Independent Predictors Of Malignancy Research Articles

The spectrum of ECG abnormalities in a large cohort of histologically proven cardiac tumors

Abstract Background Cardiac tumors represent a heterogeneous clinical scenario. The role of ECG in the diagnostic work-up remains to be investigated. Objectives To describe the spectrum of electrocardiographic abnormalities in a large cohort of histologically proven cardiac tumors and to evaluate potential red flags of malignancy. Material and Methods 247 consecutive patients with histologically proven cardiac tumors and available ECG at Bologna University Hospital were enrolled. All ECGs were independently analyzed off-line using a manual caliper by two experienced cardiologists who were blinded to clinical information and histological results. In case of disagreements, a third consensus re-assessment was performed to resolve any discrepancies. Multivariable regression analysis was used to assess potential predictors of malignancy among electrocardiographic abnormalities. Results Of 247 patients, 98 (39.7%) had malignant tumors. Compared with patients with benign tumors, those with malignant tumors exhibited a higher heart rate, right axis deviation, greater depolarization, repolarization abnormalities and bradyarrhythmia at presentation. Regarding specific ECG features, a higher heart rate on admission (p=0.001), bradyarrhythmias (p=0.01), ischemic-like repolarization abnormalities (ST-segment deviation, both depression and elevation, and negative T-wave; p<0.001) and low voltages (p=0.005) were identified as independent predictors of malignancy. Conclusion ECG is frequently abnormal in case of malignant cardiac tumors. Some specific electrocardiographic changes could have a supportive role in the diagnostic workup of patients with cardiac tumors by increasing the clinical suspicion of malignancy.ECG Tumors

MRI and CT imaging characteristics in parotid tumors with false-negative fine-needle aspirations

BackgroundsPreoperative imaging, particularly with magnetic resonance imaging (MRI) and computed tomography (CT) scans, plays a crucial role in distinguishing between benign and malignant parotid gland tumors, while the reliability of Ultrasound-Guided Fine Needle Aspiration (FNA) in diagnosing these masses remains a topic of debate.MethodsThis two-center retrospective analysis was conducted on 347 patients with parotid gland tumors who had FNA and preoperative imaging (CT or MRI). All patients underwent surgery and final histopathological examination was available, along with complete medical records between January 2008 and May 2023.ResultsAmong the 347 patients, 318 (92%) had benign and 10 (3%) had malignant tumors based on FNA, with 19 (5%) unsatisfactory specimens. Final histological diagnosis revealed 303 (87%) benign and 44 (13%) malignant lesions, with a false-negative rate of 10.6% for FNA. Multivariate analysis identified irregular shape and invasion as independent predictors of malignancy in patient with benign or unsatisfactory FNA results. The odds ratio for irregular shape was 3.06 and for invasion was 12.73.ConclusionImaging characteristics, such as irregular shape and invasion may indicate towards malignant parotid tumors, even in patients with false-negative benign findings in FNA.

Value of spectral parameters in the differential diagnosis of benign and malignant breast nodules in non-enhanced chest CT.

Dual-layer spectral computed tomography (DSCT) is capable of acquiring both conventional and spectral images during one routine scan, and is widely used for the quantitative and qualitative analyses of substances, differential diagnosis, and disease staging. However, limited research has been conducted on its performance in the differential diagnosis of benign and malignant breast nodules using non-enhanced scans. This study aimed to assess the diagnostic performance of multiple quantitative parameters derived from non-enhanced DSCT in differentiating benign from malignant breast nodules. This retrospective cross-sectional study examined a total of 121 breast nodules from 114 patients (malignant group: n=68; benign group: n=53) identified during chest physical examination or routine admission for the treatment of breast diseases at The First Affiliated Hospital of Soochow University from March 2023 to December 2023. All the patients underwent DSCT scanning and pathological diagnosis. The DSCT quantitative parameters, including the effective atomic number (Zeff), computed tomography (CT) attenuation values at 40-70 keV, and the slope of the spectral Hounsfield unit curve (λHU), in non-enhanced images were measured. The λHU was calculated as follows: λHU = CT70 keV - CT40 keV/30 HU. Additionally, typical radiological features were analyzed. A DSCT parameter diagnostic model and a conventional CT diagnostic model were assessed using receiver operating characteristic (ROC) curves. The Delong test was used to assess and compare the diagnostic performance of each model. The DSCT parameters, including the Zeff (P<0.001), λHU (P<0.001), and CT attenuation values at 40 keV (P<0.001) and 50 keV (P=0.001), as well as the presence of the lobular sign (P<0.001) and spicule sign (P<0.001), exhibited statistically significant differences between the benign and malignant groups. The logistic regression analysis revealed that the Zeff [odds ratio (OR): 9.22; 95% confidence interval (CI): 2.11-40.35; P=0.003], λHU (OR: 0.64; 95% CI: 0.52-0.79; P<0.001), 40 keV CT attenuation value (OR: 8.69; 95% CI: 3.28-23.06; P<0.001), 50 keV CT attenuation value (OR: 0.01; 95% CI: 0.001-0.07; P<0.001), and lobular sign (OR: 3.95; 95% CI: 1.52-10.31; P=0.005) were independent predictors of malignancy. Compared to the benign group, the malignant group had a higher likelihood of presenting with the lobular sign and higher Zeff values but lower λHU values. The ROC curve indicated that the Zeff had the highest diagnostic efficacy [area under the curve (AUC) of the ROC =0.792, 95% CI: 0.71-0.87]. Further, the DSCT parameter diagnostic model had improved diagnostic efficacy with an AUC of 0.899 (95% CI: 0.84-0.96), which was higher than the AUC of the conventional CT diagnostic model (AUC =0.796, 95% CI: 0.72-0.87). The Delong test revealed a statistically significant difference between these two models (P=0.04). DSCT parameters derived from non-enhanced DSCT images, such as the Zeff value and λHU, can be used to differentiate benign and malignant breast nodules, and the differential diagnosis efficacy of the DSCT parameters is higher than that of conventional CT parameters.

Positive predictive value of malignancy for additional calcifications found during evaluation of a synchronous breast cancer

PurposeTo evaluate the positive predictive value and factors predictive of malignancy of additional calcifications in the pre-therapeutic work-up of a synchronous breast cancer. Materials and methodsInstitutional review board approval was obtained for this retrospective study and informed consent was waved. Consecutive patients referred to our center between January 1st 2018 and December 31st 2022 for a breast cancer and who presented additional calcifications detected during the pretreatment work-up were eligible for inclusion in this study. Morphology, distribution and BI-RADS category of the calcifications were assessed in consensus by 3 radiologists specialized in breast imaging. Side and distance from the cancer were collected. The predictive value of malignancy of the calcifications was calculated for each BI-RADS category. Factors associated with malignancy were evaluated by logistic non-conditional regression on univariate and multivariate analysis. ResultsOne hundred and thirteen clusters of calcifications in 103 patients were included. Among the groups of calcifications 41 % were malignant, 31 % benign and 28 % were atypia on biopsy. After exclusion of the non-operated atypia, 50.5 % of additional calcifications were ultimately malignant and 49.5 % were benign. The predictive value of malignancy was 20.7 %; 40.7 %; 63 %; 85.7 % and 100 % for category BI-RADS 3, 4a, 4B, 4c and 5 respectively. On multivariate analysis, multifocality or centricity of the index tumour (P = 0.01), BI-RADS classifications (P = 0.0001) and location ipsilateral less than 35 mm to the index cancer (P = 0.008) of the additional calcifications were found to be independent predictors of malignancy. Sixty percent of calcifications were not described on the initial out-center diagnostic work-up. ConclusionAdditional calcifications detected during the pretreatment work-up of a breast cancer are associated with a higher probability of malignancy than in a screening population and require biopsy even when demonstrating probably benign (BI-RADS 3) features.

Intratumoral calcification on CT assists in distinguishing benign and malignant upper abdomen neoplasm.

The significance of calcification and microcalcification in diagnosing malignant tumors is well established, but their role in the upper abdomen is less explored in routine radiology. To assess the effectiveness of computed tomography (CT) imaging in detecting intratumoral calcification within upper abdominal tumors. This study retrospectively enrolled patients with upper abdominal tumors featuring intratumoral calcifications who underwent plain and contrast-enhanced CT scans between January 2016 and December 2019. We examined the imaging characteristics of calcifications, including location, edges, shape, CT values, and association with necrosis. The diagnostic utility of calcification for distinguishing benign and malignant tumors was assessed using receiver operating characteristic curves. Univariate and multivariate logistic regression analyses were conducted to identify independent predictive factors for the diagnosis of malignancy characterized by intratumoral calcification. This study included 153 patients (median age 49 ± 21years; 83 men) with pathologically confirmed tumors of the upper abdomen (including liver, pancreas, and gastrointestinal tract) with intratumoral calcifications. Significant differences in CT values between benign and malignant tumors were observed (P < .001), with high diagnostic accuracy of calcification in CT imaging (receiver operating characteristic area = 0.884, sensitivity = 0.815, specificity = 0.976). The characteristics of calcification, including its edge and shape, were significantly correlated with tumor differentiation (P < .01). Multivariate logistic regression analysis revealed that the presence of adjacent necrosis around intracalcification is an independent predictor of malignancy (odds ratio = 5.48; 95% confidence interval: 1.55, 19.41; P = .008). Intratumoral calcification in CT imaging is a key marker for distinguishing between benign and malignant epigastric tumors, offering high specificity. Key message • What is already known on this topic - Intratumoral calcification, as a highly sensitive radiological marker, has shown potential in differentiating between benign and malignant tumors in thyroid and breast cancers. However, its discriminatory role in upper abdominal tumors is often overlooked. Therefore, assessing the diagnostic accuracy of intratumoral calcification on CT scans is crucial for improving diagnostic efficiency and avoiding unnecessary examinations. • What this study adds - Intratumoral calcification on CT exhibits high specificity in differentiating between benign and malignant upper abdominal tumors, providing a simple and reliable criterion for improving diagnostic accuracy. • How this study might affect research, practice or policy - This study highlights the significance of intratumoral calcification characteristics observed on CT in determining whether upper abdominal tumors are benign or malignant. The findings could pave the way for the development of a CT-based calcification scoring system, which would facilitate rapid and accurate diagnostics in clinical practice, thereby optimizing treatment strategies and enhancing patient prognosis.

Utilization of Texture Analysis in Differentiating Benign and Malignant Breast Masses: Comparison of Grayscale Ultrasound, Shear Wave Elastography, and Radiomic Features.

This study aims to determine which qualitative and quantitative US features are independently associated with malignancy, including those derived from grayscale imaging morphology, shear wave elastography (SWE), and texture analysis. This single-center retrospective study was approved by the institutional research ethics board. Consecutive breast US studies performed between January and December 2020 were included. Images were acquired using a Canon Aplio i800 US unit (Canon Medical Systems, Inc., CA) and i18LX5 wideband linear matrix transducer. Grayscale US features, SWE mean, and median elasticity were obtained. Single representative grayscale images were analyzed using dedicated software (LIFEx, version 6.30). First-order and gray-level co-occurrence matrix second-order texture features were extracted. Multivariate logistic regression was performed to assess for predictors of malignancy (STATA v16.1). One hundred forty-seven cases with complete SWE data were selected for analysis (mean age 54.3, range 21-92). The following variables were found to be independently associated with malignancy: age (P <.001), family history (P = .013), irregular mass shape (P = .024), and stiffness on SWE (mean SWE ≥40 kPa; P <.001). Remaining variables (including texture features) were not found to be independently associated with malignancy (P >.05). US texture analysis features were not associated with malignancy independent of other qualitative and quantitative US characteristics currently utilized in clinical practice. This suggests texture analysis may not be warranted when differentiating benign and malignant breast masses on US. In contrast, irregular mass shape on grayscale imaging and increased stiffness on SWE were found to be independent predictors of malignancy.

Spectrum of electrocardiographic abnormalities in a large cohort of cardiac masses

BackgroundCardiac masses represent a heterogeneous clinical scenario. Potential electrocardiographic (ECG) red flags of malignancy remain to be investigated. ObjectivesThe purpose of this study was to describe the spectrum of ECG abnormalities in a large cohort of cardiac masses and to evaluate potential red flags suggestive of malignancy. MethodsThis was an observational cohort study of 322 consecutive patients with a cardiac mass and available ECG at Bologna University Hospital. All masses were diagnosed by histologic examination or, in the case of cardiac thrombi, by radiologic resolution after proper anticoagulant therapy. Multivariable regression analysis was used to assess potential predictors of malignancy among ECG abnormalities. All-cause mortality at follow-up was evaluated. ResultsOf 322 patients, 98 (30.4%) had malignant tumors. Compared with patients with benign masses, those with malignant tumors exhibited a higher heart rate, right-axis deviation, greater depolarization, repolarization abnormalities, and bradyarrhythmia at presentation. Regarding specific ECG features, a higher heart rate on admission (P = .014), bradyarrhythmias (P = .009), ischemic-like repolarization abnormalities (ST-segment deviation, both depression and elevation, and negative T-wave; P <.001), low voltages (P = .001), and right-axis deviation (P = .025) were identified as independent predictors of malignancy. Considering these specific ECG alterations, a malignancy-oriented ECG was associated with higher mortality at follow-up (median 20.7 months). ConclusionECG frequently is abnormal in cases of malignant cardiac tumors. Some specific ECG changes are strongly suggestive for malignancy and type of infiltration.

The efficacy of clinicopathological and imaging features in differentiating benign from malignant parotid micro- and minitumors: a retrospective analysis

ObjectiveTo compare clinicopathological and imaging and features of micro- and minitumors of the parotid gland and provide a reference for preoperative prediction of benign vs. malignant status. Study DesignPatients with parotid gland tumors treated surgically were selected. Relevant clinicopathological and imaging data were collected for patients with maximum tumor diameters ≤ 20 mm on preoperative computed tomography (CT). The lesions were divided into two groups, microtumors and minitumors, based on maximum tumor diameter. CT imaging features of benign and malignant tumors were compared through binary logistic regression analysis. ResultsMicrotumors and minitumors were categorized by maximum diameters < 10 mm (n = 74) and 10-20 mm (n = 611), respectively. Benign and malignant minitumors exhibited significant differences in boundary, tumor density, margin morphology, spiculation margin, and CT values in the plain and arterial phase (P < 0.05), resembling those found in typical malignant parotid gland tumors. However, no significant differences were observed between benign and malignant microtumors. Logistic regression analysis identified boundary, margin morphology, and spiculation margin as independent predictors of malignancy. The prediction model excelled in identifying benign lesions but was less successful in identifying malignancies. ConclusionParotid gland minitumors had imaging features similar to typical larger malignant tumors. Active exclusion of the malignant risk and early surgical treatment is recommended for these tumors. Statement of Clinical RelevanceThis study analyzed the clinicopathological and imaging features of micro- and minitumors of the parotid gland to provide a reference for preoperative prediction and treatment. Active exclusion of malignant risk and early surgical treatment is recommended for small parotid tumors.

High Malignancy Risk and Its Predictors in South Indian Patients With Bethesda II Thyroid Nodules.

Global data reports a low malignancy risk, whereas regional data report a variable risk of malignancy in Bethesda II thyroid nodules. The limited availability of surgical histopathology might have underestimated the risk of malignancy. Here, we report the prevalence of malignancy and its predictors in Bethesda II thyroid nodules for which the surgical histopathological diagnosis was available. This retrospective study was done at a tertiary healthcare center in South India between January 2008 and September 2015. Case records of adults with thyroid nodules who underwent surgery were collected. Patients with inadequate data were excluded from the study. The data was analyzed using SPSS version 21.0 and a p-value of < 0.05 was considered statistically significant. A total of 563 patients were included in the study with a mean age of 36±12 years. Serum thyrotropin (TSH) was low in 87 (15.4%) patients whereas 362 (64.2%) patients had multinodular goiter (MNG). Sonographic evidence of suspicious cervical lymph node and microcalcification was seen in four (0.7%) and 48 (8.5%) patients, respectively. A total of 48 (8.5%) patients had thyroid carcinoma in the final histopathology. Of these, 42 (87.5%) had papillary thyroid carcinoma, five (10.4%) had follicular thyroid carcinoma and one (4.1%) had anaplastic carcinoma. Age, gender, and maximum nodule size were not associated with malignancy. Thyrotoxicosis was negatively associated with malignancy whereas multi-nodularity, thyroid calcification, or suspicious cervical lymph node on ultrasound and total thyroidectomy were positively associated with malignancy on univariate analysis. On binary logistic regression, only the former four, but not total thyroidectomy, were independent predictors of malignancy. We report a high (8.5%) prevalence of malignancy among South Indian patients with Bethesda II thyroid nodules. Thyroid microcalcification, presence of suspicious cervical lymph node on ultrasound, and multinodularity were associated with high and suppressed TSH with low risk of malignancy. Further prospective studies are warranted to confirm the study observations.

Prediction model based on MRI morphological features for distinguishing benign and malignant thyroid nodules

BackgroundThe low specificity of Thyroid Imaging Reporting and Data System (TI-RADS) for preoperative benign-malignant diagnosis leads to a large number of unnecessary biopsies. This study developed and validated a predictive model based on MRI morphological features to improve the specificity.MethodsA retrospective analysis was conducted on 825 thyroid nodules pathologically confirmed postoperatively. Univariate and multivariate logistic regression were used to obtain β coefficients, construct predictive models and nomogram incorporating MRI morphological features in the training cohort, and validated in the validation cohort. The discrimination, calibration, and decision curve analysis of the nomogram were performed. The diagnosis efficacy, area under the curve (AUC) and net reclassification index (NRI) were calculated and compared with TI-RADS.Results572 thyroid nodules were included (training cohort: n = 397, validation cohort: n = 175). Age, low signal intensity on T2WI, restricted diffusion, reversed halo sign in delay phase, cystic degeneration and wash-out pattern were independent predictors of malignancy. The nomogram demonstrated good discrimination and calibration both in the training cohort (AUC = 0.972) and the validation cohort (AUC = 0.968). The accuracy, sensitivity, specificity, PPV, NPV and AUC of MRI-based prediction were 94.4%, 96.0%, 93.4%, 89.9%, 96.5% and 0.947, respectively. The MRI-based prediction model exhibited enhanced accuracy (NRI>0) in comparison to TI-RADSs.ConclusionsThe prediction model for diagnosis of benign and malignant thyroid nodules demonstrated a more notable diagnostic efficacy than TI-RADS. Compared with the TI-RADSs, predictive model had better specificity along with a high sensitivity and can reduce overdiagnosis and unnecessary biopsies.

Evaluation of Malignancy Risk of Ampullary Tumors Detected by Endoscopy Using 2-[18F]FDG PET/CT.

We aimed to investigate whether 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) can aid in evaluating the risk of malignancy in ampullary tumors detected by endoscopy. This single-center retrospective cohort study analyzed 155 patients (79 male, 76 female; mean age, 65.7 ± 12.7 years) receiving 2-[18F]FDG PET/CT for endoscopy-detected ampullary tumors 5-87 days (median, 7 days) after the diagnostic endoscopy between June 2007 and December 2020. The final diagnosis was made based on histopathological findings. The PET imaging parameters were compared with clinical data and endoscopic features. A model to predict the risk of malignancy, based on PET, endoscopy, and clinical findings, was generated and validated using multivariable logistic regression analysis and an additional bootstrapping method. The final model was compared with standard endoscopy for the diagnosis of ampullary cancer using the DeLong test. The mean tumor size was 17.1 ± 7.7 mm. Sixty-four (41.3%) tumors were benign, and 91 (58.7%) were malignant. Univariable analysis found that ampullary neoplasms with a blood-pool corrected peak standardized uptake value in early-phase scan (SUVe) ≥ 1.7 were more likely to be malignant (odds ratio [OR], 16.06; 95% confidence interval [CI], 7.13-36.18; P < 0.001). Multivariable analysis identified the presence of jaundice (adjusted OR [aOR], 4.89; 95% CI, 1.80-13.33; P = 0.002), malignant traits in endoscopy (aOR, 6.80; 95% CI, 2.41-19.20; P < 0.001), SUVe ≥ 1.7 in PET (aOR, 5.43; 95% CI, 2.00-14.72; P < 0.001), and PET-detected nodal disease (aOR, 5.03; 95% CI, 1.16-21.86; P = 0.041) as independent predictors of malignancy. The model combining these four factors predicted ampullary cancers better than endoscopic diagnosis alone (area under the curve [AUC] and 95% CI: 0.925 [0.874-0.956] vs. 0.815 [0.732-0.873], P < 0.001). The model demonstrated an AUC of 0.921 (95% CI, 0.816-0.967) in candidates for endoscopic papillectomy. Adding 2-[18F]FDG PET/CT to endoscopy can improve the diagnosis of ampullary cancer and may help refine therapeutic decision-making, particularly when contemplating endoscopic papillectomy.

Management of thyroid tumors diagnosed cytologically as follicular neoplasms in a high-volume center: utility of a scoring system using serum thyroglobulin level, tumor size, ultrasound testing, and cytological diagnosis.

Managing thyroid nodules diagnosed cytologically as follicular neoplasms (FN) is challenging for patients and clinicians. Gene panel testing was recently introduced to determine the management strategy for FN; however, it is unavailable in Japan. In this study, we assessed FN management. This study included 2,144 FNs from 2,067 patients diagnosed between 2012 and 2018. Of these, 952 (44.5%) tumors underwent active surveillance, and 1,188 (55.6%) underwent immediate surgery (IS). Tumors of young patients (<55 years), male patients, and patients with serum thyroglobulin (Tg) ≥500 ng/mL, ultrasound diagnoses as FN or malignancy, large tumors (>4 cm), non-oxyphilic cytology, and cytological findings favoring malignancy and multiplicity underwent IS more frequently. Of the 1,412 tumors that underwent surgery, 279 (19.8%) and 1,133 (80.2%) were pathologically diagnosed as malignant and benign tumors or low-risk neoplasms, respectively. High Tg levels, non-benign ultrasound findings, cytological findings favoring malignancy, non-oncocytic cytology, and large tumor size were related to malignant pathology; however, tumor enlargement was not. The former three were independent predictors of malignancy in the multivariate logistic analysis. After assigning scores of 2 and 1 for cytological findings favoring malignancy and others, respectively, a receiver operating characteristic curve analysis indicated a score of 3 as the optimal cutoff for predicting malignant diagnosis; however, the area under the curve remained low, at 0.642. Accurately predicting the malignant pathology of FNs is challenging, and inducing gene panel testing will be helpful for managing FN tumors. Our scoring system would also be useful in estimating the risk of malignancy.

A clinical–radiological predictive model for solitary pulmonary nodules and the relationship between radiological features and pathological subtype

To develop a clinical-radiological model to predict the malignancy of solitary pulmonary nodules (SPNs) and to evaluate the accuracy of chest computed tomography imaging characteristics of SPN in diagnosing pathological type. The predictive model was developed using a retrospective cohort of 601 SPN patients (Group A) between July 2015 and July 2020. The established model was tested using a second retrospective cohort of 124 patients between August 2020 and August 2021 (Group B). The radiological characteristics of all adenocarcinomas in two groups were analysed to determine the correlation between radiological and pathological characteristics. Malignant nodules were found in 78.87% of cases and benign in 21.13%. Two clinical characteristics (age and gender) and four radiological characteristics (calcification, vascular convergence, pleural retraction sign, and density) were identified as independent predictors of malignancy in patients with SPN using logistic regression analysis. The area under the receiver operating characteristic curve (0.748) of the present model was greater than the other two reported models. Diameter, spiculation, lobulation, vascular convergence, and pleural retraction signs differed significantly among pre-invasive lesions, minimally invasive adenocarcinoma, and invasive adenocarcinoma. Only diameter and density were significantly different among invasive adenocarcinoma subtypes. Older age, male gender, no calcification, vascular convergence, pleural contraction sign, and lower density were independent malignancy predictors of SPNs. Furthermore, the pathological classification can be clarified based on the radiological characteristics of SPN, providing a new option for the prevention and treatment of early lung cancer.

Echocardiographic markers in the diagnosis of cardiac masses

Abstract Funding Acknowledgements Type of funding sources: None. Background The echocardiographic parameters required for a comprehensive assessment of cardiac mass (CMs) are still largely unknown. Objectives To identify and integrate the echocardiographic features of CMs that can accurately predict malignancy. Methods Observational cohort study of 286 consecutive patients who underwent a standard echocardiographic assessment for suspected cardiac mass between 2004 and 2022. A definitive diagnosis was achieved by histological examination or, in case of cardiac thrombi, with radiological evidence of thrombus resolution after an appropriate anticoagulant treatment. Logistic and multivariable regression analysis was performed to confirm the ability of 6 echocardiographic parameters to discriminate malignant from benign masses. The unweighted count of these parameters was used as a numerical score, ranging from 0 to 6, with a cut-off of &amp;gt;3 balancing sensitivity and specificity with respect to the histological diagnosis of malignancy. Classification tree analysis (CTA) was used to determine the ability of echocardiographic parameters to discriminate sub-groups of patients with a differential risk of malignancy. Results Benign masses were more frequently pedunculated, mobile, and adhered to the interatrial septum (p&amp;lt;0.001). Malignant masses showed a greater diameter and exhibited a higher frequency of irregular margins, an inhomogeneous appearance, sessile implantation, polylobate shape, and pericardial effusion (p&amp;lt;0.001). Infiltration, moderate-severe pericardial effusion, non-left localization, sessile, polylobate, and inhomogeneity were confirmed to be independent predictors of malignancy in both univariate and multivariable models. The predictive ability of the unweighted count of &amp;gt;3 was very high (&amp;gt;0.90) and similar to that of the previously published weighted score. The CTA generated an algorithm in which infiltration was the best discriminator of malignancy, followed by non-left localization and sessile shape. The percentage correctly classified by the CTA as malignant was 87.5%. Agreement between observer readings and cardiac mass histology ranged between 85.1–91.5%. The presence of at least 3 echocardiographic parameters was associated with a lower survival. Conclusions In the approach to CM, some echocardiographic parameters can serve as markers to accurately predict malignancy, thereby informing the need for second-level investigations and minimizing the diagnostic delay in such a complex clinical scenario.

A PROSPECTIVE CLINICAL STUDY OF THYROID MALIGNANCIES AND THE ROLE OF SERUM TSH IN PREDICTING MALIGNANCY

Introduction: Serum TSH is an independent predictor of malignancy in thyroid nodules according to the recent publications. Thyroid malignancies could be screened by using this biochemical marker (TSH) as a preliminary step. In this study, we looked into the usefulness of TSH in predicting cancer as well as the typical clinical presentation of thyroid cancers. Aims And Objectives: To assess the value of serum TSH measurement as a biochemical predictor of malignancy in suspicious thyroid nodules and to study the clinical manifestations and management of different thyroid malignancies. Place of Study: NRI Medical College Materials And Methods: and General Hospital, chinnakakani. Study population: All patients presented to General Surgery Department of NRI medical college and hospital, chinnakakani with clinically suspicious thyroid swellings of malignancy during the study period. Duration of Study: This was done over period Of one year from August 2021 to August 2022. It has a follow up of 6 months. Most of the Results: patients were females.40 years is the mean age of malignancy.mean age in male is 59 years and the mean age in females is 38 years. It commonly manifested as a rapidly growing swelling in the thyroid with shorter duration or development of secondary symptoms in a long standing goiter. Most of the patients are presented with STN. Malignancy occurred more frequently in SNT (36%) than MNG (19%).%. Mean preoperative TSH values of benign illness is less compared to those with malignancy. Higher TSH readings were associated with an increased risk of cancer. Higher TSH levels are Conclusion: denitely used as a predictor. The FNAC can be reexamined in these circumstances where the TSH result is high to correlated with malignancy. In cases with clinically suspected malignant thyroid swelling with a benign FNAC report, TSH values may be conrm the diagnosis

A Reappraisal of Suspicious Sonographic Features of Thyroid Nodules: Shape Is Not an Independent Predictor of Malignancy.

For the correct clinical application of the sonographic risk-stratification systems, the definition of independent risk features that are foundational to each system is crucial. The aim of this study was to identify the gray-scale sonographic features independently associated with malignancy, and to compare different definitions. This prospective, diagnostic accuracy study took place in a single thyroid nodule referral center. All patients consecutively referred to our center for fine-needle aspiration cytology of a thyroid nodule between November 1, 2015 and March 30, 2020, were enrolled before cytology. Each nodule was examined by 2 experienced clinicians to record the sonographic features on a rating form. Histologic (when available) or cytologic diagnosis was used as the reference standard. For each single sonographic feature and definition, the sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratios (DOR) were calculated. The significant predictors were then included in a multivariable regression model. The final study cohort consisted of 903 nodules in 852 patients. A total of 76 nodules (8.4%) were malignant. Six features were independent predictors of malignancy: suspicious lymph node (DOR 16.23), extrathyroidal extension (DOR 6.60), irregular or infiltrative margins (DOR 7.13), marked hypoechogenicity (DOR 3.16), solid composition (DOR 3.61), and punctate hyperechoic foci (including microcalcifications and indeterminate foci; DOI 2.69). Taller-than-wide shape was not confirmed as an independent predictor. We identified the key suspicious features of thyroid nodules and provided a simplified definition of some debated ones. Malignancy rate increases with number of features.

Echocardiographic Markers in the Diagnosis of Cardiac Masses

The echocardiographic parameters required for a comprehensive assessment of cardiac masses (CMs) are still largely unknown. To identify and integrate the echocardiographic features of CMs that can accurately predict malignancy. Observational cohort study of 286 consecutive patients who underwent a standard echocardiographic assessment for suspected cardiac mass in Bologna University Hospital between 2004 and 2022. A definitive diagnosis was achieved by histological examination or, in case of cardiac thrombi, with radiological evidence of thrombus resolution after an appropriate anticoagulant treatment. Logistic and multivariable regression analysis was performed to confirm the ability of 6 echocardiographic parameters to discriminate malignant from benign masses. The unweighted count of these parameters was used as a numerical score, ranging from 0 to 6, with a cut-off of >3 balancing sensitivity and specificity with respect to the histological diagnosis of malignancy. Classification tree analysis (CTA) was used to determine the ability of echocardiographic parameters to discriminate sub-groups of patients with a differential risk of malignancy. Benign masses were more frequently pedunculated, mobile, and adherent to the interatrial septum (p<0.001). Malignant masses showed a greater diameter and exhibited a higher frequency of irregular margins, an inhomogeneous appearance, sessile implantation, polylobate shape, and pericardial effusion (p<0.001). Infiltration, moderate-severe pericardial effusion, non-left localization, sessile, polylobate, and inhomogeneity were confirmed to be independent predictors of malignancy in both univariate and multivariable models. The predictive ability of the unweighted count of >3 was very high (>0.90) and similar to that of the previously published weighted score. The CTA generated an algorithm in which infiltration was the best discriminator of malignancy, followed by non-left localization and sessile shape. The percentage correctly classified by the CTA as malignant was 87.5%. Agreement between observer readings and cardiac mass histology ranged between 85.1-91.5%. The presence of at least 3 echocardiographic parameters was associated with a lower survival. In the approach to CM, some echocardiographic parameters can serve as markers to accurately predict malignancy, thereby informing the need for second-level investigations and minimizing the diagnostic delay in such a complex clinical scenario.

Coexisting Molecular Alterations Increase the Risk of Malignancy in Thyroid Nodules with Copy Number Alterations.

Molecular mutations and alterations play a role in thyroid tumorigenesis. Different alterations are associated with different clinical and pathological characteristics. Copy number alterations (CNAs) are known to be present in some thyroid tumors; however, their idiosyncratic clinicopathological implications are not yet well elucidated. A retrospective chart review was performed to identify patients with CNAs on pre-operative molecular testing results who subsequently underwent surgical treatment between January 2016 and April 2022 at McGill University teaching hospitals. Of the 316 patients with thyroid nodules who opted for molecular testing with ThyroSeqV3 followed by surgery, 67 (21.2%) nodules were positive for CNAs, including 23 Bethesda III, 31 Bethesda IV, 12 Bethesda V and 1 Bethesda VI nodules. On surgical pathology, 29.9% were benign and 70.1% were malignant or non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Among those that were malignant/NIFTP, 17.02% were considered to be aggressive cancers. The presence of other molecular alterations was found to be an independent predictor of malignancy in multivariate analysis (OR = 5.087, 95% C.I. = 1.12-23.04, p = 0.035). No unique factor was correlated with aggressiveness; however, CNA-positive thyroid nodules that were associated with high-risk mutations such as BRAF V600E, TP53, NTRK1/3 fusion, or PTEN mutation with high allele frequency (AF) ended up being aggressive cancers. Most of the CNA-positive thyroid nodules resulted in follicular patterned tumors in 41 (65.2%) cases and oncocytic tumors in 20 (29.9%) cases. This study demonstrates that 70.1% of surgically resected thyroid nodules with CNAs were malignant/NIFTP. Most CNA-positive thyroid nodules were either oncocytic patterned tumors or follicular patterned tumors. Furthermore, CNA-positive thyroid nodules were more likely to be malignant if they were associated with other molecular alterations or mutations.

Small (≤5 cm) soft tissue tumors of the extremity and superficial trunk: MRI features and demographic characteristics associated with malignancy.

Although a substantial proportion of small soft tissue tumors are malignant, magnetic resonance imaging (MRI) features and demographic characteristics associated with these tumors have not been well described. To investigate the MRI features and demographic characteristics associated with small (≤5 cm) malignant soft tissue tumors, and to identify independent predictors that allow differentiation of small benign and malignant soft tissue tumors. This retrospective study evaluated patients who underwent surgical excision of small soft tissue tumors of the extremities and superficial trunk, and preoperative contrast-enhanced MRI. Seven MRI findings (tumor depth, tumor-fascia relationship, heterogeneity of signal intensity, necrosis, peritumoral edema, peritumoral enhancement, and margin) and two demographic parameters (age and sex) were included in univariate and multivariate logistic regression analyses to identify independent predictors of small malignant soft tissue tumors. A total of 221 patients (102 men; mean age=45.6 ± 17.6 years) with 72 malignant and 149 benign tumors were included. In the univariate analysis, peritumoral edema (odds ratio [OR] = 3.854; P < 0.001) and peritumoral enhancement (OR = 3.966; P < 0.001) and patient age (≥46 years) (OR = 2.154; P = 0.009) were significantly associated with malignancy. Multivariate analysis showed that peritumoral enhancement on MRI (OR = 3.728; P < 0.001) and patient age (≥46 years) (OR = 1.907; P = 0.036) were independent predictors of malignancy. The combination of these two parameters showed accuracy of 75.1%, sensitivity of 55.6%, and specificity of 84.6% to predict malignancy. Among several MRI and demographic features, the presence of peritumoral enhancement on MRI and patient age (≥46 years) were independent predictors of malignancy in small soft tissue tumors.

Threshold of main pancreatic duct for malignancy in intraductal papillary mucinous neoplasm at head-neck and body-tail

BackgroundMain pancreatic duct (MPD) dilation is a high-risk stigmata/worrisome feature of malignancy in intraductal papillary mucinous neoplasms (IPMNs). The threshold of MPD diameter in predicting malignancy may be related to the lesion location. This study aimed to separately identify the thresholds of MPD for malignancy of IPMNs separately for the head-neck and body-tail.Materials and methodsA total of 185 patients with pathologically confirmed IPMNs were included. Patient demographic information, clinical data, and pathological features were obtained from the medical records. Those IPMNs with high-grade dysplasia or with associated invasive carcinoma were considered as malignant tumor. Radiological data including lesion location, tumor size, diameter of the MPD, mural nodule, and IPMN types (main duct, MD; branch duct, BD; and mixed type, MT), were collected on computed tomography or magnetic resonance imaging. Serum carbohydrate antigen 19-9 levels, serum carcinoembryonic antigen levels, and the medical history of diabetes mellitus, chronic cholecystitis, and pancreatitis were also collected.ResultsMalignant IPMNs were detected in 31.6% of 117 patients with lesions in the pancreatic head-neck and 20.9% of 67 patients with lesions in the pancreatic body-tail. In MPD-involved IPMNs, malignancy was observed in 54.1% of patients with lesions in the pancreatic head-neck and 30.8% of patients with lesions in the pancreatic body-tail (p < 0.05). The cutoff value of MPD diameter for malignancy was 6.5 mm for lesions in the head-neck and 7.7 mm for lesions in the body-tail in all type of IPMNs. In MPD-involved IPMNs, the threshold was 8.2 mm for lesion in pancreatic head-neck and 7.7 mm for lesions in the body-tail. Multivariate analysis confirmed that MPD diameter ≥ 6.5 mm (pancreatic head-neck) and MPD diameter ≥ 7.7 mm (pancreatic body-tail) were independent predictors of malignancy (p < 0.05). Similar results were observed in MPD-involved IPMNs using 8.2 mm as a threshold.ConclusionThe thresholds of the dilated MPD may be associated with IPMNs locations. Thresholds of 6.5 mm for lesions in the head-neck and 7.7 mm for lesions in the body-tail were observed. For MPD-involved IPMNs alone, threshold for lesions in the head-neck was close to that in the body-tail.