Background and Clinical Significance: Primary pancreatic extramedullary plasmacytomas (EMP) are extremely uncommon, representing less than 0.1% of all pancreatic masses and being far more uncommon than secondary involvement by an underlying multiple myeloma. Case presentation: A 69-year-old male was found with a solitary pancreatic mass. Endoscopic ultrasound (EUS)-guided fine-needle biopsy (FNB) revealed a monoclonal plasmacytic proliferation with molecularly confirmed KRAS (A146V) and BRAF (G469V) mutations. Multidisciplinary assessment ruled out a secondary localization, thus leading to the ultimate diagnosis of primary pancreatic EMP. Conclusions: Reaching a definitive diagnosis of primary pancreatic EMP requires a negative bone marrow biopsy and histological confirmation of the plasma cell nature of the pancreatic process. As for the latter, EUS-FNB may be a pivotal technique to avoid upfront surgical procedures.
Late gadolinium enhancement (LGE) cardiac magnetic resonance is the reference standard for non-invasive myocardial tissue characterization. Conventional LGE analysis focuses on the presence and extent of fibrosis, yet these measures incompletely describe the spatial complexity of myocardial scar that underpins arrhythmogenesis. Entropy, derived from radiomic analysis of LGE signal-intensity distributions, has emerged as a surrogate marker of myocardial tissue heterogeneity. Mechanistically, heterogeneous fibrosis promotes electrical conduction alterations, and entropy serves as a global descriptor of this complex substrate. A growing body of evidence suggests that higher LGE entropy is associated with increased arrhythmogenicity and major adverse cardiac events. Several studies have shown that this association remains significant after adjustment for conventional clinical and imaging predictors. A smaller number of studies have gone further, demonstrating that incorporation of LGE entropy improves the discriminatory or reclassification performance of established risk-prediction models. This narrative review critically synthesizes the current evidence on LGE-derived entropy, compares methodological approaches and clinical applications, and discusses its principal limitations. After standardization and prospective validation, entropy-based phenotyping may prove useful for individualized risk stratification beyond conventional LGE metrics and guide clinical decision-making.
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with ectopic fat accumulation and alterations in adipose tissue function. However, the relationships of structural and thermogenic adipose imaging markers with hepatic steatosis remain incompletely understood. This study aimed to jointly evaluate the cross-sectional associations of epicardial adipose tissue (EAT) thickness and infrared thermography (IRT)-derived brown adipose tissue (BAT)-related thermogenic activity with controlled attenuation parameter (CAP)-defined hepatic steatosis severity in adults with suspected MASLD. Methods: In this cross-sectional study, 207 adults undergoing clinical evaluation for suspected MASLD underwent transient elastography to obtain the controlled attenuation parameter (CAP) for hepatic steatosis assessment. EAT thickness was measured by transthoracic echocardiography, and BAT-related thermogenic activity was assessed by infrared thermography using the supraclavicular-to-chest temperature difference (ΔTemp). Associations of these adipose imaging phenotypes with CAP were evaluated using correlation analyses, sequential multivariable linear regression models, and BAT-stratified analyses. Results: EAT thickness increased progressively across CAP-defined steatosis grades (p < 0.001) and was positively correlated with CAP (r = 0.637, p < 0.001), whereas ΔTemp decreased with increasing steatosis severity and was inversely correlated with CAP (ρ = −0.277, p < 0.001). In sequential multivariable regression models, EAT thickness remained independently associated with CAP across adjustments for age, sex, body mass index, metabolic variables, and ΔTemp (standardized β = 0.559–0.623; all p < 0.001). Both EAT thickness and ΔTemp were independently associated with CAP in the fully adjusted model, with a stronger association for EAT thickness (standardized β = 0.559 vs. −0.167; p < 0.001 and p = 0.004, respectively). Stratified analyses demonstrated consistent associations between EAT thickness and CAP across both BAT-low and BAT-high activity groups. Conclusions: Greater EAT thickness and lower IRT-derived ΔTemp were independently associated with greater CAP-defined hepatic steatosis severity, with EAT thickness showing the stronger standardized association. These complementary structural and thermogenic imaging correlates warrant prospective evaluation to clarify their directionality and clinical relevance.
Background/Objectives: Prehospital identification of non-ST-elevation acute coronary syndrome remains unresolved, and available risk scores incorporate troponin categorically. We compared the discriminative performance of cardiac troponin I measured in a blood sample obtained at first prehospital medical contact, analysed as a continuous variable, against the HEART, GRACE, and TIMI scores for predicting 30-day major adverse cardiac events. Methods: We conducted a prospective cohort study in 333 adults with non-traumatic chest pain suggestive of non-ST-elevation acute coronary syndrome, which was attended by two physician-staffed advanced life support units. Venous blood was drawn at first medical contact and analysed later in the laboratory; the results were not available during patient care. All three scores used this same determination as their troponin component. The primary outcome was a composite of all-cause mortality, type 1 myocardial infarction, and unplanned coronary revascularisation at 30 days. Results: The primary outcome occurred in 82 patients (24.6%). Prehospital troponin discriminated better (area under the curve 0.916, 95% CI 0.875–0.952) than TIMI (0.817), GRACE (0.767), and HEART (0.721); all comparisons were p < 0.001. An exploratory rule-out threshold of 80 ng/L identified 61 patients (18.3%) with no events (sensitivity and negative predictive value 100%, exact 95% CI 95.6–100 and 94.1–100), whereas the ≥780 ng/L stratum showed an event rate of 69.4%. Conclusions: A blood sample obtained at first prehospital medical contact carries substantial prognostic information that clinical scores discard by categorising it. Because it was analysed subsequently in the laboratory, these findings do not evaluate a real-time strategy; they support development and validation of point-of-care devices.
Background/Objectives: Deep learning has achieved remarkable success in medical image analysis; however, limited model interpretability remains a major barrier to its clinical translation. MRI-negative temporal lobe epilepsy (TLE) is characterized by the absence of readily identifiable structural abnormalities on conventional MRI. Methods: We propose a hierarchical, multiscale 3D residual network (H-MSResNet) combined with layer-wise relevance propagation (LRP). The study included structural T1-weighted MRIs from 101 patients with MRI-negative TLE and 101 healthy controls. Model classification performance was evaluated using a fivefold cross-validation approach. Subsequently, group-level LRP analysis was integrated with a standard brain atlas to quantify the anatomical regions contributing to the model’s decisions. Results: H-MSResNet achieved an average classification accuracy of 76.27% and a best single-fold accuracy of 82.50%, with higher accuracy, specificity, and F1 score but lower sensitivity and AUC than the two comparison models. Group-level, LRP-based analysis combined with a standard brain atlas revealed that the model’s decision-making primarily focused on structures related to the temporal lobe and limbic system, including regions such as the hippocampus, parahippocampal gyrus, and amygdala. Population-level attribution also showed interhemispheric differences across several regions. Conclusions: Structural MRIs of MRI-negative TLE contain latent discriminative information that can be recognized by deep learning models. The H-MSResNet and LRP framework provides viable, explainable methodological support for the computer-aided diagnosis and brain region analysis of MRI-negative epilepsy.
Background/Objectives: Wilson disease (WD) is an autosomal recessive disorder of copper metabolism caused by pathogenic variants in the ATP7B gene. Early diagnosis and appropriate treatment are essential for preventing irreversible complications. This study demonstrated the clinical utility of integrated high-throughput genomic analysis for molecular diagnosis and genetic counseling in a large Thai family affected by WD. Methods: A 32-year-old woman with clinical features suggestive of WD underwent clinical, biochemical, and molecular genetic evaluations, including sequencing of the entire ATP7B gene and SNP microarray. Fluorescent PCR followed by capillary electrophoresis was used for segregation analysis in available family members. SNP microarray analysis and whole-exome sequencing were performed on the proband’s husband to identify pathogenic variants in the ATP7B gene and other disease-associated genes for reproductive risk assessment. Results: The proband presented with hepatic dysfunction, Kayser–Fleischer rings, low serum ceruloplasmin, and a family history of fatal liver disease. She also developed progressive weakness, with nerve conduction findings consistent with axonal sensorimotor polyneuropathy predominantly affecting the lower limbs. Sequencing identified a novel homozygous 28-bp splice-junction deletion, c.4022-24_4025del, which disrupted the canonical splice acceptor site at the intron 19/exon 20 boundary and was classified as pathogenic variant. Segregation analysis confirmed carrier status in the proband’s father and identified heterozygous carrier or homozygous wild-type status among her living siblings. SNP microarray analysis revealed a 46.7 Mb copy-neutral long contiguous stretch of homozygosity (CN-LCSH) encompassing ATP7B, with CN-LCSH regions accounting for 2.046% of the total autosomal genome. These findings potentially reflected segmental uniparental isodisomy or identity by descent, while the overall homozygosity pattern did not support recent consanguinity. Combined genomic analyses of the proband’s husband revealed no pathogenic or likely pathogenic ATP7B variants. Based on the available testing, all offspring are expected to be heterozygous carriers, and the risk of an affected child is considered very low. Conclusions: This study highlights the value of integrated genomic analysis for molecular diagnosis, cascade testing, and reproductive risk counseling. Further functional studies should be conducted to validate their pathogenicity.
Background/Objectives: Because brain MRI and initial CSF cytology have limited sensitivity, suspected leptomeningeal metastasis (LM) may remain unresolved. We developed a model using clinical and CSF measurements available in source records to support identification of current LM in patients with lung adenocarcinoma undergoing CSF evaluation. Methods: This single-center retrospective cohort included 533 patients with lung adenocarcinoma and CNS metastases: 366 with a retrospectively verified reference diagnosis of current LM and 167 with brain metastases only. An eight-variable logistic model underwent repeated nested cross-validation. Conditional internal performance was estimated using outer-split thresholds selected by inner resampling at specificity >0.90. Results: Mean outer held-out AUROC was 0.960 (95% CI, 0.942–0.974), Brier score was 0.068 (0.054–0.084), calibration slope was 0.864 (0.708–1.106), sensitivity was 0.912 (0.883–0.938), and specificity was 0.901 (0.857–0.939). In a descriptive full-cohort analysis, the model flagged 157 of 170 (92.4%) current-LM patients not identified by the brain MRI strategy and 59 of 65 (90.8%) not identified by first CSF cytology for further evaluation. These were not independent head-to-head accuracy comparisons because MRI and cytology contributed to the reference diagnosis. Conclusions: In this selected cohort, the clinical and CSF measurements captured a multivariable pattern associated with a retrospectively verified reference diagnosis of current LM. The model showed strong conditional internal performance and may serve as an investigational adjunct to prompt further LM-directed evaluation. Independent multicenter validation is required before clinical use.
Objective: This study evaluates the prognostic significance of pretreatment [18F]FDG PET/CT metabolic parameters in esophageal cancer and identifies independent predictors of overall survival (OS). Methods: This retrospective single-center study included 152 treatment-naïve patients with histopathologically confirmed esophageal cancer who underwent staging [18F]FDG PET/CT between May 2015 and August 2025. SUVmax, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured for the primary tumor. Overall survival was analyzed with Kaplan–Meier and Cox proportional hazards models, and cut-off values were derived by receiver operating characteristic (ROC) analysis. Results: During a median follow-up of 70 months, 106 patients (69.7%) died. In comparisons of median values, MTV and TLG were higher in patients who died (p = 0.004 and p = 0.035), whereas SUVmax and SUVmean did not differ; both volumetric indices were associated with shorter OS as continuous variables and when dichotomized at their ROC-derived cut-offs. Their discrimination was comparable and modest (AUC 0.647 and 0.608). A multivariable model incorporating high TLG achieved a Harrell’s C of 0.715, at least as high as the primary MTV-based model (C = 0.687), so the data do not establish MTV as superior to TLG. In the primary multivariable model, distant metastasis (HR 2.46, 95% CI 1.53–3.98, p < 0.001), and high MTV (≥11.44 cm3; HR 1.79, 95% CI 1.18–2.71, p = 0.006) remained independent predictors of death. Conclusions: Volumetric [18F]FDG PET/CT indices (MTV and TLG) rather than SUVmax carried independent prognostic information for overall survival, alongside distant metastasis, supporting their use as an adjunct to established staging in pretreatment risk stratification, pending prospective multicenter validation.
Background/Objectives: Perioperative androgen-deprivation therapy (ADT) and androgen-receptor pathway inhibitors (ARPIs) are increasingly used in high-risk prostate cancer, yet patient-centred functional-recovery data after radical prostatectomy are scarce and rarely standardized. We assessed whether a smartphone-based digital monitoring pathway could characterize social-continence recovery and capture differences associated with a perioperative hormonal therapy (PHT) strategy after robot-assisted radical prostatectomy with pelvic lymph-node dissection (RARP + LND). Methods: In a two-centre consecutive cohort (n = 98) of men with high-risk, non-metastatic prostate cancer aligned with SUGAR and PROTEUS criteria, we compared upfront surgery (standard of care [SOC], n = 72) with a planned PHT strategy (ADT or ARPI, n = 26); all patients were urinary-continent preoperatively. Clinical data were prospective; patient-reported and patient-experience measures were captured through a routine-care digital platform (Betty Coaching application) delivering an identical prehabilitation/rehabilitation pathway to both groups, with pre- and postoperative pelvic-floor muscle training performed by all patients. The primary endpoint was 6-month social continence (0–1 pad/day), assessed by clinician and patient reports as co-primary sources. Differences are reported as risk differences with 95% confidence intervals (CIs). Results: At 6 weeks, no statistically clear difference was observed (clinician 66.2% vs. 56.5%; risk difference 9.7 percentage points, 95% CI −12 to 32). At 6 months, social continence was lower with PHT (clinician 87.1% vs. 65.0%, difference 22.1 points, 95% CI 2.6 to 44.7; patient 81.3% vs. 58.3%, 22.9 points, 95% CI 2.4 to 43.9), converging by 12 months (96.9% vs. 95.0%). Analgesic-free rates were lower with PHT on postoperative days (POD) 7 and 10. Conclusions: Digital monitoring captured granular recovery trajectories and identified a mid-term social-continence signal associated with PHT, compatible with a transient delay in recovery. These hypothesis-generating findings support embedding standardized digital functional-outcome monitoring in perioperative trials.
Background/Objectives: Cervical cancer recurrence after definitive treatment remains a major clinical challenge, and early detection may improve patient outcomes. This study evaluated the diagnostic performance of fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) for detecting recurrent cervical cancer according to clinical context. Methods: We retrospectively reviewed 1727 post-treatment PET/CT examinations obtained from 659 patients who achieved a complete response after definitive treatment between 2005 and 2024. After excluding 15 examinations that detected second primary malignancies, the recurrence-specific analysis included 1712 examinations from 654 patients. PET/CT findings were classified as true positive, true negative, false positive, or false negative based on histopathology or serial imaging follow-up. Generalized estimating equations were used to account for within-patient clustering. Subgroup analyses were performed according to histology, International Federation of Gynecology and Obstetrics (FIGO) 2009 stage, interval from treatment completion to PET/CT, and clinical context. Results: Of the 1712 examinations, 136 (7.9%) were true positive, 1525 (89.1%) were true negative, 43 (2.5%) were false positive, and 8 (0.5%) were false negative. Overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 94.4%, 97.3%, 76.0%, 99.5%, and 97.0%, respectively. Diagnostic performance was similar across histologic subtypes and FIGO stages. In routine follow-up settings without clinical suspicion of recurrence, PET/CT showed a high NPV (100.0%), whereas examinations performed for clinically suspected recurrence showed a high PPV (96.5%). Conclusions: These findings suggest that the diagnostic interpretation and clinical utility of post-treatment PET/CT may vary according to the clinical setting.
Background/Objectives: High-risk human papillomavirus (HR-HPV) causes cervical cancer, but other sexually transmitted infections (STIs) act as possible cofactors. We herein evaluated the feasibility, logistics, and epidemiology of a community-based screening program in Romania using an innovative veil-based self-sampling device and a digital platform. Methods: Adult women self-collected genital secretions using the Vaginal Veil Collector V-Veil UP2™ device (V-Veil-Up Production SRL, Pitesti, Romania). A digital platform managed registration and results. Dry impregnated veils were transported at ambient temperature via standard courier to an accredited French laboratory for molecular testing using in parallel the Allplex™ HPV HR Detection assay (Seegene, Seoul, Republic of Korea), detecting 14 HR-HPVs, and the Allplex™ STI Essential Assay (Seegene), detecting 7 major pathogens causing STIs [Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum]. Results: Among 960 included women (mean age 41.3 years), technical success was high: 97.7% of samples yielded valid results for HR-HPV and 97.4% for STIs. Sample stability at ambient temperature eliminated cold-chain requirements. Overall, 17.2% of women were positive for HR-HPV and 26.7% for an STI. The most frequent genotypes were HPV-68 (3.0%), HPV-16 (2.9%), and HPV-31 (2.3%); Ureaplasma parvum (24.0%) was the most prevalent bacterial pathogen. The 18–29 age group exhibited the highest risk for HR-HPV (22.2%) and STIs (36.8%). Multivariate analysis revealed strong biological associations: Chlamydia trachomatis was independently associated with overall HR-HPV (aOR: 4.52; 95% CI: 1.26–16.11) and multiple HR-HPV infections (aOR: 13.96; 95% CI: 3.70–52.64). Mycoplasma hominis and Ureaplasma species were also independently associated with HR-HPV (aOR: 1.83 and 1.67, respectively) or nonvaccine types (aOR: 2.75 and 5.03, respectively). Conclusions: Veil-based self-sampling combined with digital logistics is highly feasible, scalable, and overcomes geographical barriers. The marked association between Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma species, and HR-HPV strongly advocates for integrated molecular co-testing models in public health screening programs.
Background/Objectives: Deep learning-based medical imaging applications often require large and diverse datasets to achieve reliable performance. However, publicly available palpebral conjunctiva datasets for non-invasive hemoglobin assessment remain limited in both size and demographic diversity. The objective of this study was to develop and evaluate a conditioning-guided Latent Diffusion Model (LDM) for controllable palpebral conjunctiva image synthesis under limited-data conditions. Methods: The proposed framework employs an image-to-image latent diffusion strategy conditioned on continuous hemoglobin values together with gender and country information to generate realistic synthetic conjunctiva images with controllable clinical and demographic characteristics. The proposed LDM was compared with GAN-based approaches, including cDCGAN and StyleGAN2-ADA, using evaluation criteria covering image realism, diversity, conditioning consistency, and computational efficiency. Analyses of frequency-domain characteristics, zero-shot cross-population evaluation, and blinded clinical assessment were performed for the proposed LDM. Results: The proposed LDM achieved the lowest FID score (15.86±0.23) among the evaluated models, indicating superior image realism relative to cDCGAN and StyleGAN2-ADA, while maintaining image diversity comparable to StyleGAN2-ADA and substantially outperforming cDCGAN. Conditioning evaluation demonstrated strong consistency between the target hemoglobin values and the generated images, achieving a Pearson correlation coefficient of r=0.910±0.025. Frequency-domain analysis, zero-shot cross-population evaluation, and blinded clinical assessment further supported the realism, structural consistency, and clinical plausibility of the generated images. Conclusions: The findings demonstrate the potential of conditional latent diffusion models for controllable palpebral conjunctiva image synthesis under limited-data conditions. The proposed framework provides a promising approach for generating realistic synthetic conjunctiva images with controllable clinical and demographic characteristics.
Background/Objectives: First-trimester anatomical screening (FTAS) enables early detection of fetal structural anomalies. However, data on transvaginal ultrasound performance across different operator experience levels remains limited. The primary objective was to compare the performance of transvaginal FTAS between inexperienced and experienced operators by comparing complete scan rates and anatomical visualization scores. The secondary objectives were to compare scan duration and learning curves between the two operators and to identify factors associated with successful examinations. Methods: In this randomized controlled trial, participants underwent transvaginal FTAS performed either by a first-year maternal–fetal medicine (MFM) fellow (inexperienced operator) or an MFM specialist (experienced operator) according to International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines. Complete scan rates, anatomical visualization scores, scan duration, factors affecting visualization, and learning curves were compared between groups. Results: A total of 139 participants were included in the analysis, with 70 and 69 examinations performed by the inexperienced and experienced operators, respectively. Complete scan rates and visualization scores were not significantly different between groups (41.4% vs. 44.9% and 86.4% vs. 91.2%, respectively). On multivariate analysis, operator experience was independently associated with higher visualization scores (p = 0.010), but not complete scan rates. Scan duration was similar between groups (median (IQR): 20 (17) vs. 20 (15) min; p = 0.211). Fetal presentation and uterine position significantly influenced visualization outcomes. The inexperienced operator demonstrated a trend of gradual improvement over time, though not significantly, whereas the experienced operator maintained stable performance throughout the study period. Conclusions: After training, no statistically significant differences were observed between less experienced and experienced operators with respect to complete scan rate, scan duration, and learning curve, although visualization score was significantly higher in the experienced examiner on multivariate analysis. However, our findings should be interpreted with caution, as the conclusions were based on the performance of only one examiner in each group.
Background/Objectives: Eyelid malpositions can alter corneal shape through chronic mechanical forces, yet conventional topographic devices do not distinguish epithelial from stromal contributions to these changes. This study aimed to characterize layer-specific corneal remodeling after surgical correction of ptosis and ectropion using hybrid spectral-domain OCT/Placido tomography and to assess whether epithelial thickness mapping provides clinically relevant information beyond standard corneal topography. Methods: This study is a retrospective single-center study evaluating 33 eyes of 20 patients: 16 with ptosis and 17 with ectropion. MS-39 imaging was collected preoperatively, at 14 days, and at 6 months. Primary outcomes included sectoral epithelial thickness and inferior–superior (I-S) epithelial asymmetry. Secondary outcomes included central corneal and estimated minimum stromal thickness; keratometric values were analyzed as tertiary outcomes. Results: In the ptosis group, superior epithelial thickness increased from 40.7 to 44.3 µm at 6 months (p = 0.001), while I-S asymmetry decreased from 10.1 to 4.5 µm (p = 0.001). In the ectropion group, inferior epithelial thickness decreased from 54.8 to 51.0 µm, with changes detectable at 14 days, and I-S asymmetry decreased from 8.1 to 3.8 µm. Central corneal and estimated minimum stromal thickness remained stable in both groups. K2 and anterior corneal astigmatism decreased significantly by 6 months in both groups. Conclusions: Surgical correction of eyelid malpositions was associated with predominantly epithelial remodeling, while stromal thickness remained stable. These epithelial changes may modify keratometric and astigmatic measurements, supporting reassessment after corneal stabilization, the timing of which requires further characterization, in patients considered for refractive or premium cataract surgery.
Background: Neoadjuvant systemic therapy (NST) enables tumor downsizing and increases the feasibility of breast-conserving surgery (BCS) in patients with early breast cancer (EBC). Reliable tumor localization after NST remains challenging, particularly in patients with a complete clinical response. If clips are not visible on ultrasound, stereotactic mammography-guided wire localization is required, which involves additional radiation exposure and may increase patient discomfort and procedural complexity. The 3D-shaped Tumark® Vision clip may enable ultrasound-guided localization after NST. Methods: In this prospective multicenter registry study (NCT04468113), 324 patients with biopsy-proven EBC scheduled for NST and breast-conserving surgery were enrolled across 19 German centers. Clip placement was performed under ultrasound guidance prior to NST, and clip detectability was assessed at predefined time points during therapy (4–8, 9–12, and ≥13 weeks after treatment initiation). Detection rates, visualization, and preoperative localization methods were recorded. Non-detectable clips required stereotactic wire localization, whereas ultrasound-guided localization was performed for detectable clips. Results: The preoperative detection rate was 91.1%. Clip detectability was higher in patients with longer NST durations and partial response by imaging. Ultrasound-guided wire localization was feasible in 214 patients (83.9%); among these, 165 patients (64.7%) underwent localization without and 49 patients (19.2%) with post-procedural mammographic verification. Stereotactic localization was required in 41 patients (16.1%), primarily due to non-visualization of the clip on ultrasound. The accuracy of ultrasound for residual tumor assessment was moderate (72.0%), with a sensitivity of 70.7%, indicating limitations in its ability to reliably assess residual tumor extent as a standalone modality. Conclusions: The 3D nickel–titanium clip enables ultrasound-guided tumor localization after NST in the majority of patients with early breast cancer, although additional mammographic guidance remains necessary in a relevant proportion of cases.
Background/Objectives: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be performed via pathways that differ in anesthesia, setting, airway management, monitoring, recovery, and hospitalization. We compared an outpatient endoscopy suite pathway with sedation and spontaneous breathing, and an operating room pathway with general anesthesia and laryngeal mask ventilation, assessing cytology-based yield, sample adequacy, workflow, and costs. Methods: This single-center observational study included consecutive EBUS-TBNA procedures. Allocation was nonrandom and reflected workflow, operating room availability, complexity, airway/anesthetic considerations, and judgment. The primary endpoint was cytology-based diagnostic yield in the diagnostic cohort; staging outcomes included cytology distribution, sample adequacy, and positivity among adequate samples. Systematic diagnostic verification was not available for the entire cohort; however, postoperative nodal pathology was retrospectively retrieved when available in the staging cohort. Because verification remained incomplete and selectively available, sensitivity, specificity, negative predictive value, and overall diagnostic accuracy were not estimated. Results: Clinical outcome analyses included 447 procedures (319 diagnostic and 128 staging), while the administrative cost dataset included 533 completed procedures. Diagnostic yield was similar between pathways (108/229, 47.2% vs. 45/90, 50.0%; p = 0.740). In the staging cohort, sample adequacy was comparable (83/85, 97.6% vs. 39/42, 92.9%; p = 0.331), and positivity among adequate samples did not differ (21.7% vs. 20.5%; p = 1.000). Exploratory postoperative pathological nodal-stage data were available for 60/128 staging procedures; among 58 cases with interpretable EBUS-TBNA results, patient-level N-stage concordance was 44/58 (75.9%), and postoperative nodal upstaging occurred in 11/58 (19.0%). No prespecified intraprocedural composite adverse events were documented. Duration appeared shorter in operating room cases but, owing to incomplete differential recording, was descriptive only. Length of stay and costs were markedly higher in the operating room pathway. Conclusions: The pathways showed similar cytology-based outcomes but differed in hospitalization rates and costs. Nonrandom allocation and pathway heterogeneity preclude causal interpretation as a sedation-versus-general-anesthesia comparison. Prospective studies with standardized allocation, diagnostic verification, systematic capture of adverse events, and follow-up are warranted.
Background/Objectives: Estrogen receptor immunohistochemistry (ER-IHC) exhibits heterogeneous staining and substantial class imbalance, complicating segmentation of ordered expression categories. We evaluated whether class weighting, minority-focused crop sampling, adaptive minority curriculum (AMC), and Focal–Tversky optimization improved a common ResUNet-DS backbone for segmenting background/non-target pixels and C1 ER-negative, C2 weak-positive, C3 moderate-positive, and C4 strong-positive foreground categories. Methods: The dataset comprised 220 paired 512×512 image–mask patches organized into 44 recovered five-patch source groups. A source-group-preserving nested five-fold design used outer folds of 45, 45, 45, 45, and 40 patches. Six controlled training conditions were compared, with four independently selected inner models ensembled for each condition and outer fold. Results: Unweighted random training achieved the best numerical mean for all five primary endpoints: foreground Dice (0.7479±0.0123), C2–C4 Dice (0.7098±0.0128), foreground IoU (0.6074±0.0147), foreground quadratically weighted kappa (0.9761±0.0040), and foreground-ordinal MAE (0.0446±0.0062). Weighted random training was the strongest weighted/minority-sensitive condition but did not exceed the unweighted reference. None of 25 paired outer-fold comparisons reached p<0.05; the minimum raw p-value was 0.0625, and all Holm-adjusted p-values were 0.3125. A 20,000-replicate paired source-group bootstrap preserved the same overall ordering. Conclusions: More complex imbalance-handling strategies did not improve aggregate segmentation over unweighted training. Post hoc analyses showed scope-dependent probability quality and error ranking. IHC4BC provided expression-ordering consistency but not direct external segmentation validation. The findings support preliminary source-group-preserving methodological evidence rather than patient-level, whole-slide, or clinical validity.
Background/Objectives: Fibrosing interstitial lung disease (F-ILD) is associated with progressive respiratory impairment and substantial symptom burden. Diaphragmatic ultrasound (DUS) is a non-invasive method for assessing diaphragmatic structure and function, but its clinical role in F-ILD remains uncertain. This systematic review evaluated the available evidence on DUS in adults with F-ILD. Methods: This systematic review was conducted and reported according to the PRISMA guidelines. MEDLINE, Embase, CINAHL, and the Cochrane Library were searched and observational studies evaluating DUS in adults with F-ILD were included. Risk of bias was assessed using the QUADAS-2, and outcome-level certainty of evidence was evaluated by GRADE framework. Results: Six cross-sectional observational studies involving 232 participants were included. Diaphragmatic excursion (DE) was assessed in all six studies, while diaphragm thickness (DT) and thickening fraction (TF) were evaluated in four. Some studies reported abnormalities in DUS parameters during deep breathing and cross-sectional associations with pulmonary function, exercise capacity, dyspnoea, or radiological severity. Substantial heterogeneity in study populations, ultrasound protocols, and outcome reporting precluded meta-analysis. The certainty of evidence was very low. Conclusions: Current evidence suggests that DUS may detect diaphragmatic abnormalities in patients with F-ILD and may have future complementary value alongside established clinical assessments. However, the evidence is limited, heterogeneous, and of very low certainty and does not establish diagnostic accuracy, prognostic value, or usefulness for longitudinal monitoring. Accordingly, DUS cannot currently be recommended for routine clinical implementation in F-ILD, and prospective longitudinal validation is required.
Background/Objectives: The study aimed to investigate the significance of laboratory biomarkers, particularly the lactate-to-hemoglobin ratio at admission in predicting 30-day mortality in patients with acute upper gastrointestinal bleeding (UGIB). Methods: Patients who presented to the emergency department due to acute UGIB between January and December 2024 were included in the study. The laboratory parameters at the time of admission, medication usage, endoscopic diagnoses, and 30-day mortality rates of the patients were investigated. It was investigated whether there were differences in biochemical parameters such as hemoglobin, hematocrit, neutrophil, lymphocyte, platelet, international normalized ratio (INR), pH, lactate, blood urea nitrogen (BUN), creatinine, C-reactive protein (CRP), albumin, BUN to creatinine ratio, and lactate to hemoglobin ratio between patients with and without 30-day mortality. In addition, the relationship between mortality, drug use, and endoscopic diagnoses was examined. Results: A total of 241 patients participated in the study. Of the participants in the study, 79 (32.8%) were women and 162 (67.2%) were men. The average age of the patients was 70 years. The most common causes of bleeding were, in order, bulbar ulcer (n = 84, 34.9%) and gastric ulcer (n = 79, 32.8%). A total of 15 (6.2%) patients developed mortality within 30 days. In the mortality group, lymphocyte (p = 0.016) and albumin (p = 0.026) values were statistically low, while INR (p = 0.041), creatinine (p = 0.020), CRP (p < 0.01), lactate (p = 0.014) and lactate to Hb ratio (LHR) (p = 0.012) values were significantly high. In cases of bleeding due to malignancy, mortality was higher. No association was found between medication use and mortality. Conclusions: In this exploratory study, the LHR showed potential as an adjunctive biomarker for estimating 30-day mortality in patients with non-variceal acute UGIB. It can be readily calculated based on common laboratory values, does not necessitate complex scoring systems, and can help with quick risk assessment in emergency conditions. Large, multicenter prospective studies are required to confirm prediction accuracy as well as identify optimum cutoff values for clinical application.
Background/Objectives: Accurate preoperative detection of locally advanced breast cancer is essential for neoadjuvant therapy planning. We developed and validated gradient-boosting models using structured BI-RADS mammographic features to simultaneously predict locally advanced breast cancer (LABC), DCIS component, and multifocality in a multi-center cohort. Methods: This retrospective study enrolled 2295 patients from three university-affiliated hospitals; features were coded according to BI-RADS. CatBoost and logistic regression models were built using stratified 60/20/20 splits, with performance assessed via bootstrap resampling, nested cross-validation, and sensitivity analyses. AUROC, AUPRC, Brier score, and calibration metrics assessed discrimination and clinical utility; a leakage audit and SHAP analysis supported interpretation. Results: CatBoost achieved an AUROC of 0.906 (95% CI: 0.876–0.932) for LABC. Because several top predictors overlap with the anatomical criteria defining this outcome, we repeated the analysis excluding them; the reduced model retained a mean AUROC of 0.739, indicating genuine predictive signal beyond the staging overlap. Net benefit was positive across all relevant thresholds, with calibration error of 0.053. DCIS prediction was highly accurate (AUROC 0.979; nested AUROC 0.9707), with no evidence of leakage. Multifocality prediction was more modest (AUROC 0.810), reflecting known limits of two-dimensional mammography. Sensitivity analyses confirmed stable performance across splits, training sizes, and class-weighting schemes. Conclusions: Structured mammographic features combined with gradient-boosting support clinically meaningful, though partly overlapping, risk stratification for LABC; once accounted for, the model still retains independent value. The DCIS model performed very well; multifocality prediction remains more limited, and external validation is needed before clinical use.
