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Schubert M, Tihon A, Andresen K, Ruchay Z, Farrokh A, Maass N, Elischer P, Longardt AC, Tesch K, Lebenatus A, Krüger M, Alkatout I. Peripartal management of dichorial twin pregnancy in a bicornuate bicollis uterus: a case report and review of the literature. J Med Case Rep 2024; 18:196. [PMID: 38643176 PMCID: PMC11032606 DOI: 10.1186/s13256-024-04506-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/12/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION The management of a pregnancy in a bicornuate uterus is particularly challenging. A bicornuate uterus is a rare occurrence and a twin pregnancy in a bicornuate uterus even more rare. These pregnancies call for intensive diagnostic investigation and interdisciplinary care. CASE PRESENTATION We report on a 27-year-old European woman patient (gravida I, para 0) with a simultaneous pregnancy in each cavity of a bicornuate bicollis uterus after embryo transfer. The condition was confirmed by hysteroscopy and laparoscopy. Several unsuccessful in vitro fertilization (IVF) attempts had been performed earlier before embryo transfer in each cornus. After a physiological course of pregnancy with differential screening at 12 + 6 weeks and 22 + 0 weeks of gestation, the patient presented with therapy-resistant contractions at 27 + 2 weeks. This culminated in the uncomplicated spontaneous delivery of the leading fetus and delayed spontaneous delivery of the second fetus. DISCUSSION Only 16 cases of twin pregnancy in a bicornuate unicollis uterus have been reported worldwide and only 6 in a bicornuate bicollis uterus. The principal risks in such pregnancies are preterm labor, intrauterine growth restriction, malpresentation and preeclampsia. These typical risk factors of a twin pregnancy are greatly potentiated in the above mentioned setting. CONCLUSION A twin pregnancy in the presence of a uterine malformation is rare and difficult to manage. These rare cases must be collected and reported in order to work out algorithms of monitoring and therapy as well as issue appropriate recommendations for their management.
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Affiliation(s)
- Melanie Schubert
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany.
| | - Anastasia Tihon
- Department of Obstetrics and Gynecology, University Hospital of Würzburg, 97080, Würzburg, Germany
| | - Kristin Andresen
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Zino Ruchay
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany
| | - André Farrokh
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Philipp Elischer
- Department for Pediatrics and Adolescent Medicine I, Neonatology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Ann Carolin Longardt
- Department for Pediatrics and Adolescent Medicine I, Neonatology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Karolin Tesch
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Annett Lebenatus
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Magret Krüger
- Center for Operative Gynecology, Park Clinic, 24116, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany.
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Vogel-Minea CM, Bader W, Blohmer JU, Duda V, Eichler C, Fallenberg EM, Farrokh A, Golatta M, Gruber I, Hackelöer BJ, Heil J, Madjar H, Marzotko E, Merz E, Müller-Schimpfle M, Mundinger A, Ohlinger R, Peisker U, Schäfer FK, Schulz-Wendtland R, Solbach C, Warm M, Watermann D, Wojcinski S, Dudwiesus H, Hahn M. Best Practice Guideline - DEGUM Recommendations on Breast Ultrasound. Ultraschall Med 2023; 44:520-536. [PMID: 37072031 DOI: 10.1055/a-2020-9904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Alongside mammography, breast ultrasound is an important and well-established method in assessment of breast lesions. With the "Best Practice Guideline", the DEGUM Breast Ultrasound (in German, "Mammasonografie") working group, intends to describe the additional and optional application modalities for the diagnostic confirmation of breast findings and to express DEGUM recommendations in this Part II, in addition to the current dignity criteria and assessment categories published in Part I, in order to facilitate the differential diagnosis of ambiguous lesions.The present "Best Practice Guideline" has set itself the goal of meeting the requirements for quality assurance and ensuring quality-controlled performance of breast ultrasound. The most important aspects of quality assurance are explained in this Part II of the Best Practice Guideline.
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Affiliation(s)
- Claudia Maria Vogel-Minea
- Brustzentrum, Diagnostische und Interventionelle Senologie, Rottal-Inn Kliniken Eggenfelden, Eggenfelden, Germany
| | - Werner Bader
- Zentrum für Frauenheilkunde, Brustzentrum, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld, Bielefeld, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Duda
- Senologische Diagnostik, Universitätsklinikum Gießen und Marburg, Marburg, Germany
| | - Christian Eichler
- Klinik für Brusterkrankungen, St Franziskus-Hospital Münster GmbH, Münster, Germany
| | - Eva Maria Fallenberg
- Department of Diagnostic and Interventional Radiology, Technical University of Munich Hospital Rechts der Isar, Munich, Germany
| | - André Farrokh
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Michael Golatta
- Sektion Senologie, Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany
- Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
| | - Ines Gruber
- Frauenklinik, Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Jörg Heil
- Sektion Senologie, Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany
- Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
| | - Helmut Madjar
- Gynäkologie und Senologie, Praxis für Gynäkologie, Wiesbaden, Germany
| | - Ellen Marzotko
- Mammadiagnostik, Frauenheilkunde und Geburtshilfe, Praxis, Erfurt, Germany
| | - Eberhard Merz
- Frauenheilkunde, Zentrum für Ultraschall und Pränatalmedizin, Frankfurt, Germany
| | - Markus Müller-Schimpfle
- DKG-Brustzentrum, Klinik für Radiologie, Neuroradiologie und Nuklearmedizin, varisano Klinikum Frankfurt Höchst, Frankfurt am Main, Germany
| | - Alexander Mundinger
- Brustzentrum Osnabrück - Bildgebende und interventionelle Mamma Diagnostik, Franziskus Hospital Harderberg, Niels Stensen Kliniken, Georgsmarienhütte, Germany
| | - Ralf Ohlinger
- Interdisziplinäres Brustzentrum, Universitätsmedizin Greifswald, Klinik für Frauenheilkunde und Geburtshilfe, Greifswald, Germany
| | - Uwe Peisker
- BrustCentrum Aachen-Kreis Heinsberg, Hermann-Josef Krankenhaus, Akademisches Lehrkrankenhaus der RWTH-Aachen, Erkelenz, Germany
| | - Fritz Kw Schäfer
- Bereich Mammadiagnostik und Interventionen, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Christine Solbach
- Senologie, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Mathias Warm
- Brustzentrum, Krankenhaus Holweide, Kliniken der Stadt Köln, Koeln, Germany
| | - Dirk Watermann
- Frauenklinik, Evangelisches Diakoniekrankenhaus, Freiburg, Germany
| | - Sebastian Wojcinski
- Zentrum für Frauenheilkunde, Brustzentrum, Universitätsklinikum OWL Bielefeld, Bielefeld, Germany
| | | | - Markus Hahn
- Frauenklinik, Department für Frauengesundheit, Universität Tübingen, Tübingen, Germany
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Bader W, Vogel-Minea CM, Blohmer JU, Duda V, Eichler C, Fallenberg E, Farrokh A, Golatta M, Gruber I, Hackelöer BJ, Heil J, Madjar H, Marzotko E, Merz E, Müller-Schimpfle M, Mundinger A, Ohlinger R, Peisker U, Schäfer FKW, Schulz-Wendtland R, Solbach C, Warm M, Watermann D, Wojcinski S, Hahn M. Best Practice Guideline - DEGUM Recommendations on Breast Ultrasound. Ultraschall Med 2022; 43:570-582. [PMID: 34921376 DOI: 10.1055/a-1634-5021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
For many years, breast ultrasound has been used in addition to mammography as an important method for clarifying breast findings. However, differences in the interpretation of findings continue to be problematic 1 2. These differences decrease the diagnostic accuracy of ultrasound after detection of a finding and complicate interdisciplinary communication and the comparison of scientific studies 3. In 1999, the American College of Radiology (ACR) created a working group (International Expert Working Group) that developed a classification system for ultrasound examinations based on the established BI-RADS classification of mammographic findings under consideration of literature data 4. Due to differences in content, the German Society for Ultrasound in Medicine (DEGUM) published its own BI-RADS-analogue criteria catalog in 2006 3. In addition to the persistence of differences in content, there is also an issue with formal licensing with the current 5th edition of the ACR BI-RADS catalog, even though the content is recognized by the DEGUM as another system for describing and documenting findings. The goal of the Best Practice Guideline of the Breast Ultrasound Working Group of the DEGUM is to provide colleagues specialized in senology with a current catalog of ultrasound criteria and assessment categories as well as best practice recommendations for the various ultrasound modalities.
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Affiliation(s)
- Werner Bader
- Zentrum für Frauenheilkunde, Brustzentrum, Universitätsklinikum OWL Bielefeld, Germany
| | - Claudia Maria Vogel-Minea
- Brustzentrum, Diagnostische und Interventionelle Senologie, Rottal-Inn-Kliniken Eggenfelden, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum, Charité-Universitätsmedizin Berlin, Germany
| | - Volker Duda
- Senologische Diagnostik, Universitätsklinikum Gießen und Marburg, Germany
| | | | - Eva Fallenberg
- Brustzentrum, Diagnostische und Interventionelle Senologie, LMU Klinikum der Universität München Medizinische Klinik und Poliklinik IV, München, Germany
| | - André Farrokh
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Germany
| | - Michael Golatta
- Sektion Senologie, Universitäts-Frauenklinik Heidelberg, Germany
| | - Ines Gruber
- Department für Frauengesundheit, Universitätsfrauenklinikum Tübingen, Germany
| | | | - Jörg Heil
- Sektion Senologie, Universitäts-Frauenklinik Heidelberg, Germany
| | - Helmut Madjar
- Gynäkologie und Senologie Wiesbaden, Praxis, Wiesbaden, Germany
| | - Ellen Marzotko
- Mammadiagnostik, Frauenheilkunde und Geburtshilfe, Praxis, Erfurt, Germany
| | - Eberhard Merz
- Ultraschall und Pränatalmedizin Frankfurt, Zentrum, Frankfurt/Main, Germany
| | - Markus Müller-Schimpfle
- DKG-Brustzentrum, Klinik für Radiologie, Neuroradiologie und Nuklearmedizin Frankfurt, Frankfurt am Main, Germany
| | - Alexander Mundinger
- Brustzentrum Osnabrück - Bildgebende und interventionelle Mamma Diagnostik, Franziskus Hospital Harderberg, Niels-Stensen-Kliniken, Georgsmarienhütte, Germany
| | - Ralf Ohlinger
- Interdisziplinäres Brustzentrum, Universitätsmedizin Greifswald, Klinik für Frauenheilkunde und Geburtshilfe, Greifswald, Germany
| | - Uwe Peisker
- BrustCentrum Aachen-Kreis Heinsberg, Hermann-Josef-Krankenhaus, Akademisches Lehrkrankenhaus der RWTH Aachen, Erkelenz, Germany
| | - Fritz K W Schäfer
- Bereich Mammadiagnostik und Interventionen, Universitätsklinikum Schleswig-Holstein Campus Kiel, Germany
| | | | - Christine Solbach
- Senologie, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Germany
| | - Mathias Warm
- Brustzentrum, Krankenhaus Holweide, Kliniken der Stadt Köln, Köln, Germany
| | - Dirk Watermann
- Frauenklinik, Evangelisches Diakoniekrankenhaus, Freiburg, Germany
| | - Sebastian Wojcinski
- Zentrum für Frauenheilkunde, Brustzentrum, Universitätsklinikum OWL Bielefeld, Germany
| | - Markus Hahn
- Department für Frauengesundheit, Universitätsfrauenklinikum Tübingen, Germany
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Ferraioli G, Barr RG, Farrokh A, Radzina M, Cui XW, Dong Y, Rocher L, Cantisani V, Polito E, D'Onofrio M, Roccarina D, Yamashita Y, Dighe MK, Fodor D, Dietrich CF. How to perform shear wave elastography. Part II. Med Ultrason 2022; 24:196-210. [PMID: 34379714 DOI: 10.11152/mu-3342] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Recently a series of papers was introduced describing on "how to do" certain techniques. More specifically we published on how to perform strain imaging using the transcutaneous and endoscopic ultrasound approach and shear wave elastography (SWE). In the first part we describe how to optimize the examination technique, discussing normal values, pitfalls, artefacts and specific tips for applying SWE to specific organs (liver, breast, thyroid, salivary glands) as part of a diagnostic US examination. In part II, the use of SWE in the pancreas, spleen, kidney, prostate, scrotum, musculoskeletal system, lymph nodes and future developments are discussed.
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Affiliation(s)
- Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Medical School University of Pavia, Pavia, Italy
| | - Richard G Barr
- Northeastern Ohio Medical University, Rootstown, Ohio, USA
| | - André Farrokh
- University Hospital Schleswig-Holstein, Campus Kiel, Department of Gynecology and Obstetrics, Germany
| | - Maija Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - Xin Wu Cui
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Laurence Rocher
- Service de Radiologie, APHP Hôpitaux Paris Saclay, Hôpital Antoine Béclère, Clamart, France. Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Vito Cantisani
- Department of Radiology, Oncology, Anatomo-Pathology, Sapienza-University of Rome, Rome, Italy
| | - Eleonora Polito
- Department of Radiology, Oncology, Anatomo-Pathology, Sapienza-University of Rome, Rome, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Italy
| | - Davide Roccarina
- Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK, SOD Medicina Interna ed Epatologia, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Yasunobu Yamashita
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Manjiri K Dighe
- Department of Radiology, University of Washington, Seattle, USA
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
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Ferraioli G, Barr RG, Farrokh A, Radzina M, Cui XW, Dong Y, Rocher L, Cantisani V, Polito E, D'Onofrio M, Roccarina D, Yamashita Y, Dighe MK, Dietrich CF. How to perform shear wave elastography. Part I. Med Ultrason 2022; 24:95-106. [PMID: 33945590 DOI: 10.11152/mu-3217] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We recently introduced a series of papers describing how to do certain techniques. This article is the first part of a review of shear wave elastography (SWE). It reports the principles and interpretation of the technique and describes how to optimize it. Normal values, pitfalls and artefacts for the examination of liver, breast. thyroid and salivary gland with shear wave elastography are presented. The manuscript provides specific tips for applying SWE as part of a diagnostic US examination.
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Affiliation(s)
- Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Medical School University of Pavia, Pavia, Italy
| | - Richard G Barr
- Northeastern Ohio Medical University, Rootstown, Ohio, USA
| | - André Farrokh
- University Hospital Schleswig-Holstein, Campus Kiel, Department of Gynecology and Obstetrics, Germany
| | - Maija Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - Xin Wu Cui
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Laurence Rocher
- Service de Radiologie, APHP Hôpitaux Paris Saclay, Hôpital Antoine Béclère, Clamart, France. Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Vito Cantisani
- Department of Radiology, Oncology, Anatomo-Pathology, Sapienza-University of Rome, Rome, Italy
| | - Eleonora Polito
- Department of Radiology, Oncology, Anatomo-Pathology, Sapienza-University of Rome, Rome, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Italy
| | - Davide Roccarina
- Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK, SOD Medicina Interna ed Epatologia, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Yasunobu Yamashita
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Manjiri K Dighe
- Department of Radiology, University of Washington, Seattle, USA
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
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Farrokh A, Goldmann G, Meyer-Johann U, Hille-Betz U, Hillemanns P, Bader W, Wojcinski S. Clinical Differences between Invasive Lobular Breast Cancer and Invasive Carcinoma of No Special Type in the German Mammography-Screening-Program. Women Health 2022; 62:144-156. [DOI: 10.1080/03630242.2022.2030448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- André Farrokh
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | | | - Ursula Hille-Betz
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Werner Bader
- Department of Obstetrics and Gynecology, Klinikum Bielefeld, Bielefeld, Germany
| | - Sebastian Wojcinski
- Department of Obstetrics and Gynecology, Klinikum Bielefeld, Bielefeld, Germany
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Săftoiu A, Gilja OH, Sidhu PS, Dietrich CF, Cantisani V, Amy D, Bachmann-Nielsen M, Bob F, Bojunga J, Brock M, Calliada F, Clevert DA, Correas JM, D'Onofrio M, Ewertsen C, Farrokh A, Fodor D, Fusaroli P, Havre RF, Hocke M, Ignee A, Jenssen C, Klauser AS, Kollmann C, Radzina M, Ramnarine KV, Sconfienza LM, Solomon C, Sporea I, Ștefănescu H, Tanter M, Vilmann P. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018. Ultraschall Med 2019; 40:425-453. [PMID: 31238377 DOI: 10.1055/a-0838-9937] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This manuscript describes the use of ultrasound elastography, with the exception of liver applications, and represents an update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography.
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Affiliation(s)
- Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Paul S Sidhu
- Department of Radiology, King's College London, King's College Hospital, United Kingdom of Great Britain and Northern Ireland
| | | | - Vito Cantisani
- Radiological, Pathological and Oncological Sciences Department, University Sapienza, Rome, Italy
| | - Dominique Amy
- Radiology Department, Breast Center, Aix-en-Provence, France
| | | | - Flaviu Bob
- Nephrology Department, University of Medicine and Pharmacy "Victor Babeș" Timișoara, Romania
| | - Jörg Bojunga
- Med. Klinik I, Department of Endocrinology Universitätsklinikum, Frankfurt am Main, Germany
| | - Marko Brock
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Germany
| | - Fabrizio Calliada
- Department of Radiology, Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Dirk André Clevert
- Department of Clinical Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Jean-Michel Correas
- Service de Radiologie adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - Caroline Ewertsen
- Department of Radiology, Copenhagen-University-Hospital, Rigshospitalet, Copenhagen OE, Denmark
| | - André Farrokh
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Germany
| | - Daniela Fodor
- 2nd Medical Clinic, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Pietro Fusaroli
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | - Roald Flesland Havre
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | | | - André Ignee
- Medizinische Klinik 2, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
| | | | - Christian Kollmann
- Center for Medical Physics & Biomedical Engineering, Medical University of Vienna, Austria
| | - Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, Medical faculty, University of Latvia, Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, Riga, Latvia
| | - Kumar V Ramnarine
- Medical Physics Department, Guy's and St Thomas' NHS Foundation Trust, London, and University of Leicester, Leicester, United Kingdom of Great Britain and Northern Ireland
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy and Department of Biomedical Sciences for Health, University of Milano, Italy
| | - Carolina Solomon
- Radiology Department, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeș" Timișoara, Romania
| | - Horia Ștefănescu
- Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Mickael Tanter
- Physics for Medicine Paris Institute, INSERM, CNRS, ESPCI Paris, France
| | - Peter Vilmann
- Endoscopy Department, Copenhagen University Hospital Herlev, Denmark
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Farrokh A, Maass N, Treu L, Heilmann T, Schäfer FK. Accuracy of tumor size measurement: comparison of B-mode ultrasound, strain elastography, and 2D and 3D shear wave elastography with histopathological lesion size. Acta Radiol 2018; 60:451-458. [PMID: 30043622 DOI: 10.1177/0284185118787354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Predicting the exact extent of a breast tumor is of great importance for oncologic treatment strategies. Different types of elastography can be used as new tools for measuring lesion size. PURPOSE To provide evidence regarding the accuracy of tumor size measurement of strain elastography (SE), two-dimensional (2D) and three-dimensional (3D) shear wave elastography (SWE), and conventional B-image ultrasound. MATERIAL AND METHODS In this prospective study, the diameter of 105 malignant breast lesions was measured by SE, 2D and 3D SWE, and B-mode ultrasound. The histopathological lesion size was compared to all imaging-based measuring methods. RESULTS The mean lesion size of all breast carcinomas was 1.54 cm. B-mode ultrasound underestimates breast cancer size in 65.7 % of all cases in this study ( P < 0.0001). Mean lesion size was more accurately determined by SE, 2D and 3D SWE compared to B-mode ultrasound. Absolute differences between measured and actual lesion are smaller for B-mode ultrasound (0.26 cm) than for SE (0.41 cm) and 2D and 3D SWE (0.41 cm and 0.44 cm, respectively). CONCLUSION B-mode ultrasound allows more accurate lesion size measurement than SE and 2D or 3D SWE but has a significantly higher risk of underestimating tumor size which could lead to incomplete margins during surgery. 3D SWE was not superior to 2D SWE or SE but by trend more precise in predicting the size of invasive lobular carcinoma.
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Affiliation(s)
- André Farrokh
- 1 Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nicolai Maass
- 1 Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Linn Treu
- 3 Department of Gynecology and Obstetrics, Imland Klinik Rendsburg, Rendsburg, Germany
| | - Thorsten Heilmann
- 1 Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Fritz Kw Schäfer
- 2 Breast Imaging and Interventions, Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Kiel, Germany
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Farrokh A, Erdönmez H, Schäfer F, Maass N. SOFIA: A Novel Automated Breast Ultrasound System Used on Patients in the Prone Position: A Pilot Study on Lesion Detection in Comparison to Handheld Grayscale Ultrasound. Geburtshilfe Frauenheilkd 2018; 78:499-505. [PMID: 29880985 PMCID: PMC5986565 DOI: 10.1055/a-0600-2279] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/31/2018] [Accepted: 04/01/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction
Most of the currently available automated breast ultrasound systems require patients to be in the supine position. Previous data, however, show a high recall rate with this method due to artifacts. The novel automated breast ultrasound scanner SOFIA scans the breast with the patient in a prone position, resulting in even compression of breast tissue. We present our initial results with this examination method.
Material and Methods
63 patients were analyzed using a handheld B-mode ultrasound. In cases of BI-RADS 1, 2 or 5, a SOFIA scan was performed. Sensitivity, specificity and accuracy were calculated. Interobserver agreement was evaluated using Cohenʼs kappa. The duration of the scan was measured for both methods.
Results
No BI-RADS 5 lesion was missed with SOFIA. The SOFIA had an additional recall rate of 16.67% compared to B-mode ultrasound. The sensitivity, specificity and accuracy of SOFIA was 100, 83.33 and 88.89%, respectively. Cohenʼs kappa showed substantial agreement (κ = 0.769) between examiner 1 (B-mode) and examiner 2 (SOFIA). The mean scan duration for the B-mode system and the SOFIA system was 24.21 minutes and 12.94 minutes, respectively. In four cases, D-cup breasts were not scanned in their entirety.
Conclusion
No cancer was missed when SOFIA was used in this preselected study population. The scanning time was approximately half of that required for B-mode ultrasound. The additional unnecessary recall rate was 16.67%. Larger D cup-size breasts were difficult to position and resulted in an incomplete image in four cases.
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Affiliation(s)
- André Farrokh
- Universitätsklinik Schleswig-Holstein, Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
| | - Harika Erdönmez
- Klinikum Bremerhaven-Reinkenheide, Frauenklinik, Bremerhaven, Germany
| | - Fritz Schäfer
- Universitätsklinik Schleswig-Holstein, Campus Kiel, Mammazentrum, Klinik für Gynäkologie und Geburtshilfe und Klinik für Radiologie und Neuroradiologie, Kiel, Germany
| | - Nicolai Maass
- Universitätsklinik Schleswig-Holstein, Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
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Farrokh A, Schaefer F, Degenhardt F, Maass N. Comparison of Two Different Ultrasound Devices Using Strain Elastography Technology in the Diagnosis of Breast Lesions Related to the Histologic Results. Ultrasound Med Biol 2018; 44:978-985. [PMID: 29477744 DOI: 10.1016/j.ultrasmedbio.2018.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/08/2018] [Accepted: 01/18/2018] [Indexed: 06/08/2023]
Abstract
This study was conducted to provide evidence that elastograms of two different devices and different manufacturers using the same technical approach provide the same diagnoses. A total of 110 breast lesions were prospectively analysed by two experts in ultrasound, using the strain elastography function from two different manufacturers (Hitachi HI-RTE, Hitachi Medical Systems, Wiesbaden, Germany; and Siemens eSie Touch, Siemens Medical Systems, Erlangen, Germany). Results were compared with the histopathologic results. Applying the Bowker test of symmetry, no statistically significant difference between the two elastography functions of these two devices was found (p = 0.120). The Cohen's kappa of k = 0.591 showed moderate strength of agreement between the two elastograms. The two examiners yielded moderate strength of agreement analysing the elastograms (Hitachi HI-RTE, k = 0.478; Siemens eSie Touch, k = 0.441). In conclusion, evidence is provided that elastograms of the same lesion generated by two different ultrasound devices equipped with a strain elastography function do not significantly differ.
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Affiliation(s)
- André Farrokh
- University Hospital Schleswig-Holstein, Campus Kiel, Department of Gynecology and Obstetrics, Kiel, Germany.
| | - Fritz Schaefer
- University Hospital Schleswig-Holstein, Campus Kiel, Department of Breast Imaging and Interventions, Kiel, Germany
| | - Friedrich Degenhardt
- Hannover Medical School, Department of Gynecology and Obstetrics, Hannover, Germany
| | - Nicolai Maass
- University Hospital Schleswig-Holstein, Campus Kiel, Department of Gynecology and Obstetrics, Kiel, Germany
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Dietrich CF, Barr RG, Farrokh A, Dighe M, Hocke M, Jenssen C, Dong Y, Saftoiu A, Havre RF. Strain Elastography - How To Do It? Ultrasound Int Open 2017; 3:E137-E149. [PMID: 29226273 DOI: 10.1055/s-0043-119412] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 12/11/2022] Open
Abstract
Tissue stiffness assessed by palpation for diagnosing pathology has been used for thousands of years. Ultrasound elastography has been developed more recently to display similar information on tissue stiffness as an image. There are two main types of ultrasound elastography, strain and shear wave. Strain elastography is a qualitative technique and provides information on the relative stiffness between one tissue and another. Shear wave elastography is a quantitative method and provides an estimated value of the tissue stiffness that can be expressed in either the shear wave speed through the tissues in meters/second, or converted to the Young's modulus making some assumptions and expressed in kPa. Each technique has its advantages and disadvantages and they are often complimentary to each other in clinical practice. This article reviews the principles, technique, and interpretation of strain elastography in various organs. It describes how to optimize technique, while pitfalls and artifacts are also discussed.
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Affiliation(s)
| | - Richard G Barr
- Radiology, Northeastern Ohio Medical University, Rootstown, United States
| | - André Farrokh
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Manjiri Dighe
- Department of Biology, University of Washington, Radiology, Seattle, United States
| | - Michael Hocke
- HELIOS Klinikum Meiningen, Internal Medicine II, Meiningen, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Klinik für Innere Medizin, Wriezen, Germany
| | - Yi Dong
- Zhongshan Hospital, Ultrasound, Shanghai, China
| | - Adrian Saftoiu
- University of Medicine and Pharmacy of Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania
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Pecks U, Rath W, Maass N, Berger B, Lueg I, Farrokh A, Farrokh S, Eckmann-Scholz C. Fetal gender and gestational age differentially affect PCSK9 levels in intrauterine growth restriction. Lipids Health Dis 2016; 15:193. [PMID: 27842594 PMCID: PMC5109703 DOI: 10.1186/s12944-016-0365-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Maternal and fetal Low Density Lipoprotein-Cholesterol (LDL-C) concentrations are compromised in intrauterine growth restriction (IUGR). Generally, LDL-C catabolism is under control of PCSK9 by binding to the LDL-receptor leading to its degradation. Hence, we hypothesized a role for PCSK9 in the modulation of lipid metabolism and placental transport in IUGR. METHODS 172 women, 70 IUGR and 102 controls were included in the study. Maternal and fetal serum PCSK9 levels and lipid profiles including LDL-C were measured. Placental LDL-receptor and PCSK9 expressions were estimated by tissue microarray immunohistochemistry, and analyzed by two blinded observers using an immunoreactivity score. Non-parametric tests and multivariate regression analyses were used for statistical estimations. RESULTS PCSK9 levels in the maternal and fetal compartment independently predicted LDL-C levels (maternal compartment: adjusted R 2 = 0.2526; coefficient b i = 0.0938, standard error s bi =0.0217, rpartial = 0.4420, t-value = 4.323, p < 0.0001; fetal compartment: adjusted R 2 = 0.2929; b i = 0.1156, s bi =0.020, rpartial = 0.5494, t-value = 5.81, p < 0.0001). We did not find significant differences in maternal PCSK9 concentrations between IUGR and controls. However, we found lower fetal serum PCSK9 concentrations in IUGR than in controls (IUGR median 137.1 ng/mL (95% CI 94.8-160.0) vs. controls 176.8 (154.6-202.5), p = 0.0005). When subgrouping according to early onset, late onset IUGR, and fetal gender differences remained consistent only for male neonates born before 34 weeks of gestation. In the placenta we found no correlation between PCSK9 and LDL-receptor expression patterns. However, the LDL-receptor was significantly upregulated in IUGR when compared to controls (p = 0.0063). CONCLUSIONS Our results suggest that PCSK9 play a role in impaired fetal growth by controlling fetal LDL-C metabolism, which seems to be dependent on gestational age and fetal gender. This underlines the need to identify subgroups of IUGR that may benefit from individualized and gender-specific pharmacotherapy in future studies.
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Affiliation(s)
- Ulrich Pecks
- Department of Obstetrics and Gynecology, University Hospital of the RWTH, Aachen, Germany
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Werner Rath
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Bartlomiej Berger
- Department of Obstetrics and Gynecology, University Hospital of the RWTH, Aachen, Germany
| | - Imke Lueg
- Department of Obstetrics and Gynecology, University Hospital of the RWTH, Aachen, Germany
| | - André Farrokh
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sabrina Farrokh
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christel Eckmann-Scholz
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
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Hedemann N, Rogmans C, Farrokh A, Pecks U, Weimer JP, Arnold N, Maass N, Bauerschlag DO. Validierung der Metalloprotease ADAM17 als potentiell prädiktiver Marker im Ovarialkarzinom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Farrokh A, Wojcinski S, Degenhardt F. Evaluation of real-time tissue sono-elastography in the assessment of 214 breast lesions: limitations of this method resulting from different histologic subtypes, tumor size and tumor localization. Ultrasound Med Biol 2013; 39:2264-2271. [PMID: 24063962 DOI: 10.1016/j.ultrasmedbio.2013.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/12/2013] [Accepted: 08/07/2013] [Indexed: 06/02/2023]
Abstract
Real-time sono-elastography is an ultrasound-based technique used to estimate tissue elasticity. Several publications have reported that this method has the ability to differentiate between malignant and benign breast lesions. However, on the basis of current literature, sono-elastography returned false-negative results in 25% of cases with certain lesions, such as mucinous carcinoma. Our data indicate that elastography has higher specificity (96.5% vs. 84.4%) and lower sensitivity (86.9% vs. 93.9%) than B-mode ultrasound. Our evidence suggests that elastography performs significantly worse in lesions ≥20 mm in diameter (sensitivity = 61.1%, specificity = 97.2%) than in lesions <20 mm in diameter (sensitivity = 92.6%, specificity = 96.2%). Furthermore, elastography returned false-negative results in all cases mucinous carcinoma. Finally, in eight cases we obtained a valid elastogram. Our data indicate that this finding is probably due to tumor depth.
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Affiliation(s)
- André Farrokh
- Franziskus Hospital Bielefeld, Department of Gynecology and Obstetrics/Breast Center, Bielefeld, Germany.
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Wojcinski S, Gyapong S, Farrokh A, Soergel P, Hillemanns P, Degenhardt F. Diagnostic performance and inter-observer concordance in lesion detection with the automated breast volume scanner (ABVS). BMC Med Imaging 2013; 13:36. [PMID: 24219312 PMCID: PMC3831756 DOI: 10.1186/1471-2342-13-36] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 11/08/2013] [Indexed: 01/22/2023] Open
Abstract
Background Automated whole breast ultrasound scanners of the latest generation have reached a level of comfortable application and high quality volume acquisition. Nevertheless, there is a lack of data concerning this technology. We investigated the diagnostic performance and inter-observer concordance of the Automated Breast Volume Scanner (ABVS) ACUSON S2000™ and questioned its implications in breast cancer diagnostics. Methods We collected 100 volume data sets and created a database containing 52 scans with no detectable lesions in conventional ultrasound (BI-RADS®-US 1), 30 scans with benign lesions (BI-RADS®-US 2) and 18 scans with breast cancer (BI-RADS®-US 5). Two independent examiners evaluated the ABVS data on a separate workstation without any prior knowledge of the patients’ histories. Results The inter-rater reliability reached fair agreement (κ=0.36; 95% confidence interval (CI): 0.19-0.53). With respect to the true category, the conditional inter-rater validity coefficient was κ=0.18 (95% CI: 0.00-0.26) for the benign cases and κ=0.80 (95% CI: 0.61-1.00) for the malignant cases. Combining the assessments of examiner 1 and examiner 2, the diagnostic accuracy (AC), sensitivity (SE) and specificity (SP) for the experimental ABVS were AC = 79.0% (95% CI: 67.3-86.1), SE = 83.3% (95% CI: 57.7-95.6) and SP = 78.1% (% CI: 67.3-86.1), respectively. However, after the ABVS examination, there were a high number of requests for second-look ultrasounds in up to 48.8% of the healthy women due to assumed suspicious findings in the volume data. In an exploratory analysis, we estimated that an ABVS examination in addition to mammography alone could detect a relevant number of previously occult breast cancers (about 1 cancer in 300 screened and otherwise healthy women). Conclusions The ABVS is a reliable imaging method for the evaluation of the breast with high sensitivity and a fair inter-observer concordance. However, we have to overcome the problem of the high number of false-positive results. Therefore, further prospective studies in larger collectives are necessary to define standard procedures in image acquisition and interpretation. Nevertheless, we consider the ABVS as being suitable for integration into breast diagnostics as a beneficial and reliable imaging method.
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Affiliation(s)
- Sebastian Wojcinski
- Department of OB/GYN, Hannover Medical School, OE 6410, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
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Wojcinski S, Boehme E, Farrokh A, Soergel P, Degenhardt F, Hillemanns P. Ultrasound real-time elastography can predict malignancy in BI-RADS®-US 3 lesions. BMC Cancer 2013; 13:159. [PMID: 23530903 PMCID: PMC3618252 DOI: 10.1186/1471-2407-13-159] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 03/19/2013] [Indexed: 12/21/2022] Open
Abstract
Background Lesions of the breast that are classified BI-RADS®-US 3 by ultrasound are probably benign and observation is recommended, although malignancy may occasionally occur. In our study, we focus exclusively on BI-RADS®-US 3 lesions and hypothesize that sonoelastography as an adjunct to conventional ultrasound can identify a high-risk-group and a low-risk-group within these patients. Methods A group of 177 breast lesions that were classified BI-RADS®-US 3 were additionally examined with real-time sonoelastography. Elastograms were evaluated according to the Tsukuba Elasticity Score. Pretest and posttest probability of disease (POD), sensitivity (SE), specificity (SP), positive (PPV) and negative predictive values (NPV) and likelihood-ratios (LR) were calculated. Furthermore, we analyzed the false-negative and false-positive cases and performed a model calculation to determine how elastography could affect the proceedings in population screening. Results In our collection of BI-RADS®-US 3 cases there were 169 benign and eight malignant lesions. The pretest POD was 4.5% (95% confidence interval (CI): 2.1–9.0). In patients with a suspicious elastogram (high-risk group), the posttest POD was significantly higher (13.2%, p = 0.041) and the positive LR was 3.2 (95% CI: 1.7–5.9). With a benign elastogram (low-risk group), the posttest POD decreased to 2.2%. SE, SP, PPV and NPV for sonoelastography in BI-RADS®-US 3 lesions were 62.5% (95% CI: 25.9–89.8), 80.5% (95% CI: 73.5–86.0), 13.2% (95% CI: 5.0–28.9) and 97.8% (95% CI: 93.3–99.4), respectively. Conclusions Sonoelastography yields additional diagnostic information in the evaluation of BI-RADS®-US 3 lesions of the breast. The examiner can identify a low-risk group that can be vigilantly observed and a high-risk group that should receive immediate biopsy due to an elevated breast cancer risk.
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Wojcinski S, Farrokh A, Schmidt J, Hillemanns P, Degenhardt F. P2-10-07: Triple-Negative Breast Cancer May Have Ultrasonographic Features Mimicking Nonmalignant Lesions. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-10-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Triple-negative breast cancer (TNBC) is known to have unique molecular, clinical and pathologic characteristics. Histological studies illustrate high mitotic counts, geographic necrosis, pushing borders of invasion, and stromal lymphocytic response. These growth patterns may also affect the appearance of TNBC in ultrasound.
Our study evaluates the ultrasonographic features of TNBC according to the ACR BI-RADS®-US classification system and compares these features with non-TNBC.
Materials and methods: Data of 385 consecutive breast cancer cases were collected from our hospital database. Digitally recorded ultrasound images were available for 292 patients. These images were interpreted according to the BI-RADS® system by an examiner blinded to the patients’ characteristics and histological results. The ultrasonographic features of TNBC (n=45) and non-TNBC (n=247) were compared using Fisher's exact test.
Results: TNBC was more common in younger patients and exhibited higher tumor grades and more advanced tumor stages. Focusing on the ultrasound features, TNBC was more likely to exhibit round or oval shape (35.5% versus 25.9% in non-TNBC) and the margin of TNBC was more frequently described as microlobulated (48.9% versus 37.7% in non-TNBC) instead of angular or spiculated. In TNBC the echogenic halo was significantly less often observed (46.7% versus 64.4% in non-TNBC, p=0.0302) and we found less architectural distortions (65.5% versus 84.3% in non-TNBC, p=0.0341). Regarding the posterior acoustic features, an enhancement was significantly more often observed in TNBC (26.7% versus 13.0% in non-TNBC, p=0.0391).
Discussion: TNBC and non-TNBC seem to have different ultrasonographic features. This can be explained by the unique pathologic profile of this breast cancer subtype. As some of the distinct ultrasound criteria of TNBC are associated with benign masses, TNBC may mimic nonmalignant lesions. Being familiar with these features can avoid false-negative classification of TNBC.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-10-07.
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Affiliation(s)
- S Wojcinski
- 1Franziskus Hospital, Bielefeld, Germany; Hannover Medical School, Hannover, Germany
| | - A Farrokh
- 1Franziskus Hospital, Bielefeld, Germany; Hannover Medical School, Hannover, Germany
| | - J Schmidt
- 1Franziskus Hospital, Bielefeld, Germany; Hannover Medical School, Hannover, Germany
| | - P Hillemanns
- 1Franziskus Hospital, Bielefeld, Germany; Hannover Medical School, Hannover, Germany
| | - F Degenhardt
- 1Franziskus Hospital, Bielefeld, Germany; Hannover Medical School, Hannover, Germany
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Farrokh A, Wojcinski S, Bösing T, Otte J, Degenhardt F. Fetomaternale Makrotransfusion – Ein Fallbericht. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Farrokh A, Wojcinski S, Degenhardt F. [Diagnostic value of strain ratio measurement in the differentiation of malignant and benign breast lesions]. Ultraschall Med 2011; 32:400-405. [PMID: 20425688 DOI: 10.1055/s-0029-1245335] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE The aim of this study was to evaluate the strain ratio measurement of breast lesions, to calculate the diagnostic value and to provide practically oriented recommendations concerning execution. MATERIALS AND METHODS 117 breast lesions in 98 patients were included in the study. All lesions were examined by B-mode ultrasound and elastography using strain ratio measurement. The preinterventional findings of the different methods were compared to the final histopathological results. The sensitivity, specificity, positive and negative predictive value and the diagnostic accuracy were calculated for each method. RESULTS There was a significant difference between the strain ratio of malignant (mean 6.50; sd 3.03; 95 %-CI 5.68 - 7.33) and benign (mean 1.79; sd 3.83; 95 %-CI 0.92 - 2.75) lesions. The strain ratio showed a sensitivity of 92.6 % (95 %-CI 82.1 - 97.9) and a specificity of 95.2 % (95 %-CI 86.7 - 99.0). The positive and negative predictive values were 94.3 % and 93.7 %. B-mode ultrasound achieved a sensitivity of 94.4 % (95 %-CI 84.6 - 98.8) and a specificity of 87.3 % (95 %-CI 76.5 - 94.3). The positive and negative predictive values were 86.4 % and 94.8 %. CONCLUSION Strain ratio measurement of breast lesions is a standardized fast method for analyzing the stiffness inside the examined areas. Used as an additional tool to B-mode ultrasound, it helps to increase the specificity of the examination.
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Affiliation(s)
- A Farrokh
- Frauenklinik, Franziskus Hospital, Bielefeld, Germany.
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Wojcinski S, Farrokh A, Peisker U, Thomas A, Degenhardt F, Hahn M. Neue diagnostische Verfahren - Sono-Elastografie der Mamma. ACTA ACUST UNITED AC 2011. [DOI: 10.1055/s-0031-1275480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wojcinski S, Farrokh A, Weber S, Thomas A, Fischer T, Slowinski T, Schmidt W, Degenhardt F. Multicenter study of ultrasound real-time tissue elastography in 779 cases for the assessment of breast lesions: improved diagnostic performance by combining the BI-RADS®-US classification system with sonoelastography. Ultraschall Med 2010; 31:484-491. [PMID: 20408116 DOI: 10.1055/s-0029-1245282] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE Hitachi real-time tissue elastography (HI-RTE) is an ultrasound technique that facilitates the estimation of tissue elasticity. Our study evaluates whether sonoelastography improves the differentiation of benign and malignant breast lesions. MATERIALS AND METHODS In a multicenter approach sonoelastography of focal breast lesions was carried out in 779 patients with subsequent histological confirmation. We present data from 3 study centers (Berlin, Bielefeld, Homburg/Saar) focusing on the sensitivity (SE), specificity (SP) and the positive (PPV) and negative predictive value (NPV) of sonoelastography. In addition we performed an analysis of the diagnostic performance, expressed by the pretest and posttest probability of disease (POD), in BI-RADS®-US 3 or 4 lesions as these categories can imply both malignant and benign lesions and a more precise prediction would be a preferable aim. RESULTS Sonoelastography demonstrated an improved SP (89.5 %) and an excellent PPV (86.8 %) compared to B-mode ultrasound (76.1 % and 77.2 %). Especially in dense breasts ACR III-IV, the SP was even higher (92.8 %). In BI-RADS-US 3 lesions, a suspicious elastogram significantly modified the POD from 8.3 % to a posttest POD of 45.5 %. In BI-RADS-US 4 lesions, we found a pretest POD of 56.6 %. The posttest POD changed significantly to 24.2 % with a normal elastogram and to 81.5 % with a suspicious elastogram. CONCLUSION Our data demonstrates that the complementary use of sonoelastography definitely improves the performance in breast diagnostics. Finally we present a protocol of how sonoelastography can be integrated into our daily practice.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy
- Breast/pathology
- Breast Neoplasms/classification
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/classification
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/classification
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Lobular/classification
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Child
- Diagnosis, Differential
- Elasticity Imaging Techniques/instrumentation
- Equipment Design
- Female
- Fibroadenoma/classification
- Fibroadenoma/diagnostic imaging
- Fibroadenoma/pathology
- Fibrocystic Breast Disease/classification
- Fibrocystic Breast Disease/diagnostic imaging
- Fibrocystic Breast Disease/pathology
- Humans
- Image Interpretation, Computer-Assisted/instrumentation
- Middle Aged
- Reference Standards
- Sensitivity and Specificity
- Software
- Ultrasonography, Mammary/instrumentation
- Young Adult
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Affiliation(s)
- S Wojcinski
- Klinik für Frauenheilkunde und Geburtshilfe, Franziskus Hospital, Bielefeld, Germany.
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Thomas A, Degenhardt F, Farrokh A, Wojcinski S, Slowinski T, Fischer T. Significant differentiation of focal breast lesions: calculation of strain ratio in breast sonoelastography. Acad Radiol 2010; 17:558-63. [PMID: 20171905 DOI: 10.1016/j.acra.2009.12.006] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2009] [Revised: 12/01/2009] [Accepted: 12/01/2009] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES Initial data suggest that elastography can improve the specificity of ultrasound in differentiating benign and malignant breast lesions. The aim of this study was to compare elastography and B-mode ultrasound to determine whether the calculation of strain ratios (SRs) can further improve the differentiation of focal breast lesions. MATERIALS AND METHODS A total of 227 women with histologically proven focal breast lesions (113 benign, 114 malignant) were included at two German breast centers. The women underwent a standardized ultrasound procedure using a high-end ultrasound system with a 9-MHz broadband linear transducer. B-mode scans and sonoelastograms were analyzed by two experienced readers using the Breast Imaging Reporting and Data System criteria. SRs were calculated from a tumor-adjusted region of interest (mean color pixel density) and a comparable region of interest placed in the lateral fatty tissue. Sensitivity, specificity, and cutoff values were calculated for SRs (receiver-operating characteristic analysis). RESULTS The women had a mean age of 54 years (range, 19-87 years). The mean lesion diameter was 1.6 +/- 0.9 cm. Sensitivity and specificity were 96% and 56% for B-mode scanning, 81% and 89% for elastography, and 90% and 89% for SRs. An SR cutoff value of 2.45 (area under the curve, 0.949) allowed significant differentiation (P < .001) of malignant (mean, 5.1 +/- 4.2) and benign (mean, 1.6 +/- 1.0) lesions. The quantitative method of SR calculation was superior to subjective interpretation of sonoelastograms and B-mode scans, with a positive predictive value of 89% compared to 68% and 84% for the other two methods. CONCLUSIONS Calculation of SRs contributes to the standardization of sonoelastography with high sensitivity and allows significant differentiation of benign and malignant breast lesions with higher specificity compared to B-mode ultrasound but not elastography.
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Affiliation(s)
- Anke Thomas
- Department of Obstetrics and Gynecology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Kilbinger H, Farrokh A, Hohenfellner M, Mang CF. Nitrergic modulation of acetylcholine release in the enteric nervous system: differences between guinea-pig and man. Inflammopharmacology 2002. [DOI: 10.1163/156856002321544927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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