Anju Sahdev | Queen Mary, University of London (original) (raw)

Papers by Anju Sahdev

Poster: "ECR 2018 / C-2450 / The Recto-Vaginal Septum; The Forgotten Wall" by: "S.... more Poster: "ECR 2018 / C-2450 / The Recto-Vaginal Septum; The Forgotten Wall" by: "S. Vickramarajah, R. Tanna, P. Nandra, A. Hameeduddin, A. Sahdev; london/UK"

Endocrine Abstracts, 2018

Treatment of Cancer, 2008

Journal of Clinical Oncology, 2020

5074 Background: Existing clinicopathological tools are unable to accurately identify renal cell ... more 5074 Background: Existing clinicopathological tools are unable to accurately identify renal cell carcinoma (RCC) patients who will develop metastases after surgery. As a result, it is unclear how long and how often to follow-up patients post-operatively. Tumor macropathology, as assayed by CT scanning, represents the sum product of tumor biology and microenvironment. We hypothesized that quantitative tumor features extracted from CT scans (termed radiomics) could discriminate between metastatic and non-metastatic RCCs. Methods: This retrospective study incorporated three cohorts of clear-cell RCC patients (n = 279, from TCGA, CPTAC and KiTS19 datasets) treated with nephrectomy. The study cohort was sub-divided into metastatic (n = 54, M1 at diagnosis or recurrence after surgery), high metastatic risk/HMR (n = 85, N1, T3-4, T2G3/4, T1G4) or low metastatic risk/LMR (n = 140, absence of these features) subsets. 3D primary tumor segmentation of arterial contrast CT scans was performed b...

Endocrine-Related Cancer, 2018

Endocrine-Related Cancer retinal angiomas, a phaeochromocytoma, a ccRCC and a small pNET which is... more Endocrine-Related Cancer retinal angiomas, a phaeochromocytoma, a ccRCC and a small pNET which is under surveillance.

Clinical Endocrinology, 2018

Objective: With the discovery that familial phaeochromocytoma and paraganglioma syndrome can be c... more Objective: With the discovery that familial phaeochromocytoma and paraganglioma syndrome can be caused by mutations in each subunit of the succinate dehydrogenase enzyme (SDH), has come the recognition that mutations in the individual subunits have their own distinct natural histories. Increased genetic screening is leading to the identification of increasing numbers of, mostly asymptomatic, gene mutation carriers and the implementation of screening strategies for these individuals. Yet there is, to date, no international consensus regarding screening strategies for asymptomatic carriers.

Diagnostic and Interventional Radiology, 2017

terine artery embolization (UAE) has become a first-line treatment for symptomatic uterine fibroi... more terine artery embolization (UAE) has become a first-line treatment for symptomatic uterine fibroids alongside the conventional surgical treatment of hysterectomy and myomectomy. A 2014 Cochrane review including six randomized trials compared UAE versus hysterectomy or myomectomy for the treatment of symptomatic fibroids. UAE had similar short-and mid-term outcomes, such as symptom control, quality of life and patient satisfaction, while benefiting from uterine preservation, shorter hospital stay, and a shorter recovery before resuming activities of normal life (1). These benefits are in keeping with the minimally invasive nature of the embolization procedures. Magnetic resonance imaging (MRI) is the best imaging modality to diagnose, map, and characterize fibroids. MRI can also diagnose benign and malignant concurrent pelvic pathology, which may also be attributing to symptoms. Some of these pathologies may preclude uterine artery embolization (UAE), or change the embolization protocol, such as the presence of adenomyosis. There are absolute contraindications to fibroid embolization including a viable pregnancy, active uterine infection, and uterine or ovarian malignancy unless performed for palliation or as an adjunct to surgery (2). For technically successful fibroid embolization, a microcatheter should be inserted into the uterine artery without complications, such as arterial spasm, dissection, or perforation. It is necessary to delineate the origin of the uterine artery, which is variable, and to understand its three-dimensional configuration. Although conventional angiography remains the gold standard for vascular evaluation, preprocedural three-dimensional (3D) magnetic resonance angiography (MRA) can give relevant preliminary information on uterine, ovarian, and pelvic vascular anatomy, shortening the operative time and increasing technical success rates. A reporting template for MRI/MRA preassessment of UAE for fibroid treatment is presented in the Table. Evaluation of diagnostic pre-embolization MRI Differentiation of fibroids from adenomyosis Adenomyosis is characterized by the presence of heterotopic endometrial glands and stroma deep within the myometrium with adjacent myometrial hyperplasia (3). Adenomyosis is generally diffuse but focal adenomyosis and adenomyoma, a focal nodular form, also exist. Adenomyosis occasionally mimics fibroids and the two conditions can coexist (Fig. 1) (4). Concomitant adenomyosis in hysterectomy specimens of women with leiomyoma ranges from 15% to 57% (5).

Journal of Clinical Oncology, 2014

531 Background: Everolimus (mTOR inhibitor) and dovitinib (VEGF and FGF-2 inhibitor) demonstrate ... more 531 Background: Everolimus (mTOR inhibitor) and dovitinib (VEGF and FGF-2 inhibitor) demonstrate activity in metastatic clear cell renal cancer. The combination of these agents has a broad spectrum of relevant activity. In this study we establish the tolerability and an early activity signal of this combination. Methods: Patients with metastatic clear cell renal cancer who have failed VEGF targeted therapy were eligible. Up to four cohorts of three to six patients (3+3 design) were treated with escalated doses of daily oral everolimus (5-10 mg PO OD) and dovitinib (200-500mg 5/7 days PO) Dose-limiting toxicities (DLTs) were assessed determine the MTD. An expansion cohort (n=15) was treated to obtain additional efficacy and safety information. Results: Overall 18 patients were recruited into the study. Fifteen patients received the MTD, which was everolimus 5 mg PO OD and dovitinib 200mg PO day 1-5/7. The MTD was associated with toxicity, which included fatigue, mucositis and diarrho...

BMC medicine, Nov 14, 2016

Molecular intratumour heterogeneity (ITH) is common in clear cell renal carcinomas (ccRCCs). Howe... more Molecular intratumour heterogeneity (ITH) is common in clear cell renal carcinomas (ccRCCs). However, it remains unknown whether this is mirrored by heterogeneity of drug responses between metastases in the same patient. We performed a retrospective central radiological analysis of patients with treatment-naïve metastatic ccRCC receiving anti-angiogenic tyrosine kinase inhibitors (TKIs) (sunitinib or pazopanib) within three similar phase II trials. Treatment was briefly interrupted for cytoreductive nephrectomy. All patients had multiple metastases that were measured by regular computed tomography scans from baseline until Response Evaluation Criteria In Solid Tumours (RECIST)-defined progression. Each metastasis was categorised as responding, stable or progressing. Patients were classed as having a homogeneous response if all lesions were of the same response category and a heterogeneous response if they differed. A total of 115 metastases were assessed longitudinally in 27 patient...

JAMA oncology, Jan 2, 2016

The role of cytoreductive nephrectomy in patients with metastatic renal cancer in the era of targ... more The role of cytoreductive nephrectomy in patients with metastatic renal cancer in the era of targeted therapy is uncertain. To establish the safety and efficacy of upfront pazopanib therapy prior to cytoreductive nephrectomy in previously untreated patients with metastatic clear cell renal cancer. Single-arm phase 2 study of 104 previously untreated patients with metastatic clear cell renal cancer recruited between June 2008 and October 2012 at cancer treatment centers with access to nephrectomy services. The minimum follow-up was 30 months. Patients received 12 to 14 weeks of preoperative pazopanib therapy prior to planned cytoreductive nephrectomy and continued pazopanib therapy after surgery. Treatment was stopped at disease progression. The primary end point was clinical benefit (using Response Evaluation Criteria in Solid Tumors, version 1.1) prior to surgery (at 12-14 weeks). Secondary end points included surgical complications, progression-free survival (PFS), overall surviva...

Postgraduate Medical Journal, 1994

European Radiology, 2009

The syndrome of ectopic adrenocorticotrophin secretion (EAS) is rare and is due to excess adrenoc... more The syndrome of ectopic adrenocorticotrophin secretion (EAS) is rare and is due to excess adrenocorticotrophin (ACTH) production from a nonpituitary tumour. These tumours can be covert, where the tumours are not readily apparent, and very small making them challenging to image. It is clinically and biochemically difficult to distinguish between covert EAS and Cushing's disease. The first-line investigation in locating the source of ACTH production is computed tomography (CT). The aim of this pictorial review is to illustrate the likely covert sites and related imaging findings. We review the CT appearances of tumours resulting in covert EAS and the associated literature. The most common tumours were bronchial carcinoid tumours, which appear as small, well-defined, round or ovoid pulmonary lesions. Rarer causes included thymic carcinoids, gastrointestinal carcinoids and pancreatic neuroendocrine tumours. Awareness of the imaging characteristics will aid identification of the source of ACTH production and allow potentially curative surgical resection.

Treatment of Cancer Fifth Edition, 2008

Context: Preoperative localisation of insulinoma improves cure rate and reduces complications, bu... more Context: Preoperative localisation of insulinoma improves cure rate and reduces complications, but may be challenging. Objective: To review diagnostic features and localisation accuracy for insulinomas. Design: Cross-sectional, retrospective analysis. Setting: A single tertiary referral centre. Patients: Patients with insulinoma in the years 1990-2009, including sporadic tumours and those in patients with multiple endocrine neoplasia syndromes. Interventions: Patients were identified from a database, and case notes and investigation results were reviewed. Tumour localisation by computed tomography (CT), magnetic resonance imaging (MRI), octreotide scanning, endoscopic ultrasound (EUS) and calcium stimulation was evaluated. Main outcome measure(s): Insulinoma localisation was compared to histologically confirmed location following surgical excision. Results: Thirty-seven instances of biochemically and/or histologically proven insulinoma were identified in 36 patients, of which seven were managed medically. Of the 30 treated surgically, 25 had CT (83.3%) and 28 had MRI (90.3%), with successful localisation in 16 (64%) by CT and 21 (75%) by MRI respectively. Considered together, such imaging correctly localised 80% of lesions. Radiolabelled octreotide scanning was positive in 10 out of 20 cases (50%); EUS correctly identified 17 lesions in 26 patients (65.4%). Twenty-seven patients had calcium stimulation testing, of which 6 (22%) did not localise, 17 (63%) were correctly localised, and 4 (15%) gave discordant or confusing results. Conclusions: Preoperative localisation of insulinomas remains challenging. A pragmatic combination of CT and especially MRI predicts tumour localisation with high accuracy. Radionuclide imaging and EUS were less helpful but may be valuable in selected cases. Calcium stimulation currently remains useful in providing an additional functional perspective.

The main objective of imaging patients with symptoms suggestive of ovarian lesions is to distingu... more The main objective of imaging patients with symptoms suggestive of ovarian lesions is to distinguish benign findings from malignant disease. Masses can be characterized with a variety of noninvasive imaging techniques, including transabdominal and transvaginal ultrasound, CT, and MRI. Each of these modalities has its advantages and limitations.

Poster: "ECR 2018 / C-2450 / The Recto-Vaginal Septum; The Forgotten Wall" by: "S.... more Poster: "ECR 2018 / C-2450 / The Recto-Vaginal Septum; The Forgotten Wall" by: "S. Vickramarajah, R. Tanna, P. Nandra, A. Hameeduddin, A. Sahdev; london/UK"

Endocrine Abstracts, 2018

Treatment of Cancer, 2008

Journal of Clinical Oncology, 2020

5074 Background: Existing clinicopathological tools are unable to accurately identify renal cell ... more 5074 Background: Existing clinicopathological tools are unable to accurately identify renal cell carcinoma (RCC) patients who will develop metastases after surgery. As a result, it is unclear how long and how often to follow-up patients post-operatively. Tumor macropathology, as assayed by CT scanning, represents the sum product of tumor biology and microenvironment. We hypothesized that quantitative tumor features extracted from CT scans (termed radiomics) could discriminate between metastatic and non-metastatic RCCs. Methods: This retrospective study incorporated three cohorts of clear-cell RCC patients (n = 279, from TCGA, CPTAC and KiTS19 datasets) treated with nephrectomy. The study cohort was sub-divided into metastatic (n = 54, M1 at diagnosis or recurrence after surgery), high metastatic risk/HMR (n = 85, N1, T3-4, T2G3/4, T1G4) or low metastatic risk/LMR (n = 140, absence of these features) subsets. 3D primary tumor segmentation of arterial contrast CT scans was performed b...

Endocrine-Related Cancer, 2018

Endocrine-Related Cancer retinal angiomas, a phaeochromocytoma, a ccRCC and a small pNET which is... more Endocrine-Related Cancer retinal angiomas, a phaeochromocytoma, a ccRCC and a small pNET which is under surveillance.

Clinical Endocrinology, 2018

Objective: With the discovery that familial phaeochromocytoma and paraganglioma syndrome can be c... more Objective: With the discovery that familial phaeochromocytoma and paraganglioma syndrome can be caused by mutations in each subunit of the succinate dehydrogenase enzyme (SDH), has come the recognition that mutations in the individual subunits have their own distinct natural histories. Increased genetic screening is leading to the identification of increasing numbers of, mostly asymptomatic, gene mutation carriers and the implementation of screening strategies for these individuals. Yet there is, to date, no international consensus regarding screening strategies for asymptomatic carriers.

Diagnostic and Interventional Radiology, 2017

terine artery embolization (UAE) has become a first-line treatment for symptomatic uterine fibroi... more terine artery embolization (UAE) has become a first-line treatment for symptomatic uterine fibroids alongside the conventional surgical treatment of hysterectomy and myomectomy. A 2014 Cochrane review including six randomized trials compared UAE versus hysterectomy or myomectomy for the treatment of symptomatic fibroids. UAE had similar short-and mid-term outcomes, such as symptom control, quality of life and patient satisfaction, while benefiting from uterine preservation, shorter hospital stay, and a shorter recovery before resuming activities of normal life (1). These benefits are in keeping with the minimally invasive nature of the embolization procedures. Magnetic resonance imaging (MRI) is the best imaging modality to diagnose, map, and characterize fibroids. MRI can also diagnose benign and malignant concurrent pelvic pathology, which may also be attributing to symptoms. Some of these pathologies may preclude uterine artery embolization (UAE), or change the embolization protocol, such as the presence of adenomyosis. There are absolute contraindications to fibroid embolization including a viable pregnancy, active uterine infection, and uterine or ovarian malignancy unless performed for palliation or as an adjunct to surgery (2). For technically successful fibroid embolization, a microcatheter should be inserted into the uterine artery without complications, such as arterial spasm, dissection, or perforation. It is necessary to delineate the origin of the uterine artery, which is variable, and to understand its three-dimensional configuration. Although conventional angiography remains the gold standard for vascular evaluation, preprocedural three-dimensional (3D) magnetic resonance angiography (MRA) can give relevant preliminary information on uterine, ovarian, and pelvic vascular anatomy, shortening the operative time and increasing technical success rates. A reporting template for MRI/MRA preassessment of UAE for fibroid treatment is presented in the Table. Evaluation of diagnostic pre-embolization MRI Differentiation of fibroids from adenomyosis Adenomyosis is characterized by the presence of heterotopic endometrial glands and stroma deep within the myometrium with adjacent myometrial hyperplasia (3). Adenomyosis is generally diffuse but focal adenomyosis and adenomyoma, a focal nodular form, also exist. Adenomyosis occasionally mimics fibroids and the two conditions can coexist (Fig. 1) (4). Concomitant adenomyosis in hysterectomy specimens of women with leiomyoma ranges from 15% to 57% (5).

Journal of Clinical Oncology, 2014

531 Background: Everolimus (mTOR inhibitor) and dovitinib (VEGF and FGF-2 inhibitor) demonstrate ... more 531 Background: Everolimus (mTOR inhibitor) and dovitinib (VEGF and FGF-2 inhibitor) demonstrate activity in metastatic clear cell renal cancer. The combination of these agents has a broad spectrum of relevant activity. In this study we establish the tolerability and an early activity signal of this combination. Methods: Patients with metastatic clear cell renal cancer who have failed VEGF targeted therapy were eligible. Up to four cohorts of three to six patients (3+3 design) were treated with escalated doses of daily oral everolimus (5-10 mg PO OD) and dovitinib (200-500mg 5/7 days PO) Dose-limiting toxicities (DLTs) were assessed determine the MTD. An expansion cohort (n=15) was treated to obtain additional efficacy and safety information. Results: Overall 18 patients were recruited into the study. Fifteen patients received the MTD, which was everolimus 5 mg PO OD and dovitinib 200mg PO day 1-5/7. The MTD was associated with toxicity, which included fatigue, mucositis and diarrho...

BMC medicine, Nov 14, 2016

Molecular intratumour heterogeneity (ITH) is common in clear cell renal carcinomas (ccRCCs). Howe... more Molecular intratumour heterogeneity (ITH) is common in clear cell renal carcinomas (ccRCCs). However, it remains unknown whether this is mirrored by heterogeneity of drug responses between metastases in the same patient. We performed a retrospective central radiological analysis of patients with treatment-naïve metastatic ccRCC receiving anti-angiogenic tyrosine kinase inhibitors (TKIs) (sunitinib or pazopanib) within three similar phase II trials. Treatment was briefly interrupted for cytoreductive nephrectomy. All patients had multiple metastases that were measured by regular computed tomography scans from baseline until Response Evaluation Criteria In Solid Tumours (RECIST)-defined progression. Each metastasis was categorised as responding, stable or progressing. Patients were classed as having a homogeneous response if all lesions were of the same response category and a heterogeneous response if they differed. A total of 115 metastases were assessed longitudinally in 27 patient...

JAMA oncology, Jan 2, 2016

The role of cytoreductive nephrectomy in patients with metastatic renal cancer in the era of targ... more The role of cytoreductive nephrectomy in patients with metastatic renal cancer in the era of targeted therapy is uncertain. To establish the safety and efficacy of upfront pazopanib therapy prior to cytoreductive nephrectomy in previously untreated patients with metastatic clear cell renal cancer. Single-arm phase 2 study of 104 previously untreated patients with metastatic clear cell renal cancer recruited between June 2008 and October 2012 at cancer treatment centers with access to nephrectomy services. The minimum follow-up was 30 months. Patients received 12 to 14 weeks of preoperative pazopanib therapy prior to planned cytoreductive nephrectomy and continued pazopanib therapy after surgery. Treatment was stopped at disease progression. The primary end point was clinical benefit (using Response Evaluation Criteria in Solid Tumors, version 1.1) prior to surgery (at 12-14 weeks). Secondary end points included surgical complications, progression-free survival (PFS), overall surviva...

Postgraduate Medical Journal, 1994

European Radiology, 2009

The syndrome of ectopic adrenocorticotrophin secretion (EAS) is rare and is due to excess adrenoc... more The syndrome of ectopic adrenocorticotrophin secretion (EAS) is rare and is due to excess adrenocorticotrophin (ACTH) production from a nonpituitary tumour. These tumours can be covert, where the tumours are not readily apparent, and very small making them challenging to image. It is clinically and biochemically difficult to distinguish between covert EAS and Cushing's disease. The first-line investigation in locating the source of ACTH production is computed tomography (CT). The aim of this pictorial review is to illustrate the likely covert sites and related imaging findings. We review the CT appearances of tumours resulting in covert EAS and the associated literature. The most common tumours were bronchial carcinoid tumours, which appear as small, well-defined, round or ovoid pulmonary lesions. Rarer causes included thymic carcinoids, gastrointestinal carcinoids and pancreatic neuroendocrine tumours. Awareness of the imaging characteristics will aid identification of the source of ACTH production and allow potentially curative surgical resection.

Treatment of Cancer Fifth Edition, 2008

Context: Preoperative localisation of insulinoma improves cure rate and reduces complications, bu... more Context: Preoperative localisation of insulinoma improves cure rate and reduces complications, but may be challenging. Objective: To review diagnostic features and localisation accuracy for insulinomas. Design: Cross-sectional, retrospective analysis. Setting: A single tertiary referral centre. Patients: Patients with insulinoma in the years 1990-2009, including sporadic tumours and those in patients with multiple endocrine neoplasia syndromes. Interventions: Patients were identified from a database, and case notes and investigation results were reviewed. Tumour localisation by computed tomography (CT), magnetic resonance imaging (MRI), octreotide scanning, endoscopic ultrasound (EUS) and calcium stimulation was evaluated. Main outcome measure(s): Insulinoma localisation was compared to histologically confirmed location following surgical excision. Results: Thirty-seven instances of biochemically and/or histologically proven insulinoma were identified in 36 patients, of which seven were managed medically. Of the 30 treated surgically, 25 had CT (83.3%) and 28 had MRI (90.3%), with successful localisation in 16 (64%) by CT and 21 (75%) by MRI respectively. Considered together, such imaging correctly localised 80% of lesions. Radiolabelled octreotide scanning was positive in 10 out of 20 cases (50%); EUS correctly identified 17 lesions in 26 patients (65.4%). Twenty-seven patients had calcium stimulation testing, of which 6 (22%) did not localise, 17 (63%) were correctly localised, and 4 (15%) gave discordant or confusing results. Conclusions: Preoperative localisation of insulinomas remains challenging. A pragmatic combination of CT and especially MRI predicts tumour localisation with high accuracy. Radionuclide imaging and EUS were less helpful but may be valuable in selected cases. Calcium stimulation currently remains useful in providing an additional functional perspective.

The main objective of imaging patients with symptoms suggestive of ovarian lesions is to distingu... more The main objective of imaging patients with symptoms suggestive of ovarian lesions is to distinguish benign findings from malignant disease. Masses can be characterized with a variety of noninvasive imaging techniques, including transabdominal and transvaginal ultrasound, CT, and MRI. Each of these modalities has its advantages and limitations.