Emerging technology for intraoperative margin assessment and post-operative tissue diagnosis for breast-conserving surgery.

INTRODUCTION: Tissue-preserving surgery is utilized progressively in cancer therapy, where a clear surgical margin is critical to avoid cancer recurrence, specifically in breast cancer (BC) surgery. The Intraoperative pathologic approaches that rely on tissue segmenting and staining have been recognized as the ground truth for BC diagnosis. Nevertheless, these methods are constrained by its complication and timewasting for tissue preparation. OBJECTIVE: We present a non-invasive optical imaging system incorporating a hyperspectral (HS) camera to discriminate between cancerous and non-cancerous tissues in ex-vivo breast specimens, which could be an intraoperative diagnostic technique to aid surgeons during surgery and later a valuable tool to assist pathologists. METHODS: We have established a hyperspectral Imaging (HSI) system comprising a push-broom HS camera at wavelength 380∼1050 nm with source light 390∼980 nm. We have measured the investigated samples' diffuse reflectance (Rd), fixed on slides from 30 distinct patients incorporating mutually normal and ductal carcinoma tissue. The samples were divided into two groups, stained tissues during the surgery (control group) and unstained samples (test group), both captured with the HSI system in the visible and near-infrared (VIS-NIR) range. Then, to address the problem of the spectral nonuniformity of the illumination device and the influence of the dark current, the radiance data were normalized to yield the radiance of the specimen and neutralize the intensity effect to focus on the spectral reflectance shift for each tissue. The selection of the threshold window from the measured Rd is carried out by exploiting the statistical analysis by calculating each region's mean and standard deviation. Afterward, we selected the optimum spectral images from the HS data cube to apply a custom K-means algorithm and contour delineation to identify the regular districts from the BC regions. RESULTS: We noticed that the measured spectral Rd for the malignant tissues of the investigated case studies versus the reference source light varies regarding the cancer stage, as sometimes the Rd is higher for the tumor or vice versa for the normal tissue. Later, from the analysis of the whole samples, we found that the most appropriate wavelength for the BC tissues was 447 nm, which was highly reflected versus the normal tissue. However, the most convenient one for the normal tissue was at 545 nm with high reflection versus the BC tissue. Finally, we implement a moving average filter for noise reduction and a custom K-means clustering algorithm on the selected two spectral images (447, 551 nm) to identify the various regions and effectively-identified spectral tissue variations with a sensitivity of 98.95%, and specificity of 98.44%. A pathologist later confirmed these outcomes as the ground truth for the tissue sample investigations. CONCLUSIONS: The proposed system could help the surgeon and the pathologist identify the cancerous tissue margins from the non-cancerous tissue with a non-invasive, rapid, and minimum time method achieving high sensitivity up to 98.95%.

Correlation of Renal Scarring to Urinary Tract Infections and Vesicoureteral Reflux in Children.

Objective: To study the association of the grade of vesicoureteral reflux (VUR) and urinary tract infections (UTI) with renal scarring at the first clinical presentation of patients who underwent antireflux surgery. Materials and methods. Between 2015 and 2020, 150 patients (194 units) who underwent antireflux surgery had dimercaptosuccinic acid (DMSA) renal scans preoperatively. Patients were classified into the nonscar and scar groups according to DMSA scan results. Moreover, cases were classified into afebrile UTI, febrile UTI, and antenatal hydronephrosis (ANH) according to the mode of presentation. We correlated the mode of presentation and the grade of VUR to the presence/absence of renal scars in both groups. Results: The mean follow-up was 45 months preoperatively. The mode of presentation was afebrile, febrile UTIs, and antenatal hydronephrosis in (50, 14), (20, 46), and (10, 10) patients in the nonscar and scar groups, respectively. Of the 20 patients who presented ANH, 10 (50%) had scars. Clinical presentation was correlated to the presence of renal scarring and its degree. The scar group had significantly higher grades of VUR than the nonscar group (grades I-II (50 units versus 10 units), grade III (28 units versus 40 units), and grade IV-V (22 units versus 44 units) for the nonscar versus scar groups, respectively (pvalue <0.001). Conclusion: Renal scarring is associated with higher grades of reflux and urinary tract infections. We advocate further research investigating infants who had UTIs with or without fever for early detection of reflux.

Severe colic mimicking intussusception: a new phenomenon.

OBJECTIVE: To highlight a new phenomenon that we have encountered in children during the past 5 years. Children in this group have a pathognomonic clinical picture of sudden acute severe abdominal colic during which the child is continuously screaming for 1-2 min. All these patients were initially diagnosed on clinical and ultrasonographic grounds as acute intussusception. Careful interpretation of the radiological findings revealed faecal impaction of the terminal ileum and caecum. DESIGN: This is a retrospective study looking at children presenting between 2009 and 2014 with acute severe abdominal colic pain. These were 11 patients aged 9 months to 5 years. We reviewed our experience in the management and diagnosis of these patients. RESULT: All patients were diagnosed initially as intussusception, which was confirmed by ultrasonography (US). US revealed an appearance mimicking intussusception, 3 cases of which were intermittent. This US appearance proved to be a hard stool filling the terminal ileum. In all patients, abdominal X-ray revealed stool at the right side of the colon filling the caecum. Diagnostic gastrografin enemas that were performed in four patients excluded intussusception and confirmed stool at the caecum and ascending colon. In none of those patients had contrast passed into the terminal ileum. There was dramatic response to fleet and/or gastrografin enemas. Five patients required a second dose of enema and two patients required three doses. CONCLUSIONS: We highlight a new phenomenon of severe abdominal pain caused by faecal impaction of the terminal ileum and caecum. Increased awareness of this condition helps to avoid unnecessary investigations and/or surgical exploration.