The main goal of this study was to compare the results of computer aided detection (CAD) analysis in screening mammography with the results independently obtained by two radiologists for the same ...samples and to determine the sensitivity and specificity of CAD for breast lesions. A total of 436 mammograms were analyzed with CAD. For each screening mammogram, the changes in breast tissue recognized by CAD were compared to the interpretations of two radiologists. The sensitivity and specificity of CAD for breast lesions were calculated using contingency table. The sensitivity of CAD for all lesions was 54% and specificity 16%. CAD sensitivity for suspicious lesions only was 86%. CAD sensitivity for microcalcifications was 100% and specificity 45%. CAD mainly ‘mistook’ glandular parenchyma, connective tissue and blood vessels for breast lesions, and blood vessel calcifications and axillary folds for microcalcifications. In this study, we confirmed CAD as an excellent tool for recognizing microcalcifications with 100% sensitivity. However, it should not be used as a stand-alone tool in breast screening mammography due to the high rate of false-positive results.
Shear wave elastography (SWE) is a type of ultrasound elastography with which the elastic properties of breast tissues can be quantitatively assessed. The purpose of this study was to determine the ...impact of different regions of interest (ROI) and lesion size on the performance of SWE in differentiating malignant breast lesions. The study included 150 female patients with histopathologically confirmed malignant breast lesions. Minimal (Emin), mean (Emean), maximal (Emax) elastic modulus and elasticity ratio (e-ratio) values were measured using a circular ROI size of 2, 4 and 6 mm diameters and the lesions were divided into large (diameter ≥ 15 mm) and small (diameter < 15 mm). Highest Emin, Emean and e-ratio values and lowest variability were observed when using the 2 mm ROI. Emax values did not differ between different ROI sizes. Larger lesions had significantly higher Emean and Emax values, but there was no difference in e-ratio values between lesions of different sizes. In conclusion, when measuring the Emin, Emean and e-ratio of malignant breast lesions using SWE the smallest possible ROI size should be used regardless of lesion size. ROI size has no impact on Emax values while lesion size has no impact on e-ratio values.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Aim To determine the relationship between breast stiffness assessed with sonoelastography (elasticity) and breast tissue density assessed with mammography (MG) and ultrasound (US). Methods This ...cross-sectional study involved 100 women who underwent MG, gray-scale US, and shear-wave sonoelastography during 2013. Mammographic density was categorized into four groups and sonographic density into three groups according to Breast Imaging-Reporting and Data System criteria. The stiffness of breast parenchymal and adipose tissue in all breast quadrants was quantified by shear-wave sonoelastography. Mean elastographic estimates were compared with MG- and US-derived density estimates. Results Parenchymal and adipose tissue elasticity positively correlated with MG- and US-derived breast density (for parenchyma: for MG Kendall's tau b 0.522; Jonckheere-Terpstra test P < 0.001 and for US Kendall's tau b 0.533; Jonckheere-Terpstra test P < 0.001); the higher was the breast density on MG and US, the higher was the elastographic stiffness. Conclusion Sonoelastographic breast stiffness strongly positively correlated with breast density. Thus, sonoelastography may have a potential for estimating the breast cancer risk, which allows a novel application of this technique in routine clinical practice.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives
To evaluate shear-wave elastographic (SWE) features of triple negative breast cancers (TNBC) and determine useful discriminators from other types of invasive breast cancers.
Methods
SWE ...features of 26 TNBC were reviewed and compared to 32 non-TNBC. Qualitative SWE features of lesion colour appearance, shape and homogeneity were analysed. Quantitative features were measured: mean (El mean), maximum (El max) and minimum (El min) elasticity value of the stiffest portion of the mass, mean elasticity of the surrounding tissue (El mean surr) and lesion to fat elasticity ratio (E ratio).
Results
TNBC are more often regularly shaped (57.7 % vs. 6.2 %), while non-TNBC are more commonly red (93.7 % vs 42.3 %) and heterogeneous (68.7 % vs 42.3 %). The stiffness of TNBC is significantly lower compared to non-TNBC. The two groups could be distinguished on the basis of El max (
p
= 0.001), El mean (
p
= 0.001), El min (
p
= 0.001) and E ratio (
p
= 0.0017). Lesion to fat elasticity ratio in TNBC group was statistically significantly lower than in the non-TNBC control group (
p
= 0.009).
Conclusions
TNBC often demonstrate benign morphological features, are softer on SWE and have a lower lesion to fat stiffness ratio compared to the other, more common types of invasive breast cancers.
Key Points
•
TNBC often demonstrate benign morphological features on SWE.
•
TNBC present on elastography mostly as red, regularly shaped, heterogeneous lesions.
•
TNBC are less stiff compared to other invasive breast cancers.
•
TNBC have lower lesion to fat stiffness ratio than other breast cancers.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Breast cancer (BC) is a highly heterogeneous disease. Aim was to evaluate imaging features of triple negative breast cancers (TNBC) in comparison to non-TNBC. We reviewed data of 30 patients who had ...been diagnosed as having TNBC and 37 patients with non-TNBC (control group) using criteria described for mammography (MMG), ultrasound (US) and magnetic resonance imaging (MRI) in Breast Imaging-Reporting and Data System (BI-RADS) lexicon for image interpretation. Age of patients, size of tumor, multifocality, histological type, tumor grade and status of lymph nodes were reviewed. TNBC were more often histological grade 3 and had significantly more positive lymph nodes at the time of diagnosis on pathology reports. On MMG, US and MRI TNBC mostly appeared as regularly shaped masses. On US as hypoechogenic masses with no posterior acoustic features and on MRI as masses with rim type of enhancement, fast wash-in and plateau type of curves. Most frequent category reported after MMG and US was BI RADS 4, and after MRI BI RADS 5. In conclusion, our study confirmed higher histological grade of TNBC, as well as more frequent lymph node involvement in comparation to the non-TNBC. TNBC showed tendency to affect younger women and to be larger than non-TNBC. Although, they most often presented as a mass on mammography and sonography, in a significant number of cases they remained miscategorized, due to the benign imaging features. All cases are recognized on MRI where they appear as rim enhancing masses.
Breast cancer (BC) is a highly heterogeneous disease. Aim was to evaluate imaging features of triple negative breast cancers (TNBC) in comparison to non-TNBC. We reviewed data of 30 patients who had ...been diagnosed as having TNBC and 37 patients with non-TNBC (control group) using criteria described for mammography (MMG), ultrasound (US) and magnetic resonance imaging (MRI) in Breast Imaging-Reporting and Data System (BI-RADS) lexicon for image interpretation. Age of patients, size of tumor, multifocality, histological type, tumor grade and status of lymph nodes were reviewed. TNBC were more often histological grade 3 and had significantly more positive lymph nodes at the time of diagnosis on pathology reports. On MMG, US and MRI TNBC mostly appeared as regularly shaped masses. On US as hypoechogenic masses with no posterior acoustic features and on MRI as masses with rim type of enhancement, fast wash-in and plateau type of curves. Most frequent category reported after MMG and US was BI RADS 4, and after MRI BI RADS 5. In conclusion, our study confirmed higher histological grade of TNBC, as well as more frequent lymph node involvement in comparation to the non-TNBC. TNBC showed tendency to affect younger women and to be larger than non-TNBC. Although, they most often presented as a mass on mammography and sonography, in a significant number of cases they remained miscategorized, due to the benign imaging features. All cases are recognized on MRI where they appear as rim enhancing masses.
Rak dojke (RD) vrlo
je heterogena bolest. Cilj istraživanja bio je procijeniti slikovne značajke
trostrukog negativnog karcinoma dojke (TNRD) u usporedbi s ne-TNRD-om.
Pregledali smo podatke 30 pacijenata kojima je dijagnosticiran TNRD te 37
pacijenata s ne-TNRD-om (kontrolna skupina) koristeći kriterije opisane za
mamografiju (MMG), ultrazvuk (US) i magnetsku rezonancu (MRI) u Breast Imaging-Reporting
and Data System (BI-RADS) za interpretaciju slike. Analizirana je dob
pacijenata, veličina tumora, multifokalnost, histološki tip, gradus tumora i
status limfnih čvorova. TNRD-i su češće bili histološki gradus 3 i znatno su
više imali pozitivne limfne čvorove u vrijeme dijagnoze na patohistološkim izvješćima.
Na MMG-u, US-u i MRI-u TNRD-i su se uglavnom pojavljivali kao pravilno
oblikovane mase, na US-u kao hipoehogene mase bez stražnjih akustičnih
značajki, a na MRI-u kao mase koje rubno nakupljaju kontrasno sredstvo, uz
dinamičke krivulje s brzim nakupljanjem i platoom. Najčešća kategorija
zabilježena nakon MMG-a i US-a bila je BI RADS 4, a nakon MRI-a BI RADS 5. U
zaključku je naša studija potvrdila viši histološki gradus TNRD-a, kao i češće
zahvaćanje limfnih čvorova u odnosu na kontrolnu skupinu. Pokazali smo
tendenciju pojavljivanja kod mlađih žena, kao I veće dimezije u odnosu na
kontrolnu skupinu. Iako su se najčešće predstavljali kao tvorba na MMG-a i USu,
u određenome broju slučajeva pogrešno su kategorizirani zbog benignih slikovnih
značajki. Svi su slučajevi na MRI-u dijagnosticirani kao masa koja rubno
nakuplja kontrastno sredstvo.
Breast sonoelastography is a relatively novel ultrasound (US) method that enables estimation of tissue stiffness to estimate the elasticity of normal breast tissue and seek to correlate it with ...well-known breast cancer risk factors. Two hundred women of different age were included in the study and completed a questionnaire about personal, familiar, and reproductive history. Glandular and fatty tissue elasticity in all breast quadrants was measured by shear wave elastography (SWE). Mean elastographic values of breast tissue were calculated and compared to personal history risk factors. Elasticity of normal glandular tissue (66.4 kilopascals (kPa)) was higher than fatty tissue (26.1 kPa) in all breast quadrants and in both breasts. Lower outer quadrant (LOQ) had the lowest elasticity values of both parenchyma and fat. Higher elasticity values of breast tissue were confirmed in the left breast than in the right breast. Glandular and fat tissue elasticity negatively correlated with body mass index (BMI). Women with mastodynia had higher glandular elastographic values compared to subjects without breast pain. Nuliparity was also associated with higher elasticity of glandular breast tissue. The results of this study are promising and could, over time, contribute to a better understanding of glandular breast tissue elasticity as a potential risk factor for breast cancer.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The main goal of this study was to compare the results of computer aided detection (CAD) analysis in screening mammography with the results independently obtained by two radiologists for the same ...samples and to determine the sensitivity and specificity of CAD for breast lesions. A total of436 mammograms were analyzed with CAD. For each screening mammogram, the changes in breast tissue recognized by CAD were compared to the interpretations of two radiologists. The sensitivity and specificity of CAD for breast lesions were calculated using contingency table. The sensitivity of CAD for all lesions was 54% and specificity 16%. CAD sensitivity for suspicious lesions only was 86%. CAD sensitivity for microcalcifications was 100% and specificity 45%. CAD mainly 'mistook' glandular parenchyma, connective tissue and blood vessels for breast lesions, and blood vessel calcifications and axillary folds for microcalcifications. In this study, we confirmed CAD as an excellent tool for recognizing microcalcifications with 100% sensitivity. However, it should not be used as a stand-alone tool in breast screening mammography due to the high rate of false-positive results. Key words: Breast neoplasm; Image interpretation computer-assisted; Mammography; Computer aided detection (CAD); CAD sensitivity; CAD specificity Svrha ovoga istrazivanja bila je usporediti rezultate racunalno potpomognute analize (computer aided detection, CAD) u probirnoj mamografiji s rezultatima analize dva neovisna radiologa te utvrditi osjetljivost i specificnost CAD-a za lezije u dojkama. Analizirali smo 436 mamograma pomocu CAD-a i usporedili rezultate s interpretacijom dva neovisna radiologa. Izracunali smo osjetljivost i specificnost CAD-a za lezije u dojkama putem tablica kontingencije. Osjetljivost CAD-a za otkrivanje svih lezija u dojkama iznosila je 54%, a specificnost 16%. Osjetljivost CAD-a za sumnjive lezije bila je 86%, a za mikrokalcifikacije 100% uz specificnost od 45%. CAD je uglavnom pogresno interpretirao zljezdani parenhim, vezivno tkivo i krvne zile kao tvorbe u dojkama, dok je kalcifikacije u krvim zilama i aksilarni nabor mijesao s mikrokalcifikacijama. Ovom studijom smo potvrdili da je CAD izvrstan alat za otkrivanje mikrokalcifikacija s osjetljivoscu od 100%. No, ipak se ne bi trebao rabiti kao jedina metoda u probirnoj mamografiji dojki uzimajuci u obzir kolicinu lazno pozitivnih rezultata koja je prilicno visoka. Kljucne rijeci: Karcinom dojke; Racunalno potpomognuta analiza slika; Mamografija; Racunalno potpomognuta analiza (CAD); Osjetljivost CAD; Specificnost CAD
Breast cancer (BC) is a highly heterogeneous disease. Aim was to evaluate imaging features of triple negative breast cancers (TNBC) in comparison to non-TNBC. We reviewed data of 30 patients who had ...been diagnosed as having TNBC and 37 patients with non-TNBC (control group) using criteria described for mammography (MMG), ultrasound (US) and magnetic resonance imaging (MRI) in Breast Imaging-Reporting and Data System (BI-RADS) lexicon for image interpretation. Age of patients, size of tumor, multifocality, histological type, tumor grade and status of lymph nodes were reviewed. TNBC were more often histological grade 3 and had significantly more positive lymph nodes at the time of diagnosis on pathology reports. On MMG, US and MRI TNBC mostly appeared as regularly shaped masses. On US as hypoechogenic masses with no posterior acoustic features and on MRI as masses with rim type of enhancement, fast wash-in and plateau type of curves. Most frequent category reported after MMG and US was BI RADS 4, and after MRI BI RADS 5. In conclusion, our study confirmed higher histological grade of TNBC, as well as more frequent lymph node involvement in comparation to the non-TNBC. TNBC showed tendency to affect younger women and to be larger than non-TNBC. Although, they most often presented as a mass on mammography and sonography, in a significant number of cases they remained miscategorized, due to the benign imaging features. All cases are recognized on MRI where they appear as rim enhancing masses.
Akutna aortalna okluzija Džoić Dominković, Martina; Fila, Jana; Radović, Niko ...
Medicina Fluminensis,
03/2013, Volume:
49, Issue:
1
Web Resource
Open access
Cilj: Cilj ovog rada je prikazati akutnu aortalnu okluziju, stanje hitnoće, često nazivano
i „vaskularnom katastrofom” zbog toga što nosi lošu prognozu. To je stanje dijagnostički
izazov jer ...zahtijeva rano prepoznavanje i hitno liječenje. Prikazat ćemo dva slučaja akutne aortalne
okluzije. Prikaz slučaja: U oba slučaja bolesnici su se javili u hitnu službu Kliničke bolnice
Dubrava; radilo se o ženama između 55 i 65 godina, kojima se nakon prethodne bolesti pogoršalo
stanje u smislu bola u obje noge. Jedna je bolesnica imala i osjećaj slabosti u obje noge te
neurološke ispade na prijemu, dok su se kod druge bolesnice našli samo znaci arterijske insuficijencije
(hladni ekstremiteti i odsutnost pulsa). U prvom slučaju učinili smo pregled doplerom
dupleksom koji je pokazao niske brzine protoka u obje arterije femoralis superficialis s PSV-om
(engl. peak systolic velocity) manjim od 5 cm/sek te izmijenjene spektre, što u prvom redu
upućuje na proksimalnu patologiju. Višeslojna kompjutorizirana tomografija (engl. multi-slice
computerised tomography; MSCT) angiografija abdominalne aorte pokazala je trombotske
mase abdominalne aorte u infrarenalnom dijelu, koje u potpunosti ispunjavaju lumen. Učinjena
je trombektomija infrarenalne aorte. U drugom slučaju odmah smo pristupili MSCT angiografiji
abdominalne aorte prema standardnom protokolu u hitnoj službi, koji pokaže potpunu
okluziju aorte iznad bifurkacije uz prisutnu okluziju obje ilijačne arterije. Učinjena je Fogartyjeva
embolektomija. Rasprava i zaključak: Radi se o rijetkom stanju koje je lako previdjeti,
premda se karakteristično očituje. Pravilno postavljena indikacija za slikovne metode i njihovo
izvođenje od krucijalne je važnosti za dijagnozu stanja koje se liječi kirurški te nosi visok mortalitet.
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