Search Results (479)

Extrahepatic cholangiocarcinoma (eCCA) is a highly aggressive malignancy arising from the biliary epithelium, with surgical resection representing the only potentially curative treatment. The predominant periductal infiltrating growth pattern, characterized by subepithelial tumor spread and desmoplastic stromal reaction, severely limits the diagnostic sensitivity of conventional endoscopic sampling techniques, which primarily assess the luminal mucosal surface. This review provides a histomorphology-oriented diagnostic framework for indeterminate extrahepatic biliary strictures, integrating advanced endoscopic technologies with emerging optical diagnostic approaches. ERCP combined with cholangioscopy demonstrates superior sensitivity for perihilar strictures, while EUS-guided tissue acquisition shows higher diagnostic yield in distal cholangiocarcinoma, also providing locoregional staging. Advanced EUS technologies—including elastography, contrast harmonic EUS, and Detective Flow Imaging—further improve characterization of indeterminate strictures by evaluating tissue stiffness, microvascular architecture, and periductal infiltration. Ex vivo fluorescence confocal laser microscopy (FCM) enables real-time microscopic evaluation of biopsy specimens, reducing diagnostic turnaround time and minimizing inadequate sampling. A location-adapted diagnostic algorithm integrating cross-sectional imaging, ERCP, cholangioscopy, and EUS is proposed. An integrated, biology-informed endoscopic approach tailored to tumor location and ductal wall involvement may significantly improve early eCCA detection and guide patient selection for curative treatment. Full article

Introduction: Clinical staging based on digital rectal examination is imprecise, leading to pathological upstaging in patients with prostate cancer (PCa). Accurate preoperative assessment remains a challenge despite the use of multiparametric magnetic resonance imaging (mpMRI) and fusion-guided biopsy. This study aims to identify key predictors of upstaging in preoperative patients. Materials and Methods: A retrospective analysis of 924 patients who underwent radical prostatectomy between July 2012 and January 2025 was performed. Variables included prostate-specific antigen, prostate volume, biopsy type, MRI, body mass index and age. Upstaging was defined as ≥pT3 in patients staged clinically as cT1–2. Optimal cut-offs for continuous variables were defined statistically. Multivariable logistic regression was applied to identify independent predictors of upstaging and minor staging upgrading (MSU)—defined as any upward shift in the pathological T stage relative to the clinical T stage. Model performance was evaluated using the area under the Receiver Operating Characteristic (ROC) curve (AUC). Results: Upstaging occurred in 31.9% and MSU in 50.6% of patients. The mean age was 65 years. Cut-off values for PSA density (PSAD) were 0.29 for upstaging and 0.28 for MSU. In the full-cohort model (AUC = 0.628), PSAD (odds ratio (OR) = 2.55), age (OR = 1.04), and hypertension (HT) (OR = 1.47) were associated with upstaging. In PIRADS-based models, PIRADS 5 and PSAD predicted both upstaging (OR = 1.62 and 6.10, respectively; AUC = 0.664) and MSU (OR = 1.75 and 4.67, respectively; AUC = 0.659). MSU was also associated with HT and a lack of fusion biopsy (AUC = 0.622). Conclusions: PSAD and PIRADS 5 lesions are strong determinants of pathological upstaging and MSU in PCa. These factors should be considered in preoperative risk stratification to improve staging accuracy. Despite advances in imaging and biopsy techniques, upstaging remains a common phenomenon, underlining the need for further refinement of diagnostic protocols. Full article

Breast cancer remains the most frequently diagnosed malignancy in women worldwide, accounting for approximately 2.3 million new cases and 670,000 deaths annually. The diagnostic landscape has undergone a paradigm shift over the past two decades, evolving from morphology-based classification toward molecularly informed, precision-guided strategies. Early and accurate diagnosis is fundamental to improving outcomes; advances in imaging technology, including digital breast tomosynthesis (DBT), contrast-enhanced mammography (CEM), and abbreviated magnetic resonance imaging (MRI), have improved sensitivity and specificity in diverse patient populations. Simultaneously, the integration of artificial intelligence (AI) and radiomics into screening workflows offers unprecedented potential for risk stratification and a reduction in false-positives. At the pathological level, multi-gene expression profiling assays such as Oncotype DX, MammaPrint, Prosigna, and EndoPredict have refined prognostic classification and guide adjuvant chemotherapy decisions in early-stage hormone receptor-positive disease. The emergence of liquid biopsy, circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), and exosomal biomarkers provides minimally invasive tools for real-time monitoring of response, residual disease, and the evolution of resistance mechanisms. Precision diagnostics now encompass next-generation sequencing (NGS)-based comprehensive genomic profiling, enabling identification of actionable alterations such as PIK3CA mutations, HER2 amplification, BRCA1/2 pathogenic variants, and NTRK fusions, each linked to approved therapeutic agents. The purpose of this review is to provide a comprehensive synthesis of current and emerging diagnostic modalities in breast cancer—from population-level screening to individualized molecular profiling—and to examine how integrative, multimodal diagnostic platforms are reshaping clinical decision-making in the era of precision medicine. Full article

This narrative review describes variants of heterotopic and ectopic spleen tissue, focusing on its appearance under contrast-enhanced ultrasound (CEUS) with SonoVue (SonoVue^®; Bracco, Milano, Italy). Typical feature of splenic tissue with SonoVue is its long-lasting enhancement. The diagnosis of these splenic variants, in the vast majority of cases, has primarily been performed with CT, MRI, spleen-specific scintigraphy, or image-guided biopsy. In this review, we analyze published cases and also include our own case examples where CEUS has been used, and describe the enhancement characteristics of splenosis and atypical (intrapancreatic) accessory spleens. CEUS can provide valuable diagnostic information in patients with suspected ectopic splenic tissue, particularly when interpreted together with clinical history and complementary imaging modalities. Ultimately, ectopic splenic tissue should be considered, especially after splenectomy or splenic trauma, in cases of well-defined, hypervascularized lesions where CEUS may help avoid unnecessary invasive procedures in selected cases. Full article

Myositis ossificans (MO) is a benign, self-limiting heterotopic ossification process that typically develops within soft tissues following trauma, although non-traumatic forms have also been described. Despite its benign nature, MO frequently represents a diagnostic challenge, particularly in its early stages when imaging findings may mimic aggressive soft-tissue tumors, leading to unnecessary biopsies or surgical interventions. This narrative review provides an updated overview of the classification, pathophysiology, and imaging features of myositis ossificans, with a specific focus on the time-dependent evolution of radiologic appearances across different imaging modalities. Radiologic findings are discussed according to disease stage, highlighting key diagnostic clues such as the zonal phenomenon and peripheral maturation pattern. In addition, the main entities included in the differential diagnosis are reviewed, with particular emphasis on imaging features that help distinguish myositis ossificans from soft-tissue sarcomas and other calcified or ossified lesions. Finally, current management strategies and the role of imaging in patient follow-up are summarized. A thorough understanding of the evolving imaging spectrum of myositis ossificans is essential for radiologists and clinicians to achieve an accurate diagnosis, guide appropriate management, and avoid overtreatment. Full article

Minimally invasive parafascicular surgery (MIPS) represents a paradigm shift in the management of deep-seated brain tumors, enabling function-sparing resections previously limited to biopsy and/or medical therapy. Central to MIPS are structured frameworks guiding preoperative planning and intraoperative execution. The six-pillar concept—comprising imaging, navigation, atraumatic access, optics, resection, and postoperative care—provides a comprehensive approach to integrate advanced neuroimaging, tractography, tubular retractor systems, fluorescence-guided resection, and neuromonitoring to optimize functional outcomes. Five-point target-trajectory complex planning—craniotomy, outer radial corridor, inner radial corridor, target, and resection margins—translates preoperative imaging and functional mapping into a precise surgical trajectory, balancing maximal tumor resection with minimal disruption of eloquent brain structures. Preoperative assessment of tumor characteristics, vascular relationships, and cortical eloquence informs trajectory planning and intraoperative adjustments. A critical determinant of MIPS success is the intraoperative golden hour, referring to the high-risk period surrounding brain cannulation with a tubular retractor. Key principles include (1) precannulation system checks to ensure instrument readiness; (2) access injury prevention through optimized craniotomy sizing and sulcal preparation; (3) tubular-tumor targeting accuracy addressing brain and tubular translation, tumor displacement, and white-matter sleeves; and (4) intracranial pressure control strategies to minimize tissue strain and venous congestion. Overcoming this period enables a controlled resection phase guided by the above-mentioned surgical adjuncts. The six-pillar concept and five-point target-trajectory complex planning are the foundations of MIPS planning, whereas the intraoperative golden hour provides a roadmap for successful intraoperative delivery of the surgical plan. Full article

Background and Objectives: Prostate cancer is the second most common cancer in men worldwide, with 1,466,680 new cases and 396,792 deaths reported in 2022. Accurate preoperative grading is critical, as the grade assessed on biopsy cores may be underestimated compared to radical prostatectomy specimens. The aim of this study was to assess the ability of quantitative diffusion parameters derived by the standard monoexponential model (ADC—apparent diffusion coefficient) and kurtosis model (Dapp—apparent diffusion coefficient corrected for non-Gausion behavior and K-kurtosis) to predict Gleason Grade Group (GG) upgrading from transrectal ultrasound-guided (TRUS) biopsy to radical prostatectomy within each GG. Materials and Methods: This retrospective study included 128 patients with prostate cancer who underwent systematic TRUS biopsies and multiparametric magnetic resonance imaging (mpMRI) at 3T before prostatectomies between 2017 and 2021. Mean values of quantitative diffusion parameters (ADC, Dapp, K) were compared between upgraded and non-upgraded cohorts within each Grade Group obtained at biopsy. Results: Significant differences in ADC and K values were found between upgraded and non-upgraded lesions in GG1 and GG2 cohorts at biopsy, with lower ADCs and higher K values indicating a higher likelihood of upgrading. In GG1, ADC demonstrated an AUC of 0.762 (p < 0.05) and K an AUC of 0.846 (p < 0.05). In GG2, ADC showed an AUC of 0.814 (p < 0.001) and K an AUC of 0.755 (p < 0.001). No significant differences were observed in GG3 and GG4 cohorts. Conclusions: Quantitative diffusion parameters—particularly ADC and kurtosis (K)—demonstrated significant predictive value for Grade Group upgrading in patients with biopsy-proven GG1 (AUC: K = 0.846, ADC = 0.762) and GG2 (AUC: ADC = 0.814, K = 0.755, D = 0.810) prostate cancer. These findings suggest that incorporating quantitative DWI parameters into preoperative assessments may improve risk stratification and support clinical decision-making, particularly regarding the selection of patients for active surveillance. Validation in larger, multicenter cohorts is warranted. Full article

The objective of this review is to deepen the understanding and mastery of non-mass breast pathologies, enabling ultrasonographers to enhance diagnostic accuracy and improve their capabilities in image analysis and clinical interpretation. Narrative means have been used to synthesize evidence in this review. Currently, “non-mass breast lesions” are not included in ultrasound terminology of the 5th Edition Breast Imaging Reporting and Data System (BI-RADS). Although multiple classification systems have been proposed in the literature, there remains no standardized ultrasound definition or malignant risk grading for non-mass lesions. The ultrasound features of benign and malignant non-mass breast lesions are often subtle and partially overlapping, complicating differential diagnosis and impacting clinical evaluation and management. This paper reviews the ultrasound definitions and classifications of non-mass breast lesions, exploring the correlation between their ultrasound features and pathological histology as well as malignant risk. It also discusses the diagnostic values of conventional ultrasound, automated breast ultrasound, ultrasound elastography, and contrast-enhanced ultrasound for non-mass breast lesions. Finally, it compares the diagnostic accuracy of various ultrasound-guided needle biopsy techniques for non-mass lesions. Through the synthesis and summarization of the relevant literature, this paper aims to enhance the diagnostic proficiency of sonographers in evaluating non-mass breast lesions. Full article

Adrenocortical carcinomas (ACCs) are rare, aggressive tumors often discovered incidentally. These malignancies may present with abnormal hormone secretion or, as in some cases, as non-functioning masses causing discomfort. We present a case of brain metastasis in a patient with a giant ACC. A 50-year-old man presented with headache and dizziness. A computed tomography (CT) scan showed an intracranial lesion within the parenchyma measuring 73*60*46 mm with left internal temporal involvement, abundant vasogenic edema and compressing the lateral left ventricle. Further imaging investigations identified a large necrotic tissue mass measuring 15 cm, located on both sides of the right diaphragmatic dome, in the middle posterior region. Hormonal workup was conducted and excluded a functional adrenal tumor. A CT-guided biopsy was performed, confirming ACC. Despite medical management, the patient’s condition deteriorated rapidly, with the cerebral metastasis proving fatal. This case underscores the challenges posed by advanced ACC, particularly when associated with atypical metastatic sites. Giant ACC, though rare, presents significant diagnostic and therapeutic challenges. Surgical excision with appropriate oncologic management can lead to favorable outcomes. This report contributes to the limited literature on cerebral metastases in ACC, aiming to enhance awareness among clinicians managing this rare entity. Full article

Background: Pleuroparenchymal fibroelastosis (PPFE) is a rare fibroelastotic lung disease characterized histologically by dense pleural and subpleural fibrosis with upper-lobe predominance. In clinical practice, diagnosis often relies on characteristic radiologic findings, as surgical lung biopsy is rarely feasible. Unlike idiopathic pulmonary fibrosis, robust radiologic criteria validated against biopsy-proven cohorts remain limited, and the diagnostic performance of imaging alone is incompletely defined. Although initially described as idiopathic, PPFE is increasingly recognized in secondary settings, including connective tissue disease-associated interstitial lung disease (CTD-ILD), where it frequently overlaps with more common fibrotic patterns. Methods: We conducted a focused narrative review of the literature on PPFE in CTD-ILD, synthesizing evidence on morphology, epidemiology, clinical course, prognostic implications, and proposed pathobiological mechanisms, with emphasis on distinguishing true PPFE from PPFE-like lesions. Results: CTD-associated PPFE is associated with accelerated lung function decline, increased risk of pneumothorax, and poorer outcomes, particularly in systemic sclerosis and rheumatoid arthritis. However, distinguishing true PPFE from radiologic mimics remains challenging, and diagnostic approaches rely heavily on imaging without robust histopathologic validation. Proposed mechanisms include epithelial injury, immune dysregulation, and vascular or lymphatic abnormalities, although causal links remain unproven. Significant gaps persist regarding natural history and therapeutic responsiveness. Conclusions: Earlier identification of PPFE in CTD-ILD is important, as misclassification may delay risk stratification and management. Longitudinal imaging, multidisciplinary evaluation, and standardized diagnostic criteria are needed to improve clinical care and guide future research. Full article

Breast cancer (BC) requires the evaluation of tumor aggressiveness features to guide treatment decisions. Biopsy-derived prognostic information may differ from surgical histopathology due to tumor heterogeneity. Hybrid PET/MRI can provide additional information for tumor characterization, supporting initial therapy planning and prognosis. In this work, we acquired 157 BC patients using a hybrid PET/MRI scanner. The PET data were combined with ADC and semi-quantitative DCE-MRI metrics to derive “hybrid PET/MRI parameters.” Pathological data such as tumor grade, hormone receptors, proliferation index (Ki67), and surrogate molecular subtype were collected, and we evaluated their associations with hybrid imaging, also comparing with the PET and MRI data analyzed separately. Ki67 showed moderate correlations with PET, ADCmin, and most hybrid parameters. The PET and hybrid data differentiate histopathological factors, while ADCmin differentiates G1 vs. G2 and luminal A vs. luminal B. In the ROC analysis, hybrid SUVmax/ADCmin shows better performance to predict luminal B from luminal A (AUC 0.720, sensitivity 73.1%, specificity 63.2%, PPV 54.3%, NPV 79.7%) than SUVmean alone. Our findings suggest that these novel hybrid PET/MRI parameters may help the characterization of tumor tissue in IDC. However, a multivariate analysis is needed to confirm our preliminary results. Full article

Paediatric medulloblastoma is the most common malignant brain tumour in children, exhibiting substantial biological heterogeneity that drives variable treatment outcomes. Despite advances in multimodal therapy, treatment-related morbidity remains a critical concern, underscoring the need for biomarkers to guide precision therapy. This review synthesises current knowledge on biomarkers of treatment response, encompassing molecular, epigenetic, transcriptomic, protein, and imaging-based markers. WNT-activated tumours show excellent prognosis and are candidates for therapy de-escalation; SHH-driven tumours demonstrate age-dependent outcomes influenced by TP53 status; Group 3 tumours carry the poorest prognosis; and Group 4 tumours display highly variable outcomes. DNA methylation profiles, transcriptional programs, and non-coding RNAs provide additional predictive insights. Protein biomarkers and advanced imaging, including liquid biopsy and radiomics, offer minimally invasive approaches for real-time monitoring of treatment efficacy. The review also addresses challenges such as intra-tumour heterogeneity, limited tissue availability, technical variability, and ethical considerations in paediatric oncology. Finally, we explore future directions, highlighting integrative, longitudinal, and ethically grounded biomarker strategies that have the potential to optimise therapy, minimise long-term toxicity, and improve both survival and quality of life for children with medulloblastoma. Full article

Background: Transperineal magnetic resonance (MRI)/ultrasound (US) fusion-guided prostate biopsy has emerged as a promising alternative to the transrectal approach by improving lesion targeting and reducing infectious complications. However, real-world data addressing factors that influence the detection of clinically significant prostate cancer (csPCa), including imaging characteristics and procedural experience, remain limited. Objective: To evaluate the diagnostic performance, safety profile, and independent predictors of csPCa detection in patients who underwent transperineal MR/US fusion-guided prostate biopsy, with particular emphasis on PIRADS category, prostate-specific antigen (PSA) level, and procedural learning curve. Methods: In this study, patient data were prospectively recorded in a routinely maintained institutional database, while the present analysis was conducted retrospectively. A total of 136 patients with clinical suspicion of prostate cancer—defined as elevated prostate-specific antigen (PSA), abnormal digital rectal examination, or PIRADS ≥3 on multiparametric MRI—underwent transperineal MR/US fusion-guided biopsy between January 2023 and October 2024. Results: Prostate cancer was detected in 45.5% of patients, whereas csPCa was identified in 32.3%. The PIRADS category emerged as the strongest independent predictor of csPCa detection, with PIRADS-5 lesions showing a significantly greater likelihood of csPCa than PIRADS-3 lesions (OR 6.70, p = 0.006). The PSA level was also independently associated with csPCa detection (OR 1.06 per ng/mL increase, p = 0.033). Although csPCa detection rates increased across learning curve groups, procedural experience was not an independent predictor after adjustment. The procedure demonstrated a favorable safety profile, with a low rate of infectious and noninfectious complications despite minimal use of antibiotic prophylaxis. The multivariable model showed moderate explanatory power and acceptable overall classification accuracy. Conclusions: Transperineal MR/US fusion-guided prostate biopsy provides reliable detection of clinically significant prostate cancer with a low complication rate and consistent performance across different stages of institutional experience. The PIRADS category and PSA level remain key determinants of csPCa detection, supporting the integration of MRI-based risk stratification into contemporary prostate cancer diagnostic methods. Full article

Objective: To assess the safety and diagnostic outcomes of image-guided, non-target renal biopsies performed in cancer patients. Materials and Methods: We retrospectively identified patients who underwent percutaneous, image-guided, non-target renal biopsy between January 2017 and December 2020 in our institution. We recorded demographics, clinical, procedural, and pathologic details. Univariate and multivariable logistic regression models were used to assess the association between various variables and diagnostic yield or development of adverse events. Results: A total of 318 biopsies were performed in 318 patients (178 male, 140 female) with a median BMI of 28.4 kg/m². Median systolic and diastolic BP at the time of biopsy were 133 mmHg and 74 mmHg, respectively. Tissue was obtained using 18-gauge needles (99%). Adverse events were documented in 57 cases (18%), with 12 cases (3.8%) classified as grade 2 or higher per SIR classification. Diagnosis was achieved in 310 biopsies (97%). The median number of the glomeruli identified by light microscopy, immunofluorescence, and electron microscopy was 25, 8, and 3, respectively, and a higher number of identified glomeruli was associated with diagnostic yield in univariate analysis, although not in multivariable analysis. Diastolic BP higher than 80 mmHg and CT imaging guidance were associated with the development of adverse events in univariate analysis, and CT use remained so in the final multivariable analysis (p < 0.001). No other variables, including pre-biopsy anticancer or immunotherapy medications, were associated with increased risk of adverse events. Conclusions: Percutaneous, image-guided, non-target renal biopsy in cancer patients using an 18-gauge needle has a high diagnostic yield and safety profile. Full article

Background/Objectives: Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive liver disease and a major driver of cirrhosis, liver failure, and mortality worldwide. Despite the urgent need for effective therapies, clinical trials in MASH cirrhosis face substantial challenges due to the heterogeneity and the lack of standardization in study endpoints. A clear understanding of how endpoints are defined and applied across trials is critical for interpreting efficacy, comparing results, and guiding regulatory decisions. The objective of this systematic review was to classify and critically evaluate the primary, secondary, and exploratory endpoints used in phase 2 and 3 clinical trials of novel therapies for MASH cirrhosis, and to assess their consistency, strengths, and limitations. Methods: PubMed, Embase, and Cochrane Library databases were searched to identify Phase 2 and 3 trials of novel therapies for MASH-related cirrhosis. Studies of adults with biopsy-confirmed MASH cirrhosis in which clinical, histological, hemodynamic, imaging, and laboratory outcomes being assessed were included. Results: Nine eligible trials were included. Histological measures, most commonly improvement in fibrosis stage without worsening of MASH, were generally considered key efficacy outcomes. Biochemical (e.g., ALT, AST, Pro-C3, composite fibrosis scores) and imaging-based markers (e.g., liver stiffness) were widely used as secondary or exploratory endpoints and more frequently demonstrated treatment-related changes than histology. Hepatic venous pressure gradient (HVPG) was selected as a primary endpoint in some studies and as an exploratory outcome in others. Patient-centered outcomes, when incorporated, were typically exploratory. Conclusions: Phase 2 and 3 trials in MASH cirrhosis employ diverse and inconsistently defined endpoints, with limited standardization across studies. Establishing consensus on endpoint classification, definitions and clinical relevance is critical to advancing therapeutic development and ensuring regulatory acceptance in this high-risk patient population. Full article