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Fang C, Garzillo G, Batohi B, Teo JTH, Berovic M, Sidhu PS, Robbie H. Extent of pulmonary thromboembolic disease in patients with COVID-19 on CT: relationship with pulmonary parenchymal disease. Clin Radiol 2020; 75:780-788. [PMID: 32684301 PMCID: PMC7351373 DOI: 10.1016/j.crad.2020.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/07/2020] [Indexed: 01/11/2023]
Abstract
AIM To report the severity and extent of pulmonary thromboembolic disease (PTD) in COVID-19 patients undergoing computed tomography pulmonary angiography (CTPA) in a tertiary centre. MATERIALS AND METHODS This is a retrospective analysis of COVID-19 patients undergoing CTPA over a period of 27 days. The presence, extent, and severity of PTD were documented. Two observers scored the pattern and extent of lung parenchymal disease including potential fibrotic features, as well as lymph node enlargement and pleural effusions. Consensus was achieved via a third observer. Interobserver agreement was assessed using kappa statistics. Student's t-test, chi-squared, and Mann-Whitney U-tests were used to compare imaging features between PTD and non-PTD sub-groups. RESULTS During the study period, 100 patients with confirmed COVID-19 underwent CTPA imaging. Ninety-three studies were analysed, excluding indeterminate CTPA examinations. Overall incidence of PTD was 41/93 (44%) with 28/93 patients showing small vessel PTD (30%). D-dimer was elevated in 90/93 (96.8%) cases. A high Wells' score did not differentiate between PTD and non-PTD groups (p=0.801). The interobserver agreement was fair (kappa=0.659) for parenchymal patterns and excellent (kappa=0.816) for severity. Thirty-four of the 93 cases (36.6%) had lymph node enlargement; 29/34 (85.3%) showed no additional source of infection. Sixteen of the 93 (17.2%) cases had potential fibrotic features. CONCLUSION There is a high incidence of PTD in COVID-19 patients undergoing CTPA and lack of a risk stratification tool. The present data indicates a higher suspicion of PTD is needed in severe COVID-19 patients. The concomitant presence of possible fibrotic features on CT indicates the need for follow-up.
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Affiliation(s)
- C Fang
- Department of Radiology, King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London SE5 9RS, UK
| | - G Garzillo
- Department of Radiology, King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London SE5 9RS, UK.
| | - B Batohi
- Department of Radiology, King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London SE5 9RS, UK
| | - J T H Teo
- Department of Neurology, King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London SE5 9RS, UK
| | - M Berovic
- Department of Radiology, King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London SE5 9RS, UK
| | - P S Sidhu
- Department of Radiology, King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London SE5 9RS, UK
| | - H Robbie
- Department of Radiology, King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London SE5 9RS, UK
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Batohi B, Fang C, Michell MJ, Morel J, Shah C, Wijesuriya S, Peacock C, Rahim R, Wasan R, Goligher J, Satchithananda K. An audit of mammographic screen detected lesions of uncertain malignant potential (B3) diagnosed on initial image guided needle biopsy: how has our practice changed over 10 years? Clin Radiol 2019; 74:653.e19-653.e25. [PMID: 31078275 DOI: 10.1016/j.crad.2019.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/03/2019] [Indexed: 11/25/2022]
Abstract
AIM To review all cases of B3 lesion diagnosed at initial image-guided needle biopsy over two 5-year cohorts to identify upgrade rates to malignancy and the effect of changing guidance on the management of such lesions. MATERIALS AND METHODS Data was collected retrospectively. Mammographic features, biopsy type and management were recorded for each lesion. Upgrade rates for each B3 histological category were quantified. Statistical analysis was performed using SPSS. RESULTS There were 224 cases in 2005-2010 and 240 cases in 2010-2015. Mammographically 211 lesions were microcalcifications, 182 masses, 65 distortions and six asymmetric densities with no difference in the mammographic features in the two cohorts. Two hundred and eight 14 G core biopsies and 256 initial vacuum-assisted biopsies were performed. There was a statistically significant reduction in benign surgical biopsies and an increase in second-line vacuum biopsy/excision in the latter cohort, with no significant change in the upgrade rate. There was an overall 6% upgrade to invasive malignancy and 13% upgrade to ductal carcinoma in situ (DCIS). The upgrade rates for the following histological categories were atypical intraductal epithelial proliferation (AIDEP) 33.2% (21/63); classical (not pleomorphic) in situ lobular neoplasia (ISLN) 18.2% (6/33); flat epithelial hyperplasia (FEA) 21.7% (20/92); papilloma with atypia 53.8% (7/13), without atypia 12.1% (8/66); and radial scar/complex sclerosing lesion with atypia 16.7% (2/12), and without atypia 7.9% (6/76). CONCLUSION Upgrade rates remain high for some histological categories even with first-line use of vacuum biopsy. Management of borderline lesions should be considered carefully in a multidisciplinary meeting. In many cases, the need for diagnostic surgical excision has been replaced by image-guided vacuum sampling.
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Affiliation(s)
- B Batohi
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
| | - C Fang
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - M J Michell
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - J Morel
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - C Shah
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - S Wijesuriya
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - C Peacock
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - R Rahim
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - R Wasan
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - J Goligher
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - K Satchithananda
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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Batohi B, Rahim R, Adejolu M, Michell M. PB.41: Audit of screening-detected breast cancers with discordant interpretations on double-read screening mammography. Breast Cancer Res 2013. [PMCID: PMC3980438 DOI: 10.1186/bcr3541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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