ABSTRACT
Objective:To study the diagnostic value of the artificial intelligence (AI) diagnostic system, ACR TI-RADS classification and AI+ ACR TI-RADS combined diagnostic performance in benign and malignant thyroid nodules and its guiding significance for surgical treatment.Methods:From Nov. 1, 2021, to Feb. 26, 2022, 349 patients with 605 thyroid nodules who received surgical treatment in Department of Thyroid (Hernia) Surgery, Department of General Surgery, the First Medical Center of the PLA General Hospital, were selected. There were 95 males and 254 females, male: female=1:2.67, aged 16-78 years, and the nodule diameter was 0.2-5.6 cm. SPSS 26.0 and R studio software were used for data processing. AI diagnostic system, ACR TI-RADS grading and AI+ ACR TI-RADS combined diagnostic efficacy were statistically analyzed, respectively. ROC curve analysis was performed in parallel.Results:The AUC value of AI+ ACR TI-RADS combined diagnosis was 0.900, greater than 0.857 of AI diagnostic system and 0.788 of ACR TI-RADS, and the difference was statistically significant ( Z= 7.631, both P<0.001) . The sensitivity of the combined diagnosis was 95.32%, the specificity was 84.61%, the accuracy was 92.56%, the positive predictive value was 94.69%, the negative predictive value was 86.27%, the missed diagnosis rate was 4.68%, and the misdiagnosis rate was 15.38%, which were better than the other two diagnostic methods. With an excellent coincidence rate with postoperative pathological results ( Kappa=0.804, P<0.001) . The accuracy of combined diagnosis in identifying the maximum diameter of different tumors was 89.58% for d≤0.5 cm, 96.09% for 0.5<d≤1.0 cm, 95.45% for 1.0<d≤2.0 cm, 87.88% for 2.0<d≤4.0 cm, and 85.71% for d>4.0 cm, better than the other two diagnostic methods. Conclusions:The combined application of AI+ACR TI-RADS has a certain primary screening value in evaluating thyroid nodule properties. The combined diagnosis of the two can more effectively determine the benign and malignant thyroid nodules.
ABSTRACT
Multiple primary lung cancer (MPLC) refers to lung cancer in which two or more primary lesions occurred simultaneously or successively in different parts of the same patient's lungs. The diagnosis interval is 6 months. MPLC is divided into synchronous MPLC (sMPLC) and metachronous MPLC (mMPLC). sMPLC and intrapulmonary metastasis (IM) are different in treatment strategies and prognosis. However, there are many controversies about the distinction between the two in clinical practice. This article summarizes the current main methods of diagnosing MPLC, and focuses on the latest research progress in distinguishing MPLC from IM. It aims to provide a theoretical basis for accurate diagnosis and treatment of patients with multifocal lung cancer. .
ABSTRACT
Papillary adenoma (PA) of kidney is defined as a lesion measuring less than 15 mm and featuring papillary or tubular architecture along with nuclei of low grade.Clear cell renal cell carcinoma (CCRCC) is the most common seen group of malignant neoplasms consists of cells with clear or eosinophilic cytoplasm.The coexistence of these two kinds of tumor is rare and was only reported in one piece of literature to date.We report a thought-provoking case in which CCRCC is coexisting with multiple PAs.The CCRCC shows no difference with other common cases while the PAs share the same clinical and pathological features with other ones and demonstrates no amplifying of 3,7 or 17 chromosome.However,the multiple PAs were neglected by imaging doctors and surgeons,and some tiny lesions were not found until the observation under microscope.This case reminds that patients accepting partial nephrectomy for CCRCC may have PAs,so attention should be paid to the image studies along with routine pathological examination of kidney for that there may exists two or more kinds of lesions.
ABSTRACT
Dentro de la práctica clínica en pediatría existen situaciones en las que el diagnóstico oportuno de una enfermedad involucra la meditación de situaciones insospechadas; en niños muy pequeños el interrogatorio indirecto bien realizado y detallado se convierte en herramienta fundamental para su tratamiento. En un evento de aspiración de cuerpo extraño existen indicadores específicos para tener sospecha de que estamos ante un caso; sin embargo, no todos los pacientes presentan signos y síntomas clásicos, por lo que la experiencia del clínico es vital. Se presenta el caso de un niño de veintiún meses de edad que broncoaspiró una corona de acero cromo en un consultorio dental; ésta no fue identificada sino hasta 60 días después del accidente. Es importante que los clínicos encargados de la salud bucal de los niños estén capacitados para auxiliar a sus pacientes ante un evento de aspiración de cuerpo extraño, tanto de forma inmediata como mediata, teniendo una conducta responsable ante la sospecha fundamentada de que ocurrió un accidente de esta naturaleza.
Within the scope of pediatric medical practice, certain situations arise where timely diagnosis of a condition implies facing unforeseen situations. Clinical history is clearly paramount for the correct and precise handling of any patient, even more so for very young patients from whom obtained data can be frequently imprecise. With respect to foreign body aspiration accidents, there are specific indicators which substantiate a suspicion of that case. Nevertheless, not all cases are typical, therefore, experience of the clinical operator is essential. The present study presents the case of a one year and nine months old patient who broncho-aspirated a chrome-steel crown in a dental practice, and the situation was only diagnosed 60 days later. The present diagnosis was emitted at once when the patient arrived at the National Pediatrics Institute. To that aim, a thorax X-ray was taken. The present case can be considered a paradigm. It supports the idea that the oral cavity of very young patients must be treated by qualified specialists, and that such care must be given in centers which can guarantee the patient's safety. A foreign body can remain in the bronchii for a long time, without directly endangering the patient's life. Nevertheless, this situation would introduce the patient into a dangerous chronicity, therefore, emergency room physicians should be aware of the possibility of a substantiated suspicion of foreign body aspiration. These cases, after suitable history research and auscultation could have been avoided, and thus avoid a serious chronic situation in these patients.