Objectives To evaluate the quality of the reports of loco-regional staging computed tomography (CT) or magnetic resonance imaging (MRI) in head and neck (H&N) cancer. Methods Consecutive reports of staging CT and MRI of all H&N cancer cases from 2018 to 2020 were collected. We created lists of quality indicators for tumor (T) for each district and for node (N). We marked these as 0 or 1 in the report calculating a report score (RS) and a maximum sum (MS) of each list. Two radiologists and two otolaryngologists in consensus classified reports as low quality (LQ) if the RS fell in the percentage range 0-59% of MS and as high quality (HQ) if it fell in the range 60-100%, annotating technique and district. We evaluated the distribution of reports in these categories. Results Two hundred thirty-seven reports (97 CT and 140 MRI) of 95 oral cavity, 52 laryngeal, 47 oropharyngeal, 19 hypo-pharyngeal, 14 parotid, and 10 nasopharyngeal cancers were included. Sixty-six percent of all the reports were LQ for T, 66% out of all the MRI reports, and 65% out of all CT reports were LQ. Eight-five percent of reports were HQ for N, 85% out of all the MRI reports, and 82% out of all CT reports were HQ. Reports of oral cavity, oro-nasopharynx, and parotid were LQ, respectively, in 76%, 73%, 100% and 92 out of cases. Conclusion Reports of staging CT/MRI in H&N cancer were LQ for T description and HQ for N description.

To compare the outcome of US-guided percutaneous irrigation of calcific tendinopathy (US-PICT) of the rotator cuff in patients with or without previous external shockwave therapy (ESWT). We analyzed all patients treated with US-PICT from March 1, 2016, to October 1, 2019, with shoulder pain refractory to conservative management for rotator cuff calcific tendinopathy, diagnosed with ultrasound. Each patient was examined using the Constant–Murley Score (CMS) questionnaire (score 0–100) before and after treatment. We tested CMS differences using the Mann–Whitney U (Wilcoxon rank-sum) test in the two groups. US-PICT was performed placing two or multiple 14G needles, according to the calcification size, inserted under US guidance to create a circuit of irrigation in the calcified tendon. NaCl solution at 38 °C was then injected from the entry needle in a variable amount to hydrate and fragment the calcification, finally allowing for its expulsion through the exit needle. All patients also received an intrabursal steroid injection. From 2016 to 2019, 72 US-PICT treatments were performed on 70 patients (females = 46; males = 26) with a mean age of 49.7 years (SD = 8.7. Thirty-three (47%) underwent previous ESWT, while thirty-seven (53%) had no previous treatments. No treatment-related complications were observed. Follow-up was averagely 14.4 months (median = 11.6, SD = 11.9, range 1–45); 37 patients had a follow-up shorter than 12 months (1–11.6); 35 patients were visited after more than 1 year (12.2–45.6, Table W). Before treatment, the mean CMS was 35 (SD = 21); after treatment, it reached 75.4, with an average CMS improvement of 40.3 points (SD = 23.7, p < 0.001). The comparison of improvement between the ESWT and non-ESWT group yielded no significant difference (p = 0.3). US-PICT of the rotator cuff is an effective procedure to reduce shoulder pain and increase mobility in patients with calcific tendinopathy, both in short- and long-term time intervals. Previous unsuccessful ESWT does not affect the outcome of US-PICT.

Patients treated with third-generation EGFR TKIs will develop resistance to treatment at a certain point. Early detection of resistance occurrence could allow more options for treatment.We discuss the development of third-generation EGFR TKIs, focusing on osimertinib and discuss the most common resistance mechanisms under evaluation. We also debate how this resistance can be detected; particularly we review the possible application of liquid biopsy in this scenario. Lastly we discuss available treatment options when resistance occurs, with an eye on ongoing trials and possible future developments.As resistance will ultimately develop, a strict instrumental follow-up as per international guidelines is required with the aim of detecting this resistance in an early phase. Detecting an oligoprogression could allow the integration of local ablative therapies while further delaying the need for a systemic therapy change. By exploiting the increasing potentiality of liquid biopsy, in the near future, physicians could be able to understand why a patient develops resistance and therefore can choose the best possible individualized treatment option.

Introduction Patients treated with third-generation EGFR TKIs will develop resistance to treatment at a certain point. Early detection of resistance occurrence could allow more options for treatment. Areas covered We discuss the development of third-generation EGFR TKIs, focusing on osimertinib and discuss the most common resistance mechanisms under evaluation. We also debate how this resistance can be detected; particularly we review the possible application of liquid biopsy in this scenario. Lastly we discuss available treatment options when resistance occurs, with an eye on ongoing trials and possible future developments. Expert opinion As resistance will ultimately develop, a strict instrumental follow-up as per international guidelines is required with the aim of detecting this resistance in an early phase. Detecting an oligoprogression could allow the integration of local ablative therapies while further delaying the need for a systemic therapy change. By exploiting the increasing potentiality of liquid biopsy, in the near future, physicians could be able to understand why a patient develops resistance and therefore can choose the best possible individualized treatment option.

BACKGROUND: Endovascular treatment of abdominal aortic aneurysms (AAA) has become more common and is expected to fit best for high risk patients even if it displays an increased number of secondary reintervention when compared to open surgery. METHODS: Cohort study of 311 consecutive patients with AAs treated by endovascular repair from 2004 to 2015 in a single University Hospital were analyzed and included in the study. We computed Kaplan-Meier life tables to estimate all-cause survival at 30 days and 1 year as well as to estimate rate of endovascular and global (endovascular + surgical) reintervention, incidence of endoleaks and of aneurysm progression at 1 month, 3 months, 6 months and 1 year. Patients were observed from the date of intervention. RESULTS: Sixty-eight patients were lost to follow-up. No statistically significant differences emerged from the comparison of 30 days mortality between the 6 endograft groups (overall rate 1.7%, P=0.787). No significant differences of mean aneurysm diameter reduction recorded within 1 year from intervention were observed between the groups. Overall diameter stability, regression and progression occurred in 82.5%, 12.5% and 4.5%, respectively. Cook device displayed the highest incidence of type I endoleak within the 1st postoperative year (11.5% vs. 2.4%; HR=4.48, 95% CI: 1.05-19.20, P=0.043) while Gore and Anaconda devices of type II endoleaks within the same period (49.5% vs. 26.0%; HR=1.78, 95% CI: 0.95-3.33, P=0.073). Endovascular aneurysm repair treatment failed in 16 patients (5.1%) who were thus converted to open surgery. CONCLUSIONS: Gore and Cook devices resulted those with the highest incidence of type II endoleaks and of global reintervention while AFX resulted the device with the lowest incidence of both the events mentioned. In conclusion, regular follow-up of patients is mandatory for the effectiveness of endovascular treatment and to detect early complications and when EVAR fails, open surgical repair is still a reasonable surgical alternative.