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Practical considerations in starting a peripheral lymphedema magnetic resonance imaging program
No full textThe management of chronic peripheral lymphedema benefits from a multidisciplinary approach in which magnetic resonance imaging (MRI) can play a key role. The imaging has been well described in the literature (including this journal), but the process for starting a novel imaging service line is complex. Participants in this process, including radiologists, imaging technical staff, information technologists, and revenue cycle managers, must be engaged and work in harmony to achieve success. The purpose of this article is to detail the building blocks and steps in starting a peripheral lymphedema MRI program, how our process evolved, and lessons learned along the way
Current and future opportunities for liquid biopsy of circulating biomarkers to aid in early cancer detection
No full textEarly diagnosis of cancer can significantly improve treatment and survival outcomes. Imaging and tissue biopsy are the gold standard diagnostic approaches but are costly, invasive, and often unable to detect early-stage tumors. The past decade has marked an acceleration in the discovery and development of liquid biopsy tests for aiding in the detection of various types of tumor markers in non-tissue samples, such as blood. Liquid biopsy markers include circulating tumor cells, as well as tumor cell fragments, nucleic acids, and proteins. Liquid biopsy may be useful in screening patients considered to be at high risk of developing cancer, for refining diagnosis when combined with other test results, and for early detection of recurrence. Advances in big data analytics, informatics, and artificial intelligence will make it possible to combine patient history, clinical data, and liquid biopsy marker profiles to achieve more accurate and earlier diagnosis. In this review, we summarize the current use of liquid biopsy in cancer care, including the development of multi-analyte panels to improve diagnostic accuracy and detect several cancer types in a single assay. We highlight recent advances for potential future applications of liquid biopsy to aid in the diagnosis of early-stage lung cancer. We also discuss the opportunities and challenges of integrating liquid biopsy into current algorithms for cancer screening and diagnosis
Overcoming tumor antigen heterogeneity in CAR-T cell therapy for malignant mesothelioma (MM)
No full textMalignant mesothelioma (MM) is a rare, aggressive solid tumor with limited therapeutic options and poor therapeutic response. The role of immunotherapy in MM is now well established and therapeutic options, such as checkpoint inhibitors, are increasingly being approved. Chimeric antigen receptor (CAR)-T cell therapy is successfully implemented in several hematologic cancers, but currently has inadequate effect in solid tumors, owing to several limitations, such as trafficking and infiltration, limited T cell persistence and exhaustion, the immunosuppressive TME and tumor antigen heterogeneity. The lack of uniform and universal expression of tumor-associated antigens (TAAs) on tumor cells, as well as TAA heterogeneity following tumor editing post-therapy, are issues of significant importance to CAR-T cell and associated antigen-targeting therapies. Our review discusses the concept of tumor antigen heterogeneity in MM, the consequences for CAR-T cell therapies and the strategies to overcome it
The role of modern immunotherapy in metastatic urothelial cancer: mini review
No full textThe approval of immune checkpoint inhibitors (ICIs) has changed the treatment landscape in many aspects of urothelial cancer (UC), in both non-muscle-invasive bladder cancer and muscle-invasive bladder cancer and has introduced the concept of long-term remission for some patients in the metastatic setting. Front-line chemotherapy remains superior at achieving initial control of disease compared to front-line immune therapy. However, long-term durable responses are limited by chemotherapy resistance. The maintenance approach, sequencing chemotherapy with ICIs, could be considered a best of both worlds approach, achieving initial control with chemotherapy, which is maintained in some individuals with avelumab. However, outcomes for patients with metastatic UC remain poor. There are three steps to improving outcomes for these patients; the first is to develop better drugs and combinations of therapies, the second is the development of novel biomarkers and techniques to better select patients for treatment, and the third area of development is to give the drugs in the most optimal setting
Multimodality imaging for repaired tetralogy of Fallot
No full textDespite complete repair at an optimal time in the current era, almost all patients with tetralogy of Fallot will have residual anatomic and hemodynamic sequelae, which make ongoing surveillance of paramount importance. Echocardiography suffices surveillance matrix in most pre-operative cases unless there is a specific question about coronary artery anomaly or branch pulmonary arteries when cardiac catheterization or computed tomography scan can be extremely helpful. For long-term follow-up of repaired tetralogy of Fallot patients, several diagnostic/imaging monitoring modalities are available; however, no single modality is perfect in terms of obtaining all the necessary information. A multimodality approach is suggested for long-term surveillance where a diagnostic test is selected based on the clinical circumstances/questions raised and institutional preference/expertise
Clinical application of cardiac scintigraphy with bone tracers: controversies and pitfalls in cardiac amyloidosis
No full textCardiac amyloidosis (CA) is a life-threatening disease caused by extracellular deposition of amyloidogenic proteins in the heart tissue; it could be associated with a poor prognosis and remains underdiagnosed and underestimated. During the last years, bone scintigraphy has been widely used to facilitate the diagnosis of CA, avoid endomyocardial biopsy, and differentiate amyloid light-chain amyloidosis from transthyretin amyloidosis. Technetium-99m pyrophosphate (99mTc-PYP) is the most used tracer in the United States, but a standardized and shared acquisition protocol is still lacking; technetium-99m 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) is widely used in Europe and can count on a more grounded data than 99mTc-PYP. Both tracers suffer from some diagnostic limitations (due to their biochemical characteristics) and pitfalls that can lead to a misdiagnosis of CA. We aim to briefly describe the main differences between 99mTc-PYP and 99mTc-DPD, analyzing the data available in the literature and highlighting the most frequent causes of misdiagnosis and pitfalls. Both 99mTc-DPD and 99mTc-PYP show good accuracy for the diagnosis of CA with high specificity and sensibility. Nevertheless, to achieve this accuracy, the correct acquisition protocols must be followed for each tracer, as suggested in the latest recommendation. Proper diagnosis of CA has a crucial role in patient management; therefore, it is important for nuclear physicians to have the most specific approaches in acquiring and interpreting bone scintigraphy for transthyretin cardiac amyloidosis
New endovascular techniques for false lumen thrombosis in aortic dissection after thoracic endovascular aortic repair
No full textOver the past decades, both open surgery and endovascular treatment of aortic dissection have made great progress with good clinical outcomes. However, despite this progress, the presence of distal re-entry tears can sustain perfusion of false lumen (FL) and induce aneurysm formation or growth. In particular, about 20% of patients undergoing thoracic endovascular aortic repair (TEVAR) for aortic dissection require reintervention because of incomplete FL thrombosis promoting aortic wall degeneration, post-dissection aortic aneurysm, and rupture. Endovascular techniques to promote FL thrombosis after TEVAR show good early results together with minimal invasiveness, offering different alternatives depending on the case and the level of urgency. Endovascular techniques include FL embolization (with coils, vascular plugs, etc.), candy-plug techniques, parallel stent graft, and branched and fenestrated aortic endoprosthesis. Each of these solutions has advantages and disadvantages. We herein describe the available endovascular options
Comparative outcomes of laparoscopic fundoplication and magnetic sphincter augmentation: is there a difference?
No full textThe prevalence of gastrointestinal reflux disease and reflux-related complications continue to rise, and treatment options are limited. Medical management alone is often ineffective and chronic use carries inherent risk. Magnetic sphincter augmentation represents a reasonable and viable treatment option for appropriately selected patients. Compared to surgical wraps, magnetic sphincter augmentation (MSA) may provide similar rates of patient satisfaction, anti-acid medication cessation, and decreased esophageal acid exposure. Additionally, MSA may lower postoperative gas bloat symptoms and better preserve the ability to belch or vomit, versus surgical wraps. Magnetic sphincter augmentation, however, is still relatively new, and further study is needed to evaluate and compare outcomes more appropriately to that of surgical wraps
Ureter identification utilizing indocyanine green (ICG) imaging in colorectal surgery: a systematic review of the literature
No full textAim: To describe the currently available evidence regarding the efficacy and safety of intraureteral indocyanine green (ICG) instillation for ureteral identification in colorectal surgery. Methods: Systematic search of PubMed and Scopus through May 2022 reported according to PRISMA 2020. Studies reporting treatment of patients < 18 years, with unavailable full-text, reviews, editorials, animal studies, and studies including non-colorectal operations were excluded.Results: Seven retrospective studies, published between 2020 and 2022, were identified, in which 142 patients (43% females) were evaluated, of which three were undertaken in the USA, two in Japan, and two in India. The most common indications for surgery were cancer in 58 patients (41%) and diverticular disease in 52 patients (36.6%). Most patients involved underwent robotic surgery (70%), while the remaining patients had laparoscopic surgery. The intraoperative ureteral injury was reported in one patient, while adverse effects (mainly transient hematuria) were reported in 10% of the study population (14 patients). The use of intrauretal ICG prolonged surgery by a median of 12.8 minutes.Conclusion: Intraoperative visualization of ureters using ICG in colorectal surgery is safe and effective, according to the results of this study. However, this technique still bears the potential disadvantages of ureteral catheterization. Research is focusing on future dyes combining the ICG properties with renal excretion to minimize the need for stents. Further comparative studies are needed to reach safe results
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