CA : A Cancer Journal for Clinicians

Objective To address terminology and other issues related to thyroid fine-needle aspiration (FNA), the National Cancer Institute (NCI) hosted The NCI Thyroid FNA State of the Science Conference. The conclusions regarding terminology and morphologic criteria from the NCI meeting led to the Bethesda Thyroid Atlas Project and form the framework for the Bethesda System for Reporting Thyroid Cytopathology. Design Participants of the Atlas Project were selected from among the committee members of the NCI FNA State of the Science Conference and other participants at the live conference. The terminology framework was based on a literature search of English language publications dating back to 1995 using PubMed as the search engine; online forum discussions ( http://thyroidfna.cancer.gov/forums/default.aspx ); and formal interdisciplinary discussions held on October 22 and 23, 2007, in Bethesda, MD. Main outcome For clarity of communication, the Bethesda System for Reporting Thyroid Cytopathology recommends that each report begin with one of the six general diagnostic categories. Each of the categories has an implied cancer risk that links it to an appropriate clinical management guideline. Conclusions The project participants hope that the adoption of this framework will facilitate communication among cytopathologists, endocrinologists, surgeons, and radiologists; facilitate cytologic-histologic correlation for thyroid diseases; facilitate research into the understanding of thyroid diseases; and allow easy and reliable sharing of data from different laboratories for national and international collaborative studies.

The Bethesda System for Reporting Thyroid Cytopathology.

Summary Background Compared with open resection, laparoscopic resection of rectal cancers is associated with improved short-term outcomes, but high-level evidence showing similar long-term outcomes is scarce. We aimed to compare survival outcomes of laparoscopic surgery with open surgery for patients with mid-rectal or low-rectal cancer. Methods The Comparison of Open versus laparoscopic surgery for mid or low REctal cancer After Neoadjuvant chemoradiotherapy (COREAN) trial was an open-label, non-inferiority, randomised controlled trial done between April 4, 2006, and Aug 26, 2009, at three centres in Korea. Patients (aged 18–80 years) with cT3N0–2M0 mid-rectal or low-rectal cancer who had received preoperative chemoradiotherapy were randomly assigned (1:1) to receive either open or laparoscopic surgery. Randomisation was stratified by sex and preoperative chemotherapy regimen. Investigators were masked to the randomisation sequence; patients and clinicians were not masked to the treatment assignments. The primary endpoint was 3 year disease-free survival, with a non-inferiority margin of 15%. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00470951. Findings We randomly assigned 340 patients to receive either open surgery (n=170) or laparoscopic surgery (n=170). 3 year disease-free survival was 72·5% (95% CI 65·0–78·6) for the open surgery group and 79·2% (72·3–84·6) for the laparoscopic surgery group, with a difference that was lower than the prespecified non-inferiority margin (–6·7%, 95% CI −15·8 to 2·4; p Interpretation Our results show that laparoscopic resection for locally advanced rectal cancer after preoperative chemoradiotherapy provides similar outcomes for disease-free survival as open resection, thus justifying its use. Funding National Cancer Center, South Korea.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(14)70205-0.pdf

Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial.

Objective:To determine the safety of laparoscopy-assisted distal gastrectomy (LADG) compared with open distal gastrectomy (ODG) in patients with clinical stage I gastric cancer in Korea.Background:There is still a lack of large-scale, multicenter randomized trials regarding the safety of LADG.Method

/pdf/decreased-morbidity-of-laparoscopic-distal-gastrectomy-4wpqxuemft.pdf

Decreased Morbidity of Laparoscopic Distal Gastrectomy Compared With Open Distal Gastrectomy for Stage I Gastric Cancer: Short-term Outcomes From a Multicenter Randomized Controlled Trial (KLASS-01).

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The Foundations Of Differential Geometry

Purpose

To evaluate the role of diffusion-weighted imaging (DWI) in the detection of breast cancers, and to correlate the apparent diffusion coefficient (ADC) value with prognostic factors.



Materials and Methods

Sixty-seven women with invasive cancer underwent breast MRI. Histological specimens were analyzed for tumor size and grade, and expression of estrogen receptors (ER), progesterone receptors, c-erbB-2, p53, Ki-67, and epidermal growth factor receptors. The computed mean ADC values of breast cancer and normal breast parenchyma were compared. Relationships between the ADC values and prognostic factors were determined using Wilcoxon signed rank test and Kruskal-Wallis test.



Results

DWI detected breast cancer as a hyperintense area in 62 patients (92.5 %). A statistically significant difference in the mean ADC values of breast cancer (1.09 ± 0.27 × 10−5 mm2/s) and normal parenchyma (1.59 ± 0.27 × 10−5 mm2/s) was detected (P < 0.0001). There were no correlations between the ADC value and prognostic factors. However, the median ADC value was lower in the ER-positive group than the ER negative group, and this difference was marginally significant (1.09 × 10−5 mm2/s versus 1.15 × 10−5 mm2/s, P = 0.053).



Conclusion

The ADC value was a helpful parameter in detecting malignant breast tumors, but ADC value could not predict patient prognosis. J. Magn. Reson. Imaging 2009;30:615–620. © 2009 Wiley-Liss, Inc.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmri.21884

Diffusion‐weighted imaging of breast cancer: Correlation of the apparent diffusion coefficient value with prognostic factors

The complex two-plane Grassmannian G
2(C

 m+2
 in equipped with both a Kahler and a quaternionic Kahler structure. By applying these two structures to the normal bundle of a real hypersurface M in G
2(C

 m+2
 one gets a one- and a three-dimensional distribution on M. We classify all real hypersurfaces M in G
2
C

 m+2
 , m≥3, for which these two distributions are invariant under the shape operator of M.

Real Hypersurfaces in Complex Two-Plane Grassmannians

We classify all real hypersurfaces with isometric Reeb flow in the complex Grassmann manifold G
2 (ℂ
 m+2
 ) of all 2-dimensional linear subspaces in ℂ
 m+2
 , m ≥ 3.

Real hypersurfaces with isometric Reeb flow in complex two-plane Grassmannians

It is known that there do not exist real hypersurfaces with parallel curvature tensor in quaternionic projective spaces. In this paper we classify real hypersurfaces of quaternionic projective space whose curvature tensor is parallel in the direction of certain 3-dimensional distribution.

Real hypersurfaces of quaternionic projective space satisfying ▽UiR = 0

Systemic inflammatory markers derived from peripheral blood cell, such as the neutrophil-lymphocyte ratio (NLR), derived neutrophil-lymphocyte ratio (dNLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR), have been demonstrated as prognostic markers in several types of malignancy. Here, we investigated and compared the association between systemic inflammatory markers and survival and developed a prognostic nomogram in breast cancer patients. We reviewed the clinical and pathological records of 661 patients diagnosed with invasive breast carcinoma between 1993 and 2011. The NLR, dNLR, PLR and LMR in the immediate preoperative period were assessed. We analyzed the relationship between these inflammatory markers and clinicopathologic variables, disease-specific survival (DSS), and disease-free survival (DFS) in patients. A nomogram was developed to predict 3- and 5-year DSS for breast cancer. In the univariate analysis, high NLR, dNLR, PLR and low LMR were all significantly associated with poor DSS and DFS. In the multivariate analysis, only the PLR (HR 3.226, 95% CI 1.768-5.885 for DSS and HR 1.824, 95% CI 1.824-6.321 for DFS) was still identified as an independent predictor of outcomes. A subgroup analysis revealed that the PLR was the sole independent marker predicting poor DSS in patients with lymph node metastasis (HR 2.294, 95% CI 1.102-4.777) and with luminal subtype (HR 4.039, 95% CI 1.905-8.562). The proposed nomogram, which includes the PLR, shows good accuracy in predicting DSS with a concordance index of 0.82. PLR is an indicator of systemic inflammation as a part of the host immune response. As an independent prognostic factor, an elevated preoperative PLR is superior to the NLR, dNLR, and LMR in predicting clinical outcomes in patients with breast cancer. Moreover, the nomogram incorporating the PLR could accurately predict individualized survival probability in breast cancer.

/pdf/prognostic-value-of-systemic-inflammatory-markers-and-25r92dl3he.pdf

Young Jin Suh

Papers

Diffusion‐weighted imaging of breast cancer: Correlation of the apparent diffusion coefficient value with prognostic factors

Real Hypersurfaces in Complex Two-Plane Grassmannians

Real hypersurfaces with isometric Reeb flow in complex two-plane Grassmannians

Real hypersurfaces of quaternionic projective space satisfying ▽UiR = 0

Prognostic value of systemic inflammatory markers and development of a nomogram in breast cancer