Shear wave elastography (SWE) has shown promise in distinguishing lymph node malignancies. However, the diagnostic accuracies of various SWE parameters that quantify tissue stiffness are yet to be demonstrated. To evaluate the pooled diagnostic accuracy of different SWE parameters for differentiating lymph node malignancies, we conducted a systematic screening of four databases using the PRISMA guidelines. Lymph node biopsy was adopted as the reference standard. E_max (maximum stiffness), E_mean (mean stiffness), E_min (minimum stiffness), and E_sd (standard deviation) SWE parameters were subjected to separate meta-analyses. A sub-group analysis comparing the use of E_max in cervical (including thyroid) and axillary lymph node malignancies was also conducted. Sixteen studies were included in this meta-analysis. E_max and E_sd demonstrated the highest pooled sensitivity (0.78 (95% CI: 0.69–0.87); 0.78 (95% CI: 0.68–0.87)), while E_mean demonstrated the highest pooled specificity (0.93 (95% CI: 0.88–0.98)). From the sub-group analysis, the diagnostic performance did not differ significantly in cervical and axillary LN malignancies. In conclusion, SWE is a promising adjunct imaging technique to conventional ultrasonography in the diagnosis of lymph node malignancy. SWE parameters of E_max and E_sd have been identified as better choices of parameters for screening clinical purposes.

Maturity-onset diabetes of the young (MODY) is often misclassified and can significantly impact the management of these patients and their families. We present three cases initially diagnosed as type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and fasting hyperglycemia, which were later identified as MODY. A 38-year-old Caucasian lady, previously diagnosed with T2DM, was referred to the diabetes antenatal clinic. She was treated with gliclazide and metformin before pregnancy. She required insulin glargine during her pregnancy. Her diabetes autoantibodies were negative. MODY was suspected and genetic testing confirmed HNF1A MODY gene mutation. A 57-year-old Caucasian lady was diagnosed with T1DM at the age of 18 years. Since diagnosis, she was treated with insulin glargine without any short-acting insulin, yet persistently suffered from hypoglycemia. MODY was suspected and genetic testing confirmed HNF4A gene mutation. A 33-year-old South Asian lady was referred to a diabetes clinic for suspected T2DM due to strong family history of T2DM, ethnicity, and persistently elevated fasting blood glucose levels. Her genetic testing confirmed GCK-MODY (Glucokinae-maturity-onset diabetes of the young). MODY represents a group of genetic diabetes that can often go unrecognized due to misdiagnosis. Achieving an accurate diagnosis is important as it guides appropriate treatment strategies, improves patient outcomes, and has an impact on other family members due to the hereditary nature of the condition. Employing a systematic approach is crucial. Our cases highlight that it is never too late to challenge the diabetes classification.

Introduction: Inclusion Health (IH) encompasses individuals facing social exclusion, presenting a myriad of risk factors leading to compromised health. IH populations, including homeless individuals, substance abusers, and vulnerable migrants, have higher disease prevalence, earlier mortality, and more barriers to healthcare access, with increased risks of developing cardiovascular diseases. While QRISK3 is a validated tool for predicting ten-year cardiovascular risks in the general population in primary care, its application in secondary care or IH populations remains underexplored.Methods: This prospective study, conducted at University College London Hospital (UCLH) between December 2021 and December 2023, evaluated IH patients using a locally-developed Collaborative Holistic Inclusion Health Patient Assessment (CHIPA) tool, incorporating clinical scoring systems including QRISK3. QRISK3 scores and corresponding Q ages were calculated independently using its online platform, based on patient demographics, cardiovascular histories, and cholesterol levels. The CHIPA was a detailed medical and social history questionnaire used to evaluate the IH patients referred to IHT in a consistent manner, including the incorporation of questions related to QRISK3 and other scoring systems.Results: A total of 217 IH individuals were included in this study (median: 48 years; range: 25-81 years). Our IH patient cohort exhibited significantly higher QRISK3 scores compared to the general population (p < 0.001, paired Wilcoxon test), ranging from 0.1% to 81.7%, with an average increase of 8.6%. The corresponding Q age was, on average, 13 years older than patients' actual age, with a median of 62 years, and 35% of patients had a positive cardiovascular history. The relative risk ranged from 0.5 to 78.0, with an average of 4.0. Compared with the general population, IH patients demonstrated elevated cardiovascular risk.Discussion: We highlight the utility of QRISK3 and CHIPA tools in early cardiovascular risk identification within the Inclusion Health cohort of patients, facilitating timely interventions. Integrating clinical risk scores into holistic assessments can improve referral practices, potentially enhancing overall health outcomes and reducing mortality in IH patients.

Introduction: Pancreatic neuroendocrine tumors (pNETs) are a recognized feature of tuberous sclerosis complex (TSC). The current evidence suggests that pNETs occurring in TSC may exhibit a different clinical course from sporadic cases, but their natural history remains poorly characterized. Objective: This study aimed to characterize the demographics, clinical presentation, management, and long-term outcomes of TSC-associated-pNETs and to propose possible guidelines for surveillance and management. Materials and Methods: We conducted a multicenter retrospective review of TSC-pNET patients from 6 UK TSC specialist clinics and from 3 NET referral centers, from 2008 to 2024. Data on demographics, tumor characteristics, management, and outcomes, were collected. A systematic review of the literature from 2009 to 2026 on TSC-pNETs was also performed. Results: We identified a total of 26 consecutive cases with the TSC-pNET-association in our cohort: 21 cases of pNETs from TSC specialist clinics (1.1% of the population), and 5 cases of TSC-pNETs from the NET referral centers (0.25% of the population). An additional 80 cases were identified from the published literature. We observed a wide spectrum of clinical phenotypes, with the majority being nonfunctioning pNETs (n = 24; 92%), whereas 2 patients were diagnosed with glucagonomas. Surgical intervention was the mainstay initial treatment, the indication being either functional pNETs, or large or symptomatic nonfunctioning pNETs. Conclusion: TSC-pNETs are rare and mostly nonfunctioning tumors with variable clinical behavior. Due to their uncertain malignant potential, we suggest that baseline pancreatic imaging should be incorporated into TSC surveillance, and we emphasize the need for heightened pNET surveillance and updated management recommendations.

Endometrial cancer (EC) and cervical cancer (CC) are common malignancies in women in clinical practice. More uncommon non-ovarian malignancies, such as vulval cancer (VC), are also becoming more prevalent in women of all ages. Currently, there are few comprehensive reviews on the management of these conditions, despite the recent advances in the use of immunotherapy in the management of other forms of cancer. The treatment modalities for EC, CC and VC vary; however, platinum-based chemotherapy, surgical resection and radiotherapy are the main forms of treatment. In more advanced or recurrent disease, there is a limited number of efficacious treatments, with many clinicians relying on adjuvant chemotherapy despite the increased rationale for the use of immunotherapy. With the development of the novel adoptive T-cell therapy, intra-tumoural oncolytic viral therapy and cancer vaccines, the landscape of gynaecological cancer management is changing, and it is likely that treatment efficacy and outcomes will improve dramatically. This review aims to summarise the current management of endometrial, cervical and vulval cancer and to evaluate the novel therapies under development, as well as the future of the management of non-ovarian gynaecological malignancies.

Introduction: This study evaluates the impact of a Point-of-Care Ultrasound (POCUS) workshop delivered at the 6th Radiology Resident Forum conference, assessing how its student-led and clinician-supervised approach affects the knowledge, confidence and attitude of workshop participants, giving scope for future recommendations of implementation of formal POCUS teaching in medical curricula. Methods: Four POCUS workshops were conducted at an international radiology conference, with participants comprising of resident doctors and medical students. Workshop sessions included a 15-min teaching session and a 40-min hands-on session covering POCUS fundamental skills. Pre- and post-workshop participant and instructor questionnaires assessed educational merit using three domains of Bloom’s taxonomy: knowledge, confidence and skill. Statistical analysis with Wilcoxon signed-rank tests was used to compare pre- and post-workshop scores for paired Likert-type scale responses. Results: Thirty-nine participants were included, the majority of which were resident doctors (74.3%) with minimal exposure to ultrasound. Wilcoxon signed-rank tests demonstrated statistically significant improvement across all three Bloom’s domains ( p < 0.01). All attendees considered POCUS a valuable addition to clinical practice and indicated a willingness to continue their learning. Instructor post-workshop skill assessments categorised attendees as proficient-to-expert with respect to ergonomics, scanning and image interpretation. Conclusion: POCUS is increasingly being shown to augment clinical examination and improve patient flow and outcomes. As such, there is an unmet demand from resident doctors to learn this skill. We demonstrate that structured, near-peer POCUS workshop teaching for resident doctors can result in significant short-term skill improvement and educational merit, suggesting justification for its formal implementation within UK postgraduate curricula.