Preoperative Diagnostic Findings Research Articles

Long-term outcomes associated with a modified versus traditional closed anal sacculectomy for treatment of canine anal sac neoplasia.

To report the short-term and long-term outcomes of dogs that underwent the modified closed and traditional closed anal sacculectomy procedures for the treatment of anal sac neoplasia. 90 client-owned dogs. The medical records of 2 tertiary referral hospitals were reviewed to identify dogs that underwent anal sacculectomy for treatment of anal sac neoplasia between January 2016 and December 2020. Data collected included signalment and preoperative diagnostic findings. The occurrence of intraoperative and postoperative complications, short-term outcomes, and long-term outcomes were also collected. Descriptive statistics were calculated to summarize dog signalment information, and recurrence, metastasis, and survival proportions were compared between techniques using Fisher exact tests. 35 and 55 dogs, respectively, underwent the modified or traditional closed anal sacculectomy procedure. Minor postoperative complications that resolved with minimal intervention occurred in 5 of 35 (14.3%) modified approach dogs and 12 of 55 (21.8%) traditional approach dogs. Tumor recurrence was confirmed in 8 of 35 (22.9%) modified and 8 of 55 (26.4%) traditional approach dogs and was suspected in 3 of 35 (8.6%) and 6 of 55 (13.2%; P = .68), respectively. Confirmed metastatic disease was identified in 8 of 35 (22.9%) and 14 of 53 (26.4%) modified and traditional approach dogs, respectively, and was suspected in 4 of 35 (11.4%) and 7 of 53 (13.2%). Sixty-three (70%) dogs survived to study conclusion. No benefits in complication rate or local recurrence were identified in dogs following the modified approach as opposed to the traditional closed anal sacculectomy technique.

Surgical Excision of Intramuscular Sarcomas: Description of Three Cases in Dogs.

Compartmental excision consists of the complete resection of an anatomic district in which specific structures act as a barrier to local tumour invasion. It is a well-established procedure in human medicine, while only a few reports are available in veterinary medicine. The aim of this study was to describe complete muscle resection in 3 dogs affected by different intramuscular sarcomas. The clinical outcome was also reported. Medical records were searched, including preoperative diagnostic findings, compartmental excision, histologic diagnosis, and outcome. Three dogs fit the inclusion criteria, which had a sarcoma confined to a single muscular belly (semitendinosus, biceps, and splenius capitis muscles). Complete excision of the affected muscle was performed in all cases. One dog showed moderate lameness in the immediate postoperative period, resulting from the dorsal lifting of the scapula due to serratus ventralis tenotomy performed to remove the caudal insertion of the splenius capitis muscle. All the dogs recovered fully within one month, experiencing good clinical function. Histopathology showed complete tumour removal with no neoplastic fascial disruption in all cases. Compartmental excision provides effective local tumour control, representing an alternative to limb amputation or more radical excision if adjuvant radiotherapy is not an option for owners.

P-251 Multidisciplinary challenge for the oncologist and surgeon: Gastrointestinal stromal tumors. Follow-up of a tertiary surgical department

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in gastrointestinal system with most found in stomach. With the characteristic of being mostly c-KIT positive (CD117) as a mutation carrier, genetics is a part of the management of GIST, helping both the surgeon and the oncologist. The diagnosis and the definition of the characteristics of tumor will help to define the response to treatment procedures, which is fundamental for oncologists and surgeons to create an algorithm for their patients. The follow-up should be done both with oncologists and surgeons in order to define early recurrences and metastasis. This study is based on the follow-up of GIST patients operated in a tertiary general surgery department. 43 patients have been operated on between January 2017-December 2018. Routine preoperative diagnostic findings and postoperative pathological evaluations are identified and noted. In our hospital, routine management of GIST is as follows: In case of high grade GISTs, postoperative adjuvant imatinib therapy is routinely given for three years, and if there is metastasis or locally unresectable tumor, neoadjuvant imatinib treatment is given for shrinking the primary tumor and curing the systemic disease before the surgery. As the primary and golden treatment of GIST is surgery, surgery is always an option for even metastatic disease. Of 43 patients, 23 patients had a mitosis rate under 5/50, whereas 5 patients had a mitosis rate between 5/50 – 10/50, and 15 patients had a mitosis rate over 10/50. According to the size of the tumor, 3 patients had a single tumor under 2 cm. All of these three patients had lesions in the prepiloric area, and got operated with the symptoms of gastric outlet syndrome. 17 patients had a tumor between 2-5 cm, whereas 14 patients had a tumor between 5-10 cm. 9 patients had GIST tumors over 10 cm in diameter. Interestingly, all patients with liver metastasis had liver lesions over 10 cm. One patient with a tumor bigger than 10 cm had an extragastrointestinal stromal tumor, arising from the mesentery. The pathological results of the specimens were as follows: 29 spindle cell histologic subtype, 3 epitheloid cell subtype, and 11 mixed cell subtype. The focal necrosis was present in 14 patients. From 43 patients, three patients got reoperated. The first patient was reoperated at the fifth month postoperatively because of mechanical obstruction. The second patient got reoperated at the ninth month postoperatively because of incisional hernia. The third reoperated patient was reoperated because of the first pathological specimen was found out to be surgical borders millimetrically positive. The reoperation rate for our patients in three years of follow up was 6.97%. All reoperated patients had a pathological finding of spindle-cell type of morphology, with mitosis rates over 10/50. There needs to be more studies based on reoperation rates after GIST surgeries, but this study evaluated that complications after GIST surgery should be followed both by the oncologist and the surgeon.

Development and validation of a brachycephalic risk (BRisk) score to predict the risk of complications in dogs presenting for surgical treatment of brachycephalic obstructive airway syndrome.

To develop and validate a preoperative brachycephalic risk (BRisk) score that objectively and accurately predicts the risk of major complications or death in dogs undergoing corrective surgery for brachycephalic obstructive airway syndrome (BOAS). Retrospective multicenter cohort study. Score development n = 233 dogs, validation n = 50 dogs. Data were collected on signalment, medical history, reason for presentation, physical examination, and preoperative diagnostic findings. The primary outcome measures included risk of major complications (requirement for postoperative oxygen support for >48 hours or postoperative temporary/permanent tracheostomy) or death within the hospitalization period. The score was developed by using data from two centers and was validated in a third center. The 10-point BRisk score was modeled on breed, history of previous surgery, concurrent procedures, body condition score, airway status, and admission rectal temperature. The score was associated with negative outcome (P < .0001) and discriminated well in both the construction (area under the receiver operator characteristic [AUROC] = 0.83) and validation groups (AUROC = 0.84). Dogs with scores >3 were 9.1 times more likely to have a negative outcome (95% CI = 3.9-21.2) compared with dogs with scores ≤3. The BRisk score developed from admission data in this study accurately rated the risk of negative outcome of dogs undergoing corrective surgery for BOAS. Preoperative determination of the BRisk score may assist triage, management of owner expectations, decision making regarding intervention selection, and characterization of populations in clinical research.

Differential diagnosis between uterine sarcoma and leiomyoma using preoperative clinical characteristics.

The aim of this study was to identify the preoperative diagnostic findings suggestive of uterine sarcoma. We retrospectively reviewed the medical records of 31 patients with pathologically confirmed uterine sarcoma including leiomyosarcoma, endometrial stromal sarcoma, and undifferentiated sarcoma, between 2003 and 2011. The cases were matched by age, year of procedure (plus or minus 1 year), and surgeon, to controls (1:3 ratio) selected from all the patients who underwent hysterectomy for uterine myoma during the same period. Uterine sarcomas had larger tumor size compared with leiomyoma on sonography (P = 0.006). There was no significant difference in the total number of masses found on ultrasonography (P = 0.066). On multivariate analysis increased neutrophil-to-lymphocyte ratio (NLR > 2.1), large tumor size (> 8.0 cm), and lower body mass index (BMI ≤ 20) were independent risk factors for uterine sarcoma (P = 0.014, 0.048, and 0.048, respectively). Sarcoma index was calculated by summing the number of risk factors. Higher sarcoma index was associated with increased risk of uterine sarcoma (0, 13.6%; 1, 21.7%; 2, 62.5%; 3, 100%). Preoperative NLR, tumor size, and BMI could be useful for the discrimination of sarcoma from leiomyoma of uterus.

Intraoperative findings on ECAP-measurement: Normal or special case?

Objective: This study aimed to investigate the measurability and threshold level of electrically evoked compound action potentials (ECAPs) in order to provide a baseline for the development of diagnostic references to support aftercare procedures. Design: In this retrospective study, cochlear implant patients were grouped according to the electrode array type and preoperative diagnostic findings from radiological imaging. ECAP measurements were performed intraoperatively on 22 electrodes for each patient resulting in two comparisons: (1) normal vs. pathological findings based on imaging with same electrode array, (2) perimodiolar electrode vs. straight electrode array within the normal group. Study sample: The study sample consisted of 218 ears with a Nucleus® implant. Results: In the group with normal radiological imaging, the percentage of measurable ECAPs was higher than in the pathological group. The ECAP thresholds on 21 electrodes were significantly different between the two groups. Furthermore the thresholds were significantly lower for basal electrodes mainly for the two different electrode types. Conclusion: The pathological changes in the inner ear, the type of electrode array, and the electrode position affect the ECAP threshold. Further consideration suggests that a receiver operating characteristic curve can be derived from the results.

Scattered Psammomatous Calcifications around Papillary Thyroid Carcinoma

Although psammomatous calcification is a characteristic pathologic feature of papillary thyroid carcinoma (PTC), the clinical meaning of histologically determined scattered psammomatous calcifications around PTC is unknown. The aim of this study was to evaluate the clinical significance of scattered psammomatous calcifications around PTC. Between January 2009 and July 2009, a total of 546 patients who underwent total thyroidectomy for PTC were enrolled. They were classified into two groups: patients with scattered psammomatous calcifications and patients without psammomatous calcifications. The clinical findings, preoperative diagnostic findings, and histopathologic features were compared between the two groups. Scattered psammomatous calcifications around PTC were found in 209 patients (38 %), and mostly in younger patients (p = 0.007), those with infiltrative tumor margin (p = 0.022), those with capsule invasion (p = 0.013), and those with lymph node metastasis (p < 0.001). No statistical significance was found in gender, tumor size, multiplicity, and coexisting lymphocytic thyroiditis. Although further studies with large-scale, long-term follow-up will be necessary to validate the relationship between scattered psammomatous calcifications and prognosis, scattered psammomatous calcification around PTC may have correlations with the aggressiveness of the PTC.

579 Analysis of atypical hyperplasia and carcinoma in situ in nonpalpable breast lesions: final outcome and underestimation rates

To examine factors associated with one step surgery in case of non-palpable breast cancer.Clinical data of 152 consecutively diagnosed patients with breast cancer were analyzed retrospectively. Preoperative diagnostic findings were divided in subgroups: mammographically visible mass/microcalcifications/sonographically visible mass/sonographically visible architectural distortion. Correlation between tumor-size, radiologic tumor morphology, quality of localization and number of operation was evulated. For localization exact wire position was defined less than 3 mm apart from the lesion.One hundred and thirty-six patients attempted breast conservation and underwent preoperative tumor localization. Fourteen of 16 patients had mastectomy without preoperative localization. Average tumor size was 12 mm for one-operation, and 17 mm for re-operation. Significant correlation (p < 0.001) was found between one operation and masses visible in mammograms (55/62 (89%) patients) or sonography (53/64 (83%) patients). Significant correlation was found (p < 0.001) between more re-operation and microcalcifications in mammograms (33/89 (37% patients). In 123/138 (89%) cases wire position was central, in 15/138 (11%) cases distance was maximally 10 mm. No significant correlation was found between number of operation and wire position. Re-operation was required in 38 cases.Mammographically or sonographically visible mass, small size of tumors, preoperative percutaneous biopsy and exact preoperative localization are important for a single step procedure for definite surgical treatment, that we found in 74% of the patients.

The Gist of Literature on Pediatric GIST

To provide a review of existing literature on pediatric GIST with focus on clinical presentation. A MEDLINE search was conducted in July 2007 to give an overview on literature concerning pediatric gastrointestinal stromal tumors (GISTs) with a focus on clinical presentation, using keywords "gastrointestinal stromal tumor" and one of the following "young/boy/girl/child/children/pediatric." Two of the authors sorted the resulting abstracts by relevance for a review on clinical aspects of pediatric GIST if they were in English language, not explicitly only reporting of adults and describing clinical features of patients. One hundred and six articles were found, 43 of which were excluded because they did not match the criteria mentioned above. We found 97 patients in the articles meeting our criteria, of which 38 cases had to be excluded, because of lacking clinical data, negative staining for CD117 or syndromal occurrence. This left 59 patients for analysis of clinical symptoms in the presentation of nonsyndromal CD117-positive GIST in children. Clinical feature most frequent was anemia in 86.4% (n=51) symptomatic either through acute or subacute bleeding. There was no palpable tumor in 88.1% (n=52), no abdominal pain in 84.7% (n=50), and no vomiting in 88.1% (n=52). Girls tend to show more high-grade tumors and existing case reports show a 2.7-fold higher incidence in females. Altogether epithelioid cell tumors are most frequent, although in boys spindle-cell tumors are reported more often. On the basis of National Institute of Health criteria (6) tumors were low grade in 22% (n=13), medium grade in 37.3% (n=22), and high grade in 35.6% (n=21). There were more high-grade tumors in girls than in boys (40.5% vs. 28.6%). Local excision was the operation most often performed, but details of surgery were missing in most cases. Pediatric GIST is a rare but considerable diagnosis in chronic anemia, which is the most frequent clinical finding with this tumor entity. Recent review articles focus on histopathologic criteria but omit clinical features and course of disease. In nonsyndromal CD117-positive GIST, girls tend to show more high-grade tumors and existing literature on pediatric GIST shows a 2.7-fold higher incidence in females. Altogether epithelioid cell tumors are most frequent, although in boys spindle-cell tumors are reported more often. Together with known differences in molecular changes and local as well as systemic tumor behavior this strongly suggests that pediatric GIST represents a different entity than adult GIST. After establishment of clear-cut pathologic features in the past, reports on preoperative diagnostic findings, long-term follow-up, and therapy have to be emphasized to clarify the relationship of these entities.

Factors associated with one step surgery in case of non-palpable breast cancer

Purpose To examine factors associated with one step surgery in case of non-palpable breast cancer. Materials and methods Clinical data of 152 consecutively diagnosed patients with breast cancer were analyzed retrospectively. Preoperative diagnostic findings were divided in subgroups: mammographically visible mass/microcalcifications/sonographically visible mass/sonographically visible architectural distortion. Correlation between tumor-size, radiologic tumor morphology, quality of localization and number of operation was evulated. For localization exact wire position was defined less than 3 mm apart from the lesion. Results One hundred and thirty-six patients attempted breast conservation and underwent preoperative tumor localization. Fourteen of 16 patients had mastectomy without preoperative localization. Average tumor size was 12 mm for one-operation, and 17 mm for re-operation. Significant correlation ( p < 0.001) was found between one operation and masses visible in mammograms (55/62 (89%) patients) or sonography (53/64 (83%) patients). Significant correlation was found ( p < 0.001) between more re-operation and microcalcifications in mammograms (33/89 (37% patients). In 123/138 (89%) cases wire position was central, in 15/138 (11%) cases distance was maximally 10 mm. No significant correlation was found between number of operation and wire position. Re-operation was required in 38 cases. Conclusion Mammographically or sonographically visible mass, small size of tumors, preoperative percutaneous biopsy and exact preoperative localization are important for a single step procedure for definite surgical treatment, that we found in 74% of the patients.

Predictive Factors of Malignant or Invasive Intraductal Papillary-Mucinous Neoplasms of the Pancreas

The aim of this study was to identify useful preoperative diagnostic findings indicative of malignant or invasive intraductal papillary-mucinous neoplasms (IPMN) of the pancreas to determine an optimal operative procedure for IPMN. Sixty-two IPMNs, which consisted of 29 adenomas, 10 borderline tumors, 11 adenocarcinomas in situ, and invasive adenocarcinomas were reviewed from 1990 to 2003. Preoperative predictive factors of malignant or invasive IPMN were analyzed among 10 factors by univariate and multivariate analysis. Diameter of the main pancreatic duct (≧6 mm) and cytological examination of the pancreatic juice (the presence of malignant cells) were identified as independent predictive factors of malignant IPMN, and only cytological examination of the pancreatic juice (the presence of malignant cells) was identified as an independent predictor of invasive IPMN by multivariate analysis (P < 0.05). There was no recurrent disease in patients with adenoma and adenocarcinoma in situ, whereas recurrences occurred in 6 of 12 patients with invasive IPMN. Patient survival in noninvasive IPMN was significantly (P = 0.018) better than that in invasive IPMN (The overall 5-year survival rates were 87.2% and 49.2%, respectively). These results might be useful for selecting an optimal surgical procedure for IPMN.

Small carcinoma of the pancreas is curable: New computed tomography finding, pathological study and postoperative results from a single institute

It is well known that pancreatic cancer is rarely cured and is usually fatal. The clinicopathological features of small (greatest dimension < or = 2 cm by histologic measurement) carcinoma of the pancreas (s-PC), were reviewed, paying special attention to new computed tomography (CT) finding that suggests the presence of s-PC. Sixteen patients with s-PC have undergone curative surgery at Aichi Cancer Center Hospital during the past 11 years. Their preoperative diagnostic findings, pathological findings and postoperative prognoses were analyzed. The most useful diagnostic clue was dilatation of the main pancreatic duct (MPD). It was difficult to identify the tumor in four patients because of pancreatitis accompanying the MPD obstruction. In three of these four cases, early phase-enhanced CT revealed a contrasting effect between the proximal and distal sides of the pancreatic parenchyma at the site of the MPD obstruction (black & white sign). The longest diameters of the tumors ranged from 0.9 to 2 cm (average 1.3 cm). Positive rates of capsular invasion, retroperitoneal invasion, and lymph node metastasis were 6.3% (1/16), 31.3% (5/16), and 18.8% (3/16), respectively. Six patients (37.5%) were classed at stage I, six (37.5%) stage II, three (18.8%) stage III, and one (6.2%) at stage IV according to pathological TNM classification. One patient died of the disease, and the cumulative 3- and 5-year survival rates were 88.9% and 59.3%, respectively. The presence of s-PC qualifies as early PC and has a good prognosis. The CT black + white sign will be useful in the diagnosis of s-PC accompanying pancreatitis.

Surgical management of substernal goiters: clinical experience of 170 cases.

To discuss the presentation, diagnosis, treatment, histopathological findings, and complications of patients who underwent thyroidectomy for substernal goiter in our surgical clinic. We retrospectively analyzed 170 patients with substernal goiters among 2650 patients undergoing surgical treatment for various thyroid diseases between 1990 and 2003. We evaluated the clinical data, preoperative diagnostic findings, surgical treatments, histopathological results, and postoperative complications. The most common symptoms were a cervical mass (88%) and dyspnea (35%), but 26% of the patients were asymptomatic. Chest radiography provided the first evidence of a substernal goiter in 77% of the patients. We performed total or near total thyroidectomy and operated through a cervical incision in all but 12 of the patients. There was no operative mortality but 12 (7%) patients suffered temporary hypoparathyroidism and 4 suffered transient vocal cord paralysis (2%). Malignancy was diagnosed by histopathological examination in 22 (13%) patients. We think that the diagnosis of a substernal goiter is an indication for thyroidectomy, which is associated with very low postoperative morbidity.

耳小骨３次元ＣＴの臨床応用

This study was performed to evaluate the usefulness of three-dimensional (3D) helical CT imaging of the ossicles. High quality 3D images could be obtained in normal ear and diseased ears of cases of ossicular abnormality and chronic otitis media. But, the very thin structures of stapes, such as the stapedial crura and foot plate, could not be represented. Preoperative diagnostic findings of ossicles in diseased ears through 3D images corresponded with their surgical observations. As a result, this study showed that 3D images of the ossicles by helical CT can offer detailed diagnosis and are clinically useful.

Three-dimensional CT of the ossicles of the middle ear

This study was performed to evaluate the usefulness and limitations of three-dimensional (3-D) imaging of the ossicular chain in the middle ear by high speed helical CT. One dissected human temporal bone, five normal ears, and twelve diseased ears (trauma, ossicular anomaly, cholesteatoma, chronic otitis media) were scanned in 1.0mm slices and reconstructed at a thickness of 0.2-0.5mm. All 3-D CT specimens can be observed in any plane and from any direction. Ossicular 3-D CT temporal bone images were reconstructed as if the malleus, incus and stapes were being observed under a microscope. No defect in the ossicles or their joints was seen in the images. The entire structure of the stapes could not be represented by conventional two-dimensional CT, but the 3-D CT in our study showed the head, crus and foot plate of the stapes in detail. Ossicular 3-D CT images of normal ears yielded the same findings as those recorded in the temporal bone. Preoperative diagnostic findings of ossicles in diseased ears were very useful. 3-D CT was diagnostic and its accuracy was confirmed by surgical observations, especially in ossicular anomalies. 3-D CT was also an important method of postoperative evaluation of ossicular reconstruction, i.e. TORP and PORP. It could represent the anatomical relation between prosthesis and the oval window. Postoperative hearing improvement can be compared with 3-D CT findings. High-speed helical CT can scan an object more quickly and clearly than conventional CT, and its biological damage in humans is less than that of other methods.

Transvaginal ultrasonography versus hysteroscopy in the diagnosis of uterine submucous myomas

Seventy-one women with symptomatic uterine myomas, hospitalized for hysterectomy, underwent preoperative transvaginal ultrasonography and hysteroscopy to compare their reliability in the diagnosis of submucous myomas. After the operation, the surgical specimen was studied carefully and the results were compared with the preoperative diagnostic findings. Transvaginal ultrasonography had a sensitivity of 100% and specificity of 94%; the predictive value of an abnormal ultrasound scan was 81% and that of a normal one was 100%. The sensitivity of hysteroscopy was 100% and the specificity 96%; the predictive value of an abnormal hysteroscopic finding was 87% and that of a normal result was 100%. Mapping of uterine myomas is more precise with transvaginal ultrasonography than with hysteroscopy, but the former method cannot distinguish between a myoma and an endometrial polyp.