Radiomic features disclose the presence of microvascular invasion in hepatocellular carcinoma

Purpose or Learning Objective To investigate whether a radiomic analysis performed on hepatocellular carcinoma can reveal the presence of microvascular invasion (MVI). Methods or Background The dataset includes seventy-one early-stage HCC nodules (Milan criteria, nodule 643 cm, without macrovascular invasion and extrahepatic spread), where forty-two are MVI positive (MVI+) and twenty-nine are MVI negative (MVI-), at histopathological report obtained after surgery. Radiomic analysis is performed on contrast-enhanced CT imaging during the arterial phase. HCC nodules were manually segmented and eighty-four local first-order radiomic features (RFs) are computed from HCC Region of Interest (ROIs). To avoid overfitting, only one couple of RFs is selected for discriminating MVI+ and MVI- into three steps: (i) a subset of RFs is first selected through LASSO; (ii) linearly correlated couples are discarded; (iii) after computing the ROC curve, the most discriminating couple is selected as that one yielding the highest AUC. The discrimination between MVI+ and MVI- is assessed through specificity and sensitivity computed at the Youden Index (YI). Results or Findings The selected couple combines a measure of local heterogeneity to mean CT image values in HCC ROIs and allows achieving an AUC=0.86, with specificity=81% and sensitivity=83% at the YI=0.64. Conclusion The radiomic analysis allows unravelling different inner properties of HCC MVI+ nodules, which show a more heterogeneous tumour pattern with respect to MVI-. Limitations This radiomic analysis was performed exclusively on arterial-phase contrast enhanced images, although it is reasonable arguing that the next inclusion of venous phase images must only improve the outcomes

Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

BACKGROUND: The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic.METHODS: The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March-May 2020), II (June-September 2020), and III (October-December 2020).RESULTS: Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (>200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (<20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices.CONCLUSION: This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic