Search

Purpose : To investigate the use of apparent diffusion coefficient (ADC) values and other MRI features for the prediction of positive surgical margins (PSMs) in patients undergoing radical prostatectomy. Materials and methods : 400 consecutive patients who underwent surgery for prostate cancer between January 2015 and June 2016 were retrospectively identified. ADC values of the index lesion and other preoperative MRI features, including tumor site, laterality and level, Prostate Imaging Reporting and Data System (PI-RADS) category, European Society of Urogenital Radiology (ESUR) extra-capsular extension score (ECE score) and prostate volume, were assessed. Univariate and multivariable logistic regression were performed. Performance in predicting the occurrence of PSMs was measured using the area under the curve (AUC), and AUC differences were evaluated with the DeLong method. The Youden index was calculated to identify the ADC threshold to best discriminate patients with PSMs. Results : A total of 105 out of the 400 patients (26.2%) had PSMs after radical prostatectomy. ADC values, PI-RADS category, ECE score, tumor site and laterality were significantly associated with PSMs (p Conclusions : ADC values and preoperative MRI features can help estimate the risk of PSMs after radical prostatectomy. Micro Abstract : We retrospectively analysed 400 consecutive patients who underwent surgery for prostate cancer to investigate the use of apparent diffusion coefficient (ADC) values and other MRI features for the prediction of positive surgical margins (PSMs). ADC values, PI-RADS category, extra-capsular extension score, site, and laterality were significantly associated with PSMs; ADC performed well in PSM prediction, both in the univariate or multivariable analyses, with lower ADC values being present in patients with PSMs.

Tiroidectomia totale versus emitiroidectomia: approccio chirurgico al carcinoma papillare della tiroide T1-T2.Il carcinoma papillare della tiroide rappresenta l’80-90% dei tumori tiroidei e la sua incidenza è attualmente in aumento. Vogliamo valutare i risultati oncologici e funzionali del trattamento chirurgico del cancro della tiroide: tiroidectomia totale versus emitiroidectomia. Abbiamo effettuato uno studio monocentrico di coorte storica in un centro di riferimento terziario. Abbiamo raccolto i dati demografici, clinicopatologici e complicanze post operatorie di 586 pazienti trattati nel nostro istituto per carcinoma papillare della tiroide. Sono stati applicati modelli di rischio proporzionale Cox per valutare le differenze nei risultati, stratificandoli con il propensity score. I nostri dati suggeriscono che l’emitiroidectomia non porta ad un aumento del rischio di ricaduta locoregionale né a distanza rispetto alla tiroidectomia totale nei pazienti affetti da carcinoma in stadio T1-2 N0. La tiroidectomia totale riveste un ruolo importante in termini di miglioramento della prognosi nei casi di metastasi linfonodali del comparto centrale del collo (pN1a) (p = 0,001). Nella nostra casistica la tiroidectomia totale ha un rischio più elevato di complicanze chirurgiche in termini di ipocalcemia post operatoria e paralisi ricorrenziali (p0,001 e p = 0,02 rispettivamente).The incidence of papillary thyroid carcinoma, which accounts for 80-90% of all thyroid cancers, has recently been increasing. The current study aimed to compare the oncological and functional outcomes of total thyroidectomy (TT) and thyroid lobectomy (TL). To this end, a retrospective single-centre cohort study involving a tertiary care institution was conducted. Data regarding demographics, clinicopathology and postoperative complications from 586 patients with papillary thyroid cancer treated in a single institution were collected. Cox proportional-hazards models were utilised to determine differences in outcomes stratified according to propensity score. Our data suggested no significant difference in the risk for locoregional recurrence or distant metastasis between TL and TT among patients with pT1-2 pN0 papillary carcinoma. TT plays an important role in improving prognosis among patients with metastatic lymph nodes in the central neck compartment (pN1a) (p = 0.001). Moreover, TT had significantly higher rates of postoperative hypocalcaemia and recurrent laryngeal nerve paralysis compared to TL (p0.001 and p = 0.02, respectively).

Background Primary hyperparathyroidism is primarily caused by parathyroid adenoma, followed by hyperplasia and parathyroid carcinoma. In the era of minimally invasive, targeted parathyroidectomy, the main challenge remains that of distinguishing intraoperatively pathological parathyroid from normal glands and peri-thyroid fat tissue. The aim of this study is to evaluate the surgical outcomes of a novel minimally invasive technique called ultrasound-guided dye-assisted parathyroidectomy (USDAP). Methods We perform a retrospective analysis of patients affected by parathyroid adenoma, treated with USDAP at our institution between 2014 and 2019. Data were collected on patient age and sex, tumor location and size, preoperative investigations, histopathology, perioperative complications and surgical outcomes. Results Between January 2014 and June 2019, 43 patients underwent parathyroidectomy in our Institute. Each case was discussed by the Institutional Multidisciplinary Board. All patients undergoing thyroidectomy together with USDAP or patients undergoing USDAP under endoscopic control were excluded from the present study. The final cohort, the largest to our knowledge, consisted of 29 patients. All patients were successfully treated with USDAP and remained disease-free during follow up. In all cases, pathological parathyroid was correctly identified and removed. There was no postoperative allergic reaction, nor were there neurotoxicity complications. USDAP permitted a shortening of operative and hospitalization time. Conclusions USDAP is an effective and safe procedure both as first line treatment and as a re-operative procedure after previous surgical failures in selected cases.