Malignant Lesions Research Articles

Management of Oral Leukoplakia – A Systematic Umbrella Review of Global Evidence

Objective: To summarize the global evidence related to various interventions for treating Oral Leukoplakia. Introduction: Oral leukoplakia is a common oral potentially malignant lesion that precedes the development of oral cancer. The main aim of any treatment is to prevent the malignant transformation. This umbrella review updates the global evidence of different medicinal treatment available for Oral Leukoplakia. Methods: The databases searched were Cochrane database of systematic reviews, JBI Evidence Synthesis, MEDLINE, Web of Science, Scopus. The key terms used were leukoplakia, oral leukoplakias, Proliferative verrucous leukoplakia, interventions, management, chemoprevention, laser, photodynamic, topical agents. JBI Sumari software was used to screen and appraise the articles along with data extraction and data synthesis. Results: A total of 670 citations were identified through the electronic search. Out of which 61 systematic reviews were recognized. Following removal of duplicates, 47 records were retrieved. The full texts of 13 papers were retrieved for further examination with 9 systematic reviews meeting the inclusion criteria and therefore included in this umbrella review. Study overlap calculation was conducted and pooled results showed that the treatments available for oral leukoplakia has little effect on clinical response and malignant transformation rate. Conclusions: Currently we do not have evidence of a treatment that is preventing oral leukoplakia from converting to oral cancer. Treatments such as vitamin A and beta carotene may be effective in reducing clinical size of oral lesions. More long-term studies are required for surgical management, lasers and photodynamic therapy.

Dermoscopic Features and Algorithm- A Guide to Detecting Pre-Malignant Facial Pigmented Skin Lesions in Ethnic Skin

Introduction: Detection of pre malignant facial pigmented lesions on a photo damaged ethnic skin has been crucial for dermatologists in preventing malignant transformation. Facial Pigmented Skin Lesions (FPSLs) that render a diagnostic challenge include, Pigmented Actinic Keratosis (PAK), early Seborrheic Keratosis (SK), Solar Lentigo (SL) and Lentigo Maligna (LM). Dermatoscopy or epiluminescence microscopy, is skin surface microscopy that has demonstrated to be a non-invasive, in vivo, high yield technique to evaluate a pigmented macule for an atypical evolution. Objective: To establish dermatoscopic findings of clinically challenging FPSLs conforming PAK, SK, SL and LM and derive an Algorithm with diagnostic features for detecting Premalignant Facial Pigmented Skin Lesions. Subjects and Methods: We here in conducted a largest case study a cross-sectional analysis of clinically challenging 182 flat FPSLs, evaluated dermoscopic images consistent to pigmented AK, early SK, SL and LM and subsequently biopsied for histopathological evidence. Four major dermoscopic features were appraised: pigment pattern, sharp demarcation, vascular criteria and follicular/epidermal pattern. Study Design: Cross sectional validation-study Setting: Department of Dermatology Unit II, King Edward Medical University, Mayo Hospital Lahore. Study was conducted for a period of six months. Result: We derived an “Algorithm” elucidating diagnostic findings of FPSLs. Pigmented AK on dermoscopy has strawberry pattern in 42% of lesions (pink to red pseudo-network with erythematous background, prominent follicular ostia fenced by a white targetoid halo), while Sharp demarcation (57.15%) and follicular/epidermal pattern (cerebriform pattern 100% of lesions, milia-like cysts, 50%, and comedo-like openings 38.57%) are distinctively observed SK. In SL, homogenous structureless pigmentation is significant entirely (100%). However, in LM predominates pseudonetwork (89.47%), homogenous structureless pigmentation (78%) and vascular patterns while strawberry pattern is observed in (26.31%) of lesions. Conclusion Our “Dermoscopic Algorithm” constitutes diagnostic characteristics of “Facial Pigmented Skin Lesions,” that would not only aid in early corrective detection of clinically similar lesions with different biologic behavior, but serve the the purpose to prevent vigorous malignant transformation in photo damaged ethnic skin, particularly Lentigo Maligna turning into a potential Melanoma, Hence, Sharp demarcation with cribriform pattern is specific of Sebhorric Keratosis (SK), while homogenous structureless pigmentation without prominent vascular pattern is distinctive of Solar Lentigo (SL). Pigmented Actinic Keratosis (AK) is described by prominent strawberry pattern. Nonetheless, homogenous structureless pigmentation and vascular pattern with pseudonetwork are featured in Lentigo Maligna (LM), lacking of prominent strawberry pattern. Conflict of Interest: The Authors have no conflict of interest to disclose.

Contrast-Enhanced Intraoperative Ultrasound Shows Excellent Performance in Improving Intraoperative Decision-Making.

The aim of this study was to evaluate the performance and the impact of contrast-enhanced intraoperative ultrasound (CE-IOUS) on intraoperative decision-making, as there is still no standardized protocol for its use. Therefore, we retrospectively analyzed multiple CE-IOUS performed in hepato-pancreatic-biliary surgery with respect to pre- and postoperative imaging and histopathological findings. Data of 50 patients who underwent hepato-pancreatic-biliary surgery between 03/2022 and 03/2024 were retrospectively collected. CE-IOUS was performed with a linear 6-9 MHz multifrequency probe connected to a high-resolution device. The ultrasound contrast agent used was a stabilized aqueous suspension of sulphur hexafluoride microbubbles. In total, all 50 lesions indicated for surgery were correctly identified. In 30 cases, CE-IOUS was used to localize the primary lesion and to define the resection margins. In the remaining 20 cases, CE-IOUS identified an additional lesion. Fifteen of these findings were identified as malignant. In eight of these cases, the additional malignant lesion was subsequently resected. In the remaining seven cases, CE-IOUS again revealed an inoperable situation. In summary, CE-IOUS diagnostics resulted in a high correct classification rate of 95.7%, with positive and negative predictive values of 95.2% and 100.0%, respectively. CE-IOUS shows excellent performance in describing intraoperative findings in hepato-pancreatic-biliary surgery, leading to a substantial impact on intraoperative decision-making.

Use of a handheld system for interventional ultrasound with puncture and biopsy in an in vitro liver model.

Ultrasound-guided interventions (such as biopsies) of unclear lesions are indicated if microcirculatory changes indicate possible malignant lesions. These place high demands on the ultrasound device used. In order to potentially reduce the often associated high technical effort, the wireless ultrasound device Vscan AirTM was examined as a possible ultrasound device for the intervention biopsy. As part of an advanced training course on Computertomographie- and ultrasound-guided biopsy and ablation procedures, participants were asked about the image quality of the handheld device used by means of questionnaires. Various lesions were evaluated at a depth of 1.0 to 5.0 cm in an in vitro liver model. The image quality was evaluated independently before, during and after the intervention. The rating scale contained values from 0 (no assessment possible) to 5 (maximum high image quality). A high-end device was used as a reference. A total of 11 participants took part in the study (n = 4 male [36.4%], n = 7 female [63.6%]). A total of five tumor like lesions at different depths (1 cm, 2 cm, 3 cm, 4 cm, >4 cm) were assessed separately. In all cases, an adequate biopsy of the target lesion (1 cm in length, core filling 5 mm) was successful. From a depth of 3 cm, the image quality of the mobile device increasingly decreased, but the image quality of the high-end system was still not impaired. Compared to the high-end device, there was a highly significant difference in image quality from a depth of 3 cm (p < 0.01). Assessment by inexperienced examiners using a handheld device was adequately possible. Mobile interventional ultrasound represents a potential alternative for the biopsy of unclear tumorous lesions with microcirculatory disorders with limited depth localization.

A hybrid features fusion-based framework for classification of breast micronodules using ultrasonography

BackgroundBreast cancer is one of the leading diseases worldwide. According to estimates by the National Breast Cancer Foundation, over 42,000 women are expected to die from this disease in 2024.ObjectiveThe prognosis of breast cancer depends on the early detection of breast micronodules and the ability to distinguish benign from malignant lesions. Ultrasonography is a crucial radiological imaging technique for diagnosing the illness because it allows for biopsy and lesion characterization. The user’s level of experience and knowledge is vital since ultrasonographic diagnosis relies on the practitioner’s expertise. Furthermore, computer-aided technologies significantly contribute by potentially reducing the workload of radiologists and enhancing their expertise, especially when combined with a large patient volume in a hospital setting.MethodThis work describes the development of a hybrid CNN system for diagnosing benign and malignant breast cancer lesions. The models InceptionV3 and MobileNetV2 serve as the foundation for the hybrid framework. Features from these models are extracted and concatenated individually, resulting in a larger feature set. Finally, various classifiers are applied for the classification task.ResultsThe model achieved the best results using the softmax classifier, with an accuracy of over 95%.ConclusionComputer-aided diagnosis greatly assists radiologists and reduces their workload. Therefore, this research can serve as a foundation for other researchers to build clinical solutions.

Mesenchymal Tumors of the Skin: A Review

Mesenchymal tumors of the skin are rare and clinically heterogeneous, and can represent diagnostic challenge for pathologists. Most of these lesions have overlapping clinical and histological features, thus the understanding of architectural patterns, cytoplasmic and stromal features can facilitate proper diagnosis. Anatomic site may be an important factor in the differential diagnosis, as are patient’s age and sex. Ancillary tests are often required and can be useful to rule out other entities. Molecular diagnostics is playing an increasingly important role in the diagnosis of soft tissue neoplasms. Here, we review clinical, histological, and molecular features of some of the most common of these uncommon entities including benign and malignant lesions.

Bronchial branch tracing navigation in ultrathin bronchoscopy-guided radial endobronchial ultrasound for peripheral pulmonary nodule

BackgroundMost malignant peripheral pulmonary lesions (PPLs) are situated in the peripheral region of the lung. Although the ultrathin bronchoscope (UTB) can access these areas, a robust navigation system is essential for precise localisation of these small peripheral PPLs. Since many UTB procedures rely on automated virtual bronchoscopic navigation (VBN), this study aims to determine the accuracy and diagnostic yield of the manual bronchial branch tracing (BBT) navigation in UTB-guided radial endobronchial ultrasound (rEBUS) procedures.MethodsSingle-centre retrospective study of UTB-rEBUS patients with PPLs smaller than 3 cm over a two year period.ResultsOur cohort consisted of 47 patients with a mean age of 61.6 (SD 9.53) years and a mean target size of 1.91 (SD 0.53) cm. Among these lesions, 46.8% were located in the 6th airway generation, and 78.7% exhibited a direct bronchus sign. Navigation success using BBT was 91.5% based on positive rEBUS identification. The index diagnostic yield was 82.9%, increasing to 91.5% at 12 months of follow-up. Malignant lesions accounted for 65.1% of cases, while 34.9% were non-malignant. The presence of a direct bronchus sign was the sole factor associated with higher navigation success and diagnostic yield. Cryobiopsy outperformed forceps biopsy in non-concentric rEBUS lesions (90.9% vs. 50.0%, p < 0.05), but not in concentric orientated lesions. One pneumothorax occurred in our cohort.ConclusionsBBT as an exclusive navigation method for small PPLs in UTB-rEBUS procedures has proved to be safe and feasible. Combination of UTB with cryobiopsy remains efficient for eccentric and adjacently oriented rEBUS lesions.

Ultrasound Multimodality Examination Improves the Diagnostic Efficiency of Non-Mass-Like Breast Lesions

This study is focused on ultrasound multimodality examination, which refers to the combined use of three ultrasound examination modalities, ultrasound (US), acoustic radiation force impulse (ARFI) imaging, and contrast-enhanced ultrasound (CEUS). The purpose of this study is to analyze the value of applying ultrasound multimodality examination in the differential diagnosis of benign and malignant breast non-mass-like lesions (NMLs). Cases of breast NMLs were analyzed retrospectively, and the nature of all the lesions was verified by pathological examination. Based on the gray-scale ultrasound image characteristics, the cases were classified into types Ⅰ to Ⅴ, and type Ⅰ and type Ⅱ were further classified into 4 subtypes, Ⅰa, Ⅰb, Ⅱa, and Ⅱb, according to whether there was also calcification, and the proportion of malignant cases in each subtype was statistically analyzed. Logistic regression models of US, US+ARFI, US+CEUS, and US+ARFI+CEUS for the diagnosis of malignant cases were established, ROC curves were drawn, the area under the curve (AUC) was calculated, and comparisons were made accordingly. The detection rate of malignant NMLs without calcification (atypical malignant NMLs) by the combination examination of US, ARFI, and CEUS was analyzed. A total of 407 cases were included in the study. All subjects were female, aged 22 to 81 years, with the average age being (47.0±11.0) years. There were 220 benign cases and 187 malignant cases. Ranked from the highest to the lowest, the malignancy proportion of the different types was Ⅰb>Ⅱb>Ⅲ>Ⅴ>Ⅰa>Ⅱa>Ⅳ. The malignant proportion of the low echo area with calcification was significantly higher than that of the lesions without calcification. The AUC (95% confidence interval [CI]) for diagnosing malignant cases with the logistic regression models of US, US+ARFI, US+CEUS, and US+ARFI+CEUS were 0.895 (0.862-0.927), 0.908 (0.878-0.937), 0.921 (0.893-0.948), and 0.927 (0.902-0.952), respectively. Comparison of the AUC of the 4 regression models showed significant differences (P<0.001). The detection rate of US for NMLs without calcification was 80.7%. When US was used in combination with ARFI and CEUS, 86.4% of the malignant NMLs lesions without calcification could be detected if the lesion CEUS score was 4 or 5 points or if shear-wave velocity (SWV)≥4.28 m/s. Breast NMLs with calcification show high risks of malignancy, and a pathological examination is always recommended for a conclusive diagnosis. Ultrasound multimodality examination can improve the diagnostic accuracy of breast NML without calcification.

Implementation of a New Classification and Stratification System for Solitary Bone Tumor: Osseous Tumor Radiological and Interpretation and Management System (OT-RIMS)

Abstract Objectives To propose a histological-grades-based Osseous Tumor Radiological Interpretation and Management System (OT-RIMS) that would simplify the radiological evaluation of bone tumors, categorize key radiological features into severity levels, and inform corresponding patient management actions. Methods This retrospective study between January 2015 and August 2022 evaluated patients with solitary bone tumors confirmed by pathology and imaging follow-up received two or three imaging modalities of radiographs, CT, or MRI. Three radiologists independently assessed radiological features, categorized bone lesions based on OT-RIMS criteria, and reached a consensus. Kappa statistics and observed agreement were calculated. Results A total of 341 patients (mean age, 26.0 years; 159 women) were included, with 102 malignant, 177 benign, and 62 intermediate or low-grade malignant bone lesions. Sensitivity and specificity of readers 1, 2, and 3, respectively, in the identification of malignant tumors into OT-RIMS 4 were 93.1% (95 of 102) and 93.3% (223 of 239), 96.1% (98 of 102) and 91.6% (219 of 239), 92.2% (94 of 102) and 89.5% (214 of 239). Inter-reader agreement of OT-RIMS category for three readers was considered excellent (Kendall’s W = 0.924, p &amp;lt; 0.001) with a kappa value of reproducibility in categories 1&amp;2, 3, and 4 of 0.764, 0.528, and 0.930, respectively. Conclusion The OT-RIMS category demonstrated excellent reproducibility despite the reader’s expertise level in categorizing the risk stratification of bone tumors and informing patient management, with histological grades used as the reference standard. Advances in knowledge The OT-RIMS category reliably stratifies bone tumors into four categories corresponding to histological grades and standardized patient management.

Narrow band imaging: Important tool for early diagnosis, management, and improved outcomes in gastrointestinal lesions.

Narrow band imaging-magnifying endoscopy (NBI-ME) is used to identify changes in mucosal or vascular pattern observed on GI endoscopy in real time on the basis of optical image enhancement.It has a significant role in early detection of dysplasia, premalignant, and Malignant lesions along with its depth of invasion. Upper and lower GI endoscopy performed in 1742 patients who presented with gastrointestinal symptoms at this tertiary center over 5years out of which 1623 were evaluated with both NBI-ME and histopathology. Real time endoscopic assessment was performed. Targeted biopsies were taken for comparative analysis. Of the 1742 patients, 119 were excluded from the study. 807 underwent upper GI endoscopy and 816 underwent lower GI endoscopy. Mean age of presentation was 38 +/- 2.7years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of NBI-ME for neoplastic esophageal lesions were 96.3%, 90.6%, 91.1%, 96.03%, respectively. For Barrett's esophagus it was 95.4%, 90.7%, 86.1%, and 90.7%; For gastric neoplastic lesions the values were 96.1%, 91.04%, 83.8%, and 97.9%. For colorectal it was 96.7%, 91.3%, 88.0%, and 97.7%. Overall sensitivity, specificity, PPV, andNPVof NBI-ME for neoplastic lesions (both upper and lower GI) were 96.2%, 91.0%, 96.2%, and 97.2%. Of the 1623 patients, 951 received medical management with regular surveillance and 672 patients with high-grade dysplasia, premalignant, and malignant conditions underwent interventions in form of either endoscopy or surgery. NBI-ME has a greater role and can be considered as an effective tool in making early diagnosis and guiding optimum treatment.

Benign Lobular Inner Nuclear Layer Proliferations of the retina.

Report the clinical and imaging findings of a patient with an intraretinal benign tumor that was documented as an unexpected clinical finding after an ischemic stroke in the context of mitral valve disease. This tumor must be distinguished from retinoblastoma and other malignant neoplasms. A patient with intraretinal tumor of the inner nuclear layer (INL) underwent a combination of ophthalmic examination, fundus photography, fluorescein angiography, optical coherence tomography (OCT), and optical coherence tomography angiography (OCT-A). A 64-year-old male patient with unilateral benign tumor lesions dependent on the internal retina, centered in the posterior pole, and multifocal. OCT showed that these lesions were centered within the INL at the edge of the inner plexiform layer and were not associated with other findings in the posterior pole. Benign Lobular Inner Nuclear Layer Proliferations (BLIP) of the Retina are recently described lesions that should be considered, given their distinctive characteristics that set them apart from other benign and malignant retinal lesions.

Discrimination Between Benign and Malignant Lesions With Restriction Spectrum Imaging MRI in an Enriched Breast Cancer Screening Cohort.

Breast cancer screening with dynamic contrast-enhanced MRI (DCE-MRI) is recommended for high-risk women but has limitations, including variable specificity and difficulty in distinguishing cancerous (CL) and high-risk benign lesions (HRBL) from average-risk benign lesions (ARBL). Complementary non-invasive imaging techniques would be useful to improve specificity. To evaluate the performance of a previously-developed breast-specific diffusion-weighted MRI (DW-MRI) model (BS-RSI3C) to improve discrimination between CL, HRBL, and ARBL in an enriched screening population. Prospective. Exactly 187 women, either with mammography screening recommending additional imaging (N = 49) or high-risk individuals undergoing routine breast MRI (N = 138), before the biopsy. Multishell DW-MRI echo planar imaging sequence with a reduced field of view at 3.0 T. A total of 72 women had at least one biopsied lesion, with 89 lesions categorized into ARBL, HRBL, CL, and combined CLs and HRBLs (CHRLs). DW-MRI data were processed to produce apparent diffusion coefficient (ADC) maps, and estimate signal contributions (C1, C2, and C3-restricted, hindered, and free diffusion, respectively) from the BS-RSI3C model. Lesion regions of interest (ROIs) were delineated on DW images based on suspicious DCE-MRI findings by two radiologists; control ROIs were drawn in the contralateral breast. One-way ANOVA and two-sided t-tests were used to assess differences in signal contributions and ADC values among groups. P-values were adjusted using the Bonferroni method for multiple testing, P = 0.05 was used for the significance level. Receiver operating characteristics (ROC) curves and intra-class correlations (ICC) were also evaluated. C1, √C1C2, and were significantly different in HRBLs compared with ARBLs (P-values < 0.05). The had the highest AUC (0.821) in differentiating CHRLs from ARBLs, performing better than ADC (0.696), especially in non-mass enhancement (0.776 vs. 0.517). This study demonstrated the BS-RSI3C could differentiate HRBLs from ARBLs in a screening population, and separate CHRLs from ARBLs better than ADC. 2.

Vocal dysfunction following thyroid surgery: a multidimensional subjective and objective study

Background and objectiveFollowing thyroid surgery, vocal changes are a common complication and well-known morbidity that may be linked to neuronal and non-neuronal voice breakdown. Nevertheless, their effects on different voice characteristics are not fully understood, and their bases are still poorly characterized. In order to determine the diagnostic indicators that address the nature of such post-thyroidectomy voice alternations, this study was designed to provide a multidimensional assessment of vocal function after thyroid surgery.MethodsThis research was a 1-year prospective cohort study conducted on 100 adult patients aged 40.19 (± 12.82) years who were recruited from the outpatient clinic of Phoniatric Unit, Assiut University Hospital, and scheduled to undergo thyroid surgery during the period from November 2020 to November 2021. All subjects underwent vocal assessment preoperatively and 15 days, 1 month, and 2 months postoperatively by filled in subjective evaluation of voice complaints via voice handicap index (VHI-30), auditory perceptual assessment (APA) of the voice, and videolaryngoscopy in addition to acoustic analysis using computerized speech lab (CSL). Statistical analysis was performed to compare multi-parameter voice assessment tools across different assessment time points.ResultsThe voice changes were significantly decreased from 51.0% after 15 days postoperatively to 33.0% after 2 months of follow-up. Among these cases, 35.0% cases developed vocal fold paralysis and complained of a breathy voice (27% developed unilateral vocal fold paralysis, and 8% developed bilateral focal fold lesions), and the remaining 16.0% cases had no paralytic manifestations. Also, only one case developed gross lesion “bilateral vocal fold nodules.” The subjective evaluation of voice outcome after thyroidectomy showed significant improvement in VHI subscales and total score from 15 days postoperatively to 2 months of follow-up (P < 0.001). All of the acoustic parameters except HNR showed a significant difference across the different assessment settings (P < 0.001).ConclusionThyroidectomy can result in significant vocal alterations, even in cases where the laryngeal nerve is unharmed. These changes should be taken into consideration in patient having thyroid surgery, especially a total thyroidectomy because of malignant lesions. More efforts are needed in order to determine the extent and pathophysiological reasons for the vocal alterations following thyroid surgery in order to reduce the morbidity associated with one of the most popular surgical procedures performed globally.

Usefulness of Combined Advanced Dynamic Contrast-Enhanced and Diffusion-Weighted MRI Over Ultrasonography in Differentiating Cancer From Benign Lesions in Dense Breasts.

Aim To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) in characterizing suspicious lesions in dense breasts compared to ultrasonography (USG). Materials and methods Eighty-two consecutive female patients with suspicious lesions in dense breast parenchyma showing the American College of Radiology Breast Imaging Reporting And Data System (ACR BI-RADS) c/d composition on mammography underwent USG, where 63 lesions of 63 patients were suspicious. They underwent multiparametric MRI, followed by histopathological evaluation (HPE) of the lesions.Statistical analysis was done to calculate the sensitivity, specificity, and accuracy of USG and MRI in lesion characterization and the combined accuracy of DCE-MRI with DWI.The receiver operating characteristic (ROC) curve analysis provided the cut-off for the apparent diffusion coefficient (ADC) value. Results The sensitivity, specificity, and accuracy of USG were 91.7%, 63%, and 79.4%, respectively. Kinetic curve analysis on DCE-MRI showed a type I curve only in benign lesions. Malignant lesions predominantly showed a type III curve.The sensitivity, specificity, and accuracy of DCE-MRI were 95.8%, 78.5%, and 85.7%, respectively.The optimum cut-off ADC value was 1.05x10-3 mm2/s with sensitivity, specificity, and accuracy of 83.3 % each.The specificity and accuracy of combined DCE-MRI with DWI were 94.4% and 88.1%, respectively. Conclusion Advanced MRI, including a combination of DCE-MRI kinetics and DWI, would be more effective and accurate for lesion characterization in dense breasts and act as a superior problem-solving tool compared to USG in differentiating carcinoma from benign lesions.

Ultrasomics differentiation of malignant and benign focal liver lesions based on contrast-enhanced ultrasound

ObjectivesTo establish a nomogram for differentiating malignant and benign focal liver lesions (FLLs) using ultrasomics features derived from contrast-enhanced ultrasound (CEUS).Methods527 patients were retrospectively enrolled. On the training cohort, ultrasomics features were extracted from CEUS and b-mode ultrasound (BUS). Automatic feature selection and model development were performed using the Ultrasomics-Platform software, outputting the corresponding ultrasomics scores. A nomogram based on the ultrasomics scores from artery phase (AP), portal venous phase (PVP) and delayed phase (DP) of CEUS, and clinical factors were established. On the validation cohort, the diagnostic performance of the nomogram was assessed and compared with seniorexpert and resident radiologists.ResultsIn the training cohort, the AP, PVP and DP scores exhibited better differential performance than BUS score, with area under the curve (AUC) of 84.1-85.1% compared with the BUS (74.6%, P < 0.05). In the validation cohort, the AUC of combined nomogram and expert was significantly higher than that of the resident (91.4% vs. 89.5% vs. 79.3%, P < 0.05). The combined nomogram had a comparable sensitivity with the expert and resident (95.2% vs. 98.4% vs. 97.6%), while the expert had a higher specificity than the nomogram and the resident (80.6% vs. 72.2% vs. 61.1%, P = 0.205).ConclusionsA CEUS ultrasomics based nomogram had an expert level performance in FLL characterization.

The Role of Predictive and Prognostic Biomarkers in Lower Female Genital Tract Pathology: PD-L1, MMR, HER2, p16, p53, and Beyond.

Biomarkers play a crucial role in the diagnosis, treatment planning, and prognosis of premalignant and malignant lesions and are increasingly used in neoplasia of the lower female genital tract (LFGT) including the cervix, vagina, and vulva. This review will discuss key biomarkers routinely used in LFGT pathology, including programmed cell death ligand 1 (PD-L1), mismatch repair (MMR), and tumor mutational burden (TMB) testing, which are FDA-approved companion diagnostics for anti-PD-1 checkpoint inhibitors. Recent developments in HER2 testing as a marker for anti-HER2 therapies, and prognostic biomarkers such as p53 in HPV-independent vulvar intraepithelial lesions and carcinomas, are also reviewed.

Empirical Study of Ovarian Tumors Detection and Classification in Ultrasound Images

Ovarian cancer is one of the leading causesof death in women. Ultrasound images often provide initialfindings and diagnosis before further tests are performed.Despite some progress in medical image analysis, the detectionand recognition of ovarian cancers remains still quite limited.Most existing works focused on detecting or classifying twotumor categories, namely benign and malignant lesions. Thispaper presents an initial comprehensive study of ovariantumor detection, and at the same time classifies eight classesof ovarian tumors in ultrasound images using deep-learningmodels. Due to the lack of training data, we implemented adata augmentation process and examined the improvementof performance with and without data augmentation. Experimentscarried out on the OTU-2D set of MMOTU dataset withYOLOv5, YOLOv7, and YOLOv7 variants show promisingdetection and classification results.

Abstract A013: Advanced Gene Signatures for the Diagnosis and Personalized Treatment of Pancreatic Ductal Adenocarcinoma

Abstract Pancreatic ductal adenocarcinoma (PDA) is among the most lethal tumors, with limited treatment options. The absence of reliable screening and diagnostic tools (biomarkers or procedures) significantly contributes to its poor prognosis. Biomarkers that can diagnose PDA, select optimal therapy combinations, and predict the risk of occult metastases are crucial for enhancing treatment outcomes. Previously, we identified methylation signatures capable of predicting outcomes and diagnosing PDA, focusing on genes/proteins with preclinical evidence of influencing key drugs (gemcitabine [Gem], 5-fluorouracil [5FU], oxaliplatin, cisplatin, paclitaxel, and irinotecan) used in treatment. To make these findings more clinically applicable and propose a novel approach for personalized treatment selection between Gem-based (Gem/nab-paclitaxel) and 5FU-based (FOLFIRINOX) combinations, we explored the diagnostic value of genes associated specifically with Gem and 5FU. The objective was to develop a gene signature for diagnosing PDA and aiding in treatment selection. Based on recent literature, we updated our previous gene panels (from 55 to 93 for Gem, and from 20 to 28 for 5FU). We analyzed RNA and gene expression differences between normal (NT) and PDA tissues using TNMplot.com, a web tool that leverages data from the Gene Expression Omnibus (NCBI-GEO), Cancer Genome Atlas (TCGA), Therapeutically Applicable Research to Generate Effective Treatments (TARGET), and The Genotype-Tissue Expression (GTEx) repositories, employing Mann-Whitney or Kruskal-Wallis tests for statistical significance. For the Gem-specific gene panel, the combined RNA expression of 90 out of 93 genes was significantly higher in PDA compared to NT (2.59, p=6.48e-61), while the combined gene expression of 80 out of 93 genes was also significantly higher in PDA tissues (1.62, p=3.48e-29). For the 5FU-specific gene panel, the combined RNA expression of 27 out of 28 genes was significantly elevated in PDA (2.00, p=5.44e-57), and the combined gene expression of 23 out of 28 genes was significantly higher in PDA tissues (1.21, p=1.44e-7). Our preliminary findings suggest that this approach has the potential to serve as an effective tool for diagnosing PDA and guiding treatment selection. However, these results must be validated through larger prospective studies. Additionally, this application could serve as a screening tool for high-risk populations, such as individuals with potentially malignant lesions like intraductal papillary mucinous neoplasms, first-degree relatives of PDA patients, or those with concerning genetic risks (e.g., BRCA1 or BRCA2 mutations). Citation Format: Harshitha Puram, Deepak Sherpally, Sravan Jeepalyam, Ashish Manne. Advanced Gene Signatures for the Diagnosis and Personalized Treatment of Pancreatic Ductal Adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr A013.

The management of retrorectal tumors - a single-center analysis of 21 cases and overview of the literature.

Retrorectal tumors are rare and heterogeneous. They are often asymptomatic or present with nonspecific symptoms, making management challenging. This study examines the diagnosis and treatment of retrorectal tumors. Between 2002 and 2022, 21 patients with retrorectal tumors were treated in our department. We analyzed patient characteristics, diagnosis and treatment modalities retrospectively. Additionally, a literature review (2002-2023, "retrorectal tumors" and "presacral tumors", 20 or more cases included) was performed. Of the 21 patients (median age 54 years, 62% female), 17 patients (81%) suffered from benign lesions and 4 (19%) from malignant lesions. Symptoms were mostly nonspecific, with pain being the most common (11/21 (52%)). Diagnosis was incidental in eight cases. Magnetic resonance imaging was performed in 20 (95%) and biopsy was obtained in 10 (48%). Twenty patients underwent surgery, mostly via a posterior approach (14/20 (70%)). At a mean follow-up of 42 months (median 10 months, range 1-166 months), the local recurrence rate was 19%. There was no mortality. Our Pubmed search identified 39 publications. Our data confirms the significant heterogeneity of retrorectal tumors, which poses a challenge to management, especially considering the often nonspecific symptoms. Regarding diagnosis and treatment, our data highlights the importance of MRI and surgical resection. In particular a malignancy rate of almost 20% warrants a surgical resection in case of the findings of a retrorectal tumour. A local recurrence rate of 19% supports the need for follow up.

Comprehensive Evaluation of Pulmonary Masses Using Multi-detector CT: Correlating Morphological Features With CT-Guided Histopathological Findings for Enhanced Diagnostic Accuracy.

Lung masses pose a significant diagnostic challenge due to their diverse causes, from benign hamartomas to malignant bronchogenic carcinoma. Multi-detector CT (MDCT) is essential in evaluating these masses, offering detailed morphological insights to help differentiate between benign and malignant lesions. However, a definitive diagnosis often requires histopathological confirmation. CT-guided biopsy is crucial, providing a minimally invasive method to obtain tissue samples and thus guiding clinical management and treatment decisions. The primary objective of this study was to assess the diagnostic accuracy of MDCT in differentiating between benign and malignant lung mass lesions. The study focused on evaluating the characteristic features of lung masses on MDCT that aid in this differentiation, correlating imaging findings with histopathological results from CT-guided biopsies, and determining the overall diagnostic utility of MDCT in thoracic lesions. This hospital-based observational study was conducted over a period of 17 months. The study included 52 patients with thoracic lesions, identified through imaging techniques such as chest radiographs and CT scans. These patients underwent CT-guided biopsy, with tissue samples sent for histopathological examination. Inclusion criteria involved patients with clinically and radiographically diagnosed lung masses, while exclusion criteria included those who did not consent, had contraindications to contrast media, or had conditions such as severe respiratory distress or coagulopathy. The data were analyzed using descriptive statistics, with efficacy measures such as yield and failure rates of CT-guided biopsies and validation measures like sensitivity, specificity, positive predictive value, and negative predictive value for MDCT. The study included 52 patients (50% male, 50% female), aged 16-80, with the most common age group being 51-60 years. Lesions were mainly in the lung parenchyma (65.38%), followed by the mediastinum (15.38%), hilar region (11.54%), and pleura (7.69%). MDCT evaluation classified 84.44% of the lesions as malignant, characterized by irregular contours, inhomogeneous texture, and contrast enhancement, while 15.55% were benign. Histopathology confirmed 42 malignant lesions, with squamous cell carcinoma being the most prevalent. Benign lesions included abscesses, tuberculosis, and pneumonitis. The study achieved a 100% success rate for CT-guided biopsy, with one minor complication (pneumothorax). The diagnostic accuracy of MDCT was notable, with a sensitivity of 100% for detecting malignancies, a specificity of 77.78%, a positive predictive value of 87.50%, and a negative predictive value of 100%, emphasizing its effectiveness in thoracic lesion evaluation. MDCT is a highly effective tool in the evaluation of lung masses, providing critical information that aids in distinguishing between benign and malignant lesions. When combined with CT-guided biopsy, it offers a reliable method for obtaining diagnostic tissue samples, with a high degree of accuracy and a low complication rate. The study underscores the importance of integrating imaging and histopathological findings in the management of thoracic lesions, ultimately enhancing diagnostic precision and informing appropriate clinical interventions.