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The application of genomic profiling assays using plasma circulating tumor DNA (ctDNA) is rapidly evolving in the management of patients with advanced solid tumors. Diverse plasma ctDNA technologies in both commercial and academic laboratories are in routine or emerging use. The increasing integration of such testing to inform treatment decision making by oncology clinicians has complexities and challenges but holds significant potential to substantially improve patient outcomes. In this review, the authors discuss the current role of plasma ctDNA assays in oncology care and provide an overview of ongoing research that may inform real‐world clinical applications in the near future.

The applications of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/X-ray computed tomography (PET/CT) in the management of patients with breast cancer have been extensively studied. According to these studies, PET/CT is not routinely performed for the diagnosis of primary breast cancer, although PET/CT in specific subtypes of breast cancer correlates with histopathologic features of the primary tumor. PET/CT can detect metastases to mediastinal, axial, and internal mammary nodes, but it cannot replace the sentinel node biopsy. In detection of distant metastases, this imaging tool may have a better accuracy in detecting lytic bone metastases compared to bone scintigraphy. Thus, PET/CT is recommended when advanced-stage disease is suspected, and conventional modalities are inconclusive. Also, PET/CT has a high sensitivity and specificity to detect loco-regional recurrence and is recommended in asymptomatic patients with rising tumor markers. Numerous studies support the future role of PET/CT in prediction of response to neoadjuvant chemotherapy (NAC). PET/CT has a higher diagnostic value for prognostic risk stratification in comparison with conventional modalities. With the continuing research on the treatment planning and evaluation of patients with breast cancer, the role of PET/CT can be further extended.

The tumor, node, metastasis (TNM) staging system approved by International Association for the Study of Lung Cancer (IASLC) and the American Joint Committee on Cancer (AJCC) to stage lung cancer was recently revised. The latest revision is the 8th edition published in January, 2017. This new edition made some important changes to the previous edition, including modification of the T classification based on 1 cm increment, downstage of T descriptor including endobronchial tumor disregarding its distance from carina (T2), merging total and partial atelectasis/pneumonitis into the same T category (T2), upstage diaphragmatic invasion to T4, new classification concept of adenocarcinoma in situ and minimally invasive adenocarcinoma for pure and part-solid ground-glass nodules, and further division of extrathoracic metastasis into M1b and M1c based on the number and sites of extrathoracic metastases. Consensus is reached for debating situations not covered in the previous edition of staging system, such as the classification of pancoast tumor based on its invasion depth and staging tumors that extend directly across the fissure as T2a. Classification of multiple sites of pulmonary involvement, including multiple primary lung cancer, separate lung cancer nodules, multiple ground-glass or lepidic lesions, and consolidation, is also discussed. Even though the 8th edition of the TNM lung staging system provides us with more precise classification based on prognostic analysis of each TNM descriptors, there are still some potential limitations and clinical situations that have not yet been clarified in terms of clinical staging by imaging. It is important for radiologists to understand the major changes introduced in the 8th edition of TNM staging and to recognize the potential pitfalls and limitations of imaging interpretation to precisely classify the clinical stage of lung cancer.

In 2016, a Choosing Wisely guideline was published recommending omission of sentinel lymph node biopsy (SLNB) in low-risk elderly females with breast cancer. Our study evaluated trends and factors associated with omission of axillary surgery. Patients ≥70 years old undergoing surgery for an initial diagnosis of invasive breast cancer from 2014 to 2022 ​at our institution were retrospectively reviewed. A sub-group of pT1, cN0, ER+/HER2-patients was analyzed. A total of 218 pT1, cN0, ER+/HER2-patients were identified. In these patients, the percentage of SLNB performed decreased from 73 ​% in 2014 to 30 ​% in 2022 (p ​< ​0.0001). Older age (OR 0.82, 95 ​% CI 0.73–0.91) and smaller preoperative tumor size (OR 3.63, 95 ​% CI 1.62–8.14) were associated with SLNB omission. There were no differences in loco-regional recurrence-free survival (p ​= ​0.57) and disease-free survival (p ​= ​0.66) with SLNB omission. With increasing omission of axillary staging, there was no adverse impact on recurrence-free survival. •Use of Choosing Wisely is associated with age and preoperative tumor size.•Patients treated with mastectomy are unlikely to omit sentinel lymph node biopsy.•Loco-regional and distant recurrence remain low when adhering to Choosing Wisely.•Disease-free survival is unchanged with adoption of Choosing Wisely.

PurposeBreast cancer is a group of diseases with different intrinsic molecular subtypes. However, anatomic staging alone is insufficient to determine prognosis. The present study analyzed the prognostic value of the American Joint Committee for Cancer (AJCC) 8th edition cancer staging system.MethodsThis retrospective, single-center study included breast cancer cases diagnosed from January 1999 to December 2008. We restaged patients based on the 8th edition AJCC cancer staging system and analyzed the prognostic value of the anatomic and prognostic staged groups. Follow-up data including disease-free survival (DFS), overall survival (OS), and clinic-pathological data were collected to analyze the differences between the two staging subgroups.ResultsThe study enrolled 7458 breast cancer patients with a 98.7-month median follow-up. Both the 5-year DFS and OS were significantly different between the anatomic and prognostic staged groups. The 5-year OS according to disease subtype was as follows: hormone receptor-positive/human epidermal growth factor receptor 2-negative [HR(+)/HER2(−)], 90.9%; HR(+)/HER2(+), 84.7%; HR(−)/HER2(+), 81.1%; and HR(−)/HER2(−), 80.9%. According to the anatomic stage, the 5-year OS of patients with stage III HR(+)/HER2(−) disease was superior to that of patients with stage II HR(−)/HER2(−) disease (88.3 vs. 86.5%). Per the prognostic stage, both the 5-year DFS and OS rates of patients with stage II HR(−)/HER2(−) disease were higher than those of patients with stage III HR(+)/HER2(−) disease (90.1 and 94.3% vs. 79.1 and 88.9%).ConclusionsThe prognostic staging system is a refined version of the anatomic staging system and encourages a more personalized approach to breast cancer treatment.

Purpose of Review Nasopharyngeal carcinoma (NPC), characterized by its aggressive nature and sensitivity to radiation, demands accurate staging for optimal clinical outcomes. The purpose of this review was to provides a comprehensive overview of the evolution of the TNM staging system for NPC based on recent and previously published studies, with particular emphasis on the transition from the 7th to the 9th edition. Recent Findings The 9th edition introduces critical changes, particularly in the N and M classifications, to enhance prognostic accuracy. Our analysis also incorporates the burgeoning roles of biomarkers, especially Epstein-Barr virus (EBV)-DNA, and the potential of Artificial Intelligence (AI) in refining NPC staging. Summary Each iteration of the TNM staging system for NPC has successfully enhanced the prognostic precision of NPC, with notable advancements from the 7th to the 9th edition. We also delves into the incorporation of biomarkers, such as EBV-DNA, and the potential of AI in refining staging accuracy. These innovations are anticipated to offer personalized prognoses and inform tailored treatment strategies for NPC patients in the future.

Lymph node metastasis (LNM) is an independent prognostic factor for patients with gastric cancer (GC), and an accurate lymph node (LN) staging system is crucial for guiding adjuvant therapy and assessing patient prognosis. The most commonly used staging systems for GC are the tumor-node-metastasis (TNM) system developed by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC), as well as the Japanese classification system. The N staging system in both classification methods has undergone multiple revisions and improvements. Early versions classified N stage based on the distance between the tumor margin and metastatic LNs. Over time, this shifted to a system based on the number of metastatic LNs, significantly improving staging precision. To further enhance the accuracy of N staging, the researchers have introduced new concepts such as the metastatic lymph nodes ratio (LNR), the log odds of positive lymph nodes (LODDS), and the negative lymph node count (NLNC). These new parameters have demonstrated better prognostic accuracy than the eighth edition of the UICC/AJCC N staging system. In addition, artificial intelligence (AI) has emerged as a rapidly evolving domain, demonstrating exponential growth in algorithmic sophistication and computational applications. Machine learning (ML) models and deep learning (DL) models have demonstrated superior performance in assessing LNM, aiding in staging, and predicting prognosis in GC. This review provides a systematic overview of the historical evolution, current practices, and recent innovations in GC lymph node staging, aiming to inform the development of next-generation prognostic frameworks.

PET/CT with 18F-FDG is increasingly being used for staging, restaging, and treatment monitoring for cancer patients. CT is still frequently used only for attenuation correction and lesion localization. However, increasing sales of high-end scanners that combine PET with 64-detector CT strongly suggest that the field is moving toward a comprehensive concept, whereby diagnostic CT studies during intravenous contrast material application are combined with the highest-quality PET studies. At many institutions, in-line PET/CT has replaced separately acquired PET and CT examinations for many oncologic indications. This replacement has occurred despite the fact that only a relatively small number of well-designed prospective studies have verified imaging findings against the gold standard of histopathologic tissue evaluation. However, a large number of studies have used acceptable reference standards, such as pathology, imaging, and other clinical follow-up findings, for validating PET/CT findings. From these data, we believe, has emerged reliable evidence in support of the notion that PET/CT offers diagnostic advantages over its individual components for the major cancers.

Traditionally, early esophageal cancer (i.e., cancer limited to the mucosa or superficial submucosa) was managed surgically; the gastroenterologist’s role was primarily to diagnose the tumor. Over the last decade, advances in endoscopic imaging, ablation, and resection techniques have resulted in a paradigm shift—diagnosis, staging, treatment, and surveillance are within the endoscopist’s domain. Yet, there are few reviews that provide a focused, evidence-based approach to early esophageal cancer, and highlight areas of controversy for practicing gastroenterologists. In this manuscript, we will discuss the following: (1) utility of novel endoscopic technologies to identify high-grade dysplasia and early esophageal cancer, (2) role of endoscopic resection and imaging to stage early esophageal cancer, (3) endoscopic therapies for early esophageal cancer, and (4) indications for surgical and multidisciplinary management.

Key Points Transperineal prostate biopsy provides better anteroapical sampling than transrectal ultrasonography (TRUS)-guided biopsy, leading to improved cancer detection rates Although usually used as a confirmatory test after negative TRUS-guided biopsy, transperineal biopsy shows promise as an initial investigation Transperineal biopsy frequently requires higher levels of anaesthesia relative to TRUS-guided biopsy, especially when >10–12 cores are taken In patients at high risk of infection (such as those with diabetes mellitus or who recently travelled to countries with high prevalence of antimicrobial resistance), transperineal biopsy is safer than TRUS-guided biopsy in terms of reducing sepsis Multiparametric MRI technology improves the cancer detection rate and accuracy of disease grading in needle biopsy and enables targeted biopsy, which reduces the risk of complications Transperineal prostate biopsy is re-emerging after decades of being an underused alternative to transrectal biopsy guided by transrectal ultrasonography (TRUS). The authors describe the evolution of both the prostate biopsy techniques, focusing on the clinical implications of the transperineal approach and the potential future directions for prostate biopsy. Transperineal prostate biopsy is re-emerging after decades of being an underused alternative to transrectal biopsy guided by transrectal ultrasonography (TRUS). Factors driving this change include possible improved cancer detection rates, improved sampling of the anteroapical regions of the prostate, a reduced risk of false negative results and a reduced risk of underestimating disease volume and grade. The increasing incidence of antimicrobial resistance and patients with diabetes mellitus who are at high risk of sepsis also favours transperineal biopsy as a sterile alternative to standard TRUS-guided biopsy. Factors limiting its use include increased time, training and financial constraints as well as the need for high-grade anaesthesia. Furthermore, the necessary equipment for transperineal biopsy is not widely available. However, the expansion of transperineal biopsy has been propagated by the increase in multiparametric MRI-guided biopsies, which often use the transperineal approach. Used with MRI imaging, transperineal biopsy has led to improvements in cancer detection rates, more-accurate grading of cancer severity and reduced risk of diagnosing clinically insignificant disease. Targeted biopsy under MRI guidance can reduce the number of cores required, reducing the risk of complications from needle biopsy.