Similar Diagnostic Accuracy and Reproducibility of BIRADS 4 and 5 Lesions in Radial and Meander-Like Breast Ultrasound

Breast ultrasound is crucial in the diagnostics of breast cancer. While meander-like Ultrasound (m-US) is most commonly used, radial Ultrasound (r- US) is emerging as suitable alternative. Breast lesions category BI-RADS 4 and 5 are suspicious and highly suggestive of malignancy, respectively, and mandate breast biopsy. We compare m-US and r-US in real-time with regard to diagnostic accuracy, examination time and the agreement in location, size and final BIRADS classification of BI-RADS 4 and 5 lesions. Out of 1948 dual examinations (m-US and r-US), 57 lesions were classified as BI-RADS 4 or 5 either by r-US or m-US or by both scanning methods. For breast lesions category BI-RADS 4 or 5, sensitivity (both scan methods 94.1%), specificity (m-US 21.7%, r-US 39.1%), cancers missed rate (both 5.9%), accuracy (m-US 64.9%, r-US 71.9%), positive predictive value (m-US 64.0%, r-US 69.6%) and negative predictive value (both 100%) were similar. In m-US, the malignancy rate for category BI-RADS 5 was 93.8% versus for 50.0% for BI-RADS 4 whereas in r-US, malignancy rates were 88.2% and 58.6% for category BI-RADS 5 and 4, respectively. The examination was significantly shorter (p<0.01) for r-US (13.6 minutes) compared to m-US (27.8 minutes). Our results support radial ultrasound as an alternative to meander-like ultrasound in breast lesions category BI-RADS 4 and 5 where patients benefit from a significantly shorter examination time.

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Radial and meander-like Breast Ultrasound demonstrate similar diagnostic accuracy and reproducibility for BI-RADS 3 Lesions

Medical Research Archives ◽

10.18103/mra.v9i5.2416 ◽

2021 ◽

Vol 9 (5) ◽

Author(s):

Rosanna Zanetti-Dällenbach ◽

Pascale Brasier-Lutz ◽

Claudia Jäggi-Wickes ◽

Sabine Schaedelin ◽

Rosemarie Burian ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Breast Biopsy ◽

Benign Lesion ◽

Random Order ◽

Breast Ultrasound ◽

Breast Lesions ◽

Lesion Volume ◽

Scanning Method ◽

Examination Time ◽

The Mean

Introduction Radial ultrasound (r-US) or ductosonography is usually applied as an adjunct to meander-like ultrasound (m-US) but rarely as the sole scanning method. Here we compare r-US and m-US with regard to breast lesions detected and interpreted as BI-RADS 3 , i.e. probably benign. Materials and Methods Eligible patients received a meander-like and a radial breast ultrasound in random order on the same day by two different examiners. The same type of ultrasound equipment was used but with specific probes. Results We performed 1984 dual ultrasound examinations. In 121 BI-RADS 3 lesions, a breast biopsy was performed and the histology of two (1.7%) BI-RADS 3 lesions turned out to be malignant. The specificity for m-US was 95.0%, and 96.6% for r-US. One (0.8%) benign lesion was missed by m-US, whereas r-US missed 2 (1.7%) benign lesions. Each missed lesion was identified by the other scanning method. The mean maximal lesion diameter (ICC 0.82), the mean lesion volume (ICC 0.87), the clock-face localization (κ 0.82) and the mean distance to the skin (ICC 0.77) show excellent, and the mean distance from the lesion to the mammilla (ICC 0.65) good agreement between m-US and r-US. The agreement between m-US and r-US in regard to sonomorphologic criteria ranged from excellent to poor. In 71.9% the lesion was classified as BI-RADS 3 by m-US as well as r-US. The examination time for r-US was significantly shorter than for m-US. Conclusion For BI-RADS 3 breast lesions, radial breast ultrasound is an alternative to meander-like ultrasound since the diagnostic accuracy of the two scanning methods is comparable. Notably, patients benefit from a significantly shorter examination time.

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Diagnostic Accuracy of Magnetic Resonance Spectroscopy (MRS) in Diagnosing Malignant Breast Lesions Taking Histopathology as Gold Standard

10.53350/pjmhs211571847 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1847-1849

Author(s):

Adnan Ahmed ◽

Jawad Ali Memon ◽

Muhammad Sibtain Shah ◽

Hafeez ur Rehman ◽

Tahir Baig ◽

...

Keyword(s):

Breast Cancer ◽

Magnetic Resonance ◽

Magnetic Resonance Spectroscopy ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Gold Standard ◽

Resonance Spectroscopy ◽

Breast Lesions ◽

Female Patients ◽

Malignant Breast

Background and Aims: Breast cancer is the prime cause of mortality among women of both developing and developed world. Out of 34.6% of female cancer patients, malignant breast cancer being the most common cancer found in Pakistan. The current study aims to evaluate the diagnostic accuracy of magnetic resonance spectroscopy in diagnosing malignant breast lesions taking histopathology as a gold standard. Materials and Methods: This cross-sectional study was carried out on 135 female patients with suspicious palpable lesions for malignancy referred from surgical OPD of Liaquat University of Medical and Health Sciences, Jamshoro during the period from October 2020 to March 2021. Magnetic resonance spectroscopy (MRS) dynamic enhanced images taken with contrast on 1.5 Tesla MRI machines were assessed based on kinetic and morphology. Malignancy biomarker was assessed with choline peak (Cho) allowed by MRS. The Single-voxel technique was utilized in order to evaluate the diagnostic performance of MRS in breast lesions malignancy. A comparison was made between MRS and biopsy findings. Results: Out of 135 female patients, 118 (87.40%) were malignant lesions patients assessed by MRS while histopathologically proven patients were 104 (77.33%). The calculated mean age of all the malignant patients was 48.3 ± 14.5 years with a range of 40-79 years. The diagnostic parameters of MRS such as specificity, accuracy, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) was 74%, 88.2%, 93%, 77.8%, and 93.1% respectively while taking histopathology as a gold standard. Conclusion: MRS must be utilized as a primary imaging technique for the diagnosis of breast lesions malignancy due to its higher specificity, sensitivity, and accuracy in breast lumps characterization. MRS was found to be specific 74%, sensitive 88.2%, and accurate 93% in malignant breast cancer diagnosis. Keywords: MRS, Malignant breast lesions, Histopathology

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Contrast Enhanced Mammography: The added value in the assessment of Suspicious Breast Lesions

QJM ◽

10.1093/qjmed/hcaa068.001a ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

R Abdullah ◽

L Abdelmonem ◽

N Nasry ◽

M Ayoub

Keyword(s):

Breast Cancer ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Malignant Tumors ◽

High Energy ◽

Added Value ◽

Breast Lesions ◽

Predictive Values ◽

Dense Breasts ◽

Contrast Enhanced

Abstract Background Breast cancer in women is a major public health problem throughout the world, being the second most common cancer worldwide. Sonomammography has been always recommended as the basic breast imaging modality for early detection and diagnosis of breast cancer. Some malignant tumors have been missed, specially in dense breasts, and high false-negative rate have been reported. Contrast enhanced spectral mammography is a new modality, used to depict the tumor vascularity and neoangiogenesis; a classic sign of malignant tumors. Aim of Work The purpose of this study is to determine the added value of dual energy contrast mammography to sono-mammography in the assessment of suspicious breast lesions. Patients and Methods 36 patients were included in the study, referred from outpatient clinics in private settings and from Demerdash Hospitals. Contrast enhanced spectral mammography CESM was performed by using a digital mammography unit (Seno DS; GE, Buc, France) that had been adapted to obtain two images for each view: a low-energy image (below the k edge of iodine, 33.2 keV) and a high-energy image (above the k edge of iodine) at 45 to 49 kVp. Results: CEDM versus sonomammography shows p (0.021) value less than 0.05. Also the area under the ROC curve was higher for MX+CEDM (94.4%) than that was for sonomammography (63.8%) compared to pathology analysis with 100% sensitivity, 88.2 % specificity, 90.48 %PPV and 100 % NPV in diagnosis of suspicious lesions. Conclusion The diagnostic accuracy of CEDM+ MX for the detection of breast carcinoma has proven to be superior to sonomammography alone. CEDM had a better diagnostic accuracy mainly due to improved positive and negative predictive values (Positive predictive value about 90.48, negative predictive value 100). The role of CEDM in detection of multifocal / multicentric carcinomas with particular interest for the assessment of the extent of disease specially in dense breasts is appreciated.

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Histological Assessment of Breast Lesions Identified Exclusively by Magnetic Resonance

The American Surgeon ◽

10.1177/000313481408001007 ◽

2014 ◽

Vol 80 (10) ◽

pp. 944-947

Author(s):

Victoria O'connor ◽

Elizabeth Arena ◽

Joslyn Albright ◽

Nefertiti Brown ◽

Ryan O'connor ◽

...

Keyword(s):

Breast Cancer ◽

Magnetic Resonance ◽

Breast Biopsy ◽

Ductal Carcinoma ◽

Low Grade ◽

Breast Lesions ◽

Significant Family History ◽

Ductal Hyperplasia ◽

Significant Pathology

Radiologic–pathologic correlation of lesions diagnosed by magnetic resonance (MR) is precluded by insufficient data on histological characteristics of lesions suspicious on MR but not visible on concurrent mammogram or ultrasound. The objective of this study was to describe histological features of breast lesions diagnosed exclusively by MR. The participants underwent MR-guided breast biopsy between 2007 and 2012 for a suspicious lesion not identified by mammography or ultrasound. Histology slides were interpreted retrospectively by a breast pathologist. Of 126 patients (126 lesions), 34 (27%) had new breast cancer, 51 (40.5%) previous breast cancer, and 41 (32.5%) dense breasts or a significant family history of breast cancer. MR identified 23 (18.3%) invasive cancers: 20 were Grade 1 and 17 were ductal. Of the 126 lesions, 16 (13%) were ductal carcinoma in situ (DCIS), four were atypical ductal hyperplasia and atypical lobular hyperplasia (3%), and 68 (54%) were benign. Fifteen biopsies (12%) had no significant pathology. Five DCIS lesions were upgraded to T1 invasive cancers. Approximately 30 per cent of suspicious lesions detected exclusively by MR are invasive or in situ cancers that are predominantly low grade. Further studies are needed to determine if malignant lesions can be prospectively distinguished by MR characteristics.

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Evaluation of a novel immunoassay to detect p-tau Thr217 in the CSF to distinguish Alzheimer disease from other dementias

Neurology ◽

10.1212/wnl.0000000000010814 ◽

2020 ◽

Vol 95 (22) ◽

pp. e3026-e3035

Author(s):

Jozef Hanes ◽

Andrej Kovac ◽

Hlin Kvartsberg ◽

Eva Kontsekova ◽

Lubica Fialova ◽

...

Keyword(s):

Alzheimer Disease ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Healthy Controls ◽

Class Iii ◽

Total Tau ◽

Β Amyloid ◽

Healthy Participants

ObjectiveTo investigate whether tau phosphorylated at Thr217 (p-tau T217) assay in CSF can distinguish patients with Alzheimer disease (AD) from patients with other dementias and healthy controls.MethodsWe developed and validated a novel Simoa immunoassay to detect p-tau T217 in CSF. There was a total of 190 participants from 3 cohorts with AD (n = 77) and other neurodegenerative diseases (n = 69) as well as healthy participants (n = 44).ResultsThe p-tau T217 assay (cutoff 242 pg/mL) identified patients with AD with accuracy of 90%, with 78% positive predictive value (PPV), 97% negative predictive value (NPV), 93% sensitivity, and 88% specificity, compared favorably with p-tau T181 ELISA (52 pg/mL), showing 78% accuracy, 58% PPV, 98% NPV, 71% specificity, and 97% sensitivity. The assay distinguished patients with AD from age-matched healthy controls (cutoff 163 pg/mL, 98% sensitivity, 93% specificity), similarly to p-tau T181 ELISA (cutoff 60 pg/mL, 96% sensitivity, 86% specificity). In patients with AD, we found a strong correlation between p-tau T217 and p-tau T181, total tau and β-amyloid 40, but not β-amyloid 42.ConclusionsThis study demonstrates that p-tau T217 displayed better diagnostic accuracy than p-tau T181. The data suggest that the new p-tau T217 assay has potential as an AD diagnostic test in clinical evaluation.Classification of evidenceThis study provides Class III evidence that a CSF immunoassay for p-tau T217 distinguishes patients with AD from patients with other dementias and healthy controls.

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Examination of the predictive value of structural magnetic resonance scans in bipolar disorder: a pattern classification approach

Psychological Medicine ◽

10.1017/s0033291713001013 ◽

2013 ◽

Vol 44 (3) ◽

pp. 519-532 ◽

Cited By ~ 35

Author(s):

V. Rocha-Rego ◽

J. Jogia ◽

A. F. Marquand ◽

J. Mourao-Miranda ◽

A. Simmons ◽

...

Keyword(s):

Bipolar Disorder ◽

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Resonance Imaging ◽

Structural Magnetic Resonance Imaging ◽

Subcortical Structures ◽

Neuroanatomical Data

BackgroundBipolar disorder (BD) is one of the leading causes of disability worldwide. Patients are further disadvantaged by delays in accurate diagnosis ranging between 5 and 10 years. We applied Gaussian process classifiers (GPCs) to structural magnetic resonance imaging (sMRI) data to evaluate the feasibility of using pattern recognition techniques for the diagnostic classification of patients with BD.MethodGPCs were applied to gray (GM) and white matter (WM) sMRI data derived from two independent samples of patients with BD (cohort 1: n = 26; cohort 2: n = 14). Within each cohort patients were matched on age, sex and IQ to an equal number of healthy controls.ResultsThe diagnostic accuracy of the GPC for GM was 73% in cohort 1 and 72% in cohort 2; the sensitivity and specificity of the GM classification were respectively 69% and 77% in cohort 1 and 64% and 99% in cohort 2. The diagnostic accuracy of the GPC for WM was 69% in cohort 1 and 78% in cohort 2; the sensitivity and specificity of the WM classification were both 69% in cohort 1 and 71% and 86% respectively in cohort 2. In both samples, GM and WM clusters discriminating between patients and controls were localized within cortical and subcortical structures implicated in BD.ConclusionsOur results demonstrate the predictive value of neuroanatomical data in discriminating patients with BD from healthy individuals. The overlap between discriminative networks and regions implicated in the pathophysiology of BD supports the biological plausibility of the classifiers.

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ROLE OF ULTRASOUND STRAIN ELASTOGRAPHY FOR THE EVALUATION OF BREAST LESIONS

10.36106/gjra/2105109 ◽

2020 ◽

pp. 4-6

Author(s):

Deoyani S Sarjare ◽

Arti Anand ◽

Soumya Agrawal ◽

Shanas K. P. ◽

Sandhya Yeshwante

Keyword(s):

Predictive Value ◽

Breast Biopsy ◽

Mammographic Screening ◽

P Value ◽

Breast Lesions ◽

Chi Square ◽

Cross Sectional ◽

Strain Elastography ◽

Malignant Breast ◽

Breast Lumps

Introduction: Ultrasound (US) elastography is an emerging technique that can be used during breast US examination. Guidelines recommend mammographic screening and US for diagnosis of breast cancer. The specificity of these techniques is not high enough to prevent unnecessary biopsies. Hence there is need for a more specific technique to overcome this problem. This study aimed to evaluate the value of strain elastography (SE) for breast lesions. Materials and Methods: In this cross sectional observational study over 18 months, 60 women with palpable breast lumps were evaluated with conventional US and SE. Results obtained were correlated with histopathological findings for statistical analysis. Result: A statistically significant correlation was found between SE and histopathological outcome with a p value of 0.03(<0.05). The positive predictive value (PPV) was 76.92% and the negative predictive value (NPV) was 76.47% with Chi square= 8.4. Conclusion: Ultrasound with SE can substantially improve the possibility of differentiating benign from malignant breast lesions thereby limiting recourse to biopsy and considerably reducing the number of benign breast biopsy diagnoses.

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Artificial Intelligence for early Detection of Breast Cancer and Classification of Mammographic Masses

International Journal of Recent Technology and Engineering - 2 ◽

10.35940/ijrte.f9219.038620 ◽

2020 ◽

Vol 8 (6) ◽

pp. 4314-4320

Keyword(s):

Breast Cancer ◽

Artificial Intelligence ◽

Image Processing ◽

Early Stage ◽

Probabilistic Neural Network ◽

Breast Lesions ◽

Test Image ◽

False Positive Detection ◽

Processing Techniques

Every single year thousands of women endure painful and invasive surgery to remove breast lesions. Most of the time the mammographic image analysis leads to false positive detection and the majority of this actions reveal the lesions to be benign. Refining present detection and diagnostic tool is a major priority of our work. MATLAB R2015a is been used to develop the algorithm, which aids in detection of breast cancer in its early stage. The algorithm comprises of image processing and applying artificial intelligence where in the system is trained with a set of images so that when the input or the test image is given, the algorithm performs the image processing techniques and then applies the Probabilistic Neural Network (PNN) technique for detection of cancer. The system performance is also been calculated in order to estimate its reliability.

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ROLE OF ULTRASONOGRAPHIC ELASTOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF BREAST MASSES AND ITS CONTRIBUTION TO CLASSICAL ULTRASONOGRAPHIC EVALUATION

10.36106/ijsr/0733120 ◽

2021 ◽

pp. 48-50

Author(s):

Ashok Kumar Verma ◽

Rashmi Rashmi ◽

Rakesh Kumar Verma ◽

Mahendra Kumar Pandey

Keyword(s):

Breast Cancer ◽

Breast Imaging ◽

Diagnostic Performance ◽

Breast Biopsy ◽

Strain Ratio ◽

Breast Lesions ◽

Breast Masses ◽

Screening Programs ◽

Imaging Department ◽

Malignant Breast

Introduction: India is experiencing an unprecedented rise in the number of breast cancer cases across all sections of society. Breast cancer is now the most common malignancy in women and the second leading cause of cancer- related mortality. Breast cancer is quite easily and effectively treated, provided it is detected in it's early stages. There is a drastic drop in the survival rates when women present with advanced stage of breast cancer, regardless of the setting. Unfortunately, women in resource-poor and developing countries, like India, generally present at a later stage of disease than women elsewhere, partly due to the absence of effective awareness programs and partly due to the lack of proper mass screening programs Aims And Objectives: The diagnostic performance of elastography in differentiating benign from malignant breast lesions. To assess whether elastography has the potential to reduce the need for breast biopsy /FNAC. Cut off value of Strain Ratio for benign versus malignant breast lesions. Further characterize BI-RADS 3 lesions using elastography Materials And Methods: The study was approved by the GSVM MEDICAL COLLEGE AND LLR HOSPITAL Ethics Committee. All patients that presented to the Radiology and Imaging Department of LLR HOSPITAL for diagnostic work up for breast pathology were included in the study. After obtaining a written and signed informed consent from all patients, they were subjected to conventional B-Mode ultrasonography followed by elastography. All diagnostic breast imaging was done with Samsung RS80A ultrasound machine using linear array transducer of frequency 5-12MHz.Observations & Results: The elastography patterns for each lesion were assessed and documented in color scale. Color images were constructed automatically and displayed as a color-overlay on the B-mode image. The color pattern of each lesion was then evaluated on a scale of 1-5 according to the Tsukuba elasticity scoring system. Conclusion: Strain Ratio cutoff of 3.3 is a sensitive parameter to differentiate benign and malignant breast lesions. Elastography is a specic test for differentiating benign and malignant breast lesions. The combined use of elasticity score, strain ratio and B- Mode sonographyincreases the diagnostic performance in distinguishing benign from malignant breast masses.

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Agreement in Breast Lesion Assessment and Final BI-RADS Classification Between Radial and Meander-Like Breast Ultrasound

10.21203/rs.3.rs-56000/v1 ◽

2020 ◽

Author(s):

Pascale Brasier-Lutz ◽

Claudia Jäggi-Wickes ◽

Sabine Schaedelin ◽

Rosemarie Burian ◽

Cora-Ann Schoenenberger ◽

...

Keyword(s):

Breast Lesion ◽

Morphological Characteristics ◽

Lesion Size ◽

Breast Ultrasound ◽

Architectural Distortion ◽

Suitable Alternative ◽

Lesion Location ◽

High Degree ◽

Face Localization

Abstract Background: This study prospectively investigates the agreement between radial (r-US) and meander-like (m-US) breast ultrasound with regard to lesion location, lesion size, morphological characteristics and final BI-RADS classification of individual breast lesions. Methods: Each patient of a consecutive, unselected, mixed collective received a dual ultrasound examination. Results: The agreement between r-US and m-US for lesion location ranged from good (lesion to mammilla distance ICC 0.64; lesion to skin distance ICC 0.72) to substantial (clock-face localization κ 0.70). For lesion size the agreement was good (diameter ICC 0.72; volume ICC 0.69), for lesion margin and architectural distortion it was substantial (κ 0.68 and 0.70, respectively). Most importantly, there was a substantial agreement (κ 0.76) in the final BI-RADS classification between r-US and m-US.Conclusions: Our recent comparison of radial and meander-like breast US revealed that the diagnostic accuracy of the two scanning methods was comparable. In this study, we observe a high degree of agreement between m-US and r-US for the lesion description (location, size, morphology) and final BI-RADS classification. These findings corroborate that r-US is a suitable alternative to m-US in daily clinical practice.Trial registration: NCT02358837. Registered January 2015, retrospectively registeredhttps://clinicaltrials.gov/ct2/results?cond=&term=NCT02358837&cntry=&state=&city=&dist=

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