Preoperative Diagnostic Method Research Articles

Synergizing traditional CT imaging with radiomics: a novel model for preoperative diagnosis of gastric neuroendocrine and mixed adenoneuroendocrine carcinoma.

To develop diagnostic models for differentiating gastric neuroendocrine carcinoma (g-NEC) and gastric mixed adeno-neuroendocrine carcinoma (g-MANEC) from gastric adenocarcinoma (g-ADC) based on traditional contrast enhanced CT imaging features and radiomics features. We retrospectively analyzed 90 g-(MA)NEC (g-MANEC and g-NEC) patients matched 1:1 by T-stage with 90 g-ADC patients. Traditional CT features were analyzed using univariable and multivariable logistic regression. Tumor segmentation and radiomics features extraction were performed with Slicer and PyRadiomics. Feature selection was conducted through univariable analysis, correlation analysis, LASSO, and multivariable stepwise logistic. The combined model incorporated clinical and radiomics predictors. Diagnostic performance was assessed with ROC curves and DeLong's test. The models' diagnostic efficacy was further validated in subgroup of g-NEC vs. g-ADC and g-MANEC vs. g-ADC cases. Tumor necrosis and lymph node metastasis were independent predictors for differentiating g-(MA)NEC from g-ADC (P < 0.05). The clinical model's AUC was 0.700 (training) and 0.667(validation). Five radiomics features were retained, with the radiomics model showing AUC of 0.809 (training) and 0.802 (validation). The combined model's AUCs were 0.853 (training) and 0.812 (validation), significantly outperforming the clinical model (P < 0.05). Subgroup analysis revealed that the combined model exhibited acceptable performance in differentiating g-NEC from g-ADC and g-MANEC from g-ADC, with AUCof0.887 and 0.823 in the training cohort and 0.852 and 0.762 in the validation cohort. A combined model based on traditional CT imaging and radiomic features provides a non-invasive and effective preoperative diagnostic method for differentiating g-(MA)NEC from g-ADC.

MRI-based deep learning and radiomics for prediction of occult cervical lymph node metastasis and prognosis in early-stage oral and oropharyngeal squamous cell carcinoma: a diagnostic study.

The incidence of occult cervical lymph node metastases (OCLNM) is reported to be 20-30% in early-stage oral cancer and oropharyngeal cancer. There is a lack of an accurate diagnostic method to predict occult lymph node metastasis and to help surgeons make precise treatment decisions. To construct and evaluate a preoperative diagnostic method to predict OCLNM in early-stage oral and oropharyngeal squamous cell carcinoma (OC and OP SCC) based on deep learning features (DLFs) and radiomics features. A total of 319 patients diagnosed with early-stage OC or OP SCC were retrospectively enrolled and divided into training, test and external validation sets. Traditional radiomics features and DLFs were extracted from their MRI images. The least absolute shrinkage and selection operator (LASSO) analysis was employed to identify the most valuable features. Prediction models for OCLNM were developed using radiomics features and DLFs. The effectiveness of the models and their clinical applicability were evaluated using the area under the curve (AUC), decision curve analysis (DCA), and survival analysis. Seventeen prediction models were constructed. The Resnet50 deep learning (DL) model based on the combination of radiomics and DL features achieves the optimal performance, with AUC values of 0.928 (95% CI: 0.881-0.975), 0.878 (95% CI: 0.766-0.990), 0.796 (95% CI: 0.666-0.927), and 0.834 (95% CI: 0.721-0.947) in the training, test, external validation set1, and external validation set2, respectively. Moreover, the Resnet50 model has great prediction value of prognosis in patients with early-stage OC and OP SCC. The proposed MRI-based Resnet50 DL model demonstrated high capability in diagnosis of OCLNM and prognosis prediction in the early-stage OC and OP SCC. The Resnet50 model could help refine the clinical diagnosis and treatment of the early-stage OC and OP SCC.

Adnexal torsion in girls: Predictors and methods for surgical treatment. Case reports and review

Modern diagnostic and treatment methods make it possible to establish a preoperative diagnosis of uterine torsion and provide surgical assistance. Thus, the causes of this disease and the scope of surgical treatment must be investigated. This study reports the cases of 20 patients aged 3–17 years with uterine torsion who were treated at the St. Vladimir Children’s City Clinical Hospital between 2017 and 2023. Ultrasonography is a mandatory preoperative screening diagnostic method. All patients underwent laparoscopic surgery. During the postoperative period, magnetic resonance imaging was performed to confirm the diagnosis. Increased ovarian size due to cysts (7), paramesonephric cysts (4), and fixed lateroflexion (6) were identified as predictors of torsion. In 3 (15%) patients, the cause of torsion was unknown. Paramesonephric cysts were resected, and two adnexectomies were performed. After detorsion, 12 (60%) patients underwent fixation of the appendages. A literature search was conducted using PubMed, Scopus, eLibrary, and RSCI. A total of 47 articles were analyzed, 58 articles were reviewed, and 39 on the problems of determining predictors of uterine torsion in children and methods of surgical correction were selected. Based on the data obtained, the main disease predictors were clarified. A change in the angle of the uterus (lateroflexion) was found to cause the atypical location of the ovaries, which in turn can lead to torsion of the changed or unchanged appendage. Suggestions have been made regarding the connection between connective tissue dysplasia and uterine lateroflexion in the development of adnexal torsion in childhood. The results confirmed the complexity of the radiological diagnosis of lateroflexion. The scope of the surgical intervention for acute torsion of the uterine appendages was dependent on the etiology of the torsion and the degree of ischemia of the appendage. Various options for detorsion with unilateral and bilateral oophoropexy and without fixation of the injured appendage have been proposed. Removal of uncomplicated paramesonephric formations of the uterine appendages identified during diagnostic laparoscopy is a simple procedure and helps prevent torsion. Thus, puncture of accidentally detected ovarian cysts in patients who have not been examined for tumor markers is deemed inappropriate.

Diagnostic Efficacy of Type B Vessels in the Japan Esophageal Society Classification for the Depth of Invasion of Superficial Esophageal Squamous Cell Carcinoma.

The preoperative diagnostic method for superficial esophageal squamous cell carcinoma (SESCC) invasion depth based on the Japan Esophageal Society (JES) classification has been promoted. However, there have been a few investigations into its diagnostic performance in clinical settings. Therefore, we aimed to elucidate the actual diagnostic performance of the JES classification using a single-center retrospective study design. We retrospectively analyzed the clinical data of 315 newly diagnosed SESCC patients who underwent narrow-band imaging magnifying endoscopy (NBI-ME) examination and received endoscopic submucosal dissection (ESD) or esophagectomy in our center during the past 5 years. To evaluate the diagnostic performance of JES classification in assessing the depth of invasion of SESCC, clinical data of these patients were collected, and the concordance between NBI-ME findings and postoperative pathology reports was analyzed. This study included a total of 338 lesions. The diagnostic accuracy of vascular morphology was 76.0%. The sensitivity (87.0%) and positive predictive value (PPV, 85.4%) of B1 vessels were high, but the specificity (42.0%) and negative predictive value (NPV, 45.3%) were low. The specificity (86.9% and 98.8%) and NPVs (87.5% and 96.8%) of B2 and B3 vessels were high, but the sensitivity (36.4% and 21.4%) and PPVs (35.1% and 42.9%) ware low. Furthermore, only a few lesions (n = 57) described avascular area, but the overall diagnostic accuracy was not ideal (21.1%). However, if lesions invading the superficial submucosa or shallower were included in the category of "suitable for ESD", the overall accuracy of the JES classification was found to be 95.6%. In actual clinical settings, the overall accuracy of the JES classification system decreases, but the diagnostic performance of each subtype retains its original characteristics. Additionally, this classification is appropriate for determining whether type 0-II SESCC lesions are suitable for ESD.

Sonographic features of adenomyosis correlated with clinical symptoms and intraoperative findings: a case–control study

PurposeAdenomyosis is a common disease of females during their reproductive age. As of today, histologic examination of the uterus after hysterectomy constitutes the gold standard for diagnosis. The aim of this study was to determine the validity of sonographic, hysteroscopic, and laparoscopic criteria for the diagnosis of the disease.MethodsThis study included data collected from 50 women in the reproductive age of 18–45 years, who underwent a laparoscopic hysterectomy in the gynecology department of the Saarland University Hospital in Homburg between 2017 and 2018. The patients with adenomyosis were compared with a healthy control group.ResultsWe collected data of anamnesis, sonographic criteria, hysteroscopic criteria and laparoscopic criteria and compared it with the postoperative histological results. A total 25 patients were diagnosed with adenomyosis postoperatively. For each of these; at least three sonographic diagnostical criteria for adenomyosis were found compared with a maximum of two for the control group.ConclusionThis study demonstrated an association between pre- and intraoperative signs of adenomyosis. In this way, it shows a high diagnostic accuracy of the sonographic examination as a pre-operative diagnostic method of the adenomyosis.

BRAF p.V600E genetic testing based on ultrasound-guided fine-needle biopsy improves the malignancy rate in thyroid surgery: our single-center experience in the past 10 years

PurposeUltrasound-guided fine-needle aspiration biopsy (UG-FNAB) was implemented in Qilu Hospital of Shandong University in 2015 as a preoperative diagnostic method for thyroid surgery. BRAF p.V600E genetic testing was implemented in 2019. This study evaluated the impact of these two tests on the malignancy rate in patients undergoing thyroidectomy.MethodsA total of 19,496 patients were included in the study. We retrospectively collected data from patients undergoing thyroid surgery in the Hospital Information System (HIS) of Qilu Hospital of Shandong University from January 2012 to December 2021. Meanwhile, data of FNAB, UG-FNAB, and BRAF p.V600E genetic testing were collected. Differences in means among groups were analyzed via one-way ANOVA, and differences in frequencies were analyzed via Pearson’s chi-squared test.ResultsIn this study, the 10-year period was divided into three stages, with the implementation of UG-FNAB in 2015 and that of BRAF p.V600E genetic testing in 2019 as dividing lines. The malignancy rate in thyroid surgery increased significantly during these three stages (48.06% vs. 73.47% vs. 88.17%; P < 0.001). In the same period (May 2019 to December 2021), the malignancy rate in thyroid surgery was significantly different between the Non-FNAB, UG-FNAB, and UG-FNAB-BRAF groups (78.87% vs. 95.63% vs. 98.32%; P < 0.001).ConclusionsThe successful implementation of UG-FNAB and BRAF p.V600E genetic testing improved the malignancy rate in thyroid surgery and reduced unnecessary diagnostic surgery for benign and marginal lesions. It can, therefore, provide a clinical reference for other hospitals.

Solid pseudopapillary neoplasms of the pancreas: Is there a factor determining the prognosis? Experience of a single institution.

Solid pseudopapillary neoplasms (SPNs) are frequently seen in young women. Although the behavior pattern varies, these rare lesions generally have a low malignant potential. In this study, the aim was to investigate the effect of clinicopathological features of lesions on the recurrence in and survival of patients. In this study, patients of our clinic who were pathologically diagnosed with SPN after pancreatic surgery between July 2008 and December 2020 were evaluated retrospectively. Patients’ age, gender, comorbidities, symptoms at the time of application, preoperative CA 19-9, CEA value, preoperative cross-sectional diagnostic imaging method and lesion characteristics, surgery, postoperative complications, length of hospital stay, and histopathological features were evaluated. Early and late mortality, overall survival, disease-free survival, and recurrence rate were determined. Four of the 23 patients diagnosed with SPN were male and the median age was 29 (23–47) years. Of the study patients, 69.56% experienced pain symptoms and 30.43% were asymptomatic. The median tumor size was 4 cm (1.5–15). The most common surgical procedure was distal pancreatectomy (56.5%). The median length of hospital stays was 5 (3–120) days and morbidity was observed in 9 cases (39.13%). The mortality rate was 4.35%. The mean follow-up period in the series was 53 (8–132) months and none of the patients developed recurrence. In this study, no significant difference was found regarding recurrence in patients with SPN with histopathologically aggressive biological behavior. The overall survival rate was 95.7%. SPNs are rare lesions with low malignant potential. SPNs are associated with longer-term survival after surgical resection.

Duplex ultrasound for diagnosing symptomatic carotid stenosis in the extracranial segments.

Duplex ultrasound for diagnosing symptomatic carotid stenosis in the extracranial segments.

Evaluation of preoperative diagnostic methods for resectable pancreatic cancer: a diagnostic capability and impact on the prognosis of endoscopic ultrasound-guided fine needle aspiration

BackgroundA pathological diagnosis of pancreatic cancer should be performed as much as possible to determine the appropriate treatment strategy, but priorities and algorithms for diagnostic methods have not yet been established. In recent years, the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become the primary method of collecting tissues from pancreatic disease, but the effect of EUS-FNA on surgical results and prognosis has not been clarified.AimsTo evaluate the diagnostic ability of EUS-FNA and its effect on the preoperative diagnosis, surgical outcome, and prognosis of pancreatic cancer.MethodsBetween January 2005 and June 2017, 293 patients who underwent surgical resection for pancreatic cancer were retrospectively evaluated. The outcomes of interest were the diagnostic ability of EUS-FNA and its influence on the surgical results and prognosis.ResultsThe diagnostic sensitivity of EUS-FNA was 94.4%, which was significantly higher than that of endoscopic retrograde cholangiopancreatography (ERCP) (45.5%) (p < 0.001). The adverse event rate in ERCP was 10.2%, which was significantly higher than EUS-FNA (1.3%) (p = 0.001). Patients were divided into FNA group (N = 160) and non-FNA group (N = 133) for each preoperative diagnostic method. In the study of surgical curability R0 between the two groups, there was no significant difference in FNA group (65.0% [104/160]) and non-FNA group (64.7% [86/133], p = 1.000). In the prognostic study, 256 patients with curative R0 or R1 had a recurrence rate was 54.3% (70/129) in the FNA group and 57.4% (73/127) in the non-FNA group. Moreover peritoneal dissemination occurred in 34.3% (24/70) in the FNA group and in 21.9% (16/73) in the non-FNA group, neither of which showed a significant difference. The median survival times of the FNA and non-FNA groups were 955 days and 799 days, respectively, and there was no significant difference between the two groups (log-rank p = 0.735). In the Cox proportional hazards model, factors influencing prognosis, staging, curability, and adjuvant chemotherapy were the dominant factors, but the preoperative diagnostic method (EUS-FNA) itself was not.ConclusionsEUS-FNA is a safe procedure with a high diagnostic ability for the preoperative examination of pancreatic cancer. It was considered the first choice without the influence of surgical curability, postoperative recurrence, peritoneal dissemination and prognosis.

Preoperative Doppler Ultrasonography Allen Test for Radial Forearm Free Flap in Oral Cancer Reconstruction: Implications in Clinical Practice.

The Radial Forearm Free Flap (RFFF) is one of the most widely used microsurgical flaps for intraoral reconstruction. Although the Clinical Allen Test (CAT) is the most widely used preoperative diagnostic method with which to study the distal patency of the hand prior to the use of RFFF, several authors have reported potentially preventable serious vascular complications. This study included 87 consecutive patients with cancer of the oral cavity and RFFF as the flap of choice who were treated between 2010 and 2020, and compares the results of the Clinical Allen Test (CAT), the Doppler Allen Test (DAT) and the Surgical Allen Test (SAT). The preoperative vascular study found vascular abnormalities severe enough for the surgical team to change the preoperative flap of choice in 39% of patients. The Kappa index showed a weak concordance between the CAT and DAT. The study reflected a total concordance in the preoperative results of the Doppler study and the intraoperative results of the SAT. Due to its excellent agreement with SAT, the DAT would be the preoperative test of choice in patients who are candidates for RFFF. This study of vascular mapping tests with Doppler is intended to inform therapeutic decisions and present methods to gain information that cannot be obtained by physical examination alone.

English

BACKGROUND Breast cancer is now the most common cancer in cities in India and 2 nd most common cancer in the rural areas. Fine needle aspiration cytology (FNAC) is a less invasive pre-operative diagnostic method and is preferred over core / excision biopsy to decide the benign or malignant nature of the breast lump. Prognostic factor assessment by FNAC would allow the identification of patients who would benefit from neo adjuvant treatment (patients with grade 3 tumours) and in whom conservation surgery is inadvisable.1 The purpose of this study is to compare the grades of breast cancer in FNAC with histopathology as gold standard and compare the oestrogen (ER) and progesterone (PR) hormonal expression pattern on immunocytochemistry (ICC) with immunohistochemistry (IHC). From this study we intend to assess the usefulness of cytological grading and ER, PR hormone receptor status pre-operatively so that hormonal therapy can be included with neoadjuvant chemotherapy. METHODS This is a cross sectional study with a sample size of 50, conducted in the Department of Pathology. RESULTS Out of 50 cases, maximum number of patients were in the age group of 51 - 60 years. 68 % had attained menopause; 69 % of patients had tumour size between 2 - 5 cm and 90 % of tumours were in the upper outer quadrant of breast. Considering hormonal expression, in case of ER there was a moderate agreement between ICC and IHC (κ = .428, P = 0.005) and no agreement was seen in case of PR (κ = .073, P = 0.625). Regarding the cytological grading, this study showed highest degree of concordance with grade II tumours with a sensitivity of 75.9 %. For Grade I it was 2.5 % and for grade III, it was 33.3 %. CONCLUSIONS Evaluation of hormonal status and nuclear grading is fairly reliable on cytology when performed on qualitatively superior FNAC material from the primary breast lesions. KEYWORDS Carcinoma Breast, FNAC, ER / PR, Immunocytochemistry, Immunohistochemistry, Cytological Nuclear Grading

Morcellation in gynecology: short review and suggestions from Turkish Society of Minimally Invasive Gynecologic Oncology

Morcellation allows the removal of a large uterus and fibroids through small incisions with minimally invasive surgery. It helps to prevent the complications associated with large incisions in both hysterectomy and myomectomy operations. Currently, there is much debate regarding the use of power morcellation in laparoscopic hysterectomy and myomectomy, mainly due to the risk of peritoneal dissemination of undiagnosed uterine sarcomas. Unfortunately, there is no valid pre-operative diagnostic method that can differentiate sarcomas from myomas, and the currently available scientific literature regarding morcellation is insufficient. As the Turkish Society of Minimally Invasive Gynecological Oncology, we present our consensus opinion and suggestions for the preoperative evaluation and morcellation of fibroids, in line with the recent literature.

Accuracy and clinical value of an adhesion scoring system: A preoperative diagnostic method using transvaginal ultrasonography for endometriotic adhesion.

To investigate the accuracy and clinical value of an adhesion scoring system using transvaginal ultrasonography for endometriotic adhesion. In this prospective observational study, we included 131 patients with endometriosis who underwent surgery. Before surgery, transvaginal ultrasonography and adhesion mapping were performed to determine the presence or absence of adhesions at 10 sites of the pelvis. Mapping accuracy was determined by comparing the mapping findings with the surgical findings. To determine the severity of pelvic adhesions, we developed an adhesion score (0-10). With the adhesion score, we assessed the effect of surgical adhesiolysis and evaluated the relationship between postoperative adhesions and infertility. Of the 10 sites assessed for adhesions, the most frequent site of adhesions was the site between the left ovary and the uterus (70.5%). The overall sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy of adhesion mapping were 80.4%, 86.1%, 78.8%, 87.2%, 5.79, 0.23 and 83.9%, respectively. The adhesion score in this system was significantly correlated with the adhesion-related score in the revised American Society for Reproductive Medicine classification (R2 = 0.734). Surgical adhesiolysis yielded only about 30% improvement postoperatively. The adhesion score 1 month after surgery in the non-in vitro fertilization (IVF) pregnancy group was significantly lower than that in the IVF pregnancy group (3.45 vs 5.21; P = 0.02). Our adhesion scoring system allowed an accurate prediction of the pelvic adhesion status and may potentially be an indicator of postoperative adhesions and infertility.

Combining Ultrasound with a Pediatric Appendicitis Score to Distinguish Complicated from Uncomplicated Appendicitis in a Pediatric Population.

Background:The accurate diagnosis of complicated appendicitis has been improved by using various diagnostic modalities. However, no preoperative diagnostic method could completely confirm the results. Therefore, preoperative diagnosis of complicated appendicitis to have the right management is still a huge challenge.Objectives:The aim of this study was to evaluate the diagnostic value of ultrasound combined with pediatric appendicitis score for differentiation between acute uncomplicated appendicitis and acute complicated appendicitis in a pediatric population.Methods:We prospectively evaluated 120 pediatric patients who underwent surgery for acute appendicitis from November 2017 to June 2019. Pediatric appendicitis score (PAS) was calculated and ultrasound (US) was performed before surgery. The histopathology of phlegmonous appendicitis corresponds to uncomplicated appendicitis (AUA), while gangrenous appendicitis and perforation are classified as complicated appendicitis (ACA).Results:Histopathologically, the results provided a diagnosis of acute appendicitis including 86 (71.7%) patients with AUA and 34 (28.3%) children with ACA. US findings showed a sensitivity of 23.5%, the specificity of 95.4%, PPV of 66.7%, NPV of 75.9%, and an accuracy of 75%. PAS of 8 was found to be the most appropriate cutoff point compatible with ACA; it resulted in a sensitivity of 76.5% and a specificity of 84.1%. Combining ultrasound with a pediatric appendicitis score resulted in a higher specificity to distinguish complicated from uncomplicated appendicitis when compared with ultrasound or PAS solely.Conclusions:the US is highly specific but nonsensitive for detecting complicated pediatric appendicitis. Combining ultrasound with pediatric appendicitis is a very good concept to distinguish complicated from uncomplicated appendicitis in a pediatric population.

Head and Neck Schwannomas: A Tertiary Referral Single-Center Experience

Objective: The aim is to share our experience of the clinical features and important issues encountered in diagnosing and treating multiple head and neck schwannoma cases seen at our centre, all of which went on to have surgical treatment. Methods: This was a retrospective review of the medical records of cases over an 11-year period (2007–2018) diagnosed with schwannoma by post-surgical histopathology. The demographic characteristics of these cases, along with their clinical characteristics, namely, tumour location, preoperative diagnostic tests undertaken, surgical approach used, and any postoperative complications, including the management of such complications, were reviewed. Results: A total of 31 patients (18 male, and 13 female) were included in the study. Contrast-enhanced magnetic resonance imaging was the most commonly used pre-operative diagnostic method (77%). 58% of the cases were extra- and 42% intra-cranial. Extracranial schwannomas were noted to arise from several different areas of the head and neck region. The most common neurological deficit post-operatively was facial paralysis. Conclusion: Since head and neck schwannomas can develop from any area where the nerve sheath is present, they may present with a wide variety of non-specific symptoms. The treatment plan should be made with the anticipated preoperative and postoperative neurological deficit firmly in mind.

Triple Diagnostic Accuracy on Early Stage Breast Cancer at Cipto Mangunkusumo Hospital and Persahabatan Hospital

Introduction. Breast cancer is the most common cancer in Indonesia with incidence rate 40.3 per 100.000 women and mortality rate 16.6 per 100.000 women. On early stage, the decision for operative procedure (i.e. mastectomy) requires intraoperative frozen section to assess malignancy; which is mostly unavailable in secondary hospitals. The triple diagnostic (TD) test consists of physical examination, breast ultrasonography and fine needle aspiration biopsy is an accurate and simple preoperative diagnostic method that may solve the problem. The study aimed to find out conformance of the triple diagnostic to histopathology findings in those with breast lump where the malignancy was suspected. Method. A study of diagnostic accuracy conducted enrolling subjects with suspected malignant breast lump managed in dr Cipto Mangunkusumo General Hospital (RSCM) and Persahabatan Hospital (RSP) in period of February 2016 to August 2017 who met the criteria: those underwent preoperative triple diagnostic, intraoperative frozen section and histopathology examination. The conformance of TD and frozen section were compared to histopathology findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were the focuses of the study. Results. There were 33 subjects enrolled (prevalence of 4.3%), mean age of 49.6 years ± 10.9, were above 40 years (78.8%). Tumor size of 2–5 cm found in 63.6% subjects, and the most histopathology finding was invasive carcinoma (84.8%). Frozen section showed sensitivity of 96.8%, specificity of 100%, PPV of 100%, NPV of 66.7% and accuracy of 97.0%. TD showed sensitivity of 77.4%, specificity of 100%, PPV of 100%), NPV of 22.2% and accuracy of 78.8% (p = 0.016). Conclusion. Triple diagnostic reaches up to 78% accuracy on early stage breast cancer may be used secondary hospital in Indonesia whenever frozen section is unavailable

Clinical cohort study of imaging evaluation and postoperative pathology of carotid vulnerable plaque

Objective: To evaluate the accuracy of contrast-enhanced ultrasound(CEUS) scanning in identifying vulnerable plaque in carotid artery. Methods: The study included a total of 25 patients who suffered from carotid artery stenosis and underwent carotid endarterectomy from January 2016 to December 2017 in Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University. Preoperative carotid artery contrast enhanced ultrasound and High-resolution MRI were performed to all patients to determine whether the plaques were stable. All patients then underwent carotid endarterectomy, during which, plaques were completely removed. Biopsies were performed using HE staining and CD31, CD34 and SMA immunohistochemistry was used to identify the plaques properties, including the thickness and integrity of the fiber cap, neovascular endothelium, hemorrhage, and inflammatory cells in the removed plaques.The results of these tests were compared with the diagnosis through the pre-operative imaging. Results: Among twenty-five cases, the pre-operative CEUS revealed sixteen with unstable plaques and nine with stable plaques. Meanwhile the post-operation pathology confirmed seventeen cases with unstable plaque components. The sensitivity of CEUS in the identification of carotid vulnerable plaque was 88.2%(15/17), the specificity was 87.5%(7/8), and the overall diagnostic accuracy was 88%(22/25). The sensitivity, specificity and overall diagnostic accuracy of high resolution MR for vulnerable plaque identification were 83.3%(10/12), 71.4%(5/7), 78.9%(15/19), respectively. There were no significant difference between two groups(χ(2)=0.003, P>0.05). Conclusions: The sensitivity, specificity and overall diagnostic accuracy of the CEUS for vulnerable plaque identification are high.Therefore, CEUS is recommended as one of the pre-operative diagnostic method for unstable plaque in carotid stenosis.

Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) level difference in benign and malignant epithelial ovarian tumor

Background: Malignant ovarian tumor is one of the most common types of cancer in women worldwide, and most patients come with advanced stage. Until now, a pre-operative diagnostic method to determine malignant ovarian tumor was considered unsatisfying. Neutrophil gelatinase-associated lipocalin (NGAL) allegedly plays a role in proliferation and metastasis of the cancer cells, so it is important to explore the difference of serum NGAL levels between benign and malignant epithelial ovarian tumor.Aim: to determine the characteristics of patients with benign and malignant epithelial ovarian tumor, histologic types, and serum NGAL levels difference in benign and malignant epithelial ovarian tumor.Method: This was a comparative analytic study with a cross-sectional design. Forty patients were chosen with consecutive sampling; each group consists of 20 female patients who will undergo primary surgery for suspicious of benign and malignant epithelial ovarian tumor. A blood sample was collected one day prior to the surgery and confirmed with histopathologic examination after surgery.Results: most of the patients aged 20-50 years old, had ≥1 child and the most common histopathology type of malignant epithelial ovarian tumor was mucinous adenocarcinoma while the majority of the benign epithelial ovarian tumor was endometriotic cyst. The median rate of NGAL in the malignant epithelial ovarian tumor was 219.5 ng/ml, higher than median rate of NGAL in benign epithelial ovarian tumor with 132.5 ng/ml, the difference was statistically significant (p &lt; 0.001). The median rate of NGAL in malignant epithelial ovarian tumor according to the stage of disease showed no significant difference.Conclusion: A new diagnostic criteria of epithelial ovarian tumor needs to be considered which include NGAL as one of the screening components.

P1.03-082 18F-FDG PET/CT Value Staging NSCLC Extension to the Lymph Nodes, Single Center Experience

Non small-cell lung carcinoma (NSCLC) is the most common type of lung cancer. Correct clinical and pathological lymph node (N) staging is critical for choosing the best treatment. Positron emission tomography/computed tomography (PET/CT), being non-invasive pre-operative diagnostic method is becoming increasingly popular. Therefore, we aimed to evaluate the accuracy same as false-negative and false-positive results of PET/CT when compared to histopathological diagnoses at Vilnius university hospital Santariskiu klinikos (VUL SK). A retrospective analysis included 15 NSCLC patients who underwent preoperative PET/CT scan and postoperative histopathological analysis for the N staging at VUL SK. PET/CT N stage was compared with gold standard histopathological N stage to assess the sensitivity, specificity, positive and negative predictive values for N staging of NSCLC. There were 15 patients (11 men (73,3%), 4 women (26,7%)) with average age of 66,1±10,2 years included into the study. Ten patients (66,7%) were staged N>0 by PET/CT, histopathological analysis confirmed 4 diagnoses (40%), other 6 diagnoses (60%) were considered false positive. Five patients (33,3%) were staged N0 by PET/CT, histopathological analysis confirmed 3 diagnoses (60%), other 2 diagnoses (40%) were false negative. Estimated specificity of PET/CT for N staging of NSCLC was 25%; sensitivity – 57,14%, positive predictive value – 40%, negative predictive value – 60%. Despite many advantages, PET/CT still has limited value staging NSCLC. Significant number of inaccuracies in N staging may occur evaluating inflammatory lymph nodes. The necessity of histologic confirmation of N stage in stage I-IIIa NSCLC is crucial as these patients may have surgical treatment combination and better outcomes.

Discordance between clinical and pathological TNM classification: influence on results of treatment and prognosis in patients with laryngeal cancer.

The goals of this retrospective cohort study were to compare the results of clinical and pathological TNM staging in patients with laryngeal squamous cell carcinoma and to determine the impact of the discordance on prognosis and treatment results. Atotal of 124 patients with laryngeal cancer, primarily indicated for surgical treatment, were enrolled. The concordance or discordance between the clinical and pathological staging was compared with the frequency of cancer relapse and disease-specific survival. Other potential prognostic factors, like age, the stage and location of the primary tumor, the status of neck lymph nodes, histological margins, and an indication for postoperative radiotherapy, were also evaluated. Adisparity in at least one component of TNM staging was found in 40 patients (32%). The discordance had significant negative influence on both disease-free survival (DSF) and disease-specific survival (DSS). Other significant negative prognostic factors were the stage of the primary tumor, nodal status and postoperative radiotherapy. Our results indicate that the discordance between clinical and pathological staging affects the results of cancer treatment significantly. Some improvement can be probably achieved with higher preoperative diagnostic method accuracy.