Combining Virtual Touch Tissue Imaging and BI-RADS May Improve Solid Breast Lesion Evaluation

Background: Ultrasound elastography (UE) is a novel imaging method. The purpose of this study was to determine the utility of Virtual Touch tissue imaging in the evaluation of solid breast lesions. Patients and Methods: 209 breast solid lesions in 192 patients that had been evaluated using ultrasound (US) and UE were reviewed and analyzed. Results: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for UE, US, and US plus UE in the differentiation of malignant from benign breast lesions were 80.8, 75.6, 77.9, 73.1, and 82.8% for UE, 87.2, 86.1, 86.6, 83.7, and 89.2% for US, and 92.5, 86.9, 89.5, 85.3, and 93.4% for US plus UE. There were significant differences between UE and US plus UE (all p < 0.05). Except for accuracy, there were no significant differences between UE and US or US and US plus UE (all p > 0.05). The area under the curve obtained from the ROC curve for UE, US, and US plus UE in differentiating malignant from benign lesions was 0.845, 0.884, and 0.922, respectively. Conclusion: The UE scoring system is not superior to BI-RADS in the sonographic evaluation of solid breast lesions. Combined use may improve the performance.

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Added value of strain elastography in the characterisation of breast lesions: A prospective study

Ultrasound ◽

10.1177/1742271x20912762 ◽

2020 ◽

Vol 28 (3) ◽

pp. 164-173

Author(s):

Dimpi Sinha ◽

Sukrity Sharma ◽

Nischal G Kundaragi ◽

Sudhir Kumar Kale

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Histopathological Examination ◽

Area Under The Curve ◽

Added Value ◽

Breast Lesions ◽

Strain Elastography ◽

Combined Use ◽

Significant Difference ◽

Malignant Breast

Background Elastography is a new promising ultrasonographic technique which is used to differentiate benign and malignant breast lesions based on the stiffness of the lesion. Purpose To determine the role of strain elastography in characterisation of breast lesions and to compare the diagnostic performances of strain elastography and conventional ultrasound (US). Methods In total, 113 breast lesions in 100 women were prospectively evaluated by US and strain elastography followed by the histopathological examination. Elastography score based on the Tsukuba colour scale and strain ratio were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated for each modality and the diagnostic performances were compared. The best cut-off point was calculated for each of the elastography parameters using the receiver operator curve analysis. Results Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). The area under the curve for elastography score showed significant difference with that of US: 0.98 versus 0.90 (Difference = 0.08, p =0.02). The elastography parameters were more specific as compared to US (ES-95 and SR-93% vs. 63%, p < 0.05) with a high negative predictive value. The combined use of elastography and US gave better results with 95% sensitivity, 94% specificity, 94% accuracy and negative predictive value reaching 97%. Conclusion Strain elastography is a useful adjunct to conventional ultrasonography. The combined use of strain elastography and ultrasound improves the characterisation of breast lesions and helps in down-staging of assigned BI-RADS category, thereby avoiding unnecessary biopsies. ES is the most useful elastography parameter to differentiate between benign and malignant breast lesions.

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The value of color-map virtual touch tissue imaging (CMV) in the differential diagnosis of benign and malignant breast lesions

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-201088 ◽

2021 ◽

pp. 1-8

Author(s):

Kai-Mei Lian ◽

Teng Lin

Keyword(s):

Work Experience ◽

Weighted Kappa ◽

Observer Agreement ◽

Tissue Imaging ◽

Breast Lesions ◽

Malignant Breast ◽

Sensitivity Specificity ◽

Accuracy And Repeatability ◽

Color Map ◽

Virtual Touch Tissue Imaging

BACKGROUND: Researchers have evaluated the VTI value in the diagnosis of breast lesions, mostly based on gray-scale. PURPOSE: This study aimed to evaluate the value of color-map virtual touch tissue imaging (CMV) in the diagnosis of breast lesions. METHODS: We retrospectively analyzed the virtual touch tissue imaging (VTI) images of 55 breast lesions in 49 female patients who underwent an examination of breast lesions in our hospital from January 2019 to December 2019. The pathological results were taken as the gold standard. The receiver operating characteristic (ROC) curve of CMV was analyzed, and its diagnostic performance was evaluated. Weighted Kappa (k) statistics were used to assess the inter-observer agreement for CMV. RESULTS: A total of 55 breast lesions were included, including 19 malignant lesions and 36 benign lesions. Multivariate analysis showed that patients with higher CMV scores (P = 0.014, odds ratio [OR] = 13.667, 95% CI = 1.702–109.773) were independent predictors of breast cancer. The sensitivity, specificity, and the area under curve (AUC) of CMV were 94.47%, 72.22%, and 0.912. The CMV’s inter-observer agreement was almost perfect among radiologists with different work experience (k = 0.854, standard error = 0.049, 95% confidence interval = 0.758–0.950). CONCLUSIOS: CMV has high accuracy and repeatability in the diagnosis of malignant breast lesions.

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Classification of Male Breast Lesions According to the IAC Yokohama System for Reporting Breast Cytopathology

Acta Cytologica ◽

10.1159/000512041 ◽

2020 ◽

pp. 1-8

Author(s):

Melissa Oosthuizen ◽

Rubina Razack ◽

Jenny Edge ◽

Pawel Tomasz Schubert

Keyword(s):

Predictive Value ◽

Best Practice ◽

Internal Audit ◽

Needle Aspiration ◽

Male Breast ◽

Histopathological Diagnosis ◽

Breast Lesions ◽

Risk Of Malignancy ◽

Sensitivity Specificity

Objective: This study aims to determine the diagnostic utility of the International Academy of Cytology (IAC) Yokohama System for reporting breast cytopathology in lesions of the male breast. Study Design: Fine-needle aspiration biopsy (FNAB) reports between 2015 and 2019 were retrospectively recategorized according to the 5-tiered IAC Yokohama Reporting System. Our database yielded a total of 1,532 FNAB reports from breast lesions, obtained from 1,350 male patients. The risk of malignancy (ROM) and diagnostic performance of FNAB were determined using follow-up histopathological diagnosis and/or clinical follow-up, where available, for each category. Results: The category distribution were as follows: inadequate, 40%; benign, 57%; atypical, 0.6%; suspicious for malignancy, 0.7%; and malignant, 1.6%. The ROM in each category was nondiagnostic, 11%; benign, 3%; atypical, 28%; suspicious for malignancy, 56%; and malignant, 100%. The sensitivity, specificity, positive predictive value, and negative predictive value were recorded as 63, 100, 100, and 84.6% respectively, when only malignant cases were considered as positive tests. Conclusion: This study validates the IAC Yokohama System for reporting male breast cytopathology. In accordance with the aim of the Yokohama System to establish best practice guidelines for reporting breast cytopathology, this comprehensive scheme facilitates comparisons between local and international institutions. The ROM acts as an internal audit for quality assurance within one’s own laboratory and provides guidance for clinical management. It highlights inefficiencies such as high inadequacy rates for category 1 and also features strengths with impressive specificity for categories 4 and 5.

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New screening approach to detecting congenital syphilis in China: a retrospective cohort study

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-320549 ◽

2020 ◽

pp. archdischild-2020-320549

Author(s):

Fang Hu ◽

Shuai-Jun Guo ◽

Jian-Jun Lu ◽

Ning-Xuan Hua ◽

Yan-Yan Song ◽

...

Keyword(s):

Predictive Value ◽

Congenital Syphilis ◽

Area Under The Curve ◽

Diagnostic Tools ◽

Operating Characteristics ◽

Loss To Follow Up ◽

Sensitivity Specificity ◽

Mother To Child ◽

Rule Out

BackgroundDiagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS.MethodsConfirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women.ResultsAmong 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively.ConclusionsAn algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools.

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Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in A Poor-Resource Setting

Diagnostics ◽

10.3390/diagnostics9030109 ◽

2019 ◽

Vol 9 (3) ◽

pp. 109 ◽

Cited By ~ 1

Author(s):

Ukweh ◽

Ugbem ◽

Okeke ◽

Ekpo

Keyword(s):

Predictive Value ◽

Performance Metrics ◽

Area Under The Curve ◽

Youden Index ◽

Likelihood Ratios ◽

Diagnostic Efficacy ◽

Predictive Values ◽

Resource Setting ◽

Post Test ◽

Sensitivity Specificity

Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th–22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15–46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68–84.6), 99.5 (95% CI: 99.3–99.7), and 88.3 (95% CI: 83.7–92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7–79.0), negative predictive value, 99.6 (95% CI: 99.5–99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37–2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7–221.4) and 0.23 (95% CI: 0.16–0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65–79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed.

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Identification of the most specific markers to differentiate primary pulmonary carcinoma from metastatic gastrointestinal carcinoma to the lung

Diagnostic Pathology ◽

10.1186/s13000-021-01184-2 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Bachar Alabdullah ◽

Amir Hadji-Ashrafy

Keyword(s):

Gastrointestinal Tract ◽

Predictive Value ◽

Regression Models ◽

Area Under The Curve ◽

Roc Curves ◽

Multivariate Models ◽

Gastrointestinal Carcinoma ◽

Lung Tumours ◽

Napsin A ◽

Sensitivity Specificity

Abstract Background A number of biomarkers have the potential of differentiating between primary lung tumours and secondary lung tumours from the gastrointestinal tract, however, a standardised panel for that purpose does not exist yet. We aimed to identify the smallest panel that is most sensitive and specific at differentiating between primary lung tumours and secondary lung tumours from the gastrointestinal tract. Methods A total of 170 samples were collected, including 140 primary and 30 non-primary lung tumours and staining for CK7, Napsin-A, TTF1, CK20, CDX2, and SATB2 was performed via tissue microarray. The data was then analysed using univariate regression models and a combination of multivariate regression models and Receiver Operating Characteristic (ROC) curves. Results Univariate regression models confirmed the 6 biomarkers’ ability to independently predict the primary outcome (p < 0.001). Multivariate models of 2-biomarker combinations identified 11 combinations with statistically significant odds ratios (ORs) (p < 0.05), of which TTF1/CDX2 had the highest area under the curve (AUC) (0.983, 0.960–1.000 95% CI). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 75.7, 100, 100, and 37.5% respectively. Multivariate models of 3-biomarker combinations identified 4 combinations with statistically significant ORs (p < 0.05), of which CK7/CK20/SATB2 had the highest AUC (0.965, 0.930–1.000 95% CI). The sensitivity, specificity, PPV, and NPV were 85.1, 100, 100, and 41.7% respectively. Multivariate models of 4-biomarker combinations did not identify any combinations with statistically significant ORs (p < 0.05). Conclusions The analysis identified the combination of CK7/CK20/SATB2 to be the smallest panel with the highest sensitivity (85.1%) and specificity (100%) for predicting tumour origin with an ROC AUC of 0.965 (p < 0.001; SE: 0.018, 0.930–1.000 95% CI).

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Incorporating diffusion-weighted imaging in a diagnostic algorithm for multiparametric MR mammography

Acta Radiologica ◽

10.1177/02841851211041822 ◽

2021 ◽

pp. 028418512110418

Author(s):

Katerina Vassiou ◽

Michael Fanariotis ◽

Ioannis Tsougos ◽

Ioannis Fezoulidis

Keyword(s):

Sensitivity And Specificity ◽

Predictive Value ◽

Region Of Interest ◽

Diagnostic Algorithm ◽

Breast Lesions ◽

Adc Value ◽

Diffusion Weighted ◽

Adc Values ◽

Single Formula ◽

Sensitivity Specificity

Background Apparent diffusion coefficient (ADC) measurements are not incorporated in BI-RADS classification. Purpose To assess the probability of malignancy of breast lesions at magnetic resonance mammography (MRM) at 3 T, by combining ADC measurements with the BI-RADS score, in order to improve the specificity of MRM. Material and Methods A total of 296 biopsy-proven breast lesions were included in this prospective study. MRM was performed at 3 T, using a standard protocol with dynamic sequence (DCE-MRI) and an extra echo-planar diffusion-weighted sequence. A freehand region of interest was drawn inside the lesion, and ADC values were calculated. Each lesion was categorized according to the BI-RADS classification. Logistic regression analysis was employed to predict the probability of malignancy of a lesion. The model combined the BI-RADS classification and the ADC value. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. Results In total, 153 malignant and 143 benign lesions were analyzed; 257 lesions were masses and 39 lesions were non-mass-like enhancements. The sensitivity and specificity of the combined method were 96% and 86%, respectively, in contrast to 95% and 81% with BI-RADS classification alone. Conclusion We propose a method of assessing the probability of malignancy in breast lesions by combining BI-RADS score and ADC values into a single formula, increasing sensitivity and specificity compared to BI-RADS classification alone.

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The role of red cell distribution width in the differential diagnosis of iron deficiency anemia and non-transfusion dependent thalassemia patients

Hematology Reports ◽

10.4081/hr.2018.7605 ◽

2018 ◽

Vol 10 (3) ◽

Cited By ~ 3

Author(s):

Pokpong Piriyakhuntorn ◽

Adisak Tantiworawit ◽

Thanawat Rattanathammethee ◽

Chatree Chai-Adisaksopha ◽

Ekarat Rattarittamrong ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Area Under The Curve ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Operating Characteristics ◽

Training Set ◽

Distribution Width ◽

Validation Set ◽

Sensitivity Specificity

This study aims to find the cut-off value and diagnostic accuracy of the use of RDW as initial investigation in enabling the differentiation between IDA and NTDT patients. Patients with microcytic anemia were enrolled in the training set and used to plot a receiving operating characteristics (ROC) curve to obtain the cut-off value of RDW. A second set of patients were included in the validation set and used to analyze the diagnostic accuracy. We recruited 94 IDA and 64 NTDT patients into the training set. The area under the curve of the ROC in the training set was 0.803. The best cut-off value of RDW in the diagnosis of NTDT was 21.0% with a sensitivity and specificity of 81.3% and 55.3% respectively. In the validation set, there were 34 IDA and 58 NTDT patients using the cut-off value of >21.0% to validate. The sensitivity, specificity, positive predictive value and negative predictive value were 84.5%, 70.6%, 83.1% and 72.7% respectively. We can therefore conclude that RDW >21.0% is useful in differentiating between IDA and NTDT patients with high diagnostic accuracy

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Validation of the Indonesian Version of Modified Checklist for Autism in Toddlers: a diagnostic study

Paediatrica Indonesiana ◽

10.14238/pi60.3.2020.159-65 ◽

2020 ◽

Vol 60 (3) ◽

pp. 159-65

Author(s):

Hendra Salim ◽

Soetjiningsih Soetjiningsih ◽

I Gusti Ayu Trisna Windiani ◽

I Gede Raka Widiana ◽

PITIKA ASPR

Keyword(s):

Predictive Value ◽

Characteristic Curve ◽

Area Under The Curve ◽

Negative Likelihood Ratio ◽

Autism Spectrum ◽

Diagnostic Study ◽

Diagnostic Validity ◽

Dsm Iv ◽

Pediatric Outpatients ◽

Sensitivity Specificity

Background Autism is a developmental disorder for which early detection in toddlers is recommended because of its increased prevalence. The Modified Checklist for Autism in Toddlers (M-CHAT) is an easy-to-interprete tool that can be filled out by parents. It has been translated into the Indonesian language but needs to be validated. Objective To evaluate the diagnostic validity of the Indonesian version of M-CHAT in detection of autism spectrum disorder in Indonesia. Methods A diagnostic study was conducted at Sanglah Hospital, Denpasar, Bali, from March 2011 to August 2013. Pediatric outpatients aged 18 to 48 months were included. The Indonesian version of the M-CHAT tool was filled by parents. Autism assessment was done according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV-TR). The assessment results were analyzed with the MedCalc program software, in several steps: (i) reliability of M-CHAT; (ii) description, distribution, and proportion to determine the characteristics of the subjects of research; and (iii) validity of M-CHAT compared to the gold standard DSM-IV-TR by a receiver operating characteristic curve and several area under the curve cut-off points, in order to assess the sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio, accompanied by the 95% confidence interval of each value. Results The Indonesian version of M-CHAT in toddlers had 82.35% sensitivity and 89.68% specificity, using the cut-off point of more than 6 failed questions. Conclusion The Indonesian version M-CHAT translated by Soetjiningsih has optimal diagnostic validity for detection of autism in toddlers.

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Comparison of Point-of-Care Ultrasonography and Radiography in the Diagnosis of Long-Bone Fractures

Medicina ◽

10.3390/medicina55070355 ◽

2019 ◽

Vol 55 (7) ◽

pp. 355 ◽

Cited By ~ 5

Author(s):

Avci ◽

Kozaci ◽

Tulubas ◽

Caliskan ◽

Yuksel ◽

...

Keyword(s):

Predictive Value ◽

Bone Fractures ◽

Point Of Care ◽

High Sensitivity ◽

Long Bone ◽

Imaging Method ◽

Fracture Characteristics ◽

Point Of Care Ultrasonography ◽

Sensitivity Specificity

Background and objectives: In this study, the accuracy of point-of-care ultrasonography (POCUS) was compared to radiography (XR) in the diagnosis of fractures, the determination of characteristics of the fractures, and treatment selection of fractures in patients admitted to the emergency department (ED) due to trauma and suspected long bone (LB) fractures. Materials and Methods: The patients were included in the study, who were admitted to ED due to trauma, and had physical examination findings suggesting the presence of fractures in LB (humerus, radius, ulna, femur, tibia, and fibula). The patients were evaluated by two emergency physicians (EP) in ED. The first EP examined LBs with POCUS and the second EP examined them with XR. LBs were evaluated on the anterior, posterior, medial, and lateral surfaces and from the proximal joint to the distal one (shoulder, elbow, wrist, hip, knee, and ankle joint) in both longitudinal and transverse axes with POCUS. Results: A total of 205 patients with suspected LB fractures were included in the study. LB fractures were determined in 99 patients with XR and in 105 patients with POCUS. The sensitivity, specificity, positive predictive value, negative predictive value of POCUS in determining the fractures were 99%, 93%, 93%, and 99%, respectively, compared to XR. Compared to XR, POCUS was able to determine 100% of fissure type fractures (kappa (κ) value: 0.765), 83% of linear fractures (κ: 0.848), 92% of fragmented fractures(κ: 0.756), 67% of spiral fractures (κ:0.798), 75% of avulsion type fractures (κ: 0.855), and 100% of full separation type fractures (κ: 0.855).Conclusions: This study has demonstrated that POCUS has a high sensitivity in diagnosing LB fractures. POCUS has a high sensitivity in identifying fracture characteristics. POCUS can be used as an alternative imaging method to XR in the diagnosis of LB fractures and in the determination of fracture characteristics.

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