EP31.07: Preoperative staging of deep endometriosis with volume ultrasound

Introduction Raltitrexed is a folate analogue, which selectively inhibits thymidylate synthase, used in the treatment of colorectal carcinoma. Common side effects include asthenia and gastrointestinal and haematological toxicities. Case report We present the case of a 74-year-old gentleman with incidental mild interstitial lung disease on preoperative staging CT Chest who developed acute breathlessness whilst undergoing adjuvant raltitrexed treatment for a completely excised colorectal adenocarcinoma. Management and outcome Discontinuation of raltitrexed and a course of steroid therapy resulted in resolution of symptoms, mirrored by an improvement in lung function tests. Discussion The clinical pattern of rapid progression with steroid response highlights the potential for significant acceleration of interstitial lung disease by raltitrexed.

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TIRADS, SRE and SWE in INDETERMINATE thyroid nodule characterization: Which has better diagnostic performance?

La radiologia medica ◽

10.1007/s11547-021-01349-5 ◽

2021 ◽

Author(s):

Ilaria Celletti ◽

Daniele Fresilli ◽

Corrado De Vito ◽

Marco Bononi ◽

Sara Cardaccio ◽

...

Keyword(s):

Thyroid Nodule ◽

Preoperative Staging ◽

Shear Wave Elastography ◽

Roc Curves ◽

Strain Ratio ◽

Multicenter Studies ◽

Increased Sensitivity ◽

Bonferroni Test ◽

Indeterminate Cytology ◽

Sensitivity Specificity

Abstract Purpose To assess Strain Ratio (SRE) and Shear Wave Elastography (SWE) accuracy alone and with TIRADS classification, for the risk stratification of indeterminate thyroid nodules. Materials and methods 128 Patients with 128 indeterminate nodules candidates for thyroidectomy underwent preoperative staging neck ultrasound and were classified according to K-TIRADS score. After TIRADS evaluation, semi-quantitative (SRE) and quantitative (SWE expressed in kPa) elastosonography were performed and relative diagnostic performances, alone and in combination, were compared through ROC curves analysis. In order to maximize the SRE and SWE sensitivity and specificity, their cut-off values were calculated using the Liu test. Bonferroni test was used to evaluate statistically significant differences with a p value < 0.05. Results Sensitivity, specificity, PPV and NPV were, respectively, 71.4%, 82.4%, 62.5%, 87.5% for K-TIRADS baseline US, 85.7%, 94.1%, 85.7%, 94.1% for SRE and 57.1%, 79.4%, 53.3%, 81.8% for SWE (kPa expressed). SRE evaluation showed the best diagnostic accuracy compared to the SWE (kPa expressed) (p < 0.05) and to the K-TIRADS (p > 0.05). The association of SRE with conventional ultrasound with K-TIRADS score increased sensitivity (92.9% vs 71.4%) but decreased the specificity than conventional US alone (76.5% vs 82.4%). Conclusion Strain Elastosonography can be associated with K-TIRADS US examination in the thyroid nodule characterization with indeterminate cytology; in fact, adding the SRE to K-TIRADS assessment significantly increases its sensitivity and negative predictive value. However, further multicenter studies on larger population are warranted.

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Ultrasonographic 3D Evaluation in the Diagnosis of Bladder Endometriosis: A Prospective Comparative Diagnostic Accuracy Study

Gynecologic and Obstetric Investigation ◽

10.1159/000516634 ◽

2021 ◽

pp. 1-8

Author(s):

Fabio Barra ◽

Franco Alessandri ◽

Carolina Scala ◽

Simone Ferrero

Keyword(s):

Diagnostic Accuracy ◽

Three Dimensional ◽

3D Ultrasound ◽

Diagnostic Accuracy Study ◽

Extensive Experience ◽

Deep Endometriosis ◽

3D Reconstructions ◽

Analysis Group ◽

Bladder Endometriosis ◽

Accuracy Study

Objective: The use of three-dimensional (3D) transvaginal ultrasonography (TVS) has been investigated for the diagnosis of deep endometriosis (DE). This study aimed to evaluate if 3D reconstructions improve the performance of TVS) in assessing the presence and characteristics of bladder endometriosis (BE). Design: This was a single-center comparative diagnostic accuracy study. Participants/Materials, Setting, Methods: Patients referred to our institution (Piazza della Vittoria 14 Srl, Genova, Italy) with clinical suspicion of DE were included. In case of surgery, women underwent systematic preoperative ultrasonographic imaging; an experienced sonographer performed a conventional TVS; another experienced sonographer, blinded to results of the previous exam, performed TVS, with the addition of 3D modality. The presence and characteristics of BE nodules were described in accord with International DE Analysis group consensus. Ultrasound data were compared with surgical and histological results. Results: Overall, BE was intraoperatively found in 34 out of 194 women who underwent surgery for DE (17.5%; 95% confidence interval: 12.8–23.5%). TVS without and with 3D reconstructions were able to detect endometriotic BE in 82.2% (n = 28/34) and 85.3% (n = 29/34) of the cases (p = 0.125). Both the exams similarly estimated the largest diameter of BE (p = 0.652) and the distance between the endometriotic nodule and the closest ureteral meatus (p = 0.341). However, TVS with 3D reconstructions was more precise in estimating the volume of BE (p = 0.031). In one case (2.9%), TVS without and with 3D reconstructions detected the infiltration of the intramural ureter, which was confirmed at surgery and required laparoscopic ureterovesical reimplantation. Limitations: The extensive experience of the gynecologists performing the ultrasonographic scans, the lack of prestudy power analysis, and the population selected, which may have been influenced by the position of the institution as a referral center specialized in the treatment of severe endometriosis, are limitations of the current study. Conclusion: Our results demonstrated the high accuracy of ultrasound for diagnosing BE. The addition of 3D reconstructions does not improve the performance of TVS in diagnosing the presence and characteristics of BE. However, the volume of BE may be more precisely assessed by 3D ultrasound.

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Monotonic Functions Method and Its Application to Staging of Patients with Prostate Cancer According to Pretreatment Data

Applied Sciences ◽

10.3390/app11093836 ◽

2021 ◽

Vol 11 (9) ◽

pp. 3836

Author(s):

Valeri Gitis ◽

Alexander Derendyaev ◽

Konstantin Petrov ◽

Eugene Yurkov ◽

Sergey Pirogov ◽

...

Keyword(s):

Prostate Cancer ◽

Learning Algorithm ◽

Binary Classification ◽

Preoperative Staging ◽

Threshold Value ◽

Logical Function ◽

Adequate Treatment ◽

Monotonic Functions ◽

Selection Of

Prostate cancer is the second most frequent malignancy (after lung cancer). Preoperative staging of PCa is the basis for the selection of adequate treatment tactics. In particular, an urgent problem is the classification of indolent and aggressive forms of PCa in patients with the initial stages of the tumor process. To solve this problem, we propose to use a new binary classification machine-learning method. The proposed method of monotonic functions uses a model in which the disease’s form is determined by the severity of the patient’s condition. It is assumed that the patient’s condition is the easier, the less the deviation of the indicators from the normal values inherent in healthy people. This assumption means that the severity (form) of the disease can be represented by monotonic functions from the values of the deviation of the patient’s indicators beyond the normal range. The method is used to solve the problem of classifying patients with indolent and aggressive forms of prostate cancer according to pretreatment data. The learning algorithm is nonparametric. At the same time, it allows an explanation of the classification results in the form of a logical function. To do this, you should indicate to the algorithm either the threshold value of the probability of successful classification of patients with an indolent form of PCa, or the threshold value of the probability of misclassification of patients with an aggressive form of PCa disease. The examples of logical rules given in the article show that they are quite simple and can be easily interpreted in terms of preoperative indicators of the form of the disease.

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