Mammographic features of calcifications in DCIS: correlation with oestrogen receptor and human epidermal growth factor receptor 2 status

Objective

This study investigated the correlation of oestrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status with the probability of malignancy (POM) of mammographic calcifications in ductal carcinoma in situ (DCIS).

Methods

A total of 101 women (age range, 27–83 years) with pure DCIS that presented as mammographic calcifications were included. Three radiologists independently reviewed mammograms according to the BI-RADS lexicon and provided 100-point POM scores and a BI-RADS category. ER, HER2 and breast cancer subtypes were determined using immunohistochemistry (IHC) and fluorescence in situ hybridisation. Pairwise correlations between POM and IHC biomarker scores were calculated, and mammographic features were compared between breast cancer subtypes.

Results

HER2 level positively correlated with the POM score (P?<?0.0001) and BI-RADS category (P?<?0.0001), and ER level inversely correlated with the POM score (P?<?0.013) and BI-RADS category (P?<?0.010). Fine linear branching (P?=?0.004) and segmental (P?=?0.014) calcifications were significantly associated with HER2-positive cancers, and clustered calcifications were more frequently observed in ER-positive cancers (P?=?0.014).

Conclusion

HER2 status in DCIS correlated positively with the POM of mammographic calcifications, as determined by radiologists on the basis of the BI-RADS lexicon.

Key Points

? Prediction of malignancy on mammographic ductal carcinoma in situ is difficult. ? HER2 level correlated positively with the probability of malignancy assigned by radiologists. ? ER level correlated inversely with the probability of malignancy assigned by radiologists. ? HER2-positive DCIS more frequently exhibited fine linear branching or segmental calcifications. ? ER-positive DCIS more frequently exhibited clustered calcifications.     

Cancelled stereotactic biopsy of calcifications not seen using the stereotactic technique: do we still need to biopsy?

Objective

To determine the frequency of cancelled stereotactic biopsy due to non-visualisation of calcifications, and assess associated features and outcome data.

Methods

A retrospective review was performed on 1,874 patients scheduled for stereotactic-guided breast biopsy from 2009 to 2011. Medical records and imaging studies were reviewed.

Results

Of 1,874 stereotactic biopsies, 76 (4 %) were cancelled because of non-visualisation of calcifications. Prompt histological confirmation was obtained in 42/76 (55 %). In 28/76 (37 %) follow-up mammography was performed, and 7/28 subsequently underwent biopsy. Of 27 without biopsy, 21 (78 %) had follow-up. Nine cancers (9/49, 18 %) were found: 6 ductal carcinoma in situ (DCIS), 3 infiltrating ductal carcinoma (IDC). Of 54 patients with either biopsy or at least 2 years’ follow-up, 9 (17 %) had cancer (95 % CI 8–29). Cancer was present in 7/42 (17 %, 95 % CI 7–31 %) lesions that had prompt histological confirmation (DCIS?=?5, IDC?=?2) and in 2/28 (7 %, 95 % CI 0.8–24 %) lesions referred for follow-up (DCIS?=?1, IDC?=?1). Neither calcification morphology (P?=?0.2), patient age (P?=?0.7), breast density (P?=?1.0), personal history (P?=?1.0) nor family history of breast cancer (P?=?0.5) had a significant association with cancer.

Conclusion

Calcifications not visualised on the stereotactic unit are not definitely benign and require surgical biopsy or follow-up. No patient or morphological features were predictive of cancer.

Key points

? Half of cancelled stereotactic biopsies were due to non-visualisation of calcified foci. ? This reflects the improved detection of calcifications by digital mammography. ? Calcifications too faint for the stereotactic technique require alternative biopsy or follow-up ? 17?% of patients with biopsy or at least 2 years’ follow-up had cancer. ? No patient/morphological features were found to aid selection for re-biopsy vs. follow-up.     

Characteristics and screening outcome of women referred twice at screening mammography

Objectives

To determine the characteristics and screening outcome of women referred twice at screening mammography.

Methods

We included 424,703 consecutive screening mammograms and collected imaging, biopsy and surgery reports of women with screen-detected breast cancer. Review of screening mammograms was performed to determine whether or not an initial and second referral comprised the same lesion.

Results

The overall positive predictive value of referral for cancer was 38.6% (95% CI 37.3-39.8%). Of 147 (2.6%) women referred twice, 86 had been referred for a different lesion at second referral and 32 of these proved malignant (37.2%, 95% CI 27.0-47.4%). Sixty-one women had been referred twice for the same lesion, of which 22 proved malignant (36.1%, 95% CI 24.1-48.0%). Characteristics of these women were comparable to women with cancer diagnosed after first referral. Compared with women without cancer at second referral for the same lesion, women with cancer more frequently showed suspicious densities at screening mammography (86.4% vs 53.8%, P?=?0.02) and work-up at first referral had less frequently included biopsy (22.7% vs 61.5%, P?=?0.004).

Conclusions

Cancer risk in women referred twice for the same lesion is similar to that observed in women referred once, or referred for a second time but for a different lesion.

Key Points

? Cancer risk was 36% for lesions referred twice at screening mammography ? The cancer risk was similar for lesions referred only once at screening ? Densities at first referral were associated with increased cancer risk at second referral ? No biopsy at first referral was associated with increased cancer risk at second referral ? Patient and tumour characteristics were similar for women with and without diagnostic delay     

Performance comparison of single-view digital breast tomosynthesis plus single-view digital mammography with two-view digital mammography

Objective

To determine the performance of combined single-view mediolateral oblique (MLO) digital breast tomosynthesis (DBT) plus single-view cranio-caudal (CC) mammography (MX) compared with that of standard two-view digital mammography.

Methods

A multi-reader multi-case (MRMC) receiver-operating characteristic (ROC) study was conducted, involving six breast radiologists. Two hundred fifty patients underwent bilateral MX and DBT imaging. MX and DBT images with the adjunct of the CC-MX view from 469 breasts were evaluated and rated independently by six readers. Differences in mean areas under the ROC curves (AUCs), mean sensitivity and mean specificity were analysed by analysis of variance (ANOVA) to assess clinical performance.

Results

The combined technique was found to be non-inferior to standard two-view mammography (MX_(CC+MLO)) in mean AUC (difference: +0.021;95 % LCL = ?0.011), but was not statistically significant for superiority (P?=?0.197). The combined technique had equivalent sensitivity to standard mammography (76.2 % vs. 72.8 %, P?=?0.269) and equivalent specificity (84.9 % vs. 83.0 %, P?=?0.130). Specificity for benign lesions was significantly higher with the combination of techniques versus mammography (45.6 % vs. 36.8 %, P?=?0.002).

Conclusion

In this enriched study population, the combination of single-view MLO tomosynthesis plus single-view CC mammography was non-inferior to that of standard two-view digital mammography in terms of ROC curve area, sensitivity and specificity.

Key Points

? Breast tomosynthesis (DBT) has emerged as a valuable adjunct to mammography (MX). ? Combination DBT/MX demonstrated non-inferior clinical performance to standard two-view MX. ? Combination DBT/MX was superior to two-view MX in recognising benign lesions. ? Combination DBT/MX reduced variability compared with two-view MX.     

MRI of the breast in patients with DCIS to exclude the presence of invasive disease

Objectives

Core biopsy underestimates invasion in more than 20% of patients with preoperatively diagnosed ductal carcinoma in situ (DCIS) without evidence of invasion (pure DCIS). The aim of the current study was to evaluate the efficacy of preoperative magnetic resonance imaging (MRI) to discriminate between patients with DCIS who are at high risk of invasive breast cancer and patients at low risk.

Methods

One hundred and twenty-five patients, preoperatively diagnosed with pure DCIS (128 lesions; 3 bilateral) by core-needle biopsy, were prospectively included. Clinical, mammographic, histological (core biopsy) and MRI features were assessed. All patients underwent breast surgery. Analyses were performed to identify features associated with presence of invasion.

Results

Eighteen lesions (14.1%) showed invasion on final histology. Seventy-three lesions (57%) showed suspicious enhancement on MRI with a type 1 (n?=?12, 16.4%), type 2 (n?=?19, 26.0%) or type 3 curve, respectively (n?=?42, 57.5%). At multivariate analysis, the most predictive features for excluding presence of invasive disease were absence of enhancement or a type 1 curve on MRI (negative predictive value 98.5%; A_Z 0.80, P?=?0.00006).

Conclusion

Contrast medium uptake kinetics at MRI provide high negative predictive value to exclude presence of invasion and may be useful in primary surgical planning in patients with a preoperative diagnosis of pure DCIS.

Key Points

? It is important to determine invasion in breast DCIS. ? MRI contrast medium uptake kinetics can help exclude the presence of invasion. ? However, the positive predictive value for the presence of invasion is limited. ? MRI features were more accurate at predicting invasion than mammographic features alone.     

Impact of the digitalisation of mammography on performance parameters and breast dose in the Flemish Breast Cancer Screening Programme

Objectives

To investigate the impact of digitalisation on performance parameters and breast dose of the Flemish Breast Cancer Screening Programme. Both computed (CR) and direct radiography (DR) are compared with screen-film mammography (SFM).

Methods

Data from 975,673 mammographic examinations were collected from units which underwent digitalisation from SFM to CR (41 units) or DR (72 units) in the period 2005-2011. Performance indicators were obtained by consulting the Screening Programme database. Phantom and patient dosimetry data were acquired from the physical technical quality assurance of the programme.

Results

Digitalisation induced no significant change in cancer detection rate (CDR), percentage of ductal carcinomas in situ and percentage of breast cancers smaller than 1 cm. A decrease in false-positive results and third readings was observed, which was a time-related observation. After digitalisation, positive predictive value (PPV) increased and recall rates decreased. Compared with SFM, an increase of 30 % in mean glandular dose (MGD) was found for CR, while a similar change in the opposite direction was found for DR.

Conclusions

No major differences in performance parameters after digitalisation were found. Transition of SFM to CR resulted in a higher MGD and associated lower detection-over-induction ratio (DIR), while the change to DR induced an improvement of DIR.

Key Points

? Performance parameters showed no major differences after digitalisation to CR or DR. ? Transition from SFM to CR results in a higher mean glandular dose. ? Transition from SFM to DR results in a lower mean glandular dose.     

The role of breast MR imaging in pre-operative determination of invasive disease for ductal carcinoma in situ diagnosed by needle biopsy

Objectives

To evaluate whether magnetic resonance (MR) imaging features can predict the presence of occult invasion in cases of biopsy-proven pure ductal carcinoma in situ (DCIS).

Methods

We retrospectively reviewed 92 biopsy-proven pure DCIS in 92 women who underwent MR imaging. The following MR imaging findings were compared between confirmed DCIS and invasive breast cancer (IBC): lesion size, type, morphological and kinetic assessments by ACR BI-RADS MRI, and findings of fat-suppressed T2-weighted (FS-T2W) imaging.

Results

Sixty-eight of 92 (74%) were non-mass-like enhancements (NMLE) and 24 were mass lesions on MR imaging. Twenty-one of 68 (31%) NMLE and 13 of 24 (54%) mass lesions were confirmed as IBC. In NMLE lesions, large lesions (P?=?0.007) and higher signal intensities (SI) on FS-T2W images (P?=?0.032) were significantly associated with IBC. Lesion size remained a significant independent predictor of invasion in multivariate analysis (P?=?0.032), and combined with FS-T2W SIs showed slightly higher observer performances (area under the curve, AUC, 0.71) than lesion size alone (AUC 0.68). There were no useful findings that enabled the differentiation of mass-type lesions.

Conclusions

Breast MR imaging is potentially useful to predict the presence of occult invasion in biopsy-proven DCIS with NMLE.

Key Points

• MR mammography permits more precise lesion assessment including ductal carcinoma in situ
• A correct diagnosis of occult invasion before treatment is important for clinicians
• This study showed the potential of MR mammography to diagnose occult invasion
• Treatment and/or aggressive biopsy can be given with greater confidence
• MR mammography can lead to more appropriate management of patients

     

Nitroglycerine use in transcatheter arterial (chemo)embolization in patients with hepatocellular carcinoma and dual-energy CT assessment of Lipiodol retention

Objectives

To investigate whether the addition of nitroglycerine to transcatheter arterial (chemo)embolization (TAE/TACE) can increase the delivery and effectiveness of TAE/TACE in patients with hepatocellular carcinoma (HCC) by dual-energy CT.

Methods

HCC patients (BCLC stage A or B) were randomized to (n?=?51) or not to (n?=?50) receive nitroglycerine and an emulsion of Lipiodol with or without doxorubicin, followed by embolization with Gelfoam pledgets. Dual-energy CT was performed pre- and 1 to 3?months post-embolization to assess changes in tumour diameter and Lipiodol levels in tumours.

Results

Median tumour diameter decreased from baseline in both groups with and without nitroglycerine (7.11?% vs. 12.5?%, respectively), and was statistically significant in the group receiving nitroglycerine (P?=?0.023). There was no difference between the two groups in disease response (P?=?0.237). The concentration and percentage of Lipiodol retained in tumours were significantly greater in patients treated with nitroglycerine compared to those without (median concentration 15.05?mg/mL vs. 4.40?mg/mL, respectively, P?P?Conclusions Nitroglycerine increased delivery of the Lipiodol emulsion via TAE/TACE to HCC tumours with significant tumour reduction. Dual-energy CT can accurately quantify the amount of Lipiodol deposited in tumours.

Key Points

? Nitroglycerine improves delivery of tumour-targeted therapy via enhanced permeability and retention. ? In hepatocellular carcinoma, nitroglycerine added to TAE/TACE showed greater tumour reduction. ? Dual-energy CT can reliably quantify the amount of Lipiodol in TAE/TACE.     

Somatostatin receptor scintigraphy with 111In-octreotide in pulmonary carcinoid tumours correlated with pathological and 18FDG PET/CT findings

Purpose

Pulmonary carcinoid (PC) tumors are rare neoplasms of the lung with good prognosis but diagnosis may be demanding since there is no exclusive modality alone to clearly differentiate a PC tumor. The purpose of this study is to establish the diagnostic features of somatostatin receptor scintigraphy (SRS), comparatively (where available) with ¹⁸FDG PET/CT (PET/CT) correlated with histopathologic findings.

Methods

Twenty-one patients who underwent SRS with ¹¹¹In-octreotide and were diagnosed as having PC tumors were retrospectively studied. Thirteen patients were performed PET/CT. Primary tumour size, Ki-67 indexes, image analysis data of SRS and PET/CT including maximum standardized uptake values (SUVmax) together with false negative, false positive, true positive and true negative lesions were documented and discussed.

Results

Eleven (52.4?%) patients were typical (TC) and 10 (47.6?%) were atypical carcinoids (AC) with mean Ki-67 indexes of 2.1 and 24?%, respectively. Patients underwent SRS for solitary pulmonary nodule (SPN) characterization (n?=?12) and determination of disease extension (n?=?9). Overall sensitivity and specificity of SRS in the detection of primary tumour, lymph nodes (LN) and distant metastasis (DM) were 76 and 97?%, respectively, whereas, positive and negative predictive values were 95 and 86?%. PET/CT was performed for determining disease spread (n?=?3) and metabolic characterization (n?=?10) of SPNs. Mean SUVmax in the primary pulmonary lesion in TCs and ACs were 2.9?±?0.8 and 7.9?±?5.4, respectively. Nodal involvement (n?=?5) and DM (n?=?3) were also detected. Sensitivity and specificity of PET/CT in the detection of primary tumour, LNs and DM were 85 and 89.4?%, respectively.

Conclusion

SRS is useful in the diagnosis and monitoring of PC tumors when incorporated with ¹⁸FDG PET/CT as a primary staging tool particularly in the determination of disease spread.     

Can positron emission mammography help to identify clinically significant breast cancer in women with suspicious calcifications on mammography?

Objective

To evaluate the diagnostic accuracy of positron emission mammography (PEM) for identifying malignant lesions in patients with suspicious microcalcifications detected on mammography.

Methods

A prospective, single-centre study that evaluated 40 patients with suspicious calcifications at mammography and indication for percutaneous or surgical biopsy, with mean age of 56.4 years (range: 28-81 years). Patients who agreed to participate in the study underwent PEM with 18F-fluorodeoxyglucose before the final histological evaluation. PEM findings were compared with mammography and histological findings.

Results

Most calcifications (n?=?34; 85.0 %) were classified as BIRADS 4. On histology, there were 25 (62.5 %) benign and 15 (37.5 %) malignant lesions, including 11 (27.5 %) ductal carcinoma in situ (DCIS) and 4 (10 %) invasive carcinomas. On subjective analysis, PEM was positive in 15 cases (37.5 %) and most of these cases (n?=?14; 93.3 %) were confirmed as malignant on histology. There was one false-positive result, which corresponded to a fibroadenoma, and one false negative, which corresponded to an intermediate-grade DCIS. PEM had a sensitivity of 93.3 %, specificity of 96.0 % and accuracy of 95 %.

Conclusion

PEM was able to identify all invasive carcinomas and high-grade DCIS (nuclear grade 3) in the presented sample, suggesting that this method may be useful for further evaluation of patients with suspected microcalcifications.

Key Points

? Many patients with suspicious microcalcifications at mammography have benign results at biopsy. ? PEM may help to identify invasive carcinomas and high-grade DCIS. ? Management of patients with suspicious calcifications can be improved.

     

3-T breast magnetic resonance imaging in patients with suspicious microcalcifications on mammography

Objective

To investigate the diagnostic value of 3-Tesla (T) breast MRI in patients presenting with microcalcifications on mammography.

Methods

Between January 2006 and May 2009, 123 patients with mammographically detected BI-RADS 3–5 microcalcifications underwent 3-T breast MRI before undergoing breast biopsy. All MRIs of the histopathologically confirmed index lesions were reviewed by two breast radiologists. The detection rate of invasive carcinoma and ductal carcinoma in situ (DCIS) was evaluated, as well as the added diagnostic value of MRI over mammography and breast ultrasound.

Results

At pathology, 40/123 (33 %) lesions proved malignant; 28 (70 %) DCIS and 12 (30 %) invasive carcinoma. Both observers detected all invasive malignancies at MRI, as well as 79 % (observer 1) and 86 % (observer 2) of in situ lesions. MRI in addition to conventional imaging led to a significant increase in area under the receiver operating characteristic (ROC) curve from 0.67 (95 % CI 0.56–0.79) to 0.79 (95 % CI 0.70–0.88, observer 1) and to 0.80 (95 % CI 0.71–0.89, observer 2), respectively.

Conclusions

3-T breast MRI was shown to add significant value to conventional imaging in patients presenting with suspicious microcalcifications on mammography.

Key points

? 3-T MRI is increasingly used for breast imaging in clinical practice. ? On 3-T breast MRI up to 86 % of DCIS lesions are detected. ? 3-T MRI increases the diagnostic value in patients with mammographically detected microcalcifications.     

Accuracy of tumour size assessment in the preoperative staging of breast cancer: comparison of digital mammography, tomosynthesis, ultrasound and MRI

Purpose

Accurate measurement of breast tumour size is fundamental for treatment planning. We compared the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US) and magnetic resonance imaging (MRI) for the preoperative evaluation of breast cancer size.

Materials and methods

We retrospectively reviewed 149 breast cancers in 110 patients who underwent DM, DBT, US and MRI between January 2010 and December 2011, before definitive surgery. The lesions were measured by two radiologists, without knowledge of the final histological examination, considered the gold standard. For each imaging modality, the maximum tumour size was measured to the nearest millimetre; the measurements were considered concordant if they were within ±5 mm. Pearson’s correlation coefficient was calculated for each imaging modality.

Results

The median pathological tumour size was 22.3 mm. MRI and DBT had a level of concordance with pathology of 70% and 66%, respectively, which was higher than that of DM (54%). DBT and MRI measurements had a better correlation with pathological tumour size (R:0.89 and R:0.92, respectively) compared to DM (R:0.83) and US (R:0.77).

Conclusions

DBT and MRI are superior to DM and US in the preoperative assessment of breast tumour size. DBT seems to improve the accuracy of DM, although MRI remains the most accurate imaging modality for breast cancer extension.     

Does digital mammography in a decentralized breast cancer screening program lead to screening performance parameters comparable with film-screen mammography?

Objective:

To evaluate if the screening performance parameters of digital mammography (DM) in a decentralized screening organization were comparable with film-screen mammography (FSM).

Methods:

A nationwide screening program was launched in 2001, and since 2005 screening with DM has been allowed. Firstly, the parameters of the three regional screening units (RSUs) that first switched to DM (11,355 women) were compared with the FSM period of the same three RSUs (23,325 women). Secondly, they were compared with the results of the whole central breast unit (CBU).

Results:

The recall rate (RR) of the DM group in the initial round was 2.64% [2.40% for FSM (p?=?0.43)] and in the subsequent round 1.20% [1.58% for FSM (p?=?0.03)]. The cancer detection rate (CDR) was 0.59% for DM and 0.64% for FSM (p?=?0.56). The percentage of ductal carcinoma in situ was 0.07% for DM and 0.16% for FSM (p?=?0.02). The positive predictive value was high in the subsequent rounds (DM 48.00%, FSM 45.93%) and lower in the initial round (DM 24.05%, FSM 24.86%). Compared with the results of the whole CBU, DM showed no significant difference.

Conclusion:

DM can be introduced in a decentralized screening organization with a high CDR without increasing the RR.     

Obesity: An Independent Risk Factor for Insufficient Hemostasis Using the AngioSeal Vascular Closure Device After Antegrade Puncture

Purpose

This study was designed to investigate the efficacy of the AngioSeal vascular closure device after antegrade puncture of the femoral artery.

Methods

In a prospective study, 120 consecutive patients underwent lower limb vascular intervention by an antegrade access to the common femoral artery (CFA). After intervention, a 6F (n?=?88) or an 8F (n?=?32) AngioSeal vascular closure device was used to achieve hemostasis. The technical success or the cause of failure was documented. In addition, the coagulation status (platelets, INR, prothrombin time, atrial thromboplastin time (PTT)), hypertonus, locoregional habitus of the groin, body mass index (BMI), presence of calcifications, and history of previous surgical interventions of the CFA were evaluated.

Results

Hemostasis was achieved in 97 patients (81%). In 12 patients (10%), persistent bleeding of the puncture site required manual compression. In another nine patients (8%) a kink of the sheath obviated the passage of the collagen plug toward the vessel, and in two patients the anchor dislodged out of the vessel, requiring manual compression. There were no significant differences between the groups of successful and unsuccessful sealing regarding the mean platelets (241 vs. 254?*?10⁹/l; P?=?0.86), INR (1.06 vs. 1.02; P?=?0.52), prothrombin time (90% vs. 90%; P?=?0.86), and PTT (30 vs. 31?s; P?=?0.82). However, unsuccessful sealing was more likely in obese patients with an increased BMI (26.6 vs. 28.8?kg/m²; P?=?0.04).

Conclusions

Obesity seems to be an independent risk factor for insufficient sealing using the AngioSeal vascular closure device after antegrade puncture of the CFA. In 8% of our patients, hemostasis could not be achieved due to kink of the flexible sheath.     

Comparison between two-dimensional synthetic mammography reconstructed from digital breast tomosynthesis and full-field digital mammography for the detection of T1 breast cancer

Objective

To evaluate the interpretative performance of two-dimensional (2D) synthetic mammography (SM) reconstructed from digital breast tomosynthesis (DBT) in the detection of T1-stage invasive breast cancers, compared to 2D full-field digital mammography (FFDM).

Methods

This retrospective study enrolled 214 patients. For each patient, FFDM and DBT were performed between January and June 2013, and SM was reconstructed from DBT data. Three radiologists interpreted images and recorded visibility scores and morphologies of cancers. Diagnostic performances of SM and FFDM were compared. Percentages of detected cancers and visibility scores were compared for tumour size, and presence of calcifications for each observer.

Results

Observer sensitivity showed no difference for detection with SM and FFDM (P?>?0.05). One observer showed a higher specificity (P?=?0.02) and higher positive predictive value with SM (95 % CI 0.6–16.4), but the differences in the corresponding values between SM and FFDM for the other observers were not statistically significant. In subgroup analyses according to tumour size and presence of calcifications, percentages of detected cancers and visibility scores were not significantly different.

Conclusions

Diagnostic performances of SM and FFDM are comparable for detecting T1-stage breast cancers. Therefore, our results indicate that SM may eliminate the need for additional FFDM during DBT-based imaging.

Key Points

? DBT plus FFDM increases radiation dose compared to FFDM alone.? Detecting T1-stage cancers with only SM is comparable to detection with FFDM.? Two-dimensional SM may replace dose-requiring FFDM in DBT-based imaging.

     

Relationship between diabetes mellitus with dural arteriovenous fistula

Introduction

The aetiology of dural arteriovenous fistula (DAVF) is not well known, but it has been suggested that abnormality in angiogenesis plays a pathological role. Abnormality in angiogenesis is also involved in diabetes mellitus (DM). The purpose of this study was to quantify the relation between DAVF and DM in a Korean population.

Methods

Medical records of 192 patients with DAVF between 2002 and 2011 were reviewed. Age, sex and the presence of DM, hypertension, hyperlipidaemia, stroke, coronary artery disease and cancers were compared between DAVF and control subjects. Data for control were obtained from the Korean National Health and Nutrition Examination Survey. The relationship of DM and DAVF location, presenting symptoms (benign vs. aggressive) and classification (Borden and Geibprasert) were assessed using the Pearson’s chi-square test.

Results

Prevalence of DM was higher in DAVF patients (19.8 %) than in controls (9.5 %; p?=?0.004). Univariate analysis showed that DM (odds ratio (OR), 2.356; 95 % confidence interval (CI), 1.634–3.399; p?<?0.001) and age (OR, 1.022; 95 % CI, 1.012–1.032; p?<?0.001) increased the odds of DAVF. This was supported by multivariate analysis (DM: OR, 2.092; 95 % CI, 1.391–3.145; p?=?0.0004 and Age: OR, 1.021; 95 % CI, 1.009–1.033; p?=?0.001). When these analyses were repeated after stratification by sex, there was no relation between age and DAVF in men. Borden II and III (p?=?0.038) and aggressive symptoms (p?=?0.023) were related to DM.

Conclusion

There was a positive relation between DM and DAVF in a Korean population. DAVFs with aggressive symptoms and behaviour were more commonly related to DM.     

Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: a meta-analysis

Objective

To evaluate the diagnostic performance of digital breast tomosynthesis (DBT) and digital mammography (DM) for benign and malignant lesions in breasts.

Methods

Document retrieval was conducted on PubMed, EMBASE, the Cochrane Library, Web of Science and Chinese Biomedical Literature Database, etc., from 1950 to June 2013. Metadisc1.4 software was used to analyse the pooled sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratio. The heterogeneity was assessed using forest plots and the inconsistency index (I²). Before statistical comparison, the area under (AUC) the summary receiver-operating characteristic curve (SROC) of two different diagnostic methods was calculated respectively.

Results

A total of seven studies involving 2,014 patients and 2,666 breast lesions were included. Compared with the gold standard (histological results), the pooled sensitivity and specificity of DBT were 90.0 % and 79.0 %, and for DM they were 89.0 % and 72.0 %, respectively. The pooled positive likelihood ratio of DBT and DM was 3.50 and 2.83; the pooled negative likelihood ratio of DBT and DM was 15 % and 18 %; the pooled DOR for DBT and DM was 26.04 and 16.24, respectively.

Conclusions

Digital breast tomosynthesis has a higher sensitivity and specificity in breast diagnosis than digital mammography.

Key Points

? Digital breast tomosynthesis has high sensitivity and specificity in breast diagnosis. ? DBT appears to have superior diagnostic accuracy relative to digital mammography. ? DBT images were captured at a lower dose than 2D images. ? DBT displays abnormal features of lesions more clearly than DM. ? Digital breast tomosynthesis could become the first choice for assessing breast lesions.     

Effect of vascular haemoglobin concentrations on ultrasound-guided diffuse optical tomography in differentiating benign from malignant breast lesions

Objectives

Ultrasound-guided diffuse optical tomography (US-DOT) can potentially detect breast carcinomas by measuring total tumour haemoglobin concentrations (TTHC). The purpose of this study was to evaluate whether vascular haemoglobin concentrations (VHC) affect the ability of US-DOT to distinguish breast carcinomas from benign.

Materials and methods

In 85 women (97 palpable lesions) referred for core breast biopsy, we measured VHC with a complete blood count and calculated TTHCs for each lesion with US-DOT. Anaemia was defined as a VHC less than 120.0 g/L.

Results

Mean TTHCs were significantly higher in malignant lesions (n?=?53) than in benign lesions (n?=?44), regardless of whether the lesions were from women with anaemia (TTHC, 248.5 vs. 123.3 μmol/L; P?=?0.001) or from those without (TTHC, 229.7 vs. 173.9 μmol/L; P?=?0.016). A cut-off TTHC of 155.1 μmol/L provided 81.3 % sensitivity, 81.8 % specificity and 81.5 % accuracy for detecting malignant tumours in women with anaemia and 78.4 % sensitivity, 54.5 % specificity and 67.1 % accuracy for women without. There was no significant difference in sensitivity (P?=?0.813), specificity (P?=?0.108) and accuracy (P?=?0.162) between the anaemic group and the non-anaemic group.

Conclusions

Vascular haemoglobin concentrations did not affect the ability of US-DOT to differentiate breast carcinomas from benign lesions.

Key Points

? US-DOT can differentiate benign from malignant breast lesions by measuring TTHC. ? No difference in TTHC between the anaemia and non-anaemia group. ? Vascular haemoglobin concentrations do not affect the diagnostic ability of US-DOT.     

Locally advanced rectal cancer: diffusion-weighted MR tumour volumetry and the apparent diffusion coefficient for evaluating complete remission after preoperative chemoradiation therapy

Objective

To evaluate DW MR tumour volumetry and post-CRT ADC in rectal cancer as predicting factors of CR using high b values to eliminate perfusion effects.

Methods

One hundred rectal cancer patients who underwent 1.5-T rectal MR and DW imaging using three b factors (0, 150, and 1,000 s/mm²) were enrolled. The tumour volumes of T2-weighted MR and DW images and pre- and post-CRT ADC_150–1000 were measured. The diagnostic accuracy of post-CRT ADC, T2-weighted MR, and DW tumour volumetry was compared using ROC analysis.

Results

DW MR tumour volumetry was superior to T2-weighted MR volumetry comparing the CR and non-CR groups (P?<?0.001). Post-CRT ADC showed a significant difference between the CR and non-CR groups (P?=?0.001). The accuracy of DW tumour volumetry (A_z?=?0.910) was superior to that of T2-weighed MR tumour volumetry (A_z?=?0.792) and post-CRT ADC (A_z?=?0.705) in determining CR (P?=?0.015). Using a cutoff value for the tumour volume reduction rate of more than 86.8 % on DW MR images, the sensitivity and specificity for predicting CR were 91.4 % and 80 %, respectively.

Conclusion

DW MR tumour volumetry after CRT showed significant superiority in predicting CR compared with T2-weighted MR images and post-CRT ADC.

Key Points

? Diffusion-weighted MR (DWMR) imaging offers new information about rectal cancer. ? DWMR helps to predict complete remission after chemoradiotherapy in patients with advanced rectal cancer. ? DWMR provides more accurate diagnostic information than T2-weighted MRI. ? Apparent diffusion coefficients can predict CR, but they have certain clinical limitations.