A Comprehensive Approach to the Thyroid Bethesda Category III (AUS) in the Transition Zone Between 2nd Edition and 3rd Edition of The Bethesda System for Reporting Thyroid Cytopathology: Subcategorization, Nuclear Scoring, and More.

Significant interobserver variabilities exist for Bethesda category III: atypia of undetermined significance (AUS) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Thus, subcategorization of AUS including AUS "nuclear" and AUS "other" is proposed in the recent 3rd edition of TBSRTC. This study investigated the impact of the nuclear features/architectural features/nuclear score (NS) (3-tiered)/subcategories and subgroups on risk of malignancy (ROM) in thyroid fine-needle aspirations (FNA). 6940 FNAs were evaluated. 1224 (17.6%) cases diagnosed as AUS were reviewed, and 240 patients (initial FNAs of 260 nodules and 240 thyroidectomies) were included. Subcategories and subgroups were defined according to TBSRTC 2nd and 3rd editions. Histological diagnostic groups included nonneoplastic disease, benign neoplasm, low-risk neoplasm, and malignant neoplasm. Overall, ROM was 30.7%. ROM was significantly higher in FNAs with nuclear overlapping (35.5%), nuclear molding (56.9%), irregular contours (42.1%), nuclear grooves (74.1%), chromatin clearing (49.4%), and chromatin margination (57.7%), and these features were independent significant predictors for malignancy. FNAs with NS3 had significantly higher ROM (64.2%). Three-dimensional groups were significantly more frequent in malignant neoplasms (35.7%). ROM was significantly higher in AUS-nuclear subcategory (48.2%) and in AUS-nuclear and architectural subcategory (38.3%). The highest ROM was detected in AUS-nuclear1 subgroup (65.2%). ROM was significantly higher in the group including AUS-nuclear and AUS-nuclear and architectural subcategories, namely "high-risk group" than the group including other subcategories, namely "low-risk group" (42.0%vs 13.9%). In conclusion, subcategorization may not be the end point, and nuclear scoring and evaluation of architectural patterns according to strict criteria may provide data for remodeling of TBSRTC categories.

The Role of Superb Microvascular Imaging and Shear Wave Elastography in the Prediction of Hemorrhage Complications After Renal Parenchyma Biopsy.

OBJECTIVES: The aim of study was to evaluate the diagnostic utility of the renal parenchyma elasticity with the shear wave elastography (SWE) and microvascularization with the superb microvascular imaging (SMI) technique before kidney biopsy and to predict the complication of hemorrhage before kidney biopsy. METHODS: A total of 75 patients were included in the prospective study. Before the biopsy, vascularity features of the kidney parenchyma in the area to be biopsied were assessed by SMI and parenchymal stiffness by SWE and were examined by 2 independent radiologists. RESULTS: A statistically significant difference was found in the SMI and SWE values between the groups with and without hematoma and hematuria when compared with the Student t test and Mann-Whitney U test ( P < 0.05). The SWE hardness cutoff value, which maximizes the prediction of the development of hematuria, was found to be 18.40 kPa, and the sensitivity and specificity values were 84.4% and 62.8%, respectively. In SMI vascularity index values, the cutoff value was found to be 0.247410800 kPa, and sensitivity and specificity values were 81.3% and 83.7%, respectively. The cutoff value of the SMI vascularity index values that maximized the prediction of hematoma development was 0.297009650, and the sensitivity and specificity values were 87% and 87%, respectively. CONCLUSIONS: We believe that evaluating and standardizing the microvascularization and elasticity of the kidney parenchyma before a percutaneous kidney biopsy will be potentially useful as a guiding method in the prediction of postbiopsy hemorrhage development.

Um Stent Mal Colocado na Artéria Septal Perfurante: Fístula Ventricular Direita, Hematoma do Septo Interventricular e Obstrução da Via de Saída do Ventrículo Direito / A Stent Misplaced in the Septal Perforating Artery: Right Ventricular Fistula, Interventricular Septal Hematoma, and Right Ventricular Outflow Tract Obstruction

Resumo As fístulas coronário-camerais, embora consideradas em sua maioria como entidades congênitas, também têm sido encontradas como complicações de grandes traumas e intervenções coronárias percutâneas (ICPs).1 Por outro lado, o hematoma do septo interventricular (SIV) pode potencialmente surgir principalmente durante intervenções de oclusão total crônica retrógrada (OTC) e tem um curso benigno nesse contexto.2 Aqui, descrevemos uma complicação desafiadora da ICP (e sua estratégia de manejo) apresentando hematoma do SIV, fístula ventricular direita e obstrução da via de saída do ventrículo direito (VSVD) devido a um stent coronário mal implantado na artéria septal perfurante (ASP).

Abstract Coronary-cameral fistulas, though mostly regarded as congenital entities, have also been encountered as complications of major traumas and percutaneous coronary interventions (PCIs).1 On the other hand, interventricular septal (IVS) hematoma might potentially arise mostly during retrograde chronic total occlusion (CTO) interventions and has a benign course in this context.2 Herein, we describe a challenging PCI complication (and its management strategy) presenting with IVS hematoma, right ventricular fistula, and right ventricular outflow tract (RVOT) obstruction due to a misimplanted coronary stent in the septal perforating artery (SPA).

Predictive evaluation of SIRI, SII, PNI, and GPS in cholecystostomy application in patients with acute cholecystitis.

BACKGROUND: The aims of this study were to investigate the clinical significance of systemic inflammatory response index (SIRI), systemic inflammation index (SII), prognostic nutritional index (PNI), and Glasgow prognostic score (GPS) in deciding whether to perform cholecystostomy when determining if cholecystostomy is the right choice for acute cholecystitis (AC) patients. METHODS: Between January 2018 and December 2020, 126 consecutive patients with AC with and without cholecystostomy were retrospectively recruited from the Trakya University in Edirne, Turkey. Group I included AC patients with cholecystostomy and Group II included AC patients without cholecystostomy. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) were calculated. The PNI and SII were calculated RESULTS: There is significant difference between the two groups by the comparison of SIRI, SII, PNI, and GPS values (p<0.001). In Group I, SIRI, SII, and GPS values are higher than the Group II and PNI value in Group I is lower than the Group II. Furthermore, the NLR and PLR ratios in Group I are significantly higher than Group II, and the LMR ratio in Group I is significantly lower than Group II. CONCLUSION: According to our study, we can say that NLR, PLR, SII, SIRI, and GPS are positive predictors and LMR and PNI are negative predictors for the severity of AC. Therefore, when we decide to treat AC medically, we may prefer the application of chole-cystostomy tube at the beginning of hospitalization by the help of evaluating NLR, PLR, LMR, SIRI, SII, GPS, and PNI values.

Contrast nephropathy in cancer patients receiving anti-VEGF therapy: a prospective study.

OBJECTIVES: Contrast nephropathy risk has been increasing in cancer patients. Nephrotoxic side effects of anti-vascular endothelial growth factor/receptor (anti-VEGF/R) drugs used in oncologic treatment are also prominent. The purpose of this study was to identify the possible association among anti-VEGF/R drugs use and development of the contrast-induced nephropathy (CIN) in patients with cancers. METHODS: A total of 92 patients were included in this prospective cross-sectional study. Patients whose glomerular filtration rate (GFR) of < 50 ml/min, hemoglobin of < 10 g/dl, and eastern cooperative oncology group (ECOG) score of ≥ 2 and had received nephrotoxic drugs were not included in the study. Blood samples were collected baseline at pre computed tomography (CT) and day 2, day 3 and day 7 later CT imaging. CIN was defined as either an increased serum creatinine value of 0.5 mg/dl or increased 25% to baseline. CIN frequency between groups receivingand not receiving anti-VEGF/R was compared using the chi-squared test. CIN frequency between bevacizumab and other anti-VEGF/R was also analyzed. RESULTS: There were 39 patients in the anti-VEGF/R (+) group and 53 patients in the anti-VEGF/R (-) group. Eleven patients (28%) in the anti-VEGF/R (+) group and 3 patients (5.6%) in the anti-VEGF/R (-) group had CIN (p = 0.006). In the anti-VEGF/R (+) group, 23 patients received bevacizumab (combined with FOLFOX/FOLFIRI), while 16 patients received other anti-VEGF/R (sunitinib, axitinib, regorafenib, aflibercept) effective treatments. CIN ratio in patients who received bevacizumab or other anti-VEGFR therapy was similar (p = 0 = 50). Of the patients, one patient had acute kidney injury leading to death. CONCLUSION: CIN was significantly more frequent in cancer patients who receiving anti-VEGF/R drugs than those not receiving anti-VEGF/R drugs.

Quantitative Assessment of Salivary Gland Parenchymal Vascularization Using Power Doppler Ultrasound and Superb Microvascular Imaging: A Potential Tool in the Diagnosis of Sjögren's Syndrome

Background: Primary Sjögren's syndrome is a chronic inflammatory autoimmune disease. Minor salivary gland biopsy is the gold standard for the diagnosis of primary Sjögren's syndrome. Superb microvascular imaging, power Doppler ultrasound, and color Doppler of the salivary glands represent non-invasive, non-irradiating modality for evaluating the vascularity of the salivary glands in the diagnosis and follow-up of primary Sjögren's syndrome. Aims: To evaluate the efficacy of superb microvascular imaging and vascularity index in salivary glands for the sonographic diagnosis of primary Sjögren's syndrome. Study Design: Prospective case-control study. Methods: Twenty participants with primary Sjögren's syndrome and 20 healthy subjects were included in the study. Both parotid glands and submandibular glands were evaluated by superb microvascular imaging, power Doppler ultrasound, and color Doppler. The diagnostic accuracy of superb microvascular imaging was compared using these techniques. Results: In the patient group, the vascularity index values of superb microvascular imaging in parotid glands and submandibular glands were 3.5±1.66, 5.06±1.94, respectively. While the same values were 1.0±0.98 and 2.44±1.34 in the control group (p≤0.001). In the patient group, the vascularity index values of power Doppler ultrasound in parotid glands and submandibular glands were 1.3±1.20 and 2.59±1.82, respectively. While the same values were 0.3±0.32 and 0.85±0.68 in the control group (p≤0.001). The superb microvascular imaging vascularity index cut-off value for the diagnosis of primary Sjögren's syndrome in parotid glands that maximizes the accuracy was 1.85 (area under the curve: 0.906; 95% confidence interval: 0.844, 0.968), and its sensitivity and specificity were 87.5% and 72.5%, respectively. While the superb microvascular imaging vascularity index cut-off value for the diagnosis of primary Sjögren's syndrome in submandibular gland that maximizes the accuracy was 3.35 (area under the curve: 0.873; 95% confidence interval: 0.800, 0.946), its sensitivity and specificity were 82.5% and 70%, respectively. Conclusion: Superb microvascular imaging with high reproducibility of the vascularity index has a higher sensitivity and specificity than the power Doppler ultrasound in the diagnosis of primary Sjögren's syndrome. It can be a noninvasive technique in the diagnosis of primary Sjögren's syndrome when used with clinical, laboratory and other imaging methods.

Relationship between the Size and Location of the Mass and Hilar and Mediastinal Lymph Node Metastasis in Early and Locally Advanced Non-small Cell Lung Cancer.

OBJECTIVE: To determine whether there is a relationship between the size and location of the mass and lymph node metastasis in non-small cell lung cancer. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Medical Oncology of Trakya University, from November 2013 to November 2018. METHODOLOGY: Records of 112 patients, who were followed up for non-small cell lung cancer, were retrospectively reviewed. Patients with distant organ metastasis (M1) and distant lymph node metastasis (N3), a previous history of malignancy, synchronous or metachronous tumors, and those for whom required data could not be obtained were excluded. Lymph nodes were evaluated according to pathology reports in patients undergoing invasive procedures. In patients without invasive procedures, lymph node larger than 1 cm in thorax CT, SUV above 2.5 in PET, and acceptance of metastasis at the Oncology Council was considered decisive. Diameter of the tumor, the shortest distance between the tumor and the mediastinum, the shortest distance between the tumor and the hilum, and the diameters of the largest mediastinal or hilar lymph nodes were measured from the thoracic computed tomography (CT) taken at the time of the diagnosis. The relationship between these values and lymph node metastasis was statistically evaluated. RESULTS: Upon consideration of thoracic CT measurements, lymph node metastasis was found to have a statistically significant relationship with tumors with a large diameter (>55 mm) (p<0.001), tumors close to the mediastinum (<7 mm) (p=0.003), and tumors close to the hilum (<60 mm) (p=0.045). The evaluation of the distinctiveness of markers in diagnosis through ROC analysis showed AUC of 0.70 (p<0.001) for the largest tumor diameter, and the risk of lymph node metastasis was higher for lesions above 55 mm. CONCLUSION: In thorax CT, Large tumor size, tumor close to mediastinum, tumor close to hilum, large lymph node, and high SUV value of lymph node in PET-CT are associated with increased chances of metastasis.

Apparent Diffusion Coefficient Measurement in Mediastinal Lymphadenopathies: Differentiation between Benign and Malignant Lesions.

OBJECTIVES: We aimed to prospectively assess the diagnostic value of apparent diffusion coefficient (ADC) measurement in the differentiation of benign and malignant mediastinal lymphadenopathies. MATERIALS AND METHODS: The study included 63 consecutive patients (28 women, 35 men; mean age 59.3 years) with 125 mediastinal lymphadenopathies. Echoplanar diffusion-weighted magnetic resonance imaging of the mediastinum was performed with b-factors of 0 and 600 mm2/s before mediastinoscopy and mediastinotomy, and ADC values were measured. The ADC values were compared with the histological results, and statistical analysis was done. P < 0.05 was considered statistically significant. RESULTS: The mean ADC value of malignant mediastinal lymphadenopathy (1.030 ± 0.245 × 10-3 mm2/s) was significantly lower (P < 0.05) when compared to benign lymphadenopathies (1.571 ± 0.559 × 10-3 mm2/s). For differentiating malignant from benign mediastinal lymphadenopathy, the best result was obtained when an ADC value of 1.334 × 10-3 mm2/s was used as a threshold value; area under the curve 0.848, accuracy 78.4%, sensitivity 66%, specificity of 86%, positive predictive value 76.7%, and negative predictive value of 79.2%. Interobserver agreement was excellent for ADC measurements. CONCLUSIONS: ADC measurements could be considered an important supportive method in differentiating benign from malignant mediastinal lymphadenopathies.