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2.
Ann Surg Oncol ; 2024 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-38954095

RESUMEN

BACKGROUND: With nodal surveillance increasingly used for sentinel lymph node-positive (SLN+) melanoma following the Second Multicenter Selective Lymphadenectomy Trial (MSLT-II), high-quality nodal ultrasonography (U/S) has become a critical need. Previous work has demonstrated low utilization of MSLT-II U/S criteria to define abnormal lymph nodes requiring intervention or biopsy. To address this gap, an evidence-based synoptic template was designed and implemented in this single-center study. METHODS: Sentinel lymph node-positive patients undergoing nodal surveillance at a tertiary cancer center from July 2017 to June 2023 were identified retrospectively. Ultrasound reporting language was analyzed for MSLT-II criteria reported and clinically actionable recommendations (e.g., normal, abnormal with recommendation for biopsy). Following a multidisciplinary design process, the synoptic template was implemented in January 2023. Postimplementation outcomes were evaluated by using U/S reports and provider surveys. RESULTS: A total of 337 U/S studies were performed on 94 SLN+ patients, with a median of 3 U/S per patient (range 1-12). Among 42 synoptic-eligible U/S performed postimplementation, 32 U/S (76.0%) were reported synoptically. Significant increases were seen in the number of MSLT-II criteria reported (Pre 0.5 ± 0.8 vs. Post 2.5 ± 1.0, p < 0.001), and clinically actionable recommendations for abnormal findings (Pre 64.0% vs. Post 93.0%, p = 0.04). Nearly all surgeon and radiologist survey respondents were "very" or "completely" satisfied with the clinical utility of the synoptic template (90.0%). CONCLUSIONS: Following implementation of a synoptic template, U/S reports were significantly more likely to document MSLT-II criteria and provide an actionable recommendation, increasing usefulness to providers. Efforts to disseminate this synoptic template to other centers are ongoing.

3.
Abdom Radiol (NY) ; 2024 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-38763936

RESUMEN

Ultrasound (US) is the imaging modality of choice for evaluation of superficial palpable lesions. A large proportion of these lesions have characteristic sonographic appearance and can be confidently diagnosed with US without the need for biopsy or other intervention. The Society of Radiologists in Ultrasound (SRU) recently published a Consensus Conference Statement on superficial soft tissue masses. The goal of this manuscript is (a) to serve as a sonographic pictorial review for palpable lesions based on the SRU statement, (b) present the typical sonographic features of palpable lesions that can be confidently diagnosed with US, and (c) provide an overview of other palpable lesions with a framework to interpret the US studies and advise on appropriate further management.

4.
Radiology ; 310(1): e230453, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38259204

RESUMEN

Background Splenic biopsy is rarely performed because of the perceived risk of hemorrhagic complications. Purpose To evaluate the safety of large bore (≥18 gauge) image-guided splenic biopsy. Materials and Methods This retrospective study included consecutive adult patients who underwent US- or CT-guided splenic biopsy between March 2001 and March 2022 at eight academic institutions in the United States. Biopsies were performed with needles that were 18 gauge or larger, with a comparison group of biopsies with needles smaller than 18 gauge. The primary outcome was significant bleeding after the procedure, defined by the presence of bleeding at CT performed within 30 days or angiography and/or surgery performed to manage the bleeding. Categorical variables were compared using the χ2 test and medians were compared using the Mann-Whitney test. Results A total of 239 patients (median age, 63 years; IQR, 50-71 years; 116 of 239 [48.5%] female patients) underwent splenic biopsy with an 18-gauge or smaller needle and 139 patients (median age, 58 years [IQR, 49-69 years]; 66 of 139 [47.5%] female patients) underwent biopsy with a needle larger than 18 gauge. Bleeding was detected in 20 of 239 (8.4%) patients in the 18-gauge or smaller group and 11 of 139 (7.9%) in the larger than 18-gauge group. Bleeding was treated in five of 239 (2.1%) patients in the 18-gauge or smaller group and one of 139 (1%) in the larger than 18-gauge group. No deaths related to the biopsy procedure were recorded during the study period. Patients with bleeding after biopsy had smaller lesions compared with patients without bleeding (median, 2.1 cm [IQR, 1.6-5.4 cm] vs 3.5 cm [IQR, 2-6.8 cm], respectively; P = .03). Patients with a history of lymphoma or leukemia showed a lower incidence of bleeding than patients without this history (three of 90 [3%] vs 28 of 288 [9.7%], respectively; P = .05). Conclusion Bleeding after splenic biopsy with a needle 18 gauge or larger was similar to biopsy with a needle smaller than 18 gauge and seen in 8% of procedures overall, with 2% overall requiring treatment. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Grant in this issue.


Asunto(s)
Biopsia Guiada por Imagen , Agujas , Bazo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Angiografía , Biopsia Guiada por Imagen/efectos adversos , Agujas/efectos adversos , Agujas/estadística & datos numéricos , Estudios Retrospectivos , Bazo/diagnóstico por imagen , Bazo/patología , Anciano
6.
Abdom Radiol (NY) ; 46(5): 2140-2145, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33151361

RESUMEN

PURPOSE: To determine the prevalence of isolated right-sided varicocele due to an obstructing malignancy in patients with no other evidence of malignancy. METHODS: This retrospective, multi-institutional study included a text search for right-sided varicocele in consecutive reports of scrotal ultrasound studies performed between 4/22/1999 and 06/24/2018. Diagnosis was confirmed by a radiologist based on the following criteria: pampiniform plexus vein diameter of ≥ 2 mm, which has augmented flow or increases by ≥ 1 mm on Valsalva. Inclusion criteria for adequate follow-up were (1) abdominopelvic CT or MRI performed within 3 months prior to, or any time after, the ultrasound study; or (2) presence of clinical documentation more than 2 years after the ultrasound date. Exclusion criteria were existing cancer diagnosis in the abdomen or pelvis, epididymo-orchitis, intratesticular or intrascrotal mass, and prior scrotal surgery. Images of available CT or MRI studies were reviewed for presence of any explanation of right-sided varicocele. RESULTS: 210 patients with right-sided varicocele met inclusion and exclusion criteria. 118/210 had abdominopelvic CT or MRI in the assigned timeframe. Of these, no patients had malignancy that could account for right-sided varicoceles. Of the 92/210 patients without CT or MRI but with available clinical follow-up, none had a malignancy that could have caused an isolated right-sided varicocele. There was no underlying malignancy to explain the right-sided varicocele in any of the patients, 0/210, 95% CI [0.0-1.4%]. CONCLUSION: No associated malignancy was found in patients with isolated right-sided varicoceles to support additional imaging for malignancy screening.


Asunto(s)
Neoplasias , Varicocele , Humanos , Masculino , Estudios Retrospectivos , Escroto/diagnóstico por imagen , Ultrasonografía , Varicocele/diagnóstico por imagen
7.
Radiol Imaging Cancer ; 2(4): e190074, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33778722

RESUMEN

Purpose: To investigate the prognostic value of differential enhancement on baseline dual-energy CT images in patients with treatment-naive pancreatic ductal adenocarcinoma (PDAC), with a focus on tumor-host interface characterization. Materials and Methods: This was a retrospective, institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study of 158 consecutive adult patients (mean age, 68 years; age range, 40.9-88.9 years; 50% women) with histopathologically proven, treatment-naive PDAC, who had undergone multiphasic pancreatic dual-energy CT from December 2011 to March 2017. Regions of interest in tumor core, tumor border, pancreas border with tumor, nontumoral pancreas, and aorta were recorded on pancreatic parenchymal phase (PPP) dual-energy CT 70-keV, 52-keV, and iodine material density (MD) images, plus portal venous phase (PVP) conventional CT images. Enhancement gradient (delta) across the tumor-pancreas interface was calculated. Delta was evaluated combining the dual-energy CT values with the PVP values and as individual predictors. Receiver operating characteristic analysis with logistic regression was used to determine the optimal cut point for each dual-energy CT delta to predict disease outcome based on highest Youden index. Survival curves were generated using Kaplan-Meier method, and comparison between two independent groups (high and low delta) was evaluated with log-rank test. Clinical outcomes included overall survival and distant metastasis-free survival. Three independent blinded radiologists visually scored tumor conspicuity (subjective delta score) on a 1-5 scale, and agreement was evaluated with κ statistic. Results: Ninety-three patients had advanced stage (50 locally advanced and 43 metastatic) and 65 had lower stage (48 resectable and 17 borderline resectable) tumors. Patients with high delta tumors (≥ 40 HU) on either 70-keV PPP images or conventional PVP images had significantly shorter overall survival compared with those with low delta tumors (< 40 HU) in both early stage PDAC (13.5 months vs 23.3 months; hazard ratio [HR], 1.87; 95% confidence interval [CI]: 1.01, 3.5; P = .04) and advanced stage PDAC (10.8 months vs 18.0 months; HR, 2.1; 95% CI: 1.28, 3.6; P = .003). Qualitative visual scoring of tumor conspicuity also showed shorter overall survival in patients with more conspicuous tumors. Highest interreader agreement for subjective delta score was 0.73 and 0.60 using iodine MD and 52-keV images, respectively. Conclusion: Increased quantitative and qualitative border conspicuity (high delta) is associated with shorter survival in patients with PDAC. Agreement on the subjective qualitative characterization of PDAC borders is best achieved using iodine MD and lower-energy simulated monoenergetic images at pancreatic protocol dual-energy CT.Keywords: Abdomen/GI, CT, CT-Dual Energy, CT-Quantitative, PancreasSupplemental material is available for this article.© RSNA, 2020.


Asunto(s)
Adenocarcinoma , Neoplasias Pancreáticas , Imagen Radiográfica por Emisión de Doble Fotón , Adenocarcinoma/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico por imagen , Pronóstico , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
8.
Radiol Clin North Am ; 57(3): 585-600, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30928079

RESUMEN

Renal masses are common incidental findings. Although most are benign, it is important to evaluate for features concerning for malignancy. Because of its relative low cost; excellent differentiation among simple cysts, complex cysts, and solid lesions; and lack of ionizing radiation, ultrasound is the preferred modality for initial workup of renal lesions. Given the increasing availability of contrast-enhanced ultrasound, more and more lesions are now able to be completely characterized by sonography alone, including use of the Bosniak criteria.


Asunto(s)
Enfermedades Renales/diagnóstico por imagen , Ultrasonografía/métodos , Medios de Contraste , Diagnóstico Diferencial , Humanos , Sensibilidad y Especificidad
9.
J Thorac Cardiovasc Surg ; 144(1): 81-6, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22498085

RESUMEN

OBJECTIVE: Patients with medically inoperable nonsmall-cell lung cancer generally have limited staging of the mediastinum using computed tomography and combined positron emission tomography and computed tomography, before stereotactic radiosurgery. Historical data have demonstrated the superiority of tissue sampling techniques such as endobronchial ultrasonography and mediastinoscopy compared with imaging studies in accurately determining the nodal stage. We believe, that at a minimum, mediastinal interrogation with endobronchial ultrasonography should be performed before patients undergo stereotactic radiosurgery. METHODS: A retrospective review of 59 consecutive patients undergoing bronchoscopic fiducial marker placement as potential candidates for stereotactic radiosurgery was done. All these patients had undergone endobronchial ultrasonography to assess the mediastinum. Transbronchial needle aspirates were taken using standard criteria defined by a lymph node size greater than 5 mm in diameter and/or in the appropriate lymph node drainage pathway. The biopsies were reviewed by the institution's pathologists. RESULTS: Mediastinal lymph node specimens were not taken in 9 patients because they did not meet our criteria. Of the 50 patients who underwent mediastinal lymph node sampling, 10 had evidence of nodal involvement. On review, 2 of these 10 patients had evidence of mediastinal adenopathy on computed tomography. After excluding those 2 patients, the mediastinal lymph nodes were positive for metastatic disease in 8 (16%) of 50 patients without previous radiographic evidence of disease. These patients were previously thought to be suitable candidates for stereotactic radiosurgery. Also 5 of 10 patients with endobronchial ultrasound-positive lymph nodes had had positron emission tomography-negative findings in the mediastinum. Finally, 10% of the patients suspected to have stage II or III were downstaged with endobronchial ultrasonography and considered for stereotactic radiosurgery. CONCLUSIONS: Endobronchial ultrasonography-transbronchial needle aspirates is more accurate than computed tomography and positron emission tomography in staging the mediastinum, can be performed with minimal morbidity, and should be considered for all patients considered candidates for stereotactic radiosurgery.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Mediastino/patología , Anciano , Anciano de 80 o más Años , Biopsia con Aguja , Broncoscopía , Carcinoma de Pulmón de Células no Pequeñas/patología , Endosonografía , Femenino , Marcadores Fiduciales , Humanos , Neoplasias Pulmonares/patología , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Radiocirugia , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
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