Mean Lesion Diameter Research Articles

Microwave ablation followed by cTACE in 5-cm HCC lesions: does a single-session approach affect liver function?

PurposeMicrowave ablation (MWA) and conventional transarterial chemoembolization (cTACE) are locoregional treatments commonly performed in very early, early and intermediate stages of hepatocellular carcinoma (HCC). Despite combined locoregional approaches have shown encouraging results in obtaining complete tumor necrosis, their application in a single session is poorly described.Our aim was to evaluate the safety and efficacy of single-session MWA and cTACE treatment in 5-cm HCCs and its influence on liver function.Materials and methodsAll 5-cm HCCs treated by MWA and cTACE performed in a single-session in our Interventional Radiology unit between January 2020 and December 2022 were retrospectively recorded and analyzed. Patients with poor or missing pre- and post-treatment imaging were excluded. Technical success, clinical success, and complications rate were examined as primary endpoints. Pre- and post-treatment liver function laboratory parameters were also evaluated.ResultsA total of 15 lesions (mean lesion diameter, 5.0 ± 1.4 cm) in 15 patients (11 men; mean age, 67.1 ± 8.9 years) were retrospectively evaluated. Technical and clinical success were 100% and 73%, respectively. Four (27%) cases of partial response and no cases of progressive or stable disease were recorded. AST and ALT values have found to be significantly higher in post-treatment laboratory tests. No other significant differences between pre- and post-treatment laboratory values were registered. AST and ALT pre- and post-treatment higher differences (ΔAST and ΔALT) were significantly associated with a lower clinical success rate.ConclusionMWA and cTACE single-session approach is safe and effective for 5-cm HCCs, without significant liver function impairment. A post-treatment increase in AST and ALT values may be a predictor for clinical failure.

The impact of the relationship between lesion diameter and total core length on the detection rate of clinically significant prostate cancer for PI-RADS 3 lesions

BackgroundThe aim of our study was to determine the effect of total core length (TCL) for prostate imaging reporting and data system (PI-RADS) 3 lesions to facilitate clinically significant prostate cancer (csPCa) detection based on the lesion diameter.Materials and methodsA total of 149 patients with at least 1 lesion with a PI-RADS 3 were evaluated retrospectively. The lesions with diameters of < 1 cm were categorized as small lesions and lesions of ≥ 1 cm were categorized as large lesions. The lengths of biopsy cores from PI-RADS 3 lesions were summed for each lesion separately, and TCL was calculated. The relationship between TCL and csPCa was analyzed separately for the small and large groups with multiple logistic regression analyses.ResultsA total of 208 lesions were detected by multiparametric magnetic resonance imaging (MpMRI) in 149 males included in the study. The mean TCL was 44.68 mm (26–92) and the mean lesion diameter was 10.73 mm (4–27) in PIRADS 3 lesions. For small diameter lesions (< 1 cm), the odds of finding clinically insignificant prostate cancer (ciPCa) increase by 1.67 times if TCL increases by one unit. Hence, increasing TCL for small lesions only increases the odds of ciPCa detection. For large diameter lesions (≥ 1 cm), if TCL increases by one unit, the odds of finding ciPCa increase 1.13 times and the odds of finding csPCa increases1.16 times. Accordingly, large lesions are more likely to have both csPCa and ciPCa as TCL increases.ConclusionsOur study showed that for PI-RADS 3 lesions, both more csPCa and more ciPCa were detected as TCL increased. However, in lesions with a size of < 1 cm, only ciPCa was detected more frequently as TCL increased. In conclusion, taking more and longer biopsy cores in PI-RADS 3 lesions below 1 cm does not contribute to the detection of csPCa.

Clinical, Biochemical, and Radiological Retrospective Analysis in Patients with Adrenal Incidentaloma – A Secondary Publication

Objective: To evaluate the epidemiological, demographic, clinical features, treatment approaches, and survival of patients followed up for adrenal incidentaloma. Methods: Data from 46 patients who were treated and followed up due to adrenal incidentaloma in the Endocrinology Department of Mersin University Health Research and Application Hospital between 2010 and 2014 were retrospectively analyzed. Results: Of the cases included in the study, 13 were male, 33 were female, and the mean age was 54.09 ± 10.7 years. The most common reason for admission was abdominal pain in 34.78% of the patients, the most commonly diagnosed radiological method was dynamic adrenal CT in 60.87%, and the most common location was the left adrenal gland. The mean lesion diameter was between 26.8 ± 16.5 mm. The frequency of hypertension was 50%, obesity 47.8%, type 2 diabetes 21.7%, osteoporosis 42.8%, and metabolic syndrome 41.3%. According to hormonal evaluation results, non-functional adrenal adenoma (NFAA) was found in 82.61%, subclinical Cushing’s syndrome (SCS) in 15.21%, and aldosteronoma in 2.1%. Myelolipoma, pheochromocytoma, and adrenocortical adenoma were diagnosed in 8 cases undergoing adrenalectomy. One patient died due to liver failure. No hormonal activation or growth in lesion size was detected during the follow-up of the patients. Conclusion: Due to the very different pathological and radiological appearances of adrenal incidentaloma, it is important to evaluate demographic, etiological, clinical, laboratory, and radiological data as a whole in the treatment and follow-up.

T1a renal cancer cryoablation - first experiences in Poland.

Cryoablation is one of the methods of treating patients with renal cancer with curative intent. This procedure is not widely available in Poland due to the lack of reimbursement until April 2023. The purpose of this study is to present the results of the first experiences in cryoablation of renal cell carcinoma in Poland. Patients with renal cell carcinoma in T1a stage (up to 4 cm in diameter) were treated with percutaneous cryoablation between December 2020 and December 2023. All patients were disqualified from surgical treatment due to age, comorbidities, or history of nephrectomy. Diagnosis was confirmed by computed tomography (CT)-guided core needle biopsy that was performed 2-4 weeks before cryoablation. Twenty-five patients underwent CT-guided cryoablation of T1a renal cancer. The mean age of the patients was 77 years (43-91 years). The mean diameter of lesions was 27 mm (15-40 mm). None of the patients presented with local or distant recurrence within the mean 12-months of follow-up period (100% progression-free survival). Urine leak treated with a stent was detected in one patient. Four patients died within the follow-up period, but none of the deaths was directly related to the procedure. Cryoablation is an effective and safe procedure and should be available to more patients in Poland.

Comparison of the Efficiency and Safety of Photodynamic Therapy Combined Intravitreal Bevacizumab and Intravitreal Triamcinolone Treatments in Age-Related Macular Degeneration

Objective: This study aims to retrospectively examine the mid and long-term results of the photodynamic therapy (PDT) +IVTA group and the PDT +IVB applied Group in the treatment of choroid neovascularization (CNV) due to age-related macular degeneration (AMD) and to compare the results with the results of multicenter clinical studies. Materials and Methods: 64 eyes of 64 patients admitted to Haseki Training and Research Hospital, Department of Ophthalmology, Retina unit between June 2003 and March 2009, diagnosed with CNV secondary to age-related macular degeneration and treated, were included in the study. Thirty-five eyes with PDT +IVTA were classified as Group I, and 29 with PDT +IVTA were classified as Group II. Visual acuities of the cases were evaluated with ETDR and Snellen charts and converted to their equivalents on the Logarithm of Minimal Angle of Resolution (logMAR) scale. All patients underwent an ophthalmological examination before and after the treatment; fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were performed to see if there was any recurrence in the patients. Patients who were found to have relapsed were re-treated. Results: There were 26 (40.6%) female cases and 38 (59.4%) male cases. The ages ranged from 55 to 88, with a mean age of 73.85±7.26. The follow-up period of the patients ranged from 5 months to 69 months; the mean was 17.65±13.48 months. When evaluated according to FFA images, 40 (62.5%) were occult, 12 (18.8%) were minimal-classical, and 12 (18.8%) were dominant-classical. After treatment, visual acuity decreased in 20% of the PDT +IVTA group and increased or remained the same in 80%. In the PDT +IVB group, blurred vision decreased by 27.6% and increased or remained the same by 72.4%. There was no statistically significant difference between the groups regarding the change in visual acuity after treatment compared to before treatment (p&gt;0.05). In OCT, the decrease in the mean central foveal thickness (CFT) after treatment compared to the mean CFT before treatment in Group I was statistically significant (p&lt;0.05). In Group II - the decrease in the mean CFT after treatment compared to the mean CFT before treatment was statistically significant (p&lt;0.01). In Group I, there was no statistically significant change in the mean lesion diameter after treatment compared to the mean lesion diameter before treatment (p&gt;0.05). However, the decrease in Group II was statistically significant (p&lt;0.01). While the increase in CFT (central foveal thickness) and lesion diameter was more pronounced in the PDT+IVTA group post-treatment compared to the pre-treatment group, no significant difference was observed in visual acuity change within the PDT+IVTA group. Conclusion: In the treatment of choroidal neovascularization secondary to age-related macular degeneration, the combination of Triamcinolone or Bevacizumab with photodynamic therapy has proven to be both effective and safe. This approach helps preserve the current vision and even enhance visual outcomes. Combination therapy reduces the frequency and number of monotherapies used to achieve visual success.

Percutaneous ultrasound-guided radiofrequency ablation for patients with liver metastases from gastrointestinal stromal tumors

Objectives This study aimed to analyze the survival outcomes and prognostic factors of radiofrequency ablation (RFA) for liver metastases from gastrointestinal stromal tumors (GISTs). Methods Between March 2011 and November 2022, 34 patients (16 males; age range, 25–72 [median age, 52.5] years) who underwent RFA for liver metastasis from GISTs were included. The mean maximum diameter of metastatic lesions was 2.4 ± 1.0 (range, 1.1–5.2) cm. Survival curves were constructed using the Kaplan–Meier method and compared using the log-rank test. Multivariate analyses were performed using a Cox proportional hazards model. Results For 79 lesions among 34 patients, all targeted lesions were completely ablated. The mean hepatic progression-free survival (HPFS) period was 28.4 ± 3.8 (range, 1.0–45.7) months. The 1-, 3-, and 5-year HPFS rates were 67.2%, 60.5%, and 20.2%, respectively. Based on the univariate analysis, the number of metastatic tumors and tyrosine kinase inhibitors(TKI) therapy before RFA were prognostic factors for HPFS. Multivariate analysis showed that pre-RFA TKI therapy was associated with a better HPFS(p = 0.030). The mean overall survival (OS) period was 100.5 ± 14.1 (range, 3.8–159.5) months and the 1-, 3-, and 5-year survival rates were 96.9%, 77.1%, and 58.7%, respectively. Both univariate and multivariate analysis indicated that extrahepatic metastasis before RFA (p = 0.044) was a significant prognostic factor for OS. Conclusions Liver metastases from GIST exhibit relatively mild biological behavior. RFA is safe and effective, particularly in patients without pre-RFA extrahepatic metastases. Patients received targeted therapy before RFA can obtain an extended HPFS.

Application of artificial intelligence-based dual source CT scanning in the differentiation of lung adenocarcinoma in situ and minimally invasive adenocarcinoma.

Lung adenocarcinoma is the most common type of lung cancer with highly incidence and mortality. Due to the overlap of morphological features, it is difficult to distinguish clinically between preinvasive lesions (in situ adenocarcinoma, AIS) and invasive lesions (minimally invasive adenocarcinoma, MIA), which appear as ground glass cloudy nodules. This study was performed to probe the application value of artificial intelligence (AI)-based dual source CT scanning in the differentiation of AIS as well as MIA. The clinical data of 136 patients in Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine from January 2019 to January 2022 were retrospectively analyzed. The accuracy of AI in distinguishing lung AIS (n=76) and MIA (n=60) were analyzed. The effectiveness of AI in detecting nodules and its diagnostic efficacy for AIS and MIA were explored. The proportion of patients with clear and regular lesion boundaries in AIS was higher than that in MIA. The mean lesion diameter of AIS patients was shorter than MIA patients. There was no difference in the CT value between AIS and MIA in the ground glass nodule density area of pure ground glass nodule and mixed ground glass nodule, but the CT value of the solid nodule density area in AIS was lower. The occurrence of pulmonary vascular abnormality, air bronchogram sign, and pleural depression in AIS patients were lower than MIA patients. The detection rate of AI for lung adenocarcinoma with nodule diameter ≤ 5 mm, complete solid nodules and ground glass nodules was significantly higher than radiologists. The sensitivity, specificity, positive prediction rate, negative prediction rate and accuracy of AI detection were significantly higher than radiologists. AI-based dual source CT scanning can clearly show the morphological characteristics of lung adenocarcinoma, which is helpful for the differential diagnosis of lung AIS as well as MIA.

Cone-Beam Computed Tomography-Guided Cryobiopsy Combined with Conventional Biopsy for Ground Glass Opacity-Predominant Pulmonary Nodules

Introduction: Cryobiopsy (CB) using a 1.1-mm cryoprobe under fluoroscopic guidance is feasible and safe for diagnosis of ground glass opacity (GGO) lesions. However, the efficacy of CB combined with cone-beam CT (CBCT) for GGO-predominant pulmonary nodules remains elusive. Methods: We retrospectively studied patients who underwent CB combined with conventional biopsy under CBCT guidance for GGO-predominant pulmonary nodules with a consolidation-to-tumour ratio <50.0%. Results: A total of 32 patients with GGO-predominant pulmonary nodules were enrolled: 17 pure GGOs and 15 mixed GGOs. The mean lesion diameter was 15.81 ± 5.52 mm and the overall diagnostic yield was 71.9%. Seven lesions were diagnosed by CB alone, which increased the diagnostic outcomes by 21.9%. Diagnostic yields for CB, forceps biopsy (FB), brushing, and guide sheath flushing were 65.6%, 46.9%, 15.6%, and 14.3%, respectively. Univariate analysis revealed that positive computed tomography (CT) bronchus sign (p = 0.035), positive CBCT sign (p < 0.01), and CB-first biopsy sequence (p = 0.036) were significant predictive factors for higher diagnostic yield. Specimens obtained by CB had larger mean sample size (p < 0.01), lower blood cell area (p < 0.01), and fewer crush artefacts (p < 0.01) than specimens from FB. No severe bleeding or other complications occurred. Conclusion: CB using a 1.1-mm cryoprobe under CBCT guidance increased diagnostic yield for GGO-predominant pulmonary nodules based on conventional biopsy. Further, it provided larger and nearly intact samples compared with forceps.

Evaluation of Endo Perio Lesions Using Cone Beam Computed Tomography (CBCT) - A Cross Sectional Study.

An accurate assessment of the disease extent and lesion size is needed for appropriate therapy decisions of endodontic-periodontic (endo-perio) lesions. CBCT imaging with less radiation and high spatial resolution can provide a comprehensive evaluation of endo-perio lesions. A total of 71 teeth with endo-perio lesions were assessed using CBCT. Periodontal bone defects were studied for bone loss pattern (horizontal/vertical) along with bone loss levels on mesial and distal sides in association with furcation involvement. The periapical lesions were studied for their prevalence and extent based on CBCT PAI Score. Horizontal and vertical bone loss were detected in 54 teeth (76.1%) and 17 teeth (23.95%), respectively. Mean crestal bone loss levels on mesial and distal aspects were 4.80 ± 3.21 mm and 5.74 ± 3.91 mm, respectively. The mean height, width, and depth of furcation defects were 3.19 ± 2.99 mm, 1.94 ± 0.98 mm, and 4.44 ± 1.92 mm, respectively. Periapical lesions were recorded in 55 teeth (77.5%). A CBCT PAI score of 5 was scored in 35 teeth with a mean lesion diameter of 11.3 ± 2.83 mm, while 16 teeth had healthy periapical tissues (scores of 0 and 1). CBCT is a valuable diagnostic tool that can help assess endo-perio lesions by providing morphometric measurements of periodontal bone defects and the extent of associated periapical lesions.

Long-Term Outcomes in a Phase II Study of Hypofractionated IGRT 60Gy/ 20F in Patients with Isolated Lymph Node Recurrence after Surgery for Esophageal Carcinoma

In oligo metastases in lymph node recurrence after surgery for esophageal cancer, since SBRT (BED>100 Gy10) to mediastinal and abdominal lymph node lesions was not an option due to toxicities in the organs at risk (OAR) such as vessels and gastrointestinal tract, we performed a prospective cohort study of hypofractionated IGRT for isolated lesions. The primary end-points of this study are disease specific survival (DSS) and late treatment toxicities. From 2011 to 2021, 60 Gy/20F/4-4.5wks (78 Gy10) hypofractionated IGRT was performed in a total ITT population of 70 patients after radical surgery (67 cases) and ESD (3 cases), who were diagnosed by CT/PET-CT as having solitary lymph node recurrence (62 cases) or up to 2 adjacent nodes (8 cases). The mean time from surgery to recurrence was 17.9 months (SD 18.1) with a mean age of 67.5 years (SD 9.3), and male to female ratio was 62:8. Pathological results showed that 63 patients (90%) had squamous cell carcinoma. The mean maximum diameter of lesions was 2.5 cm (SD; 1.1 cm). And 51 cases (73%) were treated with CRT concurrently using 5FU plus CDDP (FP), and the rest were treated with RT alone. Lymph node location was lower neck or upper mediastinum in 42 cases, middle and lower mediastinum in 16 cases, and abdomen in 12 cases, respectively. Treatment planning was performed by taking 4DCT fusing PET or MRI images. The Kaplan-Meier method and the Cox proportional hazards regression model were used for overall survival (OS), DSS, and progression free survival (PFS). The mean observation period was 38 months. Primary efficacy was CR in 45 cases (64%), but CR was maintained only in 29 cases (41%). Twenty-two of the 70 patients were relapse-free. OS were 53% and 34% at 2 and 5 years, DSS were 56% and 38% at 2 and 5 years, and PFS were 40% and 39% at 2 and 5 years, respectively. The site of first recurrence was the same or adjacent lymph nodes in 33 cases (47%) and distant metastases in 9 cases (13%). Number of tumors (1 vs. 2), age, and CRT were not significant prognostic factors for OS, DSS, or PFS. In a multivariate analysis, the time from surgery to recurrence ≥12 months was the only significant prognostic factor for PFS (p = 0.018, HR0.50). The same multivariate analysis showed that the only significant prognostic factor for DSS was the location of the recurrent lymph node in the neck and upper mediastinal regions (p = 0.009, HR 0.59). The only late adverse events of Grade 2 or higher were Grade 2 pleural effusion (little and transient) in 6 cases and Grade 2 radiation pneumonitis in 1 case. No acute adverse events were observed other than hematologic toxicity due to FP administration. In locally advanced esophageal cancer, a relatively reliable regional lymph node dissection is often performed, so there is still a chance to aim for cure in cases of solitary recurrence. We found that if the lesion is solitary, localized RT of about 60 Gy/20F/4-4.5 weeks with IGRT can achieve a long-term survival in 40% of patients without any significant adverse events.

Staged Stereotactic Radiosurgery as a Novel Adaptive Approach to Salvage Previously Irradiated Brain Metastases

We report outcomes specific to a novel 3 fraction (frx) staged stereotactic radiosurgery (St-SRS) regimen designed to salvage metastases previously irradiated and considered to be at high risk of radiation necrosis (RN). A total of 24 patients with 55 metastases treated with our 3 frx St-SRS approach were reviewed. Prior to each frx, patients were re-simulated and planned with a new MRI to allow for treatment adaption. The primary endpoint was the cumulative incidence of local failure (LF) and secondary endpoints included tumor dynamics and RN rates. The median follow up was 9.0 months (range: 2.7-40.1 months) and median age was 59-years (range: 32-84). Primary cancers were of breast (44%), lung (33%), melanoma (22%), and gastro-intestinal (1%) origin. Individual metastases treated with St-SRS had initially failed surgery and post-op cavity hypofractionated SRS (HSRS) for 2/55 (4%), SRS alone for 19/55 (34%), whole brain radiation (WBRT) alone for 6/55 (11%), HSRS for 2/55 (4%), and prior SRS and WBRT exposure for 28/55 (51%). 46/55 (84%) were prescribed 8 Gy, 8 Gy, 4 Gy; 8/55 (14%) had 6 Gy, 6 Gy, 4 Gy and 1/55 (2%) had 8 Gy, 8 Gy, 6 Gy. The median number of weeks between frx was 2.6 (range: 1.0-6.8). The median of the mean and maximum target doses were 9.7 Gy (range: 5.4-11.7 Gy) and 12.4 Gy (range, 7.5-16.0 Gy) respectively. The median prescription isodose line was 62% (range: 50-85%). The mean lesion volume and diameter was 3.8cc (range: 0.05-24.8cc) and 1.6cm (range: 0.2-4.4cm), respectively. The mean percent target volume coverage, Paddick Conformality Index and Gradient Index were 100% (range: 97-100%), 0.7 (range: 0.1-0.9), and 3.2 (range: 2.5-6.7), respectively. The mean volume change between staged frxs was -4.2% (range: -69.3 to +63.1%), and based on the first and last St-SRS MRI was -10.8% (range: -86.6% to +68.7%). The crude LF rate was 27%. The median time to LF was 3.4 months (range: 1.2-7.4 months). Amongst those with a LF, 7/15 (46%) were melanoma, 6/15 (40%) HER2 positive breast cancer, 1/15 (7%) gastrointestinal and 1/15 (7%) non-small cell lung carcinoma. 8/15 (53%) had prior WBRT and SRS exposure, 1/16 (7%) surgery and cavity HSRS, 5/15 (33%) SRS alone and 1/15 (7%) WBRT alone. Only asymptomatic RN events were observed in 4/55 (7%). St-SRS is a promising approach to salvage previously irradiated brain metastases, including prior SRS, with a favorable rate of RN. Tumor volume dynamics between stages can be significant warranting adaptive replanning.

Spaghetti Technique Versus Wide Local Excision for Lentigo Maligna Affecting the Head and Neck Regions: Surgical Outcome and Descriptive Analysis of 79 Cases from a Single Practice Cohort.

Lentigo maligna is a subtype of melanoma in situ that typically affects the head and neck region with an increasing incidence. Margin-controlled techniques, such as spaghetti technique (ST), have gained popularity over wide local excision (WLE) with a margin of 5 mm. To evaluate the outcomes of lentigo maligna cases in the head and neck area treated by either WLE or ST in a tertiary referral hospital. The secondary goal was to describe the demographic and clinical characteristics of our series. Cohort study of patients diagnosed with lentigo maligna on the head and neck region between January 2014 and February 2022 in a tertiary hospital. In total, 79 lentigo maligna were studied, corresponding to 77 patients. Fifty-three lesions (67%) were treated with WLE and 26 (33%) with ST. The mean age of the patients was 73 years and 58% were men. Most of the tumors were located on the cheek (50%) and mean lesion diameter was 2.2 cm for the ST group and 1.2 cm for the WLE group. Mean duration follow-up was 44 months. There were two local recurrences in the WLE group (2/53; 3.7%) and none in the ST group. Both WLE and ST are appropriate surgical approaches for lentigo maligna. ST offers an efficient alternative to Mohs surgery for treating lentigo maligna in the head and neck area, especially when guided by reflectance confocal microscopy.

Endoscopic ultrasonographic features of submucosal lesions of upper digestive tract suspected gastrointestinal stromal tumors and their correlation with progression and pathological risk grade of the lesions

Objective: To investigate the endoscopic ultrasonographic (EUS) characteristics of submucosal lesions of upper digestive tract suspected gastrointestinal stromal tumors (GIST) and their correlation with biological behaviors and pathological risk grade of the tumors. Methods: Retrospective cohort study. The EUS findings, follow-up review, surgical treatment and pathological data of patients with suspected GIST at the Gastrointestinal Endoscopy Center of Peking University People's Hospital from January 2013 to April 2021 were collected. All samples were divided into follow-up group and treatment group based on the pathological condition and the patient's treatment intention. According to whether or not the tumor was enlarged in EUS, the follow-up group was divided into non-enlarged group and enlarged group. Paired T-test was used to compare the lesion size before and after follow-up, and logistic regression was used to analyze the risk factors of tumor enlargement. According to the treatment methods, the treatment group was further divided into endoscopic treatment group and surgical treatment group. According to the pathological results and risk grade, the treatment group was further divided into the low-risk group and the medium-risk group. The risk factors of pathological malignant risk were analyzed by logistic regression, and the tumor diameter of patients with moderate or above pathological risk was predicted by receiver operation characteristic (ROC) curve. The relationship between the findings of EUS and the progression and pathological risk of GIST were also explored. Results: Seventy-three cases including 23 males and 50 females, with an age of 58 (30-88) years, were included in the follow-up group, with a mean lesion diameter of (1.21±0.49) cm before follow-up, median follow-up interval of 33.8 months, and a lesion diameter of (1.18±0.49) cm after follow-up. There was no significant difference (all P>0.05) in lesion diameter between before and after follow-up. There was no significant difference (all P>0.05) between tumor enlargement group (18 cases, 24.7%) and non-enlargement group (55 cases, 75.3%). One hundred and thirty-eight cases, including 52 males and 86 females, with an age of 60 (19-84) years, were enrolled in the treatment group, with a mean EUS estimated diameter of (2.55±1.35) cm and pathological diameters of (3.43±2.42) cm. Ninety-five (68.8%) of these cases were pathologically confirmed as GIST while 43 cases were diagnosed as other tumor types, including 37 benign tumors and 6 malignant tumors. In multifactorial logistic regression analysis, only the increase of tumor diameter [OR (95%CI): 1.800 (1.172-2.766), P=0.007] was a risk factor for pathological intermediate or higher risk. The optimal tumor diameter for predicting pathological intermediate or higher risk using ROC curve analysis was 2.75 cm, with a sensitivity 71.4%, specificity 79.0%, Youden index 0.5 and area under ROC curve 0.807 (95%CI: 0.703-0.909). Conclusions: EUS is essential for assessing the risk of progression and malignancy of submucosal lesions of upper digestive tract suspected GIST. For lesions of small diameter, the interval of follow-up shall be relatively extended while the indication of treatment could be partially waived.

Evaluation of force time integral, force time current integral and lesion size index in a new force sensing catheter

Abstract Funding Acknowledgements Type of funding sources: None. Background Radiofrequency current remains one of the most important ablation techniques in the EP lab. Creating durable lesions is key to successful ablation. Evaluating lesion quality and progression of lesion growth is difficult as many parameters influence lesion formation. Therefore, several approaches were developed, as monitoring RF duration, power and contact force seems insufficient in clinical practice. Force-time-integral (FTI) and force-time-current-integral (FTCI), as well as the ablation index (AI) and lesion size index (LSI) showed decent results in past studies. Recently, a new force sensing catheter (NFSC) was released. By now, data about lesion formation and correlation with the FTI, FTCI and LSI is lacking with this NFSC. This study aimed to further investigate lesion formation with the NFSC in an ex vivo model. Methods 30 RF-lesions were created using an ex vivo porcine cardiac model with the NFSC catheter. The experimental setup consisted of a saline-filled container, a dispersive electrode, a heated thermostat and a circulation pump to imitate in vivo conditions. Global impedance was kept at 120 Ohm as well as the temperature at 37°C. In a first set of lesions, CF was varied (1g, 5g, 10g, 20g). Three lesions were created in each CF-level with 30W. In a second set of lesion, CF was kept at 10 – 15 g, but ablation power was set to 20W, 30W, 40W, 50W, 60W and 70W. In every power level, three lesions were created. All parameters (power, temperature, global impedance, contact force, lesion size) were measured constantly during application of RF-current, enabling real-time correlation of RF parameters and lesion size. In case of an audible steam pop, RF application was stopped. Results 1640 measurement in 30 lesions were included into the analysis. Mean lesion diameter was 7.82 ± 1.52 mm, mean lesion depth 4.80 ± 1.08 mm. Baseline global impedance (GI) was 138.10 ± 10.93 Ω, mean GI-drop 28.10 ± 8.00 Ω. In average, CF of 12.10 ± 5.87 g was used. Correlations of lesion size, FTI and FTCI are shown in table 1. Interestingly, LSI correlated best with lesion size (r = 0.851 and r = 0.852 for lesion depth and diameter; p&amp;lt;0.001). Figure 1 illustrates a scatter plot of LSI and lesion depth (Figure 1a) and lesion diameter (Figure 1b). Figure 2 shows dynamic changes in lesion depth compared to changes in LSI and FTCI. During RF-application, development of lesion formation and LSI is comparable from approximately second 7 onwards. FTCI is rising in a linear manner, whereas lesion formation increases monoexponentially. Conclusion In the NFSC, lesion size correlates strongest with the LSI in power levels up to 70 Watts. FTI and FTCI also showed decent correlations. Regarding dynamic changes in lesion size, LSI is best comparable to actual lesion growth.

Microwave ablation of colorectal cancer lung metastases — the first experience in Poland

Introduction. This study aimed to present the results of the first experiences in thermal ablation of colorectal cancer lung metastases in Poland. Material and methods. Seven patients with colorectal cancer lung metastases were treated with CT-guided microwave ablation. One of them was lost to follow-up, so 6 patients with 7 metastatic foci were included in this study. The mean diameter of lesions was 15 mm (10–20 mm). The patients were disqualified from surgical treatment due to comorbidities. Results. The mean duration of follow-up was 15 months (range: 6–29). No mortality was noted during that period. Local progression was not reported, while distant progression was found in two patients. Two patients presented with pneumothorax just after the ablation, and one of them required chest tube drainage. No complications were noted. Conclusions. Patients with a few small colorectal cancer lung metastases can benefit from thermal ablation. The method is safe and should be available for medically inoperable patients with pulmonary oligometastatic disease.

“UTILITY OF IOTA ADNEX MODEL IN PRE-OPERATIVE EVALUATION OF ADNEXAL MASSES WITH HPE CO-RELATION IN FEMALES BETWEEN 30-70 YEARS IN TERTIARY CARE CENTRE OF CENTRAL INDIA”

1. Objectives: Ÿ To prove that there is a role of IOTA ADNEX model in preoperative evaluation of adnexal masses. 2. Conclusion And Results: Ÿ In our study, out of 65 patients, most of the patients were ≤50 years of age. Age was statistically signicant with HPE (p0.032). Ÿ We found that, most of the patients had family history in Malignant group compared to Benign group but this was not statistically signicant (p-0.951). Ÿ Our study showed that, a greater number of patients had more than 10 locules in Malignant group compared to Benign group though it was not statistically signicant (p-0.87). Ÿ Higher number of patients had Ascites in Malignant group compared to Benign group which was statistically signicant (p&lt;0.001). Ÿ More number of patients had Post Acoustic Shadowing in Malignant group compared to Benign group which was statistically signicant (p&lt;0.001). Ÿ It was found that, the mean CA 125 U/mL was higher in Malignant group compared to Benign group it was statistically signicant (p&lt;0.001). Ÿ The mean Lesion Diameter (mm) was more in Malignant group compared to Benign group but this was not statistically signicant (p-0.701). Ÿ We showed that, the mean Solid Component Size (mm) was more in Malignant group compared to Benign group which was statistically signicant (p&lt;0.001). Ÿ The mean number of Papillary Projections was more in Malignant group compared to Benign group which was statistically signicant (p-0.005). Ÿ We observed that, majority of lesions which were categorized as malignant by IOTA ADNEX model turned out to be malignant and benign lesions turned out to be benign on HPE, it was statistically signicant (p-0.0001). 3. Inference: IOTA ADNEX MODEL proved to be a useful tool in early detection of adnexal lesions and differentiating them into beningn and malignant groups. The discriminating performance of ovarian tumors with the IOTA-ADNEX model has been better than other existing models. In 2014, ADNEX model was developed. The ADNEX model helps in differentiation of benign from malignant by using 9 predictors, 3 of them are clinical (age, CA 125 and type of centre) and rest 6 are sonographic variables (maximal diameter of lesion, proportion of solid tissue, more than 10 cyst locules, no. of papillary projections, acoustic shadow and ascites. This study aimed to test reliability of these risks prediction models to improve the performance of pelvic ultrasound and discriminate between benign and malignant lesions. Association of results of IOTA ADNEX model with HPE was statistically signicant (p&lt;0.0001)

Long term results of photodynamic therapy in intraocular tumors

PurposeTo report long term results of photodynamic therapy (PDT) as treatment for intraocular tumors MethodsRetrospective interventional case series of 15 patients. All patients treated with standard-fluence PDT (83 s; 50 J/cm2) using verteporfin. Outcome measuresTumor diameter, tumor thickness, subretinal fluid resolution, best-corrected visual acuity,intraocular pressure and PDT complications. Results10 patients (66.7% of total patients) were diagnosed with choroidal hemangioma, 3 patients (20% of total patients) were diagnosed with choroidal melanoma, and 2 patients (13,3% of total patients) were diagnosed with choroidal osteoma.. Mean follow-up time was 33±18 months. The mean visual acuity was determined as 1.29 ± 0.98 logMAR in the examinations just before the PDT application. At the end of the follow-up period, the mean visual acuity was calculated as 1.41 ± 1.07 logMAR. While VA increased in 3 (20%) patients and decreased in 5 (33.3%) patients; It was determined that VA value did not change after treatment in 7 (46.7%) patients. The mean lesion diameter before PDT was 6573 ± 2115 µm (range; 1500–10,000 µm). The mean tumor thickness before PDT was 3624 ± 1404 µm (range; 600–6000 µm). The mean lesion diameter after treatment was 6026 ± 2521 µm (range; 0–9000 µm), and the mean tumor thickness after treatment was 2280 ± 1740 µm (range; 0–6000 µm).After the PDT, tumor size decreased in 8 (53.3%) patients, increased in 3 (20%) patients, and no change in tumor size was observed in 4 (26.7%) patients. Mean IOP values of all patients were 14.06 ± 3.17 mmHg before treatment; after treatment, it was measured as 13.46 ± 1.70 mmHg. After the treatment, geographic atrophy developed in 1 (6.7%) patient, cystoid macular edema developed in 1 (6.7%) patient, Retinal Pigment Epithelium (RPE) and choroidal atrophy developed in 1 (6.7%) patient. ConclusionThere are not enough cases of each to clearly distinguish between these 3 types of ocular cancers.However PDT may be a good option in the treatment of intraocular tumors with the chance of selective treatment and successful response.

ENDOVASCULAR TREATMENT OF AORTIC COARCTATION

Objectives: The aim of this study is to present our center’s experience with the endovascular treatment inaortic coarctation with a follow-up of 10 years. Background: Stent implantation has been evolved as an important therapeutic strategy for coarctation of the aorta. However, available data is frequently flawed by short follow up, retrospective data and disparity in the approach. Methods: Clinical data, imaging studies and angiographic outcomes of 24 patients treated for CoA were reviewed between january 2007 to december2018. We included native diagnosed aortic coarctation (NCO) and recurrent coarctation. Results: There were 57% male patients and 43% female with a mean age of 26+/- 11 years. 90% of patients had NCO and 10% had re-coarctation after surgical repair in childhood (21+/- 4years after initial repair). Endovascular treatment was performed using BMS (PalmazGenesis peripheral stent, Cordis) in 71% of cases. Covered stent (mounted covered CP stent; Numed) was placed in 2 patients. One patient was treated by balloon angioplasty. Acute procedural success had reached 92% in our series with a technical failure in 2 cases. Mean lesion length and diameter were respectively 15,3+/-11,9 mm and 7,2+/- 2,7mm. Mean systolic pressure gradient decreased from 51,4 +/- 20,4 mm Hg to 7,7±10 mmHg (P &lt; 0,05). After a mean follow-up of 60 +/- 38 months, the blood pressure profile was evaluated. the CT scan showed a local aortic wallanevrysms in 1 patient (4.1%). Surgical intervention was needed in 2 patients forrecoarctationand aortic valve replacement. Conclusion: Percutaneous aortic coarctation treatment is effective with an acceptable safety and a good long-termoutcome. Therefore, patients require regular clinical and radiological monitoring tobalance blood pressure, look for local aortic wall complications and assess associated lesions such as aortic bicuspid valve and ascending aorta dimension.

A prospective evaluation of the effect of transanal minimally invasive surgery (TAMIS) on low anterior resection syndrome

PurposeTransanal minimally invasive surgery (TAMIS) is a surgical alternative to transanal endoscopic microsurgery (TEM), transanal excision and proctectomy in the management of benign rectal polyps and early rectal cancers. Low anterior resection syndrome (LARS) describes the constellation of symptoms which result from and are common after distal colorectal resection. Symptoms include incontinence, frequency, urgency and evacuatory dysfunction. The aim of the current study was to prospectively evaluate pre- and post-operative LARS in patients who undergo TAMIS.MethodsWe conducted a prospective analysis of a consecutive series of patients who underwent TAMIS at our institution between January 2021 and February 2022. A LARS questionnaire was undertaken preoperatively, at 1 month and at 6 months post-operatively.ResultsTwenty patients were recruited to this pilot study. The mean age was 63 ± 12 years, 11 of the patients were male, mean pre-operative BMI was 29 ± 6 kg/m2, and 30% (n = 6) of patients underwent TAMIS for an invasive rectal cancer, with all patients receiving an R0 resection. Mean distance from the anal verge was 5.7 ± 3.2 cm, and mean lesion diameter was 46 ± 20.5 mm. A statistically significant interval reduction was observed between preoperative (20.3 ± 12.9) and 6-month post-operative (12.6 ± 9.7) LARS scores (p = 0.02) and also between 1-month (18.2 ± 10.6) and 6-month post-operative scores (p = 0.01).ConclusionsWe noted a high prevalence of LARS across our cohort preoperatively, and this had improved significantly at 6-month review post-TAMIS. This study reaffirms the safety and efficacy of TAMIS for the treatment of early rectal neoplasia.

Surgical approach in liver hemangiomas with special emphasis on lesion diameter and type of surgery: a retrospective cohort of 69 patients

Purpose: Liver hemangioma (LH) being the most common benign tumor of the liver is a rare indication for liver surgery. Indications include symptomatic disease, diagnostic suspicion of malignancy, increase in lesion size, and Kasabach-Merritt syndrome. Surgical treatment mainly consists of enucleation or liver resection (LR). The study aimed to evaluate surgical outcomes in patients with LHs.&#x0D; Methods: In this study, surgical treatment for liver hemangioma in a single center were retrospectively reviewed. Demographics, preoperative and postoperative laboratory values, imaging studies, and follow-up data of patients were collected.&#x0D; Results: The mean age was 51.9±11.0 years and 69.6% were female. Abdominal pain was present preoperatively in 32 (46.4%) cases. Mean lesion diameter was 7.5 (1.2-20) cm. Giant hemangioma was reported in 54 (78.3%) patients. Liver resection (LR) and enucleation were preferred for 37 (53.6%) and 32 (46.4%) patients, respectively. Intraoperative transfusion requirement was more common in enucleation than LRs (78.1% vs. 48.6%, p=0.012). Intraoperative erythrocyte transfusion was more frequently in operations of giant hemangiomas (68.5% vs. 40.0%, p=0.044). Complications were observed more frequently in giant hemangioma group regardless of grades (40.7% vs. 13.3%, p=0.049). Preoperative thrombocytopenia was found more frequent in cases with serious complications (66.7% vs 22.2%, p=0.019).&#x0D; Conclusion: Emerging percutaneous intervention and imaging modalities are expected to decrease number of surgeries for liver hemangiomas. Although enucleation, LR and even liver transplantation are still required for a set of patients. Enucleation and LR have similar outcomes, but transfusions are more common according to the present study. Size of LHs is related with complications and transfusion requirements.