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Examines the possibilities and limitations of imaging in the staging of prostate cancer. Examples of different clinical staging methods; Criteria to predict extracapsular extension with accuracy, specificity, sensitivity, and positive predictive value on endorectal coil magnetic resonance imaging; Evaluation of the cost-effectiveness of prostate imaging methods used in cancer staging.

Abstract: Objectives: To determine whether the failure of chemotherapy in patients with regionally metastatic or unresectable transitional cell carcinoma (TCC) of the bladder can be predicted early in the course of chemotherapy with magnetic resonance (MR) imaging. Methods: In this prospective study, 36 patients with regionally metastatic or unresectable TCC of the urinary bladder underwent MR imaging before and after two, four, and six cycles of chemotherapy with Methotrexate, Vinblastine, Adriamycin (doxorubicin) and Cisplatin (MVAC). The response after two cycles of MVAC was evaluated by using conventional tumour size parameters with unenhanced MR imaging and with changes in the time to the start of tumour or lymph node enhanced at fast dynamic contrast-enhanced MR imaging. The results obtained with these techniques were compared with the findings at histopathology in cystectomy or transurethral resection specimens that were obtained after chemotherapy. Duration of survival was defined as the time from the start of chemotherapy until disease-specific death. Kaplan-Meier curves were drawn to determine the difference in prognosis between responders and nonresponders. Results: After two cycles of chemotherapy, the accuracy, sensitivity, and specificity in distinguishing responders from nonresponders with conventional MR imaging were 69%, 81%%, and 50%, respectively. With the fast dynamic contrast-enhanced technique, accuracy, sensitivity, and specificity were 92%, 91%, and 93% respectively. The median bladder cancer specific survival was 28 months for all patients studied. Responders to chemotherapy at fast dynamic contrast-enhanced MR had better median disease-specific survival than nonresponders (42 months vs. 12 months [p <0.0001]). Conclusion: We can predict whether a patient will respond to chemotherapy after two cycles of chemotherapy with fast dynamic contrast-enhanced MR imaging. [Copyright &y& Elsevier]

Summary: Pilot study evaluating the diagnostic value of magnetic resonance lymphography (MRL) compared with conventional imaging techniques in the preoperative staging of the clinically (palpable) negative neck (cN0) in squamous cell carcinoma of the oral cavity (SCCOC). Patients with SCCOC without clinical evidence of lymph node metastasis and scheduled for surgery underwent MRL in combination with ultrasound with or without fine needle aspiration cytology and multi-detector computer tomography. MRL images were interpreted by 2 independent radiologists. All patients were planned for resection of the primary tumor and a selective neck dissection of levels I–III. Histopathologic results were evaluated as the gold standard and compared with preoperative findings. One of nine evaluated patients had a metastatic node on histopathologic analysis. In all but 1 patient, MRL showed possible metastatic spread in at least 1 node. On a node-to-node basis, negative predictive value (NPV) and sensitivity reached 100% for 1.5- en 3Tesla (T) MRL, specificity reached 92% at 1.5T and 93% at 3T MRL, and positive predictive value (PPV) was 8% at 1.5T MRL, for both radiologists. PPV at 3T MRL was 10% and 9%, for radiologists I and II, respectively. This pilot study shows that MRL has a high NPV based on a node-to-node analysis. However, its PPV was only 10%, and therefore its use as a single imaging technique in the preoperative staging of the cN0 neck in SCCOC seems to be limited. Further studies are needed to confirm these data. [Copyright &y& Elsevier]

Aim: To compare the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of lymph node metastases in prostate cancer. Methods: After a comprehensive literature search, studies were included that allowed construction of contingency tables for detection of lymph node metastases using CT or MRI. In addition, a summary receiver-operating characteristic (ROC) analysis was performed. Results: A total of 24 studies were included. For CT, pooled sensitivity was 0.42 (0.26–0.56 95% CI) and pooled specificity was 0.82 (0.8–0.83 95% CI). For MRI, the pooled sensitivity was 0.39 (0.22–0.56 95% CI) and pooled specificity was 0.82 (0.79–0.83 95% CI). The differences in performance of CT and MRI were not statistically significant. Conclusion: CT and MRI demonstrate an equally poor performance in the detection of lymph node metastases from prostate cancer. Reliance on either CT or MRI will misrepresent the patient''s true status regarding nodal metastases, and thus misdirect the therapeutic strategies offered to the patient. [Copyright &y& Elsevier]

Abstract: The aim of the study was to evaluate mammography in detecting and staging of invasive lobular carcinoma (ILC) in order to assess the performance and impact of observer variability. Forty-two cases of ILC were retrospectively evaluated twice by two breast radiologists. Mammographic performance as well as intra- and interobserver variations was evaluated. Thirty-five percent to 37% of the cases were understaged. The largest differences between radiologists were found in the breast imaging reporting and data system (BIRADS) classification and staging performance. These results can have serious influence on patient management. [Copyright &y& Elsevier]