Actual Pathology Research Articles

Appendicitis but Not Appendicitis; Utility of Ultrasound in Management of Children with Suspected Appendicitis

Objective: Undifferentiated abdominal pain in children is a common presentation to Emergency Department (ED). Diagnostic imaging, in particular, ultrasound, in addition to laboratory tests is often used in this cohort. This study aims to assess the utility of ultrasound in suspected appendicitis in management options. Methods: A 5-year retrospective cross-sectional data analysis of children under the age of 16 presented to Monash Health EDs with abdominal pain between June 2014 and June 2019 was conducted. Among 271934 (total) presentations, 20934 presented with abdominal pain (traumatic and non-traumatic) and 1131 patients were highly suspected for appendicitis who were investigated in ED or hospitalised for ongoing investigation and management. Results: 162 (14.3%; 95% CI, 12.3-16.4) patients had ultrasound findings suggestive of appendicitis, with a further 147 (13.0%; 95% CI, 11.0-15.0) admitted to paediatric surgical ward. 111 (9.81%; 95% CI, 8.1-11.5) patients subsequent underwent diagnostic laparoscopy during their admission which 109 (9.63%; 95% CI, 7.9- 11.4) confirmed intraoperative appendicitis. The mean appendix size difference in patients discharged vs admitted and cases that underwent diagnostic laparoscopy vs conservative management were 0.576mm (95% CI, -1.16-2.32). and 0.217 (95% CI, -1.03-1.47) respectively. Given that the P values of the differences are 0.513 and 0.732 respectively (P>0.05), the results are not statistically significant. Conclusions: The appendix size on ultrasound did not show any correlation with the actual pathology or management option. Clinical picture and clinician’s judgement were the main factors in determining management.

Peculiar presentation of congenital cholesteatoma in a young girl with congenital canal atresia

Congenital cholesteatoma is a rare entity, which traditionally is diagnosed as an incidental finding. The patient typically turns out to clinic complaining of reduced hearing and classical otoscopic finding of congenital cholesteatoma leads to the diagnosis. These may not be the case in a patient with underlying canal atresia which oftentimes may feign the actual pathology. Herein, we present a case of cholesteatoma in a teenage girl with congenital canal atresia who presented with recurrent postauricular abscess. The patient subsequently underwent modified radical mastoidectomy with meatoplasty. We would like to draw attention to the fact that early recognition and intervention are prudent as delaying appropriate management may succumb both patient and physicians to devastating outcomes and unnecessary burden.

Intraoperative electrophysiology in children - Single institute experience of 96 examinations.

To summarize our experience gathered during the use of different intraoperative electrophysiological modalities in children. We analyzed the data collected from 96 pediatric neurosurgical interventions. During the operations, we used a combination of intraoperative electrophysiological examinations tailored to the actual pathologies. The modalities included cortical and white matter mapping, cranial nerve and cranial nerve nucleus stimulation, motor evoked potential (MEP), somatosensory evoked potential (SSEP), peripheral nerve stimulation, bulbocavernosus reflex, and a special setup for selective dorsal rhizotomy. The success ratio of the different modalities varied between 25% and 100%. All the applied methods could be used in children. Although the application of certain intraoperative techniques could be limited due to the ongoing developmental and maturation processes in childhood, we can not exclude the possibility of successful recording in any modality. Thus, we recommend to apply all the available methods in children bearing in mind that the success ratio might be lower than that in the adult population.

713P - Advantage of three-dimensional image analysis of pancreatic cancer using computed tomography

BackgroundAlthough pancreatic cancer has irregular shape in three-dimensional (3D), when T staging by imaging, only the axial plane is generally used to measure the largest diameter of the mass. We analysed the size of the pancreatic cancer from multi-plane and 3D reconstructed CT images and investigated their clinical usefulness. MethodsPatients who underwent surgery for pancreatic adenocarcinoma from 2009 to 2016 were included in this study. We measured the largest diameter of pancreatic cancer in axial, coronal, and sagittal planes of CT. In addition, semi-automated segmentation was performed and three-dimensional (3D) maximal diameter and cancer volume were obtained. The obtained data were compared with the actual pathology report and the effect of each value on prognosis was analyzed by receiver operating characteristics (ROC) curves. ResultsA total of 183 patients were analyzed. The maximal pathologic diameter of cancer was 3.4±1.4 cm and median survival was 18.1 months. The maximal diameters measured in axial, coronal, and sagittal planes were 2.9 ± 1.1, 3.2 ± 1.0, and 3.2 ± 0.9, respectively, which were significantly smaller than pathologic data (all p<0.05 by paired T test). The longest diameter among measured on the 3 planes (3.4 ± 1.1) were not significantly different from that of pathologic report and maximal diameter from 3D image (3.8 ± 1.3) was larger than pathologic diameter. Cancer volume demonstrated the higher area under the ROC curve [0.714, (95% confidence interval: 0.640-0.788)] in predicting early death within 18 months than any measured diameter. ConclusionsThe diameter of pancreatic cancer needs to be measured on all of axial, coronal, and sagittal planes of CT. Cancer volume had a stronger correlation with overall survival than cancer diameter. Legal entity responsible for the studyThe authors. FundingThe National Research Foundation of Korea. DisclosureAll authors have declared no conflicts of interest.

Whole slide imaging equivalency and efficiency study: experience at a large academic center

Whole slide imaging is Food and Drug Administration-approved for primary diagnosis in the United States of America; however, relatively few pathology departments in the country have fully implemented an enterprise wide digital pathology system enabled for primary diagnosis. Digital pathology has significant potential to transform pathology practice with several published studies documenting some level of diagnostic equivalence between digital and conventional systems. However, whole slide imaging also has significant potential to disrupt pathology practice, due to the differences in efficiency of manipulating digital images vis-à-vis glass slides, and studies on the efficiency of actual digital pathology workload are lacking. Our randomized, equivalency and efficiency study aimed to replicate clinical workflow, comparing conventional microscopy to a complete digital pathology signout using whole slide images, evaluating the equivalency and efficiency of glass slide to whole slide image reporting, reflective of true pathology practice workloads in the clinical setting. All glass slides representing an entire day's routine clinical signout workload for six different anatomic pathology subspecialties at Memorial Sloan Kettering Cancer Center were scanned on Leica Aperio AT2 at ×40 (0.25 µm/pixel). Integration of whole slide images for each accessioned case is through an interface between the Leica eSlide manager database and the laboratory information system, Cerner CoPathPlus. Pathologists utilized a standard institution computer workstation and viewed whole slide images through an internally developed, vendor agnostic whole slide image viewer, named the “MSK Slide Viewer”. Subspecialized pathologists first reported on glass slides from surgical pathology cases using routine clinical workflow. Glass slides were de-identified, scanned, and re-accessioned in the laboratory information system test environment. After a washout period of 13 weeks, pathologists reported the same clinical workload using whole slide image integrated within the laboratory information system. Intraobserver equivalency metrics included top-line diagnosis, margin status, lymphovascular and/or perineural invasion, pathology stage, and the need to order ancillary testing (i.e., recuts, immunohistochemistry). Turnaround time (efficiency) evaluation was defined by the start of each case when opened in the laboratory information system and when the case was completed for that day (i.e., case sent to signout queue or pending ancillary studies). Eight pathologists participated from the following subspecialties: bone and soft tissue, genitourinary, gastrointestinal, breast, gynecologic, and dermatopathology. Glass slides signouts comprised of 204 cases, encompassing 2091 glass slides; and digital signouts comprised of 199 cases, encompassing 2073 whole slide images. The median whole slide image file size was 1.54 GB; scan time/slide, 6 min 24 s; and scan area 32.1 × 18.52 mm. Overall diagnostic equivalency (e.g., top-line diagnosis) was 99.3% between digital and glass slide signout; however, signout using whole slide images showed a median overall 19% decrease in efficiency per case. No significant difference by reader, subspecialty, or specimen type was identified. Our experience is the most comprehensive study to date and shows high intraobserver whole slide image to glass slide equivalence in reporting of true clinical workflows and workloads. Efficiency needs to improve for digital pathology to gain more traction among pathologists.

Efficacy of complex medical rehabilitation of employees of special squads with the autonomic dysfunction of the cardiovascular system

Relevance. Vegetative dysfunctions of the cardiovascular system are an actual pathology among the employees of the special agent, while vegetative disorders are not severe. In diagnostics, simple physical methods for estimating are effective, the results of which correlate with the data of instrumental survey. Aticle is devoted to the question of comparing the effectiveness of various schemes of medical rehabilitation of employees of the special agent having manifestations of autonomic dysfunction of the cardiovascular system at the stationary stage. The methods of traditional rehabilitation with the use of physical methods and methods, including complex effects of physical, psychotherapeutic and medicinal methods were compared. It is shown that the complex rehabilitation of the special component. In provides the best performance recovery in the short term and ensures the preservation of good indicators of tolerability of professional factors in the long term.&#x0D; Purpose. Study the effectiveness of various schemes of medical rehabilitation of employees of the special agent having manifestations of autonomic dysfunction of the cardiovascular system&#x0D; Material and methods. Study was conducted in a group of 60 employees who underwent medical rehabilitation and examination of temporary disability at the centers for medical rehabilitation of the Ministry of internal Affairs of Russia after performing special tasks in 20122013.&#x0D; Results. It is shown that complex rehabilitation of a special component C in C provides the best indicators of recovery of working capacity at the short-term stage and ensures the preservation of good indicators of tolerability of professional factors in the long-term period.&#x0D; Conclusions. The results obtained show significant advantages of conducting comprehensive medical rehabilitation of employees after performing special tasks, both immediately after their implementation, and in achieving stable remission in the long term, ensuring the retention of qualified and experienced employees and prolonging professional longevity.

Purging ‘Factionalist’ Opposition to Kim Il Sung – The First Party Conference of the Korean Worker’s Party in 1958

In March 1958, delegates from across North Korea met in the National Art Theatre in Pyongyang for the First Conference of the Korean Worker’s Party. To date, it has an event largely overlooked by South Korean and Western historians of North Korea because of a lack of source material. The newly unearthed official minutes, however, reveal a highly staged event in which the opponents of high-level party opponents of Kim Il Sung (Kim Ilsŏng 김일성) are subjected to what amounts to a show trial, before they lose their party membership. The official minutes are notable for containing one of the only official North Korean descriptions of the alleged plot by certain military members of the Yanan Faction to overthrow the Kim Il Sung government in a military coup. The purpose of the Party Conference within Marxist-Leninist parties is discussed, the background to the Conference and developments in the communist world are also described. The delegate roster is then briefly analysed, interesting and significant statistics are explained with broader reference to North Korean history—the context and what it can tell us about the structure of power in the Korean Workers Party back then. Following this, the show trial by conference is detailed. The trial by conference is split into two parts, the first dealing with their economic crimes and the second with their political crimes. This article discusses both sets of allegations in light of the actual economic pathologies of Soviet-type economies and the political nature of the Kim Il-sungist system.

Questioning the status quo: Should Gleason 3+3=6 PCa be considered a “negative core” for pre-RP risk nomograms?

31 Background: Current pre-radical prostatectomy (RP) nomograms predicting RP pathology do not differentiate between Gleason 6 prostate cancer (Gl6 PCa) and clinically significant Gleason 7-10 PCa. As such, use of these nomograms can be problematic. We assess the impact of excluding Gl6 PCa on nomogram and RP outcomes. Methods: Utilizing a prospectively maintained database, all men who underwent prostate biopsy (PBx) prior to RP were identified. Each patient was assessed using the MSKCC Kattan and Briganti nomogram using the following iterations: 1) “Original” [ORIG] (all available core data) and 2) "Selective” [SEL] (only cores Gleason score ≥7). Nomogram outcomes (risk of LNI, ECE, SVI, and OCD), were compared across iterations and stratified based on pre-RP risk classification (3+3 [low], 3+4, 4+3, 8-10 [high]). Clinically significant impact on management [CSIM] was defined as a change in risk of LNI above or below 2% (Δ2) or 5% (Δ5), based on current guidelines recommendations for PLND. Nomogram outcomes were validated using RP pathology. Results: 1118 men met inclusion criteria. Using the Kattan nomogram, when compared to actual RP pathology, the SEL iteration was a better predictor of LNI, ECE and OCD than the ORIG iteration, but not SVI. Using the Briganti nomogram, the SEL iteration was a better predictor of LNI. As for CSIM, the greatest impact was on men with Gl7 PCa. In the 359 Gl 3+4 patients, Δ2 was 3.9-28.13% and Δ5 was 12.81-17.27%. In the 184 Gl 4+3 patients, Δ2 was 0% and Δ5 was 7.61-11.41%. In all cases, the change favored decreased need for PLND. Conclusions: As Gleason 3+3=6 PCa is increasingly being considered an insignificant prostate cancer, its inclusion in established pre-RP nomograms becomes problematic. We find that excluding Gl6 PCa cores from these nomograms can reduce the need to complete a PLND at the time of RP, and more importantly, may better reflect the true extent of cancer. [Table: see text]

Contribution of Metagenomics Towards Identification of Oral Flora-A Review

Oral flora has always presented itself in a perplexing way in terms of its biodiversity and niche. Over the years numerous techniques have been used to identify and relate these microbes to oral and systemic diseases. Recently, metagenomics has gained predominance in this field due to its potential in detecting non-cultivable flora. In the previous decade several reports have been published on identification of floral pattern, new flora and relation of such patterns to pathological processes and risk marking. But a consolidated review, linking these to actual pathology is still not published. This review provides an insight into current status of such associations.

Incidental mastoiditis on magnetic resonance imaging scans: clinical relevance and cost implications.

To determine: (1) the incidence of incidental 'mastoiditis' reported on magnetic resonance imaging scans performed in patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus; (2) how many of those patients have actual otological pathology and/or require treatment; and (3) the financial implications of such a reporting practice. Retrospective case series. Between October 2015 and November 2016, 500 patients underwent magnetic resonance imaging of the internal auditory meatus to rule out cerebellopontine angle lesions. There was an incidental finding of increased mastoid signalling in 5.8 per cent (n = 29), of which 20.7 per cent (6 of 29) were reported as bilateral cases. The diagnosis of 'mastoiditis' was found in 39.7 per cent (29 of 73). None of these patients had any pathology identified clinically. Other significant pathology was identified in a further 8.8 per cent (n = 44). The diagnosis of mastoiditis is primarily clinical. An incidental finding of high signalling in the mastoid region on magnetic resonance imaging is highly unlikely to represent actual clinical disease. In patients who are scanned for other reasons and who do not complain of otological symptoms, such findings are unlikely to require otolaryngology input.

New technique of ultrasound-guided injection in the carpal tunnel syndrome

In conventional ultrasound-guided corticosteroid injection in carpal tunnel syndrome (CTS), the entry point is usually at the distal crease of the wrist. However, actual pathology of CTS is caused by thickening of the transverse carpal ligament (TCL). Injection of corticosteroid can reduce inflammation and ameliorate the symptoms, but it cannot reduce the thickness of TCL. If we change the entry point to just 10 mm below the distal crease rather than at the distal crease, we can inject corticosteroid around the median nerve and into the TCL. Five patients with CTS treated with ultrasound-guided corticosteroid injection around median nerve and into the TCL. The diagnosis of CTS was made by history, physical examination, sonographic evaluation, and electrophysiologic confirmation. Sonographic examinations were performed by one physiatrist using Samsung scanner with a 5–12 MHz linear transducer. Standard 23-gauge needles were used for administration of local anesthetics and triamcinolone mixture (total 1 cm 3 ). After transverse view and longitudinal view, the entry point was determined. The entry point was below the distal crease, where the needle could easily introduce the injection material into the thickened TCL. The direction of the needle entry point was from lateral to ulnar side. Total of five female patients with CTS were included. The mean age was 55.4 ± 3.6 years. The mean duration of disease was 4.6 (range 3–8 mo) months. The results were good to excellent in all patients. There were no complications during the procedure. Ultrasound-guided corticosteroid injection in CTS, combined with injection at the thickened TCL may be a good method and further research is needed to confirm the usability.

Anonymous live liver donation: Outcomes of 50 cases

The aim of this study was to discuss the macroscopic and microscopic properties of gallbladder specimens obtained from living liver donors.The study retrospectively analyzed the clinical and histopathological data of 1088 donors who underwent living donor hepatectomy between March 2005 and September 2014 at Inonu University Faculty of Medicine, Liver Transplantation Center. Age, sex, macroscopic, and microscopic properties of the gallbladder (bladder length, diameter, content, and histopathological properties) were recorded by 2 researchers.A total of 1009 donors aged 17 to 66 years (31.1 ± 9.5) met the inclusion criteria, whereas 79 donors were excluded due to missing data. In total, 587 donors were male (30.5 ± 9.1 years [16–63 years]) and 422 were female (31.8 ± 9.8 years [18–66 years]). Preoperative tests revealed Gilbert syndrome in 3 subjects, whereas other donors' biochemical tests were within normal ranges. The macroscopic examination of gallbladders revealed mean gallbladder wall thickness, length, and width of 1.82 ± 0.8 mm (1–10 mm), 72 ± 11.4 mm (40–120 mm), and 52.5 ± 14 mm (15–90 mm), respectively. The microscopic gallbladder examination showed that 740 donors had a normal gallbladder, 193 had chronic cholecystitis (1 donor had antral metaplasia and 1 had intestinal metaplasia), 40 had cholesterolosis (1 donor had both tubular adenoma and intestinal metaplasia), 15 had minimal chronic cholecystitis (1 donor had pyloric metaplasia), 14 had cholelithiasis, 2 had adenomyosis, 2 had muscular hypertrophy, 1 had papillary hyperplasia, 1 had microdiverticulitis, and 1 had mucosal lymphatic ectasia.The results of this study reflect the actual gallbladder pathologies that can be detected in healthy people. Clearer conclusions can be reached about the epidemiological data on gallbladder as the number of living liver donors increases in the future.

Routine addition of diffusion-weighted imaging to pediatric brain imaging with acute presentation: An initial experience

Context: A number of disorders affecting the pediatric brain pose a diagnostic challenge. Magnetic resonance imaging (MRI) is widely accepted as a sensitive technique for the diagnosis of ischemia, encephalitis, and leukodystrophies. Conventional MR sequences used in routine practice include T1-weighted (T1-W), T2-weighted, and fluid-attenuation inversion recovery (FLAIR) sequences. However usually, the presentation in small children is confusing and presents a diagnostic challenge even after the use of these various MR sequences requiring repeated MRI examinations. Detecting pathological changes occurring at microenvironment level is vital for early diagnosis, effective treatment, and obviating the need of repeated MRI. Aims: The purpose of our study was to assess the additional role of diffusion-weighted imaging (DWI) in better detection of these various pathologies of brain. Settings and Design: This was a prospective study. Subjects and Methods: Thirty children of ages ranging from neonate to 12 years of age with various complaints of central nervous system involvement were evaluated with MRI brain within 72 h of initial clinical presentation. T1 and T2 spin-echo sequences FLAIR and postcontrast T1-W imaging were done. DWI was performed with echoplanar imaging using depth-resolved surface coil spectroscopy sequence. The lesions were evaluated on DWI and conventional sequences. The final diagnosis was established on the basis of clinical evaluation, electroencephalographic findings, imaging, cerebrospinal fluid analysis, serologic tests, and fatty acid evaluation in plasma assay. Statistical Analysis Used: This was a descriptive study. Results: The patients were divided into three groups. Group A included patients in whom DWI detected more lesions or showed a greater extent of lesions on apparent diffusion coefficient (ADC) map than conventional MRI. This group had 11 cases including 7 cases of ischemic encephalopathy, one case of adrenoleukodystrophy (ADL) showing increased extent of lesion with restricted diffusion at the advancing edge and 3 cases of viral encephalitis. In Group B, 12 cases had similar results in both DWI and conventional MRI imaging. Of these, 7 cases with no specific diagnosis and subsequent spontaneous recovery showed no lesion on both conventional and DWI; 5 cases showed equal extent and number of lesions on DWI; 1 case was diagnosed as ADL, 2 as viral encephalitis, and 2 as ischemic encephalopathy on final workup. In Group C, T2 and FLAIR showed more lesions than DWI and had 7 cases. 5 had normal ADC maps but 1–2 small hyperintense lesions on T2 and FLAIR imaging, while the remaining two diagnosed with ischemic encephalopathy had hyperintense areas on T2 and FLAIR sequences with associated ventricular enlargement and cortical atrophy while DWI revealed them to be T2 shine through areas with increased ADC value focally. The 5 cases with hyperintensity on T2 and FLAIR, but normal ADC maps were labeled as nonspecific white matter hyperintensities. These children showed neither any progress of lesion nor any further clinical symptoms during the duration of study. Conclusions: We concluded that DWI was more sensitive than the other MR sequences in detecting early pathological changes even in cases of viral encephalitis and leukodystrophy apart from ischemia. It was also helpful in delineating the area more accurately at the microscopic level. We were also able to rule out actual pathology from nonspecific hyperintensities on T2 and FLAIR in some cases on DWI.

Evaluación multidimensional de la calidad de voz de los futuros intérpretes vocales de élite

Introduction and objective: This study correlates the Singing Voice Handicap Index (SVHI) scores with videostrobolaryngoscopy and acoustic analysis in healthy professional singers, as a measure of self-perceived vocal health, versus actual pathology diagnosed during examination by stroboscopy, or by modification at the acoustic voice evaluation. The objectives of the study were to measure the strength of self-assessment among professional singers and to determine whether there is a benefit of combining SVHI, acoustic analysis and videostrobolaryngoscopy for the routine assessment of singers who have no obvious singing voice problem. Method: Prospective cross-sectional study. The voice quality of 40 students of the Music Academy, Cluj-Napoca, was assessed by means of a multidimensional test battery containing a singing voice handicap index (SVHI), as well as SVHI-10, videolaryngostroboscopy, maximum phonation time on vowel /a/, S/Z ratio, Jitter, Shimmer and NHR (Harmonic Noise Ratio, at lowest, highest and conversational frequency). Additionally, in a questionnaire on daily habits has been recorded for the participants, covering the prevalence of smoking, eating habits, and vocal abuse. The correlation between SVHI scores, acoustic analysis and pathologic findings seen on videostrobolaryngoscopy was analyzed using linear regression and serial t tests to draw the conclusions of this study. Results: Both SVHI and SVHI-10 scores showed, as previously expected, normal values for healthy singers (SVHI-10 being the singers preferred metric). However, although all participants self-identified as healthy, laryngeal abnormalities were relatively common. Acoustic analysis of students voices identified relative instability of pitches, problems with F0 variation, TMF (Maximum Phonation Time) and S/Z ratio. No Significant correlation (P = 0.9501) between SVHI scores, acoustic analysis and videostrobolaryngoscopy findings were shown by the linear regression analysis. Conclusions: Multidimensional assessment of voice quality for the routine evaluation of singers without obvious singing voice problems is an important tool for the early detection of voice problems, despite appearances of a healthy voice. A trained singer has the possibility to compensate minor laryngeal modifications using singing techniques and, thus, is at risk of overlooking or ignoring an existing pathology. In conclusion, acoustic evaluation of the performers’ voices through the methods outlined above could assist in early detection and treatment of vocal pathology.

Accuracy of kidney cancer diagnosis and histological subtype within Canadian cancer registry data.

Provincial/territorial cancer registries (PTCRs) are the mainstay for Canadian population-based cancer statistics. Each jurisdiction captures this data in a population-based registry, including the Nova Scotia Cancer Registry (NSCR). The goal of this study was to describe data from the NSCR regarding renal cell carcinoma (RCC) pathology subtype and method of diagnosis and compare it to the actual pathology reports to determine the accuracy of diagnosis and histological subtype assignment. This retrospective analysis included patients diagnosed with RCC in the NSCR from 2006-2010 with an ICD-O-3 code C64.9 seen or treated in the largest NS health district. From the NSCR, method of diagnosis and pathological diagnosis was recorded. All diagnoses of non-clear-cell RCC (nonccRCC) from NSCR were compared to the actual pathology report for descriptive comparison and reasons for discordance. 723 patients make up the study cohort. 81.3% of patients were diagnosed by nephrectomy, 11.1% radiography, 6.9 % biopsy, and 0.7% autopsy. By NSCR data, 52.8% had clear-cell (ccRCC), 20.5% RCC not otherwise specified (NOS), 12.7% papillary, 4% chromophobe, and the rest had other nonccRCC subtypes. By pathology reports, 69.5% had clear-cell, 15% papillary, 5% chromophobe, only 2.7% RCC NOS. There was a discordance rate of 15.4% between NSCR data and diagnosis from pathology report. Reasons for discordance were not enough information by the pathologist in 45.5%, misinterpretation of report by data coder in 22.2%, and true coding error in 32.3%. When using PTCR for RCC incidence data, it is important to understand how the diagnosis is made, as not all are based on pathological confirmation; in this cohort 11% were based on radiology. One must also be aware that clear-cell and non-clear-cell subtypes may differ between the PTCR data and pathology reports. In this study, ccRCC made up 52.8% of the registry diagnoses, but increased to 69.6% on pathology report review. Use of synoptic reporting and ongoing education may improve accuracy of registry data.

The Accuracy of the Pelvic Exam Compared to Ultrasound and Pathology Measurements Based on Body Mass Index [28H

INTRODUCTION: The purpose of this study was to evaluate the accuracy of pelvic exam when compared to ultrasound measurements and pathology weight depending on BMI. To our knowledge, there are limited studies evaluating the effect of BMI on accuracy of bimanual examination and a more recent investigation is long overdue. METHODS: This was a retrospective chart review of patients over the age of 18 undergoing hysterectomy for benign indications between July 2010 and July 2015. Bimanual examination and ultrasound measurements of the uterus prior to surgery were compared to pathology weight and then their accuracy was compared based on BMI. Concordance correlation coefficients were used to estimate accuracy of these measurements. Bland-Altman plots were used to compare the weights from clinical exam and ultrasound to the actual pathology weight. RESULTS: 981 records were reviewed, of those 364 met inclusion criteria. Average weight of the uterus was 454.04 gm (+/-475.27). Average age and BMI of women undergoing hysterectomy was 45.5 years (+/-7.5) and 31.65 (+/- 7.09) respectively. Overall concordance between the three different methods of estimating uterine size ranged from 0.73 to 0.82. Concordance did not differ significantly between different BMI categories. CONCLUSION: The findings of pelvic exam are similar to ultrasound measurements when compared to pathology weight regardless of BMI whenever the uterine size can be estimated. These results suggest that if uterine size can be assessed, ultrasound may not be necessary for preoperative evaluation.

MP33-18 OVER HALF OF CONTEMPORARY CLINICAL GLEASON 8 ON PROSTATE BIOPSY ARE DOWNGRADED AT RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Detection & Screening III1 Apr 2017MP33-18 OVER HALF OF CONTEMPORARY CLINICAL GLEASON 8 ON PROSTATE BIOPSY ARE DOWNGRADED AT RADICAL PROSTATECTOMY Tracy Han, Ilhan Gokhan, Ghalib Jibara, Robert Qi, and Judd Moul Tracy HanTracy Han More articles by this author , Ilhan GokhanIlhan Gokhan More articles by this author , Ghalib JibaraGhalib Jibara More articles by this author , Robert QiRobert Qi More articles by this author , and Judd MoulJudd Moul More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1014AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Accurate biopsy Gleason scoring is critical for the proper treatment of prostate cancer (PC). Here, we present an alarming discrepancy between PC diagnosed as high-risk pathology on biopsy and their actual pathology after radical prostatectomy (RP). METHODS We retrospectively reviewed 1034 men who underwent open RP by a single surgeon between 2004 and 2015. 112 men were diagnosed with Gleason 8 pathology on prostate biopsy. We excluded 5 patients whose RPs were aborted and 4 whose neoadjuvant treatments prevented proper Gleason scoring. Biopsy and RP pathology were compared in aggregate and over one-year time intervals. Chi-squared test, Fisher's exact test, Student's t-test, and Wilcoxon Rank-Sum test were used for statistical analysis. RESULTS 61.1% (63/103) of clinical Gleason 8 diagnoses were downgraded on surgical pathology after RP, with 60 specimens being downgraded to Gleason 7 (Gleason 4+3 n=39; Gleason 3+4 n=21). There were significant in-group differences among the one-year cohorts (p<0.02), with increased pathology downgrading over time that includes an 84.2% (32/38) downgrade rate from 2012-2015. Pathology downgrading is significantly associated with lower PSA at biopsy (median 6.9 vs 9.4 ng/ml, p<0.01), decreased tumor percentage (median 12 vs 15%, p<0.03), and lower percentage of positive margins (47.6 vs 66.7%, p<0.04). It is borderline associated with lower percentage of seminal vesicle invasion (11.1 vs 25.6%, p<0.06) and extracapsular extension (49.2 vs 69.2%, p<0.08). Neoadjuvant treatment (14/103), race, age, and clinical staging were not significantly associated with pathology downgrading. CONCLUSIONS The large, increasing percentage of pathology downgrading implies a high rate of over-diagnosis of Gleason 8 scores on biopsy, potentially leading to suboptimal treatment strategies and much patient distress. Our study adds great urgency to the efforts refining PC diagnostic techniques. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e424 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Tracy Han More articles by this author Ilhan Gokhan More articles by this author Ghalib Jibara More articles by this author Robert Qi More articles by this author Judd Moul More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Case‐Based Learning Using Cadaveric Pathology Specimens Enhances Learner Engagement in Reviewing Normal Anatomy

The University of Oklahoma College of Medicine implemented a major curricular change in 2010 that resulted in a shift from discipline‐based courses to integrated systems‐based pre‐ clinical courses. In the process, the traditional 16‐week Gross Anatomy course was transformed into a 6.5‐week foundational Human Structure course that includes gross anatomy, embryology, histology, radiologic anatomy, and clinical application of anatomical knowledge. The intent was to provide a foundational knowledge of anatomy that would be re‐visited in the subsequent systems‐based courses. During the 2011–2014 academic years, we provided review anatomy lectures in the Gastrointestinal/Hepatobiliary, and Reproductive Medicine courses. The education literature suggests that passive lectures are the less effective in producing desired learning outcomes than active learning methodologies.Study ObjectiveDetermine if it is possible to review anatomy at an appropriate level and cover adequate content in a more active learning process than traditional lectures.HypothesisStudents will successfully review systems‐based anatomy with improved engagement and retention of material by actively exploring anatomically‐based pathologies in cadavers and their corresponding case studies.InterventionWe developed an innovative way to review anatomy while also engaging students in clinical problem‐solving. Laboratory based case‐studies based on actual cadaveric pathologies were implemented in the MS2 CRR and Reproductive Medicine courses, and the MS1 GIH course.ResultsData collected on student attitudes, student learning outcomes, and faculty perceptions of the laboratories was analyzed to determine perceived effectiveness of the intervention. End of course evaluations indicate that students successfully review anatomy content and gain a deeper understanding of specific anatomically‐based pathologies. In addition, clinical faculty facilitators rated the teaching/learning experience highly.ConclusionLearners and faculty facilitators report that the experiential learning promoted by the pathology‐based laboratory review is engaging, enjoyable, and effective in reviewing systems‐based anatomy. Learners indicate that the case‐based anatomy laboratory enhanced their understanding of clinical applications throughout the remainder of the course.

Application of a computer-assisted flexible endoscope system for transoral surgery of the hypopharynx and upper esophagus.

Zenker's diverticulum is a common pathology in the transition zone of the posterior hypopharynx and esophagus. Surgical treatment is routinely performed by ENT and general surgeons. Besides the traditional open transcervical diverticulectomy, the introduction of transoral rigid treatment led to a paradigm change and is now the preferred treatment option for patients who are fit for general anesthesia. The implementation of interventional flexible endoscopy has opened another new micro-invasive approach for patients with high morbidity. Here, we present the potential utilization of a flexible, single port, robot-assisted, and physician-controlled endoscope system to facilitate transoral surgical access to the hypopharynx and upper esophagus. Transoral surgery of the hypopharynx and upper esophagus was performed in human cadavers (n = 5) using the Flex System (Medrobotics, Raynham, USA). Anatomical landmarks were identified, and posterior cricothyroid myotomy was performed with compatible flexible instruments in all cases. The approach to the hypopharynx and upper esophagus using the Flex system is feasible in a cadaveric model. Myotomy with a flexible tool and needle knife (from the perspective of treatment of Zenker´s diverticulum) was successful in all cases. Visualization of the surgical site with the system's HD camera is suitable and the flexible instruments meet the special needs of a micro-invasive transoral approach. Zenker´s diverticulum can be potentially treated with a transoral minimally invasive approach using a computer-assisted flexible endoscope system. This setup could be of advantage in patients with reduced mobility of the cervical spine to prevent open transcervical surgery. In our study, the Flex system enabled advanced visualization of the surgical site and extended intervention options, compared to standard flexible endoscopic treatment. However, general anesthesia is mandatory for the presented approach. Application in live patients with actual pathologies of the hypopharynx and upper esophagus will have to prove suitability for the treatment of Zenker's diverticulum. Further development of the system could include improved instrumentation and an adoption by other disciplines with challenging anatomy such as colorectal surgery.

A novel method of micro-tomography geometric angle calibration with random phantom.

The objective of this study is to develop and test the feasibility of applying a machine learning method for geometry calibration of angles in micro-tomography systems. Increasing importance of micro-tomography systems are manifested with escalating applications in various scenarios including but not limited to oral and maxillofacial surgery, vascular and intervention radiology, among other specific applications for purposes of diagnosis and treatments planning. There is possibility, however, actual pathology is confused by artifact of tissue structures after volume reconstruction as a result of CT construction errors. A Kernel Ridge Regression algorithm for micro-tomography geometry estimation and its corresponding phantom is developed and tested in this study. Several projection images of a rotating Random Phantom of some steel ball bearings in an unknown geometry with gantry angle information were utilized to calibrate both in-plane and out-plane rotation of the detector. The described method can also be expanded to calibrate other parameters of CT construction effortlessly. Using computer simulation, the study results validated that geometry parameters of micro-tomography system were accurately calibrated.