Nondiagnostic Results Research Articles

Risk factors of non-diagnostic percutaneous liver tumor biopsy: a single-center retrospective analysis of 938 biopsies based on cause of error.

To evaluate the risk factors of non-diagnostic results based on cause of error in liver tumor biopsy. This single-institution, retrospective study included 843 patients [445 men, 398 women; median age, 67years] who underwent a total of 938 liver tumor biopsies between April 2018 and September 2022. An 18-G cutting biopsy needle with a 17-G introducer needle was used. Ultrasound was used as the first choice for image guidance, and computed tomography was alternatively or complementarily used only for tumors with poor ultrasound visibility. Non-diagnostic biopsies were divided into two groups depending on the cause of error, either technical or targeting error. Biopsies in which the biopsy needle did not hit the target tumor were classified as technical error. Biopsies in which insufficient tissue was obtained due to necrosis or degeneration despite the biopsy needle hitting the target tumor were classified as targeting error. This classification was based on pre-procedural enhanced-imaging, intro-procedural imaging, and pathological findings. Statistical analysis was performed using binary logistic regression. The non-diagnostic rate was 4.6%. Twenty-six and seventeen biopsies were classified as technical and targeting errors, respectively. In the technical error group, tumor size ≤ 17mm and computed tomography-assisted biopsy due to poor ultrasound visibility were identified as risk factors (p < 0.001 and p = 0.021, respectively), and the tumors with both factors had a significantly high risk of technical error compared to those without both factors (non-diagnostic rate: 17.2 vs 1.1%, p < 0.001). In the targeting error group, tumor size ≥ 42mm was identified as a risk factor (p = 0.003). Tumor size ≤ 17mm and computed tomography-assisted biopsy due to poor ultrasound visibility were risk factors for technical error, and tumor size ≥ 42mm was a risk factor for targeting error in liver tumor biopsies.

Feasibility, efficacy, and safety of core needle biopsy as a first-line method for cervical lymphadenopathy.

This study aimed to determine the feasibility, diagnostic efficacy, and safety of ultrasound-guided core needle biopsy (CNB) as a first-line biopsy method for cervical lymphadenopathy of non-thyroid origin. This retrospective cohort study included consecutive patients with cervical lymphadenopathy in whom US-guided CNB was used as the first-line biopsy method for cervical lymph nodes (LNs) of presumed non-thyroid origin. The coaxial CNB technique was routinely used, while the tilting and hydrodissection CNB techniques were selectively employed for small high-risk LNs. The primary endpoint of this study was the diagnostic efficacy of CNB, evaluated by the rate of inconclusive results (nondiagnostic and indeterminate) and diagnostic accuracy (criterion 1: malignant results; criterion 2: malignant or indeterminate result). The secondary outcomes included the feasibility and safety of CNB, assessed based on the technical success rate and complication rate, respectively. The rates of nondiagnostic, indeterminate, and inconclusive results were 0.7%, 3.4%, and 4.1%, respectively. The sensitivity, specificity, and accuracy of CNB for malignant LNs were 96.2%, 100%, and 97.8%, respectively, with criterion 1, and these values were all 99.8% with criterion 2. The technical success rate of CNB was 99.3%. There were no major complications and 7 cases (0.6%) of minor complications (asymptomatic hematomas). CNB was technically feasible, effective, and safe as a first-line biopsy method for cervical lymphadenopathy of non-thyroid origin with high diagnostic accuracy for malignant nodal disease. Question The role of US-guided CNB as a first-line biopsy method for cervical LNs has not yet been verified and established. Findings US-guided CNB, as a first-line method, demonstrated a high technical success rate and diagnostic accuracy for malignant nodes, with few minor complications. Clinical relevance US-guided CNB can be used as an effective first-line biopsy method for cervical lymphadenopathy and will enable accurate diagnosis of malignant LNs.

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).

6511 Provider Opinions on Holding Antiplatelet and Anticoagulant Drugs Prior to Thyroid Nodules FNA Biopsy: A Survey Study

Abstract Disclosure: M.D. Lundholm: None. P.P. Rao: None. Objective: It is thought that anticoagulant (AC) or antiplatelet (AP) therapy at the time of thyroid nodule fine needle aspiration biopsy (TNFNAB) may increase the risk of non-diagnostic results and post-procedure hematomas. However, interrupting a patient’s AC or AP can lead to procedural delays or have thrombotic consequences. Since there is currently no consensus on whether or not to hold these medications, this study aims to survey the expertise of our providers across multiple specialties. Methods: A survey was sent out to Cleveland Clinic providers who have performed TNFNABs for patients with an active prescription for AC or AP since 2010. Providers were asked if they routinely held a number of blood thinner medication classes and included a free response section for open-ended comments. Results: The survey responses represented 60 providers (of 68 invited, 88% response rate). Respondents were 51.7% medical endocrinologists, 30% interventional radiologists, 13% surgical endocrinologists, and 5% ENTs. Of respondents, 13.3% held aspirin 81 mg, 15.0% held aspirin 325 mg, 41.7% held other antiplatelet agents, 73.3% held warfarin, 43.3% held direct oral anticoagulants (DOACs), and 43.3% held heparin. No department was uniform in practice, with the least agreement (responses closest to 50%) amongst medical endocrinologists. In a subset of 15 providers who have performed ≥100 TNFNABs on patients with AC/AP, a consensus emerged not to hold aspirin at any dose, but there was no agreement in any other AC/AP categories (hold rates ranging 53.5-66.6%). Free response themes reiterated that the main concerns for continuing blood thinners are hematomas and non-diagnostic results. Other comments included consideration of the nodule features such as location as well as strategies used to lower risk for hematomas (i.e., small-gauge needles, ice, holding pressure). A couple responses referred to the Society of Interventional Radiology (SIR) and the International Society on Thrombosis and Haemostasis (ISTH) guidelines which offer INR and platelet goal recommendations prior to any procedure with a low bleeding risk. Discussion: A survey of Cleveland Clinic providers demonstrated that ≥85% continue aspirin therapies prior to TNFNAB. However, there is no such agreement in any other category of AC/AP medication, even amongst the most experienced providers. The closest guidelines available come from SIR and ISTH and rely on recent platelet and/or INR information, which may not be available in routine endocrinology practice. The caveat is that these recommendations are not specific to TNFNAB and do not take into account the nuances of this procedure. Conclusion: There is wide variation in provider opinions and practice patterns regarding AC and AP medications prior to TNFNAB. This highlights the need for further study into the safety and adequacy of TNFNAB performed on uninterrupted AC or AP therapy. Presentation: 6/3/2024

8012 A Severe Thrombotic Event Following Blood Thinner Interruption for Thyroid Fine Needle Aspiration Biopsy: A Case Report

Abstract Disclosure: V.A. Mendpara: None. P.P. Rao: None. M.V. Kellis: None. M.D. Lundholm: None. Background: This case highlights the potential severe thrombotic consequences of blood thinner medication interruption for thyroid fine needle aspiration (FNA). Case Presentation: A 77-year-old woman came to the endocrinology clinic for follow-up on thyroid nodules. She was a former smoker with controlled type 2 diabetes, hypertension, hyperlipidemia, and atrial fibrillation with patent foramen ovale on apixaban. She had no family history of thyroid cancer and no radiation exposure. Thyroid nodules were found incidentally, and she denied compressive symptoms. She had annual surveillance for the past 4 years, and her latest thyroid US redemonstrated 4 solid, hypoechoic nodules. The largest nodule, previously biopsied and benign in 2020, remained stable on the right. The next largest nodule in the left mid-thyroid was now 1.1 x 0.8 x 0.9 cm—a 30% growth from the previous year—with new punctate echogenic foci consistent with the TIRADS 5 classification. This finding was shared with the patient, who favored investigating with an FNA. At the recommendation of her PCP and the performing provider, she held her apixaban for approximately 48 hours before the FNA procedure.The US-guided thyroid FNA biopsy was uneventful, and the results indicated a benign nodule. However, 4 hours post-procedure, the patient suddenly became unresponsive while in the middle of cooking dinner. She was taken to the ED and found to have an ischemic stroke by basilar embolism, attributed to her interruption in apixaban therapy. Tenectaplase led to initial improvement but had subsequent hemorrhagic transformations affecting the midbrain, thalamus, and pons. This marked the beginning of a complex 2-month hospitalization requiring tracheostomy and percutaneous endoscopic gastrostomy (PEG) placement, followed by nearly a year of physical, occupational, and speech rehabilitation. Despite these efforts, she has not been able to return to her pre-stroke level of function and independence. Discussion: There is no consensus on the safety of performing a thyroid fine needle aspiration (FNA) biopsy for patients on blood thinner medications. Providers who favor holding blood thinners before FNA cite concerns for post-procedural hematoma formation or increased risk of non-diagnostic results. However, there is less discussion about the risks of interrupting these medications. This case emphasizes the potential for severe consequences from interrupting medically-indicated blood thinner therapy. The temporary discontinuation of apixaban for a routine thyroid FNA led to a life-threatening thrombotic event in our patient’s case. This outcome highlights the importance of carefully weighing the risks and benefits of medication interruptions for vulnerable populations. Further study is needed to investigate the safety of thyroid FNA on uninterrupted blood thinner therapy. Presentation: 6/2/2024

The evaluation of fine needle aspiration biopsy results in differentiating between benign and malignant thyroid nodules

Introduction: Thyroid fine-needle aspiration biopsy (FNAB) has begun playing an important role in the evaluation of thyroid nodules, in addition to physical examination and imaging techniques. The purpose of this study was to evaluate the results of patients who underwent thyroid FNAB together with their demographic data, imaging findings, and follow-up compliance. Methods: Patients who underwent thyroid FNAB procedures in our hospital’s interventional radiology unit between January 2022 and May 2024 were evaluated retrospectively. Data were retrieved from patient records. Cytological results were classified as malignant, atypia of undetermined significance, benign, and non-diagnostic material. Results: Two hundred twelve solid nodules were detected in the patients who underwent biopsy, and 59 mixed nodules with a cystic component. Non-diagnostic material was reported in 51 cases at cytological examination, benign cytology in 150, atypia of undetermined significance in 53, and malignant material in 17. The incidence of non-diagnostic results was significantly higher in hypoechoic nodules and low-volume nodules. Conclusions: Thyroid FNAB is a valuable diagnostic tool due to its ease of application and provision of useful information in benign-malignant differentiation. Once it becomes capable of application by primary physicians and local state hospitals in Türkiye it will reduce delayed diagnoses, unnecessary surgical procedures, and economic burdens on social security institutions.

The current landscape of clinical exome and genome reanalysis in the U.S.

The majority of patients undergoing exome or genome sequencing receive a nondiagnostic result. Periodic reanalysis is known to increase diagnostic yield from exome sequencing, yet laboratory reanalysis practices are obscure. We sought to define the landscape of exome and genome reanalysis across clinical laboratories. Genetic testing registries were queried to identify eligible clinical genetic laboratories offering exome and/or genome sequencing in the United States. A survey administered to lab representatives investigated reanalysis offerings, policies, perceived uptake, bioinformatic steps, and billing options. The analysis consisted of descriptive statistics. Survey data were collected from 30 of 32 eligible laboratories (93%), comprising 28 exome products and 13 genome products. Reanalysis was widely available for both exomes (n = 27/28, 96%) and genomes (n = 12/13, 92%). Most participating laboratories required ordering providers to initiate reanalysis (n = 24/28, 86%). Most respondents estimated providers initiated reanalysis in less than 10% of all exomes (n = 12/22) or genomes (n = 6/9) sequenced. The approach to reanalysis varied greatly by laboratory. Laboratory approaches to exome and genome reanalysis are highly variable and typically require provider initiation. This could contribute to low reanalysis uptake and increased administrative burden on providers. Further work should emphasize development of clinical exome and genome reanalysis standards.

The Association of Non-diagnostic Result and Thyroid Cancer in Patients Who Underwent Fine Needle Aspiration Biopsy

The Association of Non-diagnostic Result and Thyroid Cancer in Patients Who Underwent Fine Needle Aspiration Biopsy

The effectiveness of coronary computed tomography angiography and functional testing for the diagnosis of obstructive coronary artery disease: results from the individual patient data Collaborative Meta-Analysis of Cardiac CT (COME-CCT)

AimTo determine the effectiveness of functional stress testing and computed tomography angiography (CTA) for diagnosis of obstructive coronary artery disease (CAD).Methods and resultsTwo-thousand nine-hundred twenty symptomatic stable chest pain patients were included in the international Collaborative Meta-Analysis of Cardiac CT consortium to compare CTA with exercise electrocardiography (exercise-ECG) and single-photon emission computed tomography (SPECT) for diagnosis of CAD defined as ≥ 50% diameter stenosis by invasive coronary angiography (ICA) as reference standard. Generalised linear mixed models were used for calculating the diagnostic accuracy of each diagnostic test including non-diagnostic results as dependent variables in a logistic regression model with random intercepts and slopes. Covariates were the reference standard ICA, the type of diagnostic method, and their interactions. CTA showed significantly better diagnostic performance (p < 0.0001) with a sensitivity of 94.6% (95% CI 92.7–96) and a specificity of 76.3% (72.2–80) compared to exercise-ECG with 54.9% (47.9–61.7) and 60.9% (53.4–66.3), SPECT with 72.9% (65–79.6) and 44.9% (36.8–53.4), respectively. The positive predictive value of CTA was ≥ 50% in patients with a clinical pretest probability of 10% or more while this was the case for ECG and SPECT at pretest probabilities of ≥ 40 and 28%. CTA reliably excluded obstructive CAD with a post-test probability of below 15% in patients with a pretest probability of up to 74%.ConclusionIn patients with stable chest pain, CTA is more effective than functional testing for the diagnosis as well as for reliable exclusion of obstructive CAD. CTA should become widely adopted in patients with intermediate pretest probability.Systematic review registrationPROSPERO Database for Systematic Reviews—CRD42012002780.Critical relevance statementIn symptomatic stable chest pain patients, coronary CTA is more effective than functional testing for diagnosis and reliable exclusion of obstructive CAD in intermediate pretest probability of CAD.Key PointsCoronary computed tomography angiography showed significantly better diagnostic performance (p < 0.0001) for diagnosis of coronary artery disease compared to exercise-ECG and SPECT.The positive predictive value of coronary computed tomography angiography was ≥ 50% in patients with a clinical pretest probability of at least 10%, for ECG ≥ 40%, and for SPECT 28%.Coronary computed tomography angiography reliably excluded obstructive coronary artery disease with a post-test probability of below 15% in patients with a pretest probability of up to 74%.Graphical

CT-Guided Core Needle Biopsy of Pulmonary Lesions Associated With Cystic Airspaces: A Case-Control Study.

BACKGROUND. Concern may exist that pulmonary lesions associated with cystic airspaces are at risk of increased biopsy complications or lower biopsy accuracy given challenges in targeting tissue abutting or intermingled with the cystic airspaces. OBJECTIVE. The purpose of this study was to evaluate the safety and diagnostic performance of CT-guided core needle biopsy (CNB) of pulmonary lesions associated with cystic airspaces. METHODS. This retrospective study included 90 patients (median age, 69.5 years; 28 women, 62 men) who underwent CT-guided CNB of pulmonary lesions associated with cystic airspaces (based on review of procedural images) from February 2010 to December 2022 and a matched control group (2:1 ratio) of 180 patients (median age, 68.0 years; 56 women, 124 men) who underwent CNB of noncystic noncavitary lesions during the same period. The groups were compared in terms of complications, nondiagnostic biopsies (i.e., nonspecific benignities, atypical cells, or insufficient specimens), and CNB diagnostic performance for detecting malignancy using as reference the final diagnosis from a joint review of all available records. For lesions associated with cystic airspaces that underwent surgical resection after CNB, histologic slides were reviewed to explore the nature of the cystic airspace. RESULTS. The final diagnosis was malignant in 90% (81/90) of lesions associated with cystic airspaces and 92% (165/180) of noncystic noncavitary lesions. Patients with lesions associated with cystic airspaces and patients with noncystic noncavitary lesions showed no significant difference in frequency of complications (overall: 40% [36/90] vs 38% [68/180], p = .79; major: 4% [4/90] vs 6% [10/180], p = .78; minor: 36% [32/90] vs 32% [58/180], p = .59), frequency of nondiagnostic biopsies (12% [11/90] vs 9% [16/180], p = .40), or diagnostic performance (accuracy: 94% [85/90] vs 97% [175/180], p = .50; sensitivity: 94% [76/81] vs 97% [160/165], p = .50; specificity: 100% [9/9] vs 100% [15/15]; p > .99), respectively. All false-negative results for malignancy in both groups occurred in patients with nondiagnostic CNB results. Among lesions associated with cystic airspaces that were resected after CNB (all malignant), the cystic airspaces most commonly represented tumor degeneration (22/31 [71%]). CONCLUSION. CT-guided CNB is safe and accurate for assessing pulmonary lesions associated with cystic airspaces. CLINICAL IMPACT. CNB may help avoid a missed or delayed cancer diagnosis in pulmonary lesions with cystic airspaces.

Muscle biopsy practices in the evaluation of idiopathic inflammatory myopathies: An international survey of expert clinicians

BackgroundMuscle biopsy is an important test in the evaluation of individuals with suspected myopathy, including those with suspected idiopathic inflammatory myopathy (IIM). Various approaches, including open surgical biopsy, needle biopsy and conchotome forceps, have been reported. However the real-world utilisation of these approaches remains unclear. There are no established guidelines for the use of muscle biopsy, or selection of biopsy technique, in investigating IIM and international practices are not well-documented. This study describes current approaches to muscle biopsy amongst clinicians with expertise in IIM. MethodsA survey regarding muscle biopsy practices was disseminated among members of the International Myositis Assessment and Clinical Studies (IMACS) group. Data were analysed using descriptive statistics. ResultsOne-hundred and sixteen clinicians completed the survey, primarily rheumatologists. Open surgical biopsy was the most commonly employed technique (74.5 %), followed by needle (11.3 %) and conchotome (9.4 %) approaches. Clinical examination was the most common method of muscle selection, with 85.2 % of respondents reporting they ‘always or almost always’ relied on it. MRI and electromyography were also frequently utilised for muscle selection (51.9 %, 45.4 % respectively). There was variability in the perceived utility of muscle biopsy in certain clinical contexts, such as presence of myositis specific antibodies or cutaneous manifestations of dermatomyositis. While respondents generally reported low complication rates following muscle biopsy, non-diagnostic histopathology was commonly reported, regardless of procedural approach. ConclusionClinicians managing IIM report muscle biopsy to be well tolerated however, non-diagnostic results are common. Substantial heterogeneity regarding perceived indications for biopsy, procedural approaches, and muscle selection strategies were observed within this expert group. Future research is needed to establish best practice and determine the role of muscle biopsy in the context of continued advancements in serological profiling of IIM.

Prenatal genetic diagnosis of fetuses with dextrocardia using whole exome sequencing in a tertiary center

To evaluate the genetic etiology of fetal dextrocardia, associated ultrasound anomalies, and perinatal outcomes, we investigated the utility of whole exome sequencing (WES) for prenatal diagnosis of dextrocardia. Fetuses with dextrocardia were prospectively collected between January 2016 and December 2022. Trio-WES was performed on fetuses with dextrocardia, following normal karyotyping and/or chromosomal microarray analysis (CMA) results. A total of 29 fetuses with dextrocardia were collected, including 27 (93.1%) diagnosed with situs inversus totalis and 2 (6.9%) with situs inversus partialis. Cardiac malformations were present in nine cases, extra-cardiac anomalies were found in seven cases, and both cardiac and extra-cardiac malformations were identified in one case. The fetal karyotypes and CMA results of 29 cases were normal. Of the 29 cases with dextrocardia, 15 underwent WES, and the other 14 cases refused. Of the 15 cases that underwent WES, clinically relevant variants were identified in 5/15 (33.3%) cases, including the diagnostic variants DNAH5, DNAH11, LRRC56, PEX10, and ZIC3, which were verified by Sanger sequencing. Of the 10 cases with non-diagnostic results via WES, eight (80%) chose to continue the pregnancies. Of the 29 fetuses with dextrocardia, 10 were terminated during pregnancy, and 19 were live born. Fetal dextrocardia is often accompanied by cardiac and extra-cardiac anomalies, and fetal dextrocardia accompanied by situs inversus is associated with a high risk of primary ciliary dyskinesia. Trio-WES is recommended following normal karyotyping and CMA results because it can improve the diagnostic utility of genetic variants of fetal dextrocardia, accurately predict fetal prognosis, and guide perinatal management and the reproductive decisions of affected families.

Role of Macrocalcification in Raising the Suspicion of Malignancy among the ACR TIRADS Thyroid Nodules Detected by Ultrasonography

Abstract Background Thyroid nodules are a frequent finding on neck sonography. The US is the most commonly used imaging technique for the evaluation of thyroid nodules. The Thyroid Imaging, Reporting and Data System (TIRADS) developed by the American college of radiology (ACR) for classification of thyroid nodules is a practical and convenient method for risk stratification of thyroid malignancy, based on allocating points for different sonographic features of thyroid nodules in five morphologic categories (composition, echogenicity, margins, shape, and presence of echogenic foci). Objective To evaluate the role of macrocalcification in raising the suspicious of malignancy among ACR TIRADS 3 and 4 group without macrocalcification Patients and Methods Our study was conducted on 60 adult patients, 20 patients with TIRADS 3 nodule, 20 patients with TIRADS 4 group with macrocalcification nodules and 20 patients group TIRADS 4 without macrocalcification nodules, whose ages range between 23 and 65 years old and were referred to undergo FNA procedures. Results The present study concludes parenchymal macrocalcifications showed no statistically significant difference in raising percentage of malignancy among TIRADS 4 patients. Conclusion We conclude that the added macrocalcification showed no statistically significant difference in raising percentage of malignancy compared to TIRADS 4 without calcification group. Also, presence of macrocalcification should not prevent clinicians from making further assessments in case of nondiagnostic results to exclude their association with rather than their causal relation with thyroid malignancies.

Improving Cancer Probability Estimation in Nondiagnostic Bronchoscopies: A Meta-analysis

BackgroundIn patients with peripheral pulmonary lesions (PPL), non-diagnostic bronchoscopy, results are not uncommon. The conventional approach to estimate the probability of cancer (pCA) following bronchoscopies relies on dichotomous test assumptions, utilizing prevalence, sensitivity, and specificity to determine negative predictive value (NPV). However, bronchoscopy is a multi-disease test, raising concerns about the accuracy of dichotomous methodologies. Research QuestionBy how much does calculating pCA using a dichotomous approach (pCAdichotomous) underestimate the true pCA when applied to multi-disease tests like bronchoscopy for the diagnosis of PPL? MethodsMeta-analysis of cohort studies involving radial-EBUS for PPL. PRISMA guidelines were followed, constructing 2×2 contingency tables for calculating pCAdichotomous. For the multi-disease test approach, 3×3 contingency tables for calculating pCAmulti-disease using the likelihood ratio method for non-diagnostic results LR(T0) was used. Observed malignancy rates in patients with non-diagnostic results were compared to pCAdichotomous and pCAmulti-disease. ResultsIn 46 studies (7506 patients), malignancy was the underlying diagnosis in 76%, another specific disease in 13%, and non-specific fibrosis/scar in 10%. The percentage of patients with non-diagnostic results who had malignancy matched pCAmulti-disease across all studies. In contrast, pCAdichotomous consistently underestimated cancer risk (median difference: 0.12, 25th−75th percentile: 0.06−0.23), particularly in studies with a higher prevalence of non-malignant disease. The pooled LR(T0) was 0.46 (95% CI 0.40−0.52, I2 76%, p<0.001), and correlated with the prevalence of non-malignant diseases (p=0.001). InterpretationConventional dichotomous methods for estimating pCA after non-diagnostic bronchoscopies underestimate the likelihood of malignancy. Physicians should opt for the multi-disease test approach when interpreting bronchoscopy results.

Clinical, Radiological, and Etiological Aspects of Pachymeningitis: A Study of 24 Cases.

Introduction and importance Hypertrophic pachymeningitis (HP) is an uncommon disorder with varied etiological origins and heterogeneous clinical presentation. Establishing the etiological diagnosis poses a challenge, but prompt identification provides a treatment window, potentially leading to a reversal of symptoms.MRI is the reference examination, allowingnot onlythe early diagnosis of pachymeningitisbut alsothe assessment of its extent and importance, detection of possible complications, and suggestion of etiology. Case presentation We conducted a retrospective study involving 24 patients recruited over 5 years for who brain imaginghad revealed the presence ofpachymeningitis.The average age of the patients was 40 years, with a male-to-female ratio of 0.6. Clinical discussion Headache was present in 54.17% of patients. All the patients underwent MRI examinations utilizing different sequences, with subsequent Gadolinium injection showing localized and asymmetrical meningeal thickening in 13cases,and diffuse in the rest. The cerebrospinal fluid study unveiled an inflammatory fluid characterized by a lymphocytic predominance and hyperproteinorrhea, noted in 50% of the patients. The histopathological analysis of a stereotactic biopsyconductedon an individual patient revealed non-diagnostic results. The etiological investigationwas dominatedby tuberculosis, which was detectedin 33.3% of cases.Idiopathic origin was identifiedin 16.7% of patients. Conclusion Meningeal thickening is rare, and the multitude of potential causes makes the etiological investigation challenging unless they fall within the scope of secondary meningeal disorders; otherwise, a dural biopsy becomes necessary, and the prompt initiation of treatment, along with determining the etiology influences the prognosis.

Unrecognized bone fractures of the extremities in Emergency Radiology: the invisible become visible on 3D 80 micron

PurposeIn the last few years CBCT’s applications have expanded, especially in the field of musculoskeletal. In this study, we aim to analyze the diagnostic value and the use of CBCT in Emergency Radiology for the evaluation of extremity trauma.MethodsThe present retrospective study included a total of 72 distal limb trauma cases who were admitted in the Emergency Radiology Department of “Policlinico Riuniti di Foggia” during September 2022 to December 2023. All the cases required further medical diagnostic investigation after an initial examination CR. Among these, 12 were excluded for suspected poly-traumas and MDCT was directly performed. Of the 60, divided into 2 groups, 42 had negative or non-diagnostic CR result, and CBCT was performed as second-level exam, 18 with a fracture confirmed by CR underwent CBCT for surgical planning.ResultsIn the first group, 17 (40.5%) had negative CR results, and 25 (59.5%) had doubtful/non-diagnostic CR results. 25 (59.5%) presented a positive CBCT exam for fracture. In the second group, anyone required further diagnostic investigations for orthopedic surgery.ConclusionsThanks to high spatial resolution, low radiation dose, fast acquisition, and its three-dimensionality in space (3D), CBCT could be the first investigation in the cases of fractures clinically suspicious in locations with bone overlap.

Thyroid core-needle biopsy. first experience in romania. 281 cases with only 1% non-diagnostic results

Thyroid core-needle biopsy. first experience in romania. 281 cases with only 1% non-diagnostic results

Repetition of thyroid fine-needle aspiration cytology after an initial nondiagnostic result: Is there an optimal timing?

IntroductionIt is suggested to wait at least 3 months to repeat a fine needle aspiration cytology (FNAC) to avoid possible inflammatory cytological changes induced by a previous procedure. This study evaluated the influence of the interval between 2 FNACs in a cohort with a previous non-diagnostic (ND) FNAC. We analysed the occurrence of ND or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) results in the second FNAC, based on the intervals between procedures. Patients and methodsRetrospective study (2017–2020) including thyroid nodules with a ND result, subjected to another FNAC. Demographic, clinical and echographic data, interval between FNACs and their results were collected. We considered the intervals: ≤/>3 months and ≤/>6 months. Second FNAC results were classified as ND, AUS/FLUS or diagnostic (including the other Bethesda categories). ResultsIncluded 190 nodules (190 patients – 82.1% women, mean age 60±13.7 years) with a first ND FNAC. The second FNAC results were: ND in 63 cases, AUS/FLUS in 9 and diagnostic in 118 cases. There were no statistical differences in FNAC results performed≤3 months (13 ND, 2 AUS/FLUS, 19 diagnostic) vs >3 months (50 ND, 7 AUS/FLUS, 99 diagnostic; p=0.71). Similarly, there were no statistical differences considering a longer time interval: ≤6 months (32 ND, 3 AUS/FLUS, 59 diagnostic) vs >6 months (31 ND, 6 AUS/FLUS, 59 diagnostic; p=0.61). ConclusionsTime interval between FNACs was not relevant to the final cytological result. Early FNAC repetition did not increase the cases of ND or AUS/FLUS.

КЛИНИЧЕСКИЙ СЛУЧАЙ УСПЕШНОГО 120-ДНЕВНОГО КОМПЛЕКСНОГО ЛЕЧЕНИЯ ИНФЕКЦИОННОГО ЭНДОКАРДИТА МИКСОМАТОЗНО-ИЗМЕНЕННОГО МИТРАЛЬНОГО КЛАПАНА, ОСЛОЖНЕННОГО КАРДИОГЕННЫМ И СЕПТИЧЕСКИМ ШОКОМ С ПОЛИОРГАННОЙ НЕДОСТАТОЧНОСТЬЮ

Annotation. Estimated incidence of infectious endocarditis (IE) is 13.8 cases per 100.000 subjects per year while mortality as high as 0.87 death cases per 100.000 patients demonstrating upstroke trend in majority countries in the world over past 30 years. Imaging positive for IE is among major diagnostic criteria of which transthoracic echocardiography is recommended as the first-line imaging modality in suspected IE. Negative, non-diagnostic or inconclusive results of echocardiography make diagnosis of IE challenging followed by treatment delays and poor outcomes. Within current clinical case we discuss the experience of diagnosis and successful treatment of IE of mitral valve with mixomatous degeneration and rupture of chordae tendineae that challenged vegetations detection and delayed surgical treatment followed by development of complications as cardiogenic and septic shock with multiple organ failure.

Retrospective Analysis of the Outcomes of Genetic Testing in Patients Suspected to Have Hereditary Hearing Loss or Deafness.

Uncorrected hearing loss can result in detrimental sequelae. Research addressing clinical presentation and genetic testing would inform clinical decision making. A retrospective chart review of 96 patients aged 1 month to 46 years (median age = 6 years) diagnosed with hearing loss or deafness and who underwent genetic testing at University of Rochester Medical Center from 2011 to 2021. Chi-square and Fisher's exact tests examined the relationship between a diagnostic positive genetic test result and various characteristics of hearing loss, including congenital (n = 52), noncongenital (n = 34), prelingual (n = 53), postlingual (n = 33), progressive (n = 13), not progressive (n = 47), bilateral (n = 67), unilateral (n = 26), sensorineural (n = 68), conductive (n = 14), mixed (n = 5), syndromic (n = 10), and nonsyndromic (n = 87) hearing loss. We also examined the number of patients with presence of developmental disabilities (n = 35), having a first-degree relative with hearing loss (n = 19), having hearing aids or cochlear implants (n = 45), and having a multisystem presentation prior to diagnosis (n = 45). Patients with sensorineural hearing loss (44.1%) had significantly more diagnostic positive results than those with mixed (0%) or conductive hearing loss (21.4%), p = .004. However, significantly fewer patients with disabilities (19.4%) had diagnostic positive tests than those without disabilities (43.3%), p < .05. More patients with a multisystem presentation were also found to have syndromic causes of hearing loss (23.3%) than patients who did not have a multisystem presentation, p < .05. Our study suggests a significant association between sensorineural type of hearing loss and a diagnostic positive genetic test result, while the presence of disabilities was significantly associated with a nondiagnostic genetic test result. Knowledge of these findings is critical for understanding the cause of the hearing loss, identifying other associated symptoms, and determining risk to family members.