Preoperative Diagnostic Modality Research Articles

Thyroid fine-needle aspiration cytology: malignancy rate in the category of indeterminate significant atypia/indeterminate significant follicular lesion.

Fine needle aspiration cytology (FNAC) is a standard preoperative diagnostic modality for thyroid nodules. The Bethesda Thyroid Cytopathology Reporting System (TBSRTC) defines the FNAC atypia group as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS). Determine the risk of malignancy after surgical resection in patients with AUS/FLUS. Retrospective. Pathology department of a tertiary care center. All thyroid FNACs between 2015 and 2023 that were diagnosed as AUS/FLUS in Turkey. Patient demographics, preoperative ultrasonographic features, and follow-up data were collected. Relationship between AUS/FLUS diagnosis and final histopathological diagnosis. 562. In total, 562 thyroid nodules were diagnosed as AUS/FLUS, and 267 (47.5%) were surgically excised. A malignant histopathological diagnosis was given in 28 cases (10.4%). Malignancy risk sensitivity of AUS/FLUS diagnosis was 75.68% (95% CI=58.80-88.23%), specificity was 55.24% (95% CI=50.91-59.52%), positive predictive value was 10.49% (95% CI=8.71-12.58%), and negative predictive value was 97.04% (95% CI=94.86-98.31%). In the ultrasonographic data, having symptomatic nodules, nodule calcification, and irregular nodule borders were all statistically significant signs of cancer in a one-variable analysis (P<.01). The presence of a family history emerged as a statistically significant prognostic marker for malignancy (P=.012). Although not statistically significant, the malignancy rate for nodules with nuclear atypia was 11.9%, significantly higher than the rate of 8.3% for nodules with architectural atypia only (P=0.32). The diagnosis of AUS/FLUS has a high rate of predicting the risk of malignancy and should continue to be offered. In addition to cytopathological features, ultrasound data and family history should be taken into consideration when evaluating the case. Retrospective design and no molecular studies.

Diagnostic Accuracy of FNAC and Ultrasonography in Salivary Gland Lesions in Comparison with Histopathology

Introduction: Modern era demands for early and accurate diagnosis. Fine Needle Aspiration Cytology (FNAC) and Ultrasonography (USG) are two such diagnostic modalities which have gained importance in recent years due to their rapid, repeatable and precision properties. Aim: To study the accuracy of FNAC and USG in diagnosing salivary gland lesions in comparison with histopathology and to study the expression of p63 and Cytokeratin 7 (CK7) Immunohistochemical (IHC) markers in malignant salivary gland tumours. Materials and Methods: A cross-sectional study was conducted on 106 cases who presented with salivary gland lesions possessing USG reports and underwent FNAC and surgical specimens received in Cytopathology and Histopathology Department, Government Medical College Thiruvananthapuram, Kerala, India during one year period (February 2017-January 2018). In each case FNAC was performed and slides were stained with Papanicolaou and Giemsa, surgical specimens were grossed, histopathological features studied under microscope and tumours classified according to World Health Organisation (WHO) Classification of Salivary gland Tumours 2017. Diagnosis on USG and FNAC were compared with histopathological diagnosis. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), diagnostic accuracy, concordance and discordance was calculated by Statistical Package for the Social Sciences (SPSS) software 24.0 version. p63 and CK7 IHC markers were done only in malignant salivary gland tumours. Results: In the present study majority of lesions i.e. 82 cases (77.4%) were seen predominantly in parotid gland and pleomorphic adenoma was the most commonest lesion and neoplasm overall with 50 cases (47.2%). Most common malignant neoplasm was mucoepidermoid carcinoma (four cases, 3.8%). USG and FNAC had high diagnostic accuracy of 89.6% and 97.2% in comparison to histopathology in diagnosing salivary gland lesions. Conclusion: High sensitivity and specificity of USG and FNAC makes them most acclaimed preoperative diagnostic modality for salivary gland lesions, but histopathology remains gold standard. Subtyping of malignant and cystic lesions were difficult in USG and cytology

EP.TH.756Post-operative sepsis: Is CT reliable in diagnosing the cause of post-operative sepsis?

Abstract Aim To assess the reliability of computerised tomography in post-operative sepsis in patients who previously underwent laparotomy in the same hospital admission. Introduction Method This study was done on re-operations following an abdominal operation from April 2012 to April 2016 at a district general hospital. Data regarding demography, initial operation, post-operative problems, pre-operative diagnosis, and use of computed tomography, the findings on CT, and operative findings were collected. A comparison was made between the CT findings and findings on re-laparotomy. Also noted was the number of patients who did not have a re-laparotomy following CT. Result There were 87 patients, of whom, 10 had no accessible notes and were removed from the list. Of the remaining 77, 53(68.8%) had CT scans, 24 did not (31.2%). Of these that had CT, 29 (54.7%) had findings which matched with intra-operative findings on re-laparotomy, in 12 (22.6%) CT findings did not match 4(7.5%) had minor findings not needing surgery and 8(15.5%) had normal or insignificant findings. Conclusions We found in this study that, CT did have a significant contributory role in the arsenal of methods to aid source control in those patients that are septic following an abdominal operation, and this should be used as a pre-operative diagnostic modality.

A COMPARATIVE ANALYSIS OF FNAC AND BIRADS IN EVALUATION OF PALPABLE BREAST LUMP

Breast lump is one of the most common complaint among female patients in India. FNAC is one of the important preoperative diagnostic modality in case of breast lesion. Correlation between BIRADS category and cytological findings are useful to establish an accurate preoperative diagnosis and further treatment protocols. In the present study, FNAC smear were stained by Leishman &amp; Giemsa stain. Reporting was done in correlation with BIRADS category. Our study consisted of 80 cases of palpable breast lesions, of which 54 were benign and 26 malignant. The study showed overall 8 1.25% concordance with BIRADS category

Diagnostic Utility of Ultrasound-Guided Fine-Needle Aspiration Cytology in Gall Bladder Lesions: An Experience from a Tertiary Care Cancer Center in Eastern India.

Introduction:Gallbladder cancer (GBC) is the most common malignancy, representing 80–95% of biliary tract cancers. Although ultrasonography-guided fine-needle aspiration cytology (USG-FNAC) has emerged as an effective diagnostic the tool for the precise diagnosis of gallbladder lesions, data on its diagnostic utility and cytomorphological categorization of gallbladder lesions are lacking.Aims:To study the diagnostic utility of USG-FNAC in gallbladder lesions.Materials and Methods:This study was the conducted prospectively on patients who came with clinical and radiological evidence of gallbladder space-occupying lesion and then advised to USG-FNAC over 2 years and 6 months from January 2018 to June 2020.Results:A total of 314 cases were included. The mean age was 56 years, with a range of 17–88 years. Women predominated over men (Male:Female = 1:2.3). Primary adenocarcinoma of the gallbladder was most common. On cyto-histological correlation, the sensitivity, specificity, and diagnostic accuracy of USG-FNAC of gallbladder lesions were found to be 98.82, 87.23, and 96.3%, respectively.Conclusion:The USG-FNAC of gallbladder lesion was found to be an easy, quick, cost-effective, and presumptive diagnostic procedure. It should be opted as an initial preoperative diagnostic modality in high incidence areas to avoid inappropriate management with unnecessary morbidity and cost. Moreover, a close cytological examination of the architectural pattern and the cytomorphological features would help in the sub-typing and prognosticating the tumor.

Fetus in Fetu: Lessons Learned from a Large Multicenter Cohort Study.

Fetus in fetu (FIF) is an extremely rare condition of abnormal twinning during embryogenesis. Most publications are single case reports. We describe the combined experience of four large tertiary referral centers with FIF which were not previously reported or published, and thereby draw conclusions to establish criteria for the workup, diagnosis, and management including intraoperative risk. A survey was forwarded to a national pediatric surgery group which includes members from all pediatric surgery centers in the country enquiring about unpublished cases of FIF encountered over a 20-year interval. The cohort was analyzed for age of presentation, type of presentation, diagnostic workup, surgical management, and outcome. From 1998 to 2018, a total of 10 FIF cases were included in the study. Mean age of presentation was 4 months. Computed tomography and ultrasound were the main preoperative diagnostic modality in our cohort. Resection of the mass was curative in nine cases. Two cases in which the FIF was in direct topographic proximity to the biliary tree suffered severe intraoperative or lethal postoperative complications. Complete excision of FIF is the treatment of choice and generally results in excellent long-term quality of life. Mortality is rare and may be associated with biliary involvement and retroperitoneal right upper quadrant location of the FIF tends to be associated with increased risk in excision, and there is also a possible association with the presence of immature elements in the pathology report.

Fine needle aspiration cytology of epididymal nodules and its corroboration with ultrasonographic-histological findings.

Fine needle aspiration cytology (FNAC) assisted with scrotal ultrasonography is the best preoperative diagnostic modality for palpable epididymal nodules. It also aids in their successive remedial approach as well as serves semi-therapeutically in cystic lesions. The objectives of this study are to recognize the spectrum of pathological conditions giving rise to epididymal nodules, then to compare them with corresponding ultrasound images, and to evaluate the histological features wherever practicable. Total 62 patients underwent FNAC as well as sonographic evaluation for their epididymal nodules. Histopathology was performed in only 20 cases. Epididymitis either caused by tuberculosis (30.6%), or in its acute (11.3%) and chronic (8.1%) forms remained the commonest cytological diagnosis. Neoplastic lesions included mostly adenomatoid tumors (8.1%), and another case of seminomatous spread from ipsilateral testicular primary. Nineteen of the excised masses corroborated with their respective cytodiagnoses. The discrepant lesion was actually a papillary cystadenoma, which was cytologically misinterpreted as adenomatoid tumor. FNAC becomes the first-hand investigative measure for epididymal nodules, by virtue of its early, easy and highly accurate diagnostic implications. It segregates the patients into proper therapeutic protocol and thereby estranges those who really need operative management. When deployed together with ultrasound, the diagnostic accuracy of FNAC improves further.

Factors Associated with Reoperation in Breast-Conserving Surgery for Cancer: A Prospective Study of American Society of Breast Surgeon Members

BackgroundMore than 20% of patients undergoing initial breast-conserving surgery (BCS) for cancer require reoperation. To address this concern, the American Society of Breast Surgeons (ASBrS) endorsed 10 processes of care (tools) in 2015 to be considered by surgeons to de-escalate reoperations. In a planned follow-up, we sought to determine which tools were associated with fewer reoperations.MethodsA cohort of ASBrS member surgeons prospectively entered data into the ASBrS Mastery® registry on consecutive patients undergoing BCS in 2017. The association between tools and reoperations was estimated via multivariate and hierarchical ranking analyses.ResultsSeventy-one surgeons reported reoperations in 486 (12.3%) of 3954 cases (mean 12.7% [standard deviation (SD) 7.7%], median 11.5% [range 0–32%]). There was an eightfold difference between surgeons in the 10th and 90th percentile performance groups. Actionable factors associated with fewer reoperations included routine planned cavity side-wall shaves, surgeon use of ultrasound (US), neoadjuvant chemotherapy, intra-operative pathologic margin assessment, and use of a pre-operative diagnostic imaging modality beyond conventional 2D mammography. For patients with invasive cancer, ≥ 24% of those who underwent reexcision did so for reported margins of < 1 or 2 mm, representing noncompliance with the SSO-ASTRO margin guideline.ConclusionsAlthough ASBrS member surgeons had some of the lowest rates of reoperation reported in any registry, significant intersurgeon variability persisted. Further efforts to lower rates are therefore warranted. Opportunities to do so were identified by adopting those processes of care, including improved compliance with the SSO-ASTRO margin guideline, which were associated with fewer reoperations.

The impact of preoperative elevated serum C-reactive protein on postoperative morbidity and mortality after anatomic resection for lung cancer

IntroductionThe aim of this study was to determine whether preoperative elevated serum C-reactive protein (CRP) is an independent risk factor of postoperative morbidity and mortality after pulmonary resection for lung cancer. Material and methodsA retrospective analysis of prospectively collected data on 1414 consecutive patients that underwent an anatomic resection for lung cancer was performed. Patients’ characteristics, operative procedures and the postoperative outcome were assessed with a standardised data entry form. Univariate and multivariate analyses were conducted to identify factors that affect morbidity and mortality. ResultsPostoperative complications occurred in 35.5% of the patients. The mortality rate was 3.2%. Patients with preoperative C-reactive protein above 40mg/l showed more overall complications and a higher mortality than patients below this limit. Patients with a CRP level between 3mg/l and 40mg/l had no significant increase in morbidity and mortality compared to patients with values ​​below the detection limit (< 3mg/l). ConclusionsPreoperative serum C-reactive protein level is an independent and significant indicator for elevated morbidity and mortality after pulmonary resection. We propose the evaluation of CRP levels as a preoperative diagnostic modality of risk assessment in addition to standardised functional testing.

Chondrosarcoma of the hyoid bone – Report of a case and a literature review of the suitable treatment strategy

Chondrosarcoma is a rare malignant tumor occurring in the trunk and long bones. We present an extremely rare case of chondrosarcoma of the hyoid bone with clinical and pathological correlation and a literature review. We searched all cases of the hyoid chondrosarcoma in PubMed (MEDLINE) between 1990 and 2015. Eighteen cases were analyzed, including the present case. Most of them were low grade type. In 12 cases where intraoperative findings were recorded, no adhesion to the surrounding tissue was observed. Chondrosarcoma of the hyoid bone is usually low grade type, and there may be no invasion to the adjacent structures even if invasion is suspected by imaging findings. In order to preserve swallowing and laryngeal function, total hyoidectomy without laryngectomy should be indicated according to the intraoperative findings. Needle biopsy is an effective diagnostic technique, but open biopsy should be avoided to prevent the dissemination. To the best of our knowledge, this is the first presentation of hyoid bone chondrosarcoma with the investigation of intraoperative findings and pre-operative diagnostic modality.

Preoperative Diagnosis of Pancreatic Cystic Lesions: The Accuracy of Endoscopic Ultrasound and Cross-Sectional Imaging.

This study aimed to evaluate the accuracy of endoscopic ultrasound (EUS) and cross-sectional imaging including multidetector computed tomography (MDCT) or magnetic resonance imaging (MRI) as a preoperative diagnostic modality for the pancreatic cystic lesions. Three hundred eighteen patients with surgically proven pancreatic cystic lesions were enrolled as a study cohort from 1998 to 2011. Preoperative radiological, EUS, and final histopathologic diagnosis were correlated to measure several kinds of diagnostic performance. A total of 318 patients underwent preoperative MDCT, with additional imaging modalities such MRI and/or EUS in 215 (67.6%) and 108 (34.0%) patients, respectively. κ Values among the different modalities were as follows: MDCT versus pathology = 0.52 (P < 0.0001), MDCT + MRI versus pathology = 0.674 (P < 0.0001), and EUS versus pathology = 0.558 (P < 0.0001). The sensitivity and specificity in terms of ability to predict neoplastic cysts were as follows: MDCT, 83.1%/70.0%; MDCT + MRI, 94.7%/58.7%; and EUS, 88.5%/52.9%. The diagnostic accuracies of MDCT and MDCT + MRI were 61.4% (62/101) and 80.5% (173/215), respectively, and that of EUS was 70.4% (76/108). Magnetic resonance imaging as an additional diagnostic modality to MDCT increased the accuracy, sensitivity, and specificity, as well in terms of predicting neoplastic cysts.

Tracheobronchomalacia in pediatric patients with esophageal atresia: Comparison of diagnostic laryngoscopy/bronchoscopy and dynamic airway multidetector computed tomography

PurposeDiagnostic laryngoscopy and bronchoscopy (DLB) has been the traditional preoperative diagnostic modality for evaluating presence and severity of tracheobronchomalacia (TBM), and requires anesthesia. Alternatively, multidetector computed tomography (MDCT) is potentially a noninvasive modality that provides high-resolution, 3-dimensional (3D) imaging of the thorax providing preoperative guidance for pediatric surgeons. This study compares MDCT with intraoperative DLB in the assessment of TBM in symptomatic pediatric patients with esophageal atresia (EA). MethodsFollowing IRB approval all pediatric patients (≤18years) who had EA and who underwent an MDCT study as a preoperative evaluation of TBM prior to aortopexy were retrospectively reviewed. Patients with incomplete reports on intraoperative DLB or MDCT studies were excluded. Two pediatric radiologists independently evaluated all MDCT studies in a blinded fashion. On both DLB and MDCT studies, TBM was scored as present or absent in five anatomic segments: upper, middle, and lower trachea, as well as right and left main stem bronchi. Operative reports including DLB findings were reviewed and compared to findings from MDCT study using the chance corrected kappa (κ) coefficient. Diagnostic accuracy of dynamic MDCT for detecting TBM was determined by sensitivity and specificity, and interobserver agreement between two radiology reviewers was measured by the kappa statistic. ResultsThe final study population included 18 patients (8 males and 10 females) with ages ranging from 1month to 11years (median: 7months). Their presenting clinical symptoms included apneic spells (n=15, 83%) and failure to extubate (n=3, 17%). The overall diagnostic accuracy of dynamic airway MDCT compared to DLB was 91% (82/90 possible segments for TBM) with excellent overall agreement across all 5 anatomic segments (κ=0.82, p<0.001). The agreements for upper, mid, lower trachea, and right and left trachea were 89% (κ=0.73, p<0.001), 94% (κ=0.85, p<0.001), 89% (κ=0.76, p<0.001), 94% (κ=0.82, p<0.001), and 89% (κ=0.61, p=0.005); respectively. Interobserver agreement between two radiologists was excellent (κ=0.98, 95% confidence interval: 0.94–1.00, p<0.001) with only 1 disagreement between two radiologists that was found for the left main bronchus. Fifteen (83.3%) of the patients clinically improved after the aortopexy. ConclusionMDCT with 3D imaging is a highly accurate and reliable preoperative noninvasive imaging modality for evaluating TBM in pediatric patients with EA providing anatomic information consistent with and complimentary to bronchoscopy.

Robinson’s cytological grading of breast carcinoma and its correlation with Scarff Bloom Richardson’s histologic grading

Background: Carcinoma of the breast is one of the most common cancers in women. Fine needle aspiration cytology is the most common preoperative diagnostic modality. Preoperative grading of breast carcinomas would be desirable for the selection of patients for neoadjuvant therapy. This study is aimed at to grade the Fine Needle Aspiration Cytology (FNAC) smears of breast carcinomas and to correlate with histological grading.Methods: FNAC of 45 patients with breast cancer were studied. The cytological grading was evaluated using Robinson method (RGS) and the histological grading using Scarff-Bloom-Richardson grading system (SBR). Statistical analysis was performed using the SSPS statistical software package (SSPS) (Chicago, Illinois, USA).Correlation was established using Spearman correlation coefficient.Results: There were 45 cases and the age of the patients ranged from 26 years to 75 years with a mean age of 53.6 years. Univariate analysis showed strong correlation. By doing multiple regression analysis of cytologic features revealed that cell size, uniformity and nucleoli were the most potent features. There was a significant association (P < 0.000) between the grades assigned to cytologic and histologic specimens.Conclusion:Cytological grade could be used to predict histological grade as significant relationship exist between grades assigned to cytology and histology specimensCytologic grade may provide relevant information on the aggressiveness of ductal breast carcinoma and could be a useful parameter to take into consideration while selecting cases for neoadjuvant therapy

The Role of CT Scan and Histopathology in Diagnosis of Allergic Fungal Sinusitis

ABSTRACT Allergic fungal sinusitis is the disease with emerging incidence in last decade. The diagnosis of AFS requires a combination of clinical, radiographic, microbiological and histopathological information. CT scan findings in AFS are considered important in preoperative diagnosis but definitive diagnosis requires histological verification. The role of CT scan as the preoperative diagnostic modality in AFS has been analyzed in 50 patients in a prospective study conducted at our institute and results have been very assuring. This article will surely satisfy many inquisitive minds about the speculations regarding the diagnosis of AFS. How to cite this article Bhardwaj BB, Gill JS, Singh T. The Role of CT Scan and Histopathology in Diagnosis of Allergic Fungal Sinusitis. Clin Rhinol An Int J 2014;7(3):117-120.

Prediction of Risk of Malignancy of Gastrointestinal Stromal Tumors by Endoscopic Ultrasonography

Background/AimsThe accurate preoperative prediction of the risk of malignancy of gastrointestinal stromal tumors (GISTs) is difficult. The aim of this study was to determine whether tumor size and endoscopic ultrasonography (EUS) features can preoperatively predict the risk of malignancy of medium-sized gastric GISTs.MethodsSurgically resected, 2 to 5 cm gastric GIST patients were enrolled and retrospectively reviewed. EUS features, such as heterogeneity, hyperechoic foci, calcification, cystic change, hypoechoic foci, lobulation, and ulceration, were evaluated. Tumors were grouped in 1 cm intervals. The correlations of tumor size or EUS features with the risk of malignancy were evaluated.ResultsA total of 75 patients were enrolled. The mean tumor size was 3.43±0.92 cm. Regarding the risk of malignancy, 51 tumors (68%) had a very low risk, and 24 tumors (32%) had a moderate risk. When the tumors were divided into three groups in 1 cm intervals, the proportions of tumors with a moderate risk were not different between the groups. The preoperative EUS features also did not differ between the very low risk and the moderate risk groups.ConclusionsTumor size and EUS features cannot be used to preoperatively predict the risk of malignancy of medium-sized gastric GISTs. A preoperative diagnostic modality for predicting risk of malignancy is necessary to prevent the overtreatment of GISTs with a low risk of malignancy.

Schwannoma of the Facial Nerve

There is no preoperative diagnostic modality that can identify facial nerve schwannoma with certainty. Difficulty in locating the facial nerve intraoperatively raises suspicion of a neurogenous tumor of the facial nerve, and this may prevent unnecessary damage to the nerve. Not every facial nerve schwannoma should be resected.

Mo2024 Treatment of Single- Nodule Hepatocellular Carcinoma: Comparison Between Surgical Resection and Transcatheter Arterial Chemioembolization Combined With Percutaneous Radiofrequency (TACE-RFA)

Background : Endoscopic ultrasonography (EUS) is considered to be the best modality to predict the neoplastic polyps of the gallbladder. However, EUS has several limitations following as 1) the considerable experience of investigators, 2) presence of the interobserver variations and 3) unavailability of EUS in some centers. Multidetector computed tomography (MDCT) provides fine section image of gallbladder and allows to reduce the interobserver variations. We evaluated the accuracy of MDCT combined with high resolution ultrasonography (HRUS) for gallbladder polyps smaller than 2cm compared with EUS. Methods : From Dec 2005 to June 2010, 109 patients who underwent cholecystectomy due to gallbladder polyps were enrolled. Subjects were divided in two groups (reference group : 63 patients who were performed MDCT and HRUS vs. validation group : 46 patients who underwent MDCT, HRUS, and EUS). New scoring system was developed from reference group, and applied to validation group, while previously reported EUS scoring system was applied to the same validation group. Results : In reference group, size (p,0.001), number (p=0.015), shape (p=0.001), and CT/US size ratio of polyps (p=0.008) were significant variables in univariate analysis. Area under the ROC curve draw by new scoring system was 0.859 and cut-off value was set to 3. In validation group, new scoring system showed comparable accuracy (65.2%) with previously reported EUS scoring system(73.9%, p=0.434). Conclusion : MDCT combined with HRUS provide comparatively high accuracy in small gallbladder polyps in distinguishing between neoplastic and non-neoplastic polyps as preoperative diagnostic modality.

Mo2026 Epidemiology and Clinical Outcomes of Asians With Hepatocellular Carcinoma (HCC) Compared to Non-Asian Patients

Background : Endoscopic ultrasonography (EUS) is considered to be the best modality to predict the neoplastic polyps of the gallbladder. However, EUS has several limitations following as 1) the considerable experience of investigators, 2) presence of the interobserver variations and 3) unavailability of EUS in some centers. Multidetector computed tomography (MDCT) provides fine section image of gallbladder and allows to reduce the interobserver variations. We evaluated the accuracy of MDCT combined with high resolution ultrasonography (HRUS) for gallbladder polyps smaller than 2cm compared with EUS. Methods : From Dec 2005 to June 2010, 109 patients who underwent cholecystectomy due to gallbladder polyps were enrolled. Subjects were divided in two groups (reference group : 63 patients who were performed MDCT and HRUS vs. validation group : 46 patients who underwent MDCT, HRUS, and EUS). New scoring system was developed from reference group, and applied to validation group, while previously reported EUS scoring system was applied to the same validation group. Results : In reference group, size (p,0.001), number (p=0.015), shape (p=0.001), and CT/US size ratio of polyps (p=0.008) were significant variables in univariate analysis. Area under the ROC curve draw by new scoring system was 0.859 and cut-off value was set to 3. In validation group, new scoring system showed comparable accuracy (65.2%) with previously reported EUS scoring system(73.9%, p=0.434). Conclusion : MDCT combined with HRUS provide comparatively high accuracy in small gallbladder polyps in distinguishing between neoplastic and non-neoplastic polyps as preoperative diagnostic modality.

A new method of endoscopic ultrasonography for determining lesion depth in early gastric cancer

Correspondence: Atsushi Mitsunaga Tokyo Women’s Medical University Yachiyo Medical Center, 477-96 Owada-shinden, Yachiyo, Chiba 276-8524, Japan Tel +81 47 450 6000 Fax +81 47 458 7047 email mitunaga@tymc.twmu.ac.jp Purpose: Endoscopic submucosal dissection (ESD) is recommended for the treatment of early gastric cancer (EGC) diagnosed as differentiated adenocarcinoma ,30 mm in diameter with depth of invasion into the submucosa #500 μm (ie, submucosal [SM] 1 cancer). It is therefore important to develop a method for the differential diagnosis of SM1 (invasion depth #500 μm) from SM2/3 cancers (invasion depth .500 μm), of which the latter cannot be treated with ESD. To aid in differential diagnosis, a prospective study was conducted to establish a new diagnostic method for more accurate differential diagnosis by measurement of lesion depth using endoscopic ultrasonography (EUS) as a preoperative diagnostic modality. Patients and methods: The lesions of 92 EGC patients were examined by EUS prior to ESD or surgery to identify and measure the area with the most thickened submucosal layer. A pathological examination of the entire resected lesion was conducted to diagnose depth of invasion and histological type of EGC. Using receiver operating characteristic analysis, a cutoff threshold of 2.2 mm for submucosal thickness was calculated for differential diagnosis of mucosal (M)-SM1 from SM2/3 cancers. Results: By using thickness of the submucosal layer as measured by EUS and a cut-off threshold of 2.2 mm, M-SM1 could be distinguished from SM2/3 cancer with 98.6% accuracy, 93.2% sensitivity, and 94.7% specificity. Conclusion: Using the thickness of the submucosal layer of an EGC lesion as determined by EUS and a cut-off threshold of 2.2 mm is a highly accurate means of differentiating M-SM1 from SM2/3 cancers when determining the best means of EGC treatment.

A Case Report of Ectopic Cervical Thymoma: A New Approach for a Preoperative Diagnosis

We report an unusual case of ectopic cervical thymoma. A 35-year-old female patient presented with an anterior neck mass that developed over a five-month duration. The patient underwent fine-needle aspiration cytology (FNAC) twice, but the tumor type could not be diagnosed. The surgically removed tumor was white in color and had a smooth surface. According to the postoperative pathological examination, the tumor was diagnosed as a Stage I ectopic cervical thymoma and Type B1 according to the Masaoka staging system and the World Health Organization (WHO) histological staging system, respectively. The patient was in good overall health and remained without tumor recurrence at the time of the 10-month follow-up. Because it was difficult to make a preoperative definite diagnosis by FNAC for the thymoma, we constructed a cell block from the existing cytological specimen. Immunohistological staining using the cell-block method clearly demonstrated the biphasic cellular population pattern that is a characteristic of thymoma. Therefore, this method may be useful as a preoperative differential diagnostic modality for cervical thymomas.