Paraskevi Liakou

University of Thessaly, Iolcus, Thessaly, Greece

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Publications (30)83.74 Total impact

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    ABSTRACT: An ever growing number of medical organizations, societies, working groups and governmental agencies issue algorithms i.e. guidelines, of decision making flowcharts in diagnosis and treatment in a variety of diseases. In the field of evidence-based diagnosis and treatment of breast cancer, a large number of guidelines are available both from medical associations and national health departments. Among the most appreciated and utilized comprehensive guides is the European Society for Medical Oncology (ESMO) Breast Cancer Guidelines and from the other side of the Atlantic the National Comprehensive Cancer Network (NCCN) Guidelines in Breast Cancer. Although there is much concordance between the guidelines from these two organizations, it is intriguing to locate their discrepancies also. The aim of this report is to present a number of different points between ESMO and NCCN in the whole spectrum of breast cancer management, from prevention and diagnosis to treatment and follow up. This systematic review was performed in accordance with the PRISMA guidelines using a predefined search strategy and summarizes in detail, the differences between ESMO and NCCN guidelines regarding genetic risk evaluation and screening, surgery, chemotherapy, endocrine treatment, targeted biological agents, radiotherapy, pregnancy and fertility and follow-up. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Breast (Edinburgh, Scotland) 03/2015; DOI:10.1016/j.breast.2015.02.031 · 2.58 Impact Factor
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    ABSTRACT: To demonstrate the use of a new 3D diagnostic imaging technology, termed Multimodal Ultrasonic Tomography (MUT), for the detection of solid breast lesions < 15 mm in maximum dimension.
    European Radiology 09/2014; 25(2). DOI:10.1007/s00330-014-3415-3 · 4.34 Impact Factor
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    ABSTRACT: To evaluate breast cancer characteristics in women aged 25 years and younger. This was a retrospective, nested, within-cases matched study. The study design was based on a two-phase protocol. In the first phase, stage, grade, histologic subtype, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 status were compared between 28 patients (aged 25 years and younger) and 685 older premenopausal women (aged older than 25 years) with breast cancer. The second phase aimed to determine whether young patients exhibited worse prognosis when compared with older premenopausal women. Young patients presented at a more advanced stage (P=.012) and exhibited a higher grade (P=.018). No significant differences were noted regarding histologic subtype, estrogen receptor, and progesterone receptor status. Genetic testing for BRCA1 and BRCA2 mutations was performed in 12 of 28 young patients and mutations were found in 25% of them. Moreover, young women presented poorer overall survival (hazard ratio [HR] 4.30, 95% confidence interval [CI] 1.09-17.03) than their older counterparts, matched by histologic subtype, stage, and grade; a similar pattern was noted regarding relapse-free survival (HR 8.28, 95% CI 2.24-30.60). Breast cancer diagnosis in women aged 25 years and younger is uncommon; however, these patients present at a more advanced stage, with a higher grade, and exhibit poorer survival. : II.
    Obstetrics and Gynecology 06/2013; 121(6):1235-40. DOI:10.1097/AOG.0b013e318291ef9a · 4.37 Impact Factor
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    ABSTRACT: Evidence from a recent randomized study of our group suggests that intravenous clarithromycin resulted in earlier resolution of ventilator-associated pneumonia. The need to understand the mechanism of action of clarithromycin guided to the study of a model of experimental empyema by multidrug-resistant Pseudomonas aeruginosa in 40 rabbits. Animals were randomized into controls (group A); treatment with clarithromycin (group B); treatment with piperacillin/tazobactam (group C); and treatment with both agents (group D). Pleural fluid was collected at regular time intervals for quantitative culture, estimation of cell apoptosis and of concentrations of tumour necrosis factor-alpha (TNFα). After 7 days, animals were euthanized for estimation of tissue growth. Bacterial growth in the pleural fluid of group D was significantly decreased compared with the other groups on day 5. Lung growth of group D was lower than group A. That was also the case of cytokine stimulation by pleural fluid samples on U937 monocytes. It is concluded that administration of clarithromycin enhanced the antimicrobial efficacy of piperacillin/tazobactam and decreased bacterial growth in the pleural fluid and in tissues. It also attenuated the pro-inflammatory phenomena induced by the β-lactam.
    Apmis 05/2013; 122(1). DOI:10.1111/apm.12094 · 1.92 Impact Factor
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    ABSTRACT: BACKGROUND: Stereotactic vacuum assisted breast biopsy (VABB) procedures remain of key importance in the diagnostic evaluation of suspicious non-palpable mammographic lesions. The Breast Lesion Excision System(®) (BLES) is an image-guided percutaneous biopsy method that utilizes radiofrequency (RF) in order to retrieve an intact-tissue biopsy specimen. The purpose of this study is to determine the effects of RF application on the tissue specimen and the possible interference with the histopathologic results. METHODS: In this study we included 265 patients with suspicious non-palpable mammographic lesions who underwent 273 stereotactic VABB procedures using the BLES. All biopsies were performed by the same surgical-radiology team under local anesthesia. The specimen thermal damage was classified according to the pathology report in 3 categories: Severe (extensive thermal damage or inability to diagnose), medium (ability to diagnose but either circumferential damage >1.5 mm or diffuse areas of thermal damage) and mild (circumferential thermal damage <1.5 mm but >0.5 mm). RESULTS: Radiofrequency-associated thermal damage of the specimen was observed in 14 cases (5.13 %), and was classified as severe in 5, medium in 5, and mild in 4 specimens. Within the group of RF damaged specimens, we found a significant (p < 0.05) positive correlation between fat cell content and classification of thermal damage. CONCLUSIONS: Although thermal damage is of concern during BLES breast biopsy, the incidence is low, and the outcome of the histopathologic assessment is not affected even in severely damaged specimens. Increased thermal damage seems to correlate with higher fat cell content of the specimen.
    Breast Cancer 03/2013; 22(1). DOI:10.1007/s12282-013-0458-2 · 1.51 Impact Factor
  • The American surgeon 11/2012; 78(11):457-8. · 0.92 Impact Factor
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    ABSTRACT: OBJECTIVES: To introduce a new three-dimensional (3D) diagnostic imaging technology, termed "multimodal ultrasonic tomography" (MUT), for the detection of breast cancer without ionising radiation or compression. METHODS: MUT performs 3D tomography of the pendulant breast in a water-bath using transmission ultrasound in a fixed-coordinate system. Specialised electronic hardware and signal processing algorithms are used to construct multimodal images for each coronal slice, corresponding to measurements of refractivity and frequency-dependent attenuation and dispersion. In-plane pixel size is 0.25 mm × 0.25 mm and the inter-slice interval can vary from 1 to 4 mm, depending on clinical requirements. MUT imaging was performed on 25 patients ("off-label" use for research purposes only), presenting lesions with sizes >10 mm. Histopathology of biopsy samples, obtained from all patients, were used to evaluate the MUT outcomes. RESULTS: All lesions (21 malignant and four benign) were clearly identified on the MUT images and correctly classified into benign and malignant based on their respective multimodal information. Malignant lesions generally exhibited higher values of refractivity and frequency-dependent attenuation and dispersion. CONCLUSION: Initial clinical results confirmed the ability of MUT to detect and differentiate all suspicious lesions with sizes >10 mm discernible in mammograms of 25 female patients. KEY POINTS: • Technical advances in ultrasound offer new diagnostic opportunities in breast imaging • 3D ultrasound can detect breast cancer without ionising radiation or compression • Multimodal 3D ultrasound assesses acoustic refractivity, frequency-dependent attenuation and dispersion • MUT can differentiate between benign and malignant breast lesions.
    European Radiology 09/2012; DOI:10.1007/s00330-012-2659-z · 4.34 Impact Factor
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    ABSTRACT: PURPOSE: Acute appendicitis within a femoral hernia is a rare condition that was first described by Rene Jacques de Garengeot. In the present study, we summarize the existing evidence on de Garengeot's hernia, with special emphasis on its clinical presentation and diagnostic approach. METHODS: A thorough search of the English-language literature published between 1980 and 2011 was performed. Studies reporting cases of de Garengeot's hernia were selected using specific inclusion criteria (description of femoral hernia appendicitis, statement of patient demographics and symptoms, and statement of diagnostic tests performed). RESULTS: Thirty-one studies that encompassed 36 patients (28 women, mean age 71.5 years) with de Garengeot's hernia were included in our analysis. Patients presented with a right groin mass in 35 (97 %) cases. The mass was almost always painful (n = 35, 97 %), while 14 (39 %) of the patients were febrile. Mean duration of symptoms was 5.17 days. Fifty-six percent of the groin masses were erythematous. Leukocytosis was present in 67 % of the patients, and 25 patients underwent imaging investigation with X-ray (n = 11), Ultrasound (n = 5) or Computed Tomography (CT, n = 9). Twenty percent of the Ultrasound and 44 % of the CT studies were diagnostic, leading to an overall rate of 14 % of femoral hernia appendicitis preoperative diagnosis. Eighty-one percent of the patients underwent herniorrhaphy with sutures while a mesh was used in 19 %. Mean hospital stay was 6.23 days. CONCLUSION: Preoperative diagnosis of de Garengeot's hernia is difficult due to its atypical clinical presentation. Further surgical treatment depends on the surgeon's sound clinical judgment.
    Hernia 09/2012; 17(2). DOI:10.1007/s10029-012-0993-3 · 2.09 Impact Factor
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    ABSTRACT: Endothelin-1 (ET-1), a potent vasoconstricting peptide, plays an important role in carcinogenesis. Previous in vitro studies have shown that colorectal cancer cells produce ET-1. ET-1 and its receptors ET-A (ET(A) R) and ET-B (ET(B) R) were analyzed in colorectal cancer cell lines and tumors by Western blot and immunohistochemistry. Also, ET-1 levels were measured by ELISA in blood samples collected before and after tumor resection. ET-1 was immunohistochemically expressed by tumor cells at a variable level in 39 cases tested. The adjacent normal mucosa was negative for ET-1 expression. Strong ET(A) R expression observed in the deeper infiltrating areas at the periphery of neoplastic tissue correlated significantly with tumor stage. ET(B) R levels were very low or undetectable. Western blot analysis in paired (normal, tumor) fresh-frozen samples of colorectal cancers and in four colon carcinoma cell lines confirmed these findings. In addition, lower levels of ET-1 in the peripheral circulation after the tumor resection were found by ELISA as compared to those observed before surgery. ET-1 and ET(A) R, but not ET(B) R, are expressed at a higher level in primary and cultured colon carcinoma cells as compared to normal colon mucosa cells. Further functional studies are needed to explore the role of ET-1/ET(A) R axis in colon carcinogenesis.
    Journal of Surgical Oncology 06/2012; 105(7):643-9. DOI:10.1002/jso.23017 · 2.84 Impact Factor
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    ABSTRACT: Deregulation of the endothelin system, comprised of endothelin-1 (ET-1), its isoforms (ET-2 and ET-3) and their receptors (ET(A)R and ET(B)R), is under investigation in various types of human cancer. ET-1 has been suggested to participate in breast cancer development and progression, while Big ET-1, its biological precursor, has also been found elevated in breast cancer patients. In the present study, we investigated plasma ET-1 and Big ET-1 levels in patients with suspicious mammographic lesions, in order to assess their potential application as diagnostic biomarkers in the early estimation of breast disease. The study consisted of 94 patients (Group A to 30 patients with invasive ductal carcinoma: Group B, 30 with ductal carcinoma in situ; and group C, 34 with papilloma or ductal hyperplasia), who underwent an image-guided vacuum-assisted breast biopsy, and 30 healthy controls (group D). ET-1 and Big ET-1 plasma levels were measured with enzyme-linked immunosorbent assay. ET-1 levels did not exhibit significant differences between patients and healthy controls (Group A to 0.92 fmol/mL; Group B: 0.90 fmol/mL; Group C: 0.66 fmol/mL; and Group D: 0.86 fmol/mL). In contrast, Big ET-1 levels were significantly higher in patients with invasive or in situ carcinoma compared to healthy controls (Group A: 0.69 fmol/mL; Group B, 0.62 fmol/mL; and group D: 0.39 fmol/mL; p < 0.001 and p < 0.01). Plasma Big ET-1 may provide a useful tool for the early detection of invasive or noninvasive ductal breast cancer. The utilization of such a diagnostic tool would greatly assist in the modern management of breast cancer.
    Tumor Biology 03/2012; 33(4):1231-6. DOI:10.1007/s13277-012-0371-x · 2.84 Impact Factor
  • European Journal of Cancer 03/2012; 48:S61. DOI:10.1016/S0959-8049(12)70139-9 · 4.82 Impact Factor
  • European Journal of Cancer 03/2012; 48:S64. DOI:10.1016/S0959-8049(12)70150-8 · 4.82 Impact Factor
  • European Journal of Cancer 03/2012; 48:S60. DOI:10.1016/S0959-8049(12)70134-X · 4.82 Impact Factor
  • European Journal of Cancer 03/2012; 48:S59. DOI:10.1016/S0959-8049(12)70131-4 · 4.82 Impact Factor
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    ABSTRACT: PURPOSE To demonstrate the ability of the new diagnostic imaging technology of Multimodal Ultrasonic Tomography (MUT) to achieve early detection of breast cancer (down to mm-size lesions) in initial clinical trials through its unique non-invasive tissue-differentiation capability. METHOD AND MATERIALS We performed 3D tomographic scans of pendulant breasts in water-bath for 64 volunteers with BI-RADS 4 mammograms, presenting 93 lesions (42 malignant and 51 benign), using transmission ultrasound in a fixed-coordinate system. Specially coded sequences of ultrasonic pulses were properly analyzed with novel methodologies to obtain MUT images of refractivity, frequency-dependent attenuation and dispersion. In-plane pixel size was 0.25 mm x 0.25 mm and vertical separation between adjacent coronal slices was 2-4 mm (depending on clinical requirements). The examined hypothesis was that the obtained multimodal images can be fused to achieve reliable detection and differentiation of breast lesions down to mm size. All lesions were confirmed via histopathology performed in the normal course of clinical practice. There were no operational complications in any of the MUT scans and all volunteers attested to total comfort. RESULTS All 93 lesions were clearly detected on the MUT diagnostic images and were also classified correctly into benign (51) or malignant (42) using their respective multimodal information and the novel classification method developed for MUT. The lesions ranged in size from 2 mm to 38 mm. An illustrative example of composite MUT “diagnostic images” is shown in the attached Figure, depicting a small (3 mm x 4 mm) malignant IDC lesion and a DCIS lesion with maximum dimension of 2 mm. Malignant lesions generally exhibited higher (calibrated) values of refractivity, attenuation and dispersion. However, proper combination of these attributes was necessary in order to achieve high sensitivity and specificity. CONCLUSION Initial clinical results demonstrated the ability of the MUT technology to detect all 93 lesions in 64 volunteers with BI-RADS 4 mammograms and confirmed the non-invasive lesion differentiation capability of MUT in all cases. CLINICAL RELEVANCE/APPLICATION The high sensitivity and specificity of the MUT technology offers the prospect of an improved screening modality for the early diagnosis of breast cancer without ionizing radiation at modest cost.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
  • The Breast 03/2011; 20. DOI:10.1016/S0960-9776(11)70110-2 · 2.58 Impact Factor
  • The American surgeon 01/2011; 77(1):E7-8. · 0.92 Impact Factor
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    ABSTRACT: Vacuum-assisted breast biopsy (VABB) is used for the diagnosis of non-palpable breast lesions. Hematoma has been recognized as the main complication of the procedure. Its main disadvantage is the underestimation rate. Generally speaking, approximately up to 24 cores are excised in most published series. It has been suggested that excision of more cores per lesion can reduce the underestimation rate. The present study aims to evaluate hematoma formation with regard to the number of cores excised. A total of 660 women underwent VABB; 232 women were allocated to the standard protocol (24-36 cores excised, 2-3 offsets) and 428 women were allocated to the extended protocol (96 cores excised, 8 offsets). Cases were derived from a double blind study, as well as from the periods before (standard protocol) and after (mainly extended protocol) the study. In all cases, the occurrence of organized hematomas within the subsequent 20 days was followed up by ultrasound. In the standard protocol, the frequency of clinically significant and subsequently organized hematomas was 3.5%. However, in the extended protocol the respective hematoma percentage was 7.5%. Clinically significant and subsequently organized hematomas were significantly more frequent in the extended protocol (Pearson's chi-squared=4.29, p=0.038). Despite the superiority of the extended protocol in terms of underestimation, the approximately two-fold increase in hematoma occurrence prompts the need for careful patient selection prior to its performance.
    In vivo (Athens, Greece) 01/2011; 25(4):703-5. · 1.15 Impact Factor
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    ABSTRACT: Epidural bleeding as a complication of catheterization or epidural catheter removal is often associated with perioperative thromboprophylaxis especially in adult reconstructive surgery. We report on a case of a 19 years old male athlete that underwent anterior cruciate ligament reconstruction, receiving low molecular weight heparin for thromboprophylaxis and developed an epidural hematoma and subsequent cauda equina syndrome two days after removal of the epidural catheter. An urgent magnetic resonance imaging scan revealed an epidural hematoma from the level of L3 to L4. Emergent decompression and hematoma evacuation resulted in patient's significant neurological improvement immediately postoperatively. A high index of clinical suspicion and surgical intervention are necessary to prevent such potentially disabling complications especially after procedures on a day-case basis and early patient's discharge.
    Cases Journal 05/2009; 2:6732. DOI:10.1186/1757-1626-2-6732
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    ABSTRACT: Although the issue of drain use in open cholecystectomy has been adequately addressed by prospective randomized trials, there is lack of evidence on the usefulness of drains in elective laparoscopic cholecystectomy, and the surgeons follow their beliefs and bias on this debate. Therefore, a controlled randomized trial was designed to assess the value of drains in elective laparoscopic cholecystectomy. During a 5-year period (January 2002 to December 2006), 284 patients were randomized to have a drain placed (group A), whereas 281 patients were randomized not to have a drain (group B) placed in the subhepatic space. End points of this trial were to detect any differences in morbidity, postoperative pain, and hospital stay between the 2 groups. There was no mortality in either group and no statistically significant difference in morbidity or hospital stay between the 2 groups. However, postoperative pain was significantly increased in patients who had a drain placed; median visual analog scale (VAS) score was 5 (range 1 to 8) versus 3 (range 1 to 8), in the non-drained group (P < .0001). Interestingly, in 2 of 3 patients in whom a drain was placed against randomization because of bile leak suspicion, a bile leak occurred. The routine use of a drain in elective laparoscopic cholecystectomy has nothing to offer; in contrast, it is associated with increased pain. It would be reasonable, however, to leave a drain if there is a worry about an unsolved or potential bile leak, bearing in mind that drain placement, although sometimes providing a false sense of security, does not guarantee either prevention or treatment of postoperative bile collections, bleeding, or bile peritonitis.
    American journal of surgery 10/2008; 197(6):759-63. DOI:10.1016/j.amjsurg.2008.05.011 · 2.41 Impact Factor

Publication Stats

140 Citations
83.74 Total Impact Points

Institutions

  • 2008–2012
    • University of Thessaly
      • • Χειρουργική Κλινική
      • • Τμήμα Γενικής Χειρουργικής
      Iolcus, Thessaly, Greece
  • 2011
    • Hippokration General Hospital, Athens
      Athínai, Attica, Greece
  • 2007–2008
    • General University Hospital of Larissa
      • • Department of General Surgery
      • • Department of Anatomy
      Lárissa, Thessaly, Greece