In current practice, the traditional strategy of excising all IDPs has been replaced by more selective management. However, criteria for selecting patients for surveillance remain unclear, and no widely accepted predictive model exists. We retrospectively analyzed real-world data from 325 cases of IDPs diagnosed via core needle biopsy (CNB) at a tertiary teaching hospital between 2010 and 2023. We assessed upgrade rates to malignancy and evaluated potential predictive factors. Two previously published models were applied to our cohort, and a new model was developed based on our data. Overall, 17% (55/325) of IDPs were upgraded to malignancy. Among lesions without atypia on CNB (n=215), the upgrade rate was 8.8% (19/215), compared to 40% (23/58) in those with atypia (p<0.001). Previously suggested models yielded modest results when applied to our study population. First model would have spared 11% (24/215) of patients from surgery, while the second model would have spared 17% (36/215), with one missed upgrade. Our model identified all upgraded cases and would have spared 33% (72/215) of non-atypical IDPs from surgery. Atypia on CNB is a strong predictor of upgrade to malignancy. Existing models showed limited utility in reducing unnecessary surgeries. Our proposed model demonstrated improved performance and may support more individualized management of IDPs.

The role of ultrasound in decision-making for the management of suspected acute appendicitis during pregnancy.

This study critically examines how the unregulated expansion of private healthcare, coupled with health-system challenges such as corruption, and lack of monitoring and accountability, affects women's experiences of obtaining healthcare in Bangladesh. Based on in-depth qualitative interviews with 31 female patients, 28 biomedical providers, and 12 health administrators and policymakers, we found that the absence of effective regulation, supervision, and accountability, particularly in the private healthcare sector, has fostered an environment where private biomedical providers can engage in harmful practices. These practices are often facilitated by informal actors, popularly known as "dalal" (middlemen or brokers). These middlemen serve as marketing channels for many private healthcare providers, directing socially and economically marginalized women toward unregulated services. This situation can result in harmful medical practices, such as unnecessary hysterectomy surgeries, leading to serious complications like genital fistula. Our findings illustrate that increased access to healthcare providers, without adequate regulation and monitoring, fails to ensure a better quality of care for disadvantaged women and instead exacerbates their health issues while creating financial burdens for families. The presence of middlemen in healthcare is not merely indicative of individual misconduct but reflects broader policy and systemic failures. Addressing their role requires structural reforms that emphasize regulation, public accountability, and quality of care, alongside a critical re-examination of global health metrics that emphasize contact and access over equity and health outcomes.

BackgroundDiscriminating breast adenosis from carcinoma remains challenging due to their overlapping imaging appearances. This study aimed to develop and validate a fusion model combining ultrasound (US) and MRI-based radiomics for improved differentiation.MethodsIn this retrospective study, 260 patients (147 adenosis, 113 carcinoma) with preoperative US and MRI from March 2019 to July 2025 were enrolled and randomly split into training (n=182) and testing (n=78) cohorts at a 7:3 ratio. Radiomic features were extracted from grayscale US images depicting the largest lesion diameter and from the second-phase enhancement of DCE-MRI. After selection via maximum relevance minimum redundancy(mRMR) and Least Absolute Shrinkage and Selection Operator (LASSO) regression, radiomics models (US_Rad, MRI_Rad) were built based on selected features using the optimal algorithm among 12 candidates. A BI-RADS model based on significant US and MRI BI-RADS features was also constructed. A fusion model integrated US_Rad, MRI_Rad, BI-RADS, and age. Receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of the four models.ResultsIn the training cohort, the area under the curve (AUC) for BI-RADS and radiomic models based on US (US_Rad) and MRI (MRI_Rad) were 0.89 (95% CI, 0.84–0.93), 0.84 (95% CI, 0.78–0.90), and 0.85 (95% CI, 0.79–0.90), respectively. In the testing cohort, the AUCs were 0.91 (95% CI, 0.83–0.97), 0.82 (95% CI, 0.73–0.91), and 0.82 (95% CI, 0.73–0.90). The fusion model achieved superior AUCs of 0.96 (95% CI, 0.94–0.98, training) and 0.97 (95% CI, 0.92–1.00, testing), significantly outperforming both the unimodal radiomic model and the BI-RADS model (all p < 0.01).ConclusionOur findings suggest that the US-MRI radiomics fusion model exhibits potential in distinguishing breast adenosis from carcinoma, which may help reduce unnecessary surgeries. However, further multi-center validation is required to evaluate its generalizability before clinical application.

Accessory spleens are congenital foci of spleen tissue present in body sites outside of the normal spleen. The majority of accessory spleens are found in the splenic hilum and pancreatic tail. They are benign, often incidental findings and share similar histological characteristics to thenormal spleen. When an accessory spleen is present in an unusual or rare location, it may be miscategorized, which may lead to unnecessary surgery. Here we report a 55-year-old female with a history of well-differentiated neuroendocrine tumor of the stomach who was found to have a gastric submucosal nodule during a routine upper endoscopy surveillance. Endoscopic ultrasound-guided fine-needle aspiration was performed. It is proven to be an accessory spleen on cytologic examination with immunohistochemical analysis, which showed a sinusoidal pattern of CD8. Retrospectively, we also demonstrated steroidogenic factor 1 (SF-1) expression in sinusoids of gastric accessory spleen for the first time. SF-1 exhibited similar distribution to CD8. It is imperative to provide the correct diagnosis in such cases to avoid unnecessary surgical intervention.

To describe the longitudinal ultrasound features and clinical course of ovarian endometriomas in postmenopausal women, aiming to improve diagnostic accuracy and guide follow-up strategies. This retrospective observational study included postmenopausal women with at least one ovarian endometrioma identified by transvaginal ultrasound (TVUS) and monitored for a minimum of 24 months at the University of Rome Tor Vergata (2018-2023). All had a known premenopausal endometriosis detected by TVUS at our Unit. Clinical and ultrasound assessments were conducted at baseline and at 12 and 24 months, recording changes in TVUS characteristics and symptoms. Endometrioma size was classified using the #Enzian classification. Forty-one postmenopausal patients (mean age 53.5 ± 6.4 years) were included. A total of 45 endometriomas were analyzed, mostly unilocular (100%), with a typical "ground glass" echogenicity (75.6%) and classified as #Enzian O1 (82.2%) at the first postmenopausal scan. A significant early dimensional reduction occurred between pre- and postmenopause: the mean maximum diameter decreased from 29.0 ± 15.2 to 20.6 ± 9.7 mm (p = 0.002), and the mean diameter from 24.5 ± 13.1 to 17.9 ± 8.9 mm (p = 0.006), with continued decline at 12 and 24 months (p < 0.05). In contrast, morpho-structural changes emerged later during follow-up, with the proportion of cysts showing wall irregularities rising from 11.1% in premenopause to 38.6% at 24 months (p = 0.003). Vascularization remained minimal throughout. All serum epithelial tumor markers stayed within normal ranges, no suspicious or malignant transformations were observed, and pain symptoms remained stable during follow-up. Ovarian endometriomas in postmenopausal women exhibit a benign evolution, characterized by early dimensional regression and later structural remodeling without malignant features. Regular ultrasound surveillance remains essential to recognize benign morphologic changes, avoid unnecessary surgery, and promptly identify lesions requiring further evaluation.

Surgical resection is recommended for intraductal papillary mucinous neoplasms (IPMN) with high-risk stigmata (HRS). However, in clinical practice, some patients are managed conservatively because of their advanced age or comorbidities. We aimed to evaluate the clinical course and identify risk factors for malignant progression in patients with HRS-positive IPMN. We retrospectively analyzed 100 consecutive patients with HRS-positive IPMN treated at a single tertiary center between 2015 and 2024. Patients were classified into a surgical group (n = 63) and an observation group (n = 37). Malignant progression was defined as pathologically confirmed invasive carcinoma in resected specimens or as clinical progression in the observation cohort. Logistic regression analysis was performed to identify factors associated with malignant progression. Malignant progression occurred in 18 patients (18%), including 13 with invasive carcinoma in the surgical group and 5 with clinical progression in the observation group. The median time to progression was 12 months (range 1-83 months). In multivariate analysis, carbohydrate antigen 19-9 (CA19-9) > 37 U/mL (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.5-20.7, p = 0.0097) and fluorodeoxyglucose (FDG) uptake with a standardized uptake value (SUV) > 3 on positron emission tomography-computed tomography scan (PET-CT) (OR 4.7, 95% CI 1.3-17.1, p = 0.0189) were independently associated with malignant progression, whereas enhancing mural nodules ≥ 5 mm were not statistically significant. In patients with HRS-positive IPMN, malignant progression was associated with tumor biological and metabolic markers rather than with morphologic criteria alone. Risk-adapted decision-making incorporating CA19-9 and FDG-PET findings may help refine patient selection and avoid unnecessary surgery in selected high-risk patients.

Medical ethics is an applied branch of ethics that addresses the moral issues and challenges encountered in clinical practice. Medical ethics should be adhered to during clinical practice. Non-adherence to medical ethics may cause unnecessary burdens and consequences on patients, deterioration of health status, exposure to other health problems or diseases, unnecessary surgery, additional medical expenditure, psychological distress, bodily injury and death. Globally, adherence to medical ethics is not uniform, while in Ethiopia, there is limited information on adherence to medical ethics and its determinants. Therefore, this study aimed to assess the level of adherence to medical ethics and its determinants among medical doctors in Ethiopia. An institution-based cross-sectional study was conducted among 1,012 medical doctors from 01 August 2024 to 31 October 2024 in Ethiopia. A multistage sampling technique was applied to select the respondents. A structured self-administered questionnaire was used for data collection. Relevant descriptive statistics was done for all variables. Multivariable binary logistic regression analysis was used to identify factors significantly associated with adherence to medical ethics. The study revealed that only 588 (58.1%) medical doctors had good adherence to medical ethics. Year of medical ethics course (AOR: 1.77; 95% CI: 1.27, 2.46), integration of medical ethics course with clinical practice (AOR: 1.34; 95% CI: 1.08, 1.72), pre-service orientation on medical ethics (AOR: 1.60; 95% CI: 1.15, 2.23), in-service training on medical ethics (AOR: 1.44; 95% CI: 1.11, 1.89), institutional ethics committee (AOR: 1.54; 95% CI: 1.11, 2.13), clinical communication skills (AOR: 1.68; 95% CI: 1.08, 2.61), clinical leadership skills (AOR: 1.74; 95% CI: 1.07, 2.86), knowledge of medical ethics (AOR: 2.56; 95% CI: 1.72, 3.83), and attitude towards medical ethics (AOR: 10.38; 95% CI: 7.02, 15.33) were significantly associated with adherence to medical ethics. Adherence to medical ethics among medical doctors was low. Year of medical ethics course, integration of medical ethics course with clinical practice, pre-service orientation on medical ethics, in-service training on medical ethics, institutional ethics committee, clinical communication skills, clinical leadership skills, knowledge of medical ethics, and attitude towards medical ethics were significantly associated with adherence to medical ethics. Therefore, the implementation of various strategies and interventions is very important to improve adherence to medical ethics among medical doctors in Ethiopia.

Kikuchi-Fujimoto disease (KFD) is a rare necrotizing lymphadenitis. Brachial plexus neuritis is an exceptionally rare complication of KFD. A 31-year-old Asian female was diagnosed with KFD via excisional biopsy of a posterior cervical lymph node. Four days after the biopsy, pain and disability occurred in her left arm and shoulder. While Magnetic Resonance Imaging (MRI) suspected compression of the brachial plexus nerves, the ultrasound indicated inflammatory changes consistent with neuritis. Diagnosis was challenging; however, distinguishing between mechanical compression and inflammation was crucial. Instead of surgery, steroids and intravenous immunoglobulin (IVIG) were prescribed, and her pain was relieved within 1 week, while her disability did not disappear until 9 months later. We report a rare case of KFD-associated brachial plexus neuritis emerging shortly after lymph node biopsy. We hypothesize that surgical positioning or traction, superimposed on the KFD inflammatory background, may precipitate this condition. Clinicians should be vigilant for this complication to ensure prompt anti-inflammatory treatment and avoid unnecessary secondary surgeries.

The global rise in thyroid cancer incidence has intensified the demand for reliable, rapid and minimally invasive diagnostic tools as current clinical practice often result in unnecessary surgical procedures for benign thyroid nodules. In this context, this work proposes a highly sensitive label-free biosensor, based on a heterojunction gate-all-around ferroelectric p-n-i-n tunnel field effect transistor (HJ-GAA-Fe p-n-i-n TFET) for early thyroid cancer detection. The sensing mechanism leverages variations and the dielectric properties and charge states of thyroid cells, which modulates electrostatic environment of the device. A ferroelectric gate stack introduces a negative capacitance effect that amplifies biomolecule induced electrical perturbations, while a nanocavity beneath the gate metal provides a dedicated region for thyroid cell immobilization. TCAD based simulations are used to evaluate clinically relevant sensitivity metrics including drain current, ON-OFF current ratio and threshold voltage. Furthermore, the proposed biosensor's reliability is assessed through response time, limit of detection (LOD), temperature stability, fill factor variation, early-stage detection capability, steric hindrance effect and noise immunity. The influence of both charged and neutral thyroid cancer cells is systematically analyzed. The proposed biosensor achieved a drain current sensitivity of 5.2 x 108, an ON-OFF ratio sensitivity of 3.23 x 106, a threshold voltage shift of 0.25 V, and selectivity of 12.41 of cancerous thyroid cells, indicating strong potential for accurate and early thyroid cancer diagnostic purpose.

The American College of Radiology Ovarian and Adnexal Reporting and Data System (O-RADS) is a risk stratification system for ovarian and adnexal lesions. Its primary objective is to minimize unnecessary workup and surgery for benign and physiologic lesions while optimizing outcomes for patients with ovarian cancer. US is the primary imaging modality used in O-RADS assessment, with MRI serving a complementary role to enhance specificity of diagnosis. Given that O-RADS US serves as the gatekeeper for determining whether a lesion requires additional evaluation, requires imaging surveillance, or may be dismissed, accurate lesion characterization is paramount. However, US is a highly operator-dependent imaging modality, and image quality is directly influenced by the skill of the sonographer or sonologist performing the examination. Adherence to correct US technique is essential and is directly related to machine settings, optimization techniques, and maneuvers performed during the examination. Inadequate US technique can lead to adverse consequences, including potential of misdiagnosis, patient anxiety, and unnecessary surgery with associated morbidity. Rather than considering the operator-dependent nature of US as a limitation, we encourage users to view it as an opportunity. The authors provide a comprehensive review of gray-scale and Doppler US technique optimization, including field of view, focal zone, measurements, and gain, and outline special sonographic maneuvers to aid in identifying the location and contents of lesions. Insight into common pitfalls and troubleshooting strategies is crucial, especially in challenging cases, to improve the accuracy of adnexal lesion diagnosis by the interpreting physician. ©RSNA, 2026 Supplemental material is available for this article.

Extra-hepatic cholangiocarcinoma diagnosis: from classical pathological analysis to the emerging omics tests.

Re-evaluating routinely collected clinical and laboratory parameters in the preoperative risk assessment of intraductal papillary mucinous neoplasms: model development and internal validation.

Lithium is a commonly used mood stabilizer in managing bipolar disorder. While its therapeutic benefits are well-documented, its potential to induce thyroid-related disorders has long been recognized. Hypothyroidism is the most common thyroid dysfunction associated with lithium, though lithium-induced thyroiditis remains a rare and often overlooked complication. In this report, we describe a thyroid nodule initially diagnosed as "high-grade thyroid carcinoma" due to severe histomorphologic changes at an outside institution, which was later reclassified at our review as an iatrogenic effect of long-term lithium therapy. Preoperative fine needle aspiration, interpreted as "atypical follicular neoplasm (Bethesda Category IV)," prompted a diagnostic right lobectomy. No molecular testing was performed. The lobectomy was misinterpreted as carcinoma, leading to completion thyroidectomy. Histologic features included intersecting fibrosis, patchy lymphocytic inflammation, hyperplastic changes with pseudopapillary formation, nuclear pleomorphism with hyperchromasia, and giant cell formation, but notably absent were mitotic activity and necrosis, which are required for poorly differentiated or differentiated high-grade thyroid carcinoma under the 2022 WHO criteria. The patient's long history of lithium therapy was instrumental in recognizing the functional origin of the thyroid changes, which, if identified earlier, could have prevented unnecessary completion surgery. This report highlights the evolving diagnostic criteria for thyroid tumors, illustrating how lithium-associated thyroiditis can mimic malignancy and lead to overtreatment if historical context is not considered.

The evolving role of [¹⁸F]FDG PET/CT in reducing or replacing biopsy in selected malignancies: A narrative literature review.

Spontaneous intramural small-bowel hematoma (SISBH) is a rare but potentially life-threatening complication of anticoagulant therapy and severe coagulopathy. Because it may mimic acute abdomen or intestinal obstruction, delayed recognition can lead to unnecessary surgery. This study aimed to describe the clinical characteristics, imaging findings, and outcomes of patients with SISBH secondary to vitamin K antagonist-related coagulopathy. We retrospectively analyzed 11 consecutive patients with SISBH secondary to vitamin K antagonist-related coagulopathy, including available follow-up data up to 3 months after treatment. The median age was 65 years, and 72.3% were male. All patients presented with acute abdominal pain. Abdominal distension occurred in 63.6%, vomiting in 45.5%, and gastrointestinal bleeding in 9.1%. All patients had markedly abnormal coagulation profiles, with a median international normalized ratio (INR) of 8.5 and a median prothrombin activity of 8%. Contrast-enhanced computed tomography revealed circumferential bowel wall thickening with increased intramural attenuation and luminal narrowing in all cases. Partial intestinal obstruction was identified in 54.5%. Ten patients (90.9%) were treated conservatively with discontinuation of anticoagulants, intravenous vitamin K, and fresh frozen plasma. One patient underwent diagnostic laparoscopy without bowel resection. Coagulation parameters improved significantly after treatment (INR, P = .003). The median hospital stay was 6 days. No in-hospital mortality occurred. During the 3-month follow-up period, 1 patient experienced recurrence. Markedly elevated INR in patients with acute abdominal pain should raise suspicion for SISBH. Early computed tomography evaluation and timely correction of coagulopathy may facilitate conservative management and reduce the need for surgical exploration in selected cases.

Two-part surgical neck fractures are the most common displaced proximal humeral fractures in the elderly. Most fractures can be categorized into varus-impacted or medially translated fracture patterns. The natural healing process often involves secondary displacement and partial resorption of the humeral head, but these changes are poorly correlated with shoulder function and patient satisfaction. Randomized trials have been unable to identify any benefits from surgery but report a high proportion of implant-related complications. In large prospective cohort studies, patients aged 60 or older with two-part surgical neck fractures treated non-operatively report shoulder function and quality of life close to the background population six months post-injury. Evidence-based and eminence-based approaches to interventions for osteoporotic proximal humeral fractures appear to collide.

Introduction: Breast involvement by acute lymphoblastic leukemia (ALL) is an exceedingly rare clinical entity, often posing a significant diagnostic challenge as it can mimic common benign or malignant breast conditions. Case presentation: A 17-year-old female presented with a palpable right breast mass and axillary lymphadenopathy. Initial imaging and clinical findings were misinterpreted as an infectious or inflammatory process. Her course was complicated by axillary vein thrombosis and a large pleural effusion. Subsequent clinical deterioration prompted a peripheral blood smear and bone marrow biopsy, which revealed B-ALL with 40% blasts, confirmed by immunohistochemistry (positive for LCA, CD20, PAX5, TDT). Despite an initial favorable response to chemotherapy (BFM protocol), a breast biopsy revealed persistent disease. The treatment was escalated to hyper-CVAD, but the patient succumbed to complications, including neutropenic fever, pneumonia, and paraplegia. Conclusion: This case underscores the diagnostic consequence of leukemic breast infiltration. A high index of suspicion for hematological malignancy is essential when evaluating breast masses, particularly in young patients with atypical or rapidly progressing features. Fine-needle aspiration (FNA) coupled with immunophenotyping is a rapid and effective diagnostic tool that can prevent unnecessary surgeries and ensure the initiation of systemic chemotherapy for managing this aggressive disease.

BACKGROUND Penetrating abdominal injuries are rare in central Europe; therefore, most trauma surgeons have little experience in the treatment of these injuries. The optimal management of penetrating abdominal injuries remains debated. While immediate surgery is standard for unstable patients or those with peritonitis, bowel evisceration, or gunshot wounds, the treatment of stable patients is still controversial. This study aimed to assess the reliability of preoperative diagnostics compared to intraoperative findings. MATERIAL AND METHODS Forty-nine patients with penetrating abdominal injuries were admitted to our hospital from 2006 to 2015. Seven were excluded due to emergency surgery without preoperative computed tomography (CT) scans. CT findings were compared with intraoperative surgical findings to calculate sensitivity and specificity. RESULTS The average age was 39.9 years; 83% were male. Most injuries were stab wounds (83%). Most injuries resulted from interpersonal violence (64.3%), whereas 15 cases (35.7%) were due to failed suicide attempts. In 69% of cases, CT and surgical findings matched. CT underestimated injuries in 69.2% of discordant cases. Sensitivity, specificity, and accuracy were 52.6%, 82.6%, and 57.4%, respectively. Laparotomy revealed no intra-abdominal injury in 45.2%. CONCLUSIONS Conservative management is justified in stable patients with negative CT findings, but requires close monitoring to avoid delayed intervention and unnecessary surgery. Nearly 50% of laparotomies could have been avoided, given that no intra-abdominal injuries were identified in those patients, and their in-hospital stay was prolonged.

An acute scrotum with a focal intratesticular lesion represents a diagnostic challenge and may lead to misdiagnosis and inappropriate management, such as unnecessary orchidectomy or empirical antibiotic therapy. In an emergency setting of acute scrotal pain, a wide spectrum of underlying conditions may be encountered, including testicular tumors with necrotic changes, abscesses, infarctions, and spontaneous hematomas. The latter are uncommon and frequently underrecognized entities, carrying a significant risk of mismanagement; therefore, particular emphasis is placed on their imaging features. Multiparametric ultrasound (US), including contrast-enhanced ultrasound and shear wave elastography (SWE), combined with multiparametric enhanced magnetic resonance imaging (MRI), plays a pivotal role in establishing an accurate diagnosis and guiding appropriate treatment decisions. This pictorial review illustrates the broad spectrum of focal intratesticular lesions presenting in the context of acute scrotum, emphasizing the role of imaging in differentiating benign conditions-such as spontaneous hematomas, which can be managed conservatively-from malignant tumors requiring prompt surgery. CRITICAL RELEVANCE STATEMENT: Multiparametric ultrasound and MRI improve the diagnostic accuracy of focal intratesticular lesions in acute scrotum, particularly spontaneous hematomas, helping avoid misdiagnosis and unnecessary surgical intervention. KEY POINTS: Acute scrotum associated with a focal intratesticular lesion is a diagnostic pitfall that may lead to inappropriate management, including unnecessary surgery. Multiparametric ultrasound (including CEUS and elastography) and MRI are complementary for distinguishing benign from malignant lesions and guiding management. Spontaneous testicular hematomas are rare benign entities characterized by T1-weighted image hyperintensity with a hypointense core and no enhancement on subtraction imaging, supporting conservative treatment. Lack of internal enhancement and geographic margins are keys for diagnosing segmental infarction, whereas enhancing thickened or nodular walls and increased stiffness suggest necrotic or hemorrhagic tumors; abscesses typically show dominant inflammatory changes with extra-testicular involvement.