99mTc sestamibi scintimammography

Summary Aim: Investigation of the diagnostic role of technetium-99m methoxyisobutylisonitrile (99mTc sestamibi) scintimammography in non-palpable, suspicious breast lesions described as microcalcification, mass and increased density using mammography. Patients, method: 35 women with non-palpable breast lesions were enrolled in the study. Anterior, left and right lateral, ipsilateral posterior oblique images were obtained 15 min after the injection of 740 MBq of 99mTc sestamibi. All scintigraphic images were evaluated visually and focal increased 99mTc sestamibi uptake was accepted as malignant lesion. Breast lesions were classified as microcalcification (13 women), mammographic mass (16 women) and increased density (6 women). Excisional biopsy was performed in all of them irrespective of the scintigraphic results. Results: The focally increased 99mTc sestamibi uptake was seen in 11 breast lesions with malignant lesions and in 4 breast lesions with benign lesions. The diffuse uptake of 99mTc sestamibi was seen in 18 breast lesions with benign lesions and 2 breast lesions with malignant lesions. There was no false positive result of 99mTc sestamibi in microcalcification group and there was no false negative result of the mammographic mass and increased density groups. Conclusion: Scintimammography might be a complementary method in decision making for the non-palpable, suspicious breast lesions that were evaluated as microcalcification, mass and increased density mammograpically.

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Mammographic evaluation of palpable breast masses with pathological correlation: a tertiary care centre study in Nepal

Journal of Institute of Medicine ◽

10.3126/jiom.v32i2.4940 ◽

1970 ◽

Vol 32 (2) ◽

pp. 21-25 ◽

Cited By ~ 1

Author(s):

G Gurung ◽

RK Ghimire ◽

B Lohani

Keyword(s):

Breast Cancer ◽

Benign Lesion ◽

Tertiary Care ◽

False Negative ◽

Malignant Lesion ◽

Institute Of Medicine ◽

Breast Lump ◽

Major Health Problem ◽

Malignant Lesions ◽

Palpable Breast

Introduction: Breast cancer is one of the major health problem for all countries. . In Nepal , breast cancer is the second most common cancer in female. Early detecting tools like mammography can able to detect location , size, morphology, and nature of breast lesions that can help to reduced mortality and morbidity from breast cancer significantly. Methods: This prospective study was carried out at the department of Radiology, Surgery and Pathology for a period of one year. A total of 100 patients with clinically palpable breast lump were subjected to mammography and subsequently to FNA or biopsy. The mammograms were reviewed by two senior consultant radiologists and pathology by a senior pathologist. Results: Out of 100 patients, 65% had mammographic features of benign lesion and 35% had features of malignancy. Pathology revealed 64% of lesion to be benign and 36% of lesion to be malignant. There were four false negative (6.2%) and three false positive (8.6%) cases. The sensitivity and specificity of mammography were 88.9% and 95.53% respectively. The mean age of patient with malignant lesion was 46.3 years (SD=11.5) and 34.7 years (SD=10.6) for benign lesions. Among malignant lesion 37.1% had lobulated, 14.3% had oval, 31.4% round and 17.1% had irregular shape with spiculated margin in 60% and indistinct margins in 34.3%. Among benign 7.7% showed lobulated shape, 41.5% oval and 50.8% round shape. Circumscribed margin was found in 93.9% of benign and 5.7% of malignant lesions. Punctuate and polymorphic calcification was found in malignant lesions (25.7% and 5.7%). Secondary changes were found in only in the malignant cases. Halo sign was found only in benign cases and most common in fibroadenoma (38.4%). Conclusions: Mammography is an effective diagnostic tool for benign and malignant characteristic of palpable breast mass. Keywords: Breast lump; mammography; micro calcification DOI: http://dx.doi.org/10.3126/joim.v32i2.4940 Journal of Institute of Medicine, August, 2010; 32: 21-25

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Evaluation of breast lesions with Doppler ultrasound: Diagnostic accuracy of resistive index as a predictor of malignancy.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.04.3947 ◽

2020 ◽

Vol 27 (04) ◽

pp. 825-830

Author(s):

Ishrat Parveen ◽

Koukab Javed ◽

Breeha Elahi ◽

Faran Nasrullah ◽

Rashid Mahmood ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Doppler Ultrasound ◽

Predictive Value ◽

Gold Standard ◽

False Negative ◽

Malignant Lesion ◽

Resistive Index ◽

Breast Lesions ◽

Malignant Lesions ◽

Noninvasive Characterization

Objectives: To evaluate breast lesions with doppler ultrasound and calculated the diagnostic accuracy of resistive index as a predictor of malignancy, taking histopathology as gold standard. Study Design: Cross-sectional study. Setting: Radiology Department, CMH Multan. Period: December 2015 to May 2016. Material & Methods: 150 female patients, having age between 20 – 60 years, with palpable breast lumps were admitted in the study. Doppler ultrasound of the lesion was performed with emphasis on the vascularity and resistive index was formulated. Categorization as malignant or otherwise was declared as established by doppler ultrasound. Patients then underwent biopsy followed by histopathology. Correlation of doppler ultrasound and histopathological findings was done with calculation of diagnostic accuracy of doppler ultrasound, keeping histopathology as gold standard. Results: The mean of age was 40.23 ± 5.75 years. In 81 breast doppler ultrasound positive patients, 73 (True Positive) showed malignant lesions in breast while 08 (False Positive) did not have malignancy on biopsy. Among 69 Breast Doppler Ultrasound negative patients, 06 (False Negative) demonstrated malignancy on biopsy whereas 63 (True Negative) did not have any malignant lesion. Overall specificity was 88.77%, sensitivity 92.40%, negative predictive value 91.30%, positive predictive value 90.12% and diagnostic accuracy of Doppler Ultrasound came out 90.67%. Conclusion: Angiogenesis in malignant lesions lead to formation of structurally abnormal and tortuous vessels with increased resistive index. Doppler ultrasound is a safe and effective modality which shows acceptable diagnostic accuracy for noninvasive characterization of malignant breast lesions. Therefore, it can be employed as an alternative to histopathology in patients who present with breast lesions.

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UTILITY OF FNAC AS A FIRST LINE INVESTIGATION IN THE EVALUATION OF PALPABLE BREAST LUMPS WITH HISTOPATHOLOGICAL CORRELATION: A FIVE YEAR STUDY.

10.36106/gjra/2915610 ◽

2021 ◽

pp. 253-255

Author(s):

Manisha Khare ◽

Saraswathi J ◽

Yogita Sable ◽

Yasmeen Khatib ◽

Prajakta Gupte

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Ductal Carcinoma ◽

Benign Lesion ◽

Breast Lesions ◽

Benign Lesions ◽

Malignant Lesions ◽

Palpable Breast ◽

Breast Lumps

Introduction: Fine needle aspiration cytology (FNAC) is a simple cost-effective and rapid diagnostic modality for the evaluation of breast lumps. The aim of the present study was to correlate the cytological diagnosis with histopathological ndings and to nd out the accuracy of FNAC in the evaluation of breast lesions. FNAC is very helpful in distinguishing benign from malignant lesions and deciding the further management of the patient. Materials And Methods: The study comprised of 250 cases of FNAC of palpable breast lesions with histological correlation. All the aspirates were examined using PAP and Giemsa stains. The accuracy of FNAC was calculated by determining the sensitivity, specicity, positive predictive value, negative predictive value and accuracy. Results: Total 250 cases were studied of which there were 246 female and 4 male patients. A concordant diagnosis was made on FNAC in 134 out of 136 of benign lesions, one of two cases of suspicious for malignancy and all 112 cases of malignant lesions. Fibroadenoma(FA) (63.2%) was the commonest benign lesion observed while ductal carcinoma (42%) was the most frequent malignancy seen. In the diagnosis of breast lesions FNAC had a sensitivity of 99.12%, specicity of 98.54%, positive predictive value of 98.25%, negative predictive value of 99.26% and accuracy of 98.8%. Conclusion: FNAC is a reliable tool for diagnosis of breast lesions. It is minimally invasive and is a good alternative to biopsy in the diagnosis of benign lesions. However for the cases which fall into “suspicious for malignancy” category biopsy is advisable.

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An A.I. classifier derived from 4D radiomics of dynamic contrast-enhanced breast MRI data: potential to avoid unnecessary breast biopsies

European Radiology ◽

10.1007/s00330-021-07787-z ◽

2021 ◽

Author(s):

Nina Pötsch ◽

Matthias Dietzel ◽

Panagiotis Kapetas ◽

Paola Clauser ◽

Katja Pinker ◽

...

Keyword(s):

Principal Component Analysis ◽

False Negative ◽

Malignant Lesion ◽

Principal Component ◽

High Sensitivity ◽

Test Sample ◽

Component Analysis ◽

Training Dataset ◽

Breast Lesions ◽

Malignant Lesions

Abstract Objectives Due to its high sensitivity, DCE MRI of the breast (bMRI) is increasingly used for both screening and assessment purposes. The high number of detected lesions poses a significant logistic challenge in clinical practice. The aim was to evaluate a temporally and spatially resolved (4D) radiomics approach to distinguish benign from malignant enhancing breast lesions and thereby avoid unnecessary biopsies. Methods This retrospective study included consecutive patients with MRI-suspicious findings (BI-RADS 4/5). Two blinded readers analyzed DCE images using a commercially available software, automatically extracting BI-RADS curve types and pharmacokinetic enhancement features. After principal component analysis (PCA), a neural network–derived A.I. classifier to discriminate benign from malignant lesions was constructed and tested using a random split simple approach. The rate of avoidable biopsies was evaluated at exploratory cutoffs (C1, 100%, and C2, ≥ 95% sensitivity). Results Four hundred seventy (295 malignant) lesions in 329 female patients (mean age 55.1 years, range 18–85 years) were examined. Eighty-six DCE features were extracted based on automated volumetric lesion analysis. Five independent component features were extracted using PCA. The A.I. classifier achieved a significant (p < .001) accuracy to distinguish benign from malignant lesion within the test sample (AUC: 83.5%; 95% CI: 76.8–89.0%). Applying identified cutoffs on testing data not included in training dataset showed the potential to lower the number of unnecessary biopsies of benign lesions by 14.5% (C1) and 36.2% (C2). Conclusion The investigated automated 4D radiomics approach resulted in an accurate A.I. classifier able to distinguish between benign and malignant lesions. Its application could have avoided unnecessary biopsies. Key Points • Principal component analysis of the extracted volumetric and temporally resolved (4D) DCE markers favored pharmacokinetic modeling derived features. • An A.I. classifier based on 86 extracted DCE features achieved a good to excellent diagnostic performance as measured by the area under the ROC curve with 80.6% (training dataset) and 83.5% (testing dataset). • Testing the resulting A.I. classifier showed the potential to lower the number of unnecessary biopsies of benign breast lesions by up to 36.2%, p < .001 at the cost of up to 4.5% (n = 4) false negative low-risk cancers.

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201Tl Scintigraphy in the Evaluation of Palpable and Nonpalpable Breast Lesions: Correlation with Mammography and Ultrasonography

Nuklearmedizin ◽

10.1055/s-0038-1629848 ◽

1997 ◽

Vol 36 (08) ◽

pp. 282-288 ◽

Cited By ~ 8

Author(s):

T. Atasever ◽

A. Özdemir ◽

I. Öznur ◽

N. I. Karabacak ◽

N. Gökçora ◽

...

Keyword(s):

Final Diagnosis ◽

Lower Sensitivity ◽

Breast Lesions ◽

Breast Cancers ◽

Combined Use ◽

Malignant Breast ◽

Malignant Lesions ◽

Benign Breast Lesions ◽

Palpable Breast ◽

Metastatic Sites

Summary Aim: Our goal was to determine the clinical usefulness of TI-201 to identify breast cancer in patients with suspicious breast lesions on clinical examination, and/or abnormal radiologic (mammography and/or ultrasonography) findings. Methods: TI-201 scintigraphy were performed in sixty-eight patients with 70 breast abnormalities (51 palpable, 19 nonpalpable) and compared with mammography and ultrasonography (US). Early (15 min) and late (3 h) images of the breasts were obtained following the injection of 111 MBq (3 mCi) of TI-201. Visual and semiquantitative interpretation was performed. Results: Final diagnosis confirmed 52 malignant breast lesions and 18 benign conditions. TI-201 visualized 47 of 52 (90%) overall malignant lesions. Thirty-eight of 40 (95%) palpable and 9 of 12 (75%) nonpalpable breast cancers were detected by TI-201 scintigraphy. The smallest mass lesion detected by TI-201 measured 1.5x1.0 cm. Eleven breast lesions were interpreted as indeterminate by mammography and/or sonography. TI-201 scintigraphy excluded malignancy in 7 of 8 (88%) patients with benign breast lesions interpreted as indeterminate. Five of the 18 (28%) benign breast lesions showed TI-201 uptake. None of the fibroadenoma and fibrocystic changes accumulated TI-201. TI-201 scintigraphy, mammography and ultrasonography showed 90%, 92%, 85% overall sensitivity and 72%, 56%, 61% overall specificity respectively. Twenty-one of the 28 (75%) axillary nodal metastatic sites were also detected by TI-201. In malignant and benign lesions, early and late lesion/contralateral normal side (L/N) ratios were 1.58 ± 0.38 (mean ± SD) and 1.48 ± 0.32 (p >0.05), 1.87 ± 0.65 and 1.34 ± 0.20 (p<0.05) respectively. The mean early and late L/N ratios of malignant and benign groups did not show statistical difference (p>0.05). Conclusion: Overall, TI-201 scintigraphy was the most specific of the three methods and yielded favourable results in palpable breast cancers, while it showed lower sensitivity in nonpalpable cancers and axillary metastases. Combined use of TI-201 scintigraphy with mammography and US seems to be useful in difficult cases, such as dense breasts and indeterminate breast lesions.

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Prevalence of c-myc expression in breast lesions associated with microcalcifications detected by routine mammography

Sao Paulo Medical Journal ◽

10.1590/s1516-31802009000200003 ◽

2009 ◽

Vol 127 (2) ◽

pp. 66-70 ◽

Cited By ~ 2

Author(s):

Renato Coimbra Mazzini ◽

Simone Elias ◽

Afonso Celso Pinto Nazário ◽

Cláudio Kemp ◽

Ângela Flávia Logullo

Keyword(s):

Breast Imaging ◽

Ductal Carcinoma ◽

Percutaneous Biopsy ◽

Screening Mammography ◽

University Hospital ◽

Premalignant Lesions ◽

Breast Lesions ◽

Benign Lesions ◽

Cross Sectional ◽

Malignant Lesions

CONTEXT AND OBJECTIVE: Genetic abnormalities in cell proliferation-regulating genes have been described in premalignant lesions. The aims here were to evaluate c-myc protein expression in non-palpable breast lesions associated with microcalcifications, detected by screening mammography, and to compare these results with histopathological, clinical and epidemiological variables. DESIGN AND SETTING: Analytical cross-sectional study, with retrospective data collection, in a university hospital in São Paulo. METHODS: Seventy-nine female patients who underwent routine mammography between 1998 and 2004 were studied. Lesions classified by the Breast Imaging Reporting and Data System (BI-RADS) as 4 or 5 underwent percutaneous biopsy using a large-core needle. Ninety-eight lesions were studied anatomopathologically. Paraffin blocks properly representing the lesions were selected for immunohistochemical analyses using the streptavidin-biotin-peroxidase technique with monoclonal mouse c-myc antibodies. RESULTS: Among the 98 lesions, 29 (29.6%) contained malignant neoplasia; 40 (40.8%) had a positive immunohistochemical reaction for c-myc. When the groups were divided between lesions without atypias versus atypical lesions plus malignant lesions, 31.03% of the 58 lesions without atypias were positive for c-myc and 55% of the 40 malignant and atypical lesions (P = 0.018). Comparing the atypical lesions with ductal carcinoma in situ versus the benign lesions without atypias, c-myc was present in 51.61% of the 31 atypical lesions and 31.03% of the benign lesions without atypias (P = 0.057). CONCLUSION: C-myc protein was more frequently expressed in atypical and malignant lesions than in benign lesions without atypias. C-myc expression correlated with the presence of atypias (P = 0.018).

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A pilot study on the clinical value of 18F-sodium fluoride PET/CT in advanced prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.10589 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 10589-10589

Author(s):

Joseph W. Kim ◽

Maria Liza Lindenberg ◽

William L. Dahut ◽

James L. Gulley ◽

Ravi A. Madan ◽

...

Keyword(s):

Prostate Cancer ◽

Bone Metastases ◽

Sodium Fluoride ◽

Advanced Prostate Cancer ◽

Bone Scan ◽

Malignant Lesion ◽

Benign Lesions ◽

Pet Ct ◽

Medicine Physician ◽

Malignant Lesions

10589 Background: We evaluated the clinical utility of 18F-sodium fluoride PET/CT bone scan (18F-NaF) in the detection of bone metastases in patients (pts) with prostate cancer in comparison with Technetium-99m MDP bone scan (TcBS). Methods: In a prospective study, from October 2010-December 2011, 30 prostate cancer pts (ages 51-79), 21 with known bone metastases and 9 without known bone metastases, had18F-NaF and a TcBS performed. Abnormal foci of uptake on both TcBS and 18F-NaFwere classified as benign, malignant or indeterminate. Benign lesions included uptake in the joints and linear uptake at the endplates of the vertebral bodies consistent with degenerative changes. Malignant uptake on 18F-NaF scans was confirmed by characteristic osteoblastic features on CT. All TcBS and 18F-NaF were reviewed by an experienced nuclear medicine physician. For the patient-based analysis, scan results were categorized as positive (POS) = any malignant lesion; indeterminate (IND) = not distinctly malignant or benign; negative (NEG) = benign lesions only. Results: In the lesion-based analysis, 21 of 30 (70%) pts had more malignant lesions identified on 18F-NaF than on TcBS. The mean number of additional malignant lesions per patient on 18F-NaF vs TcBS was 4. Eight of the 30 pts had same number of malignant lesions identified in both studies. One of 30 pts had one less malignant lesion identified on 18F-NaF than on TcBS. CT correlation by 18F-NaF PET/CT of this particular lesion did not confirm osteoblastic feature. Malignant lesion distribution on 18F-NaF included: spine (28%), thorax (26%), pelvis (24%), long bones (13%) and skull (10%). In the patient-based analysis, 24 pts (80%) were POS by 18F-NaF, of whom 14 pts were POS, 8 were IND, and 2 were NEG by corresponding TcBS; in the 4 pts with NEG 18F-NaF, zero were POS, 2 were IND and 2 were NEG by corresponding TcBS. Conclusions: 18F-NaF identified more malignant lesions than TcBS. 18F-NaF may also add useful information in the management of advanced prostate cancer pts with and without known bone metastases.

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Non-Palpable Breast Lesions

Acta Radiologica ◽

10.1177/028418518802900305 ◽

1988 ◽

Vol 29 (3) ◽

pp. 285-288

Author(s):

P. Hallgrimsson ◽

R. Kåresen ◽

K. Årtun ◽

A. Skjennald

Keyword(s):

Malignant Lesion ◽

Breast Lesions ◽

Routine Procedure ◽

Localization Method ◽

Palpable Breast

Marking of non-palpable breast lesions for biopsy has become a routine procedure in patients in whom mammography has suggested malignancy. Between October 1981 and December 1985 a localization method was used in 123 patients. In 35 per cent of the biopsies a malignant lesion was disclosed. In patients with a mass only, malignancy was found in 37 per cent of the biopsies. If microcalcifications alone were the main reason for the biopsy, malignancy was disclosed in 25 per cent. If both a mass and microcalcifications were present, 52 per cent of the biopsies disclosed a malignant lesion.

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Thyroid lesions incidentally detected by 18F-FDG PET-CT ― a two centre retrospective study

Radiology and Oncology ◽

10.2478/raon-2014-0039 ◽

2015 ◽

Vol 49 (2) ◽

pp. 121-127 ◽

Cited By ~ 10

Author(s):

Jan Jamsek ◽

Ivana Zagar ◽

Simona Gaberscek ◽

Marko Grmek

Keyword(s):

Fdg Pet ◽

Malignant Lesion ◽

Standardized Uptake Value ◽

Benign Lesions ◽

Fdg Uptake ◽

Pet Ct ◽

Thyroid Uptake ◽

Malignant Lesions ◽

Fdg Pet Ct ◽

Thyroid Lesions

AbstractBackground. Incidental18F-FDG uptake in the thyroid on PET-CT examinations represents a diagnostic challenge. The maximal standardized uptake value (SUVmax) is one possible parameter that can help in distinguishing between benign and malignant thyroid PET lesions.Patients and methods. We retrospectively evaluated18F-FDG PET-CT examinations of 5,911 patients performed at two different medical centres from 2010 to 2011. If pathologically increased activity was accidentally detected in the thyroid, the SUVmaxof the thyroid lesion was calculated. Patients with incidental18F-FDG uptake in the thyroid were instructed to visit a thyroidologist, who performed further investigation including fine needle aspiration cytology (FNAC) if needed. Lesions deemed suspicious after FNAC were referred for surgery.Results. Incidental18F-FDG uptake in the thyroid was found in 3.89% ― in 230 out of 5,911 patients investigated on PET-CT. Malignant thyroid lesions (represented with focal thyroid uptake) were detected in 10 of 66 patients (in 15.2%). In the first medical centre the SUVmaxof 36 benign lesions was 5.6 ± 2.8 compared to 15.8 ± 9.2 of 5 malignant lesions (p < 0.001). In the second centre the SUVmaxof 20 benign lesions was 3.7 ± 2.2 compared to 5.1 ± 2.3 of 5 malignant lesions (p = 0.217). All 29 further investigated diffuse thyroid lesions were benign.Conclusions. Incidental18F-FDG uptake in the thyroid was found in 3.89% of patients who had a PET-CT examination. Only focal thyroid uptake represented a malignant lesion in our study ― in 15.2% of all focal thyroid lesions. SUVmaxshould only serve as one of several parameters that alert the clinician on the possibility of thyroid malignancy.

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