Preoperative Staging Diagnosis Research Articles

Comparative Study of Preoperative Staging of Bladder Cancer Assessed by Contrast-enhanced Ultrasound and CT

Objective: To investigate the differences and advantages of contrast-enhanced ultrasound and CT in the preoperative staging evaluation of bladder cancer. Methods: 55 patients with bladder cancer admitted to the hospital from March 2023 to March 2024 were selected as study samples. All patients were confirmed by surgical pathology, and CT enhanced scan and contrast-enhanced ultrasound were selected for preoperative staging. The postoperative pathological staging was taken as the gold standard. The accuracy rate of CT and contrast-enhanced ultrasound in the preoperative staging diagnosis of bladder cancer was compared, and ROC curves were drawn to compare the diagnostic value of both in bladder cancer. Results: There was no significant difference in T1, T4 and T3 between contrast-enhanced ultrasound and CT before bladder cancer detection (P > 0.05). The diagnostic coincidence rate of CEUS in T2 stage was higher than that of CT (P < 0.05). ROC curve analysis showed that the sensitivity and specificity of CEUS in diagnosing T-stage bladder cancer were higher than those of CT (P < 0.05). Conclusion: The overall coincidence rate of CEUS in the assessment of bladder cancer before surgery and in the diagnosis of T2 stage bladder cancer is higher than that of CT, and its diagnostic sensitivity and specificity are also higher than that of CT.

Bariatric surgery and the diseased kidney: a 5-year assessment of safety and postoperative renal outcomes.

Obesity and its related medical conditions are well-established contributors to the development of chronic kidney disease (CKD). Metabolic and bariatric surgery (MBS), including procedures such as sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), is a potential intervention for these individuals. However, the heightened risk of postoperative complications casts doubts on the suitability of MBS in this population. Our aim is to evaluate the long-term safety, anthropometric and renal outcomes of MBS in patients with CKD. A retrospective review of patients who underwent primary laparoscopic MBS with a BMI ≥ 35kg/m2 and a preoperative diagnosis of stage 2 to 5 CKD. Criteria for CKD diagnosis and staging were based on estimated glomerular filtration rate measurements in accordance with established guidelines. Anthropometric and renal outcomes were measured at 3-, 6-, 12-, 24- and 60-months postoperatively. A total of 302 patients (177 SG, 125 RYGB) were included. RYGB was preferred for patients with stage 3 CKD, while SG was more common in stages 4 and 5. At 5-year follow-up, percentage of total weight loss was higher in the RYGB cohort compared to SG (25.1% vs. 18.6%, p = 0.036). Despite SG patients having more advanced CKD, the incidence of late complications was significantly higher following RYGB, with 11 incidents (8.8%), compared to the SG cohort with only 4 cases (2.3%) (p = 0.014). In those with preoperative CKD stage 3, 76 patients (43.2%) improved to stage 2, with another 9 patients (5.1%) improving further to stage 1. Of all patients, 63 (20.8%) eventually received a successful renal transplant. MBS is an effective strategy for sustained weight loss in patients with CKD with acceptable complications rates. RYGB leads to a higher percentage of overall weight loss, albeit with an elevated likelihood of late surgical complications. Future studies are needed to determine the safety of MBS in this demographic.

Multiorientation Simultaneous Computation of Back-Projection CT Image Reconstruction Algorithm in Staging Diagnosis of Bladder Cancer.

The objective of this research was to investigate the multidirectional synchronous calculation of the back-projection computed tomography (CT) image reconstruction algorithm (MSBP) in the staging diagnosis of bladder cancer. Sixty patients with bladder cancer admitted to the hospital were selected for enhanced CT scanning, all of which were randomly divided into control group (n = 30) and study group (n = 30). The filtered back-projection (FBP) algorithm was employed to reconstruct the scanned image, and the MSBP was additionally applied to the images of the study group. Fringe artifact (SA), overall mass (OQ), effective radiation dose (ED), CT dose-exponential volume (CTDI), and dose-length product (DLP) of the two groups of images were compared and analyzed. The results showed that the total time of the traditional algorithm was 5.473 s, and the total time of MSBP combined with FBP algorithm was 2.832 s, which was significantly higher than that of the traditional algorithm (P < 0.05). CT scan bladder cancer staging results of all patients were compared with surgical pathological staging results, and the results were evaluated according to the coincidence rate. SA in the study group was lower than that in the control group (P < 0.05), and OQ was not statistically significant. The ED of the study group was significantly lower than that of the control group by 33%. The coincidence rate of postoperative pathological staging results and CT staging results was 96%, and T1, T2a, and T4 coincidence rate was 100%, The coincidence rates of T2b, T3a, and T3b were 90%, 83.3%, and 66.67%, respectively. In summary, using MSBP method combined with FBP algorithm can improve OQ while reducing ED of patients. The introduction of MSBP into CT reconstruction image simplified the pixel location operation of projection calculation, showing an important application value in preoperative staging diagnosis of bladder cancer.

Multi-Slice Spiral Computed Tomography Image Features under Hybrid Iterative Reconstruction Algorithm in Staging Diagnosis of Bladder Cancer.

Objective This study was aimed to explore the accuracy of multi-slice spiral computed tomography (CT) scan in preoperative staging diagnosis of bladder cancer based on hybrid iterative reconstruction algorithm, so as to provide a more reasonable supporting basis for guiding clinical work in the future. Methods Retrospectively, 120 patients admitted to hospital from July 2019 to April 2021, who were confirmed to be with urothelial carcinoma of the bladder by pathological examination after surgical treatment, were selected. CT images before processing were set as the control group and those after processing were set as the observation group according to whether they were processed by the hybrid iterative algorithm. Postoperative pathological examination was utilized as the standard for analysis. The accuracy and consistency of the two methods were compared. Results The accuracy of the results of each stage of the observation group (T1 stage: 91.09%, T2 stage: 89.66%, T3 stage: 88.89%, and T4 stage: 88.89%) and consistency (T1 stage: 0.66, T2 stage: 0.69, T3 stage: 0.71, and T4 stage: 0.82) were higher than those of the control group (accuracy: T1—57.01%, T2—48.28%, T3—44.44%, and T4—44.44%). The consistency was as follows: T1—0.32, T2—0.24, T3—0.37, and T4—0.43, and the comparison was statistically significant (P < 0.05). Conclusion The adoption value of the image features based on the hybrid iterative reconstruction algorithm in the diagnosis of bladder cancer staging was higher than that of the conventional multi-slice spiral CT, indicating that the hybrid iterative reconstruction algorithm had a good adoption prospect in clinical examination.

Preoperative Staging Diagnosis of Colorectal Cancer Based on Multi-Row Spiral CT

Colorectal cancer is a common malignant tumor of digestive tract, and its incidence has increased significantly in recent years. The 5-year survival rate of patients with early local colorectal cancer is more than 90%, with local invasion of about 68%, and distant metastasis of less than 10%. Therefore, early diagnosis and early treatment is an effective means for the prevention and treatment of colorectal cancer. At present, X-ray air-barium double contrast radiography and fiberoptic endoscope are most commonly used in the examination of colorectal tumors in the world. These two methods have the advantages of simple operation, intuition and low cost. However, it is limited to judge the depth of tumor invasion, whether to break through the serosa, lymphatic metastasis, and distant metastasis. In this work, it can be confirmed that the measurement of preoperative tumor vascular volume reconstruction density is feasible in the preoperative evaluation of colorectal cancer, it will provide clinicians with more valuable information about preoperative tumor staging. Besides, multi-slice spiral CT has the advantages of less trauma, high speed, and clear image. It can not only judge the location of the tumor, the depth, and extent of tumor invasion, and show distant organ metastasis, but also has good application value in tumor staging. In this paper, the clinical data and MSCT imaging data of patients with colorectal cancer were analyzed retrospectively, and the value of MSCT in the diagnosis of colorectal cancer was discussed.

Accuracy of Magnetic Resonance Imaging in Staging Rectal Cancer with Multidisciplinary Team: A Single-Center Experience.

Purpose: To investigate the accuracy of magnetic resonance imaging (MRI) in preoperative staging diagnosis for rectal cancer with multidisciplinary team (MDT) discussion.Methods: The retrospective study included 377 patients of rectal cancer with preoperative MRI staging from February 2015 to April 2018, in which 137 patients (36 received MDT discussion) received neoadjuvant therapy, 240 did not (97 received MDT discussion) and direct surgery was given. With postoperative pathological stage as the standard, the accuracy of MRI in preoperative staging for rectal cancer with MDT discussion was compared with non-MDT.Results: For direct surgery group, 21 out 97 (21.6%) patients changed their therapy strategy due to the change of the stage assessment after MDT. The accuracy of MRI for the diagnosis of preoperative N stage with MDT was significantly higher than those without MDT (56.2% vs. 42.1%, P=0.021). And for those without lymph node metastasis, the accuracy of MRI was higher after MDT (61.2% vs. 37.8%, P=0.009). For neoadjuvant therapy group, 7 out of 36 (19.4%) patients altered their therapy after MDT because of the changed stage. MDT improved the accuracy of restaging N stage with MRI (70.0% vs. 33.3%, P=0.003). The accuracy of MRI in staging T stage seemed not improved after MDT in both groups.Conclusions: In conclusion, MDT discussion increased the accuracy of MRI in preoperative staging diagnosis for rectal cancer. This mode could give a more accurate clinical stage of patients, which was in favor of choosing a preferable therapy strategy.

Thoracoscopic decortication for stage III empyema; a minimal invasive approach in a delayed presentation disease

BackgroundStage III empyema still a problem that thoracic surgeons should deal with. We try to reduce the postoperative pain and hospital stay for those patients with using a minimal invasive approach in every case. MethodsProspective study of all cases assigned for one surgeon with diagnosis of turbid and/or hemorrhagic pleural effusion that showed loculations with thick peal or failed simple chest tube drainage admitted to our thoracic surgery service. An informed consent was taken of a trial for thoracoscopic procedure (VATS) with the possibility of open surgery in case that thoracoscopy fail to proceed. Operative technique was to completely remove the fibrous peel at the surface of the lung without parietal decortication. ResultsForty-seven patients who met the inclusion criteria were assigned for the study, 38 males and 9 females. Mean age was 45.32 (17-82 years). Twenty-eight cases need only drainage and debridement with lysis of fine adhesions without the need for visceral decortication. The remaining 19 cases were subjected to VATS decortication. Of the 19 cases of decortication, 2 cases (10.52%) need conversion to open thoracotomy and one case converted from uniportal to 2 ports approach. All cases of decorication were discharged with mean drainage days of 5.42 (2-30 days). Mean operative time for decortication cases was 116.68 min (86-140 min). ConclusionsStage III empyema is no longer an absolute contraindication for VATS with the fact that not all cases with a preoperative diagnosis of stage III empyema might need decortication. Moreover, VATS decortication is feasible with a reasonable operative time, short hospital stay and no mortality compared to historical control.

Clinical data combined with radiological imaging improves the accuracy of TNM staging of pancreatic body and tail adenocarcinoma.

PurposePancreatic body and tail adenocarcinoma (PBTA) remains one of the deadliest cancers, and current radiological modalities still have limitations on the staging of PBTA. Improving PBTA staging will contribute to the management of this disease.Patients and methodsClinicopathological characteristics of 91 surgically treated PBTA patients were retrospectively retrieved. Clinical data associated with postoperative tumor staging (pTNM) were assessed using ordinal logistic regression model. Discriminant analysis was performed using function formula based on multivariate analysis results; further cross-validation was conducted by Bootstrap methods.ResultsMultivariate analysis showed that carbohydrate antigen 19-9 ≥955.0 U/L, albumin, and alkaline phosphatase/total bilirubin ratio were independent factors contributing to improved accuracy of pTNM staging. Discriminant analysis exhibited better performance and showed that the probability of accurate prediction of pTNM stage was 90.6% and the probability of cross-validation was 85.9%. After excluding patients with preoperative diagnosis of stage IV disease, the probability of accurate prediction of pTNM stage was 86.1% and the probability of cross-validation was 75.0%.ConclusionThe combination of imaging and clinical data has higher accuracy in staging PBTA than radiological data alone. A model proposed in this study will improve the management of PBTA.

Applacation of imaging examination in the preoperative staging diagnosis of colorectal cancer

The accuracy of preoperative staging diagnosis of colorectal cancer directly determines the accuracy of treatment and prognosis. Endoscopic ultrasonography, CT, MRI and positron emission tomography/computed tomography (PET/CT) imaging have their own advantages and disadvantages in preoperative staging of colorectal cancer. According to the actual situation of patients, choosing the best method of examination, when necessary, several effective methods combined, can improve the accuracy of preoperative staging diagnosis of colorectal cancer. Key words: Colorectal neoplasms; Neoplasm staging; Endosonography; Tomography, X-ray computed; Magnetic resonance imaging

Local recurrence after five years is associated with preoperative chemoradiotherapy treatment in patients diagnosed with stage II and III rectal cancer

AimTo asses the moment of local recurrence and its influence on the appraisal of the results of neoadjuvant chemoradiotherapy (CRT). MethodsWe evaluated 317 patients with a preoperative diagnosis of stage II or III rectal cancer who underwent rectal resection. Gender, age, neoadjuvant treatment, circumferencial resection margin, adjuvant treatment, pretreatment carcinoembryonic antigen level, tumor location, TNM stage, lymph node retrieval, abdominoperineal resection, and lymphatic or vascular infiltration were registered prospectively. Follow-up was performed to detect local or systemic recurrences. Timing of local recurrence (LR) in regard to analyzed variables was performed by using analysis of variance. To evaluate the influence of late local recurrence (LLR) on the results of neoadjuvant CRT, we performed a log-rank test censoring all observations at 60 and at 120 months. ResultsAfter a mean follow-up of 73.6 months (range, 1–171), 68 patients developed a recurrence. Twenty-three patients developed LRs (6.9%), and 5 developed LLRs. The earliest relapse was diagnosed 4 months after rectal surgery, and the latest was diagnosed 120 months after surgery. Patients who underwent neoadjuvant CRT developed LR significantly later than patients without neoadjuvant CRT (51.8 vs 13.5 months; P = 0.002). LR rates in patients who underwent preoperative CRT and those who did not were 9.2% and 3.5% (difference, 5.7%), respectively, after censoring all observations at 60 months and 9.2% and 6.1% (difference, 3.1%) after censoring all observations at 120 months. ConclusionLocal recurrence was diagnosed significantly later in patients treated with neoadjuvant CRT. Follow-up longer than 5 years is needed to evaluate definitive results in patients treated with neoadjuvant CRT.

Application of CO2 injection method in the magnetic resonance imaging preoperative staging diagnosis for stage I carcinoma of endometrium

Objective To explore the accuracy rate of CO2 injection method and conventional magnetic resonance imaging (MRI) in the staging diagnosis for stage Ⅰ carcinoma of endometrium. Methods Preoperative staging diagnosis for stage Ⅰ carcinoma of endometrium was done, and the method of injecting CO2 gas into the uterine lumen by catheter was applied for pelvic MRI scan in 38 cases of stage Ⅰ carcinoma of endometrium. The pathological staging result was treated as the gold standard to compare the accuracy rate of CO2 injection method with conventional scan method (43 cases). Results For conventional MRI scan group, the accuracy rate of staging diagnosis in stage Ⅰ carcinoma of endometrium was 81.3 % (35/43), including stage ⅠA 75.0 %(6/8), stage ⅠB 83.9 %(26/31), stage ⅠC 75.0 %(3/4). For CO2 injection group, the accuracy rate was 89.4 %(34/38), including stage ⅠA 85.7 %(6/7), stage ⅠB 88.9 %(16/18), stage ⅠC 84.6 %(12/13). There was a statistical difference between the accuracy rates of two methods (χ2=7.81, P<0.05). Conclusion Compared with conventional scan method, the CO2 injection method with better simplicity, safety and application value, could be more accurate to determine the location of endometrial cancer and the degree of myometrial infiltration. Key words: Endometrial neoplasms; Magnetic resonance imaging; Neoplasm staging; CO2 injection method

Long-term survival results of the patients who were enrolled to the feasibility study of laparoscopy-assisted distal gastrectomy for c-stage I gastric cancer.

166 Background: We introduced laparoscopy-assisted distal gastrectomy (LADG) as multi-institutional feasibility study, and already reported that the overall morbidity rate was 1.6% in the study (Gastric Cancer 2012). The aim of this study is to evaluate the long-term survival results of the patients who were enrolled to the study and finished 5-year follow-up. Methods: A total of 165 c-stage I gastric cancer patients who were registered from Kanagawa Cancer Center were included to the study. The Kaplan-Meier method was used to evaluate overall survival and recurrence-free survival. Results: Median follow-up period of the patients was 1901 days. The reconstruction methods were either B-I (n=150), R-Y (n=14), or B-II (n=1). The accuracy for preoperative diagnosis of stage I was 87.2% (144/165). Among 14 patients with p-stage II/III excluding T3N0/T1N2-3, eight patients received postoperative adjuvant chemotherapy. The recurrence rates by pathological stage were 0% (0/123) for stage IA, 4.7% (1/21) for stage IB, 6.2% (1/16) for stage II, and 60% (3/5) for stage III/IV, respectively. The organ of recurrence was mainly observed in liver (n=3), followed by bone, lymph node, peritoneum (n=1). The 5-year recurrence-free survival rates were 94.5% for all patients, 97.2%/92.3%/60% for pT1/pT2/pT3/4, 98.5%/82.4%/71.4%/66.7% for pN0/pN1/pN2/pN3, 97.9%/81.3%/40% for p-stage I/p-stage II/p-stage III/IV. Conclusions: LADG for c-stage I gastric cancer was feasible in long-term result, as well as in short-term outcome.

Retrieval and in vitro maturation of human oocytes from ovaries removed during surgery for endometrial carcinoma: a novel strategy for human oocyte research

To collect human oocytes from ovaries removed as part of surgical treatment for endometrial carcinoma, and to induce in vitro maturation of such oocytes to obtain material for research on human ovarian aging. Prospective clinical study. University Hospital. Eight patients aged 35-44years with a preoperative diagnosis of Stage I endometrial cancer agreed to participate in this project. Surgically removed ovaries were punctured; oocytes were collected from follicular fluid and matured in vitro. Immunofluorescent detection of microtubules and DNA labeling were performed after in vitro maturation. Number of oocytes collected and their in vitro maturation stage. In total, 87 oocytes were collected, 11 of which had completed metaphase II. Of the oocytes collected, 75% were from three patients in their 30s, while the remaining 25% were from five patients in their 40s. Several stages of oocytes were collected and the detection of microtubule arrangement and chromatin in various stages using fluorescence was possible. Material for research on human ovarian aging can be obtained from ovaries removed during surgery for endometrial cancer.

A feasibility study of postoperative chemotherapy with S-1 and cisplatin (CDDP) for gastric carcinoma (CCOG0703)

The outcome of stage III gastric cancer patients treated by D2 dissection followed by adjuvant chemotherapy with S-1 remains unsatisfactory. Moreover, some patients with a preoperative diagnosis of stage II/III turn out to be stage IV after surgical exploration, and a standard postoperative treatment for this population has not been established. A feasibility study of postoperative S-1/cisplatin (CDDP) was performed with patients who underwent gastrectomy for what turned out to be a stage IV gastric cancer. The primary endpoint of the trial was the relative dose intensity during five courses of S-1/CDDP. Several criteria to skip, postpone, or reduce the dose had been predetermined. Between 2007 and 2009, 31 patients were accrued, including 19 patients who were positive for peritoneal washing cytology, 6 with peritoneal seeding, 5 with metastasis to the paraaortic nodes, and 4 with other distant metastases. Only 7 patients completed five cycles as planned (median, two cycles). The median relative dose intensities of S-1 and CDDP were 37% and 40%, respectively. Causes of treatment failure were failure to fulfill criteria for starting a new course within 5 weeks of the last administration of S-1 in 7, patient refusal in 6, disease recurrence/progression in 4, need to reduce dose by two levels in 4, and two successive skips of CDDP in 3 patients. The median progression-free survival time of all patients was 363 days. Although promising in the neoadjuvant and advanced/metastatic setting, S-1/CDDP is too toxic as a postgastrectomy treatment for Japanese patients.

Phase II Trial to Evaluate Laparoscopic Surgery for Stage 0/I Rectal Carcinoma

Recently reported randomized controlled trials demonstrated that laparoscopic surgery (LS) was comparable or superior to open surgery with regard to the long-term outcome for colon and rectosigmoidal carcinoma; however, controversy persists with regard to the appropriateness of LS for patients with rectal carcinoma. To examine the technical and oncological feasibility of LS for rectal carcinoma, a phase II trial was started in patients with a preoperative diagnosis of Stage 0/I rectal carcinoma, under the direction of the Japan Society of Laparoscopic Colorectal Surgery. Surgeons in 39 specialized institutions will recruit 350 patients. The primary end-point in the first stage is the anastomotic leakage rate by double-stapling technique and that in the second stage is overall survival. Secondary end-points are relapse-free survival, short-term clinical outcome, adverse events, the rate of histologically curative operation, the proportion of completion of LS and the conversion rate.

USPIO-enhanced MRI for preoperative staging of gynecological pelvic tumors: preliminary results.

The aim of this study was to assess nodal enhancement with ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) during preoperative staging of gynecological pelvic tumors within the same imaging session for the primary tumor. Pelvic MRI was performed 18-28 h after intravenous infusion of USPIO (Combidex/Sinerem, 2.6 mg Fe/kg body weight) in 13 women (mean age 51 years) scheduled for surgery for biopsy proven ( n=11) or clinically suspected ( n=2) uterine carcinoma. Axial T1-weighted spin-echo (SE), T2-weighted fast SE (FSE; with fat saturation), fast spoiled gradient-recalled (FSPGR) echo, sagittal and oblique T2-weighted FSE sequences were acquired on a 1.5-T system. Lymph nodes were prospectively staged using standard criteria, i.e., size and shape, as well as USPIO enhancement. Results were correlated with histology findings. MRI correctly staged all primary uterine tumors. In one case, the preoperative diagnosis of stage IV switched the therapeutic approach to radiochemotherapy. Ninety-one (86 benign, 5 malignant) of the histologically characterized nodes could be correlated with their MRI counterparts. One node was false positive; three micrometastases greater than 5 mm and one 5-mm metastasis were missed. On a nodal basis, the sensitivity score was 0.33 and the specificity score, 0.99. On a patient basis, the sensitivity score was 0.25 and the specificity score, 0.80. Our preliminary results indicate that USPIO-enhanced pelvic MRI for preoperative nodal assessment is feasible within one imaging session for primary tumors and that it has a high specificity. However, the low sensitivity in the present study is a limitation for the clinical application of this technique.

Preoperative CA 125 in endometrial cancer: Is it useful?

Objective: We sought to determine the clinical utility of preoperative CA 125 measurement in determining the need for lymphadenectomy in patients with endometrial carcinoma. Study Design: A prospective nonrandomized study was performed over a 2-year period. Patients referred with the diagnosis of endometrial carcinoma had CA 125 levels determined before surgical staging. Operative findings were then correlated with preoperative CA 125 values. Standard statistical calculations were used to determine sensitivity, specificity, positive predictive value, and false-positive and false-negative rates. The Student t test was used to determine differences between mean values. Results: Either a CA 125 level of >20 U/mL or a grade 3 tumor or both of these correctly predicted 87% of patients requiring surgical staging. In patients with a preoperative diagnosis of stage I, grade 1 or 2 tumors, a CA 125 level of >20 U/mL correctly identified 75% (9/12) of patients requiring lymphadenectomy compared with only 50% (6/12) identified when a CA 125 level of >35 U/mL was used. Two of 16 low-risk patients with preoperative grade 1 tumors and CA 125 levels of <20 U/mL had occult extrauterine disease at surgery. Conclusion: Measurement of preoperative CA 125 is a clinically useful test in endometrial cancer. CA 125 levels of >35 U/mL strongly predicted extrauterine disease but lacked sensitivity in identifying patients needing staging. Either a CA 125 level of >20 U/mL or a grade 3 tumor or both of these correctly identified 75% to 87% of patients requiring lymphadenectomy. Until more data are collected, abdominal hysterectomy should be the procedure of choice for patients with grade 1 tumors and CA 125 levels of <20 U/mL. (Am J Obstet Gynecol 2000;182:1328-34.)