DOCSLIB.ORG

Diagnostic Accuracy of Shear Wave Elastography for Prediction of Breast Malignancy in Patients with Pathological Nipple Discharge

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Open Access Research BMJ Open: first published as 10.1136/bmjopen-2015-008848 on 22 January 2016. Downloaded from Diagnostic accuracy of shear wave elastography for prediction of breast malignancy in patients with pathological nipple discharge Xiaobo Guo,1 Ying Liu,1 Wanhu Li2 To cite: Guo X, Liu Y, Li W. ABSTRACT Strengths and limitations of this study Diagnostic accuracy of shear Objectives: Pathological nipple discharge (PND) may wave elastography for indicate malignant breast lesions. As the role of shear ▪ prediction of breast Diagnostic accuracy of shear wave elastography wave elastography (SWE) in predicting these malignant malignancy in patients with (SWE) for detecting malignancy of patients with pathological nipple discharge. lesions has not yet been evaluated, we aim to evaluate PND has rarely been studied. BMJ Open 2016;6:e008848. the diagnostic value of SWE for this condition. ▪ For the first time, this study tested diagnostic doi:10.1136/bmjopen-2015- Design: Prospective diagnostic accuracy study accuracy of a synthesised measurement of quali- 008848 comparing a combination of qualitative and quantitative tative and quantitative measures of SWE for measurements of SWE (index test) to a ductoscopy detecting malignancy in patients with PND. ▸ Prepublication history for and microdochectomy for histological diagnosis ▪ Limitations include the fact that the weight of this paper is available online. (reference test). each measurement in the synthesised score was To view these files please Setting: Fuzhou General Hospital of Nanjing military assigned evenly and the surgeon was not visit the journal online command. blinded. (http://dx.doi.org/10.1136/ Participants: A total of 379 patients with PND were bmjopen-2015-008848). finally included from January, 2011 to March 2014, after we screened 1084 possible candidates. All INTRODUCTION Received 21 May 2015 In 2014, the American Cancer Society Revised 13 October 2015 participants were evaluated through SWE, with Accepted 2 November 2015 qualitative parameters generated by Virtual Touch reported 235 030 new cases of breast cancer 1 http://bmjopen.bmj.com/ tissue imaging (VTI) and quantitative parameters and 40 430 breast cancer-related deaths. generated by Virtual Touch tissue quantification (VTQ). The prevalence rate of breast cancer is the All the patients were consented to receive a highest of all types of malignant carcinoma ductoscopy and microdochectomy for histological in Chinese women.2 The cases of Chinese diagnosis, and the results were set as a reference test. women with breast cancer account for 12.2% Outcome measures: Sensitivity and specificity of the of all newly diagnosed breast cancer around combined VTI and VTQ of the SWE for detection of the world and 9.6% of deaths from breast malignancy in patients with PND. cancer.2 Results: The 379 participants presented with 404 on September 26, 2021 by guest. Protected copyright. Pathological nipple discharge (PND) is the lesions. The results of pathological examination third most common symptom of patients, showed that 326 (80.7%) of the 404 lesions were prompting referral to doctors for breast dis- benign and the other 78 (19.3%) were malignant. An 3 area under the curve of elasticity score, VTQm and eases. PND is believed to be an indicator for VTQc, were 0.872, 0.825 and 0.857, respectively, with breast carcinoma, especially when the nipple 3 the corresponding cut-off point as 2.50, 2.860 m/s and discharge is bloody. Mastectomies were 1Department of 3.015 m/s, respectively. After a combination of these unnecessarily carried out without obtaining a Ultrasonography, 476 Clinical measurements, the sensitivity, specificity, and positive histopathological diagnosis before the year Department, Fuzhou General and negative predictive value (PPV and NPV), were 1950. Although mastectomies are not neces- Hospital of Nanjing Military 89.7%, 72.1%, 43.5% and 96.7%, respectively. The sarily needed nowadays, patients with PND Region, Fuzhou, China sensitivity analysis showed 82% of the sensitivity and 2Department of Radiology, would normally be advised to undergo 96.8% of the specificity, in which patients with no further examinations to rule out breast Shandong Cancer Hospital pathological findings in ductoscopy were excluded. and Institute, Jinan, China malignancy. These examinations involve Conclusions: Ultrasonographic elastography is mammography, ultrasonography, ductoscopy sensitive for patients with PND and could be used as a Correspondence to with or without galactography, as well as cyto- Dr Xiaobo Guo; triage test before ductoscopy examination. Studies for [email protected] and further improvement of diagnostic sensitivity are logical tests. Mammography and B-mode Wanhu Li; warranted. ultrasonography (BUS) are used for screen- [email protected] ing patients with high risk of breast Guo X, et al. BMJ Open 2016;6:e008848. doi:10.1136/bmjopen-2015-008848 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2015-008848 on 22 January 2016. Downloaded from carcinoma, but they are not sensitive enough for detect- inclusion criteria: (1) an age over 18 years; (2) with or ing malignancy in patients with PND, since small lesions without palpable breast masses; (3) agreeing to partici- may be occult with these two modalities.4 Ductoscopy pate in this study; (4) providing written consent for and microdochectomy are the gold standard for diagno- further examination, biopsy and use of the study data. sis of malignancy in patients with PND.56In clinical We excluded participants who (1) refused to receive a practice, patients with PND are conventionally advised a ductoscopy and microdochectomy or a biopsy; (2) had ductoscopy, but ductoscopy and microdochectomy are serious damage of internal organs, which could poten- invasive examinations with high cost, so some patients tially bias the results; (3) could not receive local anaes- refuse ductoscopy and turn to other non-invasive tests thesia because of allergy; (4) were taking or had taken instead. Cytological tests can only be used as supportive chemotherapy or radiotherapy for malignant breast evidence.7 Therefore, a triage test is needed before tumours. patients with PND are asked to take a ductoscopy and microdochectomy examination. Ultrasonographic imaging Ultrasonographic elastography works through the Eligible participants were asked to take ultrasonographic assumption that tissue compression produces strain examinations before undergoing ductoscopy and microdo- within the tissue, and that the strain is less in firm tissue chectomy. The ultrasonographic examinations included a than in soft tissue. So the firmness of the tissue to predict BUS and an elastography with acoustic radiation force malignancy can be evaluated through measuring the impulse (ARFI), which were performed with a Siemens tissue strain ratio, which is usually measured as elasticity.8 ACUSON S2000 ultrasonographic system (Siemens Ltd, Recently, several studies indicated that ultrasonographic China, product standard: YZB/USA 3876–2010). One elastography may be a useful tool for differentiating operator (with 10 years of experience in ultrasonography benign and malignant masses. The sensitivity of predict- imaging) ran the BUS and the ARFI to get the BUS and ing malignancy in patients with breast lesions ranges elastography images, using a superficial probe (9L4, from 80% to 98%, while the specificity ranges from 66% Siemens Ltd, China) with a frequency of 4–9Hz. – to 84%.9 14 Recently, a shear wave elastography (SWE) The BUS images of the breast lesions were obtained was reported to be less operator-dependent, and predict- and categorised according to the Breast Imaging ive of ductal or intraductal carcinoma.81516A five-level Reporting and Data System (BI-RADS). In the BI-RADS, elasticity score is normally used for qualitative assessment the number 1 refers to negative findings; number 2 of the images of elastography, while a quantitative meas- refers to benign findings; number 3 refers to probably urement of elastography is also becoming popular; a benign findings; number 4 refers to suspicious malig- combination of these ultrasonic measurements seems to nancy; and number 5 is highly suggestive of malignancy. be beneficial for improving diagnostic accuracy of breast Moreover, we applied a subclassification scheme for malignancies.816We noticed that the diagnostic value of BI-RADS 4: (1) 4A: low suspicious for malignancy; (2) http://bmjopen.bmj.com/ SWE to detect malignancy in patients with PND has 4B: intermediate suspicious for malignancy; (3) 4C: rarely been studied, especially with a combination of moderate concern, but not classic for malignancy.18 Two qualitative and quantitative measurements of SWE. So we radiologists (XBG and YL, who each have at least 5 years conducted a study aiming to find out the sensitivity and of experience in ultrasonography) independently specificity accuracy of SWE for predicting malignancy in assessed the BUS images for the following aspects: the patients with PND. shape of the mass, its depth, orientation and margin, boundary of the lesions, echo pattern, posterior acoustic features as well as surrounding tissue changes. All the on September 26, 2021 by guest. Protected copyright. METHODS AND MATERIALS detected masses were divided into two types (solid and This study is designed for evaluating the diagnostic cystic) according to the presence of a cystic portion. In accuracy of SWE for detection of malignancy in patients cases involving a solid mass in a dilated duct (intraduc-
Recommended publications
  • Reimbursement Information for Diagnostic Elastography1

    Reimbursement Information for Diagnostic Elastography1

    Reimbursement Information for Diagnostic Elastography1 August 2017 gehealthcare.com/reimbursement This Advisory addresses Medicare coding and payment information for diagnostic ultrasound and associated tissue elastography measurements for hospital outpatient and physician office sites of service. Although information in the Advisory reflects Medicare policies, it may also be applicable to certain private payer reimbursement policies within the United States.2, 3 Current Procedural Terminology (CPT) ACR Coding Guidance American College of Radiology (ACR) has provided coding Coding, Definitions and Medicare guidance for the two elastography CPT codes 91200 and Payment Rates 0346T in their 2017 Ultrasound Coding Users Guide.4 The recommendations for reporting procedures are as follows: Overview • CPT code 91200 should be reported for mechanically induced Tissue stiffness is often related to suspicious abnormalities or shear wave technique without imaging for liver studies. Per underlying disease. Using sensitive measurement techniques the 2017 update, code 91200 can be used for all forms of such as elastography, tissue stiffness can be accurately quantified shear wave liver elastography, including both those using and stiffness changes assessed over time to better inform mechanical (transient elastography – Fibroscan®) or acoustic physician diagnoses. (ARFI) techniques to generate the shear waves. The shear wave The American Medical Association (AMA) has created two CPT speed can be reported in meters/second (m/s) or converted codes to describe
  • Evicore Breast Imaging Guidelines

    Evicore Breast Imaging Guidelines

    CLINICAL GUIDELINES Breast Imaging Guidelines Version 2.0 Effective September 1, 2021 eviCore healthcare Clinical Decision Support Tool Diagnostic Strategies: This tool addresses common symptoms and symptom complexes. Imaging requests for individuals with atypical symptoms or clinical presentations that are not specifically addressed will require physician review. Consultation with the referring physician, specialist and/or individual’s Primary Care Physician (PCP) may provide additional insight. CPT® (Current Procedural Terminology) is a registered trademark of the American Medical Association (AMA). CPT® five digit codes, nomenclature and other data are copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in the CPT® book. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for the data contained herein or not contained herein. © 2021 eviCore healthcare. All rights reserved. Breast Imaging Guidelines V2.0 Breast Imaging Guidelines Abbreviations for Breast Guidelines 3 BR-Preface1: General Considerations 5 BR-1: Breast Ultrasound 8 BR-2: MRI Breast 10 BR-3: Breast Reconstruction 12 BR-4: MRI Breast is NOT Indicated 13 BR-5: MRI Breast Indications 14 BR-6: Nipple Discharge/Galactorrhea 18 BR-7: Breast Pain (Mastodynia) 19 BR-8: Alternative Breast Imaging Approaches 20 BR-9: Suspected Breast Cancer in Males 22 BR-10: Breast Evaluation in Pregnant or Lactating Females 23 ______________________________________________________________________________________________________
  • Biopsy Needles and Drainage Catheters

    Biopsy Needles and Drainage Catheters

    Needles & Accessories | Catheters & Accessories Dilation & Accessories Spinal & Accessories | Implantable & Accessories Product Catalog ISO 13485 & ISO 9001 Certified Company Rev. 01 - 2019/03 About ADRIA Srl. Adria is a worldwide leader in developing, manufacturing and marketing healthcare products. The main focus is on Radiology, Oncology, Urology, Gynecology and Surgery . Adria' s corporate headquarter is based in Italy, it is ISO Certified and products are CE . marked. Adria was incorporated more than 20 years ago in Bologna , where the corporate headquarter and production plant is located. Adria is leader in developing and manufacturing healthcare products and keeps the status to be one of the first companies aimed to develop single patient use biopsy needles and drainage catheters. Over the time, thanks to the experience of specialized doctors and engineers , Adria product range and quality have been progressively enhanced, involving and developing the spine treatment line. Nowadays Adria has a worldwide presence . Reference markets are France, Spain, Turkey and products are distributed in more than 50 countries, through a large and qualified network of dealers. Since far off the very beginning, many things have changed, but Adria' s philosophy and purpose have always remained unchanged: helping healthcare providers to fulfill their mission of caring for patients. Table of Contents Needles & Accessories …………………………………………….....…...3 Catheters & Accessories ……………………….………………..…...…...18 Dilation & Accessories ……………………………………………...…...25 Spinal & Accessories ……………………………………………...…...30 Implantables & Accessories……………………………………………...…...35 Needles & Accessories HYSTO SYSTEM Automatic Biopsy Instrument……………………….……….…….. 4 HYSTO SYSTEM II Automatic Biopsy Instrument…………………….……….……...5 SAMPLE MASTER Semi-Automatic Biopsy Instrument…………………………….. 6 HYSTO-ONE Automatic Reusable Biopsy Instrument & MDA Biopsy Needle ....... 7 HYSTO-TWO Automatic Reusable Biopsy Instrument & MDS Biopsy Needle…...
  • Evaluation of Nipple Discharge

    Evaluation of Nipple Discharge

    New 2016 American College of Radiology ACR Appropriateness Criteria® Evaluation of Nipple Discharge Variant 1: Physiologic nipple discharge. Female of any age. Initial imaging examination. Radiologic Procedure Rating Comments RRL* Mammography diagnostic 1 See references [2,4-7]. ☢☢ Digital breast tomosynthesis diagnostic 1 See references [2,4-7]. ☢☢ US breast 1 See references [2,4-7]. O MRI breast without and with IV contrast 1 See references [2,4-7]. O MRI breast without IV contrast 1 See references [2,4-7]. O FDG-PEM 1 See references [2,4-7]. ☢☢☢☢ Sestamibi MBI 1 See references [2,4-7]. ☢☢☢ Ductography 1 See references [2,4-7]. ☢☢ Image-guided core biopsy breast 1 See references [2,4-7]. Varies Image-guided fine needle aspiration breast 1 Varies *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level Variant 2: Pathologic nipple discharge. Male or female 40 years of age or older. Initial imaging examination. Radiologic Procedure Rating Comments RRL* See references [3,6,8,10,13,14,16,25- Mammography diagnostic 9 29,32,34,42-44,71-73]. ☢☢ See references [3,6,8,10,13,14,16,25- Digital breast tomosynthesis diagnostic 9 29,32,34,42-44,71-73]. ☢☢ US is usually complementary to mammography. It can be an alternative to mammography if the patient had a recent US breast 9 mammogram or is pregnant. See O references [3,5,10,12,13,16,25,30,31,45- 49]. MRI breast without and with IV contrast 1 See references [3,8,23,24,35,46,51-55].
  • Advanced Ultrasound Technologies for Diagnosis and Therapy

    Advanced Ultrasound Technologies for Diagnosis and Therapy

    Journal of Nuclear Medicine, published on March 1, 2018 as doi:10.2967/jnumed.117.200030 1 Advanced Ultrasound Technologies for Diagnosis and Therapy Anne Rix1, Wiltrud Lederle1, Benjamin Theek1, Twan Lammers1,2, Chrit Moonen3, Georg Schmitz4, Fabian Kiessling1* 1Institute for Experimental Molecular Imaging, RWTH-Aachen University, Aachen, Germany 2Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands 3Imaging Division, University Medical Center Utrecht, Utrecht, The Netherland 4Department of Medical Engineering, Ruhr-University Bochum, Bochum, Germany * Corresponding author: Fabian Kiessling MD, Institute for Experimental Molecular Imaging, University Aachen (RWTH), Forckenbeckstrasse 55, 52074 Aachen, Germany. Phone:+49-241- 8080116; fax:+49-241-8082442; e-mail: [email protected] First author: Anne Rix B.Sc., Institute for Experimental Molecular Imaging, University Aachen (RWTH), Forckenbeckstrasse 55, 52074 Aachen, Germany. Phone:+49-241-8080839; fax:+49- 241-8082442; e-mail: [email protected] Running title Advanced Ultrasound Imaging and Therapy 1 2 ABSTRACT Ultrasound is among the most rapidly advancing imaging techniques. Functional methods such as elastography have been clinically introduced, and tissue characterization is improved by contrast- enhanced scans. Here, novel super-resolution techniques provide unique morphological and functional insights into tissue vascularisation. Functional analyses are complemented with molecular ultrasound imaging, to visualize markers of inflammation and angiogenesis. The full potential of diagnostic ultrasound may become apparent by integrating these multiple imaging features in radiomics approaches. Emerging interest in ultrasound also results from its therapeutic potential. Various applications on tumor ablation with high intensity focused ultrasound (HIFU) are clinically evaluated and its performance strongly benefits from the integration into Magnetic Resonance Imaging (MRI).
  • Ultrasound Elastography: Principles and Techniques

    Ultrasound Elastography: Principles and Techniques

    Diagnostic and Interventional Imaging (2013) 94, 487—495 . CONTINUING EDUCATION PROGRAM: FOCUS Ultrasound elastography: Principles and techniques ∗ J.-L. Gennisson , T. Deffieux, M. Fink, M. Tanter Institut Langevin, ondes et images [Waves and Images], ESPCI ParisTech, CNRS UMR 7587, Inserm ERL U979, université Paris VII, 1, rue Jussieu, 75238 Paris cedex 05, France KEYWORDS Abstract Ultrasonography has been widely used for diagnosis since it was first introduced Ultrasound in clinical practice in the 1970’s. Since then, new ultrasound modalities have been developed, elastography; such as Doppler imaging, which provides new information for diagnosis. Elastography was devel- Quasi-static method; oped in the 1990’s to map tissue stiffness, and reproduces/replaces the palpation performed Dynamic method; by clinicians. In this paper, we introduce the principles of elastography and give a technical Impulse summary for the main elastography techniques: from quasi-static methods that require a static elastography; compression of the tissue to dynamic methods that uses the propagation of mechanical waves Shear wave in the body. Several dynamic methods are discussed: vibro-acoustography, Acoustic Radiation elastography Force Impulsion (ARFI), transient elastography, shear wave imaging, etc. This paper aims to help the reader at understanding the differences between the different methods of this promising imaging modality that may become a significant tool in medical imaging. © 2013 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved. Ultrasonography is a widely used medical imaging technique with many clinical appli- cations. Used in clinical practice for more than 40 years, it is highly regarded for its ease of use, real-time capability, portability and low cost.
  • Ultrasound Elastography in Musculoskeletal Radiology: Past, Present, and Future

    Ultrasound Elastography in Musculoskeletal Radiology: Past, Present, and Future

    156 Ultrasound Elastography in Musculoskeletal Radiology: Past, Present, and Future Žiga Snoj, MD, PhD1,2 C. H. Wu, MD3 M.S. Taljanovic, MD4 I. Dumić-Čule, MD5 E. E. Drakonaki, MD6 Andrea S. Klauser, MD7 1 Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Address for correspondence Žiga Snoj, MD, PhD, Radiology Institute, Slovenia University Medical Centre Ljubljana, Ljubljana, Slovenia 2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia (e-mail: [email protected]). 3 Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital College of Medicine, National Taiwan University, Taipei, Taiwan 4 Department of Medical Imaging, University of Arizona, Business, SimonMed Imaging, Scottsdale, Arizona 5 Department of Diagnostic and Interventional Radiology, University Hospital, Zagreb, Croatia 6 Medical School of the European University, Cyprus 7 Department of Radiology, Division of Rheumatology and Sports Imaging, Medical University Innsbruck, Innsbruck, Austria Semin Musculoskelet Radiol 2020;24:156–166. Abstract Ultrasound elastography (USE) is becoming an important adjunct tool in the evaluation of various musculoskeletal (MSK) traumatic conditions and diseases, with an increasing number of applications and publications in recent years. This rapidly evolving technique enhances the conventional ultrasound (US) examination by providing information on the elastic properties of tissue alongside the morphological and Keywords vascular information obtained from B-mode US and Doppler imaging. Those perform- ► ultrasound ing USE must have basic knowledge of its proper imaging techniques and limitations. In ► elastography this review article, we place the USE in historical perspective and discuss basic ► musculoskeletal techniques and current applications of USE in the evaluation of various traumatic ► quantitative imaging and pathologic conditions of fasciae, nerves, muscles, tendons, ligaments, and MSK ► shear deformation soft tissue masses.
  • Ultrasound, Elastography and MRI Mammography

    Ultrasound, Elastography and MRI Mammography

    EAS Journal of Radiology and Imaging Technology Abbreviated Key Title: EAS J Radiol Imaging Technol ISSN 2663-1008 (Print) & ISSN: 2663-7340 (Online) Published By East African Scholars Publisher, Kenya Volume-1 | Issue-2 | Mar-Apr-2019 | Research Article Ultrasound, Elastography and MRI Mammography Correlation in Breast Pathologies (A Study of 50 Cases) Dr Hiral Parekh.1, Dr Lata Kumari.2, Dr Dharmesh Vasavada.3 1Professor, Department of Radiodiagnosis M P Shah Government Medical College Jamnagar, Gujarat, India 2Resident Doctor in Radiodiagnosis Department of Radiodiagnosis M P Shah Government Medical College Jamnagar, Gujarat, India 3Professor, Department of Surgery M P Shah Government Medical College Jamnagar, Gujarat, India *Corresponding Author Dr Dharmesh Vasavada Abstract: Introduction: The purpose of this study is to investigate the value of MRI in comparison to US and mammography in diagnosis of breast lesions. MRI is ideal for breast imaging due to its ability to depict excellent soft tissue contrast. Methods: This study of 50 cases was conducted in the department of Radiodiagnosis, Guru Gobinsingh Government Hospital, M P Shah Government Medical College, Jamnagar, Gujarat, India. All 50 cases having or suspected to have breast lesions were chosen at random among the indoor and outdoor patients referred to the Department of Radiodiagnosis for imaging. Discussion: In the present study the results of sonoelastography were compared with MRI. The malignant masses were the commonest and the mean age of patients with malignant masses in our study was 45 years, which is in consistent with Park‟s statement that the mean age of breast cancer occurrence is about 42 years in India3.
  • Mr Elastography Update

    Mr Elastography Update

    MR ELASTOGRAPHY UPDATE Jonathan R. Dillman, MD, MSc Associate Professor Associate Chair, Research Medical Director, Imaging Research Center @CincyKidsRad facebook.com/CincyKidsRad Disclosures • Investigator-initiated research support from: – Siemens US, Toshiba US • In-kind research support from: – Perspectum Diagnostics • Travel support from: – Philips Healthcare – GE Healthcare Learning Objectives 1. Review MR elastography (MRE) and how it works 2. Review the evidence for MRE in the pediatric population – Diagnostic performance – Failure rate – Accelerated imaging Pediatric Chronic Liver Diseases & Fibrosis • Many causes – Hepatitis (infection, autoimmune) – Biliary obstruction (BA, PSC, CF) – Iron, copper deposition – Steatosis/NASH – Metabolic/genetic defects (α-1 antitrypsin) • Chronic injury (inflammation/necrosis) myofibroblast activation fibrogenesis (scarring) Liver Fibrosis & Biopsy • “Gold” standard for fibrosis detection/measurement – Invasive, high cost, sampling error • Staged semi-quantitatively (e.g., Metavir, Ishak, NASH CRN) – Imperfect inter-pathologist agreement Asselah, et al. Gut 2009; 58:846-858 Unmet Need • Noninvasive, rapid, well-tolerated method for accurately 1) detecting, 2) measuring, and 3) following liver fibrosis Elasticity Imaging • Analogous to palpation • Unique form of image contrast at US & MRI • Indirectly detects/measures liver fibrosis Shear Wave Elastography • Based on measurement of shear wave speed propagation through tissue • SWS is related to Young’s modulus, E (kPa) – Defines relationship
  • Ijcem0007780.Pdf

    Ijcem0007780.Pdf

    Int J Clin Exp Med 2015;8(6):8506-8515 www.ijcem.com /ISSN:1940-5901/IJCEM0007780 Original Article Ultrasound elastography and magnetic resonance examinations are effective for the accurate diagnosis of mammary duct ectasia Feixue Zhang1, Dexin Yu2, Mingming Guo3, Qing Wang2, Zhigang Yu3, Fei Zhou3, Meng Zhao2, Feng Xue2, Guangrui Shao4 1Department of Radiology, Division of Ultrasound, The Second Hospital of Shandong University, Jinan City, Shan- dong Province, P.R. China; 2Department of Radiology, Qilu Hospital, Shandong University, Jinan City, Shandong Province, P.R. China; 3Department of Breast Surgery, The Second Hospital of Shandong University, Jinan City, Shandong Province, P.R. China; 4Department of Radiology, The Second Hospital of Shandong University, Jinan City, Shandong Province, P.R. China Received March 10, 2015; Accepted May 28, 2015; Epub June 15, 2015; Published June 30, 2015 Abstract: Objectives: This study is to investigate the values of multiple quantitative evaluation parameters in the diagnosis of mammary duct ectasia (MDE), using real-time ultrasound elastography (UE) and magnetic resonance imaging (MRI). Methods: This retrospective study was performed on 15 patients (16 lesions) with MDE. Ultrasound examination was performed with the LOGIQ E9 ultrasound instrument, with all lesions being examined by routine ultrasound and UE. MRI examination was performed with a Signa HD × 3.0T TWINSP MR System, including of plain- scan, diffusion-weighted imaging, dynamic contrast-enhanced MRI, and proton magnetic resonance spectroscopy. Imaging features, as well as semi-quantitative and quantitative parameters, were analyzed to determine their diag- nostic value for MDE. Results: According to the five-point scale in UE, twelve lesions belonged to 1-3 point scale, and four lesions were in 4-5 point scale, with an average of 2.93 ± 0.77.
  • Journal of Surgery Leong A, Et Al

    Journal of Surgery Leong A, Et Al

    Journal of Surgery Leong A, et al. J Surg: JSUR-1154. Research Article DOI: 10.29011/2575-9760. 001154 Variations in Abnormal Nipple Discharge Management in Women- a Systematic Review and Meta-analysis Alison Leong, Alison Johnston, Michael Sugrue* Department of Breast Surgery, Breast Centre North West, Donegal Clinical Research Academy, Letterkenny University Hospital, Done- gal, Ireland *Corresponding author: Michael Sugrue, Department of Breast Surgery, Breast Centre North West, Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland. Tel: +353749188823; Fax: +353749188816; Email: michael.sugrue@ hse.ie Citation: Leong A, Johnston A, Sugrue M (2018) Variations in Abnormal Nipple Discharge Management in Women- a Systematic Review and Meta-analysis. J Surg: JSUR-1154. DOI: 10.29011/2575-9760. 001154 Received Date: 13 July, 2018; Accepted Date: 19 July, 2018; Published Date: 26 July, 2018 Abstract Nipple discharge accounts for 5% of referrals to breast units; breast cancer in image negative nipple discharge patients varies from 0 to 21%. This systematic review and meta-analysis determined variability in breast cancer rates in nipple discharge patients, diagnostic accuracy of modalities and surgery rates. An ethically approved meta-analysis was conducted using data- bases PubMed, EMBASE, and Cochrane Library from January 2000 to July 2015. For the breast cancer rates’ review, studies were excluded if no clinical follow-up data was available. For the diagnostic accuracy meta-analysis, studies were excluded if there was no reference standard, or the number of true and false positives and negatives were not known. Pooled sensitivities were determined using Mantel-Haenszel method. For the surgery rates’ review, only studies with consecutive nipple discharge patients were included.
  • Stiffness of the Surrounding Tissue of Breast Lesions Evaluated by Ultrasound Elastography

    Stiffness of the Surrounding Tissue of Breast Lesions Evaluated by Ultrasound Elastography

    Eur Radiol DOI 10.1007/s00330-014-3152-7 BREAST Stiffness of the surrounding tissue of breast lesions evaluated by ultrasound elastography JianQiao Zhou & WeiWei Zhan & YiJie Dong & ZhiFang Yang & Chun Zhou Received: 27 October 2013 /Revised: 24 January 2014 /Accepted: 12 March 2014 # European Society of Radiology 2014 Abstract Keywords Ultrasound . Elastography . Stiffness . Strain Objective To evaluate the stiffness of the surrounding tissue ratio . Breast of breast lesions using the strain ratio assessment method by ultrasound (US) elastography. Methods This was an institutional ethics committee approved Introduction prospective study. A total of 127 breast lesions in 118 women (mean age 48.23±14.32, range 20–90) were examined with Breast cancer is the most common cancer in both the devel- conventional and elastographic US. The strain ratio assess- oping and developed world, and is the leading cause of death ment method was utilized to semi-quantitatively evaluate the among women globally [1]. Mammography, magnetic reso- stiffness of the breast lesions and the surrounding tissue. nance imaging and ultrasound (US) are the main imaging Results Fifty-five lesions were malignant and 72 were benign. diagnostic methods employed for characterization of breast The strain ratio of the surrounding tissue was significantly lesions and determination of their risk for malignancy [2–5]. higher in malignant cases (1.49±0.67) than in benign ones The advantage of US is that it can distinguish cystic from solid (1.17±0.44) (P=0.001), and yielded an Az value of 0.669 in lesions with a high degree of certainty. However, the inade- the diagnosis of breast lesions.