Suspicious Lesions Research Articles

Heterotopic Splenic Tissue Mimicking Metastases on Magnetic Resonance Imaging.

Heterotopic splenic tissue can occur following splenectomy and is typically asymptomatic, often discovered incidentally during imaging for other conditions. This benign condition may mimic malignant processes, posing diagnostic challenges especially in patients with a history of cancer or concurrent malignancy. We report the case of a 60-year-old male with a history of well-controlled hypertension and a splenectomy following a traumatic injury at age 7. The patient underwent routine screening which revealed elevated prostate-specific antigen (PSA) levels. Subsequent magnetic resonance imaging (MRI) identified suspicious lesions in the prostate and a left lower quadrant mass. Prostate biopsy confirmed an adenocarcinoma with a Gleason score of 6, while biopsy of the abdominal mass revealed heterotopic splenic tissue. The management strategy included active surveillance for prostate cancer, considering the tumour's low aggressiveness and the benign nature of the splenic tissue. This case highlights the importance of considering heterotopic splenic tissue in differential diagnosis when evaluating abdominal masses in patients with a history of splenectomy. Accurate diagnosis through careful imaging and biopsy is crucial to avoid misdiagnosis and unnecessary treatments, particularly in patients with concurrent malignancies. In patients who have had a prior splenectomy for trauma, heterotopic splenic tissue may be mistaken for metastases on MRI.

Incidence of Carotid Atheroma in Patients Received Radiotherapy in Neck Field-A Case Series Study

Introduction: Atheroma is a condition that affects various blood vessels, primarily forming at junctions of moderate to large vessels, such as the carotid artery, where it is known as carotid atheroma (CA). Atheroma can lead to myocardial infarction or stroke. Previous studies have shown that head and neck radiotherapy can induce CA, even in young patients. Early diagnosis of atheroma in panoramic views can help prevent ischemic attacks in the brain and potentially save lives. Case Presentation: Thirty-six patients were referred to Semnan Dental School for dental screening by a hematologist-oncologist. An oral medicine specialist ordered panoramic radiographs for each patient, and radiopaque lesions were detected in the para-spinal region in four patients. These lesions were diagnosed as Carotid Atheroma by an Oral and Maxillofacial Radiologist, and this case series was reported. Conclusions: Radiotherapy is a component of treatment for head and neck malignancies and can cause atherosclerosis in carotid junctions. Dentists should monitor panoramic views of patients receiving radiotherapy for any signs of suspicious lesions. If carotid atheroma is detected, the patient should be referred to a cardiovascular specialist for further evaluation and treatment.

Endoscopic ultrasound-guided bite-on-bite biopsy and endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of gastric tumors with negative malignant endoscopy biopsies: a retrospective cohort study

Background Specific types of gastric tumors, including gastric linitis plastica and lymphoma, may cause extensive deep-layer infiltration, impeding an accurate diagnosis with endoscopic biopsy. This study aims to evaluate the efficacy of endoscopic ultrasound (EUS)-guided bite-on-bite biopsy and EUS-guided fine-needle aspiration (EUS-FNA) in diagnosing gastric malignancies with negative endoscopic biopsies. Methods We retrospectively analyzed suspicious malignant gastric lesion cases in our hospital from October 2017 to August 2023. Clinical manifestations, radiographical examinations, endoscopic examinations, histopathological results, and therapeutic strategies were recorded and analyzed. Results Forty malignant gastric tumor cases with negative endoscopic biopsies were incorporated into our study. EUS-guided bite-on-bite biopsy was performed in 16 cases exclusively, whereas 17 patients received EUS-FNA exclusively, and seven patients underwent both simultaneously. Among the 23 patients who received the EUS-guided bite-on-bite biopsy, 22 (95.7%) were diagnosed with malignancies. Among the 24 patients who received EUS-FNA, a total of 19 cases with malignancies (79.2%) were confirmed by EUS-FNA (p = 0.11): 13 gastric adenocarcinomas, five metastatic malignancies, and one malignant stromal tumor. No adverse events were observed in any of the cases. Conclusions EUS-guided bite-on-bite biopsy and EUS-FNA possess their advantages and disadvantages. EUS-guided bite-on-bite biopsy could serve as a reliable diagnostic method for shallow lesions with negative malignant endoscopic biopsies.

Deep Learning Algorithms for the Detection of Suspicious Pigmented Skin Lesions in Primary Care Settings: A Systematic Review and Meta-Analysis.

Early detection of suspicious pigmented skin lesions is crucial for improving the outcomes and survival rates of skin cancers. However, the accuracy of clinical diagnosis by primary care physicians (PCPs) is suboptimal, leading to unnecessary referrals and biopsies. In recent years, deep learning (DL)algorithms have shown promising results in the automated detection and classification of skin lesions. This systematic review and meta-analysis aimed to evaluate the diagnostic performance of DL algorithms for the detection of suspicious pigmented skin lesions in primary care settings. A comprehensive literature search was conducted using electronic databases, including PubMed, Scopus, IEEE Xplore, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science. Data from eligible studies were extracted, including study characteristics, sample size, algorithm type, sensitivity, specificity, diagnostic odds ratio (DOR), positivelikelihood ratio (PLR), negative likelihood ratio(NLR), and receiver operating characteristic curve analysis. Three studies were included. The results showed that DL algorithms had a high sensitivity (90%, 95% CI: 90-91%) and specificity (85%, 95% CI: 84-86%) for detecting suspicious pigmented skin lesions in primary care settings. Significant heterogeneity was observed in both sensitivity (p = 0.0062, I2 = 80.3%) and specificity (p < 0.001, I2 = 98.8%). The analysis of DOR and PLR further demonstrated the strong diagnostic performance of DL algorithms. The DOR was 26.39, indicating a strong overall diagnostic performance of DL algorithms. The PLR was 4.30, highlighting the ability of these algorithms to influence diagnostic outcomes positively. The NLR was 0.16, indicating that a negative test result decreased the odds of misdiagnosis. The area under the curve of DL algorithms was 0.95, indicating excellent discriminative ability in distinguishing between benign and malignant pigmented skin lesions. DL algorithms have the potential to significantly improve the detection of suspicious pigmented skin lesions in primary care settings. Our analysis showed that DL exhibited promising performance in the early detection of suspicious pigmented skin lesions. However, further studies are needed.

Acoustic Character Governing Variation in Normal, Benign, and Malignant Voices.

Benign and malignant vocal fold lesions (VFLs) are growths that occur on the vocal folds. However, the treatments for these two types of lesions differ significantly. Therefore, it is imperative to use a multidisciplinary approach to properly recognize suspicious lesions. This study aimed to determine the important acoustic characteristics specific to benign and malignant VFLs. The acoustic model of voice quality was utilized to measure various acoustic parameters in 157 participants, including individuals with normal, benign, and malignant conditions. The study comprised 62 female and 95 male participants (43 ± 10 years). Voice samples were collected at the Shanghai Eye, Ear, Nose, and Throat Hospital of Fudan University between May 2020 and July 2021. The acoustic variables of the participants were analyzed using Principal Component Analysis (PCA) to present important acoustic characteristics that are specific to normal vocal folds, benign VFLs, and malignant VFLs. The similarities and differences in acoustic factors were also studied for benign conditions including Reinke's edema, polyps, cysts, and leukoplakia. Using the PCA method, the components that accounted for the variation in the data were identified, highlighting acoustic characteristics in the normal, benign, and malignant groups. The analysis indicated that coefficients of variation in root mean square energy were observed solely within the normal group. Coefficients of variation in pitch (F0) were found to be significant only in benign voices, while higher formant frequencies and their variability were identified as contributors to the acoustic variance within the malignant group. The presence of formant dispersion (FD) as a weighted factor in PCA was exclusively noted in individuals with Reinke's edema. The amplitude ratio between subharmonics and harmonics (SHR) and its coefficients of variation were evident exclusively in the polyps group. In the case of voices with cysts, both pitch (F0) and coefficients of variation for FD were observed to contribute to variations. Additionally, higher formant frequencies and their coefficients of variation played a role in the acoustic variance among voices of patients with leukoplakia. Experimental evidence demonstrates the utility of the PCA method in the identification of vibrational alterations in the acoustic characteristics of voice affected by lesions. Furthermore, the PCA analysis has highlighted underlying acoustic differences between various conditions such as Reinke's edema, polyps, cysts, and leukoplakia. These findings can be used in the future to develop an automated malignant voice analysis algorithm, which will facilitate timely intervention and management of vocal fold conditions.

Validation of Contrast-Enhanced Mammography as Breast Imaging Modality Compared to Standard Mammography and Digital Breast Tomosynthesis.

Contrast-enhanced mammography (CEM) is a relatively new imaging technique that allows morphologic, anatomic and functional imaging of the breast. The aim of our study was to validate contrast-enhanced mammography (CEM) compared to mammography (MMG) and digital breast tomosynthesis (DBT) in daily clinical practice. This retrospective study included 316 consecutive patients who underwent MMG, DBT and CEM at the Centre for Prevention and Diagnosis of Chronic Diseases of Primorsko-goranska County. Two breast radiologists independently analyzed the image data, without available anamnestic information and without the possibility of comparison with previous images, to determine the presence of suspicious lesions and their morphological features according to the established criteria of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The diagnostic value of MMG, DBT and CEM was assessed by ROC analysis. The interobserver agreement was excellent. CEM showed higher diagnostic accuracy in terms of sensitivity and specificity compared to MMG and DBT, the reporting time for CEM was significantly shorter, and CEM findings resulted in a significantly lower proportion of equivocal findings (BI-RADS 0), suggesting fewer additional procedures. In conclusion, CEM achieves high diagnostic accuracy while maintaining simplicity, reproducibility and applicability in complex clinical settings.

An Unusual Pulmonary Lobe

A 58-year-old man diagnosed with colon cancer underwent a thoracic CT scan as part of the preoperative evaluation. A thoracic CT scan was performed as part of the pretherapeutic evaluation. The scan did not reveal any suspicious pleuro-parenchymal lesions. Additionally, we describe an incidental finding of an unusual pulmonary lobe: azygos lobe.

Ultrafast sequence-based prediction model and nomogram to differentiate additional suspicious lesions on preoperative breast MRI.

To investigate whether ultrafast sequence improves the diagnostic performance of conventional dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiating additional suspicious lesions (ASLs) on preoperative breast MRI. A retrospective database search identified 668 consecutive patients who underwent preoperative breast DCE-MRI with ultrafast sequence between June 2020 and July 2021. Among these, 107 ASLs from 98 patients with breast cancer (36 multifocal, 42 multicentric, and 29 contralateral) were identified. Clinical, pathological, conventional MRI findings, and ultrafast sequence-derived parameters were collected. A prediction model that adds ultrafast sequence-derived parameters to clinical, pathological, and conventional MRI findings was developed and validated internally. Decision curve analysis and net reclassification index statistics were performed. A nomogram was constructed. The ultrafast model adding time to peak enhancement, time to enhancement, and maximum slope showed a significantly increased area under the receiver operating characteristic curve compared with the conventional model which includes age, human epidermal growth factor receptor 2 expression of index cancer, size of index cancer, lesion type of index cancer, location of ASL, and size of ASL (0.92 vs. 0.82; p = 0.002). The decision curve analysis showed that the ultrafast model had a higher overall net benefit than the conventional model. The net reclassification index of ultrafast model was 23.3% (p = 0.001). A combination of ultrafast sequence-derived parameters with clinical, pathological, and conventional MRI findings can aid in the differentiation of ASL on preoperative breast MRI. Our prediction model and nomogram that was based on ultrafast sequence-derived parameters could help radiologists differentiate ASLs on preoperative breast MRI. Ultrafast MRI can diminish background parenchymal enhancement and possibly improve diagnostic accuracy for additional suspicious lesions (ASLs). Locationof ASL, larger size of ASL, and highermaximum slope were associated with malignant ASL. The ultrafast model and nomogram can help preoperatively differentiate additional malignancies.

Machine learning can reliably predict malignancy of breast lesions based on clinical and ultrasonographic features.

To establish a reliable machine learning model to predict malignancy in breast lesions identified by ultrasound (US) and optimize the negative predictive value to minimize unnecessary biopsies. We included clinical and ultrasonographic attributes from 1526 breast lesions classified as BI-RADS 3, 4a, 4b, 4c, 5, and 6 that underwent US-guided breast biopsy in four institutions. We selected the most informative attributes to train nine machine learning models, ensemble models and models with tuned threshold to make inferences about the diagnosis of BI-RADS 4a and 4b lesions (validation dataset). We tested the performance of the final model with 403 new suspicious lesions. The most informative attributes were shape, margin, orientation and size of the lesions, the resistance index of the internal vessel, the age of the patient and the presence of a palpable lump. The highest mean negative predictive value (NPV) was achieved with the K-Nearest Neighbors algorithm (97.9%). Making ensembles did not improve the performance. Tuning the threshold did improve the performance of the models and we chose the algorithm XGBoost with the tuned threshold as the final one. The tested performance of the final model was: NPV 98.1%, false negative 1.9%, positive predictive value 77.1%, false positive 22.9%. Applying this final model, we would have missed 2 of the 231 malignant lesions of the test dataset (0.8%). Machine learning can help physicians predict malignancy in suspicious breast lesions identified by the US. Our final model would be able to avoid 60.4% of the biopsies in benign lesions missing less than 1% of the cancer cases.

Outbreak of Feline Sporotrichosis with Zoonotic Potential in the Seventh Health District of Maceió-AL.

Sporotrichosis is a mycosis with zoonotic potential caused by species of Sporothrix. Once thought rare in northeastern Brazil, the disease has recently been spreading, leading to an emergency health issue. In this paper, we describe an outbreak of feline sporotrichosis in the Seventh Health District of Maceió-AL. We collected samples from 23 domiciled and non-domiciled felines without regard for age, breed, sex, and neutering state. Skin samples were analyzed cytologically under a light microscope and seeded onto Sabouraud dextrose agar at 25 °C for from 15 to 30 days. Fifteen of the twenty-three cats with suspected skin lesions were positive for Sporothrix spp. on either cytological or microbiological evaluation. Most of the infected cats were male, young adults, non-neutered, with free access to external areas, and living in environments with poor sanitation, a high population density, and an accumulation of garbage and organic matter. Three owners were bitten or scratched by infected cats and subsequently developed suspicious cutaneous lesions suggestive of sporotrichosis. The epidemiological features of feline sporotrichosis in the outbreaks of Maceió seemed to share similarities with the data obtained from outbreaks in current hyperendemic areas. Identifying geographical sites of infection and providing compulsory notification of the disease is essential for avoiding an epidemic in Alagoas.

Pixel-level classification of pigmented skin cancer lesions using multispectral autofluorescence lifetime dermoscopy imaging.

There is no clinical tool available to primary care physicians or dermatologists that could provide objective identification of suspicious skin cancer lesions. Multispectral autofluorescence lifetime imaging (maFLIM) dermoscopy enables label-free biochemical and metabolic imaging of skin lesions. This study investigated the use of pixel-level maFLIM dermoscopy features for objective discrimination of malignant from visually similar benign pigmented skin lesions. Clinical maFLIM dermoscopy images were acquired from 60 pigmented skin lesions before undergoing a biopsy examination. Random forest and deep neural networks classification models were explored, as they do not require explicit feature selection. Feature pools with either spectral intensity or bi-exponential maFLIM features, and a combined feature pool, were independently evaluated with each classification model. A rigorous cross-validation strategy tailored for small-size datasets was adopted to estimate classification performance. Time-resolved bi-exponential autofluorescence features were found to be critical for accurate detection of malignant pigmented skin lesions. The deep neural network model produced the best lesion-level classification, with sensitivity and specificity of 76.84%±12.49% and 78.29%±5.50%, respectively, while the random forest classifier produced sensitivity and specificity of 74.73%±14.66% and 76.83%±9.58%, respectively. Results from this study indicate that machine-learning driven maFLIM dermoscopy has the potential to assist doctors with identifying patients in real need of biopsy examination, thus facilitating early detection while reducing the rate of unnecessary biopsies.

Computer-assisted discrimination of cancerous and pre-cancerous from benign oral lesions based on multispectral autofluorescence imaging endoscopy.

Diagnosis of cancerous and pre-cancerous oral lesions at early stages is critical for the improvement of patient care, to increase survival rates and minimize the invasiveness of tumor resection surgery. Unfortunately, oral precancerous and early-stage cancerous lesions are often difficult to distinguish from oral benign lesions with the existing diagnostic tools used during standard clinical oral examination. In consequence, early diagnosis of oral cancer can be achieved in only about 30% of patients. Therefore, clinical diagnostic technologies for fast, minimally invasive, and accurate oral cancer screening are urgently needed. This study investigated the use of multispectral autofluorescence imaging endoscopy for the automated and noninvasive discrimination of cancerous and precancerous from benign oral epithelial lesions. In vivo multispectral autofluorescence endoscopic images of clinically suspicious oral lesions were acquired from 67 patients undergoing tissue biopsy examination. The imaged lesions were classified as precancerous (n = 4), cancerous (n = 29), and benign (n = 34) lesions based on histopathology diagnosis. Multispectral autofluorescence intensity feature maps were generated for each oral lesion and used to train and optimize support vector machine (SVM) models for automated discrimination of cancerous and precancerous from benign oral lesions. After a leave-one-patient-out cross-validation strategy, an optimized SVM model developed with four multispectral autofluorescence features yielded levels of sensitivity and specificity of 85% and 71%, respectively and overall accuracy of 78% in the discrimination of cancerous/precancerous versus benign oral lesions. This study demonstrates the potentials of a computer-assisted detection system based on multispectral autofluorescence imaging endoscopy for the early detection of cancerous and precancerous oral lesions.

Mammary Paget's Disease Mimicking Benign and Malignant Dermatological Conditions: Clinical Challenges and Diagnostic Considerations.

Mammary Paget's disease (MPD) or Paget's disease of the breast is a rare dermatological malignancy of the nipple-areolar complex that manifests with a spectrum of symptoms spanning from itching and redness to more severe indications such as breast lump, nipple-areolar complex destruction, or nipple discharge. It is predominantly associated with an underlying ductal carcinoma in situ or invasive ductal carcinoma. MPDoften masquerades as other benign and malignant dermatological conditions, including eczema, atopic dermatitis, psoriasis, and squamous and basal cell carcinomas, leading to delayed diagnosis and inappropriate treatment. Only one-third of the patients present with a palpable lump; therefore, advanced age with chronic and unilateral lesions should raise concern for MPD. Our review article presents case reports of MPD imitating other skin conditions and underscores the key findings of clinical features and diagnostic workup to help differentiate the condition. A literature review revealed that studies emphasize caution regarding the sole use of mammography and ultrasound in diagnosing MPD, particularly in cases lacking a palpable lump. This highlights the MRI as a superior and more accurate imaging tool. However, any suspicious lesion must be biopsied to allow histopathological and immunohistochemical examination, since there are some cases where MRI findings were negative in the presence of a biopsy-proven MPD. This highlights the need for clinicians to investigate any suspicious lesion of the nipple or breast using the complete triple assessment approach to exclude an underlying malignancy. It is imperative to establish therapeutic guidelines to approach any nipple lesion to minimize the risk of misdiagnosing any underlying cancer, which can be potentially fatal if left alone.

Highly Elevated Alpha-fetoprotein Concentration in a Premature Infant

Alpha-1-fetoprotein (AFP) is a protein produced by the liver. Although its biological function is not fully understood, it is often used as a marker for cancer. High levels of AFP are also observed in premature infants. Reference ranges for AFP levels in premature infants are not specified. The authors present a case of a male newborn born at 25+5/7 weeks of gestational age. The boy underwent oncological diagnostics due to the detection, on the 24th day of life, of a liver lesion in an abdominal ultrasound examination, as well as significantly elevated AFP levels (&gt;430,000 ng/mL). With each passing day, the AFP level gradually decreased, and the suspicious lesion was not visualized on abdominal ultrasound or magnetic resonance imaging on the 59th day of life. Based on the conducted examinations, prematurity and its treatment were considered the cause of high AFP levels. The aim of the study was to present the diagnostic difficulties associated with the lack of AFP norms for premature infants.

ER-Targeted PET for Initial Staging and Suspected Recurrence in ER-Positive Breast Cancer

There are insufficient data comparing 16α-18F-fluoro-17β-estradiol (FES) positron emission tomography (PET) computed tomography (CT) with standard-of-care imaging (SOC) for staging locally advanced breast cancer (LABC) or evaluating suspected recurrence. To determine the detection rate of FES PET/CT and SOC for distant metastases in patients with estrogen receptor (ER)-positive LABC and recurrences in patients with ER-positive BC and suspected recurrence. This diagnostic study was conducted as a single-center phase 2 trial, from January 2021 to September 2023. The study design provided 80% power to find a 20% detection rate difference. Participants included patients with ER-positive LABC (cohort 1) or suspected recurrence (cohort 2). Data were analyzed from September 2023 to February 2024. Participants underwent both SOC imaging and experimental FES PET/CT. When there were suspicious lesions on imaging, 1 was biopsied for histopathological reference standard to confirm presence (true positive) or absence (false positive) of malignant neoplasm. The outcome of interest was the detection rate of FES PET CT vs SOC for distant metastases and recurrences. A total of 124 patients were accrued, with 62 in cohort 1 (median [IQR] age, 52 [32-84] years) and 62 in cohort 2 (median [IQR] age, 66 [30-93] years). In cohort 1, of 14 true-positive findings, SOC imaging detected 12 and FES detected 11 (P > .99). In cohort 2, of 23 true-positive findings, SOC detected 16 and FES detected 18 (P = .77). In 30 patients with lobular histology, of 11 true-positive findings, SOC detected 5 and FES detected 9 (P = .29). There were 6 false-positive findings on SOC and 1 false-positive finding on FES PET/CT (P = .13). In this diagnostic study with pathological findings as the reference standard, no difference was found between FES PET/CT and current SOC imaging for detecting distant metastases in patients with ER-positive LABC or recurrences in patients with ER-positive tumors and suspected recurrence. FES PET/CT could be considered for both clinical indications, which are not part of current Appropriate Use Criteria for FES PET. The findings regarding FES PET/CT in patients with lobular tumors, and for lower false positives than current SOC imaging, warrant further investigation.

AI in Dermatology: A Systematic Review on Skin Cancer Detection

Skin cancer is the most common type of cancer worldwide and poses a significant public health challenge. Its visible nature often leads individuals to seek medical attention, highlighting the importance of early detection for better patient outcomes. In recent years, Artificial Intelligence (AI) has shown promise in improving the detection and diagnosis of skin cancer, offering the potential to enhance clinical outcomes. A systematic review was conducted, involving a comprehensive literature search to identify studies focused on AI techniques in detecting, diagnosing, or treating skin cancer. Strict inclusion and exclusion criteria were applied to assess the eligibility of scientific articles, resulting in the selection of nine relevant studies. These studies were analyzed to address predefined research questions about the effectiveness of AI in diagnosing skin cancer. The review found that AI-assisted clinicians achieved higher sensitivity and specificity in diagnosing skin cancer than those without assistance. Various AI algorithms demonstrated high sensitivity in detecting skin cancers, highlighting their potential to support primary care clinicians in evaluating suspicious lesions. The analysis also highlighted the effectiveness of smartphone applications designed for skin cancer risk assessment, which could facilitate self-examinations and enhance early detection rates. Despite these promising findings, the field of AI in skin cancer diagnosis is still in its early stages. Challenges remain, including developing robust algorithms, addressing data quality issues, and improving the interpretability of AI-generated results. Collaboration between AI developers and healthcare professionals is crucial to ensure these tools' clinical effectiveness and safety. The review emphasizes the need for continued validation of AI technologies and their integration into clinical practice to improve patient outcomes and alleviate the burden on healthcare systems.

Increased [68Ga]Ga-SST uptake in the uncinate pancreatic process in new digital PET/CT machine and potential association with clinical and histologic factors in NET patients

IntroductionA physiological increase in the uptake of [68Ga]Ga-labeled somatostatin analogues ([68Ga]Ga-SST) PET tracers has been reported in the uncinate pancreatic process (UP) and might be even higher in latest generation of PET/CT scanners and might be falsely interpreted as NET. We aimed to investigate the uptake of UP in a large population of NET patients who underwent [68Ga]Ga-SST PET/CT with digital SiPM detectors. We also explored potential associations between UP uptake and various clinical, imaging, and pathological factors routinely assessed in NET patients.MethodsWe analyzed all consecutive NET patients from July 2018 to June 2022 in this retrospective, single-center study. All patients underwent a [68Ga]Ga-SST PET/CT scan on a digital SiPM PET/CT scanner. On visual analysis, we distinguished between normal linear and homogenous UP uptake or abnormal if otherwise. We compared SUVmax/mean in patients with normal UP uptake to those with abnormal UP uptake with suspicious NET lesions on contrast-enhanced CT (ce-CT) and according to the site of the primary NET (pancreatic NET vs. other), patient gender (female vs. male) and tumor grade (grade 1–2 vs. 3) using a Mann–Whitney test. We also assessed the correlation between SUVmax/mean values in UP with patients’ age, primary NET Ki-67 counting, and its SUVmax/mean, TLA and MTV values.ResultsWe included 131 NET patients with a total of 34 [68Ga]Ga-DOTATATE PET/CT and 113 [68Ga]Ga-DOTATOC PET/CT scans. An abnormal UP uptake was seen in 32 patients with 65.7% of suspicious NET lesion or extrinsic compression on morphological imaging. Normal UP uptake SUVmax/mean were measured in 115 [68Ga]Ga-SST scans (78.2%) with normal UP uptake and without suspicious lesion on morphological imaging. We found an average SUVmax of 12.3 ± 4.1 for [68Ga]Ga-DOTATATE and 19.8 ± 9.8 g/ml for [68Ga]Ga-DOTATOC, hence higher than those reported in the literature [SUVmax 5 ± 1.6 to 12.6 ± 2.2 g/ml] with significant difference with abnormal UP uptake and between both PET tracers (both p < 0.01). Significant results were a higher UP uptake on [68Ga]Ga-DOTATOC in male patients (p = 0.02) and significant associations between UP uptake on [68Ga]Ga-DOTATOC and SUVmax/mean of the primary tumor (ρ [0.337–0.363]; p [0.01–0.02]).ConclusionWe confirmed a higher and very frequent UP uptake in latest SiPM-detector [68Ga]Ga-SST PET/CT with an even higher uptake in patients that had [68Ga]Ga-DOTATOC PET/CT. SUVmean/max were significantly higher in abnormal UP uptake but there were overlaps with UP SUV values for both [68Ga]Ga-SST and a correlation to morphological imaging is crucial. Besides, significant associations between UP uptake and SUVmean/max of the primary NET as well as patients’ gender were seen in the larger cohort of [68Ga]Ga-DOTATOC patients suggesting that both physiological and pathological parameters could affect UP uptake.

Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province.

In sub-Saharan Africa, ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour and is strongly associated with HIV infection. This range of ocular malignancies can be managed early to prevent large tumours requiring invasive treatment, facial disfigurement and mortality. Primary healthcare workers (HCWs) play a critical role in the early identification of the lesion. In addition, the ocular lesion can also be the presenting sign of HIV infection in individuals who have not yet been diagnosed. The aim of the present study was to assess the management of suspicious conjunctival growths in HIV-infected patients in primary health facilities and a specialist eye clinic in South Africa. To assess the knowledge, attitude and current practice of HCWs working in HIV clinics regarding ocular surface lesions and to evaluate the management of patients with ocular surface lesions at a tertiary hospital. A cross-sectional study design was used (November 2020 - May 2021), for which 149 HCWs were invited to assessments about their knowledge, attitudes and practices regarding ocular surface lesions. In addition, files of patients with ocular surface lesions who presented between January 2018 and August 2020 to the eye clinic were reviewed using a data extraction sheet. One hundred-and-three HCWs agreed to participate in the survey (response rate 69.1%). Of these participants, 84.5% were experienced professional nurses (6 - 15 years of work experience) but had minimal experience with detection and management of eye complaints and lesions. Twenty-seven (26.2%) of the participants recognised some ocular surface lesions and 86 (83.5%) reported that they would refer patients with suspicious lesions. Sixty-two files were reviewed and 51 (82.2%) of the patients had an HIV-positive diagnosis. Fifty percent had carcinoma-in situ and squamous cell carcinoma of the conjunctiva. Thirty-one (50%) of the patients were lost to follow-up. OSSN is an important manifestation of HIV infection. It would be beneficial for patients to receive a basic ocular examination as part of the baseline clinical evaluation; this may contribute to early referral to an eye care facility. The health system would benefit from establishing an eye health support system with the nearby health facilities, thereby educating primary HCWs about the association between HIV and OSSN.

Higher intraoperative detection rate of suspicious non-palpable lesions using wire marking in skin cancer patients.

Follow-up protocols in patients after complete resection of high-risk cutaneous tumors lead to a discovery of metastases in very early stages, but surgery on non-palpable lesions proves to be challenging. In this monocenter retrospective study 39 patients suffering from malignant skin tumors with suspicious non-palpable lesions located in the lymph nodes (90%) or deep subcutaneously/intramuscularly (10%) were included. In 21 patients the lesions were excised under ultrasound guidance, and 18 patients received a wire marking before surgery. Both patient groups were compared regarding successful intraoperative finding of the lesion, duration of the procedure, and complications. Wire marking led to a significantly higher intraoperative detection rate of 100% versus 76% (p<0.05). The average time needed for the complete procedure (p = 0.91) or the rate of complications (p = 0.70) did not differ significantly between both groups. The size of the malignant lesions successfully removed by wire marking was significantly smaller (p<0.05). Of all 34 detected lesions only 20 (58.8%) were confirmed to be malignant. Wire marking increases the detection rate of non-palpable suspicious subcutaneous or lymphatic lesions. It leads to earlier diagnosis of metastasis but also allows to avoid unnecessary complete lymph node dissection.

Comparing Two Targeted Biopsy Schemes for Detecting Clinically Significant Prostate Cancer in Magnetic Resonance Index Lesions: Two- to Four-Core versus Saturated Transperineal Targeted Biopsy.

Since the optimal scheme for targeted biopsies of magnetic resonance imaging (MRI) suspicious lesions remains unclear, we compare the efficacy of two schemes for these index lesions. A prospective trial was conducted in 1161 men with Prostate Imaging Reporting and Data System v 2.1 3-5 undergoing targeted and 12-core systematic biopsy in four centers between 2021 and 2023. Two- to four-core MRI-transrectal ultrasound fusion-targeted biopsies via the transperineal route were conducted in 900 men in three centers, while a mapping per 0.5 mm core method (saturated scheme) was employed in 261 men biopsied in another center. A propensity-matched 261 paired cases were selected for avoiding confounders other than the targeted biopsy scheme. CsPCa (grade group ≥ 2) was identified in 125 index lesions (41.1%) when the two- to four-core scheme was employed, while in 187 (71.9%) when the saturated biopsy (p < 0.001) was used. Insignificant PCa (iPCa) was detected in 18 and 11.1%, respectively (p = 0.019). Rates of csPCa and iPCa remained similar in systematic biopsies. CsPCa detected only in systematic biopsies were 5 and 1.5%, respectively (p = 0.035) in each group. The saturated scheme for targeted biopsies detected more csPCa and less iPCa than did the two- to four-core scheme in the index lesions. The rate of csPCa detected only in the systematic biopsies decreased when the saturated scheme was employed.