- Email: [email protected]
Diagnostic usefulness of galectin 3 as surrogate biomarker for differentiating benign from malignant thyroid lesions
Poster Session, Sunday 29 January 2017
Abstracts
neck cancer patients. A secondary analysis of the prospective clinical trial on repeated pre- and per-treatment [18 F]fluoromisonidazole (FMISO) PET/CT imaging aimed to assess whether parallel evaluation of the oxygenation status in lymph node metastases (LN) and the Tu increases its prognostic value. Patients and Methods: Patients with LN-positive disease from the trial (NCT00180180, Zips et al. 2012, Seidlitz et al. 2015) were included in this analysis (n = 45). The patients were treated with curatively intended radiochemotherapy (RCT). The imaging protocol consisted of FMISO PET/CT at four time points: baseline, week 1, 2 and 5. Delineation of the Tu and LNs was based on pre-treatment FDG PET/CT. Qualitative hypoxia analysis was performed for each Tu and LN using a visual binary scale: hypoxic or normoxic being FMISO uptake higher than or equal to background respectively. Based on this scale two prognostic parameters were defined: Tu-hypoxia (patients with a hypoxic Tu, independently of LN oxygenation status) and synchronous Tu- and LN-hypoxia (Tu&LN-hypoxia). In the patients with a large LN (n = 15) a quantitative analysis of FMISO PET/CT was performed to validate the qualitative hypoxia scale. The log-rank test and multivariate Cox-regression were used to evaluate the prognostic impact of hypoxia on local control (LC) and loco-regional control (LRC). Table 1. Prognostic value of the hypoxia parameters − p value of log rank test
FMISO-PET/CT-sets Local control Tu-hypoxia Tu&LN-hypoxia Loco-regional control Tu-hypoxia Tu&LN-hypoxia
Baseline
Week 1
Week 2
Week 5
n = 45
n = 40
n = 44
n = 45
0.133 0.001
0.090 0.011
0.001 <0.001
0.004 0.001
0.129 <0.001
0.084 0.005
0.001 <0.001
0.001 <0.001
Results: Qualitative FMISO assessment (Table 1) confirmed poor LC in patients with Tu-hypoxia in week 2 and 5. Detection of synchronous Tu- and LN-hypoxia had a strong negative impact on LC and LRC at all measured time-points. These results were supported by multivariate analysis (for LRC: HR = 14.8, p = 0.016; HR = 8.3, p = 0.003 and HR = 5.5, p = 0.005 at baseline, in week 2 and week 5, respectively). Moreover, there was a significant correlation between the qualitative and quantitative FMISO PET/CT parameters (p < 0001; R > 0.6−0.8). Conclusions: Parallel evaluation of tumor and LN hypoxia improved the prognostic information in comparison to primary tumor assessment alone, based on secondary analysis of the Dresden FMISO PET/CT trial. If this prognostic value of synchronous tumor- and LN-hypoxia is confirmed in ongoing prospective clinical trials and show to outperform tumor assessment only, it may become a powerful decision-making parameter useful for dose escalation or combined modality trials. No conflict of interest.
Poster Session (Sunday 29 January 2017) Head and Neck Cancer 877 POSTER Diagnostic usefulness of galectin 3 as surrogate biomarker for differentiating benign from malignant thyroid lesions A. Edris1 , B. Alzain2 , H. Saeed3 , E. Siddig4 . 1 Assistant Professor, Histopathology and Cytology, Sudan, Sudan; 2 Ibn Sina University, Department of histopathology and cytology, Sudan, Sudan; 3 PortSudan ALAhlia collage, Department of histopathology and cytology, Sudan, Sudan; 4 University of Khartoum, Histopathology and Cytology, Sudan, Sudan Introduction: Better and accurate diagnosis of thyroid cancer offers better treatment. However, the preoperative diagnosis of thyroid lesions is not only the serious existing challenge that needs to be addressed by pathologist, but also very often, establishing the differential diagnosis between benign and malignancy of a thyroid nodule, based only on the histopathological exam, can be quite difficult. Outstandingly, galectin 3 expression among thyroid lesions has recently gained momentum and has been extensively studied as an immunohistochemical marker of thyroid malignancy, and a high diagnostic accuracy has been reported even for difficult pathological diagnoses, such as minimal invasive follicular carcinoma. Objectives: The present study aimed at evaluating the diagnostic utility of galectin 3 expression among different thyroid lesions. Materials and Methods: This is a descriptive, retrospective, hospital-based study conducted at Soba Teaching Hospital, Total Lab care Clinic, and Faculty of Medical laboratory sciences, University of Khartoum during a
S103
period from January 2016 till July 2016. We retrieved 60 archived formalinfixed paraffin-embedded blocks from patients with thyroid lesions and stained them using immunohistochemistry for galectin 3. Results: Immunoreactivity of galectin 3 was observed in 12 (20%) thyroid lesions. Our current study shows that 100% of Graves’ disease were found to be negative and 100% of medullary carcinoma [d1] were found negative for the marker. Intriguingly, about 33.4% of multinodular goiters were found positive for the marker, along with 27.8% of follicular carcinomas were found positive. Furthermore, 18.75% of papillary carcinoma was positive also for the marker and 100% of Hurthle cell carcinoma was positive. Conclusion: Galectin-3 expression is a valuable evidence of malignancy in cases where cytomorphological features are not conclusive, however it should not be used alone in thyroid panel therefore the search for other molecular markers must continue in order to enhance this diagnostic accuracy since the results found still show a persistency of false-negative and false-positive tests. No conflict of interest. 879 POSTER Locally advanced nasopharyngeal cancer − a 7-year retrospective analysis ´ 1. A. Nogueira1 , M. Teixeira1 , L. Khouri1 , F. Branquinho1 , H. Gervasio 1 Coimbra’s Portuguese Institute of Oncology, Oncology, Coimbra, Portugal Background: Nasopharyngeal cancer is a rare entity in Europe, accounting for 4760 new cases per year. Survivals rates for these patients are 76% at 1 year and 50% at 5 years. Prognostic factors are still under investigation. Material and Methods: Retrospectively, we reviewed clinical files from patients treated for advanced nasopharynx’s cancer (stage III, IVA and IVB) from January 2009 to December 2015. We assessed population characteristics, treatment safety and efficacy, PFS, OS and prognostic value of population and treatment’s features. Results: All 33 patients, 33.3% females and 66.7% males, had a median diagnosis age of 47 years (15−74 years) and a good performance status (ECOG 0 or 1). History of tobacco and alcohol use was present in 51.5% and 36.4%, respectively, and 39.4% had history of occupational exposure. Epstein Barr DNA test was positive in 21% of them. Histological study revealed undifferentiated carcinoma in 81.8% of cases. Tumors were classified as stage III (45.4%), IVA (27.3%) and IVB (27.3%). In this population, 84.8% underwent concomitant chemoradiotherapy with cisplatin 100 mg/m2 3/3 weeks. Of those, 32.1% received the 3 planed cycles. Radiotherapy dose was 70.2 Gy/33 Fractions/6.5 weeks. 69.7% of patients underwent adjuvant chemotherapy with 5-FU and cisplatin with a median of 2 cycles, mostly with dose reduction. Major acute toxicities were grade 3/4 neutropenia (26%), grade 3 mucositis (13%), nauseas and vomiting (8.7% and 4.3%, respectively), anemia (8.7%). There were major infectious complications in 33.3%. There was a complete response in 48.3%, partial response in 44.8%, stable diseases in 3.4% and progression in 3.4%. One-year and 5-year PFS was 72.2% and 46.4% respectively. Infectious complications had a negative correlation on PFS (p < 00001) and adjuvant chemotherapy had a positive correlation (p = 0.019). One-year and 5-year OS was 84.3% and 42.6% respectively. Infectious complications and weight loss had a negative correlation on OS (p < 00001 and p = 0.004, respectively) and the use of gastrostomy and adjuvant chemotherapy had a positive correlation (p = 0.045 and p = 0.047, respectively). Conclusions: Both OS and PFS in our population were similar to current literature. We found a significant correlation between treatment features (use of gastrostomy, adjuvant chemotherapy, infectious complications) and patients features (weight loss) with survival outcomes. No conflict of interest. 880 POSTER Evaluating cervical lymph node metastasis: a comparative study of CT scan and physical examination with cytological results N. Arora1 , J.L. Davessar1 , J. Singh1 . 1 Guru Gobind Singh Medical College and Hospital, ENT Head Neck Surgery, Faridkot, India Background: The most important prognostic factor in squamous cell carcinoma of the head and neck is the presence or absence of clinically involved neck nodes. The presence of metastases in a lymph node is said to reduce the 5-years survival rate by about 50%. The appropriate diagnosis of the presence of metastatic node is very important for the management of squamous cell carcinoma of the head and neck. The aim of this work was to conduct a comparative study of CT scanning and Physical examination with Cytological evaluation, in detecting the cervical lymph node metastasis in known cases of squamous cell carcinoma in the head and neck.
Abstracts
neck cancer patients. A secondary analysis of the prospective clinical trial on repeated pre- and per-treatment [18 F]fluoromisonidazole (FMISO) PET/CT imaging aimed to assess whether parallel evaluation of the oxygenation status in lymph node metastases (LN) and the Tu increases its prognostic value. Patients and Methods: Patients with LN-positive disease from the trial (NCT00180180, Zips et al. 2012, Seidlitz et al. 2015) were included in this analysis (n = 45). The patients were treated with curatively intended radiochemotherapy (RCT). The imaging protocol consisted of FMISO PET/CT at four time points: baseline, week 1, 2 and 5. Delineation of the Tu and LNs was based on pre-treatment FDG PET/CT. Qualitative hypoxia analysis was performed for each Tu and LN using a visual binary scale: hypoxic or normoxic being FMISO uptake higher than or equal to background respectively. Based on this scale two prognostic parameters were defined: Tu-hypoxia (patients with a hypoxic Tu, independently of LN oxygenation status) and synchronous Tu- and LN-hypoxia (Tu&LN-hypoxia). In the patients with a large LN (n = 15) a quantitative analysis of FMISO PET/CT was performed to validate the qualitative hypoxia scale. The log-rank test and multivariate Cox-regression were used to evaluate the prognostic impact of hypoxia on local control (LC) and loco-regional control (LRC). Table 1. Prognostic value of the hypoxia parameters − p value of log rank test
FMISO-PET/CT-sets Local control Tu-hypoxia Tu&LN-hypoxia Loco-regional control Tu-hypoxia Tu&LN-hypoxia
Baseline
Week 1
Week 2
Week 5
n = 45
n = 40
n = 44
n = 45
0.133 0.001
0.090 0.011
0.001 <0.001
0.004 0.001
0.129 <0.001
0.084 0.005
0.001 <0.001
0.001 <0.001
Results: Qualitative FMISO assessment (Table 1) confirmed poor LC in patients with Tu-hypoxia in week 2 and 5. Detection of synchronous Tu- and LN-hypoxia had a strong negative impact on LC and LRC at all measured time-points. These results were supported by multivariate analysis (for LRC: HR = 14.8, p = 0.016; HR = 8.3, p = 0.003 and HR = 5.5, p = 0.005 at baseline, in week 2 and week 5, respectively). Moreover, there was a significant correlation between the qualitative and quantitative FMISO PET/CT parameters (p < 0001; R > 0.6−0.8). Conclusions: Parallel evaluation of tumor and LN hypoxia improved the prognostic information in comparison to primary tumor assessment alone, based on secondary analysis of the Dresden FMISO PET/CT trial. If this prognostic value of synchronous tumor- and LN-hypoxia is confirmed in ongoing prospective clinical trials and show to outperform tumor assessment only, it may become a powerful decision-making parameter useful for dose escalation or combined modality trials. No conflict of interest.
Poster Session (Sunday 29 January 2017) Head and Neck Cancer 877 POSTER Diagnostic usefulness of galectin 3 as surrogate biomarker for differentiating benign from malignant thyroid lesions A. Edris1 , B. Alzain2 , H. Saeed3 , E. Siddig4 . 1 Assistant Professor, Histopathology and Cytology, Sudan, Sudan; 2 Ibn Sina University, Department of histopathology and cytology, Sudan, Sudan; 3 PortSudan ALAhlia collage, Department of histopathology and cytology, Sudan, Sudan; 4 University of Khartoum, Histopathology and Cytology, Sudan, Sudan Introduction: Better and accurate diagnosis of thyroid cancer offers better treatment. However, the preoperative diagnosis of thyroid lesions is not only the serious existing challenge that needs to be addressed by pathologist, but also very often, establishing the differential diagnosis between benign and malignancy of a thyroid nodule, based only on the histopathological exam, can be quite difficult. Outstandingly, galectin 3 expression among thyroid lesions has recently gained momentum and has been extensively studied as an immunohistochemical marker of thyroid malignancy, and a high diagnostic accuracy has been reported even for difficult pathological diagnoses, such as minimal invasive follicular carcinoma. Objectives: The present study aimed at evaluating the diagnostic utility of galectin 3 expression among different thyroid lesions. Materials and Methods: This is a descriptive, retrospective, hospital-based study conducted at Soba Teaching Hospital, Total Lab care Clinic, and Faculty of Medical laboratory sciences, University of Khartoum during a
S103
period from January 2016 till July 2016. We retrieved 60 archived formalinfixed paraffin-embedded blocks from patients with thyroid lesions and stained them using immunohistochemistry for galectin 3. Results: Immunoreactivity of galectin 3 was observed in 12 (20%) thyroid lesions. Our current study shows that 100% of Graves’ disease were found to be negative and 100% of medullary carcinoma [d1] were found negative for the marker. Intriguingly, about 33.4% of multinodular goiters were found positive for the marker, along with 27.8% of follicular carcinomas were found positive. Furthermore, 18.75% of papillary carcinoma was positive also for the marker and 100% of Hurthle cell carcinoma was positive. Conclusion: Galectin-3 expression is a valuable evidence of malignancy in cases where cytomorphological features are not conclusive, however it should not be used alone in thyroid panel therefore the search for other molecular markers must continue in order to enhance this diagnostic accuracy since the results found still show a persistency of false-negative and false-positive tests. No conflict of interest. 879 POSTER Locally advanced nasopharyngeal cancer − a 7-year retrospective analysis ´ 1. A. Nogueira1 , M. Teixeira1 , L. Khouri1 , F. Branquinho1 , H. Gervasio 1 Coimbra’s Portuguese Institute of Oncology, Oncology, Coimbra, Portugal Background: Nasopharyngeal cancer is a rare entity in Europe, accounting for 4760 new cases per year. Survivals rates for these patients are 76% at 1 year and 50% at 5 years. Prognostic factors are still under investigation. Material and Methods: Retrospectively, we reviewed clinical files from patients treated for advanced nasopharynx’s cancer (stage III, IVA and IVB) from January 2009 to December 2015. We assessed population characteristics, treatment safety and efficacy, PFS, OS and prognostic value of population and treatment’s features. Results: All 33 patients, 33.3% females and 66.7% males, had a median diagnosis age of 47 years (15−74 years) and a good performance status (ECOG 0 or 1). History of tobacco and alcohol use was present in 51.5% and 36.4%, respectively, and 39.4% had history of occupational exposure. Epstein Barr DNA test was positive in 21% of them. Histological study revealed undifferentiated carcinoma in 81.8% of cases. Tumors were classified as stage III (45.4%), IVA (27.3%) and IVB (27.3%). In this population, 84.8% underwent concomitant chemoradiotherapy with cisplatin 100 mg/m2 3/3 weeks. Of those, 32.1% received the 3 planed cycles. Radiotherapy dose was 70.2 Gy/33 Fractions/6.5 weeks. 69.7% of patients underwent adjuvant chemotherapy with 5-FU and cisplatin with a median of 2 cycles, mostly with dose reduction. Major acute toxicities were grade 3/4 neutropenia (26%), grade 3 mucositis (13%), nauseas and vomiting (8.7% and 4.3%, respectively), anemia (8.7%). There were major infectious complications in 33.3%. There was a complete response in 48.3%, partial response in 44.8%, stable diseases in 3.4% and progression in 3.4%. One-year and 5-year PFS was 72.2% and 46.4% respectively. Infectious complications had a negative correlation on PFS (p < 00001) and adjuvant chemotherapy had a positive correlation (p = 0.019). One-year and 5-year OS was 84.3% and 42.6% respectively. Infectious complications and weight loss had a negative correlation on OS (p < 00001 and p = 0.004, respectively) and the use of gastrostomy and adjuvant chemotherapy had a positive correlation (p = 0.045 and p = 0.047, respectively). Conclusions: Both OS and PFS in our population were similar to current literature. We found a significant correlation between treatment features (use of gastrostomy, adjuvant chemotherapy, infectious complications) and patients features (weight loss) with survival outcomes. No conflict of interest. 880 POSTER Evaluating cervical lymph node metastasis: a comparative study of CT scan and physical examination with cytological results N. Arora1 , J.L. Davessar1 , J. Singh1 . 1 Guru Gobind Singh Medical College and Hospital, ENT Head Neck Surgery, Faridkot, India Background: The most important prognostic factor in squamous cell carcinoma of the head and neck is the presence or absence of clinically involved neck nodes. The presence of metastases in a lymph node is said to reduce the 5-years survival rate by about 50%. The appropriate diagnosis of the presence of metastatic node is very important for the management of squamous cell carcinoma of the head and neck. The aim of this work was to conduct a comparative study of CT scanning and Physical examination with Cytological evaluation, in detecting the cervical lymph node metastasis in known cases of squamous cell carcinoma in the head and neck.