1,885 research outputs found

    The complementary role of imaging and tumor biomarkers in gynecological cancers: an update of the literature

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    Gynecological tumors, including endometrial, cervical and ovarian cancer, have increased in incidence over time. The widespread introduction of screening programs and advances in diagnostic imaging methods has lead to a progressive increase in gynecological cancer detection. Accurate diagnosis and proper monitoring of disease remain the primary target for a successful treatment. In the last years, knowledge about cancer biomarkers has considerably increased providing great opportunities for improving cancer detection and treatment. In addition, in the last few years there has been an important development of imaging techniques. Nowadays, a multimodal approach including the evaluation of serum tumor biomarkers combined with imaging techniques, seems to be the best strategy for assessing tumor presence, spread, recurrence, and/or the response to treatment in female cancer patients In this review we provide an overview of the application of biomarkers combined with novel imaging methods and highlight their roles in female cancer diagnosis and follow-up

    Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging - IDKD Book

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    Gastrointestinal disease; PET/CT; Radiology; X-ray; IDKD; Davo

    Ca 125 in the physiology and pathology of the female reproductive tract: With particular reference to the diagnosis of ovarian cancer

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    This thesis addresses the hypothesis that "the CA 125 tumour associated antigen is of value in the diagnosis of ovarian cancer". The literature concerning CA 125 and diagnostic aspects of ovarian cancer are reviewed in chapter 1 and the research methodology and the characteristics of CA 125 assay systems are described in chapters 2 and 3. Chapters 4-6 describe studies of the compartmental distribution of CA 125 in the female reproductive tract in physiological and pathological states. The results suggest that CA 12 5 is a product of normal endometrium, pregnancy endometrium and benign ovarian tumours as well as malignant ovarian tumours, and that there is a physiological rise in serum CA 125 levels during menstruation and early pregnancy. It is concluded that the main factor influencing serum levels of CA 12 5 is the integrity of the blood: tissue barrier. Chapter 7 describes a prospective study to evaluate serum CA 125 measurement in the preoperative diagnosis of ovarian cancer. The results indicate that the accuracy of CA 125 measurement is superior to clinical criteria and similar to ultrasound. The highest diagnostic accuracy was achieved by combining CA 125, ultrasound and menopausal status in a risk of malignancy index. Chapter 8 describes phase 1 of a prospective study of screening for ovarian cancer amongst postmenopausal women. The results indicate that to achieve satisfactory specificity will require a multimodal approach combining CA 125 measurement with either pelvic examination or ultrasonography. Chapter 9 is a report of a phase 2 study of screening for ovarian cancer using the sequential combination of CA 125 and ultrasound. The preliminary results in 20,000 postmenopausal volunteers suggest that the lead time achieved over clinical presentation using this screening protocol is greater than 1 year. It is concluded that despite limitations of specificity and sensitivity, CA 125 is of value in the preoperative diagnosis of ovarian cancer and may have a role in a multimodal screening protocol for early stage disease

    Validation of a Multivariate Serum Profile for Epithelial Ovarian Cancer Using a Prospective Multi-Site Collection

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    In previous studies we described the use of a retrospective collection of ovarian cancer and benign disease samples, in combination with a large set of multiplexed immunoassays and a multivariate pattern recognition algorithm, to develop an 11-biomarker classification profile that is predictive for the presence of epithelial ovarian cancer. In this study, customized, Luminex-based multiplexed immunoassay kits were GMP-manufactured and the classification profile was refined from 11 to 8 biomarkers (CA-125, epidermal growth factor receptor, CA 19-9, C-reactive protein, tenascin C, apolipoprotein AI, apolipoprotein CIII, and myoglobin). The customized kits and the 8-biomarker profile were then validated in a double-blinded manner using prospective samples collected from women scheduled for surgery, with a gynecologic oncologist, for suspicion of having ovarian cancer. The performance observed in model development held in validation, demonstrating 81.1% sensitivity (95% CI 72.6 – 87.9%) for invasive epithelial ovarian cancer and 85.4% specificity (95% CI 81.1 – 88.9%) for benign ovarian conditions. The specificity for normal healthy women was 95.6% (95% CI 83.6 – 99.2%). These results have encouraged us to undertake a second validation study arm, currently in progress, to examine the performance of the 8-biomarker profile on the population of women not under the surgical care of a gynecologic oncologist

    Abdominal CT findings in HIV-infected patients presenting with acute abdomen

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    A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in Diagnostic Radiology. Johannesburg, 2016INTRODUCTION: Clinicians have often been faced with the dilemma of whether to manage HIV-positive patients presenting with an acute abdomen surgically or conservatively. Since poorer outcomes have been associated with surgery, CT scan has been an important tool in clinical decision-making. AIM: The aim of the study was to evaluate the abdominal CT findings of HIV-positive patients that presented with an acute abdomen, with specific interest in abdominal TB. METHOD: A retrospective and quantitative study was conducted on HIV-positive adults (50) referred for diagnosis of "acute abdomen" RESULTS: Fifty percent the patients had a radiological emergency diagnosis, of which only 18% needed surgery, and 44% had a TB related diagnosis on discharge. CT scan had a sensitivity of 73% and a specificity of 64% (PPV 36%, NPV 89%) in the diagnosis of abdominal TB when compared to laboratory diagnostic tests. When CT scan was compared to a "probable diagnosis" of TB the sensitivity and specificity, increased to 81% and 83% respectively (PPV 77%, NPV 86%).The inter-reader agreement ranged from moderate to almost perfect. CONCLUSIONS: CT scan was found to be a very useful tool in the management of HIVpositive patients who presented with an acute abdomen. Not only did CT scan identify TB of the abdomen, when surgical management could have been avoided, it frequently excluded TB as a cause and assisted in the further surgical management of the patient. The HIV-positive patient with acute abdomen should receive a contrasted CT scan as part of their work-up not only to diagnose surgical emergencies but also to avoid unnecessary surgery.MT 201

    Positron emission tomography in ovarian cancer: 18F-deoxy-glucose and 16α-18F-fluoro-17β-estradiol PET

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    The most frequently used molecular imaging technique is currently 18F-deoxy-glucose (FDG) positron emission tomography (PET). FDG-PET holds promise in the evaluation of recurrent or residual ovarian cancer when CA125 levels are rising and conventional imaging, such as ultrasound, CT, or MRI, is inconclusive or negative. Recently, integrated PET/CT, in which a full-ring-detector clinical PET scanner and a multidetector helical CT scanner are combined, has enabled the acquisition of both metabolic and anatomic imaging data using one device in a single diagnostic session. This can also provide precise anatomic localization of suspicious areas of increased FDG uptake and rule out false-positive PET findings. FDG-PET/CT is an accurate modality for assessing primary and recurrent ovarian cancer and may affect management. FDG-PET/CT may provide benefits for detection of recurrent of ovarian cancer and improve surgical planning. And FDG-PET has been shown to predict response to neoadjuvant chemotherapy and survival in advanced ovarian cancer. This review focuses on the role of FDG-PET and FDG-PET/CT in the management of patients with ovarian cancer. Recently, we have evaluated 16α-18F-fluoro-17β-estradiol (FES)-PET, which detects estrogen receptors. In a preliminary study we reported that FES-PET provides information useful for assessing ER status in advanced ovarian cancer. This new information may expand treatment choice for such patients

    Diffusion-weighted images and its application in the clinical diagnostic testing of endometrial focal lesions

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    Background: Numerous endometrial disorders can create several difficulties for the radiologist due to the overlapping of imaging characteristics and diverse endometrial pathologies. The most frequently utilized imaging tool for diagnosing and characterizing endometrial focal lesions is magnetic resonance imaging (MRI) with diffusion weighted images (DWI).Objective: We conducted this study to determine the efficacy of MRI with DWI in improving the diagnostic accuracy of endometrial focal lesions, especially in the differential diagnosis of benign and malignant focal endometrial masses.Patients and Methods: This study recruited 36 women (21 postmenopausal and 15 premenopausal) who experienced vaginal bleeding and had endometrial thickness and focal endometrial lesions with a distinct echo pattern on ultrasound (US) examination. The age of patients was between 27 to 85 years, with an average of 45.2 years. Ethics Committee approval was obtained in addition to written informed consent from all included patients.Results: The 36 patients included in this study, were classified according to their lesions histopathological results; Benign group (15 lesions; 41.67%) and malignant group (21 lesions; 58.33%). The most common benign lesion was endometrial polyp (9/15) while the most common malignant lesion was endometrial carcinoma (21/21). In the current study MRI with diffusion could correctly diagnose 33 lesions out of 36 lesions, achieving (91.6%) sensitivity, (100%) specificity, (100%) positive predictive value (PPV), (95.6%) negative predictive value (NPV) and accuracy (97.05 %).Conclusion: Integrating DWI and ADC mapping at a high b value in pelvic MRI examination improves the sensitivity, specificity, and precision of diagnosing endometrial focal lesions

    Role of MRI in staging and follow-up of endometrial and cervical cancer:pitfalls and mimickers

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    Abstract MRI plays important roles in endometrial and cervical cancer assessment, from detection to recurrent disease evaluation. Endometrial cancer (EC) is the most common malignant tumor of the female genital tract in Western countries. EC patients are divided into risk categories based on histopathological tumor type, grade, and myometrial invasion depth. EC is surgically staged using the International Federation of Gynecology and Obstetrics (FIGO) system. Since FIGO (2009) stage correlates with prognosis, preoperative staging is essential for tailored treatment. MRI reveals myometrial invasion depth, which correlates with tumor grade and lymph node metastases, and thus correlates with prognosis. Cervical cancer (CC) is the second most common cancer, and the third leading cause of cancer-related death among females in developing countries. The FIGO Gynecologic Oncology Committee recently revised its CC staging guidelines, allowing staging based on imaging and pathological findings when available. The revised FIGO (2018) staging includes node involvement and thus enables both therapy selection and evaluation, prognosis estimation, and calculation of end results. MRI can accurately assess prognostic indicators, e.g., tumor size, parametrial invasion, pelvic sidewall, and lymph node invasion. Despite these important roles of MRI, radiologists still face challenges due to the technical and interpretation pitfalls of MRI during all phases of endometrial and cervical cancer evaluation. Awareness of mimics that can simulate both cancers is critical. With careful application, functional MRI with DWI and DCE sequences can help establish a correct diagnosis, although it is sometimes necessary to perform biopsy and histopathological analysis
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