Browsing by Author "Joshi, Birendra Raj"
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Publication Comparison of Sonographic Findings with Diagnostic Mammography(Nepal Health Research Council, 2024) Joshi, Birendra Raj; Paudel, Bishnu; Jha, AnamikaBackground: Breast cancer is the leading female cancer worldwide with a high mortality rate. Early detection of the suspicious lesion is crucial for better prognosis. Higher breast density decreases the sensitivity of mammogram. Ultrasound can differentiate between cystic and solid masses and further characterize these as benign or possibly malignant. Our objective was to compare the findings of sonography with diagnostic mammography. Methods: This was a cross sectional study including 125 females who underwent diagnostic mammogram in a tertiary care center. The mammograms were evaluated and the patients were scanned by ultrasound and categorized as per ACR- BIRADS category. The findings of diagnostic mammography were compared with that of ultrasonography using SPSS version 25. Results: The heterogeneously dense breast in diagnostic mammography corresponded to the heterogenous- fibroglandular breast in ultrasonography. In majority, ultrasound increased the BIRADS category for the lesion than designated by the diagnostic mammography. It was particularly useful for category 0 and 3 lesions which were indeterminate and required further imaging. Conclusions: Ultrasound was useful in evaluation of dense breasts with ACR-BIRADS 0 and 3 in diagnostic mammogram. For category 3 and 4 in diagnostic mammogram, ultrasound showed category 1 or 2 lesions which aided to alleviate patient anxiety and avoid unnecessary biopsies. With emerging technological advances in ultrasound, it can used as a powerful tool for breast lesion detection and patient management. Keywords: Breast density; diagnostic mammogram; ultrasonography.Publication Determination of Gestational Age by Fetal Kidney Length Measurement After the 20th Week in Healthy Women With Uncomplicated Pregnancy in Tertiary Care Centre(Nepal Paediatric Society (JNPS), 2021) Joshi, Birendra Raj; Chaurasia, Akash Kumar; Khanal, Umesh PrasadAbstract: Introduction: Various organs are measured to estimate the gestational age of fetus. Sonographically derived parameters used to date pregnancy include crown rump length, biparietal diameter, head circumference, femoral length and abdominal circumference. Fetal kidney length, transcerebellar diameter and placental thickness are emerging as new parameters and are claiming to be more accurate in certain situations. In Nepalese context fetal kidney length has not been studied yet so this study was done to fill this need. Methods: Obstetric sonography was performed in 108 pregnant women with uncomplicated pregnancy to evaluate the efficacy of FKL as a measure to calculate the predicted gestational age. Gestational age ranged from 20 weeks to term. Only patient with known LMP and previous history of normal menstrual cycle were included in the study. Results: The study showed mean fetal kidney length at 20 - 24, 25 - 29, 30 - 34 and 35 - 37 weeks gestation as 22.5 ± 0.5, 26.9 ± 0.7, 32.32 ± 0.7 and 36.3 ± 0.6 respectively. Overall in combined second and third trimester, fetal kidney length showed strong linear correlation with gestation age with highest significant Pearson correlation coefficient of 0.989 as compared to other parameters (BPD = 0.986, HC = 0.976, AC = 0.971, FL = 0.984). Conclusions: Fetal kidney showed strongest linear correlation with clinical gestational age and it also demonstrated positive correlation with biparietal diameter, head circumference, abdominal circumference and femur length. Therefore fetal kidney length can be used as a reliable parameter for determination of gestational age.Publication Sonography as an Adjunct to Digital Mammography in Patients with Dense Breasts(Nepal Health Research Council, 2024) Jha, Anamika; Regmi, Pradeep Raj; Pradhan, Huney; Thakur, Minaxi; Joshi, Birendra RajBackground: Dense breasts are associated with an increased risk of cancer and also mask lesions on mammograms. In our study, we evaluated the role of sonography as an adjunct to digital mammography in patients with dense breasts. Methods: Sonography of 676 female patients with American College of Radiology category C or D mammographic density was done in this prospective cross-sectional analytical study in the Department of Radiology, Tribhuvan University Teaching Hospital. The final imaging diagnosis was classified as per the American College of Radiology Breast Imaging Reporting and Data System categories. Tissue diagnosis was obtained in patients with sonographic category 3 solid lesions larger than 3 cm, category 4 and 5 lesions. The data were tabulated and analyzed using Statistical Package for Social Service (SPSS) for Windows version 22. Results: Additional sonography confirmed all BIRADS 1 mammograms as normal or benign, 95.7 % (112) of inconclusive, and 82.8% (n=135) of BIRADS 3 ones as benign. It had higher sensitivity and negative predictive value (100%) than mammography with similar accuracy. Most patients (479, 70.9%) had diagnostic indications. There were 540 (79.9%) cases in ACR BIRADS category c. A final diagnosis of benign (316, 46.7%) was most common, followed by normal (293, 43.4%) and malignant (67, 9.9%). The majority of the malignant lesions were Invasive Ductal Carcinoma (59, 88%). Conclusions: Additional sonography confirmed mammography findings as normal, benign, or suspicious for malignancy, definitely described morphology and extent of mass, and also guided biopsy. It had higher sensitivity than mammography in dense breasts. Keywords: Breast density; mammography; ultrasonography mammary.