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Background: The purpose of this study was to identify the factors influencing oncologic outcomes for patients with early-intermediate glottic cancer treated by transoral laser microsurgery (TLM)., Methods: This was a retrospective mono-institutional study. A total of 590 patients with cTis-cT3 glottic cancer underwent TLM with curative intent., Results: TLM alone was performed in 538 patients (91.2%) and TLM followed by adjuvant radiotherapy (RT) was done in 52 (8.8%). Five-year recurrence-free survival (RFS) and 10-year overall survival (OS) were 85.3% and 74.7%, respectively. The larynx-preservation ratio was 95.9%. In particular, from our data, we found that occult metastases were rare (1.2%); preventive tracheotomy was not necessary; the local recurrence rate of Tis was similar to that in the T2 and T3 group; and no major or lethal complications were observed., Conclusion: Age (>60 vs ≤60), type of cordectomy (≥IV vs ≤III), status of margins, fixed arytenoid, and pathologic T classification, were the variables associated with RFS, OS, and organ-preservation rate. © 2016 Wiley Periodicals, Head Neck 39: 71-81, 2017., (© 2016 Wiley Periodicals, Inc.)

Objectives: To assess the independent prognostic value of standardized uptake value (SUV) and apparent diffusion coefficient (ADC), separately and combined, in order to evaluate if the combination of these two variables allows further prognostic stratification of patients with head and neck squamous cell carcinomas (HNSCC)., Methods: Pretreatment SUV and ADC were calculated in 57 patients with HNSCC. Mean follow-up was 21.3 months. Semiquantitative analysis of primary tumours was performed using SUV maxT/B , ADC mean , ADC min and ADC max . The prognostic value of SUV maxT/B , ADC mean , ADC min and ADC max in predicting disease-free survival (DFS) was evaluated with log-rank test and Cox regression models., Results: Patients with SUV maxT/B ≥5.75 had an overall worse prognosis (p = 0.003). After adjusting for lymph node status and diameter, SUV maxT/B and ADC min were both significant predictors of DFS with hazard ratio (HR) = 10.37 (95 % CI 1.22-87.95) and 3.26 (95 % CI 1.20-8.85) for SUV maxT/B ≥5.75 and ADC min ≥0.58 × 10 -3 mm 2 /s, respectively. When the analysis was restricted to subjects with SUV maxT/B ≥5.75, high ADC min significantly predicted a worse prognosis, with adjusted HR = 3.11 (95 % CI 1.13-8.55)., Conclusions: The combination of SUV maxT/B and ADC min improves the prognostic role of the two separate parameters; patients with high SUV maxT/B and high ADC min are associated with a poor prognosis., Key Points: • High SUV maxT/B is a poor prognostic factor in HNSCC • High ADC min is a poor prognostic factor in HNSCC • In patients with high SUV maxT/B , high ADC min identified those with worse prognosis.

Purpose: The authors assessed the adequacy and sensitivity of CT-guided bone biopsy in 308 procedures performed in 286 cancer patients with suspected bone metastases., Materials and Methods: An electronic search of our CT-guided bone biopsy database was retrospectively performed to evaluate the adequacy of samples and, in the event of negative samples, whether the patients had radiological progression at the site of biopsy (false negative). Adequacy and false-negative rate were compared with radiological features, biopsy location, specimen length and complications to assess any statistically relevant association with a multivariate logistic regression model., Results: A total of 290/308 (94.1 %) samples were adequate. Forty-five patients had normal bone marrow and were followed-up, with evidence of progression at the site of biopsy in 10 cases (false-negative cases); overall sensitivity was 96.7 %. Specimen length was significantly correlated to the probability of an adequate biopsy (p = 0.035) and inversely correlated to the probability to obtain a false-negative result (p = 0.02). We encountered 11/308 (3.5 %) minor complications and no major complications., Conclusion: CT-guided biopsy of bone lesions in cancer patients allows for a final diagnosis in 94 % of cases. A specimen longer than 1 cm may lead to a significant result in terms of adequacy and sensitivity. Negative biopsies with positive positron emission tomography or magnetic resonance imaging and specimen shorter than 1 cm should be repeated to avoid a false-negative result.

Has color Doppler a role in the evaluation of mammary lesions? A schematic review of color Doppler diagnostic criteria, indicating a benign or malignant lesion, are described.Malignant tumors have a tendency to show increased vascularization, but avascular tumors may be found as well as hypervascular benign tumors.Number of vessels, blood-flow velocity, and intra-tumoral vessel resistance assessed by color Doppler ultrasonography don't permit clear differentiation between malignant and benign tumors, but intra-tumoral blood-flow analysis well correlates with aggressiveness and histological grade of the mass, so a preoperative assessment using Color Doppler may give preliminary prognostic informations useful for therapeutic planning.Color Doppler ultrasound may be valuable also in assessing the efficacy of neoadjuvant chemotherapy and in particular of antiangiogenesis treatments.Color Doppler ultrasound has many other useful applications in the evaluation of diseases of the female and male breast, that are reviewed in the paper.Color Doppler however is not conceived as a stand-alone examination, but associated with B-mode ultrasound that is quite effective as a diagnostic tool, often not requiring Doppler informations.

Background: We describe preoperative computed tomography (CT)-guided injection of radiotracer technetium (99m) macroaggregates ((99m)Tc-MAA) in challenging small lung nodules, intraoperative localization, and resection., Methods: Between November 2007 and February 2010, 44 patients with 47 lung nodules which were detected incidentally or at screening and that were (18)F-fluorodeoxyglucose positron emission tomography ((18)F FDG-PET) positive or increasing in size at subsequent CT scans were candidates for surgical biopsy. Inclusion criteria for preoperative percutaneous CT-guided (low-dose technique) (99m)Tc-MAA localization included having at least one of the following characteristics: nodule size less than 1 cm, subsolid morphology, or distance from the pleura greater than 1 cm., Results: Mean nodule size was 11 mm (range, 5 to 24 mm); 24 nodules were nonsolid, 15 nodules were partially solid, and 8 nodules had a solid morphology. Mean distance from the pleura was 11 mm (range, 0 to 35 mm). Localization complications included 13 minor asymptomatic pneumothoraces, 9 parenchymal hemorrhage suffusions, 1 mild allergic reaction to contrast medium, and 2 patients with chest pain after the procedure. Nine patients had mild extravasation of radiotracer into the pleura. In 2 cases, there was an extravasation of a significant quantity of radiotracer into the pleural cavity. Thoracoscopic biopsy was performed in 30 cases, 2 cases were converted to thoracotomy, and 12 patients underwent intentional thoracotomy., Conclusions: Asymptomatic subjects with suspicious nodules detected by screening or incidental CT are best candidates due to small lesion size and high percentage of nonsolid morphology, making thoracoscopic biopsy potentially difficult. Radiotracer localization is a safe, versatile, simple technique to help perform diagnosis with a minimally invasive approach in nonpalpable lung lesions., (Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Low-dose computed tomography (ld-CT) for lung cancer screening in high-risk subjects is performed within clinical trials and has started to be used in routine clinical practice. The technique is well defined, even if some methodological problems are still debated, such as the measurements of pulmonary nodules, the size to define them as clinically significant, the management of small or non-solid nodules and the best diagnostic work-up to optimize diagnostic accuracy. The data derived from an IEO observational study, started in 2000, shows a high prevalence and incidence of early stage lung cancer detected at ld-CT, demonstrating the need to prolong observation for a long period of time. The high survival rate of patients with screening-detected cancer has recently been debated in a number of papers using statistical models, but the advantage of the yearly ld-CT for the individuals is unquestionable; its benefit on the population base has still to be demonstrated by ongoing randomized trials.

Purpose: To prospectively compare clinical breast examination (CBE), mammography, ultrasonography (US), and contrast material-enhanced magnetic resonance (MR) imaging for screening women at genetic-familial high risk for breast cancer and report interim results, with pathologic findings as standard., Materials and Methods: Institutional review board of each center approved the research; informed written consent was obtained. CBE, mammography, US, and MR imaging were performed for yearly screening of BRCA1 or BRCA2 mutation carriers, first-degree relatives of BRCA1 or BRCA2 mutation carriers, or women enrolled because of a strong family history of breast or ovarian cancer (three or more events in first- or second-degree relatives in either maternal or paternal line; these included breast cancer in women younger than 60 years, ovarian cancer at any age, and male breast cancer at any age)., Results: Two hundred seventy-eight women (mean age, 46 years +/- 12 [standard deviation]) were enrolled. Breast cancer was found in 11 of 278 women at first round and seven of 99 at second round (14 invasive, four intraductal; eight were

The introduction of an evaluation standard for the response to therapy of neoplastic lesions is necessary not only for the standardisation of clinical research protocols, but also to allow the objective and transferable management of the oncology patient in routine clinical practice. The international criteria that define how to evaluate a neoplastic disease and to determine its response to treatment were first introduced in the 80s by the WHO and have been recently updated with the new RECIST criteria defined by broad consensus of European and U.S. oncology organisations and published in 2000. The new criteria, especially those related to lesion measurement are substantially different from the previous criteria, they are simpler and easier to use, but present some problems that should be brought to the attention of radiologists who must adjust them with the common sense and balance of judgement resulting from our practice. These problems refer above all to certain types of lesions (such as cystic, bone and nodal metastases), to the method for measuring the maximum diameter, to the use of contrast agents and to the frequency of follow-up examinations, with consequent effects on radioprotection and workloads. In any case, the radiologist who examines a patient with neoplastic lesions and compares the examination results with previous images, should make sure the report does not contain vague language, that the maximum diameters of the lesions are always indicated and that any morphological and/or contrast enhancement changes are described: the report should enable clinicians to make a complete evaluation of the condition and of disease progression, for a global management of the oncology patient.