Ovarian cancer represents worldwide the second most frequent and the most fatal gynecological mal... more Ovarian cancer represents worldwide the second most frequent and the most fatal gynecological malignancy, with approximately two thirds of the patients presenting with advanced disease. Cytoreductive surgery, primary or after neoadjuvant chemotherapy, in combination with platinum-based chemotherapy is the standard of care for these patients. Despite the improvement in quality of cytoreductive surgery as well as development of novel drugs and chemotherapy regimens, still most women with ovarian cancer will ultimately develop recurrent disease and die of their disease. In contrast to the management of primary disease, the standard treatment of patients with recurrent ovarian cancer remains a topic of debate. While platinum-based or second line systemic chemotherapy, depending on the time after last platinum treatment, is standard of care, the role of secondary cytoreductive surgery has been a controversial issue for the last decades. Potential outcome benefit must be also weighed agai...
Peritoneal sarcomatosis from uterine sarcoma is a rare disease with no effective treatment and po... more Peritoneal sarcomatosis from uterine sarcoma is a rare disease with no effective treatment and poor prognosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has successful results in peritoneal carcinomatosis from gastrointestinal/gynecological origins. We show that CRS/ HIPEC is safe, feasible, and may benefit selected patients with peritoneal sarcomatosis from uterine sarcoma.
PURPOSE To investigate and histopathologically validate the role of model selection in the design... more PURPOSE To investigate and histopathologically validate the role of model selection in the design of novel parametric meta-maps towards the discrimination of low from high-grade soft tissue sarcomas (STSs) using multiple Diffusion Weighted Imaging (DWI) models. METHODS DWI data of 28 patients were quantified using the mono-exponential, bi-exponential, stretched-exponential and the diffusion kurtosis model. Akaike Weights (AW) were calculated from the corrected Akaike Information Criteria (AICc) to select the most suitable model for every pixel within the tumor volume. Pseudo-colorized classification maps were then generated to depict model suitability, hypothesizing that every single model underpins different tissue properties and cannot solely characterize the whole tumor. Single model parametric maps were turned into meta-maps using the classification map and a histological validation of the model suitability results was conducted on several subregions of different tumors. Several histogram metrics were calculated from all derived maps before and after model selection, statistical analysis was conducted using the Mann-Whitney U test, p-values were adjusted for multiple comparisons and performance of all statistically significant metrics was evaluated using the Receiver Operator Characteristic (ROC) analysis. RESULTS The histologic analysis on several tumor subregions confirmed model suitability results on these areas. Only 3 histogram metrics, all derived from the meta-maps, were found to be statistically significant in differentiating low from high-grade STSs with an AUC higher than 89 %. CONCLUSION Embedding model selection in the design of the diffusion parametric maps yields to histogram metrics of high discriminatory power in grading STSs.
Proceedings of the 33rd Computer Graphics International, 2016
Non-invasive imaging biomarkers that assess angiogenic response and tumor microvascular environme... more Non-invasive imaging biomarkers that assess angiogenic response and tumor microvascular environment at an early stage of therapy could provide useful insights into therapy planning. Tissue hypoxia is related to the insufficient supply of oxygen and is associated with tumor vasculature and perfusion. Thus, knowledge of the hypoxic areas could be of great importance. There is no golden standard for imaging tumor hypoxia yet, however Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) is among the most promising non-invasive clinically relevant imaging modalities. In this work, DCE-MRI data from neck sarcoma are analyzed through a pattern recognition technique which results in the separation of the tumor area into well-perfused, hypoxic and necrotic regions.
Background: Surgical treatment of intra-abdominal cancer is often followed by local recurrence. I... more Background: Surgical treatment of intra-abdominal cancer is often followed by local recurrence. In a subgroup of patients, local recurrence is the sole site of disease, re¯ecting biologically low-grade malignancy. These patients might, therefore, bene®t from local treatment. Recently, debulking surgery followed by hyperthermic chemoperfusion has been proposed in the treatment of locally advanced or recurrent intra-abdominal cancer. This paper reviews the rationale and assesses the currently accepted indications for and results of this novel treatment. Methods: A systematic web-based literature review was performed. Information was also retrieved from handbooks, congress abstracts and ongoing clinical trials. Results: A growing body of experimental evidence supports the use of hyperthermia combined with chemotherapy as an adjunct to cytoreductive surgery. Randomized clinical trials are available to support its use in the treatment and prevention of peritoneal carcinomatosis following resection of pathological tumour stage pT 3 or pT 4 gastric cancer; several other phase III trials are ongoing. Numerous phase I and II trials have reported good results for various other indications, with acceptable morbidity and mortality rates. Case mix, limited patient numbers and absence of a standardized technique are, however, a drawback in many of these series. Conclusion: For a subgroup of patients with peritoneal cancer without distant disease, debulking surgery followed by hyperthermic chemoperfusion may offer a chance of cure or palliation in this otherwise untreatable condition. This novel therapy should, however, be considered experimental until further results from ongoing phase III trials become available.
ABSTRACT Peritoneal carcinomatosis represents an advanced form of intra-abdominal and pelvic mali... more ABSTRACT Peritoneal carcinomatosis represents an advanced form of intra-abdominal and pelvic malignant tumours that has been generally associated with a grim prognosis. The peritoneal component of cancer is often the major source of morbidity and mortality. Despite advances in its diagnosis, peritoneal surface malignancy has always been a major problem in cancer management. Surgery alone can never be therapeutic. Even if all visible tumour deposits can be removed, most likely microscopic residual disease will be left behind and progression of peritoneal disease will occur. On the other hand, systemic chemotherapy, alone or in combination with surgery, is generally not so effective such that patients will ultimately die of their disease. In most cases, peritoneal metastases are usually relatively resistant to intravenously administered cytotoxic drugs. A clear dose-effect relation exists, but the intravenously administered dose that is significantly effective generally exceeds the dose that causes lethal systemic toxicity.
Background: In recent years surgical cytoreduction followed by intra-operative hyperthermic intra... more Background: In recent years surgical cytoreduction followed by intra-operative hyperthermic intraperitoneal chemotherapy (HIPEC) was introduced as treatment modality in patients with peritoneal surface malignancy. In the current review the rational for this approach, the prerequisites and the different techniques used are discussed. Methods: A literature search through PubMed was performed. Results: Pharmacokinetic studies have shown an important dose advantage for intraperitoneal versus intravenous application. Hyperthermia enhances the penetration of cytostatic drugs into tumour tissue and also shows synergism with various cytostatic drugs. The penetration depth of drugs into tissue is limited, therefore HIPEC can only be effective in patients with minimal residual disease after (aggressive) surgery. HIPEC can be conducted in various ways, without clear proven advantage of one method over the others. Local complications after this combined treatment approach are mainly surgery related. Intraperitoneal chemotherapy may cause systemic toxicity, dependant on the drug used. In randomised studies cytoreductive surgery followed by HIPEC has proven its value in the prevention of peritoneal dissemination in gastric cancer. Phase II data on HIPEC in peritoneal carcinomatosis of colorectal origin and pseudomyxoma peritonei are promising, but randomised studies are still not available. Conclusion: Aggressive surgical cytoreduction and HIPEC in patients with peritoneal surface malignancy has a clear rational and seems to have clinical value.
In breast cancer, expression of Cluster of Differentiation 24 (CD24), a small GPI-anchored glycop... more In breast cancer, expression of Cluster of Differentiation 24 (CD24), a small GPI-anchored glycoprotein at the cell periphery, is associated with metastasis and immune escape, while its absence is associated with tumor-initiating capacity. Since the mechanism of CD24 sorting is unknown, we investigated the role of glycosylation in the subcellular localization of CD24. Expression and localization of wild type N36- and/or N52-mutated CD24 were analyzed using immunofluorescence in luminal (MCF-7) and basal B (MDA-MB-231 and Hs578T) breast cancer cells lines, as well as HEK293T cells. Endogenous and exogenously expressed wild type and mutated CD24 were found localized at the plasma membrane and the cytoplasm, but not the nucleoplasm. The cell lines showed different kinetics for the sorting of CD24 through the secretory/endocytic pathway. N-glycosylation, especially at N52, and its processing in the Golgi were critical for the sorting and expression of CD24 at the plasma membrane of HEK2...
BACKGROUND Subcutaneous fat may have variable signal intensity on T2w images depending on the cho... more BACKGROUND Subcutaneous fat may have variable signal intensity on T2w images depending on the choice of imaging parameters. However, fatty components within tumors have a different degree of signal dependence on the acquisition scheme. This study examined the use of T2, T2* relaxometry and spin coupling related signal changes (Spin Coupling ratio, SCr) on two different imaging protocols as clinically relevant descriptors of benign and malignant lipomatous tumors. MATERIALS AND METHODS 20 patients with benign lipomas or liposarcomas of variable histologic grade were examined at an 1.5 T scanner with Multi Echo Spin Echo (MESE) different echo spacing (ESP) in order to produce bright fat T2w images (ESP: 13.4 ms, 25 equidistant echoes) and dark fat images (ESP: 26.8 ms with 10 equidistant echoes). T2* relaxometry acquisition comprises 4 sets of in-opposed echoes (2.4-19.2 ms, ESP: 2.4 ms) Multi Echo Gradient Echo (MEGRE) sequence. All parametric maps were calculated on a pixel basis. RESULTS Significant differences of SCr were found for five different types of lipomatous tumors (Pairwise t-test with Bonferroni correction): lipomas, well differentiated liposarcomas, myxoid liposarcomas, pleomorphic liposarcomas and poorly differentiated liposarcomas. SCr surpassed the classification performance of T2 and T2* relaxometry. DATA CONCLUSION A novel biomarker based on spin coupling related signal loss, SCr, is indicative of lipomatous tumor histological grading. We concluded that T2, T2* and SCr can be used for the classification of fat containing tumors, which may be important for biopsy guidance in heterogeneous masses and treatment planning.
Peritoneal seeding from colorectal cancer has a very poor prognosis and is relatively resistant t... more Peritoneal seeding from colorectal cancer has a very poor prognosis and is relatively resistant to systemic chemotherapy. We performed a phase I/II trial to investigate the feasibility and effectiveness of extensive cytoreductive surgery in combination with intra-operative hyperthermic intraperitoneal chemotherapy (HIPEC) in these patients. 29 patients with peritoneal carcinomatosis of colorectal origin without evidence of distant metastases underwent cytoreductive surgery and intra-operative HIPEC with mitomycin-C (MMC), followed by systemic chemotherapy with 5-fluorouracil (5-FU)/leucovorin. Surgical complications occurred in 11 patients (38%). One patient died directly related to the treatment, resulting in a mortality rate of 3%. MMC toxicity existed mainly of leucocytopenia (in 15 patients; 52%). After a median follow-up of 38 months (range 26-52 months) we found a 2-and 3-year survival rate (Kaplan-Meier) of 45 and 23%, respectively. Extensive cytoreductive surgery and HIPEC is feasible in patients with peritoneal seeding of colorectal cancer. First results suggest that a higher median survival could be achieved compared with conventional palliative surgery and systemic chemotherapy, therefore a randomised phase III study is now being conducted.
Departments of 1Surgery, 2Oncology and Radiotherapy, 3Pathology and 4Nuclear Medicine, Turku Univ... more Departments of 1Surgery, 2Oncology and Radiotherapy, 3Pathology and 4Nuclear Medicine, Turku University Hospital, and 5Department of Biostatistics, Turku University, Turku, and Departments of 6Oncology, 7Pathology and 8Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland Correspondence to: Mr I. Koskivuo, Department of Surgery, Turku University Hospital, PO Box 52, FI-20521 Turku, Finland (e-mail: ilkka.koskivuo@tyks.fi)
Purpose: The proposed study aims to develop an MRI-based radiomics analysis framework and investi... more Purpose: The proposed study aims to develop an MRI-based radiomics analysis framework and investigate the feasibility of the calculated quantitative imaging features for differentiating low from high grade soft tissue sarcomas (STSs). Material and Methods: A total of 22 patients (9 low grade and 13 high grade) who were pathologically diagnosed with soft tissue sarcomas were recruited for the analysis and corresponding T2-weighted MR images were acquired for further post-processing. Tumour delineations were manually traced slice by slice concluding to whole tumour annotated volumes from all enrolled patients. A total of 1165 high-throughput patient-specific quantitative imaging features were exported from each volume using radiomics and evaluated using random forest machine learning classifiers. The overall analysis framework was coupled with feature selection and oversampling techniques to address high-dimensionality dataset issues and the unbalanced ratio between the two examined g...
Erythema can be described only through subjective evaluation, except when it is quantified by dig... more Erythema can be described only through subjective evaluation, except when it is quantified by digital image analysis software. Using such software, the authors performed comparisons of the erythema produced after skin closure of clean surgical wounds. Five suture materials were compared with respect to the local skin irritation that was caused. Different quantities of erythema are produced by suture material after the skin closure of clean surgical wounds. The authors present an objective method of measuring how unreactive a suture material is in comparison with another when applied to the skin. The suture materials polydioxanone, polypropylene blue, polyamide 6, metallic clips, and polyglactin were compared in the present study. Digital photographs of 100 patients were compared by means of software, evaluating red color superiority (mean value of red color) in the region surrounding the wound. The least to most irritation caused to the skin by different suture materials was established for paired data. The Kolmogorov-Smirnov criterion and the Wilcoxon signed rank test were used. Polydioxanone was found to have the best performance, followed in order by polyglactin, polyamide, polypropylene, and metallic clips. Immediately after suture removal, differences between the effects of suture materials were statistically significant on postoperative day 10. Absorbable sutures can be used in skin closure of clean surgical wounds and can produce less erythematous reaction than nonabsorbable ones. Digital image analysis is a reliable method of quantitative evaluation of skin erythema resulting after skin closure of surgical wounds.
Ovarian cancer represents worldwide the second most frequent and the most fatal gynecological mal... more Ovarian cancer represents worldwide the second most frequent and the most fatal gynecological malignancy, with approximately two thirds of the patients presenting with advanced disease. Cytoreductive surgery, primary or after neoadjuvant chemotherapy, in combination with platinum-based chemotherapy is the standard of care for these patients. Despite the improvement in quality of cytoreductive surgery as well as development of novel drugs and chemotherapy regimens, still most women with ovarian cancer will ultimately develop recurrent disease and die of their disease. In contrast to the management of primary disease, the standard treatment of patients with recurrent ovarian cancer remains a topic of debate. While platinum-based or second line systemic chemotherapy, depending on the time after last platinum treatment, is standard of care, the role of secondary cytoreductive surgery has been a controversial issue for the last decades. Potential outcome benefit must be also weighed agai...
Peritoneal sarcomatosis from uterine sarcoma is a rare disease with no effective treatment and po... more Peritoneal sarcomatosis from uterine sarcoma is a rare disease with no effective treatment and poor prognosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has successful results in peritoneal carcinomatosis from gastrointestinal/gynecological origins. We show that CRS/ HIPEC is safe, feasible, and may benefit selected patients with peritoneal sarcomatosis from uterine sarcoma.
PURPOSE To investigate and histopathologically validate the role of model selection in the design... more PURPOSE To investigate and histopathologically validate the role of model selection in the design of novel parametric meta-maps towards the discrimination of low from high-grade soft tissue sarcomas (STSs) using multiple Diffusion Weighted Imaging (DWI) models. METHODS DWI data of 28 patients were quantified using the mono-exponential, bi-exponential, stretched-exponential and the diffusion kurtosis model. Akaike Weights (AW) were calculated from the corrected Akaike Information Criteria (AICc) to select the most suitable model for every pixel within the tumor volume. Pseudo-colorized classification maps were then generated to depict model suitability, hypothesizing that every single model underpins different tissue properties and cannot solely characterize the whole tumor. Single model parametric maps were turned into meta-maps using the classification map and a histological validation of the model suitability results was conducted on several subregions of different tumors. Several histogram metrics were calculated from all derived maps before and after model selection, statistical analysis was conducted using the Mann-Whitney U test, p-values were adjusted for multiple comparisons and performance of all statistically significant metrics was evaluated using the Receiver Operator Characteristic (ROC) analysis. RESULTS The histologic analysis on several tumor subregions confirmed model suitability results on these areas. Only 3 histogram metrics, all derived from the meta-maps, were found to be statistically significant in differentiating low from high-grade STSs with an AUC higher than 89 %. CONCLUSION Embedding model selection in the design of the diffusion parametric maps yields to histogram metrics of high discriminatory power in grading STSs.
Proceedings of the 33rd Computer Graphics International, 2016
Non-invasive imaging biomarkers that assess angiogenic response and tumor microvascular environme... more Non-invasive imaging biomarkers that assess angiogenic response and tumor microvascular environment at an early stage of therapy could provide useful insights into therapy planning. Tissue hypoxia is related to the insufficient supply of oxygen and is associated with tumor vasculature and perfusion. Thus, knowledge of the hypoxic areas could be of great importance. There is no golden standard for imaging tumor hypoxia yet, however Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) is among the most promising non-invasive clinically relevant imaging modalities. In this work, DCE-MRI data from neck sarcoma are analyzed through a pattern recognition technique which results in the separation of the tumor area into well-perfused, hypoxic and necrotic regions.
Background: Surgical treatment of intra-abdominal cancer is often followed by local recurrence. I... more Background: Surgical treatment of intra-abdominal cancer is often followed by local recurrence. In a subgroup of patients, local recurrence is the sole site of disease, re¯ecting biologically low-grade malignancy. These patients might, therefore, bene®t from local treatment. Recently, debulking surgery followed by hyperthermic chemoperfusion has been proposed in the treatment of locally advanced or recurrent intra-abdominal cancer. This paper reviews the rationale and assesses the currently accepted indications for and results of this novel treatment. Methods: A systematic web-based literature review was performed. Information was also retrieved from handbooks, congress abstracts and ongoing clinical trials. Results: A growing body of experimental evidence supports the use of hyperthermia combined with chemotherapy as an adjunct to cytoreductive surgery. Randomized clinical trials are available to support its use in the treatment and prevention of peritoneal carcinomatosis following resection of pathological tumour stage pT 3 or pT 4 gastric cancer; several other phase III trials are ongoing. Numerous phase I and II trials have reported good results for various other indications, with acceptable morbidity and mortality rates. Case mix, limited patient numbers and absence of a standardized technique are, however, a drawback in many of these series. Conclusion: For a subgroup of patients with peritoneal cancer without distant disease, debulking surgery followed by hyperthermic chemoperfusion may offer a chance of cure or palliation in this otherwise untreatable condition. This novel therapy should, however, be considered experimental until further results from ongoing phase III trials become available.
ABSTRACT Peritoneal carcinomatosis represents an advanced form of intra-abdominal and pelvic mali... more ABSTRACT Peritoneal carcinomatosis represents an advanced form of intra-abdominal and pelvic malignant tumours that has been generally associated with a grim prognosis. The peritoneal component of cancer is often the major source of morbidity and mortality. Despite advances in its diagnosis, peritoneal surface malignancy has always been a major problem in cancer management. Surgery alone can never be therapeutic. Even if all visible tumour deposits can be removed, most likely microscopic residual disease will be left behind and progression of peritoneal disease will occur. On the other hand, systemic chemotherapy, alone or in combination with surgery, is generally not so effective such that patients will ultimately die of their disease. In most cases, peritoneal metastases are usually relatively resistant to intravenously administered cytotoxic drugs. A clear dose-effect relation exists, but the intravenously administered dose that is significantly effective generally exceeds the dose that causes lethal systemic toxicity.
Background: In recent years surgical cytoreduction followed by intra-operative hyperthermic intra... more Background: In recent years surgical cytoreduction followed by intra-operative hyperthermic intraperitoneal chemotherapy (HIPEC) was introduced as treatment modality in patients with peritoneal surface malignancy. In the current review the rational for this approach, the prerequisites and the different techniques used are discussed. Methods: A literature search through PubMed was performed. Results: Pharmacokinetic studies have shown an important dose advantage for intraperitoneal versus intravenous application. Hyperthermia enhances the penetration of cytostatic drugs into tumour tissue and also shows synergism with various cytostatic drugs. The penetration depth of drugs into tissue is limited, therefore HIPEC can only be effective in patients with minimal residual disease after (aggressive) surgery. HIPEC can be conducted in various ways, without clear proven advantage of one method over the others. Local complications after this combined treatment approach are mainly surgery related. Intraperitoneal chemotherapy may cause systemic toxicity, dependant on the drug used. In randomised studies cytoreductive surgery followed by HIPEC has proven its value in the prevention of peritoneal dissemination in gastric cancer. Phase II data on HIPEC in peritoneal carcinomatosis of colorectal origin and pseudomyxoma peritonei are promising, but randomised studies are still not available. Conclusion: Aggressive surgical cytoreduction and HIPEC in patients with peritoneal surface malignancy has a clear rational and seems to have clinical value.
In breast cancer, expression of Cluster of Differentiation 24 (CD24), a small GPI-anchored glycop... more In breast cancer, expression of Cluster of Differentiation 24 (CD24), a small GPI-anchored glycoprotein at the cell periphery, is associated with metastasis and immune escape, while its absence is associated with tumor-initiating capacity. Since the mechanism of CD24 sorting is unknown, we investigated the role of glycosylation in the subcellular localization of CD24. Expression and localization of wild type N36- and/or N52-mutated CD24 were analyzed using immunofluorescence in luminal (MCF-7) and basal B (MDA-MB-231 and Hs578T) breast cancer cells lines, as well as HEK293T cells. Endogenous and exogenously expressed wild type and mutated CD24 were found localized at the plasma membrane and the cytoplasm, but not the nucleoplasm. The cell lines showed different kinetics for the sorting of CD24 through the secretory/endocytic pathway. N-glycosylation, especially at N52, and its processing in the Golgi were critical for the sorting and expression of CD24 at the plasma membrane of HEK2...
BACKGROUND Subcutaneous fat may have variable signal intensity on T2w images depending on the cho... more BACKGROUND Subcutaneous fat may have variable signal intensity on T2w images depending on the choice of imaging parameters. However, fatty components within tumors have a different degree of signal dependence on the acquisition scheme. This study examined the use of T2, T2* relaxometry and spin coupling related signal changes (Spin Coupling ratio, SCr) on two different imaging protocols as clinically relevant descriptors of benign and malignant lipomatous tumors. MATERIALS AND METHODS 20 patients with benign lipomas or liposarcomas of variable histologic grade were examined at an 1.5 T scanner with Multi Echo Spin Echo (MESE) different echo spacing (ESP) in order to produce bright fat T2w images (ESP: 13.4 ms, 25 equidistant echoes) and dark fat images (ESP: 26.8 ms with 10 equidistant echoes). T2* relaxometry acquisition comprises 4 sets of in-opposed echoes (2.4-19.2 ms, ESP: 2.4 ms) Multi Echo Gradient Echo (MEGRE) sequence. All parametric maps were calculated on a pixel basis. RESULTS Significant differences of SCr were found for five different types of lipomatous tumors (Pairwise t-test with Bonferroni correction): lipomas, well differentiated liposarcomas, myxoid liposarcomas, pleomorphic liposarcomas and poorly differentiated liposarcomas. SCr surpassed the classification performance of T2 and T2* relaxometry. DATA CONCLUSION A novel biomarker based on spin coupling related signal loss, SCr, is indicative of lipomatous tumor histological grading. We concluded that T2, T2* and SCr can be used for the classification of fat containing tumors, which may be important for biopsy guidance in heterogeneous masses and treatment planning.
Peritoneal seeding from colorectal cancer has a very poor prognosis and is relatively resistant t... more Peritoneal seeding from colorectal cancer has a very poor prognosis and is relatively resistant to systemic chemotherapy. We performed a phase I/II trial to investigate the feasibility and effectiveness of extensive cytoreductive surgery in combination with intra-operative hyperthermic intraperitoneal chemotherapy (HIPEC) in these patients. 29 patients with peritoneal carcinomatosis of colorectal origin without evidence of distant metastases underwent cytoreductive surgery and intra-operative HIPEC with mitomycin-C (MMC), followed by systemic chemotherapy with 5-fluorouracil (5-FU)/leucovorin. Surgical complications occurred in 11 patients (38%). One patient died directly related to the treatment, resulting in a mortality rate of 3%. MMC toxicity existed mainly of leucocytopenia (in 15 patients; 52%). After a median follow-up of 38 months (range 26-52 months) we found a 2-and 3-year survival rate (Kaplan-Meier) of 45 and 23%, respectively. Extensive cytoreductive surgery and HIPEC is feasible in patients with peritoneal seeding of colorectal cancer. First results suggest that a higher median survival could be achieved compared with conventional palliative surgery and systemic chemotherapy, therefore a randomised phase III study is now being conducted.
Departments of 1Surgery, 2Oncology and Radiotherapy, 3Pathology and 4Nuclear Medicine, Turku Univ... more Departments of 1Surgery, 2Oncology and Radiotherapy, 3Pathology and 4Nuclear Medicine, Turku University Hospital, and 5Department of Biostatistics, Turku University, Turku, and Departments of 6Oncology, 7Pathology and 8Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland Correspondence to: Mr I. Koskivuo, Department of Surgery, Turku University Hospital, PO Box 52, FI-20521 Turku, Finland (e-mail: ilkka.koskivuo@tyks.fi)
Purpose: The proposed study aims to develop an MRI-based radiomics analysis framework and investi... more Purpose: The proposed study aims to develop an MRI-based radiomics analysis framework and investigate the feasibility of the calculated quantitative imaging features for differentiating low from high grade soft tissue sarcomas (STSs). Material and Methods: A total of 22 patients (9 low grade and 13 high grade) who were pathologically diagnosed with soft tissue sarcomas were recruited for the analysis and corresponding T2-weighted MR images were acquired for further post-processing. Tumour delineations were manually traced slice by slice concluding to whole tumour annotated volumes from all enrolled patients. A total of 1165 high-throughput patient-specific quantitative imaging features were exported from each volume using radiomics and evaluated using random forest machine learning classifiers. The overall analysis framework was coupled with feature selection and oversampling techniques to address high-dimensionality dataset issues and the unbalanced ratio between the two examined g...
Erythema can be described only through subjective evaluation, except when it is quantified by dig... more Erythema can be described only through subjective evaluation, except when it is quantified by digital image analysis software. Using such software, the authors performed comparisons of the erythema produced after skin closure of clean surgical wounds. Five suture materials were compared with respect to the local skin irritation that was caused. Different quantities of erythema are produced by suture material after the skin closure of clean surgical wounds. The authors present an objective method of measuring how unreactive a suture material is in comparison with another when applied to the skin. The suture materials polydioxanone, polypropylene blue, polyamide 6, metallic clips, and polyglactin were compared in the present study. Digital photographs of 100 patients were compared by means of software, evaluating red color superiority (mean value of red color) in the region surrounding the wound. The least to most irritation caused to the skin by different suture materials was established for paired data. The Kolmogorov-Smirnov criterion and the Wilcoxon signed rank test were used. Polydioxanone was found to have the best performance, followed in order by polyglactin, polyamide, polypropylene, and metallic clips. Immediately after suture removal, differences between the effects of suture materials were statistically significant on postoperative day 10. Absorbable sutures can be used in skin closure of clean surgical wounds and can produce less erythematous reaction than nonabsorbable ones. Digital image analysis is a reliable method of quantitative evaluation of skin erythema resulting after skin closure of surgical wounds.
Uploads
Papers by Eelco de Bree