Solid Nodules Research Articles

Microwave versus Radiofrequency Ablation in Treating Predominantly Solid Benign Thyroid Nodules: A Randomized Controlled Trial.

Background Current guidelines recommend radiofrequency ablation (RFA) as the first-line treatment for benign thyroid nodules. Purpose To compare the efficacy and safety of microwave ablation (MWA) and RFA for the treatment of predominantly solid benign thyroid nodules. Materials and Methods This prospective, randomized, open-label, multicenter study was conducted from August 2019 to February 2023. Participants with nonfunctioning, predominantly solid benign thyroid nodules from five institutions were randomly assigned with a 1:1 ratio to receive MWA or RFA treatment. Participants were followed up for at least 2 years. Primary outcomes were 6-month and 2-year volume reduction rate (VRR) of nodules after ablation. Secondary outcomes included VRR change over time, complications, and technique efficacy (defined as volumetric reduction ≥ 50% of the initial nodule volume). Continuous variables and categorical variables were compared using the t test and the χ2 test or Fisher exact test, respectively. Results This study included 76 participants in the MWA group (mean age, 46 years ± 12 [SD]; 58 female participants) and 76 in the RFA group (mean age, 50 years ± 13; 56 female participants). MWA was noninferior to RFA in terms of 6-month (mean difference, -5.6%; P = .01) and 2-year (-2.4%; P < .001) VRR after ablation. Comparing MWA and RFA, no evidence of a difference was observed for VRR change over time (mean difference from mixed-effects analysis, 6.9% [95% CI: -0.5, 13.9]; P = .73) or technique efficacy (91% vs 86%; P = .40). The most common major complication was voice change, which occurred in 6.6% of participants in the MWA group and 1.3% of participants in the RFA group (P = .21). Conclusion MWA and RFA showed comparable efficacy for treating participants with predominantly solid benign thyroid nodules. However, a larger sample size is needed to demonstrate that safety is comparable between the procedures. ClinicalTrials.gov Identifier: NCT04046354 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by McGahan in this issue.

Using CT features of cystic airspace to predict lung adenocarcinoma invasiveness.

Lung adenocarcinoma associated with cystic airspace (LACA) was once considered an uncommon manifestation of lung adenocarcinoma (LUAD), and understandings of it are limited; however, it is being observed more frequently in clinical practice. This study sought to assess the prevalence of LACA, and compare the high-resolution computed tomography (HRCT) features of LACA in patients with varying degrees of invasiveness. This study retrospectively reviewed the HRCT scans of 1,525 patients with LUAD ≤3 cm in diameter at the Shanghai Chest Hospital between January 2016 and May 2016. Each nodule was examined to detect the presence of cystic airspace. Additionally, we analyzed the qualitative HRCT findings of the cystic airspaces, including the pattern, number, wall component density, distribution, inner surface, mural nodules, septa, and vessels passing through the cystic airspace using the Pearson χ2 test or Fisher's exact test as appropriate. We also analyzed the quantitative measurements, such as the cystic airspace diameter, wall thickness, and thin-wall proportion, using a one-way analysis of variance or the Kruskal-Wallis rank-sum test as appropriate. LACAs were observed on HRCT in 11.5% (176/1,525) of the patients, of whom 7.1% (36/505) had pure ground-glass nodules, 13.5% (112/830) had mixed ground-glass nodules, and 14.7% (28/190) had solid nodules (P=0.001). The surgical procedures for LACAs varied (P=0.012). The incidence of LACAs increased as nodule diameter and invasiveness increased (both P<0.001). Statistically significant differences were observed in the wall component density, distribution, septa, vessels passing through the cystic airspace, cystic airspace diameter, wall thickness, and thin-wall proportion among the preinvasive lesion (PL), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC) groups (P<0.001, P=0.024, P=0.001, P=0.025, P=0.001, P<0.001, and P<0.001, respectively). Wall component density increased as invasiveness increased (P<0.001). Unlike those in the MIAs and IACs, cystic airspaces in PLs typically lacked septa (P=0.001, and P<0.001, respectively). The IACs had larger cystic airspace diameters than the PLs (6.5 vs. 3.7 mm) (P<0.001). The IACs also had thicker wall thickness (11.8 vs. 6.8 mm, 11.8 vs. 8.3 mm) (P<0.001, and P<0.001, respectively) and smaller thin-wall proportions (181.5° vs. 264.8°, 181.5° vs. 223.8°) (P<0.001, and P=0.039, respectively) than the PLs and MIAs. The prevalence and characteristics of cystic airspaces on HRCT can be used to predict invasiveness in patients with LUADs ≤3 cm in diameter.

Preoperative markers for identifying CT ≤2 cm solid nodules of lung adenocarcinoma based on image deep learning.

The solid pattern is a highly malignant subtype of lung adenocarcinoma. In the current era of transitioning from lobectomy to sublobar resection for the surgical treatment of small lung cancers, preoperative identification of this subtype is highly important for patient surgical approach selection and long-term prognosis. A total of 1489 patients with clinical stage IA1-2 primary lung adenocarcinoma were enrolled. Based on patient clinical characteristics and lung imaging features obtained via deep learning, highly correlated diagnostic factors were identified through LASSO regression and decision tree analysis. Subsequently, a logistic model and nomogram were constructed. A restricted cubic spline (RCS) was used to calculate the optimal inflection point of quantitative data and the differences between the groups. The three-dimensional proportion of solid component (PSC), sex, and smoking status was identified as being highly correlated diagnostic factors for solid predominant adenocarcinoma. The logistic model had good prediction efficiency, and the area under the ROC curve was 0.85. Decision curve analysis demonstrated that the application of diagnostic factors can improve patient outcomes. RCS analysis indicated that the proportion of solid adenocarcinomas increased by 4.6 times when the PSC was ≥72%. A PSC of 72% is a good cutoff point. The preoperative diagnosis of solid-pattern adenocarcinoma can be confirmed by typical imaging features and clinical characteristics, assisting the thoracic surgeon in developing a more precise surgical plan.

Impact on Prognosis of Stage I Non-Small Cell Lung Cancer Secondary to Delays in Diagnostic Workup.

Background Diagnostic workup of small pulmonary nodules often requires follow-up CT scans to confirm nodule growth before invasive diagnostics or treatment. Purpose To confirm prior results from the International Early Lung Cancer Action Program (I-ELCAP) on quantifying decreases in lung cancer prognosis by using two large databases, the National Lung Screening Trial (NLST) and International Association for the Study of Lung Cancer (IASLC). Materials and Methods In this retrospective study, a model was developed to predict cure rates based on size of solid nodules using the NLST (August 2002 to summer 2007) and IASLC (January 2011 to December 2019) databases, focusing on stage I non-small cell lung cancer (NSCLC). Kaplan-Meier methods were used to calculate 10-year lung cancer-specific survival and 5-year overall survival rates for different tumor sizes. Tumor diameter increases after 90-, 180-, and 365-day delays were estimated using volume doubling times (VDTs) of 60, 120, and 240 days corresponding to fast, moderate, and slow tumor growth. Initial and delayed lung cancer cure rates were assessed across nine scenarios of time delays and tumor growth rates and compared with the previous results of the I-ELCAP database. Results Using regression models based on 166 NLST and 22 590 IASLC patients with NSCLC, 10-year lung cancer-specific survival and 5-year overall survival, respectively, for tumors 4.0-20.0 mm in diameter were estimated. For a 20.0-mm tumor with a 60-day VDT in the NLST database, the lung cancer-specific survival decreased from 83.4% to 76.5%, 66.8%, and 32.3% after 90, 180, and 365 days, respectively. The IASLC database showed similar decreases in 5-year overall survival, from 81.2% to 73.4%, 62.4%, and 23.3% after 90, 180, and 365 days, respectively. Comparison across NLST, IASLC, and I-ELCAP databases revealed minor variations in lung cancer cure rates between 79.9% and 83.4%, with reductions of 6.9%-8.3% after a 180-day delay with a 120-day VDT. Conclusion The NLST and IASLC databases confirmed prior estimates from the I-ELCAP database for the decrease in lung cancer prognosis due to diagnostic delays. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Park and Lee in this issue.

The study of plain CT combined with contrast-enhanced CT-based models in predicting malignancy of solitary solid pulmonary nodules

To compare the diagnostic performance between plain CT-based model and plain plus contrast CT-based modelin the classification of malignancy for solitary solid pulmonary nodules. Between January 2012 and July 2021, 527 patients with pathologically confirmed solitary solid pulmonary nodules were collected at dual centers with similar CT examinations and scanning parameters. Before surgery, all patients underwent both plain and contrast-enhanced chest CT scans. Two clinical characteristics, fifteen plain CT characteristics, and four enhanced characteristics were used to develop two logistic regression models: model 1 (plain CT only) and model 2 (plain + contrast CT). The diagnostic performance of the two models was assessed separately in the development and external validation cohorts using the AUC. 392 patients from Center A were included in the training cohort (median size, 20.0 [IQR, 15.0–24.0] mm; mean age, 55.8 [SD, 9.9] years; male, 53.3%). 135 patients from Center B were included in the external validation cohort (median size, 20.0 [IQR, 16.0–24.0] mm; mean age, 56.4 [SD, 9.6] years; male, 51.9%). Preoperative patients with 201 malignant (adenocarcinoma, 148 [73.6%]; squamous cell carcinoma, 35 [17.4%]; large cell carcinoma,18 [9.0%]) and 326 benign (pulmonary hamartoma, 118 [36.2%]; sclerosing pneumocytoma, 35 [10.7%]; tuberculosis, 104 [31.9%]; inflammatory pseudonodule, 69 [21.2%]) solitary solid pulmonary nodules were gathered from two independent centers. The mean sensitivity, specificity, accuracy, PPV, NPV, and AUC (95%CI) of model 1 (Plain CT only) were 0.79, 0.78, 0.79, 0.67, 0.87, and 0.88 (95%CI, 0.82–0.93), the model 2 (Plain + Contrast CT) were 0.88, 0.91, 0.90, 0.84, 0.93, 0.93 (95%CI, 0.88–0.98) in external validation cohort, respectively. A logistic regression model based on plain and contrast-enhanced CT characteristics showed exceptional performance in the evaluation of malignancy for solitary solid lung nodules. Utilizing this contrast-enhanced CT model would provide recommendations concerning follow-up or surgical intervention for preoperative patients presenting with solid lung nodules.

Driver gene alterations in NSCLC patients in southern China and their correlation with clinicopathologic characteristics.

In this study, we aimed to explore the relationship between clinicopathological features and driver gene changes in Chinese NSCLC patients. Amplification refractory mutation system PCR was used to detect the aberrations of 10 driver oncogenes in 851 Chinese NSCLC patients, and their correlation with clinicopathological characteristics was also analyzed. Moreover, three models of logistic regression were used to analyze the association between histopathology and EGFR or KRAS mutations. The top two most frequently aberrant target oncogenes were EGFR (48.06%) and KRAS (9.51%). These were followed by ALK (5.41%), HER2 (2.35%), MET (2.23%), RET (2.11%), ROS1 (1.88%), BRAF (0.47%), NRAS (0.24%), and PIK3CA (0.12%). Additionally, 11 (1.29%) patients had synchronous gene alterations in two genes. The main EGFR mutations were exon 21 L858R and exon 19-Del, which accounted for 45.97% and 42.79% of all EGFR mutations, respectively. Logistic regression analysis showed that the frequency of EGFR mutations was positively correlated with women, non-smokers, lung adenocarcinoma, and invasive non-mucinous adenocarcinoma (IA), and negatively correlated with solid nodule, micro-invasive adenocarcinoma, and solid-predominant adenocarcinoma. KRAS mutations were positively associated with men and longer tumor long diameters and negatively correlated with lung adenocarcinoma (P < 0.05 for all). Our findings suggest that the EGFR mutation frequency was higher in women, non-smokers, lung adenocarcinoma, and the IA subtype in lung adenocarcinoma patients, while the KRAS mutation rate was higher in men and patients with longer tumor long diameter and lower in lung adenocarcinoma patients.

Clinical features of 20 cases with Pneumocystis jirovecii pneumonia after allogeneic hematopoietic stem cell transplantation

This study included 20 patients with hematological diseases who developed Pneumocystis jirovecii pneumonia (PJP) after receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT) from April 2014 to October 2022 at Peking University People's Hospital. The 20 patients comprised 13 males (65.0% ) and seven females (35.0% ), with a median age of 34 (19-60) years. Eleven cases (55.0% ) of acute myeloid leukemia, four cases (20.0% ) of acute lymphocytic leukemia, two cases (10.0% ) of myelodysplastic syndrome, one case (5.0% ) of chronic myelomonocytic leukemia, one case (5.0% ) of non-Hodgkin lymphoma, and one case (5.0% ) of aplastic anemia were analyzed. Three cases (15.0% ) of HLA-identical sibling hematopoietic stem cell transplantation, three cases (15.0% ) of matched unrelated donor hematopoietic stem cell transplantation, and 14 cases (70.0% ) of haploid hematopoietic stem cell transplantation were identified. The median onset time of PJP was 353 (74-1121) days after transplantation. The clinical symptoms mainly included fever, cough, expectoration, and dyspnea. All patients presented signs of infection based on the CT scan, including bilateral diffuse ground-glass opacities, patchy shadows, and solid nodules. Nine patients (45.0% ) required respiratory support via nasal catheter oxygen inhalation, while seven patients (35.0% ) required ventilator-assisted breathing. Seven (35.0% ) severe infections and 13 (65.0% ) mild to moderate infections were recorded. Moreover, eight patients (40.0% ) were complicated with human cytomegalovirus infection, whereas two patients were complicated with EB virus infection. Furthermore, all 20 patients received treatment with compound sulfamethoxazole (standard dose, 11 cases; low dose, 9 cases). Furthermore, 19 patients survived and one patient died.

Detection of Pulmonary Nodules on Ultra-low Dose Chest Computed Tomography With Deep-learning Image Reconstruction Algorithm.

To evaluate the accuracy of ultra-low dose (ULD) chest computed tomography (CT), with a radiation exposure equivalent to a 2-view chest x-ray, for pulmonary nodule detection using deep learning image reconstruction (DLIR). This prospective cross-sectional study included 60 patients referred to our institution for assessment or follow-up of solid pulmonary nodules. All patients underwent low-dose (LD) and ULD chest CT within the same examination session. LD CT data were reconstructed using Adaptive Statistical Iterative Reconstruction-V (ASIR-V), whereas ULD CT data were reconstructed using DLIR and ASIR-V. ULD CT images were reviewed by 2 readers and LD CT images were reviewed by an experienced thoracic radiologist as the reference standard. Quantitative image quality analysis was performed, and the detectability of pulmonary nodules was assessed according to their size and location. The effective radiation dose for ULD CT and LD CT were 0.13±0.01 and 1.16±0.6mSv, respectively. Over the whole population, LD CT revealed 733 nodules. At ULD, DLIR images significantly exhibited better image quality than ASIR-V images. The overall sensitivity of DLIR reconstruction for the detection of solid pulmonary nodules from the ULD CT series was 93% and 82% for the 2 readers, with a good to excellent agreement with LD CT (ICC=0.82 and 0.66, respectively). The best sensitivities were observed in the middle lobe (97% and 85%, respectively). At ULD, DLIR reconstructions, with minimal radiation exposure that could facilitate large-scale screening, allow the detection of pulmonary nodules with high sensitivity in an unrestricted BMI population.

EP264 - Dermatofibrosarcoma protuberance of the perianal region

Abstract Introduction Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade sarcoma affecting dermis and subcutaneous fat. Typically presents as slow-growing lump on the trunk, extremities or head and neck.(1) It can be locally aggressive with a high recurrence rate.(2) Only 6 reported cases of DFSP in peri-anal region. Case Description A 26-year-old male presented with slow-growing peri-anal lump for over a year with intermittent localised pain and episodes of bleeding. No other symptoms or trauma to peri-anal area noted. No relevant medical or surgical history. Examination revealed an irreducible two-by-five by one-centimetre semi-pedunculated perianal lump extending from the seven o’clock to eleven o’clock position. It was firm and tethered to the skin. Case Description Flexible sigmoidoscopy was normal. Excision biopsy histology reported diffuse infiltration of spindle cells with storiform pattern of growth without clear margins. Immunohistochemistry analysis expressed CD34 with minimal focal expression of SMA and variable Ki-67 proliferation indexed up to 15-20% in most active areas. SOX10, S100, desmin, factor XIIIA, MNF116 and CD31 were negative. Diagnosis was DFSP. Local lower gastrointestinal multi-disciplinary arranged urgent imaging and referral to tertiary centre. Magnetic resonance imaging of the pelvis identified no definite underlying localised restricted diffusion or solid enhancing nodule. Wide local excision at tertiary centre with histopathology confirmed clear margins. Conclusion Patient is under follow-up locally and at the tertiary. Urgency and a singular episode of stool incontinence was reported at two-weeks follow-up which subsequently normalised. He is currently under 3-6 monthly reviews with repeat MRI prior to next appointment. Patient has returned to normal activities.

The scoring system combined with radiomics and imaging features in predicting the malignant potential of incidental indeterminate small (

ObjectiveDevelop a practical scoring system based on radiomics and imaging features, for predicting the malignant potential of incidental indeterminate small solid pulmonary nodules (IISSPNs) smaller than 20 mm.MethodsA total of 360 patients with malignant IISSPNs (n = 213) and benign IISSPNs (n = 147) confirmed after surgery were retrospectively analyzed. The whole cohort was randomly divided into training and validation groups at a ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) algorithm was used to debase the dimensions of radiomics features. Multivariate logistic analysis was performed to establish models. The receiver operating characteristic (ROC) curve, area under the curve (AUC), 95% confidence interval (CI), sensitivity and specificity of each model were recorded. Scoring system based on odds ratio was developed.ResultsThree radiomics features were selected for further model establishment. After multivariate logistic analysis, the combined model including Mean, age, emphysema, lobulated and size, reached highest AUC of 0.877 (95%CI: 0.830–0.915), accuracy rate of 83.3%, sensitivity of 85.3% and specificity of 80.2% in the training group, followed by radiomics model (AUC: 0.804) and imaging model (AUC: 0.773). A scoring system with a cutoff value greater than 4 points was developed. If the score was larger than 8 points, the possibility of diagnosing malignant IISSPNs could reach at least 92.7%.ConclusionThe combined model demonstrated good diagnostic performance in predicting the malignant potential of IISSPNs. A perfect accuracy rate of 100% can be achieved with a score exceeding 12 points in the user-friendly scoring system.

Diagnostic yield of combined ACR TI-RADS and Sonoelastography in solid thyroid nodules in tertiary care center: A prospective cross-sectional Study

Background: Thyroid nodules are prevalent, and accurate differentiation between benign and malignant nodules is crucial for management. We aim to evaluate the effectiveness of combining Thyroid Imaging Reporting and Data System (TIRADS) scoring with strain elastography, specifically the Elasticity Contrast Index (ECI), to differentiate between benign and malignant thyroid nodules. Methods: This analytical cross-sectional study involved 77 patients with solid thyroid nodules identified through B-mode ultrasonography. ACR TI-RADS scores, ECI values, and combined scores were compared with Fine needle aspiration Cytology (FNAC) results. Statistical analysis was performed using SPSS, and Pearson correlation tests were conducted to assess the correlation with FNAC findings. Result: The TI-RADS scoring system has a sensitivity of 83.3%, a specificity of 66.1%, and a positive predictive value of 42.9% for distinguishing benign and malignant nodules. Strain elastography with ECI values has a sensitivity of 94.4%, specificity of 98.3%, PPV of 94.4%, and NPV of 98.3%. Combining ACR TI-RADS and strain elastography achieves a sensitivity of 100%, specificity of 66.1%, NPV of 100%, and PPV of 47.4%. Conclusion: The study emphasizes the benefits of integrating noninvasive methods like ultrasound elastography and ACR TI-RADS for improved diagnostic precision, minimizing invasion and patient discomfort. This strategy is particularly advantageous for TI-RADS 3 nodules and reduces unnecessary procedures. However, FNAC should be reasonable and validated for higher classifications.

Radiological and pathological predictors of post-operative upstaging of breast ductal carcinoma in situ (DCIS) to invasive ductal carcinoma and lymph-nodes metastasis; a potential algorithm for node surgical de-escalation

Background/aimDuctal carcinoma in situ is considered a local disease with no metastatic potential, thus sentinel lymph node biopsy (SLNB) may be deemed an overtreatment. SLNB should be reserved for patients with invasive cancer, even though the risk of upstaging rises to 25 %. We aimed to identify clinicopathological predictors of post-operative upstaging in invasive carcinoma. MethodsWe retrospectively analyzed patients with a pre-operative diagnosis of DCIS subjected to breast surgery between January 2017 to December 2021, and evaluated at the Breast Unit of PTV (Policlinico Tor Vergata, Rome). ResultsOut of 267 patients diagnosed with DCIS, 33(12.4 %) received a diagnosis upstaging and 9(3.37 %) patients presented with sentinel lymph node (SLN) metastasis. In multivariate analysis, grade 3 tumor (OR 1.9; 95 % CI 1.2–5.6), dense nodule at mammography (OR 1.3; 95 % CI 1.1–2.6) and presence of a solid nodule at ultrasonography (OR 1.5; 95 % CI 1.2–2.6) were independent upstaging predictors. Differently, the independent predictors for SLNB metastasis were: upstaging (OR 2.1.; 95 % CI 1.2–4.6; p = 0.0079) and age between 40 and 60yrs (OR 1.4; 95 % CI 1.4–2.7; p = 0.027).All 9 patients with SLN metastasis received a diagnosis upstaging and were aged between 40 and 60 years old. ConclusionWe identified pre-operative independent predictors of upstaging to invasive ductal carcinoma. The combined use of different predictors in an algorithm for surgical treatments of DCIS could reduce the numbers of unnecessary SLNB.

Safety and efficacy of a novel transbronchial radiofrequency ablation system for lung tumours: One year follow-up from the first multi-centre large-scale clinical trial (BRONC-RFII).

Radiofrequency ablation (RFA) is an emerging treatment of lung cancer, yet it is accompanied by certain safety concerns and operational limitations. This first multi-centre, large-scale clinical trial aimed to investigate the technical performance, efficacy and safety of an innovative transbronchial RFA system for lung tumours. The study enrolled patients with malignant lung tumours who underwent transbronchial RFA using an automatic saline microperfusion system between January 2021 and December 2021 across 16 medical centres. The primary endpoint was the complete ablation rate. The performance and safety of the technique, along with the 1-year survival rates, were evaluated. This study included 126 patients (age range: 23-85 years) with 130 lung tumours (mean size: 18.77 × 14.15 mm) who had undergone 153 transbronchial RFA sessions, with a technique success rate of 99.35% and an average ablation zone size of 32.47 mm. At the 12-month follow-up, the complete ablation rate and intrapulmonary progression-free survival rates were 90.48% and 88.89%, respectively. The results of patients with ground-glass nodules (GGNs) were superior to those of the patients with solid nodules (12-month complete ablation rates: solid vs. pure GGN vs. mixed GGN: 82.14% vs. 100% vs. 96.08%, p = 0.007). No device defects were reported. Complications such as pneumothorax, haemoptysis, pleural effusion, pulmonary infection and pleural pain were observed in 3.97%, 6.35%, 8.73%, 11.11% and 10.32% of patients, respectively. Two subjects died during the follow-up period. Transbronchial RFA utilizing an automatic saline microperfusion system is a viable, safe and efficacious approach for the treatment for lung tumours, particularly for patients with GGNs.

Comparison of clinical and patient-reported outcomes in patients with benign euthyroid solitary nodules after ultrasound-guided percutaneous microwave ablation and endoscopic thyroidectomy.

Percutaneous ultrasound-guided microwave ablation (MWA) for benign solid thyroid nodules is the newest modality for treatment. However, the differences in treatment outcomes between MWA and endoscopic thyroidectomy vestibular approach (TOETVA) for patients with benign euthyroid solitary nodules remain unknown. We are sharing initial results from our prospective study. Prospective study between January 2022 and December 2023 was conducted and data were noted at 3 time points in patients planned for treatment (Preoperative, 1week, and 12months). Main outcome measures were clinical outcome and comparison of thyroid-related quality of life using the ThyPRO-39hin and swallowing-related quality of life using the SWAL-QoL. Of the 36 included patients, 20 patients underwent TOETVA and 16 underwent MWA. Both the groups were comparable in terms of demographic and clinicopathological profiles. The nodule volume reduction rate of patients at 12months after MWA was 75.10% and 100% for TOETVA. The mean preoperative ThyPRO-39hin and SWAL-QoL scores were comparable in all domains between the two groups. Mean ThyPRO-39hin and SWAL-QoL scores on postoperative day 7 were significantly better in the MWA group in domains impaired social life (p<0.0001) and impaired daily life (p=0.0002). However, at the end of 12months, mean ThyPRO-39hin and SWAL-QoL scores became significantly better in the TOETVA group as compared to the MWA group. Our findings suggest that transoral endoscopic thyroidectomy results in significant superior clinical outcome, thyroid-related quality of life, and swallowing-related quality of life in the long term.

Poorly Differentiated Large Cell Neuroendocrine Carcinoma of the Transverse Colon: Case Report

Introduction: Neuroendocrine carcinomas (NECs) of the colon and rectum are extremely rare malignant subtypes of neuroendocrine tumors, with a reported incidence of 0.1% to 3.9% of all colorectal malignancies. Large cell neuroendocrine carcinomas of the colon (LCNECs) are even rarer, aggressive in nature and have a poor prognosis due to their tendency to early metastasis. Case report: Large cell neuroendocrine carcinoma in the transverse colon with liver metastasis of a 66 years- old male patient, who reported cramping abdominal pain for two months, weight loss of 12 kilos and melena during this period. Abdominal tomography showing circumferential parietal thickening with an infiltrative and stenosing appearance in the transverse colon on the right and multiple hypovascular solid hepatic nodules. Pathology of the lesion compatible with poorly differentiated carcinoma and liver metastases was metastatic adenocarcinoma. Material from the colon biopsy and liver lesions were sent for immunohistochemical studies confirming the diagnosis of high-grade neuroendocrine carcinoma. Conclusion: Early detection can offer a better prognosis for other patients and correct diagnosis is of great importance, as they are often misdiagnosed as adenocarcinoma or another malignant tumor on first imaging or histological study.

Idiopathic hyalinizing fibrosclerosis: A systemic steroid-resistant condition distinct from IgG4-related disease

Since the concept of IgG4-related disease (IgG4-RD) was proposed, that diagnosis has been considered in idiopathic fibroinflammatory diseases in various organs, particularly in cases with multi-organ involvement. We have recently encountered three cases of fibrosing disease of uncertain etiology with shared microscopic appearances. Case 1 (56-year-old man) had an irregular mass at the base of mesentery. Case 2 (29-year-old woman) presented with obstructive jaundice due to an ill-defined mass at the hepatic hilum and two lung nodules. Case 3 (53-year-old man) had multiple solid nodules in the mediastinum, peritoneum, retroperitoneum, and mesentery; he also had diffuse irregular narrowing of the intra- and extra-hepatic bile ducts in keeping with sclerosing cholangitis. Serum IgG4 concentrations were not elevated. Biopsies from the nodular lesions showed extensive hyalinizing fibrosis with an only focal lymphoplasmacytic infiltrate. Thick collagenous bundles are arranged in an irregular or partly whorl pattern. Typical storiform fibrosis or obliterative phlebitis was not observed. The number of IgG4-positive plasma cells was <10 cells/high-power field; the ratio of IgG4/IgG-positive plasma cells was <30%. After the histological diagnosis of sclerosing mesenteritis, pulmonary hyalinizing granuloma, and mediastinal fibrosis was made, they were treated with a trial of steroids, but none showed a significant response. In conclusion, a hyalinizing fibrotic condition can occur at various anatomical sites. They have shared microscopic findings, and are steroid-resistant. Although the clinical presentation may mimic IgG4-RD, the two conditions are likely distinct. We would propose a diagnostic term of ‘idiopathic hyalinizing fibrosclerosis’ for this under-recognized, rare, systemic condition.

Increased Scan Speed and Pitch on Ultra-Low-Dose Chest CT: Effect on Nodule Volumetry and Image Quality.

Background and Objectives: This study's objective was to investigate the influence of increased scan speed and pitch on image quality and nodule volumetry in patients who underwent ultra-low-dose chest computed tomography (CT). Material and Methods: One hundred and two patients who had lung nodules were included in this study. Standard-speed, standard-pitch (SSSP) ultra-low-dose CT and high-speed, high-pitch (HSHP) ultra-low-dose CT were obtained for all patients. Image noise was measured as the standard deviation of attenuation. One hundred and sixty-three nodules were identified and classified according to location, volume, and nodule type. Volume measurement of detected pulmonary nodules was compared according to nodule location, volume, and nodule type. Motion artifacts at the right middle lobe, the lingular segment, and both lower lobes near the lung bases were evaluated. Subjective image quality analysis was also performed. Results: The HSHP CT scan demonstrated decreased motion artifacts at the left upper lobe lingular segment and left lower lobe compared to the SSSP CT scan (p < 0.001). The image noise was higher and the radiation dose was lower in the HSHP scan (p < 0.001). According to the nodule type, the absolute relative volume difference was significantly higher in ground glass opacity nodules compared with those of part-solid and solid nodules (p < 0.001). Conclusion: Our study results suggest that HSHP ultra-low-dose chest CT scans provide decreased motion artifacts and lower radiation doses compared to SSSP ultra-low-dose chest CT. However, lung nodule volumetry should be performed with caution for ground glass opacity nodules.

Clinical application of convolutional neural network lung nodule detection software: An Australian quaternary hospital experience.

Early-stage lung cancer diagnosis through detection of nodules on computed tomography (CT) remains integral to patient survivorship, promoting national screening programmes and diagnostic tools using artificial intelligence (AI) convolutional neural networks (CNN); the software of AI-Rad Companion™ (AIRC), capable of self-optimising feature recognition. This study aims to demonstrate the practical value of AI-based lung nodule detection in a clinical setting; a limited body of research. One hundred and eighty-three non-contrast CT chest studies from a single centre were assessed for AIRC software analysis. Prospectively collected data from AIRC detection and characterisation of lung nodules (size: ≥3 mm) were assessed against the reference standard; reported findings of a blinded consultant radiologist. One hundred and sixty-seven CT chest studies were included; 52% indicated for nodule or lung cancer surveillance. Of 289 lung nodules, 219 (75.8%) nodules (mean size: 10.1 mm) were detected by both modalities, 28 (9.7%) were detected by AIRC alone and 42 (14.5%) by radiologist alone. Solid nodules missed by AIRC were larger than those missed by radiologist (11.5 mm vs 4.7 mm, P < 0.001). AIRC software sensitivity was 87.3%, with significant false positive and negative rates demonstrating 12.5% specificity (PPV 0.6, NPV 0.4). In a population of high nodule prevalence, AIRC lung nodule detection software demonstrates sensitivity comparable to that of consultant radiologist. The clinical significance of larger sized nodules missed by AIRC software presents a barrier to current integration in practice. We consider this research highly relevant in providing focus for ongoing software development, potentiating the future success of AI-based tools within diagnostic radiology.

Effect of Deep Learning Image Reconstruction Algorithms on Radiomic Features of Pulmonary Nodules in Ultra-Low-Dose CT.

The purpose of this study is to explore the impact of deep learning image reconstruction (DLIR) algorithm on the quantification of radiomic features in ultra-low-dose computed tomography (ULD-CT) compared with adaptive statistical iterative reconstruction-Veo (ASIR-V). One hundred eighty-three patients with pulmonary nodules underwent standard-dose computed tomography (SDCT) (4.30 ± 0.36 mSv) and ULD-CT (UL-A, 0.57 ± 0.09 mSv or UL-B, 0.33 ± 0.04 mSv). SDCT was the reference standard using (ASIR-V) at 50% strength (50%ASIR-V). ULD-CT was reconstructed with 50%ASIR-V, DLIR at medium and high strength (DLIR-M, DLIR-H). Radiomics analysis extracted 102 features, and the intraclass correlation coefficient (ICC) quantified reproducibility between ULD-CT and SDCT reconstructed by 50%ASIR-V, DLIR-M, and DLIR-H for each feature. Among 102 radiomic features, the percentages of reproducibility of 50%ASIR-V, DLIR-M, and DLIR-H were 48.04% (49/102), 49.02% (50/102), and 52.94% (54/102), respectively. Shape and first order features demonstrated high reproducibility across different reconstruction algorithms and radiation doses, with mean ICC values exceeding 0.75. In texture features, DLIR-M and DLIR-H showed improved mean ICC values for pure ground glass nodules (pGGNs) from 0.69 ± 0.23 to 0.75 ± 0.18 and 0.81 ± 0.12, respectively, compared with 50%ASIR-V. Similarly, the mean ICC values for solid nodules (SNs) increased from 0.60 ± 0.19 to 0.66 ± 0.14 and 0.69 ± 0.13, respectively. Additionally, the mean ICC values of texture features for pGGNs and SNs in both ULD-CT groups decreased with reduced radiation dose. DLIR can improve the reproducibility of radiomic features at ultra-low doses compared with ASIR-V. In addition, pGGNs showed better reproducibility at ultra-low doses than SNs.

Distribution of Solid Lung Nodules Presence and Size by Age and Sex in a Northern European Nonsmoking Population.

Background Most of the data regarding prevalence and size distribution of solid lung nodules originates from lung cancer screening studies that target high-risk populations or from Asian general cohorts. In recent years, the identification of lung nodules in non-high-risk populations, scanned for clinical indications, has increased. However, little is known about the presence of solid lung nodules in the Northern European nonsmoking population. Purpose To study the prevalence and size distribution of solid lung nodules by age and sex in a nonsmoking population. Materials and Methods Participants included nonsmokers (never or former smokers) from the population-based Imaging in Lifelines study conducted in the Northern Netherlands. Participants (age ≥ 45 years) with completed lung function tests underwent chest low-dose CT scans. Seven trained readers registered the presence and size of solid lung nodules measuring 30 mm3 or greater using semiautomated software. The prevalence and size of lung nodules (≥30 mm3), clinically relevant lung nodules (≥100 mm3), and actionable nodules (≥300 mm3) are presented by 5-year categories and by sex. Results A total of 10 431 participants (median age, 60.4 years [IQR, 53.8-70.8 years]; 56.6% [n = 5908] female participants; 46.1% [n = 4812] never smokers and 53.9% [n = 5619] former smokers) were included. Of these, 42.0% (n = 4377) had at least one lung nodule (male participants, 47.5% [2149 of 4523]; female participants, 37.7% [2228 of 5908]). The prevalence of lung nodules increased from age 45-49.9 years (male participants, 39.4% [219 of 556]; female participants, 27.7% [236 of 851]) to age 80 years or older (male participants, 60.7% [246 of 405]; female participants, 50.9% [163 of 320]). Clinically relevant lung nodules were present in 11.1% (1155 of 10 431) of participants, with prevalence increasing with age (male participants, 8.5%-24.4%; female participants, 3.7%-15.6%), whereas actionable nodules were present in 1.1%-6.4% of male participants and 0.6%-4.9% of female participants. Conclusion Lung nodules were present in a substantial proportion of all age groups in the Northern European nonsmoking population, with slightly higher prevalence for male participants than female participants. © RSNA, 2024 Supplemental material is available for this article.