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Lung cancer remains one of the most common cancers worldwide. Temporal evaluation is a useful tool for analyzing the malignant behavior of a lesion during treatment or that of indeterminate lesions which may be benign. Thereby, this work proposes a methodology for analysis, quantification and visualization of unsupervised changes in lung lesions, through principal component analysis. From change regions, we extracted texture features for lesion classification as benign or malignant. To reach this purpose, two databases with distinct behavior were used, one of which concerning malign under treatment and another indeterminate, but likely benign, lesions. The results have shown that the lesion’s density changes in a public database of malignant lesions under treatment were greater than the private database of benign lung nodules. From the texture analysis of the regions where the density changes occurred, we were able to discriminate lung lesions with an accuracy of 98.41 %, showing that these changes could point out the nature of the lesion. Other contribution was visualization of changes occurring in the lesions over time. Besides, we quantified these changes and analyzed the entire set through volumetry, the most commonly used technique to evaluate progression of lung lesions.

In selected patients, our Unit has recently moved from handheld ultrasound-guided vacuum-assisted core biopsy (VACB) piecemeal acquisition of tissue to the handheld Intact Breast Lesion Excision System (Intact). Intact removes a single piece of tissue, potentially allowing radiologists to excise the entire lesion as well as allowing pathologists to visualise lesion architecture more easily and to calculate margins. We evaluated our early experience of excising benign or likely benign breast lesions using the 20 mm Intact.

Enucleation is the preferred surgical management of small, likely benign, insulinomas. Sparing pancreatic parenchyma and minimizing morbidity are of greater importance in these patients due to their anticipated long survival time. Although a laparoscopic approach is ideal, it can be particularly challenging when the insulinoma is retropancreatic or adjacent to critical vascular structures [i.e., superior mesenteric vein-portal vein confluence (SMV-PV)].A 35-year-old woman with neuroglycopenic symptoms and hypoglycemia was diagnosed with hyperinsulinemia. Preoperative CT and EUS-FNA confirmed a 6- × 9-mm neuroendocrine tumor in the parenchyma of the posterior pancreatic neck along the left lateral aspect of the SMV-PV.With the patient in stirrups and arms tucked (French Position), the lesser sac was opened to expose the pancreatic body. A retropancreatic tunnel was created anterior to the SMV-PV and the pancreatic neck encircled with umbilical tape to allow for retraction while minimizing pancreatic manipulation. The insulinoma was definitively identified using intraoperative ultrasound (IOUS). IOUS-guided clip placement facilitated direct identification and permitted safe image-guided enucleation. The enucleation was performed at the parenchymal interface, minimizing the risk of main pancreatic duct injury.Complete pancreatic neck mobilization and view through the laparoscope along the axis of the PV can facilitate exposure at the challenging location of the retropancreatic neck. Transpancreatic IOUS guidance is crucial to identify and safely enucleate small insulinomas in this location. This totally minimally invasive approach can reduce the morbidity of pancreatic surgery for these patients and permit organ-sparing despite the challenging anatomic location.