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When used with ultrasound, elastography helps distinguish between cancerous and benign breast lesions, which reduces unnecessary biopsies, U.S. researchers have found.

About 80 percent of breast lesions that are biopsied turn out to be benign, according to the American Cancer Society.

“There’s a lot of room to improve specificity with ultrasound, and elastography can help us do that,” Dr. Stamatia V. Destounis, a diagnostic radiologist at Elizabeth Wende Breast Care in Rochester, N.Y., and the study’s lead author, said in a news release from the Radiological Society of North America. “It’s an easy way to eliminate needle biopsy for something that’s probably benign.”

Elastography measures the compressibility and mechanical properties of a lesion. Cancerous tumors tend to be stiffer than surrounding tissues or cysts, whereas benign lesions are more compressible.

“You can perform elastography at the same time as hand-held ultrasound and view the images on a split screen, with the two-dimensional ultrasound image on the left and the elastography image on the right,” Destounis said.

As part of an ongoing study, 179 women underwent breast ultrasound and elastography. The researchers performed biopsies on the 134 solid lesions they detected. . They found that elastography correctly identified 98 percent of cancerous lesions and 82 percent of benign lesions, and they also determined that elastography was more accurate than ultrasound in gauging the size of the lesions.

The findings were to be presented Nov. 30 in Chicago at the annual meeting of the Radiological Society of North America.

In another study scheduled to be presented at the meeting, researchers found that high-frequency ultrasound with elastography can help distinguish between cancerous and benign skin lesions, which could improve the efficiency of skin cancer diagnosis.

Dr. Eliot L. Siegel, vice chairman of the radiology department at the University of Maryland School of Medicine in Baltimore and the study’s lead author, said in the news release that “dermatologists tend to biopsy any lesions that seem visually suspicious for disease.”

“Consequently,” he said, “many benign lesions are needlessly biopsied in order to avoid the risk of missing a potentially deadly melanoma.”

Siegel and his colleagues used ultra-high-frequency ultrasound to image cancerous and benign skin lesions on 40 people. They also calculated the elasticity ratio of the lesions and adjacent normal skin and used laboratory analysis to confirm their diagnoses. They found that benign lesions had high levels of elasticity, whereas cancerous lesions were much less elastic. The elasticity ratio of normal skin to adjacent lesions ranged from 0.04 to 0.3 for benign lesions to above 10.0 for cancerous lesions.

“The visualized portion of a skin lesion can be just the tip of the iceberg, and most dermatologists operate ‘blindly’ beyond what they can see on the surface,” Siegel said. “High-frequency ultrasound provides almost microscopic resolution and enables us to get size, shape and extent of the lesion prior to biopsy.”

People who work in detergent factories are at increased risk of developing respiratory problems, including asthma, probably from exposure to chemicals contained in detergent, two new studies hint.

But a spokesman for the detergent industry argues that the findings from these studies don’t apply to the US and European detergent industries at large. “Over the years, the detergent industry has developed successful product stewardship programs to promote the safe use of enzymes, using appropriate risk assessment and risk management strategies to avoid unacceptable risks in the workplace,” Richard Sedlak, vice president of technical and internal affairs for The Soap and Detergent Association (SDA), said in a prepared statement.

While the author of one of the new studies agrees that the industry overall has done a good job protecting workers, he said regulatory agencies’ current exposure standards are too high.

Exposure to chemicals found in powdered detergent was first recognized in 1969 to cause job-related asthma. Since then, the industry has introduced measures for limiting workers’ exposure, although outbreaks of occupational asthma still occur.

In the latest issue of the journal Occupational and Environmental Medicine, Dr. Frits van Rooy of the Institute for Risk Assessment Sciences in Utrecht, The Netherlands, and colleagues note that workers exposed to detergents in liquid form are not considered to be at risk of these lung problems. But their findings suggest that they should be.

In a related paper, Dr. Paul Cullinan of Imperial College in London and his colleagues report evidence suggesting that current standards for workplace exposure to powdered detergent chemicals are too high to protect workers from respiratory problems.

The chemicals in question are enzymes, which break down other chemicals, and hence help remove stains. The four types of enzymes used in detergents include proteases, which break down proteins; alpha-amylases, which break down starch; lipases, which break down fat; and cellulases, which break down cellulase, a major component of plants.

Cullinan and his team looked specifically at the relationship between lower or upper respiratory disease and exposure to proteases. They compared 570 workers in a European detergent factory who had developed respiratory problems ranging from runny, itchy noses to asthma, to an additional 2,137 workers with no respiratory disease.

Workers in areas where protease exposure was the highest were at double the risk of lower respiratory disease, Cullinan and his team found, while even lower exposures increased the risk of upper respiratory problems.

And the airborne protease concentrations found to produce these symptoms were well within current regulatory guidelines designed to protect workers’ health. However, Cullinan noted in an email to Reuters Health, “most of the industry works to very low exposure standards already, essentially far lower than those set by regulating authorities (which are almost certainly too high).”

Van Rooy and his team looked at 109 people working in a factory producing liquid detergent, placing them into three groups based on their level of exposure. The 16 percent of workers in the highest exposure group were at four times greater risk of itchy nose and sneezing than the lowest-exposure group, who made up half of the study population. Risk of wheezing in the highest-exposure group was tripled.

Blood tests of 106 of the workers showed that 14 percent were sensitized to at least one of the enzymes contained in the detergent; this meant their bodies were hypersensitive to the chemical, putting them at risk of developing an allergy to it. One worker appeared to have developed allergic asthma related to workplace enzyme exposure, while two workers had allergic rhinitis (stuffy, runny, itchy nose).

The researchers conclude that “exposure to liquid detergent enzymes should be regarded as an occupational hazard leading to sensitization and occupational allergy,” and call for companies to minimize this exposure.

While better regulatory standards are clearly necessary, Cullinan said, more data is needed before they can be set. “Setting proper standards will require further work, but this should not be difficult for an industry who for many years has taken great care in measuring both exposures and health outcomes in their factory workforces.”

Falls in the home can lead to serious injury, including the all-too-common broken hip.

The American Academy of Orthopaedic Surgeons offers these suggestions to minimize the risk of falling:
Keep stairs clear and well-lit, and make sure there are handrails on both sides. Also, there should be no loose rugs, carpets or boards.
Make sure there’s a slip-resistant rug outside the shower, with handrails and non-skid strips on the shower/tub floor.
In the bedroom, make sure there is clear and easy access to the door. Also, keep a lamp or flashlight near the bed.
Install a night light in the hallway, making that late-night trip to the bathroom safer.
Make sure furniture and decorations don’t block walkways.
Keep all cords neat and out of the way, and all rugs or carpets firmly attached to the floor.