Agreement between dynamic contrast-enhanced magnetic resonance imaging and pathologic tumour size of breast cancer and analysis of the correlation with BI-RADS descriptors

Purpose: The purpose of this study was to evaluate magnetic resonance imaging (MRI)-pathology concordance of tumour size in patients with invasive breast carcinoma, with an emphasis on Breast Imaging Reporting and Data System (BI-RADS) descriptors of dynamic contrast-enhanced MRI (DCE-MRI). Material and methods: Of patients who had preoperative DCE-MRI, 94 were enrolled. Concordance between MRI and the pathological findings was defined as a difference in tumour size of 5 mm or less. The greatest dimension was measured by two radiologists, and BI-RADS descriptives were described in accordance. The gold standard was chosen as the pathologic assessment. Results: Tumour measurements determined by MRI and the pathological reports were not statistically different (2.64 ± 1.16 cm, Wilcaxon Z = -1.853, p = 0.064). Tumour sizes were concordant in 72/94 patients (76.6%). The mean difference between the pathological and MRI tumour sizes was -0.1 cm. MRI overestimated the size of 17/94 tumours (18.1%) and underestimated the size of 5/94 tumours (5.3%). Discordance was associated with larger tumour size. Histologic and molecular type of tumours, patient age, histologic grade, lymphovascular invasion or perineural invasion positivity, fibroglandular volume, background parenchymal enhancement, and being mass or non-mass were not associated with concordance. Irregular margin and heterogenous enhancement in DCE-MRI were associated with discordance in logistic regression analysis (p = 0.035, OR: 4.24; p = 0.021, OR: 4.96). Conclusions: Two BI-RADS descriptors of irregular contour and heterogeneous contrast uptake were found to be associated with tumour size discrepancy. This might be attributed to the dynamic and morphologic specialities of tumours primarily rather than tumour biology

Analysis of Obesity And Axillary Lymph Nodes on Mammography

Fat-infiltrated lymph nodes mostly seen on mammograms (MG) of the elderly and obese women. We analyzed the fat infiltration of lymph nodes for its potential use in estimating body mass index (BMI). 2D digital MG of 157 women assessed by one breast radiologist and one radiology resident. For each patient, the largest lymph node chosen as the index by analyzing the medial, lateral oblique (MLO) views. The width and length of the node and the hilum, the cortex, and the Hilo-cortical ratio (HCR) were measured. Breast density was categorized according to the ACR BI-RADS 4th edition and divided into two groups as dense and non-dense. Obesity was defined as BMI ≥ 30 kg/m2, overweight as BM

Comparison of ultrasound, mammography and histopathology findings of the cases with gynecomastia

Background: Gynecomastia is the development of a fibroepithelial structure in the male breast as a result of many benign and malignant effects. In this study, after the confirmation of gynecomastia diagnosis in the male cases with swelling, mass and tenderness in the breast using ultrasound and mammography examinations, its etiology was clarified by laboratory tests. In case of suspicion, the diagnosis was confirmed using Fine-Needle Aspiration Biopsy (FNAB). The adequacy of ultrasound and mammography was discussed with the obtained information and the information in the literature, and the etiological and radiological classification was done.Methods: Ultrasound and mammography examinations were performed on 74 male patients with growth, palpable masses or pain in the breast. Biochemistry and hormone analysis were performed with imaging methods in the cases of possible gynecomastia. Biopsy was performed on the cases with the suspicion.Results: Gynecomastia were divided into three types in ultrasonic and mammographic examination. The most frequent gynecomastia was observed as Type 3 (51.43%) in ultrasonic examination and as diffuse type (61.42%) in mammographic examination. Pain and tenderness accompanied with swelling at the breast were present in 37.84% of the cases. 31.42% had pubertal gynecomastia, 25.71% had gynecomastia secondary to drug use, and 15% had idiopathic gynecomastia.Conclusions: Combined use of ultrasound and mammography in the diagnosis and classification of gynecomastia is highly sufficient and biopsy should be performed if malignancy is suspected.

Sex Estimation From Sternal Measurements Using Multidetector Computed Tomography

We aimed to show the utility and reliability of sternal morphometric analysis for sex estimation. Sex estimation is a very important step in forensic identification. Skeletal surveys are main methods for sex estimation studies. Morphometric analysis of sternum may provide high accuracy rated data in sex discrimination. In this study, morphometric analysis of sternum was evaluated in 1mm chest computed tomography scans for sex estimation. Four hundred forty 3 subjects (202 female, 241 male, mean age: 44 +/- 8.1 [ distribution: 30-60 year old]) were included the study. Manubrium length (ML), mesosternum length (2L), Sternebra 1 (S1W), and Sternebra 3 (S3W) width were measured and also sternal index (SI) was calculated. Differences between genders were evaluated by student t-test. Predictive factors of sex were determined by discrimination analysis and receiver operating characteristic (ROC) analysis. Male sternalmeasurement values are significantly higher than females (P< 0.001) while SI is significantly low in males (P< 0.001). In discrimination analysis, MSL has high accuracy rate with 80.2% in females and 80.9% in males. MSL also has the best sensitivity (75.9%) and specificity (87.6%) values. Accuracy rates were above 80% in 3 stepwise discrimination analysis for both sexes. Stepwise 1(ML, MSL, S1W, S3W) has the highest accuracy rate in stepwise discrimination analysis with 86.1% in females and 83.8% in males. Our study showed that morphometric computed tomography analysis of sternum might provide important information for sex estimation

Sex estimation in a Turkish population using Purkait’s triangle: a virtual approach by 3-dimensional computed tomography (3D-CT)

Sex estimation is considered one of the first steps in the forensic identification process. Morphological and morphometrical differences between males and females have been used as means for morphoscopic and metric methods on both cranial and postcranial skeletal elements. When dry skeletal elements are not available, virtual data can be used as a substitute. The present research explores 3-dimensional (3D) scans from a Turkish population to test a sex estimation method developed by Purkait (2005). Overall, 296 individuals were used in this study (158 males and 138 females). Purkait’s triangle parameters were measured on computed tomography (CT) scans obtained from both right and left femora of each patient at the Bakirkoy Dr. Sadi Konuk Training Research Hospital (Istanbul, Turkey). Intra- and inter-observer errors were assessed for all variables through technical error of measurements analysis. Bilateral asymmetry and sex differences were evaluated using parametric and non-parametric statistical approaches. Univariate and multivariate discriminant function analyses were then conducted. Observer errors demonstrated an overall agreement within and between experts, as indicated by technical error of measurement (TEM) results. No bilateral asymmetries were reported, and all parameters demonstrated a statistically significant difference between males and females. Fourteen discriminant models were generated by applying single and combined parameters, producing a total correct sex classification ranging from 78.4% to 92.6%. In addition, over 67% of the total sample was accurately classified, with 95% or greater posterior probabilities. Our study demonstrates the feasibility of 3D sex estimation using Purkait’s triangle on a Turkish population, with accuracy rates comparable to those reported in other populations. This is the first attempt to apply this method on virtual data and although further validation and standardisation are recommended for its application on dry bone, this research constitutes a significant contribution to the development of population-specific standards when only virtual data are available

Virtual morphometric method using seven cervical vertebrae for sex estimation on the Turkish population

Sex estimation from skeletal remains is crucial for the estimation of the biological profile of an individual. Although the most commonly used bones for means of sex estimation are the pelvis and the skull, research has shown that acceptable accuracy rates might be achieved by using other skeletal elements such as vertebrae. This study aims to contribute to the development of sex estimation standards from a Turkish population through the examination of CT scans from the seven cervical vertebrae. A total of 294 individuals were included in this study. The CT scans were obtained from patients attending the Bakirkoy Training and Research Hospital (Turkey) and the data was collected retrospectively by virtually taking measurements from each cervical vertebrae. The full database was divided into a training set (N = 210) and a validation set (N = 84) to test the fit of the models. Observer error was assessed through technical error of measurement and sex differences were explored using parametric and non-parametric approaches. Logistic regression was applied in order to explore different combinations of vertebral parameters. The results showed low intra- and inter-observer errors. All parameters presented statistically significant differences between the sexes and a total of 15 univariate and multivariate models were generated producing accuracies ranging from a minimum of 83.30% to a maximum of 91.40% for a model including three parameters collected from four vertebrae. This study presents a virtual method using cervical vertebrae for sex estimation on the Turkish population providing error rates comparable to other metric studies conducted on the postcranial skeleton. The presented results contribute not only to the development of population-specific standards but also to the generation of virtual methods that can be tested, validated, and further examined in future forensic cases

Učinak mamografskog postupka na serumske razine upalnih i/ili tumorskih biljega

Mammography is one of the gold standard screening tests for breast cancer. The effects of mammography procedure on blood parameters are not known. This study aimed to investigate whether the procedure-associated breast compression affects the widely and simultaneously performed blood measurements of C-reactive protein (CRP), carcinoembryonic antigen (CEA), and cancer antigen (CA) 15-3. According to breast ultrasound examination results, participants were divided into 3 groups as follows: group 1 (participants with breast mass size ≥20.0 mm, n=48); group 2 (participants with breast mass size <20.0 mm, n=17); and group 3 (participants with no breast mass, n=23). In groups 1 and 2, on the day of the mammographic imaging study, serum CRP, CEA, and CA 15-3 levels were measured before and after the imaging study. Participants in group 3 had their blood parameters measured without mammography and/or any breast compression. Post-mammography blood measurements displayed a significant increase in serum CRP levels, and a significant decrease in serum CEA and CA 15-3 levels in group 1 (in comparison with the same day pre-mammography blood sampling levels; p<0.05 all). Although pre-mammography serum CEA levels in group 1 participants were significantly higher than those in group 2 and 3 participants, this significant elevation became nonsignificant at post-mammography measurements (p0.05, respectively). On the day of the mammographic imaging study, the optimal time of blood sampling for testing CRP, CEA and CA 15-3 levels in persons with a breast mass is before, but not after the mammographic imaging procedure. This issue requires additional detailed studies.Mamografija je jedan od ‘zlatnih’ standardnih testova probira za rak dojke. Učinci mamografskog postupka na krvne parametre nisu poznati. Cilj ovog istraživanja bio je ispitati djeluje li kompresija dojke povezana s ovim postupkom na često i istodobno izvođena mjerenja C-reaktivnog proteina (CRP), karcinoembrijskog antigena (CEA) i karcinom antigen (CA) 15-3 u krvi. Ispitanice su podijeljene u 3 skupine prema rezultatima ultrazvučnog pregleda dojki: 1. skupina (ispitanice s masom u dojci ≥20,0 mm, n=48); 2. skupina (ispitanice s masom u dojci <20,0 mm, n=17); 3. skupina (ispitanice bez mase u dojci, n=23). U 1. i 2. skupini serumske razine CRP, CEA i CA 15-3 mjerene su prije i nakon mamografskog postupka. Kod ispitanica 3. skupine krvni parametri mjereni su bez mamografije i/ili bilo kakve kompresije dojke. Mjerenja provedena nakon mamografije pokazala su značajan porast serumskih razina CRP i značajan pad serumskih razina CEA i CA-15-3 u 1. skupini u usporedbi s razinama tih parametara zabilježenim istoga dana prije mamografije (p<0,05 sve). Iako su razine CEA u serumu prije mamografije bile značajno više u 1. skupini u usporedbi s 2. i 3. skupinom, značajnost tog porasta izgubila se kod mjerenja nakon mamografije (p0,05). Dakle, u danu kad je zakazana mamografija optimalno vrijeme za uzorkovanje krvi za mjerenje razina CRP, CEA i CA 15-3 kod osoba s masom u dojci je prije, a ne poslije mamografskog postupka. Ovo pitanje zahtijeva daljnje podrobne studije

Retrospektivna analiza graničnih tumora jajnika: ishodi u jednom centru

We wanted to discuss our experiences in the approach to borderline ovarian tumors, which constitute a group different from epithelial ovarian tumors with respect to their biological structure in line with retrospective information gathered from our cases. A total of 25 patients operated on for the indication of adnexal masses diagnosed as borderline ovarian tumors based on frozen section results were included in our study. Patient age, tumor diameter, tumor markers and surgeries performed were discussed in the light of the literature. Statistical analyses were performed using the SPSS software. The patient mean age was 43.84±11.34 years. The mass was localized in the right (n=13), left (n=11) or both (n=1) adnexal regions. The mean tumor diameter was 12.9±5.84 cm. Histopathologic examination established the diagnosis of serous borderline (n=14 patients) and mucinous borderline (n=11) ovarian tumors. Although the results of our study are consistent with current literature data, a greater number of current studies should be performed on borderline ovarian tumors, which are defined as a class of tumors different from epithelial ovarian tumors.Želja nam je opisati naša iskustva u pristupu graničnim tumorima jajnika kao skupini tumora koji se razlikuju od epitelnih tumora jajnika prema biološkoj strukturi, sukladno retrospektivnim podacima prikupljenim iz naših slučajeva. U istraživanje je bilo uključeno 25 bolesnica operiranih pod indikacijom adneksnih tvorevina dijagnosticiranih kao granični tumori jajnika na osnovi rezultata dobivenih iz zamrznutih uzoraka. Prikazani su sljedeći podaci bolesnica: dob, promjer tumora, tumorski biljezi i izvedeni operativni zahvati, u odnosu na literaturne podatke. Statistička analiza je provedena primjenom programa SPSS. Srednja dob bolesnica bila je 43,84±11,34 godine. Tumorska masa bila je smještena u desnoj (n=13) ili lijevoj (n=11) adneksnoj regiji, a kod jedne bolesnice u objema adneksnim regijama. Srednji promjer tumora bio je 12,9±5,84 cm. Histopatološkom analizom postavljena je dijagnoza seroznog graničnog (n=14) i mucinoznog graničnog (n=11) tumora jajnika. Iako su rezultati ovoga istraživanja sukladni literaturnim podacima, potrebno je provesti veći broj studija graničnih tumora jajnika, koji se definiraju kao vrsta tumora različita od epitelnih tumora jajnika

Psychiatric Comorbidity in the Subtypes of ADHD in Children and Adolescents with ADHD According to DSM-IV

Introduction: The prevalence rate of psychiatric comorbidity in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) was 60-80%. The objective of this study was to examine comorbid disorders associated with ADHD and the subtypes of ADHD in children and adolescents with the diagnosis of ADHD. Method: The study included 326 children and adolescents aged between 8-15 years who were diagnosed with ADHD for the first time as a result of an interview by psychiatry, in a child adolescent psychiatry clinic in Izmir. Sociodemographic form, Turgay DSM-IV Disruptive Behavior Disorders Rating Scale and Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version were used to assess psychiatric comorbidity. Results: The comorbidities accompanied ADHD were disruptive behavior disorder (28.8%), depressive disorder (13.2%), obsessive-compulsive disorder (9.5%) and anxiety disorder (6.1%), in respectively. When the subtypes of ADHD were assessed according to psychiatric comorbidity, oppositional defiant disorder and conduct disorder were frequently seen with ADHD combined type, whereas anxiety disorder was seen more frequent in children diagnosed with ADHD inattentive type. Discussion: Especially the presents of comorbidities in cases with ADHD Combined type increases the severity of disease, causes to retard in responses to treatment and exacerbates prognosis. Therefore, it is very important to determine which psychiatric diagnosis accompany with ADHD

Increased cerebral blood flow in the right anterior cingulate cortex and fronto-orbital cortex during go/no-go task in children with ADHD

Objective Arterial spin labeling (ASL) is a relatively new imaging modality in the field of the cognitive neuroscience. In the present study, we aimed to compare the dynamic regional cerebral blood flow alterations of children with ADHD and healthy controls during a neurocognitive task by using event-related ASL scanning. Methods The study comprised of 17 healthy controls and 20 children with ADHD. The study subjects were scanned on 3 Tesla MRI scanner to obtain ASL imaging data. Subjects performed go/no-go task during the ASL image acquisition. The image analyses were performed by FEAT (fMRI Expert Analysis Tool) Version 6. Results The mean age was 10.88 +/- 1.45 and 11 +/- 1.91 for the control and ADHD group, respectively (p = .112). The go/no-go task was utilized during the ASL scanning. The right anterior cingulate cortex (BA32) extending into the frontopolar and orbitofrontal cortices (BA10 and 11) displayed greater activation in ADHD children relative to the control counterparts (p < .001). With a lenient significance threshold, greater activation was revealed in the right-sided frontoparietal regions during the go session, and in the left precuneus during the no-go session. Conclusion These results indicate that children with ADHD needed to over-activate frontopolar cortex, anterior cingulate as well as the dorsal and ventral attention networks to compensate for the attention demanded in a given cognitive task