Showing papers by "Geerard L. Beets published in 2004"

Rectal Cancer: Review with Emphasis on MR Imaging

Abstract: One concern after rectal cancer surgery is the high local recurrence rate. Randomized trials have shown that the best local control rate for rectal cancer patients as a group is achieved after a short course of radiation therapy followed by optimal surgery. It is debatable, however, whether all patients with rectal cancer should undergo preoperative radiation therapy. Preoperative identification of those most likely to benefit from neoadjuvant therapy is important. Therefore, the challenge for preoperative imaging in rectal cancer is to determine subgroups of patients with different risks for recurrence: those with superficial tumors, who can be treated with surgery alone; those with operable tumors and a wide circumferential resection margin, who can be treated with a short course of radiation therapy followed by total mesorectal excision; and those with advanced cancer and a close or involved resection margin, who require a long course of radiation therapy, with or without chemotherapy, and extensive surgery. So far, there is no consensus on the role of diagnostic imaging (endorectal ultrasonography, computed tomography, and magnetic resonance [MR] imaging) in the care of patients with primary rectal cancer. Preoperative staging has long relied on digital examination alone, which indicates that it has been difficult to achieve accuracy levels high enough for clinical decision making with preoperative imaging. In this review, the relevance of preoperative imaging in staging the local extent of primary rectal cancer will be discussed. Research on various imaging modalities, with an emphasis on MR, will be discussed under four main headings that address the most relevant aspects of local spread of rectal tumors: T stage, circumferential resection margin, locally advanced rectal cancer, and N stage.

Costs and effects of ultrasonography in the evaluation of palpable breast masses.

Abstract: Costs and effects of ultrasonography in the evaluation of palpable breast masses. Flobbe K, Kessels AG, Severens JL, Beets GL, de Koning HJ, von Meyenfeld MF, van Engelshoven JM. Department of Radiology, Maastricht University Hospital, The Netherlands. flobbe@rad.unimaas.nl OBJECTIVE: To study the costs and effects of incorporating ultrasonography in the triple assessment of palpable breast masses. METHODS: A decision analytic model was designed to compare a conventional strategy of performing fine-needle aspiration cytology after clinical examination and mammography, with three different experimental strategies of preceding ultrasonography. Empirical data were used from a prospective study in 522 breasts in 492 patients with a palpable mass, including 93 malignancies. In strategy 1, cases with probably benign, suspect malignant, and malignant ultrasonography results were referred for fine-needle aspiration cytology; in strategy 2, benign cases were also referred for fine-needle aspiration cytology; and in strategy 3, ultrasonography was only performed in patients with benign results on clinical examination and mammography, whereas immediate fine-needle aspiration cytology was performed in patients with suspicious lesions. Outcome variables included the total costs and the expected number of life years. Sensitivity analysis was performed on all parameters in the model. RESULTS: All strategies reported a similar life expectancy of 31.0 years. Cost-minimization demonstrated that experimental strategy 3 was the least expensive strategy (3013 Euro). Experimental strategy 2 was the most costly one (3512 Euro). Compared with the conventional strategy of immediate fine-needle aspiration cytology (3087 Euro), both ultrasonography strategies 1 and -3 were preferred. CONCLUSIONS: Incorporating ultrasonography in the triple assessment of palpable breast masses can result in a reduction of the total costs for the diagnosis and treatment of breast cancer.

Rectal Tumours — MRI

Abstract: Colorectal cancer is a major health problem with over 7500 new cases diagnosed each year in the Netherlands (Visser et al. 1996). One third of all colorectal cancers occur in the rectosigmoid. Rectal cancer carries a poor prognosis because of the risk of metastases and local recurrences. After curative resection of the rectum for rectal cancer, local recurrence rates can vary from 3%–32% (Sagar and Pemberton 1996). Although local recurrence has a small impact on survival, it has a profound impact on quality of life as it is often debilitating from severe pain and immobility, and involves prolonged and multiple hospital admissions for surgery, radiation and chemotherapy.