Amr A. Soliman

The Automated Breast Volume Scanner (ABVS): initial experiences in lesion detection compared with conventional handheld B-mode ultrasound: a pilot study of 50 cases

The idea of an automated whole breast ultrasound was developed three decades ago. We present our initial experiences with the latest technical advance in this technique, the automated breast volume scanner (ABVS) ACUSON S2000™. Volume data sets were collected from 50 patients and a database containing 23 women with no detectable lesions in conventional ultrasound (BI-RADS®-US 1), 13 women with clearly benign lesions (BI-RADS®-US 2), and 14 women with known breast cancer (BI-RADS®-US 5) was created. An independent examiner evaluated the ABVS data on a separate workstation without any prior knowledge of the patients’ histories. The diagnostic accuracy for the experimental ABVS was 66.0% (95% confidence interval [CI]: 52.9–79.1). The independent examiner detected all breast cancers in the volume data resulting in a calculated sensitivity of 100% in the described setting (95% CI: 73.2%–100%). After the ABVS examination, there were a high number of requests for second-look ultrasounds in 47% (95% CI: 30.9–63.5) of the healthy women (with either a clearly benign lesion or no breast lesions at all in conventional handheld ultrasound). Therefore, the specificity remained at 52.8% (95% CI: 35.7–69.2). When comparing the concordance of the ABVS with the gold standard (conventional handheld ultrasound), Cohen’s Kappa value as an estimation of the inter-rater reliability was κ = 0.37, indicating fair agreement. In conclusion, the ABVS must still be regarded as an experimental technique for breast ultrasound, which definitely needs to undergo further evaluation studies.

Sonographic Features of Triple-Negative and Non–Triple-Negative Breast Cancer

Triple‐negative breast cancer (TNBC) is known to have unique molecular, clinical, and pathologic characteristics. The growth pattern of this cancer may also affect its appearance on sonography. Our study evaluated the sonographic features of TNBC according to the American College of Radiology Breast Imaging Reporting and Data System sonographic classification system and compared these features with those of non‐TNBC.

Variations in the Elasticity of Breast Tissue During the Menstrual Cycle Determined by Real-time Sonoelastography

The purpose of this study was to determine the dependence of breast tissue elasticity on the menstrual cycle of healthy volunteers by means of real‐time sonoelastography.

A retrospective analysis of survival and prognostic factors of male breast cancer from a single center

BackgroundLess than 1% of all breast cancer cases are found in men, who reportedly have inferior outcomes compared with matched women patients. Ethnic differences may also affect their prognosis. Here, we investigated overall survival (OS) and major prognostic factors for male breast cancer (MBC) in a cohort of Egyptian patients.MethodsWe retrospectively analyzed OS in a cohort of 69 male patients with MBC who were surgically treated at the Mansoura Cancer Center, Egypt between 2000 and 2007. We registered demographic data, age, height, weight and body mass index, tumor size, histology, number of infiltrated axillary lymph nodes, hormone receptor (HR) status and metastatic presence, and TNM staging. Patients’ OS was the primary endpoint. Patients received treatment to the medical standards at the time of their diagnosis.ResultsIn the 69 patients who met the inclusion criteria and had complete stored patient data, tumors ranged from T1c to T3. We could gather cancer-related survival data from only 56 patients. The collective 5-year survival in this cohort was 46.4%. Only five patients had distant metastasis at diagnosis, but they showed a null percent 5-year survival, whereas those with no lymph node infiltration showed a 100% 5-year survival. Lymph node status and tumor grading were the only prognostic factors that significantly affected OS.ConclusionsLymph node status and tumor grade are the most important prognostic factors for overall survival of MBC in Egyptian male patients; whereas even remarkably low HR expression in MBC did not significantly affect OS. Further research is needed to understand the factors that affect this disease.

Ultrasonographic examination of the endometrium and myometrium using acoustic radiation force impulse (ARFI) imaging technology: An initial experience with a new method

PURPOSE Acoustic radiation force impulse (ARFI) imaging technology provides measurable values of the elasticity/stiffness of the tissues examined. This work is a pilot study to determine the shear wave velocity values of normal endometrium and myometrium in healthy asymptomatic women. METHODS In a prospective observational study that recruited asymptomatic women, we used the ARFI (Virtual Touch tissue quantification(™); Siemens Medical Solutions) to examine six different points in the uterus of each woman; two points in the endometrium and four points in the myometrium. Two readings were obtained at each of the examined points to test the intra-observer reproducibility. RESULTS A total of 32 women were recruited. The age range was 19-68 years with a median age of 42 years. The menopausal status did not have any significant influence on the shear wave velocity measurements. The mean readings in the endometrium were 1.96, 2.03, 2.04 and 2.08 m/s while in the myometrium they were 2.78, 2.85, 2.87, 2.89, 2.91, 2.99, 3.2 and 3.23 m/s, respectively. CONCLUSIONS The ARFI procedure is a novel, reproducible ultrasonographic modality that can provide information about tissue stiffness. Transvaginal transducers fitted with this technology are sought as well as larger studies validating our findings.

Power Doppler flow mapping and four-dimensional ultrasound for evaluating tubal patency compared with laparoscopy

OBJECTIVES To study the accuracy of four-dimensional (4D) ultrasound and power Doppler flow mapping in detecting tubal patency in women with sub-/infertility, and compare it with laparoscopy and chromopertubation. STUDY DESIGN A prospective study. The study was performed in the outpatient clinic and infertility unit of a university hospital. The sonographic team and laparoscopic team were blinded to the results of each other. Women aged younger than 43 years seeking medical advice due to primary or secondary infertility and who planned to have a diagnostic laparoscopy performed, were recruited to the study after signing an informed consent. All of the recruited patients had power Doppler flow mapping and 4D hysterosalpingo-sonography by injecting sterile saline into the fallopian tubes 1 day before surgery. Registering Doppler signals, while using power Doppler, both at the tubal ostia and fimbrial end and the ability to demonstrate the course of the tube especially the isthmus and fimbrial end, while using 4D mode, was considered a patent tube. RESULTS Out of 50 recruited patients, 33 women had bilateral patent tubes and five had unilateral patent tubes as shown by chromopertubation during diagnostic laparoscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for two-dimensional power Doppler hysterosalpingography were 94.4%, 100%, 100%, 89.2%, and 96.2%, respectively and for 4D ultrasound were 70.4%, 100%, 100%, 70.4%, and 82.6%, respectively. CONCLUSIONS Four-dimensional saline hysterosalpingography has acceptable accuracy in detecting tubal patency, but is surpassed by power Doppler saline hysterosalpingography. Power Doppler saline hysterosalpingography could be incorporated into the routine sub-/infertility workup.

Neonatal blood rheological parameters at delivery in healthy neonates and in those with morbidities.

Rheological blood parameters of neonates are different form those of adults. Many authors have studied changes in blood rheology in neonates in different clinical disorders. To-date, no one set the normal values for blood rheological parameters in healthy neonates. The aim of this study is to set the norm for rheological blood parameters in healthy newborns and to describe the changes in those parameters in common clinical disorders that affect the newborns. We recruited all the neonates born to mothers experiencing un eventful pregnancies, blood was taken from the umbilical cord right after the delivery. In this time period we recruited 4985 neonate. From this huge database we were able to set the standards for blood rheology in neonates, namely plasma viscosity of 1.06±0.072 mPa, erythrocyte aggregation at stasis of 2.41±2.74 s-1 and erythrocyte aggregation under low shear forces of 8.51±6.38 s-1. These values changed significantly in some diseased neonates. This is the largest study investigating normal rheological parameters and deviations from the norm in common clinical disorders occurring in this early stage of life.

Is there yet a role for internal iliac artery ligation in obstetric hemorrhage with the current gain in popularity of other uterus sparing techniques

Abstract Purpose: To evaluate the success rates and subsequent fertility outcomes of internal iliac artery ligation (IIAL) in uterine atony (primary ligated and secondary added to other uterus sparing techniques), retroperitoneal hematoma, and placenta adherent abnormalities. Material and methods: Fifty two women who underwent IIAL for different causes of postpartum hemorrhage were retrospectively evaluated. Results: Among 26 women with intractable uterine atony, 12 had primary, and 14 secondary IIAL, due to ongoing bleeding following the B-Lynch suture or the Bakri balloon tamponade. The success rates were 91% and 71.4% in the primary and secondary IIAL groups, respectively. The success rates of IIAL in 12 women with placental adhesion abnormalities and another 12 with obstetric retroperitoneal hematoma were 75% (9/12) and 83% (10/12) respectively. Nine (17%) hysterectomies were performed after failure of IIAL. Two maternal deaths occurred in our study. The rate of achieving pregnancy was not significantly different between the groups. Conclusions: Hysterectomy rates might be decreased with the addition of IIAL provided that other uterus sparing techniques; B-Lynch or the Bakri balloon was to fail separately. IIAL can save lives in severe obstetric retroperitoneal hematoma. IIAL does not affect fertility even it is combined with other uterus sparing techniques like the Bakri balloon and B-Lynch suture.

Correlation of rheological parameters in maternal and fetal blood at term

Abstract Objective: An association between maternal and fetal blood rheology has not yet been investigated nor is it known whether and to what extent fetal blood rheology may be affected by maternal conditions. Methods: At delivery, blood was drawn from the cubital vein of 4985 consecutive mothers and from the umbilical cord during birth for determination of blood rheological parameters (erythrocyte aggregation stasis [E0], low shear [E1], plasma viscosity [Pv]) in addition to hemoglobin (Hb) values and hematocrit (Hct). Results: Maternal and newborn Pv (r = 0.2; p < 0.0001) correlated statistically significant. There was a remarkable correlation between fetal Pv and gestational age (r = 0.197; p < 0.001). Iron supplementation during pregnancy led to increased fetal Hb, Hct as well as E0 and E1 (p < 0.0001), did not have a significant impact on neonatal Pv (p = 0.068). Smoking mothers gave birth to neonates with significantly higher Pv (p = 0.049), E0 (p = 0.016) and E1 (p = 0.013). Conclusions: The increase of fetal plasma viscosity at advanced delivery time-points refers to a more gaining protein synthesis by the fetal liver and thus maturity of the fetus. Iron supplementation as well as smoking during pregnancy is associated with a relative hyper-viscosity in the fetus at delivery.

Antiphopholipid Antibodies and Functional Activated Protein C Resistance in Patients With Breast Cancer During Anthracycline-Based Chemotherapy Administered Through an Intravenous Port-Catheter Device

Venous thromboembolic events (VTEs) are life-threatening complications in patients with cancer and remain the second most common cause of death in hospitalized patients with cancer, after death from cancer itself. Patients with breast cancer, however, are considered to be at relatively low risk of developing VTE. In a cohort of 108 255 patients with breast cancer, the 1and 2-year cumulative incidence of VTE was estimated to be 0.9% and 1.2%, respectively. Both chemotherapy in general and the agent used in particular were found to increase the risk of developing VTE. A systematic screening for thrombosis during anthracycline-based regimens in adjuvant settings revealed a higher VTE (10%) rate when compared to the conventional cyclophosphamide methotrexate fluorouracil therapy (5.4%). The route of application of chemotherapeutic agents represents another high risk factor for the development of VTE. Catheter-related thrombosis (CRT) involves 70% to 80% of all upper extremity thrombotic events and represents about 10% of all cases of VTE in patients with cancer receiving chemotherapy. The role of acquired thrombophilia such as the induction of antiphospholipid antibodies (aPL-abs) and lupus anticoagulant (LAC) in the pathogenesis of VTE in patients with breast cancer has been reported but is still a matter of debate. In a prospective, case-controlled study, we assessed the rate of symptomatic VTE in primary nonmetastatic, patients with breast cancer who received adjuvant anthracycline-based chemotherapy regimens postoperatively via an intravenous port-catheter device (Hickman port, Celsite Access Port venous low-profile composite access ports with titanium chamber, Braun Melsungen AG, Germany). The standard combination administered every 3 weeks and for 6-treatment cycles was as follows: cyclophosphamide 500 mg/m, doxorubicin/epirubicin 15 mg/m, and flurouracil 1000 mg/m. Prior to primary surgery and each of the 6 cycles of chemotherapy, laboratory tests for anticardiolipin antibodies (aCL-ab; immunoglobulin [Ig] G-, IgM-enzyme-linked immunosorbent assay [ELISA] >15 U/mL), LAC (partial thromboplastin time ratio > 1.2), resistance to activated protein C (APC, Coatest; Chromogenix, Molndal, Sweden; APC ratio 500 mg/L) were performed. None of the patients received anticoagulants unless thrombosis was confirmed. Concomitantly, clinical signs for thrombosis were assessed, namely, increasing girth, marked edema, vague pain, and redness in the corresponding upper limb. The collected data were tabulated and analyzed using PSPP-project version 0.7.9, released February 2012. Over a period of 1.5 years, 42 patients with breast cancer (age: 60.6 + 7.5 years) were recruited; 49 age-matched healthy women served as controls (age: 59.0 + 11.2 years; P 1⁄4 .41). In the study period, 7.2% of the patients with breast cancer (n 1⁄4 3) developed symptomatic VTE, which were all localized in the subclavian vein at the side of the port-catheter. All of them occurred after the first chemotherapy cycle and were proven by contrast phlebography. Low-molecular-weight heparin at therapeutic dose was initiated and continued until removal of the device after the sixth cycle of chemotherapy. Symptomatic thrombosis of the pelvic veins, lower extremities, or in other regions was not detected in any of the patients during the