Biomedical subjects

H Madjar

Publications and source records attributed to H Madjar.

At least 19 recordsLinked to original sources

PubMed1998

Differentiation of benign and malignant breast tumors by logistic regression and a classification tree using Doppler flow signals.

In breast examinations with Doppler, an increased flow is found in malignant tumors. With the relatively new color Doppler, we measured different flow values in 133 cancer patients and in 325 women with benign disease. These measurements were used to develop diagnostic rules. For the highly correlated flow values, we used a stepwise procedure to select a final logistic regression model and a tree-based approach, which is a different way of modeling. With both approaches we developed simple diagnostic rules of which the sensitivity and the specificity exceeded 90%. There are no differences between the two approaches concerning discriminative ability. As complex statistical modeling leads to an overoptimism in the assessment of the error rates, we applied sensitivity analysis, investigated the stability of the selected logistic regression model, and estimated the magnitude of the overoptimism of the diagnostic rules with resampling methods. The results indicate that the estimates of sensitivity and specificity are probably close to realistic values for a clinical setting.

Blood Flow Velocity↗

PubMed1997

Color Doppler and duplex flow analysis for classification of breast lesions.

The purpose of this study was to evaluate the differences of blood supply in benign and malignant breast tumors by color Doppler flow measurements. The study included 471 patients, 133 with carcinomas, 325 with benign breast lesions, and 13 with mastitis. An ATL UM9/HDI was used with an electronic 10-MHz linear array broadband transducer. The following flow data were analyzed: Presence of vascularity; number of tumor arteries; the mean, minimum, maximum RI index, and AB ratio; the mean, minimum, and maximum peak systolic flow velocity and the sum of all peak systolic flow velocities in each tumor. In all cancers and in most benign pathologies vascularity was found. Highly significant differences between benign and malignant were found for all quantitative flow data such as number of tumor arteries and blood flow velocity (P < 0.0001). Flow profiles analyzed by RI index and AB ratio showed a trend for increased flow resistance in malignancies. However, due to the wide overlap between benign and malignant, indices did not allow a sufficient differentiation. The study showed that standardization of the Doppler examination technique and equipment parameters is essential for vascularity assessment of tumors.

Adult↗

PubMed1997

Diagnostic formula for the differentiation of adnexal tumors by transvaginal sonography.

OBJECTIVE: To create a strategy for sonographic differentiation of benign and malignant adnexal tumors in premenopausal and postmenopausal patients. METHODS: Multiple sonomorphologic criteria were analyzed prospectively in 754 tumors. Four hundred were found in premenopausal and 354 in postmenopausal women. In a logistic regression model, relevant criteria were selected, and a diagnostic formula for tumor differentiation was derived. RESULTS: There were 165 malignant tumors, of which 37 (9.2%) were found in premenopausal and 128 (36.2%) in postmenopausal women. In both groups, the criteria of solid phase and ascites were the most significant. Further important diagnostic criteria were structure and tumor size in premenopausal women and cyst architecture and tumor surface in postmenopausal women. These results allowed an estimation of the probability of malignancy. Using a cutoff point of 10% for the probability to classify tumors as malignant, the sensitivity and specificity in premenopausal patients were 86.5% and 92.6%, respectively, with an accuracy of 92%. In postmenopausal women, the sensitivity, specificity, and accuracy were 93%, 82.7%, and 86.6%, respectively. Assuming a prevalence as given in the study, the positive and negative predictive values were 54.4% and 98.5% in premenopausal and 75.3% and 95.4% in postmenopausal women. CONCLUSIONS: With four binary criteria, a useful diagnostic formula for tumor differentiation was obtained. However, estimates for sensitivity, specificity, and accuracy may be too optimistic because they were derived from the same data that were already used for model selection.

Adnexa Uteri↗

PubMed1997

Multiple giant fibroadenomas: clinical presentation and radiologic findings.

We describe the case of a 25-year-old Caucasian woman suffering from unilateral enlargement of the breast. Morphologic evaluation of various imaging modalities including mammography, ultrasound, and magnetic resonance imaging suggested a benign tumor embedded in stromal tissue. The time course of the Gd-DTPA uptake in dynamic magnetic resonance imaging, however, was also compatible with a malignant lesion. Postoperative pathological examination revealed multiple giant fibroadenomas, a rare disease, usually encountered in black female adolescents. Radiologic presentation, differential diagnosis, and morphologic findings are discussed, and a review of the literature is contained herein.

Adult↗

PubMed1996

Classification of adnexal tumors by transvaginal color Doppler.

The purpose was to evaluate the validity of transvaginal color Doppler sonography for differentiating between benign and malignant ovarian tumors. Color Doppler and Duplex measurements were obtained in 212 (144 benign, 68 malignant) ovarian and tubarian tumors preoperatively. One hundred and thirty-one patients were postmenopausal and 81 premenopausal. An ATL UM9/HDI was used. The following criteria were analyzed: minimum and mean resistance index and pulsatility index, number and distribution of tumor arteries, diastolic notch, and the maximum, minimum, mean, and sum of all peak systolic, maximum enddiastolic, and time-average maximum velocities. Most criteria showed highly significant differences between benign and malignant tumors with variable overlaps. RImin gives a sensitivity of 80%, specificity of 69%, and accuracy of 75% for postmenopausal patients and 80, 59, and 67% for pre- and postmenopausal patients, respectively. PImin gives equivalent results. The number of tumor arteries and the maximum flow velocities increase the accuracy. The summation of all flow velocities gives the best result with a sensitivity of 93%, specificity of 85%, and accuracy of 87% for postmenopausal and 91, 76, and 80% for pre- and postmenopausal tumors, respectively. Flow data show no relevant differences between low malignant potential tumors and ovarian carcinomas. Serous cystadenomas and benign teratomas show higher differences than mucinous cystadenomas, functional cysts, and endometriomas in comparison to malignancies. A separate analysis of pre- and postmenopausal tumors is important. Differentiation seemed better for post- than for premenopausal tumors. The four flow criteria (RImin, number of tumor arteries, and maximum and sum of all peak systolic velocities) seemed appropriate for tumor differentiation. However, this study confirms that a single measurement is not sufficient to differentiate ovarian lesions. Measurements of flow velocities (e.g., maximum and sum of all peak systolic velocities) are superior compared with RImin and PImin.

Blood Flow Velocity↗

PubMed1996

[Ultrasound and mammography follow-up of findings after breast saving operation and adjuvant irradiation].

AIM: The aim of our controlled retrospective study was to assess the diagnostic value of sonography for detection and characterisation of changes compared to mammography and palpation. METHOD: In 80 patients sonographic and clinical follow-up examinations were performed every 3 to 6 months, mammography examinations were performed every 6 to 12 months during the first 2 years after breast-preserving therapy (BPT) and irradiation. Extension, echogenicity, and configuration of lesions in sonography, and semiquantitiative description of diffuse or circumscribed changes in mammography were the basis of comparative follow-up observation. RESULTS: Postoperative seromas and haematomas, initially presenting echo-free or as hypoechoic lesions, showed an increase in echogenicity within 18 months after irradiation. Fat necrosis occurred in 9.5% of patients, lymph cysts developed in 4%, granuloma in 3%, recurrence of neoplasma in 1.6%. The diffuse loss of transparency in mammography that was associated with radiation therapy, showed a peak 6-12 months after irradiation. CONCLUSION: Sonography and sonographic guided puncture are mandatory tools to characterise circumscribed unclear lesions after breast-conserving therapy and irradiation in specialised centers. We recommend a 6-month interval for combined sonography, palpation, and mammography within the first 2 years after BPT and irradiation, because shorter control intervals did not result in relevant diagnostic advantages.

Adult↗

PubMed1996

[Phantom studies of ultrasound equipment for quality improvement in breast diagnosis].

AIM: According to the German guidelines for quality control of ultrasonic equipment, the following conditions are required for breast ultrasound: A transducer frequency between 5-7.5 MHz and a minimum field of view of 5 cm. Satisfactory images must be obtained in a depth between 0.5 and 4 cm with a wide tolerance of the focal zones. This allows the use of poor quality equipment which does not produce satisfactory image quality and it excludes a number of high frequency and high resolution transducers with a field of view below 5 cm. This study with a test phantom was performed to define image quality objectively. METHOD: Sixteen ultrasound instruments in different price categories were used to perform standardized examinations on a breast phantom model 550 (ATS Laboratories, Bridgeport, USA). Contrast and spatial resolution in different penetration depths were investigated on cyst phantoms from 1-4 mm diameter and wire targets with defined distances between 0.5-3 mm 4 investigations reported the images. RESULTS: A positive correlation was seen between price category and image quality. CONCLUSION: This study demonstrates that transducer frequency and image geometry do not allow sufficient quality control. An improvement of ultrasound diagnosis is only possible if equipment guidelines are based on standard examinations with test phantoms.

Breast Neoplasms↗

PubMed1996

[Combined evaluation of ovarian tumors with transvaginal B-image and color Doppler ultrasound].

Transvaginal sonomorphologie and colour Doppler measurements were obtained preoperatively in 212 adnexal tumours: 81 premenopausal tumours (13 malignant and 68 benign) and 131 postmenopausal tumours (55 vs 76). Tumours were divided into five different scores according to their sonomorphology [16]. Scores I and II are related to benign tumours. Score V represents typically malignant tumours. Scores III and IV are associated with benign and malignant tumours. If score I and II are considered as benign and score III to V as malignant the sensitivity in pre- and postmenopausal tumours is 90%. However, the specificity is only 56% vs 70% respectively. In order to improve the accuracy, colour Doppler was additionally performed in tumours with sonomorphological score III and IV. The following criteria were tested: minimum resistance index (Rlmin), number of tumour arteries (ART), maximum (Smax) and sum (Ssum) of peak systolic velocities. All criteria showed significant differences between benign and malignant tumours. Tumours of score III and IV were differentiated by colour Doppler with an accuracy between 66% and 81% for premenopausal and 69% to 86% for postmenopausal women. The combination of sonomorphology and colour Doppler increased the accuracy between 84% and 90% with a sensitivity of up to 92% in pre- and 89% in postmenopausal patients. Sequential colour Doppler sonography as a supplement to transvaginal sonography improves tumour differentiation. The limitation of colour Doppler measurements to score III and IV lesions reduced the length of examination time to a reasonable extent.

Adolescent↗

PubMed1995

Differential diagnosis of breast lesions by color Doppler.

Color Doppler allows flow detection in small tumor vessels. Due to the vascularity associated with the growth of malignancies, this method can be used to differentiate between benign and malignant breast lesions. In order to study the typical flow characteristics, we investigated multiple Doppler flow parameters. A UM9 HDI (ATL) was used with a linear transducer L 10-5. The number of tumor vessels and the mean, maximum and total flow velocity were measured in 325 benign and 133 malignant lesions and showed highly significant differences (p < 0.0001). Flow profiles (resistance index and systolic/diastolic frequency ratio) showed a large overlap and did not allow accurate tumor differentiation when mean and minimum values were analyzed. Surprisingly, the maximum resistance index and systolic/diastolic frequency ratio were significantly higher in carcinomas than in benign lesions, but the overlap of the values was wider than the flow velocity measurements. Using the vessel number and the total tumor vascularity, 90% of all lesions could be differentiated. A difficulty that we encountered was that a few cancers have very low flow values and some of the proliferative benign lesions can have increased flow.

Adolescent↗

PubMed1994

Phase II study of pirarubicin combined with cisplatin in recurrent ovarian cancer.

Although 50%-80% of patients with advanced ovarian cancer demonstrate an objective response after platinum-based chemotherapy, a majority of these patients will ultimately experience a relapse of their disease. Effective second-line treatment for these patients is of the most importance. We performed a phase II study with cisplatin and pirarubicin (each drug 50 mg/m2 i.v. every 28 days) in 17 patients with relapsed or persistent ovarian carcinoma. All patients had received platinum-containing primary chemotherapy. Overall survival from the time of diagnosis was 38.3 months (45.3 months in relapsed ovarian carcinoma and 28.3 months in ovarian carcinoma persisting after primary chemotherapy). Survival from entrance into the study was 13.0 months (14.2 months in relapsed disease and 11.2 months in refractory disease). Time to progression was 10.3 months. An objective response was observed in 4 patients and another 3 patients had stable disease. Major toxicity consisted of emesis (grade III/IV in 60/64 courses) and myelosuppression WHO grade III/IV in 15 courses. Neurotoxicity occurred in 3 patients and nephrotoxicity in 1 patient. Alopecia occurred in 12 patients. Tachycardia and other low-grade heart toxicities were observed after 5 courses. Dose reduction was necessary because of severe myelosuppression in 4 courses and because of nephrotoxicity in 1 course. Delay of subsequent chemotherapy courses for more than 7 days was necessary after 13 courses and was always due to myelosuppression. The dose-limiting toxicity of combination chemotherapy with cisplatin and pirarubicin is myelosuppression. Response and survival rates are superior in patients with relapsed disease compared to patients with resistant ovarian carcinoma.

Adolescent↗

PubMed1994

Color Doppler flow criteria of breast lesions.

Color Doppler technique has been available for several years. The sensitivity of the equipment has improved and allows for assessment of tumor vascularity. We investigated multiple parameters in 258 patients, with 176 benign and 82 malignant lesions to define characteristic flow criteria. Median (25-75% quartiles) and p-values are given for benign vs. malignant lesions. Number of tumor vessels: 2 (1-2) vs. 8 (5-14), p < 0.0001; mean peak systolic flow velocity: 11.1 cm/s (6.4-14.9) vs. 18.8 cm/s (13.7-25.1), p < 0.0001; maximum flow velocity: 12.5 cm/s (6.7-18) vs. 32.5 cm/s (22.5-47.3), p < 0.0001; sum of all systolic flow velocities: 18.9 cm/s (7-34.2) vs. 147 cm/s (71.3-266.7), p < 0.0001; minimum systolic flow velocity: 8.9 cm/s (5.4-12.1) vs. 9 cm/s (6.3-11.3), p > 0.05; average resistance index (RI): 0.68 (0.58-0.72) vs. 0.75 (0.67-0.81), p > 0.05; maximum RI: 0.71 (0.65-0.78) vs. 0.88 (0.78-0.99), p < 0.0001; minimum RI: 0.64 (0.57-0.68) vs. 0.64 (0.53-0.71), p > 0.05; average A/B ratio: 3.1 (2.7-3.7) vs. 4.3 (3.2-7.7), p < 0.0001; maximum A/B ratio: 3.4 (2.9-4.6) vs. 8.4 (4.5-9.9), p < 0.0001; minimum A/B ratio: 2.8 (2.3-3.2) vs. 2.9 (2.2-3.5), p > 0.05. The data analysis shows that flow resistance in malignancies is increased. This is in contrast to gynecological malignancies, where an increased diastolic flow indicates that flow resistance is decreased.

Adolescent↗

PubMed1994

[Value of high resolution sonography in breast cancer screening].

Breast ultrasound has mainly been used for differentiation of cystic and solid lesions. With high resolution technique, which was introduced several years ago, early cancers can now be detected by ultrasound. In this study, 1016 women were examined within 3 months. Mammography was used independently. According to the expected prevalence, 4 nonpalpable carcinomas were detected by sonography. The study proves that high-quality ultrasound equipment allows a primary detection of subclinical breast cancers. In premenopausal patients the sensitivity of mammography is reduced. Therefore, ultrasound should be used complementary to mammography in this age group. Widespread use is not possible due to a deficiency in experienced staff. However, in experienced centres, ultrasound could be used as a supplement to mammographic screening to prove if breast cancer mortality in premenopausal women can be reduced.

Adult↗

PubMed1994

[Color Doppler flow data of breast tumors].

The recent development of high-quality colour Doppler instruments allows flow detection in small vessels below the resolution of B-mode imaging. Therefore, Doppler is now frequently used for flow detection in tumours. For breast examinations, CW Doppler has been in use for many years, which allows a sufficient definition of diagnostic criteria. Nevertheless, it is surprising that new studies using colour Doppler try to define different diagnostic criteria. To characterise the vascularity of breast lesions by colour Doppler we investigated 127 symptomatic patients. In 54 carcinomas the average flow velocity was 32 cm/s and 12.6 cm/s in 73 benign conditions (p > 0.0001). Total tumour vascularisation was characterised by a new parameter: the sum of all flow velocities in all tumour vessels. In carcinomas the mean total flow as 197.9 cm/s, and 52.7 cm/s in benign pathologies (p > 0.0001). Mean RI (resistance index) and PI (pulsatility index) were calculated to describe the flow profiles. The wide variation did not allow for a differentiation between benign and malignant lesions.

Arteries↗

PubMed1994

[Transvaginal color-coded Doppler ultrasound in ovarian tumors].

In 129 patients with ovarian tumours, a preoperative examination by transvaginal colour Doppler sonography (ATL UM9 HDI) was performed. 45 were malignant and 84 benign. 46 patients were premenopausal and 83 postmenopausal. All tumour vessels were analysed by spectrum analysis. The number of tumour vessels and the lowest resistance index (RImin) and pulsatility index (PImin) of all vessels were evaluated as diagnostic criteria of the neovascularisation. Up to 19 vessels were found in 115 (89%) tumours. In benign lesions, the number of vessels was significantly lower than in malignancies (median 3 versus 9, p < 0.0001). The RImin and PImin values between benign and malignant tumours were also significantly different, independent of the menopausal status. In postmenopausal patients, the median RImin in 42 benign tumours was 0.62 (0.26-1.0) and in 41 malignancies 0.40 (0.22-0.66). The median PImin was 0.98 (0.31-5.84) in benign tumours and 0.53 (0.25-1.22) in malignant tumours. However, due to the overlapping range between benign and malignant tumours, these parameters do not allow an accurate differentiation. With a cut off value for RImin = 0.5 and PImin = 0.7, the sensitivity is 85% or 82.5% respectively. The specificity for RImin and PImin is 77%, and the diagnostic accuracy is 84% and 80% respectively. The correlation coefficient between RImin and PImin is 0.99 in benign and malignant tumours and both indices are adequate. The calculation of the RI is more easily available and should be preferred as a diagnostic parameter.

Adolescent↗

PubMed1994

Transvaginal sonography of myometrial invasion depth in endometrial cancer.

The myometrial invasion depth of endometrial cancer is an important prognostic factor. The preoperative assessment is decisive for the appropriate surgical treatment. In 96 patients with endometrial cancer, the myometrial invasion depth (greater than 50% or less than 50%) was measured preoperatively using transvaginal sonography (TVS). The sonographic results were compared to the histopathological findings. A sensitivity of 93% was obtained for invasion depths greater than 50%. The predictive value of an invasion depth less than 50% was 93% as well. In 16% of the cases the invasion depth was overestimated while, in only 3% it was underestimated. The diagnostic accuracy was 81%. Forty-five patients were examined preceding a diagnostic dilatation and curettage and fifty-one were examined following a diagnostic dilatation and curettage. The diagnostic accuracy in both groups was equivalent. Using transvaginal sonography, the spread of cancer to the cervix was observed in five of the seven cases in which it was postoperatively confirmed. TVS is a valuable, non-invasive diagnostic method for patients with endometrial cancer. When the TVS data are combined with results from other preoperative tests, the prognostic information obtained provides a useful basis in choosing the appropriate therapy.

Aged↗

PubMed1994

Twin pregnancies with single fetal death.

OBJECTIVE: Analysis of the fetal outcome of the surviving twin and the cause of fetal death. PATIENTS: Between January 1979 and December 1992, 43 twin pregnancies with single fetal death were observed: in 11 cases (group I) before 16 weeks of gestation, in 11 cases (group II) between 17 and 24 weeks, and in 21 cases (group III) after 24 weeks of gestation. RESULTS: The pregnancies in group I continued without complication. In groups II and III the incidence of preterm delivery was 50%, of cesarean section 59%, of growth retardation of the surviving twin 22% and perinatal mortality was 13%. Twenty-five (78%) of the surviving twins had a normal postnatal development and one (3%) was handicapped. CONCLUSION: Loss of one of the twins in the first trimester does not impair the development of the surviving fetus. In the second trimester however this even is associated with increased risk for the survivor as reflected by a high incidence of growth retardation, premature labor and perinatal mortality.

Female↗

PubMed1994

Comparison of the emetogenic potential between cisplatin and carboplatin in combination with alkylating agents.

Platinum-based polychemotherapy is widely used in the treatment of gynecological cancer. Emesis is one of the most disturbing side-effects of platinum therapy. We performed a study to evaluate and compare the emetogenic potential and the different emesis pattern after cisplatin and carboplatin under antiemetic treatment with ondansetron. One hundred and twenty-two patients with either cisplatin-containing (n = 70) or carboplatin-containing (n = 52) first-line chemotherapy were included. Treatment with cisplatin led more frequently to emesis and patients suffered from more severe emesis than carboplatin treated patients. Delayed emesis was observed after both platinum analogues but occurred more frequently and lasted longer after cisplatin.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1993

[Doppler ultrasound in high grade multiple pregnancies].

From 1987 until 1992, 16 triplets and 2 quadruplets were studied by pulsed Doppler ultrasound between 17 and 36 weeks of gestation. A resistance index (RI) of the foetal aorta and umbilical artery above the 95th percentile was considered pathological. Elevated RI-values of the umbilical artery as compared to the A. cerebri media were indicative of circulatory centralisation. Intrauterine growth retardation (IUGR) was found in 9 (16%) foetuses, discordant growth occurred in 7 (39%) pregnancies. 41 (73%) of 56 foetuses survived in good health. Four of 7 foetuses with pathological Doppler findings died. The three survivors were markedly retarded. Four of 6 cases of intrauterine endangered foetuses were detected by Doppler sonography. The diagnosis of IUGR or discordant growth was based more frequently on pathological Doppler findings than on biometry and improved upon by combinations of both methods. Doppler sonography proved to be an important complementary method in the monitoring of high-grade multiple pregnancies.

Adolescent↗