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Introduction In patients with invasive breast cancer (IBC), the presence of lymphovascular invasion (LVI) is strongly associated with elevated risks of local recurrence, tumor metastasis, and poor prognosis. In this study, we aimed to develop a prior-radiomics-guided multiscale feature extraction network (PRM-Net) for predicting LVI in IBC using preoperative magnetic resonance imaging (MRI). Methods This retrospective study involved a cohort of 303 female patients with IBC who underwent MRI and surgical resection at our hospital between January 2019 and December 2023. The enrolled patients were randomly split into training and validation cohorts at a 7:3 ratio, with the training set used for model development and the validation set reserved for performance evaluation. Four predictive models were developed: 1) a diagnostic imaging hallmark model using logistic regression to analyze MRI morphological features; 2) a radiomics classifier incorporating feature engineering and operator-based feature selection; 3) a multiscale feature extraction deep learning network (M-Net), designed for end-to-end extraction of multiscale features from MRI scans; and 4) PRM-Net, which integrated deep learning and radiomics by the fusion of multiscale deep features and engineered radiomic features. Results PRM-Net achieved the highest diagnostic accuracy for LVI prediction [area under the curve (AUC) = 0.854, 95% confidence interval (CI): 0.779–0.929], outperforming M-Net (AUC = 0.816, 95% CI: 0.732-0.901), radiomics classifiers (AUC = 0.771, 95% CI: 0.648-0.894), and traditional imaging hallmarks (AUC = 0.761, 95% CI: 0.655-0.866). Conclusions These findings highlight the potential of PRM-Net in the preoperative prediction of LVI in patients with IBC and underscore the value of combining advanced radiomics with deep learning in clinical oncology. This approach may facilitate the identification of optimal surgical strategies tailored to individual patient needs.

To date, diffusion weighted imaging (DWI) is included in routine magnetic resonance imaging (MRI) protocols for several cancers. The real additive role of DWI lies in the “functional” information obtained by probing the free diffusivity of water molecules into intra and inter-cellular spaces that in tumors mainly depend on cellularity. Although DWI has not gained much space in some oncologic scenarios, this non-invasive tool is routinely used in clinical practice and still remains a hot research topic: it has been tested in almost all cancers to differentiate malignant from benign lesions, to distinguish different malignant histotypes or tumor grades, to predict and/or assess treatment responses, and to identify residual or recurrent tumors in follow-up examinations. In this review, we provide an up-to-date overview on the application of DWI in oncology.

Purpose of Review A large number of ultrasound studies are being performed, yielding an increasing number of suspected unclear renal lesions, which then need further evaluation with CT or MRI scans. Contrast-enhanced ultrasonography (CEUS) can give additional information about perfusion and solid part of a renal lesion. Recent Findings With the introduction of fast multi-slice CT scanners, even the whole body can be scanned in an early arterial phase. Thus, additional information about an unclear tumor, such as tumor perfusion, can be gathered. MRI with its imaging capabilities offers further information in the differentiation of renal lesions. Diffusion weighted imaging give additional information about the density of a lesion. Summary MRI with new imaging modalities such as diffusion-weighted imaging and perfusion imaging, may also provide further information about a tumor beyond T1 and T2-weighted imaging. Fast CT scanners give information about the perfusion of a renal lesion. Conclusion Modern surgical techniques such as nephron-sparing surgery demand high-quality imaging in the preoperative workup of renal lesions, as well as modern medical therapies, and the follow-up after nephron-sparing surgery needs reliable diagnostic information.

Purpose of Review To describe the current role of imaging in the detection, staging, therapy planning and response assessment in lung cancer. Recent Findings Lung cancer screening using low-dose CT has been shown to reduce mortality in risk groups of active or former smokers and has, thus, been recommended by several societies and organisations worldwide. There remain, however, questions regarding optimum definition of risk factors and screening intervals. Staging criteria for lung cancer have been updated in the 8th edition of the TNM staging to better reflect prognosis. Preliminary research in radiomics in lung cancer has provided data that may add to identification of early lung cancer, prediction of prognosis and therapy response. Targeted systemic therapy has recently had a significant impact in advanced lung cancer both in terms of efficacy and toxicity, but radiologists need to be aware that response assessment criteria differ from those used for classic chemotherapy, and new side effects that may occur. Summary Modern imaging, particulary exploiting radiomics will improve early detection, classification, staging, therapy planning and ultimately, hopefully, prognosis in lung cancer.

Purpose of Review The American Cancer Society estimated that cancer of the thyroid causes 53,990 new cases and about 2060 deaths in 2018. The chance of being diagnosed with thyroid cancer has risen and this increment seems to be the result of increased use of ultrasound, CT and MR imaging examinations for reasons unrelated to the thyroid. Up to 50% of adults in central Europe have one or multiple thyroid nodules. However, the prevalence of latent carcinoma in an unselected autopsy study was 8.6%. The main diagnostic task is to differentiate between benign and malignant lesions, preferably based upon on ultrasound parameters or scoring systems like TI-RADS. Recent Findings Although there are no pathognomonic features for malignant thyroid nodules at ultrasonography or any other imaging modality, sonography of the thyroid gland has beyond doubt become the imaging method of choice for the last three decades, combined with FNA in suspicious cases. Summary Several technological improvements like ultrasound elastography, and a proliferating literature of different scoring systems allow the conclusion that ultrasound is an important gatekeeper for further diagnostic steps but not capable, so far, to identify autonomy or malignancy with a sufficiently high accuracy.

Uveal melanoma (UM) is the most common primary intra-ocular tumour. Treatment is determined by tumour size and location. Generally, smaller tumours are eligible for brachytherapy unless they are located close to posterior pole. Larger tumours are enucleated or undergo proton beam therapy (PBT), which is more expensive than brachytherapy and less available. Accuracy of tumour size determination is critical for accurate planning and delivery of treatment, particularly to ensure tumour coverage, critical structure sparing, and for the choice of treatment modality. This is particularly the case for tumour dimensions that are close to the cut-off point for a specific type of treatment: in the case of the brachytherapy protocol at our institution, 6-8 mm. Ultrasound is conventionally used, but magnetic resonance imaging (MRI) has recently become an additional available tool. Although more expensive, it enables more accurate measurements and is particularly useful in combination with clinical fundus examination, fundus photography and ultrasound. Our aim in this paper was to determine the economic value of MRI for UM treatment. We retrospectively analysed 60 patients' MRI scans acquired as part of a study or for clinical care. For each patient, we assessed whether the extra cost of an MRI generated economic benefit or change in optimal treatment. MRI indicated a smaller tumour prominence than US in 10% of patients with intermediate tumour size, resulting in a change from PBT to brachytherapy. The costs of MRI, €200-€1000, are significantly lower than the higher costs of PBT compared to brachytherapy, €24,000 difference. In addition, the annual total economic burden of severe vision impairment associated with eye removal is €10,000. Furthermore, for patients where ultrasound was impossible due to previous surgery, MRI enabled eye-preserving treatment. An additional MRI for specific patients with UM improves economic value as it enables less expensive treatment in a sufficient percentage of patients to compensate for the MRI costs. Value is increased in terms of quality of care as it enables for some a treatment option which spares more vision.

PurposeNationwide mass vaccination against Covid-19 started in Israel in late 2020. Soon we identified on [18F]FDG PET-CT studies vaccine-associated hypermetabolic lymphadenopathy (VAHL) in axillary or supraclavicular lymph nodes (ASLN) ipsilateral to the vaccination site. Sometimes, differentiation between the malignant and benign nature of the hypermetabolic lymphadenopathy (HLN) could not be made, and equivocal HLN (EqHL) was reported. The purpose of the study was to determine the overall incidence of VAHL after BNT162b2 vaccination and also its relevance to PET-CT interpretation in oncologic patients.MethodsA total of 951 consecutive patients that underwent [18F]FDG PET-CT studies in our department were interviewed regarding the sites and dates of the vaccine doses. A total of 728 vaccinated patients (All-Vac group) were included: 346 received the first dose only (Vac-1 group) and 382 received the booster dose as well (Vac-2 group). Studies were categorized as no HLN, malignant-HLN (MHL), VAHL, or EqHL. In studies with VAHL, location, [18F]FDG-intensity uptake and nodes size were recorded.ResultsThe incidences of HLN were 45.6%, 36.4%, and 53.9% in All-Vac, Vac-1, and Vac-2 groups, respectively. VAHL was reported in 80.1% of vaccinated patients with HLN. Lower incidences of VAHL were found during the first 5 days or in the third week after the first vaccine and beyond 20 days after the booster dose. In 49 of 332 (14.8%) vaccinated patients, we could not determine whether HLN was MHL or VAHL. Breast cancer and lymphoma were the leading diseases with EqHL.ConclusionVAHL is frequently observed after BNT162b2 administration, more commonly and with higher intensity following the booster dose. To minimize false and equivocal reports in oncological patients, timing of [18F]FDG PET-CT should be based on the time intervals found to have a lower incidence of VAHL, and choice of vaccine injection site should be advised, mainly in patients where ASLN are a relevant site of tumor involvement.

Status of lymph node metastasis has important implications in deciding treatment of oncologic patients. The appropriate choice of imaging modality is crucial to obtain accurate evaluation of lymph node status. Current imaging methods are mainly divided into two categories, conventional structural imaging and more recently emerging functional imaging. In depth understanding of these imaging tools is essential in making the correct choice for individual patients, and eventually for better diagnosis and treatment.

Imaging plays a crucial role in the management of oncologic patients, from the initial diagnosis to staging and treatment response monitoring. Recently, it has been suggested that its importance could be further increased by accessing a new layer of previously hidden quantitative data at the pixel level. Using a multi-step process, radiomics extracts potential biomarkers from medical images that could power decision support tools. Despite the growing interest and rising number of research articles being published, radiomics is still far from fulfilling its promise of guiding oncologic imaging toward personalized medicine. This is, at least partly, due to the heterogeneous methodological quality in radiomic research, caused by the complexity of the analysis pipelines. In this review, we aim to disentangle this complexity with a stepwise approach. Specifically, we focus on challenges to face during image preprocessing and segmentation, how to handle imbalanced classes and avoid information leaks, as well as strategies for the proper validation of findings.

18F-N-(2-(Diethylamino)ethyl)-5-(2-(2-(2-fluoroethoxy)ethoxy)ethoxy) picolinamide (18F-PFPN) is a novel positron emission tomography (PET) probe designed to specifically targets melanin. This study aimed to evaluate the diagnostic feasibility of 18F-PFPN in patients with ocular or orbital melanoma.OBJECTIVE18F-N-(2-(Diethylamino)ethyl)-5-(2-(2-(2-fluoroethoxy)ethoxy)ethoxy) picolinamide (18F-PFPN) is a novel positron emission tomography (PET) probe designed to specifically targets melanin. This study aimed to evaluate the diagnostic feasibility of 18F-PFPN in patients with ocular or orbital melanoma.Three patients with pathologically confirmed ocular or orbital melanoma (one male, two females; age 41-59 years) were retrospectively reviewed. Each patient underwent comprehensive 18F-PFPN and 18F-fluorodeoxyglucose (18F-FDG) PET scans. The maximum standardized uptake value (SUVmax) of the lesion and the interference caused by background tissue were compared between 18F-PFPN and 18F-FDG PET imaging. In addition, the effect of intrinsic pigments in the uvea and retina on the interpretation of the results was examined. The contralateral non-tumorous eye of each patient served as a control.MATERIALS AND METHODSThree patients with pathologically confirmed ocular or orbital melanoma (one male, two females; age 41-59 years) were retrospectively reviewed. Each patient underwent comprehensive 18F-PFPN and 18F-fluorodeoxyglucose (18F-FDG) PET scans. The maximum standardized uptake value (SUVmax) of the lesion and the interference caused by background tissue were compared between 18F-PFPN and 18F-FDG PET imaging. In addition, the effect of intrinsic pigments in the uvea and retina on the interpretation of the results was examined. The contralateral non-tumorous eye of each patient served as a control.All primary tumors (3/3) were detected using 18F-PFPN PET, while only two primary tumors were detected using 18F-FDG PET. Within each lesion, the SUVmax of 18F-PFPN was 2.6 to 8.3 times higher than that of 18F-FDG. Regarding the quality of PET imaging, the physiological uptake of 18F-FDG PET in the brain and periocular tissues limited the imaging of tumors. However, 18F-PFPN PET minimized this interference. Notably, intrinsic pigments in the uvea and retina did not cause abnormal concentrations of 18F-PFPN, as no anomalous uptake of 18F-PFPN was detected in the healthy contralateral eyes.RESULTSAll primary tumors (3/3) were detected using 18F-PFPN PET, while only two primary tumors were detected using 18F-FDG PET. Within each lesion, the SUVmax of 18F-PFPN was 2.6 to 8.3 times higher than that of 18F-FDG. Regarding the quality of PET imaging, the physiological uptake of 18F-FDG PET in the brain and periocular tissues limited the imaging of tumors. However, 18F-PFPN PET minimized this interference. Notably, intrinsic pigments in the uvea and retina did not cause abnormal concentrations of 18F-PFPN, as no anomalous uptake of 18F-PFPN was detected in the healthy contralateral eyes.Compared to 18F-FDG, 18F-PFPN demonstrated higher detection rates for ocular and orbital melanomas with minimal interference from surrounding tissues. This suggests that 18F-PFPN could be a promising clinical diagnostic tool for distinguishing malignant melanoma from benign pigmentation in ocular and orbital melanomas.CONCLUSIONCompared to 18F-FDG, 18F-PFPN demonstrated higher detection rates for ocular and orbital melanomas with minimal interference from surrounding tissues. This suggests that 18F-PFPN could be a promising clinical diagnostic tool for distinguishing malignant melanoma from benign pigmentation in ocular and orbital melanomas.