Pathologic Size Research Articles

Primary Retroperitoneal Lymph Node Dissection for Seminoma Metastatic to the Retroperitoneum.

Primary surgical treatment with retroperitoneal lymph node dissection aims to accurately stage and treat patients with node-positive pure seminoma while avoiding long-term risks of chemotherapy or radiation, traditional standard-of-care treatments. We reported the pathologic and oncologic outcomes of patients with pure seminoma treated with primary retroperitoneal lymph node dissection in a retrospective, single-institution case series over 10 years. The primary outcome was 2-year recurrence-free survival stratified by adjuvant management strategy (surveillance vs adjuvant chemotherapy). Forty-five patients treated with primary retroperitoneal lymph node dissection for pure testicular seminoma metastatic to the retroperitoneum were identified. Median size of largest lymph node before surgery was 1.8 cm. Viable germ cell tumor, all of which was pure seminoma, was found in 96% (n=43) of patients. The median number of positive nodes and nodes removed was 2 and 54, respectively. Median positive pathologic node size was 2 cm (IQR 1.4-2.5 cm, range 0.1-5 cm). Four of 29 patients managed with postoperative surveillance experienced relapse; 2-year recurrence-free survival was 81%. Median follow-up for those managed with surveillance who did not relapse was 18.5 months. There were no relapses in the retroperitoneum, visceral recurrences, or deaths. Among the 16 patients who received adjuvant treatment, 1 patient experienced relapse in the pelvis at 19 months. Primary retroperitoneal lymph node dissection for pure seminoma with low-volume metastases to the retroperitoneum is safe and effective, allowing most patients to avoid long-term toxicities from chemotherapy or radiation.

Value of mammographic microcalcifications and MRI-enhanced lesions in the evaluation of residual disease after neoadjuvant therapy for breast cancer.

Microcalcifications persist even if a patient with breast cancer achieves pathologic complete response (pCR) as confirmed by surgery after neoadjuvant treatment (NAT). In practice, surgeons tend to remove all the microcalcifications. This study aimed to explore the correlation between changes in the extent of microcalcification after NAT and pathological tumor response and compare the accuracy of mammography (MG) and magnetic resonance imaging (MRI) in predicting the size of residual tumors. This was a retrospective study which included a consecutive series of patients in Guangdong Provincial People's Hospital. Between January 2010 and January 2020, 127 patients with breast cancer and Breast Imaging Reporting and Data System (BI-RADS) 4-5 microcalcifications were included in this study. The maximum diameter of the microcalcifications on MG and lesion enhancement on MRI pre- and post-NAT were measured. The correlations between the changes in residual microcalcifications on MG and pCR were analyzed. Intraclass correlation coefficients (ICCs) were computed between the extent of the residual microcalcifications, residual enhancement, and residual tumor size. There were no statistically significant differences in the changes in microcalcifications after NAT according to the RECIST criteria on MRI (P=0.09) and Miller-Payne grade (P=0.14). MRI showed a higher agreement than did residual microcalcifications on MG in predicting residual tumor size (ICC: 0.771 vs. 0.097). MRI is more accurate for evaluating residual tumor size in breast cancer. In our study, the extent of microcalcifications on MG after NAT had nearly no correlation with the pathological size of the residual tumor. Therefore, residual tumors with microcalcifications may not necessarily be a contraindication to breast-conserving surgery.

The Role of MRI in Assessing Residual Breast Cancer After Neoadjuvant Chemotherapy.

Breast cancer is the most common malignancy among women in the world. The role of neoadjuvant chemotherapy (NAC) in the management of breast cancer is increasing. The decision about the management after NAC depends mainly on the tumor response to NAC. The role of the current study is to evaluate the role of the MRI scan in assessing the residual disease after NAC, which would help in decision making regarding the best treatment plan for the patient. We did this retrospective review for all patients who were diagnosed with breast cancer in our center and had NAC over four years. All patients in our study had a post-NAC magnetic resonance imaging (MRI) scan to assess the residual tumor size. A 2×2 table was used to calculate the diagnostic accuracy, and SPSS software version 25 was used to get the correlation coefficients between the post-NAC MRI measurements and pathological size. 28 female patients were included in our study. The average age was 45.25 ± 10years. We utilized the tumor size on histology as the standard for comparison. We calculated MRI sensitivity, specificity, PPV, and NPV rates of 90.9%, 100%, 100%, and 94.4%, respectively. The correlation coefficient was strong (r = 0.859, P = 0.01). Magnetic resonance imaging is a good test to assess the residual tumor disease after NAC in breast cancer patients. However, cases of under- and overestimation are still seen, which require more caution when making a decision regarding the management of such cases.

The Correlation of Thyroid Hormone Levels and Anti-Thyroidal Drugs on Thyroid Size, Weight, and Ease of Surgical Dissection for Thyroidectomy for Graves' Disease.

Patients with Graves' Disease often have a larger thyroid size than patients without thyroid disease. These patients also have elevated T3 and T4 with decreased TSH. We evaluate whether these thyroid labs, the use of antithyroid agents, or the size of a thyroid on ultrasound, correlate with the pathological size of a thyroid in patients who undergo total thyroidectomy for Graves' Disease. We further determine whether these parameters affect perioperative complications. A retrospective review of patients undergoing total thyroidectomy for Graves' Disease was performed from January 2004 to December 2016 in a single institution. 392 patients were included in the study. Univariate analyses were performed to compare thyroid size on US and pathology as well as weight to preoperative thyroid hormone values and medical comorbidities. Spearman rank correlation and ANOVA were used to identify factors associated with thyroid weight, total pathology size, and differences in size. Multivariate analysis was also performed to evaluate for correlation between thyroid function and perioperative complications. We found that elevated pre-operative T3 levels were associated with larger pathologic size (P = .027) and a greater difference in pathology vs. US thyroid volumes (P = .005), but not increased thyroid weight (P = .286). No significant differences were found for thyroid weight, pathology size, or difference in size for TSH, T4, or any specific preoperative ATD given. Only postoperative calcium levels were found to be statistically significant for TSH < 0.27 (P = .024) for peri-operative complications. These findings may allow for more accurate preoperative planning and intraoperative expectations in patients with Graves' Disease.

Voiding efficiency in children is significantly impaired by the presence of the urethral catheter during pressure-flow studies

Little is known about the effect of catheterization during pressure-flow studies (PFS) on voiding efficiency in children. Our objective was to determine the effect of urethral catheterization on Qmax and flow index (FI) during PFS compared to the free flow of uroflowmetry (UF). We retrospectively reviewed 63 consecutive children who underwent UF and PFS at our center on the same day (2019-2022). Voiding data was available for 46 patients. Patients first underwent a UF with full bladder, then PFS after urethral catheter insertion. Patients with urethral pathologies (n=6), on clean intermittent catheterization (CIC) (n=2) and with major comorbidities (n=2) were excluded. Indications for UF/PFS were LUTS, recurrent UTIs, incontinence or neurosurgical pre-operative evaluation. Data was collected from the UF and the PFS and compared using paired t-test. The idealized Qmax and flow index (FI) were calculated for UF and PFS using the formulas described by Franco etal.: Male Qmax=11.26+0.0701(TBC [total bladder capacity])-0.0000513(TBC); Female Qmax=10.723+0.073(TBC)-0.0000423(TBC), FI=Actual Qmax/Expected Qmax (Franco and etal., 2016; Franco etal., 2018; Franco and etal., 2016). Median age was 7 years old (IQR 5-11). Twenty-one (40%) patients were male and 32 (60%) patients were female. Of the 53 patients, 3 boys and 4 girls (n=7; 13%) were unable to void with the catheter in place during PFS but able to void after its removal. Of the remaining 46 cases, the Qmax during PFS was 5mL/s slower than the Qmax recorded on the UF without catheter, representing a decrease of 29% (12.3 vs 17.3mL/s; p<0.0001). The impact of urethral catheter during PFS was more important in males vs females (Qmax decreased by 7.7 vs 3.3mL/s, or 45 vs 19%). The mean FI during PFS was 44%, which was a 30% reduction compared to the 74% FI obtained with UF (p<0.00001). In males, the FI decreased by 37% on PFS, whereas it decreased 26% in females, similar to the Qmax decrease. Voiding efficiency, as assessed by Qmax and FI, is decreased during PFS compared to uroflow studies. Our data documents for the first time the impact of urethral catheterization on pediatric voiding efficiency. Abnormal flow rates and elevated PVRs should be used to guide patient management only if obtained by uroflow. Prospective validation comparing free flow with PFS studies will help characterize the impact of urethral catheter relative to bladder pathology, age, gender and catheter size used.

Endoscopic ultrasound-guided versus percutaneous drainage for the management of post-operative fluid collections after distal pancreatectomy.

Post-operative pancreatic fluid collections (POPFCs) can be drained using percutaneous or endoscopic approaches. The primary aim of this study was to compare rates of clinical success between endoscopic ultrasound-guided drainage (EUSD) with percutaneous drainage (PTD) in the management of symptomatic POPFCs after distal pancreatectomy. Secondary outcomes included technical success, total number of interventions, time to resolution, rates of adverse events (AEs), and POPFC recurrence. Adults who underwent distal pancreatectomy from January 2012 to August 2021 and developed symptomatic POPFC in the resection bed were retrospectively identified from a single academic center database. Demographic data, procedural data, and clinical outcomes were abstracted. Clinical success was defined as symptomatic improvement and radiographic resolution without requiring an alternate drainage modality. Quantitative variables were compared using a two-tailed t-test and categorical data were compared using Chi-squared or Fisher's exact tests. Of 1046 patients that underwent distal pancreatectomy, 217 met study inclusion criteria (median age 60years, 51.2% female), of whom 106 underwent EUSD and 111 PTD. There were no significant differences in baseline pathology and POPFC size. PTD was generally performed earlier after surgery (10 vs. 27days; p < 0.001) and more commonly in the inpatient setting (82.9% vs. 49.1%; p < 0.001). EUSD was associated with a significantly higher rate of clinical success (92.5% vs. 76.6%; p = 0.001), fewer median number of interventions (2 vs. 4; p < 0.001), and lower rate of POPFC recurrence (7.6% vs. 20.7%; p = 0.007). AEs were similar between EUSD (10.4%) and PTD (6.3%, p = 0.28), with approximately one-third of EUSD AEs due to stent migration. In patients with POPFCs after distal pancreatectomy, delayed drainage with EUSD was associated with higher rates of clinical success, fewer interventions, and lower rates of recurrence than earlier drainage with PTD.

Neoadjuvant endocrine therapy for early-stage breast cancer: An institutional experience during the COVID19 pandemic.

e12625 Background: Neoadjuvant Endocrine therapy (NET) is under-utilized for locally advanced hormone receptor + breast cancer (BC) despite literature to date concluding that chemotherapy and NET have comparable response rates but with lower toxicity for the latter. The COVID19 pandemic presented a unique occasion to extend the use of NET for localized BC. Many surgical procedures across the country, including at Dartmouth-Hitchcock Medical Center (DHMC) were postponed in order to redirect resources. The American Society of Breast Surgeons released guidelines to manage patients in which surgery was delayed. For Estrogen Receptor + (ER+), HER2- early-stage tumors, the guidelines recommended NET as first-line treatment. Herein we review the rate of adoption of NET and patient/tumor characteristics associated with NET adoption at DHMC during the lockdown. Methods: A Retrospective analysis of patients diagnosed with early-stage ER+, HER2- BC between December 2019 and June 2020. Inclusion criteria included patients with non-metastatic hormone receptor + BC. Data extracted from chart review included age, menopausal status, tumor stage/grade, body mass index (BMI). A delay in surgery was defined as days between surgical consult and surgery over 14 days. Descriptive statistics will be applied to data collected on patient/tumor characteristics, and the number of patients accepting or declining NET. Results: 109 cases were identified within the study period with 42 cases designated as experiencing delays in surgery. The median age of the group (n = 42) was 62 and the majority was post-menopausal. 36 patients received NET with most started on an aromatase inhibitor. Median BMI was 28.5. Median duration of treatment was 39.5 days. Tumor response to NET was not clearly described in the pathology reports. Three cases were noted to have some decrease in cellularity for pathologic partial response and four had no definite response. Imaging modalities were compared to pathology size and MRI was found to be a fair predictor of size obtained from pathology specimens with a correlation metric of 0.78 indicating that it may serve as the best proxy for pre-treatment size. Pre-surgical MRIs were obtained in 51.3% of cases. The majority of patients on NET had no change in the grade of their pathology. During the course of the pandemic long-term adherence of adjuvant endocrine therapy decreased from 78% for those diagnosed in early 2020 to 56% for those diagnosed in late 2020. Conclusions: The COVID19 crisis was an unprecedented challenge to healthcare systems. Delays in surgery resulted in increased use of NET in early-stage BC. We plan to integrate other data including impact of NET on long-term adherence to endocrine therapy. Change in clinical vs pathologic stage will be reported for those with or without NET. This experience may help guide care during healthcare crises or in resources limited settings.

Pathologic Tumor Size versus Mammography, Sonography, and MRI in Breast Cancer Based on Pathologic Subtypes

The standard of care for imaging of breast pathology has historically been mammography and sonography. MRI is a modern adjunct in the surgeon's toolkit. We looked to examine the differences in imaging modalities and their ability to predict the size in relation to the pathologic size after excision with focus on pathologic subtypes. We analyzed patient records across a 4-year period from 2017 to 2021 who were treated surgically for breast cancer at our facility. We used a retrospective chart review to collect measurements that were recorded of the tumors by the radiologist for available mammography, ultrasound, and MRI which were compared to pathology report measurements of the final specimens. We subdivided the results by pathologic subtypes including invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), and ductal carcinoma in situ (DCIS). 658 total patients met criteria for analysis. Mammography overestimated specimens with DCIS by 1.93mm (P = .15), US underestimated by .56 (.55), and MRI overestimated by 5.77mm (P < .01). There was no statistically significant difference in any modalities with IDC. With specimens of ILC, all 3 imaging modalities underestimated tumor size, with only US being significant. Mammography and MRI consistently overestimated tumor size with the exception of ILC while US underestimated tumor size on all pathologic subtypes. MRI significantly overestimated tumor size in DCIS by 5.77mm. Mammography was the most accurate imaging modality for all pathologic subtypes and never had a statistically significant difference from actual tumor size.

Prognostic impact of noninvasive areas in resected pathological stage IA lung adenocarcinoma.

In non-small-cell lung cancer, ground-glass opacity on computed tomography imaging reflects pathological noninvasiveness and is a favorable prognostic factor. However, the significance of pathological noninvasive areas (NIAs) has not been fully revealed. In this study, we aimed to elucidate the prognostic impact of NIAs on lung adenocarcinoma. We analyzed 402 patients with pathological stage (p-Stage) IA lung adenocarcinoma who underwent surgery in 2013-2016 at two institutions and examined the association of the presence of NIAs with clinicopathological factors and prognosis. Furthermore, after using propensity-score matching to adjust for clinicopathological factors, such as age, sex, smoking history, pathological invasive area size, pathological T factor (p-T), p-Stage, and histological subtype (lepidic predominant adenocarcinoma [LPA] or non-LPA), the prognostic impact of NIAs was evaluated. Patients were divided into NIA-present (N = 231) and NIA-absent (N = 171) groups. Multivariable analysis showed that NIA-present was strongly associated with earlier p-T, earlier p-Stage, LPA, and epidermal growth factor receptor mutation. Kaplan-Meier survival analysis showed that the NIA-present group displayed a better prognosis than the NIA-absent group in disease-free survival (DFS) and overall survival (OS) (5-year DFS 94.6% vs. 87.2%, 5-year OS 97.2% vs. 91.1%). However, after adjusting for clinicopathological factors by propensity score matching, no significant differences in prognosis were identified between the NIA-present and NIA-absent groups (5-year DFS 92.4% vs 89.6%, 5-year OS 95.6% vs 94.3%). Our current study suggests that the prognostic impact of the presence of NIAs on lung adenocarcinoma is due to differences in clinicopathological factors.

Safety and effectiveness of laparoscopic appendectomy in patients undergoing abdominal surgery

Abstract Background Although laparoscopic appendectomy is the criterion-standard treatment method for acute appendicitis, the decision on laparoscopic or conventional technique is usually made according to individual perspectives. The reasons affecting this individual point of view include whether the disease is complicated, the infrastructure of the hospital, the patient's comorbid factors, and previous intra-abdominal operations. This cross-sectional retrospective study aimed to evaluate the safety of laparoscopic appendectomy in patients with a possible diagnosis of “appendicitis” in patients who had undergone previous abdominal surgery. Methods Patients who were operated on with the diagnosis of acute appendicitis in our clinic between March 2021 and March 2022 were retrospectively analyzed. Patients were grouped as those with a history of abdominal surgery (group 1) and without (group 2). In addition, demographic data of the patients (age, sex), body mass index, presence of comorbid disease, history of abdominal surgery, operation time, rate of conversion to open surgery, postoperative hospital stay, complications, and radiological and pathological appendix size were recorded. Results A total of 181 patients were included in the study. The mean age was 32.51 ± 15.89 years. Seventy (38.7%) of the patients were female, and 111 (61.3%) were male. Thirty-four patients (18.8%) were in group 1, and 111 patients (81.2%) were in group 2. The mean age, body mass index, and operation time in group 1 were statistically higher than in group 2 (P &lt; 0.001). However, there was no difference between the groups regarding postoperative hospital stay, radiological and pathological appendix size, conversion to open surgery, and presence and severity of complications (P &gt; 0.05). Conclusion In line with the data the authors have shown in their study, a laparoscopic appendectomy can be performed safely in patients who have undergone abdominal surgery. Therefore, surgeons should not stray from a laparoscopic appendectomy when they see an abdominal incision.

Predictive value of pathological carcinoma size in patients with T2 glottic laryngeal squamous cell carcinoma

Background T2N0M0 glottic laryngeal squamous cell carcinoma (LSCC) is a common type of laryngeal cancer. Objectives The objective of this research was to assess the predictive value of tumor size for the rates of overall survival (OS) and disease-free survival (DFS) as determined by postoperative pathological examination in patients with T2 LSCC. Methods A retrospective study was conducted on 535 successive patients with T2 glottic LSCC who underwent operation from 2005 to 2010. The effect of tumor size on OS and DFS results was evaluated by the affected area. Results Of the cohort, 528 (98.7%) were male, and 7 (1.3%) were female, with an average age of 60.1 ± 9.4 years. The 10-year DFS and OS rates were 72.1% and 76.3%, respectively. The tumor diameter and area cut-off values that best discriminated OS and DFS rates were 1.35 cm and 1 cm2, respectively. Patients with glottis carcinoma with a longer tumor diameter and larger tumor area had inferior OS and DFS rates. Tumor diameter and tumor area were independent predictive factors for the rates of OS and DFS in patients with T2 glottic LSCC. Conclusion and significance This research showed that patients with T2 glottic LSCC with a carcinoma diameter >1.35 cm or a tumor area >1 cm2 have worse survival outcomes. These factors independently predict survival outcomes in patients.

Motor neuron involvement threatens survival in spinocerebellar ataxia type 1.

Motor neuron involvement threatens survival in spinocerebellar ataxia type 1.

Abstract P3-04-08: Comparison Of Cone Beam Breast CT And Breast MRI In Preoperative Assessment Of Primary Breast Cancer Tumor Size

Abstract Comparison Of Cone Beam Breast CT And Breast MRI In Preoperative Assessment Of Primary Breast Cancer Tumor Size Yinan Ji＊1, Geyi Liao＊1, Ningbing Luo2, Yi Jiang1, Xiaoming Liao1, Wei Tang1, Huawei Yang 1. 1Department of Breast Surgery, 2Department of Radiology, Guangxi Medical University Tumor Hospital, Nanning, China Correspondence to: Dr. Huawei Yang, Department of Breast Surgery, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, Guangxi Zhuang Autonomous Region 530021, P.R. China Email: Lordyhw@163.com ＊Contributed equally Background: Breast cancer is the malignant tumor with the highest incidence among women in China, seriously endangering women’s health. After breast cancer is diagnosed, surgery is one of the primary treatments. Assessing the extent of breast cancer is vitally important to formulate the best surgical option, obtain clear margins while minimizing the volume of removed tissue, and improve the treatment outcome and patient’s quality of life. Currently, breast surgery relies heavily on Breast MRI (bMRI) for preoperative assessment. However, bMRI may overestimate the tumor sizes. bMRI is contraindicated in patients with claustrophobia, metal implants, and allergy to gadolinium contrast medium. In addition, bMRI is generally expensive and time-consuming. Some patients find bMRI less favorable for cost and time concerns. Cone Beam Breast CT (CBBCT) is a new modality using Cone Beam CT technology and iodinated contrast media for true 3D high-resolution imaging of the breast. Our previous studies have proved the feasibility of CBBCT in the preoperative assessment of breast cancer. A large-scale study has been done to further examine the clinical significance of CBBCT in pre-operative assessment compared with bMRI. Methods: 273 female primary breast cancer patients were included in this study. The maximal diameters of the tumors were measured in CBBCT and bMRI images by an experienced radiologist. The differences between the image-measured size and surgical pathology size (gold standard) were calculated as ΔDCT and ΔDMR. ΔD ˃ 5mm was considered an overestimation and ΔD ˂-5mm was considered an underestimation. The absolute values of ΔDCT and ΔDMR were also calculated as ΔDCT_abs and ΔDMR_abs. A Student t-test was used to compare the statistical differences between ΔDCT_abs and ΔDMR_abs. Among ΔDCT_abs and ΔDMR_abs, a 5mm cut-off value was used to determine the concordance between image and pathology. The concordance rates of CBBCT-Pathology and bMRI-Pathology were tested with the χ2 method. Factors that may affect the accuracy of tumor size measurement were analyzed. Results: Overall there were no statistically significant differences between ΔDCT_abs and ΔDMR_abs. (0.58±0.68cm vs. 0.65±0.68cm; t=1.653, P=0.100). Using 5mm as the cut-off value of concordance, there was no significant difference in the CBBCT-Pathology and bMRI-Pathology concordance rates (64.8% vs. 60.1%, χ2 =1.320, P=0.251). The overestimation rate of CBBCT was significantly lower than that of bMRI (11.4% vs. 19.4%, χ2=6.810, P=0.009). But there was no significant difference in the underestimation rates (23.8% vs. 20.5%, χ2=0.860, P=0.354). ΔDCT_abs is significantly smaller than ΔDMR_abs among the invasive ductal carcinoma group (P=0.017), the premenopausal group (P=0.004), and the small tumor size (≤2cm) group (P=0.003). ΔDCT_abs and ΔDMR_abs.have no significant differences among the lymph node metastasis group, multi-lesion group, and enhancement type group (P &amp;gt; 0.05). Conclusions: CBBCT is concordant with surgical pathology in breast tumor size measurement and provides more accurate tumor size estimation compared with bMRI. CBBCT can be used as a valuable modality for pre-operative assessment. Citation Format: YINAN JI, Geyi Liao, Ningbing Luo, Yi Jiang, Xiaoming Liao, Wei Tang, Huawei Yang. Comparison Of Cone Beam Breast CT And Breast MRI In Preoperative Assessment Of Primary Breast Cancer Tumor Size [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-04-08.

The flubbed body: Pathological body size representation in personal neglect

Personal Neglect (PN) is a disorder in which patients fail to attend or explore the contralateral side of their body. An increasing number of studies have considered PN as a form of body representation disorder frequently observed following damage to parietal areas. The extent and the direction of the body misrepresentation is still unclear with recent studies suggesting a general reduction of contralesional hand size. However, little is known about the specificity of this representation and whether the misrepresentation also generalises to other body parts. We explored the features of the representation of the hands and face in a group of 9 right brain damaged patients with (PN+) and without PN (PN-), when compared to a healthy control group. For this, we used a body size estimation task with pictures, in which patients were required to choose the one that most closely matched the perceived size of their body part. We found that PN + patients showed a labile body representation for both hands and face, having a larger distorted representational range. Interestingly, in comparison with PN + patients and healthy controls, PN- patients also showed misrepresentation of the left contralesional hand which could be related to impaired motor performance of their upper limb. Our findings are discussed within a theoretical framework suggesting a reliance on multisensory integration (body representation, ownership, and motor influences) for an ordered representation of the size of the body.

Honeycomb lung is a major risk factor for preoperative radiological tumor size underestimation in patients with primary lung cancer.

Lung cancer frequently occurs in lungs with background idiopathic interstitial pneumonias (IIPs). Limited resection is often selected to treat lung cancer in patients with IIPs in whom respiratory function is already compromised. However, accurate surgical margins are essential for curative resection; underestimating these margins is a risk for residual lung cancer after surgery. We aimed to investigate the findings of lung fields adjacent to cancer segments affect the estimation of tumor size on computed tomography compared with the pathological specimen. This analytical observational study retrospectively investigated 896 patients with lung cancer operated on at Fujita Health University from January 2015 to June 2020. The definition of underestimation was a ≥10 mm difference between the radiological and pathological maximum sizes of the tumor. The lung tumors were in 15 honeycomb, 30 reticulated, 207 emphysematous, and 628 normal lungs. The ratio of underestimation in honeycomb lungs was 33.3% compared to 7.4% without honeycombing (P=0.004). Multivariate analysis showed that honeycombing was a significant risk factor for tumor size underestimation. A Bland-Altman plot represented wide 95% limits of agreement, -40.8 to 70.2 mm, between the pathological and radiological maximum tumor sizes in honeycomb lungs.

Comparison of automated breast volume scanning with conventional ultrasonography, mammography, and MRI to assess residual breast cancer after neoadjuvant therapy by molecular type

To compare the accuracy of hand-held ultrasonography (US), mammography (MG), magnetic resonance imaging (MRI), and automated breast volume scanning (ABVS) in defining residual breast cancer tumour size after neoadjuvant therapy (NAT). Patients diagnosed breast cancer and who received NAT at the Breast Center, Peking University People's Hospital, were enrolled prospectively. Imaging was performed after the last cycle of NAT. The residual tumour size, intraclass correlation coefficients (ICCs), and receiver operating characteristic (ROC) to predict pathological complete response (pCR) were analysed. A total of 156 patients with 159 tumours were analysed. ABVS had a moderate correlation with histopathology residual tumour size (ICC=0.666), and showed high agreement among triple-positive tumours (ICC=0.797). With 5 mm as the threshold, the coincidence rate reached 64.7% between ABVS and pathological size, which was significantly higher than that between US, MG, MRI, and pathological size (50%, 45.1%, 41.4%; p=0.009, p=0.001, p<0.001, respectively). For ROC analysis, ABVS demonstrated a higher area under the ROC curve, but with no statistical difference, except for MG (0.855, 0.816, 0.819, and 0.788, respectively; p=0.183 for US, p=0.044 for MG, and p=0.397 for MRI, with ABVS as the reference). The longest tumour diameter on ABVS had a moderate correlation with pathological residual invasive tumour size. ABVS was shown to have good ability to predict pCR and would appear to be a potential useful tool for the assessment after NAT for breast cancer.

Full physicochemical and biocompatibility characterization of a supercritical CO2 sterilized nano-hydroxyapatite/chitosan biodegradable scaffold for periodontal bone regeneration

Despite bone's innate self-renewal capability, some periodontal pathologic and traumatic defects' size inhibits full spontaneous regeneration. This current research characterized a 3D porous biodegradable nano-hydroxyapatite/chitosan (nHAp/CS, 70/30) scaffold for periodontal bone regeneration, which preparation method includes the final solvent extraction and sterilization through supercritical CO2 (scCO2).Micro-CT analysis revealed the fully interconnected porous microstructure of the nHAp/CS scaffold (total porosity 78 %, medium pore size 200 μm) which is critical for bone regeneration. Scanning electron microscopy (SEM) showed HAp crystals forming on the surface of the nHAp/CS scaffold after 21 days in simulated body fluid, demonstrating its bioactivity in vitro. The presence of nHAp in the scaffolds promoted a significantly lower biodegradation rate compared to a plain CS scaffold in PBS. Dynamic mechanical analysis confirmed their viscoelasticity, but the presence of nHAp significantly enhanced the storage modulus (42.34 ± 6.09 kPa at 10 Hz after 28 days in PBS), showing that it may support bone ingrowth at low-load bearing bone defects. Both scaffold types significantly inhibited the growth, attachment and colony formation abilities of S. aureus and E. coli, enhancing the relevance of chitosan in the grafts' composition for the naturally contaminated oral environment. At SEM and laser scanning confocal microscopy, MG63 cells showed normal morphology and could adhere and proliferate inside the biomaterials' porous structure, especially for the nHAp/CS scaffold, reaching higher proliferative rate at day 14. MG63 cells seeded within nHAp/CS scaffolds presented a higher expression of RUNX2, collagen A1 and Sp7 osteogenic genes compared to the CS samples.The in vivo subcutaneous implantation in mice of both scaffold types showed lower biodegradability with the preservation of the scaffolds porous structure that allowed the ingrowth of connective tissue until 5 weeks. Histology shows an intensive and progressive ingrowth of new vessels and collagen between the 3rd and the 5th week, especially for the nHAp/CS scaffold.So far, the scCO2 method enabled the production of a cost-effective and environment-friendly ready-to-use nHAp/CS scaffold with microstructural, chemical, mechanical and biocompatibility features that make it a suitable bone graft alternative for defect sites in an adverse environment as in periodontitis and peri-implantitis.

Pre-Operative MRI in HER-2 Receptor Positive and Her-2 Receptor Negative Breast Cancer: A Comparison

Objectives: MRI is the most sensitive modality for local staging of breast cancer. Herceptin receptor over-expression is seen in 15% - 30% of breast tumours, and is associated with increased aggression, poorer prognosis, higher grade at diagnosis and increased lymphatic dissemination. This study aimed at evaluating the role of MRI in Herceptin receptor positive vs negative tumours. Methods: 193 pre-operative MRIs were performed in 2021 for staging of 162 Her-2 negative and 37 Her-2 positive tumours. Recall rates and further biopsies (ipsilateral/contralateral) were assessed in both groups, and MRI largest size was compared to pathological size of invasive cancer and DCIS. Results: 36.4% of Her-2 negative tumours were recalled; further ipsilateral malignancy was identified in 13.6%. Contralateral malignancy was identified in 1.2%. 29.7% of Her-2 positive tumours were recalled; further ipsilateral malignancy was identified in 16.2%. No contralateral malignancy was seen in Her-2 positive tumours. The OR of Her-2 positive tumours having ipsilateral foci of malignancy on MRI is 0.83 (CI 0.3, 2.2). Pathological size concordance with MRI size was seen in 70.3% of Her-2 negative, and 48.6% of Her-2 positive tumours. Discordance in both groups was due to MRI size overestimation (70.8% of Her-2 negative discordance; 89.4% of Her-2 positive discordance). Conclusions: Pre-operative MRI did not detect significant increased additional foci in Her-2 positive tumours. Significant concordance with pathological size was not seen in both groups; MRI overestimation was the most frequent cause for discordance in both groups. Advances in Knowledge: This study compares MRI features of Her-2 positive and Her-2 negative tumours. It demonstrates that there is no significant increased multifocality or multicentricity of Her-2 positive tumours, but MRI over-estimates size in 30% of Her-2 negative and 51% of Her-2 positive cancers.

Current Trends in Endoscopic Ear Surgery.

Current Trends in Endoscopic Ear Surgery.

Underestimation of endoscopic size in large gastric epithelial neoplasms.

Endoscopic submucosal dissection (ESD) is an effective method for resecting gastric adenomas and adenocarcinomas. A significant discrepancy was observed between endoscopic and pathological sizes in samples obtained from patients undergoing ESD. This study elucidates the factors affecting size discrepancy after formalin fixation. The records of 64 patients with 69 lesions were analyzed, including 50 adenomas and 19 adenocarcinomas. Data on location, gross shape, histology, and size after fixation in formalin were collected. The mean size of the resected specimen appeared to decrease after formalin fixation (37.5 mm prefixation vs. 35.8 mm postfixation, p<0.05). The mean long axis diameter of the lesions was 20.3±7.9 mm prefixation and 13.4±7.9 mm postfixation. Size differences in lesions smaller than 20 mm were significantly greater than those in lesions larger than 20 mm (7.6±5.6 mm vs. 2.5±5.8 mm, p<0.01). In multivariate analysis, a tumor size of ≥20 mm was found to be an independent factor affecting size postformalin fixation (p<0.05). The endoscopic size of lesions before ESD may be underestimated in tumors larger than 20 mm in size. Therefore, increased attention must be paid during ESD to avoid instances of incomplete resection.