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R S Liu

Publications and source records attributed to R S Liu.

At least 73 records · Page 4Linked to original sources
PubMed1998

Synthesis and evaluation of [14C]-labelled and fluorescent-tagged paclitaxel derivatives as new biological probes.

Our present report deals with the preparation of hitherto unreported 7-([carbonyl-14C]-acetyl)paclitaxel 4 and two new bioactive 7-substituted fluorescent taxoids (FITC 9 and rhodamine 11), as well as evaluation towards their applications as biological probes. The results in this report demonstrate that (a) the new paclitaxel derivatives 4, 9, 11 could be prepared with good yields starting from paclitaxel; (b) the [14C]acetylation step was found to be better by using [14C]acetic anhydride rather than [14C]sodium acetate; (c) the radiochemical purity of 4 was 96% and its specific activity was 48 mCi/mmol; (d) the cytotoxicity of 4 was close to that of paclitaxel whereas 9, 11 were far less active than paclitaxel, but these cytotoxic levels were good enough for their biological applications; (e) the drug-quantitation by flow cytometric analysis using 9 and 11 was proved to be equally efficient with respect to the radioactivity-based determination employing 4; (f) the intracellular fluorescence mapping by 9 and 11 was found to be effective and the microtubule network pattern was visible in both the cases; (g) the overall fluorescence imaging efficiency was better with 11 while the intensity of fluorescence was higher with 9; (h) staining of nucleolus was observed in fluorescence studies of both 9 and 11. Based on these results, the newly prepared paclitaxel derivatives can be considered as efficient biological probes and should find further use in relevant applications.

Acetylation↗
PubMed1998

Elevated cytokeratin-19 expression associated with apoptotic resistance and malignant progression of human cervical carcinoma.

Cytokeratin-19 is an intermediate filament protein associated with the integrity of cell structure, and its elevated expression has been reported to correlate with the disease progression of oesophagus and lung cancers. In this study, we examined the level of cytokeratin-19 in five cervical cancer cell lines by immunobinding and Western blotting analyses. Compared with two control cell lines, FS-4 (foreskin cell line) and G9T (glioma cell line), all five cervical carcinoma cell lines (Caski, CC7T, ME180, HeLa and SIHA) showed higher cytokeratin-19 expression. By double-staining flow cytometry, expression of cytokeratin-19 in cervical cancer cells was suggested to be in a cell cycle-independent manner. Furthermore, we could specifically localize the SIHA cell-derived tumours in nude mice by injecting with cytokeratin-19-recognized radiolabelled MAb Cx-99 antibody, suggesting the possibility of using cytokeratin-19 as a marker of cervical carcinoma. A clinical investigation was therefore performed on 19 patients (11 patients with cervical carcinoma and eight patients with benign neoplasia). In the 11 patients having cervical carcinoma, all eight patients with advanced stages and one out of three patients with early stage diseases showed higher cytokeratin-19 protein contents than the other 10 patients with benign neoplasia. This suggested that elevation of cytokeratin-19 level was associated with cervical cancer staging. In addition, we have studied the biological significance of elevated cytokeratin-19 level in malignant cervical cancer. The apoptotic rate of cervical carcinoma cells in response to cisplatin was increased if their cellular cytokeratin-19 level was reduced by specific antibody MAb Cx-99. These results indicated that elevation of cytokeratin-19 expression could associate with the apoptotic resistance and malignant progression of cervical carcinoma.

Journal Article↗
PubMed1998

Generation of murine monoclonal antibodies in serum-free medium.

Traditional hybridoma fusion technology requires complete medium with serum supplements to support the growth of hybridoma cells. Serum is also required for subcloning of hybridoma cells to support low density cell growth. IL-6 has been shown to enhance the growth of hybridomas and stimulate antibody production by B cells. We found that the serum requirement in media used for generation of hybridomas can be totally eliminated by substituting with 300 units/ml of IL-6. Stable hybridoma cell lines were generated to peptide and protein antigens using serum-free adapted P3.653 myelomas as the fusion partner and medium containing IL-6. Our results indicate that, in general, the fusion efficiencies of serum-free IL-6 supplemented fusions are lower than the fusions employing serum containing media (40%-60% vs. 80%-100%). However, in spite of the lower fusion efficiency, the number of antigen-specific clones generated using IL-6 was equal to or greater than fusions using serum supplements. The use of IL-6 instead of serum in the generation of monoclonal antibodies (MAbs) has several advantages. We are able to eliminate the costly need for serum in media by using IL-6 that is prepared in house. In addition, we eliminate the need for time-consuming serum-free adaptation of hybridoma cell lines prior to transfer to hollow fiber bioreactors.

Animals↗
PubMed1998

Positron emission tomography in asymptomatic gene carriers of Machado-Joseph disease.

OBJECTIVES: The metabolic changes in the brain of symptomatic subjects affected with Machado-Joseph disease have been previously documented using PET with fluorine-18-fluorodeoxyglucose (FDG). The aim of this study was to evaluate these changes in asymptomatic Machado-Joseph disease gene carriers. METHODS: Seven asymptomatic Machado-Joseph disease gene carriers, identified using a molecular test, and 10 normal control subjects were recruited for PET studies using FDG. Regional uptake ratios of FDG were calculated from the radioactivity of the cerebellar hemispheres, brainstem, and the temporal, parietal and occipital cortices, divided by the activity in the thalamus. RESULTS: In comparison with data obtained from normal control subjects, there was significantly decreased FDG utilisation in the cerebellar hemispheres, brainstem, and occipital cortex, and increased FDG metabolism in the parietal and temporal cortices of asymptomatic Machado-Joseph disease gene carriers, suggesting preclinical disease activity. Discriminant analysis of regional FDG uptake correctly classified genetic status (Machado-Joseph disease mutation carriers v mutation negative subjects) in 25 of 25 subjects (100% sensitivity and 100% specificity), and clinical status (asymptomatic mutation carriers v symptomatic patients) in 14 of 15 subjects (100% sensitivity and 85.7% specificity). CONCLUSION: Subclinical changes of FDG consumption, as measured by noninvasive PET, can act as an objective marker of preclinical disease activity in Machado-Joseph disease.

Adolescent↗
PubMed1998

Regional decrease in brain glucose metabolism in asymptomatic gene carriers of Machado-Joseph disease: a preliminary report.

BACKGROUND: The molecular abnormality responsible for Machado-Joseph disease (MJD), a neurodegenerative disorder, has recently been described. It has also been previously documented using positron emission tomography (PET) with [18F]-2-fluoro-2-deoxy-D-glucose (FDG) to record the metabolic changes in the brains of symptomatic subjects affected with MJD. The present study evaluated these changes in asymptomatic MJD gene carriers, previously identified by molecular analysis. METHODS: PET with FDG was used to study glucose metabolism in the brains of three asymptomatic MJD gene carriers who were identified by molecular analysis, and in 10 normal control subjects. RESULTS: By comparison with data obtained from normal control subjects, significantly decreased glucose utilization was found in the cerebellar hemisphere and occipital cortex of these three asymptomatic MJD gene carriers, suggesting preclinical disease activity. The sensitivity of diagnosis based on PET examination alone was 100% in this study, using significant decrease in glucose metabolism in the cerebellar hemisphere as a criterion. CONCLUSIONS: Measurement of regional brain metabolism by PET is noninvasive, and subclinical reduction of FDG consumption in the cerebellar hemisphere and occipital cortex is found to act as an objective marker of disease activity. Based on the results from a limited number of patients, the sensitivity of PET is sufficient to justify its routine use in the investigation of asymptomatic at-risk MJD subjects.

Adult↗
PubMed1998

A SPECT study of patients with gait apraxia without evidence of frontal lobe dysfunction.

BACKGROUND: The pathogenesis of gait apraxia (GA) is unknown. Even though imaging studies provide excellent assessment of brain morphology, there is still a lack of congruous results. Single photon emission computed tomography (SPECT) using Tc-99m hexamethylpropyleneamine oxime (HMPAO) may show alterations in regional cerebral blood flow (rCBF) and provide indirect information about brain metabolism. METHODS: We conducted a SPECT study of GA patients and evaluated the related cortical function. rCBF was assessed in 16 GA patients (15 male, one female; age range 65-79 years, mean 70.5 years) by SPECT using HMPAO. Mean HMPAO cortical or basal ganglia/cerebellum activity ratios were calculated. The regions of interest included the frontal lobe, parietal lobe and basal ganglia. A battery of GA tests and magnetic resonance imaging (MRI) of the brain were also performed in these 16 patients. RESULTS: Nine of the patients had equilibrium disorder, and all 16 patients had locomotion disorder. The MRI findings were lacunar infarct (16/16 in basal ganglia, or 6/16 in thalamus), leukoaraiosis (4/16), enlarged ventricle (3/16), frontal lesion (3/16) and parietal lesion (1/16). Lower rCBF was noted in the frontal lobe (3/16), occipital lobe (1/16, thalamus (7/16) and basal ganglia (9/16). Though SPECT showed decreased rCBF in nine patients (9/16), mean cortical and basal ganglia regional uptake ratios in the patient group were not significantly different from values in the control group (cortical p = 0.0613; basal ganglia p = 0.0576, by Student's t-test). CONCLUSIONS: Though only a small number of patients were studied, it was clear that brain SPECT and MRI did not show any significant abnormalities in the frontal or parietal lobes of patients with GA. Thus, the pathogenesis of GA and its related anatomic lesion should be further investigated.

Aged↗
PubMed1998

Effects of gamma knife radiosurgery for brain tumors: clinical evaluation.

BACKGROUND: Gamma knife radiosurgery is a safe and effective alternative to microsurgery in the management of selected intracranial lesions. In our initial three-year experience with gamma knife radiosurgery, 431 patients were treated using this method. This report presents the treatment results for three different types of brain tumors: benign meningiomas, malignant metastases and gliomas. METHODS: A retrospective study was performed to analyze a consecutive series of 71 meningiomas, 31 metastatic tumors and 21 gliomas treated by gamma knife radiosurgery between March 1993 and May 1996. The treatment results were investigated using regular magnetic resonance examinations and tumor volume measurement at six-month intervals to observe sequential changes of the tumors. Patients with meningiomas were further divided into three groups according to the peripheral radiation doses: high-dose (20-17 Gy, n = 18), medium-dose (16-15 Gy, n = 33) and low-dose (14-12 Gy, n = 20). The Generalized Estimation Equation was applied to compare treatment results in these three groups with different doses and tumor volumes. RESULTS: Volume measurements of the 71 meningiomas showed that 76% decreased in size, 16% stabilized and 8% increased in size. The volumes increased most frequently in the early stage (6-12 months) after treatment and subsequently regressed after the twelfth month. The tumor control rate for meningiomas in our three-year follow-up was over 90%. For meningiomas, the statistical analysis showed that both the radiation dose and tumor volume were significantly related to the development of adverse radiation effects (p < 0.05). In metastatic tumors, rapid tumor regression after radiosurgery was found in 87% of the patients. In gliomas, radiosurgery effectively inhibited tumor growth in selected patients with small, circumscribed, less infiltrative tumors. Ependymomas and low-grade astrocytomas had more favorable outcomes than other gliomas. CONCLUSIONS: Gamma knife radiosurgery is effective for controlling tumor growth in benign meningiomas for up to three years after surgery. In selected cases of malignant metastasis and gliomas, most patients appeared to benefit from the treatment with symptomatic improvement and prolonged survival. Treatment strategy and dose selection in radiosurgery should be adjusted to optimize tumor control and avoid adverse radiation effects.

Brain Neoplasms↗
PubMed1997

Sequential changes of esophageal motility after endoscopic injection sclerotherapy or variceal ligation for esophageal variceal bleeding: a scintigraphic study.

OBJECTIVE: Endoscopic injection sclerotherapy and variceal ligation are two popular endoscopic methods used to treat esophageal variceal hemorrhage. These two methods have not been compared with regard to esophageal dysfunction after treatment. This is a prospective investigation of esophageal dysmotility after endoscopic injection sclerotherapy and variceal ligation. METHODS: Sequential changes of esophageal motility after endoscopic injection sclerotherapy (n = 25) and variceal ligation (n = 25) were investigated in 50 cirrhotic patients with recent variceal bleeding. Another 22 cirrhotics without esophageal varices were included as controls. Radionuclide esophageal transit tests were performed before initial endoscopic treatment, and 1 and 3 months after variceal eradication. RESULTS: The baseline esophageal transit time was longer in both the sclerotherapy (n = 25, 7.8 +/- 1.4 s) and ligation groups (n = 25, 8.2 +/- 1.8 s) than in controls (n = 22, 6.7 +/- 0.7 s, p < 0.005). The transit time was longer in patients with large varices than in those with small varices (8.3 +/- 1.7 vs. 7.2 +/- 0.7 s, p < 0.05). In the sclerotherapy group, the transit time was prolonged 1 month after variceal eradication, compared with its pretreatment state (n = 20, 7.6 +/- 1.5 vs. 10.0 +/- 2.2 s, p < 0.0001) but was shortened at 3 months compared with 1 month after variceal eradication (n = 12, 10.7 +/- 1.5 vs. 8.6 +/- 2.2 s, p < 0.05). Multiple regression analysis showed that the number of treatment sessions required to eradicate varices was the only significant factor associated with prolonged transit time (p < 0.05). In the ligation group, the transit time changed little at 1 month or 3 months after variceal eradication. CONCLUSIONS: Impairment of esophageal motility can be significant with endoscopic injection sclerotherapy but is reversible. However, endoscopic variceal ligation exerts no significant impact on esophageal motility.

Esophageal and Gastric Varices↗
PubMed1996

Fluorine-18 fluoromisonidazole tumour to muscle retention ratio for the detection of hypoxia in nasopharyngeal carcinoma.

In vivo demonstration of hypoxia is of significance for tumour patient management. Fluorine-18 fluoromisonidazole ([18F]FMISO) is a proven hypoxic imaging agent. We developed an [18F]FMISO tumour to muscle retention ratio (TMRR) for the detection of tumour hypoxia in nasopharyngeal carcinoma (NPC). Data were acquired by positron emission tomography (PET) of the nasopharynx and neck after intravenous injection of 370 MBq of [18F]FMISO. Two imaging protocols were adopted: a long protocol for comprehensive dynamic information and a short protocol for a simple, clinically convenient imaging procedure. Tomograms were reconstructed and evaluated visually. ROI analysis on the basis of time-activity curve evaluation was performed to calculate the TMRR of NPC or cervical nodal metastases (CNMs) in relation to the suboccipital muscles at 2 h. The calculation of the TMRR was exactly the same for both the long and the short protocol as two 30-min composite frames had been created immediately after intravenous injection and 2 h after injection of [18F]FMISO in the long protocol. The normal tissue to muscle retention ratio (NTMRR) was derived similarly from the normal nasopharynx. The data of 12 controls and 24 patients with NPC were analysed. The long protocol was used in 15 patients, and the short protocol in nine. In controls, the mean NTMRR+/-1 SD was 0.96+/-0.14. The mean TMRRs for NPC and CNMs were 2.56+/-1.50 and 1.35+/-0.51, respectively; these values were significantly higher than the mean NTMRR for normal controls (P<0.005 in each case). At the retention threshold value of 1.24, tumour hypoxia occurred in 100% of the primary lesions of NPC and 58% of CNMs. The TMRR for undifferentiated carcinoma was significantly lower than that for non-keratinized carcinoma (P<0.05). The [18F]FMISO TMRR is a simple and clinically useful index for detecting tumour hypoxia in NPC.

Carcinoma↗
PubMed1996

Detection of anaerobic odontogenic infections by fluorine-18 fluoromisonidazole.

Odontogenic infections are a potential risk for patients who receive cervicofacial radiotherapy and should be treated before irradiation. Anaerobic microbial infections are the most common causes. This study assessed the value of the hypoxic imaging agent fluorine-18 fluoromisonidazole (FMISO) in detecting anaerobic odontogenic infections. Positron emission tomography (PET) imaging was performed at 2 h after injection of 370 MBq (10 mCi) of FMISO in 26 nasopharyngeal carcinoma patients and six controls with healthy teeth. Tomograms were interpreted visually to identify hypoxic foci in the jaw. All patients received thorough dental examinations as a pre-radiotherapy work-up. Fifty-one sites of periodontitis, 15 periodontal abscesses, 14 sites of dental caries with root canal infection, 23 sites of dental caries without root canal infection, and seven necrotic pulps were found by dental examination. Anaerobic pathogens were isolated from 12 patients. Increased uptake of FMISO was found at 45 out of 51 sites of periodontitis, all 15 sites of periodontal abscess, all 14 sites of dental caries with root canal infection, all seven sites of necrotic pulp and 15 sites of dental caries without obvious evidence of active root canal infection. No abnormal uptake was seen in the healthy teeth of patients or in the six controls. The diagnostic sensitivity, specificity, positive and negative predictive values, and accuracy of FMISO PET scan in detecting odontogenic infections were 93%, 97%, 84%, 99% and 96%, respectively. 18F-fluoride ion bone scan done in three patients showed that 18F-fluoride ion plays no role in the demonstration of anaerobic odontogenic infection. FMISO PET scan is a sensitive method for the detection of anaerobic odontogenic infections, and may play a complementary role in the evaluation of the dental condition of patients with head and neck tumours prior to radiation therapy.

Bacteria, Anaerobic↗
PubMed1996

Superscan in patients with nasopharyngeal carcinoma.

Bone scintigraphy plays an important role in the early detection of bone metastases in patients with nasopharyngeal carcinoma and serial scans may aid the clinician to assess the therapeutic response. A superscan is a pattern described as abnormal bone scan, indicating extensive bony metastases associated with various neoplastic diseases. Bone scans from 407 patients with nasopharyngeal carcinoma were reviewed retrospectively. Only six superscans (1.5%) were found. The appearance of a superscan is frequently accompanied by an abnormal titer of serological markers IgG-VCA and IgA-VCA, liver metastases, and poor survival. Although a superscan rarely occurs in nasopharyngeal carcinoma, its appearance may represent a poor prognosis in these patients.

Adult↗
PubMed1996

Clinical evaluation of the bone marrow imaging agent 99Tcm-phytate in the detection of bone metastases.

The aims of this study were to assess whether 99Tcm-phytate can detect metastatic skeletal lesions, and to compare it with 99Tcm-methylene diphosphonate (99Tcm-MDP) and 99Tcm-labelled human serum albumin nanocolloids (99Tcm-NC). Twenty-four patients with multiple bony metastases, investigated by 99Tcm-MDP whole-body scintigraphy, underwent 99Tcm-phytate bone marrow imaging. A separate bone marrow scintigram with 99Tcm-NC was performed in 20 of the patients. All of the metastatic lesions detected on the 99Tcm-phytate scintigrams exhibited photon-abundant foci only. Most of the 99Tcm-phytate scintigrams detected fewer metastatic lesions than the corresponding bone scintigrams. Visual comparison of the 99Tcm-NC images showed that 13 of 20 99Tcm-NC images were superior to the 99Tcm-phytate images in the detection of metastatic involvement of the skeleton. Thus 99Tcm-phytate should not be used as a bone marrow imaging agent for the detection of skeletal metastases.

Adult↗
PubMed1996

Comparative radionuclide imaging of metastatic insular carcinoma of the thyroid: value of technetium-99m-(V)DMSA.

We report a case of metastatic insular carcinoma of the thyroid evaluated with 201TI, 99mTc-MIBI, 99mTc-(V)DMSA, 99mTc-MDP and 131I whole-body scans, which were obtained after total thyroidectomy. For the majority of lesions detected in the skeleton and soft tissue, 131I images were generally available, although most were visualized easier with 99mTc-(V)DMSA. Technetium-99m-MDP images were considered better than 99mTc-(V)DMSA images in showing bone lesions but not soft-tissue lesions. Both 201TI and 99mTc-MIBI scans provided sufficient advantage to exhibit neck and mediastinal metastases, but they did not surpass 99mTc-(V)DMSA in detecting abdominal or bony lesions. In this patient with various metastases from insular carcinoma of the thyroid, 99mTc-(V)DMSA seemed to be the tracer of choice for whole-body imaging.

Bone Neoplasms↗
PubMed1996

Technetium-99m-DMSA renal SPECT in diagnosing and monitoring pediatric acute pyelonephritis.

UNLABELLED: This study compares the sensitivity of 99mTc-dimercaptosuccinic acid (DMSA) renal SPECT with planar scintigraphy, concluding the importance of 99mTc-DMSA renal SPECT for the early diagnosis of acute pyelonephritis (APN) in patients under 3 yr of age. METHODS: Twenty-seven children under 3 yr of age, with clinical and/or laboratory suspicion of APN, were investigated. All 99mTc-DMSA renal SPECT and planar images and voiding cystoureterogram (VCUG) were obtained within 3 days of hospitalization. RESULTS: In the first examination, renal cortical defects were detected in 23 patients (42 kidneys) with SPECT and in 9 patients (11 kidneys) with planar scintigraphy. One year after treatment, constant renal cortical lesions were observed in 11 patients (14 kidneys) with SPECT and 4 patients (4 kidneys) with planar scintigraphy. The high grades of vesicoureteral reflux (VUR) (grade >or= 3) correlate better with APN diagnosed by SPECT (34 kidneys) than by planar scintigraphy (8 kidneys). Multiple renal cortical defects (number of lesions >or= 4) were only seen in patients under 1.5 yr old and none of those with a negative 99mTc-DMSA renal SPECT had a positive 99mTc-DMSA renal planar scintigraphy at any time. There is a significant difference (p < 0.05) between the diagnostic ability of these two methods of examination. CONCLUSION: Our results suggest that 99mTc-DMSA renal SPECT should be used, where possible, instead of planar DMSA in routine examination of children with clinical suspicion of APN, especially for those under 3 yr of age.

Acute Disease↗
PubMed1995

Liver disease after bone marrow transplantation--the Taiwan experience.

To investigate the causes of impaired liver function (LF)* after BMT, 88 patients were included for analysis of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, transplant methods, preconditioning regimens, and graft-versus-host disease (GVHD). Fifty of them (56.8%) developed abnormal LF after BMT and among them, 29 (32.9%) developed chronic hepatitis (CH). By univariate analysis, HCV infection, pretransplant abnormal LF, allogeneic BMT, and preconditioning regimen with total body irradiation were all significantly related to higher incidence of post-BMT impaired LF. However, only HCV infection, pretransplant abnormal LF, and acute GVHD were associated with higher incidence of CH. By multivariate logistic regression analysis, HCV infection and pretransplant abnormal LF were the two most significant interpreters for abnormal LF, especially for CH (odds ratios: 7.86 and 4.735, respectively) after BMT. Although the incidence of abnormal LF was found high in this study, there was no significant disadvantage in terms of survival for patients who developed abnormal acute and chronic liver function after BMT. However, a long-term follow-up is needed to evaluate survival pathology of CH, such as liver cirrhosis and hepatoma.

Adolescent↗
PubMed1995

Use of fluorine-18 fluorodeoxyglucose positron emission tomography in the detection of thymoma: a preliminary report.

Thymomas are lacking in malignant cytological features. Their staging is defined by the invasiveness of the tumour. This study aimed to analyse the uptake patterns of fluorine-18 fluorodeoxyglucose (FDG) in thymomas of different stages. FDG positron emission tomography (PET) scan was performed in 12 patients suspected of having thymoma and in nine controls. Qualitative visual interpretation was used to detect the foci with FDG uptake higher than that of normal mediastinum. Tumour/lung ratio (TLR) was calculated from the counts of ROIs over the mass and over comparable normal lung tissue in thymoma patients. Mediastinum/lung ratio (MLR) was calculated from the counts of ROIs over the anterior mediastinum and lung in controls. The PET scan patterns of distribution of foci with FDG uptake and TLRs were correlated with the computed tomography (CT) or magnetic resonance imaging (MRI) findings, and staging of the thymomas. Thymectomy was performed in ten patients and thoracoscopy was done in two patients. The results revealed ten thymomas (two stage I tumours, two stage II, four stage III and two stage IV, according to the Masaoka classification), and two cases of thymic hyperplasia associated with myasthenia gravis. Myasthenia gravis was also noted in four thymoma patients. FDG studies showed (a) diffuse uptake in the widened anterior mediastinum in patients with thymic hyperplasia, (b) confined focal FDG uptake in the non-invasive or less invasive, stage I and II thymomas, and (c) multiple discrete foci of FDG uptake in the mediastinum and thoracic structures in stage III and IV advanced invasive thymomas. The thymomas had the highest TLRs, followed by the TLRs of thymic hyperplasia and the MLRs of control subjects (P <0.005). No significant difference was found between thymomas in different stages or between thymomas with and thymomas without myasthenia gravis. In comparison with CT and/or MRI, FDG-PET detected more lesions in patients with invasive thymomas and downgraded the staging of thymoma in four patients. Our preliminary results suggest that FDG-PET is useful in the assessment of the invasiveness of thymomas, and may have the potential to differentiate thymomas from thymic hyperplasia.

Adult↗