Benign Pathologic Lesions Research Articles

A COMPARATIVE STUDY OF PAP SMEAR CYTOLOGY AND HISTOPATHOLOGY OF CERVIX BIOPSY

ntroduction: Carcinoma cervix is one of the leading causes of death of the female population in developing countries. By virtue of its accessibility, cancer of the cervix can be readily diagnosed even in its preinvasive stage. If treated in the earlier stages the patient can often be cured of the disease. Carcinoma of the cervix is the fourth most frequent cancer in women worldwide and the leading cause of death from cancer in several developing countries including India. The use of cervical smear (Papanicolaou/Pap) as a screening tool has signicantly reduced the incidence of cervical cancer. Materials and Methods: Out of 100,000 Pap smears, a total number of 75 eligible women with atypical glandular cells (AGCs) referred to gynaecology clinics in Isfahan, Iran, and seventy women were selected to undergo Pap smear test, colposcopic examination and ECC. EMC was performed in women older than 35. Pap smear test results were classied as normal, inammation, AGCs and necrosis. Colposcopy, ECC and EMC ndings were classied as normal, benign and malignant pathologic lesions. Results: Majority of the women were between 31-40 years (59.6%).On PAP smear, ASC-US was found in 5.8% of women, ASC-H in 1.4% of women, LSIL in 6.7% of women and HSIL in 6.2% of women. On colposcopy, LSIL was seen in 26.4% of women and HSIL in 17.8% of women. On histopathological examination, CIN I was seen in 16.8% of women followed by CIN II(8.2%)and CIN III(5.8%).Sensitivity and specicity of PAP smear was 29.7% and 94.4%.Sensitivity and specicity of colposcopy was 85.9% and 74.3%. Conclusion: Pap smear had a poor sensitivity compared to colposcopy but a better specicity than colposcopy .Hence, it may be better to utilise both tests in screening of premalignant lesions of cervix as they complement each other.

Endometrial Hiperplazi ile Komplike Obez ve Premenopozal Hastalarda Vücut Yağ Dokusu Dağılımının Etkisi

Objective: There is a close association between obesity and menstrual irregularity. This study aims to investigate lipoid tissue accumulation between overweight or obese premenopausal patients with endometrial hyperplasia and with benign pathologic lesions via using the bioimpedance method.Materials and Methods: Obese or overweight volunteers with abnormal uterine bleeding were examined. Eighty-eight volunteers meet the inclusion criteria. We obtained fat mass, fat percentage and impedance of body parts by using Multi-Frequency Body Composition Analyzer. Blood lipid profile and ultrasonographic measurement of endometrial thickness were also performed. Results: 33 volunteers were in the hyperplasia group and 55 were in the control group. 28 of the 33 volunteers (84.8%) had at least one increased fatty acid. 41 of the 55 patients (74.5%) had at least one increased fatty acid in the control group. Total cholesterol levels are higher in the hyperplasia group than in the control group (p=0.006). There was no significant difference between the groups for bioimpedance analyses. Conclusion: Hyperlipidemia remains an important factor that contributes to endometrial pathologies. Serum cholesterols were significantly high in the endometrial hyperplasia group. Rather than lipoid tissue distribution, increased cholesterol may contribute to gynecologic pathology occurrence in obese individuals complicated with endometrial hyperplasia.

Forms of Breast Disorders within Females Visiting Breast Disease Clinic

1.1. Background: Breast disorders, either benign or malignant in nature, are clinically common. The forms of breast disorders vary within different nations. 1.2. Objectives: The goal of the current research study is to explore and observe the forms of breast disease and their correlation with various obtained variables of interest in females visiting the breast disease clinic. 1.3. Methodology: A cross-sectional research study performed at El Sahel Teaching Hospital from 1st of May 2017 till 1st of February 2017. A randomly selected cohort of 500 research subjects of all age categories have been enrolled in the research study. The cases have been cat- egorized according to their clinical diagnosis into 3 classes of breast conditions: normal, benign and malignant. The statistical significance was <0.05. 1.4. Results: breast disorders of benign nature diagnosed among (63%) of cases while breast dis- eases of malignant nature composed of (13.2%). The commonest clinical presentation have been mastalgia and breast mass (39.2%), mastalgia (37.6%), and breast mass only (23.2%). Fibro- adenoma (26.2%) has been the most common benign clinical disease with greatest incidence (76.9%) in the age research group below 20 years. Malignant breast diseases have been more frequent with increasing age. Benign breast clinical disorders and pathological lesions were correlated more with nulliparous females (p<0.001). Breast cancer observed (p <0.001) more frequent in a statistically significant fashion with in lactating females recruited in the research cohort. 1.5. Conclusion: Benign diseases and various disorder of the breast is a popular clinical di- agnosis mostly presented in younger females. Breast malignant disease despite the fact that is clinically diagnosed in lower frequency and mainly presented in older age groups, yet its sig- nificance oblige a meticulous evaluation of females of various clinical presentations particularly that of breast mass only or associated with mastalgia.

Evaluation of the Proximal Tibia as a Donor Site of Cancellous Bone for Intraoral Grafting Procedures-A Retrospective Study.

Background: Autogenous bone grafts remain the “gold standard” in maxillofacial reconstructive procedures. The objective of this study was to evaluate the proximal tibia as a donor site of cancellous bone for bone grafting procedures of the mandible on the basis of intraoperative parameters and clinical observations. Methods: The study was based on a medical record search of 40 patients who underwent surgical procedures because of benign pathological lesions of the jaws resulting in 3-wall bone defects of the mandible and qualified for surgical removal of the lesion with simultaneous bone grafting of the defect with autogenous cancellous bone harvested from the proximal tibia. Results: The use of the proximal tibia for bone grafting procedures enables large amounts of cancellous bone (15.09 cc in average) to be obtained. The procedure is characterized by a low risk of early and late complications, which include excessive bleeding, wound infection, lengthy healing time, scars, a loss of sensation around the scars, aching, a dip in bone, swelling and tenderness. Conclusions: The ability to obtain large amounts of cancellous bone and a low risk of intra- and postoperative complications make the proximal tibia an attractive donor site for the bone grafting procedures in maxillofacial surgery.

Ameliyat Sonrası Oluşan Çene Defektlerini Tedavi Etmek İçin Dental İmplantların Kullanılması: Kohort Çalışması

Objective: Many studies have documented spontaneous bone repair after the excision of benign jaw lesions, however implant placement after lesional removal has received less attention. Following bone pathology enucleation, bone defects may arise. Reconstruction techniques with various bone grafting materials are preferred in order to promote bone healing and to support alveolar bone. Another option is to initially allow physiological healing of the cavity without using any graft materials. In this study, it was planned to rehabilitate the patients by using dental implants after the physiological healing of the postoperative defects. Material and Methods: This study included patients with benign lesions greater than 5 mm in diameter and patients who underwent dental implants without any grafting procedures. Data from 18 patients who received dental implants after complete removal of benign pathological lesions were evaluated. We included 8 males and 10 females aged 16-78 years. A total of 41 implants were placed. Implants were applied 18-36 months after removal of the lesions. Eight of the 41 implants (19.5%) were placed in the maxilla. Thirteen of the 18 (72.2%) lesions were (histopathologically) odontogenic cysts; the remaining lesions comprised odontogenic fibromyxomas, an arteriovenous malformation, and a central giant cell granuloma. Results: Most of the lesions in the present study were localized in the posterior mandible and the pathological fracture was not reported following cyst enucleation nor dental implant placement. Conclusion: No implant failed during 2 years of follow-up. It was observed that the dental implants were found usefull for the reconstruction of post-surgical defects.

18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging review of benign lesions of the thorax.

2-deoxy-2-(Fluorine-18) fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) has been used exclusively to diagnose malignancies. However, increased 18F-FDG uptake is not always limited to malignant lesions. This imaging review demonstrates the physiological 18F-FDG uptake of normal structures in the thorax and illustrates many benign pathological lesions with standardized uptake value >2.5. These various conditions can be broadly categorized into three groups: infective lesions, active granulomatous diseases such as sarcoidosis, noninfectious/inflammatory, or proliferative conditions such as radiation pneumonitis, postlung transplant lymphoproliferative disorders, occupational pleuropulmonary complications, and postsurgical conditions, all of which can demonstrate varying degrees of 18F-FDG uptake on PET/CT based upon the degree of inflammatory activity. Familiarity of false-positive findings improves the PET/CT evaluation accuracy of benign lesions of the thorax. Radiation exposure and surgical history correlation along with imaging cross check evaluation of radiographs and magnetic resonance images for the anatomic location remains the mainstay of PET/CT characterization of positive findings.

Immediate Reconstruction of Segmental Mandibular Defects With Nonvascular Bone Grafts: A 30-Year Perspective

The use of nonvascular bone grafts for immediate mandibular reconstruction has remained a controversial topic. The purpose of the present study was to investigate the variables that might influence graft survival examining the outcomes from 30years of experience. We designed a retrospective cohort study to analyze the data from patients at a tertiary university medical center who had undergone segmental mandibular resection with immediate reconstruction with a nonvascularized free bone graft with or without adjuncts from 1989 to 2019. The predictor variables recorded included general demographic data, pathologic diagnosis, resection length, reconstruction modality, bone graft type, and inferior alveolar nerve procedures. The primary outcome variable was graft success, defined as bony union demonstrated on panoramic radiographs and mandibular stability demonstrated on clinical examination at 4months postoperatively. Descriptive, bivariate, and linear regression models were computed. The sample included 47 subjects with a mean age of 43±16years; 51.1% were men. Of the 47 patients, 25 had a tissue diagnosis of benign tumor, most of which were ameloblastoma (n=16) or ossifying fibroma (n=6), and 22 had a tissue diagnosis of osteomyelitis or medication-related osteonecrosis of the jaw (MRONJ). The average resection size for all the patients was 6.9±2.5cm and was 6.1±1.5cm for those with a benign tumor and 7.8±3.1cm for those with osteomyelitis or MRONJ. The mean defect size of grafts that failed was 10.7±3.5cm and 6.5±2.0cm for those that succeeded (P≤.001). A linear regression model revealed that graft length correlated significantly with graft outcome (β-coefficient, -0.548; 95% confidence interval, 0.905 to 1.542; P≤.001). The results of our study have shown that nonvascular bone grafts can be used to immediately reconstruct mandibular defects greater than 6cm from benign pathologic lesions; however, larger grafts are more likely to fail.

Computer-Aided Design and Computer-Aided Manufacturing Versus Conventional Free Fibula Flap Reconstruction in Benign Mandibular Lesions: An Italian Cost Analysis

The cost of computer-aided design and computer-aided manufacturing (CAD-CAM) technology has created obstacles for its widespread use despite its several advantages. This study compared the cost of CAD-CAM technology with that of the conventional freehand technique in fibula reshaping for mandibular reconstruction. A retrospective comparative study was conducted at the Maxillofacial and Dental Unit of the Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico (Milan, Italy). The study compared 15 patients in the CAD-CAM group with 10 patients in the conventional freehand group. Only benign pathologic lesions that required at least 3 fibular segments for reconstruction were included. The consumption of resources was estimated using micro-costing analysis (activity-based costing approach). The CAD-CAM group included 15 patients (7 men and 8 women) with a mean age of 42.2±1.5years, and the conventional freehand group included 10 patients (4 men and 6 women) with a mean age of 40.8±0.9years. Although CAD-CAM was a statistically expensive procedure in the perioperative phase (P<.0001), no significant difference was shown in total health care costs between the 2 groups (P=.98). CAD-CAM technology had a comparable expense to the conventional freehand technique, specifically for defects requiring at least 3 fibular segments.

The use of reconstruction plates to treat benign mandibular pathological lesions: A retrospective clinical study

IntroductionThe purpose of this retrospective clinical study was to evaluate the indications for and the utility of reconstruction plates in the management of benign mandibular pathological lesions. The complications associated with plate use were also assessed. Patients and methodsThe clinical and radiological data of 23 patients (16 males, 7 females) with large, benign mandibular pathologies were evaluated. During operations, reconstruction plates were used to prevent mandibular fracture or to allow for bone reconstruction after segmental or disarticulation resection. The mean follow-up time was 11.2months. ResultsCondylar sag was observed in one patient who had undergone disarticulation resection. A reconstruction plate was removed from one patient because of pain. A plate became exposed in one patient who had undergone a disarticulation resection. Two patients reported slight paraesthesia. Screw-loosening was observed in one patient who had received a non-locking plate. ConclusionReconstruction plates can be safely used to manage benign mandibular lesions. Preoperative bending of the plates on individualised models is useful for reducing the time required for plate adaptation during operation. Locking reconstruction plates are preferable for preventing screw-loosening. All complications can be managed with careful follow up.

Incidental Findings on Pediatric Abdominal Computed Tomography At A Pediatric Trauma Center

BackgroundThe increasing availability and use of computed tomography (CT) in pediatric abdominal trauma has increased the detection of incidental findings. While some of these findings are benign, others may require further evaluation for possible clinical importance. ObjectivesThis study aimed to identify the frequency and type of incidental findings and their need for follow-up on abdominal CT in patients at a pediatric trauma center. MethodsThis was a retrospective, observational study on trauma patients ≤21 years of age who presented to the emergency department between January 1, 2004 and July 31, 2016 and underwent CT scans of the abdomen and pelvis. Findings were classified as benign anatomic variants, benign pathologic lesions, and pathologic lesions requiring additional work-up. ResultsThere were 1073 patients included in the study population, with a mean age of 15.5 years; 707 (66%) were males. A total of 418 incidental findings were identified in 345 patients. Of these, 290 (69%) were benign and 60 (14%) were likely benign pathologic that required possible outpatient monitoring. Of those requiring additional evaluation, 5 (1%) patients warranted further evaluation before discharge. ConclusionsNearly one-third of patients had at least one radiographic finding unrelated to their injury. Of these, more than two-thirds did not require additional evaluation, but nearly one-third of patients required some form of further work-up.

Diagnostic accuracy of pre-operative imaging findings in presumed clinical T1a renal cell carcinomas.

Despite the development of recent imaging modalities, certain pathological misdiagnoses remain for surgical specimens of presumed small renal cell carcinomas (RCCs). In the present study, a retrospective analysis of benign pathological lesions diagnosed as small RCC prior to surgery was performed. In total, the cases of 196 sporadic renal tumors that was surgically treated as clinical T1a RCCs were reviewed, and the accuracy of the pathological diagnoses was calculated. The pre-operative findings for benign pathological lesions was investigated, and the lesions were observed in 13 (6.63%) of the 196 tumors. Pre-operative computed tomography images were obtained in all cases, and magnetic resonance images were available in 10 cases. The diagnostic accuracy of imaging modalities was significantly lower in the tumors with a diameter of ≤20 mm. In all cases, the possible pathological diagnosis of RCC could not be excluded even by retrospective imaging analysis. Several benign pathological lesions were found in small renal masses presumed to be clinical T1a RCC. In conclusion, there may be limitations to the pre-operative imaging for certain types of small renal mass.

Incidence of benign results after laparoscopic radical nephroureterectomy.

Background and Objectives:Studies of patients with benign pathologic lesions who underwent laparoscopic radical nephroureterectomy (RNU) with preoperative suspicion of upper urinary tract urothelial carcinoma are lacking. The aim of this retrospective cross-sectional study was to evaluate the incidence of benign pathologic lesions on laparoscopic RNU for upper urinary tract tumors that are presumed to be urothelial carcinoma. The clinicopathologic characteristics of these lesions were also determined.Methods:Between January 2004 and December 2010, 244 patients underwent laparoscopic RNU for possible upper urinary tract urothelial carcinoma at our institute. Seven (2.9%) had benign lesions at the final pathologic examination. The preoperative features of these patients were investigated, including imaging findings, urine cytologic results, and ureteroscopic findings.Results:The 7 patients comprised 5 men and 2 women. The lesions were located in the ureter in 5 patients and in the renal pelvis in 2. All patients underwent preoperative voided urine cytology and cystoscopy. Two patients underwent preoperative ureteroscopy. In 1 patient, definite pathologic lesions were not identified in the surgical specimen. Urinary tract tuberculosis was diagnosed in 1 patient, inflammatory pseudotumor in 2, and fibroepithelial polyps in 1. In 2 patients, stones were detected (stone with atypical papillary urothelial hyperplasia and polypoid ureteritis with ureter stone, respectively) after laparoscopic RNU.Conclusion:Benign pathologic lesions were detected in 7 patients (2.9%) who had undergone laparoscopic RNU for upper urinary tract tumors that were presumed to be urothelial carcinoma. The description of these false-positive cases will help improve the preoperative counseling of these patients.

Rehabilitation of benign pathological condition by dental implants

Dentigerous cysts are benign odontogenic cysts that arise from the dental follicle of an unerupted or developing tooth. They are the second most common odontogenic cysts after radicular cysts and account for approximately 24% of the jaw cysts. Patient may give the history of slowly enlarging swelling. A female patient aged 54 years came to our unit with a diffuse swelling on the left side of her face which was found to be dentigerous cyst on clinical, radiological and histopathological examination. The patient underwent enucleation with extraction of affected teeth leading to partial edentulous state without any pathological fracture of the mandible. Post-operatively after 8 months, adequate bone filling was noted. Implant-supported rehabilitation was done. The present case emphasizes the maintenance of the new bone formation without using any graft materials for the placement of dental implants and also the implant-supported rehabilitation has proven good results in benign pathological lesions.

Incidence of benign pathologic lesions at nephrectomy for renal masses presumed to be stage I renal cell carcinoma in Japanese patients: Impact of sex, age, and tumor size.

374 Background: The widespread use of modern imaging techniques has resulted in the increased detection of small, asymptomatic renal tumors. Some recent studies from Western countries have reported that the incidence of benign lesions is approximately 15% in patients undergoing definitive surgery for renal masses presumed to be clinical stage I renal cell carcinoma (RCC). The high level of noncancerous lesions is, to some extent, due to the fact that no imaging feature can accurately distinguish either oncocytoma or lipid-poor angiomyolipma (AML) from RCC. This study attempts to determine the incidence of benign pathologic findings for such renal masses in Asian patients. Methods: Between 1991 and 2009, 711 consecutive patients (218 women and 493 men) underwent partial (n=206) or radical (n=505) nephrectomy for renal masses presumed to be stage T1N0M0 (T1a/T1b= 503/208) sporadic RCC on preoperative imaging in two Japanese centers. The mean size of the lesions was 3.3 cm (range 0.3-7.0). The pathologic features were reviewed by an experienced pathologist. Results: Of the 711 masses, 53 (7.5%) revealed benign pathologic findings. Twenty-two (3.1%) were AMLs, 13 (1.8%) were oncocytomas, 8 (1.1%) were complicated cysts, and 10 were others. Twenty-eight (12.8%) of the 218 females and 25 (5.1%) of the 493 males had benign lesions (p=0.0005). Of the 357 patients aged 60 years or younger, 37 (10.4%) had benign lesions while only 16 (4.5%) of the 354 patients over 60 years did (p=0.024). Forty six (9.2%) of the 503 T1a and 7 (3.4%) of the 203 T1b masses were benign (p=0.0071). A multivariate logistic regression model showed that sex, age and tumor size were all independently predictive of benign histology, particularly of AML. Conclusions: The present incidence (7.5%) of benign lesions in presumed clinical stage T1N0M0 RCC masses at nephrectomy was lower than the incidence of approximately 15% previously reported from Western countries, probably because of the low incidence of oncocytomas in Japanese patients. Female gender, young age and small tumor size are all independently predictive of benign lesions, particularly of AML in Japanese patients. No significant financial relationships to disclose.

Trends in the incidence of benign pathological lesions at partial nephrectomy for presumed renal cell carcinoma in renal masses on preoperative computed tomography imaging: A single institute experience with 290 consecutive patients

The aim of this study was to determine trends in the incidence of benign lesions in patients undergoing surgery for suspicious renal masses on preoperative computed tomography scan. The records of 1065 patients who underwent open consecutive partial nephrectomy (PN) or radical nephrectomy (RN) between January 2001 and December 2008 were reviewed. Patients who underwent PN during the periods 2001-2002, 2003-2004, 2005-2006, and 2007-2008 were assigned to groups 1, 2, 3 and 4, respectively. The frequencies of benign and malignant lesions in these groups were assessed according to size and histology subtypes. The ratio of PN to RN was 12.4%, 18.3%, 24.3% and 37.2% in groups 1, 2, 3 and 4, respectively (P < 0.05). The mean size of resected lesions was 2.6 cm (range 0.8-6.2 cm). Of the 290 cases, histopathology revealed benign findings in 52 (17.9%). Benign pathology was found in three of 18 cases (16.7%) in group 1, seven of 36 cases (19.4%) in group 2, 12 of 63 cases (19.0%) in group 3 and 30 of 173 cases (17.3%) in group 4. There was no significant difference in the frequency of benign histology among groups. PN, as opposed to RN, has shown a rising tendency over time. The frequency of benign pathology findings after PN for suspicious renal masses on preoperative computed tomography imaging has not decreased. Proper management should favor nephron-sparing surgery for renal lesions if such lesions can be removed satisfactorily with PN.

Human Kallikrein 5: An Interesting Novel Biomarker in Ovarian Cancer Patients That Elicits Humoral Response

Kallikrein-related peptidases are secreted serine proteases that exert stimulatory or inhibitory effects on tumor progression. A recent study demonstrated that kallikrein-related peptidase 5 (KLK5) concentration is elevated in serum of patients with ovarian carcinoma. At the moment, the presence of KLK5 in other ovarian pathological lesions is not clearly determined. Moreover, the possibility of a spontaneous humoral immune response to KLK5 has not been studied yet. In this study, we examined KLK5 levels and antibody (IgG and IgM) response to KLK5 in the serum of 50 healthy women, 50 patients with benign pelvic masses, 17 patients with ovarian borderline tumors, and 50 patients with ovarian carcinomas, using 3 enzyme-linked immunosorbent assay tests available in-house. At 95% specificity on healthy controls, 52% of patients with ovarian carcinoma showed high serum KLK5 (sKLK5) levels, whereas patients with benign pathological lesions or borderline tumors showed almost undetectable sKLK5 levels. Moreover, sKLK5 levels were positively associated to International Federation of Gynaecologists and Obstetricians stage suggesting a possible role of sKLK5 in ovarian cancer progression. Our results about humoral response showed elevated levels of KLK5-specific antibodies in 20% of patients with benign masses, 26% of patients with borderline tumors, and 36% of patients with ovarian carcinomas when compared with healthy controls. Interestingly, KLK5 antibodies were also found in patients with undetectable sKLK5 levels. In conclusion, our results showed that KLK5 is a potential new biomarker to be used in combination with other biomarkers for ovarian cancer detection. Moreover, the existence of KLK5 antibodies suggests that KLK5 might represent a possible target for immune-based therapies.

The Prevalence of Incidental Findings on Abdominal Computed Tomography Scans of Trauma Patients

Abdominal computed tomography scanning (AbdCTS) is the standard of care in the evaluation of blunt trauma patients. The liberal use of AbdCTS coupled with advancing imaging technology often results in the detection of incidental findings. We sought to characterize the incidence and prevalence of such findings, describe the lesions most frequently seen on AbdCTS performed on patients admitted to a Level I trauma center, and develop a plan for follow-up through our performance improvement process. AbdCTS reports of all admissions to a Level I trauma center between January 2000 and December 2002 were reviewed. Incidental findings identified were classified into benign anatomic variants, benign pathologic lesions, and pathologic lesions requiring further work-up. A total of 3,113 patients were evaluated by AbdCTS during this time period. There were 1474 incidental findings in 1,103 patients. Seventy-five percent of patients with incidental lesions had no traumatic findings. Benign anatomic variants were present in 1.8%, benign pathologic findings in 27.5%, and pathologic findings requiring work-up in 6.1%. Congenital renal anomalies and duplicate inferior vena cava were the most common benign anatomical findings. Renal and hepatic cysts were the most frequent benign lesions and non-calcified pulmonary nodules and adrenal masses were the pathologic lesions most commonly seen. Incidental findings are seen in up to 35% of trauma AbdCTS. No concomitant traumatic injuries are present in up to 75% of these patients. Protocols for appropriate intervention or arrangements for follow-up care need to be incorporated into the care of the trauma patients.

Incidence of Benign Pathologic Lesions at Partial Nephrectomy for Presumed RCC Renal Masses: Japanese Dual-Center Experience with 176 Consecutive Patients

To determine the incidence of benign pathologic findings at elective partial nephrectomy for renal masses thought to be renal cell carcinoma (RCC) on preoperative imaging in Japanese patients. From 1993 to 2007, 176 patients (46 women and 130 men) underwent elective partial nephrectomy for presumed RCC masses in 2 Japanese centers. The mean size of the resected lesions was 2.3 cm (range 0.3-5.8). Overall, 97 and 79 patients had a renal mass of < or = 2 cm and > 2 cm, respectively. Of the 176 patients, 100%, 89%, and 32% had preoperatively undergone computed tomography, ultrasonography, and magnetic resonance imaging, respectively. Of the 176 masses resected, the pathologic examination revealed benign findings in 19 (11%), angiomyolipoma in 10 (5.7%), oncocytoma in 5 (2.8%), complicated cysts in 2 (1.1%), and a solitary fibrous tumor and scar of the kidney 1 each (0.6%). Of the 46 women, 12 (26.1%) had benign lesions compared with 7 of the 130 men (5.3%; P = .0003). Of the 10 angiomyolipomas diagnosed, 8 were diagnosed in women (P = .0004). Tumor size was not associated with benign histologic findings. The incidence of benign lesions was equivalent (10% and 12%) between the 2 centers. The present incidence (11%) of benign lesions in presumed RCC masses at surgery in Japanese patients was lower than the incidence of 20%-30% previously reported from Western countries, probably because of the low incidence of oncocytomas in Japanese patients. Women had almost 5 times the likelihood of having a benign lesion compared with men, because of the high incidence of angiomyolipomas in women.

Freehand Real-Time Elastography: Impact of Scanning Parameters on Image Quality and In Vitro Intra- and Interobserver Validations

Real-time elastography is a method for visualization of the elastic properties of soft tissue and may potentially enable differentiation between malignant and benign pathologic lesions. Our aim was to validate the method on a tissue-mimicking (TM) phantom and to evaluate the influence of different scanning parameters and investigator variability. A TM-phantom containing eight spherical inclusions with known storage modulus was examined using two different transducers on an ultrasound (US) scanner equipped with software for real-time elasticity imaging. The ultrasound transducers were moved vertically in a repetitive manner to induce strain. Two investigators performed series of standardized elastography scans applying a 0-4 categorical quality scale to evaluate the influence of seven parameters: dynamic range of elasticity, region-of-interest, frequency of transducer movement, rejection of elastogram noise, frame rate, persistence and smoothing. Subsequently, repeated examinations of four selected inclusions were performed using a visual analog scale (VAS) where investigators marked a 100 mm horizontal line representing the span in image quality based on experience from the first examination. The hardest and softest inclusions were imaged more clearly than the inclusions with elasticity more similar to the background material. Intraobserver agreement on elastogram quality was good (kappa: 0.67 - 0.75) and interobserver agreement average (kappa: 0.55 - 0.56) when using the categorical scale. The subsequent VAS evaluation gave intraclass-correlation coefficients for the two observers of 0.98 and 0.93, respectively, and an interclass-correlation coefficient of 0.93. Real-time elastography adequately visualized isoechoic inclusions with different elastic properties in a TM-phantom with acceptable intra- and interobserver agreement. Dynamic range of elasticity was the parameter with most impact on the elastographic visualization of inclusions. (E-mail: roald.flesland.havre@helse-bergen.no)

Breast disease evaluation with fat-suppressed magnetic resonance imaging

Thirty patients with a variety of pathologically confirmed malignant and benign pathologic lesions of the breast were evaluated with a spectrally selective fat suppression imaging technique to obtain fat-suppressed images of the breast. The technique, a selective partial inversion-recovery (SPIR) method, demonstrated the architectural relationship of malignant and benign tumors with respect to the normal water-containing elements of the breast. These relationships included signs of advanced malignant disease such as tissue retraction, invasive growth, and multicentricity, which appeared on the fat-suppressed images. Fat-suppressed imaging provided useful information for assessing the breasts of both pre- and postmenopausal women, especially in the latter group, where fatty involution of the breast is common. Microcysts, which are normally not visualized by conventional methods, were demonstrated and associated with patients having confirmed fibrocystic disease of the breast. As expected, the SPIR technique did not improve the ability to distinguish between tissues having similar T 1 and T 2 relaxation time values, such as malignant tumors and normal breast parenchymal tissues. The technique was able to demonstrate that the intense lipid signal, known to be responsible for obscuring the borders of water-fat interfaces and small tumors, could be eliminated in a variety of pathological settings.