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Thứ Năm, 12 tháng 7, 2018

Dense breast tissue translates into higher cancer odds.

By Kate Madden Yee, AuntMinnie.com staff writer
June 26, 2018 -- A large study out of Norway found that women with dense breast tissue do have higher odds of both screen-detected and interval breast cancer -- and that automated breast density measurement tools can accurately categorize tissue density, according to a study published online June 26 in Radiology.
The findings suggest that automated density measurement tools offer an effective alternative to subjective density assessments, and they point to the need to continue notifying women of their tissue density and improving supplemental screening methods, wrote Dr. Liane Philpotts of Yale School of Medicine in an editorial that accompanied the research.
"This study is important for two main reasons," Philpotts wrote. "First, [it] provides validation that automated means of density classification can correctly identify a percentage of women with dense tissue. Second, women with dense tissue have poorer performance at screening mammography. This study lends support to the density notification movement, along with redoubling efforts toward optimizing methods of supplemental screening."
Density matters
Breast density has been under examination in recent years as researchers have investigated its effects on screening mammography and, in light of mammography's limitations with dense tissue and a grassroots density notification movement, sought to develop alternative imaging options. All along, the issue of how to characterize breast tissue -- whether through radiologists' subjective judgments based on the BI-RADS scale or through automated tools -- has continued to be debated.
"No reference standard exists for breast density determination," wrote the team led by Dr. Nataliia Moshina, PhD, from the Cancer Registry of Norway in Oslo. "[And although for example, in] the United States, more than half the states have enacted breast density notification legislation ... [which] mandates that women should be informed about their breast density or that additional imaging could be beneficial ... supplemental screening for women with dense breasts is not currently recommended by any major societies or organizations."
Moshina and colleagues sought to assess the effectiveness of automated volumetric breast density measurement software in identifying women with dense tissue, as well as to examine how dense breast tissue affects screening performance and outcomes. The group used data from BreastScreen Norway, a screening initiative coordinated by the Cancer Registry of Norway, and included 107,949 women between the ages of 50 and 69 who underwent 2D screening mammography between January 2007 and December 2015, resulting in 307,015 exams. Moshina's team tracked recall, biopsy, and rates of screen-detected and interval cancer, along with sensitivity, specificity, and histopathologic tumor characteristics.
Breast density was assessed with automated software from Volpara Solutions, which uses a four-category scale considered comparable to BI-RADS density categories:
  • Density grade 1: ≤ 4.5% density (BI-RADS 1, fatty tissue)
  • Density grade 2: 4.5% to 7.49% density (BI-RADS 2, scattered fibroglandular tissue)
  • Density grade 3: 7.5% to 15.49% density (BI-RADS 3, heterogeneously dense tissue)
  • Density grade 4: ≥ 15.5% density (BI-RADS 4, extremely dense tissue)
Of the total number of breasts screened, 28% were classified as dense. The researchers found that dense breast tissue translated into higher recall rates, lower mammographic sensitivity, larger tumor size, and more lymph node-positive disease.
Characteristics of screen-detected cancers by density category
MeasureNondense tissue (volumetric density < 7.5%)Dense tissue (volumetric density ≥ 7.5%)p-value
Biopsy rate1.1%1.4%< 0.0001
Positive lymph node18%24%0.02
Rate of interval cancer (per 1,000 exams)1.22.8< 0.0001
Rate of screen-detected cancer (per 1,000 exams)
Recall rate2.7%3.6%< 0.0001
Sensitivity81.6%70.8%< 0.0001
Specificity97.9%97%< 0.0001
Tumor diameter (mean)15.1 mm16.6 mm0.009
The adjusted odds of screen-detected breast cancer were 1.37 times higher in women with dense breasts than in those with nondense tissue. In addition, the odds of interval cancer were 2.93 times higher in women with dense tissue than in their nondense counterparts, the researchers found.
"These findings suggest that mammographic density impacts the performance of breast cancer screening and the results show worse outcome for women with dense breasts," corresponding author Solveig Hofvind, PhD, told AuntMinnie.com via email. "The study corroborates previous findings on the association of high breast density and less favorable tumor characteristics, including tumor size and lymph node involvement."
Dealing with density
Using automated volumetric density assessment software helped Moshina's team confirm that women with dense breast tissue have higher recall and biopsy rates and higher odds of screen-detected and interval breast cancer, as well as larger tumors and more positive lymph nodes. Although the higher recall and biopsy rates were likely due to interpretation challenges, they noted that these rates were still substantially lower than rates in the U.S., which are usually around 10%.
The researchers also emphasized that the relatively small difference in biopsy rates between women with dense and nondense breast tissue is "clinically relevant for a screening program that covers about 85% of the 600,000 women in [Norway's] target population." And the finding that mammography is less sensitive in dense tissue underlines the need to find effective supplemental imaging.
"The lower sensitivity of mammography screening among women with dense breasts indicates that mammographic screening is less effective for [them]," the group wrote. "This is because of a higher rate of interval breast cancers with less favorable tumor characteristics compared with screen-detected breast cancers."
The study suggests that automated volumetric density categorization software is a helpful tool for identifying women at higher risk of breast cancer, and it could improve the way women with dense tissue are identified and tracked, Philpotts concluded in her editorial.
"Automated volumetric determination could better standardize density compared with subjective methods and provide greater confidence that this group of women could consistently be identified," she wrote. "This should also help radiology practices to be open to adopting methods to screen such women. Breast density is here to stay, and it is in everyone's best interest to embrace understanding and optimization of breast imaging practice to best address the needs of women with dense tissue."

Thứ Bảy, 30 tháng 6, 2018


Thoát vị bàng quang vào bìu hiếm gặp. Thường là thoát vị bẹn trượt (sliding inguinal hernia), có nhiều nguyên nhân, nhưng ca 501 Medic chỉ do thành bụng bẹn T yếu, trong khi y văn cho thấy là do biến chứng sau mổ tiền liệt tuyến với vùng bẹn yếu, hay giảm trương lực bàng quang thứ phát do u xơ tiền tuyến hay bế tắc đường tiểu. Triệu chứng điển hình là tiểu 2 lần: lần đầu tiểu ngẩu nhiên bình thường, kế đó ép khối vùng bẹn và đi tiểu tiếp tục.
Chẩn đoán  trước mổ chủ yếu là siêu âm và chụp cản quang bàng quang ngược dòng, với hình bàng quang thoát vị dạng quả tạ [dumbbell shaped urinary bladder];  chẩn đoán đúng gíup tránh làm rách bàng quang khi mổ khâu thoát vị bẹn [herniorhapphy].

J Radiol Case Rep. 2009;3(2):7-9. doi: 10.3941/jrcr.v3i2.91. Epub 2009 Feb 1.

Cystogram with dumbbell shaped urinary bladder in a sliding inguinal hernia.


Sliding inguinal hernias present with various symptoms and these are usually direct inguinal hernias containing various abdominal viscera. Case reports and series have been published with various organs and rare organs being part of the hernia. Urinary bladder is a known content of sliding hernias. This case report emphasizes this aspect in a picturesque manner and the importance of radiological investigations for pre-surgical evaluation.


Bladder herniation; Cystogram; Inguinal hernia; Prostatic hypertrophy; Sliding hernia

 [Bladder hernia]. Ann Ital Chir. 1995 May-Jun;66(3):363-9.
 [Article in Italian]
A case of bladder hernia in a 61 years old patient affected by benign prostatic hypertrophy is presented. Pre-operative diagnosis was made by cystography. After an adenomiomectomy of the prostate, the patient underwent the resection of the herniated bladder which gave the bladder its normal shape with only a slight reduction of its capacity. Inguino-scrotal bladder hernias are very rare; recognized predisponing factors are weakening of muscular and connective structures of the inguinal canal, and bladder hypotonia secondary to urethro-prostatic obstruction.
These hernias, according to the anatomical position of the hernial sac, bladder and peritoneum, are classified in paraperitoneal (most frequent), intraperitoneal and extraperitoneal. The typical symptom of this disease is the two-stage micturition: the patient after a first spontaneous voiding, presses the mass and voids again. Other than cystography, useful diagnostic means are urography and cystoscopy which may confirm the diagnosis and rule out associated urinary disease.
The treatment consists of either simple reduction of the bladder hernia, if the hernia is small, or resection of the herniated portion of the bladder, if the hernia is large or is associated with other diseases (e.g. tumors). Bladder resection is then followed by closure of the bladder wall in two layers and by inguinal hernia repair.
Actas Urol Esp. 1999 Jan;23(1):79-82.
[A massive hernia of the bladder into the scrotum. A report of a case].
[Article in Spanish]
The hernia of the bladder in the scrotum is a highly uncommon observation. From the clinical standpoint the usual manifestation is a two-stroke voiding. The recommended urological examinations to reach a diagnosis are ultrasound, endovenous urography, retrograde urethrocystography and cystoscopy. Management includes the de-obstruction of the lower urinary tract, if present, resection of associated peritoneum, resection or reduction of the vesical hernia and repairment of inguinal path. The case contributed corresponds to a vesical hernia in a 72-year-old patient, with no obstructive cause, that was treated surgically by resection of the herniated bladder, with good morphological and functional results.
 1997 May;21(5):514-8.

[Vesico-scrotal hernia. Report of a clinical case].

[Article in Spanish]


Incidental discovery of vesical hernias during herniorrhaphy is quite common. In such cases, patients are usually asymptomatic since the hernia portion is small and easily repairable. On the other hand, vesical solid protrusion to the scrotum is quite unusual, and is generally found associated to obstructive urinary symptoms. Management involves basically the correction of any associated obstructive conditions, correction of the vesical hernia and herniorrhaphy.