Search Results (380)

Background/Objectives: Rotator cuff calcific tendinopathy (RCCT) is one of the most common causes of non-traumatic shoulder pain. To date, there is still no consensus regarding the most effective method for its treatment. Ultrasound-guided percutaneous aspiration is suggested during the reabsorption phase of calcific metaplasia. We aimed to evaluate the effectiveness of ultrasound-guided lavage for RCCT from a clinical and radiological perspective. Methods: We involved patients affected by RCCT of the supraspinatus tendon. The approach used for the calcification lavage was the one-needle technique, consisting in inserting a 16–18 G needle on a 20 mL syringe with 0.9% saline solution, in the calcific metaplasia, under ultrasound guidance, using an in-plane approach; the repetitive action of pressing and releasing the plunger was repeated until the contents of the syringe became milky, at which point the syringe was replaced with a new one, always containing saline solution. The physiotherapy treatment began 7 days after the procedure. We assessed the Numeric Rating Scale, the Gartner classification, the Disability of the Arm, Shoulder and Hand scale, the Constant–Murley shoulder score, and the passive range of motion of flexion and abduction. Results: We included 23 subjects. The analysis of the data at baseline and t1 showed a statistically significant improvement in all the functional variables (p < 0.05). This result was mainly evident for pain, with a p-value of 0.001. Conclusions: The findings of the present prospective case series study showed an improvement in the clinical and radiological outcomes after ultrasound-guided percutaneous aspiration for rotator cuff calcific tendinopathy. Full article

Background/Objectives: Thyroid nodules are commonly found through sensitive imaging methods like ultrasonography. While most nodules are benign and asymptomatic, certain characteristics may indicate malignancy, prompting fine needle aspiration biopsy. Factors like age and gender affect cancer risk, complicating ultrasound-based risk systems. We aimed to determine whether the cytological malignancy rate of thyroid nodules could be adjusted for several clinical parameters. Methods: Data from patients aged 18 and above with thyroid nodules assessed via fine needle aspiration (FNA) were retrospectively reviewed. Malignancy classification was based on cytopathology and histopathology results. The study examined how various clinical parameters, adjusted for the ACR TI-RADS category, affected thyroid nodule malignancy rates, including age, sex, Body Mass Index (BMI), nodule size, presence of autoimmunity, and thyroxine therapy. Additionally, we analyzed the performance of ACR TI-RADS in predicting malignant cytology across different age subgroups of thyroid nodules. Results: The study included 1128 thyroid nodules from 1001 adult patients, with a median age of 48 years and predominantly female (76.68%). Malignancy rates varied across ACR TI-RADS categories, with higher rates associated with larger nodules and younger age groups. Age emerged as a significant predictor of malignancy, with a consistent decrease in the odds ratio for malignant cytology with advancing age across all ACR TI-RADS categories, indicating its potential utility in risk assessment alongside nodule size and sex. Conclusions: Raising the size threshold for recommending FNA of TR3-3 nodules and incorporating patients’ age and gender into the evaluation process could enhance the system’s accuracy in assessing thyroid nodules and guiding clinical management decisions. Full article

Objectives: Oncocyte-rich indeterminate thyroid nodules (O-ITNs) present diagnostic and management challenges due to overlapping features between benign and malignant lesions and differing cytological classifications. This study aimed primarily to assess the ultrasound (US) characteristics and US-based risk of O-ITNs using the American College of Radiology Thyroid Imaging Reporting And Data Systems (ACR TI-RADS). A secondary objective was to compare the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) and Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC) cytological systems regarding classification and clinical management implications for O-ITNs. Methods: A retrospective study was conducted on 177 ITNs (TIR3A and TIR3B) evaluated between June 2023 and December 2024 at CTO-Alesini, Rome (Italy). Nodules were assessed with US, cytology, and histology. Oncocyte predominance was defined as >70% oncocytes on fine-needle aspiration (FNA). US features were analyzed according to ACR TI-RADS. Nodules were reclassified by BSRTC, and potential differences in clinical case management (CCM) were analyzed. Results: O-ITNs comprised 47.5% of the sample. Compared to non-O-ITNs, O-ITNs were larger and more frequently showed low-risk US features, including a higher prevalence of ACR TI-RADS 3 nodules. However, no progressive increase in the risk of malignancy (ROM) was observed across ACR TI-RADS classes within O-ITNs. Histological malignancy was identified in 47.1% of O-ITNs, a lower proportion compared to non-O-ITNs, though the difference was not statistically significant. Classification discordance with potential management impact was lower in O-ITNs (20.2%) than in non-O-ITNs (38.7%). Conclusions: O-ITNs typically exhibit benign-appearing US features and lower classification discordance between BSRTC and ICCRTC, yet US risk stratification fails to differentiate malignancy risk within O-ITNs. A tailored approach integrating cytology and cautious US interpretation is essential for optimal O-ITN management. Full article

Background: Thyroid neoplasms exhibit a diverse molecular landscape, and the 2022 WHO classification emphasizes the critical role of molecular profiling in thyroid cancer management; however, comprehensive mutational data from fine-needle aspiration cytology (FNAC) samples using targeted next-generation sequencing (NGS) are still limited, necessitating further investigation to guide clinical practice. Purpose: To characterize the mutational landscape of thyroid neoplasms using targeted NGS of FNAC samples and to assess the clinical implications of molecular profiling. Materials and Methods: This retrospective study included 952 patients with thyroid carcinomaneoplasms who underwent surgery at Sun Yat-sen Memorial Hospital from 2021 to 2023. Preoperative ultrasound, FNAC, and targeted NGS were performed. NGS panels covering 18, 88, and pan-cancer genes were used to analyze FNAC samples. Molecular alterations were correlated with clinical and pathological features. Results: The most frequent mutation was BRAF^V600E (84.45%), followed by RET (6.41%), BRCA1/2 (4.41%) and RAS (4.41%). Patients were categorized into BRAF-like (830 cases), RAS-like (36 cases), high-risk mutations (25 cases), and other mutations (28 cases). High-risk mutations were associated with older age and larger tumor size. BRAF-like tumors had a higher lymph node metastasis rate (58.77%) compared to RAS-like tumors (33.33%). Tumor mutation burden varied significantly among different thyroid neoplasm subtypes. Conclusions: Molecular profiling using targeted NGS of FNAC samples provides valuable insights into the genetic landscape of thyroid neoplasms and has significant clinical implications for diagnosis and personalized treatment strategies. Further validation with paired tumor and plasma samples is warranted. Full article

Background/Objectives: Accurate determination of malignancy in pancreatic masses through endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is crucial for appropriate clinical management and prognostic assessment. However, the diagnostic sensitivity of conventional cytology using Papanicolaou (Pap) staining remains limited, often leading to inconclusive results. In this study, we investigated the diagnostic utility of methionyl-tRNA synthetase 1 (MARS1) through immunohistochemical (IHC) and immunofluorescence (IF) staining as a potential biomarker for pancreatic cancer. IHC analysis was conducted on resected tissue samples from 10 patients, including both pancreatic ductal adenocarcinoma and corresponding non-neoplastic pancreatic tissue. Additionally, cytologic samples were obtained from 198 patients with pancreatic masses who underwent EUS-FNA for diagnostic evaluation. Pap staining and MARS1 IF staining were performed on liquid-based cytology slides derived from EUS-FNA specimens. Results: MARS1 was detected by IHC staining in the 10 surgical specimens diagnosed with pancreatic adenocarcinomas. After Pap staining, 37 patients were excluded because of unsuitable specimens, leaving 161 patients who underwent both Pap and MARS1 IF staining. EUS-FNA specimens from the 151 patients with pancreatic ductal adenocarcinoma were classified by Pap staining as atypia (n = 36), suspicious for malignancy (n = 55), or malignancy (n = 60). MARS1 IF staining was positive in 147 of these patients and negative in 4. MARS1 IF staining distinguished pancreatic cancer in specimens with atypia on Pap staining. The sensitivity for detecting pancreatic cancer was significantly higher for MARS1 IF staining than for conventional Pap staining (97.4% vs. 79.1%, p < 0.0001). Conclusions: The high sensitivity of MARS1 IF staining improved malignancy detection in pancreatic masses. Further prospective studies are required to validate our findings. Full article

Background/Objectives: Lung cancer is a highly diverse disease, and reliable preclinical models that accurately reflect tumor characteristics are essential for studying lung cancer biology and testing new therapies. This study aimed to establish patient-derived tumor organoids (PDTOs) using small biopsy samples and surgical specimens to create a model system that preserves the genetic and histological features of the original tumors. Methods: PDTOs were generated from 163 lung cancer specimens, including 109 samples obtained using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) or bronchoscopy, 52 surgical specimens, and 2 pleural fluid samples. The organoid establishment rate beyond passage three was assessed, and histological subtypes and genetic profiles were analyzed using immunohistochemical staining and targeted exome sequencing. Results: The overall PDTO establishment rate was 34.4% (56/163), and 44.6% (25/56) of these organoids retained the histological and genetic features of the parental tumors. Genetic analysis identified key mutations, including KRAS G12C, EGFR L858R, MET exon 14 skipping mutation, and ROS1 fusion. PDTOs successfully formed tumors in mice while maintaining the genetic characteristics of the original tumors. Co-culture of PDTOs with cancer-associated fibroblasts (CAFs) resulted in increased resistance to paclitaxel. In the co-culture model of PDTOs with immune cells, dose-dependent growth inhibition of PDTOs was observed in response to immune checkpoint inhibitors. Conclusions: PDTOs established from small biopsy and surgical specimens serve as a valuable model for studying lung cancer biology, tumor microenvironment interactions, and drug response. This model has the potential to improve personalized treatment strategies. Full article

Endoscopic ultrasound (EUS) is a helpful tool for the study of the mediastinum, a challenging region for both transesophageal and endobronchial (EBUS) endosonography. This area is divided into sections and contains numerous lymph nodes essential for the staging and diagnosis of conditions like lung cancer, sarcoidosis, and infections. EUS allows for detailed examination of the mediastinal region, identifying various kinds of abnormalities, whether they are benign cysts or malignant tumors. The aim of this narrative review is to provide a clear overview of how EUS contributes to mediastinal diagnostics and to offer practical insights for clinicians. A comprehensive, non-systematic search of PubMed was conducted by the authors to identify relevant studies. EUS methods, such as elastography and contrast-enhanced imaging, have improved diagnosis by analyzing tissue stiffness and blood flow, and they help endosonographers distinguish between different conditions. EUS-guided tissue sampling techniques, like fine needle aspiration and biopsy, are crucial for detecting cancer and examining lymph nodes in a minimally invasive way. By combining EUS with endobronchial ultrasound, operators can achieve more accurate results, especially in cancer staging and treatment planning. Overall, this approach is a key tool in treating thoracic and mediastinal conditions. Full article

Background: Solid pseudopapillary neoplasm (SPN) is a rare pancreatic tumor with malignant potential. Its diagnosis has grown alongside increased use of abdominal imaging. SPN is suspected after classical findings in abdominal imaging studies; however, endoscopic ultrasound-guided (EUS) fine needle aspiration can support preoperative diagnosis. The treatment of choice is still surgical intervention, with an intent to reach curative resection. The prognosis is excellent. Recently, emerging data on EUS-guided radiofrequency ablation (RFA) suggest changing the choice of treatment for small SPN. Methods: We provide a comprehensive overview on pancreatic SPN with a focus on treatment, adverse events, recurrence rate, and outcomes. In addition, we provide a literature summary and pool data analysis. Results: Overall, 70 papers including 6651 patients were identified. The mean SPN size was 5.8 cm, metastasis rate was 1.9%, and recurrence rate was 3%. Moreover, the mortality rate was low at 0.2%, although high postoperative adverse events were reported (32.4%). Small SPN (<2 cm) was present in 4.1% of the studies. Two studies reported EUS-RFA for small SPN <2 cm, without recurrence at a median follow-up of 18.5 months. Conclusions: SPN still necessitates surgical intervention given its malignant potential. However, EUS-RFA can represent a promising and safe therapeutic option for SPN < 2 cm. Full article

It has been demonstrated that needle guidance systems can enhance the precision and safety of ultrasound-guided punctures in human medicine. Systems that permit the utilization of commercially available standard needles, instead of those that necessitate the acquisition of costly, proprietary needles, are of particular interest. The objective of this phantom study is to evaluate the reliability and accuracy of magnet-based ultrasound needle guidance systems, which superimpose the position of the needle tip and a predictive trajectory line on the live ultrasound image. We conducted fine-needle aspiration cytology of thyroid nodules. The needles utilized in these procedures are of a slender gauge (21–27G), with lengths ranging from 40 to 80 mm. A dedicated training workstation with integrated software-based analyses of the movement of the needle tip was utilized in 240 standardized phantom punctures (angle: 45°; target depth: 20 mm). No system failures occurred, and the target achieved its aim in all cases. The analysis of the software revealed stable procedural parameters with minor relative deviations from the predefined reference values regarding the distance of needle tip movement (−4.2% to +6.7%), needle tilt (−6.4% to +9.6%), and penetration depth (−7.5% to +4.5%). These deviations appeared to increase with the use of thin needles and, to a lesser extent, long needles. They are attributed to the slight bending of the needle inside the (phantom) tissue. The training workstation we employed is thus suitable for use in educational settings. Nevertheless, in intricate clinical puncture scenarios—for instance, in the case of unfavorable localized small lesions near critical anatomical structures, particularly those involving thin needles—caution is advised, and the system should not be relied upon exclusively. Full article

Background and Objectives: The necessity of repeat fine-needle aspiration biopsy (FNAB) in nodules diagnosed as atypia of undetermined significance (AUS) remains debated. This study evaluates the role of a second FNAB in surgical decision making. Materials and Methods: A retrospective analysis was conducted on 131 patients (105 females and 26 males) who underwent surgery following an AUS diagnosis between 2020 and 2024. Patients were grouped based on whether surgery was performed after the first or second FNAB. Demographics, pathology, and ultrasound findings were compared. Results: Of the patients, 66 (50.7%) underwent surgery after the first FNAB and 65 (50.3%) after a second AUS diagnosis. Malignancy was detected in 47 out of 66 (71.2%) patients in the single biopsy group and in 44 out of 65 (67.7%) patients in the repeat biopsy group (p = 0.804). T1a tumors were more frequent in the first FNAB group (63.8% vs. 37.2%, p = 0.021). The EU-TIRADS classifications showed no significant differences. Conclusions: The malignancy rate observed (71.2%) exceeds reported rates in the literature, suggesting regional variability. Early-stage cancers were more frequent in patients operated on after the first FNAB, questioning the necessity of repeat biopsy and indicating a potential need to revise current guidelines. Full article

Introduction: Intradural extramedullary and intramedullary spinal tumors are rare, complex to treat, and require advanced surgical techniques. Ultrasonic aspirators, commonly used for tumor removal, can cause sensory and motor deficits, including loss of motor evoked potentials (MEPs). This study aims to evaluate the safety and efficacy of ultrasonic aspirators in intramedullary tumor surgery using a swine model, comparing different systems and techniques. Methods: Ten pigs underwent D1-D3 laminectomy and myelotomy, with adipose tissue simulating a tumor. The ultrasonic aspirators were tested under varying conditions (fragmentation power, suction, application time, and vibration mode). The primary endpoint is to evaluate the impact of the chosen variables on motor function damage. The secondary endpoints are histological evaluation of the type of damage caused by ultrasound aspirators and the effect of steroid drugs on MEPs’ impairment recovery. Results: Ultrasound aspirators can cause a significant MEP signal reduction when used in continuous mode, with fragmentation power >30 for more than 2 min (p < 0.001). Suction does not affect MEPs. When used in alternating/pulsatile mode, fragmentation power and application time do not affect MEPs. The two-way ANOVA analysis on the interaction between fragmentation power and application time in continuous mode did not demonstrate a significant interaction (p = 0.155). Time alone does not affect motor damage (p = 0.873). Betamethasone can restore MEPs’ signal after damage if administered immediately. Conclusions: Using ultrasonic aspirators in an animal model of intramedullary tumor surgery is safe. The main factor that resulted in the responsibility of motor function impairment is the fragmentation power. Full article

Background: The distinction between N2a and N2b in the lung cancer TNM 9th edition staging system has reduced the heterogeneity of prognosis using the previous staging system. Moreover, this distinction may enable new treatment approaches in non-small-cell lung cancer (NSCLC). We aimed to evaluate the differences in survival between 8th- and 9th-edition staging and the mortality prediction of the TNM 9th edition in NSCLC patients who did not undergo surgical staging and who were “N”-staged with solely endobronchial ultrasound–transbronchial needle aspiration (EBUS–TBNA) without endoscopic ultrasonography (EUS). Methods: Lung cancer patients who were newly diagnosed and staged with EBUS between May 2016 and January 2023 were retrospectively reviewed. Patients were divided into two groups, “All M0 = Model 1” and “T1–2 N1–2–3 M0 = Model 2”, and compared according to their survival for both the 8th and 9th edition TNM staging systems. Cox regression analyses were performed for independent predictors of 2-year mortality. Results: In this retrospective study, a total of 90 patients were included. Most of the patients were male (84.4%), and the mean age of the study group was 64.0 ± 9.6; deceased patients were older (p = 0.024). There were no differences between groups in terms of smoking habit, comorbidities, tumor PET/CT localization, or 8th and 9th N-staging results with EBUS. The median follow-up period was 26 (0–100) months and longer for living patients than deceased patients in both groups (42 (23–100) vs. 18 (0–74), p = 0.03; 36 (24–100) vs. 20 (1–74), p < 0.001). According to the 8th edition of TNM staging, N2 stage (HR 2.26, 95% CI 1.01–5.05, p = 0.045) and N3 disease (HR 3.31, 95% CI 1.43–7.67, p = 0.005) are independent predictors of two-year mortality for Model 1 patients. When patients were staged according to the 9th edition TNM with EBUS, the relationship between N2a and mortality was not significant, while N2B disease increased the 2-year mortality risk by 2.78-fold (95% 1.07–7.22, p = 0.035), and N3 disease increased it by 3.31-fold (95% 1.43–7.67, p = 0.005). Conclusions: According to the TNM 9th edition staging system, we demonstrated that N2b disease significantly increases the risk of mortality in NSCLC cases using systematic mediastinal staging with EBUS–TBNA alone. Full article

Current therapeutic approaches for prostatic cysts and abscesses involve surgical methods like reduction and omentalization. This retrospective study evaluates the effectiveness and safety of ultrasound-guided percutaneous drainage combined with alcoholization as a minimally invasive treatment for prostatic cysts and abscesses in dogs. Forty-three male dogs with a single prostatic cavity (1–6 cm) were enrolled and categorized into two groups: group A (twenty-two dogs with prostatic abscesses treated via alcoholization) and group B (twenty-one dogs with BPH-associated cysts). Group B was further subdivided into three subgroups: B1 (finasteride only), B2 (alcoholization only), and B3 (combined finasteride and alcoholization). Alcoholization involved sedation, drainage of the cavity, and two ethanol instillations (first: 1/3–1/4 of aspirated volume; second: 1/10 after 25 min). Ultrasound evaluations were performed at scheduled intervals of up to 150 days. In group A, 76.19% of abscesses were resolved within 30 days, with complete resolution in all dogs by day 150. In group B, the combined treatment (group B3) showed superior outcomes, with significant cyst diameter reduction observed in all dogs within 30 days and complete resolution in 62.5% by day 150. These findings support alcoholization as an effective, low-complication alternative to surgery for selected prostatic lesions in dogs. Full article

Thyroid nodules are accidentally found in up to 68% of people undergoing neck ultrasound (US) examination, and fine needle aspiration (FNA) is the current gold standard to discriminate between malignancy and benign lesions. Unfortunately, one-third of FNAs are classified as indeterminate, requiring surgery for definitive diagnosis. This leads to high costs and health risks of unnecessary procedures, since malignancies are observed in less than half of operative specimens. This narrative review aims to describe the most innovative multi-omics approach techniques, including genomics, proteomics, and metabolomics, aimed at making the preoperative evaluation of indeterminate thyroid nodules more accurate. The advantages and disadvantages of the techniques are described in detail, and a SWOT (strengths, weaknesses, opportunities, and threats) analysis of the multi-omic approach is provided. Full article

Background: Supraclavicular lymph nodes (SCLNs) are often indicative of malignancy, but the effectiveness of ultrasound (US) and hematological parameters in their assessment and the prognosis of patients with malignant SCLNs need further study. Methods: We retrospectively reviewed 348 patients with SCLNs from July 2007 to June 2023, including patients over 18 years of age who underwent fine needle aspiration (FNA) or core needle biopsy (CNB). Our analysis focused on clinical characteristics, US features and hematological parameters to differentiate between benign and malignant SCLNs and to assess their prognostic value, especially in the Asian population. Results: The malignancy rate was 49%, with lung cancer (22%) and lymphoma (16%) being the most common. The malignant nodes were larger and had a greater short-to-long axis ratio, irregular margins, and abnormal vascular patterns (p < 0.01). The 5-year survival rate for patients with malignant SCLNs was 40%. Blood markers, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune–inflammation index (SII) (SII ≥ 970), were significant prognostic factors for overall survival (OS). Compared with lymphoma patients, patients with malignancies of supraclavicular and infraclavicular origins had significantly worse OS. Conclusions: Our findings highlight the importance of ultrasound in evaluating SCLNs. Furthermore, hematological markers (NLR, PLR, and SII) and the origin of SCLNs have important prognostic value. Full article