Comparison between Histological Features and Strain Elastographic Characteristics in Canine Mammary Carcinomas

Elastography is a sonographic technique that provides a noninvasive evaluation of the stiffness of a lesion. The objective of this work was to evaluate the accuracy of strain elastography, the most accessible modality in clinical practice, to discriminate between different histological types of malignant mammary neoplasms in the canine species, which can provide complementary information in real time to the diagnosis and thus help in the choice of surgical technique. A total of 34 females with 56 mammary carcinomas were selected and classified into three histological groups according to their aggressiveness. The histological and elastographic characteristics of these malignant tumors were analyzed and compared to evaluate the diagnostic accuracy of strain elastography. Visual score presented a sensitivity of 88.0%, specificity of 58.1%, and accuracy of 71.43% in distinguishing the most aggressive group of carcinomas. The strain ratio had a sensitivity of 84.0%, specificity of 61.1%, and accuracy of 69.64%. On the other hand, intratumoral strain ratio obtained a sensitivity of 71.40% and specificity of 61.90% when intratumoral fibrosis was taken as reference, with an accuracy of 66.07%. Similarly, peritumoral strain ratio was also positively related to fibrosis in the periphery of lesions (p ≤ 0.001), with a sensitivity of 93.80%, specificity of 77.50% and an accuracy of 92.87%. In conclusion, accuracy of this elastographic modality can be a useful method to differentiate more aggressive histological types. Therefore, it represents an additional diagnostic technique useful in the daily clinic thanks to the short time required for the examination, which allows real-time visualization and immediate interpretation of the results.

Multi-institution Assessment of the Accuracy of Cardiac Computed Tomography in Preparation for Superior Cavopulmonary Connection

Background Patients with single ventricle (SV) congenital heart disease (CHD) undergo several interventions in the first years of life. Advanced diagnostics are required for interstage assessment of anatomy, but are associated with significant diagnostic risk. We sought to evaluate image quality, risk, and accuracy of cardiac computed tomography (CCT) for evaluation of anatomy prior to superior cavopulmonary connection (SCPC) compared to surgical findings across 2 institutions. Methods A retrospective evaluation of image quality, risk, and accuracy of pre-SCPC CCT was performed at 2 institutions between January 1, 2010 and September 30, 2016. Results CCT was performed in 90 SV CHD patients with a median age of 4.03 months (interquartile range [IQR] 3.36, 5.33) prior to SCPC. Image quality was optimal (84%) or good (16%) in all patients, without significant discrepancy compared to surgical findings. 7 patients (8%) required interventional cardiac catheterization subsequent to CCT and before surgical intervention. 49% of scans were performed without sedation, 43% of scans were performed with mild to moderate sedation, and 8% of scans were performed with general anesthesia. The median total procedural dose-length product (DLP) was 18 (IQR 14, 26) mGy*cm, estimating an age adjusted radiation dose of 1.4 millisievert (mSv). One minor (1%) adverse event was reported within 24 h of the CCT. Surgical complications were unrelated to the presurgical findings. Conclusions CCT for pre-SCPC evaluation is safe, with excellent accuracy for anatomy at the time of surgical intervention across 2 institutions. In select patients, noninvasive evaluation with CCT may be indicated.

Noninvasive Evaluation of Liver Fibrosis in a Sample of Putative Inactive HBV Carriers in Rome, Italy

Background. Noninvasive methods are useful for investigating patients with chronic HBV infection. The severity of liver disease in inactive HBsAg carriers can be noninvasively assessed by transient elastography (TE) alone or in association with biochemical markers of fibrosis. Objectives. The study evaluates the effectiveness of the TE compared to common fibrosis scores (FSs), APRI, Forns Index, and FIB4, for identifying significant fibrosis in Italian and foreigner HBsAg carriers. To investigate the risk of progression of the liver disease, liver stiffness (LS) and HBV-DNA were monitored over time. Methods. Viral load, biochemical parameters, and LS have been retrospectively evaluated in 125 putative inactive HBV carriers, who visited two outpatient departments (Colleferro Hospital and INMP) from 01/03/2014 to 31/12/2019. Differences in clinical, biochemical, and demographic variables between Italians and foreigners were analyzed. 66 of 125 patients were followed up for 24 months by monitoring liver stiffness and HBV-DNA. Results. Mean overall LS was 5.55 ± 1.92 kPa; 18 (14.4%) patients had a LS ≥7.5 kPa. Mean of APRI, Forns, and FIB4 was 0.29 ± 0.11, 4.15 ± 1.63, and 1.16 ± 0.59, respectively. FS did not differ between the patients with LS <7.5 kPa and those with LS ≥7.5 kPa. Italians displayed a significant lower ALT (0.53 ± 0.18 vs. 0.67 ± 0.33, p < 0.05 ) and AST (0.59 ± 0.16 vs. 0.70 ± 0.21, p < 0.01 ) value than foreigners. No differences in LS and HBV-DNA levels were observed. In 66 patients followed up for 24 months, HBV-DNA increased by ≥2000 UI/ml after 12 months in 15 individuals and remained ≥2000 UI/ml after 24 months in 10/15 individuals. 7/10 patients showed LS ≥ 7.5 kPa after 24 months, and 4 of them underwent antiviral therapy for HBV. Patients with HBV-DNA <2000 IU/ml had a significantly lower LS than those with HBV-DNA ≥2000 IU/ml (5.30 ± 1.43 vs. 7.69 ± 1.07, p < 0.0001 ). Conclusions. Analysis shows lower effectiveness of FS vs. TE in the assessment of putative inactive HBV carriers. Furthermore, using FibroScan® and HBV-DNA can identify “false” inactive carriers.

Value of ddPCR in the Preoperative Diagnosis of Solitary Pulmonary Nodules Based on the Observation of Virtual Reality Images of Smart Medical Treatment

At present, lung cancer ranks the first cause of tumor death in the world, and malignant tumors in the SPN detected by imaging account for 5–40%, most of which are peripheral lung cancer. The recovery of the solitary nodules in the lung after treatment has also been paid attention to. In order to explore the correlation of solitary pulmonary nodule (SPN) with microvessel density (MVD), vascular parameters, and vascular ratio under virtual reality images of smart medical treatment and evaluate the differentiation of SPN by ddPCR under virtual reality image observation diagnosis value, this article collects relevant information by investigating patients, investigating relevant literature, interviewing professionals, and constructing a case template, using a comprehensive quantitative and qualitative analysis method to create a damage assessment matrix. Experimental results prove that there are significant differences in the microvascular architecture within the SPN in the benign, inflammatory, and malignant groups. The correlation between ddPCR and vascular parameters (especially the ratio of luminal vessels) under the virtual reality image observation of smart medical treatment is better than other detection methods, and its accuracy is about 10% higher. Based on the observation of smart medical virtual reality images, ddPCR can be used as an index for noninvasive evaluation of tumor angiogenesis, which is helpful for the differential diagnosis of SPN.