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21.05.2016
Insulin-like growth factor 1 (IGF-1), sometimes called somatomedin C, is a hormone that promotes growth and prevents cell death. IGF-1 binds to two types of receptors on the outer surface of cellular membranes: the IGF-1 receptor (IGF1R) and the insulin receptor. The effects of the hormone can be modulated by a series of six or seven proteins called insulin-like growth factor binding proteins (IGFBPs). Synthetic IGF-1, known as mecasermin, is used as a treatment for hormonal growth deficiency. A lump may be discovered by a woman doing breast self-exam or by her health care provider during a physical exam.
It is important to become familiar with how your breasts normally look and feel so that you are able to report any changes to your doctor. If a lump is proven to be benign by its appearance on these exams, no further steps may need to be taken.
MRI-guided biopsy: During this type of biopsy, using an MRI machine to localize the area of concern, a radiologist will administer local anesthesia and then position a sampling needle at this site to remove thin tissue samples for further evaluation. Often, the radiologist will place a tiny metal marker (approximately the size of one sesame seed) in the area where tissue was sampled so that any residual lump will not need additional testing if it is seen on future mammograms. If you need a biopsy, it is important to choose a facility with expertise, preferably one where the radiologists specialize in breast imaging. You may have several consultations with other physicians for additional treatment, including radiation therapy and chemotherapy or hormone therapy.
Web page review process: This Web page is reviewed regularly by a physician with expertise in the medical area presented and is further reviewed by committees from the American College of Radiology (ACR) and the Radiological Society of North America (RSNA), comprising physicians with expertise in several radiologic areas.
To help ensure current and accurate information, we do not permit copying but encourage linking to this site. This protein triggers a process that ultimately causes a cell to take in more glucose from the bloodstream. IGFBP-2 and and IGFBP-5 inhibit its effects by preventing it from binding to a cellular receptor.
Breast and prostate cancers may be caused by a failure of cell death connected to this chemical system.
Several different companies have attempted to create and release versions of this drug, with various levels of scientific and legal success. Breast ultrasound can capture images of areas of the breast that may be difficult to see with mammography.
MRI is helpful in evaluating breast lumps that are not visible with mammography or ultrasound. Your doctor may want to monitor the area at future visits to check if the breast lump has changed, grown or gone away. The biopsy procedure is usually quick, but it may take a few days before the final tissue analysis (pathology report) is ready. One measure of a facility's expertise in breast biopsy can be found in its ACR accreditation status.
The surgeon will explain appropriate surgical options and provide you with the information necessary to make this decision. Please contact your physician with specific medical questions or for a referral to a radiologist or other physician. The costs for specific medical imaging tests, treatments and procedures may vary by geographic region.
RadiologyInfo.org, ACR and RSNA are not responsible for the content contained on the web pages found at these links. This hormone is used across the lifespan of a human organism, but becomes most prominent during childhood and adolescence. Gigantism and acromegaly, which causes unnatural growth and swelling in the body, may also be connected to an excess of this molecule.
If the lump is confirmed to be benign, no further action may be needed but your doctor may want to monitor it to see if it changes, grows or disappears over time.
Some lumps cause pain or nipple discharge, while others go unnoticed until identified during an imaging test. To locate a medical imaging or radiation oncology provider in your community, you can search the ACR-accredited facilities database. Because it is correlated with growth hormone, these problems may result originally from excesses in growth hormone.
University of Michigan Health System, 1500 East Medical Center drive, Ann Arbor, Michigan, USATweet Introduction:Surgery is the established treatment for early stage primary lung cancers (cancer that started in lung) or limited secondary cancers (cancer that started outside and spread to lung, also known as metastases or metastatic cancer).
If the tests are inconclusive, a biopsy using ultrasound, x-ray or magnetic resonance imaging guidance may be performed. Doctors suspecting these conditions may take measurements of IGF-1 for diagnostic purposes, since these usually also reflect the production of growth hormone.
External beam radiation is an alternative local therapy to surgery, particularly for patients who are not candidates for surgery due to other medical conditions.
Thermal ablation, using either heat or cold, is a newer treatment to destroy cells in lung tumors. Percutaneous radiofrequency thermal ablation of lung VX2 tumors in a rabbit model using a cooled tip-electrode: feasibility, safety, and effectiveness. RFA of tumors has gained significant interest and acceptance in the last decade due to its potential to produce a large volume of cancer cell death in a controlled fashion.What is RFA?RFA stands for Radio Frequency Ablation.
Feasibility of percutaneous radiofrequency ablation for intrathoracic malignancies: a large single-center experience.
Radiofrequency energy oscillation agitates cells thereby increasing the frictional heating with in tissues resulting in cell death. The feasibility of lung RFA has been demonstrated in animals (1-3), and the feasibility, safety and long term efficacy of lung RFA to treat tumors have been reported in humans, both in the United States and internationally (4-13). During the RFA procedure, rapidly alternating current is applied with a frequency in the range of 460-500 kHz through the RFA electrode (14). Percutaneous radiofrequency ablation of lung neoplasms: a minimally invasive strategy for inoperable patients.


Applying a temperature greater than 50 degrees centigrade for five minutes results in tumor cell death. Too high a temperature is not desirable as it will cause charring and gas formation immediately adjacent to the electrode and prevent the homogeneous heating of the entire tumor. During RFA, reaching a temperature of 60-100 degrees centigrade within the tumor is generally desired, as charring and gas formation occur at approximately 105-115 degrees centigrade (14, 15). Percutaneous imaging-guided radiofrequency ablation in patients with colorectal pulmonary metastases: 1-year follow-up. Ideally, the goal is to achieve complete cell death within the tumor, as well as in a 1 cm margin of the adjacent normal lung (14, 16).Who is suitable for RFA?Patients with tumors that are 3 cm or smaller are best suited for RFA treatment.
A typical patient undergoing RFA is an adult who cannot undergo lung cancer surgery despite having a tumor that is at an early stage. Examples of patients who may not be able to undergo surgery include those with poor lung function, other coexisting other diseases, poor general performance status which might deteriorate further following lung surgery, and patients with lung tumors that either do not respond to maximum conventional therapy, including radiation therapy, or recur after treatment. In other words, these patients have tumors that can be potentially removed by surgery, but the presence of other additional diseases in these patients prevent them from undergoing surgery.
Unresectable pulmonary malignancies: CT-guided percutaneous radiofrequency ablation--preliminary results.
Although few studies report that RFA can be safely performed in tumors close to vital organs such as the heart, generally tumors that are close to the lung hilum (where the airtubes and blood vessels enter the lung) are not amenable to RFA (17, 18).
How is RFA performed?This technique has many similarities to CT-guided lung biopsy procedures. Patients undergo this procedure either under moderate sedation with pain relief or under general anesthesia. General anesthesia has the advantage of complete control over patient's breathing pattern and motion that helps to accurately place the RFA electrode within the tumor.
One study comparing conscious sedation to general anesthesia did not show any major difference in tumor control or procedure related complication rates, however the number of patients in both groups was small (19). A survey of centers performing RFA for lung tumors indicated that conscious sedation is used more commonly than general anesthesia (12). During the procedure, tumor cells are destroyed by placing a needle (RFA electrode) within the center of the tumor. The RFA electrodes come in various shapes, length and thickness, depending on the manufacturer (Figure 1). The RFA electrodes are carefully placed into the center of the tumor undergoing ablation using the guidance of images in the CT suite. Multiple CT images are taken to confirm the safe placement of RFA electrodes, and to avoid adjacent vital organs. Percutaneous radiofrequency ablation of lung tumors with expandable needle electrodes: current status. As the temperature increases above 45-50 degrees centigrade within the tumor, cellular proteins denature and cell structure disintegrates.
Effect of vessel diameter on the creation of ovine lung radiofrequency lesions in vivo: preliminary results. This results in thermal coagulation in tumor cells, ultimately leading to tumor destruction. Percutaneous radiofrequency ablation of pulmonary tumors--is there a difference between treatment under general anaesthesia and under conscious sedation?
Subsequently, patients are closely observed for any post procedural complications such as lung collapse.
Biologic effects of radiofrequency thermal ablation on non-small cell lung cancer: results of a pilot study. Following an uncomplicated RFA procedure, patients are discharged home mostly after overnight observation or rarely the same day.Lung tissue characteristics may play a role in the effectiveness of RFA. The normal lung tissue surrounding the tumor is relatively resistant to heating due to its high electrical impedance (20, 21). Radiofrequency ablation of primary and metastatic lung tumors: preliminary experience with a single center device.
Therefore, the heat energy created by RFA is preferentially deposited in the tumor facilitating higher temperatures.
Also, large blood vessels (> 3 mm) near a tumor constantly cool the tissue due to the flowing blood that takes heat away from the area being treated, commonly known as the heat sink effect (14, 20). CT imaging findings of pulmonary neoplasms after treatment with radiofrequency ablation: results in 32 tumors. As a result, tumors in continuity with large blood vessels may be suboptimally treated with RFA.
Primary and secondary lung malignancies treated with percutaneous radiofrequency ablation: evaluation with follow-up helical CT.
Percutaneous radiofrequency ablation for inoperable non-small cell lung cancer and metastases: preliminary report. Within one week, the hazy opacity changes to dense opacity like pneumonia (consolidation) (11).
The ablation zone is frequently larger than the original tumor, which may be a reflection of ablation of normal lung adjacent to the lesion, which is the desired result. Time-related changes in computed tomographic appearance and pathologic findings after radiofrequency ablation of the rabbit lung: preliminary experimental study. Following RFA, the tumor is monitored with the help of serial surveillance CT examinations, often accompanied by intermittent positron emission tomography (PET) scans.
An increase in the size of the ablated lesion has been reported to occur within the first three months after RFA. Radiofrequency ablation in a porcine lung model: correlation between CT and histopathologic findings. Beyond that time, continued increase in growth of the ablation zone should be viewed as suspicious for incomplete tumor destruction and recurrent tumor (22).
Based on the tumor appearance on CT examinations it may be difficult to determine if the tumor was fully ablated in the first few months after RFA. Other approaches to evaluating the effectiveness of ablation include PET scans and enhancement of the ablation zone using intravenous contrast material-enhanced CT perfusion imaging.


Immediately following RFA, the ablated tumor may show no enhancement with intravenous contrast material on CT.
Radiofrequency ablation of primary lung cancer: results from an ablate and resect pilot study. The presence of nodule-like enhancing areas within the ablation zone suggests residual tumor (24). Most patients with cavities have no specific symptoms, and the cavities usually spontaneously contract with time (Figures 3-6).
Other CT findings after RFA include bubble lucencies or pleural thickening within or near the ablation zone (22).
Midterm local efficacy and survival after radiofrequency ablation of lung tumors with minimum follow-up of 1 year: prospective evaluation. Pathologic correlation to prove the effectiveness of lung RFA is available from animal and human studies. In a rabbit model, the ground-glass opacity seen immediately after RFA correlated with lung thermal injury. Progressive necrosis was seen in the area of ground glass opacity and is thought to represent lung that has been effectively ablated or destroyed by the heat energy (25). Pneumothorax, pleural effusion, and chest tube placement after radiofrequency ablation of lung tumors: incidence and risk factors. A study of pig lungs demonstrated that ground glass opacity represents a combination of lung cell death and bleeding, and that the apparent initial increase in size of the ablated tumor was due to the presence of granulation tissue as a result of heat damage to lung and not continued tumor growth (26).
Goldberg and colleagues have reported effective cell death in a rabbit lung sarcoma model (27). Another study using similar methodology reported 65% overall cell death in 9 patients with proven primary lung cancer (20). CT-guided radiofrequency ablation: a potential complementary therapy for patients with unresectable primary lung cancer--a preliminary report of 33 patients. During RFA, display panels show ablation parameters such as tissue impedance, current flow, and target tissue temperature. Radiofrequency ablation followed by conventional radiotherapy for medically inoperable stage I non-small cell lung cancer. During RFA, probes were accurately placed in the middle of the nodule (arrow in Figure 4) along its long axis. Figure 3During RFA, probes were accurately placed in the middle of the nodule (arrow in Figure 4) along its long axis.
Treatment failure after percutaneous radiofrequency ablation for nonsurgical candidates with pulmonary metastases from colorectal carcinoma. Many studies have reported that the complication rates are quite similar to those of CT-guided lung biopsy procedures. Percutaneous radiofrequency ablation of pulmonary metastases from colorectal carcinoma: prognostic determinants for survival. The reported incidence of pneumothorax in the larger series is 10-50%, but a smaller number of patients require chest tube insertion to facilitate lung re-expansion (13, 29-32).
Other relatively common complications that occur in 10-30% of patients include hemoptysis (coughing blood-tinged sputum) and pleural effusion (fluid accumulation outside the lung within the pleura) (33-35).
More serious, but rare complications include severe bleeding in the lung, hemothorax (blood accumulation outside the lung within the pleura), air-leak from lung into the chest wall, empyema (infected fluid accumulation outside the lung within the pleura), bronchopleural fistula (a connection between airways in lungs and the pleural space outside the lung), continuous chest wall pain, and acute respiratory distress syndrome (30, 33, 36).
Very rarely, urgent surgery may need to be performed to deal with one of these complications. Other reported complications, such as death and stroke, are rare.What is the impact of RFA in the treatment of primary lung cancer?To date, studies evaluating RFA have included patients with a mixture of both primary lung tumors and metastases. Dupuy et al reported on 24 patients with stage I non-small cell lung cancer who uncerwent RFA followed by radiation therapy. Two years later, 50% of the study patients were alive, and at five years at 39% were alive (37). A similar study by Grieco et al of 41 patients with stage I or II lung cancer treated with both RFA and external beam radiation therapy or brachytherapy demonstrated a median survival of 19.5 months, with survival at one, two, and three years of 87%, 70%, and 57%, respectively (36).
Simon et al in a study of 75 patients undergoing RFA for stage I lung cancers who were not surgical candidates reported survival rates of 78 % at one year, 36% at three years and 27% at five years, with a median survival of 29 months (13).
A similar median survival was reported in a smaller study involving 36 patients with stage I lung cancers (31).The survival rates reported in patients treated with RFA for stage I and II lung cancer appears to compare favorably with published data for external beam conventional radiation treatment. However, given the lack of randomized studies, such historical comparisons are of limited value. However, those who are unable to undergo surgery may benefit from RFA.What is the impact of RFA in the treatment of metastases?Surgical removal of metastatic lung tumors is an accepted curative therapy provided the primary tumor is fully cured or controlled.
Complete surgical removal of lung metastases in patients with selected types of cancer is associated with overall survival rates of 36% at 5 years, 26% at 10 years, and 22% at 15 years (38).
Simon et al reported that RFA of metastatic lung nodules results in overall survival rates of 70%, 54%, and 44% at 1, 2, and 5 years, respectively. For metastases from colon cancer, they also report 1, 2, and 5 year overall survival rates of 87%, 78%, and 57%, respectively (13). After RFA of metastases in 55 patients, Yan et al reported median overall survival of 33 months, with 1, 2, and 3 year overall survival rates of 85%, 64%, and 46%, respectively (39). However, sufficient long term results beyond 5 years are not yet available due to the relatively short time that this technology has been in use. Patients with smaller tumors (less than or equal to three cm) and fewer tumor nodules (less than or equal to five lesions) who are considered poor surgical candidates or who develop residual or recurrent disease despite maximal conventional therapy, and have tumors that are away from vital structures are the best candidates for RFA. However the role of RFA in patients who are candidates for surgical resection is unproven, and there is no evidence on whether RFA is more or less effective that focused radiation (sterotactic body radiation therapy).



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