Reliability of tumour grade 1 and endometrioid cell type on preoperative endometrial biopsy.

The aim of this study was to evaluate the reliability of using tumour grade and cell type on preoperative endometrial biopsy for the selection of patients for conservative hormone treatment. We retrospectively reviewed results of 643 patients with endometrial carcinoma for tumour grade and 817 for tumour cell type who underwent endometrial biopsy followed by surgery. Of the 357 patients with a grade 1 tumour on preoperative endometrial biopsy, 58 (16.2%) were upgraded based on a final pathology report from hysterectomy specimens. For grade 1, the preoperative endometrial biopsy showed a sensitivity of 80.4%, a specificity of 78.6%, a positive predictive value (PPV) of 83.8% and a negative predictive value (NPV) of 74.5%. Of the 672 patients with the endometrioid cell type on preoperative biopsy, 46 (5.6%) showed a different cell type on final pathology. For the endometrioid cell type, preoperative endometrial biopsy had a sensitivity of 91.3%, a specificity of 64.9%, a PPV of 93.2% and an NPV of 58.6%. This weak predictive value should be considered when selecting patients for conservative hormone treatment.

Age-and region-dependent changes in three-dimensional microstructural properties of proximal femoral trabeculae.

UNLABELLED: This study investigated regional variations in the 3D microstructure of trabecular bone in human proximal femur, with respect to aging. The results demonstrate that age-related changes in trabecular microstructure significantly varied from different sub-regions of the proximal femur. INTRODUCTION: We hypothesize that the age-related changes in trabecular bone microstructure appear to be varied from specific anatomic sub-regions of the proximal femur followed by non-uniform bone loss. The purpose of this study was therefore to explore regional variations in the 3D microstructure of trabecular bone in human proximal femur, with respect to aging. METHODS: A total of 162 trabecular bone cores from six regions of 27 femora of male cadaver donors were scanned using micro-computed tomography (micro-CT). The following microstructural parameters were calculated: bone volume fraction (BV/TV), trabecular number (Tb.N), thickness (Tb.Th) and separation (Tb.Sp), structure model index (SMI), and degree of anisotropy (DOA). RESULTS: Age-related changes in trabecular microstructure varied from different regions of the proximal femur. There was a significant decrease in bone volume fraction and an almost identical decrease in trabecular thickness associated with aging at any region. Regional analysis demonstrated a significant difference in BV/TV, Tb.Th, Tb.Sp, Tb.N and DOA between superior and inferior neck, as well as a significant difference in BV/TV, Tb.Sp, Tb.N, SMI and DOA between superior and inferior trochanter. CONCLUSIONS: Age-related changes in bone loss and trabecular microstructure within the male proximal femur are not uniform in this cadaveric population.

Variations of the 'grand-piano sign' during total knee replacement. A computer-simulation study.

The appearance of the 'grand-piano sign' on the anterior resected surface of the femur has been considered to be a marker for correct femoral rotational alignment during total knee replacement. Our study was undertaken to assess quantitatively the morphological patterns on the resected surface after anterior femoral resection with various angles of external rotation, using a computer-simulation technique. A total of 50 right distal femora with varus osteoarthritis in 50 Korean patients were scanned using computerised tomography. Computer image software was used to simulate the anterior femoral cut, which was applied at an external rotation of 0 degrees, 3 degrees and 6 degrees relative to the posterior condylar axis, and parallel to the surgical and clinical epicondylar axes in each case. The morphological patterns on the resected surface were quantified and classified as the 'grand-piano sign', 'the boot sign' and the 'butterfly sign'. The surgeon can use the analogy of these quantified sign patterns to ensure that a correct rotational alignment has been obtained intra-operatively.