Accuracy of preoperative urinary symptoms, urinalysis, computed tomography and cystoscopic findings for the diagnosis of urinary bladder invasion in patients with colorectal cancer

Development of a CT radiomics model for detection of bladder invasion by colorectal carcinoma

To investigate the feasibility of a radiomics model for the detection of bladder invasion (BI) by colorectal cancer (CRC) on CT images. Ninety-six patients with CRC and a suspicion of BI who underwent tumor resection with partial or total cystectomy were reviewed. The 96 patients were randomly assigned to the training dataset (n = 68) or test dataset (n = 28) at a ratio of 7:3. The CT images were reviewed by two experienced radiologists, who provided a CT impression of the invasion of the bladder by CRC. A region of interest (ROI) on the CT images for each case was manually labeled by two radiologists. A radiomics model was constructed using a Categorical Boosting (CatBoost) classifier. The predicted probability by CatBoost was used to evaluate the efficacy of the radiomics model. The areas under the curve (AUCs) of the receiver operating characteristic were compared between the radiomics model and the CT impression. In the training dataset, the AUC of the radiomic model [0.864 (95% CI: 0.778, 0.951)] was significantly greater than that of CT impression [0.678 (95% CI: 0.569. 0.786), P = 0.007]. In the test dataset, the AUC of the radiomic model [0.883 (95% CI: 0.699, 1.000)] was also significantly greater than that of CT impression [0.570 (95% CI: 0.370, 0.770), P = 0.040]. It is feasible to use radiomics models for the prediction of BI by CRC, which might perform better than human radiologists.

Diagnostic accuracy of cystoscopy and ultrasonography in the prenatal diagnosis of abnormally invasive placenta

The aim of this study was to compare the accuracy of cystoscopy and ultrasonography for the prenatal diagnosis of abnormally invasive placenta (AIP), including its subgroups: placenta accreta (PA), placenta increta (PI), and placenta percreta (PP).A retrospective observational study including a total of 85 pregnant women at high risk for AIP underwent prenatal cystoscopy and ultrasonography evaluations. The sensitivity (Se), specificity (Sp), positive predictive value, negative predictive value, and exact diagnosed were calculated and compared for both cystoscopy and ultrasonography. Se and Sp values of cystoscopy and ultrasonography were compared by means of the McNemar test.Of the 85 patients, there were 24 (28.2%) PA, 35 (41.2%) PI, 4 (4.7%) PP, and 22 (25.9%) nonadherent placenta. The mean maternal age and gestational age of delivery were 31.88 ± 4.42 years and 36.14 ± 1.84 weeks, respectively. No one was found to develop any complications with cystoscopy like urinary tract infection, or ureteral injury or perforations. Se in the diagnosis of AIP was 50.8% with ultrasonography and 61.9% for cystoscopy. Sp was 86.4% with cystoscopy and 72.7% for ultrasonography. In subgroups, Se with cystoscopy was 25.0%, 62.9%, and 100.0% in PA, PI, and PP, respectively, and 37.5%, 74.3%, and 100.0%, respectively, for ultrasonography; Sp remained unchanged with 86.4% for cystoscopy and 72.7% for ultrasonography. After McNemar test, no difference was found in either Se or Sp between cystoscopy and ultrasonography in AIP and its subgroups.According to the depth of invasion, the diagnostic value of cystoscopy and ultrasonography is all conspicuous increased and they have similar test validity for prenatal diagnosis of AIP and its subgroups.

T4 Colon Cancer - Current Management

Colorectal cancer is the third most often encountered type of cancer and represents the third leading cause of cancer related deaths, on both sexes. One of the most important prognostic parameters is the tumor’s stage at the time of the diagnosis. T4 cancers represent advanced tumors associated with penetration of the visceral peritoneum (T4a) and/or direct invasion in adjacent structures (T4b). Preoperative diagnosis is influenced by the inability of the existent imaging modalities to accurately differentiate the true invasion from the simple, inflammatory adherence to the neighboring structures. As a consequence surgical treatment must follow the principle of en bloc resection; however the ability of achieving an R0 resection depends on the tumor location, invaded organ, and the type of the surgical procedure required. Neoadjuvant treatment for advanced colon cancer it may be very difficult to be applied. This review is focused on preoperative workup, therapeutic strategies and subsequent results in advanced T4 colon cancers.