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Öğe Causes of failure in removing calcium in microcalcification-only lesions using 11-gauge stereotactic vacuum-assisted breast biopsy(Turkish Soc Radiology, 2012) Gumus, Hatice; Gumus, Metehan; Devalia, Haresh; Mills, Philippa; Fish, David; Jones, Peter; Uyar, AsurPURPOSE The aim of this study was to determine the causes and rate of failure in removing calcification in microcalcification-only lesions using 11-gauge stereotactic vacuum-assisted breast biopsy. MATERIALS AND METHODS In total, 1365 microcalcification-only lesions were included in this study. The breast biopsy database was reviewed retrospectively. The biopsies were divided into two groups based on whether the specimen X-ray showed calcium within the cores. Breast composition, lesion size, calcification distribution, density on mammography, and the number of specimens were compared between the two groups. RESULTS In 11 (0.8%) biopsies, no calcium in the specimen radiography could be identified. Re-biopsy was performed in five cases. The initial biopsy result was unchanged at the second biopsy in three cases containing calcium, while in the other two cases, a benign biopsy result was upgraded to atypical ductal hyperplasia and ductal carcinoma in situ, respectively. In six cases, the biopsy was not repeated despite the absence of calcium in the specimen X-ray. In three of these cases, calcifications were reported histopathologically and deemed to be too small to be identified on specimen X-ray. In two of six patients, sufficient information was found in the cores without microcalcification to indicate the need for surgery. One patient refused re-biopsy. A statistically significant higher failure rate was observed in low-density calcification compared with intermediate or high-density calcification on mammography. CONCLUSION The failure to retrieve microcalcification is uncommon when an 11-gauge vacuum-assisted breast biopsy is used. Low-density calcifications have a higher rate of failure. In cases in which no calcium is observed in specimen radiography, repeated biopsy is recommended.Öğe Factors that impact the upgrading of atypical ductal hyperplasia(Aves, 2013) Gumus, Hatice; Mills, Philippa; Gumus, Metehan; Fish, David; Jones, Sue; Jones, Peter; Devalia, HareshPURPOSE The purpose of this study was to identify the factors that may have an impact on upgrading atypical ductal hyperplasia (ADH) lesions to malignancy. MATERIALS AND METHODS Between February 1999 and December 2010, the records of 150 ADH lesions that had been biopsied were retrospectively reviewed. The biopsy types included 11-gauge stereotactic vacuum-assisted biopsy (SVAB) (n=102) and ultrasonography (US)-guided 14-gauge automated biopsy (n=48). The patients were divided into two groups: those who had cancer in the final pathology and those who did not. Variables associated with underestimation of ADH lesions were compared between the groups. RESULTS The underestimation rates according to the biopsy types were 41.7% (20/48) for the US-guided 14-gauge automated biopsy and 20.6% (21/102) for the 11-gauge SVAB (P = 0.007). The rate of underestimation was significantly higher in lesions greater than 7 mm than it was in smaller lesions, with both US-guided 14-gauge automated biopsy and 11-gauge SVAB (P = 0.024 and P = 0.042, respectively). The rate of underestimation was significantly higher with the 11-gauge SVAB (P = 0.025) in lesions that were suspicious (R4) and highly suggestive of malignancy (R5) than in those that were probably benign (R3). CONCLUSION The underestimation rate in ADH lesions was significantly higher with US-guided 14-gauge automated biopsy compared to the 11-gauge SVAB. The underestimation rate was also significantly higher in lesions greater than 7 mm regardless of the biopsy type, and in lesions biopsied using SVAB that were regarded as suspicious (R4) or highly suggestive of malignancy (R5) on imaging.Öğe In vivo studies on non-viral transdifferentiation of liver cells towards pancreatic β cells(2012) Çim, Abdullah; Sawyer, Greta Jane; Zhang, Xiaohong; Su, Haibin; Collins, Louise; Jones, Peter; Antoniou, MichaelTransdifferentiation in vivo is an attractive option for autologous replacement of pancreatic ? cells in patients with type 1 diabetes. It has been achieved by adenoviral delivery of genes for transcription factors in the liver and pancreas of hyperglycaemic mice. However, these viral approaches are not clinically applicable. We used the hydrodynamic approach to deliver genes Pdx1, Ngn3 (Neurog3) and MafA singly and in combination to livers of normoglycaemic rats. Five expression plasmids were evaluated. Livers were removed 1, 3, 7, 14 and 28 days after gene delivery and assayed by quantitative PCR, semi-quantitative PCR and immunohistology. Functional studies on hyperglycaemic rats were performed. The highest and most sustained expression was from a CpG-depleted plasmid (pCpG) and a plasmid with an in-frame scaffold/matrix attachment region ((pEPI(CMV)). When Pdx1, Ngn3 and MafA were delivered together to normoglycaemic rats with these plasmids, insulin mRNA was detected at all time points and was ~50-fold higher with pCpG. Insulin mRNA content of livers at days 3 and 7 was equivalent to that of a pancreas, with scattered insulin-positive cells detected by immunohistology, but levels declined thereafter. Prohormone convertase 1/3 was elevated at days 3 and 7. In hyperglycaemic rats, fasting blood glucose was lower at days 1, 3 and 7 but not thereafter, and body weight was maintained to day 28. We conclude that hydrodynamic gene delivery of multiple transcription factors to rat liver can initiate transdifferentiation to pancreatic ? cells, but the process is reversible and probably requires more sustained transcription factor expression.Öğe INVASIVE LOBULAR CARCINOMA: THE CONCORDANCE OF PATHOLOGIC TUMOR SIZE WITH MAGNETIC RESONANCE IMAGING(Aves, 2012) Gumus, Hatice; Mills, Philppa; Jones, Sue; Jones, Peter; Fish, David; Gumus, Metehan; Devalia, HareshPurpose: The purpose of this study was to determine the adjunct value to mammography and ultrasonography of magnetic resonance imaging (MRI) in determining the presence, extend and multifocality of invasive lobular cancer (ILC). Materials and methods: We retrospectively reviewed 38 ILC lesions that had been detected by mammography, ultrasounography, MRI and that had been diagnosed on the basis of histopathological analysis. The size, presence of multifocality and multicentricity of the tumors were recorded at imaging. The findings were compared with the final pathological size. Results: The mean age of the patients was 63 (range; 45-85) years. All of the imaging modalities were performed on each patient. The sensitivity of the detection of ILC was much better with MRI (100%) compared to ultrasounography (95%) and mammography (84%). MRI identified multifocal tumor in seven patients (18.4%) and a contralateral tumor in one patient (2.6%), neither of which was identified with mammography and ultrasounography. MRI overestimated the tumor's size in 11 tumors and underestimated the tumor's size in three tumors. Ultrasounography overestimated the tumor size in three tumors and underestimated the tumor size in 18 tumors. Mammography overestimated the tumor's size in two tumors and underestimated the tumor's size in 17 tumors. The correlation of the tumor's size on imaging with final pathology was better for MRI than for mammography and ultrasounography (p = 0.026). Conclusions: MRI has better sensitivity of detection and correlation with ILC tumor size at pathology than mammography and ultrasounography. MRI is shown to be superior to mammography and ultrasounography in detecting multifocal and contralateral tumors.Öğe Invasive lobular carcinoma: The concordance of pathologic tumor size with magnetic resonanceimaging(2012) Gümüş, Metehan; Gümüş, Hatice; Jones, Peter; Sever, Ali; Devalıa, Haresh; Mılls, Philppa; Fısh, DavidAmaç: Bu çalışmanın amacı, invaziv lobuler kanserin (İLK) varlığını, yayılımını ve multifokalitesini belirlemede manyetik rezonans görüntülemenin (MRG) mamografi ve ultrasonografi ek olarak değerini tespit etmekti. Yöntem ve gereçler: Mamografi, ultrasonografi ve MRG ile tespit edilmiş, histopatolojik olarak tanı konulmuş 38 İLK tanılı lezyonu retrospektif olarak değerlendirdik. Görüntülemedeki tümörün boyutu, multifokalitesi ve multisentrisitesi kaydedildi. Bulgular final patolojide tümör büyüklüğü ile karşılaştırıldı. Bulgular: Hastaların ortalama yaşı 63 (aralık; 45 85) yıl idi. Tüm görüntüleme yöntemleri her bir hasta için yapıldı. İLKnın belirlenmesindeki sensitivite ultrasonografi (%95) ve mamografi (%84) ile karşılaştırıldığında MRGde (%100) daha iyiydi. MRG, mamografi ve ultrasonografi ile tespit edilemeyen, 7 hastada (%18,4) multifokal tümörü ve bir hastada (%2,6) kontralateral tümörü tespit etti. MRGde 11 tümör olduğundan büyük, üç tümör olduğundan küçükdü. Ultrasonografide 3 tümör olduğundan büyük, 18 tümör olduğundan küçükdü. Mamografide 2 tümör olduğundan büyük, 17 tümör olduğundan küçükdü. Görüntüleme ile patolojideki tümör boyutunun uyumu MRGde mamografi ve ultrasonografiden daha iyiydi (p = 0,026). Sonuç: İLKnın patolojideki tümör boyutu ile uyumunda ve tümörün belirlenmesindeki sensitivitede, MRG, mamografi ve ultrasonografiden daha iyidir. MRG, multifokal ve kontrlateral tümörün tespitinde mamografi ve ultrasonografiye üstündür.
