Publications (40) View all
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Article: Histology obtained by needle biopsy gives additional information on the prognosis of hepatocellular carcinoma.
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ABSTRACT: Aim: Hepatocellular carcinomas (HCC) have a strong biological heterogeneity. Current prognostic scores do not include histology. Information on the behavior of HCC based on histology has been characterized on retrospective data and large tissue specimens. We aimed to assess the additional value of needle biopsy and keratin 19 (K19) assessment in a prospective manner. Methods: Between 2003 and 2008, all patients with a confirmed diagnosis of HCC by a percutaneous or laparoscopic needle biopsy at the time of diagnosis, and of Barcelona Clinic Liver Cancer (BCLC) stage A, B or C, were included. The exclusion criterion was a palliative setting. Biopsies were scored for microvascular invasion, differentiation, K19, epithelial cell adhesion molecule and α-fetoprotein staining. Clinical and radiological features were registered at time of biopsy. The added value of K19 was assessed using Cox proportional hazards regression. Results: Of 74 patients screened, we included 58 patients. Based on the BCLC, 41% presented with early disease (BCLC A), 16% with intermediate disease (BCLC B) and 43% with advanced disease (BCLC C). In nine patients (16%), K19 staining was positive. Median follow up was 54 months (range 1-74) and 43 patients (72%) died. BCLC classification predicted the prognosis accurately, but histology offered additional prognostic information. In multivariate analysis, K19 was a strong predictor of overall survival (hazard ratio 4.57, 95% confidence interval 1.86-10.6), which improved predictive performance. No needle tract dissemination was observed. Conclusion: Despite the possible problem of sampling error, needle biopsy offered additional prognostic information. This is especially the case for K19 staining.Hepatology Research 03/2012; 42(10):990-8. · 2.20 Impact Factor -
Article: Wandering spleen on a 68Ga-DOTATOC-PET/CT scan.
European Journal of Nuclear Medicine 01/2011; 38(5):982. · 4.53 Impact Factor -
Article: Long-term monitoring of infliximab therapy for perianal fistulizing Crohn's disease by using magnetic resonance imaging.
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ABSTRACT: Magnetic resonance imaging (MRI) is used to assess the outcome of infliximab (IFX) therapy in patients with perianal fistulizing Crohn's disease (pfCD). However, few long-term data are available about its efficacy. We assessed 59 patients with pfCD by MRI and clinical evaluation at baseline. Treated patients then received paired clinical and MRI examinations for a median time period of 36 (11-53.3) weeks. Short-, mid-, and long-term effects of therapy, as well as the ability of MRI to predict treatment outcome and need for surgery, were evaluated. Compared with the baseline MRI, the short-term follow-up MRI (n = 29) revealed a reduced number of fistula tracks in 13.8% and in the inflammatory activity in 55.2% of patients, respectively; mid-term MRI (n = 25) in 56% and in 52%, respectively; and long-term MRI (n = 13) in 15.4% and in 31%, respectively. Improvement of pfCD based on MRI results coincided with clinical improvement in 54.7% of the patients. Short-term and mid-term (but not long-term) MRI showed a significant decrease in the activity score. Therapy outcome was worse among patients with persisting fistulas (P = .01), collections (P = .009), and rectal wall involvement (P = .01) in the final MRI. Patients with single-branched fistulas (P < .0001) and collections (P = .006) in their baseline MRI were more likely to undergo surgery. MRI is a useful technique for evaluation of pfCD during the first year of follow-up. In the long-term, the MRI improvement coincides with clinical and endoscopic response to IFX in 50% of the patients.Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 11/2010; 9(2):130-6. · 5.64 Impact Factor -
Chapter: The Performance of CTC
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ABSTRACT: In Western Europe and the United States, colorectal carcinoma (CRC) remains the second leading cause of cancer-related death (Jemal et al. 2005; Ferlay et al. 2007). In Belgium, each year 7,700 new colorec-tal cancers are diagnosed (De Laet et al. 2006). Fortunately, the majority of these cancers originate from pre-existing benign lesions from the mucosal lining of the bowel wall. These “adenomatous polyps” have the potential to progress into a malignant lesion, a carcinoma, over a period of 10 years, the dwelling time (Stryker et al. 1987). Identification and subsequent removal of these adenomas by way of endos-copy determines a significant decrease in the incidence of CRC (Winawer et al. 1993). Once a cancer has been diagnosed, the 5-year survival declines significantly. This justifies a population-based screening for the early detection of the disease. Such screening tests should be sufficiently accurate, i.e. be able to detect polyps ≥ 10 mm, be acceptable to “patients”, be feasible in clinical practice, and be neither harmful nor too expensive. The test should be cost-effective where the potential benefits must outweigh the costs. Depending on genetic and environmental factors, the risk for cancer transformation is variable and associated with the histological characteristics of a polyp, in particular the villous component of a lesion or the flat aspect of a lesion. But since these histologi-cal characteristics can only be determined after the removal of a lesion, it would be more convenient to determine this risk prior to removal. Unfortunately, most of these characteristics can be evaluated only after polyp resection, either surgically or after an endoscopy. Further, endoscopic polyp resection has both an inherent procedural risk and an additional risk because of the need for pharmacological sedation (Bowles et al. 2004).12/2009: pages 17-28; -
Article: Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer.
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ABSTRACT: Computed tomographic (CT) colonography has been recognized as an alternative for colorectal cancer (CRC) screening in average-risk individuals, but less information is available on its performance in individuals at increased risk of CRC. To assess the accuracy of CT colonography in detecting advanced colorectal neoplasia in asymptomatic individuals at increased risk of CRC using unblinded colonoscopy as the reference standard. This was a multicenter, cross-sectional study. Individuals at increased risk of CRC due to either family history of advanced neoplasia in first-degree relatives, personal history of colorectal adenomas, or positive results from fecal occult blood tests (FOBTs) were recruited in 11 Italian centers and 1 Belgian center between December 2004 and May 2007. Each participant underwent CT colonography followed by colonoscopy on the same day. Sensitivity and specificity of CT colonography in detecting individuals with advanced neoplasia (ie, advanced adenoma or CRC) 6 mm or larger. Of 1103 participants, 937 were included in the final analysis: 373 cases in the family-history group, 343 in the group with personal history of adenomas, and 221 in the FOBT-positive group. Overall, CT colonography identified 151 of 177 participants with advanced neoplasia 6 mm or larger (sensitivity, 85.3%; 95% confidence interval [CI], 79.0%-90.0%) and correctly classified results as negative for 667 of 760 participants without such lesions (specificity, 87.8%; 95% CI, 85.2%-90.0%). The positive and negative predictive values were 61.9% (95% CI, 55.4%-68.0%) and 96.3% (95% CI, 94.6%-97.5%), respectively; after group stratification, a significantly lower negative predictive value was found for the FOBT-positive group (84.9%; 95% CI, 76.2%-91.3%; P < .001). In a group of persons at increased risk for CRC, CT colonography compared with colonoscopy resulted in a negative predictive value of 96.3% overall. When limited to FOBT-positive persons, the negative predictive value was 84.9%.JAMA The Journal of the American Medical Association 07/2009; 301(23):2453-61. · 30.03 Impact Factor
