Comparative analysis of MRI vs mammography in evaluation of size, number of lesions and nodal status of breast cancer

600 Background: Breast MRI is thought to be better in evaluating patients (pts) with BrCa. Our study was to compare MRI vs mam to predict leisons and LNS in BrCa. Methods: A retrospective study of 100 consecutive pts with pathologically proven BrCa was done. All had preoperative MRI and mam. Findings were compared to the final pathologic size, used as gold standard. MRI and was done at same center and single surgeon did all surgeries. Results: Of 100 pts,MRI reported 124 lesions. MRI reported size in 107 and mam reported size in 63 lesions. In MRI detected sizes 8% had same size as pathological size, 66% were overestimated by a mean of 0.64cm and 26% were underestimated by a mean of 0.48cm. For mam lesions, 10% had same size, 34% were overestimated by a mean of 1.10cm, 57% were underestimated by a mean of 0.78 cm. Total of 25 additional lesions were found in 23 pts in same and 6 leisons in 6 pts in contralateral breast by MRI. MRI also detected enlarged axillary and intramammary LN in 15% pts, 40% were true positives(+ve) and 60% were false +ve. One pt had metastatic LN in the contralateral axilla detected by MRI and confirmed by lymphoscintogram and pathology. 3% pts had neo-adjuvant chemotherapy Conclusion: In our study mam underestimated the breast lesion size in pts significantly more than MRI, but MRI overestimated BrCa lesion size in more number of pts. The mean difference in size on MRI when compared to the pathological size is less than 1 cm, while mam overestimated by a mean of greater than 1cm. This might be particularly important for T1 and T2 lesions, where size is the most important criterion for the T-stage classification. The identification of additional lesions and enlarged LN on MRI further validates the utility of MRI. [Table: see text] No significant financial relationships to disclose.

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Topical Colchicine Gel versus Diclofenac Sodium Gel for the Treatment of Actinic Keratoses: A Randomized, Double-Blind Study

Advances in Medicine ◽

10.1155/2016/5918393 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Gita Faghihi ◽

Azam Elahipoor ◽

Fariba Iraji ◽

Shadi Behfar ◽

Bahareh Abtahi-Naeini

Keyword(s):

Gold Standard ◽

Diclofenac Sodium ◽

Lesion Size ◽

Blind Study ◽

Double Blind Study ◽

Double Blind ◽

Actinic Keratoses ◽

Before And After ◽

The Mean ◽

Effective Medication

Introduction. Actinic keratoses (AKs), a premalignant skin lesion, are a common lesion in fair skin. Although destructive treatment remains the gold standard for AKs, medical therapies may be preferable due to the comfort and reliability .This study aims to compare the effects of topical 1% colchicine gel and 3% diclofenac sodium gel in AKs.Materials and Methods. In this randomized double-blind study, 70 lesions were selected. Patients were randomized before receiving either 1% colchicine gel or 3% diclofenac sodium cream twice a day for 6 weeks. Patients were evaluated in terms of their lesion size, treatment complications, and recurrence at 7, 30, 60, and 120 days after treatment.Results. The mean of changes in the size was significant in both groups both before and after treatment (<0.001). The mean lesion size before treatment and at 30, 60, and 120 days was not different between the two groups (p> 0.05). No case of erythema was seen in the colchicine group, while erythema was seen in 22.9% (eight cases) of patients in the diclofenac sodium group (p= 0.005).Conclusions. 1% colchicine gel was a safe and effective medication with fewer side effects and lack of recurrence of the lesion.

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Minimally invasive breast cancer excision using the breast lesion excision system under ultrasound guidance

Breast Cancer Research and Treatment ◽

10.1007/s10549-020-05814-z ◽

2020 ◽

Vol 184 (1) ◽

pp. 37-43

Author(s):

W. B. G. Sanderink ◽

L. J. A. Strobbe ◽

P. Bult ◽

M. S. Schlooz-Vries ◽

S. Lardenoije ◽

...

Keyword(s):

Breast Lesion ◽

Lobular Carcinoma ◽

Breast Mri ◽

Lesion Size ◽

Breast Cancers ◽

Breast Carcinomas ◽

Small Breast ◽

Technical Complication ◽

Invasive Breast Carcinomas ◽

Invasive Carcinomas

Abstract Purpose To assess the feasibility of completely excising small breast cancers using the automated, image-guided, single-pass radiofrequency-based breast lesion excision system (BLES) under ultrasound (US) guidance. Methods From February 2018 to July 2019, 22 patients diagnosed with invasive carcinomas ≤ 15 mm at US and mammography were enrolled in this prospective, multi-center, ethics board-approved study. Patients underwent breast MRI to verify lesion size. BLES-based excision and surgery were performed during the same procedure. Histopathology findings from the BLES procedure and surgery were compared, and total excision findings were assessed. Results Of the 22 patients, ten were excluded due to the lesion being > 15 mm and/or being multifocal at MRI, and one due to scheduling issues. The remaining 11 patients underwent BLES excision. Mean diameter of excised lesions at MRI was 11.8 mm (range 8.0–13.9 mm). BLES revealed ten (90.9%) invasive carcinomas of no special type, and one (9.1%) invasive lobular carcinoma. Histopathological results were identical for the needle biopsy, BLES, and surgical specimens for all lesions. None of the BLES excisions were adequate. Margins were usually compromised on both sides of the specimen, indicating that the excised volume was too small. Margin assessment was good for all BLES specimens. One technical complication occurred (retrieval of an empty BLES basket, specimen retrieved during subsequent surgery). Conclusions BLES allows accurate diagnosis of small invasive breast carcinomas. However, BLES cannot be considered as a therapeutic device for small invasive breast carcinomas due to not achieving adequate excision.

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Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

Scientific Reports ◽

10.1038/s41598-021-92462-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jeongseok Kim ◽

Jisup Kim ◽

Eun Hye Oh ◽

Nam Seok Ham ◽

Sung Wook Hwang ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Neuroendocrine Tumors ◽

Similar Efficacy ◽

En Bloc Resection ◽

Lesion Size ◽

Bloc Resection ◽

En Bloc ◽

Delayed Bleeding ◽

Mucosal Resection ◽

The Mean

AbstractSmall rectal neuroendocrine tumors (NETs) can be treated using cap-assisted endoscopic mucosal resection (EMR-C), which requires additional effort to apply a dedicated cap and snare. We aimed to evaluate the feasibility of a simpler modified endoscopic mucosal resection (EMR) technique, so-called anchored snare-tip EMR (ASEMR), for the treatment of small rectal NETs, comparing it with EMR-C. We retrospectively evaluated 45 ASEMR and 41 EMR-C procedures attempted on small suspected or established rectal NETs between July 2015 and May 2020. The mean (SD) lesion size was 5.4 (2.2) mm and 5.2 (1.7) mm in the ASEMR and EMR-C groups, respectively (p = 0.558). The en bloc resection rates of suspected or established rectal NETs were 95.6% (43/45) and 100%, respectively (p = 0.271). The rates of histologic complete resection of rectal NETs were 94.1% (32/34) and 88.2% (30/34), respectively (p = 0.673). The mean procedure time was significantly shorter in the ASEMR group than in the EMR-C group (3.12 [1.97] vs. 4.13 [1.59] min, p = 0.024). Delayed bleeding occurred in 6.7% (3/45) and 2.4% (1/41) of patients, respectively (p = 0.618). In conclusion, ASEMR was less time-consuming than EMR-C, and showed similar efficacy and safety profiles. ASEMR is a feasible treatment option for small rectal NETs.

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No Difference in Outcomes Following Osteochondral Allograft with Fresh Precut Cores Compared to Hemi-Condylar Allografts

Cartilage ◽

10.1177/19476035211021911 ◽

2021 ◽

pp. 194760352110219

Author(s):

Danielle H. Markus ◽

Anna M. Blaeser ◽

Eoghan T. Hurley ◽

Brian J. Mannino ◽

Kirk A. Campbell ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Knee Injury ◽

Lesion Size ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Radiographic Outcomes ◽

Significant Difference ◽

Patient Reported ◽

The Mean

Objective The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. Design A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. Results Overall, 52 total patients who underwent OCA with either fresh precut OCA cores ( n = 26) and hemi-condylar OCA ( n = 26) were pair matched at a mean follow-up of 34.0 months (range 12 months to 99 months). The mean ages were 31.5 ± 10.7 for fresh precut cores and 30.9 ± 9.8 for hemi-condylar ( P = 0.673). Males accounted for 36.4% of the overall cohort, and the mean lesion size for fresh precut OCA core was 19.6 mm2 compared to 21.2 mm2 for whole condyle ( P = 0.178). There was no significant difference in patient-reported outcomes including Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and Tegner ( P > 0.5 for each), or in MOCART score (69.2 vs. 68.3, P = 0.93). Conclusions This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.

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Neoadjuvant Chemotherapy for Breast Cancer: Evaluation by PET / CT

QJM ◽

10.1093/qjmed/hcab106.065 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Rania Ali Maarouf ◽

Amgad S Abdel-Rahman ◽

Samar Ibrahim Mohamed

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Therapeutic Response ◽

Left Breast ◽

Breast Lesions ◽

Mean Values ◽

Pet Ct ◽

The Mean ◽

Neo Adjuvant Chemotherapy ◽

Fdg Pet Ct

Abstract Background Breast cancer (BC)is the most commonly occurring cancer in women and the second most common cancer overall.An increase in the rate of breast preservation has come to be expected because of tumor reduction using neo-adjuvant chemotherapy (NAC) for locally advanced cancer and it is important to accurately determine the effects of NAC. Patients and Methods This study was conducted on 30 female patients with histopathologically confirmed breast cancer referred for a PET/CT scan aiming to demonstrate the role of 18F-FDG PET/CT in detecting the pathological response to NAC in BC patients. Results No statistically significant differences were found between the baseline number of lesions and that after three cycles of chemotherapy. Also, no statistically significant differences were found between the mean values of baseline and after three cycles of chemotherapy of both liver activity and size of right breast lesions. Meanwhile, the mean values of SUV of right and left breast lesions as well as the size of left breast lesions were significantly lower after three cycles of chemotherapy when compared to their baseline values. And no statistically significant differences were found between complete and partial therapeutic response in the right breast lesions as well as between complete and no therapeutic response in the left breast lesions as regards baseline SUV and SUV after 3 cycles of chemotherapy. Conclusion It can be concluded that FDG-PET/CT is useful for evaluation of neo-adjuvant chemotherapy for breast cancer. However, more studies are needed to validate the results of the current study.

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Can Cut-Off-Values for Tumor Size or Patient Age in Breast Ultrasound Reduce Unnecessary Biopsies or is it all About Bi-rads?– A Retrospective Analysis of 763 Biopsied T1-Sized Lesions

Ultrasound International Open ◽

10.1055/s-0043-110476 ◽

2017 ◽

Vol 03 (03) ◽

pp. E94-E98 ◽

Cited By ~ 1

Author(s):

Laura Holzer-Fruehwald ◽

Matthias Meissnitzer ◽

Michael Weber ◽

Stephan Holzer ◽

Klaus Hergan ◽

...

Keyword(s):

Regression Models ◽

Breast Lesion ◽

Binary Logistic Regression ◽

Lesion Size ◽

Breast Lesions ◽

Predictive Values ◽

Logistic Regression Models ◽

Independent Variables ◽

Oval Shape ◽

Histological Result

Abstract Aims and Objectives To assess whether it is possible to establish a size cut-off-value for sonographically visible breast lesions in a screening situation, under which it is justifiable to obviate a biopsy and to evaluate the grayscale characteristics of the identified lesions. Materials and Methods Images of sonographically visible and biopsied breast lesions of 684 patients were retrospectively reviewed and assessed for the following parameters: size, shape, margin, lesion boundary, vascularity, patient’s age, side of breast, histological result, and initial BI-RADS category. Statistical analyses (t-test for independent variables, ROC analyses, binary logistic regression models, cross-tabulations, positive/negative predictive values) were performed using IBM SPSS (Version 21.0). Results Of all 763 biopsied lesions, 223 (29.2%) showed a malignant histologic result, while 540 (70.8%) were benign. Although we did find a statistically significant correlation of malignancy and lesion size (p=0.031), it was not possible to define a cut-off value, under which it would be justifiable to obviate a biopsy in terms of sensitivity and specificity (AUC: 0.558) at any age. Lesions showing the characteristics of a round or oval shape, a sharp delineation and no echogenic rim (n=112) were benign with an NPV of 99.1%. Conclusion It is not possible to define a cut-off value for size or age, under which a biopsy of a sonographically visible breast lesion can be obviated in the screening situation. The combination of the 3 grayscale characteristics, shape (round or oval), margin (circumscribed) and no echogenic-rim sign, showed an NPV of 99.1%. Therefore, it seems appropriate to classify such lesions as BI-RADS 2.

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Comparison of Validity of Mapping between Drug Indications and ICD-10

Methods of Information in Medicine ◽

10.3414/me13-01-0053 ◽

2014 ◽

Vol 53 (03) ◽

pp. 195-201 ◽

Cited By ~ 5

Author(s):

Y. Choi ◽

C. Jung ◽

Y. Chae ◽

M. Kang ◽

J. Kim ◽

...

Keyword(s):

Gold Standard ◽

Kappa Statistic ◽

Direct Approach ◽

Free Text ◽

Good Opportunity ◽

Mapping Approach ◽

Icd 10 ◽

Standard Terminology ◽

The Mean ◽

Experienced Nurse

SummaryBackground: Mapping of drug indications to ICD-10 was undertaken in Korea by a public and a private institution for their own purposes. A different mapping approach was used by each institution, which presented a good opportunity to compare the validity of the two approaches.Objectives: This study was undertaken to compare the validity of a direct mapping approach and an indirect terminology based mapping approach of drug indications against the gold standard drawn from the results of the two mapping processes.Methods: Three hundred and seventy-five cardiovascular reference drugs were selected from all listed cardiovascular drugs for the study. In the direct approach, two experienced nurse coders mapped the free text indications directly to ICD-10. In the indirect terminology based approach, the indications were extracted and coded in the Korean Standard Terminology of Medicine. These terminology coded indications were then manually mapped to ICD-10. The results of the two approaches were compared to the gold standard. A kappa statistic was calculated to see the compatibility of both mapping approaches. Recall, precision and F1 score of each mapping approach were calculated and analyzed using a paired t-test.Results: The mean number of indications for the study drugs was 5.42. The mean number of ICD-10 codes that matched in direct approach was 46.32 and that of indirect terminology based approach was 56.94. The agreement of the mapping results between the two approaches were poor (kappa = 0.19). The indirect terminology based approach showed higher recall (86.78%) than direct approach (p < 0.001). However, there was no difference in precision and F1 score between the two approaches.Conclusions: Considering no differences in the F1 scores, both approaches may be used in practice for mapping drug indications to ICD-10. However, in terms of consistency, time and manpower, better results are expected from the indirect terminology based approach.

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Impact of a dedicated multidisciplinary meeting on the management of superficial cancers of the digestive tract

Endoscopy International Open ◽

10.1055/a-0658-1350 ◽

2018 ◽

Vol 06 (12) ◽

pp. E1470-E1476 ◽

Cited By ~ 2

Author(s):

Solène Dermine ◽

Maximilien Barret ◽

Caroline Prieux ◽

Sophie Ribière ◽

Sarah Leblanc ◽

...

Keyword(s):

Digestive Tract ◽

Endoscopic Resection ◽

Gastrointestinal Endoscopy ◽

Lesion Size ◽

Concordance Rate ◽

Resection Rate ◽

Tertiary Referral Center ◽

Multidisciplinary Meeting ◽

The Mean ◽

The Impact

Abstract Background The recent development of endoscopic resection for superficial gastrointestinal cancers could justify the need for a dedicated oncological multidisciplinary meeting (MDM). The aim of our study was to evaluate the impact of the dedicated MDM on the management of superficial cancers of the digestive tract. Methods A dedicated MDM was developed at our tertiary referral center. A retrospective review of the MDM conclusions for all patients referred from March 2015 to March 2017 was performed. Outcomes measurements were the outcomes of endoscopic resection, and the concordance rate between the MDM recommendations, European Society of Gastrointestinal Endoscopy (ESGE) guidelines, and final patient management. Results In total, 153 patients with a median age of 69 years were included. Half of the patients had major comorbidities. The mean lesion size was 25 mm, and R0 and curative resection rate were 73.9 % and 56.9 %, respectively. Forty-three patients had an indication for surgery after endoscopic resection. The concordance rate between ESGE guidelines and MDM recommendation was 92.2 %, and 12 patients did not receive the treatment recommended due to comorbidities. Conclusion A MDM dedicated to superficial tumors helped tailor the ESGE guidelines to each patient in order to avoid unnecessary surgery.

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Safety and reliability of computed tomography-guided lipiodol marking for undetectable pulmonary lesions

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz304 ◽

2020 ◽

Vol 30 (4) ◽

pp. 546-551

Author(s):

Kazuhiro Ito ◽

Junichi Shimada ◽

Masanori Shimomura ◽

Kunihiko Terauchi ◽

Motohiro Nishimura ◽

...

Keyword(s):

Computed Tomography ◽

Lesion Size ◽

Ct Guided ◽

Pulmonary Lesions ◽

Pleural Surface ◽

Intraoperative Fluoroscopy ◽

Safety And Reliability ◽

Preoperative Ct ◽

The Mean ◽

Lipiodol Marking

Abstract OBJECTIVES This study aimed to evaluate the safety and reliability of percutaneous computed tomography (CT)-guided lipiodol marking for undetectable pulmonary lesions before video-assisted thoracic surgery (VATS). METHODS We retrospectively analysed the cases of CT-guided lipiodol marking followed by VATS in 9 institutes from May 2006 to March 2018. Lipiodol (0.2–0.5 ml) was percutaneously injected closely adjacent to undetectable pulmonary lesions with computed-tomography guidance. Lipiodol spots were identified using C-arm-shaped fluoroscopy during VATS. We grasped the lipiodol spots, including the target lesions, with ring-shaped forceps and resected them. RESULTS Of 1182 lesions, 1181 (99.9%) were successfully marked. In 1 case, the injected lipiodol diffused, and no spot was created. Of the 1181 lesions, 1179 (99.8%) were successfully resected with intraoperative fluoroscopy. Two lipiodol spots were not detected because of the lipiodol distribution during the division of pleural adhesions. The mean lesion size was 9.1 mm (range 1–48 mm). The mean distance from the pleural surface was 10.2 mm (range 0–43 mm). Lipiodol marking-induced pneumothorax occurred in 495 (57.1%) of 867 cases. Of these, chest drainage was required in 59 patients (6.8%). The other complications were 19 (2.2%) cases of bloody sputum, 3 (0.35%) cases of intravascular air, 1 (0.12%) case of pneumonia and 1 (0.12%) case of cerebral infarction. There were no lipiodol marking-induced deaths or sequelae. CONCLUSIONS Preoperative CT-guided lipiodol marking followed by VATS resection was shown to be a safe and reliable procedure with a high success rate and acceptably low severe complication rate.

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