Preoperative Histological Diagnosis Research Articles

Is histological confirmation necessary to avoid futile resections? Comparative of 4 university hospitals.

There is no consensus in the literature on preoperative histological analysis for lung cancer. The objective of this study was to assess 4 diagnostic models used in different hospitals with differing practices regarding preoperative histological diagnosis and the consequences in terms of unnecessary surgery and futile major resection. We carried out a retrospective observational study collected from 4 university hospitals in Spain over 3 years (January 2019 to December 2021). We included all patients with a confirmed diagnosis of primary lung cancer and any patients with suspected primary lung cancer who had undergone surgery. All patients underwent computed tomography and positron emission tomography/computed tomography scans. Each multidisciplinary committee was free to choose whether to perform flexible bronchoscopic or transthoracic lung biopsy. Decisions concerning whether to perform intraoperative sample analysis, the surgical approach and the type of resection were left to the surgical team. We included a total of 1642 patients. The use of flexible endoscopy and its diagnostic performance varied substantially between hospitals (range: 23.8-79.3% and 25-60.7%, respectively); and the same was observed for transthoracic biopsy and its performance (range: 16.9-82.3% and 64.6-97%, respectively). Regarding major resection surgery (lobectomy or more extensive resection), the lowest rate was observed in hospital C (1%) and the highest in hospital B (2.8%), with between-hospital differences not reaching significance (P = 0.173). The rate of histological sampling before lung cancer surgery still varies between hospitals. In spite of very diverse multidisciplinary management, the rate of futile lobectomy is not significantly higher in hospitals with lower rates of preoperative histological analysis.

Abstract A021: Pilot study of daily exemestane in patients with Endometrial Intraepithelial Neoplasia (EIN) or grade 1 endometrial cancer

Abstract Introduction: The purpose of this study is to evaluate exemestane, an aromatase inhibitor, as a potential agent for the chemoprevention of endometrial cancer. Experimental procedures: This is a multi-center, phase IIA, single arm ‘window of opportunity’ pilot study of 25 mg per day of exemestane for 21-42 days in postmenopausal patients undergoing hysterectomy for endometrial intraepithelial neoplasia (EIN) or low-grade endometrial cancer. The primary objective is to determine if there is a decrease in proliferation index, measured by percent Ki-67 expression in endometrial tissue, from pre-treatment to post-exposure. Results of Ki-67 are compared with a historic control cohort of tumors from patients matched by preoperative histologic diagnosis, age, BMI category. Specimens from the historic control cohort included a preoperative endometrial biopsy as well as a surgical specimen, separated in time by less than 42 days. Secondary outcomes include comparison of Ki67 to historic controls, circulating serum estradiol and progesterone levels, pathologic response, tissue biomarkers, safety and adverse effects. Summary of Data: Forty patients accrued to the study between January of 2018 and March of 2021. The mean age was 63 (range 52-75). Thirty-nine patients (97.5%) self identifiedself-identified as white; 1 patient (2.5%) identified as Asian. The mean BMI was 40.3 (SD 9.75, range 22.8-60.5). Preoperative diagnoses included EIN, grade 1 endometrial adenocarcinoma, and grade 2 endometrial adenocarcinoma in 11 (27.5%), 26 (65%), and 3 (7.5%) patients respectively. Thirty-nine patients (97.5%) were compliant with exemestane dosing. All patients completed the study and no patients discontinued or interrupted therapy due to treatment related adverse events. Thirty-eight patients had evaluable specimens for both pre and post-treatment Ki-67 analysis. Median Ki-67 score decreased from 40.7% [IQR (33.9%, 50.3] at baseline to 18.1% [IQR (8.8%, 31.8%)]. This represents a median absolute change from baseline of -20.4% [IQR (-29.9, -6.7), p<0.001]. In total, percentage of Ki-67 in tumor cells declined in 31 patients and increased in 7 patients. In the historic control cohort, patients also had a decrease in Ki-67 score with a median absolute change from baseline of -6.7% [IQR (-12.7%, -1.3%), p<0.001]. However, the decrease in Ki-67 was greater in the study patients than the matched historic controls, with a median difference between the groups of -13.4% [IQR= (-23.3%, 6.9%), p=0.0095]. Serum estradiol levels did not change significantly between baseline and post-treatment (p=0.16). There was a small but significant increase from baseline to post-treatment in serum progesterone (0.14 ng/mL vs 0.37 ng/mL, p<0.001). Conclusion: In this pilot window of opportunity study, exemestane demonstrates anti-proliferative effects in endometrial intraepithelial neoplasia and low-grade endometrial cancer. This agent warrants further evaluation for the chemoprevention of endometrial cancer. Citation Format: Britt K. Erickson, Lisa Barrioullet, Rebecca C. Arend, Dina El-Rayes, Mahmoud Khalifa, Amy Skubitz, Kristin Boylan, Andrew Nelson, Bharat Thyagarajan, Thomas Havighurst, Richard Chappell, Eileen Dimond, Katina Deshong, Goli Samimi, Eva Szabo, Howard Bailey. Pilot study of daily exemestane in patients with Endometrial Intraepithelial Neoplasia (EIN) or grade 1 endometrial cancer [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr A021.

Combined use of the Da Vinci robot system and the LungPoint Virtual Bronchoscopic Navigation system in the management of lung cancer: First Hong Kong experience

AbstractSmall ground‐glass opacity intrapulmonary lesions without preoperative histological diagnosis are difficult to localise in minimal invasive thoracic surgery, especially in robotic‐assisted surgery which has limited haptic feedback. Here we present two cases of using the LungPoint Virtual Bronchoscopic Navigation system for indocyanine green injection to assist with localization during robotic thoracic surgery, which might be a safe and feasible technique for such cases with impalpable lesions with no prior histological proof.

Identification of intraductal component by core-biopsy in invasive breast cancer and its impact on pCR achievement.

e12554 Background: Core biopsy is considered to be a highly accurate method of gaining a preoperative histological diagnosis of invasive breast cancer (IBC). Intraductal component (IC) is often an accompanying element of IBC. Due to the growing interest in the use of minimally invasive interventions in IBC treatment, in particular vacuum-aspiration biopsy, the accurate determination of the presence of an IC before surgery becomes crucial, since the presence of IC is an exclusion criterion in many trials. Methods: We retrospectively analyzed data from 505 patients treated in 2020-2022 for whom information about diagnostic core biopsy and postoperative histology were available with an indication of IC presence. 274 patients received neoadjuvant systemic therapy (NST) and we assessed the role of IC in achieving pCR in this subgroup. Results: In the overall population (505 pts), intraductal component was found in 167 (33.1%) pts by core-biopsy and in 294 (58.2%) pts on postoperative histology. For the overall population, sensitivity was 44.56% (95% CI 38.79 to 50.44%), specificity was 82.94% (95% CI 77.17to 87.75%), positive predictive value was 78.44% (95% CI 72.47 to 83.42%), negative predictive value was 51.78% (95% CI 48.79 to 54.75%) and false negative rate was 55.4%. The presence of an intraductal component was significantly associated with the status of receptors on the surface of tumor according to core-biopsy (HR+/HER2- = 123 from 347 pts, HER2+ = 32 from 84 pts, HR-/HER2- = 15 from 74 pts. p=0.003) and according to postoperative histology with exception of patients achieved pCR (HR+/HER2- = 66 from 102 pts, HER2+ = 9 from 18 pts, HR-/HER2- = 12 from 33 pts. p=0.014). In the population without NST (231 pts), intraductal component was found in 85 (36.7%) pts by core-biopsy and in 188 (81.4%) pts on postoperative histology. For this population, sensitivity was 44.15% (95% CI 36.93 to 51.56%), specificity was 95.56% (95% CI 84.85 to 99.46%), positive predictive value was 97.65% (95% CI 91.38 to 99.39%), negative predictive value was 29.05% (95% CI 26.22 to 32.06%) and false negative rate was 55.8%. In the population which underwent NST (274 pts), intraductal component was found in 81 (29.6%) pts by core-biopsy and in 106 (38.8%) pts on postoperative histology. For this population, sensitivity was 45.28% (95% CI 35.59 to 55.25%), specificity was 79.76% (95% CI 72.88 to 85.56%), positive predictive value was 58.54% (95% CI 49.47 to 67.06%), negative predictive value was 69.79% (95% CI 65.66 to 73.63%) and false negative rate was 53.7%. pCR rate was 44.3% (121 pts). Presence of intraductal component in core-biopsy specimen did not significantly impact pCR achievement (p=0.374). Conclusions: Core-biopsy is not very effective tool in diagnosis of intraductal component preoperatively. pCR achievement is not dependent on presence of IC in core-biopsy specimen. Presence of IC is significantly associated with receptor status of the tumor.

Prognostic biomarkers in and selection of surgical patients with hepatocellular carcinoma.

Prognostic biomarkers in and selection of surgical patients with hepatocellular carcinoma.

Lung Cancer resection in the absence of pre-operative histology: The Accuracy of Multidisciplinary Team Consensus

BackgroundLung resection remains the gold-standard of treatment for non-small cell lung cancer (NSCLC). British Thoracic Society (BTS) guidelines recommends the pursuit of pre-operative histological diagnosis and staging where possible. In the absence of pre-operative histology, surgical treatment can be offered in conjunction with multidisciplinary team (MDT) and patient consensus. We undertook a single-centre analysis of the accuracy of the lung cancer MDT in recommending surgical resection for those with suspected lung malignancy in the absence of pre-operative histological diagnosis over a six-year period. MethodsA retrospective review was performed of patients undergoing any pulmonary oncological resection with therapeutic intent without pre-operative histological diagnosis at the recommendation of the lung cancer MDT in our unit between May 2016 and July 2022. Results270 consecutive patients underwent lung resection for a lung nodule of indeterminate significance. This accounted for 45% of the oncological resections performed over this period. The mean age of the cohort was 67.9 years, and 47.4% were male. Overall, 10% of resected specimens (n = 27) were benign on final histopathology. 93% of those undergoing a lobectomy received a malignant diagnosis. Across the study cohort, surgical resection was well tolerated with a low complication rate. ConclusionsLung cancer resection in the absence of pre-operative histological diagnosis is feasible in a select patient cohort. This approach requires an experienced multi-disciplinary team and careful patient counselling. Our study demonstrates this adapted approach to be a pragmatic solution to the management of indeterminate pulmonary nodules in centres where biopsy is not routinely available due to existing constraints on the health system.

Quality performance indicator compliance for the treatment of gastric adenocarcinoma.

Quality performance indicators (QPI) are objective measurements of aspects of patient care that affect clinical outcome. This study investigates the compliance rate to published QPIs of gastric adenocarcinoma (GA) management, in a single institution, to determine areas of strong performance and those requiring improvement. All patients with GA treated from 2010 to 2015, and 2020 to 2021 were included. Electronic data in the form of clinic letters, operation notes, and histology and radiology reports were reviewed with ethics approval. QPI adherence was collected in binary form. QPIs with high compliance rate include preoperative radiological staging and histological diagnosis, subspecialty surgeon training and pathology report documentation. QPIs with low compliance include perioperative chemotherapy (31.6%), postoperative radiological surveillance (32.5%) and minimally invasive approaches to surgical resection (12.5%). QPIs from the systematic review are variably implemented in clinical practice, thus informing on their relevance to real world clinical practice whilst also identifying the areas requiring focus for improvement.

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.

Clinical Outcomes after Upfront Surgery in Clinical Stage I-IIA Small Cell Lung Cancer.

Upfront surgery followed by systemic treatment is recommended to treat clinical stage I-IIA small cell lung cancer (SCLC), but data on the clinical outcomes are sparse. Thus, this study evaluated the stage migration and long-term prognosis of surgically treated clinical stage I-IIA SCLC. We retrospectively reviewed 49 patients with clinical stage I-IIA SCLC who underwent upfront surgery between 2000 and 2020. Additionally, we re-evaluated the TNM (tumor-node-metastasis) staging according to the eighth edition of the American Joint Committee on Cancer staging system for lung cancer. The clinical stages of SCLC were cIA in 75.5%, cIB in 18.4%, and cIIA in 6.1% of patients. A preoperative histologic diagnosis was made in 65.3% of patients. Lobectomy and systematic lymph node dissection were performed in 77.6% and 83.7% of patients, respectively. The pathological stages were pI in 67.3%, pII in 24.5%, pIII in 4.1%, and pIV in 4.1% of patients. The concordance rate between clinical and pathological stages was 44.9%, and the upstaging rate was 49.0%. The 5-year overall survival (OS) rate was 67.8%. No significant difference in OS was found between stages pI and pII. However, the OS for stages pIII/IV was significantly worse than for stages pI/II (p<0.001). In clinical stage I-IIA SCLC, approximately half of the patients were pathologically upstaged, and OS was favorable after upfront surgery, particularly in pI/II patients. The poor prognosis of pIII/IV patients indicates the necessity of intensive preoperative pathologic mediastinal staging.

The great masquerader of pancreatic tuberculosis

BackgroundPancreatic tuberculosis is a rare clinical entity. It represents a diagnostic challenge as the clinical presentation may mimic pancreatic malignancy.Case presentationA 66-year-old gentleman presented with an incidental finding of a pancreatic tail mass on routine ultrasonography of the abdomen whilst working up on chronic kidney disease. He denied abdominal pain, fever, night sweats, constitutional symptoms or tuberculosis contact. On examination, there was no palpable mass per abdomen. The tumour marker of Ca 19-9 was normal. Ultrasonography revealed a lobulated heterogeneous hypovascular and hypoechoic mass at the tail of the pancreas. Contrast-enhanced computed tomography (CT) of the thorax and abdomen revealed a thickened right pleura, right pleural effusion with right lung collapsed consolidation and multiple mediastinal lymph nodes. There is an ill-defined hypodense mass seen in the tail and body of the pancreas measuring 3 × 7 × 3 cm with the presences of calcification within. The constellation of CT findings suggests a pancreatic malignancy with metastasis to the lungs. Endoscopic ultrasonography (EUS) assessment showed an irregular hypoechoic mass measuring 3.0 × 2.7 cm at the tail of the pancreas. Multiple rounded hypoechoic lesions were also seen scattered within the body of the pancreas with multiple enlarged para-aortic lymph nodes. A fine-needle aspiration biopsy of the lesion was consistent with granulomatous inflammation. The diagnosis of disseminated tuberculosis was made. The patient was subsequently started on antitubercular medication and recovered well.ConclusionA high index of suspicion is needed to diagnose pancreatic tuberculosis, especially in patients whose radiological imaging shows a pancreatic mass with necrotic peripancreatic lymphadenopathy in endemic countries. EUS-guided fine-needle aspiration is the diagnostic modality of choice, and vigorous attempts should be made at obtaining a preoperative histological or bacteriological diagnosis to avoid unnecessary surgery.

Preoperative Histological Diagnosis of Pancreatic Cystic Neoplasms: Is Through the Needle Forceps Sampling the Answer?

AbstractAccurate preoperative diagnosis of pancreatic cystic lesions (PCLs) is a challenge as image-guided cytology has a very low sensitivity for its diagnosis. The recent advances in endoscopic ultrasound (EUS) such as needle confocal laser endomicroscopy and through the needle biopsy forceps has led to better characterization and diagnosis of the PCL. In this news and views, we discuss a prospective study that has evaluated the efficacy and safety of EUS-guided throughtheneedle biopsy sampling (EUS-TTNB) for diagnosis of PCLs.

473 Endometrial intraepithelial neoplasm: 8-year audit of a single centre

Endometrial hyperplasia (EH) is often a precursor lesion to endometrial carcinoma (EC). The gold standard for the diagnosis of EH is an endometrial biopsy guided by hysteroscopy. The 2014 WHO classification divides EH into two categories: hyperplasia without atypia (non-neoplastic) and atypical hyperplasia (endometrial intraepithelial neoplasm- EIN). To investigate the global features and outcome of women undergoing surgery due to EIN. Retrospective analysis of clinical data from a set of 58 women with pre-operative histologic diagnosis of EIN who were submitted to surgery after being presented at the Multidisciplinary Tumour Board, between January of 2013 and December of 2020.

Percutaneous intravenous catheter forceps biopsy in right atrial mass: two case reports and literature review

BackgroundPrimary malignant tumors of the heart are rare. Although preoperative histological diagnosis is difficult, it has paramount value in therapeutic strategy development and prognostic estimation. Herein, we reported 2 cases of intracardiac tumors.Cases presentationBoth patients presented to the hospital with heart-related symptoms. Echocardiography showed massive masses in the atrium and positron emission tomography–computed tomography (PET/CT) revealed hypermetabolism and invasiveness. One patient cannot take surgery due to extensive metastasis and poor condition. The other patient was primarily diagnosed with lymphoma, and surgery was not recommended. They successfully underwent intravenous atrial biopsy, and histological samples confirmed intimal sarcoma and diffuse large B cell lymphoma. Based on immunohistochemical and molecular assessments, targeted chemotherapy was administered, resulting in clinical and imaging remission at discharge.ConclusionsPercutaneous intravenous catheter biopsy as a safe invasive test provides an accurate pathological diagnosis after imaging evaluation, and offers a therapeutic direction. Nonmalignant masses and some chemo-radiosensitive malignant tumors in the atrium could have good prognosis after targeted therapy.

Pancreatic Solid Lesions Accompanied by Large Pseudocysts – How to Obtain a Histological Diagnosis

Background: Pseudocysts accompanying pancreatic solid lesions are rare findings and represent a big hurdle in obtaining a pre-operative histological diagnosis. Although they are usually complications of pancreatitis, pseudocysts can develop as a consequence of compression on the main pancreatic duct of solid masses whose characterization is essential. If the cyst is of moderate-large size, the acoustic effect of the fluid content and also the compression of the cyst itself on the pancreatic parenchima make often impossible to visualize the lesion which is squeezed too far from the probe to be seen. As a result, perfoming endoscopic-ultrasound guided fine needle aspiration/biopsy (EUS-FNA/B) of the solid mass underneath it is usually very challenging. Description of the technique: When there is a suspicion of a solid mass along with a moderate-large size pseudocyst, having a histological confirmation of cancer before surgery is essential and nowadays considered as standard of care. Using a 19G FNA needle to aspirate the cyst to dryness improves dramatically the lesion accessibility which becomes in the end visible and approachable with a standard EUS guided FNA or FNB. The procedure is safe and easy to perform under conscious sedation. Conclusions: EUS guided aspiration of large pseudocysts developed as complication of pancreatic lesions can be a crucial step in facilitating the histological confirmation of potential malignant lesions prior to surgery, allowing their visualization and biopsy.

The impact of preoperative EUS-FNA for distal resectable pancreatic cancer: Is it really effective enough to take risks?

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is frequently used for the preoperative histologic diagnosis of pancreatic cancer. However, debate continues regarding the clinical merits of preoperative EUS-FNA for the management of resectable pancreatic cancer. We aimed to evaluate the benefits and safety of preoperative EUS-FNA for resectable distal pancreatic cancer. The medical records of 304 consecutive patients with suspected distal pancreatic cancer who underwent EUS-FNA were retrospectively reviewed to evaluate the clinical benefits of preoperative EUS-FNA. We also reviewed the medical records of 528 patients diagnosed with distal pancreatic cancer who underwent distal pancreatectomy with or without EUS-FNA. The recurrence rates and cancer-free survival periods of patients who did or did not undergo preoperative EUS-FNA were compared. The diagnostic accuracy of preoperative EUS-FNA was high (sensitivity, 87.5%; specificity, 100%; positive predictive value 100%; accuracy, 90.7%; negative predictive value, 73.8%). Among patients, 26.7% (79/304) avoided surgery based on the preoperative EUS-FNA findings. Of the 528 patients who underwent distal pancreatectomy, 193 patients received EUS-FNA and 335 did not. During follow-up (median 21.7months), the recurrence rate was similar in the two groups (EUS-FNA, 72.7%; non-EUS-FNA, 75%; P = 0.58). The median cancer-free survival was also similar (P = 0.58); however, gastric wall recurrence was only encountered in the patients with EUS-FNA (n = 2). Preoperative EUS-FNA is not associated with increased risks of cancer-specific or overall survival. However, clinicians must consider the potential risks of needle tract seeding, and care should be taken when selecting patients.

MICROINVASIVE PROTOCOL FOR PREOPERATIVE DIAGNOSIS OF MINOR SALIVAR GLANDS MEC ALLOWING TARGETED SURGICAL THERAPY

<h3>Background</h3> Mucoepidermoid carcinoma (MEC) is the most common intraoral malignancy and is mainly located between hard and soft palate. Its surgical therapy could be difficult and depends on location, dimension, infiltration, and histologic grading. <h3>Objective</h3> The aim is to report the importance of a clinicopathologic protocol for microinvasive preoperative diagnosis, grading, and staging of MEC to sketch out a targeted surgical therapy in intraoral difficult locations. <h3>Methods</h3> In 64 cases of intraoral MEC treated between 2000 and 2019 at the Oro-maxillo-facial Surgery Unit of Policlinico-University-Hospital of Bari (Italy), the following preoperative protocol was performed: clinical examination, high-definition intraoral ultrasonography, radiological assessment (rxOPT, computed tomography/magnetic resonance imaging), microinvasive biopsy with fine-needle aspiration biopsy/fine-needle aspiration cytology with HeE, PAS+/−Alcian stains, and immunohistochemical panel (high-/low-molecular-weight cytokeratins, calponin, smooth muscle actin, S-100, Ki-67). Surgery was targeted for each patient and guided from histopathologic data and consisted of conservative excision with wide margins for low-grade MEC and demolitive resection with neck dissection for high-grade MEC. <h3>Results</h3> Application of our protocol gave a 100% preoperative histologic diagnosis and grading. Forty-one cases were low-grade MEC (29 female and 12 male patients, mean age = 37; site: 33 palate, 4 cheek, 2 lip, and 2 tongue); 23 were high-grade MEC (16 female and 7 male patients, mean age = 41; site: 19 palate, 1 cheek, 2 lip, and 1 tongue), and 4 were clear cells. <h3>Conclusions</h3> Preoperative fine-needle aspiration biopsy/fine-needle aspiration cytology for histologic diagnosis of MEC is mandatory in order to make decisions on the type of surgical treatment to avoid over- or undertreatment.

Is preoperative histological diagnosis in lung metastases necessary?

Is preoperative histological diagnosis in lung metastases necessary?

Pancreatic ductal adenocarcinoma and distal cholangiocarcinoma: a proposal of preoperative diagnostic score for differential diagnosis

PurposeThe differential diagnosis between primary adenocarcinoma of the pancreas head and distal cholangiocarcinoma remains a clinical challenge. Recent studies have shown important differences in terms of survival between these tumors. Therefore, different treatments should be considered, but the preoperative histological diagnosis is still difficult. Aim of this study is to create a preoperative diagnostic score for differential diagnosis between primary pancreatic adenocarcinoma and primary distal cholangiocarcinoma.MethodsOne hundred eighty consecutive patients who underwent pancreaticoduodenectomy at Sapienza University of Rome from January 2010 to December 2019 were retrospectively analyzed. Inclusion criteria were pancreatic or biliary histologic origin obtained by definitive postoperative histological examination. Exclusion criteria were diagnosis of ampullary carcinoma, non-ampullary duodenal adenocarcinoma, pancreatic metastasis, and benign disease. One hundred one patients were considered eligible for the retrospective study. Preoperative biological, clinical, and radiological parameters were considered.ResultsCRP > 10 mg/dL (p = 0.001), modified Glasgow Prognostic Score 2 (p = 0.002), albumin < 35 g/L (p = 0.05), CA 19-9 > 230 U/mL (p = 0.001), and Wirsung diameter > 3 mm (p < 0.001) were significant at univariate logistic analysis. Multivariate logistic analysis has shown that parameters independently associated with primary pancreatic adenocarcinoma were CRP > 10 mg/dL (p = 0.012), CA 19-9 > 230 U/mL (p = 0.043), and diameter of the Wirsung > 3 mm (p = 0.005). Through these parameters, a diagnostic score has been developed to predict a primary pancreatic adenocarcinoma when > 1 and a primary distal cholangiocarcinoma when < 1.ConclusionThis feasible and low-cost diagnostic score could have a potential impact to differentiate pancreatic cancer histologic origin and to improve target therapeutic strategy.

Benefit of radiofrequency ablation after widespread endoscopic resection of neoplastic Barrett's esophagus in daily practice.

BackgroundHigh-grade dysplasia (HGD) and intramucosal carcinoma (IMC) in Barrett’s esophagus (BE) are now well-established indications for endoscopic resection (ER). Radiofrequency ablation (RFA) can be combined with ER in case of flat or long-segment BE ablation. We report here our experience of complementary RFA after widespread ER of neoplastic BE in daily practice.MethodWe retrospectively reviewed data of 89 patients, treated between 2006 and 2013 by ER alone (group 1) or by ER combined with RFA (group 2).ResultsFifty-five patients in group 1 (7F/48M, mean age 68 years) underwent widespread ER with eradication of residual non-dysplastic BE. Complete eradication of HGD/IMC and intestinal metaplasia (IM) was achieved in 32/32 (100%) and 48/55 (87.3%) patients, respectively. Thirty-four patients in group 2 (3F/31M, mean age 67 years) had a multimodal treatment strategy, with widespread ER followed by RFA. Mean Prague classification of BE in this group was significantly longer (C4.4M6.6 vs. C2.7M4.5, P<0.001). Complete eradication of HGD/IMC and non-dysplastic BE was confirmed in 26/27 (96.3%) and 20/34 (58.8%) patients, respectively. There was no significant difference between groups concerning adverse events (16.4% vs. 23.5%, P=0.58) or recurrence rate of HGD/IMC (9.1% vs. 14.7%, P=0.42). The mismatch rate between preoperative and final histological diagnosis was high in both groups, at 45.5% and 26.5%.ConclusionsA combination of ER and RFA can treat significantly longer neoplastic BE than ER alone, with the same efficiency and safety. Widespread ER, in contrast, is the only method of obtaining a reliable histological diagnosis.

Gynecological hysterectomy in Northern Tanzania: a cross- sectional study on the outcomes and correlation between clinical and histological diagnoses

BackgroundHysterectomy is one of the most common gynaecological procedures performed worldwide. The magnitude of the complications related to hysterectomy and their risk factors are bound to differ based on locations, availability of resources and level of surgical training. Documented complications rates and their correlates are reported from high income countries while data from low- and middle-income countries including Tanzania is scare.MethodsThis was a hospital based cross-sectional study conducted at a tertiary facility in northern Tanzania where 178 women who underwent elective gynecological hysterectomies in the department of obstetrics and gynecology within the study period were enrolled. Logistic regression was performed to determine the association between risk factors and occurrence of surgical complication where p-value of < 0.05 was considered statistically significant. The degree of correlation between pre-operative clinical and histological diagnosis was determined by kappa correlation test.ResultsA total of 75 (42%) of women had surgical complications within 10 days of surgery. Blood transfusion and intra-operative bleeding were the most common complications observed in 34 (19.1%) and 17 (9.6%) women respectively. Independent risk factors for complications included obesity (OR 3.9; 95% CI 1.44–10.46), previous abdominal operations (OR 8.44; 95% CI 2.52–28.26) and longer duration of operation (> 2 h) (OR 5.02; 95% CI 2.18–11.5). Both uterine fibroid and adenomyosis had good correlation of clinical and histological diagnosis (p-value < 0.001).ConclusionBleeding and blood transfusion were the most common complications observed in this study. Obesity, previous abdominal operation and prolonged duration of operation were the most significant risk factors for the complications. Local tailored interventions to reduce surgical complications of hysterectomy are thus pivotal. Clinicians in this locality should have resources at their disposal to enhance definitive diagnosis attainment before surgical interventions.