Borderline Lesions Research Articles

Clinicopathological Study of Breast Lesions with Special Reference to the Role of CD34 Immunostaining in DiagnosisA Cross-sectional Study from a Tertiary Care Hospital of West Bengal, India

Introduction: Breast carcinoma is the most common cancer among women and leading cause of mortality. Prognosis of breast carcinoma primarily depends on early detection. The changes in molecular and antigenic expression in stromal microenvironment surrounding the tumour cells was noted earlier in tumours of skin and gastrointestinal tract which showed loss of Cluster of Differentiation 34 (CD34) expression in stromal cell of malignant tumours. Aim: To evaluate the intensity of CD34 staining in benign, borderline and malignant lesions of breast and to find out whether it can help to differentiate benign and malignant lesions from borderline and in situ carcinomas. Materials and Methods: This was a cross-sectional prospective study done over a period of 18 months in a tertiary care hospital of Bankura, West Bengal, India. Total 78 specimens of breast lesions obtained by lumpectomy and Modified Radical Mastectomy (MRM) were first evaluated on routine histology and classified as benign, borderline or malignant accordingly. Subsequent immunohistochemical staining was performed for CD34 and intensity of expression in stromal cells was graded from 0 to 3+. Then comparison of CD34 expression in different lesions was done and level of significance was assessed by using Student’s t-test. Results: Out of total 78 cases evaluated, 50 (64.1%) were categorised as benign and rest 28 (35.9%) were either premalignant or malignant lesions. Intensity of CD34 expression was found to be significantly higher in benign and in situ lesions compared to malignant epithelial lesions of breast (p<0.05) whereas those between borderline and malignant phyllodes found to be statistically non significant (p-value 0.342). Conclusion: CD34 immunostaining can help to differentiate benign and in situ carcinomas from invasive carcinomas, however its role in differentiating borderline from malignant phyllodes tumour is limited.

Molecular pathology of thymoma and thymic carcinoma

Thymic epithelial tumors (TETs) comprise a heterogeneous group of epithelial-derived thymic neoplasms with diverse clinical behavior and underlying molecular genetic features. Owing to their rare nature, the molecular classification of TETs has only recently begun to be fully explored. The advent of advanced molecular studies, particularly the ability to sequence the DNA and RNA of tumors in a massively parallel fashion, has led to an increased understanding of the molecular underpinnings of thymic neoplasia. Thymomas, characterized by a heterogeneous group of molecular alterations, tend to have low mutational burdens and various copy number abnormalities including a characteristic loss of chromosomal material in the region of 6q25.2-p25.3, a recurrent, specific point mutation GTF2I p.L424H, and specific expression of certain microRNAs. Thymic carcinomas, in contrast, are generally characterized by increased tumor mutational burdens, multiple copy number alterations, and varied, non-recurrent, somatic mutations. Advances in molecular knowledge of TETs allow for more precise molecular classification of these tumors, and the presence of specific alterations aids in the diagnosis of borderline lesions. In the future, additional molecular studies will better delineate the molecular landscape of these tumors and may one day allow for more targeted treatment algorithms. This review aims to cover the current understanding of the molecular alterations thus far identified in thymomas and thymic carcinomas.

Pathological diagnosis of general rules for the description of thyroid cancer by Japanese Society of Thyroid Pathology and Japan Association of Endocrine Surgery.

The Japanese Society of Thyroid Pathology and the Japan Association of Endocrine Surgeons developed the eighth edition of the General Rules for the Description of Thyroid Cancer (GRDTC) in December 2019. This article describes the pathological diagnosis of the GRDTC, which has been improved through repeated revisions based on the experience of Japanese pathologists and translated into English to introduce the Japanese diagnostic standard to foreign countries. In this edition of the GRDTC, the histopathological classification and descriptions differ in some respects from those of the fourth edition of the World Health Organization (WHO) classification as revised in 2017. For example, the GRDTC does not adopt the concept of borderline lesions (FT-UMP, WDT-UMP, and NIFTP) of the WHO, taking into consideration the popular histological criteria accepted by Japanese pathologists. The cytological reporting system of the GRDTC was partly modified from the Bethesda system in 2015. It has an additional cyst fluid category separated from the unsatisfactory category that has been demonstrated to be useful in Japan. This translated edition makes it easy to submit Japanese clinicopathological studies of thyroid tumors in an international journal. We also wish to contribute to the improvement, standardization, and globalization of the pathological diagnosis of thyroid tumors.

Is routine appendectomy justified in mucinous borderline ovarian cancer?

Mucinous borderline ovarian tumors represent up to one half of cases diagnosed with borderline lesions and are usually associated with favourable outcomes. When it comes to the therapeutic options in these cases, the initial trend was to adopt the same strategy as in cases presenting invasive mucinous lesions. However, studies conducted so far cam to demonstrate that the appendix presented tumoral infiltration in an extremely low number of cases especially if a normal macroscopical aspect was present and therefore routine appendectomy was no longer recommended. The aim of the current paper is to investigate in which cases appendectomy should still be part of the therapeutic strategy in mucinous borderline ovarian tumors.

Radiological Imaging and CA125 Correlation as Predictive Variables in Ovarian Pathologies

Introduction: Primary Ovary Neoplasms are the most frequent tumors showing epithelial differentiation. Tumour Marker CA-125, glycoprotein synthesized mainly by neoplastic cells with epithelial differentiation. Serum Level of CA-125 has a biological potential of these lesions. This study is mainly done to evaluate the association between serum CA-125 levels and imaging findings and to predict malignancy in various ovarian lesions.
 Objectives: To evaluate the capacity of CA125 and Imaging findings to predict malignancy in various ovarian pathologies.
 Materials and Methods: Study area: Department of Radiology, Saveetha Medical College and Hospital, Chennai, Study design: Retrospective study.
 Study period: 6months.
 Study population: Patients with history and clinical symptoms of ovarian lesions and USG detected ovarian lesions confirmed on Radiological Imaging.
 Sampling method: Purposive sampling Sample size: 30.
 Inclusion criteria: Patients with clinically suspected ovarian lesions or indeterminate ovarian lesions on USG who underwent Radiological imaging and CA-125 estimation.
 Exclusion criteria: Children less than 12years of age are excluded from this study.
 Results: Among 30 cases, 19(63.33%) were benign and 2(6.67%) were borderline and 9(30%) were malignant lesion in the present study. Ovarian pathologies is mostly seen in women of age above 25 yrs(86.67%). In this study Ovarian lesions are more commonly seen in married women(86.67%) and menstruating women(56.67%). Out of 30 Cases, Serum CA-125 level <35IU/ml is seen among 13(43.33%) and level >35IU/ml is seen among 17(56.67%). Out of 17 women with CA-125 level >35IU/ml, 9 had malignant lesions on histopathology while 7 women had benign lesions and 1 women had borderline lesion.
 Conclusion: The present study shows significant association of Serum CA-125 levels with mixed solid cystic ovarian lesions ill defined margins (possible Malignant Ovarian lesions) (p<0.05) especially in Post-menopausal women.

Evaluating The Impact of Fractional Flow Reserve (Ffr) On Decision-Making for Treatment of Borderline Coronary Artery Lesions: Must University Experience; Egypt

Evaluating The Impact of Fractional Flow Reserve (Ffr) On Decision-Making for Treatment of Borderline Coronary Artery Lesions: Must University Experience; Egypt

Abstract 10622: Z Scores in Pediatric Cardiac Magnetic Resonance: Reclassification of Smaller, Younger Hearts with Novel Calculator

Introduction: The use of z scores to describe growth of normal structures is necessary in the management of pediatric cardiac disorders, particularly in babies and toddlers. Z score calculators for cardiac magnetic resonance (CMR) have traditionally relied on a convenience sample given complexity of the test. A recently published, novel z score calculator from prospectively-imaged, awake, healthy children ages 0-12 years may add value to assessments of ventricular size compared to traditional calculators. Hypothesis: A novel z score calculator (“Olivieri et al”) with robust prediction in younger, smaller children may reclassify right and left ventricular end diastolic volumes and mass (RVEDV, LVEDV, LVM) compared to the traditional calculator (“Buechel et al”). Methods: A retrospective cohort of subjects less than 12 years of age who underwent clinical CMR imaging on a 1.5T scanner (n=96; median age 5.5 years (IQR 3.7-7.6 years); 42% female) was studied. Z scores were calculated using both novel and traditional models for RVEDV, LVEDV and LVM. Subjects were categorized into the agreement group (both calculators agree) or disagreement groups, where novel calculator reclassified to normal (z< ± 2) or abnormal (z> ±2). Reclassified subject characteristics were compared with ANOVA and t-test. Results: Novel and traditional z scores agreed for 77%, 58% and 62% of cases for RVEDV, LVEDV and LVM, respectively. Amongst disagreements, subjects reclassified from abnormal to normal by the novel calculator had significantly lower age, BSA and RV size (Table 1). Reclassified subjects showed no association with specific diagnoses. Conclusion: The novel z score calculator reclassifies younger, smaller children away from severe z scores into more normal z scores. Ventricular volume assessment is highly relevant to critical decision-making in the first years of life in borderline lesions.

Genomic Analysis of Cutaneous CD30-Positive Lymphoproliferative Disorders

Primary cutaneous CD30+ T-cell lymphoproliferative disorders are the second most common cutaneous lymphomas. According to the World Health Organization, CD30+ T-cell lymphoproliferative disorders include primary cutaneous anaplastic large cell lymphoma (C-ALCL) and lymphomatoid papulosis (LyP) as well as borderline lesions. C-ALCL and LyP are thought to represent two ends of a spectrum of diseases that have different clinical presentations, clinical courses, and prognoses in their classic forms but share the same histology of medium to large CD30+ atypical lymphoid cell infiltrates. Because the behavior of these entities is different clinically and prognostically, we aim to search for oncogenic genomic variants using whole-exome sequencing that drive the development of LyP and C-ALCL. Clinical information, pathology, immunohistochemistry, and T-cell rearrangements on six cases of LyP and five cases of C-ALCL were reviewed to confirm the rendered diagnosis before whole-exome sequencing of all specimens. Both LyP and C-ALCL had recurrent alterations in epigenetic modifying genes affecting histone methylation and acetylation (SETD2, KMT2A, KMT2D, and CREBBP). However, they also harbor unique differences with mutations in signal transducer and activator of transcription gene STAT3 of the Jak/signal transducer and activator of transcription pathway and EOMES, a transcription factor involved in lymphocyte development, only noted in C-ALCL specimens. Genomic characterization of LyP and C-ALCL in this series confirms the role of multiple pathways involved in the biology and development of these lymphomatous processes. The identification of similar aberrations within the epigenetic modifying genes emphasizes common potential development mechanisms of lymphomagenesis within lymphoproliferative disorders being shared between LyP and C-ALCL; however, the presence of differences may account for the differences in clinical course.

Genomic Analysis of Cutaneous CD30-Positive Lymphoproliferative Disorders

Primary cutaneous CD30+ T-cell lymphoproliferative disorders (CD30+ LPD) are the second most common cutaneous lymphomas. According to the World Health Organization (WHO), CD30+ LPD include primary cutaneous anaplastic large cell lymphoma (pcALCL) and lymphomatoid papulosis (LyP) as well as borderline lesions. pcALCL and LyP is thought to represent two ends of a spectrum of diseases that have different clinical presentations, clinical courses, and prognoses in their classic forms, but share the same histology of medium to large CD30+ atypical lymphoid cell infiltrates. Because the behavior of these entities is different clinically and prognostically, we aim to search for oncogenic genomic variants using whole exome sequencing (WES) that drive the development of LyP and pcALCL.Clinical information, pathology, immunohistochemistry, and T-cell rearrangements on six cases of LyP and five cases of pcALCL were reviewed to confirm the rendered diagnosis prior to WES of all specimens. All cases of CD30 LPD had recurrent mutations in at least one of the epigenetic modifying genes, with the most frequent mutations found in the mixed lineage methyltransferase family involved in the methylation of H3K4: CREBBP (27%), KMT2A (36%), KMT2D (36%), SETD2 (27%), and SMARCA4 (27%) (Figure). Within the JAK/STAT pathway, mutations of STAT3 were observed in 2 cases of pcALCL (n=2, 18%), STAT5B in one case of LyP (n=1, 9%) and JAK1 mutation in one case of LyP(n=1, 9%). Lastly, mutations were also identified in the T-cell signaling pathway. 3/5 cases of pcALCL demonstrated loss of function mutations in EOMES, a T-box transcription factor important in lymphocyte development. We had two cases of C-ALCL and one case of LyP with NOTCH1 mutations supporting the importance of this gene in T-cell lymphomas.TP53 mutations and copy number loss is more characteristic of aggressive lymphomas and these abnormalities were absent in pcALCL and LyP and may explain the indolent nature of CD30+ LPD.While the JAK/STAT pathway, T-signaling, and epigenetic alterations possibly play a role in the pathogenesis of these diseases, genes involved in cell-cycle control and apoptosis (ie. TP53) that are characteristic of more aggressive diseases were not identified. Extending this investigation to a larger number of samples will allow us to detect additional mutations that may help distinguish between CD30+ LPDs of LyP and pcALCL as well as other histologic mimics such as systemic ALCL and large cell transformation of MF. [Display omitted] DisclosuresAbdulla: Caris Life Licenses: Current Employment. Zain: Kiyoaw Kirin, Secura Bio, Seattle Genetics: Honoraria; Secura Bio, DaichiSankyo, Abbvie: Research Funding; Secura Bio, Ono , Legend, Kiyowa Kirin, Myeloid Therapeutics Verastem Daichi Sankyo: Consultancy.

Evidence-Based Pragmatic Approach to the Management of Borderline or High-Risk Breast Lesions.

The management of borderline or high-risk breast lesions (HRLs) remains controversial. We propose a pragmatic evidence-based approach based on lesion type. For lobular carcinoma in situ with pleomorphism, papilloma with atypia, atypical ductal hyperplasia, and fibroepithelial lesions, surgical consultation and excision are recommended. Patients with other borderline or HRLs are referred for surgical consultation to discuss excision versus surveillance. Our recommendations align with American Society of Breast Surgeons guidelines, which aim to reduce unnecessary surgery and ensure appropriate follow-up.

Decrease in CD14++CD16+ Monocytes in Low-Immunological-Risk Kidney Transplant Patients with Subclinical Borderline Inflammation.

DefinitionWe determined the association between CD14++CD16+ monocytes and subclinical infiltrates that do not reach the histological threshold for rejection (≥Banff IA). We studied low-immunological-risk kidney-transplant recipients in a clinical trial (NCT02284464; EudraCT 2012-003298-24) whose protocol biopsy in the third month showed no significant changes or borderline lesions (BL). Flow cytometry was used to analyze the percentage of CD14++CD16+ monocytes in peripheral blood (PB) and blood from a fine-needle-aspiration biopsy (FNAB). A protocol biopsy was performed in 81 low-immunological-risk patients, of whom 15 were excluded (BK polyomavirus and rejection). The 28 (42.4%) with borderline lesions had significantly low levels of CD14++CD16+ in PB compared to patients with normal biopsies (7.9 ± 5.4 vs. 13.0 ± 12.8; p = 0.047). Patients without significant changes had similar percentages of CD14++CD16+ monocytes in the graft blood (GB) and FNAB blood. The percentage of these monocytes in the patients with an interstitial infiltrate, however, increased significantly in the FNAB blood compared to the GB: 16.9 ± 16.6 vs. 7.9 ± 5.4; p = 0.006. A difference of 50% in CD14++CD16+ in the GB versus the PB was a significant risk factor (p = 0.002) for BL, increasing the risk seven times. A decrease in CD14++CD16+ in the PB could be associated with the recruitment of these cells to the graft tissue in cases of subclinical BL inflammatory infiltrates below the threshold for rejection.

EP.TH.528The Accuracy of the Multi-slice detector CT Scan (MDCT) in staging borderline resectable periampullary carcinoma

Abstract Objectives Assess MDCT accuracy in staging cancers periampullary cancers. Introduction Periampullary malignancies are highly aggressive with poor outcomes. Surgery is the only curative option. It is crucial to define the patients who can advantage from a Whipple’s resection and who can avoid. Methodology and Results RCT investigated randomly 28 patients over 15 months. The patients were sub-divided into 2 groups. Group A, we relied mainly on the MDCT for preoperative staging, while in Group B staging laparoscopy was added before the abdominal exploration. Sensitivity of the MDCT and its accuracy were 100% in defining the signs of irresectability. For borderline staging, the accuracy of the scan was 62.5% and 71%, in groups A and B. The Overall accuracy of MDCT was 75%. It decreased to 68.1% for borderline lesions. The addition of staging laparoscopy to the diagnostic work up, increased the accuracy to 92.5%. The camera test was able to see occult findings which were missed in the images. liver Mets and malignant peritoneal fluid were localized in 18% and 9% respectively. 3 cases in group A and one in group B underwent unnecessary laparotomy. Thus, the false negative incidences were 21% and 7% in group A and B, with overall incidence 14.2%. Conclusion MDCT is highly sensitive and specific with high stage periampullary cancers. These parameters drop in border tumors with reduced accuracy in detecting the degree of vascular abutment and distant-occult findings. Addition of other adjuncts to decrease the rate of un-indicated laparotomy is advised.

Association Between Excessive Joint Laxity and a Wider Hill-Sachs Lesion in Anterior Shoulder Instability

Background: Excessive general joint laxity, a negative prognostic factor in joint instability, has not been studied to determine its relationship with bipolar bone loss in anterior shoulder instability. Purpose/Hypothesis: This study aimed to investigate the characteristics of bipolar bone defects in the presence of excessive joint laxity and the clinical outcomes based on the on-track/off-track theory. We hypothesized that (1) patients with excessive joint laxity might have less significant bipolar bone defects compared with those without excessive joint laxity and (2) no significant difference would be found in the clinical outcomes, including recurrence rate. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 81 patients who had undergone arthroscopic Bankart repair, with (group L; n = 33) or without (group N; n = 48) excessive joint laxity. The presence of excessive joint laxity was defined as a score of ≥4 using Beighton and Horan criteria preoperatively. Bipolar bone lesions were assessed using preoperative 3-dimensional computed tomography. Additional remplissage was performed for cases with off-track or positive engagement test in borderline on-track lesions. The functional outcomes at the 2-year follow-up were assessed using the recurrence rate, Subjective Shoulder Value, Rowe score, University of California Los Angeles shoulder score, active range of motion, and the sports/recreation activity level. Results: No significant difference was found in the glenoid bone defect between groups (14.1%, group L; 14.4%, group N). Off-track lesions were identified in 39.4% (13/33) of group L and 14.6% (7/48) of group N (P = .011). The mean Hill-Sachs interval to glenoid track ratio was 83.1% in group L and 75.2% in group N (P = .021). Additional remplissage procedures were more frequently performed in group L (48.5%; 16/33) than in group N (16.7%; 8/48) (P = .002). However, no significant difference was observed in the shoulder functional scores and recurrence rates between the groups. Conclusion: Patients with anterior shoulder instability and excessive joint laxity had significantly wider Hill-Sachs lesions and more off-track lesions than did those with normal joint laxity despite the lack of a significant difference in the glenoid bone defect. However, these differences in the Hill-Sachs lesion were not related to differences in the functional outcomes between the groups.

The Usefulness of Urinary Periostin, Cytokeratin-18, and Endoglin for Diagnosing Renal Fibrosis in Children with Congenital Obstructive Nephropathy.

Congenital obstructive nephropathy (CON) leads to renal fibrosis and chronic kidney disease. The aim of the study was to investigate the predictive value of urinary endoglin, periostin, cytokeratin-18, and transforming growth factor-β1 (TGF-β1) for assessing the severity of renal fibrosis in 81 children with CON and 60 controls. Children were divided into three subgroups: severe, moderate scars, and borderline lesions based on 99mTc-ethylenedicysteine scintigraphy results. Periostin, periostin/Cr, and cytokeratin-18 levels were significantly higher in the study group compared to the controls. Children with severe scars had significantly higher urinary periostin/Cr levels than those with borderline lesions. In multivariate analysis, only periostin and cytokeratin-18 were independently related to the presence of severe and moderate scars, and periostin was independently related to borderline lesions. However, periostin did not differentiate advanced scars from borderline lesions. In ROC analysis, periostin and periostin/Cr demonstrated better diagnostic profiles for detection of advanced scars than TGF-β1 and cytokeratin-18 (AUC 0.849; 0.810 vs. 0.630; 0.611, respectively) and periostin for detecting borderline lesions than endoglin and periostin/Cr (AUC 0.777 vs. 0.661; 0.658, respectively). In conclusion, periostin seems to be a promising, non-invasive marker for assessing renal fibrosis in children with CON. CK-18 and TGF-β1 demonstrated low utility, and endoglin was not useful for diagnosing advanced scars.

"Borderline" epithelial lesions of the breast: what have we learned in the past three decades?

SummaryAtypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH) and flat epithelial atypia (FEA) are common lesions mainly detected during mammographic screening. They are considered lesions at risk for the development of breast cancer, and they have been documented as non-obligate precursors of low grade in situ carcinomas. In a monumental work in 1991 Rosai gathered them as “borderline epithelial lesions”, and he described and demonstrated the subjectivity in their microscopic interpretation. Such subjectivity persists nowadays and limits considerably the diagnostic consistency. With his incredible ability to see, analyze and rationalize, Rosai introduced the concept of “mammary intraepithelial neoplasia (MIN) of either ductal or lobular type, followed by a grading system” which would have better represented the biological continuum between these lesions and benign and malignant lesions.

Fractional flow reserve-guided treatment in coronary artery disease: Clinical practice.

The assessment of functional severity of moderate coronary stenoses is challenging. Coronary angiography remains the standard technique for diagnosis, although, due to its limitations, it is frequently insufficient to detect relevant myocardial ischemia. Fractional flow reserve (FFR) is defined as the ratio between the mean hyperemic coronary artery pressure distal to the lesion and mean pressure in the aorta. The FFR measurement is currently supported by guidelines to evaluate the hemodynamic significance of lesions. Proper identification of patients that have the potential to benefit from revascularization is crucial. Based on already published literature, we focus on the long-term follow-up of patients with FFR-driven treatment. We also provide a review of specific clinical cases such as borderline FFR values, comorbidities or lesions in anatomical risk locations, in which interpretation can be challenging during the physiological assessment. The aim of this paper is to provide an overview of the evidence of FFR implementation in daily clinical practice and determine issues that raise doubts.

Assessment of quantitative dynamic contrast-enhanced MRI in distinguishing different histologic grades of breast phyllode tumor

To investigate whether quantitative DCE-MRI (qDCE-MRI) could help distinguish breast phyllodes tumor (PT) grades. This retrospective study included 67 breast PTs (26 benign lesions, 25 borderline lesions, and 16 malignant lesions) from April 2016 to July 2020. MRI was performed with a 1.5-T MR system. Perfusion parameters (Ktrans, kep, ve, iAUC60) derived from qDCE-MRI, tumor size, and the mean ADC value were correlated with histologic grades using Spearman's rank correlation coefficient. Ktrans, kep, ve, and iAUC60 of three histologic grades were also calculated and compared. The Spearman correlation coefficient with histologic grade of the tumor size was 0.578 (p < 0.001); the ADC value was not correlated with histologic grades of breast PT (p = 0.059). The Ktrans, kep, ve, and iAUC60 of benign breast PTs were significantly lower than those of borderline breast PTs (p < 0.001) and lower than those of malignant breast PTs (p < 0.001). In comparison, the Ktrans, ve, and iAUC60 of borderline breast PTs were significantly lower than those of malignant breast PTs (p < 0.001, p < 0.001, p = 0.007, respectively). For ROC analysis, AUCs of Ktrans, ve, and iAUC60 were higher than tumor size and ADC value for differentiating three PT grades. Quantitative and semi-quantitative perfusion parameters (Ktrans, ve, and iAUC60, especially Ktrans) derived from qDCE-MRI showed better diagnosis efficiency than tumor size and ADC for grading breast PTs. Therefore, qDCE-MRI may be helpful for preoperative differentiating breast PT grades. • Quantitative dynamic contrast-enhanced MRI can be used as a complementary noninvasive method to improve the differential diagnosis of breast PT. • Ktrans, ve, and iAUC60 derived from qDCE-MRI showed better diagnosis efficiency than tumor size and ADC for grading breast PTs.

Role of Adding Diffusion-Weighted MR Imaging to Conventional MR Imaging in Evaluation of Ovarian Masses

Abstract Background: Ovarian cancer is a leading cause of death among gynecological malignancies and the fifth most common cause of cancer deaths in women. Aim of Study: To determine whether the addition of DW sequences to a conventional MR imaging protocol can help in the prediction of the nature of suspicious ovarian masses which are detected previously by conventional ultrasound. Patients and Methods: Thirty-five female patients with initial undetermined ovarian lesions were included in this study during the period from December 2019 to September 2020. Women who present with an ovarian mass on previous US examination and were referred to the Radiology Department of Alexandria Main University Hospital and Radiology De-partment of Ain Shams University Hospitals for further assessment and characterization by MRI imaging with adding DW-MR imaging Sequence. Results: In the current study, the mean patient age was 41.00±13.37 years. 17 (48.57%) of 35 ovarian masses were benign, and 12 (34.29%) were malignant, and 6 (17.14%) were borderline. Diffusion-weighted MRI findings of the different histopathological types showed restricted diffusion in 83.3% of borderline lesions and 91.7% of malignant lesions while only 17.6% of benign lesions showed restriction diffusion with a statistically significant difference at p-value 0.025*. DWI had shown 91.7% sensitivity and low specificity 82.4%. Combined DWI and conventional MRI sequences had the highest accuracy 93.1%, and sensitivity at 95.3%. Conclusion: Our results concluded that the DWI can help and increase the confidence of MRI in assessment or exclude potential malignancy in ovarian masses.

Functional assessment of coronary blood flow as contemporary method for optimizing results of percutaneous coronary interventions in patients with ischemic heart disease

Coronary angiography is still the ‘gold standard’ in assessing the severity of stenotic lesions of the coronary arteries in the catheter laboratory. However, it is often difficult to identify the hemodynamic significance of one or another coronary artery stenosis, which is especially difficult in the case of borderline lesions with a coronary artery stenosis of 40–70 % according to angiography. It is important to note that the results of performed PCI are still largely assessed only on the basis of control angiographic data. This is due to the fact that the largest difference between angiography and FFR is in the intermediate range, and in general there is much less variation between angiography and fractional blood flow reserve (FFR) in the severe and mild lesions. However, the results of studies evaluating FFR after PCI showed a wide range of FFR values after satisfactory results of stenting according to angiography data. This additionally confirms the thesis that only one angiography is limited in determining the ischemic boundaries after PCI, and the level of FFR values after PCI is directly related to the results in the long-term period. Percutaneous coronary interventions under the control of FFR allows the operator to improve the results of endovascular treatment of coronary lesions in patients with coronary heart disease. The use of FFR in a catheter laboratory contributes to an increase in the clinical and economic efficiency of procedures, which is achieved due to the fact that the determination of FFR before PCI can significantly reduce the number of stents implanted during PCI, as well as to avoid unnecessary PCI stages in the treatment of patients with lesions of the LMCA. In addition, FFR allows to timely optimize the results of suboptimal PCI, as well as to reduce the frequency of main adverse cardiovascular events in the long-term period.

Effectiveness of a Cloud-Based Telepathology System in China: Large-Sample Observational Study.

BackgroundWhole-slide imaging allows the entire slide to be viewed in a manner that simulates microscopy; therefore, it is widely used in telepathology. However, managing the large digital files needed for whole-slide imaging is difficult. To solve this problem, we set up the Chinese National Cloud-Based Telepathology System (CNCTPS). CNCTPS has been running for more than 4 years and has accumulated a large amount of data.ObjectiveThe main purpose of this study was to comprehensively evaluate the effectiveness of the CNCTPS based on a large sample. The evaluation indicators included service volume, turnaround time, diagnosis accuracy, and economic benefits.MethodsDetails of 23,167 cases submitted to the CNCTPS from January 2016 to December 2019 were collected to analyze the service volume, turnaround time, and economic benefits. A total of 564 patients who visited the First Affiliated Hospital of Zhengzhou University and obtained final diagnoses were followed up to analyze the diagnostic accuracy of the CNCTPS.ResultsFrom 2016 to 2019, the service volume of the CNCTPS increased from 2335 to 9240, and the number of participating hospitals increased from 60 to 74. Consultation requests from county-level hospitals accounted for 86.57% (20,287/23,167). A total of 17,495 of 23,167 cases (75.52%) were confirmed, including 12,088 benign lesions, 5217 malignant lesions, and 190 borderline lesions. Of the cases, 3.85% (893/23,167) failed to be diagnosed for reasons such as poor slice quality and incomplete sampling. The median turnaround time was 16.93 hours and was shortened yearly (between 2018 and 2019: adjusted P=.01; other groups: adjusted P<.001); 82.88% cases were diagnosed in 48 hours. There was a discrepancy between the diagnosis and final diagnosis for 11 cases, including 4 false-positive cases and 7 false-negative cases. The sensitivity and specificity were 97.66% and 98.49%, respectively. The diagnostic accuracy of the system was 98.05%, with no statistical difference from the final diagnosis in the hospital (P=.55). By using this system, a total of US $300,000 was saved for patients every year.ConclusionsThe novel cloud-based telepathology system has the potential to relieve the shortage of pathologists in primary hospitals. It can also simultaneously reduce medical costs for patients in China. It should, therefore, be further promoted to enhance the efficiency, quantity, and quality of telepathology diagnoses.