Füsun Taşkın

Sclerosing adenosis of the breast: radiologic appearance and efficiency of core needle biopsy.

PURPOSE To examine the mammography and ultrasonography findings of patients who have a final histopathological diagnosis of sclerosing adenosis after breast biopsy, and to evaluate the follow-up results of patients who underwent core needle biopsies. MATERIALS AND METHODS Seventy-six of the 723 patients who underwent breast biopsy in our institution were diagnosed with sclerosing adenosis on histopathological examination. Mammography and ultrasonography findings from these 76 lesions were analyzed retrospectively. Thirty-seven of these lesions were sampled by image-guided core needle biopsy; the remaining lesions were excised surgically. Mammograms and ultrasound images of the lesions were re-evaluated, and the post-biopsy medical records of these patients were evaluated. RESULTS Sclerosing adenosis was the main diagnosis in 41 patients and the complementary diagnosis in 35 patients. Among the first 41 lesions in which sclerosing adenosis was the main diagnosis, there were 18 (44%) mass lesions, 16 (39%) microcalcification clusters, two (5%) lesions with asymmetrical opacity, three (7%) lesions with architectural distortion, and two (5%) lesions with focal acoustical shadowing that was only detected by ultrasonography. No alterations suggesting malignancy were noted during the follow-up examinations of 35 patients who underwent core needle biopsy. CONCLUSION Sclerosing adenosis is a benign proliferative disease of the breast that can be confused with malignancy on clinical, radiological, and even histopathological examination. There is no typical radiological criterion for diagnosis. Core needle biopsy or excisional biopsy can be used, depending on the lesions characteristics. Core needle biopsy can be the first step in the diagnosis of sclerosing adenosis.

The impact of pre-procedural waiting period and anxiety level on pain perception in patients undergoing transrectal ultrasound-guided prostate biopsy.

PURPOSE To investigate the effect of pre-procedural waiting period and anxiety level on pain perception during transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS Sixty patients who had undergone transrectal ultrasound-guided prostate biopsy were enrolled in this prospective study. The subjects were asked to fill out the State-Trait Anxiety Inventory Scale-1 to measure the level of state anxiety at three times: 1) at the time of the procedure request, 2) before the procedure, and 3) before getting the result. Just after biopsy, the patients were asked to fill out a visual analog scale to evaluate pain perception resulting from the biopsy. RESULTS The mean pre-procedural level of state anxiety score was well correlated with the visual analog scale score (r=0.498; P < 0.001). The mean level of state anxiety scores before biopsy (39.7±9.4) and before getting the result (39.9±8.4) were significantly higher than the mean level of state anxiety score when the procedure was requested (31.4±7.9) (P < 0.001 for both). The patient group was divided into two subgroups according to the waiting time between the request and the procedure itself; the cut-off value between the short and long groups was 10 days. The difference between the mean visual analog scale scores from transrectal ultrasound-guided prostate biopsy patients with the short (n=23, 1.49±0.95) and long (n=37, 2.35±1.12) waiting periods was statistically significant (P = 0.003). CONCLUSION In conclusion, performing the transrectal ultrasound-guided prostate biopsy procedure as soon as possible and using more effective anesthetic methods, especially for patients with high level of state anxiety scores, may have a positive impact on patient tolerance.

Sonographic features of histopathologically benign solid breast lesions that have been classified as BI-RADS 4 on sonography

To describe the sonographic (US) features associated with ultrasonography BI‐RADS category 4 lesions that have a benign histopathological outcome.

Pseudolesions of left liver lobe during helical CT examinations: prevalence and comparison between unenhanced and biphasic CT findings

OBJECTIVE Localized low attenuated areas (pseudolesions) in the medial segment of left liver lobe are not rarely seen in the screening of abdomen using helical CT. The purpose of this study was to determine the prevalence of pseudolesions in the routine helical CT of abdomen and to evaluate the morphologic and enhancement features of pseudolesions in the unenhanced and enhanced CT examinations. MATERIALS AND METHODS We retrospectively evaluated 333 contrast enhanced abdominal CT examination of 328 patients with no known liver disease, to detect the presence of pseudolesion of liver. In the presence of unenhanced and arterial phase examinations, these images were also analyzed. The imaging criteria for pseudolesion of liver was localized low attenuated area with geometric, ovoid or nodular shaped and with no mass effect adjacent to the falciform ligament, gallbladder, or porta hepatis. Previous CT, CTAP and MR examinations were also reviewed to understand the evolution of pseudolesion in patients in whom a pseudolesion was detected in the portal phase of helical CT examination. RESULTS We identified a pseudolesion in the 65 (19.8%) of 328 patients in portal phase of helical CT examinations. Pseudolesions were identified in the medial segment of left liver lobe adjacent to falciform ligament in the 92.8% of patients, both sides of falciform ligament in the 1.5% of patients, adjacent to porta hepatis in the 3% of patients and adjacent to gallbladder 3% of patients. These lesions had triangular shape in the 66.1% of patients, ovoid shape in the 18.6% of patients, and nodular shape in the 15.3% of patients. Unenhanced, arterial and portal phase images were exist in the 50.7% of 65 patients. The pseudolesions were not identified on the unenhanced images in the 75.7% of patients and on the arterial phase images in the 55.6% of patients. CONCLUSION Pseudolesions around the falciform ligament are not rarely seen in the routine helical CT examination of liver and abdomen. The pseudolesions are more encountered in the portal phase of helical CT examination. These lesions seem to be likely focal fatty infiltration or perfusion defect due to venous supply variation or both. Nodular shaped pseudolesions may be interpreted as true tumors and further study may require for differential diagnosis.

Imaging-Histological Discordance after Sonographically Guided Percutaneous Breast Core Biopsy

Background: The objectives of this study were to determine the frequency of imaging-histological discordance and to compare the frequency of carcinoma between discordant lesions at ultrasound (US)-guided core needle biopsy. Materials and Methods: From November 2009 to June 2012, we performed US-guided 14-gauge core needle biopsies on 989 breast lesions in 961 women. We reviewed 58 (5.8%) cases that had imaging-histological discordance after percutaneous breast biopsy and underwent subsequent excisional biopsy. The clinical, radiological, and histological findings were reviewed for those 58 cases. Results: Among the 58 cases, subsequent excisions revealed 16 (27.5%) malignancies, which were categorized as 9 (15.5%) invasive ductal carcinomas, 4 (6.9%) malignant phyllodes tumors, and 3 (5.1%) ductal carcinomas in situ. Conclusion: The malignancy rate of 27.5% suggests that surgical excision should be performed in those cases presenting with imaging-histological discordance after US-guided core biopsy. Careful correlation of clinical, radiological, and histological results as well as appropriate follow-up are essential.

Review and management of breast lesions detected with breast tomosynthesis but not visible on mammography and ultrasonography

Background Breast tomosynthesis is more sensitive than mammography and can detect lesions that are not always visible with conventional methods such as digital mammography (MG) and ultrasonography (US). No standardized approach is available for the management of lesions that are detectable with tomosynthesis but are not visible on MG or US. Purpose To review suspicious breast lesions detected with tomosynthesis but not visible on two-dimensional (2D) MG or US and to determine the management options for these lesions. Material and Methods Ethical committee approval was obtained. The radiological records, biopsy or surgery results, and follow-up findings of 107 patients who had a tomosynthesis-positive but MG- or US-negative breast lesion between 2011 and 2016 were retrospectively evaluated. Results Of 107 lesions visible only with tomosynthesis, 74% were architectural distortions and 26% were asymmetrical opacities. All patients underwent magnetic resonance imaging (MRI) for further evaluation. Among the 48 (45%) MRI-negative lesions, none had a suspicious alteration during the follow-up period. Among the MRI-positive lesions, 28% of the 50 architectural distortions and 11% of the nine asymmetrical opacities were malignant. Conclusion Given the inherent high false-positive rate of breast tomosynthesis, breast MRI prior to biopsy may reduce the number of unnecessary biopsies for suspicious breast lesions that are tomosynthesis-positive only.

Correlation of Tumoral Prognostic Factors by Sonoelastography Score in Patients to be Operated Due to Breast Cancer

Predictability of pre-op prognosis on patient with a diagnosis of breast cancer is quite valuable for the choice of both surgical technique and adjuvant therapy. With the aim of evaluation of sonoelastography score utility in this respect, correlation of tumoral prognostic factors by sonoelastography score in patients be operated due to breast cancer was analyzed on our study. Pre-op sonoelastography results and tumoral hystopathological properties of 60 patients operated with a diagnosis of breast cancer in 2011 at Adnan Menderes University Faculty of Medicine General Surgery Department were analyzed retrospectively. As an elastography scoring method, “Tsukuba scoring system” was used. Statistically significant differences(p < 0,05) were determined between tumor grade and Ki-67 analyzed as prognostic factor with tumors reported as sonoelastography score 4 and score 5, on the other hand there were no statistically significant differences between tumor size, positivity of axillary lymph nodes, significance of lymphovascular invasion, p-53 positivity, CerbB-2 positivity, hormone receptor positivity, tumor hysthologic type and applied surgical technique between tumors reported as elastography score 4 and score 5. (p > 0.005). Foresee ability of prognostic factors correlation by sonoelastography score will be guide way for the choice of surgery technique, determination of adjuvant therapy and patient follow-up.

Problem-solving breast MRI: useful or a source of new problems?

PURPOSE We aimed to evaluate the findings and results from breast magnetic resonance imaging (MRI) examinations performed for problem-solving purposes due to inconclusive conventional imaging findings. METHODS Imaging findings, biopsy and follow-up results were retrospectively evaluated for breast MRI performed for problem-solving purposes at our department between January 2011 and December 2016 for cases whose mammography, tomosynthesis, or ultrasonography findings were inconclusive. RESULTS Lesions were identified in 414 of 986 problem-solving MRI examinations, and 13.3% of these lesions were diagnosed as malignant. A total of 124 lesions were additionally found by MRI, and 9.7% of these lesions were diagnosed as malignant. MRI produced false-negative results in four cases. In cases whose conventional imaging methods yielded indefinite results, the sensitivity, specificity, negative and positive predictive values of MRI were found to be 96.3%, 83%, 99.3%, and 46.5%, respectively. For the additional lesions identified, the sensitivity, specificity, negative and positive predictive values of MRI were found to be 91.7%, 69%, 98.7%, and 24%, respectively. CONCLUSION Breast MRI is a reliable problem-solving method for excluding malignancy that cannot be confirmed by conventional imaging. In such cases, additional findings from MRI may help identify new cancers that cannot be detected with conventional methods. However, it has moderately low specificity which may cause unnecessary biopsies, follow-ups, and anxiety to patients.

The role of tomosynthesis in intraoperative specimen evaluation

To investigate the contribution of breast tomosynthesis to intraoperative specimen evaluation in subjects with breast cancer. Approval was obtained from the hospital ethics committee. Specimen mammography, tomosynthesis, and, if available, ultrasonography images were retrospectively assessed for 208 women who had undergone conservative surgery at our hospital between January 2013 and April 2016 after being diagnosed with breast cancer. The success of mammography, tomosynthesis, and ultrasonography in lesion detection and characterization was evaluated. Of 208 lesions, 142 (68.3%) and 198 (95.2%) were detected by mammography and tomosynthesis, respectively. All lesions were detected in 150 subjects undergoing ultrasonography (124 dense breasts, 26 fatty breasts). In 84 women who had fatty breasts, all lesions were detected both by mammography and by tomosynthesis. In 124 women with dense breasts, lesions were detected by mammography in 59 (48%) and in 114 (92%) by tomosynthesis. The success of tomosynthesis in lesion detection was found to be markedly higher than mammography (P = .00). In conclusion, tomosynthesis contributed to mammography in specimen evaluation in a total of 101 subjects. The success of tomosynthesis in lesion detection and characterization during intraoperative specimen evaluation is higher than mammography. In daily practice, ultrasonography is performed for lesions which cannot be evaluated by specimen mammography due to dense parenchymal pattern. Tomosynthesis may reduce the need for and the time and workforce allocated to specimen ultrasonography in an important group of subjects.

Lesion characteristics, histopathologic results, and follow-up of breast lesions after MRI-guided biopsy

PURPOSE We aimed to assess the effectiveness of magnetic resonance imaging (MRI)-guided vacuum-assisted breast biopsy (VABB), evaluate and compare the characteristics and histopathologic findings of lesions, and overview the follow-up results of benign lesions. METHODS MRI findings and histopathologic results of breast lesions biopsied by MRI-guided VABB between 2013 and 2016 were retrospectively analyzed. MRI findings closely related with malignancy were investigated in particular. Follow-up results of benign lesions were evaluated. RESULTS MRI-guided VABB was applied to 116 lesions of 112 women. Of the lesions, 75 (65%) were benign, while 41 (35%) were malignant. Segmental (94%), clustered (89%), and clustered ring (67%) non-mass-like enhancement patterns were found to be more related with malignancy. False-negative rate of MRI-guided VABB was 12%, underestimation rate was 21%. One of the 54 followed-up benign lesions had a malignant result. CONCLUSION MRI-guided VABB is a reliable method for the diagnosis of breast lesions that are positive only on MRI. Follow-up results show that cancer detection rate is low for radio-pathologically concordant lesions. Further multicenter studies with larger patient population are needed to elucidate these results.