There are significant gender differences in the diameter of both the VA and BA, indicating that gender needs to be considered in the diagnosis of VBD. These results also provide much needed quantitative data for the diagnosis of VBD in Chinese people.
Background: Tumors of the skull base pose unique challenges to radiosurgical treatment because of their irregular shapes, proximity to critical structures and variable tumor volumes. In this study, we investigate whether acceptable treatment plans with excellent conformity and homogeneity can be generated for complex skull base tumors using the Cyberknife ® radiosurgical system.
Objective: To describe the clinical and pathological features of endometrial carcinoma with extraperitoneal metastasis and examine whether surgery could improve the prognosis. Methods: The Surveillance, Epidemiology, and End Results database was used to analyze 730 patients who were diagnosed with extraperitoneal metastasis of endometrial cancer from 2010 to 2015, including metastasis to the lung, bone, or brain. Results: Of the 730 patients, 372 (50.96%) patients had single lung metastases, and 196(26.85%) patients had multiple organ metastases that included pulmonary invasion. Therefore, the lung was the most common target organ for extraperitoneal metastasis of endometrial cancer. In multivariate risk factor analysis, grade 3 tumor (odds ratio = 3.39, P < .001), positive peritoneal cytology (odds ratio = 2.02, P < .001), and cervical stromal invasion (odds ratio = 1.42, P = .030) were independent risk factors for extraperitoneal metastasis. Once metastasis occurred in the brain or multiple organs, the prognosis was often poor. Of the patients, 362 underwent surgery, and surgery was performed only for primary tumors of the reproductive organs in almost all patients (97.23%) with extraperitoneal metastasis. The median cancer-specific survival periods of patients with solitary pulmonary metastasis undergoing surgery and those without surgery were 23 (16.43-29.57) months and 9 (6.21-11.79) months, respectively ( P < .001), and survival superiority also existed in patients with bone metastasis (19 vs 8 months, P = .015) and multiple organs metastases (15 vs 4 months, P < .001). However, patients with brain metastasis had the same median survival period in the 2 groups (6 months, P = .146). Conclusions: The lung was the most common target organ for extraperitoneal metastasis in patients with endometrial cancer. Surgery was associated with improved survival in women with extraperitoneal metastasis, except for patients with brain metastasis.
This study was aimed to evaluatethe usefulness of conventional ultrasound (US) and US elastography, including the latest virtual touch tissue imaging and quantification (VTIQ), in malignancy prediction for complex cystic and solid breast lesions. Eighty-nine complex cystic and solid breast lesions were subject to conventional US and US elastography, including strain elastography (SE), virtual touch tissue imaging (VTI) and VTIQ. Among the 89 lesions, thirty-four (38.2%) lesions were malignant and 55 (61.8%) lesions were benign. Sixteen variables were subject to multivariate logistic regression analysis. Pattern 4b in VTI (odds ratio, OR:15.278), not circumscribed margin of lesion (OR:12.346), SWS mean >4.6 m/s in VTIQ (OR:11.896), and age elder than 50 years (OR:6.303) were identified to be independent predictors for malignancy. In receiver operating characteristic (ROC) curve analyses, associated areas under the ROC curve (Az) for conventional US could be significantly elevated, from 0.649 to 0.918, by combining with US elastography (p < 0.0001). The combined diagnostic method was able to improve the specificity (32.7% vs. 87.3%, p < 0.0001) without sacrificing the sensitivity (97.1% vs. 85.3%, p = 0.075). Both conventional US and US elastography contribute substantially to malignancy prediction in complex cystic and solid lesions. The diagnostic efficacy of conventional US in terms of Az and specificity could be significantly improved by combining with US elastography.
This study aimed to assess the dosimetric differences between iodine-125 seed stereotactic brachytherapy (SBT) and stereotactic body radiation therapy (SBRT) in the treatment of non-small cell lung cancer (NSCLC). An SBT plan and an SBRT plan were generated for eleven patients with T1-2 NSCLC. Prescription of the dose and fractionation (fr) for SBRT was 48Gy/4fr. The planning aim for SBT was D90 (dose delivered to 90% of the target volume)≥120Gy. Student’s paired t test was used to compare the dosimetric parameters. The SBT and SBRT plans had comparable PTV D90 (104.73±2.10Gyvs.107.64±2.29Gy), and similar mean volume receiving 100% of the prescription dose (V100%) (91.65% vs.92.44%, p = 0.410). The mean volume receiving 150% of the prescribed dose (V150%) for SBT was 64.71%, whereas it was 0% for SBRT. Mean heterogeneity index (HI) deviation for SBT vs. SBRT was 0.73 vs. 0.19 (p<0.0001), and the mean conformity index (CI) for SBT vs. SBRT was 0.77 vs. 0.81 (p = 0.031). The mean lung doses (MLD) in SBT were significantly lower than those in SBRT (1.952±0.713 vs. 5.618±2.009, p<0.0001). In conclusion, compared with SBRT, SBT can generate a comparable dose within PTV, while the organs at risk (OARs) only receive a very low dose. But the HI and CI in SBT were lower than in SBRT.
Sterilization, male and female combined, is the most common use of contraception in the United States. Despite the lower risk, higher cost-efficacy, and high efficacy of vasectomy compared with female sterilization, more US women rely on female sterilization than male sterilization. Reasons for low use of vasectomy include lack of knowledge and misconceptions about the procedure, lack of access, provider bias, and patient preferences. This article will provide a basic overview of male and female sterilization, an exploration of vasectomy barriers, and ways obstetrician-gynecologists can increase vasectomy uptake including regular recommendation of vasectomy to patients in long-term committed relationships considering sterilization.
PurposeTo determine the optimal standardized uptake value (SUV) of 18F-fluorodeoxyglucose (18F-FDG) for positron emission tomography (PET) imaging, at which the PET-defined gross tumor volume (GTVPET) best matches with the pathological volume (GTVPATH) in the cervical cancer.Materials and MethodsTen patients with the cervical cancer who underwent surgery were enrolled in this study. The excised specimens were processed for whole-mount serial sections and H-E staining. The tumor borders were outlined in sections under a microscope, histopathological images were scanned and the GTVPATH calculated. The GTVPET was delineated automatically by using various percentages relative to the maximal SUV and absolute SUV. The optimal threshold SUV was further obtained as the value at which the GTVPET best matched with the GTVPATH.ResultsAn average of 85±10% shrinkage of tissue was observed after the formalin fixation. The GTVPATH was 13.38±2.80 cm3 on average. The optimal threshold on percentile SUV and absolute SUV were 40.50%±3.16% and 7.45±1.10, respectively. The correlation analysis showed that the optimal percentile SUV threshold was inversely correlated with GTVPATH (p<0.05) and tumor diameter (p<0.05). The absolute SUV was also positively correlated with SUVmax (p<0.05).ConclusionThe pathological volume could provide the more accurate tumor volume. The optimal SUV of FDG for PET imaging by use of GTVPATH as standard for cervical cancer target volume delineation was thus determined in this study, and more cases are being evaluated to substantiate this conclusion.
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