Predictive Factors For Malignancy Research Articles

Evaluation of Peripheral Lymphadenopathies in Children in a Single Center: Predictive Factors for Malignancy.

Lymphadenopathy (LAP) is a common finding in pediatric patients. It was aimed to determine predictive factors in distinguishing cases with malignant or benign lymphadenopathy in this study. Between January 2022 and January 2023, 101 patients (1-16 years old) with lymphadenopathy were retrospectively examined. LAP was localized in 80.2% (n=81) cases and generalized in 19.8% (n=20) cases. In 60 cases (59.4%), lymph node sizes were found to be greater than 20×20 mm in width and length. The most common infectious causative agent was Epstein Barr Virus (EBV). Seven (6.9%) patients underwent biopsy and all were diagnosed with malignancy. When the benign and malignant groups were compared, age, lymph node length, and width on physical examination, anteroposterior and longitudinal diameter of the lymph node on ultrasonography (USG) were statistically significantly higher in the malignant group (p<0.05). The presence of supraclavicular lymphadenopathy was found to be an important factor in differentiating the malignant group (p<0.003). The most important factors in distinguishing the groups are respectively were the anteroposterior diameter of the lymph node on ultrasonography and the presence supraclavicular lymph node in multivariate logistic regression analysis. It is not always easy to distinguish benign and malignant etiologies in patients with lymphadenopathy. A detailed history, a careful physical examination, laboratory studies, and excisional biopsy are guiding.

Risk of malignancy in adrenal tumors in patients with a history of cancer.

Adrenal gland is a common site of metastasis and on the other hand, metastases are the most frequent malignant adrenal tumors. The aim of this study was to estimate the risk of malignancy in suspicious adrenal mass in patients with a history of cancer. This is a single-center retrospective analysis of patients with adrenal tumors treated previously for different types of cancers. Between 2004 and 2021a hundred and six such patients were identified. Mean age of patients was 62.6 years (30-78), and mean time from oncologic treatment was 55.8 months (0-274). The most common primary cancer was kidney (RCC): 29 (27.4%), colon/rectum (CRC): 20 (18.9%) and lung (NSCLC): 20 (18.9%). Of 106 patients, 12 had hormonally active (HA) (11,3%) and 94 (88,7%) non active (HNA) tumors In group of patients with HA tumours 4 had hypercortisolaemia and 8 had elevation of urinary metanephrines. In the first group of HA patients pathology confirmed preoperative diagnosis of adrenocortical cancer and no metastasis was found. In all patients from the second group pheochromocytomas were confirmed. Primary (PM) and secondary (SM) malignancies were found in 50 patients (47.2%). In hormone inactive group only SM - 46/94 (48.9%) were diagnosed. The odds that adrenal lesion was a metastasis were higher if primary cancer was RCC (OR 4.29) and NSCLC (OR 12.3). Metastases were also more likely with high native tumor density, and bigger size in CT. The cut-off values for tumor size and native density calculated from receiver operating characteristic (ROC) curves were 37mm and 24, respectively. Risk of malignancy of adrenal mass in a patient with a history of cancer is high (47,2%), regardless of hormonal status. 47,2% risk of malignancy. In preoperative assessment type of primary cancer, adrenal tumour size and native density on CT should be taken into consideration as predictive factors of malignancy. Native density exceeding 24 HU was the strongest risk factor of adrenal malignancy (RR 3.23), followed by history of lung or renal cancer (RR 2.82) and maximum tumor diameter over 37mm (RR 2.14).

Intraductal Papillary Mucinous Neoplasm of Pancreas with High-Risk Stigmata or Worrisome Features: What do You Do? Physician’s View

There are still debated about surveillance interval, duration, diagnostic modality and treatment for intraductal papillary mucinous neoplasm (IPMN) of the pancreas. In recent guidelines, ‘high risk stigmata (HRS)’ and ‘worrisome feature (WF)’ are defined as predictive factors for malignancy in IPMN. IPMNs with HRS and main duct- IPMN are more likely to accompany malignancies, thus require surgery. However, in the case of only WF, since the risk of malignancy is different for each factor, the management decision can be variable according to the number of overlapping WFs. In addition, for segmental main pancreatic duct dilatation without enhancing mural nodules, careful surveillance might be considered rather than immediate surgery. In IPMN patients with elderly or severe comorbidities, treatment strategy should be determined based on surgical and malignant risk assessment. To date, the natural course of IPMN patients with HRS and WF is not well understood, thus further studies with a large number of patients are needed.

Dilatation of the main pancreatic duct of unknown origin: causes and risk factors of pre-malignancy or malignancy.

A dilatation of the main pancreatic duct (MPD) is mainly due to obstructive causes (pancreatic tumor, chronic pancreatitis) or intraductal papillary mucinous neoplasm (IPMN). This study aims to assess the risk of pre-malignancy or malignancy in case of MPD dilatation with no visible mass nor obstructive calcification on computed tomography scan (CT-scan) in a population operated for it. All patients operated on from November 2015 to December 2019 in our center for a significant dilatation of the MPD without visible obstructive cause on CT-scan were included. Preoperative work-up included at least CT-scan, magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS). Primary endpoint was the final pathological diagnosis. Secondary endpoints were predictive factors of malignancy. 101 patients were included, mean age 68years-old. Final pathological data were pancreatic adenocarcinoma (n = 2), IPMN with high-grade dysplasia (n = 37), high-grade Pancreatic Intraepithelial Neoplasia (PanIN) (n = 2) (total of pre-malignant or malignant lesions: n = 41), neuroendocrine tumor (n = 6), IPMN with low-grade dysplasia (n = 45), low-grade PanIN (n = 5), chronic pancreatitis (n = 3), and benign stenosis (n = 1). On preoperative explorations, the median diameter of MPD was 7mm [3-35]. MRI and/or EUS showed intraductal material, nodule, or cyst in 22, 32, and 52 patients, respectively; 22 patients without nodule visible on MRI or EUS had still a pre-malignant or malignant lesion. In multivariate analysis, predictive factors forpre-malignancy or malignancy were symptoms before surgery (p = 0.01), MPD dilatation without downstream stenosis (p = 0.046), and the presence of nodule (p = 0.009). A dilatation of the MPD without detectable mass or obstructive calcification on CT-scan was associated with a pre-malignant or malignant lesion in 41 patients. Symptoms before surgery, MPD dilatation without duct narrowing, and the presence of nodules on MRI/EUS were associated with the risk of pre-malignancy ormalignancy.

P-67 Comparison of the malignant predictors in intrahepatic and extrahepatic intraductal papillary neoplasm of bile duct

Intraductal papillary neoplasm of the bile duct (IPNB) is a precancerous lesion of cholangiocarcinoma, for which surgical resection is the most effective treatment. We evaluated the predictors of malignancy in IPNB according to anatomical location and the prognosis without surgery. A total of 196 IPNB patients who underwent pathologic confirmation by surgical resection or endoscopic retrograde cholangiography or percutaneous transhepatic cholangioscopic biopsy were included. Clinicopathological findings of IPNB with invasive carcinoma or mucosal dysplasia were analyzed according to anatomical location. Of the 116 patients with intrahepatic IPNB (I-IPNB) and 80 patients with extrahepatic IPNB (E-IPNB), 62 (53.4%) and 61 (76.3%) were diagnosed with invasive carcinoma, respectively. Multivariate analysis revealed that mural nodule > 12 mm (p=0.043) in I-IPNB and enhancement of mural nodule (p=0.044) in E-IPNB were predictive factors for malignancy. Pathology discrepancy before and after surgery, IPNB has 71.2% of sensitivity and 82.3% of specificity. In the non-surgical IPNB group, composed of nine I-IPNB and seven E-IPNB, 43.7% progressed to IPNB with invasive carcinoma within 876 days. E-IPNB has a higher rate of malignancy than I-IPNB. The predictive factor for malignancy is mural nodule > 12 mm in I-IPNB and mural nodule enhancement in E-IPNB.

Clinicopathological study of malignancy in solitary thyroid nodule

Objectives. To study proportion of malignancy in patients with solitary thyroid nodule who had underwent hemi/total thyroidectomy. Methodology. Study design: Cross sectional study. Study setting: Patients in the Out-patient and In-patient Department of General Surgery, Government Medical College, Thiruvananthapuram. Sample size: 150 patients Study Procedure: Data was collected using a structured proforma. An informed consent written in the local language was read out to the study subjects and signature was obtained. All the questions in the proforma were read to the study subjects and responses recorded. Investigation reports and previous medical reports were used for filling relevant parts of the proforma. Analysis: Data collected was entered in excel sheets and analyzed using SPSS software. Results. 150 patients were operated for clinically detected STN. 16 (10.67%) were malignant. Papillary thyroid cancer was the most common type (93.75%). Mean age of patients with malignancy (n = 58) was 39.94 ± 14.83 years. Out of them 12 were females and 4 were male patients (F: M = 3: 1). 134 STNs were benign (23 males and 111 females). Malignant STN was reported in 14.81% males and 9.76% females. No significant correlation between tumour size and the risk of malignancy (P = 0.338). Altered thyroid function status is not a predictive factor for malignancy (P=0.801). FNAC (P=0.002) and USG (P=&lt;0.001) were predictive of malignancy. Complications were more associated with total thyroidectomy (53.57%). Most frequent complication was transient hypocalcemia (15.4%). Hospital stay were more in patients who had underwent total thyroidectomy (P=&lt;0.001). Conclusions. STN has high malignant potential compared to MNG. Preoperative evaluation with thorough history, physical examination, USG and FNAC could diagnose STN as benign or malignant. Strong predictors of malignancy include male gender, micro calcification and cervical lymphadenopathy. Complications are more associated with Total thyroidectomy. Hypocalcemia was the most common complication following thyroid surgery.

Comparison of the Malignant Predictors in Intrahepatic and Extrahepatic Intraductal Papillary Neoplasm of the Bile Duct.

Background: Intraductal papillary neoplasm of the bile duct (IPNB) is a precancerous lesion of cholangiocarcinoma, for which surgical resection is the most effective treatment. We evaluated the predictors of malignancy in IPNB according to anatomical location and the prognosis without surgery. Methods: A total of 196 IPNB patients who underwent pathologic confirmation by surgical resection or endoscopic retrograde cholangiography or percutaneous transhepatic cholangioscopic biopsy were included. Clinicopathological findings of IPNB with invasive carcinoma or mucosal dysplasia were analyzed according to anatomical location. Results: Of the 116 patients with intrahepatic IPNB (I-IPNB) and 80 patients with extrahepatic IPNB (E-IPNB), 62 (53.4%) and 61 (76.3%) were diagnosed with invasive carcinoma, respectively. Multivariate analysis revealed that mural nodule > 12 mm (p = 0.043) in I-IPNB and enhancement of mural nodule (p = 0.044) in E-IPNB were predictive factors for malignancy. For pathologic discrepancy before and after surgery, IPNB has a 71.2% sensitivity and 82.3% specificity. In the non-surgical IPNB group, composed of nine I-IPNB and seven E-IPNB patients, 43.7% progressed to IPNB with invasive carcinoma within 876 days. Conclusions: E-IPNB has a higher rate of malignancy than I-IPNB. The predictive factor for malignancy is mural nodule > 12 mm in I-IPNB and mural nodule enhancement in E-IPNB.

Ultrasound-guided wire localization biopsy in non-palpable breast lesions: predictive factors for malignancy.

The aim of the study was to evaluate the results of ultrasound-guided excisional biopsy in patients with nonpalpable breast lesions and examine factors associated with malignancy. A total of 380 patients who underwent ultrasound-guided excisional biopsy for suspected nonpalpable breast masses, between May 2012 and 2018, were retrospectively examined. Histopathological results of the patients were compared regarding age, ultrasound findings, ultrasonographic and mammographic Breast Imaging Reporting and Data System (BI-RADS) categories and factors predicting malignancy were determined. The mean age of the patients was 48.35 ± 11.23 (17-86) years. There was a history of breast cancer in the families of 22 (5.8%) patients, and 187 (49.2%) patients were in menopause. The complication rate was found to be 6.6%. Malignant lesions were detected in 76 (20%) patients and benign lesions were detected in 304 (79.99%) patients. Some benign lesions were high-risk lesions (16.8%). Most of the patients with malignant lesions had early-stage breast cancer (83.3%). In univariate analyzes, ultrasonographic BI-RADS, mammographic BI-RADS and age variables were found to be associated with malignancy (p = 0.0001). In the multiple logistic regression analysis, ultrasonographic and mammographic BI-RADS values were found to be risk factors for malignancy (p = 0.0001). BI-RADS scoring was used to determine risk factors in predicting malignancy in the evaluation of suspected nonpalpable lesions. The ultrasound-guided wire localization biopsy is a useful method in nonpalpable breast lesions with suspected malignancy that cannot be diagnosed by core/vacuum biopsy or in cases where incompatibility between pathology and radiology results exists.

P-170 Assessment of long-term outcomes and predictive factors of malignancy in branch-duct intraductal papillary mucinous neoplasms: A retrospective study in a Canadian referral center

While incidental diagnosis of branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) on imaging studies has been increasing in the last decades, data on long-term outcomes of these lesions with malignant potential are lacking. Long-term surveillance of BD-IPMN remains controversial in current guidelines, particularly in regard to cysts follow-up> 5 years, causing discrepancies in management strategies. Further studies are essential to better guide physicians in the assessment of high-risk lesions needing further evaluation.

Predictive factors of malignancy in pediatric patients with thyroid nodules and performance of the Italian classification (SIAPEC 2014) in the outcome of the cytological FNA categories

PurposeThe rate of malignancy (ROM) among pediatric studies using the Bethesda System is 39.5% and 41.5% for atypia of undetermined significance/follicular lesion of undetermined significance and for suspected follicular neoplasm, respectively. Data reported on the basis of Bethesda System showed lower ROM in adults with indeterminate nodules (30.5 and 28.9% respectively). Studies on adults based on the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification, report ROM of 14.2% for TIR3a and 44.6% for TIR3b category, showing greater sensitivity in detecting malignancy. To date, no performance data are available about SIAPEC classification in pediatric age.MethodsRetrospective data were collected from 200 pediatric subjects with thyroid nodules in the period 2000–2020.ResultsThe distribution of cytological categories after fine needle aspiration biopsy (FNAB) was 7 TIR1, 4 TIR1c, 22 TIR2, 14 TIR3a, 9 TIR3b, 3 TIR4, and 16 TIR5. The surgical approach was performed in 40/200 subjects, with total ROM of 65% (0% for TIR1-TIR3a, 77.8% for TIR3b, and 100% for TIR4–TIR5). Total FNAB accuracy was 95%, while the sensibility and specificity were 92.3 and 92.6%, respectively.ConclusionsThe reported data seem to confirm a greater sensitivity of SIAPEC classification to identify malignancy within the indeterminate category also in pediatric age and not only in adulthood. This finding may orient clinicians toward clinical follow-up for the indeterminate TIR3a group and toward surgical approach with total thyroidectomy in the indeterminate TIR3b group, although this indication should be confirmed in further national multicenter studies including larger cohorts.

Differentiating focal interstitial fibrosis from adenocarcinoma in persistent pulmonary subsolid nodules (&gt; 5 mm and &lt; 20 mm): the role of coronal thin-section CT images

To investigate thin-section computed tomography (CT) features of pulmonary subsolid nodules (SSNs) with sizes between 5 and 20 mm to determine predictive factors for differentiating focal interstitial fibrosis (FIF) from adenocarcinoma. From January 2017 to December 2018, 169 patients who had persistent SSNs 5-20 mm in size and underwent preoperative nodule localization were enrolled. Patient characteristics and thin-section CT features of the SSNs were reviewed and compared between the FIF and adenocarcinoma groups. Univariable and multivariable analyses were used to identify predictive factors of malignancy. Receiver operating characteristic (ROC) curve analysis was used to quantify the performance of these factors. Among the 169 enrolled SSNs, 103 nodules (60.9%) presented as pure ground-glass opacities (GGOs), and 40 (23.7%) were FIFs. Between the FIF and adenocarcinoma groups, there were significant differences (p< 0.05) in nodule border, shape, thickness, and coronal/axial (C/A) ratio. Multivariable analysis demonstrated that a well-defined border, a nodule thickness >4.2, and a C/A ratio >0.62 were significant independent predictors of malignancy. The performance of a model that incorporated these three predictors in discriminating FIF from adenocarcinoma achieved a high area under the ROC curve (AUC, 0.979) and specificity (97.5%). For evaluating persistent SSNs 5-20 mm in size, the combination of a well-defined border, a nodule thickness > 4.2, and a C/A ratio > 0.62 is strongly correlated with malignancy. High accuracy and specificity can be achieved by using this predictive model. • Thin-section coronal images play an important role in differentiating FIF from adenocarcinoma. • The combination of a well-defined border, nodule thickness>4.2 mm, and C/A ratio >0.62 is associated with malignancy. • This predictive model may be helpful for managing persistent SSNs between 5 and 20 mm in size.

Is SUVmax of 18F-FDG PET/CT Predictive Factor for Malignancy in Gastrointestinal Tract?

Increasing use of 18F-FDG PET/CT in cancer patients, has led to more common detection of 18F- FDG uptake in the gastrointestinal tract (GIT). The objective of this study was to assess 18F-FDG uptake in incidental and known GIT malignancy. A total of 6500 patients followed-up in a single and tertiary center between January 2010 and September 2016 were retrospectively reviewed. Of 2850 patients assessed with 18FDG-PET/CT, known GIT malignancy and 18F-FDG uptake cases during follow-up were included in the study. Of 658 patients with 18F-FDG uptake, 150 patients who underwent endoscopy were included in the study. Seventy-seven of these patients had known GIT malignancy and 73 had incidental 18F-FDG uptake. Among these 73 patients; 7 (9.6%) had malignancy, 20 (27,2%) adenoma and 24 (32.9%) inflammation that were confirmed. Endoscopy was normal in 22 (30.2%) patients. One hundred forty-three (95.3%) patients had focal and 7 (4.7%) had diffuse uptake. While no malignancy was detected in patients with diffuse uptake, 58.7% (84/143) of the patients with focal uptake presented malignancy. Mean the standardized uptake value (SUV) max values were found as 15.0 ± 10.6 (range, 3.8-56.5) in malignant disease, 10.2 ± 4.3 (range, 2.4-19.7) in adenoma, 7.3 ± 3.6 (range, 3.6-18.7) in inflammation, and 9.8 ± 4.2 (range, 3.8-19.9) in normal endoscopy groups (p < 0.001, rho = 0.378). Although this study demonstrated high probability of malignant disease with increased 18F-FDG uptake in the GIT, it would be a more appropriate approach to confirm all patients with 18F-FDG uptake through endoscopy as SUVmax values vary in a wide range.

Analysis of breast nodule vascularity as a predictive factor for malignancy

Introduction: Ultrasound is considered the main complementary diagnostic method to mammography in screening malignant breast nodules. The fifth edition of the BI-RADS® classification suggests analyzing nodule vascularity and the resistance index (RI) during the ultrasound. However, they are still not considered a decisive factor for the final classification. Objectives: To evaluate if the vascularity of breast nodules is a predictive factor for malignancy, and identify the RI value of the vessel most associated with malignant results. Methodology: This retrospective cross-sectional study assessed 750 ultrasound-guided breast biopsies performed at the Mastology Outpatient Clinic of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) from August 2015 to May 2017. The variables analyzed included examination date, ultrasound BI-RADS® category, internal nodule vascularity, RI value, and biopsy result. Exams from patients with no breast nodule were excluded. The statistical analysis was performed using Pearson's X² test. Results: The presence of vessels inside the nodule was highly associated with malignancy (OR=7.2, p&lt;0.0001) and also with BI-RADS® categories of greater risk (p&lt;0.0001). The median RI was 0.7 (interquartile range – IQR=0.23) in benign nodules with vessel and 0.86 (IQR=0.23) in malignant ones, with statistical significance (p&lt;0.0001). The RI cut-off point to predict malignancy was 0.71 with 83.8% accuracy, 91.9% sensitivity, and 57% specificity (according to the Receiver Operating Characteristic – ROC – curve). Nodules initially classified as 4A but with internal vascularity and high resistance (RI&gt;0.71) proved to be malignant in the biopsy in 35.7% of cases, that is, much higher than expected for the category (2% to 10%). Similarly, 72% of nodules initially classified as 4B but with internal vascularity and high resistance were malignant. On the other hand, 18.4% of nodules classified as 4C but without internal vascularity had malignancy confirmed by biopsy, far below the expected for the category (50% to 95%). Conclusion: The presence of internal vascularity and the RI were important factors for differentiating benign nodules from malignant ones on ultrasound, and in images classified as BI-RADS® 4, this information can be essential when dividing these nodules into subcategories (4A, 4B, and 4C).

Clinical impact of strain histogram EUS elastography and contrast-enhanced EUS for the differential diagnosis of focal pancreatic masses: A prospective multicentric study.

Background:Recent advances in EUS techniques (real-time EUS elastography and contrast-enhanced EUS) have allowed a better characterization of focal pancreatic masses. Mean strain histograms (SHs) are considered a good parameter for the semi-quantitative evaluation of focal pancreatic masses, alongside complementary contrast-enhanced EUS parameters which can be quantified during both the early arterial and late venous phase.Materials and Methods:The study design was prospective, blinded, and multicentric, assessing real-time EUS elastography and contrast-enhanced EUS results for the characterization of focal pancreatic masses using parametric measurements, in comparison with pathology which is the gold standard. SHs were performed based on the embedded software of the ultrasound system, with the values being reversed as opposed to our initially published data on hue histograms. Consequently, a cutoff of 80 was derived from previous multicentric trials. Contrast-enhanced EUS also allowed the focal masses to be classified as hyper-, iso-, or hypoenhanced in comparison with the normal pancreatic parenchyma. EUS-FNA was then performed for all patients, with a positive cytological diagnosis taken as a final proof of malignancy for the pancreatic masses. The diagnoses obtained by EUS-FNA were verified further either by surgery or during a clinical follow-up of at least 6 months.Results:A total number of 97 consecutive patients with focal pancreatic masses were included in the study. Based on previously defined cutoffs of 80, the values of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the mean SHs for the diagnosis of pancreatic cancer were 100%, 29.63%, 78.65%, 100%, and 80.41%, respectively. Corresponding values for contrast-enhanced EUS (taking into consideration hypoenhencement as a predictive factor of malignancy) were 98.57%, 77.78%, 92%, 95.45%, and 92.78%, respectively. Combining contrast enhancement-EUS (hypoenhencement) and semi-quantitative EUS elastography (SH cutoffs <80), the resulting values corresponding for sensitivity, specificity, and accuracy were 98.57%, 81.48%, and 93.81%, respectively.Conclusion:The current study using objective parametric tools for both EUS elastography and contrast-enhanced EUS confirmed the results of previous studies and meta-analyses that indicated a complementary role for the differential diagnosis of focal pancreatic masses. Moreover, the best values for the receiver operating curves were obtained using a sequential clinical algorithm based on the initial use of elastography, followed by contrast enhancement.

Evaluation of Malignancy Risk in 18F-FDG PET/CT Thyroid Incidentalomas

Thyroid incidentalomas detected by 18 fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography/computed tomography (PET/CT) are a real challenge for nuclear medicine physicians and clinicians. This study aimed to evaluate the risk of malignancy for patients with focal thyroid incidentalomas (TIs) diagnosed through FDG PET/CT. Data from 6900 patients, with a known primary tumor, who had an FDG PET/CT investigation performed were analyzed for the presence of incidental thyroid uptake. The focal TIs were reported, and the patients were referred for further investigation to the endocrinology department. There were 126 patients (1.82%) who presented with focal thyroid uptake, and for 87 of them, investigations were completed with ultrasonography (US), and for 29 with a fine needle aspiration biopsy (FNAB) procedure. Malignancy was detected in 7.93% (10/126) of cases. An arbitrary cutoff value of four was established for the standard uptake value lean body mass (SUVlbm Max) to differentiate the malignant nodules from the benign ones, and this value was significantly associated with malignancy (p = 0.0168). TIs are not so frequent, but they have a potential malignancy risk, and a proper evaluation is required. Even though SUVlbm Max is a predictive factor for malignancy, the FNAB remains the main diagnostic method for the therapeutic management of these patients.

Predictive factors of malignancy in thyroid nodules categorized as atypia of undetermined significance or follicular lesion of undetermined significance

Predictive factors of malignancy in thyroid nodules categorized as atypia of undetermined significance or follicular lesion of undetermined significance

Treatment of solitary thyroid nodules according to size, preoperative fine-needle aspiration cytology and frozen section: a retrospective single centre study

Background: In order to avoid unnecessary thyroidectomies, it is important to predict the nature of thyroid nodules the more accurately possible. The size of the nodule as a predictive factor for malignancy is very controversial. Another point of debate is the accuracy of preoperative fine-needle aspiration cytology (FNAC) and frozen section (FS). The aim of our study is to correlate the nodule size with the final histological diagnosis and to estimate the accuracy of preoperative FNAC and FS.Methods: Retrospective study including 387 operated patients with ultrasound-detected solitary thyroid nodules from 01 January 2001 to 31 December 2013. The following data were collected: patient age and sex, nodule size, FNAC, FS and final histology results.Results: The odds ratio for malignancy within nodules <40 mm was 2.12 (95% CI: 1.104–4.084). The specificity of FNAC was 97.78% and the negative predictive value (NPV) was 97.78% for nodules ≥40 mm and 93.2% and 96.5% for nodules <40 mm, respectively. The observed specificity and NPV of FS ranged from 98% to 100% and from 87.4% to 98%, respectively. When combining FNAC and FS, the specificity and the NPV were 99% and 98%, respectively.Conclusions: The nodule size is not a predictive factor for thyroid cancer and therefore nodules ≥40 mm should not be routinely resected. A lege artis preparation and performance of FNAC along with an expertise on cytological interpretation can considerably diminish false-negative rate. FS can offer additional accuracy on FNAC results and should, therefore, be a part of patient treatment.

Investigation of contrast-enhanced ultrasound findings for the differential diagnosis of small breast lesions

Purpose Widespread ultrasound (US) screening is expected to increase the number of small breast masses that are found, making it difficult to differentiate between benign and malignant tumors. Miyamoto1 et al showed that contrast-enhanced ultrasound (CEUS) with perflubutane (Sonazoid®) has significantly higher accuracy and specificity in comparison with conventional US for the differential diagnosis of lesions Patients and methods A total of 109 patients with small breast lesions were enrolled from December 2012 to December 2018. The tumor diameter of all cases was ≤ 10 mm, and the pathological results were also known. Forty-one lesions were malignant, and sixty-eight lesions were benign on histopathology. The mean age of the malignant group was 56.0 years (range: 40-81 years), whereas the mean age of the benign group was 56.3 years (range: 30-79 years). The mean diameter of the malignant group was 6.6 mm (range: 2-10 mm) and that of the benign group was 6.7 mm (range: 3-10 mm). The enhancement pattern, including the intensity, type, and range of enhancement, as well as the time intensity curve for CEUS and the presence of internal vascularity on color flow images, was compared between the malignant and benign groups. Results There were few cases with breast imaging reporting and data system (BI-RADS) Category 4A or higher on mammogram (17.1% in the malignant group and 5.9% in the benign group). The rate of BI-RADS Category 4A or higher for conventional US was higher in the malignant group (65.9%) than in the benign group (47.1%). However, this difference was not significant. There was no difference between the malignant (39.0%) and benign (41.2%) groups in terms of the internal vascularity on color flow images. Therefore, CEUS was performed on the cases that were difficult to differentially diagnose. In the comparison of the enhancement pattern on CEUS, there was a significant difference only in the range of enhancement (P=.0001). In the multivariate analysis, the range of enhancement extending outward beyond the expected border of the lesion was a predictive factor for malignancy (P=.001). There was no difference in the other enhancement patterns. Conclusion In cases of difficult-to-diagnose small breast lesions, enhancement extending outward beyond the expected border of the lesion may be useful for differential diagnosis.

Predictive factors of malignancy in dogs with focal liver lesions using clinical data and ultrasonographic features

A definitive diagnosis of focal liver lesions (FLLs) requires invasive procedures for histopathologic examination. Thus, a simpler noninvasive diagnostic method, such as conventional ultrasonography combined with clinical data, is needed for the prediction of liver malignancy. The objective of this study was to examine the diagnostic accuracy of clinical data and ultrasonographic (US) features to differentiate benign and malignant liver lesions. Medical records and US images from dogs with FLLs that underwent abdominal US and histopathologic examinations following surgery or liver biopsy were retrospectively reviewed. Clinical data, including signalment, clinical signs and laboratory findings, and the US features of liver lesions that could act as predictive factors were assessed using univariate and multivariate analyses to evaluate the associations between predictive factors and liver malignancy. Based on the histopathologic results, 55 dogs with malignant lesions and 28 dogs with benign lesions were included in the study. The results of univariate analysis showed that several US features and platelet count were significantly associated with liver malignancy. Multivariate analysis revealed that the platelet count (thrombocytosis; odds ratio [OR]: 4.13, 95% confidence intervals [CI]: 1.81−9.41), lesion size (4.1 cm or greater; OR: 23.83, 95% CI: 3.74−151.95) and echotexture of FLLs (heterogenous; OR: 8.44; 95% CI: 1.37−51.91) were independent predictors for differentiating benign and malignant liver lesions, suggesting that a combination of clinical data and US findings of FLLs could predict liver malignancy in dogs.

Solitary fibrous tumors of the pleura: A single center experience at National Cancer Center, China.

BackgroundThis study explored the clinicopathological features, predictive factors of malignancy, effectiveness of video assisted thoracic surgery (VATS), and prognosis of solitary fibrous tumor of the pleura (SFTP).MethodsA single‐center retrospective study of the data of 82 patients with SFTP who were surgically treated in our department between January 2003 and December 2015 was conducted.ResultsA total of 82 SFTPs (70 benign, 12 malignant) were included and all patients underwent complete en bloc resection. SFTPs originated from the visceral pleura in 47 (57%) and the parietal pleura in 35 (43%) patients. In our cohort, malignant tumors were often symptomatically large, and the patients with malignant SFTPs (mSFTPs) often had a family history of neoplasms. Patients in the VATS group (n = 22) had tumors with significantly smaller diameters, required a shorter surgical duration and shorter hospital stay, and experienced less intraoperative blood loss and less postoperative chest tube drainage compared to the thoracotomy group (n = 60). No tumor recurrence was found in benign SFTP (bSFTP) patients. The long term survival and disease‐free survival rates of mSFTP patients were 76% and 53%, respectively.ConclusionLarger tumor diameter and a family history of neoplasm may be predictive factors for mSFTP; however, this conclusion needs to be verified in large cohort. VATS is safe and reliable for treating selected SFTP patients. Local recurrence is associated with mSFTP patient death, thus close follow‐up of such patients is crucial.