Diagnostics最新文献

{"title":"Observed Clinical and Operational Factors Are Associated with Biomarker Test Utilization in Respiratory Virus RT-PCR Testing: A Real-World Analysis of Inflammatory, Cardiac, and Thrombotic Biomarkers.","authors":"Yonghee Lee, Ga-Yeon Kim, Jae Kyung Kim","doi":"10.3390/diagnostics16193232","DOIUrl":"10.3390/diagnostics16193232","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Routinely collected biomarker data are generated through selective testing. We examined associations of observed clinical and operational factors with biomarker availability and explored the incremental discrimination provided by biomarker concentrations for respiratory viral RT-PCR positivity. <b>Methods:</b> This retrospective study included 7726 testing episodes for 13 respiratory viral targets from July 2020 to March 2025. Seven biomarkers were linked using a ±24-h reporting-time window. Models included age, sex, requesting department, operational time, calendar month, and year. Additional analyses included inverse probability weighting (IPW), weight and overlap diagnostics, and five repetitions of five-fold cross-validation. <b>Results:</b> Viral positivity was 12.72%. Biomarker availability ranged from 98.87% for C-reactive protein to 22.87% for B-type natriuretic peptide. Procalcitonin (PCT) result availability was associated with lower odds of viral positivity after adjustment (OR, 0.702; 95% CI, 0.583-0.846). Among episodes with a PCT result, the concentration association was close to the null (OR per doubling, 0.991; 95% CI, 0.953-1.030). The complete-cohort base model had an apparent area under the receiver operating characteristic curve (AUC) of 0.8263. The largest apparent ΔAUC was 0.00418 for D-dimer; its mean out-of-fold ΔAUC was 0.00367. IPW diagnostics showed substantial reductions in effective sample size and sensitivity to extreme weights for some biomarkers. <b>Conclusions:</b> Biomarker availability was associated with the observed clinical and operational factors, whereas concentrations added little discrimination for positivity within the available viral panel. These findings illustrate selection in retrospective laboratory data and do not assess biomarker usefulness for their intended clinical indications.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hashimoto Thyroiditis Modifies the Association Between Nuclear Atypia and Malignancy in Bethesda III Thyroid Nodules.","authors":"Adem Şentürk, Yusuf Öztürk, Emre Gönüllü, İsmail Özer, Kübra Tuba Çayir, Ahmet Tarık Harmantepe, Yavuz Selim Kahraman, Fuldem Mutlu","doi":"10.3390/diagnostics16193235","DOIUrl":"10.3390/diagnostics16193235","url":null,"abstract":"<p><p><b>Background:</b> Nuclear atypia is associated with an increased risk of malignancy in Bethesda III thyroid nodules; however, reactive nuclear changes related to Hashimoto thyroiditis (HT) may complicate its interpretation. We investigated whether HT modifies the association between nuclear atypia and malignancy in Bethesda III nodules. <b>Methods:</b> This retrospective single-center study included 426 surgically selected patients with Bethesda III nodules who underwent thyroidectomy between January 2015 and August 2026. HT was defined by postoperative histopathology. The association between nuclear atypia and malignancy was evaluated according to HT status. Effect modification was assessed using an HT × nuclear atypia interaction term in unadjusted and multivariable logistic regression models. <b>Results:</b> HT was present in 199 (46.7%) patients. Malignancy was less frequent in patients with HT than in those without HT (26.1% vs. 38.8%, <i>p</i> = 0.006), whereas nuclear atypia was more frequent (91.0% vs. 45.8%, <i>p</i> < 0.001). In patients without HT, nuclear atypia was strongly associated with malignancy and remained an independent predictor after multivariable adjustment (adjusted OR 13.24, 95% CI 5.46-32.10; <i>p</i> < 0.001). In patients with HT, nuclear atypia was not associated with malignancy (OR 0.68, 95% CI 0.24-1.94; <i>p</i> = 0.466). The HT × nuclear atypia interaction was significant in both unadjusted (OR 0.040, <i>p</i> < 0.001) and adjusted models (OR 0.031, <i>p</i> < 0.001). <b>Conclusions:</b> HT significantly modified the association between nuclear atypia and malignancy in Bethesda III nodules. Nuclear atypia strongly predicted malignancy in the absence of HT but not in its presence. Given the postoperative definition of HT, prospective validation using preoperative HT indicators is required before clinical application.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sonographic Diagnosis of Intraplacental Hematoma in Preterm Pregnancy: A Case Report and Review of Literature.","authors":"Sonia-Teodora Luca, Vlăduț Săsăran, Ovidiu Grama, Diana Maria Chiorean, Claudiu Mărginean","doi":"10.3390/diagnostics16193233","DOIUrl":"10.3390/diagnostics16193233","url":null,"abstract":"<p><p><b>Background:</b> Intraplacental hematomas are uncommon placental lesions with potentially significant clinical implications, and their antenatal diagnosis remains challenging. This case report aims to present a rare case of a rapidly enlarging intraplacental hematoma diagnosed antenatally by serial ultrasonographic examinations and to highlight the potential role of ultrasonography in its diagnosis. <b>Case Presentation:</b> A 22-year-old gravida 2, para 2 woman presented at 34 weeks and 3 days of gestation for routine antenatal evaluation. Her pregnancy was complicated by intrahepatic cholestasis of pregnancy, treated with ursodeoxycholic acid, with subsequent improvement in biochemical parameters and symptoms. Although asymptomatic, she was noted to have intermittent hypertension. Ultrasonography revealed a well-circumscribed, hypoechoic intraplacental mass measuring 4.37 × 4.0 cm. Color Doppler demonstrated several apparent vascular channels extending through and around the lesion. Repeat ultrasonography 10 min later showed rapid enlargement, raising suspicion of an active intraplacental hematoma. In view of the rapidly progressive sonographic findings and maternal hypertension, emergency cesarean delivery was performed. A newborn was delivered with Apgar scores of 8 and 9 at 1 and 5 min, respectively. Histopathological examination confirmed extensive recent intraplacental hemorrhage, with erythrocyte extravasation into the intervillous spaces and compression of adjacent chorionic villi, without evidence of organization. <b>Conclusions:</b> Meticulous placental assessment during prenatal ultrasonography is important, particularly in complicated pregnancies. Color Doppler and serial ultrasonographic examinations may help characterize intraplacental lesions and detect rapid interval changes, facilitating timely obstetric intervention. Histopathological examination remains essential for definitive diagnosis. Further research is needed to clarify the pathogenesis and clinical significance of intraplacental hematomas.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Performance of the Elecsys HCV Duo Immunoassay Compared with a Standard-of-Care Algorithm Using Alinity Anti-HCV Screening and HCV RNA Confirmation.","authors":"Jaeeun Yoo, Hye-Sun Park, JoungOk Kim, Sang-Ik Cho, Seong Hwan Jo, Seo-A Park, Min-Seok Kwon, Ae-Ran Choi, Eun-Jee Oh","doi":"10.3390/diagnostics16193239","DOIUrl":"10.3390/diagnostics16193239","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The Elecsys HCV Duo immunoassay simultaneously detects HCV core antigen (HCV Ag) and anti-HCV antibodies in a single sample. We evaluated its clinical performance against a standard-of-care reference algorithm of anti-HCV antibody and HCV RNA testing. <b>Methods:</b> We retrospectively analyzed 1332 residual serum or plasma samples tested with reference HCV RNA assays and the Alinity i Anti-HCV assay. Samples were classified as reference-positive, indicating current or past HCV infection (<i>n</i> = 166; 88 RNA+/Ab+ with active infection and 78 RNA-/Ab+ with resolved or treated infection), or reference-negative (n = 1166; RNA-/Ab-), including 1000 randomly selected blood donor samples. All specimens were tested with the Elecsys HCV Duo (cobas^® e 801, Roche Diagnostics). Positive and negative percent agreements (PPA and NPA) were calculated against the combined reference standard. Results were further analyzed by infection status and viral load. No HCV RNA+/anti-HCV- (window-period) specimens were available. <b>Results:</b> Overall agreement was high (PPA 98.8% [164/166; 95% CI, 95.7-99.9%]; NPA 99.9% [1165/1166; 95% CI, 99.5-100.0%]). Agreement of the anti-HCV component with the Alinity i Anti-HCV assay was identical (PPA 98.8%, NPA 99.9%). The HCV Duo Ag component showed a PPA of 60.2% (95% CI, 49.2-70.5%) and NPA of 99.0% (95% CI, 98.3-99.5%) against HCV RNA detection. The Ag module was also reactive in 12 of 78 (15.4%) RNA-/Ab+ specimens, all from previously treated patients; thus, 53 of 65 (81.5%) dual Ag/Ab-reactive specimens had detectable HCV RNA. HCV Ag positivity was highest at HCV RNA ≥10⁶ IU/mL (77.4%, 41/53), compared with 32.1% (9/28) at 10⁴-10⁶ IU/mL and 42.9% (3/7) at <10⁴ IU/mL. Receiver operating characteristic analysis of the Ag component yielded an area under the curve of 0.920 (95% CI, 0.904-0.934). <b>Conclusions:</b> The Elecsys HCV Duo demonstrated high overall agreement with the reference methods, supporting its potential as a single-step screening test for HCV infection. Most, but not all, dual Ag/Ab-reactive specimens were viremic, so this result may help prioritize anti-HCV-positive individuals for linkage to care; however, the assay does not replace HCV RNA testing, which remains necessary to confirm active infection, particularly in Ag-negative or previously treated individuals. Because no window-period specimens were included, the potential of the assay for earlier detection of acute infection could not be evaluated.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Segment-Level Evaluability of Dedicated Non-ECG-Gated Coronary CT Angiography: Associations with Calcification, Heart Rate, Vessel Territory, and Caliber.","authors":"Kun Wang, Aiyun Sun, Xia Qiu, Chunqiao Wu, Hong Ren, Yueqiao Zhang","doi":"10.3390/diagnostics16193234","DOIUrl":"10.3390/diagnostics16193234","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Dedicated coronary CT angiography (CCTA) without physical electrocardiographic gating may simplify acquisition, but segment-level interpretability may vary across the coronary tree. We evaluated coronary segment evaluability and factors associated with non-evaluability on dedicated non-ECG-gated CCTA. <b>Methods:</b> This retrospective single-center study included 320 patients and 3739 anatomically present coronary segments with a reference diameter of at least 1.5 mm. Evaluability required confident classification of diameter stenosis as <50% or ≥50%. Segment calcification was graded separately using a prespecified visual scale as none, mild, moderate, or severe. Patient-clustered generalized estimating equations used a binomial distribution, logit link, exchangeable working correlation, and robust standard errors. <b>Results:</b> Overall, 3378 segments (90.3%) were evaluable. All included segments were evaluable in 118/320 patients (36.9%); 202/320 (63.1%) had at least one non-evaluable segment and 111/320 (34.7%) had at least one proximal/mid non-evaluable segment. Examination success was 320/336 (95.2%). When 182 observed eligible segments from the 16 globally non-diagnostic examinations were included as non-evaluable, segment evaluability was 3378/3921 (86.2%); an additional 18-segment worst-case boundary yielded 3378/4027 (83.9%). Evaluability declined from 93.4% without calcification to 88.8%, 84.3%, and 74.3% with mild, moderate, and severe calcification. Adjusted odds ratios for non-evaluability were 1.95 (95% CI, 1.46-2.60), 3.13 (2.18-4.49), and 6.53 (4.39-9.71), respectively, versus no calcification. Higher heart rate (per 10 beats/min: OR, 1.52; 95% CI, 1.36-1.69) and right coronary artery location (OR, 1.56; 95% CI, 1.20-2.02) were associated with non-evaluability, whereas larger reference diameter was associated with lower odds (per 1 mm: OR, 0.69; 95% CI, 0.53-0.89). <b>Conclusions:</b> Most included coronary segments were evaluable on dedicated non-ECG-gated CCTA, but interpretability varied with calcification, heart rate, vessel territory, and caliber. These findings characterize segment-level feasibility and do not establish diagnostic accuracy, equivalence to ECG-gated CCTA, or a clinical eligibility threshold.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Computational Analysis of Diagnostic Misrecognition in Co-Occurring Primary Headache Disorders: Prime Encoding of ICHD3 Criteria Reveals 72 Potentially Spurious Diagnoses.","authors":"Pengfei Zhang","doi":"10.3390/diagnostics16193231","DOIUrl":"10.3390/diagnostics16193231","url":null,"abstract":"<p><p><b>Background/Objectives</b>: In clinical circumstances with more than one headache disorder, misrecognition can occur if each headache disorder is not separately and individually evaluated. For example, consider the case of a patient with baseline tension-type headaches lasting hours who now develops cluster headaches with nausea. Merging the characteristics of both disorders may yield the illusion of migraine. Do these types of misrecognitions occur necessarily because of ICHD3 criteria? Are there combinations of ICHD3 criteria, if any, which yield this type of misrecognition? This work seeks to determine whether a new, unintended diagnosis can be arrived at when one merges two primary ICHD3 diagnoses. <b>Methods</b>: ICHD3 primary headache disorders, as well as headache phenotypes closely mimicking ICHD3 criteria, were translated as numerical data using the prime encoding method. The encoding of two concurrent diagnoses in an individual was then modeled by multiplying all pairings of the ICHD3 encoding. The results were algorithmically diagnosed to see which pairings, if any, generate logically spurious diagnoses. <b>Results</b>: A total of 117,526 phenotypes were generated. After duplicate pairings of diagnoses were removed, a total of 72 pairings of unique ICHD3 diagnoses were derived that yield a \"new\" diagnosis. Thirty-seven (51%) of these pairings arise from our model's idiosyncrasy of encoding chronic migraine without encoding migraine with or without aura explicitly. Of the rest, 23 pairings involve combining paroxysmal hemicrania with either a longer- or shorter-duration headache. I further generalize the condition under which the above logically spurious diagnosis occurs as a mathematical observation. <b>Conclusions</b>: Misrecognition arises naturally if diagnostic criteria consist solely of characteristics from another headache disorder or a combination of two headache disorders. Specifically, combining headaches with different duration and/or frequency is most likely to yield these \"logically spurious\" diagnoses.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which Clinical, Radiological, Inflammatory, and Lesion-Related Characteristics Are Associated with Early Neurological Decompensation After Intracranial Mass Lesion Surgery?","authors":"Fatma Betül Saylak, Burak Bahadır","doi":"10.3390/diagnostics16193240","DOIUrl":"10.3390/diagnostics16193240","url":null,"abstract":"<p><p><b>Background:</b> Early neurological decompensation is a clinically relevant concern following intracranial surgery, but factors associated with this early outcome remain incompletely characterized. This study evaluated factors associated with neurological decompensation within 48 h after surgery. <b>Methods:</b> This retrospective, single-center study included 301 surgical episodes involving intracranial mass lesions. Early neurological decompensation was defined as a ≥2-point decrease in Glasgow Coma Scale (GCS) score, the development of a new neurological deficit, or the objective worsening of a pre-existing deficit within 48 h. Clinical, radiological, lesion-related, and hematological factors were evaluated using logistic regression and ROC analyses, with bootstrap internal validation. <b>Results:</b> Early neurological decompensation occurred in 63 surgical episodes (20.9%). Preoperative Karnofsky Performance Status (KPS) was independently associated with the outcome (aOR = 0.50; 95% CI: 0.38-0.67 per 10-point increase; corresponding per-1-point aOR = 0.93; 95% CI: 0.91-0.96; <i>p</i> < 0.001), while peritumoral edema showed a statistically significant but imprecisely estimated association (aOR = 5.10; 95% CI: 1.14-22.79; <i>p</i> = 0.033). In extended models, malignant lesion category and peripheral contrast enhancement were independently associated with the outcome, whereas NLR was not after multivariable adjustment. The primary model had an AUC of 0.793 and a bootstrap-corrected AUC of 0.777. <b>Conclusions:</b> Preoperative KPS showed the most consistent independent association with early neurological decompensation. Additional radiological and lesion-related factors did not demonstrate significant incremental discrimination beyond KPS alone. External validation is required before clinical application.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Specific Ultrasound Reference Data for the Laterolateral Rectal Diameter in Healthy Children.","authors":"Aleksandra Pucar, Sofija Cvejić, Darko Laketić, Dubravka Milutinović, Luka Đjoković, Teodora Pecarski, Matija Bećirović, Radmila Balaban Đurević, Zoran Radojičić, Nataša Milić","doi":"10.3390/diagnostics16193236","DOIUrl":"10.3390/diagnostics16193236","url":null,"abstract":"<p><p><b>Background:</b> Transabdominal ultrasonographic measurement of rectal diameter is increasingly used as a non-invasive adjunct for assessing rectal distension and fecal loading in children. However, interpretation is limited by the lack of age-stratified reference data in pediatric populations without bowel dysfunction. This study aimed to characterize the distribution of the laterolateral (LL) rectal diameter across childhood and adolescence and provide preliminary age-stratified empirical reference percentiles. <b>Methods:</b> This single-center cross-sectional study included pediatric participants aged ≤18 years who underwent clinically indicated abdominal ultrasonography for reasons unrelated to bowel or anorectal disorders and fulfilled predefined eligibility criteria. Maximal LL rectal diameter was measured transabdominally using a standardized protocol. Empirical percentiles were calculated for four age groups (6-36, 37-72, 73-144, and 145-216 months), with precision assessed using non-parametric bootstrap resampling with 10,000 repetitions. <b>Results:</b> The cohort comprised 188 participants: 46, 43, 62, and 37 in the four age groups, respectively; 107 (56.9%) were boys. Overall LL rectal diameter was 3.55 ± 1.46 cm (median, 3.20 cm; IQR, 2.50-4.30 cm), ranging from 1.01 to 8.00 cm. The LL diameter differed significantly across age groups (<i>p</i> = 0.002), with mean values increasing from 3.02 cm in the youngest group to 3.96 cm in the oldest group. No significant sex-related difference was observed (<i>p</i> = 0.843). P5-P95 ranges were 1.60-4.90, 1.51-5.89, 2.20-6.59, and 2.27-7.00 cm, respectively. Bootstrap confidence intervals were wider for extreme percentiles, particularly in smaller age strata. <b>Conclusions:</b> LL rectal diameter shows substantial interindividual variability and a modest age-related increase during childhood. These findings provide preliminary age-stratified empirical reference data rather than diagnostic thresholds or definitive normative limits. Larger multicenter studies are needed for external validation and more precise estimation of extreme percentiles.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Large Language Model-Generated Artificial Intelligence Risk Estimates on Clinical Decision-Making in Breast Imaging: A Simulation-Based Study.","authors":"Ebru Dusunceli Atman, Sena Bozer Uludag, Çağlar Uzun, Gizem Agaran, Zeynep Eskalen, Kazim Burak Karaca","doi":"10.3390/diagnostics16193241","DOIUrl":"10.3390/diagnostics16193241","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Large language models (LLMs) are increasingly used as decision-support tools in radiology, yet their influence on clinical decision-making remains a significant concern. This study evaluates how artificial intelligence (AI)-generated malignancy risk estimates influence clinical decisions in breast imaging and assesses automation bias (AB) among radiology residents at different training levels. <b>Methods:</b> In this simulation-based study, 20 residents reviewed radiology reports for 15 synthetic breast imaging cases generated by ChatGPT-4 Turbo, each presented in either a concordant or discordant format. Participants were stratified into two groups based on their completion of a breast imaging rotation and evaluated each case by assigning a BI-RADS score, recommending management, and rating their confidence in the AI risk estimate. Diagnostic accuracy and independent predictors of AB were analyzed using Generalized Estimating Equations (GEE) to account for reader-level clustering. <b>Results:</b> Overall management accuracy was significantly lower in cases with discordant AI outputs (<i>p</i> = 0.008). A similar, albeit non-significant, decreasing trend was observed for BI-RADS accuracy. While advanced residents maintained high management accuracy regardless of AI concordance, early-stage residents showed a sharp decline in discordant cases (77.3% vs. 45.3%; <i>p</i> = 0.006). This decline was most critical in malignant cases for early-stage residents, where accuracy dropped from 92.0% to 48.0% (<i>p</i> < 0.001). In the multivariable GEE logistic regression model, training level was the only independent predictor of AB (OR: 0.09, 95% CI: 0.03-0.28, <i>p</i> < 0.001). <b>Conclusions:</b> In this simulation study, advanced clinical training was associated with lower susceptibility to AB in breast imaging, although training level alone is unlikely to be a sufficient safeguard. Safe integration of AI tools will require caution among junior trainees alongside system-level measures such as model transparency and institutional oversight.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metachronous Metastatic Invasive Breast Carcinoma and Metastatic Small Cell Carcinoma Clinically and Radiologically Favoured to Be of Pulmonary Origin: A Case Report.","authors":"Adeline-Roxana Bucur, Alexandru Cristian Cindrea, Petra Curescu, Antonia Armega-Anghelescu, Alina Cristina Barb, Flavia Zara","doi":"10.3390/diagnostics16193237","DOIUrl":"10.3390/diagnostics16193237","url":null,"abstract":"<p><p><b>Background:</b> In patients with metastatic breast carcinoma, newly identified visceral or pulmonary lesions may represent progression of the known malignancy or, less commonly, a distinct second primary tumor. Histopathological and immunohistochemical evaluation is therefore essential for establishing tumor lineage and guiding treatment. <b>Case Presentation:</b> We report the case of a 46-year-old woman diagnosed in 2021 with metastatic hormone receptor-positive/HER2-negative breast carcinoma, presenting with a left breast mass and multiple osteolytic bone metastases. Histopathological examination demonstrated invasive breast carcinoma of no special type, with 98% estrogen receptor expression, 98% progesterone receptor expression, a Ki-67 proliferation index of 15%, and negative HER2 status. She received palliative radiotherapy for painful bone metastases and systemic treatment with letrozole and ribociclib. Five years later, she was evaluated for newly detected liver lesions. Positron emission tomography-computed tomography also demonstrated a metabolically active right centrohilar pulmonary lesion, although a primary lung tumor could not be definitively distinguished radiologically from nodal disease. Liver biopsy revealed a high-grade small-cell neuroendocrine carcinoma with positivity for TTF-1, chromogranin, synaptophysin, and CD56, a Ki-67 proliferation index of 85%, and negative GATA3 expression. These findings, together with the clinical and radiological features, favored a pulmonary origin. The patient was subsequently treated with cisplatin, etoposide, and atezolizumab. <b>Discussion:</b> This case illustrates the difficulty of distinguishing progression of metastatic breast carcinoma from a metachronous second malignancy. The markedly different morphology with a discordant neuroendocrine immunophenotypic profile together with the radiological and serological findings, favored a distinct second malignancy rather than progression of the known breast carcinoma. <b>Conclusions:</b> New metastatic-appearing lesions in patients with a known malignancy should not automatically be attributed to progression of the original cancer. Re-biopsy and integrated histopathological, immunohistochemical, clinical, and radiological assessment may identify a distinct second malignancy and substantially alter systemic treatment and clinical management.</p>","PeriodicalId":11225,"journal":{"name":"Diagnostics","volume":"16 19","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}