Diagnosis Of Postoperative Recurrence Research Articles

P485 Do intestinal ultrasound scores have a role in the diagnosis of post-operative recurrence?

Abstract Background Ileocolonoscopy and Rutgeerts endoscopic score remains the gold standard to evaluate post-operative recurrence (POR) in Crohn's disease (CD) patients. Intestinal ultrasound (IUS) is proposed as a non-invasive alternative to ileocolonoscopy for the diagnosis of POR, with a sensitivity of 94% and specificity of 84%. There are several IUS scores that evaluate CD disease activity such as SUS-CD (validated), IBUS-SAS and Simple US Score, which have not yet been studied in the diagnosis of POR. The aim of this study is to assess whether IUS parameters and ultrasound scores correlate with endoscopy in the diagnosis of POR. Methods A unicentric retrospective study was performed. There were included patients with CD with both an ileocolonoscopy and intestinal ultrasound performed for the detection of POR, the time between tests was less than 6 months and there was no therapeutic change between tests. Endoscopic POR was evaluated with Rutgeers score (RS), considering POR RS ≥i2b. In IUS, were used: Simple US Score, SUS-CD and IBUS-SAS. Results 103 patients were included, baseline characteristics are in Table 1. 30 patients (29.1%) had no endoscopic POR, 22 (21.4%) had RS i2a, 12 (11.6%) RS i2b and 39 (37.9%) had severe POR (RS i3-i4). The mean wall thickness measured by IUS in patients without endoscopic POR was 2.7 mm (SD +/- 1.3) versus 5.0 (SD +/- 1.7) in patients with RS ≥i2b (p 0.001). Hyperemia (Limberg >1) was present in 60 patients (82.2%) with RS ≥i2a vs in 4 patients (13.3%) without endoscopic POR (p 0.001). Both hyperemia and wall thickness had a sensitivity of 89.0% and specificity of 76.7% in the diagnosis of POR. The mean values for IUS scores were: Simple US Score 5.5 (SD +/- 3.1), SUS-CD 2.1 (SD +/- 1.8) and IBUS-SAS 32.9 (SD +/- 26.3). There were positive correlation for IUS scores (Simple US Score r 0.68, SUS-CD r 0.68 and IBUS-SAS r 0.67) with RS (p <0.0001). For the Simple US Score an area under the ROC curve (AUC) of 84.13% (95% CI 76.81 – 91.45) was obtained, with a score ≥3, the sensitivity (S) was 82.19% and specificity (E) 80.0%. IBUS-SAS presented an AUC of 84.93% (95% CI 77.98 - 91.87), a result ≥15 granted a S 82.19% and E 80.0%. The SUS-CD index had an AUC of 83.38% (95% CI 75.55 - 91.20), a result ≥1 presented S 82.19% and E 80.0%. Conclusion In our experience, IUS scores (IBUS-SAS, SUS-CD and Simple US Score) show a high sensitivity and specificity in the diagnosis of POR. The three scores had AUC greater than 80%, IBUS-SAS showed slightly higher AUC results.

P360 Role of intestinal ultrasound scores in the diagnosis of post-operative recurrence in Crohn's disease

Abstract Background Ileocolonoscopy is the gold standard to evaluate post-operative recurrence (POR) in Crohn's disease (CD) patients. Rutgeerts endoscopic score remains the gold standard in the evaluation of post-operative recurrence in CD. Intestinal ultrasound (IUS) is proposed as a non-invasive alternative to ileocolonoscopy for the diagnosis of POR, with a sensitivity of 94% and specificity of 84%. There are several IUS scores that evaluate CD disease activity such as SUS-CD (validated), IBUS-SAS and Simple US Score, which have not yet been studied in the diagnosis of POR. The aim of this study is to assess whether these ultrasound scores correlate with endoscopy in the diagnosis of PR. Methods A retrospective study was performed. Patients with CD who had undergone ileocecal resection, with both an ileocolonoscopy and intestinal ultrasound performed for the detection of POR were included. The time between tests was less than 6 months and there was no therapeutic change between tests. Endoscopic POR was evaluated with Rutgeers score (RS), considering POR RS ≥i2b. In IUS, were used: Simple US Score, SUS-CD and IBUS-SAS. Results Forty-five patients were included (female 48,89%, male 51,11%). The Montreal classification was: L1 n=22 (48,89%), L2=1 (2,22%), L3 n=22 (48,89%), B1 n=3 (6,67%), B2 24 (54,4%) and B3 n=18 (40%). 24 patients (53%) had no endoscopic POR, 6 (6%) had RS i2b and 15 (33.33%) had severe POR. The mean wall thickness measured by IUS was 4.39 mm (SD +/- 1.92) and 26 patients (57.77%) had hyperemia (Limberg score >1). The mean values for IUS scores were: Simple US Score 5.79 (SD +/- 2.81), SUS-CD 2.35 (SD +/- 1.62) and IBUS-SAS 34.04 (SD +/- 24.21). For the Simple US Score an area under the ROC curve (AUC) of 80.65% (95% CI 67.7 - 93.6) was obtained, with a score ≥5.4. The sensitivity (S) was 95.24% and specificity (E) 66.67%. IBUS-SAS presented an AUC of 87% (95% CI 76.98 - 97.02), a result ≥28 granted a S 90.48% and E 70.83%. The SUS-CD index had an AUC of 79% (95% CI 76.98 - 97.92), a result ≥3 presented S 90.48% and E 62.5%. Conclusion In our experience, IUS scores (IBUS-SAS, SUS-CD and Simple US Score) show a high sensitivity in the diagnosis of POR.

P215 Correlation between small bowel capsule endoscopy and biomarkers in postoperative recurrence in Crohn’s Disease

Abstract Background Endoscopic postoperative recurrence (POR) measured by the Rutgeert′s score is a strong predictor of clinical recurrence. Ileocolonoscopy is the gold standard in the diagnosis of POR by recent guidelines and is recommended within the first 6 to 12 months after surgery. After the initial ileocolonoscopy the monitoring is usually based on non-invasive test such as fecal calprotectin (FCP), imaging studies or small bowel capsule endoscopy (SBCE) since symptoms are not reliable of mucosal lesions. Our aim was to evaluate the accuracy of FCP and C-reactive protein (CRP) for detection of endoscopic recurrence measured by SBCE. Methods We included all patients with known CD with previous ileocolonic resection followed in the Inflammatory Bowel Disease Unit of Hospital Universitario de Navarra from 01/01/2008 to 31/12/2019 in which a SBCE was performed. CRP was considered elevated if >5g/L. To avoid bias from disease activity in colon undetectable by SBCE, only L1 patients were included in this specific analysis. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and diagnostic Odds Ratio (DOR) were calculated. Receiver operating characteristic curve (ROC) and its area under the curve (AUC) were calculated with FCP and CRP. Results A total of 113 SBCE procedures were performed for evaluation of POR but only 89 were L1 patients. CRP was available for all patients (16.9% elevated) and FCP for 66.3% within 3 months previous to SBCE. Patients with significant POR had a higher mean CRP (4.8 ± 6.6 vs 2.5 ± 5.2, p= 0.017) and FCP (176.3 ± 178 vs 86.3 ± 132, p= 0.04). Diagnostic performance for detecting ≥i2 in neoterminal ileum for CRP was: sensitivity 24.4 %, specificity 89.6%, PPV 66.7%, NPV 58.1%, DOR 2.8. Diagnostic accuracy was obtained for FCP levels of 50 µg/g, 100 µg/g, 150 µg/g and 200µg/g and shown on the table.CRP and FCP had an AUC of 0.7 (95% CI 0.56–0.84) and 0.7 (95% CI 0.56–0.84) respectively. Conclusion FCP is an accurate surrogate marker of postoperative endoscopic recurrence. The FCP cut-off 100 µg/g appears to have the best overall accuracy.

Prognosis of Patients with Pathological Stage I/II Lung Adenocarcinoma in Whom Diagnosis of Postoperative Recurrence Is Delayed after Initial Recognition of Elevated Serum Carcinoembryonic Antigen

Prognosis of Patients with Pathological Stage I/II Lung Adenocarcinoma in Whom Diagnosis of Postoperative Recurrence Is Delayed after Initial Recognition of Elevated Serum Carcinoembryonic Antigen

Application of 3D-Arterial Spin Labeling Brain Perfusion Imaging in the Preoperative Diagnosis and Grading of Glioma

To explore the value of three-dimensional arterial spin labeling brain perfusion imaging in the preoperative diagnosis and grading of glioma. A total of 128 patients with preoperative and postoperative intracranial occupying lesions and glioma between January 2018 and December 2020, including 76 preoperative patients and 52 postoperative patients. Routine magnetic resonance imaging and three-dimensional arterial spin labeling perfusion examinations were performed in all patients, and the cerebral blood flow values and the area size of the lesions were measured preoperatively and postoperatively, and the ratio of the two was calculated to standardize the regional cerebral blood flow. The perfusion of three-dimensional arterial spin labeling in glioma was characterized by high perfusion in solid areas of high-grade glioma and low perfusion in solid areas of low-grade glioma. The correct diagnostic rate of perfusion grading in threedimensional arterial spin labeling was found to be 93.21 %, while the accuracy rate of magnetic resonance imaging was only 84.33 %, using pathological diagnostic results as the standard. The difference between the two was statistically significant (p 0.05). In the diagnosis of postoperative recurrence, the cerebral blood flow values of lesions in the glioma recurrence group were significantly higher than those in the glioma non-recurrence group. The regional cerebral blood flow values of lesions in the glioma recurrence group were significantly higher than those in the glioma non-recurrence group, and the differences between the two groups were statistically different (p<0.05). Three-dimensional arterial spin labeling can provide a more comprehensive and accurate assessment of glioma, which provides a new theoretical basis for preoperative grading of glioma, prediction of postoperative recurrence and assessment of surgical planning.

Application value of 18F-FDG PETCT imaging in the clinical initial diagnosis and follow-up of primary lesions of cervical cancer.

BackgroundCervical cancer is a common malignant tumor in gynecology with a high death rate. his study aims to analyze the application value of 18F-fluorodeoxyglucose imaging examination (18F-FDG PETCT) imaging in the initial clinical diagnosis and follow-up examination of cervical cancer.MethodsThe clinical data of 71 patients with cervical lesions who were admitted to our hospital from March 2017 to March 2019 were retrospectively collected all patients underwent 18F-FDG PETCT examination. The results of the pathological examination were a benchmark to calculate the sensitivity, specificity, and accuracy of 18F-FDG PETCT imaging in the diagnosis of primary lesions of cervical cancer and the diagnosis of postoperative recurrence, residual, and metastasis.ResultsThere were 39 patients initially suspected, and 30 cases were diagnosed as cervical cancer by pathological examination, including 22 cases with squamous cell carcinoma, 4 cases with adenocarcinoma, 3 cases with carcinoma in situ, and 1 case with adenosquamous carcinoma. The maximum standard uptake (SUVmax) value was (10.36±5.22), and the patient’s lesions showed different degrees of increase of 18F-FDG metabolism. The necrotic area in the patient's lesion showed reduced/defect metabolism. The sensitivity of 18F-FDG PETCT imaging in the diagnosis of primary lesions of cervical cancer was 86.66%, specificity was 44.44%, and accuracy was 76.92%. In the 32 cases followed up for monitoring after the operation, 16 cases showed recurrence, metastasis, residual and other conditions, and 7 cases showed local recurrence/metastasis. 18F-FDG PETCT images showed: abnormal widening of the cervix, stump nodules/mass in the vagina, and rectal and bladder infiltration. All patients with local recurrence were treated with local tissue biopsy or surgical resection under 18F-FDG PETCT image localization. The diagnostic sensitivity, specificity and diagnostic coincidence rate of 18F-FDG PETCT imaging for postoperative follow-up of cervical cancer patients were 100%, 75.00% and 87.50%, respectively.ConclusionsFor patients with cervical cancer who are initially diagnosed or followed up, they can all be tested by 18F-FDG PETCT imaging, which can provide a reference for the formulation of diagnosis and treatment plan and the evaluation of prognosis.

True-FISP MRI in diagnosis of postoperative hernia recurrence: a brief report

A 24-year-old man underwent laparoscopic mesh repair of a right direct inguinal hernia which had recurred after previous surgery 3 months previously. A large swelling was noted in the right groin 4 h postoperatively, which was reduced initially but recurred within 24 h. A differential diagnosis of postoperative recurrence versus hematoma was considered, and patient was referred for imaging. The patient was imaged using different modalities including B-mode ultrasonography, computed tomography (CT) of the pelvis, and True-FISP magnetic resonance imaging (true imaging with steady-state precession MRI). Initial focused ultrasound (US) [corrected] was suggestive of but equivocal for recurrence. Subsequent non-contrast CT of the region followed by rapid sequence (true-FISP) MRI confirmed the presence of bowel in the inguinal canal. Imaging has a role in the diagnosis of postoperative hernia recurrence in cases where there is a clinical diagnostic dilemma, especially MRI using true-FISP sequence, which is acquired in seconds, is a non-ionising radiation modality and does not have inter operator variability.

Role of Ultrasonography in the Diagnosis of Postsurgical Recurrence of Crohn's Disease

Ultrasonography is a valid tool in the diagnosis of Crohn's disease, but its sensitivity, specificity, and overall accuracy in the diagnosis of postoperative recurrence are still not well established. The aim of this study was to evaluate the accuracy of ultrasonography compared with endoscopy in the diagnosis of postoperative recurrence of Crohn's disease. Forty-seven patients resected for Crohn's ileitis were studied by ultrasonography and colonoscopy to detect possible recurrence of the disease; 10 patients operated on for cancer of the right colon were used as controls. Six patients with Crohn's disease were excluded from the study because of failure to endoscopically reach the anastomosis; the remaining 41 patients had both ultrasonography and colonoscopy over a period of 14 days. Sonographic recurrence was defined as the presence of >5 mm thickness of the ileal wall. Sensitivity, specificity, and overall accuracy of ultrasonography in diagnosis of postoperative recurrence were 81%, 86%, and 83% respectively. Positive predictive value was 96% and negative predictive value was 57%. This study is the first to assess the role of ultrasonography in comparison with endoscopy in detecting Crohn's disease recurrence after surgery. Our data suggest that ultrasonography should be used first in the case of clinical suspicion of Crohn's disease recurrence, reserving ileocolonoscopy for negative or uncertain cases.

Role of ultrasonography in the diagnosis of postsurgical recurrence of Crohn’s disease

Objective: Ultrasonography is a valid tool in the diagnosis of Crohn’s disease, but its sensitivity, specificity, and overall accuracy in the diagnosis of postoperative recurrence are still not well established. The aim of this study was to evaluate the accuracy of ultrasonography compared with endoscopy in the diagnosis of postoperative recurrence of Crohn’s disease. Methods: Forty-seven patients resected for Crohn’s ileitis were studied by ultrasonography and colonoscopy to detect possible recurrence of the disease; 10 patients operated on for cancer of the right colon were used as controls. Six patients with Crohn’s disease were excluded from the study because of failure to endoscopically reach the anastomosis; the remaining 41 patients had both ultrasonography and colonoscopy over a period of 14 days. Sonographic recurrence was defined as the presence of >5 mm thickness of the ileal wall. Results: Sensitivity, specificity, and overall accuracy of ultrasonography in diagnosis of postoperative recurrence were 81%, 86%, and 83% respectively. Positive predictive value was 96% and negative predictive value was 57%. Conclusion: This study is the first to assess the role of ultrasonography in comparison with endoscopy in detecting Crohn’s disease recurrence after surgery. Our data suggest that ultrasonography should be used first in the case of clinical suspicion of Crohn’s disease recurrence, reserving ileocolonoscopy for negative or uncertain cases.

CLINICAL SIGNIFICANCE OF THREE PARAMETERS, CD16, IAP AND CEA IN PATIENTS WITH STAGE IV GASTRIC CANCER

In order to find an index for early diagnosis of post operative recurrence in stage IV gastric cancer, we studied in serum CD16, IAP and CEA.Seventy operated patients with stage IV gastric cancer were divided into those survived for more than one year after the operation (group A; 29) and those died within one year (group B; 41), and compared for time-dependent changes in serum CD16, IAP and CEA. There was no significant difference in preoperative abnormal level in the 3 parameters between both groups. While, postoperative time-dependent changes were minimal in group A, but showed an increasing tendency in group B. In this study, recurrence-positive symptoms were designated in CD16 by more than 10% increase during 3 months; in IAP by more than 500μg/ml; and in CEA by more than 10 ng/ml. In 16 patients of group A who experienced clinical recurrence, 9 patients were CD 16-positive, 5 were IAP-positive, and 10 were CEA positive at the time of clinical manifestation of recurrence or before the manifestation. In addition, 15 patients had at least one positive symptom among of them at the time of or before recurrence. Recurrence-free cases did not show any such findings.These results suggest that estimation of these three parameters may be useful for early diagnosis of recurrence in patients with gastric cancer.