Nodule Size Research Articles

Lymph Node Metastasis and Its Diagnostic Implications Among Women Possessing Ductal Carcinoma of the Breast

Abstract Background: Lymph node metastasis is a significant prognostic marker in breast cancer treatment and it is associated with poor prognosis. Periodic acid Schiff’s reagent positive complex in metastatic lymph nodes is an indicator of poor prognosis. The metastatic lymph node variables were evaluated including periodic acid–Schiff (PAS) stain and its significance in prognosis and their association was analyzed concerning clinical and microscopic parameters. Objective: The objective of this study is to determine the lymph node metastasis variables, including its size, number of lymph nodes involved, and other associated pathologies. The clinical and microscopic parameters, including immunohistochemistry (IHC) of the tumor, were studied, and their association with lymph nodes was analyzed. Materials and Methods: In this study, the patients who were diagnosed with ductal carcinoma breast along with lymph node metastasis from 2008 to 2022 were included. The metastatic lymph node size, number, and other associated pathologies were evaluated and PAS stain where ever possible applied, and the results were compared concerning patient age, menopause status, tumor size, grade, invasion, necrosis, calcification, and prognosis (Nottingham prognostic index). IHC for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 /neu status along with vimentin and p53 was also applied and compared. Results: The results revealed that the maximum number of patients below 50 years of age was 54 (58.6%), and belonging to the premenopausal group was 50 (54.3%). The common tumor size among these patients was 5 cm, and below 5 cm was 64 (69.5%). The frequent histological grade was grade II 67 (72.8%), similarly, the favorable prognosis was moderate 55 (59.7%). The largest size of lymph nodes retrieved was 4 cm, the maximum number of lymph nodes involved was 17/19, and >3 metastatic lymph nodes were in 54.34% of cases. The other pathologies, which were found in lymph nodes included granulomatous lesion 2 (2.17%), microfilaria 2 (2.17%), and calcification 4 (4.34%). Immunohistochemistry (IHC) results in tumors having positive nodes were ER (16.30%), PR (11.95%), HER2/neu (21.73%), vimentin (16.30%), and p53 (6.52%). On PAS staining, loops and arches were frequently appreciated. Conclusion: This study concludes that metastatic lymph node is a potential predictor of poor prognosis. It synchronizes with other poor prognostic markers, such as younger age, larger tumor size, grade, invasion, and IHC markers, such as HER2/neu, vimentin, and p53. Other than that, PAS being a cheap and easily available stain, it must applied in metastatic lymph nodes for the determination of prognosis. These factors may be used for better management of breast cancer patients.

Utility of PET for Nodal Staging in Subsolid Clinical Stage IA (T1 N0) Lung Adenocarcinoma

BackgroundPositron emission tomography (PET) is the standard of care for non-small cell lung cancer (NSCLC) clinical staging, but it may have limited utility in evaluating subsolid lung adenocarcinomas that can have relatively indolent behavior without hypermetabolic activity. MethodsThe sensitivity and specificity of PET for determining pathologic lymph node status and disease-free survival were assessed in patients operated on for cT1 N0 subsolid lung adenocarcinoma from January 2006 to June 2022 (at Stanford University School of Medicine, Stanford, CA). Patients with clinical or pathologic tumor size >30 mm, hilar or mediastinal lymph node size >1cm, and purely solid tumors were excluded. ResultsPET was available in 498 of 534 (93.2%) patients and more often was used in older patients with larger and more solid tumors. The overall pathologic lymph node–positive rate was 8.4% (45 of 534). PET specificity was 95.1%, but sensitivity was only 20.0%. A tumor diameter of 18.5 mm and a solid component percentage of 62.5% had the maximum predictive accuracy for pathologic lymph node positivity, with a 0% and 1.5% rate of pathologic and PET lymph node positivity, respectively, for tumors with values lower than those thresholds. There was no significant difference in 5-year disease-free survival between individuals who did and did not undergo PET scanning (76.6% vs 96.8%; P = .07). Conversely, 134 (26.9%) patients who underwent PET scanning had 171 incidentally detected hypermetabolic lesions unrelated to lung cancer, with only 13 of 134 (9.7%) patients identified as having non-NSCLC premalignant or malignant conditions requiring further therapy. ConclusionsPET scan use for subsolid lung adenocarcinoma has high specificity but limited sensitivity for predicting pathologic lymph node positivity. PET also has no association with disease-free survival and often detects clinically unimportant findings rather than changing lung cancer management, particularly for patients with smaller and less solid tumors.

Intrathoracic Lymph Node Microcalcifications are Associated With a High Prevalence of Malignancy and Anaplastic Lymphoma Kinase Rearrangement: The "Calce" Study.

Microcalcifications are acknowledged as a malignancy risk factor in multiple cancers. However, the prevalence and association of intrathoracic lymph node (ILN) calcifications with malignancy remain unexplored. In this cross-sectional study, we enrolled patients with known/suspected malignancy and an indication for endosonography for diagnosis or ILN staging. We assessed the prevalence and pattern of calcified ILNs and the prevalence of malignancy in ILNs with and without calcifications. In addition, we evaluated the genomic profile and PD-L1 expression in lung cancer patients, stratifying them based on the presence or absence of ILN calcifications. A total of 571 ILNs were sampled in 352 patients. Calcifications were detected in 85 (24.1%) patients and in 94 (16.5%) ILNs, with microcalcifications (78/94, 83%) being the predominant type. Compared with ILNs without calcifications (214/477, 44.9%), the prevalence of malignancy was higher in ILNs with microcalcifications (73/78, 93.6%; P<0.0001) but not in those with macrocalcifications (7/16, 43.7%; P=0.93). In patients with lung cancer, the high prevalence of metastatic involvement in ILNs displaying microcalcifications was independent of lymph node size (< or >1cm) and the clinical stage (advanced disease; cN2/N3 disease; cN0/N1 disease). The anaplastic lymphoma kinase (ALK) rearrangement was significantly more prevalent in patients with than in those without calcified ILNs (17.4% vs. 1.7%, P<0.001), and all of them exhibited microcalcifications. ILN microcalcifications are common in patients undergoing endosonography for suspected malignancy, and they are associated with a high prevalence of metastatic involvement and ALK rearrangement.

Can Ultrasound Evaluation of Lymph Node Size and Necrosis Rate Predict Chemotherapy Response in Cervical Tuberculous Lymphadenitis?

To explore the relationship between the initial size and the necrotic rate of lymph nodes evaluated by ultrasound in patients with cervical tuberculous lymphadenitis (CTL) and therapeutic response. Overall, 55 patients were included in this study. Conventional ultrasound and contrast-enhanced ultrasound examination were performed before anti-tuberculosis chemotherapy. Based on the different therapeutic outcomes, they were divided into responder groups (n = 39) and non-responder groups (n = 16). The relationship between the initial size (maximum area, length diameter, short diameter), rate of necrosis, and therapeutic response were compared and analyzed between two groups. There was a significant difference in maximum area, short diameter and rate of necrosis of lymph nodes between the responder groups and the non-responder groups (P < 0.05). The receiver-operating-characteristic (ROC) curve analysis was used to differentiate the two groups, it showed that the area under the curve was 0.746 for maximum area and 0.721 for short diameter, respectively. The cut-off value for the lymph node maximum area and short diameter based on ROC curve analysis was determined as 3.94cm2 (sensitivity 76.9%, specificity 68.7%) and 1.15cm (sensitivity 59.0%, specificity 93.7%), respectively. A negative correlation was observed between maximum area, short diameter, and therapeutic response. The initial maximum area and short diameter of lymph nodes were found to have a negative correlation with chemotherapy response in patients with CTL. The treatment outcomes are typically unsatisfactory for lymph nodes exhibiting an initial necrosis rate of 50% or higher. These findings may be helpful for evaluating therapeutic response.

Optimization of Endoscopic Ultrasound Characteristics in the Diagnosis of Malignant Intraductal Papillary Mucinous Neoplasm.

Endoscopic ultrasound (EUS) is an excellent diagnostic tool that provides high-resolution images of pancreatic cystic lesions. However, its role in the diagnosis of malignant intraductal papillary mucinous neoplasm (IPMN) remains limited and unclear. We aimed to determine the usefulness of this modality for such diagnosis. Overall, 246 patients who underwent EUS for IPMN after computed tomography (CT)/magnetic resonance imaging (MRI) from April 2018 to June 2021 were followed up until March 2022. We assessed the added value of performing EUS after CT or MRI for diagnosing malignant IPMN, using receiver operating characteristic curve analysis. Walls as thick as 2 mm were considered thickened in this study if they were highly uneven. EUS clearly enhanced accuracy in identifying enhancing nodules and thickened walls. The areas under the receiver operating characteristic curve and corresponding 95% confidence intervals were 0.655 (0.549-0.760) and 0.566 (0.478-0.654) upon CT/MRI but 0.853 (0.763-0.942) and 0.725 (0.634-0.817) when observed using EUS. The combination of nodule size, thickened wall, and main duct size yielded the highest area under the receiver operating characteristic curve (0.944 [0.915-0.973]). EUS more accurately detects malignant IPMN, as uneven wall thickening and certain nodules cannot be identified with CT/MRI.

The relationship between clustering and networked Turing patterns.

Networked Turing patterns often manifest as groups of nodes distributed on either side of the homogeneous equilibrium, exhibiting high and low density. These pattern formations are significantly influenced by network topological characteristics, such as the average degree. However, the impact of clustering on them remains inadequately understood. Here, we investigate the relationship between clustering and networked Turing patterns using classical prey-predator models. Our findings reveal that when nodes of high and low density are completely distributed on both sides of the homogeneous equilibrium, there is a linear decay in Turing patterns as global clustering coefficients increase, given a fixed node size and average degree; otherwise, this linear decay may not always hold due to the presence of high-density nodes considered as low-density nodes. This discovery provides a qualitative assessment of how clustering coefficients impact the formation of Turing patterns and may contribute to understanding why using refuges in ecosystems could enhance the stability of prey-predator systems. The results link network topological structures with the stability of prey-predator systems, offering new insights into predicting and controlling pattern formations in real-world systems from a network perspective.

The Efficacy of Ultrasound-Guided Microwave Ablation for Benign Thyroid Nodules and the Correlation Analysis of Its Influencing Factors

Objective: To investigate the efficacy of ultrasound-guided microwave ablation (MWA) for benign thyroid nodules and to analyze the correlation between treatment outcomes and various influencing factors. Methods: 95 patients with pathologically confirmed benign thyroid nodules（ totally 96 nodules) who underwent MWA under ultrasound guidance were enrolled in this retrospective study. Pre-ablation and post-ablation follow-up examinations including two-dimensional ultrasound, color Doppler, and contrast-enhanced ultrasound were conducted at 1, 3, and 6 months. The clinical efficacy was assessed, including the reduction in nodule volume and the success rate of ablation. Factors that might influence treatment outcomes, such as patient age, gender, nodule size, type, and ablation parameters, were analyzed. Statistical correlations were evaluated using Spearman’s correlation coefficient and multiple regression analysis. Results: MWA has demonstrated favorable efficacy in treating benign thyroid nodules, with a low incidence of complications. Most nodules experienced significant volume reduction or even complete disappearance after treatment (P &lt; 0.05). The average volume reduction ratio (VRR) of benign thyroid nodules undergoing MWA at 1 month, 3 months, and 6 months post-operation were 52.98%±22.23%, 68.18%±19.81%, and 82.39%±15.03%, respectively, with a significant reduction rate (VRR &gt; 50%) observed in 95.8% (92/96) of the nodules (VRR &gt; 50%). Cystic nodules exhibited the most substantial volume reduction following ablation. The initial volume of the nodule, blood flow status, nodule composition, and the energy absorption per unit volume were all related to the postoperative VRR (P &lt; 0.05). Factors such as patient age, gender, and ablation duration did not show significant correlation with ablation efficacy (P＞0.05). Conclusion: MWA is a promising minimally invasive treatment for benign thyroid nodules. The treatment efficacy is closely related to the initial volume of the thyroid nodule, the composition of the nodule, the blood flow situation of the nodule, and the ablation energy per unit volume.

The Efficacy of Ultrasound-Guided Microwave Ablation for Benign Thyroid Nodules and the Correlation Analysis of Its Influencing Factors

Objective: To investigate the efficacy of ultrasound-guided microwave ablation (MWA) for benign thyroid nodules and to analyze the correlation between treatment outcomes and various influencing factors. Methods: 95 patients with pathologically confirmed benign thyroid nodules（ totally 96 nodules) who underwent MWA under ultrasound guidance were enrolled in this retrospective study. Pre-ablation and post-ablation follow-up examinations including two-dimensional ultrasound, color Doppler, and contrast-enhanced ultrasound were conducted at 1, 3, and 6 months. The clinical efficacy was assessed, including the reduction in nodule volume and the success rate of ablation. Factors that might influence treatment outcomes, such as patient age, gender, nodule size, type, and ablation parameters, were analyzed. Statistical correlations were evaluated using Spearman’s correlation coefficient and multiple regression analysis. Results: MWA has demonstrated favorable efficacy in treating benign thyroid nodules, with a low incidence of complications. Most nodules experienced significant volume reduction or even complete disappearance after treatment (P &lt; 0.05). The average volume reduction ratio (VRR) of benign thyroid nodules undergoing MWA at 1 month, 3 months, and 6 months post-operation were 52.98%±22.23%, 68.18%±19.81%, and 82.39%±15.03%, respectively, with a significant reduction rate (VRR &gt; 50%) observed in 95.8% (92/96) of the nodules (VRR &gt; 50%). Cystic nodules exhibited the most substantial volume reduction following ablation. The initial volume of the nodule, blood flow status, nodule composition, and the energy absorption per unit volume were all related to the postoperative VRR (P &lt; 0.05). Factors such as patient age, gender, and ablation duration did not show significant correlation with ablation efficacy (P＞0.05). Conclusion: MWA is a promising minimally invasive treatment for benign thyroid nodules. The treatment efficacy is closely related to the initial volume of the thyroid nodule, the composition of the nodule, the blood flow situation of the nodule, and the ablation energy per unit volume.

Association between non-alcoholic fatty liver disease and the risk of pulmonary nodules in patients with intestinal polyps.

Associations between metabolic risk factors and lung cancer remain elusive, and evidence on the linkage between non-alcoholic fatty liver disease (NAFLD) and pulmonary nodules is limited. This study sought to examine the independent association between NAFLD and the risk of pulmonary nodules. Cross-sectional analyses of 1,119 patients with intestinal polyps hospitalized at the Department of Gastroenterology, Minhang District Central Hospital of Shanghai, China, were conducted. NAFLD was diagnosed based on hepatic ultrasonography or computed tomography (CT) findings of hepatic steatosis, with exclusion criteria ensuring patients had no history of significant alcohol consumption, viral infections, or hepatic autoimmune diseases. The currently accepted definition of a pulmonary nodule is a solid or sub-solid shadow ≤3 cm in diameter that appears as a solid or semi-solid pattern on a chest CT scan (our specific treatment is pulmonary nodule size: 5 mm to 3 cm). Adjusted 95% confidence intervals (CIs) and odds ratios (ORs) for NAFLD and the clinical features connected with pulmonary nodule risk were determined using a multivariable logistic regression analysis. Among the 979 intestinal polyp patients, the prevalence rates of NAFLD and pulmonary nodules were 25.9% and 32.8%, respectively. Patients with pulmonary nodules exhibited higher rates of NAFLD (31.5% vs. 23.3%, P=0.006) and obesity (41.4% vs. 32.5%, P=0.006) compared to those without pulmonary nodules. After removing all the possible confounding variables, the adjusted ORs for NAFLD, an older age, smoking, and obesity were 1.370 (95% CI: 1.006-1.867, P=0.04), 1.022 (95% CI: 1.010-1.033), 1.599 (95% CI: 1.033-2.475), and 1.410 (95% CI: 1.057-1.880), respectively (all P values <0.05). NAFLD showed a significant association with an increased risk of pulmonary nodules. NAFLD was independently linked to an increased incidence of pulmonary nodules in intestinal polyp patients, which emphasizes the importance of screening and managing these conditions in lung cancer prevention.

Online monitoring of the size distribution of lime nodules in a full-scale operated lime kiln using an in-situ laser triangulation camera

To maximize efficiency of the recausticizing process in a pulp mill, producing a reburned lime with high and consistent reactivity is process critical. Prior investigations have demonstrated a correlation between the reactivity of lime and its nodule size, as well as the dusting behavior of the kiln. Therefore, monitoring the nodule size produced in the lime kiln could be a promising indirect method to measure the performance of the lime kiln. The objective of this investigation was to evaluate the utility of a laser triangulation camera for online monitoring of nodule size distribution for the lime kiln. A series of full-scale trials were performed in a lime kiln of a kraft pulp mill in which a camera was installed at the exit conveyor to analyze the lime discharging from the kiln. The nodule size distribution was analyzed for correlation with the lime temperature, flue gas temperature, and rotational speed of the kiln. The monitoring demonstrated temporal stability, and the results showed that the lime temperature had the most significant effect on the nodule size. The rotational speed of the lime kiln and the flue gas temperature showed limited effect on nodule size, but they had significant impact on the specific energy demand. The overall conclusion of the study is that the camera methodology effectively correlates lime temperature with nodule size distribution, and it advocates for the methods of implementation in automating lime temperature control, facilitating the production of consistently reactive lime at a lower specific energy consumption.

Prevalence of Thyroid Nodules in Residents of Ukraine Exposed as Children or Adolescents to Iodine-131 from the Chornobyl Accident.

Background: Although childhood exposure to radioactive iodine-131 (I-131) is an established risk factor for thyroid cancer, evidence for an association with thyroid nodules is less clear. The objective of this study is to evaluate the association between childhood I-131 exposure and prevalence of ultrasound-detected thyroid nodules overall and by nodule histology/cytology (neoplastic/suspicious/non-neoplastic), size (<10 mm/≥10 mm), and number (single/multiple). Methods: This is a cross-sectional study of radiation dose (mean = 0.53 gray, range: 0.0003-31 gray) and screen-detected thyroid nodules conducted in 1998-2000 (median population age 21.5 years) in a cohort of 13,243 residents of Ukraine who were under 18 years at the time of the Chornobyl accident on April 26, 1986. Excess odds ratios per gray (excess odds ratio [EOR]/Gy) and confidence intervals (CIs) were estimated using logistic regression. Results: Among 13,078 eligible individuals, we identified 358 (2.7%) with at least one thyroid nodule. Significantly increased dose-response associations were found for all nodules and nodule groups with doses <5 Gy except individuals with non-neoplastic nodules. Among individuals with doses <5 Gy, the EOR/Gy for neoplastic nodules (5.35; CI: 2.19-15.5) was significantly higher than for non-neoplastic nodules (0.24; CI: 0.07-0.74), but the EOR/Gy did not vary by nodule size or number. Conclusions: Childhood exposure to I-131 is associated with an increased risk of thyroid nodules detected 12-14 years following exposure, and the risk for neoplastic nodules is higher than for non-neoplastic nodules. Analyses of incident thyroid nodules may help clarify dose-response patterns by nodule characteristics and provide insights into thyroid nodule etiology.

Abscopal effect after bronchial artery embolization for cancer-related hemoptysis

AbstractThe abscopal effect, a rare phenomenon in cancer treatment, involves tumor regression in a distant location from the targeted therapy. This case focuses on a 74-year-old woman with metastatic papillary thyroid cancer. Despite prior treatments, she experienced pulmonary nodule progression and hemoptysis. Bland particle embolization was performed on the right bronchial artery branches supplying lung metastases, leading to significant reductions in size, number, and metabolic activity of the right-sided nodules and decreased metabolic activity of the untreated left-sided nodules, without additional cancer-related treatments. The abscopal effect has been observed with various interventional oncologic procedures, indicating a potential role in stimulating the immune response and altering the tumor microenvironment. Further investigation is needed to understand bland embolization's immunomodulatory effects and implications for triggering the abscopal effect.

Genetic parameters and correlations for behavioural response traits towards humans in South African Black ostriches

ABSTRACT 1. The aim of this study was to estimate heritability and genetic correlations, first among behavioural responses of juvenile South African Black ostriches towards humans and secondly with slaughter weight and skin traits. 2. Behavioural traits, such as willingness of the birds to approach humans, keeping a distance from the human observer and allowing touch interactions by a human were recorded (n = 1012 birds). In addition, slaughter weight, skin size, scores for nodule size, nodule shape and the presence of hair follicles were recorded. 3. Single- and multi-trait animal model analyses performed on the data using ASReml4 revealed high heritability estimates of 0.44 for allowing touch interactions and 0.48 for both willingness to approach and keeping a distance from the human observer. In addition, significant genetic correlations among behavioural response traits were estimated, ranging from −0.99 between keeping a distance and willingness to approach the human observer, to 0.87 between allowing touch interactions and willingness to approach the human observer. 4. In contrast, genetic correlations of behavioural response traits with most slaughter and skin traits were low, variable, and not significant. The exception was hair follicle score, which appeared to be unfavourably correlated with key behavioural traits. 5. This study suggested that the temperament of ostriches could be improved by selection of birds that demonstrate willingness to associate with humans without compromising slaughter weight or skin traits.

Effect of Cu Addition Above the Solubility Limit on Microstructure Formation and Cu Segregation in 800 MPa Grade Ductile Cast Iron During Solidification

In this study, the effect of 3 mass%Cu additions on microstructure formation and Cu segregation in 800 MPa grade ductile cast iron during solidification was investigated. The calculated phase diagram showed that after the addition of 3 mass%Cu, the Cu phase with a negligible amount appeared below 1000°C, and most Cu was included in the matrix. Based on optical microstructure, after the addition of 3 mass%Cu, the size of graphite nodules became finer, and the microstructure rarely had an area with α-ferrite. Image analysis showed that the fraction of pearlite increased significantly, indicating that Cu greatly promoted the formation of pearlite. Compositional analysis by scanning electron microscopy indicated that the pearlitic area also contained approximately 3 mass%Cu, which corresponds to those of primary and secondary austenite calculated. A small and bright phase particle containing a large amount of Cu was observed at the interface of graphite and matrix.

Limited Additional Value of a Chest CT in Whole-Body Staging with PET-MRI: A Retrospective Cohort Study.

Hybrid PET-MRI systems are being used more frequently. One of the drawbacks of PET-MRI imaging is its inferiority in detecting lung nodules, so it is often combined with a computed tomography (CT) of the chest. However, chest CT often detects additional, indeterminate lung nodules. The objective of this study was to assess the sensitivity of detecting metastatic versus indeterminate nodules with PET-MRI compared to chest CT. A total of 328 patients were included. All patients had a PET/MRI whole-body scan for (re)staging of cancer combined with an unenhanced chest CT performed at our center between 2014 and 2020. Patients had at least a two-year follow-up. Six percent of the patients had lung metastases at initial staging. The sensitivity and specificity of PET-MRI for detecting lung metastases were 85% and 100%, respectively. The incidence of indeterminate lung nodules on chest CT was 30%. The sensitivity of PET-MRI to detect indeterminate lung nodules was poor (23.0%). The average size of the indeterminate lung nodules detected on PET-MRI was 7 ± 4 mm, and the missed indeterminate nodules on PET-MRI were 4 ± 1 mm (p < 0.001). The detection of metastatic lung nodules is fairly good with PET-MRI, whereas the sensitivity of PET-MRI for detecting indeterminate lung nodules is size-dependent. This may be an advantage, limiting unnecessary follow-up of small, indeterminate lung nodules while adequately detecting metastases.

The European Thyroid Imaging and Reporting Data System as a Remedy for the Overdiagnosis and Overtreatment of Thyroid Cancer: Results from the EUROCRINE Surgical Registry.

The European Thyroid Imaging and Reporting Data System (EU-TIRADS) aims to reduce the overdiagnosis of thyroid cancer (TC) by guiding the selection of nodules for fine-needle aspiration biopsy (FNAB). This study sought to validate EU-TIRADS nodule selection criteria using data from EUROCRINE, an extensive international endocrine surgery registry. We reviewed indications for FNAB among patients with TC compared to those with benign disease who underwent surgery between March 2020 and March 2022, considering preoperative EU-TIRADS scores and dominant nodule size (FNAB is recommended in Category 5 (˃10 mm or ˂10 mm with suspicious lymph nodes), 4 (˃15 mm), and 3 (˃20 mm)). Patients were categorized into three risk groups: minimal risk (patients with papillary microcarcinoma), high risk (patients with pT3b stage or higher, pN1b, or pM1), and low-moderate risk (all other patients). We conducted a Receiver Operating Characteristic (ROC) analysis to assess the diagnostic accuracy of the EU-TIRADS. We analyzed 32,008 operations. Approximately 68% of the surgical records included EU-TIRADS classifications. The EU-TIRADS exhibited diagnostic accuracy across high-volume sites, with a median ROC Area Under the ROC Curve (AUC) of 0.752, indicating its effectiveness in identifying malignancy. Among the cases, 7907 patients had TC. Notably, 55% of patients with TC underwent FNAB despite not initially meeting the EU-TIRADS criteria. These patients were distributed across the minimal- (58%), low-moderate- (36%), and high-risk (5.8%) categories. Of the patients with TC recommended for FNAB, 78% were deemed low-moderate risk, 21% high risk, and only 0.7% minimal risk. The EU-TIRADS offers effective preoperative malignancy risk stratification. Promoting the proper use of the EU-TIRADS in clinical practice is essential to mitigate the overdiagnosis and overtreatment of low-risk TC.

Construction and Analysis of Intelligent Analysis and Disposal Model for Internet Security Events in Power System

The reliability of nodes is rugged to determine, and the global accuracy is low in identifying secure access nodes of ubiquitous power network gateways. Therefore, this project intends to establish a universal power grid gateway security access node identification model. Sensor technology collects secure access nodes of IoT gateways and evaluates their reliability. It is integrated with the security level of the network to form a virtual security domain. Then, the access node is searched and controlled twice. The access node identification of the universal power IoT gateway is realized according to the reliability calculation. Simulation results show that under the same parameter conditions, when the node size increases and the number of malicious nodes increases, the proposed method can obtain higher accuracy of secure access to nodes. This proves the advantages of the proposed method.

Radiology-Pathology Concordance and Prognostication of Nodal Features in pN+ Oral Cavity Cancer.

The aims of our study are to evaluate the diagnostic performance and prognostic value of radiological lymph node (LN) characteristics in pN+ oral cavity squamous carcinoma (OSCC). pN+ OSCC treated between 2012 and 2020 were included. Preoperative imaging was reviewed by a single radiologist blinded to pathologic findings for the following nodal features: imaging-positive LN (iN+), laterality and total number, and image-identified extranodal extension (iENE). The sensitivity of iN+ for pN+ was calculated. The diagnostic performance of other nodal features was evaluated in the iN+ subgroup. The association of radiologic nodal features with overall survival (OS) was evaluated. Inter-rater kappa for radiologic nodal features was assessed in 100 randomly selected cases. Of 406 pN+ OSCC, 288 were iN+. The sensitivity of iN+ for pN+ was 71% overall, and improved to 89% for pN+ LN >1.5 cm. Within iN+, sensitivity/specificity for LN size (>3 cm), total LN number (>4), and ENE were 0.44/0.95, 0.57/0.84, and 0.27/0.96, respectively. Sensitivity of iENE was higher in the subset, with major (>2 mm) versus minor (≤2 mm) pENE (43% vs. 13%, p = 0.001). Reduced OS was observed in iN+ versus iN- (p = 0.006), iENE+ versus iENE- (p = 0.004), LN size >3 versus ≤3 cm (p < 0.001), and higher LN number (p < 0.001). Inter-rater kappa for iN+, laterality, total LN number, and presence of iENE were 0.71, 0.57, 0.78, and 0.69, respectively. Our study shows that despite modest sensitivity of most radiological nodal features, the specificity of image-identified nodal features is high and their prognostic values are retained in pN+ OSCC. Level 3 (retrospective review comparing cases and controls) Laryngoscope, 2024.

Recommendations to Improve Management of Incidental Pulmonary Nodules in Canada: Expert Panel Consensus.

Introduction: Incidental pulmonary nodules (IPN) are common radiologic findings, yet management of IPNs is inconsistent across Canada. This study aims to improve IPN management based on multidisciplinary expert consensus and provides recommendations to overcome patient and system-level barriers. Methods: A modified Delphi consensus technique was conducted. Multidisciplinary experts with extensive experience in lung nodule management in Canada were recruited to participate in the panel. A survey was administered in 3 rounds, using a 5-point Likert scale to determine the level of agreement (1 = extremely agree, 5 = extremely disagree). Results: Eleven experts agreed to participate in the panel; 10 completed all 3 rounds. Consensus was achieved for 183/217 (84.3%) statements. Panellists agreed that radiology reports should include a standardized summary of findings and follow-up recommendations for all nodule sizes (ie, <6, 6-8, and >8 mm). There was strong consensus regarding the importance of an automated system for patient follow-up and that leadership support for organizational change at the administrative level is of utmost importance in improving IPN management. There was no consensus on the need for standardized national referral pathways, development of new guidelines, or establishing a uniform picture archiving and communication system. Conclusion: Canadian IPN experts agree that improved IPN management should include standardized radiology reporting of IPNs, standardized and automated follow-up of patients with IPNs, guideline adherence and implementation, and leadership support for organizational change. Future research should focus on the implementation and long-term effectiveness of these recommendations in clinical practice.

Liver Transplantation for Hepatocarcinoma: Results over Two Decades of a Transplantation Programme and Analysis of Factors Associated with Recurrence.

In recent years, many studies have attempted to develop models to predict the recurrence of hepatocarcinoma after liver transplantation. A single-centre, retrospective cohort study analysed patients receiving transplants due to hepatocarcinoma during the 20 years of the transplant programme. We analysed patient survival, hepatocarcinoma recurrence and the influence of the different factors described in the literature as related to hepatocarcinoma recurrence. We compared the results of previous items between the first and second decades of the transplantation programme (1995-2010 and 2010-2020). Of 265 patients, the patient survival rate was 68% at 5 years, 58% at 10 years, 45% at 15 years and 34% at 20 years. The overall recurrence rate of hepatocarcinoma was 14.5%, without differences between periods. Of these, 54% of recurrences occurred early, in the first two years after transplantation. Of the parameters analysed, an alpha-fetoprotein level of >16 ng/mL, the type of immunosuppression used and the characteristics of the pathological anatomy of the explant were significant. A trend towards statistical significance was identified for the number of nodules and the size of the largest nodule. Logistic regression analysis was used to develop a model with a sensitivity of 85.7% and a specificity of 35.7% to predict recurrences in our cohort. Regarding the comparison between periods, the survival and recurrence rates of hepatocarcinoma were similar. The impact of the factors analysed in both decades was similar. Most recurrences occur during the first two years post-transplantation, so closer follow-ups should be performed during this period, especially in those patients where the model predicts a high risk of recurrence. The detection of patients at higher risk of recurrence allows for closer follow-up and may, in the future, make them candidates for adjuvant or neoadjuvant systemic therapies to transplantation.