The utility of post-diagnostic imaging in cases of atypical endometrial hyperplasia.

AIM: To contribute to the evidence base evaluating the usefulness of preoperative imaging in management of atypical endometrial hyperplasia. MATERIALS AND METHODS: A single-centre retrospective observational study was conducted comparing preoperative, post-diagnostic radiological staging with surgicopathological staging. The effect on patient management and any changes in final histological diagnosis were recorded. RESULTS: There were 38 patients who underwent preoperative imaging (32 magnetic resonance imaging [MRI], one MRI and computed tomography [CT], three CT, and two transvaginal ultrasound) for atypical endometrial hyperplasia from 2007 to 2018. Thirty-four women subsequently underwent surgery. The final histopathological diagnosis was upgraded to cancer in 35% (12/34) and downgraded in 38% (13/34). There was good concordance between preoperative CT/MRI and surgicopathological staging. Of the 12 patients with a malignant diagnosis, all were early-stage disease with 11/12 stage IA and 1/12 stage IB. CONCLUSION: Preoperative staging with CT/MRI for atypical endometrial hyperplasia contributed no useful additional information, made no change to patient management, and is therefore not indicated.

Minimising the impact of errors in the interpretation of CT images for surveillance and evaluation of therapy in cancer.

Radiological error is inevitable and usually multifactorial. Error can be secondary to radiologist-specific causes, including cognitive and perceptive errors or ambiguity of report, or system-related causes, including inadequate, misleading, or incorrect clinical information, poor imaging technique, excessive workload, and poor working conditions. In this paper, we discuss a systematic approach to reduce errors in oncological radiology reporting, thus reducing risk to the patient. Rather than attempt to discuss all types of error, we concentrate on the most important and commonly occurring errors that we have encountered over 20 years of practice, based on weekly discrepancy reviews of our practice and independent reviews of clinical and research imaging from other institutions. This review focuses on computed tomography (CT) reporting for staging, surveillance, and response assessment of cancer patients, but the messages apply to all imaging methods.

The role of ultrasound in the management of flexor tendon injuries.

The use of ultrasound scanning to establish tendon pathologies was assessed retrospectively in 17 patients in 18 digits. The ultrasound scan demonstrated four patterns: (1) normal intact tendons in four, (2) ruptured tendons in three, (3) tendons in continuity but attenuated in five and (4) tendons in continuity but thickened with fibrosis and decreased movement representing adhesions in five patients. Surgery was undertaken in only three cases, confirming the ultrasound diagnosis in two. Surgery was offered to all three patients with ruptures but was declined by two. Ultrasound imaging helped to avoid surgery in 14 cases by excluding flexor tendon re-ruptures. This allowed on-going mobilisation, leading to recovery of function.