scholarly journals Preoperative staging of rectal cancer: Role of 3D endorectal ultrasonography

2012 ◽  
Vol 59 (2) ◽  
pp. 57-61 ◽  
Author(s):  
Giulio Santoro
Keyword(s):  
Rectal Cancer ◽  
Clinical Decision Making ◽  
Preoperative Staging ◽  
Three Dimensional ◽  
Good Deal ◽  
Clinical Decision ◽  
Cancer Staging ◽  
Relevant Information ◽  
Endorectal Ultrasonography ◽  
Cross Sectional

Endorectal ultrasonography has become important part of preoperative staging of rectal cancer, providing adequate information for clinical decision- making in many cases. However, with the currently available ultrasonographic equipment and techniques, a good deal of relevant information may remain hidden. The advent of high-resolution three-dimensional endoluminal ultrasound, constructed from a synthesis of standard two-dimensional cross-sectional images, and of "Volume Render Mode," a technique to analyze information inside a threedimensional volume, promises to improve the accuracy of rectal cancer staging. The anatomic structures in the pelvis, the axial and longitudinal extension of the tumor, the presence of slight or massive submucosal invasion in early rectal cancer may be imaged in greater detail. This additional information will bring an improvement for both planning and conduct of surgical procedures.

scholarly journals Structured Reporting of Rectal Cancer Staging and Restaging: A Consensus Proposal

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2135
Author(s):  
Vincenza Granata ◽  
Damiano Caruso ◽  
Roberto Grassi ◽  
Salvatore Cappabianca ◽  
Alfonso Reginelli ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Correlation Coefficient ◽  
Clinical Decision Making ◽  
Intraclass Correlation ◽  
Clinical Decision ◽  
Cancer Staging ◽  
Structured Reporting ◽  
Quality Analysis ◽  
Promising Tool ◽  
Structured Reports

Background: Structured reporting (SR) in oncologic imaging is becoming necessary and has recently been recognized by major scientific societies. The aim of this study was to build MRI-based structured reports for rectal cancer (RC) staging and restaging in order to provide clinicians all critical tumor information. Materials and Methods: A panel of radiologist experts in abdominal imaging, called the members of the Italian Society of Medical and Interventional Radiology, was established. The modified Delphi process was used to build the SR and to assess the level of agreement in all sections. The Cronbach’s alpha (Cα) correlation coefficient was used to assess the internal consistency of each section and to measure the quality analysis according to the average inter-item correlation. The intraclass correlation coefficient (ICC) was also evaluated. Results: After the second Delphi round of the SR RC staging, the panelists’ single scores and sum of scores were 3.8 (range 2–4) and 169, and the SR RC restaging panelists’ single scores and sum of scores were 3.7 (range 2–4) and 148, respectively. The Cα correlation coefficient was 0.79 for SR staging and 0.81 for SR restaging. The ICCs for the SR RC staging and restaging were 0.78 (p < 0.01) and 0.82 (p < 0.01), respectively. The final SR version was built and included 53 items for RC staging and 50 items for RC restaging. Conclusions: The final version of the structured reports of MRI-based RC staging and restaging should be a helpful and promising tool for clinicians in managing cancer patients properly. Structured reports collect all Patient Clinical Data, Clinical Evaluations and relevant key findings of Rectal Cancer, both in staging and restaging, and can facilitate clinical decision-making.

scholarly journals The value of endorectal ultrasonography in rectal cancer staging

2008 ◽  
Vol 61 (11-12) ◽  
pp. 557-561 ◽  
Author(s):  
Zoran Radovanovic ◽  
Dragana Radovanovic ◽  
Milan Breberina ◽  
Tomislav Petrovic ◽  
Andrija Golubovic ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Preoperative Staging ◽  
Cancer Staging ◽  
Preoperative Chemoradiation ◽  
Depth Of Invasion ◽  
Endorectal Ultrasonography ◽  
Accuracy Rate ◽  
Diagnostic Modality ◽  
Rectal Cancer Staging ◽  
First Choice

Introduction Preoperative staging of rectal cancer is considered essential to select patients adequately for different therapeutic regimes. The aim of the present study was to evaluate the accuracy of endorectal ultrasonography in preoperative staging of rectal cancer. MATERIALS AND METHODS Fifty rectal cancer patients (31 men, 19 women) underwent endorectal ultrasonography with a 7.5-MHz probe. Thirty-eight of these patients had preoperative chemoradiation and in these patients examination was done before and after the radiotherapy treatment. The results of examinations were compared with the histological findings of the resected specimens. RESULTS Histopathology showed 4 stage T0, 3 stage T1, 12 stage T2, 30 stage T3, and one stage T4 tumor. Nodal metastases were seen in 17 patients. The overall accuracy of endorectal ultrasonography for determining the depth of invasion (T stage) was 66% (33/50). The accuracy rate of T1 was 100% (1/1), T2 was 45% (9/20), T3 was 79% (22/28), and T4 was 100% (1/1). Overstaging was 18% (9/50) and understaging 16% (8/50). In staging lymph node metastasis, the overall accuracy rate was 70% (18/25) with 18% (9/50) overstaged and 12% (6/50) understaged. With regard to nodal involvement, sensitivity was 65% and specificity 73%. Regarding penetration of the rectal wall (stages T1 and T2 vs stages T3 and T4 / Dukes' classification A versus B), endorectal sonography showed sensitivity, specificity, and accuracy of 74%, 68%, and 72%, respectively. CONCLUSION Endorectal ultrasonography is a valuable diagnostic modality for rectal cancer staging. It is fast, safe, accurate, well tolerated by the patient and cheap procedure and therefore should be used as a diagnostic modality of the first choice in rectal cancer staging although one must take into consideration possible limitations in cases of preoperative chemoradiation.

scholarly journals The Role of 3-D Endorectal Ultrasound in Rectal Cancer: Our Experience

2014 ◽  
Vol 99 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Nikola Y. Kolev ◽  
Anton Y. Tonev ◽  
Valentin L. Ignatov ◽  
Aleksander K. Zlatarov ◽  
Vasil M. Bojkov ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Rectal Wall ◽  
Preoperative Staging ◽  
Three Dimensional ◽  
Cancer Staging ◽  
Endorectal Ultrasound ◽  
Diagnostic Methods ◽  
Diagnostic Modality ◽  
Locoregional Staging

Abstract In the last 20 years, endorectal ultrasound (ERUS) has been one of the main diagnostic methods for locoregional staging of rectal cancer. ERUS is accurate modality for evaluating local invasion of rectal carcinoma into the rectal wall layers (T category). Adding the three-dimensional modality (3-D) increases the capabilities of this diagnostic tool in rectal cancer patients. We review the literature and report our experience in preoperative 3-D ERUS in rectal cancer staging. In the group of 71 patients, the staging of preoperative 3-D endorectal ultrasonography was compared with the postoperative morphologic examination. Three-dimensional ERUS preoperative staging was confirmed with morphologic evaluation in 66 out of 71 cases (92.9%). The detection sensitivities of rectal cancer with 3-D ERUS were as follows: T1, 92.8%; T2, 93.1%; T3, 91.6%; and T4, 100.0%; with specificity values of T1, 98.2%; T2, 95.4%; T3, 97.8%; and T4, 98.5%. Three-dimensional ERUS correctly categorized patients with T1, 97.1%; T2, 94.3%; T3, 95.7%; and T4, 98.5%. The percentage of total overstaged cases was 2.75% and that of understaged cases was 6.87%. The metastatic status of the lymph nodes was determined with a sensitivity of 79.1% (19 of 24), specificity of 91.4% (43 of 47), and diagnostic accuracy of 87.3% (62 of 71). In our experience, 3-D ERUS has the potential to become the diagnostic modality of choice for the preoperative staging of rectal cancer.

scholarly journals Telomere Architecture Correlates with Aggressiveness in Multiple Myeloma

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1969
Author(s):  
Aline Rangel-Pozzo ◽  
Pak Yu ◽  
Sadhana LaL ◽  
Yasmin Asbaghi ◽  
Luiza Sisdelli ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Disease Progression ◽  
Genomic Instability ◽  
Clinical Decision Making ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Response To Treatment ◽  
Average Intensity ◽  
Patient Response ◽  
Smoldering Multiple Myeloma

The prognosis of multiple myeloma (MM), an incurable B-cell malignancy, has significantly improved through the introduction of novel therapeutic modalities. Myeloma prognosis is essentially determined by cytogenetics, both at diagnosis and at disease progression. However, for a large cohort of patients, cytogenetic analysis is not always available. In addition, myeloma patients with favorable cytogenetics can display an aggressive clinical course. Therefore, it is necessary to develop additional prognostic and predictive markers for this disease to allow for patient risk stratification and personalized clinical decision-making. Genomic instability is a prominent characteristic in MM, and we have previously shown that the three-dimensional (3D) nuclear organization of telomeres is a marker of both genomic instability and genetic heterogeneity in myeloma. In this study, we compared in a longitudinal prospective study blindly the 3D telomeric profiles from bone marrow samples of 214 initially treatment-naïve patients with either monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), or MM, with a minimum follow-up of 5 years. Here, we report distinctive 3D telomeric profiles correlating with disease aggressiveness and patient response to treatment in MM patients, and also distinctive 3D telomeric profiles for disease progression in smoldering multiple myeloma patients. In particular, lower average intensity (telomere length, below 13,500 arbitrary units) and increased number of telomere aggregates are associated with shorter survival and could be used as a prognostic factor to identify high-risk SMM and MM patients.

scholarly journals Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carlos Alfonso Romero-Gameros ◽  
Tania Colin-Martínez ◽  
Salomón Waizel-Haiat ◽  
Guadalupe Vargas-Ortega ◽  
Eduardo Ferat-Osorio ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tool ◽  
Clinical Decision Making ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
World Health ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Health Organization

Abstract Background The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. Methods An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. Results A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52–4.17), fever OR 2.98 (95% CI; 2.47–3.58), dyspnea OR 2.9 (95% CI; 2.39–3.51]) and cough OR 2.73 (95% CI: 2.27–3.28). Conclusion The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. Trial registration Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.

Standardized Synoptic Cancer Pathology Reports — So What and Who Cares?: A Population-Based Satisfaction Survey of 970 Pathologists, Surgeons, and Oncologists

2013 ◽  
Vol 137 (11) ◽  
pp. 1599-1602 ◽  
Author(s):  
Sara Lankshear ◽  
John Srigley ◽  
Thomas McGowan ◽  
Marta Yurcan ◽  
Carol Sawka
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Physician Satisfaction ◽  
Cross Sectional ◽  
Cancer Pathology ◽  
Report Turnaround Time ◽  
Significant Difference ◽  
Pathology Reporting ◽  
The Impact

Context.—Cancer Care Ontario implemented synoptic pathology reporting across Ontario, impacting the practice of pathologists, surgeons, and medical and radiation oncologists. The benefits of standardized synoptic pathology reporting include enhanced completeness and improved consistency in comparison with narrative reports, with reported challenges including increased workload and report turnaround time. Objective.—To determine the impact of synoptic pathology reporting on physician satisfaction specific to practice and process. Design.—A descriptive, cross-sectional design was utilized involving 970 clinicians across 27 hospitals. An 11-item survey was developed to obtain information regarding timeliness, completeness, clarity, and usability. Open-ended questions were also employed to obtain qualitative comments. Results.—A 51% response rate was obtained, with descriptive statistics reporting that physicians perceive synoptic reports as significantly better than narrative reports. Correlation analysis revealed a moderately strong, positive relationship between respondents' perceptions of overall satisfaction with the level of information provided and perceptions of completeness for clinical decision making (r = 0.750, P &lt; .001) and ease of finding information for clinical decision making (r = 0.663, P &lt; .001). Dependent t tests showed a statistically significant difference in the satisfaction scores of pathologists and oncologists (t169 = 3.044, P = .003). Qualitative comments revealed technology-related issues as the most frequently cited factor impacting timeliness of report completion. Conclusion.—This study provides evidence of strong physician satisfaction with synoptic cancer pathology reporting as a clinical decision support tool in the diagnosis, prognosis, and treatment of cancer patients.

scholarly journals Factors Influencing Physicians' Clinical Decision-making at Upazila Health Complexes in Bangladesh

2020 ◽  
Vol 3 (4) ◽  
pp. 125-133
Author(s):  
M. Aminul Islam ◽  
M. Abdul Awal
Keyword(s):  
Decision Making ◽  
Social Networks ◽  
Clinical Decision Making ◽  
Average Length ◽  
Clinical Decision ◽  
Primary Data ◽  
Decision Making Process ◽  
Cross Sectional ◽  
The Right ◽  
Consultation Session

ABSTRACT Introduction Selecting the most appropriate treatment for each patient is the key activity in patient-physician encounters and providing healthcare services. Achieving desirable clinical goals mostly depends on making the right decision at the right time in any healthcare setting. But little is known about physicians' clinical decision-making in the primary care setting in Bangladesh. Therefore, this study explored the factors that influence decisions about prescribing medications, ordering pathologic tests, counseling patients, average length of patient visits in a consultation session, and referral of patients to other physicians or hospitals by physicians at Upazila Health Complexes (UHCs) in the country. It also explored the structure of physicians' social networks and their association with the decision-making process. Methods This was a cross-sectional descriptive study that used primary data collected from 85 physicians. The respondents, who work at UHCs in the Rajshahi Division, were selected purposively. The collected data were analyzed with descriptive statistics including frequency, percentage, one-way analysis of variance, and linear regression to understand relationships among the variables. Results The results of the study reveal that multiple factors influence physicians' decisions about prescribing medications, ordering pathologic tests, length of visits, counseling patients, and referring patients to other physicians or hospitals at the UHCs. Most physicians prescribe drugs to their patients, keeping in mind their purchasing capacity. Risk of violence by patients' relatives and better management are the two key factors that influence physicians' referral decisions. The physicians' professional and personal social networks also play an influential role in the decision-making process. It was found that physicians dedicate on average 16.17 minutes to a patient in a consultation session. The length of visits is influenced by various factors including the distance between the physicians' residence and their workplace, their level of education, and the number of colleagues with whom they have regular contact and from whom they can seek help. Conclusion The results of the study have yielded some novel insights about the complexity of physicians' everyday tasks at the UHCs in Bangladesh. The results would be of interest to public health researchers and policy makers.

scholarly journals The Role of Micro-RNAs and Circulating Tumor Markers as Predictors of Response to Neoadjuvant Therapy in Locally Advanced Rectal Cancer

2020 ◽  
Vol 21 (19) ◽  
pp. 7040 ◽  
Author(s):  
Fatima Domenica Elisa De Palma ◽  
Gaetano Luglio ◽  
Francesca Paola Tropeano ◽  
Gianluca Pagano ◽  
Maria D’Armiento ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Clinical Decision Making ◽  
Locally Advanced ◽  
Therapy Response ◽  
Predictive Biomarkers ◽  
Advanced Rectal Cancer ◽  
Clinical Decision ◽  
Locally Advanced Rectal Cancer ◽  
Specific Expression ◽  
Micro Rnas

The response to neoadjuvant chemoradiation (nCRT) is a critical step in the management of locally advanced rectal cancer (LARC) patients. Only a minority of LARC patients responds completely to neoadjuvant treatments, thus avoiding invasive radical surgical resection. Moreover, toxic side effects can adversely affect patients’ survival. The difficulty in separating in advances responder from non-responder patients affected by LARC highlights the need for valid biomarkers that guide clinical decision-making. In this context, microRNAs (miRNAs) seem to be promising candidates for predicting LARC prognosis and/or therapy response, particularly due to their stability, facile detection, and disease-specific expression in human tissues, blood, serum, or urine. Although a considerable number of studies involving potential miRNA predictors to nCRT have been conducted over the years, to date, the identification of the perfect miRNA signatures or single miRNA, as well as their use in the clinical practice, is still representing a challenge for the management of LARC patients. In this review, we will first introduce LARC and its difficult management. Then, we will trace the scientific history and the key obstacles for the identification of specific miRNAs that predict responsiveness to nCRT. There is a high potential to identify non-invasive biomarkers that circulate in the human bloodstream and that might indicate the LARC patients who benefit from the watch-and-wait approach. For this, we will critically evaluate recent advances dealing with cell-free nucleic acids including miRNAs and circulating tumor cells as prognostic or predictive biomarkers.

scholarly journals Relationships between emotional schemas, mindfulness, self-compassion and unconditional self-acceptance on the regulation of psychological needs

2020 ◽  
Vol 23 (2) ◽  
Author(s):  
Bruno Faustino ◽  
António Branco Vasco ◽  
Ana Nunes Silva ◽  
Telma Marques
Keyword(s):  
Experiential Avoidance ◽  
Clinical Decision Making ◽  
Psychological Symptoms ◽  
Well Being ◽  
Clinical Decision ◽  
Psychological Needs ◽  
Self Report ◽  
Cross Sectional ◽  
Self Compassion ◽  
Self Acceptance

Emotional schemas are pervasive mental structures associated with a wide array of psychological symptoms, while mindfulness, self-compassion, and self-acceptance are viewed as adaptive psychological constructs. Psychological needs may be described as the cornerstone of mental health and well-being. However, a study of the relationships between emotional schemas, mindfulness, self-compassion, and self-acceptance with psychological needs was not performed. For this purpose, 250 subjects (M=20.67, SD=4.88, Male=33, Female=217), were evaluated through self-report questionnaires, in a cross-sectional design. Negative correlations were found between emotional schemas, mindfulness, self-compassion, unconditional self-acceptance, and psychological needs. Symptomatology was positively correlated with emotional schemas. Mindfulness, self-compassion, and unconditional self-acceptance predicted the regulation of psychological needs and mediated the relationship between emotional schemas and psychological needs. Emotional schemas may be associated with a tendency for experiential avoidance of internal reality, self-rejection/shame and self-criticism which may impair the regulation of psychological needs. These variables may be targets of integrative case conceptualization and clinical decision making focused on patient’s timings, styles of communication and needs.

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