Acta Radiologica
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Background: The diagnosis of phyllodes tumors of the breast is challenging due to many similarities with common fibroadenomas.
Purpose: To determine the diagnostic accuracy of core needle biopsy in diagnosing phyllodes tumors and to analyze the ultrasonographic (US) features of phyllodes tumors and fibroadenomas.
Material and Methods: From 1999 to 2003, 1010 breast lesions underwent imaging-guided core needle biopsy. Of these, 57 fibroadenomas and 12 phyllodes tumors were removed surgically. The US and needle biopsy results of a total of 64 lesions (52 fibroadenomas and 12 phyllodes tumors) were further analyzed, compared, and correlated with surgical histological results.
Results: The median sonographic sizes of the phyllodes tumors and the fibroadenomas were 3.2 cm and 1.6 cm, respectively. At US, 58% of the phyllodes tumors (7/12) were classified as equivocal or suspicious of malignancy and 42% (5/12) as probably benign, while 54% of the fibroadenomas (28/52) were classified as probably benign and 46% (24/52) as equivocal. The sensitivity, specificity, and positive and negative predictive values of core needle biopsy histology regarding tumor phyllodes were 83%, 92%, 71%, and 96%, respectively.
Conclusion: Imaging-guided core needle biopsy was accurate in differentiating between fibroadenomas and phyllodes tumors. US classification was unreliable due to considerable overlap in the findings. Combined use of US feature analysis and needle biopsy may help to avoid the misinterpretation of phyllodes as fibroadenoma.
Fine-needle aspiration biopsy of the spleen was performed on 101 patients with suggested sarcoidosis; it was the final diagnosis in 79. Adequate specimens were obtained in all cases with a 0.8×80 mm or 0.7×40 mm disposable needle. Fine-needle biopsy specimens of the spleen showed a granulomatous reaction in 19 out of the 79 cases with sarcoidosis (24%). There were three minor biopsy complications that required no treatment.
A spin-echo diffusion-sensitized pulse sequence using high gradients (23 mT/m) is introduced.
In order to minimize motion artefacts, velocity-compensating gradients, ECG-triggering and post-processing with phase correction and raw data averaging using navigator echoes was performed. The in vitro ratio of diffusion coefficients for water and acetone was determined and the water self-diffusion coefficient at different temperatures was evaluated. The pulse sequence was tested in 7 healthy volunteers and in 2 tumour patients with astrocytomas of grades I—II and III—IV. Both single-slice and multi-slice techniques were used.
The incorporation of phase correction clearly improved the quality of both diffusion-encoded images and the calculated diffusion maps. Mean values of the diffusion coefficients in vivo were for CSF 2.66×10−9 m2/s and for white and grey matter 0.69×10−9 m2/s and 0.87×10−9 m2/s, respectively.
Velocity-compensating gradients in combination with a high gradient strength were shown to be useful for in vivo diffusion MR imaging.
Male breast cancer is a rare disease with an incidence between 0.5% and 2.4% of that in women. We report a case of intracystic papillary carcinoma of the breast in a 75-year-old Japanese man. The macroscopic features of the carcinoma could be accurately demonstrated by pneumocystography and ultrasonography preoperatively.
In current clinical trials of treating ovarian cancer patients, how to accurately predict patients’ response to the chemotherapy at an early stage remains an important and unsolved challenge.
To investigate feasibility of applying a new quantitative image analysis method for predicting early response of ovarian cancer patients to chemotherapy in clinical trials.
A dataset of 30 patients was retrospectively selected in this study, among which 12 were responders with 6-month progression-free survival (PFS) and 18 were non-responders. A computer-aided detection scheme was developed to segment tumors depicted on two sets of CT images acquired pre-treatment and 4–6 weeks post treatment. The scheme computed changes of three image features related to the tumor volume, density, and density variance. We analyzed performance of using each image feature and applying a decision tree to predict patients’ 6-month PFS. The prediction accuracy of using quantitative image features was also compared with the clinical record based on the Response Evaluation Criteria in Solid Tumors (RECIST) guideline.
The areas under receiver operating characteristic curve (AUC) were 0.773 ± 0.086, 0.680 ± 0.109, and 0.668 ± 0.101, when using each of three features, respectively. AUC value increased to 0.831 ± 0.078 when combining these features together. The decision-tree classifier achieved a higher predicting accuracy (76.7%) than using RECIST guideline (60.0%).
This study demonstrated the potential of using a quantitative image feature analysis method to improve accuracy of predicting early response of ovarian cancer patients to the chemotherapy in clinical trials.
We aimed to describe the frequency of atelectasis occurring during anaesthesia, to describe the size and pattern of the atelectasis, and to standardise the method of identifying the atelectasis and calculate its area.
Patients (n=109) scheduled for elective abdominal surgery were examined with CT of the thorax during anaesthesia.
In 95 patients (87%) dependent pulmonary densities were seen, interpreted as atelectasis. Two different types of atelectasis were found — Homogeneous (78%) and non-homogeneous (9%). Attenuation values in histograms of the lung and atelectasis were studied using 2 methods of calculating the atelectatic area.
On the basis of the present findings, we defined atelectasis as pulmonary dependent densities with attenuation values of —100 to +100 HU.
Purpose: To evaluate the utility and economic costs of the 11‐G vacuum‐assisted biopsy probe under ultrasound (US) guidance as an alternative to surgical excision in patients with probably benign lesions.
Material and Methods: US‐guided 11‐G vacuum‐assisted biopsy was performed in 102 probably benign breast lesions in 97 women who refused radiological follow‐up. Complete removal of the lesion was intended in all cases. Open biopsy was done if questionable pathologic findings were present. Treatment was indicated if the diagnosis was malignant. Economic costs were estimated taking into consideration monetary expenses generated to the public health system, as well as expenses for the patients receiving percutaneous and open surgical biopsy.
Results: Median patient age was 42 years (range 18–77). Median lesion size was 14.7 mm (range 6–30 mm). Complete removal of the lesion seen at imaging was achieved in 72.5% of cases. Adequate tissue samples for histopathological evaluation were obtained in all cases. Surgical biopsy was recommended in nine cases. One patient diagnosed with mucinous carcinoma underwent immediate surgical treatment. The remaining 87 women with 92 lesions were included in a follow‐up program. Economic cost of the 11‐G vacuum‐assisted percutaneous biopsy was 82% lower than the surgical biopsy (total savings in this series: €136,402.84). Time spent for the patient was 71% less in percutaneous biopsy than in surgery.
Conclusion: Ultrasound‐guided 11‐G directional vacuum‐assisted breast biopsy is an accurate and less expensive procedure that can be used as an alternative to open surgical excision in a selected group of patients.
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