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Research and Reports in Urology 2024Contact laser vaporization of the prostate (CVP) for benign prostatic hyperplasia is a widely accepted and safe procedure for elderly patients because of its lower...
PURPOSE
Contact laser vaporization of the prostate (CVP) for benign prostatic hyperplasia is a widely accepted and safe procedure for elderly patients because of its lower bleeding risks. However, CVP lacks a postoperative pathological examination for prostate cancer. Concomitant prostate biopsy and CVP may complement this disadvantage; however, the risk of bleeding associated with this procedure remains unclear. This study aimed to evaluate the safety of a concomitant prostate biopsy and CVP.
PATIENTS AND METHODS
This retrospective study included 106 men who had undergone CVP in Nerima General Hospital. Prostate biopsies and CVP were performed simultaneously on 16 patients. We defined the "hemorrhage group" by a >5% decrease in hemoglobin the day after surgery. Preoperative and operative indices were evaluated based on the association with the hemorrhage group.
RESULTS
Participants in the concomitant biopsy group were older ( = 0.001), had larger prostates ( = 0.014), a lower rate of prostate biopsy history ( = 0.046), longer postoperative urinary catheter duration ( = 0.024), and a higher rate of decline in hemoglobin levels the day after surgery ( = 0.023). Patients in the hemorrhage group ( = 20, 18.9%) showed a significantly higher rate of concomitant biopsy and CVP ( = 0.006). Multivariate analysis showed that concomitant prostate biopsy ( = 0.009, odds ratio = 4.61) was the sole statistically significant predictive factor for hemorrhage.
CONCLUSION
Concomitant prostate biopsy and CVP of the prostate may increase the risk of bleeding.
PubMed: 38855129
DOI: 10.2147/RRU.S457307 -
Cureus May 2024Thyroid nodules are a common clinical challenge, with a significant proportion being cancerous. Fine-needle aspiration cytology (FNAC) is widely used for diagnosis but...
Evaluation of the Efficacy of Thyroid Imaging Reporting and Data Systems Classification in Risk Stratification and in the Management of Thyroid Swelling by Comparing It With Fine-Needle Aspiration Cytology and Histopathological Examination.
BACKGROUND
Thyroid nodules are a common clinical challenge, with a significant proportion being cancerous. Fine-needle aspiration cytology (FNAC) is widely used for diagnosis but has limitations. Ultrasound has emerged as a promising tool for distinguishing between benign and malignant nodules. This study aims to compare the diagnostic accuracy of ultrasonography (USG) and FNAC in diagnosing malignant thyroid swelling using postoperative histopathological examinations as the gold standard.
METHOD
A diagnostic accuracy study was conducted over 1.5 years at Rajendra Institute of Medical Sciences, Ranchi, India. A total of 132 patients with thyroid swellings were included. Patients underwent USG and FNAC, and 99 patients subsequently underwent surgery and histopathological examination. Statistical analysis was performed to evaluate the performance of USG and FNAC, including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).
RESULTS
The study encompassed 132 patients, predominantly 94 (71.21%) females. Most patients, i.e., 76 out of 132 (57.58%), were aged 30-50 years, with an average age of presentation at 41 years. Socioeconomic status revealed 120 (90.9%) belonging to Classes II and III. USG and FNAC exhibited sensitivities of 77.4% and 90.3%, specificities of 94.1% and 98.5%, and accuracies of 88.9% and 96.0%, respectively. FNAC demonstrated superior diagnostic performance metrics compared to USG, with higher PPV and NPV, indicating its stronger ability to correctly identify true-positive cases. Ultrasound features and FNAC findings showed significant associations with biopsy results, reaffirming their utility in diagnosing thyroid nodules.
CONCLUSION
FNAC emerged as a highly accurate diagnostic tool for distinguishing between benign and malignant thyroid nodules, outperforming USG. Understanding demographic and clinical characteristics can aid in the timely diagnosis and management of thyroid disorders. Further research is warranted to enhance diagnostic algorithms and optimize patient care in resource-constrained settings.
PubMed: 38854328
DOI: 10.7759/cureus.59949 -
Cureus May 2024Hibernomas, rare benign tumors originating from brown adipose tissue, pose diagnostic challenges due to their infrequent occurrence and slow growth. We present a case of...
Hibernomas, rare benign tumors originating from brown adipose tissue, pose diagnostic challenges due to their infrequent occurrence and slow growth. We present a case of a 38-year-old woman with a progressively enlarging mass in her right lateral chest wall, initially stable in size but growing during pregnancy and causing pain and functional impairment. Radiological evaluation, including x-ray and MRI, provided inconclusive results, necessitating a biopsy for a definitive diagnosis. Ultrasound-guided needle aspiration biopsy revealed typical histopathological features consistent with hibernoma. A subsequent total surgical excision with negative margins was performed. The patient achieved complete recovery without recurrence during two years of follow-up. This case underscores the importance of considering hibernoma in the differential diagnosis of adipose tissue tumors, particularly in atypical clinical presentations. Moreover, it highlights the challenges in diagnosing and managing hibernomas and emphasizes the role of MRI and biopsy in achieving accurate diagnosis and optimal treatment outcomes. Continued reporting of such cases is crucial for increasing awareness and improving the management of this rare tumor.
PubMed: 38854230
DOI: 10.7759/cureus.59943 -
BioRxiv : the Preprint Server For... Jun 2024An oxygen sensor-mounted fine-needle biopsy tool was used for measurement of oxygen levels in tumor xenografts. The system provides a means of measuring the oxygen...
An oxygen sensor-mounted fine-needle biopsy tool was used for measurement of oxygen levels in tumor xenografts. The system provides a means of measuring the oxygen content in harvested tumor tissue from specific locations. Oxygen in human tumor xenografts in a murine model was observed for over 1 min. Tissues were mapped in relation to oxygen tension (pO) readings and sampled for conventional cytological examination. Careful modeling of the pO readings over 60 seconds yielded a diffusion coefficient for oxygen at the sensor tip, providing additional diagnostic information about the tissue before sampling. Oxygen level measurement may provide a useful adjunct to the use of biomarkers in tumor diagnosis.
PubMed: 38854036
DOI: 10.1101/2024.05.27.596060 -
International Journal of Surgery Case... Jul 2024Xanthogranulomatous pancreatitis (XGP) is a rare, benign, and idiopathic disease that often presents with non-specific symptoms and can mimic or coexist with other...
INTRODUCTION
Xanthogranulomatous pancreatitis (XGP) is a rare, benign, and idiopathic disease that often presents with non-specific symptoms and can mimic or coexist with other pancreatic diseases. Despite its infrequency, XGP is frequently misdiagnosed as a pancreatic neoplasm, with only 15 reported cases in the literature. The pathogenesis of XGP remains unclear.
CASE REPORT
We present the case of a 34-year-old woman with no pathological history who experienced continuous abdominal pain and oral intolerance, without signs of cholestasis. An abdominal CT scan initially suggested a cystic neoplasm of the pancreas, leading to a laparotomic cephalic duodenopancreatectomy. The anatomopathological study and immunohistochemistry revealed XGP in association with a mucinous cystic neoplasm with mild to moderate atypia. The patient remained hospitalized for six days post-surgery without any complications.
DISCUSSION
XGP may be induced by the inflammatory reaction secondary to the obstruction of the pancreatic duct by mucin. The etiology is unknown, but it is attributed to a combination of obstruction, hemorrhage, or ductal infection. Abdominal pain is the most common symptom. Differentiating XGP from malignant processes of the pancreatic gland is challenging. Surgical treatment typically involves the Whipple procedure; however, echoendoscopy with biopsy is now available for a more accurate and early differential diagnosis.
CONCLUSION
XGP is a rare and challenging differential diagnosis for pancreatic neoplasms. Due to its potential to mimic malignant lesions, a high index of suspicion is necessary. Echoendoscopy with fine-needle aspiration biopsy should be considered a routine diagnostic tool before major surgery, such as the Whipple procedure.
PubMed: 38852573
DOI: 10.1016/j.ijscr.2024.109810 -
The Brazilian Journal of Infectious... 2024We report an autochthonous case of mild unifocal chronic pulmonary paracoccidioidomycosis in a 48-year-old previously healthy woman with no history of possible...
We report an autochthonous case of mild unifocal chronic pulmonary paracoccidioidomycosis in a 48-year-old previously healthy woman with no history of possible environmental exposures in endemic rural areas, supposedly resulting from reactivation of a latent pulmonary focus secondary to the use of methotrexate for the control of Chikungunya arthropathy. Laboratory investigation ruled out other immunosuppression. Her only symptoms were a dry cough and chest pain. Diagnosis confirmed by needle lung biopsy. There were no abnormalities on physical examination nor evidence of central nervous system involvement. MRI of the total abdomen showed no involvement of other organs. Computed chest tomography showed a favorable evolution under the use of itraconazole (200 mg/day). Different tomographic presentations findings are highlighted when performed before and after treatment. CONCLUSIONS: PCM should be considered even in a woman without a history of consistent environmental exposure and in a non-endemic geographic area.
Topics: Humans; Female; Paracoccidioidomycosis; Middle Aged; Methotrexate; Lung Diseases, Fungal; Chronic Disease; Itraconazole; Tomography, X-Ray Computed; Antifungal Agents; Immunosuppressive Agents
PubMed: 38851212
DOI: 10.1016/j.bjid.2024.103768 -
The Lancet. Digital Health Jul 2024Accurately distinguishing between malignant and benign thyroid nodules through fine-needle aspiration cytopathology is crucial for appropriate therapeutic intervention....
BACKGROUND
Accurately distinguishing between malignant and benign thyroid nodules through fine-needle aspiration cytopathology is crucial for appropriate therapeutic intervention. However, cytopathologic diagnosis is time consuming and hindered by the shortage of experienced cytopathologists. Reliable assistive tools could improve cytopathologic diagnosis efficiency and accuracy. We aimed to develop and test an artificial intelligence (AI)-assistive system for thyroid cytopathologic diagnosis according to the Thyroid Bethesda Reporting System.
METHODS
11 254 whole-slide images (WSIs) from 4037 patients were used to train deep learning models. Among the selected WSIs, cell level was manually annotated by cytopathologists according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) guidelines of the second edition (2017 version). A retrospective dataset of 5638 WSIs of 2914 patients from four medical centres was used for validation. 469 patients were recruited for the prospective study of the performance of AI models and their 537 thyroid nodule samples were used. Cohorts for training and validation were enrolled between Jan 1, 2016, and Aug 1, 2022, and the prospective dataset was recruited between Aug 1, 2022, and Jan 1, 2023. The performance of our AI models was estimated as the area under the receiver operating characteristic (AUROC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. The primary outcomes were the prediction sensitivity and specificity of the model to assist cyto-diagnosis of thyroid nodules.
FINDINGS
The AUROC of TBSRTC III+ (which distinguishes benign from TBSRTC classes III, IV, V, and VI) was 0·930 (95% CI 0·921-0·939) for Sun Yat-sen Memorial Hospital of Sun Yat-sen University (SYSMH) internal validation and 0·944 (0·929 - 0·959), 0·939 (0·924-0·955), 0·971 (0·938-1·000) for The First People's Hospital of Foshan (FPHF), Sichuan Cancer Hospital & Institute (SCHI), and The Third Affiliated Hospital of Guangzhou Medical University (TAHGMU) medical centres, respectively. The AUROC of TBSRTC V+ (which distinguishes benign from TBSRTC classes V and VI) was 0·990 (95% CI 0·986-0·995) for SYSMH internal validation and 0·988 (0·980-0·995), 0·965 (0·953-0·977), and 0·991 (0·972-1·000) for FPHF, SCHI, and TAHGMU medical centres, respectively. For the prospective study at SYSMH, the AUROC of TBSRTC III+ and TBSRTC V+ was 0·977 and 0·981, respectively. With the assistance of AI, the specificity of junior cytopathologists was boosted from 0·887 (95% CI 0·8440-0·922) to 0·993 (0·974-0·999) and the accuracy was improved from 0·877 (0·846-0·904) to 0·948 (0·926-0·965). 186 atypia of undetermined significance samples from 186 patients with BRAF mutation information were collected; 43 of them harbour the BRAF mutation. 91% (39/43) of BRAF-positive atypia of undetermined significance samples were identified as malignant by the AI models.
INTERPRETATION
In this study, we developed an AI-assisted model named the Thyroid Patch-Oriented WSI Ensemble Recognition (ThyroPower) system, which facilitates rapid and robust cyto-diagnosis of thyroid nodules, potentially enhancing the diagnostic capabilities of cytopathologists. Moreover, it serves as a potential solution to mitigate the scarcity of cytopathologists.
FUNDING
Guangdong Science and Technology Department.
TRANSLATION
For the Chinese translation of the abstract see Supplementary Materials section.
Topics: Humans; Thyroid Nodule; Deep Learning; China; Retrospective Studies; Biopsy, Fine-Needle; Prospective Studies; Female; Male; Middle Aged; Adult; Sensitivity and Specificity; Thyroid Gland; Aged; Thyroid Neoplasms
PubMed: 38849291
DOI: 10.1016/S2589-7500(24)00085-2 -
Danish Medical Journal May 2024The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) is used to categorise thyroid fine-needle aspiration (FNA). The aim of this study was to validate the...
INTRODUCTION
The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) is used to categorise thyroid fine-needle aspiration (FNA). The aim of this study was to validate the BSRTC in a consecutive cohort and to evaluate the derived management in terms of performing repeat FNA or thyroid surgery.
METHODS
Results of thyroid FNAs assessed at the Department of Pathology, Aarhus University Hospital, in the period 2016-2019 were retrieved from The Danish Pathology Registry. FNA category according to the BSRTC along with the histological diagnosis (if available) were linked to the individual patient.
RESULTS
In total, 3,669 biopsies were included from 2,873 thyroid nodules in 2,547 patients. Repeat FNA was performed in 23.6% of nodules. The majority of primary FNAs were Benign (BSRTC II; 52.4%). Non-diagnostic (ND) (BSRTC I) was found in 26.3% and BSRTC III-VI were found in 3.6-7.5%. Compared with the first with the last FNA, the frequency of Benign (BSRTC II) increased (61.3%), whereas the frequency of ND (BSRTC I) decreased (14.8%). Surgery was performed in 38.2% (n = 1,097) of nodules. The malignancy rate of 11.5% correlated positively with the BSRTC category, being 2.8% in Benign (BSRTC II) and 95.7% in Malignant (BSRTC VI).
CONCLUSIONS
The malignancy rates in the BSRTC categories were in accordance with reports from other countries. Since the BSRTC ensures a standardised and concise communication of cytopathology assessments, application of the BSRTC for thyroid nodule management in a Danish setting is recommended.
FUNDING
None.
TRIAL REGISTRATION
Not relevant.
Topics: Humans; Biopsy, Fine-Needle; Denmark; Thyroid Nodule; Thyroid Neoplasms; Thyroid Gland; Male; Female; Middle Aged; Tertiary Care Centers; Adult; Aged; Registries; Cytology
PubMed: 38847411
DOI: 10.61409/A10230677 -
Indian Journal of Pathology &... Jun 2024Angiosarcoma is a rare soft tissue sarcoma. Primary angiosarcoma of the lung is even rarer. This case presents a patient with hemoptysis for 3 months. A chest computed...
Angiosarcoma is a rare soft tissue sarcoma. Primary angiosarcoma of the lung is even rarer. This case presents a patient with hemoptysis for 3 months. A chest computed tomography (CT) showed multiple patches of nodules with peripheral exudates distributed along the vascular bundles in both lungs, and the biopsy suggested IgG4 disease. However, the hemoptysis worsened for 3 days, and the patient underwent partial resection of the left upper lung, revealing eight masses of 0.5-2 cm in diameter. The tumor was composed of spindle, round, or polygonal cells arranged in bundles or sheets, and tumor cells were positive for vascular tumor markers. The patient was treated with six cycles of paclitaxel combined with gemcitabine chemotherapy, reducing the volume of the masses and improving hemoptysis.
PubMed: 38847188
DOI: 10.4103/ijpm.ijpm_794_23 -
Gland Surgery May 2024Frozen section (FS) analysis is strongly influenced by the experience of surgeons and pathologists. We analyzed its performance in a secondary care hospital with...
BACKGROUND
Frozen section (FS) analysis is strongly influenced by the experience of surgeons and pathologists. We analyzed its performance in a secondary care hospital with surgical and pathologic experience transferred from a university hospital.
METHODS
Indications, results, and consequences of all thyroid FS performed between January 1, 2021 and December 31, 2022 were critically reviewed.
RESULTS
FS was performed in 90 (26.5%) of 340 procedures. Indications consisted in a suspicious fine needle biopsy in 28 (31.1%) cases, (99m) Technetium-Methoxy-Isobutyl-Isonitrile (MIBI) retaining hypofunctional nodules in 25 (27.8%), the intraoperative appearance in 18 (20%), the sonographic appearance in 18 (20%) and a positron emission tomography (PET) positive result in 1 case (1.1%). Malignancy was diagnosed in 21 (23.3%) and confirmed by final histology in all cases (100%). In the remaining 69 (76.7%) FS displaying no positive malignancy criteria, final histology delivered benign in 62 (89.8%) and malignant diagnoses in 7 cases (10.1%). 25% of thyroid carcinomas could not be diagnosed by FS. FS sensitivity was consequently 75% (95% CI: 55.1-89.3%). All missed malignancies were papillary thyroid carcinomas of follicular variant (fvPTC). FS sensitivity was lowest in MIBI positive hypofunctional nodules (33%) and Bethesda III (50%) as opposed to Bethesda V (92.9%) and to those cases with suspicious sonographic or intraoperative appearance (71.4%). Two-staged surgery was necessary in 10 (15.8%) of carcinomas.
CONCLUSIONS
Sensitivity of FS in a secondary care hospital offering surgical and pathologic experience from a specialized university center is 75% and mainly reduced by the prevalence of fvPTC. Omitting FS in Bethesda III and MIBI positive hypofunctional nodules might improve FS performance.
PubMed: 38845828
DOI: 10.21037/gs-23-105