Quantitative assessment of microcirculation perfusion state of rectal cancer patients after neoadjuvant treatment by contrast-enhanced ultrasound

AbstractAccurate preoperative staging of colorectal cancers is critical in selecting patients for neoadjuvant therapy prior to resection. Inaccurate staging, particularly understaging, may lead to involved resection margins and poor oncological outcomes. Our aim is to determine preoperative imaging accuracy of colorectal cancers compared to histopathology and define the effect of inaccurate staging on patient selection for neoadjuvant treatment(NT). Staging and treatment were determined for patients undergoing colorectal resections for adenocarcinomas in a single tertiary centre(2016–2020). Data were obtained for 948 patients. The staging was correct for both T and N stage in 19.68% of colon cancer patients. T stage was under-staged in 18.58%. At resection, 23 patients (3.36%) had involved pathological margins; only 7 of which had been predicted by pre-operative staging. However, the staging was correct for both T and N stage in 53.85% of rectal cancer patients. T stage was understaged in 26.89%. Thirteen patients had involved(R1)margins; T4 had been accurately predicted in all of these cases. There was a general trend in understaging both the tumor and lymphonodal involvement (T p < 0.00001 N p < 0.00001) causing a failure in administrating NT in 0.1% of patients with colon tumor, but not with rectal cancer. Preoperative radiological staging tended to understage both colonic and rectal cancers. In colonic tumours this may lead to a misled opportunity to treat with neoadjuvant therapy, resulting in involved margins at resection.

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Response to neoadjuvant treatment among rectal cancer patients in a population-based cohort

International Journal of Colorectal Disease ◽

10.1007/s00384-020-03744-2 ◽

2020 ◽

Vol 36 (1) ◽

pp. 177-185

Author(s):

Elizabeth Alwers ◽

Lina Jansen ◽

Jakob Kather ◽

Efrat Amitay ◽

Hendrik Bläker ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Tumor Response ◽

Patient Survival ◽

Neoadjuvant Treatment ◽

Population Based ◽

Pathological Examination ◽

Study Patient ◽

Molecular Characteristics ◽

Tumor Characteristics

Abstract Background In rectal cancer, prediction of tumor response and pathological complete response (pCR) to neoadjuvant treatment could contribute to refine selection of patients who might benefit from a delayed- or no-surgery approach. The aim of this study was to explore the association of clinical and molecular characteristics of rectal cancer with response to neoadjuvant treatment and to compare patient survival according to level of response. Methods Resected rectal cancer patients were selected from a population-based cohort study. Molecular tumor markers were determined from the surgical specimen. Tumor response and pCR were defined as downstaging in T or N stage and absence of tumor cells upon pathological examination, respectively. The associations of patient and tumor characteristics with tumor response and pCR were explored, and patient survival was determined by degree of response to neoadjuvant treatment. Results Among 1536 patients with rectal cancer, 602 (39%) received neoadjuvant treatment. Fifty-five (9%) patients presented pCR, and 239 (49%) and 250 (53%) patients showed downstaging of the T and N stages, respectively. No statistically significant associations were observed between patient or tumor characteristics and tumor response or pCR. Patients who presented any type of response to neoadjuvant treatment had significantly better cancer-specific and overall survival compared with non-responders. Conclusion In this study, patient characteristics were not associated with response to neoadjuvant treatment, and molecular characteristics determined after surgical resection of the tumor were not predictive of pCR or tumor downstaging. Future studies should include molecular biomarkers from biopsy samples before neoadjuvant treatment.

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CEA, EpCAM, αvβ6 and uPAR Expression in Rectal Cancer Patients with a Pathological Complete Response after Neoadjuvant Therapy

Diagnostics ◽

10.3390/diagnostics11030516 ◽

2021 ◽

Vol 11 (3) ◽

pp. 516

Author(s):

Daan Linders ◽

Marion Deken ◽

Maxime van der Valk ◽

Willemieke Tummers ◽

Shadhvi Bhairosingh ◽

...

Keyword(s):

Rectal Cancer ◽

Neoadjuvant Therapy ◽

Cancer Patients ◽

Pathological Complete Response ◽

Neoadjuvant Treatment ◽

Complete Response ◽

Response Evaluation ◽

Tumor Bed ◽

Upar Expression ◽

Diagnostic Biopsy

Rectal cancer patients with a complete response after neoadjuvant therapy can be monitored with a watch-and-wait strategy. However, regrowth rates indicate that identification of patients with a pathological complete response (pCR) remains challenging. Targeted near-infrared fluorescence endoscopy is a potential tool to improve response evaluation. Promising tumor targets include carcinoembryonic antigen (CEA), epithelial cell adhesion molecule (EpCAM), integrin αvβ6, and urokinase-type plasminogen activator receptor (uPAR). To investigate the applicability of these targets, we analyzed protein expression by immunohistochemistry and quantified these by a total immunostaining score (TIS) in tissue of rectal cancer patients with a pCR. CEA, EpCAM, αvβ6, and uPAR expression in the diagnostic biopsy was high (TIS > 6) in, respectively, 100%, 100%, 33%, and 46% of cases. CEA and EpCAM expressions were significantly higher in the diagnostic biopsy compared with the corresponding tumor bed (p < 0.01). CEA, EpCAM, αvβ6, and uPAR expressions were low (TIS < 6) in the tumor bed in, respectively, 93%, 95%, 85%, and 62.5% of cases. Immunohistochemical evaluation shows that CEA and EpCAM could be suitable targets for response evaluation after neoadjuvant treatment, since expression of these targets in the primary tumor bed is low compared with the diagnostic biopsy and adjacent pre-existent rectal mucosa in more than 90% of patients with a pCR.

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An Original Methodology for Quantitative Assessment of Perfusion in Small Animal Studies Using Contrast-Enhanced Ultrasound

2007 29th Annual International Conference of the IEEE Engineering in Medicine and Biology Society ◽

10.1109/iembs.2007.4352295 ◽

2007 ◽

Author(s):

Sebastien Mule ◽

Alain De Cesare ◽

Frederique Frouin ◽

Olivier Lucidarme ◽

Alain Herment

Keyword(s):

Animal Studies ◽

Quantitative Assessment ◽

Small Animal ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced

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The value of contrast-enhanced ultrasound for sentinel lymph node identification and characterisation in pre-operative breast cancer patients: A prospective study

European Radiology ◽

10.1007/s00330-017-5089-0 ◽

2017 ◽

Vol 28 (4) ◽

pp. 1654-1661 ◽

Cited By ~ 14

Author(s):

Jing Zhao ◽

Jing Zhang ◽

Qing-Li Zhu ◽

Yu-Xin Jiang ◽

Qiang Sun ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Prospective Study ◽

Cancer Patients ◽

Contrast Enhanced Ultrasound ◽

Breast Cancer Patients ◽

Sentinel Lymph Node Identification ◽

Contrast Enhanced ◽

A Prospective Study

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Combining contrast-enhanced ultrasound and blood cell analysis to improve diagnostic accuracy of plasma cell mastitis

Experimental Biology and Medicine ◽

10.1177/15353702211049361 ◽

2021 ◽

pp. 153537022110493

Author(s):

Yan Zheng ◽

Lin Wang ◽

Xiu Han ◽

Lin Shen ◽

Chen Ling ◽

...

Keyword(s):

Breast Cancer ◽

Blood Cell ◽

Diagnostic Accuracy ◽

Cancer Patients ◽

Plasma Cell ◽

Perfusion Defect ◽

Cell Analysis ◽

Contrast Enhanced Ultrasound ◽

Breast Cancer Patients ◽

Contrast Enhanced

Plasma cell mastitis is a benign suppurative disease of the breast, lack of specific clinical manifestations, which is easy to be misdiagnosed and mistreated, often confused with mastitis, breast cancer (BC), and other diseases. Thus, we aimed to establish a combined model of promoting diagnostic accuracy of plasma cell mastitis by contrast-enhanced ultrasound (CEUS) patterns and routine blood cell analysis. Eighty-eight plasma cell mastitis, 91 breast cancer, and 152 other benign breast diseases’ patients grouped according to pathological diagnosis underwent CEUS and blood cell analysis examination; 100 healthy female donors were involved. All the plasma cell mastitis and breast cancer patients presented hyperenhancement of CEUS breast lesions compared with others. The majority of plasma cell mastitis (65/88) showed perfusion defect of CEUS patterns with smooth edge (56/65) and multiple lesions (49/65); in contrast, fewer breast cancer patients (30/91) displayed perfusion defect. White blood cell count (WBC), neutrophils, and neutrophils/lymphocytes ratio of blood cell analysis in plasma cell mastitis patients increased significantly compared with other patients ( P < 0.0001). Combining perfusion defect of CEUS patterns and WBC yielded an area under the receiver operating characteristic curve of 0.831, higher than single 0.720 and 0.774, respectively. The cut-off value of WBC (7.28 × 109/L) helped remaining 65.2% (15/23) atypical cases to be correctly diagnosed as plasma cell mastitis, not misdiagnosed as breast cancer. In conclusion, CEUS presented a clear perfusion defect pattern of plasma cell mastitis lesion for the first time. A precise WBC by routine blood cell analysis test can assist CEUS examination in the differential diagnosis of plasma cell mastitis and breast cancer. It is a promised combination for laboratory diagnostic of PCM.

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