The Application of Artificial Intelligence-Assisted Colposcopy in a Tertiary Care Hospital within a Cervical Pathology Diagnostic Unit.

The rising global incidence of cervical cancer is estimated to have affected more than 600,000 women, and nearly 350,000 women are predicted to have died from the disease in 2020 alone. Novel advances in cancer prevention, screening, diagnosis and treatment have all but reduced the burden of cervical cancer in developed nations. Unfortunately, cervical cancer is still the number one gynecological cancer globally. A limiting factor in managing cervical cancer globally is access to healthcare systems and trained medical personnel. Any methodology or procedure that may simplify or assist cervical cancer screening is desirable. Herein, we assess the use of artificial intelligence (AI)-assisted colposcopy in a tertiary hospital cervical diagnostic pathology unit. The study group consisted of 48 women (mean age 34) who were referred to the clinic for a routine colposcopy by their gynecologist. Cervical images were taken by an EVA-Visualcheck TM colposcope and run through an AI algorithm that gave real-time binary results of the cervical images as being either normal or abnormal. The primary endpoint of the study assessed the AI algorithm's ability to correctly identify histopathology results of CIN2+ as being abnormal. A secondary endpoint was a comparison between the AI algorithm and the clinical assessment results. Overall, we saw lower sensitivity of AI (66.7%; 12/18) compared with the clinical assessment (100%; 18/18), and histopathology results as the gold standard. The positive predictive value (PPV) was comparable between AI (42.9%; 12/28) and the clinical assessment (41.8%; 18/43). The specificity, however, was higher in the AI algorithm (46.7%; 14/30) compared to the clinical assessment (16.7%; 5/30). Comparing the congruence between the AI algorithm and histopathology results showed agreement 54.2% of the time and disagreement 45.8% of the time. A trained colposcopist was in agreement 47.9% and disagreement 52.1% of the time. Assessing these results, there is currently no added benefit of using the AI algorithm as a tool of speeding up diagnosis. However, given the steady improvements in the AI field, we believe that AI-assisted colposcopy may be of use in the future.

Endoscopic approach in diagnosis and treatment of biliary complications after laparoscopic cholecystectomy.

BACKGROUND/AIMS: The aim of this retrospective study is to follow the main parameters such as the success of performing diagnostic endoscopic retrograde cholangiopancreatography (ERCP) and to determine the effectiveness and morbidity of therapeutic ERCP. METHODOLOGY: The study of the group took 12 years (January 1997-December 2008). The paper assesses in retrospect 138 patients who underwent laparoscopic cholecystectomy (LCE). Signs leading to the suspicion of possible biliary complications (BC) after previous LCE appeared in these patients in the postoperative period, indicating the performance of ERCP. RESULTS: Diagnostic ERCP was successful in all 138 patients (i.e. in 100% of cases). There were normal ERCP results in 8 patients and pathological results in the sense of some of the BC in the remaining 130 patients. Endoscopic therapy was performed after diagnostic ERCP in 115 of 130 patients with proved BC. Therapeutic ERCP was absolutely successful in altogether 111 of 130 patients (85.38%) with BC after LCE. CONCLUSIONS: The success rate of therapeutic ERCP in our group was 85.38%. Morbidity in relation to therapeutic ERCP was 4.2%. ERCP appears to be highly effective diagnostic and primarily therapeutic method in solving BC after LCE.

[Gallstone ileus--the diagnostic and therapeutic challenge]. / Biliární ileus--diagnostická i terapeutická výzva.

Gallstone ileus as a complication of gallstone disease is a diagnostic as well as therapeutic challenge. Its development is frequently sneaking, so correct diagnosis and surgical therapy is often delayed. Thus morbidity and mortality is high. Concrement extraction by open enterotomy is a therapeutic choice. The discussed issue is if one-stage cholecystectomy and fistula closure should be done too. The paper presents a female patient with gallstone ileus treated with open enterotomy only, with no postoperative complication. The literature review follows. Authors conclude that one-stage procedure, if feasible, is acceptable method for the low risk patients.