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Background We sought to assess health professionals’ satisfaction with the National Pressure Injury Advisory Panel staging system (NPUAP). Methods A paper survey assessing the satisfaction with the NPUAP was distributed to participants of a national wound care meeting. A total of 88 surveys were completed. Results were tabulated using SPSS. Results The survey response rate was 50%. Nearly all respondents (95.0%) used NPAUP for documentation. 75.3% indicated that a better staging system was needed. When participants were asked to evaluate their current staging system, 63.5% stated that the system does not adequately reflect patient’s clinical condition, 61.6% felt that the current staging system was not easily reproducible, 58.0% believed that the current staging system was generally easy-to-use, and 43.9% indicated that it is unable to suggest management recommendations. When asked about an ideal classification system, the respondents proposed incorporating tissue necrosis (97.6%), depth of tissue involvement (96.3%), discharge documentation (92.5%), presence of osteomyelitis (90%), local infection (88.8%), and systemic infection (80.0%). Overall, 67.0% of the participants wanted to use a classification system that would reflect the progress of injury healing and could be used to indicate the need for intervention. Discussion Health care workers caring for pressure injury patients indicated dissatisfaction with the NPAUP.

Aim: The aim of this study is to evaluate the inter-observer and intra-observer agreement of the myopic traction maculopathy (MTM) staging system (MSS). Methods: The agreement test for MSS was based on the evaluation of 104 optical coherence tomography (OCT) scans from 104 myopic eyes. According to the MSS, six observers were asked to identify, in each image, one among four retinal patterns and one among three foveal patterns of MTM, the presence of an outer lamellar macular hole (OLMH) and an epiretinal membrane (ERM). Each observer repeated the agreement test after a 60 days interval. Results: Inter-observer reliability: the agreement of the test for the retina pattern was substantial (0.724), for the fovea pattern was 0.821, for the OLMH was 0.656, and for the ERM was 0.463. When all the criteria are included in the validation test the agreement was 0.657. Regarding the weighted statistics (Gwet’s AC2, 95% CI), the validation test was statistically significant both when the variables were considered one by one, with an excellent agreement, respectively for the retina pattern (0.955) and the fovea pattern (0.963) and when all the variables were included in the tests (0.930). Intra-observer repeatability: all observers rerun the test after 2 months with a statistically significant percentage of confirmation of the previous test. Conclusion: The MSS offers in one Table information on diagnosis, natural history, function, prognosis, and management of MTM. The MSS is user-friendly and highly reproducible.

Purpose: The purpose of this research was to assess the agreement between the new optical coherence tomography (OCT) glaucoma staging system (GSS) and the visual field (VF) GSS 2 (GSS2). Methods: This is a cross-sectional study of 161 eyes of 110 patients with controlled primary open-angle glaucoma (POAG). All eyes were subjected to VF examination using standard automated perimetry and Humphrey field analyzer II 750. GSS2 was used for the classification of the VF defects’ severity. OCT of the optic disc and the macular ganglion cell complex (GCC) was performed using RTVue. Patients were classified by OCT GSS into six stages. Results: The study examined 161 eyes of 110 patients with controlled POAG. The staging according to VF GSS2 was as follows: stage 0 (12.42%), border stage (12.42%), stage 1 (13.04%), stage 2 (14.29%), stage 3 (14.28%), stage 4 (14.28%), and stage 5 (19.25%). The staging by OCT GSS was as follows: stage 0 (18.6 %), border stage (17.3%), stage 1 (6.8%), stage 2 (9.31%), stage 3 (6%), stage 4 (11.8%), and stage 5 (30.43%). The sensitivity of the new OCT GSS was different in different stages of glaucoma. In this study, no normal control group was considered; thus, the specificity could not be calculated. There was moderate agreement between the two staging systems. Conclusions: OCT GSS is a reliable and objective method for diagnosing and monitoring glaucoma. Correlations were found between GSS2, inferior and total macular GCC thickness values, and cup-to-disc ratios, so considering these items as additional parameters may make this new classification even more sensitive than VF GSS2.

Background Although the National Comprehensive Cancer Network guidelines recommend routine lymph node dissection (LND) in intrahepatic cholangiocarcinoma (ICC), the role of LND remains controversial, and the node (N) stage is oversimplified. Methods Patients were identified from the Surveillance, Epidemiology, and End Results research data 18 (SEER 18). Propensity score matching (PSM) was used to reduce bias, and Kaplan–Meier curves and Cox proportional hazards models were used to compare overall survival (OS). The best cutoff values were found using X-tile software. Results Of 2037 patients included in SEER 18, 1147 underwent LND (56.3%); 389 (34.3%) had pathologically confirmed lymph node metastasis (LNM), and 316 (27.6%) had at least 6 LNDs. The median OS was worse for LND patients (34 months vs. 40 months, respectively), and this result remained after PSM. Male sex, age ≥60 years, tumor size > 5 cm, and LNM were independent prognostic risk factors for ICC. LNM ≥3 was associated with worse OS. Conclusions Only a few LNDs met the requirements per the guidelines. LND does not improve OS in ICC, and the best approach to LND and a better N staging method should be explored further.

Objective This study aimed to validate new staging of Japanese patients with human papillomavirus-mediated oropharyngeal cancer (HPV+-OPC) and the effectiveness of transoral surgery. Methods Fifty-three patients with HPV+-OPC were classified according to the seventh and eighth editions of the American Joint Committee on Cancer (AJCC) staging, along with assessment of prognosis, smoking and alcohol status, and treatment outcome. Transoral videolaryngoscopic surgery (TOVS) was performed as transoral surgery. Results The 5-year overall survival (OS) rate was 77.3% in all patients. Five-year OS rates of seventh edition staging were as follows: II, 100%; III, 100%; IVa, 75.9%; and IVb and IVc, 0%. Five-year OS rates of the eighth edition clinical staging were as follows: I, 89.3%; II, 88.9%; III, 46.3%; and IV, 0%. In non-smoking and smoking patients with HPV+-OPC, the 5-year OS rates were 90.9% and 70.7%, respectively. TOVS was used for treating 20 smokers with HPV+-OPC (5-year OS: 85.7%), while 12 were treated with chemoradiotherapy (5-year OS: 75.0%). Conclusions The eighth edition of the AJCC determines the prognosis of HPV+-OPC more accurately than the seventh edition in clinical staging. Smokers with HPV+-OPC have a poor prognosis, but TOVS might improve the prognosis.

Background: This study aimed to evaluate T staging system for non-small cell lung cancer (NSCLC) using tumor volume (TV) and other prognostic factors. Methods: This study included 1309 cases. The TV and greatest tumor diameter (GTD) were semi-automatically measured. The receiver operating characteristic (ROC) curves of TV and GTD were used to predict survival. The regression analysis was used to describe the correlation between GTD and TV. Overall survival (OS) was analyzed using the Kaplan-Meier method. Cox’s proportional hazards regression model was applied for multivariate analysis. Results: Using the OS in pN0M0 patients (997 cases), we obtained 4 optimal cutoff values and divided all cases into 5 TV groups (V1: TV ≤ 2.80 cm3; V2: TV > 2.80–6.40 cm3; V3: TV > 6.40–12.9 cm3; V4: TV > 12.9–55.01 cm3; V5: TV > 55.01 cm3) with significant OS ( P < 0.001). Multivariate analysis showed that age, visceral pleural invasion (VPI), and all TV cutoff points were independent factors of OS ( P < 0.05). For V3 and V4 groups, the OS in patients without VPI was better than that in patients with VPI. Using the values of TV, VPI, and N stages, we classified all cases into 5 stages from I to V depending on the OS. The OS in I, II, III, IV, and V stages were 71.3%, 65.5%, 59.8%, 47.7%, and 35.1% respectively ( P < 0.001). Conclusions: We proposed a new T staging system using TV as the main prognostic descriptor in NSCLC patients, which may provide a better comprehensive clinical value than GTD in clinical applications.

BACKGROUND AND AIM: The Barcelona Clinic Liver Cancer (BCLC) staging system is commonly used to classify hepatocellular carcinoma (HCC) patients. However, other staging classification schemes have been proposed. We aimed to compare the prognostic accuracy of the Hong Kong Liver Cancer Staging (HKLC), the Model to Estimate Survival for HCC (MESH), and the BCLC staging systems using a Western cohort of HCC patients. METHODS: We retrospectively analyzed 918 patients diagnosed with HCC treated at the University Medical Center of Mainz between 2005 and 2014. We compared the predictive power of survival time of the BCLC, HKLC, and MESH. Predictive ability was tested using the integrated Brier score (IBS) and Harrell’s C index. RESULTS: Kaplan–Meier analyses showed significant differences in survival between stages defined by the BCLC, HKLC, and MESH. The HKLC classification demonstrated a more robust classification concordance and lower prediction error compared to the BCLC and MESH. In addition, we found that the BCLC offers superior predictive ability to the MESH in the first four years, whereas the MESH is superior for long-term predictions. CONCLUSION: Our analyses confirm the prognostic value of three different HCC scoring systems. When compared, the HKLC provides superior prognostication ability.

Controversy exists over the staging of gastroesophageal junction (GEJ) adenocarcinomas. The aim of our study was to assess the adequacy of the American Joint Committee on Cancer 7th edition esophageal (E7) and gastric (G7) staging systems for GEJ tumors in a western population. All patients with GEJ adenocarcinoma who underwent curative resection from 2000 to 2012 were identified from the United States Gastric Cancer Collaborative database and assessed according to the E7 and G7 systems. Fifty-one patients were identified. Neither the E7 nor G7 system adequately stratified patients by Tor N stage with a loss of distinctiveness between T1 to 4 and N0 to 3 tumors. On final stage analysis, the outcomes were similar between both systems; however, neither system, with the exception of the G7 stage I versus II, adequately stratified patients by stage (E7: I vs II, P = 0.07; II vs III, P = 0.23; G7: I vs II, P = 0.02; II vs III, P = 0.13). Histologic grade was not associated with survival (P = 0.27) and did not improve the ability to stratify patients in the E7 system. Our study identifies limitations in the proper stratification of patients with GEJ adenocarcinoma using either the American Joint Committee on Cancer 7th esophageal or gastric systems. The classification of GEJ adenocarcinoma within either system needs to be further studied in a larger patient population.

Category: Ankle, Ankle Arthritis Introduction/Purpose: The Takakura staging system has been used for the stratification in ankle osteoarthritis(OA). Patient’s OA stage is determined by visual examination on the status of talar and distal tibia in anteroposterior ankle radiograph. Clinical decisions about whether to treat conservatively or to treat with operation such as supra-malleolar osteotomy or arthroplasty may depend on this grading system. However, this is not completely reproducible between examiners and it makes a debating situation about different treatment method to a same ankle radiograph. If highly reproducible measurement method may be suggested this debating may no longer need. Therefore, the purpose of this study was to suggest a deep learning-based algorithm that automatically grades ankle osteoarthritis and to present feasibility of the provided automatic grading system. Methods: 2529 AP both-ankle radiographs were collected and graded for OA by a radiologist and orthopedic surgeon. We converted Takakura staging system into 3 grades(Grade1: stageI, Grade2: II-IIIa, Grade3: IIIb-IV) according to treatment plan. To confine the region of interest(ROI), a rectangle encompassing ankle portion was automatically generated using an object detection model(YOLOv2). The data oversampling was done to overcome small data and class imbalance. Four pre-trained convolutional networks(One Inception-v3 and three ResNet models) were fine-tuned using augmented data. We tried two different ensemble methods: voting ensemble and gradient boosting. Voting ensemble adjusts the decision through selecting majority votes among trained models. Gradient boosting(XGboost model) trains new classification model to focus on the cases that previous model mis- classified. The evaluation of trained models and ensemble model were performed in terms of average classification accuracy. Gradient-class activation map(CAM) method was utilized to present CAM highlighting the location where highly affected the network for the decision. Results: A total of 3836 original ROIs were obtained and as follows: grade 1, 1382; grade 2, 1927; grade 3, 527. The number of oversampled ROIs was 16398 like follows: grade 1, 5528; grade 2, 7708; grade 3, 3162. The performance of each classifier was ranged 71.0% ˜ 77.3% in terms of average classification accuracy. Ensemble methods yielded average classification accuracies of 78.1% and 79.2% for voting ensemble and XGboost, respectively. Conclusion: Deep learning-based algorithm application for automatic grading of ankle osteoarthritis based on Takakura staging system is feasible. This approach is expected to be applied to various staging system for arthritis assessment through radiographs.

Objectives To investigate the expression of eukaryotic initiation factor 4 E (eIF4E) in hypopharyngeal carcinoma compared with benign lesions, and the relationships between eIF4E expression and various clinicopathological parameters. Methods Expression of eIF4E was analysed retrospectively in specimens from hypopharyngeal carcinomas and benign hypopharyngeal lesions using immunohistochemical staining and Western blotting. Tumours were classified using the tumour–node–metastasis staging system and the degree of histological differentiation was assessed. Results A total of 55 hypopharyngeal carcinoma and 20 benign specimens were analysed. All the hypopharyngeal carcinoma samples were positive for eIF4E expression on immunohistochemistry, whereas the benign lesions were negative or weakly positive. Semi-quantitative assessment (eIF4E score) showed that eIF4E expression was significatly higher in hypopharyngeal carcinoma than in benign lesions. On Western blotting, eIF4E expression assessed using integrated optical density (IOD) was significantly higher in hypopharyngeal carcinoma than in benign lesions. The eIF4E score and IOD value were significantly associated with tumour stage, lymphatic metastasis and degree of differentiation. The IOD value was significantly higher in recurrent compared with initial cases. Conclusions eIF4E may play an important role in the development and metastasis of hypopharyngeal carcinoma;its expression may be helpful in establishing the diagnosis, stage and prognosis of this tumour type.

Background: Treatment for capitellar osteochondritis dissecans (COCD) lesions is usually based on their stability from the bony floor after arthroscopic or open direct observation. Thus, a noninvasive means of lesion stability assessment by use of imaging is desirable to preoperatively determine treatment strategy. Purpose: To evaluate our modified MRI staging system for COCD, we compared the results of MRI staging with the International Cartilage Repair Society (ICRS) classification for lesion stability. Intra- and interrater reliability for MRI staging was examined as well. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Fifty-two COCD lesions were preoperatively evaluated by T2-weighted MRI and classified into 5 stages: stage 1 = normally shaped capitellum with several spotted areas of high signal intensity that is lower than that of cartilage; stage 2 = as with stage 1 but with several spotted areas of higher intensity than that of cartilage; stage 3 = as with stage 2 but with both discontinuity and noncircularity of the chondral surface signal of the capitellum and no high signal interface apparent between the lesion and the floor; stage 4 = lesion separated by a high intensity line in comparison with cartilage; and stage 5 = capitellar lesion displaced from the floor or defect of the capitellar lesion noted. The MRI staging results were compared with the intraoperative ICRS classification for lesion stability of each patient. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were all determined for fragment instability. Intra- and interrater correlations for our MRI staging were calculated among 3 examiners. Results: Preoperative MRI grading correctly matched ICRS classification in 49 of 52 patients (94%), with a sensitivity of 100% and a specificity of 80%. The PPV and NPV were 93% and 100%, respectively, for diagnosing lesion instability. Intrarater reliability (intraclass correlation coefficient [ICC]) for MRI staging was high at ICC(1, 1) = 0.86 and ICC(1, 2) = 0.90, as was interrater reliability at ICC(2, 1) = 0.82 and ICC(2, 3) = 0.88. Conclusion: The MRI staging system provides accurate and reliable evidence for estimating ICRS classification and instability of COCD and is useful to decide appropriate treatment.

The Barcelona Clinic Liver Cancer (BCLC) staging classification is commonly used for staging hepatocellular carcinoma (HCC). This system assumes the coexistence of cirrhosis; however, a significant proportion of patients with HCC present without cirrhosis. Recently, an alternative system was proposed that stratifies patients according to alpha-fetoprotein (AFP) level. The aim of this study was to apply the AFP staging system to noncirrhotic patients with HCC and evaluate its ability to predict overall survival (OS). A prospective hepatopancreatobiliary database was reviewed for all patients with a diagnosis of HCC. Patients were staged based on BCLC classification as well as by AFP stage according to four levels: less than 10 ng/mL, 10 to 150 ng/mL, 150 to 500 ng/mL, and greater than 500 ng/mL. Cirrhotic patients were compared with noncirrhotic patients in terms of patient demographics and HCC stage. Kaplan-Meier (KM) analysis of OS was performed for noncirrhotic patients according to BCLC and AFP staging systems. Cirrhotic and noncirrhotic patients differed significantly in terms of median age at presentation (64 vs 70 years, P < 0.001) and gender (76 vs 65% male, P = 0.006). BCLS staging classification did not distinguish between cirrhotics and noncirrhotics ( P = 0.733), whereas AFP staging demonstrated a significant difference between the two groups ( P < 0.0001). KM analysis of OS for noncirrhotic patients with HCC was significant for both the BCLC and the AFP staging systems ( P = 0.003 vs P < 0.0001, respectively). Patients presenting with HCC in the absence of cirrhosis appear to have different characteristics than patients with cirrhosis. Staging according to AFP level is an appropriate predictor of prognosis in noncirrhotic patients with HCC.

To evaluate the prognostic utility of the American Joint Committee on Cancer (AJCC) staging system for ocular adnexal lymphoma (OAL). A multicenter, consecutive case series of patients with biopsy-proven conjunctival, orbit, eyelid, or lacrimal gland/sac lymphoma was performed. The electronic pathology and clinical records were reviewed for new or recurrent cases of ocular adnexal lymphoma. The main outcome measures included pathology and clinical staging (AJCC and Ann Arbor systems), treatment, and recurrence (local and systemic). Statistical analysis included demographic evaluations and the Kaplan-Meier survival probability method. Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue were the most common (n=60/83, 72%). The most common Ann Arbor clinical stages were IE (76%) followed by IIE (17%) and IIIE (7%). Pathology identified 13 cases (15%) that were upstaged to group IV (p=0.017). Similarly, AJCC clinical stages were cT1NOMO (21.7%), cT2NOMO (44.6%), cT3N0M0 (5%), and cT4NOMO (2.4%). Local control was achieved in 75% of treated patients. There were 19 local recurrences from which 14 (74%) belonged to the non-radiation treatment groups. Lower-risk groups (T1 and T2 without lymph node involvement or metastatic disease of AJCC and IE of Ann Arbor) had longer disease-free survival than the higher-risk groups (AJCC T1, T2 with nodal involvement or metastatic disease, T3, and T4 as well as Ann Arbor II, III, and IV). The overall mean follow-up was 43.3 months (range 6-274). Regardless of stage, recurrence and disease-free survival were more closely related to treatment and histopathology rather than tumor size or site-specific location.

Sonography remains the cornerstone in the assessment of twin-to-twin transfusion syndrome in monochorionic twin pregnancies. Twin-to-twin transfusion is a common complication in monochorionic pregnancies, resulting in high perinatal morbidity and mortality rates. A disproportionate placental interconnection leads to hypovolemia and oligohydramnios in the donor twin and hypervolemia and polyhydramnios in the recipient twin. Ruben A. Quintero and his associates developed a staging system with definite sonographic criteria necessary for prognosis and management of these pregnancies. Quintero staging criteria consist of the following: stage 1, bladder of donor twin still visible; stage 2, bladder of donor twin no longer visible, no critical abnormal Doppler; stage 3, critical abnormal Doppler waveforms; stage 4, hydrops; and stage 5, demise of one or both twins.

Objectives We described the characteristics of congenital cholesteatoma in Japanese patients and assessed whether the staging system is useful for predicting the rate of residual disease, the need for reexploration, and surgical outcomes. Methods We performed a retrospective chart analysis of 23 consecutive patients with congenital cholesteatoma. Results The proportion of cases with anterior-superior quadrant involvement was significantly lower in the Asian group than in Western patients. The total residual rate was 26%, and there was a positive association between stage and residual rate, ranging from 0% in stage I and II to 44% in stage IV. Canal wall–up tympanomastoidectomy was the most frequent procedure (57%), and 61% had reexploration. Conclusions Congenital cholesteatoma in Asia is less likely to involve the anterior-superior quadrant than in Western patients. The 4-stage system was useful for predicting residual rates, even in patients in whom anterior-superior quadrant involvement was less common. Postoperative hearing was significantly related to the stages. A routine second-look procedure may be unnecessary in the early stages, whereas reexploration would be better performed in advanced stages. Endoscopy might reduce residual disease and the need for reexploration in the near future.

Background Arthroscopic microfracture is frequently used to repair osteochondral lesions of the talus. However, despite the popularity of this technique, no study has been conducted on cartilage repair after microfracture by second-look arthroscopy. Purpose The purpose of the present study was to evaluate cartilage repair in osteochondral lesions of the talus by second-look arthroscopy and to compare arthroscopic findings with clinical outcomes 12 months postoperatively. Study Design Case series; Level of evidence, 4. Methods Second-look arthroscopies were performed in 20 ankles of 19 patients at 12 months postoperatively. Arthroscopic findings were classified using the Ferkel and Cheng staging system, and cartilage repair was assessed using the International Cartilage Repair System (ICRS). Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. Results According to the Ferkel and Cheng staging at second-look arthroscopy, 7 of the 20 ankles (35%) showed incomplete healing (stage D). In terms of ICRS overall repair grades, 8 ankles (40%) were abnormal (grade III). Mean AOFAS scores for Ferkel and Cheng stages A to C (n 5 13) and stage D (n 5 7) were 88.5 and 82.0 points, and those for ICRS repair grades I and II (n 5 12) and grade III (n 5 8) were 88.7 and 82.5, respectively. Good correlations were found between AOFAS scores and Ferkel and Cheng stages and ICRS grades. Overall, 90% of ankles achieved an excellent or good AOFAS score of over 80 points. Conclusion Second-look arthroscopic findings at 12 months postoperatively after microfracture for osteochondral lesions of the talus revealed that 40% of lesions were incompletely healed. Nevertheless, the majority of patients achieved a good clinical outcome. Furthermore, postoperative clinical scores were found to be correlated with ICRS repair grades.

Background The aim of this study was to determine the interrater reliability and correlation between computed tomography (CT) and endoscopic components of the University of Miami (UM) Chronic Rhinosinusitis Staging System (UMCRSS), a comprehensive staging system for chronic rhinosinusitis (CRS). Methods A prospective analysis of 55 patients undergoing endoscopic sinus surgery for CRS was performed. The population consisted of 28 men and 27 women, with a mean age of 45.9 years. All patients underwent staging, via the CT and endoscopic components of the UMCRSS in the operating room, by three examiners. The reliability of the system and all of its components was determined by K-coefficient analysis, comparing the data from all three examiners. Correlation between the CT and endoscopic arms was analyzed by Pearson's product moment coefficient. Results Interrater reliability for the CT arm (κ = 0.83) and endoscopic arm (κ = 0.74 for the revision population, and κ = 0.72 for the primary surgery population) were found to be significant. Endoscopic staging established significant correlation with CT staging (Pearson's r2 = 0.40; p < 0.0001 overall, 0.57, p < 0.0001 for revision, and 0.42, p < 0.0001 for primary cases). Conclusion The UMCRSS is a comprehensive and reliable staging system with very strong and positive correlation between the CT and endoscopic components.

Objectives A new staging system recently proposed by the IGCA has demonstrated a better capacity for stratifying different prognoses for gastric cancer than the 7th edition AJCC staging system (AJCC7). The aim of this study was to evaluate the efficacy of the IGCA system in Chinese patients. Methods Medical records of patients with gastric cancer who received curative surgery in our centre from January 2003 to December 2011 were reviewed retrospectively. All the lesions were staged according to both AJCC7 and IGCA staging systems. Overall survival (OS) of the patients was used as the observation endpoint. Results One thousand five hundred and twenty-six cases were included in this study. By comparing the AJCC7 system with the IGCA system, 395 cases were stratified into different stages, most of which were in stage III. The IGCA system could better stratify stage IIIB and IIIC patients (5-year OS, 38.1% vs. 29.0%; p=0.005) than the AJCC7 system (5-year OS, 38.2% vs. 35.9%; p=0.148). T3N3bM0, T4aN2M0 and T4aN3bM0 made up 97.5% (385/395) of the stage shift. T3N3bM0, which was stratified to stage IIIB in the AJCC7 system, showed a significantly poorer prognosis than T4aN2M0 and T4aN3aM0, which were staged to IIIB and IIIC in the same system. The improper staging was revised in the IGCA staging system. Conclusions The IGCA staging system can stratify stage III gastric cancer patients more correctly than the AJCC7 system. Acknowledgement Supported by the National Natural Science Foundation of China (Grant No. 14B520013) and the Scientific Research Project from the open fund of Henan Key laboratory (Grant No. 172400410344).

Staging nasopharyngeal carcinoma (NPC) by the UICC 4th-edition TNM classification system (the old system) did not give an accurate prognosis because of the uneven distribution of patients in each stage. This system was revised in 1997 (the new system). To evaluate the performance of the new system, 35 patients with NPC who had been staged by the old system were restaged according to the new system. Restaging of the patients resulted in an overall “downstaging.” Differences in the overall survival rates of the early group (stages I, II, III), stage IVA, stage IVB, and stage IVC patients were statistically significant (75%, 48%, 74%, and 0%, respectively; p = .01). T4 was a significant factor of poor outcome (hazard rate, 2.932; 95% CI, 1.667 to 8.545), whereas N3 was not (hazard rate, 0.858; 95% CI, 0.281 to 2.618). The new staging system is more useful than the old system.

The aim of this study is to evaluate the impact of CT and MRI staging on the RT plan analyzing the patterns of spread of nasopharyngeal tumours. Pre-treatment CT and MRI examinations of 28 patients (28–65 years old, mean age 42; 16 men, 12 women) with primary nasopharyngeal cancer were retrospectively evaluated. CT and MRI in clinically known or suspected nasopharyngeal cancer showed in all cases the extent and spread of the pathologic tissue; consequently the Americal Joint Committee on Cancer (AJCC) staging system for primary nasopharyngeal tumours was strictly respected. Imaging permitted in all cases a good evaluation of neck nodes; retropharyngeal, junctional, jugulo-digastric and accessory spinal lymph nodes were correctly staged on the basis of size, density-intensity, shape and contrast enhancement. The impact of non- and minimally-invasive diagnostic imaging techniques on head and neck diseases is well known. Clinical evaluation of the nasopharynx and nearby deep fascial planes is hard and fiberoptic examination detects only mucosal surfaces of the organ. Consequently prognosis and therapy of nasopharyngeal carcinomas depend on CT and MR staging both of the primary site and neck nodes. The RT beam and portals are focused on the basis of imaging and the results of the therapy may be correctly investigated only by the comparative analysis of the first follow-up examination with pre-treatment morphological data.

Background Brusini developed a new interpretation system for Octopus and Humphrey automated perimeters that is based on mean defect (MD) and corrected loss variance (CLV) or corrected pattern standard deviation (CPSD). This study tested the performance of Brusini's glaucoma staging system (GSS) in staging and follow-up. Methods Retrospectively, 610 visual fields of 64 eyes of open-angle glaucoma patients were analyzed with Brusini GSS and compared with Aulhorn-Karmeyer stages and by PeriData 7.0 trend analysis. Results Follow-up was comparable to PeriData 7.0 trend analysis in 97%. Change was observed in 41% of eyes, i.e., initial improvement (19% eyes), deterioration (16%), and after an initial improvement, either deterioration (11%) or a stable period (5%). No change was seen in 59% of the eyes, of which 30% showed small and 19% high long-term fluctuation (LF) due to fatigue effect, poor cooperation of patient, impaired reliability, or short-term fluctuation (SF) greater than 1.7 dB. However, for 8% of the eyes there was no apparent reason for high LF. Conclusions Brusini GSS is useful for staging and recommended for follow-up evaluation of visual fields in glaucoma.

Background Diffuse malignant pleural mesotheliomas (DMPMs) are highly lethal tumors that are becoming more common. Standard management approaches have provided limited effectiveness. Methods The literature on management has been revised, and the authors present their data on outcomes for 120 patients treated with an aggressive trimodality approach. Results An aggressive trimodality approach including extrapleural pneumonectomy followed by chemoradiation produces low mortality and acceptable morbidity. The five-year survival rate in patients with epithelial histology and negative nodes approaches 40%. Conclusions Nodal status and histologic subtype are major predictors for survival in patients with early DMPM. A uniformly accepted staging system would allow comparison of treatment approaches from various institutions. More effective management interventions are required.

Functional endoscopic sinus surgery (F.E.S.S.) is an efficient, safe treatment of chronic sinus disease. A retrospective individual review of 81 patients (41 males, 40 females) all having undergone F.E.S.S. at Saint Barnabas Medical Center in Livingston, New Jersey, reveals positive patient reactions. The senior author (N.H.) performed all surgery on an outpatient basis. Surgery has been classified by the Anand & Panje staging system. Each patient was sent a comprehensive questionnaire at least 6 months postoperatively. A critical assessment was completed of subjects ‘ preoperative and postoperative histories along with a patient survey of their personal perspectives on preoperative symptoms and postoperative symptomatic relief. This paper describes patient perspective outcomes of symptomatic relief in patients who underwent F.E.S.S. Ninety-four percent of the patients indicated overall improvement. Ninety-one % of the patients who responded were satisfied with results, and 86% of the patients stated they would undergo this procedure again if necessary.

The success of outcomes research for sinus disease will depend in part on the utilization of a computed tomography (CT) staging system that meets rigorous statistical criteria. Such a staging system must demonstrate an even distribution of population by scale, a high inter-rater and intra-rater agreement, and a low percentage of unclassifiable scans. Four proposed sinus CT classification systems were evaluated for these parameters. Each system was used by four masked raters to rate 42 consecutive preoperative CT scans on two separate occasions. One of these systems is based on the site of disease rather than the degree of sinus opacification and gives a clear definition of sinus disease (2 mm or greater of mucosal thickening). This system had the highest inter-rater agreement (κ = 0.61, range = 0.38 to 0.61) and the lowest percentage of unclassifiable scans (0.6%, range = 0.6 to 14.2%). The statistical attributes of this particular sinus CT staging system support its use for outcomes research in sinus disease.

Whole organ serial-section study contributes to our understanding of neonatal intubation injury by demonstrating the previously undescribed “V” configuration of the posterior cricoid lamina; this may be readily correlated with subarytenoid paramedian intubation injury. This technique also permits detailed study of an anomalous larynx and permits the precise identification of a “tracheal” anomaly as a cricoid malformation. The need for a fetal staging system is reemphasized.

One hundred patients with chronic lymphocytic leukemia (CLL) followed in our department between November 1969 and December 1982 were reviewed and classified according to the staging system proposed by the International Workshop on CLL (IWCLL). Analysis of actuarial survival curves revealed a significant chisquare value for heterogeneity and trend. In addition, thrombocytopenia and anemia appeared to be the most important risk factors. A large variability in the course of disease, not well explained by the staging system of the IWCLL, was found among the nonanemic and nonthrombopenic patients. Analysis of A and B stage patients according to absolute peripheral blood lymphocytosis (less or more than 50 × 109/liter) showed two separate patterns of survival.

The experience of the Intergroup Rhabdomyosarcoma Study in the treatment of this relatively common pediatric malignancy is described, and the group's standardized staging system is outlined.

There is no agreement on the single best staging system for patients with nasopharyngeal carcinoma. We have evaluated prospectively several staging systems and have assessed the predictive value of many variables on survival and found that the most important are extensive tumor within the nasopharynx or regional extension, nodes in the lower portion of the neck, and cranial nerve involvement. Other variables that have not been used in traditional extent of disease staging systems but that have an adverse bearing on survival have been studied by multiple regression techniques in the Cox proportional hazards model. Two prognostic scores, which can be used for classifying patients into survival groups, ranging from excellent survival (low score) to poor survival (high score), have also been presented. With these schemes, patients who are at high risk for recurrence after conventional therapy can be reliably selected.