Whole-lesion histogram analysis of the apparent diffusion coefficient: Evaluation of the correlation with subtypes of mucinous breast carcinoma.

PURPOSE: To evaluate the utility of the whole-lesion histogram apparent diffusion coefficient (ADC) for characterizing the heterogeneity of mucinous breast carcinoma (MBC) and to determine which ADC metrics may help to best differentiate subtypes of MBC. MATERIALS AND METHODS: This retrospective study involved 52 MBC patients, including 37 pure MBC (PMBC) and 15 mixed MBC (MMBC). The PMBC patients were subtyped into PMBC-A (20 cases) and PMBC-B (17 cases) groups. All patients underwent preoperative diffusion-weighted imaging (DWI) at 1.5T and the whole-lesion ADC assessments were generated. Histogram-derived ADC parameters were compared between PMBC vs. MMBC and PMBC-A vs. PMBC-B, and receiver operating characteristic (ROC) curve analysis was used to determine optimal histogram parameters for differentiating these groups. RESULTS: The PMBC group exhibited significantly higher ADC values for the mean (P = 0.004), 25th (P = 0.004), 50th (P = 0.004), 75th (P = 0.006), and 90th percentiles (P = 0.013) and skewness (P = 0.021) than did the MMBC group. The 25th percentile of ADC values achieved the highest area under the curve (AUC) (0.792), with a cutoff value of 1.345 × 10-3 mm2 /s, in distinguishing PMBC and MMBC. The PMBC-A group showed significantly higher ADC values for the mean (P = 0.049), 25th (P = 0.015), and 50th (P = 0.026) percentiles and skewness (P = 0.004) than did the PMBC-B group. The 25th percentile of the ADC cutoff value (1.476 × 10-3 mm2 /s) demonstrated the best AUC (0.837) among the ADC values for distinguishing PMBC-A and PMBC-B. CONCLUSION: Whole-lesion ADC histogram analysis enables comprehensive evaluation of an MBC in its entirety and differentiating subtypes of MBC. Thus, it may be a helpful and supportive tool for conventional MRI. LEVEL OF EVIDENCE: 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:391-400.

Short-Term Outcomes of Single-Incision Versus Conventional Laparoscopic Surgery for Colorectal Diseases: Meta-Analysis of Randomized and Prospective Evidence.

BACKGROUND: Conventional laparoscopic surgery (CLS) has been established as an alternative to open surgery for colorectal diseases (CRDs); simultaneously, single-incision laparoscopic surgery (SILS) is gaining popularity. OBJECTIVE: The aim of this study was to compare the short-term efficacy and safety of SILS with CLS for CRDs. METHODS: MEDLINE, EMBASE, and the Cochrane Library were searched for relevant randomized and prospective studies. Reference lists of relevant articles and reviews, conference proceedings, and ongoing trial databases were also screened. Outcome measures included surgical parameters, postsurgical recovery, pain, and adverse events. Meta-analysis was conducted where appropriate, comparing items using weighted mean differences (WMDs) and risk ratios (RRs) according to data type. RESULTS: A total of nine prospective (three randomized and six non-randomized) researches published from 2011 to 2015 were identified. The overall pooled results showed compared to CLS, SILS was associated with fewer blood transfusions, shorter incision length, and slighter postoperative pain, but more extra ports. All the other parameters were comparable. Randomized evidence supported SILS was associated with less blood loss, and shorter hospital stay, but longer operative time. For only colectomy cases, SILS was associated with more conversions to open surgery. SILS was associated with longer surgical time for Easterners, but not for Westerners. The detected differences were clinically insignificant. CONCLUSIONS: The results based on randomized and prospective evidence provide convincing support for the clinical similarity that SILS is basically as applicable, effective, and safe as CLS when dealing with colorectal lesions, but not for superiority.

[Multiphasic spiral CT scanning features in 100 patients with small renal cell carcinoma].

OBJECTIVE: To investigate the role of multiphasic spiral computed tomography (SCT) in the differential diagnosis of small renal cell carcinoma. METHODS: The data of 100 patients with small renal cell carcinoma (< or = 3.0 cm) proved by pathology were retrospectively reviewed in order to analyze the features of SCT during plain, corticomedullary and excretory phases. There were 83 males and 17 females, with a mean age of 54. 3 years ranging from 9 to 81 years. RESULTS: There were 38 tumor masses in the left kidney and 62 in the right one. They were 1.0-3.0 cm (mean, 2.5 cm) in the greatest dimension. According to the 2004 WHO histological classification criteria for the tumors of the kidney. Seventy-six patients had clear cell renal cell carcinoma, 4 multilocular clear cell renal cell carcinomas, 9 papillary renal cell carcinoma, 4 chromophobe renal cell carcinomas and 7 unclassified renal cell carcinomas. Clear cell renal cell carcinoma exhibited rich blood supply and inhomogeneous density due to hemorrhage, necrosis or cystic degeneration. Multilocular clear cell renal cell carcinoma presented as a multilocular cystic mass with thin wall and septa, instead of an expansile nodule. Papillary renal cell carcinoma showed inhomogeneous density and hypovascular distribution. Chromophobe renal cell carcinoma was relatively homogeneous and hypovascular. Compared with clear cell renal cell carcinoma, unclassified renal cell carcinoma showed inhomogeneous density and hypervascular distribution with more invading growth features than the other subtypes. CONCLUSION: Commonly encountered subtypes of the small renal cell carcinoma exhibit their own specific features in multiphasic spiral CT, which may be helpful in differential diagnosis, but each subtype should be differentiated from the renal oncocytoma, cystic nephroma, complex renal cyst, renal angiomyolipoma with minimal fat and renal infiltrating urothelial carcinoma.