Feasibility of Predicting Surgical Duration in Endometriosis Using Numerical Multi-Scoring System of Endometriosis (NMS-E).

BACKGROUND: Endometriosis is a multifaceted gynecological condition that poses diagnostic challenges and affects a significant number of women worldwide, leading to pain, infertility, and a reduction in patient quality of life (QoL). Traditional diagnostic methods, such as the revised American Society for Reproductive Medicine (r-ASRM) classification, have limitations, particularly in preoperative settings. The Numerical Multi-Scoring System of Endometriosis (NMS-E) has been proposed to address these shortcomings by providing a comprehensive preoperative diagnostic tool that integrates findings from pelvic examinations and transvaginal ultrasonography. METHODS: This retrospective study aims to validate the effectiveness of the NMS-E in predicting surgical outcomes and correlating with the severity of endometriosis. Data from 111 patients at Nippon Medical School Hospital were analyzed to determine the correlation between NMS-E scores, including E-score-a severity indicator-traditional scoring systems, surgical duration, blood loss, and clinical symptoms. This study also examined the need to refine parameters for deep endometriosis within the NMS-E to enhance its predictive accuracy for disease severity. RESULTS: The mean age of the patient cohort was 35.1 years, with the majority experiencing symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. A statistically significant positive correlation was observed between the NMS-E's E-score and the severity of endometriosis, particularly in predicting surgical duration (Spearman correlation coefficient: 0.724, p < 0.01) and blood loss (coefficient: 0.400, p < 0.01). The NMS-E E-score also correlated strongly with the r-ASRM scores (coefficient: 0.758, p < 0.01), exhibiting a slightly more excellent predictive value for surgical duration than the r-ASRM scores alone. Refinements in the methodology for scoring endometriotic nodules in uterine conditions improved the predictive accuracy for surgical duration (coefficient: 0.752, p < 0.01). CONCLUSIONS: Our findings suggest that the NMS-E represents a valuable preoperative diagnostic tool for endometriosis, effectively correlating with the disease's severity and surgical outcomes. Incorporating the NMS-E into clinical practice could significantly enhance the management of endometriosis by addressing current diagnostic limitations and guiding surgical planning.

Target volumes comparison between postoperative simulation magnetic resonance imaging and preoperative diagnostic magnetic resonance imaging for prone breast radiotherapy after breast-conserving surgery.

BACKGROUND: This study investigated the differences in target volumes between preoperative magnetic resonance imaging (MRIpre) and postoperative MRI (MRIpost) for breast radiotherapy after breast-conserving surgery (BCS) using deformable image registration (DIR). METHODS AND MATERIALS: Seventeen eligible patients who underwent whole-breast irradiation in the prone position after BCS were enrolled. On MRIpre, the gross tumor volume (GTV) was delineated as GTVpre, which was then expanded by 10 mm to represent the preoperative lumpectomy cavity (LC), denoted as LCpre. The LC was expanded to the clinical target volume (CTV) and planning target volume (PTV) on the MRIpre and MRIpost, denoted as CTVpre, CTVpost, PTVpre, and PTVpost, respectively. The MIM software system was used to register the MRIpre and MRIpost using DIR. Differences were evaluated regarding target volume, distance between the centers of mass (dCOM), conformity index (CI), and degree of inclusion (DI). The relationship between CILC /CIPTV and the clinical factors was also assessed. RESULTS: Significant differences were observed in LC and PTV volumes between MRIpre and MRIpost (p < 0.0001). LCpre was 0.85 cm3 larger than LCpost, while PTVpre was 29.38 cm3 smaller than PTVpost. The dCOM between LCpre and LCpost was 1.371 cm, while that between PTVpre and PTVpost reduced to 1.348 cm. There were statistically significant increases in CI and DI for LCpost-LCpre and PTVpost-PTVpre (CI = 0.221, 0.470; DI = 0.472, 0.635). No obvious linear correlations (p > 0.05) were found between CI and GTV, primary tumor volume-to-breast volume ratio, distance from the primary tumor to the nipple and chest wall, and body mass index. CONCLUSIONS: Despite using DIR technology, the spatial correspondence of target volumes between MRIpre and MRIpost was suboptimal. Therefore, relying solely on preoperative diagnostic MRI with DIR for postoperative LC delineation is not recommended.

Mapping of the supplementary motor area using repetitive navigated transcranial magnetic stimulation.

Background: The supplementary motor area (SMA) is important for motor and language function. Damage to the SMA may harm these functions, yet tools for a preoperative assessment of the area are still sparse. Objective: The aim of this study was to validate a mapping protocol using repetitive navigated transcranial magnetic stimulation (rnTMS) and extend this protocol for both hemispheres and lower extremities. Methods: To this purpose, the SMA of both hemispheres were mapped based on a finger tapping task for 30 healthy subjects (35.97 ± 15.11, range 21-67 years; 14 females) using rnTMS at 20 Hz (120% resting motor threshold (RMT)) while controlling for primary motor cortex activation. Points with induced errors were marked on the corresponding MRI. Next, on the identified SMA hotspot a bimanual finger tapping task and the Nine-Hole Peg Test (NHPT) were performed. Further, the lower extremity was mapped at 20 Hz (140%RMT) using a toe tapping task. Results: Mean finger tapping scores decreased significantly during stimulation (25.70taps) compared to baseline (30.48; p < 0.01). Bimanual finger tapping led to a significant increase in taps during stimulation (28.43taps) compared to unimanual tapping (p < 0.01). Compared to baseline, completion time for the NHPT increased significantly during stimulation (baseline: 13.6 s, stimulation: 16.4 s; p < 0.01). No differences between hemispheres were observed. Conclusion: The current study validated and extended a rnTMS based protocol for the mapping of the SMA regarding motor function of upper and lower extremity. This protocol could be beneficial to better understand functional SMA organisation and improve preoperative planning in patients with SMA lesions.

A Review of Evidence for the Involvement of the Circadian Clock Genes into Malignant Transformation of Thyroid Tissue.

(1) Background: In 2013, the results of a pioneer study on abnormalities in the levels and circadian rhythmicity of expression of circadian clock genes in cancerous thyroid nodules was published. In the following years, new findings suggesting the involvement of circadian clockwork dysfunction into malignant transformation of thyroid tissue were gradually accumulating. This systematic review provides an update on existing evidence regarding the association of these genes with thyroid tumorigenesis. (2) Methods: Two bibliographic databases (Scopus and PubMed) were searched for articles from inception to 20 March 2023. The reference lists of previously published (nonsystematic) reviews were also hand-searched for additional relevant studies. (3) Results: Nine studies published between 2013 and 2022 were selected. In total, 9 of 12 tested genes were found to be either up- or downregulated. The list of such genes includes all families of core circadian clock genes that are the key components of three transcriptional-translational feedback loops of the circadian clock mechanism (BMAL1, CLOCK, NPAS2, RORα, REV-ERBα, PERs, CRYs, and DECs). (4) Conclusions: Examination of abnormalities in the levels and circadian rhythmicity of expression of circadian clock genes in thyroid tissue can help to reduce the rate of inadequate differential preoperative diagnosis for thyroid carcinoma.

Role of Surgery in Intracranial Tuberculomas and Proposal of a Novel Diagnostic Criteria for Diagnosis (Sri Venkateswara Institute of Medical Sciences Criteria).

OBJECTIVE: Intracranial tuberculomas (IT) are often misdiagnosed or overdiagnosed, resulting either in delay in treatment of this curable illness or in unnecessary surgical intervention. A new method of diagnostic criteria for preoperative diagnosis of IT is proposed. METHODS: A retrospective analysis was performed of all patients with a preoperatively suspected diagnosis of IT who were operated on at our institute from 2010 to 2019. The patients were divided into 2 groups: biopsy-proven IT and biopsy ruled out IT. Tests of diagnostic accuracy were applied for each finding. RESULTS: A total of 69 patients were operated on in the given period, 40 of whom were proved by biopsy as having tuberculoma. In the remaining 29 patients, the biopsy ruled out tuberculoma. Three features were identified as major criteria and 7 features were identified as minor criteria. We suggest that the diagnosis of IT should be made preoperatively, in the presence of 3 major criteria, 2 major and 3 minor criteria, 1 major and 5 minor criteria, or 7 minor criteria. By applying these diagnostic criteria to each of the 69 patients, we could diagnose IT in all 40 patients and exclude IT in all 29 patients preoperatively. CONCLUSIONS: We suggest that empirical antituberculous treatment should be started in a patient without the need for invasive surgery if our criteria are met. If the criteria are not met, we suggest further evaluation of the patient for an alternative diagnosis or early surgery for definitive management. Surgery decreases the duration of antituberculous treatment and helps in early resolution of lesions.

Clinical impact of pre-treatment FDG-PET/CT staging of primary ovarian, fallopian tube, and peritoneal cancers in women.

INTRODUCTION: To assess the clinical impact of preoperative fludeoxyglucose (FDG) with positron emission tomography (PET) and computed tomography (CT) in women with ovarian, fallopian tube, or peritoneal cancer with focus on consequences of added findings (AFs). MATERIAL AND METHODS: FDG-PET/CT was implemented as a standard imaging modality for women with newly diagnosed ovarian, fallopian tube, or peritoneal cancer at our institution in 2008. After full implementation, all preoperative scans were reviewed and AFs were evaluated from January 2011 to December 2012. Decisions regarding further examination made at the first multidisciplinary team conference were recorded. Subsequent procedures were tracked via medical records, and the impact of AFs on additional examinations, delay, and change in treatment plans was evaluated. RESULTS: Forty-four (21.1%) of 209 women presented with AFs. Further examination was performed in 35/44 (79.5%). Malignancy was identified in 15/35 (42.9%), revealing metastases from ovarian, fallopian tube, or peritoneal cancer in 11, a synchronous primary cancer in 3, and recurrence of a previous cancer in 1 woman. The ovarian, fallopian tube, or peritoneal cancer metastases were localized in the lungs, uterus, colon, vagina, and breasts. The remaining 20 AFs revealed 2 benign lesions and 1 pre-malignant lesion, whereas no abnormality was found in 17. Further examination of AFs resulted in a significant time delay until treatment start of median 4 days (range 1-83 days, P < 0.004). CONCLUSIONS: Further examinations of AFs by FDG-PET/CT delayed time to start of treatment by median 4 days in women with newly diagnosed ovarian, fallopian tube, or peritoneal cancer in a contemporary institution with fast-track access to additional diagnostics. The clinical implications of this must be balanced against the gain of detecting unrecognized malignancy in 15 of 209 women (7.2%).

Perioperative Guidelines in Anesthesia.

Agreement between surgical and anesthesia teams regarding appropriate perioperative management strategies is vital to delivering safe and effective patient care. Perioperative guidelines serve as a valuable reference in optimizing patients for surgery. The article provides a broad set of guidelines related to cardiovascular evaluation, medication reconciliation, and preoperative fasting and includes a framework for the care of patients with comorbidities, such as coronary artery disease and obstructive sleep apnea.

A comparative study based on deformable image registration of the target volumes for external-beam partial breast irradiation defined using preoperative prone magnetic resonance imaging and postoperative prone computed tomography imaging.

BACKGROUND: To explore the differences and correlations between the target volumes defined using preoperative prone diagnostic magnetic resonance imaging (MRI) and postoperative prone computed tomography (CT) simulation imaging based on deformable image registration (DIR) for external-beam partial breast irradiation (EB-PBI) after breast-conserving surgery (BCS). METHODS: Eighteen breast cancer patients suitable for EB-PBI were enrolled. Preoperative prone diagnostic MRI and postoperative prone CT scan sets for all the patients were acquired during free breathing. Target volumes and ipsilateral breast were all contoured by the same radiation oncologist. The gross tumor volume (GTV) delineated on the preoperative MRI images was denoted as the GTVpreMR and the tumor bed (TB) delineated on the postoperative prone CT images was denoted as the GTVpostCT. The MIM software system was used to deformably register the MRI and CT images. RESULTS: When based on the coincidence of the compared target centers, there were statistically significant increases in the conformity index (CI) and degree of inclusion (DI) values for GTVpostCT-GTVpreMR, GTVpostCT-CTVpreMR + 10, CTVpostCT + 10-GTVpreMR, and CTVpostCT + 10-CTVpreMR + 10 when compared with those based on the DIR of the thorax (Z = - 3.724, - 3.724, - 2.591, - 3.593, all P < 0.05; Z = -3.724, - 3.724, - 3.201, - 3.724, all P < 0.05, respectively). CONCLUSIONS: Although based on DIR, there was relatively poor spatial overlap between the preoperative prone diagnostic MRI images and the postoperative prone CT simulation images for either the whole breast or the target volumes. Therefore, it is unreasonable to use preoperative prone diagnostic MRI images to guide postoperative target delineation for EB-PBI.

Preoperative biopsy does not affect postoperative outcomes of resectable non-small cell lung cancer.

OBJECTIVES: Preoperative diagnostic interventions such as transbronchial biopsy and/or computed tomography-guided biopsy inevitably disrupt the lung structures and may disseminate tumour cells into the airway, vessels, or pleural cavity. Therefore, these procedures may affect the postoperative outcomes. Thus, we aimed to compare the survival outcomes in patients diagnosed by transbronchial biopsy vs computed tomography-guided biopsy vs lung resection. METHODS: In a single-institution retrospective analysis, data from consecutive patients with cTanyN0M0 lung cancer, who underwent surgery between January 2006 and December 2012, were extracted by chart review. The overall and recurrence-free survivals of patients diagnosed by transbronchial biopsy, computed tomography-guided biopsy, and lung resection were compared using the univariate and multivariate Cox proportional hazard models. A stepwise backward elimination method, with a probability level of 0.15, was used to select the most powerful sets of outcome predictors. RESULTS: Transbronchial biopsy and/or computed tomography-guided biopsy were performed for larger and more advanced tumours, than lung resection (intra- or postoperative-diagnosis group). At crude analysis, transbronchial biopsy group and computed tomography-guided biopsy group showed higher probability of pleural dissemination, and worse prognosis than the lung resection group. At multivariate analysis, the diagnostic methods were not identified as independent risk factors of pleural dissemination, overall survival, or recurrence-free survival. CONCLUSIONS: Preoperative diagnostic interventions did not affect the relapse risk and prognosis, in this study cohort. Thus, preoperative diagnostic intervention is recommended if deemed necessary.

A comparative study of target volumes based on deformation registration using preoperative prone magnetic resonance imaging and postoperative prone computed tomography imaging for patients undergoing breast-conserving surgery / 中华放射医学与防护杂志

Objective@#To explore the differences and correlation between the target volumes based on deformation registration (DIR) using preoperative prone diagnostic magnetic resonance (MR) imaging and postoperative prone computed tomography (CT) simulation imaging for patients undergoing breast-conserving surgery (BCS).@*Methods@#Eighteen breast cancer patients suitable for external-beam partial breast irradiation (EB-PBI) after BCS were enrolled. Preoperative prone diagnostic MR and postoperative prone CT scan sets were acquired during free breathing for all patients. The gross tumor volume (GTV) delineated on the preoperative diagnostic MR images was defined as GTVMRI, the clinical target volumes (CTVMRI+ 1 and CTVMRI+ 2)were defined as 10 and 20 mm margins around the GTVMRI, and the planning target volume (PTVMRI+ 1 and PTVMRI+ 2) were defined as 15 and 25 mm margins around the GTVMRI, respectively. Tumor bed (TB) delineated on the postoperative prone CT simulation images acquired during free breathing was defined as GTVTB, CTV and PTV were defined as 10 and 15 mm margins around the GTVTB, respectively. The target volume of the whole breast contoured on the MR and CT images were defined as CTVBreast-MRI and CTVBreast-CI, respectively. The MR and CT images were registered deformably in MIM software system.@*Results@#The GTVTB, CTVTB and PTVTB were significantly greater than GTVMRI, GTVMRI+ 1 and PTVMRI+ 1, respectively (Z=-3.593, -3.593, -2.983, P<0.05). Meanwhile, the CTVTB and PTVTB were significantly less than the CTVMRI+ 2 and PTVMRI+ 2, respectively(Z=-2.722, -2.853, P<0.05). The conformal index (CI) and degree of inclusion (DI) of GTVTB-GTVMRI, GTVTB-CTVMRI+ 1, CTVTB-GTVMRI and CTVTB-GTVMRI+ 1 based on center-coincidence of the compared targets were better than those based on DIR of the thorax(Z=-3.724、-3.724、-2.591、-3.593, P<0.05; Z=-3.724、-3.724、-3.201、-3.724, P<0.05).@*Conclusions@#For the patients enrolled for prone EB-PBI, target volumes delineated on the preoperative prone MR images were significantly smaller compared to that on the postoperative prone CT images, but a statistically significant positive correlation was found between the MR and CT target volumes. There were still relatively poor spatial overlap whether for the whole breast or the targets between the preoperative prone diagnostic MR images and the postoperative prone simulation CT images based on DIR. Therefore, it is infeasible to guide postoperative EB-PBI target delineation using the preoperative prone diagnostic MR images.

Perioperative Colonic Evaluation in Patients with Rectal Cancer; MR Colonography Versus Standard Care.

RATIONALE AND OBJECTIVES: Preoperative colonic evaluation is often inadequate because of cancer stenosis making a full conventional colonoscopy (CC) impossible. In several studies, cancer stenosis has been shown in up to 16%-34% of patients with colorectal cancer. The purpose of this study was to prospectively evaluate the completion rate of preoperative colonic evaluation and the quality of perioperative colonic evaluation using magnetic resonance colonography (MRC) in patients with rectal cancer. MATERIALS AND METHODS: Patients diagnosed with rectal cancer were randomized to either group A: standard preoperative diagnostic work-up or group B: preoperative MR diagnostic work-up (standard preoperative diagnostic work-up + MRC). A complete and adequate perioperative clean-colon evaluation (PCE) was defined as either a complete preoperative colonic evaluation or a complete colonic evaluation within 3 months postoperatively. RESULTS: Twenty-eight patients were randomized to group A and 28 to group B. Complete preoperative colonic evaluation with CC was achieved in 39% patients in group A and 93% for group B (Fisher's exact test, P < .001). PCE with CC was achieved in 64% and 93% in groups A and B, respectively (Fisher's exact test, P = .02). In group A, one synchronous cancer was found by CC. However, the location was misjudged as a sigmoid cancer. In group B, two synchronous cancers were found in the same patient who had an insufficient preoperative CC due to an obstructing rectal cancer. CONCLUSIONS: MRC is a valuable tool and is recommended as part of the standard preoperative evaluation for patients with rectal cancer.

The role of routine preoperative EUS when performed after contrast enhanced CT in the diagnostic work-up in patients suspected of pancreatic or periampullary cancer.

BACKGROUND: In patients suspected of pancreatic or periampullary cancer, abdominal contrast-enhanced computed tomography (CT) is the standard diagnostic modality. A supplementary endoscopic ultrasonography (EUS) is often performed, although there is only limited evidence of its additional diagnostic value. The aim of the study is to evaluate the additional diagnostic value of EUS over CT in deciding on exploratory laparotomy in patients suspected of pancreatic or periampullary cancer. METHODS: We retrospectively analyzed 86 consecutive patients who routinely underwent CT and EUS before exploratory laparotomy with or without pancreatoduodenectomy for suspected pancreatic or periampullary carcinoma between 2007 and 2010. Primary outcomes were visibility of a mass, resectability on CT/EUS and resection with curative intent. RESULTS: A mass was visible on CT in 72/86 (84%) patients. In these 72 patients, EUS demonstrated a mass in 64/72 (89%) patients. Resectability was accurately predicted by CT in 65/72 (90%) and by EUS in 58/72 (81%) patients. In 14/86 (16%) patients no mass was seen on CT. EUS showed a mass in 12/14 (86%) of these patients. A malignant lesion was histological proven in 11/12 (92%) of these patients. Overall, resectability was accurately predicted by CT and EUS in 90% (77/86) and 84% (72/86), respectively. CONCLUSIONS: In patients with a visible mass on CT, suspected for pancreatic or periampullary cancer, EUS has no additional diagnostic value, does not influence the decision to perform laparotomy and should therefore not be performed routinely. In patients without a visible mass on CT, EUS is useful to confirm the presence of a tumor.

Comparing and Filtrating the Methods to Improve the Preoperative Earlier Diagnostic Accordance Rate of the Breast Cancer / 医学研究杂志

Objective To explore the preoperative misdiagnosis in the breast cancer and the methods to improve the diagnostic accordance rate. Methods The preoperative diagnosis and results of 358 cases with breast cancer has been analysized retrospectively in the recent ten years. Results Total Cases with present diagnostic technique diagnosed befor operation was 176 only;the accordance rate was less than 50%.With aspiration biopsy and molybdenum palladium roentgenograph,the rate was 25%(79 cases).The actual preoperative accordance rate was less than 10%(32 cases).It is said approximately 90% cases were postoperatively diagnosed. Conclusion The present excision biopsy not only has made many patients lost the chance of chemotherapy preoperation, but also interferenced the application of new therapic methods in the clinical practice.Infrared spectroscopy and ultrasonography have been commonly used in the clinical practice.With the low diagnostic accordance rate,they were applied only for screening.With simplity and high diagnostic accor dance rate,aspiration biopsy and molybdenum pall adium roentgenograph should be enrolled extensively in the clinical practice. The puncture and specimen fixing technique also should be improved.

Clinical analysis of preoperative diagnostic methods in small sized lung cancer (≤3 cm) / 中国癌症杂志

Purpose:Analyzing diagnostic accuracy of various methods in preoperative small sized lung cancer (≤3 cm).Methods:Retrospective analyses of the accuracy of sputum, fiberoptic bronchoscopy, CT guided percutaneous aspiration in 266 cases lung cancer with the primary lesion diameter less than or equal to 3 cm. Results:The application of sputum and TBB brush are higher than others, TBB biopsy and CT guided percutaneous aspiration have higher accuracy. The positive rates of sputum and fiberoptic bronchoscopy brush are higher in central lesion than in peripheral type, P