Radical orchidectomy for suspected testicular cancer: Is preoperative staging computed tomography justified?

2020 ◽  
pp. 205141582098315
Author(s):  
Christopher T Berridge ◽  
Sophie Stanley ◽  
Arumugam Rajesh ◽  
TR Leyshon Griffiths
Keyword(s):  
Computed Tomography ◽  
Tumour Size ◽  
Preoperative Staging ◽  
Standard Of Care ◽  
Tumour Markers ◽  
Testicular Tumour ◽  
Level Of Evidence ◽  
Benign Pathology ◽  
Benign Histology ◽  
Unnecessary Radiation

The standard of care for men with a suspected malignant testicular tumour and normal contralateral testis is radical orchidectomy, testicular tumour markers and computed tomography scan staging. If the definitive orchidectomy histopathology is benign, young men are potentially exposed to unnecessary radiation. We sought to establish the rate of benign pathology returned from radical orchidectomy at our local urology multidisciplinary team (MDT) and if there were any preoperative factors suggestive of benign lesions. We included patients discussed at our local MDT meeting regarding testicular tumours with histology following radical orchidectomy between 1 January 2016 and 31 December 2018. A total of 113 patients were included, with benign histology following radical orchidectomy in seven (6.2%) patients. The benign histology included one adenomatoid tumour, and the remainder showed features of either infarction or inflammation. Metastases were detected on staging imaging in 21% of patients. Of these, 64% had normal preoperative tumour markers. Neither tumour size nor number of preoperative ultrasounds correlated with a risk of benign histology. One patient had chemotherapy prior to orchidectomy. It was reassuring that just 6.2% of patients had benign histology with no significant factors predictive of benign histology. This supports pre-orchidectomy staging imaging and the current MDT pathway for suspected testicular cancers. Level of evidence: Level 2C.

scholarly journals Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711879074 ◽  
Author(s):  
Robert C. Spang ◽  
Daniel B. Haber ◽  
Brendin R. Beaulieu-Jones ◽  
Kristen L. Stupay ◽  
George Sanchez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
National Football League ◽  
Treatment Method ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Specific Performance ◽  
Incomplete Healing ◽  
Bony Healing ◽  
The Mean ◽  
Career Performance

Background: Jones fractures result in subsequent dysfunction and remain an issue for athletes. Purpose: To (1) describe the epidemiology, treatment, and impact of Jones fractures identified at the National Football League (NFL) Scouting Combine on players’ early careers and (2) establish the value of computed tomography (CT) to determine bony healing after a fracture in prospective players. Study Design: Cohort study; Level of evidence, 3. Methods: All players who attended the combine between 2009 and 2015 were retrospectively reviewed to identify their history of Jones fractures. The playing position, treatment method, and number of missed collegiate games were recorded. The mean overall draft pick number, number of games started and played, snap percentage, and position-specific performance scores (fantasy score) over the first 2 years in the NFL were compared between players with fractures and controls. An imaging classification system was applied based on grading of each quadrant of the fifth metatarsal (plantar, dorsal, medial, lateral), with a score of 0 for not healed or 1 for healed. Results: Overall, the number of Jones fractures identified was 72 in 2285 athletes (3.2%), with all treated via intramedullary screw fixation. The mean overall draft pick number for players with fractures was 111.2 ± 67.9 compared with 99.0 ± 65.9 for controls ( P = .12). Performance scores for players with fractures were lower than those for controls across all positions, with a significant difference in running backs (2.6 vs 4.0, respectively; P < .001) and defensive linemen (1.4 vs 2.3, respectively; P = .02). The mean CT score was 2.5 ± 1.3. Of the 32 athletes who underwent imaging, 16 Jones fractures (50.0%) were healed or nearly healed, 12 (37.5%) were partially healed, and 4 (12.5%) showed little or no healing. The plantar cortex demonstrated the least healing (18/32; 56.3%), followed by the lateral cortex (15/32; 46.9%). Players with a mean score <1 were found to have fewer games started (2.7 ± 2.5) than those with 1 to 3 cortices healed (17.4 ± 10.4) or all cortices healed (8.7 ± 11.2). Conclusion: Based on CT, 50% of all players with a previous Jones fracture demonstrated incomplete healing. Moreover, position-specific performance scores over the first 2 years of a player’s career were lower across all positions for those with fractures compared with controls. Players with CT scores <1 were found to start fewer games and were drafted later than controls.

COMPUTED TOMOGRAPHY (CT) IMAGE IN REPAIRING TENDON INJURY IN ATHLETES

2021 ◽  
Vol 27 (7) ◽  
pp. 699-702
Author(s):  
Hongliang Li
Keyword(s):  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
Tendon Injury ◽  
Fracture Dislocation ◽  
Ct Image ◽  
Diagnostic Efficiency ◽  
Level Of Evidence ◽  
Anatomical Basis ◽  
Hands And Feet ◽  
Ct And Mri

ABSTRACT Introduction: endon injury can usually be divided into the following types: fracture, dislocation, compression, bone insert, tendon injury, among which dislocation and compression are more common. Objective: To evaluate the application value of Computed Tomography (CT) image in tendon display. Methods: CT scan of the hands and feet was performed in our hospital for suspected tendon lesions. The CT and MRI data of 61 patients with tendon injury were retrospectively analyzed, and the diagnostic efficiency of CT and MRI were compared and analyzed. Results: The diagnostic accuracy of 61 patients was 89.71% (61/68). Except for chronic tendon injury (12/19), the diagnostic accuracy of other lesions was 100%. The sensitivity of CT and MRI in the diagnosis of hand tendon injury was 94.7% and 90.7%, the specificity was 99.3% and 98.6%, and the coincidence rate was 97.7% and 96.3%. Conclusions: CT images are accurate in localization and characterization of tendon injury, with high sensitivity and specificity, and can provide accurate anatomical basis for surgery. Level of evidence II; Therapeutic studies - investigation of treatment results.

How Accurate is Preoperative Staging by Computed Tomography in Esophageal Carcinoma

1988 ◽  
pp. 177-180
Author(s):  
J. Laas ◽  
E. Scheller ◽  
A. Haverich ◽  
K. Frimpong ◽  
Ph. Hendrickx ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Esophageal Carcinoma ◽  
Preoperative Staging

3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

2019 ◽  
Vol 40 (6) ◽  
pp. 720-726 ◽  
Author(s):  
Jian Zhong Zhang ◽  
François Lintz ◽  
Alessio Bernasconi ◽  
Shu Zhang ◽  
Keyword(s):  
Computed Tomography ◽  
Comparative Study ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Mean Values ◽  
Intraclass Correlation Coefficients ◽  
Prospective Comparative Study

Background: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA. Methods: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet). Results: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064. Conclusions: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination. Level of Evidence: Level II, prospective comparative study.

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