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Jovanovic MM, Stefanovic AD, Sarac D, Kovac J, Jankovic A, Saponjski DJ, Tadic B, Kostadinovic M, Veselinovic M, Sljukic V, Skrobic O, Micev M, Masulovic D, Pesko P, Ebrahimi K. Possibility of Using Conventional Computed Tomography Features and Histogram Texture Analysis Parameters as Imaging Biomarkers for Preoperative Prediction of High-Risk Gastrointestinal Stromal Tumors of the Stomach. Cancers (Basel) 2023; 15:5840. [PMID: 38136387 PMCID: PMC10742259 DOI: 10.3390/cancers15245840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The objective of this study is to determine the morphological computed tomography features of the tumor and texture analysis parameters, which may be a useful diagnostic tool for the preoperative prediction of high-risk gastrointestinal stromal tumors (HR GISTs). METHODS This is a prospective cohort study that was carried out in the period from 2019 to 2022. The study included 79 patients who underwent CT examination, texture analysis, surgical resection of a lesion that was suspicious for GIST as well as pathohistological and immunohistochemical analysis. RESULTS Textural analysis pointed out min norm (p = 0.032) as a histogram parameter that significantly differed between HR and LR GISTs, while min norm (p = 0.007), skewness (p = 0.035) and kurtosis (p = 0.003) showed significant differences between high-grade and low-grade tumors. Univariate regression analysis identified tumor diameter, margin appearance, growth pattern, lesion shape, structure, mucosal continuity, enlarged peri- and intra-tumoral feeding or draining vessel (EFDV) and max norm as significant predictive factors for HR GISTs. Interrupted mucosa (p < 0.001) and presence of EFDV (p < 0.001) were obtained by multivariate regression analysis as independent predictive factors of high-risk GISTs with an AUC of 0.878 (CI: 0.797-0.959), sensitivity of 94%, specificity of 77% and accuracy of 88%. CONCLUSION This result shows that morphological CT features of GIST are of great importance in the prediction of non-invasive preoperative metastatic risk. The incorporation of texture analysis into basic imaging protocols may further improve the preoperative assessment of risk stratification.
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Affiliation(s)
- Milica Mitrovic Jovanovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.J.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Aleksandra Djuric Stefanovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.J.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Dimitrije Sarac
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.J.)
| | - Jelena Kovac
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.J.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Aleksandra Jankovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.J.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Dusan J. Saponjski
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.J.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Boris Tadic
- Department for HBP Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Milena Kostadinovic
- Center for Physical Medicine and Rehabilitation, University Clinical Centre of Serbia, Pasterova Street, No. 2, 11000 Beograd, Serbia
| | - Milan Veselinovic
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia
| | - Vladimir Sljukic
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia
| | - Ognjan Skrobic
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia
| | - Marjan Micev
- Department for Pathology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia
| | - Dragan Masulovic
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.J.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Predrag Pesko
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia
| | - Keramatollah Ebrahimi
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
- Department of Stomach and Esophageal Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Koste Todorovica Street No. 6, 11000 Belgrade, Serbia
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Mitrovic-Jovanovic M, Skrobic O, Odalovic S, Djikic Rom A, Plavsic A, Jankovic A, Kostadinovic M, Ivanovic N, Simic A, Djuric-Stefanovic A, Kovac JD. CT and 18FDG-PET/CT findings in progressive mediastinal idiopathic fibrosis as a benign mimicker of esophageal carcinoma: a case report. J Int Med Res 2023; 51:3000605231213212. [PMID: 38041832 PMCID: PMC10693803 DOI: 10.1177/03000605231213212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/23/2023] [Indexed: 12/04/2023] Open
Abstract
Idiopathic mediastinal fibrosis, also called sclerosing or fibrosing mediastinitis, is a very rare and aggressive fibroinflammatory process characterized by fibrous tissue proliferation in the mediastinal region. Herein, we present a rare case of idiopathic mediastinal fibrosis presenting with esophageal obstruction, most likely associated with immunoglobulin G (IgG4)-related disease, affecting the posterior mediastinum with intrapulmonary infiltration. Computed tomography revealed a narrowed lumen and thickened wall of the distal esophagus surrounded by a necrotic mass with infiltration into the nearby structures, suggesting a locally advanced malignant process. Positron emission tomography revealed intense accumulation of 18F-fluorodeoxyglucose, indicating an active inflammatory component, which complicates further differential diagnosis of mediastinal masses. Thoracoscopic biopsy and immunohistochemical analysis confirmed a fibroinflammatory process with perivascular lymphoid cell infiltration that was cluster of differentiation (CD)3 (++) and CD20 (++), with massive numbers of IgG4-immunoreactive plasma cells. Although a benign condition, sclerosing mediastinitis is a close mimicker of esophageal carcinoma, which cannot be differentiated by computed tomography or positron emission tomography and must be considered in a differential diagnosis.
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Affiliation(s)
- Milica Mitrovic-Jovanovic
- Department of Digestive Radiology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Ognjan Skrobic
- Department of Esophageal and Gastric Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Koste Todorovica Street, Belgrade, Serbia
- Department of Surgery and Anesthesiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Strahinja Odalovic
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
- Center for Nuclear Medicine, University Clinical Centre of Serbia, No. 26 Višegradska street, Belgrade, Serbia
| | - Aleksandra Djikic Rom
- Department of Pathology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
| | - Aleksandra Plavsic
- Clinic of Allergy and Immunology, University Clinical Centre of Serbia, No. 2 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Internal medicine, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica street, Belgrade, Serbia
| | - Aleksandra Jankovic
- Department of Digestive Radiology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Milena Kostadinovic
- Center for Physical Medicine and Rehabilitation, University Clinical Centre of Serbia, No. 2 Pasterova Street, Belgrade, Serbia
| | - Nenad Ivanovic
- Department of Esophageal and Gastric Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Koste Todorovica Street, Belgrade, Serbia
- Department of Surgery and Anesthesiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Aleksandar Simic
- Department of Esophageal and Gastric Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Koste Todorovica Street, Belgrade, Serbia
- Department of Surgery and Anesthesiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Aleksandra Djuric-Stefanovic
- Department of Digestive Radiology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Jelena Djokic Kovac
- Department of Digestive Radiology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
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Dikic M, Nikolic D, Todorovic J, Terzic-Supic Z, Kostadinovic M, Babic U, Gacevic M, Santric-Milicevic M. Alignment of Perceived Competencies and Perceived Job Tasks among Primary Care Managers. Healthcare (Basel) 2019; 8:healthcare8010009. [PMID: 31892238 PMCID: PMC7151202 DOI: 10.3390/healthcare8010009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/19/2019] [Accepted: 12/24/2019] [Indexed: 11/29/2022] Open
Abstract
In this study we aimed to explore how managers in primary health care (PHC) organizations assess their managerial knowledge and skills, as well as the importance of these competencies for their job, and to identify whether there is an alignment between these two perceptions; therefore, whether there is a need for management competency improvement. With this study, we tried to address a high demand for information about health managers, especially in health systems in low- and middle-income countries. In a sample of 58 primary health care centers (n = 106 managers) in Serbia, we used a basic managerial competency matrix consisting of the following six competencies—communication, team-building, planning and priority-setting, performance assessment, problem-solving, and leading. Managerial perception of the importance of their job tasks differs by educational level and managerial position. The best alignment between the importance of knowledge and skills was for communication and leading. The study pointed out that managers were aware of the necessity to improve their level of managerial competencies, particularly in the domains of planning and priority-setting, performance assessment, and problem solving. The study highlights the need for formal managerial education for managers in PHC settings and commitment to continuously evaluate and improve management competencies in order to better manage PHC.
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Affiliation(s)
- Milica Dikic
- Center-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.D.); (J.T.); (Z.T.-S.)
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.K.); (U.B.); (M.G.)
- University Children’s Hospital, 11000 Belgrade, Serbia
| | - Jovana Todorovic
- Center-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.D.); (J.T.); (Z.T.-S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.K.); (U.B.); (M.G.)
| | - Zorica Terzic-Supic
- Center-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.D.); (J.T.); (Z.T.-S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.K.); (U.B.); (M.G.)
| | - Milena Kostadinovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.K.); (U.B.); (M.G.)
- Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Uros Babic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.K.); (U.B.); (M.G.)
- Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Marijana Gacevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.K.); (U.B.); (M.G.)
| | - Milena Santric-Milicevic
- Center-School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.D.); (J.T.); (Z.T.-S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (D.N.); (M.K.); (U.B.); (M.G.)
- Correspondence:
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