Background/Objectives: Sentinel lymph node biopsy (SLNB) is currently the standard approach for axillary staging in breast cancer. Conventional techniques are radioisotope-based (Technetium-99m, Tc99m) and remain widely used, but novel tracers like Indocyanine Green (ICG) fluorescence provide potential advantages regarding feasibility and logistics. Methods: We conducted a prospective, observational study including 476 female patients diagnosed with primary invasive breast cancer who underwent SLNB at the Institute of Oncology “Prof. Dr. I. Chiricuță”, Cluj-Napoca, Romania, between January 2022 and May 2025. Clinical, surgical, and pathological variables were systematically extracted. SLNB was performed using either Tc99m or ICG, according to institutional protocols. Comparative analyses were performed to evaluate sentinel node characteristics, histopathological parameters, and positive surgical margins predictors. Results: The median age was 60 years (IQR: 52–69). Breast-conserving surgery (BCS) was performed in 77.9% of cases, while mastectomy was performed in 22.1%. Sentinel lymph node positivity was reported in 25.6% of cases, with no significant differences in the number of excised or metastatic nodes between Tc99m and ICG (mean nodes: 3.23 vs. 3.20, p = 0.860; mean positive nodes: 0.35 vs. 0.36, p = 0.897). Histologically, invasive carcinoma NST was predominant (90.1%), and surgical margins were negative in 96.8% of patients, with all margin-positive cases occurring following BCS. No pathological markers (grade, Ki67, TILs, DCIS extent) predicted margin status or nodal involvement. Notably, younger age correlated inversely with the extent of ductal carcinoma in situ (r = −0.21, p < 0.00001). Conclusions: Tc99m and ICG provided comparable diagnostic performance in performing SLNB, with equivalent rates of nodal detection and pathological yield. These findings support that ICG is a safe and effective alternative for routine axillary staging in breast cancer.

Background: Breast cancer (BC) is the most frequently diagnosed cancer in women and the leading cause of cancer-related deaths in women globally. Carriers of P/LP variants in the BRCA1, BRCA2, TP53, PTEN, CDH1, PALB2, and STK11 genes have an increased risk of developing BC, which is why more and more guidelines recommend prophylactic mastectomy in this group of patients. Because traditional genetic testing is expensive and can cause delays in patient management, radiomics based on diagnostic imaging could be an alternative. This study aims to evaluate whether ultrasound-based radiomics features can predict P/LP variant status in BC patients. Methods: This retrospective study included 88 breast tumors in patients tested with multigene panel tests, including all seven above-mentioned genes. Ultrasound images were acquired prior to any treatment, and the tumoral and peritumoral areas were used to extract radiomics data. The study population was divided into P/LP and non-P/LP variant groups. Radiomics features were analyzed using machine learning models, alone or in combination with clinical features, with the aim of predicting the genetic status of BC patients. Results: We observed significant differences in radiomics features between P/LP- and non-P/LP-variant-driven tumors. The developed radiomics model achieved a maximum mean accuracy of 85.7% in identifying P/LP variant carriers. Including features from the peritumoral area yielded the same maximum accuracy. Conclusions: Radiomics models based on ultrasound images of breast tumors may provide a promising alternative for predicting P/LP variant status in BC patients. This approach could reduce dependence on costly genetic testing and expedite the diagnostic process. However, further validation in larger and more diverse populations is needed.

Background/Objectives: Testicular ultrasound (US) imaging is a critical modality for diagnosing a variety of testicular pathologies, including malignancies. This study aimed to develop and validate a standardized diagnostic algorithm to enhance diagnostic accuracy and consistency in evaluating testicular lesions, particularly for distinguishing between benign and malignant conditions. Methods: The algorithm was applied retrospectively to 110 testicular imaging cases, including 90 abnormal and 20 normal cases, analyzed by three radiologists with varying experience levels. Key diagnostic features, including lesion morphology, vascularity, and echotexture, were evaluated to guide the differentiation process. Results: demonstrated high diagnostic accuracy, with sensitivity reaching 100% for detecting abnormal cases and specificity ranging between 80% and 95%. In distinguishing benign from malignant lesions, the algorithm achieved an area under the curve (AUC) of up to 0.917, with specificities exceeding 93%. Notably, strong inter-rater agreement was observed, underscoring the algorithm’s reliability across different expertise levels. While the algorithm significantly improved standardization and diagnostic performance, some variability in sensitivity for less experienced evaluators highlights the need for further refinement. Conclusions: This study shows that the proposed diagnostic algorithm is an effective tool for testicular US, facilitating accurate and reproducible assessments, which are crucial for early detection and optimal management of testicular pathologies.

Background: Breast cancer is a leading cause of cancer-related mortality among women worldwide. Accurate staging, including the detection of axillary metastases, is vital for treatment planning. This study evaluates the efficacy of MRI relaxometry as a diagnostic tool for axillary lymph node metastases in breast cancer patients. Methods: A prospective study was conducted on 67 consecutive breast cancer patients. Relaxometry parameters, including T2Max, T2Min, and 1HAv, were assessed using 1.5 Tesla MRI. All axillary metastases were histologically confirmed using core-needle biopsy or surgical specimens. Statistical analyses included ROC curves, chi-square tests, and multivariate analysis to determine correlations between imaging findings and pathological results. Results: Significant associations were found between T2Min-ipsilateral (p = 0.018), 1HAv-ipsilateral (p = 0.003), and axillary metastases. ROC analysis demonstrated that T2Min-ipsilateral and 1HAv-ipsilateral have modest to acceptable discriminatory abilities (AUC = 0.681 and AUC = 0.740, respectively). Combined clinical and imaging models enhanced diagnostic accuracy (AUC = 0.749). Conclusions: MRI relaxometry improves the detection of axillary metastases in breast cancer, particularly when integrated with clinical and pathological evaluations.

Background/Objectives: In patients with clinically node-positive breast cancer, axillary response to neoadjuvant systemic treatment is heterogeneous and might depend on tumor biology. In patients with cN2 disease, the identification of factors linked to nodal response could improve risk stratification and contribute to the development of individualized post-neoadjuvant axillary management strategies. Methods: This cohort study has a retrospective design and included 560 female patients with invasive breast cancer (proven via biopsy) and cN2 disease. All patients received neoadjuvant systemic treatment accompanied by breast and axillary surgery at the Institute of Oncology “Prof. Dr. Ion Chiricuță” Cluj-Napoca (IOCN), Romania, between 2017 and 2025. The primary endpoint was the rate of axillary pathological complete response (pCR) following neoadjuvant systemic therapy, defined as ypN0. Secondary endpoints included breast pCR (ypT0), overall pCR (ypT0N0), the association between breast and axillary pathological response and survival analysis, including overall survival (OS) and disease-free survival (DFS). Clinicopathological predictors were assessed using univariate and multivariate logistic regression, while survival outcomes were evaluated with time-to-event analyses. Results: Complete axillary pathological response occurred in 282/560 patients (50.4%), and it increased to 53.2% when ypN0, including ypN0(i+). Breast pathological complete response was achieved in 31.2%, while overall pCR was 27.0%. Axillary response was significantly different in terms of molecular subtype, as ypN0 rates were 26.6% in Luminal A-like, 32.5% in Luminal B-like, 78.9% in HER2-positive and 72.6% in TNBC (p < 0.001). Nottingham grade 3 and HER2-positive disease were independently related to increased odds of ypN0, while TILs <10% were associated with lower odds of complete axillary response when multivariate analysis was performed. Breast and axillary responses were significantly associated (but were not interchangeable), as ypT0 showed 53.5% sensitivity and 91.9% specificity for ypN0. Overall pCR was associated with improved DFS (p = 0.040), while ypN0 and ypT0 were not significantly associated with DFS. No significant OS differences were noticed regarding pathological response. Conclusions: Nearly half of patients with cN2 breast cancer presented a complete axillary response after the completion of neoadjuvant treatment. Molecular subtype, histological grade and TILs were strongly associated with axillary response. In our cohort, breast pathological response alone was insufficient in order to be regarded as a predictor of nodal clearance, further supporting independent assessments of breast and axillary response. Further prospective studies are needed to determine whether these findings can inform individualized axillary management after neoadjuvant treatment.

Zinner syndrome is a rare congenital anomaly of the male genitourinary tract, characterized by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction. Owing to its low prevalence and nonspecific clinical presentation, diagnosis is often delayed or incidental, with imaging playing a central role in detection and characterization. This study presents a narrative review with an illustrative case report, aiming to summarize the imaging features of Zinner syndrome, outline the main radiologic differential diagnoses of seminal vesicle cysts, and highlight common diagnostic pitfalls, with emphasis on cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI). The narrative review of the literature highlights that CT and MRI are essential for accurate anatomical localization, characterization of cystic content, and identification of associated genitourinary anomalies. MRI, in particular, provides superior soft-tissue contrast and is considered the reference modality for diagnosis and differential evaluation of male pelvic cystic lesions. Key differential diagnoses include Müllerian duct cysts, prostatic utricle cysts, and ejaculatory duct cysts. As an illustrative example, we report the case of a young adult male presenting with pelvic discomfort, infertility, and mild lower urinary tract symptoms. Imaging findings, including ultrasound and cross-sectional studies, demonstrated a seminal vesicle cyst associated with ipsilateral renal agenesis, consistent with Zinner syndrome. Zinner syndrome should be considered in the evaluation of male pelvic cystic lesions, particularly in the presence of unilateral renal agenesis. Awareness of its characteristic imaging features is essential for accurate diagnosis and appropriate management, with MRI playing a pivotal role in confirming the diagnosis and distinguishing it from other pelvic cystic entities.