Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): Guidelines for medical 3D printing and appropriateness for clinical scenarios

Este número da revista Cadernos de Estudos Sociais estava em organização quando fomos colhidos pela morte do sociólogo Ernesto Laclau. Seu falecimento em 13 de abril de 2014 surpreendeu a todos, e particularmente ao editor Joanildo Burity, que foi seu orientando de doutorado na University of Essex, Inglaterra, e que recentemente o trouxe à Fundação Joaquim Nabuco para uma palestra, permitindo que muitos pudessem dialogar com um dos grandes intelectuais latinoamericanos contemporâneos. Assim, buscamos fazer uma homenagem ao sociólogo argentino publicando uma entrevista inédita concedida durante a sua passagem pelo Recife, em 2013, encerrando essa revista com uma sessão especial sobre a sua trajetória

Advanced Ovarian Cancer. A multimodal diagnostic approach to predict outcome

Primary debulking surgery (PDS) followed by platinum-based postoperative chemotherapy isthe standard of care for advanced ovarian cancer (AOC). Absence of macroscopic residualdisease after debulking surgery is the strongest prognostic factor achieved by surgery. Correctcharacterization of the tumor specimen and tumor spread in combination with patient’scharacteristics such as age, comorbidity, and personal wishes, can help to select more effectivetherapeutic approaches for each patient before initial intervention.The overall aim of this thesis were to evaluate diagnostic, from the preoperative to theintraoperative stage, to investigate how an accurate diagnosis could predict surgical outcomeand survival in patients with advanced ovarian cancer.Study I: A retrospective population-based review was conducted of 328 biopsies, in order toassess the adequacy, accuracy and safety of tru-cut biopsy in gynecological malignancies fromthe perspective of a daily clinical practice. The tru-cut biopsy was shown to be a reliable andsafe diagnostic method, with adequacy of 86.3%, accuracy of 97.5% and a complication rate of1.3%. The adequacy of tru-cut biopsy depends on the site of the tissue sample, indications forthe biopsy and the experience of the operator.Study II: A single-center, retrospective population-based study was conducted on 358 patients,to evaluate the reliability of intraoperative FS diagnosis for planning the treatment of patientswith suspected ovarian cancer (OC), from a multidisciplinary perspective. Prevalence,sensitivity, specificity, positive predictive value and negative predictive value for invasivemalignancies on FS were 54.0%, 88.1%, 98.8%, 98.9% and 87.6% respectively. Malignancywas observed to be underestimated, but overestimation in malignancy grading was rare.Borderline-related tumors were more likely to be incorrectly graded by FS, as were rare tumortypes. Despite diagnostic difficulties, in some of the cases, the oral communication duringdeliverance of frozen section diagnosis resulted in adequate treatment decisions, whichminimalized the risk for reoperation or delay of chemotherapy treatment.Studies III and IV: A single-center, retrospective population-based study was conducted on 118patients with AOC, to determine whether the PCI and the quantity of ascites visualized bycomputed tomography (CT) could assess the extent of the tumor (S-PCI) and residual disease(RD) for AOC patients treated with PDS. Furthermore, in study IV, we examine the impact ofthe tumor extent on survival. CT-PCI correlated well with S-PCI and the risk of RD, with a cutoffof 21 for CT-PCI (0.715, p = 0.000). The risk of RD was 3.5 times higher when the quantityof ascites on CT (CTascites) was estimated to be above 1000ml. Regardless of the completenessof cytoreductive surgery or the complication rate, the extent of the tumor at the beginning ofsurgery seemed to affect OS in patients with AOC. PCI above 18.5 doubled the risk of dyingof the disease. CT-PCI seemed to play a prognostic role for PFS, but its prognostic role for OSis still to be investigated.Conclusions: The existing methods of preoperative material retrieval and histopathologicaldiagnosis of ovarian cancer are reliable, when performed by highly trained specialists. Thepreoperative CT is accessible and can be used by an experienced radiologist as a singletechnique to select patients as candidates for PDS. The complete removal of the tumor is a veryimportant prognostic factor for prognosis in AOC, but patient’s status and tumor biology arealso important factors in the decisionmaking on a treatment plan. This thesis maintain the ideathat centralization of cancer care to tertiary centres results in highly specialized pathology,radiology, oncology and surgical departments, and that the multidisciplinary diagnostic andtherapeutic efforts improve health care, and possibly the outcome, for patients with AOC

The Era of Radiogenomics in Precision Medicine: An Emerging Approach to Support Diagnosis, Treatment Decisions, and Prognostication in Oncology

With the rapid development of new technologies, including artificial intelligence and genome sequencing, radiogenomics has emerged as a state-of-the-art science in the field of individualized medicine. Radiogenomics combines a large volume of quantitative data extracted from medical images with individual genomic phenotypes and constructs a prediction model through deep learning to stratify patients, guide therapeutic strategies, and evaluate clinical outcomes. Recent studies of various types of tumors demonstrate the predictive value of radiogenomics. And some of the issues in the radiogenomic analysis and the solutions from prior works are presented. Although the workflow criteria and international agreed guidelines for statistical methods need to be confirmed, radiogenomics represents a repeatable and cost-effective approach for the detection of continuous changes and is a promising surrogate for invasive interventions. Therefore, radiogenomics could facilitate computer-aided diagnosis, treatment, and prediction of the prognosis in patients with tumors in the routine clinical setting. Here, we summarize the integrated process of radiogenomics and introduce the crucial strategies and statistical algorithms involved in current studies

Autoantibodies to Tumor-Associated Antigens in Epithelial Ovarian Carcinoma

This review will focus on recent knowledge related to circulating autoantibodies (AAbs) to tumor-associated antigens (TAAs) in epithelial ovarian carcinoma. So far, the following TAAs have been identified to elicit circulating AAbs in epithelial ovarian carcinoma: p53, homeobox proteins (HOXA7, HOXB7), heat shock proteins (HSP-27, HSP-90), cathepsin D, cancer-testis antigens (NY-ESO-1/LAGE-1), MUC1, GIPC-1, IL-8, Ep-CAM, and S100A7. Since AAbs to TAAs have been identified in the circulation of patients with early-stage cancer, it has been speculated that the assessment of a panel of AAbs specific for epithelial ovarian carcinoma TAAs might hold great potential as a novel tool for early diagnosis of epithelial ovarian carcinoma

Virtual biopsy in abdominal pathology: where do we stand?

In recent years, researchers have explored new ways to obtain information from pathological tissues, also exploring non-invasive techniques, such as virtual biopsy (VB). VB can be defined as a test that provides promising outcomes compared to traditional biopsy by extracting quantitative information from radiological images not accessible through traditional visual inspection. Data are processed in such a way that they can be correlated with the patient’s phenotypic expression, or with molecular patterns and mutations, creating a bridge between traditional radiology, pathology, genomics, and artificial intelligence (AI). Radiomics is the backbone of VB, since it allows the extraction and selection of features from radiological images, feeding them into AI models in order to derive lesions' pathological characteristics and molecular status. Presently, the output of VB provides only a gross approximation of the findings of tissue biopsy. However, in the future, with the improvement of imaging resolution and processing techniques, VB could partially substitute the classical surgical or percutaneous biopsy, with the advantage of being non-invasive, comprehensive, accounting for lesion heterogeneity, and low cost. In this review, we investigate the concept of VB in abdominal pathology, focusing on its pipeline development and potential benefits

Imaging of preclinical endometrial cancer models for monitoring tumor progression and response to targeted therapy

Endometrial cancer is the most common gynecologic malignancy in industrialized countries. Most patients are cured by surgery; however, about 15% of the patients develop recurrence with limited treatment options. Patient-derived tumor xenograft (PDX) mouse models represent useful tools for preclinical evaluation of new therapies and biomarker identification. Preclinical imaging by magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT), single-photon emission computed tomography (SPECT) and optical imaging during disease progression enables visualization and quantification of functional tumor characteristics, which may serve as imaging biomarkers guiding targeted therapies. A critical question, however, is whether the in vivo model systems mimic the disease setting in patients to such an extent that the imaging biomarkers may be translatable to the clinic. The primary objective of this review is to give an overview of current and novel preclinical imaging methods relevant for endometrial cancer animal models. Furthermore, we highlight how these advanced imaging methods depict pathogenic mechanisms important for tumor progression that represent potential targets for treatment in endometrial cancer.publishedVersio

Clinical application of novel circulatory biomarkers in epithelial ovarian cancer

Epithelial ovarian cancer (EOC) encompasses a heterogenous group of malignancies with a poor overall survival rate. The two root problems behind the poor survival of patients are the lack of precise enough biomarkers to enable screening and early detection of the disease and the development of a chemotherapy resistant, fatal disease. Cancer antigen 125 (CA125) is currently the only biomarker validated and widely adopted in the diagnosis, treatment monitoring and follow-up of EOC. However, CA125 is not the ideal biomarker, as it is non-specific for EOC and does not reliably express changes in tumor load. In the current study, the feasibility of four novel biomarkers were investigated: CA125-STn and -MGL, human epididymis protein 4 (HE4) and circulating tumor DNA (ctDNA). This prospective study included 253 women with histologically confirmed EOC, 317 women with benign gynecological diseases and 36 healthy controls. Both CA125- STn and -MGL differentiated EOC from benign diseases with improved specificity compared to conventional CA125. In the longitudinal analyses, HE4, CA125-STn and -MGL, contrarily to CA125, showed good correlation with tumor burden. In addition, HE4 at the time of progression predicted the survival of patients. The longitudinal mutation tracking of plasma ctDNA revealed dynamic, actionable mutations during EOC treatment and follow-up. CA125-STn and -MGL are EOC-specific biomarkers that showed, similar to HE4, good prognostic potential. The CA125 glycoform assays utilize a robust and affordable measurement technique, which makes them feasible biomarkers also in the clinical setting. Based on the current study, HE4 is an indicator of disease aggressiveness and might be a potential tool in the selection of targeted second line treatments. Similarly, the ctDNA analyses revealed actionable mutations enabling the individual treatment of selected HGSC patients. Overall, these novel biomarkers represent state of the art approaches in the diagnosis, treatment monitoring and follow-up of EOC