Local Extent Research Articles

Diagnostic Accuracy and Observer Agreement of the MRI Prostate Imaging for Recurrence Reporting Assessment Score.

Background Prostate cancer local recurrence location and extent must be determined in an accurate and timely manner. Because of the lack of a standardized MRI approach after whole-gland treatment, a panel of international experts recently proposed the Prostate Imaging for Recurrence Reporting (PI-RR) assessment score. Purpose To determine the diagnostic accuracy of PI-RR for detecting local recurrence in patients with biochemical recurrence (BCR) after radiation therapy (RT) or radical prostatectomy (RP) and to evaluate the interreader variability of PI-RR scoring. Materials and Methods This retrospective observational study included patients who underwent multiparametric MRI between September 2016 and May 2021 for BCR after RT or RP. MRI scans were analyzed, and a PI-RR score was assigned independently by four radiologists. The reference standard was defined using histopathologic findings, follow-up imaging, or clinical response to treatment. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated to assess PI-RR performance for each reader. The intraclass correlation coefficient was used to determine interreader agreement. Results A total of 100 men were included: 48 patients after RT (median age, 76 years [IQR, 70-82 years]) and 52 patients after RP (median age, 70 years [IQR, 66-74 years]). After RT, with PI-RR of 3 or greater as a cutoff (assigned when recurrence is uncertain), diagnostic performance ranges were 71%-81% sensitivity, 74%-93% specificity, 71%-89% PPV, 79%-86% NPV, and 77%-88% accuracy across the four readers. After RP, with PI-RR of 3 or greater as a cutoff, performance ranges were 59%-83% sensitivity, 87%-100% specificity, 88%-100% PPV, 66%-80% NPV, and 75%-85% accuracy. The intraclass correlation coefficient was 0.87 across the four readers for both the RT and RP groups. Conclusion MRI scoring with the Prostate Imaging for Recurrence Reporting assessment provides structured, reproducible, and accurate evaluation of local recurrence after definitive therapy for prostate cancer. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Haider in this issue. An earlier incorrect version appeared online. This article was corrected on May 11, 2022.

Diagnostic Accuracy of MRI in Local Staging (T Category) of Penile Cancer and the Value of Artificial Erection: A Systematic Review and Meta-Analysis.

BACKGROUND. Treatment recommendations of penile cancers are determined primarily by the local extent of the primary tumor. Clinical palpation is used for local staging. OBJECTIVE. We reviewed diagnostic performance of MRI in local staging of penile cancer in three clinical scenarios (questions [Qs] 1 through 3, Q1-Q3) and one imaging scenario (Q4). Q1 asked whether MRI reliably distinguishes ≤ T1 from ≥ T2 disease. Q2 asked whether clinical staging reliably identifies ≤ T1 versus ≥ T2 disease and how clinical staging compares to MRI. Q3 asked if MRI is accurate for diagnosis of T3 disease. Q4 asked if artificial erection (by intracavernosal injection of prostaglandin E1) improved accuracy of MRI in T categorization. EVIDENCE ACQUISITION. MEDLINE, EMBASE, and Cochrane Library databases were searched through September 13, 2021, for studies evaluating local staging of penile cancer using MRI with surgical pathology as the reference standard. Diagnostic accuracy was calculated using a bivariate random-effects model and hierarchic summary ROC mode Meta-regression was performed to test for covariate effects of MRI and artificial erection in Q3 and Q4, respectively. EVIDENCE SYNTHESIS. Eight studies and 481 patients were included. The sensitivity and specificity of MRI for Q1 were 86% (95% CI, 73-94%) and 89% (95% CI, 77-95%), respectively. AUC for MRI (0.94; 95% CI, 0.92-0.96) did not differ from clinical staging (0.87; 95% CI, 0.84-0.90; p = .83). For Q3, MRI had sensitivity and specificity of 80% (95% CI, 70-87%) and 96% (95% CI, 85-99%), respectively. For Q4, sensitivity and specificity for MRI with versus without artificial erection were 85% (95% CI, 71-92%) and 93% (95% CI, 77-98%) versus 86% (95% CI, 68-95%) and 84% (95% CI, 70-93%), respectively (p = .50). CONCLUSION. MRI staging of penile cancer may be considered for ≤ T1 versus ≥ T2 disease but did not appear more accurate than clinical staging. High specificity of MRI for diagnosis of ≥ T3 disease suggests that MRI may be useful when organ-sparing approaches are planned. MRI with and without artificial erection showed similar accuracy in local staging. CLINICAL IMPACT. MRI, with or without artificial erection, may be valuable in routine preoperative evaluation of local staging of penile cancer, particularly when organ-sparing options are considered.

From Macroscopy to Ultrastructure: An Integrative Approach to Pulmonary Pathology.

Pathology and radiology are complimentary tools, and their joint application is often crucial in obtaining an accurate diagnosis in non-neoplastic pulmonary diseases. However, both come with significant limitations of their own: Computed Tomography (CT) can only visualize larger structures due to its inherent–relatively–poor resolution, while (histo) pathology is often limited due to small sample size and sampling error and only allows for a 2D investigation. An innovative approach of inflating whole lung specimens and subjecting these subsequently to CT and whole lung microCT allows for an accurate matching of CT-imaging and histopathology data of exactly the same areas. Systematic application of this approach allows for a more targeted assessment of localized disease extent and more specifically can be used to investigate early mechanisms of lung diseases on a morphological and molecular level. Therefore, this technique is suitable to selectively investigate changes in the large and small airways, as well as the pulmonary arteries, veins and capillaries in relation to the disease extent in the same lung specimen. In this perspective we provide an overview of the different strategies that are currently being used, as well as how this growing field could further evolve.

Interfacial Behaviour in Polymer Composites Processed Using Droplet-Based Additive Manufacturing.

In this study, we show the extent of interfacial behaviour in the mechanical performance of thermoplastic polyurethane elastomer (TPU)/acrylonitrile butadiene styrene (ABS) composite material manufactured using droplet-based additive manufacturing. Both the interface orientation and the interface strength are varied during the processing. Prior to tensile experiments, X-ray micro-tomography imaging is undertaken to obtain the microstructural arrangement of polymer droplets in the part. Tensile loading is performed simultaneously with digital image acquisition to reveal the extent of strain localization using a digital image correlation approach. The experiments are performed up to the failure of the specimens. Finite element computation based on 3D imaging of the ABS/TPU composite is considered to predict the role of the interface as well as the defect influence on the tensile performance. The experimental results show a major connectivity of the process-generated porosity and a distinct morphology of the ABS/TPU interface. The predictions demonstrate that, despite the limited amount of porosity, their connectivity plays a significant role in triggering damage initiation and growth up to the failure of the composite material.

Neoadjuvant tyrosine kinase inhibitor therapy in locally advanced differentiated thyroid cancer: a series

IntroductionLocally advanced differentiated thyroid cancer (LADTC) management depends on a complex interplay of patient and tumour factors. When primary resection cannot be achieved, neoadjuvant tyrosine kinase inhibitor (TKI) therapy can be considered, but little evidence is available on its success and outcomes. Our aim was to describe a small series of LADTC managed with neoadjuvant TKI therapy.MethodsSuitable patients were prospectively identified in NHS Lothian February 2016 – March 2020.ResultsFour patients were eligible for inclusion, 3 females; 1 male, aged 39–79 years. All were T4a at presentation; three papillary and one Hurthle cell carcinoma. One had pulmonary metastases. Two refused laryngectomy, one was deemed unresectable with extensive tracheal involvement, and one commenced TKI due to COVID-19 related surgical delay. TKI treatment length varied from 1–18 months. There was a marked reduction in tumour volume and local extent in three cases, such that surgical resection without laryngectomy could be achieved. The fourth patient was intolerant of TKI. All ceased TKIs 2 weeks prior to total thyroidectomy, with neck dissection in three, and tracheal resection and re-anastomosis in two. All then had 3700MBq RAI and all patients are currently alive with 14–58 months follow-up. Two patients have no evidence of residual or recurrent disease. The M1 patient has stable low-volume local and distant disease, and one patient has stable low volume indeterminate pulmonary nodules.ConclusionNeoadjuvant TKI therapy in LADTC can be effective in reducing primary tumour extent to potentially facilitate limited surgical resection in a highly selected patient group.

Myriad Manifestations of Gallbladder Carcinoma on Multidetector Computed Tomography: Retrospective Study of 230 Patients from Tertiary Care Centre of North India

Background: Gallbladder carcinoma is endemic in India. Though imaging findings of gallbladder carcinoma are very well-described in the literature, the research question that guided this study was to evaluate various imaging manifestations of the disease in this particular geographic region of North India which is a highly endemic region for gallbladder cancer and compare with studies from other parts of the world. Aims and Objective: The purpose of the study was to retrospectively analyse spectrum of findings on Multidetector Computed Tomography (MDCT) in histologically proven gallbladder carcinoma detected at a tertiary care centre from the NorthIndia. The primary objective was to define the various patterns of growth while the secondary objective was to analyse the specific prevalence and patterns of spread of the disease. Materials and Methods: We retrospectively studied contrast enhanced Computed Tomography (CECT) findings in 230 patients of histologically proven gallbladder carcinoma. Patients with previous cholecystectomy or biliary intervention were excluded. Results: In our study, focal or asymmetrical wall thickening of the gallbladder was the most common growth pattern seen in 140(61%) patients. Contiguous infiltration of liver was seen in 190 (83%) cases. Regional nodal involvement was observed in 90 (39%) patients, while 100 (43%) patients had both regional & distant nodal involvement. Liver and peritoneal metastases were noted in 71 (31%) patients and 96 (42%) patients respectively. Majority (81%) of patients had stage IV disease. Conclusion: MDCT provides comprehensive information regarding the local extent as well as distant spread of gallbladder carcinoma. Asymmetric gall bladder wall thickening in this geographical region must be considered suspicious and should evoke histopathological analysis to exclude malignancy.

Defining Endocytic Pathways of Fucoidan-Coated PIBCA Nanoparticles from the Design of their Surface Architecture.

PurposeThis work investigated the endocytic pathways taken by poly(isobutylcyanoacrylate) (PIBCA) nanoparticles differing in their surface composition and architecture, assuming that this might determine their efficiency of intracellular drug delivery.MethodsNanoparticles (A0, A25, A100, R0, R25 ) were prepared by anionic or redox radical emulsion polymerization using mixtures of dextran and fucoidan (0, 25, 100 % in fucoidan). Cell uptake was evaluated by incubating J774A.1 macrophages with nanoparticles. Endocytic pathways were studied by incubating cells with endocytic pathway inhibitors (chlorpromazine, genistein, cytochalasin D, methyl-ß-cyclodextrin and nocodazole) and nanoparticle uptake was evaluated by flow cytometry and confocal microscopy.ResultsThe fucoidan-coated PIBCA nanoparticles A25 were internalized 3-fold more efficiently than R25 due to the different architecture of the fucoidan chains presented on the surface. Different fucoidan density and architecture led to different internalization pathway preferred by the cells. Large A100 nanoparticles with surface was covered with fucoidan chains in a loop and train configuration were internalized the most efficiently, 47-fold compared with A0, and 3-fold compared with R0 and R25 through non-endocytic energy-independent pathways and reached the cell cytoplasm.ConclusionInternalization pathways of PIBCA nanoparticles by J774A.1 macrophages could be determined by nanoparticle fucoidan surface composition and architecture. In turn, this influenced the extent of internalization and localization of accumulated nanoparticles within cells. The results are of interest for rationalizing the design of nanoparticles for potential cytoplamic drug delivery by controlling the nature of the nanoparticle surface.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s11095-022-03202-4.

Current Opinion on the Use of Magnetic Resonance Imaging in Staging Prostate Cancer: A Narrative Review.

Accurate staging is critical for treatment planning and prognosis in men with prostate Cancer. Prostate magnetic imaging resonance (MRI) may aid in the staging evaluation by verifying organ-confined status, assessing the status of the pelvic lymph nodes, and establishing the local extent of the tumor in patients being considered for therapy. MRI has a high specificity for diagnosing extracapsular extension, and therefore may impact the decision to perform nerve sparing prostatectomy, along with seminal vesicle invasion and lymph node metastases; however, its sensitivity remains limited. Current guidelines vary significantly regarding endorsing the use of MRI for staging locoregional disease. For high-risk prostate cancer, most guidelines recommend cross sectional imaging, including MRI, to evaluate for more extensive disease that may merit change in radiation field, extended androgen deprivation therapy, or guiding surgical planning. Although MRI offers reasonable performance characteristics to evaluate bone metastases, guidelines continue to support the use of bone scintigraphy. Emerging imaging technologies, including coupling positron emission tomography (PET) with MRI, have the potential to improve the accuracy of prostate cancer staging with the use of novel radiotracers.

Fire severity and its local extent are key to assessing impacts of Australian mega‐fires on koala (Phascolarctos cinereus) density

AbstractAimMega‐fires are predicted to increase with climate change. Australia experienced the largest ever documented forest fires in 2019–2020, but the response of most taxa remains poorly known. We used acoustic arrays to estimate impact of the mega‐fires on the density of an iconic marsupial.LocationNorth‐east New South Wales, Australia.Time periodPre‐fire density estimated in 2018–2019 and post‐fire density in 2019–2020.Major taxa studiedKoala, Phascolarctos cinereus.MethodsWe estimated male density before and after fires using large acoustic arrays and spatial count models. Acoustic arrays sampled three timber production forests with a gradient in fire severity and three unburnt controls in national parks.ResultsKoalas were temporarily extirpated where high fire severity dominated the landscape, but some localized recovery was evident after 1 year. Where moderate severity fire dominated, density was reduced by about 50% within 1 year, but koalas were widespread throughout the burnt area. In our third area dominated by low severity fire, no impact was detected as pre‐ and post‐fire uncertainty intervals overlapped. Control sites surveyed at similar times showed little change in density between years. There was no relationship between pyrodiversity and koala density. Within arrays broadly dominated by moderate or high severity fire, density 1 year after fire was lower in burnt patches of both low and high severity fire. Regionally, 9.8% of landscape samples (2 km × 2 km) in koala habitat were dominated by high fire severity, while a further 6.1% were dominated by moderate fire severity, suggesting c. 13% decline in koala density.Main conclusionsA substantial impact of high severity fire was confirmed. Severe impacts were localized across the landscape, recovery had begun within a year and resilience was evident where low severity fire dominated. However, more frequent fires in the future will compound koala losses.

Intraperitoneal Fecaloma associated with a locally advanced anal cancer - an unintended consequence of COVID 19

Background: Tumours of the anal canal represent only 2,6% of the digestive system tumors, but their incidence has been increasing in the past few decades. The vast majority are squamous cell carcinomas. The most common presenting symptom is bleeding, but may also present with palpable mass, pain, or discharge and incontinence. Diagnosis of s suspicious mass on physical examination or anoscopy is confirmed with biopsy of the suspected mass, followed by imaging of the pelvis with MRI or CT to assess local extent and evaluate pelvic lymph nodes.Less than 20% of all patients present with unresectable disease or metastatic disease.

COMMUNITY-BASED COOPERATION AS AN EFFECTIVE MECHANISM OF THE RECOVERY OF THE HIGLANDS IN GEORGIA

There could be no progress Georgia without strengthening the vitality of rural areas and agriculture. Strength of rural community depends on developing and pursuing sound public policies. In the thirty-year history of Georgia's independence, there have been made numerous attempts to pursue regional policies aimed at improving the well-being of rural people. Time has shown that each strategy or program designed for this purpose has always been unsystematic and fragmented. As a result, we obtained an almost irreversible process of rural exodus in Georgia, especially in the highland border sector. These areas of Georgia require highly specific approaches. Local Georgians closest to the origins of Georgian civilization still keep in their daily lives the customs that have existed continuously for many centuries (community-based use and enjoyment of land, partnership, community). The goal of the public support programs designed for them is to create conditions that will naturally encourage people to be there on a permanent-type basis. We consider it expedient to create special economic entities in the higher altitude regions of the country, to which the revenues generated from pasture lands and forest funds will accumulate. Within the mentioned economic entities, agricultural production should be developed on a cooperative basis, by organizing a single production cycle within cooperatives (production, processing and marketing of primary products). The owners of these types of economic entities can only be people permanently residing in a certain territory. The revenues from leasing or other agricultural activities can only be spent based on democratic decisions for general purposes to improve the living conditions. Such purposes may include education, healthcare, infrastructure, transport, etc., which will be pre-determined by the Government of Georgia. When specifying the optimal form of local territorial extent of agricultural cooperatives, priority is given to community-based cooperatives. They will be formed within the administrative units, taking into account the factors of production specialization and concentration of the productive forces. Community-based cooperatives contribute to creating conditions for mass community engagement in the cooperative process, where economies of scale can be used and population’s ability and material resources can be capitalized on the ground, which is of particular importance for inclusive (comprehensive) entrepreneurship development. There are unique opportunities for organic production in the mountains of Georgia. The basis for the rational use of natural pasture lands in all vertical zones is the introduction of a system of plot-rotational or similar cattle grazing. Increasing the production of all types of food (green, juicy, coarse) on natural pasture lands, improving their quality and reducing the cost is the main basis for livestock development, because 65-75% of the cost of livestock products is related to feed costs. The organization of a single production cycle within the cooperative (stock feed for livestock, dairy and dairy products (including products produced on the place of origin: “dambalkhacho (a kind of blue cheese), stuffed cheese, sheep cheese), meat and meat products, wool and leather production) will ensure the rational use of grasslands, reduce feed costs and will significantly increase shareholder returns. In view of the diversity of non-timber forest products in the highlands of Georgia and the rapidly growing demands in international markets, wild-growing fruit picking (dog-rose, crab apple, cornel, sea buckthorn, etc.) within community cooperatives and developing their drying, storage and bio-production and sales at high prices have great potential. Creating a value chain for the production of non-timber forest products in Georgia would be ensured through supporting the strengthening of the organizational and technical-technological capabilities of the community-based cooperatives. The above model of the Highland Caucasus can be extended to all communities and villages after defining the status of village and rural entrepreneur (village as a territorial unit/vital area), which implies the transfer of the permanent ownership and use of state-owned land, forest, pasture, water and mineral resources to the communities. If this model is properly organized, the most complex military-political, economic and demographic problems related to the highland border sectors will be addressed without an additional financial cost to the State and changes in the internal territorial arrangement of the country. The people who live here will simultaneously act as guardians, border guards and farmers of the country. One of the primary objectives of State policy should be to encourage care and support of people living in rural areas, as well as to give them incentives to work (strengthening the authority of farming) in order to feed society.

Numerical simulation of the interaction between shock train and combustion in three-dimensional M12-02 scramjet model

The characteristics of combustion flow fields and performance for hypersonic M12-02 scramjet were numerically simulated and analyzed. The compressible two-equation k-w SST turbulence model was employed for the turbulence model and the 9-species, 27-reaction-step hydrogen-air reaction mechanism was used as the reaction kinetics model. The numerical method was verified and a good agreement was obtained between the results of the numerical simulations and the experimental data. The results showed that shock waves from the upper and lower walls respectively crossed with each other near the central axis, forming a ‘diamond’ shape in the high-temperature combustion region. Compared to the conventional scramjet engine, most of the fuel reaction was in pure supersonic combustion mode for this hypersonic scramjet engine. Changes in the distribution of fuel on the upper and lower walls could have an appreciable impact on the combustion flow field. Average fuel distribution between upper and lower walls is benefit for combustion enhancement while the heat transfer in the corner of the side wall is severe and should be avoided during operation. The flame investigation showed that it cannot automatically predict the flame surface temperature in advance only based on the equivalence ratio Φ according to diffusion combustion theory. Compared to Φ = 1.0 condition, the flame surface temperature for Φ = 0.8 condition is higher as the complicated interaction between shock waves and combustion, which makes the local air temperature and mixing extent in flame surface is more appropriate. However, in terms of the overall engine performance, the Φ = 1.0 condition has the better combustion efficiency along the whole flow path.

A descriptive neuroimaging study of retinoblastoma in children: magnetic resonance imaging features.

PurposeRetinoblastoma (RB) is the most common intraocular malignancy of childhood. Magnetic resonance imaging (MRI) is essential for initial diagnosis, tumour extension, staging, and treatment planning of RB. Awareness of neuro-imaging findings and determining local extent are essential for early diagnosis and therapy guidance. The purpose of this study is to evaluate and to provide a detailed list of neuroimaging features of RB to improve the diagnostic work-up of children with RB.Material and methodsRetrospective review was performed among children with confirmed RB diagnosis. MRI features were identified to evaluate: 1) growth pattern; 2) intraocular extension; 3) extraocular extension; 4) central nervous system disease; 5) conventional MRI characteristics of the RB lesions; and 6) DWI and ADC characteristics. These features were compared between unilateral and bilateral RB lesions.ResultsTwenty-four children (male/female: 18/6) were included in this study. The mean age at the time of diagnosis was 14.7 (11.4) months. In total, 34 RB lesions (bilateral = 18) were evaluated for the study. The most common features on MRI were: 1) endophytic RB lesion (50%); 2) subretinal haemorrhage (38%); 3) scleral involvement (3%); 4) leptomeningeal disease (12%); 5) contrast enhancement (97%); and 6) restricted diffusion (88%). The mean ADC value was 0.64 (0.15) × 10-3 mm2/s. Choroidal invasion (p = 0.05) and scleral involvement (p = 0.04) were significantly higher for bilateral RB lesions.ConclusionsContrast enhancement and restricted diffusion are the most common neuroimaging features of RB. Choroidal invasion and scleral involvement are more frequently seen in bilateral disease.

Neoadjuvant Pelvic Radiotherapy in the Management of Rectal Cancer with Synchronous Liver Metastases: Is it Worth it?

Introduction: The use of neoadjuvant pelvic radiotherapy was a major advance in oncologic care for locally-advanced rectal cancer (RC) in the 20th century. The extrapolation of the care of locally-advanced RC to the management of RC with treatable liver metastases is controversial. The aim of this systematic review is to examine the available data on the role of pelvic radiotherapy and chemoradiation in the setting of treatable metastatic liver disease. Methods: A systematic review of MEDLINE was performed to report the landmark randomized controlled trials between 1993-2021. Results: Attaining liver clearance and total mesorectal excision with negative margin remains the mainstay of cure. There is uncertainty regarding the sequencing of treatment. The literature lacks randomized clinical trials comparing the rectal first, liver first, interval strategy and simultaneous surgical approaches. A multidisciplinary discussion regarding the utility of radiotherapy is emphasized to achieve the goals of treatment. Short-course radiotherapy has proved comparable disease-control outcomes to long-course chemoradiation with a significantly improved cost-performance. The implementation of short-course radiotherapy in the interval strategy and simultaneous surgical approach is promising. Neoadjuvant pelvic radiotherapy can be omitted in patients with metastatic RC if adequate margin clearance is achievable. Conclusion: The use of pelvic radiotherapy in metastatic RC is popular, but can be omitted when R0 resection can be achieved. Treatment should be tailored to the local extent of RC and priority of liver metastasis management. The optimal treatment strategy in patients with synchronous rectal liver metastases needs to be studied in randomized trials.

Emergence and Tuning of Multiple Flat Bands in Twisted Bilayer γ-Graphyne.

Using twisted bilayer γ-graphyne (TBGY) as an example, we show that it is possible to create multiple flat bands in carbon allotropes without the requirement of a specified magic angle. The origin of the flat bands can be understood by a simple two-level coupling model. The narrow bandwidth and strong localization of the flat band states might lead to strong correlation effects, which make TBGY a good platform for studying correlation physics. On the basis of the two-level coupling model, we further propose that the width and extent of localization of flat bands can be tuned by an energy mismatch ΔE between the two layers of TBGY, which can be realized by either applying a perpendicular electric field or introducing a heterostrain. This allows continuous modulation of TBGY from the strong-correlation regime to the medium- or weak-correlation regime, which could be utilized to study the quantum phase transition.

Local Extent of Prostate Cancer at MRI versus Prostatectomy Histopathology: Associations with Long-term Oncologic Outcomes.

Background It is unknown how the imperfect accuracy of MRI for local staging of prostate cancer relates to oncologic outcomes. Purpose To analyze how staging discordances between MRI and histopathologic evaluation relate to recurrence and survival after radical prostatectomy. Materials and Methods Health Insurance Portability and Accountability Act-compliant retrospective analysis of preprostatectomy T2-weighted prostate MRI (January 2001 to December 2006). Extraprostatic extension and seminal vesicle invasion were assessed by using five-point Likert scales; scores of 4 or higher were classified as positive. Biochemical recurrence (BCR), metastases, and prostate cancer-specific mortality rates were estimated with Kaplan-Meier and Cox models. Results A total of 2160 patients (median age, 60 years; interquartile range, 55-64 years) were evaluated. Among patients with histopathologic extraprostatic (pT3) disease (683 of 2160; 32%), those with organ-confined disease at MRI (384 of 683; 56%) experienced better outcomes than those with concordant extraprostatic disease at MRI and pathologic analysis: 15-year risk for BCR, 30% (95% CI: 22, 40) versus 68% (95% CI: 60, 75); risk for metastases, 14% (95% CI: 8.4, 24) versus 32% (95% CI: 26, 39); risk for prostate cancer-specific mortality, 3% (95% CI: 1, 6) versus 15% (95% CI: 9.5, 23) (P < .001 for all comparisons). Among patients with histopathologic organ-confined disease (pT2) (1477 of 2160; 68%), those with extraprostatic disease at MRI (102 of 1477; 7%) were at higher risk for BCR (27% [95% CI: 19, 37] vs 10% [95% CI: 8, 14]; P < .001), metastases (19% [95% CI: 6, 48] vs 3% [95% CI: 1, 6]; P < .001), and prostate cancer-specific mortality (2% [95% CI: 1, 9] vs 1% [95% CI: 0, 5]; P = .009) than those with concordant organ-confined disease at MRI and pathologic analysis. At multivariable analyses, tumor extent at MRI (hazard ratio range, 4.1-5.2) and histopathologic evaluation (hazard ratio range, 3.6-6.7) was associated with the risk for BCR, metastases, and prostate cancer-specific mortality (P < .001 for all analyses). Conclusion The local extent of prostate cancer at MRI is associated with oncologic outcomes after prostatectomy, independent of pathologic tumor stage. This might inform a strategy on how to integrate MRI into a clinical staging algorithm. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Gottlieb in this issue.

Preoperative Thrombocytosis is Not Associated with Overall Survival in 309 Glioblastoma Patients.

In recent years, a correlation of thrombocytosis and a worse prognosis was shown for many solid cancers, including glioblastoma multiforme (GBM). A retrospective review was performed for all patients with a histologically proven and first-diagnosed GBM between 2005 and 2015 in our department. Clinical and paraclinical parameters were acquired from patient documentation and structured for subsequent data analysis. The association of potential risk factors with overall survival was assessed using the Kaplan-Meier survival analysis and Cox regression. The present study includes 309 patients first diagnosed with primary GBM. Our analyses validate well-known risk factors of a decreased overall survival such as higher patient age, a larger preoperative tumor volume, Karnofsky performance status, extent of resection, tumor localization, and adjuvant treatment. However, no correlation was observed between a preoperative thrombocytosis, the mean platelet volume, leucocyte count, activated partial thromboplastin time (apTT), fibrinogen level, and acetylsalicylic acid 100 co-medication. Patients with preoperative hemoglobin below 7.5 mmol/L had decreased overall survival. The present study, enrolling the largest numbers of patients assessing this topic to date, did not find any association between a preoperative thrombocytosis and overall survival in 309 patients with GBM.

The Study of Climatourism Management and the Determination of Climatourism Calendar in Ardabil Province of Iran with emphasis on GIS

Purpose The Climate is considered as one of the most important factors of tourism industry. Numerical indicators have been widely used in climatic studies that are related to tourism climatology or climate tourism. Among synthetic indicators of climate tourism, temperature-physiology depends on the balance of human body energy. In the current research, Ardabil province has been studied from Climatourism point of view. Methodology: We used a 26-year climatic data (1987-2013), and specified climatic factors including minimum temperature, the percentage of relative humidity, wind speed, cloudiness and pressure in Ardabil, Meshkin Shahr, Parsabad and Khalkhal Stations. Human individual indicators (age, weight, and height) and activity type factors were used to calculate the temperature-physiology (PET and PMV). Findings: Ray Man model wasapplied in this regard and results show that in local extent there is not much difference between various stations, and with respect to the space there are different climatic stresses. In the next level the obtained results are imported to Arc GIS software and are used about Climatourism and its analysis. The most comfortable daily periods refer to Meshkin Shahr station (with 60 comfortable climatic days) and the least comfortable daily period belongs to Ardabil station (with 37 comfortable days). Originality/Value: In this study we attempted to find the most appropriate tourism times and also to determine the local and temporal differences of comfortable region in Ardabil province of Iran in different seasons.

Surgical treatment and long-term outcomes of low-grade myofibroblastic sarcoma: a single-center case series of 15 patients

BackgroundLow-grade myofibroblastic sarcoma (LGMS) is a poorly studied, rare, soft tissue sarcoma. LGMS is characterized by a low malignancy potential, tendency for local recurrence, and low likelihood of distant metastases. However, no studies have reported on the surgical treatment method and its long-term outcomes.MethodsWe included all patients treated for LGMS at our institution between March 2010 and March 2021. Medical charts were retrospectively reviewed to collect demographic information, as well as information about the clinical course, tumor characteristics, and outcomes. Statistical analysis was performed to identify the factors associated with the recurrence rate.ResultsFifteen patients who underwent surgical treatment were enrolled in this study. There were seven cases in the upper extremities, four in the trunk area, three in the lower extremities, and one in the head and neck area. There were no metastatic cases and two cases of local recurrence.ConclusionsThe incidence of LGMS in the extremities or trunk may be higher than expected based on the current literature. Univariate analysis showed that local tissue invasion and surgical method could be associated with local recurrence. Although further large studies are needed to establish risk factors of local recurrence or extent of resection margins, based on our study, wide local excision under the proper diagnosis is the most important treatment.

Stage Migration in Cervical Cancer Using the FIGO 2018 Staging System: A Retrospective Survival Analysis Using a Single-Institution Patient Cohort.

IntroductionThe International Federation of Gynecology and Obstetrics (FIGO) changed the staging system for cervical cancer in 2018 and formally allowed cross-sectional imaging for staging purposes. Stage IB is now divided into three substages based on tumor size (IB1 < 2 cm, IB2 2-4 cm and IB3 > 4 cm). The presence of lymph nodes in the pelvis or para-aortic region will upstage the patient to stage IIIC. The purpose of this study was to evaluate the extent of stage migration using the FIGO 2018 staging system for cervical cancer and validate the new staging system by assessing the survival outcomes.MethodsAn Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant retrospective analysis was performed on 158 patients from the cervical cancer database at the University of Mississippi Medical Center, USA. Patients had been treated between January 2010 and December 2018, and they were all staged according to the FIGO 2009 staging system previously. We collected data regarding tumor size, lymph node presence, and extent of metastatic disease in the pretreatment CT, positron emission tomography (PET), or MRI scans and restaged the patients using the FIGO 2018 system. The extent of stage migration was evaluated using the new staging system. We analyzed the three-year overall survival (OS) using both FIGO 2009 and 2018 staging systems for validation purposes. Kaplan-Meier analyses were performed using SPSS version 24.ResultsFifty-nine percent of the patients were upstaged when they were restaged using the FIGO 2018 staging system. In the current 2018 staging system, Stage IB3 accounted for 4%, and Stage IIIC accounted for 48% of the patient cohort, while other stages accounted for the rest. The median overall survival of the entire cohort was 20.5 months. There was a change in the survival curves using FIGO 2018 stages compared to those of FIGO 2009. There was a numerical improvement in three-year OS in stages IB and III among the two staging systems; however, it was not statistically significant. Interestingly, the three-year overall survival of Stage IIIC patients was better when compared to Stages III A& B combined (61% vs. 25%, p=0.017).ConclusionThe increased availability of cross-sectional imaging across the world has led to recent changes in the FIGO staging system for cervical cancer, which allowed imaging in staging. We identified a significant stage migration in our patient cohort with the FIGO 2018 staging system, but no difference in the three-year overall survival was observed. Local tumor extent may be a worse prognostic indicator than nodal metastasis among stage III patients.