Positive predictive value of biopsy of palpable masses following mastectomy

Determine the positive predictive value (PPV) of biopsy of palpable masses following mastectomy (MX). Determine if there are patient characteristics, tumor, or imaging features more predictive of cancer. IRB‐approved retrospective review of 16 396 breast ultrasounds June 2008‐December 2015 identified patients with MX presenting with palpable masses. Medical records and imaging studies were reviewed. Statistical analysis was performed using Fisher's exact test. 95% confidence intervals (CI) were calculated. In all, 117 patients presented with palpable masses on the MX side. 101/117 patients who had a palpable mass on physical examination had a true sonographic mass to correlate with the clinical findings. 91/101 (90%) underwent biopsy: 19/91 (21%, 95% CI; 13‐31) biopsies were malignant. 72/91 (79%) were benign. All 19 cancers were on the original cancer side. Recurrences ranged from 0.4 to 4.5 cm maximum diameter, mean 1.3 cm. Prophylactic vs therapeutic mastectomy was very statistically significant (P = .01). The use of tamoxifen or an AI was also statistically significant (P = .04). Patient age (P = 1.0), radiation therapy (P = 1.05), chemotherapy (P = .2), immediate breast reconstruction (P = .2), or implant vs flap (P = .2) had no statistically significant association with finding cancer on biopsy. Lesion shape (irregular vs oval/round) was highly statistically significant (P = .0003) as was non‐parallel orientation on ultrasound (P = .008). Circumscribed vs non‐circumscribed margins was also statistically significant (P = .008). The PPV of biopsy of palpable masses on the side of MX was 21% (95% CI; 13‐31). All recurrences were on the original cancer side and this was very statistically significant.     

Positive predictive value of the Breast Imaging Reporting and Data System.

BACKGROUND: The American College of Radiology has established guidelines for outcomes monitoring known as the Breast Imaging Reporting and Data System (BIRADS). These recommendations include calculation of positive predictive values (PPV) and tracking of both benign and malignant histology. We collected this data for 688 radiographically guided biopsies and organized it according to the BIRADS assessment categories. The objective was to evaluate the contribution of the BIRAD System when used to stratify PPV, histology, and biopsy modality data according to the overall assessment rating. STUDY DESIGN: This study included data from 688 image-guided biopsies. Mammographic studies were either assigned a BIRADS rating at the time of examination or, if the image was taken before our use of BIRADS, examined retrospectively and rated. In these retrospective cases, the histologic outcomes of the biopsy remained unknown to the radiologist until ratings were assigned. Positive predictive value was calculated for each BIRADS category. RESULTS: The overall PPV for the sample was 0.23. The PPVs increased with increasing level of suspicion as follows: category 1 (0.0), category 2 (0.04), category 3 (0.03), category 4 (0.23), category 5 (0.92). Category 1 lesions represented 0.1% of the biopsies; category 2, 3.6%; category 3, 46.8%; category 4, 34.0%; and category 5, 15.4%. The most common histologic diagnoses of benign lesions biopsied were fibroadenoma and fibrocystic changes-proliferative and nonproliferative. The most common histologic diagnoses of malignant lesions biopsied were infiltrating ductal carcinoma and ductal carcinoma in situ. Utilization rates of the biopsy techniques varied by BIRADS category. CONCLUSIONS: Our study revealed that BIRADS does improve the quality of the risk assessment information by making the PPV more specific to a patient's mammogram rather than simply related to an overall PPV. Our histology analysis showed category 3 and category 4 benign biopsies were predominantly because of fibrocystic changes. Category 5 lesions were predominantly invasive ductal carcinoma. Analysis of biopsy modalities indicated the preferred method for management of radiographically detected lesions evolved from stereotactic core biopsy to directional, vacuum-assisted biopsy over the course of the study.     

Socioeconomic status and microalbuminuria in an Asian population

Background. In studies from developed Western countries, lowersocioeconomic status (SES) has been reported to be associatedwith kidney diseases. However, this hypothesis has not beenexamined in populations from newly industrialized Asian countries.We evaluated the association between SES and micro/macroalbuminuriain a population-based sample in Singapore. Methods. We examined 920 participants of Malay ethnicity aged40–80 years (49.6% female). SES was defined through education,income and housing type of participants. The main outcome ofinterest was the presence of micro/macroalbuminuria definedas a urinary albumin-to-creatinine ratio (ACR) 17 mg/g for menand 25 mg/g for women. Results. Lower categories of SES were associated with micro/macroalbuminuria;compared to the higher categories of SES, the odds ratio (95%confidence interval) of micro/macroalbuminuria was 1.76 (1.23–2.52)for primary/lower education, 1.64 (1.16–2.31) for income<1000 Singapore dollars (SGD)/retired status, 1.44 (1.01–2.06)for small/medium housing type and 2.37 (1.56–3.60) forthe coexistence of all three low SES factors (primary/ beloweducation, income <1000 SGD/retired status and small/mediumhousing type) compared to 1 low SES factor. This pattern ofassociation was consistently present in subgroup analyses bygender and age. Conclusions. Lower SES is associated with the presence of micro/macroalbuminuriaindependent of age, gender, smoking, alcohol intake and bodymass index among Malay adults in Singapore.     

Epidemiology of abdominal aortic aneurysm in an Asian population

Background: Abdominal aortic aneurysms (AAA) are common in the Caucasian population. Apart from reported differences in the occurrence of AAA in the black and white populations, there are few studies on the incidence of AAA in the Asian population. Methods: A prospective database of all patients with AAA seen between 1996 and 1999, in the South‐East Asian state of Sarawak in Borneo Island, was analysed. The demographic data included patient's age, sex, ethnic group, date of diagnosis, comorbidities, presentations and treatment outcomes. These were compared with the state population's demographic statistics. Results: Diagnoses of AAA were made in 123 patients during the study period. The male to female ratio was 3.5 : 1. The age range was 39?88 years with a median age of 70 years. Four patients were younger than 55 years. The incidence rate for the at‐risk male population older than 50 years was 25.6/100 000. The incidence rate reached 78.3/100 000 for males older than 70 years. The incidence rate for females older than 50 years was 7.6/100 000 and for those older than 70 years it was 18.7/100 000. All races were affected. Smoking, hypertension or respiratory disorders were present in more than 40% of the patients. Half of the patients underwent surgical repair. Conclusion: This study shows that AAA in this Asian population is not uncommon and the incidence is comparable to the Western world.     

Spectrum of severe infections in an Asian renal transplant population

Infections in renal transplant recipients (RTX) account for 26% of hospitalization days annually and 40% of overall mortalities. A retrospective study of infections requiring hospitalization occurring among 725 Asian RTX in 2002 was performed. RESULTS: Serious infections requiring at least one hospitalization occurred in 9.2% of RTX (n = 67). Multiple pathogens affected 28.4% of patients, resulting in 118 infectious episodes during 93 hospitalizations. Mean age of affected patients was 48 years and female to male ratio was 2:1. Forty-one (61.2%) had impaired renal function (serum creatinine >141 mumol/L). Mean duration of hospitalization per patient was 17 days and the in-patient mortality rate was 17.9% eighty-one (87%) hospitalizations were for late infections (>6 months posttransplant). Cyclosporine (CsA) with prednisolone with or without azathioprine was the immunosuppressant in 62.7% (n = 42) of RTX but proportionally, infections were more frequent among RTX on other more potent immunosuppressants (n = 21; 7.4% CsA-based vs. 19.3%, potent, P < .05). Bacterial, viral, fungal, and Pneumocystis carinii infections comprised 64.4%, 20.3%, 5.9%, and 4.2% respectively. Urinary tract infection, pneumonia, and bacterial septicemia (35.52%, 31.6%, and 11.8%, respectively) were the major presentations. E. coli, cytomegalovirus (CMV), and Candida were the most common pathogens. Notably, 13 out of 18 (72.2%) viral CMV infections were co- infections, occurring together with bacterial infections. CONCLUSIONS: Late infections with the use of potent immunosuppressives and concurrent CMV reactivation are a major cause of morbidity. Longer antibacterial prophylaxis and closer monitoring for CMV infections may help reduce morbidity.     

Positive predictive value of maximal posterior joint-line tenderness in diagnosing meniscal pathology: a pilot study

OBJECTIVE: The purpose of this prospective study was to determine the positive predictive value (PPV) of the point of maximal posterior joint line tenderness (JLT), as a clinical sign, to diagnose underlying meniscal tears. METHODS: We conducted a prospective study of patients requiring arthroscopic surgery, who consecutively presented to the University of Calgary's Sport Medicine Centre. The femurotibial joint line was palpated for the point of maximal tenderness. We recorded the data on the arthroscopy report. A second examiner (orthopedic sport medicine surgical fellow or sport medicine physician) performed the same protocol. An arthroscopist documented the site of pathology as detected by arthroscopy. RESULTS: We found a PPV of 60.0% and a negative predictive value of 62.5%, suggesting that maximal posterior JLT may be predictive of meniscal pathology. The sensitivity and specificity were 84.6% and 31.2%, respectively (p = 0.155), with Fisher's exact test. The kappa score assessed interobserver reliability and was good at 0.48. Patients with maximal posterior JLT but no meniscal pathology did have other confounding pathology and patients with no maximal posterior JLT who had meniscal pathology usually had confounding knee pathology. CONCLUSIONS: We found a PPV of 60.0% of maximal posterior JLT and meniscal pathology located at the same anatomical site on arthroscopic examination.     

Prevalence of obstructive sleep apnea in an Asian bariatric population: an underdiagnosed dilemma

BackgroundObesity is a growing health problem that has become a global epidemic. Serial population studies have shown the same in Malaysia, where the prevalence of obesity increased rapidly in the last decade. Currently, bariatric surgery is the most effective treatment in patients with morbid obesity. Obstructive sleep apnea (OSA) is the most common type of sleep-related breathing disorder seen in obesity.ObjectivesWe aim to ascertain the prevalence and severity of OSA in Asian patients who underwent bariatric surgery and were seen in our center.SettingThe study was conducted in our university hospital.MethodsStudy approval was obtained from our institutional review board for a retrospective chart review. A total of 226 patients were included in this review. OSA was noted as absent or present and graded from mild to severe. The patient population was stratified by body mass index according to the World Health Organization guidelines for Asian population.ResultsThe overall sample prevalence of OSA was 80.5%. Of these, 24.3% had mild OSA, 23.9% had moderate OSA, and 32.3% had severe OSA. Only 17.3% have been diagnosed with OSA before bariatric workup. Among men, the prevalence of OSA was 93.7% and 75.5% among women.ConclusionBased on these findings, Asian patients undergoing bariatric workup should be considered for routine polysomnography to enable treatment of OSA.     

Pediatric tracheotomies in an Asian population: the Singapore experience.

OBJECTIVE: Over the past 2 decades, tracheotomy in children and infants has evolved from a primarily emergent procedure for upper airway obstruction into a semielective procedure for airway access in assisted ventilation. We present a 12-year retrospective review of tracheotomies performed in the pediatric population in Singapore. STUDY DESIGN AND SETTING: We reviewed all tracheotomies performed in children below the age of 16 years in 2 tertiary pediatric medical centers in Singapore from January 1991 to December 2003. Indications for surgery are reviewed, and outcomes in terms of morbidity rate, mortality rate, postoperative rehabilitation, and duration of decannulation process were analyzed. RESULTS: Tracheotomies were performed in 48 children during the study period. The mean age of patients was 3.24 years, with ages ranging from 16 days to 14 years. Sixty-three percent of tracheotomies were done within the 1st year of life. The chief indication was airway access for assisted ventilation. The overall complication rate was 31%. There were 13 attempts at decannulation, with 9 successes. No tracheotomy-related deaths occurred. CONCLUSION: Tracheotomy is a relatively safe procedure in children and infants. Lower decannulation rates and the evolving role of tracheotomy for early access in assisted ventilation permits earlier discharge with tracheotomy in situ.     

结合弹性成像调整超声BI-RADS分级后对乳腺肿块的诊断价值

目的分析超声BI-RADS分级在结合弹性成像并调整分级后对乳腺肿块的诊断价值。 方法回顾性分析2016年1月至12月南方医科大学附属东莞人民医院进行手术或活检获得病理结果的乳腺肿块,比较术前常规超声BI-RADS分级（US-BI-RADS）和结合弹性成像并调整后的BI-RADS分级（UE-BI-RADS）诊断乳腺肿块的价值。 结果US-BI-RADS对3~5级病灶诊断恶性的阳性预测值分别为0.86%、6.80%、26.04%、71.58%、91.25%;UE-BI-RADS分别为0.57%、6.67%、31.91%、79.31%、96.77%。US-BI-RADS诊断乳腺恶性肿瘤的敏感度为82.22%,特异度为88.43%,约登指数为0.71,ROC曲线下面积为0.919;UE-BI-RADS诊断的敏感度为87.18%,特异度为88.98%,约登指数为0.76,ROC曲线下面积为0.941。 结论UE-BI-RADS能提高超声对乳腺恶性病变的诊断价值;对US-BI-RADS 4级以上的病灶,有必要进行弹性成像后调整评分。     

The predictive value of microalbuminuria

An elevated urinary albumin excretion (termed microalbuminuria) has been proposed as a predictor for later development of clinical diabetic nephropathy (hypertension, falling glomerular filtration rate [GFR], and urinary albumin excretion greater than 300 mg/24 h). However, review of the original reports on the predictability of microalbuminuria revealed a concomitant presence of elevated BP and a propensity to falling GFR. Thus, the predictability of microalbuminuria rests on the added evaluation of BP and GFR. Additional investigation is needed to address the possibility that microalbuminuria and either a rising BP or a falling GFR or both indicates established diabetic nephropathy rather than predicting its development.     

Peak bone mineral density and its determinants in an Asian Indian population

Data on peak bone mineral density (BMD) and its determinants in Asian Indians are limited. We studied the peak BMD and its determinants in Asian Indians. A total of 1137 young (age: 25--35yr) healthy volunteers of either sex (558 men and 579 women) were recruited for dietary evaluation, analyses of serum calcium, inorganic phosphorus, alkaline phosphatase, 25-hydroxyvitamin D [25(OH)D], and intact parathyroid hormone (iPTH) levels, and measurement of BMD with dual-energy X-ray absorptiometry. In men and women, peak bone mass (PBM) at the femoral neck, femoral trochanter, total femur, and lumbar spine was achieved between 25 and 30yr of age, whereas PBM at the femoral intertrochanter occurred between 30 and 35yr of age. Peak BMD was lower than that of Caucasians by 15.2--21.1% in men and 14.4--20.6% in women. On stepwise multiple regression, height and weight were the most consistent predictors of BMD at all sites in both groups. In men, 25(OH)D positively predicted BMD at the hip, whereas in women, serum iPTH negatively predicted BMD at the femoral trochanter and total femur. The study concluded that Asian Indians have significantly lower peak BMD than Caucasians and that weight and height are the most consistent predictors of BMD at all sites in both men and women.     

Contralateral prophylactic mastectomy in an Asian population: A single institution review

BackgroundContralateral prophylactic mastectomy (CPM) removes the non-diseased breast in women who have unilateral breast cancer. This reduces the incidence of contralateral breast cancer, and potentially improves survival in high risk patients. Such surgical risk-reduction strategy is increasingly being adopted in the United States, despite a decreasing incidence of contralateral breast cancer. The use of CPM in an Asian population is yet unknown. We present the first Asian report on CPM rates and trends in Singapore, the country with the highest incidence of breast cancer in Asia.MethodsA retrospective review of all patients who had breast cancer surgery from 2001 to 2010 at the largest healthcare system in Singapore was performed. Patient demographics and tumour characteristics were analysed with regards to type of surgery performed. Factors associated with CPM were identified.ResultsFrom 2001 to 2010, a total of 5130 patients underwent oncological breast surgery. A decreasing trend of mastectomies (82.7%–70.8%), an upward trend of breast conserving surgery (BCS) (17.3%–29.2%) and an increasing trend in CPM (0.46%–1.25%) is observed. Patients who opted for CPM are likely to be younger (48.4 ± 9.4 years), married (60%), parous (56.7%), with no family history of breast/ovarian cancer (66.7%), and diagnosed at an earlier stage. The rate of synchronous occult breast malignancy was found to be 10% (n = 30), and these were in patients who were of a low cancer-risk profile.ConclusionsThis retrospective study reflects an increasing incidence of breast cancer in Singapore, with a decrease in mastectomies, and an increase in BCS and CPM rates, similar to Western data. Similar to Western populations, the Asian woman who opts for CPM is likely to be young and have an earlier stage of breast cancer. In contrast, the Asian woman is likely to have no family history of breast or ovarian cancers. Commonly cited reasons for increased CPM rates such as the increased availability of genetic counselling and pre-operative MRI evaluation, along with wide use of reconstruction, do not feature as dominant factors in our population, suggesting that the Asian patients may have different considerations when electing for CPM.