Risk Of Malignancy Research Articles

Advancing immunosuppression in liver transplantation: the role of regulatory T cells in immune modulation and graft tolerance.

Prolonged immunosuppressive therapy in liver transplantation (LT) is associated with significant adverse effects, such as nephrotoxicity, metabolic complications, and heightened risk of infection or malignancy. Regulatory T cells (Tregs) represent a promising target for inducing immune tolerance in LT, with the potential to reduce or eliminate the need for life-long immunosuppression. This review summarizes current knowledge on the roles of Tregs in LT, highlighting their mechanisms and the impact of various immunosuppressive agents on Treg stability and function. The liver's distinct immunological microenvironment, characterized by tolerogenic antigen-presenting cells and high levels of interleukin (IL)-10 and transforming growth factor-β, positions this organ as an ideal setting for Treg-mediated tolerance. We discuss Treg dynamics in LT, their association with rejection risk, and their utility as biomarkers of transplant outcomes. Emerging strategies, including the use of low-dose calcineurin inhibitors with mammalian target of rapamycin inhibitors, adoptive Treg therapy, and low-dose IL-2, aim to enhance Treg function while providing sufficient immunosuppression. Thus, the future of LT involves precision medicine approaches that integrate Treg monitoring with tailored immunosuppressive protocols to optimize long-term outcomes for LT recipients.

CAR T-cells in autoimmunity: game changer or stepping stone?

The advent of chimeric antigen receptor (CAR) T-cells has revolutionized the treatment landscape for hematologic malignancies, and emerging evidence suggests their potential in autoimmune diseases (AIDs). This article examines the early successes and future implications of B-cell-targeting CAR T-cell therapy in AIDs. Initial applications, particularly in refractory systemic lupus erythematosus (SLE), have demonstrated significant and durable clinical remissions, with accompanying evaluation of the immune system suggesting a so-called "reset" of innate inflammation and adaptive autoimmunity. This has generated widespread interest in expanding this therapeutic approach. CAR T-cells offer unique advantages over other treatment modalities, including very deep B-cell depletion and unique therapeutic activity within inflamed tissues and associated lymph structures. However, the field must address key concerns, including long-term toxicity, particularly the risk of secondary malignancies, and future accessibility given the higher prevalence of AIDs compared to malignancies. Technological advances in cell therapy, such as next-generation CAR T-cells, allogeneic off-the-shelf products and alternative cell types such as regulatory CAR T-cells, are being explored in AIDs to improve efficacy and safety. In addition, bispecific antibodies are emerging as potential alternatives or complements to CAR T-cells, potentially offering comparable efficacy without the need for complex logistics, lymphodepletion and the risk of insertional mutagenesis. As the field evolves, cellular therapists will play a critical role in the multidisciplinary teams managing these complex cases. The transformative potential of CAR T-cells in AIDs is undeniable, but careful consideration of safety, efficacy, and implementation is essential as this novel therapeutic approach moves forward.

Performance of computer scientists in the assessment of thyroid nodules using TIRADS lexicons.

Ultrasound (US) evaluation is recognized as pivotal in assessing the risk of malignancy (RoM) of thyroid nodules (TNs). Recently, various US-based risk-classification systems (Thyroid Imaging and Reporting Data Systems [TIRADSs] have been developed. An important ongoing project concerns the creation of an international system (I-TIRADS) using unique terminology. Since online tool allow clinicians and patients to stratify the RoM of any TN, the role of computer scientist (CS) should be relevant. This study explored the performance of CS in assessing TNs across the TIRADS categories. The most diffused TIRADSs (i.e., ACR, EU, and K) were considered. Three-hundred scenarios were created. A CS was asked to assess the 300 TNs according to ACR-, EU-, and K-TIRADS. These data were compared with that of clinicians. The inter-observer agreement was estimated with Cohen kappa (κ). Word-cloud plots were used to graph the US descriptors with disagreement. The correspondence of the CS's assessment with the physicians was 100%, 81%, and 43%, using ACR-, EU-, and K-TIRADS, respectively. The CS was unable to classify 19/100 TNs according to EU-TIRADS and 15/100 TNs according to K-TIRADS. The inter-observer agreement between CS and physicians was excellent for ACR-TIRADS (κ = 1), moderate for EU-TIRADS (κ = 0.56), and fair for K-TIRADS (κ = 0.22). Among the non-concordant cases, 16/22 descriptors for EU-TIRADS and 18/18 descriptors for K-TIRADS were found. CSs are confident with the ACR-TIRADS lexicon and structure while not with EU- and K-TIRADS, probably because they are pattern-based systems requiring medical training.

Changes in the Volume and Diameter of Benign Thyroid Nodules: A 10-Year Follow-Up Study.

Background: The incidence of asymptomatic thyroid nodules has risen enormously, with > 90% being benign. Despite limited long-term data, significant nodule growth (SNG) is common. Guidelines recommend cytology reevaluation if SNG occurs. Our study aimed to identify the rate and factors associated with SNG, compare diameter and volume-based assessments, and examine the association between SNG and malignancy risk over the long term (10 years). Methods: The retrospective cohort study, conducted at Ankara University, School of Medicine, Department of Endocrinology and Metabolism, included 732 nodules from 376 euthyroid patients, all monitored over a 10-year period by the same experienced sonographer, with evaluations at baseline, 5th and 10th years. The nodules were cytologically benign and/or sonographically in the low-to-intermediate risk category. Size changes at the 5th and 10th years were considered significant if there was a 20% or 2 mm increment in two diameters according to diameter-based criterion (DBC) or 50% increment in volume-based criterion (VBC) designed by the ellipsoid formula. Generalized linear mixed-effects models were used to account for the clustered data structure and analyze factors affecting nodule growth. Nodule growth was the dependent variable, while sex, age at diagnosis, initial TSH level, total nodule count, nodule volume, echogenicity, and localization were independent variables. Results: At the 5th and 10th years, SNG frequencies were higher when calculated using VBC [27.7% (n = 203) and 44% (n = 321), respectively] compared with DBC [19.1% (n = 140) and 35% (n = 256), respectively], with the differences being statistically significant (McNemar test, p < 0.01). Factors associated with SNG included being younger than 45 years of age (VBC OR = 1.704, CI = 1.227-2.366, p = 0.002; DBC OR = 1.913, CI = 1.379-2.656, p < 0.001), having higher number of nodules (VBC: OR = 1.171, CI = 1.061-1.291, p = 0.002; DBC: OR = 1.147, CI = 1.040-1.265, p = 0.006), and having smaller nodule volume (VBC: OR = 0.870, CI = 0.806-0.940, p < 0.001; DBC: OR = 0.912, CI = 0.850-0.978, p = 0.010). Thyroid cancer was diagnosed in four original nodules (0.5%), whereas the malignancy rate in biopsies performed was 1.4% (n = 4). Conclusions: In long-term follow-ups of sonographically and/or cytologically benign thyroid nodules, SNG is not rare. Growth is more likely in younger patients, those with higher number of nodules and smaller nodules. In the follow-up of nodule size, VBCs yield augmented results compared with DBCs. However, malignancy is quite rare in growing nodules. Therefore, adopting flexible long-term follow-up protocols appears to be practical for benign nodular thyroid disease.

Identifying subtle differences : a radiomics model assessment for gastric schwannomas and gastrointestinal stromal tumors across risk grades

ObjectiveThis study aims to develop and validate an enhanced computed tomography (CT)-based radiomics model to differentiate gastric schwannomas (GS) from gastrointestinal stromal tumors (GIST) across various risk categories.MethodsThis retrospective analysis was conducted on 26 GS and 82 GIST cases, all confirmed by postoperative pathology. Data was divided into training and validation cohorts at a 7:3 ratio. We collected patient demographics, clinical presentations, and detailed CT imaging characteristics. Through univariable and multivariable logistic regression analyses, we identified independent predictors for discriminating between GS and GIST, facilitating the construction of a conventional model. Radiomic features were extracted and refined through manual 3D segmentation of venous phase thin-slice images to develop a radiomics model. Subsequently, we constructed a comprehensive combined model by integrating selected clinical and radiomics indicators. The diagnostic performances of all models in differentiating GS from GIST and stratifying GISTs according to malignancy risk were evaluated.ResultsWe identified several key independent variables distinguishing GS from GIST, including tumor location, cystic changes, degree of enhancement in arterial phase, and enhancement uniformity. The conventional model achieved AUCs of 0.939 and 0.869 in the training and validation cohort, respectively. Conversely, the radiomics model, predicated on eight pivotal radiomics features, demonstrated AUCs of 0.949 and 0.839. The combined model, incorporating tumor location, degree of enhancement in arterial phase, enhancement uniformity, and a radiomics model derived rad-score, significantly outperformed the traditional approach, achieving AUCs of 0.989 and 0.964 in the respective cohorts. The combined model showed superior diagnostic accuracy in distinguishing GS from GIST, as well as GS from high or low malignancy potential GISTs, as evidenced by IDI values of 0.2538, 0.2418, and 0.2749 (P&amp;lt;0.05 for all).ConclusionThe combined model based on CT imaging features and radiomics features presents a promising non-invasive approach for accurate preoperative differentiation between gastric schwannomas and gastrointestinal stromal tumors.

Nonmass Lesions on Breast Ultrasound: Interreader Agreement and Associations With Malignancy.

Background: Nonmass lesions (NMLs) on breast ultrasound lack clear definition and encompass a broad range of benign and malignant entities. Given anticipated inclusion of NMLs in the BI-RADS 6th edition, thorough understanding of these lesions will be critical for optimal management. Objective: To evaluate interreader agreement for classification of lesions on breast ultrasound as NMLs and to identify imaging features associated with malignancy in these lesions. Methods: This retrospective study included 2007 patients (2005 female, 2 male; mean age, 54.0±9.6 years) who underwent ultrasound-guided biopsy of 2381 breast lesions between January 2020 and December 2020. Two radiologists independently classified lesions as masses or NMLs, using a definition of NMLs from a presentation at the 2023 Radiological Society of North America annual meeting. The radiologists attempted to reach consensus for discordant cases. Another radiologist recorded NMLs' mammographic and ultrasound characteristics. Pathological outcomes for NMLs were extracted from the EHR. Results: Interreader agreement for lesion classification (mass vs NML) was substantial (κ=0.73) A total of 216 lesions were classified as NMLs by both readers independently; an additional 101 lesions were classified as NMLs by consensus review after initial discordance. Thus, 317/2381 (13.3%) of lesions were classified as NMLs, of which 101/317 (31.9%) had initial discordance. A total of 133/317 (42.0%) NMLs were malignant, including invasive ductal carcinoma (48/133), ductal carcinoma in situ (43/133), and microinvasive ductal carcinoma (34/133). A total of 30.8% of malignant NML lacked correlative mammographic abnormalities. Ultrasound findings with highest accuracy for identifying malignancy of NMLs were calcifications (65.6%), posterior shadowing (62.8%), and non-parallel orientation (59.3%). In multivariable analysis, variables showing significant independent associations with malignancy included calcifications (OR=8.9), asymmetry (OR=4.7), and mass (OR=4.7) on mammography, and greater size (OR=1.03), non-parallel orientation (OR=8.7), and posterior shadowing (OR=6.3) on ultrasound. Conclusion: The analysis provides insights into reader variability for classifying ultrasound lesions as NML by an existing definition, as well as into imaging findings' potential utility for characterizing such lesions as malignant. Clinical Impact: These findings indicate the need for further precision and clarification regarding the definition of NMLs and for further investigation into which NMLs have greatest malignancy risk.

Unveiling the Malignancy Risk of Surgically Treated Bethesda III Thyroid Nodules: A 10-Year Retrospective Study Comparing Fine-Needle Aspiration Cytology (FNAC) and Histopathology

Unveiling the Malignancy Risk of Surgically Treated Bethesda III Thyroid Nodules: A 10-Year Retrospective Study Comparing Fine-Needle Aspiration Cytology (FNAC) and Histopathology

The Effect of Milk-Derived Extracellular Vesicles on Intestinal Epithelial Cell Proliferation

Inflammatory bowel disease (IBD) is a chronic, relapsing inflammation disorder of the gastrointestinal tract characterized by disrupted intestinal epithelial barrier function. Despite advances in treatment, including biological agents, achieving sustained remission remains challenging for many patients with IBD. This highlights the urgent need for novel therapeutic strategies. Milk-derived extracellular vesicles (MDEs) have emerged as a promising therapeutic option. In this study, we isolated and characterized MDEs and evaluated their effects on the function of intestinal epithelial cells (IECs). Using a murine model of Dextran Sulfate Sodium (DSS)-induced colitis, we observed that MDEs significantly ameliorated disease symptoms. The upregulation of β-catenin, a crucial mediator of Wnt signaling, in colonic tissues suggests that MDEs may facilitate epithelial regeneration and restore barrier function. In patient-derived colon organoids (PDCOs), MDEs were internalized and modulated the expression of key signaling molecules, such as the upregulation of β-catenin, cyclin D1, and the proliferation marker Ki67, indicating their potential to promote IEC proliferation and intestinal barrier repair. Importantly, MDEs demonstrated selective activity by downregulating β-catenin and cyclin D1 in colon cancer cells, leading to reduced proliferation. This selectivity indicates a dual therapeutic potential of MDEs for promoting healthy IEC proliferation while potentially mitigating malignancy risks.

Risk of malignancy and the use of disease-modifying therapy in multiple sclerosis: exploring the role of DMT in a multi-center study

Risk of malignancy and the use of disease-modifying therapy in multiple sclerosis: exploring the role of DMT in a multi-center study

Validation of ACR TI-RADS performance in transition age: results from a multicenter retrospective study by the TALENT study group.

Although thyroid nodules are less common in the pediatric population, the risk of malignancy is higher than in adult patients. The aim of this study was to evaluate the ultrasonographic predictive factors of malignancy in thyroid nodules and to validate American College of Radiologists (ACR) TI-RADS performance in transition age patients. One hundred forty-two patients aged between 14 and 21 years referred to the participating centers for FNA biopsy of a thyroid nodule between 2007 and 2022 were included and ultrasound reports and sonographic images were retrospectively analyzed. Nodule features were defined according to the ACR-TIRADS lexicon. Two reference standards were applied: FNA cytology and surgical histology. The diagnostic performance of single sonographic features was estimated. Significant predictors were then included in a multivariate regression model. Nodules included in ACR-TIRADS categories TR4 or TR5 had 10-fold increased risk of indeterminate or suspicious/malignant cytology [p < 0.001]. In univariate analysis, solid composition [p = 0.016] and presence of hyperechoic foci [p = 0.040] significantly increased the likelihood of malignant histology. In multivariate regression analysis, irregular margins [p = 0.011] and hyperechoic foci [p = 0.019] were independent predictors of indeterminate or suspicious/malignant cytology. Nodules included in ACR-TIRADS categories TR4 or TR5 had 10-fold increased risk of indeterminate or suspicious/malignant cytology in transition age. ACR-TIRADS was not able to rule-out malignancy compared to FNAB alone, suggesting the need to reconsider recommendations in the transition age group.

Reporting Bone Cytopathology-A Proposal Based on a Single Tertiary Centre Experience.

Fine-needle aspiration cytology (FNAC) from bone lesions has been proven to be a useful diagnostic tool but lacks standardisation. The aim of the study was to evaluate the diagnostic utility of FNAC as a basis to propose and test a reporting system for bone reporting cytopathology. This retrospective study is based on patients with bone lesions, that were approached by cytology at Skåne University Hospital, Sweden between 2015 and 2023. The diagnostic performance was measured by sensitivity, specificity and accuracy analyses. All diagnoses were then distributed in six categories: (I) Non-diagnostic, (II) Benign, (III) Atypia, (IV) Bone neoplasm of uncertain significance, (V) Suspicious for malignancy and (VI) Malignant. The risk of malignancy (ROM) in each category was calculated. The final cohort consisted of 721 cases. Bone cytology was able to differentiate between benign and malignant lesion with a sensitivity of 89% and a specificity of 99%. The overall diagnostic accuracy was 65% but varied significantly among different types of lesions. Within the tested diagnostic categories, the ROM was (I) 48%, (II) 6.7%, (III) 69%, (IV) 28%, (V) 93% and (VI) 100%. FNAC from bone lesions is a sensitive and specific diagnostic tool with high diagnostic accuracy among various tumour types. This study provides valuable insights for the development of a standardised reporting system for bone cytopathology.

Applicability of the International Cytopathology Reporting System of Serous Fluids in a Brazilian City.

The International Academy of Cytology and the American Society of Cytopathology developed the International System of Serous Fluid Cytopathology (TIS) to standardize cytological reports. Effusions in pleural, peritoneal, and pericardial cavities are valuable sources of information for medical diagnosis, especially in oncological scenarios. The TIS classification is divided into five categories: non-diagnostic (ND), negative for malignancy (NFM), atypia of uncertain significance (AUS), suspected malignancy (SFM), and malignant (MAL). It facilitates global communication between specialists, aiming for future clinical management guidelines based on malignancy risk assessment. This quantitative analytical and retrospective study evaluated serous fluids (pleural, pericardial, and peritoneal) sent to the Instituto de Patologia de Araçatuba (IPAT), São Paulo, Brazil, from public and private hospitals between January 2017 and December 2022. Epidemiological and clinical data were collected from institutional files, including biopsies and immunohistochemical results. The study included 719 patients with 763 serous fluid samples (pericardial, pleural, and peritoneal) analyzed over six years. The majority of samples were from pleural effusions (n = 438; 57.4%), followed by peritoneal (n = 293; 38.4%) and pericardial effusions (n = 32; 4.2%). Samples were classified using the International Serous Fluid Cytopathology System (TIS), revealing the following distribution: ND (0.41%), NFM (70.30%), AUS (0.95%), SFM (11.90%), and MAL (16.44%). The risk of malignancy calculated for each category were ND 66.67%, NFM 23.39%, AUS 28.57%, SFM 48.28%, and MAL 84.17%. The ROM was out of the interval proposed by the TIS in all categories. These findings suggest the applicability of TIS even outside of the cancer center environment, although the presented ROM frequencies were out of the recommended range.

Comparison of 6 cycles of isatuximab with lenalidomide, bortezomib and dexamethasone (I-VRd) versus 3 cycles of I-VRd followed by one cycle of high-dose melphalan in newly diagnosed low-risk multiple myeloma. Protocol for a multicenter, prospective, randomized, phase II clinical trial (ELIAS-Trial)

Newly diagnosed multiple myeloma patients who are eligible for transplant usually receive several induction cycles of therapy, followed by one or two cycles of high-dose melphalan and autologous stem cell transfusion. In myeloma patients, high-dose melphalan improves overall survival and progression-free survival. However, melphalan exposure increases the risk of secondary malignancies and may lead to the transformation of residual myeloma cells into more aggressive clones, which may accelerate relapse. It remains to be determined whether low-risk patients also derive additional benefit from high-dose melphalan therapy compared with less toxic regimens. Here we publish the study protocol of a multicenter, interventional, controlled, randomized, prospective and open-label phase II trial to investigate whether patients with a low-risk profile (R-ISS stage I, characterized by a low tumor burden and the absence of negative cytogenetic findings or elevated LDH levels) and a standard-risk gene expression profile (using the SKY92 GEP assay) can be sufficiently treated with intensified consolidation regimens without prior high-dose melphalan chemotherapy. The primary objective is to assess whether three cycles of isatuximab, bortezomib, lenalidomide and dexamethasone (I-VRd) followed by stem cell apheresis and three additional cycles of I-VRd will result in a non-inferior rate of complete remission (CR) combined with MRD-negativity at week 40 after the start of induction therapy compared to three cycles of I-VRd followed by standard of care treatment (such as stem cell apheresis, high-dose melphalan, and autologous stem cell transplantation). We hypothesize that this approach could reduce toxicity, cost of treatment and the likelihood of the development of a more malignant plasma cell clone, while improving overall survival (OS) and progression-free survival (PFS) in newly diagnosed low risk myeloma patients.EU Trial Number2022-500453-16-00, https://clinicaltrials.gov/study/NCT05665140, identifier NCT05665140. Registration Date: 21.07.2022.

Papanicolaou Society of Cytopathology System vs World Health Organization of Reporting System for Pancreaticobiliary Cytopathology‐Comparison of Risk of Malignancy and Diagnostic Predictive Values: A 3 Year Retrospective Study in India

Papanicolaou Society of Cytopathology System vs World Health Organization of Reporting System for Pancreaticobiliary Cytopathology‐Comparison of Risk of Malignancy and Diagnostic Predictive Values: A 3 Year Retrospective Study in India

Cryptorchidism: A 20-Year Journey of Patient Outcomes and Family Concerns – A Cohort Study at a Single Center

Background: Undescended testis (UDT), or cryptorchidism, is a prevalent pediatric condition with significant implications for fertility and malignancy risk if untreated. Affecting 1–5% of male infants, UDT is influenced by genetic, hormonal, and environmental factors. Methods: This retrospective cohort study examines 470 pediatric UDT cases treated at a single center over two decades (2004–2024) at a single pediatric surgery center - The Maternity and Child Teaching Hospital, Al Qadisiya, Iraq, focusing on surgical outcomes, fertility, long-term testicular health, and family concerns. Inclusion criteria; Patients were identified from hospital records and outpatient clinic registries confirmed diagnosis of UDT (unilateral or bilateral), availability of complete medical records, patients who underwent chromosomal analysis as part of their diagnostic workup, and underwent surgical intervention within the study timeframe at our center with at least three years of follow-up. Results: The mean age at diagnosis was 18 months, with 45% diagnosed within the first year. Unilateral UDT predominated (60%), and testicular position influenced size and outcomes. Surgical success was achieved in 90% of cases, with minor complications including wound infections (5%) and reoperations (5%). Earlier diagnosis correlated with improved fertility outcomes, with normal spermatogenesis observed in 75% of early cases but declining significantly with delayed treatment (P &lt; 0.05). Chromosomal abnormalities, present in 9% of patients, heightened family concerns, particularly regarding fertility and psychosocial impacts. Conclusion: Family concerns evolved through stages of care, initially focusing on fertility and malignancy risks, then shifting to surgical safety and postoperative recovery. Tailored counseling and psychosocial support were integral to family satisfaction. This study underscores the importance of early diagnosis, multidisciplinary care, and culturally sensitive family engagement to optimize outcomes and enhance the quality of life for patients with UDT. Future recommendations include routine genetic screening and targeted educational initiatives to address community-specific challenges.

Incidence of splenic malignancy and hemangiosarcoma in dogs undergoing splenectomy surgery at a surgical specialty clinic: 182 cases (2017-2021).

The objectives of this study were to evaluate the risk and predictive factors of splenic malignancy and hemangiosarcoma in dogs undergoing splenectomy at a surgical specialty clinic. Medical records, hematologic results, surgical reports, and histopathologic results from 182 dogs that underwent splenectomy for the treatment of splenic masses or nodules were reviewed retrospectively. The majority of dogs (57.7%) had benign splenic diagnoses with no malignancy. Hemangiosarcoma was diagnosed in 32.4% of the dogs. A final multivariable model indicated that thrombocytopenia, anemia, and a smaller diameter of the largest splenic nodule were risk factors for hemangiosarcoma (P<0.001), and hemoperitoneum (P = 0.01) was an additional risk factor when nodule diameter was not evaluated. There were 91 dogs that had hemoperitoneum, and 60.4% of those dogs had malignant splenic lesions. Of the 33 dogs that underwent a splenectomy for incidentally identified splenic lesions, 93.9% had benign splenic lesions. Breed size was not a significant predictor of splenic malignancy risk; however, all 6 of the German shepherds included in the study had a hemangiosarcoma diagnosis. Overall prevalence of splenic malignancy including HSA may be overestimated in some canine populations.

Genetic and environmental risks for clonal hematopoiesis and cancer.

Somatic variants accumulate in all organs with age, with a positive selection of clonal populations that provide a fitness advantage during times of heightened cellular stress leading to clonal expansion. Easily measured within the hematopoietic compartment, clonal hematopoiesis (CH) is now recognized as a common process in which hematopoietic clones with somatic variants associated with hematopoietic neoplasms exist within the blood or bone marrow of individuals without evidence of malignancy. Most cases of CH involve a limited number of genes, most commonly DNMT3A, TET2, and ASXL1. CH confers risk for solid and hematopoietic malignancies as well as cardiovascular and numerous inflammatory diseases and offers opportunities for cancer prevention. Here, we explore the genetic and environmental factors that predispose individuals to CH with unique variant signatures and discuss how CH drives cancer progression with the goals of improving individual cancer risk stratification, identifying key intervention opportunities, and understanding how CH impacts therapeutic strategies and outcomes.

CRH-YOLO for precise and efficient detection of gastrointestinal polyps

Gastrointestinal polyps are early indicators of many significant diseases within the digestive system, and timely detection of these polyps is crucial for preventing them. Although clinical gastrointestinal endoscopy and interventions help reduce the risk of malignancy, most current methods fail to adequately address the uncertainties and scale issues associated with the presence of polyps, posing a threat to patients’ health. Therefore, this paper proposes a novel single-stage method for polyp detection. Specifically, by designing the CRFEM, the network’s ability to perceive contextual information about polyp targets is enhanced. Additionally, the RSPPF is designed to assist the network in more meticulously completing the fusion of multi-scale polyp features. Finally, one detection head is removed from the original model to reduce a substantial number of parameters, and a high-dimensional feature compensation structure is designed to address the decline in recall rate caused by the absence of the detection head. Experiments were conducted using public datasets such as Kvasir-seg, which includes gastric and intestinal polyps. The results indicate that CRH-YOLO achieves 88.8%, 86.0%, and 90.7% on three key metrics: Precision (P), Recall (R), and mean average precision at 0.5 (map@.5), significantly outperforming current mainstream detection models like YOLOv8n. Notably, CRH-YOLO improves the map@.5 metric by 2.4% compared to YOLOv8n. Furthermore, the model demonstrates excellent performance in detecting smaller or less obvious polyps, providing an effective solution for the early detection and prediction of polyps.

Enhancing Diagnostic Precision and Clinical Outcomes With FNAC in Parotid Gland Masses.

Parotid gland masses encompassing both neoplastic and non-neoplastic conditions present diagnostic challenges. Fine-needle aspiration cytology (FNAC) is commonly used to differentiate between benign and malignant lesions but has limitations such as variable sensitivity and potential sampling errors. This study assesses FNAC's accuracy for parotid gland lesions, evaluates the Milan Salivary Gland Cytopathology Reporting System (MSRSGC), and compares FNAC results with histopathological findings. This retrospective study at our medical center analyzed data from 2321 patients who underwent parotid gland FNAC followed by surgical resection over 20 years. Patients were included if they had both cytological analysis and surgery between January 2004 and July 2024. Surgical procedures varied based on mass characteristics and FNAC results, and all samples were assessed using MSRSGC. Statistical analysis compared FNAC results with histopathology findings, calculating sensitivity, specificity, and accuracy. This study included 352 patients who underwent both FNAC and surgical resection. FNAC had an overall accuracy of 93.9%, with a sensitivity of 78.3% and specificity of 91.5%. The risk of malignancy was 30% for Milan Category I (nondiagnostic), 6.3% for Category II (non-neoplastic), 0% for Category III (Atypia of Undetermined Significance), 2.3% for Category IVa (benign neoplasm), 5.8% for Category IVb (neoplasm of uncertain malignant potential), 58.8% for Category V (suspicious for malignancy), and 95% for Category VI (malignant). The false negative rate was 2.4%, while the false positive rate was 3.4%. The malignancy risk increased with age, and malignant masses were larger and more likely to cause facial paralysis. FNAC is a key diagnostic tool for parotid gland masses, offering high specificity and accuracy despite some limitations. Patients with young ages and inappropriate histories should be assessed more carefully. MSRSGC is a useful system to show appropriate risk of malignancy.

Risk Factors Associated With Major Adverse Cardiovascular Events and Malignancies in Patients With Rheumatoid Arthritis in a Real-World Setting in Japan.

To identify risk factors associated with major adverse cardiovascular events (MACE) and malignancies in patients with rheumatoid arthritis (RA) using real-world data from Japan. This cohort study used the Real World Data database of medical institutions in Japan. Eligible patients (January 2013-December 2021) had ≥ 1 RA diagnosis, were aged ≥ 18 years, prescribed ≥ 1 antirheumatic drug, had no psoriasis diagnosis, and had a record postindex. Patients had no myocardial infarction/stroke ≤ 31 days (MACE cohort) or malignancy < 1 year (malignancy cohort) before index. Cohorts were determined by incidence of initial MACE or malignancy. Known/exploratory variables were selected using Cox regression models. Across MACE (n = 16 012) and malignancy (n = 14 545) cohorts, most patients were female and aged ≥ 65 years. Overall, 214 MACE per 43964.7 patient-years (incidence rate 0.49 per 100 patient-years) and 315 malignancies per 40251.6 patient-years (incidence rate 0.78 per 100 patient-years) occurred. Male sex, older age (≥ 65 years), hypertension, renal disease, cerebrovascular disease, and prior X-ray examination were significantly associated with increased MACE risk. Male sex, older age (≥ 50 years), nonsteroidal anti-inflammatory drug use, emphysema, serious infection, malignancy history, and prior X-ray examination were significantly associated with increased malignancy risk. Conversely, glucocorticoid use and fracture diagnosis were significantly associated with reduced malignancy risk. In patients with RA in Japan, male sex, older age, and prior X-ray examination were associated with increased MACE and malignancy risk.