Mô tuyến vú trên siêu âm liên quan đến nguy cơ ung thư vú

Từ AuntMinnie.com

Ngày 21 tháng 7 năm 2021 - Mô tuyến có liên quan đến nguy cơ ung thư vú trong tương lai ở phụ nữ có mô vú đặc theo một nghiên cứu về phụ nữ ở Hàn Quốc được công bố ngày 19 tháng 7 trên tạp chí Radiology .

Các nhà nghiên cứu dẫn đầu bởi đồng tác giả Tiến sĩ Su Hyun Lee, Tiến sĩ và Tiến sĩ Han-Suk Ryu, từ Đại học Quốc gia Seoul, Hàn Quốc cho biết với những phát hiện này, thành phần mô tuyến trong siêu âm vú nên được xem xét để phân tầng nguy cơ trong quá trình sàng lọc.

Tăng mật độ vú khi chụp nhũ ảnh, được xác định bởi số lượng mô sợi liên quan đến mô mỡ  trên hình ảnh, là một yếu tố nguy cơ  ung thư vú. Nó  cản trở việc phát hiện ung thư vú vì che khuất và làm khó phân biệt giữa mô tuyến và mô xơ.

Nhóm nghiên cứu muốn tìm ra mối liên quan giữa thành phần mô tuyến khi siêu âm tầm soát và nguy cơ ung thư vú ở phụ nữ có mô vú đặc Nhóm cũng muốn tìm ra mối liên hệ giữa thành phần mô tuyến và sự tiến hóa của tiểu thùy.

Xem xét dữ liệu thu thập từ 8.483 phụ nữ từ năm 2012 đến năm 2015 không có tiền sử ung thư vú và độ tuổi trung bình là 49 tuổi. Những người được siêu âm vú và có mô vú đặc với kết quả âm tính trước đó từ chụp nhũ ảnh. Có 137 ca trong số này phát triển ung thư vú với thời gian theo dõi trung bình là 5,3 năm.

Nhóm nghiên cứu phát hiện ra rằng thành phần mô tuyến vừa phải hoặc nhiều có liên quan đến tăng nguy cơ ung thư theo độ tuổi và mật độ vú. Tuy nhiên, điều ngược lại cũng được xác định là đúng với diễn tiến phát triển của tiểu thùy. 

Cần xác nhận thêm về thành phần mô tuyến trong quá trình siêu âm sàng lọc vú. Điều này có thể hữu ích trong việc phân tầng nguy cơ ung thư vú và nhu cầu kiểm tra bổ sung ở phụ nữ có mô vú đặc.

Họ cũng kêu gọi các nghiên cứu trong tương lai so sánh thành phần và sự phát triển của tiểu thùy tại cùng một vị trí trong vú.

CT and US provide chance for fatty liver disease screening

By AuntMinnie.com staff writers

May 25, 2021 -- Abdominal CT and ultrasound can be useful tools for opportunistic screening for hepatic steatosis, or fatty liver disease, according to a study published May 24 in the Journal of the American College of Radiology.

Hepatic steatosis is a common incidental finding on abdominal imaging, a group led by Dr. Rubal Penna of Virginia Mason Medical Center in Seattle noted. But it's not always taken seriously, despite the fact that it is associated with liver disease, cirrhosis, and diabetes.

In the new study, Penna's group explored whether adding a standardized note regarding incidentally identified hepatic steatosis to a patient's radiology report would not only help referring clinicians follow up but also identify significant disease.

The study included 1,256 patients who underwent either CT or ultrasound and whose reports included a note about the presence of hepatic steatosis between April 2016 and September 2017. The researchers assessed whether any follow-up clinical action had been taken in response, tracking patient demographics, type of referring provider, and urgency of exam results.

Follow-up was more likely for patients whose exams had been ordered by primary care providers, whose exam results weren't urgent, and who had undergone ultrasound. Follow-up of the study cohort found fatty liver disease in 70%, nonalcoholic steatohepatitis in 6%, and alcoholic hepatitis in 17%.

"Opportunistic screening for incidental hepatic steatosis on abdominal CT and ultrasound is feasible, with substantial yield for patients with clinically important entities including nonalcoholic fatty liver disease and nonalcoholic steatohepatitis," the team concluded.

US Screening during wellness visits spots abnormalities in 94% of patients

Matt O'Connor | July 21, 2021 | Diagnostic & Screening

Ultrasound screening during annual visits for older patients frequently identifies abnormalities and new chronic conditions. And implementing these exams during wellness visits may be highly beneficial, authors argued in a new analysis.

Standard Medicare Wellness checkups require no physical exam beyond blood pressure, and many doctors perform limited assessments in these situations, authors wrote in the Journal of Ultrasound in Medicine. But providers from Minneapolis-based Allina Health instituted a primary care clinic US program to determine the benefits of preventative ultrasound.

The effort proved successful, leading to meager follow-up testing costs and high patient acceptance marks.

“One or more abnormalities were found in 94% of our participants, the great majority of which would have been undetected by a traditional physical exam.

The program employed an experienced physician to perform US screening in patients 65-85 years old during their annual Medicare Wellness visits. Overall, only 108 people were examined, leading to 283 abnormalities and 172 new diagnoses.

Abdominal findings most often included liver steatosis and kidney cysts, while cardiovascular abnormalities typically consisted of carotid plaque, tricuspid valve regurgitation and left ventricular diastolic dysfunction.

Doctors ordered 30 total follow-ups, resulting in no added costs for 76% of patients. Fifteen percent faced tabs between $5-$50.

Rosborough and co-authors said screening during these appointments is at least “mildly beneficial,” but more research is needed.

“A larger study with multiple US-enabled physicians would be required to assess the generalizability and cost-effectiveness of an US screening exam as part of a wellness visit,” the authors added. “We continue to investigate how to implement an US screening exam for select patients having periodic health visits.”

Optimal Intervals of Ultrasonography Screening for Early Diagnosis of Hepatocellular Carcinoma in Taiwan

Abstract 

IMPORTANCE 

There are different clinical practices regarding ultrasonography screening intervals for hepatocellular carcinoma (HCC) despite recommendations from international guidelines.

 OBJECTIVE

 To evaluate whether ultrasonography screening using intervals suggested by international guidelines is associated with cancer stage shifting, reductions in mortality, and improved quality of life (QoL) for patients with HCC. 

DESIGN, SETTING, AND PARTICIPANT

 This nationwide comparative effectiveness research study estimated lifetime survival functions using interlinkages of 3 databases from Taiwan—the Taiwan National Health Insurance, Taiwan National Cancer Registry, and National Mortality Registry— combined with QoL measurements obtained from National Cheng Kung University Hospital. In total, 114 022 patients listed as having newly diagnosed HCC from 2002 through 2015 in the Taiwan National Cancer Registry were followed up until 2017. The QoL values of 1059 patients with HCC who visited National Cheng Kung University Hospital were prospectively measured with the European QoL-5 dimensions questionnaire from 2011 through 2019. Patients were categorized based on the time between their last ultrasonography screening and the index date (90 days prior to HCC diagnosis) as 1 of 5 subcohorts: 6 months (0-6 months), 12 months (7-12 months), 24 months (13-24 months), 36 months (25-36 months), and longer than 36 months (no screening in the previous 3 years). Data were analyzed from April 2020 to April 2021. 

MAIN OUTCOMES AND MEASURES 

Life expectancy, quality-adjusted life expectancy, and loss of life expectancy or loss of quality-adjusted life expectancy compared with age-, sex-, and calendar year–matched cohorts. 

RESULTS 

There were 59 194 patients with Barcelona Clinic Liver Cancer staging information, including 42 081 men (mean [SD] age, 62.2 [12.6] years) and 17 113 women (mean [SD] age, 69.0 [11.2] years). There was a consistent trend showing that the longer the interval between ultrasonography examinations, the higher the loss of life expectancy and loss of quality-adjusted life expectancy for both sexes. Loss of quality-adjusted life expectancy values for male subcohorts were 10.0 (95% CI, 9.1-10.9) quality-adjusted life-years (QALYs) for ultrasonography screening intervals of 6 months, 11.1 (95% CI, 10.4-11.8) QALYs for 12 months, 12.1 (95% CI, 11.5-12.7) QALYs for 24 months, 13.1 (95% CI, 12.6-13.6) QALYs for 36 months, and 14.6 (95% CI, 14.2-15.0) QALYs for longer than 36 months. Loss of quality-adjusted life expectancy values for female subcohorts were 9.0 (95% CI, 8.3-9.6) QALYs for 6 months, 9.7 (95% CI, 9.2-10.2) QALYs for 12 months, 10.3 (95% CI, 9.8-10.7) QALYs for 24 months, 10.7 (95% CI, 10.2-11.1) QALYs for 36 months, and 11.4 (95% CI, 11.0-11.8) QALYs for longer than 36 months. Patients with underlying hepatitis B virus infection or cirrhosis had the greatest improvement in life expectancy with shorter screening intervals.  

Findings 

This comparative effectiveness research study evaluated 59 194 patients with HCC in Taiwan who were followed up for 14 years, with loss of quality-adjusted life expectancy estimated by comparison with age-, sex-, and calendar year–matched referents simulated from vital statistics data. Compared with  abdominal ultrasonography screening within 36 months before diagnosis, screening 6 months before diagnosis was associated with an additional 4.6 QALYs for men and 2.4 QALYs for women. Meaning In this study, ultrasonography screening using shorter intervals for high-risk patients detected HCC earlier, suggesting that such a screening approach may save more lives and improve quality of life. 

CONCLUSIONS AND RELEVANCE

 Regular ultrasonography screening with intervals less than 6 to 12 months may be associated with early detection of HCC, save lives, and improve the quality of life for patients with HCC from a lifetime perspective. 

Key Points Question What is the optimal interval of ultrasonography screening for early diagnosis of hepatocellular carcinoma (HCC) among high-risk patients? 

JAMA Network Open. 2021;4(6):e2114680. doi:10.1001/jamanetworkopen.2021.14680

POCUS in diagnosis of pediatric transient synovitis

By Amerigo Allegretto, AuntMinnie.com staff writer

July 13, 2021 -- Point-of-care-ultrasound (POCUS) in combination with a decision-support checklist can help accurately diagnose transient synovitis in pediatric patients, according to research published July 13 in JAMA Network Open.

A group led by Marah Zoabi, a research assistant from the Technion-Israel Institute of Technology in Haifa, found that a POCUS decision-support algorithm can help provide more efficient diagnosis of transient synovitis and avoid unnecessary blood tests.

"To our knowledge, this study is the first to suggest a rule-in diagnostic tool for transient synovitis, instead of one of exclusion," Zoabi and colleagues wrote. "The traditional approach advocates the use of laboratory tests to differentiate between transient synovitis and other serious diseases."

Transient synovitis causes acute hip pain and is confirmed by excluding other severe diseases, such as septic arthritis, osteomyelitis, and Legg-Calvé-Perthes disease. Hip effusion, meanwhile, is typically found using ultrasonography.

The team's POCUS decision-support algorithm is used regularly to identify transient synovitis in pediatric patients. It includes a set of five clinical criteria that must be met, followed by bedside ultrasonography of the hip joint. The criteria include the following:

• Age 3-10 years
• Fever less than 38° C
• Pain with weight-bearing movement
• Concerns started seven days ago or earlier
• Absence of paleness, splenomegaly, and generalized lymphadenopathy

The researchers wanted to test the accuracy of the algorithm in diagnosing the disease. To do so, they looked at data gathered from 1,461 children with nontraumatic hip tenderness between October and November 2020.

The POCUS algorithm was applied to 621 patients (429 boys, 192 girls) with an average age of 5.5 years. Out of these patients, 539 were correctly diagnosed as having transient synovitis. Meanwhile, 22 patients were correctly diagnosed as not having synovitis and 54 were misdiagnosed as not having synovitis, but they were correctly diagnosed at follow-up visits.

Six emergency department patients were misdiagnosed as having synovitis, but they were found to have another condition at follow-up visits.

The algorithm showed high sensitivity at 90.9% and high positive predictive value at 98.9%. Specificity, meanwhile, was 78.6% and negative predictive value was 28.9%.

The algorithm's positive likelihood ratio of 4.25 suggests it can be helpful in ruling in the diagnosis of transient synovitis, the authors concluded.

Hip effusion may not always be present when patients present with transient synovitis. This is reflected by the limited specificity and low negative predictive value, suggesting the algorithm cannot reliably rule out synovitis, they added.

Potential limitations of the study included its retrospective nature, the operator-dependent nature of the ultrasonography exam, the absence of an objective reference standard, and the lack of external validation of the algorithm, according to Zoabi and colleagues.

However, "these data provide evidence for the safety of the POCUS decision-support algorithm," they wrote.

US finds brain differences in infants exposed to Zika virus

By Amerigo Allegretto, AuntMinnie.com staff writer

July 6, 2021 -- Cranial ultrasound found lenticulostriate vasculopathy to be more common in infants exposed to the mosquito-borne Zika virus, according to research from Brazil published June 29 in Radiology.

A team of researchers led by Sara Reis Teixeira, PhD, from the University of São Paulo found that lenticulostriate vasculopathy, a cranial ultrasound finding related to pre- or perinatal brain injury, was 9 times more frequent in infants exposed to the Zika virus infants compared with otherwise healthy infants.

"Our results demonstrate a spectrum of neuroimaging findings in a large cohort of infants born to infected pregnant women and support recent guidelines in recommending postnatal cranial ultrasound for all infants with possible congenital Zika virus infection, regardless of the presence of microcephaly," the study authors said.

Zika virus infection during pregnancy may lead to a wide range of central nervous system changes, the researchers said. While most previous studies have assessed patients who are severely affected, such as having microcephaly, there is little information on abnormalities in infants with normal head size.

The investigators wanted to find out the prevalence of cranial ultrasound findings in a large group of infants born to women with Zika virus infection with infants born to mothers not infected. They also wanted to study signs of prenatal Zika virus exposure on cranial ultrasound scans, looking at infants from the 2015-2016 Zika virus outbreak in southeast Brazil.

"Neuroimaging is a fundamental component of the diagnostic evaluation of infants at risk for congenital Zika virus syndrome," the study authors wrote. "Information regarding the spectrum of brain findings in a large cohort of infants born to infected women is still scarce."

The study included 220 infants exposed to the Zika virus, with an average age of 53.3 days. Of these, 113 were boys and 107 were girls. Meanwhile, 170 infants with an average age of 45.6 days (102 boys, 68 girls) who were not exposed to the virus were in a control group.

Cranial ultrasound found a Zika virus-like pattern in 11 of the 220 virus-exposed infants, but not in the control group infants.

Calcifications and subcortical calcifications were found only in Zika-exposed infants. Other intracranial calcifications, such as those in the basal ganglia, periventricular area, and scattered in the brain, were also associated with virus exposure. However, the frequency of most mild cranial ultrasound findings was not significantly different between both groups.

However, the finding of lenticulostriate vasculopathy was found in 12 of the virus-exposed infants, while being found in only one infant in the control group (p = 0.01).

The team said that further studies are needed to evaluate the potential clinical significance of lenticulostriate vasculopathy and other mild cranial ultrasound findings in infants exposed to Zika virus.

An accompanying editorial written by Dr. Carol Benson from Harvard Medical School said that long-term neurodevelopmental outcomes in infants exposed to the virus in utero are also needed to determine how best to counsel patients exposed while pregnant, as well as to understand the clinical significance of mild sonographic abnormalities in infants.

Short US screening intervals improve liver cancer outcomes

By Amerigo Allegretto, AuntMinnie.com staff writer

June 25, 2021 -- Ultrasound screenings with shorter intervals for high-risk patients with hepatocellular carcinoma (HCC) may save more lives and improve quality of life, according to research published June 24 in JAMA Network Open.

The results suggest a relatively easy way to improve HCC patient outcomes, wrote a team led by Dr. Shih-Chiang Kuo from the National Cheng Kung University Hospital in Taiwan.

"Our finding shows a clear indication of saving life-years and quality of life, and clinicians can use this knowledge to remind their patients, especially those with viral infection and/or cirrhosis of liver," said Dr. Jung-Der Wang, one of the study's co-authors.

Hepatocellular carcinoma accounts for most liver cancer cases. But despite improvements in medical technology and treatment, the five-year survival rate of HCC remains low, according to Kuo's team.

Early detection by screening is recommended by medical societies, but some research does not support six-month screening intervals using abdominal ultrasonography. Along with that, an "inadequate" number of high-risk patients do not adhere to regular screenings, the authors noted.

"Many patients with viral hepatitis B or C infection, or, cirrhosis of liver might feel tired of such examinations after negative results of the initial several years," Wang told AuntMinnie.com. "Then, many of them would consider that they might not be the unlucky one who would later develop HCC and stop the biannual screening ultrasonography."

Kuo and colleagues sought to investigate the optimal interval of ultrasonography screening for early diagnosis of HCC among high-risk patients via a study that included 59,194 patients; of these, 42,081 were men (average age, 62.2 years) and 17,113 were women (average age, 69).

The team found the longer the interval between ultrasonography screenings, the higher the loss of life expectancy and loss of quality-adjusted life expectancy for both men and women.

Loss of quality-adjusted life years by ultrasound screening interval period in patients with HCC
Gender	6 months	12 months	24 months	36 months	More than 36 months
Men	10	11.1	12.1	13.1	14.6
Women	9	9.7	10.3	10.7	11.4

The authors also noted that patients with underlying hepatitis B virus infection or cirrhosis had the greatest improvement in life expectancy with shorter screening intervals.

Although multiple medical societies recommend ultrasonography screening for HCC every six to 12 months, the researchers found that only 31.4% of men and 42.2% of women with HCC in Taiwan underwent ultrasonography within six months before diagnosis, and only 39.3% of men and 51.9% of women underwent such screening within 12 months.

"Moreover, among those with underlying liver cirrhosis, only 35.5% of men and 49.1% of women underwent ultrasonography within six months before HCC diagnosis, indicating underutilization of ultrasonography screening in Taiwan," the team wrote.

The study highlights the fact that use of ultrasound for early detection of HCC could be improved, according to the authors.

"The results of this study suggest that regular ultrasonography screening with an interval of six to 12 months or less may lead to early detection of HCC and may save lives and improve utility for patients with HCC from a lifetime perspective," they concluded. "Because people with underlying risk factors ... showed only slightly more frequent ultrasonography screening than those without ... we recommend improving this clinical practice."

Wang told AuntMinnie.com that the team is looking into what even more frequent screening, namely three months, would do for patients, as well as the cost-effectiveness of such screening in terms of cost per quality-adjusted life-year saved.

Elastography helpful in breast microcalcification cases

By Amerigo Allegretto, AuntMinnie.com staff writer

June 21, 2021 -- Shear-wave elastography could be useful in helping decide whether women undergoing breast screening should receive a second biopsy or excision when it comes to suspicious microcalcifications, according to research published June 11 in Ultrasound in Medicine and Biology.

A team led by Dr. Yasemin Kayadibi from Istanbul University in CerrahpaŞa in Turkey found that despite biopsy being recommended for showing suspicious microcalcifications, 2D shear-wave elastography is a "useful" method for characterizing microcalcifications that can be visualized with ultrasonography.

"We believe that shear-wave elastography may assist, when the pathologic and radiologic findings are discordant, in the decision to send a patient for a second biopsy or excision," Kayadibi and her team wrote. "We [also] believe that identifying the most pathologic area using elastography with ultrasonography is more practical and efficient in clinical practice."

About 25% of cancers with suspicious microcalcifications presented on mammography consist of ductal carcinoma in situ (DCIS).

While most DCIS cases can be diagnosed through the presence of suspicious microcalcifications on mammograms classified as BI-RADS 4 or 5, only 10% to 43% of microcalcifications that are considered suspicious and subjected to biopsy end up being diagnosed as malignant, the study authors wrote.

Stereotactic biopsy is the recommended method for assessing these microcalcifications, but the researchers noted their reported disadvantages; these include extended compression of the breast, radiation, and the requirement for expensive equipment.

To assess the value of shear-wave elastography, the team evaluated 50 patients with an average age of 43.7 years who presented with suspicious microcalcifications and without accompanying masses. The patients underwent ultrasonography and 2D shear-wave elastography before biopsy.

Out of the 50 patients, 27 malignant lesions were found, including 18 invasive ductal carcinomas, one invasive lobular, and eight DCIS. The remaining 23 lesions were found to be benign. There was a statistically significant difference between the shear-wave elastography values of malignant and benign microcalcifications.

Diagnostic performance of shear-wave elastography for suspicious breast lesions
	Malignancy	Invasiveness	High grade
Sensitivity	93%	83%	88%
Specificity	91%	88%	53%
Positive predictive value	93%	94%	44%
Negative predictive value	91%	70%	90%
Area under the curve	0.952	0.885	0.776

However, the authors said that biopsy remains the best option for suspicious microcalcifications that show up on mammography images.

"Additional studies are required to verify the factors influencing the decision to perform biopsy for microcalcifications, because our study was conducted with a limited number of cases," they wrote. 

The team also said that more comprehensive studies with long-term follow-up are needed to support these findings.