Malignant Pathology Research Articles

Effects of surgeon specialization on the outcome of emergency colorectal surgery

Background: Colonic emergencies remain a major lifethreatening condition associated with high morbidity and mortality rates. Unlike elective colorectal surgical procedures, a large portion of emergency colorectal surgical procedures are performed by noncolorectal surgeons (NCRS). The impact of specialization on the outcome of emergency colorectal surgery has not yet been well described. We aimed to evaluate the impact of surgeon specialization on the outcomes of emergency colorectal surgeries. Materials and Methods: A Retrospective cohort study conducted in a tertiary care center in Riyadh, Saudi Arabia between July 2008 to July 2020. Patients underwent emergency colorectal surgeries and met study inclusion criteria were identified and grouped according to the specialty of the primary surgeon: colorectal surgeons [CRS] or NCRS. Relevant study data was obtained from patient medical files. Bivariate and multivariate regression analyses were used to assess the association between the surgeons’ specialty and outcomes. Results: Of 219 included patients, there were 126 men [57.5%] and 93 women [42.4%]. Of all population 128 patients [58%] were operated on by CRS while 91 patients [42%] were operated on by NCRS. Most common procedure performed by CRS was left hemicolectomy [n=45, 67.2%] while the most common procedure performed by NCRS was right hemicolectomy [n=26, 51%]. The most common reason for surgery was malignant pathologies [n=129, 58.9%]. Patients who had their surgeries performed by a CRS had a significant decrease in 30-day mortality [odds ratio [OR] 0.23, 95% confidence interval [CI] 0.065–0.834]. Reoperation also decreased in this group [OR 0.413, 95% CI 0.179–0.956]. Moreover, both hospital length of stay and ICU length of stay decreased CRS compared with the NCRS [OR 0.636, 95% CI 0.465–0.869, and OR 0.385, 95% CI 0.235–0.63, respectively]. Conclusion: Specialization in colorectal surgery has a significant influence on morbidity and mortality after emergency operations. These findings may in improving emergency services and support remodeling the referral system in the institutions.

EGS SO30 - Management of Iatrogenic Oesophageal Perforations in the era of Endo-Vacuum Therapy- Preliminary Results of a Single-Institution Study

Abstract Background Iatrogenic oesophageal perforation (IOP) following diagnostic and therapeutic interventions at the oesophagus or adjacent organs are responsible for nearly half of oesophageal perforations. If not recognised within 24 hours of injury, then they are associated with devastating morbidity and mortality. Available treatment options encompass non-operative for early perforation without sepsis, endoscopic with endoclip/stent and surgical including primary repair, exclusion and diversion or oesophagectomy. Recently, Endoscopic Vacuum Therapy (EVT) has been introduced as safe and effective alternative approach. We sought to assess treatment outcomes in patients with IOPs prior to and during periods where EVT was available as treatment option. Method A single-centre retrospective cohort study incorporating all consecutive patients (N=30) presented or transferred to our tertiary oesophagogastric unit for IOP management between 01/01/2009-31/12/2023 was undertaken. Patients with anastomotic leak post-surgery or spontaneous perforation secondary to malignancy or benign pathology were excluded. Primary study-outcomes were treatment type including non-operative, EVT after 01/01/2018 or other endoscopic therapy, surgical operation including laparotomy, thoracotomy, primary defect repair or over a T-tube, disconnection with oesophagostomy, stenting or other interventional radiology procedures and their rate of success or failure. Secondary outcomes were length of stay, 90-day complications requiring re-intervention or re-admission, 30-, 90-day and 1-year mortality. Results In 2009-2017 pre-EVT period, 11/30 patients were managed a) non-surgically 7/11, b) endoclip 3/11 and stenting 1/11. 30-day and 90-day mortality were 1/11, 90-day morbidity Clavien-Dindo >IIIa 3/11 (27.3%), 90-day reintervention 8/11 (72.7%), median LOS 27 days. In 2018-2023 EVT period, 19/30 patients were treated with a) laparotomy, left thoracotomy, defect repair over t-tube, chest drainage in 5/19, b) non-surgical 7/19, c) IR NJT, stent or PEG in 6/19 d) EVT in 4/19. 30-day mortality was 0/19, 90-day mortality 1/19 (5.2%), 90-day morbidity Clavien-Dindo >IIIa 7/19 (36.8%), 90-day reintervention 9/19 (47.4%), median LOS 61 days. 1-year mortality was 0/19 for both. Conclusion EVT therapy appears to be a feasible additional treatment modality in the management of iatrogenic oesophageal perforations. Careful patient selection, therapeutic endoscopic expertise, knowledge of the technique, multidisciplinary approach and team collaboration are essentials for favourable outcomes. Of note, management of oesophageal perforations in a dedicated UGI centre is directly related to patient outcomes and is a sine qua non.

Cytokines levels in saliva in periodontitis, oral potentially malignant disorders and squamous cell carcinoma

Biopsy and histopathological examination continue to be the gold standards for diagnosing oral cancer and oral potentially malignant disorders (OPMD). The prognosis of these conditions is significantly influenced by established factors such as the degree of dysplasia, tumour size, grade, and patient age. While these traditional diagnostic approaches are crucial, there is a growing need for innovative methods to improve diagnosis and monitoring of these conditions. We hypothesize that identifying specific diagnostic biomarkers in human saliva, alongside traditional methods, could enhance clinical outcomes in managing both malignant and non-malignant oral pathologies. In this study, salivary levels of previously described biomarkers BDNF, IL-6, IL-8, IL-10, IL-15, IL-1RA, LIF, and TNF-α were compared among oral cancer patients, patients with OPMD, periodontal disease patients, and healthy volunteers. The results indicated that these cytokines have the potential to distinguish cancer cases, though they are less effective in differentiating between OPMD and periodontitis. Using pairs or groups of biomolecules could improve the ability to differentiate between different pathological entities. We found the following panel IL-6, IL-15, and IL-1RA to be particularly significant as diagnostic biomarkers for oral squamous cell carcinoma and OPMD.

TMOD-14. ESTABLISHING A CLINICALLY RELEVANT MOUSE MODEL TO STUDY NECROSIS AS A PRIMARY VARIABLE IN GLIOBLASTOMA

Abstract All glioblastoma (GBM) molecular subsets share the common trait of accelerated progression following necrosis, which cannot be adequately explained by cellular proliferation arising from accumulated genetic alterations. We suggest that necrosis is much more than a passive phenomenon related to rapid growth but rather is a driving force causing tumor microenvironment (TME) restructuring and biologic progression. yet mechanisms remain poorly understood due to a lack of animal models to study necrosis as a primary variable. In GBM, the most malignant primary brain tumor, vascular pathology and central necrosis precede rapid, radial expansion. To reveal spatio-temporal changes directly following vascular damage in the brain, we developed methodology to induce clinically relevant thrombosis vaso-occlusion within GBMs in immunocompetent RCAS/tv-a mouse model to study TME restructuring by intravital microscopy and demonstrate its impact on glioma progression in real-time. We found that following Rose Bengal photothrombosis, GBMs rapidly expanded radially, with glioma migration away from central necrosis and tumor-associated macrophages (TAMs) and glioma stem cells (GSCs) increased dramatically in the peri-necrotic zones. Through the single cell tracking analysis, we found that TAMs displaying increased displacement toward necrosis and greater overall migration distances. Collectively, this model introduces necrosis as the primary variable and captures glioma growth dynamics and TME restructuring in a manner that will facilitate the development of therapies that antagonize these mechanisms to improve outcomes.

Clinical Results of Percutaneous Transhepatic Biliary Drainage With Different Hepatic Access and Methods in the Treatment of Obstructive Jaundice

Background: Percutaneous transhepatic biliary drainage (PTBD) is a common procedure for biliary obstruction jaundice caused by biliary tract obstruction. PTBD can be performed using external or external-internal methods, by the right or left lobe approach. However, differences in both the method used and the hepatic approach may affect success rates and complications. Therefore, this study aimed to examine the outcomes and complications of PTBD and compare them according to different methods and hepatic approaches. Methods: Patients who underwent PTBD procedures in our interventional radiology department due to benign or malignant pathologies between March 2021 and March 2024 were included in the study. The diagnoses of the patients, and total and direct bilirubin values before and after the procedure were recorded. The clinical results and the complications of PTBD were compared statistically according to the hepatic approach and method. Univariate logistic regression analysis was performed to determine significant factors associated with PTBD success and complications. Results: Sixty patients were included in our study (32 men, 28 women; mean age: 67.14±13.61 y). The most common indication was malignant bile duct obstruction (90%). The obstruction was mostly at the level of the common bile duct (46.7%). The success rate of PTBD was the highest with the left-side external biliary drainage approach (left-side external biliary drainage, 81.2%; right-side internal-external biliary drainage, 77.8%; right-side external biliary drainage, 69.2%; P=0.596). The complication rate was higher for right-side access (right side 15.9%, left side 12.5%, P=0.744). Univariate logistic regression analysis revealed that PTBD success in females was 5 times higher than in males [Exp(B): 5.000, β: 1.609, P<0.05]. Univariate logistic regression analysis revealed that methods used, entry lobes, and entry levels did not significantly affect PTBD success and complication incidence (P>0.05). Conclusion: All approaches and methods used during PTBD were associated with low complications and high success rates. Nevertheless, external biliary drainage with right hepatic access has the lowest clinical success rate and a higher complication rate than the left-lobe approach. We observed that left-sided external biliary drainage was the most successful method and had fewer complications.

Comparison of histopathological diagnoses of ENT diseases in the COVID-19 pandemic with other periods

Abstract OBJECTIVE. It is aimed to reveal the frequency of histopathological diagnosis in ENT diseases during the COVID-19 period and whether it is different from diagnoses in other periods. MATERIAL AND METHODS. The files of 1442 patients diagnosed with pathological material in the ENT clinic between 2017 and 2022 were retrospectively scanned. Two groups were created: the 1st group of patients between 2017-2019 (non-COVID-19 period) (Group 1) and the 2nd group of patients between 2020-2022 (COVID-19 period) (Group 2). RESULTS. Pathological samples were sent from 1163 patients in Group 1 and from 279 patients in Group 2. Of 1442 patients, 815 were male and 627 were female, and the mean age was 25 (3-94 years). There was a statistically significant difference between the groups in terms of age (p=0.001). There was no significant difference in terms of gender (p=0.756). The most common histopathological diagnoses in both periods were chronic tonsillitis lymphoid hyperplasia (bilateral tonsillectomy + adenoidectomy) (19.5%), chronic inflammation lymphoid hyperplasia (adenoidectomy) (19.3%) and nasal polyp (19.2%). The incidence of malignant tumors was found to be 1.4% in Group 1 and 2.8% in Group 2. The incidence of benign tumors was found to be 7.6% in Group 1 and 12.8% in Group 2. In terms of frequency, the ratio of malignant and benign tumors was higher in Group 2. CONCLUSION. The number of patients with histopathological diagnoses decreased due to the decrease in hospitalizations during the COVID-19 period. Delayed diagnosis in malignant pathologies significantly worsens the prognosis. All these results show that new cancer diagnostic strategies are needed for epidemic diseases such as COVID-19.

Relevance of Thyroid Microcarcinoma and Its Diagnosis

Microcarcinoma is a thyroid gland cancer with a size of less than 1 cm. The aim: To determine the frequency of microcarcinoma among malignant pathologies of the thyroid gland based on fine-needle aspiration biopsies (FNAB) data. Materials and Methods: A retrospective analysis of 2490 FNAB data was conducted under ultrasound control from 2007 to 01.07. 2024 at the Ternopil Regional Clinical Hospital. FNAB results were categorized into four groups: the first group – non-diagnostic results, the second – suspicion of thyroid cancer, the third – thyroid cancer, and the fourth – benign lesions. After the Bethesda system was introduced, FNAB classifications were based on this system. Results: Thyroid cancer was diagnosed in 186 cases (7.5%). Among these, macrocarcinoma was identified in 152 cases (81.7%) and microcarcinoma in 34 cases (18.3%). The peak incidence of microcarcinoma is observed in the 40-50 age, with approximately 90% of patients being women. Microcarcinomas in solitary nodules were found in 16 cases (47%); among multinodular goiters in 18 cases (53%). In 8 cases (23.5%), microcarcinoma was associated with larger thyroid cancers (multifocal process) and in 4 cases (11.8%) with benign nodules. In 6 cases (17.7%), microcarcinomas were associated with nodules suspicious for cancer. Conclusions: Indications for FNAB should be guided by the identified sonographic characteristics (solid echostructure of the nodule; hypoechogenicity; vertical orientation of nodules; indistinct margins of the nodule; presence of microcalcifications; regional cervical lymphadenopathy with signs of malignancy).

Benign biliary conditions with increased risk of malignant lesions.

Numerous conditions and pathologies affect the biliary system, many of which have underlying benign courses. However, these overall benign conditions can predispose the patient to malignant pathologies, often due to malignancy arising from abnormal biliary ducts (such as with cholangiocarcinoma) or due to malignancy arising from end-stage liver disease caused by the biliary condition (such as with hepatocellular carcinoma). While these malignancies can at times be obvious, some pathologies can be very difficult to detect and distinguish from the underlying benign biliary etiology. This paper discusses various benign biliary pathologies, with discussion of epidemiology, imaging features, malignant potential, and treatment considerations, with the goal of educating radiologists and referring clinicians to the risk and appearance of hepatobiliary malignancies associated with benign biliary conditions.

Endoscopic ultrasound-guided biliary rendezvous after failed cannulation, and comparison between benign vs malignant biliopancreatic disorders: outcomes at a single tertiary-care centre

Background Endoscopic ultrasound (EUS)-guided biliary rendezvous (RV) is an EUS-assisted technique described as a rescue method in cases of failed biliary cannulation via endoscopic retrograde cholangiography (ERC). Current literature remains unclear regarding its current role. The study aim was to evaluate the effectiveness for biliary EUS-RV, and comparison between benign vs malignant biliopancreatic disorders. Methods Retrospective observational study with prospective consecutive inclusion in a specific database from a tertiary-center. All patients with biliopancreatic diseases that underwent a EUS-assisted ERC between October-2010 and November-2022 for failed ERC were included. Main outcomes were technical/overall success. Secondary outcomes were safety, potential factors related to failure/success or safety; and a comparative analysis between EUS-RV and EUS-guided transmural drainage (TMD) in malignant cases. Results A total of 69 patients who underwent EUS-RV procedures, with benign and malignant pathologies (n = 40 vs n = 29), were included. Technical / overall success and related-adverse events (AEs) were 79.7% (95%CI, 68.3-88.4) / 74% (95%CI, 61-83.7) and 24% (95%CI, 15.1-36.5), respectively. Failed cases were mainly related with guidewire manipulation. Seven failed RV were successfully rescued by EUS-TMD. On multivariable analysis, EUS-RV and malignant pathology was associated with a greater failure rate (technical success: OR,0.21; 95%CI,0.05-0.72; p = 0.017), and higher AEs rate (OR,3.46; 95%CI,1.13-11.5; p = 0.034). Also, the EUS-TMD group had greater technical success (OR,16.96; 95%CI,4.69-81.62; p < 0.001) and overall success (OR, 3.09; 95%CI,1.18-8-16; p < 0.026) with a lower AEs rate (OR,0.30; 95%CI,0.11-0.78; p = 0.014) than EUS-RV in malignant disorders. Conclusions EUS-RV is a demanding technique with better outcomes in benign than in malignant biliopancreatic diseases. Comparison of the EUS-TMD group on malignant disorders showed worse outcomes with EUS-RV. Given these findings, maybe EUS-RV is not the best option for malignant biliopancreatic disorders.

A National Study of the Rate of Benign Pathology After Partial Nephrectomy for T1 Renal Cell Carcinoma: Should We Be Satisfied?

Objectives: To determine the rate of benign pathology in cT1 tumors following partial nephrectomy in the Netherlands, thereby evaluating the rate of overtreatment. Methods: Data were collected from a nationwide database containing histopathology of resected renal tissue from 2014 to 2022. Patients who underwent partial nephrectomy for suspected RCC staged T1a-b were extracted for analysis. Data are shown in percentages, and multivariable logistic regression was performed to determine predictive factors for benign pathology. Results: 3409 cases were analyzed, of which 403 (12%) were benign and 3006 (88%) malignant. Subtype analysis showed 2126 (62%) cases of clear-cell RCC, followed by 604 (18%) of papillary RCC and 344 (10%) oncocytomas. Mean age was 63 years among patients with malignant pathology versus 65 years for patients with benign lesions (p &lt; 0.001). Mean tumor size was 3.2 cm for malignant pathology and 2.9 cm for benign (p &lt; 0.001). The rates of benign and malignant pathology did not change between 2014 and 2022 (p = 0.377). Multivariable regression showed age ≥ 65 years (65–79 years [OR 1.881, p = 0.002], ≥ 80 years [OR 3.642, p &lt; 0.001]) and tumor size (OR 0.793, p &lt; 0.001) as predictors for benign pathology. The main limitation of this study is that we do not know the biopsy rate of our cohort. Conclusion: This study reports a low rate of 12% benign pathology after partial nephrectomy in the Netherlands. It remains debatable whether these rates are acceptable, or if renal tumor biopsies should be utilized more frequently to reduce overtreatment.

DICER1 Syndrome in a 25-Year-Old Female: Autopsy Case Report of Mixed Sex Cord-Stromal and Primitive Sarcoma Tumors with Diverse Differentiation Patterns

Abstract Introduction/Objective DICER-1 syndrome is a rare disorder characterized by germline mutations in the DICER1 gene, known to confer a lifetime risk of developing a variety of benign and malignant pathologies. This syndrome typically affects young individuals, though it exhibits exceedingly variable and relatively low penetrance of the neoplastic manifestations. Methods/Case Report We report on a 25-year-old woman with a history of metastatic DICER-1 related mixed pattern sex-cord stromal tumor of the ovary and primitive sarcoma of the liver. Her treatment involved extensive surgeries, including oophorectomy, salpingectomy, and partial hepatectomy, and multiple cycles of chemotherapy. Antemortem surgical pathological analyses revealed a poorly differentiated, primitive sarcoma in the liver and a sex cord-stromal tumor with Sertoli-Leydig and juvenile granulosa cell tumor-like features. The liver tumor exhibited a primitive spindle cell sarcoma with anaplastic features as well as chondrosarcomatous and rhabdomyosarcomatous patterns, suggesting a primary DICER1-related sarcoma. Immunohistochemistry confirmed the tumor’s complex multilineage differentiation, showing variable positivity for CD99, vimentin, CD10, BCL2, and Glypican-3. Positivity for Desmin and MyoD1 was focal, while the tumor was negative for inhibin, calretinin, AE1/3, AFP, and beta-catenin, overall supporting a DICER1-associated sarcoma diagnosis. She eventually died from terminal cardiac arrest secondary to complications from her metastatic cancer. An autopsy revealed a significant abdominopelvic mass leading to hemoperitoneum and extensive organ involvement, highlighting the aggressive nature of DICER1-associated malignancies. Results (if a Case Study enter NA) NA Conclusion This case underscores the importance of recognizing the broad manifestations of DICER-1 syndrome for accurate diagnosis, genetic counseling, and tailored management. Highlighting tumor morphology and immunohistochemical features enriches our understanding of DICER-1 pathology, advancing diagnosis and treatment prospects for affected individuals.

Comparison of Frozen and Final Pathology Results in Patients Operated for Endometrial Hyperplasia

OBJECTIVE: Our study aimed to determine the frequency of endometrial cancer in patients undergoing surgery with a diagnosis of endometrial hyperplasia and to evaluate the concordance between preoperative diagnosis, frozen section examination, and final pathology results. STUDY DESIGN: The clinical findings, imaging results, and all pathology reports of patients who underwent total abdominal hysterectomy for endometrial hyperplasia (atypical or non-atypical) between January 2020 and January 2023 at our hospital were retrospectively evaluated. Demographic and clinical characteristics (age, menopausal status, parity, body mass index, presence of diabetes and hypertension) and pathology results were recorded from patient records. RESULTS: 144 patients diagnosed with endometrial hyperplasia were included in the study. The frozen section and final pathology results of all patients diagnosed with non-atypical endometrial hyperplasia were reported as benign lesions. In the atypia group, the intraoperative frozen section results of 80.7% of the patients were classified as benign lesions, while the results of 19.3% were reported as malignant pathology. A statistically significant difference was found between the benign and malignant lesion groups, which were classified based on the final pathology results, with respect to age, menopausal status, and average endometrial thickness before biopsy. CONCLUSION: In cases of endometrial hyperplasia with atypia, the possibility of cancer appearing in the final pathology results should be taken into consideration. In the preoperative evaluation of patients, characteristics such as endometrial thickness, age, and menopausal status may suggest the likelihood of encountering endometrial cancer during surgery in this patient group.

7355 A Case of High-Risk Thyroid Tumor Markers Found in Subcutaneous Thyroid Implants in a Patient with Benign Thyroid Pathology

Abstract Disclosure: J. Fedorko: None. S. Fatima: None. A.P. Amblee: None. C.A. Poku: None. Background: While fine needle aspiration (FNA) remains the primary diagnostic tool for thyroid malignancies, the utilization of molecular markers has become increasingly common in the workup of thyroid nodules. They play a useful role in distinguishing between malignant and benign pathology when cytology is indeterminate and in formulating treatment plans. The vast majority of research for these genetic markers is conducted in cases with thyroid malignancy. However, there have been numerous cases where these genetic markers were identified in benign thyroid tissue. Case: A 73-year-old male with left hemithyroidectomy (benign left nodule) presented 6 years later with new superficial neck nodules along the midline, left thyroid bed and R thyroid lobe. FNA of the right thyroid nodule was benign. Three months later the patient underwent an excision of the midline neck nodules which revealed thyroid tissue arranged in nests of fibrotic tissue without definite features of papillary thyroid carcinoma. Molecular analysis (Thyroseq) was positive for HRAS, E1F1AX and TERT mutations thus metastatic follicular carcinoma was suspected. The patient underwent complete thyroidectomy. Pathology revealed normal thyroid tissue and a diagnosis of thyroid neck implants was made. Given the benign pathology, the plan was for close follow-up with neck imaging every 6 months. Discussion: Thyroid tissue implants can rarely be caused by previous surgical interventions, especially partial thyroidectomy. There is literature documenting similar clinical cases in which subcutaneous thyroid implants are found in patients after undergoing total or subtotal thyroidectomy. In one case series, there were cases in which thyroid implants were discovered 26 years post-surgery, with most of the cases reporting benign pathology. Given our patient’s presentation and clinical history, the possibility remains that his subcutaneous tissue findings were caused by his prior partial thyroidectomy. A recent article reviewed 60 publications and &amp;gt;8000 patients for the prevalence of high-risk tumor markers (RAS mutation, RET/PTC, and PAX8/PPAR-gamma chromosomal rearrangements) in benign thyroid tissue. They concluded that prevalence findings were highly variable, warning providers to exercise caution when using these genetic markers to guide diagnosis and treatment decisions. Conclusion: While certain high-risk genetic tumor markers are increasingly used to help identify thyroid malignancies, it is important to keep in mind that these genetic markers are not exclusively found in cancerous tissue, and should not be used as the sole diagnostic tool for diagnosis and treatment. While it is imperative that metastatic disease is ruled out, it is essential to consider other pathologies when evaluating recurrent thyroid and neck masses in patients with a history of benign thyroid lesions. Presentation: 6/3/2024

8314 Masculinizing Hormone Therapy and Gynecological Neoplasm: a Single Institution Cohort

Abstract Disclosure: S. Korpaisarn: None. T. Ngaothepphurktharam: None. Y. Tingthanatikul: None. Background: Gynecological neoplasm/malignancy is one of the concerned areas among transgender men on masculinizing hormone therapy (MHT). Long-term MHT and gynecological neoplasm/malignancy remain unclear. Methods: A retrospective cohort chart review was done on all transgender men (TM) who underwent hysterectomy with or without oophorectomy between January 2014 and October 2022. Intraoperative findings and pathological results of genital organs, including the cervix, endometrium, myometrium, and fallopian tubes, were extracted. The pathological results were classified as benign, precancerous, and malignant. Descriptive statistical analysis was used to demonstrate the prevalence of gynecological neoplasm and malignancy. Results: A total of 30 TM underwent hysterectomy with oophorectomy. Twenty-eight (93%) had bilateral oophorectomy, and 7% had unilateral oophorectomy due to gynecological conditions. The mean age when TM underwent surgery was 32.1 ± 5.1 years, and the mean age of gender-affirming hormone initiation was 28.7± 5.1 years. The median duration of MHT before gynecological surgery was 32 months (IQR 22-59). Most TM (73%) used testosterone enanthate, 17% testosterone undecanoate, and 2 transgender men did not start MHT before genital surgery. All TM who used GHT became amenorrheic before surgery. The median preoperative testosterone level was 561.5 ng/dL (IQR 776-1189). Intraoperative findings revealed that most TM (86.7%) had unremarkable uterus size, and 13% showed enlarged uterus size. In the latter, all were from myoma uteri. Most intraoperative findings of ovaries showed 93% unremarkable. One TM had intraoperative polycystic ovarian morphology, and one showed a unilateral ovarian cyst. Cervical pathological reports showed unremarkable results in 67%. Five TM (17%) had chronic cervical inflammation. There was 1 TM (3%) who showed low-grade squamous intraepithelial lesion (LSIL) with squamous metaplasia. Regarding endometrial pathology, the mean endometrial thickness was 0.13 ± 0.08 cm. Most endometrial reports (66%) were in a proliferative phase, 27% were in an atrophic or inactive endometrium, and 7% were in the secretory phase. Regarding pathological reports of ovaries, 80% had cystic ovaries. None of the TM showed precancerous or malignant conditions of endometrium, ovaries, and fallopian tubes. PAP smear was available in 27 TM; all were negative for intraepithelial lesions or malignancy. Conclusion: Among a cohort of TM who received MHT for 32 months, there is no evidence of precancerous or malignant pathology of the endometrium, ovaries, and fallopian tubes. Most of them had thin endometrium with cystic ovaries. One TM showed LSIL with squamous metaplasia of the cervix. Healthcare providers should follow local gynecological cancer screening guidelines developed for cisgender women in their clinical practice. Presentation: 6/2/2024

Clinical Implication of the New AI-TIRADS Classification of Thyroid Nodules; Our Real Clinical Experience

Background: Ultrasound and fine needle aspiration biopsy (FNAB) play a primary role in determining the nature of nodules. Objectives: The aim of our study is to determine the diagnostic accuracy, sensitivity, and specificity of artificial intelligence-thyroid imaging reporting and data system (AI-TIRADS) in differentiating malignant from benign nodules to establish the treatment plan for patients and avoid unnecessary FNAB. Methods: This cross-sectional study was conducted between September 2020 and September 2021 (one year). Patients (n = 133) who had an indication for surgery due to nodular thyroid disease and were referred to the therapeutic training center of 5 Azar and Falsafi private section hospitals, Gorgan, Iran, were included. The diagnostic accuracy of FNAB and AI-TIRADS was calculated. Results: The mean age of patients with malignant pathology (39.65 ± 11.69) was lower than that of patients with benign pathology (44.14 ± 13.54), which was statistically significant (P = 0.042). Fifty-two out of 72 nodules less than 25 mm were malignant, demonstrating a higher prevalence of benign pathology in larger nodules. A pooled analysis of thyroid reporting (TR) = 2 and TR points ≥ 7 for their power in predicting the final pathology outcome showed figures of 0.97, 0.93, 0.97, and 0.97 for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), respectively, with an overall pooled accuracy of 0.97 for these two groups of sonographic results. Conclusions: We concluded that AI-TIRADS has a high sensitivity and diagnostic accuracy in differentiating benign from suspicious nodules.

Predictors of hypocalcemia and hypoparathyroidism in patients undergoing thyroidectomy for benign and malignant pathologies

Objective To analyse the risk factors of hypoparathyroidism and hypocalcemia after total thyroidectomy. Methods Clinical data of patients who underwent total thyroidectomy in a tertiary care hospital from the southern part of India was collected retrospectively from January 2021 to May 2023. Multivariate logistic regression was used to analyse the risk factors associated with transient hypoparathyroidism and hypocalcemia separately. Results A total of 300 patients who underwent total thyroidectomy were enrolled. The median age of the study population was 41 years, and 70% were females. Histopathological examination showed 80.3% had thyroid cancer. The incidence of postoperative transient hypoparathyroidism was 26.7%, while postoperative transient hypocalcemia was 12.3%. Multivariate analysis showed that presence of hypothyroidism before surgery (OR 3.230,95%CI:1.368–7.624,p=0.007), performing central compartment neck dissection (CCND) (OR 2.196,95%CI:1.133-4.257,p=0.02) and parathyroid gland in surgical specimen (OR 5.547, 95%CI:3.065–10.036,p&lt;0.0001) were independent predictors of postoperative transient hypoparathyroidism. Female gender (OR 2.689,95%CI:1.049-6.895,p= 0.039), presence of parathyroid in the surgical specimen (OR 1.067,95%CI:0.367-8.438,p=0.004) and performing CCND (OR 2.192,95%CI:0.990-4.850,p=0.05) were independent predictors of postoperative transient hypocalcemia. Conclusion Hypoparathyroidism and hypocalcemia after thyroid surgery are common, and most of them are transient. Independent predictors of hypoparathyroidism and hypocalcemia differs. Hypoparathyroidism appears to be a better predictor for patients who will develop postoperative hypocalcemia.

Reliability, reproducibility, and potential pitfalls of the O-RADS scoring with non-dynamic MRI.

The O-RADS scoring has been proposed to standardize the reporting of adnexal lesions using magnetic resonance imaging (MRI). To assess intra- and inter-observer agreement of the O-RADS scoring using non-dynamic MRI and its agreement with pathologic diagnosis, and to provide the pitfalls in the scoring based on discordant ratings. Adnexal lesions that were diagnosed using non-dynamic MRI at two centers were scored using O-RADS. Intra- and inter-observer agreements were assessed using kappa statistics. Cross-tabulations were made for intra- and inter-observer ratings and for O-RADS scores and pathological findings. Intra- and inter-observer agreements were assessed for 404 lesions in 339 patients who were admitted to center 1. Intra-observer agreement was almost perfect (97.8%, kappa = 0.963) and inter-observer agreement was substantial (83.2%, kappa = 0.730). The combined data from center 1 and center 2 included 496 patients; of them, 295 (59.5%) were operated. There was no borderline or malignant pathology for the lesions with O-RADS 1 or 2. Of those with an O-RADS score of 3, 3 (4.1%) lesions were borderline and none were malignant. The O-RADS scoring in discriminating borderline/malignant lesions from benign lesions was outstanding (area under the ROC curve 0.950, 95% CI = 0.923-0.971). Sensitivity, specificity, positive, and negative predictive values of O-RADS 4/5 lesions for borderline/malignant lesions were 96.2%, 87.1%, 72.8%, and 98.4%, respectively. The O-RADS scoring using non-dynamic MRI is a reproducible method and has good discrimination for borderline/malignant lesions. Potential factors that may lead to discordant ratings are provided here.

Navigating the gray zone: Machine learning can differentiate malignancy in PI-RADS 3 lesions

IntroductionThe objective of this study is to predict the probability of prostate cancer in PI-RADS 3 lesions using machine learning methods that incorporate clinical and mpMRI parameters. MethodsThe study included patients who had PI-RADS 3 lesions detected on mpMRI and underwent fusion biopsy between January 2020 and January 2024. Radiological parameters (Apparent diffusion coefficient (ADC), tumour ADC/contralateral ADC ratio, Ktrans value, periprostatic adipose tissue thickness, lesion size, prostate volume) and clinical parameters (age, body mass index, total prostate specific antigen, free PSA, PSA density, systemic inflammatory index, neutrophil-lymphocyte ratio [NLR], platelet lymphocyte ratio, lymphocyte monocyte ratio) were documented. The probability of prostate cancer prediction in PI-RADS 3 lesions was calculated using 6 different machine-learning models, with the input parameters being the aforementioned variables. ResultsOf the 235 participants in the trial, 61 had malignant fusion biopsy pathology and 174 had benign pathology. Among 6 different machine learning algorithms, the random forest model had the highest accuracy (0.86±0.04; 95% CI 0.85–0.87), F1 score (0.91±0.03; 95% CI 0.91–0.92) and AUC value (0.92±0.06; 95% CI 0.88–0.90). In SHAP analysis based on random forest model, tumour ADC, tumour ADC/contralateral ADC ratio and PSA density were the 3 most successful parameters in predicting malignancy. On the other hand, systemic inflammatory index and neutrophil lymphocyte ratio showed higher accuracy in predicting malignancy than total PSA, age, free PSA/total PSA and lesion size in SHAP analysis. ConclusionAmong the machine learning models we developed, especially the random forest model can predict malignancy in PI-RADS 3 lesions and prevent unnecessary biopsy. This model can be used in clinical practice with multicentre studies including more patients.

Solid volume ratio in predicting pathological features of cT1 lung adenocarcinoma.

More effective methods are urgently needed for predicting the pathological grade and lymph node metastasis of cT1-stage lung adenocarcinoma. We analyzed the relationships between CT quantitative parameters (including three-dimensional parameters) and pathological grade and lymph node metastasis in cT1-stage lung adenocarcinoma patients of our center between January 2015 and December 2023. A total of 343 patients were included, of which there were 233 males and 110 females, aged 61.8 ± 9.4 (30-82) years. The area under the receiver operating characteristic (ROC) curve for predicting the pathological grade of lung adenocarcinoma using the consolidation tumor ratio (CTR) and the solid volume ratio (SVR) were 0.761 and 0.777, respectively. The areas under the ROC curves (AUCs) for predicting lymph node metastasis were 0.804 and 0.873, respectively. Multivariate logistic regression analysis suggested that the SVR is an independent predictor of highly malignant lung adenocarcinoma pathology, while the SVR and pathological grade are independent predictors of lymph node metastasis. The sensitivity of predicting the pathological grading of lung adenocarcinoma based on SVR>5% is 97.2%, with a negative predictive value of 96%. The sensitivity of predicting lymph node metastasis based on SVR>47.1% is 97.3%, and the negative predictive value is 99.5%. The SVR has greater diagnostic value than the CTR in the preoperative prediction of pathologic grade and lymph node metastasis in stage cT1-stage lung adenocarcinoma patients, and the SVR may replace the diameter and CTR as better criteria for guiding surgical implementation.

Influence of Pre-Operative Estimation of Draf III Expected Diameter on Surgical Outcome.

Introduction: The DRAF III procedure is indicated for the treatment of benign and selected malignant frontal sinus pathology. Several attempts have been made to find an intra or pre-operative measurement that was predictive of the feasibility of this operation and its success. Among those, the frontal sinus outflow tract anteroposterior diameter (FOAP) appears to be the one with the highest applicability in clinical practice, since it is easy to measure on pre-operative CT scan. The objective of the study is to evaluate whether the minimum and maximum frontal sinus outflow anteroposterior diameters (FOAP min and FOAP max) are associated with the risk of failure and consequently with the need for surgical revision. Secondly, we ought to evaluate whether the angle between the glabella and the nasion on the sagittal plane could influence surgical outcome. Material and Methods: This is a retrospective study on patients who underwent DRAF III for benign pathologies at a tertiary Italian referral center from January 2000 to July 2022. FOAP min and FOAP max were measured on the mid-sagittal sections of a pre-operative CT scan. The glabella-nasion angle (G-N angle) was calculated on the same sagittal section. These measurements were compared between patients who experienced a recurrence and those who did not. If a post-operative CT scan was available, the obtained anteroposterior diameter (OD) of the frontal sinus neo-ostium was also measured on the same section. A correlation analysis was performed between the three pre-operative radiologic parameters and OD. Results: Twenty-nine patients were included in the study. Six patients experienced restenosis requiring surgical revision. The median FOAP max resulted significantly higher in patients who did not experience recurrence (median: 14.8 mm, IQR: 3.84) than in patients who experienced a recurrence (median: 11.9 mm, IQR: 1.14) (p = 0.04). The FOAP max also showed a good positive correlation with OD (p = 0.0001; r = 0.7). The correlation between FOAP min and OD was not statistically significant, nor was a correlation found between FOAP min and recurrence risk. The G-N angle was not significantly different in patients who experienced recurrence and those who did not, nor did it show a correlation with OD. Discussion: The FOAP max might be a valid pre-operative radiologic parameter to guide a surgeon's approach to a DRAF III procedure, as it is easy to measure, shows a good correlation with OD, and seems to influence the risk of recurrence.