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OBJECTIVE: To assess the correlation between the general (gender, age, and maximum tumor size) and 3D morphotopometric features of the renal tumor node, following the MSCT data post-processing, and the tumor histological structure; to propose an equation allowing for kidney malignancy assessment based on general and morphometric features. MATERIALS AND METHODS: In total, 304 patients with unilateral solitary renal neoplasms underwent laparoscopic (retroperitoneoscopic) or robotic partial or radical nephrectomy. Before the procedure, kidney contrast-enhanced MSCT followed by the tumor 3D-modeling was performed. 3D model of the kidney tumor, and its morphotopometric features, and histological structure were analyzed. The morphotopometric ones include the side of the lesion, location by segments, the surface where the tumor, the depth of the tumor invasion into the kidney, and the shape of tumor. RESULTS: Out of 304 patients, 254 (83.6%) had malignant kidney tumors and 50 (16.4%) benign kidney tumors. In total, 231 patients, out of 254 (90.9%) were assessed for the degree of malignant tumor differentiation. Malignant tumors were more frequent in men than in women (p < 0.001). Mushroom-shaped tumors were the most common shapes among benign renal masses (35.2%). The most common malignant kidney tumors had spherical with a partially uneven surface (27.6%), multinodular (tuberous (27.2%)), and spherical with a conical base (24.8%) shapes. Logistic regression model enabled the development of prognostic equation for tumor malignancy prediction ("low" or "high"). The univariate analysis revealed the correlation only between high differentiation (G1) and a spherical tumor with a conical base (p = 0.029). CONCLUSION: The resulting logistic model, based on the analysis of such predictors as gender and form of kidney lesions, demonstrated a large share (87.6%) of correct predictions of the kidney tumor malignancy.

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PURPOSE: To evaluate the predictive factors of tumor growth in patients with vestibular schwannoma (VS) managed with the wait-and-scan approach. METHODS: The data of 31 patients diagnosed with intracanalicular VS and followed for > 5 years were retrospectively analyzed. VS was diagnosed according to MRI findings and tumor growth was monitored. Tumor growth was defined as an increase of 2 mm or more in the maximal tumor diameter. The association between the initial tumor size and shape and tumor growth was assessed. RESULTS: Tumor growth was observed in 16 of 31 patients (51.6%) over a mean follow-up duration of 7.3 years. The initial tumor size was not statistically correlated with tumor growth. However, fusiform or cylindrical tumors exhibited higher growth rates than oval or round tumors. Additionally, a significant correlation was observed between cerebellopontine angle extension and tumor shape. CONCLUSION: In this study, 51.6% of the patients with intracanalicular VS who were managed with the wait-and-scan strategy over a follow-up period of > 5 years showed tumor growth. Tumor shape, especially fusiform or cylindrical shape, was found to be a significant predictor of tumor growth.

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Intraoperative ultrasound (IOUS) is a potentially useful adjunct to the resection of oral tongue cancers (OTC). IOUS images of the tumor-normal tissue interface show different patterns of invasion. In this retrospective series of 29 patients treated for OTC, we evaluated if there was a correlation between IOUS findings of patterns of invasion and final histology and assessed if there was any associated risk of increased incidence of positive or close margins with different patterns of invasion as seen on ultrasound. Although we found no significant correlation between ultrasound patterns of invasion and histological evaluation, we did find that an infiltrative pattern of invasion on IOUS did result in a significant risk of a close margin. Further exploration of these findings in a larger prospective study could provide definitive information on the efficacy of this modality in OTC resections.

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Purpose: Endoscopic transsphenoidal surgery (ETSS) is an increasingly utilized approach for resection of pituitary tumors. Prior studies have evaluated preoperative tumor size, location, and extent as prognostic factors for surgical resection. There is little data on the relationship between preoperative pituitary tumor radiographic morphology and surgical outcomes. Study Design: Retrospective longitudinal study. Setting: Single tertiary care institution. Subjects and Methods: Preoperative magnetic resonance imaging and computed tomography scans from patients undergoing ETSS for pituitary tumor resections from 2007 to 2017 were retrospectively evaluated. A neuroradiologist classified these pituitary tumors into six morphologic groups, each defined by volume, dimensions, extension, and shape. Surgical difficulty, rates of incomplete resection, and postoperative complications were then stratified in relation to the morphologic groups. Results: Pituitary tumors from 131 patients were classified from preoperative imaging into six characteristic morphologies: (1) microtumor, (2) round, (3) transverse oblong, (4) superior-inferior oblong, (5) bilobed, and (6) large lobulated. Tumors that were characterized with the large lobulated, bilobed, and transverse oblong morphologies correlated with higher rates of postoperative evidence of residual tumor (70%, 36%, and 47%, respectively, all P < 0.002). Likewise, large lobulated, bilobed, and transverse oblong morphologies were also associated with intraoperative cerebrospinal fluid leaks (70%, 31%, and 35%, respectively, all P < 0.05). Conclusions: We describe a novel descriptive system for the morphology of pituitary tumors that can be determined from preoperative imaging. Different tumor morphologic groups are associated with varying degrees of gross tumor resection, complications, and surgical difficulty. Utilizing pituitary tumor morphology may aid surgeons in planning the extent of resection, need for complex closure, and patient counseling.

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BACKGROUND: This study aimed to estimate the value of a morphological feature on ultrasound (US) for preoperative diagnosis of axillary lymph node (ALN) status in patients with early-stage invasive breast cancer (ESIBC). METHODS: In this retrospective work, a total of 239 ESIBC patients, were recruited, and their preoperative US images and postoperative pathology results were collected. The relationship between US images based on morphological features and ALN metastasis was investigated. The tumor circularity and US-reported ALN status were developed as a nomogram to predict the ALN status. RESULTS: Among the 239 participants, 82 (34.31%) had ALN metastasis, and 157 (65.69%) did not. There was a statistically significant difference in tumors between participants diagnosed with and without ALN metastasis. The median value was 0.47 vs. 0.62 (P<0.001) in the training group, respectively, and the value was 0.50 vs. 0.60 (P<0.001) in the validation group, respectively. The clinical model nomogram was shown to have high efficiency in predicting ALN status among our research population. The area under the curve (AUC) was 0.89 in the training group and 0.90 in the validation group and the accuracy was 85.79% and 81.63%, respectively. CONCLUSIONS: The clinical model nomogram based on tumor circularity and US-reported ALN status is a non-invasive approach for ALN metastasis prediction in ESIBC patients with high efficacy.

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PURPOSE: Imaging biomarkers (IBMs) are increasingly investigated as prognostic indicators. IBMs might be capable of assisting treatment selection by providing useful insights into tumor-specific factors in a non-invasive manner. METHODS: We investigated six three-dimensional shape-based IBMs: eccentricities between (I) intermediate-major axis (Eimaj), (II) intermediate-minor axis (Eimin), (III) major-minor axis (Emj-mn) and volumetric index of (I) sphericity (VioS), (II) flattening (VioF), (III) elongating (VioE). Additionally, we investigated previously established two-dimensional shape IBMs: eccentricity (E), index of sphericity (IoS), and minor-to-major axis length (Mn_Mj). IBMs were compared in terms of their predictive performance for 5-year overall survival in two independent cohorts of patients with lung cancer. Cohort 1 received surgical excision, while cohort 2 received radiation therapy alone or chemo-radiation therapy. Univariate and multivariate survival analyses were performed. Correlations with clinical parameters were evaluated using analysis of variance. IBM reproducibility was assessed using concordance correlation coefficients (CCCs). RESULTS: E was associated with reduced survival in cohort 1 (hazard ratio [HR]: 0.664). Eimin and VioF were associated with reduced survival in cohort 2 (HR 1.477 and 1.701). VioS was associated with reduced survival in cohorts 1 and 2 (HR 1.758 and 1.472). Spherical tumors correlated with shorter survival durations than did irregular tumors (median survival difference: 1.21 and 0.35 years in cohorts 1 and 2, respectively). VioS was a significant predictor of survival in multivariate analyses of both cohorts. All IBMs showed good reproducibility (CCC ranged between 0.86-0.98). CONCLUSIONS: In both investigated cohorts, VioS successfully linked shape morphology to patient survival.

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OBJECTIVES: The purpose of this study was to assess the clinical value of ultrasound (US) features of breast lesions for predicting the risk of axillary lymph node metastasis in patients with breast cancer. METHODS: In this retrospective study, 425 patients with breast cancer were recruited, and their preoperative US features and postoperative pathologic results were collected. The association of these US features of breast cancer with axillary lymph node metastasis was determined by univariate and multivariate analyses. RESULTS: Among the 425 patients, 200 (47.1%) had axillary lymph node metastasis, and 225 (52.9%) did not. The parameters of tumor shape, color Doppler flow imaging grades, histologic grade, and E-cadherin level were significantly and independently associated with axillary lymph node metastasis (P < .05 for all). CONCLUSIONS: Axillary lymph node metastasis was prone to happen in patients with US features of an irregular tumor shape and higher color Doppler flow imaging grades. Ultrasound imaging provides a promising tool for predicting axillary lymph node metastasis in patients with breast cancer.

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Objective@#To evaluate the effect of tumor shape and location on pulmonary dose-volume parameters by intensity-modulated radiation therapy (IMRT) in patients with non-small cell lung cancer (NSCLC), aiming to provide a reference basis for establishing limits of the pulmonary dose-volume parameters during IMRT.@*Methods@#Clinical data of 208 NSCLC patients undergoing radical IMRT from June 2009 to June 2016 were retrospectively analyzed. According to the tumor shape and location, 208 cases were divided into the vertical bar group (n=127) and the horizontal bar group (n=81), the superior lung group (n=103) and the inferior lung group (n=105). Regression model curve was used to evaluate the effect of tumor shape and location upon the common pulmonary dose-volume parameters(V5, V20, MLD, AVS5 and AVS20).@*Results@#In all groups, the fitting curves of V5, V20 and MLD were manifested in the quadratic equation pattern, and AVS5 and AVS20 in the logarithmic equation manner. In the vertical bar group, the V5(P=0.015), V20(P=0.047) and MLD (P=0.012) were significantly higher, whereas the AVS5(P=0.044) was significantly lower compared with those in the horizontal bar group. No statistical significance was observed in AVS20 between two groups (P=0.490). The tumor location exerted significant effect upon V5 alone (P=0.009).@*Conclusions@#When the tumors presents in the vertical bar shape, the limits of the common lung dose-volume parameters are likely to exceed those of tumors in the vertical bar shape. Lung tumors located in the inferior lobe exerts a more significant effect upon the low-dose region volume compared with the tumors in the superior lobe.

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Recent studies identified distinct genomic subtypes of lower-grade gliomas that could potentially be used to guide patient treatment. This study aims to determine whether there is an association between genomics of lower-grade glioma tumors and patient outcomes using algorithmic measurements of tumor shape in magnetic resonance imaging (MRI). We analyzed preoperative imaging and genomic subtype data from 110 patients with lower-grade gliomas (WHO grade II and III) from The Cancer Genome Atlas. Computer algorithms were applied to analyze the imaging data and provided five quantitative measurements of tumor shape in two and three dimensions. Genomic data for the analyzed cohort of patients consisted of previously identified genomic clusters based on IDH mutation and 1p/19q co-deletion, DNA methylation, gene expression, DNA copy number, and microRNA expression. Patient outcomes were quantified by overall survival. We found that there is a strong association between angular standard deviation (ASD), which measures irregularity of the tumor boundary, and the IDH-1p/19q subtype (p < 0.0017), RNASeq cluster (p < 0.0002), DNA copy number cluster (p < 0.001), and the cluster of clusters (p < 0.0002). The RNASeq cluster was also associated with bounding ellipsoid volume ratio (p < 0.0005). Tumors in the IDH wild type cluster and R2 RNASeq cluster which are associated with much poorer outcomes generally had higher ASD reflecting more irregular shape. ASD also showed association with patient overall survival (p = 0.006). Shape features in MRI were strongly associated with genomic subtypes and patient outcomes in lower-grade glioma.

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BACKGROUND: Increasing attention is focused on polyp-related features that may contribute to the operator-dependent nature of colonoscopy. Few data on polyps are available from high-yield colonoscopies, which may serve as a benchmark for quality control. OBJECTIVES: Describe regional distribution, histology, size and shape of polyps, and the influence of patient age and gender, in colonoscopies performed by a colonoscopist with high lesion detection rate. METHODS: Analysis of 698 consecutive patients with diagnostic, screening or surveillance colonoscopies. RESULTS: In 704 colonoscopies, 1908 polyps were removed (360 were protruded and 1548 flat; 1313 were hyperplastic, 562 adenomas, 5 serrated adenomas and 8 mixed). There were 232 adenomas in female patients and 343 in male patients; 39% of the adenomas were protruded and 61% were flat. The peak adenoma detection rate (ADR) was 51% in patients beyond age 79 years. Men older than 49 years had a higher ADR than women. In men and women, respectively: 40% and 32% of adenomas were in the right colon, 31% and 22% were in the transverse colon, and 30% and 47% were in the left colon. Beyond age 59 years, the majority of adenomas were in the proximal colon. CONCLUSIONS: An excess of adenomas in the proximal colon started at age 60 and this was more pronounced in men than in women. In all colonic regions, the majority of adenomas had a shape that was flat and smaller than 6 mm.

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The characterization of tumors after being imaged is currently a qualitative process performed by skilled professionals. If we can aid their diagnosis by identifying quantifiable features associated with tumor classification, we may avoid invasive procedures such as biopsies and enhance efficiency. The aim of this paper is to describe the 3D EdgeRunner Pipeline which characterizes the shape of a tumor. Shape analysis is relevant as malignant tumors tend to be more lobular and benign ones tare generally more symmetrical. The method described considers the distance from each point on the edge of the tumor to the centre of a synthetically created field of view. The method then determines coordinates where the measured distances are rapidly changing (peaks) using a second derivative found by five point differentiation. The list of coordinates considered to be peaks can then be used as statistical data to compare tumors quantitatively. We have found this process effectively captures the peaks on a selection of kidney tumors.

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BACKGROUND: The computational methods provide condition for investigation related to the process of drug delivery, such as convection and diffusion of drug in extracellular matrices, drug extravasation from microvessels or to lymphatic vessels. The information of this process clarifies the mechanisms of drug delivery from the injection site to absorption by a solid tumor. In this study, an advanced numerical method is used to solve fluid flow and solute transport equations simultaneously to investigate the effect of tumor shape and size on drug delivery to solid tumor. METHODS: The advanced mathematical model used in our previous work is further developed by adding solute transport equation to the governing equations. After applying appropriate boundary and initial conditions on tumor and surrounding tissue geometry, the element-based finite volume method is used for solving governing equations of drug delivery in solid tumor. Also, the effects of size and shape of tumor and some of tissue transport parameters such as effective pressure and hydraulic conductivity on interstitial fluid flow and drug delivery are investigated. RESULTS: Sensitivity analysis shows that drug delivery in prolate shape is significantly better than other tumor shapes. Considering size effect, increasing tumor size decreases drug concentration in interstitial fluid. This study shows that dependency of drug concentration in interstitial fluid to osmotic and intravascular pressure is negligible. CONCLUSIONS: This study shows that among diffusion and convection mechanisms of drug transport, diffusion is dominant in most different tumor shapes and sizes. In tumors in which the convection has considerable effect, the drug concentration is larger than that of other tumors at the same time post injection.

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Cryoablation is a minimally invasive technique that kills tissue in situ through freezing and is used to destroy unresectable benign and malignant tumors. A key objective of this therapeutic technique is to kill cells within a closely defined malignant region while inflicting minimal thermal injury to the surrounding healthy tissue. The extremely low temperatures used in cryoablation inevitably cause varying degrees of damage to the surrounding healthy tissue. Thus, we proposed a simple, effective, and non-invasive heating device that can be easily incorporated into the existing cryosurgical technology. The chief aim of this device is to reduce the over-freezing of neighboring healthy tissue. A model was developed to study the performance of the proposed device during cryo-freezing of a biological tissue, for example porcine liver. The model, validated with the in vitro experimental data, demonstrated good agreement of up to 6.3%. The performance of the proposed device was evaluated using a dimensionless parameter termed the heating coil coefficient. Results demonstrated that the implementation of a heating coil is instrumental for reducing the size of undesired boundary lesions. The adoption of a 50-mm-diameter heating coil reduced the freezing of neighboring tissue by up to 56% within a freezing time of 10 min. This study establishes a framework for the selection of a correctly sized heating device to reduce the over-freezing of neighboring healthy tissue optimally.

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