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Abstract: Background: Conventional imaging (CI) techniques are inadequate for lymph node (LN) staging in prostate cancer (PCa). Objectives: To assess the accuracy of 11C-Choline positron emission tomography/computerized tomography (PET/CT) for LN staging in intermediate-risk and high-risk PCa and to compare it with two currently used nomograms. Design, Setting, and Participants: From January 2007 to September 2007, 57 PCa patients at intermediate risk (n =27) or high risk (n =30) were enrolled at two academic centres. All patients underwent preoperative PET/CT and radical prostatectomy with extended pelvic LN dissection (PLND). Risk of LN metastasis (LNM) was assessed using available nomograms. Measurements: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and number of correctly recognized cases for LNM detection at PET/CT were assessed. The accuracy of PET/CT for LNM detection was compared with the accuracy of nomograms for LNM prediction by using receiver operating characteristic (ROC) analysis. Results and Limitations: Fifteen patients (26%) had LNMs, and a total of 41 LNMs were identified. On a patient analysis, sensitivity, specificity, PPV, NPV, and number of correctly recognized cases at PET/CT were 60.0%, 97.6%, 90.0%, 87.2%, and 87.7% while, on node analysis, these numbers were 41.4%, 99.8%, 94.4%, 97.2%, and 97.1%. The mean diameter (in mm) of the metastatic deposit of true-positive LNs was significantly higher than that of false-negative LNs (9.2 vs 4.2; p =0.001). PET/CT showed higher specificity and accuracy than the nomograms; however, in pairwise comparison, the areas under the curve (AUCs) were not statistically different (all p values >0.05). Conclusions: In patients with intermediate-risk and high-risk PCa, 11C-Choline PET/CT has quite a low sensitivity for LNM detection but performed better than clinical nomograms, with equal sensitivity and better specificity. [Copyright &y& Elsevier]

Aim: To define the histopathological features predictive of post-transplant hepatocellular carcinoma (HCC) recurrence after transarterial chemoembolization, applicable for recipient risk stratification., Methods: We retrospectively reviewed the specimens of all suspicious nodules (total 275) from 101 consecutive liver transplant recipients which came to our Pathology Unit over a 6-year period. All nodules were sampled and analyzed, and follow-up data were collected. We finally considered 11 histological variables for each patient: total number of nodules, number of viable nodules, size of the major nodule, size of the major viable nodule, occurrence of microscopic vascular invasion, maximum Edmondson's grade, clear cell/sarcomatous changes, and the residual neoplastic volume. Survival data were computed by means of the Kaplan-Meier procedure and analyzed by means of the Cox proportional hazards model. The multivariate linear regression and a k-means cluster analysis were also used in order to compute the standardized histological score., Results: The total number of nodules, the residual neoplastic volume (the total volume of all evaluated nodules minus the necrotic portion) and the microvascular invasion entered the Cox multivariate hazard model with HCC recurrence as dependent variable. The histological score was therefore computed and a cluster analysis sorted recipients into 3 risk groups, with 3.3%, 18.5% and 53.8% respectively of tumor recurrence rates and 1.6%, 11.1% and 38.5% of tumor-related mortality respectively at the end of follow-up., Conclusion: The histological score allows a reliable stratification of HCC recurrence risk, especially in those recipients found out to be beyond the Milan criteria after orthotopic liver transplantation (OLT).

Unlabelled: The aim of the present study was to examine the metabolic profile of normal and tumoral renal tissues by ex vivo high resolution magic angle spinning magnetic resonance spectroscopy (HR-MAS MRS)., Patients and Methods: Five patients, three affected by clear cell renal cell carcinoma (RCC) and two by papillary RCC, were examined. A radical nephrectomy was performed in each. In all patients, fresh tissue samples taken from normal cortex, normal medulla and tumor were collected and analyzed by mono-dimensional HR-MAS MRS., Results: The spectra of human normal cortex and medulla showed the presence of differently distributed organic osmolytes as markers of a physiological renal condition. The marked decrease or disappearance of these metabolites and the high lipid content (triglycerides and cholesteryl esters) is typical of clear cell RCC, while papillary RCC are characterized by the absence of lipids and very high amounts of taurine., Conclusion: This paper demonstrates that ex vivo HR-MAS MRS is a viable and powerful means of probing for molecular information in human normal and tumoral renal tissues. This research will constitute the basis for a biochemical classification of renal neoplastic pathologies, especially for RCCs, which can be thus evaluated by in vivo MRS for clinical purposes. Moreover, these data may contribute to a better knowledge of the molecular processes for the basis of the onset of renal carcinogenesis.

Objective: The aim of the present study was to evaluate the effectiveness of a new method of spectral analysis of the radiofrequency (RF) ultrasonic echo signal in discriminating neoplastic from non-neoplastic tissue of the prostate gland., Material and Methods: The proposed method was previously set up on ten prostatic glands where cancer had been detected by histology in order to correlate the tumour areas with specific spectral parameters. In the present study sixty prostate specimens of patients undergoing radical retropubic prostatectomy for clinically localized prostate cancer were examined. The surgically removed prostate glands were scanned using an echo signal acquisition apparatus and the spectral parameters were obtained by the wavelet transform. The echographic scans of all cases were then compared with the whole-mount histological sections of the prostate in order to evaluate sensitivity and specificity of the proposed method., Results: The sensitivity and specificity for cancer detection were 93% and 91%, respectively. The specificity was invalidated by the fact that in some of the cases studied, the tumour was located in areas of benign prostatic hyperplasia (BPH). As for the sensitivity, of the three false negative cases two were due to the coexistence of cancer foci and BPH., Conclusions: Our proposed method, named WAMBLE (Wavelet Analysis Multi Band Local Estimator), is accurate in detecting prostate cancer. Further in vivo studies are warranted to confirm the clinical value of this technique.

Reduction of waiting-list length requires extension of the organ-donor pool to elderly males bearing an higher risk of prostate cancer incidence. Prostate-cancer screening in organ donors is currently based on prostate-specific antigen (PSA) assays (total PSA and free/total PSA). However, the specificity of these assays is restricted, limiting risk-benefit analysis. Since 2001, 33 multiorgan donor candidates presenting within Emilia-Romagna (Italy) with suspect ultrasonography or abnormal PSA values were submitted to a histopathologic screening method of the entire prostate based on extemporary frozen-section analysis (maximum 1 hour) of over 50% of the organ at 0.1 mm cutting levels. Extemporary diagnosis of adenocarcinoma was made in 12 (36%) cases, corresponding to 4.5% of the male candidates aged more than 50 years in the donor pool. In all cases, the final diagnosis confirmed the extemporary analysis. As well as maximizing safety, this novel approach should permit more refined risk-benefit analysis.

Aim: Only a minority of patients carrying a defined viral aetiologic agent develop cirrhosis and ultimately hepatocellular carcinoma (HCC), the mechanism underlying the worsening is still undefined. Experimental infection by Helicobacter hepaticus in mice causes chronic hepatitis and HCC and recently, more Helicobacter species (Helicobacter spp.) have been detected in the liver of patients suffering from cholestatic diseases and HCC arising from non-cirrhotic liver. We investigated whether Helicobacter spp. sequences could be detected in the liver of patients with cirrhosis and HCC compared to subjects with metastasis to liver from colon cancer., Methods: Twenty-three liver samples from patients operated upon for HCC superimposed on hepatitis C virus (HCV)-related cirrhosis and 6 from patients with resected metastases from colorectal cancer, were tested by polymerase chain reaction for presence of genomic 16S rRNA of Helicobacter genus using specific primers. DNA sequencing and cag A gene analysis were also performed., Results: Genomic sequences of Helicobacter spp. were found in 17 of 20 (85%) liver samples from patients with HCC and in 2 of 6 samples from patients with liver metastasis. In three samples of the first group the result was uncertain. H pylori was revealed in 16 out of 17 positive samples and Helicobacter pullorum in the other., Conclusion: Helicobacter spp., carcinogenic in mice, were found at a higher frequency in the liver of patients with HCV-related cirrhosis and HCC than those in patients without primary liver disease.