1.Image Quality of Two Full Field Digital Mammography Using A Female Breast Phantom
Chelliah, Kanaga Kumari ; Ang, Wee Chin ; Abd Aziz Tajuddin ; Arasaratnam, Shantini A ; Suraya Aziz ; Laila Suryani Elias.
Malaysian Journal of Health Sciences 2009;7(1):65-72
Digital mammography has been progressively introduced in screening centers and the concern is to achieve an image of diagnostic value which would be
able to detect early changes in the breast tissue. The aim of this study was to evaluate the image quality of mammograms using quantitative and qualitative
methods of two FFDM systems with variations in breast thickness and anode/filter combination. This study was done from January to April 2008 with two
FFDM systems; Siemens Mammomat NovationDR at Diagnostic Imaging Department, Hospital Kuala Lumpur and Hologic Lorad Selenia at Breast Clinic, National Cancer Society. A CIRS012A tissue equivalent breast phantom
(4, 5 and 6 cm) thickness was used to obtain images in the craniocaudal plane with 26-32 kVp and a combination of molybdenum/molybdenum (Mo/Mo) and
molybdenum/rhodium (Mo/Rh) anode/filter. For the qualitative evaluation, two independent radiologist with a minimum of five years experience was used
to score the images. Wilcoxon Sign Rank Test showed that there are no significant differences (p > 0.05) in image quality between both the FFDM systems. Kappa analysis had a poor agreement between the scores given by the
two radiologists. The quantitative analysis using Mann-Whitney test showed that there are significant differences (p < 0.05) between the SNR values of both
FFDM systems. Although the qualitative evaluation was similar, the study showed that Lorad Selenia had a significantly superior SNR value, hence would
be a better tool to detect early changes in the breast tissue. This study also demonstrated that a lower kVp is more suitable with molybdenum filter and as
the breast thickness is increased rhodium filter with higher kVp displayed better quality images.
2.Beta-human Chorionic Gonadotropin-secreting Lung Adenocarcinoma
Yin Ping Wong ; Geok Chin Tan ; Suraya Aziz ; Sucharit Pongprakyun ; Fuad Ismail
Malaysian Journal of Medical Sciences 2015;22(4):76-80
Overexpression of beta-human chorionic gonadotropin (β-hCG) is frequently associated with germ cell tumours, especially choriocarcinoma. Ectopic secretion of β-hCG by non-small cell lung cancer is exceptional. We present an exceedingly rare case of pulmonary adenocarcinoma that secretes β-hCG. Our patient is a 62-year-old postmenopausal woman, a nonsmoker, who presented with a six-month history of progressive dyspnoea, associated with decreased appetite and significant weight loss. Her serum β-hCG was very high (11211.9 mIU/ml), which prompted investigations to exclude germ cell tumour. Radiological imaging revealed a 10-cm right lung mass with adrenal metastasis. No other focal lesions were detected. Microscopy of the lung biopsy specimen showed replacement of normal lung tissue by sheets of malignant cells, forming vague glands in some areas. Immunohistochemically, the malignant cells showed focal immunopositivity for thyroid transcription factor 1 (TTF-1), napsin A, cytokeratin 7 (CK7) and β-hCG. A diagnosis of β-hCG-secreting pulmonary poorly differentiated adenocarcinoma was rendered. Serum β-hCG level decreased significantly to 168.6 mIU/ml after the first cycle of chemotherapy. In conclusion, β-hCG expression in lung cancer should be recognised to facilitate prompt diagnosis and initiation of appropriate intervention.
3.Lymphocytic Mastitis Mimicking Breast Carcinoma, Radiology and Pathology Correlation: Review of Two Cases
Sharifah Majedah Idrus Alhabshi ; Kartini Rahmat ; Caroline Judy Westerhout ; Nani Harlina Md Latar ; Patricia Ann Chandran ; Suraya Aziz
Malaysian Journal of Medical Sciences 2013;20(3):83-87
Lymphocytic mastitis, or diabetic mastopathy, is an unusual finding in early-onset and long-standing diabetes. It can presents as a non-tender or tender palpable breast mass. Mammogram and ultrasound frequently demonstrate findings suspicious of malignancy, thus biopsy and histological confirmation is usually required. We reviewed two cases of lymphocytic mastitis with characteristics findings on mammogram, ultrasound, and histopathology. Diagnoses were confirmed with excision biopsy.
Breast Neoplasms
;
Diabetes Mellitus
4.Management of congenital choanal atresia (CCA) after multiple failures: A Case Report
Asma binti Abdullah ; Roslenda Binti Abdul Rahman ; Suraya Binti Aziz ; Saraiza Binti Abu Bakar ; Aini Binti AbAziz
The Medical Journal of Malaysia 2013;68(1):76-78
Nasal obstruction in neonates is a potentially fatal condition because neonates are obligatory nasal breathers. Bilateral choanal atresia is therefore a neonatal emergency. Several approaches for corrections of choanal atresia are available including the helium laser: YAG. A 5-year-old Chinese girl born with bilateral choanal atresia, had birth asphyxia that required intubation. She underwent multiple surgeries for correction of choanal atresia at other hospitals but failed to
improve. She was referred to Universiti Kebangsaan
Malaysia Medical Center (UKMMC) after presenting with
intermittent respiratory distress and cyanosis following an
upper respiratory tract infection. A repeat computed
tomography (CT) scan done preoperatively showed
complete bony stenosis over the left choana and finding was
confirmed by examination under general anesthesia. She
underwent endoscopic transnasal removal of left bony
atretic plate. There was no intra or postoperative
complications. During follow up 10 years later, the airway on both sides remains patent.
5.Role of high resolution ultrasound in ulnar nerve neuropathy
Radhika Sridharan ; Lee Yee Ling ; Low Soo Fin ; Fazalina Mohd Fadzilah ; Sharifah Majedah Idrus Alhabshi ; Suraya Aziz ; Rajesh Singh ; Jamari Sapuan ; Tan Hui Jan ; Norlinah Mohamed Ibrahim
The Medical Journal of Malaysia 2015;70(3):158-161
SUMMARY
Aim: This study was conducted to measure the cross
sectional area (CSA) of the ulnar nerve (UN) in the cubital
tunnel and to evaluate the role of high-resolution
ultrasonography in the diagnosis of ulnar nerve neuropathy
(UNN).
Materials and Methods This was a cross sectional study with
64 arms from 32 patients (34 neuropathic, 30 nonneuropathic).
Diagnosis was confirmed by nerve conduction
study and electromyography. The ulnar nerves were
evaluated with 15MHz small footprint linear array transducer.
The ulnar nerve CSA was measured at three levels with arm
extended: at medial epicondyle (ME), 5cm proximal and 5cm
distal to ME. Results from the neuropathic and nonneuropathic
arms were compared. Independent T-tests and
Pearson correlation tests were used. P value of less than
0.05 was considered significant.
Results: Mean CSA values for the UN at levels 5cm proximal
to ME, ME and 5cm distal to ME were 0.055, 0.109, 0.045 cm2
respectively in the neuropathic group and 0.049, 0.075, 0.042
cm2 respectively in the non-neuropathic group. The CSA of
the UN at the ME level was significantly larger in the
neuropathic group, with p value of 0.005. However, there was
no statistical difference between the groups at 5cm proximal
and distal to the ME, with p values of 0.10 and 0.35
respectively.
Conclusion: There is significant difference in CSA values of
the UN at ME between the neuropathic and non-neuropathic
groups with mean CSA value above the predetermined
0.10cm2 cut-off point. High-resolution ultrasonography is
therefore useful to diagnose and follow up cases of elbow
UNN.
Ulnar Nerve
6.Comparison on the use of semi-automated and automated core biopsy needle in ultrasound guided breast biopsy
Radhika Sridharan ; Shereen Mohd Yunos ; Suraya Aziz ; Rizuana Iqbal Hussain ; Sharifah Majedah Idrus Alhabshi ; Suria Hayati Md Pauzi ; Saladina Jaszle Jasmin ; Zulfiqar Mohd Annuar
The Medical Journal of Malaysia 2015;70(6):325-333
Objective: The aim of this study was to compare the use of
semi-automated (Medax Velox 2; Poggio Rusco, Italy) and
automated (Bard Magnum Biopsy Instrument; Covington,
GA, USA) core biopsy needles, for ultrasound guided breast
biopsy.
Materials and Methods: A 14G semi-automatic spring loaded
core biopsy needle with a 22-mm-throw (Medax Velox 2;
Poggio Rusco, Italy) and 14-gauge automated needle device
with a 22-mm-throw biopsy gun (Bard-Magnum Biopsy
Instrument, Covington, GA, USA) were used for breast
biopsies under ultrasound guidance on alternate months
during the study period between July 2009 and May 2011.
One hundred and sixty lesions were biopsied and
specimens were sent for histological evaluation.
Results: The automated needle obtained a higher number of
histology reports at 84% (67/80) as compared with the semiautomated
needle at 60% (48/80) (Fisher exact test, p
value=0.023). Inadequate samples with the automated
needle were much less at 9% (7/60) than with the semiautomated
needle at 23% (18/60) (Fisher exact test, p
value=0.028). The semi-automated needle showed slightly
less fragmented samples. However, the number of
fragmented samples with definitive diagnosis was slightly
higher with the automated compared with the semiautomated
needle, at 16% (13/80) and 13% (10/80)
respectively. Compared with histology of 29 lesions that
were excised, the semi-automated needle had higher
sensitivity (100%) but lower specificity (75%) and accuracy
(90%) compared with the automated needle (88% sensitivity,
100% specificity, 95% accuracy).
Conclusion: Definitive diagnosis from the study samples
slightly favours the use of automated core biopsy needle as
compared to semi-automated core biopsy needle.