Non-alcoholic fatty liver disease(NAFLD) associated hepatocellular carcinoma(HCC) incidence is increasing worldwide, paralleling the obesity epidemic. Although most cases are associated with cirrhosis, HCC can occur w...Non-alcoholic fatty liver disease(NAFLD) associated hepatocellular carcinoma(HCC) incidence is increasing worldwide, paralleling the obesity epidemic. Although most cases are associated with cirrhosis, HCC can occur without cirrhosis in NAFLD. Diabetes and obesity are associated risk factors for HCC in patients. Given the sheer magnitude of the underlying risk factors(diabetes, obesity, non-cirrhotic NAFLD) screening for HCC in the non-cirrhotic population is not recommended. Optimal screening strategies in NAFLD cirrhosis are not completely elucidated with Ultrasound having significant limitations in detection of liver lesions in the presence of obesity and steatosis. Consequently NAFLD-HCC is more often diagnosed at a later stage with larger tumors and reduced opportunities for curative treatments as opposed to HCC in other causes of cirrhosis. When HCC is found at a curative stage treatments including liver transplantation, resection and loco-regional therapies are associated with good results similar to that seen in HCV-HCC. Future strategies under study include the use of chemopreventive and antioxidant agents to reduce development of cirrhosis and non-alcoholic steatohepatitis(NASH). Strategies to reverse NASH via weight loss, control of associated conditions like diabetes are key strategies in reducing the increasing incidence of NASH-HCC. Novel therapeutic agents for NASH are in trials and if successful in achieving reversal of NASH will be an important strategy in reducing NAFLD-HCC.展开更多
AIM:To study the indications for sentinel lymph node biopsy(SLNB) in clinically-detected ductal carcinoma in situ(CD-DCIS).METHODS:A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an i...AIM:To study the indications for sentinel lymph node biopsy(SLNB) in clinically-detected ductal carcinoma in situ(CD-DCIS).METHODS:A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy(CNB) between June 2006 and June 2012 was conducted at King Faisal Specialist Hospital.The accuracy of performing SLNB in CD-DCIS,the rate of sentinel and non-sentinel nodal metastasis,and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed.The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion.We excluded any patient with evidence of microinvasion or invasion.There were two cases of mammographically detected DCIS and 18 cases of CDDCIS.All our patients were diagnosed by an imageguided CNB except two patients who were diagnosed by fine needle aspiration(FNA).All patients underwent breast surgery,SLNB,and axillary lymph node dissection(ALND) if the SLN was positive.RESULTS:Twenty patients with an initial diagnosis of pure DCIS underwent SLNB,2 of whom had an ALND.The mean age of the patients was 49.7 years(range,35-70).Twelve patients(60%) were premenopausal and 8(40%) were postmenopausal.CNB was the diagnostic procedure for 18 patients,and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate.Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis.Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%.The false negative rate was 0%.Only 2 patients had a positive SLNB(10%) and neither had additional metastasis following an ALND.After definitive surgery,3 patients were upstaged to invasive ductal carcinoma(3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion(3/18 = 16.6%).Therefore the histologic underestimation rate of invasive disease was 33%.CONCLUSION:SLNB in CD-DCIS is technically feasible and highly accurate.We recommend limiting SLNB to patients undergoing a mastectomy.展开更多
Background Sensitive and specific biomarkers for identifying early stage of non-small cell lung cancer （NSCLC） are urgently needed to improve the therapeutic outcome and reduce the mortality.Small non-coding microRN...Background Sensitive and specific biomarkers for identifying early stage of non-small cell lung cancer （NSCLC） are urgently needed to improve the therapeutic outcome and reduce the mortality.Small non-coding microRNAs （miRNAs） are key components of cancer development and are considered as potential biomarkers for cancer diagnosis and for monitoring treatment.The aim of this study was to determine whether aberrant miRNA expression can be used as a marker in peripheral blood mononuclear cells （PBMC） for the diagnosis of NSCLC.Methods The levels of two mature miRNAs （miR-143 and miR-150） were detected by probe-based stem-loop quantitative reverse-transcriptase PCR （RT-qPCR） in PBMC of 64 patients with NSCLC and 26 healthy individuals,and the relationship between miR-143 and miR-150 levels and clinical and pathological factors was explored.Results All endogenous miRNAs were present in peripheral blood in a remarkably stable form and detected by RT-qPCR.MiR-143 expression in the PBMC specimens was significantly lower in NSCLC patients than in healthy individuals （P ＜0.0001）.MiR-150 expression in the PBMC specimens was not significantly different between NSCLC patients and healthy individuals （P=0.260）.MiR-150 expression was significantly higher in lung adenocarcinoma patients than in healthy individuals （P=0.001）.There was a very strong difference in the expression level of miR-150 between lung adenocarcinoma patients and lung squamous cell caminoma patients （P ＜0.0001）.In receiver operating characteristic curve （ROC） analysis,low expression of miR-143 showed the area under the ROC （AUC） of 0.885 for distinguishing cancer patients from healthy subjects.High expression of miR-150 had an AUC of 0.834 for distinguishing lung adenocarcinoma patients from healthy subjects.High expression of miR-150 had an AUC of 0.951 for distinguishing lung adenocarcinoma from lung squamous cell carcinoma.The miR-150 level was significantly associated with distant metastasis （P=0.014）.Conclusions It is indicated that there is a potential for using miR-143 as a novel diagnostic biomarker for NSCLC.Moreover,miR-150 can be a highly accurate marker for differentiating adenocarcinoma from squamous cell carcinoma.展开更多
文摘Non-alcoholic fatty liver disease(NAFLD) associated hepatocellular carcinoma(HCC) incidence is increasing worldwide, paralleling the obesity epidemic. Although most cases are associated with cirrhosis, HCC can occur without cirrhosis in NAFLD. Diabetes and obesity are associated risk factors for HCC in patients. Given the sheer magnitude of the underlying risk factors(diabetes, obesity, non-cirrhotic NAFLD) screening for HCC in the non-cirrhotic population is not recommended. Optimal screening strategies in NAFLD cirrhosis are not completely elucidated with Ultrasound having significant limitations in detection of liver lesions in the presence of obesity and steatosis. Consequently NAFLD-HCC is more often diagnosed at a later stage with larger tumors and reduced opportunities for curative treatments as opposed to HCC in other causes of cirrhosis. When HCC is found at a curative stage treatments including liver transplantation, resection and loco-regional therapies are associated with good results similar to that seen in HCV-HCC. Future strategies under study include the use of chemopreventive and antioxidant agents to reduce development of cirrhosis and non-alcoholic steatohepatitis(NASH). Strategies to reverse NASH via weight loss, control of associated conditions like diabetes are key strategies in reducing the increasing incidence of NASH-HCC. Novel therapeutic agents for NASH are in trials and if successful in achieving reversal of NASH will be an important strategy in reducing NAFLD-HCC.
文摘AIM:To study the indications for sentinel lymph node biopsy(SLNB) in clinically-detected ductal carcinoma in situ(CD-DCIS).METHODS:A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy(CNB) between June 2006 and June 2012 was conducted at King Faisal Specialist Hospital.The accuracy of performing SLNB in CD-DCIS,the rate of sentinel and non-sentinel nodal metastasis,and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed.The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion.We excluded any patient with evidence of microinvasion or invasion.There were two cases of mammographically detected DCIS and 18 cases of CDDCIS.All our patients were diagnosed by an imageguided CNB except two patients who were diagnosed by fine needle aspiration(FNA).All patients underwent breast surgery,SLNB,and axillary lymph node dissection(ALND) if the SLN was positive.RESULTS:Twenty patients with an initial diagnosis of pure DCIS underwent SLNB,2 of whom had an ALND.The mean age of the patients was 49.7 years(range,35-70).Twelve patients(60%) were premenopausal and 8(40%) were postmenopausal.CNB was the diagnostic procedure for 18 patients,and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate.Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis.Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%.The false negative rate was 0%.Only 2 patients had a positive SLNB(10%) and neither had additional metastasis following an ALND.After definitive surgery,3 patients were upstaged to invasive ductal carcinoma(3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion(3/18 = 16.6%).Therefore the histologic underestimation rate of invasive disease was 33%.CONCLUSION:SLNB in CD-DCIS is technically feasible and highly accurate.We recommend limiting SLNB to patients undergoing a mastectomy.
基金This study was supported by grants from the National Natural Science Foundation of China （No. 30900247） and the Cooperative Research Project of Foundation and Clinic from Capital Medical University （No. 11JL48）.
文摘Background Sensitive and specific biomarkers for identifying early stage of non-small cell lung cancer （NSCLC） are urgently needed to improve the therapeutic outcome and reduce the mortality.Small non-coding microRNAs （miRNAs） are key components of cancer development and are considered as potential biomarkers for cancer diagnosis and for monitoring treatment.The aim of this study was to determine whether aberrant miRNA expression can be used as a marker in peripheral blood mononuclear cells （PBMC） for the diagnosis of NSCLC.Methods The levels of two mature miRNAs （miR-143 and miR-150） were detected by probe-based stem-loop quantitative reverse-transcriptase PCR （RT-qPCR） in PBMC of 64 patients with NSCLC and 26 healthy individuals,and the relationship between miR-143 and miR-150 levels and clinical and pathological factors was explored.Results All endogenous miRNAs were present in peripheral blood in a remarkably stable form and detected by RT-qPCR.MiR-143 expression in the PBMC specimens was significantly lower in NSCLC patients than in healthy individuals （P ＜0.0001）.MiR-150 expression in the PBMC specimens was not significantly different between NSCLC patients and healthy individuals （P=0.260）.MiR-150 expression was significantly higher in lung adenocarcinoma patients than in healthy individuals （P=0.001）.There was a very strong difference in the expression level of miR-150 between lung adenocarcinoma patients and lung squamous cell caminoma patients （P ＜0.0001）.In receiver operating characteristic curve （ROC） analysis,low expression of miR-143 showed the area under the ROC （AUC） of 0.885 for distinguishing cancer patients from healthy subjects.High expression of miR-150 had an AUC of 0.834 for distinguishing lung adenocarcinoma patients from healthy subjects.High expression of miR-150 had an AUC of 0.951 for distinguishing lung adenocarcinoma from lung squamous cell carcinoma.The miR-150 level was significantly associated with distant metastasis （P=0.014）.Conclusions It is indicated that there is a potential for using miR-143 as a novel diagnostic biomarker for NSCLC.Moreover,miR-150 can be a highly accurate marker for differentiating adenocarcinoma from squamous cell carcinoma.
