Benign Lesions Research Articles

Microwave ablation: a technical and clinical comparison to other thermal ablation modalities to treat benign and malignant thyroid nodules.

Microwave ablation (MWA) is a novel modality for thermal ablation (TA) to treat benign and malignant thyroid nodules, mostly papillary thyroid cancer (PTC). Compared to surgery, TA is less invasive and less painful, has faster recovery, better cosmetic outcomes, and fewer complications. TA techniques have been evolving over the past decade to be more energy efficient, precise, and produce long-lasting results. The general approach is similar between various TA techniques. However, each technique has uniqueness in its energy delivery and, thus, risk profile and outcomes. MWA has a few critical technical differences that make it safer for patients with surgical implants and cardiac comorbidities. It has proven effective in treating benign thyroid nodules (BTNs) in adults and pediatric populations with benign and malignant lesions. The clinical and theoretical outcomes of MWA compared to other thermal ablative techniques, such as radiofrequency ablation (RFA) and laser ablation (LA), have been investigated in some studies and meta-analyses. Minimally invasive procedures such as MWA are an important tool for the management of thyroid lesions. Thus, it is crucial for clinicians to be equipped with the knowledge to use these tools. In this review, we provide a clinical review detailing the technical differences and clinical outcomes for the three major TA techniques-MWA, RFA, and LA.

Intramuscular ganglionic cyst in the extensor digitorum longus muscle of the leg: A case report and review of literature

Ganglionic cysts are benign soft-tissue lesions with unclear etiology and pathogenesis commonly occurring on the wrists and hands. Although their diagnosis and management in these characteristic locations are easy, rare occurrences in atypical locations are difficult to diagnose. Ultrasonography and magnetic resonance imaging (MRI) are helpful in diagnosing and differentiating a ganglionic cyst from other soft-tissue lesions. Here, we report a case of 60-year-old male patient with intramuscular ganglionic cyst, measuring 68×41×48 mm, arising in the extensor digitorum muscle of the left leg, which was diagnosed using MRI and treated using excision and biopsy.

YOLO-based thyroid ultrasound for assisted diagnosis

Abstract Real-time intelligent diagnosis of thyroid ultrasound images using deep learning techniques can mitigate the impact of human subjective factors on diagnostic outcomes. Three thousand and fifty-five thyroid ultrasound images were acquired from 205 selected patients aged 10 to 77 years who underwent ultrasound examinations between 2019 and 2023. Each image contained at least one area of thyroid nodules, totaling 3, 088 nodules, including 1, 752 benign and 1, 336 malignant nodules. YOLOV8 is the baseline model for developing an end-to-end architecture for thyroid nodule detection. This architecture automatically identifies nodule lesions in ultrasound images, classifies them as benign or malignant, and enables real-time detection in video frames. The experimental results on 611 clinical thyroid ultrasound images demonstrate that our method can accurately diagnose benign and malignant nodal lesions in thyroid ultrasound with 88.1% and 84.6% accuracy, respectively. The mean average accuracy is as high as 91.1%, indicating a 5.1% improvement compared to the baseline model.

Skin Biopsies and Diagnostic Outcomes at a Multisite Family Medicine Residency Network.

Physicians other than dermatologists evaluate nearly 60% of all skin diseases, and 22% of these physicians are family physicians. Dermatology education is therefore an important aspect of Family Medicine training. Dermatologic procedural training in Family Medicine residency is not standardized, however, so family physicians graduate with highly variable skills. This study describes the scope and diagnostic outcomes of skin biopsies performed by residents at a multisite Family Medicine residency network in comparison with those performed by attendings at a Family Medicine faculty community practice. We performed a retrospective chart review of patients evaluated at eight Family Medicine residency training sites and one Family Medicine faculty community practice within a regional academic health system between January 2020 and October 2022. Patients with a skin finding who underwent at least one skin biopsy during their visit were included in the study. Among all of the skin findings, the incidence of skin biopsy was 3.6% (258/7104) for residents and 1.8% (175/9917) for attendings (P < 0.001). Family Medicine residents performed fewer shave biopsies (57.8% vs 77.7%, P < 0.001) and more punch biopsies (25.6% vs 11.4%, P < 0.001) compared with attendings. Most biopsies performed by residents and attendings were benign, although residents biopsied significantly more benign (79.1% vs 64.6%, P < 0.001) and malignant lesions (11.2% vs 5.7%, P = 0.049). Attendings biopsied significantly more low-to-moderate-grade dysplastic (22.3% vs 5.0%, P < 0.001) and high-grade atypical lesions (4.0% vs 0.8%, P = 0.034). Family Medicine residents at this residency network receive training in a variety of skin biopsy types. Distinct skin biopsy practices and outcomes between residents and attendings may reflect differences in patient populations, clinical expertise, and dermatology referral patterns.

Machine learning-based discrimination of benign and malignant breast lesions on US: The contribution of shear-wave elastography

PurposeTo build and validate a combined radiomics and machine learning (ML) approach using B-mode US and SWE images to differentiate benign from malignant solid breast lesions (BLs) and compare its performance with that of an expert radiologist. MethodsPatients with at least one BI-RADS 2–6 BL who performed breast US integrated with SWE were retrospectively included. B-mode US and SWE images were manually segmented to extract radiomics features. A multi-step feature selection process was performed and a predictive model built using the Logistic Regression algorithm. The diagnostic accuracy was evaluated with the AUC and Matthews Correlation Coefficient (MCC) metrics. The performance of the ML classifier was compared to that of an expert radiologist. Results427 Bls were included and divided into a training (286 BLs, of which 127 benign and 159 malignant) and a test set (141 BLs, of which 59 benign and 82 malignant). Of 1098 features extracted from B-mode US and SWE images, 13 were finally selected. The ML classifier showed an AUC of 0.768 and 0.746, and an MCC of 0.403 and 0.423 in the training and test sets, respectively. The performance was higher than that of the expert radiologist assessing only B-mode US images, but significantly lower when SWE images were also provided. ConclusionA ML approach based on B-mode US and SWE images may represent a potential tool in the characterization of BLs. SWE still gives its most relevant contribution in the clinical setting rather than included in a radiomics pipeline.

A combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound in the Kupffer phase for the diagnosis of well-differentiated hepatocellular carcinoma and atypical focal liver lesions: a prospective, multicenter study.

The objective of this study was to develop a combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound (CEUS) during the Kupffer phase and to evaluate its value in differentiating well-differentiated hepatocellular carcinoma (w-HCC) from atypical benign focal liver lesions (FLLs). A total of 116 patients with preoperatively Sonazoid-CEUS confirmed w-HCC or benign FLL were selected from a prospective multiple study on the clinical application of Sonazoid in FLLs conducted from August 2020 to March 2021. According to the randomization principle, the patients were divided into a training cohort and a test cohort in a 7:3 ratio. Seventy-nine patients were used for establishing and training the radiomics model and combined model. In comparison, 37 patients were used for validating and comparing the performance of the models. The diagnostic efficacy of the models for w-HCC and atypical benign FLLs was evaluated using ROCs curves and decision curves. A combined model nomogram was created to assess its value in reducing unnecessary biopsies. Among the patients, there were 55 cases of w-HCC and 61 cases of atypical benign FLLs, including 28 cases of early liver abscess, 16 cases of atypical hepatic hemangioma, 8 cases of hepatocellular dysplastic nodules (DN), and 9 cases of focal nodular hyperplasia (FNH). The radiomics model and combined model we established had AUCs of 0.905 and 0.951, respectively, in the training cohort, and the AUCs of the two models in the test cohort were 0.826 and 0.912, respectively. The combined model outperformed the radiomics feature model significantly. Decision curve analysis demonstrated that the combined model achieved a higher net benefit within a specific threshold probability range (0.25 to 1.00). A nomogram of the combined model was developed. The combined model based on the radiomics features of Sonazoid-CEUS in the Kupffer phase showed satisfactory performance in diagnosing w-HCC and atypical benign FLLs. It can assist clinicians in timely detecting malignant FLLs and reducing unnecessary biopsies for benign diseases.

Can artificial intelligence aid the urologists in detecting bladder cancer?

ABSTRACT Introduction: The emergence of artificial intelligence (AI)-based support system endoscopy, including cystoscopy, has shown promising results by training deep learning algorithms with large datasets of images and videos. This AI-aided cystoscopy has the potential to significantly transform the urological practice by assisting the urologists in identifying malignant areas, especially considering the diverse appearance of these lesions. Methods: Four databases, the PubMed, ProQuest, EBSCOHost, and ScienceDirect were searched, along with a manual hand search. Prospective and retrospective studies, experimental studies, cross-sectional studies, and case–control studies assessing the utilization of AI for the detection of bladder cancer through cystoscopy and comparing with the histopathology results as the reference standard were included. The following terms and their variants were used: “artificial intelligence,” “cystoscopy,” and “bladder cancer.” The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A random effects model was used to calculate the pooled sensitivity and specificity. The Moses–Littenberg model was used to derive the Summary Receiver Operating Characteristics (SROC) curve. Results: Five studies were selected for the analysis. Pooled sensitivity and specificity were 0.953 (95% confidence interval [CI]: 0.908–0.976) and 0.957 (95% CI: 0.923–0.977), respectively. Pooled diagnostic odd ratio was 449.79 (95% CI: 12.42–887.17). SROC curve (area under the curve: 0.988, 95% CI: 0.982–0.994) indicated a strong discriminating power of AI-aided cystoscopy in differentiation normal or benign bladder lesions from the malignant ones. Conclusions: Although the utilization of AI for aiding in the detection of bladder cancer through cystoscopy remains questionable, it has shown encouraging potential for enhancing the detection rates. Future studies should concentrate on identification of the patients groups which could derive maximum benefit from accurate identification of the bladder cancer, such as those with intermediate or high-risk invasive tumors.

Atypical presentation of Kaposi sarcoma in an HIV-negative patient: a case report and comprehensive literature review

Introduction: Kaposi’s sarcoma (KS) is a systemic disease that is marked by the presence of neoplastic lesions caused by Human Herpesvirus-8 (HHV-8) infections. KS usually impacts people with weakened immune systems, although there have been a few cases of it occurring in individuals with normal immune function. Medical records and histopathological slides of the case were retrospectively reviewed. This work has been reported based on SCARE criteria {1} . Case presentation: A 51-year-old man from Palestine came in with a single, painless, purple growth on his left forearm that had been growing quickly for six months. The patient did not have a history of using immunosuppressants, HIV infection, or engaging in unconventional sexual practices. Histopathological examination confirmed nodular-stage KS, with positive HHV-8 immunostain. The lesion was excised without complications, and the patient remains under periodic follow-up. Discussion: KS typically manifests with multiple lesions in individuals with weakened immune systems. This case showcases a unique presentation in a patient with a strong immune system and no notable risk factors. Histopathological confirmation is necessary to differentiate between benign and infectious vascular lesions when considering the diagnosis of KS. The treatment approaches can differ depending on the extent of the lesion and the condition of the patient. Conclusion: this case emphasizes the significance of considering KS as a potential cause for solitary vascular lesions, even in people who have a healthy immune system. It also emphasizes the need for a comprehensive diagnostic evaluation and personalized management.

The efficacy, safety, and related factors of bronchial artery embolization for hemoptysis: a systematic review and meta-analysis with subgroup analysis.

Bronchial artery embolization (BAE) is a common and important way to manage hemoptysis. This study's purpose was to summarize the efficacy, safety, and related factors of BAE in the treatment of hemoptysis. From January 2010 to August 2023, a systematic literature search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Library databases. Original studies with BAE for hemoptysis were included, with no restrictions on language. The outcomes of interest were technical success rate, clinical success rate, recurrence rate, mortality rate, and major complication rate. Pooled proportions with 95% confidence intervals (CIs) were calculated using random-effects models. The Newcastle-Ottawa Scale (NOS) was employed for quality assessment. Factors such as publication year, region, sample size, amount of hemoptysis, etiology, and embolization materials were extracted for subgroup analyses. Additionally, sensitivity analyses and test for publication bias were conducted. A total of 32 studies, including 6,032 patients, met our inclusion criteria. 27 studies were of high quality, while five of moderate quality. The results indicated the prevalence of technical success was 97.2% (95% CI: 95.1-98.8%) and 93.2% (95% CI: 90.3-95.7%) in clinical success. Hemoptysis recurrence and mortality rates after BAE were 24.8% (95% CI: 20.5-29.4%) and 2.3% (95% CI: 1.1-3.8%), respectively. Moreover, the pooled prevalence of major complication was 0.1% (95% CI: 0.0-0.4%). Subgroup analysis revealed that studies published after 2017 demonstrated a higher technical success rate and a lower recurrence rate. Massive hemoptysis showed a higher technical success rate but a lower clinical success rate. BAE also demonstrated superior efficacy in patients with bronchiectasis. The clinical success rate was significantly higher in patients with benign diseases than those with malignancies. Gelatin sponge (GS) showed poor embolization efficacy. N-butyl-2-cyanoacrylate (NBCA) and coils exhibited reduced recurrence rates, while NBCA displayed an even lower recurrence rate than non-absorbable particles. The study by Ishikawa et al. influenced the stability of the pooled major complication rate, and the sensitivity analysis confirmed the robustness of the remaining results. BAE is safe and effective in treating different degrees of hemoptysis caused by benign and malignant lesions. Promising clinical efficacy was observed with NBCA as an embolic material for the treatment of hemoptysis. However, further conclusions should be investigated using evidence-based medicine.

Intraoperative Molecular Imaging with Pafolacianine in Resection of Occult Pulmonary Malignancy in the ELUCIDATE trial

Clinical studies have demonstrated that intraoperative molecular imaging (IMI) with pafolacianine identifies occult pulmonary lesions that are not identified by preoperative CT or by intraoperative inspection techniques in ∼20% of patients. In this study we provide a description of occult lesion clinical data and evaluate characteristics so that surgeons can better incorporate this emerging technology into clinical decision making. Participants (n=100) enrolled in a Phase 3 trial of IMI with pafolacianine during pulmonary resection (ELUCIDATE, NCT04241315) were identified. Participants underwent preoperative computed tomography (CT)with 1.25mm slices. Variables and lesion characteristics were analyzed. Positive predictive value and false positive rates were tabulated for IMI fluorescent lesions with predictors of malignant versus benign occult lesions described. IMI identified 29 occult lesions in 23 (23%) participants. Seventeen of 29 (58%) lesions were identified within the same lobe as known lesions; 12 of 29 (42%) identified in a different lobe from the suspicious nodule known by preoperative assessment. Twenty-three of 29 (79%) of occult lesions found by IMI were resected with an additional wedge resection. Ten of 29 (34%) lesions identified by IMI were malignant. There was no additional morbidity in participants with lesions resected. With pafolacianine, 7 participants had a synchronous primary stage I lung cancer identified and one subject had additional metastases identified. . IMI with pafolacianine identifies occult malignant lesions during pulmonary resection despite thorough preoperative imaging and intraoperative assessment by experienced surgeons.

Circulating exosomal PCAT1 as a complement of carcinoembryonic antigen for early colorectal cancer diagnosis

BackgroundsGiven the global prevalence of colorectal cancer (CRC), advancements in prompt and accurate diagnosis are crucial. Long non-coding RNAs (lncRNAs) in serum exosomes are emerging as potential diagnostic biomarkers. This study evaluated the feasibility of using serum exosomal lncRNAs for early-stage CRC diagnosis in clinical practice. MethodsCandidate serum exosomal lncRNAs were identified through an integrated analysis of two GEO datasets (GSE100206 and GSE100063) containing non-coding RNA expression profiles in serum exosomes. Exosomes isolated from participants' serum were validated using transmission electron microscopy (TEM) and immunoblotting. The expression levels of serum exosomal PCAT1 were measured by quantitative real-time polymerase chain reaction (qRT-PCR). Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis. ResultsSerum exosomal PCAT1 levels were evaluated in 150 CRC patients, 66 patients with benign colorectal lesions, and 128 healthy controls. ROC analysis demonstrated high diagnostic efficacy of serum exosomal PCAT1 for CRC. Notably, the predictive performance was sufficient to distinguish early-stage CRC patients. Additionally, the diagnostic value was significant for CRC patients with low serum carcinoembryonic antigen (CEA) levels. Measuring serum exosomal PCAT1 could complement CEA assessment, enhancing CRC diagnostic accuracy. ConclusionsSerum exosomal PCAT1 can complement CEA assessment, aiding in early CRC diagnosis and helping to differentiate the disease, especially in patients with low CEA levels.

SOFT TISSUE TUMORS OF THE LOWER LEG, FOOT AND ANKLE: A CROSS-SECTIONAL OBSERVATIONAL STUDY ANALYSING 376 CASES

Fewer than 5 % of soft tissue sarcomas arise in the foot and ankle. It can be difficult to distinguish between benign and malignant lesions which leads to a delay in diagnosis. Initial inappropriate procedures limit options for limb salvage and increasing rates of local recurrence. Our aim is to improve understanding of the presentation and management of these rare tumors to reduce delays in diagnosis and decrease the occurrence of inappropriate or unwarranted procedures. A prospectively maintained database of 376 new referrals to the West of Scotland regional musculoskeletal oncology service for soft tissue lesions of the foot, ankle, and lower leg over a 10-year period was analysed retrospectively. An assessment was made of patient demographics, presentation, anatomical location, diagnosis, classification, management, and outcomes for all patients. Of all new referrals, 53.5 % were diagnosed with primary benign soft tissue tumors and 16 % with primary malignant soft tissue tumors. The most common primary benign tumor in our population was schwannoma (15.9 %) and primary malignant tumor was undifferentiated sarcoma (26.7 %). In the foot alone, soft tissue sarcomas most commonly occurred in the forefoot (44.4 %). The most common presenting complaints were rest pain and focal swelling. Symptoms were present for on average 7 months prior to referral. Death from disease in sarcomas was 41.7 % over a 10 year follow up period, higher than other body areas. Soft tissue sarcomas in the foot and ankle remain a diagnostic challenge. Local biopsies should only be performed following discussion with an oncology surgeon. We have provided a management protocol in order to reduce the number of inappropriate procedures performed in this group and expedite referral to specialist centres, optimising clinical outcomes and reducing the cost of litigation to healthcare services.

Benign breast tumors may arise on different immunological backgrounds.

Benign breast tumors are a nonthreatening condition defined as abnormal cell growth within the breast without the ability to invade nearby tissue. However, benign lesions hold valuable biological information that can lead us toward better understanding of tumor biology. In this study, we have used two pathway analysis algorithms, Pathifier and gene set variation analysis (GSVA), to identify biological differences between normal breast tissue, benign tumors and malignant tumors in our clinical dataset. Our results revealed that one-third of all pathways that were significantly different between benign and malignant tumors were immune-related pathways, and 227 of them were validated by both methods and in the METABRIC dataset. Furthermore, five of these pathways (all including genes involved in cytokine and interferon signaling) were related to overall survival in cancer patients in both datasets. The cellular moieties that contribute to immune differences in malignant and benign tumors were analyzed using the deconvolution tool, CIBERSORT. The results showed that levels of some immune cells were specifically higher in benign than in malignant tumors, and this was especially the case for resting dendritic cells and follicular T-helper cells. Understanding the distinct immune profiles of benign and malignant breast tumors may aid in developing noninvasive diagnostic methods to differentiate between them in the future.

Machine learning models based on CT radiomics features for distinguishing benign and malignant vertebral compression fractures in patients with malignant tumors.

Radiomics has become an important tool for distinguishing benign and malignant vertebral compression fractures (VCFs). It is more clinically significant to concentrate on patients who have malignant tumors and differentiate between benign and malignant VCFs. To explore the value of multiple machine learning (ML) models based on CT radiomics features for differentiating benign and malignant VCFs in patients with malignant tumors. This study retrospectively analyzed 78 patients with malignant tumors accompanied by VCFs, 45 patients with benign VCFs, and 33 patients with malignant VCFs. A total of 140 lesions (86 benign lesions, 54 malignant lesions) were ultimately included in this study. All patients were divided into training sets (n = 98) and validation sets (n = 42) according to the 7:3 ratio. The radiomics features were screened and dimensioned, and multiple radiomics ML models were constructed. The receiver operating characteristic (ROC) curve was performed to assess the diagnostic performance. Five radiomics features were included in the model. All the ML models built have good diagnostic efficiency, among which the support vector machine (SVM) model performs better. The area under the curve (AUC), sensitivity, specificity, and accuracy in the training set were 0.908, 0.816, 0.883, and 0.857, respectively, while those in the validation set were 0.911, 0.647, 0.92, and 0.81, respectively. A variety of ML models built based on CT radiomics features have good value for differentiating benign and malignant VCFs in malignant tumor patients, and the SVM model has a better performance.

Evaluation of GARP immunohistochemical expression in papillary thyroid carcinoma

BackgroundGlycoprotein A repetitions predominant (GARP) is a novel transmembrane protein highly expressed on the surface of regulatory T cells (Tregs), which are a subset of immunosuppressive T lymphocytes that play a major role in inhibiting the antitumor immune response. Many studies documented increased GARP expression in various tumors, which is related to a poorer prognosis, and only one single paper investigated its expression in thyroid tumors.AimTo evaluate the immunohistochemical expression of GARP in differentiated thyroid carcinomas and their tumor-infiltrating lymphocytes (TILs) in comparison to its expression in other benign and low-risk lesions.MethodsSixty-nine cases of different thyroid lesions were subgrouped into 37 cases of malignant thyroid neoplasms, 25 cases of benign thyroid lesions, and 7 cases of low-risk neoplasms collected from the Pathology Department Laboratories of Ain Shams University Hospitals during the period from January 2017 to December 2021 and stained immunohistochemically for GARP. Immunohistochemical (IHC) results were evaluated in thyroid epithelial cells and TILs. The expression of GARP was correlated with the different clinicopathological parameters.ResultsGARP expression discloses a significant statistical difference between the three studied groups (P < 0.001). High GARP expression was detected in 89.19% of the malignant cases and in 28.57% of low-risk neoplasms, while all benign lesions exhibited low GARP expression. High GARP expression of TILs was detected in 60% of the malignant cases. Synchronous high GARP expression in tumor tissue and in the surrounding TILs was detected in 63.16% of the malignant cases, yet these results did not reach statistical significance.ConclusionGARP is a marker of Tregs, whose high expression is increased in malignant over benign and low-risk lesions. It might be a potential novel target for anticancer immunotherapy.

Psammoma bodies in thyroid: are they always indicative of malignancy? A multi-institutional study.

Traditionally, psammoma bodies (PB) have been considered as tale-tell evidence of papillary thyroid carcinoma (PTC) and are frequently encountered in classic and other subtypes of PTCs. However, the presence of PBs in the thyroid gland does not always indicate malignancy. The leading hypothesis on their origin suggests that PB are remnants of papillary structures that have undergone thrombosis, necrosis, and subsequent calcification. From January 2010 to May 2024, 26 patients with psammoma bodies associated with benign thyroid lesions, mainly thyroid follicular nodular disease (TFND), Hashimoto thyroiditis (HT), Graves' disease, and follicular adenomas, were found. The case cohort included 16 females and 10 males with a median age of 49.3years. The series included 12 TFND, two HT, and 12 follicular adenomas (11 out of 12 were oncocytic adenomas). Twenty-four out of 26 underwent total thyroidectomy. In 24 out of 26 cases, the entire lobes and parenchyma were included and serial cuts at multiple levels were performed in cases with PB but without any evidence of malignancy. Even though the detection of PB is associated with a malignant thyroid lesion, especially PTC and its subtypes, our multi-institutional series showed that in a minority PB can be found in a variety of benign thyroid lesions. Evaluation of the entire thyroid parenchyma at multiple levels is mandatory to exclude sub-centimeter papillary thyroid carcinoma.

Case report of a rare benign breast lesion: Unveiling nipple adenoma

Nipple adenoma is a rare and benign proliferative lesion originating from the lactiferous ducts of the nipple. It predominantly affects middle-aged women and can mimic the clinical and radiological features of more concerning breast malignancies. Due to its uncommon occurrence and overlapping characteristics with malignant lesions, a definitive diagnosis often requires histopathological examination. We present a case of nipple adenoma in a 30-year-old woman, detailing the clinical, radiological, and histopathological features, as well as the management and outcomes.

Reliability, reproducibility, and potential pitfalls of the O-RADS scoring with non-dynamic MRI.

The O-RADS scoring has been proposed to standardize the reporting of adnexal lesions using magnetic resonance imaging (MRI). To assess intra- and inter-observer agreement of the O-RADS scoring using non-dynamic MRI and its agreement with pathologic diagnosis, and to provide the pitfalls in the scoring based on discordant ratings. Adnexal lesions that were diagnosed using non-dynamic MRI at two centers were scored using O-RADS. Intra- and inter-observer agreements were assessed using kappa statistics. Cross-tabulations were made for intra- and inter-observer ratings and for O-RADS scores and pathological findings. Intra- and inter-observer agreements were assessed for 404 lesions in 339 patients who were admitted to center 1. Intra-observer agreement was almost perfect (97.8%, kappa = 0.963) and inter-observer agreement was substantial (83.2%, kappa = 0.730). The combined data from center 1 and center 2 included 496 patients; of them, 295 (59.5%) were operated. There was no borderline or malignant pathology for the lesions with O-RADS 1 or 2. Of those with an O-RADS score of 3, 3 (4.1%) lesions were borderline and none were malignant. The O-RADS scoring in discriminating borderline/malignant lesions from benign lesions was outstanding (area under the ROC curve 0.950, 95% CI = 0.923-0.971). Sensitivity, specificity, positive, and negative predictive values of O-RADS 4/5 lesions for borderline/malignant lesions were 96.2%, 87.1%, 72.8%, and 98.4%, respectively. The O-RADS scoring using non-dynamic MRI is a reproducible method and has good discrimination for borderline/malignant lesions. Potential factors that may lead to discordant ratings are provided here.

Bronchial washing fluid sequencing is useful in the diagnosis of lung cancer with necrotic tumor

BackgroundEarly-stage lung cancers detected by low-dose computed tomography (CT) often require confirmation through invasive procedures due to the absence of endobronchial lesions. This study assesses the diagnostic utility of bronchial washing fluid (BW) sequencing, a less invasive alternative, aiming to identify patient characteristics most suited for this approach. MethodsFrom June 2017 to March 2018, we conducted a prospective cohort study by enrolling patients with incidental lung lesions suspected of early-stage lung cancer at two independent hospitals, and 114 were diagnosed with lung cancer while 50 were diagnosed with benign lesions. BW sequencing was performed using a targeted gene panel, and the clinical characteristics of patients detected with cancer through sequencing were identified. ResultsMalignant cells were detected in 33 patients (28.9 %) through BW cytology. By applying specificity-focused mutation criteria, BW sequencing classified 42 patients (36.8 %) as having cancer. Among the cancer patients who were BW sequencing positive and BW cytology negative, 15 patients (75.0 %) showed necrosis on CT. The sensitivity of BW sequencing was particularly enhanced in patients with necrotic tumors, reaching 75 %. ConclusionsBW sequencing presents a viable, non-invasive diagnostic option for early-stage lung cancer, especially valuable in patients with necrotic lesions. By potentially reducing the reliance on more invasive diagnostic procedures, this method could streamline clinical workflows, decrease patient burden, and improve overall diagnostic efficiency.

Usefulness of intralesional contrast injection as a prebiopsy confirmation technique in a case of breast hemangioma

Hemangiomas are uncommon benign vascular lesions of breast. They have nonspecific imaging features and can be isoechoic or hypoechoic or of heterogeneous echotexture in ultrasound (USG). When isoechoic, it may be difficult to identify these lesions with confidence against a fatty background. Here, we report such a case of a high-density lesion detected in screening mammogram, which was not so obvious in USG. We used the technique of intralesional contrast injection into the probable USG correlate for confirmation, before proceeding with the biopsy and establishing the diagnosis of hemangioma. Thus, this simple prebiopsy confirmation technique helps in identifying the definitive USG correlate, thereby facilitating a USG-guided biopsy. This is very useful, especially in the peripheral healthcare centers where stereotactic facility may not be available. Another learning point from this case is that in case of superficially located lesions that are readily visible in mammogram but less conspicuous in USG, the possibility of hemangioma can be considered in the differentials. This observation has been mentioned in other case reports as well and reiterated in our case. However, due to the nonspecific imaging features and low incidence, it is difficult to make diagnosis of hemangioma without tissue sampling. The imaging features of breast hemangioma in mammogram and ultrasound are reviewed and described in this case report with an emphasis on the role of intralesional contrast injection in lesion localization.