Since 2010, substantial progress has been made in artificial intelligence (AI) and its application to medicine. AI is explored in gastroenterology for endoscopic analysis of lesions, in detection of ...cancer, and to facilitate the analysis of inflammatory lesions or gastrointestinal bleeding during wireless capsule endoscopy. AI is also tested to assess liver fibrosis and to differentiate patients with pancreatic cancer from those with pancreatitis. AI might also be used to establish prognoses of patients or predict their response to treatments, based on multiple factors. We review the ways in which AI may help physicians make a diagnosis or establish a prognosis and discuss its limitations, knowing that further randomized controlled studies will be required before the approval of AI techniques by the health authorities.
We report the emergence of an atpE mutation in a clinical Mycobacterium tuberculosis strain. Genotypic and phenotypic bedaquiline susceptibility testing displayed variable results over time and ...ultimately were not predictive of treatment outcome. This observation highlights the limits of current genotypic and phenotypic methods for detection of bedaquiline resistance.
Approximately one-quarter of adnexal masses detected at ultrasonography are indeterminate for benignity or malignancy, posing a substantial clinical dilemma.
To validate the accuracy of a 5-point ...Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) score for risk stratification of adnexal masses.
This multicenter cohort study was conducted between March 1, 2013, and March 31, 2016. Among patients undergoing expectant management, 2-year follow-up data were completed by March 31, 2018. A routine pelvic MRI was performed among consecutive patients referred to characterize a sonographically indeterminate adnexal mass according to routine diagnostic practice at 15 referral centers. The MRI score was prospectively applied by 2 onsite readers and by 1 reader masked to clinical and ultrasonographic data. Data analysis was conducted between April and November 2018.
The primary end point was the joint analysis of true-negative and false-negative rates according to the MRI score compared with the reference standard (ie, histology or 2-year follow-up).
A total of 1340 women (mean range age, 49 18-96 years) were enrolled. Of 1194 evaluable women, 1130 (94.6%) had a pelvic mass on MRI with a reference standard (surgery, 768 67.9%; 2-year follow-up, 362 32.1%). A total of 203 patients (18.0%) had at least 1 malignant adnexal or nonadnexal pelvic mass. No invasive cancer was assigned a score of 2. Positive likelihood ratios were 0.01 for score 2, 0.27 for score 3, 4.42 for score 4, and 38.81 for score 5. Area under the receiver operating characteristic curve was 0.961 (95% CI, 0.948-0.971) among experienced readers, with a sensitivity of 0.93 (95% CI, 0.89-0.96; 189 of 203 patients) and a specificity of 0.91 (95% CI, 0.89-0.93; 848 of 927 patients). There was good interrater agreement among both experienced and junior readers (κ = 0.784; 95% CI, 0.743-0824). Of 580 of 1130 women (51.3%) with a mass on MRI and no specific gynecological symptoms, 362 (62.4%) underwent surgery. Of them, 244 (67.4%) had benign lesions and a score of 3 or less. The MRI score correctly reclassified the mass origin as nonadnexal with a sensitivity of 0.99 (95% CI, 0.98-0.99; 1360 of 1372 patients) and a specificity of 0.78 (95% CI, 0.71-0.85; 102 of 130 patients).
In this study, the O-RADS MRI score was accurate when stratifying the risk of malignancy in adnexal masses.
•Management based on the O-RADS MRI scoring system could allow avoidance of non - essential surgery in 88.2% cases.•This strategy would lead to 8 false negative cases: 6 with borderline and 2 with ...invasive lesions.•The use of the O-RADS MRI scoring system to refine surgical indications should be promoted.
To assess the potential impact of the O-RADS MRI score on the decision-making process for the management of adnexal masses.
EURAD database (prospective, European observational, multicenter study) was queried to identify asymptomatic women without history of infertility included between March 1st and March 31st 2018, with available surgical pathology or clinical findings at 2-year clinical follow-up. Blinded to final diagnosis, we stratified patients into five categories according to the O-RADS MRI score (absent i.e. non adnexal, benign, probably benign, indeterminate, probably malignant). Prospective management was compared to theoretical management according to the score established as following: those with presumed benign masses (scored O–RADS MRI 2 or 3) (follow-up recommended) and those with presumed malignant masses (scored O–RADS MRI 4 or 5) (surgery recommended).
The accuracy of the score for assessing the origin of the mass was of 97.2 % (564/580, CI95% 0.96–0.98) and was of 92.0 % (484/526) for categorizing lesions with a negative predictive value of 98.1 % (415/423, CI95% 0.96–0.99). Theoretical management using the score would have spared surgery in 229 patients (87.1 %, 229/263) with benign lesions and malignancy would have been missed in 6 borderline and 2 invasive cases. In patients with a presumed benign mass using O-RADS MRI score, recommending surgery for lesions >= 100 mm would miss only 4/77 (4.8 %) malignant adnexal tumors instead of 8 (50 % decrease).
The use of O-RADS MRI scoring system could drastically reduce the number of asymptomatic patients undergoing avoidable surgery.
To assess the influence of gray-level discretization on inter- and intra-observer reproducibility of texture radiomics features on clinical MR images.
We studied two independent MRI datasets of 74 ...lacrymal gland tumors and 30 breast lesions from two different centers. Two pairs of readers performed three two-dimensional delineations for each dataset. Texture features were extracted using two radiomics softwares (Pyradiomics and an in-house software). Reproducible features were selected using a combination of intra-class correlation coefficient (ICC) and concordance and coherence coefficient (CCC) with 0.8 and 0.9 as thresholds, respectively. We tested six absolute and eight relative gray-level discretization methods and analyzed the distribution and highest number of reproducible features obtained for each discretization. We also analyzed the number of reproducible features extracted from computer simulated delineations representative of inter-observer variability.
The gray-level discretization method had a direct impact on texture feature reproducibility, independent of observers, software or method of delineation (simulated vs. human). The absolute discretization consistently provided statistically significantly more reproducible features than the relative discretization. Varying the bin number of relative discretization led to statistically significantly more variable results than varying the bin size of absolute discretization.
When considering inter-observer reproducible results of MRI texture radiomics features, an absolute discretization should be favored to allow the extraction of the highest number of potential candidates for new imaging biomarkers. Whichever the chosen method, it should be systematically documented to allow replicability of results.
To investigate the diagnostic accuracy of applying four levels of manual pressure in Shear Wave Elastography (SWE) of the breast and to assess inter-rater reliability.
Single-center prospective ...preliminary study including patients receiving ultrasound examination of breast lesions as part of routine clinical practice. SWE was performed on 60 breast masses (26 benign and 34 malignant) in 54 patients by a breast fellowship trained radiologist. Stiffness values were compared between benign and malignant masses at four levels of manual compression: none, mild, moderate, and marked. Accuracy of SWE was assessed using receiving operating characteristics analysis at each level. In 18 patients, a second radiologist repeated the SWE acquisitions to evaluate reproducibility. Reproducibility was assessed using intraclass correlation coefficient.
Without compression, we observed no significant difference in stiffness (p > 0.99) between benign and malignant lesions, and SWE demonstrated low accuracy (area under the curve = 0.64). Stiffness was higher in malignant lesions at all levels of compression (p < 0.001). SWE demonstrated good accuracy at all three levels of compression (from area under the curve = 0.71 to 0.84 across Emax and Emean), with high interobserver agreement.
This preliminary study suggests that not using compression during SWE for breast lesion characterization offers suboptimal results. On the contrary, application of compression yields high diagnostic performance with good interobserver agreement and, as such, should be included in routine clinical practice.
Objectives
Multidisciplinary tumour boards (MTBs) play an increasingly important role in managing cancer patients from diagnosis to treatment. However, many problems arise around the organisation of ...MTBs, both in terms of organisation-administration and time management. In this context, the European Society of Oncologic Imaging (ESOI) conducted a survey among its members, aimed at assessing the quality and amount of involvement of radiologists in MTBs, their role in it and related issues.
Methods
All members were invited to fill in a questionnaire consisting of 15 questions with both open and multiple-choice answers. Simple descriptive analyses and graphs were performed.
Results
A total of 292 ESOI members in full standing for the year 2018 joined the survey. Most respondents (89%) declared to attend MT-Bs, but only 114 respondents (43.9%) review over 70% of exams prior to MTB meetings, mainly due to lack of time due to a busy schedule for imaging and reporting (46.6%). Perceived benefits (i.e. surgical and histological feedback (86.9%), improved knowledge of cancer treatment (82.7%) and better interaction between radiologists and referring clinicians for discussing rare cases (56.9%)) and issues (i.e. attending MTB meetings during regular working hours (71.9%) and lack of accreditation with continuing medical education (CME) (85%)) are reported.
Conclusions
Despite the value and benefits of radiologists’ participation in MTBs, issues like improper preparation due to a busy schedule and no counterpart in CME accreditation require efforts to improve the role of radiologists for a better patient care.
Key Points
• Most radiologists attend multidisciplinary tumour boards, but less than half of them review images in advance, mostly due to time constraints.
• Feedback about radiological diagnoses, improved knowledge of cancer treatment and interaction with referring clinicians are perceived as major benefits.
• Concerns were expressed about scheduling multidisciplinary tumour boards during regular working hours and lack of accreditation with continuing medical education.
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