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Mammography in detection clinically occult breast carcinoma
Golubi?i? I.V.,Pavlovi? T.M.,Borojevi? N.,Dodi? R.
Acta Chirurgica Iugoslavica , 2007, DOI: 10.2298/aci0703027g
Abstract: Aim: The significance of mammography in detection of nonpalpable breast cancer Material and methods: This prospective study was conducted at the Institute for oncology and radiology of Serbia in Belgrade. It involved 198 asymptomatic women with performed screening mammography, 154 specimen mammography, out of witch 38 had stereotaxic mark, "ex tempore" biopsy, while 44 women had "ex tempore" biopsy and adequate surgery. Results: Screening mammography revealed suspect microcalcifications in 148 cases, impaired structural tissue in 59 and focal condensation in 55 cases. Histologic examination verified breast carcinoma in 80 patients with very statistical significance of ductal type, especially comedo subvariant (p<0.001). Pleomorphic microcalcifications smaller than 0.5 mm of grouped or segmented form are statistically very significant for malignity (p<0,001) as well as associated microcalcifications with altered architectony and focal tissue condensation (p<0.001). Conclusion: Mammography has great significance in detection of occult breast carcinoma which are not only preinvasive, but also microinvasive and invasive. This fact leads to the neccesity of introduction of legal obligation for mammography screening, especially for women aged between 50 and 70 years.
Clinically Apparent and Occult Metastasized Seminoma: Almost Indistinguishable on the Transcriptional Level  [PDF]
Christian G. Ruf, Matthias Port, Hans-Ulrich Schmelz, Walter Wagner, Felix Müller, Sven Senf, Cord Matthies, Bertram Müller-Myhsok, Viktor Meineke, Michael Abend
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0095009
Abstract: Purpose The aim of the present study was to examine the biological differences between seminomas with occult and clinically apparent metastases at the time of diagnosis of the primary tumor to gain insight into the biology of these tumors and facilitate the identification of novel predictors of seminoma metastasis. Materials and Methods Total RNA including small RNAs was isolated from testicular tumors of patients with pure seminoma presenting with lymphogenic metastasis (n = 5, clinical stage IIb/c) and occult metastasis (n = 5, clinical stage I). The regulation of biological processes was examined (1) throughout the mRNA transcriptome (whole genome microarrays, 8×60 K Array, Agilent with 4 samples/group) and (2) the miRNA transcriptome employing small RNA next generation sequencing (SOLID, Life Technologies with 5 samples/group). Protein coding genes (mRNAs) and small RNAs showing a significant (≥2-fold) difference between the groups were identified. Finally (3), we examined 95 candidate miRNAs in 36 apparent metastasized and another 5 occult metastasized seminoma using logistic regression analysis. Results Among 19,596 genes, on average 12,894 mRNAs appeared expressed (65.8%, SD+/?2.4; range, 62.0–69.3%) and 16.99×106/13.94×106 small RNA reads were identified for apparent/occult metastasized seminoma. These reads on average convert into 9,901/9,675 small RNAs including 422/404 mature microRNAs. None of these mRNAs/small RNAs met our selection criteria for candidate genes. From 95 candidate miRNAs 44 appeared expressed, with 3 of them showing weak but significant (p = 0.05) differences among both groups. Conclusions Occult and apparent metastasized seminomas are biologically almost indistinguishable and probably represent no separate tumor entities. These findings may simplify future research on seminoma metastasis.
Role of MRI in Characterization of Occult Breast Lesions in High Risk Population  [PDF]
Caroline AY Habi., Hisham MA Mansour, Mohsen G Hassan, Ayman M IbrahimS
Egyptian Journal of Hospital Medicine , 2012,
Abstract: OBJECTIVE: To evaluate the diagnostic validity of breast MRI in discriminating benign from malignant lesions in women with occult breast lesions who are at a high risk of developing breast cancer, with histopathologic findings and/or follow up used as the reference standard. PATIENTS AND METHODS: Contrast-enhanced bilateral breast MRI was performed on 100 women at high risk of developing breast cancer with indeterminate imaging findings by mammography and/or ultrasonography. Lesions detected by MRI that could represent potential malignancies in both breasts were evaluated. Morphologic assessment and kinetic analysis (contrast enhancement and time/intensity curves) were performed on each lesion using dedicated postprocessing and display software. Functional MR tools were used in about 60% of cases to help in the differential diagnosis between malignant and benign of suspicious lesions detected at conventional MRI. RESULTS: Among 100 patients included in the study12% of the patients were finally diagnosed as free of any pathology, 56% had benign findings, while 31% of the patients were malignant. (24 IDC, 4 Invasive Lobular Carcinoma, 1 Medullary carcinoma, 1 Mucinous carcinoma and 1 DCIS.) The sensitivity, specificity, positive and negative predictive values of CE-MRI, were 100%, 93%, 86%, and 100% respectively. Overall accuracy of MRI breast was 95%. CONCLUSION: Breast MRI is highly effective in detection and characterization of occult breast lesions in high risk population, with excellent sensitivity and high specificity. Development of functional MRI tools contributed to the improving validity of this modality
Isolated submandibular gland metastasis from an occult papillary thyroid cancer
Sarda A,Pandey D,Bhalla S,Goyal A
Indian Journal of Cancer , 2004,
Abstract: A case of an isolated submandibular gland metastasis from a clinically occult papillary thyroid carcinoma is described in a 46-year old lady. Initial surgery was done based on the fine needle aspiration cytology (FNAC) report of adenocarcinoma of the submandibular gland. Histopathologic examination of the specimen suggested a metastatic papillary carcinoma. Occult papillary carcinoma in the thyroid was found by multiple blind FNACs. Subsequently to near-total thyroidectomy, no other site of metastasis was found on radio-iodine scanning.
Parameters in panoramic radiography for differentiation of radiolucent lesions
Raitz, Ricardo;Assun??o Júnior, José Narciso Rosa;Correa, Luciana;Fenyo-Pereira, Marlene;
Journal of Applied Oral Science , 2009, DOI: 10.1590/S1678-77572009000500006
Abstract: objective: the aims of this study were to establish parameters in panoramic radiography for interpretation of unilocular radiolucent lesions, and to compare the accuracy of diagnoses given by examiners before and after using these parameters. material and methods: in part i, 12 specialists analyzed 24 images and the diagnostic criteria used by each examiner to make correct diagnoses were used to build a list of basic radiographic parameters for each pathology (ameloblastoma, keratocystic odontogenic tumor, dentigerous cyst, and idiopathic bone cavity). in part ii, this list was used by 6 undergraduate students (un), 8 recently graduated dentists (d), 3 oral pathologists, 3 stomatologists, 3 oral radiologists, and 3 oral surgeons to diagnose the corresponding pathologies in the other set of 24 panoramic radiographs (t2). the same analysis occurred without using this list (t1). the method of generalized estimating equations (gee) was used in order to estimate the probability of making a correct diagnosis depending on the specialty of the examiner, type of lesion, and moment of the evaluation, t1 or t2 (before or after they had access to the list of parameters, respectively). results: higher values were obtained for the probability (gee) of making a correct diagnosis on t2; the group un presented the highest improvement (14.6 %); no differences between the probabilities were observed either between un and d, or among the different groups of specialists. conclusions: the use of panoramic radiographic parameters did allow improving the diagnostic accuracy for all groups of examiners.
Radioguided occult lesion localization versus wire-guided localization for non-palpable breast lesions: randomized controlled trial
Ocal, Koray;Dag, Ahmet;Turkmenoglu, Ozgur;Gunay, Emel Ceylan;Yucel, Erdem;Duce, Meltem Nass;
Clinics , 2011, DOI: 10.1590/S1807-59322011000600014
Abstract: aim: this prospective randomized clinical study was conducted to compare radioguided occult lesion localization (roll) with wire-guided localization to evaluate optimum localization techniques for non-palpable breast lesions. methods: a total of 108 patients who were undergoing an excisional biopsy for non-palpable breast lesions requiring pathologic diagnosis were randomly assigned to the roll group (n = 56) and wire-guided localization group (n = 52). in the study, patients' characteristics, radiological abnormalities, radiological technique of localization, localization time, operation time, weight of the excised specimen, clearance margins, pathological diagnosis and perioperative complications were assessed. results: there were no differences between the two groups in terms of age, radiological abnormalities and localization technique (p = non-significant for all). roll techniques resulted in 100% retrieval of the lesions; for the wire-guided localization technique, 98%. both localization time and operation time were significantly reduced with the roll technique (p = significant for all). the weight of the specimen was significantly lower in the roll group than in the wire-guided localization group (p = significant). the overall complication rate and pathological diagnosis were similar for both groups (p = non-significant for all). clear margins were achieved in 91% of roll patients and in 53% of wire-guided localization patients, and the difference was significant. conclusions: the present study indicated that the roll technique is as effective as wire-guided localization for the excision of non-palpable breast lesions. in addition, roll improved the outcomes by reducing localization and operation time, preventing healthy tissue excision and achieving clearer margins.
Incidence of Occult Carcinoma and High-Risk Lesions in Mammaplasty Specimens  [PDF]
Beth C. Freedman,Sharon M. Rosenbaum Smith,Alison Estabrook,Jasminka Balderacchi,Paul I. Tartter
International Journal of Breast Cancer , 2012, DOI: 10.1155/2012/145630
Abstract: Objectives. To determine the incidence and type of premalignant or malignant changes in mammaplasty specimens and to determine the incidence of these changes according to age distribution. Methods. Retrospective database review of patients who underwent a reduction mammaplasty between 1999 and 2009 was performed from pathology records at a single institution. Results. 700 patients were identified. Of the 644 patients who had bilateral reductions, 25 (4%) had significant pathologic findings. The likelihood of finding premalignant changes or cancer increased with advancing patient age (0.8 percent for patients <40 years old and 10 percent for patients >60 years old). Of the 56 patients who underwent unilateral mammaplasty, 12 patients (21%) had significant pathologic findings. The incidence of finding premalignant changes or cancer in this population also increased with advancing patient age (0 for patients <40 years old to 25 percent for patients >60 years old). Conclusions. When a unilateral mammaplasty is performed to match a breast reconstructed after cancer surgery, the likelihood of identifying premalignant changes or cancer increases more than fourfold. Therefore, one should consider additional radiologic imaging in the preoperative workup of patients with a history of carcinoma prior to undergoing unilateral mammaplasty. 1. Background There were more than 83,000 reduction mammaplasties performed in the United States in 2010 [1]. Numerous studies have reported that breast cancers and high risk lesions are occasionally found in the breast tissue removed during bilateral reduction mammaplasties. Among patients undergoing unilateral mammaplasty to match a reconstructed breast after breast cancer, the incidence of occult malignancy is higher. We investigated the incidence of pathologic findings in reduction mammaplasty specimens in these two groups and then evaluated the incidence in relation to patient age. 2. Methods A retrospective review was performed using the computerized pathology database at St. Luke’s-Roosevelt Hospital Center, New York, NY, USA. The database was searched for “mammaplasty” between 1999 and 2009. Patients included in the study underwent either bilateral reduction mammaplasty or unilateral reduction mammaplasty to match a reconstructed breast after breast cancer surgery. Their operative reports and pathology reports were reviewed. Three random sections were taken from specimens of patients undergoing bilateral reduction and up to 8 random sections were taken from specimens of patients undergoing unilateral reduction. High risk
MANAGEMENT OF CLINICALLY INDEFINITE RIGHT ILIAC FOSSA LESIONS
A Abdel-Razek, A Afifi, A-A El Nekeidy
Alexandria Journal of Medicine , 2010,
Abstract: Many diseases can cause lesions in right iliac fossa with indefinite clinical presentations. Improper diagnosis, missed lesions and unexpected morbidity may follow variable clinical puzzles. Objective: The aim of this study was to assess the clinically indefinite right iliac fossa lesions and to evaluate the role of multislice CT to improve their diagnostic accuracy and surgical management. Methods: Fifty two patients with indefinite clinical presentations related to right iliac fossa lesions were assessed before and after multiplanner reformatted images of multislice CT. The impact on diagnostic accuracy and surgical management was evaluated. Results: Variable lesions were detected in these patients. CT showed different radiological diagnostic signs. The diagnosis of clinically indefinite lesions was improved by MDCT with sensitivity 95.8%, specificity 83.3% and accuracy 94.4%. Conclusions: This study showed the great variability of lesions in the right iliac fossa and of therapeutic surgical procedures. Not every pain is due to appendicitis; and hasty diagnosis must be avoided. Multislice CT and multiplanner reformatted images were markedly valuable in providing diagnostic signs, guiding to select further valuable investigations, staging of tumors, assessment of operability, planning the proper surgical management and avoiding unnecessary surgical intervention for lesions that can be treated by non-surgical measures.
Comparative Study of Accuracy of Digital Radiography and Digital Subtraction Radiography in Detection of Simulated Lesions on Alveolar Crest of Dried Human Mandible
Zamani Naser Asieh,Hekmatian Ehsan,Sadraie Vahid Dentist
Research Journal of Biological Sciences , 2012,
Abstract: Several studies have shown that, there are some advantages of Digital Radiography compared with conventional radiography. Many studies have been performed with the aim of improving radiographic interpretation through modern computerized technology. It has been shown that diagnostic accuracy improved when overlaying structure can be removed by subtraction technique and then this technology evaluate ability to detect periodontal lesion. In this experimental study that was done in radiology department of Isfahan, dental school, 5 block of dried mandible established in abutments. A digital sensor and X-ray tube were established on the another abutment too. Radiographs were made from 26 alveolar crestal regions as primary Radiographs using Kvp = 70 and t = 0.01s. With a round bur artificial periodontal lesions, were simulated on 16 crestal regions out of 26, then second radiagraphs were made from all 26 crestal regions, whitout any changes in position of X-ray and tube. Two radiographs were subtracted by a soft ware. Radiography and subtraction radiography were compared by 2 post graduate students of periodontic. Results analyzed with statistical methods and SPSS soft ware. The willcoxon test was applied for assessment of statistically significant differences with respect of sensitivity, specificity and positive diagnostic value in diagnosis of crestal changes in digital image and subtracted digital images. Accuracy of digital subtraction radiography (DSR): sensitivity and specificity was better than conventional digital radiography. The digital subtraction method may be useful in the quantification of Alveolar bone loss in clinic, more studies about advantages and disadvantages of DSR is recommended.
Comparative Study of Accuracy of Digital Radiography and Digital Subtraction Radiography in Detection of Simulated Lesions on Alveolar Crest of Dried Human Mandible
Zamani Naser Asieh,Hekmatian Ehsan,Sadraie Vahid Dentist
Research Journal of Biological Sciences , 2008,
Abstract: Several studies have shown that, there are some advantages of Digital Radiography compared with conventional radiography. Many studies have been performed with the aim of improving radiographic interpretation through modern computerized technology. It has been shown that diagnostic accuracy improved when overlaying structure can be removed by subtraction technique and then this technology evaluate ability to detect periodontal lesion. In this experimental study that was done in radiology department of Isfahan, dental school, 5 block of dried mandible established in abutments. A digital sensor and X-ray tube were established on the another abutment too. Radiographs were made from 26 alveolar crestal regions as primary Radiographs using Kvp = 70 and t = 0.01s. With a round bur artificial periodontal lesions, were simulated on 16 crestal regions out of 26, then second radiagraphs were made from all 26 crestal regions, whitout any changes in position of X-ray and tube. Two radiographs were subtracted by a soft ware. Radiography and subtraction radiography were compared by 2 post graduate students of periodontic. Results analyzed with statistical methods and SPSS soft ware. The willcoxon test was applied for assessment of statistically significant differences with respect of sensitivity, specificity and positive diagnostic value in diagnosis of crestal changes in digital image and subtracted digital images. Accuracy of digital subtraction radiography (DSR): sensitivity and specificity was better than conventional digital radiography. The digital subtraction method may be useful in the quantification of Alveolar bone loss in clinic, more studies about advantages and disadvantages of DSR is recommended.
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