Screening for distant metastases in patients with ipsilateral breast tumor recurrence: the impact of different imaging modalities on distant recurrence-free interval

Purpose In patients with ipsilateral breast tumor recurrence (IBTR), the detection of distant disease determines whether the intention of the treatment is curative or palliative. Therefore, adequate preoperative staging is imperative for optimal treatment planning. The aim of this study is to evaluate the impact of conventional imaging techniques, including chest X-ray and/or CT thorax-(abdomen), liver ultrasonography(US), and skeletal scintigraphy, on the distant recurrence-free interval (DRFI) in patients with IBTR, and to compare conventional imaging with 18F-FDG PET-CT or no imaging at all. Methods This study was exclusively based on the information available at time of diagnoses of IBTR. To adjust for differences in baseline characteristics between the three imaging groups, a propensity score (PS) weighted method was used. Results Of the 495 patients included in the study, 229 (46.3%) were staged with conventional imaging, 89 patients (19.8%) were staged with 18F-FDG PET-CT, and in 168 of the patients (33.9%) no imaging was used (N=168). After a follow-up of approximately 5 years, 14.5% of all patients developed a distant recurrence as frst event after IBTR. After adjusting for the PS weights, the Cox regression analyses showed that the diferent staging methods had no signifcant impact on the DRFI. Conclusions This study showed a wide variation in the use of imaging modalities for staging IBTR patients in the Netherlands. After using PS weighting, no statistically signifcant impact of the diferent imaging modalities on DRFI was shown. Based on these results, it is not possible to recommend staging for distant metastases using 18F-FDG PET-CT over conventional imaging technique

Parallel object-oriented term rewriting : the booleans

As a first case study in parallel object-oriented term rewriting, we give two implementations of term rewriting algorithms for boolean terms, using the parallel object-oriented features of the language Pool-T. The term rewriting systems are specified in the specification formalism ASF. Correctness proofs for the implementations are sketched

The free process algebra generated by δ, ε and τ

We establish the structure of the initial process algebra with additive and multiplicative identity elements and no article silent step

Model-based evolutionary analysis: the natural history of phage-shock stress response

The evolution of proteins is inseparably linked to their function. Because most biological processes involve a number of different proteins, it may become impossible to study the evolutionary properties of proteins in isolation. In the present article, we show how simple mechanistic models of biological processes can complement conventional comparative analyses of biological traits. We use the specific example of the phage-shock stress response, which has been well characterized in Escherichia coli, to elucidate patterns of gene sharing and sequence conservation across bacterial species.</jats:p