Placenta accreta spectrum in early and late pregnancy from an imaging perspective. A scoping review.

Placenta accreta spectrum (PAS) disorders (with increasing order of the depth of invasion: accreta, increta, percreta) are quite challenging for the purpose of diagnosis and treatment. Pathological examination or imaging evaluation are not very dependable when considered as stand-alone diagnostic tools. On the other hand, timely diagnosis is of great importance, as maternal and fetal mortality drastically increases if patient goes through the third phase of delivery in a not well-suited facility. A multidisciplinary approach for diagnosis (incorporating clinical, imaging, and pathological evaluation) is mandatory, particularly in complicated cases. For imaging evaluation, the diagnostic modality of choice in most scenarios is ultrasound (US) exam; patients are referred for MRI when US is equivocal, inconclusive, or not visualizing placenta properly. Herewith, we review the reported US and MRI features of PAS disorders (mainly focusing on MRI), going over the normal placental imaging and imaging pitfalls in each section, and lastly, covering the imaging findings of PAS disorders in the first trimester and cesarean section pregnancy (CSP).

El espectro de placenta acreta en la etapa temprana y final del embarazo. Un repaso a través de la imagen / Placenta Accreta Spectrum in Early and Late Pregnancy from an Imaging Perspective, A Scoping Review

Los trastornos del espectro de placenta acreta (EPA) (en orden ascendente en función de la profundidad de la invasión: acreta, increta y percreta) plantean un desafío diagnóstico y de tratamiento. El examen patológico o la evaluación por técnicas de diagnóstico por imagen no son muy fiables si se consideran como herramientas diagnósticas independientes. Sin embargo, un diagnóstico temprano es de gran importancia, ya que la mortalidad materna y fetal aumentan de forma drástica si la paciente se encuentra en unas instalaciones inadecuadas en la tercera fase del parto. Es imperativo adoptar un enfoque multidisciplinario para el diagnóstico (que incorpore la evaluación clínica, por imagen e histopatológica), en particular en los casos con complicaciones. Para la evaluación mediante imagen, la modalidad diagnóstica de preferencia en la mayoría de los escenarios es la exploración mediante ecografía; las pacientes son derivadas para la resonancia magnética (RM) cuando los resultados de la ecografía son ambiguos, no concluyentes o no permiten una visualización adecuada de la placenta. Este artículo repasa las características ecográficas y de RM de los trastornos del EPA (centrándonos principalmente en la RM), examinamos las imágenes placentarias normales y los puntos débiles de las técnicas de diagnóstico por imagen en cada sección. Por último, comentamos los hallazgos de imagen de los trastornos del EPA en el primer trimestre. Por ultimo comentaremos los hallazgos de imagen de los trastornos del EPA en el primer trimestre y en la cicatriz de cesárea anterior.(AU)

Placenta accreta spectrum (PAS) disorders (with increasing order of the depth of invasion: accreta, increta, percreta) are quite challenging for the purpose of diagnosis and treatment. Pathological examination or imaging evaluation are not very dependable when considered as stand-alone diagnostic tools. On the other hand, timely diagnosis is of great importance, as maternal and fetal mortality drastically increases if patient goes through the third phase of delivery in a not well-suited facility. A multidisciplinary approach for diagnosis (incorporating clinical, imaging, and pathological evaluation) is mandatory, particularly in complicated cases. For imaging evaluation, the diagnostic modality of choice in most scenarios is ultrasound (US) exam; patients are referred for MRI when US is equivocal, inconclusive, or not visualizing placenta properly. Herewith, we review the reported US and MRI features of PAS disorders (mainly focusing on MRI), going over the normal placental imaging and imaging pitfalls in each section, and lastly, covering the imaging findings of PAS disorders in the first trimester and cesarean section pregnancy (CSP).(AU)

Inter-observer variability in the histologic criteria of diagnosis of hydatidiform moles.

INTRODUCTION: In the event of encountering hydropic villi in products of conception specimens, pathologists will have to distinguish complete and partial hydatidiform mole (CHM & PHM) from hydropic abortion (HA). The histological diagnostic criteria are subjective and demonstrate considerable inter-observer variability. MATERIALS AND METHODS: This study evaluated the inter-observer variability in diagnosis of CHM, PHM and HA according to defined histologic criteria. Ninety abortus conception specimens were reviewed. Representative haematoxylin and eosin-stained slides were assigned independently to two pathologists who were asked to make a diagnosis of CHM, PHM or HA, and provide a report of the identified diagnostic histological criteria. Kappa value was calculated for the inter-observer agreement. RESULTS: There was a total of 36.7% disagreement between two pathologists (K = 0.403, Strength of Agreement = moderate), of which 24.4% and 12.2%, were differentiating PHM from CHM and PHM from HA, respectively. Among defined diagnostic histological criteria, the highest rate of agreement was observed in the identification of cistern formation and hydropic changes (K = 0.746 and 0.686 respectively, Strength of Agreement = substantial). CONCLUSION: There was moderate to substantial agreement rate between two pathologists in identification of two essential histologic criteria for diagnosis of molar pregnancies i.e. "hydropic change" and "trophoblastic proliferation".

Quality control in cervicovaginal cytology by cytohistological correlation.

OBJECTIVE: Frequent studies attest to the correlation of cytological interpretations with defined histopathological entities. Nevertheless, as part of quality control, cytology laboratories are required to compare Papanicolaou smear reports with those of cervical biopsies to search for discrepancies. We have attempted to determine and categorize the causes of existing discrepancies in our laboratory in order to clarify the source of errors. METHODS: We reviewed 670 cervical smears that were paired with subsequent punch biopsy or endocervical curettage samples, obtained within 2 months of the cytology, and found out that 60 smear-biopsy pairs were discrepant regarding the diagnosis. These cases were categorized into four error groups after careful re-evaluation of the original smear and biopsy slides. RESULTS: In 51 (85%) of 60 cervical smear-biopsy pairs with reports that disagreed, the initial diagnoses of both cervical smear and biopsy were confirmed by the review opinion; in these cases, cytology and biopsy 'sampling errors' were responsible for 40 and 11 instances of discrepancy, respectively. Seven cases (11.1%) were discrepant due to 'smear interpretation errors' and consisted of five cases with initial under-diagnosis and two cases with initial over-diagnosis. One case (1.7%) was due to 'screener error'. In another case, discordance was due to cervical 'biopsy interpretation error', with initial over-diagnosis as squamous intraepithelial lesion. CONCLUSION: In this retrospective study, we determined the causes of cytohistological discrepancies in cervical samples. The main explanation for discrepancy was 'sampling error'.

Comparison of Shear Bond Strength of Orthodontic Brackets Bonded to Enamel Prepared By Er:YAG Laser and Conventional Acid-Etching.

INTRODUCTION: The purpose of this study was to compare shear bond strength (SBS) of orthodontic brackets bonded to enamel prepared by Er:YAG laser with two different powers and conventional acid-etching. MATERIALS AND METHODS: Forty-five human premolars extracted for orthodontic purposes were randomly assigned to three groups based on conditioning method: Group 1- conventional etching with 37% phosphoric acid; Group 2- irradiation with Er:YAG laser at 1 W; and Group 3- irradiation with Er:YAG laser at 1.5 W. Metal brackets were bonded on prepared enamel using a light-cured composite. All groups were subjected to thermocycling process. Then, the specimens mounted in auto-cure acryle and shear bond strength were measured using a universal testing machine with a crosshead speed of 0.5 mm per second. After debonding, the amount of resin remaining on the teeth was determined using the adhesive remnant index (ARI) scored 1 to 5. One-way analysis of variance was used to compare shear bond strengths and the Kruskal-Wallis test was performed to evaluate differences in the ARI for different etching types. RESULTS: The mean and standard deviation of conventional acid-etch group, 1W laser group and 1.5W laser group was 3.82 ± 1.16, 6.97 ± 3.64 and 6.93 ± 4.87, respectively. CONCLUSION: The mean SBS obtained with an Er:YAG laser operated at 1W or 1.5W is approximately similar to that of conventional etching. However, the high variability of values in bond strength of irradiated enamel should be considered to find the appropriate parameters for applying Er:YAG laser as a favorable alternative for surface conditioning.