Ugur Topal

Transthoracic needle biopsy: factors effecting risk of pneumothorax

OBJECTIVE to evaluate the factors that could effect the risk of pneumothorax in patients undergoing transthoracic biopsy. MATERIAL AND METHODS variables that could increase the risk of pneumothorax were evaluated in 453 CT-guided transthoracic biopsies. Factors were evaluated in two groups: (1) lesion related (presence of emphysema around the lesion, lesion depth, cavitation, presence of fissure/atelectasis and pleural tag in the needle trajectory); and (2) procedure related (biopsy type, needle size, number of passages, level of experience of the operator). All variables were analysed by chi2 test and multivariate logistic regression statistics. RESULTS pneumothorax was developed in 85 (18.8%) out of 453 procedures. A chest tube was inserted in ten (11.7%) of them. Variables that were significantly associated with an increased risk of pneumothorax were depth of the lesion (P<0.001) and severity of the emphysema (P<0.01). CONCLUSION the length of the lung parenchyma traversed during the biopsy is the predominant risk factor for pneumothorax in patients undergoing CT-guided transthoracic biopsy. The risk of pneumothorax was also increased with the severity of the emphysema around the lesion.

Power Doppler sonography: Anything to add to BI-RADS US in solid breast masses?

OBJECTIVE To evaluate the contribution of power Doppler ultrasonography (PDUS) to breast imaging reporting and data system ultrasonography (BI-RADS US) categorization of solid breast masses. MATERIALS AND METHODS Totally 94 solid lesions with histopathological results in 49 patients were included in the study. US features of the lesions were classified according to American College of Radiologists (ACR) BI-RADS US lexicon. Lesions were evaluated qualitatively according to their PDUS properties and quantitatively with spectral analysis. Hypervascularity, penetration of vessels into the mass or branching-disordered course and resistivity index values higher than 0.85 were accepted as probable malignant criteria. RESULTS Fifty-five of 94 lesions were benign (58.5%), while 39 (41.5%) were malignant histopathologically. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US and PDUS in the diagnosis of malignant lesions were 100%, 58.2%, 62.9%, 100% and 71.8%, 81.8%, 73.7%, 80.4%, respectively. Criteria used for the distinction of malignant and benign lesions like number of vessels (p<0.05), distribution of tumoral vessels, morphology of vessels and resistivity index values higher than 0.85 showed statistically significant difference (p<0.001). When sonographic findings were combined with PDUS and spectral analysis findings, sensitivity, specificity, PPV and NPV were 100%, 52.7%, 60% and 100%, respectively. CONCLUSION PDUS and spectral analysis have no contribution to BI-RADS US. For the spectral analysis, when RI value is one or greater, malignancy risk significantly increases.

Effects of hormone replacement therapy regimens on mammographic breast density: The role of progestins

Aim:  To evaluate the effects of different regimens of hormone replacement therapy (HRT) on mammographic breast density.

Carcinoma originating from aberrant breast tissue. A case report and review of the literature

Carcinoma arising from ectopic breast tissue, either supernumerary breast or aberrant breast tissue, is extremely rare. Carcinoma occurs more frequently in the ectopic breast tissue of the axilla than in extra-axillary ectopic breast tissue. Here we report a case of an invasive lobular carcinoma arising from extra-axillary ectopic breast tissue and presenting as a subcutaneous nodule.

Phase II Study of Gemcitabine Plus Paclitaxel in Metastatic Breast Cancer Patients with Prior Anthracycline Exposure

Chemotherapy provides palliation and modest prolongation of symptom-free survival in metastatic breast cancer. Taxane containing regimens are commonly considered to be among the initials in metastatic setting due to earlier use of anthracyclines in the course of breast cancer. Therefore, we conducted this Phase II study to assess efficacy and safety of gemcitabine plus paclitaxel (GT) combination therapy in anthracycline pretreated metastatic first-line setting. Patients and Methods: The study enrolled 26 women with pathologically confirmed and measurable metastatic breast cancer who were previously treated with anthracycline but no prior chemotherapy for metastatic disease. Twenty six and twenty four patients were eligible for toxicity and efficacy evaluations respectively. Mean age was 47.3 years and median ECOG performance status was 0. Twenty patients (76.9 percent) had visceral metastases, most commonly located in liver and lung. Treatment schedule was as follows: paclitaxel 175 mg/m2 was administered intravenously in 3 hours on Day 1 and gemcitabine 1000 mg/m2 was administered intravenously in 30 minutes on Day 1 after paclitaxel application, and on Day 8 every 21 days. Results: Objective response rate was 41.7 percent (95 percent CI: 21.9–61.4) with 16.7 percent (95 percent CI: 1.7–31.6 percent) CR, and 25.0 percent (95 percent CI: 7.6–42.3 percent) PR. Median time to progression and overall survival were 9.6 and 14.5 months, respectively. Grade 3–4 toxicity was observed in 34.6 percent (9) patients. Treatment of two patients was discontinued due to toxicity, consisting of Grade 3 hypersensitivity reactions and Grade 4 infections in one patient each. Dose reductions due to myelotoxicity were performed in 4 (15.3 percent) patients. Hematologic toxicities were generally manageable with appropriate dose modifications and supportive care. Conclusion: Gemcitabine and paclitaxel combination regimen is effective and has manageable toxicity profile as first line metastatic setting.

Malignant spiculated breast masses: Dynamic contrast enhanced MR (DCE-MR) imaging enhancement characteristics and histopathological correlation

AIM Spiculation of breast masses is usually the result of significant desmoplastic reaction. Diminished neovascularization is expected due to sparsely dispersed tumor cells within the lesion. This feature can cause differences in enhancement patterns which can cause pitfalls while evaluating MR images as well. Aim of this study is to explore the enhancement characteristics of malignant spiculated masses and to correlate these findings with histopathological features. MATERIALS AND METHODS Eighteen spiculated and seventeen non-spiculated masses depicted with mammography were included in the study. MR imaging was performed with 1.5 T magnet with breast coil. In MR imaging, T2-weighted turbo spin echo (TSE) with fat suppression sequence followed by pre- and post-contrast T1-weighted 3D-fast low angle shot (FLASH) sequences were used. Lesions were evaluated according to enhancement characteristics: early phase enhancement (first 2 min; less than 50%, 50-100% and more than 100%), late phase enhancement (2-6 min; persistent, plateau and washout) and inner enhancement pattern (homogenous, heterogenous and rim). Desmoplasia and lymphocyte infiltration was classified as mild, moderate and severe. MR images and histopathological findings (desmoplasia, lymphocyte infiltration and grade) of both groups were compared. RESULTS Mean ages of patients in spiculated and non-spiculated-mass groups were 55.07 (41-71) and 47.35 (31-62), respectively. Mean diameter of lesions was 17.3mm (10-31 mm) for spiculated masses while non spiculated masses were 15.8mm (6-40 mm). There were statistically significant differences between late phase enhancement, persistent enhancement, plateau and washout (p<0.05). Intergroup comparison of desmoplasia revealed significant difference between severe versus and mild, moderate (p<0.05). CONCLUSION Spiculated malignant lesions are supposed to contain intense desmoplastic reaction. On DCE-MR images they can show persistent enhancement pattern more often than non-spiculated lesions.

Desmoid tumor of the chest wall

Abstract Desmoid tumors are low-grade fibrosarcomas that do not metastasize but are frequently associated with one or more recurrences and subsequent associated morbidity. Desmoid tumors of the chest wall are rare and have been described mainly in single case reports or as isolate cases in large series of extra-abdominal desmoid tumors. We report a case of desmoid tumor in the chest wall mimicking superior sulcus tumor.

Chemical Shift MRI: Is There any Contribution to Morphologic Evaluation of Solid Breast Masses?

RATIONALE AND OBJECTIVES To investigate the contribution of chemical shift magnetic resonance imaging for assessment of the margins of solid breast masses by benefiting from India ink artifact. METHODS AND MATERIALS Eighty-eight masses in 64 patients were evaluated in T1- and T2-weighted images, dynamic contrast and chemical shift studies according to Breast Imaging Reporting and Data System magnetic resonance lexicon. Subtraction images were automatically obtained by chemical shift imaging and dynamic studies. Each sequence was scored using a scale of 1 to 5 according to its ability to demonstrate margins separate from surrounding parenchyma. Breast parenchyma was evaluated as fatty and dense. The results were compared with the histopathologic results. RESULTS Twenty-eight (31.8%) of the lesions were localized in fatty breast, and the remaining 60 (68.2%) lesions were localized in dense breast. There were 34 (38.6%) benign and 54 (61.4%) malignant masses. In fatty breast, chemical shift subtraction and T1-weighted images were valuable both for the demonstration and differentiation of benign lesions (P < .05). None of the sequence was valuable for both the demonstration and differentiation of malignant lesions in fatty breasts (P > .05). In dense breasts, chemical shift subtraction and dynamic contrast subtraction images were valuable for both the demonstration and differentiation of benign and malignant lesions. Additional to these sequences, T2-weighted images was also valuable for benign lesions (P < .05). CONCLUSION Chemical shift subtraction can contribute to routine dynamic contrast subtraction in morphologic analysis particularly for the evaluation of margins of benign lesions in fatty breasts. It can also help in morphologic analysis of masses in dense breast.

Risk factors of pneumothorax and chest tube placement after computed tomography-guided core needle biopsy of lung lesions: a single-centre experience with 822 biopsies

Purpose To determine the risk factors of pneumothorax and chest tube placement after computed tomography-guided core needle lung biopsy (CT-CNB). Material and methods Variables that could increase the risk of pneumothorax and chest tube placement were retrospectively analysed in 822 CT-CNBs conducted with 18-gauge non-coaxial CT-CNB in 813 patients (646 men and 167 women; range: 18-90 years; mean: 59.8 years). Predictor variables were age, gender, patient position, severity of pulmonary emphysema, lesion size and localisation, contour characteristics, presence of atelectasis, pleural tag and fissure in the needle-tract, length of the aerated lung parenchyma crossed by the needle, needle entry angle, number of pleural punctures, experience of the operator, and procedure duration. All variables were investigated by ×2 test and logistic regression analysis. Results The overall incidence of pneumothorax was 15.4% (127/822). Chest tube placement was required for 22.8% (29/127) of pneumothoraxes. The significant independent variables for pneumothorax were lesions smaller than 3 cm (p = 0.009), supine and lateral decubitus position during the procedure (p < 0.001), greater lesion depth (p = 0.001), severity of pulmonary emphysema (p < 0.001), needle path crossing the fissure (p < 0.001), and a path that skips the atelectasis (p < 0.001) or pleural tag (p < 0.001); those for chest tube placement were prone position (p < 0.001), less experienced operator (p = 0.001), severity of pulmonary emphysema (p < 0.001), and greater lesion depth (p = 0.008). Conclusions The supine and lateral decubitus position, a needle path that crosses the fissure, and a path that skips the atelectasis or a pleural tag are novel predictors for the development of pneumothorax.

A Case of Conjunctival Melanoma Presenting with Breast Metastasis

DOI: 10.4328/JCAM.1137 Received: 06.06.2012 Accepted: 02.07.2012 Printed: 01.09.2015 J Clin Anal Med 2015;6(5): 633-4 Corresponding Author: Mustafa Canhoroz, Department of Medical Oncology, Fırat University, 23100, Elazığ, Turkey. T.: +905052379326 F.: +904242388096 E-Mail: mcanhoroz@gmail.com Özet Meme kitlelerinin çoğunluğu memeden kaynaklanan kitlelerdir. Meme metastazı nadir karşılaşılan bir durumdur. Meme derisi ve parankimi çeşitli tümörler için metastaz yeri olabilmektedir. Özellikle lösemi, akciğer kanseri ve malign melanom memeye metastaz yapabilen tümörlerdendir. Meme metastazı ilk semptom olabilmekle birlikte primer malignitesi olanlarda takipte ortaya çıkabilmektedir. Primer malign melanom tanısı olan hastalarda meme metastazı arasındaki süre ortalama 62 (13-178) ay olarak belirlenmiş. 7 vakalık bir çalışmada hematolojik nedenler (HL, NHL, Lösemi) ön planda iken 1 vakada malign melanom saptanmış. Memeye metastaz yapmış 15 vakalık malign melanoma serisinde sıklıkla primer tümör üst ekstremite ve gövde yerleşimli saptanmış. 256 vakalık bir konjunktival malign melanom serisinde mortalite sıklığı tümör derinliği >4 mm olanlarda belirgin yüksek saptanmış. 45 vakalık bir başka seride de tümör çapının > 10 mm olması yüksek mortalite ile ilişkili bulunmuş. Sonuç olarak primer malignitesi olan hastalardaki meme kitlesinin mutlaka primermetastaz, malign-benign ayrımını için histopatolojik değerlendirilme yapılması gerekmektedir.