Journal articles on the topic 'Intraoperative cancer diagnostics'
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Rzepakowska, Anna. "Modern diagnostics of early glottic cancer." Polski Przegląd Otorynolaryngologiczny 9, no. 4 (December 7, 2020): 1–5. http://dx.doi.org/10.5604/01.3001.0014.5706.
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This article is a review of literature and a summary of the current guidelines in the diagnosis of hypertrophic vocal folds suspected of malignancy. It gives a detailed overview both of initial diagnosis, as well as the methods of in-depth intraoperative diagnostics and proposals for careful evaluation during post-treatment follow-up examinations.
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Putova, M. V., K. K. Noskova, B. A. Pomortsev, N. E. Semenov, and R. E. Izrailov. "CYTOLOGICAL DIAGNOSTICS OF INTRAOPERATIVE PERITONEAL WASHES IN GASTRIC CANCER." Russian Clinical Laboratory Diagnostics 64, no. 4 (October 7, 2019): 225–28. http://dx.doi.org/10.18821/0869-2084-2019-64-4-225-228.
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Diagnosis of peritoneal microcanceromatosis is the most important task allowing to determine treatment strategy for patients with stomach cancer. Laparoscopy combined with peritoneal flushing and subsequent cytological examination should be performed to detect the peritoneal microcanceromatosis at the preoperative stage. The objective of this work was to improve cytological diagnostics of peritoneal washings using immunocytochemical techniques and the cell block method. The work was carried out on the basis of 276 surgical peritoneal washings in patients with stomach cancer who were on treatment in the department of high-tech surgery of the Moscow Clinical Scientific Centre of the State Budgetary Healthcare Institution named after Loginov A.S. from June 2016 to June 2018. As a result, the optimal panel of monoclonal antibodies (Ber-EP4, CEA, CK20) was chosen, which increased the sensitivity from 52% to 96% and the specificity of cytological diagnosis from 80% to 98%, and the overall accuracy of the method from 67% to 98%.
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Reshetov, I., E. Filonenko, A. Golubtsov, and E. Kirpa. "8584 POSTER Intraoperative Photodynamical Navigation in Thyroid Cancer Diagnostics." European Journal of Cancer 47 (September 2011): S568. http://dx.doi.org/10.1016/s0959-8049(11)72226-2.
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Saevets, V. V., A. Y. Shamanova, Y. A. Semenov, and A. V. Chizhovskaja. "Diagnostic possibilities and limitations of urgent intraoperative pathologicanatomical studies in oncogynecology." Ural Medical Journal 20, no. 2 (July 19, 2021): 8–13. http://dx.doi.org/10.52420/2071-5943-2021-20-2-5-11.
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Introduction. One of the variants of intravital pathological and anatomical diagnostics is intraoperative pathological and anatomical ("urgent") examination, which serves for tumor process verification. Urgent intraoperative pathological and anatomical examination is widely used when there are certain differential diagnostic difficulties and limitations of instrumental methods of examination.The purpose of the study — to analyze the possibilities, limitations and the accuracy of "urgent" pathologic and anatomical diagnostics in oncogynecological diseases. Materials and methods. We retrospectively analyzed medical records of 378 inpatients treated in the gynecologic oncology department of CHOKZO and NM for the period from January 2016 to January 2021. Results and discussion. Urgent histological examination was used to diagnose ovarian tumors (82%, n=310); to evaluate the extent of a tumor process in uterine body cancer, ovarian cancer, cervical cancer (peritoneal carcinomatosis, ingrowth into adjacent tissues and organs) (15%, n=57); less often to evaluate resection margin ablation in cervical cancer, uterine body cancer (3%, n=11). In a comparison of conclusions after urgent morphological examination and conduction of material, discrepancies were registered only in hypodiagnostic ovarian tumors (in 5.8% of all "urgent" ovarian tumor studies, n=18), when the question about the malignancy potential of a process cannot be reliably decided. The reliability of intraoperative morphological verification of the process is 94.2%. The sensitivity is 96%, specificity is 97%, which is consistent with the results of other studies. Conclusions. Intraoperative morphological diagnosis is a highly specific and highly sensitive method of investigation. There are limitations of this diagnostic method depending on the volume of tissue material, quality of cryostat sections, as well as tumor features (e.g., ovarian masses) consisting of heterologous morphological areas. A compliant, multidisciplinary approach is required to successfully meet the challenges of intraoperative examination.
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Farrakhova, Dina, Artem Shiryaev, Dmitry Yakovlev, Kanamat Efendiev, Yulia Maklygina, Alexandr Borodkin, Maxim Loschenov, et al. "Trials of a Fluorescent Endoscopic Video System for Diagnosis and Treatment of the Head and Neck Cancer." Journal of Clinical Medicine 8, no. 12 (December 17, 2019): 2229. http://dx.doi.org/10.3390/jcm8122229.
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This article presents the results of intraoperative fluorescent diagnostics via the endoscopic system for assessing the quality of photodynamic therapy (PDT) of head and neck cancer. The diagnosis and PDT procedures were performed on the five patients with malignant neoplasms of the vocal cords, lateral surface of the tongue, and trachea and cancer of the left parotid salivary gland. Molecular form of chlorin E6 (Ce6) was intravenously administered with a 1.0–1.1 mg/kg concentration for PDT. Fluorescent diagnostics (FD) was conducted before PDT and after PDT procedures. Control of PDT efficiency was carried out by evaluating the photobleaching of the drug (photosensitizer). The method of intraoperative fluorescent imaging allows determining the exact location of the tumor and its boundaries. The assessment of photosensitizer photobleaching in real time regime allows making quick decisions during PDT procedure, which helps improving the quality of patients’ treatment. The results showed the convenience of endoscopic fluorescent video system in various nosologies of head and neck cancer. Therefore, this diagnostic approach will improve the effectiveness of cancer treatment.
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SUN, JONATHAN G., STEVEN G. ADIE, ERIC J. CHANEY, and STEPHEN A. BOPPART. "SEGMENTATION AND CORRELATION OF OPTICAL COHERENCE TOMOGRAPHY AND X-RAY IMAGES FOR BREAST CANCER DIAGNOSTICS." Journal of Innovative Optical Health Sciences 06, no. 02 (April 2013): 1350015. http://dx.doi.org/10.1142/s1793545813500156.
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Pre-operative X-ray mammography and intraoperative X-ray specimen radiography are routinely used to identify breast cancer pathology. Recent advances in optical coherence tomography (OCT) have enabled its use for the intraoperative assessment of surgical margins during breast cancer surgery. While each modality offers distinct contrast of normal and pathological features, there is an essential need to correlate image-based features between the two modalities to take advantage of the diagnostic capabilities of each technique. We compare OCT to X-ray images of resected human breast tissue and correlate different tissue features between modalities for future use in real-time intraoperative OCT imaging. X-ray imaging (specimen radiography) is currently used during surgical breast cancer procedures to verify tumor margins, but cannot image tissue in situ. OCT has the potential to solve this problem by providing intraoperative imaging of the resected specimen as well as the in situ tumor cavity. OCT and micro-CT (X-ray) images are automatically segmented using different computational approaches, and quantitatively compared to determine the ability of these algorithms to automatically differentiate regions of adipose tissue from tumor. Furthermore, two-dimensional (2D) and three-dimensional (3D) results are compared. These correlations, combined with real-time intraoperative OCT, have the potential to identify possible regions of tumor within breast tissue which correlate to tumor regions identified previously on X-ray imaging (mammography or specimen radiography).
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Xu, Jian, David Kooby, Brad Kairdolf, and Shuming Nie. "New horizons in intraoperative diagnostics of cancer in image and spectroscopy guided pancreatic cancer surgery." European Journal of Molecular & Clinical Medicine 1 (September 7, 2017): 2. http://dx.doi.org/10.1016/j.nhccr.2017.06.139.
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Pirro, V., A. K. Jarmusch, C. M. Alfaro, E. M. Hattab, A. A. Cohen-Gadol, and R. Graham Cooks. "Utility of neurological smears for intrasurgical brain cancer diagnostics and tumour cell percentage by DESI-MS." Analyst 142, no. 3 (2017): 449–54. http://dx.doi.org/10.1039/c6an02645a.
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Yang, Lingxiao, Jaena Park, Marina Marjanovic, Eric J. Chaney, Darold R. Spillman, Heidi Phillips, and Stephen A. Boppart. "Intraoperative Label-Free Multimodal Nonlinear Optical Imaging for Point-of-Procedure Cancer Diagnostics." IEEE Journal of Selected Topics in Quantum Electronics 27, no. 4 (July 2021): 1–12. http://dx.doi.org/10.1109/jstqe.2021.3054578.
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Rumyantsev, P. O., A. A. Bubnov, P. V. Sviridov, P. A. Nikiforovich, A. A. Trukhin, and S. V. Korenev. "MOLECULAR IMAGING AND INTRAOPERATIVE RADIONAVIGATION IN PROSTATE CANCER." Siberian journal of oncology 20, no. 4 (August 30, 2021): 108–15. http://dx.doi.org/10.21294/1814-4861-2021-20-4-108-115.
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Introduction. Prostate cancer is one of the most common malignant neoplasms. Strategies to improve early diagnosis and subsequent therapy are being improved. An emphasis is placed on maintaining the quality of life and working capacity of patients after treatment. This can be achieved by improving methods of focal therapy, which depends on the accuracy of topical diagnosis and classification of the tumor. Hybrid molecular imaging (pet/ct and spect/ct) is used in addition to the methods of structural imaging (ultrasound, ct, mri). Intraoperative imaging using radionavigation systems is also used in open and endoscopic surgery for prostate cancer. Currently, it is a tool capable of reducing the invasiveness of surgery, localizing the area of metastatic lesions with a sensitivity and specificity of up to 95 %.Objective of the study: an overview of current and promising future methods of intraoperative radio navigation in the surgical treatment of prostate cancer.Material and methods. The review presents the methods of intraoperative radionavigation in the surgical treatment of prostate cancer. Radionavigation in the context of using tumarotropic radiopharmaceutical based on a prostate-specific membrane antigen, in which the drug accumulates in all tumor foci expressing this receptor, is also considered.Conclusion. The use of preoperative hybrid imaging and radio-guided surgery facilitate lesion identification and resection. Gamma probing allows detection of psma-positive tumor foci regardless of their depth. Fluorescence imaging methods (icg, photodynamic diagnostics, autofluorescence) are also used for intraoperative detection of pathological foci in real time. Multichannel gamma probing and cherenkov radiation detection, which combine the advantages of indirect and direct intraoperative imaging, have enormous potential.
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Starkova, M. V., E. N. Slavnova, and A. D. Zikiryakhodzhaev. "Application of fluorescent immunocytochemistry in intraoperative diagnostics of metastases in sentinel lymph nodes in early breast cancer." Russian Clinical Laboratory Diagnostics 67, no. 1 (January 21, 2022): 31–36. http://dx.doi.org/10.51620/0869-2084-2022-67-1-31-36.
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The aim of the study was to show the possibilities of fluorescent immunocytochemistry in urgent intraoperative examination of sentinel lymph nodes in patients with early breast cancer. The authors analyzed the data on the state of the lymph nodes in 94 patients with early breast cancer who had been operated on since December 2016 to January 2018 in the Department of reconstructive plastic surgery of the breast and skin of the P.A. Herzen Moscow Oncological Institute. As a result of the use of the «Tekhnefit99ᵐTc» radiopharmaceutical during the operation, sentinel lymph nodes were isolated, the state of which was assessed by the method of urgent intraoperative cytology. In difficult-to-diagnose cases, fluorescent immunocytochemistry was used, which made it possible to avoid hypo- and overdiagnosis in 30 patients with early breast cancer. The sensitivity of the urgent cytological method for examining the sentinel lymph nodes smears was 83.3%, the specificity - 100%, the efficiency -83%, the predictive value of a positive result - 83.3%, and the predictive value of a negative result - 100%. Thus, the diagnostic accuracy of urgent cytological examination of the sentinel lymph node was 94%.
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Romashchenko, P. N., N. A. Maistrenko, R. V. Orlova, and A. I. Babich. "RESULTS OF DIAGNOSTICS AND TREATMENT OF ADRENOCORTICAL CANCER." Grekov's Bulletin of Surgery 174, no. 3 (June 28, 2015): 29–39. http://dx.doi.org/10.24884/0042-4625-2015-174-3-29-39.
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The results of examination and treatment of 96 patients with adrenocortical cancer (ACC) were analyzed. Local forms of ACC (I and II stages (T1-2N0M0) were found in 19 patients, locally advanced forms (III stage (T1-4N1M0; T3-4N0M0) - in 62 cases and metastatic forms of ACC (IV stage (TxNxM1) - in 15 patients. The diagnostic approach to ACC was optimized. It allowed identifying ACC on early stages of oncological process and staging of oncological process preoperatively in order to justify a rational treatment option. Surgical interventions were performed on 85 patients. The authors used an open access in 75 patients and endovideosurgical - in 10. The most common way of surgery was to remove an affected adrenal gland with fat of upper paranephrium and regional for adrenal lymph nodes (n=56). The adrenalectomy and nephrectomy were fulfilled on 23 patients. A removal of the right adrenal with tumor and thrombus of the interior vena cava was carried out in 2 patients. Some patients (n=4) underwent the explorative interventions. Combined treatment was applied in 28 patients with ACC of III stage. This gave a possibility to increase their life-span from 17,5±8,4 to 36,3±6 months. The overall 3-year survival rate for patients with ACC was 41,2% and 5-year survival observed in 18,7%. An application of modified treatment-and-diagnostics algorithm allowed increasing detection of patients with local and locally advanced forms of ACC in 2,5 times. Therefore, the application of rational treatment options have reduced the number of intraoperative complications from 38,8% to 10,2% and postoperative complication rates- from 61,1% to 20,4%, the lethality rate - from 7,1% to 0% in early postoperative period. These measures have increased the life-span and life quality in 2 times.
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Kubelt, Carolin, Björn Brändl, Alena van Bömmel, Christian Rohrandt, Gaojianyong Wang, Maximilian Evers, Stephan Kolkenbrock, et al. "PATH-45. INTRAEPIGLIOM - RAPID SEQUENCING-BASED DIAGNOSIS OF BRAIN TUMORS." Neuro-Oncology 24, Supplement_7 (November 1, 2022): vii160—vii161. http://dx.doi.org/10.1093/neuonc/noac209.618.
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Abstract The intraoperative diagnosis of brain tumors remains a clinical challenge despite recent technological advances. The current clinical practice differentiates non-surgical brain tumors from those preferably treated with cytoreductive surgery employing intraoperative frozen section diagnostics. A detailed molecular diagnosis required for this classification task within the timeframe of a routine neurosurgical procedure is currently unavailable. We have analyzed a clinical cohort of several brain tumor entities using Nanopore long-read sequencing on two Oxford Nanopore Technologies sequencing platforms (MinION, PromethION). Since currently available molecular cancer classifiers such as the DKFZ methylation profiling classifier cannot be readily adapted to real-time sequencing analysis, we implemented a novel algorithm (MethyLYZR) to predict the underlying cancer type. Publicly available Illumina Infinium array data were used to train the classifier to distinguish 91 brain tumor classes. For validation of classification accuracy, we conducted a comprehensive validation strategy. Both nanopore platforms could sequence more than 5,000 pre-selected CpG within less than 20 minutes for most of our samples. When combining an optimized library preparation protocol with the time used for sequencing the minimal number of CpGs needed for classification, we saw sample-to-answer times of less than 1 hour – in many cases within 45 minutes - from receiving a fresh biopsy to a robust cancer type prediction. Comparing actual and predicted diagnoses resulted in a favorable error rate, indicating potentially highly clinical validity. Our real-time based molecular diagnostic algorithm enables, in most cases, a reliable diagnostic call within the timeframe of a typical neuro-oncological surgery. MethyLYZR as a predictive tool may allow us to adjust the surgical strategy and deliver the prognosis to our patients right after surgery, thus allowing for as-of-yet unexplored opportunities for the intraoperative application of individualized therapeutic modalities.
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Kleine Borgmann, Felix, Andreas Husch, Redouane Slimani, Finn Jelke, Giulia Mirizzi, Karoline Klein, Michel Mittelbronn, and Frank Hertel. "PATH-29. POTENTIAL OF RAMAN SPECTROSCOPY IN ONCOLOGICAL NEUROSURGERY." Neuro-Oncology 21, Supplement_6 (November 2019): vi149. http://dx.doi.org/10.1093/neuonc/noz175.625.
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Abstract Raman spectroscopy (RS) has gained increasing interest for the analysis of biological tissues within the recent years. It is a label-free, non-destructive method providing insights in biochemical properties of tumor cells. It is possible to compare RS signals with histological properties of identical tissue parts. Therefore, RS bears promising potentials in neurosurgical neurooncology. On one hand, it could potentially be used for both intraoperative tumor diagnostics and resection control. On the other hand, it could provide important knowledge on tumor biochemistry and used for a subclassification of tumors with a potential impact on personalized therapy approaches. Within our group, we analyzed over 3000 measurement points in different brain tumors ex vivo with a robotized RS system and correlated the spectral curves with histopathological results. We separated and subclassified the data by AI-based methods. Additionally, we compared the latter results with those of a handheld probe, which is potentially navigatable for in vivo, intraoperative applications. We could demonstrate, that it is possible to separate distinct tumor groups only based on RS signals, especially by using computer-based signal analysis. Furthermore, we could demonstrate the differences of the spectra of deep-frozen and formalin-fixed tissues versus non-fixed tissues. Based on our results, we will highlight the potentials of RS for intraoperative neurosurgical application in resection control for brain tumors, as well as we will focus on the potentials for brain tumor diagnostics based purely on this method or by using it as an adjunct. Those methods bear additional potentials in the field of personalized chemotherapy approaches.
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Djurdjevic, Srdjan, Sanja Stojanovic, Marijana Basta-Nikolic, and Dragan Nikolic. "Novel diagnostic and therapeutic approaches to the treatment of ovarian cancer." Medical review 72, no. 1-2 (2019): 11–16. http://dx.doi.org/10.2298/mpns1902011d.
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Introduction. Ovarian cancer is an intra-abdominal, chemosensitive, chronic disease and according to current protocols, it is primarily treated with surgery followed by adjuvant chemotherapy. In Serbia, 820 cases of ovarian cancer are newly diagnosed annually. The aim of the study is to present the results of surgical treatment in 304 patients with ovarian cancer, treated during a 15-year period (2003 - 2017) at the Clinic of Gynecology and Obstetrics, Clinical Center of Vojvodina in Novi Sad. Material and Methods. Before the operation, clinical, gynecological, ultrasonography examination and analysis of cancer antigen 125 blood concentrations were performed in all patients. Based on basic diagnostics, additional pelvic, abdominal and thoracic computed tomography or magnetic resonance imaging studies, together with colonoscopy if needed, were performed. The selection of the type and extent of surgical procedure was based on intraoperative assessment of the stage of disease, intraoperative histopathological confirmation of ovarian cancer, wish for fertility preservation and general patient?s condition. Exclusion criteria were histopathologically confirmed benign or borderline ovarian tumors, i. e. absence of cancer in the final microscopic specimen. Results. The patients? age ranged from 19 - 88 years, with a median of 53.4 years. According to the International Federation of Gynecology and Obstetrics staging, most patients had stage III - 98 (33.1%) and epithelial ovarian cancer - 240 (84.2%). The most common surgical procedures were hysterectomy with bilateral adnexectomy and omentectomy, whereas cytological analysis was performed in 138 (45.4%) treated patients. Complications were recorded in 13 (4.3%) operated patients with inflammation and wound seroma being the most common (4 patients - 1.3% of cases). Conclusion. Ovarian cancer treatment is planned individually, depending on the stage of the disease, histological tumor type, patient?s general condition, wish for fertility-sparing treatment and technical capacity of the institution where the treatment is performed.
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Hocotz, Thaddäus, Olga Bibikova, Valeria Belikova, Andrey Bogomolov, Iskander Usenov, Lukasz Pieszczek, Tatiana Sakharova, et al. "Synergy Effect of Combined Near and Mid-Infrared Fibre Spectroscopy for Diagnostics of Abdominal Cancer." Sensors 20, no. 22 (November 23, 2020): 6706. http://dx.doi.org/10.3390/s20226706.
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Cancers of the abdominal cavity comprise one of the most prevalent forms of cancers, with the highest contribution from colon and rectal cancers (12% of the human population), followed by stomach cancers (4%). Surgery, as the preferred choice of treatment, includes the selection of adequate resection margins to avoid local recurrences due to minimal residual disease. The presence of functionally vital structures can complicate the choice of resection margins. Spectral analysis of tissue samples in combination with chemometric models constitutes a promising approach for more efficient and precise tumour margin identification. Additionally, this technique provides a real-time tumour identification approach not only for intraoperative application but also during endoscopic diagnosis of tumours in hollow organs. The combination of near-infrared and mid-infrared spectroscopy has advantages compared to individual methods for the clinical implementation of this technique as a diagnostic tool.
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Knospe, Luise, Ines Gockel, Boris Jansen-Winkeln, René Thieme, Stefan Niebisch, Yusef Moulla, Sigmar Stelzner, et al. "New Intraoperative Imaging Tools and Image-Guided Surgery in Gastric Cancer Surgery." Diagnostics 12, no. 2 (February 16, 2022): 507. http://dx.doi.org/10.3390/diagnostics12020507.
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Innovations and new advancements in intraoperative real-time imaging have gained significant importance in the field of gastric cancer surgery in the recent past. Currently, the most promising procedures include indocyanine green fluorescence imaging (ICG-FI) and hyperspectral imaging or multispectral imaging (HSI, MSI). ICG-FI is utilized in a broad range of clinical applications, e.g., assessment of perfusion or lymphatic drainage, and additional implementations are currently investigated. HSI is still in the experimental phase and its value and clinical relevance require further evaluation, but initial studies have shown a successful application in perfusion assessment, and prospects concerning non-invasive tissue and tumor classification are promising. The application of machine learning and artificial intelligence technologies might enable an automatic evaluation of the acquired image data in the future. Both methods facilitate the accurate visualization of tissue characteristics that are initially indistinguishable for the human eye. By aiding surgeons in optimizing the surgical procedure, image-guided surgery can contribute to the oncologic safety and reduction of complications in gastric cancer surgery and recent advances hold promise for the application of HSI in intraoperative tissue diagnostics.
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Raja, Siva, Talal El-Hefnawy, Lori A. Kelly, Melissa L. Chestney, James D. Luketich, and Tony E. Godfrey. "Temperature-controlled Primer Limit for Multiplexing of Rapid, Quantitative Reverse Transcription-PCR Assays: Application to Intraoperative Cancer Diagnostics." Clinical Chemistry 48, no. 8 (August 1, 2002): 1329–37. http://dx.doi.org/10.1093/clinchem/48.8.1329.
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Abstract Background: Rapid-cycling, real-time PCR instruments bring the opportunity for improved intraoperative detection of metastasis to sentinel lymph nodes. Rapid, standardized, and internally controlled assays need to be developed that are sensitive and accurate. Methods: We describe rapid, multiplexed, internally controlled, quantitative reverse transcription-PCR (QRT-PCR) assays for tyrosinase and carcinoembryonic antigen mRNAs on the SmartCycler (Cepheid). We used a temperature-controlled primer-limiting approach to eliminate amplification of the endogenous control gene as soon as its signal had reached threshold. Positive-control oligonucleotide mimics were incorporated into all reactions to differentiate failed reactions from true negative samples. Results: The optimized assays for rapid QRT-PCR yielded results with threshold cycle values that were only 1–2 cycles higher than slower, more conventional protocols. In rapid PCR, the temperature-controlled multiplex assay was quantitative over a dynamic range of at least 15 cycles, compared with only 6 cycles for conventional multiplexing methods. All histologically positive lymph nodes examined were also QRT-PCR positive for the appropriate marker, and the exogenous, internal positive-control mimics produced signals in all negative samples. Conclusion: Internally controlled, rapid QRT-PCR assays can be performed in an intraoperative time frame and with sufficient sensitivity to detect histologically identified metastases to lymph nodes.
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Bharadwaj, Barasha Sarma, Muktanjalee Deka, Manisha Salvi, B. K. Das, and B. C. Goswami. "Frozen Section Versus Permanent Section in Cancer Diagnosis: A Single Centre Study." Asian Pacific Journal of Cancer Care 7, no. 2 (May 15, 2022): 247–51. http://dx.doi.org/10.31557/apjcc.2022.7.2.247-251.
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Introduction: Frozen section is an intraoperative pathological technique which has very important role to play in diagnostics and also it plays important role in futher surgical management as specially in oncology setup. Most common indications for frozen section were confirmation of neoplasms, evaluation of margins status, evaluation of metastasis etc. Materials and Methods: This is a prospective study of 200 frozen section cases, where frozen sections were compared with permanent Haematoxylin and Eosin stained slides. Accuracy of frozen sections were analysed with various parameters like true positive, false positive, sensitivity, specificity, concordance rate etc. Results: Highest number cases were from gall bladder/ biliary tract (45) followed by breast tissue (43), lymph node (32) etc. Diagnostic accuracy of frozen section was 95.5% (191/200 cases) when compared with permanent section. Concordance rate was 191 (95.5%), sensitivity 89.5% with positive predictive value 96.7% and negative predictive value 94.9% respectively. Conclusion: Adequate and accurate sampling is recommended and also interpretation error should be minimized to help reducing the rate of discordant cases.
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Kaliszewski, Krzysztof, Maksymilian Ludwig, Bartłomiej Ludwig, Agnieszka Mikuła, Maria Greniuk, and Jerzy Rudnicki. "Update on the Diagnosis and Management of Medullary Thyroid Cancer: What Has Changed in Recent Years?" Cancers 14, no. 15 (July 27, 2022): 3643. http://dx.doi.org/10.3390/cancers14153643.
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Medullary thyroid carcinoma (MTC) is a neoplasm originating from parafollicular C cells. MTC is a rare disease, but its prognosis is less favorable than that of well-differentiated thyroid cancers. To improve the prognosis of patients with MTC, early diagnosis and prompt therapeutic management are crucial. In the following paper, recent advances in laboratory and imaging diagnostics and also pharmacological and surgical therapies of MTC are discussed. Currently, a thriving direction of development for laboratory diagnostics is immunohistochemistry. The primary imaging modality in the diagnosis of MTC is the ultrasound, but opportunities for development are seen primarily in nuclear medicine techniques. Surgical management is the primary method of treating MTCs. There are numerous publications concerning the stratification of particular lymph node compartments for removal. With the introduction of more effective methods of intraoperative parathyroid identification, the complication rate of surgical treatment may be reduced. The currently used pharmacotherapy is characterized by high toxicity. Moreover, the main limitation of current pharmacotherapy is the development of drug resistance. Currently, there is ongoing research on the use of tyrosine kinase inhibitors (TKIs), highly specific RET inhibitors, radiotherapy and immunotherapy. These new therapies may improve the prognosis of patients with MTCs.
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Morozov, D. A., E. S. Pimenova, and E. D. Mirokova. "Thyroid Adenomas in Children." Annals of the Russian academy of medical sciences 70, no. 5 (December 2, 2015): 513–18. http://dx.doi.org/10.15690/vramn.v70.i5.1436.
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According to the papers thyroid nodules are quite rare in the first two decades of life. However, there are some exceptions, relating to areas with an iodine deficiency or affected by radioactive fallout, where the risk of nodules and carcinomas is increased. Therefore, it is a great challenge for the physician to distinguish between benign and malignant lesions preoperatively, and not only in these areas of greater risk. The authors analyzed current works, which are devoted to diagnostics and treatment of adenomas of thyroid gland in children. This literature review is based on works dedicated to epidemiology, histotypes study, and methods of diagnostics, surgical treatment, prognosis and complications of this pathology. The current tendencies in surgical approaches, intraoperative monitoring of recurrent laryngeal nerve are also discussed. The actuality of this problem is connected with last decade increase of adenomas in structure of thyroid gland nodules, increase of number of patients with multiple adenomas and with polypathias: adenomas with nodular goiter, autoimmune thyroiditis and cancer in children. The difficulties of diagnostic of adenomas are related to the similar clinical symptoms, cytogenetic characteristics of growth of benign and malignant lesions of thyroid gland. Additionally there is no systematic review about thyroid adenomas in children recent years.
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Bandzevičiūtė, Rimantė, Gediminas Platkevičius, Justinas Čeponkus, Arūnas Želvys, Albertas Čekauskas, and Valdas Šablinskas. "Differentiation of Urothelial Carcinoma and Normal Bladder Tissues by Means of Fiber-Based ATR IR Spectroscopy." Cancers 15, no. 2 (January 13, 2023): 499. http://dx.doi.org/10.3390/cancers15020499.
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Surgical treatment is widely applied curative approach for bladder cancer. White light cystoscopy (WLC) is currently used for intraoperative diagnostics of malignant lesions but has relatively high false-negative rate. Here we represent an application of label free fiber-based attenuated total reflection infrared spectroscopy (ATR IR) for freshly resected human bladder tissue examination for 54 patients. Defined molecular spectral markers allow to identify normal and urothelial carcinoma tissues. While methods of statistical analysis (Hierarchical cluster analysis (HCA) and Principal component analysis (PCA)) used for spectral data treatment allow to discriminate tissue types with 91% sensitivity and 96–98% specificity. In the present study the described method was applied for tissue examination under ex vivo conditions. However, after method validation the equipment could be translated from laboratory studies to in situ or even in vivo studies in operating room.
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Slashchuk, K. Yu, M. V. Degtyarev, P. O. Rumyantsev, A. K. Eremkina, N. V. Tarbaeva, D. G. Beltsevich, I. V. Kim, G. A. Melnicthhenko, and N. G. Mokrysheva. "Preoperative imaging and intraoperative navigation of the parathyroid glands neoplasms in primary hyperparathyroidism." Head and Neck Tumors (HNT) 11, no. 4 (February 12, 2022): 10–21. http://dx.doi.org/10.17650/2222-1468-2021-11-4-10-21.
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Introduction. Primary hyperparathyroidism is one of the most common diseases of the endocrine system, after diabetes mellitus and thyroid pathologies. Early diagnosis and treatment of primary hyperparathyroidism allow avoiding severe damage to the bones, kidneys, other organs, thereby reducing the incidence of disability and improving the patients quality of life. The only radical treatment for primary hyperparathyroidism is the surgical removal of the pathologically altered, hyperfunctioning parathyroid glands.The study objective – to increase the efficiency of preoperative topical diagnosis and intraoperative navigation of parathyroid glands.Materials and methods. 200 patients with laboratory-verified primary hyperparathyroidism, who underwent preoperative topical diagnostics (ultrasound, planar scintigraphy and single-photon emission computed tomography, combined with computed tomography (SPECT / CT), in some cases supplemented with contrast enhanced CT with / or fine needle aspiration biopsy with flushing from a needle on for parathyroid hormone) and received surgical treatment, in period from 2017 to 2020. A single-stage, open-label comparative study was carried out, including clinical, laboratory and instrumental data of patients. The follow-up period after surgery for primary hyperparathyroidism was at least 6 months.Results. From 200 included patients, surgical treatment in the amount of minimally invasive parathyroidectomy was performed in 189 patients. As a result of the analysis of the diagnostic accuracy, for a combination of ultrasound and SPECT/CT with augmented contrast enhanced CT, the overall accuracy in visualizing of parathyroid glands was 99 % (95 % confidence interval (CI): 97–100), diagnostic specificity 77 % (95 % CI: 54–100), sensitivity 100 % (95 % CI: 98–100), the predictive value of positive and negative results was 98 % (95 % CI: 97–100) and 100 % (95 % CI: 98–100) respectively.Conclusion. The results allowed us to develop an algorithm for preoperative topical diagnosis of parathyroid glands in patients with laboratory-verified primary hyperparathyroidism and indications for surgical treatmen. We recommend to perform ultrasound of the thyroid and parathyroid glands in all patients at the first stage, in the absence of evident changes in the thyroid gland, at the second stage – scintigraphy and SPECT / CT with 99mTc-MIBI; in cases with significant concomitant functional or structural pathology of the thyroid gland – contrast enhanced CT; if necessary, supplementing fine needle aspiration biopsy with flushing from a needle on for parathyroid hormone.
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Brielmaier, M. C., J. Reifenrath, N. Pensel, F. Ganster, J. Bierlein, A. Wagner, J. Gempt, and J. Schlegel. "P05.01.B Distribution of the staining agent sodium-fluorescein in cerebral neoplasia - a comparison between intraoperative confocal laser endomicroscopy and in vitro fluorescence microscopy." Neuro-Oncology 24, Supplement_2 (September 1, 2022): ii36. http://dx.doi.org/10.1093/neuonc/noac174.120.
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Abstract Background While conventional frozen sections and other ex vivo microscopy always come along with artefacts, in vivo confocal laser endomicroscopy (CLE) offers less invasive, less manipulated imaging of living tissues. Understanding the distribution of the staining agent sodium-fluorescein (NaFl) plays a key role in establishing in vivo CLE as a new opportunity for real-time transmitted, in vivo imaging. By comparing the distribution of NaFl in in vivo and ex vivo CLE to conventional fluorescence microscopy of NaFl incubated tumor cell cultures we gain a better understanding of the staining mechanism. Material and Methods Sodium-fluorescein is the water-soluble sodium salt of fluorescein and is used as a fluorescent tracer in neurosurgery. The staining agent was applied intravenously at the beginning of the surgical procedure. In vivo CLE of the lesion was performed 30 to 50 minutes later and compared to ex vivo CLE imaging and conventional fluorescence microscopy. In addition, different tumor cell lines derived from malignant gliomas and carcinomas, respectively, were incubated with NaFl in vitro and the uptake of the fluorescent dye was monitored over time. Results From initial results, the intraoperative images showed specific fluorescein distribution depending on the architecture of the tumor entity. In most cases, glial tumors demonstrated higher accumulation of the staining agent in the extracellular tumor matrix, whereas the cells of carcinoma metastases appeared to take up NaFl intracellularly. These results were corroborated by NaFl uptake in cell culture experiments. Compared to ex vivo CLE, in vivo imaging offered a faster assessment of the tissue, brighter images and higher staining levels. Due to movement artefacts and the narrow intraoperative imaging time frame, in vivo CLE images were sometimes impaired by lower image quality. Conclusion The specific distribution of the fluorescent agent NaFl allowed for a discrimination between the different neoplastic entities. Images from in vivo and ex vivo confocal laser endomicroscopy showed NaFl uptake in concordance with the results of NaFl incubated cell cultures. Intraoperative, in vivo confocal laser endomicroscopy shows promising first results in the understanding of brain tumor histomorphology in situ. Being faster and less manipulated by artefacts than ex vivo investigations, it opens up wider opportunities for research and intraoperative diagnostics.
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Beton, Karolina, and Beata Brozek-Pluska. "Vitamin C—Protective Role in Oxidative Stress Conditions Induced in Human Normal Colon Cells by Label-Free Raman Spectroscopy and Imaging." International Journal of Molecular Sciences 22, no. 13 (June 28, 2021): 6928. http://dx.doi.org/10.3390/ijms22136928.
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Colorectal cancer is the second most frequently diagnosed cancer worldwide. Conventional diagnostics methods of colorectal cancer can detect it at an advanced stage. Spectroscopic methods, including Raman spectroscopy and imaging, are becoming more and more popular in medical applications, and allow fast, precise, and unambiguous differentiation of healthy and cancerous samples. The most important advantage of Raman spectroscopy is the ability to identify biomarkers that help in the differentiation of healthy and cancerous cells based on biochemistry of sample and spectra typical for lipids, proteins, and DNA. The aim of the study was to evaluate the biochemical and structural features of human colon cell lines based on Raman spectroscopy and imaging: normal cells CCD-18 Co, normal cells CCD-18 Co under oxidative stress conditions, and normal cells CCD-18 Co at first treated by using tert-Butyl hydroperoxide and then supplemented by vitamin C in high concentration to show the protective role of vitamin C in micromolar concentrations against ROS (Reactive Oxygen Species). Raman data obtained for normal cells injured by ROS were compared with spectra typical for cancerous cells. Statistically assisted analysis has shown that normal ROS-injured and cancerous human colon cells can be distinguished based on their unique vibrational properties. The research carried out proves that label-free Raman spectroscopy may play an important role in clinical diagnostics differentiation of normal and cancerous colon cells and may be a source of intraoperative information supporting histopathological analysis.
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Radovanovic, Dragan, Dejan Stevanovic, Ivan Pavlovic, Damir Jasarovic, Nebojsa Mitrovic, and Ivana Ilic. "Gastrointerstinal stromal tumors of gaster: Case reports." Medical review 61, no. 7-8 (2008): 409–13. http://dx.doi.org/10.2298/mpns0808409r.
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Introduction Gastrointestinal stromal tumors are the most common mesenchimal tumors of the gastrointestinal tract. Despite the enormous progress made in the field of diagnostics, most often diagnosis is made during the explorative laparotomy and postoperative immunohystochemical analysis of specimen. The surgical treatment is often indicated, although scarce preoperative diagnosis causes intraoperative dilemma concerning the level of radicality. Material and methods In this paper we have analyzed two patients with gastric GIST. The first patient was 59 years old male, with preoperatively diagnosed colonic cancer. Intraoperatively besides the transverse colon cancer, we found intramural gastric tumor. This patient underwent subtotal gastrectomy and subtotal colectomy. The immunohystochemical analysis of gastric tumor proves benign GIST. The second patient was 50 years old male presented with repeated upper GI bleeding. The endoscopic ultrasound showed intramural tumor of the anterior gastric wall, with a visible blood vessel bleeding during endoscopy. After the resuscitation, we performed subtotal gastrectomy. The immunohystochemical analysis proved malignant GIST. Discussion In the cases with inadequate preoperative diagnoses, the level of resection procedure is based on the size of tumor and the presence of necrosis and bleeding inside the tumor. Tumors larger than 5 cm in diameter with signs of necrosis and bleeding are parameters of malignant nature of GIST, therefore demanding a radical surgical treatment. Conclusion The surgical resection is a treatment of choice for gastrointestinal stromal tumors. It has been shown that adequate surgical resection correlates with high 5-years survival rates for patients with gastric GIST.
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Gavrilyuk, Dmitry V., and Ruslan A. Zukov. "Difficulties of diagnostics of parothoid adenoma in the background of combined treatment of advanced thyroid cancer." Russian Journal of Oncology 26, no. 6 (November 14, 2022): 199–206. http://dx.doi.org/10.17816/onco111587.
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In clinical practice, the most common sporadic variant of solitary parathyroid adenoma. Atypical adenomas of the parathyroid glands are a rare form and present the greatest difficulty in determining the potential for malignancy, the extent of surgical treatment, and the patients dynamic follow-up regimen. They are not characterized by the classic signs of malignant growth invasion beyond the formation capsule or the presence of metastases. Specific clinical and prognostic phenotypes of parathyroid adenomas are highly individual.
No more than 3% of parathyroid adenomas are associated with papillary thyroid cancer. Awareness of such a combination of pathology allows us to assess possible risks and determine the scope of surgical intervention as the only method of radical treatment of pathologically altered parathyroid tissue. With early detection of recurrence of thyroid cancer, it is necessary to conduct additional monitoring of hormonal activity and radiation diagnosis of tumor pathology of the parathyroid glands.
The presented clinical case showed that the cytological and histological diagnosis of parathyroid adenoma against the background of recurrence of advanced thyroid cancer can fundamentally differ at different stages of the morphological study. With parathyroid adenoma in the preoperative period, there may be a discrepancy between these methods of radiation and intraoperative diagnostics and the results of an urgent and planned histological examination. The uncharacteristic course of solitary parathyroid adenoma after thyroidectomy in combination with false positive results due to ultrasound location of thyroid nodules (residual tumors and cancer recurrences, as well as paratracheal metastases) and nervous tissue (paraganglioma) contributes to incorrect preoperative diagnosis of thyroid bed tumors. At the preoperative stage of diagnosing tumor pathology of the parathyroid glands, it is advisable to perform scintigraphy of the parathyroid glands with a simultaneous combination of ultrasound, which will increase the sensitivity of the diagnosis.
After surgical treatment of tumor pathology of the parathyroid tissue, in some cases, the result of differential diagnosis is an immunohistochemical study to form a final diagnosis and determine further patient management tactics.
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Shcherbakov, Ilya E., Roman A. Chernikov, Vladimir F. Rusakov, Elysey A. Fedorov, Uriy N. Fedotov, Ilya V. Sablin, Igor K. Chinchuk, et al. "Modern possibilities of the urine steroid profile testing applying for the adrenocortical cancer diagnosis." Endocrine Surgery 14, no. 1 (August 17, 2020): 4–13. http://dx.doi.org/10.14341/serg12307.
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BACKGROUND: X-ray diagnostics methods are important in detection of adrenal neoplasms malignant nature. The sensitivity and specificity of these methods are high enough. However the hormonal tests are also necessary to make an accurate clinical diagnosis with the high diagnostic efficiency of modern X-ray methods for adrenal tumors diagnosing. The urine steroid profile violations are detected with the adrenal glands various pathologies (primary hyperaldosteronism, hypercorticism, congenital hyperplasia of the adrenal cortex and adrenocortical cancer). Urine steroid profile tests in patients with diagnosed adrenal neoplasms are intended primarily to confirm or refute the adrenocortical cancer risk. At the same time in the medical community to date there are a number of disagreements accumulated regarding the accuracy and significance of the urine steroid profile tests.
AIMS: The study aims to determine the urine steroid profile determination accuracy limits for the adrenocortical cancer diagnosis.
MATERIALS AND METHODS: In total 62 samples were tested for urine steroid profile by gas chromatography-mass spectrometry. 58 patients had morphologically confirmed adrenal neoplasms. The study was blind prospective. To increase the study accuracy the 30 patients with adrenocortical adenomas (n = 17) and adrenocortical cancer (n = 13) were selected out of 58 tested persons. The sensitivity, specificity and accuracy of the urine steroid profile were determined in order to assess information content of such method for the adrenocortical carcinoma diagnosis.
RESULTS: The possibilities of the urine steroid profile determining for the adrenocortical cancer diagnosis are estimated. The method sensitivity was 46.2%, specificity and accuracy were 70.6% and 60% respectively. The most reliable of adrenocortical cancer markers were tetrahydro-11-deoxycortisol and dehydroepiandrosterone (38.5% of cases) increasing concentrations.
CONCLUSIONS: The present study demonstrates relatively low diagnostic efficacy of the urine steroid profile as a primary diagnostic method for adrenocortical cancer determining. This is especially evident in comparison with X-ray diagnostic methods. The technique interpretation is complex and accessible only to specialists with extremely high qualifications. Such fact complicates the distribution and widespread use in clinical practice of this testing method. At the same time the urine steroid profile determination in the future (after additional study) may be apply as an auxiliary diagnostic method which in some cases determines the treatment tactics for patients undergoing adrenocortical cancer adrenalectomy treatment.KEYWORDS: dPheochromocytoma; intraoperative hemodynamic instability; laparoscopic adrenalectomy; Endovascular embolization of preoperative; сase report.
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Kovács, Adorján F., Natascha Döbert, Jochen Gaa, Christian Menzel, and Klaus Bitter. "Positron Emission Tomography in Combination With Sentinel Node Biopsy Reduces the Rate of Elective Neck Dissections in the Treatment of Oral and Oropharyngeal Cancer." Journal of Clinical Oncology 22, no. 19 (October 1, 2004): 3973–80. http://dx.doi.org/10.1200/jco.2004.01.124.
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Purpose To assess the impact of a diagnostic ladder including [18F]fluorodeoxyglucose positron emission tomography (PET) and lymphoscintigraphy guided sentinel node biopsy (LS/SNB) on neck treatment in patients with oral and oropharyngeal squamous cell carcinoma (OOSCC). Patients and Methods Prospectively, 62 patients with resectable T1-3 OOSCC underwent computed tomography (CT) and PET. Patients without neck uptake in PET were defined as cN0 and were accrued for LS/SNB. Results were correlated with histopathology. The traditional guidelines according to CT findings were compared to the actual regimen and the outcome. Results Sensitivity, specificity, validity, and positive and negative predictive value of PET versus CT were 72% v 89%, 82% v 77%, 79% v 80.5%, 62% v 61.5%, and 88% v 94.5% (not significant). Thirty-eight PET negative patients underwent LS/SNB. Sentinel lymph nodes were found in all 38 patients. Five patients had positive nodes (PET false-negatives) and underwent neck dissection (ND). Fifty-one neck sides in 36 patients who were CT-negative would have been treated with selective ND according to the guidelines, and at least 45 neck sides would have had to undergo extensive ND because of positive CT findings (96 of 124 neck sides). In contrast, PET in combination with LS/SNB spared 59 neck sides, and 41 of 124 neck sides actually underwent ND as a result of PET staging, LS/SNB, and intraoperative decision. After a median follow-up of 35 months, two patients (both cN+ve and pN+ve) suffered from neck relapses. Conclusion Diagnostics using PET in combination with LS/SNB considerably reduced the number of extensive ND in OOSCC as compared to CT without locoregional hazard.
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Chagovets, Vitaliy V., Natalia L. Starodubtseva, Alisa O. Tokareva, Vladimir E. Frankevich, Valerii V. Rodionov, Vlada V. Kometova, Konstantin Chingin, Eugene N. Kukaev, Huanwen Chen, and Gennady T. Sukhikh. "Validation of Breast Cancer Margins by Tissue Spray Mass Spectrometry." International Journal of Molecular Sciences 21, no. 12 (June 26, 2020): 4568. http://dx.doi.org/10.3390/ijms21124568.
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Current methods for the intraoperative determination of breast cancer margins commonly suffer from the insufficient accuracy, specificity and/or low speed of analysis, increasing the time and cost of operation as well the risk of cancer recurrence. The purpose of this study is to develop a method for the rapid and accurate determination of breast cancer margins using direct molecular profiling by mass spectrometry (MS). Direct molecular fingerprinting of tiny pieces of breast tissue (approximately 1 × 1 × 1 mm) is performed using a home-built tissue spray ionization source installed on a Maxis Impact quadrupole time-of-flight mass spectrometer (qTOF MS) (Bruker Daltonics, Hamburg, Germany). Statistical analysis of MS data from 50 samples of both normal and cancer tissue (from 25 patients) was performed using orthogonal projections onto latent structures discriminant analysis (OPLS-DA). Additionally, the results of OPLS classification of new 19 pieces of two tissue samples were compared with the results of histological analysis performed on the same tissues samples. The average time of analysis for one sample was about 5 min. Positive and negative ionization modes are used to provide complementary information and to find out the most informative method for a breast tissue classification. The analysis provides information on 11 lipid classes. OPLS-DA models are created for the classification of normal and cancer tissue based on the various datasets: All mass spectrometric peaks over 300 counts; peaks with a statistically significant difference of intensity determined by the Mann–Whitney U-test (p < 0.05); peaks identified as lipids; both identified and significantly different peaks. The highest values of Q2 have models built on all MS peaks and on significantly different peaks. While such models are useful for classification itself, they are of less value for building explanatory mechanisms of pathophysiology and providing a pathway analysis. Models based on identified peaks are preferable from this point of view. Results obtained by OPLS-DA classification of the tissue spray MS data of a new sample set (n = 19) revealed 100% sensitivity and specificity when compared to histological analysis, the “gold” standard for tissue classification. “All peaks” and “significantly different peaks” datasets in the positive ion mode were ideal for breast cancer tissue classification. Our results indicate the potential of tissue spray mass spectrometry for rapid, accurate and intraoperative diagnostics of breast cancer tissue as a means to reduce surgical intervention.
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Dzidzava, I. I., B. N. Kotiv, I. V. Dmitrochenko, E. E. Fufaev, D. A. Yasuychenya, A. V. Kudryavtseva, S. N. Bardakov, and A. A. Apollonov. "Tumors of thymus gland: clinical features, diagnosis, treatment." Bulletin of the Russian Military Medical Academy 20, no. 1 (March 15, 2018): 225–29. http://dx.doi.org/10.17816/brmma12337.
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Main aspects of histogenesis, morphology and classification of tumors of the thymus, the current state of their diagnosis and treatment are submitted. Clinical manifestations of thymomas are dependent on their endocrine activity, pace and nature of growth, size and relationship with surrounding structures of mediastinum. Hormonal tumors of thymus are often accompanied by the development of generalized myasthenia gravis. Spiral computed and magnetic resonance tomography are recognized as the leading methods of diagnostics and differential diagnostics of the tumors of thymus gland. However, frequency of diagnostic errors can reach 10-30% of observations. The main method of treatment is surgical, as providing radical and the best long-term results. An adequate volume of surgical treatment of tumors of the thymus gland is thymomthymectomy- enblock removal of a tumor and the entire gland tissue along with fatty tissue and lymph nodes of anterior mediastinum. Various «open» and endovideosurgical approaches to thymus removal have been proposed. Minimally invasive endovideoscopic removal of thymus has a number of advantages over traditional, «open» thymectomy and is characterized by a much smaller intraoperative blood loss and duration of drainage of the pleural cavities, early activization of a patient and a shorter hospital stay. The implementation of endovideosurgical intervention is prescribed with the removal of thymoma I-II stage of cancer progression, as well as in some cases of combined operational benefits at stage III. However, international experience is not sufficient for making decisions regarding the selection of an optimal surgical approach in each case. In invasive tumors of thymus, combined treatment with the inclusion of radiation and chemotherapy is recommended. However, the choice of components of a treatment, modes and sequence remain controversial.
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Georg Klamminger, Gilbert, Laurent Mombaerts, Finn Jelke, Redouane Slimani, Giulia Mirizzi, Karoline Klein, Andreas Husch, Frank Hertel, Michel Mittelbronn, and Felix Kleine Borgmann. "PATH-01. EVALUATION OF RAMAN SPECTROSCOPY AS A DIAGNOSTIC TOOL IN NEUROPATHOLOGY FOR TUMOR CLASSIFICATION." Neuro-Oncology 24, Supplement_7 (November 1, 2022): vii149. http://dx.doi.org/10.1093/neuonc/noac209.574.
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Abstract BACKGROUND Raman spectroscopy (RS) has shown its applicability in neurooncological diagnostics ranging from intraoperative tumor identification to peri- and postoperative tissue analyses. In the present study, we applied RS to track changes in the molecular vibrational status of a broad spectrum of formalin fixed paraffin-embedded (FFPE) intracranial neoplasms (primary brain tumors, meningiomas, brain metastases) and evaluated its potential as an additional method in the neuropathology toolbox, considering specific challenges when employing RS on FFPE tissue. Material and METHODS We examined 82 cases of intracranial neoplasms (679 individual measurements) by RS and applied a machine learning pipeline for recognition of spectral properties. The discrimination potential of the machine learning algorithms was evaluated using standard performance metrics such as AUROC and AUPR values, macro and weighted average of accuracy, precision, recall, and f1 scores. To address occurring misclassifications and further evaluate our models we searched for important Raman bands usable for tumor identification. RESULTS Using our trained machine learning model, we differentiated between different types of gliomas and determined the primary origin in case of a brain metastasis. We further spectroscopically diagnosed tumor types solely based on biopsy fragments of necrosis, something not possible by means of light microscopy. During the validation process we confirmed a high complexity within the spectroscopic data, possibly resulting not only from biological tissue which has undergone a rough chemical procedure but also from residual components of the fixation/paraffination process. CONCLUSIONS Our study demonstrates possibilities and limits of RS as a potential diagnostic tool in neuropathology, considering accompanying difficulties in the vibrational spectroscopic examination of FFPE tissue.
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Savelieva, T. A., I. D. Romanishkin, Yu S. Maklygina, P. V. Grachev, N. A. Kalyagina, A. V. Borodkin, A. V. Orlov, et al. "Optical biopsy: fundamentals and applications in neurosurgery." Journal of Physics: Conference Series 2058, no. 1 (October 1, 2021): 012024. http://dx.doi.org/10.1088/1742-6596/2058/1/012024.
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Abstract Currently, there is a significant increase in the incidence of cancer of the central nervous system. Determination of the boundaries of intracerebral and intramedullary tumors is especially difficult. The urgency of the problem of determining the boundaries of astrocytic tumors is due to the peculiarities of their growth along myelinated nerve fibers and vessels, leading to the infiltration of healthy white matter by tumor cells, which affects the high frequency of postoperative relapses. The complexity of surgery for intramedullary tumors of the spinal cord is that the tumor does not always have a clear border and the risk of injury is high due to the smaller size of the operated area compared to the brain. Reliable information regarding the volume of the resected tumor should be obtained by intraoperative imaging. The solution to this problem is implemented mainly in three directions: the use of intraoperative computed tomography, magnetic resonance imaging and ultrasound scanning, and various combinations of these methods. Unfortunately, all these methods of intraoperative diagnostics do not allow real-time examination of tissues in an operating wound and/or do not provide a simultaneous analysis of both structural and metabolic changes. The limitations of intraoperative navigation methods in neurosurgery have led to the relevance of the development of an accurate spectroscopic method for in vivo determination of the content of specific metabolic markers and structural changes accompanying the development of the tumor process in the nervous tissue. Various approaches to intraoperative navigation based on optical spectroscopy are called optical biopsy. In this article, we present the methods and tools developed in recent years for spectroscopic guidance in neurooncology. First of all, this, of course, concerns the analysis of spectral dependences recorded before, during and after tumor removal. We have used such modalities of optical spectroscopy as fluorescence, diffuse reflectance spectroscopy and spontaneous Raman scattering. An equally important issue on the way to increasing the efficiency of tumor resection is the development of new instrumentation; therefore, we have developed a number of new devices, which are a combination of well-known neurosurgical instruments and laser and fiber-optic technologies. Last but not least is the issue of rapid classification of the studied tissues based on the recorded signals, which was solved by us using machine learning methods.
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Smirnov, A. V., A. I. Cherepanin, and R. V. Ishchenko. "Is there a place for multivisceral resections in the treatment of gastric cancer?" Almanac of Clinical Medicine 47, no. 8 (January 1, 2020): 707–11. http://dx.doi.org/10.18786/2072-0505-2019-47-081.
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It is known that multivisceral resections (MVR) are associated with significant numbers of post-operative complications. However, the effectiveness of MVR in increasing the patients' life expectancy remains a matter of debate. Are the risks of extended volume resections justified? It has been previously assumed that the removal of adjacent organs could improve the prognosis of the disease, even in the absence of direct invasion. However, in the era of the big potential of chemoand radiation therapy, the implementation of an over-extensive surgical volume in the absence of tumor invasion is doubtful. In the presence of regional lymphatic nodes metastases, MVR do not improve prognosis, compared to that after palliative resections. If the patient has distant metastases, or the operation has been obviously not radical enough, MVR worsen the prognosis. In grade T4b invasion and with the absence of life threatening complications, it is optimal to start with neoadjuvant or perioperative chemotherapy. In the case of intraoperative suspicion of adjacent anatomical structures involvement, with no distant metastases, en bloc resection in combination with D2 lymphodissection is indicated. In approximately 30–60% of cases, invasion is not confirmed by histology. The only way to improve the results of surgical treatment of gastric cancer patients is to carefully assess the extension of the disease at the preoperative stage, select patients and team work of surgeons with chemotherapists, radiologists and specialists in diagnostics.
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Konovalenko, Volodymyr, Oleg Drobotun, Nikolai Ternovyy, Sergii Konovalenko, and Oksana Garashchenko. "Monitoring and personalization in treatment of breast cancer patients with metastatic bone lesions." EUREKA: Health Sciences, no. 1 (January 31, 2022): 37–48. http://dx.doi.org/10.21303/2504-5679.2022.002270.
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The aim. To increase the efficiency of treatment of BC patients with metastatic lesions of long tubular bones by using, Multidetector computed tomography (MDCT) and bone marrow markers for diagnostics and monitoring the clinical course of the oncologic process, accompanied by surgical intervention with endoprosthetics along with the treatment of polymorbid pathology in a specific patient.
Materials and methods. Authors provide systemic personification including visualization of the tumor site and its vascularization; printing out the 3D model; surgical planning, including optimal surgical access to the tumor site considering the volume and topographic and anatomical location and dissemination of the tumor, the convenience of intraoperative tasks (removal of the tumor, bone grafting or endoprosthetics), preoperative planning of bone resection lines with maximum preservation of intact bone tissue.
Results. Personalization of the treatment of breast cancer patients with metastatic bone lesions contributes to a significant reduction in postoperative complications of endoprosthetic replacement of large joints (up to 15.2 %) and increases the overall three-year survival rate (up to 40.6 %), as well as significantly improves their quality of life.
Conclusions. The personalization of treatment of patients with tumor lesions of the skeletons contributes to a significant decrease in the indicator of postoperative complications of endoprosthetics of great joints and to an increase in the total three-year survival rate, as well as to the improvement of the quality of life after the conducted treatment.
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Jovic, Rajko, Karol Canji, Slobodan Mitrovic, and Vladimir Kljajic. "Selective neck dissection in the treatment of pN1/2 neck lymph-node metastases." Medical review 56, no. 5-6 (2003): 221–6. http://dx.doi.org/10.2298/mpns0306221j.
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Introduction As yet there is no single reliable and accurate method for detection of neck lymph node metastases. Therapeutic approaches differ from one author to other. The aim of this paper was to establish the extent to which, with good control of primary process, we can control spreading of malignant disease by means of selective neck dissection. Material and method This retrospective study included 595 surgically treated patients in the period 1990 - 1998. There were 525 patients with malignant laryngeal tumors, and 70 patients with malignant hypopharyngeal tumors. Preoperative diagnostics of enlarged lymph nodes was based on palpation of the neck without CT, US, NMR diagnostics. With all risky N0 patients, selective neck dissection was performed for presence of occult metastases. Intraoperative frozen section analysis was not performed. Adjuvant radiotherapy was performed in all patients in whom presence of neck lymph node metastases was histologically proved. Results Selective lateral neck dissection was performed in 389 (65.4%) patients. In 78 (20%) patients, lymph node metastases were patohistologically detected. In 5 (6.4%) transitional cellular cancer was histologically diagnosed, and the remaining 73 (93.6%) presented with squamous cell cancer. Postoperative radiation therapy was applied in 54 patients (69.2%) while 24 (30.8%) were not irradiated. 5-year survival was achieved in 18 (23.1%), and 3-year survival was achieved in 15 (19.2%) patients. Out of 45 patients who lived less than tree year, 18 (40%) presented with metastatic relapse and fatal outcome. Relapse of neck metastases appeared in 12 (11.9%) on the side and in the zones of lymph nodes which were included in neck dissection. Recurrence of neck metastases appeared in 8.3% of patients who were not irradiated postoperatively and in 32.1% of cases irradiated postoperatively. Discussion This study includes comparison of our results with results of literature data. Conclusion Neck lymph node metastases point to advanced malignant process of the third or forth stage of the disease when results are the worst and 5-year survival decreases with or without adjuvant radiotherapy.
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Schulz-Wendtland, Rüdiger, P. Dankerl, M. Bani, P. Fasching, K. Heusinger, M. Lux, S. Jud, et al. "Evaluation of a Marker Clip System in Sonographically Guided Core Needle Biopsy for Breast Cancer Localization Before and After Neoadjuvant Chemotherapy." Senologie - Zeitschrift für Mammadiagnostik und -therapie 14, no. 04 (December 2017): 214–20. http://dx.doi.org/10.1055/s-0043-123432.
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Abstract Introduction The placement of intramammary marker clips has proven to be helpful for tumor localization in patients undergoing neoadjuvant chemotherapy and breast-conserving surgery. The purpose of our study was to investigate the feasibility of using a clip marker system for breast cancer localization and its influence on the imaging assessment of treatment responses after neoadjuvant chemotherapy. Patients and Methods Between March and June 2015, a total of 25 patients (n = 25), with a suspicion of invasive breast cancer with diameters of at least 2 cm (cT2), underwent preoperative sonographically guided core needle biopsy using a single-use breast biopsy system (HistoCore™) and intramammary clip marking using a directly adapted clip system based on the established O-Twist Marker™, before their scheduled preoperative neoadjuvant chemotherapy. Localization of the intramammary marker clip was controlled by sonography and digital breast tomosynthesis. Results Sonography detected no dislocation of intrammammary marker clips in 20 of 25 patients (80 %), while digital breast tomosynthesis showed accurate placement without dislocation in 24 patients (96 %) (p < 0.05). There was no evidence of significant clip migration during preoperative follow-up imaging after neoadjuvant chemotherapy. No complication related to the clip marking was noted and there was no difficulty in evaluating the treatment response to neoadjuvant chemotherapy. Among the breast-conserving surgeries performed, no cases were identified in which intraoperative loss of the marker clip had occurred. Conclusion Our study underscores the importance of intramammary marking clip systems before neoadjuvant chemotherapy. Placement of marker clips is advised to facilitate accurate tumor bed localization. With regard to digital breast tomosynthesis, its development continues to improve the quality of diagnostics and the therapy of breast cancer particularly for small breast cancer tumors or in neoadjuvant chemotherapy setting.
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Slashchuk, Konstantin Y., Mikhail V. Degtyarev, Pavel O. Rumyantsev, Olga Y. Rebrova, Alina R. Elfimova, Liliya S. Selivanova, and Nataliya G. Mokrysheva. "Factors associated with the degree of 99mTc-MIBI accumulation in parathyroid glands neoplasms during planar scintigraphy and SPECT/CT in primary hyperparathyroidism." Journal of Modern Oncology 24, no. 1 (April 30, 2022): 97–105. http://dx.doi.org/10.26442/18151434.2022.1.201252.
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Background: Primary hyperparathyroidism (PHPT) is the third most common endocrine disease, after diabetes mellitus and thyroid gland disorders. Surgical removal of the hyperfunctioning parathyroid glands is the only radical treatment. Various methods of preoperative imaging and intraoperative navigation are developed. Planar scintigraphy with 99mTc-MIBI is used for visualization and it is the most frequently performed radionuclide study in PHPT, while it has a relatively low sensitivity and specificity. SPECT/CT can reduce false-negative and false-positive results, and combines the advantages of radionuclide diagnostic methods and computed tomography. However, the factors that prevent the accumulation of 99mTc-MIBI in patients with PHPT are not clear enough.
Aim: To identify the factors associated with the degree of accumulation (uptake rate) of 99mTc-MIBI in the parathyroid glands during planar scintigraphy and SPECT/CT.
Materials and methods: The cross-sectional comparative study included 186 patients with PHPT who underwent planar scintigraphy and SPECT/CT for topical diagnosis of parathyroid glands and minimally invasive parathyroidectomy (MIP) followed by histological and immunohistochemical examination of parathyroid glands. The patients were divided into 3 groups depending on the accumulation of 99mTc-MIBI. The accumulation of 99mTc-MIBI was assessed by the expert as low-, moderate-, and high-intensity.
Results: The association between the volume of the parathyroid glands on ultrasound and the intensity of the capture of the radiopharmaceutical was revealed, and 80% of low uptake is observed if volume is less than 0,215 cm3 (it corresponds to the linear size of the parathyroid gland 5 mm). Next factor that complicate the interpretation of the results of planar scintigraphy and SPECT/CT in patients with PHPT is thyroid diseases. The associations of the level of PTH, calcium in the blood, the localization and cellular composition of the parathyroid glands, the index of proliferative activity (Ki67), the expression of PTH, P-glycoprotein, cyclin D1 in the PTG tissue with the intensity of 99mTc-MIBI accumulation were not found.
Conclusions: The main factor that positively associates with the degree of 99mTc-MIBI accumulation with planar scintigraphy and SPECT / CT is the volume of the parathyroid glands according to ultrasound data. Comorbidity of the thyroid gland has tendency to be associated with a negative result of radionuclide diagnostics, thus based on the ultrasound data of the thyroid and parathyroid glands it is possible to choose the second preferable method of imaging (SPECT/CT or contrast enhanced CT).
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Wawroschek, F., H. Wengenmair, T. Wagner, J. Kopp, R. Dorn, S. Gröber, P. Heidenreich, and H. Vogt. "Sentinel lymph node diagnostic in prostate carcinoma: Part I: Technique and clinical evaluation." Nuklearmedizin 41, no. 02 (2002): 95–101. http://dx.doi.org/10.1055/s-0038-1625646.
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Summary Aim: Evaluation of the significance of lymphoscintigraphy and intraoperative probe measurement for the identification of the sentinel lymph node (SLN) in prostate cancer. Patients and method: In 117 patients with prostate cancer scintigrams in various projections were acquired till approximately 6 hours p.i. after ultrasound guided transrectal intraprostatic injection of 99mTc-Nanocoll ®. On the following day the SLNs were identified in the operation theatre with a gamma probe and removed. Pelvic standard lymph node dissection followed SLNE. Results: In three of 117 patients with preoperative lymphoscintigraphy no SLN was scintigraphically detectable. These three patients had antecedent transurethral resection of the prostate. In 113 of the residual 114 patients SLN could be intraoperatively localized. In the mean four SLNs per patient were removed. 28 of 117 patients had pelvic lymph node metastases. In 25 cases SLN were right-positive, in one false-negative and in one intraoperatively not detectable. In one patient we found macrometastasis of up to 4 cm diameter (one SLN was tumour positive). In 15 cases only the SLN was bearing tumour. Conclusion: The SLNE with preoperative lymphoscintigraphy and intraoperative gamma probe measurement is suitable for detecting lymph node metastasis in prostate cancer. SLNE is superior to the surgical techniques commonly used in pelvic lymphadenectomy.
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Kubeček, Ondřej, Jan Laco, Jiří Špaček, Alena Kubečková, Jiří Petera, Iva Selke Krulichová, Aleš Bezrouk, Stanislav Filip, and Jindřich Kopecký. "Clinicopathological Characteristics and Prognostic Factors in Ovarian Metastases from Right- and Left-Sided Colorectal Cancer." Current Oncology 28, no. 4 (August 3, 2021): 2914–27. http://dx.doi.org/10.3390/curroncol28040255.
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Background: Secondary tumors of the ovary (STOs) account for 10–25% of all ovarian malignancies, including metastases from primary gynecological tumors. Colorectal cancer (CRC) has been recognized as one of the most common causes of STOs in Western countries. Despite it being well-known that CRC originating from the right versus left side of the colon/rectum differ substantially, there is a paucity of information regarding the effect of the primary tumor sidedness on the clinicopathological characteristics of STOs. Methods: This retrospective, observational chart review study included patients with histologically confirmed STOs of CRC origin diagnosed between January 2000 and December 2019. The clinicopathological characteristics of STOs originating from left-sided and right-sided CRC were compared. Univariable and multivariable analyses employing elastic net Cox proportional hazard models were used to evaluate potential prognostic factors. Further, the role of imaging methods in STOs diagnostics was evaluated. Results: Fifty-one patients with STOs of colorectal origin were identified. The primary tumor originated in the right and left colon/rectum in 39% and 61% of the cases, respectively. STOs originating from right-sided primary tumors were more frequently bilateral, associated with peritoneal carcinomatosis, had the ovarian surface affected by the tumor, and contained a mucinous component. The independent prognostic factors for overall survival in the whole cohort included: the presence of macroscopic residual disease after cytoreductive surgery, menopausal status, the application of systemic therapy, and the application of targeted therapy. In 54% of cases, the imaging methods failed to determine the laterality of the STOs correctly as compared to pathological reports and/or intraoperative findings. Conclusion: STOs originating from left-sided and right-sided CRC show distinct clinicopathological characteristics. Moreover, different metastatic pathways might be employed according to the primary tumor sidedness. Considering the discrepancies between radiological assessment and histopathological findings regarding the laterality of STOs, bilateral adnexectomy should be advised whenever feasible.
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Haar, Ronald W. Ter, Gerlof D. Valk, Inne HM Borel Rinkes, and Menno R. Vriens. "Parathyroid Carcinoma, a Rare Entity with Varying Presentation and Treatment." World Journal of Endocrine Surgery 2, no. 1 (2010): 33–36. http://dx.doi.org/10.5005/jp-journals-10002-1018.
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ABSTRACT Background Parathyroid carcinoma is a rare entity that has diverse presentation and diverse treatments. This case-series highlights the atypical and diverse presentation of parathyroid carcinoma and stresses the importance of the diagnostic approach and intraoperative strategy. Methods We report three patients with parathyroid cancer. Results In one patient, a parathyroid lesion was found to be a parathyroid carcinoma intraoperatively, resulting in a change of operative strategy. In another, parathyroid carcinoma was suspected preoperatively and was treated accordingly. A third patient presented with an already a metastasized parathyroid carcinoma. Conclusion The diagnostic approach and intraoperative strategy are instrumental to determining the best treatment and yielding the best outcome.
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Digby, Richard, Piravin Ramakrishnan, Saad Moughal, Arundhati Chakrabarty, and Ryan Mathew. "QLTI-19. EVALUATION OF INTRA-OPERATIVE BRAIN TUMOUR DIAGNOSTIC SERVICES – A LARGE TERTIARY UK CENTRE EXPERIENCE." Neuro-Oncology 24, Supplement_7 (November 1, 2022): vii238. http://dx.doi.org/10.1093/neuonc/noac209.921.
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Abstract INTRODUCTION Brain tumour intraoperative diagnosis (smear cytology, frozen section) is a commonly performed, routine diagnostic service. Currently, samples must be transported from the operating room (OR) to pathology, impacting turnaround time (TAT), carbon emissions (if cross-site), and motivation for repeat sampling. We performed a broad evaluation of current practice in a large, tertiary, UK brain tumour centre, to identify potential gains in real-time tissue diagnosis. METHODS All brain tumour samples (n=228) sent for intraoperative diagnosis in 2021 were analysed retrospectively. TAT was assessed by capturing different timepoints along the pathway. Concordance between diagnoses at the following stages was determined: preoperatively based on radiology, intraoperatively (frozen section or smear), provisional paraffin and final integrated. Additionally, we anonymously surveyed neurosurgeons’ opinions (n=18) on the current service. RESULTS The mean (±SD) specimen transportation time was 10.6±2.0 minutes, with an estimated total TAT of 30-60 minutes. Intraoperative diagnosis provided a slightly higher rate of concordance with provisional paraffin diagnosis than preoperative radiological diagnosis (89.5% vs 86.3%). Non-concordance was most commonly due to non-representative sampling (e.g., predominantly necrotic), with no repeat sample being sent/available intraoperatively. Prevailing neurosurgical opinion of the intraoperative diagnostic service was dissatisfaction or neutrality (50% and 39% of respondents), with a minority being positive (11%). Reasons for this included: intraoperative delay due to TAT (47%), perceived inaccuracy of results (41%), and perceived reduced out-of-hours availability (56%). CONCLUSIONS Current brain tumour intraoperative diagnostic practice relies on physical sample transportation and manual processing; the resultant long TAT causes surgeon dissatisfaction and dissuades repeat analysis in the case of non-representative sampling. Real-time tissue diagnostic technologies such as OR-sited probe-based confocal endomicroscopy, scanners and Raman spectroscopy should be considered to facilitate faster and repeated examination. The latter may have additional benefits in real-time expert pathology feedback, tumour margin-zone analysis and increased extent of resection.
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Kleine Borgmann, Felix, Andreas Husch, Redouane Slimani, Finn Jelke, Giulia Mirizzi, Karoline Klein, Michel Mittelbronn, and Frank Hertel. "PATH-31. BUILDING A RAMAN SPECTROSCOPY REFERENCE DATABASE FOR TUMOR IDENTIFICATION AND CLASSIFICATION." Neuro-Oncology 21, Supplement_6 (November 2019): vi149—vi150. http://dx.doi.org/10.1093/neuonc/noz175.627.
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Abstract Brain tumor resection requires careful assessment of the nature and malignancy of the tumor tissue during intervention, as this is the basis for the decision as to how radical surgery has to be. Typically, there is no tissue available for analysis prior to the surgery. Intraoperative histopathological examination of tumor samples is time consuming and puts the patient to a significant amount of strain due to ongoing anesthesia and prolonged surgery, thus there is a need to develop faster methods for thorough diagnostics. Raman spectroscopy allows for a fast analysis of samples without the need for labeling and sample preparation, making it a useful tool for peri- and intrasurgical application. We collect Raman spectra and correlated histopathological results to build a database of different tumor types. As intrasurgical use of Raman spectroscopy will typically be applied to native specimens, the respective database has to be based on native samples as well. We collected several thousands of measurements from more than 100 patients and continue to assemble a native database. Tumors that do not occur with a high frequency are not sufficiently represented in the database. Therefore, we investigate whether it is possible to integrate fixed and frozen specimens in the collection of Raman spectra and the classifier. Fixation results in characteristic changes to the biochemistry of biological tissues. We collect pairs of spectra from native and fixed as well as from native and frozen specimens and use the difference of the spectra to create an algorithm for filtering of the specific changes in the spectra. These data can be used to train a classifier for the identification of native samples. This opens the way for assessing large collections of pathological samples in fixed and frozen state to cover any type of neoplastic disease in the database.
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Stovgaard, Elisabeth Specht, Tove Filtenborg Tvedskov, Anne Vibeke Lænkholm, and Eva Balslev. "Cytokeratin on Frozen Sections of Sentinel Node May Spare Breast Cancer Patients Secondary Axillary Surgery." Pathology Research International 2012 (May 9, 2012): 1–5. http://dx.doi.org/10.1155/2012/802184.
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Background. The feasibility and accuracy of immunohistochemistry (IHC) on frozen sections, when assessing sentinel node (SN) status intraoperatively in breast cancer, is a matter of continuing discussion. In this study, we compared a center using IHC on frozen section with a center not using this method with focus on intraoperative diagnostic values. Material and Methods. Results from 336 patients from the centre using IHC intraoperatively were compared with 343 patients from the center not using IHC on frozen section. Final evaluation on paraffin sections with haematoxylin-eosin (HE) staining supplemented with cytokeratin staining was used as gold standard. Results. Significantly more SN with isolated tumor cells (ITCs) and micrometastases (MICs) were found intraoperatively when using IHC on frozen sections. There was no significant difference in the number of macrometastases (MACs) found intraoperatively. IHC increased the sensitivity, the negative predictive value, and the accuracy of the intraoperative evaluation of SN without decreasing the specificity and positive predictive value of SN evaluation. Conclusions. IHC on frozen section leads to the detection of more ITC and MIC intraoperatively. As axillary lymph node dissection (ALND) is performed routinely in some countries when ITC and MIC are found in the SN, IHC on frozen section provides valuable information that can lead to fewer secondary ALNDs.
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Wadiura, L. I., B. Kiesel, T. Roetzer-Pejrimovsky, M. Mischkulnig, C. Vogel, J. A. Hainfellner, A. Woehrer, K. Roessler, and G. Widhalm. "PL01.5.A Towards modernizing intraoperative histopathological assessment in brain and spinal tumors - Comparison of the novel Stimulated Raman Histology with conventional H&E staining." Neuro-Oncology 24, Supplement_2 (September 1, 2022): ii1. http://dx.doi.org/10.1093/neuonc/noac174.002.
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Abstract Background By intraoperative analysis of fresh frozen sections, neuropathologists provide important information of different brain and spinal tumors to the neurosurgeon during surgery. This facilitates characterization of these tumors intraoperatively to optimize the surgical strategy and patient management. However, preparation and staining are time consuming using conventional techniques of intraoperative fresh frozen section. Stimulated Raman Histology (SRH) was introduced as novel technique providing high-resolution digital images of unprocessed tissue samples directly in the operating room comparable to conventional histopathological images. Additionally, SRH images are fast and easily accessible by neuropathologists. Recently, first data showed promising results on the accuracy and feasibility of SRH in comparison to conventional H&E staining. Material and Methods In a time period of 4 months, patients with different brain or spinal tumors who underwent neurosurgical resection or open/stereotactic biopsy at the Dept. of Neurosurgery, Medical University Vienna were included in this study. Tumor tissue samples were collected intraoperatively whenever safely possible for analysis with SRH. Subsequently, unprocessed tissue samples were scanned by SRH, and intraoperative histopathological images were created directly in the operating room within a few minutes. All collected tissue samples were then sent for routine neuropathological workup. In an overall analysis, SRH images and H&E staining of all patients were analyzed separately by two board certified neuropathologists. Information on age, localization and suspected diagnosis was provided in each case in order to simulate the situation of intraoperative fresh frozen section. In a next step the technical feasibility and diagnostic accuracy of SRH was calculated. Results In this study, tissue samples of 95 patients who underwent neurosurgical resection or open/stereotactic biopsy of different brain and spinal tumors were collected intraoperatively and analyzed by SRH. In total, 31 gliomas, 30 meningiomas, 19 metastases, 7 neurinomas and 8 rare tumors were analyzed. In the present study the use of SRH was technically feasible in all cases and could be easily integrated in the neurosurgical workflow to provide rapid digital histopathological images for the analyzing neuropathologists. According to our data, SRH provided high diagnostic accuracy (>95%) in the investigated different brain and spinal tumors. Conclusion Based on our preliminary data the technical use of SRH is feasible and showed a high rate of diagnostic accuracy in a large series of different brain and spinal tumors. By using this promising technique, we intend to modernize intraoperative histopathological assessment by providing rapid digital images of brain and spinal tumors to optimize the management of these patients.
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Snell, Sarah B., Earl E. Gaar, Scott P. Stevens, and Michael B. Flynn. "Parathyroid Cancer, a Continued Diagnostic and Therapeutic Dilemma: Report of Four Cases and Review of the Literature." American Surgeon 69, no. 8 (August 2003): 711–16. http://dx.doi.org/10.1177/000313480306900813.
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Parathyroid cancer presents a diagnostic challenge as a rare endocrine malignancy usually not recognized preoperatively and often not conclusively identified intraoperatively. We examined a cluster of parathyroid cancers treated at University of Louisville-affiliated hospitals during a 5-year interval. Clinical and histologic data from patient records at University Surgical Associates, the University of Louisville Hospital, Norton Hospital, and the Louisville Veterans Administration Medical Center in Louisville, KY were retrospectively reviewed. During the study interval surgical exploration of the neck was undertaken on 175 patients with primary hyperparathyroidism; four parathyroid malignancies (2%) were identified. Three of the four patients exhibited symptomatic hyperparathyroidism with very high diagnostic calcium and parathormone levels. All patients had multiple coexisting diseases and two had undergone previous parathyroid surgery. Sestamibi scan localized the lesion in two patients, ultrasound was used in one patient, and a positron emission tomography scan was needed to identify the lesion in the fourth. Intraoperative findings varied from multiple nodules involving the thyroid and paratracheal nodules to otherwise normal-appearing enlarged parathyroid gland. External pathologic review was needed to conclusively establish the diagnosis in all cases, even though initial histologic analysis was suggestive of malignancy. All patients are alive, well, and free of disease. This rarely occurring malignancy may be suggested by very high preoperative calcium parathormone levels. Intraoperative and histologic findings are often inconclusive resulting in therapeutic decisions made by the operating surgeon on the basis of limited or incomplete information.
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Elliott, Robin M., Robert R. Shenk, Cheryl L. Thompson, and Hannah L. Gilmore. "Touch Preparations for the Intraoperative Evaluation of Sentinel Lymph Nodes After Neoadjuvant Therapy Have High False-Negative Rates in Patients With Breast Cancer." Archives of Pathology & Laboratory Medicine 138, no. 6 (June 1, 2014): 814–18. http://dx.doi.org/10.5858/arpa.2013-0281-oa.
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Context.— The use of a touch preparation for intraoperative sentinel lymph node diagnosis has become a preferred method of many pathologists because of its reported high sensitivity and rapid turnaround time. However, after neoadjuvant chemotherapy many lymph nodes have significant treatment-related changes that may affect the diagnostic accuracy of the intraoperative evaluation. Objective.— To determine the accuracy of touch preparation for the intraoperative diagnosis of metastatic breast carcinoma in the neoadjuvant setting. Design.— We reviewed retrospectively the results of intraoperative evaluations for 148 different sentinel lymph nodes from 63 patients who had undergone neoadjuvant chemotherapy for invasive breast cancer at our institution. The intraoperative touch preparation results were compared with the final pathology reports in conjunction with relevant clinical data. Results.— Use of touch preparation for the evaluation of sentinel lymph nodes intraoperatively after neoadjuvant therapy was associated with a low sensitivity of 38.6% (95% confidence interval [CI], 24.4–54.5) but high specificity of 100% (95% CI, 96.5–100). There was no difference in sensitivity rates between cytopathologists and noncytopathologists in this cohort (P = .40). Patients with invasive lobular carcinoma and those who had a clinically positive axilla before the initiation of neoadjuvant therapy were the most likely to have a false-negative result at surgery. Conclusions.— Intraoperative touch preparations should not be used alone for the evaluation of sentinel lymph nodes in the setting of neoadjuvant therapy for breast cancer because of low overall sensitivity.
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Gitsch, Eduard, Norbert Pateisky, and Ch Schatten. "Diagnostic and intraoperative immunoscintigraphy in ovarian cancer." European Journal of Obstetrics & Gynecology and Reproductive Biology 32, no. 1 (July 1989): 33–37. http://dx.doi.org/10.1016/0028-2243(89)90124-x.
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Gubbala, Phanedra K., Alexandros Laios, Zhe Wang, Sunanda Dhar, Pubudu J. Pathiraja, Krishnayan Haldar, and Sean T. Kehoe. "Routine Intraoperative Frozen Section Examination to Minimize Bimodal Treatment in Early-Stage Cervical Cancer." International Journal of Gynecologic Cancer 26, no. 6 (July 2016): 1148–53. http://dx.doi.org/10.1097/igc.0000000000000738.
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ObjectiveIn early-stage cervical cancer, single modality therapy is the main objective, to minimize patient morbidity while offering equivalent cure rates. Intraoperative frozen section examination (FSE) of lymph nodes (LNs) can facilitate this aim, ensuring that radical surgery is avoided in patients requiring adjuvant therapy for metastatic LN involvement. We aimed to evaluate the accuracy of routine intraoperative FSE of pelvic LNs during the surgical staging of early-stage cervical cancers and identify a group at low risk for nodal metastases.MethodsA retrospective cohort study of 94 women aged 23 to 80 years who underwent primary surgery and planned intraoperative FSE of the pelvic LNs at the gynecological cancer center in Oxford was performed. The diagnostic value of FSE and the prediction of metastatic nodal disease were assessed by use of preoperative and intraoperative variables.ResultsA total of 1825 LNs were submitted for FSE. Of 94 women (13.8%), 13 had positive LNs at FSE. Two false-negative cases were reported with micrometastases but no false-positive cases. Frozen section examination as a diagnostic test reached a sensitivity of 86.7% and a specificity of 100%. A regression model including grade I to II and tumor size of less than 20 mm identified a low-risk group for LN involvement.ConclusionsIn light of diverse practice patterns, FSE should be routinely offered to women with early-stage cervical cancer in a 1-step protocol. We equally devised a model to predict those patients at least risk of nodal disease, who may be spared of FSE.
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Özdemir, Suna, Çetin Çelik, Dilek Emlik, Demet Kiresi, and Hasan Esen. "Assessment of Myometrial Invasion in Endometrial Cancer by Transvaginal Sonography, Doppler Ultrasonography, Magnetic Resonance Imaging and Frozen Section." International Journal of Gynecologic Cancer 19, no. 6 (July 2009): 1085–90. http://dx.doi.org/10.1111/igc.0b013e3181ad3eb6.
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Objective:We aimed to compare the diagnostic performance of transvaginal sonography (TVS), magnetic resonance imaging (MRI), and intraoperative frozen section in the assessment of myometrial invasion and to evaluate intratumoral blood flow in any myometrial invasion with transvaginal Color Doppler ultrasonography (TV-CDU).Methods:This prospective study included 64 women consecutively diagnosed with endometrial carcinoma. The subjects were evaluated by TVS, MRI, and TV-CDU by 2 radiologists with a special training in gynecology. Intraoperatively, a frozen section was obtained and processed for interpretation by a blinded pathologist. Sensitivity, specificity, negative, and positive predictive values were calculated for each imaging modality and frozen section with regard to assessment of myometrial invasion. The intratumoral blood flow was evaluated by TV-CDU.Results:Transvaginal sonography, MRI, and frozen section showed no statistical significant differences in overall diagnostic performance for the preoperative and intraoperative assessment of any myometrial invasion, although frozen section seemed to be slightly superior to the imaging techniques. The positive rate of intratumoral blood flow was higher in deep myometrial invasion, but statistical significance was not obtained. The mean value of resistance index was significantly lower in the cases with deep myometrial invasion.Conclusions:Transvaginal sonography with concomitant TV-UCD is low-cost, easily performed, and repeated technique for particularly deep myometrial invasion. Because of its high costs and time-consuming, MRI may be recommended in the cases with poor quality of TVS. Because depending solely on imaging methods could lead to insufficient treatment schedules, intraoperative frozen section should also be performed for myometrial assessment.