Postoperative Histopathological Findings Research Articles

Does a surgical access for rectal cancer in older patients affect postoperative morbidity and oncological safety?

AIM: to evaluate the effect of a surgical access on postoperative morbidity and oncological safety in older patients.PATIENTS AND METHODS: a multicenter retrospective study included 179 patients aged 60–74 years who underwent surgery for middle and low rectal cancer (T1-3N0-N2bM0) in 2021-2023. The patients were divided into 3 groups: the first ones underwent robotic (ROB) surgery (n = 62), the second — laparoscopic (LAP) surgery (n = 55), and the third — open (OPEN) surgery (n = 62). Parameters of pre-, intra-, and postoperative periods and histopathological findings were evaluated. Neural network modeling was used to predict anastomotic leakage (AL).RESULTS: the blood loss was 150 (100; 200) ml with OPEN versus 100 (50; 100) with ROB and LAP, the operation time was 255 (210; 300) min with ROB versus 180 (150; 240) min with LAP and 140 (120; 150) min with OPEN. In ROB and LAP groups, anastomoses were formed in 61 (98.4%) and 54 (98.2%) cases compared with 45 (72.6%) cases in the OPEN group (p = 0.00001). The splenic flexure was mobilized in 54 (98.2%) cases in the LAP group, 55 (88.7%) cases in the OPEN group, and 50 (80.7%) cases in the ROB group (p = 0.01). Conversion rates were 10.9% (6/55) and 1.6% (1/62) in LAP and ROB groups, respectively (p = 0.00001). Postoperative complications in the OPEN group occurred in 48 (77.4%) cases compared with 31 (50%) and 12 (21.8%) in ROB and LAP groups (p = 0.02). Inflammatory complications predominated in the OPEN group. Distal and lateral margins, the quality of mesorectal excision, and the number of examined and affected lymph nodes did not differ. However, the good quality of mesorectal excision prevailed in ROB and OPEN groups, where as the satisfactory quality was more common in the LAP group. The most important predictors of AL were American Society of Anesthesiologists (ASA) physical status II, neoadjuvant chemoradiotherapy, stage I and IIa cancer, end-to-end anastomosis, Charlson Comorbidity Index scores of 3–4, and surgeon’s experience (20–40 operations for rectal cancer per year). The least important predictors were the level of mesenteric vessel ligation and the access.CONCLUSIONS: the surgical access does not affect the AL rate. The histology revealed that all the 3 approaches ensure compliance with principles of oncological safety. Compared with open surgery, robotic and laparoscopic surgery result in less blood loss and faster recovery of intestinal function; however, the operation time increases.

Enhancing Precision in Rectal Cancer Care: Unravelling the Correlation Between MRI Locoregional Staging and Prognostic Factors, With Post-resection Pathology.

Introduction Magnetic resonance imaging (MRI) serves as a pivotal tool in the preoperative assessment of rectal cancer. This study aims to evaluate the accuracy of preoperative MRI pelvis in rectal cancer for locoregional staging, circumferential margin (CRM+), and vascular invasion (V1) with postoperative histopathological findings. Methods All patients who underwent preoperative staging MRI pelvis scanning for histology-proven primary rectal adenocarcinoma between January 2020 and July 2022 were included in this study. Preoperative MRI assessment data, including tumor (T), nodal (N) staging, and other prognostic factors, including circumferential margin and vascular invasion, were compared with histopathological reports. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy were calculated. Agreement between MRI and pathology reports was evaluated using the weighted kappa statistic. Results The study included 143 patients. The accuracy of MRI is at its peak for T0 and T4 tumors (T0-97.9%,T4-93.37). The weighted kappa statistic for T staging is 0.401, and for N staging, it is 0.286. The standard kappa statistic for extramural vascular invasion (V) and circumferential resection margin (CRM) is 0.269 and 0.225, respectively. Conclusion MRI demonstrates fair agreement with pathology regarding T and N staging and exhibits high specificity for CRM and V1.

ZNAČAJ DIGITALNE STEREOTAKSIJSKE BIOPSIJE U KORELACIJI SA PATOHISTOLOŠKIM POSTOPERATIVNIM NALAZIMA

Aim : This research was conducted with the aim of analyzing the accuracy and diagnostic value of digital stereotactic breast biopsy compared to the postoperative histopathological findings. Methods : A retrospective-prospective study was carried out over a period of 10 months, involving 30 female patients who underwent stereotactic breast biopsy. Data were collected on BI-RADS status, histopathological findings after stereotactic breast biopsy and after surgical excision, basic demographic and relevant medical history data. The patients were divided according to the degree of malignancy into three groups: patients with benign, patients with suspicious and patients with malignant pathohistological findings. The BIS and RIS systems were used for data collection, and the data were statistically analyzed using STATISTICA for Windows. Results : All patients had a radiological finding of BI-RADS 3 or higher. Histopathological results after stereotactic biopsy showed benign findings in 17 patients (B1 and B2), borderline malignant changes were present in 4 patients (B3), one patient had a lesion suspicious for malignancy (B4), and 8 had confirmed malignant lesions (B5). Out of the total 30 patients, 13 underwent surgical treatment. Postoperative histopathological findings in 4 patients showed benign changes, 6 patients had an invasive form of carcinoma, including 5 with invasive NST breast carcinoma and one characterized as invasive ductal breast carcinoma, while three patients had Ductal Carcinoma In Situ (DCIS). A correlation test was performed between the estimated degree of malignancy from the pathohistological findings after stereotaxic biopsy and after surgical operation. Spearman's ρ test showed a significant correlation between the two methods (p < 0.001). Conclusion : The results of histopathological analysis of samples obtained through the stereotactic biopsy method largely correlate with the postoperative histopathological diagnosis in patients who underwent surgical treatment. Keywords : digital stereotactic breast biopsy, PHD findings, BI-RADS, NST, Ductal Carcinoma In Situ.

Contrast-Enhanced Intraoperative Ultrasound Shows Excellent Performance in Improving Intraoperative Decision-Making.

The aim of this study was to evaluate the performance and the impact of contrast-enhanced intraoperative ultrasound (CE-IOUS) on intraoperative decision-making, as there is still no standardized protocol for its use. Therefore, we retrospectively analyzed multiple CE-IOUS performed in hepato-pancreatic-biliary surgery with respect to pre- and postoperative imaging and histopathological findings. Data of 50 patients who underwent hepato-pancreatic-biliary surgery between 03/2022 and 03/2024 were retrospectively collected. CE-IOUS was performed with a linear 6-9 MHz multifrequency probe connected to a high-resolution device. The ultrasound contrast agent used was a stabilized aqueous suspension of sulphur hexafluoride microbubbles. In total, all 50 lesions indicated for surgery were correctly identified. In 30 cases, CE-IOUS was used to localize the primary lesion and to define the resection margins. In the remaining 20 cases, CE-IOUS identified an additional lesion. Fifteen of these findings were identified as malignant. In eight of these cases, the additional malignant lesion was subsequently resected. In the remaining seven cases, CE-IOUS again revealed an inoperable situation. In summary, CE-IOUS diagnostics resulted in a high correct classification rate of 95.7%, with positive and negative predictive values of 95.2% and 100.0%, respectively. CE-IOUS shows excellent performance in describing intraoperative findings in hepato-pancreatic-biliary surgery, leading to a substantial impact on intraoperative decision-making.

The added value of shear wave elastography when combined to conventional ultrasonography and fine-needle aspiration cytology in detection of malignant thyroid nodule

BackgroundThis study aims to evaluate the effectiveness of ultrasound criteria, TI-RADS score, and elastography in distinguishing benign thyroid nodules from malignant ones, as a substitute for invasive diagnostic procedures. Although the minority of thyroid nodules is malignant, invasive diagnostic procedures are often necessary.MethodsIn this prospective study, a total of 104 thyroid nodules were assessed using fine-needle aspiration cytology. The euthyroid state of the patients was ensured. Conventional ultrasound and shear wave elastography (SWE) were performed by a single experienced operator. Final postoperative histopathologic findings were compared to conventional ultrasound and elastography findings.ResultsSWE elasticity indices (EIs) were found to be significantly higher in malignant nodules than benign ones (p < 0.05). Combined results of both TI-RADS and SWE increased the sensitivity of detection of malignant nodules.ConclusionCombined SWE and TI-RADS could enhance the diagnostic accuracy in differentiating thyroid nodules by leveraging their complementary strengths.

Laryngeal nodular fasciitis in a 75-year-old man: a rare case report and review of the literature.

Nodular fasciitis (NF) is a benign and self-limiting fibroblastic proliferation that originates from the superficial fascia and extends into the subcutaneous tissue or muscle. It typically manifests in individuals aged 20 to 35 years, with rare occurrences observed in patients over the age of 60 years. We herein report a case involving a 75-year-old man with NF in the right vocal cord. The patient sought medical attention at the Department of Otolaryngology of our hospital because of a 1-month history of hoarseness and breathlessness. The diagnosis was unable to be confirmed through preoperative pathological examination. After admission to our hospital, various examinations were completed and surgical treatment was performed, and the postoperative histopathological findings revealed the presence of NF in the right vocal cord. NF of the vocal cord is a rare clinical entity. Given its rapid progression and propensity for marked infiltration, it often poses diagnostic challenges because it can mimic various malignant soft tissue tumors. Therefore, thorough exclusion of other neoplastic lesions is imperative prior to confirming the diagnosis of NF through pathological examination. Local surgical resection remains the primary treatment modality.

Retrospective study on the profile of patients undergoing intraoperative radiotherapy with INTRABEAM for breast cancer treatment at a Brazilian cancer center.

e12538 Background: Conservative breast therapy combined with adjuvant radiotherapy has been the preferred treatment for early-stage breast cancer for many decades. Considering that most breast cancer recurrences occur near the original tumor site, partial breast radiotherapy has become an alternative for patients in this scenario, allowing for a single-dose radiation application directly to the tumor site. This technique has advantages such as reducing local toxicity and improving the quality of life for treated patients, in addition to decreasing the waiting time for radiotherapy treatment in developing countries like ours. Our case series is the largest in Latin America to date, and we believe that reporting the results of our experience will be valuable for the scientific community and aid in treatment decision-making in low- and middle-income countries. Methods: This is a retrospective study based on data from the medical records of 209 patients with early-stage breast cancer undergoing conservative surgery and intraoperative radiotherapy at A.C. Camargo Cancer Center (São Paulo, Brazil) from 2016 to 2023. Results: In our cohort, 88.5% of tumors were invasive ductal carcinomas. The majority were T1b (41.8%), had histological grade 2 (45.4%), nuclear grade 2 (62.7%), and showed no axillary involvement (87.6%). All patients received intraoperative radiotherapy in a single dose of 20 Gy radiation at the tumor site with a voltage of 50 kV. In our study, 17.7% of patients required additional external radiotherapy due to postoperative histopathological findings inconsistent with treatment indication criteria, including 35.3% for micrometastasis and 32.4% for nodal macrometastasis, 10.8% for narrow or compromised margins, 10.8% for histological types not covered in the final report, 2.7% for multifocality, 2.7% for extensive ductal carcinoma in situ, 2.7% for negative progesterone receptor, and 2.7% for the presence of lymphatic vascular invasion. The average follow-up time for patients was 36 months. The local recurrence rate was 0.5%. Conclusions: The results of this study support established data indicating the efficacy of intraoperative radiotherapy in early-stage breast cancer treatment. Therefore, for carefully selected patients, this technique with should be considered as a treatment option. We will continue to follow this patient cohort to identify the occurrence of late recurrences and publish long-term follow-up data.

Utility of perioperative ultrasonography and fine-needle aspiration cytology in differentiation between benign and malignant cervical lymphadenopathy: a retrospective cohort study

Background: The preoperative differentiation of benign form malignant cervical lymphadenopathy (CLA) is crucial in determining the need for surgical intervention. This study aims to assess the diagnostic performance of ultrasonography (US), fine-needle aspiration cytology (FNAC), and their combination with the postoperative histopathological diagnoses of CLA. Method: In a retrospective study between April 2021 and May 2023, 214 patients with CLA were assessed with preoperative US and FNAC. The morphological parameters, including tissue margins, vascularity, and fatty hilum echogenicity, were collected and analyzed retrospectively. The diagnostic efficacies of US, FNAC, and their combined use were compared to the postoperative histopathological findings. Result: In the final histopathological examination, 185 cases (86.4%) were found to be benign, while 29 cases (13.6%) were determined to be malignant. The US features of fatty hilum, echogenicity, and vascularity pattern had the highest diagnostic accuracy in characterizing CLA patterns, with values of 88.3%, 85.5%, and 85.0%, respectively. The ROC curve showed a significantly higher AUC value of 0.883 (95% CI: 0.832 to 0.923; P&lt;0.0001) for the combined use of all US parameters with better sensitivity (93.10%) and specificity (68.65%) than individual parameters. The overall sensitivity, specificity, and accuracy of FNAC were 97.3%, 82.8%, and 95.3%, respectively. Additionally, US parameters and FNAC together showed a significantly higher AUC value of 0.924 (95% CI: 0.880 to 0.956; P&lt;0.0001) and achieved a sensitivity of 86.21% and specificity of 88.65%. Conclusions: The combined use of US and FNAC provides high sensitivity, specificity, and diagnostic accuracy in characterizing CLA patterns. In limited-resources settings, this approach is feasible, less invasive, and cost-effective thereby enabling clear management strategies and avoiding additional surgical interventions.

Early and late complications arising from various bariatric surgical procedures in a tertiary center in Saudi Arabia

Background Individuals who are obese or morbidly obese face a significantly higher risk of experiencing postoperative complications. To evaluate high-risk patients undergoing bariatric surgery and mitigate the likelihood of further postoperative complications, various indicators are utilized. There are no prior reports about bariatric surgical procedures-related early/late complications that came out from the western region of Saudi Arabia. Aim This retrospective study aims to evaluate both short-term and long-term postoperative complications after several bariatric surgeries, including sleeve gastrectomy, Roux-en-Y gastric bypass, and revisional bariatric surgery. Patients and methods The assessment of complications in 328 patients who underwent bariatric surgery involved analyzing demographic data, medical and surgical history, preoperative and postoperative BMI, histopathologic findings, and early and late complications. These data were obtained from a prospectively maintained database. Results Of the total participants, 241 underwent sleeve gastrectomy, 43 underwent gastric bypass, and 44 had revisional bariatric surgery. Complication rates varied among the different bariatric surgeries. Specifically, SG patients had the lowest early major complication rate (2.1%), while gastric bypass patients had a rate of 4.7%. Conversely, the ‘revisional’ operations reported the highest rate of early complications at 9.1%. Late complications demonstrated varying rates, with sleeve gastrectomy patients experiencing the highest incidence of gastroesophageal reflux disease at 39%, and gastric bypass patients showing the highest rate of nutritional deficiency at 58%. Conclusion The study found that the baseline characteristics of patients did not exert a statistically significant influence on the occurrence of postoperative complications. However, different types of bariatric surgeries presented varying complication rates. Patients who underwent gastric bypass tended to have the highest rate of nutritional deficiency, while sleeve gastrectomy patients exhibited the highest rate of gastroesophageal reflux disease. Selecting the appropriate bariatric surgical procedure warrants careful consideration of patients’ preferences, demographic characteristics, presence of other medical conditions, and a comprehensive understanding of the potential advantages and disadvantages of each surgical option. Collectively, our findings would help discussing the expected outcome with the patients before surgery.

Clinical characteristics and outcomes of patients operated for primary hyperparathyroidism at Tampere University Hospital in 2017-2018.

Studies on the outcomes of parathyroid surgery are scarce. The aim was to report the outcomes and to study the association between pre- and peri-operative information with the outcomes of patients operated for primary hyperparathyroidism. This was a retrospective, descriptive study with unselected patients treated surgically for primary hyperparathyroidism from a catchment population of 704,500 in Finland. Data were acquired from the electronic hospital registers based on parathyroid surgery procedure codes between 1 January 2017 and 31 December 2018. Preoperative data, surgical data, preoperative and postoperative laboratory values, histopathological findings, and postoperative clinical data were recorded. During the 2-year study period, 149 patients with primary hyperparathyroidism were treated surgically with a 97% remission rate. Surgical complications included postoperative bleeding in two patients (1%) and vocal cord paralysis in one patient (0.6%). No postoperative infections were reported. Three patients (2%) developed postoperative hypoparathyroidism necessitating the use of alfacalcidol more than 1 month after surgery. Ionized calcium measured 0-1 days after surgery was not statistically significantly associated with remission or postoperative hypoparathyroidism. Serum parathyroid hormone (PTH) assessed 0-1 days postoperatively was associated with persistent disease, but not with postoperative hypoparathyroidism. The histopathological diagnosis was adenoma or hyperplasia in 112 patients (75%), atypical adenoma in 28 patients (19%), and carcinoma in five patients (3%). Patients with parathyroid carcinoma had higher preoperative ionized calcium and PTH values than those with adenoma or hyperplasia. Most patients who were operated due to primary hyperparathyroidism achieved normocalcemia after surgery, and the frequency of complications was low. Ionized calcium taken 0-1 days after surgery was not associated with remission of hyperparathyroidism or postoperative hypoparathyroidism. High postoperative serum PTH predicted persistent disease.

Clinical, Radiological, and Pathological Correlation of Mandibular Invasion in Carcinoma Bucco-alveolar Complex.

A prospective cross-sectional study was conducted to correlate clinically, radiologically, and pathologically the mandibular invasion in carcinoma bucco-alveolar complex. All biopsy-proven oral cavity cancer cases (64 patients) were assessed clinically and radiologically for involvement of the mandible. Preoperative clinicoradiological findings were compared with postoperative histopathological findings. In our study, oral cancer was 4 times more prevalent in males as compared to females and clinical evaluation was found to be highly sensitive in predicting mandibular invasion. Orthopantomogram showed sensitivity of 66.6% and specificity of 100%. CT scan showed sensitivity of 100% and specificity of 46% whereas MRI showed sensitivity of 54.5% and a specificity of 96%. MRI correlates well with final histopathology in predicting size of tumor. Prevalence of bony invasion in carcinoma oral cavity was 18%. We noted an inverse relation with tumor differentiation and mandibular invasion, and none of the verrucous carcinoma lesions showed mandibular invasion. Association of clinical T and N staging with postoperative histopathology was found to be statistically significant. Despite recent advances in molecular biology, radiological techniques, and newer modalities like visual surgical planning, exact measurement of bone invasion is still challenging. At present, CT scan and MRI along with clinical evaluation are widely used to evaluate mandibular invasion in carcinoma oral cavity, and all these are complementary to each other. The recent progress in tissue engineering technologies and stem cell biology has significantly promoted the development of regenerative reconstruction of jawbone defects.

Correlation of CT Scan Response to Necrosis and Volume Changes With Histopathology in Children With Wilms' Tumor

BackgroundWilms’ tumor is the most common renal tumor in children. ObjectiveTo correlate the percentage of necrosis and tumor volume change found in preoperative Contrast Enhance Computed Tomography (CECT) scan of the abdomen with post-operative histopathological findings of Wilms Tumor (WT). MethodsIn this prospective study from January 2020 to December 2022, out of 33 patients, 15 patients with unilateral localized WT (stage I, II, and III) treated according to SIOP UMBRELLA protocol 2016 were included. Bilateral, syndromic, and stage IV WT were excluded. The radiological response was measured in preoperative CECT by estimating the percentage of necrosis found in static images and compared with post-operative histopathological findings. Tumor volume changes were measured by comparing CECT at diagnosis and following chemotherapy. Tumor volume change was also compared with histology. ResultsThere was a significant positive correlation between radiological response to necrosis with histology as per Pearson correlation. Significant positive correlation also found between volume changes on pre and post chemotherapy CECT with histology as per Spearman correlation. ConclusionsThe changes in tumors during preoperative radiological evaluation and histologically confirmed necrosis are strongly related.

Etiology of Intestinal Obstruction - Correlation between Pre-operative and Per-operative Findings with Histopathology

Background: Intestinal obstruction is one of the most common causes of acute abdomen and often requires surgical intervention. However, pre-operative and per-operative diagnosis often do not correlate with postoperative histopathology done in suspected cases. Therefore, the study was designed to identify the etiology of intestinal obstruction correlating to pre-operative and per-operative findings with postoperative histopathological findings in suspected cases. Methods: A cross sectional study was conducted at the department of General Surgery, Mymensingh Medical College &amp; Hospital, Mymensingh for 18 months following ethical approval from Institutional Review Board (IRB) of Mymensingh Medical College. During the study period, all patients with suspected intestinal obstruction admitted in Department of Surgery were included based on selection criteria. Total 103 patients were assessed in pre-operative and per-operatively. Histopathological examination was done in suspected cases where diagnosis could not be confirmed without histopathology. Data collection was done with a data collection form. After collection of all the required data, final analysis was carried out by using the SPSS version 21.0. Results: Among 103 cases of intestinal obstruction, mean age was 45.50±14.37 SD (years) with male female ratio-1.78:1. About 66% came from rural areas and 34% were from urban areas. Abdominal pain was the commonest symptom present among the cases which was observed in 91.3% cases. Others common symptoms were vomiting, abdominal distension absolute and relative constipation in 72.8%, 69.9%, 12.6% and 63.1% cases respectively, while abdominal tenderness was the commonest sign present in all cases. Among study population, 68.9% was small bowel obstruction and 31.1% was obstruction in large bowel. According to per-operative findings 22.3% cases were suspected as malignant. Finally 24.3% cases were proved as malignant in subsequent histopathological examination and 75.7% cases

Evaluation of Modified Alvarado Score Compared with Histopathological Diagnosis in Acute Appendicitis

Background: Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide, despite much advancement in abdominal surgery. A number of scoring systems have been advocated to minimize the number of negative appendectomies. However, Modified Alvarado Score System (MASS) is the most prominent and widely used one. Considering limited data regarding correlation between Modified Alvarado Score and post-operative histopathological findings, the study was designed to assess the usefulness of Modified Alvarado Score compared with histopathological report in diagnosis of acute appendicitis. Methods: This cross sectional observational study was conducted at the department of General Surgery, Mymensingh Medical College &amp; Hospital, Mymensingh. All of the admitted patients with acute appendicitis were approached for inclusion of the study. All patients who met the inclusion criteria were consecutively enrolled in the study. Prior final inclusion, informed written consent form was ensured. Ethical issues were maintained in according to the Declaration of Helsinki. Appendicectomy was done based on the overall clinical judgement. Pre-operative Modified Alvarado Score was assessed for all patient. The diagnosis was confirmed by histopathological examination. Data was collected by the researcher(me) and total 106 patients were included. Following collection, all data were sorted, checked and verified. After that data analysis was done by using SPSS statistical computer software (version 22). Results: A total number of 106 patients were studied. Their ages ranged from 12 to 51 years (mean 26.38±7.49 SD). There were 73.6% males and 26.4% females. All patients in this study underwent appendicectomy. Majority respondents had Modified Alvarado Score more than or equal to 7 (84%) and 16% had score below 7. According to histopathology findings, 14.16% respondents had normal appendix with or without other pathology and 85.84% had acute appendicitis. ....

CLINICOPATHOLOGICAL EVALUATION OF ABNORMAL UTERINE BLEEDING IN PERIMENOPAUSAL WOMEN

Objective: Abnormal uterine bleeding (AUB) is defined as any bleeding from the uterus that is deviated from normal in terms of regularity, duration, frequency, and amount of blood loss. It interferes with the woman’s physical, emotional, social, and material quality of life. The prevalence of AUB ranges between 11% and 13% rising to 24% in perimenopausal women. The aim of this study is to analyze the demographic profile and risk factors of AUB in perimenopausal women, to classify the causes of AUB based on PALM-COEIN classification, and to correlate the clinical and sonological findings with post-operative histopathology findings. Methods: A cross-sectional study was conducted in the Department of Obstetrics and Gynecology at GIMSR hospital, Visakhapatnam, for 1 year from September 2022 to September 2023. A total of 151 perimenopausal women with complaints of AUB in the age group of 41–50 years who underwent hysterectomy were included in the study. Results: The most common clinical presentation was heavy menstrual bleeding (HMB) seen in 96 cases (63.5%). Clinically, the PALM component accounted for 61% of cases and the COEIN component accounted for 39% of cases. Ultrasonographically, the PALM component was detected in 76.8% of cases. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for detection of PALM lesions. Conclusion: Leiomyoma was the most common cause clinically, sonologically, and pathologically. Correlation was good for leiomyoma. USG has good specificity for diagnosis of AUB-A and AUB-P but low sensitivity.

Staging of Laryngeal Cancer: Clinicoradiological versus Histopathological Findings using Modified Laryngeal Sectioning

Staging of Laryngeal Cancer: Clinicoradiological versus Histopathological Findings using Modified Laryngeal Sectioning

Successful management of a giant retroperitoneal ancient schwannoma mimicking malignant tumors: A case report and literature review

Introduction and Importance: Schwannomas, originating from Schwann cells surrounding nerve sheaths, tend to be slow-growing. Among these, giant ancient schwannomas are remarkable for their rare occurrence and their capacity for substantial growth and regressive changes. Furthermore, the expansiveness and flexibility of the retroperitoneal space often conceal the symptoms of retroperitoneal schwannomas, leading to delayed diagnosis and allowing these tumors to grow significantly and become large and long-standing before detection. Case Presentation: A 24-year-old man presented with left flank pain and a growing abdominal bulge in the left upper quadrant. Computed tomography scan revealed a 15×15×10 cm lytic expansile lesion. Consequently, the encapsulated mass was surgically excised and diagnosed as an ancient retroperitoneal schwannoma through histological and immunohistochemical studies. Clinical Discussion: Comprehensive preoperative planning and a multidisciplinary strategy are imperative for the complete excision of schwannomas. These tumors can present diagnostic complexities, particularly due to nuclear atypia and pleomorphism, which might lead to misinterpretation regarding malignancy. Despite the risks associated with percutaneous biopsies, the low mitotic count is a critical diagnostic factor. Our study underscores the consensus that the definitive diagnosis should rely on postoperative histopathological findings, highlighting the importance of accurate assessment. Conclusion: Rare giant retroperitoneal ancient schwannomas pose diagnostic challenges due to their rarity, lack of distinct symptoms, and atypical locations. This study presents a successful case and management.

Evaluation of an Objective MRI-Based Tumor Regression Grade (mrTRG) Score and a Subjective Likert Score for Assessing Treatment Response in Locally Advanced Rectal Cancers-A Retrospective Study.

Purpose: Magnetic resonance imaging (MRI) with the help of MRI-based tumor regression grade (mrTRG) score has been used as a tool to predict pathological tumor regression grade (pTRG) in patients of rectal cancer post-neoadjuvant chemoradiation. Our study aims to evaluate the ability of MRI in assessing treatment response comparing an objective mrTRG score and a subjective Likert score, with a focus on the ability to predict pathologic complete response (pCR). Methods: Post-treatment MRI studies were retrospectively reviewed for 170 consecutive cases of histopathologically proven rectal cancer after receiving neoadjuvant chemoradiation and prior to surgery by two oncoradiologists blinded to the eventual postoperative histopathology findings. An objective (mrTRG) and a subjective Likert score were assigned to all the cases. Receiver operating characteristic curves were constructed to determine the ability of Likert scale and mrTRG to predict pCR, with postoperative histopathology being the gold standard. The optimal cutoff points on the scale of 1 to 5 were obtained for mrTRG and Likert scale with the greatest sum of sensitivity and specificity using the Youden Index. Results: The most accurate cutoff point for the mrTRG to predict complete response was 2.5 (using Youden index), with a sensitivity of 69.2%, specificity of 69.6%, positive predictive value (PPV) of 85.6%, negative predictive value (NPV) of 46.4%, and accuracy of 69.3%. The most accurate cutoff for the Likert scale to predict complete response was 3.5, with a sensitivity of 47.5%, specificity of 89.1%, PPV of 91.9%, NPV of 39.4%, and accuracy of 59%. mrTRG had a lower cutoff and was more accurate in predicting pCR compared to Likert score. Conclusion: An objective mrTRG was more accurate than a subjective Likert scale to predict complete response in our study.

Accuracy of Breast Ultrasonography and Mammography in Comparison with Postoperative Histopathology in Breast Cancer Patients after Neoadjuvant Chemotherapy.

Nowadays chemotherapy in breast cancer patients is optionally applied neoadjuvant, which allows for testing of tumor response to the chemotherapeutical treatment in vivo, as well as allowing a greater number of patients to benefit from a subsequent breast-conserving surgery. We compared breast ultrasonography, mammography, and clinical examination (palpation) results with postoperative histopathological findings after neoadjuvant chemotherapy, aiming to determine the most accurate prediction of complete remission and tumor-free resection margins. To this end, clinical and imaging data of 184 patients (193 tumors) with confirmed diagnosis of breast cancer and neoadjuvant therapy were analyzed. After chemotherapy, tumors could be assessed by palpation in 91.7%, by sonography in 99.5%, and by mammography in 84.5% (chi-square p < 0.0001) of cases. Although mammography proved more accurate in estimating the exact neoadjuvant tumor size than breast sonography in total numbers (136/163 (83.44%) vs. 142/192 (73.96%), n.s.), 29 tumors could be assessed solely by means of breast sonography. A sonographic measurement was feasible in 192 cases (99.48%) post-chemotherapy and in all cases prior to chemotherapy. We determined a superiority of mammography and breast sonography over clinical palpation in predicting neoadjuvant tumor size. However, neither examination method can predict either pCR or tumor margins with high confidence.

Tumor Characterization by [68Ga]FAPI-46 PET/CT Can Improve Treatment Selection for Pancreatic Cancer Patients: An Interim Analysis of a Prospective Clinical Trial.

Correct and timely diagnosis of pancreatic cancer (PC) is essential for treatment selection but is still clinically challenging. Standard-of-care imaging methods can sometimes not differentiate malignancies from inflammatory lesions or detect malignant transformation in premalignant lesions. This interim analysis of a prospective clinical trial aimed to evaluate the diagnostic accuracy of [68Ga]fibroblast activation protein inhibitor (FAPI)-46 PET/CT for PC and determine the sample size needed to demonstrate whether this imaging technique improves the characterization of equivocal lesions detected by standard-of-care imaging methods. Methods: [68Ga]FAPI-46 PET/CT imaging was performed on 30 patients scheduled for surgical resection of suspected PC. Target lesions were delineated, SUVmax and SUVmean were determined, and the results were compared with those of standard-of-care imaging. Receiver operating characteristics were calculated for the whole cohort and a subcohort of 11 patients with an equivocal clinical imaging work-up preoperatively. Postoperative histopathologic findings served as a reference standard, and the statistical power was determined. Results: Histopathologic examination revealed malignancy in 20 patients and benign lesions in 10 patients. Significantly elevated [68Ga]FAPI-46 uptake was observed in malignant tumors compared with benign lesions (P < 0.001). Receiver-operating-characteristic analyses established optimal cutoffs for both SUVs for differentiation of malignant from nonmalignant pancreatic tumors. The optimal SUVmax cutoff was 10.2 and showed 95% sensitivity and 80% specificity for the whole cohort, as well as 100% diagnostic accuracy when considering the subcohort with equivocal imaging work-up only. For sufficient statistical power, 38 equivocal observations are needed. Conclusion: We conclude that [68Ga]FAPI-46 PET/CT can accurately differentiate malignant from benign pancreatic lesions deemed equivocal by standard-of-care imaging. This trial will therefore continue to recruit a total of 120 patients to reach those 38 equivocal observations needed for sufficient statistical power. On the basis of our findings, we propose that [68Ga]FAPI-46 PET/CT not only can be clinically applied as a complement but also could become a necessary tool when standard-of-care imaging is inconclusive.