Nodule Diameter Research Articles

Machine Learning Model for Risk Stratification of Papillary Thyroid Carcinoma Based on Radiopathomics.

This study aims to develop a radiopathomics model based on preoperative ultrasoundand fine-needle aspiration cytology (FNAC) images to enable accurate, non-invasive preoperative risk stratification for patients with papillary thyroid carcinoma (PTC). The model seeks to enhance clinical decision-making by optimizing preoperative treatment strategies. A retrospective analysis was conducted on data from PTC patients who underwent thyroidectomy between October 2022 and May 2024 across six centers. Based on lymph node dissection outcomes, patients were categorized into high-risk and low-risk groups. Initially, a clinical predictive model was established based on the maximum diameter of the thyroid nodules. Radiomics features were extracted from preoperative two-dimensional ultrasound images, and pathomics features were extracted from 400x magnification H&E-stained tumor cell images from FNAC. The most predictive radiomics and pathomics features were identified through univariate analysis, Pearson correlation analysis and LASSO algorithm. The most valuable radiopathomics features were then selected by combining these predictive features. Finally, machine learningwith the XGBoost algorithm was employed to construct radiomics, pathomics, and radiopathomics models. The performance of the models was evaluated using the area under the curve (AUC), decision curve analysis, accuracy, specificity, sensitivity, positive predictive value, and negative predictive value. A total of 688 PTC patients were included, with 344 classified as intermediate/high-risk and 344 as low-risk. The multimodal radiopathomics model demonstrated excellent predictive performance, with AUCs of 0.886 (95% CI: 0.829-0.924) and 0.828 (95% CI: 0.751-0.879) in two external validation cohorts, significantly outperforming the clinical model (AUCs of 0.662 and 0.601), radiomics model (AUCs of 0.702 and 0.697), and pathomics model (AUCs of 0.741 and 0.712). The radiopathomics model exhibits significant advantages in accurately predicting preoperative risk stratification in PTC patients. Its application is expected to reduce unnecessary lymph node dissection surgeries, optimize treatment strategies, and improve therapeutic outcomes.

An early lung cancer diagnosis model for non-smokers incorporating ct imaging analysis and circulating genetically abnormal cells (CACs)

BackgroundAn increase in the prevalence of lung cancer that is not smoking-related has been noticed in recent years. Unfortunately, these patients are not included in low dose computer tomography (LDCT) screening programs and are not actually considered in early diagnosis. Therefore, improved early diagnosis methods are urgently needed for non-smokers. It is necessary to establish a prediction model for non-smoking individuals at intermediate to high risk of developing lung cancer (LC) and develop a tool to address the significant gap in evaluating pulmonary nodules in non-smokers.MethodsWe retrospectively investigated 1121 patients with pulmonary nodules, who underwent LDCT examinations between September 2019 and March 2023. Five artificial intelligence (AI) algorithms were used to build two kinds of models and identify which one was better at diagnosing non-smoking pulmonary nodules patients. In the first model, we assigned 554 non-smoking individuals to a training cohort and 150 non-smoking patients to an independent validation cohort. The second model included 971 patients for the training set and 150 non-smoking patients for an independent validation set. All LDCT images of participants were obtained for AI analysis. AI of LDCT scans, liquid biopsy, and clinical characteristics were collected for model building.ResultsAmong LC patients, 58,4% were non-smokers. Non-smoking patients had a high incidence of LC (71.4%), and women showed a significant excess risk compared with non-smoking men in terms of LC risk. Furthermore, our results indicated that the model built using random forest (RF) method, which integrates clinical characteristics (age, extra-thoracic cancer history, gender), radiological characteristics of pulmonary nodules (nodule diameter, nodule count, upper lobe location, malignant sign at the nodule edge, subsolid status), the artificial intelligence analysis of LDCT data, and liquid biopsy achieved the best diagnostic performance in the independent external non-smokers validation cohort (sensitivity 92%, specificity 97%, area under the curve [AUC] = 0.99).ConclusionsThese results could significantly improve early non-smoker LC diagnosis and treatment for non-smoker patients with malignant nodules. The established multi-omics model is a noninvasive prediction tool for non-smoking malignant pulmonary nodule diagnosis. Validation revealed that these models exhibited excellent discrimination and calibration capacities, especially the first model built using the RF method, suggesting their clinical utility in the early screening and diagnosis of non-smoking LC.

Natural History and Long Term Follow-Up of Incidental Thyroid Nodules on Computed Tomography Imaging.

incidental thyroid nodules (ITNs) are found in up to 25% of CT scans. Increased use of cross-sectional imaging has contributed to the increased incidence of thyroid cancer worldwide. ITNs pose a management dilemma since nodule malignancy rate is 5-15% but most cancers are indolent and prognosis in differentiated thyroid cancer is excellent. Study aims are to determine prevalence of ITNs ≥1 cm on CT scans, evaluate reporting practices, assess for emergence of clinically evident thyroid cancer during 13-year follow-up and assess interim nodule growth and clinical outcomes in nodules that were further investigated. direct image review of 1499 consecutive CT scans that included the thyroid, performed during January 2009 in a large NHS health board was performed. Clinical data up to January 2022 was analysed in 150 patients with at least one ITN > =1cm. ITN prevalence was 11% with mean patient age 70 years and mean nodule diameter 17.5 mm. 30% of ITNs were mentioned in the CT report. During the follow-up period 11% proceeded to thyroid ultrasound, 5% fine needle aspiration and 2% diagnostic hemithyroidectomy with no thyroid malignancy found. 120 patients (80%) were deceased by the study endpoint, none from thyroid malignancy. No patients presented with clinically evident thyroid malignancy during follow-up. None of150 ITN cases developed clinically evident thyroid malignancy in a 13-year follow-up period with 80% of patients deceased by the study endpoint from non-thyroid causes. This would suggest that ITNs detected on CT do not require further investigation unless malignant appearances or significant clinical concern for thyroid malignancy.

Ultrasound-guided needle positioning confirmation with injection of saline solution for nodal dynamic contrast-enhanced MR-lymphangiography in pediatric patients.

To assess the success rate of confirmation of ultrasound-guided intranodal needle positioning by saline injection for dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) in pediatric patients. Data from children undergoing nodal DCMRL after ultrasound-guided needle positioning into inguinal lymph nodes and validation of the needle position by injection of plain saline solution between 05/2020 and 12/2022 were reviewed. On injection of saline solution, adequate needle position was confirmed by lymph node distension without leakage. Detection rates and lymph node diameters were recorded. Technical success of needle placement was defined as enhancement of ipsilateral iliac draining lymph vessels on DCMRL, while clinical success was based on enhancement of central lymphatics and/or lymphatic pathologies being observed. One hundred sixteen DCMRLwere performed in 90 children (58 male, mean age 6.1 years, range 3 weeks-18 years). In 232/232 groins lymph nodes were identified on ultrasound with a mean diameter of 2.5 mm (smallest diameter 1 mm in n = 24 patients). Due to skin inflammation, no puncture was performed in 2/232 groins. Saline injection showed lymph node distension in 230/230 punctured nodes. On MR contrast injection enhancement of draining lymph vessels was seen in 228/230 nodes. In 1/230 nodes, in-bore needle retraction led to lymphatic enhancement, so a total of 229/230 needle placements were technically successful. One of the 230 DCMRLs was successful with only a unilateral contrast application. Overall, 116/116 DCMRLs were clinically successful. Confirmation of ultrasound-guided needle positioning for nodal DCMRL using saline injection is a reliable technique with a very high success rate in pediatric patients with small lymph nodes. Question Evaluation of ultrasound-guided injection needle positioning for dynamic contrast-enhanced MR-lymphangiography in children requires validation. Findings Confirmation of needle positioning by ultrasound-guided saline injection is a reliable technique with a very high success rate for MR-lymphangiography in pediatric patients. Clinical relevance Intranodal needle position for dynamic contrast-enhanced lymphangiography can be confirmed with a very high success rate using saline injection alone in a pediatric cohort.

Preoperative CT lymph node size as a predictor of nodal metastasis in resectable Colon cancer: a retrospective study of 694 patients

PurposeThis study aimed to investigate the efficacy of measuring lymph node size on preoperative CT imaging to predict pathological lymph node metastasis in patients with colon cancer to enhance diagnostic accuracy and improve treatment planning by establishing more reliable assessment methods for lymph node metastasis.MethodsWe retrospectively analyzed 1,056 patients who underwent colorectal resection at our institution between January 2004 and March 2020. From this cohort, 694 patients with resectable colon cancer were included in the study. We analyzed the relationship between lymph node size on preoperative CT imaging and lymph node metastasis identified on postoperative pathological examination.ResultsThe optimal cutoff values for the maximum long diameter and short diameter of regional lymph nodes on preoperative CT were identified as 6.5 mm and 5.5 mm, respectively, with an AUC of 0.7794 and 0.7755, respectively. Notably, the predictive accuracy varied by tumor location. Higher cutoff values were observed in the right-sided colon (maximum long diameter: 7.7 mm, maximum short diameter: 5.9 mm) compared to the left-sided colon (maximum long diameter: 5.8 mm, maximum short diameter: 5.2 mm).ConclusionLymph node size on preoperative CT is a significant predictor of pathological lymph node metastasis in colon cancer. Notably, the optimal cutoff values for predicting lymph node metastasis vary depending on the specific region within the colon.

Kirsten Rat Sarcoma Virus Mutations Effect On Tumor Doubling Time And Prognosis Of Solid Dominant Stage I Lung Adenocarcinoma.

To analyze the impact of Kirsten-Rat-Sarcoma Virus (KRAS) mutations on tumor-growth as estimated by tumor-doubling-time (TDT) among solid-dominant clinical-stage I lung adenocarcinoma. Moreover, to evaluate the prognostic role of KRAS mutations, TDT and their combination in completely-resected pathologic-stage I adenocarcinomas. In this single-center retrospective analysis, completely resected clinical-stage I adenocarcinomas presenting as solid-dominant nodules (consolidation-to-tumor ratio > 0.5) in at least 2 preoperative computed-tomography scans were enrolled. Nodules' growth was scored as fast (TDT < 400 days) or slow (TDT > 400 days). KRAS-mutated adenocarcinomas were identified with next-generation sequencing. Logistic- and Cox-regressions were used to identify predictors of fast-growth and disease-free survival (DFS), respectively. Among 151 patients, 83 (55%) had fast-growing nodules and 64 (42.4%) were KRAS-mutated. Fast-growing nodules outnumbered in the KRAS-mutated group (n = 45; 70.3%), median TDT 95-days (interquartile range, IQR 43.5-151.5) compared to the KRAS wild-type group (38, 43.7%), median TDT 138-days (IQR 70.3-278.5). KRAS-mutations predicted faster-growth at multivariable analysis (P = .009). In a subgroup analysis including 108 pathologic-stage I adenocarcinomas, neither KRAS-mutations (P = .081) nor fast-growing pattern (P = .146) affected DFS. Nevertheless, the association of KRAS-mutations and fast-growing pattern identified a subgroup of patients with worse DFS (P = .02). The combination of fast-growing and KRAS-mutations (hazard-ratio 2.97 [95%CI 1.22-7.25]; P = .017) and average nodule diameter at diagnosis (hazard-ratio 1.08 [95%CI 1.03-1.14]; P = .004) were independent predictors of worse DFS. KRAS mutations are associated to faster growth, in clinical-stage I adenocarcinoma presenting at diagnosis as solid-dominant nodules undergoing complete resection. Moreover, faster-growth identifies a subgroup of pathologic-stage I KRAS-mutated adenocarcinomas with higher recurrences.

Maximum Diameter of Ileocecal Lymph Nodes Measured Using Abdominal Ultrasonography Allows for the Discrimination of Yersinia pseudotuberculosis Infection from Kawasaki Disease.

This study aimed to determine whether the maximum diameter of ileocecal lymph nodes measured using abdominal ultrasonography is useful for differentiating Yersinia pseudotuberculosis infection from Kawasaki disease in the acute phase. The optimal maximum diameter cutoff of the ileocecal lymph nodes was also explored to optimize differentiation between these 2 diseases. We included pediatric patients <15 years old who met the diagnostic criteria for Kawasaki disease. Stool culture testing, loop-mediated isothermal amplification of stool specimens, and serological diagnosis were performed to confirm the presence or absence of Y. pseudotuberculosis infection. Of the 122 patients included in the analysis, 17 were confirmed to have Y. pseudotuberculosis infection and 105 were not. The age (in months), white blood cell count, C-reactive protein level, prediction score (risk score) for nonresponse to intravenous immunoglobulin, and number of intravenous immunoglobulin doses did not differ significantly between the Y. pseudotuberculosis -positive and -negative groups. The maximum diameter of ileocecal lymph nodes was 6.0 (5.5-9.5) mm in the Y. pseudotuberculosis -positive group and 3.0 (2.5-3.8) mm in the Y. pseudotuberculosis -negative group (numbers presented as median, interquartile range), with a significantly larger diameter in the Y. pseudotuberculosis -positive group ( P < 0.01, Mann-Whitney U test), suggesting potency of ultrasonography. In patients meeting the diagnostic criteria for Kawasaki disease, the possibility of Y. pseudotuberculosis infection is significantly higher if the maximum ileocecal lymph node diameter ≥5.1 mm. Its sensitivity and specificity being 100%, and 89.5%, respectively.

Exploration of optimal thresholds for predicting the invasive nature of stage T1 lung adenocarcinoma using artificial intelligence-based 3D solid component volume segmentation.

The accuracy of intraoperative rapid frozen pathology is suboptimal, and the assessment of invasiveness in malignant pulmonary nodules significantly influences surgical resection strategies. Predicting the invasiveness of lung adenocarcinoma based on preoperative imaging is a clinical challenge, and there are no established standards for the optimal threshold value using the threshold segmentation method to predict the invasiveness of stage T1 lung adenocarcinoma. This study aimed to explore the efficacy of three-dimensional solid component volume (3D SCV) [calculated by artificial intelligence (AI) threshold segmentation method] in predicting the aggressiveness of T1 lung adenocarcinoma and to determine its optimal threshold and cut-off point. A retrospective case-control analysis was conducted on 1,179 confirmed T1 lung adenocarcinoma nodules from two centers. AI-based threshold segmentation was used to calculate seven sets of solid component volume data (V-550, V-450, V-350, V-250, V-150, V-50, V0) at seven computed tomography (CT) threshold values (-550, -450, -350, -250, -150, -50, 0 HU). The receiver operating characteristic (ROC) curve was employed to explore the optimal threshold value for predicting the invasiveness of T1 lung adenocarcinoma based on solid component volume. Subgroup analysis was performed according to the diameter of the pulmonary nodule, divided into T1a (≤10 mm), T1b (10 mm < T1b ≤20 mm), and T1c (20 mm < T1b ≤30 mm), to investigate the optimal threshold for each subgroup. The solid component volume was a stable predictive factor for the invasiveness of T1 lung adenocarcinoma. The optimal threshold value for predicting the invasiveness of T1 lung adenocarcinoma using AI-based 3D SCV segmentation was -350 HU, with an area under the curve (AUC) and 95% confidence interval (CI) of 0.930 (0.915-0.945), a cut-off value of 106.5 mm3, a sensitivity of 88.462%, and a specificity of 83.853%. For the T1a subgroup, the optimal threshold was -450 HU, with an AUC of 0.926, a cut-off value of 204.5 mm3, a sensitivity of 85.269%, and a specificity of 87.013%. For the T1b subgroup, the optimal threshold was -250 HU, with an AUC of 0.922, a cut-off value of 106 mm3, a sensitivity of 89.726%, and a specificity of 82.266%. For the T1c subgroup, the optimal threshold was -350 HU, with an AUC of 0.961, a cut-off value of 472 mm3, a sensitivity of 95.652%, and a specificity of 83.529%. The -350 HU threshold is reasonable for predicting the invasiveness of T1 lung adenocarcinoma based on solid component volume using the threshold segmentation method. However, there are certain differences in the threshold values depending on the diameter of the pulmonary nodule.

Differentiating Pulmonary Nodule Malignancy Using Exhaled Volatile Organic Compounds: A Prospective Observational Study.

Advances in imaging technology have enhanced the detection of pulmonary nodules. However, determining malignancy often requires invasive procedures or repeated radiation exposure, underscoring the need for safer, noninvasive diagnostic alternatives. Analyzing exhaled volatile organic compounds (VOCs) shows promise, yet its effectiveness in assessing the malignancy of pulmonary nodules remains underexplored. Employing a prospective study design from June 2023 to January 2024 at the Affiliated Hospital of Yangzhou University, we assessed the malignancy of pulmonary nodules using the Mayo Clinic model and collected exhaled breath samples alongside lifestyle and health examination data. We applied five machine learning (ML) algorithms to develop predictive models which were evaluated using area under the curve (AUC), sensitivity, specificity, and other relevant metrics. A total of 267 participants were enrolled, including 210 with low-risk and 57 with moderate-risk pulmonary nodules. Univariate analysis identified 11 exhaled VOCs associated with nodule malignancy, alongside two lifestyle factors (smoke index and sites of tobacco smoke inhalation) and one clinical metric (nodule diameter) as independent predictors for moderate-risk nodules. The logistic regression model integrating lifestyle and health data achieved an AUC of 0.91 (95% CI: 0.8611-0.9658), while the random forest model incorporating exhaled VOCs achieved an AUC of 0.99 (95% CI: 0.974-1.00). Calibration curves indicated strong concordance between predicted and observed risks. Decision curve analysis confirmed the net benefit of these models over traditional methods. A nomogram was developed to aid clinicians in assessing nodule malignancy based on VOCs, lifestyle, and health data. The integration of ML algorithms with exhaled biomarkers and clinical data provides a robust framework for noninvasive assessment of pulmonary nodules. These models offer a safer alternative to traditional methods and may enhance early detection and management of pulmonary nodules. Further validation through larger, multicenter studies is necessary to establish their generalizability. Number ChiCTR2400081283.

The value of MR neuroimaging in image evaluation of facial neuritis

Objective:To exploring the value of MR neuroimaging for quantitative assessment of the facial nerve and peripheral lymph nodes in patients with acute peripheral facial paralysis. Methods:Based on a prospective experimental design, 32 patients with idiopathic peripheral facial palsy were enrolled in the experiment. Based on MR neuroimaging technology, MR high-resolution thin-layer images of bilateral facial nerves were acquired. The diameters of different segments of the bilateral facial nerve were measured, including the labyrinthine segment, the geniculate ganglion, the horizontal segment, the vertical segment, the stem-mammary foramen segment, the trunk of the parotid segment, the temporal trunk, and the cervical trunk, as well as the quantitative indicators of peri-auricular and parotid lymph nodes（number, length and diameter of the largest lymph nodes）. Differences in quantitative indices of nerve diameter and peripheral lymph nodes between the paraplegic and healthy sides were compared using the paired t-test and Wilcoxon signed rank test. Results:The diameter of geniculate ganglion, mastoid foramen stem, parotid main trunk, temporal facial trunk, and cervical facial trunk were notably increased on the facial paralysis side compared to the contralateral side（P<0.05）. However, no significant differences were observed in the diameter of labyrinthine segment, horizontal segment, or vertical segment compared to the contralateral side. There were significantly more periauricular lymph nodes on the facial paralysis side than the contralateral side（P=0.001）. Conclusion:MR neuroimaging enables the quantitative assessment of structural changes in the facial nerve of patients with acute peripheral facial paralysis, demonstrating nerve enlargement in the geniculate ganglion, stylomastoid foramen segment, main trunk of the parotid segment, temporal facial trunk, and cervical facial trunk. Additionally, an increased number of periauricular lymph nodes is observed on the affected side. These findings may aid clinicians in assessing the efficacy of treatments and predict the prognosis of these patients.

Investigating the optimal maximum diameter of benign thyroid nodules for thermal ablation on the basis of complete disappearance rate

Objective Thermal ablation (TA) is a safe and effective treatment for benign thyroid nodules (BTNs). However, there has been no consensus on the optimal maximum diameter (MD) of BTNs for TA. This study aimed to identify the optimal MD of BTNs for TA based on complete disappearance rate after TA. Materials and methods This retrospective study included 639 BTNs treated with TA from June 2014 to January 2022. The complete disappearance rate of BTNs after TA was summarized, related influencing factors were explored, and the optimal MD of BTNs for TA was identified. Results At the final follow-up (median: 40 months, range: 24–95 months), the overall volume reduction rate was 95.4 ± 9.0%, and 50.5% of the BTNs (323/639) completely disappeared. The MD was significantly negatively correlated with complete disappearance (odds ratio 0.89, 95% confidence interval 0.87–0.92; p < 0.001). Calcification, comet-tail artifacts, multilocular cysts, and composition of BTNs, as well as diabetes were negatively correlated with complete disappearance. Restricted cubic spline indicated that an MD of 25.0 mm was the optimal threshold of BTNs for TA, which was confirmed by subgroup logistic regression analysis. Compared with BTNs with MD ≤ 25.0 mm, those with MD > 25.0 mm had a greater complication rate (6.5% vs. 2.4%, p = 0.012). Conclusions The MD of BTNs was negatively correlated with complete disappearance after TA; an MD > 25.0 mm indicated a reduced likelihood of complete disappearance compared with an MD ≤ 25.0 mm. An MD of 25.0 mm is an appropriate threshold of BTNs for TA on the basis of complete disappearance rate.

Assessment of Rat Spleen Structure under an Isolated and Combined Action of Selenium and Ethyl Carbamat

The immune system, having a complex structural organization, performs the main functions in providing an anti-inflammatory and antitumor immune response. The spleen, as a peripheral organ of the immune system, plays an important role in realization of these functions and contains a significant number of immune cells. Ethylcarbamate, being a group 2A carcinogen, can provoke the development of neoplastic processes through activation of Kras gene mutation and stimulation of oncogenic signals. Alongside with that, selenium affects the immune response, reducing the proliferation of tumor cells and producing an anti-inflammatory effect. Despite the existence of several studies on the effect of ethyl carbamate and selenium on the animal body, there is no data on the combined effect of these substances on the rat spleen under experimental conditions in the scientific literature. The aim of the study was to evaluate morphological and morphometric changes in the structure of the spleen in male rats with oral administration of selenium into their body and intraperitoneal injection of ethyl carbamate. Materials and methods of the study. The body mass of male rats and their spleen were studied, morphological and morphometric parameters of the spleen were evaluated, the lymphoid coefficient and the Kernoghan index were calculated. The animals were divided into four groups: N1 – control group; N2 – animals receiving selenium with drinking water; N3 – animals injected intraperitoneally with ethyl carbamate; N4 – animals receiving selenium with drinking water followed by injection of ethyl carbamate. Results. It was found that in the group 2, the area of lymphoid nodules was reduced, the Kernoghan index was reduced and the lymphoid coefficient was increased, while the body weight of rats and their spleen remained unchanged. In a month after an isolated intake of ethyl carbamate, both the body weight and the spleen weight in rats were significantly decreased. At this, in group 3, the area and the diameter of the germinal center, the thickness of the periarterial lymphoid sheath and the Kernoghan index were increased, and the lymphoid coefficient was reduced. At the ultramicroscopic level, an increase in the number of plasma cells was detected in group N3, as well as the number of swollen mitochondria in lymphocytes. In group 4, an increase in the area and the diameter of lymphoid nodules, the germinal center, as well as the lymphoid coefficient was determined, and the Kernoghan index was unchanged. When studying ultrathin sections in group 4 lymphocytes of various transitional forms were revealed. Conclusions. It was found that against the background of selenium intake into the body of male rats, a morphological rearrangement of the white pulp of the spleen occurred, probably associated with the reaction of T-lymphocytes. Ethyl carbamate injection resulted in a predominant effect on the B-cell link of the immune response of the spleen. In combined intake of selenium and ethyl carbamate, hyperplasia of the white pulp was revealed, consisting in an increase in its structures.

Changes in the Volume and Diameter of Benign Thyroid Nodules: A 10-Year Follow-Up Study.

Background: The incidence of asymptomatic thyroid nodules has risen enormously, with > 90% being benign. Despite limited long-term data, significant nodule growth (SNG) is common. Guidelines recommend cytology reevaluation if SNG occurs. Our study aimed to identify the rate and factors associated with SNG, compare diameter and volume-based assessments, and examine the association between SNG and malignancy risk over the long term (10 years). Methods: The retrospective cohort study, conducted at Ankara University, School of Medicine, Department of Endocrinology and Metabolism, included 732 nodules from 376 euthyroid patients, all monitored over a 10-year period by the same experienced sonographer, with evaluations at baseline, 5th and 10th years. The nodules were cytologically benign and/or sonographically in the low-to-intermediate risk category. Size changes at the 5th and 10th years were considered significant if there was a 20% or 2 mm increment in two diameters according to diameter-based criterion (DBC) or 50% increment in volume-based criterion (VBC) designed by the ellipsoid formula. Generalized linear mixed-effects models were used to account for the clustered data structure and analyze factors affecting nodule growth. Nodule growth was the dependent variable, while sex, age at diagnosis, initial TSH level, total nodule count, nodule volume, echogenicity, and localization were independent variables. Results: At the 5th and 10th years, SNG frequencies were higher when calculated using VBC [27.7% (n = 203) and 44% (n = 321), respectively] compared with DBC [19.1% (n = 140) and 35% (n = 256), respectively], with the differences being statistically significant (McNemar test, p < 0.01). Factors associated with SNG included being younger than 45 years of age (VBC OR = 1.704, CI = 1.227-2.366, p = 0.002; DBC OR = 1.913, CI = 1.379-2.656, p < 0.001), having higher number of nodules (VBC: OR = 1.171, CI = 1.061-1.291, p = 0.002; DBC: OR = 1.147, CI = 1.040-1.265, p = 0.006), and having smaller nodule volume (VBC: OR = 0.870, CI = 0.806-0.940, p < 0.001; DBC: OR = 0.912, CI = 0.850-0.978, p = 0.010). Thyroid cancer was diagnosed in four original nodules (0.5%), whereas the malignancy rate in biopsies performed was 1.4% (n = 4). Conclusions: In long-term follow-ups of sonographically and/or cytologically benign thyroid nodules, SNG is not rare. Growth is more likely in younger patients, those with higher number of nodules and smaller nodules. In the follow-up of nodule size, VBCs yield augmented results compared with DBCs. However, malignancy is quite rare in growing nodules. Therefore, adopting flexible long-term follow-up protocols appears to be practical for benign nodular thyroid disease.

Initial experience and results of robotic lateral pelvic lymph node dissection in locally advanced rectal cancer—a single center experience of 17 consecutive procedures

PurposeWe have evaluated lateral pelvic lymph node dissection (LPLND) in combination with rectal resection in the treatment of locally advanced rectal cancer in a specialized colorectal surgical department with a focus on safety and feasibility.MethodsThe study analyzed surgical-pathologic outcomes in 17 consecutive patients who underwent robotic LPLND and rectal resection between May 2018 and June 2024 at a high-volume colorectal cancer center in Denmark. Patients were selected for the procedure based on lateral lymph node (LLN) diameter ≥ 8 mm before and ≥ 5 mm after neoadjuvant treatment.ResultsOut of 17 patients (15 men and 2 females) included in this study, 13 patients (76%) had undergone neoadjuvant therapy. The median age was 63 years (range 35–79) with a median BMI of 25.6 kg/m2 (range 19.4–34.5). The total median operation time was 335 min (range 182–526 min) with no conversions necessary. Additional resection of structures beyond the total mesorectal excision plane was performed in eight patients (47%). The median hospital stay was 4 days (range 2–14) and one patient was readmitted within 30 days. Seven patients experienced postoperative complications within 30 days, with only one CD complication ≥ grade 3. The median number of resected LLNs was 4 (range 0–11) per patient and malignant LLNs were verified in three patients (17.6%).ConclusionThis study shows that simultaneous robot-assisted LPLND and rectal resection can be performed safely and effectively in selected patients with locally advanced rectal cancer, with a short hospital stay and few readmissions and postoperative complications.

Correlation Between Ultrasound Manifestations and Traditional Chinese Medicine Syndrome Differentiation of Breast Nodules

&amp;lt;i&amp;gt;Background &amp;lt;/i&amp;gt;Breast nodules are a health issue that concerns women, and clinical practice entails great concern for accurate diagnosis and appropriate prevention and treatment. This study examined the correlation between ultrasound manifestations and traditional Chinese medicine (TCM) syndrome differentiation of breast nodules. &amp;lt;i&amp;gt;Methods &amp;lt;/i&amp;gt;This study included 128 patients with breast nodules based on ultrasound-dependent Breast Imaging-Reporting and Data System (BI-RADS) grading and ultrasound elastography (UE) scoring. This study explored the correlation of syndrome differentiation with age, medical history, nodule size, morphology, boundary status, blood flow signals, BI-RADS grading, and UE score. &amp;lt;i&amp;gt;Results &amp;lt;/i&amp;gt;Age and medical history were significantly correlated with TCM syndrome differentiation. Patients with the Chong–Ren imbalance syndrome were older, and those with the phlegm–blood stasis syndrome had the longest disease course. The maximum nodule diameter was not correlated with TCM syndrome differentiation. Furthermore, nodule blood flow signal, BI-RADS grading, and UE scoring were significantly correlated with TCM syndrome differentiation. Patients with the phlegm–blood stasis syndrome had the highest proportion of those with “blood flow signal,” BI-RADS Grade 4, and UE score of four points. Furthermore, the morphology and boundary state of the nodules were not correlated with TCM syndrome differentiation. &amp;lt;i&amp;gt;Conclusio&amp;lt;/i&amp;gt;n Age, medical history, ultrasound blood flow signals, BI-RADS grading, and UE scoring were correlated with TCM syndrome differentiation in patients with breast nodules, particularly for BI-RADS Grade 4 and UE 4-point nodules, the prevalence of phlegm–blood stasis syndrome is at its highest. After excluding malignant transformation, patients with breast nodules at risk of cancer can receive preventive TCM treatment.

Primary retroperitoneal lymph node dissection in clinical stage 2a/b non-seminomatous germ cell tumour.

To reassess the role of primary retroperitoneal lymph node dissection (RPLND) in patients with marker-negative non-seminomatous germ cell tumour (NSGCT) clinical stage (CS) 2a, to explore results in patients with CS 2b and to evaluate surgical methods, recurrence, and adjuvant chemotherapy indications. Data from 17 institutions were collected, comprising 305 men who underwent primary RPLND for CS 2 NSGCT. Regression analyses were conducted to predict histology in the RPLND specimen and disease-free survival (DFS). A larger retroperitoneal lymph node diameter was associated with pure teratoma in the RPLND specimen (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.07; P = 0.03), but no association was observed with DFS. The 5-year DFS rates in marker negative CS 2a and 2b were 79% and 76%. In men with non-teratomatous viable cancer in the RPLND specimen, the 5-year DFS rates for CS 2a and 2b were 95% and 87% with adjuvant chemotherapy, and 67% and 74% without adjuvant chemotherapy. We did not identify an association between the number of adjuvant chemotherapy cycles and DFS. Our study suggests considering primary RPLND not only in marker-negative CS 2a but also in CS 2b. Further research should determine the efficacy of primary RPLND in men with CS 2c and marker-positive CS 2, as well as which patients may benefit from adjuvant chemotherapy and the optimal cycle number.

Identification of QTLs and Key Genes Enhancing Lodging Resistance in Soybean Through Chemical and Physical Trait Analysis

Lodging of soybean (Glycine max (L.) Merril.) significantly reduces seed yield and quality, particularly in high-yielding environments. This phenomenon occurs when stems weaken under the weight of the plants, complicating harvesting. This study investigated the relationship between soybean stem chemical composition, physical traits, and lodging resistance to improve yield and resilience. We found that as plant density increased, stem hardness decreased, and the elasticity increased, heightening the risk of lodging. Conversely, high temperature (28 °C) boosted lignin, cellulose and pectin content in the stem cell walls, enhancing the lodging resistance. Additionally, after excluding differences in phylogenetic relationships through cluster analysis, we mapped environment-stable genes linked to lodging resistance and identified new QTLs on Chr3 and Chr16. Candidate genes associated with these QTLs were confirmed using qRT–PCR and hormone treatments across diverse soybean varieties. It was found that the expression of stem tip genes was closely related to stem node diameter. These findings provide a theoretical foundation for breeding high-yielding soybean varieties with improved lodging resistance, and advance efforts to develop resilient soybean cultivars.

A novel tool to predict lymph node metastasis in patients with prostate cancer based on clinical and 68Ga-PSMA PET/CT parameters.

We sought to develop a model that predicts lymph node invasion (LNI) in patients with intermediate- and high-risk prostate cancer incorporating preoperative clinical and 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) parameters. A cohort of 413 consecutive patients diagnosed with prostate cancer who underwent 68Ga- PSMA PET/CT prior to radical prostatectomy from 2015-2020 was used to develop and validate the model. The cohort was split into a learning (70%) and a validation group (30%). The former was used to identify clinical and 68Ga-PSMA PET/CT parameters (number and diameter of PET-positive lymph nodes) for prediction of pathologic LNI by applying multivariable logistic regression analyses. The discrimination ability of the model was evaluated using the area under the receiver operating characteristic (ROC) curve and internal validation was performed using the validation cohort. One-hundred sixty-three men (39%) were categorized as high-risk, 168 (41%) as unfavorable-intermediate-risk, and 82 (20%) as favorable-intermediate-risk. Thirty-one patients (7.5%) had LNI on final pathology. All underwent extended lymph node dissection. Clinical stage, the presence of PET-positive lymph nodes, and diameter of the largest PET-positive node were included in the final predictive model. Four different categories were defined for estimating the risk for LNI. Internal validation was completed after applying the four-tire classification on both the learning and validation groups and achieving similar results. The sensitivity, specificity, positive predictive value, and negative predictive value of the model were 97%, 54%, 15%, and 99%, respectively, and area under the ROC curve was 0.906 (95% confidence interval 0.83-0.95, p<0.001). Using a 5% cutoff as a threshold for performing lymph node dissection, only one patient with LNI on final pathology would have been classified erroneously as node negative, while 206 (50%) men would have been spared an unwarranted lymph node dissection. We present a novel prediction model for LNI that incorporates clinical staging and molecular imaging data. Pending further validation, this model may improve the risk stratification and patient selection for lymph node dissection at time of radical prostatectomy.

Incidence of splenic malignancy and hemangiosarcoma in dogs undergoing splenectomy surgery at a surgical specialty clinic: 182 cases (2017-2021).

The objectives of this study were to evaluate the risk and predictive factors of splenic malignancy and hemangiosarcoma in dogs undergoing splenectomy at a surgical specialty clinic. Medical records, hematologic results, surgical reports, and histopathologic results from 182 dogs that underwent splenectomy for the treatment of splenic masses or nodules were reviewed retrospectively. The majority of dogs (57.7%) had benign splenic diagnoses with no malignancy. Hemangiosarcoma was diagnosed in 32.4% of the dogs. A final multivariable model indicated that thrombocytopenia, anemia, and a smaller diameter of the largest splenic nodule were risk factors for hemangiosarcoma (P<0.001), and hemoperitoneum (P = 0.01) was an additional risk factor when nodule diameter was not evaluated. There were 91 dogs that had hemoperitoneum, and 60.4% of those dogs had malignant splenic lesions. Of the 33 dogs that underwent a splenectomy for incidentally identified splenic lesions, 93.9% had benign splenic lesions. Breed size was not a significant predictor of splenic malignancy risk; however, all 6 of the German shepherds included in the study had a hemangiosarcoma diagnosis. Overall prevalence of splenic malignancy including HSA may be overestimated in some canine populations.

The effectiveness and safety of computed tomography-guided hook-wire localization for secondary video-assisted thoracoscopic surgery: a retrospective study.

Computed tomography (CT)-guided hook-wire localization is currently the most commonly used technique for preoperative localization of pulmonary nodules in clinical practice. With the increasing incidence of multiple primary lung cancers and the increasing occurrence of second primary lung cancers or local recurrences after lung cancer surgery, some patients need to undergo an ipsilateral or contralateral second pulmonary resection. In order to reduce the surgical difficulty of the second operation and accurately guide the surgical resection, preoperative localization of some nodules is necessary. This study retrospectively analyzed the CT-guided hook-wire localization information of patients undergoing a second ipsilateral or contralateral video-assisted thoracoscopic surgery (VATS), discussed the safety and effectiveness of hook-wire localization for ipsilateral and contralateral surgeries, and analyzed the risk factors for complications after localization. This study retrospectively collected data from 113 patients with isolated solitary pulmonary nodules who underwent a second pulmonary resection and completed CT-guided hook-wire localization at The First Affiliated Hospital of Soochow University from January 2020 to June 2024. The patients were divided into contralateral surgery group and ipsilateral surgery group to compare clinical characteristics, localization time, incidence of complications, and other information between the two groups. Logistic regression analysis was used to identify the risk factors for complications associated with the localization methods in each group. Compared to the contralateral group, the ipsilateral group had a longer interval between the two surgeries, which was 28.0±9.3 months (P<0.001). The maximum diameter of nodules in the ipsilateral group was 10.8±1.7 mm, higher than that in the contralateral group (P<0.001). There were no statistical differences between the two groups in terms of localization time, number of CT scans, depth of the release position, and incidence of complications. In the contralateral group, 25 patients (30.5%) developed pneumothorax, while in the ipsilateral group, there were 2 cases (6.5%), showing a statistically significant difference (P=0.008). In the contralateral group, 3.7% patients developed hemopneumothorax, while the incidence in the ipsilateral group was as high as 16.1% (P=0.04). Localization time [odds ratio (OR) =1.306, P=0.006] and depth of the release position (OR =1.202, P<0.001) were independent risk factors for the overall occurrence of complications and pneumothorax, while thoracic adhesions (OR =4.115, P=0.03) was an independent risk factor for hemopneumothorax. History of localization (OR =0.109, P=0.02) was identified as a protective factor for pneumothorax. CT-guided hook-wire localization can effectively complete the localization of isolated nodules on the ipsilateral or contralateral side in patients requiring a second pulmonary resection, with similar safety. In the future, it is more advisable to promote more precise and personalized localization methods for different patients in clinical practice.