Reply to: Triple-phase CT scan for disease progression prediction in cirrhosis: A valid repurpose?

2021 ◽  
pp. 110076
Author(s):  
Elton Dajti ◽  
Antonio Colecchia ◽  
Nicolò Brandi ◽  
Rita Golfieri ◽  
Matteo Renzulli
Keyword(s):  
Ct Scan ◽  
Disease Progression ◽  
Progression Prediction

Prevalence of radiologic evidence of metastatic pancreatic ductal adenocarcinoma (PDAC) at first post-operative restaging studies in patients (pts) undergoing pancreatic cancer surgery with curative intent.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 225-225
Author(s):  
Sofia Palacio ◽  
Peter Joel Hosein ◽  
Joe U Levi ◽  
Jaime R. Merchan ◽  
Jorge Monge ◽  
...  
Keyword(s):  
Ct Scan ◽  
Disease Progression ◽  
Surgical Resection ◽  
Metastatic Disease ◽  
Disease Recurrence ◽  
Early Recurrence ◽  
Ductal Adenocarcinoma ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Curative Intent

225 Background: Surgical resection is the only potentially curative modality for PDAC. However, even after a successful surgical resection outcomes are poor due to both local and distant disease recurrence. Patients with early recurrence likely derive no benefit from surgery and could be considered for a non-surgical approach as initial therapy. Since the incidence of recurrent/metastatic disease at first post-operative staging scan is not well documented, our aim was to determine this incidence. Methods: This IRB-approved analysis identified all pts diagnosed with resectable PDAC that underwent surgery with intent to cure at the University of Miami/Sylvester Comprehensive Cancer Center between 2010 and 2012. Patients with imaging before and within 6 months after surgery were included. All post-operative CT scans performed within 3 months after surgery were reviewed for the presence of recurrent and/or metastatic disease. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Results: Data from105 pts were analyzed. Mean age was 61, 63% were male, 91% had adenocarcinoma, 84% had disease in the head of the pancreas. 11 out of 85 (13%) pts had recurrent/metastatic disease detected on first post-operative CT scan; 64% stage IIB and 73% had positive lymph nodes. 54 out of 105 (51%) had disease progression. 60% had local recurrence, 40% had distant metastasis. The mean time from preoperative CT scan to surgery was 35 days. Patients with early and late recurrence had similar OS from diagnosis (median 27.7 and 27.1 months, respectively) but worse than those with no disease recurrence (median not reached, OS rate 78% at 36 months). Conclusions: The relatively high incidence (13%) of early recurrence in this retrospective cohort suggests that further studies aimed at improving patient selection for surgery are warranted and provides a strong rationale for the use of neoadjuvant therapy to select patients with early disease progression who would not have benefitted from surgery.

scholarly journals Mediastinal lymph node enlargement in idiopathic pulmonary fibrosis: relationships with disease progression and pulmonary function trends

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Giacomo Sgalla ◽  
Anna Rita Larici ◽  
Nicoletta Golfi ◽  
Mariarosaria Calvello ◽  
Alessandra Farchione ◽  
...  
Keyword(s):  
Lymph Node ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Lymph Nodes ◽  
Ct Scan ◽  
Disease Progression ◽  
Mediastinal Lymph Node ◽  
Mediastinal Lymph Nodes ◽  
Lymph Node Enlargement

Abstract Background and objectives Evidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients. Methods This retrospective study included IPF patients referred to a single ILD centre in Italy. A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). The annualized rates of change in functional parameters for each patient were calculated using mixed linear models. Results The study population consisted of 152 IPF patients, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86–13.62, p ≤ 0.001) and significant disease progression (HR 2.99, 95% CI 1.22–7.33, p = 0.17) as compared to patients without LNE, after adjusting for GAP stage. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time. Conclusions Diffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF.

Early detection of disease progression after palliative chemotherapy in NSCLC patients by 18F-FDG-PET

2014 ◽  
Vol 53 (05) ◽  
pp. 197-204 ◽  
Author(s):  
E. Tauhardt ◽  
A. Reissig ◽  
T. Winkens ◽  
M. Freesmeyer
Keyword(s):  
Ct Scan ◽  
Disease Progression ◽  
Fdg Pet ◽  
Palliative Chemotherapy ◽  
Treatment Plan ◽  
Early Detection Of Disease ◽  
Free Interval ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

SummaryAim: We investigated whether 18F-fluorodeo- xyglucose positron emission tomography (FDG-PET) is capable of detecting renewed disease progression earlier than computed tomography (CT) in patients with inoperable non-small cell lung cancer (NSCLC) who have undergone chemotherapy as part of a palliative treatment plan. Patients, methods: 18 patients were studied retrospectively. Three FDG-PET/CT scans for initial and follow-up diagnostic purposes were evaluated. Palliative chemotherapy was administered between the first FDG-PET/CT scan (t0) and the second (t1), followed by a treatment-free interval between the second FDG-PET/CT scan (t1) and the third (t2). Maximum standardized uptake values (SUVmax) and largest diameters of lesions were determined for PET scans and the corresponding CTs. Lesion-based and patient-based assessments were performed, as were assessments according to RECIST/PER- CIST. Results: 82 lesions were identified in 18 patients. In interval t1-t2, the increase in diameter in the lesion-based evaluation was 5.0% (non-significant), while the patient based evaluation showed a non-significant reduction of 2.8%. Considering PET, both the lesion-based and patient-based evaluations found a significant increase in SUVmax by a median of 30.4 % and 45.8 %, respectively. PERCIST criteria at time point t2 identified ten more patients with progression than did REC- IST. Conclusion: In patients with NSCLC, renewed progression during the treatment-free interval after palliative chemotherapy can be detected earlier with PET than with CT. Thus, FDG-PET appears to be a useful diagnostic imaging procedure regarding this aspect. Its clinical relevance should be investigated in further studies.

scholarly journals Sister Mary Joseph Nodules: A Case Report about a Rare Location of Skin Metastasis

2021 ◽  
pp. 664-670
Author(s):  
Brice Leyrat ◽  
Maureen Bernadach ◽  
Angeline Ginzac ◽  
Sejdi Lusho ◽  
Xavier Durando
Keyword(s):  
Abdominal Pain ◽  
Ct Scan ◽  
Disease Progression ◽  
Poor Prognosis ◽  
Line Treatment ◽  
First Line ◽  
Peritoneal Disease ◽  
Skin Metastases ◽  
Patient Reported ◽  
Sister Mary Joseph

Umbilical skin metastases (or Sister Mary Joseph nodules) are rare. Their presence typically indicates the late manifestation of deep-seated abdominopelvic malignancy. They occur mainly in gynecological cancers, and gastrointestinal cancers in men. The most common histology is adenocarcinoma (∼75% of cases), but it can also rarely be squamous cell or undifferentiated carcinoma. These metastases can be present at diagnosis or appear at disease recurrence, and are associated with a very poor prognosis with an average survival of 11 months. We report the clinical case of a 58-year-old man with metastatic pancreatic adenocarcinoma and umbilical cutaneous metastasis after receiving first-line chemotherapy. The diagnosis was established upon liver biopsy in July 2019, after the patient presented with a complaint of transfixing abdominal pain. The first-line treatment consisted of six cycles of modified FOLFIRINOX chemotherapy. However, in November 2019, computed tomography (CT) scan showed disease progression. Second-line treatment with gemcitabine (Gemzar®) led to a 16% decrease in target lesions. During the fourth cycle, three periumbilical indurated nodules appeared. After six cycles, skin infiltration had increased, and the patient reported his abdominal pain had intensified. Reassessment by CT scan showed an increase in both hepatic and peritoneal disease progression. Third-line treatment with FOLFIRI, started on April 15, 2020, could not control the disease, leading to greater induration and subcutaneous infiltration, which were responsible for the increased pain and ultimate death. Umbilical skin metastases are rare, and they are associated with advanced metastatic disease and a very poor prognosis. Cases reporting Sister Mary Joseph nodules are needed to better understand the conditions and mechanisms of their appearance and dissemination.

scholarly journals Mediastinal lymph node enlargement in idiopathic pulmonary fibrosis: relationships with disease progression and pulmonary function trends.

2020 ◽  
Author(s):  
Giacomo Sgalla ◽  
Anna Rita Larici ◽  
Nicoletta Golfi ◽  
Mariarosaria Calvello ◽  
Alessandra Farchione ◽  
...  
Keyword(s):  
Lymph Node ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Lymph Nodes ◽  
Ct Scan ◽  
Disease Progression ◽  
Mediastinal Lymph Node ◽  
Mediastinal Lymph Nodes ◽  
Lymph Node Enlargement

Abstract Background and objectivesEvidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients.MethodsThis retrospective study included IPF patients referred to a single ILD centre in Italy. A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). The annualized rates of change in functional parameters for each patient were calculated using mixed linear models.Results152 IPF patients were included in the analysis, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86-13.62, p≤0.001) and significant disease progression (HR 2.99, 95% CI 1.22-7.33, p=0.17) as compared to patients without LNE, after adjusting for GAP stage. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time.ConclusionsDiffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF.

scholarly journals A Novel Bayesian Framework For Multi-State Disease Progression Of Lung Cancer

2021 ◽  
Vol 12 (10) ◽  
pp. 3675-3680
Author(s):  
K. Karthikayani, Et. al.
Keyword(s):  
Lung Cancer ◽  
Disease Progression ◽  
Lung Cancer Mortality ◽  
Learning System ◽  
Chain Code ◽  
Ct Screening ◽  
Lung Cancer Diagnosis ◽  
System A ◽  
Segmentation Approach ◽  
Progression Prediction

CT screening has been commonly used to identify and diagnose lung cancer in its early stages. CT has been shown in clinical studies to reduce lung cancer mortality by 20% as compared to plain chest radiography; however, existing CT screening services face obstacles such as high over diagnosis rates, high costs, and elevated radiation exposure.The study develops computer and deep learning models for predictive lung cancer diagnosis and disease progression prediction in an effort to solve these difficulties. Using a symmetric chain code method and a machine learning system, a novel lung segmentation approach was first developed. The lung nodules connected to the lung wall are included in this process, which minimises over-segmentation error. Finally, to predict the inter disease progression of lung cancer, a Bayesian method was coupled with a prolonged Markov model.The resultant model calculates specific lung cancer state transition data, which can be used to make customised screening recommendations. Extensive trials and results have shown the efficacy of these approaches, paving the way for current CT screening systems to be optimised and improved.

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