Diagnostic Accuracy of MRI in Local Staging (T Category) of Penile Cancer and the Value of Artificial Erection: A Systematic Review And Meta-Analysis

  •  Treatment recommendations of penile cancers are determined primarily by the local extent of the primary tumor. Clinical palpation is used for local staging.
  • We reviewed diagnostic performance of MRI in local staging of penile cancer in three clinical scenarios (Q1-Q3]) and one imaging scenario (Q4). Q1 asked Bio Med Frontiers whether MRI reliably distinguishes ≤ T1 from ≥ T2 disease. Q2 asked whether clinical staging reliably identifies ≤ T1 versus ≥ T2 disease and how clinical staging compares to MRI. Q3 asked if MRI is accurate for diagnosis of T3 disease. Q4 asked if artificial erection (by intracavernosal injection of prostaglandin E1) improved accuracy of MRI in T categorization.
  • Medline, Embase, and Cochrane databases were searched through September 13, 2021, for studies evaluating local staging of penile cancer using MRI with surgical pathology as the reference standard. Diagnostic accuracy was calculated using a bivariate random-effects model. Meta-regression was performed to test for covariate effects of MRI and artificial erection in Q3 and Q4, respectively.
  •  Eight studies and 481 patients were included. The sensitivity and specificity of MRI for Q1 were 86% (95% CI, 73-94%) and 89% (95% CI, 77-95%), respectively. AUC for MRI (0.94; 95% CI, 0.92-0.96) did not differ from clinical staging (0.87; 95% CI, 0.84-0.94; p = .83). For Q3, MRI had sensitivity and specificity of 80% (95% CI, 70-87%) and 96% (95% CI, 85-99%). For Q4, sensitivity and specificity for MRI with versus without artificial erection were 85% (95% CI, 71-92%) and 93% (95% CI, 77-98%) versus 86% (95% CI, 68-95%) and 84% (95% CI, 70-93%) respectively (p = .50).
  • MRI staging of penile cancer may be considered for ≤ T1 vs ≥ T2 disease but did not appear more accurate than clinical staging. High specificity of MRI for diagnosis of ≥ T3 disease suggests that MRI may be useful when organ-sparing approaches are planned. MRI with and without artificial erection showed similar accuracy in local staging. MRI, with or without artificial erection, may be valuable in routine preoperative evaluation of local staging of penile cancer, particularly when organ-sparing options are considered.

Machine learning-based diagnostic evaluation of shear-wave elastography in BI-RADS category 4 breast cancer screening: a multicenter, retrospective study.

Ultrasound is commonly used in breast cancer screening but lacks quantification ability and diagnostic power due to its low specificity, which can lead to overdiagnosis and unnecessary biopsies.
This study evaluated the diagnostic efficacy and clinical utility of adding shear-wave elastography (SWE) to the screening of the Breast Imaging Reporting and Data System (BI-RADS) category 4 breast cancer.
A machine learning-based diagnostic model was constructed using data retrospectively collected from 3 independent cohorts with features selected using lasso regression and support Contact Bio Med Frontiers vector machine-recursive feature elimination algorithms.
Propensity score matching (PSM) was used to preclude confounding baseline characteristics between malignant and benign lesions. 
A decision curve analysis (DCA) was used to evaluate the clinical benefit of the diagnostic model in identifying high-risk tumor patients for intervention while simultaneously avoiding overtreatment of low-risk patients with integrative evaluation using a net benefit value and treatment reduction rate.
In our training center, a total of 122 patients were enrolled, and 577 breast tumors were collected. The comparison between malignant and benign lesions revealed significant differences in patient age, tumor size, resistance index (RI), and elasticity values.
The maximum elasticity value (Emax) was identified as an independent diagnostic feature and was included in the diagnostic model.
The combination of Emax with BI-RADS category 4 demonstrated a significantly better diagnostic efficacy than the BI-RADS category alone [BI-RADS+Emax: AUC =0.908, 95% confidence interval (CI): 0.842-0.974; BI-RADS: AUC =0.862, 95% CI: 0.784-0.94; P=0.024] and significantly increased the clinical benefit for patients and policy makers by effectively reducing overdiagnosis and biopsy rates.
In the BI-RADS category 4A subgroup, adding Emax to breast cancer screening benefited patients and showed a greater absolute benefit than did the BI-RADS category alone when used for patients with a higher probability of cancer (>0.403), demonstrating a 50% overtreatment reduction.
Conclusions: Adding Emax to BI-RADS category 4 breast cancer screening using SWE significantly reduced overdiagnosis and biopsy rates compared with the BI-RADS category alone, especially for BI-RADS 4A patients.

Lung-RADS Category 3 and 4 Nodules on Lung Cancer Screening in Clinical Practice.

 Lung-RADS category 3 and 4 nodules account for most cancers among screening-detected lung cancers and are considered actionable nodules with management implications.
The cancer frequency among such nodules is estimated in the Lung-RADS recommendations and has been investigated primarily using retrospectively assigned Lung-RADS classifications. 
 To assess the frequency of cancer among lung nodules assigned Lung-RADS category 3 or 4 at lung cancer screening (LCS) in clinical practice and factors that impact the cancer frequency within each category.
This retrospective study was based on review of clinical radiology reports of 9148 consecutive low-dose CT LCS examinations performed in 4798 patients between June 2014 and January 2021 as part of an established LCS program.
Unique nodules assigned Lung-RADS category 3 or 4 (4A, 4B, or 4X) that were clinically categorized as benign or malignant by a multidisciplinary conference, considering histologic analysis and follow-up imaging, were selected for further analysis; benign diagnoses based on stability required at least 12 months of follow-up imaging. Indeterminate nodules were excluded. Cancer frequencies were evaluated.
 Of the 9148 LCS examinations, 857 (9.4%) were assigned Lung-RADS category 3, and 721 (7.9%) were assigned category 4.
The final analysis included 1297 unique nodules in 1139 patients (598 men, 541 women; mean age, 66.0±6.3 years). A total of 1108/1297 (85.4%) nodules were deemed benign, and 189/1297 (14.6%) were deemed malignant. Frequencies of malignancy for category 3, 4A, 4B, and 4X nodules were 3.9%, 15.5%, 36.3%, and 76.8%, respectively. A total of 45/46 (97.8%) endobronchial nodules (all category 4A) were deemed benign based on resolution. Cancer frequency was 13.1%, 24.4%, and 13.5% for solid, part-solid, and ground-glass nodules, respectively. 
When applying Lung-RADS for LCS clinical practice, the frequency of Lung-RADS category 3 and 4 nodules, as well as cancer frequency in these categories, were higher than prevalence and cancer risk estimated for category 3 and 4 nodules in the Lung-RADS recommendations and reported in earlier studies using retrospective category assignments.
Nearly all endobronchial category 4A nodules were benign. Future Lung-RADS iterations should consider these findings from real-world practice to improve the system’s clinical utility.

Immunotherapies for well-differentiated grade 3 gastroenteropancreatic neuroendocrine tumors: A new category in the World Health Organization classification.

According to the 2019 World Health Organization (WHO) classification, well-differentiated grade 3 (G3) gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) are a new category of cancer of the digestive system. G3 GEP-NET research and treatment are not as robust as those of lower grade (G1/2) NETs and poorly differentiated neuroendocrine carcinomas (NECs).
Previously, the management of high-grade NETs was mainly based on NEC therapies, as high-grade NETs were classified as NECs under the previous WHO classification.
Despite this, G3 GEP-NETs are significantly less responsive to platinum-based chemotherapy regimens than NECs, due to their distinct molecular pathogenesis and course of pathological grade transition. Patients with advanced G3 GEP-NETs, who have progressed or are intolerant to chemotherapy regimens such as capecitabine plus temozolomide, have limited treatment choices.

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Immunotherapy has helped patients with a variety of cancers attain long-term survival through the use of immune checkpoint inhibitors. Immunotherapies, either alone or in combination with other therapies, do not have a clear function in the treatment of G3 GEP-NETs.
Currently, the majority of immunotherapy studies, both prospective and retrospective, do not reliably differentiate G3 GEP-NETs from NECs. By contrast, a significant number of studies include non-GEP neuroendocrine neoplasms (NENs).
Therefore, there is an urgent need to summarize and evaluate these data to provide more effective therapeutic approaches for patients with this rare tumor. The purpose of this mini-review was to screen and summarize information on G3 GEP-NETs from all studies on NENs immunotherapy.

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