Benign Biopsy Research Articles

Digital Breast Tomosynthesis With Synthetic Mammography: Are We Missing Calcifications That Matter?

To determine whether there are differences in the biopsy outcomes for suspicious calcifications detected with screening mammography using the digital breast tomosynthesis and synthetic 2D (DBT/SM) technique compared to calcifications detected using the full-field digital (DM) technique. This retrospective study was IRB approved. The records for all stereotactic biopsies performed for suspicious calcifications detected on screening mammograms using DM in 2011-2014 and DBT/SM in 2017-2020 were reviewed. We collected patient, imaging, and pathology data from the breast imaging database and from retrospective review of a subset of mammograms. The biopsy outcome results were categorized as benign, benign with upgrade potential (BWUP), and malignant based on final pathology. Frequencies and proportions of outcomes were calculated and compared using Mann-Whitney U tests and Wilcoxson signed-rank tests with P-values and 95% confidence intervals (95% CIs). From 2011 to 2014 (DM), 1274 stereotactic biopsies of calcifications yielded 74.2% (945/1274) benign, 11.5% (147/1274) BWUP, and 14.3% (182/1274) malignant outcomes. From 2017 to 2020 (DBT/SM), 1049 stereotactic biopsies yielded 65.2% (684/1049) benign, 15.6% (164/1049) BWUP, and 19.2% (201/1049) malignant outcomes. With DBT/SM, benign biopsy outcomes decreased (9.0%, 95% CI 0.87-11.53, P < 0.05), whereas malignant biopsy outcomes increased (4.9%, 95% CI 0.94-8.36, P < 0.05). There was no significant difference in BWUP biopsy outcomes and total biopsy rates between techniques (P > 0.05). Calcifications detected with screening DBT/SM technique were significantly more likely to be malignant than those found using DM. These results support using the DBT/SM technique without obtaining concurrent DM images.

Clinical Breast MRI-based Radiomics for Distinguishing Benign and Malignant Lesions: An Analysis of Sequences and Enhanced Phases.

Previous studies have used different imaging sequences and different enhanced phases for breast lesion calsification in radiomics. The optimal sequence and contrast enhanced phase is unclear. To identify the optimal magnetic resonance imaging (MRI) radiomics model for lesion clarification, and to simulate its incremental value for multiparametric MRI (mpMRI)-guided biopsy. Retrospective. 329 female patients (138 malignant, 191 benign), divided into a training set (first site, n = 192) and an independent test set (second site, n = 137). 3.0-T, fast spoiled gradient-echo and fast spin-echo T1-weighted imaging (T1WI), fast spin-echo T2-weighted imaging (T2WI), echo-planar diffusion-weighted imaging (DWI), and fast spoiled gradient-echo contrast-enhanced MRI (CE-MRI). Two breast radiologists with 3 and 10 years' experience developed radiomics model on CE-MRI, CE-MRI + DWI, CE-MRI + DWI + T2WI, CE-MRI + DWI + T2WI + T1WI at each individual phase (P) and for multiple combinations of phases. The optimal radiomics model (Rad-score) was identified as having the highest area under the receiver operating characteristic curve (AUC) in the test set. Specificity was compared between a traditional mpMRI model and an integrated model (mpMRI + Rad-score) at sensitivity >98%. Wilcoxon paired-samples signed rank test, Delong test, McNemar test. Significance level was 0.05 and Bonferroni method was used for multiple comparisons (P = 0.007, 0.05/7). For radiomics models, CE-MRI/P3 + DWI + T2WI achieved the highest performance in the test set (AUC = 0.888, 95% confidence interval: 0.833-0.944). The integrated model had significantly higher specificity (55.3%) than the mpMRI model (31.6%) in the test set with a sensitivity of 98.4%. The CE-MRI/P3 + DWI + T2WI model is the optimized choice for breast lesion classification in radiomics, and has potential to reduce benign biopsies (100%-specificity) from 68.4% to 44.7% while retaining sensitivity >98%. 3 TECHNICAL EFFICACY: Stage 2.

Fish: A Promising Screening Tool for Malignancy After Augmentation Cystoplasty?

IntroductionMalignancy after augmentation cystoplasty (AC) is reported up to 5.5 %. We assessed the use of urine fluorescence in situ hybridization (FISH) screening for bladder malignancy after AC. Patients and methodsIn this study, 36/98 patients under follow-up who have completed tenth year after ileal AC were included prospectively. Twenty-four (66.7 %) patients were tested with FISH initially and overall 28 (77.8 %) patients with conventional cytology (CC). Twenty-four (66.7 %) patients with FISH analysis also had cytology analysis. Blinded from the cytology results, 32 (88.9 %) patients who were consented underwent cystoscopy with random biopsy (native bladder, ileal segment, ileovesical junction). Two patients those were tested with FISH did not consented cystoscopy. This study was registred to the government registry (No: 71146310). ResultsMean follow-up time after AC was 15.4 ± 4.8 years. 2/32 (5.6 %) patients were diagnosed with adenocarcinoma in cyctoscopic biopsy. FISH analysis of 3/24 (12.5 %) patients demonstrated abnormal findings consistent with malignancy. Two FISH malignant patients were patients who had adenocarcinoma. The third patient's biopsy was benign and the third year control cystoscopy was normal. 2/4 patients with malignant CC had adenocarcinoma and 2/4 patients had benign biopsy. The sensitivity and specificity of FISH in our series were 100 % and 95 % respectively. Whereas the sensitivity and specificity of CC was 100 % and 91.6 % respectively. ConclusionDespite limited number of patients in this study, FISH showed higher specificity than CC in this series. FISH is a promising tool for malignancy screening after AC. Type of StudyDiagnostic Studies. Level of EvidenceII.

Association of Clinicodemographic Factors and Tissue Biopsy Results Among Patients with Thyroid Nodules at the Southern Philippines Medical Center

Objective: To compare selected clinicodemographic factors of patients with thyroid nodules who underwent thyroid surgeries with their tissue biopsy results and determine any association between clinicodemographic factors and tissue biopsy results.&#x0D; Methods:Design: Retrospective review of recordsSetting: Tertiary Government Training HospitalParticipants: 251 patients with thyroid nodules&#x0D; Results: Of 251 patients with thyroid nodules, the majority (218; 86.9%) were females while 33 (13.1%) were males. The average age in years was 41.5±13.3 The same population also had malignant outcomes at 79.3%. Most of the patients did not have family history of thyroid malignancy (54%) and had no palpable cervical lymph nodes at presentation (75.9%). Furthermore, there was no distant metastasis at presentation for both lungs (97.7%) and bones (98.9%). There were no significant differences in tissue biopsy results when correlated with age (df=249; t=-.144; p = .886), duration of goiter (df=249; t=-.829; p = .408), and distant metastasis at presentation for lungs (Z=-5.977; p = .052) and bones (Z=-.457; p = .648). Significant differences were only evident for clinicodemographic factors such as sex (Z=-2.570; p = .010), family history (Z=-2.239; p = .020), palpable cervical lymph nodes at presentation (Z=-5.977; p = .000), and the following comorbidities: pulmonary tuberculosis (Z=-2.388; p = .017) and bronchial asthma (Z=-2.148; p = .032) and smoking history (Z=-3.455; p=.001). Furthermore, having no palpable cervical lymph nodes at presentation were associated with malignant tissue biopsy results (B=3.616; p=.001). Patients without palpable cervical lymph nodes at presentation were 37.204 times [OR=37.204] more likely to have benign biopsy results [95% CI: 4.705 – 294.168].&#x0D; Conclusion: There are greater odds of having benign biopsy results for patients without palpable cervical lymph nodes at presentation.

Extending the Breast Cancer Surveillance Consortium Model of Invasive Breast Cancer.

We extended the Breast Cancer Surveillance Consortium (BCSC) version 2 (v2) model of invasive breast cancer risk to include BMI, extended family history of breast cancer, and age at first live birth (version 3 [v3]) to better inform appropriate breast cancer prevention therapies and risk-based screening. We used Cox proportional hazards regression to estimate the age- and race- and ethnicity-specific relative hazards for family history of breast cancer, breast density, history of benign breast biopsy, BMI, and age at first live birth for invasive breast cancer in the BCSC cohort. We evaluated calibration using the ratio of expected-to-observed (E/O) invasive breast cancers in the cohort and discrimination using the area under the receiver operating characteristic curve (AUROC). We analyzed data from 1,455,493 women age 35-79 years without a history of breast cancer. During a mean follow-up of 7.3 years, 30,266 women were diagnosed with invasive breast cancer. The BCSC v3 model had an E/O of 1.03 (95% CI, 1.01 to 1.04) and an AUROC of 0.646 for 5-year risk. Compared with the v2 model, discrimination of the v3 model improved most in Asian, White, and Black women. Among women with a BMI of 30.0-34.9 kg/m2, the true-positive rate in women with an estimated 5-year risk of 3% or higher increased from 10.0% (v2) to 19.8% (v3) and the improvement was greater among women with a BMI of ≥35 kg/m2 (7.6%-19.8%). The BCSC v3 model updates an already well-calibrated and validated breast cancer risk assessment tool to include additional important risk factors. The inclusion of BMI was associated with the largest improvement in estimated risk for individual women.

Label-free multimodal electro-thermo-mechanical (ETM) phenotyping as a novel biomarker to differentiate between normal, benign, and cancerous breast biopsy tissues.

Technologies for quick and label-free diagnosis of malignancies from breast tissues have the potential to be a significant adjunct to routine diagnostics. The biophysical phenotypes of breast tissues, such as its electrical, thermal, and mechanical properties (ETM), have the potential to serve as novel markers to differentiate between normal, benign, and malignant tissue. We report a system-of-biochips (SoB) integrated into a semi-automated mechatronic system that can characterize breast biopsy tissues using electro-thermo-mechanical sensing. The SoB, fabricated on silicon using microfabrication techniques, can measure the electrical impedance (Z), thermal conductivity (K), mechanical stiffness (k), and viscoelastic stress relaxation (%R) of the samples. The key sensing elements of the biochips include interdigitated electrodes, resistance temperature detectors, microheaters, and a micromachined diaphragm with piezoresistive bridges. Multi-modal ETM measurements performed on formalin-fixed tumour and adjacent normal breast biopsy samples from N = 14 subjects were able to differentiate between invasive ductal carcinoma (malignant), fibroadenoma (benign), and adjacent normal (healthy) tissues with a root mean square error of 0.2419 using a Gaussian process classifier. Carcinoma tissues were observed to have the highest mean impedance (110018.8 ± 20293.8 Ω) and stiffness (0.076 ± 0.009 kNm-1) and the lowest thermal conductivity (0.189 ± 0.019 Wm-1K-1) amongst the three groups, while the fibroadenoma samples had the highest percentage relaxation in normalized load (47.8 ± 5.12%). The work presents a novel strategy to characterize the multi-modal biophysical phenotype of breast biopsy tissues to aid in cancer diagnosis from small-sized tumour samples. The methodology envisions to supplement the existing technology gap in the analysis of breast tissue samples in the pathology laboratories to aid the diagnostic workflow.

Contrast-Enhanced Mammography for Women with Palpable Breast Abnormalities

To examine the role of contrast-enhanced mammography (CEM) in the work-up of palpable breast abnormalities. In this single-center combination prospective-retrospective study, women with palpable breast abnormalities underwent CEM evaluation prospectively, comprising the acquisition of low energy (LE) images and recombined images (RI) which depict enhancement, followed by targeted ultrasound (US). Two independent readers retrospectively reviewed the imaging and assigned BI-RADS assessment based on LE alone, LE plus US, RI with LE plus US (CEM plus US), and RI alone. Pathology results or 1-year follow-up imaging served as the reference standard. 237 women with 262 palpable abnormalities were included (mean age, 51 years). Of the 262 palpable abnormalities, 116/262 (44%) had no imaging correlate and 242/262 (92%) were benign. RI alone had better specificity compared toLE plus US (Reader 1, 94% versus 89% (p=0.009); Reader 2, 93% versus 88% (p=0.03)), better positive predictive value (Reader 1, 52% versus 42% (p=0.04); Reader 2, 53% versus 42% (p=0.04)), and better accuracy (Reader 1, 93% versus 89% (p=0.05); Reader 2, 93% versus 90% (p=0.06)). CEM plus US was not significantly different in performance metrics versus LE plus US. RI had better specificity compared toLE in combination with US. There was no difference in performance between CEM plus US and LE plus US, likely reflecting the weight US carries in radiologist decision-making. However, the results indicate that the absence of enhancement on RI in the setting of palpable lesions may help avoid benign biopsies.

Prostate Cancer Mortality Among Elderly Men After Discontinuing Organised Screening: Long-term Results from the European Randomized Study of Screening for Prostate Cancer Rotterdam

BackgroundThe optimal timing for discontinuing screening of prostate cancer (PCa) in elderly men is currently not known and remains debated. ObjectiveTo assess prostate cancer–specific mortality (PCSM) in elderly men who previously underwent prostate-specific antigen (PSA)-based screening and to identify those who may benefit from continued screening. Design, setting, and participantsA total of 7052 men, who participated in the screening arm of the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer and were aged 70–74 yr at their last screening visit after undergoing a maximum of three screening rounds without being diagnosed with PCa, were included. Outcome measurements and statistical analysisThe cumulative incidence of PCSM by the age of 85 yr was assessed. Additionally, a competing risk regression was performed to assess the potential predictors of PCSM. Results and limitationsThe median follow-up was 16 yr. The cumulative incidence of PCSM by the age of 85 yr was 0.54% (95% confidence interval [CI]: 0.40–0.70) in all men, 0.11% (95% CI: 0.05–0.27) in men with PSA <2 ng/ml, 0.85% (95% CI: 0.47–1.5) in men with PSA 2–3 ng/ml, and 6.8% (95% CI: 3.1–15) in men with PSA ≥6.5 ng/ml and no previous benign biopsy. PSA (subdistribution hazard ratio [sHR]: 2.0; 95% CI: 1.7–2.3), previous benign prostate biopsy (sHR: 0.41; 95% CI: 0.23–0.72), and hypertension (sHR: 0.48; 95% CI: 0.25–0.91) were significantly associated with PCSM. ConclusionsMen aged 70–74 yr who have previously undergone PSA-based screening without receiving a PCa diagnosis have a very low risk of dying from PCa by the age of 85 yr. These data suggest that screening may be discontinued in men with PSA <3.0 ng/ml or previous benign prostate biopsies. Those with higher PSA levels and no prior biopsies may consider continued screening if life expectancy exceeds 10 yr. Patient summaryThis study shows that men who participated in a prostate cancer screening trial have a very low risk of dying from prostate cancer if they have not been diagnosed with prostate cancer by the age of 74 yr.

SAT553 A Case of Metastatic Functional Papillary Thyroid Cancer in the Setting of Graves’ Disease

Abstract Disclosure: N. Manuel: None. S.J. Sternlieb: None. J. Dendy: None. Q.Z. Iqbal: None. A Case of Metastatic Functional Papillary Thyroid Cancer In the Setting of Graves’ DiseaseManuel, N., Sternlieb, S., Grissett, B., Iqbal, Q., Dendy, J. Background: Grave’s disease (GD) and papillary thyroid cancer (PTC) can be concomitant diseases. We report a rare case of metastatic PTC with concomitant GD leading to symptomatic hyperthyroidism despite total thyroidectomy. Clinical Case: A 58-year-old woman with longstanding history of thyroid nodules and left dominant nodule with benign biopsy on multiple occasions presented to her PCP with dyspnea, weight loss and globus sensation. CT of the chest was obtained revealing tracheal deviation from neck mass, mediastinal lymphadenopathy and multiple pulmonary nodules. Biopsy of lung nodule showed follicular features consistent with tumor cells of thyroid origin. She had a total thyroidectomy with central neck dissection with a final diagnosis of left sided 5 cm infiltrative follicular variant papillary thyroid carcinoma. Thyroid hormone replacement was initiated and on follow up 4 weeks later she was noted to be tachycardic at weight-based dose. At that time TSH was &amp;lt;0.010 uIU/mL (0.400 - 4.00), free T4 was 1.96 ng/dL (0.71 – 1.51) and Thyroglobulin was found to be 31516 ng/dL (Athyrotic &amp;lt;0.1). Prior to planned RAI she developed symptoms of dyspnea on exertion and edema and was sent to the ER for abnormal D. Dimer. Workup for PE was negative including CTA of the chest. A follow up visit showed further symptoms of hyperthyroidism with worsening fatigue, dyspnea, palpitations and new onset tremor. Levothyroxine dose was decreased further but 2 weeks later she returned to the ER with worsened thyroid function tests, and she was admitted for symptomatic hyperthyroidism. Levothyroxine was held and she was placed on PTU and propranolol. Given the overt symptomatic hyperthyroidism there were concerns for either Jod-Basedow phenomenon from iodine load with recent imaging or for hyperfunctioning PTC metastasis as the cause. Thyrotropin receptor antibody level was checked to further clarify and was elevated at 22 IU/L (0.00 – 1.75) consistent with GD. An I-131 diagnostic whole-body scan demonstrated small foci of right thyroid bed remnant and iodine-avid metastases involving mediastinal nodal disease as well as pulmonary and osseous metastases. She then underwent RAI therapy with 104.5 mCi I-131 without Thyrogen stimulation. Follow up whole body scan showed persistence of iodine-avid metastasis without any new foci of uptake compared to pretreatment scans. Conclusion: Although the coexistence of them is rare, GD should be put into the differential of rapidly progressive metastatic PTC especially if patient markedly hyperthyroid on lower doses of thyroid hormone. While functional thyroid carcinoma is rare, with less than 100 cases in literature, thorough investigation should be completed in order to not miss this concomitant disease process. Presentation Date: Saturday, June 17, 2023

SAT493 Laser Ablation For Benign Thyroid Nodules: A Way To Treat And Still Preserve The Thyroid

Abstract Disclosure: N. Kalara: None. D.L. Bignoli: None. C.M. Acosta: None. A. Manzano: None. Introduction: Thyroid nodules in adults have a prevalence of 3-7% based on palpation and 20-76% based on ultrasound examination. The majority of which are benign but some increase in size causing compressive symptoms or cosmetic concerns, thus, needing treatment. Laser ablation (LA) is a safe, non-surgical approach for the management of benign thyroid nodules now approved in the US. Nodule reduction is achieved through laser induced cytoreduction and tissue coagulation. Two benign FNA biopsies 3-6 months apart and a nodule size of more than 2.5 cm are some of the inclusion criteria for LA. We present a case of a benign thyroid nodule causing compressive symptoms where LA was done since the patient declined surgery. Case description: 76-year-old female with a history of type 2 diabetes mellitus, hypertension, and multinodular goiter for many years presented with concerns of neck fullness and discomfort for the past 6 months. Thyroid ultrasound confirmed a large dominant right complex nodule of 2.8 x 1.13 x 3 cm with a volume of 5 ml. Thyroid function test showed Thyroid stimulating hormone (TSH) 1.2 mIU/mL (0.40-4.50) and free T4 1.24 ng/dl (0.9-1.7). Two FNA biopsies done 3 months apart in the past were Bethesda II. Given the compressive symptoms due to a multinodular gland thyroidectomy was discussed as a treatment option with the patient which she declined. Hence, LA was discussed as an option for the largest nodule. The procedure was performed without complications. The nodule received 1450 Joules at 6 watts using one Elesta laser fiber. At the end of 2 months post-LA, thyroid ultrasound showed a significant reduction of the nodule with a current size of 1.5 x 1 x 1.6 cm and 1.4ml volume. She continued to be clinically and biochemically euthyroid with a total volume reduction close to 70% and complete resolution in compressive symptoms. Conclusion: Percutaneous laser ablation is a non-surgical, minimally invasive procedure to treat benign thyroid nodules that is now accessible in the US with promising results and a good safety profile. It is covered by insurance in various states. In our case the patient refused surgical intervention, thus, laser ablation was done that resulted in the resolution of her compressive symptoms without any complications. More awareness regarding the laser ablation procedure and its availability for patients is needed, especially in cases where preservation of the thyroid gland is desired. Reference: 1. Gambelunghe G, Stefanetti E, Avenia N, De Feo P. Percutaneous Ultrasound-Guided Laser Ablation of Benign Thyroid Nodules: Results of 10-Year Follow-Up in 171 Patients. J Endocr Soc. 2021 May 5;5(7):bvab081. doi: 10.1210/jendso/bvab081. PMID: 34159286; PMCID: PMC8212682. Presentation Date: Saturday, June 17, 2023

SAT532 A Rare Case of Thyroid Carcinoma Noted in a Patient with Thyroid Nodule Showing Prior Benign Biopsy and Prior Negative Molecular Testing

Abstract Disclosure: M.M. Hillhouse: None. P. Madhavan: None. F.M. Woron: None. Background: Molecular studies have a high sensitivity for ruling out malignancy (1). This patient was diagnosed with the follicular variant of papillary thyroid carcinoma despite negative molecular testing and benign cytology in multiple prior biopsies. Clinical Case: 31 y.o. female with a past medical history of Hashimoto's disease on levothyroxine presented for follow up of thyroid nodules. She does not have a family history of thyroid cancer or personal history of neck radiation. The patient was noted to have a right thyroid nodule around 14 years of age and this was monitored during her childhood. The nodule measured 2.3 x 0.6 cm on ultrasound in 2015. The nodule measured 2.0 x 1.6 x 1.5 cm in 2017. FNA in 2017 revealed benign cytology (Bethesda II). On ultrasound in 03/2019, the nodule measured 2.2 x 1.5 x 1.8 cm. The nodule demonstrated a greater than 20% increase in all dimensions on ultrasound images in 12/2020 to 2.9 x 2.0 x 2.6 cm. A repeat ultrasound in 04/2021 demonstrated no significant change in size. Repeat FNA performed in 07/2021 demonstrated clusters of follicular cells in flat and microfollicular groups and was interpreted as atypia of undetermined significance (Bethesda III). AFIRMA testing was benign (∼4% of malignancy. The nodule increased in size to 3.5 x 2.6 x 3.1 cm on ultrasound in 07/2022. It appeared solid and hyperechoic and was classified as TI-RADS 3. A new 0.8 cm nodule on the left lobe was also identified. Repeat FNA of the right nodule in 09/2022 demonstrated macrophages, colloid and groups of follicular cells and was classified as non-diagnostic (Bethesda I). She reported difficulty breathing in the supine position and she underwent a right hemithyroidectomy and isthmusectomy in 11/2022. Pathology results were remarkable for invasive encapsulated follicular variant of papillary thyroid carcinoma with focal angioinvasion and tumor capsular invasion. The margins were negative for tumor. The parenchyma was consistent with lymphocytic thyroiditis. Ultrasound after interval right hemithyroidectomy in 12/2022 in an outside facility demonstrated an unchanged subcentimeter left thyroid nodule and multiple bilateral anterior cervical/level 6 lymph nodes suspicious for metastatic disease given the absence of hilum. Patient is currently undergoing repeat imaging and work up for the lymphadenopathy. Conclusion: This case study highlights the importance of maintaining high clinical suspicion for thyroid malignancy in cases of increasing thyroid nodule size and compressive symptoms despite negative cytological and molecular testing.

SAT533 The Case of an Ectopic Thyroid Twin

Abstract Disclosure: A. Abu Limon: None. S.A. Aldasouqi: Consulting Fee; Self; Abbott Laboratories. P. Kachhadia: None. S. Khan: None. Introduction: Ectopic thyroid tissue is a rare but known developmental abnormality during the descent of the thyroid tissue from the floor of the foregut to its final location Infront of the trachea. The most frequent ectopic locations are the base of the tongue and anywhere along the course of the thyroglossal duct. It is very rare to have an ectopic thyroid tissue located in the mediastinum. It’s even more rare when the patient still has an almost normal thyroid gland in its usual location in the neck, and both are sizable and functional. Case Presentation: We are reporting the case of a 38-Year-old African American Female, who was involved in a car accident with non-critical injuries to her neck and chest area. She underwent a contrasted CT scan of her neck and chest that showed an anterior mediastinal mass towards the right at the level of the great vessels and arch, right paratracheal location overall measuring 6.0 x 4.6 x 4.5 cm. She was seen by Cardiothoracic surgery group and underwent Mediastinoscopy that confirmed a large firm to hard mass just inferior to the innominate artery was firmly adherent to the trachea as well as surrounding structures. Multiple biopsies showed thyroid tissue with focal mild chronic inflammation, benign. No atypia or malignancy is noted. Then, she was referred to our clinic for further evaluation. When interviewed, the patient denies any compressive symptoms (Shortness of breath, palpitations, chest pain or dysphagia). The patient has no personal or family history of thyroid disorders, including no thyroid cancer history. She has no Goiter on exam and no Pemberton sign is elicited. Laboratory work up was unremarkable including normal thyroid functions. Neck Ultrasound confirmed presence of a thyroid gland in its expected location, with Right Lobe Measurement: 5.04 x 1.70 x 1.47 cm Vol: 6.02 ml and Left Lobe Measurement: 3.94 x 1.25 x 1.21 cm Vol: 2.87 ml. We were keen to explore this matter further and ordered a thyroid uptake scan with 0.97 uCi iodine-123, that showed a 24-hour normal uptake of 27.4% at the thyroid bed and a separate substernal and RT paratracheal location uptake. Discussion: This patient has supplementary ectopic thyroid tissue in her mediastinum along with a normal thyroid gland in her neck. From the literature review and search, This is a very rare occurrence. The discussion with the patient is about the specific concern of the malignant potential of this ectopic thyroid and if surgical intervention is needed. The probability of cancer on ectopic thyroid tissue is less than 1% and when it occurs papillary carcinoma is the most common histology. Our patient has benign biopsy results and no signs nor symptoms related to this ectopic thyroid gland. The final decision is to not undergo surgery, but rather, a follow up with CT scan in 6 months. Presentation Date: Saturday, June 17, 2023

Relationship Between Sonographic Findings, Fine Needle Aspiration, and Histopathological Findings of Post-thyroid Surgery.

Thyroid diseases can affect various bodily functions and often go unnoticed. Tools such as sonography and fine needle aspiration (FNA) puncture are necessary to diagnose diseases that require surgical intervention. These tools help identify signs of malignancy or benignity and obtain further data to guide therapeutic decisions. This study aims to validate the relationship between sonographic results, FNA, and final thyroid pathology. This research describes the level of correlation between sonographic findings and FNA, the sonographic and final pathology reports, and the FNA and final pathology reports. Additionally, this research aims to identify the most common diagnoses in the final pathology. A retrospective descriptive observational study was carried out with a sample of 95 patients who underwent thyroid surgery at the National Institute of Diabetes, Endocrinology, and Nutrition (INDEN), Dominican Republic, in 2019 to determine whether a relationship exists between the sonography findings, FNA, and the final pathology in surgical thyroid pathologies. A total of 95 patients were studied. The success rate of the sonography results compared with the benign final biopsy result was 100% and 45.9% with the malignant final biopsy result. The success rate of the fine needle biopsy results was 95.9% for the benign final biopsy and 28% for the malignant final biopsy. Of the malignant final biopsy reports, 84.6% were papillary carcinomas, 7.7% were follicular carcinomas, and 7.7% were medullary carcinomas. The relationship between the sonographic results, FNA, and histopathological findings of surgical thyroid diseases is validated. The sonographic findings are specific for diagnosing benignity and malignancy. A fine needle biopsy is useful for diagnosing benignity, and the final biopsy is the standard for confirming both benign and malignant pathologies.

Supplemental Optoacoustic Imaging of Breast Masses: A Cost-Effectiveness Analysis

To evaluate the cost-effectiveness of utilizing supplemental optoacoustic ultrasound (OA/US) versus gray-scale ultrasound (US) alone to differentiate benign and malignant breast masses in a diagnostic setting. We created a decision-tree model to compare the cost-effectiveness of OA/US and US from the perspective of the UShealthcare system. We utilized diagnostic test performance parameters from the PIONEER-01(NCT01943916) clinical trial and cost parameters (USD) from the Truven Health MarketScanDatabases. Utility (quality adjusted life year,QALY) values were determined following published patient-reported outcomes. Cost-effectiveness was calculated through incremental cost-effectiveness ratio (USD/QALY, ICER) and net monetary benefit (NMB) in a Markov chain model. Deterministic and probabilistic sensitivity analyses were performed to determine the significance of variation in input parameters. A willingness-to-pay (WTP) threshold of $100,000/QALY was used for the study. OA/US had an estimated cumulative cost of $16,617.36 and the outcome of 16.85 QALYs in the 25-year period. The incremental NMB for OA/US was $1495.36, and the ICER was -$31,715.82/QALY, indicating that supplemental use of OA/US was more cost-effective than US alone. In the deterministic sensitivity analysis, when the cost of OA/US exceeded $1030.61 or the sensitivity of OA/US fell below 79.7%, or the specificity fell below 30.5%, the US alone strategy yielded higher NMB values compared to supplemental OA/US. According to probabilistic sensitivity analysis, OA/US was the better strategy in 98.69% of 10,000 iterations. OA/US is more cost-effective than US to differentiate benign or malignant breast masses in the diagnostic setting. It can reduce costs while improving patients' quality of life, primarily by reducing false-positive results with consequent benign biopsies.

Effect of Benign Biopsy Findings on an Artificial Intelligence–Based Cancer Detector in Screening Mammography: Retrospective Case-Control Study

Background Artificial intelligence (AI)–based cancer detectors (CAD) for mammography are starting to be used for breast cancer screening in radiology departments. It is important to understand how AI CAD systems react to benign lesions, especially those that have been subjected to biopsy. Objective Our goal was to corroborate the hypothesis that women with previous benign biopsy and cytology assessments would subsequently present increased AI CAD abnormality scores even though they remained healthy. Methods This is a retrospective study applying a commercial AI CAD system (Insight MMG, version 1.1.4.3; Lunit Inc) to a cancer-enriched mammography screening data set of 10,889 women (median age 56, range 40-74 years). The AI CAD generated a continuous prediction score for tumor suspicion between 0.00 and 1.00, where 1.00 represented the highest level of suspicion. A binary read (flagged or not flagged) was defined on the basis of a predetermined cutoff threshold (0.40). The flagged median and proportion of AI scores were calculated for women who were healthy, those who had a benign biopsy finding, and those who were diagnosed with breast cancer. For women with a benign biopsy finding, the interval between mammography and the biopsy was used for stratification of AI scores. The effect of increasing age was examined using subgroup analysis and regression modeling. Results Of a total of 10,889 women, 234 had a benign biopsy finding before or after screening. The proportions of flagged healthy women were 3.5%, 11%, and 84% for healthy women without a benign biopsy finding, those with a benign biopsy finding, and women with breast cancer, respectively (P&lt;.001). For the 8307 women with complete information, radiologist 1, radiologist 2, and the AI CAD system flagged 8.5%, 6.8%, and 8.5% of examinations of women who had a prior benign biopsy finding. The AI score correlated only with increasing age of the women in the cancer group (P=.01). Conclusions Compared to healthy women without a biopsy, the examined AI CAD system flagged a much larger proportion of women who had or would have a benign biopsy finding based on a radiologist’s decision. However, the flagging rate was not higher than that for radiologists. Further research should be focused on training the AI CAD system taking prior biopsy information into account.

Evaluation of standard breast ultrasonography by adding two-dimensional and three-dimensional shear wave elastography: a prospective, multicenter trial

ObjectiveTo reduce the number of biopsies performed on benign breast lesions categorized as BI-RADS 4–5, we investigated the diagnostic performance of combined two-dimensional and three-dimensional shear wave elastography (2D + 3D SWE) with standard breast ultrasonography (US) for the BI-RADS assessment of breast lesions.MethodsA total of 897 breast lesions, categorized as BI-RADS 3–5, were subjected to standard breast US and supplemented by 2D SWE only and 2D + 3D SWE analysis. Based on the malignancy rate of less than 2% for BI-RADS 3, lesions assessed by standard breast US were reclassified with SWE assessment.ResultsAfter standard breast US evaluation, 268 (46.1%) participants underwent benign biopsies in BI-RADS 4–5 lesions. By using separated cutoffs for upstaging BI-RADS 3 at 120 kPa and downstaging BI-RADS 4a at 90 kPa in 2D + 3D SWE reclassification, 123 (21.2%) participants underwent benign biopsy, resulting in a 54.1% reduction (123 versus 268).ConclusionCombining 2D + 3D SWE with standard breast US for reclassification of BI-RADS lesions may achieve a reduction in benign biopsies in BI-RADS 4–5 lesions without sacrificing sensitivity unacceptably.Clinical relevance statementCombining 2D + 3D SWE with US effectively reduces benign biopsies in breast lesions with categories 4–5, potentially improving diagnostic accuracy of BI-RADS assessment for patients with breast lesions.Trial registrationChiCTR1900026556Key Points• Reduce benign biopsy is necessary in breast lesions with BI-RADS 4–5 category.• A reduction of 54.1% on benign biopsies in BI-RADS 4–5 lesions was achieved using 2D + 3D SWE reclassification.• Adding 2D + 3D SWE to standard breast US improved the diagnostic performance of BI-RADS assessment on breast lesions: specificity increased from 54 to 79%, and PPV increased from 54 to 71%, with slight loss in sensitivity (97.2% versus 98.7%) and NPV (98.1% versus 98.7%).

259 Avoiding Face-to-Face Appointments Following Benign Breast Biopsies: Improving The Patient Experience Without Compromising Safety

Abstract Aim Minimising face to face (F2F) contact can reduce the costs of outpatient clinics and increase patient satisfaction. Patients undergoing biopsy for suspected benign disease need discussing at an MDT meeting as per national guidelines, however, the majority of these do not need further treatment. We aimed to assess the utility and safety of managing patients without a further F2F appointment following benign MDT discussion. Method A retrospective case-note review was performed on 100 patients discussed at the benign biopsy MDT between June and August 2020. Clinicopathological data was collected on presenting symptoms, histopathology, management, and subsequent requirement for F2F appointment. Results Median age was 43 years (range 25-88). Eighty-one patients (81%) presented with a lump or nipple discharge. The final diagnosis was normal in 22(22%) patients, a diagnosis of fibroadenoma in 35(35%), a B3 lesion in 8 (8%) patients and another benign diagnosis in the remaining 35(35%) patients. Sixteen (16%) patients required surgery or vacuum-assisted-Biopsy, 18(18%) required further clinical or radiology follow up and 66(66%) were reassured and discharged. Forty-three (43%) patients were informed of the MDT plan by letter and 42(42%) by telephone. There were no malignancies identified in any patients. Fourteen (14%) patients required a F2F appointment most commonly because of further clinical review, patient request or interpreter requirements. Conclusions The vast majority of patients undergoing benign biopsy can avoid a further F2F appointment, even if further biopsies or intervention is needed. This can reduce the burden on outpatient clinics whilst improving patient convenience.

Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood.

This study aimed to explore the benefits of theranostic robot-assisted radical prostatectomy (T-RARP) for clinically highly suspicious prostate cancer (PCa) without proven biopsies. Between February 2016 and December 2020, we included men with clinically highly suspicious PCa in this study. They were assessed to have possible localized PCa without any initial treatments, and were categorized into previous benign biopsies or without biopsies. Furthermore, another group of malignant biopsies with RARP in the same time frame was adopted as the control group. The endpoints were to compare the oncological outcome and functional outcome between malignant biopsies with RARP and T-RARP. p < 0.05 was considered to be significant. We included 164 men with proven malignant biopsies treated with RARP as the control group. For T-RARP, we included 192 men. Among them, 129 were preoperatively benign biopsies, and 63 had no biopsies before T-RARP. Approximately 75% of men in the T-RARP group had malignant pathology in their final reports, and the other 25% had benign pathology. T-RARP provides several oncological advantages, such as a higher initial pathological T stage, lower Gleason grade, and lower odds of positive surgical margins. However, the biochemical recurrence rates were not significantly decreased. From our cohort, T-RARP (odds ratio with 95% confidence interval; erectile recovery: 3.19 (1.84-5.52), p < 0.001; continence recovery: 2.25 (1.46-3.48), p < 0.001) could result in better recovery of functional outcomes than malignant biopsies with RARP. For clinically highly suspicious PCa, T-RARP was able to detect around 75% of PCa cases and preserved their functional outcomes maximally. However, in 25% of men with benign pathology, approximately 6% would have incontinence and 10% would have erectile impairment. This part should be sufficiently informed of the potential groups considering T-RARP.

Diagnostic accuracy of intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) MRI to differentiate benign from malignant breast lesions: A systematic review and meta-analysis

PurposeMagnetic resonance imaging (MRI) can reduce the need for unnecessary invasive diagnostic tests by nearly half. In this meta-analysis, we investigated the diagnostic accuracy of intravoxel incoherent motion modeling (IVIM) and dynamic contrast-enhanced (DCE) MRI in differentiating benign from malignant breast lesions. MethodWe systematically searched PubMed, EMBASE, and Scopus. We included English articles reporting diagnostic accuracy for both sequences in differentiating benign from malignant breast lesions. Articles were assessed by quality assessment of diagnostic accuracy studies-2 (QUADAS-2) questionnaire. We used a bivariate effects model for standardized mean difference (SMD) analysis and diagnostic test accuracy analysis. ResultsTen studies with 537 patients and 707 (435 malignant and 272 benign) lesions were included. The D, f, Ktrans, and Kep mean values significantly differ between benign and malignant lesions. The pooled sensitivity (95 % confidence interval) and specificity were 86.2 % (77.9 %–91.7 %) and 70.3 % (56.5 %–81.1 %) for IVIM, and 93.8 % (85.3 %–97.5 %) and 68.1 % (52.7 %–80.4 %) for DCE, respectively. Combined IVIM and DCE depicted the highest area under the curve of 0.94, with a sensitivity and specificity of 91.8 % (82.8 %–96.3 %) and 87.6 % (73.8 %–94.7 %), respectively. ConclusionsCombined IVIM and DCE had the highest diagnostic accuracy, and multiparametric MRI may help reduce unnecessary benign breast biopsy.

Host, reproductive, and lifestyle factors in relation to quantitative histologic metrics of the normal breast

BackgroundEmerging data indicate that variations in quantitative epithelial and stromal tissue composition and their relative abundance in benign breast biopsies independently impact risk of future invasive breast cancer. To gain further insights into breast cancer etiopathogenesis, we investigated associations between epidemiological factors and quantitative tissue composition metrics of the normal breast.MethodsThe study participants were 4108 healthy women ages 18–75 years who voluntarily donated breast tissue to the US-based Susan G. Komen Tissue Bank (KTB; 2008–2019). Using high-accuracy machine learning algorithms, we quantified the percentage of epithelial, stromal, adipose, and fibroglandular tissue, as well as the proportion of fibroglandular tissue that is epithelium relative to stroma (i.e., epithelium-to-stroma proportion, ESP) on digitized hematoxylin and eosin (H&E)-stained normal breast biopsy specimens. Data on epidemiological factors were obtained from participants using a detailed questionnaire administered at the time of tissue donation. Associations between epidemiological factors and square root transformed tissue metrics were investigated using multivariable linear regression models.ResultsWith increasing age, the amount of stromal, epithelial, and fibroglandular tissue declined and adipose tissue increased, while that of ESP demonstrated a bimodal pattern. Several epidemiological factors were associated with individual tissue composition metrics, impacting ESP as a result. Compared with premenopausal women, postmenopausal women had lower ESP [β (95% Confidence Interval (CI)) = −0.28 (− 0.43, − 0.13); P < 0.001] with ESP peaks at 30–40 years and 60–70 years among pre- and postmenopausal women, respectively. Pregnancy [β (95%CI) vs nulligravid = 0.19 (0.08, 0.30); P < 0.001] and increasing number of live births (P-trend < 0.001) were positively associated with ESP, while breastfeeding was inversely associated with ESP [β (95%CI) vs no breastfeeding = −0.15 (− 0.29, − 0.01); P = 0.036]. A positive family history of breast cancer (FHBC) [β (95%CI) vs no FHBC = 0.14 (0.02–0.26); P = 0.02], being overweight or obese [β (95%CI) vs normal weight = 0.18 (0.06–0.30); P = 0.004 and 0.32 (0.21–0.44); P < 0.001, respectively], and Black race [β (95%CI) vs White = 0.12 (− 0.005, 0.25); P = 0.06] were positively associated with ESP.ConclusionOur findings revealed that cumulative exposure to etiological factors over the lifespan impacts normal breast tissue composition metrics, individually or jointly, to alter their dynamic equilibrium, with potential implications for breast cancer susceptibility and tumor etiologic heterogeneity.