Diagnosis Of Suspicious Lesions Research Articles

Effectiveness of Tomosynthesis Versus Digital Mammography in the Diagnosis of Suspicious Lesions for Breast Cancer in an Asymptomatic Population.

IntroductionThe most frequent malignant tumor in women is breast cancer. A dense breast may mask lesions within the tissue. The constant improvement in diagnosis techniques has made the diagnosis more accurate. Digital mammography loses sensitivity in dense breasts as lesions may be masked by the over-position of tissue. Tomosynthesis increases sensitivity and specificity over diagnostic mammography. In this study, we examine the effectiveness of tomosynthesis versus digital mammography in asymptomatic patients.Materials and methodsA cohort study of 1,499 Mexican patients that came for screening at a private health service from January to December 2015. A Breast Imaging Reporting and Database System (BI-RADS) classification was given by a breast radiologist with the digital mammography reading. Later, a second breast radiologist reviewed the same patients with tomosynthesis and assigned a second BI-RADS category.ResultsPatients were divided into three age groups. The one with the most had patients between 40-49 years (51.3%), where re-staging to a higher BI-RADS occurred in 40 patients. Re-staging to a lower category was most common in the group of age above 50, where 30 patients were assigned BI-RADS 2 after tomosynthesis. Dense breast (C and D) represented 38%. After tomosynthesis, 28 patients were classified as BI-RADS 4 or 5. The prevalence of diseases in groups BI-RADS 4 and BI-RADS 5 after re-staging and a breast cancer result was 0.024, with a sensitivity of 54% and a specificity of 88%. When re-staging 2D mammography with 3D tomosynthesis for suspicious lesions classified BI-RADS 3, 4, or 5, the prevalence was 0.23, with a sensitivity of 45% and a specificity of 98%.In this study, patients were asymptomatic, yet 20 breast cancers were detected, with a sensitivity of 54% and a specificity of 88%, exceeding the specificity of diagnostic mammography. Moreover, when re-staging to a BI-RADS of suspicious findings, the sensitivity was 45%, with a specificity of as high as 98%.

Initial results from a multi-center population-based cluster randomized trial of esophageal and gastric cancer screening in China

BackgroundWe initiated the first multi-center cluster randomized trial of endoscopic screening for esophageal cancer and gastric cancer in China. The objective of the study was to report the baseline screening findings in this trial.MethodsWe recruited a total of 345 eligible clusters from seven screening centers. In the intervention group, participants from high-risk areas were screened by endoscopy; in non-high-risk areas, high-risk individuals were identified using a questionnaire and advised for endoscopy. Lugol’s iodine staining in esophagus and indigo carmine dye in stomach were performed to aid in the diagnosis of suspicious lesions. The primary outcomes of this study were the detection rate (proportion of positive cases among individuals who underwent endoscopic screening) and early detection rate (the proportion of positive cases with stage 0/I among all positive cases).ResultsA total of 149,956 eligible subjects were included. The detection rate was 0.7% in esophagus and 0.8% in stomach, respectively. Compared with non-high-risk areas, the detection rates in high-risk areas were higher, both in esophagus (0.9% vs. 0.1%) and in stomach (0.9% vs. 0.3%). The same difference was found for early-detection rate (esophagus: 92.9% vs. 53.3%; stomach: 81.5% vs. 33.3%).ConclusionsThe diagnostic yield of both esophagus and stomach were higher in high-risk areas than in non-high-risk areas, even though in non-high-risk areas, only high-risk individuals were screened. Our study may provide important clues for evaluating and improving the effectiveness of upper-endoscopic screening in China.Trial registration: Protocol Registration System in Chinese Clinical Trial Registry, ChiCTR-EOR-16008577. Registered 01 June 2016-Retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=14372

Contrast Enhanced Mammography: The added value in the assessment of Suspicious Breast Lesions

Abstract Background Breast cancer in women is a major public health problem throughout the world, being the second most common cancer worldwide. Sonomammography has been always recommended as the basic breast imaging modality for early detection and diagnosis of breast cancer. Some malignant tumors have been missed, specially in dense breasts, and high false-negative rate have been reported. Contrast enhanced spectral mammography is a new modality, used to depict the tumor vascularity and neoangiogenesis; a classic sign of malignant tumors. Aim of Work The purpose of this study is to determine the added value of dual energy contrast mammography to sono-mammography in the assessment of suspicious breast lesions. Patients and Methods 36 patients were included in the study, referred from outpatient clinics in private settings and from Demerdash Hospitals. Contrast enhanced spectral mammography CESM was performed by using a digital mammography unit (Seno DS; GE, Buc, France) that had been adapted to obtain two images for each view: a low-energy image (below the k edge of iodine, 33.2 keV) and a high-energy image (above the k edge of iodine) at 45 to 49 kVp. Results: CEDM versus sonomammography shows p (0.021) value less than 0.05. Also the area under the ROC curve was higher for MX+CEDM (94.4%) than that was for sonomammography (63.8%) compared to pathology analysis with 100% sensitivity, 88.2 % specificity, 90.48 %PPV and 100 % NPV in diagnosis of suspicious lesions. Conclusion The diagnostic accuracy of CEDM+ MX for the detection of breast carcinoma has proven to be superior to sonomammography alone. CEDM had a better diagnostic accuracy mainly due to improved positive and negative predictive values (Positive predictive value about 90.48, negative predictive value 100). The role of CEDM in detection of multifocal / multicentric carcinomas with particular interest for the assessment of the extent of disease specially in dense breasts is appreciated.

Advanced Endoscopic Navigation: Surgical Big Data, Methodology, and Applications.

Interventional endoscopy (e.g., bronchoscopy, colonoscopy, laparoscopy, cystoscopy) is a widely performed procedure that involves either diagnosis of suspicious lesions or guidance for minimally invasive surgery in a variety of organs within the body cavity. Endoscopy may also be used to guide the introduction of certain items (e.g., stents) into the body. Endoscopic navigation systems seek to integrate big data with multimodal information (e.g., computed tomography, magnetic resonance images, endoscopic video sequences, ultrasound images, external trackers) relative to the patient's anatomy, control the movement of medical endoscopes and surgical tools, and guide the surgeon's actions during endoscopic interventions. Nevertheless, it remains challenging to realize the next generation of context-aware navigated endoscopy. This review presents a broad survey of various aspects of endoscopic navigation, particularly with respect to the development of endoscopic navigation techniques. First, we investigate big data with multimodal information involved in endoscopic navigation. Next, we focus on numerous methodologies used for endoscopic navigation. We then review different endoscopic procedures in clinical applications. Finally, we discuss novel techniques and promising directions for the development of endoscopic navigation.

Modern endoscopic imaging tools for urothelial carcinoma of the urinary bladder

Cystoscopy is the gold standard for the initial diagnosis of urothelial carcinoma in the urinary bladder (UCB). White light exhibits significant limitations in its ability to detect flat lesions or carcinoma in situ. Photodynamic Diagnosis (PDD) and Narrow Band Imaging (NBI) are established techniques which may improve the detection rates of UCB and reduce the risk of recurrence. Multiple novel tools have been developed in order to improve the diagnostic accuracy of endoscopic procedures, including Digital Contrast Enhancement Technology, Confocal Laser Endomicroscopy (CLE) and Optical Coherence Tomography (OCT). In future, spectral analysis of urothelial lesions may be achieved by Raman spectroscopy, thus providing information about biological alterations in the tissue. Furthermore, molecular imaging may allow specific targeting by fluorescent antibodies or small molecule agents, thus enabling differential diagnosis of suspicious lesions. Software-based approaches have been developed to incorporate computer-aided diagnosis and improve digital documentation of endoscopic findings. This study reviews current and future developments in the field of modern endoscopy of the urinary bladder and discusses the different approaches.

Radiology Update Ultrasound Elastography – Quintessence for the Primary Care Physician

Ultrasound elastography visualizes and measures elasticity of tissue. Depending on the methods there are four types of elastography: strain elastography (SE), transient elastography (TE), acoustic radiation force impulse imaging (ARFI) and shear wave elastography (SWE). Due to the fact that pathological changes in the tissue in most of the cases mean a lower elasticity, ultrasound elastography is able to diagnose diseases such as liver fibrosis, liver cirrhosis, to help in the diagnosis of suspicious lesions in mamma, prostate and thyroid gland. So far, ultrasound elastography is not yet able to replace other standardized diagnostic tools but can add valuable diagnostic information.

Frequency of the morphological criteria of prostate adenocarcinoma in 387 consecutive prostate needle biopsies: emphasis on the location and number of nucleoli

Introduction and objectives: We evaluated the sensitivity and specificity of morphological criteria for the diagnosis of prostate adenocarcinoma in consecutive, prostate needle biopsies specimens with emphasis on the location and number of nucleoli. Methods: The morphological features of 387 consecutive prostate needle biopsies specimens, in 2013, were systematically examined and stratified according to the final diagnosis of benign, suspicious and malignant lesions. We also tested how well each criterion predicted the final diagnosis after the immunohistochemical evaluation for expression of the basal cell markers (p63 and high molecular weight cytokeratin) and racemase. Results: A prominent nucleoli is the most common feature of carcinoma; however it is also relatively common in benign cases. The frequencies of prominent central nucleoli in malignant, suspicious and benign cases were 99%, 89% and 27%, respectively. Marginated nucleoli (85%, 60% and 7%), double nucleoli (86%, 53% and 10%), and multiple nucleoli (47%, 14% and 2%) were less common in benign cases, with significant difference among the groups. From the 36 cases initially diagnosed as suspicious, the presence of marginated nucleoli and mitoses were associated with the final diagnosis of malignancy. Prominent central nucleoli were more associated with cases which the final diagnosis after immunohistochemistry was benign. Conclusion: The location and number of nucleoli may be valuable morphological markers to identify suspicious lesions, since these features are more specific for malignancy than nucleolar prominence. The presence of prominent nucleoli commonly leads to the initial diagnosis of suspicious lesion that, subsequently, will be resulted in benignity confirmed by immunohistochemistry.

Scrape cytology in ophthalmology: Our experience with three cases

The aim was to describe the use of scrape cytology as a procedure for the preliminary diagnosis of suspicious lesions in case of three patients. The first patient was diagnosed with sebaceous gland carcinoma of the upper lid, second patient had squamous cell carcinoma (SCC) of the bulbar conjunctiva, and the third patient had SCC of the skin of medial canthus of eye. In this article, we have discussed the history of evolution of cytology briefly. Different types of cytology procedures as well as advantages and disadvantages of each procedure have also been discussed. We have described the procedure of taking scrape specimen and further processing in brief. The article emphasizes the role of scrape cytology in initial diagnosis, treatment plan, prognosis, and subsequent follow-ups in patients of ocular surface tumor.

Abstract P2-03-06: Sonographic evaluation of MRI-detected lesions of the breast using image fusion technique with magnetic navigation

Abstract [Back ground] Breast magnetic resonance imaging (MRI) is being increasingly evaluated in the screening of patients at high risk of breast cancer and screening of the contralateral breast in newly diagnosed breast cancer. However, the utility of MRI is restricted by its limited specificity and moderate positive predictive value (PPV) because of the overlap of imaging features in benign and malignant lesions. Therefore, tissue sampling should be required for definitive diagnosis of suspicious lesions, especially in cases of MRI-detected lesions. To localize MRI-detected lesions and confirm histopathologic results, MRI-guided biopsy has been introduced with high rates of success. If MRI-detected lesions can be detected with second-look sonography, sonography-guided biopsy, which is more broadly available, less costly, and less time-consuming, is recommended. [Purpose] The aim of this study was to verify the utility of second-look sonography using real-time virtual sonography (RVS), a coordinated sonography and MRI system that uses an image fusion technique with magnetic navigation, in the sonographic evaluation of MRI-detected lesions of the breast. [Materials and methods] Of 196 consecutive patients who were examined with breast MRI in our hospital from 2006 to 2009, those who underwent second-look sonography to identify MRI-detected lesions were enrolled in this study. MRI was performed using a 1.5-T imager with the patient in a supine position. To assess the efficacy benefits of RVS, the correlations between lesion detection rates, MRI features, distribution, and histopathological classification on second-look sonography using conventional B-mode or RVS were analyzed. [Results] Of 196 patients, 55 (28%) demonstrated 67 lesions initially detected by MRI, followed by second-look sonography. Of the 67 MRI-detected lesions, 18 (27%) were identified with second-look sonography using conventional B-mode alone, whereas 60 (90%) lesions were detected with second-look sonography using RVS (p < 0.001). The detection rates of 16 focal lesions, 46 mass lesions, 16 lesions sized <5 mm, 45 lesions sized 5-10 mm, 26 lesions situated within the mammary gland, 41 lesions situated around mammary fascia, 24 malignant lesions, and 43 benign lesions were 25%, 26%, 25%, 24%, 42%, 17% 33%, and 23% by conventional B-mode, and were significantly higher at 94%, 89%, 94%, 89%, 88%, 90%, 92% and 88% by RVS, respectively. Of the 7 lesions with no sonographic correlates, 5 could be biopsied by marking MRI information onto the body surface using RVS. Overall, 65 of 67 (97%) MRI-detected lesions were confirmed by histopathological results. [Conclusions] Our results suggest that the additional use of RVS on second-look sonography significantly increases the sonographic detection rate of MRI-detected lesions without operator dependence. The majority of MRI-detected lesions had sonographic correlates and sonography-guided biopsy could subsequently be performed by adding RVS. It might contribute to identifying cases in which MRI-guided biopsy is absolutely necessary. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-03-06.

Preliminary results on the use of a noninvasive instrument for the evaluation of the depth of pigmented skin lesions: numerical simulations and experimental measurements

The early detection of cutaneous pigmented lesions is an important aid to the clinician in recognizing malignant melanoma. In an attempt to correlate the depth of a pigmented skin lesion with its malignant potential, phantoms able to simulate the diffuse reflectance of some lesions of different thicknesses were manufactured and tested to validate a diagnostic instrument developed in-house. Such optical skin-tissue phantoms may be useful for accelerating and optimizing the diagnosis of suspicious lesions of the skin. In fact, benign melanocytic lesions are different in terms of their diffuse reflectance from melanoma. The diffuse reflectance of pigmented skin lesions depends on the amount and distribution of the absorbing/diffusing chromophores embedded in the skin layers. The basic phantom material is a PVA hydrogel in which appropriate amounts of optical scatter are added extraneously at the time of formation to achieve tunability of the optical properties. Liquid Indian ink is used to simulate melanin and all the other chromophores. Slabs were prepared to mimic lesions of different depths. The optical properties of the tissue phantoms were determined in the visible and near-infrared spectral ranges using a noninvasive instrument made from a purpose-modified digital camera. The measured reflectance was correlated with the depth of the lesion both in a Monte Carlo simulation environment and in a laboratory experiment.

Transrectal ultrasound-guided punch biopsies of the prostate. Indication, technique, results, and complications

The golden standard for diagnosis of prostate cancer is transrectal ultrasound-guided systematic biopsy (TRUS-Bx). The optimal number of cylinders, sampling design, and indications for repeat biopsy are still in a state of flux. At the beginning of the 1980s, considerable doubts persisted regarding the benefit of ultrasound-guided punch biopsy for the diagnosis of prostate cancer. The examination on a chair with a fixed ultrasound head caused the patient substantial discomfort. Besides, in the pre-PSA era, most prostate carcinomas were detected by palpation and digitally guided biopsies were easily obtained. Indeed, the DRU procedure alone exhibited low sensitivity. Keetch et al. found that in only 25% of patients with abnormal palpatory findings and PSA between 4 and 20 ng/ml was a carcinoma revealed upon biopsy. On the other hand, patients with suspicious palpatory findings and proven malignancy suffered more frequently from locally advanced and systemic metastasizing tumors. As a result of restaging based on PSA, in most series more than half of the detected carcinomas presented normal palpatory findings. Ultrasound examination made precise imaging of zonal structures possible and thus offered the advantage of precision guidance for tissue biopsy despite lower sensitivity and specificity for diagnosis of suspicious lesions. Furthermore, calculation of prostate volume was possible. At the end of the 1980s, Hodge defined the systematic sextant biopsy as the first golden standard for early detection of prostate cancer. This meant the systematic removal of three punch cylinders from both lateral lobes of the prostate in the parasagittal midline at various levels (apex, middle, and base).