Biopsy Diagnosis Research Articles

Use of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography in diagnosing giant cell arteritis in a Western Australian tertiary centre: a 36-month analysis.

Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) has been established as a beneficial diagnostic tool in large vessel vasculitis. There have been limited studies of its use in real-world clinical practice. We examined patients at Royal Perth Hospital (RPH) with suspected giant cell arteritis (GCA) from January 2019 to 2022 who had 18F-FDG-PET/CT, and analysed its diagnostic accuracy compared to temporal artery biopsy (TAB) and clinical diagnosis at 6 months. Patients referred to RPH Rheumatology with suspected GCA from January 2019 to 2022 were identified as having had 18F-FDG-PET/CT for diagnostic evaluation. 18F-FDG-PET/CT results were dichotomous into positive (consistent with GCA) or negative, and compared to TAB and clinical diagnosis of GCA at 6 months by a consultant rheumatologist. A total of 32 patients had 18F-FDG-PET/CT for diagnostic purposes; nine of 32 18F-FDG-PET/CT scans were positive. Compared to TAB, 18F-FDG-PET/CT had a sensitivity of 50%, a specificity of 93%, a positive predictive value (PPV) of 86%, a negative predictive value (NPV) of 68% and accuracy of 61.5%. Compared to clinical diagnosis, 18F-FDG-PET/CT had a sensitivity of 41%, a specificity of 100%, a PPV of 100%, an NPV of 44% and accuracy of 59.4%. Only one 18F-FDG-PET/CT (11%) had cranial artery involvement. The median time taking glucocorticoids (GCs) was 7 days (interquartile range (IQR) 0-22.5 days) for positive 18F-FDG-PET/CT scans, versus 13 days (IQR 8-39 days) for negative 18F-FDG-PET/CT scans. The median time from request to scan was 29 days (IQR 31.5-77 days) for 18F-FDG-PET/CT on 14 or more days of GCs. 18F-FDG-PET/CT is more likely to be positive if it is performed within 7 days of steroid commencement. 18F-FDG-PET/CT had lower sensitivity and higher specificity than reported in clinical studies. In clinical practice, the significant delays from steroid start to scan time may reduce diagnostic sensitivity. A negative 18F-FDG-PET/CT scan did not negate the need for further investigations.

Diagnostic utility of cell block preparations from liquid-based cytology in cervical lesions: A comparative retrospective analysis

Objective Cervical cancer ranks as the fourth most prevalent cancer among women globally; it originates in the cervix and has a significant association with human papillomavirus (HPV) infection. The purpose of this study was to investigate the diagnostic utility of cell block (CB) preparations from liquid-based cytology samples in identifying cervical lesions among Turkish patients with HPV. This approach was intended to supplement conventional Pap smear tests and HPV testing. Material and Methods A retrospective analysis was conducted on 60 HPV-positive cervical smear samples processed through the ThinPrep Pap test. CBs were prepared from liquid-based residues, stained with hematoxylin and eosin, and analyzed. Cytological diagnoses were compared with histopathological findings from colposcopy-guided biopsies. The relationships between the Pap smear, CB, and biopsy results were statistically analyzed. Results Pap smear cytology identified 1.6%, 16.6%, 43.3%, and 3.3% as high-grade squamous intraepithelial lesion (HSIL), low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells of undetermined significance, and atypical squamous cells - HSIL cannot be excluded + LSIL, respectively. The CB evaluations classified 6.6% of the samples as cervical intraepithelial neoplasia (CIN)1, 1.6% as CIN2, and 1.6% as squamous cell carcinoma (SCC), with 78.3% deemed negative. Histopathological biopsy revealed CIN1 in 11.7%, CIN2 in 1.7%, and CIN3 in 8.3% of the patients. High concordance was observed between the Pap smear and CB diagnoses for negative and low-grade lesions, although discrepancies occurred in higher-grade lesions. HPV testing revealed 65% high-risk positivity, predominantly for HPV16 and HPV18. Significant correlations were found among HPV subtype positivity, CB, and biopsy diagnosis (P < 0.05). Conclusion CB preparations provide enhanced diagnostic accuracy for high-grade lesions and SCC, thus complementing Pap smear cytology and HPV testing. This approach supports their integration into the routine cervical cancer screening protocols in Türkiye. Further global, multicenter studies are recommended to validate these findings.

Nonsclerotic Lichen Sclerosus of Vulva: A Clinicopathologic Analysis.

The International Society of the Study of Vulvovaginal Diseases (ISSVD) recently defined nonsclerotic lichen sclerosus (NSLS) as a scenario wherein the clinical findings are consistent with lichen sclerosus (LS), but no microscopic evidence of dermal sclerosis is found and recognized 4 histologic subcategories. Herein, we present an institutional experience with NSLS, with an emphasis on frequency, application of the ISSVD categories in routine practice, and clinicopathologic correlation. The authors reviewed clinical and pathologic findings for consecutive vulvar biopsies in which LS was a clinical and/or pathologic consideration. Cases were classified as classical/sclerotic LS (CLS), NSLS (per ISSVD criteria), and "unclassified," the latter of which were cases not classifiable as NSLS or CLS, despite a clinical impression or LS or LS being a significant clinical consideration (ie, "clinical LS"). In clinical LS cases, CLS and NSLS were diagnosed histologically in 61% (182/298) and 15% (44/298), respectively, whereas the remainder were histologically unclassified. The latter group was microscopically heterogeneous, devoid of a consistent pathologic profile, and generally showed absence, focality, minimality, ambiguity, or infrequency of features that would have allowed their categorization into one of the NSLS categories. Among the 4 categories for the categorizable NSLS cases, the "lichenoid dermatitis" pattern (61.4%) was the commonest, followed by dermal fibrosis with acanthosis (22.7%), dermal fibrosis without acanthosis (9.1%), and hypertrophic lichenoid dermatitis (6.8%). The clinical response rates to topical therapies for the NSLS and unclassified groups were 71% and 62%, respectively ( P =0.4). Our findings highlight the significance of clinicopathologic correlation in the diagnosis of NSLS. In the setting of clinical LS, some histologic evidence to support that impression is found in most cases when the ISSVD system for diagnosis and classification of biopsies is applied. However, a subset of clinical LS cases are not pathologically classifiable as either CLS or any of the NSLS categories; these display nonspecific histologic features and require future study.

Raman microspectroscopy in the diagnosis of skin malignancies

The development of methods for early diagnosis of tumor diseases of the head and neck is one of the most important areas of biomedicine and healthcare in general. Special attention should be paid to consideration of issues related to the diagnosis of malignant neoplasms of the skin of the head and neck area. In this aspect, confocal Raman microspectroscopy is of interest. To demonstrate the feasibility of using Raman microspectroscopy to differentiate intact skin from malignant skin neoplasms. The study used Raman microspectroscopy with an excitation wavelength of 532 nm to diagnose basal cell carcinoma and squamous cell carcinoma of the skin and differentiate them from intact skin. During the study, spectra of intact skin and skin neoplasms in the head and neck region (basal cell and squamous cell carcinoma of the skin) were obtained. The results of the study can be used in the future for optical biopsy and early diagnosis of tumors.

Clinical application of transvaginal core needle biopsy for pelvic masses under finger guidance via vagino-recto-abdominal examination

Objective: To explore the feasibility of transvaginal core needle biopsy for pelvic masses under finger guidance during a vagino-recto-abdominal examination. Methods: The clinicopathological data and follow-up information of 29 patients with pelvic masses who underwent transvaginal core needle biopsy under finger guidance during a vagino-recto-abdominal examination at Affiliated Hospital of Southwest Medical University from January 2020 to July 2024 were collected, and the safety and diagnostic accuracy of the procedure were retrospectively analyzed. Results: (1) A total of 29 patients with pelvic masses were enrolled in this study, with a median age of 50 years (range: 29-73 years), and a median tumor diameter of 3.9 cm (range: 2.7-13.3 cm). Among these patients, 7 were newly diagnosed, and 22 were follow-up. The pre-procedure disease types included 21 patients (72%, 21/29) cervical cancer, 6 patients (21%, 6/29) epithelial ovarian cancer, and 2 patients (7%, 2/29) other suspected gynecologic tumors. (2) Among 29 patients with pelvic masses, 8 cases (28%, 8/29) were diagnosed with benign diseases according to core needle biopsy pathological findings, and 1 case suggested possible residual cervical cancer in the parametrial region by contrast-enhanced magnetic resonance imaging after radical chemoradiotherapy 3 months, while the result of core needle biopsy for this patient was negative, with follow-up after 1 year revealed progression of the lesion in the right parametrial area. Another patient underwent fine-needle aspiration cytology, which suggested gastrointestinal stromal tumor, requiring differentiation from endometriosis, and core needle biopsy pathology confirmed endometriosis, with follow-up at 6 months revealed no evidence of malignancy in this patient. The remaining 6 patients with benign diagnoses had follow-up periods exceeding 1 year without imaging or clinical evidence of local lesion progression or malignancy. Among the 21 patients (72%, 21/29) diagnosed with malignant tumors by core needle biopsy, 14 cases were suspected cases of residual or recurrent cervical cancer, 6 cases had advanced ovarian cancer, and 1 case had rectal cancer metastasis, with all biopsy diagnoses being consistent with preoperative clinical findings and imaging results. The overall diagnostic accuracy of the core needle biopsy was 97% (28/29). Among the 7 newly diagnosed patients, the diagnostic accuracy was 7/7, while it was 95% (21/22) for the 22 follow-up patients, with no statistically significant difference observed between the two groups (P=1.000). (3) All 29 patients with pelvic masses successfully underwent transvaginal core needle biopsy guided by vagino-recto-abdominal examination. Among them, 28 cases (97%, 28/29) reported tolerable pain during the procedure, while 1 case (3%, 1/29) experienced transient syncope at the end of the procedure due to pain, which resolved within seconds. Vaginal bleeding exceeding 50 ml occurred in 3 patients (10%, 3/29) during paracervical tissue sampling, with the maximum blood loss being 150 ml, and hemorrhage was successfully controlled using vaginal tamponade. The overall incidence of adverse events during the core needle biopsy procedure was 14% (4/29). Conclusion: Transvaginal core needle biopsy for pelvic masses guided by vagino-recto-abdominal examination is a simple, safe, and accurate diagnostic method, suitable for patients with gynecologic malignancies, non-gynecologic malignancies suspected of pelvic mass metastasis, and other benign pelvic lesions.

Intelligent diagnosis of pancreatic biopsy from endoscopic ultrasound-guided fine-needle aspiration via stimulated Raman histopathology.

Intelligent diagnosis of pancreatic biopsy from endoscopic ultrasound-guided fine-needle aspiration via stimulated Raman histopathology.

Renal Pathology Society/International Kidney and Monoclonal Gammopathy Research Group Consensus on Pathologic Definitions and Terminology of Monoclonal Gammopathy Associated Kidney Lesions.

Renal Pathology Society/International Kidney and Monoclonal Gammopathy Research Group Consensus on Pathologic Definitions and Terminology of Monoclonal Gammopathy Associated Kidney Lesions.

Abstract 7411: Screening of nasopharyngeal cancer in a multi-ethnic healthy Singaporean cohort

Abstract Background: Epstein-Barr Virus (EBV)-positive Nasopharyngeal Cancer (EBV-NPC) is highly prevalent in Asia, with annual incidences of 20-100 per 100, 000. In Singapore's multi-ethnic population, EBV IgA serologies targeting viral capsid antigen (VCA) and early antigen (EA) are commonly performed for NPC screening. However, the longitudinal variability of EBV IgA serologies and its relationship with NPC risk remains unclear. This study evaluates the longitudinal patterns of EBV IgA serologies and NPC development in a tertiary medical center. Methods: Retrospective analysis of asymptomatic individuals referred for NPC screening at Singapore General Hospital between 2008-2021 was performed. Demographics, EBV IgA serologies titers, plasma DNA PCR, nasoendoscopy, biopsy, and MRI post-nasal space (PNS) findings were collected. A positive family history was defined as any first-degree relative with a prior history of NPC. Patients with only one serology test and screening of less than 1 year were excluded. Results: 4586 patients had EBV IgA serologies performed and 1977 met our inclusion criteria. Patients (45.6% male, 54.4% female; aged 12-90) had a median follow-up of 207.1 months (range: 12-5125 months) and were predominantly Chinese (95%), with 1.16% Indian, 1.66% Malay, and 2.17% from other ethnicities. All were screened using nasal endoscopy examination (n=11, 423) and 725 biopsies were performed. Adjunctive tests including MRI PNS (n=876) and EBV DNA-PCR (n=392) were also performed as per physician’s discretion. EBV serologies were repeated in 2-5 times (61%), 6-10 (21.3%), or >10 (18.1%) over the screening period. Titre fluctuations showed no clear pattern: 61.96% were positive for only one serology type, 12.13% were persistently positive for both, 23.4% had decreasing titers, and 2.42% had increasing titers. Six patients (0.3%) developed NPC, all ethnic Chinese, asymptomatic, and aged 50 on average. Among these, 3/6, 1/6, and 2/6 had Stage I, III, and IV NPC at diagnosis, respectively. Two had a family history of NPC. The mean detection time was 61 months, and follow-up averaged 12.7 years. Serology titer patterns were persistently positive or increasing. Increased EBV EA-IgA (2/6) or VCA-IgA (2/6) titers were observed 1-2 years before diagnosis. One patient had a normal biopsy but suspicious MRI, leading to repeat biopsy and NPC diagnosis. Conclusion: In this longitudinal heterogeneous healthy multi-ethnic NPC screening cohort, the NPC detection rate was 0.3%. Fluctuation of EBV IgA serologies was variable, and increasing titers of both Ea and VCA serologies were identified in 33.3% of NPC. Future evaluation of high risk cohorts and cost-effectiveness of NPC screening are warranted. Citation Format: Ashlynn Chen, Arthur Tan, Jia Hui Isabelle Jang, Song Tar Toh, Wei Yee Wan, Chwee Ming Lim. Screening of nasopharyngeal cancer in a multi-ethnic healthy Singaporean cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 7411.

Long-Term Outcomes in Nephrotic Syndrome by Kidney Biopsy Diagnosis and Proteinuria.

The UK Registry of Rare Kidney Diseases (RaDaR) Idiopathic Nephrotic Syndrome cohort includes adults and children with genetic nephrotic syndrome, Focal Segmental Glomerulosclerosis (FSGS) and minimal change disease. This study examines long-term patient outcomes as a function of kidney biopsy diagnosis and proteinuria control. 2467 adults and 1599 children were followed to establish outcomes including eGFR slope and kidney survival by diagnosis, analysed as a function of proteinuria from disease onset for FSGS and minimal change disease. Enrollment began in 2010, with follow-up to September 2023. Index date for the survival analyses was date of disease onset. The cohort had median [IQR] follow up of 8.2 [4.3-13.1] years; 30% of patients reached kidney failure or died. 1303 patients had FSGS, 1153 minimal change disease, 105 monogenic nephrotic syndrome. Children showed relatively preserved mean kidney function at disease onset (eGFR>100 ml/min/1.73m2), compared to adults (FSGS 61ml/min/1.73m2; minimal change disease 76ml/min/1.73m2). Kidney survival probability (95% CI) at 10 years varied with diagnosis: Genetic 29% (20-38), FSGS 58% (55-61), minimal change disease 87% (85-89) with mean (SD) rates of eGFR loss -26.5 (34.7), -6.2 (14.3), and -1.9 (10.2) ml/min/1.73m2 per year respectively. FSGS 10-year kidney survival (95% CI) for 6-12 months lowest proteinuria value in complete remission (<0.3g/g), partial remission (0.3-3.5g/g) and no remission (>3.5g/g) was 88% (70-96). 65% (50-76) and 37% (26-48), respectively. Time-averaged proteinuria of <1.5g/g over 6-24 months from disease onset was associated with 90% 10-year kidney survival. For minimal change disease, patients' 10-year kidney survival (95% CI) stratified by 6-12 months lowest proteinuria value was: complete remission 89% (79-94), partial remission 75% (51-89), and no remission 64% (41-81). In FSGS and minimal change disease 10-year eGFR slope was strongly correlated with absolute levels of proteinuria. Kidney outcomes were poor in genetic nephrotic syndrome; in FSGS outcomes were strongly associated with proteinuria level. Minimal change disease patients had better proteinuria control than FSGS and had better outcomes at each proteinuria level.

Site of Biopsy and Its Accuracy in Preoperative Diagnosis of Superficial Nonampullary Duodenal Epithelial Tumors: Retrospective Study.

Background/Objectives: As endoscopy is increasingly being used to diagnose superficial nonampullary duodenal epithelial tumors (SNADETs), there is a growing need for their early detection and minimally invasive treatment. This study investigated the diagnostic accuracy of biopsy specimens for SNADETs. Methods: We conducted a retrospective analysis of clinicopathologic data from 98 patients with SNADETs who had undergone endoscopic resection. The presurgical diagnosis, based on biopsy specimens, was compared with the histological diagnosis of the excised specimens. Results: Herein, preoperative biopsies were performed on 98 SNADETs specimens from 91 patients. Of the 68 adenomas and 30 carcinomas, 22.4% adenomas were later found to be carcinomas. Carcinoma biopsy diagnosis sensitivity, specificity, and accuracy were 54.6%, 80.0%, and 71.4%, respectively. Biopsy accuracy for carcinoma differed significantly by location to the papilla of Vater (p = 0.0455). The preoperative biopsy diagnostics' sensitivity, specificity, and accuracy for oral and anal carcinomas to Vater papilla were 69.2%, 92.0%, and 84.2% and 42.1%, 73.2%, and 63.3%, respectively. Conclusions: The diagnostic accuracy of biopsy for SNADETs was low; however, it was higher on the oral side than the anal side of the papilla of Vater. The biopsy of duodenal lesions should be performed after an endoscopic examination, considering their location and reducing the risks of fibrosis.

Comparison of the efficiency of digital pathology with the conventional methodology for the diagnosis of biopsies in an anatomical pathology laboratory in Spain

Comparison of the efficiency of digital pathology with the conventional methodology for the diagnosis of biopsies in an anatomical pathology laboratory in Spain

Non-invasive biopsy diagnosis of diabetic kidney disease via deep learning applied to retinal images: a population-based study.

Non-invasive biopsy diagnosis of diabetic kidney disease via deep learning applied to retinal images: a population-based study.

Partition-Less Digital Immunoassay Using Configurable Topographic Nanoarrays for Extracellular Vesicle Diagnosis of Ewing Sarcoma.

Emerging digital bioassays provide opportunities for bioanalysis and clinical diagnostics due to their improved analytical performance. Prevailing digitization strategies rely on partitioning single molecules into discrete compartments for which bead-based capture may be used. Herein we report a partition-free digital enzyme-linked immunosorbent assay (dELISA) named microfluidic Topographically Intensified, Partition-less dELISA (μTIP-dELISA). Our method builds on a single-molecule signal amplification technique that employs a simple micropost device to generate a topographic nanogap array to significantly enhance surface-bound enzymatic reactions. Compared to existing dELISA methods, our approach features appreciable simplicity and enhanced adaptability as it obviates the needs for sophisticated device fabrication, complicated workflow for off-line immunomagnetic capture, and ultralow-volume compartmentalization. Moreover, μTIP-dELISA integrates the inherent advantages of microfluidics in improving the assay performance and throughput and enhancing the scalability and automation. As a proof-of-concept for potential biomedical applications, we adapted μTIP-dELISA to extracellular vesicle (EV)-based liquid biopsy diagnosis of a pediatric cancer, Ewing sarcoma (EWS). Our technology confers >300-fold improvement over the conventional ELISA in detecting four EWS protein biomarkers. We demonstrated highly sensitive and specific detection of EWS cases with a machine-learning-defined four-marker EV signature. The four EV markers were further tested to assess age as a prognostic factor, resulting in an overall accuracy of 97% for classifying the control, pediatric and adult subjects. Overall, we envision that our μTIP single-molecule signal amplification strategy could promote the development and adaptation of digital bioassays and that the μTIP-dELISA could provide a useful tool for clinical diagnostics for many malignancies.

Inflammatory bowel disease-associated serrated lesions with dysplasia are frequently associated with advanced neoplasia: supporting a unified classification approach.

Inflammatory bowel disease (IBD)-associated serrated lesions are categorized into three distinct subtypes: traditional serrated adenoma (TSA)-like lesion, sessile serrated lesion (SSL)-like lesion, and serrated lesion, not otherwise specified (NOS). Although the risk of neoplastic progression of serrated lesions without dysplasia has not been shown to exceed that of sporadic cases, the clinicopathologic features of the three serrated subtypes with dysplasia remain poorly understood in the context of IBD. We analysed 87 serrated lesions with dysplasia (collectively referred to as serrated dysplasia) identified endoscopically in 58 IBD patients, including 51 (59%) TSA-like dysplasia, 24 (28%) SSL-like dysplasia, and 12 (14%) serrated dysplasia NOS. Inclusion criteria required all three serrated subtypes to show morphologic evidence of dysplasia and to be located within areas of colitis. We also compared the clinicopathologic features of serrated dysplasia with those of 239 conventional (adenomatous) dysplastic lesions from 149 IBD patients. The cohort included 39 (67%) men and 19 (33%) women, with a mean age of 54 years and a mean IBD duration of 20 years. Most patients had ulcerative colitis (n = 41; 71%) and pancolitis (n = 48; 83%). The majority of serrated lesions with dysplasia had a polypoid or visible endoscopic appearance (n = 73; 84%), with a mean size of 1.4 cm, and were found in the left colon (n = 66; 76%). Most lesions (n = 73; 84%) demonstrated low-grade dysplasia at the time of biopsy diagnosis, whereas high-grade dysplasia (HGD) was identified in the remaining 14 (16%) lesions. SSL-like dysplasia was more frequently associated with ulcerative colitis (94%) compared to TSA-like dysplasia (67%) and serrated dysplasia NOS (56%) (P = 0.042). Although only seven (12%) patients had a concurrent history of primary sclerosing cholangitis, it was exclusively identified in the TSA-like dysplasia group (19% versus 0% in both the SSL-like dysplasia group and the serrated dysplasia NOS group; P = 0.017). Serrated dysplasia NOS more commonly demonstrated HGD at the time of biopsy diagnosis (42%) compared to TSA-like dysplasia (12%) and SSL-like dysplasia (13%) (P = 0.022). Serrated dysplasia NOS was also more frequently associated with synchronous and/or metachronous nonconventional dysplasia (60%) compared to TSA-like dysplasia (16%) and SSL-like dysplasia (9%) (P = 0.037). Serrated dysplasia, regardless of subtype, was associated with high rates of advanced neoplasia (HGD or colorectal cancer) at the previous biopsy site or in the same colonic segment during follow-up. Within a mean follow-up time of 13 months, advanced neoplasia was detected in 50% of the TSA-like dysplasia group, 67% of the SSL-like dysplasia group, and 100% of the serrated dysplasia NOS group (P = 0.622). Moreover, at least one-third of patients in each group (58% in the TSA-like dysplasia group, 44% in the SSL-like dysplasia group, and 33% in the serrated dysplasia NOS group; P = 0.332) developed synchronous/metachronous dysplasia, with at least 50% of these lesions progressing to advanced neoplasia within a mean follow-up time of 11 months (P = 1.000). The serrated dysplasia group showed nearly six times the incidence of advanced neoplasia upon follow-up (59%) compared to the conventional dysplasia group (10%) (P < 0.001). TSA-like dysplasia, SSL-like dysplasia, and serrated dysplasia NOS show distinct clinicopathologic features. However, all three serrated subtypes were associated with high rates of advanced neoplasia (50%-100%) during follow-up, suggesting that these lesions could potentially be combined into one diagnostic category, such as serrated dysplasia.

Assessment of the quality and diagnostic accuracy of patient self-generated photographs used in oculoplastic virtual clinics

Background A barrier to video consultation in oculoplastics is visualising pathology too small for video resolution. Patient self-generated photographs, which is well-documented in teledermatology but not in oculoplastics, may provide a solution. Purpose To assess the quality and diagnostic accuracy of patient self-generated photographs of presumed benign eyelid pathology. Methods 300 patients with suspected benign lid lesions emailed self-captured photographs that were reviewed by two independent reviewers for quality, focussing, and lighting. The photographs were used in a virtual clinic alongside video consultation. Accuracy of virtual clinic diagnosis was measured by comparison to biopsy or in-person diagnosis where available. Results 895 photographs were submitted. 84.5% of these were graded as excellent or adequate quality and there was no statistical difference in image quality based on patient age. Concordance between observers for quality of photographs, measured using Cohen's kappa, was k = 0.77 ( P = &lt;0.01). Virtual clinic diagnosis was verified in 236 (78.7%) patients by biopsy or in-person review. Correct diagnosis was made in 80.5%. 99.1% of benign lesions were correctly identified as low-risk, 50% of pre-malignant lesions were identified as suspicious, and 100% of malignant lesions were correctly identified as cancerous. Conclusions Patients of all ages can provide adequate quality photographs that can aid video consultations for benign lid lesions. We still recommend in-person review where suspicious features are present, or photo quality is suboptimal.

Concepts in Cutaneous Vasculitis.

Skin biopsy plays a fundamental role in the diagnosis of vasculitis. However, the general pathologist or dermatopathologist who encounters these diagnostic findings in their early stages often faces the paradox that the clinician requests the exclusion of various systemic diseases, when the biopsy only shows leukocytoclastic vasculitis. In other cases, even though the affected vessels are small, some of them seem deep within the biopsy, raising differential diagnosis with several entities of systemic repercussion. Lastly, although the dermatopathologist has a histological picture before them, they are often required to correlate it with laboratory data such as the presence of antineutrophil antibodies, for example. Therefore, the objective of this article is conceptual, emphasizing those basic aspects that can contribute to a better understanding and diagnosis of skin biopsy in vasculitis.

394 Contribution of Rapid On-Site Evaluation for Lymphoma Diagnosis in Head and Neck Lymph Node Fine Needle Aspiration Biopsies: A Multi-Institutional Report

394 Contribution of Rapid On-Site Evaluation for Lymphoma Diagnosis in Head and Neck Lymph Node Fine Needle Aspiration Biopsies: A Multi-Institutional Report

Underrecognized diagnostic discordance and delay in endometrial dedifferentiated and undifferentiated carcinoma.

Dedifferentiated and undifferentiated endometrial carcinoma (DC/UC) is a rare subtype of endometrial cancer characterized by undifferentiated carcinoma components. This study aimed to investigate diagnostic discrepancies and delays in DC/UC and compare them with low-grade endometrioid carcinoma (LGEC). We retrospectively analyzed 20 DC/UC and 40 LGEC cases finally diagnosed at our hospital (2016-2024). We compared the data of the two groups, including clinicopathologic characteristics and diagnostic intervals defined as the time from the date of initial biopsy to the date of definitive diagnosis. We assessed diagnostic discordances between preoperative diagnoses, including radiological, clinical, and biopsy, and final diagnoses with immunohistochemical analyses. DC/UC cases exhibited significantly longer diagnostic intervals (median 46 vs. 5 days, p = 0.037) and required more biopsy attempts (median two vs. 1, p = 0.002) and immunohistochemical tests (median 19 vs. 6, p = 0.001) than LGEC cases. In preoperative diagnoses, 60% of DC/UC cases showed diagnostic discrepancies. Radiological findings frequently suggested uterine sarcoma in DC/UC (30%, 6/20). Only 50% of DC/UC were suggested via initial biopsy. Immunohistochemistry revealed mismatch repair deficiency in 70% of DC/UC cases. Frequent diagnostic discrepancies and delays were observed in DC/UC, possibly due to its atypical imaging and histopathological features. Raising awareness of DC/UC's clinical and pathological characteristics is crucial to minimizing diagnostic delays. Given its frequency (at least 1% of endometrial cancers) and eligibility for emerging therapies, prioritizing DC/UC in differential diagnoses and improving diagnostic workflows through interdisciplinary collaboration are required for timely and effective treatment.

FDG PET Detection of Neurolymphomatosis in Diffuse Large B-cell Lymphoma, With Neuropathy as Presenting Complaint

Two patients with neurolymphomatosis as the initial manifestation of diffuse large B-cell lymphoma are presented. Both patients experienced mixed severe sensorimotor neuropathy as their presenting complaint. Subsequently, both had a prolonged interval to diagnosis, 6 and 14 months, respectively. MRI or CT imaging in both cases was nondiagnostic, and FDG PET/CT was used to demonstrate intense uptake throughout spinal nerves, leading to biopsy and definitive diagnosis. FDG PET/CT is a valuable investigation that should be considered early in cases of intractable progressive neuropathy to eliminate malignant differential causes.

Dyes-encapsulated metal-organic cage as fluorescence sensor array for the auxiliary differential diagnosis of MCD and FSGS in early renal disorders.

Dyes-encapsulated metal-organic cage as fluorescence sensor array for the auxiliary differential diagnosis of MCD and FSGS in early renal disorders.