Malignancy Risk Stratification Research Articles

Lack of effect of renal function on uptake of 99mTc-sestamibi in renal masses.

The appropriate clinical management of indeterminate small renal masses can be improved based on accurate risk stratification. This study aimed to investigate the impact of renal function on the uptake of technetium-99m (99mTc)-sestamibi, a widely available imaging agent that can be utilized to identify oncocytomas and other benign/indolent renal masses. A retrospective cohort study was conducted, involving 100 consecutive patients who underwent 99mTc-sestamibi single-photon emission computed tomography/computed tomography. Renal function was evaluated based on creatinine levels and glomerular filtration rate (GFR). Statistical analyses, including correlation and regression analyses, were performed to explore the relationship between renal function and 99mTc-sestamibi uptake. The results revealed that discrepancies can occur between imaging and pathology results, emphasizing the need for careful interpretation of imaging findings. Correlation analysis demonstrated no significant correlation between relative tumor uptake of 99mTc-sestamibi and GFR or serum creatinine levels. These findings highlight the relative independence of renal function and 99mTc-sestamibi uptake and suggest sestamibi may be of use even in patients with relatively poor renal function. However, further research with larger sample sizes is required to validate and generalize these findings. Ultimately, understanding the broad variety of applicability of 99mTc-sestamibi uptake for risk stratification of renal malignancy could aid in appropriate clinical decision-making.

Size threshold as a risk for malignant transformation in typical ovarian dermoid lesions: a scoping review.

The O-RADS malignancy risk stratification of typical ovarian dermoid cysts by using a 10cm threshold is based on expert consensus rather than analysis of objective clinical data. This comprehensive scoping review consolidated all currently available studies evaluating typical benign ovarian dermoid cyst size and risk for malignant transformation. A systematic review of MEDLINE, Embase, Scopus and the Cochrane library was performed from inception to January 14, 2024, using PRISMA-ScR guidelines. A grey literature search and forward searching of reference lists from included studies were performed. Case reports and case series evaluating dermoid cyst size and malignant transformation as defined by a pathological reference standard were included. Data synthesis was provided as a qualitative review of the existing literature. Twenty-five studies were included in qualitative synthesis comprising 6 case reports and 19 retrospective studies with a total of 15,295 dermoid cysts. Of these, 215 lesions demonstrated malignant transformation. Studies reporting dermoid size with malignant transformation ranged from 1 to 32cm with 46/173 (27%) total malignant transformation lesions measuring < 10cm. Solid enhancing components were infrequently reported but all measured > 1cm when described. More than 25% of dermoid cysts with malignant transformation may be classified as "almost certainly benign" with the current 10cm O-RADS malignancy risk threshold. Although surveillance of O-RADS 2 dermoid cysts may improve sensitivity, modifying a caveat recommendation for MRI O-RADS +/- gyn-oncologist referral when potentially solid components are present in otherwise typically benign dermoid cysts may be appropriate.

Malignancy risk stratification prediction of BI-RADS 4B calcifications based on contrast-enhanced mammographic features: a multicenter study

PurposeThis study aims to investigate the factors influencing the malignant risk of BI-RADS 4B calcification-only lesions detected on Contrast-Enhanced Mammography (CEM) and to develop a predictive model for stratifying malignant risk.MethodsA retrospective analysis was conducted on 131 calcification-only lesions of BI-RADS 4B identified on low-energy (LE) images of CEM from 125 females between March 2017 and April 2023 at three institutions. The patients were grouped as training (95 lesions) and external validation sets (36 lesions). On LE images, morphological features of the calcifications, including morphology, distribution and size, were evaluated. On recombined images, the presence and types of enhancement were assessed as qualitative variables, and the grey values from lesion areas and background were measured as quantitative variables. Multivariate logistic regression analysis was used to construct a predictive model. The discrimination of the model was assessed by the receiver operating characteristic (ROC) curve and confirmed by the external validation set.ResultsOf the 131 lesions, 43 were malignant. The morphology, distribution, the presence and types of enhancement and the grey values of calcifications showed significant differences between benign and malignant lesions. The nomogram was developed based on morphology and the presence of enhancement, with areas under the ROC curve of 0.859 (95% confidence interval [CI]: 0.769, 0.949) and 0.856 (95% CI: 0.729, 0.983) in the training and external validation sets, respectively.ConclusionOn CEM, the presence of enhancement and morphology were identified as independent predictors of malignant calcifications of BI-RADS 4B. The predictive model demonstrated favorable performance.

Learning curve: machine learning takes on pediatric hematologic malignancy risk-stratification.

Learning curve: machine learning takes on pediatric hematologic malignancy risk-stratification.

Oral Bacterial Lysate OM-85: Advances in Pharmacology and Therapeutics.

Bacterial lysates are known for having immunomodulatory properties and have been used mainly for the prevention and treatment of respiratory tract infections (RTIs). However, rigorous studies are needed to confirm the clinical efficacy of bacterial lysates with various bacterial antigen components, preparation methods, administration routes and course of treatment. OM-85, an oral standardized lysate prepared by alkaline lysis of 21 strains from 8 species of common respiratory tract pathogens, is indicated as immunotherapy for prevention of recurrent RTIs and acute infectious exacerbations of chronic bronchitis. OM-85 acts on multiple innate and adaptive immune targets and can restore type 1helper T (Th1)/Th2 balance. Sporadic studies have shown advances in pharmacology and therapeutics of OM-85, and thus an update review is necessary. Literature was retrieved by searching PubMed, Web of science, Embase, CNKI, and Full Text Database of Chinese Medical Journals. New roles of OM-85 were discovered in prevention and treatment of lung cancer, pulmonary tuberculosis, SARS-CoV-2 infection, allergic rhinitis, pulmonary fibrosis, atopic dermatitis, and nephrotic syndrome. Pharmacoeconomic values of OM-85 were demonstrated in prophylaxis and treatment of RTIs, chronic obstructive pulmonary disease, asthma, chronic bronchitis, rhinosinusitis and allergic rhinitis. Two consecutive courses of OM-85 (6 or 12 months apart) could prevent recurrent RTIs in children. Maternal OM-85 treatment could offer benefits for offspring. Product-specific response was observed. The efficacy of OM-85 may be associated with patient's characteristics (eg, severity of the disease, age, immune response pattern, malignancy risk stratification). OM-85 can improve effectiveness of standard care for some primary diseases, and carry significant pharmacoeconomic implications. The benefits shown by OM-85 in vitro and in vivo, when extrapolated to humans, are exciting but also require caution. Individualized treatment may need to be considered. It is necessary to compare the efficacy and safety of various bacterial lysate preparations.

Beyond malignancy risk stratification: FNAC report anticipates thyroid cancer staging. Insights from recent studies.

Fine-needle-aspiration-cytology (FNAC) is safe and cost-effective procedure for evaluating thyroid nodules. The non-negligible rate of indeterminate cytology (ITN), warrants diagnostic surgery for histological assessment, in some cases. Two recent studies (from Europe and the U.S.) reported that the clinical behavior of a histologically proven thyroid cancer (TC) varies according to its pre-surgical FNAC results. Despite differences in study design, inclusion criteria, and the use of different cytology classification systems (Italian and Bethesda), the overall results were comparable. In order to further discuss these results and to provide additional perspective on the topic, the senior authors of the two studies invited other thyroid experts and cytologists not involved in the previous studies to participate in the present commentary. The strong, consistent clinical message that emerges, especially regarding PTC, is that TC with an initial diagnosis of ITN has a less aggressive clinical presentation, lower rates of: i) lymph-node metastasis; ii) more aggressive variants; iii) BRAFV600E mutations, as compared with DTC with an initial diagnosis of "suspicious for malignancy" or "malignant". These results were consistent in both studies and strongly point toward a more indolent clinical phenotype of DTC with a preoperative diagnosis of ITN as opposed to suspicious for malignancy or malignant. Further understanding the clinical implications of these data appears of clinical relevance and will be discussed from both the endocrinologist and cytologist point of view. The here overviewed data provide the foundation for beginning to examine the impact of less aggressive therapies for TC with an initial ITN diagnosis.

Clinical, ultrasound and anatomopathological concordance of thyroid nodules in Kinshasa: a cross-sectional study

BackgroundThe European Thyroid Association Thyroid Imaging Data and Reporting Systems (EU-TIRADS) is widely used in the risk stratification of thyroid nodule malignancy. However, data on the subject in Sub-Saharan Africa are limited. The objective of this study is to evaluate the clinical, sonographic and histopathological concordance of thyroid nodules in the diagnosis of thyroid cancer.MethodsThis was an analytical cross-sectional study that examined the clinical, ultrasound and pathological data of 61 patients from 4 hospitals in the city province of Kinshasa over a period of 24 months, from June 01, 2020 to May 31, 2022.ResultsOf the 61 patients, their mean age was 47.38 ± 8.8 years. The mean clinical score of the patients was 3.4 ± 0.84 with the extremes ranging from 1 to 5. The majority of the patients were classified as having an intermediate risk, ie 85.2% of the cases. It was noted that 41% of the nodules had a high risk according to the EU-TIRADS score and 8.2% of the nodules were malignant after histopathological analysis. The ROC curves reported at the diagnosis of malignancy show an area under the curve of 0.709 with 95% CI (0.486–0.931), a Youden index of 0.769 for the clinical score, and an area under the curve of 0.830 with 95% CI (0.605–0.995), a Youden index of 0.772 for the EU-TIRADS score.ConclusionIn a low-income country, a well-performed thyroid ultrasound and the well-applied clinical score could be an important tool in the selection of thyroid nodules suspected of malignancy and requiring histopathological examination to avoid excessive acts in the patient.

Assessing the transportability of radiomic models for lung cancer diagnosis: commercial vs. open-source feature extractors.

Radiomics has shown promise in improving malignancy risk stratification of indeterminate pulmonary nodules (IPNs) with many platforms available, but with no head-to-head comparisons. This study aimed to evaluate transportability of radiomic models across platforms by comparing performances of a commercial radiomic feature extractor (HealthMyne) with an open-source extractor (PyRadiomics) on diagnosis of lung cancer in IPNs. A commercial radiomic feature extractor was used to segment IPNs from computed tomography (CT) scans, and a previously validated radiomic model based on commercial features was used as baseline (ComRad). Using same segmentation masks, PyRadiomics, an open-source feature extractor was used to build three open-source radiomic models (OpenRad) using different methods: de novo open-source model derived using least absolute shrinkage and selection operator (LASSO) for feature selection, selecting open-source features matched to ComRad features based upon Imaging Biomarker Standardization Initiative (IBSI) nomenclature, and selecting open-source features most highly correlated to ComRad features. Radiomic models were trained on an internal cohort (n=161) and externally validated on 3 cohorts (n=278). We added Mayo clinical risk score to OpenRad and ComRad models, creating integrated clinical radiomic (ClinRad) models. All models were compared using area under the curve (AUC) and evaluated for clinical improvement using bias-corrected clinical net reclassification indices (cNRIs). ComRad AUC was 0.76 [95% confidence interval (CI): 0.71-0.82], and OpenRad AUC was 0.75 (95% CI: 0.69-0.81) for LASSO model, 0.74 (95% CI: 0.68-0.79) for Spearman's correlation, and 0.71 (95% CI: 0.65-0.77) for IBSI. Mayo scores were added to OpenRad LASSO model, which performed best, forming open-source ClinRad model with AUC of 0.80 (95% CI: 0.74-0.86), identical to commercial ClinRad's AUC. Both ClinRad models showed clinical improvement compared to Mayo alone, with commercial ClinRad achieving cNRI of 0.09 (95% CI: 0.02-0.15) for benign and 0.07 (95% CI: 0.00-0.13) for malignant, and open-source ClinRad achieving cNRI of 0.09 (95% CI: 0.02-0.15) for benign and 0.06 (95% CI: 0.00-0.12) for malignant. Transportability of radiomic models across platforms directly does not conserve performance, but radiomic platforms can provide equivalent results when building de novo models allowing for flexibility in feature selection to maximize prediction accuracy.

A multi-center study of malignancy risk stratification of indeterminate thyroid fine needle aspiration cytologies based on mirna expression

A multi-center study of malignancy risk stratification of indeterminate thyroid fine needle aspiration cytologies based on mirna expression

Sydney Reporting System for Lymph Node Fine-Needle Aspiration and Malignancy Risk Stratification: Is It of Clinical Value?

Lymphadenopathy is a common presentation of both reactive and malignant diseases, and lymph node fine-needle aspiration cytology (LN-FNAC) is an effective and inexpensive screening method. It can prevent unnecessary invasive surgery and excisional biopsy, especially in benign cases. Unfortunately, the lack of universally accepted terminology for reporting results has hindered its widespread support. The Sydney system proposal for lymph node cytopathology categorization and reporting introduced five diagnostic categories to address the lack of universally accepted terminology for reporting results in lymphadenopathy. Our study analyzed 188 lymph node fine-needle cytology (FNC) samples from King Abdulaziz University Hospital, Saudi Arabia, examining clinical follow-up data, pathology records, patient information, and final diagnosis from January 2019 to December 2022. Most specimens were from axillary lymph nodes, with 99.5% tissue correlation. The Sydney system category classification identified 56.9% of cases as malignant, while 26.1% were benign. The final surgical specimen diagnosis revealed a higher percentage of malignant diagnoses, with the highest risk of malignancy (ROM) in malignant/category V. In conclusion, our study demonstrates that LN-FNAC offers high diagnostic accuracy for lymph node (LN) aspirates, with the Sydney approach potentially aiding risk stratification and achieving consistency in cytologic diagnosis, but further multi-centric research is needed.

Effects of the Paris System on the Unsatisfactory Category in a Cytohistologic Correlation Study of Patients With Urothelial Carcinoma.

The main objectives of the Paris System are to detect high-grade urothelial carcinoma, to standardize morphologic criteria and the cytopathologic report, to reduce the prevalence of the atypia category, and to improve the malignancy risk stratification. To compare the results and sensitivity of cytologic classification before and after reclassification by the Paris System. Urinary cytology samples from patients with a histologic diagnosis of urothelial carcinoma were reclassified on the basis of the Paris System categories. The diagnoses before reclassification were divided into 5 categories (A, B, C, D, E) and compared with the Paris System (I, II, III, IV, V). Sensitivity was calculated considering cytohistologic agreement in relation to high-grade urothelial carcinoma. A total of 111 urinary cytology samples from patients were analyzed, corresponding to 40 histologic samples; of these, 12 (30%) were high grade and the remaining were low grade. Comparison of the correlated categories showed an increase from 3 (3 of 111; 2.7%) (A) to 31 (31 of 111; 27.9%) (I) in unsatisfactory cases and a decrease from 67 (67 of 111; 60,0%) to 30 (30 of 111; 27.0%) in negative cases, while the atypia category remained unchanged (15 cases [15 of 111; 13.5%]) (C and III). Suspicious cases increased from 5 (5 of 111; 4.5%) (D) to 14 (14 of 111; 12.6%) (IV) and cases of urothelial carcinoma were unchanged (21 cases [21 of 111; 18.9%]) (E and V). Sensitivity was 69% for the previous classification and 90% for the Paris System. The Paris System improved the sensitivity of urinary cytology and the standardization of the unsatisfactory criteria, with an increase of cases in this category and a decrease of cases previously classified as negative among patients with a subsequent histologic diagnosis of urothelial carcinoma.

Prediction of malignant risk stratification model for parotid gland nodules based on clinical and conventional ultrasound features: construction and validation.

Ultrasound is widely used in the examination of the parotid gland, but no single ultrasound feature has demonstrated satisfactory diagnostic performance in predicting the nature of parotid nodules. Unlike the established and widely used grading systems for breast and thyroid nodules, a universally adopted and clinically accepted risk stratification system for malignancy in parotid gland nodules remains absent at present. This study aims to establish a malignant risk stratification model for parotid nodules by analyzing patients' clinical features and conventional ultrasound image characteristics. In this study, clinical data and ultrasound images of 736 patients with parotid nodules were retrospectively analyzed. Pathological results served as the gold standard, and the patients were randomly divided into training and validation groups in a 7:3 ratio. Clinical and ultrasound features of parotid nodules in the training group were compared. Multifactor logistic regression analysis was employed to screen for risk factors of malignant nodules and quantify scores. The probability of malignant risk was assessed and classified into five grades (Grade 1, normal parotid; Grade 2, definitive benign; Grade 3, possibly benign; Grade 4, suspicious malignant; Grade 5, high probability of malignancy). The diagnostic performance of the model was assessed by using calibration curves, receiver operating characteristic curves, decision curves, and clinical impact curves. Facial symptoms, unclear margin, irregular shape, microcalcification, and abnormal cervical lymph nodes were independent risk factors for malignant parotid nodules. The area under the curve of the model was 0.850 [95% confidence interval (CI): 0.816-0.879] in the training group and 0.846 (95% CI: 0.791-0.891) in the validation group. The malignancy risk stratification model based on clinical and ultrasound image features has a good differentiation between benign and malignant parotid nodules, which is helpful for diagnosis and guiding clinical treatment.

Assessment of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS™) with modification of the management recommendations for pediatric thyroid nodules.

Thyroid nodules are unusual in children, but when present, they carry a higher risk for malignancy, as compared to adults. Several guidelines have been created to address the risk stratification for malignancy of thyroid nodules in adults, but none has been completely validated in children. A few authors have proposed lowering the size threshold to the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS™) management guidelines to decrease missed carcinomas at presentation in children; however, little information is known regarding their accuracy. To assess the performance of proposed modifications of the ACR TI-RADS™ size criteria to guide management decisions in pediatric thyroid nodules and to assess the associated increase in number of fine needle aspiration (FNA) and follow-up exams. This is a retrospective study of children under 18years old who underwent ultrasound assessment of a thyroid nodule at a tertiary care pediatric institution between January 2006 and August 2021. The largest dimension, maximum ACR TI-RADS™ score, and final thyroid nodules' diagnoses were documented. The course of action based on the adult ACR TI-RADS™ and after modifying the size threshold for management recommendations was documented and compared. Statistics included descriptive analysis, weighted Kappa statistics, sensitivity, specificity, accuracy, and positive/negative predictive values of the ACR TI-RADS™ presented with 95% confidence intervals (CI) using either Clopper-Pearson or standard logit methods. Of 116 nodules, 18 (15.5%) were malignant. Most malignant nodules (94.4%, n = 17) were ACRTI-RADS™ 4 and ACRTI-RADS™ 5 categories. Based on the adult ACR TI-RADS™ criteria, 24 (24.5%) benign and 15 (83.3%) malignant nodules would have undergone FNA; 14 (14.3%) benign and 3 (16.7%) malignant nodules would have been followed up; and 60 (61.2%) benign and none of malignant nodules would have been dismissed. Three (16.7%) malignant nodules would not have been recommended FNA at presentation, delaying their diagnoses. By lowering the size-threshold criteria of the ACR TI-RADS™ guidelines, no malignancy would have been missed at presentation, but this also resulted in a higher number of FNA from 24 (24.5%) to 36 (36.7%) and follow-up ultrasound exams from 14 (14.3%) to 62 (63.3%). Applying potential modifications to the ACR TI-RADS™ guideline lowering the size threshold criteria of the thyroid nodule to guide management decisions for pediatric thyroid nodules can lead to early detection of malignant nodules in children, but at the cost of a significantly increased number of biopsies or ultrasound exams. Further tailoring of the guideline with larger multicentric studies is needed, before warranting its acceptance and general use in the pediatric population.

Superb microvascular imaging (SMI) and elastosonography in thyroid nodule: diagnostic value in a real-time cohort

PurposeIn clinical practice, thyroid nodules are classified according to TI-RADS by B-mode and color-flow Doppler study. The aim of the study is to evaluate the possible added value of Superb microvascular imaging (SMI) and elastosonography in the stratification of malignancy risk of thyroid nodules.MethodsAll patients with thyroid nodules who were candidates for needle aspiration were enrolled. Experienced operators performed a standard examination with TI-RADS calculation, followed by SMI and elastosonography on the nodules. The needle aspiration outcome was used as the gold standard. Statistical analysis calculated the ROC curves of the techniques applied individually and serially.ResultsIn this prospective study, we analysed 260 nodules, found in 251 patients (mean age 58.6 yo ± 14). 11.2% were TI-RADS 1, 18.9% TI-RADS 2, 41.1% TI-RADS 3, 28.1% TI-RADS 4, and 0.8% TI-RADS 5.The SMI technique showed an AUC of 0.57 (95% CI 0.49; 0.66) while elastosonography had an AUC of 0.58 (95% CI 0.49; 0.67) when used individually. SMI together with elastosonography had AUC of 0.62 (95% CI 0.52; 0.71). TI-RADS had AUC of 0.67 (95% CI 0.59; 0.75). SMI and elastosonography applied together with TI-RADS had AUC of 0.69 (95% CI 0.61; 0.77).ConclusionIn the real-world cohort of patients, the SMI technique and elastosonography slightly increase the AUC of TI-RADS. Taken individually, SMI and elastosonography do not have a very strong AUC.

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

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

The European Thyroid Imaging and Reporting Data System as a Remedy for the Overdiagnosis and Overtreatment of Thyroid Cancer: Results from the EUROCRINE Surgical Registry.

The European Thyroid Imaging and Reporting Data System (EU-TIRADS) aims to reduce the overdiagnosis of thyroid cancer (TC) by guiding the selection of nodules for fine-needle aspiration biopsy (FNAB). This study sought to validate EU-TIRADS nodule selection criteria using data from EUROCRINE, an extensive international endocrine surgery registry. We reviewed indications for FNAB among patients with TC compared to those with benign disease who underwent surgery between March 2020 and March 2022, considering preoperative EU-TIRADS scores and dominant nodule size (FNAB is recommended in Category 5 (˃10 mm or ˂10 mm with suspicious lymph nodes), 4 (˃15 mm), and 3 (˃20 mm)). Patients were categorized into three risk groups: minimal risk (patients with papillary microcarcinoma), high risk (patients with pT3b stage or higher, pN1b, or pM1), and low-moderate risk (all other patients). We conducted a Receiver Operating Characteristic (ROC) analysis to assess the diagnostic accuracy of the EU-TIRADS. We analyzed 32,008 operations. Approximately 68% of the surgical records included EU-TIRADS classifications. The EU-TIRADS exhibited diagnostic accuracy across high-volume sites, with a median ROC Area Under the ROC Curve (AUC) of 0.752, indicating its effectiveness in identifying malignancy. Among the cases, 7907 patients had TC. Notably, 55% of patients with TC underwent FNAB despite not initially meeting the EU-TIRADS criteria. These patients were distributed across the minimal- (58%), low-moderate- (36%), and high-risk (5.8%) categories. Of the patients with TC recommended for FNAB, 78% were deemed low-moderate risk, 21% high risk, and only 0.7% minimal risk. The EU-TIRADS offers effective preoperative malignancy risk stratification. Promoting the proper use of the EU-TIRADS in clinical practice is essential to mitigate the overdiagnosis and overtreatment of low-risk TC.

Ovarian-Adnexal Reporting &amp; Data System (O-RADS) versus modified benign descriptors and IOTA ADNEX (two-step strategy) in classification of ovarian masses.

e17569 Background: The use of a single and common language in the diagnosis of ovarian tumors is a multidisciplinary effort spanning several decades that has allowed the global adoption of the Ovarian-Adnexal Reporting &amp; Data System (O-RADS) and the International Ovarian Tumor Analysis (IOTA). The objective is to determine the diagnostic accuracy of O-RADS versus modified benign descriptors and IOTA ADNEX in the classification of adnexal masses. Methods: Ambispective diagnostic accuracy study based on ultrasound data collected at a university hospital with a gynecologic oncology unit between 2012 and 2022. Two IOTA-certified level III sonographers classified adnexal masses using modified benign descriptors (MBD). The main outcome was the classification of the masses as benign or malignant for each strategy. Histopathology was used as the diagnostic reference standard. A diagnostic test analysis was performed. Results: 876 patients with 902 adnexal masses were included in the study for both analysis strategies. For the two-step analysis, 573 (64%) met the classification criteria for their evaluation based on MBD (first step) and 329 (36%) were assessed using IOTA ADNEX. 99% (567/573) of the masses classified according to the MBD, were benign by histopathology. The diagnostic performance of IOTA ADNEX (second step) had a sensibility of 93%, specificity of 64%, positive predictive value of 48%, negative predictive value of 96%, AUC (0,880). Regarding the analysis of the O-RADS system to stratify malignancy risk, we observed a prevalence of 58% for O-RADS 2, 22% for O-RADS 3, 11% for O-RADS 4, and 9% for O-RADS 5. Sensibility was 92%, specificity 88%, positive predictive value 48%, negative predictive value del 99%, AUC (0,886). Conclusions: In our experience, the diagnostic accuracy of the two-step strategy or the O-RADS system is similar. However, the ORADS system had a lower proportion of false negatives.

Diagnostic Accuracy of American College of Radiology Thyroid Imaging Reporting Data System: A Single-center Cross-sectional Study.

This study aims to evaluate the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting Data System (ACR TI-RADS) in identifying nodules that need to undergo fine-needle aspiration biopsy (FNAB) and identify specific thyroid ultrasound characteristics of nodules associated with thyroid malignancy in Filipinos in a single tertiary center. One hundred seventy-six thyroid nodules from 130 patients who underwent FNAB from January 2018 to December 2018 were included. The sonographic features were described and scored using the ACR TI-RADS risk classification system, and the score was correlated to their final cytopathology results. The calculated malignancy rates for TI-RADS 2 to TI-RADS 5 were 0%, 3.13%, 7.14%, and 38.23%, respectively, which were within the TI-RADS risk stratification thresholds. The ACR TI-RADS had a sensitivity of 89.5% and specificity of 54%, LR + of 1.95 and LR - of 0.194, NPV of 97.7%, PPV of 19.1%, and accuracy of 58%. The ACR TI-RADS may provide an effective malignancy risk stratification for thyroid nodules and may help guide the decision for FNAB among Filipino patients. The classification system may decrease the number of unnecessary FNABs for nodules with low-risk scores.

Enhancing cancer prediction in challenging screen-detected incident lung nodules using time-series deep learning

Lung cancer screening (LCS) using annual computed tomography (CT) scanning significantly reduces mortality by detecting cancerous lung nodules at an earlier stage. Deep learning algorithms can improve nodule malignancy risk stratification. However, they have typically been used to analyse single time point CT data when detecting malignant nodules on either baseline or incident CT LCS rounds. Deep learning algorithms have the greatest value in two aspects. These approaches have great potential in assessing nodule change across time-series CT scans where subtle changes may be challenging to identify using the human eye alone. Moreover, they could be targeted to detect nodules developing on incident screening rounds, where cancers are generally smaller and more challenging to detect confidently.Here, we show the performance of our Deep learning-based Computer-Aided Diagnosis model integrating Nodule and Lung imaging data with clinical Metadata Longitudinally (DeepCAD-NLM-L) for malignancy prediction. DeepCAD-NLM-L showed improved performance (AUC = 88%) against models utilizing single time-point data alone. DeepCAD-NLM-L also demonstrated comparable and complementary performance to radiologists when interpreting the most challenging nodules typically found in LCS programs. It also demonstrated similar performance to radiologists when assessed on out-of-distribution imaging dataset. The results emphasize the advantages of using time-series and multimodal analyses when interpreting malignancy risk in LCS.

Stepwise analysis of thyroid diagnostic modalities with genomic imprinting detection.

The current preoperative malignancy risk evaluation for thyroid nodules involves stepwise diagnostic modalities including ultrasonography, thyroid function serology and fine-needle aspiration (FNA) cytopathology, respectively. We aimed to substantiate the stepwise contributions of each diagnostic step and additionally investigate the diagnostic significance of quantitative chromogenic imprinted gene in-situ hybridization (QCIGISH)-an adjunctive molecular test based on epigenetic imprinting alterations. A total of 114 cytopathologically-diagnosed and histopathologically-confirmed thyroid nodules with complete ultrasonographic and serological examination records were evaluated using QCIGISH in the study. Logistic regression models for thyroid malignancy prediction were developed with the stepwise addition of each diagnostic modality and the contribution of each step evaluated in terms of discrimination performance and goodness-of-fit. From the baseline model using ultrasonography [area under the receiver operating characteristics curve (AUROC): 0.79; 95% confidence interval (CI): 0.71-0.86], significant improvements in thyroid malignancy discrimination were observed with the stepwise addition of thyroid function serology (AUROC: 0.82; 95% CI: 0.74-0.90; P=0.23) and FNA cytopathology (AUROC: 0.88; 95% CI: 0.81-0.94; P=0.02), respectively. The inclusion of QCIGISH as an adjunctive molecular test further advanced the preceding model's diagnostic performance (AUROC: 0.95; 95% CI: 0.91-1.00, P=0.007). Our study demonstrated the significant stepwise diagnostic contributions of standard clinical assessments in the malignancy risk stratification of thyroid nodules. However, the addition of molecular imprinting detection further enabled a more accurate and definitive preoperative evaluation especially for morphologically indeterminate thyroid nodules and cases with potentially discordant results among standard modalities.