Follicular lesions of the thyroid are traditionally difficult and tedious challenges in diagnostic surgical pathology in part due to lack of obvious discriminatory cytological and microarchitectural features. We describe a computerized method to detect and classify follicular adenoma of the thyroid, follicular carcinoma of the thyroid, and normal thyroid based on the nuclear chromatin distribution from digital images of tissue obtained by routine histological methods. Our method is based on determining whether a set of nuclei, obtained from histological images using automated image segmentation, is most similar to sets of nuclei obtained from normal or diseased tissues. This comparison is performed utilizing numerical features, a support vector machine, and a simple voting strategy. We also describe novel methods to identify unique and defining chromatin patterns pertaining to each class. Unlike previous attempts in detecting and classifying these thyroid lesions using computational imaging, our results show that our method can automatically classify the data pertaining to 10 different human cases with 100% accuracy after blind cross validation using at most 43 nuclei randomly selected from each patient. We conclude that nuclear structure alone contains enough information to automatically classify the normal thyroid, follicular carcinoma, and follicular adenoma, as long as groups of nuclei (instead of individual ones) are used. We also conclude that the distribution of nuclear size and chromatin concentration (how tightly packed it is) seem to be discriminating features between nuclei of follicular adenoma, follicular carcinoma, and normal thyroid. ' 2010 International Society for Advancement of Cytometry Key terms follicular; thyroid; image analysis; nuclear structure; classification THE distinction between follicular adenoma of the thyroid (FA; neoplastic, but not capable of metastases) and follicular carcinoma of the thyroid (FTC; neoplastic, capable of metastases) has largely been a tedious and difficult task for pathologists and until very recently pathologists have only been able to rely on the histopathology to distinguish them. The encompassing differential diagnosis of follicular lesions of the thyroid includes follicular adenoma, follicular carcinoma, follicular variant of papillary carcinoma, and nodular goiter. Follicular variant of papillary carcinoma is usually not as troublesome as the distinction between FA and FTC due to the presence of distinctive and unique nuclear features in this variant of papillary carcinoma. The microscopic presence of tumor invasion into the capsule (fibrous covering around the lesion) and/or invasion of the tumor into small vessels of the capsule (vascular invasion) are the distinguishing hallmarks of FTC. FA may have a fibrous capsule, but lacks capsular and/or vascular invasion. These two features are diagnostic because other visual features commonly used by pathologists including microarchitecture and cytological characteristics, notably nuclear and cytoplasm...
Although magnetic resonance imaging (MRI) can accurately measure lower limb skeletal muscle (SM) mass, this method is complex and costly. A potential practical alternative is to estimate lower limb SM with dual-energy X-ray absorptiometry (DXA). The aim of the present study was to develop and validate DXA-SM prediction equations. Identical landmarks (i.e., inferior border of the ischial tuberosity) were selected for separating lower limb from trunk. Lower limb SM was measured by MRI, and lower limb fat-free soft tissue was measured by DXA. A total of 207 adults (104 men and 103 women) were evaluated [age 43 +/- 16 (SD) yr, body mass index (BMI) 24.6 +/- 3.7 kg/m(2)]. Strong correlations were observed between lower limb SM and lower limb fat-free soft tissue (R(2) = 0.89, P < 0.001); age and BMI were small but significant SM predictor variables. In the cross-validation sample, the differences between MRI-measured and DXA-predicted SM mass were small (-0.006 +/- 1.07 and -0.016 +/- 1.05 kg) for two different proposed prediction equations, one with fat-free soft tissue and the other with added age and BMI as predictor variables. DXA-measured lower limb fat-free soft tissue, along with other easily acquired measures, can be used to reliably predict lower limb skeletal muscle mass.
ObjectiveTo evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA) muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis.MethodsForty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery.ResultsVideostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P < 0.05); most of the vocal function parameters were improved postoperatively compared with the preoperative parameters, albeit without a significant difference (P > 0.05). No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation.ConclusionsReinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity.
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