Objective: To analyze the safety and adequacy of image guided TRU-CUT biopsy in Kuwait Teaching Hospital, Peshawar Materials and Methods: This retrospective cross-sectional study was conducted in Radiology Department of Kuwait Teaching Hospital from 1st January to 31st December 2016. A total 354 patients presenting for image guided TRUCUT biopsies were included in study, specimens were sent to reputable laboratories for evaluation of sample adequacy whereas, safety of the procedure was assessed by rate of major complications. SPSS version19 was used for statistical analysis. Results: 100% of CT guided biopsies generated adequate samples, whereas 326 out of 336 U/S guided biopsies produced adequate specimen with overall diagnostic adequacy of 97.1%. Scrutiny of results depicts no major complications in any patient. There was statistically insignificant effect of needle parameters or imaging modality, having P value > 0.005, on the adequacy of biopsy specimen. Conclusion: Image guided TRU-CUT biopsy is effective and safe procedure. Our study can help counsel patients about safety and effectiveness of procedure and avoiding more invasive open biopsies.
Introduction: Pancreatic adenocarcinoma is a major health concern as it is the third most common cause of cancer-related death. Surgery is the only curative option, but it is associated with a high rate of morbidity and mortality. Objective: To accurately identify the patients with unresectable pancreatic cancer through the use of computed tomography imaging. Material & Methods: This descriptive case series was conducted at Kuwait Teaching Hospital from July 2019 to June 2020. A total of 52 patients were evaluated with ages ranging from 11-90 years comprising 24 males and 28 females. CT scan abdomen with the pancreatic protocol was done on 16 slice Toshiba CT scanner in the Radiology department of Kuwait Teaching Hospital. Images were evaluated in axial, coronal and sagittal planes following pancreatic protocol. Data like patient age, gender, tumor location, size, venous and arterial involvement, lymph nodal and adjacent visceral involvement were collected and subjected to statistical analysis. Results: Out of a total of 52 patients, pancreatic carcinoma was most prevalent in the head region which was observed in 35(67.3%) patients. The next common site was the uncinate process followed by the body and then the tail. In 57.7% the size of primary malignancy was more than 2 cm and in 42.3% of the patients, it was less than 2 cm. Superior Mesenteric Vein (SMV) was involved in pancreatic carcinoma in 7.7%, Inferior Vena Cava (IVC) in 3.8% and Portal Vein (PV) in 11.5% of the cases. The Celiac Artery was involved by the pancreatic tumor in 11.5% and Superior Mesenteric Artery (SMA) in 23.1% of the cases. Lymph nodal involvement was observed in 42.3% of the cases and adjacent visceral involvement was noted in 34.6% of the cases. Conclusion: Pancreatic carcinoma was identified as surgically unresectable by CT scans in the majority of patients because of locally advanced disease having a size more than 2 cm, and with vascular, lymph nodal and adjacent visceral involvement.
Introduction: Evaluation of mesorectal fascial involvement in rectal cancer is of prime importance in decision making regarding treatment options. Objective: To determine diagnostic accuracy of Magnetic Resonance Imaging (MRI) in detection of mesorectal fascia involvement in rectal carcinoma patients using histopathology as gold standard. Materials & Methods: A comparative study was performed in the Radiology department of Kuwait Teaching Hospital, Peshawar, from January 1, 2021, till December 31, 2021, on 155 patients of rectal carcinoma who had their MRI done for rectal cancer on 0.3T MR Machine. Surgical findings like mesorectal fascial involvement by the tumor, presence/absence of pelvic lymph nodes within 5mm of mesorectal fascia, and staging of the tumor were included as variables. Specimens were sent in formalin to a histopathologist, and findings were considered for comparison. Data were analyzed using SPSS version 23. Results: Out of 155 patients, 82 patients showed mesorectal fascial involvement whereas 73 patients were Circumferential Resection Margin (CRM) negative. Out of these 7 patients were falsely labeled as CRM positive on MRI, whereas 9 patients were falsely labeled as CRM negative on MRI. Positive predictive value was 91%, with negative predictive value of 88%. Diagnostic accuracy was 89.6%. Sensitivity was 89% whereas specificity was 90.4%. Conclusion: MRI has high sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for detection of mesorectal fascial involvement in case of rectal carcinoma taking 5mm as cut off value.
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