for assessment of adnexal masses size and pattern

ultrasound

cancer antigen 125 level

Doppler

The presence of an adnexal mass is a frequent reason for a woman to be referred to a gynaecologist. The discrimination between benign and malignant adnexal masses is central to decisions regarding clinical management and surgical planning in such patients. Patients with malignant tumours should be referred to a gynaecological oncologist, as the quality of cytoreductive surgery and surgical staging/lymph node dissection are important prognostic factors in ovarian cancer. These specialized surgical procedures require the specific skills and experience provided by gynaecologic oncology surgeons. Furthermore, appropriate and timely referral to a gynaecologic oncologist has been proven to increase survival in patients with ovarian cancer.Conversely, patients believed to have a benign mass requiring surgery are able to have this performed by a general gynaecologist. A standardized method for preoperative identification of probable malignant masses would allow optimization of first-line treatment for women with ovarian cancer. A risk of malignancy index would be valuable for the selective referral of relevant patients to specialized oncology centres. Currently, clinical examination, ultrasound assessment, and assays of tumour markers are part of the standard work-up for an adnexal mass. Although none of these indicators alone is very sensitive or specific for detecting malignancy, an index developed by Jacobs et al. incorporates information about the patient's menopausal status and serum Cancer antigen A-125 levels, and ultrasound characteristics of the mass to predict the risk of malignancy with greater sensitivity and specificity than any one factor alone.Some of the potential advantages of risk malignant index include rapid triage of patients through the referral system and fewer operations for benign masses being performed by gynaecologic oncologists.

Risk of Malignancy Index and Assiut Scoring Model for Adnexal Malignancy

Comparative Study Between Use of the Risk of Malignancy Index Versus Assiut Scoring Model in Preoperative Prediction of Adnexal Malignancy

Assiut University

Lecturer

Neoplasms

Nervous System Diseases

All Conditions

Brain Neoplasms

Central Nervous System Neoplasms

Nervous System Neoplasms

Brain Diseases

Central Nervous System Diseases

Adjuvants, Anesthesia

Central Nervous System Depressants

Psychotropic Drugs

All Drugs and Chemicals

Midazolam

Intraoperative ultrasensitive Doppler acquisitions by using an ultrasound device for functional area detection

Ultrasensitive Doppler acquisition obtained with the Aixplorer ultrasound device

Ultrasound device

Dorian Chauvet, MD

A wide spectrum of methods is used to image brain activation in vivo. It can be directly detected by neurons electrical activity imaging (cortical simulation mapping, calcium imaging, voltage sensitive dyes) or indirectly by imaging hemodynamic changes induced by the neurovascular coupling in the vessels surrounding the activated neurons (intrinsic optical imaging, photoacoustic imaging, positron emission tomography (PET), functional magnetic resonance imaging (fMRI)).

Ultrasound as the potential to complement these functional imaging techniques at low cost. Ultrasound imaging can do real-time in-depth imaging of brain. However, its use to imaging of major vessels has been limited until now due to its poor sensitivity. To overcome this limitation functional ultrasound (fUS) was developed in Institut Langevin since 2011. This technique enables high spatio-temporal resolution imaging of whole-brain microvasculature dynamics in response to brain activation without the need of contrast agent.

This fUS method relies on a new power Doppler imaging sequence sensitive enough to detect blood flow in most of cerebral vessels (arterioles, big venules and larger vessels). Repeating the acquisition of such ultrasensitive Doppler images over time enables to follow flow dynamics in such vessels modulated by local neuronal activity.

Applied to the rat brain, fUS was proved able to map brain activation at high spatiotemporal resolution and high signal to noise ratio. The aim of this study is now to apply fUS on human brain in intraoperative condition.

The main objective of this study is to find activation maps through intraoperative ultrasensitive Doppler compared to gold standard cortical simulation mapping and functional MRI.

Secondly the investigators want to test sensitivity of this new Doppler mode. fUS method will be used for different types of stimuli and intensity and the investigators will do some control acquisitions. Blood vessel density observed with a conventional Doppler will be compared to the one measured with the ultrasensitive Doppler to prove that this new Doppler mode enhance micro vessel visualization.

Intraoperative Functional Ultrasound

Doppler Ultrasonore Ultrasensible Peropératoire du Cerveau - Vers Une Aide Temps Reel à la Cartographie Corticale Fonctionnelle

fUS method will be tested for different types of stimuli and intensity and the investigators will do some control acquisitions.

Blood vessel density observed with a conventional Doppler will be compared to the one measured with the ultrasensitive Doppler.

Institut National de la Santé Et de la Recherche Médicale, France

Infections

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Immune System Diseases

Symptoms and General Pathology

Rare Diseases

Sarcoma

Acquired Immunodeficiency Syndrome

HIV Infections

Sarcoma, Kaposi

Neoplasms, Connective and Soft Tissue

Neoplasms by Histologic Type

Communicable Diseases

Herpesviridae Infections

Virus Diseases

DNA Virus Infections

Neoplasms, Vascular Tissue

Soft Tissue Sarcoma

Kaposi Sarcoma

Antineoplastic Agents

Doxorubicin

Liposomal doxorubicin

Interleukin-12

Adult patients with biopsy-proven cutaneous Kaposi's sarcoma. Some participants received interleukin-12 and liposomal doxorubicin. However, the therapy was administered on a different protocol and was not part of this study.

Robert Yarchoan, M.D.

The purpose of this study is to develop imaging techniques to determine the density of blood vessels and the amount of blood flow in Kaposi s sarcoma (KS) tumors. KS tumors depend on the formation of new blood vessels for their growth. Some experimental therapies for KS are directed at reducing the amount of blood vessels and blood flow in these lesions. Measurement of blood vessel density and blood flow in these lesions could be useful in evaluating the effectiveness of both standard and experimental treatments for this disease.

Patients 18 years of age or older with Kaposi's sarcoma involving the skin may be eligible for this study. Participants will have photographs taken of their lesions and will undergo three imaging procedures (described below) at the beginning of the study (baseline) and then about once every 3 months or so while on the study (up to 2 years) to compare the test results over time. (Imaging may be done at more or less frequent intervals depending on the findings.) A small amount of blood (less than a tablespoon) will be drawn the day of each imaging procedure.

Laser Doppler imaging This technique measures the amount of blood flow in KS lesions by scanning the lesions with a low-power laser beam. Each lesion takes about 3 minutes to scan. The imaging may be done before and after a blood pressure cuff around the arm is inflated for a short time (usually less than 30 seconds).

Multi-spectral imaging This technique uses light to measure the total blood volume in each lesion and how much oxygen is in the blood. Oxygen is carried to the body s cells by a protein in red blood cells called hemoglobin. The light on the multi-spectral imaging instrument is absorbed differently depending on whether the hemoglobin has oxygen attached to it or not. It takes about 2 minutes to scan each lesion.

Infrared thermal imaging This test uses a special camera to take digital infrared pictures of the skin. Images formed of the temperature of the KS lesions are used to assess blood flow in the lesions. This imaging takes about 1 minute per lesion.

...

Background:

Kaposi's sarcoma is a highly vascular tumor. As such, it may provide a good model for the study of angiogenesis-based therapy in cancer. However, there are no standardized techniques now available to assess the effects of anti-angiogenesis therapy on blood flow in KS tissues. The present protocol was written to allow us to explore and gain experience with four promising techniques to examine tumor vasculature in cutaneous KS lesions: a) laser Doppler imaging; b) multi-spectral imaging; c) infrared thermal imaging; and d) optical coherence tomography.

Objectives:

The main objective is to assess, in preliminary fashion, non-invasive methods for studying tumor vascularity and vascular changes in patients with Kaposi's sarcoma using four different imaging techniques. Other objectives are to correlate these techniques to each other and to conventional KS tumor assessment, and to assess the response of these techniques in patients receiving therapy for Kaposi s sarcoma.

Eligibility:

Patients 18 of more years of age with biopsy-proven cutaneous Kaposi's sarcoma involving the skin or mucosa are eligible. They must be willing and able to give informed consent.

Design:

This will be a preliminary study to explore these techniques in Kaposi's sarcoma. Selected Kaposi's sarcoma lesions of patients will be assessed using laser Doppler imaging, multi-spectral imaging, infrared thermal imaging, and optical coherence tomography at entry and then additional time points for up to 4 years. Lesions will also be assessed by conventional measurement and photographs with conventional cameras. In selected patients in which there are Kaposi's sarcoma lesions on the arm, the effects of stopping venous flow for up to 10 seconds will be assessed on the measurements. A complete blood count will be done the day of the measurements. The results of the imaging techniques will be compared with each other, and with conventional tumor assessments. Changes over time will be assessed.

Assessment of Blood Vessel Density in Kaposi's Sarcoma Lesions

Protocol to Assess Vascularity in Kaposi's Sarcoma Lesions Utilizing Non-Invasive Imaging Techniques

Temperature in KS lesions compared to normal skin either adjacent to the lesion or on the contralateral side was measured with thermography (thermal energy). A higher temperature is proportional to the severity of the lesion (worst outcome). A reduction in temperature is consistent with a decrease in severity of the lesions (better outcome).

Blood velocity in Kaposi's Sarcoma lesions as compared to the surrounding area was measured with laser doppler imaging with a low power laser beam. Higher velocity is an indication of more severe lesions.

Temperature in KS lesions compared to normal skin either adjacent to the lesion or on the contralateral side was measured with thermography (thermal energy). A higher temperature is proportional to the severity of the lesion (worst outcome). A reduction in temperature is consistent with a decrease in severity of the lesions (better outcome). The value at week 18 is compared to the baseline value for each subject, and the difference reported.

Blood velocity in Kaposi's Sarcoma lesions as compared to the surrounding area was measured with laser doppler imaging with a low power laser beam. Higher velocity is an indication of more severe lesions. The value at week 18 is compared to the baseline value for each subject, and the difference reported.

Here is the count of participants with serious and non-serious adverse events assessed by the Common Terminology Criteria for Adverse Events (CTCAE v4.0). A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life-threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned.

National Cancer Institute (NCI)

Principal Investigator

Kaposi's Sarcoma

Adult patients with biopsy-proven cutaneous Kaposi's sarcoma

Age, Categorical

Age, Continuous

Sex: Female, Male

Ethnicity (NIH/OMB)

Race (NIH/OMB)

United States

Region of Enrollment

Dr. Robert Yarchoan

Only 16/29 participants were analyzed for this outcome measure. Due to the assay being developed, results data were not collected in a consistent manner for the remaining 13 participants.

Preliminary Assessment of the Temperature of Kaposi's Sarcoma Lesions Compared to the Temperature in the Normal Skin Measured With Thermography

Preliminary Assessment of the Blood Velocity in Kaposi's Sarcoma (KS) Lesions Compared to That in the Surrounding Area

Only 10/29 participants were analyzed for this outcome measure.

Preliminary Assessment of the Temperature Change in Kaposi Sarcoma Lesions at Week 18 of Therapy Compared to Baseline as Measured With Thermography

Preliminary Assessment of the Change in Blood Velocity in Kaposi's Sarcoma Lesions Measured With Laser Doppler Imaging Before and After Therapy

Number of Participants With Serious and Non-serious Adverse Events

Overall Study

The group includes patients who have malignant axillary lymph nodes which are proven by biopsy

The group includes patients who have benign axillary lymph nodes which are proven either by biopsy or follow-up

Each participant has undergone to ultrasound and biopsy procedure if they have suspicious lymph node in axillar region

Ultrasound and biyopsy

Pelin Seher Oztekin, Assoc. Prof.

102 patients who have suspicious ALNs were included in our prospective study, which was approved by a tertiary health care facility ethics committee. Each suspicious lymph nodes (LNs) were examined with PDUS and SMI in terms of distribution, appearance and number of vascular structures and the still images were stored. Subsequently, imaging findings were re-evaluated after histopathological or follow-up results and were compared between benign and malign groups. In addition, we revealed the diagnostic perfomance of using the each possible combination of these features in PDUS and SMI. Finally, two radiologists with 22 years and 4 years of experience analyzed the images and interobserver agreement was assessed

MATERIAL AND METHOD Patient The hospital's ethics committee approved this single-center prospective study (E-93471371-514.10). 139 female patients, ages 18 to 74, who had suspicious lymph nodes in the axilla during a breast ultrasound examination at our clinic between April 2021 and April 2022 were included in the study. 20 patients did not come back for follow-ups, 4 patients' ultrasonographic images were not sufficient diagnostic quality, and 13 patients were excluded from the study because the biopsy result was not diagnostic and the patient did not undergo re-biopsy. As a result, 108 lymph nodes from 102 patients were included in the study, and 37 patients were excluded.

Patients who were male, under the age of 18, underwent axillary lymph node dissection, had active infection in the axillary region, were diagnosed with histopathologically confirmed axillary lymph node metastasis, had received known chemotherapy or radiotherapy to the axillary region, or did not sign the informed consent form were excluded from the study. Patients who had their pathology results unavailable or who later decided not to participate in the study were also excluded.

Ultrasonographic Evaluation Suspicious axillary lymph nodes in the patients included in the study were evaluated with Toshiba Aplio a (Toshiba Medical Systems Corporation, Tokyo, Japan) ultrasound (US) device and 14-18 MHz high frequency linear probe. Gray scale US, PDUS and SMI images of the lymph nodes were stored. PRF and gain settings were adjusted to prevent from artifacts and to obtain the highest amount of signal while images were taken. In both Doppler methods, these parameters remained unchanged. The routine examination time for each patient extended 1-2 minutes by the SMI evaluation. At the end of the evaluation, a histological assessment using a 21G fine needle aspiration (FNA) biopsy or core biopsy (16-18G) from the relevant lymph nodes, or follow-up with US was performed, depending on the clinical suspicion. Any lymph nodes that regressed or disappeared throughout the US follow-up period of 1-3 months were considered benign. The lymph nodes that remained stable or progressed were evaluated through histopathological sampling. In case of non-diagnostic biopsy, patients were recalled and FNA/core biopsy was repeated. Cytology and pathology specimens were evaluated by a pathologist with at least 10 years of experience. Before the histopathological diagnosis, all patients were prospectively evaluated with ultrasonography by a radiologist blinded to the patient's clinic and history, and images were taken. After the pathology results, PDUS and SMI images were re-evaluated and the findings were compared with each other and pathology results. Finally, two radiologists with 22 years and 4 years of experience evaluated the images in terms of separately determined features without knowing the patient's clinical information and pathology result. The results were compared with each other in order to assess interobserver agreement.

Both PDUS and SMI assessed vascular patterns based on the number of internal vessels, the distribution (avascular/central/peripheral/mixed) and appearance (normal, dysplasic, avascular) of internal vessels. On SMI, both monochrome (mSMI) and color (cSMI) images were assessed. If there was diffuse cortical thickening of the lymph node, the entire cortex was included the images. Likewise if there was an asymmetric cortical thickening, images focused on that part.

Cortical flow signals were taken into account while internal vascularity was quantified. The lymph nodes with no vascular signals in the cortex were classified as avascular, the nodes with peripheral vascular signals as peripheral, the nodes with vascular signals extending from the hilus to the cortex as central, and the nodes with vascular signals in both the periphery and the central as mixed. To evaluate the morphology of the vessels, the signals with smooth, symmetrical hilar extension were considered as normal, the eccentric signals were identified as diplasic, and the lymph nodes without a signal were regarded as avascular.

Statistical Analysis In the study, mean and standard deviation were used for continuous variables, while frequency and percentage values were used when specifying categorical variables. The Kolmogorov-Smirnov and Shapiro Wilk test was used to evaluate the homogeneity of the patient distribution. Student t-test and Mann Whitney U test were used for continuous variables. Chi-square test or Fisher's exact chi-square test was used to evaluate categorical features In order to evaluate the diagnostic performance of each investigated feature of Doppler methods in the differentiation of benign and malignant lymph nodes, the area under the curve (AUC) was calculated separately by receiver operating characteristic (ROC) analysis, depending on whether they were used individually or together. Logistic regression analysis was used to determine the significance value when the features were used together. In addition, sensitivity, specificity, positive predictive value(PPV), negative predictive value (NPV) and accuracy of each method were evaluated.

The Kohen Kappa test was used for categorical features in both SMI and PDUS to assess interobserver agreement. Intragroup correlation coefficient test was used to compare vascular numbers. Chi-square test or Fisher's exact chi-square test was used to evaluate vascular properties between benign and malignant categories after consensus.

All statistical analyses was performed with SPSS version 25.0 (IBM Corp. Armonk, NY: USA. Released 2017). P value \<0.05 was considered statistically significant.

Benign-Malign Differentiation of Axillary Lymph Nodes: The Role Of Superb Microvascular Imaging

Benign-Malign Differentiation Of Axillary Lymph Nodes: The Role Of Superb Microvascular Imaging

The number of vascularity in axillary lymph nodes are assessed via inspection of the images of Superb Microvascular Imaging and Power Doppler Ultrasound by observers. Countable vascular signals are noted for each lymph nodes

Vascular distributions in axillary lymph nodes are assessed via inspection of the images of Superb Microvascular Imaging and Power Doppler Ultrasound by observers and are categorized as avascular, central, peripheral and mix.

Vascular appearance in axillary lymph nodes are assessed via inspection of the images of Superb Microvascular Imaging and Power Doppler Ultrasound by observers and are categorized as normal/central,eccentric, avascular.

Ankara Education and Research Hospital

Digestive System Diseases

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

Current best practice of intraoperative fluid restriction

Oesophageal Doppler-guided fluid administration

Non-invasive measurement of doppler-derived cardiovascular variables (CO, aortic flow rate). Used safely over 800, 000 times

Oesophageal Doppler

Current best practice of avoiding fluid overload by intraoperative fluid restriction

Intraoperative fluid restriction

Andrew G Hill, MBChB MD FRACS

Perioperative fluid management has been historically dictated by outdated, contradictory concepts. Excessive or inadequate fluid administration around surgery is deleterious and hence goal-directed fluid therapy using Oesophageal Doppler-derived cardiac indices is preferable to optimize tissue perfusion. Previous studies in this area have been hampered by lack of standardization in other aspects of perioperative care and none have explored the impact of individualized fluid therapy on post-operative fatigue.The investigators proposed a study involving 80 patients having open/ laparoscopic colonic surgery to investigate the effect of Oesophageal Doppler guided fluid administration intraoperatively compared to current best practice of fluid restriction. The investigators have an optimized peri-operative care pathway established at the Manukau Surgical Centre (MSC), Middlemore Hospital. All patients will be cared for under the Enhanced Recovery After Surgery (ERAS) multimodal care plan therefore ensuring that all other aspects of care besides intraoperative fluid administration remain homogenous. Outcomes will include post-operative recovery, clinical outcomes as well as physiological data with follow-up to 30 days.

Until very recently, modern perioperative fluid management has involved routine administration of large quantities of fluids during major surgical procedures, typically causing a weight increase of 3-6 kg in the early post-operative period.Several factors, including concern about preoperative dehydration, attempts to support the circulation and cardiac function after general and regional anaesthesia, prevention of blood transfusion and maintenance of adequate kidney perfusion have historically lead to excess perioperative fluid administration.

However administration of excess fluid has been shown to contribute to postoperative morbidity. It increases demand on the heart and may adversely affect postoperative cardiac function. It may also lead to increased pulmonary complications. Fluid overload may lead to oedema of the gastrointestinal tract and hence contribute to post-operative gastrointestinal paralysis, bacterial translocation and sepsis. Excess fluid also has been shown to decrease tissue oxygen tension with potential deleterious effects on anastomotic and wound healing.

Therefore, current best practice has centred on fluid restriction peri-operatively with an increased focus on the intraoperative fluid regimen. Since hypovolaemia is also associated with a myriad of adverse outcomes, a balanced perioperative intravenous fluid regimen focussing on tissue perfusion is thought to be optimal. By using the Oesophageal Doppler Monitor (ODM) as a means to non-invasively estimate intra-operative cardiac output, significant improvements in outcome have been observed in patients undergoing major orthopaedic and cardiac procedures. Previous studies in patients undergoing major abdominal surgery have demonstrated that goal-directed intraoperative fluid administration using ODM may result in improved outcomes such as reduced number of critical care admissions, reduced hospital stay and overall decreased morbidity.

In the broader context of perioperative care in colonic surgery, recent developments have included Enhanced Recovery After Surgery (ERAS) programmes- a combination of various evidence-based strategies implemented together as part of a standardised protocol to synergistically decrease post-operative fatigue and improve outcomes. These strategies include preoperative counselling, avoidance of mechanical bowel preparation, pre-operative carbohydrate loading, perioperative high-flow oxygen therapy, mid-thoracic epidural analgesia, avoidance of parenteral opioids and routine wound drainage, use of short or transverse incisions, early mobilisation, early feeding and a balanced analgesia regiment. ERAS protocols are also ideal for well-designed clinical trials as they provide a template to trial new interventions on the background of an otherwise homogenous, optimised perioperative care programme. An ERAS programme has been implemented and prospectively evaluated at Manukau Surgical Centre, Middlemore Hospital in Auckland.

In a recently published systematic review, we identified that a major short-coming of the literature in this field is the non-standardised nature of peri-operative management of the patients in these studies. Although fluid management was optimised, the other aspects of care were not optimised or even standardised, introducing the risk of significant confounding. Furthermore, none have explored the role of fluid management on post-operative functional recovery- an important metric of patient-relevant outcomes evaluating recovery beyond physiological and clinical parameters. Furthermore, none of the published ERAS programmes have used ODM as part of their peri-operative strategies. Consequently, the true impact of optimised fluid therapy within an environment of current best-practice (ERAS) is unknown.

Methods Research Design We will conduct a double-blinded, randomised controlled trial of ODM versus fluid restriction (current best-practice) in patients undergoing colonic surgery within our ERAS programme to determine whether individualising fluid administration enhances post-operative recovery, thereby improving patient outcomes.

Sample Size:

To detect a 20% improvement in recovery as measured by the Surgical recovery Score at Day 7 (based on data from our previous work), we will require 37 patients in each arm (α= 0.05, β= 0.8) Therefore, we shall aim to recruit 80 patients anticipating for possible drop-outs.

Patients will be consented and then randomised by computer generated random numbers and the opaque envelope method. All Patients will have an oesophageal probe inserted with readings not available to the anaesthetist for patients in the control group (the screen will be covered). At the commencement of anaesthesia, the patient will be randomised to receive fluid management optimised by ODM data or by standard parameters. The patients, surgeons and investigators will be blinded to the intervention. The anaesthetists will use a validated protocol for the treatment group. Measurements of cardiac indices (Cardiac Output, Aortic Flow Rate) from the ODM will be noted intraoperatively. The Oesophageal probe shall be removed at the end of surgery prior to the patient waking up. All other aspects of perioperative care will be according to our previously developed ERAS programme.

Randomised Trial of Doppler-Optimised Fluid Balance in Elective Colectomy

Prospective, Double-Blinded, Randomised Controlled Trial of Doppler-Optimised Fluid Balance in Elective Colectomy Within an ERAS Protocol

As defined using trial by Buzby et al Am J Nutr 1989 and graded according to Clavien-Dindo classification

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Risk of Malignancy Index and Assiut Scoring Model for Adnexal Malignancy	NCT03404687	Risk Malignant ...	ultrasound cancer antigen ... Doppler	18 Years - 60 Years	Assiut University
Intraoperative Functional Ultrasound	NCT02656407	Brain Tumor Brain Lesion	Ultrasound devi...	18 Years -	Institut National de la Santé Et de la Recherche Médicale, France
Assessment of Blood Vessel Density in Kaposi's Sarcoma Lesions	NCT00026793	Kaposi's Sarcom...		18 Years - 100 Years	National Institutes of Health Clinical Center (CC)
Benign-Malign Differentiation of Axillary Lymph Nodes: The Role Of Superb Microvascular Imaging	NCT05927727	Diagnosis Axilla; Breast	Ultrasound and ...	18 Years - 74 Years	Ankara Education and Research Hospital
Randomised Trial of Doppler-Optimised Fluid Balance in Elective Colectomy	NCT00911391	Colorectal Canc... Colectomy Surgery Perioperative C...	Oesophageal Dop... Intraoperative ...	18 Years - 90 Years	University of Auckland, New Zealand

Spots Global Cancer Trial Database for doppler

Every month we try and update this database with for doppler cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Spots Global Cancer Trial Database for doppler

Every month we try and update this database with for doppler cancer trials from around the world to help patients and their families find trials that might be right for them. We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Every month we try and update this database with for doppler cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.