Malignancy Rate Research Articles

Changes in the Volume and Diameter of Benign Thyroid Nodules: A 10-Year Follow-Up Study.

Background: The incidence of asymptomatic thyroid nodules has risen enormously, with > 90% being benign. Despite limited long-term data, significant nodule growth (SNG) is common. Guidelines recommend cytology reevaluation if SNG occurs. Our study aimed to identify the rate and factors associated with SNG, compare diameter and volume-based assessments, and examine the association between SNG and malignancy risk over the long term (10 years). Methods: The retrospective cohort study, conducted at Ankara University, School of Medicine, Department of Endocrinology and Metabolism, included 732 nodules from 376 euthyroid patients, all monitored over a 10-year period by the same experienced sonographer, with evaluations at baseline, 5th and 10th years. The nodules were cytologically benign and/or sonographically in the low-to-intermediate risk category. Size changes at the 5th and 10th years were considered significant if there was a 20% or 2 mm increment in two diameters according to diameter-based criterion (DBC) or 50% increment in volume-based criterion (VBC) designed by the ellipsoid formula. Generalized linear mixed-effects models were used to account for the clustered data structure and analyze factors affecting nodule growth. Nodule growth was the dependent variable, while sex, age at diagnosis, initial TSH level, total nodule count, nodule volume, echogenicity, and localization were independent variables. Results: At the 5th and 10th years, SNG frequencies were higher when calculated using VBC [27.7% (n = 203) and 44% (n = 321), respectively] compared with DBC [19.1% (n = 140) and 35% (n = 256), respectively], with the differences being statistically significant (McNemar test, p < 0.01). Factors associated with SNG included being younger than 45 years of age (VBC OR = 1.704, CI = 1.227-2.366, p = 0.002; DBC OR = 1.913, CI = 1.379-2.656, p < 0.001), having higher number of nodules (VBC: OR = 1.171, CI = 1.061-1.291, p = 0.002; DBC: OR = 1.147, CI = 1.040-1.265, p = 0.006), and having smaller nodule volume (VBC: OR = 0.870, CI = 0.806-0.940, p < 0.001; DBC: OR = 0.912, CI = 0.850-0.978, p = 0.010). Thyroid cancer was diagnosed in four original nodules (0.5%), whereas the malignancy rate in biopsies performed was 1.4% (n = 4). Conclusions: In long-term follow-ups of sonographically and/or cytologically benign thyroid nodules, SNG is not rare. Growth is more likely in younger patients, those with higher number of nodules and smaller nodules. In the follow-up of nodule size, VBCs yield augmented results compared with DBCs. However, malignancy is quite rare in growing nodules. Therefore, adopting flexible long-term follow-up protocols appears to be practical for benign nodular thyroid disease.

Can structured integration of BI-RADS criteria by a clinical decision rule reduce the number of unnecessary biopsies in BI-RADS 4 lesions? A systematic review and meta-analysis.

This systematic review and meta-analysis investigate the added value of structured integration of Breast Imaging Reporting and Data System (BI-RADS) criteria using the Kaiser score (KS) to avoid unnecessary biopsies in BI-RADS 4 lesions. A systematic review and meta-analysis were conducted using predefined criteria. Eligible articles, published in English until May 2024, dealt with KS in the context of BI-RADS 4 MRI. Two reviewers extracted study characteristics, including true positives (TP), false positives (FP), true negatives (TN), and false negatives (FN). Sensitivity, specificity, negative likelihood ratio, and positive likelihood ratio were calculated using bivariate random effects. Fagan nomograms identified the maximum pre-test probability at which post-test probabilities of a negative MRI aligned with the 2% malignancy rate benchmark for downgrading BI-RADS 4 to BI-RADS 3. I² statistics and meta-regression explored sources of heterogeneity. p-values < 0.05 were considered significant. Seven studies with 1877 lesions (833 malignant, 1044 benign) were included. The average breast cancer prevalence was 47.3%. Pooled sensitivity was 94.3% (95%-CI 88.9%-97.1%), and pooled specificity was 68.1% (95%-CI 56.6%-77.7%) using a random effects model. Overall, 52/833 cases were FNs (6.2%). Fagan nomograms showed that KS could rule out breast cancer in BI-RADS 4 lesions at a pre-test probability of 20.3% for all lesions, 25.4% for masses, and 15.2% for non-mass lesions. In MRI-assessed BI-RADS 4 lesions, applying structured BI-RADS criteria with the KS reduces unnecessary biopsies by 70% with a 6.2% FN rate. Breast cancer can be ruled out up to pre-test probabilities of 20.3%. Question What, if any, value is added by structured integration of BI-RADS criteria using the Kaiser Score (KS) to avoid unnecessary biopsies in BI-RADS 4 lesions? Findings The structured integration of BI-RADS criteria using the Kaiser Score (KS) reduces unnecessary biopsies in BI-RADS 4 lesions by 70%. Clinical relevance The structured approach offered by the Kaiser Score (KS) avoids unnecessary recalls, potentially reducing patient anxiety, lessening the burden on medical personnel, and the need for further imaging and biopsies due to more objective and thus efficient clinical decision-making in evaluating BI-RADS 4 lesions.

Histopathologic And Clinical Features of Bethesda III-VI Nodules Harboring Isolated RAS Mutations.

Though thyroid tumors possessing isolated RAS mutations are generally considered to be indolent, the oncologic outcomes of tumors evaluated with comprehensive molecular testing have not been well characterized. We performed a retrospective cohort study of 368 consecutive patients with Bethesda III - VI thyroid nodules at a single institution (2016 to 2021) who underwent molecular testing with Thyroseq v3. Patients with isolated RAS mutations were identified, and those with isolated BRAF V600E-mutated cancers were used as comparators. Outcomes of interest included rate of malignancy, high-risk histopathologic features, and structural disease recurrence. A total of 50 (14%) patients had an isolated RAS-mutated nodule, of which 41 underwent surgery (median age 43 years, 83% female). The malignancy rate on final pathology was 46%, while 32% of patients had NIFTP and 22% of patients had benign histopathology. In comparison, the isolated BRAF-mutated cohort (86 [24%] patients, median age 45 years, 68% female) had a 100% rate of malignancy. Only 2 (11%) of the isolated RAS patients with malignant histopathology had lymph node metastasis, compared to 34 (39%) of the BRAF cohort (p=0.016). Over a median follow up of 5 years, no patients with isolated RAS mutations had a structural recurrence compared to 5 (6%) patients in the isolated BRAF cohort. Bethesda III-VI thyroid nodules with isolated RAS mutations have a low rate of aggressive histopathologic features and are unlikely to recur. Thyroid lobectomy may be sufficient treatment for these tumors.

RGIE: A Gene Selection Method Related to Radiotherapy Resistance in Head and Neck Squamous Cell Carcinoma.

Head and Neck Squamous Cell Carcinoma (HNSCC) is a malignant tumor with a high degree of malignancy, invasiveness, and metastasis rate. Radiotherapy, as an important adjuvant therapy for HNSCC, can reduce the postoperative recurrence rate and improve the survival rate. Identifying the genes related to HNSCC radiotherapy resistance (HNSCC-RR) is helpful in the search for potential therapeutic targets. However, identifying radiotherapy resistance-related genes from tens of thousands of genes is a challenging task. While interactions between genes are important for elucidating complex biological processes, the large number of genes makes the computation of gene interactions infeasible. We propose a gene selection algorithm, RGIE, which is based on ReliefF, Gene Network Inference with Ensemble of Trees (GENIE3) and Feature Elimination. ReliefF was used to select a feature subset that is discriminative for HNSCC-RR, GENIE3 constructed a gene regulatory network based on this subset to analyze the regulatory relationship among genes, and feature elimination was used to remove redundant and noisy features. Nine genes (SPAG1, FIGN, NUBPL, CHMP5, TCF7L2, COQ10B, BSDC1, ZFPM1, GRPEL1) were identified and used to identify HNSCC-RR, which achieved performances of 0.9730, 0.9679, 0.9767, and 0.9885 in terms of accuracy, precision, recall, and AUC, respectively. Finally, qRT-PCR validated the differential expression of the nine signature genes in cell lines (SCC9, SCC9-RR). RGIE is effective in screening genes related to HNSCC-RR. This approach may help guide clinical treatment modalities for patients and develop potential treatments.

An ultrasonography of thyroid nodules dataset with pathological diagnosis annotation for deep learning

Ultrasonography (US) of thyroid nodules is often time consuming and may be inconsistent between observers, with a low positivity rate for malignancy in biopsies. Even after determining the ultrasound Thyroid Imaging Reporting and Data System (TIRADS) stage, Fine needle aspiration biopsy (FNAB) is still required to obtain a definitive diagnosis. Although various deep learning methods were developed in medical field, they tend to be trained using TI-RADS reports as image labels. Here, we present a large US dataset with pathological diagnosis annotation for each case, designed for developing deep learning algorithms to directly infer histological status from thyroid ultrasound images. The dataset was collected from two retrospective cohorts, which consists of 8508 US images from 842 cases. Additionally, we explained three deep learning models used as validation examples using this dataset.

Radiomics-based automated machine learning for differentiating focal liver lesions on unenhanced computed tomography.

Enhanced computed tomography (CT) is the primary method for focal liver lesion diagnosis. We aimed to use automated machine learning (AutoML) algorithms to differentiate between benign and malignant focal liver lesions on the basis of radiomics from unenhanced CT images. We enrolled 260 patients from 2 medical centers who underwent CT examinations between January 2017 and March 2023. This included 60 cases of hepatic malignancies, 93 cases of hepatic hemangiomas, 48 cases of hepatic abscesses, and 84 cases of hepatic cysts. The Pyradiomics method was used to extract radiomics features from unenhanced CT images. By using the mljar-supervised (MLJAR) AutoML framework, clinical, radiomics, and fusion models combining clinical and radiomics features were established. In the training and validation sets, the area under the curve (AUC) values for the clinical, radiomics, and fusion models exceeded 0.900. In the external testing set, the respective AUC values for the clinical, radiomics, and fusion models were as follows: 0.88, 1.00, and 1.00 for hepatic cysts; 0.81, 0.90, and 0.97 for hepatic hemangiomas; 0.89, 0.98, and 0.92 for hepatic abscesses; and 0.23, 0.80, and 0.93 for hepatic malignancies. The diagnostic accuracy rates for hepatic cysts, hemangiomas, malignancies, and abscesses by radiologists in the external testing cohort were 0.96, 0.60, 0.79, and 0.66, respectively. The fusion model based on noninvasive radiomics and clinical features of unenhanced CT images has high clinical value for distinguishing focal hepatic lesions.

A real-world comparison of the diagnostic performances of six different TI-RADS guidelines, including ACR-/Kwak-/K-/EU-/ATA-/C-TIRADS

PurposeTo compare the diagnostic performance of six different currently available guidelines including the American College of Radiology Thyroid Imaging and Reporting Data System (ACR-TIRADS), Kwak-TIRADS, Korean TIRADS (K-TIRADS), European TIRADS (EU-TIRADS), American Thyroid Association (ATA) and Chinese TIRADS (C-TIRADS), in differentiating malignant from benign thyroid nodules (TN). Materials and methodsIn this single-center study, between January-2007 and September-2023, ultrasound (US) images of TNs that were pathologically proven either by surgery or by fine needle aspiration biopsy (FNAB), were retrospectively evaluated and categorized according to six different currently available guidelines. Area under curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) and miss rates for malignancy (MRM) were calculated for each guideline. ResultsA total of 829 TNs (n = 234 malignant and n = 595 benign) were included. AUC, sensitivity, specificity, PPV, NPV and accuracy for ACR-TIRADS were 0.786, 99.8 %, 27.1 %, 31.92 %, 99.73 % and 54.6 %, respectively; for Kwak-TIRADS 0.839, 97.8 %, 42.1 %, 36.29 %, 98.11 % and 63.1 %, respectively; for K-TIRADS 0.797, 97.6 %, 41.6 %, 36.01 %, 84.85 % and 62.8, respectively, for EU-TIRADS 0.766, 97.8 %, 35.6 %, 33.89 %, 97.92 % and 59.1 %, respectively, for ATA 0.788, 97.5 %, 49.8 %, 32.86 %, 88.16 % and 64.2 %, respectively and for C-TIRADS 0.842, 0 %, 92.8 %, 54.3 %, 39.53 %, 90.42 %, and 68.8 % respectively. MRM regarding ACR-/Kwak-/K-/EU−/ATA-/C-TIRADS were 2.2 %, 0.5 %, 2.9 %, 2.5 %, 3.3 % and 0.1 %, respectively. ConclusionSix different currently available TIRADS guidelines can provide effective differentiation of malignant TNs from benign ones with similar diagnostic performances. However; C-TIRADS offered the highest AUC and the lowest MRM than the other guidelines, in this series.

Oncological Outcomes of Patients With Oral Potentially Malignant Disorders

Understanding the clinical course and malignant transformation rate of oral potentially malignant disorders (OPMDs)-including oral leukoplakia, oral erythroplakia, oral submucous fibrosis, and oral lichen planus-is crucial for early detection and improved survival rates in patients with oral cancer. To evaluate the progression of oral cancer from OPMDs using a large US electronic medical database. This retrospective cohort study used data from the University of California, San Francisco's PatientExploreR database between January 1973 and March 2024. Patients with oral leukoplakia, oral erythroplakia, oral submucous fibrosis, and oral lichen planus were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes and keywords. Demographics, tobacco and alcohol use, HIV status, and other known risk factors for oral cancer were recorded to identify factors associated with malignant transformation. Logistic regression and descriptive analyses were used. Diagnosis of oral leukoplakia, oral erythroplakia, oral submucous fibrosis, or oral lichen planus. Incidence of oral cancer, malignant transformation rate, median time to progression, and associations between demographics and risk factors and the development of oral cancer. Among 4 225 251 individuals in the database, 4371 were diagnosed with oral cancer (median [IQR] age, 63 [53-71] years; 2610 [59.9%] male; 0.1% of the cohort), and 110 (2.5%) had a preceding OPMD. Oral leukoplakia was found in 1124 patients, with 94 (8.4%) undergoing malignant transformation (median [IQR] time to progression, 25 [7-129] months). HIV-positive patients with oral leukoplakia were more likely to develop oral cancer (odds ratio, 3.80; 95% CI, 1.35-10.70). Of 22 patients with oral erythroplakia, 11 (50.0%) developed oral cancer (median [IQR] time to progression, 3.7 [0.2-334] months). Those who smoked tobacco with oral erythroplakia showed a higher malignant transformation rate (odds ratio, 3.75; 95% CI, 0.54-26.05). Of the 78 patients with oral submucous fibrosis, 4 (5.1%) underwent malignant transformation (median [IQR] time to progression, 36 [36-48] months). Only 1 patient with oral lichen planus developed oral cancer after 5 years. This cohort study showed that OPMDs have notable but varying propensities to progress to oral cancer. Early detection and monitoring of OPMDs are crucial for improving patient outcomes. However, the risk, etiopathogenesis, and clinical presentation vary for each OPMD and should, therefore, be considered distinct diseases.

The Influence of Age Factor and Industrial Area on The Malignancy Rate of Bone Tumours

Bone tumour is a term for a group of tumours located in the bones. World Health Organization data in 2020 stated that the incidence rate of bone sarcoma in the Americas and Europe was 0.8 per 100,000 population. Industrial development, especially in areas with high population density, has environmental impacts such as air pollution and contamination of water sources. This has been associated with an increase in the prevalence of bone tumours in children. However, studies on this matter are still limited. This study aims to analyze the effect of industrial areas and age factors on the level of bone tumour malignancy. This study used observational analytics with a case-control design. Osteosarcoma as the case variable and GCT as the control variable. The sample used was 106, consisting of 53 osteosarcoma tumours and 53 GCT tumours. Age classification is divided into 0-18 years and 319 years. Industrial area classification is divided into &lt;2.5 km and 32.5 km. Bivariate analysis using the chi square test. Has obtained approval from the Health Research Ethics Commission (KEPK) of RSUD dr. Moewardi with Number: 1.557/VI/HREC/2024. Results found no significant effect of age factor on the level of bone tumour malignancy (p-value=0.204). Meanwhile, an insignificant effect was also found between the proximity of residence to industrial areas on the level of bone tumour malignancy (p-value=0.121). This study shows that age factor and proximity of residence to industrial areas do not affect the level of bone tumour malignancy.

Advances in neoadjuvant therapy for resectable intrahepatic cholangiocarcinoma: An invited commentary

Abstract Intrahepatic cholangiocarcinoma (ICC) poses a significant threat to human health owing to its high malignancy rate and poor prognosis. Surgery is the most effective treatment option for ICC. However, the prognosis remains unfavorable even after surgical resection. Therefore, neoadjuvant therapy has emerged as a potential treatment option for patients with ICC. Neoadjuvant therapy can improve patient prognosis by reducing the tumor size and eliminating tiny lesions that are not visible to the naked eye. Nevertheless, specific treatment options for neoadjuvant therapy are unavailable. This review summarizes the studies on neoadjuvant therapy for ICC in the last decade, including chemotherapy, radiotherapy, interventional therapy, targeted therapy, and immunotherapy, with the aim of providing suggestions for the selection of clinical treatment options for patients with ICC. Current reports suggest that chemotherapy is the most effective neoadjuvant treatment option. However, radiotherapy and interventional therapies require further investigation to obtain conclusive recommendations. Although targeted therapies and immunotherapies have been studied less extensively, several ongoing clinical trials are investigating these promising approaches.

Unexpected Pathology During Pelvic Organ Prolapse Repair in an Urban Population.

This study quantifies the occult pathology risk among our urogynecologic patient population and highlights the importance of preoperative counseling, particularly in patients who have been underrepresented in prior studies. The aim of the study was to estimate unexpected gynecologic pathology incidence among a low-risk, racially, and ethnically representative patient population undergoing surgery for symptomatic pelvic organ (POP) prolapse. This was a retrospective study of patients undergoing hysterectomy for POP at an urban academic medical center. Patients with abnormal preoperative pathologic evaluation were excluded. Data were abstracted from the electronic health record, including demographic and clinical history, preoperative laboratory evaluation, and clinical risk factors for gynecologic malignancy. Two hundred ninety-nine nononcologic patients who underwent POP repair with hysterectomy were assessed. Thirty-six percent of patients identified as Hispanic, 17% as non-Hispanic Black, and 38% as non-Hispanic White. Twenty-three percent of patients reported abnormal uterine bleeding, 36% underwent a preoperative ultrasound examination, and 15% underwent endometrial biopsy. Two patients (0.9%) were diagnosed with endometrial carcinoma. Two patients (0.9%) were diagnosed with cervical dysplasia. No patients with concurrent oophorectomy or salpingectomy had ovarian or tubal pathology. The overall incidence of unexpected gynecologic pathology at the time of hysterectomy for prolapse was 1.7%. The rate of endometrial cancer in our cohort is on the higher end of previously published data, although absolute rates of unanticipated malignancy remain low. Future studies should examine the pathological findings of larger, racially, and ethnically diverse cohorts of patients undergoing POP surgery with hysterectomy, which can aid in providing relevant estimates for preoperative counseling.

Node-RADS: a systematic review and meta-analysis of diagnostic performance, category-wise malignancy rates, and inter-observer reliability.

To perform a systematic review and meta-analysis to estimate diagnostic performance, category-wise malignancy rates, and inter-observer reliability of Node Reporting and Data System 1.0 (Node-RADS). Five electronic databases were systematically searched for primary studies on the use of Node-RADS to report the possibility of cancer involvement of lymph nodes on CT and MRI from January 1, 2021, until April 15, 2024. The study quality was assessed by modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Quality Appraisal of Diagnostic Reliability (QAREL) tools. The diagnostic accuracy was estimated with bivariate random-effects model, while the pooled category-wise malignancy rates were obtained with random-effects model. Six Node-RADS-CT studies and three Node-RADS-MRI studies covering nine types of cancer were included. The study quality was mainly damaged by inappropriate index test and unknown timing according to QUADAS-2, and unclear blindness during the rating process according to QAREL. The area under hierarchical summary receiver operating characteristic curve (95% conventional interval) was 0.92 (0.89-0.94) for Node-RADS ≥ 3 as positive and 0.91 (0.88-0.93) for Node-RADS ≥ 4 as positive, respectively. The pooled malignancy rates (95% CIs) of Node-RADS 1 to 5 were 4% (0-10%), 31% (9-58%), 55% (34-75%), 89% (73-99%), and 100% (97-100%), respectively. The inter-observer reliability of five studies was interpreted as fair to substantial. Node-RADS presented a promising diagnostic performance with an increasing probability of malignancy along higher category. However, the evidence for inter-observer reliability of Node-RADS is insufficient, and may hinder its implementation in clinical practice for lymph node assessment. Question Node-RADS is designed for structured reporting of the possibility of cancer involvement of lymph nodes, but the evidence supporting its application has not been summarized. Findings Node-RADS presented diagnostic performance with AUC of 0.92, and malignancy rates for categories 1-5 ranged from 4% to 100%, while the inter-observer reliability was unclear. Clinical relevance Node-RADS is a useful tool for structured reporting of the possibility of cancer involvement of lymph nodes with high diagnostic performance and appropriate malignancy rate for each category, but unclear inter-observer reliability may hinder its implementation in clinical practice.

Long-Term Follow-Up After Non-Curative Endoscopic Submucosal Dissection for Early Gastrointestinal Cancer-A Retrospective Multicenter Analysis.

Background: Endoscopic Submucosal Dissection (ESD) has become the standard therapy for early malignant lesions in the gastrointestinal tract and has shown as good oncological surgery results. Approximately 30% of ESDs do not meet the criteria for oncological curability, and upfront surgery is indicated. Hence, about 40% of patients with an indication for surgery are advised against surgery because of comorbidities and an advanced age. Methods: We performed a multicenter retrospective cohort study on the long-term outcomes of non-curative ESDs, performed between 2009 and May 2024, without additional tumor therapy. The primary outcome was the recurrence of malignancy, either local malignancy or lymph node metastasis during follow-up, or death. We compared the outcomes between two cohorts: after non-curative ESD (ncESD) and after curative ESD (cESD). Results: A total of 374 ESDs were analyzed in this study. Overall, the technical success rate was 91%, and the oncological curative resection criteria were met in 70.9% of patients. Severe complications occurred in 5% of cases without procedure-associated mortality. In the ncESD group, 20% (7/35) of patients had a recurrence of malignancy primarily due to positive horizontal margins in the resection specimens, and 3 out of 35 died due to a non-oncological reason during the follow-up (mean length 36.6 months). In the cESD group, 3% (1/33) of patients had tumor recurrence, and 1 patient died because of a non-oncological reason. The tumor recurrence rate between the cohorts was significant (p = 0.017), and overall mortality did not show significance (p = 0.33). Conclusions: Especially in the elderly and multimorbid patients, the recommendation to perform rescue surgery after non-curative ESD remains challenging. Residual malignancy rates in surgical resection specimens are low, recurrence rates of malignancy are low, and mortality rates for non-oncological reasons are high in this population. There is a need for more data for the individualization of patient management after non-curative ESD.

A Clinicopathologic Study of 1598 Ultrasound-Guided Needle Prostate Biopsies and Trends in Prostate Cancer Over a 14-Year Period

BackgroundProstate cancer manifests in various forms, ranging from occult and localized to metastatic disease. Analyzing prostate biopsies offers insights into histopathological characteristics, enhancing disease understanding and management. MethodsThis 14-year study reviewed ultrasound-guided needle prostate biopsies, collecting data via questionnaires and medical records, focusing on Gleason group, tumor involvement percentage, and predicted cancer stage. A comparative analysis across 2 distinct 7-year intervals was conducted. Statistical analyses included the Kolmogorov–Smirnov test, chi-square test, Fisher's exact test, and Analysis of Covariance, all performed using SPSS software. ResultsAmong 1,598 biopsies, 624 cases of adenocarcinoma were identified. Malignancy incidence significantly correlated positively with age, prostate-specific antigen (PSA), and PSA density (PSAD), and inversely with prostate volume and the free-to-total PSA ratio (%fPSA). Notably, 30.8% of malignancies were classified as Gleason groups 4 or 5, displaying significantly higher PSA levels. Patients with prior transurethral resection of the prostate exhibited increased malignancy rates and higher Gleason groups. Diagnostic accuracy, measured by Area Under the Curve, was 0.719 for PSA, 0.730 for %fPSA, and 0.817 for PSAD. The later phase of the study showed higher cancer detection, lower PSA levels, and a greater incidence of higher Gleason groups despite a lower predicted stage. ConclusionThe prevalence of higher Gleason groups was similar to other studies. PSAD demonstrated greater diagnostic reliability than PSA alone. Additionally, higher malignancy rates and Gleason groups were observed in patients with prior transurethral resection of the prostate. The increase in cancer detection rates during the second period likely indicates improved biopsy candidate selection.

Assessment of Nonmass Lesions Detected with Screening Breast US Based on Mammographic Findings.

Background Breast nonmass lesions (NMLs) are observed at screening and diagnostic US. However, knowledge is limited on imaging features of NMLs at screening US. Purpose To identify features of NMLs at screening US that are suspicious for malignancy based on mammographic findings. Materials and Methods This retrospective, multicenter study included asymptomatic women who underwent screening US between January 2012 and December 2019. Eligible women had NMLs at US, concurrent screening mammography, and record of a final diagnosis. Logistic regression analyses were used to identify factors associated with malignancy. The diagnostic performance of each sonographic feature according to mammographic findings was calculated. A reader study was performed to assess interreader agreement for sonographic features. Results Among 993 NMLs in 993 patients (mean age, 50 years ± 9 [SD]), 914 (92.0%) were benign and 79 (8.0%) were malignant. Mean size was larger for malignant NMLs than for benign NMLs (2.6 cm ± 1.1 vs 1.9 cm ± 0.8; P < .001). In multivariable analysis, associated calcifications (odds ratio [OR], 21.6 [95% CI: 8.0, 58.2]; P < .001), posterior shadowing (OR, 6.9 [95% CI: 2.6, 18.4]; P < .001), segmental distribution (OR, 6.2 [95% CI: 2.7, 14.4]; P < .001), mixed echogenicity (OR, 5.0 [95% CI: 1.8, 14.0]; P < .001), and size (OR, 1.5 [95% CI: 1.1, 2.1]; P = .01) at US were associated with malignancy. Associated calcifications, posterior shadowing, segmental distribution, and mixed echogenicity showed positive predictive values (PPVs) of 44%, 22%, 22.9%, and 16.6%, respectively. Having a negative mammogram was associated with a lower malignancy rate (2.8% vs 28.8%) and lower PPVs for sonographic features (0.7%-10.4% vs 24%-55%) than having a positive mammogram. Interreader agreement for sonographic features was good to excellent (Fleiss κ 95% CI lower bound range, 0.63-0.81). Conclusion Calcifications, posterior shadowing, segmental distribution, and mixed echogenicity associated with NMLs can be considered suspicious features for malignancy at screening US. As malignancy rates and PPVs differ according to mammographic abnormalities, combined assessment is mandatory. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Grimm in this issue.

Loss of Follow-up for Thyroid Nodules in Patients Living in Poverty

IntroductionInadequate surveillance of thyroid nodules can lead to cancer progression. This study examines patient characteristics that correlate with failure to follow up after thyroid nodule detection. MethodsWe performed a retrospective analysis of patients who underwent fine needle aspiration for thyroid nodules and studied subsequent thyroid ultrasounds, clinic visits, and thyroidectomies longitudinally. Poverty areas are census tracts where at least 20% of residents live below the poverty line. Logistic regression was used to assess associations between patient characteristics and follow-ups, with results expressed as odds ratios (ORs) and 95% CIs. ResultsOf 2446 patients included, the majority were White (62.6%) and female (78.5%), with an average age of 55 ± 16 years. 28% patients were from high poverty areas. Benign findings (Bethesda II) were observed in 73.5% of the biopsies. 42.5% of patients underwent at least one follow-up ultrasound, 59% had at least one clinic visit, and 24.4% underwent a thyroidectomy, with a 34.8% malignancy rate on surgical pathology. Patients from high poverty areas were significantly less likely to receive follow-up ultrasounds (35.7% vs 45.9%, P < .001) or clinic visits (53.7% vs 61.2%, P = .001). Multivariable analysis revealed that poverty was significantly associated with not having follow-up in all patients (OR = 0.78, 95% CI 0.64-0.96) and non-benign biopsy (Bethesda 3 or higher) results (OR = 0.44, 95% CI 0.24-0.81). ConclusionThere is a notable disparity in the follow-up of thyroid nodules, with patients from high poverty areas being more susceptible to loss of follow-ups.

The Value of Second-look Ultrasound and Mammography for Assessment and Biopsy of MRI-detected Breast Lesions

Rationale and ObjectivesSuspicious lesions detected in multiparametric breast MRI can be further analyzed with second-look ultrasound (SLUS) and/or mammography. This study aims to assess the value of second-look imaging in selecting the appropriate biopsy method for different lesion characteristics. Materials and MethodsBetween January 2021 and December 2023, 212 women underwent contrast-enhanced multiparametric breast MRI at 3.0 Tesla. A total of 241 suspicious lesions (108 malignancies, 44.8%) were further assessed with SLUS and second-look mammography. Subsequent image-guided biopsy of each lesion was performed using the most suitable modality. Size-dependent lesion detection rates in SLUS and mammography were compared by means of the McNemar test. ResultsLesions referred to MRI-guided biopsy were predominantly ≤ 10 mm in size (52.8%). SLUS displayed higher detection rates than mammography for mass lesions (55.6% [95% confidence interval 46.4–64.4%] versus 16.7% [10.6–24.3%]; p<0.001) with a particularly high sensitivity for malignant mass lesions > 10 mm (88.5 % [69.9–97.6%]). In contrast, the detection rate for malignant non-mass lesions was lower in SLUS than in second-look mammography (22.0% [11.5–36.0%] versus 38.0% [24.7–52.8%]; p<0.001). The malignancy rates in ultrasound-, mammography-, and MRI-guided biopsies were 53.7%, 55.2%, and 35.0%, respectively. ConclusionSLUS is an excellent tool for further assessment and biopsy of suspicious mass lesions > 10 mm without associated calcifications. In contrast, supplemental ultrasound is of limited value in the evaluation and biopsy guidance of suspicious non-mass lesions compared to second-look mammography.

Health status and quality of life before critical illness: Northern Finland Birth Cohort 1966 study.

Previous findings support the claim intensive care unit (ICU) patients have a higher rate of comorbidities and reduction of health- and functional status compared with the normal population. In this prospective observational study, our aim was to determine those health-related factors at the age of 31 years which were associated with a later critical illness among previously un-hospitalized individuals by exploring data obtained from the Northern Finland Birth Cohort 1966 (NFBC1966). NFBC1966 is a Finnish birth cohort, which includes 12,058 live births with expected dates of delivery during 1966. The study was conducted among cohort participants who had not been hospitalized for any reason before the cohort follow-up visit at the age of 31. The study group included NFBC1966 participants who were admitted to the ICU of the Oulu University Hospital. The control group included participants who were treated for any reason in regular hospital wards. The data considering the participants' health status and behavior at the age of 31 were collected from the NFBC1966 database. The gathering of ICU and hospitalization data was concluded on December 31, 2016. 849 NFBC1966 participants met the inclusion criteria: 69 were treated in the ICU (study group) and 780 on regular hospital wards (controls). In the study group, the rate of neurological diseases (26% vs. 16%, 95% CI: -21.8%, -0.2%), malignancy (3% vs. 0.7%, 95% CI: -9.7%, 0.0%), alcohol abuse (4.5% vs. 1%, 95% CI: -11.5%, -0.3%) and smoking (77% vs. 65%, 95% CI: -21.6%, -0.3%) were higher compared with the control group. The patients in the ICU group were also more prone to violent injuries, (17% vs. 7%, 95% CI: -20.2%, -1.9%), practiced less hard physical activity (65% vs. 78%, 95% CI: 2.1%, 25.3%) and had lower maximal muscle strength according to the hand grip test (30 vs. 34 kg, 95% CI: -8.2, 8.6 kg). In this study examining previously un-hospitalized patients, the main factors associated with future critical illness were neurological comorbidities, malignancy, alcohol misuse, smoking, low maximum muscle strength, and less frequent physical exercise compared with those with hospitalization not requiring ICU admission.

Evolving epidemiology of non-alcoholic fatty liver disease in South Korea: incidence, prevalence, progression, and healthcare implications from 2010 to 2022.

Non-alcoholic fatty liver disease (NAFLD), now the most common chronic liver worldwide, has become a significant public health concern. This study aims to analyze the evolving epidemiology of NAFLD in South Korea. We utilized claim data from the Korean National Health Insurance Service from 2010 to 2022 to analyze NAFLD's incidence, prevalence, and progression. From 2010 to 2022, the incidence and prevalence rates of NAFLD each increased from 1.87% to 4.47% and from 10.49% to 17.13%, respectively. The differences in prevalence rates between urban and rural areas were minimal in 2012 and 2022, yet both areas showed significant increases in the prevalence of NAFLD over the decade. The NAFLD group had a higher prevalence of comorbidities compared to the control group, and the most common comorbid condition was hypertension. Moreover, the ten-year incidence rates of malignancy, heart disease, and stroke in the NAFLD group were 13.42%, 15.72%, and 8.36%, respectively, which were significantly higher than those in the control group. The incidence rates of cirrhosis and hepatocellular carcinoma in NAFLD over 10 years were 2.22% and 0.77%, respectively. The total medical costs of NAFLD patients more than doubled over ten years and were all significantly higher than those of the control group. A significant increase in NAFLD prevalence and its impact on healthcare utilization was observed in South Korea. With NAFLD leading to serious liver diseases and increased healthcare costs, integrated care strategies that include both medical treatment and lifestyle modifications are essential.

Towards optimized biopsy use in vertebral compression fractures: integrating risk assessment for better clinical decision-making.

Tissue biopsy is the gold standard for differentiating osteoporotic vertebral compression fractures from malignant lesions. However, the necessity of routine biopsies during percutaneous vertebroplasty and kyphoplasty is debated due to the low malignancy detection rates. This study aims to identify key predictors of positive biopsy outcomes in patients undergoing these procedures, with the goal of refining biopsy selection criteria to enhance diagnostic yield and improve clinical decision-making. We conducted a retrospective cohort study involving 295 patients who underwent percutaneous vertebroplasty and kyphoplasty with biopsy between June and December 2023. Clinical data, including age, gender, fracture aetiology, imaging findings, and biopsy results, were collected. Binary logistic regression analysis was employed to identify significant predictors of positive biopsy outcomes. The biopsy results revealed an overall malignancy rate of 1.01% (3/295). Among the 17 cases with abnormal (positive) biopsy findings, 17.6% were malignant, while the remainder were benign. Significant predictors included age (OR = 0.936), gender (OR = 0.307 for males), fracture aetiology (OR = 5.300 for fractures with no apparent cause), and imaging abnormalities (OR = 8.388). This study underscores the low malignancy detection rate in routine biopsies for vertebral compression fractures, advocating for a more selective approach by reserving biopsies for patients with specific high-risk factors. A targeted biopsy strategy, informed by enhanced pre-operative screening, could improve diagnostic accuracy and treatment outcomes, optimizing clinical management.