Eugênio Américo Bueno Ferreira

Sensitivity, specificity, and predictive value of laparoscopy for the staging of gastric cancer and for the detection of liver metastases

Three hundred and sixty patients with gastric carcinoma were evaluated by laparoscopy. The following tumor attributes were used in the staging workup: serosal infiltration, tumor fixation, metastasis to lymph nodes, peritoneal dissemination, and liver metastasis. For the detection of liver metastases, subgroups of these patients were also tested by liver scintigraphy, ultrasonography, and serum alkaline phosphatase determination. Use of diagnostic indexes with their confidence intervals provided an objective means of assessing performance for the various combinations of tests and attributes. The attributes which were most accurately detected by laparoscopy were peritoneal dissemination and liver metastases with 89.4% and 96.5% efficiency, respectively. Laparoscopy was a superior diagnostic method when compared to the other tests for detection of liver involvement. Scintigraphy and ultrasonography presented comparable sensitivities, 78.7% and 78.6%, respectively (as opposed to 87.2% of laparoscopy), but the former yielded a high rate of false‐positive results, 62.6%. Detection of liver metastases by assaying alkaline phosphatase levels was the least sensitive diagnostic alternative examined. Cancer 58:1–6, 1986.

End results of a prospective trial on elective lateral neck dissection vs type III modified radical neck dissection in the management of supraglottic and transglottic carcinomas

Either modified type III radical neck dissection (MRND) or lateral neck dissections (LNDs) are considered valid treatments for patients with laryngeal carcinoma with clinically negative neck findings (N0). The object of this prospective study was to compare complications, neck recurrences, and survival results of elective MRND and LND on the management of laryngeal cancer patients.

DNA image cytometric analysis of differentiated thyroid adenocarcinoma specimens

A total of 117 differentiated thyroid adenocarcinomas that had been removed by total thyroidectomy were studied. Seventy (60%) were papillary, 36 (30%) were follicular, and 11 (10%) were Hürthle cell adenocarcinomas. The mean length of follow-up was 57.7 months. Adverse prognostic factors according to multivariate analysis were adjacent tissue infiltration (p = 0.0004), histologic type (p = 0.0049), and patient age (p = 0.033). The nuclear DNA content of tumor cells and of morphologically normal adjacent tissue was assessed by image cytometry, and correlations between nuclear DNA content and prognostic factors were examined. Fifty-four (75%) adenocarcinomas were classified as aneuploid, 9 (13%) as diploid, and 9 (12%) as borderline. Thirty-four (60%) specimens of morphologically normal adjacent tissue were classified as aneuploid, 18 (32%) as diploid, and 5 (8%) as borderline. The correlation between tumor ploidy and selected prognostic factors was statistically significant for patient age (p = 0.004) and histologic type (p = 0.033). Despite the fact that ploidy could not be identified as a prognostic factor, we suggest that, because of its correlation with age and histologic type, it might prove prognostic if the number of patients were increased. We also emphasize the importance of evaluating morphologically normal adjacent tissue because of the high rates of aneuploidy in these areas.