Presence Of Solid Component Research Articles

Modified Computed Tomography Scoring System for Ovarian Tumors

Objective: Ovarian cancer is the sixth most common cancer in Thailand. Given the absence of a computed tomography (CT) score for differentiating between benign and malignant ovarian tumors, this study aimed to develop a CT scoring system for differentiating between benign and malignant ovarian tumors using pathologic findings as the reference standard.Material and Methods: This retrospective study included all female patients having undergone abdominal/pelvic CT scans for evaluation of ovarian masses at our institute, from January 2011 to December 2021. Two radiologists independently reviewed CT features and obtained a CT score for each tumor. Comparison of the differentiation performance of the CT score, with reference to the pathologic findings, was performed using Fisher’s exact or chi-squared test. The diagnostic performance of the CT score was evaluated.Results: A total of 144 patients with 191 ovarian masses were enrolled. Tumor component characteristics, septate thickness, ascites, and metastasis significantly differed between benign and malignant tumors (p-value<0.05). Multivariate logistic regression analysis showed that the presence of solid components and metastasis were significant independent differentiating factors (p-value<0.001). The CT score significantly differed between benign and malignant tumors (p-value<0.001), with 93.5% sensitivity and 81.6% specificity.Conclusion: The CT scoring system can differentiate between benign and malignant ovarian tumors with high sensitivity and specificity. Furthermore, the presence of a solid component and metastasis are CT features that can be used to differentiate between benign and malignant tumors.

A Comparative Cross-sectional Study to Evaluate Thyroid Imaging Reporting and Data System and Fine-needle Aspiration Cytology in Predicting Benign and Malignant Nature of Thyroid Nodules

Abstract Introduction: Thyroid ultrasound (US) should be performed in the initial assessment of the gland. The fine-needle aspiration cytology (FNAC) is an inexpensive and useful tool for detecting thyroid cancer. In the management of thyroid nodule patients, recommending who should be submitted to FNAC is still controversial. Aim: The aim of the study was to evaluate whether the US-based Thyroid Imaging Reporting and Data System (TI-RADS) scoring system is reliable in differentiating between benign and malignant thyroid nodules when compared to FNAC and its practical application in clinical decision-making. Materials and Methods: A total of 59 patients having solitary thyroid nodules were studied over 20 months. Thyroid function tests, US and FNAC of the thyroid were done. Using US, the thyroid nodule was evaluated for five sonological features: internal composition, echogenicity, margins, presence and type of calcification and shape of the lesion. The nature of the lesion was assessed based on the TI-RADS score calculated from the five US parameters. This result, along with FNAC, which was reported using The Bethesda System for Reporting Thyroid Cytopathology was finally compared with the histopathology reports. Results: When the suspicious sonological features were evaluated, the presence of solid components and taller-than-wide shapes was found to be maximum sensitive but less specific. Specificity, positive predictive value and negative predictive value were found to be maximum for the presence of microcalcification and presence of hypoechogenicity. The sensitivity of TI-RADS to detect malignancy was higher (100%) than FNAC (66.7%). The specificity of TI-RADS to detect malignancy was lower (36.2%) as compared to FNAC. Conclusion: TI-RADS can be used to avoid unnecessary fine-needle aspirations. It helps in decreasing confusion and assists in deciding when FNAC should be performed. TI-RADS is cost-effective and has a vital role in the initial evaluation and investigation of patients presenting with solitary nodules of the thyroid. Moreover, it is simple to use, reliable and easily reproducible.

Predictors of malignant intraductal papillary mucinous neoplasm of the pancreas

Intraductal papillary mucinous neoplasm (IPMN) is the most common pancreatic cystic neoplasm with a tendency to malignancy,and the 5-year survival rate of patients with invasive IPMN is less than 40%. Therefore,early detection of malignant cases and surgical intervention will significantly improve patient outcomes. The clinical guidelines recommended risk factors for IPMN malignancy according to imaging characteristics,clinical manifestations and serum tumor markers,among which dilation of the main pancreatic duct≥10 mm,the presence of solid components or enhanced mural nodules,and obstructive jaundice were recognized as high-risk factors. However,clinical practice has shown that the risk factors recommended by the current guidelines are not highly accurate in predicting IPMN malignancy,and the main problem is that the guidelines are less specific and allow follow-up cases to undergo unnecessary surgical resection. In recent years,the development of new technologies and methods such as genomics,radiomics,and artificial intelligence has greatly promoted the research progress of IPMN. Endoscopic ultrasound-guided fine needle aspiration of cystic fluid combined with molecular detection such as DNA and RNA,as well as radiomics combined with machine learning modeling,have shown superiority in improving the prediction accuracy of malignant IPMN,and will become an important tool to assist the diagnosis and treatment of IPMN in the future.

Ovarian Masses in Children and Adolescents: A Review of the Literature with Emphasis on the Diagnostic Approach.

Most abdominal masses in the pediatric population derive from the ovaries. Ovarian masses can occur in all ages, although their incidence, clinical presentation and histological distribution vary among different age groups. Children and adolescents may develop non-neoplastic ovarian lesions, such as functional cysts, endometrioma, torsion, abscess and lymphangioma as well as neoplasms, which are divided into germ cell, epithelial, sex-cord stromal and miscellaneous tumors. Germ cell tumors account for the majority of ovarian neoplasms in the pediatric population, while adults most frequently present with epithelial tumors. Mature teratoma is the most common ovarian neoplasm in children and adolescents, whereas dysgerminoma constitutes the most frequent ovarian malignancy. Clinical manifestations generally include abdominal pain, palpable mass, nausea/vomiting and endocrine alterations, such as menstrual abnormalities, precocious puberty and virilization. During the investigation of pediatric ovarian masses, the most important objective is to evaluate the likelihood of malignancy since the management of benign and malignant lesions is fundamentally different. The presence of solid components, large size and heterogenous appearance on transabdominal ultrasonography, magnetic resonance imaging and computed tomography indicate an increased risk of malignancy. Useful tumor markers that raise concern for ovarian cancer in children and adolescents include alpha-fetoprotein, lactate dehydrogenase, beta subunit of human chorionic gonadotropin, cancer antigen 125 and inhibin. However, their serum levels can neither confirm nor exclude malignancy. Management of pediatric ovarian masses needs to be curative and, when feasible, function-preserving and minimally invasive. Children and adolescents with an ovarian mass should be treated in specialized centers to avoid unnecessary oophorectomies and ensure the best possible outcome.

Malignancy risk factors and prognostic variables of pancreatic mucinous cystic neoplasms in Chinese patients.

Pancreatic mucinous cystic neoplasms (MCNs) represent one of the precursor lesions of pancreatic ductal adenocarcinoma, and their detection has been facilitated by advances in preoperative imaging. Due primarily to the rarity of MCNs, however, there is limited knowledge regarding the prognostic variables and high-risk factors for malignant transformation. A more comprehensive and nuanced approach is necessary to fill this gap and provide a basis for improved treatment decisions and patient outcomes. To investigate the high-risk factors associated with malignant MCNs and to explore the prognostic factors of MCN with associated invasive carcinoma (MCN-AIC). All cases of resected MCNs from a single high-volume institution between January 2012 and January 2022 were retrospectively reviewed. Only cases with ovarian-type stroma verified by progesterone receptor staining were included. Preoperative features, histological findings and postoperative course were documented. Multivariate logistic regression was employed to investigate variables related to malignancy. Survival analysis was performed using the Kaplan-Meier curve, and the prognostic factors were assessed to evaluate the postoperative course of patients with MCN-AIC. Among the 48 patients, 36 had benign MCNs, and 12 had malignant MCNs (1 high-grade atypical hyperplasia and 11 MCN-AIC). Age, tumour size, presence of solid components or mural nodules and pancreatic duct dilatation were identified as independent risk factors associated with malignancy. The follow-up period ranged from 12 mo to 120 mo, with a median overall survival of 58.2 mo. Only three patients with MCN-AIC died, and the 5-year survival rate was 70.1%. All 11 cases of MCN-AIC were stage I, and extracapsular invasion was identified as a prognostic factor for poorer outcomes. The risk factors independently associated with malignant transformation of MCNs included age, tumour size, presence of solid components or mural nodules, and pancreatic duct dilatation. Our study also revealed that encapsulated invasion was a favourable prognostic factor in MCN-AIC patients.

European guidelines for the surgical management of pure ground-glass opacities and part-solid nodules: Task Force of the European Association of Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons.

Pulmonary nodules are often encountered by respiratory physicians, radiologists, and thoracic surgeons alike. The European Society of Thoracic Surgery (ESTS) and European Association of Cardiothoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in managing pulmonary nodules with the aim of producing the first joint comprehensive review of the scientific literature, with a specific focus on the management of pure ground glass opacities and part-solid nodules. The scope of the document has been defined by the EACTS and ESTS governing bodies and focuses on six areas of main interest agreed upon by the Task Force. These include: management of solitary and multiple pure ground glass nodules, solitary part-solid nodules, identifying the non-palpable lesion, the role of minimally invasive surgery and the decision making behind sub-lobar versus lobar resection. The literature revealed that with the increasing use of incidental CT scans and CT lung cancer screening programs, the detection of early-stage lung cancer is going to rise with a higher number of potential cancers presenting on the ground glass and part-solid nodule spectrum. Given that the gold standard for improved survival is surgical resection, there is an urgent need for comprehensive characterisation of these nodules and guidelines that are directed towards their surgical management. It is recommended that standard decision-making tools are used to determine the risk of malignancy and thus guide referral for surgical management and decisions for surgical resection are made in a multidisciplinary setting with equitable consideration given to radiological characteristics, the evolution of the lesion, presence of solid component, patient fitness and co-morbidities. Given the recent surge in robust level I data comparing sublobar and lobar resection with the release of JCOG0802 and CALGB140503 data, a global overview of an individual case must be adopted into clinical practice. This set of recommendations are based on the available literature; however, close collaboration in the design and conduct of randomized controlled trials is still of utmost importance to answer further questions in this rapidly evolving field.

Pancreatic Intraductal Papillary Mucinous Neoplasms: A Narrative Review.

Intraductal papillary mucinous neoplasms (IPMNs) are the most frequent cystic pancreatic neoplasm. They derive from the main pancreatic duct or branch ducts. This narrative review aims to present and compare the current guidelines on the management of IPMNs. We reviewed the most important scientific literature on the management of IPMNs. The clinical presentation of IPMNs is usually nonspecific; common symptoms are abdominal pain, weight loss, and jaundice. There are no sex differences, and the incidence increases with age. It is considered a premalignant lesion associated with synchronous or metachronous carcinomas. Multifocal sites within the pancreas and the presence of solid components, like mural nodules, are predictive factors for developing malignancy. Magnetic resonance imaging (MRI) is the imaging technique of choice. However, computed tomography (CT) and endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) can also contribute to the diagnosis. Resection is the optimal treatment for IPMNs that arise from the main duct, while several indications are suggested for the surgery on IPMNs of branch ducts. The decision on surgery is not always a simple task and should be based on high-risk features of the neoplasm. In any case, re-examination and follow-up are highly recommended.

Clinical Characteristics of Patients WithSurgically Resected Pancreatic Cysts: A Retrospective Analysis of 136 Patients.

To retrospectively analyze the characteristics of pancreatic cysts with respect to histopathological diagnosis and various diagnostic imaging tools. The clinical features of 136 patients and characteristics of histopathologically diagnosed cysts were retrospectively assessed. The diagnostic accuracy of endoscopic ultrasound (EUS), computed tomography (CT), and magnetic resonance imaging (MRI) for pancreatic cysts was compared. Risk factors for high-grade dysplasia/invasive cancer in patients with intraductal papillary mucinous neoplasms (IPMNs) were also determined. The final analysis included 30 serous cystic neoplasms (SCNs) (21.6%), 13 mucinous cystic neoplasms (MCNs) (9.4%), 65 IPMNs (46.8%), and 13 solid pseudopapillary neoplasms (SPNs) (9.4%). The percentage of women with MCNs, SPNs, SCNs, and IPMNs was 100.0, 76.9, 73.3, and 47.7%, respectively (P < .001). The percentages of patients over 60 years of age with IPMNs, SCNs, MCNs, and SPNs were 73.9, 23.3, 0, and 0%, respectively (P < .001). The percentage of cysts located in the body and tail of the pancreas in MCNs, SCNs, SPNs, and IPMNs was 100, 70, 53.9, and 46.2%, respectively (P < .001). A unique honeycomb appearance was observed in 26.7% of SCNs. The overall diagnostic accuracy of EUS, CT, and MRI for pancreatic cysts was 82.6, 72.5, and 73.9%, respectively. Lesion size and presence of solid components were independent predictors of high-risk IPMNs. Patient characteristics and cyst features can help to differentiate pancreatic cyst types and identify high-risk IPMNs. The diagnostic accuracy of EUS for pancreatic cysts is superior to that of CT and MRI.

Circulating cytokines allow for identification of malignant intraductal papillary mucinous neoplasms of the pancreas.

Intraductal papillary mucinous neoplasms (IPMNs) are the precursor lesions of pancreatic cancers, requiring active surgical intervention during cancer development. However, the current criteria for predicting malignant IPMNs remain challenging and limited. Hence, this study aimed to assess the discriminatory performance of circulating cytokines, including TNF-α, IL-2R, IL-6, and IL-8, then build a novel predictive model to improve the diagnostic accuracy. A total of 131 retrospective (from March 2016 to December 2019) and 53 prospective (from March 2020 to January 2021) patients who were histologically confirmed as IPMNs were consecutively collected and analyzed. The circulating levels of TNF-α, IL-2R, IL-6, and IL-8 were significantly elevated in malignant IPMNs, and were verified as independent factors for malignant IPMNs (p < 0.05). Then, a novel score, the circulating cytokine score (CCS), was calculated and demonstrated as an independent predictive indicator with a higher area under the curve (AUC) than each cytokine alone (p < 0.001). Besides the CCS, two high-risk stigmata features, the presence of solid component (PSC), and main pancreatic duct (MPD) dilation ≥10 mm were also demonstrated as independent indicators for predicting malignant IPMNs. Finally, a novel nomogram incorporating the CCS and these two high-risk stigmata features presented a remarkable diagnostic performance, both in the training and validation cohorts with AUCs of 0.928 and 0.873, respectively. The CCS can be considered a novel independent predictive indicator for malignant IPMNs. Additionally, the formulated nomogram model integrating the CCS, PSC, and MPD ≥10 mm can be a valuable and promising tool for predicting the malignant transformation of IPMNs during long-term follow-ups to assist in timely and accurate surgical decisions.

Computed tomography in secondary spontaneous pneumothorax: Reading the fine print.

Objectives:To identify specific characteristics, distribution and associated findings of lesions causing secondary spontaneous pneumothorax (SSP)Methods:Computed tomography (CT) chest of 37 patients (between October 2011 and January 2020) was evaluated by two radiologists. They were classified into ‘Infectious’ and ‘Non-infectious’ groups, based on cause of pneumothorax. A scoring system (score 0–10) was proposed based on parameters which were statistically significantResults:Out of 37 patients with pneumothorax, 18 could be attributed to infectious aetiology and remaining 19 were due to noninfectious causes. The most common infectious cause of spontaneous pneumothorax was tuberculosis and noninfectious cause was chronic obstructive airway disease (COAD). Statistically significant difference was found for lesion wall thickness and presence of solid component between these two groups. No significant difference was found between both groups when comparing age, gender, lesion size and lesion distribution. The presence of pleural thickening, consolidation and mediastinal lymphadenopathy were statistically significant. Pleural effusion was never present in the noninfectious group. The area under receiver operating characteristic for differentiating patients in the two groups was 0.931 (standard error, 0.038; 95% CI, 0.856–1.000), and optimal threshold score for identifying patients with infectious causes was 4.5, with 77.8% sensitivity and 89.5% specificityConclusion:Pneumothorax is almost equally common due to infectious and noninfectious causes. The most common infectious cause of spontaneous pneumothorax was tuberculosis and noninfectious cause was COAD. Based on certain CT findings, we have proposed a scoring system to differentiate between these two groups.

Circulating Cytokine Model Allows for Identification of Malignant Intraductal Papillary Mucinous Neoplasms

Introduction: Intraductal papillary mucinous neoplasms (IPMNs) are the precursor lesions of pancreatic cancer. The objective of this study is to assess the discriminatory performance of circulating cytokines containing TNF-α, IL-2R, IL-6 and IL-8, and then build a novel predictive model to improve the diagnostic accuracy. Method: The demographic and clinical characteristics of consecutive patients histologically confirmed as IPMNs between March 2016 and December 2019 were retrospectively collected and analyzed for model establishment. Then, another prospective consecutive cohort was enrolled from March 2020 to January 2021 for further validation. Results: The circulating TNF-α, IL-2R, IL-6 and IL-8 levels were significantly elevated in malignant IPMNs compared to benign IPMNs (p<0.001), and all four circulating cytokines were verified as independent predictors (p<0.05). Then, based on the Logistic algorithm, a novel circulating cytokine score (CCS) was calculated and proved to be an independent predictive indicator (p<0.001). Besides CSS, two high-risk stigmata features containing presence of solid component (PSC) and main pancreatic duct (MPD) dilation ≥ 10 mm were also confirmed as independent indicators for predicting malignant IPMNs. Finally, a novel nomogram incorporating CCS with these two high-risk stigmata features showed a remarkable diagnostic performance both in the training and validation cohorts with AUCs of 0.928 and 0.873, respectively. Conclusion: CCS can be considered as a novel independent predictive indicator for malignant IPMNs, and the formulated nomogram model integrating CCS, PSC and MPD ≥ 10 mm will be a valuable and promising tool for predicting the probability of malignant IPMNs to implement appropriate managements.

Case Report of a Rapidly Growing Sacrococcygeal Teratoma: A Planned Preterm Cesarean Delivery May Improve Fetal Outcome

Sacrococcygeal teratoma (SCT) is the most commonly diagnosed congenital tumor during the neonatal period. The outcome of SCT is dependent on the growth rate, the presence of solid components in cancer, and the presence or absence of high flow cardiac involvement of the fetus. This case report presents the management and outcome of a pregnant woman carrying a fetus with a rapidly growing SCT. Confirmation of diagnosis was based on the universal prenatal ultrasound examination standards. Eventually, the patient delivered a girl weighing 2.9 kg, including the neoplasm, by a planned Cesarean section. The newborn received one dose of surfactant and underwent complete resection of the teratoma on the second day with a favorable outcome. This case report aims to show that rapidly growing SCT requires frequent antenatal follow-up with serial prenatal ultrasound examinations, optimum timing, mode, and appropriate place of delivery for a better fetal outcome. Keywords: Prenatal diagnosis, Preterm delivery, Rapidly growing neoplasm, Sacrococcygeal teratoma, Surgical resection of teratoma

Comparative Study of Ultrasound and Magnetic Resonance Imaging of Adnexal Masses

Background: Current study aimed to assess the role of ultrasound and MRI in the evaluation of adnexal mass lesions and comparison with clinical outcomes. Subjects &amp; Methods: A total of 30 suspected adnexal mass detected on ultrasonography was performed MRI, and accuracy of both USG and MRI were compared with histopathology. Results: Abdominal pain was predominantly confined to the lower abdomen in13 of 30 cases (43.3%). On USG total number of benign lesions was 19, and the total number of malignancies was 11. However, on MRI, 21 cases were mild, and 9 cases were malignant. six cases were diagnosed as malignant in ultrasound. In these six cases, two cases were serous cystadenocarcinoma, two were mucinous cystadenocarcinoma, one was serious papillary cystadenocarcinoma of the fallopian tube, and one was a malignant tubo-ovarian mass. MRI accurately diagnosed 4 indeterminate cases that correlated with the histopathology report. 9 malignant lesions were diagnosed as malignant by MRI were 3 cases of serous cystadenocarcinoma, 2 cases of mucinous cystadenocarcinoma, 1 case of malignant tubo-ovarian mass, 1 case of endometrioid carcinoma, 1 case of serous papillary cystadenocarcinoma of the fallopian tube and 2 cases of malignant sex cord-stromal neoplasms. Both the cases of serous cystadenomas were correctly diagnosed as benign lesions on both ultrasound and MRI. There were 2 cases of mucinous cystadenocarcinoma, which were accurately diagnosed as malignant on both USG and MRI due to the presence of solid components, mural thickening. The sensitivity, specificity, and accuracy of USG were 36.6%, 94% and 55% respectively. The sensitivity, specificity, and accuracy of MRI were 81.80%, 94.7%, and 65.7%, respectively. Conclusion: The best agreement was observed between MR findings and diagnosis in origin, tissue content, and tissue characteristics. Sonography had a weak correlation in context to the definitive diagnosis for the origin and tissue content of a mass.

Accuracy of intraoperative frozen section analysis in borderline ovarian tumor and the factors affecting it

Objective: To analyze the accuracy of frozen section (FS) examination of a borderline ovarian tumor (BOT) and the factors affecting it.Methods : We retrospectively evaluated 132 patients who were operated on in our clinic for ovarian mass between 1996 and 2016, who underwent FS examination and who had a BOT as a result of the final pathology. We investigated the Frozen accuracy, overdiagnosis and underdiagnosis rates and the factors affecting the accuracy of the diagnosis.Results : The mean age of the sample group was 44.6 ± 15.2 years. 50.8% of our patients were serous, 34.8% were mucinous and 14.4% were sero-mucinous in histology. Our Frozen Section accuracy rate was 75%, and underdiagnosis and overdiagnosis rates were 20.5% and 4.5%, respectively.The factors affecting the accuracy of the frozen section were histological type (p = 0.003), presence of solid component (p = 0.002) and preoperative CA 125 value (p = 0.001).Conclusion : Frozen examination has a low accuracy rate that affects the correct selection of surgical treatment for BOTs. FS should be performed by experienced gyneco-pathologists and it is necessary to consider carefully the factors that may cause misdiagnosis of the pathology.

Laparoscopic Management of Giant Ovarian Cysts Using the Alexis Laparoscopic System®: A Case Series.

Objective: The aim of this study was to review the characteristics of patients who underwent laparoscopic removal of giant ovarian cysts using the Alexis Laparoscopic System® and confirm the safety and feasibility of this technique.Method: We conducted a retrospective review of data of women undergoing the procedure from March 2014 to February 2019. Inclusion criteria were ovarian cysts of at least 15 cm. Exclusion criteria were the presence of solid components and suspicion of neoplasia on imaging.Results: Six patients were included in the series. Median size of the cysts at imaging was 22.8 cm (range 15–30 cm), while median volume was 5.9 L (range 1.9–15.6 L). Mean age of operated women was 59 years (range 21–88 years). All patients underwent exclusive laparoscopic management except one patient who underwent a conversion into midline laparotomy. The size of the skin incision initially performed to puncture the cyst ranged from 2.5 to 4 cm. On final pathological reports, two cysts were mucinous cystadenomas, and four were serous cystadenomas. There was no epithelial ovarian cancer or borderline tumor in any of the specimen operated.Conclusion: Laparoscopic management of giant ovarian cysts using the Alexis Laparoscopic System® is safe and feasible in well-selected cases. Midline laparotomy can thus be avoided, decreasing the risk of post-operative complications and increasing quality of life of patients.

Performance of Selected Models for Predicting Malignancy in Ovarian Tumors in Relation to the Degree of Diagnostic Uncertainty by Subjective Assessment With Ultrasound.

The study's main aim was to evaluate the relationship between the performance of predictive models for differential diagnoses of ovarian tumors and levels of diagnostic confidence in subjective assessment (SA) with ultrasound. The second aim was to identify the parameters that differentiate between malignant and benign tumors among tumors initially diagnosed as uncertain by SA. The study included 250 (55%) benign ovarian masses and 201 (45%) malignant tumors. According to ultrasound findings, the tumors were divided into 6 groups: certainly benign, probably benign, uncertain but benign, uncertain but malignant, probably malignant, and certainly malignant. The performance of the risk of malignancy index, International Ovarian Tumor Analysis assessment of different neoplasias in the adnexa model, and International Ovarian Tumor Analysis logistic regression model 2 was analyzed in subgroups as follows: SA-certain tumors (including certainly benign and certainly malignant) versus SA-probable tumors (probably benign and probably malignant) versus SA-uncertain tumors (uncertain but benign and uncertain but malignant). We found a progressive decrease in the performance of all models in association with the increased uncertainty in SA. The areas under the receiver operating characteristic curve for the risk of malignancy index, logistic regression model 2, and assessment of different neoplasias in the adnexa model decreased between the SA-certain and SA-uncertain groups by 20%, 28%, and 20%, respectively. The presence of solid parts and a high color score were the discriminatory features between uncertain but benign and uncertain but malignant tumors. Studies are needed that focus on the subgroup of ovarian tumors that are difficult to classify by SA. In cases of uncertain tumors by SA, the presence of solid components or a high color score should prompt a gynecologic oncology clinic referral.

Can preoperative findings help to interpret neoplastic and non-neoplastic lesions of ovary and affect surgical decisions in children and adolescents?

Ovarian masses are common in all pediatric age groups. Ovarian-sparing surgery is favored since most cases are benign or functional cysts. Detection of a few malignant cases prevents morbidity and mortality. Objective: to investigate which of the preoperative findings can help to distinguish the pathology of the ovarian lesions, affect the surgical decision and predict the possibility of ovarian preservation. Patients operated with diagnosis of ovarian mass were enrolled in the study between 2000-2015. Age, symptoms, physical examination findings, tumor markers, radiologic features, operative notes, and pathology results were reviewed retrospectively. During the study period, 98 patients were operated and 86 were included. Mean age was 9.7±5.62 years. Non-neoplastic pathologies constitute 68.6 % of cases; 31.4 % was neoplastic. Malignancy rate was 4.6 %. Solid component, absence of ovarian torsion and diameter > 9 cm were more commonly seen in neoplastic cases (p < 0.001, p < 0.001, p=0.001). Adnexal torsion was found in 30 (34.9 %) patients. Mean diameter did not differ significantly between groups with or without torsion; incidence of torsion was greater in patients with masses < 6 cm (p=0.019). Ovariansparing surgery was performed in 48 (55.8 %) and oopherectomy in 38 (44.2 %) patients. Surgical approach was affected by nature (p < 0.001) and size (p < 0.001) of the lesion; it was independent of age and presence of torsion. A purely cystic mass < 9 cm, with torsion and negative markers, orients towards a non-neoplastic mass. The presence of solid component and absence of torsion are associated with increased risk of malignancy.

P2.17-22 Retrospective Analysis of Spread Through Air Spaces and Other Features in Patients with Stage IA Adenocarcinoma by the 8th TNM Classification

We have recently demonstrated that the presence of the Spread Through Air Spaces (STAS) increased the risk of recurrence after resection for small lung adenocarcinoma (ADC). Currently, the TNM classification of lung cancer was revised and T-factor was changed to be basically determined by its invasive size. The purpose of this study is to examine the impact of presence of STAS in stage IA ADC according to the 8th TNM classification. Patients with pleural invasion, lymph node metastasis, distant metastasis, and neoadjuvant therapy were excluded. All available tumor slides from patients with surgically resected solitary lung ADC (2000-2015) were reviewed. Patients with stage IA ADC according to the 8th TNM classification were collected. Overall survival (OS) and recurrence-free probability (RFP) were estimated using the Kaplan-Meier method. Propensity score was generated from age, operation year, gender, lymphatic invasion, vascular invasion, the presence of solid component ≥5%, the presence of micropapillary component ≥5%, limited resection, and invasive size. One-by-one nearest neighbor matching by the presence of STAS was adapted to reduce the bias. In all, 295 patients met study criteria with median age of 68. Male gender comprised 48.8% (n=144), lymphatic invasion positive 4.7% (n=14), and vascular invasion positive 14.9% (n=44). By T-factor (7th edition), 216 (73.2%) were T1a, 53 (18.0%) T1b, 23 (7.8%) T2a, 2 (0.7%) T2b, and 1 (0.3%) T3. By T-factor (8th edition), 100 (33.9%) were T1mi, 111 (37.6%) T1a, 70 (23.7%) T1b, and 14 (4.7%) T1c. By operation method, 241 (81.7%) underwent lobectomy, 15 (5.1%) segmentectomy, and 39 (13.2%) partial resection. Adjuvant chemotherapy was given in 2.7% (n=8) of patients. STAS was seen in 22.7% (n=67) of patients. Five-year OS was 95.3% for STAS-negative and 91.1% for STAS-positive (p=0.0262), and the 5-year RFS was 96.8% and 83.9%, respectively (p=0.0003). In matched cohorts, each cohort included 48 patients and the 5-year OS was 95.0% for STAS-negative and 90.6% for STAS-positive (p=0.3201). The 5-year RFS was 93.3% and 91.3%, respectively (p=0.9363). Patients with pathologic stage IA ADC with STAS, according to the 8th TNM classification, had a worse prognosis in unmatched cohorts even though adenocarcinoma in situ was excluded. Because of various confounding factors, the propensity score matching revealed the presence of STAS as a non-significant prognostic factor in our matched cohorts. This study was a retrospective analysis, and a prospective study is needed regarding the indication of limited resection.

Factors Associated With Management of Pediatric Ovarian Neoplasms

Available evidence supports ovary-sparing surgery for benign ovarian neoplasms; however, preoperative risk stratification of pediatric ovarian masses can be difficult. Our objective of this study was to characterize the surgical management of pediatric ovarian neoplasms across 10 children's hospitals and to identify factors that could potentially aid in the preoperative risk stratification of these lesions. A retrospective review of girls and women aged 2 to 21 years who underwent surgery for an ovarian neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariable logistic regression was used to examine the relationships between the preoperative cohort characteristics, procedure performed, and risk of malignancy. Among 819 girls and women undergoing surgery for an ovarian neoplasm, malignant lesions were identified in 11%. The overall oophorectomy rate for benign disease was 33% (range: 15%-49%) across institutions. Oophorectomy for benign lesions was independently associated with provider specialty (P = .002: adult gynecologist, 45%; pediatric surgeon, 32%; pediatric gynecologist, 18%), premenarchal status (P = .02), preoperative suspicion for malignancy (P < .0001), larger lesion size (P < .0001), and presence of solid components (P < .0001). Preoperative findings independently associated with malignancy included increasing size (P < .0001), solid components (P = .003), and age (P < .0001). The rate of oophorectomy for benign ovarian disease remains high within the pediatric population. Identification of factors associated with the choice of procedure and the risk of malignancy may allow for improved preoperative risk stratification and fewer unnecessary oophorectomies. These results have been used to develop and validate a multidisciplinary preoperative risk stratification algorithm that is currently being studied prospectively across 10 institutions.

Development and Validation of a Predictive Score for Preoperative Diagnosis of Early Stage Epithelial Ovarian Cancer

Objective:To develop and validate a simplified multi-parameter risk-based scoring system for preoperative diagnosis of early stage epithelial ovarian cancer. Methods:All women presented with adnexal mass and were scheduled for operation at Phrapokklao hospital during September 2013 – December 2017 were included and categorized according to their histopathologic reports into early stage ovarian cancer groups and benign ovarian tumor groups. Multivariable logistic regression was used to explore for potential predictors. The selected logistic coefficients were transformed into risk-based scoring system. Internal validation was done with bootstrapping procedure.Results:A total of 270 participants were included in analysis and predictive model development, 54 in early stage ovarian cancer group and 216 in benign ovarian tumor group. Menopausal status, two abnormal ultrasound findings (presence of solid component or ascites), tumor size and serum CA-125 level were used for derivation of the scoring system. The score-based model showed area under ROC of 0.88 (95%CI 0.82-0.93). The developed scoring system ranged from 0 to 51 was classified into 3 subcategories for clinical practicability. The positive predictive values for the presence of early stage ovarian cancer were 2.07 (95%CI 0.43-6.05) for low risk patient, 29.13(95%CI 19.65-41.58) for moderate risk patient, and 95.45(95%CI 77.16-99.88) for high risk patient. Conclusion:This simplified risk-based scoring system for preoperative diagnosis of early stage ovarian cancer could aid general physicians or general gynecologists in evaluation of patients presenting with ovarian tumors and help gynecologic oncologists in management planning and prioritization of patients for operation.