Gray scale histogram analysis of solid breast lesions with ultrasonography: can lesion echogenicity ratio be used to differentiate the malignancy?

PurposeThe aim of this study was to investigate the diagnostic performance of lesion echogenicity ratios (LER) calculated by image histogram analysis for distinction of malignant and benign breast lesions.Material and methodsA total of 55 patients (mean age, 44 years) with 59 lesions were included. Ultrasound images were analyzed retrospectively.ResultsMean LER values in benign and malignant lesions were 1.63±0.41 and 3.1±0.87, respectively. The difference between LER values of benign and malignant breast lesions was statistically significant (P<.001).ConclusionLER can be used as an adjunct ultrasound parameter to differentiate between benign and malignant breast lesions.     

Breast neoplasms detected only with ultrasonography: incidental finding or clinical evidence?

INTRODUCTION: Mammography is the only technique of proven efficacy in the early diagnosis of breast cancer, even though its sensitivity is much lower in breasts that are dense or with a high parenchymal-stromal component. In the past malignant breast nodules detected at US in patients with negative mammographic and physical findings were considered incidental findings, but more recent papers report increasing numbers of breast cancers detected only at US. PURPOSE: We investigated the yield of US performed as a diagnostic complement in asymptomatic women with mammographic findings that were either negative or poorly readable because of dense breast. MATERIAL AND METHODS: We examined 13 women 37 to 55 years old (mean 47): 9 of them were asymptomatic and 4 had poorly specific physical findings. The patients underwent physical examination, mammography, US, microhistologic biopsy with 14G needles under US guidance and surgery. RESULTS: Fourteen breast lesions 7.0-15 mm in diameter were detected only by US. Mammography (2 or 3 standard views) was negative in all cases. The lesions detected only by US (10% of all carcinomas) were typified with US-guided needle biopsy and finally confirmed surgically. DISCUSSION AND CONCLUSIONS: Though obtained in a small series, our results seem to suggest that US should be included in the diagnostic work-up, especially of women with dense breast. Also, any hypoechoic lesion detected at breast US in clinically asymptomatic women with negative mammographic findings should be further investigated with US, needle aspiration or core biopsy to make the final diagnosis.     

Witness evidence: can it be trusted?

Basic statistical principles are often widely misunderstood (and often mistrusted) by many members of the public at large. It comes as no shock that this also applies to legal practitioners. If there is an ignorance of the intricacies of statistics by the judiciary and counsel, it is not surprising that erroneous conclusions based on the evidence have arisen. These have even been afforded their own special designation as 'fallacies', including those of both the prosecutor and defence. Whether or not the underlying mathematics is fully understood, it is essential that practitioners can correctly interpret information provided by witnesses, expert or otherwise. This article provides one contribution in that direction toward cases that specifically involve medical situations. It considers some of the more outrageous conclusions made, and accepted, in several high profile cases and considers the evidence more carefully. The challenge is to be able to determine the likelihood that any assertion made is actually true from a statistical point of view. Examples of how to make this determination are provided, including the all-important notion of conditional probability.     

High-resolution sonography of the rib: can fracture and metastasis be differentiated?

OBJECTIVE: Our aim was to evaluate whether high-resolution sonography can provide additional information concerning rib lesions compared with radiography or bone scintigraphy. MATERIALS AND METHODS: Fifty-eight patients with high-uptake rib lesions seen on bone scintigraphy were selected. Radiography and rib high-resolution sonography were performed on these patients. High-resolution sonography was performed using a linear 5-12 MHz transducer. By means of clinical history, histopathologic examination, and follow-up observation, these patients were classified into rib fracture (n = 37), rib metastasis (n = 18), or unknown (n = 3) groups. High-resolution sonography images of the 55 proven cases were reviewed for the presence of five representative findings: cortical disruption, callus formation, cortical deformity, mass, or bone destruction. The frequencies of these findings were compared between the groups with fracture and metastasis. RESULTS: Rib lesions were matched by bone scintigraphy and high-resolution sonography in 53 (96%) of 55 patients and by bone scintigraphy and plain radiography in 23 (42%) of 55 patients. High-resolution sonography revealed 17 (94%) of 18 patients with metastasis and 36 (97%) of 37 patients with rib fractures. Metastatic lesions were seen as mass formation (n = 13) and irregular bone destruction (n = 7) on high-resolution sonography. Fracture was seen as cortical disruption with or without hematoma (n = 17), callus formation (n = 9), or cortical deformity, such as angling or stepping (n = 12). CONCLUSION: High-resolution sonography of the ribs is a useful method of characterizing rib lesions in patients who have hot-uptake lesions on bone scintigraphy.     

Diving reflex: can the time course of heart rate reduction be quantified?

In this meta-analysis of diving bradycardia in humans, we sought to quantify any heart rate (HR) reduction using a relatively simple mathematical function. Using the terms "diving reflex,"diving bradycardia,"diving response,"diving plus heart rate," databases were searched. Data from the studies were fitted using HR=c+aexp(-(t-t(0))/τ), where c is the final HR, a is the HR decrease, τ is the time constant of HR decay, and t(0) is the time delay. Of 890 studies, 220 were given closer scrutiny. Only eight of these provided data obtained under comparable conditions. Apneic facial immersion decreased HR with τ=10.4 s and in air alone it was less pronounced and slower (τ=16.2 s). The exponential function fitted the time course of HR decrease closely (r(2)>0.93). The fit was less adequate for apneic-exercising volunteers. During apnea both with and without face immersion, HR decreases along a monoexponential function with a characteristic time constant. HR decrease during exercise with and without face immersion could not readily be described with a simple function: the parasympathetic reaction was partially offset by some sympathetic activity. Thus, we succeeded in quantifying the early time course of diving bradycardia. It is concluded that the diving reflex is useful to diagnose the integrity of efferent cardiovascular autonomic pathways.     

Criminalizing suicide attempts: can it be a deterrent?

Suicidal behaviour constitutes a serious public as well as mental health problem all over the world. Many developed countries have done away with the legal provision of punishing attempted suicides. However, in India this continues to be a punishable offence under the Indian Penal Code (1833). This review discusses the various issues related to criminalizing suicide and their implications.