Artificial Intelligence in BI-RADS Categorization of Breast Lesions on Ultrasound: Can We Omit Excessive Follow-ups and Biopsies?

RATIONALE AND OBJECTIVES: Artificial intelligence (AI) systems have been increasingly applied to breast ultrasonography. They are expected to decrease the workload of radiologists and to improve diagnostic accuracy. The aim of this study is to evaluate the performance of an AI system for the BI-RADS category assessment in breast masses detected on breast ultrasound. MATERIALS AND METHODS: A total of 715 masses detected in 530 patients were analyzed. Three breast imaging centers of the same institution and nine breast radiologists participated in this study. Ultrasound was performed by one radiologist who obtained two orthogonal views of each detected lesion. These images were retrospectively reviewed by a second radiologist blinded to the patient's clinical data. A commercial AI system evaluated images. The level of agreement between the AI system and the two radiologists and their diagnostic performance were calculated according to dichotomic BI-RADS category assessment. RESULTS: This study included 715 breast masses. Of these, 134 (18.75%) were malignant, and 581 (81.25%) were benign. In discriminating benign and probably benign from suspicious lesions, the agreement between AI and the first and second radiologists was moderate statistically. The sensitivity and specificity of radiologist 1, radiologist 2, and AI were calculated as 98.51% and 80.72%, 97.76% and 75.56%, and 98.51% and 65.40%, respectively. For radiologist 1, the positive predictive value (PPV) was 54.10%, the negative predictive value (NPV) was 99.58%, and the accuracy was 84.06%. Radiologist 2 achieved a PPV of 47.99%, NPV of 99.32%, and accuracy of 79.72%. The AI system exhibited a PPV of 39.64%, NPV of 99.48%, and accuracy of 71.61%. Notably, none of the lesions categorized as BI-RADS 2 by AI were malignant, while 2 of the lesions classified as BI-RADS 3 by AI were subsequently confirmed as malignant. By considering AI-assigned BI-RADS 2 as safe, we could potentially avoid 11% (18 out of 163) of benign lesion biopsies and 46.2% (110 out of 238) of follow-ups. CONCLUSION: AI proves effective in predicting malignancy. Integrating it into the clinical workflow has the potential to reduce unnecessary biopsies and short-term follow-ups, which, in turn, can contribute to sustainability in healthcare practices.

Comparison of clinical outcomes in idiopathic pulmonary fibrosis patients with and without hiatal hernia.

Introduction: Idiopathic pulmonary fibrosis (IPF) is a progressive disease of unknown etiology with an unpredictable course. We aimed to investigate the effects of the presence of hiatal hernia (HH) and its consequences on the clinical manifestation of IPF. Materials and Methods: Patients diagnosed with IPF with or without hiatal hernia were retrospectively compared in terms of clinical findings, total fibrosis scores (TFS), and lung function in the interstitial lung diseases (ILD) outpatient clinic. Result: A total of 142 IPF patients were included in the study. HH was detected in 62.7% (n= 89) of the patients. There was no statistically significant difference between IPF patients with or without HH in terms of age, gender, smoking history, and anti-reflux drug use (p> 0.05). There was no statistically significant difference between IPF patients with or without HH in terms of symptoms such as dyspnea, cough, regurgitation, heartburn, nausea, dysphagia, chest pain, and hoarseness (p> 0.05). In addition, no statistically significant difference was found between IPF patients with or without HH in terms of mortality rate, survival time after diagnosis, and exacerbations (p> 0.05). Six-minute walking distance and SpO2 change, percentage of predicted forced vital capacity (FVC) value, and percentage of predicted diffusing capacity for carbon monoxide (DLCO) value did not differ significantly between the groups (p> 0.05). There was no statistically significant difference between the groups in terms of total fibrosis score (p= 0.668). Conclusions: According to the results of this study, 62.7% (n= 89) of IPF patients had HH, and there was no difference in clinical outcomes, TFS, and pulmonary functions between IPF patients with or without HH.

The Comparison Between Non-High Risk Patients with and Without Cancer Diagnosed with Pulmonary Embolism.

OBJECTIVE: This study aimed to compare the pulmonary embolism (PE) location and clot burden on computed tomography pulmonary angiography (CTPA), the degree of right ventricular dysfunction (RVD), D-dimer, and cardiac troponin I (cTnI) levels, and the presence of a lower extremity deep venous thrombosis (DVT) in patients with and without cancer diagnosed with a non high risk pulmonary embolism (PE). METHOD: We calculated Miller score for each patient for clot burden. The location of PE was also evaluated at CTPA. D-dimer and cardiac cTnI levels were measured. Patients had echocardiography for RVD and lower extremity color flow Doppler ultrasonography for DVT. RESULTS: The study included 71 patients with PE. The patients were divided into two groups according to the presence of cancer. There was no statistically significant difference for D-dimer levels (P=0.15), PE location (p=0.67), clot burden (P=0.34), RVD (P=0.28) and DVT (P=0.33) between groups (P=0.15). Cancer patients diagnosed as PE had statistically significantly higher levels of cTnI than those who were diagnosed as PE without cancer (P=0.03). CONCLUSION: There was no significant difference between patients diagnosed as PE with and without cancer in terms of D-dimer levels, clot burden and emboli location, RVD and DVT. cTnI levels were higher in non-high risk PE patients with cancer than these patients without cancer.

Non-invasive evaluation of obstruction after ureteroscopic stone removal: Role of renal resistive index assessment.

OBJECTIVES: The aim of this study is to evaluate prediction of postoperative ureteral obstruction needing ureteral stent insertion by evaluating the resistive index (RI) values and the grade of hydronephrosis. MATERIAL AND METHODS: A total of 66 adult patients undergoing stentless endoscopic ureteral stone treatment (URS) between January 2018 and January 2019 were included in this prospective study. Preoperative patient and stone characteristics were noted. All patients were evaluated with renal Doppler ultrasonography study to assess degree of hydronephrosis and RI values. A renal Doppler ultrasonography was repeated at postoperative 1st, 3rd and 7th days. Changes in both RI and hydronephrosis levels before and after the procedures were noted. On the postoperative 7th day, patients were divided into two groups including obstructive and non-obstructive cases according to RI values assessed where a RI value of 0.7 was accepted as the cut-off for obstruction. The preoperative and perioperative characteristics of both groups were evaluated in a comparative manner. RESULTS: The mean patient age was 43.6 ± 1.72 years. Significant improvements were noted in RI and grade of hydronephrosis after the operation. The grade of hydronephrosis and RI values were found to improve more significantly on postoperative 3rd day when compared to the postoperative 7th day (p < 0.01 and p < 0.01). A significant correlation was detected between the grade of hydronephrosis (>grade 2) and obstructive RI values (> 0.7) in each postoperative visits (p: 0.001). RI values (> 0.7) at postoperative seventh days were correlated with larger mean stone size, increased ureteral wall thickness, increased diameter of the ureter proximal to the stone, and longer duration of the operation. Preoperative high-grade hydronephrosis indicated obstructive RI values at postoperative seventh day (p = 0.001) Conclusion: Changes in RI values on Doppler sonography and the grade of hydronephrosis may be a guiding parameter in assessing postoperative ureteral obstruction.

Evaluation of the relationship between Behcet's disease and cardiovascular disorders through metabolic function and copeptin.

INTRODUCTION: Behcet's disease (BD) is a chronic inflammatory and multisystem vasculitis. Cardiac involvement is one of the major complications of BD. Cardiac involvement is sporadic in terms of its specific relationship to mortality. How to identify and follow up on cardiac-related complications in BD patients has yet to be determined. AIM: The aim of our study is to assess cardiovascular diseases in BD patients by measuring metabolic function and copeptin levels and comparing these to a healthy control group. Knowing the specific metabolic functions that are negatively affected by BD will help doctors determine which functions need to be more closely monitored in BD patients. Our study is the first study in the available literature that evaluates copeptin in BD patients. MATERIAL AND METHODS: A control group of 58 healthy volunteers, including 32 females and 26 males (average age: 39.8 ±10.3 years, range: 18-50 years), was formed to compare with 84 BD patients (average age: 40.5 ±11 years, range: 21-63 years), including 39 females and 45 males. Diastolic and systolic blood pressure, height, weight, body mass index (BMI), and waistline were measured for both groups. All study patients were also given hemograms, and fasting blood sugar (FBS), uric acid, lipid profile, insulin, C-reactive protein (CRP), and copeptin levels were measured. An ELISA Kit was used to measure copeptin. RESULTS: FBS, CRP, and insulin levels were significantly higher in the patient group (p < 0.001, p = 0.004, and p = 0.038, respectively). Patients who had had the disease for more than 10 years had higher BMIs, total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) levels (p = 0.034, p = 0.004, p = 0.016, and p = 0.045, respectively). Additionally, CRP levels were found to be higher in long-term patients and patients with active lesions. Diastolic blood pressure and waist circumference were also higher in the BD group. Patients who had active lesions had significantly higher diastolic blood pressure (p = 0.047). There were no statistically significant differences in copeptin levels between BD and control groups. CONCLUSIONS: Cardiovascular involvement rarely contributes to the high mortality rate of BD patients. There were meaningful elevations in metabolic markers identified when BD and cardiovascular disease risk was assessed with metabolic parameters. The cardiac disease risk should be closely followed using metabolic functions, particularly in long-term BD patients with vascular involvement.

Radiologic evaluation of children prior to SWL: to what extent they are exposed to radiation?

The objective of this study is to evaluate the average radiation exposure in children with renal stones before SWL treatment. Mean radiation exposure values were evaluated in 110 children before SWL treatment. While some children referred to the emergency department (ED) with colic pain, remaining cases referred to outpatient department (OD). Although low-dose NCCT was performed in ED; KUB and abdominal sonography were first performed in other cases referring to OD where CT has been applied if needed. The type of imaging modality used and the mean radiation exposure were evaluated and comparatively evaluated with respect to the department referred, patient as well as stone related parameters. 49 children referred to ED and 61 children referred to OD. Mean stone size was 7.24 ± 0.29 mm. 62 cases had opaque stones. Mean radiation exposure values were higher in children referring to ED than the other cases. However, there was no significant difference between the two groups regarding the mean number of KUB, IVU and sonographic evaluation performed prior to SWL management. There was a significant correlation between the mean radiation exposure and the stone size as well degree of hydonephrosis in a positive manner. Although a significant correlation was present between the mean radiation exposure and stone opacity in a negative manner; there was no correlation with respect to the other related parameters. Unnecessary use of X-ray based imaging modalities in children could be effectively avoided using KUB and US combination beginning from the diagnostic phase of stone disease.

Evaluation of Stress Scores Throughout Radiological Biopsies.

BACKGROUND: Ultrasound-guided biopsy procedures are the most prominent methods that increase the trauma, stress and anxiety experienced by the patients. OBJECTIVES: Our goal was to examine the level of stress in patients waiting for radiologic biopsy procedures and determine the stress and anxiety level arising from waiting for a biopsy procedure. PATIENTS AND METHODS: This prospective study included 35 female and 65 male patients who were admitted to the interventional radiology department of Kartal Dr. Lütfi Kirdar training and research hospital, Istanbul between the years 2014 and 2015. They filled out the adult resilience scale consisting of 33 items. Patients who were undergoing invasive radiologic interventions were grouped according to their phenotypic characteristics, education level (low, intermediate, and high), and biopsy features (including biopsy localization: neck, thorax, abdomen, and bone; and the number of procedures performed, 1 or more than 1). Before the biopsy, they were also asked to complete the depression-anxiety-stress scale (DASS 42), state-trait anxiety inventory scale (STAI-I), and continuous anxiety scale STAI-II. A total of 80 patients were biopsied (20 thyroid and parathyroid, 20 thorax, 20 liver and kidney, and 20 bone biopsies). The association between education levels (primary- secondary, high school and postgraduate) and the number of biopsies (1 and more than 1) with the level of anxiety and stress were evaluated using the above-mentioned scales. RESULTS: Evaluation of sociodemographic and statistical characteristics of the patients showed that patients with biopsy in the neck region were moderately and severely depressed and stressed. In addition, the ratio of severe and extremely severe anxiety scores was significantly high. While the STAI-I and II scores were lined up as neck > bone > thorax > abdomen, STAI-I was higher in neck biopsies compared to thorax and abdomen biopsies. Regarding STAI-I and II scales, patients with neck biopsy had the highest anxiety score. CONCLUSION: We believe that active briefing of patients who need to undergo neck and bone biopsies and have high anxiety score by healthcare personnel is an effective method to control psychological mood and increase the efficiency of treatment.

Emergency management of ureteral stones: Evaluation of two different approaches with an emphasis on patients' life quality.

OBJECTIVES: To evaluate the emergency management of obstructing ureteral calculi with two different techniques (SWL and URS) with an emphasis on patients life quality. METHODS: A total of 80 patients presenting with acute colic pain due to a single obstructing ureteral stone were treated within 24 hours following the onset of pain with two different approaches in a randomized manner. Patients requiring DJ stent placement and/or auxiliary measures after both procedures were excluded and the remaining 65 patients were evaluated [Group1: ESWL (n = 34); Group 2: URS (n = 31)]. Patients were followed during 4-weeks period with respect to the analgesic requirement, number of renal colic attacks and emergency department visits along with the HRQOL scores. RESULTS: While 26 patients treated with URS (83.9%) were stone-free, 24 cases in SWL were stone-free (70.6%) after 4 weeks. Evaluation of the cases during this follow-up period demonstrated that cases undergoing SWL required significantly higher amount of analgesics when compared with URS group (p < 0.001). In addition to the lower mean number of renal colic attacks and emergency department visits in URS group; both the mean HRQOL in terms of EQ-5D index and mean EQ-5D VAS values were also significantly higher in these cases when compared with the cases tretaed with SWL. CONCLUSIONS: Due to the negative impact of stone related events after emergency SWL on patients HRQOL, emergency URS may be applied more effectively with the advantages of prompt fragmentation of the calculi along with the immediate relief of obstruction and pain.

Does Transient Cessation of Antiplatelet Medication Prior to Shock Wave Lithotripsy Have Any Safety Concern: Evaluation of the Short Term Safety Results.

OBJECTIVE: The study aimed to evaluate the true safety of transient cessation of the antiplatelet medication before extracorporeal shock wave lithotripsy (SWL) on bleeding-related complications. PATIENTS AND METHODS: Forty cases undergoing SWL for renal pelvic stones were included and depending on the use of antiplatelet medication they were divided into 2 groups namely: group 1, cases under antiplatelet medication in whom the medication was stopped before ESWL; and group 2, cases without any antiplatelet medication. Comparative evaluation of patient, stone and treatment-related parameters were done in both groups. RESULTS: Although microscopic hematuria was present in all cases, the incidence of macroscopic hematuria was higher in cases undergoing antiplatelet medication when compared with the other cases. Regarding the microscopic hematuria again, the mean number erythrocytes per field of analysis was significantly higher in group 1 cases. The mean value of the hematoma size was similar in both groups. CONCLUSION: Our findings indicate that SWL can be applied safely in patients under antiplatelet therapy following the cessation of medication for a certain period of time. However, among the cases treated with this concept in our study, we clearly observed that the incidence of procedure-related hematoma formation and macroscopic hematuria were more common in such cases than in the normal ones.

The efficacy of diffusion weighted imaging for detection of acute pancreatitis and comparison of subgroups according to Balthazar classification.

BACKGROUND/AIMS: The aim of this study was to measure the apparent diffusion coefficient (ADC) values detected by diffusion-weighted imaging (DWI) in acute pancreatitis and compare them with computerized tomography (CT) findings in acute pancreatitis subgrouped by the Balthazar classification. MATERIALS AND METHODS: The study population included 50 patients diagnosed with clinical pancreatitis who were evaluated with both multidetector CT and magnetic resonance imaging (MRI) within 24 h of clinical presentation. We calculated pancreatic ADC values obtained from DWI (b=0 and b=1000 mm2/sn). These values were compared with their normal counterparts (n=24). The patients with acute pancreatitis were subgrouped according to the Balthazar classification. The mean ADC values were calculated in each subgroup, and they were compared with control ADC values. RESULTS: The mean pancreatic ADC values in acute pancreatitis (1.19×10(-3) mm2/sn ±0.32) was significantly lower than in the normal group (1.78×10(-3) mm2/sn ±0.29) (p<0.001). In the subgroup analysis, ADC values in each group were significantly lower than in the control group (p<0.001). In addition, as severity of pancreatitis increased according to the Balthazar classification, lower ADC values were noted. CONCLUSION: DWI with MRI and ADC values are helpful in the diagnosis of all subgroups of acute pancreatitis. Due to the lack of CT findings in grade A patients, DWI may be helpful in the diagnosis in this group as well.

A modified technique for real time ultrasound guided pediatric percutaneous renal biopsy: the angled tangential approach.

AIM: Pediatric renal biopsy may result in serious hemorrhagic complications, requiring additional diagnostic procedures, blood transfusion, vascular interventions, and prolongation of hospitalization. The aim of the present study was to propose the angled tangential approach technique for real-time ultrasound-guided pediatric percutaneous renal biopsy. METHODS: A retrospective analysis of 166 percutaneous biopsies from June 2004 to May 2009 was performed. Patients' medical records, pathology results, and complications were reviewed. RESULTS: No major complications were seen in the study group. The most frequently occurring minor complication was macroscopic hematuria, which occurred at the rate of 9.6%. Hematoma was detected in three cases and regressed spontaneously in all cases. CONCLUSIONS: The angled tangential approach is a safe technique and an alternative option in pediatric percutaneous renal biopsies.

Correlation between computerized tomography density measurements of urinary bladder and urinalysis results.

Our aim was to investigate whether there is a correlation between computerized tomography (CT) density measurements of the urinary bladder and urinalysis results. Patients were subdivided into three groups with respect to urinalysis results: Group 1, no leukocytes or erythrocytes detected in urine (n=25); Group 2, erythrocytes detected in urine (n=50); and Group 3, leukocytes and erythrocytes detected in urine (n=98). In CT sections, densitometric measurements had been performed from three zones on each section and groups were compared in terms of densitometry results. Our results indicate that density measurements of CT views form the urinary bladder may provide valuable data on hematuria and leukocyturia.

Skin autoreactivity in Hashimoto's thyroiditis patients without urticaria: autologous serum skin test positivity correlation with thyroid antibodies, sonographical volume and grading.

Recent studies have shown an association between anti-thyroid antibodies and autologous serum skin test (ASST) positive urticaria patients. However, a connection between thyroid and this reliable skin test for mast cell autoreactivity, ASST, has not been reported yet. We investigated ASST in patients with Hashimoto's thyroiditis (HT) without urticaria and compared the results with laboratory and sonographical findings of HT. 154 HT patients, 100 healthy volunteers without HT as a first control group and 46 patients with multinodular goitre but without autoimmune thyroid disease as a second control group underwent testing with ASST. ASST was applied to these groups according to two criteria, first as ASST(new): autologous serum red wheal response 1.5 mm bigger than negative control; second as ASST(old): serum red wheal response 5 mm bigger than negative control accepted as positive. Free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (anti-TPO) and thyroglobulin antibody (anti-Tg) levels were measured. ASST(old), ASST(new) scored positive in 51.3-60.4% of HT patients, with statistically significant differences. Thyroid volume grades were inversely proportional with ASST(old) and (new) positivity. Moderate (+) titers of anti-Tg in ASST(old) and (new) (+) cases were significantly higher than the same titers of anti-Tg in ASST(old) and (new) (-) cases. The prevalence of ASST positivity in HT patients was not affected by the following factors: gender, age at screening, laboratory measurements of thyroid function tests, anti-TPO antibodies and thyroid ultrasound (US) echogenicity. Positivity of ASST in HT has shown that there is a skin mast cell autoreactivity in HT patients independent of autoreactive chronic urticaria (ACU).