Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study.

PURPOSE: The clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions. METHODS: This retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson's chi-squared test, the Fisher-Freeman-Halton test, and Fisher's exact test were used for the statistical analyses. RESULTS: The overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes. CONCLUSION: ADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision.

Relationship of chest computed tomography score with disease severity and laboratory values in children with COVID-19.

AIM: Although chest computed tomography (CT) score has been well evaluated in adult coronavirus disease (COVID-19), its use in paediatric cases is insufficiently studied. Our aim is to evaluate the relationship of chest CT score with disease severity and laboratory parameters. METHODS: Seventy-six paediatric patients with confirmed COVID-19 and chest CT evaluation on admission have been included in this study. Chest CT score was calculated for each of the five lobes considering the extent of anatomical involvement, as follows: 0: 0%; 1: <5%; 2: 5%-25%; 3: 26%-50%; 4: 51%-75% and 5: >75%. The resulting total CT score was the sum of each individual lobar score; the range was between 0 and 25. RESULTS: Total chest CT score was found to be positively correlated with alanine aminotransferase and d-dimer, and negatively correlated with lymphocyte count. In receiver operating characteristic analysis, total chest CT score had area under the curve 0.99 (95% confidence interval, 0.98-1.00) at cut-off 2 with 95% sensitivity and 96% specificity for the severe disease. Furthermore, in-depth analysis of lobar CT scores showed a correlation between left upper lobe with lymphocyte count, left lower lobe with d-dimer, right middle and lower lobes with alanine aminotransferase and right upper lobe with leukocyte count. CONCLUSIONS: There is a significant relationship between chest CT score and COVID-19 severity and laboratory findings in children. This suggests that chest CT scores can be used to assess the severity of the disease and can play an important role in paediatric clinical practice.

Correlation of neuroimaging and thorax CT findings in patients with COVID-19: A large single-center experience

Background/aim: The aim of this current study was to describe the neuroimaging findings among patients with COVID-19 and to compare them with thorax CT imaging findings and clinicobiological profiles. Materials and methods: Between the period March 11 and December 31, 2020, we evaluated brain computed tomography (CT) and magnetic resonance (MR) images of patients with COVID-19. A total of 354 patients (mean age 65.2 ± 16.6, 52% female, 42% male) who had brain imaging were included in the study. Of this total sample, 218 had thorax CT scanning (65.5%). Neuroimaging and thorax CT findings, clinical course, neurologic findings, and laboratory data were evaluated. White matter lesions (WML) and thorax CT scans were scored. Participants were divided according to whether or not they had an infarction. Results: The neuroimaging findings indicated infarcts, parenchymal hemorrhage, encephalitis, cortical signal abnormality, posterior reversible encephalopathy syndrome (PRES), and cranial nerve involvement. WML significantly positively correlated with age (p < 0.01) but not with sex (p > 0.05). Thorax CT findings did not demonstrate significant correlations with infarcts, WML, or hemorrhages (p> 0.05). D-dimer and ferritin levels were significantly higher among patients with infarcts (p < 0.05). Conclusion: Immune-mediated prothrombic state and cytokine storm appear to be more responsible for etiopathogenesis than direct viral neurotropism. Neuroimaging and thorax CT findings were not correlated among patients with COVID-19 in our study. These results suggest that neurological manifestations may occur independently of pulmonary involvement and age.

Influenza A (H1N1)-Associated Acute Necrotizing Encephalopathy with Unusual Posterior Reversible Encephalopathy Syndrome in a Child.

Other than respiratory symptoms, influenza A (H1N1) can rarely cause neurological complications in children and adults. In this article, we aimed to present H1N1-associated acute necrotizing encephalopathy (ANE) and asymmetrical involvement of posterior reversible encephalopathy syndrome (PRES) in a 30-month-old male patient with clinical and radiological imaging findings. The patient who presented to the hospital with febrile convulsion and lethargy had elevated liver enzymes and coagulopathy. The magnetic resonance (MR) examination revealed diffusion restriction in bilateral cerebellar white matter, thalami, and periventricular white matter which was consistent with ANE. Susceptibility-weighted imaging (SWI) sequence showed hemorrhage in bilateral thalami and cerebellar white matter. There was high signal on fluid-attenuated inversion recovery (FLAIR) sequences in right temporooccipital cortical, subcortical, and periventricular white matter suggestive of PRES. MR angiography showed vasculopathy which is supportive for PRES. This is the second case of H1N1-associated pediatric PRES reported in the literature.

Should CT be used for the diagnosis of RT-PCR-negative suspected COVID-19 patients?

INTRODUCTION: The diagnosis of patients with Coronavirus disease 2019 (COVID-19) suspicion but negative reverse transcriptase-polymerase chain reaction (RT-PCR) test is challenging. OBJECTIVE: We aimed to investigate the diagnostic value of chest computed tomography (CT) in RT-PCR-negative patients with suspected COVID-19. MATERIALS AND METHODS: The study included patients who were admitted to our hospital with the suspicion of COVID-19 between 1 April 2020 and 30 April 2020 and tested negative after RT-PCR test, and underwent CT for further diagnosis. Initial CT findings were classified as typical, indeterminate, and atypical for COVID-19, and negative for pneumonia. Incidental findings on CT were noted. RESULTS: Of the 338 patients with a mean age of 57 years (min 18 years-max 96 years), 168 (49.70%) were male and 170 (50.29%) were female. The most common symptoms were cough (58.87%), fever (40.82%), and dyspnea (39.34%). The CT findings were typical for COVID-19 in 109 (32.24%) patients, indeterminate in 47 (13.90%) patients, and atypical in 77 (22.78%) patients. The CT findings of 105 (31.06%) patients were negative for pneumonia. Incidental lung nodules suspicious of malignancy were identified in seven patients. Seventy-seven patients (22.78%) had extrapulmonary incidental findings CONCLUSION: The diagnostic value of CT in RT-PCR-negative patients with suspected COVID-19 is not very high. Based on clinical, laboratory, and chest x-ray findings, it may be more appropriate to refer patients to CT after the first triage, when necessary.

The Efficacy of Chest Computed Tomography in Pediatric Patients With Suspected COVID-19.

OBJECTIVE: The aim of the study was to investigate chest computed tomography (CT) findings and the value of CT in the diagnosis in children with suspected coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: Chest CT images of pediatric patients with suspected COVID-19 were retrospectively evaluated. Computed tomography findings were divided into 3 groups: normal, consistent, and inconsistent with COVID-19. The sensitivity and specificity of CT were calculated by reference to reverse transcriptase polymerase chain reaction. RESULTS: The study included patients with a mean age of 11.1 years (1 month-17 years). Of the patients, 43 (40.19%) had normal CT, 34 (31.77%) had CT findings consistent with COVID-19, and 30 (28.04%) had CT findings inconsistent with COVID-19. The sensitivity, specificity, positive predictive value, and negative predictive value of CT were 47.92%, 81.36%, 67.65%, and 65.75%, respectively. CONCLUSIONS: Because the sensitivity of CT in the pediatric age group is low, it should be used cautiously for the evaluation of COVID-19 in the pediatric age group.

Comparison of Topical, Systemic, and Combined Therapy with Steroids on Idiopathic Granulomatous Mastitis: A Prospective Randomized Study.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a benign disorder of the breast, for which the optimal treatment modality remains missing. METHODS: A total of 124 patients with a histopathologically proven diagnosis of IGM were enrolled in a prospective, randomized parallel arm study. Patients were treated with topical steroids in Group T (n: 42), systemic steroids (0.8 mg/kg/day peroral) in Group S (n: 42), and combined steroids (0.4 mg/kg/day peroral + topical) in Group C (n: 40). Compliance with the therapy, response to the therapy, the duration of therapy, side effects and the recurrence rates were compared. RESULTS: Sixteen patients did not comply with the treatment, and the highest ratio of compliance with therapy was seen in Group T (p < 0.05). Complete clinical regression (CCR) was observed in 90 (83.3%) patients. Response to the treatment (RT) was evaluated radiologically and observed in 89.8% of the patients. There was no statistically significant difference between groups regarding CCR, RT and the recurrence rate. The longest duration of therapy was observed in Group T (22 ± 9.1-week), whereas the shortest was observed in Group S (11.7 ± 5.5-week) (p < 0.001). The systemic side effects were significantly lower in Group T in comparison with Groups S and C (2.4% vs. 38.2% and 30.3%, respectively) (p < 0.001). CONCLUSIONS: The efficiency of the treatment was similar for all groups, both clinically and radiologically. Although the duration of therapy was longer in Group T, the lack of systemic side effects increased the compliance of the patients with the therapy. Therefore, topical steroids would be among first-line treatment options of IGM.

Functional evaluation of secondary renal amyloidosis with diffusion-weighted MR imaging.

OBJECTIVES: This study evaluated whether diffusion-weighted magnetic resonance imaging (DW-MRI) can be used to diagnose secondary renal amyloidosis looking specifically at the diagnostic efficacy of two apparent diffusion coefficient (ADC) measurement methods as they were used with DW-MRI. METHODS: The study included 24 amyloid nephropathy (AN) patients, 20 chronic kidney disease (CKD) patients, and 20 healthy volunteers (HV). ADC values were measured using two different methods: 1) the method of the region of interest indicators (ROIs) and 2) the method of drawing whole renal parenchyma (WP). The correlation between the two methods was evaluated. RESULTS: ROIs could differentiate AN-CKD (p = 0.007). ROIs and WP could differentiate AN-HV (p < 0.05). However, none of the methods could differentiate CKD-HV (p > 0.05). The sensitivity and specificity of the ROIs method in differentiating AN from CKD patients for 1.8 × 10(-3) cutoff ADC values were 79% and 60% and for AN-HV patients 79% and 70%. ADC values of AN patients with GFR > 60 mL/min were lower than that of HV (p < 0.01). CONCLUSION: DW-MRI is a useful and non-invasive diagnostic tool in diagnosing secondary renal amyloidosis and differentiating renal amyloidosis from other CKDs. ROIs had the highest sensitivity and specificity for assessing the involvement of renal amyloidosis. MRI diagnosis of AN may obviate a renal biopsy for diagnosis.