Citations

BACKGROUNDThe objective of this study was to demonstrate that computer‐extracted image phenotypes (CEIPs) of biopsy‐proven breast cancer on magnetic resonance imaging (MRI) can accurately predict pathologic stage.METHODSThe authors used a data set of deidentified breast MRIs organized by the National Cancer Institute in The Cancer Imaging Archive. In total, 91 biopsy‐proven breast cancers were analyzed from patients who had information available on pathologic stage (stage I, n = 22; stage II, n = 58; stage III, n = 11) and surgically verified lymph node status (negative lymph nodes, n = 46; ≥ 1 positive lymph node, n = 44; no lymph nodes examined, n = 1). Tumors were characterized according to 1) radiologist‐measured size and 2) CEIP. Then, models were built that combined 2 CEIPs to predict tumor pathologic stage and lymph node involvement, and the models were evaluated in a leave‐1‐out, cross‐validation analysis with the area under the receiver operating characteristic curve (AUC) as the value of interest.RESULTSTumor size was the most powerful predictor of pathologic stage, but CEIPs that captured biologic behavior also emerged as predictive (eg, stage I and II vs stage III demonstrated an AUC of 0.83). No size measure was successful in the prediction of positive lymph nodes, but adding a CEIP that described tumor “homogeneity” significantly improved discrimination (AUC = 0.62; P = .003) compared with chance.CONCLUSIONSThe current results indicate that MRI phenotypes have promise for predicting breast cancer pathologic stage and lymph node status. Cancer 2016;122:748–757. © 2015 American Cancer Society.

Recent publications in the dermatologic surgery literature have sparked a re‐emergence of interest in anatomy relevant for the Mohs surgeon necessitating a re‐visit of under‐appreciated concepts, regarding the topography of the face and its visceral contents from a surgically relevant perspective. This paper presents a pre‐operative review and a conceptual framework for intra‐operative planning for Mohs micrographic surgery and reconstruction. The key concepts presented are based on a series of (1) reviews regarding clinically significant points aimed at improving outcomes for reconstructive surgery, (2) anatomical dissections of fresh frozen cadavers, and (3) surgical experience of the authors. Basic anatomical concepts have been assimilated, surgically evaluated and re‐directed toward the dermatologic surgeon in the hope that improved anatomic competence will reduce surgical hesitance. Clin. Anat. 29:237–246, 2016. © 2015 Wiley Periodicals, Inc.

The sphenopalatine ganglion (SPG) has attracted the interest of practitioners treating head and face pain for over a century because of its anatomical connections and role in the trigemino‐autonomic reflex. In this review, we discuss the anatomy of the SPG, as well as what is known about its role in the pathophysiology of headache disorders, including cluster headache and migraine. We then address various therapies that target the SPG, including intranasal medication delivery, new SPG blocking catheter devices, neurostimulation, chemical neurolysis, and ablation procedures.

ObjectivesTo determine the feasibility of automated co‐registration of angiography and intravascular ultrasound (IVUS) to facilitate integration of these two imaging modalities in a synchronous manner.BackgroundIVUS provides cross‐sectional imaging of coronary arteries but lacks overview of the vascular territory provided by angiography. Co‐registration of angiography and IVUS would increase utility of IVUS in the clinical setting.MethodsForty‐nine consecutive patients undergoing surveillance for cardiac allograft vasculopathy with angiography and IVUS of the left anterior descending artery (LAD) were enrolled. A pre‐IVUS angiogram of the LAD was performed followed by an ECG‐triggered fluoroscopy (ECGTF) during IVUS pullback at 0.5 mm/s using an automatic pullback device. ECGTF was used to track the IVUS catheter during pullback and establish a spatial relationship to the pre‐IVUS angiogram. Angio‐IVUS co‐registration was performed with a research prototype (Siemens Healthcare, Germany) and accuracy was evaluated by distance mismatch between angiography and IVUS images at vessel bifurcations.ResultsMedian age was 54 (44.5, 67) years. The population was 82.6% male with minimal risk factors. The median (IQR) co‐registration distance mismatch measured at 108 bifurcations in 42 (85%) patients was 0.35 (0.00–1.16) mm. Seven patients were excluded due to inappropriate data acquisition (n = 3) and failure of tracking (n = 4), e.g., due to overlapping sternal wires. Estimated effective radiation dose for ECGTF was 0.09 mSv.ConclusionThis study demonstrates the feasibility of angio‐IVUS co‐registration which may be used as a clinical tool for localizing IVUS cross‐sections along an angiographic roadmap. © 2015 Wiley Periodicals, Inc.

The Internet has placed considerable information at the disposal of patients, but the sources for credible and accurate information may be difficult for a layperson to discern. Benign prostatic hyperplasia (BPH) in elderly men can be treated with different surgical interventions. The purpose of this research was to determine information seeking behaviors (ISB) of BPH patients before and after each type of surgery. All patients who underwent surgical intervention for BPH at a tertiary training center between January 2007 and January 2013 were included in this study. A comprehensive questionnaire regarding their ISB was sent through a third-party survey center. The following areas were examined: (1) the patient’s opinion regarding information sources of BPH and its treatment, (2) the extent of ISB for each patient and its relation to the type of surgical intervention he eventually underwent, and (3) the relationship between the extent of ISB and the patient’s final satisfaction. The results indicated that the majority of patients felt that it is relatively easy to find information about BPH and its treatment. Most of the patient started with either general online search engines or used the hospital website. Patients who explored more sources of information ended up choosing a more specific and sophisticated procedure. Generally, patients used fewer sources postoperatively regardless of the procedure they underwent. There was no correlation between the extent of ISB and overall satisfaction ( r = −0.0719, p = .1610) and regret ( r = −0.0436, p = .3945).