BackgroundThailand has a high incidence of cholangiocarcinoma (CCA), particularly in the north and northeastern regions. Most CCA patients come at a late, unresectable stage and presently no optimal screening test for CCA has been established. We determined the prevalence of CCA in a remote northern village and explored if screening could lead to early detection and survival benefits.MethodsA 5-year population-based study was started in October, 2011 for consented Thai individuals, aged 30–60 years. The screening program comprised blood testing, stool examination and serial ultrasonography every 6 months.ResultsDuring the first 3 years, 4,225 eligible individuals were enrolled. CCA was detected in 32 patients, with a mean age of 51.9 years (41–62 years), and 21/32 cases were at a curative resectable stage. The prevalence rate of CCA was 165.7 per 100,000 and one- and two-year incidence rate was 236.7/100,000 and 520.7/100,000, respectively. One- and 2-year overall survival rates of CCA patients were 90.9 and 61.5 %, respectively. Prognosis was better in resectable cases with 100 % 1-year and 77.8 % 2-year survival rates. Interestingly, premalignant pathological lesions (stage 0) were identified in 11 cases with 100 % 3-year survival rate. Serum biomarkers and alkaline phosphatase were not sufficient to detect early-stage disease. In 22 patients, stool samples were positive for Opistorchis viverrini, based on polymerase chain reaction.ConclusionDetection of premalignant lesions and early-stage resectable CCA by ultrasonography resulted in improved clinical outcome. Ultrasonography should be offered as a first screening tool for CCA in an endemic area until other useful biological markers become available.

Incidental small pancreatic cystic lesions (PCLs) are often found on preoperative imaging in patients undergoing orthotopic liver transplantation (OLT). Although these are considered benign or of low malignant potential, the influence of immunosuppression after OLT may be of concern. The aim of this study was to observe the longterm outcome of these small PCLs in post-OLT patients. An institutional OLT database of 1778 consecutive OLT patients from January 2000 to December 2010 was analyzed. Computed tomography, magnetic resonance imaging, or endoscopic ultrasound at the time of OLT and all subsequent imaging, cytology, fluid analysis of PCLs, and patient status were evaluated. A total of 70 patients with 182 PCLs, of benign or low malignant potential, were identified with a mean follow-up time of 64 months. At initial diagnosis of PCLs in 48 patients, 7 branch duct-type intraductal papillary mucinous neoplasms (B-IPMNs), 1 serous cystadenoma (SCA), and 40 nonspecific benign cysts were identified. Final diagnosis at the end of the follow-up revealed 16 B-IPMNs, 3 SCAs, and a mixed acinar-neuroendocrine carcinoma, in which the latter developed 9 years after initial diagnosis of B-IPMN. During the follow-up time, average increase in size and number of PCLs were 4.5 mm and 1.4, respectively (P < 0.001 for both). The majority of incidental PCLs in OLT patients showed an indolent behavior despite immunosuppression. Risk of malignancy development was very low and comparable with normal population. Liver Transplantation 23 324-329 2017 AASLD.

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Objective: To assess the average glandular doses (AGD) from full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT). Material and Methods: Radiographic exposure parameters target/filter, tube voltage, and tube current were collected from 50 patients. Patient information including age, breast thickness, entrance surface air kerma (ESAK) and AGD from the monitor display were also recorded. The tube outputs (tube voltage and tube loadings) at the reference points in both FFDM and DBT modes were measured. The AGD was calculated from ESAK by using the correction factors following the Technical Report Series no. 457 protocol. For the DBT mode, the AGD was calculated and corrected for the X-ray gantry rotation following the Dance et al. method. Results: The radiation doses to breasts in terms of ESAK and AGD from FFDM were 4.97±2.29 and 1.36±0.48 milligray (mGy) respectively. The third quartiles were 6.5 mGy and 1.67 mGy, findings which were lower than the standard Dose Reference Levels reported by the International Atomic Energy Agency recommendation (AGD 3 mGy/view for standard breast thickness with grid). For the DBT mode, ESAK and AGD were 6.49±2.10 mGy and 1.63±0.51 mGy. The third quartiles were 7.68 mGy and 1.81 mGy which were more than the FFDM mode by 23.0% and 17.0%, respectively. Conclusion: This study found that the AGD received from the DBT mode was higher than from the FFDM mode. Patients who underwent combination modes of mammographic examination increasingly received AGD up to 1.74 mGy. However, the AGD in our institute was still lower than the standard AGD recommendations.

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