Transformation From Atypical to Anaplastic Metastatic Meningioma: Evolutionary Turning Point Marked by Strong 18 F-FDG Avidity and Uptake Collapse From 68 GA-DOTATOC.

ABSTRACT: World Health Organization (WHO) grade III anaplastic meningioma is scarce. In this way, most studies compared WHO grade I and II. Otherwise, some authors are uncertain about using 18 F-FDG as a diagnostic tool to estimate the WHO grade, especially high. We report the case from a man with a grading tumor evolution from WHO grade II atypical to grade III anaplastic metastatic meningioma. This turning point was imaged using 68 Ga-DOTATOC and 18 F-FDG. Diagnostic was confirmed by histology. The case underlines the unparalleled power of molecular imaging characterized by high sensitivity staging and spectacular avidity changing relationship with grading tumor evolution.

An artificial intelligence based on a convolutional neural network allows a precise analysis of the alignment of the lower limb.

PURPOSE: The objective of this study was to develop a numeric tool to automate the analysis of deformity from lower limb telemetry and assess its accuracy. Our hypothesis was that artificial intelligence (AI) algorithm would be able to determine mechanical and anatomical angles to within 1°. METHODS: After institutional review board approval, 1175 anonymized patient telemetries were extracted from a database of more than ten thousand telemetries. From this selection, 31 packs of telemetries were composed and sent to 11 orthopaedic surgeons for analysis. Each surgeon had to identify on the telemetries fourteen landmarks allowing determination of the following four angles: hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and joint line convergence angle (JLCA). An algorithm based on a machine learning process was trained on our database to automatically determine angles. The reliability of the algorithm was evaluated by calculating the difference of determination precision between the surgeons and the algorithm. RESULTS: The analysis time for obtaining 28 points and 8 angles per image was 48 ± 12 s for the algorithm. The average difference between the angles measured by the surgeons and the algorithm was around 1.9° for all the angles of interest: 1.3° for HKA, 1.6° for MPTA, 2.1° for LDFA, and 2.4° for JLCA. Intraclass correlation was greater than 95% for all angles. CONCLUSION: The algorithm showed high accuracy for automated angle measurement, allowing the estimation of limb frontal alignment to the nearest degree.

Intraoperative touch imprint cytology of axillary sentinel nodes for breast cancer: a series of 355 procedures.

AIMS: Our objective was to evaluate intraoperative sentinel node touch imprint cytology (IOSNTI) for breast cancer. Three hundred and fifty-five patients with invasive breast cancer (pT1N0, lobular or ductal subtype) were included in our study. IOSNTI consists of touching glass slides to the surfaces of interest after gently pressing the spatially localized specimen, taken according to predetermined conditions, in order to perform a final histological examination consisting of H&E and immunohistochemical staining. RESULTS: The total sensitivity (Se) of IOSNTI was 36% and 15% of patients with nodal metastasis went undetected during the intraoperative examination. Sensitivity was significantly lower for the oldest patients (aged over 57 years: 25%), small tumors (smaller than 12 mm: 23.3%), lobular subtypes (8.3%), in the absence of vascular emboli (33%) and for detection of micrometastases (10%). DISCUSSION: This simple, fast and relatively inexpensive method could be combined with intraoperative molecular biology methods in populations in which cytology is less efficient and produces negative results.

Intra-operative touch preparation cytology following lumpectomy for breast cancer: a series of 400 procedures.

AIMS: Achieving negative margins is essential in conservative treatment for breast cancer. The conventional method for intra-operative assessment of resection margins is gross or histological examination of frozen sections. We describe and evaluate the contribution of an original intra-operative touch preparation cytology (IOTPC) technique (400 procedures) performed on 396 patients. MATERIALS AND METHODS: IOTPC consists of touching glass slides to the surfaces of interest after gently pressing the spatially localized specimen taken according to predetermined conditions. The result is conveyed to the surgeon immediately and compared with the conventional histological findings after embedding in paraffin. RESULTS: The average response time is 10min, which renders the technique compatible with standard operating room procedures and its cost is reasonable. The method has a sensitivity of 88.6%, specificity of 92.2%, positive predictive value of 73.6%, negative predictive value of 97%, and correlation with paraffin section histology of 91.5%. Only 5 true false negatives were found in this series and the technique prevented 11.75% of secondary re-excision procedures for positive margins. CONCLUSION: IOTPC is a reliable extemporaneous method for assessing surgical margins in conservative treatment for breast cancer and a useful tool for surgeons.