Average Lesion Size Research Articles

Differences in Saprophytic Growth, Virulence, Genomes, and Secretomes of Ilyonectria robusta and I. mors-panacis Isolates from Roots of American Ginseng (Panax quinquefolius)

A comparison of the virulence, saprophytic growth, and genomes of 12 isolates of Ilyonectria mors-panacis and 4 isolates of I. robusta from Canada pathogenic to Panax quinquefolius was made. There were no significant differences in the average lesion size on detached roots between isolates of the two Ilyonectria species or isolates that originated from infected roots in first- or second-crop ginseng soils. This did not support the hypotheses that I. mors-panacis is always more virulent than I. robusta or that there is selection for higher virulence during the first crop. However, the average growth rate on potato dextrose agar for I. robusta was significantly greater than that of I. mors-panacis, and the average total genome size of I. robusta isolates was significantly smaller with a significantly higher GC content. On dendrograms based on nucleotide sequences of all predicted exons of the genomes, I. robusta isolates were distinguishable from I. mors-panacis isolates, which were similar but could be separated into types 1 and 2. The difference between type 1 and type 2 I. mors-panacis was not related to geographical origin, virulence, growth rate, or mating type. However, the division was also observed for the total predicted secretome, most notably small secreted cysteine-rich proteins and secreted proteases, indicating that type 1 and 2 isolates of I. mors-panacis may interact differently with their environment.

Geographic Atrophy after Reabsorption of Pigment Epithelial Detachment (GARPED) study

BackgroundTo describe the occurrence, rate of geographic atrophy (GA) expansion, and changes in visual acuity (VA) after reabsorption of subfoveal pigment epithelial detachments (PED).MethodsIncluded patients had reabsorption of a PED followed by GA. Patients underwent clinical examination with SD-OCT. Images were classified by size with grading occurring post reabsorption. VA was recorded pre-reabsorption, post-reabsorption, and over time.ResultsThe average age of the cohort, consisting of 22 eyes from 19 participants, was 86.9 years at reabsorption. Prior to reabsorption, the VA was 20/80 and then declined to 20/200 (p = 0.001) with an average follow-up time of 30.2 months. There was no significant VA change after the initial loss with reabsorption. The average initial lesion size of GA was 0.987 mm2 with an average growth rate of 0.274 mm/year.ConclusionsThis study longitudinally examined GA growth rate in patients with reabsorbed PEDs. These patients started with a drusenoid or serous PED, had a dramatic reduction in vision and GA that occurred in place of the PED. These GA lesions have a slower growth rate and a smaller area of onset compared to rates previously reported in the literature. They do not show significant VA change after reabsorption. As we have entered the era of GA therapy, these patients may not benefit from current treatments.

Benign incidental lesion of the calcaneus: the calcaneal vascular remnant.

The calcaneal vascular remnant, first described by Fleming et al. in 2005, is a benign intramedullary lesion of the calcaneus with a vascular origin. To determine the prevalence and magnetic resonance imaging (MRI) characteristics of incidental calcaneal vascular remnant on routine ankle MRI. We retrospectively reviewed 457 ankle MRI scans for the presence of calcaneal vascular remnant. MRI was considered positive when a focal cyst-like area was seen on a T2-weighted sequence, and a low signal intensity was identified on a T1-weighted image beneath the calcaneal sulcus. Patients with calcaneal vascular remnants were further evaluated for age, gender, right or left foot location, size, and lesion characteristics. The prevalence of incidental calcaneal vascular remnant was 21.7% on our consecutive ankle MR examinations. The average lesion size was 5.5 mm. No statistically significant difference was noted in the frequency of lesion detection between gender, age, and side of the lesions (P > 0.05). Multilobulated lesions were detected predominantly in women (P = 0.013) and classic type lesions were detected predominantly in men (P = 0.036). This report is the first to determine the prevalence and MRI characteristics of calcaneal vascular remnants. Detecting and reporting this lesion on routine MRI is essential to avoid confusion with other pathologic entities.

Five-Year Follow-Up of Adolescent Gymnasts After Surgical Treatment of Osteochondritis Dissecans of the Elbow

Elbow osteochondritis dissecans (OCD) is well-studied in throwing athletes; however, there are limited data regarding gymnasts with capitellar OCD lesions. We aimed to determine the overall rate of return to competition following surgical treatment of capitellar OCD lesions and to determine the relationship, if any, between arthroscopic grade of lesion and ability to return to competition. A medical chart Current Procedural Terminology query from 2000 to 2016 yielded data on 55 competitive adolescent gymnasts who were treated surgically for elbow OCD lesions in a total of 69 elbows. Retrospective chart review was used to collect data on preoperative and postoperative symptoms and surgical treatment. Patients were contacted to complete questionnaires (Modified Andrews Elbow Scoring System, Disabilities of the Arm, Shoulder, and Hand) on return to sport. Current elbow function and follow-up data were available for 40 of 69 elbows. Average age at time of surgery was 12.1 years with 18 of 55 (33%) of patients competing at a pre-elite level of gymnastics (level 9 or 10 of 10) before surgery. Nine out of 31 gymansts (29%) underwent bilateral surgery for OCD lesions. Average OCD lesion size was 10 mm. Thirty-one of 40 elbows (78%) were treated with debridement back to a stable cartilage rim with microfracture, and nine of 40 elbows (22%) were treated with debridement alone. Thirty-six of 40 patients (90% returned to competitive gymnastics with all returning patients competing at or above the same level after surgery. Among the patients who were followed up, 29 of 30 patients (97%) reported some difficulty with specific events on return to competition. The rate of return to sport for gymnasts at 90% is similar to that observed in other sports. This study suggests that elbow OCD lesions are not career-ending injuries for adolescent gymnasts; however, gymnasts should not expect a fully asymptomatic return to all events in a sport. Therapeutic IV.

First report of Phytophthora hibernalis, P. multivora and P. niederhauserii causing root rot and bleeding cankers on Eucalyptus globulus in Portugal

During spring 2022 Phytophthora related-disease symptoms were observed in three Eucalyptus globulus plantations in central Portugal (Aveiro district). Affected trees displayed a range of symptoms including root rot, bleeding cankers and extensive canopy dieback (Figure 1). Average disease incidence and tree mortality rate were estimated as 67 and 20% along three linear transects of 50 m, respectively. In order to isolate the causal agents, rhizosphere and root samples were collected from 20 diseased trees chosen at random in the monitored plantations. Samples were processed as described by Bregant et al. (2023) and cultured on carrot agar at 20°C in the dark. Phytophthora colonies were examined and identifying features recorded and compared with published morphological records of Phytophthora species. The following three species were identified: Phytophthora multivora (12/20 isolates), P. hibernalis (6/20) and P. niederhauserii (2/20) (Figure 2). The identity of all isolates was confirmed by analysis of the internal transcribed spacer region using the universal primers ITS1 and ITS4. DNA extraction, PCR amplification and sequencing were performed according to Bregant et al. (2023). A BLASTn search against the GenBank database showed 100% identity with sequences of the ex-type cultures of P. hibernalis (CBS 114104), P. multivora (CBS 124094) and P. niederhauserii (WPC P10616). The ITS sequence of a representative isolate of each species was deposited in GenBank (P. hibernalis: GenBank Accession No. OQ520314; P. multivora: OQ520315; and P. niederhauserii: OQ520316). The pathogenicity of a representative strain of each Phytophthora species was assessed on one-year-old E. globulus seedlings as described by Bregant et al. (2023). For each isolate ten seedlings were inoculated with an agar-mycelium plug (3 mm diameter) cut from the margin of a four-day-old colony on potato dextrose agar (PDA), whereas ten seedlings used as controls were inoculated with a sterile PDA plug. Seedlings were kept in controlled conditions at 21°C and watered regularly for 30 days. All seedlings inoculated with Phytophthora isolates showed inner bark necrotic lesions spreading up and down from the inoculation point (Figure 3). Average lesion size varied significantly among isolates: P. niederhauserii 28 ±3 mm (average ±SD), P. hibernalis 10 ±3 mm and P. multivora 7 ±3 mm. The control seedlings remained asymptomatic. All Phytophthora species were successfully re-isolated from all inoculated seedlings, thus fulfilling Koch's postulates. This study represents the first report of P. hibernalis, P. multivora and P. niederhauserii on E. globulus in Portugal and in Europe. Recently, two other species, Phytophthora cinnamomi and P. alticola, have been reported as root rot agents of E. globulus in several areas of Portugal (Diogo et al., 2023). The involvement of multiple Phytophthora on E. globulus plantations is of particular concern due to the invasiveness of the species detected and the potential spread of these pathogens into natural ecosystems adjacent to eucalypt plantations. This research has been financially supported by the Land Environment Resources and Health (L.E.R.H.) doctoral course (University of Padova) and project F4F-Forest For Future (CENTRO-08-5864-FSE-000031) from Programa Operacional Regional do Centro (Centro 2020), Portugal 2020 and Fundo Social Europeu. Thanks are due to the Portuguese Foundation for Science and Technology (FCT/MCTES) for the financial support to CESAM (UIDP/50017/2020 + UIDB/50017/2020 + LA/P/0094/2020) and the PhD grants of Sandra Hilário (SFRH/BD/137394/2018) and Eduardo Batista (PD/BD/135535/2018).

Perianal Paget's-an aggressive disease.

Perianal Paget's disease (PAPD) is a rare disorder with a predisposition to anal and colorectal malignancies and an unclear prognosis. Our previous 25-year series demonstrated a non-aggressive nature. This study aims to describe our updated institutional experience. This is a retrospective review of all patients diagnosed with primary PAPD from 1991 to 2021. A prospectively maintained institutional database was searched which included demographics, clinical and pathological manifestations, treatment methods, recurrence, oncological outcome and mortality. Thirty patients were diagnosed with PAPD. Fifteen were women (50%); the average age at diagnosis was 71 ± 10.7 years, and the average lesion size was 3.7 ± 2.6 cm. At diagnosis, 12 (40%) were harbouring invasive anal adenocarcinoma. Eight (27%) developed adenocarcinomas concurrent with PAPD recurrence at a mean interval of 9 ± 4.4 years (range 1.9-14.8). The Kaplan-Meier curve estimated overall survival of 93%, 86%, 82%, 65% and 56% at 1, 3, 5, 10 and 15 years, respectively. Median survival was 16 years. Six (20%) had disease-related mortality. Initially, nine (30%) were treated with abdominoperineal resection (APR), 15 (50%) underwent local resection, three (10%) were treated with radiotherapy, two (7%) received only topical therapy and one (3%) chose observation. Fifteen (50%) experienced recurrence of PAPD, two after undergoing APR. Five (17%) had persistent disease until death. Only 10 (33%) did not experience PAPD recurrence, seven of whom underwent APR. The mean follow-up time was 9.2 ± 6.2 years. Perianal Paget's disease is an aggressive entity with high rates of synchronous anal adenocarcinoma at diagnosis and development of metachronous adenocarcinoma later in life.

Cutaneous Squamous Cell Carcinoma in Immunocompromised Patients-A Comparison between Different Immunomodulating Conditions.

Immunosuppression is strongly associated with an increased risk of developing cutaneous squamous cell carcinoma (cSCC). Studies on solid organ transplant recipients (SOTR) and chronic lymphocytic leukemia (CLL) patients have already demonstrated higher rates of aggressive cSCC tumors in these populations compared to immunocompetent controls. Studies on other immunosuppressed patient groups are scarce. This study was aimed at assessing the effects of different immunomodulating conditions on patients diagnosed with cSCC. We sought to compare the clinical features, treatments, and survival rates among the different study groups, as well as outcomes to those of immunocompetent controls with cSCC. A retrospective analysis of 465 cSCC patients, both immunosuppressed (IS) and immunocompetent controls. Etiologies for immunosuppression included SOTR, CLL, chronic kidney disease (CKD), psoriasis, rheumatoid arthritis (RA) and systemic lupus erythematous (SLE). Compared to the control group, IS patients demonstrated several significant differences. These include higher rates of positive resection margins, higher recurrence rates, and multiple SCC tumors. Patients in the IS group, who were also given immunomodulating agents, demonstrated even lower survival rates. Cox regression analysis demonstrated statistically significant decreased overall survival (OS) rates for IS patients compared to the controls (OR = 1.9, p = 0.031). SOTR patients tend to have multiple cSCC tumors (35%), with the highest number of primary tumors compared to controls (2.54 tumors per patient on average, p < 0.001), but also compared to all other IS groups. The average SCC lesion size in the SOTR group was the smallest, measuring at 13.5 mm, compared to the control group and all other IS groups. Decreased survival rates were seen on Cox regression analysis compared to controls (HR = 2.4, p = 0.001), but also to all other IS groups. CLL patients also had the highest rates of positive margins compared to controls (36% vs. 9%, p < 0.01) and to all other IS groups. They were also most likely to get adjuvant or definitive oncological treatments, either radiotherapy or chemotherapy, compared to controls (36% vs. 15%, p = 0.02) and to other IS groups. Patients in the CKD group demonstrated the highest rates for multiple cSCC (OR = 4.7, p = 0.001) and the worst rates of survival on Cox regression analysis (HR = 3.2, p = 0.001). Both rheumatoid arthritis and psoriasis patients demonstrated the shortest disease-free survival rates (2.9y ± 1.1, 2.3y ± 0.7, respectively), compared to controls (4.1y ± 2.8) and to all other IS groups. Among cSCC patients, immunosuppression due to SOTR, CLL, CKD, RA, and psoriasis is associated with worse outcomes compared to controls and other IS groups. These patients should be regarded as high-risk for developing aggressive cSCC tumors. This study is the first to assess and compare cSCC outcomes among multiple IS patient groups.

Epidemiological, Clinical and Lifestyle Profile of Patients Diagnosed with Oral Cancer in Senegal

Oral cavity cancers (OCC) are malignant tumours that develop from tissues of buccal cavities. The objective of this study was to describe the epidemiological, clinical and lifestyle profile of patients diagnosed with OCC in Senegal. A multicentre cross-sectional study of 45 patients was conducted. Patients aged 18 years and older with histologically confirmed lesions of the oral cavity were included in the study. Data were collected on socio-demographic characteristics, clinical and para-clinical aspects, and lifestyle habits of the OCC patients. A survey directly administered to patients was used. Data entry was performed with Epi 7.2 software and descriptive analysis with Stata 17/IC. More than half (55.56%) of the patients were female. The average age was 53.09±16.80 years. The hospital university Aristide Le Dantec accounted for 55.56% of the study participants. More than 4/5 of the patients had come on their own to a consultation for an objective clinical symptomatology. The average size of lesions was 6.66±3.3 centimetres. More than 2/3 were diagnosed in the advanced stage. Less than 40% of patients had a diet rich in fruits and vegetables. Nearly 65% admitted to having oral sexual activity. The data from this study show that the profile of patients diagnosed with OCC is 50 years old, predominantly female, and not a consumer of known risk factors.

First Report of Bacterial Leaf Spot of Ficus benghalensis Caused by Pseudomonas cichorii in Pakistan.

Ficus benghalensis L. belongs to the family Moraceae, native to Asia and commonly known as Banyan. It has been identified as an important medicinal tree due to its antioxidant, anti-diabetic, and anti-inflammatory properties (Singh et al., 2009; Thite et al., 2014). In March 2021, leaf spots were observed on Banyan trees in the Kharian forest zone, District Gujrat, Punjab Province, Pakistan. Initial symptoms on leaves were irregular, water-soaked, and light brown lesions. The lesions turned dark brown at the centre, and the margins gradually turned yellow. The average size of lesions was 12 to 20 × 8 to 13 mm. The lesions coalesced and produced necrotic areas on the leaf (Figure 1). Samples (n=34) were collected based on symptoms and infected leaf segments were excised into small pieces (10-20 mm), surface disinfected with 1% NaClO for 10 seconds and rinsed three times with sterilized distilled water (SDW). Ten pieces/sample were mashed and soaked in 1.5 ml SDW to obtain a suspension. Later, 10 µL of the suspension was streaked on Nutrient agar (NA) and King's B medium (KBM) and incubated for 72 h at 30°C. After 72 h bacterial colonies appeared on NA and KBM medium. Each colony was re-streaked for three times to obtain the purified colonies. Morphological and biochemical characteristics of isolated bacterial cultures were performed by following the method of Schaad et al. (2001). Bacterial colonies appeared pale yellow to creamy, smooth, and circular with undulated margins on both NA and KBM medium. The colonies produced a fluorescent blue colour on KBM under the UV light. Isolated bacterial cultures were positive for oxidase, negative for levan production and arginine dihydrolase. Based on these characteristics, the pathogen was identified as Pseudomonas species. For molecular identification, 16S rRNA and rpoB genes were amplified and sequenced using the following primers: 27F/1492R (Lane, 1991) and LAPS/LAPS27 (Ait Tayeb et al. 2005), respectively. All the isolates were identified as P. cichorii after BLASTn analysis. The sequences of isolate BLS-01 obtained in this study were deposited in GenBank with accession No. OK397593 for 16S rRNA and OK423684 for rpoB exhibiting 100 % similarity with P. cichorii Accession No. MK356431 for 16S rRNA and JQ267563 for rpoB. A pathogenicity test was performed on healthy Banyan seedlings to fulfil Koch's postulates. Leaves from seedling plants were inoculated with 3 mL of BLS-01 suspension (108 CFU/ml) by spraying the inoculum on leaves using a sterilized spray bottle. The leaves sprayed with sterilized distilled water served as control (Figure 2). The experiment was performed three times following the same protocol as described above. Symptoms that appeared on inoculated leaves after 7-10 days were similar to the symptoms observed on original infected Banyan tree leaves in the forest zone. Control leaves remained asymptomatic during the whole experiment. The pathogen from the artificial infected leaves was re-isolated and identified as P. cichorii based on morphological, biochemical, and molecular characteristics. To our knowledge, this is the first report of leaf spot of F. benghalensis caused by P. cichorii in Pakistan.

Endoscopic Submucosal Dissection for Large Duodenal Laterally Spreading Lesions is Feasible: A Multi-Center Retrospective Study

This retrospective study aimed to evaluate the effect and safety of endoscopic submucosal dissection (ESD) for large laterally spreading lesions located in the descending duodenum based on multi-center experiences. This multicentric retrospective study included 3 hospitals in China. Fifty-one patients with laterally spreading lesions of the duodenum who underwent ESD between February 2019 and December 2020 were enrolled. The en bloc resection rates, en bloc R0 resection rates, complication rates, and local recurrence after ESD were evaluated. Of the 51 patients, the median age was 62 years old (ranging from 37 to 76 years old); among them, 29 were male and 22 were female. The average lesion size was 2.3 cm (ranging from 1.5 to 4.0cm). All 51 lesions achieved en bloc R0 resection successfully, with the procedure time ranging from 20 to 117 min (median: 45.5min). The hospital length of stay ranged from 4 to 90 days (median: 8.0d). Two patients experienced delayed bleeding 3 days after ESD and 2 other patients were diagnosed with delayed perforation. Tumor residual and local recurrence did not occur during a short follow-up period. ESD for laterally spreading lesions of the descending duodenum is feasible.

Ultrasound-guided transvaginal biopsies of pelvic lesions: diagnostic yield, safetyprofile, and technical considerations over a 20-year experience.

To evaluate diagnostic yield, safety profile, and specific technical considerations of transvaginal ultrasound (TVUS) guided biopsy/aspiration. TVUS guided biopsy (core, FNA) procedures with pre-procedure CT/MRI imaging at a single institution between 2001 and 2021 were reviewed. Relevant patient demographic data was extracted via the Electronic Health Record (EMR), technical details of the biopsy procedure were collected, and distance to target via transvaginal and transabdominal biopsy approach was measured on pre-procedure imaging. Surgical pathology was reviewed and assessed for concordance. Complications were assessed. Statistical analysis was performed using SPSS. 96 TVUS procedures (mean age, 58.7 ± 15.2years; mean BMI, 27.4) were reviewed. TVUS guided approach decreased the distance to target (mean, 1.1cm vs 8.6cm transabdominal; p < 0.0001) and created a safe path not otherwise available in two patients. Average lesion size was 4.0 ± 2.1cm (IQR 2.5, 5.2cm) and targets at or above the vaginal cuff (0.9 ± 1.5cm) and up to 0.5 ± 1.0cm above the acetabular roof were accessible. 75 (78%) cases were core biopsies (18G; median, 2 passes) and 21 were FNA. Conscious sedation was used in 84.4% (n = 81) of cases and local anesthetic was also used in 84.4% (n = 81) of cases. Overall diagnostic yield was 98.9% (n = 94) with 94.7% (n = 89) cases confirmed as concordant diagnoses, including 57.4% (n = 54) malignant. Complications occurred in eight patients (8.3%), all minor. No post-biopsy infections were encountered regardless of administration of pre-procedure antibiotics (n = 14, 14.6%,), documentation of sterile prep (n = 92, 95.8%), or speculum use (n = 19, 19.8%). 50% (n = 48) had a prior hysterectomy, with no association with adequacy or complications (p = 0.9). Transvaginal biopsy of pelvic lesions offers excellent diagnostic yield and favorable safety profile, and can dramatically decrease distance to target. Ultrasound-guided transvaginal approach offers a safe and effective way to biopsy pelvic lesions in women.

Pilot study on a new endoscopic platform for colorectal endoscopic submucosal dissection.

The endoscopic submucosal dissection (ESD) is a technically demanding and time-consuming procedure, with an increased risk of adverse events compared to standard endoscopic resection techniques. The main difficulties are related to the instability of the operating field and to the loss of traction. We aimed to evaluate in a pilot trial a new endoscopic platform [tissue retractor system (TRS); ORISE, Boston scientific Co., Marlborough, MA, USA], designed to stabilize the intraluminal space, and to provide tissue retraction and counter traction. We prospectively enrolled all consecutive patients who underwent an ESD for sigmoid/rectal lesions. The primary outcome was the rate of technical feasibility. Further technical aspects such as en-bloc and R0 resection rate, number of graspers used, circumferential incision time, TRS assemblage time, submucosal dissection time, and submucosal dissection speed were provided. Clinical outcomes (recurrence rate and adverse events) were recorded as well. In all, 10 patients (M/F 4/6, age: 70.4 ± 11.0 years old) were enrolled. Eight out of 10 lesions were located in the rectum. Average lesion size was 31.2 ± 2.7 mm, and mean lesion area was 1628.88 ± 205.3 mm2. The two sigmoid lesions were removed through standard ESD, because the platform assemblage failed after several attempts. All rectal lesions were removed in an en-bloc fashion. R0 resection was achieved in 7/8 (87.5%) patients in an average procedure time of 60.5 ± 23.3 min. None of the patients developed neither intraprocedural nor postprocedural adverse events. TRS-assisted ESD is a feasible option when used in the rectum, with promising result in terms of efficacy and safety outcomes. Nevertheless, our pilot study underlines few technical limitations of the present platform that need to be overcome before the system could be widely and routinely used.

Endoscopic submucosal dissection for gastric adenocarcinoma of the fundic gland type (chief cell predominate type): Four years' experience from a tertiary hospital.

To summarize the endoscopic and clinicopathological features of gastric adenocarcinoma of the fundic gland type (GA-FG), and to evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of GA-FGs. From September 2017 to August 2021, patients treated with ESD who were pathologically confirmed to have GA-FGs were included. Those with lymphovascular and distal metastasis were excluded before ESD. The medical records were retrospectively reviewed to obtain information regarding patient demographics, clinicopathological characteristics, tumor features, complete resection rate, and complications, etc. All patients underwent follow-up for at least 12 months to evaluate any local recurrence or distant metastasis. A total of 15 patients with an average age of 56.9 ± 10.7 years were recruited, including 11 men and 4 women. Lesions were found at the upper third (13 [86.7%]) or middle third (2 [13.3%]) of the stomach. The average lesion size was 9.1 ± 4.8 mm. Macroscopically, lesions presented as a flat elevated type with reddish or erosion on top (n=7, 46.7%), depressed type with pale color (n=5, 33.3%), or submucosal tumor (SMT)-like appearance type (n=3, 20.0%). En bloc resection, complete resection and curative resection were achieved in 14 (93.3%), 13 (86.7%), and 11 (73.3%) patients, respectively. Nine (60.0%) of the lesions had submucosal invasion. One patient underwent additional surgery. No local recurrence or metastasis was detected during the follow-up duration. GA-FGs present with various endoscopic features. ESD appears to be effective and safe for treating early-stage GA-FGs.

THORACIC SURGEON UTILIZATION OF AN ELECTROMAGNETIC NAVIGATIONAL (EMN) SYSTEM TO FACILITATE BRONCHOSCOPIC AND TRANSTHORACIC NEEDLE BIOPSY OF THORACIC LESIONS

THORACIC SURGEON UTILIZATION OF AN ELECTROMAGNETIC NAVIGATIONAL (EMN) SYSTEM TO FACILITATE BRONCHOSCOPIC AND TRANSTHORACIC NEEDLE BIOPSY OF THORACIC LESIONS

S79 EUS-Guided FNA Cytology and EUS-Guided FNB Histology Comparison for Solid Pancreatic Lesions: Single Tertiary Care Center Retrospective Study

Introduction: Endoscopic Ultrasound (EUS)-guided fine needle aspiration (FNA) and fine needle biopsy (FNB) are the current standard of care for making a diagnosis in solid pancreatic lesions (SPLs). There is conflicting data on the diagnostic utility of cytology and histology for diagnosing SPLs. The aim of this study was to evaluate the diagnostic utility of cytology and histology for diagnosing SPLs. Methods: A retrospective chart review was performed and all patients greater than 18 years with solid pancreatic lesions who underwent EUS between October 2019 and June 2021 were included. All the procedures were performed by a single advanced endoscopist and same needle (Acquire 22G, Boston Scientific) was used for all the procedures. Primary outcomes assessed were diagnostic advantage of cytology and histology in terms of providing a final diagnosis and diagnostic accuracy of cytology and histology with surgery specimen being the gold standard. Secondary outcomes assessed were relation of diagnostic accuracy to specimen length, no. of passes and size of lesion using t-test. Results: A total of 59 patients were included in our study with majority of them being males (52.4%). Mean needle passes per patient were 4.25 and average size of lesion on EUS was 3.7 cm. Turnaround time of histology was superior (2.7 days) as compared to cytology (3.3 days). In 39 cases, there was agreement between histology and cytology and 36/39 (92%) of those were malignant. Of the remaining 20 patients, histology was found to be more advantageous for 17 (85%) patients while cytology was more advantageous for the other 3 patients (15%). All 3 cases where cytology was advantageous were malignant. Of the 17 histologically advantageous cases, 15 (88%) were malignant. The histological diagnosis and cytological diagnosis were accurate in 7/8 (88%) and 3/8 (38%) respectively. T-test did not show any significant difference between two groups in relation to diagnostic accuracy to specimen length, no. of passes and size of lesion using t-test. Conclusion: Histology provided more accurate diagnosis for discordant cases and had faster turnaround times. However, there were malignant cases diagnosed on cytology which could have been missed if only histology was performed. Histology and cytology are important in conjunction with each other for maximizing the diagnostic accuracy for SPLs.

Clinical Evaluation of Efficacy of Triamcinolone Acetonide with Tacrolimus in the Management of Oral Lichen Planus: A Pilot Prospective Observational Study.

Introduction:Lichen planus (LP) is a relatively common chronic, mucocutaneous disease of autoimmune origin, involves oral mucosa, skin, scalp, nails, and genital mucosa. The prevalence of oral LP (OLP) varies worldwide, commonly seen in middle-aged and elderly people. It usually presents as symmetrical and bilateral or multiple lesions with burning sensation (BS) sometimes accompanied by pain. Corticosteroids and calcineurin inhibitors have shown promising results in the treatment of OLP, but its chronic course and unpredictable exacerbations/remission continues to result in a high degree of morbidity. The study aimed to evaluate the efficacy of intralesional triamcinolone acetonide (injection TA) combined with topical application of TA orabase and Tacrolimus (TAC) ointment for symptomatic cases of OLP.Materials and Methods:The prospective study included 52 symptomatic OLP patients to receive (0.5 ml) intralesional injection of TA once a week for the first 4 weeks followed by one injection in the 6th week along with TA mucosal paste (0.1%.) and TAC ointment (0.03%) in tapering dose till 8th week. The subjective symptoms including BS and pain were assessed on a 10 cm visual analog scale (VAS) and objective signs like size and site of the lesion were scored according to criterion scale modified by Thongprasom et al. Differences were compared after 8 weeks treatment course and follow-up observations were performed at 20th week to record any recurrent lesion.Results:41 patients (78.8%) had complete remission of disease and 11 (21%) had shown partial improvement. The VAS scores for BS and pain improved significantly. Improvement was also noted with decrease in the average size of active lesions and the number of sites with treatment. The relapse was seen in 17 patients (41%) in the 20th week.Conclusion:TA combined with TAC is a valuable therapeutic option for the treatment of symptomatic OLP. Our findings suggest that patients have shown statistically significant improvement.

Clinical Efficacy of Endoscopic Submucosal Dissection for the Treatment of Duodenal Lesions in Terms of Operative Technique and Management of Complications.

Background and Aims: Duodenal endoscopic submucosal dissection (ESD) has been considered to be the most challenging because of its high incidence of complications, which has hindered the development of duodenal ESD. The aim of this study is to discuss operation tips for duodenal ESD and to assess the efficacy and safety of duodenal ESD. Patients and Methods: Eighty-two patients who underwent ESD in the digestive endoscope center for superficial duodenal epithelial tumors (SDETs) from January 2017 to June 2021 were studied. Patients were divided into three groups according to the occurrence of complications, and the clinical characteristics and surgical efficacy of each group were compared. Results: SDETs in 82 patients were completely removed by ESD, with a 97.5% R0 resection rate. The average size of resected lesions was 23.8 ± 6.5 mm. There were significant differences in lesion size and operation time between the normal and intraprocedural complication groups (P < .05). Similarly, between the normal and delayed complication groups, significant differences were noted in lesion location, size, operation time, occupied circumference, and postoperative hospitalization duration (P < .05). Conclusion: Duodenal ESD is prone to complications that increase the complexity of the procedure. By improving the necessary technique and skills, duodenal ESD remains safe and effective.

Marked safety and high diagnostic yield of freehand ultrasound-guided core-needle biopsies performed by pulmonologists.

BackgroundAdequate tissue sampling is fundamental for establishing a definitive diagnosis, assessing prognosis and tailoring therapy. Each of the methods for obtaining tissue (e.g., endoscopic, image guidance and surgical biopsies) results in a different diagnostic yield and complication rate profile.ObjectivesPresent feasibility, and assess safety and efficacy of freehand transthoracic ultrasound‐guided core‐needle biopsies (USGNB) of thoracic lesions performed by pulmonologist.MethodsA retrospective analysis study of ultrasound‐guided core‐needle biopsies of thoracic lesions performed at the Pulmonary Institute of Rabin Medical Center was conducted from September 2020 to October 2021. All core‐needle biopsies were performed under local anesthesia with guidance of Mindray TE7 2019 US system. Procedural variables including complications and pathological diagnostic yield were the primary end point. IRB 0671‐21‐RMC.ResultsIn total 91 biopsy procedures were analyzed in38 females and 53 males, average age 71.1 years. Twenty‐three (25.3%) cases were lung lesions, 7 (7.7%) – mediastinal, 13 (14.3%) – chest wall, 27 (29.7%) – pleural, and 21 (23.1%) supraclavicular lesions. Average lesion size was 51.6 mm, the largest in the mediastinum and the smallest in supraclavicular locations (97.7mm and 28.0 mm, respectively). Overall pathological diagnostic yield was 90%, highest success in chest wall (100%) and lowest in mediastinal biopsies (71.4%). We had only one complication –hemothorax resolved by chest tube drainage‐ accounting for only 1.1% complication rate.ConclusionSafety and efficacy were demonstrated in freehand US‐guided core‐needle biopsy of thoracic lesions performed by pulmonologists. We suggest thoracic ultrasound and USG‐CNB be part of training and clinical practice in interventional pulmonology.

Focal Osteoporotic Marrow Defects – Variant of Chronic Ischemic Bone Disease? Clinicopathology Review of 596 Cases

<h3>Background</h3> Focal Osteoporotic Marrow Defects (FOMD) presents as a localized, asymptomatic, poorly-demarcated radiolucency, considered by some as a variant of normal marrow architecture. The cause of this lesion is unknown but recent examples of ischemiarelated regional osteoporosis in long bones suggest an anoxic or ischemic origin. <h3>Objective</h3> To determine the proportion of FOMD lesions showing histopathologic evidence of ischemic marrow disease. Methods: 596 intramedullary tissue samples of microscopically diagnosed FOMD were reviewed for fea- tures of regional ischemic osteoporosis. Microscopic criteria characteristic for early ischemic changes in long bones were used to compare with findings in jawbone biopsy samples of FOMD. Clinical features and patient demograph- ics were also analyzed. Results: 74% of 581 patients were female and the average age at diagnosis was 49 years. Lesions were evenly distributed between the jaws and 79% were in the retromolar/third molar area. 92% were in edentulous bone, and 77% were in old extraction sites; 3% of cases were bilateral and 30% were tender or painful. The average lesion size was 1.2 cm (range: 0.52.8 cm.) and none showed cortical expansion. 76% of FOMD lesions were comprised primarily of fatty marrow, and 88% of the total showed microscopic features of ischemic marrow damage consistent with those found in regional osteoporosis of the long bones; 9% demonstrated intravascular thrombi. Differences were found between hematopoietic and fatty FOMD lesions. <h3>Conclusions</h3> The FOMD lesion appears to be the jawbone variant of regional osteoporosis of long bones, i.e. is an ischemic phenomenon perpet- uated by compromised marrow blood flow. There are 2 subtypes of FOMD: the fatty marrow type and the less common hematopoietic marrow type; fatty lesions are much more likely to be in the maxilla, to be in males, and to be associated with pain.

Abstract P3-03-23: Surveillance breast magnetic resonance findings in asymptomatic CDH1 variant carriers

Abstract Introduction: An estimated 20% of breast cancers are attributed to a germline mutation; BRCA1/2 gene variants are most well-known and account for almost 40% of hereditary breast cancers. Families that carry CDH1 germline pathogenic or likely pathogenic (P/LP) variants have increased risk of developing diffuse type gastric cancer and invasive lobular breast cancer (LBC). Specifically, the lifetime risk of developing breast cancer due to CDH1 is estimated to be 39-55%. LBC is characterized by an infiltrative growth pattern, which results in decreased detection sensitivity by mammography. Consensus guidelines recommend annual breast surveillance with magnetic resonance (MR) imaging alternating with mammography every six months between 30 and 50 years of age. However, this patient population is less studied, particularly regarding breast cancer surveillance. We sought to determine the incidence of abnormal breast MR findings in women with CDH1 P/LP variants, identify the median age that abnormalities were discovered, and evaluate for concordance with mammogram, ultrasound, and pathology. Methods: Patients with CDH1 P/LP variants were enrolled in a prospective study of hereditary gastric cancers at a single institution between January 2017 and May 2021. Patient demographics, breast imaging findings, breast pathology, and detailed family pedigree of breast and gastric cancers were analyzed. Results: 283 patients with CDH1 P/LP variants were enrolled, of whom 154 were women. Thirty-one (31/154) women were diagnosed with breast cancer prior to enrollment and 30 were outside the recommended breast MR surveillance window (&amp;lt;30 or &amp;gt;50 years). Data were available on 64 women who underwent at least one surveillance breast MR. The majority (58/64, 91%) were Caucasian, 48 (75%) had family history of breast cancer and 48 (75%) had a family history of gastric cancer. The median age of first surveillance MR was 44 (range 25-73) with a median age of 45 at CDH1 diagnosis. Of the 64 women who underwent surveillance breast MR, a total of 106 scans were performed; 32 patients (48%) had one MR, 14 (1%) had two, and 18 (28%) had ≥3. Most women (34/64, 53%) demonstrated benign or normal findings (BIRADS 1 or 2). Abnormal or incomplete imaging was found in 19 women (BIRADS 0, 3, 4, 5). Most women (18/19, 94%) with a breast abnormality were discovered during the first surveillance scan, whereas one woman had an abnormality on subsequent imaging. Four (4/19) women demonstrated multifocal lesions and four had bilateral enhancing lesions. The average size of contrast-enhancing lesion was 1.3cm (0.3-4.4cm). Further diagnostic workup was available on 15 women, of whom four had invasive disease resulting in an overall cancer detection rate of 6% (4/64) and a false positive rate of 73% (11/15). Of the four women ultimately diagnosed with LBC, three had an initial BIRADS 4 and one was BIRADS 0. Of the 11 women who did not have invasive disease, six initially had BIRADS 0 readings, two BIRADS 3, and three BIRADS 4. Conclusions: In a cohort of women with CDH1 P/LP variants the overall detection rate of abnormal lesions on surveillance MR was 29% and the cancer detection rate was 6%. When follow-up imaging and/or biopsy was available the concordance rate was 33%. The median age of first surveillance MR and first lesion discovered were the same, suggesting the recommendation for breast cancer surveillance starting at age 30 is appropriate. These data support the use of alternating breast MR with mammogram and highlight the need for prompt diagnosis of germline CDH1 variants in order to promote early breast cancer detection. Citation Format: Lauren A. Gamble, Martha Teke, Jeremy Fridling, Sarah G. Samaranayake, Bernadette Redd, Andrew Blakely, Jeremy L. Davis. Surveillance breast magnetic resonance findings in asymptomatic CDH1 variant carriers [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-03-23.