Differentiation of Malignancy and Idiopathic Granulomatous Mastitis Presenting as Non-mass Lesions on MRI: Radiological, Clinical, Radiomics, and Clinical-Radiomics Models.

RATIONALE AND OBJECTIVES: To investigate the effectiveness of machine learning-based clinical, radiomics, and combined models in differentiating idiopathic granulomatous mastitis (IGM) from malignancy, both presenting as non-mass enhancement (NME) lesions on magnetic resonance imaging (MRI), and to compare these models with radiological evaluation. MATERIAL AND METHODS: A total of 178 patients (69 IGM and 109 breast cancer patients) with NME on breast MRI evaluated between March 2018 and April 2022, were included in this two-center study. Age, skin changes, presence of fistula, and abscess were recorded from hospital records. Two experienced radiologists evaluated MRI images according to the breast imaging reporting and data system 2013 lexicon. Lesions were segmented independently on T2-weighted, apparent diffusion coefficient, and post-contrast-T1-weighted sequences. Data were split into training and external testing sets. Machine learning models were built using Light GBM (light gradient-boosting machine). Radiological, clinical, radiomics, and clinical-radiomics models were created and compared. Decision curve analysis was performed. Quality of reporting and that of methodology were evaluated using CLEAR and METRICS tools. RESULTS: IGM group was younger (p = 0.014). Abscesses (p < 0.001), fistulas (p < 0.001), and skin changes (p < 0.001) were significantly more common in the IGM group. No significant difference was detected in terms of lesion size (p = 0.213). In the evaluation of NME, the lowest performance belonged to the radiologists' evaluation (AUC for training, 0.740; for testing, 0.737), while the highest AUC was achieved by the model developed by combined clinical and radiomics features (AUC for training, 0.979; for testing, 0.942). CONCLUSION: Our study has shown that the machine learning-based clinical-radiomics model might have the potential to accurately discriminate IGM and malignant lesions in evaluating NME areas.

Preoperative Role of Superb Microvascular Imaging and Shear-Wave Elastography for Prediction of Axillary Lymph Node Metastasis in Patients With Breast Cancer.

ABSTRACT: This study aims to evaluate the role of shearwave elastography (SWE) and superb microvascular imaging (SMI) for preoperative prediction of axillary lymph node metastasis (ALNM) in patients with breast cancer. In a cohort of 214 women with breast cancer, B-Mode ultrasonography (US), SMIvascular-index (SMIvi), and SWE (E-mean, E-ratio) values were recorded before tru-cut biopsy. Axillary fine-needle aspiration biopsy (FNAB) and sentinel lymph node sampling results were collected. Imaging findings and histopathological data were statistically compared. Receiver operating characteristic curve analysis was used to evaluate diagnostic performance. Reverse stepwise logistical regression analysis was conducted. Although ALNM was negative in 111 cases, it was positive in 103 patients. Axillary lymph node metastasis (+) group had larger size (P < 0.001), higher vascularization (SMIvi: 8.0 ± 6.0 versus 5.0 ± 4.3, P < 0.001), and higher elasticity value (E-mean: 129 ± 31 kPa versus 117.3 ± 40 kPa, P = 0.014). Axillary lymph node metastasis was observed statistically more frequently in Her-2 positive cases (P = 0.005). There was no significant difference between other B-mode US findings (P > 0.05), SMI Adler (P = 0.878), and E-ratio (P = 0.212). The most appropriate cutoff value for the prediction of ALNM was 23.5 mm for size, 3.8 for SMIvi, and 138.5 kPa for E-mean. The most sensitive (77%) method was the SMIvi measurement, while the most specific (86%) finding was Her-2 positivity. The combined model (being Her-2 positive, >23.5 cm, and >3.8 SMIvi) increased the specificity (78%), PPV (71%), and accuracy (68%). Although the increased size is a previously studied parameter in predicting the risk of ALNM, Her-2 and data obtained by SWE, and SMI can be used to assist conventional US.

The Diagnostic Role of Shear Wave Elastography and Superb Microvascular Imaging in the Evaluation of Suspicious Microcalcifications.

OBJECTIVES: The aim of this study was to investigate the role of superb microvascular imaging (SMI) and shear wave elastography (SWE) in the prediction of malignancy and invasiveness of isolated microcalcifications (MC) that can be visualized by ultrasonography (US). MATERIAL AND METHODS: Sixty-seven women with MC, who were considered suspicious on mammography were evaluated. Only those lesions that could be visualized by US and presented as non-mass lesion were included. They were evaluated by B-mode US, SMI, and SWE before US-guided core-needle biopsy. B-mode US, SMI (vascular index (SMIvi)), and SWE (E-mean, E-ratio) findings were compared with histopathologic features. RESULTS: Pathology confirmed 45 malignant (21 invasive and 24 in situ carcinomas) and 22 benign lesions. There was a statistically significant difference between malignant and benign groups in terms of size (P = .015), distortion (P = .028), cystic component (P < .001), E-mean (P < .001), E-ratio (P < .001), and SMIvi (P = .006). For differentiation of invasiveness E-mean (P = .002), E-ratio (P = .002), and SMIvi (P = .030) were statistically significant. According to ROC analysis E-mean (cut-off point at 38 kPa) was the most sensitive (78%) and the most specific (95%) value among four numeric parameters (size, SMI, E-mean, and E-ratio) with AUC = 0.895, PPV = 97%, and NPV = 68% in detecting malignancy. In the evaluation of invasiveness, the most sensitive (71.4%) method was SMI (cut-off point at 3.4) and the most specific (72%) method was E-mean (cut-off point at 91.5 kPa). CONCLUSION: Our study shows that adding SWE and SMI to the sonographic evaluation of MC would be an advantage for US-guided biopsy. Including suspicious areas according to SMI and SWE in the sampling area can help target the invasive part of the lesion and avoid underestimation of core biopsy.

Comparing the Efficiency of Imaging Modalities in Detection of Recurrent Breast Cancer.

Objective: To investigate the effectiveness of the different imaging modalities in detecting recurrence in breast cancer follow-up. Materials and Methods: Sixty-four women with recurrent breast cancer were examined between January 2020 and July 2022. Recurrency was divided into four categories: local; regional; second primary; and distant metastasis. The detectability of recurrent lesions with mammography (MG), ultrasound (US) and magnetic resonance imaging (MRI), was evaluated. In addition, recurrences that firstly appeared by positron emission tomography (PET) scan were recorded. Results: Twenty-seven (42.2%) recurrences were local, 10 (15.6%) were regional and 27 (42.2%) were second primary. Forty-six (71.9%) of them were determined to have invasive carcinoma, 8 (12.5%) were ductal carcinoma in situ, and 10 (15.6%) were axillary metastases. Eight (12.5%) of them were first diagnosed by PET-computed tomography/MRI. Among the available images performed, 78.7% could be detected pathologically by MG, 95.2% by US, and 100% by MRI. Distant metastasis associated with other types of recurrence was detected in 6 (9.4%) cases. Conclusion: MRI is the most powerful imaging modality in detecting recurrent breast cancer. With the addition of US to routine MG follow-up, a higher rate and early detection of recurrent cancers can be achieved.

Prediction of Molecular Subtypes Using Superb Microvascular Imaging and Shear Wave Elastography in Invasive Breast Carcinomas.

RATIONALE AND OBJECTIVES: To investigate the efficacy of the advanced imaging methods, superb microvascular imaging (SMI) and shear wave elastography (SWE) in predicting molecular subtypes in invasive breast carcinomas. MATERIALS AND METHODS: A total of 210 biopsy-proven breast carcinomas in 200 patients who underwent ultrasound (US) imaging with SMI and SWE were included in this study. Quantitative analyses were performed using mean elasticity (Emean) score by SWE and vascular index (VI) by SMI. For qualitative assessment of microvascularity, first, lesions were graded according to Adler's classification in four types. Then, a new morphological model was used to classify the microvascular architecture into six patterns: type one, no signal; type two, penetrant; type three, rim-like; type four, dot-like/linear/regional; type five, wheel-like and type six, irregular signals. The correlation between these variables and molecular subtypes, nuclear grade, the Ki-67 levels and axillary status was investigated. RESULTS: The average VI and Emean values were relatively higher in non-luminal subtypes (VI, p = 0.002; Emean, p > 0.05). The two microvascularisation models were significantly able to differentiate the molecular subtypes according to the Kruskal Wallis test (p < 0.05). Rim-like, penetrant and regional patterns were primarily observed in luminal subtypes. The dominant pattern in non-luminal subtypes was wheel-like pattern. VI, Emean, Adler's classification and morphological vascularisation model were not significantly correlated with the nuclear grade, Ki-67 index or axillary status. CONCLUSION: The proposed microvascular categorization model may be more valuable in predicting molecular subtypes of breast carcinomas compared to VI and Emean and may contribute to the management of breast carcinomas as a non-invasive variable.

Predicting axillary nodal metastasis based on the side of asymmetrical cortical thickening in breast cancer: Evaluation with grayscale and microvascular imaging findings.

PURPOSE: To investigate the relationship between sonographic findings and the axillary status, especially the side of thickening in the presence of cortical asymmetry. METHODS: Patients with biopsy-proven axillary lymph node (ALN) metastasis were included in this study. The lymph nodes were divided into three groups depending on the type of cortical thickening as diffuse, closer (eccentric cortical thickening on the side near the tumor and/or breast) and distant (thickening on the further side) asymmetry. Longitudinal to transverse axis (L/T) ratio, the largest cortical thickness, cortex to hilum ratio (C/H), hilar status (normal/displaced/absent), orientation (parallel/vertical), capsular integrity (sharp/indistinct), vascularisation pattern (hilar/peripheral/penetrant/anarchic/avascular) on superb microvascular imaging (SMI) and presence of conglomeration were recorded for each lymph node. Axillary nodal status on 18F-FDG PET-CT/MRI scans was recorded, if available. Features of the breast lesions like size, laterality, nuclear grade, hormone receptor status and the level of Ki-67 expression have been added. RESULTS: A total of 219 metastatic ALNs [diffuse (n = 122), closer asymmetry (n = 71), distant asymmetry (n = 26)] were evaluated. By the univariate analysis, ALN metastasis was significantly associated with the presence of closer asymmetrical cortical thickening (p < 0,0001), C/H ratio (p = 0.001), cortical thickness (p = 0.001), hilar status (p < 0.005) and vascular pattern (p < 0.005). L/T ratio was only a statistically significant parameter for lymph nodes with diffuse cortical enlargement in predicting metastasis, and conglomeration was also observed only in this group (p < 0.05). By multivariate analysis, nodal metastasis was significantly associated with asymmetrical cortical thickening (p = 0.001), C/H ratio (p = 0.005) and vascular pattern (p < 0.0001). CONCLUSION: Asymmetrical cortical enlargement on the side closer to the breast, C/H ratio and abnormal microvascular pattern are the independent predictors of axillary nodal involvement. Closer asymmetry is an eligible, easy-to-detect grayscale US finding to decide sampling that highly predicts ALN metastasis.

Is there a potential biomarker in distinguishing invasive breast carcinomas with elevated Ki-67 levels among 2D-SWE, SMI, and 18F-FDG PET-CT/MRI-derived parameters?: A single-center data.

PURPOSE: To investigate the strength of quantitative imaging and metabolic parameters in differentiating invasive breast carcinomas with elevated Ki-67 levels. MATERIALS AND METHODS: A total of 123 patients with 129 breast lesions confirmed as invasive breast carcinoma underwent shear wave elastography (SWE), superb microvascular imaging (SMI) and positron emission tomography (PET)/CT or MRI. Adler's grade (classifying the microvascularity into four types) and Vascular Index (VI) was obtained by SMI as microvascular parameters. In addition, the stiffness value (Emean ) was evaluated in kilopascal by SWE. The average of consecutive measurements was recorded as mean VI and mean Emean . PET scan parameters were obtained as SUVmax and SULpeak . Lesions were divided into two groups according to the Ki-67 expression, low as ≤ 14 and high as >14. RESULTS: Adler's grading was the most correlated imaging parameter with high Ki-67 expression (p < 0.05), while VI and Emean had poor correlation (p > 0.05). SUVmax and SULpeak indicated a significant linear correlation with Ki-67 but a moderate correlation with the high levels of Ki-67 (p < 0,001). The sensitivity of VI, Emean , SUVmax and SULpeak was 64.6%, 66.7%, 65.7%, and 66.7% when the cut-off point was set to 5.25, 102.5, 6.59, and 2.63, respectively. SUVmax had the highest AUC value of 0.740, according to the ROC curve analysis. CONCLUSIONS: Our results suggest that the quantitative parameters obtained by advanced imaging methods may be useful in predicting the high proliferation in invasive breast carcinomas. But none of them is eligible to be used as an independent biomarker in distinguishing aggressive behavior. Nevertheless, as a noninvasive method, visual assessment of microvascular morphology using SMI increases the prognostic efficiency in invasive breast carcinomas.

Diagnostic Performance of Superb Microvascular Imaging in Differentiating Benign and Malignant Axillary Lymph Nodes.

ABSTRACT: The aim was to evaluate the effectiveness of superb microvascular imaging (SMI) in axillary lymph nodes (LNs).Benign and malignant LNs diagnosed via histopathological examination constituted the study subgroups. In addition to grayscale findings for morphological evaluation, vascular patterns and appearance of internal vessels were analyzed by both power Doppler ultrasound (PDUS) and SMI. The number of vascular branches was counted, and a vascularity index (VI) was calculated by SMI.Fifty-two LNs with suspicious findings in terms of metastasis (33 malignant and 19 benign) were evaluated. Diagnostic accuracy according to vascular patterns was 82% for PDUS and 92% for SMI. In the presence of asymmetric cortical thickening, there was a significant difference between benign and malignant LNs in the number of vascular branches of both thin and thick cortical sides ( P < 0.01). Mean VI was significantly higher in the malignant group ( P < 0.05). In differentiating malignancy, when a cutoff VI value was set to 9%, sensitivity was 69.7%, and specificity was 63.2%.Evaluating the vascularity of axillary LNs by SMI is a useful tool in determining the potential of axillary metastasis, especially in the absence of typical sonographic findings. Superb microvascular imaging can beneficially be used to select the most suspicious LN and suspicious area of the LN to sample.

A Rare Cause of Breast Swelling in Lactating Women: Aquafilling® Gel Injection.

Aquafilling® gel has been used in recent years as an alternative method to breast augmentation surgery. In this case report, we aimed to discuss radiological imaging findings and complications of Aquafilling® gel injection. Case: A 34-year-old lactating female patient presented with swelling and pain in the left breast. Ultrasonography showed massive septate fluid collections with dense content in both breasts and between the pectoral muscle fibers. On mammography, both breasts appeared dense with large mass opacities. On magnetic resonance imaging, extensive fluid-signal cystic areas were observed. Peripheral enhancement around the fluid in the left breast was present in the contrast-enhanced series. We learned from her anamnesis that Aquafilling® was applied to both breasts 5 years ago. Ultrasonography-guided sampling was performed from the cystic areas in the left breast and cytological examination revealed basophilic Aquafilling® material surrounded by diffuse inflammatory infiltrates. Breast augmentation history should be questioned in suspicious cases because Aquafilling® gel injection and its complications can present with a wide variety of symptoms and may mimic various other conditions on radiological imaging, such as cancer, abscess, granulomatous mastitis, and parasite infections.

Evaluation of symptom control and functional quality of life in Turkish patients with cancer during chemotherapy.

PURPOSE: This study was designed to evaluate the severity of symptoms, functional quality of life, and related factors experienced by Turkish cancer patients receiving chemotherapy. METHODS: The study was carried out with 430 patients at a medical oncology clinic. The data were collected using a personal and disease-related characteristics questionnaire, the Edmonton Symptom Assessment Scale (ESAS) and the Functional Life Scale-Cancer (FLIC). RESULTS: The three symptoms experienced most by patients were nausea (91.2%), depression (89.1%), and anxiety (87.7%). The mean FLIC total score of patients with cancer was 86.26 ± 23.15. Age, ECOG performance score, pain, nausea, depression, and a decreased sense of well-being independently affected the FLIC score (p < 0.05). There was a negative correlation between ESAS and FLIC scores (p < 0.05). CONCLUSION: Nausea and psychological symptoms are common in Turkish patients with cancer. The more severe the symptoms, the worse the functional quality of life. Age, ECOG performance score, pain, nausea, depression, and decreased sense of well-being affect Turkish cancer patients' functional quality of life. We conclude that healthcare professionals should evaluate symptoms experienced by their patients and plan appropriate nursing interventions to address the symptoms experienced by Turkish patients with cancer.

Dramatic increase in volume versus length of invasive ductal carcinoma mimicking intramammary lymph node in a small nodular lesion.

Background: The tumor growth pattern in breast cancer appears to be variable and unpredictable. A minor increase in size in a pre-existing lesion, especially under 1 cm, corresponds to a more pronounced increase in volume. Case presentation: We report a 63-year-old woman with a nodular density mimicking intramammary lymph node, diagnosed as invasive carcinoma of luminal B subtype. The lesion increased size and density over time in following mammograms until having indistinct margins. While the tumor volume was 12.7 mm3 at the first observation on mammography, it has increased approximately 6.7 times to reach 85.7 mm3 in four years. Finally, the patient diagnosed with early-stage breast cancer (T1N0M0) was treated with breast-conserving surgery. Conclusions: Minor changes in size, density, and margin status of a lesion on serial mammograms are warning for breast cancer. Withal, a slight increase in lesion size in two dimensions can result in significant differences in volume. Therefore, comparative evaluation with previous mammograms and observing any difference in morphological features by screening are crucial for early diagnosis and optimal management of the disease.

Correlation of self-efficacy and symptom control in cancer patients.

OBJECTIVE: This cross-sectional study was planned to evaluate the self-efficacy and symptom control of cancer patients and to determine the factors affecting them. METHODS: The sample of the study consisted of 329 cancer patients who were treated in the Medical Oncology Clinic of a university hospital between April and June 2019 and accepted to participate in the study. Data were collected using the Patient Characteristics Information Form, Cancer Behavior Inventory-Short Version (CBI-SV), and Edmonton Symptom Assessment Scale (ESAS). Percentage, mean, Mann-Whitney U test, and Kruskal-Wallis analysis of variance were used in the analysis of the data. RESULTS: The mean CBI-SV score of the patients was 79.10 ± 17.55. It was determined that the highest mean score of ESAS of the patients was in the symptom of fatigue (3.53 ± 2.81). Some symptoms were statistically lower in patients with good income, who are working, and who are non-smokers. Also it was determined that the self-efficacy levels of the patients with good income and quitting smoking were higher (p < 0.05). At the same time, as the patients' self-efficacy scores increased, the severity of the symptoms they experienced decreased statistically (p < 0.05). CONCLUSION: It was found that the patients' self-efficacy score was above the moderate level, the most intense symptom experienced by the patients was fatigue, and the severity of the symptoms decreased as the patients' self-efficacy level increased. In line with these results; the symptoms, self-efficacy perceptions, and affecting factors of cancer patients should be evaluated by nurses at regular intervals, and care and consultancy services should be provided.

Magnetic resonance imaging findings associated with recurrence in idiopathic granulomatous mastitis.

PURPOSE: To evaluate magnetic resonance imaging (MRI) findings related to recurrence of idiopathic granulomatous mastitis (IGM). METHODS: Demographic data [age, number of births, duration of lactation period, body mass index (BMI) and presence of recurrence] of 71 patients who were diagnosed with IGM were analyzed retrospectively. Characteristics of IGM (maximum width, location, involvement of the retroareolar region, deep tissue, skin), fibroglandular density (FGD), background parenchymal enhancement (BPE), distribution and pattern of contrast enhancement, presence of prepectoral edema, abscesses, fistulae, axillary lymphadenopathies on MRI and apparent diffusion coefficient (ADC) values from the pathological area were recorded. RESULTS: The recurrence rate in patients was 59% (42/71). We found a statistically significant relationship between recurrence and BPE (p = 0.028) and mean ADC (p = 0.035) values (for the cut-off of 1.00 × 10-3 mm2/s; sensitivity = 61.9%, specificity = 69%, AUC = 0.648). However, patients' age (p = 0.346), lactation period (p = 0.470), number of births (p = 0.774), BMI (p = 0.630) maximum width of the area of enhancement (p = 0.112), involvement of the retroareolar region (p = 0.290), deep tissue (p = 0.285), skin (p = 0.230), distribution (p = 0.857) and enhancement pattern (p = 0.157), presence of prepectoral edema (p = 0.094), abscesses (p = 0.441), fistulae (p = 0.809), lymphadenopathies (p = 0.571), and FGT (p = 0.098) were not significantly associated with recurrence. CONCLUSION: Our results revealed that recurrent IGM patients showed high BPE and lower mean ADC values. We think that high BPE and low mean ADC (<1.00 × 10-3 mm2/s) on MRI at the diagnosis stage may be a sign of possible future recurrence, and it will be beneficial to follow the patients more closely and arrange the treatment algorithms accordingly.

Primary neuroendocrine carcinomas of the breast and neuroendocrine differentiated breast cancers: Relationship between histopathological and radiological features.

PURPOSE: The aim of this study wasto investigate whole-breast imaging findings (mammography, ultrasonography (US), magnetic resonance imaging (MRI),clinical, and histopathological findings of primary neuroendocrine carcinomas of the breast (NEC) and neuroendocrine differentiated breast cancers (NEBC). METHODS: Patients withadiagnosis of breast cancer with histopathological neuroendocrine features between the years 2010 and 2021 were retrospectively screened.The lesions were divided into two main groups depending on staining with neuroendocrine markers (synaptophysin and chromogranin A). Those showing focal staining were categorized as NEBC while those with diffuse staining as NEC.The mammography, US, and MRI of the lesionswere reviewed in consensus by two breast radiologists in order to assess imaging featuresretrospectively according to the Breast Imaging Reporting and Data System (BI-RADS) 5th lexicon.The findings were compared with breast cancers without neuroendocrine features (BC-WNE) which were randomly selected from the same database. RESULTS: A total of 105 lesions [NEBC (n = 44), NEC(n = 11), BC-WNE (n = 50)] were evaluated.Patients with neuroendocrine tumors were older (p < 0.001) than those with BC-WNE. Compared with BC-WNE tumors, radiological findings typical of malignancy such as irregular shape [NEBC (7/20); NEC(3/7) vs BC-WNE (35/43); p < 0.001], spiculation [NEBC (2/20); NEC(0/7) vs BC-WNE (21/43); p < 0.001], architectural distortion [(NEBC (3/24); NEC(0/9) vs BC-WNE (31/50); p < 0.001)], calcification [(NEBC (6/24), NEC(0/9) vs BC-WNE (n = 27/50); p = 0.001)] on mamography, non-parallel orientation to skin [(NEBC (n = 17/29), NEC(n = 4/9), BC-WNE (n = 35/42); p = 0.008)], acoustic shadowing [(NEBC (n = 12/29), NEC(1/9), BC-WNE (n = 29/42); p = 0.009)], axillary lymphadenopathy [(NEBC(n = 3/30), NEC(n = 1/9), BC-WNE (21/50); p < 0.001)]on US were less common features of the neuroendocrine carcinomas of breast. Aside from shape features, there was no significant difference in contrast pattern (p = 0.866), kinetic curve (p = 0.454) and diffusion restriction (p = 0.242) on MRI. CONCLUSION: Characteristic malignant imaging features, including irregular shape, spiculated margins, suspicious calcifications, and posterior acoustic shadowing, are uncommon in neuroendocrine carcinomas of breast. These carcinomas tend to show more benign imaging features when compared with BC-WNE.

The Role of Superb Microvascular Imaging and Shearwave Elastography in the Evaluation of Intraductal Papilloma-Like Lesions.

OBJECTIVES: The aim of this study was to investigate the role of quantitative values obtained by superb microvascular imaging (SMI) and shearwave elastography (SWE) in the prediction of malignancy in intraductal papilloma-like lesions (IDPL). METHODS: In the study, 61 patients between the ages of 14 to 73 years (mean age 44) diagnosed with IDPL on ultrasound (US) examination between the years 2020 and 2021 were included. The B-Mode US findings (shape, margins, size, echo pattern, and accompanying ductal dilatation), SMI vascular index (SMIvi), E-mean, and SWE-ratio values were recorded. RESULTS: There was a statistically significant difference between malignant (n = 14) and benign (n = 47) groups in terms of symptoms (P = .005), size (P = .042), shape (P = .002), margins (P = .001), echogenicity (P = .023), microcalcifications (P = .009), SMIvi (P = .031), E-mean (P < .005), and SWE-ratio (P = .007). According to receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, accuracy, area under the curve (AUC), positive predictive values (PPV), and negative predictive values (NPV) were 57.1%, 87.2%, 80%, 0.722, 57.1%, 87.2% for US; 71.4%, 49%, 55.7%, 0.692, 30.3%, 85.7% for SMIvi; 85.7%, 71%, 74%, 0.864, 46%, 94.3% for E-mean, and 50%, 75.4%, 83%, 0.707, 91.5%, and 50% for SWE-ratio, respectively. Best results were obtained when SMI and SWE values were used together, achieving a sensitivity, specificity, accuracy, AUC, PPD, NPD of 78.6%, 93.6%, 93.4%, 0.872, 91.7%, and 93.9%, respectively. CONCLUSIONS: The SMI and SWE examinations are successful in the differentiation of benign and malignant intraductal lesions. They complement each other and contribute to B-mode US in managing IDPLs especially when used together. Our study is the first to compare the quantitative data of SWE and SMI in the differentiation of IDPLs.

Tocilizumab in COVID-19: The Cerrahpasa-PREDICT score.

BACKGROUND: Cytokine release syndrome (CRS), characterized by overproduction of proinflammatory cytokines in the course of severe coronavirus disease 2019 (COVID-19), has been suggested as the major cause of mortality. Tocilizumab, a recombinant humanized monoclonal antibody against human IL-6 receptor, poses a therapeutic option for the treatment of CRS leading to severe acute respiratory syndrome in coronavirus-2 (SARS-CoV-2) infection. METHODS: We performed a single-center retrospective study to reveal the outcome of COVID-19 patients on tocilizumab and proposed "the Cerrahpasa-PREDICT score", a new clinical scoring system using clinical and laboratory parameters that would help predicting the 28-day mortality of COVID-19 patients receiving tocilizumab. RESULTS: Eighty-seven patients (median age: 59 years) were included of whom 75.8% were male. Tocilizumab use significantly improved clinical and laboratory parameters. The 28-day mortality rate on tocilizumab was 16.1%. The Cerrahpasa-PREDICT score, consisting of platelet counts, procalcitonin, D-dimer levels, SO2R and the time from symptom onset to tocilizumab administration had a positive predictive value of 94.5% and negative predictive value of 92.9% for anticipating 28-day mortality. CONCLUSIONS: Severe COVID-19 should closely be monitored for the signs of hyperinflammation. We showed that administration of tocilizumab early in the course of the disease (prior to ICU admission) resulted in a favorable outcome. Close monitoring usually aids identifying patients who would benefit from tocilizumab. In this regard, the Cerrahpasa-PREDICT score might serve as a practical tool for estimating the 28-day mortality in COVID-19 patients who received tocilizumab and would facilitate timely recognition of fatal cases to be evaluated for other therapeutic options.

The effectiveness of RENAL nephrometry score in ablated renal tumors via radiofrequency ablation or cryoablation

Background/aim: This study aimed to evaluate the clinical efficacy of radiofrequency ablation (RFA) and cryotherapy and to scrutinize the therapeutic success of the RENAL (radius, exophytic/endophytic, nearness to collecting system, anterior/posterior, and location) nephrometry score in terms of possible complications and the predictive status of oncological results. Materials and methods: Forty-five patients with biopsy-proven renal cell carcinomas (32 males, 13 females) treated with RFA and cryotherapy were included. Patients were 22­90 years old (average: 59.2 years). Statistical analyses were performed using SPSS for Windows. Results: A total of 79 lesions with dimensions varying between 0.9 and 4.5 cm (average: 2.2 cm) were ablated. Complete ablation was achieved for 72 (91.1%) lesions. Six repeat RFA sessions were applied for 4 (5%) lesions with residue/recurrence. The average RENAL nephrometry scores of lesions that underwent complete ablation and those that developed residue/recurrence were 6.3 and 7.7, respectively. The average recurrence-free survival time was 34.8 months (range: 3­55 months), while it was 44.6 months (range: 6­55 months) for cryotherapy and 28.6 months (range: 3­50 months) for RFA. Conclusion: Ablative therapies are minimally invasive and effective methods for treating small renal tumors. RENAL nephrometry scoring is a valuable system for standardizing renal tumors and evaluating the success of ablative therapies, possible complications, and oncological results.

Pain experiences of patients with advanced cancer: A qualitative descriptive study.

PURPOSE: Uncontrolled pain, especially in patients with advanced cancer, affects quality of life negatively and causes negative physical and psychological conditions. The aim of this study was to explore the pain experiences of patients with advanced cancer and how they manage with pain, and to present a view of pain management approaches of nurses from the perspectives of the patients. METHODS: This was a qualitative descriptive study of sixteen hospitalized patients with advanced cancer. Data were collected using semi-structured interviews with patients. Data were analysed by Colaizzi's phenomenological method. RESULTS: This study found that patients with advanced cancer who had pain experienced anxiety, helplessness, hopelessness and many restrictions in daily life as well as inability to manage with pain. Most of the patients with advanced cancer were not satisfied with their nursing care with regard to pain management. The themes that emerged were pain perception and experiences, effects of pain on daily life, pain management and management strategies and the patients' perspectives about nursing approaches to pain. CONCLUSIONS: This study demonstrated the difficulties of patients with advanced cancer who experienced pain in their daily lives, yet lack pain management strategies. Furthermore, nurses' caring approaches to patients with advanced cancer who experienced pain was found inadequate. Oncology nurses should provide educational interventions in order to enhance knowledge and skills about pain assessment and non-pharmacologic and pharmacologic strategies used in pain management.

Reflexology in the management of chemotherapy induced peripheral neuropathy: A pilot randomized controlled trial.

PURPOSE: The current experimental study aimed to evaluate the effectiveness of reflexology on the management of symptoms and functions of chemotherapy-induced peripheral neuropathy (CIPN) in cancer patients. METHOD: This study was conducted as a randomized controlled trial in 60 patients (30 experimental and 30 control patients) who had chemotherapy-induced Grade II-IV peripheral neuropathy complaints from July 2013 to November 2015. Data were collected using the patient identification form, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy (EORTC-CIPN-20) form, and BPI (used for related chemotherapy-induced peripheral neuropathy symptoms). RESULTS: The majority of the patients were being treated for gastrointestinal or breast cancer and were primarily receiving Eloxatine- or taxane-based treatment. It was found that reflexology applications did not lead to differences in either group in terms of peripheral neuropathy severity and incidence (p > 0.05) and only led to improvement in sensory functions in the experimental group (p < 0.05). CONCLUSIONS: It was determined that reflexology is not an effective method in the management of patients' activity levels, walking ability etc. and motor, autonomic functions related CIPN, but reflexology is effective method in the management of patients' sensory functions related CIPN. Key Words: Peripheral neuropathy, reflexology, chemotherapy, EORTC QLQ-CIPN-20, BPI.