Florentina Guzmán-Aroca

Background/Objectives: This study evaluates intratumoral susceptibility signals (ITSS) as imaging markers for glioma grade prediction and their association with molecular and histopathologic features, in the context of the fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System (WHO CNS5). Methods: We retrospectively analyzed patients with adult diffuse gliomas who underwent pretreatment magnetic resonance imaging. ITSS were semiquantitatively graded by two radiologists: grade 0 (no signal), grade 1 (1–5), grade 2 (6–10), and grade 3 (≥11). Relative cerebral blood volume (rCBV) and tumor volume were also obtained. Histopathologic features included tumor grade, Ki-67, mitotic count, necrosis, microvascular proliferation, and molecular alterations (isocitrate dehydrogenase [IDH], 1p/19q, cyclin-dependent kinase inhibitors 2A and 2B [CDKN2A/B], and p53). Regression models predicted tumor grade (low: 1–2, high: 3–4) using ITSS, tumor volume, and rCBV. ROC curves and diagnostic performance metrics were analyzed. Results: 99 patients were included. ITSS grading correlated with rCBV, tumor volume, mitotic count, Ki-67, and tumor grade (p < 0.001). ITSS grades 0–1 were associated with oligodendrogliomas and astrocytomas (p < 0.001), IDH mutations (p < 0.001), and 1p/19q co-deletions (p = 0.01). ITSS grades 2–3 were linked to glioblastomas (p < 0.001), necrosis (p < 0.001), microvascular proliferation (p < 0.001), and CDKN2A/B homozygous deletions (p = 0.02). Models combining ITSS with rCBV and volume showed AUC of 0.94 and 0.96 (p < 0.001), outperforming univariate models. Conclusions: Semiquantitative ITSS grading correlates with key histopathologic and molecular glioma features. Combined with perfusion and volumetric parameters, ITSS enhance non-invasive glioma grading, in alignment with WHO CNS5.

Over a 10-week period, 38 third-year medical students participated in an online course integrated into a basic breast ultrasound workshop. The primary objective of this article is to comprehensively assess the impact of the online self-directed training phase. In the experimental group, students engaged with a curated selection of publicly available audiovisual resources sourced from Instagram®, while the control group followed traditional instruction through conventional masterclasses using PowerPoint presentations. The experimental hypothesis posited that foundational breast ultrasound skills could be effectively acquired through the exploration of public Instagram content combined with self-assessment via Kahoot®. In this context, Kahoot® served not only as the platform for disseminating Instagram-related topics and links but also as a tool for ongoing formative assessments within the experimental group. A quasi-experimental design was employed, incorporating pre- and post-assessments and a control group for comparison. The findings demonstrated significant gains in both knowledge and confidence among students exposed to the gamified, Instagram-based intervention. Specifically, in the domain of Histology and Anatomy, the experimental group improved their post-test scores from 6.68 to 8.68, whereas the control group’s scores increased from 4.47 to 5.14. Regarding ultrasound physics knowledge, the experimental group's scores rose from 6.26 to 7.74, in contrast to an increase from 4.17 to 4.90 in the control group. In terms of understanding normal breast anatomy, the experimental group achieved a post-test score of 6.83, while the control group improved from 4.79 to 6.79. Moreover, the experimental group demonstrated a marked improvement in their ability to identify benign and suspicious breast findings. Self-assessment data indicated enhanced confidence in ultrasound skills among experimental group participants, who also reported high levels of enthusiasm for the program, reflected in an average satisfaction rating of 4.63 out of 5. This elevated satisfaction may contribute to increased program visibility and future enrollment. Despite these encouraging results, the limited sample size (19 participants per group) restricts the generalizability of the findings. Future research should involve larger sample sizes and longitudinal designs to better evaluate knowledge retention and the long-term impact of social media platforms on medical education. Durante 10 semanas, 38 estudiantes de medicina de tercer año participaron en un curso en línea como parte de un taller básico de ultrasonido mamario. Este artículo evalúa los efectos de la fase de autoformación en línea. Un grupo experimental utilizó recursos audiovisuales curados de Instagram®, mientras que un grupo de control continuó con clases magistrales tradicionales. La hipótesis se centró en el aprendizaje del ultrasonido mamario básico a través de material público de Instagram y autoevaluaciones mediante Kahoot®, que facilitó tanto la entrega de contenido como evaluaciones continuas para el grupo experimental.El diseño del estudio fue cuasi-experimental, utilizando evaluaciones pre y post y grupos de control. Se encontraron mejoras significativas en el conocimiento y la confianza de los estudiantes que usaron intervenciones gamificadas basadas en Instagram. En cuanto al conocimiento de histología y anatomía, el grupo experimental aumentó sus puntajes de post-prueba de 6.68 a 8.68, mientras que el grupo de control mejoró de 4.47 a 5.14. En conocimiento de física del ultrasonido, el grupo experimental pasó de 6.26 a 7.74, en contraste con el aumento del grupo de control de 4.17 a 4.90. En la comprensión de la anatomía mamaria normal, el grupo experimental alcanzó 6.83 en la post-prueba, mientras que el grupo de control subió a 6.79 desde 4.79. Además, el grupo experimental mostró confianza mejorada en sus habilidades de ultrasonido, con una alta puntuación media de satisfacción de 4.63/5. A pesar de estos hallazgos positivos, el pequeño tamaño de muestra (19 participantes por grupo) limita extrapolar, sugiriendo que futuros estudios deberían incorporar grupos más grandes y diseños longitudinales para investigar la retención del conocimiento y el impacto de las plataformas de redes sociales en la educación médica.

Background. Due to the high false negative rate (FNR) associated with sentinel lymph node biopsy (SLNB) after neoadjuvant systemic therapy (NAST), the standard surgical treatment for patients with an initially positive axilla and indicated for NAST is axillary lymph node dissection (ALND). To avoid unnecessary ALND, this multicenter, prospective, observational study aimed to determine the effectiveness and ease of using magnetic seeds (Magseed) for targeted axillary dissection (TAD) when the seeds are placed before or after NAST. Materials and Methods. We recruited 81 patients diagnosed with T1-T3 breast cancer, with clinically/radiologically positive nodal involvement (cN1, 75 patients with 13 nodes suspected nodes and 6 patients with up to 4 suspected nodes) prior to NAST. Positive nodes detected by fine-needle aspiration biopsy or core needle biopsy were marked with a stainless steel marker coil and after NAST with Magseed prior to surgery (Post-NAST group), or directly with Magseed before NAST (Pre-NAST group). The correlation between lymph nodes marked with Magseed (MLNs) and sentinel lymph nodes (SLNs) was calculated based on pathologic assessment with the OSNA assay (Sysmex Corporation, Kobe) or conventional sectioning and staining techniques according to the standard protocols of each center. Results. All magnetic seeds were successfully identified and retrieved in just over 10 minutes of surgery, guided by the Sentimag magnetometer system. The overall concordance rate between MLNs and SLNs was 81.5, and the concordance between MLNs and SLNs with metastasis was 93.8. Metastasis was detected in 54.3 of the MLNs compared with 48.1 of SLNs. In cases that presented negative MLN and negative SLN (negative TAD), the FNR was 0. No significant differences were found between the Post-NAST and Pre-NAST groups. Conclusions. Our results validate the use of Magseed for long-term marking of axillary lymph nodes and show that when used in combination with SLNB for TAD, a FNR of 0 can be achieved, avoiding unnecessary ALND.

The aim of this study was to investigate the efficacy of ultrasound-guided percutaneous needle electrolysis (PNE) in mammillary fistulas (MFs). A prospective study was performed in 18 patients with MF who were treated with the PNE technique. The technique was repeated in the case of no response or recurrence. The results obtained show that MFs revealing an elongated appearance with the ultrasound (US) are generally resolved with two sessions of PNE, whereas ovoid MFs require several sessions of PNE for complete resolution and they tend to recur. Success of the treatment with PNE was observed in 88.8% of the patients (16/18), and failure, after five or six sessions in two cases (11.2%), which were referred for surgery. Conclusions: To the best of our knowledge this is the first study to reveal that the PNE technique is safe, effective, quick, and well-tolerated by patients.

The aim of this study was to investigate the efficacy of the vacuum-assisted biopsy (VAB) system in evacuating symptomatic haematomas after VAB excision of benign breast lesions. We retrospectively analysed the data of eight patients with symptomatic and large haematomas who were treated with VAB evacuation between 10 and 14 days after VAB excision. Only one case underwent the procedure 24 h after VAB excision, due to the patient reporting intense pain, which was relieved after application of the technique, even though it had to be done twice. This new clinical application of the VAB system for evacuating symptomatic breast haematomas was successful in all the cases in the present study. No technique-related complications were observed. Conclusions: To the best of our knowledge, this is the first study to reveal that VAB evacuation of symptomatic haematomas is safe, effective, quick and well-tolerated by patients.

The aim of this study was to compare in vivo vs ex vivo liver stiffness in rats with acoustic radiation force impulse (ARFI) elastography using the histological findings as the gold standard. Eighteen male Wistar rats aged 16–18 months were divided into a control group (n = 6) and obese group (n = 12). Liver stiffness was measured with shear wave velocity (SWV) using the ARFI technique both in vivo and ex vivo. The degree of fibrosis, steatosis and liver inflammation was evaluated in the histological findings. Pearson’s correlation coefficient was applied to relate the SWV values to the histological parameters. The SWV values acquired in the ex vivo study were significantly lower than those obtained in vivo (P < 0.004). A significantly higher correlation value between the degree of liver fibrosis and the ARFI elastography assessment was observed in the ex vivo study (r = 0.706, P < 0.002), than the in vivo study (r = 0.623, P < 0.05). Assessment of liver stiffness using ARFI elastography yielded a significant correlation between SWV and liver fibrosis in both the in vivo and ex vivo experiments. We consider that by minimising the influence of possible sources of artefact we could improve the accuracy of the measurements acquired with ARFI.

Acoustic radiation force impulse (ARFI) is a non-invasive alternative to a liver biopsy for the evaluation of liver fibrosis (LF). To investigate the potential usefulness of acoustic radiation force impulse ARFI for detecting LF in overweight and obese children A cross-sectional study was conducted in 148 schoolchildren. A diagnosis of non-alcoholic fatty liver disease (NAFLD) and LF was based on ultrasound (US) and ARFI shear wave velocity (SWV). The laboratory parameters were normal in all the children. NAFLD was observed in 50 children (33.8%). The median SWV was 1.18 ± 0.28 m/s. Differences between ARFI categories and hepatic steatosis grades were observed (χ2 = 43.38, P = 0.0005). No fibrosis or insignificant fibrosis (SWV ≤ 1.60 m/s) was detected in 137 children (92.5%), and significant fibrosis (SWV > 1.60 m/s) in 11 children (7.5%), nine of whom had normal US or mild steatosis. The present study is the first to evaluate the utility of the ARFI technique for detecting LF in overweight and obese children. The results of the study suggest that children with normal laboratory parameters such as normal liver ultrasound or mild steatosis may present with significant LF.