Preoperative Assessment Of Patients Research Articles

Skin testing - A valued tool for assessing adverse reactions to anaesthetic agents in patients allergic to multiple drugs: A case report from a secondary-level hospital.

Patients with allergy to multiple drugs who have experienced anaphylaxis multiple times present a significant challenge in perioperative management. This report presents a 27-year-old female patient diagnosed with cholelithiasis scheduled for cholecystectomy. The patient has a history of adverse reaction to multiple drugs, including Amoxicillin/Clavulanic acid, Cefpodoxime, Levofloxacin and two additional drugs (one analgesic and the other multivitamin) each resulting in symptoms suggestive of anaphylaxis on separate occasions. However, the patient has demonstrated tolerance to Amikacin and Paracetamol on several occasions. Given the patient's drug hypersensitivity state, the patient's anaesthetist sought clearance for use of anaesthetic drugs and disinfectants prior to surgery. Comprehensive skin testing was conducted for the same, and all drugs tested negative. The outcomes of this testing guided the selection of anaesthesia agents, ensuring safe perioperative care. Subsequently, surgery was performed, using Succinylcholine, Propofol, Rocuronium, Atropine and Neostigmine for general anaesthesia and Chlorhexidine for disinfection, and the postoperative period was uneventful. This case highlights the significance of preoperative assessment and drug testing in patients with a history of drug allergies or anaphylaxis to multiple drugs, to prevent any perioperative complications.

Perioperative Management of Opioid-Tolerant Patients: A Comprehensive Guide

The perioperative management of opioid-tolerant patients presents significant challenges, necessitating a tailored approach to pain management and the prevention of opioid-related complications. This review discusses the essential aspects of preoperative assessment, intraoperative strategies, and postoperative care for opioid-tolerant patients. Emphasis is placed on the continuation of baseline opioid therapy, the use of multimodal analgesia, and the importance of individualized opioid dosing to achieve effective pain control while minimizing the risk of withdrawal, respiratory depression, and opioid-induced hyperalgesia. The role of a multidisciplinary team in optimizing patient outcomes and the necessity of thorough discharge planning and follow-up are also highlighted. By addressing these critical factors, healthcare providers can ensure safe and effective perioperative care for opioid-tolerant patients.

Preoperative bleeding risk assessment in cardiac surgery patients

One of the most important aspects in achieving successful outcomes in cardiac surgery is the evaluation of the risk of bleeding during and after the procedure. Preoperative anemia, intraoperative bleeding, and transfusion therapy contribute to a cumulative risk of adverse events. Given the limitations of traditional coagulation tests, a more comprehensive and patient-centered approach is necessary. Factors affecting the risk of bleeding should be considered from the perspective of both individual patient characteristics and the specific type and extent of the planned surgical intervention. The risk assessment should be informed by individual and familial history, as well as previous episodes of bleeding or other relevant information. The use of bleeding risk scales can play a crucial role in this process, providing valuable insights into the likelihood of bleeding complications. In conclusion, a comprehensive approach that takes into account the unique characteristics of each patient and the specific details of the surgical procedure is essential for minimizing the risk of complications and ensuring successful outcomes.

Navigated Transcranial Magnetic Stimulation and Diffusion Tensor Imaging Tractography in Insular Glioma Surgery.

The surgical resection of insular gliomas is associated with a high rate of postoperative morbidity as they grow close to descending motor fibers and lenticulostriate arteries. It is believed that intraoperative perforator infarctions are the determining factor for patients' postoperative outcome, while the majority of patients with intraoperative ischemic events do not develop postoperative motor deficits. This study aims to evaluate whether navigated transcranial magnetic stimulation (nTMS) and nTMS-based fiber tracking could be valuable for the preoperative assessment of patients with insular gliomas. Thirty-two patients with insular gliomas were presurgically examined by nTMS. The resting motor threshold and cortical representation areas of legs, hands, and face were identified on both hemispheres. Motor evoked potential positive stimulation points were then used as a region of interest for diffusion tensor imaging tractographies. Somatotopic fiber tracking was performed enabling analyses of the spatial relation between tumor and cortico-spinal tract (CST) as well as the extraction of fiber tract integrity, measured by fractional anisotropy and the apparent diffusion coefficient. The performance of nTMS mappings of the motor cortex and reconstruction of descending motor fibers for legs, hands, and facial functioning was successful in all patients. Higher preoperative resting motor threshold ratios and a distance between tumor and CST of <3 mm were associated with a permanent deterioration in motor function (P = .029 and P = .007). Shorter distances between CST and tumorous tissue were correlated with lowered peritumoral fractional anisotropy values, suggesting alterations in fiber tract integrity. Lower interhemispheric peritumoral fractional anisotropy ratios showed an association with new postoperative motor deficits (P = .017). nTMS-based diffusion tensor imaging tractography enables somatotopic tract visualization and provides a valuable tool for preoperative planning, intraoperative orientation, and individual risk stratification. Thus, it may be beneficial to increase safety in insular glioma resection surgery.

Smaller is better? Compact vs. Conventional gamma camera for sentinel lymph node localization in patients with breast cancer.

Sentinel lymph node biopsy (SLNB) has been recognized as "the gold standard" for axillary staging in early breast cancer patients with clinically negative lymph nodes, resulting in significant morbidity decrease and quality of life improvement. This study aims to validate the performance of a newly developed handheld portable gamma camera (PGC) produced by Imagensys (Italy), in detecting and locating sentinel lymph nodes (SLNs) during the preoperative and intraoperative phases in breast cancer patients compared to conventional lymphoscintigraphy. Adult female patients with histologically confirmed breast cancer, candidates for surgery and SLNB, were prospectively enrolled in this open-label, pre-marketing clinical trial. All patients underwent pre- operative assessment using both the PGC and conventional lymphoscintigraphy. The performance of the two devices was compared using the Poisson regression model for incidence rate ratios (IRRs). The intrinsic sensitivity of the devices was compared using the Wilcoxon Ranked Sign Test. The utility of PGC during intra-operative procedures was also evaluated. The manoeuvrability of the devices was evaluated using operator-satisfaction questioner. Sixty-eight patients (median age 50 years, BMI 21.4) were enrolled, including two patients with bilateral breast cancer, who underwent SLNB on both axillae. The PGC demonstrated superior preoperative lymph node detection rate (IRR 8.01, 95% CI 6.11-10.50; p < 0.0001) and intrinsic device sensitivity (mean counts per second 409 ± 286 vs. 255 ± 1173 for conventional device, p = 0.0003) compared to the conventional gamma camera. Intra-operative assessment with PGC was performed in 62 patients and no additional lymph nodes were visualised. However, the conventional gamma camera demonstrated superior manoeuvrability (p < 0.0001). The PGC handheld gamma camera showed promising results for preoperative SLN assessment in patients with breast cancer. The limited manoeuvrability may be related to the operator's experience leading to higher inter-operator variability. Appropriate training and frequent use of nuclear medicine and surgical equipment could overcome this limitation.

Results of CO2 laser surgery in laryngeal papillomatosis

Recurrent respiratory papillomatosis is medical condition strictly connected with HPV infection of the epithelium of the upper respiratory track. The main treatment of lesions located in larynx or lower pharynx includes microsurgical excision by using CO2 laser. A thorough preoperative assessment of patients is extremely important, which should not only be based on traditional laryngological examination, but also on endoscopy of the larynx and the use of the NBI (narrow band imaging) technique to assess the vascularization of lesions. In patients with recurrent papillomas, neoadjuvant therapy with antiviral agents or agents that inhibit angiogenesis is also often used. Among our group of 31 patients with laryngeal papillomas, 15 people (48%) required repeated surgical intervention and additional antiviral therapy while 10 (33%) people had to undergo the procedure three or more times due to disease recurrence. In this article we will discuss that laryngeal microsurgery with a CO2 laser is an effective method of treating patients with laryngeal papillomatosis and we will present the possibilities of adjuvant therapy.

Preoperative predictors of difficult early laparoscopic cholecystectomy among patients with acute calculous cholecystitis in Egypt

BackgroundEarly laparoscopic cholecystectomy (ELC) in the setting of acute calculous cholecystitis (ACC) requires to be performed by highly-skilled surgeons to avoid complications. The purpose of this study is to identify preoperative factors that would predict difficult ELC among patients with ACC prior to proceeding with surgery.MethodsWe retrospectively reviewed all patients who received ELC within 10 days from the onset of symptoms of ACC between August 1, 2018, and December 31, 2022. They were divided into 2 groups according to the difficulty of surgery.Results149 patients with ACC received ELC during the study period. ELC was considered difficult in 52 patients (35%). Five preoperative factors were identified as significant predictors of difficult ELC (DELC) on multivariate analysis: duration of acute attack ≥ 4 days from the onset of symptoms till surgery (OR 34.4, P < 0.001), ultrasound showing largest gallstone size > 20 mm (OR 20.2, P = 0.029), ultrasound showing gallstone impaction in Hartmann’s pouch (OR 7.2, P = 0.017), history of prior episode(s) of acute attack (OR 6.8, P = 0.048), and diabetes mellitus (OR 5.8, P = 0.046).ConclusionCareful preoperative assessment of patients with ACC is crucial among junior surgeons with limited surgical expertise prior to proceeding with ELC to identify those at risk of DELC to potentially reduce postoperative morbidity and mortality. If encountered, a management plan should be made, and surgery should proceed only upon confirming the availability of experienced surgeons in the field of biliary and laparoscopic surgery to supervise or assist in the procedure. Alternatively, such group of patients should rather be transferred to more advanced surgical centers which offer higher level of care to maintain patient safety and optimal surgical outcomes. More importantly, bail-out procedures should always be resorted to whenever DELC is encountered intraoperatively to prevent further surgical damage.

A preoperative planning procedure of septal myectomy for hypertrophic obstructive cardiomyopathy using image-based computational fluid dynamics simulations and shape optimization.

Although septal myectomy is the preferred treatment for medication-refractory hypertrophic obstructive cardiomyopathy (HOCM), the procedure remains subjective. A preoperative planning procedure is proposed using computational fluid dynamics simulations and shape optimization to assist in the objective assessment of the adequacy of the resection. 3 patients with HOCM were chosen for the application of the proposed procedure. The geometries of the preoperative left ventricular outflow tract (LVOT) of patients in the systolic phase were reconstructed from medical images. Computaional fluid dynamics (CFD) simulations were performed to assess hemodynamics within LVOT. Sensitivity analysis was performed to determine the resection extent on the septal wall, and the depth of the resection was optimized to relieve LVOT obstruction while minimizing damage to the septum. The optimized resection was then transferred from systole to diastole to provide surgeons with instructive guidance for septal myectomy. Comparison between preoperative and postoperative hemodynamics showed an evident improvement with respect to the pressure gradient throughout the LVOT. The resected myocardium in the diastolic phase is more extended and thinner than its state in the systolic phase. The proposed preoperative planning procedure may be a viable addition to the current preoperative assessment of patients with HOCM.

Examining the relationship between preoperative nutritional and symptom assessment and postoperative atrial fibrillation in esophageal squamous cell carcinoma patients: a retrospective cohort study

ObjectiveThe study aimed to examine the relationship between preoperative nutritional status, symptom burden, and the occurrence of postoperative atrial fibrillation in Esophageal Squamous Cell Carcinoma patients.MethodsThe study, conducted in the Department of Thoracic Surgery at the Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, applied the NRS 2002, SGA and MSAS scoring systems as measures of nutritional status and symptom occurrence in patients diagnosed with ESCC. Univariate and multivariate logistic regression analysis were performed to evaluate the association between nutritional scores, symptom scores, and postoperative complications.ResultsThe research found a significant correlation between high MSAS scores and postoperative atrial fibrillation. Patients with high symptom burden also tended to have nutritional risk or malnutrition according to the NRS2002 and SGA scores.ConclusionThere is a need for healthcare providers to pay attention to ESCC patients’ physical and psychological symptoms. Close monitoring of nutritional status and timely nutritional interventions should be integrated into these patients’ care plans as they have been found to be related to postoperative complications such as atrial fibrillation.

Could malnutrition screening tools help in preoperative assessment of patients undergoing HPB cancer surgery in terms of postoperative complications? A bi-center observational study

Could malnutrition screening tools help in preoperative assessment of patients undergoing HPB cancer surgery in terms of postoperative complications? A bi-center observational study

Anxio-depressive disorders, traumatic symptoms, and suicidality among limb amputees: A cross-sectional and prospective study

IntroductionLimb amputation represents an ultimate therapeutic option in certain severe or progressive pathologies. We conducted this study to describe anxio- depressive disorders, traumatic symptoms, and suicidality among limb amputees, as well as factors associated with their occurrence. Materials and MethodsThis was a cross-sectional and prospective descriptive and analytical study conducted over a two-year period from October 2020 to October 2022, at the following departments of the Mohammed VI University Hospital Center in Oujda: Traumatological and Orthopedic Surgery departements A and B, and Peripheral Vascular Surgery departement, involving 122 patients. ResultsThe average age of our patients was 46.42 ± 14.76 years, with a predominance of males (male-to-female ratio of 2.21). Preoperative assessment of patients occurred 6 to 24 hours before amputation. Immediate postoperative evaluation took place on average 2.18 ± 1.53 days after surgery, ranging from 1 to 8 postoperative days. The prevalence of anxio-depressive disorders according to the MINI scale was 77%, comprising Depression (9%), Adjustment Disorder (36.9%), Acute Stress Disorder (20.5%), Post-Traumatic Stress Disorder (6.6%), and Anxiety Disorders (10.7%), with suicide attempts reported in 16.4% of cases. The mean score on the Hamilton Depression Rating Scale for our patients was 10.81 ± 3.27, on the Hamilton Anxiety Rating Scale was 16.33 ± 5.54, and on the Ducher Suicide Risk Scale was 0.82 ± 1.33. ConclusionThe occurrence of postoperative anxio-depressive disorders, traumatic symptoms, and suicidal behavior is associated with the following factors: male sex, personal history of depression, family history of psychiatric disorders, quality of diagnostic disclosure, postoperative sleep disturbances, postoperative panic attacks, psychological support, and socio-professional reintegration.

Advancing gastrointestinal stromal tumor management: The role of imagomics features in precision risk assessment.

Gastrointestinal stromal tumors (GISTs) vary widely in prognosis, and traditional pathological assessments often lack precision in risk stratification. Advanced imaging techniques, especially magnetic resonance imaging (MRI), offer potential improvements. This study investigates how MRI imagomics can enhance risk assessment and support personalized treatment for GIST patients. To assess the effectiveness of MRI imagomics in improving GIST risk stratification, addressing the limitations of traditional pathological assessments. Analyzed clinical and MRI data from 132 GIST patients, categorizing them by tumor specifics and dividing into risk groups. Employed dimension reduction for optimal imagomics feature selection from diffusion-weighted imaging (DWI), T1-weighted imaging (T1WI), and contrast enhanced T1WI with fat saturation (CE-T1WI) fat suppress (fs) sequences. Age, lesion diameter, and mitotic figures significantly correlated with GIST risk, with DWI sequence features like sphericity and regional entropy showing high predictive accuracy. The combined T1WI and CE-T1WI fs model had the best predictive efficacy. In the test group, the DWI sequence model demonstrated an area under the curve (AUC) value of 0.960 with a sensitivity of 80.0% and a specificity of 100.0%. On the other hand, the combined performance of the T1WI and CE-T1WI fs models in the test group was the most robust, exhibiting an AUC value of 0.834, a sensitivity of 70.4%, and a specificity of 85.2%. MRI imagomics, particularly DWI and combined T1WI/CE-T1WI fs models, significantly enhance GIST risk stratification, supporting precise preoperative patient assessment and personalized treatment plans. The clinical implications are profound, enabling more accurate surgical strategy formulation and optimized treatment selection, thereby improving patient outcomes. Future research should focus on multicenter studies to validate these findings, integrate advanced imaging technologies like PET/MRI, and incorporate genetic factors to achieve a more comprehensive risk assessment.

The Predictive Value of the Fibrinogen-Albumin-Ratio Index on Surgical Outcomes in Patients with Advanced High-Grade Serous Ovarian Cancer.

The present study evaluates predictive implications of the pretherapeutic Fibrinogen-Albumin-Ratio Index (FARI) in high-grade serous ovarian cancer (HGSOC) patients undergoing primary cytoreductive surgery. This retrospective study included 161 patients with HGSOC International Federation of Gynecology and Obstetrics (FIGO) stage ≥ IIb, who underwent primary cytoreductive surgery followed by platinum-based chemotherapy. Associations between the FARI and complete tumor resection status were described by receiver operating characteristics, and binary logistic regression models were fitted. Higher preoperative FARI values correlated with higher ascites volumes (r = 0.371, p < 0.001), and higher CA125 levels (r = 0.271, p = 0.001). A high FARI cut at its median (≥11.06) was associated with lower rates of complete tumor resection (OR 3.13, 95% CI [1.63-6.05], p = 0.001), and retrained its predictive value in a multivariable model independent of ascites volumes, CA125 levels, FIGO stage, and Charlson Comorbidity Index (CCI). The FARI appears to act as a surrogate for higher intra-abdominal tumor load. After clinical validation, FARI could serve as a readily available serologic biomarker to complement preoperative patient assessment, helping to identify patients who are likely to achieve complete tumor resection during primary cytoreductive surgery.

Postoperative Outcomes of Fontan Operation in a Multicenter Italian Study. How Far Have We Gone? Early Outcomes After Fontan Operation.

Despite the clinical results of the Fontan operation have certainly improved, it still presents with an inherent surgical risk of death and early morbidities. This is a retrospective clinical study of children undergoing Fontan operation in 9 congenital cardiac centers in Italy between 1990 and 2023. Clinical and surgical data were collected via a dedicated RedCap database. Primary outcome was cohort's mortality, also considering different decades, while secondary outcomes were postoperative complications and reintervention. In the last 3 decades, there were 897 patients undergoing Fontan operation, M/F 512/384, median age: 4.5years (IQR 3.3-6.4), median weight 16kg (IQR 14-22). A first palliation was deemed necessary in 710 patients (80%), and most patients underwent a staged Fontan (93%); an extracardiac conduit was used in 790 patients (88%). Postoperative complications (mild to severe) occurred in 410 patients (46%), and early reinterventions were required in 66 patients (7.5%). Overall operative mortality was 1.7% (15 patients). Age at Fontan greater than 4years was associated with an early need for transcatheter reintervention (adj p value = 0.037) and a higher incidence of postoperative complications (adj p value = 0.017). The Fontan operation has seen significant improvements in immediate outcomes, notably a remarkable reduction in overall mortality to just 1.35% in the last decade. While minor complications have remained steady, there has been a substantial decrease in major early complications, deaths, and the need for reinterventions. Notably, patients aged over 4years seem to face a higher risk of postoperative morbidity, underscoring the critical role of age in preoperative assessment and management strategies for Fontan patients.

EP349 - Use of Pre-operative Risk and Frailty Assessment in patients undergoing Emergency Laparotomy

Abstract Aims Formal preoperative assessment of risk of complications and death in all patients undergoing Emergency Laparotomy is recommended by NELA (National Emergency Laparotomy Audit) in the UK. In addition, frailty assessment in patients who are 65years or older and frail undergoing Emergency Laparotomy is also recommended. In a previous 2018 audit, we had recorded Preoperative Mortality Risk in 77% patients undergoing Emergency Laparotomy and Frailty was not part of our assessment in these patients. In this audit our aim was to evaluate documentation of preoperative frailty and risk assessment in patients undergoing Emergency Laparotomy from 2019 to 2023. Methods Details of all patients who underwent Emergency Laparotomy at a University Hospital under care of one surgical team between January 2019 and December 2023 were obtained from theatre logbooks. Patient notes were retrospectively reviewed to see if frailty assessment and preoperative risk assessment scores were recorded. This data was collected and analyzed using Microsoft Excel. Results During this period, sixty-seven patients were identified. The median age was sixty-seven with an age range from four to ninety-one. Of these 38 (57%) were females. A preoperative p-possum score was documented in 59 (88.1%), 39 (58.2%) patients were 65 years or older of these 26 (66.7%) had frailty assessment carried out. Conclusions Our data suggests that we have over time made progress in the use of Perioperative Risk assessment scores and incorporated frailty assessment in our perioperative practice in patient’s undergoing Emergency Laparotomy. However there remains room for improvement.

Beyond body mass index: Body composition profiling for perioperative risk stratification in intrahepatic cholangiocarcinoma patients.

Intrahepatic cholangiocarcinoma (iCC) is an aggressive tumor, usually detected at an advanced stage. Our aim was to investigate the potential of body composition analysis (BCA) derived from presurgical staging computed tomography (CT) in predicting perisurgical complications. In this retrospective cohort study, we enrolled 86 patients who underwent CT imaging prior to liver surgery. Cox and logistic regression were performed to assess risk factors for prolonged hospital and intensive care unit (ICU) stays, as well as the occurrence of various complications. BCA parameters served as covariates besides conventional risk factors. Postoperative complications after resection of iCC significantly prolonged the overall length of hospitalization (p < .001). Presence of sarcopenia was associated with longer ICU stays. Complications were common, with 62.5% classified as Clavien-Dindo grade IIIa or lower and 37.5% as more severe. Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were identified as risk factors for complications, including bile leakage (in 24 cases, p = .025), pleural effusions (in 26 cases, p = .025), and intra-abdominal abscess formation (in 24 cases, p = .043). SAT was associated with severe complications requiring interventional therapy, whereas VAT was correlated with abscess formation. Despite normal prevalence of obesity (22%), body mass index (BMI) did not have an impact on the development of perioperative complications. BCA is a useful tool for preoperative risk stratification in patients with iCC and is superior to BMI assessment. Increased SAT and VAT were associated with the risk of perisurgical complications, prolonging hospitalization. Therefore, BCA derived from routine staging CT should be considered in the preoperative assessment of patients with iCC.

Preoperative Echocardiographic Assessment in Elective Surgery Patients: A Cross-Sectional Study From Duhok, Iraqi Kurdistan.

Background and aim Echocardiography plays a pivotal role in the preoperative risk assessment of patients undergoing various surgical procedures. Therefore, we conducted this study to detect various cardiac abnormalities through a preoperative echocardiographic study for cases undergoing elective surgeries in Duhok, Iraqi Kurdistan. Methods This cross-sectional study assessed echocardiographic findings in preoperative patients at Azadi Teaching Hospital, Duhok, Kurdistan Region of Iraq, from 2023 to 2024. The study encompasses 468 adult patients. We gathered clinicodemographic characteristics, indications of referral to a preoperative echo study, and the echocardiographic findings, particularly regional wall motion abnormalities, valvular heart diseases, and heart failure (systolic or diastolic/left ventricular hypertrophy). Results In a cohort of 468 patients, 205 (43.80%) were aged 35-54 years, and 269 (57.48%) were female. Most patients (366; 78.21%) resided in Duhok. Nearly only half of the cases 219 (46.79%) had clear preoperative echostudy indications. A total of 289 (61.74%) had no remarkable echocardiographic findings. Diastolic heart failure was most prevalent at 65 (13.89%). Older cases had more prevalent echo findings in terms of valve dysfunctions and heart failure. Notable associations were found between echocardiographic abnormalities and surgical types, particularly higher regional wall motion abnormalities in genito-urinary system operations (4; 8.16%) and valvular heart disease in orthopedic surgeries (13; 15.85%). Conclusions Echocardiographic abnormalities were remarkably observed in patients aged 65 and older. Many cases had no clear indications for preoperative echo study and hence unremarkable echo findings. More scrutiny is indicated during referral, and focusing on older adults' preoperative cardiac screening is recommended.

Preoperative risk assessment and prehabilitation strategies in patients undergoing an esophagectomy for cancer resections: a single center retrospective analysis and a review of the literature

Preoperative risk assessment and prehabilitation strategies in patients undergoing an esophagectomy for cancer resections: a single center retrospective analysis and a review of the literature

A comparison of fMRI presurgical mapping techniques with intraoperative brain mapping-based validation

Abstract Resting-state functional MRI (rsfMRI) could enable preoperative risk assessment and intraoperative guidance for patients who cannot undergo task-based fMRI (tbfMRI). To ascertain rsfMRI’s applicability, we investigated differences in accuracy between tbfMRI with a voxel size of 1.8 x 1.8 x 3.2 mm³ and rsfMRI acquired with single-echo (sTE) with a voxel size of 2 x 2 x 2.2 mm³ and multiecho (mTE) with a voxel size of 3 x 3 x 3 mm³ using intraoperative mapping with direct electrical stimulations (DES) as the ground truth. Functional sensory-motor mapping results of hands and feet were spatially compared relative to positive (pDES, functional effect) and negative (nDES, no functional effect) coordinates in 16 preoperative patients. A general linear model analysis was used for tbfMRI, and seed-based analysis (SBA) for rsfMRI. Minimum Euclidean distances between fMRI and DES were calculated and compared between fMRI methods. Receiver-operating characteristic (ROC) curves were used to compare accuracy and determine distance cutoffs for fMRI agreement with DES, and binary agreement rates were compared at different cutoffs. Two-part mixed-effects linear models were used to compare fMRI methods while accounting for unequal intersubject DES repetition. Only minor differences were found between fMRI methods in unthresholded distances (mean differences ~2 mm). ROCs and binary agreement measures showed comparable accuracy for tbfMRI and sTE-rsfMRI at 2 mm, but mildly worse for sTE-rsfMRI at 3 mm and mTE-rsfMRI. However, differences in relative accuracy between sTE-rsfMRI and mTE-rsfMRI were minor when the same distance cutoff was applied to all methods. This was also reflected in comparing binary agreement rates and confirmed by the two-part linear models, which showed no significant differences between fMRI methods and a significant effect of DES response. A similar accuracy for SBA rsfMRI functional sensory-motor mapping compared with tbfMRI for the hands and feet indicates that rsfMRI may be suitable for presurgical mapping. The differences in relative accuracy between sTE-rsfMRI and mTE-rsfMRI warrant further investigation in a larger sample.

Characteristics of regional lymph node metastasis in breast cancer and construction of a nomogram model based on ultrasonographic analysis: a retrospective study

ObjectiveThe ultrasonographic characteristics of lymph node metastasis in breast cancer patients were retrospectively analyzed, and a predictive nomogram model was constructed to provide an imaging basis for better clinical evaluation.MethodsB-mode ultrasound was used to retrospectively analyze the imaging characteristics of regional lymph nodes and tumors. Pathological examination confirmed the presence of lymph node metastasis in breast cancer patients. Univariable and multivariable logistic regression analyses were performed to analyze the risk factors for lymph node metastasis. LASSO regression analysis was performed to screen noninvasive indicators, and a nomogram prediction model was constructed for breast cancer patients with lymph node metastasis.ResultsA total of 187 breast cancer patients were enrolled, including 74 patients with lymph node metastasis in the positive group and 113 patients without lymph node metastasis in the negative group. Multivariate analysis revealed that pathological type (OR = 4.58, 95% CI: 1.44–14.6, p = 0.01), tumor diameter (OR = 1.37, 95% CI: 1.07–1.74, p = 0.012), spiculated margins (OR = 7.92, 95% CI: 3.03–20.67, p < 0.001), mixed echo of the breast tumor (OR = 37.09, 95% CI: 3.49–394.1, p = 0.003), and unclear lymphatic hilum structure (OR = 16.07, 95% CI: 2.41–107.02, p = 0.004) were independent risk factors for lymph node metastasis. A nomogram model was constructed for predicting breast cancer with lymph node metastasis, incorporating three significantly correlated indicators identified through LASSO regression analysis, namely, tumor spiculated margins, cortical thickness of lymph nodes, and unclear lymphatic hilum structure. The receiver operating characteristic (ROC) curve revealed that the area under the curve (AUC) was 0.717 (95% CI, 0.614–0.820) for the training set and 0.817 (95% CI, 0.738–0.890) for the validation set. The Hosmer–Lemeshow test results for the training set and the validation set were p = 0.9148 and p = 0.1648, respectively. The prediction nomogram has good diagnostic performance.ConclusionsB-mode ultrasound is helpful in the preoperative assessment of breast cancer patients with lymph node metastasis. The predictive nomogram model, which is based on logistic regression and LASSO regression analysis, is clinically safe, reliable, and highly practical.