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Background: Mammography screening programs (MSP) have shown that breast cancer can be detected at an earlier stage enabling less invasive treatment and leading to a better survival rate. The considerable numbers of interval breast cancer (IBC) and the additional examinations required, the majority of which turn out not to be cancer, are critically assessed., Objective: In recent years companies and universities have used machine learning (ML) to develop powerful algorithms that demonstrate astonishing abilities to read mammograms. Can such algorithms be used to improve the quality of MSP?, Method: The original screening mammographies of 251 cases with IBC were retrospectively analyzed using the software ProFound AI® (iCAD) and the results were compared (case score, risk score) with a control group. The relevant current literature was also studied., Results: The distributions of the case scores and the risk scores were markedly shifted to higher risks compared to the control group, comparable to the results of other studies., Conclusion: Retrospective studies as well as our own data show that artificial intelligence (AI) could change our approach to MSP in the future in the direction of personalized screening and could enable a significant reduction in the workload of radiologists, fewer additional examinations and a reduced number of IBCs; however, the results of prospective studies are needed before implementation., (© 2024. The Author(s).)

Competing Interests: Honorare für Fortbildungsvorträge des Referenzzentrums Mammographie Münster; Leitungsfunktion im Referenzzentrum Mammographie Münster und der zugehörigen Referenz-Screening-Einheit

In view of a recent recommendation of the European Commission to conceptualize novel screening approaches for lung, gastric, and prostate cancer, Germany is also invoked to revise its prostate early detection program. This discussion article provides an overview of new findings on prostate cancer screening, which suggest an organized and risk-adapted screening approach. Based on the German risk-adapted screening trial PROBASE, together with recently published data on organized screening programs in Europe, model projects should be established to determine the specific modalities for a new organized and risk-adapted prostate cancer screening program., (© 2024. The Author(s).)

Background and Objective: Despite the proven effectiveness of organized PSA-based screening in reducing prostate cancer-related mortality, there is currently no program in Germany covered by statutory health insurance. In accordance with the EU Council Decision (2022/0290(NLE)), the German Society of Urology (DGU) has developed a concept for risk-adapted prostate cancer early detection., Materials and Methods: Based on a literature review of current screening studies, an algorithm for PSA-based prostate cancer early detection was developed., Results: Risk-adapted prostate cancer screening involves PSA testing in the age group of 45-70 years, followed by PSA-based individual risk stratification and stepwise expansion of diagnostics through magnetic resonance imaging (MRI) to biopsy. While initially up to 2.6 million men will undergo PSA testing, a reduction in these initial examinations to fewer than 200,000 men per year will occur from year four onwards., Conclusions: The presented algorithm provides clear recommendations for risk-adapted PSA-based early detection for prostate cancer for urologists and patients. The goal is to improve diagnosis of clinically significant prostate cancer, while reducing overdiagnosis and overtreatment., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Competing Interests: S.W. Payments for lectures from the Reference Center for Mammography Münster; leadership role at the Reference Center for Mammography in Muenster and the associated Reference Screening Unit; board member of the AG Mammadiagnostik of the German Röntgen Society and German Society for Senology; before starting the TOSYMA trial, received training cases from all vendors without charge for reader training at the Reference Center for Mammography Münster. H.W.H. No relevant relationships. V.W.E. No relevant relationships. J.G. Consulting fees from Dr August Wolff, Ecker + Ecker, QUIRIS Healthcare, and TESARO; honoraria for lectures from Roche and TESARO; participation on a data and safety monitoring board or advisory board for the TOMAHAWK trial (University Medical Center Schleswig-Holstein, Campus Lübeck) and Ruxo-BEAT trial (RWTH Aachen University). W.H. Payments for lectures from the Reference Center for Mammography Münster; leadership role at the Reference Center for Mammography in Muenster and the associated Reference Screening Unit; board member/member of the European Society of Radiology, German Röntgen Society, European Society of Breast Imaging, German Society for Senology, and German Röntgen Museum; before starting the TOSYMA trial, received training cases from all vendors without charge for reader training at the Reference Center for Mammography Münster.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Since 2003, a decline in the age-standardized incidence rates of colorectal cancer (CRC) has been observed in Germany. Nonetheless, one in eight cancer cases still affects the colon or rectum. The prognosis has improved, with the relative 5‑year survival rate for CRC being approximately 65%., Methods: This positive trend is probably a result of preventive measures introduced over the last 20 years. This could be further improved, however, as CRC can not only be detected early but in almost all cases also prevented through the identification of benign precursors. Less than half of all eligible individuals participate in screening via colonoscopy. This implies that further, possibly even imaging, screening test methods should be explored and offered. Studies have reported that virtual colonography techniques have a comparable accuracy to endoscopy of about 90% for polyp sizes larger than 5 mm. The data for computed tomography (CT) is more extensive than for magnetic resonance imaging (MRI)., Conclusion: Significant challenges are posed however by the fact that in Germany CT colonography (CTC) is not considered a viable screening option due to radiation protection concerns, and MRI screening is not an established screening method. Radiologists should be familiar with classification using the CT Colonography Reporting and Data System (C-RADS), which uses criteria such as CT density, morphology, size, and location for classification. C‑RADS classification follows the categories: C0 (inadequate study), C1 (normal), C2a (indeterminate), C2b (benign), C3 (suspicious), and C4 (malignant), as well as extracolonic categories E1/2 (no clinically significant findings), E3 (likely insignificant findings), and E4 (likely significant findings)., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Clinical/methodical Issue: Lung cancer is the leading cause of cancer-related deaths worldwide. In early, asymptomatic stages, curative treatment is possible, but the disease is often diagnosed too late., Standard Radiological Methods: Lung cancer screening (LCS) using low-dose computed tomography (LDCT) helps to detect potentially malignant lesions in early stages and to reduce lung cancer mortality., Methodological Innovations: The application of artificial intelligence (AI) algorithms enables a more precise analysis of LDCT scans., Performance: A meta-analysis of eight LCS studies revealed a statistically significant 12% relative reduction in lung cancer mortality., Achievements: Based on strong scientific evidence, a recommendation for a structured lung cancer screening program using LDCT for the high-risk population in Germany was issued., Practical Recommendations: The holistic LCS program requires a clear definition of the high-risk population, individual risk assessment, qualified personnel for conducting and reading examinations, verification of all diagnostic and therapeutic steps, central documentation and quality assurance, as well as the integration of tobacco cessation programs., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The harm-to-benefit ratio of prostate cancer (PCa) screening remains controversial mainly due to the unfavorable test characteristics of prostate-specific antigen (PSA) as a screening test., Methods: In this nonsystematic review, we present a current overview of the body of evidence on prostate cancer screening with a focus on the role of magnetic resonance imaging (MRI) of the prostate., Results: Evidence generated in large randomized controlled trials showed that PSA-based screening significantly decreases cancer-specific mortality. The main obstacle in developing and implementing PCa screening strategies is the resulting overdiagnosis and as a consequence overtreatment of indolent cancers. Opportunistic screening is characterized by an adverse benefit-to-harm ratio and should, therefore, not be recommended. The German Statutory Early Detection Program for prostate cancer, which consists of a digital rectal examination (DRE) as a stand-alone screening test, is not evidence-based, neither specific nor sensitive enough and results in unnecessary diagnostics. The European Commission recently urged member states to develop population-based and organized risk-adapted PSA-based screening programs, which are currently tested in the ongoing German PROBASE trial. Finetuning of the diagnostic pathway following PSA-testing seems key to improve its positive and negative predictive value and thereby making PCa screening more accurate. Incorporation of prostatic MRI into screening strategies leads to more accurate diagnosis of clinically significant prostate cancer, while diagnosis of indolent cancers is reduced. In the future, molecular liquid-based biomarkers have the potential to complement or even replace PSA in PCa screening and further personalize screening strategies. Active surveillance as an alternative to immediate radical therapy of demographically increasing PCa diagnoses can potentially further improve the benefit-to-harm ratio of organized screening., Conclusion: Early detection of PCa should be organized on a population level into personalized and evidence-based screening strategies. Multiparametric MRI of the prostate may play a key role in this setting., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The prognosis of conventionally diagnosed lung cancer patients is still rather poor. Two large, randomized trials using screening by low dose CT could demonstrate that early detection in persons with smoking as risk factor can improve this prognosis. Early detection of lung cancer can be achieved by structured screening programs using low dose CT for persons at increased risk, but in addition also by consequent management of incidental pulmonary nodules, which are seen on imaging for other reasons. Integral part of these programs should be prevention measures, especially a consequent, repeated, low-threshold offer of a service for smoking cessation. Programs for lung cancer screening for persons at increased risk are only beneficial for the screenees and cost-effective, if the various parts of the program are optimally integrated and coordinated and all necessary disciplines (especially respiratory medicine, radiology, pathology, thoracic surgery, radiotherapy) are included in a multidisciplinary manner. For Germany the certified lung cancer centres in structured cooperation with physicians in private practice (respiratory physicians, radiologists, general practitioners) would be a good option. It is essential that there is a good perception for the need of early detection of lung cancer in politics and the public and that the persons at risk are reached, contacted and motivated by various methods., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein Erklärung zu nichtfinanziellen Interessen Der Autor arbeitet in wissenschaftlichen Gesellschaften und Gremien mit, die sich mit der Früherkennung von Lungenkarzinomen beschäftigen., (Thieme. All rights reserved.)

Background: Despite continuous improvement of diagnostic and therapeutic procedures, the number of new pancreatic ductal adenocarcinoma (PDAC) cases diagnosed annually almost equals the number of PDAC-related deaths. Prerequisite for curative treatment is a resectable tumor at the time of diagnosis. Individuals with genetic and/or familial risk profiles should therefore be screened and included in structured surveillance programs., Objectives: Description of the status quo and usefulness of current PDAC screening and surveillance concepts., Methods: A selective literature search of current national and international guidelines including underlying literature was performed., Results: Nearly half of pancreatic cancer cases are missed by currently available surveillance programs, even in high-risk cohorts. Magnetic resonance imaging and endoscopic ultrasound supplemented by CA19‑9 (± HbA 1c ) are not accurate enough to ensure robust earlier pancreatic cancer detection. Complementary biomarker panels will take on a crucial diagnostic role in the future., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The autosomal dominant inherited Li-Fraumeni syndrome (LFS) increases the lifetime risk of developing a malignancy to almost 100%. Although breast cancer, central nervous system (CNS) tumors and sarcomas are particularly common, tumors can ultimately occur almost anywhere in the body. As causal therapy is not available, the primary focus for improving the prognosis is early cancer detection. To this end, current cancer surveillance recommendations include a series of examinations including regular imaging beginning at birth., Challenges in Imaging in Lfs: Due to the wide range of tumor entities that can occur in individuals affected by LFS, a sensitive detection requires imaging of various tissue contrasts; however, because life-long screening is potentially initiated at a young age, this requirement for comprehensiveness must be balanced against the presumed high psychological burden associated with frequent or invasive examinations. As radiation exposure may lead to an increased (secondary) tumor risk, computed tomography (CT) and X‑ray examinations should be avoided as far as possible., Current Status and Perspectives: Because annual whole-body magnetic resonance imaging (MRI) has no radiation exposure and yet a high sensitivity for many tumors, it forms the basis of the recommended imaging; however, due to the rarity of the syndrome, expertise is sometimes lacking and whole-body MRI examinations are performed heterogeneously and sometimes with limited diagnostic quality. Optimization and standardization of MRI protocols should therefore be pursued. In addition, the need for an intravenously administered contrast agent has not been conclusively clarified despite its high relevance., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Gastrointestinal polyposis syndromes are the second most common cause of hereditary colorectal carcinomas after Lynch syndrome (hereditary non-polyposis colon cancer, HNPCC). The detection of a causal germline mutation in an affected family member serves for differential diagnosis, assessment of the recurrence risk and predictive testing of healthy individuals at risk., Objectives: The present article aims to provide an overview of the differential diagnosis of different gastrointestinal polyposis syndromes based on the endoscopic findings, polyp histology, extraintestinal phenotype and molecular genetic diagnostics., Materials and Methods: The present article is based on a literature search on gastrointestinal polyposis syndromes., Results: In addition to familial adenomatous polyposis (FAP), there are further subtypes of adenomatous polyposis that can often only be distinguished by the detection of a causative germline mutation and are sometimes associated with different extracolonic manifestations. In hamartomatous polyposis syndromes, the clinical overlaps often cause differential diagnostic problems. Serratated polyposis syndrome is possibly the most frequent polyposis syndrome, although its cause is currently largely unexplained., Conclusions: Early detection and correct classification of polyposis is crucial for adequate prevention and therapy. Access to multidisciplinary expert centres is useful for the care of families.

Clinical/methodical Issue: Artificial intelligence (AI) has the potential to improve diagnostic accuracy and management in patients with lung disease through automated detection, quantification, classification, and prediction of disease progression., Standard Radiological Methods: Owing to unspecific symptoms, few well-defined CT disease patterns, and varying prognosis, interstitial lungs disease represents a focus of AI-based research., Methodical Innovations: Supervised and unsupervised machine learning can identify CT disease patterns using features which may allow the analysis of associations with specific diseases and outcomes., Performance: Machine learning on the one hand improves computer-aided detection of pulmonary nodules. On the other hand it enables further characterization of pulmonary nodules, which may improve resource effectiveness regarding lung cancer screening programs., Achievements: There are several challenges regarding AI-based CT data analysis. Besides the need for powerful algorithms, expert annotations and extensive training data sets that reflect physiologic and pathologic variability are required for effective machine learning. Comparability and reproducibility of AI research deserve consideration due to a lack of standardization in this emerging field., Practical Recommendations: This review article presents the state of the art and the challenges concerning AI in lung imaging with special consideration of interstitial lung disease, and detection and consideration of pulmonary nodules.

Purpose:  Assessment of age group-dependent detection rates of invasive breast cancers among participants in mammography screening including the interval, classified into immunohistochemical subtypes indicating the intrinsic tumor aggressiveness., Materials Und Methods:  The target population comprises women aged 50 - 69 years. All invasive breast cancers diagnosed in one screening (sc) unit during the implementation phase 1/2006 - 12/2010 or identified by the cancer registry during the biennial interval (iv) were categorized based on hormonal-receptor status (HR) and Her2-expression (Her2) into the following subtypes: a) HR+ Her2-, b) HR+ Her2 +, c) HR- Her2 + or d) HR- Her2- (triple-negative); Her2 + and triple-negative types were defined as aggressive. The calculated detection rates (DR, ‰) were based on 53 375 sc-examinations and for the interval on 52 887 sc-negative examinations., Results:  The DRs of all subtypes were higher in screening versus the interval: (a) 4.95 ‰ (n = 264) vs. 1.00 ‰ (n = 53); b) 0.92 ‰ (n = 49) vs. 0.25 ‰ (n = 13); c) 0.36 ‰ (n = 19) vs. 0.06 ‰ (n = 3); d) 0.39 ‰ (n = 21) vs. 0.19 ‰ (n = 10). 77.4 ‰ (89/115) of all aggressive breast cancers including the following 2-year interval were diagnosed by screening. The sum of the DR of aggressive cancers was 1.67 ‰ in screening and 0.49 ‰ in the interval; the corresponding DRs for women aged 60 - 69 years [sc: 2.24 ‰ (51/22 814), iv: 0.58 ‰ (13/22 536)] were higher than among women aged 50 - 59 years [sc: 1.24 ‰ (38/30 561), iv: 0.43 ‰ (13/30 351)]., Conclusion:  Screening has the potential for earlier diagnosis of aggressive tumor types as its detection rate is about three-fold higher compared to the interval. Within the target group, participants aged 60 - 69 years are at risk based on absolute numbers. They show a nearly two-fold higher detection rate of Her2-positive or triple-negative tumors compared to the age group 50 - 59 years., Key Points:   · Her2-positive and triple-negative detection rates are higher in screening than in the interval.. · 77 % of aggressive subtypes are diagnosed by screening, 23 % during the 2-year interval.. · The detection rate is highest among women aged 60 - 69 years in screening.., Citation Format: · Prange A, Bokhof B, Polzer P et al. Higher Detection Rates of Biologically Aggressive Breast Cancers in Mammography Screening than in the Biennial Interval. Fortschr Röntgenstr 2019; 191: 130 - 136., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Based on the update of the S3-Guideline Early Detection, Diagnosis, Treatment and Follow-up Care of Breast Cancer (Version 4.0, December 2017, AWMF registry number 032-045OL, www.leitlinienprogramm-onkologie.de ), evolving topics and relevant changes to the former 2012 version concerning early detection and mammography screening are presented. The outline and figures follow the original text.

Clinical/methodical Issue: The National Lung Screening Trial (NLST) in 2011 was able to prove for the first time that screening with a low-dose CT can reduce lung carcinoma mortality by 20%. Despite the positive outcome of the NLST, there is-unlike in the USA-currently no systematic lung cancer screening in Europe. This is partly because several significantly smaller screening studies in Europe failed to show any improvement in lung cancer mortality., Standard Radiological Methods: On the other hand, Europe's healthcare systems differ substantially from those in the United States, so that a direct transfer of US experience to Europe is not possible. For this reason, guidelines for lung cancer screening must be developed in the individual European countries to ensure that lung cancer mortality can be reduced by means of a quality-assured and cost-effective lung cancer screening., Practical Recommendations: The experience and the expected results of the European screening studies can provide valuable help for these purposes.

Introduction: Screening programs efficiently reduce incidence of and mortality from colorectal cancer. Participation rates in Germany are still relatively low. By knowing how doctors manage their own colorectal cancer screening provides information how they estimate the potential of these strategies and what they recommend their patients., Method: A postal survey was conducted with 450 general physicians and internists aged above 50 years and registered at the KV Unterfranken. They received a questionnaire asking for their personal data, their own colorectal cancer screening and their attitude towards this topic and their patients., Results: Based on 237 questionnaires received, 72 % of the doctors had undergone cancer screening. 81 % decided for colonoscopy. Convinced of the benefit of colorectal cancer screening 90 % of the respondents actively recommend their patients to participate screning programs. 88 % advise to undergo colonoscopy., Conclusion: A high percentage of physicians undergo colorectal cancer screening. Their high participation rate can be used as an additional motivating factor in colorectal cancer prevention campaigns., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The randomized controlled PSAInForm study aims to investigate the effects of a computer-based decision aid which informs men in the age group 55-69 years about advantages and disadvantages of PSA testing. In preparation for the study, the current PSA testing practice in the Münster district was assessed., Materials and Methods: The frequencies of early detection examinations, medically indicated PSA tests, and prostate biopsies in the Münster district were determined, using aggregated data from the regional association of Statutory Health Insurance (SHI) Physicians in Westfalen-Lippe. With anonymized laboratory data, the frequency of PSA tests in general and urological practices, and their distribution among the accounting categories SHI, individual health services, and invoices for privately insured patients were investigated., Results: In about half of more than 50,000 PSA tests, the accounting category could be determined; the rest could only be assigned to SHI or non-SHI services. The percentage of PSA tests that were performed due to reasons other than medically necessary SHI-reimbursed services was > 50% in each age group; it was highest in men younger than 55 years, and declined markedly with advanced age. More than half of the PSA tests that were likely due to opportunistic screening were performed outside the age group 55-69 years., Conclusions: The percentage of PSA tests that were not carried out as SHI services was > 80% in general practices, and 60% in urological practices. These percentages decreased markedly with advancing age. Most of the PSA tests were performed outside the age group which can be considered as the target group for an effective PSA screening according to the results of the European Randomized study of Screening for Prostate Cancer (ERSPC).

The debate refers the known evidence for PSMA-PET/CT in biochemical recurrence of prostate cancer and consider carefully interdisciplinary in which situation which patient needs imaging to choose the adequate therapeutic option. General aspects for the care of cancer patients are taken into consideration., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Schattauer GmbH.)

In patients with lung cancer treatment opportunities and prognosis are correlated to the stage of disease with a chance for curative treatment in patients with early stage disease. Therefore, early detection of lung cancer is of paramount importance for improving the prognosis of lung cancer patients.The National Lung Screening Trial (NLST) has already shown that low-dose CT increases the number of identified early stage lung cancer patients and reduces lung cancer related mortality. Critically considered in terms of CT-screening are false-positive results, overdiagnosis and unessential invasive clarification. Preliminary results of relatively small European trials haven´t yet confirmed the results of the NLST-study.Until now Lung Cancer Screening by low dose CT-scan or other methods is neither approved nor available in Germany.To improve the efficacy of CT-Screening and to introduce early detection of lung cancer in standard practice, additional, complementing methods should be further evaluated. One option might be the supplementary analysis of biomarkers in liquid biopsies or exhaled breath condensates. In addition, defining the high-risk population is of great relevance to identify candidates who might benefit of early detection programs., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Modern endoscopic imaging techniques make it possible to detect tumor diseases of the upper respiratory and digestive tract and treat them minimally invasive - with a good oncologic outcome and maintaining the functionality of the tissue.Horizontal techniques permit the inspection of big mucous membrane surfaces, searching vor areas suspicious of dysplasia or tumor. They can be used as screening techniques. Vertical techniques serve for precise examination of in-depth expansion, infiltration chraracteristics and dignity of known lesions. Cellular techniques deal with the detection of cellular changes in vivo. As the techniques have different advantages and disandvantages, it is recommended to combine several techniques for best diagnostic gains., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Hematological malignancies are typical diseases of the elderly. The aging of the population in the Western World results in a significant increase in the number of elderly patients with hematological malignant diseases. This has important consequences for medicine. One consequence of this development is that the need for tools for the evaluation of both functional and global status of the elderly increases. The use of these tools enables the hematologist to better stratify the patients, to individualize therapy better, to possibly modify therapy in order to improve implementation of supportive measures and interventions, to minimize toxicity and side effects and ultimately to tailor the treatment to the individual patient. Several tools are available for geriatric assessment (GA) and there is strong evidence that an effective GA can detect previously unknown problems. The targeted intervention improves the prognosis and compliance of therapy in elderly patients with hematological malignant diseases.

Background: Differentiation between malignant and benign tumors of peripheral nerves in the early stages is challenging; however, due to the unfavorable prognosis of malignant tumors early identification is required., Objectives: To show the possibilities for detection, differential diagnosis and clinical management of peripheral nerve tumors by imaging appearance in magnetic resonance (MR) neurography., Material and Methods: Review of current literature available in PubMed and MEDLINE, supplemented by the authors' own observations in clinical practice., Results: Although not pathognomonic, several imaging features have been reported for a differentiation between distinct peripheral nerve tumors., Conclusion: The use of MR neurography enables detection and initial differential diagnosis in tumors of peripheral nerves. Furthermore, it plays an important role in clinical follow-up, targeted biopsy and surgical planning.

Lymphedema may result from various benign or malignant causes. In particular rapidly progressing central or unilateral lymphedema (even in case of only discrete clinical findings) should initiate an extensive diagnostic workup to detect underlying malignancies in order to enable early therapy.

The human microbiome - the vast amount of microbes that colonize our body - play an important role in maintaining our health. Changes in microbiome composition have been linked to multiple diseases including cancer. Although mechanisms and causalities of these associations still have to be uncovered, microbiome alterations across various stages of disease can be utilized for novel diagnostic and prognostic tests. Research on biomarkers extracted from the gut microbiome has in particular focused on colorectal cancer, where clinical use is already on the horizon. For example, multiple microbial taxonomic markers such as Fusobacterium nucleatum and other oral pathogens have been identified in human feces with potential for non-invasive diagnostics and prognostics. The article summarizes the recent developments, but also limitations and challenges for the development of microbiome-based biomarkers for cancer early detection., (© Georg Thieme Verlag KG Stuttgart · New York.)

Bronchoalveolar lavage [BAL] is an important procedure in the diagnosis of a variety of lung diseases. While it has enormous value in the diagnostics of inflammatory parenchymal diseases, its significance in lung cancer is unclear. Keeping in mind that immune therapy (e. g. application of checkpoint inhibitors) is gaining importance in the management of lung carcinoma, it is important to know if there are typical cellular patterns in BAL of lung cancer patients. Methods  In a retrospective proof of principle-study, we analyzed 38 patients who underwent BAL at the initial diagnosis of lung cancer. Results  We observed an elevated level of CD25 lymphocytes as well as an increased expression of DR antigen, both signaling lymphocyte activation. We could not find a typical cytologic pattern of inflammatory cells in lung carcinoma patients. Sensitivity of BAL to malignant cells was rare, thus confirming earlier analysis. Conclusion  We could not demonstrate typical cellular patterns in BAL of lung cancer patients. Evaluation of specific microRNA patterns might play a supporting role in the initial diagnosis as well as follow-up of lung cancer patients., (© Georg Thieme Verlag KG Stuttgart · New York.)

Advances in imaging of the female breast have substantially influenced the diagnosis and probably also the therapy and prognosis of breast cancer in the past few years. This article gives an overview of the most important imaging modalities in the diagnosis of breast cancer. Digital mammography is considered to be the gold standard for the early detection of breast cancer. Digital breast tomosynthesis can increase the diagnostic accuracy of mammography and is used for the assessment of equivocal or suspicious mammography findings. Other modalities, such as ultrasound and contrast-enhanced magnetic resonance imaging (MRI) play an important role in the diagnostics, staging and follow-up of breast cancer. Percutaneous needle biopsy is a rapid and minimally invasive method for the histological verification of breast cancer. New breast imaging modalities, such as contrast-enhanced spectral mammography, diffusion-weighted MRI and MR spectroscopy can possibly further improve breast cancer diagnostics; however, further studies are necessary to prove the advantages of these methods so that they cannot yet be recommended for routine clinical use.

Pulmonary nodules are the most frequent pathological finding in low-dose computed tomography (CT) scanning for early detection of lung cancer. Early stages of lung cancer are often manifested as pulmonary nodules; however, the very commonly occurring small nodules are predominantly benign. These benign nodules are responsible for the high percentage of false positive test results in screening studies. Appropriate diagnostic algorithms are necessary to reduce false positive screening results and to improve the specificity of lung cancer screening. Such algorithms are based on some of the basic principles comprehensively described in this article. Firstly, the diameter of nodules allows a differentiation between large (>8 mm) probably malignant and small (<8 mm) probably benign nodules. Secondly, some morphological features of pulmonary nodules in CT can prove their benign nature. Thirdly, growth of small nodules is the best non-invasive predictor of malignancy and is utilized as a trigger for further diagnostic work-up. Non-invasive testing using positron emission tomography (PET) and contrast enhancement as well as invasive diagnostic tests (e.g. various procedures for cytological and histological diagnostics) are briefly described in this article. Different nodule morphology using CT (e.g. solid and semisolid nodules) is associated with different biological behavior and different algorithms for follow-up are required. Currently, no obligatory algorithm is available in German-speaking countries for the management of pulmonary nodules, which reflects the current state of knowledge. The main features of some international and American recommendations are briefly presented in this article from which conclusions for the daily clinical use are derived.

Despite the fact that working with asbestos and placing it on the market have been banned in Germany since 1993 according to the Ordinance on Hazardous Substances, asbestos-related diseases of the lungs and pleura are still the leading cause of death in occupational diseases. The maximum industrial usage of asbestos was reached in former West Germany in the late 1970s and in former East Germany the late 1980s. Occupational diseases, mainly mesotheliomas and lung cancer emerging now are thus caused by asbestos exposure which occurred 30-40 years earlier. It is known that the combination of smoking and asbestos exposure results in a superadditive increase in the risk to develop lung cancer. No suitable screening methods for early detection of malignant mesothelioma are currently available and the therapeutic options are still very limited; however, the national lung screening trial (NLST) has shown for the first time that by employing low-dose computed tomography (LDCT) in heavy smokers, lung cancer mortality can be significantly reduced. According to current knowledge the resulting survival benefits far outweigh the potential risks involved in the diagnostic work-up of suspicious lesions. These results in association with the recommendations of international medical societies and organizations were pivotal as the German statutory accident insurance (DGUV) decided to provide LDCT as a special occupational medical examination for workers previously exposed to asbestos and with a particularly high risk for developing lung cancer.

Fecal immunochemical tests for hemoglobin (FIT) offer several advantages over guaiac-based fecal occult blood testing in colorectal cancer screening, e. g. regarding diagnostic accuracy and participation rates. There are different FITs on the market, namely qualitative FITs (point-of-care tests) and quantitative FITs. Although the European Guidelines for quality assurance in colorectal cancer screening only recommend quantitative FITs, there are continued endeavors to question this and to also allow qualitative FITs as an option. In this commentary, we explain the problems that qualitative FITs pose in terms of quality assurance, particularly regarding the sustained control of the positivity threshold. We further show that various arguments raised in favor of qualitative FITs do not stand up to a critical and rational examination. The use of qualitative FITs is thus not a tenable option for a quality-assured screening program., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Immunological fecal occult blood tests (FIT) are superior in detecting colorectal cancer and its precursors compared to conventional Guajac-based tests. Besides quantitative, laboratory-based FITs qualitative, office-based FITs are increasingly employed. Studies have shown major variation of these tests with respect to sensitivity and specificity, which is most probably caused by different detection limits. In the present study we therefore determined and compared the detection limits and other criteria of commercial FITs., Methods: We determined the detection limits for 21 qualitative and one quantitative FIT using commercial control solutions with defined hemoglobin (Hb) concentrations. These detection limits were compared with the manufacturers' data., Results: The detection limits of the tests showed a wide range of 2 to over 60 µg Hb per gram stool. In many cases the detection limits we determined were not in accordance with the manufacturers' data. Two tests didn't show a positive reaction even with the highest hemoglobin concentration of 440 ng/mL. On the other hand one test showed a positive reaction even at the lowest hemoglobin concentration of 25 ng/mL., Conclusion: The large differences in the detection limits found in this study are consistent with observations of large variation of sensitivity and specificity of qualitative FITs in screening practice. Proper clinical validation of each FIT is to be required before admission for colorectal cancer screening. An additional regular quality control, i. e. by means of external quality control measures and documentation of results of colonoscopies following positive tests results, should be mandatory., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Gold standard in the evaluation of upper aerodigestive tract (UADT) lesions is white light endoscopy followed by invasive tissue biopsy. This procedure is time consuming and expensive. Optical coherence tomography (OCT) is a noninvasive method, which provides high resolution, cross-sectional images of superficial tissue layers in real time., Objective: This article aims to present a contemporary and comprehensive review on the role of OCT in differentiating between epithelial dysplasias and early invasive carcinomas of the UADT., Materials and Methods: PubMed was searched using "optical coherence tomography/larynx" and other appropriate search strings in August 2015., Results: OCT enables differentiation between benign, premalignant, and early malignant lesions of the UADT with high sensitivity and specificity. In addition, OCT holds promise as a clinical tool for guidance of surgical biopsies, follow-up of recurrent lesions, and for demarcation of tumor margins. Inadequate evidence and technical limitations hamper implementation of OCT into clinical routine., Conclusion: If the aforementioned problems are successfully solved, OCT seems to have the potential to substantially improve both diagnosis and management of precancerous and early cancerous lesions of the UADT.

The various stages of tumor growth are characterized by typical epithelial, vascular, and secondary connective tissue changes. Narrow band imaging (NBI) endoscopy is a minimally invasive imaging technique that presents vascular structures in particular at a higher contrast than white light endoscopy alone. In combination with high-resolution image recording and reproduction (high-definition television, HDTV; ultra-high definition, 4K), progress has been made in otolaryngological differential diagnostics, both pre- and intraoperatively. This progress represents an important step towards a so-called optical biopsy. Flexible endoscopy in combination with NBI allows detailed assessment of areas of the upper aerodigestive tract which are difficult to assess by rigid endoscopy. Papillomas, precancerous, and cancerous lesions are characterized by epithelial and connective tissue changes, as well as by typical perpendicular vascular changes. Systematic use of NBI is recommended in the differential diagnosis of malignant lesions of the upper aerodigestive tract. NBI also convinces by a significant improvement in pre- and intraoperative assessment of superficial resection margins. In particular, the combination of NBI and contact endoscopy (compact endoscopy) permits excellent therapeutic decisions during tumor surgery. Intraoperative determination of resection margins at unprecedented precision is possible. In addition, assessment of the form and extent of the perpendicular vessel loops stimulated by epithelial signaling enables differential diagnostic decisions to be made, approximating our goal of an optical biopsy.

Background: Autofluorescence endoscopy is able to delineate malignancy from normal tissue by color change. The objective of the present study was to assess the value of this noninvasive imaging method for the early detection of laryngeal cancer and its precursor lesions., Patients and Methods: In a prospective study, 152 patients with a laryngeal lesion who were undergoing microlaryngoscopy were investigated. Autofluorescence endoscopy was performed after conventional white light endoscopy, just before excisional biopsy was carried out for histologic verification., Results: In the early detection of laryngeal cancer and its precursor lesions, autofluorescence endoscopy showed a significantly higher sensitivity (98 vs. 88%) and accuracy (97 vs. 90%) than white light endoscopy alone, whereas the specificity (97 vs. 93%) was essentially equal in both methods., Conclusion: Autofluorescence endoscopy qualifies as a simple screening procedure for rapid detection of suspicious lesions and assessment of their horizontal extension. This allows for guided biopsy or tumor resection, and can also be used in oncological follow-up.

Background: Early detection and adequate preoperative assessment of neoplastic lesions of the larynx allow for voice-preserving therapy concepts., Objective: The physical principles, clinical applications and most important study results of fluorescence imaging are presented., Materials and Methods: The entire literature on autofluorescence endoscopy of the larynx was analysed and compared to induced fluorescence endoscopy., Results: In detecting malignant and premalignant lesions of the larynx, autofluorescence endoscopy shows a significantly higher sensitivity, specificity and accuracy than white light endoscopy alone. Induced fluorescence endoscopy achieved an even higher sensitivity, albeit at the expense of specificity., Conclusion: Autofluorescence endoscopy represents a simple screening procedure for early detection of laryngeal cancer and its precursor lesions, whereas induced fluorescence endoscopy is more suited for the identification of recurrent disease.

Background: Early detection of cancerous lesions is still crucial for a patient's prognosis. Although diagnostic access to the oral cavity and oropharynx is comparably easy, the incidence of resulting disease remains high. This is due to the fact that in many cases, malignity is recognized too late on a purely visual basis. Previously, we discussed the application of hyperspectral imaging for early detection of precancerous and cancerous lesions of the larynx. This time, we evaluate the method in the oral cavity and oropharynx., Materials and Methods: In 85 patients scheduled for endoscopy, hyperspectral imaging was performed. We used a rigid 0-degree endoscope, a light-adjustable monochromator, and a hyperspectral camera. For evaluation of the method, 3 patients were chosen exemplarily. Training sites from physiological and cancerous tissues were marked. Hyperspectral data from 1 patient were used to train a classifier, which was then used for automatic detection of precancerous and cancerous lesions in another 2 patients., Results: Intraoperative hyperspectral imaging was performed without any problems. Classification showed sensitivities of 61 and 43%, and a specificity of 100%., Conclusion: This proof-of-concept study underscores the high potential of hyperspectral imaging for early recognition of cancer in the mouth and oropharynx. Besides a better prognosis for cancer patients, this approach could lead to higher cost efficiency in the health system.

Background: Increasing life expectancy means growing numbers of elderly survive the critical age for cardiac and vascular diseases only to later experience cancer and dementia., Objectives: Of the types of cancer affecting men, prostate cancer continues to be diagnosed early by prostate-specific antigen (PSA) screening. The clinical relevance and quality of life of those affected must be critically judged. Depending on life expectancy, active surveillance (AS) and watchful waiting (WW) will be increasingly used in geriatric patients. Risk stratification as guided by CGA facilitates the therapeutic decisions of urologists and spares metastatic castration-resistant prostate cancer patients from unnecessary and adverse overtreatment. By 2030, approximately 1.8 million people will have dementia., Conclusions: Thus, in the future, the health care system will have to treat an aging population, which will require the creation of increasing numbers of geriatric hospital departments and cooperative models between geriatrics and other specialties. The future training of medical students and continuing medical education must also be further developed to include aspects on aging. Only in this manner will it be possible to effectively confront the challenges associated with demographic change in the specialty of geriatrics.

Background: Each year in Germany, about 65,000 people are diagnosed with colorectal cancer (CRC) and more than 25,000 people die of the disease. The majority of these cases could be avoided by a more effective screening programme. Recently, a law came into force that offers a great opportunity in this regard. It calls for introducing an organised CRC screening programme in Germany, which includes an invitation system as well as further measures for quality assurance and programme evaluation. To realise this opportunity, challenges of implementation need to be considered. The aim of this review article is to elaborate the challenges of an organised CRC screening in Germany in order to derive the need for action regarding successful implementation., Methods: This review article is based on a selective literature search, including current guidelines and recommendations., Results and Conclusion: In the context of CRC screening, but also by colonoscopies performed for other indications (e.g., due to symptoms), precancerous lesions (adenomas) are detected and removed in a relevant proportion of the target population, which requires a surveillance examination after 3 or 5 years according to current recommendations. Therefore, an efficient invitation system for CRC screening should be designed to allow for a flexible interval depending on previous findings, which differs from mammography screening with its fixed interval. A prerequisite would be the standardised documentation of all colonoscopies irrespective of the indication, given that a substantial proportion of colonoscopies in Germany are performed outside of the screening program. Still, the work load regarding documentation could be less than for mammography screening. Another challenge in terms of organisation results from the parallel offer of 2 different screening tools (colonoscopy and faecal occult blood test). To realise the potential of an organised CRC screening, it seems important to devote sufficient time and resources for developing an efficient and feasible concept, while there might be interim options to avoid further delay regarding the initial invitation of the target population. Given that expertise from, amongst others, gastroenterology, epidemiology, clinical chemistry and health communication is required, an interdisciplinary approach appears essential., (© Georg Thieme Verlag KG Stuttgart · New York.)

A low birth rate in addition to an increasing life expectancy within the context of an aging population characterize the current demographic situation in Germany. Cancer is primarily a disease of old age and the frequency increases with an expanding older population. In 2013, cancer was the second most common cause of death in Germany. With the aid of screening examinations cancer should be detected in the early stages so that suitable therapeutic measures can be initiated. In Germany, screening is currently offered for breast, cervical, colorectal, skin and prostate cancer and is covered by the statutory health insurance. Mammography screening is the only organized screening program in Germany. Eligible women are regularly invited to attend this program, which is not the case for the other types of cancer screening. In accordance with the Cancer Screening and Registry Act (KFRG) of 2013, colorectal and cervical cancer screening will also be implemented as organized screening programs in the future. As is the case in the mammography screening program, those eligible to participate will receive an invitation letter and the new programs are to be continually monitored, documented and evaluated.

Secondary hypertrophic osteoarthropathy, also known as Marie-Bamberger disease, occurs in up to 5 % of patients with non-small cell lung cancer (NSCLC). If the syndrome constellation of finger clubbing and bone pain on palpation is recognized early, lung cancer can be diagnosed at an early stage. This article reports the case of a 52-year-old male patient with knee pain, distal edema, watchglass nails and finger clubbing which first appeared in August 2013. Following angiologic, cardiologic and orthopedic consultations radiographs of the hands, feet and lungs were taken. Following the presumptive diagnosis of hypertrophic osteoarthropathy, the patient was referred to a specialist pulmonary clinic where an adenocarcinoma of the lungs was diagnosed.

Evidence-based information is a prerequisite for informed choice. We compared the effect of evidence-based information on colorectal cancer screening with standard information in a randomised controlled trial. The primary endpoint was informed choice. We randomised 1,577 people insured by a large German statutory health insurance scheme, the Gmünder Ersatzkasse (GEK). The evidence-based information significantly increased informed choices: 44.0% vs. 12.8%; (difference 31.2%, 99% CI 25.7-36.7%; P<0.001)., (© Georg Thieme Verlag KG Stuttgart · New York.)