High Probability Of Malignancy Research Articles

Neoplasias quísticas hepatobiliares productoras de mucina: claves diagnósticas para radiólogos

Mucin-producing cystic hepatobiliary neoplasms are rare neoplasms which include mucinous cystic neoplasms of the liver and intraductal papillary mucinous neoplasms of the bile duct.Mucinous cystic neoplasms of the liver are characterised by the presence of ovarian-like stroma, and are usually benign. They present as large, multiloculated, cystic masses without biliary communication and are more common among middle-aged women.Intraductal papillary mucinous neoplasms of the bile duct are premalignant lesions originating in the bile duct and presenting with biliary communication. There are 3 growth patterns: cystic, duct-ectatic and mass-forming. They tend to appear between the ages of 50 and 70, with no gender predilection. There is a high probability of malignancy, so segment-oriented hepatic resection is the treatment of choice.Both entities have overlapping and distinctive features, and it is important for the radiologist to be aware of these and be able to distinguish between them, as they have different prognoses and require different management approaches.

Stereotactic body radiation therapy for clinically diagnosed early‐stage non‐small cell lung cancer: Importance of accurate CT interpretation by experts

AbstractIntroductionThis study evaluated the clinical outcomes of stereotactic body radiotherapy (SBRT) for both pathologically diagnosed (PD) and clinically diagnosed (CD) early‐stage non‐small cell lung cancer (NSCLC) and explored the significance of accurate expert computed tomography (CT) interpretation.MethodsWe retrospectively analyzed 95 patients with early‐stage NSCLC who received SBRT at our institution. Patients were classified into CD and PD groups. Two chest radiologists retrospectively interpreted the pre‐SBRT CT images to determine the tumor subtype and probability of malignancy (PM). Clinical findings, CT features, and treatment outcomes were compared between the two groups. The survival rate of the CD group was analyzed separately according to the PM grade.ResultsMedian overall survival for the CD and PD groups was 6.0 and 5.4 years (P = 0.57), respectively. Median cause‐specific survival was 10.2 years in the CD group and not reached in the PD group (P = 0.76). In the CD group, lung cancer mortality was lower in the low PM group (25% [1 of 4]) than in the high PM group (47.4% [9 of 19]).ConclusionIt may be desirable to evaluate the PM of the nodule using expert CT interpretation to decide whether SBRT is indicated in CD early‐stage NSCLC.

A case of patient with suspicious, rapidly growing thyroid tumor, with a short review of the thyroid nodular disease guidelines

Thyroid nodules, also known as goitre, is the most common thyroid disease. Its prevalence depends on age, iodine supply, and availability of ultrasonography examination. The manuscript presents a case of a patient with fast-growing thyroid nodule, with ultrasonographic and cytological features suggesting high probability of malignancy, which finally turned out to be a benign one. In addition to the presented case, the EU-TIRADS guidelines and indications for hemithyroidectomy are briefly discussed.

Multivariate index assay (MIA3G) to reduce preventive surgery for ovarian cancer.

e17607 Background: Ovarian cancer (OC) – most lethal gynecologic malignancy - is rare among women with adnexal mass. Preventive adnexal surgery is a common practice, despite pathology confirming malignancy in only 10-15% of these cases. This motivates a surveillance-based clinical management paradigm to prognosticate the risk for malignancy and channel appropriately for surgery. We recently developed a multivariate index assay -MIA3G[1] - to assess risk for OC in women with adnexal mass. In a multi-center prospective surveillance trial, we assessed the concordance between preventive surgery and clinical management using MIA3G. Methods: MIA3G risk prediction uses a DNN algorithm which models 7 serum biomarkers (CA125, HE4, BM2, APO, FSH, TFR, PreAlbumin), age and menopausal status. With NPV of 99.7% (CI:99.2–99.9) it risk stratifies patients into low probability of malignancy or indeterminate. Across 11 centers, the MIA3G cohort comprised of 546 women (IQR:41-61yo) with symptomatic or asymptomatic masses and/or presence of HBOC variants. Serial blood draws were timed with clinic-visits and the ultimate one coincident with surgery. The objectives were: 1) prognosticate the MIA3G based preventive surgery pool and 2) establish concordance between the MIA3G probabilistic risk and the pathology-based outcome of malignancy versus benign. Results: In the study cohort of 546 patients, 20.3% (111) underwent preventive surgery. Conservatively, at a 12.8% FPR[1], MIA3G would have stratified approximately 70 patients, a projection of 37% less for surgery. Partitioning by clinical characteristic: (i) symptomatic: In comparison to 27.8% (73/263) of patients referred to surgery, MIA3G projections would have resulted in a 54.8%(33/263) reduction. (ii) asymptomatic: 22.5%(31/138) of patients were referred to surgery; MIA3G projections would have resulted in a 45.2% (17/138) reduction. In the 111 preventive surgeries, pathology confirmed a malignancy rate of 6.3% (7/111). The overall concordance of MIA3G with pathology was 84.68% (94/111) which increased to 91.98% (102/111) in the pre-menopausal (PRE) sub-cohort. The malignant discordancy (MIA3G:FN), all in PRE, comprised of early-stage epithelial: endometreoid, Leiomysarcoma and Sertoli-Leydig cell where the masses were characterized as cystic benign/indeterminate by ultrasound. These findings underscore the power of MIA3G when preventive surgery is considered for patients with ovarian cancer risk. Conclusions: The multivariate index assay MIA3G reduces numbers of preventative surgery for ovarian cancer risk. The high concordance establishes that MIA3G non-invasive surveillance-based clinical management can be effective for the risk assessment of ovarian cancer in patients presented with adnexal mass. Surgical management should be reserved for high probability of malignancy. [1]: DOI 10.3389/fmed.2023.1102437.

Pathological Outcomes of Eyelid Tumors Running title: Eyelid Tumors

Objectives: To evaluate and compare the pathological outcomes, demographic and clinical features of benign and malignant tumors of the eyelid. Methods: The records of patients who were operated on for eyelid tumors in the oculoplastic surgery unit of our clinic were retrospectively reviewed. The age and sex of the patient, the location and laterality of the tumor, the histopathological diagnosis of the lesion, and whether it was benign or malignant were recorded. Results: A total of 251 patients who were operated on for eyelid tumors and underwent histopathological examination were included in the study. Histopathological results showed benign eyelid tumors in 230 patients (91.6%) and malignant eyelid tumors in 21 patients (8.4%). The age of the patients in the malignant eyelid tumors group was significantly higher than in the benign eyelid tumors group (p<0.001). The localization rate on the right side was significantly higher in malignant eyelid tumors compared to benign eyelid tumors (p=0.003). The lower eyelid localization rate was significantly higher in malignant eyelid tumors than benign eyelid tumors (p<0.001). Conclusion: Although the majority of eyelid tumors are benign, the pathological results of the patients are extremely important so that malignant masses that appear benign are not overlooked. It should be kept in mind that these tumors have a high probability of malignancy, especially in advanced age and lower eyelid locations, and may lead to serious morbidity if treated late.

Differential diagnosis of benign and malignant patchy ground-glass opacity by thin-section computed tomography

BackgroundPrevious studies confirmed that ground-glass nodules (GGNs) with certain CT manifestations had a higher probability of malignancy. However, differentiating patchy ground-glass opacities (GGOs) and GGNs has not been discussed solely. This study aimed to investigate the differences between the CT features of benign and malignant patchy GGOs to improve the differential diagnosis.MethodsFrom January 2016 to September 2021, 226 patients with 247 patchy GGOs (103 benign and 144 malignant) confirmed by postoperative pathological examination or follow-up were retrospectively enrolled. Their clinical and CT data were reviewed, and their CT features were compared. A binary logistic regression analysis was performed to reveal the predictors of malignancy.ResultsCompared to patients with benign patchy GGOs, malignant cases were older (P < 0.001), had a lower incidence of malignant tumor history (P = 0.003), and more commonly occurred in females (P = 0.012). Based on CT images, there were significant differences in the location, distribution, density pattern, internal bronchial changes, and boundary between malignant and benign GGOs (P < 0.05). The binary logistic regression analysis revealed that the independent predictors of malignant GGOs were the following: patient age ≥ 58 years [odds ratio (OR), 2.175; 95% confidence interval (CI), 1.135–6.496; P = 0.025], locating in the upper lobe (OR, 5.481; 95%CI, 2.027–14.818; P = 0.001), distributing along the bronchovascular bundles (OR, 12.770; 95%CI, 4.062–40.145; P < 0.001), centrally distributed solid component (OR, 3.024; 95%CI, 1.124–8.133; P = 0.028), and well-defined boundary (OR, 5.094; 95%CI, 2.079–12.482; P < 0.001).ConclusionsIn older patients (≥58 years), well-defined patchy GGOs with centric solid component, locating in the upper lobe, and distributing along the bronchovascular bundles should be highly suspected as malignancy.

ODP024 Adrenocortical Carcinoma Identified in a Patient With Familial Adenomatous Polyposis Syndrome

Abstract Background Numerous extracolonic manifestations are associated with familial adenomatous polyposis (FAP), including benign thyroid and adrenal nodules, less commonly thyroid and adrenal cancers. We describe a case of a patient with history of FAP who was found to have malignant lesions both in the thyroid and adrenal glands. Clinical Case A 54 year-old female with familial adenomatous polyposis (FAP) underwent partial colectomy at age 16. Known extracolonic manifestation at initial presentation was limited to a dermoid tumor of the right breast. Upon evaluation by endocrinology, she was found to have a dominant thyroid nodule in the right lobe that eventually doubled in size and was positive for papillary thyroid cancer with a BRAF V600E mutation. Successful total thyroidectomy with central neck lymph node dissection was completed, and she is now undergoing routine surveillance for ATA low risk PTC. She maintained annual endoscopic surveillance with gastroenterology and underwent serial abdominal imaging studies for complaints of abdominal discomfort. Right adrenal adenoma was first identified in August 2017 and screening for functionality, to include pheochromocytoma, was negative. Repeat abdominal imaging in 2020 showed the lesion increased in size by 30%. CT imaging identified the nodule as indeterminate based on the washout characteristics (HU 27 pre-contrast, absolute washout = 13% and relative washout = 8%). A 2cm left adrenal mass was also noted with radiographic features consistent with a lipid poor, benign, adenoma (HU 33 pre-contrast, absolute washout = 58%, relative washout = 39%). PET-CT was performed to further characterize the right sided lesion, which was vividly FDG avid at 8.7 SUV (high probability of malignancy). The left adrenal nodule was mildly FDG avid with an SUV of 2.4. CT-guided biopsy of the right adrenal gland was performed and immunohistochemistry did not stain for chromogranin, inhibin, pankeratin or calretinin. Positive staining for MART-1 was seen, which is a typically associated with adrenal cortical cells. There was a high index of suspicion for malignancy given her hereditary cancer syndrome, and the decision was made to proceed with right adrenalectomy. Final surgical pathology confirmed a low grade adrenocortical carcinoma with two nodular lesions, both staining CD10 positive with the mitotic marker (Ki-67) 2-3% positive. The patient's left adrenal gland remains functionally intact, and there were no indications to pursue postoperative treatment or adjuvant therapy. Conclusion The patient presented here is representative of incidentally discovered nonfunctional adrenocortical carcinoma in the setting of a hereditary cancer syndrome. The available literature suggests that adrenocortical tumors should be considered FAP tumors, and sporadic mutations leading to adrenocortical carcinoma are less likely related to germline APC gene mutations Presentation: No date and time listed

Silicone-induced granuloma of breast implant capsule mistaken for breast implant-associated anaplastic large cell lymphoma

For patients with breast implants who present with an isolated seroma, capsular contracture, or peri-implant mass, clinicians must rule out breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). As non-malignant silicone-induced granuloma of breast implant capsule (SIGBIC) may mimic BIA-ALCL, particular care must be exercised to prevent misdiagnosis. In this report, we describe three cases of SIGBIC misdiagnosed as BIA-ALCL. In each of these cases, a preoperative evaluation including breast magnetic resonance imaging and physical examination, as well as the fact that a textured silicone implant was used in the patients, indicated a high probability of malignancy. In all three cases, however, an explorative operation and pathologic results revealed foreign body granulomas without malignant features. While it is critical that potential cases of BIA-ALCL be diagnosed and treated quickly, hasty judgments may lead to misdiagnosis and severe emotional distress in patients. Increased awareness of SIGBIC, specifically its mimicry of BIA-ALCL, may be helpful to avoid these outcomes.

Silicone-induced granuloma of breast implant capsule mistaken for breast implant-associated anaplastic large cell lymphoma

For patients with breast implants who present with an isolated seroma, capsular contracture, or peri-implant mass, clinicians must rule out breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). As non-malignant silicone-induced granuloma of breast implant capsule (SIGBIC) may mimic BIA-ALCL, particular care must be exercised to prevent misdiagnosis. In this report, we describe three cases of SIGBIC misdiagnosed as BIA-ALCL. In each of these cases, a preoperative evaluation including breast magnetic resonance imaging and physical examination, as well as the fact that a textured silicone implant was used in the patients, indicated a high probability of malignancy. In all three cases, however, an explorative operation and pathologic results revealed foreign body granulomas without malignant features. While it is critical that potential cases of BIA-ALCL be diagnosed and treated quickly, hasty judgments may lead to misdiagnosis and severe emotional distress in patients. Increased awareness of SIGBIC, specifically its mimicry of BIA-ALCL, may be helpful to avoid these outcomes.

English

BACKGROUND The diagnosis of thyroid malignancies continues to remain a challenge, due to lack of specificity with various modalities, and intrinsic variability with clinical examination. Although histopathological diagnosis is confirmatory, there is a need for pre-surgical assessment and confirmation, which will prove to be useful in decision making regarding the course of management. The present study was carried out to evaluate the validity of various modalities for detection of thyroid malignancies. METHODS This cross-sectional study was carried out among 40 patients who presented to the outpatient clinic with thyroid nodules. All the participants were evaluated by ultrasound, fine needle aspiration cytology (FNAC) and sestamibi scintigraphy. All the participants were taken up for surgery and the resected specimen was sent for histopathology for confirmatory diagnosis. RESULTS Ultrasound and FNAC detected malignancy in 25 % of the participants, while sestamibi scintigraphy detected malignancy in 30 % of the participants. Based on histopathology, the gold standard confirmatory test, malignancy was detected in 35 % of the participants. It was observed that the sensitivity was highest for FNAC (75 %) followed by TC methoxyisobutylisonitrile (TC MIBI) (50 %). Specificity was highest for FNAC (95 %) followed by ultrasound (88 %) (P &lt; 0.0001). CONCLUSIONS FNAC has the highest sensitivity and specificity while ultrasound and sestamibi have comparable specificity. There is a high probability of malignancy when the delayed image in sestamibi scintigraphy shows retention. MIBI may prove to be useful in differentiating benign and malignant follicular lesions. KEYWORDS Papillary Carcinoma, Histopathology, Thyroid Nodule, Sestamibi, FNAC

Malignancy Risk in RAS-Mutated Cytologically Indeterminate Thyroid Nodules: Real-World Clinical Experience

Introduction: Fine needle biopsy (FNB) is the standard procedure for thyroid nodules meeting criteria for biopsy according to current national guidelines (ATA and ACR). However, 15-25% of biopsies are categorized as indeterminate in the Bethesda Categories III (Atypical/FLUS) or IV (Follicular/Hurthle Neoplasm). Molecular testing is a common way to further risk stratify these nodules for surveillance versus surgical resection. BRAF-like mutations have a high probability of malignancy while RAS-like mutations have a variable risk of malignancy. This study examines the performance of RAS mutations in identifying malignancy or NIFTP in a real-world clinical setting. Methods: 2,372 sequential thyroid FNBs were performed in our center from July 2014 to June 2020. Of these, 367 were subjected to molecular testing with either Thyroseq V2 or V3. 55 RAS-mutated BCIII or IV cases were identified and retrospectively evaluated. NIFTP was considered malignant in the calculations. ATA and ACR ultrasound classification as well as Doppler grade of the study nodule were assessed. Results: 8 cases were excluded due to lack of follow-up or incomplete data. 40 underwent surgical resection based on the cytology and molecular results. 7 did not undergo surgery based on patient preference or comorbidities and had clinical follow up with stable ultrasound for at least 6 months. Surgical pathology results: 67.5% benign, 7.5% NIFTP and 25% malignant.All 4 of the Thyroseq “currently negative” RAS nodules were benign. Of the 36 “positive” cases, 6 with additional mutations had a 66.7% ROM and the 30 RAS-only cases had a 30% ROM. Of the 9 RAS-only cases that were not benign, 3 were NIFTP, 5 FVPTC (2 unencapsulated and 3 encapsulated) and 1 was angio-invasive PTC with extensive extrathyroidal extension (this case had high-risk pre-op imaging features). None had lymph node involvement.Higher allelic frequency, abnormal gene expression (GE) and copy number alterations (CNA) all increased the risk of malignancy/NIFTP; ROM was 50% when both GE and CNA were positive. Nodules that were ATA/ACR moderate and high suspicion had an approximately 40% and 67% ROM respectively with ATA and ACR performing similarly. High intra-nodular vascularity conferred a 46% ROM. Conclusions: RAS mutations represent the most frequent abnormality found in oncogene testing however isolated RAS mutations have a low risk of malignancy and when malignant are generally non-aggressive. When both GE and CNA are positive, the risk increases. US features, including Doppler also contribute to risk assessment. Combining all these features is recommended when counseling patients on active surveillance versus surgical resection of RAS-mutated thyroid nodules.

CYTOPATHOLOGICAL SPECTRUM OF NON NEOPLASTIC AND NEOPLASTIC THYROID LESIONS AT TERTIARY CARE CENTRE, GWALIOR

Background: Thyroid lesions are the important clinical problems encountered in most of patients coming to the tertiary care centre. Fine Needle Aspiration Cytology (FNAC) is the widely accepted diagnostic technique in thyroid lesions. A solitary thyroid nodule is dened as a palpable, single, clinically detectable nodule in the thyroid. They cause more concern because of high probability of malignancy in them, which can range from 5-35% of all solitary thyroid nodules. Nodular lesion comprises those disorders that produce a clinical nodule and consists of non-neoplastic hyperplasia as well as benign and malignant tumors. Aims and Objectives:To study the spectrum of clinical presentation of individuals with thyroid lesions and cytomorphological features. Material and methods: A retrospective study was carried out in cytopathology section in Department of Pathology from January 2015 to December 2017. Total 212 patients with palpable thyroid swelling referred from the OPD of J.A hospital for FNAC were included in the study. The smears made from the aspirate were air dried and stained with May-Grunwald-Giemsa (MGG) stain. Result: The present study was carried out in the Department of Pathology from January 2015 to December 2017. Out of 212 cases most common thyroid lesion was Colloid goitre 35.38%(n=75) followed by Colloid goitre with cystic changes 19.81%(n=42), Follicular Neoplasm 19.34%(n=41), Hashimoto thyroiditis 7.55%(n=16), Colloid cyst 6.13%(n=13), Infected cystic lesion 2.83%(n=6), Benign hyperplasia of thyroid 2.36%(n=5), Adenomatoid goitre 1.89%(n=4), Thyroglossal cyst 1.89%(n=4), Granulomatous thyroiditis 1.41%(n=3), Papillary thyroid carcinoma 0.94%(n=2) and least common was Lymphoma of thyroid 0.47%(n=1). Conclusion: FNAC is almost an accurate technique in diagnosis of palpable and overt thyroid lesions. Thyroid lesions are more common in females than males. Colloid goitre is the commonest thyroid lesion.

CYTO-HISTOPATHOLOGICAL CORRELATION OF THYROID LESIONS

Introduction: Thyroid nodules show an overall incidence rate of 4-7% &amp; high probability of malignancy, constituting 5% to 35%. FNAC of Thyroid is most economical and reliable preoperative procedure to distinguish between neoplastic and non- neoplastic lesion.&#x0D; Objectives: To Study Cyto-Morphology of Fine Needle Aspiration of Thyroid nodules. To find out incidence of various types of lesions as per age &amp; sex and to confirm the findings with Histomorphological diagnosis of same nodule.&#x0D; Material &amp; Methods: 100 patients with Thyroid nodule who underwent FNAC &amp; Thyroidectomy taken for an observational study from January 2019 to June 2020. The cytological findings were correlated with histopathological diagnosis.&#x0D; Results: Out of 100 cases 14 cases were found to be malignant and 86 were found to be benign on histology while cytology showed 93 cases benign and 7 malignant cases .Out of 5 cases suspicious for neoplasm and 3 cases were of follicular neoplasm on cytology which confirmed as papillary carcinoma on histopathology.2 cases which were diagnosed as Benign Thyroid lesion turned out to be papillary carcinoma and 2 cases which were diagnosed as colloid goitre on cytology turned out to be papillary carcinoma on histo pathology .1 case diagnosed as follicular hyperplasia turned out to be papillary carcinoma on histology.1 case diagnosed as MNG in cytology was turned out to be papillary carcinoma on histo pathology.&#x0D; Conclusion: Thyroid cytology proves to be a reliable, simple and cost-effective first line diagnostic procedure with high patient acceptance and without complications. FNAC serves as useful screening test for thyroid lesions. However, inability in distinguishing follicular lesion and inadequate sampling in cystic lesion lead to false diagnosis.&#x0D; Keywords: Histopathology, Thyroid , Lesion.

Mediastinal staging for non-small cell lung cancer

The staging of mediastinal lymph nodes for lung cancer is crucial for planning treatments or reinterventions. In potentially curable patients the aim of mediastinal staging is to exclude the presence of malignancy in mediastinal lymph nodes with a high level of accuracy while also considering clinical factors and the balance of the benefits and risks of tissue sampling techniques. Mediastinal staging is based on computed tomography (CT) and positron emission tomography (PET) and can be sufficient when no mediastinal abnormalities are present and the probability of unforeseen N2 disease is low. In the case of bulky lymph nodes with a high probability of malignancy in PET-CT, tissue confirmation is not normally required. If mediastinal sampling is needed it can be achieved by endosonographic techniques, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) or a combination of the two. Positive results do not need further confirmation. In the case of negative results, surgical techniques still play a role in the selected cases discussed by multidisciplinary lung cancer committees. New mediastinal surgical techniques including video-assisted cervical mediastinoscopy (VACM), video-assisted mediastinoscopic lymphadenectomy (VAMLA), and transcervical extended mediastinal lymphadenectomy (TEMLA) have been shown to be useful in selected patients. Final pathological staging is based on lymph node removal during surgery and can be achieved by taking one of two approaches: lymph node sampling or systematic lymph node sampling. The accuracy of PET-CT and mediastinal endosonography is lower for mediastinal restaging than it is for surgical techniques; their false positive and false negative (FN) rate is high and so, they require histological confirmation. Here we explain and revise the results from the most recent studies and current international guidelines.

Application of the ROLL technique as a method of excisional biopsy in oncological pathology

ObjectiveTo evaluate the utility of the ROLL (Radioguided Occult Lesion Localization) technique as a method of excisional biopsy in hypermetabolic lesions suspected of malignancy evidenced in [18F]Fluordeoxiglucose PET/CT scans. Material and methods33 patients were retrospectively evaluated referred for metabolic studies due to tumoral pathology or suspected neoplastic process and presenting hypermetabolic adenopathies with high probability of malignancy. The group consisted of 19 women and 14 men, ranging from 23 to 77 years old. Patients were performed a ROLL technique for localization and removal the selected adenopathies, through the injection of [99mTc] macro-aggregates of albumin guided by ultrasound or CT. A detection probe and a portable gamma camera were used during the surgical procedure. ResultsIn 31 patients (94%) the location and removal of the radiolabeled adenopathies was achieved. In one patient the location of the lesion was not possible and a second patient was not operated due to inadequate dose injection confirmed by gammagraphy study. The result of the anatomopathological study of adenopathies resulted in 23 tumor affections and 8 benign processes, including a granulomatous process. ConclusionThe ROLL technique proved its utility as a radioguided excisional biopsy method for the study of lesions suspected of malignancy evidenced in patients undergoing PET/CT studies. The technique allowed to confirm the persistence of oncological process in some cases and the existence of false positives from the imaging study in others, modifying the patients therapeutic management.

Development and validation of a Web-based malignancy risk-stratification system of thyroid nodules.

Previous publications on risk-stratification systems for malignant thyroid nodules were based on conventional ultrasound only. We aimed to develop a practical and simplified prediction model for categorizing the malignancy risk of thyroid nodules based on clinical data, biochemical data, conventional ultrasound and real-time elastography. Retrospective cohort study. A total of 2818 patients (1890 female, mean age, 45.5±13.2years) with 2850 thyroid nodules were retrospectively evaluated between April 2011 and October 2016. 26.8% nodules were malignant. We used a randomly divided sample of 80% of the nodules to perform a multivariate logistic regression analysis. Cut-points were determined to create a risk-stratification scoring system. Patients were classified as having low, moderate and high probability of malignancy according to their scores. We validated the models to the remaining 20% of the nodules. The area under the curve (AUC) was used to evaluate the discrimination ability of the systems. Ten variables were selected as predictors of malignancy. The point-based scoring systems with and without elasticity score achieved similar AUCs of 0.916 (95% confidence interval [CI]: 0.885-0.948) and 0.906 (95% CI: 0.872-0.941) when validated. Malignancy risk was segmented from 0% to 100.0% and was positively associated with an increase in risk scores. We then developed a Web-based risk-stratification system of thyroid nodules (http: thynodscore.com). A simple and reliable Web-based risk-stratification system could be practically used in stratifying the risk of malignancy in thyroid nodules.

Aplicación de la técnica ROLL como método de biopsia excisional en patología oncológica

ObjectiveTo evaluate the utility of the ROLL (Radioguided Occult Lesion Localization) technique as a method of excisional biopsy in hypermetabolic lesions suspected of malignancy evidenced in [18F]Fluordeoxiglucose PET/CT scans. Material and methods33 patients were retrospectively evaluated referred for metabolic studies due to tumoral pathology or suspected neoplastic process and presenting hypermetabolic adenopathies with high probability of malignancy. The group consisted of 19 women and 14 men, ranging from 23 to 77 years old. Patients were performed a ROLL technique for localization and removal the selected adenopathies, through the injection of [99mTc] macro-aggregates of albumin guided by ultrasound or CT. A detection probe and a portable gamma camera were used during the surgical procedure. ResultsIn 31 patients (94%) the location and removal of the radiolabeled adenopathies was achieved. In one patient the location of the lesion was not possible and a second patient was not operated due to inadequate dose injection confirmed by gammagraphy study. The result of the anatomopathological study of adenopathies resulted in 23 tumor affections and 8 benign processes, including a granulomatous process. ConclusionThe ROLL technique proved its utility as a radioguided excisional biopsy method for the study of lesions suspected of malignancy evidenced in patients undergoing PET/CT studies. The technique allowed to confirm the persistence of oncological process in some cases and the existence of false positives from the imaging study in others, modifying the patients therapeutic management.

Clinical evidence based review and systematic scientific review in the identification of malignant transformation of inverted papilloma

BackgroundInverted papilloma (IP) is an unusual type of benign tumor that has high recurrence rates and the potential to transform into squamous cell carcinomas (SCC). The mechanism of the transformation process from IP to IP-SCC is uncertain and there is no consensus regarding the best practice for IP-SCC detection. The goal of this study is to identify the best clinical methods to detect for IP-SCC.MethodsAn evidence-based review was performed using Medline and Ovid to obtain all articles up to October 10th, 2019 pertaining to identification of IP malignant transformation. All manuscripts discussing clinical methods or biomarkers were included.ResultsBased on clinical research studies, convoluted cerebriform pattern and apparent diffusion coefficient values on Magnetic Resonance Imaging (MRI) can help differentiate benign IP from SCC and increased SUVmax on PET/CT is associated with higher probability of malignancy although not as specific. No consensus about the best biomarker for IP-SCC has been reached among researchers and continues to be exploratory.ConclusionEndoscopy with biopsy is the gold standard practice to identify IP-SCC; however, MRI is the preferred imaging modality to recognize malignant transformation in cases where biopsy is difficult. Multiple biomarkers have shown positive results, but no single indicator with clinical significance for monitoring malignant transformation process has been found.

Deep Neural Networks With Region-Based Pooling Structures for Mammographic Image Classification.

Breast cancer is one of the most frequently diagnosed solid cancers. Mammography is the most commonly used screening technology for detecting breast cancer. Traditional machine learning methods of mammographic image classification or segmentation using manual features require a great quantity of manual segmentation annotation data to train the model and test the results. But manual labeling is expensive, time-consuming, and laborious, and greatly increases the cost of system construction. To reduce this cost and the workload of radiologists, an end-to-end full-image mammogram classification method based on deep neural networks was proposed for classifier building, which can be constructed without bounding boxes or mask ground truth label of training data. The only label required in this method is the classification of mammographic images, which can be relatively easy to collect from diagnostic reports. Because breast lesions usually take up a fraction of the total area visualized in the mammographic image, we propose different pooling structures for convolutional neural networks(CNNs) instead of the common pooling methods, which divide the image into regions and select the few with high probability of malignancy as the representation of the whole mammographic image. The proposed pooling structures can be applied on most CNN-based models, which may greatly improve the models' performance on mammographic image data with the same input. Experimental results on the publicly available INbreast dataset and CBIS dataset indicate that the proposed pooling structures perform satisfactorily on mammographic image data compared with previous state-of-the-art mammographic image classifiers and detection algorithm using segmentation annotations.

Utility of Ultrasound Elastography to Differentiate Benign from Malignant Cervical Lymph Nodes.

Background:The purpose of this study was to evaluate the usefulness of strain elastography and acoustic radiation force impulse (ARFI) imaging in the differentiation of benign and malignant cervical lymph nodes (LNs).Materials and Methods:In this prospective study, 50 enlarged cervical LNs (33 benign and 17 malignant) were examined by B-mode ultrasound (US), color Doppler, and strain elastography. Elastographic patterns (1–5) were categorized based on distribution of hard area within LN. The shear wave velocity (SWV) of LNs was evaluated by ARFI imaging. Diagnostic performance of sonoelastographic parameters was compared taking histopathology of LN as a reference standard. Optimal cutoff value of the mean SWV values for predicting malignancy was determined using receiver operating characteristic curve analysis.Results:Among US parameters, borders of LN had the highest diagnostic accuracy (80%), while echogenicity had the least (48%). Majority of benign LNs (n = 31) had elastography patterns 1 and 2, while majority of malignant LNs (n = 16) had patterns 3–5 (P = 0.000). The sensitivity, specificity, and accuracy of elastography were 94.1%, 93.9%, and 94%, respectively. The mean SWV of benign LNs (1.670 ± 0.367 m/s) differed significantly from malignant LNs (2.965 ± 0.826 m/s; P = 0.000). A cutoff value of 2.05 m/s predicted malignancy with 88.2% sensitivity and 84.8% specificity and gave an area under the curve of 0.949 (95% confidence interval: 0.70–1.20).Conclusion:Elastography has high diagnostic accuracy in differentiating benign and malignant cervical LNs and can be potentially useful in selecting the LN with high probability of malignancy, on which fine-needle aspiration cytology/biopsy can be performed.