Circulating Tumor DNA in the Management of Early-Stage Breast Cancer

Liquid biopsies refer to the isolation and analysis of tumor-derived biological material from body fluids, most commonly blood, in order to provide clinically valuable information for the management of cancer patients. Their non-invasive nature allows to overcome the limitations of tissue biopsy and complement the latter in guiding therapeutic decision-making. In the past years, several studies have demonstrated that circulating tumor DNA (ctDNA) detection can be used in the clinical setting to improve patient prognosis and monitor therapy response, especially in metastatic cancers. With the advent of significant technological advances in assay development, ctDNA can now be accurately and reliably identified in early-stage cancers despite its low levels in the bloodstream. In this review, we discuss the most important studies that highlight the potential clinical utility of ctDNA in early-stage breast cancer focusing on early diagnosis, detection of minimal residual disease and prediction of metastatic relapse. We also offer a concise description of the most sensitive techniques that are deemed appropriate for ctDNA detection in early-stage cancer and we examine their advantages and disadvantages, as they have been employed in various studies. Finally, we discuss future perspectives on how ctDNA could be better integrated into the everyday oncology practice

Surgical management of hydatid liver disease

Background: large retrospective clinical study describing the long-term experience of a single center in the surgical management of liver echinococcosis in an endemic area. Methods: 232 patients were operated for liver hydatid disease between 1978 and 2012. Seventy-three patients (Group A) underwent a radical procedure (total pericystectomy or hepatectomy), while 145 (Group B) were treated with a more conservative method (partial cystectomy, with external drainage, omentoplasty or capitonnage) and 14 (Group C) received a combination of total and partial cystectomies. Morbidity, mortality, post-operative complications and recurrence rates in the long-term setting were retrospectively evaluated. Results: Group A patients were treated with zero mortality and a morbidity rate of 10.95%. No recurrence was documented. In Group B, mortality reached 2.76%, (p = 0.153 compared to Group A) morbidity 24.13% (p = 0.021) and there were 10 cases of relapse (6.9%) at three-year complete follow-up (p = 0.989). Extrahepatic sites of disease were not uncommon. Discussion: radical surgical procedures were better tolerated by patients and yielded better results in terms of recurrence rate

Unusual locations of hydatid disease: a 33\ua0year\u2019s experience analysis on 233 patients

Hydatid disease is caused by the tapeworm Echinococcus granulosus and it is an endemic parasitic disease of the Mediterranean countries. Although the liver is the most involved organ by this disease, hydatidosis can be found anywhere in the human body. Rare forms of location may pose diagnostic and therapeutic dilemmas. Herein we report our experience with unusual located hydatid disease diagnosed and treated at our center the last 33\ua0years. A total of 233 patients were treated for echinococcosis (91 males: 39\ua0% and 142 females: 61\ua0%) between 1980 and 2013 at our center. 18 of them (7, 8\ua0%) with uncommon located hydatid disease, were analyzed retrospectively. 18 patients (8 males and 10 females) were presented with unusual location of hydatid disease in our series. Two of them had only extrahepatic cysts (0, 9\ua0%). A total of 64 hydatid cysts with unusual location were analyzed. The most prevalent extrahepatic sites were peritoneal cavity and spleen. Total cystectomy with or without tube drainage or omentopexy was performed for hydatid cysts of the peritoneal cavity in our series. Splenectomy was performed in all cases of splenic hydatidosis. The mean time of post operative stay was 16, 3\ua0days (range 7\u201335\ua0days), morbidity 11\ua0% and mortality 5, 4\ua0%. Although echinococcosis is found most often in the liver and lungs, it seems that any organ can be involved by this zoonotic disease. The operating surgeon must always consider the possibility of unusual location of echinococcal cyst when dealing with patients with cystic mass in endemic areas, because any misinterpretation may result in unfavorable outcomes