Canan Altay

Background and Objectives: Intraoperative frozen section (FS) examination is used to differentiate malignant from benign thyroid nodules but is limited by pathologist dependence, time, and cost. This study evaluated whether ex vivo shear wave elastography (SWE), applied separately to mapped thyroid nodules, could serve as an alternative to FS and investigated the effects of nodule number and tumour size on SWE performance. Materials and Methods: A total of 343 thyroid nodules from 100 thyroidectomy patients were mapped and numbered ex vivo. Five two-dimensional SWE measurements were obtained from each nodule using a Philips EPIQ Elite ultrasound system with ElastQ Imaging. Mean, minimum, and maximum stiffness values (kPa) were recorded, and each nodule underwent individual pathological examination. Diagnostic performance was assessed using ROC analysis and the Youden index. Performance was compared according to nodule number (1, 2–3, ≥4) and tumour size (≤10, 11–20, >20 mm). Generalised Estimating Equations (GEE) logistic regression was used to assess independent effects while accounting for within-patient clustering. Results: Of 343 nodules, 229 (66.76%) were benign and 114 (33.23%) malignant. Mean SWE was significantly higher in malignant than benign nodules (49.87 ± 21.30 vs. 18.59 ± 5.53 kPa; p < 0.0001). ROC analysis yielded an AUC of 0.9396 (95% CI: 0.9110–0.9650). At the 25.40 kPa cutoff, sensitivity, specificity, and accuracy were 84.21%, 90.39%, and 88.33%, respectively. Sensitivity decreased with increasing nodule number (92.30%, 86.11%, 81.53%), whereas tumour size correlated strongly with SWE (ρ = 0.7807; p < 0.0001). Sensitivity increased from 70.17% for malignant nodules ≤ 10 mm to 100% for those >20 mm. In GEE analysis, nodule number was not independently significant after adjustment for tumour size (OR = 0.93; 95% CI: 0.58–1.47; p = 0.75), whereas tumour size remained significant (p < 0.0001). Conclusions: Ex vivo nodule-based SWE accurately predicts thyroid malignancy. The apparent effect of nodule multiplicity on sensitivity is largely explained by tumour size. SWE may therefore represent a useful adjunct or potential alternative to intraoperative FS, particularly when nodule size is considered.

Background and Objectives: Intraoperative sentinel lymph node (SLN) assessment is a pivotal step in early-stage breast cancer surgery. Frozen section (FS) analysis remains a widely utilised technique; however, its limitations, particularly in the detection of micrometastases, are well-documented. The process is both time-consuming and costly. The objective of this study was to investigate the potential of ex vivo shear-wave elastography (SWE) as a rapid and reproducible method for quantifying lymph node stiffness and predicting metastatic involvement. Materials and Methods: Between January 2022 and January 2024, 100 patients with biopsy-confirmed invasive breast cancer undergoing SLNB were enrolled in the study. A total of 384 excised axillary lymph nodes were subjected to ex vivo SWE immediately following excision, prior to the standard histopathological procedure. The mean stiffness (Emean) values were recorded, and the diagnostic performance was evaluated with the use of ROC analysis. Results: Of the 384 nodes examined, 45 (11.6%) were found to have metastases on final histopathology. It was demonstrated that Emean exhibited excellent discriminatory power, with an Area Under the Curve (AUC) value of 0.957. At the optimal cut-off of 28 kPa, the sensitivity and specificity levels were recorded as 91% and 87%, respectively. Conclusions: The findings of this study indicate that ex vivo SWE is a highly accurate and reproducible method for identifying metastatic sentinel lymph nodes. The technique has the potential to complement or selectively replace intraoperative FS, thereby reducing unnecessary tissue processing. The logical next step is multicentre validation.

Aim: This study aimed to look into how well ureteral jet flow can predict whether ureteral stones will pass naturally and to observe any changes in jet flow after treatment, with a focus on where the stones are located. Materials and Methods: We conducted this study with 50 adults who had acute renal colic and were found to have a single ureteral stone less than 10 mm through non-contrast CT scans. We used Doppler ultrasound before treatment and again between days 15 and 20 to measure jet frequency (JETfreq) and mean jet velocity (JETmean). We checked to see if the stones passed after 28 days. For analysis, we used paired tests, the Mann Whitney U test, and Pearson correlation. Results: After treatment, we saw significant increases in JETfreq and JETmean only in the obstructed ureter, which suggests some recovery. For stones located farther down the ureter, the jet measurements improved more than in those closer to the kidney. In total, 54% of patients passed their stones naturally. Those who did not had stones that were larger, covered a bigger area, and had higher Hounsfield Birimi HU values (p

Background/Objectives: To evaluate the clinical utility and diagnostic performance of quantitative MRI parameters (T1, T2*, R2*, and ADC) in differentiating renal tumor subtypes and WHO grades, and to assess their potential role in non-invasive tumor characterization. Methods: This retrospective study included 82 patients with histopathologically confirmed renal tumors who underwent preoperative contrast-enhanced MRI between July 2019 and January 2024. Quantitative measurements were obtained from tumor regions and contralateral healthy renal cortex using standardized ROI-based analysis. Parameters included T2*, native and post-contrast T1, R2* (1/T2*), and ADC values. Interobserver agreement was assessed. A Random Forest model was used as a supplementary analytical tool. Results: The cohort included 82 patients (mean age: 59.3 years). Tumors were classified into multiple subtypes, with clear cell carcinoma being the most common (n = 46). High-grade tumors (WHO grades 3–4) demonstrated significantly lower ADC values (p = 0.029) and larger tumor size (p = 0.0017). Significant differences in T2*, R2*, and ADC values were observed across tumor subtypes (p < 0.05). Quantitative MRI parameters demonstrated moderate discriminatory performance, with ADC emerging as the most robust biomarker. The Random Forest model achieved an overall accuracy of 93.2%, primarily driven by ADC and post-contrast T1 values. Conclusions: Quantitative MRI parameters, particularly ADC, provide clinically meaningful non-invasive biomarkers for renal tumor characterization. Their combined interpretation, supported by contralateral renal cortex comparison, may enhance clinical decision-making. Further validation in larger cohorts is warranted.

Objectives The aim of the study was to evaluate the preoperative magnetic resonance imaging (MRI) features that best distinguish leiomyomas (UM) from leiomyosarcomas (LMS) and to predict UMs preoperatively using an MRI scoring system. Methods This was a cross-sectional study conducted at a tertiary center. Between 2013 and 2023, 109 patients who underwent myomectomy or hysterectomy with pelvic MRI in the six months before the operation and had a histopathologically confirmed report of UM or LMS were included in the study. The cases were classified as Group 1 (UM; n=101, 92.6%) and Group 2 (LMS; n=8, 7.4%) according to histopathology reports. Non-normally distributed variables were analyzed using the Mann-Whitney U test. Categorical data were analyzed using the Chi-square test and Fisher's exact test. Receiver Operating Characteristic (ROC) analysis was performed to calculate the cut-off value, specificity and sensitivity of MRI scoring system. Logistic regression analysis were used to evaluate MRI features. The p value considered statistically significant was <0.05. Results Six of the 15 MRI features were statistically different between the groups. Total MRI predictive score was 3 in the UM group and 4.5 in the LMS group. There was a statistical difference between the groups (p<0.01). Total score lower than 7 was calculated as the cut-off point prediciting UM (sensitivity 98%; specificity 38%; PPV 95.5%; NPV 60%, p<0.01). Conclusion This preoperative MRI scoring system demonstrates predictive capability in distinguishing between UMs and LMSs.

Purpose: The aim of this study is to assess the presence of sarcopenia in multiple myeloma (MM) patients both before and after autologous stem cell transplantation (ASCT) and to investigate if ASCT is a causative factor for sarcopenia. This study is the first to examine the impact of ASCT on sarcopenia in individuals with MM via bioelectrical impedance analysis (BIA), computed tomography (CT), and performance tests simultaneously. Materials and Methods: The prospective study was conducted from January 2022 to April 2023. The median duration of the follow‐up period was 12 months. All of the participants were assessed for sarcopenia by BIA, CT, and performance tests at 1 month (±2 weeks) prior to the conditioning regimen and 6 months (±4 weeks) following the transplant. The EWGSOP 2018 guideline was used for sarcopenia diagnosis. Results: In the study, 102 patients who were ≥ 18 years and diagnosed with MM according to the criteria established by the International Myeloma Working group (IMWG) were enrolled. Pre‐ASCT, 47 (46%) patients and post‐ASCT, 51 patients (50%) were sarcopenic ( p = 0.12). Pre‐ASCT, a low skeletal muscle index (SMI) was identified in 51% of the patients, and this percentage increased to 56% after ASCT ( p = 0.03). In multivariate analysis, female sex (odds ratio [OR]: 1.25; 95% CI: 1.12–1.38; and p = 0.007), higher Hematopoietic Cell Transplantation‐Specific Comorbidity Index (HCT‐CI) score (OR: 1.16; 95% CI: 1.04–1.29; and p = 0.008), and lower body mass index (BMI) (OR per unit increase: 0.94; 95% CI: 0.88–0.99; and p = 0.045) were independently associated with sarcopenia. Conclusions: Our study revealed a high prevalence of sarcopenia among individuals with MM. We demonstrated that individuals with comorbidities, a low BMI, and female sex have a higher predisposition to sarcopenia. There was no increase in the occurrence of sarcopenia after ASCT; however, SMI decreased.

Gastrointestinal Neuroendocrine Neoplasms - Türk Radyoloji Seminerleri

Background: Adnexal torsion is a gynecological emergency that can lead to loss of ovarian function if not diagnosed promptly. This study aimed to determine which computed tomography (CT) findings, or combinations of findings, can accurately diagnose adnexal torsion in women presenting with abdominal pain and adnexal masses. Methods: In this retrospective single-center cohort study conducted between January 2018 and December 2023, a total of 66 patients were evaluated. Group 1 (n = 35; 53%) included women who underwent preoperative CT for abdominal pain and were subsequently diagnosed with adnexal torsion. Group 2 (n = 31; 47%) served as the control group and comprised patients who underwent preoperative CT for untwisted adnexal masses. Statistical analysis was performed using SPSS version 26.0. Normality was assessed with the Kolmogorov-Smirnov test. Non-normally distributed variables were analyzed using the Mann-Whitney U test. Categorical variables were analyzed using the chi-square test or Fisher’s exact test. Interobserver agreement for CT findings was evaluated, and logistic regression analyses were conducted. A p-value < 0.05 was considered statistically significant. Results: Interobserver agreement was almost perfect for the identification of unusual adnexal and uterus location, the presence of an interutero-ovarian mass, the whirlpool sign, peritoneal effusion, and tubal thickening. The unusual location of the adnexa and the presence of the whirlpool sign were significantly more frequent in the adnexal torsion group (Group 1) and remained statistically significant in the logistic regression analysis. Conclusion: Accurate interpretation of CT scans performed in emergency settings, particularly in experienced centers, may help in reliably diagnosing or excluding adnexal torsion, potentially reducing unnecessary surgical interventions.

Background/Aims: The prevalence of sarcopenia and osteopenia/osteoporosis is increased in chronic pancreatitis (CP). This study aims to evaluate the prevalence and related factors of osteosarcopenia in CP patients. Materials and Methods: Eighty-three CP patients were included in this cross-sectional observational study. Sarcopenia was assessed by measuring the surface area of the paravertebral muscles at the third lumbar region. Pancreatic fecal elastase (PFE) tests evaluated exocrine pancreatic insufficiency (EPI), while dual-energy x-ray absorptiometry scans assessed osteopenia/osteoporosis. EORTC PAN26 and a symptom questionnaire were administered, alongside nutritional marker assessments concurrent with PFE. Results: The prevalence of sarcopenia and osteopenia/osteoporosis was found to be 22.9% (n = 19) and 68.7% (n = 44), respectively. Factors associated with sarcopenia included male gender (OR: 4.9, P = .044), severe EPI (OR: 4.2, P = .043), smoking (OR: 4.6, P = .040), and zinc deficiency (OR: 2.2, P = .029). Severe EPI was significantly associated with osteopenia/osteoporosis (P = .010), diabetes mellitus (P = .001), sarcopenia (P = .016), and zinc deficiency (P = .012). Individuals with osteoporosis had higher PAN26 scores (P = .029). Factors independently associated with osteopenia/osteoporosis included female gender (OR: 7.8, P = .004), severe EPI (OR: 8.1, P = .003), and sarcopenia (OR: 5, P = .037). The prevalence of osteosarcopenia was 19.2%. Conclusion: Osteosarcopenia is common in CP patients. Smoking, zinc deficiency, EPI, and male gender are strongly associated with sarcopenia. Screening for osteosarcopenia is essential in CP patients to facilitate appropriate interventions. Cite this article as: Döngelli H, Bengi G, Yarol RC, et al. Clinical features and prevalence of osteosarcopenia in chronic pancreatitis. Turk J Gastroenterol. 2025;36(10):669-679.