Total Number Of Lesions Research Articles

Clinical outcomes and efficacy of endoscopic ultrasound guided ablation of pancreatic cancer a systematic review and a meta-analysis.

e16261 Background: Endoscopic ultrasound-guided ablation therapy (EUS-A) is a minimally invasive technique increasingly used for the management of surgically unresectable pancreatic cancer. The data on the efficacy and clinical outcome of EUS-A for unresectable pancreatic cancer is lacking. We conducted this systematic review and meta-analysis to evaluate the safety, technical and clinical success of EUS-A therapies specifically for unresectable pancreatic cancer. Methods: Studies were identified with a comprehensive search for EUS-A and pancreatic cancer on PubMed, Google Scholar, Web of Science and Embase data search as of October 2020. The technical and clinical success rates of EUS-A were primary outcomes while adverse events (AEs) rate was secondary outcome. We defined technical success as successful placement of probe within tumor and able to perform ablation regardless of tumor outcome. Clinical success was defined as symptomatic improvement and/or any reduction in tumor size or evidence of necrosis on radiological imaging after EUS-A. A compute pooled analysis was performed using the ‘meta’ package by Schwarzer et al. in the R programming language (version 4.0.2) using random effect model. Results: Nineteen studies including 192 patients (54% females) were included. Common pancreatic tumors were nonfunctional neuroendocrine tumor (NNET) 43.5% (97), followed by locally advanced pancreatic ductal adenocarcinoma (LAPDAC) 27.3% (61), insulinoma 17.9% (40), cystic neoplastic lesions 8.5% (19). The pancreatic head was the most common site of tumor 49.8% (111), followed by body, neck and tail 44.8% (100). EUS-RFA was the most commonly used ablative therapy 63% (12/19 studies), followed by EUS-EA (ethanol ablation) 26% (5/19 studies) while EUS-A using laser and lauromacrogol injection was used in one study each. The mean number of ablation sessions per patient was 1.4 based on the total 243 sessions in 176 patients. The pooled technical success rate of EUS-A was 99.5% [95% CI = 0.90-0.97, I2 = 0%]. The pooled clinical success rate calculated out of total number of pancreatic lesions was 91.1% [95% CI = 0.79-0.92, I2 = 16%]. Clinical improvement in symptoms was reported in 11 studies and a complete resolution or decrease in tumor size was reported in 16 studies. The pooled AEs rate was 22.9% [95% CI = 0.17-0.37, I2 = 43%]. Common AEs were abdominal pain 7.8% (15), pancreatitis 5.2% (10) and pancreatic pseudocyst 2.1% (4). The median follow-up was 9.5 months. Conclusions: EUS-A is a safe and promising modality in the management of unresectable pancreatic cancer with a high technical and clinical success rate. Large prospective studies and clinical trials are required for comparison of clinical outcome of different EUS-A therapies and its widespread application for unresectable pancreatic cancer.

FDG-PET/CT response and outcome of neoadjuvant immunotherapy for clinical stage III melanoma.

e21569 Background: Neoadjuvant immunotherapy with nivolumab 3mg/kg and ipilimumab 1mg/kg for two cycles(N3+I1) or anti-PD1 for 3-8 weeks for clinical stage III melanoma have shown rates of pCR/near-pCR about 60% or 30%, respectively. The prognosis of this group seems to be excellent so far. On the other hand, patients classified as pathological non-response have a worse outcome and early identification of this group may allow us to tailor treatment before surgery. Methods: We conducted a retrospective analysis of patients with clinical stage III melanoma treated with neoadjuvant immune checkpoint blockade who did baseline and pre-operative FDG-PET/CT. The total number of FGD avid lesions and the percentual difference between the maximum SUV per lesion was calculated. The pathological results were correlated to FGD-PET/CT findings. Results: Between January 2019 and January 2021, nine patients with clinical stage III melanoma were identified. Six patients received Nivolumab 3m/kg and Ipilimumab 1mg/kg for two cycles and 3 received anti-PD1 for 60 days. Baseline FDG-PET/CT showed just one avid lesion in 7 patients, 2 avid lesions in one patient and 3 avid lesions in one patient. All known lesions identified by CT scan were also captured by FGD-PET/CT. After the neoadjuvant treatment, 4 patients achieved pCR/near-pCR. All of them were treated with N3+I1. Two of them had metabolic complete response (including the one with 3 PET- avid lesions) and 2 had reduction on FDG concentration (-31% and – 76%). Three patients had absence of response: 100% of viable tumor cells (VTC), all of them with increase in FDG concentration (+12% to + 307%) and appearance of a new lesion in one case. Two out of them were treated with anti-PD1. One patient had partial response (40% of VTC). Interestingly, this patient developed sarcoidosis-like reaction with increase of SUV in the index lesion (+68%) and appearance of mediastinal lymph-nodes. One patient, who had two lesions, presented a mixed response: complete response in one and 90% of VTC in the other. FDG-PET/CT was able to detect both responses (metabolic complete response and increase of FGD concentration of 17%, respectively). Conclusions: Reduction in FGD-PET/CT concentration with no appearance of new lesion(s) is associated with significant pathological response. An increase of SUV or appearance of new lesion(s) should be carefully interpreted.

Deficiency of MMP1a (Matrix Metalloprotease 1a) Collagenase Suppresses Development of Atherosclerosis in Mice: Translational Implications for Human Coronary Artery Disease.

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The effect of oral miltefosine in treatment of antimoniate resistant anthroponotic cutaneous leishmaniasis: An uncontrolled clinical trial.

BackgroundRecent circumstantial evidence suggests increasing number of Iranian patients with cutaneous leishmaniasis (CL) who are unresponsive to meglumine antimoniate (MA), the first line of treatment in Iran. Oral meltifosine was previously reported to be effective in visceral leishmaniasis as well CL. The current study is designed to determine efficacy and safety of oral miltefosine for the treatment of anthroponotic cutaneous leishmaniasis (ACL) cases who were refractory to MA in Iran.Methodology/Principal findingsMiltefosine was orally administered for 27 patients with MA resistant ACL with approved L.tropica infection, at a dosage of ∼2.5 mg/kg daily for 28 days. Patients were evaluated on day 14 and 28, as well as 3, 6 and 12 month post treatment follow up sessions. Laboratory data were performed and repeated at each visit. Data were analyzed using SPSS version 17. Twenty-seven patients including 16 men (59.25%) and 11 women (40.74%) with mean age of 28.56 ± 4.8 (range 3–54 years old) were enrolled. Total number of lesions were 42 (1–4 in each patient). Most of lesions were on face (76.19%). Mean lesions’ induration size was 2.38 ± 0.73 cm at the base-line which significantly decreased to1.31 ± 0.58 cm and 0.61 ±0.49 cm after 14 and 28 days of therapy, respectively (p value <0.05). At 12-months follow-up post treatment, 22 patients had definite/partial cure (81.48%) including 17 definitely cured patients, corresponding to a cure rate of 68% on per protocol analysis, and 62.96% according to intention to treat analysis. Recurrence of lesion was only occurred in one patient (3.70%). Nausea was the most subjective complication during the therapy (33.33%).ConclusionOral miltefosine could be an effective alternative for the treatment of MA-resistant ACL.

Histopathological study of salivary gland lesions-an institutional study

Background: The salivary glands are the site of origin of a variety of neoplasm and are also relatively uncommon accounting for Materials and Methods: this study was conducted for two years (Nov 2018-Nov 2020) in the department of pathology KBNIMS, kalaburagi. Total number of salivary gland lesions included were 50. Specimens were processed and stained by hematoxylin and eosin stain followed by microscopic examination. Results: out of total 50 cases 54% were non neoplastic and 46% were neoplastic. Predominantly salivary gland lesions were found in the 3rd -4th decade. Male predominance was seen in all salivary gland lesions. In non neoplastic lesions chronic sialadenitis was predominant (32%) followed by mucocele (10%). In neoplastic lesions, Pleomorphic adenoma was commonest benign tumor accounting for 22%. Mucoepidermoid carcinoma was most common malignant salivary gland tumor. Most of the salivary gland lesions were found in the submandibular gland. Conclusion: Histopathological examination remains gold standard because of their varied histomorphological features Keywords: Sialadenitis, Salivary gland lesions, Pleomorphic adenoma, Mucoepidermoid carcinoma.

Isolation, Identification and Inducing Systemic Resistance to Beet Mosaic Virus (BTMV) Infecting Sugar Beet Plants in Egypt

The objective of the study described in this paper was to isolate and determine a range of a potyvirus in sugar beet crop. The virus inoculum was taken from obviously diseased sugar beet plants (Beta vulgaris L.cv. Top), screening mild to severe mosaic complemented with leaves malformation and distortion, suspected to be caused by virus infection. Leaf samples were togethered from different areas in Menoufia Governorate, Egypt. The determination of the isolate was based on symptomatology, host range, modes of transmission (mechanical- insect), serological tests (Direct ELISA, DBIA and TBIA ), light microscopy. BtMV infection distributed some of photosynthetic pigments in infected beet leaves, i.e. chlorophyll, carotenoids and also reduced the concentration of total carbohydrates and total sugar in roots. Currently, different inducers stemmed from several materials were used to decrease the virus concentration. Preliminary showing were actual in reducing the number of local lesions formed by challenge inoculation of BtMV. Both inducers ( plant extracts and Salicylic acid (SA) showed reducing in the total numbers of local lesions and concentration of the virus. Among the inducers used for introduction of resistance against BtMV, Dianthus caryophyllus extract was found to be most effective. Also, Our results revealed that Salicylic acid (SA) used for screening was effective in reducing the concentration of virus and the number of local lesions formed by the challenge inoculation of BtMV .

Routine cavity shaves following breast conserving surgery; friend or foe?

BackgroundRadial margin status is considered one of the most important prognostic predictor for patients undergoing breast-conserving surgery (BCT), not only related to regional recurrence but also to 5y survival, especially in patients with invasive disease. AimWhile our primary aim was to evaluate whether doing routine radial cavity shaves following at the time of primary conservative breast surgery will decrease the need for a second operation or not, our secondary aim was to assess time added to the operation to resect and mark the radial shaves, as well as patients’ satisfaction with the results. Material and methodsWe have conducted a case series prospective analysis, including158 patients who underwent breast-conserving surgery looking into the histological status of resection margins and radial shaves, added time taken to take and mark the shaves as well as patients’ satisfaction. Results158 female breast cancer patients have been included in our analysis, the mean age was 56 years; total number of lesions was 160. While 89.3% of lesions were palpable, 10.6% were not requiring wire-guided localisation. Mean tumour size was 24 mm SD 7, final histology revealed that 86.8% lesion was invasive ductal carcinoma, 5.6% invasive lobular carcinoma, 1.2% medullary carcinoma. 12.4% had invasive disease as well as DCIS, and 1.8% had DCIS only with no invasive disease.Mean preoperative breast volume was 723 ml, Mean wide local excision specimen weight was 73 g, and mean shave weight was 1.6 g.Total number of radial margins was 640, 81.8% was clear, 14.6% was close, and 3.4% was involved. Total number of shaves was 640 out of which 98.7% was clear 0.7% was close and 0.4% was involved.Out of the 160 lesions, 3.7% required a second procedure to clear margins, out of which 2.5% had re-excision for close or involved single shaves each while 1.2% had mastectomy due to close or involved two shaves each.Average time utilised in resection of radial shaves and marking was 7 min 0.6% of patients developed a haematoma, 1.8% had a Seroma, and 1.2% had wound infection. Mean hospital stay was 1day SD 1. ConclusionRoutine radial cavity shaves not only ensure microscopic clearance, reduce the need for re‐excision with no significant added operating time but also has no impact on patients’ satisfaction.

Rhodomyrtone as a New Natural Antibiotic Isolated from Rhodomyrtus tomentosa Leaf Extract: A Clinical Application in the Management of Acne Vulgaris.

Rhodomyrtone, a plant-derived principal compound isolated from Rhodomyrtus tomentosa (Myrtaceae) leaf extract, was assessed as a potential natural alternative for the treatment of acne vulgaris. The clinical efficacy of a 1% liposomal encapsulated rhodomyrtone serum was compared with a marketed 1% clindamycin gel. In a randomized and double-blind controlled clinical trial, 60 volunteers with mild to moderate acne severity were assigned to two groups: rhodomyrtone serum and clindamycin gel. The volunteers were instructed to apply the samples to acne lesions on their faces twice daily. A significant reduction in the total numbers of acne lesions was demonstrated in both treatment groups between week 2 and 8 (p < 0.05). Significant differences in acne numbers compared with the baseline were evidenced at week 2 onwards (p < 0.05). At the end of the clinical trial, the total inflamed acne counts in the 1% rhodomyrtone serum group were significantly reduced by 36.36%, comparable to 34.70% in the clindamycin-treated group (p < 0.05). Furthermore, a commercial prototype was developed, and a clinical assessment of 45 volunteers was performed. After application of the commercial prototype for 1 week, 68.89% and 28.89% of volunteers demonstrated complete and improved inflammatory acne, respectively. All of the subjects presented no signs of irritation or side effects during the treatment. Most of the volunteers (71.11%) indicated that they were very satisfied. Rhodomyrtone serum was demonstrated to be effective and safe for the treatment of inflammatory acne lesions.

The effects of biological agents on vascular structural lesions in Takayasu's arteritis.

The aim of the present study was to evaluate the effects of biological disease-modifying antirheumatic drugs (bDMARDs) administered to patients with Takayasu's arteritis (TAK) on disease activity and vascular damage. This study included TAK patients who were receiving bDMARDs for at least six months. Disease activity (National Institutes of Health [NIH]), vascular lesions, and vascular damage (Combined Arteritis Damage Score [CARDS]) scores were determined. There were 21 TAK patients who received infliximab (INF) and/or tocilizumab (TCZ) (mean age = 38.6±11.8 years; female proportion = 20 [95.2%]). The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and NIH disease activity score were found to significantly decrease with bDMARD treatments. There were also significant decreases in the mean CARDS and the total number of vascular lesions after treatment (p<0.05). Unlike occlusions, an important decrease was observed in the occurrences of stenosis and aneurysms with bDMARD treatments. Regression was detected in the vascular lesions of 15 (71.4%) patients compared to the last image before bDMARD therapies. Our study results indicate that biological agents, such as INF and/or TCZ, that are used in the treatmentof TAK are capable of remedying certain vascular lesions and may provide additional benefits to patients with TAK who do not sufficiently respond to conventional synthetic disease-modifying antirheumatic drug (DMARD) treatment.

Effects of shoulder distraction on canine shoulder arthroscopy.

To evaluate the use of the Leipzig distractor during canine shoulder arthroscopy. Experimental, ex vivo. Paired shoulder joints from 15 large breed canine cadavers. Standard lateral shoulder arthroscopy was performed with or without the use of the Leipzig distractor (n = 15 each). Joint space width, procedure time, and visibility and palpability of the intra-articular structures were assessed during the arthroscopy. After the arthroscopic evaluation, each shoulder joint was disarticulated to assess the area and number of iatrogenic articular cartilage injury (IACI) lesions. Sites around the distraction device were assessed for the presence of iatrogenic injury. With shoulder distraction, median joint space width was 4 mm larger (P = .01), IACI area was 9.5 mm2 lower (P = .003), and there were two fewer total number of IACI lesions (P = .004) compared with nondistracted shoulders. The mean total surgery time was 93 seconds shorter (P = .01) in distracted shoulders. Although distraction was associated with increased visibility of the supraglenoid tubercle (P = .015), no significant differences were found for other intra-articular structures for their visibility and palpability. Unexpected lesions at the sites around the distraction device were not encountered. Use of the distraction device decreased the area and incidence of IACI lesions and shortened the arthroscopy time. However, no improvement was found in the visibility or palpability of the intra-articular structures. Although additional clinical studies are required to evaluate the effect of the distraction device on pathologic articular conditions and intraoperative manipulation, the use of a shoulder distraction device might improve the outcomes of shoulder arthroscopy by decreasing IACI and arthroscopy time.

The effect of initial complaints and third year MRI lesion load on EDSS of multiple sclerosis patients

Aim: We aimed to investigate the effect of initial complaints and third-year MRI lesion burden on Expanded Disability Status Scale (EDSS) of Multiple Sclerosis Patients.Materials and Methods: Patients who were admitted to the Mustafa Kemal University Faculty of Medicine Neurology clinic and diagnosed with Multiple Sclerosis according to Mc Donald diagnostic criteria were included in the study. The initial symptoms of patients, MRI lesion burden at the end of the third year, and the EDSS score were recorded retrospectively from the patient files. 74.5 % of the participants were female and 25.5 % were male. The most common initial symptoms were: Sensory symptoms, vision symptoms, pyramidal tract symptoms, and polysymptomatic. The mean age of the patients was 33.4. Mean EDSS was found to be 1.8±1.3. The total number of lesions in the brain was 14.8 ± 4.83 on average.Results: If patients compared according to the initial symptoms at the end of the third year, the highest EDSS score was at the polysymptomatic onset group, the second-highest score was at the motor onset group. The patients with the initial symptoms of motor or polysymptomatic group had a higher mean EDSS score than the patients with the initial symptoms of vision, sensorial symptoms, or cranial neuropathy. When we examine the relationship between MRI lesion load at the end of the third year and the EDSS score, there is a strong positive correlation between them. Patients who have more lesions in the brain on MRI studies have higher average EDSS scores than patients who have fewer lesions in the brain.Conclusion: We found that the initial symptoms are directly related to the third-year EDSS score and the prognosis of the disease. We found that there was a significant relationship between the number of lesions in the brain on MRI studies at the end of the third year and the mean EDSS score.

Diagnosis and analysis of primary central nervous system lymphoma based on MRI segmentation algorithm.

Objective:This paper summarizes the MRI imaging findings of primary central nervous system lymphoma (PCNSL) in the posterior cranial fossa to improve the accuracy of PCNSL diagnosis in the posterior cranial fossa.Methods:This study retrospectively analyzed the MRI imaging manifestations of 15 PCNSL posterior cranial fossa cases confirmed by puncture or surgical pathology from June 2017 to May 2018, including their occurrence sites, the number of lesions, MRI plain and enhanced manifestations, and diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy. Imaging (MRS) performance.Results:A total of 15 cases were enrolled, including 10 cases of single lesion and five cases of multiple lesions. The total number of lesions was 25, which were in the cerebellar hemisphere and cerebellar vermis, midbrain, fourth ventricle, and pontine cerebellum. The lesions were round, irregular, nodular, patchy, with low or medium signals on T1WI, equal or slightly higher signals on T2WI, and enhanced with 25 meningiomas-like gray matter signals. All of them were significantly strengthened. “Acupoint sign” and “umbilical depression sign” were seen in eight lesions. There were 17 massive and nodular enhancements, four striped enhancements, three patchy enhancements, and one circular enhancement. five cases of DWI showed homogeneous high signal, two cases showed uneven high signal, and 3 cases showed medium signal. The ADC value of tumor parenchyma in 10 patients was (0.62±0.095)×10-3mm2/s. MRS examination showed obvious Lip peak in two cases.Conclusion:PCNSL in posterior cranial fossa has certain characteristics. DWI, ADC value and MRS are helpful to improve the correct diagnosis rate of PCNSL.

The Effectiveness of Pulsed Dye Laser in Management of Acne Vulgaris: A Systematic review and meta-analysis

Background: Acne vulgaris is one of the most prevalent skin diseases, affecting up to 85% of teenagers and young adults. Multiple treatment options including topical, systemic or physical therapies. However, the effects of conventional therapies are limited due to antibi-otic resistance and adverse effects such as irritation and teratogenicity of isotretinoin. Light-based therapy is an alternative and/or adjuvant therapy in patients who cannot tolerate or unresponsive to conventional therapies that may provide fewer side effects, patient com-fort, fast onset of action, and with equal or greater effectiveness. We aimed to assess the effectiveness of using Pulsed Dye Laser as a treatment option for acne vulgaris. A systemat-ic Review and Meta-analysis was peformed of randomized clinical trials assessing the ef-fectiveness of Pulsed Dye Laser in management of acne vulgaris. Methods: Medline Pubmed, Scopus, Cochrane library, the reference list, conference pro-ceedings, researchers in field of eligible studies were searched. Eight studies (n=275 sub-jects) were included in qualitative analysis of which six studies (n=190 subjects) were in-cluded in meta-analysis. The mean age of the participant was 21,94 years old. Intervention using application of Pulsed dye laser as monotherapy or combination in acne vulgaris pa-tients with follow-up at least 12 weeks. and the outcomes is a decrease mean of acne vul-garis lesions counts after received pulsed dye laser therapy. Results: Pooling of data using random effects model showed that the group that received PDL therapy alone or in combination had a lower number of acne lesions than the control group with the mean difference was -0.593 (95% CI = -1.290 to 0.104), the z value was -1.668 with p = 0.095. This shows that the number of lesions in the group that received sin-gle or combined PDL therapy was lower than the control group. However the difference is insignificant. Conclusion. From the results of the systematic review conducted, it can be concluded that in the group given Pulsed Dye Laser therapy there was a decrease in the total number of acne vulgaris lesions compared to before treatment, and the decrease, which was indicated by the difference in the mean number of acne lesions, was significantly greater compared to the control who was only given placebo. Pulsed Dye Laser therapy can be an alternative treatment option for acne vulgaris in patients who are unresponsive to previous treatment or conditions where there are contraindications to systemic therapy.

Effectiveness of Hormone Based Therapies (Spironolactone and Combined Oral Contraceptives in the Management of Acne Vulgaris in Women: A Systematic review and meta-analysis

Background: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous follicular unit that often occurs. Acne is a skin disorder that is not life-threatening but is mostly complained of because it is aesthetically disruptive, which can cause significant psychological problems for sufferers. The management of acne vulgaris in female patients has its challenges. There are many histories of failed therapy using conventional therapy, such as with antibiotics or isotretinoin, and female patients have a predisposition to the condition of androgen excess. Also, the increasing awareness about limiting the use of antibiotics to prevent resistance in dermatological cases, including acne vulgaris, encourages other treatment options in the female patient population, one of which is hormone-based therapy. A systematic review and meta-analysis were performed of randomized clinical trials assessing the effects of Hormone Based Therapies (Spironolactone and Combined Oral Contraceptives) in the management of Acne Vulgaris in Women. Methods: Medline Pubmed, Scopus, Cochrane Library, the reference list, conference proceedings, researchers in the field of eligible studies were searched. Ten studies (n=1906 sub-jects) were included in qualitative analysis, of which two studies (n=1842 subjects) were included in the meta-analysis. The age of the participant was greater than 14 years old. Intervention using combined oral contraceptives (n=8) or oral spironolactone (n=2). Duration of intervention (minimum six months for COC and three months for SL) and out-comes of mean difference number of acne vulgaris lesions before and after treatment. Results: Pooling of data using random-effects model found a significant difference in the mean difference in the number of lesions after treatment in the group receiving hormone-based therapy (spironolactone and combined oral contraceptives) and those receiving control therapy (p = 0.005). The overall mean difference was -0.890 ± 0.316. A negative value indicating the number of lesions after hormone-based therapy (spironolactone and combined oral contraceptives) was significantly lower than those receiving control therapy (p = 0.005). Conclusion: From the results of the systematic review and meta-analysis conducted, it can be concluded that in the group given hormone-based therapy (spironolactone and Combined Oral Contraceptives), there was a decrease in the total number of acne vulgaris lesions compared to before treatment, and the mean difference in the number of lesions was significantly lower after getting hormone-based therapy (spironolactone and combined oral contraceptives) compared with controls.

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.

Study to Evaluate the Role of Computer aided Detection Using Full Field Digital Mammography in Breast Cancer Imaging

Background: Mammography is acknowledged as the single most effective method of screening for breast cancer and is credited with helping to reduce breast cancer mortality by approximately 30%. CAD systems are a new tool in detecting breast cancers on screening mammograms and in detecting potentially suspicious abnormalities on a mammogram. The aim &amp; objective is to main aim of the present study to evaluate the performance of Computer Aided Detection using Full Field Digital Mammography in Breast Cancer imaging. Subjects and Methods:In the present study, Cases with lump breast with clinical suspicion of breast cancer and post op recurrence of breast cancer were imaged with FFDM and images were read on the viewing monitor without and with the aid of CAD software. The present study confirms that the diagnosis of breast cancer is made only following histopathology of respected specimen. Results: The maximum incidence was in 41-50 years and 51-60 years which was 13 cases in each group (30 %). There were 25 cases out of 40 (62.5%) in which the lesion was marked by CAD. Out of which in 20 cases (50%) only one lesion was marked by CAD and in 4 cases (10%) two lesions were marked by CAD. The total number of lesions marked by CAD was 25 (62.5%). Majority of patients had scattered fibro glandular density of breast. This was present in 19 patients (47.5%). 10 patients (20%) had heterogeneously dense breast, 07 patients (17.5%) had fatty breast and 04 patients (10%) had extremely dense breast. In majority of cases the lesion type was mass alone which was present in 26 cases (60%). While 10 cases (25%) presented as mass with microcalcifications and 4 cases (10%) presented with microcalcifications alone. In 24 cases there was no spread of cluster of micro calcification (60%). In 7 cases (17.5%) the spread of cluster of micro calcification was &lt;10mm, in 4 cases (10%) the spread of cluster of micro calcification was 21-30 mm and in 5 cases ( 12.5%) the spread of cluster of micro calcification was &gt; 40mm. In majority of cases the HPE revealed DCIS which was seen in 22 cases (55%), 08 cases (20%) were invasive ductal carcinoma and 02 cases was invasive lobular carcinoma. In 22 cases (55%) the BIRADS for the breast affected with cancer was BIRADS-V. While in 14 cases (35%) the score was BIRADS-IV, 04 cases (10%) the score was BIRADS-VI and in 02 case (5%) the score was BIRADS-III. The sensitivity, specificity and accuracy of CAD for detection of mass were 70%, 100% and 85% respectively and for detection of cluster of microcalcification were 100% respectively. Conclusion: CAD with FFDM is good at detection of Microcalcifications. Detection of masses is better without the aid of CAD as compared to CAD. However detection of lesion improves if reading of mammogram is done both with and without CAD.

Clinical Utility of Plasma KRAS, NRAS and BRAF Mutational Analysis with Real Time PCR in Metastatic Colorectal Cancer Patients-The Importance of Tissue/Plasma Discordant Cases.

Background: Tumor tissue (T) mutational analysis represents the standard for metastatic colorectal cancer (mCRC); however, circulating tumor DNA (ctDNA) detected by liquid biopsy in plasma (PL) can better represent tumor heterogeneity. Methods: mCRC patients undergoing standard first-line chemotherapy with known T-KRAS/NRAS/BRAF status were enrolled in the present prospective study. PL mutations were assessed within 2 weeks before chemotherapy start with real time PCR and correlated with T status and Progression free survival (PFS). Clinical and biochemical variables including also total number of tumor lesions (TNL) and the sum of maximum diameter (SMD) of all lesions were assessed as potential predictors of T/PL discordance. RESULTS: Among 45 enrolled patients, all BRAF mutations were concordant between T and PL and there were 20% of patients RAS discordant: 9% wild type in T and mutated in PL and 11% mutated in T and wild type in PL. T mutations were significantly associated to median PFS (mPFS of 4.5, 8.3 and 22.9 months for T-BRAF mutated, T-RAS mutated, and T-wild type patients, respectively, p for trend 0.00014). PL mutations further refined prognosis: RAS wild type in T and mutated in PL had significantly shorter PFS than concordant RAS wild type in T and PL: mPFS 9.6 vs. 23.3 months, respectively, p = 0.02. Patients RAS mutated in T and wild type in PL had longer PFS than concordant RAS mutated in T and PL: 24.4 vs. 7.8 months, respectively, p = 0.008. At a multivariate cox regression analysis for PFS, PL mutations were independent prognostic factor superior to T analysis (HR 0.13, p = 0.0008). At multivariate logistic regression analysis TNL and SMD were significant predictors of discordant cases. Conclusions: PL mutational analysis allows a better prognostication than T analysis alone and could help in mCRC treatment management.

Revealing vascular abnormalities and measuring small vessel density in multiple sclerosis lesions using USPIO

Background and PurposeMultiple Sclerosis (MS) is a progressive, inflammatory, neuro-degenerative disease of the central nervous system (CNS) characterized by a wide range of histopathological features including vascular abnormalities. In this study, an ultra-small superparamagnetic iron oxide (USPIO) contrast agent, Ferumoxytol, was administered to induce an increase in susceptibility for both arteries and veins to help better reveal the cerebral microvasculature. The purpose of this work was to examine the presence of vascular abnormalities and vascular density in MS lesions using high-resolution susceptibility weighted imaging (SWI). MethodsSix subjects with relapsing remitting MS (RRMS, age = 47.3 ± 11.8 years with 3 females and 3 males) and fourteen age-matched healthy controls were scanned at 3 T with SWI acquired before and after the infusion of Ferumoxytol. Composite data was generated by registering the FLAIR data to the high resolution SWI data in order to highlight the vascular information in MS lesions. Both the central vein sign (CVS) and, a new measure, the multiple vessel sign (MVS) were identified, along with any vascular abnormalities, in the lesions on pre- and post-contrast SWI-FLAIR fusion data. The small vessel density within the periventricular normal-appearing white matter (NAWM) and the periventricular lesions were compared for all subjects. ResultsAveraged across two independent raters, a total of 530 lesions were identified across all patients. The total number of lesions with vascularity on pre- and post-contrast data were 287 and 488, respectively. The lesions with abnormal vascular behavior were broken up into following categories: small lesions appearing only at the vessel boundary; dilated vessels within the lesions; and developmental venous angiomas. These vessel abnormalities observed within lesions increased from 55 on pre-contrast data to 153 on post-contrast data. Finally, across all the patients, the periventricular lesional vessel density was significantly higher (p < 0.05) than that of the periventricular NAWM. ConclusionsBy inducing a super-paramagnetic susceptibility in the blood using Ferumoxytol, the vascular abnormalities in the RRMS patients were revealed and small vessel densities were obtained. This approach has the potential to monitor the venous vasculature present in MS lesions, catalogue their characteristics and compare the vascular structures spatially to the presence of lesions. These enhanced vascular features may provide new insight into the pathophysiology of MS.

Effects of a Lacto-Ovo-Vegetarian Diet on the Plasma Lipidome and Its Association with Atherosclerotic Burden in Patients with Coronary Artery Disease-A Randomized, Open-Label, Cross-over Study.

A vegetarian diet has been associated with a lower risk of coronary artery disease (CAD). Plasma triacylglycerols, ceramides, and phosphatidylcholines may improve prediction of recurrent coronary events. We sought to investigate effects of a lacto-ovo-vegetarian diet (VD) on plasma lipidome in CAD patients and simultaneously assess associations of plasma lipids with the extent of coronary atherosclerotic burden. We analyzed 214 plasma lipids within glycerolipid, sphingolipid, and sterol lipid classes using lipidomics from a randomized controlled, crossover trial comprising 31 CAD patients on standard medical therapy. Subjects completed a four-week intervention with VD and isocaloric meat diet (MD), separated by a four-week washout period. The VD increased levels of 11 triacylglycerols and lowered 7 triacylglycerols, 21 glycerophospholipids, cholesteryl ester (18:0), and ceramide (d18:1/16:0) compared with MD. VD increased triacylglycerols with long-chain polyunsaturated fatty acyls while decreased triacylglycerols with saturated fatty acyls, phosphatidylcholines, and sphingomyelins than MD. The Sullivan extent score (SES) exhibited on coronary angiograms were inversely associated with triacylglycerols with long-chain polyunsaturated fatty acyls. Phosphatidylcholines that were lower with VD were positively associated with SES and the total number of stenotic lesions. The VD favorably changed levels of several lipotoxic lipids that have previously been associated with increased risk of coronary events in CAD patients.

Automated Baseline Fluorodeoxyglucose-Positron Emission Tomography Imaging and High BCL2 Expression Provide Orthogonal Prognostic Value in Predicting High-Risk De Novo Diffuse Large B-Cell Lymphoma Patients

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, accounting for 30─40% of cases (Li, et al. Pathology 2017). Although rituximab (R) plus CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) cures approximately 50─60% of patients, clinical outcomes remain poor for those with relapsed or refractory (R/R) disease (Liu and Barta. Am J Hematol 2019). Current prognostic models such as the International Prognostic Index (IPI) have suboptimal sensitivity and specificity to identify these patients at diagnosis. Models that combine biological, clinical and imaging markers may improve prognostication in DLBCL. Methods: We evaluated fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging features alongside clinical and biomarker data in modeling disease prognosis with a primary endpoint of investigator-assessed progression-free survival (PFS) for de novo DLBCL patients from the randomized phase III GOYA study (NCT01287741) comparing R-CHOP versus obinutuzumab (G)-CHOP. Imaging features were derived using a computer-vision modeling algorithm (Jemaa, et al. J Digit Imaging 2020), and included total and by-organ number and volume of lesions. The evaluable population (n=1286) was split into pre-defined training (n=964; PFS events=307) and holdout populations (n=322; PFS events=96). Baseline clinical and imaging features were dichotomized by median or a clinically relevant threshold, and screened with univariate Cox proportional hazard (PH) models (Figure A). Screened variables were further selected to construct a multivariate Cox PH model for risk prognosis utilizing a regularized LASSO Cox regression (Simon, et al. J Statistical Software 2011). Model performance was evaluated by area under the receiver operating characteristic curve (AUC) and C-index on the holdout population. Additional biomarker features were evaluated, including, BCL2 protein expression as determined by Ventana investigational-use only immunohistochemistry (IHC) assay, gene expression quantified by TruSeq® (Illumina) RNAseq, next generation sequencing-based genomic profiling using the FoundationOne HemeTM platform (F1H, Foundation Medicine Inc. [FMI]) and cell of origin (COO) by the Nanostring assay. Results: Total metabolic tumor volume (TMTV), total number of lesions, longest diameter of any lesion, number of kidney lesions, and number of liver lesions were selected as prognostic imaging factors for PFS in de novo DLBCL patients. Strong correlation was observed between corresponding volume and lesion number features, as expected, though collinearity appeared to otherwise be minimal (Figure B). Performance of the resulting model composed of these imaging variables alongside standard clinical features and treatment (AUC=0.66; C-Index=0.64) improved upon a model composed of IPI categories (AUC=0.60; C-Index=0.60). High risk, defined by log-hazard &amp;gt;0 was associated with reduced PFS (Figure C). High BCL2 expression by IHC (score &amp;gt;1) was prognostic for PFS independent of clinical and imaging features (HR, 2.02; CI: 1.36─2.98). High BCL2 was predictive of PFS in patients treated with G-CHOP over R-CHOP in de novo DLBCL patients (HR, 0.55; CI: 0.32─0.97) (Figure D). This trend held when adjusting for COO separate to imaging features. Mutational analysis using the FMI panel also indicated the additional prognostic value of BCL2 and TP53 single-nucleotide variants through selection by LASSO. Conclusions: Automated baseline imaging features and high BCL2 expression demonstrated prognostic value orthogonal to standard clinical features in predicting high-risk de novo DLBCL despite limitations imposed by sample size and multicollinearity among features. These findings support the integration of imaging, genomic and clinical factors in prognostic models to improve the identification of high-risk de novo DLBCL patients. Disclosures Jemaa: F. Hoffmann-La Roche: Current equity holder in publicly-traded company; Genentech, Inc.: Current Employment. Tracy:Genentech, Inc.: Current Employment; F. Hoffmann-La Roche: Current Employment, Current equity holder in publicly-traded company. Bottos:F. Hoffmann-La Roche: Current Employment, Current equity holder in private company. de Crespigny:Genentech, Inc.: Current Employment; F Hoffmann-La Roche: Current equity holder in publicly-traded company. Bengtsson:Genentech, Inc.: Current Employment; F Hoffmann-La Roche: Current equity holder in publicly-traded company. Nielsen:F. Hoffmann-La Roche: Current Employment, Current equity holder in publicly-traded company. Paulson:Genentech, Inc.: Current Employment; F. Hoffmann-Roche: Current equity holder in private company, Current equity holder in publicly-traded company.