Scoring to predict the possibility of upgrades to malignancy in atypical ductal hyperplasia diagnosed by an 11-gauge vacuum-assisted biopsy device: an external validation study.

BACKGROUND: Ko's scoring system was developed to predict malignancy upgrades in patients diagnosed with atypical ductal hyperplasia by core needle biopsy. The Ko algorithm was able to identify a subset of patients who were eligible for exclusively clinical follow-up. The current study statistically investigated the patient outcomes to determine whether this scoring system could be translated and used safely in clinical practice. METHODS: We tested the statistical performance of the Ko scoring system against an external independent multicentre population. One hundred and seven cases of atypical ductal hyperplasia diagnosed by an 11-gauge biopsy needle were available for inclusion in this study. The discrimination, calibration and clinical utility of the scoring system were quantified. In addition, we tested the underestimation rate, sensitivity, specificity, and positive and negative predictive values according to the score threshold. RESULTS: The overall underestimation rate was 19% (20/107). The area under the receiver operating characteristic curve for the logistic regression model was 0.51 (95% confidence interval: 0.47-0.53). The model was not well calibrated. The lowest predicted underestimation rate was 11%. The sensitivity, specificity, positive predictive value, and negative predictive values were 90%, 22%, 20%, and 89%, respectively, according to the most accurate threshold proposed in the original study. CONCLUSION: The scoring system was not sufficiently accurate to safely define a subset of patients who would be eligible for follow-up only and no additional treatment. These results demonstrate a lack of reproducibility in an external population. A multidisciplinary approach that correlates clinicopathological and mammographic features should be recommended for the management of these patients.

Autologous blood programs: what is happening?

UNLABELLED: Preoperative autologous blood collection has been advocated for many years and has seen increased application following the AIDS epidemic. Such autologous programs have been both applauded and criticized in recent years with little information available regarding actual application. METHODS: One hundred and fifty-five of the largest hospitals in the province of Ontario received surveys assessing the demographics, logistics and funding of autologous blood programs available to them. Results, a total of 78 hospitals replied, indicating that 77 sites had access to an autologous program with 26 sites having a program within their hospital. The local blood provider, Canadian Blood Services (CBS), provided access to autologous donations either alone or to the hospital in 62 sites. Three hospitals operated the program entirely on their own. Fifteen hospitals had no access to an autologous program at any site. Programs were funded in a variety of ways including patient fees in five hospitals. DISCUSSION: In the largest Canadian province the autologous blood programs are highly variable with service not provided at all in some regions whereas in others there is a very active program often involving Canadian blood services either as a stand-alone or hospital integrated supplier. This variation in activity of the autologous program is in marked contrast to those for whole blood and apheresis collections where great standardization, through the CBS is the norm.

[Diagnosis and treatment of multifocal neonatal hepatic abscesses using echography]. / Diagnostic et traitement d'une abcédation hépatique néo-natale multifocale par l'échographie.

An infant born of a diabetic mother at 36 weeks developed three liver abscesses consecutive to umbilical vein catheterization. After medical treatment, 2 abscesses were aspirated percutaneously under ultrasonic guidance. The child recovered rapidly.

Small-parts real-time sonography: a new "water path".

A new commercially available gel material was used as a convenient and inexpensive water path. It enabled conventional real-time equipment with 3.5- or 5-MHz transducers to yield satisfactory results during superficial and small-parts examinations.

[Contribution in oncology of fine needle puncture-aspiration of abdominal organs under echographic guidance in real time. Apropos of 265 cases]. / Apport en cancérologie de la ponction-aspiration à l'aiguille fine d'organes abdominaux sous contrôle échographique en temps réel. A propos de 265 observations.

The authors report a 3-year experience in the field of real-time ultrasonically-guided fine-needle aspiration biopsies of abdominal lesions in a Cancer Institution. The procedure is performed using a linear-array electronic biopsy transducer. Results obtained in a series of 265 aspirations are analyzed. Major benefits and applications of this technique in oncology are discussed while emphasis is put on the economical aspects of this diagnostic "shunt".

Sonography of the patellar tendon: preliminary observations.

A technique using linear-array real-time sonography was used to study patellar tendon and adjacent muscular injuries. Of 65 subjects examined, normal patellar tendon sonographic anatomy was defined in 32. Of 33 patients with sonographic abnormalities, 15 had pathologic correlation. Two patients had focal degenerative tendonitis, and nine had diffuse dystrophic change. There were three cases of intratendinous hematoma and one of mucoid degeneration. These results demonstrate accurate differentiation of the normal from the abnormal tendon. In many instances, particularly when a focal lesion is present, the sonogram is as or more diagnostic than the radiographic and physical examinations.

[Diagnosis of calcification of the patellar tendon. Echo-radiographic comparison]. / Diagnostic des calcifications du tendon rotulien. Comparaison écho-radiographique.

Real-time sonography was compared to low-kilovoltage radiographs in the diagnosis of intra-tendinous calcifications in 10 patients with chronic patellar tendonitis. In these patients sonography demonstrated thickening (100% of cases) and hypoechogenicity (90% of cases) of the patellar tendon. Ultrasound disclosed all calcifications displayed on radiographs showing hyperechoic foci. The associated acoustic shadow was absent in one case of a calcification less than one millimeter in diameter. Real-time ultrasound appears highly reliable in the diagnosis of even minute intra-tendinous calcifications. It also provides an accurate three-dimensional localization of the calcific deposits in the tendons.

[Interposition material for the echography of superficial organs]. / Un matériau d'interposition pour l'échographie des organes superficiels.

The authors report a technique of real-time small parts ultrasonography using a commercially available gel material.

Ultrasonography in the evaluation of muscular trauma.

Ultrasonography was performed to assess muscle injuries in 120 advanced-level athletes. Real-time sonography was chosen for evaluation since it allowed a comparison between the muscles at rest and during contraction. Pathologic patterns are reported and compared with the normal ultrasonic muscular anatomy. Twenty-five subjects were referred for surgery. All lesions had abnormal sonograms, and these were correctly described in 21 cases (84 per cent). Ultrasonic investigation is a reliable, useful method to confirm, locate and evaluate traumatic muscular lesions and to assess the need for surgical repair.

[Ultrasonographic assessment of traumatic muscle injuries in athletes (author's transl)]. / Accidents musculaires du sportif. Apport original de l'ultrasonographie.

In the absence of reliable objective methods to assess traumatic muscle injuries in athletes, the authors have chosen to perform routine ultrasonography. Taking the thigh as an example, they describe the appearance of normal muscles on ultrasonographic images and compare these with CT sections. The results of examination in 61 athletes with traumatic injury are reported. The different ultrasonic patterns are described and compared with surgical findings in 16 cases. All lesions could be detected by ultrasonography, and 87% were correctly identified. Ultrasonography provides direct and clear imaging of the muscles. It constitutes an excellent means of detecting severe lesions and locating them accurately before surgical repair. It is highly reliable and deserves to be adopted by all physicians and surgeons specialized in sports medicine.

[Male genitourinary ultrasound studies (MGUUS) (author's transl)]. / Ultrasonographie génito-urinaire masculine (USGUM).

The authors report their experience of male genitourinary ultrasound studies of the anterior pelvis over a period of 4 years and involving almost 500 patients. The authors first used a classical ultrasound apparatus in real-time via an anterior abdominal approach. They now have an Aloka mode B apparatus in real-time which by use of three approaches (anterior abdominal, rectal and urethral) offers the possibility of analysis of the male anterior pelvis with four planes of section: 1 sagittal and 3 transverse. Thus MGUUS provides 12 views of the male pelvis. The authors define the techniques used in the light of their experience with this apparatus. They then describe the normal ultrasound anatomy of the male anterior pelvis. Finally, they present their results in pathology with this technique. These results have been obtained in benign and malignant prostatic pathology, everyday routine, longitudinal analyses before and after treatment: surgery, radiotherapy and medical. The results are promising in more recent indications: tumours of the bladder, endocrine andrology, pathology of fertility and in the investigation of the pathological scrotum. Implantation of MGUUS at the centre of technical approaches in urology is felt by the authors to be a necessity, making possible the rational and economic use of the apparatus for both in- and out-patients and the cost of an ultrasound apparatus for every hospital department of urology would appear to be reasonable.