Correlation Between Quantitative Parameters Obtained by Dual Energy Spectral CT and Prognostic Histopathological Factors and Biomarkers in Breast Cancer.

RATIONALE AND OBJECTIVES: To investigate the correlation between quantitative parameters obtained by dual energy spectral computed tomography (DESCT) and various histopathological factors and biomarkers associated with the prognosis of breast cancer. MATERIALS AND METHODS: Quantitative parameters such as iodine content (IC), normalized IC (nIC), iodine enhancement (IE) and normalized IE (nIE) were measured on virtual monochromatic images and iodine mapping images obtained from DESCT in 116 female breast cancer patients. The relationship between these parameters and prognostic biomarkers such as estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status and Ki67 levels, as well as the correlation with histological grade (HG), lymphovascular invasion (LVI), and metastatic axillary lymphadenopathy (LAP) were evaluated. RESULTS: ER-negative tumors had significantly higher values of IC, nIC, IE, and nIE compared to ER-positive tumors. PR-negative tumors had significantly higher values of IE and nIEc compared to PR-positive tumors. HER2 overexpressed and Ki-67 high proliferation tumors showed significantly higher values of all quantitative parameters compared to HER2 negative and Ki-67 low proliferation tumors. All quantitative parameters were significantly higher in HG 3 tumors, tumors with detected LVI, and tumors with metastatic axillary LAP compared to low-grade tumors, LVI-negative tumors and tumors without metastatic axillary lymph nodes, respectively. CONCLUSION: Quantitative parameters of IC and IE obtained from DESCT have shown potential for predicting prognosis in breast cancer patients. Higher values of these parameters have been found to correlate with poor prognostic biomarkers and histopathological features. These results suggest that quantitative DESCT imaging may offer an additional benefit in the noninvasive prediction of breast cancer prognosis.

The efficacy of abbreviated breast MRI protocols using 1.5 T MRI in the preoperative staging of newly diagnosed breast cancers.

PURPOSE: To determine the efficacy of abbreviated breast magnetic resonance imaging (MRI) protocols using 1.5 T MRI in the preoperative staging of newly diagnosed breast cancers. METHODS: Eighty patients who underwent 1.5 T MRI between August 2014 and January 2018 for the preoperative staging of breast cancer were evaluated retrospectively. Three separate abbreviated breast MRI protocols (AP) were created from a full protocol, and the images were evaluated independently by two radiologists. AP1 included axial fat-saturated T2 weighted and diffusion-weighted (DW) images, while subtracted axial fat-saturated T1 weighted images were obtained 2 min after contrast administration in AP2. Finally, AP2 and DW images were evaluated in AP3. Lesion location, number, and size, and presence of axillary lymphadenopathy were evaluated in each protocol. Pathological data (lesion quadrant, lesion size, and presence of axillary metastases) from the 80 patients were compared with the abbreviated protocols and full diagnostic protocol. RESULTS: The best correlation with the full protocol for detecting the lesion quadrant, number of lesions, and presence of axillary lymphadenopathy was achieved with AP3 for both readers (κ = 0.954, 0.954 for the lesion quadrant, κ = 0.971, 0.910 for the number of lesions, and κ = 0.973, 0.865 for the axillary lymphadenopathy). The evaluation time in all abbreviated protocols was shorter than for the full protocol (p < 0.05). Comparing the abbreviated protocols with pathological data for both readers, the best correlation for detecting the lesion quadrant, number of lesions, and presence of axillary lymphadenopathy was achieved with AP3 (κ = 0.939, 0.954 for the lesion quadrant, κ = 0.941, 0.879 for the number of lesions, and κ = 0.842, 0.740 for axillary lymphadenopathy, respectively). CONCLUSION: Abbreviated breast MRI protocols can provide sufficient diagnostic accuracy in the preoperative staging of breast cancer, with shorter imaging and evaluation times.

High-resolution diffusion-weighted imaging compared with conventional diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging with regard to image quality and assessment of breast cancer morphology

PURPOSE: To evaluate the image quality and tumor morphology depiction ability of high resolution (HR) diffusion- weighted imaging (f-DWI) in comparison to conventional DWI (c-DWI) and dynamic contrast- enhanced magnetic resonance imaging (DCE-MRI) in the primary breast cancer setting. METHODS: The f-DWI, c-DWI, and DCE-MRIs of 160 malignant breast masses were evaluated retrospectively by two independent radiologists. Data on image quality [sharpness, distortion, and perceived signalto- noise ratio (SNR)], apparent diffusion coefficient (ADC) value, lesion size, and tumor morphology (shape, margin, and internal pattern) obtained on f-DWI, c-DWI, and DCE-MRI were compared. Consistency between the readers and imaging methods for morphological parameters was analyzed. RESULTS: The ADC values measured on f-DWI were significantly lower than those measured on c-DWI for both readers (P < 0.001 for each), whereas mean lesion size was significantly larger in c-DWI than in f-DWI and DCE-MRI for both readers (P < 0.001 for each). Higher consistency values were obtained for f-DWI compared with c-DWI when correlated with DCE-MRI for each morphological parameter. The least distorted images were obtained using DCE-MRI compared with c-DWI and f-DWI for both readers, whereas the highest distortion scores were obtained using c-DWI. Sharpness and perceived SNR scores were rated as significantly higher for f-DWI and DCE-MRI images compared with c-DWI by both readers (P < 0.001 for all). The concordance between c-DWI and DCE-MRI was fair to slight (κ = 0.15 to 0.41), whereas concordance between f-DWI and DCE-MRI was significantly better (κ = 0.68 to 0.87) for each reader and for all morphological parameters (P < 0.001). The highest concordance between the readers was achieved in margin assessment (κ = 0.87 to 0.89) regardless of the MRI method, followed by shape and internal pattern parameters (κ = 0.63 to 0.79). CONCLUSION: The results demonstrated that f-DWI produces higher-quality images than c-DWI, enabling the morphological features to be identified in similar detail to that offered by HR DCE-MRI. Accordingly, f-DWI, as a method that highly correlates with DCE in determining the morphological characteristics of breast cancers, seems to have potential in the evaluation of breast tumors in patients for whom the use of contrast media is contraindicated.

The validity and clinical utility of axillary ultrasonography-guided fine needle aspiration biopsy in detection of nodal metastasis in early-stage breast cancer patients: a retrospective single-center experience.

BACKGROUND: Assessing the validity and clinical utility of axillary ultrasonography (AUS)-guided fine needle aspiration biopsy (FNAB) in detection of nodal metastasis during preoperative axillary investigation in comparison to the histopathologic diagnosis in early-stage breast cancer. METHODS: A total of 279 operated primary breast cancer patients (age: 55.3 ± 12.8, ranged 17-90 years) were included. Data on AUS findings at the time of initial diagnosis (first look AUS), second-look AUS findings performed by the breast radiologist during breast biopsy procedure and the AUS-guided FNAB findings were evaluated with respect to the final histopathology report obtained through axillary surgery via sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND). The diagnostic performance of each method in detecting metastatic ALNs were compared in terms of sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: The sensitivity, specificity, and accuracy of the first look AUS in detecting nodal metastasis were 64.56%, 86.78%, and 74.19% while the PPV and NPV were 86.44% and 65.22%, respectively. The sensitivity, specificity, and accuracy of the second-look AUS were 70.25%, 87.60%, and 77.78%, while PPV and NPV were 88.10% and 69.28%, respectively. The sensitivity, specificity, and accuracy of the second-look AUS guided FNAB were 89.19%, 73.33%, and 87.30%, while the PPV and NPV were 96.12% and 47.83%, respectively. The consideration of second-look AUS and finding of nodal metastasis in FNAB was associated with significantly higher likelihood of ALND (55.4% vs. 44.6%, p < 0.001) and lower likelihood of SLNB (34.7% vs. 65.3%, p < 0.001) compared to consideration of nonmetastatic ALN status. In 23 (22.3%) patients with positive findings on AUS-guided FNAB, SLNB was applied; 21 had positive results after surgical dissection, indicating that nearly 20% of patients had unnecessary SLNB. DISCUSSION: US-guided FNAB of suspicious ALNs is a simple, minimally invasive, and highly effective method for preoperative axillary staging in patients with invasive breast cancer avoiding the more invasive method SLNB and it enables the surgeon to proceed directly to ALND in positive cases.

White Tea Reduced Bone Loss by Suppressing the TRAP/CTX Pathway in Ovariectomy-Induced Osteoporosis Model Rats.

Osteoporosis is an important skeletal disease characterized by bone weakness and high risk of fracture in postmenopausal women. Tea consumption is known to play an important role in the prevention or alleviation of osteoporosis. However, the therapeutic effects of aqueous extracts of white tea (WT) have not been evaluated in osteoporosis rat models. The aim of this study was to investigate the potential anti-osteoporotic role of WT in ovariectomized (OVX) rats. WT was given orally at 0.5% w/v doses for 12 weeks in OVX rats. Biochemical parameters in blood samples, bone tartrate-resistant acid phosphatase (TRAP), C-terminal telopeptide of type 1 collagen (CTX) and estradiol levels were evaluated. Bone mineral density and bone mineral content values were measured in the left femur. In addition to histopathological examination, osteolcalcin, osteopontin and TUNEL levels were determined. OVX group data demonstrated that bone loss occurred by thinning of the metaphyseal growth plates of the femur. Similarly, the levels of TRAP and CTX, markers of osteoclastic activity, were found to be high concurrently with a decrease in femoral bone mineral density. In addition, increased osteolcalcin and osteopontin levels were present in the metaphyseal growth zones. On the other hand, while TRAP and CTX levels were suppressed in the OVX-WT group, bone mineral content increased. In ad-dition, TUNEL, osteocalcin and osteopontin positivity decreased in the right femoral metaphysis growth zones, proliferating zone and resting zone cells. These results showed that chronic WT consumption has a protective effect by reducing bone resorption in OVX-induced osteoporotic rats.

Contribution of diffusion-weighted MR imaging in follow-up of inflammatory appendiceal mass: Preliminary results and review of the literature.

OBJECTIVE: We aimed to search the contribution of diffusion-weighted imaging (DWI) in follow-up of patients with acute appendicitis associated inflammatory appendiceal mass (IAM). DWI was used as a monitoring imaging method to assess the response of medical treatment. MATERIALS AND METHODS: 19 patients (mean age, 37+-13.1; age range, 19-69; M/F: 10/9), presented with clinical, laboratory and computed tomography (CT) findings suggestive of IAM were enrolled prospectively in this study. CT and DWI images were evaluated by two radiologists in consensus. b values 0, 500 and 1000 s/mm(2) were used, and DWI images were analysed both qualitatively and quantitatively. Laboratory parameters were C-reactive protein value and white blood cell count. During follow-up changes in the diameter of IMA and laboratory parameters were correlated with ADC values. Conservative treatment with interval appendectomy and a total conservative approach without surgery were the treatment options during follow-up. RESULTS: We found statistically significant correlation between the ADC values, maximum IAM diameter and laboratory parameters. During follow-up five surgical procedures were performed: one patient underwent surgery for cecal adenocarcinoma and four underwent interval appendectomy. One patient developed acute relapse of IAM at the sixth month of follow-up. CONCLUSION: DWI may be used with a significant success for follow-up of patients with IAM. As a monitoring imaging method, DWI may also aid in determining of most appropriate timing for interval appendectomy as well as may help in diagnosing alternative diagnoses (e.g. malignancy and inflammatory bowel disease) that can mimic IAM.

The relation between carotid intima media thickness and serum osteoprotegerin levels in nonalcoholic fatty liver disease.

AIM: This study was designed to evaluate carotid intima media thickness (CIMT) and serum osteoprotegerin (OPG) levels in nonalcoholic fatty liver disease (NAFLD) in comparison to healthy controls and to investigate factors predicting the CIMT increase. MATERIALS AND METHODS: A total of 60 outpatients [median (min-max) age 44.5 (24.0-65.0) years, 63.3% were females] diagnosed with NAFLD via ultrasonography performed during their admission to our hospital for any reason and 30 control subjects [median (min-max) age 39.5 (24.0-57.0) years, 73.3% were females] with normal liver echogenicity in ultrasonography were included in this study. Data on demographic characteristics, anthropometric measurements, biochemical and hematological tests, CIMT measurement, serum levels for OPG, and predictive factors for the CIMT increase were collected. RESULTS: Median (min-max) CIMT [0.60 (0.40-1.10) vs. 0.50 (0.30-0.60), P<0.001) and OPG (pg/mL) [65.0 (18.1-272.8) vs. 32.0 (10.1-82.3), P<0.001] levels were significantly higher in NAFLD patients compared to controls, while there was a significant positive correlation between CIMT and serum OPG (r=0.42, P<0.001). Mean CIMT value was determined to increase significantly by 0.001 cm (P=0.001) for each 1 pg/mL of increase in OPG levels, by 0.103 cm (P<0.001) in case of concomitant NAFLD (P<0.001), and by 0.006 cm (P<0.001) for each 1 pg/mL of increase in urea levels. CONCLUSION: Our findings indicate higher levels of serum OPG and CIMT in patients with NAFLD compared to controls along with a positive correlation between serum OPG and CIMT levels. High levels of serum OPG, presence of NAFLD, and high levels of serum urea seem to be the independent risk factors predictive for the CIMT increase.

Pregnancy in the setting of asymptomatic non-cirrhotic chronic portal vein thrombosis complicated by pre-eclampsia.

Portal vein thrombosis (PVT) can be chronic or acute in nature; it is characterized by a thrombus formation in the main portal vein and/or its right or left branches. Herein, we present a 36-year-old woman with asymptomatic noncirrhotic chronic PVT who developed preeclampsia in the later stage of pregnancy. This report will emphasize the clinical differential diagnosis, outcome, and management of pregnancies complicated by noncirrhotic PVT.

In situ thrombosis in pulmonary arterial aneurysms due to Behçet's disease and efficacy of immunosuppressive therapy.

BehçetDisease (BD) is a systemic vasculitis characterized by recurrent oral and genital ulcers and uveitis, arthritis, and involvement of the gastrointestinal tract, central nervous system and blood vessels. The aneurysms of the pulmonary arteries, with or without thrombosis, are typical manifestation of BD. We report a case with BD, pulmonary arterial aneurysms(PAA) and in situ thrombosis. We aimed to show the effectiveness of immunosuppressive treatment on in situ thrombosis in a case with PAA and BD.

A case with multisystemic involved of Tuberculosis.

Cases of tuberculosis with multisystemic involvement are rarely reported and these are often children and patients with AIDS whose and immune system is suppressed. Tuberculosis can mimic and present with various disorders. A 18-year-old Georgian male patient was admitted to the hospital with double vision, swelling and wound on the 3rd digit of the right hand. We defined the multisystemic tuberculous disease including orbital bone with soft tissue tuberculosis, tuberculosis spondylitis, tuberculosis dactylitis, scrofuloderma and pulmonary tuberculosis in these patient.

Carotid and brachial artery intima-media thickness is related to coronary atherosclerotic burden and may also represent high cardiovascular risk in patients with normal coronary angiograms.

BACKGROUND: Carotid and brachial artery intima-media thicknesses (IMT) determined using B-mode ultrasonography are validated surrogate markers of the severity and extent of coronary artery disease (CAD). The markers may also reflect the general vascular atherosclerotic involvement and cardiovascular risk in patients with normal coronary arteries (NCA). We aimed to investigate the relationship of carotid artery IMT (CIMT) and brachial artery IMT (BIMT) with CAD simultaneously, and also examined whether both markers represent cardiovascular risk determined by cardiovascular risk factors in patients with NCA. METHODS: One hundred eligible patients who consecutively underwent coronary angiography under suspicion of CAD were included in this study. The patients were evaluated in terms of age, gender, and the risk factors for CAD, and their total cardiovascular risk was calculated. CIMT and BIMT measurements were performed by B-mode ultrasonography on all patients. The extent and severity of CAD were evaluated by the Gensini score, and the number of severely narrowed vessels was determined by coronary angiography. RESULTS: Sixty-three patients (47 males, 16 females) with a mean age of 62 ± 10 years had CAD, and 37 patients (20 males, 17 females) with a mean age of 51 ± 11 years had NCA on coronary angiography. The mean age and male ratio of patients with CAD were significantly higher as compared with the patients with NCA (p < 0.001, p = 0.035, respectively). The mean number of diseased vessels was 2.2 ± 0.9 (median 2.0), while the mean Gensini score was 25 ± 31 (median 14.0). The CIMT and BIMT were higher in patients with CAD than in those with NCA (0.9 ± 0.2 vs. 0.7 ± 0.2 mm and 0.5 ± 0.1 vs. 0.4 ± 0.1 mm, respectively; p < 0.001 for both). The cardiovascular risk score (CVRS) was also significantly higher in the CAD group (3.8 ± 1.1 vs. 2.9 ± 1.4, p < 0.001). CIMT, BIMT, and CVRS were significantly correlated with the Gensini score and number of diseased vessels. For the sensitivity and the specificity of CIMT, BIMT, and CVRS to detect the presence of CAD, the areas under the ROC curve were 0.785 (95% CI 0.687-0.883, p = 0.000), 0.842 (95% CI 0.764-0.920, p = 0.000), and 0.721 (95% CI 0.591-0.813, p = 0.001), respectively. When we compared the CVRSs between the groups, which were determined according to cutoff values for CIMT and BIMT (CIMT ≥0.9 vs. <0.9 and BIMT ≥0.4 vs. <0.4); among the patients with NCA, CVRSs were significantly different (3.5 ± 0.5 vs. 2.7 ± 1.4, p = 0.035 and 3.7 ± 1.1 and 2.7 ± 1.3, p = 0.073; respectively). CONCLUSION: The increases in both brachial and carotid IMT are positively correlated with the extent of CAD and the number of involved vessels, and have more predictive value for CAD than the traditional CVRS. In addition, carotid IMT is also related to high CVRS in patients with NCA, and this finding may represent general vascular involvement without coronary lesions determined by coronary angiography.