Prediction of malignancy upgrade rate in high-risk breast lesions using an artificial intelligence model: a retrospective study

PURPOSEHigh-risk breast lesions (HRLs) are associated with future risk of breast cancer. Considering the pathological subtypes, malignancy upgrade rate differs according to each subtype and depends on various factors such as clinical and radiological features and biopsy method. Using artificial intelligence and machine learning models in breast imaging, evaluations can be made in terms of risk estimation in different research areas. This study aimed to develop a machine learning model to distinguish HRL cases requiring surgical excision from lesions with a low risk of accompanying malignancy.METHODSA total of 94 patients who were diagnosed with HRL by image-guided biopsy between January 2008 and March 2020 were included in the study. A structured database was created with clinical and radiological characteristics and histopathological results. A machine learning prediction model was created to make binary classifications of lesions as malignant or benign. Random forest, decision tree, K-nearest neighbors, logistic regression, support vector machine (SVM), and multilayer perceptron machine learning algorithms were used. Among these algorithms, SVM was the most successful. The estimations of malignancy for each case detected by artificial intelligence were combined and statistical analyses were performed.RESULTSConsidering all cases, the malignancy upgrade rate was 24.5%. A significant association was observed between malignancy upgrade rate and lesion size (P = 0.004), presence of mammography findings (P = 0.022), and breast imaging-reporting and data system category (P = 0.001). A statistically significant association was also found between the artificial intelligence prediction model and malignancy upgrade rate (P < 0.001). With the SVM model, an 84% accuracy and 0.786 area-underthe- curve score were obtained in classifying the data as benign or malignant.CONCLUSIONOur artificial intelligence model (SVM) can predict HRLs that can be followed up with a lower risk of accompanying malignancy. Unnecessary surgeries can be reduced, or second line vacuum excisions can be performed in HRLs, which are mostly benign, by evaluating on a case-by-case basis, in line with radiology–pathology compatibility and by using an artificial intelligence model

Çocukluk çağı romatolojik hastalıklarında kardiyovasküler sistem tutulumu

Inflammatory connective tissue diseases are multi-systemic and chronic processes. the morbidity and mortality in these diseases may be increased in the presence of cardiovascular manifestations. in this Article, the cardiovascular manifestations of some rheumatic conditions in childhood are reviewed in the light of the current literature.İnflamatuar bağ dokusu hastalıkları, multisistemik ve kronik seyirli durumlardır. Kardiyovasküler patolojiler bu hastalıkların artmış morbidite ve mortalitesi ile ilişkili bulunmuştur. Bu makalede çocukluk çağında görülen bazı romatolojik hastalıkların kardiyovasküler sistem komplikasyonları literatür eşliğinde tartışılmıştır

SENTİNEL LENF NODU BİYOPSİSİ KLİNİK SONUÇLARI VE NOMOGRAMIN KULLANILABİLİRLİĞİ

Giriş: Bu retrospektif çalışmayı sentinel lenf nodu risk faktörlerini veMemorial Sloan-Kettering Cancer Center(MSKCC) nomogramının kendi hasta grubumuzda kullanılabilirliğini incelemek amacıyla planladık. Gereç ve yöntem: 740 hastamızın dosyaları retrospektif olarak incelendi. Her hastanın sonuçları MSKCC grubunun 2003’de hazırladığı sentinel lenf nodu için tahmin nomogramına girilerek SLN tahmin değeri alındı. ROC analizi ile klinik olarak kullanılabilirliği incelenmiştir. Bulgular: Mutivarite analiz sonucumuza göre prognostik faktör olabilecek değişkenlerimiziçinden lenfovasküler invazyon, yaş ve progesteron reseptörü sentinel lenf nodu metastazı ileilişkili bulunmuştur.ROC curve eğrisinin altında kalan alan 0.749 olarak bulunmuştur. Bu değer MSKCC SLN tahmin nomogramının bizim hasta grubumuz için kullanışlı olduğunu göstermektedir Tartışma: MSKCC SLN nomogramının kullanışlı olduğunu ve %17.5 cut-off değeri ile sentinel lenf nodu biyopsi ihtiyacı kalmadan hastanın aksiler lenf nodu negatif hasta olarak kabul edilip, hastanın evrelendirilebileceği söylenebilir.Introduction: In this retrospective study we aimed to assess if the risk factors and MSKCC nomogram can be used in predicting the axillary metastasis in our patient group Materials and Methods: The records of 740 patients treated in our hospital were retrospectively investigated. The Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram was applied for each patient and the clinical validity was assessed by ROC analysis. Results: The multivariate analyses revealed that lymphovasculary invasion, age and progesteron receptor were related to sentinel lymph node metastasis. The ROC AUC was calculated as 0.749. These results show that MSKCC SLN nomogram can be used in our patient group. Discussion: We can assert that MSKCC SLN nomogram is a useful tool and the patient can be considered as axillary lymph node negative patient without any requirement for sentinel lymph node biopsy when the cut-off value is considered as 17.5%

Sentinel Lenf Nodu Biyopsisi Klinik Sonuçları ve Nomogramın Kullanılabilirliği

Introduction: in this retrospective study we aimed to assess if the risk factors and MSKCC nomogram can be used in predicting the axillary metastasis in our patient group Materials and Methods: the records of 740 patients treated in our hospital were retrospectively investigated. the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram was applied for each patient and the clinical validity was assessed by ROC analysis. Results: the multivariate analyses revealed that lymphovasculary invasion, age and progesteron receptor were related to sentinel lymph node metastasis. the ROC AUC was calculated as 0.749. These results show that MSKCC SLN nomogram can be used in our patient group. Discussion: We can assert that MSKCC SLN nomogram is a useful tool and the patient can be considered as axillary lymph node negative patient without any requirement for sentinel lymph node biopsy when the cut-off value is considered as 17.5%.Giriş: Bu retrospektif çalışmayı sentinel lenf nodu risk faktörlerini veMemorial Sloan-Kettering Cancer Center(MSKCC) nomogramının kendi hasta grubumuzda kullanılabilirliğini incelemek amacıyla planladık. Gereç ve yöntem: 740 hastamızın dosyaları retrospektif olarak incelendi. Her hastanın sonuçları MSKCC grubunun 2003’de hazırladığı sentinel lenf nodu için tahmin nomogramına girilerek SLN tahmin değeri alındı. ROC analizi ile klinik olarak kullanılabilirliği incelenmiştir. Bulgular: Mutivarite analiz sonucumuza göre prognostik faktör olabilecek değişkenlerimiziçinden lenfovasküler invazyon, yaş ve progesteron reseptörü sentinel lenf nodu metastazı ileilişkili bulunmuştur.ROC curve eğrisinin altında kalan alan 0.749 olarak bulunmuştur. Bu değer MSKCC SLN tahmin nomogramının bizim hasta grubumuz için kullanışlı olduğunu göstermektedir Tartışma: MSKCC SLN nomogramının kullanışlı olduğunu ve %17.5 cut-off değeri ile sentinel lenf nodu biyopsi ihtiyacı kalmadan hastanın aksiler lenf nodu negatif hasta olarak kabul edilip, hastanın evrelendirilebileceği söylenebilir

CRISPR-dCas9 powered impedimetric biosensor for label-free detection of circulating tumor DNAs

Uygun, Zihni Onur/0000-0001-9045-7271WOS: 000537663300005PubMed: 32493587Label-free biosensors which can be integrated into lab-on-a-chip platforms have the advantage of using small volumes for rapid and inexpensive measurements contrary to label-based technologies which are often more costly and time-consuming. in this study, graphene oxide screen printed electrodes (GPHOXE) were modified by deactivated Cas9 (dCas9) proteins and synthetic guide RNA (sgRNA) as the biorecognition receptor for label-free detection of circulating tumor DNAs (ctDNA). This was achieved by detection of a tumor related mutation (PIK3CA exon 9 mutation) via sequence-specific recognition followed by electrochemical impedance spectroscopy (EIS) analysis. the biosensor showed high specificity as there was no impedance signal for other ctDNA sequences, even the single nucleotide mismatch. dCas9-sgRNA modified biosensor demonstrated linear detection limits between 2 and 20 nM for 120 bp ctDNA's in 40 s. the calibration curve showed good linearity, LOD was calculated as 0.65 nM and LOQ was calculated as 1.92 nM. Selectivity and repeatability studies were carried out in real blood samples and the recovery was higher than 96%. in conclusion, dCas9-sgRNAwas effectively immobilized and optimized on GPHOXE as the selective biorecognition receptor of this ultrafast impedimetric biosensor. the CRISPRd-Cas9 powered impedimetric system showed good selectivity, high repeatability and good recovery properties. This is the first literature to report the use of CRISPR/Cas technology as a label-free tool that can be used in an impedimetric system for detection of ctDNA's. (C) 2020 Elsevier B.V. All rights reserved.Scientific and Technological Research Council of TurkeyTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [TUBITAK-1001, 217S353]This study was supported by the Scientific and Technological Research Council of Turkey (TUBITAK-1001) with the project number of 217S353

Severe decrease in SpO2 and methemoglobinemia following subareolar isosulfan blue administration and clinical relevance

The level of axillary lymph node involvement in breast cancer is a critical decision factor for adjuvant therapy and the most important indicator of prognosis and survival. Sentinel lymph node biopsy is a minimally invasive technique with low morbidity in axillary staging of breast cancer. Radiocolloid substances (Technetium-99m) and/or blue dyes such as methylene blue or isosulfan blue are used during sentinel lymph node biopsy. Isosulfan blue stain is frequently used in sentinel lymph node biopsy and rarely causes complications. The present case report presents a severe decrease in SpO2 due to methemoglobinemia following isosulfan blue administration as well as skin and urine signs and inconsistency with clinical picture in a 67-year-old, 77 kg, ASA II female case who underwent sentinel lymph node biopsy under general anesthesia

Problematic Aspects of Sentinel Lymph Node Biopsy and Its Relation to Previous Excisional Biopsy in Breast Cancer

WOS: 000272363600003PubMed ID: 20139816Purpose: The aim of the study is to review problematic aspects of sentinel lymph node biopsy (SLNB) and to evaluate the influence of a previous excisional biopsy on these problems. Materials and Methods: A total of 345 patients were evaluated retrospectively, 156 of them had a previous biopsy. Tc-99m tin colloid was injected the day before surgery at 4 quadrants around the areola intradermally. Problems complicating SLNB are reviewed in 3 topics: visualization or gamma probe detection problems, dilated lymphatic channels, and misleading activity accumulation. Results: SLN detection rate and mean sentinel lymph node numbers were as follows in patients with and without biopsy, respectively: 95.5% versus 99.4% and 1.71 +/- 0.97 versus 1.70 +/- 0.92. Problems complicating the procedure occurred in 20 patients (5.8%). Among these 20 patients, 15 had a prior excisional biopsy, and incisions were located in the upper, outer and periareolar zones. Visualization or gamma probe detection problems occurred in 8 patients. Except for one with faint uptake in a sentinel node, all had a prior biopsy. Lymphatic channel dilatation complicated the procedure in 7 patients. Of these 7 patients, 4 had a previous biopsy. Misleading activity accumulations compromised SLNB in 5 patients, 4 of whom had a prior biopsy. Conclusion: Although SLNB is still applicable with a high success rate in cases with excisional biopsy, a review of problematic aspects of SLNB demonstrated a relation with the presence of a previous biopsy and its localization. The demonstration of nonvisualization preoperatively and the precise localization of atypically located activity accumulation may be helpful in the prevention of potential complications