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Chen W, Yang W, Li D, Wang Z, Zhao Q, Li Y, Cui R, Shen L. Comparative analysis of ultrasonic elastosonography and contrast-enhanced ultrasonography in the diagnosis of benign and malignant intraocular tumors. Graefes Arch Clin Exp Ophthalmol 2023; 261:2987-2996. [PMID: 37148291 DOI: 10.1007/s00417-023-06068-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 05/08/2023] Open
Abstract
PURPOSE To compare the diagnostic value of ultrasonic elastosonography (UE) and contrast-enhanced ultrasonography (CEUS) for benign and malignant intraocular tumors. METHODS This retrospective study enrolled patients with intraocular tumors at Beijing Tongren Hospital, Capital Medical University (August 2016 to January 2020). The strain rate ratio (strain rate of tumor tissue divided by strain rate of surrounding normal tissue) was measured by UE. CEUS was performed using SonoVue® contrast agent. The performance of each method at differentiating benign from malignant intraocular tumors was evaluated by receiver operating characteristic curve analysis. RESULTS The analysis included 147 eyes in 145 patients (45.6 ± 13.4 years-old; 66 males): 117 patients (119 eyes) with malignant tumors and 28 patients (28 eyes) with benign tumors. At an optimal cutoff of 22.67 for the strain rate ratio, UE distinguished benign from malignant tumors with a sensitivity of 86.6% and a specificity of 96.4%. CEUS showed that 117 eyes with malignant tumors had a fast-in, fast-out time-intensity curve, and only two eyes with malignant tumors had a fast-in, slow-out curve, while all 28 eyes with benign tumors had a fast-in, slow-out curve. CEUS differentiated benign from malignant tumors with a sensitivity of 98.3% and a specificity of 100%. The diagnostic results differed significantly between the two methods (P = 0.004, McNemar test). The diagnostic performances of the two tests were moderately consistent (κ = 0.657, P < 0.001). CONCLUSION Both CEUS and UE have good diagnostic value in the differentiation of benign intraocular tumors from malignant intraocular tumors.
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Affiliation(s)
- Wei Chen
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Wenli Yang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| | - Dongjun Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ziyang Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Qi Zhao
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yifeng Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Rui Cui
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Lin Shen
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
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Evans A, Jethwa K. Fibroepithelial lesions of the breast: improving the accuracy of imaging diagnosis and reducing unnecessary biopsy. Br J Radiol 2023; 96:20220078. [PMID: 35976616 PMCID: PMC9975516 DOI: 10.1259/bjr.20220078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 01/27/2023] Open
Abstract
Fibroadenomas and phyllodes tumours are fibroepithelial lesions of the breast. Fibroadenomas are common benign breast masses encountered both symptomatically and incidentally. Phyllodes tumours are uncommon and usually present symptomatically. Management of fibroadenomas focuses on reducing biopsies without missing cancers while radiological management of phyllodes tumours should focus on predicting the need for surgical excision with or without margins.
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Affiliation(s)
- Andrew Evans
- Breast Unit, Royal Derby Hospital, Derby, United Kingdom
| | - Ketan Jethwa
- Breast Unit, Royal Derby Hospital, Derby, United Kingdom
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3
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Lynda A, Amal K, Salah EB. Performance of Elastography, Color Doppler and B Mode Ultrasound to Differentiate Fibroadenomas from Phyllodes Tumor. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.220003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Bogach J, Shakeel S, Wright FC, Hong NJL. Phyllodes Tumors: A Scoping Review of the Literature. Ann Surg Oncol 2021; 29:446-459. [PMID: 34296360 DOI: 10.1245/s10434-021-10468-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Phyllodes tumors are rare tumors of the breast, with most literature being retrospective with limited guidelines on the management of these patients. Scoping review was performed to highlight themes and gaps in the available literature. METHODS A scoping review of the literature was performed as per PRISMA-ScR guidelines with titles, abstracts, and full texts reviewed in duplicate. Data were abstracted and summarized in categories of diagnostics, surgical management, adjuvant therapies, treatment of recurrence, and surveillance. Quality assessment was performed for each paper. RESULTS The search identified 4498 references, 434 full-text papers were reviewed, and 183 papers were included. Ultrasound, magnetic resonance imaging, and core needle biopsy are valuable preoperative diagnostics tools. Pathology reporting should include stromal overgrowth, stromal cellularity, nuclear atypia, mitotic rate, borders, and presence of heterologous elements. Ki67 may have a role in grading and prognosticating. Breast conservation is safe in all grades of phyllodes but may be associated with increased local recurrence in malignant phyllodes. Surgical margins should depend on grade. Axillary node positivity rate is very low, even with clinically enlarged lymph nodes. Adjuvant radiation is a useful tool to decrease local recurrence in malignant phyllodes tumors, tumors > 5 cm, age < 45 years, close margins, and breast conservation. There is no evidence supporting adjuvant chemotherapy. Recurrence can be managed with repeat wide excision; however, mastectomy is associated with lower re-recurrence. Surveillance protocols are variable in the literature. CONCLUSIONS There is heterogeneity in the literature on phyllodes tumors. Consensus guidelines based on the literature will help provide evidence-based care.
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Affiliation(s)
- Jessica Bogach
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Saad Shakeel
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole J Look Hong
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Niu S, Huang J, Li J, Liu X, Wang D, Wang Y, Shen H, Qi M, Xiao Y, Guan M, Li D, Liu F, Wang X, Xiong Y, Gao S, Wang X, Yu P, Zhu J. Differential diagnosis between small breast phyllodes tumors and fibroadenomas using artificial intelligence and ultrasound data. Quant Imaging Med Surg 2021; 11:2052-2061. [PMID: 33936986 DOI: 10.21037/qims-20-919] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background It is challenging to differentiate between phyllodes tumors (PTs) and fibroadenomas (FAs). Artificial intelligence (AI) can provide quantitative information regarding the morphology and textural features of lesions. This study attempted to use AI to evaluate the ultrasonic images of PTs and FAs and to explore the diagnostic performance of AI features in the differential diagnosis of PTs and FAs. Methods A total of 40 PTs and 290 FAs <5 cm in maximum diameter found in female patients were retrospectively analyzed. All tumors were segmented by doctors, and the features of the lesions were collated, including circularity, height-to-width ratio, margin spicules, margin coarseness (MC), margin indistinctness, margin lobulation (ML), internal calcification, angle between the long axis of the lesion and skin, energy, grey entropy, and grey mean. The differences between PTs and FAs were analyzed, and the diagnostic performance of AI features in the differential diagnosis of PTs and FAs was evaluated. Results Statistically significant differences (P<0.05) were found in the height-to-width ratio, ML, energy, and grey entropy between the PTs and FAs. Receiver operating characteristic (ROC) curve analysis of single features showed that the area under the curve [(AUC) 0.759] of grey entropy was the largest among the four features with statistically significant differences, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.925, 0.459, 0.978, and 0.190, respectively. When considering the combinations of the features, the combination of height-to-width ratio, margin indistinctness, ML, energy, grey entropy, and internal calcification was the most optimal of the combinations of features with an AUC of 0.868, and a sensitivity, specificity, PPV, and NPV of 0.734, 0.900, 0.982, and 0.316, respectively. Conclusions Quantitative analysis of AI can identify subtle differences in the morphology and textural features between small PTs and FAs. Comprehensive consideration of multiple features is important for the differential diagnosis of PTs and FAs.
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Affiliation(s)
- Sihua Niu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Jianhua Huang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Jia Li
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, China
| | - Xueling Liu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Dan Wang
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Yingyan Wang
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, China
| | - Huiming Shen
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, China
| | - Min Qi
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, China
| | - Yi Xiao
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Mengyao Guan
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Diancheng Li
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Feifei Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Xiuming Wang
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Yu Xiong
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Siqi Gao
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Xue Wang
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Ping Yu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Jia'an Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
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Sravani N, Ramesh A, Sureshkumar S, Vijayakumar C, Abdulbasith KM, Balasubramanian G, Ch Toi P. Diagnostic role of shear wave elastography for differentiating benign and malignant breast masses. SA J Radiol 2020; 24:1999. [PMID: 33391842 PMCID: PMC7756970 DOI: 10.4102/sajr.v24i1.1999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/23/2020] [Indexed: 11/12/2022] Open
Abstract
Background Use of B-mode ultrasound (US) may not obviate the need for diagnosis by histopathology, which is an invasive technique and remains the gold standard. These limitations are being overcome with the advent of shear wave elastography (SWE). Objectives To assess the diagnostic role of SWE parameters and combined SWE and B-mode US in diagnosing malignant breast lesions. Method This cross-sectional study included all patients with a breast mass on clinical examination. A B-mode US with a Breast Imaging Reporting and Data System (BI-RADS) assessment and SWE evaluation (distance ratio [DR], area ratio [AR] and shear wave velocity [SWV]) in the lesion and healthy breast tissue of all recruited patients was performed. Cut-offs for SWE parameters were derived by receiver operating characteristic (ROC) analysis. The diagnostic performance of the B-mode US, the SWE parameters and the combined imaging in diagnosing malignancy was assessed. Results This study included a total of 175 breast masses. The median values of the SWE parameters were significantly higher (p < 0.001) in the malignant breast masses (DR, 1.29 vs. 1.03; AR, 1.69 vs. 1.06; and SWV, 9.1 metre per second [m/s] vs. 2.1 m/s). The ROC cut-off for malignancy was derived at 1.135 m/s, 1.18 m/s and 3.18 m/s, respectively, for DR, AR and SWV. The area under the ROC curve was highest for the DR (0.930), whilst this value was 0.914 and 0.901 for the SWV and AR, respectively. Amongst the respective sensitivities and specificities of the B-mode US (90.6% and 90%), SWE (97.6% and 61.1%), SWE (excluding AR) (96.5% and 77.8%) and combined imaging (100% and 72.2%), the highest sensitivity was noted for the combined method. Conclusion All the SWE parameters were significantly higher in the malignant breast masses, compared to the benign lesions. On combining SWE and B-mode US, there was a significant increase in sensitivity but a decrease in specificity.
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Affiliation(s)
- Nichanametla Sravani
- Department of Radiodiagnosis, Faculty of Health Science, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ananthakrishnan Ramesh
- Department of Radiodiagnosis, Faculty of Health Science, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sathasivam Sureshkumar
- Department of Surgery, Faculty of Health Science, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Chellappa Vijayakumar
- Department of Surgery, Faculty of Health Science, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - K M Abdulbasith
- Department of Surgery, Faculty of Health Science, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Gopal Balasubramanian
- Department of Surgery, Faculty of Health Science, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Pampa Ch Toi
- Department of Pathology, Faculty of Health Science, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Sim Y, Lee SE, Kim EK, Kim S. A Radiomics Approach for the Classification of Fibroepithelial Lesions on Breast Ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1133-1141. [PMID: 32102739 DOI: 10.1016/j.ultrasmedbio.2020.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
A radiomics-based classifier to distinguish phyllodes tumor and fibroadenoma on gray-scale breast ultrasonography was developed and validated. A total of 93 radiomics features were extracted from representative transverse plane ultrasound images of 182 fibroepithelial lesions initially diagnosed by core needle biopsy. High-throughput radiomics features were selected using the intra-class correlation coefficient between two radiologist readers and the Least Absolute Shrinkage and Selection Operator regression through 10-fold cross-validation. When applied to the validation set, the radiomics classifier for the differentiation of phyllodes tumors and benign/fibroadenomas achieved an area under the receiver operating characteristic curve of 0.765 (95% confidence interval [CI]: 0.597-0.888) with an accuracy of 0.703 (sensitivity: 0.857; specificity: 0.5). Our radiomics signature-based classifier may help predict phyllodes tumors among fibroepithelial lesions on breast ultrasonography.
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Affiliation(s)
- Yongsik Sim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Si Eun Lee
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungwon Kim
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Mberu V, Macaskill EJ, Purdie C, Evans A. Preoperative prediction of margin requirement following a core biopsy result suggestive of a phyllodes tumour. Clin Radiol 2019; 75:319.e21-319.e27. [PMID: 31862110 DOI: 10.1016/j.crad.2019.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
AIM To determine if imaging features of lesions with a core biopsy suggestive of a phyllodes tumour can be used to identify which lesions require surgical excision with margins. MATERIALS AND METHODS Thirty-one lesions were identified from a prospective database of ultrasound visible masses. Demographic, mammographic, and ultrasound features were assessed while blinded to surgical outcome. Features of those lesions requiring a margin and those that did not were compared. Statistical significance was established using the chi-square test and receiver operating characteristic (ROC) curves. RESULTS Thirteen lesions (42%) required a margin and 18 lesions (58%) did not. Features found significantly more frequently in those requiring a margin were a poorly defined margin on mammography (7/9 [78%] versus 4/13 [31%]; p=0.04) and at ultrasound, an irregular margin (8/13 [62%] versus 3/18 [17%]; p=0.01), micro-lobulations (7/13 [54%] versus 3/18 [17%]; p=0.028), mixed echogenicity (9/13 [69%] versus 1/18 [6%]; p=0.0002), echogenic clefts (6/13 [46%] versus 1/18 [6%]; p=0.007), posterior enhancement (9/11 [82%] versus 6/18 [33%]; p=0.01), large size (p=0.003) and stiffness at shear-wave elastography (p=0.026). All six screen-detected lesions were benign. CONCLUSIONS There are multiple preoperative features that can be used to guide surgical management of lesions with a preoperative core biopsy result suggestive of a phyllodes tumour.
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Affiliation(s)
- V Mberu
- Department of Breast Imaging, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - E J Macaskill
- Department of Breast Surgery, Ninewells Hospital, NHS Tayside, James Arrott Dr, Dundee, DD2 1SY, UK
| | - C Purdie
- Department of Pathology, Ninewells Hospital, NHS Tayside, James Arrott Dr, Dundee, DD2 1SY, UK
| | - A Evans
- Department of Breast Imaging, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK.
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Zhu Y, Deng S, Zhang Y, Jiang Q. Comparative study of ultrasonic elastography and conventional ultrasound in diagnosis of malignant anus neoplasm. Exp Ther Med 2018; 15:2343-2346. [PMID: 29456640 PMCID: PMC5795467 DOI: 10.3892/etm.2018.5720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/12/2017] [Indexed: 12/26/2022] Open
Abstract
The application value of conventional ultrasound and ultrasonic elastography (UE) in preoperative diagnosis and combined diagnosis of malignant anus neoplasms was investigated. One hundred and twenty patients, whose mass was detected by digital rectal examination, were examined using UE and conventional ultrasound before operation, and the results were compared with those of histopathological examinations after operation, so that the accuracy and imaging features of UE as well as UE combined with conventional ultrasound in diagnosing malignant anus neoplasm were analyzed. Among the 120 patients, 77 were diagnosed with benign lesions and 43 were diagnosed with malignant lesions via pathological diagnosis for anal canal lesion surgery. Conventional ultrasound before operation showed that 53 patients were diagnosed with benign lesions and 26 with malignant lesions. Compared with that in the pathological diagnosis results, the diagnostic accordance rate in preoperative conventional ultrasound was 65.8%. Through UE diagnosis, 66 patients had benign lesions and 39 patients had malignant lesions. Compared with that in the pathological diagnosis results, the diagnostic accordance rate in preoperative UE was 87.5%. After the examination via UE combined with conventional ultrasound before operation, 71 patients were diagnosed with benign lesions and 40 patients were diagnosed with malignant lesions; compared with that in the pathological diagnosis results, the diagnostic accordance rate was 92.5%. In terms of mass qualitative diagnosis, the sensitivity and specificity of conventional ultrasound were 60.5 and 68.8%, respectively; those of UE were 90.7 and 85.7%, respectively, and those of UE combined with conventional ultrasound were 93.0 and 92.2%, respectively. According to the analysis results of receiver operating characteristic (ROC) curve, the area under curve (AUC) of malignant anus neoplasm diagnosed via UE was 0.732 [95% confidence interval (95% CI), 0.211-2.534], the AUC via conventional ultrasound was 0.695 (95% CI, 0.517-0.932), and that via UE combined with conventional ultrasound was 0.823 (95% CI, 0.146-4.643). In conclusion, examinations utilizing UE combined with conventional ultrasound can increase the preoperative diagnostic accordance rate in malignant anus neoplasm, which can be used as an effective method for preoperative diagnosis of malignant anus neoplasm.
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Affiliation(s)
- Yicheng Zhu
- Department of Ultrasound, Shanghai Pudong New Area People's Hospital, Shanghai 201299, P.R. China
| | - Shuhao Deng
- Department of Ultrasound, Shanghai Pudong New Area People's Hospital, Shanghai 201299, P.R. China
| | - Yuan Zhang
- Department of Ultrasound, Shanghai Pudong New Area People's Hospital, Shanghai 201299, P.R. China
| | - Quan Jiang
- Department of Ultrasound, Shanghai Pudong New Area People's Hospital, Shanghai 201299, P.R. China
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Efared B, Ebang GA, Tahiri L, Sidibé IS, Erregad F, Hammas N, Melhouf MA, Banani A, Chbani L, Fatemi HE. Phyllodes tumors of the breast: clinicopathological analysis of 106 cases from a single institution. Breast Dis 2018; 37:139-145. [PMID: 29332027 DOI: 10.3233/bd-170297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Phyllodes tumors (PT) are uncommon biphasic tumors, accounting for less than 1% of all breast primary neoplasms. They form a wide variety of tumors ranging from benign to malignant. Several histological features are used to grade PT into 3 categories: benign (grade I), borderline (grade II) and malignant (grade III) tumors. The aim of our study was to analyse histolopathological, radiological and clinical features of PT from an experience of a single center. METHODS It was a retrospective study including 106 patients diagnosed with phyllodes tumors on surgical specimens at the department of pathology, of Hassan II university hospital (Fez, Morocco), from 2009 to 2016. RESULTS The mean age was 33.81 years (range of 13-66 years), and the mean age increases with the tumor grade (mean ages of 32.32, 32.87 and 33.65 years respectively for grade I, II and III PT) (p = 0.023); 78 patients (73.58%) had benign PT, 20 (18.86%) had borderline PT and 8 (7.54%) patients were diagnosed with malignant PT. Mostly, the tumor size was <5 cm (63.2%), with BI-RADS 3 (51 patients, 48.11%). The tumor size and the radiological suspicion (ACR/BI-RADS) increased with the tumor grade (p < 0.001). Mitosis count, cellular atypia and stromal cellularity increased with the tumor grade (p < 0.001). Also, the presence of necrosis is associated with malignant PT (p < 0.001). Before surgery, patients had undergone core needle biopsies (CNB) for diagnostic purpose, and the overral sensitivity of this diagnostic procedure was 71.83%. The sentivity of the CNB decreased from grade I PT to grade III PT (from 56.81% to 37.5%), however its specificity increased from grade I to grade III PT (from 59.25% to 100%). CONCLUSION Phyllodes tumors of the breast are rare neoplasms with a wide range of clinicopathologic presentations. The core needle biopsy has a good diagnostic sensitivity compared to definitive diagnosis on surgical specimens. There was a statistically significant association between the histological grade of PT and tumor size, radiological suspicion, mitotic count, cellular atypia, stromal cellularity, and tumor necrosis.
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Affiliation(s)
- Boubacar Efared
- Department of pathology, Hassan II university hospital, Fez, Morocco
| | | | - Layla Tahiri
- Department of pathology, Hassan II university hospital, Fez, Morocco
| | - Ibrahim S Sidibé
- Department of pathology, Hassan II university hospital, Fez, Morocco
| | | | - Nawal Hammas
- Department of pathology, Hassan II university hospital, Fez, Morocco
- Laboratory of biological and translational research, Faculty of medicine and pharmacology, Sidi Mohamed Ben Abdellah university Fez, Morocco
| | - Moulay Abdelilah Melhouf
- Department of obstetrics and gynecology, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacology, Sidi Mohamed Ben Abdellah university, Fez, Morocco
| | - Abdelaziz Banani
- Department of obstetrics and gynecology, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacology, Sidi Mohamed Ben Abdellah university, Fez, Morocco
| | - Laila Chbani
- Department of pathology, Hassan II university hospital, Fez, Morocco
- Laboratory of biological and translational research, Faculty of medicine and pharmacology, Sidi Mohamed Ben Abdellah university Fez, Morocco
| | - Hinde El Fatemi
- Department of pathology, Hassan II university hospital, Fez, Morocco
- Laboratory of biological and translational research, Faculty of medicine and pharmacology, Sidi Mohamed Ben Abdellah university Fez, Morocco
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Peikari M, Salama S, Nofech-Mozes S, Martel AL. Automatic cellularity assessment from post-treated breast surgical specimens. Cytometry A 2017; 91:1078-1087. [PMID: 28976721 DOI: 10.1002/cyto.a.23244] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/11/2017] [Accepted: 08/25/2017] [Indexed: 12/18/2022]
Abstract
Neoadjuvant treatment (NAT) of breast cancer (BCa) is an option for patients with the locally advanced disease. It has been compared with standard adjuvant therapy with the aim of improving prognosis and surgical outcome. Moreover, the response of the tumor to the therapy provides useful information for patient management. The pathological examination of the tissue sections after surgery is the gold-standard to estimate the residual tumor and the assessment of cellularity is an important component of tumor burden assessment. In the current clinical practice, tumor cellularity is manually estimated by pathologists on hematoxylin and eosin (H&E) stained slides, the quality, and reliability of which might be impaired by inter-observer variability which potentially affects prognostic power assessment in NAT trials. This procedure is also qualitative and time-consuming. In this paper, we describe a method of automatically assessing cellularity. A pipeline to automatically segment nuclei figures and estimate residual cancer cellularity from within patches and whole slide images (WSIs) of BCa was developed. We have compared the performance of our proposed pipeline in estimating residual cancer cellularity with that of two expert pathologists. We found an intra-class agreement coefficient (ICC) of 0.89 (95% CI of [0.70, 0.95]) between pathologists, 0.74 (95% CI of [0.70, 0.77]) between pathologist #1 and proposed method, and 0.75 (95% CI of [0.71, 0.79]) between pathologist #2 and proposed method. We have also successfully applied our proposed technique on a WSI to locate areas with high concentration of residual cancer. The main advantage of our approach is that it is fully automatic and can be used to find areas with high cellularity in WSIs. This provides a first step in developing an automatic technique for post-NAT tumor response assessment from pathology slides. © 2017 International Society for Advancement of Cytometry.
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Affiliation(s)
| | - Sherine Salama
- Laboratory Medicine and Pathobiology, University of Toronto, Canada
| | | | - Anne L Martel
- Medical Biophysics, University of Toronto, Canada.,Physical Sciences, Sunnybrook Research Institute, Canada
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Kim GR, Choi JS, Han BK, Ko EY, Ko ES, Hahn SY. Combination of shear-wave elastography and color Doppler: Feasible method to avoid unnecessary breast excision of fibroepithelial lesions diagnosed by core needle biopsy. PLoS One 2017; 12:e0175380. [PMID: 28472030 PMCID: PMC5417487 DOI: 10.1371/journal.pone.0175380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 03/26/2017] [Indexed: 11/24/2022] Open
Abstract
Background We evaluated shear-wave elastography (SWE) and color Doppler ultrasonography (US) features for fibroepithelial lesions (FELs), and to evaluate their utility to differentiate fibroadenomas (FAs) and phyllodes tumors (PTs). Methods This retrospective study included 67 FELs pathologically confirmed (49 FAs, 18 PTs). B-mode US, SWE and color Doppler US were performed for each lesion. Mean elasticity (Emean), maximum elasticity (Emax), and vascularity were determined by SWE and Doppler US. Diagnostic performances were calculated to differentiate FAs and PTs. Equivocal FELs diagnosed by core needle biopsy (CNB) were further analyzed. Results Median Emean and Emax were significantly lower for FAs than PTs (Emean, 15.7 vs. 66.7 kPa; Emax, 21.0 vs. 76.7 kPa, P<0.01). Low vascularity (0–1 vessel flow) on color Doppler US were more frequent in FAs than in PTs (P<0.01). SWE showed significantly higher specificities (Emean >43.9 kPa, 89.8%; Emax >46.1 kPa, 79.6%) than B-mode US (42.9%) (P<0.01) for differentiating PTs from FAs. Other diagnostic values of SWE and overall diagnostic values of Doppler US were not significantly different from B-mode US (P>0.05). The combination of SWE and Doppler US with ‘Emean>43.9 kPa or high vascularity (≥2 vessel flows)’ showed a higher area under the curve (0.786 vs. 0.687) and higher diagnostic values than B-mode US (sensitivity, 100 vs. 94.4%; specificity, 57.1 vs. 42.9%; positive predictive value, 46.2 vs. 37.8%; negative predictive value, 100 vs. 95.5%), without statistical significance (P>0.05). Of the 30 equivocal FELs, all lesions with ‘Emean≤43.9 kPa and low vascularity (0–1 vessel flow)’ (23.3%, 7/30) were finally confirmed as FAs by excision. Conclusion FAs have a tendency to have less stiffness and lower vascularity than PTs. Combined SWE and color Doppler US may help patients with equivocal FELs diagnosed by CNB avoid unnecessary excision.
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Affiliation(s)
- Ga Ram Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Ji Soo Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Boo-Kyung Han
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Young Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Sook Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Li LJ, Yao JY, Zhou XC, Zhao XB, Zhong WJ, Ou B, Luo BM, Hao SY, Zhi H. What Help Could Ultrasound Elastography Give to the Diagnosis of Breast Papillary Lesions? ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:903-910. [PMID: 28256344 DOI: 10.1016/j.ultrasmedbio.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 12/02/2016] [Accepted: 01/05/2017] [Indexed: 06/06/2023]
Abstract
On the basis of results of our previous studies and the findings of other scholars, the most common histologic type of false-positive diagnosis with strain elastography (SE) was papilloma. The objectives of our study were to evaluate whether SE could contribute to conventional ultrasound differentiation between benign and malignant papillary lesions and between papillary lesions and other common benign breast lesions. Data on 89 papillary lesions at our hospital, including 74 benign and 15 malignant papillary lesions, were included in our study. In addition, 198 non-papillary benign tumors were selected as the control group, including 126 fibroadenomas and 72 cases of fibrocystic mastopathy. All patients gave written informed consent. All patients with breast lesions underwent conventional ultrasound and SE examination. Breast Imaging Recording and Data System (BI-RADS) category and SE score were compared with respect to sensitivity, specificity and accuracy in differentiating between benign and malignant papillary lesions. We then explored the possibility of using BI-RADS combined with SE to differentiate papillary lesions from non-papillary benign tumors. For differentiating between benign and malignant papillary lesions, the area under the receiver operating characteristic curve (AUC) of BI-RADS was 0.568, whereas the AUC values of SE score, strain ratio and BI-RADS combined with SE were 0.517, 0.584 and 0.509, respectively (p > 0.05). For differentiating between papillary lesions and non-papillary benign lesions, the AUC of BI-RADS combined with SE was 0.835, which was higher than the values for BI-RADS (0.775) and SE (SE score: 0.648, strain ratio: 0.661) (p < 0.001). The specificity and accuracy of BI-RADS combined with SE were significantly higher than those for BI-RADS alone without a decrease in sensitivity (p < 0.05). SE could not improve the diagnostic efficiency of BI-RADS in differentiating between benign and malignant papillary lesions. However, BI-RADS combined with SE could improve the specificity of BI-RADS without decrease in sensitivity for differentiating breast papillary lesions from non-papillary benign lesions.
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Affiliation(s)
- Lu-Jing Li
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Ji-Yi Yao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xin-Chuan Zhou
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Xin-Bao Zhao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Wen-Jing Zhong
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Bing Ou
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Bao-Ming Luo
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Shao-Yun Hao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Hui Zhi
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
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Bernal M, Chamming's F, Couade M, Bercoff J, Tanter M, Gennisson JL. In Vivo Quantification of the Nonlinear Shear Modulus in Breast Lesions: Feasibility Study. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2016; 63:101-109. [PMID: 26625412 DOI: 10.1109/tuffc.2015.2503601] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Breast cancer detection in the early stages is of great importance since the prognosis, and the treatment depends more on this. Multiple techniques relying on the mechanical properties of soft tissues have been developed to help in early detection. In this study, we implemented a technique that measures the nonlinear shear modulus (NLSM) (μ(NL)) in vivo and showed its utility to detect breast lesions from healthy tissue. The technique relies on the acoustoelasticity theory in quasi-incompressible media. In order to recover μ(NL), static elastography and supersonic shear imaging are combined to subsequently register strain maps and shear modulus maps while the medium is compressed. Then, μ(NL) can be recovered from the relationship between the stress, deduced from strain maps, and the shear modulus. For this study, a series of five nonlinear phantoms were built using biological tissue (pork liver) inclusions immersed in an agar-gelatin gel. Furthermore, 11 in vivo acquisitions were performed to characterize the NLSM of breast tissue. The phantom results showed a very good differentiation of the liver inclusions when measuring μ(NL) with a mean value of -114.1 kPa compared to -34.7 kPa for the gelatin. Meanwhile, values for the shear modulus for the liver and the gelatin were very similar, 3.7 and 3.4 kPa, respectively. In vivo NLSM mean value for the healthy breast tissue was of -95 kPa, while mean values of the benign and the malignant lesions were -619 and -806 kPa with a strong v ariability, respectively. This study shows the potential of the acoustoelasticity theory in quasi-incompressible medium to bring a new parameter for breast cancer diagnosis.
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