Degree Of Suspicion For Malignancy Research Articles

Radiological evaluation of ovarian mass by contrast-enhanced computed tomography abdomen with clinicopathological correlation in Eastern Indian population

Background: Adenexal masses present diagnostic challenges. After identification of the ovarian mass, the most critical step is to determine the degree of suspicion for malignancy. It is mainly based on imaging modalities and clinicopathological correlation. Aims and Objectives: This radiological study was designed to differentiate benign and malignant ovarian masses by contrast enhanced-computed tomography (CECT) of abdomen and correlation of the radiological findings with histopathological report. Materials and Methods: This was a hospital-based prospective study conducted in Department of Radiodiagnosis, Nilratan Sircar Medical College and Hospital, Kolkata during January 2019–June 2020. The study was done on clinically suspected 50 patients of 15–50 years with ovarian mass having CECT diagnosed solid/complex solid cystic mass. Results: Among 50 cases under study, 37(74.0%) were benign which was significantly higher than that of malignant cases (26.0%). Malignancy was significantly associated with wall irregularity, solid-cystic composition, presence of thick septations, septal enhancement, presence of both septal, and solid enhancement pattern in CECT. Conclusion: Based on the results of the present study, multi-detector contrast-enhanced CT could be a rapid non-invasive and cost-effective step in the evaluation of ovarian masses.

Clinical suspicion of pancreatic cancer despite negative endoscopic ultrasound-guided fine-needle aspiration biopsy.

The early and accurate diagnosis of pancreatic ductal adenocarcinoma is vital for improving the efficacy of therapeutic interventions and to provide patients with the best chance of survival. While endoscopic ultrasound-fine needle aspiration (EUS-FNA) has been demonstrated to be a reliable and accurate diagnostic tool for solid pancreatic neoplasms, the ongoing management of patients with a high clinical suspicion for malignancy but with a negative EUS-FNA biopsy result can prove a challenge. We describe five patients from a single centre who presented for further work-up of a pancreatic mass and/or imaging features concerning for a periampullary malignancy. All patients had at least one EUS-FNA biopsy performed which returned no malignant cells on cytology. Despite these negative cytology results, all patients underwent further invasive investigation through upfront resection (pancreaticoduodenectomy) or extra-pancreatic biopsy (laparoscopic biopsy of peritoneal nodule) due to worrisome features on imaging, biochemical factors and clinical presentation culminating in a high degree of suspicion for malignancy. The final tissue histopathological diagnosis in all patients was pancreatic ductal adenocarcinoma. This case series highlights the important clinical findings, imaging and biochemical features which need to be considered in patients who have high suspicion for malignancy despite having a negative EUS-FNA cytology result. In these patients with a high index of suspicion, surgical intervention through an upfront resection or further invasive investigation should not be delayed.

Chronic Pancreatitis or Pancreatic Tumor? A Problem-solving Approach

Certain inflammatory pancreatic abnormalities may mimic pancreatic ductal adenocarcinoma at imaging, which precludes accurate preoperative diagnosis and may lead to unnecessary surgery. Inflammatory conditions that may appear masslike include mass-forming chronic pancreatitis, focal autoimmune pancreatitis, and paraduodenal pancreatitis or "groove pancreatitis." In addition, obstructive chronic pancreatitis can mimic an obstructing ampullary mass or main duct intraductal papillary mucinous neoplasm. Secondary imaging features such as the duct-penetrating sign, biliary or main pancreatic duct skip strictures, a capsulelike rim, the pancreatic duct-to-parenchyma ratio, displaced calcifications in patients with chronic calcific pancreatitis, the "double duct" sign, and vessel encasement or displacement can help to suggest the possibility of an inflammatory mass or a neoplastic process. An awareness of the secondary signs that favor a diagnosis of malignant or inflammatory lesions in the pancreas can help the radiologist to perform the differential diagnosis and determine the degree of suspicion for malignancy. Repeat biopsy or surgical resection may be necessary to achieve an accurate diagnosis and prevent unnecessary surgery for inflammatory conditions. Online supplemental material and DICOM image stacksare available for this article. ©RSNA, 2019.

ASSESSMENT OF SUSPICIOUS OVARIAN CYSTS IN THE FEMALES BY USING OF TRANS ABDOMINAL ULTRASONOGRAPHY (TAUS) AND COMPUTED TOMOGRAPHY (CT)

Owing to the development and improvement of growing number of conservative surgeries like laparoscopic surgery, the ultimate diagnosis of an ovarian mass is considered to be an important mission in gynecologic practice. The degree of suspicion for malignancy in a given mass is based largely on imaging appearance. Suspicious ovarian masses should be evaluated preoperatively to know their nature and behavior, which in turn persuade the choice of type of surgery. Evaluation of the suspicious ovarian mass should include clinical evaluation and imaging techniques. The aim of this study is to compare the diagnostic value of transabdominal ultrasonography (TAUS) and computed tomography (CT) in evaluation of suspicious ovarian masses
 The 50 female patients referred to the Department of Radiology in the Narayan Medical College and Hospital fromJan 2018 to July 2018 was enrolled in the present study. The enrolled females were identified with the ovarian cysts. The females underwent the trans abdominal ultrasonography (TAUS) and computed tomography (CT). Detailed history of allergy and renal function tests were taken before doing CT scan and if there was history of allergy then non-ionic contrast was used. Site, size, papillary projections, wall characteristics, capsular infiltrations, the presence of solid areas inside the mass and presence of as cites were recorded both by US and CT scan.
 The results of present study suggest that in diagnosing and determining the benign or malignant potential of an ovarian mass, both USG and CT have concordant roles. CT is more sensitive in determining the malignant lesions, USG is more specific and the difference between the two is statistically insignificant.
 Keywords: Suspicious Ovarian Cysts, trans abdominal ultrasonography (TAUS) and computed tomography (CT), etc.

FNA biopsy of pediatric cervicofacial masses and validation of clinical characteristics of malignancy

IntroductionPediatric head and neck masses can pose a diagnostic challenge due to their ubiquitous nature. The vast majority of masses are inflammatory, however malignancies do occur. This study is a review of fine needle aspiration biopsy (FNA-B) as a diagnostic technique at a single institution over a 13 year period. The objectives were to examine the sensitivity and specificity of FNA-B, correlate these results with clinical characteristics of each mass and determine if such characteristics are associated with malignancy. MethodsThis was a retrospective case series of 143 consecutive pediatric patients who underwent FNA-B of 146 head and neck masses with subsequent follow up examinations from 2000 to 2012 (inclusive). We expected FNA-B to be a sensitive and specific method for determining malignancy. FNA-B diagnoses were confirmed with open biopsy pathology results and clinical follow up greater than 1 year. Physical exam characteristics of each mass including location, tenderness, firmness, and mobility were documented. Chi square and Fisher exact tests were used to determine statistical significance. ResultsThe sensitivity and specificity of FNA-B in determining malignancy were 87.5% and 100% respectively. Positive and negative predictive values were 100% and 99.1%, respectively. On univariate analysis of clinical descriptors associated with malignancy, non-mobile masses significantly correlated (p=0.0025), while the firmness and tenderness of a mass did not reach statistical significance. Of mass locations, the lateral neck had the strongest association with malignancy, but this relationship only demonstrated statistical significance when lymphomas were considered independently (p=0.0428). ConclusionsResults demonstrate FNA-B to be an effective method for the diagnosis of pediatric head and neck masses. It maintained a high sensitivity and specificity with a large sample size, to date one of the largest in the pediatric otolaryngology literature. Also, the data offered statistical validation of classical signs of malignancy and showed fixed masses to have the highest correlation. Finally, the findings support lateral neck masses to warrant a higher degree of suspicion for malignancy compared to other compartments.

The Breast Imaging Reporting and Data System (BI-RADS) in the Dutch breast cancer screening programme: its role as an assessment and stratification tool

ObjectivesTo assess the suitability of the Breast Imaging Reporting and Data System (BI-RADS) as a quality assessment tool in the Dutch breast cancer screening programme.MethodsThe data of 93,793 screened women in the Amsterdam screening region (November 2005–July 2006) were reviewed. BI-RADS categories, work-up, age, final diagnosis and final TNM classification were available from the screening registry. Interval cancers were obtained through linkage with the cancer registry. BI-RADS was introduced as a pilot in the Amsterdam region before the nationwide introduction of digital mammography (2009–2010).ResultsA total of 1,559 women were referred to hospital (referral rate 1.7 %). Breast cancer was diagnosed in 485 women (detection rate 0.52 %); 253 interval cancers were reported, yielding a programme sensitivity of 66 % and specificity of 99 %. BI-RADS 0 had a lower positive predictive value (PPV, 14.1 %) than BI-RADS 4 (39.1 %) and BI-RADS 5 (92.9 %; P < 0.0001). The number of invasive procedures and tumour size also differed significantly between BI-RADS categories (P < 0.0001).ConclusionThe significant differences in PPV, invasive procedures and tumour size match with stratification into BI-RADS categories. It revealed inter-observer variability between screening radiologists and can thus be used as a quality assessment tool in screening and as a stratification tool in diagnostic work-up.Key Points• The BI-RADS atlas is widely used in breast cancer screening programmes. • There were significant differences in results amongst different BI-RADS categories. • Those differences represented the radiologists’ degree of suspicion for malignancy, thus enabling stratification of referrals. • BI-RADS can be used as a quality assessment tool in screening. • Training should create more uniformity in applying the BI-RADS lexicon.

Effect of Clinical Information on Diagnostic Performance in Breast Sonography

The purpose of this study was to assess whether the clinical information (CI) of patients affects the degree of suspicion for malignancy by radiologists performing breast sonography. We included 150 breast lesions in 144 patients who underwent breast sonography and sonographically guided core needle biopsy. A pathologic diagnosis was available for all 150 breast lesions: 78 (52%) were malignant, and 72 (48%) were benign. Three radiologists retrospectively reviewed the sonograms of all lesions twice at 8-week intervals first without any CI for the patients (first review) and then with CI such as patient age, palpability, and personal history of risk factors for breast cancer (second review). The reviewers categorized the final assessment according to the American College of Radiology Breast Imaging Reporting and Data System. We compared diagnostic performance such as sensitivity and specificity and the degree of suspicion for malignancy between the image reviews with and without CI. In the second review, sensitivity was improved in all 3 reviewers (94.0 to 99.2%; P < .05), and specificity was decreased (39.8 to 30.8%; P = .04). There was a significant increase of suspicion for malignancy with the patients' CI (P < .05). Clinical information about a patient's breast cancer history and clinical presentation with a palpable mass can increase the suspicion for malignancy on sonography and the sensitivity of sonographic interpretation.

Ovarian cancer: the clinical role of US, CT, and MRI.

This article presents an overview of ovarian cancer, which addresses the clinical roles of imaging studies, including US, CT, and MR imaging in the course of diagnosis and treatment of this important disease. US is the modality of choice in the evaluation of patients with suspected adnexal masses. Although its accuracy is not sufficient to avert surgery, morphological analysis of adnexal masses with US helps narrow the differential diagnosis, determining the degree of suspicion for malignancy, usually in concert with a serum CA-125 level. Combined morphological and vascular imaging obtained by US appear to further improve the preoperative assessment of adnexal masses. For uncertain or problematic cases, MR imaging helps to distinguish benign from malignant, with an overall accuracy for the diagnosis of malignancy of 93%. The accuracy of MR imaging in the confident diagnosis of mature cystic teratoma, endometrial cysts, and leiomayomas is very high. CT is not indicated for differential diagnosis of adnexal masses because of poor soft tissue discrimination, except for fatty tissue and for calcification, and the disadvantages of irradiation. In the staging of ovarian cancer, CT, US, and MR imaging all have a similarly high accuracy. Although it is difficult to suggest a simple algorithm for evaluating the state of women with adnexal masses, the correct preoperative diagnosis and staging of ovarian cancer with the use of any of these imaging studies will lead to an appropriate referral to a specialist in gynecologic oncology and offer a significant survival advantage for patients with ovarian cancer.

Comparison of 99mTc-Sestamibi Scintimammography and Dynamic MR Imaging as Adjuncts to Mammography in the Diagnosis of Breast Cancer

To compare the diagnostic accuracy of planar 99mTc-sestamibi scintimammography with dynamic contrast-enhanced MRI (CE-MRI) on the basis of histopathologic results, and to determine the clinical value of these methods as adjuncts to mammography. A total of 90 consecutive women with 111 histopathologically verified breast lesions were enrolled in the study. Patients underwent scintimammography and CE-MRI in addition to mammography. Each finding was classified on a BI-RADS-like five-point rating scale describing the degree of suspicion for malignancy, and all findings were correlated with the histopathological results. The overall sensitivity/specificity/accuracy was 85%/59%/78% for mammography, 94%/47%/80% for CE-MRI, and 82%/75%/80% for scintimammography, respectively. CE-MRI showed higher sensitivity (p = 0.008), but its specificity was lower than scintimammography (p = 0.049). Using ROC analysis, significant improvement ( p = 0.034) was found between mammography and the combination of mammography + CE-MRI, while mammography + scintigraphy showed no higher diagnostic accuracy than mammography alone. If high sensitivity and spatial resolution are needed, CE-MRI is to be preferred in clinical practice as an adjunct to mammography, rather than scintigraphy.

Comparison of 99mTc-Sestamibi scintimammography and dynamic MR imaging as adjuncts to mammography in the diagnosis of breast cancer

Purpose: To compare the diagnostic accuracy of planar 99mTc-sestamibi scintimammography with dynamic contrast-enhanced MRI (CE-MRI) on the basis of histopathologic results, and to determine the clinical value of these methods as adjuncts to mammography. Material and Methods: A total of 90 consecutive women with 111 histopathologically verified breast lesions were enrolled in the study. Patients underwent scintimammography and CE-MRI in addition to mammography. Each finding was classified on a BI-RADS-like five-point rating scale describing the degree of suspicion for malignancy, and all findings were correlated with the histopathological results. Results: The overall sensitivity/specificity/accuracy was 85%/59%/78% for mammography, 94%/47%/80% for CE-MRI, and 82%/75%/80% for scintimammography, respectively. CE-MRI showed higher sensitivity ( p = 0.008), but its specificity was lower than scintimammography ( p = 0.049). Using ROC analysis, significant improvement ( p = 0.034) was found between mammography and the combination of mammography + CE-MRI, while mammography + scintigraphy showed no higher diagnostic accuracy than mammography alone. Conclusion: If high sensitivity and spatial resolution are needed, CE-MRI is to be preferred in clinical practice as an adjunct to mammography, rather than scintigraphy.

Imaging evaluation of ovarian masses.

Adnexal masses present a special diagnostic challenge, in part because benign adnexal masses greatly outnumber malignant ones. Determination of a degree of suspicion for malignancy is critical and is based largely on imaging appearance. Endovaginal ultrasonography (US) is the most practical modality for assessment of ovarian tumors because it is readily available and has a high negative predictive value. Morphologic analysis of adnexal masses is accurate for identifying masses as either low risk or high risk. The most important morphologic features are non-fatty solid (vascularized) tissue, thick septations, and papillary projections. Color Doppler US helps identify solid, vascularized components in a mass. Spectral Doppler waveform characteristics (eg, resistive index, pulsatility index) correlate well with malignancy but generally add little information to morphologic considerations. Computed tomography can help assess the extent of disease in patients before and after primary cytoreductive surgery. Magnetic resonance (MR) imaging is better reserved for problem solving when US findings are nondiagnostic or equivocal because, although it is more accurate for diagnosis, it is also more expensive. The signal intensity characteristics of ovarian masses make possible a systematic approach to diagnosis. Mature cystic teratomas, cysts, endometriomas, leiomyomas, fibromas, and other lesions can be accurately diagnosed on the basis of T1-weighted, T2-weighted, and fat-saturated T1-weighted MR imaging findings.