Mohammed Nawaf Kanaan

Aberrant drainage of sentinel lymph nodes in colon cancer and its impact on staging and extent of operation

BACKGROUND The role of aberrant lymphatic drainage in changing operations for patients undergoing sentinel lymph node mapping in colon cancer has not been described on a large scale. METHODS Patients with colon cancer underwent sentinel lymph node mapping and standard oncologic resection. Aberrant lymphatic drainage was identified outside the standard resection margin, requiring change of the extent of operation. Objectives were to identify the frequency of aberrant lymphatic drainage leading to changes of operation and staging. RESULTS Among 192 patients undergoing standard oncologic resection, 42 (22%) had extended surgery because of aberrant lymphatic drainage. Nodal positivity was higher in patients undergoing change of operation, at 62% compared with 43% of those undergoing only standard oncologic resection. In 19 of 192 patients (10%), positive sentinel nodes were found in aberrant locations. CONCLUSIONS Sentinel node mapping in patients with colon cancer detects aberrant drainage in 22% of patients, changing the extent of operation.

Impact of region of diagnosis, ethnicity, age, and gender on survival in acute myeloid leukemia (AML)

Abstract Aim: Acute myeloid leukemia (AML) is an aggressive hematopoietic clonal disorder characterized by the increased blasts and poor survival outcome, which is mainly driven by cytogenetic and molecular abnormalities. Here, we investigated the prognostic impact of other demographic parameters on the survival outcomes in AML patients. Method: We reviewed the Surveillance, Epidemiology, and End Result (SEER) database to collect demographic information, including age, diagnosis, gender, race, and geographic region in patients with non-acute promyelocytic leukemia AML, between 2004–2008. The primary end-point of our study was 3-year overall survival (OS), which was estimated by the Kaplan–Meier method and Cox regression model. Results: A total of 13,282 patients were included in our analyses. Increasing age (HR 1.2, p < .0001), male gender (HR 1.05, p = .01), and geographic region of Midwest (HR 1.07, p = .002) were associated with inferior 3-year OS in univariate analysis, and these parameters remained independent prognostic factors in multivariate analyses. Conclusions: AML is a heterogeneous myeloid neoplasm with patient outcomes largely dictated by the cytogenetics and somatic mutations. In our study, additional demographic factors, including advanced age, male gender, and geographic region of AML diagnosis were associated with OS outcome in non-APL AML patients.

Magnetic resonance imaging (MRI) as compared to mammogram (MMG) in the evaluation of size, number of lesions, and nodal positivity in breast cancer (BrCa).

1102 Background: Direct comparison between MRI and MMG for accuracy of size of the lesion or nodal status in BrCa is lacking. We aim to analyze MMG and MRI findings for nodal status and size of the lesion compared with pathology as a gold standard. METHODS A retrospective analysis was performed on patients (pts) with BrCa who had MRI and MMG. Pts who had excisional biopsy prior to MRI or neoadjuvant therapy were excluded. The number and size of lesions detected by MMG and MRI were compared to pathology. Nodal positivity of pts with additional malignant lesions detected by MRI only was compared to nodal positivity of single lesions detected by MRI and MMG. RESULTS Between 2003-2010, 318 pts, 414 lesions were identified by MMG and/or MRI. Out of 414 lesions, 210 lesions were detected by MRI and MMG, and size was available to compare to pathology. Out of 210 lesions, MRI overestimated (OE) 56% of lesions by an average of 1.0 cm, MMG underestimated (UE) the same lesions in 53% by an average of 0.6 cm and 9% of lesions MRI and MMG detected same size compared to pathology. Out of 318 pts included in the study 67 pts (21%) had additional lesions detected by MRI which were not detected by MMG; 32 pts (10%) had malignant lesions; 6 pts (2%) had DCIS and 29 pts (9%) had additional benign lesions. The nodal positivity of the 32 pts with MRI detected additional malignant lesions was 50% compared to the remaining 286 pts was 21.5%. CONCLUSIONS MRI effectively evaluates the lesion size with a tendency toward overestimation when compared to MMG. MRI can detect additional lesions when compared to MMG with higher nodal positivity. This finding suggests that MRI-detected lesions are biologically significant and may predict more aggressive disease. [Table: see text].