| 1. |
- Kindler, Csaba, et al.
(författare)
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A Deep Neural Network-Based Decision Support Tool for the Detection of Lymph Node Metastases in Colorectal Cancer Specimens
- 2023
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Ingår i: Modern Pathology. - : Elsevier. - 0893-3952 .- 1530-0285. ; 36:2
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Tidskriftsartikel (refereegranskat)abstract
- The identification of lymph node metastases in colorectal cancer (CRC) specimens is crucial for the planning of postoperative treatment and can be a time-consuming task for pathologists. In this study, we developed a deep neural network (DNN) algorithm for the detection of metastatic CRC in digitized histologic sections of lymph nodes and evaluated its performance as a diagnostic support tool. First, the DNN algorithm was trained using pixel-level annotations of cancerous areas on 758 whole slide images (360 with cancerous areas). The algorithm's performance was evaluated on 74 whole slide images (43 with cancerous areas). Second, the algorithm was evaluated as a decision support tool on 288 whole slide images covering 1517 lymph node sections, randomized in 16 batches. Two senior pathologists (C.K. and C.O.) assessed each batch with and without the help of the algorithm in a 2 x 2 crossover design, with a washout period of 1 month in between. The time needed for the evaluation of each node section was recorded. The DNN algorithm achieved a median pixel-level accuracy of 0.952 on slides with cancerous areas and 0.996 on slides with benign samples. N+ disease (metastases, micrometastases, or tumor deposits) was present in 103 of the 1517 sections. The algorithm highlighted cancerous areas in 102 of these sections, with a sensitivity of 0.990. Assisted by the algorithm, the median time needed for evaluation was significantly shortened for both pathologists (median time for pathologist 1, 26 vs 14 seconds; P < .001; 95% CI, 11.0-12.0; median time for pathologist 2, 25 vs 23 seconds; P < .001; 95% CI, 2.0-4.0). Our DNN showed high accuracy for detecting metastatic CRC in digitized histologic sections of lymph nodes. This decision support tool has the potential to improve the diagnostic workflow by shortening the time needed for the evaluation of lymph nodes in CRC specimens without impairing diagnostic accuracy.
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| 2. |
- Kindler, Csaba, et al.
(författare)
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Detection of Free Cancer Cells in Pelvic Lavage with Double Immunocytochemistry at Rectal Cancer Surgery
- 2017
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Ingår i: Anticancer Research. - : International Institute of Anticancer Research. - 0250-7005 .- 1791-7530. ; 37:4, s. 1563-1568
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim: The aim of the present study was to describe a double immunocytochemical staining method for detecting free cancer cells after rectal cancer surgery and to evaluate their extent and prognostic role. Materials and Methods: Immunocytochemistry was performed using antibodies against cytokeratin 20/caudal-typehomeobox transcription factor 2 (CDX2) and mucin glycoprotein-2 (MUC2)/p53 protein. The study included 29 patients with infraperitoneal rectal cancer who underwent bowel resection and four controls. The pelvic lavage was retrieved at the start of laparotomy, after total mesorectal excision and after abdominal lavage with sterile water. Results: Free cancer cells were detected with the double immunocytochemical method in the two controls with carcinomatosis and one control with sigmoidal cancer. None of the patients with rectal tumours had presence of free cancer cells. Conclusion: Immunocytochemical analysis of peritoneal lavage was feasible and negative in patients with infraperitoneal rectal cancer. Further studies are encouraged to investigate the clinical relevance in cases with free cancer cells after incomplete total mesorectal excision.
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| 3. |
- Nikberg, Maziar, et al.
(författare)
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Circumferential Resection Margin as a Prognostic Marker in the Modern Multidisciplinary Management of Rectal Cancer
- 2015
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Ingår i: Diseases of the Colon & Rectum. - 0012-3706 .- 1530-0358. ; 58:3, s. 275-282
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A positive circumferential resection margin has been associated with a high risk of local recurrence and a decrease in survival in patients who have rectal cancer.OBJECTIVE: The purpose of this study was to analyze the involvement of circumferential resection margin in local recurrence and survival in a multidisciplinary population-based setting by using tailored oncological therapy and surgery with total mesorectal excision.DESIGN: Data were collected in a prospective database and retrospectively analyzed. Between 1996 and 2009, 448 patients with rectal cancer underwent a curative bowel resection.SETTINGS: Population-based data were collected at a single institution in the county of Vastmanland, Sweden.RESULTS: Preoperative radiotherapy was delivered to 334 patients (74%); it was delivered to 35 patients (8%) concomitantly with preoperative chemotherapy. In 70 patients (16%), en bloc resections of the prostate and vagina were performed. Intraoperative perforations were seen in 7 patients (1.6%). The mesorectal fascia was assessed as complete in 117/118 cases. In 32 cases (7%), the circumferential resection margin was 1 mm or less. After a median follow-up of 68 months, 5 (1.1%) patients developed a local recurrence; one of them had circumferential resection margin involvement. The 5-year overall survival was 77%. In the multivariate analysis, the circumferential resection margin was not an independent factor for disease-free survival.LIMITATIONS: Mesorectal fascia was not assessed before 2007. The findings might be explained by a type II error but, from a clinical perspective, enough patients were included to motivate the conclusion of the study.CONCLUSIONS: Circumferential resection margin is an important measurement in rectal cancer pathology, but the correlation to local recurrence is much less than previously stated, probably because of oncological treatment and surgery that respects the mesorectal fascia and, when required, en bloc resections. Circumferential resection margin should not be used as a prognostic marker in the modern multidisciplinary management of rectal cancer.
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| 4. |
- Nikberg, Maziar, et al.
(författare)
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Lymphovascular and perineural invasion in stage II rectal cancer : a report from the Swedish colorectal cancer registry
- 2016
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Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 55:12, s. 1418-1424
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adjuvant chemotherapy for stage II and III rectal cancer patients is a matter of discussion. The aim of the present study was to evaluate the prognostic value of lymphovascular (LVI) and perineural (PNI) invasion in stage II rectal cancer on a national level. Materials and methods: Clinico-pathological factors associated with disease-free survival (DFS) and time to recurrence in stage II rectal cancer patients were analyzed from patient data registered in the Swedish Colorectal Cancer Registry between 2006 and 2012. Results: Of 2649 patients with TNM stage II disease, 1395 (53%) received preoperative radiotherapy and 456 (17%) preoperative chemoradiotherapy. LVI and PNI were detected in 387 (15%) and 269 (10%) patients, respectively. Adjuvant chemotherapy was planned in 14%, but more often if LVI or PNI was detected (25% and 31%, respectively, p < .001 for both). The three-year DFS and time to recurrence were 78% and 17%, respectively. Both LVI and PNI indicated worse outcome. In patients not receiving postoperative chemotherapy, the risks of recurrence after three years were 20% if LVI was seen and 22% if PNI was detected (p < .001 for both). In the absence of LVI and PNI, it was 13% and 12%, respectively. In a multivariate Cox regression analysis, patients with LVI (hazard ratio 1.44, 95% CI 1.09-1.90; p = .011) and PNI (hazard ratio 1.80, 95% CI 1.34-2.43, p < .001) had significantly increased risks of recurrence. Conclusions: Stage II rectal cancer patients with LVI and PNI have an increased risk of recurrence which emphasizes the need to properly evaluate the role of adjuvant chemotherapy particularly in these subgroups.
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| 5. |
- Tiselius, Catarina, et al.
(författare)
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Computed Tomography Follow-Up Assessment of Patients with Low-Grade Appendiceal Mucinous Neoplasms : Evaluation of Risk for Pseudomyxoma Peritonei
- 2017
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Ingår i: Annals of Surgical Oncology. - : Springer Science and Business Media LLC. - 1068-9265 .- 1534-4681. ; 24:7, s. 1778-1782
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Tidskriftsartikel (refereegranskat)abstract
- Low-grade appendiceal mucinous neoplasms are rare. Both classification and management vary. This study aimed to follow up on patients with a diagnosis of LAMN after primary surgery with computer tomography (CT) scans to examine the risk for the development of pseudomyxoma peritonei (PMP).This population-based prospective study investigated patients who underwent appendectomy between 2007 and 2013 and had histology results demonstrating the presence of LAMN. The patients were followed up with a CT scan every 6 months for 2 years, until December 2015.The study investigated 41 patients (20 females) with a median age of 65 years (range 20-87 years). The entire appendix was processed and examined, with results showing that 12 were perforated, and 3 had a positive margin. Extra-appendiceal mucin on the surface of the appendix was found in ten cases, and in two cases, extra-mucinous epithelial cells were detected. During a median follow-up period of 5.1 years (range 2-8.6 years), none of the patients experienced the development of PMP.These data suggest that for patients with LAMN confined to the appendix, involvement of the appendectomy margin or perforation with mucin locally, even with epithelial cells, did not predict the development of PMP, and a conservative approach seems justified. No reoperation was needed, and regular follow-up evaluation with CT scans was sufficient.
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| 6. |
- Tiselius, Catarina, et al.
(författare)
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Importance of Arterial Vessel Length for Metastatic Lymph Node Retrieval and Survival in Standardized Left- and Right-Sided Colon Cancer Surgery
- 2023
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Ingår i: Journal of Gastrointestinal Cancer. - : Springer Nature. - 1941-6628 .- 1941-6636. ; 54:3, s. 809-819
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Tidskriftsartikel (refereegranskat)abstract
- Background We investigated the localization of lymph node metastases, and the role of arterial vessel and specimen lengths in left- and right-sided colon cancer surgery, for survival. Methods This was a prospective cross-sectional population-based study of specimens from patients who underwent standardized surgical resection for colon cancer in 2012-2015. The mesocolon of the specimens was divided into four sections for pathological analysis of lymph nodes. Multiple linear regression analysis was used to explore the relationship between lymph node counts and patient- and surgery-related factors. For survival analysis, a multivariable Cox regression method was used. Results A total of 317 patients (160 females) were included. Median (range) age was 74 (30-95) years. Median number of lymph node retrieval was 32 (8-198) and was associated with increased specimen length but not to arterial vessel length. One hundred and thirty-three (42%) patients had lymph node metastases. All patients had these located < 5 cm from the tumour. Ten, two, and three specimens had lymph node metastases around the central and peripheral ligation of the ileocolic artery and at the central ligation of the inferior mesenteric artery, respectively. The tumour stages in these specimens were T3-4N2M0-1. No statistically significant survival benefit was associated with longer arterial vessel length (p = 0.429). Conclusions Neither retrieval of lymph nodes nor statistically significant survival was affected by vessel length in standardized left- and right-sided colon cancer surgery.
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| 7. |
- Tiselius, Catarina, et al.
(författare)
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Localization of mesenteric lymph node metastases in relation to the level of arterial ligation in rectal cancer surgery
- 2019
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 45:6, s. 989-994
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionFor oncological reasons, central arterial ligation of the inferior mesenteric artery(IMA) is suggested in rectal cancer surgery although no conclusive evidence support this. We have therefore investigated the localization of lymph node metastases and compared central ligation of the IMA versus peripheral arterial ligation, in rectal cancer specimens.MethodsThis was a cross-sectional population-based study of consecutive recruited patients who underwent resection for rectal cancer in 2012–2015. Multiple linear regression analysis was used to explore the relationship between lymph node count and age, sex, body mass index, preoperative oncological treatment, type of surgery, tumour stage, and vessel and specimen length.Results151 patients (54 women) were included, with median (range) age 70 (45–87) years. The median (range) number of lymph nodes retrieved was 25 (3–70), which was associated with body mass index, type of surgery and vessel length. Vessel length, median (range) 9.6 (5–14) and 9.2 (5–15) cm for reported central and peripheral arterial ligation, respectively, was associated with body mass index. In 39 of 42 samples, metastatic lymph nodes were located in the mesorectum, and 13 of 42 samples also had metastatic lymph nodes in the sigmoid mesentery. None were found around the ligated artery.ConclusionTo recruit all metastatic lymph nodes in rectal cancer surgery, it is important to include the sigmoid mesentery in the specimen, but not to perform a central ligation of the IMA compared with ligation of the SRA close to the left colic artery (LCA).
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