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Objetivo: Revisar la correlación radiopatológica de las lesiones de potencial maligno incierto (B3) de nuestra institución, evaluar la conducta y establecer el porcentaje de subestimación en relación a las lesiones tratadas quirúrgicamente. Material y método: Estudio retrospectivo de la base de datos de procedimientos intervencionistas efectuados en el servicio de diagnóstico por imágenes del Instituto Alexander Fleming entre mayo de 2016 y diciembre de 2019 inclusive. Se incluyeron las pacientes con resultado histológico en la biopsia percutánea de uno o más de los siguientes diagnósticos: atipia epitelial plana (AEP), cicatriz radiada/lesión esclerosante compleja (CR), hiperplasia ductal atípica (HDA), neoplasia lobular clásica (NL), lesión papilar (LP) o tumor phyllodes (TP). Resultados: De 67 pacientes analizadas, el 43.3% se manifestaron en los estudios por imágenes con nódulos y en un 37.3% con microcalcificaciones agrupadas. La LP fue la lesión B3 más frecuente en un 44.8% seguido por la AEP en un 16.4%. El 98.5% de las pacientes presentó adecuada concordancia radiopatológica. Fueron sometidas a cirugía 48 pacientes, las 19 pacientes restantes continuaron con seguimiento clínico radiológico. La anatomía patológica de la pieza quirúrgica reflejó que en un 33.3% hubo subestimación en relación a la biopsia; en más de la mitad de los casos correspondieron a CDIS. Conclusiones: El porcentaje de subestimación con resultado final de CDIS o CDI de bajo grado se encontró dentro de los parámetros hallados en la literatura. Si bien logramos reducir la tasa de cirugías al 71% de pacientes con lesiones B3, una adecuada selección para efectuar exéresis con aguja por sistema de vacío podría reducir aún más el número de cirugías innecesarias y probablemente la tasa de subestimación.
Objective: To review the radiopathological correlation of lesions of uncertain malignant potential (B3) diagnosed in our institution, as well as to evaluate the therapeutic conduct and to establish the percentage of underestimation of the excised lesions. Material and method: This work consists of a retrospective study of the database which in- cludes the interventional procedures performed in the Imaging Department of the Alexander Fleming Institute between May 2016 and December 2019. Patients with a histological outcome in the percutaneous biopsy of one or more of the following diagnosis were included: flat epithelial atypia (FEA), radial scar (RS) /complex sclerosing lesion (CSL), atypical ductal hyperplasia (ADH), classic lobular neo- plasia (LN), papillary lesión (PL) or phyllodes tumor (PT). Results: Out of the 67 analyzed patients, 43.3% were perceived as nodules at imaging examinations and 37.3% as grouped microcalcifications. Papillary lesion was the most frequently diagnosed B3 lesion (44.8%), followed by flat epithelial atypia (16.4%). 98.5% of patients presented an accurate imaging-pathology concordance. 48 patients underwent surgery and the remaining 19 patients continued with clinical and radiological follow-up. The histopathology of the surgical specimen reflected that in 33.3% of the cases there was an underestimation in relation to the percutaneous biopsy; in over half of these cases they corresponded with DCIS. Conclusions: The percentage of underestimation with final diagnosis of DCIS or low grade IDC coincided with the parameters found in current literature. Even though we were able to reduce the surgical rate to 71% of patients with B3 lesions, a proper selection of cases which could be candidates for vacuum assisted excisional biopsy could further reduce the number of unnecessary surgeries and probably the un- derestimation rate as well.
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Female , Neoplasms , Biopsy , Diagnostic ImagingABSTRACT
Objective The aim is to understand the underestimation of body weight status and its associated factors among overweight and obese adults in China. Methods Nationally representative data were collected in 2013 by the China Chronic Disease and Risk Factor Surveillance which used a multistage stratified cluster sampling method. A total of 87 552 overweight and obese adults aged ≥18 years old were included. Demographic characteristics, weight perception and disease status were obtained from in-person interviews. Height, weight and blood pressure were measured through physical examination. Venous blood samples were obtained and assayed for fasting plasma glucose, 2-hour oral glucose tolerance test, total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Complex sampling was weighted and multiple logistic regression models were used for analyzing. Results Among overweight and obese adults, 74.7% (95% CI: 73.3%-76.1%) underestimated their weight status. The mild underestimation rate was 60.7% (59.6%-61.7%) while the severe was 14.0% (13.1%-14.9%). The aged, low education level, low annual income, rural area and obesity were risk factors for both weight status underestimation and severe underestimation (all P<0.05). Awareness of having hypertension and dyslipidemia were protective factors (all P<0.05). Conclusions Most overweight and obese adults in China underestimated their own weight status, which was affected by age, education and income level, awareness of having chronic diseases and other factors. Targeted interventions should be carried out for different characteristic groups.
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Objective To analyze the risk factors of underestimation from core needle biopsy (CNB) diagnosed ductal carcinoma in situ (DCIS) to invasive cancer after surgical excision.Methods One hundred and fifteen cases of CNB diagnosed DCIS treated in Obstetrics and Gynecology Hospital,Fudan University from Jan.,2010 to Dec.,2016 were analyzed retrospectively.According to postoperative pathological conditions,the cases were divided into underestimation group and non underestimation group.The clinicopathological characteristics of two groups were compared,including age,palpability,tumor diameter,microcalcification,BI-RADS classification and CNB method.Results The overall underestimating rate was 27.0％ (31/115).Univariate analysis found correlation between a palpable lesion,diameter of tumor ＞20 mm,microcalcification,a high BI-RADS classification,use of the 14/16-gauge needle method and underestimation from CNB diagnosed DCIS.Multivariate analysis by Logistic regression showed that diameter of tumor ＞20 mm (OR =0.186,95％CI:0.043-0.810,P =0.025),microcalcification (OR=0.229,95％CI:0.070-0.749,P =0.015),use of the 14/16 gauge needle method (OR =0.171,95 ％ CI:0.043-0.679,P =0.012) were independent risk factors of underestimation from CNB diagnosed DCIS.Conclusions Size of lesion ＞20 mm,microcalcification,use of the 14/16-gauge needle method were independent risk factors of underestimation from CNB diagnosed DCIS.
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PURPOSE: PET/CT is useful in preoperative evaluation of invasive breast cancer (IBC) to predict axillary metastasis and staging workup. The usefulness is unclear in cases of ductal carcinoma in situ (DCIS) diagnosed at biopsy before surgery, which sometimes is upgraded to IBC after definitive surgery. The aim of this study is to find out the usefulness of PET/CT on DCIS as a preoperative evaluation tool. METHODS: We investigated 102 patients preoperatively diagnosed with DCIS who subsequently underwent definitive surgery between 2010 and 2015. The uptake of 18F-fluorodeoxyglucose was graded by visual and semiquantitative methods. We analyzed the maximum standardized uptake value (SUVmax) of each patient with clinicopathologic variables. We determined optimal cutoff values for SUVmax by receiver operating characteristic curve analysis. RESULTS: Fifteen cases out of 102 cases (14.7%) were upgraded to IBC after surgery. The SUVmax was higher in patients upgraded to IBC (mean: 2.56 vs. 1.36) (P = 0.007). The SUVmax was significantly higher in patients who had symptoms, palpable masses, lesions over 2 cm in size and BI-RAD category 5. Both visual and semiquantitative analysis were significant predictors of IBC underestimation. SUVmax of 2.65 was the theoretical cutoff value in ROC curve analysis in predicting the underestimation of IBC. The underestimation rate was significantly higher in patients with SUVmax >2.65 (P < 0.001), over the moderate enhanced uptake on visual analysis (P < 0.001). CONCLUSION: PET/CT can be used as a complementary evaluation tool to predict the underestimation of DCIS combined with the lesion size, palpable mass, symptomatic lesion, and BI-RAD category.
Subject(s)
Humans , Biopsy , Breast Neoplasms , Carcinoma, Ductal , Carcinoma, Intraductal, Noninfiltrating , Neoplasm Metastasis , Positron Emission Tomography Computed Tomography , ROC CurveABSTRACT
Objectives To calculate the rate of pathological underestimation for core needle biopsy (CNB)- diagnosed intraductal papillary tumors, to analyze the clinical and imaging data of patients and to dis-cuss factors for underestimation. Methods A retrospective analysis of patients undergoing core needle biopsy and subsequent surgical excision was performed. 1359 female patients undergoing CNB from Jan. 2010 to Feb. 2013 in Comprehensive Breast Health Center of Ruijin hospital were analyzed. Clinical, radiological and histo-logical variables were assessed using the Chi-square test, Fisher’s exact test and a binary logistic regression model in order to predict pathological underestimation for tumors. Results There were 50 patients with CNB-di-agnosed intraductal papillary tumors. The overall underestimation rate was about 44%(22/50). CNB-diagnosed atypical papillary lesions (OR=15.164, 95% CI 1.49-170.443) and BI-RADS 5 by MRI (OR=26.766, 95% CI 2.409-297.440)were significantly related to underestimation in these patients. Conclusions Considering the high underestimation rate in CNB-diagnosed intraductal papillary tumors, routine surgical excision should be per-formed to avoid potential malignancy, especially for patients with high risk factors. MRI is helpful in these pa-tients to predict underestimation.
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Background: Various factors contribute to the discrepancies observed between the bromocresol green (BCG) and bromocresol purple (BCP) assays of serum concentration. Either a BCG or a modified BCP assay is a routine laboratory for albumin measurement in Japan. High-dose of penicillin G underestimates serum albumin level using a modified BCP method in vitro. Therefore, we examined the serum albumin level in the patients treated with high-dose of penicillin G and also performed the experiments on coincubation with plasma, or albumin product and penicillin G solution in vitro. Methods: The medical records of 71 patients treated with high-dose of Penicillin G collected between 2009 and 2012 were reviewed for age, gender, biochemistry (total protein, albumin and potassium), underlying diseases and usage of albumin product. Patients were divided into 2 groups: BCG group (N = 38) and a modified BCP group (N = 33). We compared serum albumin levels between two groups. We performed the experiments on co-incubation with albumin product or human plasma and penicillin G solution in vitro. Results: Serum albumin levels using a modified BCP assay decreased during the treatment with high dose penicillin G (-0.4 ± 0.1 g/dL), while serum albumin levels by a BCG method did not decrease (0.06 ± 0.05 g/dL). Although only one patient revealed hypoalbuminemia (<2.0 g/dL) by a BCG method (2.6%), ten patients revealed hypoalbuminemia by a modified BCP method (33%). Penicillin G underestimated plasma albumin levels using a modified BCP methods (% underestimation: 42.9 ± 0.0%) more than those using a BCG method (% underestimation: 10.6 ± 0.0%) in co-incubation experiments in vitro. Conclusion: High-dose of penicillin G might cause the underestimation of serum albumin levels using bromocresol dye-binding methods.
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PURPOSE: The goal of this study was to examine body image satisfaction and perception according to weight status, and to investigate those associations with dietary habits and nutritional status among preadolescent children. METHODS: Body image and dietary habits and intake were assessed in 134 elementary school students in grade 4. Children were categorized according to normal and overweight or obese groups. Figure rating scales were used to assess body image perception (identification of perceived current body size) and dissatisfaction (difference between perceived current body size and ideal body image). RESULTS: There were sex differences in body image perceptions. Normal-weight girls, overweight or obese girls and boys were more likely to desire a leaner body size than their perceived body size compared with normal-weight boys. Body image satisfaction and perception showed an association with weight status. More overweight or obese children indicated dissatisfaction or underestimation of body image than normal-weight children. Children with body image dissatisfaction due to heavier perceived body size than ideal body image showed lower frequencies of consumption of meals and vegetables, compared to those who were satisfied with their body image. Children who underestimated their body image were more likely to have a lower frequency of breakfast and meal regularity and a higher frequency of eating out of home or food deliveries than those with accurate body image perception. In addition, body image underestimation showed an association with lower intakes of protein, dietary fiber and calcium, and the higher percentage of calories derived from fat. CONCLUSION: Body image dissatisfaction as well as underestimation in children before puberty showed an association with overweight or obesity, and was also related to unhealthy dietary habits. These findings highlight the importance of accurate perception and satisfaction with body image in preadolescent children in order to prevent development of obesity in adolescents and adults.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Body Image , Body Mass Index , Body Size , Breakfast , Calcium , Dietary Proteins , Eating , Feeding Behavior , Meals , Nutritional Status , Obesity , Overweight , Puberty , Sex Characteristics , Vegetables , Weights and MeasuresABSTRACT
OBJECTIVE: To investigate roles of dynamic contrast enhanced magnetic resonance (DCE MR) and diffusion-weighted (DW) imaging in preoperative prediction of underestimation of ductal carcinoma in situ (DCIS)> or =2cm on US guided core needle biopsy. MATERIALS AND METHODS: Twenty two patients with DCIS on US-guided 14 gauge core needle biopsy were included. Patients were divided into a group with and without DCIS underestimation based on histopathology. MR images including DCE and DW imaging were obtained with a 3.0-T MR. The lesion type (mass or non-mass), enhancement pattern, peak enhancement, and apparent diffusion coefficient (ADC) values of proven malignant masses were generated using software of CADstream and compared between two groups using Fisher's exact test and Mann Whitney test. RESULTS: Eight patients were in the group with underestimation and 14 patients were in the group without underestimation. The lesion type and enhancement pattern were not different between two groups (P values = 1.000 and 0.613, respectively). The median peak enhancement of lesions with underestimation was 159.5%, higher than 133.5% of those without underestimation, but not significant (P value = 0.413). The median ADC value of lesions with underestimation was 1.26x10(-3) mm2/sec, substantially lower than 1.35x10(-3) mm2/sec of those without underestimation (P value = 0.094). CONCLUSION: ADC values had the potential to preoperatively predict DCIS underestimation on US-guided core needle biopsy, although a large prospective series study should be conducted to confirm these results.