Pectoralis muscle index might be a factor associated with frailty in older women with breast cancer.

BACKGROUND: To investigate the possible relationship between pectoralis muscle (PM) measurement and frailty in older women with breast cancer (BC) (preoperatively defined as stage 1, 2, and 3 diseases). METHODS: This retrospective, observational study was conducted at Konya Training and Research Hospital between June and December 2020. A total of 102 patients [median age 62.5 years, median follow-up period two years] were included in the study. PM measurements were obtained from thorax computerized tomography (CT). Pectoralis muscle index (PMI) was calculated by dividing the PM area by the height square of the patients (cm2/m2). Pectoralis muscle density (PMD) was evaluated using CT findings, including their Hounsfield Units (HU). Frailty status and sarcopenia-risk assessments were done by a telephone interview in September 2020 using the FRAIL index (categorized as robust or nonrobust) and SARC-F questionnaire (classified as no sarcopenia-risk or risk of sarcopenia), respectively. PM measurements were compared between robust and nonrobust patients and between patients with a risk of sarcopenia and no sarcopenia risk. RESULTS: The nonrobust patients had lower pectoralis major muscle index (PMaMI) (p = 0.041) and pectoralis major muscle density(PMaD) (p = 0.020) levels than robust patients in the whole study sample. PMI (p = 0.017) and PMaMI (p = 0.010) levels were significantly lower in the nonrobust patients than in robust patients with early-stage BC. Frailty status was positively correlated with age (rho: 0.621; p < 0.001), BC stage (rho: 0.220; p = 0.026), and SARC-F score (rho: 0.747; p < 0.001), and negatively correlated with PMaMI (rho: -0.197; p = 0.047) and PMaD (rho: -0.237; p = 0.016). There were significant associations between PMaMI (OR: 0.467, 95% Confidence Interval (CI): 0.226-0.962 p = 0.039) and PMI (OR: 0.543, 95% CI: 0.299-0.986 p = 0.045) levels with frailty status (being nonrobust) in regression models. DISCUSSION: In the study, it has been shown that pectoralis muscle assessment might be a related parameter to frailty in older women with breast cancer.

The Importance of Superb Microvascular Imaging for the Differentiation of Malignant Breast Lesions from Benign Lesions.

OBJECTIVE: In this prospective study, the diagnostic performance of the new version of superb microvascular imaging (SMI) in differentiating malignant from benign lesions was evaluated. MATERIAL AND METHODS: Ninety breast lesions were included. During color SMI examination, both free-hand region of interest (ROI) and box ROI were used. Vascular index (VI) values were obtained from the lesion using both types of ROI and from normal breast tissue via box ROI. VI values, monochrome SMI grading and histopathological results were compared. The efficacy of color SMI and monochrome SMI was investigated in differentiating between benign and malignant breast lesions. RESULTS: The cut-off value, in the differentiation of benign and malignant lesions with color SMI was 0.50 for box ROI, while it was 0.30 for free-hand ROI. The specificity of VI values obtained with box ROI was higher than that of free-hand ROI when differentiating malignant lesions from benign. Comparison of VI values from a lesion and from normal breast tissue showed that VI values in malignant lesions were significantly higher (p<0.05). The VI values of benign lesions and VI values of normal breast tissue were similar. There was a statistically significant relationship between monochrome SMI grading and the malignancy or benign status of the lesion (p<0.001). CONCLUSION: Drawing the lesion circumference free-hand using a free-shape ROI did not enhance the sensitivity and specificity. Contrary to popular belief, a more easy and practical measurement method may be more suitable for SMI examination. It is hoped that this will be one of the earliest studies to assess the clinical performance of the latest version of SMI.

Serum sclerostin level and its relation to subclinical atherosclerosis in the polycystic ovary syndrome phenotypes: A prospective controlled study

Objective: We aim to study the relationship between atherosclerosis and serum sclerostin levels in different phenotypes of polycystic ovary syndrome (PCOS). Materials and Methods: A total of 134 women with PCOS and 33 age-matched controls participated in this study. Women with PCOS were further divided into subgroups based on their PCOS phenotypes: phenotype A (n=35), phenotype B (n=33), phenotype C (n=31), and phenotype D (n=35). Metabolic parameters, hormonal parameters, carotid intima-media thickness (CIMT), and sclerostin levels were compared among the PCOS phenotypes. Results: Statistically significant differences occurred among groups regarding follicle-stimulating hormone, luteinizing hormone, estradiol, total cholesterol, low-density lipoprotein, Ferriman-Gallwey score, total testosterone, and free androgen index. The mean CIMT was statistically higher in all PCOS phenotypes than in controls. In subgroup comparison, phenotypes A and B had a higher body mass index (BMI) adjusted CIMT than other phenotypes, respectively (p=0.005). Serum sclerostin levels were higher in PCOS patients than in controls. A concentration of ≥6.297 ng/mL showed a sensitivity of 56% and a specificity of 69.7% to predict PCOS. The BMI-adjusted sclerostin level was significantly higher in phenotype C (20.3±0.7 ng/mL) than in other phenotypes. Conclusion: Patients with phenotypes A and B seem to have an increased risk for atherosclerosis. Although sclerostin was higher in PCOS patients, we could not demonstrate the relation between sclerostin and atherosclerosis in different PCOS phenotypes.

Results of Excision of Unknown Papillary Neoplasms Detected on Core Biopsy.

OBJECTIVE: This study aimed to find out valuable parameters that predict the nature of breast papillary lesions before excision, and we compared our results with those in the literature. MATERIALS AND METHODS: We reviewed the medical records and pathology slides of patients diagnosed with papillary neoplasm after undergoing a core-needle biopsy between 2010 and 2020, who, subsequently, underwent surgical excision in a single tertiary care institution. The core biopsy results and pathology results of excision materials were compared with the radiological, pathological, and demographic findings. RESULTS: A total of 51 patients were included in the study. According to the excision results, the patients were divided into two groups: the atypical group, which included 20 patients (39.3%), and the benign group, which included 31 patients (61.7%). The results of the core biopsy showed that the loss of myoepithelial cell layer was identified in 18 patients in the atypical group, while it was present in all patients in the benign group. Tumor sizes were larger and patient ages were older in the atypical group compared with the benign group. No significant difference was found between atypical and benign groups in terms of breast imaging-reporting and data system (BI-RADS) classification and location (right vs left; central vs peripheral). The upgrade rate was between 0% and 16% in literature, while it was 4% in our study. CONCLUSION: There is no consensus on whether patients diagnosed with papillary neoplasia as a result of core biopsy will undergo excision. According to our results, patients with following criteria should have their lesions excised: those who are advanced in age, those who are diagnosed with a papillary lesion as a result of core biopsies with loss of myoepithelial cell layer, and those who are diagnosed with large-sized lesions without loss of myoepithelial cell layer. Patients diagnosed with small-sized lesions without loss of myoepithelial cell layer and who are young in age are to be followed up without the need for lesion excision. The lesions should be adequately sampled.

Evaluation of Ovaries in Patients with Polycystic Ovary Syndrome using Shear Wave Elastography.

BACKGROUND: Shear wave electrography (SWE) is a novel non-invasive imaging technique which demonstrate tissue elasticity. Recent research evaluating the elasticity properties of normal and pathological tissues emphasize the diagnostic importance of this technique. AIMS: Polycystic ovarian syndrome (PCOS), which is characterized by menstrual irregularity, hyperandrogenism, and polycystic overgrowth, may cause infertility. The aim of this study was to evaluate the elasticity of ovaries in patients with PCOS using SWE. METHODS: 66 patients diagnosed with PCOS according to the Rotterdam criteria (PCOS = group I) and 72 patients with non-PCOS (Control = group II), were included in the study. Demographic and clinical characteristics of the participants were recorded. Ovarian elasticity was assessed in all patients with SWE, and speed values were obtained from the ovaries. The elasticity of the ovaries was compared between the two groups. RESULTS: While there were statistically significant differences between the groups in body mass index (BMI), right and left ovarian volumes, luteinizing hormone and testosterone levels (p<0.05), no significant differences were found between groups I and II in the velocity (for the right ovary 3.89±1.81 vs. 2.93±0.72, p=0.301; for the left ovary 2.88±0.65 vs. 2.95±0.80, p=0.577) and elastography (for the right ovary 36.62±17.78 vs. 36.79±14.32, p=0.3952; for the left ovary 36.56±14.15 vs. 36.26±15.10, p=0.903) values, respectively. CONCLUSION: We could not obtain different velocity and elastography values from the ovaries of the patients with PCOS using SWE. Therefore, further large-scale studies are needed to elucidate this issue.

Hysterosalpingographic Findings of Infertile Patients Presenting to Our Reproductive Endocrinology Department: Analysis of 1,996 Cases.

BACKGROUND: To evaluate the hysterosalpingography (HSG) findings of women with infertility in a tertiary center located in central Turkey. METHODS: A total of 1,996 patients undergoing the HSG procedure for the investigation of infertility from April 2012 to 2017 were retrospectively evaluated using the archives of the reproductive endocrinology and radiology departments. Demographic and clinical characteristics of patients with normal HSG findings (n = 1,549) and patients with abnormal HSG findings (n = 447) were compared, and the distribution of pathologies on the HSG examinations was evaluated as well. RESULTS: There were statistically significant differences between patients with normal and abnormal HSG findings in terms of age (25.68 ± 4.54 vs. 35.87 ± 2.65, p < 0.001), type (for secondary) and duration of infertility [43.1% vs. 50.6% (p = 0.006); 7 (1-22) vs. 2 (1-12) (p < 0.001), respectively], and baseline follicle stimulating hormone and estradiol levels [7.22 ± 1.38 vs. 7.55 ± 1.42 (p < 0.001); 45.54 ± 9.92 vs. 44.40 ± 9.99 (p < 0.001), respectively]. Among a total of 1,996 HSG examinations, 447 (22.39%) showed abnormalities, of which 237 (11.87%) were associated with tubal pathologies, 163 (8.17%) with uterine pathologies, and 47 (2.35%) with a combination of both. While the most common tubal pathology was one-sided distal tubal occlusion (2.91%), the most common uterine pathology was filling defects (4.16%). CONCLUSION: HSG is the most commonly used, well-tolerated, low-cost, and safe radiological procedure to use for the investigation of the causes of female infertility.

Effectiveness of Superb Microvascular Imaging for the differentiation of intraductal breast lesions.

AIMS: The aim of this study was to compare the diagnostic performance of superb microvascular imaging (SMI) and power Doppler imaging (PDI) for the differentiation of intraductal breast lesions. MATERIALS AND METHODS: A total of 54 intraductal breast lesions (39 benign, 10 atypical, and 5 malignant) in 53 patients were examined using B-mode ultrasonography, PDI, and SMI. Vascularity grading, distribution of microvessels, and penetrating vessels were evaluated using each Doppler technique. The diagnostic performances of both methods were compared. RESULTS: SMI was more efficient in detecting flow signals than PDI (p=0.004). The highest diagnostic accuracy rates were achieved with SMI using vascular grading. When hypervascularity was used as a cut-off value to differentiate malignant and atypical lesions from benign lesions, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.6%, 80.7%, 66.6%, 80.7%, and 75.6%for PDI, and 86.6%, 76.9%, 68.4%, 90.9%, and 80.4% for SMI, respectively. CONCLUSIONS: SMI is more sensitive than PDI for detecting subtle blood flow in intraductal breast lesions with statistical significance. This novel and promising vascular imaging technique may be helpful in B-mode ultrasonography to distinguish intraductal breast lesions.

Advantages of b-mode ultrasound combined with strain elastography in differentiation of idiopathic granulomatous mastitis from malignant breast lesions

Background/aim: To evaluate the diagnostic performance of strain elastography (SE) combined with B-mode ultrasound in distinguishing between idiopathic granulomatous mastitis (IGM) and malignant breast lesions. Materials and methods: Seventy-seven malignant breast lesions and 36 IGM were assessed using B-mode ultrasound and SE. Ultrasonographic findings for all the breast lesions were classified based on the 2013 American College of Radiology Breast Imaging Reporting and Data System (BI-RADS-US), and the SE findings were evaluated based on the strain ratio and a five-point scale. The diagnostic performances of B-mode ultrasonography, SE, and the combination of both methods were compared. Results: Significant differences in strain ratio and elastography scores were found between IGM and malignant breast lesions. When the lesions were assessed with B-mode ultrasound alone, in order to distinguish between IGM and malignant breast lesions, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 94.8%, 66.7%, 85.9%, 85.7%, and 85.8%, respectively. However, when assessed with a combination of B-mode ultrasonography and SE, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 96.1%, 100%, 100%, 92.3%, and 97.3%, respectively. Conclusion: The combination of SE and B-mode ultrasound has better diagnostic performance in the differentiation of IGM and malignant breast lesions than B-mode ultrasonography alone.

Reference ranges for foetal nasal bone length, prenasal thickness, and interocular distance at 18 to 24 weeks' gestation in low-risk pregnancies.

BACKGROUND: The aim of the present study was to establish the normal ranges for foetal nasal bone length (NBL), prenasal skin thickness (PNT), interocular distance (IOD), and ratio of prenasal thickness to- nasal bone length (PNT/ NBL) at 18-24 weeks using two-dimensional (2D) ultrasound. METHODS: This study was a retrospective study of prenatal ultrasonographic records from 407 foetuses between 18 and 24 weeks gestational age (GA). The NBL, PNT, IOD, PNT/ NBL ratio, biparietal diameter (BPD), and femur length (FL) were investigated. The relationships among NBL, PNT, IOD, PNT/ NBL, and GA were evaluated. Additionally, descriptive statistics for NBL, PNT, and IOD values for each gestational week were obtained. RESULTS: There was a significant association between GA and NBL, PNT, and IOD between 18 and 24 weeks. NBL increased from a mean of 5.5 mm to 8.3 mm, PNT increased from a mean of 3.5 mm to 5.1 mm, and IOD increased from a mean of 11.1 mm to 14.5 mm. PNT/NBL ratio did not change with gestational age. CONCLUSIONS: This study showed normal ranges for NBL, PNT, IOD, and PNT/ NBL ratios for foetuses between 18 and 24 weeks in low-risk pregnancies. There was a positive linear relationship between GA and NBL, PNT, and IOD. The PNT/NBL ratio might be a more useful measurement than NBL or PNT alone.

Usefulness of grayscale inverted images in addition to standard images in digital mammography.

BACKGROUND: Mammography is essential for early diagnosis of breast cancer, which is the most common type of cancer in females that is associated with a high mortality rate. We investigated whether evaluation of the grayscale inverted images of mammograms would aid in increasing the diagnostic sensitivity of the mammographic imaging technique. METHODS: Our study included 636 mammograms of 159 women who had undergone digital mammography. Standard, grayscale inverted, and standard plus grayscale inverted images were sequentially examined three times, at 15-day intervals, for the presence or assessment of pathological changes in the skin, calcification, asymmetric density, mass lesions, structural distortions, and intramammary and axillary lymph nodes. To determine whether grayscale inverted image assessment improved detection rates, the results of the three assessment modes were compared using Cochran's Q test and the McNemar test (p < 0.05 was considered statistically significant). RESULTS: The average age of 159 patients was 50.4 years (range, 35-80 years). There were significant differences among the three assessment modes with respect to calcification and intramammary lymph nodes (p < 0.05); however, no significant differences were observed for the detection of other parameters. CONCLUSIONS: Assessment of grayscale inverted images in addition to standard images facilitates the detection of microcalcification.

The Influence of Fasting in Summer on Amniotic Fluid During Pregnancy.

OBJECTIVES: Ramadan is a holy month in which eating and drinking are forbidden from dawn to sunset. In this study, we investigated using ultrasonography (USG) whether fasting in summer (as occurred in Ramadan 2014) had an influence on the volume of amniotic fluid during pregnancy. MATERIALS AND METHODS: The study included 119 pregnant women in total who were admitted to our department with a request of obstetric USG between June 28, 2014, and July 27, 2014. The fasting group included 61 pregnant women and the control group of 58 pregnant women. In our study, all the fasting pregnant women had Sahur (predawn meal eaten before starting fasting) and Iftar (the evening meal for fast-breaking) every day, regularly. The women in the control group did not fast. In addition to amniotic fluid index and fetal biometric measurements during Ramadan, amniotic fluid volume was measured ultrasonographically throughout pregnancy. All ultrasound examinations were performed at least 8 h after Sahur during Ramadan. Chi-square test was utilized to compare the measurements of amniotic fluid volume, and Mann-Whitney U-test was utilized to analyze the differences in fetal growth data. Moreover, difference was considered statistically significant when the P value was <0.05. RESULTS: The mean age was 25.7 years in the fasting group and 25.8 years in the control group. Other characteristics and mean gestational weeks of the two groups were similar. Ultrasonographically, there was no significant difference between two groups in respect to amniotic fluid amount during pregnancy (P = 0.7). There was no significant difference with regard to fetal growth parameters either (P > 0.05). CONCLUSION: In pregnant women who had regular predawn and fast-breaking meals, fasting in summer did not elicit alteration in the amount of amniotic fluid throughout pregnancy.

Laparoscopic cystectomy for splenic hydatid cyst: a case report.

Even in countries where it is considered endemic, splenic hydatid cyst is a very rare disease in childhood. Partial or total splenectomy has generally been the treatment of choice for this condition. This is the first report of laparoscopic cystectomy as treatment of isolated splenic hydatid cyst in childhood. A 10-year-old girl with isolated splenic hydatid cyst was successfully treated by laparoscopic cystectomy and splenic preservation. The authors have demonstrated that laparoscopic cystectomy for an isolated splenic hydatid cyst is technically feasible, safe, and is associated with a shorter hospital stay and good cosmetic appearance.