Emine Öztürk

Preoperative Evaluation of Axillary Lymph Nodes in Malignant Breast Lesions with Ultrasonography and Histopathologic Correlation

Purpose: Our aim is to define the sonographic criteria for assessing involved axillary nodes and to evaluate the accuracy of axillary ultrasound in the staging workup of individuals with breast cancer. Materials and Methods: Thirty-five patients with breast cancer were prospectively evaluated with preoperative ultrasonography (US) to determine the presence of axillary lymph node metastasis. We determined whether there was axillary lymph node metastasis after axillary lymph node dissection or sentinel lymph node biopsy. If metastasis was found, the number of metastatic lymph nodes was recorded and compared with preoperative axillary US findings using histopathological evaluation as a reference. Results: Metastatic lymph node detection in sonographic evaluation was associated with echogenic hilus obliteration, complete hypoechoic or anechoic appearance of lymph nodes, and asymmetric/nodal or diffuse cortical thickening greater than 3.8 mm. The overall sensitivity, specificity, positive predictive value, and negative predictive value of US were calculated as (20/22) 91 percent, (10/13) 77 percent, (20/23) 87 percent, and (10/12) 83 percent, respectively. Conclusion: Ultrasonography examination is a valuable method for evaluating the axilla in newly diagnosed breast cancer patients and provides valuable information for planning proper breast cancer management.

Can Breast Magnetic Resonance Imaging Prevent Biopsy or Change the Management of BI-RADS® Category 4 Breast Lesions?

The BI-RADS® category 4 includes suspicious breast lesions which requires biopsy. The aim of this study is to investigate the contribution of breast magnetic resonance imaging to the management of BI-RADS® category 4 breast lesions detected by mammography and∕or ultrasonography. Thirty-four lesions classified as BI-RADS® category 4A, 4B, or 4C by conventional methods were evaluated with magnetic resonance imaging. All lesions were coded by using the American College of Radiology BI-RADS® lexicon. Each lesion was verified with the result of pathology. Lesions were evaluated as BI-RADS® category 1 in 1 patient (2.9%), category 3 (20.6%) in 7 patients, category 4 in 25 patients (73.6%), and category 5 in 1 patient (2.9%) with breast magnetic resonance imaging. Only the BI-RADS® 4A lesion categories were changed by breast magnetic resonance imaging, and these lesions were pathologically diagnosed as benign. The negative predictive value of breast MRI for BI-RADS® category 4A lesions was calculated as 100%. In all BI-RADS® category 4 lesions, pathologically 4 lesions found to be high risk and 3 lesions found to be malignant. The sensitivity, specificity, positive predictive, and negative predictive value of breast magnetic resonance imaging in BI-RADS® category 4 lesions were calculated as 100, 29.6, 26.9, and 100%, respectively. The area under the ROC curve was calculated 0.648. Breast magnetic resonance imaging is promising to be used as a problem-solving modality in BI-RADS® category 4A breast lesions.

Sentinel Lymph Node Detection by 3D Freehand Single-Photon Emission Computed Tomography in Early Stage Breast Cancer.

We herein present our first experience obtained by 3D freehand single-photon emission computed tomography (SPECT) (F-SPECT) guidance for sentinel lymph node detection (SLND) in two patients with early stage breast cancer. F-SPECT guidance was carried out using one-day protocol in one case and by the two-day protocol in the other one. SLND was performed successfully in both patients. Histopathologic evaluation showed that the excised nodes were tumor negative. Thus, patients underwent breast-conserving surgery alone.

Mammographic and Ultrasonographic Findings of Different Breast Adenosis Lesions

Aim: To describe imaging features of different breast adenosis lesions. Materials and methods: Mammographic and ultrasonographic findings of patients with different types of adenosis were reviewed retrospectively Tissue samples were obtained either with US-guided core needle biopsy or localization with needle-wire system and surgical excision. Results: Forty-three adenosis lesions were diagnosed in 41 patients: 27 sclerosing adenosis, 13 blunt duct adenosis and 3 microglandular adenosis. Most frequent abnormal findings of sclerosing adenosis were masses with non-circumscribed margins and focal acoustic shadowing without mass configuration (54%) on ultrasonography. Mammography was normal in 54% of sclerosing adenosis, the most common abnormality was architectural distortion (21%). In blunt duct adenosis, usually circumscribed masses (46%) were detected on ultrasonography, clustered punctate microcalcifications (23%) and circumscribed masses (23%) were observed on mammography. All microglandular adenosis lesions were non-circumscribed masses. Premalignant components were detected only with surgical excisional biopsy in three patients that showed suspicious radiological findings and benign pathological result on core biopsy. Conclusion: The adenosis lesions have no pathognomonic characteristics on mammography and ultrasound. Total excision may be considered when suspicious radiological findings are present although core needle biopsy results are benign.

İnce Barsak Hastalıklarında Enteroklizis’in Tanı Değeri

Amac: Ince barsak hastaliklarinda enteroklizisin tanisindaki degerini arastirmak. Gerec-Yontem: Ust ve alt gastrointestinal sistem degerlendirmesi ile nedeni aciklanamayan abdominal agrilar, kronik diare, nedeni aciklanamayan ancak primer ince barsak hastaligi olasiligi tasiyan kilo kaybi, halsizlik, anemi gibi yakinma ve bulgulari olan yaslari 15-84 (ort yas 47.5) arasinda degisen 9’u erkek, 7’si kadin toplam16 hastaya; baryum sulfat ve metil selluloz eriyiginin kullanildigi Herlinger teknigi ile cift kontrast enteroklizis incelemesi yapildi. Bulgular: Dort olguda malabsorbsiyon bulgulari (ince barsak segmentlerinde dilatasyon, motilitede artis, mukozal sivanmada azalma), Crohn hastaligi tanisi alan 3 olgudan ikisinde; terminal ileumde rijidite, distal kesimde ulserler, bir olguda kolon ½ distal kesiminde haustrasyon kaybi izlendi. Bir olguda askarise ait dolum defekti, 1 olguda cekum kitlesinin invazyonuna sekonder terminal ileumda rijidite ve mukozal duzensizlik, 1 olguda foldlarda kalinlasma, 2 olguda ince barsak segmentlerine distan basi bulgusu, 2 olguda normal bulgular, 1 olguda motilitede azalma, 1 olguda terminal ileumda gecirilmis operasyona sekonder degisiklikler izlendi. Sonuc: Enteroklizis, endoskopik ve radyolojik inceleme olanaklarinin sinirli oldugu ince barsak hastaliklarinin tani ve ayirici tanisinda yuksek dogruluk oranlarina sahip, oldukca duyarli bir inceleme yontemidir.