The biology of malignant breast tumors has an impact on the presentation in ultrasound: an analysis of 315 cases

BACKGROUND: The aim of this study was to evaluate the relation of some ultrasound morphological parameters to biological characteristics in breast carcinoma. METHODS: Ultrasound data from 315 breast masses were collected. We analyzed the ultrasound features of the tumors according to the ACR BI-RADS®-US classification system stratified by hormone receptor status, HER2 status, histology grade, tumor type (ductal versus lobular), triple-negativity, breast density, tumor size, lymph node involvement and patient’s age. RESULTS: We found a variety of ultrasound features that varied between the groups. Invasive lobular tumors were more likely to have an angulated margin (39% versus 22%, p = 0.040) and less likely to show posterior acoustic enhancement (3% versus 16%, p = 0.023) compared to invasive ductal carcinoma. G3 tumors were linked to a higher chance of posterior acoustic enhancement and less shadowing and the margin of G3 tumors was more often described as lobulated or microlobulated compared to G1/G2 tumors (67% versus 46%, p = 0.001). Tumors with an over-expression of HER2 exhibited a higher rate of architectural distortions in the surrounding tissue, but there were no differences regarding the other features. Hormone receptor negative tumors were more likely to exhibit a lobulated or microlobulated margin (67% versus 50%, p = 0.037) and less likely to have an echogenic halo (39% versus 64%, p = 0.001). Furthermore, the posterior acoustic feature was more often described as enhancement (33% versus 13%, p = 0.001) and less often as shadowing (20% versus 47%, p < 0.001) compared to hormone receptor positive tumors. CONCLUSION: Depending on their biological and clinical profile, breast cancers are more or less likely to exhibit the typical criteria for malignancy in ultrasound. Moreover, certain types of breast cancer tend to possess criteria that are usually associated with benign masses. False-negative diagnosis may result in serious consequences for the patient. For the sonographer it is essential to be well aware of potential variations in the ultrasound morphology of breast tumors, as described in this paper

GI2T/REGAIN spectro-interferometry with a new infrared beam combiner

We have built an infrared beam combiner for the GI2T/REGAIN interferometer of the Observatoire de la Cote d'Azur. The beam combiner allows us to record spectrally dispersed Michelson interference fringes in the near-infrared J-, H- or K-bands. The beam combiner has the advantage that Michelson interferograms can simultaneously be recorded in about 128 different spectral channels. The tilt of the spectrally dispersed fringes is a measure of the instantaneous optical path difference. We present the optical design of the beam combiner and GI2T/REGAIN observations of the Mira star R Cas with this beam combiner in the spectral range of 2.00 micron - 2.18 micron (observations on 22 and 25 August 1999; variability phase 0.08; V-magnitude approx. 6; seven baselines between 12m and 24m; reference stars Vega and Beta Peg). The spectrograph of the beam combiner consists of an anamorphotic cylindrical lens system, an image plane slit, and a grism. A system of digital signal processors calculates the ensemble average power spectrum of the spectrally dispersed Michelson interferograms and the instantaneous optical path difference error in real time. From the observed R Cas visibilities at baselines 12.0m, 13.8m and 13.9m, a 2.1 micron uniform-disk diameter of 25.3mas +/-3.3mas was derived. The unusually high visibility values at baselines >16m show that the stellar surface of R Cas is more complex than previously assumed. The visibility values at baselines >16m can be explained by high-contrast surface structure on the stellar surface of R Cas or other types of unexpected center-to-limb variations. The R Cas observations were compared with theoretical Mira star models yielding a linear Rosseland radius of 276Rsun +/-66Rsun and an effective temperature of 2685K+/-238K for R Cas at phase 0.08.Comment: 10 pages, 6 figures, see also http://www.mpifr-bonn.mpg.de/div/speckle, SPIE conf 4006 "Interferometry in Optical Astronomy", in pres

Perioperative morbidity of different operative approaches in early cervical carcinoma: a systematic review and meta-analysis comparing minimally invasive versus open radical hysterectomy

Purpose: Radical hysterectomy and pelvic lymphadenectomy is the standard treatment for early cervical cancer. Studies have shown superior oncological outcome for open versus minimal invasive surgery, but peri- and postoperative complication rates were shown vice versa. This meta-analysis evaluates the peri- and postoperative morbidities and complications of robotic and laparoscopic radical hysterectomy compared to open surgery. Methods: Embase and Ovid-Medline databases were systematically searched in June 2020 for studies comparing robotic, laparoscopic and open radical hysterectomy. There was no limitation in publication year. Inclusion criteria were set analogue to the LACC trial. Subgroup analyses were performed regarding the operative technique, the study design and the date of publication for the endpoints intra- and postoperative morbidity, estimated blood loss, hospital stay and operation time. Results: 27 studies fulfilled the inclusion criteria. Five prospective, randomized-control trials were included. Meta-analysis showed no significant difference between robotic radical hysterectomy (RH) and laparoscopic hysterectomy (LH) concerning intra- and perioperative complications. Operation time was longer in both RH (mean difference 44.79 min [95% CI 38.16; 51.42]), and LH (mean difference 20.96 min; [95% CI − 1.30; 43.22]) than in open hysterectomy (AH) but did not lead to a rise of intra- and postoperative complications. Intraoperative morbidity was lower in LH than in AH (RR 0.90 [0.80; 1.02]) as well as in RH compared to AH (0.54 [0.33; 0.88]). Intraoperative morbidity showed no difference between LH and RH (RR 1.29 [0.23; 7.29]). Postoperative morbidity was not different in any approach. Estimated blood loss was lower in both LH (mean difference − 114.34 [− 122.97; − 105.71]) and RH (mean difference − 287.14 [− 392.99; − 181.28]) compared to AH, respectively. Duration of hospital stay was shorter for LH (mean difference − 3.06 [− 3.28; − 2.83]) and RH (mean difference − 3.77 [− 5.10; − 2.44]) compared to AH. Conclusion: Minimally invasive radical hysterectomy appears to be associated with reduced intraoperative morbidity and blood loss and improved reconvalescence after surgery. Besides oncological and surgical factors these results should be considered when counseling patients for radical hysterectomy and underscore the need for new randomized trials. © 2021, The Author(s)

Auswirkung der wiederholten antenatalen Kortikosteroidbehandlung auf das intrauterine Wachstum und auf die Grössenentwicklung imKleinkindesalter

Objective:The evaluation of the effects of repeated antenatal corticosteriod (CS) medication on birth size and size at the age of 4 years. Methods: 82 children exposed to CS initially between 26 and 28 weeks of gestation were matched with 82 controls of the same gestational age and sex. Results: No differences were observed between the CS and control groups with regard to weight, head circumference, and length at birth and at the age of 4 years. Conclusions: Our study failed to demonstrate that repetitive antenatal medication with CS in order to induce lung maturation has a negative im pact on intrauterine growth and growth in early childhood. Copyright (C) 2001 S. Karger AG, Basel

Use of Surrogate end points in HTA

The different actors involved in health system decision-making and regulation have to deal with the question which are valid parameters to assess the health value of health technologies

Economic burden of vulvar and vaginal intraepithelial neoplasia: retrospective cost study at a German dysplasia centre

<p>Abstract</p> <p>Background</p> <p>Human papillomavirus is responsible for a variety of diseases including grade 2 and 3 vulvar and vaginal intraepithelial neoplasia. The aim of this study was to assess parts of the burden of the last diseases including treatment costs. The direct medical resource use and cost of surgery associated with neoplasia and related diagnostic procedures (statutory health insurance perspective) were estimated, as were the indirect costs (productivity losses) associated with surgical treatment and related gynaecology visits for diagnostic purposes.</p> <p>Methods</p> <p>Data from 1991-2008 were retrospectively collected from patient records of the outpatient unit of the Gynaecological Dysplasia Clinic, Heinrich Heine University, Dusseldorf, Germany. Two subgroups of patients were analysed descriptively: women undergoing one surgical procedure related to a diagnosis of vulvar and/or vaginal intraepithelial neoplasia, and women undergoing two or more surgical procedures. Target measures were per-capita medical resource consumption, direct medical cost and indirect cost.</p> <p>Results</p> <p>Of the 94 women analysed, 52 underwent one surgical intervention and 42 two or more interventions (mean of 3.0 interventions during the total period of analysis). Patients undergoing one surgical intervention accrued €881 in direct costs and €682 in indirect costs; patients undergoing more than one intervention accrued €2,605 in direct costs and €2,432 in indirect costs.</p> <p>Conclusions</p> <p>The economic burden on German statutory health insurance funds and society induced by surgical interventions and related diagnostic procedures for grade 2/3 vulvar and vaginal neoplasia should not be underrated. The cost burden is one part of the overall burden attributable to human papillomavirus infections.</p