Grade Lesions Research Articles

Is spleen-preserving surgery safe for abdominal trauma?

Treatment of splenic trauma is currently based on non-surgical treatment or the use of interventional radiology. The conservative surgery of the spleen in splenic trauma remains marginal. To analyze the safety and efficacy of conservative surgical treatment in splenic trauma. A retrospective study was performed over a 16-year period with the intention of recording the diagnostic and therapeutic attitude in a second level hospital, focusing on patients who received conservative splenic surgical treatment for splenic trauma, excluding splenectomies and non-surgical treatment. 110 patients presented splenic trauma. Spleen-sparing surgery was performed in 15 patients. The grades of splenic lesions were: 1 patient with grade I, 1 patient with grade II, 7 patients with grade III and 6 patients with grade IV. Surgical treatment was splenorrhaphy in 5 patients (33%), hemostatic agents and polyglycolic acid mesh in 4 (26%), partial splenectomy with placement of polyglycolic acid mesh in 3 (20%), partial splenectomy in 2 (13%), and electrocautery in 1 (6%). None of the patients initially treated with conservative surgery required posterior splenectomy and no patient died. We provide evidence supporting the usefulness and safety of conservative splenic surgery in splenic trauma, which would have its place in grades II, III and IV trauma in health centers that do not have urgent interventional radiology.

A comparative analysis of cycle threshold (Ct) values from Cobas4800 and AmpFire HPV assay for triage of women with positive hrHPV results

BackgroundTo compare the triage performance of HPV viral loads reflected by cycle threshold values (CtV) from two different HPV testing assays: the PCR based Cobas4800 and the isothermal amplification based AmpFire assay.MethodsWe used the data from a sub-study of The Chinese Multi-Center Screening Trial and analyzed the data of the cases positive in both Cobas4800 and AmpFire assays with recorded CtV. Spearman’s correlation was applied to analyze the association between CtV from AmpFire and Cobas4800 assays, as well as the correlation between CtV and the histological lesion grades. The 50th percentile of CtV was used as the cutoff to construct triage algorithms for HPV-positive cases. McNemar’s test was used to analyze the differences in sensitivity and specificity for detecting CIN2 + and CIN3 + in different triage algorithms.ResultsFour hundred forty-six HPV positive women who had consistent HPV results from Cobas4800 and AmpFire in terms of the HPV genotype and reported Ct values were included in the analysis. The mean CtV of hrHPV tested by Cobas4800 and AmpFire were linear correlated. Direct association were showed between the severity of cervical lesions and the HPV viral loads reflected by CtV of hrHPV, HPV16, non-16/18 hrHPV and A9 group from both assays. HPV16/18 genotyping combined with low-CtV for non-16/18 hrHPV, especially A9 group, were demonstrated to be satisfactory in the sensitivity and specificity for detecting CIN2 + or CIN3 + .ConclusionCt value represented a good triage marker in both PCR-based and isothermal amplification HPV detection.

The grade of individual prostate cancer lesions predicted by magnetic resonance imaging and positron emission tomography

BackgroundMultiparametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET) are widely used for the management of prostate cancer (PCa). However, how these modalities complement each other in PCa risk stratification is still largely unknown. We aim to provide insights into the potential of mpMRI and PET for PCa risk stratification.MethodsWe analyzed data from 55 consecutive patients with elevated prostate-specific antigen and biopsy-proven PCa enrolled in a prospective study between December 2016 and December 2019. [68Ga]PSMA-11 PET (PSMA-PET), [11C]Acetate PET (Acetate-PET) and mpMRI were co-registered with whole-mount histopathology. Lower- and higher-grade lesions were defined by International Society of Urological Pathology (ISUP) grade groups (IGG). We used PET and mpMRI data to differentiate between grades in two cases: IGG 3 vs. IGG 2 (case 1) and IGG ≥ 3 vs. IGG ≤ 2 (case 2). The performance was evaluated by receiver operating characteristic (ROC) analysis.ResultsWe find that the maximum standardized uptake value (SUVmax) for PSMA-PET achieves the highest area under the ROC curve (AUC), with AUCs of 0.72 (case 1) and 0.79 (case 2). Combining the volume transfer constant, apparent diffusion coefficient and T2-weighted images (each normalized to non-malignant prostatic tissue) results in AUCs of 0.70 (case 1) and 0.70 (case 2). Adding PSMA-SUVmax increases the AUCs by 0.09 (p < 0.01) and 0.12 (p < 0.01), respectively.ConclusionsBy co-registering whole-mount histopathology and in-vivo imaging we show that mpMRI and PET can distinguish between lower- and higher-grade prostate cancer, using partially discriminative cut-off values.

Evidence-based machine learning algorithm to predict failure following cartilage procedures in the knee

IntroductionClinical decision-making is highly based on expert opinion. Machine learning is increasingly used to develop patient-specific risk prediction analysis to improve patient selection prior to surgery. ObjectivesTo develop machine learning algorithms to predict failure of surgical procedures that address cartilage defects of the knee and detect variables associated with failure. MethodsAn institutional database was queried for cartilage procedures performed between 2000 and 2018. Failure was defined as revision cartilage surgery or knee arthroplasty. One hundred and one preoperative and intraoperative features were evaluated as potential predictors. Four machine learning algorithms were trained and internally validated. ResultsOne thousand and ninety-one patients with a minimum follow-up of 2 years were included and underwent chondroplasty (n = 560; 51%), osteochondral allograft transplantation (n = 306; 28%), microfracture (n = 150; 14%), autologous chondrocyte implantation (n = 39; 4%), or osteochondral autograft transplantation (n = 36; 3%). The Random Forest algorithm was the best-performing algorithm, with an area under the curve of 0.765 and a Brier score of 0.135. The most important features for predicting failure were symptom duration, age, body mass index, lesion grade, and total lesion area. Local Interpretable Model-agnostic Explanations analysis provided patient-specific comparisons for the risk of failure of an individual patient being assigned various types of cartilage procedures. ConclusionsMachine learning algorithms were accurate in predicting the risk of failure following cartilage procedures of the knee, with the most important features in descending order being symptom duration, age, body mass index, lesion grade, and total lesion area. Machine learning algorithms may be used to compare the risk of failure of specific patient-procedure combinations in the treatment of cartilage defects of the knee.

GLIOMA-11 JUVENILE OLIGODENDROGLIOMA OF THE OPTIC NERVE: UNIQUE CASE REPORT AND CHALLENGE IN DIAGNOSIS ACCORDING TO CURRENT 2021 WHO CLASSIFICATION IN LIMITED RESOURCES COUNTRIES.

Abstract BACKGROUND The list of most commonly occurring primary brain tumors includes gliomas, and the vast majority of these are astrocytomas or oligodendrogliomas. Oligodendrogliomas, account for about 3% of all intracranial tumors and 20% of gliomas. They are more commonly found in adults and occur mainly in the superficial gray matter of the cerebral hemispheres. For this tumor, 69% of the lesion is located in the frontal lobes. Involvement of the hypothalamus and optic chiasm are rarely seen and the tumor is most rare within the eye itself. The positive stain of IHC stain GFAP and OLIGO-2 overexpression is required for confirmation of diagnosis. Molecular genetics study of IDH-mutant is used for WHO grading and management of the oligodendrogliomas lesions. CASE PRESENTATION A 10 years old male presented with progressive blurred vision for 2 years and left eye globe protrusion for 1 month. On examination, he present with keratopathy, loss of vision, and pus discharge on the left eye. The Brain MRI was done and showed a left orbital heterogeneous enhancing lesion with mixed cystic and soft tissue involving both the globe and retrobulbar region with associated distortion of the optic nerve. The eye globe enucleation was done and tissue samples were taken for histopathology. The histopathology diagnosis reveals the optic nerve oligodendroglioma (NOS). The patient was kept on 8 cycles of Carboplatin chemotherapy. CONCLUSION Definitive diagnosis of Juvenile Oligodendroglioma of the optic nerve can be made only after the results of pathological and immunohistochemical analyses are known. Also, the current WHO grading of Oligodendroglioma requires molecular genetics IDH study. Although Juvenile Oligodendroglioma of the optic nerve is extremely rare, preoperatively oligodendroglioma should be included in the differential diagnosis of optic nerve tumors in pediatrics especially in limited settings with no molecular IDH testing.

Füzyon Biyopsi Sonrası Prostat Kanseri Saptanan Hastalarda Biyopsi Sonrası Patoloji ile Radikal Prostatektomi Sonrası Patolojinin Karşılaştırılması

Aims: To compare the post-radical prostatectomy (RP) final pathologies and post-biopsy pathologies of the patients diagnosed with prostate cancer (PCa) after fusion biopsy according to the International Society of Urological Pathology (ISUP) grading system. Material and Methods: In this retrospective study, data of 182 patients who underwent fusion biopsy and concomitant systematic biopsy between January 2020 and August 2022 was reviewed. All these patients were biopsy naive with PIRADS-3 lesions according to the multiparametric MRI (mp-MRI) imaging. A total of 89 patients with PCa detected by biopsy were included in the study. Age, PSA, PSA density, and lesion grades according to PI-RADS were analysed. The post-biopsy (fusion and systematic biopsy) pathology results of 60 patients who underwent RP were compared with the final pathology results after RP. Results: Pathological results after fusion biopsy and RP were compared. The individual agreement between RP and fusion biopsy for each ISUP grade was moderate to almost excellent (0.558 to 0.848). When the overall agreement between RP and fusion biopsy was evaluated, the weighted kappa was calculated as 0.721 (95% CI: 0.577 to 0.865), which was determined as substantial significant agreement. On the other hand, the overall agreement between systematic biopsy and pathology results after RP was calculated as weighted kappa 0.544 (95% CI: 0.405 to 0.683) and this agreement was determined as moderate agreement. Conclusion: Our study showed that the concordance between the pathology result after fusion biopsy and the final pathology after RP was higher than the standard TRUS prostate biopsy. We think this compliance is crucial in the regulation and follow-up of the treatment of the patients.

P16 expression and recurrent cervical intraepithelial neoplasia after cryotherapy among women living with HIV.

The expression of p16 protein, a surrogate marker for high-risk human papillomavirus (hrHPV), is associated with cervical dysplasia. We evaluated correlates of p16 expression at treatment for high-grade cervical lesions and its utility in predicting the recurrence of cervical intraepithelial lesions grade 2 or higher (CIN2+) following cryotherapy among women with HIV. This is a subgroup analysis of women with HIV in Kenya with baseline cervical biopsy-confirmed CIN2+ who were randomized to receive cryotherapy and followed every six-months for two-years for biopsy-confirmed recurrence of CIN2+. P16 immunohistochemistry was performed on the baseline cervical biopsy with a positive result defined as strong abnormal nuclear expression in a continuous block segment of cells (at least 10-20 cells). Among the 200 women with CIN2+ randomized to cryotherapy, 160 (80%) had a baseline cervical biopsy specimen available, of whom 94 (59%) were p16-positive. p16 expression at baseline was associated with presence of any one of 14 hrHPV genotypes [Odds Ratio (OR) = 3.2; 95% Confidence Interval (CI), 1.03-9.78], multiple lifetime sexual partners (OR = 1.6; 95% CI, 1.03-2.54) and detectable plasma HIV viral load (>1,000 copies/mL; OR = 1.43; 95% CI, 1.01-2.03). Longer antiretroviral therapy duration (≥2 years) at baseline had lower odds of p16 expression (OR = 0.46; 95% CI, 0.24-0.87) than <2 years of antiretroviral therapy. Fifty-one women had CIN2+ recurrence over 2-years, of whom 33 (65%) were p16-positive at baseline. p16 was not associated with CIN2+ recurrence (Hazard Ratio = 1.35; 95% CI, 0.76-2.40). In this population of women with HIV and CIN2+, 41% of lesions were p16 negative and baseline p16 expression did not predict recurrence of cervical neoplasia during two-year follow up.

Staining Intensity of P16INK4a and Ki-67 Determine the Grade of Cervical Lesion: An Experience from Single Tertiary Care Centre

Background: Various non-neoplastic and neoplastic lesions occur in cervix. HPV infection plays a major role in genesis of cervical lesions. Although most HPV infections are cleared out, infections with high risk HPVs may persist resulting in cervical dysplastic lesions. Using p16, a surrogate marker for HPV infection and Ki-67, a proliferation marker, along with histopathology, help improve the diagnostic accuracy of these lesions. The aim of the study was to evaluate the expression of p16 and Ki-67 in cervical lesions and association of their staining intensity with the histologic grading. Also to determine the predictive value of these markers in association with the cervical lesions. Methodology: A cross sectional study was carried out in 122 cases which were diagnosed histopathologically and then evaluated for the immunohistochemical expression of p16 and Ki-67 and their staining intensities. Results: The dysplastic lesions comprised of 83.7% cases [29.5% LSIL, 5.7% HSIL, 43.5% SCC and 4.9% adenocarcinoma] and 16.3% had non dysplastic lesions. p16 and Ki-67 expression were seen in 64.7% and 68% cases respectively. The intensity of p16 and Ki-67 expression was scored according to Galgano et al (2010). An increasing intensity of p16 and Ki-67 expression with higher grades of the cervical lesions was noted and this association was found to be statistically significant. (χ2 = 43.46 and p value &lt; 0.0001). Conclusion: Though histopathology is the gold standard, the role of p16 and Ki-67 have emerged as useful adjuncts in detecting the true nature of the cervical lesions. They aid in the proper diagnosis, classification and distinction from non-dysplastic lesions, helping the clinicians in taking prompt action for management of the cases.

New-Generation 0.55 T MRI of the Knee-Initial Clinical Experience and Comparison With 3 T MRI.

The aim of this study was to compare the detection rate of and reader confidence in 0.55 T knee magnetic resonance imaging (MRI) findings with 3 T knee MRI in patients with acute trauma and knee pain. In this prospective study, 0.55 T and 3 T knee MRI of 25 symptomatic patients (11 women; median age, 38 years) with suspected internal derangement of the knee was obtained in 1 setting. On the 0.55 T system, a commercially available deep learning image reconstruction algorithm was used (Deep Resolve Gain and Deep Resolve Sharp; Siemens Healthineers), which was not available on the 3 T system. Two board-certified radiologists reviewed all images independently and graded image quality parameters, noted MRI findings and their respective reporting confidence level for the presence or absence, as well as graded the bone, cartilage, meniscus, ligament, and tendon lesions. Image quality and reader confidence levels were compared ( P < 0.05 = significant), and clinical findings were correlated between 0.55 T and 3 T MRI by calculation of the intraclass correlation coefficient (ICC). Image quality was rated higher at 3 T compared with 0.55 T studies (each P ≤ 0.017). Agreement between 0.55 T and 3 T MRI for the detection and grading of bone marrow edema and fractures, ligament and tendon lesions, high-grade meniscus and cartilage lesions, Baker cysts, and joint effusions was perfect for both readers. Overall identification and grading of cartilage and meniscal lesions showed good agreement between high- and low-field MRI (each ICC > 0.76), with lower agreement for low-grade cartilage (ICC = 0.77) and meniscus lesions (ICC = 0.49). There was no difference in readers' confidence levels for reporting lesions of bone, ligaments, tendons, Baker cysts, and joint effusions between 0.55 T and 3 T (each P > 0.157). Reader reporting confidence was higher for cartilage and meniscal lesions at 3 T (each P < 0.041). New-generation 0.55 T knee MRI, with deep learning-aided image reconstruction, allows for reliable detection and grading of joint lesions in symptomatic patients, but it showed limited accuracy and reader confidence for low-grade cartilage and meniscal lesions in comparison with 3 T MRI.

Evaluation of Visual Inspection of Cervix with Acetic Acid in Detecting Precancerous Lesions

Background: Cervical cancer is a major public health problem in Bangladesh without widespread organized cervical screening programs. The acetic acid visual inspection of the cervix (VIA) is an efficient, low-cost screening test that can be paired with easy treatment procedures for early cervical lesions provided by skilled health workers. To evaluate the effect of any prevention program on cervical cancer incidence and mortality rates, women aged 25 to 50 must be adequately covered. VIA is a cost-saving method of screening, according to mathematical modeling of the expenses of various screening procedures in Bangladesh. Methods: Total 100 eligible woman who randomly came to the VIA centre of BSMMU were examined by VIA detection of well defined, opaque, acetowhite lesions close to the squamocolumner junction or in transitional zone or dense acetowhitening of ulcero proliferative growth on the cervix constitute a positive VIA Those who had abnormal results in screening test and those who had clinically suspicions lesion were sent for colposcopic evaluation and directed biopsy were taken from colposcopically suspected area. The final diagnosis was based on histology. Results: Healthy cervix was in 11 cases (11%) suspected inflammation was 4 cases (4%), CIN-I was 58 cases (58%), CIN-II was in 14 cases (14%), CNN-III was in 10 cases (10%), and invasive carcinoma was in 3 case (3%). Out of 100 patients biopsied, cervical intraepithelial neoplasia found among 81% cases of which CIN was in 52.5%, CIN II was in 17% and CIN III was in 8.5%. Invasive carcinoma found in 3% and inflammation was in 4% cases. Conclusion: VIA was as effective as colposcopy at detecting various grades of intraepithelial cervix lesions. Here, VIA was suitable for the diagnosis, follow-up care, and epidemiological research of cervical cancer, as well as for the detection of precancerous lesions in low resource settings.

Early Outcomes Following Plantar Condylectomy and Imbrication of Plantar Plate to Metatarsal Neck for Metatarsalgia and Grade 0 Lesser Toe Metatarsophalangeal Joint Instability

Background: Metatarsalgia and plantar plate tears are characterized by forefoot pain and toe deformity in severe cases. Conservative management may slow progression of symptoms; however, definitive treatment often requires operative intervention. The purpose of this observational study was to evaluate the combination of plantar condylectomy and surgical imbrication of the plantar plate to the metatarsal neck to repair grade 0 plantar plate injuries. Methods: We retrospectively identified 22 patients with metatarsalgia and low-grade plantar plate lesions (grade 0), operated between 2018 and 2021, who underwent operative repair involving plantar metatarsal condylectomy and proximal surgical imbrication of the plantar plate to the metatarsal neck. Fourteen patients underwent concomitant hallux valgus correction. Data collection was performed preoperatively and postoperatively and included Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) scores. Paired Wilcoxon signed-rank tests compared PROMIS PF and PI scores at patients’ preoperative, 6-9-week, 3-4-month, 5-6-month, and ≥9-month follow-up evaluations ( P &lt; .05). Results: Compared to their preoperative visit, patients demonstrated modest improvement in their PROMIS (pain and physical function) scores over the first ≥9 months postoperatively (median 13.0 months). Median preoperative and most recent PROMIS physical function scores were 40.5 (95% CI: 36-49) and 44.5 (95% CI: 40-52), respectively. Median PROMIS pain interference scores changed from 62.5 (95% CI: 56-67) to 56.0 (95% CI: 51-62). Improvement in pain and function was sustained in patients available for postoperative follow-up. Conclusion: In this small, early follow-up series, we found that plantar condylectomy and surgical imbrication of the plantar plate to the metatarsal neck was modestly helpful to treat metatarsalgia and grade 0 plantar plate injuries. Level of Evidence: Level IV, retrospective case series.

Correlation Between Colposcopic Patterns and Histological Grade of Vaginal Intraepithelial Neoplasia: A Retrospective Cohort Study.

Vaginal intraepithelial neoplasia (VaIN) is a rare human papillomavirus (HPV)- related premalignant condition. VaIN lesions are diagnosed histologically through colposcopy-guided biopsies of suspicious areas, conduced by gynecologists with expertise in lower genital tract diseases. The present study aimed to evaluate the accuracy of colposcopy in the diagnosis of VaIN of any grade. We conducted a retrospective analysis on a cohort of 149 women diagnosed with low grade (LG)-VaIN (VaIN1) and high grade (HG)-VaIN (VaIN2-3) between 2010 and 2022 at the "Regional Referral Center for Prevention, Diagnosis and Treatment of HPV-related Genital Disorders", Ospedale Maggiore Policlinico, Milan, Italy. All women had been referred to our center for an abnormal Pap smear or as part of routine follow-up of other HPV-related diseases and had undergone a vaginal biopsy under colposcopic guidance. The distribution of the histological grades of VaIN lesions was the following: 62 women (41.6%) were diagnosed with VaIN1, 51 (34.2%) with VaIN2, and 36 (24.2%) with VaIN3. Grade II (major) abnormal colposcopic patterns were recorded in 71 cases (47.7%) and were more commonly observed in women with VaIN3 (80.6%). However, we found a poor and not statistically significant association between colposcopic and histological grade of VaIN. The sensitivity, specificity, positive predictive value, and negative predictive value of colposcopy for histologically confirmed VaIN were 56.3%, 64.5%, 69% and 51.2%, respectively. The overall diagnostic accuracy of colposcopy was 59.7%. Colposcopy-guided biopsy plays an important role in the diagnosis of VaIN and in the distinction between low and high-grade lesions. Our data show that major colposcopic abnormalities moderately correlate with HG-VaIN and that grade I colposcopic findings do not exclude HG-VaIN, especially VaIN2. Targeted biopsies of suspicious vaginal areas must be performed in all women with an abnormal Pap smear.

Inhibition of GATA3, ABCB1, and TYR by gallic acid: A real-world approach to uncovering a preventive agent against oral squamous cell carcinoma development

ObjectiveThis study aimed to the efficacy of gallic acid (GA) as a prospective prophylactic agent against the onset of oral squamous cell carcinoma (OSCC). MethodsWe conducted bioinformatic analyses to identify the molecular targets of GA. Subsequently, we employed the 4NQO-induced animal model to evaluate the therapeutic potential of GA in OSCC. ResultsOur analysis unveiled that only three genes, ABCB1, GATA3, and SERPINE1, were associated with survival outcomes in OSCC patients. Reduced expressions of ABCB1 and GATA3 correlated with hazard ratios of 1.53 and 2.06, respectively, for mortality, while elevated SERPINE1 expression carried a 1.42-fold increased risk of death in OSCC patients. Molecular docking simulations underscored the robust affinity between GA and these genes, revealing binding energies of −6.0 kcal/mol for ABCB1, − 6.1 kcal/mol for GATA3, and −5.9 kcal/mol for SERPINE1. Furthermore, GA treatment demonstrated statistically significant reductions in the histopathological grade of 4NQO-induced lesions (p = 0.006) and mitigated liver (p < 0.001) and kidney (p < 0.001) toxicity associated with 4NQO exposure. ConclusionThe current study highlights GA as a promising contender for OSCC prevention. Mainly, GA targets critical genes such as ABCB1, GATA3, and SERPINE1, substantially impacting patient survival. Furthermore, GA administration mitigates 4NQO-induced toxicity, indicating its potential to improve animal survival by reducing lesion severity. These findings carry significant implications for OSCC research and potential clinical applications.

Safety of an esophageal deviator for atrial fibrillation catheter ablation.

Esophageal thermal injury is a complication of atrial fibrillation (AF) ablation, and it can be avoided by esophageal deviation during left atrial posterior wall radiofrequency catheter ablation. This study aimed to evaluate the safety of a nitinol-based mechanical esophageal displacement device (MEDD) and its performance. This preclinical safety study was conducted on 20 pigs, with 10 undergoing radiofrequency AF ablation using the MEDD and 10 serving as a control group under anticoagulation but without radiofrequency application. Esophageal traumatic injuries were classified from 0 to 4 and were grouped as absent (grade 0), minor (grade 1 or 2), moderate (grade 3), or major risk lesions (grade 4) by anatomopathological study. Grades 1 and 2 were considered acceptable. Fluoroscopy was used to measure displacement. Five (25%) pigs developed traumatic lesions, 4 with grade 1 and 1 with grade 2 (2-mm superficial ulcer). There was no difference in lesion occurrence between the radiofrequency and control groups (30% and 20%, respectively; P = .43). Under rightward displacement, the right edge moved 23.9 (interquartile range [IQR] 21.3-26.3) mm and the left edge moved 16.3 (IQR 13.8-18.4) mm (P < .001) from baseline. Under leftward displacement, the right edge moved 13.5 (IQR 10.9-15.3) mm and the left edge moved 16.5 (IQR 12.3-18.5) mm (P = .07). A perforation to the pharyngeal diverticulum occurred in 1 pig, related to an accidental extubation. In pigs, the MEDD demonstrated safety in relation to esophageal tissue, and successful deviation. Esophageal traumatic injuries were acceptable, but improper manipulation led to pharyngeal lesion.

Can the Gleason score be predicted in patients with prostate cancer? A dynamic contrast-enhanced MRI, (68)Ga-PSMA PET/CT, PSA, and PSA-density comparison study.

The present study aims to evaluate whether perfusion parameters in prostate magnetic resonance imaging (MRI), (68)Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT), prostate-specific antigen (PSA), and PSA density can be used to predict the lesion grade in patients with prostate cancer (PCa). The study included a total of 137 PCa cases in which 12-quadrant transrectal ultrasound-guided prostate biopsy (TRUSBx) was performed, the Gleason score (GS) was determined, and pre-biopsy multiparametric prostate MRI and (68)Ga-PSMA PET/CT examinations were undertaken. The patient population was evaluated in three groups according to the GS: (1) low risk; (2) intermediate risk; (3) high risk. The PSA, PSA density, pre-TRUSBx (68)Ga-PSMA PET/CT maximum standardized uptake value (SUVmax), perfusion MRI parameters [maximum enhancement, maximum relative enhancement, T0 (s), time to peak (s), wash-in rate (s-1), and wash-out rate (s-1)] were retrospectively evaluated. There was no significant difference between the three groups in relation to the PSA, PSA density, and (68)Ga-PSMA PET/CT SUVmax (P > 0.05). However, the values of maximum enhancement, maximum relative enhancement (%), T0 (s), time to peak (s), wash-in rate (s-1), and wash-out rate (s-1) significantly differed among the groups. A moderate positive correlation was found among the prostate volume, PSA (r = 0.490), and (68)Ga-PSMA SUVmax (r = 0.322) in the patients. The wash-out rate (s-1) and wash-in rate (s-1) had the best diagnostic test performance (area under the curve: 89.1% and 78.4%, respectively). No significant correlation was found between the (68)Ga-PSMA PET/CT SUVmax and the GS. The wash-out rate was more successful in estimating the pretreatment GS than the (68)Ga-PSMA PET/CT SUVmax.

547 Evaluating the Excision and Diagnosis Rates of Non-Melanoma Skin Cancers in a Plastic Surgery Department

Abstract Aim Skin cancer is the most common cancer in the UK. 95% of complete excision is considered the national average and achieving this is important for our patients and our practice. The aims of our study were to evaluate our complete excision rates, sensitivity, and specificity in diagnosing and excising Non-Melanoma Skin Cancers (NMSC) as a department. Method We conducted a retrospective audit of adult patients undergoing excision of NMSC in our department in July 2022. Data was collected on age, gender, clinical and pathological diagnosis, surgeon grade, complications, site and subtype of lesion excised. Results Of the 100 cases identified, 43% of lesions excised were BCC and 22% were SCC. 72% of procedures were carried out by registrars. 98% of excisions were complete with 2 incomplete excisions and 13 excisions with narrow margins. 86% of specimens with narrow margins or incomplete excision were excised from craniofacial areas. Clinical diagnosis sensitivity for BCC was 79% and 86% for SCC, whereas specificity was 79% for BCC and 58% for SCC. The overall clinical diagnosis sensitivity for NMSC was 81% and negative predictive value was 88%. Conclusions Our complete excision rate and sensitivity is above the national average, however our ability to distinguish benign from cancerous lesions has room for improvement. This may reflect surgeon grade and concerns over prolonged waiting times delaying treatment. We therefore recommend regular skin cancer teaching and encourage all grades to use loupes, dermatoscopes and adequate lighting in clinic and theatre to ensure adequate margins and adherence to national guidelines.

Extensive lesions and a positive cone margin are strong predictors of residual disease in subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3 study design

BackgroundThis study aimed to determine the predictive factors for post-conization of residual disease in subsequent hysterectomy for cervical intraepithelial neoplasia grade 2 or 3.MethodsThis retrospective study included 267 patients with histologically confirmed cervical intraepithelial neoplasia grade 2 or 3 who underwent hysterectomy within 7 months after conization. Clinical data (e.g., age, menopausal status, gravidity, parity, type of transformation zone, conization method) as well as pathological data pertaining to conization and hysterectomy were collected from medical records. A logistic regression model was used to analyze the relationship between the variables and risk of residual lesions in hysterectomy samples.ResultsOverall, 70 (26.2%) patients had residual lesions in their hysterectomy specimens. Univariate analyses revealed that age ≥ 50 years (p=0.019), endocervical gland involvement(p=0.013), positive margin(p < 0.001), and involvement of 3–4 quadrants(p < 0.001) were risk factors for residual lesions. Conversely, postmenopausal status, gravidity ≥ 3, parity ≥ 2, loop electrosurgical excision procedure, and type III transformation zone were not risk factors for residual lesions. A positive margin(p < 0.001) and multiple-quadrant involvement(p < 0.001) were identified as independent risk factors for residual lesions on multivariate analysis.ConclusionsMultiple-quadrant involvement and a positive cone margin were reliable predictive factors for residual disease. Total hysterectomy or repeated cervical conization should be considered for patients with these two risk factors. The identification of high-risk patients with extensive lesions by colposcopic examination before conization is indispensable, as it will enable surgeons to perform conization with consideration of risk factors and possibly improve the approach used for the excisional procedure. For high-risk patients, colposcope-guided cold-knife conization is preferred when resources permit.

Towards robust registration of heterogeneous multispectral UAV imagery: A two-stage approach for cotton leaf lesion grading

Multiple source images acquired from diverse sensors mounted on unmanned aerial vehicles (UAVs) offer valuable complementary information for ground vegetation analysis. However, accurately aligning heterogeneous UAV images poses challenges due to differences in geometry, intensity, and noise resulting from varying imaging principles. This paper presents a two-stage registration method aimed at fusing visible RGB and multispectral images for cotton leaf lesion grading. The coarse alignment stage utilizes Scale Invariant Feature Transform (SIFT), while the refined alignment stage employs a novel correlation coefficient-based template matching. The proposed method first employs the EfficientDet network to detect infected cotton leaves with lesions in RGB images. Subsequently, lesion leaves in multiple spectral imagery (red, green, red edge, and near-infrared bands) are located using the perspective transformation matrix derived from SIFT and the coordinates of lesion leaves in RGB images. Refined registration between RGB and multispectral imagery is achieved through template matching with the new correlation coefficient. The registered reflectance data from the different spectral bands and RGB components are utilized to classify pixels in each infected leaf into lesion, healthy, and soil parts. The lesion grade is determined based on the ratio of lesion pixels to the total corresponding leaf area. Experimental results, compared with manual assessment, demonstrate a lesion leaves detection model with a mAP@0.5 of 91.01% and a leaf lesion grading accuracy of 92.01%. These results validate the suitability of the proposed method for UAV RGB and multispectral image registration, enabling automated cotton leaf lesion grading.

Reliability and agreement testing of a new automated measurement method to determine facial vitiligo extent using standardized ultraviolet images and a dedicated algorithm.

Facial repigmentation is the primary outcome measure for most vitiligo trials. The Facial Vitiligo Area Scoring Index (F-VASI) score is often chosen as the primary outcome measure to assess the efficacy of treatments for facial vitiligo. Although useful, this scoring system remains subjective and has several limitations. To assess the agreement and reliability of an algorithmic method to measure the percentage depigmentation of vitiligo on the face. We developed a dedicated algorithm called Vitil-IA® to assess depigmentation on standardized facial ultraviolet (UV) pictures. We then conducted a cross-sectional study using the framework of the ERASE trial (NCT04843059) in 22 consecutive patients attending a tertiary care centre for vitiligo. Depigmentation was analysed before any treatment and, for 7 of them, after 3 and 6 months of narrowband UVB treatment combined with 16 mg methylprednisolone, both used twice weekly. Interoperator and interacquisition repeatability measures were assessed for the algorithm. The results of the algorithmic measurement were then compared with the F-VASI and the percentage of depigmented skin scores assessed by 13 raters, including 7 experts in the grading of vitiligo lesions. Thirty-one sets of pictures were analysed with the algorithmic method. Internal validation showed excellent reproducibility, with a variation of < 3%. The percentage of depigmentation assessed by the system showed high agreement with the percentage of depigmentation assessed by raters [mean error (ME) -11.94 and mean absolute error (MAE) 12.71 for the nonexpert group; ME 0.43 and MAE 5.57 for the expert group]. The intraclass correlation coefficient (ICC) for F-VASI was 0.45 [95% confidence interval (CI) 0.29-0.62] and 0.52 (95% CI 0.37-0.68) for nonexperts and experts, respectively. When the results were analysed separately for homogeneous and heterogeneous depigmentation, the ICC for homogeneous depigmentation was 0.47 (95% CI 0.31-0.77) and 0.85 (95% CI 0.72-0.94) for nonexperts and experts, respectively. When grading heterogeneous depigmentation, the ICC was 0.19 (95% CI 0.05-0.43) and 0.38 (95% CI 0.20-0.62) for nonexperts and experts, respectively. We demonstrated that the Vitil-IA algorithm provides a reliable assessment of facial involvement in vitiligo. The study underlines the limitations of the F-VASI score when performed by nonexperts for homogeneous vitiligo depigmentation, and in all raters when depigmentation is heterogeneous.

The Triaging Effect of the Human Papillomavirus 16/18 E7 Oncoprotein Assay in HPV 16/18-Positive Patients for High-Grade Cervical Intraepithelial Neoplasia Screening: A Cross-Sectional Study.

Objective: To investigate the triaging efficacy of the human papillomavirus (HPV) 16/18 E7 oncoprotein assay for high-grade cervical intraepithelial neoplasia (CIN2+) screening in HPV 16/18-positive patients in a tertiary hospital in China. Methods: We collected 476 cervical cell samples from women who tested positive for HPV 16/18 in the gynecological clinic of Peking Union Medical College Hospital between September 2018 and September 2022 and analyzed them by the HPV 16/18 E7 oncoprotein assay before colposcopy and biopsy. The study assessed the triaging efficacy of the HPV 16/18 E7 oncoprotein assay in HPV 16/18-positive patients by analyzing its performance against the gold standard of histologically confirmed CIN2+. Results: The positive rate of the HPV 16/18 E7 oncoprotein assay was 41.0% (114/278) in the negative for intraepithelial lesions and malignancy/CIN1 group and 80.3% (159/198) in the CIN2+ group. For triage of women with a positive HPV 16/18 test for CIN2+ detection, the HPV 16/18 E7 oncoprotein assay had a sensitivity, specificity, positive predictive value, and negative predictive value of 80.3%, 59.4%, 58.5%, and 80.9%, respectively. Furthermore, longitudinal follow-up of five patients showed a good correlation between the expression of the HPV 16/18 E7 oncoprotein and cervical lesion grades. Conclusions: As a triage method for HPV 16/18-positive patients, the HPV 16/18 E7 oncoprotein assay improves the specificity, reduces the colposcopy referral rate, and has the potential for long-term monitoring of high-grade CIN.