Pathological Examination Of Surgical Specimen Research Articles

IL-10 and TGF-β1 may weaken the efficacy of preoperative anti-tuberculosis therapy in older patients with spinal tuberculosis.

Spinal tuberculosis is a common extrapulmonary type that is often secondary to pulmonary or systemic infections. Mycobacterium tuberculosis infection often leads to the balance of immune control and bacterial persistence. In this study, 64 patients were enrolled and the clinicopathological and immunological characteristics of different age groups were analyzed. Anatomically, spinal tuberculosis in each group mostly occurred in the thoracic and lumbar vertebrae. Imaging before preoperative anti-tuberculosis therapy showed that the proportion of abscesses in the older group was significantly lower than that in the younger and middle-aged groups. However, pathological examination of surgical specimens showed that the proportion of abscesses in the older group was significantly higher than that in the other groups, and there was no difference in the granulomatous inflammation, caseous necrosis, inflammatory necrosis, acute inflammation, exudation, granulation tissue formation, and fibrous tissue hyperplasia. B cell number was significantly lower in the middle-aged and older groups compared to the younger group, while the number of T cells, CD4+ T cells, CD8+ T cells, macrophages, lymphocytes, plasma cells, and NK cells did not differ. Meaningfully, we found that the proportion of IL-10 high expression and TGF-β1 positive in the older group was significantly higher than that in the younger group. TNF-α, CD66b, IFN-γ, and IL-6 expressions were not different among the three groups. In conclusion, there are some differences in imaging, pathological, and immune features of spinal tuberculosis in different age groups. The high expression of IL-10 and TGF-β1 in older patients may weaken their anti-tuberculosis immunity and treatment effectiveness.

Acute mediastinal mass syndrome after surgical biopsy of a massive anterior mediastinal tumor: a case report

Abstract Background Mediastinal lymphatic tumors are relatively rare. The prognosis is poor but has improved due to recent advances in treatment strategies. Herein, we report a case of mediastinal lymphoma diagnosed using surgical biopsy, which was complicated by mediastinal mass syndrome due to general anesthesia. Case presentation A 25-year-old man with cough, fever, dyspnea, and night sweats was transferred to our hospital for resection of a large anterior mediastinal tumor. Although his preoperative diagnosis was WHO type B1 thymoma, the clinical findings suggested a lymphoma. A repeat surgical biopsy was performed under general anesthesia. Immediately after extubation, the patient developed acute respiratory failure with hypolucency of the right lung field on chest radiography. He was reintubated immediately and was diagnosed with negative pressure pulmonary edema in the right lung. He was managed with positive-pressure ventilation and his respiratory distress resolved within 5 days. Pathological examination of surgical specimens confirmed the diagnosis of lymphoma. Conclusion Surgical biopsy is useful for the diagnosis of mediastinal tumors. However, the risk of perioperative mediastinal mass syndrome should be carefully assessed before administering general anesthesia.

Transanal total mesorectal excision versus laparoscopic intersphincteric resection for low rectal cancer: a propensity score matching analysis.

Anus-preserving surgery for low rectal cancer has always been a serious difficulty for surgeons. Transanal total mesorectal excision (TaTME) and laparoscopic intersphincteric resection (ISR) are commonly used Anus-preserving surgeries for low rectal cancer. The aim of this study was to compare the clinical use of two surgical methods. A total of 152 patients with low rectal cancer were treated with taTME in 75 cases and ISR in 77 cases. After propensity score matching, 46 patients in each group were included in the study. Perioperative outcomes, anal function scores (Wexner incontinence score) and quality of life scores (EORTC QLQ C30, EORTC QLQ CR38) at least 1year after surgery were compared between the two groups. There were no significant differences between the two groups in terms of surgical outcomes, pathological examination of surgical specimens, postoperative recovery, and postoperative complications, except for patients in the taTME group who had their indwelling catheters removed later. Anal Wexner incontinence score was lower in taTME group than ISR group (P < 0.05). On the EORTC QLQ-C30 scale, the physical function and role function scores in the ISR group were lower than those in the taTME group (P < 0.05), while the fatigue, pain symptoms, and constipation scores in the ISR group were higher than those in the taTME group (P < 0.05). On the EORTC QLQ-CR38 scale, the scores of gastrointestinal symptoms and defecation problems in the ISR group were higher than those in the taTME group (P < 0.05). Compared with ISR surgery, taTME surgery is comparable in terms of surgical safety and short-term efficacy, and has better long-term anal function and quality of life. From the perspective of long-term anal function and quality of life, taTME surgery is a better surgical method for the treatment of low rectal cancer.

Utility of Routine Pathologic Examination for Fasciectomy for Dupuytren Contracture

The objective of this study was to examine the routine pathologic examination of surgical specimens obtained during fasciectomy for Dupuytren contracture. A total of 376 consecutive patients who underwent surgical limited fasciectomy with the excised tissue sent for histopathologic evaluation were identified. Patients were excluded for miscoded procedures, cases where no tissue was sent for pathologic review, and excisions of nodules only. Repeat surgeries in the same patient during the study period were excluded. The rates of concordant, discrepant, and discordant diagnoses were reported. Discrepant diagnoses were defined as different clinical diagnosis and pathologic diagnosis that did not change clinical management. Discordant diagnoses were defined as a different clinical diagnosis and a pathologic diagnosis that altered the treatment plan. The reference standard for final clinical decision-making was the pathologic diagnosis. The prevalence of concordant diagnoses was 97.1% (365 of 376), of discrepant diagnoses was 2.9% (11 of 376), and there were no discordant diagnoses. Of 376 patients, 43 underwent previous surgical fasciectomy before the study surgery, and pathologic examination was obtained in 10 of these patients. All 10 patients had concordant diagnoses. Our results suggest that routine pathologic examination did not alter the future treatment plan for patients who underwent limited fasciectomy. Discrepant diagnoses were encountered infrequently, and rarely in the setting of revision fasciectomy. Discordant diagnoses did not occur. Given the cost associated with pathologic evaluation, this raises the question of whether routine pathologic evaluation is necessary for Dupuytren surgery, where the capability of the treating surgeon to make a clinical diagnosis accurately may render confirmatory pathologic assessment redundant. Diagnostic II.

Robotic-assisted thoracic surgery following neoadjuvant chemoimmunotherapy in patients with stage III non-small cell lung cancer: A real-world prospective cohort study.

ObjectiveStage III non-small cell lung cancer (NSCLC) is a heterogeneous group of diseases. For this subset of patients, clinical management is still under debate and prognosis remains poor so far. In the present study, we aimed to evaluate the feasibility and safety of robotic-assisted thoracic surgery after neoadjuvant chemoimmunotherapy in stage III NSCLC.MethodsA real-world prospective cohort study was performed in a single-center setting from April 2021 to May 2022. Patients who were diagnosed with resectable or potentially resectable stage IIIA–B NSCLC and received neoadjuvant chemoimmunotherapy followed by robotic-assisted thoracic surgery were enrolled. Pathological response to neoadjuvant chemoimmunotherapy, treatment-related adverse events, and surgical outcomes of these patients were evaluated.ResultsA total of 44 patients who underwent robotic-assisted thoracic surgery after three doses of neoadjuvant chemoimmunotherapy were included in this study. Of these, 36 of 44 (81.8%) patients had a major pathological response, and 26 (59.1%) had a pathological complete response based on pathological examination of surgical specimen. Eight patients (18.2%) suffered grade 3 treatment-related adverse events, including neutropenia (n = 4), increased aminotransferases (n = 3), anemia (n = 1), and cutaneous capillary endothelial proliferation (n = 1). Robotic-assisted thoracic surgery was performed subsequently, and R0 resection was achieved in all patients. Only two (4.5%) patients required conversion to thoracotomy. Surgical complications occurred in five (11.4%) patients, including air leak (n = 3), chylothorax (n = 2), and surgical site infection (n = 1). There was no re-surgery or postoperative mortality within 90 days.ConclusionRobotic-assisted thoracic surgery following neoadjuvant chemoimmunotherapy showed good feasibility and safety in stage III NSCLC. It was not associated with unexpected perioperative morbidity or mortality and may be a promising therapeutic option in stage III NSCLC. These results need further confirmation by more large-scale clinical trials.

Neuroblastoma with ovarian and pancreatic metastasis

Neuroblastoma metastasis to the pancreas and ovaries is rare. We report a 12-year-old girl diagnosed with primary left adrenal neuroblastoma and metastases to the local lymph nodes, left orbit, left ovary, and multiple bones. After 4 courses of chemotherapy, the orbital and bone metastases disappeared; the ovarian tumor remained and the lymph node metastases were shown to be pancreatic metastases. Left adrenal tumor resection with spleen-preserving partial pancreas resection and left ovariectomy was performed. Pathological examination of surgical specimens showed viable tumor cells in the ovary but none in the pancreas. Additional chemotherapy, autologous bone marrow transplantation, I 131 -MIBG radiotherapy, and radiation therapy were performed after surgery. This case was a case where it was possible to resect a rare metastatic site, and it is thought that there are many points to discuss about the metastatic pathway, evaluation about reactivity of chemotherapy, and indication about excision of metastatic lesions.

Treatment outcomes of neoadjuvant chemotherapy and transoral robotic surgery in locoregionally advanced laryngopharyngeal carcinoma.

We aimed to identify the optimal indications of neoadjuvant chemotherapy (NACT) and transoral robotic surgery (TORS) in patients with locoregionally advanced (T3-4 or N2-3) head and neck cancer (HNC). A total of 50 patients were included in the study. T1 was identified in seven cases, T2 in 19, T3 in 22, and T4 in 2. N0 was identified in nine cases, N1 in 18, N2 in 22, and N3 in 1. There were 25 patients (50%) with complete remission of the primary lesion and 25 patients (50%) with partial remission. On pathologic examination of surgical specimens after neoadjuvant chemotherapy and TORS, 2 patients (4%) had a positive surgical margin, and 48 patients (96%) had a negative margin. Pathologic metastatic lymph nodes (LNs) were not observed in 39 cases (78%), and one metastatic LN was observed in 11 cases (22%). The 3-year recurrence-free survival (RFS) of all patients was 85.4%. On multivariate analysis, lymphovascular invasion showed a significant correlation with RFS. In patients with locoregionally advanced HNC, NACT and TORS achieved favorable oncologic and functional outcomes.

PREOPERATIVE EVALUATION OF THE SCORING SYSTEM DEVELOPED BY ATEMA TO DISTINGUISH COMPLICATED FROM UNCOMPLICATED ACUTE APPENDICITIS

Background: The diagnosis of acute appendicitis is purely based on history, clinical examination and some laboratory investigations (e.g. WBC count). Certain diagnosis can only be obtained at surgery and after pathological examination of surgical specimen. The Atema scoring system can distinguish complicated from non-complicated appendicitis preoperatively. Objective: To evaluate the validity and diagnostic accuracy of the Atema scoring system in differentiating complicated from non- complicated appendicitis before surgery. Patients and Methods: A prospective study was carried out on 60 patients complaining of acute abdominal pain, diagnosed as acute appendicitis using the Alvarado score and undergoing open appendectomy operation in the Emergency Department, Faculty of Medicine, Al-Azhar University from December 2019 to July 2020. Routine clinical and laboratory work up were done, the Atema Score was calculated to every patient in the study preoperatively. The decision to operate was made by a senior surgeon (consultant). The intraoperative finding whether the acute appendicitis was complicated or not was recorded. Post operatively, the histo-pathological examination results were recorded for each patient. The ROC curve was done, the cut-off point of the Atema scoring system was detected based on the ROC curve. The area under the ROC curve and the p-value were calculated. The sensitivity, specificity, positive predictive value and negative predictive value of the Atema scoring system above the level of the cut-off point were calculated. Results: In total of 60 patients, 37 patients (61.7%) had complicated appendicitis and 23 patients (38.3%) had non-complicated appendicitis. The sensitivity of the Atema score has a diagnostic accuracy of 0.944 (Area under the curve) with sensitivity 86.96% and specificity 89.19% with positive predictive value 83.3% and negative predictive value 91.7%. Conclusion: The Atema score can significantly differentiate between complicated and non-complicated acute appendicitis. A higher score denotes increased probability of the presence of complications as perforation and gangrene.

Sentinel lymph node biopsy may be unnecessary for ductal carcinoma in situ of the breast that is small and diagnosed by preoperative biopsy.

Current guidelines do not recommend that sentinel lymph node biopsy is routinely performed for ductal carcinoma in situ; thus, indications for sentinel lymph node biopsy in patients with ductal carcinoma in situ remain controversial. In this study, we investigated whether sentinel lymph node biopsy can be safely omitted when ductal carcinoma in situ has been diagnosed by preoperative biopsy. We retrospectively analysed sentinel lymph node metastasis rates and upstaging to invasive cancer in surgical specimens, performed receiver operating characteristic analysis for ductal carcinoma in situ lesion size and assessed correlations with preoperative clinicopathological factors of 277 patients with ductal carcinoma in situ diagnosed by preoperative biopsy at our institution. Among 277 patients with sentinel lymph node biopsy, six (2.2%) had sentinel lymph node metastasis. All six were upstaged to invasive cancer by pathological examination of surgical specimens. In total, 69 patients (24.9%) were upstaged to invasive cancer. The mean size of ductal carcinoma in situ lesions on preoperative imaging was significantly larger for the 69 upstaged patients (50.0mm) than for the non-upstaged patients (34.4mm; P<0.0001). Of the 277 patients with sentinel lymph node biopsy, 117 (42.2%) had preoperative ductal carcinoma in situ lesions <31.8mm, which was identified as the optimal cut-off size by receiver operating characteristic analysis. Of these 117 patients, 96 (82.1%, 95% confidence interval: 73.9-88.5%) could be safely omitted from sentinel lymph node biopsy because all of them remained as ductal carcinoma in situ and had negative sentinel lymph nodes at surgery. Size of ductal carcinoma in situ lesions on preoperative diagnostic imaging is a predictor of diagnosis of invasive cancer on pathological examination of surgical specimens. Sentinel lymph node biopsy may be unnecessary in ductal carcinoma in situ diagnosed by preoperative biopsy in patients with small lesions.

Robotic Hysterectomy as a Step of Gender Affirmative Surgery in Female-to-Male Patients

Introduction To evaluate the feasibility and safety of robotic hysterectomy in the “transgender male/non-conforming” population and the short and long-term surgical outcomes of robotic surgery in these patients. Materials and methods A retrospective analysis was carried out from February 2016 to January 2018. Twenty female transgender patients with a previous psychiatric diagnosis of gender dysphoria who did not present genital pathologies were included in the study. The robotic hysterectomies were performed from June 2016 to March 2018 using a Da Vinci Xi Robot (Intuitive Surgical, Sunnyvale, CA, USA). Results No intraoperative or postoperative complications were recorded. The median duration of the intervention was of 90 minutes, including docking which lasted 16 minutes, while the median stay in the operating room was of 140 minutes. The median time of duration of intervention was of 90 minutes. The median blood loss was about 90 ml with a percentage decrease in hemoglobin between pre- and post-operative of about 8%. Postoperative pain was assessed using the VAS scale in the immediate postoperative period, on the first and second day, resulting of 3 and 2, respectively. The pathological examination of surgical specimens confirmed the absence of malignancy. Conclusions The robotic approach represents a feasible, safe, and effective surgical option for hysterectomy for “transgender male” affected by gender dysphoria.

Mean Platelet Volume and Platelet Count are Elevated in Patients with Subacute Thyroiditis.

Platelet parameters have been studied in many diseases. This study explored the changes of mean platelet volume (MPV) and platelet count (PLT) in subacute thyroiditis (SAT). We retrospectively studied 44 patients with SAT and 45 healthy individuals. Diagnosis was confirmed by pathologic examination of surgical specimens. There were no significant differences in age and gender between the SAT group and the control group. We compared the above indexes between the two groups. WBC and PLT were significantly higher and MPV was obviously lower in the SAT group. PLT had high sensitivity for diagnosis of SAT. PLT was elevated and MPV was decreased in SAT patients. A negative correlation between PLT and MPV was found.

Mean Platelet Volume and Platelet Distribution Width as Markers in the Diagnosis of Acute Gangrenous Appendicitis.

Introduction. Acute gangrenous appendicitis (AGA) is a common medical condition; however, the grade of appendicitis usually cannot be established preoperatively. We have attempted to identify some indicators, such as the mean platelet volume (MPV) and the platelet distribution width (PDW), to diagnose AGA. Aims. To evaluate whether or not the MPV and PDW are suitable markers to diagnose AGA. Methods. A retrospective study of 160 patients with AGA and 160 healthy patients was undertaken. Disease diagnosis was confirmed based on the pathologic examination of surgical specimens. Patient white blood cell (WBC) count, neutrophil ratio (NR), platelet (PLT) count, MPV, PDW, and hematocrit (HCT) were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity of these indices in AGA. Results. There were no significant differences between the AGA and control groups in age and gender. Compared to the control group, the WBC count, NR, and PDW were significantly higher (P < 0.001, resp.) and the MPV and HCT were significantly lower (P < 0.001, resp.) in the AGA group. The diagnostic specificities of the WBC count, NR, PLT count, MPV, PDW, and HCT were 86.3%, 92.5%, 58.1%, 81.7%, 83.9%, and 66.3%, respectively. Therefore, the NR had the highest diagnostic specificity for the diagnosis of AGA. Conclusions. This is the first study to assess the MPV and PDW in patients with AGA. Our present study showed that the MPV is reduced and the PDW is increased in patients with AGA; the sensitivity of PDW was superior to the MPV. A decreased MPV value and an increased PDW could serve as two markers to diagnose AGA. The NR had the highest specificity for the diagnosis of AGA.

Routine Examination of Pathology Specimens Following Knee Arthroscopy: A Cost-Effectiveness Analysis.

While the clinical value of routine pathologic examination of tissues removed during orthopaedic procedures has not been determined, limited cost-effectiveness and a low prevalence of findings that alter patient management have been previously demonstrated with arthroscopy. The purpose of this study was to examine the clinical value and cost-effectiveness of routine histological examination of knee arthroscopy specimens. Retrospective chart analysis of 3797 consecutive knee arthroscopies by two surgeons from 2004 to 2013 at three affiliated hospitals within one health-care system was undertaken. Pathology reports regarding tissue removed during partial meniscectomies and anterior cruciate ligament reconstructions were reviewed to determine if the results altered patient care. The total costs of histological examination were estimated in 2012-adjusted U.S. dollars. The cost per health effect was determined by calculating the cost per discrepant and discordant diagnosis. The prevalence of concordant diagnoses was 99.3% (3769 of 3797), the prevalence of discrepant diagnoses was 0.7% (twenty-seven of 3797), and the prevalence of discordant diagnoses was 0.026% (one of 3797). The total cost of histological examinations was estimated to be $371,810. The total cost of the pathology cost per discrepant diagnosis was $13,771, and the cost per discordant diagnosis was $371,810. Routine pathological examination of surgical specimens from patients undergoing knee arthroscopy had limited cost-effectiveness because of the low prevalence of findings that altered patient management. Histological examination of surgical specimens from arthroscopic knee surgery did not alter patient care and increased costs. We suggest that gross and histological examination of tissue removed during knee arthroscopy should be done at the discretion of the orthopaedic surgeon rather than being mandatory.

Improvement in pathological reporting quality indexes for pancreatic ductal adenocarcinoma (PDAC) in a high volume surgical centre through definition of a standardized pathway in pathological examination of surgical specimen.

Background: Pancreatic ductal adenocarcinoma (PDAC) accounts for 90% of the pancreatic cancers. The incidence is around 10 cases/100.000 individuals with a similar mortality. Resection rate is around 15-20% and 5year survival around 20% of those with resected tumors. Aims: Evaluate angiolymphatic invasion (ALI) as a prognostic factor in resected N0 PDAC. Patients&methods: Retrospective analysis of 38 patients submitted to pancreaticoduodenectomy due to PDAC in a tertiary center. All specimens were analyzed with H&E stain. Tumor diameter, margins, lymph nodes, pTNM UICC, ALI, and perineural invasion were described in the pathology report. Statistical analisys considered p < 0,05 CI 95%. Results: 23 (60.5%) patients were female and 15 (39.5%) male. Mean age was 59 years. Overall survival was 22.3 months. 23 patients underwent gemcitabine based adjuvant chemotherapy or chemoradiation. There was no statistical significance between this group and the group with no adjuvant therapy (p 1⁄4 0,24). Patients with R0 ressection had significantly better survival compared with R1 ressection both in univariate and multivariate analisys (p < 0,001). 14 patients had ALI with N0 while 9 patients did not have ALI. There was no statistical significance in the number of lymphnode resection between these two groups (p 1⁄4 0,11), and survival was significantly better in the ALI-N0 group compared with the ALI+N0 group (p 1⁄4 0,021), considering T1-2-3 tumors. Conclusion: The present study shows that, even in a low-number casuistic, the angiolymphatic invasion in N0 duodenopancreatectomy can be evaluated by a cheap and easy method (H&E stain) and represents a poor prognosis factor for those patients. Abstracts / Pancreato

Primary small cell neuroendocrine carcinoma of the esophagus

Primary small cell neuroendocrine carcinoma of the esophagus is a very rare entity characterized by poor prognosis. Two new cases with clinicopathological characteristics are presented. In both female patients aged 62 and 66 who suffered from dysphagia for a few months, subtotal esophagectomy with lymph nodes dissection was performed. The final diagnosis was based on the pathological examination of surgical specimens. The morphology of tumors was typical with additional squamous cell carcinoma component inone case. Characteristic neuroendocrine granules were also revealed in electron microscope. Neoplastic cells were positive forpancytokeratin, chromogranin A and synaptophysin. Infiltration into the esophageal adventitia with vessel invasion andinvolvement of multiple regional lymph nodes was observed. The patients have died respectively nine and four months after the operation.

A multicentric randomized controlled trial on the impact of lengthening the interval between neoadjuvant radiochemotherapy and surgery on complete pathological response in rectal cancer (GRECCAR-6 trial): rationale and design

BackgroundNeoadjuvant radiochemotherapy (RCT) is now part of the armamentarium of cancer of the lower and middle rectum. It is recommended in current clinical practice prior to surgical excision if the lesion is classified T3/T4 or N+. Histological complete response, defined by the absence of persistent tumor cell invasion and lymph node (ypT0N0) after pathological examination of surgical specimen has been shown to be an independent prognostic factor of overall survival and disease-free survival. Surgical excision is usually performed between 6 and 8 weeks after completion of CRT and pathological complete response rate ranges around 12%. In retrospective studies, a lengthening of the interval after RCT beyond 10 weeks was found as an independent factor increasing the rate of pathological complete response (between 26% and 31%), with a longer disease-free survival and without increasing the operative morbidity. The aim of the present study is to evaluate in 264 patients the rate of pathological complete response rate of rectal cancer after RCT by lengthening the time between RCT and surgery.Methods/designThe current study is a multicenter randomized trial in two parallel groups comparing 7 and 11 weeks of delay between the end of RCT and cancer surgery of rectal tumors.At the end of the RCT, surgery is planified and randomization is performed after patient’s written consent for participation. The histological complete response (ypT0N0) will be determined with analysis of the complete residual tumor and double reading by two pathologists blinded of the group of inclusion. Patients will be followed in clinics for 5 years after surgery. Participation in this trial does not change patient’s management in terms of treatment, investigations or visits. Secondary endpoints will include overall and disease free survival, rate of sphincter conservation and quality of mesorectal excision. The number of patients needed is 264.Trial registrationClinicalTrial.gov: NCT01648894

Ogilvie’s syndrome following posterior spinal arthrodesis for scoliosis

We report Ogilvie's syndrome following posterior spinal arthrodesis on a patient with thoracic and lumbar scoliosis associated with intraspinal anomalies. Postoperative paralytic ileus can commonly complicate scoliosis surgery. Ogilvie's syndrome as a cause of abdominal distension and pain has not been reported following spinal deformity correction and can mimic post-surgical ileus. 12 year old female patient with double thoracic and lumbar scoliosis associated with Arnold-Chiari 1 malformation and syringomyelia. The patient underwent posterior spinal fusion from T4 to L3 with segmental pedicle screw instrumentation and autogenous iliac crest grafting. She developed abdominal distension and pain postoperatively and this deteriorated despite conservative management. Repeat ultrasounds and abdominal computer tomography scans ruled out mechanical obstruction. The clinical presentation and blood parameters excluded toxic megacolon and cecal volvulus. As the symptoms persisted, a laparotomy was performed on postoperative day 16, which demonstrated ragged tears of the colon and cecum. A right hemi-colectomy followed by ileocecal anastomosis was required. The pathological examination of surgical specimens excluded inflammatory bowel disease and vascular abnormalities. The patient made a good recovery following bowel surgery and at latest followup 3.2 years later she had no abdominal complaints and an excellent scoliosis correction. Ogilvie's syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after scoliosis correction. Early diagnosis and instigation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.

The use of ultrasound elastography in the assessment of malignancy risk in thyroid nodules and multinodular goitres

The objective of our work is to use a surgical series to analyse the validity of elastography in evaluating the malignancy of thyroid nodules and multinodular goitres. The study examined 156 patients, 134 women (85·9%) and 22 men (14·1%), who underwent surgery for nodular thyroid disease between October 2008, and November 2010. The average age of the patients was 52 years (±14·42). Thirty-six patients (23·1%) presented with a single nodule, and 120 (76·9%) exhibited multinodular goitres. Prior to surgical intervention, all patients underwent colour eco-elastography using a qualitative five-point ordinal scale for nodule classifications. Test results were analysed using a receiver operating characteristic (ROC) curve, and an anatomical pathologic examination of surgical specimens was used as a gold standard diagnostic tool for comparison. Of the 192 nodules analysed, 28 (14·6%) were malignant. Using elastography data, an ROC curve was obtained with an area under the curve of 0·662 (±0·060) and a 95% confidence interval (CI 95%) between 0·545 and 0·779 (P = 0·006). By establishing a cut-off point that classified thyroid nodules with an elastographic value greater than or equal to 3 as malignant, we achieved a sensitivity of 75%, specificity of 45·73%, positive predictive value of 19·1% and negative predictive value of 91%. The positive and negative likelihood ratios were 1·38 and 0·55, respectively. Ultrasound elastography can provide information regarding malignancy risk in thyroid nodules and multinodular goitres. However, the sensitivity and specificity values obtained in our study are below those reported by other groups, a finding that calls into question the current clinical utility of ultrasound elastography.

685 DETECTION OF FACTORS AFFECTING EARLY BLADDER RECURRENCE AFTER NEPHROURETERECTOMY IN PATIENTS WITH N0M0 UPPER URINARY TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyUrothelial Cancer: upper Tract Tumors (I)1 Apr 2013685 DETECTION OF FACTORS AFFECTING EARLY BLADDER RECURRENCE AFTER NEPHROURETERECTOMY IN PATIENTS WITH N0M0 UPPER URINARY TRACT UROTHELIAL CARCINOMA Kenji Kuroda, Junichi Asakuma, Akio Horiguchi, Shinsuke Tasaki, Akinori Sato, Kenji Seguchi, Keiichi Ito, and Tomohiko Asano Kenji KurodaKenji Kuroda Tokorozawa, Saitama, Japan More articles by this author , Junichi AsakumaJunichi Asakuma Tokorozawa, Saitama, Japan More articles by this author , Akio HoriguchiAkio Horiguchi Tokorozawa, Saitama, Japan More articles by this author , Shinsuke TasakiShinsuke Tasaki Tokorozawa, Saitama, Japan More articles by this author , Akinori SatoAkinori Sato Tokorozawa, Saitama, Japan More articles by this author , Kenji SeguchiKenji Seguchi Tokorozawa, Saitama, Japan More articles by this author , Keiichi ItoKeiichi Ito Tokorozawa, Saitama, Japan More articles by this author , and Tomohiko AsanoTomohiko Asano Tokorozawa, Saitama, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.241AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The bladder recurrence after nephroureterectomy is one of the major problems in patients with localized upper urinary tract (UUT) urothelial carcinoma (UC). Early recurrence from the time of radical surgery has especially been reported to be indicative of the repetitive recurrence of bladder tumors, which might lead to conditions requiring radical cystectomy in the future. In the present study, we evaluated factors to predict early bladder recurrence after nephroureterectomy in patients with localized UUT-UC. METHODS Our retrospective study includes 108 UUT-UC patients for whom neither preoperative radiological examination nor pathological examination of surgical specimens indicated distant or lymph node metastasis (N0M0). Forty three out of 108 patients had bladder recurrence after surgery and twelve had early intravesical recurrence. Early bladder recurrence was defined as intravesical tumor occurrence within six months after surgery. We evaluated clinicopathological parameters by using the Cox proportional hazards model, Fisher's exact probability test, multiple logistic regression analysis, and a log-rank test with Kaplan-Meier plots. We used the estimated glomerular filtration rate (eGFR: mL/min/1.73 m2) as an indicator of renal function. RESULTS The results from the Cox proportional hazards model revealed that only bladder tumor occurrence before or at the time of nephroureterectomy was significantly (p = 0.0007) associated with early bladder recurrence after nephroureterectomy. Fisher's exact probability test indicated that previous or concurrent occurrence of bladder tumors (p = 0.0032), and eGFR of less than 30 mL/min/1.73 m2 before surgery (preoperative eGFR < 30) (p = 0.0267) were independent factors for early bladder recurrence. We evaluated clinicopathological parameters from these findings, using multiple logistic regression analysis, and determined the condition of preoperative eGFR < 30 with bladder tumor occurrence before or at the time of nephroureterectomy was the only independent factor for early bladder recurrence after surgery (p = 0.0131). The Kaplan-Meier plot and log-rank test also revealed a significant difference in the time for bladder recurrence to occur in patients with and without the condition noted above (p = 0.0001). CONCLUSIONS We conclude that N0M0 UUT-UC patients with preoperative or perioperative bladder tumor and renal dysfunction need to be cared for early and possibly repetitive bladder recurrence after nephroureterectomy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e281 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenji Kuroda Tokorozawa, Saitama, Japan More articles by this author Junichi Asakuma Tokorozawa, Saitama, Japan More articles by this author Akio Horiguchi Tokorozawa, Saitama, Japan More articles by this author Shinsuke Tasaki Tokorozawa, Saitama, Japan More articles by this author Akinori Sato Tokorozawa, Saitama, Japan More articles by this author Kenji Seguchi Tokorozawa, Saitama, Japan More articles by this author Keiichi Ito Tokorozawa, Saitama, Japan More articles by this author Tomohiko Asano Tokorozawa, Saitama, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical Features and Prognosis of Patients with Benign Thyroid Disease Accompanied by an Incidental Papillary Carcinoma

To investigate the clinical features and prognosis of papillary thyroid carcinoma (PTC) with a background of benign disease. A total of 709 patients with papillary thyroid carcinoma undergoing surgical resection were analyzed retrospectively. In 147 patients who underwent surgery for benign thyroid disease, incidental PTC (IPC group) were identified by intraoperative or postoperative pathological examination of surgical specimens but were not detected by preoperative imaging studies. In the other group, according to the pathological examination with or without co-existing benign thyroid disease, 253 cases were clarified as concomitant PTC and 309 cases were clarified as dominant PTC. Incidental PTC was more common in women, about 85.7%, the mean age was 47.6±11.3 years old. Average tumor diameter was 4.4±2.2 mm, multiple lesions accounted for 12.9% (19/147), and the cervical lymph node metastasis rate was 6.1% (9/147). After radical resection 8 cases recurred, the median time of recurrence was about 12 months (0.5 to 162), there was no tumor-related death. The tumor-free survival rates were 97.3%, 95.9%, 91.5%, and 79.3% in 1, 5, 10 and 14 year respectively. Incidental PTC with a background of benign lesions is common, and the generally good prognosis can be attributed to tumor early detection and early treatment. On the intraoperative finding of incidental PTC, lobectomy (unilateral) or total thyroidectomy (bilateral) should be the first choice, but with a postoperative pathologic finding of incidental PTC, further treatment, such as completion thyroidectomy or immediate lymph dissection is not necessary. Central lymph node dissection is also not needed unless lymphadenectasis is present.