Diagnostic accuracy of sonoelastography in the non-invasive diagnosis of malignant breast cancer compared to histopathology as a gold standard

Objective: To observe the diagnostic accuracy of elastography in detecting malignant breast lesion taking strain ratio of 4.8 and histopathology as gold standard

Study Design: Descriptive cross-sectional study

Place and Duration of Study: Department of Diagnostic Radiology, from March to September 2015

Methodology: A total of 137 patients aged 20 to 60 years with clinically palpable breast lump of any size for at least one month duration were included in this study. Patients with purely cystic lesions and those on chemotherapy or hormonal therapy were excluded. Each patient was subjected to sonoelastography followed by ultrasound guided trucut biopsy. The strain ratio cut off value of 4.8 was used to differentiate benign from malignant lesion. Consultant histopathologist's report upon the biopsy specimens was obtained. Results of sonoelastography were compared with histopathology reports

Results: Mean age was 38.20 +/- 10.63 years. The size of the lesion ranged from 2.0 to 6.0 cm, a mean = 3.97 +/- 1.26 cm. The duration since the lump was noticed ranged from 12 weeks [3 months] to 20 weeks [5 months] with a mean of 15.09 +/- 2.56 weeks. Forty-one [29.9%] lesions were labelled malignant on sonoelastography while the actual number of malignant lesions was 35 [25.5%] on histopathology. When the results of sonoelastography were cross-tabulated with histopathology results, the number of TP [true positive], FN [false negative], FP [false positive] and TN [True negative] were 31, 4, 10 and 92 cases, respectively. It yielded 88.57% sensitivity, 90.20% specificity, 75.61% positive predictive value, 95.83% negative predictive value, 89.78% accuracy for sonoelastography in the diagnosis of malignant breast lesion taking histopathology as gold standard with an observed prevalence of malignant breast mass to be 25.55%

Conclusion: Using a strain ratio of 4.8, sonoelastography was found to be 88.57% sensitive, 90.20% specific, and 89.78% accurate in the diagnosis of malignant breast masses

efficacy of steroids in the treatment of bronchiolitis

To determine the efficacy of steroids in the treatment of bronchiolitis. Study Design: Randomised Controlled Trial [RCT]. The Department of Paediatrics, Military Hospital, Rawalpindi and the Department of Paediatrics, PNS Shifa Hospital, Karachi for six months, from Feb 2006 to Aug 2006. Ninety patients of bronchiolitis were sampled and randomly divided into three groups. Each group was given the same treatment protocol differing only in the steroid given [Group I - intravenous Hydrocortisone, Group II - nebulised Beclomethasone, Group III - no steroids]. Data was compiled by means of a proforma. Outcomes were length of hospital stay [LOS], difference in clinical respiratory score [R], and time to become wheeze free [W]. Mean LOS was lowest in Group II [p = 0.259]. The mean duration to become wheeze free [W] was also lowest in Group II [p= 0.40]. The biggest improvement in Respiratory Distress Assessment Instrument [RDAI] score at admission and discharge [R] was in Group I and least improvement in Group II [p=0.056]. Corticosteroids are not significantly effective in reducing length of hospital stay, duration of wheezing and improvement in clinical severity. However, inhaled steroids may possibly have a potential advantage over parenteral steroids

Hallervorden spatz disease

Hallervorden-Spatz disease is an extremely rare cause of dystonia that carries a poor prognosis. A case occurring in an 11-yearold girl with progressive extra-pyramidal symptoms since infancy is described. The clinical picture and typical radiological findings are described