-
Biomedical Engineering Online Nov 2023The contouring of organs at risk (OARs) in head and neck cancer radiation treatment planning is a crucial, yet repetitive and time-consuming process. Recent studies have... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The contouring of organs at risk (OARs) in head and neck cancer radiation treatment planning is a crucial, yet repetitive and time-consuming process. Recent studies have applied deep learning (DL) algorithms to automatically contour head and neck OARs. This study aims to conduct a systematic review and meta-analysis to summarize and analyze the performance of DL algorithms in contouring head and neck OARs. The objective is to assess the advantages and limitations of DL algorithms in contour planning of head and neck OARs.
METHODS
This study conducted a literature search of Pubmed, Embase and Cochrane Library databases, to include studies related to DL contouring head and neck OARs, and the dice similarity coefficient (DSC) of four categories of OARs from the results of each study are selected as effect sizes for meta-analysis. Furthermore, this study conducted a subgroup analysis of OARs characterized by image modality and image type.
RESULTS
149 articles were retrieved, and 22 studies were included in the meta-analysis after excluding duplicate literature, primary screening, and re-screening. The combined effect sizes of DSC for brainstem, spinal cord, mandible, left eye, right eye, left optic nerve, right optic nerve, optic chiasm, left parotid, right parotid, left submandibular, and right submandibular are 0.87, 0.83, 0.92, 0.90, 0.90, 0.71, 0.74, 0.62, 0.85, 0.85, 0.82, and 0.82, respectively. For subgroup analysis, the combined effect sizes for segmentation of the brainstem, mandible, left optic nerve, and left parotid gland using CT and MRI images are 0.86/0.92, 0.92/0.90, 0.71/0.73, and 0.84/0.87, respectively. Pooled effect sizes using 2D and 3D images of the brainstem, mandible, left optic nerve, and left parotid gland for contouring are 0.88/0.87, 0.92/0.92, 0.75/0.71 and 0.87/0.85.
CONCLUSIONS
The use of automated contouring technology based on DL algorithms is an essential tool for contouring head and neck OARs, achieving high accuracy, reducing the workload of clinical radiation oncologists, and providing individualized, standardized, and refined treatment plans for implementing "precision radiotherapy". Improving DL performance requires the construction of high-quality data sets and enhancing algorithm optimization and innovation.
Topics: Humans; Deep Learning; Organs at Risk; Head; Head and Neck Neoplasms; Algorithms; Image Processing, Computer-Assisted
PubMed: 37915046
DOI: 10.1186/s12938-023-01159-y -
Thyroid Research Feb 2024Coexistence of TSH-secreting pituitary adenoma (TSHoma) and Graves' disease (GD) is rare and complicates the management decision.
BACKGROUND
Coexistence of TSH-secreting pituitary adenoma (TSHoma) and Graves' disease (GD) is rare and complicates the management decision.
METHODS
We present a case of the co-existence of TSHoma and GD. In addition, we systematically searched articles describing TSHoma and GD in the same patient published until 20th March 2023, using Pubmed, Scopus and Embase.
CASE PRESENTATION
A 46-year-old man presented with symptoms of thyrotoxicosis. His thyroid function tests showed serum TSH 3.35 (reference range 0.3-4.2) mIU/L, FT3 19.7 (3.7-6.4) pmol/L, and FT4 68.9 (11-23.3) pmol/L. The serum TSH receptor antibody was 11.5 mIU/L (positive at ≥ 1.75 mIU/L). Pituitary magnetic resonance imaging showed macroadenoma compressing the optic chiasm. The patient underwent trans-sphenoidal resection of pituitary adenoma. Postoperatively, he remained on maintenance carbimazole and octreotide.
RESULTS
Fourteen articles comprising 15 patients were identified from the systemic search. A total of 16 patients (including the current case) were included in the systematic review. The mean (± SD) age at diagnosis was 41 ± 13.6 years. The majority were females (75%). The median (IQR) TSH was 1.95 (0.12-5.5) mIU/L, the median (IQR) free T3 was 11.7 (7.6-19.7) pmol/L and the median (IQR) free T4 level was 47.6 (33.3-64.4) pmol/L. Ten (76.9%) patients had positive TSH receptor antibody levels. 84.6% had pituitary macroadenoma. Pituitary surgery was performed in 12 (75%) patients. At the last follow-up, 4 (25%) patients had complete resolution of symptoms after pituitary surgery, 3 (18.7%) were on maintenance treatment with thionamides for GD, 1 (6.25%) on beta-blockers and 1 (6.25%) on somatostatin analog.
CONCLUSION
TSHoma and GD can co-exist, and it is essential to identify this rare association as it can significantly impact treatment strategies.
PubMed: 38311752
DOI: 10.1186/s13044-023-00184-2 -
Clinical Case Reports Mar 2024Primary GBM of the optic nerve and chiasma should be included in the differential diagnosis of progressive lesions despite initial treatment; clinicians should avoid...
KEY CLINICAL MESSAGE
Primary GBM of the optic nerve and chiasma should be included in the differential diagnosis of progressive lesions despite initial treatment; clinicians should avoid delay in confirming the histology to initiate proper treatment and improve prognosis.
ABSTRACT
Primary GBM of the optic nerve or chiasma is very rare. The characteristics of this condition have not been well-described, which poses difficulties in establishing the correct diagnosis, affecting the treatment and the prognosis. We present a case of GBM of the optic chiasma diagnosed through an open biopsy at our centre. Following the PRISMA statement, we also conducted a systematic review after protocol registration in PROSPERO (CRD42021285855). We searched Medline and Embase through Ovid from inception until December 31, 2021. Two reviewers independently screened the studies. Studies were eligible for inclusion if they reported cases of primary GBM confined to the optic nerve or chiasma as the initial radiological diagnosis. A 77-year-old female was referred for progressive visual loss lasting 8 weeks. MRI revealed a suspected lesion in the left chiasma. The patient's vision deteriorated further despite initially diagnosing an inflammatory process and empirical treatment with corticosteroids. Subsequently, the patient underwent an open biopsy and surgical debulking. Histology, including epigenetic analysis, confirmed GBM grade IV. Radiochemotherapy was administered. The patient died 19 months after surgery. We identified 45 similar cases (22 female) reported in 35 studies between 1949 and 2020. The mean age of the cases was 61 (SD = 14.6). Most cases were misdiagnosed and mistreated accordingly, so there was a median delay of 8 weeks (IQR: 5-14 weeks) in obtaining histological confirmation of the diagnosis, delaying the initiation of appropriate treatment. Five cases became no treatment since the patients died shortly after the delayed histologic diagnosis. The Kaplan-Meier estimate indicated that most patients died within 20 months of presentation, with a 1-year survival rate of 50%, and untreated cases had very low survival rates compared to treated cases. Primary GBM of the optic nerve and chiasma is a rare condition primarily affecting adults. The rarity of this condition contributes to initial misdiagnosis, mistreatment, and delays in confirming the histology and initiating appropriate treatment. The prognosis remains poor, but treatment, including surgery and radiochemotherapy, improves survival.
PubMed: 38515994
DOI: 10.1002/ccr3.8636