Endoscopic ultrasound and magnetic resonance imaging for re-staging rectal cancer after radiotherapy

AIM:To compare the sensitivity and specificity of two imaging techniques,endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI),in patients with rectal cancer after neoadjuvant chemoradiation therapy. And we compared EUS and MRI data with histological fi ndings from surgical specimens. METHODS:Thirty-nine consecutive patients (51.3% Male; mean age:68.2 ± 8.9 years) with histologically confirmed distal rectal cancer were examined for staging. All patients underwent EUS and MRI imaging before and after neoadjuvant chemoradiation therapy. RESULTS:After neoadjuvant chemoradiation,EUS and MRI correctly classified 46% (18/39) and 44% (17/39) of patients,respectively,in line with their histological T stage (P > 0.05). These proportions were higher for both techniques when nodal involvement was considered:69% (27/39) and 62% (24/39). When patients were sorted into T and N subgroups,the diagnostic accuracy of EUS was better than MRI for patients withT0-T2 (44% vs 33%,P > 0.05) and N0 disease (87% vs 52%,P = 0.013). However,MRI was more accurate than EUS in T and N staging for patients with more advanced disease after radiotherapy,though these differences did not reach statistical significance. CONCLUSION:EUS and MRI are accurate imaging techniques for staging rectal cancer. However,after neoadjuvant RT-CT,the role of both methods in the assessment of residual rectal tumors remains uncertain.

TM6SF2 E167K variant predicts severe liver fibrosis for human immunodeficiency/hepatitis C virus co-infected patients, and severe steatosis only for a non-3 hepatitis C virus genotype

AIM To evaluate the impact of the Glu167Lys(E167K) transmembrane 6 superfamily member 2(TM6SF2) variant on the biochemical and morphologic expression of liver lesions in human immunodeficiency virus(HIV)/hepatitis C virus(HCV) co-infected patients.METHODS The study comprised 167 consecutive patients with HIV/HCV coinfection and biopsy-proven chronic hepatitis. A pathologist graded liver fibrosis and necroinflammation using the Ishak scoring system, and steatosis using Kleiner's scoring system. Patients were genotyped for TM6SF2 E167K(rs58542926) by real-time Polymerase chain reaction. The 167 patients, 35 therapy-naive and 132 receiving ART, were prevalently males(73.6%), the median age was 40.7 years and the immunological condition good(median CD4+ cells/mm3 = 505.5).RESULTS The 17 patients with the TM6SF2 E167 K variant, compared with the 150 with TM6SF2-E/E, showed higher AST(P = 0.02) and alanine aminotransferase(P = 0.02) and higher fibrosis score(3.1 ± 2.0 vs 2.3 ± 1.5, P = 0.05). In a multivariate analysis, TM6SF2 E167 K was independently associated with severe fibrosis. The same analysis showed that HCV-genotype 3, present in 42.2% of patients was an independent predictor of severe steatosis. The association of TM6SF2 E167 K with severe steatosis, absent for the whole group of 167 patients, was re-evaluated separately for HCVgenotype 3 and non-3 patients: No factor was independently associated with severe steatosis in the HCV-genotype-3 subgroup, whereas an independent association was observed between severe steatosis and TM6SF2 E167 K in non-3 HCV genotypes. No association between the TM6SF2 E167 K variant and severe liver necroinflammation was observed.CONCLUSION In HIV/HCV coinfection the TM6SF2 E167 K variant is an independent predictor of severe fibrosis, but appears to be independently associated with severe steatosis only for patients with a non-3 HCV genotype.

Prognostic role of ultrasonography staging in patients with anal cancer

BACKGROUND Carcinomas of the anal canal are staged according to the size and extent of the disease;however,we propose including a novel ultrasound(US)staging system,based on depth of tumor invasion.In this study the clinical American Joint Committee on Cancer(AJCC)staging guidelines and the US classificationss in patients with anal cancer were compared.AIM To evaluate the prognostic role of the US staging system in patients with anal cancer.METHODS The data of 48 patients with anal canal squamous cells carcinoma,observed at our University Hospital between 2007 and 2017,who underwent pre-treatment assessment with pelvic magnetic resonance imaging(MRI),total body computed tomography(CT)scan and endoanal US were retrospectively reviewed.Anal canal tumors were clinically staged according to AJCC,determined by MRI by measurement of the longest tumor diameter,and CT scan.Endoanal US was performed with a high multi-frequency(9-16 MHz),360°rotational mechanical probe;US classification was based on depth of tumor penetration through the anal wall,according to Giovannini’s study.All patients were treated with definitive radiation combined with 5-fluorouracile and Mitomycin-C.After treatment patients were followed-up regularly.RESULTS At baseline there were 30 and 32 T1-2,18 and 16 T3-4,31 and 19 N+patients classified according to the clinical AJCC and US staging system respectively.After a mean follow-up of 98 months,38 patients(79.1%)are alive and 28(58.3%)are disease free.During follow up 20 patients(41.6%)experienced recurrences.After univariate analysis,American Society of Anesthesiologists(ASA)score(P=0.00000001)and US staging(P=0.009)were significantly related to disease-free survival(DFS).When overall survival and DFS functions were compared,a statistically significant difference was observed for DFS survival when the US staging was applied with respect to the clinical AJCC staging.By combining the 2 significant prognostic variables,namely the US staging with the ASA score,four risks groups with different prognoses were identified.CONCLUSION Our findings suggest that US staging may be superior to traditional clinical staging,since it is significantly associated with DFS in anal cancer patients.

Increased risk of postsurgical macular edema in high stage idiopathic epiretinal membranes

Purpose:To assess the rate of occurrence and the risk factors of postsurgical macular edema(PSME)in eyes with idiopathic epiretinal membrane(iERM)or full-thickness macular hole(FTMH).Methods:Retrospective longitudinal analysis of all subjects scheduled for vitrectomy with or without combined cataract surgery over a 6-month period.Electronic medical charts and imaging data were analyzed preoperatively and at 1,3 and 6 months after surgery.Results:From 101 patients diagnosed with iERM or FTMH,71 patients were eligible for the study.Forty-nine eyes with iERM(69.0%)and 22 eyes with FTMH(31.0%)underwent vitrectomy either isolated(31.0%)or combined with cataract extraction(69.0%).The overall rate of PSME was 26.7%,without differences between the two groups(P=0.9479).Combined cataract extraction did not affect the overall occurrence of PSME rate in both groups(P=0.9255 in FTMH and P=0.8658 in iERM).If grouped by stage,eyes with stage 4 iERM though disclosed an increased rate of PSME(57.1%)compared to lower(1 to 3)stages(14.3%,P=0.0021),particularly when combined with cataract surgery(71.4%vs.15.4%in stages≤3,P=0.0021).The PSME odds ratio for a stage 4 iERM is 8(95%CI:1.933-33.1;P=0.0041)compared to stages 3 and below.Conclusions:PSME remains a clinically relevant and frequent event after surgery for iERM and FTMH.Patients with stage 4 iERM have an 8-fold higher likelihood of developing PSME in a 6-month postsurgical period compared to iERM in 1-3 stages,especially when combined with cataract extraction.