Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition)

Granulomatous lobular mastitis (GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions, etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology. The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.Improving the Ability of Diagnosis and Treatment of Difficult Disease

Breast radiology practices during the Covid-19 pandemic

Meme kanseri taramasının en önemli amacı, kanserin erken evrede yakalanarak meme kanserine bağlı ölümlerin azaltılmasıdır. COVID-19 salgını, hastaların ve sağlık çalışanlarının sağlık durumu ile ilgili acil bir sorun olarak kısa bir süre önce dünya gündemini ve genel kaygıları değiştirmiştir. Hala meme taramanın amacı mortaliteyi azaltmaktır; ancak bunun COVID-19 (SARS-COV-2) kaynaklı ölümlere neden olmaması için ayrıntılı rehberler oluşturulmalıdır.The most important goal of breast cancer screening is to detect cancer at an early stage and reduce deaths due to breast cancer. The COVID-19 pandemic has recently changed the world agenda and general concerns as an urgent issue regarding the health status of patients and healthcare workers. Still, the goal of breast screening is to reduce mortality; However, detailed guidelines should be created so that this does not cause deaths from COVID-19 (SARS-COV-2)

Breast imaging for non-radiologists

Breast carcinoma is the most frequent malignant tumor among women worldwide, and the incidence is increasing in Turkey. Screening with imaging modalities can provide early and accurate identification, and result in a lower treatment burden. While mammography (MG) and ultrasonography (US) continue to be the principal imaging methods, breast magnetic resonance imaging (MRI) is a more advanced imaging tool. This narrative review examines imaging modalities (MG, US, and MRI), pathology, breast carcinoma screening, axilla and male breast cancer for specialists other than radiologists, such as residents and students

Diffusion-weighted imaging in ectopic pregnancy: Ring of restriction sign

WOS: 000423547100010PubMed ID: 29023142Objective: To demonstrate the diffusion-weighted imaging (DWI) findings of ectopic pregnancy (EP) and introduce the "ring of restriction" sign by discussing possible causes. Methods: Between January 2014 and January 2017, patients with EP and examined by MRI on a 3T scanner were retrospectively evaluated. MRI and DWI findings were recorded. Results: A total of 40 patients were diagnosed with EP at our university hospital, 8 of whom (20%) were evaluated by MRI and DWI. All of them were haemodynamically and clinically stable and could be imaged adequately. Locations were ovary (n = 3, 37.5%), tuba (n = 2, 25%), Caesarean section scar (n = 2, 25%) and parauterine (n = 1, 12.5%). In all eight EPs, the gestational sac diameter was compatible with 7-9 weeks. With DWI, the gestational sac was seen as a thick-walled cyst-like structure. The thick wall showed diffusion restrictions in all patients (ring of restriction sign). Conclusions: DWI through its cellular and molecular evidence may contribute diagnosis of EP

Is the necrosis/wall ADC ratio useful for the differentiation of benign and malignant breast lesions?

WOS: 000402802300017PubMed ID: 28339285Objective: To determine whether the necrosis/wall apparent diffusion coefficient (ADC) ratio is useful for the malignant-benign differentiation of necrotic breast lesions. Methods: Breast MRI was performed using a 3-T system. In this retrospective study, calculation of the necrosis/wall ADC ratio was based on ADC values measured from the necrosis and from the wall of malignant and benign breast lesions by diffusion-weighted imaging (DWI). By synchronizing post-contrast T1 weighted images, the separate parts of wall and necrosis were maintained. All the diagnoses were pathologically confirmed. Statistical analyses were conducted using an independent sample t-test and receiver operating characteristic analysis. The intraclass and interclass correlations were evaluated. Results: A total of 66 female patients were enrolled, 38 of whom had necrotic breast carcinomas and 28 of whom had breast abscesses. The ADC values were obtained from both the wall and necrosis. The mean necrosis/wall ADC ratio (6 standard deviation) was 1.6160.51 in carcinomas, and it was 0.6560.33 in abscesses. The area under the curve values for necrosis ADC, wall ADC and the necrosis/wall ADC ratio were 0.680, 0.068 and 0.942, respectively. A wall/necrosis ADC ratio cut-off value of 1.18 demonstrated a sensitivity of 97%, specificity of 93%, a positive-predictive value of 95%, a negative-predictive value of 96% and an accuracy of 95% in determining the malignant nature of necrotic breast lesions. There was a good intra- and interclass reliability for the ADC values of both necrosis and wall. Conclusion: The necrosis/wall ADC ratio appears to be a reliable and promising tool for discriminating breast carcinomas from abscesses using DWI. Advances in knowledge: ADC values of the necrosis obtained by DWI are valuable for malignant-benign differentiation in necrotic breast lesions. The necrosis/wall ADC ratio appears to be a reliable and promising tool in the breast imaging field

Does the cardiovascular drug levosimendan prevent iodinated contrast medium nephrotoxicity with glycerol aggravation in rats?

Background We investigated whether levosimendan prevents contrast medium nephrotoxicity with glycerol aggravation in rats. Methods Forty-eight Wistar albino rats were assigned to eight groups (n = 6 x 8). No medication was administered to group I (controls); glycerol (intramuscular injection of 25% glycerol, 10 mL/kg) group II; intravenous iohexol 10 mL/kg to group III; glycerol and iohexol to group IV; iohexol and intraperitoneal levosimendan 0.25 mg/kg to group V; glycerol, iohexol, and levosimendan 0.25 mg/kg to group VI; iohexol and levosimendan 0.5 mg/kg to group VII; and glycerol, iohexol, and levosimendan 0.5 mg/kg to group VIII. One-day water withdrawal and glycerol injection prompted renal damage; iohexol encouraged nephrotoxicity; levosimendan was administered 30 min after glycerol injection and continued on days 2, 3, and 4. The experiment was completed on day 5. Serum blood urea nitrogen (BUN) and creatinine levels, superoxide dismutase (SOD) activity, glutathione (GSH), malondialdehyde (MDA) levels, tumour necrosis factor-alpha (TNF-alpha), nuclear factor kappa ss (NFK-ss), interleukin 6 (IL-6), and histopathological marks were assessed. One-way analysis of variance and Duncan's multiple comparison tests were used. Results Levosimendan changed serum BUN (p = 0.012) and creatinine (p = 0.018), SOD (p = 0.026), GSH (p = 0.012), and MDA (p = 0.011). Levosimendan significantly downregulated TNF-alpha (p = 0.022), NFK-ss (p = 0.008), and IL-6 (p = 0.033). Histopathological marks of hyaline and haemorrhagic cast were improved in levosimendan-injected groups. Conclusion Levosimendan showed nephroprotective properties due to its vasodilator, oxidative distress decreasing and inflammatory cytokine preventing belongings

The benign mimickers of carcinoma on breast MRI

The similarity between benign and malignant pathologies on magnetic resonance imaging (MRI) and a wide-ranging variability of the lesions from benign proliferative changes to invasive breast carcinoma cause a lower and wide-ranging specificity of breast MRI relative to its surpass sensitivity. A wide range of tissue components such as the skin, the adipose tissue, vascular and neural tissues, connective tissues, glandular tissues, ducts, and muscle tissues are found here all together. This pictorial review was aimed at deliberating benign mimickers of breast carcinoma on MRI and trying to call attention to the overlapping and distinctive features

A novel approach to contrast-induced nephrotoxicity: The melatonergic agent agomelatine

WOS: 000376488500007PubMed ID: 26886874Objective: To study the potential nephroprotective role of agomelatine in rat renal tissue in cases of contrast-induced nephrotoxicity (CIN). The drug's action on the antioxidant system and proinflammatory cytokines, superoxide dismutase (SOD) activity, levels of glutathione (GSH) and malondialdehyde (MDA) and the gene expression of interleukin-6 (IL-6), tumour necrosis factor (TNF)-alpha and nuclear factor kappa B (NF-kappa B) was measured. Tubular necrosis and hyaline and haemorrhagic casts were also histopathologically evaluated. Methods: The institutional ethics and local animal care committees approved the study. Eight groups of six rats were put on the following drug regimens: Group 1: healthy controls, Group 2: GLY (glycerol), Group 3: CM (contrast media-iohexol 10 ml kg(-1)), Group 4: GLY+CM, Group 5: CM+AGO20 (agomelatine 20 mg kg(-1)), Group 6: GLY+CM1AGO20, Group 7: CM1AGO40 (agomelatine 40 mg kg(-1)) and Group 8: GLY+CM+AGO40. The groups were evaluated by one-way analysis of variance and Duncan's multiple comparison test. Results: Agomelatine administration significantly improved the serum levels of blood urea nitrogen (BUN) and creatinine, SOD activity, GSH and MDA. The use of agomelatine had substantial downregulatory consequences on TNF-alpha, NF-kappa B and IL-6 messenger RNA levels. Mild-to-severe hyaline and haemorrhagic casts and tubular necrosis were observed in all groups, except in the healthy group. The histopathological scores were better in the agomelatine treatment groups. Conclusion: Agomelatine has nephroprotective effects against CIN in rats. This effect can be attributed to its properties of reducing oxidative stress and inhibiting the secretion of proinflammatory cytokines (NF-kappa B, TNF-alpha and IL-6). Advances in knowledge: CIN is one of the most important adverse effects of radiological procedures. Renal failure, diabetes, malignancy, old age and nonsteroidal anti-inflammatory drug use pose the risk of CIN in patients. Several clinical studies have investigated ways to avoid CIN. Theophylline/aminophylline, statins, ascorbic acid and iloprost have been suggested for this purpose. Agomelatine is one of the melatonin ligands and is used for affective disorders and has antioxidant features. In this study, we hypothesized that agomelatine could have nephroprotective, antioxidant and anti-inflammatory effects against CIN in rats

Comparison of conventional MRI, MR arthrography, MR arthrography with traction, MR arthrography with pressure in the evaluation of articular distension

Objective: To evaluate the performance of conventional MRI, standard MR arthrography, MR arthrography with traction and MR arthrography with pressure in articular distension in patients with ACL injury. Design and patients: The consecutive patients (7 female, 21 male) with acute ACL injured conventional MRI, MR arthrography, MR arthrography with traction and MR arthrography with pressure were evaluated. Results: The amount of distension in the joint was evaluated in the posterior, femorotibial and anterior com- partments. Medially, between the meniscus posterior horn and the tibial corner, MRA with pressure was found to be more effective in showing this distance than MRA with traction (p < 0,05). Laterally, in measurements made between the posterior horn of the meniscus and the capsule, MRA with traction and MRA with pressure are more effective showing this distance than conventional MRI and standard MRA (p < 0,05). In measurements made medially, between the posterior horn of the meniscus and the capsule, MRA with traction is more effective in showing this distance than standard MRA (p < 0,05). In all three different MRA modalities, the lateral femo- rotibial joint distance was found to be statistically higher than conventional MRI (p < 0,05). Medial femorotibial joint distance was found to be statistically higher in MRA with pressure than in conventional MRI and standard MRA (p < 0,05). The medial infrapatellar distance was found to be statistically higher in MRA with pressure than standard MRA and MRA with traction (p < 0,05). The lateral infrapatellar distance is higher in MRA with pressure than in MRA with traction, and this height is statistically significant (p < 0,05). Conclusion: Traction and pressure applications added to MRA will increase the effectiveness of the method by increasing the distension in the knee joint. Although both seem to be effective in creating distension in posterior compartment and femorotibial joint distance, MRA with pressure is more effective especially in anterior compartment

Quantitative perfusion parameters of benign inflammatory breast pathologies: A descriptive study

Purpose: With this study, we evaluated the perfusion magnetic resonance imaging (MRI) features of benign inflammatory breast lesions for the first time and compared their Ktrans, Kep, Ve values and contrast kinetic curves to benign masses and invasive ductal carcinoma (IDC). Materials and methods: Perfusion MRIs of the benign masses (n = 42), inflammatory lesions (n = 25), and IDCs (n = 16) were evaluated retrospectively in terms of Ktrans, Kep, Ve values and contrast kinetic curves and compared by the Kruskal-Wallis, Mann-Whitney U, chi-square tests statistically. Cronbach α test was used to measure intraobserver and interobserver reliability. Results: Mean Ktrans values were 0.052 for benign masses, 0.086 for inflammatory lesions and 0.101 for IDC (p < 0.001). Mean Kep values were 0.241 for benign masses, 0.435 for inflammatory lesions and 0.530 for IDC (p < 0.001). Mean Ve values were 0.476 for benign masses, 0.318 for inflammatory lesions and 0.310 for IDC (p = 0.067). For inflammatory and IDC lesions, Ktrans and Kep values were found to be higher and Ve values were lower than benign masses (p = 0.001 for Ktrans, p = 0.001 for Kep, p = 0.045 for Ve). There were excellent or good intra-interobserver reliabilities. For the kinetic curve pattern, most of the benign lesions showed progressive (81%), inflammatory lesions progressive (64%) and IDC lesions plateau (75%) patterns (p < 0.001). Conclusions: On T1 perfusion MRI, similar to IDC lesions, inflammatory lesions demonstrate higher Ktrans and Kep and lower Ve values than benign masses. Quantitative perfusion parameters are not helpful in differentiating them from IDC lesions