Background: Among patients with early-stage non-small cell lung cancer (NSCLC), preoperative imaging tests are important in defining surgical candidates.
Objective: To assess whether whole-body positron emission tomography and computed tomography (PET-CT) plus cranial imaging correctly upstages cancer in more patients with NSCLC than does conventional staging plus cranial imaging.
Design: Randomized clinical trial with recruitment from June 2004 to August 2007. The centralized, computer-generated, variable block size randomization scheme was stratified by treatment center and cancer stage. Participants, health care providers, and outcome assessors were not blinded to imaging modality assignment.
Setting: 8 hospitals and 5 PET-CT centers in academic institutions.
Patients: Eligible patients were older than 18 years; had histologic or cytologic proof of stage I, II, or IIIA NSCLC on the basis of chest radiography and thoracic CT; and had a tumor considered to be resectable.
Intervention: PET-CT or conventional staging (abdominal CT and bone scan). All patients also had cranial imaging using CT or magnetic resonance imaging.
Measurements: The primary outcome was correct upstaging, thereby avoiding stage-inappropriate surgery. Secondary outcomes were incorrect upstaging and incorrect understaging.
Results: 170 patients were assigned to PET-CT and 167 to conventional staging. Eight patients (3 who had PET-CT and 5 who had conventional staging) did not have planned surgery. Disease was correctly upstaged in 23 of 167 PET-CT recipients and 11 of 162 conventional staging recipients (13.8% vs. 6.8%; difference, 7.0 percentage points [95% CI, 0.3 to 13.7 percentage points]), thereby sparing these patients from surgery. Disease was incorrectly upstaged in 8 PET-CT recipients and 1 conventional staging recipient (4.8% vs. 0.6%; difference, 4.2 percentage points [CI, 0.5 to 8.6 percentage points]), and it was incorrectly understaged in 25 and 48 patients, respectively (14.9% vs. 29.6%; difference, 14.7 percentage points [CI, 5.7 to 23.4 percentage points]). At 3 years, 52 patients who had PET-CT and 57 patients who had conventional staging had died.
Limitation: The relatively small sample and the fact that some patients did not have planned surgery limited the ability to determine precise differences in clinical outcomes that were attributable to testing strategies.
Conclusion: Preoperative staging with PET-CT and cranial imaging identifies more patients with mediastinal and extrathoracic disease than conventional staging, thereby sparing more patients from stage-inappropriate surgery, but the strategy also incorrectly upstaged disease in more patients.
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http://dx.doi.org/10.7326/0003-4819-151-4-200908180-00132 | DOI Listing |
J Relig Health
January 2025
Psychiatric Nursing Department, Gulhane Faculty of Nursing, University of Health Sciences, Turkiye, 06010, Etlik, Ankara, Turkey.
Familial Mediterranean Fever (FMF) is a genetic autoinflammatory disorder characterized by recurrent febrile episodes that are accompanied by pain in the abdomen, chest, or joints caused by peritonitis, pleuritis, skin lesions, arthritis, and pericarditis. This original article aims to provide an analytic autoethnographic account of a Turkish patient's experience of FMF, with a focus on the discovery of spiritual meaning. In addition to discussing the grief reactions to a loss of health, the article uses self-reflexive discourse and narrative-based analysis to explore four stages of discovery of spiritual meaning through FMF: "omnipotent me," "God's punishment," "God's test," and "God's mercy.
View Article and Find Full Text PDFClin Oral Investig
January 2025
Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany.
Objectives: In advanced stages of osteoradionecrosis, medication-related osteonecrosis of the jaw, and osteomyelitis, a resection of sections of the mandible may be unavoidable. The determination of adequate bony resection margins is a fundamental problem because bony resection margins cannot be secured intraoperatively. Single-photon emission computed tomography (SPECT-CT) is more accurate than conventional imaging techniques in detecting inflammatory jaw pathologies.
View Article and Find Full Text PDFSci Rep
January 2025
Department of emergency medicine, College of Medicine, Chung-Ang university, 84 Heukseok-ro, Dongjak-gu, 06974, Seoul, Republic of Korea.
The experience of performing cardiopulmonary resuscitation (CPR) can cause post-traumatic stress symptoms that negatively impact healthcare providers and reduced their clinical competency. This two-phase mixed-methods was conducted to investigate the factors that cause post-traumatic disorder (PTSD) in healthcare providers who perform CPR. Phase 1 included a survey with a trauma screening questionnaire (TSQ).
View Article and Find Full Text PDFIntroduction: Around 85% of non-small cell lung cancers (NSCLCs) are diagnosed at an advanced stage (IIIB to IV), where therapeutic options depend on molecular analysis. However, diagnostic material for molecular testing is often represented by cytological samples which are generally scarce and span a wide range of preparation types. Thus, the primary objective is to efficiently manage materials for molecular profiling.
View Article and Find Full Text PDFComput Biol Med
January 2025
Department of Mathematics and Computer Science, University of Cagliari, Via Ospedale 72, 09124, Cagliari, Italy.
Background: Malaria is a critical and potentially fatal disease caused by the Plasmodium parasite and is responsible for more than 600,000 deaths globally. Early and accurate detection of malaria parasites is crucial for effective treatment, yet conventional microscopy faces limitations in variability and efficiency.
Methods: We propose a novel computer-aided detection framework based on deep learning and attention mechanisms, extending the YOLO-SPAM and YOLO-PAM models.
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