Positive Predictive Value of Sonographic BI-RADS Final Assessment Categories for Breast Lesions

@#Introduction: We want to evaluate the sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of BI-RADS ultrasound, as well as PPV and NPV of BI-RADS ultrasound lexicon. Methods: A total of 517 ultrasound-guided breast biopsy cases were performed within three years. A total of 324 cases remained after 193 cases were excluded from this study. The sensitivity, specificity, accuracy, PPV and NPV of overall BI-RADS and PPV for each BI-RADS categories were calculated from the data when compared with histopathological examination (HPE) finding. One observer evaluated four criteria of BI-RADS ultrasound lexicon; margin, echogenicity, posterior artefact and internal echo from static sonographic images to determine the PPV and NPV of sonographic BI-RADS lexicon based on HPE correlation. Results: There were 236 (72.8%) benign and 88 (27.1%) malignant lesions. The overall BI-RADS has a sensitivity of 93.18%, specificity of 66.95%, accuracy of 74.07% with PPV and NPV of 51.25% and 96.34% respectively. The PPV of each BI-RADS categories were; BI-RADS 2 (9.09%), BI-RADS 3 (3.27%), BI-RADS 4 (39.02%) and BI-RADS 5 (91.89%). The highest predictive value for malignancy was irregular margin (52.3%) and for benign was well-defined margin (89.7%). Criteria for margin and posterior artefact had a significant association with HPE (p<0.0001) in differentiating between malignant and benign breast lesions in breast ultrasound. Conclusion: Overlapping benign and malignant sonographic breast lesion descriptors tend to influence radiologist’s decision to overcall final BI-RADS categories. The margin and posterior artefact are the important criteria in BI-RADS lexicon in differentiating benign and malignant breast lesion.

Comparison on the use of semi-automated and automated core biopsy needle in ultrasound guided breast biopsy

Objective: The aim of this study was to compare the use of semi-automated (Medax Velox 2; Poggio Rusco, Italy) and automated (Bard Magnum Biopsy Instrument; Covington, GA, USA) core biopsy needles, for ultrasound guided breast biopsy. Materials and Methods: A 14G semi-automatic spring loaded core biopsy needle with a 22-mm-throw (Medax Velox 2; Poggio Rusco, Italy) and 14-gauge automated needle device with a 22-mm-throw biopsy gun (Bard-Magnum Biopsy Instrument, Covington, GA, USA) were used for breast biopsies under ultrasound guidance on alternate months during the study period between July 2009 and May 2011. One hundred and sixty lesions were biopsied and specimens were sent for histological evaluation. Results: The automated needle obtained a higher number of histology reports at 84% (67/80) as compared with the semiautomated needle at 60% (48/80) (Fisher exact test, p value=0.023). Inadequate samples with the automated needle were much less at 9% (7/60) than with the semiautomated needle at 23% (18/60) (Fisher exact test, p value=0.028). The semi-automated needle showed slightly less fragmented samples. However, the number of fragmented samples with definitive diagnosis was slightly higher with the automated compared with the semiautomated needle, at 16% (13/80) and 13% (10/80) respectively. Compared with histology of 29 lesions that were excised, the semi-automated needle had higher sensitivity (100%) but lower specificity (75%) and accuracy (90%) compared with the automated needle (88% sensitivity, 100% specificity, 95% accuracy). Conclusion: Definitive diagnosis from the study samples slightly favours the use of automated core biopsy needle as compared to semi-automated core biopsy needle.

Role of high resolution ultrasound in ulnar nerve neuropathy

SUMMARY Aim: This study was conducted to measure the cross sectional area (CSA) of the ulnar nerve (UN) in the cubital tunnel and to evaluate the role of high-resolution ultrasonography in the diagnosis of ulnar nerve neuropathy (UNN). Materials and Methods This was a cross sectional study with 64 arms from 32 patients (34 neuropathic, 30 nonneuropathic). Diagnosis was confirmed by nerve conduction study and electromyography. The ulnar nerves were evaluated with 15MHz small footprint linear array transducer. The ulnar nerve CSA was measured at three levels with arm extended: at medial epicondyle (ME), 5cm proximal and 5cm distal to ME. Results from the neuropathic and nonneuropathic arms were compared. Independent T-tests and Pearson correlation tests were used. P value of less than 0.05 was considered significant. Results: Mean CSA values for the UN at levels 5cm proximal to ME, ME and 5cm distal to ME were 0.055, 0.109, 0.045 cm2 respectively in the neuropathic group and 0.049, 0.075, 0.042 cm2 respectively in the non-neuropathic group. The CSA of the UN at the ME level was significantly larger in the neuropathic group, with p value of 0.005. However, there was no statistical difference between the groups at 5cm proximal and distal to the ME, with p values of 0.10 and 0.35 respectively. Conclusion: There is significant difference in CSA values of the UN at ME between the neuropathic and non-neuropathic groups with mean CSA value above the predetermined 0.10cm2 cut-off point. High-resolution ultrasonography is therefore useful to diagnose and follow up cases of elbow UNN.

Lymphocytic Mastitis Mimicking Breast Carcinoma, Radiology and Pathology Correlation: Review of Two Cases

Lymphocytic mastitis, or diabetic mastopathy, is an unusual finding in early-onset and long-standing diabetes. It can presents as a non-tender or tender palpable breast mass. Mammogram and ultrasound frequently demonstrate findings suspicious of malignancy, thus biopsy and histological confirmation is usually required. We reviewed two cases of lymphocytic mastitis with characteristics findings on mammogram, ultrasound, and histopathology. Diagnoses were confirmed with excision biopsy.