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JAMA Network Open Sep 2023Although most thyroid nodules are benign, 10% to 15% of them harbor cancer. Thyroid ultrasonography is useful for risk stratification of nodules, and American College of...
IMPORTANCE
Although most thyroid nodules are benign, 10% to 15% of them harbor cancer. Thyroid ultrasonography is useful for risk stratification of nodules, and American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) classification provides recommendations for fine-needle aspiration cytology (FNAC) based on objective ultrasonographic features of these nodules.
OBJECTIVE
To validate the concordance of ACR TI-RADS classification with Bethesda classification and histopathology.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study was performed to evaluate the concordance of ACR TI-RADS classification with Bethesda classification and histopathology and was conducted in Singapore General Hospital Outpatient Otolaryngology clinic in March 2021 to May 2021. Data analysis was performed in May 2021.
MAIN OUTCOMES AND MEASURES
Results were deemed concordant when ACR TI-RADS recommendations aligned with Bethesda scores. Conversely, results were classified as nonconcordant with Bethesda scores and/or histopathology results when nodules that were recommended for FNAC yielded benign results or nodules that were not recommended for FNAC yielded malignant results.
RESULTS
A total of 446 patients (370 women [83%]; mean [range] age, 60 [24-89] years) who underwent ultrasonography of the thyroid and ultrasonography-guided thyroid FNACs were identified. A total of 492 of 630 nodules (78.1%) were benign on FNAC (Bethesda II). Score 3 ACR TI-RADS nodules yielded the highest negative predictive values: 94.6% (95% CI, 92.9%-95.9%; P < .001) compared with Bethesda scoring and 100.0% (95% CI, 15.8%-100.0%; P = .003) compared with histopathology. Score 4 or 5 ACR TI-RADS nodules yielded positive predictive values of 2.8% and 16.2%, respectively, compared with Bethesda scoring and 6.1% and 66.7%, respectively, compared with histopathology. Small (<1.5 cm) ACR TI-RADS nodules of scores of 4 and 5 that were not recommended for FNAC yielded a malignant risk of 5.7% and 25.0% on Bethesda 5 and 6, respectively. On surgical excision, 5 of 46 (10.9%) ACR TI-RADS 4 nodules and 15 of 21 (71.4%) of ACR TI-RADS 5 nodules were confirmed to be malignant. Among nodules initially not recommended for FNAC, histopathology-proven cancer was found in 4 of 13 (30.7%) and 3 of 6 (50.0%) of nodules, respectively.
CONCLUSIONS AND RELEVANCE
These findings suggest that ACR TI-RADS score 3 nodules have a low risk of cancer and should be considered for FNAC only if nodules are 2.5 cm or larger. Patients with small (<1.5 cm) ACR TI-RADS 4 and 5 nodules should be appropriately counseled for FNAC to exclude cancer.
Topics: Humans; Female; Middle Aged; Thyroid Nodule; Retrospective Studies; Biopsy, Fine-Needle; Risk Assessment
PubMed: 37703017
DOI: 10.1001/jamanetworkopen.2023.31612 -
Frontiers in Endocrinology 2023To screen out the predictors and establish a prediction model of positive fine needle aspiration biopsy (FNAB) in the Chinese Guidelines for Malignant Risk...
OBJECTIVES
To screen out the predictors and establish a prediction model of positive fine needle aspiration biopsy (FNAB) in the Chinese Guidelines for Malignant Risk Stratification of Thyroid Nodule Ultrasound (C-TIRADS) 4 thyroid nodules, and this nomogram can help clinicians evaluate the risk of positive FNAB and determine if FNAB is necessary.
METHODS
We retrospectively analyzed data from 547 patients who had C-TIRADS 4 thyroid nodules and underwent fine-needle aspiration biopsy (FNAB) at the Second Affiliated Hospital of Chongqing Medical University between November 30, 2021 and September 5, 2022. Patients who met our inclusion criteria were divided into two groups based on positive or negative FNAB results. We compared their ultrasound (US) features, BRAF V600E status, thyroid function, and other general characteristics using univariate and multivariate logistic regression analyses to identify independent predictors. These predictors were then used to construct a nomogram. The calibration plot, area under the curve (AUC), and decision curve analysis were employed to evaluate the calibration, discrimination, and clinical utility of the prediction model.
RESULTS
Out of 547 patients, 39.3% (215/547) had a positive result on fine-needle aspiration biopsy (FNAB), while 60.7% (332/547) had a negative result. Univariate logistic regression analysis revealed no significant differences in TPOAb, TgAb, TSH, Tg, nodule location, sex, or solid status between the two groups (P>0.05). However, age, nodule size, internal or surrounding blood flow signal, microcalcifications, aspect ratio, morphology, and low echo showed significant differences (P<0.05). Multivariate logistic regression analysis was conducted to explore the correlation between potential independent predictors. The results showed that only age (OR=0.444, 95% Cl=0.296~0.666, P<0.001), low echo (OR=3.549, 95% Cl=2.319~5.432, P<0.001), microcalcifications (OR=2.531, 95% Cl=1.661~3.856, P<0.001), aspect ratio (OR=3.032, 95% Cl=1.819~5.052, P<0.001), and morphology (OR=2.437, 95% Cl=1.586~3.745, P<0.001) were independent predictors for a positive FNAB. These variables were used to construct a prediction nomogram. An ROC curve analysis was performed to assess the accuracy of the nomogram, and AUC=0.793, which indicated good discrimination and decision curve analysis demonstrated clinical significance within a threshold range of 14% to 91%.
CONCLUSION
In conclusion, 5 independent predictors of positive FNAB, including age (≤45 years old), low echo (yes), microcalcifications (yes), aspect ratio (>1) and morphology (irregular), were identified. A nomogram was established based on the above 5 predictors, and the nomogram can be used as a complementary basis to help clinicians make decisions on FNAB of C-TI-RADS 4 thyroid nodules.
Topics: Humans; Middle Aged; Thyroid Nodule; Biopsy, Fine-Needle; Thyroid Neoplasms; Retrospective Studies; Ultrasonography
PubMed: 37554760
DOI: 10.3389/fendo.2023.1154984 -
Journal of Cancer Research and... Aug 2023The purpose of this study was to assess computed tomography (CT)-guided puncture biopsy of pulmonary nodules at a high risk of bleeding. First, a coaxial trocar...
CONTEXT
The purpose of this study was to assess computed tomography (CT)-guided puncture biopsy of pulmonary nodules at a high risk of bleeding. First, a coaxial trocar technique was used to radiofrequency ablate small blood vessels in the puncture area, followed by a biopsy of the pulmonary nodule.
AIM
This study aimed to evaluate the effectiveness and safety of this procedure.
METHODS
In this retrospective research, we assessed the relevant data of 45 patients who had undergone needle biopsy of pulmonary nodules at a high risk of bleeding. Twenty-five of these patients had CT-guided coaxial radiofrequency ablation (RFA)-assisted biopsy (group A). The remaining 20 had undergone conventional CT-guided needle biopsy (group B). We equated the technical success rate and the incidence of complications such as bleeding, pneumothorax, and pain in the two groups of needle biopsies.
RESULTS
Both groups had a 100% success rate with puncture biopsy. The incidences of pneumothorax in groups A and B were 10% (2/20) and 24% (6/25), respectively; this difference is not significant (P > 0.050). The rates of bleeding in groups A and B were 10% (2/20) and 44% (11/25), respectively, and the rates of pain were 30% (6/20) and 60% (15/25), both of which were statistically significant (P = 0.030; P = 0.045, respectively).
CONCLUSIONS
CT-guided coaxial trocar technique for RFA-assisted biopsy of pulmonary nodules at a high risk of bleeding is effective and safe and can significantly reduce the risk of biopsy-induced pulmonary hemorrhage.
Topics: Humans; Pneumothorax; Retrospective Studies; Hemorrhage; Image-Guided Biopsy; Multiple Pulmonary Nodules; Pain; Radiofrequency Ablation
PubMed: 37675725
DOI: 10.4103/jcrt.jcrt_2193_22 -
Cytopathology : Official Journal of the... May 2024Cytological specimens play a pivotal role in head and neck nodule/mass work up and diagnoses. The specimens´ importance has grown with the onset of personalized... (Review)
Review
Cytological specimens play a pivotal role in head and neck nodule/mass work up and diagnoses. The specimens´ importance has grown with the onset of personalized medicine and the routine use of molecular markers in the diagnostic work up. The Updates in Head and Neck Cytopathology Short Course ran during the 35th European Congress of Pathology held in Dublin, Ireland, in 2023 and brought together experts in cytopathology, pathology, and related fields to share their expertise and experience in the field of head and neck cytopathology and its future directions. Topics such as a one-stop clinic, the Milan System for Reporting Salivary Gland Cytopathology, next generation sequencing, and human papilloma virus detection in the head and neck area were covered during the short course. These topics are briefly summarized in the present review.
Topics: Humans; Biopsy, Fine-Needle; Salivary Glands; Head; Neck; Ireland; Salivary Gland Neoplasms; Retrospective Studies
PubMed: 38351503
DOI: 10.1111/cyt.13368 -
European Radiology Aug 2023The aim of this study is to describe the technique and to report early results of thoraco-abdominal biopsies in the Interventional Magnetic Resonance Imaging Suite...
OBJECTIVE
The aim of this study is to describe the technique and to report early results of thoraco-abdominal biopsies in the Interventional Magnetic Resonance Imaging Suite (IMRIS).
MATERIALS AND METHODS
We prospectively evaluated patients with indications for MRI-guided biopsy between January 2021 and May 2022. Exclusion criteria were indication for US-/CT-guided biopsy, contraindication to percutaneous biopsy, inability to lie flat for at least 30 min, claustrophobic, severe obesity, or non-MRI compatible devices. Biopsies were performed by 3 interventional radiologists, with at least 8 years of experience in oncological interventional radiology. Epidemiological, clinical, procedural, and histopathological data were retrospectively collected.
RESULTS
From an initial population of 117 patients, 57 patients (32 male, mean age 64 ± 8 y) were finally enrolled. All 57 patients suspected thoraco-abdominal malignant lesions finally underwent MRI-guided percutaneous biopsy. The mean duration of the entire procedure was 37 min (range 28-65 min); the mean duration of the total needle-in-patient time was 10 min (range 6-19 min). Technical and clinical success were obtained for all the biopsies performed. Malignancy was demonstrated in 47/57 (82%) cases and benignancy in the remaining 10/57 (18%) cases. No major complications were detected after the biopsies; two minor compliances (severe pain) occurred and were managed conservatively.
CONCLUSION
Our initial experience demonstrated the technical feasibility and the accuracy of MRI-guided biopsies of thoraco-abdominal masses. The reported data associated with the best comfort for the patient and for the operator make the use of MRI a valid alternative to other methods, especially in lesions that are difficult to approach via US or CT.
CLINICAL RELEVANCE STATEMENT
Interventional MRI is one of the most important innovations available for interventional radiologists. This method will broaden the diagnostic and therapeutic possibilities, allowing treatment of lesions up to now not approachable percutaneously. For this, it is necessary to start publishing the data of the few groups that are developing the method.
KEY POINTS
• To evaluate the use of MRI as a guide for percutaneous biopsies of various districts. • Our preliminary experience confirms experience demonstrated the technical feasibility and the accuracy of MRI-guided biopsies of thoraco-abdominal masses. • Interventional MRI can become the reference method for percutaneous biopsies in particular for lesions with difficult percutaneous approach.
Topics: Humans; Male; Middle Aged; Aged; Biopsy, Needle; Retrospective Studies; Image-Guided Biopsy; Tomography, X-Ray Computed; Neoplasms
PubMed: 37256353
DOI: 10.1007/s00330-023-09763-1 -
Digestive Endoscopy : Official Journal... May 2024Repeated endoscopic ultrasound (EUS)-guided tissue acquisition represents the standard practice for solid pancreatic lesions after previous nondiagnostic or inconclusive...
OBJECTIVES
Repeated endoscopic ultrasound (EUS)-guided tissue acquisition represents the standard practice for solid pancreatic lesions after previous nondiagnostic or inconclusive results. Since data are lacking, we aimed to evaluate the diagnostic performance of repeated EUS fine-needle biopsy (rEUS-FNB) in this setting. The primary outcome was diagnostic accuracy; sample adequacy, sensitivity, specificity, and safety were secondary outcomes.
METHODS
Consecutive patients undergoing rEUS-FNB for solid pancreatic lesions at 23 Italian centers from 2019 to 2021 were retrieved. Pathology on the surgical specimen, malignant histology together with ≥6-month follow-up, and benign pathology together with ≥12-month follow-up were adopted as gold standards.
RESULTS
Among 462 patients, 56.5% were male, with a median age of 68 (59-75) years, malignancy prevalence 77.0%. Tumor size was 26 (20-35) mm. Second-generation FNB needles were used in 89.6% cases. Diagnostic accuracy, sensitivity, and specificity of rEUS-FNB were 89.2%, 91.4%, and 81.7%, respectively (19 false-negative and 12 false-positive results). On multivariate analysis, rEUS-FNB performed at high-volume centers (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.10-3.17; P = 0.03) and tumor size (OR 1.03; 95% CI 1.00-1.06; P = 0.05) were independently related to diagnostic accuracy. Sample adequacy was 94.2%. Use of second-generation FNB needles (OR 5.42; 95% CI 2.30-12.77; P < 0.001) and tumor size >23 mm (OR 3.04; 95% CI 1.31-7.06; P = 0.009) were independently related to sample adequacy.
CONCLUSION
Repeated EUS-FNB allowed optimal diagnostic performance after nondiagnostic or inconclusive results. Patients' referral to high-volume centers improved diagnostic accuracy. The use of second-generation FNB needles significantly improved sample adequacy over standard EUS-FNB needles.
Topics: Humans; Male; Female; Aged; Middle Aged; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Pancreatic Neoplasms; Sensitivity and Specificity; Retrospective Studies; Italy
PubMed: 37712906
DOI: 10.1111/den.14686 -
The Journal of Bone and Joint Surgery.... Jul 2023Historically, open biopsy (OB) was the gold standard for sarcoma diagnosis. Core needle biopsy (CNB) has become increasingly common. There are limited data evaluating...
BACKGROUND
Historically, open biopsy (OB) was the gold standard for sarcoma diagnosis. Core needle biopsy (CNB) has become increasingly common. There are limited data evaluating how the type of biopsy impacts definitive surgical resection or postoperative outcomes. The aims of this study were to (1) characterize current international biopsy practice patterns, and (2) evaluate how the type of biopsy performed impacts the resection surgery, infection risk, oncological complications, and patient-reported functional outcome scores.
METHODS
This study was a preplanned secondary analysis of the prospective, multicenter PARITY (Prophylactic Antibiotic Regimens in Tumor Surgery) study. Patients with a benign diagnosis, metastatic disease, or no biopsy prior to surgery were excluded. Prospectively collected demographic, biopsy, surgical, and outcome variables were analyzed, and differences between patients undergoing OB and CNB were assessed. Parametric and nonparametric tests were used to compare variables between groups, and the Cox proportional hazards method was used to compare infection-related and oncological outcomes at 1 year. Median functional outcome scores at 1 year were compared.
RESULTS
Four hundred and sixty-four patients met the inclusion criteria. Data were collected from 48 sarcoma centers in 12 countries. CNB was the more utilized biopsy modality overall (57.5%). OB was more common in the U.S. and Canada. The median operative time was significantly longer for patients who underwent OB (324 versus 260 minutes; p < 0.001). Significantly more skin (p < 0.001) and fascial tissue (p < 0.001) were excised in the OB group, which also had a lower rate of primary closure (86.3% versus 92.9%; p = 0.03). There were no differences in surgical site infection or oncological outcomes between the groups at 1-year follow-up.
CONCLUSIONS
CNB was the more common biopsy modality in the PARITY study in most countries. However, OB was more common in the U.S. and Canada. Patients undergoing OB had longer operative times, more excised tissue, and lower rates of primary closure, but this did not translate to differences in infection rates or oncological outcomes, including local recurrence.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Biopsy, Large-Core Needle; Prospective Studies; Sarcoma; Soft Tissue Neoplasms; Extremities; Retrospective Studies
PubMed: 37466581
DOI: 10.2106/JBJS.22.01259 -
Cytopathology : Official Journal of the... Mar 2024The co-existence of granulomatous mastitis and collagenous spherulosis in a breast lump is an uncommon finding. The awareness of cytomorphological features can help...
The co-existence of granulomatous mastitis and collagenous spherulosis in a breast lump is an uncommon finding. The awareness of cytomorphological features can help corroborate a cytological diagnosis. A palpable breast lump in an elderly female warrants urgent attention and fine needle aspiration is a rapid, reliable method of evaluation. An elderly female with a firm breast lump mimicking malignancy was subjected to fine needle aspiration cytology (FNAC). Smears showed ill-formed granulomas, inflammatory cells and homogeneous hyaline stromal globular elements intermingled with the benign ductal epithelial and myoepithelial cells.
Topics: Female; Humans; Aged; Breast; Breast Neoplasms; Biopsy, Fine-Needle; Epithelial Cells; Hyperplasia
PubMed: 37874012
DOI: 10.1111/cyt.13316 -
International Journal of Surgical... Dec 2023Vascular lesions of the breast are uncommon, however, these are increasingly encountered now due to more frequent use of magnetic resonance imaging. They comprise a... (Review)
Review
Vascular lesions of the breast are uncommon, however, these are increasingly encountered now due to more frequent use of magnetic resonance imaging. They comprise a spectrum of lesions including benign, atypical, and malignant tumors. The prototype is a hemangioma, which is most often nonpalpable and is detected on routine screening. Different histopathologic subtypes of hemangioma have been described, including perilobular, venous, cavernous, and capillary hemangioma. Other benign vascular lesions include anastomosing hemangioma, a well-circumscribed proliferation of anastomosing blood vessels with lobular or diffuse growth pattern which affects a large segment of the breast, presenting as a painless slow enlarging palpable mass. Recent data suggest that benign vascular lesions diagnosed on core needle biopsy with concordant radiologic and pathologic findings do not require excision and have an excellent prognosis, except angiomatosis, which can be locally aggressive and may recur. The main focus of this study is to present the radiographic, gross, and histopathologic characteristics of benign vascular lesions of the breast and their differential diagnoses.
Topics: Humans; Female; Neoplasm Recurrence, Local; Breast; Hemangioma; Biopsy, Large-Core Needle; Angiomatosis; Breast Neoplasms
PubMed: 37032453
DOI: 10.1177/10668969231160254 -
Digestive Endoscopy : Official Journal... Nov 2023Considering the critical roles of cancer-associated fibroblasts (CAFs) in pancreatic cancer, recent studies have attempted to incorporate stromal elements into organoid...
Considering the critical roles of cancer-associated fibroblasts (CAFs) in pancreatic cancer, recent studies have attempted to incorporate stromal elements into organoid models to recapitulate the tumor microenvironment. This study aimed to evaluate the feasibility of patient-derived organoid (PDO) and CAF cultures by using single-pass endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) samples from prospectively enrolled pancreatic cancer patients. The obtained samples were split into two portions for PDO and CAF cultures. PDOs and CAFs were cultured successfully in 54.4% (31/57) and 47.4% (27/57) of the cases, respectively. Both components were established in 21 cases (36.8%). Various clinicopathologic factors, including the tumor size, tumor location, clinical stage, histologic subtype, and tumor differentiation, did not influence the PDO establishment. Instead, the presence of necrosis in tumor samples was associated with initial PDO generation but no further propagation beyond passage 5 (P = 0.024). The "poorly cohesive cell carcinoma pattern" also negatively influenced the PDO establishment (P = 0.018). Higher stromal proportion in tumor samples was a decisive factor for successful CAF culture (P = 0.005). Our study demonstrated that the coestablishment of PDOs and CAFs is feasible even with a single-pass EUS-FNB sample, implying an expanding role of endoscopists in future precision medicine.
Topics: Humans; Cancer-Associated Fibroblasts; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Pancreatic Neoplasms; Organoids; Tumor Microenvironment
PubMed: 37522250
DOI: 10.1111/den.14648