Proposed Grading System Research Articles

Morphological features of hepatic lipid changes in bearded dragons (Pogona vitticeps), and a proposed grading system.

Hepatic lipidosis is commonly diagnosed in pet bearded dragons (Pogona vitticeps). However, there are no studies detailing the histological features of hepatic lipid changes in this species. This study describes the microscopic features of lipid change and details an associated scoring system. Histologic hepatic sections were retrospectively evaluated from 252 bearded dragons submitted for necropsy. Pathologic assessment was used to develop a grading scheme with 2 qualitative, 1 quantitative, and 6 semi-quantitative microscopic parameters, which were refined based on variability. The final grading system developed for diffuse and panlobular lipid accumulation included 2 semi-quantitative and 1 quantitative categories: percentage of hepatocellular vacuolation, fibrosis, and hepatocellular swelling, respectively. Hepatocellular swelling was indirectly quantified by counting the number of nuclei per unit area. There was a strong positive correlation (P < .001) between the percentage of hepatocellular vacuolation and lipid content, a strong negative correlation (P < .001) between nuclear count and lipid content, and a moderate correlation (P < .001) between fibrosis and lipid content. Each category was given a numerical value ranging from 0 to 4, with the sum of each representing the final grade. Cutoff values stratified microscopic changes into mild (final grade 1-4), moderate (5-7), and severe (≥8). There was strong interrater agreement for assessment of vacuolization, fibrosis, and severity classification and moderate for hepatocellular swelling. This study documents the features of hepatic lipid changes in bearded dragons. Although a cutoff to differentiate pathologic from nonpathologic lipid accumulation could not be estimated, the proposed grading scheme can be used to inform future studies.

The IASLC Proposed Grading System Accurately Predicts Prognosis and Mediastinal Nodal Metastasis in Patients With Clinical Stage I Lung Adenocarcinoma.

The International Association for the Study of Lung Cancer (IASLC) recently proposed a new grading system for lung adenocarcinoma (LUAD). We aimed to validate the prognostic performance of the grading system and explore its role in guiding the strategy of lymph node (LN) dissection. We retrospectively reviewed 1029 patients with clinical stage I LUAD who underwent surgery between 2011 and 2013. The association between mediastinal nodal metastasis and grading system was evaluated. To investigate the value of the grading system in guiding LN dissection strategies, 3 pathologists evaluated the feasibility of identifying the grading system using frozen section (FS). The differences in prognosis between all neighboring grades were highly significant based on the grading system ( P <0.001). Notably, almost no grade 1 LUAD (1.4%) had pN2 disease, whereas higher rates were found in grade 2 LUAD (9.6%) and grade 3 LUAD (18.3%) ( P <0.001). Multivariate logistic regression analysis revealed that higher tumor grade was an independent predictor of mediastinal nodal metastasis ( P =0.002). Moreover, limited mediastinal LN dissection had equivalent prognosis in grade 1 LUAD, but significantly worse prognosis in grade 2 and grade 3 LUAD than systematic mediastinal LN dissection. The overall accuracy of using intraoperative FS to identify the IASLC grading system was 85.4% (κ=0.765) with substantial agreement. The IASLC grading system could accurately stratify prognosis and predict mediastinal nodal metastasis in patients with clinical stage I LUAD. FS was feasible for identifying the IASLC grading system.

Secretory carcinoma of the salivary gland: a multi-institutional clinicopathologic study of 90 cases with emphasis on grading and prognostic factors.

A detailed clinicopathologic review was conducted on 90 SCs from the major and minor salivary glands. The median age at presentation was 50 years (range: 7-93). Sixty-nine (77%) tumours originated from major salivary glands, whereas the remaining 21 involved minor salivary glands.Six cases (7%) had cervical nodal metastasis. Only lymphovascular invasion (LVI) was associated with a risk of nodal metastasis (P < 0.05). The 5-year disease-specific survival and disease-free survival (DFS) were 98% and 87%, respectively. On univariate survival analysis, adverse prognostic factors associated with decreased DFS included minor salivary gland origin, atypical mitosis, high mitotic index, high-grade transformation (HGT), necrosis, nuclear pleomorphism, infiltrative tumour border, fibrosis at the invasive front, LVI, positive margin, and advanced pT stage (P < 0.05). When adjusted for pT stage and margin status, mitotic index, LVI, nuclear pleomorphism, and HGT remained as independent prognostic factors. We therefore propose a two-tiered grading system for SC. The low-grade SC is defined as those with <5 mitoses /10 high-power fields and no tumour necrosis, and high-grade SC as those with ≥5 mitoses /10 high-power fields and/or necrosis. This proposed grading system can be useful to risk stratify patients with SC for appropriate clinical management.

Pathology gradual assessment of colorectal anastomosis

Aim: to analyze the state of the colorectal anastomosis after laparoscopic and open resection of the sigmoid and rectum in patients with colorectal cancer and to develop a unified grading of pathological changes in the anastomosis during its laparoscopic and videorectoscopic assessment. Materials and methods. Results of the treatment of 79 patients who underwent resection of the rectum and sigmoid colon due to adenocarcinoma were analyzed. Patients were divided into two groups. The first group consisted of 34 (43.04 %) patients, whose treatment method was laparoscopic resection of the sigmoid and rectum (main group). The second group consisted of 45 (56.96 %) patients who underwent laparotomic resection. A stapler colorectal anastomosis was formed in both groups. The patients had II–III stages of the oncological disease without prior chemotherapy or radiotherapy in the anamnesis. During the operation visual assessment of the applied anastomosis was performed taking into account both external and internal characteristics. For external examination visual assessment of the anastomosed ends from the side of the serous membrane and a pneumohydrotest were used, for internal – an ordinary 10 mm laparoscope was inserted into the anus with CO2 insufflation at the level of 6 mm Hg and a visual assessment was carried out from the side of the mucosa. According to the received data, an original gradation of pathological changes in the colorectal anastomosis and recommendations for the prevention of its failure were developed. Results. The developed technique for assessing and gradation of pathological changes in colorectal anastomosis made it possible to identify and eliminate suturing defects in 19 (24.05 %) patients, to eliminate stitching defects, control bleeding, identify ischemic zones of the anastomotic ends and improve total results of the treatment. One patient had anastomotic failure on the third day after operation. This case required reoperation with removal of the anastomosis and formation of the terminal colostomy. There were no lethal cases in both groups. Usage of additional methods for assessing the anastomosis is time-consuming and important in detecting pathological changes in the colorectal anastomosis. Conclusions. The gradation of pathologic changes in the colorectal anastomosis should be comprehensive with an assessment of not only its external characteristics but also internal ones using videorectoscopy and allows to reduce the risks of colorectal anastomosis failure. The average number of points in the combination of laparoscopic and videorectoscopic evaluation is higher than in the laparoscopic one alone, but there is no statistical significance (U = 884.5; P = 0.071). This makes it possible to use the proposed grading system both in laparoscopy and in open surgery with the same results. There is no statistically significant difference in the number of detected anastomotic complications between open and laparoscopic resection of the sigmoid colon or the rectum (P = 0.137).

Non-Invasive Grading and Sorting of Mango (Mangifera indica L.) Using Antlion Optimizer-Based Artificial Neural Networks

Mango is an imperative commercial fruit in terms of market value and volume of production. In addition, it is grown in more than ninety nations around the globe. Consequently, the demand for effective grading and sorting has increased, ever since. This communication describes a non-invasive mango fruit grading and sorting model that utilizes hybrid soft computing approach. Artificial neural networks (ANN), optimized with Antlion optimizer (ALO), are used as a classification tool. The quality of mangoes is evaluated according to four grading parameters: size (volume and morphology), maturity (ripe/unripe), defect (defective/healthy) and variety (cultivar). Besides, a comparison of proposed grading system with state-of-the-art models is performed. The system showed an overall classification rate of 95.8% and outperformed the other models. Results demonstrate the effectiveness of proposed model in fruit grading and sorting applications.

Tumor budding and fibrotic focus—proposed grading system for tumor budding in invasive carcinoma no special type of the breast

Tumor budding grade is a very useful histological prognostic indicator for colorectal cancer patients. Recently, it has been also reported as a significant prognostic indicator in invasive breast carcinoma patients. Our group and others have previously reported that the presence of a fibrotic focus in the tumor is a very useful histological finding for accurately predicting the prognosis in patients with invasive carcinoma of no special type (ICNST) of the breast. The purpose of the present study was to investigate whether a grading system incorporating tumor budding in a fibrotic focus is superior to the conventional grading system for tumor budding to accurately predict outcomes in patients with ICNST. According to our new grading system, we classified the tumors into grade I (164 cases), grade II (581 cases), and grade III (110 cases), and the results clearly demonstrated the significant superiority of the new grading system over that of conventional tumor budding alone for accurately predicting outcomes in patients with ICNST. Our findings strongly suggest that tumor cells and tumor-stromal cells interaction play very important roles in tumor progression rather than tumor cells alone.

Prognostic and predictive value of the newly proposed grading system of invasive pulmonary adenocarcinoma in Chinese patients: a retrospective multicohort study

AbstractOur aim was to validate and analyze the prognostic impact of the novel International Association for the Study of Lung Cancer (IASLC) Pathology Committee grading system for invasive pulmonary adenocarcinomas (IPAs) in Chinese patients and to evaluate its utility in predicting a survival benefit from adjuvant chemotherapy (ACT). In this multicenter, retrospective, cohort study, we included 926 Chinese patients with completely resected stage I IPAs and classified them into three groups (Grade 1, n = 119; Grade 2, n = 431; Grade 3, n = 376) according to the new grading system proposed by the IASLC. Recurrence-free survival (RFS) and overall survival (OS) were estimated by the Kaplan–Meier method, and prognostic factors were assessed using univariable and multivariable Cox proportional hazards models. All included cohorts were well stratified in terms of RFS and OS by the novel grading system. Furthermore, the proposed grading system was found to be independently associated with recurrence and death in the multivariable analysis. Among patients with stage IB IPA (N = 490), the proposed grading system identified patients who could benefit from ACT but who were undergraded by the adenocarcinoma (ADC) classification. The novel grading system not only demonstrated prognostic significance in stage I IPA in a multicenter Chinese cohort but also offered clinical value for directing therapeutic decisions regarding adjuvant chemotherapy.

Infiltration pattern predicts metastasis and progression better than the T-stage and grade in pancreatic neuroendocrine tumors: a proposal for a novel infiltration-based morphologic grading

AbstractThe advancing edge profile is a powerful determinant of tumor behavior in many organs. In this study, a grading system assessing the tumor-host interface was developed and tested in 181 pancreatic neuroendocrine tumors (PanNETs), 63 of which were <=2 cm. Three tumor slides representative of the spectrum (least, medium, and most) of invasiveness at the advancing edge of the tumor were selected, and then each slide was scored as follows. Well-demarcated/encapsulated, 1 point; Mildly irregular borders and/or minimal infiltration into adjacent tissue, 2 points; Infiltrative edges with several clusters beyond the main tumor but still relatively close, and/or satellite demarcated nodules, 3 points; No demarcation, several cellular clusters away from the tumor, 4 points; Exuberantly infiltrative pattern, scirrhous growth, dissecting the normal parenchymal elements, 5 points. The sum of the rankings on the three slides was obtained. Cases with scores of 3–6 were defined as “non/minimally infiltrative” (NI; n = 77), 7–9 as “moderately infiltrative” (MI; n = 68), and 10–15 as “highly infiltrative” (HI; n = 36). In addition to showing a statistically significant correlation with all the established signs of aggressiveness (grade, size, T-stage), this grading system was found to be the most significant predictor of adverse outcomes (metastasis, progression, and death) on multivariate analysis, more strongly than T-stage, while Ki-67 index did not stand the multivariate test. As importantly, cases <=2 cm were also stratified by this grading system rendering it applicable also to this group that is currently placed in “watchful waiting” protocols. In conclusion, the proposed grading system has a strong, independent prognostic value and therefore should be considered for integration into routine pathology practice after being evaluated in validation studies with larger series.

Operative difficulty in laparoscopic cholecystectomy: considering the role of machine learning platforms in clinical practice

Aim: Computer vision is a subset of machine learning (ML) technology that allows automated analysis of large operative video datasets. The aim of this study was to use a commercially available ML-driven platform to evaluate a subjective grading of operative difficulty in laparoscopic cholecystectomy (LC). Methods: Patients undergoing LC prospectively consented, and their operations were recorded. The intra-operative findings were prospectively graded (1-4) based on intraoperative gallbladder appearance assessments. Deidentified videos were uploaded to Touch SurgeryTMand run through the platform’s algorithm, providing automated analytics including the total operative length and operative phase length. The rate of critical view of safety (CVS) achievement was also included in the analysis. Results: 206 LC were included. 27 LC were excluded due to incomplete video recording and were therefore not amenable to the final data analysis. Grade 1 and 2 patients had significantly shorter operative time than grade 3 and 4 patients [17min and 53s (IQR 15min and 24s- 21min and 38s) vs. 25 min and 49s (IQR 20min and 12s-38min and 38s) (P &lt; 0.010)]. The operative phases for each step were significantly longer in patients with gallbladders graded 3 or 4 compared to those patients graded 1 or 2 (P &lt; 0.043). The CVS was achieved in 94% of grade 1 patients, 88% of grade 2 patients, 85% of grade 3 patients and 73% of grade 4 patients (P = 0.177). Conclusion: Increased operative time and decreased ability to achieve the CVS with more difficult intraoperative findings supports the utility of the proposed grading system. ML in surgery is a nascent field, but this study demonstrates the potential of commercially available platforms for use in operative analytics, documentation, audit and training of future surgeons.

Image Characteristicộng sự of Ruptured Arteriovenous Malformations of the Brain on the Multislice Computed Tomography

This study describes the features of the image of the Ruptures Brain Arteriovenous Malformation (AVM) based on films of Multislide Computed Tomography (MSCT) at Bach Mai Hospital. The study used descriptive cross-sectional, prospective and retrospective method to analyze the MSCTs of 40 patients at the Center of Radiology, Bach Mai Hospital, from March 2019 to March 2020. The results show that the common age of the patients was &lt;40 years old and the average age was 33.88 ± 16.27; the ratio of female/male was ≈ 1.11/1; 70% of the patients suffered from headache. On admission, 52.5% of the patients were conscious (glassgow 15 points), 30% of them lost consciousness (glassgow &lt;13 points) and 17.5% were comatose; 47.5% had a syndrome of increased intracranial pressure; 22.5% with detected cerebral AVM but never treated; 77.5% with ruptured cerebral AVM in the upper floor of the cerebellum and 57.5% had it in the highly functional area; 67.5% with cerebral AVM ≤ 3cm in size. Feeding artery ≤ 3 stalks accounted for 85%, of which 1 stem accounted for the majority. Attached aneurysm accounted for 42.5%, mainly in AVM drive aneurysm (32.5%). Pure shallow drainage veins accounted for 50%. Brain parenchymal hemorrhage alone accounted for 60%. Brain parenchymal with ventricular and subarachnoid hemorrhage accounted for 37.5%. The small size hemorrhage volume ratio (&lt;30 mm) and the average size (30-60 mm) accounted for the same percentage of 45%. According to the Spetzler - Martin classification, the cerebral ruptured venous malformation drive with low resolution (I-III) accounted for 85%. Overall, MSCT provides information to help guide the treatment of cerebral hemorrhage caused by cerebral AVM.&#x0D; Keywords:&#x0D; Arteriovenous malformation of the brain, ruptured cerebral arteriovenous malformations, Multislide Computed Tomography (MSCT).&#x0D; References&#x0D; [1] R. M. Friedlander, Clinical Practice, Arteriovenous Malformations of the Brain, N Engl J Med, Vol. 356, No. 26, 2007, pp. 2704-2712, https://doi.org/10.1056/nejmcp067192.[2] J. F. Yu, A. D. Nicholson, J. Nelson et al., Predictors of Intracranial Hemorrhage Volume and Distribution in Brain Arteriovenous Malformation, Vol. 24, No. 2, 2018, pp. 183-188, https://doi.org/10.1177/1591019917749819.[3] E. Shotar, M. Debarre, N. A. Sourour et al., Retrospective Study of Long-term Outcome after Brain Arteriovenous Malformation Rupture: the RAP Score, J Neurosurg, Vol. 128, No. 1, 2018, pp. 78-85, https://doi.org/10.3171/2016.9.jns161431.[4] P. M. Thong, N. H. An, The Initial Results of Treatment Mass the Brain Arteriovenous Malformation Rupture with Surgery in Combination with Embolization in Bach Mai Hospital; Vietnam Journal of Medicine, October, No. 1, 2017, pp. 51-56 (in Vietnames). [5] R. F. Speizler, N. A. Martin, A Proposed Grading System for Arteriovenous Malformations, J Neurosurg, Vol. 108, No. 1, 2008, pp. 186-193, https://doi.org/10.3171/jns/2008/108/01/0186[6] M. Majumdar, L. A. Tan, M. Chen, Critical Assessment of the Morbidity Associated with Ruptured Cerebral Arteriovenous Malformations, J Neurointerv Surg, Vol. 8, No. 2, 2016, pp. 163-167, https://doi.org/10.1136/neurintsurg-2014-011517. [7] R. F. Spetzler, D. S. Kondziolka, R. T. Higashida et al., Comprehensive Management of Arteriovenous Malformation of the Brain and Spine, Cambridge University Press, 2015, pp. 78-85, https://doi.org/10.1080/01616412.1998.11740583[8] R. Torné, R. A. Hernández, F. Arikan et al., Posterior Fossa Arteriovenous Malformations: Significance of Higher incidence of Bleeding and Hydrocephalus, Clin Neurol Neurosurg, Vol. 134, 2015, pp. 37-43, https://doi.org/10.1016/j.clineuro.2015.04.003.

Long-Term Outcomes of Endoscopic Third Ventricle Colloid Cyst Resection: Case Series With a Proposed Grading System

Long-Term Outcomes of Endoscopic Third Ventricle Colloid Cyst Resection: Case Series With a Proposed Grading System

Probabilistic tunnel collapse risk evaluation model using analytical hierarchy process (AHP) and Delphi survey technique

Tunnel collapse hazard is a key issue in tunnel construction, which should be adequately assessed to prevent economic damage and casualty. The present study proposed a risk evaluation model for tunnel collapse based on a quantified grading system and influence factors that significantly affected the tunnel collapse hazard. For this purpose, 24 actual tunnel collapse cases were collected, and a database was established to select significant influence factors as the risk evaluation indices. The Analytic Hierarchy Process (AHP) technique and Delphi survey analysis were then adopted to quantify the influence factors and the grading system for the risk evaluation of tunnel collapse. The significant influence factors were selected using the grading guide based on the weight importance and rating score of each considered influence factor. As an evaluation criterion, the TR index based on the probability distribution of weighted influence factors was proposed to compare the risk of collapse using Monte-Carlo simulation. The proposed evaluation model and TR index were validated by comparing and analyzing the risk index calculated using the proposed grading system for actual tunnel cases with and without collapse. The evaluated risk indices were in good agreement with the measured result from field cases.

A Proposed Grading System and Experience of COVID-19 Associated Rhino Orbito Cerebral Mucormycosis from an Indian Tertiary Care Center

Mucormycosis is an opportunistic fungal infection. India faced an unprecedented increase in patients with post coronavirus disease 2019 (COVID-19) associated rhino-orbito-cerebral mucormycosis (ROCM). This study proposes a grading system which correlates the extent of the disease with the management plan. An observational study was conducted January 2021–June 2021. We identified 65 patients. Eleven patients had mild disease, 27 patients had moderate, 16 patients were severe and 11 patients were graded as very severe. The management was planned based on this grading system. Early diagnosis, aggressive surgical debridement and antifungal drug therapy is the key to improve survival in ROCM. Procedures such as endoscopic orbital clearance, sublabial maxillectomy, and modified endoscopic Denkers (MED) approach facilitate access and surgical debridement. The new grading system proposed assists in planning the approach and extent of surgical debridement.

Validation of the Novel International Association for the Study of Lung Cancer Grading System for Invasive Pulmonary Adenocarcinoma and Association With Common Driver Mutations

IntroductionWe aimed to validate the use of the novel grading system proposed by the International Association for the Study of Lung Cancer pathology committee for prognosis stratification of invasive pulmonary adenocarcinomas (ADCs) in Chinese patients. Correlations between the grading system, common driver mutations, and adjuvant chemotherapy (ACT) were also investigated. MethodsFrom 2008 to 2016, the histologic patterns of a large cohort of 950 patients with invasive ADCs (stage I–III) were retrospectively analyzed and classified according to the proposed grading system. Subsequently, tumor grading was correlated with genetic data, ACT, and patient outcome. ResultsCompared with conventional predominant pattern-based groups, the novel grading system carried improved survival discrimination (area under the curve = 0.768 for recurrence-free survival and 0.775 for overall survival). The area under the curve was not further improved when incorporated lymphovascular invasion status. EGFR mutations (p < 0.001) were correlated with moderate grade, whereas KRAS mutations (p = 0.041) and ALK fusions (p = 0.021) were significantly more prevalent in poor grade. The reclassification of the grading system based on EGFR mutation status revealed excellent survival discrimination (p < 0.001). In particular, patients on stage Ib to III with novel high-grade ADCs had an improved prognosis with ACT. ConclusionsThe novel International Association for the Study of Lung Cancer grading system is a practical and efficient discriminator for patient prognosis and should be part of an integrated pathologic-genetic subtyping to improve survival prediction. In addition, it may support patient stratification for aggressive adjuvant chemotherapy.

Development of a standardized histopathology scoring system for human intervertebral disc degeneration: an Orthopaedic Research Society Spine Section Initiative.

BackgroundHistopathological analysis of intervertebral disc (IVD) tissues is a critical domain of back pain research. Identification, description, and classification of attributes that distinguish abnormal tissues form a basis for probing disease mechanisms and conceiving novel therapies. Unfortunately, lack of standardized methods and nomenclature can limit comparisons of results across studies and prevent organizing information into a clear representation of the hierarchical, spatial, and temporal patterns of IVD degeneration. Thus, the following Orthopaedic Research Society (ORS) Spine Section Initiative aimed to develop a standardized histopathology scoring scheme for human IVD degeneration.MethodsGuided by a working group of experts, this prospective process entailed a series of stages that consisted of reviewing and assessing past grading schemes, surveying IVD researchers globally on current practice and recommendations for a new grading system, utilizing expert opinion a taxonomy of histological grading was developed, and validation performed.ResultsA standardized taxonomy was developed, which showed excellent intra‐rater reliability for scoring nucleus pulposus (NP), annulus fibrosus (AF), and cartilaginous end plate (CEP) regions (interclass correlation [ICC] > .89). The ability to reliably detect subtle changes varied by IVD region, being poorest in the NP (ICC: .89‐.95) where changes at the cellular level were important, vs the AF (ICC: .93‐.98), CEP (ICC: .97‐.98), and boney end plate (ICC: .96‐.99) where matrix and structural changes varied more dramatically with degeneration.ConclusionsThe proposed grading system incorporates more comprehensive descriptions of degenerative features for all the IVD sub‐tissues than prior criteria. While there was excellent reliability, our results reinforce the need for improved training, particularly for novice raters. Future evaluation of the proposed system in real‐world settings (eg, at the microscope) will be needed to further refine criteria and more fully evaluate utility. This improved taxonomy could aid in the understanding of IVD degeneration phenotypes and their association with back pain.

Proposed Grading System for Posterior Atlantooccipital Membrane Complex Injuries on Cervical Magnetic Resonance Imaging

The posterior atlantooccipital membrane complex consists of the posterior atlantooccipital membrane and posterior atlantoaxial membrane. Posttraumatic, posterior atlantooccipital membrane complex injuries may have varied appearances on cervical magnetic resonance imaging. The purpose of this study was to identify the different types of posterior atlantooccipital membrane complex injuries that occur in trauma patients. Patients who suffered a posterior atlantooccipital membrane complex injury were identified retrospectively using key word searches of cervical magnetic resonance imaging reports between 2013 and 2020 using Nuance mPower software. All relevant imaging studies were reviewed by 2 neuroradiologists. A description of the location and type of posterior atlantooccipital membrane complex injury was recorded, along with additional osteoligamentous trauma of the craniocervical junction and relevant clinical history. Forty-one patients were identified with acute posterior atlantooccipital membrane complex injury. Four distinct patterns of posterior atlantooccipital membrane complex injury were observed. A grading system for posterior atlantooccipital membrane complex injuries is proposed on the basis of these data: grade 1-edema confined to the posterior atlantooccipital and atlantoaxial membrane; grade 2-edema confined to the posterior atlantooccipital and atlantoaxial membrane and ligamentum nuchae; grade 3-stripping injury of the posterior atlantooccipital membrane with C1-C2 dorsal epidural hematoma; and grade 4-frank disruption of the posterior atlantooccipital membrane at C1 with edema in the remaining posterior atlantooccipital membrane complex.

Cross-sectional Area of the Superior Petrosal Sinus is Reduced in Patients with Significant Endolymphatic Hydrops.

Purpose: To evaluate the relationship between the size of the venous structures related to the inner ear and the degree of endolymphatic hydrops (EH).Methods: Thirty-four patients with a suspicion of EH underwent whole brain MR imaging including the inner ear. Images were obtained pre- and post-administration, and at 4 and 24 hours after the intravenous administration of a gadolinium-based contrast agent (IV-GBCA). The cross-sectional areas (CSA) of the internal jugular vein (IJV), superior petrosal sinus (SPS), and inferior petrosal sinus (IPS) were measured on the magnetization prepared rapid acquisition of gradient echo (MPRAGE) images obtained immediately after the IV-GBCA. The grade of EH was determined on the hybrid of reversed image of positive endolymph signal and native image of positive perilymph signal (HYDROPS) images obtained at 4 hours after IV-GBCA as no, mild, and significant EH according to the previously proposed grading system for the cochlea and vestibule, respectively. The ipsilateral CSA was compared between groups with each level of EH grade. P < 0.05 was considered statistically significant.Results: There were no statistically significant differences between EH grades for the CSA of the IJV or that of the IPS in either the cochlea or the vestibule. The CSA of the SPS in the groups with significant EH was significantly smaller than that in the group with no EH, for both the cochlea (P < 0.01) and the vestibule (P < 0.05). In an ROC analysis to predict significant EH, the cut-off CSA value in the SPS was 3.905 mm2 for the cochlea (AUC: 0.8762, 95% confidence interval [CI]: 0.7952‒0.9572) and 3.805 mm2 for the vestibule (AUC: 0.7727, 95% CI: 0.6539‒0.8916).Conclusion: In the ears with significant EH in the cochlea or vestibule, the CSA of the ipsilateral SPS was smaller than in the ears without EH.

A novel histopathological grading system for ganglioglioma.

Gangliogliomas are central nervous system tumors located in the temporal lobe of young patients, frequently associated with epilepsy. In this paper, we propose a grading system based solely on histopathological criteria. We reevaluated all cases of ganglioglioma, atypical ganglioglioma, and anaplastic ganglioglioma diagnosed between 2011 and 2020 in the Pathology Department of the Emergency Clinical Hospital Bagdasar-Arseni, based on the type of glial mitoses, the number of neuronal and glial mitoses, presence of necrosis, microvascular proliferation, eosinophilic granular bodies, hypercellularity, presence and disposition of inflammatory infiltrate and atypical pleomorphism. Based on the proposed grading system, a score of 0–4 corresponded to a benign ganglioglioma, 5–9 to an atypical ganglioglioma, and 10–18 to an anaplastic ganglioglioma. The survival rates were 90% for benign ganglioglioma, 71.43% for atypical ganglioglioma, and 62.54% for anaplastic ganglioglioma. One case of benign ganglioglioma underwent a malignant transformation into anaplastic ganglioglioma, and recurrences were noticed in 28.57% of atypical ganglioglioma cases and 30.7% of all anaplastic gangliogliomas. The presence of rare glial mitoses and hypercellularity was correlated with mortality in cases of atypical ganglioglioma. We believe this histopathological scoring system could be used as a three-tier system to identify atypical ganglioglioma cases that are bound to have an aggressive course of evolution and require close follow-up. The other option would be to convert it to a two-tier grading system that can separate low-grade gangliogliomas from high-grade ones. The latter category can encompass both atypical and anaplastic ganglioglioma due to the high mortality of both entities.

Utility of Newly Proposed Grading System From International Association for the Study of Lung Cancer for Invasive Lung Adenocarcinoma

IntroductionThe International Association for the Study of Lung Cancer proposed a new grading criteria for invasive adenocarcinoma. However, its utility has not been validated. MethodsPatients who underwent complete resection of lung adenocarcinoma were included in this study. Then, they were divided into the following three groups on the basis of the criteria recently proposed by the International Association for the Study of Lung Cancer: grade 1, lepidic predominant tumor, with less than 20% of high-grade patterns; grade 2, acinar or papillary predominant tumor, with less than 20% of high-grade patterns; and grade 3, any tumor with greater than or equal to 20% of high-grade patterns. ResultsRecurrence-free survival (RFS) was significantly different among the proposed grades (p < 0.001). The RFS of patients upgrading from current grade 2 (papillary or acinar predominant tumor) to proposed grade 3 (5-y RFS, 65.2%) was significantly worse than that of patients with proposed grade 2 (77.1%, hazard ratio = 1.882, 95% confidence interval: 1.236–2.866) but not significantly different from that of patients with grade 3 in both the current (micropapillary or solid predominant tumor) and proposed criteria (53.2%, hazard ratio = 0.761, 95% confidence interval: 0.456–1.269). Among patients with pathologic stage 0 or I, RFS was well stratified by the new grading system (p < 0.001) but not among patients with stage II or III (p = 0.334). In the multivariable analysis, the new grading was not a predictive factor of RFS. ConclusionsAlthough the proposed grading system well stratified RFS in patients with pathologic stage 0 or I lung adenocarcinoma, there is room for improvement.

Long-Term Outcomes of Endoscopic Third Ventricle Colloid Cyst Resection: Case Series With a Proposed Grading System.

Endoscopic resection of colloid cysts has gained recent widespread practice. However, reported complication and recurrence rates are variable, possibly, in part, because of a lack of consistency with reporting of the extent of cyst capsule removal. To present the long-term outcomes of endoscopic resection of third ventricle colloid cysts without complete capsule removal and propose a grading system to allow consistent description of surgical outcomes. A retrospective review of 74 patients who underwent endoscopic resection of symptomatic third ventricle colloid cysts between 1995 and 2018 was performed. Kaplan-Meier analyses were used to assess recurrence-free survival rates. Median patient age and cyst diameter were 48.0 (13.0-80.0) yr and 12.0 (5.0-27.0) mm, respectively. Complete emptying of cyst contents with capsule coagulation was achieved in 73 (98.6%) patients. All patients improved or remained stable postoperatively, with a median follow-up duration of 10.3 (0.3-23.7) yr. Radiographic recurrence occurred in 6 (8.1%) patients after their initial surgery, 5 (6.8%) of whom underwent redo endoscopic resection. No major complications or mortality was encountered at primary or recurrence surgery. Endoscopic resection of third ventricle colloid cysts without emphasizing complete capsule removal is a viable option for successfully treating colloid cysts of the third ventricle. Long-term follow-up demonstrates that it is associated with low risks of complications, morbidity, mortality, and recurrence. The proposed extent of the resection grading scheme will permit comparison between the different surgical approaches and facilitate the establishment of treatment guidelines for colloid cysts.