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Biomedical subjects

C J Lightdale

Publications and source records attributed to C J Lightdale.

At least 19 recordsLinked to original sources
PubMed1995

Detection of anastomotic recurrence by endoscopic ultrasonography.

There seems little doubt that endoscopic ultrasonography is highly sensitive and significantly better than computed tomography for the diagnosis of recurrent cancer at the surgical anastomosis after resection of esophageal and gastric cancer. The impact of using EUS for this purpose is discussed.

Anastomosis, Surgical↗
PubMed1993

Preoperative endoscopic ultrasound can predict the risk of recurrence after operation for gastric carcinoma.

PURPOSE: Endoscopic ultrasonography (EUS) has been shown to determine accurately the depth of invasion of the stomach wall in gastric carcinoma. We undertook this study to determine if T (tumor) stage as determined by EUS correlated with recurrence after resection and could be used to identify patients preoperatively at high risk for recurrence. MATERIALS AND METHODS: We reviewed the surgical pathology and obtained follow-up data from the first 50 patients who underwent preoperative EUS for staging of gastric carcinoma. Rotating sector-scan ultrasound endoscopes were used with switchable frequencies of 7.5 MHz and 12 MHz. RESULTS: Of 50 patients, 43 underwent resection with curative intent and were available for follow-up. The concordance of EUS T stage with pathologic T stage in these patients was 86%. At a median follow-up duration of 25 months, only two of 13 patients with preoperative EUS stage T1 or T2 disease were found to have recurrence, while 23 of 30 patients with EUS stage T3 or T4 disease had recurrence (P = .0002) and 22 died. CONCLUSION: We conclude that patients with a preoperative EUS stage T1 or T2 are at low risk for postoperative recurrence, while patients with EUS stage T3 or T4 are at high risk for early postoperative recurrence. The latter patients are reasonable candidates for controlled trials of alternative preoperative management programs, such as chemotherapy, in an effort to improve their poor prognosis.

Adult↗
PubMed1992

Localization of pancreatic endocrine tumors by endoscopic ultrasonography.

BACKGROUND: After a pancreatic endocrine tumor has been diagnosed on the basis of clinical signs and the results of laboratory tests, localization of the tumor by the usual imaging procedures fails in as many as 40 to 60 percent of patients. Endoscopic ultrasonography, a sensitive test for small carcinomas of the pancreas, might also be useful in patients with endocrine tumors of the pancreas that cannot be localized by conventional methods. METHODS: We studied 37 patients later shown to have 39 endocrine tumors of the pancreas who had negative results on transabdominal ultrasonography and CT. All the patients underwent endoscopic ultrasonography, and 22 also underwent selective angiography. All the tumors were confirmed by surgical excision and immunohistologic examination; they consisted of 31 insulinomas, 7 gastrinomas, and 1 glucagonoma, 0.5 to 2.5 cm (mean, 1.4 cm) in diameter. All but one of the patients were cured of their disease, as ascertained by at least six months of clinical and laboratory follow-up. RESULTS: Using endoscopic ultrasonography, we were able to localize 32 of the 39 tumors (sensitivity, 82 percent); no tumor was incorrectly localized. The size of the tumors was very similar (within 2 mm) to that predicted by endoscopic ultrasonography. Among the 22 patients who underwent both angiography and endoscopic ultrasonography, ultrasonography was significantly more sensitive than angiography for tumor localization (sensitivity, 82 percent vs. 27 percent). Among 19 control patients without pancreatic endocrine tumors, endoscopic ultrasonography was negative in 18 (specificity, 95 percent). CONCLUSIONS: Endoscopic ultrasonography is a highly sensitive and specific procedure for the localization of pancreatic endocrine tumors. It should be considered for the preoperative localization of such tumors once the clinical and laboratory diagnosis has been established.

Adenoma, Islet Cell↗
PubMed1992

Endoscopic ultrasonography in the diagnosis, staging and follow-up of esophageal and gastric cancer.

The accumulating data show that endoscopic ultrasonography (EUS) is highly compatible with the UICC/AJCC staging classification for esophageal and gastric cancer, based on the TNM system expressing anatomical extent of disease. The great strength of EUS in staging these cancers is its ability to image the gut wall and adjacent structures in unique detail. EUS is more accurate than computed tomography in staging the depth of primary tumor invasion (T) and regional lymph node metastases (N). High frequency EUS is not useful in staging for distant metastases (M) due to limited depth of the field. EUS also has limitations in reliably distinguishing between neoplastic and inflammatory tissue. Thus, the major use of EUS is in staging rather than in diagnosis. However, initial reports indicate that EUS may be helpful in the detection of malignancy in Barrett's esophagus, in diagnosing post-operative recurrent cancer, and in evaluating the response to non-operative therapy. EUS appears to represent an important advance in the staging and follow-up of patients with esophageal and gastric cancer. Instruments and techniques will continue to evolve, but the next level of research should be designed to show that the improved staging provided by EUS has clinical utility and can affect patient outcome.

Endoscopy, Gastrointestinal↗
PubMed1991

Localization of endocrine tumors of the pancreas with endoscopic ultrasonography.

High-frequency endoscopic ultrasonography (EUS) was used to image the pancreas through the wall of the stomach and duodenum in 12 patients with clinically suspected pancreatic endocrine tumors. In another patient, endocrine tumors in the wall of the duodenum were imaged by EUS. The findings were compared with those obtained by dynamic computed tomography (all patients) and selective angiography (eight patients). Laparotomy was done in eight patients. In our 13 patients, EUS detected endocrine tumors of the pancreas and duodenum in ten patients. More than one tumor was evident in five patients, including one of two patients with multiple endocrine neoplasia syndrome type I. In the eight patients treated surgically, there was one false-positive finding as a result of hypertrophic peripancreatic lymph nodes and one false-negative finding, in retrospect obviously imaged but incorrectly interpreted. The technique of EUS imaged small tumors in the pancreas (0.5 to 2.0 cm in diameter) in five patients where dynamic computed tomography and selective angiography were negative, but surgery and pathologic examination confirmed the EUS findings. This technique appears to be an important new addition to the battery of tests used for preoperative localization of endocrine tumors of the pancreas.

Adult↗
PubMed1991

Preoperative staging of esophageal cancer: comparison of endoscopic US and dynamic CT.

Fifty patients with esophageal cancer proved by means of biopsy underwent preoperative staging with endoscopic ultrasonography (US); in 42 of the patients, dynamic CT of the chest and abdomen was also performed. All results were compared with the findings at pathologic examination of resected specimens. In staging the depth of tumor growth, endoscopic US was significantly more accurate (46 of 50 tumors [92%]) than CT (25 of 42 tumors [60%]) (P less than .0003). In staging regional lymph nodes, it was more accurate (44 of 50 patients [88%]) than CT (31 of 42 patients [74%]), but this was not statistically significant. In staging distant metastases, however, CT was more accurate (38 of 42 patients [90%]) than endoscopic US (35 of 50 patients [70%]) (P less than .016). The highest concordance with surgical and pathologic findings in overall stage (36 of 42 tumors [86%]) occurred with the combined use of CT and endoscopic US, which was significantly more accurate than use of CT alone (27 of 42 tumors [64%]) (P less than .008).

Adenocarcinoma↗
PubMed1991

Preoperative staging of gastric cancer: comparison of endoscopic US and dynamic CT.

Fifty consecutive patients with gastric adenocarcinoma proved by means of biopsy underwent preoperative staging with endoscopic ultrasonography (US). Dynamic computed tomography (CT) of the chest and abdomen was performed before surgery in 33 of the patients. In all 50 patients, the TNM classification of the American Joint Committee on Cancer was used to compare the imaging findings with pathologic findings in specimens resected at surgery. When the depth of tumor penetration was evaluated, the findings at endoscopic US and those at pathologic examination were concordant in 46 of 50 patients (92%), and the findings at dynamic CT and those at pathologic examination, in 14 of 33 patients (42%) (P less than .00042). Evaluation of regional lymph node metastases showed a concordance of 78% with endoscopic US and 48% with dynamic CT (P less than .038). Overall determination of stage with both dynamic CT and endoscopic US showed a concordance of 73%, compared with a concordance of 45% for dynamic CT alone (P less than .028).

Adenocarcinoma↗
PubMed1988

Six primary cancers in individuals. Report of four cases.

Four patients who had six or more primary cancers are described in this article. Two of the patients had seven cancers each; the most frequent cancer site was the colon. These patients were young at the onset of their first cancer and had a long survival. All the patients had a strong family history of cancer, especially colon cancer. We found that family members of individuals with multiple cancers should be considered to have an increased risk for the development of cancer.

Adult↗
PubMed1988

Ogilvie's syndrome. Successful management without colonoscopy.

We reviewed the clinical presentation, management, and outcome of 25 patients with Ogilvie's syndrome (acute colonic pseudoobstruction) at Memorial Sloan-Kettering Cancer Center from 1982 through 1985. All patients had cancer and severe associated medical problems. Abdominal x-rays uniformly showed cecal distension ranging between 9 and 18 cm. Twenty-four of the 25 patients were treated with conservative nonendoscopic management. One patient had an exploratory laparotomy for prophylactic cecostomy after only one day of conservative therapy. Of the 24 patients treated conservatively, 23 (96%) improved by both clinical and radiologic criteria in a mean of 3.0 days. The remaining patient died of multisystem failure not related to the acute colonic pseudoobstruction. Colonoscopic decompression was not attempted in any of the 25 patients. There were no colonic perforations, and there were no pseudoobstruction-related deaths. This study questions the need for early endoscopic or surgical treatment in cancer patients with acute colonic pseudoobstruction.

Colonic Pseudo-Obstruction↗