Preoperative Breast MRI detects additional cancers

A paper by Bae et al published in Radiology indicates that preoperative MRI in women whose breast cancer was detected by ultrasound found additional cancers.

The study was a retrospective review of 374 women, median age, 48 years, with breast cancer detected at screening ultrasound.

Of 374 women, 21 or 5.6% patients were diagnosed with additional cancer.  In premenopausal women with invasive breast cancer and in those with index invasive lobular histologic type had higher incidence of additional cancer detected at MR imaging.  Premenopausal status also put the women at risk.

The authors concluded that preoperative MRI detected additional sites of cancer in women with breast cancer detected at screening ultrasound.

Ultrasound is ineffective in the healing of bone fractures

A study published in the BMJ suggests that low-intensity pulsed ultrasound, used to speed healing of bone fractures, may be ineffective.

A randomized clinical trial that involved 501 patients who had surgical repair of fractures of the tibia found that patients treated with the low-intensity pulsed ultrasound (LIPUS) healed at the same rate as those given a sham treatment.

Patients self administer daily LIPUS (n=250) or use a sham device (n=251) until their tibial fracture showed radiographic healing or until one year after intramedullary fixation.

Primary registry specified outcome was time to radiographic healing within one year of fixation; secondary outcome was rate of non-union. Additional protocol specified outcomes included short form-36 (SF-36) physical component summary (PCS) scores, return to work, return to household activities, return to ≥80% of function before injury, return to leisure activities, time to full weight bearing, scores on the health utilities index (mark 3), and adverse events related to the device.

Results showed no impact on SF-36 PCS scores between LIPUS and control groups or for the interaction between time and treatment; minimal important difference is 3-5 points or in other functional measures. There was also no difference in time to radiographic healing. There were no differences in safety outcomes between treatment groups. Patient compliance was moderate; 73% of patients administered ≥50% of all recommended treatments.

It was concluded that postoperative use of LIPUS after tibial fracture fixation does not accelerate radiographic healing and fails to improve functional recovery.

The Bright Side

The Bright Side by the American artist Winslow Homer (1836-1910), was made while he was attached to the Union Army during the US Civil War. Homer was born in Boston, Massachusetts, in 1836.  In 1859 Homer enrolled at the National Academy of Design in New York and studied with Frédéric Rondel, who taught him the basics of painting in oils.  Homer is regarded by many as the greatest of the American painters in the nineteen century is best known of his marine subjects. 

In The Bright Side, four tired teamsters doze off in the morning sun and a fifth looks around to see who might be disturbing his rest.  Many Union Army teamsters were free blacks from northern states or former slaves from the South who had escaped through Union lines to join the war effort.

In 1865, when The Bright Side was painted, the Confederacy was near defeat.  When the war was over, the teamsters and other free blacks migrated into the cities seeking employment.  As most migrants they were confronted by white workers feeling threatened by the influx of new labor. Political freedom would not mean the end of hard times.

Since 1865 when Homer painted The Bright Side, generations of Americans have viewed this image and felt empathy for the black teamsters, but the hardworking men in this scene are obviously too tired after laboring all night to bring supplies into camp.  They have found a sunny spot where they can bask in the satisfaction of a job well done.

JAMA. 2016;315(24):2650-2651.

Contrast-Enhanced Ultrasound Effective in the Differential Diagnosis of Breast Lesions

Research by Ma et al published in the Journal of Ultrasound in Medicine suggests that contrast-enhanced ultrasound (CEUS) may be an effective method for the differential diagnosis of benign and malignant breast lesions, offering improvements in diagnostic accuracy over conventional breast ultrasound.

Their study was based on a meta-analysis of 29 studies and included 2,296 patients.

The investigators found that contrast-enhanced ultrasound offered a combined sensitivity of 88% and specificity of 80% and the pooled diagnostic odds ratio was 30.35

The authors concluded that CEUS could be an effective method for differential diagnosis of benign and malignant breast lesions.  Its efficacy could also improve with the advent of second-generation contrast agents.

Ultrasound in Elbow Fractures.

Avci et al published in the American Journal of EmergencyMedicine findings of their study of point-of-care ultrasound (POCUS) and computed tomography (CT) for patients presenting with elbow injuries in emergency departments. 

The authors examined 49 patients aged 5 to 65 years, who had at least 1 fracture of the elbow joint bones, and underwent CT scanning in emergency room. Patients were first evaluated with direct radiography, and then with POCUS by trained emergency physicians. Emergency physicians made treatment decisions based on the ultrasonography results. Then, CT scans were performed and were interpreted by radiologists. Orthopedic surgeons made treatment decisions based on the CT interpretations.

Of the 49 patients with elbow injury were included in the study 18 (37%) were women, and 31 (63%) were men. Compared with CT, sensitivity, specificity, positive predictive value, and negative predictive value of POCUS in fracture detection were 97%, 88%, 94%, and 93%, respectively. Although the sensitivity and specificity of POCUS in the decision for reduction were 95% and 100%, respectively, it was 93% and 100% in the decision for surgery.

The authors concluded that POCUS is effective in the diagnosis and management of elbow fractures when direct radiology is inconclusive and CT is required.