High Probability Of Malignancy Research Articles

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.

EP1.11-03 Diagnostic Evaluation of Patients with Solitary Pulmonary Nodules in a Tertiary Referral Center

Management of patients with Solitary Pulmonary Nodules (SPN) is primarily targeted at achieving an early diagnosis and treatment of all malignant nodules. We herein aimed to assess the adherence of pulmonologists to current clinical practice guidelines for SPN evaluation in a tertiary referral center for thoracic diseases. The medical records of 64 patients with SPN, diagnosed and treated at Sotiria Hospital for Chest Diseases from January 2017 to September 2018 were retrospectively reviewed. Following analysis of the clinical features and imaging characteristics of all cases, the probability of malignancy was evaluated, and the management approach followed by pulmonologists was compared to the approach suggested by issued guidelines. We observed a tendency by pulmonologists to monitor all SPN irrespective of size, density and likelihood of malignancy and reassess them at an earlier time than recommended by guidelines. Use of PET/CT in solid nodules >8 mm of very low (50%) and high (80%) probability of malignancy was also observed, despite lack of a clear indication of PET/CT in the above patients’ groups. Conventional bronchoscopy was performed in 81% of patients with a SPN of >8 mm with intermediate and high probability of malignancy, even though this is not typically recommended. A low-dose protocol was applied in the majority of SPN cases monitored by computed tomography, in accordance with guidelines. Malignancy was diagnosed in 42/64 patients. Pulmonologists in real-world practice may adopt a more "aggressive” management approach towards patients with SPN, so as to exclude the possibility of an underlying malignancy.

1471 Normal Polypoid Tissue After Endoscopic Full Thickness Resection of Colonic Lesions

INTRODUCTION: Endoscopic full thickness resection (EFTR) is a novel endoscopic procedure for management of challenging colorectal lesions. Resection site growths after EFTR are usually concerning for incomplete resection or recurrence of the initial lesion. Here we report two patients who underwent EFTR and had polypoid growth of normal tissue at the site of EFTR on surveillance colonoscopy. CASE DESCRIPTION/METHODS: Case 1 A 51-year-old Caucasian male was referred for evaluation of residual sigmoid colon tubulovillous adenoma with focal high grade dysplasia. He has a family history of late onset colorectal cancer in his mother and grandmother. He had no abdominal symptoms and examination was unremarkable. Colonoscopy revealed residual polypoid tissue at the site of a prior attempted polypectomy for which he underwent EFTR. Surveillance colonoscopy 6 months later showed a 15-mm polyp-like growth at the site of prior EFTR that was lifted and resected with a hot snare (Figure 1). Pathology showed benign mesenchymal proliferation. Case 2 A 70 year-old Caucasian female was referred to our clinic for evaluation of an incompletely resected 20-mm transverse colon tubular adenoma. Her father developed colon cancer after the age of 60. She had no abdominal symptoms and examination was unremarkable. Colonoscopy showed a 20-mm transverse colon polyp with overlying scarring. She underwent EFTR and pathology showed tubular adenoma with clear margins. Repeat colonoscopy 6 months later showed a 10-mm polyp-like lesion at the site of previous EFTR that was lifted and resected with a hot snare (Figure 2). Pathology showed normal colonic mucosa. DISCUSSION: EFTR is a novel procedure for management of lesions that are not amenable to conventional endoscopic resection methods such as non-lifting lesions, lesions with high probability of malignancy, and lesions located in difficult anatomic locations. It is an attractive alternative to surgical resection or endoscopic submucosal dissection for management of such lesions. Resection site growths after EFTR are usually concerning for recurrence. However, polyp-like growths of normal tissue after EFTR were noted in 2 out of 8 patients who underwent EFTR at our institution. Therefore, EFTR site growths may not always represent recurrence of the initial lesion. Awareness of this possibility can alleviate patient anxiety and reduce cost associated with further investigations and resections.

Is 18F-fluorodeoxyglucose positron emission tomography/computed tomography useful to discriminate metachronous lung cancer from metastasis in patients with oncological history?

Solitary pulmonary nodules detected during follow-up in patients with previous cancer history have a high probability of malignancy being either a metachronous lung cancer or a metastasis. This distinction represents a crucial issue in the perspective of "personalized medicine," implying different treatments and prognosis. Aim, to evaluate the role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in distinguishing whether solitary pulmonary nodules are metachronous cancers or metastases and the relationship between the nodule's characteristics and their nature. From a single-institution database, we retrospectively selected all patients with a previous cancer history who performed 18F-FDG PET/CT to evaluate pulmonary nodules detected during follow-up, ranging from 5 mm to 40 mm, and histologically diagnosed as malignant. Between September 2009 and August 2017, 127 patients (80 males; mean age=70.2±8.5years) with 127 malignant nodules were included: 103/127 (81%) metachronous cancers, 24/127 (19%) metastases. In both groups, PET/CT provided good and equivalent detection rate of malignancy (81% vs. 83%). No differences between metachronous cancers and metastases were found in: patient's age (70.3±8.1 years vs. 69.5±9.7years), gender (males=63.1% vs. 62.5%), interval between previous cancer diagnosis and nodules' detection (median time=4years vs. 4.5years), location (right-lung=55% vs. 54%; upper-lobes=64% vs. 67%; central-site=31% vs. 25%), size (median size=17mm vs. 19.5mm), 18F-FDG standardized uptake value (median SUVmax=5.2 vs. 5.9). In oncological patients, despite its high detection rate, 18F-FDG PET/CT, as well as any other clinico-anatomical features, cannot distinguish whether a malignant solitary pulmonary nodule is a metachronous lung cancer or a metastasis, supporting the need of histological differential diagnosis.

The value of ultrasound classification in BI-RADS category 4 of breast complex cystic masses

Objective: To analyze the feature of breast complex cystic masses and to classify it at ultrasonography (US), which applied to the Breast Imaging Reporting and Data System (BI-RADS) categories 4a to 4c with pathological results as the golden standards. Methods: The ultrasonographic data and clinical features of 78 patients with complex cystic masses confirmed by pathology in Cancer Hospital from July 2014 to June 2017 were retrospectively reviewed. The complex cystic breast masses were divided into four classes on the basis of their US features: type 1 [thick wall and (or) thick septa (> 0.5 mm)], type 2 (one or more intra-cystic masses), type 3 (mixed cystic and solid components with cystic components more than 50%) and type 4 (mixed cystic and solid components with solid components more than 50%). Positive values (PPVs) were calculated for each type. Multiple linear regression analysis was used to analyze the ultrasonographic features of the masses (lesion size, margins, blood flow resistance index, calcification, and axillary lymph nodes, etc.) with malignant correlation. Results: There were 81 lesions in 78 patients. Among the 81 masses based on US appearance, 14 (17.3%) were classified as type Ⅰ, 18 (22.2%) as type Ⅱ, 18 (22.2%) as type Ⅲ, and 31 (38.3%) as type Ⅳ. The positive predictive values of the malignant lesions of type Ⅰ, type Ⅱ, Ⅲ and Ⅳ were 7.1%, 16.7%, 61.1% and 48.3%, respectively (P=0.040). In all the 81 masses, 14 were BI-RADS categories 4a, 18 were BI-RADS categories 4b and 49 were BI-RADS categories 4c. Masses with maximum diameter equal to or larger than 2.0 cm, unclear margins, RI≥0.7 and presence of abnormal axillary nodes assessment had a high probability of malignancy (P=0.030, 0.038, <0.001 and 0.025, respectively). Conclusion: Ultrasound typing is helpful for differentiating benign and malignant breast complex cysts and classifying BI-AIDS 4a to 4c, thus providing clearer treatment for clinical practice.

Additional lesions seen in magnetic resonance imaging of breast cancer patients: the role of second-look ultrasound and imaging-guided interventions.

PurposeThe purpose of this study was to investigate the final outcomes of magnetic resonance imaging (MRI)-identified additional lesions (MRALs) in breast cancer patients and the role of second-look ultrasound (SLUS) and imaging-guided interventions.MethodsWe analyzed breast cancer patients with MRALs on preoperative MRI between January and June 2012. MRALs were defined as additional lesions suspected on MRI but not suspected on mammograms or ultrasound. The malignancy rate of MRALs, MRI-based Breast Imaging Reporting and Database System (BI-RADS) category, positional relationship with the index cancer, MRI-concordant lesion visibility on SLUS, performance of imaging-guided interventions, and total mastectomy (TM) rates were evaluated for the confirmed lesions.ResultsAmong the 119 confirmed lesions, SLUS and imaging-guided interventions were performed in 94 (79.0%) and 82 cases (68.9%), respectively. The malignancy rate was 68.1% (81 of 119), and was significantly higher in BI-RADS 4C-5 lesions than in 4A-4B lesions (94.6% vs. 56.1%, P<0.01) and in ipsilateral same-quadrant lesions than in contralateral lesions (84.2% vs. 33.3%, P<0.01). The lesion visibility rate on SLUS was 90.4%. The malignancy rate was not significantly different according to lesion visibility on SLUS. The TM rate in the 98 cases with ipsilateral MRALs was 37.8%, while it was significantly lower in patients who underwent an imaging-guided intervention than in those who did not (27.9% vs. 54.1%, P=0.017).ConclusionMRALs show a high probability of malignancy, especially if they are ipsilateral. SLUS and imaging-guided interventions can eliminate many unnecessary TMs.

Ultrasound Scoring of Endometrial Pattern for Fast-track Identification or Exclusion of Endometrial Cancer in Women with Postmenopausal Bleeding

To evaluate the risk of endometrial cancer (REC) scoring system for the prediction of high and low probability of endometrial cancer (EC) in women with postmenopausal bleeding (PMB). A prospective study (Canadian Task Force classification II-1). An academic hospital. Nine hundred fifty consecutive patients with PMB underwent transvaginal ultrasonography (TVS) and REC scoring between November 2013 and December 2015. Obstetrics and gynecology residents supervised by trained physicians scored endometrial patterns according to the previously established REC scoring system. The reference standard was endometrial samples, endometrial thickness (ET, 4-4.9 mm), operative hysteroscopy or hysterectomy (ET ≥5 mm), and 1-year follow-up in all patients presenting with ET <4 mm. Diagnostic performance for the prediction of probability of malignancy was assessed using the REC scoring system. The area under the receiver operating characteristic curve of the TVS REC scoring system was 97% (95% confidence interval [CI], 95%-98%) for the prediction of malignancy. In 656 patients with ET ≥4 mm, REC scoring effectively predicted a high probability of malignancy with sensitivity (95% confidence interval) of 92% (95% CI, 87%-95%) and specificity of 94% (95% CI, 91%-96%). An REC score of 0 was present in 206 (32%) patients with ET ≥4 mm and was associated with a low negative likelihood ratio of 0.026 for EC. There were only 7 patients with EC/atypical hyperplasia among these 206 patients. The REC scoring system identified or ruled out most ECs, clearly showing that more specific image analysis at first-line TVS can accelerate the diagnosis of EC in patients with PMB and may allow for improved selection of second-line strategies in patients with ET ≥4 mm.

Malignant potential of epithelioid angiomyolipomas of the liver: A case report and comprehensive review of the literature.

Hepatic epithelioid angiomyolipoma (HEAML) is a rare mesenchymal tumor that has been reported to have malignant potential. We herein describe a rare case of atypical HEAML. A 43-year-old Caucasian male patient visited his general practitioner due to a productive cough persisting for >2 months. During evaluation with several imaging tests, a chest computed tomography (CT) incidentally revealed a well-demarcated lesion in the caudate lobe of the liver, sized 7 cm. An abdominal magnetic resonance imaging examination confirmed the findings of the CT. The possibility of hepatocellular carcinoma at that time could not be excluded. Due to inconclusive cross-sectional imaging, the patient underwent left hepatectomy with additional resection of segment I. The patient's postoperative course was uneventful. A diagnosis of 'atypical' HEAML was established in the present case. The majority of HEAMLs are considered to be benign, although there are several reported cases exhibiting malignant behavior, such as tumor growth, presence of atypical cells, recurrence after surgical resection, metastasis and invasive growth into the liver parenchyma and alongside the vessels. From 2000 onwards, 19 cases of malignant hepatic AML have been reported. Malignant transformation is considered to occur mostly in the epithelioid subtype. To that end, when epithelioid or atypical characteristics are identified on preoperative biopsy, resection is indicated due to the high probability of malignancy.

Survival Outcomes for Patients With Indeterminate 18FDG-PET Scan for Extrahepatic Disease Before Liver Resection for Metastatic Colorectal Cancer

The aim of this study was to evaluate overall survival (OS) and cancer recurrence for patients with indeterminate positron emission tomography (PET) scan for extrahepatic disease (EHD) before liver resection (LR) for colorectal liver metastases (CLMs). Indeterminate EHD as determined by PET imaging indicates a probability of extrahepatic malignancy and potentially excludes patients from undergoing LR for CLM. In a retrospective analysis of prospectively collected data from February 2006 to December 2014, OS for patients with indeterminate EHD on FDG-PET scan before LR for CLM was performed using standard survival analysis methods, including Kaplan-Meier estimator and Cox proportional hazard models for multivariate analyses. Postoperative imaging was used as reference to evaluate the association between indeterminate EHD and recurrence. Of 267 patients with PET scans before LR, 197 patients had no EHD and 70 patients had indeterminate EHD. Median follow-up was 33 months. The estimated 5-year OS was 60.8% versus 59.4% for indeterminate and absent EHD, respectively (P = 0.625). Disease-free survival was comparable between both groups (P = 0.975) and overall recurrence was 57.1% and 59.5% for indeterminate and absent EHD, respectively (P = 0.742). About 16.9% of recurrence was associated with the site of indeterminate EHD, with 80% of associated recurrence occurring in the thorax. The site of indeterminate EHD appears to have a predictive value for recurrence, with indeterminate EHD in the thorax having a higher probability of malignancy. The evidence in this report supports the critical evaluation of PET scan results and that patients are not denied potential curative LR unless the evidence for unresectable EHD is certain.

Malignancy probability map as a novel imaging biomarker to predict malignancy distribution: employing MRS in GBM patients.

The main aim of this study was to propose a new statistical method for evaluation of spatial malignancy distribution within Magnetic Resonance Spectroscopy (MRS) grid in Glioblastoma Multiforme patients. Voxels with different malignancy probabilities were presented as a novel MRS-based Malignancy Probability Map (MPM). For this purpose, a predictive probability-based clustering approach was developed, including the two following steps: (1) Gaussian Mixture Model, (2) Quadratic Discriminate Analysis coupled with Genetic Algorithm. Clustered probability values from two methods were then integrated to exploit the MPM. Results show that the suggested method is able to estimate the malignancy distribution with over 90% sensitivity and specificity. The proposed MRS-based MPM has an acceptable accuracy for providing useful complementary information about regional diffuse glioma malignancy, with the potential to lead to better detection of tumoral regions with high probability of malignancy. So, it also may encourage the use of additional information of this map as a tool for dose painting.

Dystrophic Large Calcification in Breast Cancer

There are well established diagnostic criteria for calcifications detected on mammography which allows the division into: benign intermediate concern and higher probability of malignancy according to the morphology. Large calcifications are usually associated with benign breast conditions. We report three cases of breast cancer with large dystrophic calcification on imaging studies (mammography, ultrasound, computed -tomography) and histopatology displayed into the tumor as well as into the tributaries lymph nodes.

Value of Ultrasonographic Features for Assessing Malignant Potential of Complex Cystic Breast Lesions.

To assess the value of ultrasonography (US) features for determining the malignant potential of complex cystic lesions. Seventy-nine complex cystic lesions were reviewed retrospectively. They were classified into four types according to US features in type I, the masses have a thick outer wall, thick internal septa, or both; in type II, the masses are an intracystic type with one or more discrete solid mural lesions within a cyst; in type III, the masses contain mixed cystic and solid components and are at least 50% cystic portion in a mass; in type IV, there are predominantly (at least 50%) solid masses with eccentric or central cystic foci. Positive predictive values were calculated for all types. The frequency of malignancy was higher among type III and IV lesions than among the other two types. Lesions with a diameter greater than or equal to 20 mm, margins not circumscribed, resistance index greater than or equal to 0.7, and axillary abnormal nodes had a high probability of malignancy. US is an important adjunct to evaluate the malignant potential of complex cystic lesions.

A reporting system for endometrial cytology: Cytomorphologic criteria-Implied risk of malignancy.

There have been various attempts to assess endometrial lesions on cytological material obtained via direct endometrial sampling. The majority of efforts focus on the description of cytological criteria that lead to classification systems resembling histological reporting formats. These systems have low reproducibility, especially in cases of atypical hyperplasia and well differentiated carcinomas. Moreover, they are not linked to the implied risk of malignancy. The material was collected from women examined at the outpatient department of four participating hospitals. We analyzed 866 consecutive, histologically confirmed cases. The sample collection was performed using the EndoGyn device, and processed via Liquid Based Cytology, namely ThinPrep technique. The diagnostic categories and criteria were established by two cytopathologists experienced in endometrial cytology; performance of the proposed reporting format was assessed on the basis of histological outcome; moreover, the implied risk of malignancy was calculated. The proposed six diagnostic categories are as follows: (i) nondiagnostic or unsatisfactory; (ii) without evidence of hyperplasia or malignancy; (iii) atypical cells of endometrium of undetermined significance; (iv) atypical cells of endometrium of low probability for malignancy; (v) atypical cells of endometrium of high probability for malignancy; and (vi) malignant. The risk of malignancy was 1.42% ± 0.98%, 44.44% ± 32.46% (nine cases), 4.30% ± 4.12%, 89.80% ± 8.47%, and 97.81% ± 2.45%, respectively. We propose a clinically oriented classification scheme consisting of diagnostic categories with well determined criteria. Each diagnostic category is linked with an implied risk of malignancy; thus, clinicians may decide on patient management and eventually reduce unnecessary interventional diagnostic procedures. Diagn. Cytopathol. 2016;44:888-901. © 2016 Wiley Periodicals, Inc.

Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT: analysis of data from the randomised, controlled NELSON trial

US guidelines now recommend lung cancer screening with low-dose CT for high-risk individuals. Reports of new nodules after baseline screening have been scarce and are inconsistent because of differences in definitions used. We aimed to identify the occurrence of new solid nodules and their probability of being lung cancer at incidence screening rounds in the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON). In the ongoing, multicentre, randomised controlled NELSON trial, between Dec 23, 2003, and July 6, 2006, 15 822 participants who had smoked at least 15 cigarettes a day for more than 25 years or ten cigarettes a day for more than 30 years and were current smokers, or had quit smoking less than 10 years ago, were enrolled and randomly assigned to receive either screening with low-dose CT (n=7915) or no screening (n=7907). From Jan 28, 2004, to Dec 18, 2006, 7557 individuals underwent baseline screening with low-dose CT; 7295 participants underwent second and third screening rounds. We included all participants with solid non-calcified nodules, registered by the NELSON radiologists as new or smaller than 15 mm(3) (study detection limit) at previous screens. Nodule volume was generated semiautomatically by software. We calculated the maximum volume doubling time for nodules with an estimated percentage volume change of 25% or more, representing the minimum growth rate for the time since the previous scan. Lung cancer diagnosis was based on histology, and benignity was based on histology or stable size for at least 2 years. The NELSON trial is registered at trialregister.nl, number ISRCTN63545820. We analysed data for participants with at least one solid non-calcified nodule at the second or third screening round. In the two incidence screening rounds, the NELSON radiologists registered 1222 new solid nodules in 787 (11%) participants. A new solid nodule was lung cancer in 49 (6%) participants with new solid nodules and, in total, 50 lung cancers were found, representing 4% of all new solid nodules. 34 (68%) lung cancers were diagnosed at stage I. Nodule volume had a high discriminatory power (area under the receiver operating curve 0·795 [95% CI 0·728-0·862]; p<0·0001). Nodules smaller than 27 mm(3) had a low probability of lung cancer (two [0·5%] of 417 nodules; lung cancer probability 0·5% [95% CI 0·0-1·9]), nodules with a volume of 27 mm(3) up to 206 mm(3) had an intermediate probability (17 [3·1%] of 542 nodules; lung cancer probability 3·1% [1·9-5·0]), and nodules of 206 mm(3) or greater had a high probability (29 [16·9%] of 172 nodules; lung cancer probability 16·9% [12·0-23·2]). A volume cutoff value of 27 mm(3) or greater had more than 95% sensitivity for lung cancer. Our study shows that new solid nodules are detected at each screening round in 5-7% of individuals who undergo screening for lung cancer with low-dose CT. These new nodules have a high probability of malignancy even at a small size. These findings should be considered in future screening guidelines, and new solid nodules should be followed up more aggressively than nodules detected at baseline screening. Zorgonderzoek Nederland Medische Wetenschappen and Koningin Wilhelmina Fonds Kankerbestrijding.

Doppler evaluation of breast solid masses differentiation of benign and malignant masses role of resistive index

Objective: To know the usefulness of color and spectral doppler in evaluation of solid breast masses using vascularity and resistive index. Material and methods: We performed duplex doppler sonography on 100 patients presenting with breast mass. Resistive index and vascularity of the vessels were detected and analyzed and correlated with histopathological results. Results: 70% of the benign lesions were found having ri below 0.8 and 45 out of 50 patients had low vascularity.43 malignant lesions had high vascularity and 80% had ri above 0.8. Conclusion: High flow visualization on power doppler and indicates a higher possibility of malignancy lesions with ri greater than 0.8 gives high probability of malignancy.

Evaluation the Relationship Between Thyroid Nodule Size with Malignancy and Accuracy of Fine Needle Aspiration Biopsy (FNAB).

Introduction:Some studies have shown largest thyroid nodule size, especially ≥4cm that can predict malignancy and reduce fine needle aspiration biopsy (FNAB) accuracy. Therefore, this study is designed to evaluate relationship between thyroid nodule sizes with malignancy and its effect on FNBA accuracy.Materials and Methods:a retrospective analytical study design aims to investigate all patients with thyroid nodules who referred to surgery department of Imam-Khomeini Hospital of Mazandaran University of Medical Sciences in Sari from 20 March 2008 to 22 March 2014. We collected patient’s demographic data, nodules size, FNAB reports and final pathology (after surgery) reports from their medical records. All data were analyses performed by SPSS18.Results:167 patients (153 women) with mean age of 41.56±13.24 years old were enrolled for this study. In final pathology; 38 patients (22.8%) had malignant nodules. The mean age of patients with or without malignant nodules were 34.93±11.86 and 42.37±12.26 years old, respectively (P=0.002). The mean size of benign and malignant nodules were 2.91±1.29 cm and 3.38±1.86 cm, respectively (P=0.15). 25.2% of <4 cm nodules and 17.9% of ≥4 cm nodules were diagnosed as a malignant (P=0.29). FNAB was done on 95 patients that reported benign in 60 patients (63.2%), malignant in 18 patients (18.9%) and suspicious in 17 patients (17.9%). Positive and negative results of FNAB in all nodules were 3.5% and 6.3%, in <4cm nodules were 5.8% and 6.2% and in ≥4cm nodules were zero and 6.7%, respectively. The sensitivity, specificity, Positive predict value (PPV), negative predict value (NPV) and overall accuracy (OA) of FNAB in all nodules were 76.19%, 96.49%, 88.88%, 91.66% and 91.02%, and in <4cm nodules were 78.57%, 94.11%, 84.61%, 91.42% and 89.58%, and in ≥4cm nodules were 71.4%, 100%, 100%, 92% and 93.33%, respectively.Conclusion:the results of this study revealed that the size of the thyroid nodules is not reliable at predicting malignancy and should not be applied in medical decision making. FNAB showed good specificity but the sensitivity was low in our study. In ≥4cm nodules; FNAB sensitivity was decreased and accompanied by higher false-negative results. Furthermore, FNABs with suspicious results were associated with high probability of malignancy.

Mammographic calcifications in women in Ibadan, South-West Nigeria: A seven years review

Background/Aims: The purpose of this paper is to present the various types of calcifications seen on mammograms in Nigerian women in Ibadan. The study was to describe calcifications using the American College of Radiology Breast Imaging Reporting and Data System (ACR-BIRADS) classification, document the incidence of the various types of calcifications in a Nigerian population and also report on any association between these calcifications and the demographic variables. Materials and Methods: A prospective study of 894 mammograms done in the Radiology Department of the University College Hospital, Ibadan over a seven year period (2006–2013). The mammographic evaluation was carried out by two radiologists. Calcifications were described and classified using the ACR-BIRADS system. Patients' demographic data were obtained using the departmental breast imaging questionnaire. Results: Of the 894 women (with an age range of 30–82 years), 213 (23.8%) had calcifications on their mammograms. Macro-calcifications (81.2%) were more common than micro-calcifications (18.8%). The most common distribution of these calcifications was the clustered type. Vascular calcifications (31.2%) were the common morphologic type of macro-calcifications while the punctate calcifications (15.5%) were the common morphologic type of micro-calcifications. About 12.3% of the women had associated masses, 3.3% had associated asymmetric density and 1.9% had associated architectural distortion. A quarter of micro-calcifications fell under 'higher probability of malignancy' (BIRADS 3) and 39% fell under 'intermediate concern of malignancy' (BIRADS 2). 18.4% of the women were asked to undergo further imaging studies. Conclusion: We have reported the various types, distributions and morphology of calcifications seen in an African population, similar to those seen in developed countries.

Differentiation of Benign and Malignant Solitary Pulmonary Nodule: Literature Review

The solitary pulmonary nodule (SPN) is frequently seen on chest radiographs and computed tomography (CT), usually the identification is accidental. The overall prevalence of malignancy is relatively low but identification of malignancy of nodule is of prime importance. There are different characters of nodules indicating malignancy, and also the exposure of person to risk factors increases the chances of malignancy of nodule. Chances of malignancy rise with increasing size, the irregular, lobulated border of the nodules is highly associated with higher probability of malignancy and nodules with pure ground grass appearance have higher probability of malignancy, irregularly marginated nodule displaying a corona radiata sign indicating neoplastic infiltration with distortion of neighbouring tissue is almost certainly a malignant nodule. Stippled, punctuate, and eccentric calcifications are suggestive of malignancy. There are 20% - 75% of chances of malignancy if nodule is appeared with ground-glass opacity. Malignant nodules have higher growth rate as compared with benign nodules, malignant nodules usually have doubling time (DT) of 30 - 400 days while DT of more than 450 days is sign of benignity whereas doubling time less than 30 days is usually acute infectious process. The presence of fat within nodule is sign of benignity. Increasing density of the nodule is suggestive of malignancy and requires shorter follow up. Besides the nodule evaluation the chances of malignancy can also be evaluated through the exposure of patient to risk factors like age, current and past smoking status and history of extra thoracic malignancy. The management depends upon various factors mainly three strategies are applied for management including careful observation of nodule, use of diagnostic techniques like CT FNA, PET, and broncoscopy and surgery.

Lung cancer screening: 360 degree review

The most compelling evidence supporting the use of low dose computed tomography in the screening of high risk populations for lung cancer was generated by the National Lung Cancer Screening Trial carried out in the United States by the National Cancer Institute and the American College of Radiology Imaging Network.[1] This trial was a randomized prospective study which included over 53,000 participants. The two arms consisted of patients who were randomized to low dose CT and those who received standard radiography. Data from the NLST demonstrated that screening reduced mortality by 20% in the CT arm. Other smaller studies carried out in Europe have reported no mortality benefit. However, these studies included a younger screening population and had a smaller number of participants and probably did not have the power to show a mortality benefit.[2] Major medical societies and US government agencies such as US Preventative Services Task Force and now the Center for Medicare Services have now recommended LDCT. These decisions not only recommend screening but require US insurance companies and Medicare in the US to provide reimbursement.[3] Some of the caveats of screening result from the limits of generalization of the NLST results based on risk groups and demographics. There are also potential harms and complications from the LDCT screening which include radiation exposure, over diagnosis, the use of invasive procedures for diagnosis and the high false positive rate. [1,4] Lung cancer screening could have a strong impact on health care in Europe where there are over 268,000 lung cancer deaths per annum. Screening could save thousands of lives. However, lung cancer screening is currently not reimbursed and there are no screening programs accessible through health care systems or health plans. Important factors for lung cancer screening in Europe include refinement of inclusion criteria and stratification of risks, modeling of cost effectiveness data, and inclusion of evidence from European trials. Implementation of screening programs in Europe will require a collaborative effort among professional specialties, societies, organizations, and additional trial data. The American College of Radiology has developed a reporting system for lung cancer screening designated “Lung Rads.” [5] It is a reporting system which is very similar to Bi-Rads that includes numeric categories. It associates CT findings with guideline based management decisions. LDCT findings are categorized from 1-4 according to the likelihood of malignancy. 1 and 2 are considered benign findings and 3 and 4 have a higher probability of malignancy. There are descriptions for each of the 4 categories plus an enumeration of findings. The categories include characterization of nodules including size and density (solid, part-solid, or non- solid ground glass). In addition to the categories and findings there are guidelines for management in each category with estimates of the probability of malignancy and the estimated population prevalence. Constructing a lung cancer screening program in your institution presents many challenges. (6) Stake holders include the hospital leadership, referral providers, a multidisciplinary team, and support staff. Patient and physician outreach and education are essential. Standard protocols should be developed for image acquisition. Ideally image review should be performed by radiologists experienced in chest CT and nodule detection. Imaging software that combines CAD and volumetric measurements is desirable. Findings should be recorded according to the lung imaging reporting and data system such as Lung Rads. Communication of results to both the patient and physician is important and such communication should be stratified according to urgency.

Non-mass-like breast lesions at ultrasonography: Feature analysis and BI-RADS assessment

ObjectiveTo analyze the features of non-mass-like (NML) breast lesions on ultrasound (US) and determine their corresponding malignancy rate and to stratify these lesion patterns according to US BI-RADS categories. Materials and methodsOne hundred sixty-four consecutive lesions were retrospectively classified into four types according to the US features, the corresponding positive predictive values (PPVs) were obtained. Clinical, imaging, and histopathological findings were reviewed. ResultsAmong the 164 lesions, 39 (24%) were classified as type Ia, 14 (8%) as type Ib, 39 (24%) as type IIa, 19 (12%) as type IIb, 19 (12%) as type III, and 34 (21%) as type IV. The PPVs for malignancy were 21% for type Ia, 79% for type Ib, 10% for type IIa, 58% for type IIb, 16% for type III, and 21% for type IV. All NML lesions were classified as BI-RADS category 4a (type IIa), 4b (type Ia, III and IV) and 4c (type Ib and IIb) according to their PPVs. There was a significantly higher frequency of malignancy among lesions of type Ib and type IIb compared with the other types (P<0.01 for each). Lesions with associated calcifications, presence of abnormal axillary nodes, or a mammographic finding of suspected malignancy had a higher probability of malignancy (P<0.05 for each). ConclusionUS is useful in clarifying the indication for biopsy of NML lesions. The types of US classifications used in our study establish reliable references for the NML patterns when stratified according to the BI-RADS categories.