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Billy J, Bensamoun SF, Mercier J, Durand S. Applications of ultrasound elastography to hand and upper limb disorders. HAND SURGERY & REHABILITATION 2024; 43:101636. [PMID: 38215880 DOI: 10.1016/j.hansur.2024.101636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/14/2024]
Abstract
Ultrasound elastography is a recently developed method for accurate measurement of soft tissue stiffness in addition to the clinician's subjective evaluation. The present review briefly describes the ultrasound elastography techniques and outlines clinical applications for tendon, muscle, nerve, skin and other soft tissues of the hand and upper limb. Strain elastography provides a qualitative evaluation of the stiffness, and shear-wave elastography generates quantitative elastograms superimposed on a B-mode image. The stiffness in degenerative tendinopathy and/or tendon injury was significantly lower than in a normal tendon in several studies. Elastography is also a reliable method to evaluate functional muscle activity, compared to conventional surface electromyography. The median nerve is consistently stiffer in patients with carpal tunnel syndrome than in healthy subjects, on whatever ultrasound elastography technique. Elastography distinguishes normal skin from scars and can be used to evaluate scar severity and treatment. Elastography has huge clinical applications in musculoskeletal tissues. Continued development of systems and increased training of clinicians will expand our knowledge of elastography and its clinical applications in the future.
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Affiliation(s)
- Jessica Billy
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sabine F Bensamoun
- Sorbonne University, Université de Technologie de Compiègne, CNRS UMR 7338, Biomechanics and Bioengineering, Compiègne, France
| | - Julie Mercier
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sébastien Durand
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland.
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Bazzocchi A, Guglielmi G, Aparisi Gómez MP. Sarcoma Imaging Surveillance. Magn Reson Imaging Clin N Am 2023; 31:193-214. [PMID: 37019546 DOI: 10.1016/j.mric.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Soft tissue sarcomas (STS) are a heterogeneous group of solid tumors. There are many histologic subtypes. The prognosis after treatment may be estimated by the analysis of the type of tumor, grade, depth, size at diagnosis, and age of the patient. These type of sarcomas most commonly metastasize to the lungs and may have a relatively high rate of local recurrence, depending on the histologic type and surgical margins. Patients with recurrence have a poorer prognosis. The surveillance of patients with STS is therefore extremely important. This review analyzes the role of MR imaging and US in detecting local recurrence.
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Affiliation(s)
- Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy.
| | - Giuseppe Guglielmi
- Department of Radiology, Hospital San Giovanni Rotondo, Italy; Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Radiology, IMSKE, Calle Suiza, 11, Valencia 46024, Spain
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Hu Y, Li A, Wu MJ, Ma Q, Mao CL, Peng XJ, Ye XH, Liu BJ, Xu HX. Added value of contrast-enhanced ultrasound to conventional ultrasound for characterization of indeterminate soft-tissue tumors. Br J Radiol 2023; 96:20220404. [PMID: 36400064 PMCID: PMC10997008 DOI: 10.1259/bjr.20220404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/05/2022] [Accepted: 11/10/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To assess the added value of contrast-enhanced ultrasound (CEUS) to conventional ultrasound in differentiating benign soft-tissue tumors from malignant ones. METHODS 197 soft-tissue tumors underwent ultrasound examination with confirmed histopathology were retrospectively evaluated. The radiologists classified all the tumors as benign, malignant, or indeterminate according to ultrasound features. The indeterminate tumors underwent CEUS were reviewed afterwards for malignancy identification by using individual and combined CEUS features. RESULTS Ultrasound analysis classified 62 soft-tissue tumors as benign, 111 tumors as indeterminate and 24 tumors as malignant. There 104 indeterminate tumors were subject to CEUS. Three CEUS features including enlargement of enhancement area, infiltrative enhancement boundary, and intratumoral arrival time difference were significantly associated with the tumor nature in both univariable and multivariable analysis for the indeterminate tumors (all p < 0.05). When at least one out of the three discriminant CEUS features were present, the best sensitivity of 100% for malignancy identification was obtained with the specificity of 66.7% and the AUC of 0.833. When at least two of the three discriminant CEUS features were present, the best area under the receiver operating characteristic curve (AUC) of 0.924 for malignancy identification was obtained. The combination of at least two discriminant CEUS features showed much better diagnostic performance than the optimal combination of ultrasound features in terms of AUC (0.924 vs 0.608, p < 0.0001), sensitivity (94.0% vs 42.0%, p < 0.0001), and specificity (90.7% vs 79.6%, p = 0.210) for the indeterminate tumors. CONCLUSION The combination CEUS features of enlargement of enhancement area, infiltrative enhancement boundary and intratumoral arrival time difference are valuable to improve the discriminating performance for indeterminate soft-tissue tumors on conventional ultrasound. ADVANCES IN KNOWLEDGE The combination of peritumoral and arrival-time CEUS features can improve the discriminating performance for indeterminate soft-tissue tumors on conventional ultrasound.
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Affiliation(s)
- Yu Hu
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Ao Li
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Meng-Jie Wu
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Qian Ma
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Cui-Lian Mao
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Xiao-Jing Peng
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Xin-Hua Ye
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
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Bodard S, Lassalle L, Larousserie F, Guinebert S, Hacquart T, Campagna R, Biau D, Regnard N, Feydy A. Performance of Sonoelastography for predicting malignancy in soft tissue. BMC Cancer 2022; 22:1305. [PMID: 36513982 DOI: 10.1186/s12885-022-10300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/09/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Separating benign from malignant soft-tissue masses often requires a biopsy. The objective of this study was to assess whether shear-wave elastography (SWE) helped to separate benign from malignant soft-tissue masses. METHODS In 2015-2016, we prospectively included patients with soft-tissue masses deemed by our multidisciplinary sarcoma board to require a diagnostic biopsy. All patients underwent ultrasonography (US) followed by SWE to measure elasticity. We compared benign and malignant tumors, overall and after separating tumors with vs. without a fatty component. The biopsy findings, and surgical-specimen histology when available, served as the reference standard. RESULTS We included 136 patients, 99 with non-fatty and 37 with fatty soft-tissue masses. Mean elasticity and tumor-to-fat elasticity ratio (T/F) values were significantly lower for the benign than the malignant soft-tissue masses in the overall cohort (30.9 vs. 50.0 kilopascals (kPa), P = 0.03; and 2.55 vs. 4.30, P = 0.046) and in the non-fatty subgroup (37.8 ± 31.9 vs. 58.9 ± 39.1 kPa, P = 0.049 and 2.89 ± 5.25 vs. 5.07 ± 5.41, P = 0.046). Data for fatty tumors were non relevant due to lack of conclusive results. By receiver operating characteristics curve analysis, a T/F cutoff of 3.5 had 46% sensitivity and 84% specificity for separating benign and malignant soft-tissue masses. CONCLUSIONS SWE had good specificity and poor sensitivity for separating benign from malignant soft-tissue masses.
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Affiliation(s)
- Sylvain Bodard
- AP-HP, Hôpital Cochin, Service de Radiologie B, F-75014, Paris, France. .,AP-HP, Hôpital Necker Enfants Malades, Service d'Imagerie Adulte, F-75015, Paris, France. .,Université de Paris Cité, F-75006, Paris, France. .,Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, F-75006, Paris, France.
| | - Louis Lassalle
- AP-HP, Hôpital Cochin, Service de Radiologie B, F-75014, Paris, France
| | - Frédérique Larousserie
- Université de Paris Cité, F-75006, Paris, France.,AP-HP, Hôpital Cochin, Service de Pathologie, F-75014, Paris, France
| | - Sylvain Guinebert
- AP-HP, Hôpital Necker Enfants Malades, Service d'Imagerie Adulte, F-75015, Paris, France.,Université de Paris Cité, F-75006, Paris, France
| | - Thomas Hacquart
- CHU Clermont-Fd, Service de Chirurgie orthopédique et traumatologique, F-63000, Clermont Ferrand, France
| | - Raphael Campagna
- AP-HP, Hôpital Cochin, Service de Radiologie B, F-75014, Paris, France
| | - David Biau
- Université de Paris Cité, F-75006, Paris, France.,AP-HP, Hôpital Cochin, Service d'Orthopédie, F-75014, Paris, France
| | - Noreddine Regnard
- AP-HP, Hôpital Cochin, Service de Radiologie B, F-75014, Paris, France
| | - Antoine Feydy
- AP-HP, Hôpital Cochin, Service de Radiologie B, F-75014, Paris, France.,Université de Paris Cité, F-75006, Paris, France
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Bajaj G, Callan AK, Weinschenk RC, Chhabra A. Multiparametric Evaluation of Soft Tissue Sarcoma: Current Perspectives and Future Directions. Semin Roentgenol 2022; 57:212-231. [DOI: 10.1053/j.ro.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/11/2022]
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ANNAÇ G, CANYİĞİT M, TAN S, AKŞAM E, SÜNGÜ ADIYAMAN N, ARSLAN H. Differentiation of benign and malignant superficial soft tissue lesions using real-time strain elastography. Turk J Med Sci 2021; 51:2959-2967. [PMID: 34391320 PMCID: PMC10734816 DOI: 10.3906/sag-2101-166] [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: 01/14/2021] [Revised: 12/13/2021] [Accepted: 08/14/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim To evaluate benign and malignant cutaneous-subcutaneous lesions using real-time strain elastography (RTSE) and to compare the findings with histopathologic results. Materials and methods Over a period of 10 months, 72 patients (38 with benign and 34 with malignant cutaneous and subcutaneous lesions) were prospectively included in this study. Elasticity patterns and strain ratios were examined for each lesion. Lesions were evaluated in 4 groups as yellow-red (soft; pattern-1), green-yellow (moderate; pattern-2), blue-green (hard; pattern-3) and blue (hardest; pattern-4). The stiffness of the lesions was displayed with strain ratios by comparing of a nearby reference tissue. The recorded images were compared with histopathologic findings. Results On sonoelastograms, considering patterns 1-2 as benign and patterns 3-4 as malignant, the sensitivity, specificity, and positive and negative predictive values for the differentiation of malignant from benign lesions were 100%, 68.5%, 74%, and 100%, respectively. Considering a cut-off value of the strain ratio as > 3.05, the sensitivity, specificity, and positive and negative predictive values were 91%, 89%, 88%, and 92%, respectively. The area under the curve (AUC: 0.972) showed the excellent ability of strain elastography to differentiate benign and malignant lesions. Conclusion RTSE is an important imaging tool to differentiate benign and malignant superficial soft tissue lesions. Our results suggest that RTSE can be used to predict malignancy since malignant lesions are more confidentially diagnosed than benign superficial soft tissue lesions on elastograms.
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Affiliation(s)
- Gökçe ANNAÇ
- Department of Radiology, Bartın State Hospital, Bartın,
Turkey
| | - Murat CANYİĞİT
- Department of Radiology, Ankara City Hospital, Ankara,
Turkey
| | - Sinan TAN
- Department of Radiology, Faculty of Medicine, Kırıkkale University, Kırıkkale,
Turkey
| | - Ersin AKŞAM
- Department of Plastic, Reconstructive and Arsthetic Surgery, Faculty of Medicine, Katip Çelebi University, İzmir,
Turkey
| | | | - Halil ARSLAN
- Department of Radiology, Ankara City Hospital, Ankara,
Turkey
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Cebula A, Cebula M, Kopyta I. Muscle Ultrasonographic Elastography in Children: Review of the Current Knowledge and Application. CHILDREN 2021; 8:children8111042. [PMID: 34828755 PMCID: PMC8623756 DOI: 10.3390/children8111042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023]
Abstract
Ultrasonographic elastography is a relatively new imaging modality for the qualitative and quantitative assessments of tissue elasticity. While it has steadily gained use in adult clinical practice, including for liver diseases, breast cancer, thyroid pathologies, and muscle and tendon diseases, data on its paediatric application is still limited. Moreover, diagnosis of muscular diseases in children remains challenging. The gold standard methods, namely biopsy, electroneurography, and electromyography, are often limited owing to their invasive characteristics, possible contraindications, complications, and need for good cooperation, that is, a patient’s ability to perform certain tasks during the examination while withstanding discomfort, which is a significant problem especially in younger or uncooperative children. Genetic testing, which has broad diagnostic possibilities, often entails a high cost, which limits its application. Thus, a non-invasive, objective, repeatable, and accessible tool is needed to aid in both the diagnosis and monitoring of muscle pathologies. We believe that elastography may prove to be such a method. The aim of this review was to present the current knowledge on the use of muscle elastography in the paediatric population and information on the limitations of elastography in relation to examination protocols and factors for consideration in everyday practice and future studies.
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Affiliation(s)
- Agnieszka Cebula
- Department of Paediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Medykow Str 16, 40-752 Katowice, Poland;
- Correspondence: ; Fax: +48-322071546
| | - Maciej Cebula
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Department of Radiology and Nuclear Medicine, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, Medykow Str 14, 40-752 Katowice, Poland;
| | - Ilona Kopyta
- Department of Paediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Medykow Str 16, 40-752 Katowice, Poland;
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Dou Y, Xuan J, Zhao T, Li X, Wang H, Zhang Y, Wang S. The diagnostic performance of conventional ultrasound and strain elastography in malignant soft tissue tumors. Skeletal Radiol 2021; 50:1677-1686. [PMID: 33532939 DOI: 10.1007/s00256-021-03724-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the diagnostic value of conventional ultrasound (US) and strain elastography (SE) in malignant soft tissue tumors. METHOD A total of 83 soft tissue masses were included prospectively. US and SE imaging were performed at the same time. Two observers assessed the B mode, color Doppler, elastic scores (ES), strain ratio (SR), and SE size to B mode size (EI/B) ratio and compared the consistency of the data between the observers. According to the pathological diagnosis of resection, the cases were divided into malignant and nonmalignant groups. The diagnostic value of conventional US and SE in the prediction of malignant soft tissue tumors was assessed. RESULTS The pathology results divided cases into 36 malignant lesions and 47 nonmalignant lesions. There was no statistically significant difference in gender, location, maximum diameter, echo, tail sign, cystic component, Doppler scores, or SR between the two groups (p > 0.05). However, significant differences between the two groups were found in age, depth, heterogeneity, edge, ES, and EI/B (p < 0.05). The biggest area under the receiver operating characteristics curve (0.934) was the combination model of age, heterogeneity, edge, ES, and EI/B, and the sensitivity and specificity were 0.861 and 0.957, respectively. CONCLUSIONS Conventional US and SE are significant for the diagnosis of malignant soft tissue tumors, and SE can be used as a complementary technique to the characterization of STTs using conventional US.
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Affiliation(s)
- Yanping Dou
- Dalian Medical University, Dalian, China
- Department of Ultrasound, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jianyuan Xuan
- Department of Ultrasound, The Second Hospital, Dalian Medical University, Dalian City, Liaoning province, China
| | - Tengfei Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Dalian Medical University, Dalian, China
- Wound Repair Department, Dalian Ganjingzi District People's Hospital, Dalian, China
| | | | - Hui Wang
- Department of Ultrasound, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Yuhong Zhang
- Department of Ultrasound, The Second Hospital, Dalian Medical University, Dalian City, Liaoning province, China
| | - Shaowu Wang
- Dalian Medical University, Dalian, China.
- Department of Ultrasound, The Second Hospital, Dalian Medical University, Dalian City, Liaoning province, China.
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Ozturk M, Selcuk MB, Polat AV, Ozbalci AB, Baris YS. The diagnostic value of ultrasound and shear wave elastography in the differentiation of benign and malignant soft tissue tumors. Skeletal Radiol 2020; 49:1795-1805. [PMID: 32506224 DOI: 10.1007/s00256-020-03492-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
AIM To evaluate the diagnostic value of ultrasound (US) and shear wave elastography (SWE) in the differentiation of benign and malignant soft tissue tumors. MATERIALS AND METHODS A hundred and nine patients (mean age 43.3 ± 20.5, range 0-85; 64 men and 45 women) diagnosed with soft tissue tumors between August 2016 and January 2020 were evaluated with US and SWE. The stiffness of the lesions was measured as mean and maximum shear wave velocity (SWVmean and SWVmax) in meters/second (m/s). Two radiologists evaluated the US images independently and then reached a final consensus. Final diagnosis was obtained either by histopathological examination (core needle biopsy or surgery) or by follow-up. The diagnostic value of US and SWE in the differentiation of malignant and benign lesions was assessed. RESULTS Pathology results revealed 37 malignant and 43 benign lesions. Twenty-nine lesions were benign based on follow-up criteria. Consensus US reading revealed 91.9% sensitivity and 72.2% specificity with almost perfect inter-observer agreement (κ = 0.802). Larger lesion size, male gender, advanced patient age, deep location, hypoechoic and hypervascular appearance, ill-defined margins, and presence of cystic area were associated with malignant diagnosis (p < 0.001, p = 0.010, p = 0.001, p = 0.001, p = 0.003, p < 0.001, p = 0.001, and p = 0.011, respectively). Median SWVmean and median SWVmax of malignant lesions (2.87 and 2.68) were not significantly different than those of the benign lesions (3.30 and 3.05; p = 0.271 and p = 0.402, respectively). CONCLUSION US features can differentiate malignant and benign soft tissue tumors, whereas SWE did not contribute to the differentiation of soft tissue tumors.
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Affiliation(s)
- Mesut Ozturk
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
| | - Mustafa Bekir Selcuk
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Ahmet Veysel Polat
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Aysu Basak Ozbalci
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Yakup Sancar Baris
- Department of Pathology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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