OBJECTIVE. In this article, we review the role of imaging in cancer of unknown primary site (CUP) diagnosis and management and the utility of immunohistochemistry, serum tumor markers, and molecular profiling in the optimized care of CUP patients.
OBJECTIVE. The purpose of this study is to examine whether pretreatment findings in hepatocellular carcinoma (HCC) using contrast-enhanced ultrasound can predict local or distant recurrence after radiofrequency ablation (RFA).
Frequency of and Risk Factors for Complications After Liver Radiofrequency Ablation Under CT Fluoroscopic Guidance in 1500 Sessions: Single-Center Experience
OBJECTIVE. This study was performed to evaluate risk factors predictive of local tumor control after microwave ablation of primary and secondary lung malignancies up to 3 cm in maximal diameter.
Introduction: Imaging-guided percutaneous transthoracic biopsy has become a widely accepted, effective, and safe minimally invasive technique with which to obtain tissue specimens from a number of different intrathoracic lesions (1–3). Percutaneous biopsy yields tissue samples for diagnosis and staging and facilitates differentiation of primary cancer from distant metastasis or infective and inflammatory lesions, which is crucial for correct management of lung lesions (4). Percutaneous biopsy has also been used to obtain tissue for genetic and immunologic testing of cancer mutations, thus improving the care of patients undergoing targeted chemotherapy (5,6).
Introduction: Fine-needle aspiration cytology (FNAC) has become an essential diagnostic tool in the management of thyroid nodules (1,2). In general, thyroid nodules that are diagnosed as benign are managed clinically, and neoplastic and malignant nodules are surgically excised (3). In the majority of cases, FNAC can be used to distinguish benign nodules from malignant; this has resulted in a tremendous decrease in the number of patients undergoing surgery for excision of benign thyroid nodules (4). However, a large number of patients still need to undergo repeat FNAC owing to nondiagnostic, indeterminate, and even benign results (1,5,6). Recently, the Bethesda system for reporting thyroid cytopathology findings recommended repeat FNAC or clinical follow-up as a usual management in the cases of findings that are nondiagnostic, benign, or atypia of undetermined significance (AUS) (7). However, there is no consensus on how to decide which cases can be followed with ultrasonography (US) and which would be better managed by repeat aspiration.
Introduction: The most common cause of cancer-related deaths in both men and women in the United States in 2011 was lung cancer, which caused approximately156 940 fatalities (1). Surgical resection is the standard treatment for early stage lung cancer; however, minimally invasive percutaneous thermal ablation therapies, such as radiofrequency ablation (RFA) and microwave ablation (MWA), have emerged as safe and effective treatment alternatives for patients who are not surgical candidates (2). The safety profiles of both RFA and MWA have been well studied (3–9), and the most common adverse effects include pain, fever, pneumothorax, and pleural effusion. Long-term follow-up focuses primarily on the effectiveness of treatment, including time to tumor recurrence and patient survival. At our institution, it was noted that follow-up imaging of these patients might show rib fractures in the vicinity of the ablated zone months to years after treatment. The occurrence of rib fractures after other localized cancer therapies, particularly with the newer high-dose radiation therapies (ie, stereotactic body radiation therapy) has been well established. The strongest predictors of rib fracture in these studies (10–15) were the treatment of a small volume of lung tissue at a high radiation dose and proximity of the tumor to the chest wall, with peripheral tumors associated with the most risk. We theorized that rib fractures in patients who have undergone ablation may occur as a result of bone atrophy caused by high temperatures that are either generated during RFA and MWA or from pleural scarring that extends from the ablation zone to the ribs and causes inelastic tethering. It is important to assess the occurrence of rib fractures because of potential risks of discomfort, pulmonary infection, and/or organ injury. Thus, the purpose of this study was to retrospectively identify the incidence and probable risk factors for rib fractures after percutaneous RFA and MWA of neoplasms in the lung and to identify complications related to these fractures.
Introduction: Superior vena cava (SVC) syndrome is a complication that occurs when malignancies, particularly in advanced lung cancer and mediastinal tumors, cause obstruction to the SVC (1,2). It has been reported (3) that SVC syndrome occurs in approximately 4% of lung cancer patients at diagnosis and may develop during the disease course. Until recently, radiation therapy and chemotherapy were the standard treatments in the management of malignant SVC syndrome (4,5). However, these therapies both take several weeks before a clinical effect is observed (1,6). Moreover, neither therapy may be possible in certain conditions, such as when the cumulative maximum dosage has been reached in previous treatments. In addition, SVC syndrome may recur after successful primary therapy for tumor recurrence (5).
Introduction: Instrument navigation in interventional radiology traditionally relies on either intermittent images or continuous imaging of device advancement to monitor its position during the procedure. This is usually accomplished with use of fluoroscopy, ultrasonography (US), computed tomography (CT), or magnetic resonance (MR) imaging (1–4). With both CT and MR imaging, intermittent images are usually used during the procedure to guide the actual needle positioning; however, online guidance during the puncture is not provided. In difficult cases, this approach is associated with long procedure times owing to the need to intermittently bring the patient back into the imaging unit to image the region of interest (1,4).
Introduction: Imaging plays an important role in the evaluation of disease extent and treatment planning in patients with gynecologic malignancies. Ultrasonography (US) helps accurately assess endometrial thickness in patients presenting with postmenopausal bleeding and aids in characterizing most adnexal masses, but it does not improve upon the accuracy of clinical staging of gynecologic malignancies (1,2). Computed tomography (CT) is the modality of choice for staging in patients with ovarian cancer. It is also used to stage advanced endometrial and cervical cancer, as it can accurately depict enlarged lymph nodes, ureteric obstruction, and lung or liver metastases (3). However, the poor soft-tissue contrast of CT limits its use for local staging of endometrial and cervical cancer (4). Fluorine 18 (18F) fluorodeoxyglucose positron emission tomography (PET)/CT is useful for staging and follow-up in patients with cervical cancer, because it can show increased metabolic activity in involved lymph nodes and unsuspected distant metastases (5). The most important roles for magnetic resonance (MR) imaging are evaluation of local disease extent in uterine and cervical malignancies (3,6) and as a problem-solving modality in patients with ovarian cancer. However, it is important to recognize that there is a wide regional variation in the incorporation of MR imaging in the pretreatment assessment and follow-up of patients with gynecologic cancer. Although many institutions in Canada and in western Europe have adhered to national guidelines for the use of MR imaging in the preoperative evaluation of uterine malignancies (7–11), there is less consensus in the United States and Asia regarding the indications for MR imaging. This review will focus on the potential added value of MR imaging for assessment of local disease extent, as well as recurrence.
Summary: The vascular anatomy of the liver can be described at three different levels of complexity according to the use that the description has to serve. The first – conventional – level corresponds to the traditional 8-segments scheme of Couinaud and serves as a common language between clinicians from different specialties to describe the location of focal hepatic lesions. The second – surgical – level, to be applied to anatomical liver resections and transplantations, takes into account the real branching of the major portal pedicles and of the hepatic veins. Radiological and surgical techniques exist nowadays to make full use of this anatomy, but this requires accepting that the Couinaud scheme is a simplification, and looking at the vascular architecture with an unprejudiced eye. The third – academic – level of complexity concerns the anatomist, and the need to offer a systematization that resolves the apparent contradictions between anatomical literature, radiological imaging, and surgical practice. Based on the real number of second-order portal branches that, although variable averages 20, we submit a system called the “1-2-20 concept”, and suggest that it fits best the number of actual – as opposed to idealized – anatomical liver segments.
Summary: The practice of treating candidates for liver transplantation (LT) for hepatocellular carcinoma (HCC), with locoregional therapies, is common in most transplant centers. However, for T1 tumors and expected waiting times to LT <6months, there is no evidence that these treatments are beneficial. For T2 tumors and for longer waiting times, neo-adjuvant treatments are usually performed with transarterial chemoembolization (TACE), ablation techniques and liver resection in selected cases. The treatment choice should be based on the BCLC staging system. At present, there is no evidence of the superiority of ablation/resection vs. TACE, but some studies showed better results of the former in achieving a complete response. The response to neo-adjuvant treatments should be evaluated through mRECIST criteria, but few studies adopted these criteria and properly analyzed factors affecting response. The simultaneous evaluation of the impact of neo-adjuvant therapies on dropout rate, post-LT HCC recurrence and patient survival is rarely reported. Tumor stage and volume, alpha-fetoprotein levels, response to treatments and liver function affect pre-LT outcomes. These same factors, together with vascular invasion and poor tumor differentiation, are major determinants of poor post-LT outcomes. Due to the low number of prospective studies with well-defined entry criteria and the variability of results, the role of downstaging is still to be defined. Novel molecular markers seem promising for the estimation of prognosis and/or response to treatments. With a persistent scarcity of organ donors, neo-adjuvant treatments can help identify patients with different probabilities of cancer progression, and consequently balance the priority of HCC and non-HCC-candidates through revised additional scores for HCC.
Summary: To survey the burden of liver disease in Europe and its causes 260 epidemiological studies published in the last five years were reviewed. The incidence and prevalence of cirrhosis and primary liver cancer are key to understand the burden of liver disease. They represent the end-stage of liver pathology and thus are indicative of the associated mortality. About 0.1% of Hungarian males will die of cirrhosis every year compared with 0.001% of Greek females. WHO estimate that liver cancer is responsible for around 47,000 deaths per year in the EU.
Tumors of the biliary tree are relatively rare; but their incidence is rising worldwide. There are several known risk factors for bile duct cancers, and these are seem to be associated with chronic inflammation of the biliary epithelium. Herein, 2 risk factors have been discussed, primary sclerosing cholangitis and reflux of pancreatic juice into the bile duct, as seen in such as an abnormal union of the pancreatic-biliary junction because magnetic resonance imaging (MRI) is used widely and effectively in the diagnosis of these diseases. When biliary disease is suspected, MRI can often help differentiate between benignity and malignancy, stage tumors, select surgical candidates and guide surgical planning. MRI has many advantages over other modalities. Therefore, MRI is a reliable noninvasive imaging tool for diagnosis and pre-surgical evaluation of bile duct tumors. Nowadays remarkable technical advances in magnetic resonance technology have expanded the clinical applications of MRI in case of biliary diseases. In this article, it is also discussed how recent developments in MRI contributes to the diagnosis of the bile duct cancer and the evaluation of patients with risk factors affecting bile duct cancer.
Understanding the mutual relationship between the liver and the heart is important for both hepatologists and cardiologists. Hepato-cardiac diseases can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. Differential diagnoses of liver injury are extremely important in a cardiologist’s clinical practice calling for collaboration between cardiologists and hepatologists due to the many other diseases that can affect the liver and mimic haemodynamic injury. Acute and chronic heart failure may lead to acute ischemic hepatitis or chronic congestive hepatopathy. Treatment in these cases should be directed to the primary heart disease. In patients with advanced liver disease, cirrhotic cardiomyopathy may develop including hemodynamic changes, diastolic and systolic dysfunctions, reduced cardiac performance and electrophysiological abnormalities. Cardiac evaluation is important for patients with liver diseases especially before and after liver transplantation. Liver transplantation may lead to the improvement of all cardiac changes and the reversal of cirrhotic cardiomyopathy. There are systemic diseases that may affect both the liver and the heart concomitantly including congenital, metabolic and inflammatory diseases as well as alcoholism. This review highlights these hepatocardiac diseases
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