Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Interobserver and Intermethod Variability in Data Interpretation of Breast Strain Elastography in Suspicious Breast Lesions(2021) Turnaoglu, Hale; Haberal, Kemal Murat; Arslan, Serdar; Yavuz Colak, Meric; Ulu Ozturk, Funda; Uslu, Nihal; https://orcid.org/0000-0002-0781-0036; https://orcid.org/0000-0002-8211-4065; https://orcid.org/0000-0001-7984-4326; https://orcid.org/0000-0002-0294-6874; https://orcid.org/0000-0003-2782-2824; 32950046; AAK-8242-2021; R-9398-2019; AAA-4360-2021; JCP-5266-2023Background/aim: Strain elastography has the disadvantage of being operator-dependent. Interobserver variability is observed during image acquisition and interpretation. This study aimed to analyze the interobserver and intermethod variability of strain elastography in image interpretation and evaluate the diagnostic performance combining elasticity score and strain ratio with ultrasonography. Materials and methods: A retrospective study was conducted on 70 breast lesions evaluated with B-mode ultrasonography and strain elastography. B-mode ultrasonography findings, elasticity scores, and strain ratio values were evaluated using static images by two radiologists. BI-RADS assessment of the lesions and the decision of both observers as to whether the biopsy was required using B-mode ultrasonography, and the combined ultrasonography+elasticity score, and the combined ultrasonography+elasticity score+strain ratio were compared with the histopathological results. Also, the interobserver agreement was analyzed for all the combinations. Results: There was very good agreement (weighted kappa = 0.865) between the observers for the elasticity scores. Very good agreement was observed between the observers for BI-RADS assessments using the combined ultrasonography+elasticity score and the combined ultrasonography+elasticity score+strain ratio (weighted kappa = 0.848, and 0.902, respectively). Area under the curve of B-mode ultrasonography, the combined B-mode ultrasonography+elasticity score, and the combined B-mode ultrasonography+elasticity score+strain ratio, were calculated as 0.859, 0.866, and 0.916 for observer 1, and 0.851, 0.829, and 0.916 for observer 2, respectively. There were no statistically significant differences between the observers' diagnostic performances in any of the combinations (P = 0.703, 0.067, and 0.972, respectively). Conclusion: In the evaluation and further assessment of breast lesions, semiquantitative strain ratio calculation may help improve diagnostic accuracy by reducing interpretational variety, when used together with B-mode ultrasonography and elasticity scoring, especially for inexperienced individuals.Item Can Breast Magnetic Resonance Imaging Prevent Biopsy or Change the Management of BI-RADS (R) Category 4 Breast Lesions?(2018) Turnaoglu, Hale; Ozturk, Emine; Yucesoy, Cuneyt; Teber, Mehmet Akif; Turan, Aynur; Ozbalci, Aysu Basak; Seker, Ebru Gaye; Onal, Binnur; Hekimoglu, Baki; 0000-0002-0781-0036; AAK-8242-2021The BI-RADS (R) category 4 includes suspicious breast lesions which requires biopsy. The aim of this study is to investigate the contribution of breast magnetic resonance imaging to the management of BI-RADS (R) category 4 breast lesions detected by mammography and/or ultrasonography. Thirty-four lesions classified as BI-RADS (R) category 4A, 4B, or 4C by conventional methods were evaluated with magnetic resonance imaging. All lesions were coded by using the American College of Radiology BI-RADS (R) lexicon. Each lesion was verified with the result of pathology. Lesions were evaluated as BI-RADS (R) category 1 in 1 patient (2.9%), category 3 (20.6%) in 7 patients, category 4 in 25 patients (73.6%), and category 5 in 1 patient (2.9%) with breast magnetic resonance imaging. Only the BI-RADS (R) 4A lesion categories were changed by breast magnetic resonance imaging, and these lesions were pathologically diagnosed as benign. The negative predictive value of breast MRI for BI-RADS (R) category 4A lesions was calculated as 100%. In all BI-RADS (R) category 4 lesions, pathologically 4 lesions found to be high risk and 3 lesions found to be malignant. The sensitivity, specificity, positive predictive, and negative predictive value of breast magnetic resonance imaging in BI-RADS (R) category 4 lesions were calculated as 100, 29.6, 26.9, and 100%, respectively. The area under the ROC curve was calculated 0.648. Breast magnetic resonance imaging is promising to be used as a problem-solving modality in BI-RADS (R) category 4A breast lesions.Item The Role of Shear-Wave Elastography in the Differentiation of Benign and Malign Non-Mass Lesions of the Breast(2018) Aslan, Hulya; Pourbagher, Aysin; Ozen, Merve; 0000-0002-7138-246X; 30569901; AAK-9104-2021; HCH-8774-2022AIM: The aim of this study is to retrospectively assess the additional diagnostic value of shear wave elastography (SWE) added to ultrasound (US) versus US alone in differentiating malignant and benign non-mass lesions (NMLs) of the breast by readers with different experience levels and to assess interreader agreement. MATERIAL AND METHODS: This retrospective study enrolled 53 NMLs (31 benign, 22 malignant). Two radiologists (readers 1 and 2 had 15 years and 1 year of experience in breast imaging, respectively) independently reviewed each study and determined the BI-RADS category using US alone and again after adding SWE to US. Diagnostic performances of US alone and US combined with SWE were compared for both readers. Areas under receiver operating characteristic curves (AUCs) were estimated. The levels of interobserver agreement were determined by the calculated kappa coefficient. RESULTS: With the addition of SWE to US, AUCs for differentiation of benign and malignant lesions increased sign/ icantly for the less experienced reader (0.56 vs. 0.79; p=0.028), but not for the more experienced reader (0.60 vs. 0.75; p=0.170). While evaluating US alone, the interobserver agreement was moderate, and the interobserver variability among the readers was statistically significant (k=0.493, p<0.001). After adding SWE, the agreement increased to 0.773, and the interobserver variability among the readers became non-significant (k=0.773, p=0.688) CONCLUSIONS: SWE increased the diagnostic performance of relatively less experienced reader significantly. SWE improved interobserver agreement of two readers with different levels of experience and reduced the interobserver variability in differentiating benign and malignant NMLs of the breast.Item Is There A Correlation Between the Severity of Idiopathic Granulomatous Mastitis and Pre-Treatment Shear-Wave Elastography Findings? Original Research(2018) Aslan, Hulya; Arer, Ilker Murat; Pourbagher, Aysin; Ozen, Merve; 0000-0002-7138-246X; 30665211; AAK-9104-2021; HCH-8774-2022AIM: The aim of this study was to analyze the correlation between the severity of idiopathic Garulomatous Mastitis (IGM) and the pre-treatment Shear-Wave Elastography (SWE) findings. MATERIAL AND METHODS: A total of 39 patients diagnosed with granulomatous mastitis were included in the study between the dates of December 2014 and February 2017. The patients were divided into two groups. Group 1 was treated using a conservative protocol and steroids. Group 2 was treated surgically. Pre-treatment SWE findings of both groups were compared. RESULTS: The mean ages of the patients in group 1 and 2 were 38.44 +/- 9.6 and 3605 +/- 7.44 years, respectively. There were not any significant differences between the groups with regard to frequency of BI-BADS categories and Virtual touch tissue imaging (VTI) patterns. The mean Shear-Wave Spead (SWS) were 1.98 +/- 1.02 m/sec and 2.82 +/- 1.66 m/sec in group 1 and 2 respectively. The difference was not significant (p >= 0.05). The BI-RADS categories and VTI patterns did not show significant difference when the recurrent and non-recurrent patients were compared. CONCLUSION: There may not be a correlation with the pre-treatment SWE findings and severity of the IGM.Item Primary breast tuberculosis: imaging findings of a rare disease(2021) Baykan, Ali H.; Sayiner, Hakan S.; Inan, Ibrahim; Aydin, Elcin; Erturk, Sukru M.; 0000-0003-0907-3647; 33587199; AAI-8276-2021Breast tuberculosis is a rare form of extrapulmonary tuberculosis which tends to affect females of reproductive age, and is much rarer in males, postmenopausal women, and pre-pubescent girls. It is difficult to diagnose because it can mimic benign conditions such as a fibroadenoma, as well as malignant diseases like a carcinoma. It is also particularly difficult to distinguish breast tuberculosis from granulomatous mastitis, so other possible diagnoses should be ruled out first. The diagnosis of breast tuberculosis has three essential pillars: clinical examination, radiological evaluations, and histopathological sampling. Radiological evaluations are not only critical in diagnosis but are also important in the planning of the treatment and during the follow-up. This paper aims to review the imaging findings and the differential diagnosis of breast tuberculosis.Item Not Otherwise Specified-Type Sarcoma of Breast with CD10 Expression: Case Report(2019) Hasbay, Bermal; Bolat, Filiz Aka; Aslan, Hulya; Aytac, Huseyin Ozgur; 31620687Primary breast sarcomas are very rare and account less than 1% of invasive breast carcinomas. Primary sarcomas of breast are leiomyosarcoma, angiosarcoma, liposarcoma, fibrosarcoma, rhabdomyosarcoma, malignant peripheral nerve sheath tumor and pleomorphic sarcoma. Recently, a new CD10 positive group of sarcoma was identified. These tumors cannot be classified as a soft tissue sarcoma and show diffuse strong positive staining pattern with CD10 (NSCD10). Herein we report clinical and morphological characteristics of two cases diagnosed with not otherwise specified-type sarcoma with CD10 expression by histologically and immunohistochemical findings with the literature. NSCD10 shows similarity with leiomyosarcoma and sarcomatoid-type metaplastic carcinoma histomorphologically among specific sarcomas of breast. CD10 expression should be taken into consideration in the presence of not diagnosed and not specified tumors and CD10 should be added to the immunohistochemical panel.Item An Unusual Gastrointestinal Stromal Tumor Presentain: Breast, Liver and Lymph Node Metastasis(2017) Hasbay, Bermal; Aytac, Huseyin Ozgur; Kayaselcuk, Fazilet; Torun, Nese; 000-0002-1180-3840; 0000-0002-5597-676X; 29082381; AAE-2550-2021; AAE-2718-2021Gastrointestinal Stromal Tumors (GIST) are the common mesenchymal tumors of gastrointestinal tract. They can display benign and malignant clinical behavior. The most common metastasis sites of malignant stromal tumor are liver, peritoneum, lung and bones. Metastasis to breast is extremely rare. Here, we present a case of GIST with liver, bone, lymph node and breast metastasis by reviewing the literature.Item Ultrasound Elastography and Magnetic Resonance Imaging Findings of Breast Angiosarcoma Mimicking a Benign Lesion by Elastography: A Case Report(2017) Aslan, Hulya; Pourbagher, Aysin; Ezer, Ali; Bolat, Fİliz Aka; Yabanoglu, Hakan; 0000-0002-7138-246X; 0000-0002-1161-3369; 0000-0002-3834-9924; 0000-0003-0268-8999; AAK-9104-2021; AAJ-7865-2021; AAJ-8558-2021; AAK-2011-2021Introduction: Primary and secondary angiosarcomas of the breast are rare neoplasms. Radiologically, magnetic resonance imaging, mammography, and ultrasound (US) findings of angiosarcomas have been reported previously. However, ultrasound (US) elastography findings of angiosarcoma have not been reported yet. Currently, US elastography should be used commonly to decide biopsy or short-term follow-up of breast lesions. Case Presentation: A 39-year-old female from Adana, Turkey, was admitted to Dr.Turgut Noyan Adana Teaching and Medical Research Center at the breast center of Baskent University, with a palpable right breast mass, which had been enlarging for one year in 2015. Our breast center is a tertiary referral center. B-mode US and US elastography findings suggested that the lesion was benign; however, magnetic resonance imaging showed a mass enhancing intensely at early phases with rapid wash out. The final diagnosis of the mastectomy specimen confirmed low-grade angiosarcoma. If the recommendation would have been based on the elastography findings, it would have been catastrophic because angiosarcomas tend to rapidly increase in size. Conclusions: B-mode US and elastography findings of breast angiosarcoma may mimic benign lesions.Item Breast Involvement by Hematologic Malignancies: Ultrasound and Elastography Findings with Clinical Outcomes(2017) Aslan, Hulya; Pourbagher, Aysin; 0000-0002-7138-246X; 29296470; AAK-9104-2021Objective: Hematological malignancies very rarely involve the breast. The aim of this study is to retrospectively evaluate B-mode ultrasound (US) and elastography (ES) findings of breast involvement by hematologic malignancies with clinical outcomes. Materials and Methods: All core-needle biopsy results that were performed at our tertiary breast center from January 2013 to September 2016 were searched. Our search revealed 9 patients with breast involvement either by leukemia or lymphoma. All patients were examined using B-mode US and ES. US and ES findings were analyzed with the consensus of two radiologists, and clinical outcomes were noted. Results: The mean age of the study population was 41.6 years (range, 20-83 years). Two patients showed diffuse hypoechoic parenchymal infiltration. The elasticity assessments of these lesions were soft and intermediate. The remaining 7 patients had mass lesions. The elasticity assessment of these masses according to Breast Imaging Reporting and Data System US was as follows: Soft (n = 1), intermediate (n = 4), high (n = 2). Conclusions: It is important to consider that hematologic malignancies may appear as soft or intermediate lesions on ES. Patients' history and clinical background should help us to consider breast involvement. In addition, the clinical outcomes may not be related with elasticity assessments.