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Simple Summary: Intraoperative consultation is frequently used in clinical practice to establish the initial diagnosis of lung cancer when preoperative histological confirmation fails. The ability to distinguish benign and malignant lesions established frozen sections as the gold standard to guide surgical procedures. Ex vivo fluorescence confocal microscopy is a novel fully digital microimaging technique that enables timely examinations of fresh tissue without loss. The method proved to be an effective and safe method for diagnosing and subtyping lung cancer in our study and is therefore a promising alternative to frozen sections. It preserved the tissue as native material for subsequent examinations, which is an advantage in the diagnosis of small tumors and for biobanking. The acquired digital image data in cross-platform formats formed a suitable basis for telepathological procedures, e.g., second opinions by external specialists. Background: Intraoperative frozen sections (FS) are frequently used to establish the diagnosis of lung cancer when preoperative examinations are not conclusive. The downside of FS is its resource-intensive nature and the risk of tissue depletion when small lesions are assessed. Ex vivo fluorescence confocal microscopy (FCM) is a novel microimaging method for loss-free examinations of native materials. We tested its suitability for the intraoperative diagnosis of lung tumors. Methods: Samples from 59 lung resection specimens containing 45 carcinomas were examined in the FCM. The diagnostic performance in the evaluation of malignancy and histological typing of lung tumors was evaluated in comparison with FS and the final diagnosis. Results: A total of 44/45 (98%) carcinomas were correctly identified as malignant in the FCM. A total of 33/44 (75%) carcinomas were correctly subtyped, which was comparable with the results of FS and conventional histology. Our tests documented the excellent visualization of cytological features of normal tissues and tumors. Compared to FS, FCM was technically less demanding and less personnel intensive. Conclusions: The ex vivo FCM is a fast, effective, and safe method for diagnosing and subtyping lung cancer and is, therefore, a promising alternative to FS. The method preserves the tissue without loss for subsequent examinations, which is an advantage in the diagnosis of small tumors and for biobanking. [ABSTRACT FROM AUTHOR]

Contrast-enhanced CT is the standard imaging technique in oncological objectives. Rates of missed pathologies depend on work experience of the respective radiologists. Thus the aim of this study is to analyze the eye movements of professionals while reading CT images in order to evaluate whether the eye-fixation patterns and search strategies of experienced radiologists could explain higher detection rates of pathologies and whether such patterns can be learned.Anonymized images of 10 patients were presented to three medical students and six radiologists with different levels of work experience. During image analysis, ocular fixation positions were recorded using an eye-tracking software tool. The CT scans were analyzed retrospectively, considering the individual course of disease with the issue of successful detection of all pathologies. Visual attention and dwell time of ocular fixation on clinically important abnormalities or areas with pathological findings, general search patterns, and time efficiency were assessed. For statistical analysis, interobserver variability and accuracy of lesion detection were evaluated taking into account individual experience.The results revealed that observer sensitivity depends on work experience due to a more systematic order of inspection and a well-known course of disease, e.g. in case of metastatic spread. The areas of missed pathologies mostly included secondary findings. Inexperienced readers changed the stratification considerably more often and required more time for reporting or detecting pathologies.Our results suggest that experienced radiological physicians reduce their amount of missed findings by looking more systematically at images and by applying a more targeted inspection of clinically important regions. · CT interpretation by radiology residents is faster and less error-prone compared to postgraduate residents. · systematic image analysis is trainable. · engrams tend to be acquired through experience. · Kluge S, Schülke C, Ites HC et al. Different Evaluation Strategies of Oncological CT Examinations with Regard to Professional Experience: A Clinical Study Using Eye-tracking. Fortschr Röntgenstr 2024; DOI 10.1055/a-2452-2180., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose  To compare measurement precision and interobserver variability in the evaluation of hepatocellular carcinoma (HCC) and liver metastases in MSCT before and after transarterial local ablative therapies. Materials and Methods  Retrospective study of 72 patients with malignant liver lesions (42 metastases; 30 HCCs) before and after therapy (43 SIRT procedures; 29 TACE procedures). Established (LAD; SAD; WHO) and vitality-based parameters (mRECIST; mLAD; mSAD; EASL) were assessed manually and semi-automatically by two readers. The relative interobserver difference (RID) and intraclass correlation coefficient (ICC) were calculated. Results  The median RID for vitality-based parameters was lower from semi-automatic than from manual measurement of mLAD (manual 12.5 %; semi-automatic 3.4 %), mSAD (manual 12.7 %; semi-automatic 5.7 %) and EASL (manual 10.4 %; semi-automatic 1.8 %). The difference in established parameters was not statistically noticeable (p > 0.05). The ICCs of LAD (manual 0.984; semi-automatic 0.982), SAD (manual 0.975; semi-automatic 0.958) and WHO (manual 0.984; semi-automatic 0.978) are high, both in manual and semi-automatic measurements. The ICCs of manual measurements of mLAD (0.897), mSAD (0.844) and EASL (0.875) are lower. This decrease cannot be found in semi-automatic measurements of mLAD (0.997), mSAD (0.992) and EASL (0.998). Conclusion  Vitality-based tumor measurements of HCC and metastases after transarterial local therapies should be performed semi-automatically due to greater measurement precision, thus increasing the reproducibility and in turn the reliability of therapeutic decisions. Key points   · Liver lesion measurements according to EASL and mRECIST are more precise when performed semi-automatically.. · The higher reproducibility may facilitate a more reliable classification of therapy response.. · Measurements according to RECIST and WHO offer equivalent precision semi-automatically and manually.. Citation Format · Höink AJ, Schülke C, Koch R et al. Response Evaluation of Malignant Liver Lesions After TACE/SIRT: Comparison of Manual and Semi-Automatic Measurement of Different Response Criteria in Multislice CT. Fortschr Röntgenstr 2017; 189: 1067 - 1075., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)