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Yeow YJ, Yu CC, Cheung YC, Chen SC. A cohort study of mammography-guided vacuum-assisted breast biopsy in patients with compressed thin breasts (≦ 3 cm). Asian J Surg 2023; 46:4296-4301. [PMID: 37150735 DOI: 10.1016/j.asjsur.2023.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVES In the women with compressed thin thickness (≦ 3 cm), mammographic guiding vacuum-assist breast biopsy (MG-VABB) is a technical challenge. We herein report their performance of MG-VABB on suspicious microcalcification by modern mammography. METHODS We retrospectively reviewed the consecutive MG-VABB in our hospital from February 2019 to January 2021. All the patients received biopsy because of suspicious microcalcifications discovered by mammography and had at least one-year post-biopsy follow-up. RESULTS We reviewed 745 consecutive patients revealing 195 with compressed thin breasts ≦ 3 cm (mean age: 50.12 ± 7.0; breast thickness: 24.99 mm range 11.6-30 mm). Of the 191 patients received biopsy, the microcalcification retrieval rate was 97.9%. Using the half-open notch biopsy or horizontal needle approach, the biopsies were technically achieved in 30.4% and 9.4% of patients respectively. Regarding to the gold standard of surgicohistology, the cancer sensitivities was 88.46% and the atypia upgrade rate was 16.67%. There was no statistical difference of the procedure time between stereotactic guided and tomosynthesis guided. CONCLUSIONS The modern MG-VABB has technically improve the performance of biopsy to the patients with compressed thin breasts (≦ 3 cm), revealing approximate results to those breasts > 3 cm. The diagnosis helps the management of suspicious microcalcifications discovered by mammography.
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Affiliation(s)
- Yun-Jen Yeow
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, 5 Fuxing St., Guishan, Taoyuan, Taiwan
| | - Chi-Chang Yu
- Medial college of Chang Gung University, 5 Fuxing Sr., Guishan, Taoyuan, Taiwan; Department of General Surgery, Chang Gung Memorial Hospital, Taiwan
| | - Yun-Chung Cheung
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, 5 Fuxing St., Guishan, Taoyuan, Taiwan; Medial college of Chang Gung University, 5 Fuxing Sr., Guishan, Taoyuan, Taiwan.
| | - Shin-Cheh Chen
- Medial college of Chang Gung University, 5 Fuxing Sr., Guishan, Taoyuan, Taiwan; Department of General Surgery, Chang Gung Memorial Hospital, Taiwan
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Yao MMS, Joe BN, Sickles EA, Lee CS. BI-RADS Category 5 Assessments at Diagnostic Breast Imaging:Outcomes Analysis Based on Lesion Descriptors. Acad Radiol 2019; 26:1048-1052. [PMID: 30195413 DOI: 10.1016/j.acra.2018.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/22/2018] [Accepted: 07/29/2018] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES The Breast Imaging-Reporting and Data System (BI-RADS) atlas defines category 5 assessments as appropriate only for lesions that are almost certainly cancer, with a positive predictive value (PPV) of ≥95%. This study aims to demonstrate the feasibility of classifying lesions at diagnostic breast imaging with sufficiently high PPV to merit category 5 assessments, and to identify those lesion descriptors that yield such a high PPV. MATERIALS AND METHODS For this Health Insurance Portability and Accountability Act compliant and IRB exempt study, we reviewed diagnostic breast imaging examinations (mammography and/or ultrasound) assessed as highly suggestive of malignancy (BI-RADS category 5). Pathology diagnosis was considered the gold standard. PPV3 (biopsy performed) was calculated, and the BI-RADS descriptors for each lesion were analyzed. RESULTS Among 22,564 consecutive diagnostic breast imaging examinations between January 2010 and September 2015, we identified 239 exams (1.1%) assessed as BI-RADS category 5 (mean age 62.5 years). Malignancy (invasive breast carcinoma and/or ductal carcinoma in situ) was diagnosed in 233 examinations (PPV3 97.5% and 95% confidence interval: 96.2%-98.8%). The most common lesion types were mass (170) and calcifications (116). Of the 220 examinations involving both mammography and ultrasound, no category 5 lesions had <3 suspicious BI-RADS descriptors, only three lesions had three suspicious descriptors, but the remaining 217 lesions (98.6%) had ≥4 suspicious descriptors. CONCLUSION In clinical practice, it is feasible to make BI-RADS category 5 assessments with the intended ≥95% PPV. To justify a category 5 assessment, at least four suspicious BI-RADS descriptors should be identified at the combination of diagnostic mammography and ultrasound examinations.
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Koh J, Kim EK, Kim MJ, Yoon JH, Park VY, Moon HJ. Role of elastography for downgrading BI-RADS category 4a breast lesions according to risk factors. Acta Radiol 2019; 60:278-285. [PMID: 29890844 DOI: 10.1177/0284185118780901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Elastography has been introduced as an additional diagnostic tool to ultrasonography (US) which helps clinicians decide whether or not to perform biopsy on US-detected lesions. PURPOSE To evaluate the role of strain elastography in downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4a breast lesions according to personal risk factors for breast cancer in asymptomatic women. MATERIAL AND METHODS Strain elastography features of a total of 255 asymptomatic category 4a lesions were classified as soft and not soft (intermediate and hard). Malignancy was confirmed by surgery or biopsy, and benignity was confirmed by surgery or biopsy with no change on US for at least six months. Malignancy rates of lesions with soft and not soft elastography were calculated according to the presence of risk factors. RESULTS Of 255 lesions, 25 (9.8%) were malignant and 230 (90.2%) were benign. Of 195 lesions in average-risk women, the malignancy rate of lesions with soft elastography was 1.5% (1/68), which was significantly lower than the 14.2% (18/127) of lesions with not soft elastography ( P = 0.004). Of 60 lesions in increased-risk women, the malignancy rate of lesions with soft elastography was 15.0% (3/20), which was not significantly different from the 7.5% (3/40) of lesions with not soft elastography ( P = 0.390). CONCLUSION In average-risk women, category 4a lesions with soft elastography could be followed up with US because of a low malignancy rate of 1.5%.
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Affiliation(s)
- Jieun Koh
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Vivian Youngjean Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea
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Suh-Burgmann EJ, Flanagan T, Lee N, Osinski T, Sweet C, Lynch M, Caponigro M, Mehta J, Alavi M, Herrinton LJ. Large-Scale Implementation of Structured Reporting of Adnexal Masses on Ultrasound. J Am Coll Radiol 2018; 15:755-761. [DOI: 10.1016/j.jacr.2018.01.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/11/2018] [Accepted: 01/23/2018] [Indexed: 10/17/2022]
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Zou X, Wang J, Lan X, Lin Q, Han F, Liu L, Li A. Assessment of Diagnostic Accuracy and Efficiency of Categories 4 and 5 of the Second Edition of the BI-RADS Ultrasound Lexicon in Diagnosing Breast Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2065-71. [PMID: 27262521 DOI: 10.1016/j.ultrasmedbio.2016.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/14/2016] [Accepted: 04/27/2016] [Indexed: 05/14/2023]
Abstract
The purpose of this study was to evaluate the diagnostic accuracy and efficiency of categories 4 and 5 of the second edition of the Breast Imaging Reporting and Data System (BI-RADS) ultrasound (US) lexicon in diagnosing breast lesions. In our retrospective study, 579 lesions in 544 patients were assessed by US as the preliminary diagnosis and classified in subcategories 4a-4c and category 5 based on the second edition of the BI-RADS US lexicon with some obvious changes, such as the redefined margin, new calcification type, associated features and some special cases. Inter-observer agreement was determined. Ultrasound results were compared with the pathologic results for confirmation. Positive predictive values (PPVs) of subcategories 4a-4c were compared with theoretical values using the χ(2) test; the binomial test was used for category 5 lesions. Of the 579 lesions, 212 were confirmed as benign (36.61%), and the remaining 367 lesions were confirmed as borderline/malignant (63.39%). Inter-observer agreement was moderate for subcategories 4a-4c (κ = 0.52), moderate for subcategories 4a-4c and category 5 (κ = 0.56) and substantial for categories 4 and 5 (κ = 0.67). The PPVs for subcategories 4a-4c were 23.74%, 70.67% and 81.25%, respectively. In addition, the total PPV for category 4 was 46.92% (183/390), and the total PPV for category 5 was 97.35% (184/189). Statistical results revealed that the PPVs of subcategories 4a and 4b differed significantly from the theoretical values (p < 0.05); the PPVs of subcategory 4c and category 5 were significantly correlated with the theoretical PPVs (p > 0.05). In conclusion, subcategories 4a and 4b have lower diagnostic efficiency than subcategory 4c and category 5. Inter-observer agreement for subcategories 4a-4c remains to be improved. The most common features of subcategories 4a-4c differ, but overlap. It is recommended that inexperienced doctors in primary hospitals not classify lesions into subcategories in clinical practice.
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Affiliation(s)
- Xuebin Zou
- Department of Ultrasound, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Jianwei Wang
- Department of Ultrasound, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xiaowen Lan
- Department of Radiation Oncology, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Qingguang Lin
- Department of Ultrasound, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Feng Han
- Department of Ultrasound, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Longzhong Liu
- Department of Ultrasound, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Anhua Li
- Department of Ultrasound, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
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Youk JH, Jung I, Yoon JH, Kim SH, Kim YM, Lee EH, Jeong SH, Kim MJ. Comparison of Inter-Observer Variability and Diagnostic Performance of the Fifth Edition of BI-RADS for Breast Ultrasound of Static versus Video Images. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2083-2088. [PMID: 27324292 DOI: 10.1016/j.ultrasmedbio.2016.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 06/06/2023]
Abstract
Our aim was to compare the inter-observer variability and diagnostic performance of the Breast Imaging Reporting and Data System (BI-RADS) lexicon for breast ultrasound of static and video images. Ninety-nine breast masses visible on ultrasound examination from 95 women 19-81 y of age at five institutions were enrolled in this study. They were scheduled to undergo biopsy or surgery or had been stable for at least 2 y of ultrasound follow-up after benign biopsy results or typically benign findings. For each mass, representative long- and short-axis static ultrasound images were acquired; real-time long- and short-axis B-mode video images through the mass area were separately saved as cine clips. Each image was reviewed independently by five radiologists who were asked to classify ultrasound features according to the fifth edition of the BI-RADS lexicon. Inter-observer variability was assessed using kappa (κ) statistics. Diagnostic performance on static and video images was compared using the area under the receiver operating characteristic curve. No significant difference was found in κ values between static and video images for all descriptors, although κ values of video images were higher than those of static images for shape, orientation, margin and calcifications. After receiver operating characteristic curve analysis, the video images (0.83, range: 0.77-0.87) had higher areas under the curve than the static images (0.80, range: 0.75-0.83; p = 0.08). Inter-observer variability and diagnostic performance of video images was similar to that of static images on breast ultrasonography according to the new edition of BI-RADS.
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Affiliation(s)
- Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul, South Korea
| | - Inkyung Jung
- Department of Biostatistics and Medical Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul, South Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - You Me Kim
- Department of Radiology, Dankook University Hospital, College of Medicine, Dankook University, Yongin, South Korea
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Sun Hye Jeong
- Department of Radiology, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, College of Medicine, Yonsei University, Seoul, South Korea.
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Dimitrovska MJ, Mitreska N, Lazareska M, Jovanovska ES, Dodevski A, Stojkoski A. Hook Wire Localization Procedure and Early Detection of Breast Cancer - Our Experience. Open Access Maced J Med Sci 2015; 3:273-7. [PMID: 27275234 PMCID: PMC4877866 DOI: 10.3889/oamjms.2015.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 12/03/2022] Open
Abstract
AIM: The purpose of this study is to describe our experience with needle localization technique in diagnosing small breast cancers. MATERIAL AND METHODS: This retrospective study included a hundred and twenty patients’ with impalpable breast lesions and they underwent wire localization. All patients had mammography, ultrasound exam and pathohystological results. We use Mammomat Inspiration Siemens digital unit for diagnosing mammography, machine - Lorad Affinity with fenestrated compressive pad for wire localization and ultrasound machine Acuson X300 with linear array probe 10 MhZ. We use two types of wire: Bard hook wire and Kopans breast lesion localization needle, Cook. Comparative radiologic and pathologic data were collected and analyzed. RESULTS: In 120 asymptomatic women, 68 malignancies and 52 benign findings were detected with mammography and ultrasound. The mean age for patients with malignancy was 58.6 years. According BI-RADS classification for mammography the distribution is our group was: BI-RADS 3 was presented in 6 (8.82%) patients, BI-RADS 4 was presented in 56 (82.35%) patients and BI-RADS 5 was present in 6 (8.82%) of the patients. Most wire localizations were performed under mammographic guidance in 58 from 68 patients with malignant lesions (85.29%) and with ultrasound in 10 (14.7%). According the mammographic findings patients with mass on mammograms were 29 (42.65%), mass with calcifications 9 (13.23%), calcifications 20 (29.41%) and architectural distortions or asymmetry 10 (14.71%). CONCLUSION: Wire localization is a well established technique for the management of impalpable breast lesions.
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Affiliation(s)
- Maja Jakimovska Dimitrovska
- University Clinic of Radiology, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Nadica Mitreska
- University Clinic of Radiology, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Menka Lazareska
- University Clinic of Radiology, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Elizabeta Stojovska Jovanovska
- University Clinic of Radiology, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Ace Dodevski
- Institute of Anatomy, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Aleksandar Stojkoski
- University Clinic of Radiology, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Delmonico L, Areias VR, Pinto RC, Matos CDS, Rosa MFF, De Azevedo CM, Alves G. Protein identification from dried nipple aspirate fluid on Guthrie cards using mass spectrometry. Mol Med Rep 2015; 12:159-64. [PMID: 25760982 PMCID: PMC4438942 DOI: 10.3892/mmr.2015.3432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 02/11/2015] [Indexed: 12/19/2022] Open
Abstract
Nipple aspirate fluid (NAF) requires investigation as a potential source of biomarkers for early diagnosis or risk assessment in breast cancer and other breast disorders. The present study demonstrated that proteins were easily extracted from dried NAF spots on Guthrie cards and were suitable for mass spectrometry analysis. NAF was obtained from 80 women, collected on Guthrie cards, between 2007 and 2010. The NAF-proteins were extracted from the card by incubating the card in water. These proteins were then quantified and separated using one-dimensional, 12% SDS-PAGE, gel electrophoresis and on high-resolution gradient gels at different concentrations (4–12, 8–16 and 4–20%). The bands with the most abundant proteins were excised from the gradient gels and the proteins were identified by liquid chromatography quadrupole time of flight. Immunoglobulins, Zn-α2-glicoprotein, apoliprotein D and prolactin inducible protein were among those identified. The NAF-Guthrie card collection method has not been applied previously, however, NAF proteins have been identified using other collecting techniques, confirming the feasibility of the NAF Guthrie card collection method for analyzing the proteins within NAF. The NAF-Guthrie card collecting method has multiple advantages, including being inexpensive, non-invasive, reliable and painless, and the cards can be stored at room temperature. Examining NAF may assist in identifying individuals at a higher risk of breast cancer and in improving patient prognosis.
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Affiliation(s)
- Lucas Delmonico
- Applied Genetics Laboratory, Haematology Service, National Cancer Institute, Rio de Janeiro, 20230-130, Brazil
| | - Vivian Rabello Areias
- Applied Genetics Laboratory, Haematology Service, National Cancer Institute, Rio de Janeiro, 20230-130, Brazil
| | - Rodrigo César Pinto
- Applied Genetics Laboratory, Haematology Service, National Cancer Institute, Rio de Janeiro, 20230-130, Brazil
| | - Cintia Da Silva Matos
- Applied Genetics Laboratory, Haematology Service, National Cancer Institute, Rio de Janeiro, 20230-130, Brazil
| | | | | | - Gilda Alves
- Applied Genetics Laboratory, Haematology Service, National Cancer Institute, Rio de Janeiro, 20230-130, Brazil
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Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B, Futterer JJ, Heijmink SW, Hoskin P, Kirkham AP, Padhani AR, Raj Persad CM, van der Meulen J, Villers A, Emberton M. Clinical applications of multiparametric MRI within the prostate cancer diagnostic pathway. Urol Oncol 2013; 31:281-4. [PMID: 23627000 PMCID: PMC4274606 DOI: 10.1016/j.urolonc.2012.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Louise Dickinson
- Division of Surgery and Interventional Sciences, University College London, Gower Street London, UK
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