Agreement between frozen section and histopathology to detect malignancy in adnexal masses according to size and morphology by ultrasound.

Objective: Management of suspect adnexal masses involves surgery to define the best treatment. Diagnostic choices include a two-stage procedure for histopathology examination (HPE) or intraoperative histological analysis - intraoperative frozen section (IFS) and formalin-fixed and paraffin-soaked tissues (FFPE). Preoperative assessment with ultrasound may also be useful to predict malignancy. We aimed at determining the accuracy of IFS to evaluate adnexal masses stratified by size and morphology having HPE as the diagnostic gold standard. Methods: A retrospective chart review of 302 patients undergoing IFS of adnexal masses at Hospital de Clínicas de Porto Alegre, between January2005 and September2011 was performed. Data were collected regarding sonographic size (≤10cm or >10cm), characteristics of the lesion, and diagnosis established in IFS and HPE. Eight groups were studied: unilocular lesions; septated/cystic lesions; heterogeneous (solid/cystic) lesions; and solid lesions, divided in two main groups according to the size of lesion, ≤10cm or >10cm. Kappa agreement between IFS and HPE was calculated for each group. Results: Overall agreement between IFS and HPE was 96.1% for benign tumors, 96.1% for malignant tumors, and 73.3% for borderline tumors. Considering the combination of tumor size and morphology, 100% agreement between IFS and HPE was recorded for unilocular and septated tumors ≤10cm and for solid tumors. Conclusion: Stratification of adnexal masses according to size and morphology is a good method for preoperative assessment. We should wait for final HPE for staging decision, regardless of IFS results, in heterogeneous adnexal tumors of any size, solid tumors ≤10cm, and all non-solid tumors >10cm.

Automated treatment planning for whole breast irradiation with individualized tangential IMRT fields.

PURPOSES: This study aimed to develop and validate algorithms for automating intensity modulated radiation therapy (IMRT) planning in breast cancer patients, with a focus on patient anatomical characteristics. MATERIAL AND METHODS: We retrospectively selected 400 breast cancer patients without lymph node involvement for automated treatment planning. Automation was achieved using the Eclipse Scripting Application Programming Interface (ESAPI) integrated into the Eclipse Treatment Planning System. We employed three beam insertion geometries and three optimization strategies, resulting in 3600 plans, each delivering a 40.05 Gy dose in 15 fractions. Gantry angles in the tangent fields were selected based on a criterion involving the minimum intersection area between the Planning Target Volume (PTV) and the ipsilateral lung in the Beam's Eye View projection. ESAPI was also used to gather patient anatomical data, serving as input for Random Forest models to select the optimal plan. The Random Forest classification considered both beam insertion geometry and optimization strategy. Dosimetric data were evaluated in accordance with the Radiation Therapy Oncology Group (RTOG) 1005 protocol. RESULTS: Overall, all approaches generated high-quality plans, with approximately 94% meeting the acceptable dose criteria for organs at risk and/or target coverage as defined by RTOG guidelines. Average automated plan generation time ranged from 6 min and 37 s to 9 min and 22 s, with the mean time increasing with additional fields. The Random Forest approach did not successfully enable automatic planning strategy selection. Instead, our automated planning system allows users to choose from the tested geometry and strategy options. CONCLUSIONS: Although our attempt to correlate patient anatomical features with planning strategy using machine learning tools was unsuccessful, the resulting dosimetric outcomes proved satisfactory. Our algorithm consistently produced high-quality plans, offering significant time and efficiency advantages.

Uso de íris digitalizada na reabilitação protética ocular / Use of digital iris in ocular prosthetic rehabilitation

Introdução: um dos fatores imprescindíveis no resultado estético satisfatório do tratamento reabilitador protético ocular é a reprodução fiel da íris do olho remanescente na íris protética. Trata-se da dissimulação da perda para os pacientes afetados. Objetivo: este trabalho apresenta uma nova técnica de confecção da íris protética, utilizando imagem fotográfica digitalizada da íris remanescente, em adesivo. Métodos: em razão da fotodegradação que compromete a longevidade das próteses oculares, decidiu-se avaliar a estabilidade das cores, da técnica proposta, por meio de teste de envelhecimento acelerado. Para os ensaios, foram confeccionados corpos de prova simulando a íris protética, reproduzida em adesivo, nas cores verde, azul, marrom e preto. A variação do grau de degradação foi avaliada mediante leitura colorimétrica inicial e após, em três intervalos semanais, durante o envelhecimento artificial com radiação ultravioleta. Resultados: a análise estatística sugere que, quando as cores foram avaliadas em função do período de ensaio de envelhecimento artificial, somente na cor azul houve diferença estatisticamente significativa. Conclusões: nenhuma das cores apresentou uma degradação de cor acima do nível clinicamente aceitável, resultado bastante favorável para a viabilidade da técnica proposta.