Applying Compressed Sensing Volumetric Interpolated Breath-Hold Examination and Spiral Ultrashort Echo Time Sequences for Lung Nodule Detection in MRI

This prospective study aimed to investigate the ability of spiral ultrashort echo time (UTE) and compressed sensing volumetric interpolated breath-hold examination (CS-VIBE) sequences in magnetic resonance imaging (MRI) compared to conventional VIBE and chest computed tomography (CT) in terms of image quality and small nodule detection. Patients with small lung nodules scheduled for video-assisted thoracoscopic surgery (VATS) for lung wedge resection were prospectively enrolled. Each patient underwent non-contrast chest CT and non-contrast MRI on the same day prior to thoracic surgery. The chest CT was performed to obtain a standard reference for nodule size, location, and morphology. The chest MRI included breath-hold conventional VIBE and CS-VIBE with scanning durations of 11 and 13 s, respectively, and free-breathing spiral UTE for 3.5–5 min. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and normal structure visualizations were measured to evaluate MRI quality. Nodule detection sensitivity was evaluated on a lobe-by-lobe basis. Inter-reader and inter-modality reliability analyses were performed using the Cohen κ statistic and the nodule size comparison was performed using Bland–Altman plots. Among 96 pulmonary nodules requiring surgery, the average nodule diameter was 7.7 ± 3.9 mm (range: 4–20 mm); of the 73 resected nodules, most were invasive cancer (74%) or pre-invasive carcinoma in situ (15%). Both spiral UTE and CS-VIBE images achieved significantly higher overall image quality scores, SNRs, and CNRs than conventional VIBE. Spiral UTE (81%) and CS-VIBE (83%) achieved a higher lung nodule detection rate than conventional VIBE (53%). Specifically, the nodule detection rate for spiral UTE and CS-VIBE reached 95% and 100% for nodules >8 and >10 mm, respectively. A 90% detection rate was achieved for nodules of all sizes with a part-solid or solid morphology. Spiral UTE and CS-VIBE under-estimated the nodule size by 0.2 ± 1.4 mm with 95% limits of agreement from −2.6 to 2.9 mm and by 0.2 ± 1.7 mm with 95% limits of agreement from −3.3 to 3.5 mm, respectively, compared to the reference CT. In conclusion, chest CT remains the gold standard for lung nodule detection due to its high image resolutions. Both spiral UTE and CS-VIBE MRI could detect small lung nodules requiring surgery and could be considered a potential alternative to chest CT; however, their clinical application requires further investigation.

Development and Analysis of a Predictive Nomogram Assessing Cancer Risk in a Chinese Cohort of Patients Presenting with Pulmonary Nodules

Background: Lung cancer is a major global threat to public health for which a novel prognostic nomogram is urgently needed.Patients and methods: Here, we designed a novel prognostic nomogram using a training dataset consisting of 178 pulmonary nodules for design and 124nodules for external validation. The R ‘caret’ package was used to separate patients for design into two groups, including a training cohort (n=126) for model construction and an internal validation cohort (n=52). Optimal feature selection for this model was achieved using the least absolute shrinkage and selection operator regression (LASSO) model. C-index values, calibration plots, and decision curve analyses were used to gauge the discrimination, calibration, and clinical utility, respectively, of this predictive model. Validation was then performed with the validation cohort.Results: A predictive nomogram was successfully constructed incorporating hypertension status, plasma fibrinogen levels, serum uric acid (SUA) levels, triglyceride (TG) and high-density lipoprotein (HDL) levels, density, spicule sign, ground-glass opacity (GGO), and pulmonary nodule size. This model exhibited good discriminative ability, with a C-index value of 0.795 (95% CI: 0.720–0.870), and was well-calibrated. When we used the validation cohort to evaluate the model, the C-indexes were 0.886 (95% CI: 0.800–0.972) and 0.817 (95% CI: 0.747–0.897) for internal validation and external validation, respectively. Decision curve analyses indicated the clinical value of this predictive nomogram when used at a lung cancer possibility threshold of 9%.Conclusion: The nomogram constructed in this study, which incorporates hypertension status, plasma fibrinogen levels, SUA, TG, HDL, density, spicule sign, GGO status, and pulmonary nodule size was able to reliably predict lung cancer risk in this Chinese cohort of patients presenting with pulmonary nodules.

Reevaluation of Criteria and Establishment of Models for Total Thyroidectomy in Differentiated Thyroid Cancer

IntroductionAfter the publication of the 2015 American Thyroid Association (ATA) guidelines, the indication for total thyroidectomy (TT) was reported to be underestimated before surgery, which may lead to a substantial rate of secondary completion thyroidectomy (CTx).Methods and MaterialsWe retrospectively analyzed differentiated thyroid cancer patients from Wuhan Union Hospital (WHUH). Univariate analysis was performed to evaluate all preoperative and intraoperative factors. New models were picked out by comminating and arranging all significant factors and were compared with ATA and National Comprehensive Cancer Network (NCCN) guidelines in the multicenter prospective Differentiated Thyroid Cancer in China (DTCC) cohort.ResultsA total of 5,331 patients from WHUH were included. Pre- and intraoperative criteria individually identified 906 (17.0%) and 213 (4.0%) patients eligible for TT. Among all factors, age <35 years old, clinical N1, and ultrasound reported local invasion had high positive predictive value to predict patients who should undergo TT. Accordingly, we established two new models that minorly revised ATA guidelines but performed much better. Model 1 replaced “nodule size >4 cm” with “age <35 years old” and achieved significant increase in the sensitivity (WHUH, 0.711 vs. 0.484; DTCC, 0.675 vs. 0.351). Model 2 simultaneously demands the presence of “nodule size >4 cm” and “age <35 years old,” which had a significant increase in the specificity (WHUH, 0.905 vs. 0.818; DTCC, 0.729 vs. 0.643).ConclusionAll high-risk factors had limited predictive ability. Our model added young age as a new criterion for total thyroidectomy to get a higher diagnostic value than the guidelines.

The Value of Ultrasound-Guided Fine-Needle Aspiration Cytology Combined with Puncture Feeling in the Diagnosis of Thyroid Nodules

<b><i>Introduction:</i></b> There are few studies on the role of puncture feeling in thyroid nodules during ultrasound-guided fine-needle aspiration cytology (US-FNAC), although it is expected to become a new predictive technique. We aimed to analyze the importance of puncture feeling in combination with US-FNAC and investigate whether it can be used as an indicator to predict the nature of thyroid nodules. <b><i>Materials and Methods:</i></b> From January 1, 2018, to October 31, 2020, a total of 623 thyroid nodules were included. Puncture feeling was classified as “soft,” “hard,” or “hard with grittiness.” The correlation between puncture feeling and postoperative pathology and the diagnostic value of FNAC combined with puncture feeling were analyzed, and the influence of thyroid nodule size on puncture feeling, FNAC, and FNAC combined with puncture feeling was studied. We further explored the correlation between puncture feeling and histopathology in Bethesda III and IV thyroid nodules. <b><i>Results:</i></b> There was a significant correlation between puncture feeling and postoperative pathology (<i>p</i> &#x3c; 0.001). The sensitivity, negative predictive value, and total coincidence rate of US-FNAC combined with puncture feeling for the diagnosis of thyroid nodules were higher than those of US-FNAC alone (96.1, 83.6, and 94.7% vs. 89.0, 65.5, and 89.7%, respectively). Thyroid nodule size was the influencing factor for puncture feeling, FNAC, and FNAC combined with puncture feeling (<i>p</i> &#x3c; 0.05 for all). The area under the curve for puncture feeling, FNAC, and FNAC combined with puncture feeling for thyroid nodules of size ≤1 cm was greater than for modules of size &#x3e;1 cm. Puncture feeling was of great value in diagnosing Bethesda III thyroid nodules (<i>p</i> &#x3c; 0.001), and all Bethesda IV thyroid nodules had puncture feeling of soft. <b><i>Conclusion:</i></b> Puncture feeling is of great value during US-FNAC. “Hard” and “hard with grittiness” were indicators for malignancy, while “soft” indicated that the thyroid nodule was likely to be benign. The diagnostic value of US-FNAC combined with puncture feeling for thyroid nodules is higher than US-FNAC alone, especially when nodule size is ≤1 cm. Puncture feeling is of great value in predicting the nature of Bethesda III thyroid nodules.

Correlation of Neck Nodule Size with Body Mass Index and Karnofsky Status Before and After Neoadjuvant Cisplatin and 5-Fluorouracil Chemotherapy in Nasopharyngeal Carcinoma Type 3 Patients

Introduction: Nasopharyngeal carcinoma (NPC) is a malignancy arising from the nasopharyngeal epithelium, usually present in the Rosenmüller fossa. NPC is a cancer of the head and neck that is most common in East Asia and Southeast Asia, including in Indonesia. The main therapeutic for NPC is radiotherapy. Neoadjuvant chemotherapy reduces the local spread of advanced NPC, eradication of micrometastases, and improved local control. Neoadjuvant chemotherapy's effectiveness can be assessed by changes in the patient's neck nodule size (N), the patient's Body Mass Index (BMI), and Karnofsky's Status. Aim: To determine the correlation between N with BMI and Karnofsky status on neoadjuvant chemotherapy Cisplatin and 5-Fu in WHO type 3 of NPC patients. Methods: This study was an analytical observational study using medical record data. In this study, an assessment of N, BMI and Karnofsky status of NPC WHO type 3 patients who had undergone neoadjuvant chemotherapy using the Cisplatin and 5-Fu regimen for three cycles. Twenty-three study subjects were analyzed for N, BMI and Karnofksy status changes while undergoing neoadjuvant chemotherapy for up to 3 cycles. Result: The N value decreased, p = 0.001. BMI value decreased, p = 0.615. Karnofsky's status value experienced insignificant changes, p = 0.564. The correlation between N and BMI before a cycle I neoadjuvant chemotherapy and three cycles of neoadjuvant chemotherapy obtained r = -0.201 and p = 0.358, respectively; r = -0.070 and p = 0.751. Correlation of N with Karnofsky status was obtained r = 0.155 and p = 0.480, before cycle I neoadjuvant chemotherapy. The correlation between N and Karnofsky status was obtained r = 0.571 and p = 0.004 after cycle III neoadjuvant chemotherapy. Conclusion: Neoadjuvant chemotherapy Cisplatin and 5-Fu is effective against changes in N and correlation between N and BMI but less effective in assessing the correlation between N and Karnofsky status after three cycles of neoadjuvant chemotherapy. Correspondence should be addressed to Bagus Harning Efranto; [email protected]

A comparison of the fusion model of deep learning neural networks with human observation for lung nodule detection and classification

Objectives: To compare the diagnostic performance of a newly developed artificial intelligence (AI) algorithm derived from the fusion of convolution neural networks (CNN) versus human observers in the estimation of malignancy risk in pulmonary nodules. Methods: The study population consists of 158 nodules from 158 patients. All nodules (81 benign and 77 malignant) were determined to be malignant or benign by a radiologist based on pathologic assessment and/or follow-up imaging. Two radiologists and an AI platform analyzed the nodules based on the Lung-RADS classification. The two observers also noted the size, location, and morphologic features of the nodules. An intraclass correlation coefficient was calculated for both observers and the AI; ROC curve analysis was performed to determine diagnostic performances. Results: Nodule size, presence of spiculation, and presence of fat were significantly different between the malignant and benign nodules (p < 0.001, for all three). Eighteen (11.3%) nodules were not detected and analyzed by the AI. Observer 1, observer 2, and the AI had an AUC of 0.917 ± 0.023, 0.870 ± 0.033, and 0.790 ± 0.037 in the ROC analysis of malignity probability, respectively. The observers were in almost perfect agreement for localization, nodule size, and lung-RADS classification [κ (95% CI)=0.984 (0.961–1.000), 0.978 (0.970–0.984), and 0.924 (0.878–0.970), respectively]. Conclusion: The performance of the fusion AI algorithm in estimating the risk of malignancy was slightly lower than the performance of the observers. Fusion AI algorithms might be applied in an assisting role, especially for inexperienced radiologists. Advances in knowledge: In this study we proposed a fusion model using four state-of-art object detectors for lung nodule detection and discrimination. The use of fusion of deep learning neural networks might be used in a supportive role for radiologists when interpreting lung nodule discrimination

Thyroid nodules with indeterminate cytology: association between nodule size, histopathological characteristics and clinical outcome in differentiated thyroid carcinomas — a multicenter retrospective cohort study on 761 patients

A great number of surgical diagnostic procedures are performed every year for thyroid nodules that are included in undetermined cytological classes that reveal to be malignant thyroid carcinomas in one-third of cases. In the most recent guidelines, lobectomy is the most recommended surgical approach for this classes of nodules, but total thyroidectomy is the recommended treatment for undetermined nodules larger than 4 cm. The main study aim is to support or question the dimensional criteria as an independent clinical decision element for undetermined thyroid nodules management. We examined data regarding 761 patients undergoing thyroid surgery for undetermined thyroid nodules at two high-volume endocrine surgery units in Italy. Patients were divided into three groups based on the preoperative size of the nodules (N < 1, 1 < N < 4, N > 4 cm). Among the patients belonging to the different groups, we analyzed: differences in malignancy rate, histological characteristics of invasiveness and neoplastic aggressiveness, rates of recurrence and response to therapy. Nodule size (evaluated as a categorical variable and as a continuous variable) did not show any statistically significant correlation with the rate of malignancy, histopathological characteristics of tumor aggressiveness and the patient’s clinical outcome. Most of the tumors found were included in the low risk class (79.2%) and only one was classified as high risk. Follow up of cancer cases showed excellent results in terms of survival, response to therapy and disease recurrence. Malignant thyroid tumors of any size resulting from a nodule identified as cytologically indeterminate are usually characterized by a low risk follicular pattern, well-differentiated and with an excellent outcome. As a result, preferring an extended surgical attitude for undetermined nodules based on tumor size, in absence of other risk factors, can lead to overtreatment in a significant percentage of cases.