Benign Diagnosis Research Articles

Evaluating clinical efficacy of hospital-based surveillance with mammography and ultrasonography for breast cancer

Periodic mammography and/or sonography examinations are conducted across numerous hospitals nationalwidely, especially for antedees with a positive mammography screening. Despite the regular practice, clinical efficacy of hospital-based breast cancer surveillance remains unclear. Specifically, the impact of surveillance interval upon survival and prognostic surrogates stratified by menopausal status, as well as malignant transition rate should be deciphered. We retrieved cancer registry to ascertain 841 breast cancers with surveillance history through administration data. Healthy controls underwent breast surveillance and were concurrently free of cancer. More benign diseases rather than cancers were identified from premenopausal women (age ≤50 years) with sonography alone within one year, as well as older women (age >50) with both mammography and sonography one to two years before a cancer or benign diagnosis. Among breast cancers, mammography alone during the antecedent one to two years had a protective effect for diagnosing carcinoma in situ rather than invasive cancer (age-adjusted odds ratio: 0.048, P=0.016). Three-state time homogeneous Markov model showed that hospital-based breast surveillance within 2 years of disease onset reduced the malignant transition rate by 65.16% (59.79-76.74%). The clinical efficacy of breast cancer surveillance was evidenced.

Impact of an integrated classifier using biomarkers, clinical and imaging factors on clinical decisions making for lung nodules.

An integrated classifier that utilizes plasma proteomic biomarker along with five clinical and imaging factors was previously shown to be potentially useful in lung nodule evaluation. This study evaluated the impact of the integrated proteomic classifier on management decisions in patients with a pretest probability of cancer (pCA) ≤50% in "real-world" clinical setting. Retrospective study examining patients with lung nodules who were evaluated using the integrated classifier as compared to standard clinical care during the same period, with at least 1-year follow-up. A total of 995 patients were evaluated for lung nodules over 1 year following the implementation of the integrated classifier with 17.3% prevalence of lung cancer. 231 patients met the study eligibility criteria; 102 (44.2%) were tested with the integrated classifier, while 129 (55.8%) did not. The median number of chest imaging studies was 2 [interquartile range (IQR), 1-2] in the integrated classifier arm and 2 [IQR, 1-3] in the non-integrated classifier arm (P=0.09). The median outpatient clinic visit was 2.00 (IQR, 1.00-3.00) in the integrated classifier arm and 2.00 (IQR, 2.00-3.00) in the non-integrated classifier (P=0.004). Fewer invasive procedures were pursued in the integrated classifier arm as compared to non-integrated classifier respectively (26.5% vs. 79.1%, P<0.001). All patients in the integrated classifier arm with post-pCA (likely benign n=39) had designated benign diagnosis at 1-year follow-up. In patients with lung nodules with a pCA ≤50%, use of the integrated classifier was associated with fewer invasive procedures and clinic visits without misclassifying patients with likely benign lung nodules results at 1-year follow-up.

BT06 Using artificial intelligence to triage skin cancer referrals: outcomes from a pilot study

Abstract Artificial intelligence (AI) is a rapidly emerging field in dermatology, aimed at delivering efficient and effective patient care. To date, there is a lack of substantial evidence for the use of this technology in a clinical setting. However, the pandemic era has placed significant pressures on dermatology services, specifically the skin cancer clinics at our trust, which has experienced a 30% increase in demand compared with prepandemic levels. A novel solution for urgent referrals was to test the use of AI teledermatology software using a UK Conformity Assessed marked Class IIa Medical Device (and therefore regulated by the Medicines and Healthcare products Regulatory Agency). Appropriate cases are selected and booked for a teledermatology appointment at one of our four community-based hubs. Clinical and dermoscopic images, together with a short questionnaire, are uploaded to the software by a healthcare assistant. The AI immediately assesses the dermoscopic images of the lesion, and those cases identified as benign are discharged back to the general practitioner (GP), following a safety check by a consultant dermatologist employed by the AI provider. The trust dermatology consultants have chosen to further triage all cases suspected to be nonbenign. Patients with suitable small lesions at low-risk sites receive a telephone appointment to discuss surgery and obtain consent. Those with precancerous lesions can be discharged back to the GP with management advice. Low-risk basal cell carcinomas case are transferred to a routine pathway. Selected cases may be referred directly to other teams. The pilot started in March 2022 and now processes 5–600 cases per month at four photography hubs. To date, 19% of cases have been discharged back to the GP with a benign diagnosis. A further 15% of cases have been discharged back to the GP by the trust dermatologists, giving an overall discharge rate of 34%. Ten per cent of patients have received a telephone call to take consent for biopsy, and 2% have been referred directly to another speciality. Thirteen per cent of cases have been triaged to a routine pathway, and 38% of patients have required an urgent face-to-face appointment with a dermatologist. The trust has seen &amp;gt; 90% 2-week wait referrals within 2 weeks in the last two quarters. Since the introduction of this AI teledermatology service, we have seen a 62% reduction in the number of patients requiring an urgent face-to-face appointment with a dermatologist. Ongoing audit work is focused on the safety, acceptability and cost-effectiveness of this pathway, and will shape decision-making in the ongoing use of this technology both locally and across the UK.

Utility of cytopathologic diagnosis of adult solid renal lesions: An academic Institution's 10-year experience.

Fine needle aspiration (FNA) and/or needle core biopsy (NCB) are increasingly used for managing patients with renal lesions, especially small renal masses (SRMs). One of the treatment options for SMRs is active surveillance. Hence, accurate diagnosis of renal lesions is critical for treatment planning. The aim of this study is to investigate the utility of FNA and/or NCB in the diagnosis of adult renal lesions at our institute. Laboratory information system was queried over a period of 10 years (2011-2020) to identify cases of FNA and/or NCB with touch preparation (TP) of adult renal masses. Patient demographics, cytopathologic diagnoses, ancillary tests and follow-up surgical resection data were reviewed and correlated. A total 138 cases from 138 patients (male = 80, female = 58) were identified. Sixty-one (44.20%) cases had FNA and NCB, 48 (34.78%) had NCB only and 29 (21.01%) had FNA only. 118 (85.50%) cases had definitive diagnoses and 13 (9.42%) had indeterminant diagnoses and seven cases were non-diagnostic (5.07%). Most common benign and malignant diagnoses were oncocytoma and clear cell renal cell carcinoma (CCRCC). 41/138 (29.71%) cases had follow-up resection. There were no false positive or false negative cases. Subtyping was feasible in majority cases with only 3/138 (2.17%) misclassified cases. Majority of renal masses (85.50%) had definitive cytology diagnoses. Only three had misclassification. FNA and/or NCB are useful methods in diagnosing and subclassifying adult renal masses and showed high accuracy (91.89%) when compared to surgical resections.

Preventative therapy for breast cancer: a clinical experience

BackgroundBreast Cancer incidence in the UK is estimated to rise to 71,000 per year by 2035. Preventative strategies could significantly reduce this. Preventative therapy reduces women’s risk of oestrogen receptor positive breast cancer, but uptake remains low. Having established a preventative therapy clinic as part of a wider breast cancer prevention project, we explored qualitative data to inform future preventative efforts.MethodWomen aged 30 to 60 who had benign diagnoses at a symptomatic breast clinic or were under mammographic surveillance in the moderate risk family history clinic were invited to participate in the study. Those who expressed an interest and completed an initial questionnaire had their breast cancer risk calculated using the IBIS risk calculator. Those at increased risk were invited to a consultation about preventative therapy.Results182 women were identified as increased risk (≥ 17% lifetime or ≥ 3% 10-year risk NICE guidelines: Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer, 20131) of whom 91 women (50%) would not have been identified by family history criteria alone. 96% attended a risk/prevention consultation and all eligible women accepted screening mammography but only 14 (8%) women requested a preventative therapy prescription during the duration of the study. Reluctance to take medication and inconvenient time of life were common reasons for declining preventative therapy. Despite this, the majority were grateful for breast cancer risk and prevention information.ConclusionsWomen at increased risk of breast cancer accept additional screening but are reluctant to take preventative therapy. This suggests that stratified screening methods using risk calculations would have high uptake. Raising awareness of preventative therapy is important and the breast cancer community has yet to find the optimum timing and formula for discussing it and must accept women’s informed preferences above artificial targets.Registration numbersThe PIONEER study was granted Health Research Authority (HRA) ethical approval by the Westminster Ethics Committee. IRAS project ID 265619, ClinicalTrials.gov Identifier: NCT04574063. Recruitment began in September 2020 and was completed in October 2021.

Brief resolved unexplained event: Severity-associated factors at admission in the pediatric emergency ward

ObjectiveA brief resolved unexplained event (BRUE) is a recent clinical entity that has now replaced the term “infant discomfort”. Despite the availability of recent recommendations, identification of patients requiring further examination remains difficult. MethodWe aimed to identify factors associated with severe pathology and/or recurrence by studying the medical files of 767 patients admitted to the pediatric emergency department of a French university hospital for a BRUE. ResultsOverall, 255 files were studied; 45 patients had a recurrence and 23 patients had a severe diagnosis. The most frequently found etiology was gastroesophageal reflux in the benign diagnosis group and apnea or central hypoventilation in the severe diagnosis group. Prematurity (p = 0.032) and time since last meal >1 h (p = 0.019) were the main factors associated with severe disease. Most of the routine examination results remained non-contributive to the etiology. ConclusionAs prematurity is a factor associated with severe diagnosis, special attention should be given to this population, without subjecting them to multiple tests, since the main complication was found to be apnea or central hypoventilation. Prospective research is needed to establish the usefulness and prioritization of diagnostic tests for infants who are at “high risk” of experiencing a BRUE.

Breast cancer early diagnosis detection of breast cancer through education of primary healthcare providers in Côte D'Ivoire.

e18767 Background: In Côte d'Ivoire, &gt; 70% of women with breast cancer present with stage III/IV disease. To improve early detection, we designed and implemented an educational curriculum (EC; the Breast Health Program) for primary healthcare providers (PCPs). Methods: We performed in-depth interviews with key stakeholders to identify barriers and facilitators of breast cancer early detection. Interviews were audio-recorded, transcribed, double-coded and analyzed via thematic analysis. The EC was designed based on interview results and implemented during a one-day educational session for PCPs. Participating PCPs completed pre- and post-session surveys to assess knowledge. Data were analyzed using Fisher’s exact test. All p-values were two-sided. Results: Eighteen stakeholders participated in the interviews: 7 (39%) physicians, 5 (28%) medical students, 3 nurses, 2 cancer survivors, and 1 midwife. Identified barriers to early detection included: lack of awareness-raising campaigns to encourage earlier presentation (50%), need for patient follow-up and support after presentation to primary healthcare centers (50%), financial barriers (39%), delays due to lack of coordination in diagnosis and treatment (22%), and lack of mammography and biopsy capacity outside of the private sector (11%). Based on the interviews, the following topics were included in the EC: breast cancer and benign breast disease diagnosis and treatment, patient communication/support, clinical breast exam (CBE), symptom management, and financial navigation to assist patients access diagnosis. A total of 36 PCPs from five healthcare centers attended the educational session: 75% were female; the mean age was 41.3 years (SD 7.2); Nine (28%) were physicians, 6 (17%) nurses, 18 (50%) midwives; the median years of work experience was 7 years (range 3-32). At baseline, 18 (50%) PCPs felt qualified to evaluate patients with breast complaints; 10 (28%) did not, vs. 32 (89%) and 2 (6%) respectively at follow-up (χ2 = 8.75 p = 0.003). 15 (42%) providers felt qualified to help patients overcome barriers to diagnosis, and eleven (31%) felt unqualified/neutral at baseline, vs. 31 (86%) and 4 (11%) respectively at follow-up (χ2 = 7.67, p = 0.006). There were no statistically significant differences between baseline-follow-up in feeling qualified to perform CBE (27 (75%) vs. 32 (89%)) or ability to refer patients for diagnostic workup (29 (81%) vs. 34 (94%)). Conclusions: We identified multiple barriers to early breast cancer detection in Côte d’Ivoire. The EC was effective in improving confidence among PCPs and evaluation of breast complaints and addressing barriers to cancer diagnosis. There were no differences in feeling qualified to perform CBE or ability to refer patients to diagnostic workup, which were high at baseline. Future work includes expanding the program reach and evaluating impact on time to diagnosis.

Characterizing the mental health of South African women living with comorbid HIV and breast cancer.

e12549 Background: In South Africa’s public hospitals, 20% of new breast cancer (BC) diagnoses are in women living with HIV (WLWH). These women experience 49% higher mortality than BC patients without HIV. Mental health disorders are prevalent in both WLWH and women with BC. Symptoms of depression, anxiety, and acute stress are linked to increased circulating serum inflammatory markers, which may provide a pathophysiologic explanation for poorer outcomes. We aimed to explore whether South African BC patients living with HIV report more mental health symptoms than women with HIV alone, BC alone, or neither and to determine if comorbid HIV and BC is associated with greater systemic inflammation. Methods: We conducted a cross-sectional study of black South African women ≥18 years old. We enrolled four arms: newly diagnosed BC patients with HIV, newly diagnosed BC patients without HIV, WLWH without BC, and women with benign breast diagnoses. Participants were recruited from the breast clinic or HIV clinic at Chris Hani Baragwanath Academic Hospital. Consenting women completed the Center for Epidemiologic Studies Depression Scale (CES-D), the Generalized Anxiety Disorder 7-item Scale (GAD-7), and the Perceived Stress Scale (PSS). Blood samples were tested for serum concentrations of inflammatory markers (c-reactive protein (CRP) and S100A8/A9), pro-inflammatory cytokines (IL-1β, IL-6, IL-8, and TNF-α), and anti-inflammatory cytokines (IL-4, IL-5, and IL-10) via ELISA assays performed at the University of Miami. Results: The first three arms enrolled 25 women each and the benign arm enrolled 22 women. Participant scores on the CES-D, GAD-7, and PSS were higher than expected in all groups and seemed to be worse in participants with HIV alone. Scores consistent with clinical depression, moderate to severe anxiety, and moderate to severe stress were reported by 68-88%, 28-76%, and 72-94% of participants, respectively. We found trends towards higher concentrations of CRP, TNF-α, IL-6, and IL-8 in participants with co-morbid BC and HIV versus benign breast disease but no pattern of increased inflammatory marker concentrations in participants with dual diagnoses versus either diagnosis alone. Conclusions: Our pilot study did not find evidence of increased mental health symptom burden or systemic inflammation in South African women with comorbid breast cancer and HIV, versus either diagnosis alone. Increased mental health symptoms in women with HIV alone may reflect reduced access to supportive service available at the HIV clinic compared to the breast clinic. [Table: see text]

Analysis of histopathological findings of breast biopsies at a tertiary care centre

Background: In India, breast cancer has become a leading cause of cancer death. The indication of a breast lump can be cause of great concern in most patients. While most of the lumps are benign in nature, there is a possibility of an increased risk of developing premalignant lesions. Any breast mass/lump requires histological diagnosis to get a clear picture of the lump associated problems. Methods: This is a retrospective, descriptive and a cross-sectional study of all the patients with breast lumps seen in Bhaktivedanta Hospital and Research Institute from January 2018 till March 2022. Histopathology reports of breast biopsies of patients required at Bhaktivedanta Hospital and Research Institute were included in the study. Results: The total number of cases of breast biopsies available were 449. These cases are grouped into benign and malignant cases which comprise of 276 (61.47%) and 173 (38.53%) cases respectively. The most common benign diagnosis observed was fibroadenoma which accounted for 184 (66.67%) cases. Based on age grouping, the 21-40 age group contained the maximum number of benign cases. The most common malignancy observed was of ductal carcinoma with 163 (94.21%) cases. Based on age grouping, the age group of 41-60 contained the maximum number of malignant cases. Conclusions: It is imperative that all breast lesions should undergo biopsies irrespective of clinical findings for the following reasons: rising incidence of breast cancer, to rule out/confirm malignancy and to complete the diagnostic triad of clinical diagnosis, radiology and pathology.

Insomnia, depression and anxiety in patients urgently referred with suspicion of head and neck cancer.

To determine differences in insomnia, depression and anxiety between ENT patients with benign and malignant conditions prior to and after an urgent suspicion of cancer appointment. Out-patients with urgent suspicion of cancer completed three psychometric questionnaires prior to their appointment and at two to four weeks post-diagnosis. There was no significant difference in questionnaire scores between malignant and benign patients prior to the patients' appointments (p > 0.05 for all questionnaires). In benign patients, there was significant improvement in scores for all questionnaires (p < 0.01) and in malignant patients there was significant worsening of scores for all questionnaires (p < 0.01) at follow-up appointments. Prior to appointments, patients with benign and malignant conditions experienced similar levels of insomnia, depression and anxiety. Following diagnosis, cancer patients had significantly poorer scores, indicating worsening of these symptoms. In patients with benign diagnoses, all questionnaire scores improved, indicating resolution of their symptoms and possible association between the appointment and their baseline scores.

O136 An observational cohort study of replicate faecal immunochemical tests in symptomatic two-week wait patients

Abstract Introduction Triage of patients with suspected colorectal cancer (CRC) utilises a single faecal immunochemical test (FIT) at a defined threshold. Limited evidence exists regarding whether replicate FIT improves the positive and negative predictive value in symptomatic patients. This study examines two-week wait (TWW) patients undergoing replicate FIT. Primary aim is to assess two FITs and CRC/serious bowel disease. Secondary aims are to determine correlation and utility of replicate FIT. Methods TWW patients carried out one additional FIT during COVID-19 pandemic. FIT 1 and FIT 2 (the replicate sample) were analysed in relation to symptoms, diagnoses, investigations, future colonoscopy and missed CRC. Study period was 01/03/2020-31/07/2020. Three subgroups were compared; double positive (&amp;gt;10μg Hb/g faeces), double negative, and discordant FIT (one positive). Results 111 patients had replicate FIT (50 male, 61 female). 43 (38.7%) patients had double negative, 32 (28.8%) double positive and 36 (32.4%) had discordant FITs. Median time between FITs was 14 days (IQR=11 to 19). 83% of double positive patients underwent colonoscopy/virtual colonoscopy (61% in double negative patients). Six CRC and one high-risk polyp were in double positive patients (none in other groups). One discordant patient was not investigated and a CRC missed. Conclusion Replicate FIT as a triage strategy appears most effective where both FITs are negative. CRC risk is low when FIT results are discordant. Double negative FITs are reassuring given benign associated diagnoses, or for patients where endoscopic investigation is high-risk. Larger studies are required to evaluate discordant FITs, enabling refinement of urgent investigation pathways.

Diagnostic outcomes of robotic-assisted bronchoscopy for pulmonary lesions in a real-world multicenter community setting

BackgroundRobot-assisted bronchoscopy (RAB) is among the newest bronchoscopic technologies, allowing improved visualization and access for small and hard-to-reach nodules. RAB studies have primarily been conducted at academic centers, limiting the generalizability of results to the broader real-world setting, while variability in diagnostic yield definitions has impaired the validity of cross-study comparisons. The objective of this study was to determine the diagnostic yield and sensitivity for malignancy of RAB in patients with pulmonary lesions in a community setting and explore the impact of different definitions on diagnostic yield estimates.MethodsData were collected retrospectively from medical records of patients ≥ 21 years who underwent bronchoscopy with the Monarch® Platform (Auris Health, Inc., Redwood City, CA) for biopsy of pulmonary lesions at three US community hospitals between January 2019 and March 2020. Diagnostic yield was calculated at the index RAB and using 12-month follow-up data. At index, all malignant and benign (specific and non-specific) diagnoses were considered diagnostic. After 12 months, benign non-specific cases were considered diagnostic only when follow-up data corroborated the benign result. An alternative definition at index classified benign non-specific results as non-diagnostic, while an alternative 12-month definition categorized index non-diagnostic cases as diagnostic if no malignancy was diagnosed during follow-up.ResultsThe study included 264 patients. Median lesion size was 19.3 mm, 58.9% were peripherally located, and 30.1% had a bronchus sign. Samples were obtained via Monarch in 99.6% of patients. Pathology led to a malignant diagnosis in 115 patients (43.6%), a benign diagnosis in 110 (41.7%), and 39 (14.8%) non-diagnostic cases. Index diagnostic yield was 85.2% (95% CI: [80.9%, 89.5%]) and the 12-month diagnostic yield was 79.4% (95% CI: [74.4%, 84.3%]). Alternative definitions resulted in diagnostic yield estimates of 58.7% (95% CI: [52.8%, 64.7%]) at index and 89.0% (95% CI: [85.1%, 92.8%]) at 12 months. Sensitivity for malignancy was 79.3% (95% CI: [72.7%, 85.9%]) and cancer prevalence was 58.0% after 12 months.ConclusionsRAB demonstrated a high diagnostic yield in the largest study to date, despite representing a real-world community population with a relatively low prevalence of cancer. Alternative definitions had a considerable impact on diagnostic yield estimates.

SENODAY: A New Perspective of Handling Breast Cancer

BackgroundTo evaluate the feasibility of a same day breast cancer diagnosis and management protocol, consequently decreasing time to treatment and immediately reassuring patients with benign diagnosis. Materials and MethodsA total of 60 women underwent breast exam during SENODAY in our cancer center between January 2020 and December 2022. Patients are first seen by a breast surgeon who mentions whether the patient's history and physical exam are suspicious of malignancy. Patients are then sent to the radiologist who performs a complete radiologic assessment, classifies the lesions, and performs a biopsy when necessary. The specimen is sent to the pathologist who uses the imprint cytology technique to obtain a preliminary diagnosis. Effective counseling is established in case of breast cancer diagnosis. ResultsAmong 60 women, 25 patients were reassured by breast imaging and 35 underwent histopathological analysis (17 patients with a 1-day protocol and 18 with the standard definitive technique). Clinical examination was found to have a sensitivity of 100% and a specificity of 89.47%. The positive predictive value was 80 % and the negative predictive value was 100%. However, we did not find a strong correlation between imaging and definitive pathology. Moreover, on imprint cytology, sensitivity, specificity, PPV, and NPV were 100%. Finally, the mean time-to-treat was 28.6 days. ConclusionsSENODAY reassured 68.3% of patients. It also offered effective counseling and a treatment plan to newly diagnosed breast cancer patients within 1 day. Same day histological diagnosis by imprint cytology is effective and feasible with an excellent accuracy.

The digital expression profile of BMP7, CDKN2C, HIST1H3G, and PKMYT1 genes improves high-grade cervical lesion detection in liquid-based cytology.

Some studies reported that differential gene expression could be used as a biomarker for high-grade cervical lesion identification. The aim was to evaluate the gene expression profile of cervical intraepithelial neoplasia (CIN) to identify a gene expression signature of CIN2+ in liquid-based cytology (LBC) samples. LBC samples (n=85) obtained from women who underwent colposcopy were included with benign (n=13), CIN1 (n=26), CIN2 (n=16), and CIN3 (n=30) diagnoses. After RNA isolation, gene expression profiling was performed using the nCounter PanCancer Pathways, which consists of 730 cancer-related genes. The genes identified were in silico expression evaluated using the UALCAN database. An accurate prediction model to discriminate CIN2+ from <CIN2 lesions was determined. Immunohistochemistry was performed to assess the expression of p16 and Ki67 proteins. This study identified a gene expression profile that significantly differentiates CIN2+ cases from <CIN2. The gene signature comprised 18 genes, two genes downregulated and 16 upregulated. In silico analysis corroborated the differential expression of 11 of those genes. Further observed was that high expression of BMP7 (odds ratio [OR],4.202), CDKN2C (OR,5.326), HIST1H3G (OR,3.522), PKMYT1 (OR,4.247), and menarche age (OR,1.608) were age-adjusted and associated with CIN2+. This model demonstrates a probabilityof43% leading to an area under the curve (of.979; sensitivity of 94.9%, and specificityof91.2% for CIN2+ prediction. It was observed that p16 expression was significantly associated with CDKN2A mRNA overexpression (p=.0015). A gene expression profile that may be helpful in the identification of patients with CIN2+ was identified. This approach could be used together with currently used LBC in a clinical setting, allowing the identification of patients with high risk of CIN2+.

Evaluation of the medically necessary, time sensitive triage score during and beyond the local COVID-19 pandemic in the Gynaecologic Oncology Unit of a tertiary hospital in South Africa.

The main objective of this study was to evaluate the Medically Necessary Time Sensitive (MeNTS) scoring system in triaging gynaecologic oncologic surgery during and beyond the COVID-19 pandemic. This was a retrospective cross-sectional study including 209 patients who either had surgery (151) or surgery postponed (58) between the 26th March and 30th September 2020 in an academic hospital in South Africa. The MeNTS score was used to independently score each patient three times by two observers. The mean age of the participants was 46.6 ± 15 years and the cumulative mean MeNTS score was 51.0 ± 5.1. Over two-thirds of the cases had surgery. There was no significant difference between the first and second observers' cumulative scores, 51.0 vs 51.1 (p 0.77). The cumulative score among those who had surgery was significantly lower than that for those whose surgeries were postponed, 49.8 vs 54.1 (p <0.0001). The intra-observer and inter-observer reliability were 0.78 and 0.74 respectively. After adjusting for confounding variables, those with low cumulative MeNTS scores were about 5 times more likely to have surgery than those with high scores (Adj. OR = 4.67, 95% CI: 1.92-11.4, p <0.001. Patients with malignant diagnosis were also 5 times more likely to be operated than those with benign diagnosis (Adj. OR = 5.03, 95% CI: 1.73-14.6, p <0.001. The area under the curve (AUC) was 0.85 suggesting an excellent discriminatory power between those who were operated and those who were postponed. The study provided some insight into the potential usefulness of MeNTS score in prioritizing patients for surgery in gynaecologic oncologic sub-specialty. The score performed well across a range of gynaecologic conditions and procedures with good intra-observer and inter-observer consistency and reliability. This is a prioritization tool that is dynamically adaptable to accommodate changes in resources availability and operating theatre capacity.

Issues and Challenges in Diagnoses of Borderline Ovarian Neoplasms by Frozen Section

Introduction: Frozen section is a rapid intraoperative method of tissue sectioning with the help of cryostat to arrive at a diagnosis and guide the operative procedure. It is an important diagnostic tool in the intraoperative management of ovarian neoplasms. Aims and Objectives: 1) To evaluate clinically suspected ovarian neoplastic lesions by frozen section. 2) To analyze the factors associated with difficulty in diagnoses of borderline ovarian neoplasms. Materials and Methods: This is a cross-sectional study conducted in the Department of Pathology for a period of 2 years. 60 cases of ovarian neoplasms undergoing Frozen section and subsequent histopathological examination are included in the study. Results: The mean age of patient is 39.49 years (21-72). Of the 60 cases, 73.33% are benign, 8.33% borderline and 18.3% are malignant on histopathological diagnosis. The concordance rate of frozen section with histopathological diagnosis is 91.67%. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Frozen section in the diagnosis of Benign, Borderline and Malignant ovarian neoplasms are 95.45%, 92.73%, 97.67%, 88.24% and 88.64%; 100%, 92.16%, 55.56%, 100% and 55.56%; 72.73%, 100%, 100%, 94.23% and 72.73% respectively. Conclusion: Frozen section of ovarian neoplasms helps to arrive at a diagnosis of whether they are benign or malignant with a high level of accuracy. Diagnosis of a benign lesion in a young patient guides the surgeon to a fertility conserving surgery. Likewise, diagnosis of a malignant lesion on table guides the surgeon to execute an extensive surgery in a single setting, saving the patient of the physical, emotional, psychological and financial strain of a second look operation.

Cytological Diagnosis of Thyroid Follicular Lesion and Its Correlation with Histological Findings

Introduction: Follicular neoplasms represent a wide clinical spectrum of diseases, with tremendous overlap in clinicopathologic diagnosis, management, and prognosis. Suspicious sonographic features in conjunction with FNAC of thyroid nodules provide the most accurate preoperative diagnosis to guide therapy. Keeping the perception in mind, we summarize our experience with thyroid nodules that were defined as cellular follicular lesions by comparing the clinical, sonographic, and cytological features that were examined histologically to define the most reliable criteria of malignancy. Aim of the Study: The aim of the study was to find out the cytological diagnosis of thyroid follicular lesions and their correlation with histological findings. Methods: This cross-sectional observational study was conducted at the department of Otolaryngology, National institute of ENT, Tejgaon, Dhaka following approval of the protocol for the duration of 6 months. A total of 30 patients were included and they were subjected to details history taking, physical examination, and necessary investigations. We analyzed the data using SPSS version 23, and Chi-square test was used to analyze the significance level of P (&lt;0.05). Results: A total of 30 consecutive patients with a follicular lesion on FNAC (5 men and 25 women) were included in this study. Their mean (SD) age was 46.7 (±13.0) years. Thyroid cancer was diagnosed on histopathology in 8 patients (27%). Papillary cancer was the most common cytologic finding in 6 patients [75%]) and 2 patients (25%) had a diagnosis of follicular cancer. Of the 6 patients with papillary cancer, 2 (33%) had a follicular variant of papillary cancer. The benign histologic diagnoses were follicular adenoma in 6 cases (27%), thyroiditis in 3 cases (13%), and nodular goiter in 13 (60%). The presence of a solitary nodule was not predictive of malignancy (p=0.57). Solid echo structure (p&lt;0.02), presence of microcalcification (p&lt;0.01), and hypoechoic nodules ...

Circulating metabolites as potential biomarkers for the early detection and prognosis surveillance of gastrointestinal cancers

Background and aimsTwo of the most lethal gastrointestinal (GI) cancers, gastric cancer (GC) and colon cancer (CC), are ranked in the top five cancers that cause deaths worldwide. Most GI cancer deaths can be reduced by earlier detection and more appropriate medical treatment. Unlike the current “gold standard” techniques, non-invasive and highly sensitive screening tests are required for GI cancer diagnosis. Here, we explored the potential of metabolomics for GI cancer detection and the classification of tissue-of-origin, and even the prognosis management.MethodsPlasma samples from 37 gastric cancer (GC), 17 colon cancer (CC), and 27 non-cancer (NC) patients were prepared for metabolomics and lipidomics analysis by three MS-based platforms. Univariate, multivariate, and clustering analyses were used for selecting significant metabolic features. ROC curve analysis was based on a series of different binary classifications as well as the true-positive rate (sensitivity) and the false-positive rate (1-specificity).ResultsGI cancers exhibited obvious metabolic perturbation compared with benign diseases. The differentiated metabolites of gastric cancer (GC) and colon cancer (CC) were targeted to same pathways but with different degrees of cellular metabolism reprogramming. The cancer-specific metabolites distinguished the malignant and benign, and classified the cancer types. We also applied this test to before- and after-surgery samples, wherein surgical resection significantly altered the blood-metabolic patterns. There were 15 metabolites significantly altered in GC and CC patients who underwent surgical treatment, and partly returned to normal conditions.ConclusionBlood-based metabolomics analysis is an efficient strategy for GI cancer screening, especially for malignant and benign diagnoses. The cancer-specific metabolic patterns process the potential for classifying tissue-of-origin in multi-cancer screening. Besides, the circulating metabolites for prognosis management of GI cancer is a promising area of research.

MRI Evaluation of Soft Tissue Tumors and Tumor-Like Lesions of Extremities.

The current study aimed to evaluate the use of magnetic resonance imaging (MRI) in the diagnosis of extremity soft tissue tumors and tumor-like abnormalities. This prospective observational study of 71 patients with soft tissue lesionsof extremities was conducted at a tertiary hospital and teaching center in western India after obtaining Institutional Ethical Committee (IEC) clearance. All patients underwent an MRI of the region of interest on Siemens Magnetom Vida 3 Tesla MRI (Erlangen, Germany). MRI findings and diagnosis were correlated clinically and with histopathological examination. A total of 71 patients (49 males and 22 females) in the age group of six to 90 years were included in our study. Out of 44 patients with soft tissue tumors, the most common lesion was neurofibroma (18.1%), followed by lipoma and undifferentiatedsarcoma (9.1% each). Liposarcoma, myxoid liposarcoma, giant cell tumor of the tendon, pigmented villonodular synovitis, and schwannoma were seen in 4.5% of patients each. The soft tissue tumor-like lesions were seen in 27 (38%) patients, the most common being slow-flow vascular malformation, which was seen in 9/27 (33%) patients. The second most common pathology was actinomycosis, seen in four (14.8%) patients. Out of 44 patients with soft tissue tumors, 27 (61.4%) were benign and 17 (38.6%) were malignant.Tumor size of more than 5 cm was more commonly seen in malignant tumors (70.5%) than benign tumors (40.7%). The smooth margin was more common in benign tumors (70.3), while most malignant tumors (70.5%) had irregular or lobulated margins.Heterogenous enhancement was more common in malignant tumors (82.3%) than benign tumors (62.9). The odds of a benign histopathological diagnosis for a tumor suspected to be benign by MRI were 93.75 times higher than the odds of a benign histopathological diagnosis for a tumor suspected to be malignant by MRI. MRI is extremely useful in the evaluation of different soft tissue masses and helps in evaluating the characteristics of the masses, their extent and relationship to surrounding structures, and bone destruction, multiplicity, composition, and enhancement pattern. The systematic imaging analysis approach helps to differentiate a benign lesion from a malignant lesion and also in differentiating various soft tissue tumor mimics.

479 Insomnia and Depression Trajectories in Women with and without Breast Cancer: Protective Effects of Satisfying Relationships

OBJECTIVES/GOALS: Breast cancer survivors have a high risk for chronic disease and early mortality, especially if their psychological and physical symptoms persist beyond treatment. We compared survivors’and noncancer patient controls’health trajectories. We also examined how their relationship satisfaction—a key health determinant—impacted their health. METHODS/STUDY POPULATION: In this longitudinal study, participants were women who were married/domestic partners with an initial suggestive test of cancer identified at cancer clinics. After follow-up testing, women received either a malignant diagnosis (cancer survivors; n=139, stages 0–IIIC) or benign diagnosis (noncancer patient controls; n=69). Breast cancer survivors completed a baseline visit prior to beginning cancer treatment and two follow-up visits 6 and 18 months after treatment ended (surgery, radiation, or chemotherapy, whichever came last); noncancer patient controls completed visits within a comparable timeframe. At each visit, all women completed self-report questionnaires assessing their relationship satisfaction, insomnia, and depressive symptoms. RESULTS/ANTICIPATED RESULTS: We used mixed models and adjusted for participant age, comorbidities, cancer treatment and stage, BMI, and menopause status. At the pre-treatment visit, cancer survivors reported greater depressive symptoms than noncancer patient controls. Cancer survivors’depressive symptoms also decreased over time and were higher before treatment than at the 6- and 18-month post-treatment visits. Insomnia in cancer survivors, but not noncancer patient controls, decreased over time: insomnia was higher at the pre-treatment and 6-months post-treatment visits relative to the 18-month post-treatment visit. Survivors, but not noncancer patient controls, had lower depressive symptoms and insomnia at visits when they reported higher satisfaction than at visits when they reported lower satisfaction. DISCUSSION/SIGNIFICANCE: Cancer survivors had poorer psychological health than those without cancer before treatment, but survivors’psychological and physical health improved after finishing treatment. Survivors’satisfying relationships predicted better psychological and physical health, demonstrating the notable health benefits of survivors’relationships.