The Comparison of Efficacy and Safety between Radiofrequency Ablation Alone and Ethanol Ablation Followed by Radiofrequency Ablation in the Treatment of Mixed Cystic and Solid Thyroid Nodule.

Purpose: To compare the efficacy and safety of radiofrequency ablation (RFA) and ethanol ablation (EA) followed by RFA in treating mixed cystic and solid thyroid nodules. Materials and Methods: We included 243 nodules from 243 patients who underwent RFA for mixed cystic and solid benign nodules. The nodules were divided into two groups (RFA alone and EA + RFA). We evaluated volume reduction rate (VRR), therapeutic success rate, improvement in symptomatic and cosmetic issues, complications, and adverse effects. Results: The RFA group included 204 patients, and the EA + RFA group included 39 patients. The long-term success rates in the RFA only and EA + RFA groups were 90.2% and 97.4%, respectively. The mean VRR at the last follow-up in the RFA and EA + RFA groups were 81.6% and 87.2%, respectively. Therapeutic results were similar in both groups at the last follow-up. Cosmetic and symptomatic problems markedly improved in both groups. No major complications were observed. Conclusion: Both RFA alone and EA + RA are safe and effective methods for treating mixed cystic and solid thyroid nodules, although EA + RFA is slightly more effective.

Development and Validation of Deep Learning-Based Automated Detection of Cervical Lymphadenopathy in Patients with Lymphoma for Treatment Response Assessment: A Bi-institutional Feasibility Study.

The purpose is to train and evaluate a deep learning (DL) model for the accurate detection and segmentation of abnormal cervical lymph nodes (LN) on head and neck contrast-enhanced CT scans in patients diagnosed with lymphoma and evaluate the clinical utility of the DL model in response assessment. This retrospective study included patients who underwent CT for abnormal cervical LN and lymphoma assessment between January 2021 and July 2022. Patients were grouped into the development (n = 76), internal test 1 (n = 27), internal test 2 (n = 87), and external test (n = 26) cohorts. A 3D SegResNet model was used to train the CT images. The volume change rates of cervical LN across longitudinal CT scans were compared among patients with different treatment outcomes (stable, response, and progression). Dice similarity coefficient (DSC) and the Bland-Altman plot were used to assess the model's segmentation performance and reliability, respectively. No significant differences in baseline clinical characteristics were found across cohorts (age, P = 0.55; sex, P = 0.13; diagnoses, P = 0.06). The mean DSC was 0.39 ± 0.2 with a precision and recall of 60.9% and 57.0%, respectively. Most LN volumes were within the limits of agreement on the Bland-Altman plot. The volume change rates among the three groups differed significantly (progression (n = 74), 342.2%; response (n = 8), - 79.2%; stable (n = 5), - 8.1%; all P < 0.01). Our proposed DL segmentation model showed modest performance in quantifying the cervical LN burden on CT in patients with lymphoma. Longitudinal changes in cervical LN volume, as predicted by the DL model, were useful for treatment response assessment.

Cerebrovascular Malformation Mimicking Recurrent Lymphoma on Dual Time-Point 18F-FDOPA PET.

ABSTRACT: Although 18F-FDG is the dominant radiotracer for PET imaging of hematological malignancies, radiolabeled amino acids have also been investigated to improve image quality in areas of high 18F-FDG uptake such as the central nervous system. We present a case of a 57-year-old woman who underwent an 18F-FDOPA scan for primary CNS lymphoma, which demonstrated an unexpected false-positive uptake in the right frontal lobe, due to a developmental venous anomaly.

Comparison of the Therapeutic Efficacy and Technical Outcomes between Conventional Fixed Electrodes and Adjustable Electrodes in the Radiofrequency Ablation of Benign Thyroid Nodules.

OBJECTIVE: This study aimed to compare therapeutic efficacy and technical outcomes between adjustable electrode (AE) and conventional fixed electrode (FE) for radiofrequency ablation (RFA) of benign thyroid nodules. MATERIALS AND METHODS: Between 2013 and 2021, RFA was performed on histologically proven benign thyroid nodules. For the AE method, AE length ≥ 1 cm with higher power and < 1 cm with lower power were utilized for ablating feeding vessels and nodules, especially those near anatomical structures, respectively. The therapeutic efficacy (volume reduction rate [VRR], complication rate, and regrowth rate) and technical outcomes (total energy delivery, ablated volume/energy, RFA time, and ablated volume/time) of FE and AE were compared. Continuous parameters were compared using a two-sample t-test or Mann-Whitney U test, and categorical parameters were compared using a chi-squared test or Fisher's exact test. RESULTS: A total of 182 nodules (FE: 92 vs. AE: 90) in 173 patients (mean age ± standard deviation, 47.0 ± 14.7 years; female, 90.8% [157/173]; median follow-up, 726 days [interquartile range, 441-1075 days]) were analyzed. The therapeutic efficacy was comparable, whereas technical outcomes were more favorable for AE. Both electrodes demonstrated comparable overall median VRR (FE: 92.4% vs. AE: 84.9%, P = 0.240) without immediate major complications. Overall regrowth rates were comparable between the two groups (FE: 2.2% [2/90] vs. AE: 1.1% [1/90], P > 0.99). AE demonstrated a shorter median RFA time (FE: 811 vs. AE: 627 seconds, P = 0.009). Both delivered comparable median energy (FE: 42.8 vs. AE: 29.2 kJ, P = 0.069), but AE demonstrated higher median ablated volume/energy and median ablated volume/time (FE: 0.2 vs. AE: 0.3 cc/kJ, P < 0.001; and FE: 0.7 vs. AE: 1.0 cc/min, P < 0.001, respectively). CONCLUSION: Therapeutic efficacy between FE and AE was comparable. AE demonstrated better technical outcomes than FE in terms of RFA time, ablated volume/energy, and ablated volume/time.

Diagnostic Performance of Ultrasound-Based Risk Stratification Systems for Thyroid Nodules: A Systematic Review and Meta-Analysis.

BACKGRUOUND: This study investigated the diagnostic performance of biopsy criteria in four society ultrasonography risk stratification systems (RSSs) for thyroid nodules, including the 2021 Korean (K)-Thyroid Imaging Reporting and Data System (TIRADS). METHODS: The Ovid-MEDLINE, Embase, Cochrane, and KoreaMed databases were searched and a manual search was conducted to identify original articles investigating the diagnostic performance of biopsy criteria for thyroid nodules (≥1 cm) in four widely used society RSSs. RESULTS: Eleven articles were included. The pooled sensitivity and specificity were 82% (95% confidence interval [CI], 74% to 87%) and 60% (95% CI, 52% to 67%) for the American College of Radiology (ACR)-TIRADS, 89% (95% CI, 85% to 93%) and 34% (95% CI, 26% to 42%) for the American Thyroid Association (ATA) system, 88% (95% CI, 81% to 92%) and 42% (95% CI, 22% to 67%) for the European (EU)-TIRADS, and 96% (95% CI, 94% to 97%) and 21% (95% CI, 17% to 25%) for the 2016 K-TIRADS. The sensitivity and specificity were 76% (95% CI, 74% to 79%) and 50% (95% CI, 49% to 52%) for the 2021 K-TIRADS1.5 (1.5-cm size cut-off for intermediate-suspicion nodules). The pooled unnecessary biopsy rates of the ACR-TIRADS, ATA system, EU-TIRADS, and 2016 K-TIRADS were 41% (95% CI, 32% to 49%), 65% (95% CI, 56% to 74%), 68% (95% CI, 60% to 75%), and 79% (95% CI, 74% to 83%), respectively. The unnecessary biopsy rate was 50% (95% CI, 47% to 53%) for the 2021 K-TIRADS1.5. CONCLUSION: The unnecessary biopsy rate of the 2021 K-TIRADS1.5 was substantially lower than that of the 2016 K-TIRADS and comparable to that of the ACR-TIRADS. The 2021 K-TIRADS may help reduce potential harm due to unnecessary biopsies.

Standardized Imaging and Reporting for Thyroid Ultrasound: Korean Society of Thyroid Radiology Consensus Statement and Recommendation.

Ultrasonography (US) is a primary imaging modality for diagnosing nodular thyroid disease and has an essential role in identifying the most appropriate management strategy for patients with nodular thyroid disease. Standardized imaging techniques and reporting formats for thyroid US are necessary. For this purpose, the Korean Society of Thyroid Radiology (KSThR) organized a task force in June 2021 and developed recommendations for standardized imaging technique and reporting format, based on the 2021 KSThR consensus statement and recommendations for US-based diagnosis and management of thyroid nodules. The goal was to achieve an expert consensus applicable to clinical practice.

Correlation between radiologic depth of invasion and pathologic depth of invasion in oral cavity squamous cell carcinoma: A systematic review and meta-analysis.

OBJECTIVES: To comprehensively assess the correlation between radiologic depth of invasion (rDOI) and pathologic depth of invasion (pDOI) in oral cavity squamous cell carcinoma (OSCC) by meta-analysis. MATERIALS AND METHODS: PubMed and Embase databases were searched to find pertinent articles reporting rDOI of OSCC. Studies evaluating the correlations and mean differences (MDs) between rDOI and pDOI were included. The rDOI was measured based on ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI). The correlation coefficients and MDs between rDOI and pDOI were meta-analytically pooled. Between-study heterogeneity was assessed using Higgins' inconsistency index (I2). Subgroup analysis was performed based on imaging modality. RESULTS: Twenty-three studies with 1787 patients were included. The pooled correlation coefficient and MD were 0.86 (95 % confidence interval [CI], 0.82-0.90; I2 = 66.9 %) and 1.84 mm (95 % CI, 1.02-2.65 mm; I2 = 88.2 %), respectively. In subgroup analysis, MRI showed the largest MD (n = 12, 2.61 mm), followed by US (n = 2, -0.41 mm) and CT (n = 2, 0.12 mm). US showed the highest correlation coefficient (n = 3, 0.91), followed by MRI (n = 12, 0.85) and CT (n = 3, 0.82). CONCLUSION: rDOI measured by US, CT, and MRI demonstrated excellent correlations with pDOI.

Deep convolutional neural network for classification of thyroid nodules on ultrasound: Comparison of the diagnostic performance with that of radiologists.

PURPOSE: This study aimed to train and validate deep learning (DL) models for differentiating malignant from benign thyroid nodules on US images and compare their performance with that of radiologists. METHODS: Images of thyroid nodules in patients who underwent US-guided fine-needle aspiration biopsy at our institution between January 2010 and March 2020 were retrospectively reviewed. Four radiologists independently classified the images. Images of thyroid nodules were trained using three different image classification DL models (VGG16, VGG19, and ResNet). The diagnostic performances of the DL models were calculated for the internal and external datasets and compared with the diagnoses of the four radiologists. Pairwise comparisons of the AUCs between the radiologists and DL models were made using bootstrap-based tests. RESULTS: In total, 15,409 images from 7,321 patients (mean age, 60 ± 13 years; malignant nodules, 20.7%) were randomly grouped into training (n = 12,327) and validation (n = 3,082) sets. Independent internal (n = 432; 197 patients) and external (n = 168; 59 patients) test sets were also acquired. The DL models demonstrated a higher diagnostic performance than the radiologists in the internal test set (AUC, 0.83 - 0.86 vs. 0.71 - 0.76, P < 0.05), but not in the external test set. The VGG16 model demonstrated the highest diagnostic performance in internal (AUC, 0.86; sensitivity, 91.8%; specificity, 73.2%) and external (AUC: 0.83; sensitivity: 78.6%; specificity: 76.8%) test sets. However, no statistical differences were found in the AUCs among the DL models. CONCLUSIONS: The DL models demonstrated comparable diagnostic performance to radiologists in distinguishing benign from malignant thyroid nodules on US images and may play a potential role in augmenting radiologists' diagnosis of thyroid nodules.

Preoperative Magnetic Resonance Image and Computerized Tomography Findings Predictive of Facial Nerve Invasion in Patients with Parotid Cancer without Preoperative Facial Weakness-A Retrospective Observational Study.

(1) Background: Facial nerve resection with reconstruction helps achieve optimal outcomes in the treatment of facial nerve invasion (FNI) of parotid cancer. Preoperative imaging is crucial to predict facial nerve reconstruction. The radiological findings of CT or MRI may predict FNI in the parotid cancer even without facial paralysis. Methods: We retrospectively reviewed the records of 151 patients without facial nerve paralysis before surgery who had undergone tumor resection. Previously untreated parotid cancers were included. (2) Results: The median follow-up duration was 62 months (range: 24-120 months). The FNI (+) group (n = 30) showed a significantly worse 5-year overall survival compared with the FNI (-) group (75.5 vs. 93.9%; hazard ratio = 4.19; 95% confidence interval: 1.74-10.08; p = 0.001). The tumor margin, tumor size, presence in the anterolateral parotid region (area 3), retromandibular vein involvement, distance from the stylomastoid foramen to the upper tumor margin, and a high tumor grade were significant factors related to FNI in the univariate analysis. A spiculated tumor margin, the tumor size (2.2 cm), and presence in area 3 were factors predicting FNI in the logistic regression model (p = 0.020, 0.005, and 0.050, respectively; odds ratio: 4.02, 6.40, and 8.16, respectively). (3) Conclusions: The tumor size (≥2.2 cm), spiculated margin, and presence in area 3 as presented in CT and MRI may help clinicians preoperatively predict FNI in patients with parotid cancer and establish an appropriate surgical plan.

Radiofrequency ablation of recurrent thyroid cancers: anatomy-based management.

Although differentiated thyroid cancer has an excellent prognosis and low mortality, its recurrence rate has been reported to be very high. While surgery is recommended as the standard treatment for recurrent thyroid cancer, reoperation may increase the incidence of complications due to fibrosis and anatomical distortion. In patients with high surgical risk or those who refuse repeated surgery, ultrasonography-guided ablation techniques including radiofrequency ablation, ethanol ablation, and laser ablation are suggested as alternative treatments. In this manuscript, we introduce an anatomy-based management concept for radiofrequency ablation for recurrent thyroid cancer, and present a review of the relevant literature, including indications, basic techniques, clinical outcomes, and complications.

Effect of olfactory bulb atrophy on the success of olfactory training.

PURPOSE: To evaluate the success of olfactory training in patients with olfactory loss and olfactory bulb (OB) atrophy detected on magnetic resonance imaging (MRI) and other characteristics. METHODS: This study included 48 patients with olfactory loss who underwent a nasal endoscopic examination and MRI before olfactory training. The Korean Version of the Sniffin' Sticks Test was performed before and after training. The olfactory training success was defined as an improvement of more than 6 points in the Threshold-Discrimination-Identification (TDI) score. Patient characteristics and OB atrophy pre-training were compared between successful and unsuccessful groups. RESULTS: The etiology of olfactory loss included respiratory viral infection in 30 (62.5%), trauma in 10 (20.8%), and idiopathic loss in 8 (16.7%) patients. Twenty-three (47.9%) of 48 patients exhibited successful olfactory training. Etiology, age, gender, and symptom duration were not different between unsuccessful and successful groups. Pre-training discrimination, identification, and TDI scores were significantly different between unsuccessful and successful groups (P < 0.05). Success rate of patients with bilateral OB atrophy was significantly lower than that of patients with unilateral OB atrophy and normal morphology (P = 0.006). OB height was significantly lower in the unsuccessful group than in the successful group (P < 0.05). Bilateral OB atrophy was an independent risk factor for failure of olfactory training according to the multivariate analysis. CONCLUSION: Olfactory loss patients with bilateral OB atrophy may not be able to improve olfactory function after olfactory training.

Diffusion-weighted MRI for predicting treatment response in patients with nasopharyngeal carcinoma: a systematic review and meta-analysis.

Early prediction of treatment response in nasopharyngeal carcinoma is clinically relevant for optimizing treatment strategies. This meta-analysis was performed to evaluate whether apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI) can predict treatment response of patients with nasopharyngeal carcinoma. A systematic search of PubMed-MEDLINE and Embase was performed to identify relevant original articles until July 22, 2021. We included studies which performed DWI for predicting locoregional treatment response in nasopharyngeal carcinoma treated with neoadjuvant chemotherapy, definitive chemoradiation, or radiation therapy. Hazard ratios were meta-analytically pooled using a random-effects model for the pooled estimates of overall survival, local relapse-free survival, distant metastasis-free survival and their 95% CIs. ADC showed a pooled sensitivity of 87% (95% CI 72-94%) and specificity of 70% (95% CI 56-80%) for predicting treatment response. Significant between-study heterogeneity was observed for both pooled sensitivity (I2 = 68.5%) and specificity (I2 = 92.2%) (P < 0.01). The pooled hazard ratios of low pretreatment ADC for assessing overall survival, local relapse-free survival, and distant metastasis-free survival were 1.42 (95% CI 1.09-1.85), 2.31 (95% CI 1.42-3.74), and 1.35 (95% CI 1.05-1.74), respectively. In patients with nasopharyngeal carcinoma, pretreatment ADC demonstrated good predictive performance for treatment response.

2020 Imaging Guidelines for Thyroid Nodules and Differentiated Thyroid Cancer: Korean Society of Thyroid Radiology.

Imaging plays a key role in the diagnosis and characterization of thyroid diseases, and the information provided by imaging studies is essential for management planning. A referral guideline for imaging studies may help physicians make reasonable decisions and minimize the number of unnecessary examinations. The Korean Society of Thyroid Radiology (KSThR) developed imaging guidelines for thyroid nodules and differentiated thyroid cancer using an adaptation process through a collaboration between the National Evidence-based Healthcare Collaborating Agency and the working group of KSThR, which is composed of radiologists specializing in thyroid imaging. When evidence is either insufficient or equivocal, expert opinion may supplement the available evidence for recommending imaging. Therefore, we suggest rating the appropriateness of imaging for specific clinical situations in this guideline.

Effectiveness of Injecting Cold 5% Dextrose into Patients with Nerve Damage Symptoms during Thyroid Radiofrequency Ablation.

BACKGROUND: Although radiofrequency ablation (RFA) is a safe treatment for thyroid tumors, nerve damage is a frequent complication. A previous retrospective study suggested that an injection of cold 5% dextrose in water (5% DW) can reduce nerve damage during RFA. This study validated the efficacy of injecting cold 5% DW for management of nerve damage during RFA. METHODS: Between November 2017 and December 2018, 242 patients underwent 291 RFA sessions for treatment of benign thyroid nodules or recurrent thyroid cancers. Using a standardized technique, cold (0°C to 4°C) 5% DW was immediately injected around the damaged nerve into patients with any symptoms suggesting nerve damage. The incidence of nerve damage, the volume of 5% DW injected, symptom recovery time and the incidence of permanent nerve damage were evaluated. RESULTS: Nineteen patients experienced nerve damage symptoms related to 21 RFA sessions, including 17 patients during 19 sessions and two patients on the day after two sessions. Patients with nerve damage symptoms detected during RFA were treated by injection of a mean 41 mL (range, 3 to 260) cold 5% DW, but the two patients who experienced symptoms the next day did not receive cold 5% DW injections. Immediate recovery was observed after 15 RFA sessions in 14 patients. No patient experienced permanent nerve damage. CONCLUSION: Injection of cold 5% DW is effective in managing nerve damage during RFA of thyroid lesions.

Comparison of diagnostic performance between CT and MRI for detection of cartilage invasion for primary tumor staging in patients with laryngo-hypopharyngeal cancer: a systematic review and meta-analysis.

OBJECTIVE: To compare the diagnostic performance of contrast-enhanced CT with that of MRI in the detection of cartilage invasion in patients with laryngo-hypopharyngeal cancer. METHODS: A systematic literature search in the Ovid-MEDLINE and EMBASE databases was performed for studies reporting diagnostic accuracy of CT and/or MRI in detecting cartilage invasion from laryngo-hypopharyngeal cancer between 2000 and 2018. The pooled sensitivity and specificity, and their 95% confidence intervals were calculated for CT and MRI using bivariate random effects modeling. Subgroup and meta-regression analyses were performed. Indirect comparison was also performed by univariable meta-regression. RESULT: Fourteen articles including 776 patients were included in the systematic review and meta-analysis: eight for CT, and six for MRI. CT and MRI showed pooled sensitivities of 66% (95% CI, 49-80%) and 88% (95% CI, 79-93%), and pooled specificities of 90% (95% CI, 82-94%) and 81% (95% CI, 76-84%), respectively. MRI showed significantly higher sensitivity than CT (p = 0.02). The specificities showed no statistically significant difference between CT and MRI (p = 0.39). The CT studies showed heterogeneity and a threshold effect, while MRI showed neither heterogeneity nor threshold effect. In the meta-regression analysis for CT, the type of cartilage analyzed (thyroid only vs. thyroid/cricoid/arytenoid, p < 0.001) was a significant factor influencing the heterogeneity in the diagnostic performance of the CT studies. CONCLUSIONS: In conclusion, MRI has significantly higher sensitivity than CT for detecting cartilage invasion in patients with laryngo-hypopharyngeal cancer, without a significant difference in the specificity. KEY POINTS: • MRI has significantly higher sensitivity than CT for detecting cartilage invasion in patients with laryngo-hypopharyngeal cancer.

Computer-Aided Diagnosis System for the Evaluation of Thyroid Nodules on Ultrasonography: Prospective Non-Inferiority Study according to the Experience Level of Radiologists.

OBJECTIVE: To determine whether a computer-aided diagnosis (CAD) system for the evaluation of thyroid nodules is non-inferior to radiologists with different levels of experience. MATERIALS AND METHODS: Patients with thyroid nodules with a decisive diagnosis of benign or malignant nodule were consecutively enrolled from November 2017 to September 2018. Three radiologists with different levels of experience (1 month, 4 years, and 7 years) in thyroid ultrasound (US) reviewed the thyroid US with and without using the CAD system. Statistical analyses included non-inferiority testing of the diagnostic accuracy for malignant thyroid nodules between the CAD system and the three radiologists with a non-inferiority margin of 10%, comparison of the diagnostic performance, and the added value of the CAD system to the radiologists. RESULTS: Altogether, 197 patients were included in the study cohort. The diagnostic accuracy of the CAD system (88.48%, 95% confidence interval [CI] = 82.65-92.53) was non-inferior to that of the radiologists with less experience (1 month and 4 year) of thyroid US (83.03%, 95% CI = 76.52-88.02; p < 0.001), whereas it was inferior to that of the experienced radiologist (7 years) (95.76%, 95% CI = 91.37-97.96; p = 0.138). The sensitivity and negative predictive value of the CAD system were significantly higher than those of the less-experienced radiologists were, whereas no significant difference was found with those of the experienced radiologist. A combination of US and the CAD system significantly improved sensitivity and negative predictive value, although the specificity and positive predictive value deteriorated for the less-experienced radiologists. CONCLUSION: The CAD system may offer support for decision-making in the diagnosis of malignant thyroid nodules for operators who have less experience with thyroid US.

Advanced imaging parameters improve the prediction of diffuse lower-grade gliomas subtype, IDH mutant with no 1p19q codeletion: added value to the T2/FLAIR mismatch sign.

OBJECTIVES: A combination of T2/FLAIR mismatch sign and advanced imaging parameters may improve the determination of molecular subtypes of diffuse lower-grade glioma. We assessed the diagnostic value of adding the apparent diffusion coefficient (ADC) and cerebral blood volume (CBV) to the T2/FLAIR mismatch sign for differentiation of the IDH mutation or 1p/19q codeletion. MATERIALS AND METHODS: Preoperative conventional, diffusion-weighted, and dynamic susceptibility contrast imaging were performed on 110 patients with diffuse lower-grade gliomas. The study population was classified into three groups using molecular subtype, namely IDH mutation and 1p/19q codeletion (IDHmut-Codel), IDH wild type (IDHwt) and IDH mutation and no 1p/19q codeletion (IDHmut-Noncodel). T2/FLAIR mismatch sign and the histogram parameters of apparent diffusion coefficient (ADC) and normalised cerebral blood volume (nCBV) values were assessed. A multivariate logistic regression model was constructed to distinguish IDHmut-Noncodel from IDHmut-Codel and IDHwt and from IDHwt, and the performance was compared with that of single parameters using the area under the receiver operating characteristics curve (AUC). RESULTS: Positive visual T2/FLAIR mismatch sign and higher nCBV skewness were significant variables to distinguish IDHmut-Noncodel from the other two groups (AUC, 0.88; 95% CI, 0.81-0.96). A lower ADC10 was a significant variable for distinguishing IDHmut-Noncodel from the IDHwt group (AUC, 0.75; 95% CI, 0.62-0.89). Adding ADC or CBV histogram parameters to T2/FLAIR mismatch sign improved performance in distinguishing IDHmut-Noncodel from the other two groups (AUC 0.882 vs. AUC 0.810) or from IDHwt (AUC 0.923 vs. AUC 0.868). CONCLUSIONS: The combination of the T2/FLAIR mismatch sign with ADC or CBV histogram parameters can improve the identification of IDHmut-Noncodel diffuse lower-grade gliomas, which can be easily applied in clinical practice. KEY POINTS: • The combination of the T2/FLAIR mismatch sign with the ADC or CBV histogram parameters can improve the identification of IDHmut-Noncodel diffuse lower-grade gliomas. • The multivariable model showed a significantly better performance for distinguishing the IDHmut-Noncodel group from other diffuse lower-grade gliomas than the T2/FLAIR mismatch sign alone or any single parameter. • The IDHmut-Noncodel type was associated with intermediate treatment outcomes; therefore, the identification of IDHmut-Noncodel diffuse lower-grade gliomas could be helpful for determining the clinical approach.

Laser and radiofrequency ablations for benign and malignant thyroid tumors.

A growing body of evidence is being published regarding the safety and efficacy of minimally invasive image-guided ablation techniques. While clinical applications of these techniques are increasing, international societies have started to publish treatment guidelines and to make efforts to standardize both terminology and reporting criteria for image-guided thyroid ablations. Laser ablation and radiofrequency ablation (RFA) are among the most common ablation techniques either for benign and malignant thyroid nodules. Unlike laser ablation and RFA in the treatment of benign thyroid nodules, where safety and efficacy have been widely demonstrated, evidence regarding local tumor control of thyroid malignancies is still limited. However, preliminary results are encouraging and image-guided thermal ablation techniques can be considered a valid alternative to surgery for the treatment of benign thyroid nodules and recurrent thyroid cancers. This review evaluates the basic concept of RFA and laser ablations, their techniques, clinical outcomes, and complications based on the suggestions of several society guidelines. Multidisciplinary collaboration remains critical to identify patients which may benefit from minimally invasive image-guided thermal ablations, especially if surgery or radioiodine therapy are not feasible options.

Comprehensive Cancer Panel Sequencing Defines Genetic Diversity and Changes in the Mutational Characteristics of Pancreatic Cancer Patients Receiving Neoadjuvant Treatment.

Background/Aims: Pancreatic ductal adenocarcinoma (PDA) is associated with an extremely poor prognosis. This study assessed the genetic diversity among patients with PDA and compared their mutational profiles before and after treatment. Methods: Tumors and matched blood samples were obtained from 22 PDA patients treated with neoadjuvant chemoradiation therapy. The somatic mutations were analyzed with comprehensive cancer gene panel (CCP). In addition, the biopsy samples obtained at diagnosis and the surgically resected samples after treatment were compared for seven patients. The CCP provided formalin-fixed paraffin-embedded sample-compatible multiplexed target selection for 409 genes implicated in cancer. Results: Assessments of the MLH1, MLH3, MSH2, and PMS2 genes showed that the four patients with the highest relative burdens of mutations harbored somatic mutations in at least three of these genes. Genes in the histone-lysine N-methyltransferase 2 (KMT2) family, such as KMT2D, KMT2A, and KMT2C, were frequently mutated in tumor samples. Survival was worse in patients with ARID1A gene mutations than those without ARID1A gene mutations. Mutation patterns were compared between tissue samples before and after neoadjuvant treatment in seven patients who underwent surgical resection. The allelic fraction of mutations in KRAS codon 12 was lower in the surgically resected samples than in the endoscopic ultrasonography-guided fine needle aspiration biopsy samples of six patients. The number of mutant alleles of the histone lysine methyltransferase gene WHSC1 also decreased after treatment. Conclusions: These results indicate that tumor tissue from PDA patients is genetically diverse and suggest that ARID1A mutations may be a potential prognostic marker for PDA.

Müllerian inhibiting substance/anti-Müllerian hormone type II receptor protein and mRNA expression in the healthy and cancerous endometria.

Müllerian inhibiting substance/anti-Müllerian hormone (MIS/AMH) is a regulator of the female reproductive system, an indicator of ovarian reserve and a growth inhibitor of Müllerian duct-derived tumors in vivo and in vitro. The objective of the present study was to analyze MIS/AMH type II receptor (MIS/AMHRII) protein and mRNA expression in healthy human endometria compared with patients with endometrial hyperplasia and endometrial cancer, providing a foundation for MIS/AMH as a biological modifier for treatment of endometrial hyperplasia and endometrial cancer. The present study included healthy endometrial tissues (n=20), simple endometrial hyperplasia tissues without atypia (n=17), complex endometrial hyperplasia tissues without atypia (n=24) and endometrial cancer tissues (n=8). The location and variation of MIS/AMHRII protein expression was observed by immunohistochemistry. The expression was graded by two pathologists and was categorized as follows: Negative, weakly positive, moderately positive or strongly positive. Reverse transcription-quantitative polymerase chain reaction was used to quantify MIS/AMHRII mRNA expression. The expression of MIS/AMHRII protein was observed in the cytoplasm of healthy human endometria, endometrial hyperplasia and endometrial cancer cells. The frequency of MIS/AMHRII protein expression was 20.22±10.35% in the proliferative phase of the healthy endometrium and 24.09±11.73% in the secretory phase of the healthy endometrium. However, no differences were observed in the menstrual cycle phases. The frequency was 54.50±16.59% in endometrial hyperplasia without atypia, 55.10±15.87% in endometrial hyperplasia with atypia and 73.88±15.70% in endometrial cancer, indicating that expression was enhanced as the disease progressed from healthy to malignant status. In endometrial hyperplasia, MIS/AMHRII protein expression was significantly associated with histological complexity compared with atypia status. The present study demonstrated that MIS/AMHRII is present in healthy endometria, endometrial hyperplasia and endometrial cancer. The low expression frequency of MIS/AMHRII was not significantly different among normal endometrial tissues, however, the protein expression was elevated in endometrial hyperplasia and endometrial cancer. These findings indicated that the study of bioactive MIS/AMH, as a possible treatment for tumors expressing the MIS/AMH receptor, is essential.