Postoperative Pathological Features Research Articles

The clinical, radiological, postoperative pathological, and genetic features of nodular lung adenocarcinoma: a real-world single-center data.

The preoperative differential diagnosis of nodular lung adenocarcinoma has long been a challenging issue for thoracic surgeons. This study aimed to explore differential diagnosis of nodular lung adenocarcinoma by comprehensively analyzing its clinical, computed tomography (CT) imaging, and postoperative pathological and genetic features. The clinical, CT imaging, and postoperative pathological features of different classifications of nodular lung adenocarcinoma were retrospectively analyzed through univariate and multivariate statistical methods. There were 132 patients with nodular lung adenocarcinoma enrolled. Firstly, compared with ground-glass nodular lung adenocarcinoma, solid nodular lung adenocarcinoma was more common in women [odds ratio (OR), 3.662; 95% confidence interval (CI): 1.066-12.577] and older adults (OR, 1.061; 95% CI: 1.007-1.119), and CT signs were mostly lobulation (OR, 4.957; 95% CI: 1.714-14.337) and spiculation (OR, 8.214; 95% CI: 2.740-24.621); the mean CT (CTm) value of solid nodular lung adenocarcinoma was significantly higher than that of ground-glass nodular lung adenocarcinoma, and the optimal diagnostic threshold was -267.5 Hounsfield units (HU). Secondly, the maximum diameter of nodule size (NSmax) of invasive adenocarcinoma (IAC) was significantly greater than that of minimally IAC (MIA; OR, 6.306; 95% CI: 1.191-33.400) or atypical adenomatous hyperplasia (AAH)/adenocarcinoma in situ (AIS; OR, 189.539; 95% CI: 4.720-7,610.476), and the optimal diagnostic threshold between IAC and MIA was 1.35 cm; the CTm value of IAC was significantly higher than that of MIA, and the optimal diagnostic threshold was -460.75 HU. Thirdly, lepidic-predominant adenocarcinoma (LPA) manifest more commonly as pure ground-glass nodule (pGGN; OR, 6.252; 95% CI: 1.429-27.358) or mixed ground-glass nodule (mGGN; OR, 4.224; 95% CI: 1.223-14.585). Moreover, the mutation rate of epidermal growth factor receptor (EGFR) in IAC was 70.69% (41/58). The EGFR mutation rates of mGGNs (OR, 8.794; 95% CI: 1.489-51.933) and solid nodules (SNs; OR, 12.912; 95% CI: 1.597-104.383) were significantly higher than that of pGGNs. Furthermore, compared with those of micropapillary-predominant adenocarcinoma (MPA), solid-predominant adenocarcinoma (SPA), or invasive mucinous adenocarcinoma (IMA), there were significantly higher EGFR mutation rates in acinar-predominant adenocarcinoma/papillary-predominant adenocarcinoma (APA/PPA; OR, 55.925; 95% CI: 4.045-773.284) and LPA (OR, 38.265; 95% CI: 2.307-634.596). Different classifications of nodular lung adenocarcinoma have their own clinicopathological and CT imaging features, and the latter is the main predictor.

Clinical features combined with ultrasound characteristics to predict TERT promoter mutations in papillary thyroid carcinoma: a single-center study over the past 5 years.

Telomerase reverse transcriptase (TERT) has been reported in papillary thyroid carcinoma (PTC). This study aimed to investigate the correlation of TERT promoter mutations with clinical and ultrasound (US) features in PTC and to develop a model to predict TERT promoter mutations. Preoperative US images, postoperative pathological features, and TERT promoter mutation information were evaluated in 365 PTC patients confirmed by surgery. Univariate and multivariate factor analyses were performed to identify risk factors for TERT promoter mutations. A predictive model was established to assess the clinical predictive value. Of the 365 patients with PTC (498 nodules), the number of those with TERT promoter mutations was 67 cases (75 nodules), and the number of those without mutations was 298 cases (423 nodules). The median age was 40 years in the wild-type group and 60 years in the mutant group. Male patients made up 35.82% of the mutant group and 22.82% of the wild-type group. Multivariate analysis revealed that the independent risk factors associated with the occurrence of TERT promoter mutation in PTC were as follows: older age (odds ratio (OR) = 1.07; p = 0.002), maximum diameter of ≥ 10 mm (OR = 3.94; p < 0.0001), unilateral (OR = 4.15; p < 0.0001), multifocal (OR = 7.69; p < 0.0001), adjacent to the thyroid capsule (OR = 1.94; p = 0.044), and accompanied by other benign nodules (OR = 1.94, p = 0.039). A predictive model was established, and the area under the curve (AUC) of the receiver operating characteristic was 0.839. TERT promoter mutations were associated with high-risk US and clinical features compared with the wild-type group. TERT promoter mutations were associated with older ages. They were also found to be multifocal, with a maximum diameter of ≥ 10 mm, unilateral, adjacent to the thyroid capsule, and accompanied by other benign nodules. The predictive model was of high diagnostic value.

Preoperative, operative, and postoperative pathological features in thyroid papillary carcinoma with and without capsule invasion

Preoperative, operative, and postoperative pathological features in thyroid papillary carcinoma with and without capsule invasion

The presence of cribriform pattern in prostate biopsy and radical prostatectomy is associated with negative postoperative pathological features.

Prostate cancer is the second most common male cancer worldwide. Its rising incidence and high overtreatment rate drive the search for new prognostic factors. Histopathological variants, such as cribriform pattern (CP), are associated with poorer oncologic outcome. The aim of this study was to assess the correlation between CP in prostate biopsy and radical prostatectomy (RP) and postoperative pathological features. In this retrospective, single-centre study we analysed the reviewed medical records of 100 men who underwent minimally invasive RP in the years 2017-2019. RP histopathological examination was performed by a single expert pathologist, and preoperative biopsies were assessed by various professionals from different referral centres. 48% of men underwent endoscopic RP with limited lymphadenectomy, whereas 52% underwent laparoscopic RP with extended lymphadenectomy. CP in biopsy was present in 6 patients: 3 in each of both groups (6.3% and 5.8%, respectively). Lymph node metastases were present in 50% and 10% of patients with and without CP in biopsy, respectively (p = 0.028). Postoperative histopathological examination revealed CP in 65%. CP in RP was associated with higher International Society of Urological Pathology (ISUP) (p < 0.001), extraprostatic extension (EPE) (p = 0.001), seminal vesicle invasion (SVI) (p = 0.001), and positive surgical margin (PSM) (p = 0.004). Thirteen (20%) of the patients with CP in the RP specimen had lymph node metastasis, and none of the patients without CP in the RP specimen had regional LN metastasis. The presence of CP in a biopsy specimen and RP is associated with negative postoperative features. Therefore, efforts should be made to increase CP reporting in biopsies because its identification could trigger a more radical surgical approach with extended lymphadenectomy.

The enrichment of the gut microbiota Lachnoclostridium is associated with the presence of intratumoral tertiary lymphoid structures in hepatocellular carcinoma.

Immunotherapies have formed an entirely new treatment paradigm for hepatocellular carcinoma (HCC). Tertiary lymphoid structure (TLS) has been associated with good response to immunotherapy in most solid tumors. Nonetheless, the role of TLS in human HCC remains controversial, and recent studies suggest that their functional heterogeneity may relate to different locations within the tumor. Exploring factors that influence the formation of TLS in HCC may provide more useful insights. However, factors affecting the presence of TLSs are still unclear. The human gut microbiota can regulate the host immune system and is associated with the efficacy of immunotherapy but, in HCC, whether the gut microbiota is related to the presence of TLS still lacks sufficient evidence. We performed pathological examinations of tumor and para-tumor tissue sections. Based on the location of TLS in tissues, all patients were divided into intratumoral TLS (It-TLS) group and desertic TLS (De-TLS) group. According to the grouping results, we statistically analyzed the clinical, biological, and pathological features; preoperative gut microbiota data; and postoperative pathological features of patients. In a retrospective study cohort of 60 cases from a single center, differential microbiota analysis showed that compared with the De-TLS group, the abundance of Lachnoclostridium, Hungatella, Blautia, Fusobacterium, and Clostridium was increased in the It-TLS group. Among them, the enrichment of Lachnoclostridium was the most significant and was unrelated to the clinical, biological, and pathological features of the patients. It can be seen that the difference in abundance levels of microbiota is related to the presence of TLS. Our findings prove the enrichment of Lachnoclostridium-dominated gut microbiota is associated with the presence of It-TLS in HCC patients.

Imaging and Pathological Features and Recurrence Causes of Cystic Meningioma

Objective: This study aims to establish preoperative imaging features, establish how they are correlating with post-operative pathological features, and discover the causes of recurrence. Results: Data on imaging procedures in the preoperative period, records of surgical operations, and reports from pathology conclusions were collected. Among 623 patients who were undergoing neurosurgery resection of intracranial meningioma, 24 cases of cystic meningioma were identified, corresponding to a world incidence of 3.8 %. The hemispheric convexity was the most frequent place of localization. The apparent diffusional coefficient was significantly lower in grade 2 and grade 3 tumors if compared to grade 1. Full resection of the cystic component was possible in 18/24 cases. Partial resection in 3/24 cases. In 2/24 cases, it was not possible to make total or partial resection, but multiple biopsies were performed from the cystic walls.

Intratumoral 99mTc-DPD Uptake on Bone Scintigraphy in a Patient With Invasive Micropapillary Breast Carcinoma: A Pathologic Review.

Invasive micropapillary carcinoma (IMPC) is a rare and aggressive subtype of breast cancer with a poorer prognosis due to high local recurrence and lymphovascular invasion. Interestingly, IMPC often does not show suspicious patterns of calcifications related to malignancy on mammography. Therefore, the lack of suspicious calcifications makes it difficult to detect breast cancer on mammography. With only nonspecific calcifications on mammography, we observed an unusual intratumoral 99mTc-DPD uptake on whole-body bone scintigraphy in an IMPC breast cancer patient during the initial staging workup, and its characteristics were compared with mammographic findings and the postoperative pathologic features.

Factors associated with resistant disease in pediatric differentiated thyroid carcinomas

Purpose: Thyroid carcinoma is the most common carcinoma that originated from endocrine tissue in pediatric patients. Pediatric thyroid carcinomas are more prone to reveal lymph node or lung metastasis and recurrence. In this study, clinical, pathological and genetic features that may be related with resistant differentiated thyroid carcinoma in pediatric patients were investigated.&#x0D; Materials and Methodsː Thirty-nine pediatric patients who were 18 years old and below and were given 131I Radioactive Iodine (RAI) therapy were included to the study. 131I RAI therapy was planned in accordance with the American Thyroid Association (ATA) Guideline. Clinical and postoperative pathological features of patients were retrospectively determined and the patients who received single or multiple RAI therapy due to resistant disease compared statistically in terms of these features. Genetic analysis was also made in the patients who received multiple therapies. &#x0D; Resultsː Thirty-one patients were female and 8 patients were male. Thirty-four patients had papillary thyroid carcinoma, 4 had follicular thyroid carcinoma and 1 had mixed papillary-oncocytic carcinoma of patients. Eight patients received multiple I-131 RAI therapy cycles due to resistant disease. Any clinical, pathological feature and genetic mutation that would indicate resistant disease was not found in these patients. &#x0D; Conclusionː Although pediatric thyroid carcinoma is rarely seen, it has an increasing incidence in recent years. We were not able to reveal any feature related to resistant disease in our limited group. Clinical, pathological and genetic characteristics related to poor prognosis must be investigated with larger study groups.

The safety and prognosis of radical surgery in colorectal cancer patients over 80 years old

ObjectiveThe purpose of this study was to assess the safety and feasibility of radical surgery and to investigate prognostic factors influencing in colorectal cancer (CRC) patients over the age of 80.MethodsBetween January 2010 and December 2020, 372 elderly CRC patients who underwent curative resection at the National Cancer Center were enrolled in the study. Preoperative clinical characteristics, perioperative outcomes, and postoperative pathological features were all collected.ResultsA total of 372 elderly patients with colorectal cancer were included in the study, including 226 (60.8%) men and 146 (39.2%) women. A total of 219 (58.9%) patients had a BMI < 24 kg/m2, and 153 (41.1%) patients had a BMI ≥ 24 kg/m2. The mean operation time and intraoperative blood loss were 152.3 ± 58.1 min and 67.6 ± 35.4 ml, respectively. The incidence of overall postoperative complications was 28.2% (105/372), and the incidence of grade 3–4 complications was 14.7% (55/372). In the multivariable Cox regression analysis, BMI ≥ 24 kg/m2 (HR, 2.30, 95% CI, 1.27–4.17; P = 0.006) and N1-N2 stage (HR: 2.97; 95% CI, 1.48–5.97; P = 0.002) correlated with worse CSS.ConclusionThe findings of this study showed that radical resection for CRC is safe and feasible for patients over the age of 80. After radical resection, BMI and N stage were independent prognostic factors for elderly CRC patients.

Resection and total femoral prosthesis reconstruction treatment of massive femoral hemophilic pseudotumor: A case report.

Introduction and importanceHemophilic pseudotumor is a rare and serious complication of hemophilia, often occurring in the long bones and muscle tissue of the extremities, with an incidence of about 1–2%. However, there is no effective surgical treatment for massive hemophilia pseudotumors of the extremities. Therefore, we would like to report this case to provide new ideas and methods for the treatment of massive hemophilic pseudotumors of the extremities through resection and total femoral prosthesis reconstruction.Case presentationAfter admission, the patient first underwent a month-long coagulation factor replacement therapy to maintain the patient's factor IX level at approximately 100%. Then, extensive resection of hemophilic pseudotumor and total femoral prosthesis reconstruction was performed in collaboration with several departments, and we collected the patient's preoperative, intraoperative and postoperative data for analysis.Clinical discussionAfter coagulation factor replacement therapy the patient's factor IX level was significantly increased and approached 100%. The surgical procedure was uneventful, and postoperative X-ray suggested a well-positioned prosthesis with postoperative pathological features consistent with a hemophilic pseudotumor. The patient was able to move around with the assistance of a walker 14 days after surgery, and there was no recurrence after one year of follow-up.ConclusionFor treat the massive hemophilic pseudotumors of the extremities, extensive resection and prosthetic replacement with coagulation factor replacement therapy is a safe and effective treatment that can significantly improve the prognosis and quality of life of patients.

Development and Validation of a Nomogram Model to Predict the Prognosis of Intrahepatic Cholangiocarcinoma

Background: The effective method for predicting prognosis of ICC is still lack. This study aims to establish and verify an effective prognostic nomogram model for intrahepatic cholangiocarcinoma (ICC) after partial hepatectomy. Materials and Methods: A nomogram model was developed in a cohort of 127 patients from January 2015 to December 2019. General clinical characteristics including preoperative physical examination data and postoperative pathological features were obtained. The independent risk factors identified by univariate and multivariate COX proportional hazards regression models were used to construct nomogram model. Predictive accuracy and discriminative ability were determined using a concordance index and a calibration curve. In addition, the clinical significance of postoperative pathological subtypes was analyzed by Kaplan-Meier survival analysis. Results: Univariate analysis and multivariate COX regression analysis revealed that CEA, maximum diameter, tumor number, and large duct type ICC was the independent risk factors. These variables were incorporated into the nomogram and the C-index for one year and three year overall survival prediction was 0.765 (95% CI: 0.672–0.814) and 0.695 (95% CI: 0.672–0.814), respectively. Postoperative pathological analysis showed that the large duct ICC had a distinct clinicopathological features and poor outcome. Conclusion: The proposed nomogram enables a prognostic prediction for patients with ICC and postoperative subclassification of ICC is of great significant to the prognosis of ICC.

Establishment of a nomogram prediction model for long diameter 10–15 mm gallbladder polyps with malignant tendency

BackgroundSurgical indications for the treatment of gallbladder polyps are controversial. Evaluation of gallbladder polyps with malignant tendency and indications for cholecystectomy in patients with long diameter polyps of 10 to 15 mm require further analysis and discussion. In this study, our objective was to re-evaluate indications for the surgical resection of gallbladder polyps and construct a nomogram model for the prediction of gallbladder polyps with malignant tendency. MethodsClinicopathologic data of 2,272 patients who had undergone cholecystectomy for gallbladder polyps were collected from 11 medical centers in China. Risk factor analyses and nomogram prediction model for gallbladder polyps with malignant tendency were conducted. ResultsExcluding 311 patients with cholelithiasis and 488 patients with long diameter polyps ≤5 and >15 mm, factors that differed significantly among patients with gallbladder polyps having a long diameter of 6 to 9 mm (885 cases) and 10 to 15 mm (588 cases) were polyp detection time, CEA and CA19-9 levels, number of polyps, fundus, echogenicity, gallbladder wall thickness and postoperative pathologic features (P < .05). Among 588 patients with gallbladder polyps with a long diameter of 10 of 15 mm, multivariate analysis indicated the following independent risk factors of gallbladder polyps with malignant tendency: single polyps (OR = 0.286/P < .001), polyps with broad base (OR = 2.644/P = .001), polyps with medium/low echogenicity (OR = 2.387/P = .003), and polyps with short diameter of 7 to 9 or 10 to 15 mm (OR = 3.820/P = .005; OR = 2.220/P = .048, respectively). The C-index of the nomogram model and internal validation were .778 and .768, respectively. In addition, a sample online calculator for the nomogram prediction model had been created (https://docliqi.shinyapps.io/dynnom/). ConclusionIndications for cholecystectomy in patients with gallbladder polyps with a long diameter of 10 to 15 mm should be assessed by combining the information on short diameter, number of polyps, fundus, and echogenicity. The nomogram model can be used to predict the risk for the development of gallbladder polyps with malignant tendency.

Triplet induction chemotherapy followed by less invasive surgery without reconstruction for human papillomavirus-associated oropharyngeal cancers: Why is it successful or unsuccessful?

De-escalating treatments have been focused on for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). We assessed the efficacy of a triplet induction chemotherapy (ICT) followed by surgery with or without neck dissection (ND) for locally advanced OPSCC, aiming at less invasive surgery without free-flap reconstruction and avoiding postoperative irradiation. This was a retrospective study of 41 patients with advanced resectable HPV-positive OPSCC who underwent ICT followed by surgery of primary resection with or without ND. Patients underwent triplet ICT, including docetaxel, cisplatin, and 5-fluorouracil, or carboplatin, paclitaxel, and cetuximab. Twenty-nine patients had tonsillar cancer, 15 patients were current smokers, and 18 and 12 patients had T2N1M0 and T1N1M0 status (UICC 8th), respectively. After ICT, a surgical procedure without free-flap reconstruction and tracheostomy was possible in 90.2%. Pathological complete response at both the primary site and lymph nodes was achieved in 73.2%. Of the patients who underwent surgery, no adjuvant radiotherapy was required in 85.0%. Two patients (4.9%) experienced recurrence at regional lymph nodes, but were cured by salvage ND followed by adjuvant radiotherapy. Upfront ICT using highly responsive triplet chemotherapeutic regimens may enable us to perform less invasive surgery without free-flap reconstruction and to avoid postoperative irradiation to the locoregional field through excellent postoperative pathological features.

Evolutionary Learning-Derived Clinical-Radiomic Models for Predicting Early Recurrence of Hepatocellular Carcinoma after Resection

Background and Aims: Current prediction models for early recurrence of hepatocellular carcinoma (HCC) after surgical resection remain unsatisfactory. The aim of this study was to develop evolutionary learning-derived prediction models with interpretability using both clinical and radiomic features to predict early recurrence of HCC after surgical resection. Methods: Consecutive 517 HCC patients receiving surgical resection with available contrast-enhanced computed tomography (CECT) images before resection were retrospectively enrolled. Patients were randomly assigned to a training set (n = 362) and a test set (n = 155) in a ratio of 7:3. Tumor segmentation of all CECT images including noncontrast phase, arterial phase, and portal venous phase was manually performed for radiomic feature extraction. A novel evolutionary learning-derived method called genetic algorithm for predicting recurrence after surgery of liver cancer (GARSL) was proposed to design prediction models for early recurrence of HCC within 2 years after surgery. Results: A total of 143 features, including 26 preoperative clinical features, 5 postoperative pathological features, and 112 radiomic features were used to develop GARSL preoperative and postoperative models. The area under the receiver operating characteristic curves (AUCs) for early recurrence of HCC within 2 years were 0.781 and 0.767, respectively, in the training set, and 0.739 and 0.741, respectively, in the test set. The accuracy of GARSL models derived from the evolutionary learning method was significantly better than models derived from other well-known machine learning methods or the early recurrence after surgery for liver tumor (ERASL) preoperative (AUC = 0.687, p < 0.001 vs. GARSL preoperative) and ERASL postoperative (AUC = 0.688, p < 0.001 vs. GARSL postoperative) models using clinical features only. Conclusion: The GARSL models using both clinical and radiomic features significantly improved the accuracy to predict early recurrence of HCC after surgical resection, which was significantly better than other well-known machine learning-derived models and currently available clinical models.

Clinical preliminary study on the correlation between nodular goitre and papillary thyroid carcinoma.

BackgroundIn clinical practice, we often encounter patients with concurrent papillary thyroid carcinoma (PTC) and nodular goitre (NG). What are the similarities and differences between these patients and patients with simple NG? Whether NG-related nodules can affect the occurrence and development of PTC still remains unknown.MethodsWe retrospectively analysed 650 patients undergoing surgery for a thyroid nodule in our hospital from January 1, 2015, to January 31, 2016. A total of 574 patients who met the inclusion criteria were divided into the NG, PTC and NG&PTC groups according to their postoperative pathological features. SPSS 22 software was used to compare the characteristics of patients between the three groups, the similarities and differences of potential risk factors (such as age, sex, residence location, BMI…) and thyroid function between the NG&PTC and NG groups, and the similarities and differences of tumour pathological features between the NG&PTC and PTC groups.ResultsThere were significant differences in the composition ratios of age, gender and residence location between the NG, PTC and NG&PTC groups. There were significant differences in residence location and body mass index (BMI) between the NG group and the NG&PTC group. There were significant differences in the number of cancer nodules, lymph node metastasis, and central lymph node metastasis between the NG&PTC and PTC groups.ConclusionsOverweight may affect the occurrence of PTC in patients with NG. NG may limit the intra- or extra-glandular metastasis of PTC but does not affect the growth and invasion of PTC.

Analysis of X-ray signs and postoperative pathological features of breast cancer

Analysis of X-ray signs and postoperative pathological features of breast cancer

18F-FDG PET/CT Quantitative Parameters and Texture Analysis Effectively Differentiate Endometrial Precancerous Lesion and Early-Stage Carcinoma

Objective:This study evaluated the metabolic parameters and texture features of fluorodeoxyglucose positron emission tomography–computed tomography (PET/CT) for the diagnosis and differentiation of endometrial atypical hyperplasia (EAH), EAH with field cancerization (FC), and stage 1A endometrial carcinoma (EC 1a).Materials and Methods:We retrospectively analyzed the metabolic parameters of PET/CT in 170 patients with diagnoses confirmed by pathology, including 57 cases of EAH (57/170, 33.53%), 45 cases of FC (45/170, 26.47%), and 68 cases of EC 1a (68/170, 40.0%). Then, the texture features of each tumor were extracted and compared with the metabolic parameters and pathological results using nonparametric tests and linear regression analysis. The diagnostic performance was assessed by the area under the curve (AUC) values obtained from receiver operating characteristic analysis.Results:There were moderate positive correlations between the PET standardized uptake values (SUVpeak, SUVmax, and SUVmean) and postoperative pathological features with correlation coefficients (r s) of 0.663, 0.651, and 0.651, respectively (P < .001). Total lesion glycolysis showed relatively low correlation with pathological characteristics (r s = 0.476), whereas metabolic tumor volume and age showed the weakest correlations (r s = 0.186 and 0.232, respectively). To differentiate between the diagnosis of EAH and FC, SUVmax displayed the largest AUC of 0.857 (sensitivity, 82.2%; specificity, 84.2%). Five texture features were screened out as Percentile 40, Percentile 45, InverseDifferenceMoment_AllDirection_offset 1, InverseDifferenceMoment_angle 45_offset 4, and ClusterProminence_angle 135_offset 7 (P < .001) by linear model of texture analysis (AUC = 0.851; specificity = 0.692; sensitivity = 0.871). To differentiate between the diagnoses of FC and EC 1a, SUVpeak displayed the largest AUC of 0.715 (sensitivity, 67.6%; specificity, 77.8%), and 2 texture features were identified as Percentile 10 and CP_angle 135_offset 7 (AUC = 0.819; specificity = 0.871; sensitivity = 0.766; P < .001).Conclusions:SUVmax and SUVpeak had the highest diagnostic values for EAH, FC, and EC 1a compared with the other tested parameters. SUVmax, Percentile 40, Percentile 45, InverseDifferenceMoment_AllDirection_offset 1, InverseDifferenceMoment_angle 45_offset 4, and ClusterProminence_angle 135_offset 7 distinguished EAH from FC. SUVpeak, Percentile 10, and ClusterProminence_angle 135_offset 7 distinguished FC from EC 1a. This study showed that the addition of texture features provides valuable information for differentiating EAH, FC, and EC 1a diagnoses.

Clinicopathologic analysis of prostatic cancer with single positive core biopsy after radical prostatectomy

Objective To evaluate the clinical and pathological features of patients with prostate cancer who were diagnosed by single positive core biopsy and treated by radical prostatectomy (RP). Methods Between July 2012 and June 2016, 164 patients with prostate cancer diagnosed by single positive core biopsy underwent RP.The mean age was 66.3 years old (ranged 41-82 years old), and the mean PSA level was 12.3 ng/ml (ranged 0.6-59.5 ng/ml). The biopsy Gleason score showed 6 scores in 113 cases, 3+ 4=7 scores in 21 cases, 4+ 3=7 scores in 18 cases, ≥8 scores in 12 cases.Clinical stage was cT1 in 71 cases, cT2 in 92 cases, and cT3 in 1 case. The patients were divided into subgroups according to age, preoperative PSA level, biopsy Gleason score and clinical stage, and the pathological results were compared among these subgroups. Results Of the 164 patients, 67 cases had Gleason score ≤6, 52 cases Gleason score 3+ 4=7, 24 case Gleason score 4+ 3=7, and 11 cases Gleason score ≥8. Ten patients had pT0 disease according to the RP specimen, 3 had extraprostatic extensions, 5 had seminal vesicle invasions, and 24 had positive surgical margins. Compared to the biopsy, the Gleason score of RP specimens was higher in 53 cases, concordant in 77 cases, and lower in 24 cases. There was no significant difference in the postoperative pathological features between the age group 7 was significantly increased in PSA ≥10 ng/ml group [41.4%(36/87) vs. 66.2%(51/77), P<0.05]. When the biopsy Gleason score was divided into four groups (6, 3+ 4=7, 4+ 3=7, ≥8), there were significant differences in postoperative pathological stages among the four groups (P<0.05), and the patients with biopsy Gleason score 6 were more likely to have no residual cancer (stage T0) when compared with other Gleason scores [8.8%(10/113) vs. 0, P=0.09]. The probability of no residual cancer in clinical T1 stage patients was significantly higher than that in T2 stage [11.3%(8/71) vs. 2.8%(2/92), P=0.02], while the probability of Gleason score upgrading was significantly lower [23.9%(17/71) vs. 39.1%(36/92), P<0.05]. Conclusions Most single core prostate cancer have clinically significant disease. The treatment plan must be evaluated individually for patients with single core prostate cancer. Key words: Prostatic neoplasms; Biopsy; Single positive core; Pathological stage

Development and External Validation of Nomograms To Predict Adverse Pathological Characteristics After Robotic Prostatectomy: Results of a Prospective, Multi-institutional, Nationwide series

BackgroundThe possibility of predicting pathologic features before surgery can support clinicians in selecting the best treatment strategy for their patients. We sought to develop and externally validate pretreatment nomograms for the prediction of pathological features from a prospective multicentre series of robotic-assisted laparoscopic prostatectomy (RALP) procedures. Design, setting, and participantsBetween 2009 and 2016, data from 6823 patients undergoing RALP in 25 academic and community hospitals were prospectively collected by the Belgian Cancer Registry. Logistic regression models were applied to predict extraprostatic extension (EPE; pT3a,b–4), seminal vesicle invasion (SVI; pT3b), and high-grade locally advanced disease (HGLA; pT3b–4 and Gleason score [GS] 8–10) using the following preoperative covariates: prostate-specific antigen, clinical T stage, biopsy GS, and percentage of positive biopsy cores. Internal and external validation was performed. Outcome measurements and statistical analysisThe stability of the model was assessed via tenfold cross-validation using 80% of the cohort. The nomograms were independently externally validated using the test cohort. The discriminative accuracy of the nomograms was quantified as the area under the receiver operating characteristic curve and graphically represented using calibration plots. Results and limitationThe nomograms predicting EPE, SVI, HGLA showed discriminative accuracy of 77%, 82%, and 88%, respectively. Following external validation, the accuracy remained stable. The prediction models showed excellent calibration properties. ConclusionsWe developed and externally validated multi-institutional nomograms to predict pathologic features after RALP. These nomograms can be implemented in the clinical setting or patient selection in clinical trials. Patient summaryWe developed novel nomograms using nationwide data to predict postoperative pathologic features and lethal prostate cancer.

Pediatric differentiated thyroid carcinoma: The clinicopathological features and the coexistence of Hashimoto's thyroiditis

The purpose of this study is to assess outcomes and the detailed clinicopathological features of differentiated thyroid carcinoma (DTC), including the relation of Hashimoto's thyroiditis and postoperative pathological features in child under 18 years old. We reviewed patients with DTC under 18 years old (pediatric DTC patients) seen during recent 16 years. The clinicopathological features and outcomes of pediatric DTC were analyzed by comparison with patients of 19-20 years old or 21-44 years old. Sixty four children with DTC [median age 16 years (range, 5-18)] were studied. The ratio of female to male was 5:1, but no difference was found by comparison with adult of 21-44 years old. No difference was found in multifocality, but DTC in child showed lager tumor size (P<0.001), higher rate of extrathyroidal extension (P=0.017), more local or pulmonary metastasis (P<0.001, P<0.001 respectively) than adult thyroid carcinoma. High rate of Hashimoto's thyroiditis (19/43) without influence on pathological features was found in patients under 18 years old. No differences, except for distant metastasis, were found by comparison of clinicopathological features between patients under 18 years old and 19-20 years old. Pediatric patients possessed highest rates of persistent/recurrent disease, though only one child died. Pediatric DTC has more aggressive behavior characterized by a high rate of extrathyroidal extension, local and pulmonary metastasis. Pediatric DTC has low mortality, but active treatments are needed for the high risk of persistent or recurrent diseases. Hashimoto's thyroiditis may be associated with the pathogenesis or mechanism of pediatric DTC.