Integrated Positron Emission Tomography-Computed Tomography Does Not Accurately Stage Intrathoracic Disease of Patients Undergoing Trimodality Therapy for Malignant Pleural Mesothelioma
ABSTRACT The results of trimodality therapy for malignant pleural mesothelioma (MPM) are related to stage. Staging can be carried out by computed tomography (CT), magnetic resonance imaging and fluorodeoxyglucose positron emission tomography (FDG-PET), but all modalities suffer from limitations. We investigated whether integrated PET-CT improved the intrathoracic staging of patients undergoing trimodality therapy for MPM.
Twenty consecutive patients [18 male, median age 62 years (range 52-68)] who underwent 24 PET-CT scans prior to extrapleural pneumonectomy (EPP) as part of trimodality therapy for MPM were reviewed. The intrathoracic stage of MPM on PET-CT was compared with the pathological stage following examination of the resected specimen. Patients excluded from radical surgery due to metastatic disease were not studied here.
PET-CT was performed a median of 119 days (range 2-229) prior to EPP. 16 scans were performed after talc pleurodesis. Nine scans were performed following chemotherapy. PET-CT correctly identified the T stage in 3 patients, overstaged 4 and understaged 17. Six scans failed to identify disease that later proved to be pT4. Nine patients were found to have pN2 disease; PET-CT identified N2 disease with a sensitivity of 11.1 %, specificity of 93 % and accuracy of 66 %. Previous talc pleurodesis did not alter the accuracy of PET-CT staging.
In one of the few studies of integrated PET-CT in MPM that has complete pathological correlation we have shown that PET-CT does not accurately identify advanced tumor stage (T4) or mediastinal nodal disease (N2). The role of PET-CT staging prior to EPP lies outside the affected hemithorax.
Conference Paper: Using driver's head movements evolution as a drowsiness indicator[Show abstract] [Hide abstract]
ABSTRACT: Many studies have been conducted to try to put forward measurable indicators that could help in the design of alerting devices used to reliably monitor severe driver drowsiness. However, most of these indicators are either too sensitive to environment modifications (performance indicators), invasive for the driver (EEG, EOG...) or are complex and expensive to measure (Eye blinks, PERCLOS...). This study aims at proposing a set of indicators related to driver performance and physiology that could be efficient for monitoring driver drowsiness and be easy to measure. Thirty two subjects took part to a long duration simulated highway trip (336 km) during which performance and physiological data were recorded The analysis of these data puts forward two sets of indicators : firstly, a set of performance indicators whose evolutions are consistent with those described in literature. They ensure the detection of drowsiness during the experiment. Secondly, a set of physiological indicators : the head movements dispersion. This has revealed itself to be a very good indicator as it evolves in the same way as the performance ones on long lasting periods while being poorly influenced by the road environment, contrary to most performance indicators.Intelligent Vehicles Symposium, 2003. Proceedings. IEEE; 07/2003
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ABSTRACT: The purpose of this study was to assess the usefulness of CT-derived tumor volume, with control for other prognostic factors, for stratifying survival after surgery-based multimodality treatment of a large cohort of patients with epithelial malignant pleural mesothelioma. We retrospectively reviewed 338 patients with mesothelioma who underwent extrapleural pneumonectomy between 2001 and 2007. The study cohort comprised 88 patients with epithelial subtype tumors, DICOM-format CT scans, and data regarding neoadjuvant and adjuvant therapy. Tumor volume was calculated, and Kaplan-Meier survival and Cox regression analyses were performed to compare the estimated survival functions of patient subgroups based on volume and other covariates related to outcome (sex, age, preoperative platelet count, hemoglobin concentration, WBC count, clinical and pathologic TNM category, and administration of neoadjuvant and adjuvant therapy). A multivariate regression model was derived on the basis of the most significant univariate predictors. The median estimated tumor volume was 319 cm(3) (range, 4-3256 cm(3)). In univariate analysis, tumor volume, hemoglobin concentration, platelet count, pathologic TNM category, and administration of adjuvant chemotherapy or radiation therapy met the criteria for inclusion in the reverse stepwise regression analysis. In the final model, tumor volume, hemoglobin concentration, and administration of adjuvant chemotherapy or radiotherapy were identified as independently associated with overall survival. With control of prognostic covariates, CT-derived tumor volume can be used to stratify survival of patients with epithelial mesothelioma after extrapleural pneumonectomy and should be included in prognostic evaluation of patients for whom resection is being considered.American Journal of Roentgenology 02/2012; 198(2):359-63. DOI:10.2214/AJR.11.7015 · 2.74 Impact Factor
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ABSTRACT: The asbestos-related disorders (ARDs) are currently of significant occupational and public health concern. Asbestos usage has been banned in most developed countries but asbestos is still used in many developing countries and the number of cases of asbestos-related disorders worldwide is rising. Many countries are now experiencing an epidemic of asbestos-related diseases which is the legacy of occupational exposure in the 1960s-80s, due to the long latency period between asbestos exposure and manifestation of disease. It is likely that asbestos-related mortality and morbidity will continue to increase. Although the most feared complications of asbestos inhalation are the malignant conditions such as mesothelioma and lung cancer, asbestos inhalation more frequently results in benign conditions such as pleural plaques, diffuse pleural thickening and asbestosis (pulmonary fibrosis due to asbestos). Over recent years, there have been changes in the epidemiology of mesothelioma, in clinical management of ARDs and developments in new techniques for early detection of malignancy. This review provides an update on the respiratory manifestations of asbestos exposure, and also considers advances in screening methods which may affect future management in the workplace.The Clinical Respiratory Journal 05/2013; 8(1). DOI:10.1111/crj.12028 · 2.20 Impact Factor