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3. Priporočila za obravnavo bolnikov z melanomom kožeMartina Reberšek, Janja Ocvirk, Primož Strojan, Barbara Perić, Marko Hočevar, Katarina Šmuc Berger, Vesna Zadnik, Olga Blatnik, Katarina Zevnik, Nina Boc, Nežka Hribernik, Tanja Mesti, Karla Berlec, Nada Rotovnik-Kozjek, Maja Ebert Moltara, Jernej Benedik, Boštjan Luzar, Jože Pižem, Marko Boc, Marija Ignjatović, Katarina Barbara Karner, Gaber Plavc, Marko Kokalj, Marko Snoj, Katarina Trčko, 2024, strokovni članek Ključne besede: koža, rak (medicina), zaščitni ukrepi, dejavniki tveganja, klinična diagnostika, stadij, prognoza, histopatologija, kirurško zdravljenje, radioterapija, sistemsko zdravljenje, sledenje pacientov, prehranska podpora, paliativna oskrba, elektronske knjige Objavljeno v DiRROS: 21.05.2025; Ogledov: 138; Prenosov: 46
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4. Detection and localization of hyperfunctioning parathyroid glands on [18F]fluorocholine PET/CT using deep learning – model performance and comparison to human expertsLeon Jarabek, Jan Jamšek, Anka Cuderman, Sebastijan Rep, Marko Hočevar, Tomaž Kocjan, Mojca Jensterle Sever, Žiga Špiclin, Žiga Maček Ležaić, Filip Cvetko, Luka Ležaič, 2022, izvirni znanstveni članek Povzetek: In the setting of primary hyperparathyroidism (PHPT), [18F]fluorocholine PET/CT (FCH-PET) has excellent diagnostic performance, with experienced practitioners achieving 97.7% accuracy in localising hyperfunctioning parathyroid tissue (HPTT). Due to the relative triviality of the task for human readers, we explored the performance of deep learning (DL) methods for HPTT detection and localisation on FCH-PET images in the setting of PHPT. Patients and methods. We used a dataset of 93 subjects with PHPT imaged using FCH-PET, of which 74 subjects had visible HPTT while 19 controls had no visible HPTT on FCH-PET. A conventional Resnet10 as well as a novel mPETResnet10 DL model were trained and tested to detect (present, not present) and localise (upper left, lower left, upper right or lower right) HPTT. Our mPETResnet10 architecture also contained a region-of-interest masking algorithm that we evaluated qualitatively in order to try to explain the model’s decision process. Results. The models detected the presence of HPTT with an accuracy of 83% and determined the quadrant of HPTT with an accuracy of 74%. The DL methods performed statistically worse (p < 0.001) in both tasks compared to human readers, who localise HPTT with the accuracy of 97.7%. The produced region-of-interest mask, while not showing a consistent added value in the qualitative evaluation of model’s decision process, had correctly identified the foreground PET signal. Conclusions. Our experiment is the first reported use of DL analysis of FCH-PET in PHPT. We have shown that it is possible to utilize DL methods with FCH-PET to detect and localize HPTT. Given our small dataset of 93 subjects, results are nevertheless promising for further research Ključne besede: primary hyperparathyroidism, deep learning, nuclear medicine Objavljeno v DiRROS: 25.07.2024; Ogledov: 759; Prenosov: 288
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5. Completely resected stage III melanoma controversy : 15 years of national tertiary centre experienceBarbara Perić, Sara Milićević, Andraž Perhavec, Marko Hočevar, Janez Žgajnar, 2021, izvirni znanstveni članek Povzetek: Background Two prospective randomized studies analysing cutaneous melanoma (CM) patients with sentinel lymph node (SLN) metastases and rapid development of systemic adjuvant therapy have changed our approach to stage III CM treatment. The aim of this study was to compare results of retrospective survival analysis of stage III CM patients% treatment from Slovenian national CM register to leading international clinical guidelines. Patients and methods Since 2000, all Slovenian CM patients with primary tumour % TIb are treated at the Institute of Oncology Ljubljana and data are prospectively collected into a national CM registry. A retrospective analysis of 2426 sentinel lymph node (SLN) biopsies and 789 lymphadenectomies performed until 2015 was conducted using Kaplan-Meier survival curves and log-rank tests. Results Positive SLN was found in 519/2426 (21.4%) of patients and completion dissection (CLND) was performed in 455 patients. The 5-year overall survival (OS) of CLND group was 58% vs. 47% of metachronous metastases group (MLNM) (p = 0.003). The 5-year OS of patients with lymph node (LN) metastases and unknown primary site (UPM) was 45% vs. 21% of patients with synchronous LN metastasis. Patients with SLN tumour burden < 0.3 mm had 5-year OS similar to SLN negative patients (86% vs. 85%; p = 0.926). The 5-year OS of patients with burden > 1.0 mm was similar to the MLNM group (49% vs. 47%; p = 0.280). Conclusions Stage III melanoma patients is a heterogeneous group with significant OS differences. CLND after positive SLNB might still remain a method of treatment for selected patients with stage III. Ključne besede: cutaneous melanoma, surgery treatment, sentinel node biopsy Objavljeno v DiRROS: 17.07.2024; Ogledov: 612; Prenosov: 313
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6. Surgical options in treating patients with primary hyperparathyroidismMaša Majcen, Marko Hočevar, 2020, pregledni znanstveni članek Povzetek: Background. Primary hyperparathyroidism is the third most common endocrine disorder for which surgical procedure called parathyroidectomy is the most effective treatment. Since the early 20th century, parathyroid surgery has improved extensively. With the advances in preoperative imaging and with understanding the causes of disease, new and minimally invasive surgical approaches overrode the standard bilateral exploratory operations. Directed parathyroidectomy is currently the standard technique for treatment of primary hyperparathyroidism worldwide. Conclusions. Surgery is the only definitive treatment of primary hyperparathyroidism. The most appropriate type of surgical procedure depends on the number and localization of the hyperactive parathyroid glands, availability of modern imaging techniques, limitation of each type of procedure and expertise. Ključne besede: primary hyperparathyroidism, minimally invasive parathyroidectomy, directed parathyroidectomy Objavljeno v DiRROS: 16.07.2024; Ogledov: 539; Prenosov: 290
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7. Significance of nuclear factor - kappa beta activation on prostate needle biopsy samples in the evaluation of Gleason score 6 prostatic carcinoma indolenceMarko Zupančič, Boris Pospihalj, Snežana Cerović, Barbara Gazić, Primož Drev, Marko Hočevar, Andraž Perhavec, 2020, izvirni znanstveni članek Povzetek: The goal of our study was to find out whether the immunohistochemical expression of nuclear factor-kappa beta (NF-%B) p65 in biopsy samples with Gleason score 3 + 3 = 6 (GS 6) can be a negative predictive factor for Prostate cancer (PCa) indolence. Patients and methods Study was conducted on a retrospective cohort of 123 PCa patients with initial total PSA % 10 ng/ml, number of needle biopsy specimens % 8, GS 6 on biopsy and T1/T2 estimated clinical stage who underwent laparoscopic radical prostatectomy and whose archived formalin-fixed and paraffin-embedded (FFPE) prostate needle biopsy specimens were used for additional immunohistochemistry staining for detection of NF-%B p65. Both cytoplasmic and nuclear NF-%B p65 expression in biopsy cores with PCa were correlated with postoperative pathological stage, positive surgical margins, GS and biochemical progression of disease. Results After follow-up of 66 months, biochemical progression (PSA % 0.2 ng/ml) occurred in 6 (5.1%) patients, 3 (50%) with GS 6 and 3 (50%) with GS 7 after radical prostatectomy. Both cytoplasmic and nuclear NF-%B p65 expressions were not significantly associated with pathological stage, positive surgical margin and postoperative GS. Patients with positive cytoplasmic NF-kB reaction had significantly more frequent biochemical progression than those with negative cytoplasmic NF-kB reaction with PSA 0.2 ng/ml as cutoff point (p = 0.015) and a trend towards more biochemical progression with PSA % 0.05 ng/ml as cutoff point (p = 0.068). Conclusions Cytoplasmic expression of NF-%B is associated with more biochemical progression and might be an independent prognostic factor for recurrence-free survival (RFS), but further studies including larger patient cohorts are needed to confirm these initial results. Ključne besede: prostate cancer, needle biopsy, nuclear factor-kappa beta, Gleason Objavljeno v DiRROS: 12.07.2024; Ogledov: 574; Prenosov: 304
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8. Spremljanje bolnikov z rakom po zaključenem zdravljenjuMarko Hočevar, 2024, objavljeni strokovni prispevek na konferenci Povzetek: V razvitem zahodnem svetu s staranjem populacije strmo narašča breme raka. Prevalenca raka je v zadnjih 50 letih naraščala praktično eksponentno. Bolniki po končanem primarnem zdravljenju s kurativnim namenom so bili tradicionalno spremljani v ustanovah, kjer so bili zdravljeni, in sicer pet let ali več, glavni namen spremljanja pa je bil zgodnje odkrivanje morebitne ponovitve bolezni. Po tem obdobju so bolnike prevzeli v oskrbo družinski zdravniki. Takšen tradicionalen način spremljanja bolnikov po končanem zdravljenju (angl. follow-up) zanemari vse ostale težave in potrebe preživelih z rakom. V zadnjem obdobju se zato pojavlja nov, širši pojem spremljanja bolnikov v onkologiji (angl. survivorship), ki naslavlja različne fizične, psihosocialne, materialne in informacijske težave in potrebe, ki jih imajo ti bolniki. Idealno je, da dobi vsak bolnik z rakom ob koncu zdravljenja t. i. načrt oskrbe preživelih, ki jasno povzame opravljeno zdravljenje in hkrati natančno opiše načrt spremljanja. Težave in potrebe preživelih se močno razlikujejo med različnimi vrstami raka in med različnimi načini zdravljenja, prav tako pa po posamičnih obdobjih preživetja. V prispevku so opisani različni modeli, ki so nam na voljo pri organizaciji spremljanja bolnikov v onkologiji in predlagan način stratificiranja bolnikov v različne skupine glede na verjetnost pojava poznih posledic zdravljenja in ponovitve bolezni. Najprimernejši modeli za posamezne vrste raka bodo opisani v posebnih prispevkih in bodo upoštevali specifiko posameznih rakov (npr. ginekologi na primarnem nivoju pri ginekoloških rakih). V prispevku bo dodatno poudarjen pomen umestitve poglavja o spremljanju bolnikov v onkologiji v priporočila in klinične poti za posamične vrste raka ter njihovo sprotno posodabljanje ob novih spoznanjih. Ključne besede: bolniki, onkologija, spremljanje bolnikov Objavljeno v DiRROS: 06.06.2024; Ogledov: 717; Prenosov: 213
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9. Genetic counselling, BRCA1/2 status and clinico-pathologic characteristics of patients with ovarian cancer before 50 years of ageMirjam Cvelbar, Marko Hočevar, Srdjan Novaković, Vida Stegel, Andraž Perhavec, Mateja Krajc, 2017, izvirni znanstveni članek Povzetek: In Slovenia like in other countries, till recently, personal history of epithelial ovarian cancer (EOC) has not been included among indications for genetic counselling. Recent studies reported up to 17% rate of germinal BRCA1/2 mutation (gBRCA1/2m) within the age group under 50 years at diagnosis. The original aim of this study was to invite to the genetic counselling still living patients with EOC under 45 years, to offer gBRCA1/2m testing and to perform analysis of gBRCA1/2m rate and of clinico-pathologic characteristics. Later, we added also the data of previously genetically tested patients with EOC aged 45 to 49 years. Patients and methods. All clinical data have to be interpreted in the light of many changes happened in the field of EOC just in the last few years: new hystology stage classification (FIGO), new hystology types and differentiation grades classification, new therapeutic possibilities (PARP inhibitors available, also in Slovenia) and new guidelines for genetic counselling of EOC patients (National Comprehensive Cancer Network, NCCN), together with next-generation sequencing possibilities. Results. Compliance rate at the invitation was 43.1%. In the group of 27 invited or previously tested patients with EOC diagnosed before the age of 45 years, five gBRCA1/2 mutations were found. The gBRCA1/2m detection rate within the group was 18.5%. There were 4 gBRCA1 and 1 gBRCA2 mutations detected. In the extended group of 42 tested patients with EOC diagnosed before the age of 50 years, 14 gBRCA1/2 mutations were found. The gBRCA1/2m detection rate within this extended, partially selected group was 33.3%. There were 11 gBRCA1 and 3 gBRCA2 mutations detected. Conclusions. The rate of gBRCA1/2 mutation in tested unselected EOC patients under the age of 50 years was higher than 10%, namely 18.5%. Considering also a direct therapeuthic benefit of PARP inhibitors for BRCA positive patients, there is a double reason to offer genetic testing to all EOC patients younger than 50 years. Regarding clinical data, it is important to perform their re-interpretation in everyday clinical practice, because this may influence therapeutic possibilities to be offered. Ključne besede: ovarian cancer, BRCA 1/2, genetic counseling Objavljeno v DiRROS: 24.05.2024; Ogledov: 829; Prenosov: 327
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10. Optimal scan time for evaluation of parathyroid adenoma with [18F]-fluorocholine PET/CTSebastijan Rep, Luka Ležaič, Tomaž Kocjan, Marija Pfeifer, Mojca Jensterle Sever, Urban Simončič, Petra Tomše, Marko Hočevar, 2015, izvirni znanstveni članek Ključne besede: lesions representing enlarged parathyroid tissue, triple-phase, standardized uptake value, retention index, lesion contrast, rak (medicina), obščitnični adenomi, diagnostika Objavljeno v DiRROS: 22.04.2024; Ogledov: 993; Prenosov: 622
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