ABSTRACT Background Selective internal radiation therapy (SIRT) is an established treatment option for hepatocellular carcinoma (HCC); however, patient selection remains challenging. The MAAPE score (MELD, Albumin, AFP, PVTT, ECOG) was recently developed as a prognostic tool. This study aimed to provide an independent, single‐centre external validation of the MAAPE score in predicting clinical outcomes for patients treated with Yttrium‐90 SIRT. Methods A retrospective analysis of patients with HCC treated with SIRT at a tertiary centre in Australia between 2012 and 2024 was performed. All patients received SIRT as first‐line treatment. Patients were stratified into Good, Average, and Poor prognosis groups based on their pre‐treatment MAAPE score. Tumour response and survival outcomes at 12 months were assessed as endpoints. Statistical analysis was performed using Kendall's rank correlation, Mann–Whitney tests, and Fisher's exact tests. Results A total of 64 patients were included, of whom 62 were evaluable for 12‐month survival. Patients were stratified into Good ( n = 18; 28.1%), Average ( n = 29; 45.3%), and Poor ( n = 17; 26.6%) prognosis groups. The MAAPE score demonstrated a significant correlation with 12‐month survival ( p = 0.008) and tumour response ( p = 0.030). Patients in the Good prognosis group achieved an 88.2% survival rate at 12 months, compared to 62.1% and 43.8% for the Average and Poor groups respectively. While correlations were statistically significant, pairwise comparisons between prognosis groups were only significant when comparing Good and Poor ( p = 0.010 for 12‐month survival and p = 0.046 for tumour response). Conclusion In this small single‐centre cohort, the MAAPE score identified patients with the most and least favourable 12‐month outcomes. It did not separate the adjacent prognosis groups from each other. These findings support the score at the extremes of risk, but they are preliminary. Larger prospective multicentre studies are required to assess the value of this score in personalised patient management.
Purpose We aim to evaluate the functional and anatomical imaging characteristics of locally advanced cervical cancer (LACC) to identify potential prognosticating imaging biomarkers in the context of chemoradiotherapy treatment (CRT).Method This retrospective review analysed patient data over a period of seven years. Patients with locally advanced cervical cancer who have undergone FDG PET CT and MRI were identified through Report Analytics. Patients with LACC who have undergone chemoradiotherapy were identified through review of the electronic records. Pre and post-treatment imaging were analysed and compared. The patients were dichotomised into complete metabolic responders (CMR) and non-complete metabolic responders (N-CMR) as per European Organisation for Research and Treatment of Cancer (EORTC) criteria. Imaging parameters in PET CT and MRI including SUV max, SUV mean, total lesion glycolysis (TLG), lesion metabolic tumour volume (MTV), apparent diffusion coefficient (ADC) minimum were examined. Kaplan-Meier analysis was used to evaluate differences in overall survival (OS) and disease-free survival (DFS) between the CMR and N-CMR groups. Pearson's correlation and Fischer's exact test were used to evaluate the potential prognosticating value of the PET CT and MRI imaging parameters as predictors of metabolic response to CRT.Results A total of 159 FDG PET CT scans were conducted in the 7-year period, of which there were 61 individual patients identified for inclusion into the present study. The average imaging follow-up for the patients included between 2019 and 2024 was 63.3 months, and chemoradiotherapy follow-up was 62.9 months. The patients were dichotomized into CMR and N-CMR groups. There is a statistically significant difference in overall survival, with 1 mortality (5%) in the CMR group vs. 19 mortality (70%) in the N-CMR group (p = 0.0001). However, no statistically significant difference in follow-up 87.1 months vs. 57.1 months (p = 0.20). In the overall cervical cancer cohort as well as the squamous cell carcinoma subgroup (n = 32), the comparison of CMR and N-CMR groups revealed a statistically significant difference in the following FDG PET imaging parameters: SUV max, SUV mean, ADC minimum and MTV. The CMR group has tumours with higher SUV max and SUV mean (difference of 7.5 and 5.1 respectively) and smaller MTV (difference of 20.1 cm3). However, there was no demonstrable difference in TLG and MRI ADC min values between the dichotomized groups. The tumoral SUV max and ADC min were weakly negatively correlated. There was no statistically significant difference in International Federation of Gynaecology and Obstetrics (FIGO) stage of disease (individual stage and IIB or higher) and pathological grade in the dichotomized groups.Conclusion This retrospective analysis identified functional imaging predictors of positive response to CRT in LACC patients using FDG PET CT. Furthermore, this confirms the negative correlation between functional and anatomical imaging parameters, albeit non-statistically significant (namely SUV max and ADC min). The present results indicated cervical cancer with higher SUV values (max and mean) and smaller MTV were more likely to respond to CRT. There is no demonstrable difference in pathological grading and FIGO stage of disease. Prospective studies in larger cohorts are indicated to ascertain the predictive value of functional and anatomical imaging parameters and their correlation with tumour histopathological features.
Purpose To evaluate the diagnostic performance of ACR TI-RADS for predicting malignant cytology in thyroid nodules undergoing fine-needle aspiration (FNA) in a large tertiary centre. Methods A retrospective analysis was performed of 3368 thyroid nodules undergoing ultrasound-guided FNA. Nodules were classified according to ACR TI-RADS (TR1-TR5). Cytological outcomes were recorded using the Bethesda System. Malignant cytology was defined as Bethesda V-VI and Bethesda IV-VI was evaluated as a secondary composite cytological outcome. The distribution of cytology across TI-RADS categories was assessed, and malignancy rates were calculated. Diagnostic performance was evaluated using TR4-TR5 as a positive threshold. Results Nodules were classified as TR1 (1.4%), TR2 (5.3%), TR3 (23.7%), TR4 (51.0%) and TR5 (18.7%). Malignant cytology increased across categories from 0.0% in TR1 to 6.5% in TR5, while Bethesda IV-VI cytology increased from 0.0% to 12.6%. Among TR3-TR5 nodules, 81.0% met the corresponding ACR size threshold for FNA; malignant cytology occurred in 2.6% meeting the threshold and 1.7% below threshold (p = 0.24). TI-RADS category was significantly associated with cytological outcome (p < 0.001). Using TR4-TR5 as a threshold, sensitivity was 88.2% and negative predictive value 99.1%. Conclusion ACR TI-RADS demonstrates a clear association with cytology outcomes, with increasing malignancy risk across categories. In this large FNA-based cohort, TI-RADS showed excellent negative predictive value, supporting its role in ultrasound-based risk stratification and optimisation of FNA decision-making.
INTRODUCTION: To identify early post-drainage factors associated with escalation to additional treatment for postoperative symptomatic pelvic and inguinal lymphoceles. METHODS: This single-centre retrospective study included lymphoceles treated with percutaneous drainage between 2014 and 2024 after oncologic surgery. Lesions were classified into drainage-only and additional treatment groups; escalation was decided at the physicians' discretion without a standardized protocol. Only drainage volumes before initiation of additional treatment were analysed. Associations with escalation were assessed using generalized linear mixed models (GLMMs) with patient ID as a random effect. RESULTS: Of 61 lesions in 45 patients, 40 were managed with drainage alone, whereas 21 underwent additional treatment (sclerotherapy, n = 19; intranodal embolization, n = 2) at a median of 10 days after drainage. Median Day 2 drainage volume was higher in the additional treatment group (320 vs. 50 mL, p = 0.002). In the multivariable GLMM, Day 2 drainage volume was associated with escalation (odds ratio per 100 mL increase, 1.62; 95% confidence interval, 1.14-2.30; p = 0.008), whereas absence of infection was not. This association remained significant in a secondary analysis adjusted for CT-derived lymphocele volume. Persistent high-output drainage or insufficient reduction in drainage volume was the documented reason for additional treatment in 20 of 21 lesions. CONCLUSION: Higher Day 2 drainage volume, measured before additional treatment, was associated with subsequent escalation. Although this association may partly reflect physician decision-making, Day 2 drainage volume may help identify lesions warranting closer monitoring and earlier reassessment of the treatment strategy.
