Postoperative surgical margin results of the phyllodes tumors from a tertiary hospital

SUMMARY OBJECTIVE: Phyllodes tumors in the breast are exceptionally uncommon fibroepithelial tumors. In the literature, they are typically categorized as benign phyllodes tumor, borderline phyllodes tumor, and malignant phyllodes tumor. This study aims to assess and present the clinical and surgical outcomes of patients diagnosed with phyllodes tumor. METHODS: The outcomes of patients aged 18 years and above diagnosed with phyllodes tumor between 2006 and 2023 were retrospectively reviewed. Patients were grouped as benign phyllodes tumor and borderline/malignant phyllodes tumor and compared by clinical and surgical results. RESULTS: Of all 57 patients with phyllodes tumor, 64.9% (n=37) were benign phyllodes tumor and 35.1% (n=20) were borderline/malignant phyllodes tumor [22.8% (n=13) borderline phyllodes tumor and 12.3% (n=7) malignant phyllodes tumor]. When the patients were divided into two groups as benign phyllodes tumor and borderline/malignant phyllodes tumor and compared, our cumulative (total) recurrence rate was 14.0%, with final surgical margin width between groups [(0<final surgical margin<2 mm vs final surgical margin≥2 mm) (p=0.154)] and recurrence [(8.1% benign phyllodes tumor vs 25.0% borderline/malignant phyllodes tumor) (p=0.080)]; there was no significant difference between our rates. CONCLUSION: Phyllodes tumors of the breast can be followed up with a narrow negative surgical margin (0 mm<final surgical margin<2 mm). However, after the initial surgery, re-excision is recommended for positive margins, while a wider surgical margin (≥10 mm) is not necessary for excision.

Carcinoma escamoso variedad sarcomatoide de lengua. Reporte de caso / Sarcomatoid variant squamous cell carcinoma of the tongue. Case report

Introducción. El carcinoma de células escamosas es una patología relativamente frecuente en Paraguay, que debe ser diagnosticada y tratada a tiempo. La variedad sarcomatoide es un subtipo poco frecuente, pero mucho más agresivo que la presentación convencional, con altas tasas de recurrencia y metástasis linfática. La exposición previa a radiación es uno de los principales factores desencadenantes. Caso clínico. Paciente de 83 años con antecedente de radioterapia por carcinoma escamocelular del paladar blando, quien consultó por una masa en el borde lateral de la lengua que correspondió a un carcinoma escamocelular del subtipo sarcomatoide. Resultados. El paciente fue sometido a cirugía y quimioterapia, pero presentó recaída tumoral a los cuatro meses, sin aceptar una cirugía de rescate, optando por el tratamiento paliativo y falleciendo a los pocos meses. Conclusión. El examen exhaustivo de la cavidad oral en una primera consulta permite identificar lesiones en estadios tempranos y el tratamiento multidisciplinario temprano puede mejorar la supervivencia global. El pronóstico de estos pacientes en estadios avanzados es desalentador. Actualmente la cirugía microvascular es la mejor opción terapéutica, pero la hemiglosectomía sin reconstrucción sigue siendo una opción aceptable en nuestro medio, conociendo los altos costos de la primera y el requerimiento de un grupo mayor de especialistas, largos tiempos quirúrgicos y estancias hospitalarias.

Introduction. Squamous cell carcinoma is a relatively common pathology in Paraguay, which must be diagnosed and treated on time. The sarcomatoid variety is a rare subtype, but much more aggressive than the conventional presentation, with high rates of recurrence and lymphatic metastasis. Previous exposure to radiation is one of the main triggering factors. Clinical case. An 83-year-old patient with a history of radiotherapy for squamous cell carcinoma of the soft palate, who consulted for a mass on the lateral edge of the tongue that corresponded to a squamous cell carcinoma of the sarcomatoid subtype. Results. The patient underwent surgery and chemotherapy, but had tumor relapse after four months, without accepting salvage surgery, opting for palliative treatment and dying a few months later. Conclusion. Exhaustive examination of the oral cavity in a first consultation allows lesions to be identified in early stages and early multidisciplinary treatment can improve overall survival. The prognosis of these patients in advanced stages is discouraging. Currently, microvascular surgery is the best therapeutic option, but hemiglossectomy without reconstruction continues to be an acceptable option in our environment, knowing the high costs of the former and the requirement for a larger group of specialists, long surgical times and hospital stays.

Resultados quirúrgicos de la herniorrafia inguinal en los pacientes mayores de 80 años: Revisión sistemática y metaanálisis / Surgical outcomes of inguinal herniorrhaphy in patients over 80 yearsof age: Systematic review and meta-analysis

Introducción. Los pacientes octogenarios y nonagenarios conforman un grupo etario en progresivo crecimiento. La hernia inguinal es una patología que aumenta progresivamente con la edad. Este trabajo tuvo como objetivo conocer los resultados quirúrgicos de los pacientes mayores de 80 años a quienes se les realizó herniorrafía inguinal. Métodos. De acuerdo con las guías PRISMA, se realizó una revisión sistemática de PubMed, Embase y Google Scholar. Se incluyeron estudios que reportaron la incidencia de complicaciones y mortalidad después de una herniorrafía inguinal en los pacientes octogenarios y nonagenarios. Se calculó la proporción de pacientes con complicaciones después de una herniorrafía inguinal según los datos presentados, con su respectivo intervalo de confianza del 95 %. Resultados. Catorce estudios reportaron un total de 19.290 pacientes, entre quienes se encontró una incidencia acumulada de infección del sitio operatorio de 0,5 % (IC95% 0,460 - 0,678), seroma de 8,7 % (IC95% 6,212 - 11,842), hematoma de 2,6 % (IC95% 2,397 - 2,893), dolor crónico de 2,1 % (IC95% 0,778 - 4,090) y recidiva de 1,2 % (IC95%0,425 - 2,284), para una morbilidad de 14,7 % (IC95% 9,525 - 20,833). Conclusión. Las complicaciones de la herida quirúrgica, el dolor crónico y la recidiva en los pacientes mayores de 80 años a quienes se les realiza herniorrafia inguinal son comparables con las de la población general.

Introduction. Octogenarian and nonagenarian patients constitute a progressively growing age group. Inguinal hernia is a pathology that increases with age. This study aims to understand the surgical outcomes of inguinal herniorrhaphy in patients over 80 years of age. Methods. A systematic review of PubMed, Embase, and Google Scholar was conducted following PRISMA guidelines. Studies reporting the incidence of complications and mortality after inguinal herniorrhaphy in octogenarian and nonagenarian patients were included. The proportion of patients with complications after inguinal herniorrhaphy was calculated based on the data presented, with its respective 95% confidence interval. Results. Fourteen studies reported a total of 19,290 patients, among whom a cumulative incidence of surgical site infection of 0.5 (95% CI 0.460 ­ 0.678), seroma of 8.7% (95% CI 6.212 ­ 11.842), hematoma of 2.6% (95% CI 2.397 ­ 2.893), chronic pain 2.1% (95% CI 0.778 ­ 4.090), recurrence 1.2% (95% CI 0.425 ­ 2.284), and morbidity 14.7% (95% CI 9.525 ­ 20.833) were found. Conclusion. Surgical wound complications, chronic pain, and recurrence in patients over 80 years of age undergoing inguinal herniorrhaphy are comparable to those in the general population.

Recurring basal cell carcinoma involvingexclusively intra-oral mucosa: a case report

Basal cell carcinoma (BCC) is the most common skin cancer, but oral involvement is extremely rare. Here, we showed a case of a 71-year-old Caucasian male patient presenting an asymptomatic submucosal nodule in the left buccal mucosa on the same side of a previous BCC skin lesion. Intraoral examination revealed a circumscribed sessile and fibrous mass covered by normal mucosa. An incisional biopsy was performed. Microscopically, the lesion showed uniform, ovoid, dark-staining basaloid cells with medium-sized nuclei and little cytoplasm arranged in islands and strands, invading the underlying connective tissue. These islands demonstrated palisading of the peripheral cells and occasionally central areas with epidermoid differentiation. The final diagnosis was nodular basal cell carcinoma. Although uncommon, recurrent BCC may occur in the oral cavity. (AU)

High dose rate brachytherapy in nasopharyngeal carcinoma: a neglected practice

Nasopharyngeal carcinomas (NPCs) are one of the most chemo- and radio- sensitive cancers of the head and neck region. It differs from other head and neck cancers in terms of signs and symptoms, treatment response and overall survival. Surgery is not the preferred treatment option, with chemoradiation being the treatment of choice, with an excellent local control rate, prognosis and overall survival. But the management of recurrent NPC is quite challenging and the treatment options available includes re-irradiation, chemotherapy, brachytherapy or surgery in rare cases. Re-irradiation in case of recurrent NPC is very difficult due to the already irradiated tissue in the radiation path, but re-irradiation with brachytherapy is an excellent treatment option for giving further doses of radiation to the nasopharynx in cases of recurrence or residual disease, by taking in consideration the already irradiated area and the radiation dose given before, and achieving a good local control rate and overall survival.

Nuevas perspectivas en el tratamiento del cáncer de tiroides de bajo riesgo. Experiencia con la lobectomía tiroidea en una cohorte de 114 pacientes / New perspectives in the management of low-risk thyroid cancer. Experience with thyroid lobectomy in a cohort of 114 patients

RESUMEN Antecedentes: el tratamiento del carcinoma diferenciado de tiroides (CDT) de bajo riesgo es aún motivo de discusión. En las últimas décadas se observó una migración hacia tratamientos personalizados acordes con las características de cada paciente y de cada tumor. Las guías de práctica vigentes habilitan la lobectomía en pacientes seleccionados, con bajo riesgo de recurrencia. Objetivo: describir los resultados en una cohorte de pacientes con CDT de bajo riesgo de recurrencia tratados con lobectomía tiroidea. Material y métodos: estudio observacional descriptivo de una revisión retrospectiva de historias clínicas de 114 pacientes con CDT tratados con lobectomía tiroidea entre enero de 2015 y abril de 2023. Resultados: fueron operados 114 pacientes, con media de edad de 44 años ± 12; 90 (79%) fueron mujeres. La mediana del tamaño tumoral fue de 9,4 mm, RIC (rango intercuartílico 25-75% 7-13 mm), y 103 de los nódulos (90%) fueron ecográficamente sólidos. Solo 2 pacientes con invasión vascular mayor de 4 vasos requirieron completar la tiroidectomía total. No se registraron complicaciones de importancia, salvo una parálisis recurrencial transitoria. Con un seguimiento promedio de 33,4 meses, no se observaron recurrencias locorregionales ni a distancia en la población analizada. Conclusión: la lobectomía tiroidea en el tratamiento del CDT de bajo riesgo tuvo una baja morbilidad sin recurrencias en la serie presentada. La selección rigurosa de los pacientes y la interacción de un equipo multidisciplinario se consideran esenciales para la implementación exitosa de esta metodología terapéutica.

ABSTRACT Background: The treatment of low-risk differentiated thyroid cancer (DTC) is still a matter of debate. Over the past few decades, there has been a shift towards a more personalized approach, tailored to the individual risks of each patient and tumor. The current practice guidelines recommend lobectomy in selected patients, with low risk of recurrence. Objective: To describe the results of thyroid lobectomy in a cohort of patients with DTC with low risk of recurrence. Material and methods: We conducted a descriptive and observational study. The medical records of patients with DTC who underwent thyroid lobectomy between January 2015 and April 2023 were retrospectively reviewed. Results: A total of 114 patients were operated on; mean age was 44 ± 12 years and 90 (79%) were women. The median tumor size was 9.4 mm (IQR 25-75% 7-13 mm), and 103 nodules (90%) were solid on ultrasound. Only 2 patients with vascular invasion involving > 4 vessels required completion thyroidectomy. There were no major complications and only one patient developed temporary recurrent laryngeal palsy. There were no locoregional or distant recurrences during mean follow-up of 33.4 months. Conclusion: Thyroid lobectomy for low-risk DTC had low morbidity and no recurrences in the series presented. The rigorous selection of patients and the interaction of a multidisciplinary team are considered essential for the successful implementation of this therapeutic approach.

Assessment of factors related to treatment failure and recurrence of superficial dermatophytosis

Background: Superficial dermatophytosis, commonly known as ringworm, is a fungal infection of the skin, hair, or nails caused by dermatophytes, primarily belonging to the genera Trichophyton, Microsporum, and Epidermophyton. Despite being a superficial infection, the rising incidence of treatment failure and recurrence has become a matter of concern in recent years. Methods: This prospective observational study, conducted at the department of dermatology and venereology of Chittagong Medical College Hospital, aimed to investigate the epidemiological factors associated with treatment failure and recurrent cases of superficial dermatophytosis. The study spanned from March 2022 to February 2023, involving 249 participants diagnosed with Tinea corporis, Tinea cruris, Tinea facies, or Tinea pedis. Factors such as excessive sweating, use of warm water, clothing habits, sharing practices, and topical corticosteroid application were analyzed. Results: The most common age group affected was 21-30 years, with a male preponderance (1.6:1). Excessive sweating, wearing water-soaked garments, and sharing towels were prevalent among participants. After 4 weeks of treatment, 81.5% achieved complete cure, but 52.7% of these cases experienced a recurrence within the subsequent 4 weeks. Multivariate analysis identified sharing towels, family history of dermatophytosis, and past topical steroid use as significant risk factors for treatment failure/recurrence. Conclusions: The study emphasizes the importance of linen (sharing towels) in the transmission of dermatophytosis and highlights the increased risk associated with a family history of the condition. Additionally, the injudicious use of topical steroids emerged as a significant factor contributing to treatment failure and recurrence.

Use of CAR-T cells for the treatment of relapsed and refractory multiple myeloma: a systematic review / Uso de células CAR-T no tratamento de mieloma múltiplo recidivado e refratário: uma revisão sistemática

A systematic review of published articles based on randomized clinical trials was conducted to ascertain the efficacy or perspective of using CAR-T cell therapy for refractory multiple myeloma. The PubMed database was searched with the combination of terms "multiple myeloma", "refractory multiple myeloma", "CAR T-cell", and the PRISMA criteria were followed. Of the 78 articles found, only 5 were selected. The studies used different treatment protocols and four different types of CAR-T cells. All studies obtained interesting results in terms of increased progression-free survival and negative minimal residual disease responses. Some authors detected an expansion of CAR-T cells and noted dose-dependent relationship between treatment effectiveness and serum BCMA levels. Although the results were promising, a small number of patients still relapsed a few months after CAR-T cell infusion. Therefore, this new line of therapy should be further investigated, as it significantly increases progression-free survival and improves quality of life.

Uma revisão sistemática de artigos publicados com base em ensaios clínicos randomizados foi realizada para verificar a eficácia ou perspectiva do uso da terapia com células CAR-T para mieloma múltiplo refratário. Foi pesquisada a base de dados PubMed com a combinação dos termos "multiple myeloma", "refratory multiple myeloma", "CAR T-cell" e foram seguidos os critérios PRISMA. Dos 78 artigos encontrados, apenas 5 foram selecionados. Os estudos utilizaram diferentes protocolos de tratamento e quatro tipos diferentes de células CAR-T. Todos os estudos obtiveram resultados interessantes em termos de aumento da sobrevida livre de progressão e respostas negativas à doença residual mínima. Alguns autores detectaram uma expansão das células CAR-T e observaram uma relação dose-dependente entre a eficácia do tratamento e os níveis séricos de BCMA. Embora os resultados tenham sido promissores, um pequeno número de pacientes ainda apresentou recaída alguns meses após a infusão de células CAR-T. Portanto, esta nova linha de terapia deve ser mais investigada, pois aumenta significativamente a sobrevida livre de progressão e melhora a qualidade de vida.

Characteristics of intracranial atherosclerosis disease in stroke cases in Indonesia utilizing cerebral digital subtraction angiography

Background: Intracranial atherosclerosis disease is a cause of ischemic stroke. Risk factors of ICAD included age, gender, race/ethnicity, hypertension, diabetes mellitus, and dyslipidaemia. This study aimed to describe the profile of ICAD in first-ever stroke and its association of recurrent stroke. Methods: The was a prospective cohort study conducted at a private hospital in Indonesia between January 2021 and June 2022. Inclusion criteria included patients with first-ever stroke and intracranial stenosis confirmed through digital subtraction angiography. The incidence of recurrent stroke was observed at six-month follow-up. Results: Of 40 subjects, 25 (62.5%) were females and most ages ranged from 20 to 40 years old. The prevalent site of intracranial stenosis were internal carotid artery in 19 (23.2%) and anterior cerebral artery in 19 (23.2%) subjects. Following six-month follow-up, there was only a patient with recurrent stroke. Conclusions: In first-ever stroke in Indonesia, ICAD was predominantly described in younger men within 41-60 years old. Stroke recurrence was observed in a patient who was old and had multiple comorbid. Further studies using a larger area and longer duration of follow-up may be considered to provide a more generalized description of ICAD in Indonesia.

Laparoscopic shaving for colorectal endometriosis: a literature review

Colorectal endometriosis is one of the most challenging conditions to manage. Surgical treatment is required when lesions are symptomatic, impairing bowel, urinary, sexual, and reproductive functions. Preoperative radiological examination should be extensive to determine the appropriate surgery: laparoscopic shaving, disc excision or rectal resection. We demonstrated that in the hands of experienced surgeons, shaving technique is possible in more than 95% of colorectal endometriotic nodules, with low complication rates compared to resection. Shaving and bowel resection are associated with comparable recurrence rates. As shaving is indicated whatever the size of deep lesions, surgeons should first consider rectal shaving to remove deep bowel endometriosis. Bowel resection should only be performed in case of major rectal stenosis (>80%), multiple or posterior lesions and stenotic colorectal nodules.

Experiencia de la histeropexia vaginal, usando prótesis de polipropileno / Experience of vaginal hysteropexy, using polypropylene prosthesis

Introducción: El prolapso de órganos pélvicos (POP) o distopia genital, es el descenso o desplazamiento de los órganos del suelo pélvico a través del canal vaginal o fuera de este. Objetivo: Evaluar los resultados de la histeropexia vaginal en la corrección quirúrgica del prolapso genital apical grado III o IV, usando prótesis de polipropileno; además describir la tasa de éxito, recurrencias y complicaciones. Método: Estudio de cohorte, en 42 mujeres sometidas a histeropexia vaginal (histero-cistopexia ortotópica) mediante prótesis de polipropileno (Splentis®), entre 2016 y 2021. Se realizaron tres evaluaciones postoperatorias (tres, seis y 12 meses). Se hizo muestreo no probabilístico. Se utilizó estadística descriptiva. Resultados: La edad media fue de 56,19 ± 9,27 años. El tiempo quirúrgico de 58,95 ± 13,74 minutos, el sangrado quirúrgico de 119,85 ± 68,73 ml. La tasa de éxito a los 12 meses fue del 90,47%. La recurrencia del prolapso apical fue del 4,76% a los seis meses y del 9,52% a los 12 meses; el de compartimento anterior a los seis meses arrojó un 7,14%, frente al 11,9% a los 12 meses. El 14,28% de las pacientes presentaron complicaciones menores. La incidencia de incontinencia urinaria de esfuerzo a los 12 meses fue del 16,66%. Conclusiones: la histeropexia vaginal es un procedimiento efectivo y seguro, con bajas tasas de recurrencias o complicaciones. Es importante que se sigan haciendo estudios con mejores diseños estadísticos.

Introduction: Pelvic organ prolapse (POP), or genital dystopia, is the descent or displacement of pelvic floor organs through the vaginal canal or outside of it. Objective: To evaluate the results of vaginal hysteropexy in the surgical correction of grade III or IV apical genital prolapse, using polypropylene prosthesis; also describe the success rate, recurrences and complications. Method: Cohort study in 42 women undergoing vaginal hysteropexy (orthotopic hystero-cystopexy) using a polypropylene prosthesis (Splentis®); between 2016 and 2021. Three postoperative evaluations were carried out (three, six and twelve months). Non-probabilistic sampling was done. Descriptive statistics were used. Results: The mean age was 56.19 ± 9.27 years. Surgical time of 58.95 ± 13.74 minutes, surgical bleeding of 119.85 ± 68.73 ml. The success rate after twelve months was 90.47%. Apical prolapse recurrence was 4.76% at six months and 9.52% at twelve months; that of the previous compartment, after six months it showed 7.14%, compared to 11.9% after twelve months; 14.28% of the patients presented minor complications. The incidence of stress urinary incontinence, at twelve months, was 16.66%. Conclusions: Vaginal hysteropexy is an effective and safe procedure, with low rates of recurrence or complications. It is important that studies continue to be carried out with better statistical designs.

Tumor neuroendocrino primario de hígado / Primary neuroendocrine tumor of the liver

RESUMEN Los tumores neuroendocrinos generalmente se originan en el tracto digestivo o páncreas, desarrollando metástasis hepática a lo largo de su evolución. La presencia de un tumor neuroendocrino primario de hígado es motivo de controversia y de muy escasa casuística. Presentamos el caso de un tumor neuroendocrino primario de hígado confirmado por estudio anatomo-patológico e imágenes. La paciente fue sometida a dos resecciones hepáticas mayores, preservando sólo el segmento IV.

ABSTRACT Neuroendocrine tumors generally originate in the digestive tract or pancreas, developing liver metastases throughout their evolution. The presence of a primary neuroendocrine tumor of the liver is still controversial and there are very few cases. We present a case of a primary neuroendocrine tumor of the liver confirmed by anatomo-pathological study and images. The patient underwent two major liver resections, lastly preserving only segment IV.

Endometrioid adenofibroma of ovary-a two faced tumour: case report

Endometrioid variant of the adenofibromas accounts for only 1% of epithelial neoplasms of ovary. Though benign, specimen of endometroid adenofibroma of ovary needs to be evaluated by an experienced pathologist to rule out borderline and malignant cases. This prevents unnecessary adjuvant therapy for benign cases. We report a case of a large endometrioid adenofibroma arising at the left ovarian fossa in a post-menopausal woman who had undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy 6 years back. Recurrence of endometroid adenofibroma of ovary is rare, however, long term follow-up is mandatory due to its low malignant potential. Though benign, specimen of endometroid adenofibroma of ovary needs to be evaluated by an experienced pathologist so that borderline and malignancy can be ruled out. Endometroid adenofibroma of ovary though benign needs long term follow up due to its low malignant potential.

An overview of juvenile ossifying fibroma

Juvenile ossifying fibroma (JOF) is a cancerous bone condition that mainly affects the facial bones, particularly the jaw and upper jaw. This review article provides an overview of JOF, covering its signs, difficulties in diagnosis, radiographic characteristics, histopathological features, and current treatment strategies. The exact cause of JOF is still uncertain, leading to debates about whether it originates from a tumor growth, abnormal development, or reactive response. The way JOF presents clinically can vary greatly, emphasizing the importance of an approach when evaluating patients with facial swellings. Radiographically, JOF appears as a defined area of bone with varying degrees of mineralization. Clinical and histopathological findings must be combined with the results to diagnose this condition accurately. Histopathologically, JOF is characterized by increased tissue and mineralized components that create a two-phase pattern. Surgical treatment options range from removing the affected area to complete resection; however, achieving surgical margins can be challenging and may lead to recurrence due to its ability to infiltrate surrounding tissues. Reconstruction using either bone grafts or artificial materials is necessary for lesions caused by JOF. Long-term follow-up that includes imaging techniques is crucial due to the likelihood of recurrence in JOF cases. Various factors, such as the extent of removal and the aggressiveness of the lesion, influence recurrence rates. Highlight the complexity involved in managing JOF—emerging developments in procedures and understanding at the level offer promising possibilities for focused treatments. A comprehensive approach to managing JOF includes collaboration between healthcare experts, educating patients, and providing support. It is essential to continue research endeavors and promote data sharing to unravel the complexities surrounding JOF, improve precision and treatment approaches, and enhance well-being.

The diagnostic value of CA125, CEA, CYFRA21-1, CA19-9, and SCC-Ag in lung adenocarcinoma and their predictive value for postoperative recurrence / 中国医师杂志

Objective:To explore the diagnostic value of serum tumor marker detection for lung adenocarcinoma and its predictive value for postoperative recurrence.Methods:A total of 100 lung adenocarcinoma patients (modeling group) and 100 benign lung disease patients (control group) admitted to the Cangzhou Hospital of Integrated Traditional and Western Medicine from December 2018 to December 2020 were selected as the research subjects. In addition, 50 lung adenocarcinoma patients admitted from December 2016 to December 2017 were selected as the validation group. The serum carbohydrate antigen 125 (CA125) and carcinoembryonic antigen (CEA) levels of the modeling group and the control group were compared Levels of cytokeratin 21 fragment (CYFRA21-1), carbohydrate antigen 19-9 (CA19-9), and squamous cell carcinoma antigen (SCC-Ag). The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of CA125, CEA, CYFRA21-1, CA19-9, and SCC-Ag alone and in combination for lung adenocarcinoma; Single and multiple factor analyses were conducted to identify the risk factors for postoperative recurrence in lung adenocarcinoma patients; A column chart model for predicting postoperative recurrence in lung adenocarcinoma patients was constructed using R software, and a risk stratification system was constructed.Results:The average water levels of CA125, SCC-Ag, CEA, CYFRA21-1, and CA19-9 in the modeling group were significantly higher than those in the control group (all P<0.05). The ROC curve showed that the combined detection of CA125, CEA, CYFRA21-1, CA19-9, and SCC-Ag had high diagnostic value for lung adenocarcinoma, with an area under the curve (AUC) of 0.903 (95% CI: 0.865-0.954); Elevated levels of CEA, CA125, CA19-9, and CYFRA21-1 were independent risk factors for postoperative recurrence in lung adenocarcinoma patients (all P<0.05). Patients were divided into extremely low-risk group (total score<56 points), low-risk group (56 points≤total score<132 points), medium risk group (132 points≤total score<186 points), and high-risk group (total score≥186 points) through risk stratification. The survival curve results showed that there was a statistically significant difference in postoperative recurrence rate among patients with different risk stratification systems ( P<0.05). Conclusions:The combined detection of CA125, CEA, CYFRA21-1, CA19-9, and SCC-Ag has high diagnostic value for lung adenocarcinoma. Among them, CA125, CEA, CYFRA21-1, and CA19-9 have certain predictive value for postoperative recurrence in patients.

Assessment value of X-ray angiography in postoperative recurrence,curative effect and the reduction of the perfusion of liver tumor of interventional TACE for liver cancer / 中国医学装备

Objective:To investigate the assessment value of X-ray angiography in postoperative recurrence,curative effect and reduction of the perfusion of liver tumor of interventional transarterial chemoembolization(TACE)for liver cancer.Methods:A total of 59 patients with liver cancer who were treated in The Third the People's Hospital of Bengbu from January 2015 to December 2020 were selected.All patients underwent the examination of routine X-ray angiography one week before surgery and four weeks after surgery.The obtained image sequences were imported into the workstation equipped with imaging technology software of color coded digital subtraction angiography(ccDSA)to conduct analysis.The region of interest(ROI)was manually defined on the ccDSA images before and after TACE.And then,the time intensity curve was obtained,and the quantitative perfusion parameters included the time to peak(TTP),area under curve(AUC),maximum slope(MS)were exported from that.The receiver operating characteristics(ROC)curve was drawn,and the area under curve(AUC)of that was calculated to analyze the assessment efficacy of perfusion parameters on the postoperative recurrence,curative effect and reduction of the perfusion of liver tumor of TACE for liver cancer.Results:In the 59 patients who were included in the study,39 cases occurred postoperative recurrence and 20 cases did not occurred postoperative recurrence according to the definition of postoperative recurrence,and the perfusion TTP(7.38±1.22)s of patients with postoperative recurrence was significantly lower than that(9.03±1.01)s of patients without postoperative recurrence,and the difference of that between them was significant(t=5.198,P<0.05).The AUC and MS of patients with postoperative recurrence were significantly lower than those of patients without postoperative recurrence(t=2.868,31.499,P<0.05),respectively.There were not significant differences in TTP,AUC and MS between patients with and without postoperative recurrence before surgery(P>0.05).According to the determination criteria of curative effect,35 cases were effectiveness,and 24 cases were ineffectiveness,and the postoperative TTP(9.09±1.08)s of patients with effectiveness was significantly higher than that(7.84±2.07)s of patients without effectiveness(t=3.029,P<0.05),and AUC and MS of patients with effectiveness were significantly higher than those of patients without ineffectiveness(t=3.852,54.366,P<0.05),and there were not significant differences in preoperative TTP,AUC and MS between patients with and without effectiveness(P>0.05),and the values of TTP,AUC and MS of the group with effectiveness and group without effectiveness after surgery were significantly higher than those before surgery,and the differences of them between two groups were significant(t=3.029,3.852,54.366,P<0.05),respectively.According to the grading criteria of subjective angiographic endpoints(SACE),33 cases were grade Ⅲ,and 26 cases were grade Ⅳ,and there were not significant in TTP,AUC and MS between patients with grade Ⅲ and patients with grade IV(P>0.05).The postoperative TTP,AUC and MS of patients with grade Ⅳ were significantly lower than those of patients with grade Ⅲ(t=7.679,3.498,58.968,P<0.05),respectively.The sensitivities of TTP,AUC and MS were respectively 66.70%,89.70% and 59.00% in assessing postoperative recurrence of interventional TACE for liver cancer,and the specificities of them were respectively 55.00%,55.00% and 55.00%,and the AUC values of them were respectively 0.629(95% CI:0.478-0.779),0.827(95% CI:0.723-0.931)and 0.512(95% CI:0.356-0.667).The sensitivities of TTP,AUC and MS were respectively 64.10%,79.50% and 61.50% in assessing postoperatively curative effect of interventional TACE for liver cancer,and the specificities of them were respectively 55.00%,65.00% and 55.00%,and the AUC values of them were respectively 0.609(95% CI:0.462-0.756),0.808(95% CI:0.698-0.918)and 0.580(95% CI:0.413-0.747).The sensitivities of TTP,AUC and MS were respectively 69.20%,82.10% and 53.80% in assessing the postoperative reduction of the perfusion of liver tumor of interventional TACE for liver cancer,and the specificities of them were respectively 70.00%,75.00% and 55.00%,and the AUC values of them were respectively 0.745(95% CI:0.613-0.877),0.842(95% CI:0.724-0.960)and 0.507(95% CI:0.360-0.654).Conclusion:The TTP,AUC and MS of perfusion parameters that are obtained by ccDSA quantitative analysis for the data after X-ray angiography examination have a certain application value in assessing the postoperative recurrence,curative effect and the reduction of the perfusion of liver tumor of interventional TACE for liver cancer.

Study on the effect of Al18F-PSMA-BCH scan on early diagnosis and treatment decision of prostate cancer of biochemical recurrence / 中国医学装备

Objective:To explore the effect of the labeled positron emission tomography/computed tomography(PET/CT)scan with Al18F-PSMA-BCH(Beijing Cancer Hospital)on early diagnosis and treatment decision of prostate cancer of biochemical recurrence.Methods:A total of 80 patients who underwent radical prostatectomy(RP)for prostate cancer(PCa)in the Kashgar First People's Hospital from August 2021 to June 2022 were retrospectively analyzed.According to the presence of biochemical recurrence(BCR),they were divided into biochemical recurrence group(n=29)and non-biochemical recurrence group(n=51).All patients were scanned with Al18F-PSMA-BCH PET/CT markers.The detection situations of the labeled scan with Al18F-PSMA-BCH on clinically local recurrence or metastasis of patients with BCR were analyzed.The correlations between the maximum standardized uptake value(SUVmax)of recurrence and metastasis,the serum prostate specific antigen(PSA)and Gleason scores were compared.The detection efficiency of SUVmax on BCR patients with different risk levels under labeled scan with Al18F-PSMA-BCH was analyzed.According to the preoperative PSA,Gleason score of obtaining from postoperative pathological results and clinical stage,80 patients were divided into low-risk grade,medium risk grade and high risk grade.Results:Under the labeled scan with Al18F-PSMA-BCH PET/CT,23 patients in biochemical recurrence group occurred clinical recurrence and metastasis(79.31%),of which 14 cases existed various degrees of lymph node metastasis(60.87%),including simple pelvic lymph node metastasis in 8 cases(34.78%),simple retroperitoneal lymph node metastasis in 2 cases(8.70%),pelvic with retroperitoneal lymph node metastasis in 3 cases(13.04%)and 1 case of supraseptal lymph node metastasis(4.35%).There were 4 cases of recurrence in prostatectomy area(17.39%),1 case of visceral metastasis(4.35%)(brain),and 15 cases with various degrees of bone metastasis(65.22%).For PCa patients with BCR after RP,the area under curve(AUC)of the receiver operating characteristic(ROC)curve of the labeled scan with Al18F-PSMA-BCH PET/CT was 0.897(95% CI:0.808-0.953,P<0.001)in detecting patients with clinical local recurrence or metastasis,and the sensitivity and specificity of that were respectively 79.3% and 100.00%.The SUVmax of patients with bone metastasis was(14.82±24.32),which was positively correlated with PSA level and Gleason score(r=0.442,0.372,P<0.001),respectively.The SUVmax of patients with recurrence in operation area was(24.38±26.54),which was positively correlated with PSA level and Gleason score(r=0.423,0.338,P<0.05),respectively.The SUVmax of patients with pelvic lymph node metastasis was(45.34±47.04),which was positively correlated with PSA level and Gleason score(r=0.423,0.316,P<0.05),respectively.At the same time,in these patients with BCR,the detection rate(100%)of recurrence or metastasis in patients with Gleason score≥8 was significantly higher than that in patients with Gleason score≤7(11/17,64.71%),and the difference was statistically significant(x2=6.502,P<0.05).There were significant differences in the detection rates among patients with 0.2 ng/ml≤PSA<0.5 ng/ml(6/10),patients with 0.5 ng/ml≤PSA<1 ng/ml(6/8),patients with 1 ng/ml≤PSA<2 ng/ml(12/12)and patients with PSA≥2 ng/ml(9/9)(x2=9.041,P<0.05).The AUC values of SUVmax for recurrence or metastasis in patients with low,medium and high-risk BCR were 0.708(95% CI:0.543-0.840,P＞0.05),0.780(95% CI:0.621-0.895,P<0.05)and 0.914(95% CI:0.781-0.979,P<0.001),respectively.The diagnostic efficiency of Al18F-PSMA-BCH on local recurrence and metastasis of patients with high-risk BCR was significantly better than that of patients with low-risk BCR(x2=8.986,P<0.05).In the 23 patients who underwent labeled scan with Al18F-PSMA-BCH,15 patients(65.22%)received the added treatment of local radiotherapy,systemic chemotherapy,endocrine therapy or pelvic lymph node dissection on the basis of the original treatment plan,which changed the treatment strategies.Conclusion:The labeled scan with Al18F-PSMA-BCH has higher early diagnostic value for BCR of patients with PCa,which will have a certain influence on the treatment strategy of patients.

Predicion of initial recurrence risk in papillary thyroid carcinoma based on the multi-parametric analysis from dual-layer detector spectral CT / 中华放射学杂志

Objective:To investigate the value of multi-parametric analysis based on dual-layer detector spectral CT (DLCT) in predicting the initial recurrence risk for papillary thyroid carcinoma (PTC).Methods:From November 2021 to October 2022, 102 PTC patients confirmed by pathology were retrospectively collected at the First Affiliated Hospital of Nanjing Medical University in this cross-sectional study. There were 25 males and 77 females, with an age of (42±13) years old. The initial recurrence risk assessment for PTC patients was categorized into a low-risk group (75 cases) and an intermediate-high-risk group (27 cases). Clinical data, including age, gender, body mass index, history of nodular goiter, history of Hashimoto thyroiditis, and preoperative thyroid function, were collected. Tumor morphological features, including size, location, shape, aspect ratio, the degree of thyroid capsule contact, calcification, and cystic change, were evaluated. Quantitative DLCT parameters, including iodine concentration (IC), standardized iodine concentration (NIC), effective atomic number (Z eff), standardized effective atomic number (NZ eff), electronic density (ED), CT values under different energy levels (40-200 keV, 30 keV intervals) and slope of energy spectrum curve (λ HU) both in the arterial and venous phase were measured. The differences in clinical, morphological features, and spectral CT quantitative parameters between the two groups were compared using independent sample ttest, Mann-Whitney U test, or χ2 test. Multivariate logistic regression analyses were used to construct three models based on clinical and morphological features, quantitative DLCT parameters and their combination, respectively. The receiver operating characteristic curve was used to evaluate the predictive performance of these models for the initial recurrence risk of PTC patients, and the area under the curve (AUC) was compared using the DeLong test. Results:Significant differences were found in gender, lesion long diameter, lesion short diameter and calcification between the low-risk group and intermediate-high-risk groups ( P<0.05). The arterial phase IC, arterial phase Z eff, arterial phase λ HU, arterial phase CT 40 keV, venous phase NIC and venous phase NZ eff in intermediate-high-risk group were significantly lower than those in the low-risk group ( P<0.05). The logistic regression analysis revealed that the clinical model included gender ( OR=2.895, 95% CI 1.047-8.002, P=0.040) and lesion long diameter ( OR=1.142, 95% CI 1.042-1.251, P=0.004), with an AUC of 0.720, sensitivity of 63.0%, and specificity of 78.7% in predicting the initial recurrence risk of PTC patients. The DLCT quantitative parameter model included arterial phase IC ( OR=0.580, 95% CI 0.370-0.908, P=0.017), venous phase NIC ( OR=0.077, 95% CI 0.011-0.536, P=0.010), and venous phase NZ eff ( OR=0.002, 95% CI 0.001-0.103, P=0.009), with an AUC of 0.774, sensitivity of 71.9%, and specificity of 70.0%. The AUC of the combined model was 0.857, with a sensitivity of 74.1%, and specificity of 88.0%, outperforming the clinical model ( Z=2.92, P=0.004) and the DLCT quantitative parameter model ( Z=2.07, P=0.046). Conclusion:Multi-parametric analysis based on DLCT can help predict the initial recurrence risk for PTC, and combining it with clinical and morphological features, the predictive accuracy can be improved.

Diagnostic performance and inter-observer consistency of prostate imaging recurrence reporting system in the detection of local recurrence after radical prostatectomy in patients with prostate cancer / 中华放射学杂志

Objective:To evaluate the diagnostic efficacy of prostate imaging recurrence reporting (PI-RR) system for detecting local recurrence after radical prostatectomy (RP) in prostate cancer (PCa) and to assess the consistency of the PI-RR scores assigned by different seniority radiologists.Methods:This study was a cross-sectional study. A total of 176 PCa patients who underwent multi-parametric MRI (mpMRI) for biochemical recurrence (BCR) after RP from July 2015 to October 2021 at the First Affiliated Hospital of Soochow University were retrospectively collected. The mpMRI images were reviewed and the PI-RR scores of the main lesions were assigned independently by six different seniority radiologists (2 junior, 2 senior and 2 expert radiologists). Following the reference standard determined by biopsy pathologic results, follow-up imaging, or prostate specific antigen levels, the patients were divided into two groups: 54 patients with local recurrence and 122 patients without local recurrence. The intraclass correlation coefficient ( ICC) and Kappa test were used to evaluate the consistency of the PI-RR scores by different seniority radiologists. The receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic efficacy of the PI-RR scores assessed by different seniority radiologists for detecting local recurrence of PCa after RP. The DeLong test was utilized to compare the areas under the ROC curve (AUC) of different seniority radiologist PI-RR scores and a false discovery rate (FDR) was applied to correct results using the Benjamini and Hochberg method. Sensitivity and specificity were calculated according to the cutoff value of PI-RR score≥3 or 4. Results:The ICC (95% CI) of all different seniority radiologists was 0.70 (0.64-0.76). The Kappa value was 0.528, 0.325 and 0.370 respectively between expert and senior radiologists, expert and junior radiologists, senior and junior radiologists. The AUC (95% CI) of junior, senior, and expert radiologists were separately 0.73 (0.65-0.81), 0.81 (0.74-0.88), and 0.86 (0.80-0.93). The AUC of the expert radiologist PI-RR score was higher than those of senior and junior radiologist PI-RR scores ( Z=2.22, 3.21, FDR P=0.039, 0.003). The PI-RR score of senior radiologist had higher AUC than that of junior radiologist ( Z=2.22, FDR P=0.026). With the PI-RR score of 3 or greater as a cutoff value, the sensitivity of junior, senior and expert radiologists were respectively 0.59, 0.65, and 0.78 and the specificity were 0.82, 0.93, and 0.95. With the PI-RR score of 4 or greater as a cutoff value, the sensitivity of junior, senior and expert radiologists were respectively 0.50, 0.54, and 0.69 and the specificity were 0.88, 0.96 and 0.97. Conclusion:PI-RR score can accurately diagnose local recurrence of PCa after RP. PI-RR score has a moderate inter-reader consistency across different seniority radiologists. And the diagnostic performance is influenced by the experience of radiologists.

Patterns of treatment failure after minimally invasive esophagectomy among patients with thoracic esophageal carcinoma: implications for value of adjuvant therapy / 中华放射肿瘤学杂志

Objective:To investigate the overall recurrence rate and the pattern of treatment failure in thoracic esophageal cancer (TEC) patients after minimally invasive esophagectomy (MIE), and to evaluate the significance of adjuvant therapy after MIE.Methods:Clinical data of TEC patients who underwent MIE with or without neoadjuvant chemotherapy in the Fourth Hospital of Hebei Medical University between 2016 and 2018 were retrospectively analyzed. The pathology-based lymph node metastasis (LNM) rate, overall recurrence rate, and pattern of treatment failure following MIE were analyzed by SPSS 26.0 statistical software. Cox regression model was used to identify the high-risk factors for recurrent disease. Propensity score matching was performed to compare the survival of patients between the postoperative radiotherapy group and non-radiotherapy group.Results:A total of 443 eligible patients were enrolled in this study, and the pathology-based LNM rate in all groups was 42.0%. The overall recurrence rate was 34.8%. Regional lymphatic metastasis was the most frequent pattern of recurrence (24.2%), followed by distant metastasis (19.4%). Multivariate Cox regression analysis identified pT 3-4 stage and pN + stage as the independent risk factors for recurrence. At the same time, the total number of lymph nodes dissected ≥12 and the number of lymph nodes dissected ≥7 in the neck clavicle and upper mediastinum could reduce the risk of tumor recurrence. The 1-, 3-, and 5-year disease-free survival (DFS) rates in the postoperative radiotherapy group and non-radiotherapy group were 83.5%, 66.8%, 60.7%, and 79.2%, 61.6%, 57.2%, respectively ( χ2=0.13, P=0.715). The 1-, 3-, and 5-year overall survival (OS) rates in two groups were 92.0%, 72.0%, 67.5% and 84.0%, 68.0%, 55.4% , respectively ( χ2=0.43, P=0.513). Conclusions:Regional lymphatic and distant metastases are the main patterns of recurrence for TEC patients after MIE with or without neoadjuvant chemotherapy. pT 3-4 stage, pN + stage, insufficient total number of lymph node dissection and insufficient number of lymph nodes in neck supraclavicular and upper mediastinal dissection are high-risk factors for postoperative recurrence. The survival rate in the postoperative radiotherapy group tends to be higher than that in the non-radiotherapy group. Adjuvant therapy, including postoperative radiotherapy, may remain necessary.