Value of sentinel lymph node biopsy in papillary thyroid cancer: initial results of a prospective trial.

The objectives of the study were to evaluate the performance of sentinel lymph node biopsy (SLNB) in detecting occult metastases in papillary thyroid carcinoma (PTC) and to correlate their presence to tumor and patient characteristics. Twenty-three clinically node-negative PTC patients (21 females, mean age 48.4 years) were prospectively enrolled. Patients were submitted to sentinel lymph node (SLN) lymphoscintigraphy prior to total thyroidectomy. Ultrasound-guided peritumoral injections of (99m)Tc-phytate (7.4 MBq) were performed. Cervical single-photon emission computed tomography and computed tomography (SPECT/CT) images were acquired 15 min after radiotracer injection and 2 h prior to surgery. Intra-operatively, SLNs were located with a gamma probe and removed along with non-SLNs located in the same neck compartment. Papillary thyroid carcinoma, SLNs and non-SLNs were submitted to histopathology analysis. Sentinel lymph nodes were located in levels: II in 34.7 % of patients; III in 26 %; IV in 30.4 %; V in 4.3 %; VI in 82.6 % and VII in 4.3 %. Metastases in the SLN were noted in seven patients (30.4 %), in non-SLN in three patients (13.1 %), and in the lateral compartments in 20 % of patients. There were significant associations between lymph node (LN) metastases and the presence of angio-lymphatic invasion (p = 0.04), extra-thyroid extension (p = 0.03) and tumor size (p = 0.003). No correlations were noted among LN metastases and patient age, gender, stimulated thyroglobulin levels, positive surgical margins, aggressive histology and multifocal lesions. Sentinel lymph node biopsy can detect occult metastases in PTC. The risk of a metastatic SLN was associated with extra-thyroid extension, larger tumors and angio-lymphatic invasion. This may help guide future neck dissection, patient surveillance and radioiodine therapy doses.

The onset and duration of mobilization affect the regeneration in the rat muscle.

UNLABELLED: The effects of different mobilization protocols for muscle regeneration after myotoxin injury was compared in the rat tibialis anterior (TA) muscle. Adult Wistar rats were divided into control (C); mobilized (M); injury (I); injury + late mobilization (LM) and injury + early mobilization (EM) groups. Muscle injury was induced by intramuscular lidocaine injection. The exercised animals were mobilized for 5 and 8 days during 15 and 45 minutes/session. The swimming started 1 hour or 3 days after injury. All animals were killed 8 days after the injury, together with the control group, when the TA muscles were weighted and excised. Cross sections were obtained by cryostat and submitted to Toluidine Blue stain. Qualitative morphological characterization of muscle regeneration and quantitative analysis of muscle fiber and non-muscle fiber area density were performed. The I and late mobilization groups showed decreased muscle mass when compared to all other groups. All injured animals showed signs of muscle fiber damage, although signs of early regenerated muscle fibers were more evident in injury + mobilization groups. Only the EM groups submitted to 45 minutes of exercise had increased muscle fiber and decreased non-muscle fiber area density values when compared to I group (p<0.05). CONCLUSION: the regeneration process is related to the onset of exercise, since animals submitted to early mobilization showed improved regeneration when comparted to LM groups. Besides, the length of session is also important for accelerating the regeneration process, as it was observed that 45 minutes was better than 15 minutes duration.

Segmentation of the fibro-glandular disc in mammograms using Gaussian mixture modelling.

The paper presents a technique for the segmentation of the fibro-glandular disc in mammograms based upon a statistical model of breast density. The density function of the model was represented by a mixture of up to four weighted Gaussians, each one corresponding to a specific density class in the breast. The parameters of the model and the number of tissue classes in the breast were determined using the expectation-maximisation algorithm and the minimum description length method. Grey-level statistics of the pectoral muscle were used to determine the tissue categories that are likely to represent the fibro-glandular disc. The method was applied to 84 medio-lateral oblique mammograms from the Mini-MIAS database. The results of the segmented fibro-glandular disc were assessed by a radiologist using the original and the segmented images, with reference to a ranking table categorising the results of segmentation as: 1: excellent; 2: good; 3: average; 4: poor; and 5: complete failure. Of the 84 cases analysed, 64.3% were rated as excellent, 16.7% were rated as good, 10.7% were rated as average, and 4.7% were rated as poor; only 3.6% of the cases were rated as a complete failure with regard to segmentation of the fibro-glandular disc.

Identification of the breast boundary in mammograms using active contour models.

A method for the identification of the breast boundary in mammograms is presented. The method can be used in the preprocessing stage of a system for computer-aided diagnosis (CAD) of breast cancer and also in the reduction of image file size in picture archiving and communication system applications. The method started with modification of the contrast of the original image. A binarisation procedure was then applied to the image, and the chain-code algorithm was used to find an approximate breast contour. Finally, the identification of the true breast boundary was performed by using the approximate contour as the input to an active contour model algorithm specially tailored for this purpose. After demarcation of the breast boundary, all artifacts outside the breast region were eliminated. The method was applied to 84 medio-lateral oblique mammograms from the Mini-MIAS database. Evaluation of the detected breast boundary was performed based upon the percentage of false-positive and false-negative pixels determined by a quantitative comparison between the contours identified by a radiologist and those identified by the proposed method. The average false positive and false negative rates were 0.41% and 0.58%, respectively. The two radiologists who evaluated the results considered the segmentation results to be acceptable for CAD purposes.

Automatic identification of the pectoral muscle in mammograms.

The pectoral muscle represents a predominant density region in most medio-lateral oblique (MLO) views of mammograms; its inclusion can affect the results of intensity-based image processing methods or bias procedures in the detection of breast cancer. Local analysis of the pectoral muscle may be used to identify the presence of abnormal axillary lymph nodes, which may be the only manifestation of occult breast carcinoma. We propose a new method for the identification of the pectoral muscle in MLO mammograms based upon a multiresolution technique using Gabor wavelets. This new method overcomes the limitation of the straight-line representation considered in our initial investigation using the Hough transform. The method starts by convolving a group of Gabor filters, specially designed for enhancing the pectoral muscle edge, with the region of interest containing the pectoral muscle. After computing the magnitude and phase images using a vector-summation procedure, the magnitude value of each pixel is propagated in the direction of the phase. The resulting image is then used to detect the relevant edges. Finally, a post-processing stage is used to find the true pectoral muscle edge. The method was applied to 84 MLO mammograms from the Mini-MIAS (Mammographic Image Analysis Society, London, U.K.) database. Evaluation of the pectoral muscle edge detected in the mammograms was performed based upon the percentage of false-positive (FP) and false-negative (FN) pixels determined by comparison between the numbers of pixels enclosed in the regions delimited by the edges identified by a radiologist and by the proposed method. The average FP and FN rates were, respectively, 0.58% and 5.77%. Furthermore, the results of the Gabor-filter-based method indicated low Hausdorff distances with respect to the hand-drawn pectoral muscle edges, with the mean and standard deviation being 3.84 +/- 1.73 mm over 84 images.

Analysis of asymmetry in mammograms via directional filtering with Gabor wavelets.

This paper presents a procedure for the analysis of left-right (bilateral) asymmetry in mammograms. The procedure is based upon the detection of linear directional components by using a multiresolution representation based upon Gabor wavelets. A particular wavelet scheme with two-dimensional Gabor filters as elementary functions with varying tuning frequency and orientation, specifically designed in order to reduce the redundancy in the wavelet-based representation, is applied to the given image. The filter responses for different scales and orientation are analyzed by using the Karhunen-Loève (KL) transform and Otsu's method of thresholding. The KL transform is applied to select the principal components of the filter responses, preserving only the most relevant directional elements appearing at all scales. The selected principal components, thresholded by using Otsu's method, are used to obtain the magnitude and phase of the directional components of the image. Rose diagrams computed from the phase images and statistical measures computed thereof are used for quantitative and qualitative analysis of the oriented patterns. A total of 80 images from 20 normal cases, 14 asymmetric cases, and six architectural distortion cases from the Mini-MIAS (Mammographic Image Analysis Society, London, U.K.) database were used to evaluate the scheme using the leave-one-out methodology. Average classification accuracy rates of up to 74.4% were achieved.