Gabriele Naldini

Diagnostic accuracy of CT colonography in patients with positive faecal occult blood test: results of the Italian project Legatumori 2003–2006

PurposeIn the framework of the 3-year project of the Italian Legatumori (2003–2006), we evaluated the diagnostic accuracy of computed tomography (CT) colonography in detecting colorectal lesions in a screening population with positive faecal occult blood test (FOBT).Materials and methodsTwo hundred and thirty asymptomatic subjects (age range 45–80 years) were enrolled in the study. CT colonography was performed with standard patient preparation (no faecal tagging) and a 4-detector-row CT scanner. Image analysis was carried out with primary 2D analysis and the use of 3D endoluminal views to solve difficult cases. Patients were referred for conventional colonoscopy in the following situations: detection of three or more suspected lesions with maximum diameter ≤6 mm; evidence of one or more lesions with maximum diameter >6 mm; presence of colonic masses (maximum diameter >3 cm).ResultsCT colonography detected colonic masses in 12 out of 135 subjects (8%). It generated 93 false positives and 19 false negatives in the identification of diminutive lesions (≤6 mm), and 70 false positives and six false negatives in lesions >6 mm. Sensitivity was 83% in smaller lesions and 93% in lesions >6 mm; specificity was 45% and 59%, respectively.ConclusionsIn a screening population with positive FOBT, CT colonography without faecal tagging and no definite size threshold for the reporting of polyps showed very low specificity but high sensitivity in the detection of all colorectal lesions.RiassuntoObiettiviNell’ambito di un progetto triennale finanziato dalla Legatumori (2003–2006) è stata valutata l’accuratezza diagnostica della CV nel rilievo di lesioni colorettali in una popolazione di screening risultata positiva al test per il SOF.Materiali e metodiSono stati inclusi nello studio 230 soggetti asintomatici. La CV era eseguita con preparazione standard (senza fecal tagging) e apparecchiatura TC a 4 strati. L’analisi delle immagini era effettuata con valutazione primaria 2D e uso delle ricostruzioni 3D nei casi dubbi. L’esame di CC veniva indicato in presenza di: almeno 3 lesioni sospette per polipi con diametro inferiore o uguale a 6 mm, almeno 1 lesione con diametro superiore a 6 mm, o masse coliche (diametro massimo >3 cm).RisultatiLa CV ha consentito la diagnosi di masse coliche in 12/135 (8%) pazienti; ha generato 93 falsi positivi e 19 falsi negativi per polipi di dimensioni minori o uguali a 6 mm, e 70 falsi positivi e 6 falsi negativi per polipi di dimensioni maggiori. La sensibilità era quindi 83% per polipi clinicamente non significativi e 93% per quelli con diametro superiore a 6mm; la specificità rispettivamente di 45% e 59%.ConclusioniIn una popolazione di screening con SOF+, la CV senza fecal tagging e senza l’adozione di un cut off dimensionale nella indicazione alla colonscopia tradizionale, ha evidenziato una bassa specificità, a fronte Pickdi una elevata sensibilità nel rilievo di tutte le lesioni.

Personalizing pelvic floor reconstructive surgery in aging women

Pelvic floor dysfunction is a growingly frequent condition in aging individuals. Urinary or rectal incontinence, constipation, pelvic organ prolapse, pelvic pain or sexual dysfunction are common problems in this age range. Such conditions carry a severe impact on quality of life, but also limit individual independence in daily activities, favor social isolation and carry health risks. Diagnosis and treatment of pelvic floor dysfunction in aging women is tricky, since multiple interfering conditions affecting muscle tone and nerve function are common in these individuals. Diabetes mellitus, sarcopenia, use of drugs that affect cognition or impact bowel or urinary function are just a few examples. These conditions need to be thoroughly taken into account during pre-operative work up for their potential impact on the success of surgery and vice versa. Functional reconstruction aimed at treating symptoms rather than anatomic defects is key to success. The recent advancements in surgical treatment of urinary incontinence and pelvic organ prolapse allow for more options to achieve the best surgery in each patient.

Diagnostic accuracy of CT colonography in patients with positive faecal occult blood test: results of the Italian project

PurposeIn the framework of the 3-year project of the Italian Legatumori (2003–2006), we evaluated the diagnostic accuracy of computed tomography (CT) colonography in detecting colorectal lesions in a screening population with positive faecal occult blood test (FOBT).Materials and methodsTwo hundred and thirty asymptomatic subjects (age range 45–80 years) were enrolled in the study. CT colonography was performed with standard patient preparation (no faecal tagging) and a 4-detector-row CT scanner. Image analysis was carried out with primary 2D analysis and the use of 3D endoluminal views to solve difficult cases. Patients were referred for conventional colonoscopy in the following situations: detection of three or more suspected lesions with maximum diameter ≤6 mm; evidence of one or more lesions with maximum diameter >6 mm; presence of colonic masses (maximum diameter >3 cm).ResultsCT colonography detected colonic masses in 12 out of 135 subjects (8%). It generated 93 false positives and 19 false negatives in the identification of diminutive lesions (≤6 mm), and 70 false positives and six false negatives in lesions >6 mm. Sensitivity was 83% in smaller lesions and 93% in lesions >6 mm; specificity was 45% and 59%, respectively.ConclusionsIn a screening population with positive FOBT, CT colonography without faecal tagging and no definite size threshold for the reporting of polyps showed very low specificity but high sensitivity in the detection of all colorectal lesions.RiassuntoObiettiviNell’ambito di un progetto triennale finanziato dalla Legatumori (2003–2006) è stata valutata l’accuratezza diagnostica della CV nel rilievo di lesioni colorettali in una popolazione di screening risultata positiva al test per il SOF.Materiali e metodiSono stati inclusi nello studio 230 soggetti asintomatici. La CV era eseguita con preparazione standard (senza fecal tagging) e apparecchiatura TC a 4 strati. L’analisi delle immagini era effettuata con valutazione primaria 2D e uso delle ricostruzioni 3D nei casi dubbi. L’esame di CC veniva indicato in presenza di: almeno 3 lesioni sospette per polipi con diametro inferiore o uguale a 6 mm, almeno 1 lesione con diametro superiore a 6 mm, o masse coliche (diametro massimo >3 cm).RisultatiLa CV ha consentito la diagnosi di masse coliche in 12/135 (8%) pazienti; ha generato 93 falsi positivi e 19 falsi negativi per polipi di dimensioni minori o uguali a 6 mm, e 70 falsi positivi e 6 falsi negativi per polipi di dimensioni maggiori. La sensibilità era quindi 83% per polipi clinicamente non significativi e 93% per quelli con diametro superiore a 6mm; la specificità rispettivamente di 45% e 59%.ConclusioniIn una popolazione di screening con SOF+, la CV senza fecal tagging e senza l’adozione di un cut off dimensionale nella indicazione alla colonscopia tradizionale, ha evidenziato una bassa specificità, a fronte Pickdi una elevata sensibilità nel rilievo di tutte le lesioni.

Functional Anatomy of the Pelvic Floor

The pelvic floor is a complex interrelated structure of muscles, ligaments, and fascia with multiple functions. These functions concern support of visceral organs, maintaining continence, facilitating micturition and evacuation, as well as forming part of the birth canal. This multifunctional unit has connections to the bony pelvis, to organs, and to the extensive fibroelastic network in the fat-containing anatomical spaces.