Poster: ECR 2018 / C-0626 / Bowel Obstruction in the Adult: What the Radiologist Should Know by: A. B. Barba Arce1, E. herrera romero2, F. Pozo Pinon2, V. Fernandez-Lobo3, E. Montes Figueroa3, Y. Lamprecht3, E. Marin Diez3, P. Gallego Ferrero3, C. Gonzalez-Carrero Sixto3; 1Torrelavega, Cantabria/ES, 2Santander, Cantabria/ES, 3Santander/ES
OBJETIVOS:
• El cribado sistematico mediante mamografia, ofrece la posibilidad de reducir la mortalidad por cancer de mama y aminorar los efectos adversos del tratamiento.• Para conseguir los objetivos previstos es necesario que los programas de cribado cumplan unos criterios de calidad establecidos.
MATERIAL Y METODOS
- Se estudia una vuelta completa del Programa de cribado de cancer de mama (2013 2014) en Cantabria.- Cribado con mamografia en mujeres de edad entre 50 y 69 anos.- Analizaremos los indicadores de calidad: porcentaje de participacion, tasa de deteccion de cancer de mama, porcentaje de Carcinoma ductal in situ (CDIS) y canceres invasivos de tamano igual o inferior a 1 cm, porcentaje de canceres invasivos sin afectacion ganglionar y tasa de canceres de intervalo.
Introduction: in 1981, Dr. PH Sugarbaker, challenging oncological orthodoxy, considered carcinomatosis to be a locoregional stage of the disease that was still susceptible to treatment with curative intent.To this end he developed a new therapeutic alternative based on the combined treatment.The macroscopic disease treated by maximum radical oncological cytoreductive surgery (through the peritonectomies described by him), followed by treatment of the residual microscopic disease with the direct intra-abdominal application of intraoperative chemotherapy with locoregional intensification, modulated by hyperthermia and early normothermic postoperative intra-abdominal chemotherapy.Using this new therapeutic regimen, known as "Sugarbaker's Protocol", his group has reported 45% survival rates in carcinomatosis of colorectal origin at 5 years, and, in selected groups of patients, 50% survival rates at 5 years.The scientific community, however, has criticized these results considering that: it is a personal experience, with a not homogenous treatment protocol with developmental modifications over time, that it is a retrospective non-randomized study, and finally that the cytostatics used in his protocol are obsolete.Various European groups have replied to these main criticisms confirming the good results that this new therapeutic alternative offers for patients with carcinomatosis of colorectal origin.The purpose of this article is to present these contributions.Material and methods: all the articles published in the English language by European groups in the world's medical literature have been reviewed using the Pubmed-MEDLINE database to identify the relevant articles related to the treatment of carcinomatosis of colorectal origin using cytoreduction and intraperitoneal chemotherapy from January 1980 to January 2008.Results: the European contribution during these 25 years in favour of the "Sugarbaker's Protocol" has consisted fundamentally in: a) one multicenter retrospective study; b) two randomized prospective phase III studies; and c) the use of oxaliplatin and irinotecan as new cytostatic agents in the protocols for intraperitoneal chemotherapy.At the same time, two new transcendental European contributions have been made in which the possibility has been considered of combined simultaneous treatment for patients with hepatic metastases and carcinomatosis, and the introduction, as a selection factor, of patients responsive to intravenous induction chemotherapy within the regimen of sandwich treatment (with systemic neoadjuvant and adjuvant chemotherapy) complementary to intraperitoneal chemotherapy.Conclusions: the results obtained by European groups using "Sugarbaker's protocol" and "Elias' protocol" with oxaliplatin compel us to request that these treatments be considered by all professionals involved in the treatment of patients with colorectal carcinomatosis as the best treatment currently available for this condition.Furthermore a randomized, prospective, multicenter study should be carried out to clarify its value and the degree of scientific evidence.A validation of this treatment will change, in the future, the dogmatic consideration of carcinomatosis as an incurable disease stage.
Poster: ECR 2018 / C-0682 / Evaluation of the positive predictive value in Transthoracic lung biopsies. by: V. Fernandez-Lobo1, J. A. Parra1, A. B. Barba Arce2, E. herrera romero3, E. Montes Figueroa1, E. Yllera Contreras4, C. Jimenez Zapater1; 1Santander/ES, 2Torrelavega, Cantabria/ES, 3Santander, Cantabria/ES, 4Burgos/ES
Colonoscopy is the choice procedure to diagnose colon and rectum cancer, from early detection of small precancerous lesions (polyps), to confirmation of malign masses. However, the high variability of the organ appearance and the complex shape of both the colon wall and structures of interest make this exploration difficult. Learned visuospatial and perceptual abilities mitigate technical limitations in clinical practice by proper estimation of the intestinal depth. This work introduces a novel methodology to estimate colon depth maps in single frames from monocular colonoscopy videos. The generated depth map is inferred from the shading variation of the colon wall with respect to the light source, as learned from a realistic synthetic database. Briefly, a classic convolutional neural network architecture is trained from scratch to estimate the depth map, improving sharp depth estimations in haustral folds and polyps by a custom loss function that minimizes the estimation error in edges and curvatures. The network was trained by a custom synthetic colonoscopy database herein constructed and released, composed of 248,400 frames (47 videos), with depth annotations at the level of pixels. This collection comprehends 5 subsets of videos with progressively higher levels of visual complexity. Evaluation of the depth estimation with the synthetic database reached a threshold accuracy of 95.65%, and a mean-RMSE of 0.451 cm, while a qualitative assessment with a real database showed consistent depth estimations, visually evaluated by the expert gastroenterologist coauthoring this paper. Finally, the method achieved competitive performance with respect to another state-of-the-art method using a public synthetic database and comparable results in a set of images with other five state-of-the-art methods.