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Dento Maxillo Facial Radiology 2013The objective of this review is to evaluate the diagnostic accuracy of imaging methods for detection of mandibular bone tissue invasion by squamous cell carcinoma (SCC).... (Review)
Review
The objective of this review is to evaluate the diagnostic accuracy of imaging methods for detection of mandibular bone tissue invasion by squamous cell carcinoma (SCC). A systematic review was carried out of studies in MEDLINE, SciELO and Science Direct, published between 1960 and 2012, in English, Spanish or German, which compared detection of mandibular bone tissue invasion via different imaging tests against a histopathology reference standard. Sensitivity and specificity data were extracted from each study. The outcome measure was diagnostic accuracy. We found 338 articles, of which 5 fulfilled the inclusion criteria. Tests included were: CT (four articles), MRI (four articles), panoramic radiography (one article), positron emission tomography (PET)/CT (one article) and cone beam CT (CBCT) (one article). The quality of articles was low to moderate and the evidence showed that all tests have a high diagnostic accuracy for detection of mandibular bone tissue invasion by SCC, with sensitivity values of 94% (MRI), 91% (CBCT), 83% (CT) and 55% (panoramic radiography), and specificity values of 100% (CT, MRI, CBCT), 97% (PET/CT) and 91.7% (panoramic radiography). Available evidence is scarce and of only low to moderate quality. However, it is consistently shown that current imaging methods give a moderate to high diagnostic accuracy for the detection of mandibular bone tissue invasion by SCC. Recommendations are given for improving the quality of future reports, in particular provision of a detailed description of the patients' conditions, the imaging instrument and both imaging and histopathological invasion criteria.
Topics: Biopsy; Carcinoma, Squamous Cell; Diagnostic Imaging; Humans; Mandibular Neoplasms; Mouth Neoplasms; Neoplasm Invasiveness; Sensitivity and Specificity
PubMed: 23420854
DOI: 10.1259/dmfr.20120346 -
PloS One 2012Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical... (Comparative Study)
Comparative Study Review
BACKGROUND
Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role.
METHOD
The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT) and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence.
RESULTS
A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT.
CONCLUSION
The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection.
Topics: Ameloblastoma; Female; Frozen Sections; Histocytochemistry; Humans; Intraoperative Period; Jaw Neoplasms; Neoplasm Recurrence, Local; Surgery, Computer-Assisted; Tomography, X-Ray Computed; Young Adult
PubMed: 23094099
DOI: 10.1371/journal.pone.0047897 -
Eye (London, England) Oct 2011Capillary haemangioma or infantile haemangioma (IH) is the most common congenital vascular tumour in the periocular region. Several treatment modalities have been... (Review)
Review
Capillary haemangioma or infantile haemangioma (IH) is the most common congenital vascular tumour in the periocular region. Several treatment modalities have been documented, with variable degree of success. Propranolol has recently been reported to be an effective and safe alternative. The aim of this systematic review is to examine the evidence base for the use of propranolol administered orally in the management of periocular capillary haemangioma, and use this information to guide future research. A systematic review of literature was carried out by two independent reviewers using the search strategies highlighted below. A total of 100 cases of oral propranolol use in periorbital or orbital capillary haemangiomas have been documented in the literature. Of the 85 cases that had details of previous treatment, it was used as first-line treatment in 50 (58.8%). The commonest dose used was 2 mg/kg/day. Adverse events were documented in one-third of cases; in most cases these were minor. Improvement or complete resolution of the lesions occurred in 96% of cases. Recurrence was noted in one-fifth of cases. Propranolol has shown a lot of promise in the therapy of IH and further research in the form of properly designed randomized trials is certainly warranted. Treatment guidelines based on literature available to date is included in this review.
Topics: Administration, Oral; Antineoplastic Agents; Child, Preschool; Disease Progression; Evidence-Based Medicine; Female; Hemangioma, Capillary; Humans; Infant; Infant, Newborn; Male; Orbital Neoplasms; Propranolol; Treatment Outcome
PubMed: 21738233
DOI: 10.1038/eye.2011.164 -
Dento Maxillo Facial Radiology Jan 2011The aim of this review is to evaluate the principal clinical and conventional radiographic features of non-syndromic keratocystic odontogenic tumour (KCOT) by systematic... (Review)
Review
OBJECTIVES
The aim of this review is to evaluate the principal clinical and conventional radiographic features of non-syndromic keratocystic odontogenic tumour (KCOT) by systematic review (SR), and to compare the frequencies between four global groups.
METHODS
The databases searched were the PubMed interface of Medline and LILACS. Only those reports of KCOTs that occurred in a series of consecutive cases, in the reporting authors' caseload, were considered.
RESULTS
51 reports, of 49 series of cases, were included in the SR. 11 SR-included series were in languages other than English. KCOTs affected males more frequently and were three times more prevalent in the mandible. Although the mean age at first presentation was 37 years, the largest proportion of cases first presented in the third decade. The main symptom was swelling. Over a third were found incidentally. Nearly two-thirds displayed buccolingual expansion. Over a quarter of cases recurred. Only a quarter of all SR-included reported series of cases included details of at least one radiological feature. The East Asian global group presented significantly as well-defined, even corticated, multilocular radiolucencies with buccolingual expansion. The KCOTs affecting the Western global group significantly displayed an association with unerupted teeth.
CONCLUSIONS
Long-term follow-up of large series that would have revealed detailed radiographic description and long-term outcomes of non-syndromic KCOT was lacking.
Topics: Africa South of the Sahara; Chi-Square Distribution; Ethnicity; Europe; Asia, Eastern; Humans; Keratins; Latin America; Mandibular Neoplasms; Maxillary Neoplasms; Neoplasm Recurrence, Local; Odontogenic Tumors; Radiography; Sex Ratio; United States
PubMed: 21159911
DOI: 10.1259/dmfr/29949053 -
Oral Surgery, Oral Medicine, Oral... Feb 2010Reconstructing irradiated mandibles with biomaterials is still a challenge but little investigated. We collected data that could help us understand studies in the field... (Review)
Review
OBJECTIVE
Reconstructing irradiated mandibles with biomaterials is still a challenge but little investigated. We collected data that could help us understand studies in the field of regeneration with biomaterials and irradiated bone.
STUDY DESIGN
Systematic review of the literature.
RESULTS
Delay and duration of radiation delivery and total equivalent dose are the most variable parameters in the various studies, resulting in confusion when interpreting the literature. Most reproducible experiments show that radiation reduces osteogenic cell numbers, alters cytokine capacity, and delays and damages bone remodeling. Interindividual variations and how such changes become irreversible lesions are still uncertain. In the case of regeneration using biomaterials, most studies have addressed the question of reconstruction in previously irradiated bone. The results show that osseointegration is often possible, although the failure rate is higher. The sooner the implantation takes place after the end of the radiation, the higher the likelihood of failure. Few studies have focused on primary reconstruction followed by early irradiation, and most of the currently available engineering models would be altered by radiation. Good outcomes have been obtained with bone morphogenetic protein and with total bone marrow transplanation.
CONCLUSION
This review points out the difficulties in achieving reproducible experiments and interpreting literature in this underinvestigated field.
Topics: Animals; Bone Development; Bone Marrow Transplantation; Bone Morphogenetic Proteins; Bone Remodeling; Bone Substitutes; Bone Transplantation; Bone and Bones; Cranial Irradiation; Dose-Response Relationship, Radiation; Guided Tissue Regeneration, Periodontal; Humans; Jaw Neoplasms; Mandible; Mandibular Neoplasms; Osteogenesis, Distraction; Osteoradionecrosis; Plastic Surgery Procedures; Tissue Engineering
PubMed: 20123406
DOI: 10.1016/j.tripleo.2009.10.001 -
Journal of Clinical Neuroscience :... Dec 2009Most data regarding survival in patients with chondrosarcoma are limited to case studies and small series performed at single institutions. A systematic review was... (Review)
Review
Most data regarding survival in patients with chondrosarcoma are limited to case studies and small series performed at single institutions. A systematic review was performed to study the relationship between potential prognostic factors and survival. The survival rates were analyzed according to modality of treatment, treatment history, histological subtype, and histological grade. A total of 560 patients with intracranial chondrosarcoma were analyzed. Median follow-up time was 60 months. The 5-year mortality among all patients was 11.5% with median survival of 24 months. Mortality at 5 years was significantly greater for patients with tumors of higher grade, or of the mesenchymal subtype, or who had received surgical resection alone. The results of our systematic review provide useful data in predicting survival among intracranial chondrosarcoma patients.
Topics: Chi-Square Distribution; Chondrosarcoma; Databases, Factual; Humans; Longitudinal Studies; Prognosis; Skull Base Neoplasms; Survival Rate
PubMed: 19796952
DOI: 10.1016/j.jocn.2009.05.003 -
Annals of Internal Medicine Oct 2009Radiation therapy with charged particles can potentially deliver maximum doses while minimizing irradiation of surrounding tissues, and it may be more effective or less... (Review)
Review
BACKGROUND
Radiation therapy with charged particles can potentially deliver maximum doses while minimizing irradiation of surrounding tissues, and it may be more effective or less harmful than other forms of radiation therapy.
PURPOSE
To review evidence about the benefits and harms of charged-particle radiation therapy for patients with cancer.
DATA SOURCES
MEDLINE (inception to 11 July 2009) was searched for publications in English, German, French, Italian, and Japanese. Web sites of manufacturers, treatment centers, and professional organizations were searched for relevant information.
STUDY SELECTION
Four reviewers identified studies of any design that described clinical outcomes or adverse events in 10 or more patients with cancer treated with charged-particle radiation therapy.
DATA EXTRACTION
The 4 reviewers extracted study, patient, and treatment characteristics; clinical outcomes; and adverse events for nonoverlapping sets of articles. A fifth reviewer verified data on comparative studies.
DATA SYNTHESIS
Currently, 7 centers in the United States have facilities for particle (proton)-beam irradiation, and at least 4 are under construction, each costing between $100 and $225 million. In 243 eligible articles, charged-particle radiation therapy was used alone or in combination with other interventions for common (for example, lung, prostate, or breast) or uncommon (for example, skull-base tumors or uveal melanomas) types of cancer. Of 243 articles, 185 were single-group retrospective studies. Eight randomized and 9 nonrandomized clinical trials compared treatments with or without charged particles. No comparative study reported statistically significant or important differences in overall or cancer-specific survival or in total serious adverse events.
LIMITATION
Few studies directly compared treatments with or without particle irradiation.
CONCLUSION
Evidence on the comparative effectiveness and safety of charged-particle radiation therapy in cancer is needed to assess the benefits, risks, and costs of treatment alternatives.
Topics: Brachytherapy; Humans; Intraoperative Care; Neoplasms; Radiosurgery; Radiotherapy, High-Energy; Research Design
PubMed: 19755348
DOI: 10.7326/0003-4819-151-8-200910200-00145 -
AJNR. American Journal of Neuroradiology 2004Ecchordosis physaliphora (EP), found in about 2% of autopsies, is a clinically inconspicuous notochordal remnant appearing at the dorsal wall of the clivus. To our... (Review)
Review
BACKGROUND AND PURPOSE
Ecchordosis physaliphora (EP), found in about 2% of autopsies, is a clinically inconspicuous notochordal remnant appearing at the dorsal wall of the clivus. To our knowledge, a systematic review of its MR features does not exist. The aim of this study was to describe the MR imaging findings of incidentally found retroclival EP with special respect to its differentiation from intradural chordomas.
METHODS
We reviewed 300 consecutive 1.5-T MR imaging studies that included thin-section transverse T2-weighted images of the skull base for the presence of a retroclival EP. In cases in which an EP was identified, two neuroradiologists observed MR signal intensity characteristics, contrast enhancement, size, form, stalk of EP, and signal intensity changes of the adjacent clivus.
RESULTS
Five cases with retroclival EP were found (incidence, 1.7%). In all cases, the ecchordoses was hyperintense on T2-weighted images and hypointense on T1-weighted images. Contrary to the reported findings in chordomas, none of the lesions showed contrast enhancement. In four cases, there were signal intensity changes in the adjacent clivus. A stalklike connection between clivus and EP was seen in three patients.
CONCLUSION
Because of the benign character of EP and the difficulties in its histopathologic differentiation from chordomas, precise knowledge of the radiologic characteristics of EP is important. On the basis of these five cases and a review of literature, contrast enhancement and the presence of clinical symptoms seem to be highly reliable parameters in the differential diagnosis of intradural chordoma and EP.
Topics: Adult; Aged; Brain Diseases; Brain Neoplasms; Child; Chordoma; Choristoma; Cranial Fossa, Posterior; Diagnosis, Differential; Female; Humans; Incidental Findings; Magnetic Resonance Imaging; Male; Middle Aged; Notochord
PubMed: 15569763
DOI: No ID Found