The purpose of this study was to analyze the value of transrectal shear-wave elastography (SWE) in combination with multivariable tools for predicting adverse pathological features before radical prostatectomy (RP). Preoperative clinicopathological variables, multiparametric magnetic resonance imaging (mp-MRI) manifestations, and the maximum elastic value of the prostate (Emax) on SWE were retrospectively collected. The accuracy of SWE for predicting adverse pathological features was evaluated based on postoperative pathology, and parameters with statistical significance were selected. The diagnostic performance of various models, including preoperative clinicopathological variables (model 1), preoperative clinicopathological variables + mp-MRI (model 2), and preoperative clinicopathological variables + mp-MRI + SWE (model 3), was evaluated with area under the receiver operator characteristic curve (AUC) analysis. Emax was significantly higher in prostate cancer with extracapsular extension (ECE) or seminal vesicle invasion (SVI) with both P < 0.001. The optimal cutoff Emax values for ECE and SVI were 60.45 kPa and 81.55 kPa, respectively. Inclusion of mp-MRI and SWE improved discrimination by clinical models for ECE (model 2 vs model 1, P = 0.031; model 3 vs model 1, P = 0.002; model 3 vs model 2, P = 0.018) and SVI (model 2 vs model 1, P = 0.147; model 3 vs model 1, P = 0.037; model 3 vs model 2, P = 0.134). SWE is valuable for identifying patients at high risk of adverse pathology.
Male ; Humans ; Prostate/pathology* ; Seminal Vesicles/diagnostic imaging* ; Elasticity Imaging Techniques ; Retrospective Studies ; Extranodal Extension/pathology* ; Neoplasm Staging ; Prostatectomy/methods* ; Prostatic Neoplasms/pathology* ; Magnetic Resonance Imaging/methods*

At present, preoperative assessment of rectal cancer stage mainly relies on imaging examination, and the results of imaging reading will directly determine the treatment. In order to alleviate the reading pressure of the radiologist and improve the efficiency and accuracy of imaging diagnosis, there are related studies on using artificial intelligence automatic recognition system to assist the imaging assessment of rectal cancer staging now. Colorectal Surgery Group, Chinese Society of Surgery of the Chinese Medical Association, along with Beihang University, proposed the expert's advice on the surgical clinical application of rectal cancer staging recognition system based on artificial intelligence platform, so as to guide the standard application of this technology and promote the automation and intelligence of imaging reading.
Artificial Intelligence ; Diagnostic Imaging ; Digestive System Surgical Procedures ; Humans ; Magnetic Resonance Imaging ; Neoplasm Staging ; Rectal Neoplasms/surgery*

The International Agency for Research on Cancer (IARC) published the World Health Organization (WHO) classification of thoracic tumors (5th edition) in May 2021, only six years after the 4th edition of WHO Classification. With the application of low-dose spiral computed tomography (CT) as an early screening method for lung tumors in recent years, lung adenocarcinoma has become the main type of disease in many hospital surgical treatments. The WHO classification serves as the authoritative guide for pathological diagnosis, and any slight change in the classification is at the heart of pathologists, clinicians and patients. Adenocarcinoma in situ is a newly added type of adenocarcinoma diagnosis in the 4th edition of the WHO classification, and it is also the focus of clinical treatment and research at home and abroad in recent years. Because its catalog position has been adjusted in the 5th edition of the WHO classification, there has been a huge controversy and discussion among clinicians and patients that "adenocarcinoma in situ was excluded from the category of malignant tumors". This article will briefly explain the origin of the diagnosis of lung adenocarcinoma in situ, the adjustment of the new classification catalog, and whether adenocarcinoma in situ is benign or malignant.
.
Adenocarcinoma in Situ/pathology* ; Adenocarcinoma of Lung/diagnostic imaging* ; Humans ; Lung Neoplasms/pathology* ; Neoplasm Staging

OBJECTIVE: To evaluate the performance of 3.0T magnetic resonance imaging examination (MRI) for the local detecting of muscle invasive bladder cancer following transurethral resection of bladder tumor (TURBT). METHODS: Retrospective study identified 55 patients with pathology-proven bladder cancer who underwent transurethral resection of bladder tumor followed by 3.0T magnetic resonance imaging between September 2012 and April 2019 in our hospital. Two radiologists reviewed pelvic magnetic resonance imaging together and judged muscle invasive bladder cancer. Sensitivity, specificity and accuracy were calculated for the presence of muscle invasion by T2 weighted imaging (T2WI) only, diffusion-weighted imaging (DWI) only and T2WI+DWI compared with the findings at radical cystectomy as the reference standard. RESULTS: Of the 55 patients with pathological results from radical cystectomy, 3.64% (2/55) had no residual disease; 29.09% (16/55) were non-muscle invasive bladder cancer on pathology, including 13 cases in T1 and 3 cases in Ta; 34.55% (19/55) were in stage T2 depending on pathology, 25.45% (14/55) in T3, and 7.27% (4/55) in T4. The average age was 60.76 years, ranging from 42 to 82 years. There were 48 males and 7 females in our study. Before pelvic MRI examination, all the patients received transurethral resection of bladder tumor, including 16 cases taking the operation in our hospital and 39 cases in other hospitals. The interval between the pelvic MRI examination and transurethral resection of bladder tumor was more than 2 weeks in all the patients. They all underwent radical cystectomy within 1 month after the pelvic MRI examination, and no patient underwent radiotherapy or chemotherapy in our study during the interval between the MRI examination and radical cystectomy. T2WI only, DWI only, and T2WI+DWI of 3.0T magnetic resonance imaging for readers were with sensitivity: 94.59%, 83.78%, 91.89%; with specificity: 66.67%, 77.78%, 72.22% and with accuracy: 85.45%, 81.82%, 85.45%, respectively. CONCLUSION 3.0T MRI may have a role in diagnosing muscle invasive bladder cancer following TURBT. T2WI has the advantage of detecting the location of bladder tumor, and DWI has the advantage of differentiating between the benign and malignant lesion. 3.0T MRI T2WI+DWI has a good utility in the detection of muscle invasive bladder cancer following TURBT with satisfied accuracy.
Adult ; Aged ; Aged, 80 and over ; Cystectomy ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Urinary Bladder Neoplasms/diagnostic imaging*

BACKGROUND: An artificial intelligence system of Faster Region-based Convolutional Neural Network (Faster R-CNN) is newly developed for the diagnosis of metastatic lymph node (LN) in rectal cancer patients. The primary objective of this study was to comprehensively verify its accuracy in clinical use. METHODS: Four hundred fourteen patients with rectal cancer discharged between January 2013 and March 2015 were collected from 6 clinical centers, and the magnetic resonance imaging data for pelvic metastatic LNs of each patient was identified by Faster R-CNN. Faster R-CNN based diagnoses were compared with radiologist based diagnoses and pathologist based diagnoses for methodological verification, using correlation analyses and consistency check. For clinical verification, the patients were retrospectively followed up by telephone for 36 months, with post-operative recurrence of rectal cancer as a clinical outcome; recurrence-free survivals of the patients were compared among different diagnostic groups, by methods of Kaplan-Meier and Cox hazards regression model. RESULTS: Significant correlations were observed between any 2 factors among the numbers of metastatic LNs separately diagnosed by radiologists, Faster R-CNN and pathologists, as evidenced by rradiologist-Faster R-CNN of 0.912, rPathologist-radiologist of 0.134, and rPathologist-Faster R-CNN of 0.448 respectively. The value of kappa coefficient in N staging between Faster R-CNN and pathologists was 0.573, and this value between radiologists and pathologists was 0.473. The 3 groups of Faster R-CNN, radiologists and pathologists showed no significant differences in the recurrence-free survival time for stage N0 and N1 patients, but significant differences were found for stage N2 patients. CONCLUSION: Faster R-CNN surpasses radiologists in the evaluation of pelvic metastatic LNs of rectal cancer, but is not on par with pathologists. TRIAL REGISTRATION www.chictr.org.cn (No. ChiCTR-DDD-17013842).
Adult ; Aged ; Aged, 80 and over ; Artificial Intelligence ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Neural Networks (Computer) ; Pathologists ; Radiologists ; Rectal Neoplasms ; diagnostic imaging ; mortality ; pathology

The accurate judgement of the upper and lower borders of the adenocarcinoma of esophagogastric junction (AEG) by radiology can facilitate the decisions on surgical approach and staging criteria. X-ray double contrast radiography, CT and MRI are the common modalities. The accuracy of X-ray double contrast radiography in determining the invasion length of esophagus and the central point of gastric infiltration can be improved by standardized pretreatment, combination of multiple contrast methods such as double contrast and flow-coating procedure, and combination of multi-angle observations such as conventional frontal, left /right anterior oblique and supine right posterior oblique position. Abdominal enhanced CT is the imaging method recommended by clinical guidelines for the radiological examination of AEG. The relative position of the central point of the tumor from 2 cm line can be determined through the combination of measurement and formula calculation on multi-planar reconstructed CT images. The "three-layer four-type" classification can provide reference for the selection of abdominothoracic incision. The direct demonstration of the tumor extension can be achieved through the CT curved planar reconstruction by drawing lines along esophagus to stomach. The combination of multiple sequences of MRI is helpful to determine the extension of the lesions. In the future, more radiological studies are needed to establish criteria with high accuracy, repeatability and convenient operation,and to assist clinical evaluation of AEG invasion.
Adenocarcinoma ; classification ; diagnostic imaging ; pathology ; surgery ; Contrast Media ; Esophageal Neoplasms ; classification ; diagnostic imaging ; pathology ; surgery ; Esophagogastric Junction ; diagnostic imaging ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Neoplasm Invasiveness ; Neoplasm Staging ; Stomach Neoplasms ; classification ; diagnostic imaging ; pathology ; surgery ; Tomography, X-Ray Computed

BACKGROUND: Pneumonic-type lung carcinoma is a special type of lung cancer both clinically and radiologically. Here we present our experience on pneumonic-type lung carcinoma in an attempt to investigate the clinical, radiological and pathological features, diagnostic procedures, treatment, and prognosis of this type of tumor. METHODS: Pathologically confirmed lung cancer with a chest CT characterized by ground glass opacity or consolidation was defined as pneumonic-type lung carcinoma. Cases with advanced pneumonic-type lung carcinoma admitted to Peking Union Medical College Hospital (PUMCH) from January 1, 2013 to August 30, 2018 were enrolled. Retrospective analysis of clinical data and survival follow-up of these patients was conducted. RESULTS: A total of 46 cases were enrolled, all of which were adenocarcinoma. Cough (41/46, 89.1%) and expectoration (35/46, 76.1%) were the most prominent symptoms. The most frequent chest CT findings were ground glass attenuation (87.0%), patchy consolidation (84.8%), and multiple ground-glass nodules (84.8%). Multiple cystic changes (40%) and cavitation (13%) were also quite frequent. Ipsilateral and contralateral intrapulmonary metastasis were noted in 95.3% and 84.8% of cases respectively. The median duration from symptom onset to diagnosis was 214 days (95%CI: 129-298). Both surgical lung biopsy and CT-guided percutaneous lung biopsy had a diagnostic yield of 100%. Transbronchial lung biopsy (TBLB) combined with bronchoalveolar lavage (BAL) had a diagnostic yield of 80.9% (17/21). Sputum cytology had a diagnostic yield of 45% (9/20). Twenty-six cases were invasive mucinous adenocarcinoma (26/46, 56.5%) and the remainder were unable to identify pathological subtypes due to lack of adequate biopsy sample size. EGFR mutation was detected in 15.8% (6/38) of patients and ALK rearrangement was detected in 3.0% (1/33) of patients. The median overall survival for these patients was 522 d (95%CI: 424-619). In patients without EGFR mutation or ALK rearrangement, chemotherapy significantly improved survival (HR=0.155, P=0.002,2). The median overall survival was 547 d (95%CI: 492-602 d) with chemotherapy and 331 d (95%CI: 22-919) without chemotherapy. CONCLUSIONS Diagnosis of pneumonic-type carcinoma is usually delayed due to clinical and radiological features mimicking pulmonary infection. TBLB combined with BAL has a quite high diagnostic yield. The most frequent histological type is invasive mucinous adenocarcinoma. The incidence of EGFR mutation or ALK rearrangement is low in pneumonic-type carcinoma. For patients without cancer driver genes, chemotherapy is recommended to improve overall survival.
Aged ; Anaplastic Lymphoma Kinase ; genetics ; metabolism ; Antineoplastic Agents ; therapeutic use ; Carcinoma ; diagnostic imaging ; drug therapy ; genetics ; pathology ; ErbB Receptors ; genetics ; metabolism ; Female ; Gene Rearrangement ; Humans ; Lung Neoplasms ; diagnostic imaging ; drug therapy ; genetics ; pathology ; Male ; Middle Aged ; Mutation ; Neoplasm Staging ; Retrospective Studies ; Survival Analysis ; Tomography, X-Ray Computed

BACKGROUND: The preferred therapy for patients with pulmonary nodules which highly suspected as lung cancer by low-dose spiral computed tomography (CT) is surgery, but the best screening method of whole body is not clear yet. The aim of this study is to investigate the differences in the progression-free survival (PFS) of patients with Ia stage non-small cell lung cancer after screening of positron emission computed tomography (PET)-CT and conventional imaging (B-ultrasound/CT/MRI/ECT, BCME). METHODS: A total of 300 cases of Ia stage non-small cell lung cancer were collected, of which 170 cases were performed PET-CT and 130 cases were performed BCME before operation. The basic characteristics of the two groups were analyzed by propensity score matching (PSM), and 114 cases of each group were included in the study. The survival analysis was carried out by the Kaplan-Meier survival curve and the Cox regression analysis. RESULTS: There was no significant difference between each group analyzed by PSM. The PFS of PET-CT and BCME were (44.9±27.2) months and (44.1±33.1) months (χ2=1.284, P=0.257). Both of the method ssucceed in screening. It is not the PFS influence factors. The false positive of PET-CT and BCME were 10 cases and 8 cases (χ2=0.241, P=0.623). CONCLUSIONS Both PET-CT and BCME can be used as a screening method for Ia stage non-small cell lung cancer according to individualized choice of patients.
Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; pathology ; surgery ; Disease-Free Survival ; Early Detection of Cancer ; methods ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Positron Emission Tomography Computed Tomography ; Preoperative Period

BACKGROUND: Accurate evaluation of lymph node metastasis in bladder cancer (BCa) is important for disease staging, treatment selection, and prognosis prediction. In this study, we aimed to evaluate the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for metastatic lymph nodes in BCa and establish criteria of imaging diagnosis. METHODS: We retrospectively assessed the imaging characteristics of 191 BCa patients who underwent radical cystectomy. The data regarding size, shape, density, and diffusion of the lymph nodes on CT and/or MRI were obtained and analyzed using Kruskal-Wallis test and χ test. The optimal cutoff value for the size of metastatic node was determined using the receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 184 out of 3317 resected lymph nodes were diagnosed as metastatic lymph nodes. Among 82 imaging-detectable lymph nodes, 51 were confirmed to be positive for metastasis. The detection rate of metastatic nodes increased along with more advanced tumor stage (P < 0.001). Once the ratio of short- to long-axis diameter ≤ 0.4 or fatty hilum was observed in lymph nodes on imaging, it indicated non-metastases. Besides, lymph nodes with spiculate or obscure margin or necrosis indicated metastases. Furthermore, the short diameter of 6.8 mm was the optimal threshold to diagnose metastatic lymph node, with the area under ROC curve of 0.815. CONCLUSIONS The probability of metastatic nodes significantly increased with more advanced T stages. Once lymph nodes are detected on imaging, the characteristic signs should be paid attention to. The short diameter > 6.8 mm may indicate metastatic lymph nodes in BCa.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Staging ; Pelvic Neoplasms ; diagnostic imaging ; pathology ; secondary ; surgery ; Pelvis ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed ; Urinary Bladder Neoplasms ; diagnostic imaging ; pathology ; surgery

To determine the clinicopathological and imaging features in 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography and computed tomography (PET/CT) for paraganglioma of testis, and to increase the diagnostic accuracy.
 Methods: A case of paraganglioma of testis with multiple lymph node and lung metastasis were reported. PET/CT and pathological findings in the case were retrospectively analyzed.
 Results: The patient presented with high blood pressure, high level of catecholamine, and urinary vanillylmandelic acid. The patient underwent 18F-FDG PET/CT, which showed the features including the right testis nodule with a star lesion nearby, the right spermatic cord, the lymphadenopathy of bilateral inguinal and retroperitoneum, the posterior basal segment of right lung nodule, and a lot of brown adipose tissues (BAT) in the whole body with intense FDG uptake. 18F-FDG PET/CT showed that the intense FDG uptake of the BAT disappeared after the excision of the right testis and metastasis of paraganglioma.
 Conclusion: PET/CT shows great value in localization diagnose, clinical staging and curative evaluation. PET/CT plays a helpful role in revealing the BAT with 18F-DG avidity in the patients with paraganglioma with elevated blood pressure, high level catecholamine, and urinary vanillylmandelic acid.
Fluorodeoxyglucose F18 ; Humans ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; Male ; Neoplasm Staging ; Paraganglioma ; diagnostic imaging ; surgery ; Positron Emission Tomography Computed Tomography ; Retrospective Studies ; Sensitivity and Specificity ; Testicular Neoplasms ; diagnostic imaging ; surgery ; Testis ; diagnostic imaging ; surgery