Machine Learning-Based Ultrasound Texture Analysis in Differentiation of Benign Phyllodes Tumors from Borderline-Malignant Phyllodes Tumors.

PURPOSE: Phyllodes tumors (PTs) are uncommon fibroepithelial breast lesions that are classified as three different forms as benign phyllodes tumor (BPT), borderline phyllodes tumor (BoPT), and malignant phyllodes tumor (MPT). Conventional radiologic methods make only a limited contribution to exact diagnosis, and texture analysis data increase the diagnostic performance. In this study, we aimed to evaluate the contribution of texture analysis of US images (TAUI) of PTs in order to discriminate between BPTs and BoPTs-MPTs. METHODS: The number of patients was 63 (41 BPTs, 12 BoPTs, and 10 MPTs). Patients were divided into two groups (Group 1-BPT, Group 2-BoPT/MPT). TAUI with LIFEx software was performed retrospectively. An independent machine learning approach, MATLAB R2020a (Math- Works, Natick, Massachusetts) was used with the dataset with p < 0.004. Two machine learning approaches were used to build prediction models for differentiating between Group 1 and Group 2. Receiver operating characteristics (ROC) curve analyses were performed to evaluate the diagnostic performance of statistically significant texture data between phyllodes subgroups. RESULTS: In TAUI, 10 statistically significant second order texture values were identified as significant factors capable of differentiating among the two groups (p < 0.05). Both of the models of our dataset make a diagnostic contribution to the discrimination between BopTs-MPTs and BPTs. CONCLUSION: In PTs, US is the main diagnostic method. Adding machine learning-based TAUI to conventional US findings can provide optimal diagnosis, thereby helping to choose the correct surgical method. Consequently, decreased local recurrence rates can be achieved.

Targeting Replicative Stress and DNA Repair by Combining PARP and Wee1 Kinase Inhibitors Is Synergistic in Triple Negative Breast Cancers with Cyclin E or BRCA1 Alteration.

The identification of biomarker-driven targeted therapies for patients with triple negative breast cancer (TNBC) remains a major clinical challenge, due to a lack of specific targets. Here, we show that cyclin E, a major regulator of G1 to S transition, is deregulated in TNBC and is associated with mutations in DNA repair genes (e.g., BRCA1/2). Breast cancers with high levels of cyclin E not only have a higher prevalence of BRCA1/2 mutations, but also are associated with the worst outcomes. Using several in vitro and in vivo model systems, we show that TNBCs that harbor either mutations in BRCA1/2 or overexpression of cyclin E are very sensitive to the growth inhibitory effects of AZD-1775 (Wee 1 kinase inhibitor) when used in combination with MK-4837 (PARP inhibitor). Combination treatment of TNBC cell lines with these two agents results in synergistic cell killing due to induction of replicative stress, downregulation of DNA repair and cytokinesis failure that results in increased apoptosis. These findings highlight the potential clinical application of using cyclin E and BRCA mutations as biomarkers to select only those patients with the highest replicative stress properties that may benefit from combination treatment with Wee 1 kinase and PARP inhibitors.

Applying postoperative radioiodine therapy before 3 months seems to decrease ablation success in patients with differentiated thyroid carcinoma.

OBJECTIVES: Radioiodine can be applied for remnant ablation in low and low to intermediate-risk patients with differentiated thyroid cancer (DTC). A controversy still exists about the application time interval of radioiodine following total thyroidectomy. In this study, we investigated the effect of radioiodine (RAI) therapy timing on the success rates of the ablation. METHODS: We retrospectively reviewed the data of DTC patients who underwent total thyroidectomy and were treated with radioiodine remnant ablation during 2013-2017. Because the objective of this study was to determine the success of ablation according to the postoperative RAI therapy timing, any patients with a pathologic uptake outside the thyroid bed as well as high-risk patients determined before and at RAI therapy were excluded from the study. Finally, 503 patients with low and low to intermediate-risk groups were included in the study. Successful ablation was defined as no visible focal uptake on the neck on I-131 whole body scan with stimulated thyroglobulin (Tg) level of < 1 ng/mL and a normal or undetectable antithyroglobulin antibody (ATG). The time interval from total thyroidectomy to RAI therapy (titRAI) was calculated as months for each patient. RESULTS: A total of 115 (22.9%) patients were in the low to intermediate-risk group whereas most of the patients were at the low-risk group according to the American Thyroid Association (ATA) 2015. Successful ablation was observed in 388 (77.1%) patients. The titRAI was ≤ 3 months in 151 (30.0%) patients and > 3 months in 352 (70.0%) patients. The ratio of successful ablation was statistically higher in patients with a titRAI > 3 months (81.2% of patients) than in patients with ≤ 3 months (67.5% of patients) (χ2 11.247, p 0.001). The rate of successful ablation was 20.3% higher in patients treated after 3 months. There was no statistical difference when titRAI cut off was reduced to 2 months (p > 0.5). CONCLUSION: Investigated the effect of radioiodine therapy initiated before 3 months after total thyroidectomy and it seems to decrease ablation success.

Intra-operative parathyroid hormone evaluation is superior to frozen section analysis in parathyroid surgery.

BACKGROUND: Surgery is currently the only treatment option for patients with primary hyperparathyroidism (PHPT). Recently, minimally invasive parathyroidectomy (MIP) has begun to replace traditional bilateral neck exploration (BNE). OBJECTIVE: The aim of this study is to compare the results of parathyroidectomies performed in our hospital over the past decade that were guided by intra-operative parathyroid hormone (IOPTH) sampling or frozen section (FS) analysis. MATERIAL AND METHODS: Data on 697 patients who underwent parathyroidectomies in the Department of Endocrine Surgery, Dokuz Eylul University between January 2005 and 2018 were included in this study. Patients with malignancies other than thyroid papillary microcarcinoma and parathyroid cancer were excluded from the study. RESULTS: The concomitant use of neck ultrasound (US) and technetium 99m Sestamibi (99mTc MIBI) scintigraphy successfully localized the hyperfunctioning parathyroid glands in nearly 96% of cases. As compared with the IOPTH group, the operation time was longer in the FS group (p < 0.001), and the need for postoperative calcium (Ca) supplementation was higher (p < 0.001). The duration of hospitalization (days) was significantly higher in the FS group (4.2 ± 3.4 vs. 2.6 ± 1.9) as compared with that in the IOPTH group (p < 0.001). In addition, the recurrence rate in the FS group was significantly higher than that in the IPOTH group (p = 0.002). CONCLUSION: IOPTH sampling is a safe and effective method when performed by experienced surgeons and with appropriate preoperative screening. This study emphasizes that IOPTH sampling. We believe that the success in parathyroid surgery is due to three factors: correct indication, accurate localization and experienced surgeon.

Evaluation of Elastographic Features in Complex Fibroadenomas With Radiologic-Pathologic Correlation.

Fibroadenoma is the most common benign tumor of the breast, and complex fibroadenoma (CFA) is one of its variants. Of the fibroadenomas, 22% are CFAs, and in women with CFAs, the malignancy development is found to be higher than in women with noncomplex fibroadenomas. Although there is an increased risk of malignancy with CFAs, the imaging findings of CFAs are fundamentally similar to those of other variants of fibroadenomas. In the literature, B-mode ultrasound features of CFAs were reported in detail. To our knowledge, there is no study that has specifically described the elastographic findings of CFAs. This article aims to illustrate the elastographic features of CFAs and to correlate radiologic and histopathologic findings of different cases.

Is the extent of surgical resection important in patient outcome in benign and borderline phyllodes tumors of the breast?

Background/aim: Phyllodes tumors (PTs) of the breast are rare, and their diagnosis and treatment remain controversial. This retrospective study aims to examine the clinical outcome of benign and borderline PTs, according to the surgical margins. Materials and methods: We examined the medical records of 122 patients in our clinic, who had histologically confirmed benign and borderline PTs between 1994 and 2017. Results: The mean age of the patients was 40.6 years (range 18.0-81.0, ±12.1 standard deviation [SD]) and the mean tumor size was 25.8 mm (range 9-65, ±10.3 SD). All patients underwent a breast-conserving procedure and the median follow-up was 51 months. Tumor margins were positive (tumor touching the ink) in 43 patients (35%). Only 16 patients (13%) had margins ≥10 mm. The margins were between 2 and 10 mm in most patients (40%) and ≤1 mm in 12% of the patients. Conclusion: Although no re-excision was performed to obtain grossly clear margins, local recurrence was not observed in any patients. Therefore, revision surgery for close or positive surgical margins for benign and borderline PTs should not be performed as a rule. As most tumors recur within 2 years of diagnosis, we propose a close clinical and imaging follow-up during this period.

Evaluation and comparison of radiologic-pathologic findings in invasive cribriform carcinoma of the breast.

BACKGROUND/AIM: This study aimed to report invasive cribriform carcinoma (ICC) with radiological and histopathologic correlations. MATERIALS AND METHODS: Seventy patients with ICC were classified into two groups; pure ICC patients and patients with >50% cribriform carcinoma component were included in group 1, while patients with <50% cribriform carcinoma component were included in group 2. All patients were reviewed according to American College of Radiology (ACR) breast imaging reporting and data system (BI-RADS) lexicon of mammography (MG), ultrasonography (US), and magnetic resonance imaging (MRI). One-way analysis of variance tests and t-tests were used for analysis. P < 0.05 was accepted as statistically significant. RESULTS: Eighteen patients were in group 1 and 52 were in group 2. All patients had MG and US, while 24 patients needed MRI. According to MG ACR BI-RADS lexicon evaluation, irregular shape, spiculated margin and indistinct margin, and high density were statistically significantly higher in group 2 than the other group (respectively P = 0.001, P = 0.001, and P= 0.04). Equal density was statistically significantly higher in group 1 than the other group (P = 0.008). According to US ACR BI-RADS lexicon evaluation, irregular shape, spiculated margins, angular margins, microlobulated margins, and nonparallel orientation were more common US findings in group 2 than the other group (respectively P = 0.001, P = 0.001, P = 0.003, P = 0.04, and P = 0.04). The rate of parallel orientation was higher in group 1 than the other group (P = 0.02). CONCLUSION: Few cases showed benign characteristics and most ICCs appear with typical features of malignancy. Radiologic features of ICC could be better understood and would be helpful for radiologists in diagnosing this rare type of malignancy.

The incidence of 18F-FDG PET/CT thyroid incidentalomas andthe prevalence of malignancy: a prospective study.

BACKGROUND/AIM: To determine the prevalence of malignancy in thyroid incidentalomas (TIs) detected by fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). MATERIALS AND METHODS: 18F-FDG PET/CT images were evaluated prospectively for the presence of thyroid uptake. The patients with a TI were evaluated by an endocrinologist according to the predefined diagnostic algorithm. The final diagnosis was obtained clinically and/or by pathology. RESULTS: TI was detected in 4.2% of 4204 patients. A malignant thyroid nodule was diagnosed in 29% and 33% of the focal and diffuse-focal uptake groups, respectively. However, no malignancy was detected in the diffuse uptake group. The standardized maximum uptake values (SUVmax) of the nodules were significantly higher in patients with thyroid malignancy than in patients with benign nodules (P = 0.006). The calculated cut-off value of SUVmax for malignancy was 3.5. In 2 patients in whom the cytopathological diagnosis was benign, malignancy was diagnosed after total thyroidectomy. CONCLUSION: A malignant nodule was present in one-third of the patients with focal or diffuse-focal uptake. A SUVmax value of 3.5 was considered as a cut-off value for the differentiation of a malignant lesion. Benign cytology in fine-needle aspiration biopsy for 2 patients underestimated a thyroid malignancy.

Cystic solitary fibrous tumor of the liver: a case report.

Solitary fibrous tumors are unusual neoplasms that are rarely found in the liver parenchyma. They are usually described as hard, grayish white, well-defined lesions. Predominant cystic change in a solitary fibrous tumor is an unexpected finding, with only a few previous cases reported in the literature, two of which are localized in the head and neck region. Herein, we report a unique case of solitary fibrous tumor of the liver in a 38-year-old female with predominant multiloculated cystic appearance, and discuss the histopathologic differential diagnosis.