Biopsy Pathology Research Articles

The rare phenomenon of glomerulonephritis presentation in extra-nodal marginal zone lymphoma: summary of two cases and review of the literature.

Paraneoplastic glomerulonephritis (GN) has been reported in non-Hodgkin lymphoma (NHL), Hodgkin Lymphoma (HL), and chronic lymphocytic leukemia (CLL). Despite descriptions in NHL, very few reports have been documented in marginal zone lymphoma (MZL). In this article, we review the literature of currently known cases of MZL-associated GN and we detail two cases of patients with extra-nodal MZL (EMZL) who both presented with renal failure, fluid overload, and proteinuria which were attributed to GN after a renal biopsy. We discuss the pathology of each renal biopsy in depth and how the diagnosis of GN was made, along with potential mechanisms of how EMZL led to GN. We also discuss the treatments each patient received and whether this led to the resolution of their GN. Both cases highlight the importance of maintaining a high index of suspicion for this paraneoplastic syndrome when patients present with signs or symptoms of renal failure, proteinuria or hematuria, or potential renal involvement on imaging. In these cases, a renal biopsy should be pursued to confirm the diagnosis, and treatment should be tailored accordingly.

Correlation of clinically significant prostate cancer sites across multiparametric MRI, prostate biopsy, and whole-mount pathology for optimal prostate biopsy strategy

Data from patients with suspicious lesions on multiparametric magnetic resonance (mpMRI) and a diagnosis of clinically significant prostate cancer (csPCa) who underwent radical prostatectomy (RP) were collected. The aim was to compare csPCa sites identified through whole-mount pathological analysis (WMA) after RP with PI-RADS ≥ 3 lesions identified on mpMRI, and with csPCa foci detected through targeted-biopsy (TB) or combined targeted + systematic biopsy (TSB). A paired Student’s t-test and Pearson correlation analysis were performed to evaluate the agreement between these diagnostic methods. A total of 106 patients were included in the TSB group and 95 in the TB group. The correlation between mpMRI, PB, and WMA was moderate and comparable in both groups. No correlation between PB and WMA was found in the TB group for PI-RADS3 lesions, while a moderate-strong correlation was observed when comparing mpMRI, PB, and WMA for PI-RADS > 3 lesions. About 50% of csPCa sites remained undetected by mpMRI. TSB was able to identify 16.5% more csPCa sites than TB. mpMRI is an accurate method in the diagnosis of PCa, especially for PI-RADS > 3 lesions, although some csPCa sites remained undetected. The use of TSB improved the location agreement between PB and WMA, increasing detection rates up to 79%.

Functional analysis of heterozygous variants in the SALL1 gene in 2 children with Townes-Brocks syndrome with FSGS

BackgroundTo investigate the functional characteristics of heterozygous variants in the SALL1 gene in two children with Townes-Brocks syndrome (TBS), as well as the underlying mechanisms leading to chronic kidney disease.MethodsWe retrospectively analyzed the clinical manifestations, laboratory findings, and genetic backgrounds of two TBS patients admitted to our hospital presenting with chronic kidney disease stage 2 and focal segmental glomerulosclerosis (FSGS). The genetic function was investigated through cultured cells transfected with variants. The Sall1 protein expression level was detected by western blotting. Immunofluorescence was also employed to detect the subcellular localization of SALL1.ResultsNovel heterozygous genetic variations (c.3175 C > T and c.694 C > T) were detected in two respective probands with distinct clinical presentations: Proband 1 presented with polydactyly, nephrotic syndrome, and stage 2 chronic kidney disease; while Proband 2 manifested renal dysplasia, progressive proteinuria, and also stage 2 chronic kidney disease. FSGS was confirmed by kidney biopsies from both probands. To assess the functional impact of these variations, we introduced mutant plasmids carrying the c.3175 C > T and c.694 C > T variants into podocytes. The expression level of variant c.3175 C > T(p.Q1059X) in podocytes showed a significant decrease compared to that of the wild-type (P < 0.05), whereas variant c.694 C > T(p.Q232X) was markedly upregulated (P < 0.01). Immunofluorescence analysis revealed aberrant localization patterns for both SALL1 variants within podocytes.ConclusionsTwo patients with Townes-Brocks syndrome (TBS) harboring novel variants presented atypical phenotypes, characterized primarily by significant and rapidly progressing renal involvement. Rare renal biopsy pathology revealed the presence of focal segmental glomerulosclerosis (FSGS) in both cases. Experimental validation demonstrated that both variants led to alterations in the molecular size, expression level, and localization of the Sall1 protein, suggesting that these SALL1 gene variants might contribute to FSGS by impacting podocyte function.

Methylation of SOX1 and PAX1 Are Risk Factors and Potential Biomarkers for Cervical Lesions.

The correlation between methylation of paired box gene 1 (PAX1) and sex determining region Y-box 1 (SOX1) with human papillomavirus (HPV) infection and the progression of cervical lesions is not well understood. This study aims to explore the potential value of PAX1 and SOX1 as diagnostic biomarkers for cervical diseases. A total of 139 cervical biopsy tissue samples were obtained from the Department of Pathology, the Seventh Medical Center, Chinese PLA General Hospital from 2021 to 2023. The samples include 32 cases of chronic cervicitis (inflammation group), 30 cases of low-grade squamous intraepithelial lesions (LSIL group), 50 cases of high-grade squamous intraepithelial lesions (HSIL group), and 27 cases of cervical squamous cell carcinoma (CSCC group). DNA was extracted from paraffin-embedded tissues, and the levels of HPV infection and methylation of PAX1 and SOX1 were detected. The methylation index (M-index) of PAX1 and SOX1 in the HSIL and CSCC groups is significantly higher than in the inflammation group (both P < 0.0001), with no significant difference between the LSIL and inflammation groups. There is no significant difference in the positive PAX1 and SOX1 methylation rate with HPV infection and age. The positive rates of PAX1 methylation in the inflammation, LSIL, HSIL, and CSCC groups were 3.13%, 10.00%, 44.00%, and 88.89%, respectively. The positive rates of SOX1 methylation were 3.13%, 10.00%, 40.00%, and 77.78%, respectively, and increasing with the progression of cervical lesions (R2 = 0.9189/R2 = 0.9279, P < 0.0001/P < 0.0001). Comparing LSIL, HSIL, and CSCC with the inflammation group and using cervical biopsy pathology diagnosis as the gold standard, methylation of PAX1 and SOX1 is a risk factor for HSIL and CSCC, with odds ratio (OR) values significantly increasing as lesions progress. The sensitivity of PAX1 and SOX1 methylation to cervical lesions increases with the progression of the lesions. Methylation of SOX1 and PAX1 is not associated with HPV infection. The positive rate of methylation for SOX1 and PAX1 is positively correlated with cervical lesions, which can serve as potential biomarkers for HSIL and CSCC. They are risk factors and potential screening indicators for HSIL and above cervical lesions.

Castleman disease misdiagnosed as immunoglobulin G4-related disease: a case report

Castleman disease (CD) and immunoglobulin G4-related disease (IgG4-RD) are rare systemic immune-mediated disorders that share overlapping clinical features, posing significant challenges in differential diagnosis. Here, we present a case of generalized lymphadenopathy initially misdiagnosed as IgG4-RD, which demonstrated a poor response to hormonal therapy. Subsequent pathological biopsy and immunohistochemical analysis ultimately confirmed the diagnosis of CD. This case underscores the limitations of relying solely on serum IgG4 levels as a diagnostic marker to distinguish CD from IgG4-RD. Comprehensive evaluation, including clinical presentation, organ involvement, serological and pathological findings, as well as therapeutic response, is essential to ensure accurate diagnosis and timely management.

An Artificial Intelligence Model Using Diffusion Basis Spectrum Imaging Metrics Accurately Predicts Clinically Significant Prostate Cancer.

Conventional prostate magnetic resonance imaging has limited accuracy for clinically significant prostate cancer (csPCa). We performed diffusion basis spectrum imaging (DBSI) prior to biopsy and applied artificial intelligence models to these DBSI metrics to predict csPCa. Between February 2020 and March 2024, 241 patients underwent prostate MRI that included conventional and DBSI-specific sequences prior to prostate biopsy. We used artificial intelligence models with DBSI-metrics as input classifiers and the biopsy pathology as the ground truth. The DBSI-based model was compared with available biomarkers (PSA, PSA density, and PI-RADS) for risk discrimination of csPCa defined as Gleason score >7. The DBSI-based model was an independent predictor of csPCa (OR 2.04, 95%CI 1.52-2.73, p<0.01), as were PSA density (OR 2.02, 95%CI 1.21-3.35, p=0.01) and PI-RADS classification (OR 4.00, 95%CI 1.37-11.6 for PI-RADS 3, p=0.01; OR 9.67, 95%CI 2.89-32.7, for PI-RADS 4-5, p<0.01), adjusting for age, family history, and race. Within our dataset, the DBSI-based model alone performed similarly to PSA density + PI-RADS (AUC 0.863 vs. 0.859, p=0.89), while the combination of the DBSI-based model + PI-RADS had the highest risk discrimination for csPCa (AUC 0.894, p<0.01). A clinical strategy using the DBSI-based model for patients with PI-RADS 1-3 could have reduced biopsies by 27% while missing 2% of csPCa (compared to biopsy for all). Our DBSI-based artificial intelligence model accurately predicted csPCa on biopsy and can be combined with PI-RADS to potentially reduce unnecessary prostate biopsies.

Clinical and imaging characteristics of 135 cases of infectious sacroiliitis: a retrospective cohort study in China.

To study the clinical, imaging, and computed tomography (CT)-guided biopsy pathology of patients with infectious sacroiliitis (ISI). We retrospectively analysed 135 patients diagnosed with ISI between 2008 and 2020, comprehensively evaluating clinical characteristics, laboratory test outcomes, pathological examination results, and magnetic resonance images (MRI). Among the 135 patients with ISI, 90 (66.7%) were diagnosed with pyogenic sacroiliitis (PSI), 28 (20.7%) with tuberculous sacroiliitis (TSI), and 17 (12.6%) with brucella infectious sacroiliitis (BSI); 69 (51.1%) met the 2009 ASAS criteria for axial spondyloarthritis. The rate of back pain is lower in the PSI group (18.9%) than in the TSI (39.2%) and BSI (64.7%) groups. The Berlin MRI scoring in the sacroiliac joint showed erosion and bone marrow oedema in the PSI (3.11 ± 2.33, 8.55 ± 2.66) and TSI (3.14 ± 2.08, 7.88 ± 3.90) groups, with higher values than in the BSI group (1.62 ± 1.54, 5.23 ± 3.05). The erythrocyte sedimentation rate (ESR) was higher in the PSI (52.71 ± 29.63mm/h) and TSI (56.22 ± 19.39mm/h) groups than in the BSI group (33.29 ± 25.12mm/h). Our study is crucial because all patients underwent CT-guided sacroiliac joint biopsy; 130 patients (86.7%) had positive results through tissue culture and pathological examination, and one (0.8%) had a confirmed Malassezia fungal infection by tissue next generation sequencing. Two patients (1.5%) were diagnosed through blood culture, and another (0.8%) was diagnosed through the brucellosis agglutination test. ISI is diagnostically challenging as it can mimic spondyloarthritis, particularly when relying exclusively on imaging and clinical parameters. CT-guided sacroiliac joint biopsy is indispensable as a diagnostic intervention for precisely differentiating infectious sacroiliitis and identifying the specific pathogens involved, especially in female patients who exhibit negative HLA-B27 status and manifest systemic symptoms such as fever, elevated ESR, and unilateral lesions on imaging. Key Points • To the best of our knowledge, this is the largest single-centre cohort study on infectious sacroiliitis in China. • CT-guided biopsy of the sacroiliac joint is necessary for identifying infectious sacroiliitis and pathogens. • This study provides insights into the clinical and imaging features of infectious sacroiliitis based on a large number of cases.

Bridging the gap: Evaluating ChatGPT-generated, personalized, patient-centered prostate biopsy reports.

The highly specialized language used in prostate biopsy pathology reports coupled with low rates of health literacy leave some patients unable to comprehend their medical information. Patients' use of online search engines can lead to misinterpretation of results and emotional distress. Artificial intelligence (AI) tools such as ChatGPT (OpenAI) could simplify complex texts and help patients. This study evaluates patient-centered prostate biopsy reports generated by ChatGPT. Thirty-five self-generated prostate biopsy reports were synthesized using National Comprehensive Cancer Network guidelines. Each report was entered into ChatGPT, version 4, with the same instructions, and the explanations were evaluated by 5 urologists and 5 pathologists. Respondents rated the AI-generated reports as mostly accurate and complete. All but 1 report was rated complete and grammatically correct by the majority of physicians. Pathologists did not rate any reports as having severe potential for harm, but 1 or more urologists rated severe concern in 20% of the reports. For 80% of the reports, all 5 pathologists felt comfortable sharing them with a patient or another clinician, but all 5 urologists reached the same consensus for only 40% of reports. Although every report required edits, all physicians agreed that they could modify the ChatGPT report faster than they could write an original report. ChatGPT can save physicians substantial time by generating patient-centered reports appropriate for patient and physician audiences with low potential to cause harm. Surveyed physicians have confidence in the overall utility of ChatGPT, supporting further investigation of how AI could be integrated into physicians' workflows.

Evaluating the feasibility of AI-predicted bpMRI image features for predicting prostate cancer aggressiveness: a multi-center study

ObjectiveTo evaluate the feasibility of utilizing artificial intelligence (AI)-predicted biparametric MRI (bpMRI) image features for predicting the aggressiveness of prostate cancer (PCa).Materials and methodsA total of 878 PCa patients from 4 hospitals were retrospectively collected, all of whom had pathological results after radical prostatectomy (RP). A pre-trained AI algorithm was used to select suspected PCa lesions and extract lesion features for model development. The study evaluated five prediction methods, including (1) A clinical-imaging model of clinical features and image features of suspected PCa lesions selected by AI algorithm, (2) the PIRADS category, (3) a conventional radiomics model, (4) a deep-learning bases radiomics model, and (5) biopsy pathology.ResultsIn the externally validated dataset, the deep learning-based radiomics model showed the highest area under the curve (AUC 0.700 to 0.791). It exceeded the clinical-imaging model (AUC 0.597 to 0.718), conventional radiomic model (AUC 0.566 to 0.632), PIRADS score (AUC 0.554 to 0.613), and biopsy pathology (AUC 0.537 to 0.578). The AUC predicted by the model did not show a statistically significant difference among the three externally verified hospitals (p > 0.05).ConclusionDeep-learning radiomics models utilizing AI-extracted image features from bpMRI images can potentially be used to predict PCa aggressiveness, demonstrating a generalized ability for external validation.Critical relevance statementPredicting the aggressiveness of prostate cancer (PCa) is important for formulating the best treatment plan for patients. The radiomic model based on deep learning is expected to provide an objective and non-invasive method for evaluating the aggressiveness of PCa.Key PointsPredicting the aggressiveness of PCa is important for patients to obtain the best treatment options.The deep learning-based radiomics model can predict the aggressiveness of PCa with high accuracy.The model has good universality when tested on multiple external datasets.Graphical

Concordance with final pathology when transitioning from standard transrectal to cognitive targeted transperineal prostate biopsy.

Transrectal (TR) prostate biopsy is being increasingly abandoned in favour of a transperineal (TP) approach as well as a targeted biopsy only of the index lesion(s). It remains underreported how these changes could impact concordance at final pathology. We aimed to evaluate the impact of transitioning from standard transrectal (sTR) to cognitive targeted transperineal (cog-tTP) biopsy on final pathology including concordance and upgrading. Analysis of consecutive patients undergoing prostate biopsy and prostatectomy (RP) between January 2018 and May 2022 at a tertiary centre in Western Norway. There were 210 and 239 patients in the sTR and cog-tTP groups, respectively. The mean [IQR] number of biopsies decreased from 12 [4-12] to 3 [3-4] (p< 0.001). The overall rate of concordance between biopsy and final pathology was 64% in both groups (Table 3, Figure 1). 24% Twenty-four per cent (cog-tTP) versus 19% (sTR) had grade group (GG) upgrading, while 12% versus 17% were downgraded (p= 0.2). Regarding positive surgical margins (PSMs) that were >3 mm in extension, there were only 3.3% and 2.1% in the sTR and cog-tTP groups, respectively (p= 0.4). For surgical outcomes associated with RP, no differences in terms of postoperative complications between the groups were found (cog-tTP:10% vs. sTR:6%, p= 0.10). Transitioning from sTR biopsy to targeted cog-tTP biopsy does not compromise concordance at final pathology nor does it increase the risk of tumour upgrading.

Paraspinal synovial sarcoma mimicking tuberculosis: A case report and literature review.

Synovial sarcoma (SS) is a rare and highly malignant soft tissue sarcoma. When SS occurs in atypical locations, it can present significant diagnostic challenges. We report a case of paraspinal SS initially misdiagnosed as spinal tuberculosis, highlighting the diagnostic difficulties and the importance of considering SS in the differential diagnosis. A 23-year-old woman presented with progressively worsening lower left back pain over 3 weeks, accompanied by weakness and numbness in her left lower limb. She was initially misdiagnosed with spinal tuberculosis at 2 different hospitals based on weakly positive anti-tuberculosis antibodies and imaging findings. Despite ongoing anti-tuberculosis treatment, her condition continued to deteriorate. The first surgery revealed findings inconsistent with spinal tuberculosis, but a tumor could not be excluded. However, the initial pathological biopsy was inconclusive. A second surgery confirmed the diagnosis of SS through histopathological examination. The patient underwent a second surgery for mass resection and biopsy confirmation. Unfortunately, by the time the correct diagnosis was made, the disease had metastasized to her lungs, and the optimal window for surgical intervention had been missed. The patient's delayed diagnosis resulted in extensive diffuse metastasis to both lungs, significantly impacting her survival. This case underscores the need to consider malignancies such as SS in the differential diagnosis of spinal lesions, particularly when clinical response to treatment is poor. Early diagnosis and timely surgical intervention are critical to improving patient outcomes. Our literature review provides further insights into the characteristics of paraspinal SS and strategies to prevent misdiagnosis, emphasizing the importance of early and accurate diagnosis to enhance patient survival.

A Retrospective Study of Laparoscopic Distal Gastrectomy Guided by Carbon Nanoparticle Suspension Injection Lymphography for Gastric Cancer

Background The use of lymph node (LN) tracers can help obtain a complete dissection of the LNs and increase the detection rate of metastatic LNs. Carbon nanoparticle suspension injection (CNSI) has become increasingly used in radical gastrectomy procedures. This study is designed to evaluate the quality of LN dissection in gastric cancer patients with laparoscopic distal gastrectomy under the guidance of CNSI lymphography. Method This was a retrospective cohort study including patients with a pathological biopsy diagnosis of resectable gastric cancer who underwent laparoscopic distal gastrectomy. Data was focused on patients at [Renji Hospital of Shanghai Jiaotong University] from July 2023 to January 2024. Patients were divided into the CNSI group and control group after 1:1 propensity score matching analysis. The median number of LNs harvested was compared between groups. Perioperative status and any complications that arose within 30 days were also analyzed. Result After 1:1 propensity matching analysis, there were 49 patients each in the CNSI group and control group. The median number of harvested LNs was larger in the CNSI group than the control group ( P = 0.01). A significant difference between 2 groups was observed in surgery time ( P = 0.008). The morbidity of any short-term postoperative complications within 30 days after surgery revealed a similar outcome ( P &gt; 0.05). Discussion CNSI-guided laparoscopic distal gastrectomy is less time-consuming and harvests more LNs. For laparoscopic distal gastrectomy, CNSI-guided lymphography can be an excellent adjuvant.

Using multimodal ultrasound technology to improve the success rate of liver tumor puncture for lesions with poor visibility on conventional ultrasound imaging.

The ability of conventional ultrasound (US)-guided liver biopsy to visualize certain liver lesions, particularly those affected by conditions like hepatitis or cirrhosis, which can obscure lesion boundaries and lead to inaccurate biopsy targeting, is limited. This study aimed to evaluate the potential of multimodal US techniques to improve the visibility of liver lesions that are indistinct under conventional US, and to enhance the success rate of percutaneous biopsies. In total, 144 patients with liver masses and lesions that were not clearly visible on conventional US from October 2018 to January 2024 were enrolled in this retrospective analysis. The lesions of these patients exhibited poor visibility on conventional US, but the tumor location was visible on abdominal computerized tomography (CT) or magnetic resonance (MR) imaging scans. After excluding patients who did not undergo biopsy or patients with lesions that were remained not clearly visible on multimodal US examinations. Ultimately, a total of 95 patients were enrolled in this study. We analyzed the clinical and imaging data for all these patients. CT/MR-US fusion imaging was performed in 55 patients, contrast-enhanced ultrasound (CEUS) was performed in 95 patients, and high-frequency US was performed in 21 patients. The visibility of the lesions using these three techniques was evaluated, and the consistency between the biopsy pathology and the final diagnosis was analyzed. In the study, the detection rates of lesions using CT/MR-US fusion imaging, CEUS, and high-frequency US were 49.1%, 96.8%, and 76.2%, respectively. After confirming the target location of the lesions, all patients underwent percutaneous US-guided biopsy. The accuracy rate of the biopsies was 91.6%, and the positive concordance rate was 91.1%. Among the 13 patients with negative pathology findings after biopsy, 8 had false-negative results (based on follow-up laboratory tests and imaging results consistent with malignant tumor characteristics), resulting in a false-negative rate of 8.9%. Multimodal US significantly improved the success of biopsies for liver lesions not clearly visible on conventional US, aiding in precise treatment planning.

Advancing the clinical assessment of glomerular podocyte pathology in kidney biopsies via super-resolution microscopy and angiopoietin-like 4 staining.

Rationale: The tertiary structure of normal podocytes prevents protein from leaking into the urine. However, observing the complexity of podocytes is challenging because of the scale differences in their three-dimensional structure and the close proximity between neighboring cells in space. In this study, we explored podocyte-secreted angiopoietin-like 4 (ANGPTL4) as a potential morphological marker via super-resolution microscopy (SRM). Methods and Results: Specimens from patients with minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), and membranous nephropathy (MN), along with normal controls, were analyzed via immunofluorescence and immunohistochemistry to determine the expression and localization of ANGPTL4, confirming its extensive presence in podocytes across both healthy and diseased conditions. Immunoelectron microscopy revealed that ANGPTL4 is distributed throughout the podocyte cell body, primary processes, and foot processes. Compared with conventional podocyte markers such as nephrin and synaptopodin, ANGPTL4 excels in depicting the three-dimensional structure of podocytes via SRM imaging. We then refined a protocol using tyramide signal amplification staining and confocal microscopy to uniformly enhance podocyte fluorescence, facilitating the clinical assessment of biopsies. In patients diagnosed with MCD and FSGS, measurements of slit diaphragm density, primary process width, and foot process width were taken after further co-staining with nephrin to identify patterns of podocyte morphological alterations. Distinctive patterns of foot process effacement were identified in MCD and FSGS patients, with FSGS patients showing more pronounced podocyte injury. Conclusions: ANGPTL4 serves as a reliable morphological marker for podocyte analysis, offering enhanced visualization of their three-dimensional structure and facilitating the identification of distinct pathological changes in nephrotic syndrome patients.

SELENON-related myopathy with scoliosis and respiratory failure since early childhood diagnosed through reassessment during pediatric-to-adult healthcare transition: a case report

The patient was a 33-year-old woman with no family history of a similar disorder. At one year of age, she exhibited scoliosis and respiratory failure, necessitating a tracheostomy performed at 5 years of age (1990s). During that time, the patient was provisionally diagnosed with "non-Fukuyama congenital muscular dystrophy" via muscle biopsy. Difficulties in independent walking and standing emerged by 14 years of age, progressing to significant mobility challenges by 21 years of age. The patient was referred to our department at 33 years of age for the transition to adult care. The examination revealed predominant trunk muscle weakness, persistent scoliosis, restricted neck and trunk mobility, significant restrictive ventilatory impairment, and mild intellectual developmental delay. Reanalysis of the muscle biopsy pathology was conducted, and genetic testing identified a known homozygous mutation, c.1574T>G (p.M525R), in the SELENON (SEPN1) gene, leading to a diagnosis of SELENON-related myopathy. The pediatric-to-adult healthcare transition can provide a valuable opportunity for the reassessment of diagnoses and disabilities.

Artificial intelligence in pancreaticobiliary endoscopy: Current applications and future directions.

Pancreaticobiliary endoscopy is an essential tool for diagnosing and treating pancreaticobiliary diseases. However, it does not fully meet clinical needs, which presents challenges such as significant difficulty in operation and risks of missed diagnosis or misdiagnosis. In recent years, artificial intelligence (AI) has enhanced the diagnostic and treatment efficiency and quality of pancreaticobiliary endoscopy. Diagnosis and differential diagnosis based on endoscopic ultrasound (EUS) images, pathology of EUS-guided fine-needle aspiration or biopsy, need for endoscopic retrograde cholangiopancreatography (ERCP) and assessment of operational difficulty, postoperative complications and prediction of patient prognosis, and real-time procedure guidance. This review provides an overview of AI applications in pancreaticobiliary endoscopy and proposes future development directions in aspects such as data quality and algorithmic interpretability, aiming to provide new insights for the integration of AI technology with pancreaticobiliary endoscopy.

A Clinical Prediction Model for Pathologic Upgrade to Invasive Carcinoma Following Conization of Cervical High-Grade Squamous Intraepithelial Lesions.

To explore the risk factors associated with the pathological progression to invasive carcinoma following the conization of cervical high-grade squamous intraepithelial lesions (HSIL) and to construct a risk prediction model to guide preoperative risk assessment and optimize the selection of surgical approaches. A retrospective analysis was conducted on the clinical data of 3337 patients who underwent cervical conization for HSIL at Hunan Provincial Maternal and Child Health Care Hospital from December 2016 to March 2022. The patients were categorized into the pathological progression group (398 cases) and the nonprogression group (2939 cases) based on postconization pathology results. Statistical significance factors were selected by least absolute shrinkage and selection operator regression and then multivariate logistic regression was utilized to build predictive models, which were presented as a nomogram and evaluated for discriminability, calibration, and decision curves. The Bootstrap method was utilized for internal validation. A total of 277 patients were enrolled from April 2022 to October 2022 for external validation. The percentage of pathologic upgrades to invasive carcinoma following cervical conization was 11.9%. The predictive model included age, contact bleeding symptoms, HPV16/18 infection, HSIL cytology, cervical biopsy pathology diagnosis level, suspicious stromal infiltration in the biopsy pathology diagnosis, and endocervical curettage HSIL. The model demonstrated good overall discrimination in predicting the risk of HSIL progression to early invasive cancer, and internal validation confirmed its reliability (C-index = 0.787). Area under the curve analysis indicated good model discriminability across external datasets. The decision curve analysis also suggested that this model is clinically useful. We developed and validated a nomogram incorporating multiple clinically relevant variables to better identify cases of HSIL progressing to early cervical cancer, providing a basis for individualized treatment and surgical approach selection.

General Versus Interventional Gastroenterologists: A Comparative Analysis of Follow-Up Outcomes After Endoscopic Mucosal Resection of Colorectal Polyps.

Introduction Colorectal cancer (CRC) represents a major global health burden, significantly impacting mortality rates and healthcare systems worldwide. CRC screening through colonoscopy enables early detection and removal of precancerous polyps. While standard polypectomy suffices for small polyps, larger ones require endoscopic mucosal resection (EMR). Though post-EMR surveillance is crucial for preventing recurrence, it remains unclear whether follow-up by general gastroenterologists yields comparable outcomes to surveillance by interventional specialists. This distinction carries significant implications for resource allocation, particularly given the limited availability of interventional gastroenterologists whose expertise is needed for other complex procedures. Our study examines this unexplored question by comparing post-EMR surveillance outcomes between these provider groups. Methods We conducted a retrospective study at the Saint Louis Veterans Affairs (VA) Health Care System of patients presenting for follow-up of colorectal polyp EMR between January 2019 and December 2022. Pre-defined variables extracted from the electronic medical record system were then analyzed to discern significant differences between general and interventional gastroenterologists' outcomes. The primary outcome includes the rate of biopsy of scars after EMR between both groups. Additional outcomes include the number of polyps detected, detection of residual tissue at the EMR site, EMR site recurrence requiring polypectomy and mode of polypectomy, recommended surveillance interval suggested by the endoscopist, and the pathology of the EMR site biopsy. Results A total of 59 (N = 59) patients (median age: 67, mean age: 66.5 ± 6.6 years) met the inclusion criteria of our study. General gastroenterologists were more likely to biopsy the EMR site compared to interventional gastroenterologists (65% vs. 40%, p = 0.047). There was no difference in overall pathology detected when comparing general and interventional gastroenterologists (p = 0.074). While no EMR site biopsies were obtained in 16 patients (27.1%), there were no differences in the pathology of patients undergoing biopsy of the scar. Additionally, no significant differences were found in the Boston Bowel Preparation Score, number of polyps detected, detection of residual tissue at the EMR site, EMR site recurrence requiring polypectomy, or recommended surveillance interval. Conclusion Our study provides evidence that the outcomes of post-EMR follow-up are largely comparable between general and interventional gastroenterologists. Although general gastroenterologists exhibit higher rates of EMR site biopsy, the associated pathology shows no significant difference.

Integration of Genomic Tests in Prostate Cancer Care: Implications for Clinical Practice and Patient Outcomes.

Prostate cancer (PCa) is a common malignancy in men and is among the leading causes of cancer-related death worldwide. Genomic tests assess disease aggressiveness and guide treatment, particularly in low- and intermediate-risk PCa. We reviewed the literature on the use of four genomic tests (Prolaris®, Promark®, Oncotype DX®, and Decipher®) in assessing the prognosis of PCa and their use in treatment decision-making. Most of the studies showed that Prolaris® has a strong correlation with biochemical recurrence, metastasis risk, PCa-specific mortality (PCSM), and pathological features. Similarly, three studies on Promark® indicated a connection between results and pathological features in the subsequent prostatectomy, time to metastasis, and biochemical recurrence. Fourteen studies on Oncotype DX® showed a clear correlation between high scores, death, and PCSM. One study found that routine biopsy pathology reports, combined with serum PSA levels, provide a risk assessment comparable to Oncotype DX® testing. Results from 22 studies on Decipher® were controversial. The test was associated with conservative management, suggesting that patients with a high GC score are more likely to need radiation after surgery. Comparative studies indicated that Oncotype DX® is preferable for assessing PCSM, Decipher® for predicting metastasis, and Prolaris® for predicting recurrence. With the incidence rate of PCa dramatically increasing, genomic tests appear to be useful adjunctive precision medicine tools with significant potential in improving prognostic discrimination, facilitating better risk stratification, and guiding personalized treatment, especially in the intermediate-risk patient group. Large-scale, prospective, multi-sectional studies are required to validate the utility of these tests prior to their integration into clinical practice.

Improvement of Diagnosis by Transvaginal Ultrasound and Prognosis of Endometrial Cancer using miR-222-3p: A Prospective Cohort Study

Background: Noninvasive biomarkers need identification to enhance the diagnostic accuracy of endometrial cancer (EC) detection. The diagnostic and prognostic significance of serum miR-222-3p in EC was investigated in this study to provide a reference for clinical diagnosis and treatment. Methods: This prospective cohort study comprised 128 patients with EC and 65 patients with benign endometrial lesions (benign endometrial hyperplasia or polyps) admitted to Qionglai Medical Centre Hospital from January 2016 to December 2018. EC diagnosis was confirmed through endometrial biopsy and postoperative pathology. Serum miR-222-3p levels were quantified using the real-time reverse transcriptase-polymerase chain reaction (RT-qPCR). Pearson’s method was utilized to assess correlations between miR-222-3p and the resistance index (RI), pulsation index (PI), and mean blood flow velocity (MBFV). Diagnostic and prognostic assessments of miR-222-3p were conducted using receiver operating characteristic (ROC) curve analysis, Cox regression analysis, and Kaplan‒Meier curve analysis. Results: Serum miR-222-3p levels were higher in EC patients compared to controls and were correlated with RI, PI, and MBFV (p &lt; 0.001). Serum miR-222-3p enhanced the sensitivity (69.53% vs. 96.88%) and specificity (92.31% vs. 96.92%) of transvaginal ultrasound for EC diagnosis. Furthermore, serum miR-222-3p showed significant associations with lymph node metastasis (p = 0.002), degree of differentiation (p = 0.023), and the International Federation of Gynecology and Obstetrics (FIGO) stage (p = 0.001) in EC patients. It also predicted poor prognosis and served as an independent prognostic predictor (p = 0.036). Conclusions: The combination of miR-222-3p with transvaginal ultrasound enhanced the diagnostic efficiency of EC. Additionally, miR-222-3p holds promise as a biomarker for predicting the prognosis of EC patients.