Improvement prostate cancer detection rate of suspicious lesions through MRI/TRUS fusion guided biopsy by a multiteam of radiologists

Background The objective of our study was to analyze the data of our biopsies, determine a detection rate (DR), compare it with the data in the literature and draw possible deductions, so as to offer the patient the possibility of not having other biopsies in the future. Methods We have enrolled 189 biopsy-naive patients in the period between September 2018 and December 2020. Each patient underwent multiparametric (mp)-MRI which was reviewed by our team of radiologists. In our center, each examination is examined by 4 radiologists separately with an overall final result. Through the t student test, any statistically significant differences between the DRs and the concordance rate between the positive cores and the suspected area on MRI were analyzed for each urologist who performed the procedure. Results The absolute (DR) was 69.3% (131/189 patients). The relative DR for each PIRADS score was 41% for PIRADS 3, 70.2% for PIRADS 4, 89.3% for PIRADS 5. We found a high percentage of agreement between the positive biopsy samples and the suspicious area identified on MRI: 90.8% (119/131 patients). There were no statistically significant differences between the DRs of the urologists who performed the procedure (p = 0.89), nor for the percentage of agreement between the positivity of the core and the suspected area on MRI (p = 0.92). Conclusions MRI in the future could become the gold standard for performing MRI fusion-guided biopsies to have a better diagnostic result and avoid rebiopsies. A team MRI reading allows greater accuracy in identifying the suspected lesion, which is demonstrated by a high rate of agreement with the positivity of the cores (90.8%). There is a cost problem due to the need to carry out the mpMRI but it could have less impact in the future. In addition, the MRI provides useful information on the extent of the disease (e.g., cT3a/b) which allows you to better plan the surgical strategy or other therapies.

Texture and Color Enhancement Imaging Increases Color Changes and Improves Visibility for Squamous Cell Carcinoma Suspicious Lesions in the Pharynx and Esophagus

Texture and color enhancement imaging (TXI) has been developed as an image-enhanced endoscopy technology. TXI mode2 enhances texture and brightness, and TXI mode1 also enhances color. This study aims to assess the color differences in squamous cell carcinoma (SCC) suspicious lesions in the pharynx and esophagus using white light imaging (WLI), TXI mode1, TXI mode2, and narrow-band imaging (NBI). A total of 59 SCC suspicious lesions from 30 patients were analyzed. The color differences (ΔE) between the lesion and the surrounding mucosa were calculated for each modality. The color value was assessed using the Commission Internationale d’Eclairage L*a*b* color space. The visibility of the lesion in each modality was evaluated and compared to that in the WLI by six endoscopists. The mean ΔE values in the WLI, TXI mode1, TXI mode2, and NBI were 11.6; 18.6; 14.3; and 17.2, respectively, and the ΔE values of TXI mode1, TXI mode2, and NBI were significantly higher than those of the WLI (p < 0.001). No lesions had worse visibility, and 62.5% (37/59) had improved visibility, as assessed by more than half of the endoscopists in TXI mode1. TXI mode1 can enhance color changes and improve the visibility of SCC suspicious lesions in the pharynx and esophagus, compared to WLI.

Virtual Biopsy by Electrical Impedance Spectroscopy in Barrett’s Carcinoma

Purpose Early detection of adenocarcinomas in the esophagus is crucial for achieving curative endoscopic therapy. Targeted biopsies of suspicious lesions, as well as four-quadrant biopsies, represent the current diagnostic standard. However, this procedure is time-consuming, cost-intensive, and examiner-dependent. The aim of this study was to test whether impedance spectroscopy is capable of distinguishing between healthy, premalignant, and malignant lesions. An ex vivo measurement method was developed to examine esophageal lesions using impedance spectroscopy immediately after endoscopic resection. Methods After endoscopic resection of suspicious lesions in the esophagus, impedance measurements were performed on resected cork-covered tissue using a measuring head that was developed, with eight gold electrodes, over 10 different measurement settings and with frequencies from 100 Hz to 1 MHz. Results A total of 105 measurements were performed in 60 patients. A dataset of 400 per investigation and a total of more than 42,000 impedance measurements were therefore collected. Electrical impedance spectroscopy (EIS) was able to detect dysplastic esophageal mucosa with a sensitivity of 81% in Barrett’s esophagus. Conclusion In summary, EIS was able to distinguish different tissue characteristics in the different esophageal tissues. EIS thus holds potential for further development of targeted biopsies during surveillance endoscopy. Trial Registration NCT04046601

853 Post-BCG Surveillance – General Anesthetic Rigid Cystoscopy in Intermediate/High-Risk Bladder Cancer. A Quality Improvement Project Done at A District General Hospital in South-East England

Aim High/ intermediate risk bladder cancer is treated with BCG immunotherapy and cystoscopy surveillance is the standard of care. Performing a General Anesthetic Rigid Cystoscopy (GARC) enables resection or sampling of suspicious lesions. We aim to evaluate its benefits while the alternative is Local Anesthetic Flexible Cystoscopy (LAFC). Method A retrospective analysis of patients that underwent rigid cystoscopy under GA over 2 years from January 2018-December 2019, post induction & maintenance cycles of BCG following primary TURBT. Overall inference (cystoscopy outcomes) was based on intra-operative findings, BCG cycle, suspicious lesions, recurrence/disease progression based on histology. Results A total of 53 patients had 114 procedures. Mean age of 72.29±8.98. 14 inpatient admissions due to GA/procedural complications or social reasons. 58.2% of patients primarily had G3T1 disease, 22.6% G2, 14.3% G1 & 4.9% had primary CIS. T1 & Ta disease were 42% & 43% respectively. GA cystoscopy showed normal findings in 57.1%, 33.33% suspicious lesions & 9.6% visible recurrence. 88% suspicious lesions upon biopsy showed benign findings on histology and only 12% malignant. 24% of lesions thought to be recurrence showed benign findings on histology, 56% as G3T1 disease and 20% as G3Ta disease. No one had stage progression and 3 patients had grade progression. Sub-analysis of various stages and grades showed an average of about 10% malignant findings only. Conclusions LAFC as first line for post-BCG surveillance can be recommended which aim to prevent GA complications, extra admissions, overall cost reduction in management of bladder cancers and GARC can be reserved for second line

Spectral CT Hybrid Images in the Diagnostic Evaluation of Hypervascular Abdominal Tumors—Potential Advantages in Clinical Routine

Background: This study aimed to investigate the use of spectral computed tomography (SCT) hybrid images combining virtual monoenergetic images (VMIs) and iodine maps (IMs) as a potentially efficient search series for routine clinical imaging in patients with hypervascular abdominal tumors. Methods: A total of 69 patients with hypervascular abdominal tumors including neuroendocrine neoplasms (NENs, n = 48), renal cell carcinoma (RCC, n = 10), and primary hepatocellular carcinoma (HCC, n = 11) were analyzed retrospectively. Two radiological readers (blinded to clinical data) read three CT image sets (1st a reference set with 70 keV; 2nd a 50:50 hybrid 140 keV/40 keV set; 3rd a 50:50 hybrid140 keV/IM set). They assessed images subjectively by rating several parameters including image contrast, visibility of suspicious lesions, and diagnostic confidence on five-point Likert scales. In addition, reading time was estimated. Results: Median subjective Likert scores were highest for the 1st set, except for image contrast, for which the 2nd set was rated highest. Scores for diagnostic confidence, artifacts, noise, and visibility of suspicious lesions or small structures were significantly higher for the 1st set than for the 2nd or 3rd set (p < 0.001). Regarding image contrast, the 2nd set was rated significantly higher than the 3rd set (p < 0.001), while the median did not differ significantly compared with the 1st set. Agreement between the two readers was high for all sets. Estimated potential reading time was the same for hybrid and reference sets. Conclusions: Hybrid images have the potential to efficiently exploit the additional information provided by SCT in patients with hypervascular abdominal tumors. However, the use of rigid weighting did not significantly improve diagnostic performance in this study.

Dermatoscopic Features of Naevi During Pregnancy—A Mini Review

Changes in melanocytic naevi and development of new naevi have been reported in pregnant women. The association between pregnancy and melanoma is a controversial topic. We conducted this review to identify the dermatoscopic changes that occur in naevi during pregnancy that could facilitate in distinguishing benign from suspicious lesions. Medline, Scopus, and Embase datasets were reviewed for clinical studies on dermatoscopic characteristics of melanoma and naevus in pregnancy. Six cohort studies with a total of 258 patients with 1,167 skin lesions that were examined fulfilled the conditions to be included in the review. None of the patients developed melanoma. Development of new naevi, when reported, was observed in less than half of the participants. The most frequent observed dermatoscopic change among the studies was the increase in the number of dots. Development of new vessels, hypo- and hyperpigmentations and changes in the pigment network were common described changes. The included studies were heterogeneous not allowing head-to-head comparisons between them. Robust and larger studies of dermatoscopic evaluation of naevi in pregnant women are needed to determine high-risk dermatoscopic characteristics.

Ancillary considerations in breast surgery

Debated topics and new and evolving techniques in breast surgery are discussed in this chapter. Antibiotics and the use of closed-suction drains vary among surgeons, but the existing evidence favours discontinuation of antibiotics within 24 hours in most cases, and the indications for drains are limited but include breast reconstruction with acellular dermal matrix (ADM). ADM is a biological tissue substitute with many applications in breast surgery. The product selected and surgical technique used are often case specific; cost and patient anatomy play major roles. Although not suitable for all patients, ADM is an asset to prosthetic breast reconstruction. In addition, ADM is useful in the correction of breast surgery complications, including malpositioning and capsular contracture. It may be combined with fat grafting to mask rippling. Fat grafting, or lipomodelling, is an evolving science with promising results. Technique is critical for good results, and is described in this chapter. Radiographic changes after fat grafting are usually discernible from suspicious lesions, and growing evidence supports the oncological safety of this procedure

Renal cell carcinoma in native nephrectomy specimens of autosomal dominant polycystic kidney disease (ADPKD) patients with end-stage renal disease: Findings from an Australian transplant center

Objectives: The aim of this study was to present a contemporary review of renal cell carcinoma (RCC) in native nephrectomy (NN) specimens of patients with autosomal dominant polycystic kidney disease (ADPKD) and end-stage renal disease (ESRD). Materials (patients) and methods: A retrospective review of all ADPKD patients who underwent NN from 1 October 2010 to 31 July 2019 was performed. Data was collected on demographics, length of time on renal replacement therapy, indications for surgery, perioperative details, and histology. Results: In total, 32 NNs were performed in our study period with 12.5% ( n=4) histologically diagnosed with RCC, consisting of 75% ( n=3) Type 1 papillary RCC (p RCC) and 25% ( n=1) clear cell RCC. Average age of ADPKD patients with ESRD diagnosed with RCC was 67±5.9 years. Average time on dialysis for RCC and non-RCC patients was 35.75±46.28 and 22.04±24.33 months, respectively. We did not find a significant correlation between the diagnosis of RCC and time on dialysis. Conclusion: Our contemporary series shows a significant proportion of ADPKD patients with ESRD undergoing NN have RCC. Compared to previously published datasets, our patients are older, and selective to those with very large kidneys and lesions suspicious for RCC. While there may be a role in imaging native kidneys with ADPKD to rule out suspicious lesions, it must be balanced against the cost, radiation exposure, and potential harm from an increased rate of nephrectomy that may ensue for suspicious lesions found on screening. Level of evidence: Not applicable for this multicentre audit.