scholarly journals Which Modality Should Be Integrated to Increase the Diagnostic Efficiency of BI-RADS 0, 3, and 4 Lesions? Ultrasonography or Digital Breast Tomosynthesis?

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Zeynep Fatma Arslan ◽  
Aysegul Altunkeser ◽  
Nergis Aksoy ◽  
Muslu Kazım Korez ◽  
Ethem Omeroglu
Keyword(s):  
Diagnostic Accuracy ◽  
False Negative ◽  
Digital Breast Tomosynthesis ◽  
Dense Breast ◽  
Diagnostic Efficiency ◽  
Breast Tomosynthesis ◽  
Breast Parenchyma ◽  
Dense Breasts ◽  
Negative Results ◽  
Significant Difference

Background: Digital mammography (DM) is one of the most common and effective radiological methods for breast cancer screening and detection. A dense fibroglandular breast tissue can lead to false negative results by superimposing on the lesion margins. Therefore, adjunctive imaging methods, such as digital breast tomosynthesis (DBT) and ultrasonography (US), are needed to increase mammographic sensitivity. Objectives: This study aimed to examine the contribution of US and DBT to DM in different patient groups (patients group of BI-RADS 0 and 3-4 lesions, patients with dense breast parenchyma, patients with non-dense breast parenchyma).. Whether US and DBT can upgrade or downgrade the BI-RADS category of uncertain lesions detected on DM was also investigated. Patients and Methods: Forty-six patients, who were classified as BI-RADS categories 0, 3, and 4 in DM, according to DBT and US findings, were included in the study. DM followed by DBT was performed for the patients, and the BI-RADS classification system was applied. Subsequently, the patients were evaluated sonographically, and the BI-RADS system was applied according to the US results. Each BI-RADS category was compared with the histopathological and multimodality follow-up results. The diagnostic performance of all modalities was also examined alone and in combination. Results: The sensitivity and specificity of DM alone was 42% and 87%, respectively. DBT detected the lesions with 92% sensitivity and 68% specificity. The modality with the highest sensitivity for the detection of malignant lesions was US (100%). Besides, the specificity of DBT was significantly high for dense breasts (P < 0.001). There was no significant difference in terms of the diagnostic accuracy of US measurements between dense and non-dense breasts. For indeterminate lesions, the integration of DBT and US to DM increased the diagnostic accuracy. Conclusion: The contribution of DBT is more valuable than US in patients with dense breast parenchyma.

The Diagnostic Performance of Wide-Angle Digital Breast Tomosynthesis in Comparison to Hand-Held 2D Ultrasound in the Evaluation of Probably Benign & Malignant Lesions in Dense Breast Parenchyma

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 33-33
Author(s):  
I. Ewais ◽  
A. Awis ◽  
Y. Fahim ◽  
S. Khodair ◽  
H. Gewefel
Keyword(s):  
Diagnostic Performance ◽  
Digital Breast Tomosynthesis ◽  
Dense Breast ◽  
Architectural Distortion ◽  
Wide Angle ◽  
Benign Lesions ◽  
Breast Tomosynthesis ◽  
Dense Breasts ◽  
Negative Results ◽  
Malignant Lesions

Background: Imaging of dense breast represents a diagnostic challenge for interpreting radiologists. Tomosynthesis and ultrasound are used as additional imaging tools to compensate the lower sensitivity of 2D mammography when examining a dense breast. This study compares the diagnostic performance of 50° wide-angle digital breast tomosynthesis (wide-angle DBT) to hand-held breast ultrasound (HHUS) in the evaluation of probably benign and malignant breast lesions in dense breast. Patients and Methods: A retrospective review of 131 women with dense breasts (ACR C and D) was conducted during a 12-months period (October 2018 -October 2019). Out of the 131 women; 40 cases (30.5%) were reported to have 64 probably benign and malignant lesions (BI-RADS 3, 4 and 5) detected by combined wide-angle DBT and HHUS. Patients with negative results (BI-RADS 1) or typically benign lesions (BI-RADS 2) were excluded from this study. Median age for the included 40 cases=46.8 years (range =30-67). Women above the age of 40 (n=35, 87%) were examined with combined 2D mammogram + wide-angle DBT and ultrasound. Women below 40 (n=5, 13%) were initially examined by ultrasound and obtained complementary wide-angle DBT mammography based on clinical necessity. Separate BI-RADS were given for each modality and independently correlated with histopathological results for BI-RADS 4 and 5, or routine follow up images for BI-RADS 3. Results: Among the 64 lesions; 10 (15.6%) were pathologically proven malignant in 5 cases (two cases were presenting with multi-focal disease), and 54 (84.4%) benign lesions pathologically proven or followed up in 35 patients. Sensitivity was 100% for wide-angle DBT (10/10) and 80% for ultrasound (8/10). Specificity and positive predictive value for ultrasound was 94.4% (51/54) and 72.7% (8/11), respectively. For wide-angle DBT, specificity was 90.7% (49/54) and positive predictive value was 66.7% (10/15). Despite the high sensitivity, in our study, DBT showed equal diagnostic accuracy to that of breast ultrasound (92.2%, 59/64). Both modalities were not similar in depicting malignant lesions; two more lesions were initially identified at wide-angle DBT images presented as <1cm area of architectural distortion (p=0.07). Other two diagnostic cases presented with acute inflammatory symptoms; they showed architectural distortion in DBT, which were false-positives for the later, yet, ultrasound showed mastitis and abscess formation. Ultrasound significantly identified more benign lesions than DBT mammography (p=0.001). Conclusion: Wide-angle DBT and HHUS are indispensable in identifying probably benign and malignant lesions in dense breasts. Our study showed the role of Wide-angle DBT in detecting small (<1 cm) malignant lesions presenting as architectural distortion. However, the radiologists experience with DBT and the significant clinical information added by ultrasound may impact the diagnostic performance. Therefore, supplemental HHUS to wide-angle DBT will increase accuracy and true negative results for a lower benign biopsy rate.

scholarly journals Comparing the diagnostic efficacy of digital breast tomosynthesis with full-field digital mammography using BI-RADS scoring

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Rana M. Naeim ◽  
Rania A. Marouf ◽  
Merhan A. Nasr ◽  
Marwa E. Abd El-Rahman
Keyword(s):  
Breast Cancer ◽  
Diagnostic Accuracy ◽  
Digital Mammography ◽  
Digital Breast Tomosynthesis ◽  
Breast Lesions ◽  
Breast Tomosynthesis ◽  
Full Field ◽  
Dense Breasts ◽  
Full Field Digital Mammography ◽  
Diagnostic Indices

Abstract Background Mammography has been the mainstay for the detection of breast cancer over decades. It has gradually advanced from screen film to full-field digital mammography. Tomosynthesis has evolved as advanced imaging for early diagnosis of breast lesions with a promising role in both diagnostic and screening settings, particularly in dense and treated breasts. Results This study included 90 female patients according to our inclusion criteria. All patients perform full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) and were classified according to breast density and age groups. Breast imaging reporting and data system (BI-RADS) scoring was assigned for each case. This was correlated with the final diagnosis; the diagnostic indices of mammography were a sensitivity of 64.44%, a specificity of 77.78%, a positive predictive value (PPV) 74.63%, a negative predictive value (NPV) of 68.63%, and a diagnostic accuracy of 71.11%. Diagnostic indices of DBT were a sensitivity of 100%, a specificity of 97.77%, PPV 97.78%, NPV 100%, and diagnostic accuracy of 97.7%. In patients with dense breasts American College of Radiology (ACR) (c and d), 61% of cases had changed their BIRADS scoring with the addition of tomosynthesis. Yet, in non-dense breast ACR (a and b), 45% of cases had changed BIRADS scoring with the addition of DBT to FFDM. Conclusion DBT is a promising imaging modality offering better detection and characterization of different breast abnormalities, especially in young females, and those with dense breasts with an increase of sensitivity and specificity than FFDM. This leads to a reduction in the recalled cases, negative biopsies, and assessing the efficacy of therapy as it enables improving detection of breast cancer and different breast lesions not visualized by conventional mammography

The role of serum periostin in the diagnosis of asthma: A meta-analysis

2020 ◽  
Vol 41 (4) ◽  
pp. 240-247
Author(s):  
Lei Yang ◽  
Qingtao Zhao ◽  
Shuyu Wang
Keyword(s):  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
False Negative ◽  
Summary Receiver Operating Characteristic ◽  
True Negative ◽  
Negative Results ◽  
Noninvasive Biomarker ◽  
Sensitivity Specificity ◽  
Serum Periostin

Background: Serum periostin has been proposed as a noninvasive biomarker for asthma diagnosis and management. However, its accuracy for the diagnosis of asthma in different populations is not completely clear. Methods: This meta-analysis aimed to evaluate the diagnostic accuracy of periostin level in the clinical determination of asthma. Several medical literature data bases were searched for relevant studies through December 1, 2019. The numbers of patients with true-positive, false-positive, false-negative, and true-negative results for the periostin level were extracted from each individual study. We assessed the risk of bias by using Quality Assessment of Diagnostic Accuracy Studies 2. We used the meta-analysis to produce summary estimates of accuracy. Results: In total, nine studies with 1757 subjects met the inclusion criteria. The pooled estimates of sensitivity, specificity, and diagnostic odds ratios for the detection of asthma were 0.58 (95% confidence interval [CI], 0.38‐0.76), 0.86 (95% CI, 0.74‐0.93), and 8.28 (95% CI, 3.67‐18.68), respectively. The area under the summary receiver operating characteristic curve was 0.82 (95% CI, 0.79‐0.85). And significant publication bias was found in this meta‐analysis (p = 0.39). Conclusion: Serum periostin may be used for the diagnosis of asthma, with moderate diagnostic accuracy.

scholarly journals The underestimated issue of non-reproducible cardiac troponin I and T results: case series and systematic review of the literature

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Julien Favresse ◽  
Jean-Louis Bayart ◽  
Damien Gruson ◽  
Sergio Bernardini ◽  
Aldo Clerico ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Judgment ◽  
Troponin I ◽  
Troponin T ◽  
Case Reports ◽  
False Negative ◽  
Case Series ◽  
Elevated Alkaline Phosphatase ◽  
Negative Results ◽  
Significant Difference

Abstract Cardiac troponins (cTn) are the preferred biomarkers for the evaluation of myocardial injury and play a key role in the diagnosis of acute myocardial infarction (MI). Pre-analytical or analytical issues and interferences affecting troponin T and I assays are therefore of major concern given the risk of misdiagnosis. False positive troponin results have been related to various interferences including anti-troponin antibodies, heterophilic antibodies, or elevated alkaline phosphatase level. On the other hand, false negative results have been reported in the case of a large biotin intake. These interferences are characterized with erroneous but reproducible troponin results. Of interest, non-reproducible results have also been reported in the literature. In other words, if the sample is reanalyzed a second time, a significant difference in troponin results will be observed. These interferences have been named “fliers” or “outliers”. Compared to the biotin interference that received major attention in the literature, troponin outliers are also able to induce harmful clinical consequences for the patient. Moreover, the prevalence of outliers in recent studies was found to be higher (0.28–0.57%) compared to the biotin interference. The aim of this systematic review is to warn clinicians about these non-reproducible results that may alter their clinical judgment. Four case reports that occurred in the Clinique of Saint-Luc Bouge are presented to attest this point. Moreover, we aimed at identifying the nature of these non-reproducible troponin results, determining their occurrence, and describing the best way for their identification.

Effect of Muscle Activation on the Gravity Stress View in Unstable Weber B Ankle Fractures

2020 ◽  
Vol 41 (11) ◽  
pp. 1342-1346
Author(s):  
Kimberly K. Broughton ◽  
Caroline Williams ◽  
Christopher P. Miller ◽  
Kristen Stupay ◽  
John Y. Kwon
Keyword(s):  
Muscle Activation ◽  
False Negative ◽  
Ankle Fractures ◽  
Published Data ◽  
Neutral Position ◽  
Distal Fibula ◽  
Level Of Evidence ◽  
Negative Results ◽  
False Negative Results ◽  
Significant Difference

Background: In the setting of apparently isolated distal fibula fractures, the gravity stress view (GSV) is a validated method to determine mortise stability. There is currently no published data evaluating whether dynamic muscle activation can reduce an unstable mortise. If patients with instability can overcome gravity, resultant images could yield false-negative results. The goal of this investigation was to determine if patient effort can influence medial clear space (MCS) measurements in proven unstable bimalleolar-equivalent ankle fractures. Methods: Patients presenting with Weber B fibula fractures were assessed for mortise stability using the GSV. If the GSV demonstrated instability based on MCS widening >4 mm, 3 additional views were performed: GSV with an assistant maintaining the ankle in a neutral position; GSV with the patient actively dorsiflexing to neutral; and GSV with the patient actively dorsiflexing and supinating the foot. Twenty-four consecutive patients met inclusion criteria, with a mean age of 48.7 (range, 22-85) years. Fifteen patients (62.5%) were female and 9 (37.5%) were male. The laterality was evenly divided. Results: The mean MCS was 5.8 ± 2.0 6.0 ± 2.6, and 6.2 ± 2.7 mm for the manual assist, active dorsiflexion, and active supination radiograph measurement groups, respectively ( P = .434). Only 5 of 24 subjects had any measurable decrease in their MCS with active supination, with a maximum change of 1.2 mm. The remainder of the patients had an increase in MCS ranging from 0.1 to 4.0 mm. Conclusion: There was no significant difference between measurement states indicating that muscle activation is unlikely to yield a false-negative result on GSV. Mortise instability, secondary to deep deltoid injury in the presence of gravity stress, is unlikely to be actively overcome by dynamic stabilizers, supporting the validity and specificity of the GSV. Level of Evidence: Level III, prospective study.

scholarly journals Can Patient Effort Influence Sensitivity & Specificity of the Gravity Stress View? Assessing the Potential for False Negative Results

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0014
Author(s):  
Kimberly K. Broughton ◽  
Christopher P. Miller ◽  
Caroline Williams ◽  
Kristen L. Stupay ◽  
John Y. Kwon
Keyword(s):  
Muscle Activation ◽  
Stress Test ◽  
False Negative ◽  
Ankle Fractures ◽  
Measurement Tool ◽  
Neutral Position ◽  
Distal Fibula ◽  
Negative Results ◽  
False Negative Results ◽  
Significant Difference

Category: Ankle; Trauma Introduction/Purpose: In the setting of apparently isolated distal fibula fractures, the radiographic gravity stress view (GSV) has been validated as a reliable method to determine mortise stability. Based on previous studies demonstrating that plantarflexion can increase the measured medial clear space (MCS), patients are often asked to actively hold their ankle in a neutral position. However, it has not been studied whether dynamic muscle activation in the form of attempted dorsiflexion and/or supination can reduce and realign an unstable mortise. If these efforts can overcome gravity, resultant images could lead to a false negative result and missed diagnosis of instability. The goal of the present investigation is to determine if active effort by the patient can influence MCS measurements in proven unstable bimalleolar-equivalent ankle fractures. Methods: Eighteen consecutive patients with apparently isolated distal fibula fractures (Weber-B type) identified on initial nonweightbearing radiographs were assessed for mortise stability with a standard, unassisted GSV. If the radiograph demonstrated MCS widening > 4 mm, 3 additional views were performed: GSV with an assistant manually maintaining the ankle in a neutral position; GSV with the patient actively dorsiflexing the ankle to the same neutral position; and GSV with the patient actively dorsiflexing and supinating the foot to the same neutral position. All radiographs were digitally obtained and measured using a DICOM measurement tool. The MCS was measured by the senior author (JYK) who was blinded to the nature of the ankle position. Statistical analysis of the data was then conducted. Results: Of the eighteen patients who met inclusion criteria, the mean age was 48.9 years (range: 22-85, SD=18.9). Twelve patients (66%) were female and six (33%) were male. The laterality was evenly split with nine patients presenting with a right ankle injury and nine left ankles. The data was non-parametric; therefore, a Friedman’s test was utilized for analysis between the different MCS measurements per patient. There was no statistically significant difference in the measured MCS in any of the three tested scenarios, χ2(2)=4.261, p=0.119. Only 5 of 18 subjects had any measurable decrease in their MCS when asked to supinate their foot. Of these 5, the maximum reduction was 1.21mm. The remainder of patients had an increase in MCS ranging from 0.1 to 4.0mm. Conclusion: This investigation supports the notion that the gravity stress test is unlikely to yield false negative results when patients attempt to actively maintain a neutral ankle position during imaging. There was a non-significant inverse trend indicating that dynamic effort may in fact further displace the mortise as indicated by an increased MCS in several study participants, rather than reduce it. Thus, one can conclude that despite voluntary effort, patients with bimalleolar-equivalent ankle fractures are unlikely able to overcome the effect of gravity on the unstable mortise.

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