Operator-dependent Procedure Research Articles

Artificial intelligence improves bronchoscopy performance: a randomised crossover trial.

Flexible bronchoscopy is an operator-dependent procedure. An automatic bronchial identification system based on artificial intelligence (AI) could help bronchoscopists to perform more complete and structured procedures through automatic guidance. 101 participants were included from six different continents at the European Respiratory Society annual conference in Milan, 9-13 September 2023. Participants were split into three groups based on experience: novices (0 bronchoscopies), intermediates (1-249 bronchoscopies) and experienced (≥250 bronchoscopies). The participants performed two bronchoscopies on a realistic physical phantom, one with AI (AmbuBronchoSimulatorTrainingGUIDEv.0.0.1, Prototype version, Ambu) and one Standard procedure. The F1-group received AI guidance for their first procedure, the F2-group for their second. A crossover randomisation controlled for learning by testing. All procedures were automatically rated according to the outcome measures: inspected segments, structured progressions and procedure time. AI guidance caused the participants to inspect more segments (mean difference, paired t-test: +6.0 segments, p<0.001), perform more structured progressions (+5.2 progressions, p<0.001) and spend more time on the procedure (+72 s, p<0.001) compared to their standard procedures. The effects of AI guidance on inspected segments and structured progression were highest for novices but significant for all experience groups: novices (+8.2 segments, p=0.012 and +6.6 progressions, p<0.001), intermediates (+5.7 segments, p=0.006 and +5.1 progressions, p<0.001) and experienced (+4.3 segments, p=0.006 and +3.8 progressions, p<0.016). AI guidance helped bronchoscopists of all experience levels to inspect more segments in a more structured order. Clinical implementation of AI guidance could help ensure and document more complete bronchoscopy procedures in the future.

Binary decisions of artificial intelligence to classify third molar development around the legal age thresholds of 14, 16 and 18 years

Third molar development is used for dental age estimation when all the other teeth are fully mature. In most medicolegal facilities, dental age estimation is an operator-dependent procedure. During the examination of unaccompanied and undocumented minors, this procedure may lead to binary decisions around age thresholds of legal interest, namely the ages of 14, 16 and 18 years. This study aimed to test the performance of artificial intelligence to classify individuals below and above the legal age thresholds of 14, 16 and 18 years using third molar development. The sample consisted of 11,640 panoramic radiographs (9680 used for training and 1960 used for validation) of males (n = 5400) and females (n = 6240) between 6 and 22.9 years. Computer-based image annotation was performed with V7 software (V7labs, London, UK). The region of interest was the mandibular left third molar (T38) outlined with a semi-automated contour. DenseNet121 was the Convolutional Neural Network (CNN) of choice and was used with Transfer Learning. After Receiver-operating characteristic curves, the area under the curve (AUC) was 0.87 and 0.86 to classify males and females below and above the age of 14, respectively. For the age threshold of 16, the AUC values were 0.88 (males) and 0.83 (females), while for the age of 18, AUC were 0.94 (males) and 0.83 (females). Specificity rates were always between 0.80 and 0.92. Artificial intelligence was able to classify male and females below and above the legal age thresholds of 14, 16 and 18 years with high accuracy.

Predictability of crowding resolution in clear aligner treatment

BackgroundTo assess the predictability of crowding resolution and the efficacy of different strategies to gain space during clear aligners treatment.MethodsA total of 10 clinicians were randomly recruited using the Doctor Locator by Align Technology (California). For each clinician, four consecutive patients treated with aligners and manual stripping were selected for a total of 40 subjects. Thus, 80 arches were collected and uploaded on the Orthoanalyzer software for arch measurements. The data were gained on the starting arch form (T0), on the virtual arch developed with digital planning (vT1), and on the arch form achieved at the end of the aligner sequences (T1). The following parameters were scored: Little's Irregularity Index, transversal arch diameters, (intercuspid, interpremolar, and intermolar width), incisor position/arch length, and enamel interproximal reduction (IPR).ResultsFor all the measurements, statistically significant differences were found at different stages. The predictability of crowding resolution was very high, ranging from 87% in the upper arch and 81% in the lower one. Among the different strategies to gain space, variations in sagittal incisor position were predictable, with a value of 70% both in the upper and lower arch. Conversely, changes in arch diameters were less reliable varying between 49 and 67% in the lower arch and 59–83% in the upper one. Moreover, IPR was the least accurate procedure, wavering at 49% in the upper arch and 42% in the lower arch.ConclusionsThe predictability of crowding resolution during treatment with aligners was high. However, the virtual arch forms obtained at the end of digital planning (vT1) did not correspond with the arch forms at the end of the aligner sequences (T1). The IPR was the least predictable strategy to gain space, being, perhaps, an operator-dependent procedure.

Fully Automated Regional Analysis of Myocardial T2* Values for Iron Quantification Using Deep Learning

Cardiovascular magnetic resonance (CMR) T2* mapping is the gold standard technique for the assessment of iron overload in the heart. The quantitative analysis of T2* values requires the manual segmentation of T2* images, which is a time-consuming and operator-dependent procedure. This study describes a fully-automated method for the regional analysis of myocardial T2* distribution using a deep convolutional neural network (CNN). A CNN with U-Net architecture was trained to segment multi-echo T2*-weighted images in 16 sectors in accordance with the American Heart Association (AHA) model. We used images from 210 patients (three slices, 10 multi-echo images) with iron overload diseases to train and test the CNN. The performance of the proposed method was quantitatively evaluated on an independent holdout test set by comparing the segmentation accuracy of the CNN and the T2* values obtained by the automated method against ground-truth labels provided by two experts. Segmentation metrics and global and regional T2* values assessed by the proposed DL method closely matched those obtained by experts with excellent intraclass correlation in all myocardial sectors of the AHA model (ICC range [0.944, 0.996]). This method could be effectively adopted in the clinical setting for fast and accurate analysis of myocardial T2*.

O-099 The use of cumulus cells (CCs) to select spermatozoa for intracytoplasmic sperm injection improves blastocyst development and quality

Abstract Study question Is there a role for sperm selection based on the capacity to pass through cumulus oophorous column in improving the laboratory outcomes in ICSI cycles? Summary answer A higher rate of blastocyst formation and quality are obtained with the use of CCs to select spermatozoa for ICSI compared to conventional density gradients. What is known already The sperm selection for ICSI is an operator-dependent procedure based on sperm morphology and motility. ICSI bypasses all natural barriers of sperm selection, which may impact embryo development. During natural fertilization, only the spermatozoa that pass-through cumulus cells will have the chance to fertilize the egg. Spermatozoa capable of traverse COCs have better morphology, higher chromatin integrity and greater acrosomal reaction. Hyaluronic acid is an important component of these cells and plays a key role in the selection of spermatozoa with intact DNA. However, there is scarce data regarding this selection method for ICSI on the development of the embryo. Study design, size, duration This is a prospective randomized sibling oocyte pilot study (February-December 2021). A total of 996 metaphase II (MII) oocytes were randomized into two groups. In the control group (Group 0, n = 489 MII), ICSI was performed with sperm selected by conventional density gradients. In the study group (Group 1, n = 507 MII) the oocytes were microinjected with sperm selected through CCs. The main outcome was blastocyst formation rate and quality. Reproductive results were analyzed as secondary outcomes. Participants/materials, setting, methods Ninety-eight couples undergoing ICSI (private center) with ≥6 fresh own MII obtained after ovarian stimulation, embryo culture until blastocyst stage and ejaculated sperm samples were included in the study. All seminal samples were processed using density gradients and those in the study group were additionally passed through CCs (the patient's own CCs were used in all cases). Fertilization and day 5 blastocyst formation rates were assessed. Embryo quality was scored according to Gardner's criteria. Main results and the role of chance Data was similar with regards to cause of infertility, maternal age (36.47 vs 36.63 y.o.), sperm count (60.53 vs 58.25 mill/ml) and progressive motility (57.45 vs 57.50%) between group 0 vs 1, respectively. Fertilization rate was similar between groups (74.0% vs 78.7%; p = 0.419. Group 0 vs 1, respectively). However, the blastocyst formation rate was significantly higher in the study group compared to control (70.9% vs 60.1%; p = 0.002). In addition, high-quality blastocyst rate was significantly higher in the CCs compared to the control group (49.6% vs 38.5%; p = 0.003). After the analysis of 145 treatments (131 frozen vs 14 fresh transfers) the cumulative clinical pregnancy rate in the study group was 47.2%, higher than in the control group (32.1%), but without reaching statistical difference (p = 0.07). Limitations, reasons for caution This is an exploratory study, aimed to evaluate the effectiveness of CCs as a more “physiologic” selection of spermatozoa for ICSI treatments in terms of laboratory outcomes (blastocyst formation rate and quality). Albeit not reaching statistical significance, the higher cumulative pregnancy rate in the study group seems clinically relevant. Wider implications of the findings Our results suggest that CCs can select more competent sperm for ICSI. This “physiologic-resembling”, operator-independent selection method has the potential of increasing pregnancy outcomes in ICSI cycles, pending of confirmation in larger studies including cumulative embryo-transfer cycles. Trial registration number NA

Validation of a Lab-on-Chip Assay for Measuring Sorafenib Effectiveness on HCC Cell Proliferation.

Hepatocellular carcinoma (HCC) is a highly lethal cancer, and although a few drugs are available for treatment, therapeutic effectiveness is still unsatisfactory. New drugs are urgently needed for hepatocellular carcinoma (HCC) patients. In this context, reliable preclinical assays are of paramount importance to screen the effectiveness of new drugs and, in particular, measure their effects on HCC cell proliferation. However, cell proliferation measurement is a time-consuming and operator-dependent procedure. The aim of this study was to validate an engineered miniaturized on-chip platform for real-time, non-destructive cell proliferation assays and drug screening. The effectiveness of Sorafenib, the first-line drug mainly used for patients with advanced HCC, was tested in parallel, comparing the gold standard 96-well-plate assay and our new lab-on-chip platform. Results from the lab-on-chip are consistent in intra-assay replicates and comparable to the output of standard crystal violet proliferation assays for assessing Sorafenib effectiveness on HCC cell proliferation. The miniaturized platform presents several advantages in terms of lesser reagents consumption, operator time, and costs, as well as overcoming a number of technical and operator-dependent pitfalls. Moreover, the number of cells required is lower, a relevant issue when primary cell cultures are used. In conclusion, the availability of inexpensive on-chip assays can speed up drug development, especially by using patient-derived samples to take into account disease heterogeneity and patient-specific characteristics.

EVAR-eaSE: An Easy-to-Use Software for Planning Sac Embolization in EndoVascular Aneurysm Repair Procedure

Background: Endovascular aneurysm repair (EVAR) has become the primary choice of treatment for abdominal aortic aneurysm (AAA) and preventive intraoperative AAA sac embolization (SE) is an effective way to reduce endoleaks after EVAR. Preoperative planning of AAA SE has not been standardized yet, and typically requires a quite long and operator-dependent procedure using standard EVAR planning software. Methods: We introduce ‘EVAR-eaSE’, a software tool that we have developed to help vascular surgeons to plan the optimal SE procedure during EVAR, providing semi-automatic AAA segmentation and 3D modeling starting from patient scans, and then computing the aneurysm volumes. A preliminary accuracy evaluation on radiological phantoms, and a comparison with the commercial 3Mensio software for EVAR planning are carried out. Results: EVAR-eaSE software showed a good level of accuracy in aneurysm volume reconstruction and calculation (mean difference of 2.5% between real and segmented phantom volumes). A strong positive correlation (r = 0.940, r = 0.954, p &lt; 0.001) was found between EVAR-eaSE computation of AAA Lumen and AAA Total volumes and the same measurements obtained with 3Mensio, for a database of 26 AAA cases. Conclusions: EVAR-eaSE demonstrated to be an easy-to-use, objective and accurate tool to assist the vascular surgeons in preoperative planning of SE during EVAR.

Quality indicators in diagnostic upper gastrointestinal endoscopy.

Upper gastrointestinal (UGI) endoscopy contributes a major clinical service with consistently growing demand around the world. Its utility corresponds to varying epidemiological issues throughout the globe, with cancer screening and surveillance being of the utmost priority. Despite high accuracy in neoplasia detection, UGI endoscopy remains a highly operator-dependent procedure, characterized by a substantial rate of missed pathology. Despite an overall lack of high-quality performance measures, there is an increased level of awareness about the need for quality control of this procedure, which is reflected in several guidelines and position statements published in recent years. It is widely recognized that quality assessment should go beyond mere technical aspects of the examination, and include both pre- and post-procedural factors. By this means, quality control encompasses the entire patient experience with the health care provider, from appropriate indication and physical assessment, through high-quality endoscopy service, to appropriate follow up and patient satisfaction. This article aims to review the available and emerging quality metrics for UGI endoscopy, taken mostly from Western endoscopy societies, with references to Asian recommendations where appropriate. The paper is limited solely to diagnostic UGI endoscopy and does not include performance measures for therapeutic procedures.

Quality in endoscopy training-the endoscopic retrograde cholangiopancreatography case.

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most advanced therapeutic procedures in gastrointestinal endoscopy. It is highly operator-dependent procedure requiring specific, knowledge-based training in order to achieve competence. Strategies for assessing competency of trainees and those in practice include numbers of procedures performed, and subjective or objective assessment by a mentor or self-assessment by the trainee. However, it is still not clear how to measure the quality in (ERCP) training in an objective and reproducible way, so far. Thus, in this article, we will discuss issues related to training in ERCP and provide experience based discussion on how to best approach and master this complex and risky procedure.

Automated Prostate Gland Segmentation Based on an Unsupervised Fuzzy C-Means Clustering Technique Using Multispectral T1w and T2w MR Imaging

Prostate imaging analysis is difficult in diagnosis, therapy, and staging of prostate cancer. In clinical practice, Magnetic Resonance Imaging (MRI) is increasingly used thanks to its morphologic and functional capabilities. However, manual detection and delineation of prostate gland on multispectral MRI data is currently a time-expensive and operator-dependent procedure. Efficient computer-assisted segmentation approaches are not yet able to address these issues, but rather have the potential to do so. In this paper, a novel automatic prostate MR image segmentation method based on the Fuzzy C-Means (FCM) clustering algorithm, which enables multispectral T1-weighted (T1w) and T2-weighted (T2w) MRI anatomical data processing, is proposed. This approach, using an unsupervised Machine Learning technique, helps to segment the prostate gland effectively. A total of 21 patients with suspicion of prostate cancer were enrolled in this study. Volume-based metrics, spatial overlap-based metrics and spatial distance-based metrics were used to quantitatively evaluate the accuracy of the obtained segmentation results with respect to the gold-standard boundaries delineated manually by an expert radiologist. The proposed multispectral segmentation method was compared with the same processing pipeline applied on either T2w or T1w MR images alone. The multispectral approach considerably outperforms the monoparametric ones, achieving an average Dice Similarity Coefficient 90.77 ± 1.75, with respect to 81.90 ± 6.49 and 82.55 ± 4.93 by processing T2w and T1w imaging alone, respectively. Combining T2w and T1w MR image structural information significantly enhances prostate gland segmentation by exploiting the uniform gray appearance of the prostate on T1w MRI.

Cumulative summation test for learning curve (LC-CUSUM) in outpatient hysteroscopy.

Outpatient hysteroscopy has become an integral part of postgraduate training in gynecology. It is an operator-dependent procedure, however there are no recommendations regarding total number of performed procedures to reach proficiency. This study aimed to assess the learning curve (LC) using cumulative summation test for learning curve (LC-CUSUM). A success rate of 97% a failure rate ≥ 10% were established to denote an adequate and an inadequate performance. A third-year trainee needed 56 procedures to reach the predefined level of performance. As the length of the LC for outpatient hysteroscopy seems highly variable, it is reasonable to provide tailored monitoring while training.

Trends in Fluoroscopy Time in Fluoroscopy-Guided Lumbar Punctures Performed by Trainees Over an Academic Year

Fluoroscopy-guided lumbar puncture (FGLP) is an operator-dependent procedure that can contribute to lifetime cumulative radiation dose. Benchmark fluoroscopic times (FTs) have been published for ranges of body mass index (BMI), but trends in FT in FGLPs performed by neuroradiology trainees during their training have not been studied. The purpose of this study was to investigate the trends in FTs in FGLPs performed by neuroradiology fellows in an academic year. We retrospectively reviewed FGLPs performed at our institution from July 2013 to June 2015 and determined the FT average and standard deviation of residents and non-neuroradiology fellows, neuroradiology fellows, and neuroradiology attendings. We used the Kruskal-Wallis test to evaluate group differences in FT in operator groups and academic quarters and by patient age, BMI, and needle length. Linear and Poisson regression analyses were performed to directly examine the relationship between the number of FGLPs performed and FTs. A total of 776 patients had successful FGLPs; 594 cases (77%) were performed by neuroradiology fellows (n = 14). The average FT and variance for neuroradiology fellows significantly decreased over the year (P = 0.004 and P < 0.001) with an estimated decrease of 0.01 minute of FT per FGLP. BMI, long needle length, and age ≥65 years old significantly affected the average FT (P = 0.03, P < 0.001, and P < 0.001) and FT decreased in all of these subgroups in the academic year. FT in FGLP cases performed by neuroradiology fellows decreases during the year. Our data can be utilized by radiology training programs and practices as a benchmark to monitor individual operator FT.

An Automatic Gastrointestinal Polyp Detection System in Video Endoscopy Using Fusion of Color Wavelet and Convolutional Neural Network Features.

Gastrointestinal polyps are considered to be the precursors of cancer development in most of the cases. Therefore, early detection and removal of polyps can reduce the possibility of cancer. Video endoscopy is the most used diagnostic modality for gastrointestinal polyps. But, because it is an operator dependent procedure, several human factors can lead to misdetection of polyps. Computer aided polyp detection can reduce polyp miss detection rate and assists doctors in finding the most important regions to pay attention to. In this paper, an automatic system has been proposed as a support to gastrointestinal polyp detection. This system captures the video streams from endoscopic video and, in the output, it shows the identified polyps. Color wavelet (CW) features and convolutional neural network (CNN) features of video frames are extracted and combined together which are used to train a linear support vector machine (SVM). Evaluations on standard public databases show that the proposed system outperforms the state-of-the-art methods, gaining accuracy of 98.65%, sensitivity of 98.79%, and specificity of 98.52%.

Abstract PL02-01: Stool DNA detection of colorectal neoplasia: A new high bar for noninvasive screening

Abstract PL02-01: Stool DNA detection of colorectal neoplasia: A new high bar for noninvasive screening

MP11-06 RESULTS OF TARGETED BIOPSY WITH REAL-TIME BALLOON INFLATION ELASTOGRAPHY OF PROSTATE.

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 2015MP11-06 RESULTS OF TARGETED BIOPSY WITH REAL-TIME BALLOON INFLATION ELASTOGRAPHY OF PROSTATE. Masahiro Sumura, Kouhei Ogawa, Taichi Nagami, Haruki Anjiki, Chiaki Koike, Naoko Arichi, Yozo Mitsui, Shigenobu Nakamura, Takeo Hiraoka, Hiroaki Yasumoto, Shinji Hara, Takeshi Yoshizako, and Hiroaki Shiina Masahiro SumuraMasahiro Sumura More articles by this author , Kouhei OgawaKouhei Ogawa More articles by this author , Taichi NagamiTaichi Nagami More articles by this author , Haruki AnjikiHaruki Anjiki More articles by this author , Chiaki KoikeChiaki Koike More articles by this author , Naoko ArichiNaoko Arichi More articles by this author , Yozo MitsuiYozo Mitsui More articles by this author , Shigenobu NakamuraShigenobu Nakamura More articles by this author , Takeo HiraokaTakeo Hiraoka More articles by this author , Hiroaki YasumotoHiroaki Yasumoto More articles by this author , Shinji HaraShinji Hara More articles by this author , Takeshi YoshizakoTakeshi Yoshizako More articles by this author , and Hiroaki ShiinaHiroaki Shiina More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.387AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Efficacy in the prostate cancer detection of real-time tissue elastogarpahy (RTE) has been reported. But RTE has a major problem that RTE is highly operator dependent procedure. We hypothesized that the pressure device might decrease the operator dependency and increase the prostate cancer detection rate of RTE. The pressure device run with water pressure was developed for this study, called this procedure real-time balloon inflation elastography (RBIE). The results of targeted prostate biopsy with RBIE was studied for detection of prostate cancer. METHODS 233 patients and 1978 were enrolled in this study with abnormal findings of digital rectal examination (DRE), PSA and/ or TRUS. Median age was 73 year-old (range 54–89), median PSA was 7.6 ng/mL (range 0.8-2606.0), and median number of biopsy cores taken on each patient was 8 (range 8–10). All of 233 patients were examined with MRI prior to prostate needle biopsy. A total of 1978 specimens obtained by systemic biopsy were studied. The findings of RBIE, RTE, TRUS, PDUS and MRI (T2WI, dynamic contrast enhanced images (DCEI) and diffusion weighted image (DWI)) were compared to the histopathological findings of biopsy specimens. RESULTS The prostate cancer was detected in 113 of 233 patients (48.5%), and 412 of 1978 specimens (20.8%). Gleason score of 5 to 6, 7 and 8 to 10 tumors was 110, 166 and 138 specimens respectively. Clinical stages of T1c, T2a-c, T3a-b, and T4 were 20, 60, 22 and 11 cases. The sensitivity of RBIE, RTE, TRUS, PDUS, T2WI, DCEI and DWI were 72.1%, 72.1%, 74.5%, 72.8%, 78.2%, 77.2% and 77.2%, the specificity were 94.3%, 93.6%, 85.4% 90.5%, 92.0%, 93.7% and 92.6%, respectively. Both of the sensitivity and the specificity of RBIE were not significantly inferior to those of MRI. The results of targeted biopsy (PPV) of RBIE, RTE, TRUS, PDUS, T2WI, DCEI and DWI were 76.7%, 74.8%, 57.4%, 67.0%, 72.0%, 76.4% and 73.3%. PPV of RBIE was also comparable to those of MRI. CONCLUSIONS RBIE was low cost and low invasive procedure. The prostate cancer detection capability of RBIE might be not inferior to that of MRI, expensive and time consuming procedure. Furthermore, RBIE reveals prostate in real-time, so RBIE could enhance the prostate cancer detection as a biopsy guidance image. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e121 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masahiro Sumura More articles by this author Kouhei Ogawa More articles by this author Taichi Nagami More articles by this author Haruki Anjiki More articles by this author Chiaki Koike More articles by this author Naoko Arichi More articles by this author Yozo Mitsui More articles by this author Shigenobu Nakamura More articles by this author Takeo Hiraoka More articles by this author Hiroaki Yasumoto More articles by this author Shinji Hara More articles by this author Takeshi Yoshizako More articles by this author Hiroaki Shiina More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Learning curve for EUS in gastric cancer T staging by using cumulative sum analysis

EUS is an operator-dependent procedure and requires more technical and cognitive skills than a routine endoscopic procedure. The learning curve for the staging of gastric cancer, however, has not been evaluated. To evaluate the threshold number of EUS examinations for gastric cancer T staging. Retrospective study. University-affiliated tertiary care hospital in the Republic of Korea. Four trainees with no previous EUS experience. Analyzing performance of EUS trainees in gastric cancer T staging by using cumulative sum (CUSUM) analysis. CUSUM plot and a minimal number of procedures for reaching a plateau. A total of 553 initial EUS examinations for treatment-naïve gastric cancers, performed by trainees, were enrolled in the study. The final T stage was determined by experts by using EUS in 332 gastric cancer cases, whereas the Tstage of the other 221 lesions was determined by trainees by using EUS. The accuracy of EUS examinations performed by trainees and experts was 72.6% and 84.3%, respectively. The number of EUS examinations required to reach the first plateau in each trainee was 20, 41, 60, and65. Retrospective study with a relatively small number of trainees. The CUSUM scores of all of 4 trainees in the study reached a plateau by the 65th examination.

Operator dependent choice of prostate cancer biopsy has limited impact on a gene signature analysis for the highly expressed genes IGFBP3 and F3 in prostate cancer epithelial cells.

BackgroundPredicting the prognosis of prostate cancer disease through gene expression analysis is receiving increasing interest. In many cases, such analyses are based on formalin-fixed, paraffin embedded (FFPE) core needle biopsy material on which Gleason grading for diagnosis has been conducted. Since each patient typically has multiple biopsy samples, and since Gleason grading is an operator dependent procedure known to be difficult, the impact of the operator's choice of biopsy was evaluated.MethodsMultiple biopsy samples from 43 patients were evaluated using a previously reported gene signature of IGFBP3, F3 and VGLL3 with potential prognostic value in estimating overall survival at diagnosis of prostate cancer. A four multiplex one-step qRT-PCR test kit, designed and optimized for measuring the signature in FFPE core needle biopsy samples was used. Concordance of gene expression levels between primary and secondary Gleason tumor patterns, as well as benign tissue specimens, was analyzed.ResultsThe gene expression levels of IGFBP3 and F3 in prostate cancer epithelial cell-containing tissue representing the primary and secondary Gleason patterns were high and consistent, while the low expressed VGLL3 showed more variation in its expression levels.ConclusionThe assessment of IGFBP3 and F3 gene expression levels in prostate cancer tissue is independent of Gleason patterns, meaning that the impact of operator's choice of biopsy is low.

Tu1324 Automated, Real-Time Feedback During Colonoscopy Improves Endoscopist Technique As Intended: a Controlled Clinical Trial

Colonoscopy is an operator-dependent procedure. Sub-optimal technique is considered an important reason for development of interval colorectal cancer. Efforts to improve quality of colonoscopy by changing endoscopist technique have been mostly unsuccessful.

Effect of the time of day on the success and adverse events of ERCP

Physician fatigue and decreased concentration have been proposed as causes of lower completion and adenoma detection rates in afternoon colonoscopies compared with morning colonoscopies. ERCP is a technically demanding and highly operator-dependent procedure, and its success may similarly be affected in the afternoon compared with the morning. To compare cannulation success and adverse events between ERCP procedures performed in the morning and afternoon. Retrospective cohort study. Tertiary referral center. Patients with no previous papillary intervention who underwent ERCP at our institution between November 2006 and November 2008. Cannulation success, procedure completion rates, length of procedures, and adverse events. A total of 296 patients were studied; 114 patients (38.5%) underwent a procedure in the morning and 182 patients (61.5%) underwent a procedure in the afternoon. There were 139 male patients (47.0%). The mean patient age was 59.1 years. The deep cannulation success rate was 95.3% overall, with similar rates when performed in the morning (98.3%) and afternoon (94.0%) (P = .08). When the start time was evaluated as a continuous hour-by-hour variable, there was also no significant difference in deep cannulation success rates (P = .30). Procedure completion rates were similar in both groups (morning, 93.9%; 94.0%, afternoon; P = .97). Adverse events (8.8% for morning procedures vs 7.1% for afternoon procedures, P = .61) and length of procedures (40 minutes for morning procedures vs 40 minutes for afternoon procedures, P = .87) were also similar between the 2 groups. Small sample size and retrospective study. The timing of ERCP, morning versus afternoon, does not seem to affect cannulation success, procedure completion rates, length of procedures, or adverse events.

T1484: Interobserver Agreement on the Echosonographic Features of Lymph Nodes in Pulmonary, Esophageal and Pancreatic Nodal Malignancies

Endoscopic ultrasound (EUS) is used to locally stage gastrointestinal (GI) and pulmonary malignancies. Endosonographic features are used to predict a malignant lymph node (MLN) and to select lymph nodes appropriate for fine needle aspiration. Given the large number of lymph nodes, both benign and malignant, seen by EUS, and the fact that EUS is an operator-dependent procedure, methods to improve selection criteria, and assess interobserver agreement are needed. The aim of this study was to evaluate the interobserver agreement among expert endosonographers on the EUS features of MLN in upper aerodigestive malignancies.