Xiaoxiao Liu

Shear Wave Elastography for Differentiation of Benign and Malignant Thyroid Nodules A Meta-analysis

The purpose of this study was to assess the performance of shear wave elastography for identification of benign and malignant thyroid nodules using meta‐analysis.

Prognostic Significance of Survivin in Breast Cancer: Meta‐analysis

Survivin, an inhibitor of apoptosis protein, is a potentially prognostic factor and therapeutic target in breast carcinoma, but no consensus exists based on heterogeneous data. The aim of this present study is to clarify the prognostic relevance of survivin in breast cancer patients. Relevant articles were screened in PubMed and EMBASE databases. Patients’ clinical characteristics, overall survival (OS), disease/recurrence‐free survival (DFS/RFS) and positive expressed survivin rates were extracted for further analysis. Statistics extracted from Kaplan–Meier survival curves were calculated indirectly with methods developed by Parmar, Williamson, and Tierney. Multivariate Cox hazard regression analysis data were used directly in Stata 11.0. Pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated to evaluate the prognostic role of survivin in breast cancer. Online literature search identified 23 articles containing 3,259 breast cancer patients. Our meta‐analysis of all included studies about survival outcomes showed positive correlation between poor prognosis and survivin expression. Pooled HRs (95% CIs) for OS and DFS/RFS were 1.37 (1.12–1.68) and 1.34 (1.02–1.76), respectively. Subgroup analyses considering methods used to detect survivin (immunohistochemistry or not) and localization of survivin (whole, nuclear or cytoplasm of the cell) were also conducted, and all the above analyses supported the stability of the prognostic role of survivin. In addition, our study revealed a significant association between survivin expression and lymph node metastasis (OR: 2.74; 95% CI: 1.27–5.93) or stage of breast cancer (OR: 2.01; 95% CI: 1.29–3.13). Positive expression of survivin demonstrated a significantly higher risk of recurrence and decreased OS rates in breast cancer.

Contrast-Enhanced Ultrasound in the Diagnosis of Patients Suspected of Having Active Crohn's Disease: Meta-analysis

This meta-analysis was aimed at assessing the performance of oral/microbubble contrast-enhanced ultrasound (CEUS) in the detection of active Crohns disease (CD). A literature search of PubMed, Medline, the China National Knowledge Infrastructure and the Cochrane Library was conducted. Published articles that evaluated the diagnostic potency of CEUS in CD were included in the study. A total of eight articles, which included 428 patients, were finally analyzed. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and area under the curve were calculated to examine the diagnostic accuracy of CEUS. The pooled sensitivity and specificity of CEUS for active CD were 93% (95% confidence interval: 89%-95%) and 87% (81%-91%), respectively. The summary diagnostic odds ratio was 80.35 (30.93-208.73), and the area under the curve was 0.9633. In conclusion, this meta-analysis pooled results from previous studies to evaluate the accuracy of CEUS in the detection of CD. We found that CEUS has high accuracy in the detection of active CD using endoscopy/biopsy or clinical index as the reference standard. In the future, CEUS may also be widely used in other diseases, reducing the necessity for invasive diagnostic procedure.

Radiotherapy combined with chemotherapy versus radiotherapy alone for early stage nasal natural killer/T-cell lymphoma: a meta-analysis.

Objective: To compare the efficacy of radiotherapy (RT) plus chemotherapy (CMT) versus RT alone for early stage nasal natural killer (NK)/T-cell lymphoma. Methods: All the eligible studies were searched by PubMed, Medline, Embase and the Cochrane Library. The meta-analysis was performed to compare odds ratios (ORs) for overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS). Results: Eight studies were included in the meta-analysis. Chemotherapy group did not significantly differ from RT group. The pooled OR and 95% confidence interval (CI) for 1-year, 3-year, 5-year and 10-year OS was 1.25 [0.84, 1.87], 1.10 [0.76, 1.58], 0.83 [0.59, 1.17] and 1.05 [0.70, 1.56]. In addition, the combined OR and 95% CI for 5-year DFS and PFS were 0.96 [0.53, 1.73] and 0.71 [0.45, 1.12]. Conclusions: The current evidence suggests that CMT was not superior to RT alone. Radiotherapy may be still the main method in the treatment of early stage nasal NK/T-cell lymphoma.

Education and imaging. Hepatobiliary and Pancreatic: Pancreatic neuroendocrine neoplasm with pelvic metastases and ectopic ACTH production.

Neuroendocrine neoplasms of the pancreas, previously called islet cell tumours, are rare with an annual incidence of 2–4/million population. One classification includes low-grade neuroendocrine tumours, intermediate-grade neuroendocrine tumours and neuroendocrine carcinomas. A second issue is whether the tumours produce hormones that result in hormonal syndromes ( functioning or non-functioning tumors). In recent series, the majority (50– 75%) have been non-functioning. When the tumours are functioning, there can be hypersecretion of a variety of hormones, including insulin (insulinomas), gastrin (gastrinomas), glucagon (glucagonomas), vasoactive intestinal peptide (VIPomas) and somatostatin (somatostatinomas). Non-functioning pancreatic neuroendocrine tumours may also secrete substances such as chromogranins, neuron-specific enolase, pancreatic polypeptide and ghrelin but these do not present clinically with hormonal syndromes. The most common sites for metastases at presentation are local lymph nodes (25%) and liver (25%). The rate of growth of neuroendocrine tumors is highly variable. Some tumors show no or minimal growth over several years while others are rapidly progressive. Prognostic factors include the presence of metastases, the size of the primary tumor, histological features and perhaps hormone secretion. The patient illustrated below was unusual because of pelvic metastases and the presence of Cushings syndrome. A woman, aged 27, was admitted to our hospital with polydipsia, limb weakness, hirsutism and fasting hyperglycaemia for six months and amenorrhoea for two months. Blood tests revealed an elevated fasting blood glucose (10.8 mmol/L) and a low serum potassium (2.3 mmol/L). Hormone studies revealed an elevated plasma cortisol (8:00am > 1750 nmol/L), an elevated 24 hour urinary free cortisol (2762 μg) and an elevated level of adrenocorticotropic hormone (ACTH, 101 ng/L). Cortisol secretion was not affected by a high dose of dexamethasone. A computed tomography scan revealed a relatively large mass in the body and tail of the pancreas (Figure 1). The tumour invaded the splenic vein and, in addition, nodules were detected in the pelvis and both ovaries (Figure 2, above). A partial pancreatectomy, splenectomy, hysterectomy, bilateral oophorectomy and excision of pelvic and ovarian tumour nodules were performed. Immunohistochemical studies showed that the tumour was positive for synaptophysin, chromogranin A and ACTH. The histological appearance of the ovarian metastases in shown in Figure 2 (below). The final diagnosis was a pancreatic neuroendocrine tumour of intermediategrade with pelvic and bilateral ovarian metastases. After the operation, cortisol and ACTH levels returned to normal. In some studies, ectopic ACTH production has been an adverse prognostic feature.

Hepatobiliary and Pancreatic: Pancreatic neuroendocrine neoplasm with pelvic metastases and ectopic ACTH production

Neuroendocrine neoplasms of the pancreas, previously called islet cell tumours, are rare with an annual incidence of 2–4/million population. One classification includes low-grade neuroendocrine tumours, intermediate-grade neuroendocrine tumours and neuroendocrine carcinomas. A second issue is whether the tumours produce hormones that result in hormonal syndromes ( functioning or non-functioning tumors). In recent series, the majority (50– 75%) have been non-functioning. When the tumours are functioning, there can be hypersecretion of a variety of hormones, including insulin (insulinomas), gastrin (gastrinomas), glucagon (glucagonomas), vasoactive intestinal peptide (VIPomas) and somatostatin (somatostatinomas). Non-functioning pancreatic neuroendocrine tumours may also secrete substances such as chromogranins, neuron-specific enolase, pancreatic polypeptide and ghrelin but these do not present clinically with hormonal syndromes. The most common sites for metastases at presentation are local lymph nodes (25%) and liver (25%). The rate of growth of neuroendocrine tumors is highly variable. Some tumors show no or minimal growth over several years while others are rapidly progressive. Prognostic factors include the presence of metastases, the size of the primary tumor, histological features and perhaps hormone secretion. The patient illustrated below was unusual because of pelvic metastases and the presence of Cushings syndrome. A woman, aged 27, was admitted to our hospital with polydipsia, limb weakness, hirsutism and fasting hyperglycaemia for six months and amenorrhoea for two months. Blood tests revealed an elevated fasting blood glucose (10.8 mmol/L) and a low serum potassium (2.3 mmol/L). Hormone studies revealed an elevated plasma cortisol (8:00am > 1750 nmol/L), an elevated 24 hour urinary free cortisol (2762 μg) and an elevated level of adrenocorticotropic hormone (ACTH, 101 ng/L). Cortisol secretion was not affected by a high dose of dexamethasone. A computed tomography scan revealed a relatively large mass in the body and tail of the pancreas (Figure 1). The tumour invaded the splenic vein and, in addition, nodules were detected in the pelvis and both ovaries (Figure 2, above). A partial pancreatectomy, splenectomy, hysterectomy, bilateral oophorectomy and excision of pelvic and ovarian tumour nodules were performed. Immunohistochemical studies showed that the tumour was positive for synaptophysin, chromogranin A and ACTH. The histological appearance of the ovarian metastases in shown in Figure 2 (below). The final diagnosis was a pancreatic neuroendocrine tumour of intermediategrade with pelvic and bilateral ovarian metastases. After the operation, cortisol and ACTH levels returned to normal. In some studies, ectopic ACTH production has been an adverse prognostic feature.

Hepatobiliary and Pancreatic: Pancreatic neuroendocrine neoplasm with pelvic metastases and ectopic ACTH production: Education and Imaging

Neuroendocrine neoplasms of the pancreas, previously called islet cell tumours, are rare with an annual incidence of 2–4/million population. One classification includes low-grade neuroendocrine tumours, intermediate-grade neuroendocrine tumours and neuroendocrine carcinomas. A second issue is whether the tumours produce hormones that result in hormonal syndromes ( functioning or non-functioning tumors). In recent series, the majority (50– 75%) have been non-functioning. When the tumours are functioning, there can be hypersecretion of a variety of hormones, including insulin (insulinomas), gastrin (gastrinomas), glucagon (glucagonomas), vasoactive intestinal peptide (VIPomas) and somatostatin (somatostatinomas). Non-functioning pancreatic neuroendocrine tumours may also secrete substances such as chromogranins, neuron-specific enolase, pancreatic polypeptide and ghrelin but these do not present clinically with hormonal syndromes. The most common sites for metastases at presentation are local lymph nodes (25%) and liver (25%). The rate of growth of neuroendocrine tumors is highly variable. Some tumors show no or minimal growth over several years while others are rapidly progressive. Prognostic factors include the presence of metastases, the size of the primary tumor, histological features and perhaps hormone secretion. The patient illustrated below was unusual because of pelvic metastases and the presence of Cushings syndrome. A woman, aged 27, was admitted to our hospital with polydipsia, limb weakness, hirsutism and fasting hyperglycaemia for six months and amenorrhoea for two months. Blood tests revealed an elevated fasting blood glucose (10.8 mmol/L) and a low serum potassium (2.3 mmol/L). Hormone studies revealed an elevated plasma cortisol (8:00am > 1750 nmol/L), an elevated 24 hour urinary free cortisol (2762 μg) and an elevated level of adrenocorticotropic hormone (ACTH, 101 ng/L). Cortisol secretion was not affected by a high dose of dexamethasone. A computed tomography scan revealed a relatively large mass in the body and tail of the pancreas (Figure 1). The tumour invaded the splenic vein and, in addition, nodules were detected in the pelvis and both ovaries (Figure 2, above). A partial pancreatectomy, splenectomy, hysterectomy, bilateral oophorectomy and excision of pelvic and ovarian tumour nodules were performed. Immunohistochemical studies showed that the tumour was positive for synaptophysin, chromogranin A and ACTH. The histological appearance of the ovarian metastases in shown in Figure 2 (below). The final diagnosis was a pancreatic neuroendocrine tumour of intermediategrade with pelvic and bilateral ovarian metastases. After the operation, cortisol and ACTH levels returned to normal. In some studies, ectopic ACTH production has been an adverse prognostic feature.