Role of diffusion-weighted magnetic resonance imaging in assessment of mammographically detected asymmetric densities

Abstract Background Asymmetric breast density is a potentially perplexing finding; it may be due to normal hormonal variation of the parenchymal pattern and summation artifact or it may indicate an underlying true pathology. The current study aimed to identify the role of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) values in the assessment of breast asymmetries. Results Fifty breast lesions were detected corresponding to the mammographic asymmetry. There were 35 (70%) benign lesions and 15 (30%) malignant lesions. The mean ADC value was 1.59 ± 0.4 × 10–3 mm2/s for benign lesions and 0.82 ± 0.3 × 10–3 mm2/s for malignant lesions. The ADC cutoff value to differentiate between benign and malignant lesions was 1.10 × 10–3 mm2/s with sensitivity 80%, specificity 88.6%, positive predictive value 75%, negative predictive value 91%, and accuracy 86%. Best results were achieved by implementation of the combined DCE-MRI and DWI protocol, with sensitivity 93.3%, specificity 94.3%, positive predictive value 87.5%, negative predictive value 97.1%, and accuracy 94%. Conclusion Dynamic contrast-enhanced MRI (DCE-MRI) was the most sensitive method for the detection of the underlying malignant pathology of breast asymmetries. However, it provided a limited specificity that may cause improper final BIRADS classification and may increase the unnecessary invasive procedures. DWI was used as an adjunctive method to DCE-MRI that maintained high sensitivity and increased specificity and the overall diagnostic accuracy of breast MRI examination. Best results can be achieved by the combined protocol of DCE-MRI and DWI.

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Added value of diffusion-weighted MRI in assessment of pleural lesions

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00557-3 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Youssriah Yahia Sabri ◽

Ikram Hamed Mahmoud ◽

Lamis Tarek El-Gendy ◽

Mohamed Raafat Abd El-Mageed ◽

Sally Fouad Tadros

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Diagnostic Value ◽

Added Value ◽

Adc Value ◽

Pleural Diseases ◽

Conventional Mri ◽

Malignant Lesions

Abstract Background There are many causes of pleural disease including variable benign and malignant etiologies. DWI is a non-enhanced functional MRI technique that allows qualitative and quantitative characterization of tissues based on their water molecules diffusivity. The aim of this study was to evaluate the diagnostic value of DWI-MRI in detection and characterization of pleural diseases and its capability in differentiating benign from malignant pleural lesions. Results Conventional MRI was able to discriminate benign from malignant lesions by using morphological features (contour and thickness) with sensitivity 89.29%, specificity 76%, positive predictive value 89%, negative predictive value 76.92%, and accuracy 85.37%. ADC value as a quantitative parameter of DWI found that ADC values of malignant pleural diseases were significantly lower than that of benign lesions (P < 0.001). Hence, we discovered that using ADC mean value of 1.68 × 10-3 mm2/s as a cutoff value can differentiate malignant from benign pleural diseases with sensitivity 89.3%, specificity 100%, positive predictive value 100%, negative predictive value 81.2%, and accuracy 92.68% (P < 0.001). Conclusion Although DWI-MRI is unable to differentiate between malignant and benign pleural effusion, its combined morphological and functional information provide valid non-invasive method to accurately characterize pleural soft tissue diseases differentiating benign from malignant lesions with higher specificity and accuracy than conventional MRI.

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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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ROLE OF HYSTEROSALPINGOGRAPHY IN MANAGEMENT OF FEMALE INFERTILITY AND ITS LAPAROSCOPIC CORRELATION

10.36106/ijar/2400835 ◽

2019 ◽

pp. 1-2

Author(s):

(prof.) Alka Agrawal

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Uterine Cavity ◽

Fallopian Tubes ◽

Radiographic Technique ◽

Invasive Techniques ◽

Work Up ◽

Tubal Pathology

BACKGROUND : Infertility nowadays has become a medical as well as social problem.Laboratory findings alone is inconclusive in diagnosing infertility.HSG is the radiographic technique for evaluation of uterine cavity & fallopian tubes..Direct visualization of abdominal and pelvic organs in laparoscopy allows a definite diagnosis where clinical examination & less invasive techniques such as ultrasound & HSG fail to identify the abnormality. AIMS & OBJECTIVES :To determine the role of HSG in the evaluation of infertility & to correlate its findings with laparoscopy. METHODS : 75 infertile females aged between 20-40 years were included. HSG & laparoscopy was performed in all patients & findings were analysed. RESULTS : Sensitivity of HSG was 80 %,specificity was 76 % with positive predictive value 63%, negative predictive value 88 % in detecting tubal pathology. Sensitivity of HSG in detecting uterine pathology was 67%, specificity 73%, positive predictive value 39% and negative predictive value 89%. CONCLUSION : HSG has reasonably good sensitivity & specificity in diagnosing tubal & uerine pathology while laparoscopy has diagnostic as well as therapeutic approach.Hence they are complimentary to each other in infertility work up.

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Role of laparoscopy in the Etiologic Diagnosis of Ascites of Unknown Origin

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v13i1.16400 ◽

2017 ◽

Vol 13 (1) ◽

pp. 13-16

Author(s):

Anup Sharma ◽

P. Thapa ◽

S. N. Gupta

Keyword(s):

Positive Predictive Value ◽

Peritoneal Carcinomatosis ◽

Negative Predictive Value ◽

Predictive Value ◽

College Teaching ◽

Unknown Origin ◽

Peritoneal Tuberculosis ◽

Medical College ◽

Etiologic Diagnosis

Introduction: Ascites is a consequence of many different etiologies, such as liver cirrhosis, neoplasm, tuberculous peritonitis, pyogenic peritonitis, congestive heart failure, renal and pancreatic diseases but, in some situations, ascites is of unknown cause in spite of comprehensive study. The aim of this study was to identify the role of laparoscopy in the etiological diagnosis of ascites of unknown origin.Methods: This was a prospective study of the patients who underwent diagnostic laparoscopy to determine the causes of ascites of unknown origin in the Department of Surgery, Nepalgunj Medical College Teaching Hospital from April 2012 to May 2014. All the patients underwent laparoscopy for the evaluation of ascites after appropriate clinical and laboratory examinations, which failed to reveal the cause.Results: Peritoneal tuberculosis and carcinomatosis peritonei were the two most common causes found in 37.14% and 57.14% of cases respectively. The average age of the patients was 52 years. Distension of abdomen, abdominal pain and weight loss were the most frequently observed symptoms in 33 patients (100%), 26 patients (74.28%) and 18 patients (51.42%) respectively. The CT scan findings, were a omental thickening in 28 cases (80%), peritoneal nodules in 7(20%) patients and the intraabdominal lymph nodes in 13 patients (39.39%). Ovarian mass was found in 4 patients (11.42%). The histological diagnosis was a peritoneal carcinomatosis in 13 (37.14%) patients and peritoneal tuberculosis in 20 (57.1%) patients and in two patients nonspecific inflammation. The sensitivity and specificity of laparoscopic diagnosis in the diagnosis of peritoneal tuberculosis were 78.67% and 98.6% respectively and in the diagnosis of peritoneal carcinomatosis were 94.78% and 72.2% respectively. The positive predictive value was 97.3% and the negative predictive value was 73.7% for peritoneal tuberculosis and for peritoneal carcinomatosis the positive predictive value was 83.7% and negative predictive value was 94.87%.Conclusion: The etiologic diagnosis of ascites of unknown origin is difficult despite the availability of several tests. Laparoscopy with peritoneal biopsy has still got a role in diagnosing these types of ascites where the other laboratory and imaging studies fail to reveal the cause.Journal of Nepalgunj Medical College Vol.13(1) 2015: 13-16

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Role of ascitic fluid adenosine deaminase (ADA) and serum CA-125 in the diagnosis of tuberculous peritonitis

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v40i3.25228 ◽

2015 ◽

Vol 40 (3) ◽

pp. 89-91 ◽

Cited By ~ 5

Author(s):

N Ali ◽

NC Nath ◽

R Parvin ◽

A Rahman ◽

TM Bhuiyan ◽

...

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Diagnostic Test ◽

Ascitic Fluid ◽

Predictive Value ◽

Ca 125 ◽

Histopathological Diagnosis ◽

Diagnostic Modality ◽

Cross Sectional

This cross sectional study was carried out in the department of gastroenterology, BIRDEM, Dhaka from January 2010 to May 2011 to determine the role of ascitic fluid ADA and serum CA-125 in the diagnosis of clinically suspected tubercular peritonitis. Total 30 patients (age 39.69±21.26, 18M/12F) with clinical suspicion of tuberculosis peritonitis were included in this study after analyzing selection criteria. Laparoscopic peritoneal biopsy with histopathological diagnosis was considered gold standard against which accuracics of two biomarkers (ADA & CA-125) were compared. Cut off value of ADA and CA-125 are 24 u/l, 35 U/ml respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ADA as a diagnostic modality in tuberculos peritonitis were 87.5%, 83.33%, 95.45%, 62.5% and 86.67% respectively where as CA-125 was found to have 83.33% sensitivity, 50% specificity, 86.9% positive predictive value, 42.85% negative predictive value and 76.6% accuracy. Both biomarkers are simple, non-invasive, rapid and relatively cheap diagnostic test where as laparoscopy is an invasive procedure, costly & requires trained staff and not without risk and also not feasible in all the centre in our country. So ascitic fluid ADA and serum CA-125 are important diagnostic test for peritoneal tuberculosis.Bangladesh Med Res Counc Bull 2014; 40 (3): 89-91

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Endoscopic ultrasound-guided fine needle aspiration cytology in the mediastinum

Orvosi Hetilap ◽

10.1556/oh.2013.29556 ◽

2013 ◽

Vol 154 (9) ◽

pp. 338-344 ◽

Cited By ~ 1

Author(s):

Zsolt Dubravcsik ◽

Péter Serényi ◽

László Madácsy ◽

Attila Szepes

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Predictive Value ◽

Needle Aspiration ◽

Safe Procedure ◽

Benign Lesions ◽

Ultrasound Guided ◽

Fine Needle

Introduction: Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration in the posterior mediastinum is technically a relatively simple and safe procedure, and it can provide important information for the further management of patients. Aim: To analyze and compare the results of mediastinal endoscopic ultrasound-guided fine needle aspiration with the data available in the literatue. Patients and methods: The authors retrospectively analyzed their prospective database on mediastinal endoscopic ultrasound-guided fine needle aspiration of 49 patients referred to their endoscopy centre between 1 November 2009 and 1 November 2012. For the fine needle aspiration 22 and 25 G needles were used. Two to six needle passes were performed in each patient. All slides were prepared at the endoscopy unit and analyzed at the cytology laboratory. Results: The authors performed mediastinal endoscopic ultrasound-guided fine needle aspiration for enlarged lymph nodes or suspected mediastinal malignancy in all but 4 patients (2 suspected oesophageal cancers, 1 suspected benign oesophageal stenosis with wall thickening and 1 cardia tumour, all with non-diagnostic endoscopic biopsies). Five patients were excluded from the analysis since fine needle aspiration was not performed in them. Benign lesions were suspected based on the endoscopic ultrasound morphology in 7, and malignant disease in 37 patients. In 3 cases samples obtained by biopsy were not informative for cytological analysis. Cytology confirmed all benign lesions and showed malignancy in 28 cases. Cytology failed to reveal malignancy in 6 patients, although it was suspected based upon endoscopic ultrasound finding. Furthermore, endoscopic ultrasound-guided fine needle aspiration provided the diagnosis in 15 of the 17 patients when bronchoscopy was non-diagnostic. The diagnostic accuracy of the EUS-FNA was the following: sensitivity 82%, specificity 100%, positive predictive value 1.0, negative predictive value 0.54. Only one infectious complication was encountered after fine needle aspiration despite antibiotic prophylaxis. Discussion: Endoscopic ultrasound-guided fine needle aspiration of mediastinal pathology is an accurate, safe and technically relatively easy procedure, however it requires practice and skills in mediastinal anatomy. It has an excellent positive predictive value, a very good sensitivity, but slightly poor negative predictive value. The results of this study are concordant with the literature data. The authors suggest that at least 4 needle passes in the absence of on-site pathologist should be performed in order to minimize the number of false-negative results. Orv. Hetil., 2013, 154, 338–344.

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Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) in detection and characterization of neoplastic breast lesions

QJM ◽

10.1093/qjmed/hcab106.075 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Yahya Eltaher Elshaikh ◽

Mohsen Gomaa Hassan Ismail ◽

Nivine Abdel Moneim Chalabi ◽

Rasha Salah Eldin Hussein

Keyword(s):

Whole Body ◽

Breast Lesions ◽

Whole Body Imaging ◽

Benign Lesions ◽

Major Health Problem ◽

Adc Value ◽

Diffusion Weighted ◽

Signal Suppression ◽

Malignant Lesions

Abstract Background Breast cancer is a major health problem in women and early detection is of prime importance. Objective We aimed to evaluate the role of diffusion-weighted imaging with background body signal suppression (DWIBS) in detection of breast lesions and characterization of these detected lesions. Patients and methods 40 female patients with suspicious 50 breast lesions detected by sonomammography, in addition to the routine protocol that includes T1Wi's, T2Wi's, STIR, DCE-MRI and DWI sequences (with ADC maps) all participants underwent DWIBS sequence (with ADC maps). The histopathology served as reference standard. First, we compared the detectability of breast lesions on DWIBS with that of the DWI. We then compared the ADCs of the malignant lesions (n = 35) to that of the benign lesions (n = 15) in both DWI and DWIBS. Results Thirty seven lesions were detected via DWIBS (detectability of 74.0%) which was less than that of DWI (detectability of 78.0%). In DWIBS, the mean ADC value of the malignant lesions (0.80 ± 0.27 × 10-3mm2/s) was significantly lower than that of the benign lesions (1.40 ± 0.41 × 10-3mm2/s). With a cut-off value of 1.3 × 10-3mm2/s for ADC, DWIBS achieved 85.7% sensitivity and 80% specificity for differentiating between benign and malignant lesions. Conclusion Although it showed lower detectability for breast lesions than DWI, our study suggests that DWIBS is superior to DWI in the characterization of malignant breast lesions.. Also based on ADC, DWIBS provides additional information that may further increase the specificity of breast lesion characterization.

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The study of use of toluidine blue as an adjunctive tool to clinical examination in early diagnosis of clinically suspicious oral premalignant and malignant lesions: a study of fifty cases

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194931 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1585 ◽

Cited By ~ 1

Author(s):

Himanshu Chhagan Bayad ◽

Sanjeev Bhagat ◽

Dimple Sahni ◽

Navneet Kaur ◽

Ravinder Singh ◽

...

Keyword(s):

Early Detection ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Toluidine Blue ◽

Predictive Value ◽

Blue Staining ◽

Histopathological Diagnosis ◽

Toluidine Blue Staining ◽

Malignant Lesions

Background: Oral carcinoma is among the most prevalent malignancies of head and neck region and is often diagnosed in the advanced stage with significant morbidity and treatment cost. Thus, there is a need for early detection of oral premalignant and malignant lesions. Toluidine blue staining can be used for early detection of these lesions.Methods: The study included 50 patients with clinically suspicious oral premalignant and malignant lesions. These lesions were subjected to toluidine blue staining and biopsy. Diagnoses were confirmed by histopathological examination. Results: Sensitivity and specificity of toluidine blue for oral premalignant lesions was 92.30% and 80% respectively with the positive predictive value of 92.30%, negative predictive value of 80% and accuracy of 88.88%. Sensitivity and specificity of toluidine blue for oral malignant lesions was 96.30% and 80% respectively with the positive predictive value of 96.30%, negative predictive value of 80% and accuracy of 93.75%.Conclusions: The simplicity of toluidine blue staining and its accuracy suggest that it can be a useful adjunctive tool to diagnosis of oral lesions. Results should be carefully evaluated and correlated with clinical findings and histopathological diagnosis.

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Diagnostic Accuracy of Ultrasound in Palpable Breast Lesions

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i3.33697 ◽

2020 ◽

Vol 5 (3) ◽

pp. 1196-1200

Author(s):

Manish Raj Pathak ◽

Mahesh Gautam ◽

Rashmita Bhandari

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Diagnostic Tool ◽

Predictive Value ◽

Breast Lesions ◽

Non Invasive ◽

Malignant Lesions ◽

Palpable Breast ◽

Sensitivity Specificity

Introduction: Breast carcinoma is the second leading cause of cancer related mortality in females around the world. Ultrasound plays a key role in differentiating cystic and solid lesions and is a convenient and non-invasive diagnostic tool to differentiate between benign and malignant lesions. Objectives: The aim of this study is to evaluate the diagnostic accuracy of ultrasound in palpable breast lesions. Methodology: A prospective cross-sectional study was carried out in patients with palpable breast lesions who presented in Department of radio diagnosis and imaging of Nobel Medical collegefor a period of one-year from February 2019- January 2020 using ultrasound. A total of 60 patientswereevaluated in the study. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. Results: Out of 60 patients evaluated, ultrasound showed 46 (76.7%) cases to be benign and 14 (23.3%) cases to be malignant. FNAC revealed benign disease in 47 (78.3%) patients and malignant disease in 13 (21.7%) patients. The most common benign lesion was fibroadenoma. We found nearly 91.7% of the malignant lesions had spiculated margins and microcalcification. The sensitivity of ultrasound was 95.74% and specificity 92.3% with diagnostic accuracy 95%. Conclusion: Ultrasound is a convenient and non-invasive diagnostic tool with good sensitivity, specificity, positive predictive value, negative predictive value and accuracy in palpable breast lesions.

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The Role of Non-Echoplanar Diffusion-Weighted Magnetic Resonance Imaging in Diagnosis of Primary Cholesteatoma and Cholesteatoma Recidivism as an Adjunct to Clinical Evaluation

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418800833 ◽

2018 ◽

Vol 127 (12) ◽

pp. 919-925 ◽

Cited By ~ 1

Author(s):

Roman D. Laske ◽

Thomas N. Roth ◽

Krisztina Baráth ◽

Bernhard Schuknecht ◽

Alexander M. Huber ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Interrater Variability ◽

Magnetic Resonance Imaging Mri

Introduction: The aim of this study was to analyze the sensitivity and specificity of non-echoplanar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of cholesteatoma, with a focus on its value as an adjunct to clinical examination. Methods: In a prospective cohort study, 92 cases were divided into 2 groups: “clinically cholesteatoma” ( n = 79) and “clinically no cholesteatoma” ( n = 13). Non-EPI DW MRI was performed preoperatively in all cases. The presence of a cholesteatoma was assessed by clinicians otoscopically, by neuroradiologists on non-EPI DW MRI, by the surgeon intraoperatively, and finally by the pathologist postoperatively. Data analysis was performed for specificity, sensitivity, positive predictive value, negative predictive value, and interrater variability. Results: The sensitivity and specificity were 89.3% and 75%, respectively, in the “clinically cholesteatoma” group and 0% and 100% in the “clinically no cholesteatoma” group. Non-EPI DW MRI had a positive predictive value of 98.5% when cholesteatoma was suspected clinically and a negative predictive value of 84.6% when cholesteatoma was not suspected clinically. Conclusion: If cholesteatoma is suspected clinically, non-EPI DW MRI is not necessary. If there is no clinical suspicion of cholesteatoma in second-look situations, sensitivity is low and serial follow-up MRI with long intervals is advised.

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