The Application Value of ceMDCT in the Diagnosis of Gastric Cancer Extramural Vascular Invasion and Its Influencing Factors

Objective. To investigate the value of enhanced multislice spiral CT (ceMDCT) in the diagnosis of extramural vascular invasion of gastric cancer and the influencing factors of extramural vascular invasion. There are different methods used in this paper. Method. 131 patients with primary gastric cancer treated in our hospital from January 2017 to May 2019 were selected. All patients underwent surgical resection and ceMDCT examination before operation. Result. There were 40 cases with extramural vascular invasion of gastric cancer by surgical pathological diagnosis. The kappa value of ceMDCT in diagnosing extramural vascular invasion of gastric cancer was 0.947, and the consistency was excellent. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were 100.00%, 96.70%, 93.02%, and 100.00%, respectively. The proportions of T3-T4, tumour diameter ≥5.0 cm, and growth pattern of proximal nodular + diffuse type in patients with gastric cancer extramural vascular invasion were 92.50%, 85.00%, and 65.00%, respectively, which were significantly higher than those in patients without extramural vascular invasion ( P < 0.05 ). The logistic regression analysis results showed that T3-T4, tumour diameter ≥5.0 cm, proximal nodular + diffuse growth pattern were the risk factors for extrahepatic vascular invasion in gastric cancer (OR = 3.751, 2.901, and 3.367, P < 0.05 ). Conclusion. ceMDCT has good application value in diagnosing gastric cancer extramural vascular invasion. The occurrence of gastric cancer extramural vascular invasion is affected by T staging, tumour diameter, and tumour growth pattern.

Topography and clinical features of iris melanoma

Background To characterise the topographical and clinical features of primary iris melanoma and to visualise the patterns of tumour extent in the iris. Methods Clinical characteristics of iris melanomas were analysed, and data on their size, shape, and location were converted into a database of two-dimensional iris charts by means of computer-drawing software. The geometric centre of each tumour was entered into corresponding sectors of the chart. The extent of the melanomas was computationally visualised by merging the iris drawings and displaying the number of overlapping tumours on colour-coded iris maps. Results Twenty-nine patients (18 females and 11 males) with a mean age of 52 years met the inclusion criteria. The mean largest tumour diameter was 6.1 mm (range, 1.8–11.0 mm). Five tumours (17%) involved the pupillary margin, 10 (34%) involved the iris root, and 10 (34%) involved both sites. The hemispheric location of the tumour centroid was superior in 3 eyes (11%) and inferior in 25 (89%) (p < 0.0001), and the distribution between the temporal and nasal hemispheres was 17 (61%) and 11 (39%), respectively (p = 0.26). In females, the iris melanomas were located more temporally (p = 0.02) and had more often originated from a pre-existing naevus (p = 0.03), than in males. There was also shift towards more temporally located melanomas in younger patients. Conclusions The lower temporal iris quadrant is the preferential area of melanoma occurrence and growth. Iris melanoma tends to be more temporally located in females, who compared with males also have a higher proportion of melanomas arising from a pre-existing naevus.

Age-related Differences in Tumour Characteristics and Prognostic Factors for Disease Progression in Cutaneous Squamous Cell Carcinoma of the Head and Neck

Guidelines for cutaneous squamous cell carcinoma of the head and neck do not take the age of the patient into account, but instead assume equal tumour characteristics and prognostic factors for poor outcome in younger and elderly patients. The aim of this study was to compare tumour characteristics of younger (< 75 years) and elderly (≥ 75 years) patients and identify age-specific risk factors for progression of disease, comprising local recurrence, nodal metastasis and distant metastasis. Patient and tumour characteristics were compared using χ2 or Fisher’s exact tests. Multivariable competing risk analyses were performed to compare risk factors for progression of disease, incorporating the risk of dying before developing progression of disease. A total of 672 patients with primary cutaneous squamous cell carcinoma of the head and neck were retrospectively included. Larger tumour diameter, worse differentiation grade and deeper invasion were observed in older patients. In elderly patients, but not in younger patients, tumour diameter ≥ 40 mm, moderate differentiation grade and an invasion depth ≥ 2 mm were independent risk factors for progression of disease.

Predictors of Tumour Growth and Autonomous Cortisol Secretion Development during Follow-Up in Non-Functioning Adrenal Incidentalomas

Purpose: To assess the risk of developing autonomous cortisol secretion (ACS) and tumour growth in non-functioning adrenal incidentalomas (NFAIs). Methods: Multicentre retrospective observational study of patients with NFAIs. ACS was defined as serum cortisol >1.8 µg/dL after 1 mg-dexamethasone suppression test (DST) without specific data on Cushing’s syndrome. Tumour growth was defined as an increase in maximum tumour diameter >20% from baseline; and of at least 5 mm. Results: Of 654 subjects with NFAIs included in the study, both tumour diameter and DST were re-evaluated during a follow-up longer than 12 months in 305 patients. After a median follow-up of 41.3 (IQR 24.7–63.1) months, 10.5% of NFAIs developed ACS. The risk for developing ACS was higher in patients with higher serum cortisol post-DST levels (HR 6.45 for each µg/dL, p = 0.001) at diagnosis. Significant tumour growth was observed in 5.2% of cases. The risk of tumour growth was higher in females (HR 10.7, p = 0.004). Conclusions: The frequency of re-evaluation with DST in NFAIs during the initial 5 years from diagnosis can probably be tailored to the serum cortisol post-DST level at presentation. Re-evaluation of NFAIs with imaging studies, on the other hand, seems unnecessary in most cases, particularly if the initial imaging demonstrates features specific to typical adenoma, given the low rate of significant tumour growth.

Assessment of cervical vascularization density in patients with locally advanced squamous cell cervical carcinoma evaluated in colour Doppler and power Doppler functions

Purpose The aim of the prospective study was to assess changes during treatment and prognostic significance of cervical vascularization density in patients with cervical squamous cell carcinoma (SCC) staged II B and III B and to find relationship of cervical vascularization density with tumour diameter, grading, staging and age of patients. Methods The study group included 50 patients who underwent transvaginal Doppler ultrasonography prior to chemoradiotherapy, after external beam radiation therapy (EBRT) and 6 weeks after HDR brachytherapy. The colour Doppler (CD) vascularity index (CDVI) and the power Doppler (PD) vascularity index (PDVI) in cervical tumour were examined. Results CDVI and PDVI values decreased significantly during radiotherapy (0.13 (95% CI 0.09–0.16); 0.09 (95% CI 0.07–0.11) and 0.05 (95% CI 0.03–0.06) for CDVI (p < 0.001) and 0.26 (95% CI 0.22–0.31); 0.18 (95% CI 0.14–0.22) and 0.08 (95% CI 0.06–0.11) for PDVI (p < 0.001)). No statistically significant associations of CDVI and PDVI with tumour diameter, grading, staging and age of patients were found. The higher (above median) CDVI values before EBRT were associated with better OS (p = 0.041). The higher (above median) PDVI values before EBRT were associated with superior DFS (p = 0.011) and OS (p < 0.001). DFS and OS did not differ significantly regarding CDVI and PDVI values after EBRT and after the treatment. Conclusions In the study group, cervical vascularization density evaluated in CD and PD functions did not depend on tumour diameter, grading, staging and age of patients and decreased during radiotherapy. The prognosis for our patients with CDVI and PDVI before the treatment above the median value was better than compared to patients with these parameters below the median value.

Serial changes in tumour measurements and apparent diffusion coefficients in prostate cancer patients on active surveillance with and without histopathological progression

Objective: To analyse serial changes in MRI-derived tumour measurements and apparent diffusion coefficient (ADC) values in prostate cancer (PCa) patients on active surveillance (AS) with and without histopathological disease progression. Methods: This study included AS patients with biopsy-proven PCa with a minimum of two consecutive MR examinations and at least one repeat targeted biopsy. Tumour volumes, largest axial two-dimensional (2D) surface areas, and maximum diameters were measured on T2 weighted images (T2WI). ADC values were derived from the whole lesions, 2D areas, and small-volume regions of interest (ROIs) where tumours were most conspicuous. Areas under the ROC curve (AUCs) were calculated for combinations of T2WI and ADC parameters with optimal specificity and sensitivity. Results: 60 patients (30 progressors and 30 non-progressors) were included. In progressors, T2WI-derived tumour volume, 2D surface area, and maximum tumour diameter had a median increase of +99.5%,+55.3%, and +21.7% compared to +29.2%,+8.1%, and +6.9% in non-progressors (p < 0.005 for all). Follow-up whole-volume and small-volume ROIs ADC values were significantly reduced in progressors (−11.7% and −9.5%) compared to non-progressors (−6.1% and −1.6%) (p < 0.05 for both). The combined AUC of a relative increase in maximum tumour diameter by 20% and reduction in small-volume ADC by 10% was 0.67. Conclusion: AS patients show significant differences in tumour measurements and ADC values between those with and without histopathological disease progression. Advances in knowledge: This paper proposes specific clinical cut-offs for T2WI-derived maximum tumour diameter (+20%) and small-volume ADC (−10%) to predict histopathological PCa progression on AS and supplement subjective serial MRI assessment.

Vitreoretinal Surgery in the Prevention and Treatment of Toxic Tumour Syndrome in Uveal Melanoma: A Systematic Review

Toxic tumour syndrome (TTS) is a particularly aggressive form of secondary vasculopathy occurring after radiation therapy of uveal melanoma due to the persistence of the necrotic tumour mass inside the eye. The development of TTS confers a particularly unfavourable functional and anatomical ocular prognosis, ultimately requiring enucleation in most cases if untreated. Vitreoretinal (VR) surgery has been successfully applied for treatment and prevention of TTS using both resecting and non-resecting techniques. In this systematic review, we aim to define characteristics of uveal melanomas benefiting the most from secondary VR surgery and to outline the optimal type and timing of VR intervention in such cases. Analysis of the literature reveals that endoresection should be performed within 3 months after radiotherapy to tumours thicker than 7 mm and with a largest basal diameter between 8 mm and 15 mm with post-equatorial location, especially after proton beam treatment. Alternatively, endodrainage remains a valid therapeutic option in eyes with macula-off retinal detachment, tumour diameter larger than 15 mm or ciliary body involvement. VR surgery can be successful in the management of TTS following radiotherapy for uveal melanoma when timing and indication are appropriately evaluated.

Risk Factors for Large-Volume Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Meta-Analysis

Background We defined large-volume lymph node metastasis (L-VLNM) as more than five lymph node metastases (LNMs) or any lymph node with a diameter of 2 mm or greater in any case of papillary thyroid cancer (PTC). This study investigated risk factors for the development of L-VLNM in PTC with meta-analysis.Methods Articles published until July 2021 on clinicopathological factors of L-VLNM in PTC were searched in electronic databases (PubMed, Web of Science (WOS), Embase, Cochrane, Wanfang Data and Chinese National Knowledge Infrastructure (CNKI)) to identify studies based on predefined criteria. Statistical analysis was performed using STATA 14.0. The outcomes were clinical and pathologic factors for L-VLNM, and the individual and pooled odds ratios (ORs) with 95% confidence intervals (CIs) of each outcome were analysed by fixed-/random-effects models. Egger’s test was used to assess publication bias in the publications. This study is registered with PROSPERO (CRD 42020213831).Results Twelve studies included 10806 patients in total. Meta-analysis revealed that an increased risk of L-VLNM was associated with male sex (OR=2.20, 95% CI=1.63–2.97, P<0.001), age<45 years (OR=2.34, 95% CI=1.36–4.02, P<0.001), tumour diameter>1 cm (OR=3.99, 95% CI=3.45–4.62, P<0.001), extrathyroidal extension (OR=2.42, 95% CI=1.90–2.82, P<0.001), capsule invasion (OR=3.62, 95% CI=1.44–9.06, P<0.001) and multifocality (OR=2.02, 95% CI=1.47–2.77, P<0.001). Hashimoto’s thyroiditis (HT; OR=0.82, 95% CI=0.60–1.11, P=0.03) was not associated with L-VLNM.Conclusions Male sex, age <45 years, tumour diameter >1 cm, extrathyroidal extension, capsule invasion and multifocality were risk factors for L-VLNM, HT was not a risk factor.

874 Solitary Fibrous Tumours of the Pleura: Immunohistochemistry

Aim To evaluate immunohistopathology markers of solitary fibrous tumours of the pleura (SFTP), including markers of benign and malignant variants. Method Retrospective review of immunohistopathology reports on 4 patients diagnosed with SFTP between January-October 2020 at the Golden Jubilee National Hospital. Data was collated on markers tested or detected. Benign and malignant cases were compared. A literature review was conducted to summarise the current evidence. Results Ki-67, Anti-bcl-2, CD99, STAT6, Desmin, AE1/3, Calretinin and S100 were tested in 100% (4/4) cases. CD34, EMA and CD117 were tested in 75% (3/4). Betacatenin and Vimentin were tested in 25% (1/4). Of those tested, Ki-67 was present in 100% (4/4), Anti-bcl-2 and CD99 in 75% (3/4), STAT6 in 50% (2/4), Desmin in 25% (1/4), AE1/3 in 25% (1/4), Calretinin in 25% (1/4), S100 in 0% (0/4), CD34 in 67% (2/3), EMA in 0% (0/3), CD117 in 0% (0/3), Betacatenin in 100% (1/1) and Vimentin in 100% (1/1). One out of 4 cases were malignant based on clinical presentation. Of the markers tested in all cases, Desmin was only detected in the malignant case, AE1/3 and Calretinin only in the benign cases, and the other markers in both benign and malignant cases. Anti-bcl-2 and Ki-67 intensity did not correlate with tumour diameter or malignant potential. Immunohistopathology could not confirm SFTP diagnosis in 50% (2/4) cases; it could not determine malignant potential or SFTP-subtype in 100% (4/4) cases. Conclusions A better understanding of SFTP immunohistopathology is needed for investigating SFTP, including benign and malignant tumour variants.

1543 Response to Neoadjuvant Chemotherapy as An Indication for Breast-Conserving Surgery

Aim Pathological response to neoadjuvant chemotherapy (NAC) seeks to induce tumour regression pre-operatively. The present study aimed to assess tumour response to NAC and to evaluate the appropriateness of subsequent breast-conserving surgery (BCS) to avoid disfiguration of healthy breast tissue. Method Analysis of all patients undergoing NAC and wide local excision (WLE) surgery for primary breast cancer between April 2012 and December 2020 at a tertiary breast unit was conducted. Statistical analysis was performed using IBM® SPSS Statistics Software v27.0. Results A database of 1490 female patients undergoing WLE was retrieved, of whom 88 received NAC. Average patient age was 56 (SD = 11). Tumours were either invasive ductal (n = 86, 97.7%) or lobular (n = 2, 2.27%) carcinomas and grade 2 (n = 31, 35.2%) or grade 3 (n = 57, 64.8%). Chemotherapy regimens included: 30 FEC-T (34.1%), 22 FEC (25%), 19 TC (21.6%) and 17 other (19.3%). On average, tumour diameter (mm) decreased by 45.9%(34.5) with NAC and a further 2.29%(57.7) from NAC cessation to excision. Tumour diameter varied significantly across time points χ2 (3) = 29.057, p &lt; 0.001. Post-hoc tests revealed a significant reduction in tumour diameter from pre- to post-NAC [Mean(SD): 29.6(10.9) vs 16.1(11.3), p &lt; 0.001] and from pre-NAC to excision [14.1(12.0), p &lt; 0.001] but not from post-NAC to excision (p = 1.000). Conclusions Tumour diameter significantly reduced with the addition of NAC. There was no statistical difference between post-NAC and post-operative diameter, suggesting no growth between NAC cessation and surgery. Our findings support the use of NAC, where possible, to avoid the need for large resection margins.