Rate Of Unnecessary Biopsies Research Articles

Comb-push ultrasound shear elastography (CUSE) for evaluation of thyroid nodules: preliminary in vivo results.

In clinical practice, an overwhelming majority of biopsied thyroid nodules are benign. Therefore, there is a need for a complementary and noninvasive imaging tool to provide clinically relevant diagnostic information about thyroid nodules to reduce the rate of unnecessary biopsies. The goal of this study was to evaluate the feasibility of utilizing comb-push ultrasound shear elastography (CUSE) to measure the mechanical properties (i.e., stiffness) of thyroid nodules and use this information to help classify nodules as benign or malignant. CUSE is a fast and robust 2-D shear elastography technique in which multiple laterally distributed acoustic radiation force beams are utilized simultaneously to produce shear waves. Unlike other shear elasticity imaging modalities, CUSE does not suffer from limited field of view (FOV) due to shear wave attenuation and can provide a large FOV at high frame rates. To evaluate the utility of CUSE in thyroid imaging, a preliminary study was performed on a group of five healthy volunteers and 10 patients with ultrasound-detected thyroid nodules prior to fine needle aspiration biopsy. The measured shear wave speeds in normal thyroid tissue and thyroid nodules were converted to Young's modulus (E), indicating a measure of tissue stiffness. Our results indicate an increase in E for thyroid nodules compared to normal thyroid tissue. This increase was significantly higher in malignant nodules compared to benign. The Young's modulus in normal thyroid tissue, benign and malignant nodules were found to be 23.2 ±8.29 kPa, 91.2±34.8 kPa, and 173.0±17.1 kPa, respectively. Results of this study suggest the utility of CUSE in differentiating between benign and malignant thyroid nodules.

Computed tomography imaging findings of craniofacial fibrous dysplasia.

The purpose of this study was to retrospectively describe demographic characteristics and computed tomography (CT) imaging findings of craniofacial fibrous dysplasia (FD). Between February 2010 and February 2013, we retrospectively studied 64 patients described as FD at CT imaging. Site of involvement and CT imaging findings of craniofacial FD were recorded for each patient. Our patients are described as FD at CT imaging with the following findings: expansion, ground glass density, expansion and sclerosis, expansion with sclerosis and lytic appearance, expansion and lytic appearance, and only sclerosis. Expansion was the main feature which was seen with other findings (85%). The most common finding was ground glass density and the least appearance was expansion with lytic areas and only sclerosis. Our study has shown that it is very effective to know about CT findings and localizations of craniofacial FD to reduce unnecessary biopsy rates and increase the true diagnosis.

Incremental value of real-time ultrasound elastography in differentiating breast masses

Aim of the workTo evaluate the value of real-time ultrasound elastography (RTE) in differentiating benign from malignant breast masses. Materials and methodsThis study included, whether palpable or non-palpable, 145 sonographically proven breast masses in 121 patients, imaged by conventional B-mode US, color-flow Doppler US and RTE with histopathological analysis considered as the golden standard reference. ResultsLesions were differentiated into benign and malignant by conventional B-mode US (79; 45.5% and 66; 54.5%, respectively), RTE (80; 55.2% and 65; 44.8% respectively), and histopathology (82; 56.6% and 63; 43.4%, respectively). The mean difference in the mass size was significant between B-mode US and RTE in malignant masses (P=0.002), while not significant among benign masses (P=0.153). The B-mode US depicted sensitivity of 92.06%, specificity of 90.24%, PPV of 87.88%, NPV of 93.67% and accuracy of 91.03%, while the RTE showed sensitivity of 98.41%, specificity of 96.34%, PPV of 95.38%, NPV of 98.75% and accuracy of 97.24%. ConclusionCombined use of RTE can complement conventional B-mode US with improving its diagnostic performance in differentiating breast lesions with subsequent reduction in the rate of unnecessary biopsies in benign lesions.

Prediction of celiac disease at endoscopy

Celiac disease is increasingly recognized worldwide, but guidelines on how to detect the condition and diagnose patients are unclear. In this study the prevalence and predictors of celiac disease were prospectively determined in a cross-sectional sample of Lebanese patients undergoing esophagogastroduodenoscopy (EGD). Consecutive consenting patients (n = 999) undergoing EGD answered a questionnaire and had blood taken for serologic testing. Endoscopic markers for celiac disease were documented and duodenal biopsies were obtained. The diagnosis of celiac disease was based on abnormal duodenal histology and positive serology. Risk factors were used to classify patients to either high or low risk for celiac disease. Independent predictors of celiac disease were derived via multivariate logistic regression. Villous atrophy (Marsh 3) and celiac disease were present in 1.8 % and 1.5 % of patients, respectively. Most were missed on clinical and endoscopic grounds. The sensitivity of tissue transglutaminase (tTG) testing for the diagnosis of villous atrophy and celiac disease was 72.2 % and 86.7 %, respectively. The positive predictive value of the deamidated gliadin peptide (DGP) test was 34.2 % and that of a strongly positive tTG was 80 %. While the strongest predictor of celiac disease was a positive tTG (odds ratio [OR] 131.7, 95 % confidence interval [CI] 29.0 - 598.6), endoscopic features of villous atrophy (OR 64.8, 95 %CI 10.7 - 391.3), history of eczema (OR 4.6, 95 %CI 0.8 - 28.8), anemia (OR 6.7, 95 %CI 1.2 - 38.4), and being Shiite (OR 5.4, 95 %CI 1.1 - 26.6) significantly predicted celiac disease. A strategy of biopsying the duodenum based on independent predictors had a sensitivity of 93 % - 100 % for the diagnosis of celiac disease, with an acceptable (22 % - 26 %) rate of performing unnecessary biopsies. A strategy that excluded pre-EGD serology produced a sensitivity of 93 % - 94 % and an unnecessary biopsy rate of 52 %. An approach based solely on standard clinical suspicion and endoscopic findings is associated with a significant miss rate for celiac disease. A strategy to biopsy based on the derived celiac disease prediction models using easily obtained information prior to or during endoscopy, maximized the diagnosis while minimizing unnecessary biopsies.

Clinical outcome of preoperative breast MRI for early-stage breast cancer.

42 Background: Preoperative breast magnetic resonance imaging MRI is used in clinical practice to improve oncologic outcome of breast cancer. Concerns over increased rate of unnecessary mastectomies and additional biopsies have been raised. The purpose of our study is to review the outcome of preoperative breast MRI at our institution. Methods: The current study is a retrospective review of 215 patients with early stage breast cancer who underwent definitive surgery. Breast MRI is being used at our institution within the context of multidisciplinary approach. Patients who had complete clinical, radiologic, and pathological data available were identified and formed the basis of this analysis. Results: 215 patients were diagnosed with breast cancer stage I-II in the period of 2006-2012 and had complete data for review. 92 patients out of 215 (43%) had breast MRI prior to definitive surgery. both groups were different in regard of age. Rate of breast conservative surgery, mastectomies, and re-excision for positive margins was similar in both groups. 6 patients out of 12 patients who had breast MRI and underwent bilateral mastectomies were found to have abnormal pathological findings (DCIS 3, LCIS 1, invasive ductal carcinoma 1, and focal epithelial atypia 1). Time from first diagnostic procedure to definitive surgery was similar in both groups (29 days vs. 27.5 days). 38 (41%) patients out of 92 who had breast MRI underwent additional breast biopsies for suspicious lesions with only 8 (21%) patients found to have abnormal pathological findings. Conclusions: Use of breast MRI prior to definitive surgery for early stage breast cancer was associated with increased rate of additional biopsies for suspicious lesions with no favorable effect on re-excision rate. [Table: see text]

Computer Aided Diagnosis System for Breast Cancer Based on Color Doppler Flow Imaging

Color Doppler flow imaging takes a great value in diagnosing and classifying benign and malignant breast lesions. However, scanning of color Doppler sonography is operator-dependent and ineffective. In this paper, a novel breast classification system based on B-Mode ultrasound and color Doppler flow imaging is proposed. First, different feature extraction methods were used to obtain the texture and geometric features from B-Mode ultrasound images. In color Doppler feature extraction stage, several spectrum features are extracted by applying blood flow velocity analysis to Doppler signals. Moreover, a velocity coherent vector method is proposed based on color coherence vector, which is helpful for designing to the optimize detection of flow indices from different blood flow velocity fields automatically. Finally, a support vector machine classifier with selected feature vectors is used to classify breast tumors into benign and malignant. The experimental results demonstrate that the proposed computer-aided diagnosis system is useful for reducing the unnecessary biopsy and death rate.

Computer-aided diagnosis system for breast cancer using B-mode and color Doppler flow images

To improve the diagnostic accuracy of breast ultrasound classification, a novel computer-aided diagnosis system based on B-Mode ultrasound and color Doppler flow imaging is proposed. First, different feature extraction methods were used to obtain the texture and geometric features from B-Mode ultrasound images. In the color Doppler feature stage, both vascularity and hemodynamic features are studied by applying color distribution and periodograms analysis to Doppler signals. Finally, a support vector machine classifier with selected feature vectors is used to classify breast tumors into benign and malignant. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and areas under the ROC curves of the proposed system are 94.28%, 96.36%, 92.00%, 92.98%, 95.83%, and 0.9679, respectively. The experimental results demonstrate that the proposed computer-aided diagnosis system can improve the true-positive and decrease the false-positive diagnostic rate, which is useful for reducing the unnecessary biopsy and death rate.

Ultrasonographic differentiation of malignant from benign breast lesions: a meta-analytic comparison of elasticity and BIRADS scoring

There has been controversy regarding the accuracy of breast ultrasound elastography (USE) compared to conventional B-mode Ultrasound (USB). The purpose of this study was to conduct a direct comparative effectiveness analysis of USB versus USE or their combination in differentiating breast lesions through systematically reviewing recent literature. An extensive literature search of PubMed and other medical and general purpose databases from inception through August 2011 was conducted. Published studies that reported a direct comparison of the diagnostic performance of USE, using elasticity score versus USB, using breast imaging reporting and data system (BIRADS) for characterization of focal breast lesions were included. Summary diagnostic performance measures were assessed for each of the tests and their combination using bivariate generalized linear mixed modeling. The two tests were combined as: (1) conjunctive, where the outcome of the combination of tests is positive only if both test results are positive; (2) disjunctive, where the outcome of a combination of tests is negative only if both tests are negative. Twenty nine studies provided relevant information on 5,511 breast masses (2,065 cancers, 3,446 benign lesions). Sensitivity of USB, USE, and their conjunctive and disjunctive combinations were 96% (95% credible interval (CrI), 93-98%), 79% (95% CrI, 74-83%), 73% (95% CrI, 67-78%), and 99% (95% CrI, 98-99%), respectively. Specificity of USB, USE, and their conjunctive and disjunctive combinations were 70% (95% CrI, 55-83%), 88% (95% CrI, 82-92%), 97% (95% CrI, 95-99%), and 56% (95% CrI, 43-69%), respectively. The application of USE as a single test is not superior to USB alone. However, in low risk patients it is recommended to perform an USE following a positive USB result to decrease the rate of unnecessary biopsies.

Evaluation of prostate cancer prevalence in Iranian male population with increased PSA level, a one center experience

Purpose:This study was conducted to evaluate the incidence of prostate cancer (PCa) in Iranian male patients with increased prostate-specific antigen (PSA), and normal or abnormal digital rectal examination (DRE) that underwent prostate biopsy.Materials and methods:From March 2006 to April 2009, a total of 346 consecutive males suspected of having PCa due to increased PSA levels underwent transrectal ultrasonography (TRUS)-guided sextant biopsy of the prostate. The total PSA (tPSA), demographic data, incidence of PCa, benign prostate hyperplasia (BPH), and prostatitis were assessed.Results:The patients were divided into two groups according to their PSA values (group A serum tPSA level, 4–10 ng/mL; group B serum tPSA level, 10.1–20.0 ng/mL). Of the 346 biopsied cases, 193 cases (56%) had PCa, 80 cases (23%) had BPH, and 73 cases (21%) had prostatitis. The mean PSA and the age of the carcinoma group were significantly higher than those of the benign group (P < 0.01). The biopsy results were grouped as PCa, BPH, and prostatitis. Incidence of PCa for group A and group B cases were 115 cases (51%), and 78 cases (65%), respectively. In the case of PCa, BPH, and prostatitis, the mean PSAs were 10.02 ng/mL, 8.76 ng/mL, and 8.41 ng/mL, respectively (P < 0.40).Conclusion:TRUS-guided prostate biopsy and interpretation by a skilled team is highly recommended for early detection of PCa or its ruling-out. It seems that a PSA cutoff value of 4 ng/mL may be applied to the Iranian population. Although the chance of PCa is high in the PSA levels of 4–10 ng/mL, the combination of some data, like age and prostate volume, can decrease the rate of unnecessary prostate biopsies. We recommend prostate biopsy when PSA and/or DRE is elevated in symptomatic patients with obstructive and/or irritative lower urinary tract symptoms (LUTS) such as dysuria, frequency, or nocturia. Due to the very high incidence of PCa in the patients with PSA greater than 10 ng/mL, TRUS-guided biopsy is indicated, whatever the findings on DRE and/or LUTS, since the PCa detection rate is high.

Combined Optical and X-ray Tomosynthesis Breast Imaging

To explore the optical and physiologic properties of normal and lesion-bearing breasts by using a combined optical and digital breast tomosynthesis (DBT) imaging system. Institutional review board approval and patient informed consent were obtained for this HIPAA-compliant study. Combined optical and tomosynthesis imaging analysis was performed in 189 breasts from 125 subjects (mean age, 56 years ± 13 [standard deviation]), including 138 breasts with negative findings and 51 breasts with lesions. Three-dimensional (3D) maps of total hemoglobin concentration (Hb(T)), oxygen saturation (So(2)), and tissue reduced scattering coefficients were interpreted by using the coregistered DBT images. Paired and unpaired t tests were performed between various tissue types to identify significant differences. The estimated average bulk Hb(T) from 138 normal breasts was 19.2 μmol/L. The corresponding mean So(2) was 0.73, within the range of values in the literature. A linear correlation (R = 0.57, P < .0001) was found between Hb(T) and the fibroglandular volume fraction derived from the 3D DBT scans. Optical reconstructions of normal breasts revealed structures corresponding to chest-wall muscle, fibroglandular, and adipose tissues in the Hb(T), So(2), and scattering images. In 26 malignant tumors of 0.6-2.5 cm in size, Hb(T) was significantly greater than that in the fibroglandular tissue of the same breast (P = .0062). Solid benign lesions (n = 17) and cysts (n = 8) had significantly lower Hb(T) contrast than did the malignant lesions (P = .025 and P = .0033, respectively). The optical and DBT images were structurally consistent. The malignant tumors and benign lesions demonstrated different Hb(T) and scattering contrasts, which can potentially be exploited to reduce the false-positive rate of conventional mammography and unnecessary biopsies.

Expert system based on neuro-fuzzy rules for diagnosis breast cancer

Recent advances in the field of artificial intelligence have led to the emergence of expert systems for medical applications. Moreover, in the last few decades computational tools have been designed to improve the experiences and abilities of physicians for making decisions about their patients.Breast cancer is the commonest cancer in women and is the second leading cause of cancer death (Jemal et al., 2003). Although it is curable when detected early, about one third of women with breast cancer die of the disease (Scheidhauer, Walter, & Seemann, 2004). In this study, we have developed an expert system that we called as an Ex-DBC (Expert system for Diagnosis of Breast Cancer), because differentiating between benign and malignant mammographic findings, however, is quite difficult. Only 15–30% of biopsies performed on nonpalpable but mammographically suspicious lesions prove malignant (Hall, Storella, Silverstone, & Wyshak, 1988). The golden standard for diagnosis of breast cancer is biopsy. But, biopsy can be a source of patient discomfort, bleeding and infection, and can burden the health care system with extra costs. Thus, to reduce unnecessary biopsy rate have acquired big importance.The fuzzy rules which will be use in inference engine of Ex-DBC system were found by using neuro-fuzzy method. Ex-DBC can be used as a strong diagnostic tool with 97% specificity, 76% sensitivity, 96% positive and 81% negative predictive values for diagnosing of breast cancer. That the developed system’s positive predictive is high is very important. By means of this system can be prevented unnecessary biopsy. Beside it can be benefited from this system for training of students in medicine.

Bedeutung der Mammasonografie für die Brustkrebsfrüherkennung in der gynäkologischen Praxis

To define the value of whole breast ultrasound for breast cancer detection in primary women's health care in gynecological routing practice. Among women who were operated at the breast center of the German Diagnostic Clinic (DKD) in the year 2007, we selected different indications for the examinations which were relevant for the detection of breast lesions. Twenty-one of 86 breast cancers (24 %) which were treated at the DKD in the year 2007 were detected only because of an individual ultrasound screening examination. None of these women had abnormal clinical findings and only 8 of these women had abnormal mammograms. The majority of these cancers were early stages, pT1a/b. In this group of patients, only 8 benign lesions detected by ultrasound were operated. This corresponds to a ratio of benign vs. malignant operations of 0.4 to 1, which is far superior to the recommendations of international guidelines for quality assurance. Our results show that ultrasound screening considerably increases the detection of early breast cancers without increasing the rate of unnecessary biopsies. This should encourage gynecologists to learn and perform systematic breast ultrasound examinations and to increase their own performance by continuous training. We can expect that additional studies will prove breast ultrasound to be a powerful method for improving breast cancer detection. Currently available state-of-the-art ultrasound technology allows for early detection, but further education and quality control are important for implementation in nation-wide health care.

Screening des Lungenkarzinoms: Stand 2007

Thoughts on screening for lung cancer are based on the very poor prognosis of this tumor when the diagnosis is made because of symptoms (<15% 5-year survival), the markedly better prognosis if it is detected in asymptomatic early stages (up to 80% 5-year survival), the high sensitivity of unenhanced low-dose CT in the detection of small tumors, and the clear definition of persons at risk. Feasibility studies using well-defined diagnostic algorithms for management of detected pulmonary nodules have demonstrated a high proportion (>50 to >90%) of small, resectable non-small-cell lung carcinomas in the early stages, with a good prognosis for the patients affected and a low rate of unnecessary biopsies. However, biases such as overdiagnosis, length-time and lead-time could hamper potential reduction of mortality from lung cancer, and the results of large prospective randomized trials are therefore awaited. At the same time, other techniques for early diagnosis of lung cancer are under evaluation, such as sophisticated methods of sputum analysis, molecular markers in the blood and analysis of exhaled air.

Élastosonographie du sein : étude prospective de 122 lésions

Objective To evaluate elastography in the characterization of breast nodules. Material and methods Elastography (Hitachi, 7.5- to 13-MHz probe; Ueno classification, scores 1-3 = benign, 4-5 = malignant) was evaluated in 125 subclinical lesions in 114 patients. The results were compared to those of the ACR's BI-RADS sonography categories (benign = 2 and 3, malignant = 4 and 5) and to the results of the percutaneous samples taken and/or surgery (122 lesions evaluated, 59% <10 mm, 61 cancers, 61 benign lesions). Results There were three technical failures (2.4%). The elastography was in agreement with histology for 101 lesions, with 13 false-negative results and eight false-positive results (sensitivity, 78.7%; specificity, 86.9%; PPV, 85.7%; NPV, 80.3%); versus agreement with the BI-RADS classification for 98 lesions with one false-negative result and 23 false-positive results (sensitivity, 98.4%; specificity, 47.5%; PPV, 65.2%; NPV, 96.7%). Conclusion Elastography is a simple and rapid complementary method that can improve the specificity and the PPV of morphological imaging studies of breast nodules with a low level of suspicion (BI-RADS categories 3 and 4a), which should decrease the rate of unnecessary benign biopsies.

PSA density as a predictor of aggressive prostate cancer on repeat prostate biopsy

5007 Background: Prostate biopsy procedures carry a high false-negative rate. However, since Gleason score is strongly associated with cancer-specific mortality; efforts to identify men who harbor high-grade prostate cancer will likely assist in patient selection for repeat biopsies. We sought to identify risk factors for the detection of aggressive prostate cancer (Gleason ≥ 7) on repeat biopsy. Methods: Clinical and pathologic variables collected from subjects undergoing a repeat biopsy included all prostate specific antigen (PSA) values, PSA density (PSAD), PSA doubling time (PSADT). PSADT was examined using PSAs up to the first biopsy, and also in an exploratory analysis using both pre- and post-biopsy PSAs. Predictors of aggressive prostate cancer were identified using recursive partitioning and a stepwise Cox regression model. Results: 511 patients with initial negative biopsies underwent 1,319 biopsy procedures. Median follow-up was 3.7 years. Aggressive cancer was diagnosed in 52 of 511 (10.18%) patients. Recursive partitioning analysis selected PSAD as the sole factor for distinguishing high- and low-risk groups. Based on K-M analysis, a PSAD &lt;= 0.304 ng/ml/cc carried 2 and 5 year aggressive cancer detection rates of 4% (± 1.9%) and 9% (± 3.5%) respectively, whereas a PSAD &gt; 0.304 ng/ml/cc carried cancer detection rates of 23% (± 11.9%) and 36% (±15.3%) at 2 and 5 years (p-value &lt;.0001). Independent prognostic factors included (HR, 95% CI): PSA &gt;= 9.7 (2.565, 1.404 - 4.688), PSAD 0.13 - &lt; 0.19 ng/ml/cc (0.423, 0.179 - 0.999) and volume &gt;= 43.3 cc (0.454, 0.247 - 0.833). PSADT became significant when all PSA data were analyzed: PSADT &lt; 2 years (4.203, 1.894 - 9.325) and PSADT &gt;= 5 years (0.17, 0.89- 0.326). Conclusions: In decision tree analysis, a high PSAD is predictive of aggressive prostate cancer on a repeat biopsy. In addition, high PSA, lower PSAD and prostate volume are predictive of aggressive prostate cancer. However in follow-up using all PSA values, a PSADT &lt; 2 yrs. becomes the most significant predictor of aggressive cancer. Such data may help identify the most appropriate patients for a repeat biopsy and could reduce the rate of unnecessary biopsies and the inherent over-treatment of prostate cancer. No significant financial relationships to disclose.

Radial Scar/Complex Sclerosing Lesion of the Breast - Value of Ultrasound

Although benign, radial scar/complex sclerosing adenosis is a lesion which histopathologically resembles tubular carcinoma. On physical examination, it is difficult to distinguish radial scar from a malignant tumour. Mammography cannot differentiate radial scar from malignancy. This clinical study aims to delineate the role of preoperative ultrasonography with emphasis on the question whether ultrasonography could lower the number of false-positive readings and therefore the number of open biopsies required. In this examination, we present the clinical, mammographic, ultrasonographic, and histopathological features of 6 cases of radial scars. Although most authors describe radial scars as non-palpable, 2 of 6 lesions were indeed palpable. On mammograms, radial scars have a spiculated appearance, a feature observed in all of our cases. Numerous ultrasonographic characteristics are listed in the literature, but ultrasonography is not reported to have clear-cut advantages. Although this study did not elucidate any unique ultrasonographic features to characterise these lesions, the analysis of all ultrasonographic results made us recognise a set of "nearly specific ultrasonographic features" of radial scars. Current B-mode imaging does not appear to lead to the desirable reduction of the rate of unnecessary open biopsies.

1804: Should Complexed Prostate-Specific Antigen be the First Line Test for Prostate Cancer Early Detection: Impact on Sensitivity, Rate of Unnecessary Biopsies and Direct Biopsy Costs

You have accessJournal of UrologyDiscussed Poster, Wednesday, May 12, 2004, 8:00 am - 12:00 pm1 Apr 20041804: Should Complexed Prostate-Specific Antigen be the First Line Test for Prostate Cancer Early Detection: Impact on Sensitivity, Rate of Unnecessary Biopsies and Direct Biopsy Costs Herbert A. Fritsche, Yoshio Naya, Carol D. Cheli, and Richard J. Babaian Herbert A. FritscheHerbert A. Fritsche More articles by this author , Yoshio NayaYoshio Naya More articles by this author , Carol D. CheliCarol D. Cheli More articles by this author , and Richard J. BabaianRichard J. Babaian More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)38996-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1804: Should Complexed Prostate-Specific Antigen be the First Line Test for Prostate Cancer Early Detection: Impact on Sensitivity, Rate of Unnecessary Biopsies and Direct Biopsy Costs." The Journal of Urology, 171(4S), p. 477 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 477 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Herbert A. Fritsche More articles by this author Yoshio Naya More articles by this author Carol D. Cheli More articles by this author Richard J. Babaian More articles by this author Expand All Advertisement PDF DownloadLoading ...

Diagnostic cervical lymphadenectomy in children: a case for multidisciplinary assessment and formal management guidelines

A retrospective review was carried out of all children under 16 years of age that underwent cervical lymphadenectomy in our department within a 7-year period. The pathway of their referral from the community to hospital care was noted. The circumstances surrounding the decision for surgery, including clinical features of lymph nodes and investigation results were also recorded. We concluded that cervical lymphadenectomy is an uncommon occurrence in children with an incidence of 2.5/100,000 per year and a yield rate of 15.8% for serious conditions requiring treatment. We demonstrate the importance of joint decision-making between surgeons and paediatricians to reduce the rate of unnecessary biopsies. We also reveal the inconsistency in the pre-operative investigation of these children leading to a low number of positive biopsies and highlighting the need for formal management guidelines.

Are unnecessary follow-up procedures induced by computer-aided diagnosis (CAD) in mammography? Comparison of mammographic diagnosis with and without use of CAD

Objective: To evaluate the rate of unnecessary follow-up procedures recommended by radiologists using a CAD-system. Materials and methods: 185 patients (740 images) were consecutively selected from three groups (36 histologically proven cancers=group 1; 49 histologically proven benign lesions=group 2 and 100 screening cases (4 years-follow up=group 3). Mammograms were evaluated by a CAD system (Second Look ®, CADx, Canada). Five blinded radiologists assessed the images without/with CAD outputs. Diagnostic decisions were ranked from surely benign to surely malignant according to BIRADS classification, follow-up procedures were recommended for each observed lesion (a, screening; b, short interval follow-up examination in 6 months; c, pathologic clarification). Results: CAD-system detected 32/36 cancers (88.9%) (FP-rate: 1.04 massmarks and 0.27 calcmarks/image). The following values were reached by all observers without/with CAD in the mean: Sensitivity 80.6/80.0%, specificity 83.2/86.4%, PPV 53.1/58.1%, and NPV 94.6/94.7%. Observers described a similar number of additional lesions without/with the use of CAD (325/326). Whereas the number of unnecessary short-time follow up recommendations increased in all case-subgroups with CAD: 40.8/42.9% (group 1), 35.6/38.1% (group 2), 44.7/46.8% (group 3), respectively, the number of recommended biopsies decreased in all subgroups: group 1: 34.7/27.1%; group 2: 47.4/41.5%, group 3: 33.3/22.0%, respectively. Conclusion: In this rather small population additional usage of CAD led to a lower rate of unnecessary biopsies. The observed decrease of recommended unnecessary biopsies due to the usage of CAD in the screening group suggests a potential financial benefit by using CAD as diagnostic aid.

Lectin and serum-PSA interaction as a screening test for prostate cancer

Objectives The present investigation was designed to distinguish prostate cancer and benign prostate hyperplasia by lectin-prostate specific antigen (PSA) binding. Design & methods The quantitative precipitin method of concanavalin A (Con A)-carbohydrate interaction was explored with the serum PSA of patients suffering from prostatic complications. Results The carbohydrate content in the precipitate after binding of Con A with serum PSA of prostate cancer was significantly lower than that of benign prostate hyperplasia. This may be due to altered sugar chain structure or less glycosylation of PSA in prostate cancer. Conclusions We conclude that a serum value <3.0 μg/mL of the carbohydrate content of Con A-PSA precipitate indicates strong suspicion for prostate cancer and this cut off level is effective in reducing the rate of unnecessary biopsies in men with total PSA value between 4.0 to 10.0 ng/mL.