The Experts below are selected from a list of 10135812 Experts worldwide ranked by ideXlab platform
Chite Wang - One of the best experts on this subject based on the ideXlab platform.
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detection of cervical lymph node metastasis in head and neck cancer patients with clinically n0 neck a meta analysis comparing different imaging modalities
BMC Cancer, 2012Co-Authors: Wuchia Lo, Chite Wang, Lijen LiaoAbstract:How to properly manage clinically negative neck of head and neck cancer patients is a controversial topic. Research is now directed toward finding a method sensitive enough to bring the risk of occult metastases below 20%. The aim of this review was to compare the diagnostic accuracy of different imaging modalities, including CT, MRI, PET and US, in clinically N0 head and neck cancer patients. For this systematic review and meta-analysis, PubMed and the Cochrane Database were searched for relevant original articles published up to May 2011. Inclusion criteria were as follows: articles were reported in English; CT, MRI, PET or US were performed to identify cervical metastases in clinically N0 head and neck squamous cell carcinoma; and data were sufficient for the calculation of true-positive or false-negative values. A bivariate random effect model was used to obtain pooled sensitivity and specificity. The positive and negative test probability of neck metastasis was generated based on Bayesian theory and collected data for different pre-test possibilities. Of the 168 identified relevant articles, 7 studies fulfilled all inclusion criteria for CT, 6 studies for MRI, 11 studies for PET and 8 studies for US. There was no difference in sensitivity and specificity among these imaging modalities, except CT was superior to US in specificity. The pooled estimates for sensitivity were 52% (95% confidence interval [CI], 39% ~ 65%), 65% (34 ~ 87%) 66% (47 ~ 80%), and 66% (45 ~ 77%), on a per-neck basis for CT, MRI, PET and US, respectively. The pooled estimates for specificity were 93% (87% ~ 97%), 81% (64 ~ 91%), 87% (77 ~ 93%), and 78% (71 ~ 83%) for CT, MRI, PET and US, respectively. With pre-examination nodal metastasis probabilities set at 10%, 20% and 30%, the post-exam probabilities of positive nodal metastasis rates were 47%, 66% and 77% for CT; 27%, 46% and 59% for MRI; 36%, 56% and 69% for PET; and 25%, 42% and 56% for US, respectively. Negative nodal metastasis probabilities were 95%, 89% and 82% for CT; 95%, 90% and 84% for MRI; 96%, 91% and 86% for PET; and 95%, 90% and 84% for US, respectively. Modern imaging modalities offer similar diagnostic accuracy to define and diagnose clinically N0 neck. Minimizing morbidity and avoiding elective neck dissection is acceptable in some select cases.
Philipp Heusch - One of the best experts on this subject based on the ideXlab platform.
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diagnostic accuracy of whole body pet mri and whole body pet ct for tnm staging in oncology
European Journal of Nuclear Medicine and Molecular Imaging, 2015Co-Authors: Philipp Heusch, Felix Nensa, Benedikt Michael Schaarschmidt, Rupika Sivanesapillai, Karsten Beiderwellen, Benedikt Gomez, Jens Kohler, Henning Reis, Verena RuhlmannAbstract:In various tumours PET/CT with [18F]FDG is widely accepted as the diagnostic standard of care. The purpose of this study was to compare a dedicated [18F]FDG PET/MRI protocol with [18F]FDG PET/CT for TNM staging in a cohort of oncological patients. A dedicated [18F]FDG PET/MRI protocol was performed in 73 consecutive patients (mean age of 59 years, range 21 – 85 years) with different histologically confirmed solid primary malignant tumours after a routine clinical FDG PET/CT scan (60 min after injection of 295 ± 45 MBq [18F]FDG). TNM staging according to the 7th edition of the AJCC Cancer Staging Manual was performed by two readers in separate sessions for PET/CT and PET/MRI images. Assessment of the primary tumour and nodal and distant metastases with FDG PET/CT and FDG PET/MRI was based on qualitative and quantitative analyses. Histopathology, and radiological and clinical follow-up served as the standards of reference. A McNemar test was performed to evaluate the differences in diagnostic performance between the imaging procedures. From FDG PET/CT and FDG PET/MRI T stage was correctly determined in 22 (82 %) and 20 (74 %) of 27 patients, N stage in 55 (82 %) and 56 (84 %) of 67 patients, and M stage in 32 (76 %) and 35 (83 %) of 42 patients, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for lymph node metastases were 65 %, 94 %, 79 %, 89 % and 87 % for PET/CT, and 63 %, 94 %, 80 %, 87 % and 85 % for PET/MRI. The respective values for the detection of distant metastases were 50 %, 82 %, 40 %, 88 % and 76 % for PET/CT, and 50 %, 91 %, 57 %, 89 % and 83 % for PET/MRI. Differences between the two imaging modalities were not statistically significant (P > 0.05). According to our results, FDG PET/CT and FDG PET/MRI are of equal diagnostic accuracy for TNM staging in patients with solid tumours.
Sandy Beare - One of the best experts on this subject based on the ideXlab platform.
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best time to assess complete clinical response after chemoradiotherapy in squamous cell carcinoma of the anus act ii a post hoc analysis of randomised controlled phase 3 trial
Lancet Oncology, 2017Co-Authors: R Glynnejones, D Sebagmontefiore, Helen Meadows, David Cunningham, Rubina Begum, Fawzi Adab, Kim Benstead, Robert J Harte, Jill Stewart, Sandy BeareAbstract:Summary Background Guidelines for anal cancer recommend assessment of response at 6–12 weeks after starting treatment. Using data from the ACT II trial, we determined the optimum timepoint to assess clinical tumour response after chemoradiotherapy. Methods The previously reported ACT II trial was a phase 3 randomised trial of patients of any age with newly diagnosed, histologically confirmed, squamous cell carcinoma of the anus without metastatic disease from 59 centres in the UK. We randomly assigned patients (by minimisation) to receive either intravenous mitomycin (one dose of 12 mg/m 2 on day 1) or intravenous cisplatin (one dose of 60 mg/m 2 on days 1 and 29), with intravenous fluorouracil (one dose of 1000 mg/m 2 per day on days 1–4 and 29–32) and radiotherapy (50·4 Gy in 28 daily fractions); and also did a second randomisation after initial therapy to maintenance chemotherapy (fluorouracil and cisplatin) or no maintenance chemotherapy. The primary outcome was complete clinical response (the absence of primary and nodal tumour by clinical examination), in addition to overall survival and progression-free survival from time of randomisation. In this post-hoc analysis, we analysed complete clinical response at three timepoints: 11 weeks from the start of chemoradiotherapy (assessment 1), 18 weeks from the start of chemoradiotherapy (assessment 2), and 26 weeks from the start of chemoradiotherapy (assessment 3) as well as the overall and progression-free survival estimates of patients with complete clinical response or without complete clinical response at each assessment. We analysed both the overall trial population and a subgroup of patients who had attended each of the three assessments by modified intention-to-treat. This study is registered at controlled-trials.com, ISRCTN 26715889. Findings We enrolled 940 patients from June 4, 2001, until Dec 16, 2008. Complete clinical response was achieved in 492 (52%) of 940 patients at assessment 1 (11 weeks), 665 (71%) of patients at assessment 2 (18 weeks), and 730 (78%) of patients at assessment 3 (26 weeks). 691 patients attended all three assessments and in this subgroup, complete clinical response was reported in 441 (64%) patients at assessment 1, 556 (80%) at assessment 2, and 590 (85%) at assessments 3. 151 (72%) of the 209 patients who had not had a complete clinical response at assessment 1 had a complete clinical response by assessment 3. In the overall trial population of 940 patients, 5 year overall survival in patients who had a clinical response at assessments 1, 2, 3 was 83% (95% CI 79–86), 84% (81–87), and 87% (84–89), respectively and was 72% (66–78), 59% (49–67), and 46% (37–55) for patients who did not have a complete clinical response at assessments 1, 2, 3, respectively. In the subgroup of 691 patients, 5 year overall survival in patients who had a clinical response at assessment 1, 2, 3 was 85% (81–88), 86% (82–88), and 87% (84–90), respectively, and was 75% (68–80), 61% (50–70), and 48% (36–58) for patients who did not have a complete clinical response at assessment 1, 2, 3, respectively. Similarly, progression-free survival in both the overall trial population and the subgroup was longer in patients who had a complete clinical response, compared with patients who did not have a complete clinical response, at all three assessments. Interpretation Many patients who do not have a complete clinical response when assessed at 11 weeks after commencing chemoradiotherapy do in fact respond by 26 weeks, and the earlier assessment could lead to some patients having unnecessary surgery. Our data suggests that the optimum time for assessment of complete clinical response after chemoradiotherapy for patients with squamous cell carcinoma of the anus is 26 weeks from starting chemoradiotherapy. We suggest that guidelines should be revised to indicate that later assessment is acceptable. Funding Cancer Research UK.
I C Heyligers - One of the best experts on this subject based on the ideXlab platform.
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the use of plain radiography subtraction arthrography nuclear arthrography and bone scintigraphy in the diagnosis of a loose acetabular component of a total hip prosthesis a systematic review
Journal of Arthroplasty, 2007Co-Authors: Olivier P P Temmerman, P G H M Raijmakers, Johannes Berkhof, W Deville, L Hooft, I C HeyligersAbstract:This meta-analysis was performed to summarize and compare the diagnostic performance and diagnostic accuracy of radiographic and scintigraphic techniques in the evaluation of patients suspected of having aseptically loose acetabular components. Twenty-eight studies, published between January 1975 and October 2004, presented sufficient data for quantitative analysis. The pooled sensitivity and specificity rates for plain radiography were 70% (95% confidence interval [CI] = 59%-79%) and 80% (95% CI = 73%-86%), respectively; those for subtraction arthrography were 89% (95% CI = 84%-93%) and 76% (95% CI = 68%-82%), respectively; and those for nuclear arthrography were 87% (95% CI = 57%-97%) and 64% (95% CI = 40%-82%), respectively. Finally, bone scintigraphy had a sensitivity of 67% (95% CI = 57%-76%) and a specificity of 75% (95% CI = 64%-83%). We found a significantly higher sensitivity for subtraction arthrography as compared with plain radiography and bone scintigraphy. Therefore, subtraction arthrography is recommended for use as an additional diagnostic technique when plain radiography is found to be inconclusive.
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accuracy of diagnostic imaging techniques in the diagnosis of aseptic loosening of the femoral component of a hip prosthesis a meta analysis
Journal of Bone and Joint Surgery-british Volume, 2005Co-Authors: Olivier P P Temmerman, P G H M Raijmakers, Johannes Berkhof, O S Hoekstra, G J J Teule, I C HeyligersAbstract:In this meta-analysis we included 32 English-language articles published between January 1975 and June 2004 on the diagnostic performance of plain radiography, subtraction arthrography, nuclear arthrography and bone scintigraphy in detecting aseptic loosening of the femoral component, using criteria based on the Cochrane systematic review of screening and diagnostic tests. The mean sensitivity and specificity were, respectively, 82% (95% confidence interval (CI) 76 to 87) and 81% (95% CI 73 to 87) for plain radiography and 85% (95% CI 75 to 91) and 83% (95% CI 75 to 89) for nuclear arthrography. Pooled sensitivity and specificity were, respectively, 86% (95% CI 74 to 93) and 85% (95% CI 77 to 91) for subtraction arthrography and 85% (95% CI 79 to 89) and 72% (95% CI 64 to 79) for bone scintigraphy. Although the diagnostic performance of the imaging techniques was not significantly different, plain radiography and bone scintigraphy are preferred for the assessment of a femoral component because of their efficacy and lower risk of patient morbidity.
W J H J Meijerink - One of the best experts on this subject based on the ideXlab platform.
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sentinel lymph node procedure in colon and rectal cancer a systematic review and meta analysis
Lancet Oncology, 2011Co-Authors: Martijn Hgm Van Der Pas, S Meijer, Otto S Hoekstra, Ingid I Riphagen, Henrica C W De Vet, Dirk L Knol, Nicole C T Van Grieken, W J H J MeijerinkAbstract:Summary Background No consensus exists on the validity of the sentinel-lymph-node procedure for assessment of nodal status in patients with colorectal cancer. We aimed to assess the diagnostic performance of this procedure. Methods We searched Embase and PubMed databases for studies published before March 20, 2010. Eligible studies had a prospective design, a sample size of at least 20 patients, and reported the rate of sentinel-lymph-node positivity. Individual patient data were requested for localisation and T-stage stratification. A subset of reports with high methodological quality was selected and analysed. Findings We identified 52 eligible studies, which included 3767 sentinel-lymph-node procedures (2961 [78·6%] colon and 806 [21·4%] rectal carcinomas). Most tumours 2339 (62·1%) were stage T3 or T4. 1887 (50·1%) of patients were male, 1880 (49·9%) female. Mean overall weighted-detection rate was 0·94 (95% CI 0·92–0·95), at a pooled sensitivity of 0·76 (0·72–0·80) with limited heterogeneity (χ 2 =286·08, degrees of freedom=51; p=0·003). A mean weighted upstaging of 0·15 (95% CI 0·12–0·19) was noted. Individual patient data were available from 19 studies that included 1168 patients. Analysis of these data showed no significant difference in sensitivity between colon (0·86 [95% CI 0·83–0·90]) and rectal cancer (0·82 [0·77–0·88]; p=0·23). Also, there was no dependency of sensitivity on T stage for both colon (pT1: 0·79 [95% CI 0·73–0·84], pT2: 0·76 [0·62–0·90], pT3: 0·73 [0·59–0·87], pT4: 0·73 [0·53–0·93]) and rectal cancer (T1 or T2: 0·81 [0·52–0·94] vs T3 or T4: 0·80 [0·51–0·93]). The subgroup of eight studies with high methodological quality showed a mean detection rate of 0·96 (95% CI 0·90–0·99) for colonic tumours and 0·95 (0·75–0·99) for rectal tumours, and a mean sensitivity of 0·90 (95% CI 0·86–0·93) for colonic tumours and 0·82 (0·60–0·93) for rectal tumours. Interpretation The sentinel-lymph-node procedure shows a low sensitivity, regardless of T stage, localisation, or pathological technique. For every patient diagnosed with colon or rectal cancer without clinical evidence of lymph-node involvement or metastatic disease, this procedure in addition to conventional resection should be considered, since the prognostic information provided by this technique could be clinically significant. Funding Cancer Center Amsterdam Foundation, Amsterdam, Netherlands.
