Yu-Ting Huang

Myometrial Invasion in Endometrial Cancer: Diagnostic Accuracy of Diffusion-weighted 3.0-T MR Imaging—Initial Experience

PURPOSE To assess the diagnostic accuracy of fused T2-weighted and high-b-value diffusion-weighted (DW) magnetic resonance (MR) images at 3 T for evaluation of myometrial invasion in patients with endometrial cancer. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. From May 2006 to October 2007, 48 consecutive patients aged 25-80 years (mean age, 57 years) who had endometrial cancer were prospectively enrolled for preoperative evaluation by using a 3-T MR unit. Two radiologists interpreted the depth of myometrial invasion on T2-weighted images, dynamic contrast material-enhanced MR images, and fused T2-weighted and DW MR images (b = 1000 sec/mm(2)). Statistical methods included kappa statistics for reader agreement, Pearson analysis for pathologic correlation, accuracy assessment, and receiver operating characteristic analysis for diagnostic performance comparison. Surgical pathologic findings were the reference standard. RESULTS Reader agreement was excellent for fused T2-weighted and DW images (weighted kappa, 0.79), with a significant pathologic correlation regarding the depth of myometrial invasion (r = 0.94, P < .0001). For assessing any myometrial involvement, addition of fused T2-weighted and DW imaging to dynamic contrast-enhanced or dynamic contrast-enhanced and T2-weighted imaging was significantly better compared with dynamic contrast-enhanced imaging alone (P < .001) or dynamic contrast-enhanced and T2-weighted (P = .001) imaging; T2-weighted imaging combined with fused T2-weighted and DW imaging also was better than dynamic contrast-enhanced and T2-weighted imaging (P = .001). Tumor apparent diffusion coefficients were 0.60-1.32 x 10(-3) mm(2)/sec (median, 0.75 x 10(-3) mm(2)/sec), with no significant correlation with the depth of myometrial invasion (P = .31, r = -0.15). CONCLUSION Fused T2-weighted and high-b-value DW images at 3 T can provide accurate information for preoperative evaluation of myometrial invasion.

Comparison of the diagnostic accuracy of contrast-enhanced MRI and diffusion-weighted MRI in the differentiation between uterine leiomyosarcoma / smooth muscle tumor with uncertain malignant potential and benign leiomyoma.

To compare the diagnostic accuracy of contrast‐enhanced (CE) magnetic resonance imaging (MRI) and diffusion‐weighted MRI (DWI) in the differentiation between uterine leiomyosarcoma (LMS) / smooth muscle tumor with uncertain malignant potential (STUMP) and benign leiomyoma.

Fertility-preserving treatment in young women with endometrial adenocarcinoma: a long-term cohort study.

Objective Growing evidence suggests that fertility-preserving treatment is feasible for young women with early-stage, low-grade endometrial carcinoma. However, published data on their long-term outcomes and prognostic factors remain scanty. We aimed to investigate the outcomes of young women receiving fertility-preserving treatment. Methods Between 1991 and 2010, the outcomes of young women with grade 1 endometrioid endometrial carcinoma at presumed stage IA (without myometrial invasion) who underwent fertility-preserving treatment of megestrol acetate 160 mg/d with or without other hormonal agents were retrospectively analyzed. Results We identified 37 eligible patients (median age, 32 years; range, 18–40 years). The median follow-up time was 78.6 months (range, 19.1–252.8 months). Complete response (CR) lasting more than 6 months was achieved in 30 (81.1%) women. Responders were significantly younger than nonresponders (P = 0.032). Of the 30 women who had a CR, 15 (50.0%) had disease recurrence. The 5-, 10-, and 15-year cumulative recurrence-free survival rates were 51.0%, 51.0%, and 34.0%, respectively. Notably, those recurred were significantly older (P = 0.003), and the time to CR was significantly longer (P = 0.043) than those without recurrence. One patient developed late recurrences at 156 months, and 2 patients developed ovarian metastasis (6 and 137 months from diagnosis). All the patients are currently alive. Conclusions This study demonstrates the feasibility of high-dose megestrol acetate–based therapy for fertility preservation. The substantial risk of late recurrences highlights the need for long-term follow-up studies of large sample sizes with in-depth tumor and host molecular signatures.

CT-Guided Core Needle Biopsy of Deep Suprahyoid Head and Neck Lesions

Objective To evaluate the efficacy of computer tomography (CT)-guided core needle biopsy (CNB) in the diagnosis of deep suprahyoid lesions in patients with treated head and neck cancers. Materials and Methods Between December, 2003 and May, 2011, 28 CT-guided CNBs were performed in 28 patients with deep suprahyoid head and neck lesions. All patients had undergone treatment for head and neck cancers. Subzygomatic, paramaxillary, and retromandibular approaches were used. The surgical results, response to treatment, and clinical follow-up were used as the diagnostic reference standards. Results All biopsies yielded adequate specimens for definitive histological diagnoses. A specimen from a right parapharyngeal lesion showed atypia, which was deemed a false negative diagnosis. Diagnostic accuracy was 27/28 (96.4%). Two minor complications were encountered: a local hematoma and transient facial palsy. Between the 18 or 20 gauge biopsy needles, there was no statistical difference in the diagnostic results. Conclusion CT-guided core needle biopsy, with infrequent and minor complications, is an accurate and efficient method for the histological diagnosis of deep suprahyoid lesions in post-treated head and neck cancer patients. This procedure can preclude an unnecessary surgical intervention, especially in patients with head and neck cancers.

1H MR spectroscopy in cervical carcinoma using external phase array body coil at 3.0 Tesla: Prediction of poor prognostic human papillomavirus genotypes

To assess the clinical value of proton (1H) MR spectroscopy in cervical carcinomas, in the prediction of poor prognostic human papillomavirus (HPV) genotypes as well as persistent disease following concurrent chemoradiotherapy (CCRT).

CT-guided percutaneous core-needle biopsy of pancreatic masses: comparison of the standard mesenteric/retroperitoneal versus the trans-organ approaches

AIM To compare the safety and efficacy of percutaneous computed tomography (CT)-guided core-needle biopsy (CNB) of pancreatic masses traversing the gastrointestinal tract or solid viscera versus trans-mesenteric and retroperitoneal approaches. MATERIALS AND METHODS CT-guided CNB of pancreatic lesions performed between May 2004 and December 2014 were retrospectively analysed at a single centre. Biopsies were performed using 18- or 20-G needles with a coaxial system. CT images, histopathology reports, medical records, and procedural details for all patients were reviewed to evaluate the biopsy route, complications, and diagnostic accuracy. According to the routes, biopsies were divided into trans-mesenteric, retroperitoneal and trans-organ approaches for comparison. RESULTS A total of 85 patients, who had undergone 89 CNBs for pancreatic masses were reviewed. The overall sensitivity, specificity, and accuracy of CNB for detecting malignancy via various routes were 88.8%, 100%, and 89.9%, respectively, with a complication rate of 20.2%. Trans-organ biopsies of pancreatic masses (n=22) were performed safely via a direct pathway traversing the stomach (n=14), colon (n=3), small bowel (n=2), liver (n=2), and spleen (n=1). The sensitivity, specificity, and accuracy were 90.5%, 100%, and 90.9%, respectively. In the trans-organ biopsy group, three biopsies (13.6%) resulted in minor haematomas, but no major complications occurred. There were no statistically significant differences in the diagnostic efficacy or complication rate among the different biopsy routes. CONCLUSION Percutaneous CT-guided CNB using a trans-organ approach is a feasible technique for diagnosing pancreatic malignancy; however, as this series was small, more data is required.

Influence of menopausal status on diagnostic accuracy of myometrial invasion in endometrial cancer: diffusion-weighted and dynamic contrast-enhanced MRI at 3 T

AIM To assess the influence of menopausal status on the diagnostic accuracy of diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for evaluating myometrial invasion in patients diagnosed with endometrial cancer. MATERIALS AND METHODS In this prospective study, 91 consecutive female patients diagnosed with endometrial cancer were enrolled for preoperative evaluation using 3 T MRI. Two radiologists interpreted myometrial invasion depth on DW (b=1000 s/mm(2)) and DCE MRI images, with surgical histopathology as the reference standard. Statistical methods included kappa statistics for evaluating reader agreement and diagnostic performance analysis between pre- and postmenopausal groups. RESULTS Reader agreement of DW MRI was poor (κ=0.20) for premenopausal patients. The diagnostic accuracy of DW MRI in detecting myometrial involvement was significantly lower in premenopausal compared with postmenopausal patients (0.42 versus 0.73, p=0.006). There was no difference in the diagnostic accuracy of DW MRI in detecting deep myometrial invasion between premenopausal and postmenopausal groups (0.94 versus 0.95, p>0.99). CONCLUSION For premenopausal patients who plan to receive fertility-preserving treatment for endometrial cancer, DCE MRI is superior to DW MRI in excluding any possible myometrial invasion. For preoperative assessment of deep myometrial invasion, DW MRI can be a legitimate alternative to DCE MRI regardless of menopausal status and is particularly beneficial for patients at risk of nephrogenic systemic fibrosis.

Diagnostic efficacy of ultrasonography-guided fine needle aspiration biopsy in evaluating salivary gland malignancy

BACKGROUND Salivary gland masses constitute a diagnostic challenge in daily clinical practice and tissue sampling is required to establish a diagnosis. We aimed to evaluate the efficacy of ultrasonography-guided fine needle aspiration biopsy (UGFNAB) in the diagnosis of salivary gland lesions. METHODS From January 2007 to September 2010, a total of 158 patients who underwent both UGFNAB and surgical excision for salivary gland mass lesions were included in this study. Patients with insufficient sampling or inconclusive cytology diagnosis were excluded from the analysis of diagnostic accuracy of UGFNAB. RESULTS UGFNAB yielded sufficient sampling for analysis in 137 patients, leading to a diagnostic yield of 86.7%. Among these 137 patients, 24 patients were confirmed to have malignant tumors. The sensitivity, specificity and accuracy of UGFNAB for malignancy were 66.7%, 98.2%, and 92.7%, respectively. No UGFNAB-related complications were encountered. CONCLUSIONS UGFNAB of salivary gland masses is a safe technique that offers high specificity and accuracy but moderate diagnostic yield and sensitivity.

Trans-organ versus trans-mesenteric computed tomography-guided percutaneous fine-needle aspiration biopsy of pancreatic masses: Feasibility and safety

AIM To evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous fine-needle aspiration biopsy (FNAB) of pancreatic masses that traverses the gastrointestinal tract or solid viscera. MATERIALS AND METHODS From January 2002 to December 2012, 144 patients underwent 165 CT-guided biopsies of pancreatic masses. Biopsies were performed using a 21 or 22 G needle. Cytology reports, medical records, and procedure details for all patients were retrospectively reviewed to evaluate the biopsy route, complications, and diagnostic accuracy. RESULTS Trans-organ biopsies of pancreatic masses were safely performed via a direct pathway traversing the stomach (n = 45), colon (n = 14), jejunum (n = 4), or liver (n = 5). There were five self-limiting mesenteric haematomas along the biopsy route on immediate post-procedure CT and all patients remained asymptomatic. All haematomas occurred after a trans-mesenteric approach rather than passage through abdominal organs. Three patients had acute pancreatitis. There was no significant difference in complications and diagnostic yields between the groups. The sensitivity, specificity, positive predictive value, and negative predictive value of final FNAB cytology for malignancy were 98.3%, 100%, 100% and 71.4%, respectively. The overall accuracy was 98.4%. CONCLUSION Percutaneous FNAB using the trans-organ approach is a safe and effective technique to diagnose pancreatic malignancy.

Diagnostic accuracy of 3.0T diffusion-weighted MRI for patients with uterine carcinosarcoma: Assessment of tumor extent and lymphatic metastasis: DW MRI for Carcinosarcoma

Assessment of tumor extent and lymphatic metastasis of uterine carcinosarcomas is important for treatment planning.