Accuracy Of Ultrasound Diagnosis Research Articles

Rapunzel syndrome in children: a retrospective review of ten cases combined with literature review in a tertiary referral center.

Rapunzel syndrome is an uncommon condition in children, and its clinical features remain unclear. This study presents the largest single-center series of pediatric cases to date, with the objective of documenting the clinical characteristics and treatment approaches for children with Rapunzel syndrome. A retrospective study was conducted in children with Rapunzel syndrome from 2019 to 2023. We recorded age, gender, symptoms, locations of bezoar, complications, and treatment options. Ten patients with Rapunzel syndrome were included. The median age was 9.1years, with all of whom were female. The most common clinical symptoms were upper abdominal mass (90%), abdominal pain (80%), and nausea and vomiting (50%). Complications occurred in six cases (60%), including small bowel obstruction (20%), severe gastric dilatation (10%), intestinal perforation (10%), choledochodilation (10%), acute pancreatitis with cholecystitis (10%). Preoperative ultrasonography suggested low-echoic foreign bodies continuing to the jejunum or ileocecal region in five cases (50%). Preoperative gastroscopy attempted in four cases (40%) to remove the foreign bodies, all of which failed. All patients underwent surgical treatment, with nine cases undergoing gastric incision foreign body removal, and one case undergoing gastric incision foreign body removal combined with intestinal perforation repair. All patients recovered well. No recurrence was observed during follow-up. The accuracy of ultrasound diagnosis in identifying Rapunzel syndrome is high; however, it may lead to misdiagnosis if not complemented with the patient's medical history. Endoscopic presents a heightened treatment risk and a reduced success rate. The condition commonly presents with severe complications, thus making laparotomy a safe and effective option for intervention.

Value of 2D ultrasonography in the diagnosis and evaluation of intrauterine adhesions – a prospective study

Research questionWhat is the value of 2D ultrasonography in the diagnosis and assessment of intrauterine adhesions (IUA)? DesignThis was a prospective study conducted at a hysteroscopy centre. ResultsOf a total of 600 subjects recruited, 41 dropped out and 559 were finally enrolled and analysed. The observed 2D ultrasonography features, in decreasing order of frequency, were ‘irregular endometrium’ (37.9%), ‘broken endometrial echo’ (23.4%), ‘thin endometrium’ (13.7%), ‘loss of endometrial echo’ (13.1%,), ‘hyperechoic focus’ (12.5%) and ‘fluid in the cavity’ (8.8%). The sensitivity of individual ultrasound features ranged from 8.8% to 37.9%, whereas the specificity of individual ultrasound features ranged from 78.9% to 100%. When all the six ultrasound features were considered together, the sensitivity and specificity were 71.7% and 66.2% respectively. The sensitivity, specificity and accuracy of ultrasound diagnosis in the mid-proliferative phase, peri-ovulatory phase and mid-luteal phase did not appear to be significantly different statistically, although the results in the mid-proliferative phase appeared to be consistently higher than those in the mid-luteal phase. In women confirmed to have IUA, the likelihood of the adhesions being severe in nature in the presence of zero, one, two or three or more ultrasound features was 8.7%, 23.0%, 40.2% and 80.5%, respectively (P < 0.001). ConclusionsThe findings in this study support the notions that ultrasonography examination in women suspected to have IUA cannot replace hysteroscopy in the diagnosis of the condition. However, it does provide useful clinical information regarding severity and could help in the planning of hysteroscopy to optimize management.

6 The Value of Ultrasound in Diagnosing Acute Appendicitis

Abstract Aim The diagnosis of acute appendicitis relies on a thorough history and examination and can often be challenging. Ultrasound is widely considered to be the most appropriate first line investigation; however non-diagnostic ultrasounds are not uncommon and do lead to delays in diagnosis and/or definitive treatment by creating a need for further clinical assessment. The purpose of this study was to determine the sensitivity and specificity of ultrasound diagnosis of appendicitis in patient treated at Doncaster Royal Infirmary, and to determine the local negative appendicectomy rate. Method This was a retrospective analysis of 99 patients undergoing appendicectomy, with a prior ultrasound abdomen within one week of the procedure being undertaken. Data was collected from review of patient's hospital medical records (discharge summaries, clinic letters, PACs). Results 99 patient aged 8-76 years were studied. Male to female ratios was 3:1. The sensitivity and specificity of ultrasound was 16% (95% CI - 7% to 29%) and 96% (95% CI - 86% to 99%) respectively with PPV of 80% and NPV of 52%. The accuracy of ultrasound diagnosis was found to be 55% (95% CI 44% to 65%). The negative appendicectomy rate was 48%. Conclusions From our study, ultrasound cannot reliably identify nor exclude appendicitis. Less than 16% of patients who had proven appendicitis (positive histology) had scans that indicated. Almost 50% of the normal/indeterminate scans were false negatives. Furthermore, 20% of positive ultrasound reports were false positives. A collaborative quality improvement project with the imaging department is planned to address these findings.

P14.10: The effect of different morphological types of extrauterine ectopic pregnancies on the accuracy of ultrasound diagnosis

P14.10: The effect of different morphological types of extrauterine ectopic pregnancies on the accuracy of ultrasound diagnosis

Postnatal Ultrasound to Determine the Surgical Strategy for Congenital Diaphragmatic Hernia.

To compare defect sizes in congenital diaphragmatic hernia (CDH) measured by postnatal ultrasound (US) between neonates who underwent thoracoscopic surgery and neonates who underwent open surgery and between neonates who underwent primary repair and those who underwent patch repair; additionally, to compare the accuracy of US diagnosis with that of surgical diagnosis for the location of the diaphragmatic hernia and the hernial contents. We included 8 neonates who underwent preoperative US evaluations of CDH. We compared anterior-to-posterior diaphragm defect sizes between thoracoscopic and open surgery approaches and between primary and patch repair by using the Mann-Whitney U test. The diaphragm was divided into 3 segments: anterior, lateral, and posterior. We evaluated the location of the diaphragmatic hernia and the hernial contents. Four neonates who underwent open surgery had larger diaphragmatic hernias than those who underwent thoracoscopic surgery (mean ± SD, 30.5 ± 5.6 versus 16.3 ± 3.3 mm; P = .030). They were also larger in neonates who underwent patch repair than in those who underwent primary repair (33.0 ± 3.0 versus 17.6 ± 4.2 mm; P = .037). Detection of anterior and lateral diaphragm segments was consistent between US and surgical findings. Three of 4 neonates who underwent open surgery and all 3 neonates who underwent patch repair did not show the lateral segment. The hernial contents were also consistent between US and surgical findings. Postnatal US examinations of neonates with CDH could provide surgeons with useful information to determine the surgical approach and repair method. However, since our study cohort was small, further studies are needed with a larger number of neonates with CDH.

Recommendations for the Surgical Treatment of Endometriosis. Part 1: Ovarian Endometrioma.

STUDY QUESTIONWhat does this document on the surgical treatment of endometriosis jointly prepared by the European Society for Gynaecological Endoscopy (ESGE), ESHRE, and the World Endometriosis Society (WES) provide?SUMMARY ANSWERThis document provides recommendations covering technical aspects of different methods of surgery for endometriomas in women of reproductive age.WHAT IS ALREADY KNOWNEndometriomas (ovarian endometriotic cysts) are a commonly diagnosed form of endometriosis, owing to the relative ease and accuracy of ultrasound diagnosis. They frequently present a clinical dilemma as to whether and how to treat them when found during imaging or incidentally during surgery. Previously published guidelines have provided recommendations based on the best available evidence, but without technical details on the management of endometriosis.STUDY DESIGN SIZE, DURATIONA working group of ESGE, ESHRE and WES collaborated on writing recommendations on the practical aspects of endometrioma surgery.PARTICIPANTS/MATERIALS, SETTING, METHODSThis document focused on endometrioma surgery. Further documents in this series will provide recommendations for surgery of deep and peritoneal endometriosis.MAIN RESULTS AND THE ROLE OF CHANCEThe document presents general recommendations for surgery of endometrioma, and specific recommendations for cystectomy, ablation by laser or by plasma energy, electrocoagulation and a combination of these techniques applied together or with an interval between them.LIMITATIONS REASONS FOR CAUTIONOwing to the limited evidence available, recommendations are mostly based on clinical expertise.WIDER IMPLICATIONS OF THE FINDINGSThese recommendations complement previous guidelines on the management of endometriosis.STUDY FUNDING/COMPETING INTERESTSThe meetings of the working group were funded by ESGE, ESHRE and WES. C.B. declares to be a member of the independent data monitoring committee for a clinical study by ObsEva, and receiving research grants from Bayer, Roche Diagnostics, MDNA Life Sciences, and Volition. E.S. received honoraria for provision of training to healthcare professionals from Ethicon, Olympus and Gedeon Richter. The other authors declare that they have no conflict of interest.TRIAL REGISTRATION NUMBERNA.

Study on the diagnostic value of transvaginal ultrasound in the diagnosis of endometrial polypoid lesions

Objective To explore the diagnostic value of transvaginal ultrasound in endometrial polypoid lesions. Methods Three hundred and forty-four cases with endometrial polypoid lesions diagnosed in Hankou Hospital of Wuhan from April 2012 to December 2016 were selected as the research objects.All patients underwent color Doppler ultrasonography before surgery.The image features were analyzed, and the specificity, sensitivity and accuracy of ultrasound diagnosis of endometrial lesions were analyzed and pathological results served as the gold standard. Results According to the postoperative pathological diagnosis, 142 cases were with endometrial polyps, Including 136 cases with simple endometrial polyps and 6 cases with endometrial polyps combined with endometrial carcinoma; 160 cases were diagnosed with endometrial polyps via transvaginal ultrasound, 38 cases were misdiagnosed (11.05%, 38/344), 20 cases were missed diagnosis(5.81%, 20/344), using the postoperative pathological results as the gold standard, the sensitivity of transvaginal ultrasonography in the diagnosis of endometrial lesions was 85.92% (122/142), the specificity was 81.19% (164/202), the accuracy was 73.14% (286/344), and the diagnostic accuracy of ultrasonography was consistent with the pathological diagnosis (Kappa>0.75). Conclusion The value of transvaginal ultrasound is to observe the presence of uterine lesions, the identification of benign and malignant lesions still need hysteroscopy examination. Key words: Endometrial Polyps; Transvaginal Ultrasound; Diagnostic Value

Dye-tattooing under ultrasound guidance in preoperative localization of neck recurrences from thyroid cancer

Objective: To evaluate the efficacy and safety of the application of dye-tattooing under ultrasound guidance in preoperative localization of neck recurrences from thyroid cancer. Methods: Between October 2014 to September 2016, 25 patients with 34 lesions were enrolled. There were 22 cases of papillary thyroid carcinoma and three cases of medullary thyroid carcinoma, all of which could not be detected by computed tomography. Surgeons located the recurrent lesions using dye-tattooing under ultrasound guidance along with radiologist three days before the operation. Results: All lesions were successfully located (100%), 32 of which were located directly and two of which were located indirectly. Postoperative pathological examination confirmed 25 metastases of papillary thyroid carcinoma, two metastases of medullary thyroid carcinoma, and seven cases of false positives. The accuracy of ultrasound diagnosis was 79.4%. After 15 months of follow-up, neither tumor residual nor recurrences was detected according to imaging tests. Conclusions: Dye-tattooing under ultrasound guidance represents a reliable and safe method for localization of neck recurrences from thyroid cancer. The cooperation between experienced surgeons and radiologists will be crucial to successful location.

Influence of size on sonographic characteristics of pure mucinous carcinoma of the breast and diagnostic accuracy

Objective To investigate the influence of breast pure mucinous carcinoma size on sonographic characteristics and diagnostic accuracy. Methods Sonographic characteristics of 101 breast pure mucinous carcinoma in 100 patients were analyzed retrospectively. All lesions were divided into three groups according to maximum diameter at ultrasound. These were group Ⅰ with lesions less than 20 mm, group Ⅱ with lesions greater than or equal 20 mm, less than 40 mm, and group Ⅲ with lesions greater than or equal 40 mm. The relationship between lesions size and ultrasound parameters were analyzed. Results There were 38 lesions in group Ⅰ, 52 lesions in group Ⅱ and 11 lesions in group Ⅲ. The patients age in group Ⅲ were older than that in group Ⅰ(F=3.442, P=0.036). Among these sonographic appearances, only shape (χ2=9.813, P=0.005) and blood flow (χ2=27.952, P=0.000) indicated significant differences. The accuracy of ultrasound diagnosis of breast cancer was 85.1%, the smaller the lesions were, the higher misdiagnosis rate the lesions were. Conclusions With lesions size increased, the lobular and internal blood flow of pure mucinous carcinoma increased. More smaller the lesions were, more higher misdiagnosis rate of lesions were. Key words: Ultrasonography; Breast neoplasms; Adenocarcinoma, mucinous

Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? a multicentre diagnostic accuracy study

BackgroundEndometriosis is a common condition which causes pain and reduced fertility. Treatment can be difficult, especially for severe disease, and an accurate preoperative assessment would greatly help in the managment of these patients. The objective of this study is to assess the accuracy of pre-operative transvaginal ultrasound scanning (TVS) in identifying the specific features of pelvic endometriosis and pelvic adhesions in comparison with laparoscopy.MethodsConsecutive women with clinically suspected or proven pelvic endometriosis, who were booked for laparoscopy, were invited to join the study. They all underwent a systematic transvaginal ultrasound examination in order to identify discrete endometriotic lesions and pelvic adhesions. The accuracy of ultrasound diagnosis was determined by comparing pre-operative ultrasound to laparoscopy findings.Results198 women who underwent preoperative TVS and laparoscopy were included in the final analysis. At laparoscopy 126/198 (63.6%) women had evidence of pelvic endometriosis. 28/126 (22.8%) of them had endometriosis in a single location whilst the remaining 98/126 (77.2%) had endometriosis in two or more locations. Positive likelihood ratios (LR+) for the ultrasound diagnosis of ovarian endometriomas, moderate or severe ovarian adhesions, pouch of Douglas adhesions, and bladder deeply infiltrating endometriosis (DIE), recto-sigmoid colon DIE, rectovaginal DIE, uterovesical fold DIE and uterosacral ligament DIE were >10, whilst for pelvic side wall DIE and any ovarian adhesions the + LH was 8.421 and 9.81 respectively.The negative likelihood ratio (LR-) was: <0.1 for bladder DIE; 0.1-0.2 for ovarian endometriomas, moderate or severe ovarian adhesions, and pouch of Douglas adhesions; 0.5-1 for rectovaginal, uterovesical fold, pelvic side wall and uterosacral ligament DIE. The accuracy of TVS for the diagnosis of both total number of endometriotic lesions and DIE lesions significantly improved with increasing total number of lesions.ConclusionsOur study has shown that the TVS diagnosis of endometriotic lesion is very specific and false positive results are rare. Negative findings are less reliable and women with significant symptoms may still benefit from further investigation even if TVS findings are normal. The accuracy of ultrasound diagnosis is significantly affected by the location and number of endometriotic lesions.

Individual and Combined Diagnostic Accuracy of Ultrasound Diagnosis, Ultrasound-Guided Fine-Needle Aspiration and Polymerase Chain Reaction in Identifying Tuberculous Lymph Nodes in the Neck

The aim of this study was to assess the efficacy of, both individually and in combination, ultrasound (US) diagnosis, US-guided fine-needle aspiration (US-FNA) and polymerase chain reaction (PCR) in diagnosing tuberculous lymph nodes in the neck (i.e., tuberculous cervical lymph nodes [TCLs]). Eighty-two patients who underwent US diagnosis, US-FNA and PCR for clinical suspicion of TCLs were enrolled. Of the 82 patients, 31 were confirmed as having TCLs. The sensitivity, specificity, positive and negative predictive values and accuracy of US diagnosis, US-FNA and PCR were 93.5%, 76.5%, 70.7%, 95.1% and 82.9%; 64.5%, 98.0%, 95.2%, 82.0% and 85.4%; and 100%, 96.1%, 93.9%, 100% and 97.6%, respectively. The diagnostic values of PCR alone and in combination with US-FNA were found to be higher than those of other methods. No US feature with high sensitivity and specificity was identified.

The value of ultrasound and color doppler ultrasonography in the evaluation of periapical lesions in comparison to histopathological and/or surgical findings

Imaging techniques play a very important role in the specialty of endodontic. The ultrasonographic technique is non-expensive procedure, safe, and reproducible. The aim of the study was to determine the sensitivity, specificity, and accuracy of ultrasound and color Doppler ultrasonography in evaluation of periapical lesions (cyst, granuloma, mixed lesion cyst within graulomas mass, and abscess. Subject, Material and method: The sample consists of prospective study for 64 Iraqi participants who attended Karbalaa Specialized Center for Dentistry (males & females). Those patients were diagnosed clinically and radiographically as having periapical lesions of dental origin. They were examined by real time ultrasound and color Doppler ultrasonography with echographic predilection about the type of the lesion based on three parameters measured by ultrasound including: content, outline, and the vascularity. The echographic diagnosis was compared to the final histopathological and /or surgical findings obtained from the periapical surgeries. Results: The sensitivity, specificity and accuracy of ultrasound diagnosis were respectively as follow: for periapical cyst, they were 92.3%, 96.1%, and 95.3%. While for periapical granulomam, they were 87.0%, 92.7%, and 90.6%. For mixed lesions, they were 66.7%, 98.4%, and 96.9% and lastly for periapical abscess, they were 92.0%, 97.4%, and 95.3%. The ultrasound diagnosis in our study had an overall agreement of 89% between ultrasound diagnosis and final diagnosis based on histopathological and/ or surgical findings. Conclusion: Ultrasound is a non- invasive, low cost, and complementary method for examination and diagnosis of periapical lesions and there is correlation of ultrasonographic findings with histopathological and /or surgical findings for final diagnosis.

Differentiation between Benign and Malignant Solid Thyroid Nodules Using an US Classification System

ObjectiveTo evaluate the diagnostic accuracy of a new ultrasound (US) classification system for differentiating between benign and malignant solid thyroid nodules.Materials and MethodsIn this study, we enrolled 191 consecutive patients who received real-time US and subsequent US diagnoses for solid thyroid nodules, and underwent US-guided fine-needle aspiration. Each thyroid nodule was prospectively classified into 1 of 5 diagnostic categories by real-time US: "malignant," "suspicious for malignancy," "borderline," "probably benign," and "benign". We evaluated the diagnostic accuracy of thyroid US and the cut-off US criteria by comparing the US diagnoses of thyroid nodules with cytopathologic results.ResultsOf the 191 solid nodules, 103 were subjected to thyroid surgery. US categories for these 191 nodules were malignant (n = 52), suspicious for malignancy (n = 16), borderline (n = 23), probably benign (n = 18), and benign (n = 82). A receiver-operating characteristic curve analysis revealed that the US diagnosis for solid thyroid nodules using the 5-category US classification system was very good. The sensitivity, specificity, positive and negative predictive values, and accuracy of US diagnosis were 86%, 95%, 91%, 92%, and 92%, respectively, when benign, probably benign, and borderline categories were collectively classified as benign (negative).ConclusionThe diagnostic accuracy of thyroid US for solid thyroid nodules is high when the above-mentioned US classification system is applied.

Accuracy of ultrasound diagnosis after blunt scrotal trauma (10 years experience)

To evaluate the role of ultrasonography (US) and its accuracy, sensitivity and specificity for the diagnosis of testicular rupture after blunt scrotal trauma. Moreover, tunica albuginea breach, testicular hematoma, testis avulsion, epididymal injuries and hematocele are particularly examined. Between 1998 and 2008, 24 patients presented to Suez Canal University Hospital after blunt scrotal trauma and underwent surgical exploration. All patients had an emergency scrotal US examination with the use of a 7.5–10 MHz linear transducer. US findings were compared with the surgical findings to calculate the sensitivity and specificity of US for each type of lesion. Out of 24 patients, 12 were diagnosed as having testicular rupture and tunica albuginea breach was visualized on US in 6 patients. Sensitivity and specificity of US were 92% and 50% for testicular rupture, 85% and 75% for hematocele, 80% and 79% for testicular hematoma, and 100% and 96% for testicular avulsion, respectively. US diagnosis of epididymal injuries was poor as it failed to detect 3 out of 5 epididymal lesions. US was highly sensitive in the diagnosis of testis rupture. This can provide information on the integrity of the scrotal contents that can help the physician to determine the optimal treatment.

1070: The Accuracy of Ultrasound Diagnosis of Endometrial Polyps

1070: The Accuracy of Ultrasound Diagnosis of Endometrial Polyps

OP17.03: Variation in the morphological appearance of ovarian mature cystic teratomas: Implications for diagnosis and management

Objectives: Mature cystic teratomas (MCT) or Dermoid cysts of the ovary account for approximately 25% of all ovarian tumours. The wide range of tissue types found in these tumours give rise to a highly varied appearance on ultrasound examination. The aim of this study was to assess the frequency of different morphological features in order to improve the accuracy of ultrasound diagnosis and aid in management planning. Methods: Our gynaecology ultrasound database and the histopathology department were retrospectively searched for MTCs. All women with a histological diagnosis of MCT and preoperative ultrasound images were included in the study. The images were reviewed by a single observer who recorded the presence and extent of common and rare features of MCTs. Results: A total of 133 cysts were found in 117 women. 15/117 (12.8%) had bilateral MCTs. Hyperechoic cyst contents consistent with sebum were present in 94.7% of cysts. Other common ultrasound features included hair (91.7%), acoustic shadowing (83.5%), and healthy ovarian tissue seen at one edge of the cyst (‘‘the ovarian crescent sign’’) 75.9%. The amount of sebum within the cyst was significantly higher in older women and it was inversely proportional to the size of the cyst (P < 0.05). Conclusions: Sebum and hair are present in more than 90% of MCTs, which facilitates a correct pre-operative diagnosis on ultrasound scan. The amount of sebum within the cyst can be used to estimate the potential of the cyst to grow and require surgical intervention in the future.

Increasing accuracy of antenatal ultrasound diagnosis of cleft lip with or without cleft palate, in cases referred to the North Thames London Region

To determine the accuracy of antenatal ultrasound diagnosis of cleft lip with or without cleft palate (CL +/- P) and isolated cleft palate (CP). This was a retrospective review of 256 surviving cases referred in 2002-2003 for treatment of CL +/- P. We had referrals from 36 maternity units, 27 of which were in our local catchment area. There were 154 cases of CL +/- P, of which five had microform CL. Of the remaining 149, 88 (59%) were diagnosed on antenatal ultrasound examination. Among these 88 cases there were minor reporting errors in 22 (25%). These errors were in describing the side and type of the lip cleft in 10 cases, predicting if there was a CP in 10 cases, and recognizing the anomaly in two cases. There were 102 cases referred with isolated CP, of which 92 had overt CP and 10 submucous CP. None of these was diagnosed by antenatal ultrasound imaging. There was no significant difference in the accuracy of ultrasound diagnosis between district hospitals and teaching/tertiary units. There is a good awareness and ability to detect CL +/- P by obstetric units from which referrals are received. Inaccuracies in antenatal ultrasound reports occur frequently when attempting to determine the type of CL and when predicting if there is a CP. We recommend that families should continue to be referred to specialist centers for counseling immediately after antenatal diagnosis, and comprehensive advice should always be given about clefts of the lip and palate.

Testicular Rupture Secondary to Paint Ball Injury

No AccessJournal of UrologyCLINICAL UROLOGY: Case Reports1 Feb 2004Testicular Rupture Secondary to Paint Ball Injury FADI N. JOUDI, MATTHEW M. LUX, and JAY I. SANDLOW FADI N. JOUDIFADI N. JOUDI More articles by this author , MATTHEW M. LUXMATTHEW M. LUX More articles by this author , and JAY I. SANDLOWJAY I. SANDLOW Financial interest and/or other relationship with Sigma Tau and Solvay. More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000106504.26268.e9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Testicular Rupture Secondary to Paint Ball Injury." The Journal of Urology, 171(2), p. 797 References 1 : Ocular injuries from paintball. Am J Emerg Med2000; 18: 744. Google Scholar 2 : Accuracy of ultrasound diagnosis after blunt testicular trauma. J Urol1993; 150: 1834. Abstract, Google Scholar 3 : Genitourinary trauma. Emerg Med Clin North Am2001; 19: 569. Google Scholar From the Department of Urology, University of Iowa, Iowa City, Iowa© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 171Issue 2February 2004Page: 797 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordstestis/injuriesrupturewounds and injuriesMetricsAuthor Information FADI N. JOUDI More articles by this author MATTHEW M. LUX More articles by this author JAY I. SANDLOW Financial interest and/or other relationship with Sigma Tau and Solvay. More articles by this author Expand All Advertisement PDF downloadLoading ...

Sonographic differentiation of invasive and intraductal carcinomas of the breast.

The purpose of this study is to evaluate the diagnostic ability of ultrasound and define the sonographic features of symptomatic intraductal and invasive breast carcinoma. To achieve this the ultrasound features of 488 invasive carcinomas and 65 non-screening detected intraductal carcinomas were compared retrospectively. The features included size, AP/W (anteroposterior diameter/width) ratio, shape, margin, internal echogenicity, internal echotexture, posterior acoustic transmission, bilateral edge shadowing sign and calcifications. The sensitivity and specificity of the detection of calcifications by ultrasound in comparison with mammography were also studied. The accuracy of ultrasound diagnosis is 92.0% for invasive carcinoma of breast and 84.8% for intraductal carcinoma. Differentiation of ultrasound features of intraductal and invasive carcinoma can be based on the internal hypoechogenicity, loss of bilateral edge shadowing, posterior acoustic transmission, irregular shape and non-uniform internal echotexture with odds ratio of 0.3, 0.3, 0.4, 0.5 and 0.5, respectively. Internal echogenicity was the only significant differentiating factor on multiple logistic regression analysis. Non-comedo type ductal carcinoma in situ can be differentiated from comedo type by irregular shape with odds ratio of 0.3. The sensitivity, specificity and accuracy rate for the detection of calcifications in invasive carcinomas by ultrasound were 65.1%, 61.9% and 63.2%; in comedo type intraductal carcinoma 62.5%, 66.7% and 63.6%, and in non-comedo type intraductal carcinoma 30.0%, 86.7% and 64.0%, respectively. The ultrasound appearance of non-screening detected intraductal carcinoma is relatively isoechoic in comparison with invasive carcinoma. More than 60% of microcalcifications in comedo type intraductal carcinoma can be accurately demonstrated by ultrasound. However, the role of ultrasound in detecting symptomatic intraductal carcinoma warrants further study.

Endometriosis and recurrent pregnancy loss.

A possible association between endometriosis and spontaneous abortion has been suggested in mostly uncontrolled and/or retrospective studies. Some controlled studies evaluating the association between endometriosis and spontaneous abortion showed important methodological shortcomings: heterogeneity between cases and controls, analysis of the abortion rate before the diagnosis of endometriosis, and selection bias of study and control groups. On the basis of controlled prospective studies, there is no evidence that endometriosis is associated with (recurrent) pregnancy loss or that medical or surgical treatment of endometriosis reduces the spontaneous abortion rate. In programs of assisted reproduction, some studies have shown that the number and quality of oocytes, the fertilization rate, and the implantation rate per embryo may be reduced in women with endometriosis, but this observation has not been confirmed by other investigators. Future studies evaluating the reproductive outcome of patients with endometriosis in assisted reproduction programs should include reliable information about the date and histological confirmation of the diagnosis of endometriosis, time interval between treatment with assisted reproduction and the last laparoscopy, possible recurrence of endometriosis, effectiveness of interim hormonal (suppressive) therapy, accuracy of ultrasound diagnosis, and accuracy of "negative" diagnosis.