Detection Of Dysplasia Research Articles

Detection and treatment of developmental dysplasia of the hip in infants: updates and recommendations.

Developmental dysplasia of the hip (DDH) is common and is a source of potentially avoidable morbidity through childhood and adult life. Despite progress over the past century, there is a wide variation in policy, practice and outcomes between countries. This review considers information from a geographically wide range of locations to evaluate the impact of these variations and understand how these variations arise. The aim is to help clinicians and policymakers adopt the best practices for their population. There is a lack of randomized controlled trials to guide decisions on screening. Given the large numbers to treat and preexisting practices, it is unlikely that such trials of sufficient statistical power will be performed. However, many whole population studies are becoming available from different countries that allow an assessment and comparison of the impact of their strategies. Standardizing metrics in studies and defining late diagnosis would improve comparisons across studies. The general trend appears to favour universal screening to reduce the risk of late diagnosis, the need for surgery and the subsequent poorer outcomes. Notably, resource-constrained countries like Mongolia have successfully implemented universal screening, showing that effective strategies can be adopted regardless of resources.

Early Detection of Bronchopulmonary Dysplasia (BPD) in Preterm Infants Using Doppler Ultrasound Technology.

The purpose of this research is to determine if Doppler ultrasonography technology may be used to forecast the onset of bronchopulmonary dysplasia (BPD) in premature babies in the early postnatal stage. On days 3, 7, 14, and 28 after delivery, Doppler ultrasonography exams were performed on a prospective cohort of 170 preterm newborns. Measurements were made of parameters such right ventricular output (RVO), systolic-to-diastolic ratio (S/D ratio), pulmonary artery acceleration time (PAAT), and velocity time integral (VTI). The predictive value of these indicators was evaluated using Kaplan-Meier survival analysis and multivariate logistic regression. The severity of BPD was substantially correlated with all assessed Doppler ultrasound parameters (P<0.05). With an area under the curve (AUC) of 0.76, PAAT in particular demonstrated a reasonable capacity for prediction. A considerably greater cumulative incidence was found by Kaplan-Meier survival analysis. In conclusion, Doppler ultrasonography technology is a useful technique for identifying BPD in premature babies early on. High-risk babies can be efficiently identified by PAAT and VTI in particular, allowing for prompt intervention and possibly better results.

Pearls & Oy-sters: Increased Visibility of Focal Cortical Dysplasia in Cerebral MRI During the First Year of Life.

Early detection of focal cortical dysplasia (FCD) using brain MRI in young children presenting with drug-resistant epilepsy may facilitate prompt surgical treatment, resulting in better control of seizures and decreased associated cognitive difficulties. Characteristics of FCD described in the literature are predominantly based on MRI findings in a fully myelinated brain; therefore, changes occurring during early brain maturation are not well known. In this case report, we describe distinct MRI features of a FCD visualized best before completion of myelination of the cortex and subcortical white matter. Specifically, this lesion exhibited increased visibility because of better delineation of the borders of the pathological area involved in the malformation compared with imaging obtained after completion of myelination. Although the pathophysiology of these imaging features necessitates further investigation, one hypothesis is that excessive neuronal input in young epileptic patients could trigger premature myelination of overstimulated fibers underlying the cortical epileptogenic focus. The aim of this case report was to raise awareness that seizures might induce local changes in brain myelination, which can be detected by MRI during the first year of life. Early identification of FCD may prompt surgical treatment in selected patients with drug-resistant epilepsy.

P0465 Chromoendoscopy for Dysplasia Detection in High-Risk IBD Patients: A Decade of Experience at a Tertiary Care Centre

Abstract Background Ulcerative colitis (UC) and colonic Crohn’s disease (CD), carries an increased risk of colorectal cancer, necessitating effective surveillance strategies. Dye spraying and electronic virtual chromoendoscopy techniques enhance mucosal visualisation and aid in dysplasia detection. We aim to presents the effectiveness and characteristics of chromoendoscopy (CE) in a tertiary care center. Methods We conducted a retrospective cohort study of inflammatory bowel disease (IBD) patients who underwent CE at our center between 2014 and 2024, following recommended guidelines. Dysplasia detection rates were documented, and associated risk factors were analysed. Advanced dysplasia was defined as villous pathology features, lesion ≥ 10mm, high-grade dysplasia, or malignancy. Results A total of 139 patients (50% female; median age at procedure: 51.6 years [IQR 40.6–62.8]; median duration from diagnosis: 17.5 years [IQR 12.2–25.5]) underwent a median of 2 endoscopies (IQR 1–4) with a median Boston bowel preparation score of 8 (IQR 7–9). Among these patients, 75% had UC and 70.8% were non-smokers. Dysplasia was detected in 13 patients (9.4%) at the first surveillance. Overall, the dysplasia detection rate was 17.4% per procedure (64/367) and 14.4% per patient (20/139). Advanced dysplasia was identified in 13 procedures (3.5%). Univariate analysis revealed significant associations between dysplasia detection and male sex (67.4% vs. 44.2%; p = 0.03), age at diagnosis (35 years [IQR 28.5–41.3] vs. 29.2 years [IQR 19.6–37.6]; p = 0.03), age at procedure (62.7 years [IQR 53.2–67.1] vs. 50.4 years [IQR 43.2–62.3]; p = 0.025), and prior dysplasia at first surveillance (25.7% vs. 2.9%; p &amp;lt; 0.001). No correlations were identified with family history of colorectal cancer, treatment history, primary sclerosing cholangitis, or smoking status. Multivariate analysis identified age at procedure as the only significant risk factor (OR: 1.07, 95% CI: 1.02–1.12). Over the past decade, a notable shift was observed from dye chromoendoscopy (usage declined from 74% to 36%) to electronic chromoendoscopy (usage increased from 8.3% to 67.6%). Dysplasia detection rates remained steady over time (figure 1). Conclusion Routine chromoendoscopy surveillance in high-risk colitis patients yields high dysplasia detection rates. Our findings reaffirm the association of some of the known risk factors with increased dysplasia detection and highlight the growing preference for electronic CE in endoscopic surveillance. These results further reinforce the value of chromoendoscopy in targeted and effective surveillance strategies.

OP13 Higher neoplasia detection rate and lower number of targeted biopsies associated with virtual chromoendoscopy in IBD surveillance: a real-world, multicentre UK study

Abstract Background Dye chromoendoscopy (DCE) with targeted biopsies has traditionally been considered the gold standard for optimal detection of dysplasia in the context of inflammatory bowel disease (IBD) surveillance. Randomised trials have challenged this with both virtual chromoendoscopy (VCE) and high-definition white light endoscopy (WLE) appearing to have comparable yield. This multicentre UK study aims to test the hypothesis that neoplasia detection rate (NDR) in IBD surveillance as part of routine clinical care is not affected by the modality used. Methods IBD surveillance colonoscopy procedures for patients with ulcerative colitis (UC) and colonic Crohn’s disease (CD) performed in five UK centres between 2018 and 2024 were reviewed. For procedures with polypectomy or missing data, median withdrawal times for each modality from non-polypectomy cases were imputed. Significant variables in a univariate analysis were included in a logistic regression model to adjust NDR in the three modalities. Results A total of 2,673 IBD surveillance colonoscopies in 2,050 patients were included: 1,275 (48%) WLE, 1,032 (38%) DCE, 366 (14%) VCE. Disease breakdown included 74% UC and 26% CD, and 25% of patients had concomitant primary sclerosing cholangitis. The majority (67%) were performed by endoscopists with expertise in IBD surveillance. Median (IQR) withdrawal time in minutes without polypectomy was DCE: 17 (13, 22), VCE: 14 (12, 20), WLE: 11 (8, 14). Neoplasia was detected in 305 (11%) procedures. The NDR (95% CI) were VCE: 19% (15.3, 23.6), DCE: 12% (9.9, 13.9) and WLE: 9% (7.5, 10.7), p&amp;lt;0.001 (figure 1A). In a univariate analysis, 8 variables were significantly associated with NDR. A logistic regression model including these variables (figure 2) showed that VCE significantly increased dysplasia detection (p&amp;lt;0.001). Older age, previous dysplasia, and longer withdrawal time also significantly increased NDR (p&amp;lt;0.001), with active disease having the opposite effect (p=0.035). Adjustment for these variables did not change modality related NDR substantially (figure 1B). A higher number of targeted biopsies per procedure were taken with DCE 0.52 (SD 1.68) compared to VCE 0.33 (SD 1.59) or WLE 0.13 (SD0.78), p &amp;lt;0.001. However, this did not improve dysplasia yield within these biopsies: DCE 3.2%, VCE 5.7%, WLE 5.0%, (p=0.248). Conclusion In this study of IBD surveillance in routine clinical practice VCE has higher NDR than DCE and WLE. DCE was associated with more targeted biopsies without greater dysplasia detection.

P0491 Cumulative Inflammatory Burden and Structural Bowel Changes as Independent Risk Factors for Colonic Dysplasia in Ulcerative Colitis: A Case-Control Study

Abstract Background Long-standing inflammation has been implicated in the development of colonic dysplasia in ulcerative colitis (UC). However, the relationship between varying degrees of inflammatory exposure and dysplasia risk remains poorly understood. We aimed to identify risk factors for colonic dysplasia in UC patients, with particular focus on quantifying long-term inflammatory exposure. Methods In this retrospective single-center case-control study, we reviewed 55 UC patients diagnosed with colonic dysplasia (low-grade, high-grade, or cancer) between 2013 and 2022, and 110 randomly selected UC patients without dysplasia as controls. Endoscopic inflammation was scored using the Mayo endoscopic subscore (0-3), and cumulative inflammatory exposure was calculated by multiplying these scores with the duration of each endoscopic follow-up period. Clinical factors and endoscopic findings were compared between groups, and logistic regression analysis was performed to identify independent predictors of dysplasia. Results Univariate analysis showed that the dysplasia group had significantly higher frequencies of anemia (hemoglobin &amp;lt;10 g/dL), elevated ESR (&amp;gt;18 mm/hr at diagnosis), steroid and biologics use, tubular or shortened colon, and high cumulative endoscopic inflammation scores (&amp;gt;10). In multivariate analysis, after adjusting for age, gender, and disease duration, both tubular or shortened colon (OR 3.172, 95% CI: 1.029-9.780) and high cumulative endoscopic inflammation score(&amp;gt;10) (OR 4.205, 95% CI: 1.065-16.600) were independently associated with increased dysplasia risk. Conclusion High cumulative inflammatory burden, as indicated by elevated endoscopic inflammation scores and structural bowel changes, significantly increases the risk of colonic dysplasia in UC patients. More intensive surveillance strategies may be warranted for patients with these objective risk indicators to enable early detection of colitis-associated dysplasia.

DOP003 Cromoendoscopy versus second generation Narrow band Imaging for dysplasia detection in IBD. A prospective randomized controlled trial

Abstract Background Neoplastic risk is increased in long-standing colitis. Dye chromoendoscopy (CE) and virtual chromoendoscopy are surveillance methods. The aim of this trial is to compare methylene blue chromoendoscopy (CE) with second generation narrow band imaging (NBI) virtual chromoendoscopy in the detection of IBD-associated colonic neoplasia. Methods Prospective randomized controlled trial (NBICromo NCT04403997) including patients with clinical indication for surveillance (&amp;gt;8 years of disease, left-sided or extensive colitis, colonic Crohn´s disease with &amp;gt;2 colonic segments affected or associated primary sclerosing cholangitis). Patients were randomized on 1:1 ratio to CE with methylene blue 0,1% or NBI. All procedures were performed with Olympus HQ190 endoscopes by endoscopists with experience in IBD and chromoendoscopy. All visible lesions were resected or biopsied depending on the optical diagnosis. The primary endpoint is the difference in total number of neoplastic lesions detected in each group. Neoplastic lesions include dysplasia and serrated lesions. Secondary endopoints include withdrawal time, total number of lesions, adverse events. The study has been approved by the Hospital Ethics Committee and patients signed informed consents. Results 200 patients were included, 26 were excluded due to presence of inflammation or poor bowel preparation and finally 174 were randomized, 81 to CE arm and 93 to NBI Basal characteristics are shown in Figure 1. 118 (67,8%) patients had at least one lesion. 59 (72,8%) in the CE group and 59 (63,4%) in the NBI group p=0.22. 51 patients (29,5%) had neoplastic lesions, 24 patients in CE group (29,6%) and 25 patients with NBI (26,8%) 299 lesions were detected. 173 with CE and 126 with NBI. Of these 75 (25,1%) were neoplastic. 37 neoplastic lesions were found in NBI group and 38 in CE group p ns. 10 lesions were serrated, 6 in the NBI group and 4 in CE group p ns. No invasive cancer was detected. Lesion characteristics are shown in figure 2 Total withdrawal time (including staining and/or therapeutics) was significantly shorter in the NBI group (median 15 min (Interquartile range 11-21 vs 24 (IQ range 18-32 p&amp;lt;0.001).AE were 1 post moderate resection bleeding and 1 mild fever, both in the CE group. Conclusion In patients with IBD undergoing colitis associated neoplasia screening we found no difference between virtual chromoendoscopy with NBI and methylene blue chromoendoscopy in neoplasia detection. NBI reduces procedure time significantly.

P0812 Establishing a target dysplasia detection rate (DDR) as a quality metric for Inflammatory Bowel Disease surveillance

Abstract Background Patients with inflammatory bowel disease (IBD) have an increased risk of developing dysplasia and colorectal cancer. Endoscopic surveillance is recommended, however, key quality performance metrics for surveillance are lacking. The aim of this study was to perform a systematic review and meta-analysis of the prevalence of dysplasia in patients undergoing IBD surveillance in the era of high-definition colonoscopy, in order to determine a target dysplasia detection rate (DDR) which can be used as a quality measure. Methods The trial protocol was registered with PROSPERO (CRD42024537521). An extensive search was performed of Medline, EMBASE, Web of Science and Cochrane Library databases to identify all prospective published studies (randomised controlled trials (RCT), observational cohort studies and crossover/tandem studies) of patients undergoing IBD dysplasia surveillance using high-definition colonoscopes. Several surveillance modalities were included (high-definition white light, dye spray chromoendoscopy, virtual chromoendoscopy, full spectrum endoscopy, autofluorescence and endomicroscopy with chromoendoscopy). Two reviewers independently evaluated studies for eligibility and methodological quality. All variables of interest were collected on a standardised form. A random-effects model was used to calculate an estimate of the pooled prevalence of dysplasia defined as the dysplasia detection rate. An estimate of the pooled prevalence of cancer was also determined. A sub-group analysis was performed, by surveillance modality, for all non-crossover/tandem studies where data was available. Results Twenty-five studies (11 RCT, 8 tandem/crossover studies and 6 observational cohort studies) were included, from a total of 3029 abstracts screened. For the calculation of dysplasia and cancer prevalence rates, a total of 4136 patients (55.2% male), mean age 49.4 years and mean disease duration 16.5 years met inclusion criteria. The pooled dysplasia detection rate was 16.5% (95% CI, 14% to 19%). (Figure 1). The pooled cancer detection rate was 0.1% (95% CI, 0 to 0.2%). Subgroup analysis by surveillance modality demonstrated similar pooled dysplasia detection rates with slight differences in mean procedural withdrawal times. (Table 1). Conclusion This is the first study that attempts to measure dysplasia detection rates in a systematic fashion in patients undergoing IBD surveillance colonoscopy in the high-definition colonoscopy era. The pooled dysplasia detection rate was 16.5% and cancer detection rate was 0.1%. We propose a conservative estimate dysplasia detection rate of 14% (the lower confidence limit in our study) as a target quality metric for IBD surveillance.

Convolutional neural networks for accurate real-time diagnosis of oral epithelial dysplasia and oral squamous cell carcinoma using high-resolution in vivo confocal microscopy

Oral cancer detection is based on biopsy histopathology, however with digital microscopy imaging technology there is real potential for rapid multi-site imaging and simultaneous diagnostic analysis. Fifty-nine patients with oral mucosal abnormalities were imaged in vivo with a confocal laser endomicroscope using the contrast agents acriflavine and fluorescein for the detection of oral epithelial dysplasia and oral cancer. To analyse the 9168 images frames obtained, three tandem applied pre-trained Inception-V3 convolutional neural network (CNN) models were developed using transfer learning in the PyTorch framework. The first CNN was used to filter for image quality, followed by image specific diagnostic triage models for fluorescein and acriflavine, respectively. Images were categorised based on a histopathological diagnosis into 4 categories: no dysplasia, lichenoid lesions, low-grade dysplasia and high-grade dysplasia/oral squamous cell carcinoma (OSCC). The quality filtering model had an accuracy of 89.5%. The acriflavine diagnostic model performed well for identifying lichenoid (AUC = 0.94) and low-grade dysplasia (AUC = 0.91) but poorly for identifying no dysplasia (AUC = 0.44) or high-grade dysplasia/OSCC (AUC = 0.28). In contrast, the fluorescein diagnostic model had high classification performance for all diagnostic classes (AUC range = 0.90–0.96). These models had a rapid classification speed of less than 1/10th of a second per image. Our study suggests that tandem CNNs can provide highly accurate and rapid real-time diagnostic triage for in vivo assessment of high-risk oral mucosal disease.

Network Meta-Analysis: Comparison of Endoscopic Dysplasia Detection Technologies in Inflammatory Bowel Disease.

Novel colorectal cancer endoscopic surveillance techniques for inflammatory bowel disease (IBD) have recently been developed. Compare the efficacy of currently available techniques for dysplasia detection in colonic IBD. We conducted a systematic literature search from inception to March 2024 for randomized controlled trials (RCTs) or prospective cohort studies enrolling adults with IBD and having surveillance colonoscopy for dysplasia screening. Primary outcome was the number of dysplastic lesions (per-lesion analysis). Secondary outcome was the number of patients with dysplasia (per-patient analysis). We assessed endpoints using the frequentist NMA random effect model. We included 25 studies (22 RCTs). 4837 patients met eligibility criteria (850 total dysplastic lesions; 105 with advanced dysplasia). Nine different screening techniques were studied. In per-lesion analysis, dye-based chromoendoscopy (DCE) ranked the highest (83%) per SUCRA ranking. DCE was superior to HD-WLE (OR, 1.78; 95% CI, 1.06-3.00). There were no significant differences between NBI and DCE, HD-WLE with SR or CEM in head-to-head comparisons. In a sub-analysis confined to ulcerative colitis (UC), DCE ranked highest (98%) with per-lesion analysis, and was superior to NBI (OR, 1.69; 95% CI, 1.03-2.77). HD-WLE-SR, DCE and CEM demonstrated superiority over other techniques for detection of dysplasia in colonic IBD. DCE was superior for dysplasia detection in colonic IBD. DCE was superior to HD-WLE in colonic IBD. DCE was the best technique in UC. Further studies to compare HD-WLE-SR and NBI with DCE are warranted to ascertain performance equivalency and define the optimal surveillance technique.

Dysplasia and Colorectal Cancer Surveillance in Ulcerative Colitis Patients in Latin America: Real-World Data.

The prevalence of colorectal cancer (CRC) in patients with ulcerative colitis (UC) is higher than in the general population, in Latin America there is a progressive increase of UC, and information about CRC screening in inflammatory bowel disease (IBD) is scarce. The aim of this study was to analyze the findings of endoscopic surveillance of CRC in patients with IBD according to available technology. Multicenter, cross-sectional, analytical study conducted in Latin American countries, in patients with UC, predominantly with more than 8 years of diagnosis and different degrees of disease activity. Surveillance colonoscopies were performed according to available technology. Risk factors for dysplasia detection were analyzed. One hundred and forty-four patients, 55.5% women, mean age 47.3 (range 17.1 to 90; SD 15.64) years and mean duration of disease 12.71 (range 0.64 to 57.13; SD 8.08) years. Forty-nine lesions were identified, 18 corresponded to dysplasia. The detection rate of dysplasia per lesion and per procedure was 36.7% and 12.5%, respectively. By logistic regression analysis, the duration of disease (OR 1.12;95%CI:1.047 to 1.215, P = .002) and the presence of post-inflammatory polyps (OR 3.4;95%CI:1.11 to 10.36, P = .031) were risk factors for higher detection of dysplasia. Digital chromoendoscopy was associated with greater detection of dysplasia (OR 4.99, 95%CI: 1.092 to 22.864, P = .038). In our region, the duration of disease and the presence of post-inflammatory polyps were the factors with the highest association for dysplasia detection, and digital chromoendoscopy with directed biopsies was the technique of choice. The implementation of a specific surveillance program in colonoscopy in IBD is an effective strategy to achieve high detection rates.

Advancing Colorectal Cancer Prevention in Inflammatory Bowel Disease (IBD): Challenges and Innovations in Endoscopic Surveillance.

Patients with inflammatory bowel disease (IBD) face an elevated risk of developing colorectal cancer (CRC). Endoscopic surveillance is a cornerstone in CRC prevention, enabling early detection and intervention. However, despite recent advancements, challenges persist. Chromoendoscopy (CE), considered the gold standard for dysplasia detection, remains underutilized due to logistical constraints, prolonged procedural times, and the need for specialized training. New technologies, such as endomicroscopy, confocal laser endomicroscopy (CLE), and molecular endoscopy (ME), promise unprecedented precision in lesion characterization but are limited to specialized centers. Artificial intelligence (AI) can transform the field; however, barriers to widespread AI adoption include the need for robust datasets, real-time video integration, and seamless incorporation into existing workflows. Beyond technology, patient adherence to surveillance protocols, including bowel preparation and repeat procedures, remains a critical hurdle. This review aims to explore the advancements, ongoing challenges, and future prospects in CRC prevention for IBD patients, focusing on improving outcomes and expanding the implementation of advanced surveillance technologies.

Clinical Evaluation of an Electronic Guidance System for Optimizing the Ultrasound Screening for Developmental Hip Dysplasia in Newborns.

Background: Graf ultrasound screening is considered an established method for early detection of developmental dysplasia of the hip (DDH). Although characterized by a high degree of standardization to allow for good reproducibility of results, examination-related factors may still affect sonographic measurements. The relative tilt angle between the hip and the probe is a potential pitfall as it significantly influences sonographic measurements and consequently classification of DDH according to Graf. Objectives: Evaluation of an electronic guidance system developed to reduce relative tilt angles and increase reliability and comparability in ultrasound screening of DDH. Materials and Methods: Twenty-five newborns were examined using a prototype guidance system, which tracks the position of the transducer and the pelvis to calculate the relative tilt angles. Two ultrasound images were obtained, one conventionally and the other one using the guidance system. Subsequently, relative roll and pitch angles and sonographic measurements were determined and analyzed. Results: The relative inclination angles in the conventional group ranged from -12.6° to 14.3° (frontal plane) and -23.8° to 32.5° (axial plane). vs. -3.7° to 3.0° and -3.2° to 4.5° in the guidance system group. The variances were significantly lower in the guidance system-assisted group for both planes (p < 0.001 and p < 0.001, respectively). The optimized transducer position showed significant effects and consequently significantly reduced alpha angles were observed (p = 0.001, and p = 0.003). Conclusions: The guidance system allowed a significant reduction in the relative tilt angles, supporting optimal positioning of the transducer, resulting in significant effects on Graf sonographic measurements. This technique shows great potential for enhancing the reproducibility and reliability of ultrasound screening for DDH.

A Novel Noninvasive Approach, “DrOroscope,” for Early Detection of Dysplasia in Oral Mucosal Lesions: A Cross-sectional Study

Background Oral cancer is a significant global burden in the present scenario, and early detection has critical importance in improving the survival rate. Devices which aid in the early diagnosis of dysplastic lesions noninvasively are necessary to reduce the oral cancer burden and improve the quality of life of the patients. Purpose To evaluate the efficacy of DrOroscope in diagnosing dysplasia in oral mucosal lesions. Methods A cross-sectional study was conducted among 40 individuals clinically diagnosed with oral mucosal lesions from various demographics in Hyderabad. Participants were screened using the DrOroscope device, which detects dysplastic changes via fluorescence imaging analyzed by artificial intelligence algorithms. Based on the image analysis, lesions were categorized as variable, borderline, or severe. Confirmatory biopsies were performed on all examined lesions, with histopathological results as the gold standard. Statistical analyses, including Chi-square tests, Fisher’s exact test, Cohen’s kappa, and receiver operating characteristic (ROC) curve analysis, were conducted using SPSS version 26.0 with a confidence interval at 95% and p &lt; .05 significance. Results DrOroscope exhibited a sensitivity of 100.00% and a specificity of 69.23%. Positive predictive value was 87.10%, negative predictive value was 100.00%, and overall diagnostic accuracy was 90.00%. Cohen’s kappa value for agreement between DrOroscope and biopsy results was 0.752, indicating substantial agreement, and 0.539 for detecting dysplasia levels, indicating moderate agreement. The ROC curve analysis supported these findings, demonstrating excellent diagnostic performance. Conclusion The DrOroscope device is highly sensitive and accurate in detecting dysplastic changes in oral lesions, making it a promising adjunctive noninvasive diagnostic tool, especially in screening larger populations. This aids in the early diagnosis of dysplasia and thus reducing patients’ morbidity. However, further refinement and larger studies are needed to improve agreement with biopsy for grading of dysplasia. Clinical Significance of the Study DrOroscope plays a promising role in the early diagnosis of dysplasia. This can have a huge impact on the treatment plan, thereby improving the quality of life of the patient. Such devices play a crucial role in oral cancer screening programs, thus promoting awareness on early detection of oral cancer and also enhancing the effectiveness of oral cancer prevention.

Impact of HIV infection on cervical intraepithelial neoplasia detection in pregnant and non-pregnant women in Germany: a cross-sectional study.

Women living with HIV (WLWH) are frequently affected by cervical dysplasia caused by Human Papillomavirus (HPV) and invasive cervical cancer (CxCa). CxCa screening programs can include colposcopy, cytology, and HPV testing. These methods, however, have limitations in effectively stratifying cervical dysplasia. This study aimed to evaluate the applicability of an innovative mRNA-based multiplexed expression-quantifying assay in the detection and assessment of cervical dysplasia in WLWH. The QuantiGene-Molecular-Profiling-Histology Assay (QG-MPH) was used to detect and quantify HPV oncogene and cellular biomarker mRNA expression. These results were included in the Risk Score (QG-MPH RS) calculations that inform about the presence and severity of dysplasia. QG-MPH RS results were compared to the highly sensitive Multiplexed Papillomavirus Genotyping (MPG) Assay and clinical results obtained by cytology, colposcopy and histology. For a standardized nomenclature of clinical results, the clinical ASSIST Score was used. Of 241 WLWH, including 96 pregnant women, a concordance between the QG-MPH RS and the ASSIST Score was found to 36.3% (49/135) in non-pregnant WLWH and 67.1% (57/85) in pregnant WLWH. The QG-MPH method demonstrated high specificity for detecting high-risk HPV (HR-HPV) genotypes and high-grade cervical dysplasia, achieving 89.6% and 82.4%, respectively, including pregnant and non-pregnant WLWH. The QG-MPH assay shows potential for improving the detection and management of HPV-related cervical dysplasia in WLWH, including pregnant women. Its high specificity, however, is tempered by its tendency to overestimate dysplasia severity in certain cases, indicating that further research is needed to refine its use as a reliable diagnostic tool for this high-risk population.

Undetected Dysplasia at Colectomy in Patients With Inflammatory Bowel Diseases. What Are We Missing?

Patients with inflammatory bowel disease (IBD) have a higher risk of developing colorectal dysplasia and colorectal cancer compared to the general population. Although the use of surveillance protocols has improved the ability to detect dysplasia, some lesions are still missed at colonoscopy. This study aims to determine the rate of dysplastic lesions that are undetected at colonoscopies in IBD patients undergoing colectomy and to identify factors associated with missed dysplasia. Patients who had received a total or subtotal colectomy at Mayo Clinic (Rochester, Minnesota), between January 2003 and December 2022, and had a complete colonoscopy within 5 years before surgery were retrospectively enrolled. Data abstracted included demographic information, disease-related data, colonoscopy and pathology reports, and surgery pathology reports. Colonoscopy and surgery findings were compared, and patients were divided into 3 groups: no dysplasia at both, detected dysplasia, and undetected dysplasia. Among 1320 IBD patients undergoing colectomy, 5.4% had undetected dysplastic lesions identified only at surgery. Factors independently associated with dysplasia detection were endoscopic remission or mild endoscopic disease activity (odds ratio [OR], 2.326; P = .0081; 95% CI, 1.246-4.342), prior dysplasia detection (OR, 1.876; P = .0491; 95% CI, 1.002-3.511), colonoscopy performed for surveillance (OR, 2.380; P = .0048; 95% CI, 1.302-4.350), and longer disease duration at surgery (OR, 1.039; P = .0085; 95% CI, 1.010-1.070). Clinicians should be aware of the risk of missing dysplastic lesions, especially when endoscopic disease activity is moderate/severe, and not only for longstanding disease. Efforts should be made to obtain endoscopic remission to make the "invisible" visible.

HPB SO73 - Histopathological Patterns in Emergency and Elective Cholecystectomy

Abstract Background Laparoscopic cholecystectomy (LC) is one of the most frequently performed general surgical procedures. In the United Kingdom, gallbladder specimens are routinely submitted for histopathological analysis to detect occult pathologies, such as carcinoma in situ and early-stage carcinomas. This study aims to assess the results of routine histopathological examination of LC specimens. Method A prospectively collected database of all LCs and laparoscopic common bile duct exploration (LCBDE) performed between August 2022 and June 2024 was analysed. The database was populated from a single benign biliary center by two specialized biliary surgeons. Electronic case notes were analysed for the demographics, indication(s), operative findings and the histopathological results. All gallbladder specimens were sent for histopathology analysis, irrespective of their gross appearance. Results Of the 201 eligible patients, 164 patients had histopathology results available. Median age was 56 years (IQR 41-66) and 100 (61%) were female. 72 (43.9%) were emergency cases. 48 (29.3%) had cholecystectomy, 70 (42.7%) also had intraoperative cholangiogram and 46 (28%) had LCBDE. Conclusion Chronic calculus cholecystitis was the most frequent histopathological finding, followed by acute on chronic cholecystitis and gangrenous acute cholecystitis. Dysplasia was identified in 1.8% of patients, warranting multidisciplinary team discussion. This study underscores the significance of routine histopathological examination after cholecystectomy, as early incidental detection of dysplasia and carcinoma can modify postoperative management and improve patient outcomes.

A Quantitative Comparison Between Human and Artificial Intelligence in the Detection of Focal Cortical Dysplasia.

Artificial intelligence (AI) is thought to improve lesion detection. However, a lack of knowledge about human performance prevents a comparative evaluation of AI and an accurate assessment of its impact on clinical decision-making. The objective of this work is to quantitatively evaluate the ability of humans to detect focal cortical dysplasia (FCD), compare it to state-of-the-art AI, and determine how it may aid diagnostics. We prospectively recorded the performance of readers in detecting FCDs using single points and 3-dimensional bounding boxes. We acquired predictions of 3 AI models for the same dataset and compared these to readers. Finally, we analyzed pairwise combinations of readers and models. Twenty-eight readers, including 20 nonexpert and 5 expert physicians, reviewed 180 cases: 146 subjects with FCD (median age: 25, interquartile range: 18) and 34 healthy control subjects (median age: 43, interquartile range: 19). Nonexpert readers detected 47% (95% confidence interval [CI]: 46, 49) of FCDs, whereas experts detected 68% (95% CI: 65, 71). The 3 AI models detected 32%, 51%, and 72% of FCDs, respectively. The latter, however, also predicted more than 13 false-positive clusters per subject on average. Human performance was improved in the presence of a transmantle sign ( P < 0.001) and cortical thickening ( P < 0.001). In contrast, AI models were sensitive to abnormal gyration ( P < 0.01) or gray-white matter blurring ( P < 0.01). Compared with single experts, expert-expert pairs detected 13% (95% CI: 9, 18) more FCDs ( P < 0.001). All AI models increased expert detection rates by up to 19% (95% CI: 15, 24) ( P < 0.001). Nonexpert+AI pairs could still outperform single experts by up to 13% (95% CI: 10, 17). This study pioneers the comparative evaluation of humans and AI for FCD lesion detection. It shows that AI and human predictions differ, especially for certain MRI features of FCD, and, thus, how AI may complement the diagnostic workup.

Benchmarking high risk human papillomavirus testing against cytology and biopsy results in the detection of cervical dysplasia to inform clinical screening guidelines

The United States Preventive Services Task Force (USPSTF) recommendation for cervical cancer screening includes the option to screen with high-risk human papilloma virus (hrHPV) alone, but some studies have reported that hrHPV testing alone missed precancerous and cancerous lesions. In this study, we evaluated the test performance characteristics of hrHPV in detecting cervical dysplasia with cervical cytology and biopsy as comparators. We conducted a retrospective analysis of Papanicolaou smears between January and December 2019 performed at our institution with concurrent hrHPV and cytology testing. Cases were identified in the laboratory information system and abstracted data included patient age, hrHPV result, concurrent cytology result, and follow-up cervical biopsy result where available. A total of 3748 cases were identified with concurrent hrHPV and cytology testing and 79 cases with concurrent hrHPV and biopsy results. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) "hrHPV for detecting dysplasia on cytology was 70% (95% CI: 60.7%-77.8%), 98% (95% CI: 97.4%-98.4%), 53% (95% CI: 46.2%-58.8%), and 99% (95% 98.7%-99.2%), respectively (P value <0.00001). The sensitivity, specificity, PPV, and NPV of hrHPV for detecting dysplasia on biopsy was 76% (95% CI: 61.1%-86.7%), 30% (95% CI: 14.7%-49.4%), 64% (95% CI: 57.0%-70.5%), and 43% (95% CI: 46.6%-61.0%), respectively (Pvalue <0.3). hrHPV testing alone would have missed 30% of dysplastic samples identified by cytology and 24% of dysplastic samples confirmed by cervical biopsy. These findings support a comprehensive strategy of dual cervical cancer screening with cytology and hrHPV testing.

Timely radiographic detection of developmental dysplasia of the hip in family medicine residents. Educative intervention

Timely radiographic detection of developmental dysplasia of the hip in family medicine residents. Educative intervention