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Context Accurately distinguishing between benign thyroid nodules (BTNs) and papillary thyroid cancers (PTCs) with current conventional methods poses a significant challenge. Objective We identify DNA methylation markers of immune response–related genes for distinguishing BTNs and PTCs. Methods In this study, we analyzed a public reduced representative bisulfite sequencing dataset and revealed distinct methylation patterns associated with immune signals in PTCs and BTNs. Based on these findings, we developed a diagnostic classifier named the Methylation-based Immune Response Signature (MeIS), which was composed of 15 DNA methylation markers associated with immune response–related genes. We validated MeIS's performance in 2 independent cohorts: Z.S.'s retrospective cohort (50 PTC and 18 BTN surgery-leftover samples) and Z.S.'s preoperative cohort (31 PTC and 30 BTN fine-needle aspiration samples). Results The MeIS classifier demonstrated significant clinical promise, achieving areas under the curve of 0.96, 0.98, 0.89, and 0.90 in the training set, validation set, Z.S.'s retrospective cohort, and Z.S.'s preoperative cohort, respectively. For the cytologically indeterminate thyroid nodules, in Z.S.'s retrospective cohort, MeIS exhibited a sensitivity of 91% and a specificity of 82%; in Z.S.'s preoperative cohort, MeIS achieved a sensitivity of 84% and a specificity of 74%. Additionally, combining MeIS and BRAF V600E detection improved the detecting performance of cytologically indeterminate thyroid nodules, yielding sensitivities of 98% and 87%, and specificities of 82% and 74% in Z.S.'s retrospective cohort and Z.S.'s preoperative cohort, respectively. Conclusion The 15 markers we identified can be employed to improve the diagnostic of cytologically indeterminate thyroid nodules. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hepatic reactive lymphoid hyperplasia (RLH) is a rare benign lymphoproliferative lesion and a poorly understood disease. It is usually asymptomatic and incidental, but it is difficult to distinguish from hepatocellular carcinoma and metastatic liver tumor on imaging, and percutaneous biopsy is not sufficient to distinguish from low-grade malignant lymphoma and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), making diagnosis difficult. CASE SUMMARY: A 69-year-old woman came to our hospital for reexamination of pulmonary nodules followed by liver occupation. The lesions showed "wash-in and wash-out" on contrast-enhanced ultrasonography and magnetic resonance imaging. Enhanced magnetic resonance also showed annular envelope enhancement and limited diffusion on the ADC map during the delay period. Imaging revealed metastatic liver cancer, and the patient underwent a partial hepatectomy. However, the final histopathological diagnosis was RLH. CONCLUSION: If small isolated nodules are found in the liver of middle-aged and elderly female patients with no risk factors for liver malignancy, when the enhanced imaging suggests "wash-in and wash-out", further focus should be placed on whether the enhanced imaging shows perinodular enhancement and whether the DWI shows limited diffusion in MRI, in order to emphasize the possibility of liver RLH diagnosis. [ABSTRACT FROM AUTHOR]

Background: Microvascular invasion (MVI) is a well‐established poor prognostic factor for hepatocellular carcinoma (HCC). Preoperative prediction of MVI is important for both therapeutic and prognostic purposes, but noninvasive methods are lacking. Purpose: To develop an MR elastography (MRE)‐based nomogram for the preoperative prediction of MVI in HCC. Study Type: Prospective. Subjects: A total of 111 patients with surgically resected single HCC (52 MVI‐positive and 59 MVI‐negative), randomly allocated to training and validation cohorts (7:3 ratio). Field Strength/Sequence: 2D‐MRE and conventional sequences (T1‐weighted in‐phase and opposed phase gradient echo, T2‐weighted fast spin echo, diffusion‐weighted single‐shot spin echo echo‐planar, and dynamic contrast‐enhanced T1‐weighted gradient echo) at 3.0 T. Assessment: MRE‐stiffness and conventional qualitative and quantitative MRI features were evaluated and compared between MVI‐positive and MVI‐negative HCCs. Statistical Tests: Univariable and multivariable logistic regression analyses were applied to identify potential predictors for MVI, and a nomogram was constructed according to the predictive model. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance. Harrell's C‐index evaluated the discrimination performance of the nomogram, calibration curves analyzed its diagnostic performance and decision curve analysis determined its clinical usefulness. A P value <0.05 was considered statistically significant. Results: Tumor stiffness >6.284 kPa (odds ratio [OR] = 24.38) and the presence of arterial peritumoral enhancement (OR = 6.36) were independent variables associated with MVI. The areas under the ROC curves for tumor stiffness were 0.81 (95% confidence interval [CI]: 0.70, 0.89) and 0.77 (95% CI: 0.60, 0.90) in the training and validation cohorts, respectively. When both predictive variables were integrated, the best nomogram performance was achieved with C‐indices of 0.88 (95% CI: 0.78, 0.94) and 0.87 (95% CI: 0.71, 0.96) in the two cohorts, fitting well in calibration curves. The decision curve exhibited optimal net benefit with a wide range of threshold probabilities for the nomogram. Data Conclusion: An MRE‐based nomogram may be a potential noninvasive imaging biomarker for predicting MVI of HCC preoperatively. Evidence Level: 2. Technical Efficacy: Stage 2. [ABSTRACT FROM AUTHOR]