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Alternative Therapies in Health and... Jun 2024To evaluate the efficacy of ultrasound-guided Mammotome (MMT) vacuum-assisted biopsy (VAB) for the qualitative diagnosis of breast nodules smaller than 5 cm in diameter.
OBJECTIVE
To evaluate the efficacy of ultrasound-guided Mammotome (MMT) vacuum-assisted biopsy (VAB) for the qualitative diagnosis of breast nodules smaller than 5 cm in diameter.
METHODS
A retrospective analysis was conducted on clinical data from 102 patients with breast nodules between November 2020 and November 2023. Patients were divided into two groups: the core needle biopsy (CNB) group (n=56) and the MMT-VAB group (n=46). The MMT-VAB group underwent biopsy using the Mammotome SCM23K breast biopsy system, while the CNB group used a disposable biopsy needle. Surgical pathology results were used as the gold standard. Sensitivity, specificity, and accuracy of the two methods in diagnosing benign and malignant breast nodules were compared. Complications, such as bleeding, hematoma, subcutaneous bruising, and skin damage, were recorded and analyzed.
RESULTS
No significant differences in clinical data were observed between the CNB and MMT-VAB groups (P > .05). The sensitivity, specificity, and accuracy for the CNB group were 72.41%, 88.89%, and 80.36%, respectively, with a kappa value of 0.609. For the MMT-VAB group, sensitivity was 95.00%, specificity 92.31%, and accuracy 93.48%, with a kappa value of 0.868. The detection rate of malignant lesions was significantly higher in the MMT-VAB group (95.00%) compared to the CNB group (72.41%) (χ2=4.027, P = .045). No significant difference in complication rates was found between the two groups (χ2=3.608, P = .058).
CONCLUSION
Ultrasound-guided MMT-VAB offers higher diagnostic accuracy for breast nodules smaller than 5 cm compared to CNB, making it a valuable tool for early diagnosis. Future research should focus on enhancing MMT-VAB technology, understanding factors influencing diagnostic accuracy, expanding clinical applications, and evaluating long-term outcomes to support clinical decision-making.
PubMed: 38870513
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024This study aims to evaluate the efficiency of ultrasound-guided core needle biopsy (CNB) and fine needle aspiration biopsy (FNA) in the diagnosis of breast cancer with...
OBJECTIVE
This study aims to evaluate the efficiency of ultrasound-guided core needle biopsy (CNB) and fine needle aspiration biopsy (FNA) in the diagnosis of breast cancer with internal mammary node (IMN) metastasis. The focus is on specimen satisfaction, puncture tolerance, and classification accuracy.
METHODS
A retrospective analysis was conducted on breast cancer patients (n=106) who underwent ultrasound-guided IMN biopsy at our hospital from March 2020 to March 2023. Patients were divided into CNB and FNA groups based on the biopsy technique. The study analyzed one-time sampling satisfaction, overall specimen satisfaction, and post-puncture pain score (VAS), comparing the effectiveness of both methods in IMN diagnosis and classification.
RESULTS
In the CNB and FNA groups, 3 and 1 cases respectively had unsatisfactory specimens, later excluded in pathological examinations. The FNA group demonstrated higher one-time sampling satisfaction than the CNB group (P < .05), but no significant difference in overall specimen satisfaction was observed (P > .05). Among 102 patients with satisfactory specimens, 96 showed positive IMN metastasis. The kappa statistics measuring the consistency between biopsy methods and actual IMN (Invasive Mammary Carcinoma) metastasis show a value of 0.637 for CNB (Core Needle Biopsy) and 0.769 for FNA (Fine Needle Aspiration), indicating a higher consistency for FNA. Different IMN types also varied in kappa values. Post-puncture VAS scores were higher in the CNB group (P < .05), with no significant difference in total complication rates between the groups (P > .05).
CONCLUSION
Ultrasound-guided CNB and FNA both demonstrate good overall specimen satisfaction and equivalent safety. FNA. However, FNA showed superior performance in one-time specimen satisfaction, diagnostic consistency for IMN metastasis, and patient tolerance during the procedure.
PubMed: 38870512
DOI: No ID Found -
Spine Surgery and Related Research May 2024
PubMed: 38868790
DOI: 10.22603/ssrr.2023-0259 -
The Korean Journal of Internal Medicine Jun 2024There is limited knowledge regarding the management of duodenal subepithelial lesions (SELs) owing to a lack of understanding of their natural course. This study aimed...
BACKGROUND/AIMS
There is limited knowledge regarding the management of duodenal subepithelial lesions (SELs) owing to a lack of understanding of their natural course. This study aimed to assess the natural course of asymptomatic duodenal SELs and provide management recommendations.
METHODS
Patients diagnosed with duodenal SELs and followed up for a minimum of 6 months were retrospectively investigated.
RESULTS
Among the 443,533 patients who underwent esophagogastroduodenoscopy between 2008 and 2020, duodenal SELs were identified in 0.39% (1,713 patients). Among them, 396 duodenal SELs were monitored for a median period of 72.5 months (interquartile range, 37.7-111.3 mo). Of them, 16 SELs (4.0%) showed substantial changes in size or morphology at a median follow-up of 35.1 months (interquartile range, 21.7-51.4 mo). Of these SELs with substantial changes, tissues of two SELs were acquired using endoscopic ultrasound-guided fine needle aspiration biopsy: one was a lipoma and the other was non-diagnostic. Three SELs were surgically or endoscopically removed; two were diagnosed as gastrointestinal stromal tumors, and one was a lipoma. An initial size of 20 mm or larger was associated with substantial changes during follow-up (p = 0.016).
CONCLUSIONS
While the majority of duodenal SELs may not exhibit substantial interval changes, regular follow-up with endoscopy may be necessary for cases with an initial size of 20 mm or larger, considering a possibility of malignancy.
PubMed: 38867644
DOI: 10.3904/kjim.2023.358 -
Iranian Journal of Pathology 2024Breast sarcoma is a rare but aggressive tumor. There are few case reports in the literature and several aspects of this disease are still not completely comprehended....
Breast sarcoma is a rare but aggressive tumor. There are few case reports in the literature and several aspects of this disease are still not completely comprehended. Therefore, reporting new cases can help to enrich the literature. We report a patient with breast mass and pus secretion from her right breast, misdiagnosed as an abscess and mistreated by antibiotics. The patient was referred for an ultrasound examination and mammography, and a needle biopsy was performed that suggested an aggressive tumor. By the pathologist's suggestion, a total mastectomy of the right breast was performed with the excision of sentinel nodes. A pathological examination revealed a high-grade undifferentiated pleomorphic sarcoma (UPS) without vascular or lymph node invasion as the final diagnosis. The patient underwent postoperative chemotherapy and is currently in good condition. This case emphasizes considering this rare tumor when approaching a breast mass. Performing surgery with adequate resection margin can improve the patient's prognosis. Some suggested breast UPS cases with lung and brain metastasis would be more aggressive tumors than other breast sarcomas. Total mastectomy with negative margins and free-of-tumor lymph nodes may be the key to improve prognosis in such patients.
PubMed: 38864088
DOI: 10.30699/IJP.2023.2006411.3139 -
Frontiers in Endocrinology 2024Fine needle aspiration (FNA) is the gold standard method recommended in the diagnosis of thyroid nodules. Bethesda IV cytology results are identified in 7-9% of nodules...
INTRODUCTION
Fine needle aspiration (FNA) is the gold standard method recommended in the diagnosis of thyroid nodules. Bethesda IV cytology results are identified in 7-9% of nodules investigated through FNA, with reported malignancy rate in a wide range of 10-40%. The recommended treatment is either surgical or risk additional molecular testing before surgery. However, a large number of nodules belonging to this category (60-80%) are observed to be benign after surgical excision, which can put the patient at risk of unnecessary surgical morbidity. This study aimed to assess the diagnostic performance of conventional ultrasound, the ACR TI-RADS score and elastography in cases of Bethesda IV cytology on FNA.
METHODS
We evaluated ninety-seven consecutive cases with Bethesda category IV results on FNA by using conventional B-mode ultrasound, qualitative strain or shear-wave elastography (Hitachi Preirus Machine, Hitachi Inc., Japan and Aixplorer Mach 30 Supersonic Imagine, Aix-en-Provence, France) and all nodules were classified according to the ACR TI-RADS system. Conventional ultrasound was used to categorize the nodules as potentially malignant based on the following features: hypoechogenicity, inhomogeneity, a taller than wide shape, irregular margins, presence of microcalcifications, an interrupted thyroid capsule and suspicious cervical lymph nodes. Elastography classified nodules with increased stiffness as suspicious for malignancy.
RESULTS
We considered pathology results as the gold standard diagnosis, finding that 32 out of 97 nodules were carcinomas (33%) and 65 out of 97 were benign nodules (67%). The benign group included twenty cases of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Finally, we compared ultrasound data with pathology results, which showed that nineteen out of the 32 malignant nodules presented with increased stiffness on elastography (p=0.0002). On conventional ultrasound, we found that microcalcifications (p=0.007), hypoechogenicity and irregular margins (p=0.006) are features which can distinguish between benign and malignant nodules with statistical significance.
DISCUSSION
Integrating elastography as a parameter of the ACR TI-RADS score in the evaluation of Bethesda category IV nodules showed a sensitivity of 90.62% in detecting thyroid cancer cases (p=0.006). We can conclude that elastographic stiffness as an addition to high risk features observed on conventional ultrasound improves the detection of malignant nodules in cases with Bethesda IV cytology.
Topics: Humans; Elasticity Imaging Techniques; Thyroid Nodule; Female; Male; Middle Aged; Biopsy, Fine-Needle; Adult; Thyroid Neoplasms; Aged; Young Adult; Ultrasonography
PubMed: 38863927
DOI: 10.3389/fendo.2024.1393982 -
Journal of the ASEAN Federation of... 2024This study aims to evaluate the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting Data System (ACR TI-RADS) in identifying nodules that...
OBJECTIVE
This study aims to evaluate the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting Data System (ACR TI-RADS) in identifying nodules that need to undergo fine-needle aspiration biopsy (FNAB) and identify specific thyroid ultrasound characteristics of nodules associated with thyroid malignancy in Filipinos in a single tertiary center.
METHODOLOGY
One hundred seventy-six thyroid nodules from 130 patients who underwent FNAB from January 2018 to December 2018 were included. The sonographic features were described and scored using the ACR TI-RADS risk classification system, and the score was correlated to their final cytopathology results.
RESULTS
The calculated malignancy rates for TI-RADS 2 to TI-RADS 5 were 0%, 3.13%, 7.14%, and 38.23%, respectively, which were within the TI-RADS risk stratification thresholds. The ACR TI-RADS had a sensitivity of 89.5% and specificity of 54%, LR + of 1.95 and LR - of 0.194, NPV of 97.7%, PPV of 19.1%, and accuracy of 58%.
CONCLUSION
The ACR TI-RADS may provide an effective malignancy risk stratification for thyroid nodules and may help guide the decision for FNAB among Filipino patients. The classification system may decrease the number of unnecessary FNABs for nodules with low-risk scores.
Topics: Humans; Cross-Sectional Studies; Thyroid Nodule; Male; Female; Middle Aged; Adult; Ultrasonography; Biopsy, Fine-Needle; Thyroid Neoplasms; Thyroid Gland; Sensitivity and Specificity; Aged; Societies, Medical; Radiology Information Systems; United States; Philippines
PubMed: 38863911
DOI: 10.15605/jafes.039.01.08 -
Cirugia Y Cirujanos 2024The study aimed to assess the predictive significance of inflammatory parameters as potential markers for malignancy in individuals with thyroid nodules.
OBJECTIVE
The study aimed to assess the predictive significance of inflammatory parameters as potential markers for malignancy in individuals with thyroid nodules.
METHOD
Nine hundred and ninety-one patients with thyroid nodules who had undergone thyroid fine-needle aspiration biopsy were included and classified according to the Bethesda system. Neutrophil lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) values obtained from hemogram parameters were determined for each patient. The study examined the correlation between the Bethesda classification and NLR/SII levels. In addition, a comparison was made between the inflammatory parameters of the benign and malignant Bethesda groups.
RESULTS
Five hundred and seventy-three patients were classified as Bethesda 2 (benign), 34 as Bethesda 6 (malignant). A correlation was observed between the Bethesda classification and NLR and SII levels (r: 0.230, p < 0.001; r: 0.207 p < 0.001, respectively). NLR and SII values were significantly higher in the malignant group (p < 0.001). The cutoff value for SII in predicting benign and malignant thyroid nodules was 489.86 × 10/mm with a sensitivity of 88.2% and a specificity of 63.7%. The cutoff value for NLR for the same prediction was 2.06 with a sensitivity of 82.4% and a specificity of 83.4%.
CONCLUSIONS
The findings of this study indicate that SII and NLR may be valuable prognostic markers for predicting the malignancy of thyroid nodules.
Topics: Humans; Thyroid Nodule; Female; Male; Middle Aged; Neutrophils; Adult; Biopsy, Fine-Needle; Thyroid Neoplasms; Inflammation; Lymphocytes; Aged; Sensitivity and Specificity; Biomarkers, Tumor; Lymphocyte Count; Young Adult; Predictive Value of Tests
PubMed: 38862101
DOI: 10.24875/CIRU.23000370 -
Endocrine Regulations Jan 2024The intend of the present study was to assess the diagnostic performance of strain elastography in investigating the thyroid nodule malignancy taking the surgical... (Comparative Study)
Comparative Study
The intend of the present study was to assess the diagnostic performance of strain elastography in investigating the thyroid nodule malignancy taking the surgical biopsy as a gold standard reference test. The study included 120 patients with 123 thyroid nodules, of which 67 had total thyroidectomy. The American College of Radiology Thyroid Imaging Reporting and Data Systems (ACR-TIRADS) were evaluated for all nodules. All suspicious nodules were referred for a fine needle aspiration cytology (FNAC) if they fulfilled the required size. Strain elastography was performed for each suspicious nodule. Ultrasound-guided FNAC was performed for all suspicious nodules. Total thyroidectomy was performed in those whom the suspicious nodules were proven by FNAC. Strain ratio had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of 84%, 81%, 95%, 85%, and 84%, respectively, with a cut point 1.96. Elasticity score had a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 100%, 80%, 95%, 85% and 87%, respectively, with a cut point 0.96. The elasticity score had a statistically significantly odds ratio for detecting the benignity 3.9 C. I (1.6-9.3). Strain elastography has a high diagnostic performance in detecting the malignant as well as benign nodules, thus it can limit the rate of unneeded FNAC or surgery especially among B3 and B4 groups with indeterminate cytology.
Topics: Humans; Elasticity Imaging Techniques; Male; Female; Middle Aged; Adult; Thyroid Neoplasms; Thyroid Nodule; Biopsy, Fine-Needle; Sensitivity and Specificity; Aged; Thyroid Gland; Thyroidectomy; Image-Guided Biopsy; Young Adult; Predictive Value of Tests; Cytology
PubMed: 38861538
DOI: 10.2478/enr-2024-0014 -
Frontiers in Medicine 2024disease is an opportunistic infection, the occurrence is rare and mostly occurs in patients with immune deficiency. Even if the patient is immunocompetent, it can still...
disease is an opportunistic infection, the occurrence is rare and mostly occurs in patients with immune deficiency. Even if the patient is immunocompetent, it can still be life-threatening. This case report describes a previously healthy 78-year-old male farmer with lung lesions discovered on a computerized tomography scan. Combined with the patient's history of fever and the results of elevated laboratory markers associated with inflammation, the patient was diagnosed with a lung infection. After escalating empirical broad-spectrum antibiotics, antiviral and antifungal therapy, the patient continued to deteriorate to septic shock. In the meanwhile, the patient's sputum was cultured repeatedly, and no obvious positive pathogenic bacteria were found. Considering the patient was elderly and that these lesions were solid with burr signs, as well as the progression after antimicrobial therapy cancer was considered in the differential diagnosis. Artificial intelligence (YITU, Hangzhou Yitu Medical Technology Limited Company) was also applied, and it also calculated that these lesions were cancerous. The patient received a puncture biopsy of the largest lung lesion. During the puncture pus was withdrawn from largest lung lesion. Culture and metagenome next-generation sequencing (mNGS) detection performed on pus indicated . The test report of the mNGS is also attached with a susceptibility report of commonly used clinical antibiotics to this spp. Using this result, the patient's disease was quickly controlled after selecting the targeted drug compound sulfamethoxazole and intravenous meropenem for treatment. In view of the high misdiagnosis rate and poor sensitivity of culture for spp., this case emphasized mNGS playing a key role in the diagnosis and selection of effective antibiotics for the treatment of spp. lung infections.
PubMed: 38860208
DOI: 10.3389/fmed.2024.1373319