Retrospective Diagnosis of Ca Thyroid on Thyroid Pertechnetate Scan -A part of Routine Post Thyroidectomy Work up For Nontoxic Multi Nodular Goiter.

Unsuspected thyroid cancer can be detected in multinodular goiter (MNG) where the risk of malignancy is 7-9%. Fine needle aspiration (FNAc) is performed in case of suspicious findings on ultrasound. With benign FNAC results there is no need for surgery unless the patient has pressure symptoms or cosmetic concerns, but the risk of overlooked malignancy is always present. We present the case of a patient with unexpected detection of papillary thyroid cancer on thyroid scan.

Positive predictive value of axillary lymph node cortical thickness and nodal, clinical, and tumor characteristics in newly diagnosed breast cancer patients.

PURPOSE: Axillary lymph nodes (LNs) with cortical thickness > 3 mm have a higher likelihood of malignancy. To examine the positive predictive value (PPV) of axillary LN cortical thickness in newly diagnosed breast cancer patients, and nodal, clinical, and tumor characteristics associated with axillary LN metastasis. METHODS: Retrospective review of axillary LN fine needle aspirations (FNAs) performed 1/1/2018-12/31/2019 included 135 axillary FNAs in 134 patients who underwent axillary surgery. Patient demographics, clinical characteristics, histopathology, and imaging features were obtained from medical records. Hypothesis testing was performed to identify predictors of axillary LN metastasis. RESULTS: Cytology was positive in 72/135 (53.3%), negative in 61/135 (45.2%), and non-diagnostic in 2/135 (1.5%). At surgery, histopathology was positive in 84 (62.2%) and negative in 51 (37.8%). LN cortices were thicker in metastatic compared to negative nodes (p < 0.0001). PPV of axillary LNs with cortical thickness ≥ 3 mm, ≥ 3.5 mm, ≥ 4 mm and, ≥ 4.25 mm was 0.62 [95% CI 0.53, 0.70], 0.63 [0.54, 0.72], 0.67 [0.57, 0.76] , and 0.74 [0.64, 0.83], respectively. At multivariable analysis, abnormal hilum (OR = 3.44, p = 0.016) and diffuse cortical thickening (OR = 2.86, p = 0.038) were associated with nodal metastasis. CONCLUSION: In newly diagnosed breast cancer patients, increasing axillary LN cortical thickness, abnormal fatty hilum, and diffuse cortical thickening are associated with nodal metastasis. PPV of axillary LN cortical thickness ≥ 3 mm and ≥ 3.5 mm is similar but increases for cortical thickness ≥ 4 mm. FNA of axillary LNs with cortex < 4 mm may be unnecessary for some patients undergoing sentinel LN biopsy.

Lacrimal gland pleomorphic adenoma: a narrative review / Adenoma pleomórfico de glândula lacrimal: uma revisão narrativa

ABSTRACT We present a literature review of 57 publications describing this pathology, published from the year 2012. In all these studies patients were reported to depict a slow-growing, motionless mass, which is painless at most times. All cases were managed by total excision, except for one report where adjuvant radiotherapy was applied. Among the several therapeutic strategies, the total tumor resection, preserving the tumor pseudocapsule intact, appears to be a consensus in treating the disease efficiently. Furthermore, fine-needle aspiration biopsy, including the assessment of genetic alterations, has proved to be a valuable tool in the diagnosis of challenging cases. Our literature survey also suggests that an incisional biopsy before the surgery may lead to the pseudocapsule disruption, thus considerably increasing the chances of adenoma recurrence, enabling its malignization. At present, genetics studies indicate that the molecular aberrations involved in the adenoma are similar to those represented in the salivary gland tumor pathogenesis. Further, in the recurrent cases, the pathology becomes difficult to treat and multiple surgeries may be required, occasionally, leading to radical surgery treatment.

RESUMO Uma revisão narrativa da literatura de 57 publicações que descrevem esta patologia, publicada a partir de 2012. Os pacientes têm uma massa de crescimento lento e imóvel, que na maioria das vezes é indolor. Todos os casos foram tratados por excisão total, com exceção de um relatório de radioterapia adjuvante. Entre as estratégias terapêuticas encontradas, a ressecção total do tumor, preservando a pseudocápsula tumoral intacta, parece ser um consenso. Alternativamente, a biópsia por aspiração de agulha fina incluindo a avaliação de alterações genéticas pode representar uma ferramenta valiosa nos casos diagnósticos desafiadores. Uma biópsia incisional antes da cirurgia não é recomendada, pois a ruptura da pseudocápsula aumenta consideravelmente a recorrência do adenoma, permitindo até mesmo sua malignização. Com relação à genética, estudos atuais indicam que as aberrações moleculares envolvidas no adenoma são semelhantes às da patogênese do tumor da glândula salivar. Para casos de recorrência, a patologia torna-se difícil de tratar e múltiplas cirurgias podem ser necessárias, às vezes levando a um tratamento cirúrgico radical.

Trends in the pre-operative diagnosis and surgical management of axillary lymph node metastases in women with screen-detected breast cancer.

AIM: The aim of the current study was to investigate time-trends in pre-operative diagnosis and surgical treatment of axillary lymph node metastases in breast cancers detected at screening mammography. METHODS: We included all women who underwent screening mammography in the South of the Netherlands between 2005 and 2020. During a follow-up period of at least two years, data on clinical radiological examinations, biopsy procedures and surgical interventions were obtained. The 15 years of inclusion were divided into five cohorts of three years each. RESULTS: Of the 4049 women with invasive breast cancer, 22.1 % (896/4049) had axillary lymph node metastasis at pathology (ALN+). Percutaneous axillary biopsy was performed in 39.6 % (355/896) of these women, with the proportions of fine needle aspiration biopsy (FNAB) decreasing from 97.6 % (40/41) in 2005-2007 to 41.6 % (37/89) in 2017-2019 and core needle biopsy (CNB) rising from 2.4 % (1/41) in 2005-2007 to 58.4 % (52/89) in 2017-2019 (P < 0.001). Sensitivity of FNAB and CNB was comparable (77.4 % (188/243, 95%CI = 71%-82 %) versus 82.4 % (103/125), 95%CI = 74%-88 %) (P = 0.26). Pre-operative confirmation of ALN + by percutaneous biopsy ranged from 27.3 % (56/205) in 2011-2013 to 39.0 % (80/205) in 2017-2019, with no significant trend changes over time (P = 0.103). The proportion of ALN + women who underwent axillary lymph node dissection (ALND) decreased from 96.0 % (97/101) in 2005-2007 to 16.6 % (34/205) in 2017-2019 (P < 0.001). CONCLUSION: Pre-operative confirmation of axillary lymph node metastasis by ultrasound-guided biopsy did not rise despite the increased use of CNB at the expense of less invasive FNAB. A significant reduction in ALND was observed through the years.

Efectividad y seguridad de la biopsia hepática guiada porendosonografía en enfermedad hepática en un hospital públicode nivel III

La evaluación de la enfermedad hepática parenquimal suele comprender exámenes de laboratorio y de imagen; sin embargo, en algunos casos se puede requerir una biopsia hepática. La biopsia del hígado guiada por endosonografía se ha reportado como un procedimiento con un rendimiento diagnóstico entre 90 a 100% con un perfil bajo de eventos adversos; sin embargo, no existen estudios que reporten la experiencia y el tipo de técnica empleada en nuestro país. Objetivo: Determinar la efectividad y la seguridad de la biopsia hepática guiada por endosonografía en enfermedad hepática parenquimal. Materiales y métodos: Estudio prospectivo realizado en un hospital público de nivel de atención III-2 en Lima, Perú, el cual incluyó pacientes mayores de 18 años con sospecha de alguna enfermedad hepática parenquimal que fueron sometidos a una biopsia guiada por endosonografía desde marzo del 2018 a octubre del 2022. Resultados: El rendimiento diagnóstico de las biopsias fue de 77,02%, con una longitud media de la muestra obtenida de 13,98 mm (desviación estándar 7,34) y una mediana de 8 espacios porta completos (0-50). Cabe mencionar que solo un 31.25% de procedimientos se realizaron con aguja fina de biopsia (FNB), encontrándose una diferencia significativa entre el tipo de aguja y el rendimiento diagnóstico (p=0,01). El diagnóstico histopatológico más frecuente el de hepatitis autoinmune. Y existieron un 2,08% de complicaciones post procedimiento. Conclusiones: Las biopsias guiadas por endosonografía para el diagnóstico de enfermedad parenquimal hepática tienen una efectividad cercana al 80% en nuestro medio y con un perfil bajo de eventos adversos; sin embargo, se necesitan estudios prospectivos y con un mayor número de pacientes.

Parenchymal liver diseases are commonly evaluated by laboratory and imaging studies. However, in some cases a liver biopsy is required. Endoscopic ultrasonography-guided liver biopsy (EUS-LB) has been reported as a procedure with high diagnostic yield (90-100%) with low adverse event profile, but there are not studies which report about the experience and technique in our country. Objective: Determinate the effectiveness and the safety of endosonography-guided liver biopsy in liver parenchymal disease. Materials and methods: A prospective study was conducted at a III-2 level of care Public Hospital in Lima, Peru. It included patients over 18 years of age with suspicion of parenchymal liver disease who underwent EUS-LB for study hepatic parenchymal disease since March of 2018 to October of 2022. Results: The diagnostic yield of the biopsies was 77.02%, with a mean length of the sample of 13.98mm (standard deviation 7.34) and a median of 8 complete portal spaces (0-50). Only 31.25% of the procedures were performed with a fine needle biopsy (FNB), finding a significant difference between the type of needle and the diagnostic yield (p=0.01). The most common histopathological diagnosis was autoinmune hepatitis. There were 2.08% of post-procedure complications. Conclusions: EUS-LB for the diagnosis of liver parenchymal disease had a diagnostic yield close to 80% in our region with a low profile of adverse events. However, more prospectives studies with a larger number of patients are required.

Tissue amount and diagnostic yield of a novel franseen EUS-FNB and a standard EUS-FNA needle-A randomized controlled study in solid pancreatic lesions.

Background and Objectives: Several types of needles are available for EUS-guided tissue sampling of pancreatic lesions. Whereas fine-needle aspiration (FNA) needles typically provide cytological samples, fine-needle biopsy (FNB) needles are designed to obtain microcores with preserved tissue architecture. The aim of this study was to compare tissue amount and diagnostic yield between a modified Franseen-type FNB needle (TopGain; Medi-Globe GmbH, Grassau, Germany) and a standard FNA needle. Methods: We performed a prospective, multicenter randomized controlled study between June 2020 and September 2021, including patients with a solid pancreatic lesion referred for EUS-guided tissue sampling at 3 centers in Denmark. The patients were randomized 1:1 to either FNA needle or the novel FNB needle. Primary outcomes included the number of obtained tissue microcores and total and diagnostic tissue area. Results: Sixty-four patients were included. The median number of tissue microcores procured per pass was significantly higher in the FNB group compared with FNA (3 vs. 2, P < 0.001). Similarly, the mean total tissue area (2.74 vs. 0.44 mm2, P < 0.001) and mean diagnostic tissue area (1.74 vs. 0.28 mm2, P < 0.001) were more than 6-fold larger in the FNB samples compared with FNA. The median number of passes needed for a diagnostic sample was 1 for the FNB needle and 2 for FNA needle (P = 0.12). The novel FNB needle provided a higher percentage of samples of excellent quality (P = 0.002). Conclusions: The novel Franseen-type FNB needle seems to be significantly superior to a conventional FNA needle. The results of this study underline excellent performance of crown-cut needles.

Is the radiomics-clinical combined model helpful in distinguishing between pancreatic cancer and mass-forming pancreatitis?

PURPOSE: To develop CT-based radiomics models for distinguishing between resectable PDAC and mass-forming pancreatitis (MFP) and to provide a non-invasive tool for cases of equivocal imaging findings with EUS-FNA needed. METHODS: A total of 201 patients with resectable PDAC and 54 patients with MFP were included. Development cohort: patients without preoperative EUS-FNA (175 PDAC cases, 38 MFP cases); validation cohort: patients with EUS-FNA (26 PDAC cases, 16 MFP cases). Two radiomic signatures (LASSOscore, PCAscore) were developed based on the LASSO model and principal component analysis. LASSOCli and PCACli prediction models were established by combining clinical features with CT radiomic features. ROC analysis and decision curve analysis (DCA) were performed to evaluate the utility of the model versus EUS-FNA in the validation cohort. RESULTS: In the validation cohort, the radiomic signatures (LASSOscore, PCAscore) were both effective in distinguishing between resectable PDAC and MFP (AUCLASSO = 0.743, 95% CI: 0.590-0.896; AUCPCA = 0.788, 95% CI: 0.639-0.938) and improved the diagnostic accuracy of the baseline onlyCli model (AUConlyCli = 0.760, 95% CI: 0.614-0.960) after combination with variables including age, CA19-9, and the double-duct sign (AUCPCACli = 0.880, 95% CI: 0.776-0.983; AUCLASSOCli = 0.825, 95% CI: 0.694-0.955). The PCACli model showed comparable performance to FNA (AUCFNA = 0.810, 95% CI: 0.685-0.935). In DCA, the net benefit of the PCACli model was superior to that of EUS-FNA, avoiding biopsies in 70 per 1000 patients at a risk threshold of 35%. CONCLUSIONS: The PCACli model showed comparable performance with EUS-FNA in discriminating resectable PDAC from MFP.

Evaluation of the Role of Axillary Lymph Node Fine-Needle Aspiration Cytology in Early Breast Cancer With or Without Neoadjuvant Chemotherapy.

PURPOSE: Fine-needle aspiration cytology (FNAC) of axillary lymph nodes (AxLNs) is performed to diagnose nodal metastasis in patients with breast cancer. Although the sensitivity of ultrasound-guided FNAC for identifying AxLN metastasis is in the range of 36%-99%, whether sentinel lymph node biopsy (SLNB) should be performed for neoadjuvant chemotherapy (NAC) patients with negative FNAC results is uncertain. This study aimed to determine the role of FNAC before NAC in the evaluation and management of AxLN in early breast cancer patients. METHODS: We retrospectively analyzed 3,810 clinically node-negative (a lymph node with no clinical metastasis without FNAC or radiological suspicion of metastasis with negative FNAC results) patients with breast cancer who underwent SLNB between 2008 and 2019. We compared the positivity rate of sentinel lymph nodes (SLNs) between patients who received and those who did not receive NAC with negative FNAC results or without FNAC and axillary recurrence rate in the neoadjuvant group with negative SLNB results. RESULTS: In the non-neoadjuvant (primary surgery) group, the positivity rate of SLNs in patients with negative FNAC results was higher than that in patients without FNAC (33.2% vs. 12.9%; p < 0.001). However, the SLN positivity rate of patients with negative FNAC results (false-negative rate for FNAC) in the neoadjuvant group was lower than that in the primary surgery group (3.0% vs. 33.2%; p < 0.001). After a median follow-up of 3 years, one axillary nodal recurrence was observed, which was a case from the neoadjuvant non-FNAC group. None of the patients in the neoadjuvant group with negative FNAC results had axillary recurrence. CONCLUSION: The false-negative rate for FNAC in the primary surgery group was high; however, SLNB was the proper axillary staging procedure for NAC patients who have clinically suspicious AxLN metastases on radiologic examination but negative FNAC results.

A Comprehensive Assessment of the Harms of Fine-Needle Aspiration Biopsy for Thyroid Nodules: A Systematic Review.

BACKGRUOUND: There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of FNAB. METHODS: Studies related with the harms of FNAB were searched on MEDLINE, Embase, Cochrane library, and KoreaMed from 2012 to 2022. Also, studies reviewed in the previous systematic reviews were evaluated. Included clinical complications were postprocedural pain, bleeding events, neurological symptoms, tracheal puncture, infections, post-FNAB thyrotoxicosis, and needle tract implantation of thyroid cancers. RESULTS: Twenty-three cohort studies were included in this review. Nine studies which were related with FNAB-related pain showed that most of the subjects had no or mild discomfort. The 0% to 6.4% of the patients had hematoma or hemorrhage after FNAB, according to 15 studies. Vasovagal reaction, vocal cord palsy, and tracheal puncture have rarely described in the included studies. Needle tract implantation of thyroid malignancies was described in three studies reporting 0.02% to 0.19% of the incidence rate. CONCLUSION: FNAB is considered to be a safe diagnostic procedure with rare complications, which are mainly minor events. Thorough assessement of the patients' medical condition when deciding to perform FNABs would be advisable to lower potential complications.

Correlation between thyroid fine needle aspiration and pathological examination: a 10 year retrospective study

ABSTRACT Objective To establish the diagnostic performance of fine-needle aspiration in detecting benign and malignant neoplasm in comparison with post-thyroidectomy histopathological findings among patients who received a thyroidectomy. Methods Retrospective observational data collected between 2011-2021 were included from patients who received partial or total thyroidectomy. The Bethesda system was used to classify neoplasms from fine-needle aspiration procedures as benign or malignant. Sample characteristics, diagnostic accuracy, sensitivity, specificity, and predictive values were evaluated. Results Patients (n=360) who underwent thyroidectomy were analyzed, of whom 142 (39.4%) and 218 (60.6%) had benign and malignant neoplasms, respectively. Using the Bethesda system, 23 (6.4%) were classified as unsatisfactory result (BI), 83 (23.1%) as benign (BII), 50 (13.9%) as atypia of undetermined significance (BIII), 23 (6.4%) as suspected follicular or Hürthle cell neoplasia (BIV), 102 (28.3%) as suspected malignancy (BV) and 79 (21.9%) as malignant (BVI). The fine-needle aspiration diagnostic accuracy for carcinomas was 92%, while the sensitivity and specificity were 94.4% and 86.9%, respectively. The negative and positive predictive values were 87.9% and 93.9%, respectively. Conclusion Fine-needle aspiration has high diagnostic accuracy, sensitivity and specificity, and is a reliable test for distinguishing between benign and malignant thyroid pathologies.

Diagnostic value of BRAF V600E mutation detection in BSRTC categories Ⅰ and Ⅲ thyroid nodules / 中华核医学与分子影像杂志

Objective:To evaluate the value of B-Raf proto-oncogene, serine/threonine kinase (BRAF) V600E mutation detection in the differentiating malignant from benign with Bethesda system for reporting thyroid cytopathology (BSRTC) categories Ⅰ and Ⅲ nodules. Methods:From January 2019 to December 2020, a total of 264 nodules from 263 patients (79 males, 184 females; median age 46 years) were retrospectively enrolled and all patients underwent BRAF V600E mutation detection, fine-needle aspiration cytology (FNAC) and thyroid nodulectomy in the Affiliated Drum Tower Hospital of Nanjing University Medical School. Thirteen nodules of 12 patients had repeat aspirate samples and 51 nodules were examined with multiple genes assay in formalin fixed paraffin embedded tissues. Taken the postoperative histopathological results as the gold standard, the diagnostic efficiency of BRAF V600E mutation was analyzed by comparing the results of multiple genes assay and BRAF V600E mutation detection of repeated puncture samples. Results:Of 264 nodules, 230 were malignant (papillary thyroid cancer (PTC)) and 34 were benign, with BSRTC categories Ⅰ (nondiagnostic) and Ⅲ (follicular lesion) nodules of 58 and 206. The sensitivities of BRAF V600E mutation detection in BSRTC categories Ⅰ and Ⅲ nodules were 77.1%(37/48) and 78.0%(142/182), the specificities were 9/10 and 91.7%(22/24), the positive predictive values were 97.4%(37/38) and 98.6%(142/144), the negative predictive values were 45.0%(9/20) and 35.5%(22/62), and the accuracy rates were 79.3%(46/58) and 79.6%(164/206). The diagnostic concordance of BRAF V600E mutation detection was 90.2%(46/51) in the preoperative and postoperative samples of 51 nodules with preoperative BRAF V600E wild type but postoperative pathology confirmed as PTC and was 11/13 in repeat puncture samples. Conclusion:BRAF V600E mutation detection is an effective diagnostic method for BSRTC categories Ⅰ and Ⅲ nodules.

Clinical value of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of thyroid cancer and assessment of cervical lymph node metastasis / 中国基层医药

Objective:To explore the clinical value of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of thyroid cancer and assessment of cervical lymph node metastasis.Methods:The clinical data of 90 patients with thyroid cancer who received treatment in Zhoushan Hospital from October 2018 to April 2021 were retrospectively analyzed. All patients underwent a two-dimensional ultrasound examination and ultrasound-guided fine-needle aspiration biopsy before surgery. Taking surgical and pathological diagnosis as the gold standard, the efficiency of two-dimensional ultrasound examination versus ultrasound-guided fine-needle aspiration biopsy in the diagnosis of thyroid cancer and cervical lymph node metastasis and in the identification of benign and maligant lymph nodes were investigated. Multivariate Logistic regression analysis was performed to analyze the correlation between different ultrasound signs and the detection rate of lymph nodes. Results:Pathological results showed that among the 90 patients, 73 patients had thyroid cancer, and 17 patients had benign lesions. Ultrasound-guided fine-needle aspiration biopsy results showed that 70 patients had thyroid cancer, and 20 patients had benign lesions, including 4 cases of missed diagnosis and 2 cases of misdiagnosis. The diagnostic sensitivity, specificity, accuracy rate, and Kappa value were 94.52%, 88.24%, 93.33%, and 0.79, respectively. These were highly consistent with the surgical and pathological diagnosis (Kappa value > 0.75). Two-dimensional ultrasound revealed 69 patients with thyroid cancer and 21 patients with benign lesions, including 7 cases of missed diagnosis and 4 cases of misdiagnosis. The diagnostic sensitivity, specificity, accuracy rate, and Kappa value were 90.41%, 76.47%, 87.78%, and 0.63, respectively. Pathological results revealed that cervical lymph node metastasis occurred in 12 patients, and it did not occur in 78 patients. The diagnostic sensitivity, specificity, accuracy rate, and Kappa value of ultrasound-guided fine-needle aspiration biopsy were 83.33%, 97.50%, 95.65%, and 0.81 respectively. These were highly consistent with surgical and pathological results (Kappa value > 0.75). The diagnostic sensitivity, specificity, accuracy rate, and Kappa value of two-dimensional ultrasound examination were 75.00%, 94.87%, 92.22%, and 0.67, respectively. A total of 156 lymph nodes were detected by ultrasound-guided fine-needle aspiration biopsy, including 103 benign lymph nodes and 53 malignant lymph nodes, with a diagnostic accuracy rate of 94.17% and 96.22%, respectively. A total of 173 lymph nodes were detected by two-dimensional ultrasound, including 111 benign lymph nodes and 62 malignant lymph nodes, with a diagnostic accuracy rate of 91.89% and 91.93%, respectively. There were no significant differences in the diagnostic accuracy of benign and malignant lymph nodes between the two examination methods ( χ2 = 0.42, 0.92, both P > 0.05). Multivariate logistic regression analysis showed that hyperechoic masses, cystic lesions, and internal calcification were significantly correlated with the detection rate of lymph nodes diagnosed by two-dimensional ultrasound and ultrasound-guided fine-needle aspiration biopsy ( OR = 6.64, 5.32, 4.12, 7.07, 5.60, 5.06, all P < 0.05). Conclusion:Ultrasound-guided fine-needle aspiration biopsy has high diagnostic efficiency for thyroid cancer and cervical lymph node metastasis. Ultrasound signs of hyperechoic mass, cystic lesions, and internal calcification are significantly correlated with the detection rate of lymph nodes.

A model for training ultrasound-guided fine-needle punctures

SUMMARY OBJECTIVE: To evaluate the efficacy of a training program in ultrasound-guided fine needle puncture using a cost-effective model. METHODS: We evaluated the training of 20 resident radiology physicians, based on a theoretical course and a practical simulation part with models that focused on the puncture technique of thyroid nodules. The total time to perform the procedure, the number of punctures on the model surface, and the application of a questionnaire were used to assess the performance and confidence of the resident physicians in performing the procedure. RESULTS: The training model used was easy to reproduce, inexpensive, versatile, and capable of simulating the echotexture of thyroid tissue. There was a significant reduction in the total time needed to perform the procedure with a mean of 173.7 s±91.28 s from R1 and 112.8 s±17.66 s from R2 before the course vs. 19.2 s±112.8 s and 14.3 s±9.36 s, respectively, after the course (p<0.0001); as well as the number of superficial punctures, with a mean of 2.2 punctures±0.92 from R1 and 1.5 punctures±0.32 from R2 before the course vs 1.1 punctures±0.71 and 1.0 puncture±0.0, respectively, after the course (p<0.0001). There was also a subjective improvement in the performance and confidence in performing this procedure. CONCLUSIONS: An inexpensive and easy-to-reproduce gelatin-based model enabled adequate training of resident physicians and proved capable of improving their skills and confidence in simulating the procedure, even with a short period of training.

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.

Fetus in Fetu as a suprarenal mass in a neonate - a rare and perplexing entity.

Fetus in fetu (FIF) is a rare entity in which a malformed vertebrate fetus is incorporated within its twin. This entity should be differentiated from a teratoma, which has more malignant potential. We describe a neonate with a heterogeneous calcified suprarenal mass. The aspiration cytology revealed a heterogeneous cell population with spindle cells and small round blue cells. Operative and histopathologic examination showed features consistent with a fetus in fetu. This case report describes a rare entity and discusses its clinical presentation, cytological features on fine-needle aspiration, and the difficulties posed in its differentiation from a teratoma.

Oncocytoid Variant of High-Grade Salivary Duct Carcinoma: A Potential Diagnostic Pitfall. A Report on Two Patients.

Salivary duct carcinoma (SDC) is an uncommon and aggressive salivary malignancy. The oncocytoid variant of salivary duct carcinoma (OSDC) has only been reported in the English literature once before. Here we detail two new patients. A 71-year-old female presented with a painless enlarging left parotid mass. Imaging and fine-needle aspiration were nondiagnostic. The second patient, a 79-year-old male, presented with painless swelling in the right cheek. Imaging was nondiagnostic. Both patients underwent surgical resection. Histopathology revealed bland yet infiltrative OSDC in both cases. These tumors were AR+ (androgen receptor) by immunohistochemistry. Potential difficulty exists in distinguishing the oncocytoid variant of SDC, a rare and relatively bland tumor, from oncocytoma, a more commonly encountered entity. AR expression can aid in the correct diagnosis.

Diagnostic Performance of Thyroid Core Needle Biopsy Using the Revised Reporting System: Comparison with Fine Needle Aspiration Cytology.

BACKGROUND: We aim to validate the diagnostic performance of thyroid core needle biopsy (CNB) for diagnosing malignancy in clinical settings to align with the changes made in recently updated thyroid CNB guidelines. METHODS: We retrospectively analyzed 1,381 thyroid CNB and 2,223 fine needle aspiration (FNA) samples. The FNA and CNB slides were interpreted according to the Bethesda System for Reporting Thyroid Cytopathology and updated practice guidelines for thyroid CNB, respectively. RESULTS: Compared to FNA, CNB showed lower rates of inconclusive results categories I (2.8% vs. 11.2%) and III (1.2% vs. 6.2%), and higher rates of categories II (60.9% vs. 50.4%) and IV (17.5% vs. 2.0%). The upper and lower bounds of the risk of malignancy (ROM) for category IV of CNB were 43.2% and 26.6%, respectively. The CNB subcategory IVb with nuclear atypia had a higher ROM than the subcategory without nuclear atypia (40%-62% vs. 23%-36%). In histologically confirmed cases, there was no significant difference in the diagnostic performance between CNB and FNA for malignancy. However, neoplastic diseases were more frequently detected by CNB than by FNA (88.8% vs. 77.6%, P=0.046). In category IV, there was no difference in unnecessary surgery rate between CNB and FNA (4.7% vs. 6.9%, P=0.6361). CONCLUSION: Thyroid CNB decreased the rate of inconclusive results and showed a higher category IV diagnostic rate than FNA. The revised guidelines for thyroid CNB proved to be an excellent reporting system for assessing thyroid nodules.

Metastatic tumors to the pancreas: Balancing clinical impression with cytology findings.

BACKGROUNDS/AIMS: Metastatic lesions of the pancreas (PMET) account for 1%-5% of all malignant solid pancreatic lesions (SPL). In this study we evaluated the utility of endoscopic ultrasonography with fine needle aspiration (EUS-FNA) in diagnosing PMET. METHODS: Patients who underwent EUS-FNA at a community referral center between 2011-2017 for SPL were identified. Clinical, radiologic, and EUS-FNA features of those with PMET were compared to those with primary solid tumors of the pancreas: pancreatic adenocarcinoma (PDAC) and neuroendocrine tumors (PNET). RESULTS: A total of 191 patients were diagnosed with solid pancreatic malignancy using EUS-FNA: 156 PDAC, 27 PNET, and eight (4.2%) had PMET. Patients with PMET were less likely to have abdominal pain (25.0% vs. 76.3% vs. 48.2%; p < 0.01) or obstructive jaundice (37.5% vs. 58.3% vs. 0%; p < 0.01) compared to PDAC and PNET. Those with PMET were more likely to have mass lesions with/without biliary or pancreatic ductal dilatations (100% vs. 86.5% vs. 85.2%; p < 0.01) and lower CA19-9 (82.5 ± 43.21 U/mL vs. 4,639.30 ± 11,489.68 U/mL vs. 10.50 ± 10.89 U/mL; p < 0.01) compared to PDAC and PNET. Endosonographic features were similar among all groups. Seven (87.5%) patients with PMET had a personal history of malignancy prior to PMET diagnosis. The primary malignancy was renal cell carcinoma in five PMET. CONCLUSIONS: PMET are exceedingly rare, comprising less than 5% of SLP. Patients with PMET are less likely to present with symptoms and mostly identified by surveillance imaging for the primary malignancy.

Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms.

OBJECTIVES: To investigate the ability of the currently used ultrasound-based malignancy risk stratification systems for thyroid neoplasms (ATA, AACE/ACE/AME, K-TIRADS, EU-TIRADS, ACR-TIRADS and C-TIRADS) in distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA). Additionally, we evaluated the ability of these systems in correctly determining the indication for biopsy. METHODS: Three hundred twenty-nine follicular neoplasms with definitive postoperative histopathology were included. The nodules were categorized according to each of six stratification systems, based on ultrasound findings. We dichotomized nodules into the positive predictive group of FTC (high and intermediate risk) and negative group of FTC based on the classification results. Missed biopsy was defined as neoplasms that were diagnosed as FTCs but for which biopsy was not indicated based on lesion classification. Unnecessary biopsy was defined as neoplasms that were diagnosed as FTAs but for whom biopsy was considered indicated based on classification. The diagnostic performance and missed and unnecessary biopsy rates were evaluated for each stratification system. RESULTS: The area under the curve of each system for distinguishing follicular neoplasms was < 0.700 (range, 0.511-0.611). The missed biopsy rates were 9.0-22.4%. The missed biopsy rates for lesions ≤ 4 cm and lesions sized 2-4 cm were 16.2-35.1% and 0-20.0%, respectively. Unnecessary biopsy rates were 65.3-93.1%. In ≤ 4 cm group, the unnecessary biopsy rates were 62.2-89.7%. CONCLUSION: The malignancy risk stratification systems can select appropriate nodules for biopsy in follicular neoplasms, while they have limitations in distinguishing follicular neoplasms and reducing unnecessary biopsy. Specific stratification systems and recommendations should be established for follicular neoplasms. KEY POINTS: • Current ultrasound-based malignancy risk stratification systems of thyroid nodules had low efficiency in the characterization of follicular neoplasms. • The adopted stratification systems showed acceptable performance for selecting FTC for biopsy but unsatisfactory performance for reducing unnecessary biopsy.

Prediction of hemorrhagic complications after ultrasound-guided biopsy of the thyroid and neck.

OBJECTIVES: Hemorrhage occasionally occurs after ultrasound (US)-guided biopsy of the thyroid and neck and sometimes leads to serious complications. We aimed to identify predictors of hemorrhagic complications after US-guided biopsy of the thyroid and neck. MATERIAL AND METHODS: In this retrospective study, we analyzed consecutive patients who underwent US-guided biopsy from April 2020 to November 2020. Procedure characteristics, US features, and peri- and post-procedural patient symptoms and signs were compared between patients with and without post-biopsy hemorrhage. Associations between clinical and imaging variables and post-biopsy hemorrhage were analyzed using univariate and multivariate regression analyses. RESULTS: A total of 305 patients who underwent US-guided biopsy of the thyroid and neck were included (219 women, 86 men; age range, 20-89 years). Seventeen (5.7%) cases of post-biopsy hemorrhage were detected 30 min after biopsy and manual compression. Among them, 10 developed hemorrhage at 30 min without immediate hemorrhage. In the multivariate analysis, a high tenderness score on the visual analog scale (VAS) at 30 min after biopsy (odds ratio [OR] 5.05, p < .001) was identified as an independent predictor of post-biopsy hemorrhage. In patients with hemorrhage at 30 min, tenderness scores significantly increased over 30 min of observation. CONCLUSIONS: High tenderness scores at 30 min after biopsy and manual compression were independent predictors of hemorrhage after US-guided biopsy of the thyroid and neck. The tenderness score could serve as a valuable marker to triage patients who require further observation and management after a US-guided biopsy of the thyroid and neck. KEY POINTS: • High tenderness scores at 30 min after compression were associated with the presence of delayed post-biopsy hemorrhage at 30 min. • Patients with hemorrhage at 30 min demonstrated a significant increase in tenderness scores over time. • High tenderness scores after biopsy site compression predicted the presence of delayed post-biopsy hemorrhage in the thyroid and neck.