High-risk Lesions Research Articles

Therapeutic Strategies for Relapsed or Refractory B-Cell Acute Lymphoblastic Leukemia in Adult Patients: Optimizing the Use of Monoclonal Antibodies.

The treatment landscape for relapsed or refractory acute lymphoblastic leukemia (RR ALL) has evolved significantly with the introduction of monoclonal antibodies such as blinatumomab and inotuzumab ozogamicin. These agents have demonstrated remarkable efficacy, achieving high response rates and minimal residual disease (MRD) negativity. However, the optimal selection, sequencing, and integration of monoclonal antibodies and other modalities like standard chemotherapy or chimeric antigen receptor T-cell therapy remain areas of active investigation. The absence of direct comparative studies has led to reliance on indirect analyses, which provide conflicting results regarding the relative benefits of inotuzumab and blinatumomab. While inotuzumab is preferred in high-disease-burden settings due to its cytoreductive capabilities, blinatumomab shows superior performance in low-disease-burden settings by leveraging preserved T-cell function. Sequential and combination approaches, such as induction with inotuzumab followed by blinatumomab consolidation, may optimize outcomes, particularly for patients undergoing subsequent allogeneic stem cell transplantation (alloSCT). The interval between inotuzumab and alloSCT is critical to mitigate the risk of veno-occlusive disease (VOD). Despite these advances, the prognosis for patients with high-risk genetic lesions, such as TP53 mutations, remains poor, underscoring the need for innovative therapeutic strategies. As monoclonal antibodies increasingly move into frontline therapy, their role in relapse settings must be redefined. Future research should focus on unraveling the molecular underpinnings of resistance and refining treatment paradigms to improve survival and quality of life for patients with RR ALL.

Patients with multiple mpMRI region of interests: should we omit targeted biopsies of secondary lesions?

To assess the value of secondary lesion-targeted biopsy (SLx) in detecting prostate cancer (PCa) among patients with multifocal disease. A total of 298 biopsy-naïve patients with 612 lesions (all with Prostate Imaging Reporting and Data System [PI-RADS] v2.1 ≥ 3) underwent cognitive fusion-targeted biopsy (TB) combined with systematic biopsy (SB). Our primary endpoints were to compare the detection rates of PCa and clinically significant PCa (csPCa) across different biopsy strategies (Index lesion-targeted biopsy [ILx] vs. ILx + SLx and ILx + SB vs. ILx + SLx + SB) and to define potential indications for SLx using PI-RADS and PSA density (PSAD). Secondary endpoint was to evaluate the predictive performance of index lesion (IL)- and SL-based multivariate logistic regression (MVA) models for csPCa. The overall detection rates for PCa and csPCa were 71% and 60%, with ILx + SLx + SB as the gold standard. Adding SLx to ILx modestly increased detection rates for PCa (63% vs. 65%, P = 0.016) and csPCa (55% vs. 58%, P = 0.004), but offered no significant advantage over ILx + SB. Stratification by PI-RADS and PSAD revealed that focusing on 80% intermediate- to high-risk lesions detected 39% csPCa while reducing 20% low-risk SLx at the cost of missing 1.6% csPCa. IL-based models outperformed SL-based models in predicting csPCa (Hosmer-Lemeshow P = 0.653 vs. 0.461). SLx provides limited benefit in csPCa detection when ILx and SB have already been performed. Combining PI-RADS scores and PSAD helps identify patients who could benefit from SLx while avoiding unnecessary procedures in low-risk cases. No. 2016 - 1252, January 2017.

Clinical impact of epithelial types on postoperative outcomes for intraductal papillary mucinous neoplasms: a multicenter retrospective study.

Intraductal papillary mucinous neoplasms (IPMNs) are classified into three epithelial types with distinct biological behaviors. However, their effects on the postoperative outcomes remain unclear. This multicenter retrospective study included 556 patients with IPMNs who underwent surgical resection. The epithelial types were categorized into the gastric (n = 323), intestinal (n = 160), and pancreatobiliary (n = 73) types. Their associations with the development of extrapancreatic lesions; remnant high-risk lesions (HRLs), including metachronous pancreatic ductal adenocarcinoma (PDAC); and disease-specific survival (DSS) were analyzed. Fifty-one patients (9.2%) developed extrapancreatic lesions. The 10-year cumulative incidence rates for the gastric, intestinal, and pancreatobiliary types were 9.3%, 9.1%, and 32.0%, respectively (P < 0.001). Multivariate analysis identified invasive carcinoma, the gastric, and pancreatobiliary types as independent predictors. Among 516 patients who did not undergo total pancreatectomy, 40 (7.8%) and 13 (2.5%) developed HRLs and metachronous PDAC, respectively. The 10-year cumulative incidence rates of HRLs and metachronous PDAC for the gastric, intestinal, and pancreatobiliary types were 7.0%, 16.2%, and 37.2% and 1.8%, 3.7%, and 22.7%, respectively (P = 0.001 and P = 0.012). In multivariate analysis, the pancreatobiliary type was an independent predictor of metachronous PDAC. Five-year DSS rates for the gastric, intestinal, and pancreatobiliary types were 92.5%, 96.0%, and 76.1% (P < 0.001), respectively. Multivariate analysis identified invasive carcinoma, the gastric, and pancreatobiliary types as independent prognostic factors for DSS. IPMN epithelial type can independently affect postoperative outcomes. In particular, the pancreatobiliary type has significant impact on the development of metachronous PDAC. Therefore, postoperative surveillance should be tailored according to the epithelial type.

A95 APPROACH AND OUTCOMES OF PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING: ANALYSIS OF 50 CASES IN A TERTIARY CARE CENTRE

Abstract Background Non-variceal upper gastrointestinal bleeding (NVUGIB) is a significant cause of morbidity and mortality worldwide. NVUGIB refers to bleeding occurring above the ligament of Treitz, excluding variceal causes. Despite improvements in management, the incidence and mortality of NVUGIB remain high. Key challenges include determining optimal treatment strategies and predicting patient outcomes. Aims To analyze clinical presentation, management strategies, endoscopic findings, treatment and outcomes of NVUGIB patients. Methods A retrospective review was conducted at the University of Alberta Hospital on 50 patients diagnosed with NVUGIB who underwent endoscopy within 48 hours of presentation. We analyzed clinical presentation, management strategies, endoscopic findings, treatment and outcomes to assess their impact on patient care. Results Of the 50 patients, 54% were male, and melena was the most frequent presenting symptom (56%). Sixty-two percent of patients received intravenous proton pump inhibitors (IV PPI) during initial management, while 42% were on NSAIDs without concurrent PPI therapy. Peptic ulcer disease was the leading cause of bleeding (90%), followed by vascular lesions (6%) and Mallory-Weiss tears (4%). Among ulcers, 66.7% were classified as Forrest III. Nine patients (18%) underwent urgent endoscopy within 6-12 hours, while 30% had early endoscopy (12-24 hours), and 52% had late endoscopy (after 24 hours). High-risk lesions (Forrest Ia, Ib, IIa) were identified in 32% of patients. The early endoscopy group had the highest rate of high-risk lesions (53%), compared to the urgent group (33%) and the late group (19%). Patients with high-risk lesions experienced significantly longer hospital stays, averaging 7.8 days compared to 4.9 days for those without high-risk findings (p &amp;lt; 0.005). Re-bleeding occurred in 16% of patients after initial endoscopy. Six patients received successful repeat endoscopic therapy, while two required embolization for bleeding duodenal ulcers. No further episodes of bleeding occurred in the re-bleeding group, and one patient died within 30 days of presentation, the cause was unrelated to bleeding. Conclusions Peptic ulcer disease remains the most common cause of NVUGIB, with NSAID use as a key risk factor. Timely endoscopy and appropriate initial management are critical for optimizing outcomes. High-risk lesions are found in approximately 30% of patients and are associated with longer hospital stays. Physicians should be aware of embolization as a rescue therapy for patients who experience re-bleeding. Funding Agencies None

Natural Course and Long-Term Outcomes of Gastric Subepithelial Lesions: A Systematic Review.

Background/Objectives: Gastric subepithelial lesions (SELs) are often incidentally detected during endoscopic examinations, with most patients being asymptomatic and lesions measuring <20 mm. Despite their generally indolent nature, certain SELs, such as gastrointestinal stromal tumors, require resection. Current guidelines recommend periodic surveillance; however, the natural course and long-term outcomes of gastric SELs have not been sufficiently investigated. This systematic review aimed to synthesize evidence on the progression, growth rate, and risk factors associated with gastric SELs to inform clinical management strategies. Methods: A comprehensive search of PubMed was conducted for peer-reviewed studies published between January 2000 and November 2024. Eligible studies included original studies on the follow-up and progression of gastric SELs. Non-English articles, reviews, case reports, and unrelated topics were excluded. In total, 277 articles were screened, with 15 additional articles identified through manual screening. Ultimately, 41 articles were included in the analysis. The study protocol is registered in PROSPERO (CRD42024614865). Results: Large-scale studies reported low growth rates of 2.0-8.5% over 2.0-5.0 years, while smaller studies reported a broader range of growth rates of 5.4-28.4%. The factors contributing to these discrepancies include patient selection, follow-up duration, and growth criteria. Risk factors for lesion size increase include larger initial lesion size, irregular margins, heterogeneous echo patterns, and certain tumor locations. Conclusions: These findings underscore the need for individualized management strategies based on lesion size, imaging characteristics, and risk factors. The close monitoring of high-risk lesions is crucial for timely intervention. Standardized growth criteria and optimized follow-up protocols are essential for improving clinical decision making and patient outcomes.

SURVEILLANCE FINDINGS IN HIGH-RISK PATIENTS AFTER BASELINE COMPUTER-ASSISTED DETECTION COLONOSCOPY: A PROPENSITY SCORE MATCHING ANALYSIS.

SURVEILLANCE FINDINGS IN HIGH-RISK PATIENTS AFTER BASELINE COMPUTER-ASSISTED DETECTION COLONOSCOPY: A PROPENSITY SCORE MATCHING ANALYSIS.

Comparison of two fluorescence detectors in flow cytometry to predict malignant transformation of oral leukoplakia from cell cycle fractions.

Comparison of two fluorescence detectors in flow cytometry to predict malignant transformation of oral leukoplakia from cell cycle fractions.

Abstract TP161: Machine Learning to Glean Characteristics of Quantitative Susceptibility Maps in Cerebral Cavernous Angiomas with Symptomatic Hemorrhage

Introduction and Hypothesis: New bleeding in cerebral cavernous malformations (CCM) heralds increased risk of future hemorrhage for several years, yet conventional imaging only detects new bleeding that occurred in the prior weeks. A biomarker of hemorrhage could help identifying high risk lesions. An increase of mean lesional quantitative susceptibility mapping (QSM) ≥6% on MRI has been adjudicated as reflecting new bleeding in CCM during longitudinal follow-up. However, mean lesional QSM from a single acquisition could not diagnose or prognosticate a bleed. We hypothesize that machine learning (ML) may identify diagnostic and prognostic features of bleeding within QSM maps at a single point in time. Material and Methods: Two hundred and sixty-five QSM maps of CCM lesions were acquired in 120 patients enrolled in National Institute of Health (NIH) multisite trial readiness project (NCT03652181). Each map was classified (Yes/No) in association with symptomatic hemorrhage (SH) and/or biomarker event with QSM increase ≥6% in the prior (diagnostic association) and subsequent (prognostic association) year. Twenty-eight features were extracted including 14 texture, 5 first-order statistical, as well as 3 size, shape, and morphological. Five-fold cross-validation was conducted on a support-vector machine (SVM) with linear stepwise kernel for both diagnostic and prognostic associations. Performance of individual features and composite classifiers was evaluated using student t-test ( p &lt;0.05) with Bonferroni-correction and receiver operating characteristic (ROC) analysis, area under the curve (AUC). Results: Lesions with SH in the prior year had lower average values for sum variance (AUC=0.79, p&lt;0.001), variance (AUC=0.79, p&lt;0.001), and correlation (AUC=0.71, p=0.004) as compared to lesions without SH. The SVM classification method tasked with distinguishing lesions with mean QSM increase ≥6% in the prior year included recurrent selection of sum average, mean, sphericity and margin sharpness, yielding an AUC of 0.61 (p=0.02). In the prognostic cohort, no individual feature nor any SVM classification model was able to distinguish cases with a subsequent clinical bleed or biomarker event. Conclusion: This proof-of-concept suggests that ML may assist in deriving features on QSM maps acquired at a single timepoint, which reflect prior hemorrhagic activity in CCM. Further investigation is planned in larger cohorts and in conjunction with clinical trials of bleeding in CCM.

Long-Term Prognostic Implications of Non-Culprit Lesions in Patients Presenting With an Acute Myocardial Infarction: Is It the Angiographic Stenosis Severity or the Underlying High-Risk Morphology?

Patients with acute myocardial infarction and angiographically obstructive non-culprit lesions are at high risk for recurrent major adverse cardiac events (MACEs). However, it remains largely unknown whether events are due to stenosis severity or due to the underlying high-risk lesion morphology. Between January 2017 and December 2021, 1312 patients with acute myocardial infarction underwent optical coherence tomography of all the 3 main epicardial arteries after successful percutaneous coronary intervention. Patients and lesions were categorized according to the presence or absence of (1) 1 or more non-culprit angiographic obstructive stenoses with a visual diameter stenosis of ≥50% and (2) 1 or more lesions with an underlying high-risk morphology defined as an optical coherence tomography thin-cap fibroatheroma (TCFA). Patients were followed for up to 5 years (median 4.1 [interquartile range: 3.0-5.0] years). MACEs comprised cardiac death, non-fatal myocardial infarction, and unplanned coronary revascularization. Overall, 492 patients had at least 1 obstructive non-culprit lesion, 352 had a single lesion, and 140 had multiple obstructive non-culprit lesions. The presence and number of angiographic obstructive non-culprit lesions correlated with the proportion and number of optical coherence tomography-derived TCFAs. At the lesion level, the prevalence of TCFA was twice as high in obstructive lesions compared with nonobstructive lesions. Patients with obstructive non-culprit lesions had an increased risk of overall MACEs (17.7% versus 12.8%; hazard ratio, 1.39 [95% CI, 1.02-1.91]) and non-culprit lesion-related MACEs (8.7% versus 3.9%; HR, 2.13 [95% CI, 1.26-3.59). Results were similar when patients were categorized on the basis of the underlying TCFA. A proportionally higher rate of overall and non-culprit lesion-related MACEs was observed as the number of obstructive stenoses or TCFAs in non-culprit segments increased. The lesion-specific HRs for obstructive lesion and TCFA were 2.03 (95% CI, 1.06-3.89) and 2.39 (95% CI, 1.29-4.43), respectively. Optical coherence tomography-derived TCFA, but not angiographic obstructive stenosis, was independently predictive of recurrent MACEs in both patient-level and lesion-level multivariable models in which these 2 characteristics were introduced simultaneously. The long-term prognostic implications of the presence and extent of angiographic obstructive non-culprit lesions in patients with acute myocardial infarction are primarily due to their correlation with the underlying high-risk morphology, which confers an increased risk of recurrent MACEs.

FFR-Negative Nonculprit High-Risk Plaques and Clinical Outcomes in High-Risk Populations: An Individual Patient-Data Pooled Analysis From COMBINE (OCT-FFR) and PECTUS-obs.

Despite fractional flow reserve (FFR)-guided deferral of revascularization, recurrent events in patients with diabetes or after myocardial infarction remain common. This study aimed to assess the association between FFR-negative but high-risk nonculprit lesions and clinical outcomes. This is a patient-level pooled analysis of the prospective natural-history COMBINE (OCT-FFR) study (Optical Coherence Tomography Morphologic and Fractional Flow Reserve Assessment in Diabetes Mellitus Patients) and PECTUS-obs study (Identification of Risk Factors for Acute Coronary Events by OCT After STEMI and NSTEMI Patients With Residual Non- Flow Limiting Lesions). Optical coherence tomography was performed on all FFR-negative (FFR >0.80) native nonculprit lesions. Patients or lesions with a high-risk plaque were compared with those without a high-risk plaque. A high-risk plaque was defined in the presence of at least 2 prespecified criteria: (1) lipid arc ≥90o, (2) minimum fibrous cap thickness <65 µm, and (3) presence of either plaque rupture or thrombus. The primary end points were native major adverse cardiovascular events (composite of all-cause mortality, nonfatal myocardial infarction, or unplanned revascularization excluding stent-failure-related events and nonattributable events) and target lesion failure (composite of cardiac death, target vessel myocardial infarction, or target lesion revascularization). Among 810 patients, 450 (55.6%) had a history of diabetes and 482 (59.5%) presented with myocardial infarction. At least 1 high-risk plaque was identified in 271 (33.5%) patients and 287 (30.6%) lesions. Over a median follow-up of 761 (interquartile range, 731-1175) days, the presence of a high-risk plaque was associated with patient-level native major adverse cardiovascular events (hazard ratio, 2.127 [95% CI, 1.451-3.120]; P<0.001) and lesion-level target lesion failure (hazard ratio, 2.623 [95% CI, 1.559-4.414]; P<0.001). The risk of adverse outcomes increased with the copresence of multiple high-risk features. FFR-negative but high-risk nonculprit lesions are associated with adverse patient- and lesion-level clinical outcomes. These findings emphasize the additional value of intracoronary imaging in patients with FFR-negative nonculprit lesions. URL: https://clinicaltrials.gov; Unique identifier: NCT02989740; Unique identifier: NCT03857971.

Percutaneous Revascularization of Thrombotic and Calcified Coronary Lesions.

Percutaneous coronary intervention (PCI) for thrombotic and heavily calcified coronary artery lesions and occlusions is often hampered by difficulty in wiring the occlusions, restoring antegrade flow, and proceeding to successful stent implantation. Characterization of dynamic anatomical features such as thrombi and the calcium distribution is key to prevent periprocedural complications and long-term adverse events, which are mainly driven by stent underexpansion and malapposition and may prompt in-stent restenosis or stent thrombosis. Therefore, multimodal imaging is a critical step during PCI to better characterize these high-risk lesions and select those in which careful preparation with debulking devices is needed or to guide stent optimization with the aim of improving procedural and long-term clinical outcomes. Hence, obtaining a better understanding of the underlying cause of thrombus formation, imaging the calcium distribution, and thorough planning remain crucial steps in selecting the optimal revascularization strategy for an individual patient. In this review, we summarize current evidence about the prevalence, predictors, and clinical outcomes of "hard-rock" thrombotic lesions treated by PCI, focusing on the value of imaging and physiological assessments performed to guide interventions. Furthermore, we provide an overview of cutting-edge technologies with the aim of facilitating the use of such devices according to specific procedural features.

Lesions of uncertain malignant potential in breast: Role of multiparametric MRI and histopathological correlation

Objectives This study aims to retrospectively evaluate the role of multiparametric magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping, in predicting the histopathological upgrade of B3 breast lesions. The primary objective is to calculate the mean ADC values for B3 and B5 lesions. The secondary objective involves evaluating the kinetic enhancement patterns of these lesions. Materials and Methods This retrospective analysis includes patients who underwent MR mammography between 2019 and 2023 in our institution and subsequently underwent trucut biopsy and histopathologically proven to be either B3 or B5 category breast lesions. Results Student’s t-test was used to find out the significant difference in ADC between the two groups. B5 lesions had lower mean ADC value (0.8 ± 0.2 ×10–3 mm2/sec, p = 0.026), whereas B3 lesions had higher mean ADC value (1.1 ± 0.3 × 10–3 mm2/sec, p = 0.026). Conclusion The multiparametric MRI including DWI in high-risk breast lesions would help in predicting their pathological behavior non-invasively. Identifying the mean ADC value and MR morphological characteristics in these lesions may guide clinicians in reducing misdiagnosis and over-treatment.

Pilot Study Examining the Use of DCE MRI With Pharmacokinetic Analysis to Evaluate Hypoxia in Prostate Cancer

Purpose: This study aimed to investigate the association between tumor hypoxia, assessed through anti-HIF (hypoxia-inducible factor) staining, and aggressiveness in prostate cancer using a pharmacokinetic model, particularly those derived from the Tofts model, in predicting tumor aggressiveness. Material and Methods: From January 2019 to April 2021, we conducted a retrospective search of patients with confirmed prostate cancer and a previous magnetic resonance imaging (MRI) examination. After exclusions, a total of 57 consecutive patients were enrolled. Patient data, including demographic, laboratory, and pathologic variables, were collected. MRI acquisition followed PI-RADS guidelines, encompassing T2-weighted, diffusion-weighted imaging, and dynamic contrast-enhanced imaging. An experienced abdominal radiologist conducted both morphologic and quantitative MRI analyses, evaluating parameters such as lesion size, apparent diffusion coefficient values, and the Tofts pharmacokinetics (TF) model. The histopathologic analysis included the International Society of Uropathology (ISUP) score and hypoxia marker immunohistochemistry. Results: There were no significant demographic and imaging differences between hypoxic and nonhypoxic tumors, except for elevated prostate-specific antigen levels in the latter and decreased normalized apparent diffusion coefficient in the former. Morphologic assessments revealed larger lesions in the hypoxia group. While K trans showed a positive association with hypoxia, it did not independently predict high-risk lesions. Conclusions: Our results suggest that pharmacokinetic analysis by the Tofts model was associated with tumors with hypoxia. However, this parameter was not an independent predictor of more aggressive tumors. Further studies, with a larger number of patients, multi-institutional and prospective, are needed to verify this possible association.

Clinical Benefit of a Conservative Treatment for High-Risk Human Papillomavirus Lesions in Patients with HIV.

Infection with Human immunodeficiency virus (HIV) shows a higher risk of infection by Human papillomavirus (HPV). We aim to provide evidence about the effect of a Coriolus versicolor-based vaginal gel (Papilocare®) for treating HPV in women with HIV. Women ≥25 years coinfected by endocervical HPV and with low-grade abnormal cervicovaginal cytology were treated for 6 months with Papilocare® in this observational, prospective, non-controlled pilot study. Cytology, colposcopy, biopsy, hybrid capture test, and 5-point Likert scale were assessed to evaluate cervical lesions repair, HPV clearance, and changes in cervical reepithelization, respectively, at 6 months. Fifteen patients (25-54 years) were included. Overall HPV clearance and cytological normalization rates were 73.3% and 80.0%, respectively, and 55.6% of the abnormal colposcopies were normalized. Re-epithelialization index improved in 66.7% of cases. Papilocare® may be effective for managing endocervical HPV infection in patients living with HIV.

Role of Serpin B3 and LRG1 as biomarkers in cervical cancer diagnosis and progression

Cervical cancer is a significant health concern for women, yet it is largely preventable. Persistent infections with oncogenic human papilloma viruses (HPVs) are the predominant cause, with viral oncoproteins facilitating neoplastic growth. Acute HPV infections often result in low-grade precursor lesions that typically resolve on their own in over 90% of cases, with fewer than 10% advancing to high-grade or invasive malignancies. As a result, the implementation of Pap smear screening programs has significantly decreased the incidence and mortality associated with cervical cancer, but it still remains a global health concern. Challenges such as low sensitivity and the unavailability of tests in rural areas pose significant hurdles. Novel biomarkers that monitor critical molecular events in histological or cytological samples are expected to improve the detection of high-risk lesions in both primary screening and triage scenarios.

Optimizing the dose-averaged linear energy transfer for the dominant intraprostatic lesions in high-risk localized prostate cancer patients.

Optimizing the dose-averaged linear energy transfer for the dominant intraprostatic lesions in high-risk localized prostate cancer patients.

The Clinical Utility of Incorporating Next-Generation Sequencing Results in the Management Algorithm of Pancreatic Cysts.

The Clinical Utility of Incorporating Next-Generation Sequencing Results in the Management Algorithm of Pancreatic Cysts.

Position statement of the World Endoscopy Organization: Role of endoscopy in screening, diagnosis, and treatment of esophageal superficial squamous neoplasia.

Esophageal squamous cell carcinoma (ESCC) remains a significant global health challenge, being the sixth leading cause of cancer mortality with pronounced geographic variability. The incidence rates range from 125 per 100,000 in northern China to 1-1.5 per 100,000 in the United States, driven by environmental and lifestyle factors such as tobacco and alcohol use, dietary habits, and pollution. Major modifiable risk factors include tobacco and alcohol consumption, with a synergistic risk increase when combined. Nonmodifiable risk factors include previous diagnoses of head and neck squamous cell carcinoma (H&N SCC), achalasia, and prior radiotherapy. Prevention strategies must be tailored to specific regional burdens to efficiently allocate medical and financial resources. Gastrointestinal endoscopy is crucial in reducing ESCC burden through early detection and characterization of neoplastic changes, such as high-grade dysplasia. Early diagnosis significantly improves survival rates, while endoscopic resection of noninvasive dysplasia can prevent ESCC onset, reducing treatment burden for advanced disease. Postresection surveillance can detect high-risk metachronous lesions. Despite these benefits, endoscopic prevention faces challenges, including the lack of high-level evidence supporting its efficacy, opportunity costs, the need for specialized training and techniques, and the requirement for advanced technology investments. This Position Statement from the World Endoscopy Organization (WEO) aims to address these challenges, supplying recommendations for the exploitation of endoscopic resources regarding the possible role of screening, quality, and training for the detection, characterization, resection, and surveillance of ESCC.

Advances for Managing Pancreatic Cystic Lesions: Integrating Imaging and AI Innovations.

Pancreatic cystic lesions (PCLs) represent a spectrum of non-neoplasms and neoplasms with varying malignant potential, posing significant challenges in diagnosis and management. While some PCLs are precursors to pancreatic cancer, others remain benign, necessitating accurate differentiation for optimal patient care. Conventional approaches to PCL management rely heavily on radiographic imaging, and endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA), coupled with clinical and biochemical data. However, the observer-dependent nature of image interpretation and the complex morphology of PCLs can lead to diagnostic uncertainty and variability in patient management strategies. This review critically evaluates current PCL diagnosis and surveillance practices, showing features of the different lesions and highlighting the potential limitations of conventional methods. We then explore the potential of artificial intelligence (AI) to transform PCL management. AI-driven strategies, including deep learning algorithms for automated pancreas and lesion segmentation, and radiomics for analyzing heterogeneity, can improve diagnostic accuracy and risk stratification. These advanced techniques can provide more objective and reproducible assessments, aiding clinicians in decision-making regarding follow-up intervals and surgical interventions. Early results suggest that AI-driven methods can significantly improve patient outcomes by enabling earlier detection of high-risk lesions and reducing unnecessary procedures for benign cysts. Finally, this review emphasizes that AI-driven approaches could potentially reshape the landscape of PCL management, ultimately leading to improved pancreatic cancer prevention.

Quantitative Structural Analysis of Hyperchromatic Crowded Cell Groups in Cervical Cytology: Overcoming Diagnostic Pitfalls.

The diagnostic challenges presented by hyperchromatic crowded cell groups (HCGs) in cervical cytology often result in either overdiagnosis or underdiagnosis due to their densely packed, three-dimensional structures. The objective of this study is to characterize the structural differences among HSIL-HCGs, AGC-HCGs, and NILM-HCGs using quantitative texture analysis metrics, with the aim of facilitating the differentiation of benign from malignant cases. A total of 585 HCGs images were analyzed, with assessments conducted on 8-bit gray-scale value, thickness, skewness, and kurtosis across various groups. HSIL-HCGs are distinctly classified based on 8-bit gray-scale value. Significant statistical differences were observed in all groups, with HSIL-HCGs exhibiting higher cellular density and cluster thickness compared to NILM and AGC groups. In the AGC group, HCGs shows statistically significant differences in 8-bit gray-scale value compared to NILM-HCGs, but the classification performance by 8-bit gray-scale value is not high because the cell density and thickness are almost similar. These variations reflect the characteristic cellular structures unique to each group and substantiate the potential of 8-bit gray-scale value as an objective diagnostic indicator, especially for HSIL-HCGs. Our findings indicate that the integration of gray-scale-based texture analysis has the potential to improve diagnostic accuracy in cervical cytology and break through current diagnostic limitations in the identification of high-risk lesions.