The Effectiveness of cloud-based telepathology system in China：Large-Sample Observational Study (Preprint)

BACKGROUND Telepathology is a potent strategy to overcome the shortage of senior pathologists, whole slid imaging (WSI) is the most advanced means and has been widely used in telepathology owning to its complete scanning of glass slides, but WSI occupies large storage space and computing resource, and the WSI retrieval is time-consuming. To compensate for these shortcomings of WSI, we have established a cloud-based telepathology system and conducted detailed evaluation of its implementation effects. OBJECTIVE The cloud-based telepathology system in China has been running for more than four years, and a large number of cases were submitted. The main purpose of this study is to evaluate the operation effect of this system based on a large sample, including the overview of the submitted cases, timeliness of telepathology reports, diagnostic accuracy, and economic benefits. METHODS A total of 23,167 cases submitted to the cloud-based telepathology system of the National Telemedicine Center of China from January 2016 to December 2019 were collected as subjects. The variation tendency of the report-timeliness from the system were analyzed for years. 564 patients who also directly visited the First Affiliated Hospital of Zhengzhou University and obtained final diagnoses were followed up to analyze the diagnostic accuracy of the system. RESULTS The amounts of participated hospitals and submitted cases rose year by year. Most samples were captured from uterus, gastrointestinal tract, bone or soft tissue, breast, and esophagus. 17,495 cases were confirmed, including 12,088 benign lesions, 5217 malignant lesions, and 190 borderline lesions, the proportion of malignant lesions in esophagus, lung/mediastinum, urinary and thoracic cavity/pleura was higher than that in benign lesions, which was different from other 22 anatomic sites. The median turnaround time was 16.93 hours and shortened yearly (between 2018 and 2019 adjusted P= .012, other groups adjusted P＜ .001), 82.88% cases were diagnosed in 48 hours. The telepathological diagnosis of 11 cases were discrepant with the final diagnosis, and the diagnostic accuracy of the system was 98.05%, with no statistical difference from the final diagnosis in hospital(P= .549). 300,000 dollars were saved for patients every year with this system. CONCLUSIONS The novel cloud-based telepathology system has the potential to relieve the shortage of pathologists in primary hospitals and simultaneously reduced the high medical costs for patients in China. It should be therefore promoted further to enhance the efficiency, quantity and quality of telepathological diagnoses.

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Pathological fracture in paediatric bone tumours and tumour-like lesions: A predictor of benign lesions?

British Journal of Radiology ◽

10.1259/bjr.20201341 ◽

2021 ◽

pp. 20201341

Author(s):

Boussad Chaib ◽

Karan Malhotra ◽

Michael Khoo ◽

Asif Saifuddin

Keyword(s):

Pathological Fracture ◽

Plain Radiograph ◽

Proximal Phalanx ◽

Bone Tumour ◽

Final Diagnosis ◽

Bone Tumours ◽

Imaging Features ◽

Benign Lesions ◽

Pathological Fractures ◽

Malignant Lesions

Objective: To determine the incidence and causes of pathological fractures in paediatric bone tumours and tumour-like lesions, and to determine if they are predictive of benign lesions. Methods and materials: Retrospective review of children with suspected bone tumours referred to a specialist musculoskeletal oncology service between September 2019 and August 2020. Data recorded included patient age and gender, lesion location, the presence of a pathological fracture on the initial plain radiograph, and the final diagnosis made either by image-guided biopsy/curettage or based on typical imaging features. Results: 231 patients were included with 233 lesions (138 males and 93 females with mean age 10.5 years, range 3 months–18 years). Final diagnosis was based on histology in 85 (36.5%) cases and imaging in 148 (63.5%) cases, 52 (22.3%) lesions classed as non-neoplastic, 139 (59.7%) as benign and 42 (18%) as malignant. Pathological fractures were seen in 41 cases (17.6%) at presentation, involving the humerus in 19 (46.3%), the femur in 14 (34.1%), the tibia in 3 (7.3%), the fibula and radius in two each (4.9%) and the second toe proximal phalanx in 1 (2.4%) (p < 0.001). The commonest underlying lesions included simple bone cyst (n = 17; 41.5%) and non-ossifying fibroma (n = 10; 24.4%). Only 4 cases (9.75%) were malignant, one case each of osteosarcoma, Ewing sarcoma, leukaemia and BCOR undifferentiated round cell sarcoma. Pathological fracture occurred in 27.7% of non-malignant lesions and 9.5% of malignant lesions, this difference being statistically significant (p < 0.001). Conclusion: Pathological fractures were seen in 17.6% of paediatric bone tumours, tumour-like lesions, being significantly associated with humeral location and non-malignant diagnosis. Advances in knowledge: Demonstrates the frequency, location and underlying diagnosis of pathological fractures in paediatric bone tumour and tumour-like lesions.

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Second-look breast ultrasonography after galactography in patients with nipple discharge

Medical Ultrasonography ◽

10.11152/mu-2141 ◽

2020 ◽

Vol 1 (1) ◽

pp. 58 ◽

Cited By ~ 1

Author(s):

Hyeonseon Kim ◽

Bong Joo Kang ◽

Sung Hun Kim ◽

Jeong min Lee

Keyword(s):

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Breast Imaging ◽

Nipple Discharge ◽

Final Diagnosis ◽

Second Look ◽

Significant Difference ◽

Before And After ◽

Malignant Lesions

Aim: The objective of this study was to evaluate the diagnostic performance of second-look breast ultrasound (US) immediately after galactography in patients with nipple discharge.Materials and methods: Between January 2010 and November 2018, 89 patients with nipple discharge were retrospectively analyzed. All patients were examined by galactography and US. US was performed twice, before and after galactography. Galactography, mammography and US findings were categorized according to the Breast Imaging Reporting and Data System (BI-RADS). The final diagnosis was established by histopathological examination.Results: Out of 89 patients, 25 (28.1%) patients had positive findings as evident by US before galactography. Forty-eight (53.9%) patients had positive findings as demonstrated by galactography. Fifty-nine (66.3%) patients had positive findings as evident by second-look US after galactography (13 patients with benign, 37 with borderline and 9 with malignant lesions). Second-look US after galactography showed the highest diagnostic accuracy (83.2%), sensitivity (95.8%) and negative predictive value (93.3%) for borderline and malignant lesions. For the detection of malignant lesions, secondlook US after galactography showed the highest sensitivity (90%) and negative predictive value (96.7%). Agreement between imaging and histological result using Bland-Altman analysis exhibited no significant difference between the size establishedby ultrasound and galactography.Conclusion: The second-look US after galactography is a powerful diagnostic tool for the detection of lesions in patients with nipple discharge and demonstrates high diagnostic accuracy, sensitivity and negative predictive value.

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Paediatric bone lesions: diagnostic accuracy of imaging correlation and CT-guided needle biopsy for differentiating benign from malignant lesions

British Journal of Radiology ◽

10.1259/bjr.20201234 ◽

2021 ◽

pp. 20201234

Author(s):

Alessandro Vidoni ◽

Ian Pressney ◽

Asif Saifuddin

Keyword(s):

Diagnostic Accuracy ◽

Needle Biopsy ◽

Bone Tumour ◽

Final Diagnosis ◽

Imaging Diagnosis ◽

Ct Guided ◽

Primary Bone Tumour ◽

Primary Bone ◽

Malignant Lesions ◽

Sensitivity Specificity

Objective: To determine the sensitivity, specificity and accuracy of CT-guided needle biopsy (CT-NB) for distinguishing benign and malignant lesions in children with suspected primary bone tumours, and to assess the correlation between imaging diagnosis and final diagnosis. Methods: Retrospective review of children who underwent CT-NB of a suspected primary bone tumour between October 2016 and October 2019. Data collected included anatomical location, imaging diagnosis, type of needle, type of biopsy sample, CT-NB diagnosis, final diagnosis and post-procedural complications. The final diagnosis was established based on surgical histology or clinical/imaging follow-up. Results: 125 patients met the inclusion criteria (68M, 57F: mean age 11 years; range 10 months–18 years). Biopsy was performed using a 10 cm Jamshidi needle (10G n = 96; 13 G n = 8); 14G Tru-Cut needle (n = 18); 14G Temno needle (n = 3). The commonest anatomical locations were the femur (n = 40), tibia (n = 25) and humerus (n = 16), while the commonest diagnoses were osteosarcoma (n = 35), CRMO (n = 15) and LCH (n = 14). A benign tumour was correctly identified on imaging in 100% of cases, and a malignant tumour in 95.8%. Sensitivity, specificity and diagnostic accuracy of CT-NB for distinguishing malignant from benign lesions were 98%, 100 and 99%. Of 24 indeterminate biopsy results, all that had a non-aggressive radiological appearance were benign. No immediate complications were recorded. Conclusion: CT-NB represents a safe and very effective tool for differentiating benign and malignant lesions in children presenting with a suspected primary bone tumour. Suspected radiological diagnosis plays a pivotal role in the management of indeterminate biopsy results. Advances in knowledge: Paediatric bone tumours pose a significant diagnostic and therapeutic challenge. The interpretation of the imaging findings is essential for the successful management of indeterminate histological results.

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Ultrasonography and Magnetic Resonance Cholangiopancreatography in Patients with Obstructive Jaundice

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v16i1.26641 ◽

2020 ◽

Vol 16 (1) ◽

pp. 6-11

Author(s):

Pramod Chhettri ◽

Hari Rana

Keyword(s):

Obstructive Jaundice ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Treatment Options ◽

Magnetic Resonance Cholangiopancreatography ◽

Final Diagnosis ◽

Cross Sectional Study ◽

Benign Lesions ◽

Cross Sectional ◽

Sensitivity Specificity

Background: Jaundice is a common presenting symptom in patients with hepatobiliary disease. It can be categorized into medical and surgical jaundice and it is important to differentiate due to the different treatment options Methods: In this cross sectional study from Jan 2017 to June 2018, 84 consecutive patients with obstructive jaundice who underwent initial USG and then MRCP were included and their respective diagnosis compared keeping surgery and/or histopathology as the gold standard for final diagnosis. Results: Out of 84 patients, 67.9% were females and 32.1% were males. The most common cause for obstructive jaundice was benign in 72.6% and malignancy in 27.4%. Among the benign lesions choledocholithiasis was the most common (57.4%) followed by pancreatitis (26.2%). Cholangiocarcinoma was the most common malignant cause (47.8 %) followed by periampullary carcinoma (26.2%). The sensitivity and specificity of USG in benign lesions was 67.2% and 87% respectively, and in malignancy 56% and 95% respectively. Similarly sensitivity and specificity of MRCP for benign lesions was 95.2% and 90.9% respectively, and for malignancy 95.75% and 98.45%respectively. Overall diagnostic accuracy of USG in benign and malignant causes was 76.62% and 84.52% respectively. Similarly overall diagnostic accuracy of MRCP for benign and malignant causes was 93.98% and 97.6% respectively. Conclusions: USG is a good modality for Initial screening and for differentiating medical and surgical cause of jaundice. MRCP is a better modality with higher sensitivity, specificity and diagnostic accuracy for detecting pathology as compared to USG. Keywords: MRCP; obstructive jaundice; USG.

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Can shear wave elastography be utilized as an additional tool for the assessment of non-mass breast lesions?

Ultrasound ◽

10.1177/1742271x21998721 ◽

2021 ◽

pp. 1742271X2199872

Author(s):

Sepideh Sefidbakht ◽

Sara Haseli ◽

Neda Khalili ◽

Vahid Bazojoo ◽

Pedram Keshavarz ◽

...

Keyword(s):

High Risk ◽

Diagnostic Accuracy ◽

Shear Wave ◽

Breast Imaging ◽

Shear Wave Elastography ◽

Breast Lesions ◽

Benign Lesions ◽

Conventional Ultrasound ◽

Malignant Lesions ◽

Mass Lesions

Introduction We aimed to describe shear wave elastography parameters of non-mass lesions of the breast and to assess the measures of diagnostic accuracy of shear wave elastography in the differentiation of non-mass lesions compared with conventional ultrasound, using histopathologic results as the reference standard. Methods This retrospective study included breast ultrasound-detected non-mass lesions with a confirmed pathologic diagnosis during a two-year study period. B-mode ultrasound and shear wave elastography were performed for all lesions before biopsy. Ultrasound features, shear wave elastography parameters (mean elasticity and maximum stiffness color), as well as Breast Imaging-Reporting and Data System categories were recorded for each lesion. Measures of diagnostic accuracy of ultrasound and ultrasound + shear wave elastography were also assessed. Results From a total of 567 breast lesions requiring core-needle biopsy, 49 (8.6%) were considered as non-mass lesions. Based on histopathologic reports, 32 patients (65.3%) had non-high-risk benign lesions, five (10.2%) had high-risk benign lesions, five (10.2%) had ductal carcinoma in situ, and seven (14.3%) had invasive carcinoma. There was no significant difference in patients’ age and palpability between benign and malignant lesions ( p = 0.16 and p = 0.12, respectively). Mean elasticity values and Breast Imaging-Reporting and Data System categories were significantly higher among malignant lesions compared with benign non-mass lesions (both p < 0.001). Furthermore, the addition of shear wave elastography to grayscale ultrasound increased the specificity, positive predictive value, and diagnostic accuracy. Conclusion The complementary use of shear wave elastography with conventional ultrasound might help in the differentiation of non-mass breast lesions and has the potential to decrease the frequency of unnecessary biopsies performed for benign non-mass lesions.

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CT-guided transthoracic needle biopsy of pulmonary lesions: comparison between the cutting needle and aspiration needle

British Journal of Radiology ◽

10.1259/bjr.20190930 ◽

2020 ◽

pp. 20190930

Author(s):

Zhen-guo Huang ◽

Hong-liang Sun ◽

Cun-li Wang ◽

Bao-xiang Gao ◽

He Chen ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Complication Rate ◽

Needle Biopsy ◽

Final Diagnosis ◽

Benign Lesions ◽

Transthoracic Needle Biopsy ◽

Ct Guided ◽

Pulmonary Lesions ◽

Severe Hemorrhage ◽

Cutting Needle

Objectives: To compare CT-guided transthoracic cutting needle biopsy (TCNB) with transthoracic aspiration needle biopsy (TANB) for pulmonary lesions with respect to the diagnostic accuracy and complication rate. Methods: Of the 859 cases that underwent consecutive CT-guided biopsy of pulmonary lesions, 713 cases confirmed by surgical pathology or clinical follow-up were enrolled. Of these, the first consecutive 275 cases underwent TANB, and the remaining 438 received TCNB. The final diagnosis determined the accuracy of biopsy. Based on the post-biopsy CT and clinical medical records, the presence or absence of biopsy-related complications was determined. The χ2 test was used to compare the differences between TCNB and TANB in terms of diagnostic accuracy and complication rate. Results: Among the 713 biopsy lesions, the final diagnosis was malignant in 411 cases and benign in 302 cases. As compared to TANB, the diagnostic accuracy of TCNB (98.9% vs 93.8%, χ2 = 14.35, p < 0.01), sensitivity to malignant lesions (97.8% vs 90.6%, χ2 = 10.58, p < 0.01), negative predictive value (97.6% vs 84.8%, χ2 = 19.03, p < 0.01), and specific diagnostic rate for benign lesions (73.4% vs 57.9%, χ2 = 7.29, p < 0.01) were improved. On the other hand, a statistical difference was detected between TCNB and TANB with respect to the incidence of pneumothorax (20.6% vs 13.1%, χ2 = 6.46, p = 0.01), hemorrhage (32.2% vs 13.1%, χ2 = 33.03, p < 0.01), and hemoptysis (8.2% vs 3.3%, χ2 = 6.87, p < 0.01). One patient died just several minutes after TCNB due to severe hemorrhage with hemoptysis. Conclusions: Compared to TANB, CT-guided TCNB improves the diagnostic accuracy of pulmonary lesions, but complication rate increases significantly. Advances in knowledge: In general, TCNB should be recommended, especially for highly suspicious benign lesions. For patients with small lesions adjacent to vessels or vessels within the lesion, TANB should be considered.

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Advances in Optical Adjunctive Aids for Visualisation and Detection of Oral Malignant and Potentially Malignant Lesions

International Journal of Dentistry ◽

10.1155/2013/194029 ◽

2013 ◽

Vol 2013 ◽

pp. 1-17 ◽

Cited By ~ 39

Author(s):

Nirav Bhatia ◽

Yastira Lalla ◽

An N. Vu ◽

Camile S. Farah

Keyword(s):

Narrow Band ◽

Narrow Band Imaging ◽

The Novel ◽

Benign Lesions ◽

Oral Potentially Malignant Disorders ◽

Digital Palpation ◽

Oral Mucosal Lesions ◽

Potentially Malignant ◽

Malignant Lesions ◽

Oral Malignancies

Traditional methods of screening for oral potentially malignant disorders and oral malignancies involve a conventional oral examination with digital palpation. Evidence indicates that conventional examination is a poor discriminator of oral mucosal lesions. A number of optical aids have been developed to assist the clinician to detect oral mucosal abnormalities and to differentiate benign lesions from sinister pathology. This paper discusses advances in optical technologies designed for the detection of oral mucosal abnormalities. The literature regarding such devices, VELscope and Identafi, is critically analysed, and the novel use of Narrow Band Imaging within the oral cavity is also discussed. Optical aids are effective in assisting with the detection of oral mucosal abnormalities; however, further research is required to evaluate the usefulness of these devices in differentiating benign lesions from potentially malignant and malignant lesions.

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201Tl Scintigraphy in the Evaluation of Palpable and Nonpalpable Breast Lesions: Correlation with Mammography and Ultrasonography

Nuklearmedizin ◽

10.1055/s-0038-1629848 ◽

1997 ◽

Vol 36 (08) ◽

pp. 282-288 ◽

Cited By ~ 8

Author(s):

T. Atasever ◽

A. Özdemir ◽

I. Öznur ◽

N. I. Karabacak ◽

N. Gökçora ◽

...

Keyword(s):

Final Diagnosis ◽

Lower Sensitivity ◽

Breast Lesions ◽

Breast Cancers ◽

Combined Use ◽

Malignant Breast ◽

Malignant Lesions ◽

Benign Breast Lesions ◽

Palpable Breast ◽

Metastatic Sites

Summary Aim: Our goal was to determine the clinical usefulness of TI-201 to identify breast cancer in patients with suspicious breast lesions on clinical examination, and/or abnormal radiologic (mammography and/or ultrasonography) findings. Methods: TI-201 scintigraphy were performed in sixty-eight patients with 70 breast abnormalities (51 palpable, 19 nonpalpable) and compared with mammography and ultrasonography (US). Early (15 min) and late (3 h) images of the breasts were obtained following the injection of 111 MBq (3 mCi) of TI-201. Visual and semiquantitative interpretation was performed. Results: Final diagnosis confirmed 52 malignant breast lesions and 18 benign conditions. TI-201 visualized 47 of 52 (90%) overall malignant lesions. Thirty-eight of 40 (95%) palpable and 9 of 12 (75%) nonpalpable breast cancers were detected by TI-201 scintigraphy. The smallest mass lesion detected by TI-201 measured 1.5x1.0 cm. Eleven breast lesions were interpreted as indeterminate by mammography and/or sonography. TI-201 scintigraphy excluded malignancy in 7 of 8 (88%) patients with benign breast lesions interpreted as indeterminate. Five of the 18 (28%) benign breast lesions showed TI-201 uptake. None of the fibroadenoma and fibrocystic changes accumulated TI-201. TI-201 scintigraphy, mammography and ultrasonography showed 90%, 92%, 85% overall sensitivity and 72%, 56%, 61% overall specificity respectively. Twenty-one of the 28 (75%) axillary nodal metastatic sites were also detected by TI-201. In malignant and benign lesions, early and late lesion/contralateral normal side (L/N) ratios were 1.58 ± 0.38 (mean ± SD) and 1.48 ± 0.32 (p >0.05), 1.87 ± 0.65 and 1.34 ± 0.20 (p<0.05) respectively. The mean early and late L/N ratios of malignant and benign groups did not show statistical difference (p>0.05). Conclusion: Overall, TI-201 scintigraphy was the most specific of the three methods and yielded favourable results in palpable breast cancers, while it showed lower sensitivity in nonpalpable cancers and axillary metastases. Combined use of TI-201 scintigraphy with mammography and US seems to be useful in difficult cases, such as dense breasts and indeterminate breast lesions.

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Significance of 18F-fluorocholine PET/CT positive pulmonary lesions in prostate cancer patients

Nuklearmedizin ◽

10.3413/nukmed-0737-15-04 ◽

2015 ◽

Vol 54 (05) ◽

pp. 211-216 ◽

Cited By ~ 3

Author(s):

A. Baskin ◽

G. Amzalag ◽

F. Buchegger ◽

R. Miralbell ◽

O. Ratib ◽

...

Keyword(s):

Prostate Cancer ◽

Primary Lung Cancer ◽

Final Diagnosis ◽

Papillary Adenocarcinoma ◽

Bronchioloalveolar Carcinoma ◽

Maximum Diameter ◽

Benign Lesions ◽

Pulmonary Carcinoid ◽

Pulmonary Lesions ◽

Pet Ct

SummaryAim: To assess the frequency and the significance of incidental pulmonary lesions with 18F-fluorocholine (18F-FCH) PET/CT in prostate cancer (PCa) patients. Patients, methods: 225 consecutive PCa patients referred for 18F-FCH PET/CT (median age 68 years) were retrospectively evaluated for the presence of lesions in the lungs: 173 referred for restaging and 52 for initial staging regarding their high risk of extra prostatic extension. The final diagnosis was based on histopathological or on clinical and radiological follow-up. Results: 13 patients had 18F-FCH positive pulmonary and 8 patients malignant lesions: 5 patients (38%) had a primary lung cancer (2 squamous cell carcinomas, 1 papillary adenocarcinoma, 1 typical pulmonary carcinoid, 1 bronchioloalveolar carcinoma) and 3 patients (23%) PCa metastases. Benign lesions were found in 5 subjects (38%). SUVmax and maximum diameter were neither significantly different in primary and metastatic tumors nor between malignant and benign lesions. Conclusions: Although our results suggest that incidental uptake in the lungs in PCa patients are nonspecific, their detection may have a significant impact on patient management knowing that more than 60% represent malignant diseas.

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Shared and unique metabolic features of the malignant and benign thyroid lesions determined with use of 1H HR MAS NMR spectroscopy

Scientific Reports ◽

10.1038/s41598-020-79565-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Agnieszka Skorupa ◽

Mateusz Ciszek ◽

Ewa Chmielik ◽

Łukasz Boguszewicz ◽

Małgorzata Oczko-Wojciechowska ◽

...

Keyword(s):

Nmr Spectra ◽

Univariate Analysis ◽

Mas Nmr ◽

Metabolic Reprogramming ◽

Benign Lesions ◽

Chronic Thyroiditis ◽

Malignant Lesions ◽

Metabolic Heterogeneity ◽

Benign Thyroid ◽

Thyroid Lesions

AbstractThe purpose of this work was to investigate the distinct and common metabolic features of the malignant and benign thyroid lesions in reference to the non-transformed tissue from the contralateral gland (chronic thyroiditis and colloid goiter). 1H HR MAS NMR spectra of 38 malignant lesions, 32 benign lesions and 112 samples from the non-tumoral tissue (32 from chronic thyroiditis and 80 samples from colloid goiter) were subjected both to multivariate and univariate analysis. The increased succinate, glutamine, glutathione, serine/cysteine, ascorbate, lactate, taurine, threonine, glycine, phosphocholine/glycerophosphocholine and decreased lipids were found in both lesion types in comparison to either colloid goiter or chronic thyroiditis. The elevated glutamate and choline, and reduced citrate and glucose were additionally evident in these lesions in reference to goiter, while the increased myo-inositol—in comparison to thyroiditis. The malignant lesions were characterized by the higher alanine and lysine levels than colloid goiter and thyroiditis, while scyllo-inositol was uniquely increased in the benign lesions (not in cancer) in comparison to both non-tumoral tissue types. Moreover, the benign lesions presented with the unique increase of choline in reference to thyroiditis (not observed in the cancerous tissue). The metabolic heterogeneity of the non-tumoral tissue should be considered in the analysis of metabolic reprogramming in the thyroid lesions.

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