RESULTS: We identified 12 studies, the vast majority of which were either case reports or small case series. Treatment options included chemotherapy, radiotherapy, peptide receptor radionuclide therapy, biological agents or various combina- tions of them.
CONCLUSIONS: Increasing evidence supports the application of neoadjuvant protocols in advanced pancreatic neuroendocrine tumors aiming at tumor downsizing, thus rendering curative resection feasible. Given that prospective and controlled randomized clini- cal trials from high-volume institutions are not feasible, expert panel consensus is needed to define the optimal treatment algorithm.
El documento explica cómo localizar un libro en la biblioteca del campus de Vicálvaro mediante la consulta del catálogo bibliográfico. Indica que se debe buscar el libro de interés en el catálogo en línea haciendo clic en "Catálogo", y proporciona detalles sobre la información relevante a tener en cuenta como la signatura, tipo de material y localización del libro. También describe los diferentes tipos de signaturas y colecciones especiales, así como el préstamo intercampus para libros ubicados en otras bibliotecas.
LVSC presentation: Building Partnerships for ESF, 8 Maylvscsteve
This document provides an update on European Social Fund (ESF) programmes and partnerships for voluntary and community sector organizations. It discusses the timeline and support available for the Building Better Opportunities (BBO) programme launching in June 2015, including funding of £32.5-35 million in grants rather than contracts. Organizations are encouraged to stay updated on ESF opportunities through the LVSC website and bulletins. The agenda also included time for networking around themes of interest.
Edelweiss Management Consulting GmbH is a German consulting company with offices in Dusseldorf, London, Prague, and Kiev that has been operating successfully since 1997. They provide recruitment services with over 75,000 professionals in their database, an average vacancy closing time of 14 days, no prepayment for services, and a 100-day replacement guarantee at no cost. The document provides information on who they are, their advantages for clients, how they work with clients on vacancies, and contact details.
Blue whales can eat large amounts of krill due to their baleen plates and large gulp size. Sea snakes are ocean reptiles with long bodies that are highly venomous but use venom mainly for defense. Dolphins communicate through various noises, have feelings, and are playful animals that can perform tricks. The document discusses reasons for choosing these three sea animals for a new zoo: blue whales because they are the largest animal, sea snakes because they are unusual snakes that live in water, and dolphins because they are playful and the author has cuddled one before.
Este documento presenta una introducción al tema de las políticas culturales en América Latina. Discute cómo las políticas culturales han sido tradicionalmente vistas como un área no estructurada y ajena a lo político. Sin embargo, en las últimas décadas ha habido un mayor interés en este tema, con la creación de ministerios de cultura y planes nacionales. El documento también analiza cómo los estudios sobre políticas culturales han evolucionado, pasando de simples descripciones burocráticas a enfoques más conceptuales y críticos. Finalmente
Informe de Sostenibilidad Ambiental para el Sector Eléctrico 2015-20Tienda Solar
Informe sobre las estrategia a desempeñar por el Ministerio de Industria, Energía y Turismo de cara a la Sostenibilidad Ambiental del Sector Eléctrico, con un aumento de apoyo a las energías renovables.
The document summarizes an agenda for the 1st Annual Brazilian Retail Insurance Summit taking place from May 12-15, 2014 in São Paulo, Brazil. The summit will bring together over 23 insurance experts from major global and regional insurers, distribution channels, and other organizations to discuss opportunities in the Brazilian retail insurance market.
The agenda outlines keynote sessions and presentations on topics like capitalizing on opportunities in the Brazilian market, understanding regulation changes, challenges and opportunities in bancassurance, developing customer loyalty programs, responding to customers' financial concerns, overcoming protection gaps in life insurance, and the broker's role in the mature Brazilian market. Attendees will have the chance to network and learn best practices to help capture
Este documento presenta las bases del XXXVI Premio Hispanoamericano de Poesía Juan Ramón Jiménez del año 2016. El premio otorgará €6,000 e incluirá la publicación del libro ganador. Los participantes pueden enviar hasta tres obras originales e inéditas de al menos 500 versos antes del 11 de abril de 2016. Un jurado anónimo evaluará las obras seleccionadas y otorgará el premio, el cual no está obligado a ser otorgado. El ganador será anunciado el 29 de mayo.
Este documento presenta el Centro de Investigación en Tecnologías de la Información y las Comunicaciones (CITIC) y sus 12 áreas tecnológicas. El CITIC es un centro tecnológico singular impulsado por la Universidad de A Coruña para potenciar la investigación, desarrollo e innovación en TIC y fomentar la transferencia de conocimiento. El CITIC cuenta con más de 200 investigadores de los sectores público y privado trabajando en proyectos de I+D.
El informe destaca que los piratas informáticos operan cada vez más como empresas exitosas y utilizan sofisticadas técnicas y estrategias de negocios para robar información personal y dinero. El gusano Conficker y los ataques relacionados con la gripe H1N1 continúan siendo amenazas importantes, al igual que el spam, los worms y los mensajes de texto fraudulentos. Las empresas también deben estar atentas a las amenazas internas debido a los recientes despidos.
Le Sydney Royal Easter Show est un festival australien annuel de deux semaines et s'axe historiquement sur la mise en valeur des technologies agricoles et industrielles. 1 million de personnes s'y rendent chaque année.
Este documento describe las partes principales de tres computadoras diferentes: una para un profesor de tecnología, una para un oficinista y una para un diseñador gráfico. Para cada computadora, detalla los componentes de hardware como el monitor, placa base, memoria RAM, procesador, fuente de alimentación, unidades de disco, teclado, mouse y gabinete. Además, incluye el presupuesto estimado para cada configuración.
This document provides information about the 23rd WKF World Senior Karate Championships taking place from October 26-30, 2016 in Linz, Austria. It includes greetings from the President of the World Karate Federation and the Austrian Karate Federation praising the organization of the event. Details are given about getting to Linz via air or train, the championship venue and official hotels. Schedules, categories, registration procedures, approved equipment, tickets and additional event information are also outlined.
Este documento discute diferentes conceptos relacionados con la belleza. Define la belleza como una noción abstracta ligada a la experiencia humana que procura placer a través de los sentidos. Explica que la belleza humana se basa en una combinación de belleza interior que incluye factores psicológicos, y define la belleza interior como aspectos positivos no físicos como la bondad y la compasión. Finalmente, define la fealdad como una propiedad que no es agradable de mirar y trae una evaluación desfavorable.
This document provides biographical information about a lecturer in international relations who is running for election to Seanad Éireann. It outlines their academic and professional background, including degrees from University College Dublin, University of Limerick, and Trinity College Dublin. It then discusses why voters should support their campaign, focusing on promoting legislation and policies to address issues of gender equality, sexual violence, domestic abuse, discrimination in education, and Ireland's treatment in the European Union. Specific policy proposals are outlined to combat sexual assault, domestic violence, and the glass ceiling effect in higher education. Proposals also aim to restore Ireland's neutrality and secure fair fisheries and debt deals in the EU.
La seccional Pilar-Exaltación de la Cruz del gremio estatal ATE solicitó al Concejo Deliberante local que adhiera a una ley provincial para crear una comisión dedicada a mejorar las condiciones laborales de los municipales en relación a la salud y seguridad en el empleo. Solo dos municipios aprobaron hasta ahora la creación de esta comisión mixta integrada por sindicatos y el gobierno local.
Este documento ofrece orientación sobre la constitución de asociaciones juveniles en el medio rural. Explica que es importante que los jóvenes se asocien para participar en el desarrollo de sus comunidades y combatir el aislamiento. Detalla algunos aspectos clave como definir los objetivos y áreas de trabajo de la asociación, su ámbito de actuación y público objetivo, y asegurar que opera sin ánimo de lucro. Además, enfatiza la importancia de la motivación, formación y organización para garantizar la participación efectiva de
El documento describe las diversas actividades realizadas por los alumnos y profesores del Ciclo Formativo Superior en Actividades Físicas y Deportivas en el IES Juan de Mairena. Incluye fotos y descripciones breves de actividades acuáticas, ciclismo de montaña, carreras de orientación, buceo, acondicionamiento físico y adaptación de ejercicios para personas con discapacidad. También menciona las instalaciones del Instituto Andaluz del Deporte y agradece la colaboración de varios organismos y
All the guidelines recommend co testing as the modality of choice for cervical cancer screening.
However, Cobas test was approved by FDA as primary screening modality in 2014.
1) The document describes a quality improvement technique used at a medical center to enhance detection of ASC-H diagnoses through blinded rescreening of Pap tests.
2) It presents data on the usefulness of HPV testing for women diagnosed with ASC-H, showing higher rates of CIN among HPV-positive women compared to HPV-negative women.
3) The study found the highest CIN2/3 detection rate in women aged 30-39 with ASC-H and positive HPV tests, and that negative HPV tests had a 100% negative predictive value for ruling out CIN2/3 in women over 40.
The document discusses criteria for evaluating genomic tests, including whether the test is clinically meaningful, how it was validated, reliability, practicality, and cost-effectiveness. It emphasizes that tests must provide value beyond traditional measures and require multiple studies as evidence. Genomic tests are developed through a process similar to drug development, starting with initial studies to develop relevant profiles which are then validated in additional studies with prospective design. Sources of variability must be rigorously controlled and clinical context is important.
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.
1. The study aimed to validate immunohistochemical (IHC) surrogates for intrinsic breast cancer subtypes identified by gene expression profiling, using the PAM50 assay as the gold standard.
2. Among 46 biomarkers tested by IHC on a tissue microarray, loss of INPP4B expression showed the best combination of sensitivity (61.1%) and specificity (98.6%) for basal-like breast cancer defined by PAM50.
3. Nestin positivity also strongly correlated with basal-like subtype, consistent with other studies, and may be a useful positive basal marker. A multi-marker IHC panel may better define basal-like breast cancer than single biomarkers.
- Three major molecular assays have been developed for prognostic assessment of breast cancer: Oncotype DX, Mammaprint, and Prosigna.
- Oncotype DX uses a 21-gene signature to predict recurrence risk in ER+ breast cancer. Mammaprint uses a 70-gene signature and Prosigna uses the PAM50 intrinsic subtyping algorithm.
- Clinical trials have validated the use of these assays in lymph node positive and negative disease to predict chemotherapy benefit and guide treatment decisions. Ongoing research aims to further refine risk assessment and subclassify breast cancer.
The document discusses several clinical uses of HPV DNA testing, including:
1) Triaging women with abnormal cervical cytology results to determine who needs colposcopy.
2) Follow up of women treated for CIN II/III to monitor for recurrence.
3) Potential use as an adjunct to cytology for primary cervical cancer screening in women over 30.
HPV testing was found to be an effective triage method in the ALTS study, detecting 96% of CIN 2/3 with 56% colposcopy referral compared to cytology methods.
1 prof james bently cervical cancer screening 2014Tariq Mohammed
This document discusses options for cervical cancer screening including visual inspection with acetic acid (VIA), cervical cytology, HPV testing, and combinations of tests. It reviews the strengths and limitations of different screening methods and highlights priorities for efficient, low-cost screening in low-resource settings. Optimal screening may involve initial HPV testing at age 35 with reflex cytology for positives and cytology follow-up of negatives before longer rescreening intervals.
1 prof james bently cervical cancer screening 2014Tariq Mohammed
This document discusses options for cervical cancer screening including visual inspection with acetic acid (VIA), cervical cytology, HPV testing, and combinations of tests. It reviews the strengths and limitations of different screening methods and highlights priorities for efficient, low-cost screening in low-resource settings. Optimal screening may involve initial HPV testing at age 35 with reflex cytology for positives and cytology follow-up of negatives before longer interval rescreening.
This document discusses breast premalignant lesions, their imaging appearance, and diagnosis. It notes that while imaging cannot definitively diagnose premalignant lesions, it can provide diagnostic hypotheses and guidance for biopsy. Premalignant lesions like DCIS, ADH, ALH and LCIS can appear as masses, masses with calcifications, microcalcifications, or non-mass lesions. Biopsy is needed for histological diagnosis but underestimation of premalignant lesions is possible, especially with core needle biopsy. Careful radiologic-pathologic correlation is important to determine if surgical excision is needed.
The document describes a proposed integrated screening program for breast, cervical, ovarian, and endometrial cancers. The program would be implemented through Well Woman Clinics that provide comprehensive screening and early detection using cost-effective methods. The goals are to downstage cancers, improve outcomes, and reduce mortality. Screening would include clinical breast exams, cervical screening tests, and transvaginal ultrasounds. Positive cases would be referred for diagnostic procedures. The proposal outlines strategies for clinic operations, training, research, and public outreach to promote screening.
The document describes a proposed Well Woman Clinic that aims to provide integrated screening and early detection of cancers affecting women, including breast, cervical, ovarian, and endometrial cancers. The clinic would use a holistic approach combining routine health checks with screening exams to improve cancer outcomes. Screening strategies include clinical breast exams, breast ultrasounds, Pap smears, HPV testing, and transvaginal ultrasounds. The goals are to downstage cancers and increase early detection rates to reduce cancer mortality. Key components discussed include clinical services, equipment, training programs, and establishing benchmarks for public screening compliance rates.
HUMAN PAPILLOMAVIRUS IS A NECESSARY CAUSE OF INVASIVE CERVICAL CANCER WORLD-WIDEAlberto Cuadrado
Infection with oncogenic human papillomavirus (HPV) is the major risk factor in the aetiology of cervical cancer. In a
previous study of invasive cervical cancers collected from 22 countries (the International Biological Study on Cervical
Cancer, IBSCC), however, the PCR assay used failed to detect HPV DNA in 7% of samples. The current study
re-examined these so-called HPV-negative samples, as well as a proportion of the originally positive samples, using a
more stringent procedure to ensure the presence of carcinoma cells within the material used for PCR. In addition,
three different PCR assays targeting different open reading frames were used, to avoid misclassifying as negative
samples in which integration of HPV DNA had led to disruption of the PCR primer sequences or loss of the HPV L1
open reading frame, the target of the PCR assay used in the original study. Furthermore, sera from the patients
originally classified as HPV-negative were assayed for antibodies against viral-like particles (VLPs) and E6 and E7
proteins of HPV 16, which accounts for about 50% of HPV-positive cervical cancers world-wide.
Of those serum samples tested, antibodies to at least one HPV 16 protein were detected in a similar proportion of
those originally classified as HPV-negative or -positive: 56% and 67%, respectively. There was no significant difference
between the two groups in the proportion of antibodies reactive to VLPs, E6 or E7. After excluding histologically
inadequate samples (87%), only 6% of those initially classified as HPV-negative remained negative to all the PCR
assays used for retesting. Thus the true incidence of HPV-positive samples in the IBSCC is 99.7%.
Most of the HPV-negative samples in the earlier study proved to have been misclassified since a more stringent
testing procedure revealed them to be HPV-positive. The similarity of the serum antibody profiles from patients with
cancers originally classified as HPV-positive and –negative indicates that a significant proportion of the latter were in
fact HPV 16- associated. The extreme rarity of HPV-negative cancers reinforces the rationale for HPV testing in
addition to, or even instead of, cervical cytology in routine cervical screening.
This document summarizes a study comparing manual liquid-based cytology (MLBC) to conventional pap smear (CPS) for cervical cancer screening. The study involved 97 women who underwent both MLBC and CPS screening. Histopathological analysis was done in 41 cases. Results found specimen adequacy was slightly higher for MLBC than CPS. MLBC provided a cleaner background with uniformly distributed cells, while CPS had cells not well spread. Both screening methods were found to be comparable, with MLBC having some advantages like preserving samples for additional testing.
The document summarizes a study on using an HPV mRNA test to detect high-risk HPV infections in 302 patients. The study found the mRNA test had a low invalid rate and provided useful results. In patients with abnormal cytology results of ASCUS or LSIL, 66% and 56% respectively tested negative for high-risk HPV using the mRNA test. The test also detected active HPV infections in 10 out of 48 patients with unclear cytology results. The mRNA test was found to be a fast and reliable method for HPV detection and typing.
International Proficiency Study of a Consensus L1 PCR Assay for the Detection...Alberto Cuadrado
The PGMY L1 consensus primer pair combined with the line blot assay allows the detection of 27 genital
human papillomavirus (HPV) genotypes. We conducted an intralaboratory and interlaboratory agreement
study to assess the accuracy and reproducibility of PCR for HPV DNA detection and typing using the PGMY
primers and typing amplicons with the line blot (PGMY-LB) assay. A test panel of 109 samples consisting of
29 HPV-negative (10 buffer controls and 19 genital samples) and 80 HPV-positive samples (60 genital samples
and 20 controls with small or large amounts of HPV DNA plasmids) were tested blindly in triplicate by three
laboratories. Intralaboratory agreement ranged from 86 to 98% for HPV DNA detection. PGMY-LB assay
results for samples with a low copy number of HPV DNA were less reproducible. The rate of intralaboratory
agreement excluding negative results for HPV typing ranged from 78 to 96%. Interlaboratory reliability for
HPV DNA positivity and HPV typing was very good, with levels of agreement of >95% and kappa values of
>0.87. Again, low-copy-number samples were more prone to generating discrepant results. The accuracy varied
from 91 to 100% for HPV DNA positivity and from 90 to 100% for HPV typing. HPV testing can thus be
accomplished reliably with PCR by using a standardized written protocol and quality-controlled reagents. The
use of validated HPV DNA detection and typing assays demonstrating excellent interlaboratory agreement will
allow investigators to better compare results between epidemiological studies.
Quantum Medical Update is a CME initiative produced by the in-house clinical team of Quantum Diagnostics. This monthly newsletter is in-line with our commitment to better service our doctors.
The document discusses various options for cervical cancer screening including conventional Pap smears, liquid based cytology, and several HPV testing assays. It emphasizes that HPV testing is more sensitive than cytology alone in detecting cervical lesions. HPV co-testing or HPV testing alone are recommended, with triage of positive HPV tests by genotyping. Liquid based cytology allows for both cytology and HPV testing from a single sample. Algorithms are provided for HPV testing in primary screening and for cytology with HPV co-testing. A table compares the available cervical cancer screening tests offered.
This document provides guidance on prenatal screening tests and what they can detect. It discusses the principles of screening and outlines various first and second trimester screening options for detecting chromosomal abnormalities, structural defects, and conditions like preeclampsia. Diagnostic tests mentioned include karyotyping, FISH, QF-PCR, microarrays, and their abilities to identify abnormalities like trisomies, deletions, and duplications. Low-dose aspirin is noted as an intervention for preeclampsia in high-risk patients.
Biopsy proven cancer of the neck, which even after a complete clinical & radiological workup (that includes physical examination, CT scan, esophgeoscopy, laryngoscopy, bronchoscopy & multiple survillence biopsies) reveals or yields no primary demonstrable lesion.
Similar to Nice saint paul. biopsies mammaires, L.Rotenberg 2015 (20)
LUC ROTENBERG, GREGORY LENCZNER, ULTRASOUND GUIDED VENOUS ACCESS CHEST PORT IMPLANTATION, SUBCLAVIAN ACCESS, NO TUNELISATION, DELTOPECTORAL GROOVE INCISION AND ACCESS , TIP POSITION XRAY CONTROL
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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5. Breast lesions imaging
• Screening, detec2on or diagnosis :
• Mammography
– Full Digital Mammography
– 3D Digital Breast Tomosynthesis
• Sonography
– High frequency probe
– Doppler
– elastography
• MRI
– 1,5 or 3T magnet
– Morphologic and dynamic study, perfusion
– Diffusion
– Spectroscopy-MRI
• Goal = evalua2on for a risk : BIRADS classifica2on
10. Frederick R. Margolin1 Jessica W. T. Leung1,2 Richard P. Jacobs1
Susan R. Denny1
Percutaneous Imaging-Guided Core Breast Biopsy: 5 Years’
Experience in a Community Hospital, AJR:177, September 2001
12. Birads 1 screening
Birads 2 screening
Birads 3 Follow up except high risk
Birads 4 a
Follow up except progressive or
high risk
Birads 4 b,c
LCB or VABB
diagnosis
Birads 5/6
LCB or VABB
diagnosis ou stategical
14. Wallis M et al. EJR 2007
American College of Radiology Reston 2003
Perry EJC 2001
According to the guidelines of
the European Society of Breast
Imaging (EUSOBI),
up to 90% of suspicious breast
lesions
(BI-RADS™ 4 and 5)
should undergo most effective
percutaneous biopsy before
further treatment is planned.
21. Interventional Methods
LCNB
Verkooijen HM, Peeters PH, Buskens E et al.
Br J Cancer 2000; 82: 1017-1021
Meta - analysis: 5 Studies ( n = 865 Cases)
„ The False Rate of 2.6 ( 8 / 307 maligne Diagnosis) –
LCNB with a high sensitivity (97%) and specificity (94%) is
an excellent alternative in contrast to the wire marking.“
25. Post contrast image of lesion Confirmation of obturator location near
lesion
Post biopsy image
Macrobiopsie sous IRM
26. auteur année type
Nbre lésions
(nbre paKents)
Temps
moyen
unique mulKple
%
complicaKon
%
succès
%
cancer
Liberman et
al.
2003 VA 27 (20) 49 35 69 1 (4) 26/27 (96) 8/27 (30)
Lehman et al 2005 VA 38 (28) 50 39 61 38/38 (100) 15/38 (40)
Orel et al 2005 VA 85 (75) 30-60 0 85/85 (100) 52/85 (61)
Fast MRI-Guided Vacuum-Assisted Breast Biopsy: Initial Experience
Laura Liberman & al
Department of Radiology, Breast Imaging Section, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.
AJR 2003; 181:1283-1293
Clinical Experience with MRI-Guided Vacuum-Assisted Breast Biopsy
Constance D. Lehman & al
Department of Radiology, University of Washington Medical Center, 1959 NE Pacific, Seattle, WA 98195. Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224.
AJR 2005; 184:1782-1787
MR Imaging–guided 9-gauge Vacuum-assisted Core-Needle Breast Biopsy: Initial Experience
Susan G. Orel & al
Departments of Radiology and Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104.
Radiology 2005, 10.1148
Macrobiopsie sous IRM
27. Indications for diagnostic representative or
ablative Vacuum - Biopsy (VABB) /US
1. Aier Large Core Needle Biopsy (LCNB) and suspicion of breast cancer (BI-
RADS® 4c / 5, missmatch / discordance of the results of diagnosKc imaging
and histology)
2. Suspicious lesions (BI-RADS® 4 / 5) diameter ~ 5 mm
3. ResecKon of definitely benign, but symptomaKc findings or High risk paKents
1. symptomaKc Fibroadenoma
2. recurrent symptomaKc cysts
4. Intraductal / intracysKcal proliferaKons : singulary Papilloma, complex cyst
5. Neoadjuvant Chemotherapy
6. Suspiscious of local recurrence
7. Hazardous or dangerous locaKon : deep, superficial, implants…
29. 03/01/16
S Vacuum assisted
devices
S Mammotome
S 1995, 11 et 8 g
S Vacora (Bard)
S 2003, 10 g
S 2007, 14 g
S Atec (Suros - Hologic)
S 2007, 12 g 9 g
S Seno RX (Bard)
• 2009, 10 g, 7 g
S Intact 2009
S Large core devices
S 16 g
S 14 g
S Single use devices +++
S Other biopsy devices
S Spirotome & Coramate
(Medinvents)
S 2007, 14 et 9 g
S Celero (Hologic)
S 2008 12 g
S Finesse (Bard)
S 2010 14 g
Choice of the Needle
35. ADH
Peter R. Eby, Jennifer E. Ochsner, Wendy B. DeMartini & al, Frequency
and Upgrade Rates of Atypical Ductal Hyperplasia Diagnosed at
Stereotactic Vacuum-Assisted Breast Biopsy: 9- Versus 11-Gauge.
AJR 2009; 192:229–234
36. ADH Prevalence
RJ Jackman, RL Birdwell, DM Ikeda, Atypical Ductal Hyperplasia: Can Some Lesions Be
Defined as Probably Benign after Stereotactic 11-gauge Vacuum- assisted Biopsy,
Eliminating the Recommendation for surgical exision ? Radiology 2002; 224:548–554
37. Radial Scars
R. James Brenner, Roger J. Jackman, Steve H. Parker & al, Percutaneous Core Needle Biopsy
of Radial Scars of the Breast: When Is Excision Necessary? AJR:179, November 2002
• Carcinoma was found at excision in
– 28% (8/29) of lesions with associated atypical hyperplasia
– 4% (5/128) of lesions without associated atypia
• In the la4er group, carcinoma was found at excision in
– 3% (2/60) of masse
– 8% (3/40) of architectural distorKons
– 0% (0/28) of microcalcificaKon lesions
• Malignancy was missed in
– 9% (5/58) of lesions biopsied with a spring-loaded device LCB
– 0% (0/70) of lesions biopsied with a direcKonal vacuum-assisted device VABB
– 8% (5/60) of lesions sampled with less than 12 specimens
– 0% (0/68) sampled with 12 or more specimens
• Lesion type, maximal lesion diameter, and type of imaging guidance (stereotac2c or sonographic) were not significant
factors in determining the presence of malignancy
• CONCLUSION: Diagnosis of radial scar based on core needle biopsy is likely to be reliable when
– no associated atypical hyperplasia
– biopsy includes at least 12 specimens (VABB)
– mammographic findings are reconciled with histologic findings.
– If miss a criteria, excisional biopsy is indicated
38. Projektpartner
1. Fraunhofer-Institut für Integrierte Schaltungen IIS, Erlangen,
Kohr et al. Radiology 255: 723 - 730 (2010)
N = 991; N = 147 cases of atypia
The upgrade rate is significantly higher when ADH involves at
least three foci.
Surgical excision is recommended even when ADH involves
fewer than three foci and all mammographic calcifications
have been removed, because the upgrade rate is 12%.
Minimal Invasive Interventions
Wagoner et al. Am J Clin Pathol 131: 112 - 121 (2009)
N = 123;
Patients with ADH restricted to fewer than 3 foci may not need
surgical excision, especially when the mammographic
abnormality is completely removed by VAB.
41. • Advance in Knowledge
– When careful radiologic-pathologic correlaKon is conducted in the seƒng of a
breast core biopsy with atypical lobular hyperplasia or lobular carcinoma in situ
some women can be safely triaged to observaKon
• of the 43 benign concordant cases, none were upgraded at surgery
or extended follow-up
• ImplicaKon for PaKent Care
– Focused and complete radiologic-pathologic correlaKon may obviate
excisional biopsy in paKents with benign concordant biopsy findings
– AddiKonal validaKon of this is required before this approach can be
universally applied
Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Core Breast
Biopsy: Use of Careful Radiologic-Pathologic CorrelaKon to Recommend
Excision or ObservaKon
Kristen A. Atkins, Michael A. Cohen, Brandi Nicholson, Sandra Rao.
Northwestern Memorial Hospital, PrenKce Women’s Hospital, Chicago.
Radiology, 2013, Vol.269: 340-347, 10.1148/radiol.13121730
47. • younger women are more adversely affected by the biopsy
experience.
• ImplicaKon for PaKent Care
• Tailored prebiopsy counseling may bever prepare women
for percutaneous breast biopsy and improve their overall
experience.
Percutaneous Breast Biopsy: Effect on Short-term Quality
of Life Kathryn L. Humphrey; Janie M. Lee; Karen Donelan; Chung Y. Kong; Olubunmi
Williams; Omosalewa Itauma; Elkan F. Halpern; Beverly J. Gerade; Elizabeth A.
Rafferty; J. Shannon Swan;
MIT MGH , Boston, Radiology 2013, 10.1148/radiol.13130865
48. 03/01/16
• Side
• Size
• h x L x l
• Location
• Quadrant
• Radius zone
• Distance to the
nipple
BalisKc target tracking
• US
• RX
• MRI
49. 03/01/16
• Side
• Size
• h x L x l
• LocaKon
• Quadrant
• Radius zone
• Distance to the nipple
• Deep / cutaneous plane
US balisKc target tracking
50. 03/01/16
Mme A. 40 ans. Atcd KS qsiD 1997.
Atcd familiaux. Surv /6 mois M+US/IRM nles en 2010
05/2011
SD
CNB 14g : CCI g2
58. • At the follow-up examina2on
• both the histologic and imaging findings should be revisited
• and the mass should be assessed at mammography or US to ensure that
it is stable
• If it has grown in size or its morphologic characteris2cs have
changed
• If calcifica2ons increase in number or extent or the mass
changes
• Increases in size or its features become more suspicious
• appropriate acKon should be taken
• Excision is typically recommended
• If the lesion is stable at follow-up examina2on
• the paKent may return to the general screening populaKon
InteracKve Case Review of Radiologic and Pathologic Findings from
Breast Biopsy: Are They Concordant? How Do I Manage the
Results?
Christopher P. Ho, MD, Jennifer E. Gillis, MD, Kristen A. Atkins, MD, Jennifer A. Harvey, MD, and , Brandi T.
Nicholson, MD
University of Virginia Heath System, Chalovesville, Va. Radiographics, Volume 33-4 , 2013