Association between lesion enhancement and breast cancer in contrast-enhanced spectral mammography

Background Contrast-enhanced spectral mammography (CESM) may help to determine the malignancy potential of lesions according to the degree of enhancement. Purpose To investigate the correlation between the degree of contrast enhancement of the lesions in contrast-enhanced spectral mammography (CESM) and the final histopathological diagnosis in patients with BI-RADS 4 and 5 lesions. Material and Methods CESM was performed in 128 patients who had BI-RADS 4 and 5 lesions on mammography and underwent histopathological examination. A total of 128 index lesions were scored using a 4-point scale regarding the degree of contrast enhancement (0 = no contrast enhancement, 1 = minimal, 2 = moderate, 3 = marked), a score of 2 and 3 was accepted as suggestive of malignancy. The study was approved in our institutional scientific committee. Results In total, 76 (59.4%) of the lesions had benign histopathological results, whereas 52 of them had malignant results. Contrast enhancement was not observed in 22.7% of the lesions while 24.2% had minimal enhancement, 18.8% had moderate enhancement, and 34.4% had marked enhancement in CESM. The sensitivity of the degree of contrast enhancement in CESM was 98.1%, when the specificity was 77.6%, positive predictive value was 75%, negative predictive value was 98.3%, and accuracy was 85.9%. Conclusion This study demonstrated that the degree of contrast enhancement of the lesions in CESM may be used in daily practice with easily performing a visual scale in predicting the malignancy potential of the lesions.

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Diagnostic Accuracy of Mammography and Contrast-Enhanced MR Imaging in 238 Histologically Verified Breast Lesions

Acta Radiologica ◽

10.1080/02841859709174374 ◽

1997 ◽

Vol 38 (4) ◽

pp. 489-496 ◽

Cited By ~ 51

Author(s):

B. Boné ◽

Z. Péntek ◽

L. Perbeck ◽

B. Veress

Keyword(s):

Mr Imaging ◽

Breast Surgery ◽

Histopathological Examination ◽

High Sensitivity ◽

Histopathological Diagnosis ◽

Breast Lesions ◽

Benign Lesions ◽

Post Contrast ◽

X Ray ◽

Contrast Enhanced

Purpose: To determine the sensitivity and specificity of X-ray mammography and of MR imaging in 238 consecutively operated breasts, and to correlate the findings to histopathological diagnosis. Material and Methods: Over 15 months, 220 patients scheduled for breast surgery were examined consecutively, before surgery, by means of both mammography and MR imaging. of the 220 patients, 18 underwent bilateral breast surgery. The entire breast was examined by means of T1-weighted transversal images using a 3D fast low-angle shot (FLASH) sequence. One pre— and 2 post-contrast scans were performed. Each breast was examined by means of mammography and 3 views were applied as routine. All palpable and mammographically suspect lesions were examined on additional images as microfocus magnification or spot compression. The two methods were evaluated independently of each other. Results: In total, 145 malignant and 93 benign lesions were found at histopathological examination. The sensitivity of mammography was 89% and MR imaging 92%. The specificity was 72% in both methods. When the results of the 2 methods were combined, a sensitivity of 99% and a specificity of 55% was achieved. Conclusion: Mammography and MR imaging seemed to complement each other to produce a high sensitivity. Unfortunately it is impossible at present to supplement mammography with MR imaging in each patient as a routine owing to the current technical and financial limitations.

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Evaluation of endometrial causes of postmenopausal bleeding with it's correlation with endometrial thickness and hysteroscopy findings and endometrial tissue histopathology

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202737 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2940

Author(s):

Saurabh V. Bhangale ◽

Shailja Sharma ◽

Asmita Patil ◽

Beena Kumari

Keyword(s):

Diagnostic Accuracy ◽

Endometrial Carcinoma ◽

Predictive Value ◽

Histopathological Examination ◽

Endometrial Thickness ◽

Endometrial Tissue ◽

Transvaginal Sonography ◽

Histopathological Diagnosis ◽

Postmenopausal Bleeding ◽

Dilation And Curettage

Background: Postmenopausal bleeding (PMB)accounts for 5% of gynecology visit. All with unexpected uterine bleeding should be evaluated for endometrial carcinoma since this potentially lethal disease is the cause of bleeding in approximately 10 percent patients (range 1 to 25 percent, depending upon risk factors). The aim of the study was to evaluate endometrial causes of postmenopausal bleeding (PMB) with it's correlation with endometrial thickness (ET)and hysteroscopy findings and endometrial tissue histopathology.Methods: A total 50 consecutive cases of PMB fulfilling the inclusion and exclusion criteria and giving informed consent were selected. Each patient was subjected to transvaginal sonography (TVS) in which uterus, adnexa and endometrial thickness (ET) was assessed. Then hysteroscopy and/or dilation and curettage was scheduled at subsequent visit. Endometrial sample was sent for histopathological examination. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for ET by TVS and hysteroscopy findings, considering histopathological diagnosis as the gold standard.Results: Most common endometrial cause of PMB was atrophic endometrium (44%). The other causes were endometrial carcinoma (18%), endometrial hyperplasia (18%), endometrial polyp (12%), endometritis (4%), and leiomyoma (4%). The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%.Conclusions: Being relatively cheap, easily accessible, non-invasive, TVS with ET measurement should first line investigation in the evaluation of women with postmenopausal bleeding with suspected endometrial pathology. Although hysteroscopy is more specific and sensitive, in poor resource settings it should be limited to cases with ill-deﬁned endometrial lining, recurrent/ persistent bleeding and cases with endometrial thickness greater than 5 mm irrespective of endometrial echotexture.

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Diagnostic value of abdominal CT scan in ovarian tumors in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, from January 2017 to December 2018

Majalah Obstetri & Ginekologi ◽

10.20473/mog.v29i22021.45-52 ◽

2021 ◽

Vol 29 (2) ◽

pp. 45

Author(s):

Ida Bagus Gede Ramayuda ◽

Lies Mardiyana ◽

Dyah Erawati ◽

Indra Yuliati

Keyword(s):

Ct Scan ◽

Predictive Value ◽

Malignant Tumors ◽

Diagnostic Value ◽

Ovarian Tumors ◽

Academic Hospital ◽

Abdominal Ct ◽

Contrast Enhanced ◽

Abdominal Ct Scan ◽

Histopathological Results

HIGHLIGHTS1. Ovarian tumors diagnostic value has been determined using the tools on contrast-enhanced abdominal CT Scan2. The tools including primary finding like mass size, septation, solid component, and additional finding such as ascites, peritoneal implants, lymph node enlargement3. Most tumors were ovarian malignant tumors according to their histopathological results 4. Contrast-enhanced abdominal CT Scan of ovarian tumors evaluated by the tools gave better and more reliable diagnostic value than without using the toolsABSTRACTObjectives: The purpose of this study was to determine the diagnostic value of contrast-enhanced abdominal CT scan in ovarian tumors in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, to provide scientific and clinical benefits.Materials and Methods: Samples were taken retrospectively by contrast-enhanced abdominal CT scan raw data in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, from January 2017 to December 2018. Using inclusion and exclusion criteria, a total of 88 samples were obtained and reviewed blindly by Female Organ Division of Radiology Department, Faculty of Medicine Universitas Airlangga, and by using "tools" (primary and additional findings of modified ovarian tumors malignancy). The data were correlated with histopathological findings and analyzed by statistical tests and the results with and without "tools" were compared.Results: Samples were grouped by age, distributed with a range of 20 years and the group of 41-60 years had the highest age of ovarian tumor samples (46.6%) with 84.1% being ovarian malignant tumors according to their histopathological results. It was dominated by serous, mucinous and endometroid types with sensitivity of 93.3%, specificity of 64.3%, positive predictive value of 93.3% negative predictive value of 69.2%, and accuracy value of 89.8%. More reliable results were obtained by using “tools”.Conclusion: Contrast-enhanced abdominal CT scan of ovarian tumors in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, evaluated by “tools” still had a better and more reliable diagnostic value than without tools in determining policy steps in handling ovarian tumors with a note that more in-depth research on pitfalls is needed so it may enrich the characteristic findings in imaging.

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Contrast-Enhanced Ultrasound for the Characterization of Malignant versus Benign Focal Liver Lesions in a Prospective Multicenter Experience – The SRUMB Study

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-180 ◽

2019 ◽

Vol 28 ◽

pp. 191-196

Author(s):

Ioan Sporea ◽

Daniela Larisa Săndulescu ◽

Roxana Şirli ◽

Alina Popescu ◽

Mirela Danilă ◽

...

Keyword(s):

Predictive Value ◽

Real Life ◽

Daily Practice ◽

Focal Liver Lesions ◽

Imaging Method ◽

Liver Lesions ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Line Imaging

Aim: This study evaluated the accuracy of contrast-enhanced ultrasound (CEUS) for the differential diagnosis of benign vs. malignant focal liver lesions (FLL) in a real-life, multicenter experience. Methods: This prospective study, including 14 Romanian centers, was performed over a 6 year period (February 2011- April 2017) and included 2062 FLLs assessed by CEUS. Inclusion criteria were: newly diagnosed FLL on B-mode ultrasound, less than three lesions/patient, all FLLs evaluated by CEUS and by a second-line imaging technique (contrast enhanced CT or contrast enhanced MRI) or histology, considered as reference. The trial was registered in clinicaltrials.gov (Identifier NCT01329458). Results: From the 2062 FLLs included in the study, 57.2% (1179) were malignant and 42.8% (883) were benign. CEUS had 83.9% sensitivity (Se), 97.8% specificity (Sp), 98.1% positive predictive value (PPV), 82.2% negative predictive value (NPV) and a diagnostic accuracy (Ac) of 89.9% for the positive diagnosis of malignant lesions. For the benign lesions, CEUS had 97.8% Se, 83.9% Sp, 82.2% PPV, 98.1% NPV 89.9% Ac. The diagnostic performance of CEUS for hepatocellular carcinoma was 76.6% Se, 98.4% Sp, and 91.2% Ac; for hemangioma: 89.2% Se, 99% Sp, and 96.9% Ac and for metastases: 90.9% Se, 98.4% Sp, and 96.9% Ac. Conclusions: CEUS proved a high accuracy in differentiating the malignant vs. benign character of a FLL. It can be confidently used as a first line imaging method in daily practice.

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Clinicopathological and Radiological Profile of Multinodular Goitre – A Prospective Study

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2021.v29i2.479 ◽

2021 ◽

Vol 29 (2) ◽

pp. 164-168

Author(s):

Koustav Mondal ◽

Chiranjib Das

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Histopathological Examination ◽

Tertiary Care ◽

Final Diagnosis ◽

Needle Aspiration ◽

Histopathological Diagnosis ◽

Care Hospital ◽

Multinodular Goitre ◽

Sensitivity Specificity

Introduction Multinodular goitre (MNG) is defined as multiple palpable distinct nodules in the enlarged thyroid gland. MNG can harbour malignancy in 1-10% cases. We undertook the present study to correlate the clinical, radiological and cytological features of MNG with that of final histopathological diagnosis. Materials and Methods A prospective cohort study was done in a tertiary care hospital in northern part of West Bengal from January 2018 to December 2019. Patients aged between 12 years and 75 years, presenting with MNG on clinical examination, were included in the study. We compared the pre-operative ultrasonography (USG) of neck and fine needle aspiration cytology (FNAC) reports with post-operative histopathological examination (HPE) report. Results Among 100 patients 80 were female and 20 were male. Most patients were in 41-50 years age group. For detection of malignancy in MNG, USG had 40% sensitivity, 97.78% specificity, 66.67% positive predictive value (PPV), 93.62% negative predictive value (NPV), and 92% diagnostic accuracy. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC for detection of malignancy in MNG were 20%, 93.33%, 25%, 91.3% and 86% respectively. When USG features were combined with FNAC features non-diagnostic result decreased from 6% to 2% and diagnostic accuracy for detecting malignancy in MNG increased from 86% to 90%. Conclusion USG and FNAC are complementary to each other in the diagnostic workup of MNG. USG guided FNAC is still better for reaching final diagnosis and exclusion of malignancy.

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Clinicopathological study of solitary thyroid nodule in Kolhan belt of Jharkhand

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212115 ◽

2021 ◽

Vol 7 (6) ◽

pp. 959

Author(s):

Rajeev Saxena ◽

Shiwani Kanth ◽

Rohit Kumar Jha ◽

Devandra Jee

Keyword(s):

Diagnostic Accuracy ◽

Thyroid Nodule ◽

Predictive Value ◽

Thyroid Nodules ◽

Histopathological Examination ◽

Follicular Adenoma ◽

Daily Practice ◽

Needle Aspiration ◽

Age Group ◽

Solitary Thyroid Nodule

Background: Thyroid disorders are commonly encountered in our daily practice and specially in countries like India and Nepal (foothill areas). There are variety of lesions that can arise within thyroid gland. In such scenario it is important to diagnose neoplastic and non-neoplastic conditions accurately with minimum complications so that proper management can be done as early as possible. The aim of the study was to know clinical spectrum of solitary thyroid nodules and diagnostic accuracy of fine needle aspiration cytology as compared to histopathological examination.Methods: We conducted our study over a period of 21 months from July 2018 to March 2020. 74 patients who gave consent and presented with solitary thyroid swelling were included in the study. Results: In our study, cases mostly presented in the age group of 31-40 years with a female preponderance. Colloid goiter was the most common pathology which presented as solitary thyroid nodule. Among neoplastic lesions, follicular adenoma was the most common benign neoplasia with papillary thyroid carcinoma being the most common malignancy. FNAC had sensitivity of 78%, specificity-100%, positive predictive value-100%, negative predictive value-88% and diagnostic accuracy-92%.Conclusions: Majority of solitary thyroid nodules are found in females of middle age group. In our study we found FNAC as valuable diagnostic tool specially in benign cases.

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Incidentally Detected Liver Metastases during Pancreas Contrast-enhanced Ultrasound

BIO Integration ◽

10.15212/bioi-2021-0026 ◽

2021 ◽

Author(s):

Dan Zuo ◽

Ji-Jiang Qian ◽

Yi Dong ◽

Wen-Ping Wang ◽

Xiao-Fan Tian ◽

...

Keyword(s):

Liver Metastases ◽

Predictive Value ◽

Clinical Decision Making ◽

Late Phase ◽

Clinical Decision ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced ◽

Multiple Imaging ◽

Liver Scan ◽

Histopathological Results

Purpose: The purpose of current study was to investigate the value of the late-phase enhancement features of pancreas contrast-enhanced ultrasound (CEUS) in the detection of liver metastases in patients with pancreatic ductal adenocarcinomas (PDAC).Methods: From October 2020 to March 2021, 86 patients were prospectively enrolled. The gold standard of liver metastatic and PDAC lesions were based on histopathologically diagnoses and multiple imaging modalities results. B-mode ultrasound (BMUS) was performed to detect suspected liver metastases before CEUS. During the late phase of pancreas CEUS, the entire liver was scanned again to detect hypoenhanced liver metastases. Liver metastases were confirmed by biopsy and histopathological results. The number and size of liver metastases detected by BMUS and during CEUS late phase were recorded and compared.Results: Suspected liver metastases were detected in 14 patients by BMUS (n = 23). During the late phase of CEUS, hypoenhanced liver metastases were detected in 23 patients (n = 87). When compared with BMUS, whole-liver scan during the late phase of CEUS detected more isoechoic, small, or superficially located lesions. Compared with BMUS, the specificity, sensitivity, positive predictive value, and negative predictive value of CEUS in diagnosing of liver metastases in PDAC patients were significantly improved (96.72% vs. 100%, 48% vs. 92%, 85.71% vs. 100%, and 83.10% vs. 96.83%, respectively) (P < 0.05).Conclusion: The late phase whole liver scan during CEUS of pancreas helps to detect more liver metastases, which is important for further clinical decision-making.

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Breast Lesion Characterisation with Diffusion Weighted Imaging Versus Dynamic Contrast Enhanced-MRI: A Prospective Observational Study in a Tertiary Care Hospital

EMJ Radiology ◽

10.33590/emjradiol/21-00053 ◽

2021 ◽

pp. 75-82

Author(s):

Amandeep Singh ◽

Jasmin Purewal ◽

Kamlesh Gupta ◽

Gauravdeep Singh

Keyword(s):

Predictive Value ◽

Diffusion Weighted Imaging ◽

Histopathological Diagnosis ◽

Breast Lesions ◽

Dce Mri ◽

Dynamic Contrast Enhanced ◽

Diffusion Weighted ◽

Contrast Enhanced ◽

Malignant Lesions ◽

Lesion Characterisation

Purpose: Dynamic contrast-enhanced (DCE)-MRI has a promising role in breast cancer detection and lesion characterisation. Diffusion-weighted imaging (DWI) acts as an adjunct in the differentiation between benign and malignant lesions. The purpose of the study was to evaluate the efficacy of DCE-MRI and DWI in differentiating benign and malignant lesions. Methods: In a prospective study conducted between March 2019 and February 2020, 60 patients with breast lesions underwent DWI combined with DCE-MRI of the breast. The time–intensity curves were plotted. Lesions were classified according to the latest American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS; 5th edition). The results were compared with the histopathological diagnosis. The sensitivity and specificity of DWI, DCE-MRI, and combined DWI and DCE-MRI were calculated for detection of benign and malignant breast lesions. Results: Sixty patients underwent breast MRI in which 78 lesions were detected, out of which 28 were benign and 50 were malignant. Quantitative apparent diffusion coefficient measurement revealed 96% sensitivity and 82% specificity, with a positive predictive value of 92% and negative predictive value of 96%, for differentiating benign from malignant lesions. DCE-MRI findings showed 96% sensitivity and 78.5% specificity. The sensitivity of combined DWI and DCE-MRI was 98% and specificity was 86%, which was higher than DWI and DCE-MRI alone. Conclusion: Multiparametric MRI of the breast has very high sensitivity for detecting and characterising breast lesions as benign or malignant lesions. DWI had higher specificity than DCE-MRI, and the combined use of DWI and DCE-MRI had greater efficacy than DWI and DCE-MRI alone.

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Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography

Acta Endocrinologica ◽

10.1530/eje-12-0936 ◽

2013 ◽

Vol 168 (5) ◽

pp. 649-655 ◽

Cited By ~ 172

Author(s):

Gilles Russ ◽

Bénédicte Royer ◽

Claude Bigorgne ◽

Agnès Rouxel ◽

Marie Bienvenu-Perrard ◽

...

Keyword(s):

Scale Score ◽

Predictive Value ◽

Interobserver Agreement ◽

Kappa Statistic ◽

Data System ◽

Point Scale ◽

Gray Scale ◽

Thyroid Imaging ◽

Sensitivity Specificity ◽

Histopathological Results

ObjectiveTo evaluate prospectively the diagnostic accuracy of the thyroid imaging reporting and data system (TI-RADS) and its interobserver agreement and to estimate the reduction of indications of fine-needle aspiration biopsies (FNABs).DesignA prospective comparative study was designed.MethodsIn 2 years, 4550 nodules in 3543 patients were prospectively scored using a flowchart and a six-point scale and then submitted to US-FNAB. Results were read according to the Bethesda system. Histopathological results were available for 263 cases after surgery. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value, and accuracy were calculated for the gray-scale score, elastography, and a combination of both methods. Interobserver agreement was calculated using the kappa statistic. The reduction in the number of FNABs was estimated.ResultsWhen compared with cytopathological results, sensitivity, specificity, NPV, and accuracy were 95.7, 61, 99.7, and 62% for the TI-RADS gray-scale score; 74.2, 91.1, 98, and 90% for elastography; and 98.5, 44.7, 99.8, and 48.3% for a combination of both methods respectively. When compared with histopathological results, the sensitivity of the gray-scale score, elastography, and a combination of both methods were 93.2, 41.9, and 96.7% respectively. Interobserver agreement for the six-point scale and the recommendation for biopsy were substantial (κ value=0.72 and 0.76 respectively). The reduction in the number of FNABs was estimated to be 33.8%.ConclusionThe TI-RADS score has high sensitivity and NPV for the diagnosis of thyroid carcinoma. A hard nodule should always be considered as suspicious for malignancy but elastography cannot be used alone. Combination of elastography with gray-scale can be used to improve sensitivity or specificity. Interobserver agreement and decrease in unnecessary biopsies are significant.

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Positive correlation between neovascularization degree of carotid atherosclerosis determined by contrast-enhanced ultrasound and level of serum C-reactive protein

VASA ◽

10.1024/0301-1526/a000429 ◽

2015 ◽

Vol 44 (3) ◽

pp. 0187-0194 ◽

Cited By ~ 6

Author(s):

Xiaoni Chang ◽

Jun Feng ◽

Litao Ruan ◽

Jing Shang ◽

Yanqiu Yang ◽

...

Keyword(s):

Contrast Enhancement ◽

Rank Correlation ◽

Artery Stenosis ◽

Contrast Enhanced Ultrasound ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

Contrast Enhanced ◽

Grade 3 ◽

Axis View

Background: Neovascularization is one of the most important risk factors for unstable plaque. This study was designed to correlate plaque thickness, artery stenosis and levels of serum C-reactive protein with the degree of intraplaque enhancement determined by contrast-enhanced ultrasound. Patients and methods: Contrast-enhanced ultrasound was performed on 72 carotid atherosclerotic plaques in 48 patients. Contrast enhancement within the plaque was categorized as grade 1, 2 or 3. Maximum plaque thickness was measured in short-axis view. Carotid artery stenosis was categorized as mild, moderate or severe. Results: Plaque contrast enhancement was not associated with the degree of artery stenosis or with plaque thickness. Serum C-reactive protein levels were positively correlated with the number of new vessels in the plaque. C-reactive protein levels increased in the three groups(Grade 1: 3.72±1.79mg/L; Grade 2: 7.88±4.24 mg/L; Grade 3: 11.02±3.52 mg/L), with significant differences among them (F=10.14, P<0.01), and significant differences between each two groups (P<0.05). Spearmans rank correlation analysis showed that serum C-reactive protein levels were positively correlated with the degree of carotid plaque enhancement (Rs =0.69, P<0.01). Conclusions: The combination of C-reactive protein levels and intraplaque neovascularization detected by contrast-enhanced ultrasound may allow more accurate evaluation of plaque stability.

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