Interventional oncology procedures for breast cancer metastatic disease: current role and clinical applications

Worldwide, breast cancer constitutes the most common malignant neoplasm among females, impacting 2.1 million women annually. Interventional oncology techniques have been recently added as an additional therapeutic and palliative alternative in breast cancer metastatic disease, concerning mainly osseous, liver, and lung metastasis. In the current literature, there are reports of promising results and documented efficacy regarding the ablation of liver and lung metastasis from breast carcinoma, transarterial embolization or radioembolization, as well as the treatment of osseous metastatic disease. These literature studies are limited by the heterogeneity of breast cancer disease, the evaluation of variable different parameters, as well as the retrospective nature in most of the cases. Consequently, dedicated prospective series and randomized studies are required to identify the role of minimally invasive local therapies of interventional oncology armamentarium. The present review paper focuses upon the current role of interventional oncology techniques for the curative or palliative treatment of metastatic breast cancer disease. The purpose of this review paper is to present the current minimally invasive procedures in the treatment of metastatic breast disease, including local control rates and survival rates

Vertebral Augmentation: Is It Time to Get Past the Pain? A Consensus Statement from the Sardinia Spine and Stroke Congress

Vertebral augmentation has been used to treat painful vertebral compression fractures and metastatic lesions in millions of patients around the world. An international group of subject matter experts have considered the evidence, including but not limited to mortality. These considerations led them to ask whether it is appropriate to allow the subjective measure of pain to so dominate the clinical decision of whether to proceed with augmentation. The discussions that ensued are related below

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VII, nerves of the lower limb.

Funder: Università degli Studi di MilanoOBJECTIVES: To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton's neuroma) and provide clinical indications. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton's neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. RESULTS: Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. CONCLUSION: Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. KEY POINTS: • Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. • US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. • US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area

Percutaneous bipolar radiofrequency ablation for spine metastatic lesions

PurposeThe purpose of this review is to become familiar with the most common indications for imaging guided percutaneous bipolar radiofrequency ablation, to learn about different technical considerations during performance providing the current evidence. Controversies concerning products will be addressed.MethodsWe performed a literature review excluding non-English studies and case reports. All references of the obtained articles were also evaluated for any additional information.ResultsRFA achieves cytotoxicity by raising target area temperatures above 60 degrees C, and may be used to achieve total necrosis of lesions smaller than 3 cm in diameter, to debulk and reduce the pain associated with larger lesions, to prevent pathological fractures due to progressive osteolysis or for cavity creation aiming for targeted cement delivery in case of posterior vertebral wall breaching. Protective ancillary techniques should be used in order to increase safety and augment efficacy of RFA in the spine.ConclusionPercutaneous radiofrequency ablation of vertebral lesions is a reproducible, successful and safe procedure. Ablation should be combined with vertebral augmentation in all cases. In order to optimize maximum efficacy a patient- and a lesion-tailored approach should both be offered focusing upon clinical and performance status along with life expectancy of the patient as well as upon lesion characteristics

Computed Tomography and Ultrasounds for the Follow-up of Hepatocellular Carcinoma Ablation: What You Need to Know

Image-guided tumor ablation provides curative treatment in properly selected patients or appropriate therapeutic options whenever surgical techniques are precluded. Tumor response assessment post ablation is important in determining treatment success and future therapy. Accurate interpretation of post-ablation imaging findings is crucial for therapeutic and follow-up strategies. Computed Tomography (CT) and Ultrasound (US) play important roles in patients’ follow-up post liver thermal ablation therapies. Contrast-enhanced ultrasound (CEUS) can provide valuable information on the ablation effects faster and at a lower cost than computed tomography or magnetic resonance imaging. However, a disadvantage is that the technique cannot examine total liver parenchyma for disease progression as CT and Magnetic Resonance (MR) imaging can. Follow-up strategies for assessment of tumor response includes contrast enhanced multiphasic (non-contrast, arterial, portal, delayed phases) imaging with Computed Tomography at three, six, and 12 months post ablation session and annually ever since in order to prove sustained effectiveness of the ablation or detect progression

Η περιπετειώδης διαδρομή της διαιτησίας και οι αλλαγές που υπέστη από την καθιέρωσή της μέχρι και σήμερα

Η διαρκής «πάλη» μεταξύ εργοδοτών και εργαζομένων, η οποία έχει ως σκοπό τη ρύθμιση των μεταξύ τους σχέσεων και ιδίως την ρύθμιση των σχέσεων εργασίας, σε ατομικό και συλλογικό επίπεδο και η επίλυση αυτών μέσω του θεσμού της διαιτησίας, αποτελεί το αντικείμενο μελέτης της παρούσας διπλωματικής εργασίας. Με την παρούσα εργασία γίνεται μία προσπάθεια περιγραφής, αρχικά των αναγκών εξεύρεσης ενός αξιόπιστου συστήματος ειρηνικής επίλυσης των συλλογικών εργασιακών διαφορών, μέσω της ανάθεσης της διαφοράς σε έναν τρίτο, ο οποίος λόγω του κύρους και των ιδιαίτερων ικανοτήτων του, θα λειτουργήσει εξισσοροπητικά προς την επίλυση της συλλογικής διαφοράς. Στην πρώτη ενότητα, γίνεται προσπάθεια παρουσίασης των πρώτων βημάτων λειτουργίας του θεσμού της Διαιτησίας στην ελληνική εργατική έννομη τάξη, όπως αυτή εκδηλώθηκε και λειτούργησε για πρώτη φορά με το σύστημα του ν. 3239/1955. Εν συνεχεία, γίνεται αναφορά στο διάδοχο σύστημα της Διαιτησίας που επήλθε στη Ελλάδα μέσω του ν. 1876/1990, ενός συστήματος με περισσότερο φιλελεύθερη λειτουργία και ευελιξία, καθώς και στα πρώτα βήματα του θεσμού του ΟΜΕΔ, ο οποίος αποτέλεσε και εξακολουθεί να αποτελεί καθοριστικό παράγοντα στην ειρηνική και ουσιαστική επίλυση των συλλογικών διαφορών μεταξύ των κοινωνικών εταίρων. Ακολούθως γίνεται μία ενδελεχής αναφορά και σχολιασμός των σημαντικών μεταβολών που υπέστη ο θεσμός της διαιτησίας κατά την περίοδο της οικονομικής κρίσης, πρώτα με τις αλλαγές που επέφερε αρχικά ο ν. 3899/2010 και εν συνεχεία η ΠΥΣ του 2012, αποκορύφωμα της οποίας ήταν η κατάργηση της δυνατότητας μονομερούς προσφυγής στη Διαιτησία. Ιδιαίτερη μνεία στη συγκεκριμένη εργασία γίνεται στην απόφαση σταθμό της Ολομέλειας του Συμβουλίου της Επικρατείας 2307/2014, βάσει της οποίας ακυρώθηκε το περιεχόμενο της ΠΥΣ του 2012 ως προς τις διατάξεις περί μονομερούς προσφυγής στη Διαιτησία και στη διαδικασία προσφυγής στο σύστημα της υποχρεωτικής διαιτησία που επέφερε ο σύμφωνος με την επιταγή της Απόφασης του Ακυρωτικού Δικαστηρίου ν.4303/2014, συνοδευόμενη με μία κριτική αποτίμηση της εν λόγω μεταρρύθμισης. Τέλος, τόσο η ανάλυση των αλλαγών που επήλθαν στο θεσμό της Διαιτησίας, αρχικά με τον ν. 4549/2018 και εν συνεχεία, μέσω των αλλαγών που επήλθαν, μετά την ψήφιση του ν. 4635/2019, καθώς και μία παράλληλη προσπάθεια κριτικής προσέγγισης του θεσμού της Διαιτησίας, ιδίως σε σχέση με άλλους παρεμφερείς τρόπους επίλυσης των συλλογικών εργατικών διαφορών που ισχύουν σε άλλα κράτη-μέλη της Ευρωπαϊκής Ένωσης, αλλά και μέσω μιας συνολικής κριτικής αποτίμησης λειτουργίας του συγκεκριμένου θεσμού όπως αυτός λειτούργησε και εξακολουθεί να λειτουργεί στη χώρα μας, αποτελέι το συνολικό περιεχόμενο της παρούσας εργασίας.The constant &quot;struggle&quot; between employers and employees, which aims to regulate the relations between them and in particular the regulation of labor relations, on an individual and collective level and their resolution through the institution of arbitration, is the subject of this study. Main purpose of this work, is an attempt to describe, initially, the need to find a reliable system for the peaceful settlement of collective labor disputes, by assigning the dispute to a third party, which, due to its prestige and special capabilities, will act as a balancing factor, in order to resolve the collective difference. In the first section, an attempt is made to present the first steps of operation of the institution of Arbitration in Greece, as it manifested and operated for the first time with the system of 3239/1955 Law. Then, reference is made to the successor system of Arbitration that occurred in Greece through 1876/1990 Law, a system with more liberal operation and flexibility, as well as the first steps of the institution of Organization of Mediation and Arbitration, which was and continues to be a determining factor, in the peaceful and effective resolution of collective disputes between the social partners. Then there is a thorough report and commentary on the important changes that the institution of Arbitration underwent during the period of financial crisis, the culmination of which was the abolition the possibility of unilateral recourse to Arbitration. Special mention of this work is made in the decision station of the Plenary Session of the Council of State 2307/2014, based on which the content of the 6/2012 CM Act was annulled regarding the provisions on unilateral appeal to the Arbitration and the appeal procedure in the system of compulsory Arbitration brought by in accordance with the requirement of the Decision of the Court of Cassation 4303/2014 Law, accompanied by a critical evaluation of the said reform. Finally, both the analysis of the changes that occurred in the institution of Arbitration, initially with 4549/2018 Law and then, through the changes that occurred, after the enactment of 4635/2019 Law, as well as a parallel attempt to critically approach Arbitration, in particular in relation to other similar ways of resolving collective labor disputes in force in other Member States of the European Union, but also through a comprehensive critique of the functioning of this institution as it has operated and continues to operate in our country, the overall content of this diploma thesis

Quantitative discomanometry

Ο σκοπός της παρούσας μελέτης είναι να αναδείξει τη διαγνωστική αποτελεσματικότητα και τον προγνωστικό χαρακτήρα της ποσοτικής δισκομανομετρίας (QD) για την αξιολόγηση του δισκογενούς πόνου μέσα από μια συσχέτιση των ενδοδισκικών τιμών πίεσης που καταγράφησαν μέσω αυτής της διαγνωστικής μεθόδου και της μείωσης του πόνου που επιτεύχθηκε μετά από ελάχιστα επεμβατική απεικονιστικά καθοδηγούμενη θεραπεία μεσοσπονδύλιου δίσκου σε συνολικά 36 ασθενείς με κήλη μεσοσπονδύλιου δίσκου που πάσχουν από ισχιαλγία, με ή χωρίς οσφυαλγία. Κατά τη διάρκεια των τελευταίων 3 ετών, 36 ασθενείς (21 άνδρες / 15 γυναίκες - εύρος 18-52 έτη, μέση ηλικία 36 ± 5,8 έτη) με συμπτωματική (πόνο στα κάτω άκρα και / ή πόνος χαμηλά στη μέση - πόνος στα κάτω άκρα μεγαλύτερης έντασης από τον πόνο στην πλάτη, στις περιπτώσεις που συνυπήρξαν) κήλη μεσοσπονδύλιου δίσκου (απεικόνιση σε Μαγνητική Τομογραφία) και ανθεκτικό άλγος σε συντηρητική θεραπεία (διάρκειας 4-6 εβδομάδων) η οποία συνδυάστηκε με απεικονιστικάκαθοδηγούμενες διαδερμικές διηθήσεις υπεβλήθησαν σε διαδερμική ποσοτική δισκομανομετρία λίγο πριν τη διαδερμική ελάχιστα επεμβατική θεραπεία του μεσοσπονδύλιου δίσκου. Τα επίπεδα που περιλαμβάνονται στη μελέτη μας ήταν 02-03 (n = 1), 03-04 (n = 2), 04-05 (n = 15), 05 - I1 (n =18). Η μέση αρχική και μέγιστη πίεση ήταν 20.5 και 76.6 psi αντιστοίχως. Η μέση διαφορά αρχικής-μέγιστης πίεσης ήταν 56.1 psi, ενώ ο μέσος μέγιστος εγχεόμενος όγκος ήταν 2.8 ml με ελάχιστη τιμή 0.9 και μέγιστη τιμή 9.5 ml. Εν κατακλείδι, η αρχική πίεση (Po), η μέγιστη πίεση (Pmax), η διαφορά της μέγιστης πίεσης από την αρχική πίεση (Pmax-Po) και ο εγχυόμενος όγκος αποδεικνύονται στατιστικά σημαντικές παράμετροι στη μελέτη μας. Σε απόλυτους αριθμούς: Po <14 psi, Pmax <65 psi, Pmax-Po <47 psi και Vmax <2,4 ml αποδείχθηκε στη μελέτη μας να είναι στατιστικά σημαντικές τιμές, όταν συσχετίζονται με συγκεκριμένες τιμές μείωσης του πόνου. Η ποσοτική δισκομανομετρία φαίνεται να είναι μια αποτελεσματική διαγνωστική τεχνική για την αξιολόγηση του δισκογενούς πόνου, η οποία θα μπορούσε να χρησιμεύσει ως ένα χρήσιμο εργαλείο για τη σωστή επιλογή των ασθενών σχετικά με ελάχιστα επεμβατικές τεχνικές θεραπείας των παθολογικών μεσοσπονδύλιων δίσκων. Παρά το μικρό αριθμό ασθενών που συμπεριλήφθηκαν στη μελέτη, τα αποτελέσματά μας φαίνεται να πιστοποιούν τη συμβολή της ποσοστικής δισκομανομετρίας στη λήψη αποφάσεων για την θεραπεία παθήσεων των μεσοσπονδύλιων δίσκων σπονδυλικής στήλης

Percutaneous, Imaging-Guided Biopsy of Bone Metastases

Approximately 70% of cancer patients will eventually develop bone metastases. Spine, due to the abundance of red marrow in the vertebral bodies and the communication of deep thoracic-pelvic veins with valve-less vertebral venous plexuses, is the most common site of osseous metastatic disease. Open biopsies run the risk of destabilizing an already diseased spinal or peripheral skeleton segment. Percutaneous biopsies obviate such issues and provide immediate confirmation of correct needle location in the area of interest. Indications for percutaneous bone biopsy include lesion characterization, optimal treatment and tumor recurrence identification, as well as tumor response and recurrence rate prediction. Predicting recurrence in curative cases could help in treatment stratification, identification, and validation of new targets. The overall accuracy of percutaneous biopsy is 90&ndash;95%; higher positive recovery rates govern biopsy of osteolytic lesions. The rate of complications for percutaneous biopsy approaches is &lt;5%. The purpose of this review is to provide information about performing bone biopsy and what to expect from it as well as choosing the appropriate imaging guidance. Additionally, factors governing the appropriate needle trajectory that would likely give the greatest diagnostic yield and choice of the most appropriate biopsy system and type of anesthesia will be addressed

Percutaneous Bone and Soft Tissue Biopsies: An Illustrative Approach

Even in pandemic times cancer remains one of the leading causes of death worldwide. Spine and peripheral skeleton constitute a common location for metastatic disease whilst numerous sarcomatous and other primary cancers may be depicted in the musculoskeletal system. Tissue sampling is necessary for histopathological identification as well as for molecular profiling in order to personalize cancer prevention, diagnosis and treatment; in addition cultures of bone and soft tissue sampling contribute to identifying pathogens in order to provide the most appropriate systemic therapy. Performing an open surgical biopsy increases morbidity and mortality while at the same time runs the risk of destabilizing a pathologic segment. Imaging guidance ensures high safety and efficacy rates and contributes to the minimally invasive character of percutaneous biopsy by providing immediate confirmation of correct needle location in the area of interest. Selecting the imaging guidance method which will visualize the target lesion and the needle trajectory as well as the largest possible needle biopsy that can maximize the diagnostic yield is of outmost importance for high safety and efficacy rates. The purpose of the present review is to provide a comprehensive, current overview of percutaneous, imaging guided biopsy in the spine and peripheral skeleton, to become familiar with the most common indications, to learn about different technical considerations during performance and to provide the current evidence. Controversies concerning products will be addressed. (C) 2021 Elsevier Inc. All rights reserved

The Role of Percutaneous Ablation in the Management of Colorectal Cancer Liver Metastatic Disease

Approximately 50% of colorectal cancer patients will develop metastases during the course of the disease. Local or locoregional therapies for the treatment of liver metastases are used in the management of oligometastatic colorectal liver disease, especially in nonsurgical candidates. Thermal ablation (TA) is recommended in the treatment of limited liver metastases as free-standing therapy or in combination with surgery as long as all visible disease can be eradicated. Percutaneous TA has been proven as a safe and efficacious therapy offering sustained local tumor control and improved patient survival. Continuous technological advances in diagnostic imaging and guidance tools, the evolution of devices allowing for optimization of ablation parameters, as well as the ability to perform margin assessment have improved the efficacy of ablation. This allows resectable small volume diseases to be cured with percutaneous ablation. The ongoing detailed information and increasing understanding of tumor biology, genetics, and tissue biomarkers that impact oncologic outcomes as well as their implications on the results of ablation have further allowed for treatment customization and improved oncologic outcomes even in those with more aggressive tumor biology. The purpose of this review is to present the most common indications for image-guided percutaneous ablation in colorectal cancer liver metastases, to describe technical considerations, and to discuss relevant peer-reviewed evidence on this topic. The growing role of imaging and image-guidance as well as controversies regarding several devices are addressed