Diagnostic yield and accuracy of image-guided percutaneous core needle biopsy of paediatric solid tumours: An experience from Italy

Abstract Background Percutaneous core needle biopsy (PCNB) has become an accepted method to collect tumour tissue samples given its safety, minimal invasiveness, high accuracy and cost-effectiveness. Procedure It is a single centre, retrospective evaluation of 213 ultrasound (US) or computed tomography (CT) guided PCNBs of paediatric solid tumours performed from 2005 to 2017. Safety, diagnostic yield, accuracy, and efficacy assessments of the PCNB procedure were performed. Univariate logistic models were applied to assess the relation of the diagnostic yield with patient, procedure and lesion features. Results The image-guide was US in 91.08% of biopsies; the needle gauge was ≥16 G in 69.01% of the biopsies. The anatomical site of lesion was deep in 113 biopsies (53.05%). The nature of the lesion was the only factor associated with diagnostic yield (OR: 4.04; 95% CI 1.23–13.28; p: 0.022), with benign lesion as an unfavourable factor. Complication incidence was 1.41%. Overall, the diagnostic yield of PCNB was 93.90% (95% CI: 89.79-96.71%), the diagnostic accuracy was 96.86% (95% CI: 93.29–98.84%) and the diagnostic efficacy was 93.33% (95% CI: 86.75–97.28%). Sensitivity was 97.94% (95% CI: 92.75–99.75%) and specificity 100% (95% CI: 66.37–100%). Conclusion PCNB can be recommended as the first-choice method for solid tumours diagnosis in paediatric, adolescent and young adult patients because of its high diagnostic success, safety and accessibility

Textbook Outcome After Trans-arterial Chemoembolization for Hepatocellular Carcinoma

PurposeTextbook Outcome (TO) is inclusive of quality indicators and it not been provided for trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Materials and methodsData on treatment-naïve HCC patients receiving TACE from 10 centers were reviewed. TO was defined as "no post-TACE grade 3-4 complications, no prolonged hospital stay (defined as a post-procedure stay ≤ 75th percentile of the median values from the total cohort), no 30-day mortality/readmission and the achievement of an objective response (OR) at post-TACE imaging." Grade of adverse event was classified according to the Common Terminology Criteria for Adverse Events and short-term efficacy was assessed by response. Pooled estimates were calculated to account for hospital's effect and risk-adjustment was applied to allow for diversity of patients in each center.ResultsA total of 1124 patients (2014-2018) fulfilling specific inclusion criteria were included. Baseline clinical features showed considerable heterogeneity (I2 > 0.75) across centers. TACE-related mortality was absent in 97.6%, readmission was not required after 94.9% of procedures, 91.5% of patients had no complication graded 3-4, 71.8% of patients did not require prolonged hospitalization, OR of the target lesion was achieved in 68.5%. Risk-adjustment showed that all indicators were achieved in 43.1% of patients, and this figure was similar across centers. The median overall survival for patients who achieved all indicators was 33.1 months, 11.9 months longer than for patients who did not.ConclusionsA useful benchmark for TACE in HCC patients has been developed, which provides an indication of survival and allows for a comparison of treatment quality across different hospitals

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

Evidence-based concepts and procedures for bonded inlays and onlays. Part III. A case series with long-term clinical results and follow-up

This third article in this series (Part III) aims to present new clinical results and long-term follow-up of resin composite inlays and onlays using the modern clinical concepts presented in the Part I and Part II articles. These revised protocols have contributed to eliminating the most frequent difficulties related to the preparation, isolation, impression taking, and cementation of tooth-colored inlays and onlays. This clinical report presents a series of 25 cases of indirect or semidirect inlays and onlays (intra- and extraoral techniques) made of microhybrid and nanohybrid composites with 6- to 21-year follow-ups. The restoration performance was assessed through clinical examination, intraoral radiographs, and clinical photographs. The overall clinical assessment aimed to confirm the absence (success) or presence (failure) of decay or restoration fracture, while the restoration quality was judged on intraoral photographs. The restoration status with regard to margins, anatomy, and color was assessed using three quality scores (A = ideal, B = satisfactory, C = insufficient). Descriptive statistics were used to evaluate the possible impact of composite structure (microhybrid or nanohybrid) or observation time on restoration quality. Over this medium- to long-term observation period, no clinical failure was reported. Only a few restorations (mainly those made of conventional inhomogeneous nanohybrid) presented discrete marginal discoloration (n = 4) or occlusal anatomy change due to wear (n = 7). This first clinical survey with long-term follow-up supports the application of the aforementioned clinical concepts, which thus far have only been validated by in vitro studies

Evidence-based concepts and procedures for bonded inlays and onlays. Part I. Historical perspectives and clinical rationale for a biosubstitutive approach

This first article in the series (Part I) aims to present an updated rationale and treatment approach for indirect adhesive posterior restorations based on the best scientific and long-term clinical evidence available. The proposed treatment concept relies on the basic ideas of (1) the placement of an adhesive base/liner (Dual Bonding [DB] and Cavity Design Optimization [CDO]) and, when needed, (2) a simultaneous relocation of deep cervical margins (Cervical Margin Relocation [CMR]), prior to (3) impression taking to ensure a more conservative preparation and easier-tofollow clinical steps, and the use of (4) a highly filled, light-curing restorative material for the cementation (Controlled Adhesive Cementation [CAC]), together with restoration insertion facilitation, the application of sonic/ultrasonic energy, and/or material heating. The suggested clinical protocol will help the practitioner to eliminate the most frequently experienced difficulties relating to the preparation, isolation, impression taking and cementation of tooth-colored inlays and onlays. This protocol can be applied to both ceramics and composites as no material has been proven to be the most feasible or reliable in all clinical indications regarding its physicochemical and handling characteristics. For the time being, however, we have to regard such indirect restorations as a biosubstitution due to the monolithic nature of the restoration, with still very imperfect replication of the specific natural dentinenamel assemblage

Patients with Barcelona Clinic Liver Cancer Stages B and C Hepatocellular Carcinoma: Time for a Subclassification

Background: The Barcelona Clinic Liver Cancer (BCLC) intermediate and advanced stages (BCLC B and C) of hepatocellular carcinoma (HCC) both include heterogeneous populations. Patients classified as BCLC stage B present with different tumour burdens, and the recommended treatment is transarterial chemoembolization (TACE). A similar heterogeneity of tumour burden and liver function can be found among patients classified as BCLC stage C, which includes diverse clinical features (performance status [PS] 1–2), macrovascular invasion (MVI) including portal vein tumour (PVT) thrombosis, and/or extra-hepatic spread. Nonetheless, the anti-tumoural treatment formally recommended by Western guidelines is systemic therapy with sorafenib. Summary: Several proposals of subclassification for both these stages have been suggested in recent years, differentiating the more appropriate treatments for each substage. In particular, for BCLC stage C patients with PVT, therapeutic indications, clinical outcomes, and response to locoregional therapy are notably different in the presence of subsegmental, segmental or main PVT. Accordingly, liver resection and transarterial therapies, such as TACE or transarterial embolization (TAE) and 90Y-radioembolization (TARE), can be performed in locally advanced HCC with intrahepatic MVI according to its extent. In fact, surgery and TACE/TAE/TARE have no contraindications in the presence of PVT limited to the subsegmental or segmental branches in Child-Pugh class A patients, whereas only TARE should be utilized when there is lobar branch involvement. The presence of PS 1 should not be sufficient to allocate patients to the advanced stage since this would preclude any potential treatment for HCC. Patients should be properly classified as BCLC C only in cases of main portal trunk PVT, and treated according to the guidelines, provided that they belong to Child-Pugh class A. Key Messages: Subclassifications of BCLC B and C stages are urgently needed and require validation in order to guide clinicians towards the most effective treatment option

Safety and Efficacy of Combined Peptide Receptor Radionuclide Therapy and Liver Selective Internal Radiation Therapy in a Patient With Metastatic Neuroendocrine Tumor

Nuclear medicine treatments of well-differentiated neuroendocrine tumors (NETs) are gaining increasing acceptance among clinicians. Peptide receptor radionuclide therapy (PRRT) is an effective systemic treatment, providing a significant survival benefit and improving patients' quality of life. Locoregional selective internal radiation therapy (SIRT) is a safe and effective treatment for unresectable NET liver metastases, providing good local tumor control and symptomatic relief. Few reports in literature examine the sequential use of PRRT and SIRT in metastatic NET. We report the case of a metastatic NET patient treated with sequential PRRT-SIRT achieving a long disease control interval without cumulative toxicity issues