Additional diagnostic value of MRI in patients with suspicious breast lesions based on ultrasound.

OBJECTIVE: Biopsy has long been the standard approach in Breast Imaging Reporting and Data System® (BI-RADS) 4 or BI-RADS 5 (American College of Radiology, Reston, VA) lesions despite a wide variation in reported incidence of malignancy in BI-RADS 4 lesions. This study examined the diagnostic value of breast MRI as well as its ability to decrease unnecessary biopsies in patients with solid breast lesions who had an indication for biopsy. METHODS: In this retrospective study, 277 breast lesions with a documented histological diagnosis as established by ultrasound-guided biopsy were included. All patients were female, and biopsy was performed owing to a BI-RADS score of 4 or 5 on ultrasonography. In addition, all patients had undergone MRI before biopsy. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI in predicting malignancy were calculated. RESULTS: When all lesions were analysed, sensitivity, specificity, NPV and PPV of MRI in detecting malignancy were 94.2%, 56.1%, 90.7% and 68.1%, respectively. When only ultrasonographic BI-RADS 4 lesions are considered, the corresponding figures were as follows: 90.9%, 56.7%, 93.8% and 46.4%, respectively. False-negative rate of MRI for the latter group of lesions was 2.6%. 42% of unnecessary biopsies were avoided in sonographic BI-RADS 4 lesions. CONCLUSION: Despite promising results obtained in this study, dynamic MRI currently does not seem to be effective in ruling out the need for biopsy in the assessment of sonographic BI-RADS 4 lesions. However, advanced MRI techniques may assist in improving possible benefits of MRI in this patient group.

Morphine physical dependence intensification by hypoglycemia: NMDA receptor involvement.

The destruction of N-methyl-D-aspartate (NMDA) receptor-bearing neurons by insulin-induced hypoglycemia has long been known to be due to excessively released aspartate and glutamate. In this study, the effects of NMDA-bearing neuron destruction by insulin-induced hypoglycemia on the development of morphine (M) physical dependence, which was found related to functional states of NMDA receptors, were investigated. NMDA receptor antagonists CGP 39551 and MK-801 were used to see whether they could change intensity of precipitated abstinence syndrome by preventing destruction. Therefore, two groups of fasting rats injected IP with physiological saline, and another two groups given IP 10 mg/kg CGP 39551 and 0.5 mg/kg MK-801 received 15 IU/kg crystalline zinc insulin IP. After 2 h, the rats were orally given 2 x 4 ml of 5% glucose solution. On the third day, two pellets containing 75 mg base M were SC implanted to all rats. On the sixth day, they were IP given 2 mg/kg naloxone (NL). Then jumps, wet-dog shakes, and defecation were counted while diarrhea and ptosis were rated for 15 min. The rats given insulin manifested significantly more intense NL-precipitated abstinence syndrome than controls. The rats administered CGP 39551 showed a less intense physical dependence than those injected with only insulin. But, the intensity was still significantly higher than controls. In the rats that received MK-801, the abstinence syndrome was more or less equal to that in controls.(ABSTRACT TRUNCATED AT 250 WORDS)