Background: Breast cancer is the most common cancer in females, both in developed and developing countries. Pakistan has the highest breast cancer incidence rate in Asia. Guidelines recommend screening for detecting breast cancer with mammography and ultrasonography (US). Shear-wave elastography (SWE) is a newer technique that can aid additional characterization of breast lesions. Objective: The aim of this study was to determine the diagnostic accuracy of breast ultrasound elastography in differentiating benign from malignant breast lesions using histology diagnosis as the gold standard.Materials and methods: The study was conducted at the Abbasi Shaheed Hospital and Jinnah Post Graduate Medical Centre, Karachi. All consecutive patients undergoing breast biopsy and elastography of breast lesions were enlisted; 2 x 2 tables were used to measure the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of breast ultrasound elastography for differentiation of benign from malignant breast masses.Results: A total of 155 female patients were included with a mean age of 45.41 ± 14.24 years (range 20-70 years). On histological evaluation, 115 (74.2%) lesions were malignant and 40 (25.8%) were benign. The overall average mean elastography value was 108.45 kPa ± 52.75. The mean elastography (EMean) value for benign breast lesions was 48.96 kPa ± 42.32 and 132.78 kPa ± 42.32 for malignant lesions. The difference in mean elastography values of benign and malignant breast lesions was statistically significant (48.96 kPa ± 42.32 vs 32.78 kPa ± 42.32, P <0.001). The area under the curve (AUC) was 0.952, optimal cutoff EMean value of 72 kPa and higher likelihood ratio was 9.41. A cutoff mean elastography (EMean) value of ≤ 72 kilopascal (kPa) for benign lesions had sensitivity 92.17%, specificity 90.4%, PPV 96.36%, NPV 80.0% and diagnostic accuracy 91.61%. Conclusion: Ultrasound elastography was found to have high sensitivity and specificity and diagnostic accuracy for differentiating benign from malignant breast lesions. Use of shear-wave elastography may increase malignancy detection rate by reducing the need for biopsy in benign breast lesions.
Objectives: The Dutch Radiological Society developed CO-RADS classification, a system for the classification of CT scan chest findings among suspected COVID-19 patients. However due to some important issues it was modified by authors and then applied on our study population. The objective was to study the spectrum of lungs involvement as concluded by HRCT scan chest finding and classifying it using the “Modified CO-RADS classification” Methods: This cross-sectional study was conducted jointly by the departments of Medicine and Radiology, JPMC from January 16, 2021 to April 30, 2021. This study includes suspected cases of COVID-19 patients aged between 18-80 years who came for HRCT chest. Their data variables were recorded. HRCT findings were classified using “Modified CO-RADS classification”. Patients’ results of real time PCR for COVID-19 were also followed. Results: A total of 78 patients presented to the study department during this study period. Of them 85.8% were male (n=67) and 14.2% were female (n=11). Out of the 78 patients, 58 were tested positive for COVID-19 on first RT-PCR on follow up. Among positive two patients (3.4%) had CO-RADS-1, 4 patients (7%) had CO-RADS-2, 19 patients (32.75%) had CO-RADS-3, 21 patients (36.2%) had CO-RADS-4 while 12 patients (20.7%) had CO-RADS-5 category. (CO-RAD-6 category was omitted). Of the patient who had negative results on RT-PCR, five patients had CO-RADS-4 while three patients had CO-RADS-5. On repeat RT-PCR all (8/8) patients of category IV and V proved Covid-19 positive. Conclusion: HRCT scan chest can be used for quicker diagnosis of COVID-19 patients in patients with respiratory complaints in whom prompt diagnosis is required and when RT-PCR investigation process would be taking prolonged time due to over burden during pandemic situation. “CO-RADS classification after modification” proved more effective communicative tool to label and understand the severity of lung involvement in Covid-19 disease. doi: https://doi.org/10.12669/pjms.38.4.4687 How to cite this:Tabassum S, Haider S, Shaukat S. Spectrum of HRCT Scan Chest Findings in COVID-19 Patients as Categorized by Modified CO-RADS Classification. Pak J Med Sci. 2022;38(4):---------. doi: https://doi.org/10.12669/pjms.38.4.4687 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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