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توده های بسیار مشکوک به بدخیمی درسونوگرافی پستان

روش تشخیص ضایعات خوش خیم از بدخیم پستان در توده های بسیار مشکوک به بدخیمی درسونوگرافی پستان بدون نیاز به انجام نمونه برداری :

Breast Pain: Clinical Pattern and Aetiology in a Breast Clinic in Eastern Nigeria.
Egwuonwu OA, et al. Niger J Surg. 2016 Jan-Jun.
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BACKGROUND: Patients with breast pain are likely to be very worried because some consider pain in the breast as an indication of malignancy.

OBJECTIVE: To highlight the causes of pain in the patients are presenting to our breast clinic.

MATERIALS AND METHODS: A prospective study of all consenting patients with breast disease presenting to the breast clinic was conducted from January 2004 to December 2008.

RESULTS: A total of 664 patients presented to the breast clinic during the study period. Of this number, 127 presented with breast pain either as the sole symptom or in association with other symptoms. The presenting complaints were a pain, pain with lump, and pain with nipple discharge in 63 (49.6%), 59 (46.4%), and 5 (4.0%) patients, respectively. The pain was noncyclical in 96 (75.6%) patients. The site of the pain was whole breast in 87 (68.5%) patients and a lump in 40 (31.5%). The clinical diagnosis in 31 (24.4%) cases was fibrocystic disease, 28 (22.0%) cancer, 23 (18.1%) unknown, 10 (7.9%) fibroadenoma, 8 (6.3%) duct ectasia, 6 (4.7%) normal breast, and others 21 (16.5%) cases benign diseases were diagnosed. The histological diagnosis was fibrocystic changes, carcinoma, and fibroadenoma in 15 (42.9%), 10 (28.6%), and 5 (14.3%) patients, respectively. Others were benign phyllodes, abscess, duct ectasia, chronic mastitis, and lipoma, each constituting 1 (2.9%) case.

CONCLUSION: Breast pain constitutes a small proportion of complaints to our breast clinic. Fibrocystic changes were the most common cause of breast pain both clinically and histologically.

PMID 27013851 [PubMed] PMCID PMC4785698
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99mTc-Glu-c(RGDyK)-bombesin SPECT Can Reduce Unnecessary Biopsy of BI-RADS Category 4 On Ultrasonography.
Ji T, et al. J Nucl Med. 2016.
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The mass of Breast Imaging Reporting and Data System (BI-RADS) category 4 on ultrasonography represents possibly malignant, and a biopsy is recommended. This study explored the value of(99m)Tc-Glu-c(RGDyK)-bombesin ((99m)Tc-RGD-bombesin) in reducing unnecessary biopsy for these masses.

METHODS: Ninety female patients with a BI-RADS 4 masses by ultrasonography were enrolled for breast single-photon-emission computed tomography (SPECT) using(99m)Tc-RGD-bombesin. All SPECT images were independently interpreted using visual and semi-quantitative analyses. A final diagnosis was made based on the histopathologic examination of surgical excision or percutaneous biopsy specimens. Fractions of the samples were immunohistochemically analyzed to evaluate integrin αvβ3 and gastrin-releasing peptide receptor (GRPR) expression. The receptor positive group was further divided into three subgroups: p1 (GRPR+/αvβ3+), p2 (GRPR+/αvβ3-), and p3 (αvβ3+/GRPR-).

RESULTS: A total of 94 masses (22 malignant masses and 72 benign masses) were confirmed by histopathological examination. Based on the visual analysis, 20/22 malignant masses exhibited high(99m)Tc-RGD-bombesin accumulation. Forty-eight of 72 benign masses exhibited no(99m)Tc-RGD-bombesin accumulation. The optimal cutoff value for visual analysis was a score of 2. Semi-quantitative analysis revealed 20/22 malignant masses and 16/72 benign masses had relatively high tumor/normal tissue (T/N) ratios. The optimal cutoff value of the semi-quantitative analysis was a T/N ratio of 2.26. The mean T/N ratio of malignant masses was higher than that obtained in benign masses (3.17 ± 0.86 vs. 1.89 ± 0.71, P<0.05). The T/N ratios did not differ among the p1, p2 and p3 subgroups (P>0.05). The receiver operating characteristic areas of the visual and semi-quantitative analyses were 0.788 and 0.865, respectively, and the overall diagnostic performance did not significantly differ between these analyses (P>0.05).

CONCLUSION: (99m)Tc-RGD-bombesin SPECT can differentiate benign masses from malignant masses with high specificity in BI-RADS 4 patients. Unnecessary immediate biopsy may be avoidable with the negative SPECT results.

Copyright © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.
PMID 27013698 [PubMed - as supplied by publisher]
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شنبه, 04 ارديبهشت 1395 17:09 چاپ

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