Radiology and the new TNM classification of tumors: the future

Article Abstract:

Accurate staging and classification of tumors is imperative in successfully treating them. The TNM (tumor, nodes, metastasis) classification system is the one most widely in use. Advances in radiological imaging of tumors have led to important changes in the TNM system. These advances are examined in this article, and radiologists are encouraged to take a more active role in tumor staging. The TNM system first categorizes cancers by anatomical location and then subcategorizes them further by tumor size, regional lymph node involvement, and distant metastases - hence, the acronym TNM. The cancer is also classed by clinical and pathological features. This information is then used to diagnose and treat the cancer to the extent possible. The TNM classification system has been recently revised to reflect updated findings from imaging techniques. The use of endosonography (imaging using high frequency sound waves) has brought great changes in the way cancer of the esophagus, stomach, and rectum are diagnosed. It has been discovered that depth of invasion of the cancer as revealed by endosonography is a more important determinant of prognosis for these cancers than is the topographic (surface) extent, as was previously thought. Liver cancer classification has been virtually completely revised because of improvements in abdominal ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging. These advances have also increased the usefulness of clinical staging, such that treatment can begin prior to surgical examination of the cancer. The future changes in the TNM system due to radiological advances will include classification changes at other sites than those mentioned and application to early detection and prevention of cancer. Radiologists should be encouraged to take a more active role in tumor classification, as most of the changes in the TNM system are a consequence of technological advances. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ultrasound imaging, CT imaging, CAT scans, Identification and classification, Magnetic resonance imaging, Tumors

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Collaborative evaluations of diagnostic tests: experience of the radiology diagnostic oncology group

Article Abstract:

Imaging technologies have undergone rapid improvements and innovations in the past few years. Along with these advances have come questions about their costs and usefulness. Any technology must be cost effective and easily applied in the clinical setting for it to be useful. Careful research and evaluations of these technologies in the clinical setting are necessary before they are put into general use. The findings of the Radiology Diagnostic Oncology Group (RDOG) in evaluating imaging diagnostic tests in the clinical setting are presented. Evaluating any new technique first requires a focus on prospective studies, in which the experiment is set up first and then patients are recruited. Two important factors in setting up these studies are specifying the patient population and the disease type to be studied. The technical characteristics of the imaging technique must be consistent for all subjects. The sample size, sources of other information related to the study, and a standard of reference are other important aspects in setting up a clinical study. RDOG has put these standards into practice in a number of clinical studies comparing various imaging techniques abilities to stage a number of types of cancer. Each of the RDOG studies takes place in at least four institutions selected by RDOG. These institutions must agree to follow RDOG protocol. The studies are carefully monitored for quality control by setting standards for interpretive criteria and careful review of all imaging studies for technical performance. Images are interpreted three different ways. Pathologic determination of disease is normally used as a standard of reference. The RDOG approach to clinical studies of imaging techniques has been highly successful so far and should provide a model for future clinical research in radiology. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Medical research, Diagnostic imaging

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Patient care in interventional radiology: a perspective

Article Abstract:

The field of radiology has undergone a number of changes during the past 30 years in relation to patient contact. Direct contact with patients was the norm until the early 1970s, when diagnostic radiology began to predominate. Interventional radiology has returned many radiologists to direct contact with patients. Patient care must be a concern of the radiologist. There are a number things a radiologist must consider in his relationship with patients. Informed consent should be gained in an intelligent, trusting manner. In preparation for procedures to be performed, consideration must be given to the patient's diet before the procedure, any needed adjustments in medications being taken, and any other indication that may interfere with or be affected by the procedure. Antibiotic therapy may also be required prior to the procedure, depending upon the patient and upon the type of procedure. Patients may suffer from pain or anxiety because of the interventional radiologic procedures. Anesthesia or drugs may be needed, depending on the patient and the procedure. The radiologist must also be prepared to handle complications that arise when performing such procedures. The radiologist should be particularly familiar with problems related to bleeding and cardiovascular complications that may arise during the procedures they perform. Awareness of possible allergic reactions patients might have during procedures is important, as is awareness of patient care beyond the actual procedure. Patient follow-up should be standard. The future of clinical radiology requires radiologists to become patient-oriented in their practices. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physician and patient, Physician-patient relations, Radiology, Interventional, Interventional radiography

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