No abstract

Purpose Accurate restaging of the axilla after neoadjuvant chemotherapy (NAC) is an important issue to ensure deescalating axillary surgery in patients with initial metastatic nodes. We aimed to present our results of targeted axillary biopsy (TAB) combined with sentinel lymph node biopsy (SLNB) for axillary restaging after NAC. Methods In 64 breast cancer patients who underwent NAC, biopsy-proven positive nodes were marked with clips before NAC, and ultrasound-guided wire localization of clip-marked nodes was performed after NAC. Patients underwent TAB and SLNB for post-NAC axilla restaging. Results Identification rates of post-NAC TAB and SLNB were 98.4% and 87.5%, respectively (P = 0.033). Histopathology revealed a nodal pathologic complete response (pCR) rate of 47% in which axillary lymph node dissection (ALND) was avoided. TAB alone and SLNB alone detected residual disease in 29 (85.3%) and 20 (58.8%) patients (P = 0.029), respectively. Whereas rates of up to 97% had been achieved with a combination of TAB and SLNB. The pCR rates after NAC were 64.3% for human epidermal growth factor receptor 2 positive and triple-negative tumors and 13.6% in luminal tumors (P = 0.0002). Conclusion Pathologic analysis following TAB combined with SLNB revealed the pCR rates to NAC in a considerable number of patients that provided de-escalation of axillary surgery. A combination of SLNB and TAB was found to be an accurate procedure in establishing residual nodal disease. This combined procedure in patients with initially positive nodes was a reliable method for post-NAC axillary restaging.

Aim: Ultrasound elastography (USE) has been found useful in differentiation between malignant and benign lesions of various tissues, such as the thyroid, breast, lymph node and prostate, however, there is limited data on the parotid gland. The aim of this study is to assess the diagnostic performance of B-mode ultrasonography (US) and USE findings in differentiating between benign and malignant parotid gland masses. A secondary goal is to evaluate results for the most frequent benign lesions. Methods: In this cross-sectional study, 57 masses in 48 patients were evaluated. 2 radiologists examined each patient. B-mode US (size, contour, skin depth, internal structures, calcification, cystic component) and USE (a semiquantitative value strain index (SI)) findings were noted. We considered each feature individually. All patients underwent fine needle aspiration cytology (FNAC) and surgical resection. Results: 50 masses were benign and 7 were malignant. Among B-mode US results, contour irregularity was found to have the highest accuracy (85.7%) in differentiating malignant lesions. When USE findings were considered, intra-observer agreement was moderate to fair and interobserver agreement was moderate. Malignant masses had mildly high SI scores. There was a wide range overlap between malignant and benign lesions. There was no statistically significant difference (P=0.422) and we could not attain a reliable SI cutoff value. Conclusion: Despite the promising results of USE in breast and thyroid lesions, conventional US findings and FNAC are still the primary diagnostic tool to evaluate parotid lesions.

Role of diffusion-weighted imaging and dynamic contrast enhanced magnetic resonance imaging in the diagnosis of early sacroiliitis in seronegative spondyloarthropathies, correlation with levels of acute phase reactants

Aim:To analyze the image quality and diagnostic performance of CT angiography using low dose (60 ml) contrast medium for living kidney donors and compare with surgical results. Material and Method: Angiographic findings of 81 renal donor Candidates in 128-slice MDCT were evaluated by two independent radiologists in terms of renal artery number, early bifurcation, renal vein variations, pelvicalyceal system and ureter variations. Results were compared with intraoperative findings. The image quality, diagnostic performance and interobserver agreement of MDCT obtained with low dose contrast material were analyzed. Results:The mean age of the 81 living kidney donors included in the study was 49±12 (24-68) years. Left nephrectomy was performed in 71% (n=64) and right nephrectomy in 29% (n=17) of the donors. Intraoperative accessory arteries were detected in 22.2% (n:18) of the donors. The specificity, sensitivity, and accuracy for detecting accessory artery variation in MDCT were 100%, 88.9%, and 97.5%, respectively. Early bifurcation was observed in 21% (n=17) of the donors. Specificity, sensitivity and accuracy for early bifurcation detection were 98.4%, 94.1% and 97.5%, respectively. Renal vein variation was detected in 12.3% (n=10) of the donors. Specificity, sensitivity, and accuracy for renal vein variation detection were 100%. Variations of the pelvicalyceal system and ureter were observed in 3.7% (n=3) of the donors. The specificity, sensitivity, and accuracy for detecting pelvicalyceal system and ureteral variations were 100%. Interobserver agreement was excellent in detecting variations of accessory arteries, renal venous anomalies, pelvicalyceal system and ureters by MDCT (kappa: 1,000; p< 0.001). It was higher in early bifurcation detection (kappa: 0.853; p< 0.001). Conclusion: MDCT angiography with a lower dose of iodine contrast at 60 mL in kidney donors is sufficient to detect vascular anomalies and provide anatomical information. It is possible to reduce the contrast agent dose in CTA without affecting the preoperative evaluation.

Amaç: Çok kesitli bilgisayarlı tomografi (ÇKBT) koroner arter anatomisini ve kardiyak morfolojiyi iyi bir şekilde değerlendirmekle beraber sol ventrikül fonksiyonlarının güvenilir ve doğru şekilde hesaplanmasını da sağlamaktadır. Bu çalışmada amacımız, fonksiyonel değerlerden olan ejeksiyon fraksiyon (EF) ile koroner arter çapları arasında ilişkinin varlığını ve derecesini araştırmaktır.Gereç ve Yöntemler: Çalışmada Ocak 2015-Eylül 2015 tarihleri arasında ÇKBT tetkiki yapılan 36 hasta (25 erkek, 11 kadın) retrospektif olarak incelenmiştir. Yaş, cinsiyet, vücut kitle indeksi (VKİ), interventriküler septal kalınlık, sol ana koroner arter (LMA), sol ön inen arter (LAD), sirkümfleks (Cx) arter proksimal kesim çapları, sol ventrikül end diyastolik volüm (EDV), sol ventrikül end sistolik volüm (ESV), sol ventrikül EF değerleri incelendi.Bulgular: Çalışmamıza dahil olan hastaların yaşları ortalama (minimum-maksimum) 45 yıl (29-60 yıl) idi. Çalışmamızda LMA çapı 4.02±0.54 mm, LAD çapı 3.47±0.53 mm, Cx arter çapı 2.97±0.48 mm olarak ölçüldü. İnterventriküler septal kalınlık ortalama 10.80±1.65 mm idi. EDV değerleri ortalama 153.89±23.00 ml, ESV değerleri ortalama 64.29±11,64 ml, EF (%) ortalama %57.95±4.87 olarak hesaplandı. Hastaların yaş, cinsiyet, boy, kilo ve VKİ ölçümleri ile EF (%) ölçümleri arasında istatistiksel olarak anlamlı bir ilişki yoktu (p> 0.05).