Team Of Radiologists Research Articles

Large Right Subclavian Artery Aneurysm Presenting in a Young Patient.

Subclavian artery aneurysms are extremely rare, accounting for less than 1% all of peripheral aneurysms. They are often due to atherosclerosis or thoracic outlet syndrome and present at an average age of 47years. Here, we present an incidental finding of an 18mm rapidly increasing aneurysm involving the first and second part of the right subclavian artery in a woman in her 20s. To our knowledge, this is the youngest patient presenting with a right subclavian artery aneurysm who underwent surgical resection of the aneurysm with repair using interposition graft and successful re-implantation of the vertebral artery with antegrade flow. This report highlights the multidisciplinary care between vascular, interventional radiology and cardiothoracic teams at our tertiary hospital due to the complex nature of the aneurysm.

Impact of AI on radiology: a EuroAIM/EuSoMII 2024 survey among members of the European Society of Radiology

In order to assess the perceptions and expectations of the radiology staff about artificial intelligence (AI), we conducted an online survey among ESR members (January–March 2024). It was designed considering that conducted in 2018, updated according to recent advancements and emerging topics, consisting of seven questions regarding demographics and professional background and 28 AI questions. Of 28,000 members contacted, 572 (2%) completed the survey. AI impact was predominantly expected on breast and oncologic imaging, primarily involving CT, mammography, and MRI, and in the detection of abnormalities in asymptomatic subjects. About half of responders did not foresee an impact of AI on job opportunities. For 273/572 respondents (48%), AI-only reports would not be accepted by patients; and 242/572 respondents (42%) think that the use of AI systems will not change the relationship between the radiological team and the patient. According to 255/572 respondents (45%), radiologists will take responsibility for any AI output that may influence clinical decision-making. Of 572 respondents, 274 (48%) are currently using AI, 153 (27%) are not, and 145 (25%) are planning to do so. In conclusion, ESR members declare familiarity with AI technologies, as well as recognition of their potential benefits and challenges. Compared to the 2018 survey, the perception of AI's impact on job opportunities is in general slightly less optimistic (more positive from AI users/researchers), while the radiologist’s responsibility for AI outputs is confirmed. The use of large language models is declared not only limited to research, highlighting the need for education in AI and its regulations.Critical relevance statementThis study critically evaluates the current impact of AI on radiology, revealing significant usage patterns and clinical implications, thereby guiding future integration strategies to enhance efficiency and patient care in clinical radiology.Key PointsThe survey examines ESR member's views about the impact of AI on radiology practice.AI use is relevant in CT and MRI, with varying impacts on job roles.AI tools enhance clinical efficiency but require radiologist oversight for patient acceptance.Graphical

8194 Extramedullary Hematopoiesis Involving Bilateral Adrenal Glands In A Patient With Sickle Cell Anemia

Abstract Disclosure: V.T. Pham: None. L.N. Sendos: None. Title: Extramedullary hematopoiesis involving bilateral adrenal glands in a patient with sickle cell anemia Background: Extramedullary hematopoiesis refers to blood cell production occurring outside the bone marrow. It is a reactive process caused by inadequate production or excessive destruction of blood cells typically seen in patients with hereditary anemias or infiltrative bone marrow disorders. Extramedullary hematopoiesis usually occurs in the spleen, liver and lymph nodes, but it can also very rarely arise from the adrenal glands. Case Presentation:We present a case of a 42-year-old male with a history of sickle cell anemia who presented with chest pain and shortness of breath and had a chest CT angiography which incidentally showed a 5.6 x 3.8 cm left adrenal mass and a 2.9 x 2.1 cm right adrenal mass. Further evaluation with an MRI abdomen with and without contrast revealed a 5.5 cm lobulated left adrenal mass with patchy areas of microscopic fat and faint delayed heterogeneous enhancement as well as a 2.2 cm right adrenal nodule. The nodules were described as markedly T2 hypointense with heterogeneous T1 hyperintense/isointense signal on MRI with a broad differential diagnosis including extramedullary hematopoiesis in bilateral adrenal glands, lipid poor adenoma or neoplasm. Regarding his sickle cell disease history, the patient was diagnosed as an infant and had very rare episodes of sickle cell pain crisis as a child. However, once he entered adulthood, he began to have multiple episodes of sickle cell pain crisis requiring hospitalizations and transfusions. On further review of patient’s prior imaging scans during these previous hospitalizations, he was first noted to have bilateral sub centimeter adrenal nodules on a CT Abdomen without contrast done almost a decade prior to his current presentation. We ordered biochemical evaluation which did not show any evidence of adrenal hormonal hypersecretion. His case was discussed at our multidisciplinary conference with the radiology and surgery team and it was concluded that the imaging characteristics were most consistent with extramedullary hematopoiesis in the setting of bilateral adrenal gland involvement and patient’s history of sickle cell anemia. Therefore, no immediate surgical resection was recommended. Given the size of the left adrenal mass being greater than 4 cm in size, we advised follow-up imaging for surveillance. Discussion:There has been a rise in detection of adrenal incidentalomas due to the increased use of advanced diagnostic imaging in healthcare settings. When patients with hematologic diseases are found to have adrenal incidentalomas, it is important to consider extramedullary hematopoiesis in the differential diagnosis to avoid unnecessary invasive procedures and surgeries. Presentation: 6/2/2024

Complicated small-bowel diverticulosis and the role of Acute Care for the Elderly Unit

Small-bowel diverticulosis is a rare condition that occurs in older adults. Patients are usually asymptomatic, and some will develop complications such as gastrointestinal (GI) bleeding, intestinal obstruction, diverticulitis, and perforation. This is the case of a 95-year-old male patient with a previous history of heart failure with a preserved ejection fraction of 55%–60% and aortic stenosis since October 2019, atrial fibrillation managed with a permanent pacemaker, oral anticoagulation treatment (which was discontinued due to GI bleeding), hypertension, hypothyroidism, and chronic kidney disease. The patient presented with melena and was diagnosed with upper GI bleeding. The GI, general surgery, interventional radiology, geriatric, and palliative care teams were involved in his care. The patient received multiple blood transfusions, and upper and lower GI endoscopic and interventional radiological procedures were performed. However, owing to the patient’s functional status and age, surgery was not an option. The patient was referred to a palliative care team.

The Double 90 Rule: A New Strategy for Resuscitation in Non-academic Level II Trauma Centers

BackgroundEfficient resuscitation after trauma and shorter time to definitive hemorrhage control help improve trauma outcomes. We aimed to improve the speed and efficiency of resuscitation for critically ill trauma patients in the emergency department by involving interventional radiology and a second surgeon. Study DesignIn 2017 our community, non-academic level II trauma center implemented the Double 90 rule—for trauma patients with 2 confirmed systolic blood pressures less than 90 mm Hg—which involves a second activation including the interventional radiology team, backup trauma surgeon, and operating room charge nurse. We retrospectively reviewed our trauma registry to compare data for high-level trauma patients before (2016, “Pre-Dbl90”) and 3 consecutive years after intervention (2018-2020, “Dbl90”). ResultsAmong 613 patients who met criteria for our highest level of trauma activation, 100 either had activation of the Double 90 rule (Dbl90 patients, n=76) or met Double 90 rule criteria (Pre-Dbl90 patients, n=24). The groups were similar in age, sex, injury severity score, penetrating trauma incidence, and admission vitals. Median time to computed tomography decreased throughout the study period, from 34 minutes in 2016 to 18 minutes in 2020 (P<.001). Median time to first hemorrhage control procedure decreased from 118 minutes (2016) to 43 minutes (2020), (P=.013).Mean packed red blood cell transfusion decreased from 9.1 to 4.8 units (P = 0.016). Mortality rates were similar between groups. ConclusionThe Double 90 rule is effective for expediting trauma care starting in the emergency department, shortening the times to computed tomography, hemorrhage control intervention, and decreasing packed red blood cell transfusion.

Hybrid operating room for the multidisciplinary treatment of a juvenile nasoangiofibroma at the “Dr. Eduardo Liceaga” general hospital of Mexico: case report and literature review

Nasoangiofibroma or juvenile nasopharyngeal angiofibroma is a highly vascularized benign neoplasm, which mainly affects men between the first and second decade of life. The incidence of this type of lesion is extremely rare and occurs in a 0.05 to 0.5% of all head and neck neoplasm, in which surgical treatment is considered the best treatment option. Treatment of this pathology in a hybrid operating room is considered a novel tool, to carry out an effective multidisciplinary intervention, granting better control of the procedure and hemostasis. The purpose of this publication is to describe the advantages of performing surgery in a hybrid operating room, as well as to conduct a literature review on this condition. Two cases are reported, a 14 and 16-years old male, both with a probable diagnosis of juvenile nasoangiofibroma. The surgical treatment was carried out in the hybrid operating room of the General Hospital of Mexico “Dr. Eduardo Liceaga” by the otorhinolaryngology and the oral and maxillofacial surgery department after embolization by the interventional radiology team.

Enhancing Diagnostic Accuracy in Radiology: The Role of Efficient Radiology Staff at Eskag Sanjeevani Hospital, Kolkata, India

Diagnostic imaging is a cornerstone of modern medical diagnosis and treatment, yet missed diagnoses remain a significant issue within radiology, often resulting in delayed treatment and adverse patient outcomes. This article examines the pivotal role of radiology technicians in mitigating missed diagnoses and enhancing diagnostic accuracy. Through a detailed analysis of practices at Eskag Sanjeevani Hospital in Kolkata, India, the article highlights how the radiology team's comprehensive approach to imaging encompassing rigorous adherence to protocols, pattern recognition, and thorough communication contributes to superior diagnostic precision. The discussion includes case studies illustrating the team’s proactive identification of incidental findings, such as abnormalities in paranasal sinuses during a brain CT and posterior abnormalities detected during an abdominal CT, which led to additional diagnostic procedures and timely intervention. These practices demonstrate the significant impact of efficient radiology staff on reducing diagnostic errors, improving patient outcomes, and optimizing healthcare delivery.

460. THE ADDITIONAL VALUE OF CERVICAL ULTRASOUND IN THE DETECTION OF CERVICAL LYMPH NODE METASTASES IN PATIENTS WITH ESOPHAGEAL CANCER

Abstract Background Esophageal cancer patients with cervical lymph node metastases, staged according to the 8th edition of the American Joint Committee on Cancer (AJCC), are considered to have stage IV disease and are generally not eligible for treatment with curative intent. External cervical ultrasound (US) used to be standard in the diagnostic workup for detection of cervical lymph node metastases in the Netherlands, but is no longer included in the esophageal cancer guideline. This study aimed to assess the additional value of US over 18FDG PET-CT for the detection of cervical lymph node metastases in esophageal cancer patients, to reassure justified removal of cervical US from the guideline. Methods This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2014 and January 2021. Radiology and multidisciplinary team meeting reports were reviewed to identify patients with suspected cervical lymph node(s). Primary outcome was detection rate of cervical lymph node metastases on ultrasound and/or 18FDG PET-CT. Golden standard was etiology based on Fine Needle Aspiration (FNA). Results This study included 768 patients, with a median age of 66 years. Patients were predominantly male (75.0%) and the majority had an adenocarcinoma (71.9%). On 18FDG PET-CT, 77 patients had suspected cervical lymph nodes. Of those, 39 proved malignant. Seven malignant lymph nodes were missed on 18FDG PET-CT. 18FDG PET-CT had a positive predictive value (PPV) of 50.6%, a negative predictive value (NPV) of 99.0%, a sensitivity of 84.8% and a specificity of 94.7%. Based on US alone, 134 patients had suspected cervical lymph nodes. Of those, 45 proved malignant. One malignant lymph node was missed on US. US had a PVV of 33.6%, a NPV of 99.8%, a sensitivity of 97.8% and a specificity of 87.7%. In total, suspected cervical lymph nodes were documented in 151 patients (19.7%). FNA was conducted in 134 out of 151 patients. Of those, 46 proved malignant. No major complications after FNA were reported. For 21 patients, this resulted in stage migration and changed policy from curative intent to palliative. Conclusion Standard US increases the number of FNA conducted for benign cervical lymph nodes, as the positive predictive value is low (33.6%). However, it does have an additional value as it identifies 15% of cervical lymph node metastases that were not seen on 18FDG PET-CT.

Promoting antifungal stewardship through an antifungal multidisciplinary team in a paediatric and adult tertiary centre in the UK.

Invasive fungal infections (IFIs) present significant challenges, especially among immunocompromised patients, with associated high morbidity, mortality and significant economic impact. Diagnostic difficulties and the emergence of antifungal resistance necessitates enhanced antifungal stewardship (AFS) efforts. We report outcomes from a review of our multidisciplinary approach to AFS, based in a 1300-bed teaching hospital in the South-West of England. Retrospectively reviewing all adult and paediatric cases over 12 months in 2022, we investigated demographics, diagnosis, antifungal therapy and adherence to AFS advice, including clinical, mycological, financial and teamwork metrics. Data were extracted from our AFS database, supported by pharmacy records. The AFS multidisciplinary team (MDT) reviewed 111 patients, with 30 day and 1 year mortality of 22.7% and 35.4%, respectively. IFIs classified as proven accounted for 26%, with fungal pathogens identified in 36.3% of cases. Antifungal consumption (by 25.1%) and expenditure (by 59.9%) decreased from 2018 to 2022. The AFS MDT issued 324 recommendations, with a 93% acceptance rate. Our approach to AFS, centred around a weekly MDT, demonstrated improvements in IFI management, antifungal consumption and cost-efficiency. This single-centre study highlights the value of a comprehensive, collaborative approach to AFS involving experts in mycology, infection, radiology, antifungal therapies and clinical teams. The programme's success in paediatric and adult populations and the near-universal acceptance of its recommendations show its potential as a model for replication. It represents a model for enhancing patient care and AFS practices, with future directions aimed at expanding service reach and the integration of further rapid diagnostic modalities.

Leveraging the pleural space for anticancer therapies in pleural mesothelioma.

Most patients with pleural mesothelioma (PM) present with symptomatic pleural effusion. In some patients, PM is only detectable on the pleural surfaces, providing a strong rationale for intrapleural anticancer therapy. In modern prospective studies involving expert radiological staging and specialist multidisciplinary teams, the population incidence of stage I PM (an approximate surrogate of pleura-only PM) is higher than in historical retrospective series. In this Viewpoint, we advocate for the expansion of intrapleural trials to serve these patients, given the paucity of data supporting licensed systemic therapies in this setting and the uncertainties involved in surgical therapy. We begin by reviewing the unique anatomical and physiological features of the PM-bearing pleural space, before critically appraising the evidence for systemic therapies in stage I PM and previous intrapleural PM trials. We conclude with a summary of key challenges and potential solutions, including optimal trial designs, repurposing of indwelling pleural catheters, and new technologies.

Becoming a thrombectomy-capable stroke center: Clinical and medico-economical effectiveness at the hospital level.

Too few patients benefit from endovascular therapy (EVT) in large vessel occlusion acute stroke (LVOS), and various acute stroke care paradigms are currently investigated to reduce these inequalities in health access. We aimed to investigate whether newly set-up thrombectomy-capable stroke centers (TSC) offered a safe, effective and cost-effective procedure. This French retrospective study compared the outcomes of LVOS patients with an indication for EVT and treated at the Perpignan hospital before on-site thrombectomy was available (Primary stroke center), and after formation of local radiology team for neurointervention (TSC). Primary endpoints were 3-months functional outcomes, assessed by the modified Rankin scale. Various safety endpoints for ischemic and hemorragic procedural complications were assessed. We conducted a medico-economic analysis to estimate the cost-benefit of becoming a TSC for the hospital. The differences between 422 patients in the PSC and 266 in the TSC were adjusted by the means of weighted logistic regression. Patients treated in the TSC had higher odds of excellent functional outcome (aOR 1.77 [1.16-2.72], p = 0.008), with no significant differences in the rates of procedural complications. The TSC setting shortened onset-to-reperfusion times by 144 min (95% CI [131-155]; p < 0.0001), and was cost-effective after 21 treated LVOS patients. On-site thrombectomy saves 10.825€ per patient for the hospital. Our results demonstrate that the TSC setting improves functional outcomes and reduces intra-hospital costs in LVOS patients. TSCs could play a major public health role in acute stroke care and access to EVT.

Exploring attitudes toward safety climate: a cross-sectional study among interventional radiology team members using the Safety Attitudes Questionnaire (SAQ)

BackgroundInterventional radiology (IR) has evolved into a well-established medical discipline known for its minimally invasive procedures. Establishing a culture of safety in IR settings is crucial to improve patient safety and quality of care. This study describes and compares attitudes about patient safety among professionals working with IR in Sweden. In addition, this study evaluates whether the WHO Safety Checklist for IR is routinely used for radiological interventions.MethodsThis cross-sectional survey uses an electronic questionnaire to collect data from 25 IR units. The attitudes of IR team members (radiographers, physicians, nurses, and assistant nurses) were assessed using the Swedish Safety Attitudes Questionnaire (SAQ), which was adapted for this context.ResultsThe two highest factor scores/percentages of positive responses from the IR team were found for job satisfaction (90/94%) and teamwork climate (85/92%), and stress recognition had the lowest values (54/25%). The attitudes were relatively consistent, with few significant differences between the professions (Factor scores: P = 0.039 for job satisfaction, and P = 0.050 for working conditions. Percentage of positive responses: P = 0.027 for perceptions of management). The radiographers tended to have slightly lower values compared to the other professions among these factors (P < 0.05). The WHO safety checklist for IR was not being used on a regular basis, but the respondents recognized its importance for patient safety.ConclusionsThis study shows high factor scores for the different safety climate factors, with job satisfaction having the highest values. Areas that need improvement are perceptions of management and stress recognition. Attitudes were consistent across professions in the IR team, but radiographers had slightly lower values in some aspects.

Performance of CT in the locoregional staging of colon cancer: detailed radiology-pathology correlation with special emphasis on tumor deposits, extramural venous invasion and T staging.

To investigate the performance of computed tomography (CT) in the local staging of colon cancer in different segments, with emphasis on parameters that have been found to be significant for rectal cancer, namely, extramural venous invasion (EMVI) and tumor deposits (TDs). CT and pathology data from 137 patients were independently reviewed by radiology and pathology teams. The performance of CT in categorizing a given patient into good, versus poor prognostic groups was assessed for each segment, as well as the presence of lymph nodes (LNs), TDs and EMVIs. Discordant cases were re-evaluated to determine potential sources of error. Elastic stain was applied for EMVI discordance. The T staging accuracy was 80.2%. For T stage stratification, CT performed slightly better in the left colon, and the lowest accuracy was in the transverse colon. Under-staging was more common (in 12.4%), and most of the mis-staged cases were in sigmoid colon. According to the first comprehensive correlative analysis, the sensitivity, specificity, and accuracy of CT for detecting TDs were found to be 57.9%, 92.4%, 87.6%, respectively. These figures were 44.7%, 72.7%, and 63.5% for LN, and 58.5%, 82.1% and 73% for EMVI. The detection rate was better for multifocal EMVI. The detection rate was also comparable (although substantially underestimated) for LNs, with the half of the LNs missed by CT being < 5mm. Four patients that were classified as TD by CT, disclosed to be LNs by pathology. Correlative analysis led to refinement of the pathology criteria, with subsequent modifications of the initial reports in 13 (9.5%) patients. Overall, CT performed well in the evaluation of colon cancer, as did TD and EMVI. It is advisable to include these parameters in CT-based staging. Radiologists should be aware of the pitfalls that occur more commonly in different segments.

Night and Day, Why Radiologists Need Play

What is play and why does it matter for radiologists? Play can take many forms in the workplace, including organic, managed, task-related, diversionary, and resistive forms of play, and play may also take the form of authentic self-expression and creation. In this review article, we will discuss the benefits of play including improved problem solving, gaining perspective, and stress reduction, and also provide low-tech and high-tech examples of beneficial play for the radiology team in work and personal contexts.

Disease Classification of CXR Images by AlexNet Transfer Learning

The purpose of this study is to classify COVID-19 CXR(Chest X-Ray) images using a CNN(Convolutional Neural Network) modified from AlexNet using a transfer learning method so that it can be used as an auxiliary method when diagnosing diseases in medical settings. The Dataset used in the experiment uses "COVIDGR-1.0 Dataset". "COVIDGR-1.0 Dataset" is a collection of 784 anonymized X-ray images and, in collaboration with a team of radiologists, built into the dataset in accordance with labeling protocols.The proposed CNN is a fine-tuned build of pre-trained AlexNet, which takes the "COVIDGR-1.0 dataset" as input and categorizes it into Normal, Mild, Moderate and Sever according to the labels and categories. Experimental results of the disease classification of CXR images show that the AUC(Area Under the Curve) is 0.8781, with accuracy of 87.81%. It is believed that the results of this study can be used in the following fields. First, it can be used as an auxiliary tool for diagnosing lung diseases. Second, if the data set is ready, it can be used to classify other diseases. Third, data can be stored separately through classification. Fourth, in the medical field, the object to be classified can be imaged using a smartphone and then classified and stored. This study has the following limitations. The problem with automatically classifying diseases is the vastness and integrity of the dataset. If the data is not prepared, it will cause problems with the accuracy of classification. And in the medical field, doctors' decision-making (diagnosis) is not limited to image data. There is a limitation in that doctors make decisions based on comprehensive data and that medical decisions cannot be made by machines without the doctor's intervention. Determining the decision threshold in decision making problems by AI is also an important limitation. This is because setting reference points for sensitivity and specificity is not the domain of AI experts but of experts in the field. Therefore, medical staff in the field must participate in the process of developing AI in the medical field. Future tasks include continuing research in connection with program input stage development, performance improvement, app development, and medical big data servers.

Pancreaticopleural Fistula: Navigating the Enigma of an Elusive Diagnosis

BACKGROUND: Pancreaticopleural Fistula is a Rare Complication of Acute and Chronic Pancreatitis. This Usually Presents With Chest Symptoms Due to Pleural Effusion, Pleural Pseudocyst, or Mediastinal Pseudocyst. Diagnosis Requires a High Index of Clinical Suspicion in Patients Who Develop Alcohol-induced Pancreatitis and Present With Pleural Effusion Which is Recurrent or Persistent. Analysis of Pleural Fluid for Raised Amylase Will Confirm the Diagnosis and Investigations Like Ct. The Rarity of Pancreaticopleural Fistulas, Especially Without the Context of Chronic Pancreatitis, Makes This Case Noteworthy. The Presence of Pleural Effusion in the Absence of Lung Disease Prompted Thorough Investigation, Leading to the Identification of an Unusual Etiology. THE CASE: A 35-year-old Alcoholic Male Presented to Emergency Room With 4-day History of Breathlessness Which Was Sudden Onset, Gradually Progressing to Grade-3 Dyspnea on NYHA Scale, Associated With Dry Cough. Hospitalization and Chest Radiograph1 Revealed Gross Right Side Pleural Effusion. Emergency thoracentesis and Intercostal Drainage Tube Placement were done and Patient Was Referred to Pulmonology Department. On further Evaluation, Patient Also Complained of Mild Persistent Left Upper Quadrant Abdominal Pain for More Than 6 Months Which Was Relieved on Medication Hence, Ignoring the Complaint. Thoracentesis Procedure Yielded 1.5l Amylase-rich Fluid in the Pleural Space. The Patient Was Then Referred to Surgical Department for Further Evaluation. Usg Abdomen Was Inconclusive. Lab Reports Revealed Mildly Elevated Pancreatic Enzymes. contrast- Enhanced Computed Tomography (Ct) Scan of the Abdomen and Chest Revealed a Dilated Main Pancreatic Duct and Multiple Direct Communication Between the Pancreatic Duct(see Figures 1) and the Right Pleural Space, Leading to the Formation of Massive Pleural Effusion and Complete Collapse of Right Lung. Rest of the Pancreas Appeared Normal With No Evidence of Calcification. After a Thorough Clinical Evaluation, Laboratory Investigations, and Imaging Studies, the Patient Was Diagnosed With a Pancreaticopleural Fistula. The Patient Was Managed Through a Multidisciplinary Approach Involving Gastroenterology, radiology, and General Surgery Teams. Initial Management Included Aggressive Medical Treatment With Bowel Rest, Total Parenteral Nutrition, Antibiotics and Administration of Proton Pump Inhibitors. The Patient Showed Gradual Improvement Post-drainage, With a Significant Decrease in Pleural Effusion Volume and Resolution of Dyspnea. Follow-up With CT scan Was Advised. The patient Was Subsequently Monitored Continuously With Dietary Recommendations. CONCLUSION: the Chosen Case is Significant Due to Its Diagnostic Intricacies and the Necessity for Collaboration Among Various Medical Specialties. The Management of Pancreaticopleural Fistulas Requires a Tailored Approach. This Case Underscores the Importance of Early Diagnosis, Meticulous Evaluation, and Timely Intervention in Achieving Successful Outcomes for Patients. In conclusion,by Sharing This Case, I Aim to Contribute to the Understanding of This Rare Condition and Emphasize the Significance of Timely Diagnosis and Appropriate Management Strategies.

Diagnostic workup for esophageal cancer patients can be improved with checklists and clearer protocols; a comparative study between two tertiary centers in Europe

BackgroundRapid and complete workup of newly diagnosed esophageal cancer is vital for a timely, individual and high-quality treatment strategy. The aim of this study was to uncover potential delay, inefficiencies and non-contributing investigations in the diagnostic process in two tertiary referral centers. MethodsThis retrospective cohort study included all newly diagnosed esophageal cancer patients referred to or diagnosed in the Amsterdam UMC and Karolinska University Hospital between July 2020 and July 2021. Radiology, pathological assessment and multidisciplinary team meeting reports were reviewed. To assess time interval from diagnosis to treatment, dates of diagnosis, admittance to referral hospital, MDT meeting and start of treatment were collected. ResultsIn total, 252 esophageal cancer patients were included, 187 were treated with curative intent. Curatively treated patients had a mean age of 66 years, were predominantly male (74.9 %) with an adenocarcinoma (71.1 %). Curatively treated patients had a median time from diagnosis to referral of seven days (IQR:0–11) and of 35 days (IQR:28–45) between diagnosis and start of treatment. Main reasons for the significant (P < 0.001) differences in time between diagnosis and treatment between centers, Amsterdam UMC (39 days) vs Karolinska (27 days), were need for additional diagnostics (47.8 %) and differences in referral routine. Gastroscopy was repeated in 32.2 % of patients, mainly for further anatomical mapping. ConclusionSignificant time differences between centers in the path from diagnosis to start treatment can be explained by differences in workup approach, referral routines and MDT meeting regulations. Repeat of gastroscopy can be prevented with clearer endoscopy guidelines.

OGC P65 Diagnostic workup for esophageal cancer patients can be improved with checklists and clearer protocols; a comparative study between two tertiary centers in Europe

Abstract Background Rapid and complete workup of newly diagnosed esophageal cancer is vital for a timely, individual and high-quality treatment strategy. The aim of this study was to uncover potential delay, inefficiencies and non-contributing investigations in the diagnostic process. Methods This retrospective cohort study included all newly diagnosed esophageal cancer patients referred to or diagnosed in the Amsterdam UMC and Karolinska University Hospital between July 2020 and July 2021. Radiology, pathological assessment and multidisciplinary team meeting reports were reviewed. To assess time interval from diagnosis to treatment, dates of diagnosis, admittance to referral hospital, MDT meeting and start of treatment were collected. Results In total, 252 esophageal cancer patients were included, of which 187 were treated with curative intent. Curatively treated patients had a mean age of 66 years, were predominantly male (74.9%) with an adenocarcinoma (71.4%). Curatively treated patients had a median time from diagnosis to referral of seven days (IQR:0-11) and a median of 35 days (IQR:28-45) between diagnosis and start treatment. 69 patients had a prolonged time, defined as 40 days or more, between diagnosis and treatment. Main reasons for differences in time between diagnosis and treatment between centers, Amsterdam UMC (39 days) vs Karolinska (27 days), were additional diagnostics (47.8%) and differences in referral routine. For 27 out of 67 patients (40.3%) only logistical reasons were found for prolonged time between diagnosis and treatment. Conclusions Time between diagnosis and treatment can be improved, possibly with alterations in workup protocol, referral routines, MDT meeting regulations and workup checklists.

OGC P64 Additional value of cervical ultrasonography in the detection of cervical lymph node metastases in patients with esophageal cancer

Abstract Background External ultrasound for detection of cervical lymph node metastases used to be standard in the diagnostic work-up for esophageal cancer patients in the Netherlands. This study aimed to assess the additional value of cervical ultrasonography over 18F-FDG PET-CT for the detection of cervical lymph node metastases in esophageal cancer patients. Methods This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2014 and January 2021. Radiology and multidisciplinary team meeting reports were reviewed for presence of suspect cervical lymph node(s). Primary outcome was incidence, etiology and visibility on ultrasound and/or 18F-FDG PET-CT. Results This study included 789 patients, with a median age of 67 years. Patients were predominantly male (75.2%) and the majority had an adenocarcinoma (71.7%). Suspected cervical lymph nodes were documented in 170 patients (21.6%), 57 proved malignant (33.5%). Of these malignant lymph nodes, seven (12.3%) were visualized on ultrasound, but negative on 18F-FDG PET-CT. One was detected with 18F-FDG PET-CT but not visualized on ultrasound. Lymph node biopsy was conducted for 150 out of 170 patients. Of those, 79 proved benign. 60 patients underwent biopsy for a benign cervical lymph node suspected on ultrasound but negative on 18F-FDG PET-CT. Conclusions As 12.3% of malignant cervical lymph nodes were only visualized with ultrasound, but negative on 18F-FDG PET-CT, cervical ultrasound is of additional value in the detection of cervical lymph node metastases. However, routine cervical ultrasound also attributes to the number of biopsies taken for benign lesions.

EGS P24 Management of oesophageal denture impaction and complications - a case series

Abstract Background Dentures are sometimes inadvertently ingested and can impact in the oesophagus. This can lead to complications such as mediastinitis, perforation and major vascular fistulae. In 1914, Chiari coined ‘aorto-oesophageal syndrome’ following foreign body ingestion. Usually diagnosed post-mortem, he described a triad of chest pain, haematemesis and cardiac arrest resulting from perforation and aortic fistula. Modern dentures are radiolucent, have complex configurations and commonly impact in the oesophagus at the level of the aortic arch. Early specialist intervention by experienced oesophago-gastric (OG) surgeons is crucial to the prognosis. We present our personal experience of managing oesophageal denture impaction and complications. Methods A retrospective review of electronic health records of the authors’ case series of patients with a diagnosis of oesophageal denture impaction over a 13-year period from 01/01/2010 to 31/12/2022 was performed. The inclusion criteria was adult patients with a clinical diagnosis of oesophageal denture/dental bridge impaction. Pathology and complications from impaction and mode of intervention was reviewed. Other outcome measures evaluated were treatment complications, length of stay and 90-day mortality. Results Seven patients (6 males) with median age 54 were reviewed. Dentures were impacted at or above the aortic arch in 6 patients. Attempted retrieval with ENT rigid scope in 3 caused migration of denture causing perforation. Attempted retrieval with flexible gastroscope was successful in 3 but led to opening up of a fistula in one. Five patients underwent surgical intervention (results summarised in tables 1 and 2). 90-day mortality was 0%. The median length of stay in the surgical intervention group was 30 days. Two patients who had aorto-oesophageal fistulae required additional input by cardiac surgery and vascular radiology teams. Conclusions This is a report of the authors’ experience of managing oesophageal denture impaction and it’s sequelae. A favourable 0% 90-day mortality rate despite complex presentations including aorto-oesophageal fistulae has been described. For patients presenting with haematemesis or prolonged history of denture impaction a triple phase CT scan should be performed prior to intervention. The variable complex configuration of dentures complicates their impaction or attempts at extraction. Attempts at extraction with a rigid endoscope can lead to oesophageal perforation. Successful management of these complex cases requires an effective multidisciplinary approach in a specialist OG surgery centre.