preoperative diagnostic
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Author(s):  
Naiem T. Issa ◽  
Antonella Tosti

AbstractPreoperative diagnostic confidence and donor site assessment are important for all hair transplant surgery patients. While the majority of patients seek hair transplantation for male or female pattern hair loss (androgenetic alopecia [AGA]), there are mimickers that must be differentiated from patterned hair loss, as they alter the candidacy of the patient for transplantation. They are termed mimickers as they also can present with patterned hair loss. The use of trichoscopy has become increasingly popular for such use. Patterned hair loss mimickers, which include the underappreciated alopecia areata incognita (AAI) and fibrosing alopecia in patterned distribution (FAPD), can be identified clinically with key trichoscopic findings such as yellow dots and peripilar casts, respectively, that correlate with their histologic diagnosis. Donor hair density and putative hair pathology of the safe donor area can also by assessed via trichoscopy. This article discusses the use of trichoscopy, particularly for diagnosing mimickers of patterned hair loss as well as preoperative donor site assessment.


Author(s):  
Stephen L. Millar ◽  
Kristin M. Zersen

Abstract OBJECTIVE To assess the diagnostic value of the ultrasonographic description of a splenic mass or nodule as cavitated in dogs with nontraumatic hemoabdomen. ANIMALS 106 dogs with a nontraumatic hemoabdomen that underwent abdominal ultrasonography and splenectomy with histologic examination of splenic lesions between 2005 and 2018. PROCEDURES Medical records were reviewed for abdominal ultrasonographic and histologic findings. Diagnostic performance of ultrasonographic description of a splenic mass or nodule as cavitated as evidence of hemangiosarcoma or any malignancy was evaluated. RESULTS Ultrasonographic description of splenic lesions as cavitated had poor diagnostic utility in predicting presence of hemangiosarcoma or malignancy. Sensitivity and specificity of this test were 41.9% (95% CI, 30.5% to 54.3%) and 51.2% (95% CI, 36.8% to 65.4%), respectively, for detecting hemangiosarcoma, with positive and negative predictive values of 55.3% (95% CI, 41.2% to 68.6%) and 37.9% (95% CI, 26.6% to 50.8%), respectively. Results were similar for detecting malignancy. Cavitated lesions outside of the spleen were too rare for statistical analysis to be of value. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that relying on ultrasonographic description of cavitation to diagnose splenic lesions as malignant in dogs with nontraumatic hemoabdomen is unfounded. Other preoperative diagnostic tests may be more valuable in determining short- and long-term prognoses.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yusuke Seki ◽  
Hiroki Sakata ◽  
Toshimasa Uekusa ◽  
Hirokazu Momose ◽  
Satomi Yoneyama ◽  
...  

Abstract Background Primary hepatic neuroendocrine carcinomas (NECs) are extremely rare. The rate of recurrence after resection is extremely high, and the prognosis is poor. It is debatable whether chemotherapy or surgical resection is the optimal initial treatment for primary hepatic NECs. Therefore, selecting an appropriate therapeutic approach for patients with primary hepatic NECs remains clinically challenging. We present a case of primary hepatic NEC in a patient who developed recurrence after undergoing surgical resection. Case presentation A 78-year-old man with bone metastases of prostate cancer was referred to our department because of a solitary 66-mm tumor in the left lateral segment of the liver, which was detected on annual follow-up by computed tomography after prostate resection. A biopsy and preoperative diagnostic workup identified the lesion as a primary hepatic neuroendocrine carcinoma; therefore, left lateral segmentectomy was performed. Immunohistochemically, the tumor was positive for chromogranin A, synaptophysin, and CD 56, and the Ki-67 index was 40%. This neuroendocrine carcinoma was classified as a large cell type. Adjuvant chemotherapy with carboplatin + etoposide was initially administered a month after surgery. However, lymph node recurrence occurred 4 months after surgery, and the patient died of systemic metastases 15 months after surgical resection. Conclusions Due to the lack of availability of abundant quantities of relevant, high-quality data, there is no standard therapy for primary hepatic NECs. Selecting the most appropriate treatment for patients depending on several factors, such as the stage and differentiation of a tumor and a patient’s performance status and clinical course, is consequently preferred. More cases need to be studied to establish the best treatment strategy for primary hepatic NEC.


2021 ◽  
Vol 12 (2) ◽  
pp. 22-29
Author(s):  
V. A. Pospelov

Introduction. Recently, surgeons have been using minimally invasive methods to treat parathyroid gland pathology. More selective surgical approaches are based on the accuracy of preoperative diagnostic methods. Various radiological diagnostic techniques are used to visualize parathyroid gland pathology. New modalities are entering clinical practice along with long-known techniques. The attending physician should be guided by the most clinically effective and economically reasonable algorithm when choosing diagnostic algorithm. The aim of the study was to find the optimal diagnostic protocol for preoperative diagnosis of parathyroid gland pathology on the basis of available data. Conclusion. Preoperative imaging of parathyroid glands continues to evolve with changes of old techniques and appearance of new ones, though none of modalities has a clear advantage. The choice of imaging algorithm is largely based on the availability of techniques and the experience of particular diagnostic centers. Ultrasound and planar scintigraphy are well established and most widely used. The combination of these techniques remains the first line of diagnosis in preoperative imaging. However, there is no consensus on the choice between planar scintigraphy tech niques: the washout method or the subtraction method. Replacing planar scintigraphy with SPECT/CT improves the detectability of pathological masses and clarifies their topographic location. Computed tomography and MRI techniques are used as a second-line technique and have an advantage in small adenoma sizes, multiple lesions, ectopias, reoperations, and in case of ambiguous ultrasound and scintigraphy data. The significance of PET/CT in the diagnosis of thyroid pathology has not yet been defined, the data are still scarce and published studies are very heterogeneous, but due to the excellent diagnostic characteristics the method seems very promising, in particular in patients with persistent disease.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Akinori Maruta ◽  
Takuji Iwashita ◽  
Kensaku Yoshida ◽  
Shinya Uemura ◽  
Ichiro Yasuda ◽  
...  

Abstract Background A pathological diagnosis of pancreatic cancer should be performed as much as possible to determine the appropriate treatment strategy, but priorities and algorithms for diagnostic methods have not yet been established. In recent years, the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become the primary method of collecting tissues from pancreatic disease, but the effect of EUS-FNA on surgical results and prognosis has not been clarified. Aims To evaluate the diagnostic ability of EUS-FNA and its effect on the preoperative diagnosis, surgical outcome, and prognosis of pancreatic cancer. Methods Between January 2005 and June 2017, 293 patients who underwent surgical resection for pancreatic cancer were retrospectively evaluated. The outcomes of interest were the diagnostic ability of EUS-FNA and its influence on the surgical results and prognosis. Results The diagnostic sensitivity of EUS-FNA was 94.4%, which was significantly higher than that of endoscopic retrograde cholangiopancreatography (ERCP) (45.5%) (p < 0.001). The adverse event rate in ERCP was 10.2%, which was significantly higher than EUS-FNA (1.3%) (p = 0.001). Patients were divided into FNA group (N = 160) and non-FNA group (N = 133) for each preoperative diagnostic method. In the study of surgical curability R0 between the two groups, there was no significant difference in FNA group (65.0% [104/160]) and non-FNA group (64.7% [86/133], p = 1.000). In the prognostic study, 256 patients with curative R0 or R1 had a recurrence rate was 54.3% (70/129) in the FNA group and 57.4% (73/127) in the non-FNA group. Moreover peritoneal dissemination occurred in 34.3% (24/70) in the FNA group and in 21.9% (16/73) in the non-FNA group, neither of which showed a significant difference. The median survival times of the FNA and non-FNA groups were 955 days and 799 days, respectively, and there was no significant difference between the two groups (log-rank p = 0.735). In the Cox proportional hazards model, factors influencing prognosis, staging, curability, and adjuvant chemotherapy were the dominant factors, but the preoperative diagnostic method (EUS-FNA) itself was not. Conclusions EUS-FNA is a safe procedure with a high diagnostic ability for the preoperative examination of pancreatic cancer. It was considered the first choice without the influence of surgical curability, postoperative recurrence, peritoneal dissemination and prognosis.


2021 ◽  
Vol 116 (1) ◽  
pp. S161-S162
Author(s):  
Rohin Gawdi ◽  
Zach German ◽  
Ana Patel ◽  
Carl Westcott ◽  
Steven Clayton

2021 ◽  
Vol 12 ◽  
Author(s):  
Lisha Qi ◽  
Dandan Chen ◽  
Chunxiang Li ◽  
Jinghan Li ◽  
Jingyi Wang ◽  
...  

Objectives: To establish and validate a nomogram integrating radiomics signatures from ultrasound and clinical factors to discriminate between benign, borderline, and malignant serous ovarian tumors.Materials and methods: In this study, a total of 279 pathology-confirmed serous ovarian tumors collected from 265 patients between March 2013 and December 2016 were used. The training cohort was generated by randomly selecting 70% of each of the three types (benign, borderline, and malignant) of tumors, while the remaining 30% was included in the validation cohort. From the transabdominal ultrasound scanning of ovarian tumors, the radiomics features were extracted, and a score was calculated. The ability of radiomics to differentiate between the grades of ovarian tumors was tested by comparing benign vs borderline and malignant (task 1) and borderline vs malignant (task 2). These results were compared with the diagnostic performance and subjective assessment by junior and senior sonographers. Finally, a clinical-feature alone model and a combined clinical-radiomics (CCR) model were built using predictive nomograms for the two tasks. Receiver operating characteristic (ROC) analysis, calibration curve, and decision curve analysis (DCA) were performed to evaluate the model performance.Results: The US-based radiomics models performed satisfactorily in both the tasks, showing especially higher accuracy in the second task by successfully discriminating borderline and malignant ovarian serous tumors compared to the evaluations by senior sonographers (AUC = 0.789 for seniors and 0.877 for radiomics models in task one; AUC = 0.612 for senior and 0.839 for radiomics model in task 2). We showed that the CCR model, comprising CA125 level, lesion location, ascites, and radiomics signatures, performed the best (AUC = 0.937, 95%CI 0.905–0.969 in task 1, AUC = 0.924, 95%CI 0.876–0.971 in task 2) in the training as well as in the validation cohorts (AUC = 0.914, 95%CI 0.851–0.976 in task 1, AUC = 0.890, 95%CI 0.794–0.987 in task 2). The calibration curve and DCA analysis of the CCR model more accurately predicted the classification of the tumors than the clinical features alone.Conclusion: This study integrates novel radiomics signatures from ultrasound and clinical factors to create a nomogram to provide preoperative diagnostic information for differentiating between benign, borderline, and malignant ovarian serous tumors, thereby reducing unnecessary and risky biopsies and surgeries.


2021 ◽  
pp. 29-31
Author(s):  
Pooja ranjan ◽  
Joyeeta Mandal ◽  
Anshu jamaiyar ◽  
Sunil Kumar Mahto

Breast lump is one of the most common complaint among female patients in India. FNAC is one of the important preoperative diagnostic modality in case of breast lesion. Correlation between BIRADS category and cytological findings are useful to establish an accurate preoperative diagnosis and further treatment protocols. In the present study, FNAC smear were stained by Leishman & Giemsa stain. Reporting was done in correlation with BIRADS category. Our study consisted of 80 cases of palpable breast lesions, of which 54 were benign and 26 malignant. The study showed overall 8 1.25% concordance with BIRADS category


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Jan Philipp Kühn ◽  
Mathias Wagner ◽  
Alessandro Bozzato ◽  
Maximilian Linxweiler

Abstract Background In this report, we describe the first case in literature of a patient with multiple schwannomas of the marginal mandibular branch of the facial nerve. Case presentation A Caucasian patient presented with a sudden onset of left lower facial nerve palsy House–Brackmann score III for 1 month. Computed tomography imaging was performed to exclude a cerebral event and revealed multiple tumors within the left parotid gland. Duplex ultrasound and magnetic resonance imaging scans delineated multiple, hypoechoic tumors, round in shape and well defined without a hilar structure along the left mandible. For histological verification, a left-side partial parotidectomy and extirpation of an intraparotideal node was performed with use of a nerve-integrity monitor. Histomorphological analysis of the resected tissue revealed a benign schwannoma. Facial nerve function remained unchanged since the operation. The size of the nonresected tumors is currently monitored regularly by ultrasonography. Fibromatosis has been excluded. Conclusions If multiple tumors occur in the parotid gland and the angle of the jaw, schwannomas need to be considered as a differential diagnosis. To plan the right diagnostic surgical intervention and prevent nerve damage, a thorough ultrasound examination is essential in preoperative diagnostic work-up for any suspicious lesion of the parotid gland and jaw region.


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