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Added value of intra-operative ultrasound to determine the resectability of locally advanced pancreatic cancer following FOLFIRINOX chemotherapy (IMAGE): a prospective multicenter study.
van Veldhuisen, E, Walma, MS, van Rijssen, LB, Busch, OR, Bruijnen, RCG, van Delden, OM, Mohammad, NH, de Hingh, IH, Yo, LS, van Laarhoven, HW, et al
HPB : the official journal of the International Hepato Pancreato Biliary Association. 2019;(10):1385-1392
Abstract
BACKGROUND Determining the resectability of locally advanced pancreatic cancer (LAPC) after FOLFIRINOX chemotherapy is challenging because CT-scans cannot reliably assess vascular involvement. This study evaluates the added value of intra-operative ultrasound (IOUS) in LAPC following FOLFIRINOX induction chemotherapy. METHODS Prospective multicenter study in patients with LAPC who underwent explorative laparotomy with IOUS after FOLFIRINOX chemotherapy. Resectability was defined according to the National Comprehensive Cancer Network guidelines. IOUS findings were compared with preoperative CT-scans and pathology results. RESULTS CT-staging in 38 patients with LAPC after FOLFIRINOX chemotherapy defined 22 patients LAPC, 15 borderline resectable and one resectable. IOUS defined 19 patients LAPC, 13 borderline resectable and six resectable. In 12/38 patients, IOUS changed the resectability status including five patients from borderline resectable to resectable and five patients from LAPC to borderline resectable. Two patients were upstaged from borderline resectable to LAPC. Tumor diameters were significantly smaller upon IOUS (31.7 ± 9.5 mm versus 37.1 ± 10.0 mm, p = 0.001) and resectability varied significantly (p = 0.043). Ultimately, 20 patients underwent resection of whom 14 were evaluated as (borderline) resectable on CT-scan, and 17 on IOUS. DISCUSSION This prospective study demonstrates that IOUS may change the resectability status up to a third of patients with LAPC following FOLFIRINOX chemotherapy.
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The clinical value of imaging in primary cutaneous lymphomas: Role of high resolution ultrasound and PET-CT.
Mandava, A, Koppula, V, Wortsman, X, Catalano, O, Alfageme, F
The British journal of radiology. 2019;(1095):20180904
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Abstract
BACKGROUND Primary cutaneous lymphoma is a rare extranodal non-Hodgkin's lymphoma confined to the skin. The data on the imaging findings of primary cutaneous lymphomas are largely lacking and the current diagnosis is based on clinical and histopathological examination. With the advances in dermatological ultrasound and molecular imaging, newer perspectives in the evaluation of cutaneous lymphomas are available. OBJECTIVE To review and describe the imaging findings in patient's with the diagnosis of primary cutaneous lymphoma. METHODS A multicentric, retrospective observational study was undertaken in four countries to review the high resolution ultrasonography (HRUS) and fluorine 18-fludeoxyglucose positron emission tomography-computed tomography (PET-CT) imaging findings. RESULTS We had 41 patients, Female:Male 1:4.1; mean age, 57 years; range, 13-94 years. High resolution ultrasonography of the primary cutaneous lesions revealed thickening of the dermis in all the cases and the lesions were hypoechoic without any calcifications or central necrosis. The sonographic appearances of the lesions were categorised into focal infiltrative, nodular, pseudonodular, and diffusely infiltrative patterns. Nodular and pseudonodular lesions were predominant in B cell lymphomas, while diffusely infiltrative lesions were more common in T-cell lymphomas. On colour Doppler imaging, the lesions were hypervascular. Whole body 18F-fludeoxyglucose PET-CT imaging of the patients revealed increased uptake of the metabolite in the lesions. CONCLUSION Sonographic patterns based on high resolution ultrasonography provide early clues to the non-invasive diagnosis of primary cutaneous lymphomas and PET-CT is the recommended modality of imaging for staging and follow-up. ADVANCES IN KNOWLEDGE High resolution ultrasound with colour Doppler and PET-CT imaging are complimentary to the clinical diagnosis of primary cutaneous lymphomas.