Significant Predictors Of Malignancy Research Articles

The Utility of Contrast-Enhanced Mammography in the Evaluation of Bloody Nipple Discharge-A Multicenter Study in the Asian Population.

To assess the efficacy of contrast-enhanced mammography (CEM) in differentiating benign from malignant breast lesions in Asian patients with bloody nipple discharge (BND). This retrospective study included 58 women with BND (mean age: 51.7 years) who underwent standardized CEM at institutions in Taiwan and Singapore. Lesion characteristics (size, enhancement, conspicuity, shape, margins) were evaluated on CEM by blinded radiologists. Non-enhanced mammography (MMG) and ultrasound (US) within a defined timeframe were compared for diagnostic accuracy. Benign or malignant status was confirmed by biopsy or 2-year imaging follow-up. Malignancy was found in 29 of 58 lesions (50.0%), with ductal carcinoma in situ (DCIS) being the most common. CEM demonstrated a 100% negative predictive value (NPV) for non-enhancing lesions. Significant predictors of malignancy on multivariate analysis include enhancing lesions of size ≥ 1.5 cm (p-value 0.025) and suspicious morphological features (irregular/spiculated margins, irregular shape, segmental/linear NME distribution) (p-value < 0.001). CEM outperformed MMG (sensitivity: 58.6%) and US (sensitivity: 79.3%), achieving a sensitivity of 100% and the highest diagnostic accuracy at 81.3%. Additionally, a CEM size cut-off of 1.5 cm yielded a sensitivity of 73.5% and a specificity of 84.3%. CEM effectively differentiates benign from malignant lesions in patients with BND, improving diagnostic accuracy and potentially reducing unnecessary interventions.

Comprehensive Analysis of Receptor Status, Histopathological Classifications (B1-B5), and Cumulative Histological Dimensions in Breast Cancer: Predictors of Malignancy and Diagnostic Implications.

Breast cancer has become one of the most serious and widespread public health concerns globally, affecting an increasing number of women-and, in rare cases, men-across the world. It is the most common cancer among women across all countries. In this study, we aimed to evaluate the influence of demographic factors, medical and reproductive history, diagnostic techniques, and hormone receptor status on the development and progression of breast cancer. A total of 687 female patients from Romania underwent standard breast examination techniques, including clinical breast examination, mammography, ultrasonography, and, ultimately, breast biopsy. Statistical analysis was performed using the R programming language and RStudio software. The study included a comparative analysis and a prediction analysis for malignancy and tumor size (cumulative histological dimension) through logistic and linear regression models. The comparative analysis identified several variables associated with malignancy: older age (p < 0.001), non-vulnerability (p = 0.04), no daily physical activity (p = 0.002), no re-biopsy (p < 0.001), immunohistochemistry use (p < 0.001), use of larger gauge needles (p < 0.001), ultrasound-guided biopsy (p < 0.001), and vacuum biopsy (p < 0.001). The hormone receptor statuses-estrogen receptor (ER), progesterone receptor (PR), and androgen receptor (AR)-showed statistically significant differences in distribution across breast cancer B classifications. Logistic regression analysis identified ER, PR, and age as significant predictors of malignancy. Linear regression analysis revealed histopathological results, living environment, geographical region, vulnerability, prior breast examination, and the number of histological fragments as significant predictors of cumulative histological dimension. Our predictive models demonstrate the impact of demographic factors, medical history, diagnostic techniques, and hormone receptor status on breast cancer development and progression, accounting for a significant portion of the variance in malignancy and cumulative histological dimension.

A multivariate analysis on characteristics of hand and wrist tumours: a multiethnic study.

Hand tumours are frequently encountered in clinical practice. However, large-scale epidemiological data of soft tissue tumours in the hand are infrequently published. Epidemiological data provide diagnostic cues to guide the workup and management of hand tumours. Assessing significant independent demographic factors and tumour characteristics associated with hand tumours is essential in health care. A retrospective review of patients who underwent excision of hand tumours in Singapore General Hospital between 2004 and 2015 was conducted. The data collected included age, gender, ethnicity, histological diagnosis, malignancy and location of tumour. Generalised linear latent and mixed models (GLLAMM) analyses were performed. A total of 4476 tumours were identified from 4226 patients with a mean age of 51.3 (range 8-101) years and male to female ratio of 1 to 1.15. Most patients were Chinese (75%), followed by Malay (9%), Indian (8%) and others (8%). The most common hand tumours excised were ganglions (43%) (majority in the wrist), followed by giant cell tumours (9%) (commonly in the digits). Most soft tissue tumours were benign (97%), with only 3% of malignant cases. The GLLAMM analyses revealed further potential factors on the status of malignancy, tumour origin and tumour location. Most soft tissue tumours in the hand and wrist are benign. This can guide workup and counselling of patients before the operation. While malignant tumours are uncommon, they have the potential for significant morbidity and mortality if not appropriately evaluated or treated. The application of GLLAMM analyses showed that age, ethnicity and gender were significant predictors of malignancy.

Optimal Surgical Approaches for Thyroid Cancer: A Comparative Analysis of Efficacy and Complications.

BACKGROUND Completion thyroidectomy (CTx) is performed following hemithyroidectomy (HTx) when the risk of malignancy persists or is discovered postoperatively. Different surgical approaches, including CTx after HTx (CTx-HTx), total thyroidectomy (TTx), and revision surgery after TTx (RTx-TTx), offer varying risks and benefits, including pathological outcomes and complication rates. Understanding the predictors and rates of malignancy in these procedures is crucial for optimizing surgical management of thyroid disorders. MATERIAL AND METHODS This retrospective study analyzed data from January 2014 to October 2019, including 60 patients each in the CTx-HTx and TTx groups, and 47 in the RTx-TTx group. The CTx-HTx group was subdivided based on benign or malignant findings in CTx specimens. Clinicodemographic data and pathological features such as tumor type, size, side, capsular and vascular invasion, extrathyroidal spread, multifocality, and lymph node metastasis were reviewed. RESULTS Age and sex distributions were similar across groups. In the CTx-HTx group, 76.7% of specimens were benign and 23.3% malignant. No significant predictors of malignancy were found between the benign and malignant subgroups in univariate and multivariable analyses. In the TTx group, 75.0% of initial lobes and 13.3% of contralateral lobes were malignant. TTx was associated with a significant postoperative decrease in calcium and longer hospital stays. Multivariable analysis identified TTx as an independent risk factor for hypocalcemia. CONCLUSIONS Reducing overtreatment in thyroid cancer may involve limiting CTx after HTx and considering more conservative initial surgeries, particularly when indications for TTx are not definitive.

Predictors of malignancy and survival in patients with pheochromocytoma and paraganglioma.

e16289 Background: Pheochromocytomas (PCC) and paragangliomas (PGL) are rare neuroendocrine tumors for which the definitive diagnosis of malignancy hinges on the detection of metastatic disease, rather than histological features, making prognostication particularly challenging. Consequently, identifying reliable clinical predictors for both malignancy and survival is of utmost importance. Methods: We retrospectively analyzed records of patients with biopsy-proven PCC or PGL treated at a single center in Mexico City from 2008 to 2022. Patients with follow-up &gt; =12 months were eligible. Data was collected from electronic medical records. Independent-samples T-test and X2 and Fisher’s exact tests were used to evaluate associations between variables. We used the Kaplan-Meier method to calculate disease-free survival (DFS) and overall survival (OS) rates, and utilized the log-rank test to compare these outcomes across clinicopathological features. Cox regression analysis was used to determine survival hazard ratios (HR). Results: Among 60 patients, the mean age at diagnosis was 41 years, 37 (62%) had PCC, and 12 (20%) had malignant disease (6 distant recurrences and 6 de novo metastatic cases). Clinicopathological features according to disease type (i.e. benign or malignant) are shown in Table 1. Patients with malignant disease were more likely to have PGL (67% vs. 31%, p = 0.024) and have a body mass index of &gt; =30 kg/m2 at diagnosis (67% vs. 8%, p &lt; 0.01). With a median follow-up of 42 months (95% CI 35-49), 8 recurrences (2 local and 6 distant) and 6 deaths were recorded, yielding 3-year DFS and OS rates of 92% and 91%, respectively. In a multivariate analysis including factors associated with DFS and OS in univariate analyses (i.e. obesity status and hypertension at diagnosis), only obesity (HR 4.93, 95% CI 1.02 - 23.79; p = 0.047) remained associated with a worse DFS, with no influence on OS. Conclusions: This study highlights obesity as a significant predictor of malignancy and recurrence in patients with PCC and PGL, marking a novel finding in the literature on these tumors. Further research is warranted to explore the underlying mechanisms linking obesity with more aggressive disease in PCC and PGL. [Table: see text]

Investigation of imaging features in contrast-enhanced magnetic resonance imaging of benign and malignant breast lesions

PurposeThis study aimed to enhance the diagnostic accuracy of contrast-enhanced breast magnetic resonance imaging (MRI) using gadobutrol for differentiating benign breast lesions from malignant ones. Moreover, this study sought to address the limitations of current imaging techniques and criteria based on the Breast Imaging Reporting and Data System (BI-RADS).Materials and MethodsIn a multicenter retrospective study conducted in Japan, 200 women were included, comprising 100 with benign lesions and 100 with malignant lesions, all classified under BI-RADS categories 3 and 4. The MRI protocol included 3D fast gradient echo T1- weighted images with fat suppression, with gadobutrol as the contrast agent. The analysis involved evaluating patient and lesion characteristics, including age, size, location, fibroglandular tissue, background parenchymal enhancement (BPE), signal intensity, and the findings of mass and non-mass enhancement. In this study, univariate and multivariate logistic regression analyses were performed, along with decision tree analysis, to identify significant predictors for the classification of lesions.ResultsDifferences in lesion characteristics were identified, which may influence malignancy risk. The multivariate logistic regression model revealed age, lesion location, shape, and signal intensity as significant predictors of malignancy. Decision tree analysis identified additional diagnostic factors, including lesion margin and BPE level. The decision tree models demonstrated high diagnostic accuracy, with the logistic regression model showing an area under the curve of 0.925 for masses and 0.829 for non-mass enhancements.ConclusionThis study underscores the importance of integrating patient age, lesion location, and BPE level into the BI-RADS criteria to improve the differentiation between benign and malignant breast lesions. This approach could minimize unnecessary biopsies and enhance clinical decision-making in breast cancer diagnostics, highlighting the effectiveness of gadobutrol in breast MRI evaluations.

Characterizing Lung-RADS category 4 lesions in a university lung cancer screening program

ObjectivesTo assess the prevalence of lung cancer in Lung-RADS category 4 patients, and to elucidate if clinical or imaging features help differentiate benign lesions from lung cancer. Materials/MethodsA retrospective review of lung cancer screening (LCS) studies at a single university screening program between January 2018 and December 2021 identified all patients with Lung-RADS category 4 lesions. Patient demographics, symptoms within the prior 6 months, and imaging features were recorded. ResultsDuring the defined period, 4819 baseline and annual LCS exams were performed; 7.6 % (n = 368) of exams had category 4 nodules and 59 (1.2 %) patients had biopsy-proven lung cancer. Distribution of Lung-RADS category 4 lesions and lung cancer diagnosis were as follows: 4A − 223 nodules, 6.3 % malignant; 4B − 114 nodules, 20.2 % malignant; and 4X − 31 nodules, 71.0 % malignant. Symptoms were reported in 9.0 % (n = 20) of category 4A (2 were malignant), 15.8 % (n = 18) category 4B (1 was malignant) and 22.6 % (n = 7) category 4X (5 were malignant).Imaging features associated with malignancy included endobronchial obstruction with distal atelectasis, pleural tethering, irregular shape, cavitation, and heterogeneous cystic appearance. Twenty-four nodules increased in size, however, only 7 were biopsy proven.Relative to the risk seen with 4A disease, multivariable logistic analyses showed that the odds of a malignancy increased significantly by 3.8 fold (95 % CI: 1.9, 7.9) and 39.2 fold (95 % CI: 14.9, 103.0) with 4B and 4X disease, respectively (p < 0.0001). A separate analysis involving only category 4A and 4B patients jointly showed that disease category (OR = 3.0; 95 % CI: 1.5, 6.4) and additional imaging features (OR = 3.2; 95 % CI: 1.4, 7.0) were significant predictors of malignancy. The presence of clinical symptoms was not statistically associated with lung cancer. ConclusionsLung-RADS 4 nodules were found in 7.6% of LCS examinations and 16% of these nodules were lung cancer. The probability of lung cancer increases from category 4A to 4X, and imaging features may help differentiate benign from malignant nodules in this LCS category.

Diagnostic Performance of ACR TI-RADS and ATA Guidelines in the Prediction of Thyroid Malignancy: A Prospective Single Tertiary Center Study and Literature Review.

This study sought to compare two common risk stratification systems in terms of their diagnostic performance for the evaluation of thyroid malignancy. The American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) guidelines were compared among 571 thyroid nodules with definitive fine needle aspiration (FNA) cytology or postoperative histopathology. Ultrasound characteristics such as composition, echogenicity, shape, margin, size, and vascularity were assessed for each thyroid nodule. Diagnostic performance measures were determined and compared through receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). Of 571 nodules, 65 (11.4%) were malignant. The AUC, sensitivity, specificity, positive predictive value, and negative predictive value were 0.691, 49.2%, 84.9%, 29.6%, and 92.8% for ATA guideline, and 0.776, 72.3%, 79.2%, 30.9%, and 95.7%, for ACR TI-RADS, respectively. ACR TI-RADS was more sensitive (p = 0.003), while the ATA guideline was more specific (p < 0.001). DCA demonstrated that the ACR TI-RADS provided a greater net benefit than the ATA guideline. In addition, the net reduction in unnecessary biopsies is higher for ACR TI-RADS than ATA guidelines. The total number of indicated biopsies and unnecessary FNA rates were lower in ACR TI-RADS compared to ATA guideline (293 vs. 527 and 80.2 vs. 87.8). ACR TI-RADS presented no biopsy indication in seven malignant nodules (all categorized as TR2), whereas ATA guideline missed one. Hypoechogenicity was the most significant predictor of malignancy (OR = 8.34, 95% CI: 3.75-19.45), followed by a taller-than-wide shape (OR = 6.73, 95% CI: 3.07-14.77). Our findings suggest that each system has particular advantages in the evaluation of thyroid nodules. ACR TI-RADS reduces unnecessary FNA rates, however, malignant nodules categorized as TR2 might be missed using this system. Further evaluation of this group of nodules using Doppler and other ultrasound modalities is recommended.

A valuable endobronchial ultrasound scoring system predicting malignant lymph nodes.

This study aims to determine the sonographic criteria of lymph nodes to predict malignancy with endobronchial ultrasound. A total of 1,987 lymph nodes of 967 patients (666 males, 301 females; mean age: 62.1±11.9 years; range, 21 to 90 years) between May 2016 and July 2020 were retrospectively analyzed. The endobronchial ultrasound images of lymph nodes were evaluated according to the following criteria: size (short axis >1 cm), shape (round or oval), margin (distinct or indistinct), coagulation necrosis sign (present or absent), central hilar structure (present or absent) and echogenicity (homogeneous or heterogeneous). A scoring system was developed for predicting malignancy. A total of 765 (38.5%) of the lymph nodes were malignant. In the univariate analysis, size >1 cm, round shape, distinct margin, absence of central hilar structure, presence of coagulation necrosis sign, and heterogeneity were significant predictors of malignancy (p<0.001 for all). In the multivariate analysis, the main independent predictors were heterogeneity and presence of coagulation necrosis sign (odds ratio=5.9, 95% confidence interval: 4.2-8.2 vs. odds ratio=3.1 95% confidence interval: 2.2-4.5, respectively). A cut-off value for endobronchial ultrasound score of ≥4 increased the malignancy risk 30 times with a sensitivity of 84.7%, and specificity of 84.5%. Our study results show that endobronchial ultrasound scoring system with six criteria has a high sensitivity and specificity for predicting malignant lymph nodes.

Incidence and Risk Factors of Thyroid Malignancy in Patients with Toxic Nodular Goiter.

Background Although hyperfunctioning thyroid disorders were thought to be protective against malignancy, some recent studies reported a high incidence of incidentally discovered cancer in patients with hyperfunctioning benign thyroid disorders. We performed this study to estimate the incidence and predictors of malignant thyroid disease in patients with toxic nodular goiter (TNG). Patients and Methods. The data of 98 patients diagnosed with TNG were reviewed (including toxic multinodular goiter SMNG and single toxic nodule STN). The collected data included patients age, gender, systemic comorbidities, family history of thyroid malignancy, previous neck radiation, type of disease (multinodular or single), size of the dominant nodule by the US, operative time, and detection of significant lymph nodes during operation. Based on the histopathological analysis, the cases were allocated into benign and malignant groups. Results Malignancy was detected in 21 patients (21.43%). Although age distribution was comparable between the two groups, males showed a significant increase in association with malignancy. Medical comorbidities and family history of cancer did not differ between the two groups. However, TMNG showed a statistically higher prevalence in the malignant group. Operative data, including operative time and lymph node detection, were comparable between the two groups. On regression analysis, both male gender and TMNG were significant predictors of malignancy. Conclusion The presence of thyroid hyperfunction is not a protective factor against malignancy, as malignancy was detected in about 1/5 of cases. Male gender and TMNG were significant risk factors of malignancy in such patients.

PD04-03 DIAGNOSTIC DILEMMAS: A MULTI-INSTITUTIONAL RETROSPECTIVE ANALYSIS OF ADRENAL INCIDENTALOMA PATHOLOGY BASED ON RADIOGRAPHIC SIZE

You have accessJournal of UrologyCME1 May 2022PD04-03 DIAGNOSTIC DILEMMAS: A MULTI-INSTITUTIONAL RETROSPECTIVE ANALYSIS OF ADRENAL INCIDENTALOMA PATHOLOGY BASED ON RADIOGRAPHIC SIZE David Zekan, Robert King, Ali Hajiran, Apexa Patel, Samuel Deem, and Adam Luchey David ZekanDavid Zekan More articles by this author , Robert KingRobert King More articles by this author , Ali HajiranAli Hajiran More articles by this author , Apexa PatelApexa Patel More articles by this author , Samuel DeemSamuel Deem More articles by this author , and Adam LucheyAdam Luchey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002519.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Adrenal incidentalomas (AIs) are masses >1 cm found incidentally during radiographic imaging. They are present in up to 4.4% of patients undergoing CT scan, and incidence is increasing with usage and sensitivity of cross-sectional imaging. Most result in diagnosis of adrenal cortical adenoma, questioning guidelines recommending removal of all AIs with negative functional workup. This retrospective study analyzes histological outcome based on size of non-functional adrenal masses. METHODS: 10 years of data was analyzed from two academic institutions. Exclusion criteria included patients with positive functional workups, those who underwent adrenalectomy during nephrectomy, <18 years, and incomplete records. AI radiologic and histologic size, histologic outcome, laterality, imaging modality, gender, and age were collected. T-test was used for comparison of continuous variables, and the two-sided Fisher’s exact or chi-square test were used to determine differences for categorical variables. Univariate analysis of each independent variable was performed using simple logistic regression. RESULTS: 73 adrenalectomies met the above inclusion criteria. 60 were detected on CT scan, 12 on MRI, and one on ultrasound. Eight of 73 cases resulted in malignant pathology, 3 of which were adrenocortical carcinoma (ACC). Each ACC measured >6 cm, with mean radiologic and pathologic sizes of 11.2 cm and 11.3 cm. Both radiologic and pathologic size were significant predictors of malignancy (p=0.008 and 0.011). CONCLUSIONS: Our results question the generally-accepted 4 cm cutoff for excision of metabolically-silent AIs. They suggest a 6 cm threshold would suffice to avoid removal of benign lesions while maintaining sensitivity for ACC. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e49 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Zekan More articles by this author Robert King More articles by this author Ali Hajiran More articles by this author Apexa Patel More articles by this author Samuel Deem More articles by this author Adam Luchey More articles by this author Expand All Advertisement PDF DownloadLoading ...

Diagnostic dilemmas: a multi-institutional retrospective analysis of adrenal incidentaloma pathology based on radiographic size

Introduction/backgroundAdrenal incidentalomas (AIs) are masses > 1 cm found incidentally during radiographic imaging. They are present in up to 4.4% of patients undergoing CT scan, and incidence is increasing with usage and sensitivity of cross-sectional imaging. Most result in diagnosis of adrenal cortical adenoma, questioning guidelines recommending removal of all AIs with negative functional workup. This retrospective study analyzes histological outcome based on size of non-functional adrenal masses.Material and methods10 years of data was analyzed from two academic institutions. Exclusion criteria included patients with positive functional workups, those who underwent adrenalectomy during nephrectomy, < 18 years, and incomplete records. AI radiologic and histologic size, histologic outcome, laterality, imaging modality, gender, and age were collected. T-test was used for comparison of continuous variables, and the two-sided Fisher’s exact or chi-square test were used to determine differences for categorical variables. Univariate analysis of each independent variable was performed using simple logistic regression.Results73 adrenalectomies met the above inclusion criteria. 60 were detected on CT scan, 12 on MRI, and one on ultrasound. Eight of 73 cases resulted in malignant pathology, 3 of which were adrenocortical carcinoma (ACC). Each ACC measured > 6 cm, with mean radiologic and pathologic sizes of 11.2 cm and 11.3 cm. Both radiologic and pathologic size were significant predictors of malignancy (p = 0.008 and 0.011).ConclusionsOur results question the generally-accepted 4 cm cutoff for excision of metabolically-silent AIs. They suggest a 6 cm threshold would suffice to avoid removal of benign lesions while maintaining sensitivity for ACC.

Predictors of malignancy in patients with solitary pulmonary nodules undergoing pulmonary resection.

BackgroundThe management of a solitary pulmonary nodule is a challenging issue in pulmonary disease. Although many factors have been defined as predictors for malignancy in solitary pulmonary nodules, the accurate diagnosis can only be established with the permanent histological diagnosis.ObjectiveWe tried to clarify the possible predictors of malignancy in solitary pulmonary nodules in patients who had definitive histological diagnosis.MethodsWe made a retrospective study to collect the data of patients with solitary pulmonary nodules who had histological diagnosis either before or after surgery. We made a statistical analysis of both the clinic and radiological features of these nodules with respect to malignancy both in contingency tables and with logistic regression analysis.ResultsWe had a total of 223 patients with a radiological diagnosis of solitary pulmonary nodule. Age, smoking status and pack years of smoking, maximum standardized uptake value (SUVmax), and radiological features such as solid component, spiculation, pleural tag, lobulation, calcification, and higher density were significant predictors of malignancy in contingency tables. Age, smoking status and smoking (pack/year), SUVmax, and radiological features including spiculation, pleural tag, lobulation, calcification, and higher density were the significant predictors in univariate analysis. However, multivariate analysis revealed only SUVmax greater than 2.5 (p < 0.0001), spiculation (p = 0.009), and age older than 61 years (p = 0.015) as the significant predictors for malignancy.ConclusionAge, SUVmax, and spiculation are the independent predictors of malignancy in patients with solitary pulmonary nodules.

Translation of a circulating miRNA signature of melanoma into a solid tissue assay to improve diagnostic accuracy and precision.

Aim: Successful treatment of cutaneous melanoma depends on early and accurate diagnosis of clinically suspicious melanocytic skin lesions. Multiple international studies have described the challenge of providing accurate and reproducible histopathological assessments of melanocytic lesions, highlighting the need for new diagnostic tools including disease-specific biomarkers. Previously, a 38-miRNA signature (MEL38) was identified in melanoma patient plasma and validated as a novel biomarker. In this study, MEL38 expression in solid tissue biopsies representing the benign nevi to metastatic melanoma spectrum is examined. Patients& methods: Nanostring digital gene expression assessment of the MEL38 signature was performed on 308 formalin-fixed paraffin-embedded biopsies of nevi, melanoma insitu and invasive melanoma. Genomic data were interrogated using hierarchical clustering, univariateand multivariate statistical approaches. Classification scores computed from the MEL38 signature were analyzed for their association with demographic data and histopathology results, including MPATH-DX class, AJCC disease stage and tissue subtype. Results: The MEL38 score can stratify higher-risk melanomas (MPATH-Dx class V or more advanced) from lower-risk skin lesions (class I-IV) with an areaunder the curve of 0.97 (p<0.001). The genomic score ranges from 0 to 10 and is positively correlated with melanoma progression, with an intraclass correlation coefficient of 0.85 with stage 0-IV disease. Using an optimized classification threshold of ≥2.7 accurately identifies higher-risk melanomaswith 89% sensitivity and 94% specificity. Multivariate analysis showed the score to be a significant predictor of malignancy, independent of technical and clinical covariates. Application of the MEL38 signature to Spitz nevi reveals an intrasubtype profile, with elements in common to both nevi and melanoma. Conclusion: Melanoma-specific circulating miRNAs maintain their association with malignancy when measured in the hypothesized tissue of origin. The MEL38 signature is an accurate and reproducible metric of melanoma status, based on changes in miRNA expression that occur as the disease develops and spreads. Inclusion of the MEL38 score into routine practice would provide physicians with previously unavailable, personalized genomic information about their patient's skin lesions. Combining molecular biomarker data with conventional histopathology data may improve diagnostic accuracy, healthcare resource utilization and patient outcomes.

Prevalence of thyroid carcinoma in nodules with thy 3 cytology: the role of preoperative ultrasonography and strain elastography

BackgroundFine needle aspiration (FNA) cytology, the gold standard in assessing thyroid nodules, is limited by its inability to determine the true risk of malignancy in Thy 3 nodules. Most patients with Thy3 cytology undergo surgery to establish a histologic diagnosis. The aims of this study were to evaluate the prevalence of malignancy in Thy3 nodules, to examine the ultrasound (US) characteristics that are associated with a high cancer risk and to assess the role of real-time strain elastography.MethodsRetrospective cohort study of 99 nodules with Thy3 cytology in 99 patients who underwent thyroidectomy over a three-year period. Grayscale US, Doppler and real-time strain elastography data were evaluated.ResultsEighty-one nodules (81.82%) were benign, 18 (18.18%) were malignant, and almost all were papillary thyroid carcinoma (PTC). Univariable analysis revealed irregular margins (p = 0.02), ill-defined borders (p ≤ 0.001), a taller than wide shape (p ≤ 0.001) and the elasticity score (p = 0.02) as significant predictors of malignancy. Multivariable analysis showed that ill-defined borders and the elasticity score were significant and independent factors associated with malignancy. All soft nodules (elasticity scores 1–2) were benign (sensitivity 100%, specificity 33%, NPV 100%, and PPV 23%). There was a higher rate of malignancy in Thy3a nodules than in Thy3f nodules (42.86% versus 11.54%) (p ≤ 0.001).ConclusionsIrregular margins, ill-defined borders, a taller than wide shape and low elasticity were associated with malignancy. Elastography should be performed when evaluating Thy3 nodules.

Predictors of Malignancy in Patients With Indeterminate Biliary Strictures and Atypical Biliary Cytology: Results From Retrospective Cohort Study.

BackgroundAtypical cellular features are commonly encountered in patients with indeterminate biliary strictures, which are nondiagnostic of malignancy yet cannot rule it out. This study aims to identify clinical features that could discriminate patients with indeterminate biliary strictures and atypical biliary cytology who may harbor underlying malignancy.MethodsAll patients with an indeterminate biliary stricture and an atypical brush cytology obtained during endoscopic brushings were identified in a large tertiary-care center. Demographical information, clinical data and the final pathological diagnosis were collected. The study cohort was divided based on the final diagnosis into benign and malignant groups. Descriptive and multivariable analyses were performed.ResultsA total of 151 patients were included in the analysis. Of these, 62.9% were males with mean age of 61.7 ± 16.4 years. Overall, there was an almost equal distribution of patients in the benign and malignant groups. Older age (≥65 years), jaundice, weight loss, intrahepatic biliary and pancreatic duct dilation, double-duct sign and presence of a mass were associated with malignancy in the univariate analysis. However, only older age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00 to 1.03), jaundice (OR 3.33, 95% CI 1.11 to 9.98) and presence of a mass (OR 12.10, 95% CI 4.94 to 29.67) were significantly associated with malignancy in the multivariate analysis. High CA19-9 was associated with malignancy only in patients with primary sclerosing cholangitis.ConclusionIn patients with indeterminate biliary stricture and atypical brush cytology, older age, jaundice and presence of a mass are significant predictors of malignancy. Patients with such characteristics need prompt evaluation to rule out underlying malignancy.

The utility of 2-[18F]FDG-PET/CT maximum SUV versus CT attenuation for directing bone biopsies.

This study aimed to compare the accuracy of PET/CT parameters with CT parameters for directing bone biopsies. The study was an IRB-approved retrospective study of 388 patients who underwent both 2-[18F] FDG PET/CT and CT within 6 weeks before a bone biopsy. Age, sex, cancer type, lesion length, SUVmax, tumor to liver (T/L) ratio, CT attenuation, difference in CT attenuation between the lesion and normal bone (delta CT attenuation), and the absolute delta CT attenuation were used as predictors. T tests and chi-squared tests were used to compare variables. DeLong's test was used to compare receiver operator characteristic (ROC) curves. We reviewed the data from 388 patients. Of these, 295 patients had bone lesion biopsies, and 93 patients had bone marrow aspirations/biopsies. Biopsies of larger bone lesions (p = 0.033) and bone lesions with higher SUVmax (p = 0.005) were more likely to show malignancy. For bone lesions, the ROC curve for the SUVmax (AUC = 0.6827) was better than the ROC curves for delta CT attenuation (AUC = 0.5766, p = 0.032) and absolute delta CT attenuation (AUC = 0.5491, p = 0.006), but not significantly better than the ROC curves for CT attenuation (AUC = 0.5894, p = 0.061) and T/L ratio (AUC = 0.6778, p = 0.774). A threshold SUVmax of 5.25 had an accuracy of 0.713, sensitivity of 0.766, and specificity of 0.549 to predict malignancy in bone lesion biopsies. None of these variables predicted malignancy in bone marrow biopsies (p > 0.05 for all). Metabolic 2-[18F]FDG PET/CT parameters have more clinical impact for planning bone biopsies as compared to CT parameters. • The 2-[18F]FDG PET/CT measurement (SUVmax) has more clinical impact for planning bone biopsies as compared to CT measurements. • Neither the change in CT attenuation of the lesion relative to normal bone nor the absolute value of this change was a significant predictor of malignancy. • 2-[18F]FDG PET/CT may have clinical benefit and an additional role in directing bone biopsies.

The role of tissue elasticity in the differential diagnosis of benign and malignant breast lesions using shear wave elastography

BackgroundElastography is a promising way to evaluate tissue differences regarding stiffness, and the stiffness of the malignant breast lesions increased at the lesion margin. However, there is a lack of data on the value of the shear wave elastography (SWE) parameters of the surrounding tissue (shell) of different diameter on the diagnosis of benign and malignant breast lesions. Therefore, the purpose of our study was to evaluate the diagnostic performance of shell elasticity in the diagnosis of benign and malignant breast lesions using SWE.MethodsBetween September 2016 and June 2017, women with breast lesions underwent both conventional ultrasound (US) and SWE. Elastic values of the lesions peripheral tissue were determined according to the shell size, which was automatically drawn along the edge of the lesion using the following software guidelines: (1): 1 mm; (2): 2 mm; and (3): 3 mm. Quantitative elastographic features of the inner lesions and shell, including the elasticity mean (Emean), elasticity maximum (Emax), and elasticity minimum (Emin), were calculated using an online-available software. The receiver operating characteristic curves (ROCs) of the elastographic features was analyzed to assess the diagnostic performance, and the area under curve (AUC) of each elastographic feature was obtained. Logistic regression analysis was used to predict significant factors of malignancy, permitting the design of predictive models.ResultsThis prospective study included 63 breast lesions of 63 women. Of the 63 lesions, 33 were malignant and 30 were benign. The diagnostic performance of Emax-3shell was the highest (AUC = 0.76) with a sensitivity of 60.6% and a specificity of 83.3%. According to stepwise logistic regression analysis, the Emax-3shell and the Emin-3shell were significant predictors of malignancy (p < 0.05). The AUC of the predictive equation was 0.86.ConclusionsSWE features, particularly the combination of Emax-3shell and Emin-3shell can improve the diagnosis of breast lesions.

An epidemiological review of 623 foot and ankle soft tissue tumours and pseudo-tumours

BackgroundIn evaluating foot and ankle soft tissue masses, comprehensive epidemiological data, especially clinical predictors of malignancy, is essential knowledge. Our aim was to assess these data in a cohort of patients that have undergone surgical excision of foot and ankle soft tissue tumours and pseudo-tumours over a 10-year period. MethodsA retrospective review of foot and ankle soft tissue tumours and pseudo-tumours excised in a tertiary hospital from 1 Jan 2006 to 31 Dec 2016 was performed. Uni- and multivariable analyses via logistic regression were conducted for all independent variables to identify their relationship with malignancy. Applying receiver operating characteristic (ROC) curves and Youden’s Index to significant variables, we attempted to identify optimal threshold values to predict malignancy of the soft tissue mass. ResultsA total of 623 tumours and pseudo-tumours were analysed, and majority were benign (n = 605, 97.1%). The most common pseudo-tumour, benign, and malignant tumours were ganglion cysts (n = 289, 90.3%), plantar fibromas (n = 54, 18.9%) and pleomorphic undifferentiated sarcomas (n = 4, 22.2%), respectively. Increasing age (P = 0.036), larger size of mass (P < 0.001) and male gender (P = 0.017) were significant predictors of malignancy. ROC and Youden’s Index analyses identified optimal threshold values of 4.0 cm (area under curve [AUC] = 87.6%) for size of mass and 66 years (AUC = 60.7%) for age. ConclusionMajority of foot and ankle soft tissue masses are benign. Increasing age, larger size of mass and male gender are significant predictors of malignancy. The threshold value in predicting malignancy is 4.0 cm for size of mass and 66 years for age.

P539 Assessment of age as a risk factor for adverse events in patients from the tofacitinib ulcerative colitis clinical programme

Abstract Background Tofacitinib is an oral, small-molecule JAK inhibitor for the treatment of UC. Safety and efficacy of tofacitinib were demonstrated in Phase (P)2/3 induction studies, a 52-week, P3 maintenance study, and are being further investigated in an ongoing, open-label, long-term extension (OLE) study.1,2 Here, we provide an updated analysis of age as a risk factor for adverse events (AEs) in the tofacitinib UC clinical programme.3 Methods Proportions of AEs and serious AEs (SAEs), and incidence rates (IRs; unique patients with events per 100 patient-years) for AEs of special interest (AESIs), were determined for two cohorts: the Maintenance Cohort (patients who received placebo or tofacitinib 5 or 10 mg twice daily [BID] in the maintenance study) and the Overall Cohort (all tofacitinib 5 or 10 mg BID-treated patients in the P2/P3/OLE studies; as of May 2019), stratified by age. Multivariable Cox proportional hazards regression analyses were performed to assess whether older age was associated with increased risk of AESIs in the Overall Cohort. Results In the Maintenance Cohort, IRs of AEs and SAEs were generally similar between treatment groups, with no age-related trend in the proportions of AEs in tofacitinib-treated patients. AESIs were infrequent in both treatment groups; however, herpes zoster (HZ; non-serious and serious) IRs were numerically higher in the ≥40 to &amp;lt;50 and ≥50 years age groups for patients treated with tofacitinib 10 mg BID vs. placebo and tofacitinib 10 vs. 5 mg BID. In the Overall Cohort, IR of serious infections was generally similar between age groups, while IRs of opportunistic infections (OIs) and HZ (non-serious and serious), malignancy (excl. non-melanoma skin cancer [NMSC]), NMSC and major adverse cardiovascular events increased with increasing age. The IRs of HZ and NMSC were significantly greater in patients ≥50 years compared with patients &amp;lt;30 years, and in patients ≥30 to &amp;lt;40 years for NMSC. In multivariate analyses, older age was identified as a significant predictor of malignancy (excl. NMSC), NMSC and HZ. Conclusion In the Overall Cohort, there was a trend for an increase in the rates of OIs, HZ, malignancy (excl. NMSC) and NMSC with increasing age. In multivariate analyses, older age was associated with increased risk of malignancy (excl. NMSC), NMSC and HZ. The results of this analysis are generally consistent with previous studies suggesting older age may be associated with an increased risk of certain AESIs in patients with UC, and in some instances in the general population.4 References