Prevalence and pattern of basal skull fracture in head injury patients in an academic hospital

Background: Basal skull fractures (BSFs) have been reported to be a major cause of morbidity and mortality in the literature, particularly in young male patients. However, there are limited data available on the aetiology, prevalence and patterns of such observed in South Africa. Objectives: To evaluate the prevalence and pattern of BSF in head injury patients referred to Dr George Mukhari Academic Hospital, Gauteng, South Africa. Methods: Patients of all ages with head injuries were considered for the study, and those who met the inclusion criteria were scanned using a 128-slice multidetector helical computed tomography (CT) machine after obtaining consent. Data were prospectively obtained over a 6-month period, interpreted on an advanced workstation by two readers and statistically analysed. Results: The prevalence of BSF in this study was found to be 15.2%. The majority of patients (80.5%) were under 40 years old, with a male to female ratio of 3:1. The most common aetiology of BSF was assault, which accounted for 46% of cases. The middle cranial fossa was the most frequently fractured compartment, while the petrous bone was the most commonly fractured bone. There was a statistically significant association between head injury severity and BSF, and between the number of fracture lines and associated signs of BSF (p < 0.001). The sensitivity of clinical signs in predicting BSF was 31%, while specificity was 89.3% (p = 0.004). Conclusion: The prevalence and pattern of BSF found were consistent with data from previously published studies, although, dissimilarly, assault was found to be the most common aetiology in this study

Measuring breast density: Comparing computer-automated breast density quantification with an observer-based method in a South African academic context

Background: Dense breast tissue may not only 'mask' small, non-calcified cancers but also represents an independent risk factor for the development of breast cancer. Computer-automated breast density quantification (CABD) software tools have been developed for the calculation of volumetric breast density. Objectives: This study sought: (1) to compare observer-based breast density scores, using the fifth edition of the Breast Imaging Reporting and Data System (BI-RADS), with the breast density scores calculated using CABD quantification software tools, (2) to determine inter-reader variability in breast density scoring between qualified radiologists, between radiologists in training (registrars) and between these two groups and (3) to determine intra-reader reliability in breast density scoring. Methods: A cross-sectional study was performed using the data of 100 patients (200 breasts). Three qualified radiologists and three registrars were asked to review the mammograms in question and to assign a breast density score according to the fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) reporting system. Two readings took place at a minimum of 30 days apart. The percentage agreement between the automated and observer-based scores was calculated and intra-reader and inter-reader reliability values were determined. Results: The study found that there was poor agreement between the breast densities calculated by CABD and the more subjective observer-based BI-RADS density scores. These results further reflect a statistically significant degree of inter-reader and intra-reader variability in the evaluation of breast density. Conclusion: We conclude that the use of automated breast density quantification (i.e. CABD) is a valuable tool for the reduction of variability in breast density ratings

Human immunodeficiency virus infection in breast cancer patients: The prevalence thereof and its effect on breast cancer characteristics at Dr. George Mukhari Academic Hospital Breast Clinic, Ga-Rankuwa, South Africa

Background: Since the advent of highly active anti-retroviral therapy, improved immune functioning and prolonged survival of Human immunodeficiency virus (HIV)-positive patients has been accompanied by an increased incidence of non-AIDS-defining cancers (NADC). Breast cancer is the most prevalent NADC among HIV-positive women. However, data regarding the interaction between these two diagnoses remain limited. Objectives: To determine the effect of HIV status on the presentation of breast cancer patients at Dr. George Mukhari Academic Hospital (DGMAH). Methods: The age, gender, HIV status, CD4 count and tumour node metastases stage at presentation were recorded from the files of patients with histologically proven breast carcinoma, who had presented to the breast clinic at DGMAH from 01 January 2013 to 30 November 2017. Histological subtypes and molecular markers were retrieved from the National Health Laboratory Service. Prevalence of HIV among breast cancer patients was calculated. Cross-tabulations compared the variables between HIV-positive and HIV-negative groups. Statistical significance was assessed using Fisher's Exact Test. Results: HIV status was determined in 129 breast cancer patients. Eighty (62.02%) were HIV-negative and 49 (37.98%) were HIV-positive. All patients were female. The mean age at presentation with breast cancer in the HIV-positive group was approximately 10 years younger, compared to the entire population and to the HIV-negative group (p < 0.0001). No further statistically significant associations were observed concerning HIV status and other variables. Conclusion: HIV-positive women present with breast cancer at a significantly younger mean age. Breast cancer screening protocols may need to be adjusted accordingly in such patients

Magnetic resonance imaging of fibroadenoma-like lesions and correlation with Breast Imaging-Reporting and Data System and Kaiser scoring system

Background: Multiple breast lesions resembling fibroadenomas are a common imaging finding in patients presenting to the mammography unit at Dr George Mukhari Academic Hospital in the North-West district of Tshwane, South Africa. Patients often present with multiple lesions, up to 20 lesions per breast. These lesions often have atypical features on ultrasound and/or a clinical history of growth is commonly given. Phyllodes tumours may be indistinguishable from fibroadenomas and breast cancers may on occasion present with benign features, which can lead to misdiagnosis. Breast magnetic resonance imaging (bMRI) evaluation of lesions resembling fibroadenomas may improve accurate assessment and identification of lesions requiring biopsy. Objectives: To assess the reliability of bMRI to characterise lesions resembling fibroadenomas on ultrasound, using the Breast Imaging-Reporting and Data System (BI-RADS) and Kaiser scoring systems with histopathological correlation. Method: A quantitative, prospective, investigative study was performed with a sample size of 100 breast lesions among a total of 35 patients at Dr George Mukhari Academic Hospital. Patients were recruited after a breast ultrasound investigation revealed lesions resembling fibroadenomas, but with an indication for ultrasound-guided biopsy, for example, very large size, atypical features on ultrasound or a history of recent growth. The bMRI was performed prior to the ultrasound-guided breast biopsies. Three investigators independently evaluated the bMRI and applied BI-RADS descriptors to each lesion. The Kaiser score was then calculated for each lesion. Statistics were calculated using Pearson's and Spearman's coefficients for inter-reader variability, kappa scores for BI-RADS and Kaiser score correlation with histology. Results: Evaluation with bMRI, BI-RADS and the Kaiser scoring system showed statistically significant correlation with each other and with histopathology results for each lesion. There was statistically significant agreement among the investigators regarding the interpretation of the lesions and allocation of appropriate BI-RADS scores. Conclusion: Multiple lesions resembling fibroadenomas can be evaluated with bMRI when multiple breast biopsies would not be feasible. With a good imaging protocol and technique, adequate interpretation skills by the radiologist and the use of the Kaiser scoring system, an accurate diagnosis can be achieved