Yuhui Liu

Relationship between primary lesion FDG uptake and clinical stage at PET–CT for non-small cell lung cancer patients: An observation

The aim of the present study was to investigate the relationship between FDG uptake and clinical stage for non-small cell lung cancer. The patients who were histologically or cytologically proven to be adenocarcinoma (AC) or squamous cell carcinoma (SCC) lung cancer and conducted FDG PET/CT staging were retrospectively reviewed. The FDG uptake was quantified as the maximum standardized uptake value (SUVmax). And the T-N-M status was determined mainly by FDG PET-CT imaging according to the 1997 update of the international staging system for lung cancer. From December 2003 to November 2007, 266 cases (194 men and 72 women; age range 31-90 years, median 62 years) were analyzed, which included 161 AC and 105 SCC patients. The present study showed that both size (3.23+/-1.68cm vs 2.63+/-1.33cm, P=0.004) and SUVmax (9.82+/-5.08 vs 8.43+/-4.21, P=0.016) were significantly greater for SCC compared to AC. There was positive correlation between the SUVmax and size for both SCC and AC (r=0.651, 0.632, respectively; both P=0.000). Significant difference is found among different stages in SUVmax for AC (F=11.693, P=0.000) but not for SCC (F=1.514, P=0.216). After controlling the size factor, a significant correlation was found between tumor stage and FDG uptake value for AC (r=0.323, P=0.000), but not for SCC (r=0.113, P=0.252). In conclusion, this observation showed that tumor size and histologic subtype had influences upon FDG uptake in non-small cell lung cancer. It demonstrated significant correlation between clinical stage and SUVmax for AC, but not for SCC.

Application of texture analysis based on apparent diffusion coefficient maps in discriminating different stages of rectal cancer

To explore the potential of texture analysis based on apparent diffusion coefficient (ADC) maps, as a predictor of local invasion depth (stage pT1‐2 versus pT3‐4) and nodal status (pN0 versus pN1‐2) of rectal cancer.

CT findings of persistent pure ground glass opacity: can we predict the invasiveness?

BACKGROUND To investigate whether CT findings can predict the invasiveness of persistent cancerous pure ground glass opacity (pGGO) by correlating the CT imaging features of persistent pGGO with pathological changes. MATERIALS AND METHODS Ninety five patients with persistent pGGOs were included. Three radiologists evaluated the morphologic features of these pGGOs at high resolution CT (HRCT). Binary logistic regression was used to assess the association between CT findings and histopathological classification (pre-invasive and invasive groups). Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of diameters. RESULTS A total of 105 pGGOs were identified. Between pre-invasive (atypical adenomatous hyperplasia, AAH, and adenocarcinoma in situ, AIS) and invasive group (minimally invasive adenocarcinoma, MIA and invasive lung adenocarcinomas, ILA), there were significant differences in diameter, spiculation and vessel dilatation (p<0.05). No difference was found in air-bronchogram, bubble- lucency, lobulated-margin, pleural indentation or vascular convergence (p>0.05). The optimal threshold value of the diameters to predict the invasiveness of pGGO was 12.50mm. CONCLUSIONS HRCT features can predict the invasiveness of persistent pGGO. The pGGO with a diameter more than 12.50mm, presences of spiculation and vessel dilatation are important factors to differentiate invasive adenocarcinoma from pre-invasive cancerous lesions.

Concurrent involved-field radiotherapy and XELOX versus XELOX chemotherapy alone in gastric cancer patients with postoperative locoregional recurrence.

Purpose:To compare the treatment outcomes of concurrent involved-field radiotherapy and XELOX (oxaliplatin and capecitabine) versus XELOX chemotherapy alone in gastric adenocarcinoma patients with locoregional recurrence. Materials and Methods:From 2004 to 2008, 79 patients with recurrent locoregional gastric cancer after curative resection of gastric tumor were enrolled. Among them, 41 patients received involved-field radiotherapy (median dose 50 Gy) by a 3-dimensional conformal radiotherapy technique and concurrent XELOX chemotherapy, and 38 patients were treated with XELOX chemotherapy alone (oxaliplatin 130 mg/m2, capecitabine 1000 mg/m2, twice daily, 3 wk each cycle). Results:The concurrent radiochemotherapy group showed better overall response (including complete response and partial response) when compared with the chemotherapy group (87.8% vs. 63.0%, P=0.01). The control rates for pain, bleeding, and dysphagia/obstruction were 89.5% (17/19), 81.8% (9/11), and 80% (8/10), respectively, in the radiochemotherapy group and 58.8% (10/17), 50% (5/10), and 57.1% (4/7), respectively, in the chemotherapy group. The concurrent radiochemotherapy group showed better overall symptom-control rate when compared with the chemotherapy group (55.9% vs. 85%, P=0.006). Patients receiving concurrent radiochemotherapy trended toward a better median overall survival when compared with those receiving chemotherapy alone (13.4 vs. 5.4 mo, P=0.06). In addition, there were no significant differences in the rates of toxicity or adverse reactions between the 2 groups. Conclusions:Concurrent involved-field radiotherapy and XELOX showed better responses and overall symptom-control rates compared with XELOX chemotherapy alone in gastric cancer patients with postoperative locoregional recurrence. A trend of survival benefit from radiochemotherapy was also observed but needs to be further explored.

3.0T MR-CAD: Clinical Value in Diagnosis of Breast Tumor Compared with Conventional MRI

Purpose: to explore the clinical value of 3.0T magnetic resonance (MR) imaging compared with computer-aided MR diagnosis (MR-CAD) in differential diagnosis of benign and malignant breast tumors. Materials and Methods: MRI method and MR-CAD method was used in the diagnosis of a total of 93 breast lesions of 78 patients, based on the morphological and time-intensity-curve (TIC) analysis. The accuracy of the two modalities in differentiating malignant and benign breast tumor was compared. Results: MR-CAD method yielded a statistically better accuracy than MRI method. For 51 mass-like lesions, MRI and MR-CAD had no difference in diagnosing accuracy, but MR-CAD had better accuracy in 42 non-mass-like lesions. Conclusion: MR-CAD had a notable advantage over MRI in differential diagnosis of benign and malignant breast tumors, especially non-mass-like tumor.

Efficacy of permanent iodine-125 seed implants and gemcitabine chemotherapy in patients with platinum- resistant recurrent ovarian carcinoma.

BACKGROUND The aim of this study was to explore the efficacy and adverse reactions of CT-guided radioactive 125I-seed implantation treatment combined with chemotherapy for platinum-resistant recurrent ovarian carcinoma. MATERIALS AND METHODS From September 2010 to December 2012, 23 patients with platinum-resistant recurrent ovarian carcinoma were enrolled. All the patients refused, could not bear, or were not suitable for surgery. They all had no more than 3 lesions, which were detected and could also be measured by CT. All were clarified as single-lesion or multiple-lesion groups. A total of 41 lesions underwent implantation of from 8 to 106 125I seeds (median=43). Multi-plane implanting was adopted and 125I-seeds of (0.4-0.7)mCi were placed at intervals of (0.5-1.0) cm. After implantation treatment, all patients underwent 4 cycles of chemotherapy with gemcitabine 800 mg/m2 (days 1, 8 and 15). RESULTS The outcome was evaluated with CT 3 weeks and every 3 months after implantation treatment. After 6 months, the volume of 32 out of 41 lesions (78.0%) was reduced at least 30%, within which 9 lesions completely disappeared(22.0%). Complete response was observed in 7 cases (30.4%), with a partial response in 4 cases (17.4%),4 cases stable(17.4%)and 8 cases showing progression (34.8%). The total clinical remission rate was 47.8% (11/23). The clinical remission rate was 77.8% (7/9) in the single-lesion group and 28.6% (4/14) in the multiple-lesion group with a significant difference between the two(P=0.036). The common side effects observed were mild gastrointestinal reactions. CONCLUSIONS 125I-seed implantation combined with chemotherapy applies an effective way in the treatment of platinum-resistant recurrent ovarian epithelial carcinoma with the advantages of high local control rates, good short-term effects, little trauma and less side effects.

Identification of risk factors and the pattern of lower cervical lymph node metastasis in esophageal cancer: implications for radiotherapy target delineation.

Radiotherapy remains the important therapeutic strategy for patients with esophageal cancer (EC). At present, there is no uniform opinion or standard care on the range of radiotherapy in the treatment of EC patients. This study aimed to investigate the risk factors associated with lower cervical lymph node metastasis (LNM) and to explore the distribution pattern of lower cervical metastatic lymph nodes. It could provide useful information regarding accurate target volume delineation for EC. We identified 239 patients who initial diagnosed with esophageal squamous cell carcinoma. The clinicopathological factors related to LNM were analyzed and the locations of the lower cervical metastatic lymph nodes were transferred onto computed tomography images. The lower cervical area was further divided into four subgroups areas. The results showed that the incidence of lower cervical LNM was 37.2 % (89 of 239) and 94.4 % (84 of 89 patients) patients had subgroup II and/or subgroup III region LNM. Of those patients, 151 nodes were considered to be clinical metastatic in the lower cervical region and 96% nodes were located in group II and group III. Based on the present study, prophylactic irradiating to lower cervical areas is recommended for patients with deeper tumor invasion, the mediastinal level 1, 2, and 4 station LNM and the more number of LNM. The atlas showed that, for the lower cervical area, the subgroup II and III region should be precisely covered in the target volume and the subgroup I and IV may be spared for minimizing the toxicity.

Magnetic resonance imaging evaluation of treatment efficacy and prognosis for brain metastases in lung cancer patients after radiotherapy: A preliminary study: MRI evaluation after radiotherapy in BM

This study used magnetic resonance imaging (MRI) to monitor changes to brain metastases and investigate the imaging signs used to evaluate treatment efficacy and determine prognosis following radiotherapy for brain metastases from lung cancer.

Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation

BACKGROUND To map detail distribution of metastatic supraclavicular (SCV) lymph nodes (LN) in esophageal cancer (EC) patients and determine the precise radiation therapy clinical target volume (CTV). METHODS A total of 101 thoracic esophageal carcinoma patients after surgery experienced SCV LN metastasis were retrospectively examined. The SCV region is further divided into four subgroups. Using hand drawings registration, nodes were mapped to a template computed tomogram to provide a visual impression of nodal frequencies and anatomic distribution. RESULTS In all, 158 nodes were considered to be clinical metastatic in the SCV region in the 101 patients, 74 on the left and 84 on the right. Seven of 158 (4.4%) positive LN were located in group I, 78 of 158 (49.37%) were located in group II, 72 of 158 nodes (45.6%) were located in group III, 1 of 158 (0.63%) located in group IV. CONCLUSIONS According to our results, the SCV group II and group III are considered to be the high risk regions of esophageal squamous cell carcinoma (ESCC) LN metastasis, which were defined as elective nodal irradiation (ENI) areas.

Metastatic adenoid cystic carcinoma of external auditory canal presenting as solitary pulmonary nodule

A 60-year-old woman presented with a solitary pulmonary nodule (SPN) in the inferior lobe of the right lung during a regular chest X-ray examination. Computed tomography (CT) (Fig 1A–D) and positron emission tomography (PET)-CT (Fig. 2A–D) demonstrated an irregular highmetabolism nodule (2.2 cm ¥ 2.5 cm maximal section). An aggressive surgical approach was adopted. A right inferior lobectomy was performed. Histopathologic examination showed metastatic adenoid cystic carcinoma (Fig. 3). After re-evaluating the PET-CT images, another small highmetabolism lesion was found in the left external auditory canal. Ear, nose, and throat doctors performed resection of the tumor. Pathological examination showed adenoid cystic carcinoma of the external auditory canal. Cisplatin and 5-Fluorouracil, combined with Cetuximab, were given and the left external auditory canal received external radiation therapy. The postoperative course was uneventful and the patient was discharged after 30 days. Adenoid cystic carcinoma is an uncommon tumor that rarely involves the external ear canal. Pulmonary metastatic lesions are easy to misdiagnose as primary lung cancer. In this case, we have shown that metastatic adenoid cystic carcinoma of the external auditory canal could present as SPN. Nuclear