Change in Abdominal Aortic Aneurysm Sac Diameter After Endovascular Repair: A Single-Center Experience From Taiwan

Purpose: The purpose of this study was to investigate the change in the diameter of infrarenal abdominal aortic aneurysm (AAA) sacs after endovascular aortic repair (EVAR) in Taiwanese patients and to depict its association with clinical outcomes. Materials and Methods: This retrospective cohort study was conducted on patients who underwent EVAR for infrarenal AAA between January 2011 and December 2016. All preoperative and follow-up computed tomography (CT) images were reviewed. Postoperative CT angiography was arranged after 1 month and annually thereafter. The maximal diameter on the axial plane and the maximal diameter perpendicular to the centerline on the coronal and sagittal planes were measured. The study examined post-EVAR sac diameter change over time and compared the differences in adverse events (AEs) among groups. Results: The survey included a total of 191 patients with a median follow-up duration of 2.5 (interquartile range: 1.1–2.9) years. Overall survival rates at 1, 2, and 5 years were 92%, 81%, and 76%, respectively. According to their last CT scans, the patients were categorized into 3 groups as follows: shrinkage, stationary, and enlargement, which comprised 58 (30.4%), 118 (61.8%), and 15 (7.9%) patients, respectively. Pre-EVAR characteristics and sac diameters were similar among the groups. Sac shrinkage was exclusively observed in the first 2 years, whereas sac enlargement developed at all follow-up periods. Patients with sac enlargement had higher incidence rates of endoleaks, complications, and reintervention than the other groups. Conclusion: Based on our observations, post-EVAR sac shrinkage only occurs in the first 2 years; however, post-EVAR sacs may enlarge at any point and even after 5 years. In our study, patients with sac enlargement had higher rates of adverse events and reintervention.

Incidentally Discovered Papillary Thyroid Microcarcinoma in Patients Undergoing Thyroid Surgery for Benign Disease

IntroductionIncidence of thyroid carcinoma (TC) has grown significantly over the last few decades worldwide, partly due to the increase detection of small thyroid microcarcinoma (TMc). TMc are tumors with a maximal diameter ≤ 1 cm, identified during histopathology examination following a thyroidectomy performed for reasons not pertaining to malignancy. The aim of this study is to investigate the prevalence of papillary thyroid microcarcinoma (PTMc) according to the nature of benign pathology that submit patients to thyroid surgery and its trend evolution.MethodsRetrospective cohort analysis of 1815 patients who underwent total thyroidectomy for non-malignant disease from 2005 to 2020. ResultsThe mean age of subjects was 53.5 years, with a higher proportion of women (1481, 82.1%). A total of 167 PTMc (9.3%) were incidentally discovered. Multivariate logistic regression analysis shows no differences in prevalence according to sex or age in patients with PTMc compared to those with final benign histology. Multinodular goiter increases the risk of PTMc with an odds ratio of 2.2 (p=0.001) compared to Hashimoto's thyroiditis and Graves´ disease (GD). There is a statistically significant increase in the incidence of PTMc in the group operated between 2017-2020 vs. 2005-2008 (p=0.005)ConclusionOverall prevalence of PTMc in patients who underwent thyroid surgery for benign disease was 9.3%. Thyroid nodular hyperplasia was the most frequent benign pathology associated to this occult cancer as compared to Hashimoto or GD. Gender and age were not correlated with prevalence of TMc. Over the years, surgical findings of PTMc have grown, particularly in the 2017-2020 period.

Expression of FAP in Lung Cancer and Its Correlation With the Tumor Glucose Metabolism and the Histopathology

Purpose To explore the expression of fibroblast activation protein (FAP) in lung cancer (LC) and its correlation with tumor glucose metabolism and histopathology.Methods From June 2018 to November 2020, a total of 73 patients with newly diagnosed LC were included. Immunohistochemical staining was used to quantify the FAP expression in the tumors. The histopathological type and tumor grade were determined on the histopathological examination. Tumor glucose metabolic parameters and tumor maximal diameter were measured on [18F] F-FDG PET/CT. Univariate and multivariate analysis were used to study the correlation between FAP expression level and glucose metabolic variables and various histopathology.Results Positive FAP expression was observed in 97.3% (71/73) of LC lesions, which was significantly higher than 87.7% (64/73) of [18F] F-FDG positivity on PET/CT (χ2=4.818, P=0.028). In 12 early adenocarcinomas (ADCs), only 3 lesions (25%) were positive on PET/CT, however, 10 lesions (83.3%) were positive with FAP expression. When FAP expression was classified to low level (scores≤3) and high level (scores>4), high FAP level was found in 80.8% tumors and low FAP level in other 19.2% tumors. High FAP level was identified in 100.0% of squamous cell carcinoma (SCC), 85.7% of ADCs, 66.7% (4/6) of large cell neuroendocrine carcinoma (LCNC) and 40.0% (4/10) of small cell lung cancer (SCLC)(P<0.05). In the non-mucinous ADC lesions, on univariate analysis, FAP expression level showed close relationships with tumor metabolism parameters (SUVmax, SUVmean, and TLG), tumor diameter, tumor grade and lesion attenuation (P<0.05).Conclusion The present study demonstrates that FAP expresses widely in LC and has a great variant level in different histopathological types. High positive rate of FAP expression implies FAP targeted imaging may be a sensitive modality for diagnosing LC, especially for early ADCs, and may serve as an alternative of [18F] F-FDG PET/CT.

Novel 15-mm-long lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections located ≥10 mm from the luminal wall

Background Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) by cautery-enhanced lumen-apposing metal stents (LAMS) has largely been limited to collections located < 10 mm from the luminal wall. We present outcomes of the use of a novel 15-mm-long cautery-enhanced LAMS for drainage of PFCs located ≥ 10 mm away. Methods This international, multicenter study analyzed all adults with PFCs located ≥ 10 mm from the luminal wall who were treated by EUS-guided drainage using the 15-mm-long cautery-enhanced LAMS. The primary outcome was technical success. Secondary outcomes included clinical success (decrease in PFC size by ≥ 50 % at 30 days and resolution of clinical symptoms without surgical intervention), complications, and recurrence. Results 35 patients (median age 57 years; interquartile range [IQR] 47–64 years; 49 % male) underwent novel LAMS placement for drainage of PFCs (26 walled-off necrosis, 9 pseudocysts), measuring 85 mm (IQR 64–117) maximal diameter and located 11.8 mm (IQR 10–12.3; range 10–14) from the gastric/duodenal wall. Technical and clinical success were high (both 97 %), with recurrence in one patient (3 %) at a median follow-up of 123 days (58–236). Three complications occurred (9 %; one mild, two moderate). Conclusions The 15-mm-long cautery-enhanced LAMS was feasible and safe for drainage of PFCs located 10–14 mm from the luminal wall.

The Role of Lymphocyte-To-Monocyte Ratio In Predicting The Severe Post-Calcific Stenotic Aortic Dilatation In A Chinese Case-Control Study

Background: Calcific aortic valve stenosis (CAVS) represents a serious public health threat to elderly patients. Post-calcific stenotic aortic dilatation, a common feature in CAVS patients, might progress into aneurysm and even dissection, potentially lethal consequences of CAVS, and predicts a dismal prognosis. This study sought to testify the role of lymphocyte-to-monocyte ratio (LMR), an inflammatory biomarker, in predicting the severe post-calcific stenotic aortic dilatation in a Chinese case-control study.Materials and Methods: 208 consecutive patients with CAVS were recruited retrospectively in a Chinese case- control study, from July 1, 2015 to June 31, 2018. The LMR was statistically analyzed for its prognostic value in the severe post-calcific stenotic aortic dilatation.Results: The LMR was significantly reduced in patients with severe post-calcific stenotic aortic dilatation (2.72 vs. 3.53, p=0.002<0.05) compared to patients without severe post- calcific stenotic aortic dilatation. There was an inverse correlation observed between the maximal diameter of ascending aorta and the LMR in the overall patients (r=-0.217, p=0.002<0.05). For severe post-calcific stenotic aortic dilatation, the incidence of high- LMR group was statistically lower than that of low-LMR group (19.7% vs. 43.9%, p<0.001). And maximal diameter of ascending aorta was significantly reduced in the high-LMR group (4.35vs. 4.76, p=0.003<0.05) compared to low-LMR group. Additionally, the LMR was identified in the multivariate analysis as an independent predictor of severe post-calcific stenotic aortic dilatation (OR 0.743, 95% CI: [0.573- 0.964], p=0.025).Conclusions: This study provided the evidence of an inverse correlation between the severe post- calcific stenotic aortic dilatation and LMR. And the LMR is potentially applied as an independent predictor of severe post-calcific stenotic aortic dilatation.

Efficacy on radiofrequency ablation according to the types of benign thyroid nodules

Percutaneous radiofrequency ablation (RFA) has been recommended as minimally invasive treatment for patients with symptomatic benign thyroid nodules (BTNs) because of the large number of clinical applications. This retrospective observational study sought to evaluate the clinical outcomes of RFA for BTNs. From 2014 to 2019, a sample size of 1289 patients treated by RFA were 262 ones with solid nodules and 1027 ones with cystic-solid nodule, respectively. The efficacy including the nodule maximal diameter reduction ratio (MDRR), the volume reduction ratio (VRR) and the cosmetic scores reduction ratio (CSRR). The results of the nodule MDRR and VRR in the cystic-solid nodule group were significantly better than those in the solid nodule group at the 3rd and 6th month, and the CSRR in the two groups showed statistically significant difference at the 3rd month. In a word, RFA is an effective method for symptomatic benign solid or cystic-solid nodules. The achieved MDRR and VRR in the cystic-solid nodule group were significantly better than those in the solid nodule group at the 3rd and 6th month.

Standalone Flow Diversion Therapy Effectively Controls Rebleeding of Acutely Ruptured Internal Carotid Artery Trunk (Nonbranching) Microaneurysms

Flow diversion is a promising option in selected patients with acutely ruptured microaneurysms. In this article, we reviewed our experience. Patients with acute spontaneous subarachnoid hemorrhage (SAH) after rupture of a blister-like or saccular microaneurysm (≤2 mm maximal diameter) at a nonbranching ICA site treated from January 2016 to June 2019 using flow diversion as standalone therapy were included in this study. An EVD was usually placed preventively. Antiplatelet effects of pre-procedure DAPT were evaluated (target PRU, 80–160). After the intervention, DAPT was continued for ≥6 months, aspirin—indefinitely. Angiographic controls were obtained. Fifteen patients (12 female; mean age, 46.4 years) with 15 ruptured ICA microaneurysms (mean diameter, 1.8 mm) were included. An EVD was placed in 12 patients (75%) before DAPT administration and stenting. PRU values immediately before FDS were 1–134 (mean, 72.1). One patient died 27 days after flow diversion due to a suspected fulminant pulmonary embolism. Aneurysms were completely occluded at the 6–12-month angiographic follow-up in 14/14 surviving patients, with no rebleeding at a mean of 14 months. Late mRS was 0–2 in 13/14 patients and 3 in one due to sequelae of the original hemorrhage. Flow diversion provided robust aneurysm rebleeding control. Angiographic follow-up confirmed complete aneurysm occlusion in all the cases.

Endoluminal flow diverting stents for middle cerebral artery bifurcation aneurysms: multicenter cohort

BackgroundData regarding the safety and efficacy of flow diverting stents (FDS) in the treatment of middle cerebral artery (MCA) bifurcation aneurysms are scarce and limited to small single center series, with particular concern for increased risk of ischemic complications with jailing one of the M2 branches.MethodsProspectively-maintained databases at six North American and European centers were queried for patients harboring MCA bifurcation aneurysms undergoing treatment with FDS (2011–2018). The pertinent clinical and radiographic data were collected and analyzed.Results87 patients (median age 60 years, 69% females) harboring 87 aneurysms were included. The majority of aneurysms were unruptured (79%); 75.9% were saccular with a median maximal diameter of 8.5 mm. Radiographic imaging follow-up was available in 88.5% of cases at a median of 16.3 months post-treatment, showing complete occlusion in 59% and near complete occlusion (90–99%) in 18% of aneurysms. The overall rate of ischemic and hemorrhagic complications was 8% and 1.1%, respectively. Symptomatic and permanent complications were encountered in 5.7% and 2.3% of patients respectively, with retreatment pursued in 2.3% of patients. Jailed branch occlusion was detected in 11.5% of cases, with clinical sequelae in 2.3%. Last follow-up modified Rankin Scale of 0–2 was noted in 96.8% of patients. On multivariate analysis, male sex was the only independent predictor of aneurysmal persistence at last follow-up imaging (p=0.019).ConclusionFDS treatment for MCA bifurcation aneurysms is feasible, with comparable safety and efficacy profiles to other available endovascular options when utilized in carefully selected aneurysms. Jailing of M2 branches was not associated with a higher risk of post-procedural ischemic complications.

EPID-13. PREDICTIVE VALUE OF SERUM PROLACTIN LEVEL TO THE TUMOR SIZE RATIO FOR PREOPERATIVE DIAGNOSIS OF PROLACTIN-PRODUCING PITUITARY ADENOMA

PURPOSE Preoperative diagnosis of prolactinomas is critical because medication of dopamine agonists instead of surgical resection has been regarded as a primary treatment. However, serum prolactin level alone is suboptimal for differentiating the prolactin producing adenoma or hyperprolactinemia-causing NFPAs. The author investigated the use of ratio of PRL levels to the tumor size as the optimal cutoff value for prolactin-producing tumor, comparing with the NFPA. METHOD We performed a retrospective review of patients who underwent the transsphenoidal surgery (TSS) for pituitary lesions in the single institute between January 2015 to May 2020. A total of 223 patients with hyperprolactinemia at the initial diagnosis were analyzed in the study, including NFPA patients (n=175) and prolactinoma patients (n=48). Receiver operating curve (ROC) analyses were performed for serum prolactin levels (PRL) and serum prolactin levels/tumor maximal diameter (PRL/MD). RESULT Prolactinoma group showed higher median values in serum PRL (258.6 μg/L) and smaller maximal tumor diameter (16.6 mm), compared to those of NFPA group (serum PRL 44.4 μg/L, p-value = 0.002 and MD 23.9 mm, p-value &lt; 0.001). A moderate correlation was found between serum prolactin level and maximal diameters in prolactinomas (r=0.43, p=0.002), whereas a weak relationship was confirmed in NFPAs (r=0.17, p=0.028). The cutoff was 8.93 μg/L*mm (area under the curve [AUC] = 0.94) for PRL/MD and 99.43 μg/L for PRL (AUC = 0.91). In prolactinomas, there was no statistical difference between the PRL/MD of macroadenomas (n=36, 21.7μg/L*mm) and microadenoma (n=12, 16.8μg/L*mm) (p=0.109). CONCLUSION The serum PRL levels and tumor size exhibited stronger linear correlation in prolactinomas than in NFPAs. The PRL/MD ratio showed better diagnostic value for differentiating two pathologies than the serum PRL levels alone. These findings suggest PRL/MD ratio may be an alternative method to preoperative diagnosis of prolactinomas differentiating from hyperprolactinemia-causing NFPAs.