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Filippou A, Louca I, Damianou C. Characterization of a fat tissue mimicking material for high intensity focused ultrasound applications. J Ultrasound 2023; 26:505-515. [PMID: 36414928 PMCID: PMC10247632 DOI: 10.1007/s40477-022-00746-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Tissue-mimicking materials (TMMs) have a prominent role in validating new high intensity focused ultrasound (HIFU) therapies. Agar-based TMMs are often developed mimicking the thermal properties of muscle tissue, while TMMs simulating fat tissue properties are rarely developed. Herein, twelve agar-based TMMs were iteratively developed with varied concentrations of agar, water, glycerol and propan-2-ol, and characterized for their suitability in emulating the thermal conductivity of human fat tissue. METHODS Varied agar concentrations (2%, 4%, 6%, 8%, 12%, 16% and 20% w/v) were utilized for developing seven water-based TMMs, while a 20% w/v agar concentration was utilized for developing two water/alcohol-based TMMs (50% v/v water and 50% v/v either glycerol or propan-2-ol) and three alcohol-based TMMs (varied glycerol and propan-2-ol concentrations). Thermal conductivity was measured for all TMMs, and the tissue mimicking material (TMM) exhibiting thermal conductivity closest to human fat was considered the optimum fat TMM and was further characterized using ultrasound (US) and Magnetic Resonance Imaging (MRI). RESULTS For the seven water-based TMMs an inverse linear trend was observed between thermal conductivity and increased agar concentration, being between 0.524 and 0.445 W/m K. Alcohol addition decreased thermal conductivity of the two water/alcohol-based TMMs to about 0.33 W/m K, while in the alcohol-based TMMs, increased concentrations of propan-2-ol emerged as a modifier of thermal conductivity. The optimum fat TMM (33.3% v/v glycerol and 66.7% v/v propan-2-ol) exhibited a 0.231 W/m K thermal conductivity, and appeared hypoechoic on US images and with increased brightness on T1-Weighted MRI images. CONCLUSION The optimum fat TMM emulates the thermal conductivity of human fat tissue and exhibits a fat-like appearance on US and MRI images. The TMM is cost-effective and has a long lifespan and possesses great potential for use in HIFU applications as a fat TMM.
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Affiliation(s)
- Antria Filippou
- Department of Electrical Engineering, Computer Engineering and Informatics, Cyprus University of Technology, 30 Archbishop Kyprianou Street, 3036, Limassol, Cyprus
| | - Irene Louca
- Department of Electrical Engineering, Computer Engineering and Informatics, Cyprus University of Technology, 30 Archbishop Kyprianou Street, 3036, Limassol, Cyprus
| | - Christakis Damianou
- Department of Electrical Engineering, Computer Engineering and Informatics, Cyprus University of Technology, 30 Archbishop Kyprianou Street, 3036, Limassol, Cyprus.
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2
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Pan D, Fu S, Li X, Yu T, Huang S, Zhang B, Lai X, Liu Y, Yu X, Lin C, Liu S. The concordance between ultrasonographic stage of breast and Tanner stage of breast for overweight and obese girls: a school population-based study. J Pediatr Endocrinol Metab 2021; 34:1549-1558. [PMID: 34492746 DOI: 10.1515/jpem-2021-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In this study, we evaluated the concordance between the ultrasonographic stage of breast (US B) and Tanner stage of breast (TS B) for overweight and obese girls based on a school population study. METHODS We conducted multistage, stratified cluster, and random-proportional sampling and ultimately included 221 girls (aged 6-10 years). RESULTS This study revealed that the concordance was poor (accuracy=0.19 (95% confidence interval: 0.14, 0.25)) between US B and TS B among the 221 participants. When our subjects were stratified by weight, we observed a weak association between US B and TS B in the thin/normal weight group (r=0.34, p=0.001) but not in the overweight (r=0.097, p=0.38) or obese groups (r=-0.19, p=0.206), and as the body mass index (BMI) z-score increased, the overestimation ratio of TS B increased. US B manifested a positive correlation with breast bud diameter (BD) (r=0.885, p<0.001), follicle-stimulating hormone (r=0.235, p=0.009), and luteinizing hormone (r=0.192, p=0.037), but this was not the case with TS B. CONCLUSIONS As the BMI z-score increased, the correlation between the two methods declined, and the overestimation ratio of TS B increased. US B is an objective and quantitative method used to evaluate breast development, and whether BD might replace US B as a routine diagnostic method to evaluate breast development in clinical practice needs to be confirmed in larger-sample studies.
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Affiliation(s)
- Dongxue Pan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou City, Guangdong Province, P. R. China
- BoAi Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan City, Guangdong Province, P. R. China
| | - Simao Fu
- Zhongshan City People's Hospital of Sun-Yat-Sen University, Zhongshan City, Guangdong Province, P. R. China
| | - Xiaoqing Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Department of Clinical Epidemiology and Biostatistics, Children Health Advocacy Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Tingting Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Department of Clinical Epidemiology and Biostatistics, Children Health Advocacy Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Sizhe Huang
- Health Care Center for Primary and Secondary Schools, Zhongshan City, Guangdong province, P. R. China
| | - Bihong Zhang
- BoAi Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan City, Guangdong Province, P. R. China
| | - Xin Lai
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou City, Guangdong Province, P. R. China
- BoAi Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan City, Guangdong Province, P. R. China
| | - Yifan Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou City, Guangdong Province, P. R. China
- BoAi Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan City, Guangdong Province, P. R. China
| | - Xiaodan Yu
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center,School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - Cuilan Lin
- BoAi Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan City, Guangdong Province, P. R. China
| | - Shijian Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Department of Clinical Epidemiology and Biostatistics, Children Health Advocacy Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
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Davis J, Liang J, Roh A, Kittrell L, Petterson M, Winton L, Connell M, Viscusi R, Komenaka I, Jamshidi R. Use of breast imaging-reporting and data system (BI-RADS) ultrasound classification in pediatric and adolescent patients overestimates likelihood of malignancy. J Pediatr Surg 2021; 56:1000-1003. [PMID: 33494944 DOI: 10.1016/j.jpedsurg.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND/PURPOSE Breast masses in the pediatric population cause patient and family concern, partially driven by public awareness of adult breast cancer. However, the spectrum of breast masses in children differs greatly from that in adults, and malignancy is exceedingly rare. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) ultrasound-based classification system is the diagnostic standard, yet no study has validated BI-RADS in pediatric patients. This study compares BI-RADS classification with histologic diagnoses to evaluate BI-RADS validity in pediatric patients. METHODS Multicenter retrospective evaluation of breast masses in patients under 21 years. Ultrasound reports were compared with histologic diagnoses. RESULTS There were 283 patients with breast pathology results after excluding clinical diagnoses of gynecomastia. Mean age was 16.9 (SD 2.3), ranging 10-20 years. 227 had pre-operative ultrasounds, and 84% (191/227) were assigned a BI-RADS category. BI-RADS 4 was the most frequent category (55%, n = 124), by definition predicting 2 - 95% likelihood of malignancy. However, pathology was benign in all patients. CONCLUSIONS The current BI-RADS categorization system overestimates cancer risk when applied to pediatric patients. BI-RADS scores should not be assigned to pediatric patients, and BIRADS-defined recommendations for biopsy should be disregarded. A pediatric-specific classification system could be useful.
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Affiliation(s)
- John Davis
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Juliana Liang
- The University of Arizona College of Medicine, Phoenix, Phoenix, AZ, United States
| | - Albert Roh
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Laurel Kittrell
- The University of Arizona College of Medicine, Tucson, Tucson, AZ, United States
| | - Matthew Petterson
- The University of Arizona College of Medicine, Phoenix, Phoenix, AZ, United States
| | - Lisa Winton
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Mary Connell
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Rebecca Viscusi
- The University of Arizona College of Medicine, Tucson, Tucson, AZ, United States
| | - Ian Komenaka
- Valleywise Health Medical Center, Phoenix, AZ, United States
| | - Ramin Jamshidi
- Valleywise Health Medical Center, Phoenix, AZ, United States; The University of Arizona College of Medicine, Phoenix, Phoenix, AZ, United States; Phoenix Children's Hospital, Phoenix, AZ, United States.
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Watanabe T, Yamaguchi T, Tohno E, Tsunoda H, Kaoku S, Ban K, Watanabe R, Umemoto T, Hirokaga K, Ito T. B-mode ultrasound diagnostic flowchart for solid breast masses: JABTS BC-01 study. J Med Ultrason (2001) 2021; 48:71-81. [PMID: 33389372 PMCID: PMC7882583 DOI: 10.1007/s10396-020-01072-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
Purpose Breast ultrasound has been widely used as an essential examination for diagnosing breast cancer. However, standardized diagnostic criteria are as yet lacking. This study aimed to develop a simple diagnostic flowchart for beginners learning breast ultrasonography. The diagnostic flowchart was developed based on the recall criteria widely used in Japan. Methods We conducted a multicenter study to examine recall criteria usefulness in the diagnostic phase of breast disease. Women with ultrasound-visible breast masses who underwent B-mode breast ultrasound examination were recruited from 22 hospitals in Japan between September 2009 and January 2010. B-mode images were evaluated by members of the centralized image interpretation committee. We developed the new diagnostic flowchart based on the results. The usefulness of the diagnostic flowchart was assessed by employing datasets from the current study and another study which we conducted (BC-04 study). Results We evaluated 1045 solid masses (malignant: 495, benign: 550). Multivariate analysis showed that shape, margin, echogenic halo, interruption of the mammary gland interface, and depth width ratio were significant findings for distinguishing between benign and malignant masses. We modified the recall criteria and developed our novel diagnostic flowchart using these findings. The sensitivity and specificity of the new flowchart (current study: 0.97, 0.45; BC-04 study dataset: 0.95, 0.45) were similar to those of experts (current study: 0.96, 0.54; BC-04 study dataset: 0.98, 0.38). Conclusion We developed a simple diagnostic flowchart for breast ultrasound. This flowchart is anticipated to be applicable to educating beginners learning breast ultrasound.
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Affiliation(s)
- Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, 2-11-12 Miyaginohara, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Eriko Tohno
- Tsukuba International Breast Clinic, 2F Tsukuba CITYIA Bldg., 2-8-8 Azuma, Tsukuba, Ibaraki, 305-0031, Japan
| | - Hiroko Tsunoda
- Department of Radiology Diagnostic Breast Imaging, St Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Setsuko Kaoku
- Department of Ultrasonics, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Kanako Ban
- Department of Cancer Detection and Diagnosis, Tokyo Health Service Association, 1-2 Ichigaya-sadohara-cho, Shinjuku-ku, Tokyo, 162-8402, Japan
| | - Ryoji Watanabe
- Department of Breast Center, Itoshima Medical Association Hospital, 532-1 Urashi, Itoshima, Fukuoka, 819-1112, Japan
| | - Takeshi Umemoto
- Department of Senology, Moriya Keiyu Hospital, 980-1 Tatsuzawa, Moriya, Ibaraki, 302-0118, Japan
| | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, 13-70 Kitaoji, Akashi, Hyogo, 673-8558, Japan
| | - Toshikazu Ito
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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Alawi A, Hasan M, Harraz MM, Kamr WH, Alsolami S, Mowalwei H, Salem A, Qronfla H. Breast lesions in women under 25 years: radiologic-pathologic correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00209-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The majority of breast lesions in women under 25 years are being benign. Imaging is important for diagnosis and selecting patients for further procedures. Although malignancy is rare in this group of patients, suspected lesions must be biopsied. Imaging is very important in the selection of patients for radiological intervention. Understanding of the clinical, pathologic, and imaging features allows the radiologist to guide proper management of these patients. The aim of this study was to determine the frequency of different breast lesions in symptomatic women under 25 years and the value of radiological imaging in the diagnosis.
Results
This was a retrospective study; a total number of 250 cases with breast lumps under 25 years of age were registered in the PACKS of our institution in the period from January 01, 2017 to December 31, 2018. Two hundred three cases coped with our inclusion criteria that include available histopathological results either by biopsy or after surgery based on their referring physicians decision. Our exclusion criteria were those cases (47) with definite BIRADS 2 lesions with no available pathology reports. Ultrasonography was done to all patients (203 cases) and MRI was performed to 26 cases. All cases were histologically verified; their findings were reviewed and compared to radiological findings.
A total of 203 symptomatic breast lesions were received at the radiological department in women under 25 years; there were 115 (56.7%) benign, 85 (41.9%) cystic, and 3 (1.5%) malignant lumps. The commonest benign lesion was fibroadenoma (104 cases, 51.2%) and all the malignant lesions were invasive ductal carcinoma (IDC) (3 cases, 1.47%). The p value is > 0.05, so there were no differences between examination using the ultrasonography and the MRI imaging compared to histopathological results.
Conclusions
Most breast lesions in young women are benign. Ultrasonography is an essential first imaging modality in the diagnosis of women under 25 years with breast lesions.
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Bruserud IS, Roelants M, Oehme NHB, Eide GE, Bjerknes R, Rosendahl K, Júlíusson PB. Ultrasound assessment of pubertal breast development in girls: intra- and interobserver agreement. Pediatr Radiol 2018; 48:1576-1583. [PMID: 29982956 DOI: 10.1007/s00247-018-4188-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical assessment of pubertal breast development using Tanner staging is subjective. This has led to the introduction of ultrasound (US), aiming for a more objective analysis. However, information regarding its reliability is lacking. OBJECTIVE To examine intra- and interobserver agreement of breast maturity staging using US and to examine the precision of direct measurements of the gland. MATERIALS AND METHODS Fifty-seven healthy girls (mean age: 10.9 years, range: 6.1 to 15.9 years) were examined independently by two observers using US of the left breast to score the glandular maturity stage on a 0-5 scale, and to measure the depth and diameter. One observer repeated the examination after 20 to 35 min to assess intra-observer agreement. Cohen's kappa with linear weights was used to examine intra- and interobserver agreement of the US staging, while the measurement precision was analyzed using Bland-Altman plots and 95% limits of agreement. RESULTS The agreement of US staging on a 0-5 scale was very good (kappa 0.84; 95% confidence interval [CI] 0.78-0.91) for intra-observer observation and good (kappa 0.71; 95% CI 0.62-0.80) for interobserver observation. Measurements of glandular depth and diameter were unbiased for a single observer, but the variances were large both within and between observers. CONCLUSION US using a scale from 0 to 5 is a reliable method to stage the development of glandular breast tissue during puberty in healthy girls. Measurements of glandular depth and diameter were found to be imprecise.
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Affiliation(s)
- Ingvild Særvold Bruserud
- Department of Clinical Science, University of Bergen, Bergen, Norway. .,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
| | - Mathieu Roelants
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ninnie Helén Bakken Oehme
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Robert Bjerknes
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Pétur B Júlíusson
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
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7
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Evans A, Trimboli RM, Athanasiou A, Balleyguier C, Baltzer PA, Bick U, Camps Herrero J, Clauser P, Colin C, Cornford E, Fallenberg EM, Fuchsjaeger MH, Gilbert FJ, Helbich TH, Kinkel K, Heywang-Köbrunner SH, Kuhl CK, Mann RM, Martincich L, Panizza P, Pediconi F, Pijnappel RM, Pinker K, Zackrisson S, Forrai G, Sardanelli F. Breast ultrasound: recommendations for information to women and referring physicians by the European Society of Breast Imaging. Insights Imaging 2018; 9:449-461. [PMID: 30094592 PMCID: PMC6108964 DOI: 10.1007/s13244-018-0636-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 04/28/2018] [Accepted: 05/14/2018] [Indexed: 11/09/2022] Open
Abstract
This article summarises the information that should be provided to women and referring physicians about breast ultrasound (US). After explaining the physical principles, technical procedure and safety of US, information is given about its ability to make a correct diagnosis, depending on the setting in which it is applied. The following definite indications for breast US in female subjects are proposed: palpable lump; axillary adenopathy; first diagnostic approach for clinical abnormalities under 40 and in pregnant or lactating women; suspicious abnormalities at mammography or magnetic resonance imaging (MRI); suspicious nipple discharge; recent nipple inversion; skin retraction; breast inflammation; abnormalities in the area of the surgical scar after breast conserving surgery or mastectomy; abnormalities in the presence of breast implants; screening high-risk women, especially when MRI is not performed; loco-regional staging of a known breast cancer, when MRI is not performed; guidance for percutaneous interventions (needle biopsy, pre-surgical localisation, fluid collection drainage); monitoring patients with breast cancer receiving neo-adjuvant therapy, when MRI is not performed. Possible indications such as supplemental screening after mammography for women aged 40-74 with dense breasts are also listed. Moreover, inappropriate indications include screening for breast cancer as a stand-alone alternative to mammography. The structure and organisation of the breast US report and of classification systems such as the BI-RADS and consequent management recommendations are illustrated. Information about additional or new US technologies (colour-Doppler, elastography, and automated whole breast US) is also provided. Finally, five frequently asked questions are answered. TEACHING POINTS • US is an established tool for suspected cancers at all ages and also the method of choice under 40. • For US-visible suspicious lesions, US-guided biopsy is preferred, even for palpable findings. • High-risk women can be screened with US, especially when MRI cannot be performed. • Supplemental US increases cancer detection but also false positives, biopsy rate and follow-up exams. • Breast US is inappropriate as a stand-alone screening method.
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Affiliation(s)
- Andrew Evans
- Dundee Cancer Centre, Clinical Research Centre, Ninewells Hospital and Medical School, Tom McDonald Avenue, Dundee, UK
| | - Rubina M Trimboli
- PhD Course in Integrative Biomedical Research, Department of Biomedical Science for Health, Università degli Studi di Milano, Via Mangiagalli, 31, 20133, Milan, Italy
| | - Alexandra Athanasiou
- Breast Imaging Department, MITERA Hospital, 6, Erithrou Stavrou Str. 151 23 Marousi, Athens, Greece
| | - Corinne Balleyguier
- Department of Radiology, Gustave-Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Ulrich Bick
- Clinic of Radiology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Julia Camps Herrero
- Department of Radiology, University Hospital of La Ribera, Carretera de Corbera, Km 1, 46600, Alzira, Valencia, Spain
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Catherine Colin
- Radiology Unit, Hospices Civils de Lyon, Centre Hospitalo-Universitaire Femme Mère Enfant, 59 Boulevard Pinel, 69 677, Bron Cedex, France
| | - Eleanor Cornford
- Thirlestaine Breast Centre, Cheltenham General Hospital, Thirlestaine Road, Cheltenham, GL53 7AP, UK
| | - Eva M Fallenberg
- Clinic of Radiology, Charité Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Michael H Fuchsjaeger
- Division of General Radiology, Department of Radiology, Medical University Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills road, Cambridge, CB2 0QQ, UK
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Karen Kinkel
- Institut de Radiologie, Clinique des Grangettes, Chemin des Grangettes 7, 1224, Chêne-Bougeries, Genève, Switzerland
| | | | - Christiane K Kuhl
- University Hospital of Aachen, Rheinisch-Westfälische Technische Hochschule, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ritse M Mann
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Laura Martincich
- Unità Operativa Radiodiagnostica, Candiolo Cancer Institute - FPO, IRCCS, Str. Prov. 142, km 3.95, 10060, Candiolo, Turin, Italy
| | - Pietro Panizza
- Breast Imaging Unit, Scientific Institute (IRCCS) Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Ruud M Pijnappel
- Department of Imaging, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Sophia Zackrisson
- Diagnostic Radiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Skåne University Hospital Malmö, SE-205 02, Malmö, Sweden
| | - Gabor Forrai
- Department of Radiology, Duna Medical Center, Budapest, Hungary
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
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Chiasawas P, Boonjunwetwat D, Sampatanukul P. Ultrasonography and histology correlation in BI-RADS 4/5 small breast lesions among Thai patients. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0502.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Ultrasonography is an important imaging tool in detection of small breast cancers, particularly in younger women with dense breasts. Among the ultrasonographic characteristics for the malignancy, it is unclear which are common or more predictive.
Objective: Analyze breast ultrasonograms and determine the common and predictive characteristics of the BIRADS 4/5 small breast lesions that were correlated with histology-proved carcinoma among Thai patients.
Methods: Data were collected retrospectively between November 2006 and September 2007 at King Chulalongkorn Memorial Hospital. Forty-five BI-RADS 4 or 5 small breast lesions from 41 patients were reviewed for ultrasonographic characteristics and for correlation between each of these features and histology-proved malignancy.
Results: There were 15 out of 30 lesions of BI-RADS 4 and 14 out of 15 of BI-RADS 5 that were histologically proven breast carcinoma. The lesion dimension ranged from 0.27 cm to 1.5 cm (mean: 0.98 cm). The malignant signs that were common consisted of irregular shapes (70%) and posterior shadowing (35.6%). However, the most correlating signs for malignancy were vascularity of the lesion 100%, and spiculated margins 100%. The other characteristics for malignancy, in descending order, were marked hypoechoicity 88.9%, microcalcifications within mass 85.7%, echogenic halo 83.3%, shadowing 81.3%, branched pattern 77.8%, duct extension 75%, irregular shape72.2%, and taller than wide orientation 70%.
Conclusion: Irregular shape and shadowing were the two most common malignant signs that characterized BI-RADS 4, 5 small breast lesions by ultrasonography. However, the most predictive signs were increases in vascularity and spiculated margins.
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Affiliation(s)
- Pimlada Chiasawas
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Darunee Boonjunwetwat
- MD, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Pichet Sampatanukul
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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9
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Perlman O, Azhari H. Ultrasonic computed tomography imaging of iron oxide nanoparticles. Phys Med Biol 2017; 62:825-842. [DOI: 10.1088/1361-6560/aa51ab] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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10
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Valeur NS, Rahbar H, Chapman T. Ultrasound of pediatric breast masses: what to do with lumps and bumps. Pediatr Radiol 2015; 45:1584-99; quiz 1581-3. [PMID: 26164440 DOI: 10.1007/s00247-015-3402-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 04/15/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
The approach to breast masses in children differs from that in adults in many ways, including the differential diagnostic considerations, imaging algorithm and appropriateness of biopsy as a means of further characterization. Most pediatric breast masses are benign, either related to breast development or benign neoplastic processes. Biopsy is rarely needed and can damage the developing breast; thus radiologists must be familiar with the imaging appearance of common entities so that biopsies are judiciously recommended. The purpose of this article is to describe the imaging appearances of the normally developing pediatric breast as well as illustrate the imaging findings of a spectrum of diseases, including those that are benign (fibroadenoma, juvenile papillomatosis, pseudoangiomatous stromal hyperplasia, gynecomastia, abscess and fat necrosis), malignant (breast carcinoma and metastases), and have variable malignant potential (phyllodes tumor).
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Affiliation(s)
- Natalie S Valeur
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Teresa Chapman
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA. .,Department of Radiology, Seattle Children's Hospital, Mail Stop MA.07.220, P.O. Box 5371, Seattle, WA, 98145, USA.
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11
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Abstract
The mainstay of breast imaging in the adolescent is ultrasonography. There is occasionally a need for additional imaging, particularly with magnetic resonance imaging (MRI). Imaging of the adolescent breast differs substantially from the adult in both the imaging modalities utilized and the relative likelihood of pathologies encountered. The majority of lesions in the adolescent are benign, but the presence of a breast lesion may cause anxiety to patients and their families due to the wide awareness of breast malignancy in the adult population. It is important to be aware of the imaging modalities available to image the adolescent breast to prevent unnecessary radiation exposure while answering the clinical question. The current recommendations for adolescent diagnostic and screening breast imaging will be reviewed. Benign breast lesions such as fibroadenomas, fibrocystic change, pseudoangiomatous stromal hyperplasia, gynecomastia, and posttraumatic or infectious lesions with their associated imaging findings and management will be outlined. Additionally, review of breast malignancies that can affect adolescents will provide the reader with features to distinguish benign from malignant processes in the adolescent based on imaging findings and clinical presentation.
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Affiliation(s)
- Katie N Jones
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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12
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Chen M, Zhan WW, Wang WP. Cystic breast lesions by conventional ultrasonography: sonographic subtype-pathologic correlation and BI-RADS Assessment. Arch Med Sci 2014; 10:76-83. [PMID: 24701218 PMCID: PMC3953978 DOI: 10.5114/aoms.2014.40734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 10/22/2011] [Accepted: 12/12/2011] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Appropriate categorization is very important because the clinical management of each subtype of cystic breast lesions (CBLs) differs. The purpose was to evaluate the sonographic subtype-pathologic correlation, and to identify the effectiveness of the Breast Imaging Reporting and Data System (BI-RADS)-ultrasound (US) for differentiation of benign and malignant CBLs. MATERIAL AND METHODS A database from December 1, 2007 and November 30, 2009 was identified in the Department of Diagnostic Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, China. Those patients with palpable or clinical symptomatic breast masses were associated with a cystic component in lesions on breast US. All patients underwent a subsequent fine-needle/core-needle biopsy or surgical excision. The sonographic findings were analyzed according to the BI-RADS-US, and were categorized by two different methods of subtype categorization compared with the pathologic results. RESULTS Ninety-nine breast cystic lesions in 83 women were included, among whom 16 patients were identified with bilateral cystic lesions. The total malignancy rate of CBLs was 14.1% (95% confidence interval 7.3-21.0%). Among 99 CBLs, 14 malignant lesions were associated with sonographic appearances of complex cystic lesions, while the remaining subtypes were benign. Shape, margin, echo pattern, orientation, calcification, and vascularity were statistically significantly different between the benign and malignant lesions (p = 0.010, p = 0.004, p < 0.001, p < 0.001, p = 0.036, and p < 0.001, respectively) (degrees of freedom = 1). CONCLUSIONS By comparison of the two different methods of subtype categorization of CBLs, the appropriate 5-variety classification should be suggested. The BI-RADS-US was useful for differentiating benign from malignant cystic lesions.
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Affiliation(s)
- Man Chen
- Department of Diagnostic Ultrasound, Zhong Shan Hospital, Fu Dan University School of Medicine, Shanghai, China
- Department of Diagnostic Ultrasound, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Wei Zhan
- Department of Diagnostic Ultrasound, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Ping Wang
- Department of Diagnostic Ultrasound, Zhong Shan Hospital, Fu Dan University School of Medicine, Shanghai, China
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Hassiotou F, Geddes D. Anatomy of the human mammary gland: Current status of knowledge. Clin Anat 2012; 26:29-48. [PMID: 22997014 DOI: 10.1002/ca.22165] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 08/16/2012] [Indexed: 12/18/2022]
Abstract
Mammary glands are unique to mammals, with the specific function of synthesizing, secreting, and delivering milk to the newborn. Given this function, it is only during a pregnancy/lactation cycle that the gland reaches a mature developmental state via hormonal influences at the cellular level that effect drastic modifications in the micro- and macro-anatomy of the gland, resulting in remodeling of the gland into a milk-secretory organ. Pubertal and post-pubertal development of the breast in females aids in preparing it to assume a functional state during pregnancy and lactation. Remarkably, this organ has the capacity to regress to a resting state upon cessation of lactation, and then undergo the same cycle of expansion and regression again in subsequent pregnancies during reproductive life. This plasticity suggests tight hormonal regulation, which is paramount for the normal function of the gland. This review presents the current status of knowledge of the normal macro- and micro-anatomy of the human mammary gland and the distinct changes it undergoes during the key developmental stages that characterize it, from embryonic life through to post-menopausal age. In addition, it discusses recent advances in our understanding of the normal function of the breast during lactation, with special reference to breastmilk, its composition, and how it can be utilized as a tool to advance knowledge on normal and aberrant breast development and function. Finally, anatomical and molecular traits associated with aberrant expansion of the breast are discussed to set the basis for future comparisons that may illuminate the origin of breast cancer.
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Affiliation(s)
- Foteini Hassiotou
- Hartmann Human Lactation Research Group, School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, Crawley, Western Australia, Australia
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14
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Compressibility of thyroid masses: a sonographic sign differentiating benign from malignant lesions? AJR Am J Roentgenol 2012; 198:434-8. [PMID: 22268190 DOI: 10.2214/ajr.11.6446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the manual compressibility of thyroid masses with an ultrasound probe and to determine whether this ultrasound feature can be used to differentiate benign from malignant thyroid lesions. SUBJECTS AND METHODS We prospectively compared images obtained during compression with an ultrasound probe and noncompressed ultrasound images of 180 pathologically proven thyroid masses (51 malignant, 129 benign) smaller than 2 cm in 169 patients (127 women, 42 men; mean age, 51.2 years). The size (anteroposterior and transverse dimensions) and shape (ratio of anteroposterior to transverse dimension) of the selected lesions were measured on both noncompressed and compressed ultrasound images at a computer workstation, and the compressibility (anteroposterior-to-transverse ratio on noncompressed images minus anteroposterior-to-transverse ratio on compressed images) was calculated. Compressibility was analyzed to determine its association with histopathologic results (benign versus malignant) and the characteristics of the thyroid mass (involved lobe, location in lobe, halo, and composition). The area under the receiver operating characteristic curve was used as an indicator of performance. RESULTS The mean anteroposterior-to-transverse ratio of a thyroid mass on compressed ultrasound images was significantly lower than that on noncompressed images (0.78 ± 0.28 vs 0.92 ± 0.30; p < 0.001). The compressibility of masses was greater for benign than for malignant lesions (0.19 ± 0.16 vs 0.05 ± 0.12; p < 0.001). No statistically significant association was identified between compressibility and other characteristics of a lesion. The area under the receiver operating characteristic curve for compressibility of thyroid masses was 0.78. On the basis of a cutoff value for malignancy of compressibility less than 0.10, the sensitivity, specificity, and accuracy were 72.5%, 72.9%, and 72.8%. CONCLUSION Compressibility with an ultrasound probe is a useful criterion for differentiating benign from malignant lesions of the thyroid.
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Sohn YM, Kim MJ, Kwak JY, Moon HJ, Kim SJ, Kim EK. Breast ultrasonography in young Asian women: analyses of BI-RADS final assessment category according to symptoms. Acta Radiol 2011; 52:35-40. [PMID: 21498323 DOI: 10.1258/ar.2010.100250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast ultrasound is the major imaging modality in young women because it incurs no radiation exposure and dense breast tissue, which is common in young women, yields a high rate of false-negative results on mammography. PURPOSE To investigate the cancer rates of the sonographic BI-RADS categorization and histopathologic results according to the presence of symptoms in young Asian women. MATERIAL AND METHODS We included 811 young women under 30 years of age who underwent a breast ultrasound during the study period. The mean age of all subjects was 24.5 years (range 11-29 years). Histopathologic results were compared with the results after application of the BI-RADS categorization. RESULTS Sonographic findings were classified as category 1 (n=192), category 2 (n=81), category 3 (n=399), category 4 (n=134), and category 5 (n=5). The cancer rates for category 1, 2, 3, 4, and 5 were 0, 0, 0.3, 6.3, and 100% in the symptomatic group, respectively. For the asymptomatic group, the cancer rates were 0, 0, 0, 8.7, and 100%, respectively. More cancers were found in high-risk women (22.2%, 4/18) than in non-high-risk women (1.4%, 11/793). CONCLUSION BI-RADS categorization was helpful for predicting the probability of malignancy in young Asian women.
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Affiliation(s)
- Yu-Mee Sohn
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
| | - Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
| | - Soo Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul
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16
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Oh YJ, Choi SH, Chung SY, Yang I, Woo JY, Lee MJ. Spontaneously infarcted fibroadenoma mimicking breast cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1421-1423. [PMID: 19778895 DOI: 10.7863/jum.2009.28.10.1421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Yu Jin Oh
- Department of Radiology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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17
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Chung EM, Cube R, Hall GJ, González C, Stocker JT, Glassman LM. From the archives of the AFIP: breast masses in children and adolescents: radiologic-pathologic correlation. Radiographics 2009; 29:907-31. [PMID: 19448124 DOI: 10.1148/rg.293095010] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The spectrum of breast lesions in children and adolescents varies markedly from that for adults, with the former lesions being overwhelmingly benign. A breast mass in a young boy or girl may arise from normal and abnormal breast development. Other causes of masses include infection, trauma, and cyst formation. After onset of puberty, most cases of breast enlargement arise from benign fibroadenoma in girls and gynecomastia in boys. These conditions have specific imaging appearances, although juvenile (often giant) fibroadenoma cannot be distinguished from phyllodes tumor, which can be benign or malignant. In children, both conditions usually appear as well-circumscribed, hypoechoic masses at sonography and show diffuse enhancement except for nonenhancing septations at magnetic resonance imaging. A diagnosis of juvenile papillomatosis (a benign lesion) portends later development of breast cancer, and patients with this condition should be closely monitored. Malignant lesions of the breast in children are rare. The most common malignant lesions are metastases and are usually associated with widespread disease. The most common primary breast malignancy is malignant phyllodes tumor. Primary breast carcinoma is exceedingly rare in the pediatric age group, but its imaging appearance in children is the same as seen in adults and is different from that of almost all benign lesions. In girls, diagnostic interventions may injure the developing breast and cause subsequent disfigurement. Given this risk and the low prevalence of malignant disease in this population, a prudent course should be followed in the diagnosis of breast lesions. Imaging findings are very helpful for selecting patients for further diagnostic procedures. Although malignancy is rare, lesions with suspicious imaging findings or progressive growth should be subjected to cytologic or histologic examination.
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Affiliation(s)
- Ellen M Chung
- Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.
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18
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Evaluation of breast enlargement in young males and factors associated with gynecomastia and pseudogynecomastia. Ir J Med Sci 2009; 179:575-83. [DOI: 10.1007/s11845-009-0345-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 04/06/2009] [Indexed: 11/27/2022]
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19
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Erickson SJ, Godavarty A. Hand-held based near-infrared optical imaging devices: A review. Med Eng Phys 2009; 31:495-509. [DOI: 10.1016/j.medengphy.2008.10.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 07/12/2008] [Accepted: 10/15/2008] [Indexed: 11/15/2022]
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20
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Yap MH, Edirisinghe E, Bez H. Processed images in human perception: a case study in ultrasound breast imaging. Eur J Radiol 2009; 73:682-7. [PMID: 19144483 DOI: 10.1016/j.ejrad.2008.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 11/10/2008] [Indexed: 11/19/2022]
Abstract
Two main research efforts in early detection of breast cancer include the development of software tools to assist radiologists in identifying abnormalities and the development of training tools to enhance their skills. Medical image analysis systems, widely known as Computer-Aided Diagnosis (CADx) systems, play an important role in this respect. Often it is important to determine whether there is a benefit in including computer-processed images in the development of such software tools. In this paper, we investigate the effects of computer-processed images in improving human performance in ultrasound breast cancer detection (a perceptual task) and classification (a cognitive task). A survey was conducted on a group of expert radiologists and a group of non-radiologists. In our experiments, random test images from a large database of ultrasound images were presented to subjects. In order to gather appropriate formal feedback, questionnaires were prepared to comment on random selections of original images only, and on image pairs consisting of original images displayed alongside computer-processed images. We critically compare and contrast the performance of the two groups according to perceptual and cognitive tasks. From a Receiver Operating Curve (ROC) analysis, we conclude that the provision of computer-processed images alongside the original ultrasound images, significantly improve the perceptual tasks of non-radiologists but only marginal improvements are shown in the perceptual and cognitive tasks of the group of expert radiologists.
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Affiliation(s)
- Moi Hoon Yap
- Department of Computer Science, Loughborough University, Ergonomics & Safety Research Institute, Holywell Park, UK.
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21
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Kwong A, Cheung PSY, Wong AYW, Hung GTY, Lo G, Tsao M, Chan EWK, Wong T, Ma M. The acceptance and feasibility of breast cancer screening in the East. Breast 2008; 17:42-50. [PMID: 17720500 DOI: 10.1016/j.breast.2007.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2007] [Revised: 05/22/2007] [Accepted: 06/20/2007] [Indexed: 10/22/2022] Open
Abstract
Breast cancer, traditionally a disease prevalent among women in the West, has become an increasing disease burden in the East. In Hong Kong, breast cancer is the number one incident cancer in women. In Asian countries, due to the lower incidence rate, population screening is still controversial. Most screening programs are not population-based, and are either self-financed privately or partially subsidized by the government. Since the first government-subsidized screening program was set up in 1991 in Hong Kong, numerous private and government health centres for women have been set up. A dedicated private Breast Care Centre was set up at the Hong Kong Sanatorium and Hospital (HKSH) in 1999. Over an 8-year period from October 1999 to September 2006, 14,596 women were screened, of whom 11,408 were asymptomatic. This study aims to produce the first report on breast screening experience in the largest cohort of asymptomatic Chinese women in the private sector. An overall malignancy detection rate of 2.3 per 1000 screens and a recall rate of 9.2% were found. Despite culture differences and differences in breast characteristics (denser and smaller breasts), breast screening is feasible and acceptable in the East.
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Affiliation(s)
- Ava Kwong
- Breast Care Centre, Hong Kong Sanatorium and Hospital, Hong Kong, China.
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22
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Serrano D, Gandini S, Mariani L, Bonanni B, Santinelli A, Guerrieri-Gonzaga A, Pelosi G, Cassano E, Montironi R, Decensi A. Computer-assisted image analysis of breast fine needle aspiration in a randomized chemoprevention trial of fenretinide vs. placebo in HRT users. Breast 2007; 17:91-7. [PMID: 17768053 DOI: 10.1016/j.breast.2007.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 07/24/2007] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Digital nuclear morphometric analysis can capture subtle differences along neoplastic progression. Studies showed different profiles from normal to cancer lesions. Our goal is to utilize this method as biomarker in chemoprevention trials. METHODS Postmenopausal women were randomized to oral (CEE) or transdermal (E2) estrogen replacement therapy (ERT) in association with fenretinide or placebo. Ultrasound-guided fine needle aspiration (FNA) was performed at baseline and after 12 months in a subset of subjects. RESULTS Ten samples were analyzed by karyometry. E2 compared with CEE increased nuclear area (p=0.01). A similar pattern was observed for other DNA content and chromatin texture features. Fenretinide vs. placebo, increased nuclear area and shape while decreased slope, peak and entropy. CONCLUSION Preliminary results indicate that nuclear morphometry is feasible on FNA samples. ERT and fenretinide induced significant karyometric changes. These results support further investigation of this procedure as surrogate biomarker in chemoprevention trial.
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Affiliation(s)
- Davide Serrano
- Division of Chemoprevention, European Institute of Oncology, Milan, Italy.
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23
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Mesurolle B, Helou T, El-Khoury M, Edwardes M, Sutton EJ, Kao E. Tissue harmonic imaging, frequency compound imaging, and conventional imaging: use and benefit in breast sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1041-51. [PMID: 17646366 DOI: 10.7863/jum.2007.26.8.1041] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate different sonographic settings (tissue harmonic, frequency compounding, and conventional imaging) and to determine which setting optimizes breast lesion detection and lesion characterization. METHODS Four hundred thirteen consecutive breast lesions (249 benign and 164 malignant) were evaluated by sonography using 4 different modes (conventional imaging at 14 MHz, tissue harmonic imaging at 14 MHz [THI], and frequency compound imaging at 10 MHz [CI10] and 14 MHz [CI14]). The images were reviewed by consensus by 2 breast radiologists. For each image, the lesion was graded for conspicuity, mass margin assessment, echo texture assessment, overall image quality, and posterior acoustic features. RESULTS For lesion conspicuity, THI and CI14 were better than conventional imaging (P < .01) and CI10 (P < .01) particularly against a fatty background (P < .01 for THI versus conventional for a fatty background versus P = .13 for a dense background). Frequency compound imaging at 10 MHz performed the best in echo texture assessment (P < .01), as well as overall image quality (P < .01). For margin assessment, CI10 performed better for deep and large (> or =1.5-cm) lesions, whereas CI14 performed better for small (<1.5-cm) and superficial lesions. Finally, THI and CI14 increased posterior shadowing (P < .01) and posterior enhancement (P < .01). CONCLUSIONS The standard breast examination incorporates 2 distinct processes, lesion detection and lesion characterization. With respect to detection, THI is useful, especially in fatty breasts. With respect to characterization, compound imaging improves lesion echo texture assessment. No single setting in isolation can provide the necessary optimized information for both of these tasks. As such, a combination approach is best.
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Affiliation(s)
- Benoît Mesurolle
- Department of Radiology, McGill University Health Center, Montreal General Hospital, Montreal, QC, Canada.
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24
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Abstract
Mammography is considered the "gold standard" in the evaluation of the breast from an imaging perspective. Multiple studies have demonstrated the benefit of mammography in detecting smaller cancers, leading to identification of early-stage breast cancers, which largely accounts for decreased mortality from breast cancer and the increased rate of breast conservation. Identification of a suspicious lesion on a mammogram prompts further evaluation including additional mammographic views, ultrasound examination, and biopsy. Recently, MRI and positron emission tomography are being offered as adjuncts to the preoperative workup to better stage the patient; however, there is still controversy over the most appropriate use of these modalities.
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Affiliation(s)
- Nora M Hansen
- Lynn Sage Comprehensive Breast Center, Northwestern Memorial Hospital, 675 North St. Clair Street, Galter 13-104, Chicago, IL 60611, USA.
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25
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Mesurolle B, Bining HJS, El Khoury M, Barhdadi A, Kao E. Contribution of tissue harmonic imaging and frequency compound imaging in interventional breast sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:845-55. [PMID: 16798895 DOI: 10.7863/jum.2006.25.7.845] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The purpose of this study was to retrospectively compare conventional imaging, frequency compound imaging (CI), and tissue harmonic imaging (THI) in interventional breast sonography. METHODS Institutional Review Board approval and patient informed consent were not required. The authors reviewed 104 sonographically guided breast procedures in 83 patients. For each biopsy, 4 images obtained with conventional imaging, frequency CI at 10 and 14 MHz (CI10 and CI14), and THI were graded independently by 2 radiologists for lesion conspicuity, needle conspicuity, lesion and needle conspicuity, and overall image quality. Frequency CI at 10 MHz, CI14, and THI were compared with conventional imaging. Different clinical scenarios (fatty versus glandular background, fine needle versus core needle, and oblique versus horizontal needle direction) were evaluated. RESULTS Statistical analysis showed that for overall image quality, CI10 was the best setting (odds ratios [OR], 3.67 and 7.48). For lesion conspicuity, CI14 (OR, 3.55) and THI (OR, 1.77) improved lesion visibility in a fatty background, whereas THI (OR, 0.26) was very limited in a glandular background. For needle conspicuity, no setting was better than conventional, whereas THI was the least valuable setting (OR, 0.011 and 0.049). For lesion and needle conspicuity, CI10 showed significantly better results than conventional for a dense background (P = .0268 and .4028; OR, 2.435 and 1.383) with 1 reviewer, whereas THI was the least valuable setting (OR, 0.014 and 0.042). CONCLUSIONS Conventional imaging provided the best assessment of lesion and needle conspicuity. Frequency compounding is a useful setting for dense breast and for fine-needle aspiration. Tissue harmonic imaging has a role in the visualization of a lesion against a fatty background but is of limited value in needle visualization.
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Affiliation(s)
- Benoît Mesurolle
- Department of Radiology, Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, Quebec, Canada.
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26
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Abstract
Frequent advances in transducer design, electronics, computers, and signal processing have improved the quality of ultrasound images to the extent that sonography is now a major mode of imaging for the clinical diagnosis of breast cancer. Breast ultrasound is routinely used for differentiating cysts and solid nodules with high specificity. In combination with mammography, ultrasound is used to characterize solid masses as benign or malignant. There is growing interest in using Doppler ultrasound and contrast agents for measuring tumor blood flow and for imaging tumor vascularity. Ease of use and real-time imaging capability make breast ultrasound a method of choice for guiding breast biopsies and other interventional procedures. Breast ultrasound is used in many forms. B-mode is the most common form of imaging for the breast, although compound imaging and harmonic imaging are being increasingly applied to better visualize breast lesions and to reduce image artifacts. These developments, together with the formulation of a standardized lexicon of solid mass features, have improved the diagnostic performance of breast ultrasound. Several approaches that are currently being investigated to further improve performance include: (1) computer-aided-diagnosis; (2) the assessment of tumor vascularity and tumor blood flow with Doppler ultrasound and contrast agents; and (3) tissue elasticity imaging. In the future, ultrasound will play a greater role in differentiating benign from malignant masses and in the diagnosis of breast cancer.
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Affiliation(s)
- Chandra M Sehgal
- Silverstein, Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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27
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Zhu Q, Cronin EB, Currier AA, Vine HS, Huang M, Chen N, Xu C. Benign versus malignant breast masses: optical differentiation with US-guided optical imaging reconstruction. Radiology 2005; 237:57-66. [PMID: 16183924 PMCID: PMC1533766 DOI: 10.1148/radiol.2371041236] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate prospectively the feasibility of using optical tomography with ultrasonographic (US) localization to differentiate malignant from benign breast masses and to compare optical tomography with color Doppler US. MATERIALS AND METHODS The study was approved by the local internal review board committee and by the Human Subjects Research Review Board of Army Medical Research and Materiel Command. Signed informed consent was obtained, and the study was HIPAA compliant. Between May 2003 and March 2004, 65 consecutive women (mean age, 51 years; age range, 24-80 years) with 81 breast lesions underwent US-guided biopsy and were scanned with a combined imager. The hand-held probe, which consisted of a centrally located US transducer surrounded by near-infrared sensors, was used to simultaneously acquire coregistered US images and optical data. The lesion location obtained at US was used to guide optical imaging reconstruction. Light absorption was measured at two wavelengths. From these measurements, tumor angiogenesis was assessed on the basis of calculated total hemoglobin concentration. A Student t distribution was used to calculate the statistical significance of mean maximum and mean average hemoglobin concentrations obtained in malignant and benign lesion groups, and P < .001 was considered to indicate a statistically significant difference. RESULTS Biopsy results revealed eight early stage invasive carcinomas (malignant group) and 73 benign lesions (benign group). The mean maximum and mean average hemoglobin concentrations in the malignant group were 122 micromol/L +/- 26.8 (+/- standard deviation) and 88 micromol/L +/- 24.5, respectively. The mean maximum and mean average hemoglobin concentrations in the benign group were 55 micromol/L +/- 24.8 and 38 micromol/L +/- 17.4, respectively. Both the maximum and average total hemoglobin concentrations were significantly higher in the malignant group compared with the benign group (P < .001). When a maximum hemoglobin concentration of 95 micromol/L was used as the threshold value, the sensitivity, specificity, positive predictive value, and negative predictive value of optical tomography were 100%, 96%, 73%, and 100%, respectively, and the sensitivity, specificity, positive predictive value, and negative predictive value of color Doppler US were 63%, 69%, 19%, and 94%, respectively. CONCLUSION Findings indicate that optical tomography with US localization is feasible for differentiating benign and early stage malignant breast lesions.
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Affiliation(s)
- Quing Zhu
- Bioengineering Program, Electrical and Computer Engineering Department, University of Connecticut, 371 Fairfield Rd, U2157, Storrs, CT 06269-1157, USA.
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Biglia A, Blanco JL, Martínez E, Domingo P, Casamitjana R, Sambeat M, Milinkovic A, Garcia M, Laguno M, Leon A, Larrousse M, Lonca M, Mallolas J, Gatell JM. Gynecomastia among HIV-Infected Patients Is Associated with Hypogonadism: A Case-Control Study. Clin Infect Dis 2004; 39:1514-9. [PMID: 15546089 DOI: 10.1086/425363] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Accepted: 07/23/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The prevalence, risk factors, and potential hormonal abnormalities associated with gynecomastia in a cohort of HIV-infected men are poorly understood. METHODS Breast enlargement was assessed in consecutively evaluated HIV-infected men, and gynecomastia was subsequently confirmed with sonography. For each patient with breast enlargement, a randomly selected control subject without breast enlargement was studied. Clinical data were obtained, including age, body mass index, clinically evident lipodystrophy, prior symptomatic hyperlactatemia, current antiretroviral therapy and duration of exposure to each antiretroviral drug, history of injection drug use, and serological status regarding hepatitis B and hepatitis C. Laboratory parameters, including plasma HIV-1 RNA load, CD4 cell count, free testosterone index, and levels of fasting triglycerides, cholesterol, prolactin, total testosterone, sex hormone-binding globulin, 17-beta-estradiol, follicle-stimulating hormone, luteinizing hormone, and thyroid-stimulating hormone, were measured. RESULTS There were 44 of 2275 patients with breast enlargement, of whom 40 (1.8%) had gynecomastia. The mean free testosterone index (+/-SD) was significantly lower among the 40 patients with gynecomastia (42.6%+/-24.0%) than among the 44 control subjects (58.0%+/-25.3%) (P=.006). Although the proportion of patients who were receiving treatment with zidovudine, stavudine, and/or efavirenz at the time of the present study was significantly different between case patients and control subjects, the duration of exposure to each individual antiretroviral drug was not. Lipoatrophy (adjusted odds ratio [OR], 5.6; 95% confidence interval [CI], 1.7-18.6; P=.005), hepatitis C (adjusted OR, 6.1; 95% CI, 1.8-20.6; P=.003), and hypogonadism (adjusted OR, 7.6; 95% CI, 1.8-32.2; P=.003) were independent factors associated with gynecomastia. CONCLUSIONS The data suggest that gynecomastia among HIV-infected patients is related to hypogonadism, rather than to an adverse effect of antiretroviral drugs.
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Affiliation(s)
- Alejandra Biglia
- Infectious Diseases Unit, Hospital Clinic-Institut d'Investigaciones Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Kwak JY, Kim EK, You JK, Oh KK. Variable breast conditions: comparison of conventional and real-time compound ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:85-96. [PMID: 14756357 DOI: 10.7863/jum.2004.23.1.85] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To illustrate and compare the appearances of variable breast conditions by conventional and real-time spatial compound images. METHODS Cases illustrative of a broad range of breast conditions were collected. Each image pair consisted of conventional and real-time compound images with a stationary probe to maintain an identical projection. RESULTS The various breast conditions, including normal anatomic structures and abnormal lesions, were evaluated and compared by conventional and real-time compound images. The real-time compound images revealed more realistic and clear images with reduced artifacts. CONCLUSIONS Real-time compound images are superior to conventional images of normal and abnormal breast conditions. Real-time compound imaging is a good technique for evaluating the breast state.
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Affiliation(s)
- Jin Young Kwak
- Department of Diagnostic Radiology, Pochon Cha University, College of Medicine, Kyonggi, South Korea
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30
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Moy L, Slanetz PJ, Moore R, Satija S, Yeh ED, McCarthy KA, Hall D, Staffa M, Rafferty EA, Halpern E, Kopans DB. Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review. Radiology 2002; 225:176-81. [PMID: 12355002 DOI: 10.1148/radiol.2251010999] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the number of patients who received a diagnosis of breast cancer after having an area of clinical concern at presentation and combined negative mammographic and ultrasonographic (US) findings. MATERIALS AND METHODS During a 4-year period, 829 patients with a palpable abnormality at presentation and combined negative mammographic and US findings were identified. The number of women who went on to receive a diagnosis of breast cancer was determined retrospectively. The authors searched the breast imaging database and the pathology database, sent a contact letter to the referring physicians, and linked their data to the State Cancer Registry. They also analyzed the breast parenchymal density among all patients who had more than 2 years of follow-up. RESULTS Of the 829 women, 374 had follow-up information. Two-hundred thirty-three patients had negative imaging findings with more than 2 years of follow-up. The other 141 women were presumed to be cancer free, as they were not identified by the State Cancer Registry. Six (2.6%) of the 233 women had a diagnosis of breast cancer in the area of the palpable abnormality. The six cancers were diagnosed among the 156 women who had radiographically dense breast tissue (Breast Imaging Reporting and Data System category 3 or 4). Among the 77 women with predominantly fatty tissues, no cancers were diagnosed. CONCLUSION A negative mammographic and US finding of a palpable abnormality does not exclude breast cancer, but the likelihood of breast cancer is low, approximately 2.6%-2.7%. It may be higher if the breast tissues are dense and lower if they are predominantly fatty.
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Affiliation(s)
- Linda Moy
- Breast Imaging Center, New York University School of Medicine, 530 First Ave, FPT Suite 8N, New York, NY 10016-6497, USA.
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Schininà V, Busi Rizzi E, Zaccarelli M, Carvelli C, Bibbolino C. Gynecomastia in male HIV patients MRI and US findings. Clin Imaging 2002; 26:309-13. [PMID: 12213363 DOI: 10.1016/s0899-7071(02)00439-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the role of MRI and sonography in differential diagnosis between gynecomastia and lipomastia in adult male HIV patients treated with high-activity antiretroviral therapy (HAART) for guide management. MATERIALS AND METHODS Nineteen adult male HIV patients with enlargement of the breast, which developed during treatment with HAART, were examined with ultrasound (US) and magnetic resonance imaging (MRI). RESULTS MRI was performed with SPIR T2WI, depicted in 95% of the patients, true gynecomastia and in the remaining 5% lipomastia; US demonstrated in all patients, in the subareolar region, a hypoechoic area, but was enable to make a differential diagnosis between glandular tissue and fat accumulation. CONCLUSION US and MRI scan should be advised in HIV-infected patient in antiretroviral therapy with enlargement of the breast, in order to assess the best choice in managing this clinical condition. MRI with fat saturation sequences clarifies the tissue distribution in the mammary gland and helps to assess the amount of fat accumulated in the breast.
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Affiliation(s)
- Vincenzo Schininà
- Department of Radiology, National Institute for Infectious Diseases Lazzaro Spallanzani Via Portuense 292, Rome 00149, Italy
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Arger PH, Sehgal CM, Conant EF, Zuckerman J, Rowling SE, Patton JA. Interreader variability and predictive value of US descriptions of solid breast masses: pilot study. Acad Radiol 2001; 8:335-42. [PMID: 11293782 DOI: 10.1016/s1076-6332(03)80503-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES This study evaluated the specificity of ultrasound (US) characteristics of solid breast lesions and the interreader variability in their interpretation. MATERIALS AND METHODS In 61 patients, 70 sonographically visible solid masses, scheduled for biopsy because of findings from conventional imaging, were prospectively and sequentially accrued for evaluation. Three readers interpreted the sonograms and described the solid masses in terms of established US characteristics. The specificity and positive predictive value (PPV) for each characteristic were calculated by comparing US findings with biopsy findings, and interreader variability was evaluated. Five assessment categories were developed to guide recommendations for patient care. The relative performance of each reader was assessed by measuring the PPV for each assessment category and by measuring the area under the receiver operating characteristic curve. RESULTS The specificity and PPV were calculated for all characteristics and for each reader. The average specificities of the three readers for the most frequently used six characteristics were as follows: spiculation, 97%+/-5 (standard deviation); taller than wide, 91%+/-4; central shadowing, 77%+/-1; markedly hypoechoic, 86%+/-5; duct extension, 95%+/-5; and microlobulation, 84%+/-3 (overall average specificity, 88.5%). The average PPVs for categories II-V were 5%, 10%, 63%, and 94%, respectively. The readers' interpretations were similar and correlated well. CONCLUSION The proposed US recommendation system is an accurate predictor of histologic findings. A sonographic classification lexicon should prove valuable.
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Affiliation(s)
- P H Arger
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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Cawson JN, Law EM, Kavanagh AM. Invasive lobular carcinoma: sonographic features of cancers detected in a BreastScreen Program. AUSTRALASIAN RADIOLOGY 2001; 45:25-30. [PMID: 11259968 DOI: 10.1046/j.1440-1673.2001.00867.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sixty-two screen-detected invasive lobular carcinomas (ILC) were studied for sonographic, mammographic, clinical and histological findings. Ultrasound (US) features were compared with 60 invasive duct cancers (IDC). Size and axillary lymph node status in ILC were compared with all other cancers detected. In 41 ILC examined with US, 36 were found as masses (87.8% sensitivity; 95% CI 77.8-97.8%). Some US features of ILC and IDC differed: ILC were 9.94 times more likely to be hyperechoic (odds ratio, OR, 9.94; 95% CI 3.28-31.74) and 77% less likely to be taller than wide (OR 0.23; 95% CI 0.18-0.62). Thirty-three ILC showed typical malignant features of spiculate margins and acoustic shadowing. invasive lobular carcinomas had a greater mean diameter (20.4 mm; n = 60) than other invasive cancers (14.4 mm; n = 322) (P < 0.001). Ultrasound-guided needle biopsy was the method of diagnosis in 26 of 41 impalpable ILC (63%). Ultrasound has high sensitivity in characterizing screen-detected ILC, which may have atypical sonographic features including hyperechogenicity and a wider than tall shape. Ultrasound was an important contributor to diagnosis.
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Affiliation(s)
- J N Cawson
- St Vincent's BreastScreen, St Vincent's Hospital, University of Melbourne, Fitzroy and Australian Research Centre in Sex, Health & Society, Melbourne, Victoria, Australia.
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Rubin E, Mennemeyer ST, Desmond RA, Urist MM, Waterbor J, Heslin MJ, Bernreuter WK, Dempsey PJ, Pile NS, Rodgers WH. Reducing the cost of diagnosis of breast carcinoma: impact of ultrasound and imaging-guided biopsies on a clinical breast practice. Cancer 2001; 91:324-32. [PMID: 11180078 DOI: 10.1002/1097-0142(20010115)91:2<324::aid-cncr1005>3.0.co;2-o] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The objective of this study was to determine whether the use of ultrasound and percutaneous breast biopsies in patients with screen-detected nonpalpable abnormalities can reduce benign open surgical biopsies of the breast without increasing cost or sacrificing detection of potentially curable breast carcinomas. METHOD Using a computerized mammography database and consecutive logs of needle localization procedures and fine- and large core needle biopsies of a single university-based breast imaging practice, the authors determined the breast carcinoma yield and cost of diagnosis over a 14-year period and the changes that occurred over time with the sequential introduction of ultrasound, ultrasound-guided biopsies, and stereotactic biopsies. RESULTS The overall breast carcinoma yield for needle localization biopsies of nonpalpable lesions increased from 21% in 1984 to 68% in 1998 (P < 0.0001). The yield for nonpalpable masses increased from 21% to 87% (P < 0.0001) over the same period. The selective use of ultrasound alone and percutaneous fine- and large core needle biopsy resulted in a substantial reduction in benign open surgical biopsies. A cost analysis showed a 50% reduction in the average expense of discovering breast carcinoma. The breast carcinomas detected after introduction of these methods were prognostically favorable with 88% measuring 1.5 cm or less in size and 66% measuring less than 1 cm. CONCLUSIONS Selective use of ultrasound and imaging-guided percutaneous biopsies can significantly reduce the number of benign open surgical biopsies generated by mammographic screening. This can result in substantial cost savings without decreasing the sensitivity for detecting small potentially curable lesions.
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Affiliation(s)
- E Rubin
- Department of Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA.
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Breast Sonography. Breast Cancer 2001. [DOI: 10.1007/978-0-387-21842-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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García CJ, Espinoza A, Dinamarca V, Navarro O, Daneman A, García H, Cattani A. Breast US in children and adolescents. Radiographics 2000; 20:1605-12. [PMID: 11112814 DOI: 10.1148/radiographics.20.6.g00nv171605] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasonography (US) is of value in the evaluation and characterization of breast masses in children. Most masses represent either normal breast tissue, cysts, or fibroadenomas. Premature thelarche may be unilateral, and normal breast tissue is found at US. Cysts are commonly retroareolar; when they become infected, they appear sonographically as a complex mass. Fibroadenoma is the most frequent breast tumor in adolescent girls, and it is usually solitary, homogeneous, and hypoechoic. Malignant breast lesions are very rare in children; most are due to metastatic disease secondary to rhabdomyosarcoma, leukemia, lymphoma, and neuroblastoma, and their US appearance is nonspecific. Gynecomastia in boys can be mimicked by general obesity and pectoral hypertrophy; US is helpful in the diagnosis, especially when gynecomastia is asymmetric. Most breast lesions in children and adolescents are benign, and surgery should be avoided to prevent later deformity. US is the ideal imaging modality to evaluate breast lesions and may be used to guide a fine-needle aspiration biopsy. Color Doppler US evaluation is helpful; cysts are avascular, fibroadenomas may be avascular or hypovascular, and abscesses show peripheral increased flow. Bloody nipple discharge is more common in prepubertal patients, may occur in infants, and may be secondary to mammary ductal ectasia. Discharge commonly resolves spontaneously, and findings at US are frequently normal.
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Affiliation(s)
- C J García
- Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile.
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Leung JW, Sickles EA. Multiple bilateral masses detected on screening mammography: assessment of need for recall imaging. AJR Am J Roentgenol 2000; 175:23-9. [PMID: 10882241 DOI: 10.2214/ajr.175.1.1750023] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE When multiple bilateral partially circumscribed masses having a similar appearance are detected on screening mammography, some radiologists recommend recall examination to identify imaging features suggestive of malignancy that are not evident on standard screening views. This study assesses the need for such recall imaging. SUBJECTS AND METHODS Cases of multiple masses were identified by reviewing the mammographic reports of 84,615 consecutive screening examinations. Each case of multiple masses was prospectively interpreted as benign, with recommendations for follow-up mammography in 1 year and for aspiration of any palpable masses if clinically indicated. Subsequently diagnosed cancers were identified through data linkage with our regional tumor registry and through our institution's computer-based outcomes tracking system. RESULTS Among 84,615 consecutive screening examinations, we identified 1440 (1.7%) cases of multiple masses. Among the multiple-masses cohort, two interval cancers were found. Both were early-stage (T1bN0M0; T1cN0M0) and low-grade (histologic grade 1) cancers. The interval cancer rate among the multiple-masses cohort was 0.14%, which is somewhat lower than the age-matched United States incident cancer rate of 0.24%. CONCLUSION The frequency of cancer development and the stage at cancer diagnosis among nonrecalled cases of multiple masses are similar to those observed in the general screening mammography population. Therefore, recall imaging for women with multiple masses does not appear to be justified.
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Affiliation(s)
- J W Leung
- Department of Radiology, University of California San Francisco Medical Center 94143-1667, USA
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Zhu Q, Conant E, Chance B. Optical imaging as an adjunct to sonograph in differentiating benign from malignant breast lesions. JOURNAL OF BIOMEDICAL OPTICS 2000; 5:229-236. [PMID: 10938788 DOI: 10.1117/1.429991] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/1999] [Revised: 02/22/2000] [Accepted: 02/22/2000] [Indexed: 05/23/2023]
Abstract
The role of near infrared (NIR) diffusive light imaging as an adjunct to ultrasound in differentiating benign from malignant lesions was evaluated in 27 mammography patients with infiltrating ductal carcinomas, apocrine metaplasia, fibroadenomas, radial scar and ductal hyperplasia, cysts, and normal tissues. Conventional ultrasound/mammography images were graded based on BI-RADS assessment categories. The spatial NIR measurements were made at wavelengths of 750 and 830 nm. Functional images, such as relative changes of deoxyhemoglobin (deoxyHb) and total blood concentration, were estimated from the dual wavelength measurements. Maximum relative deoxyHb and blood concentration changes were measured, and spatial correlation of masses in relative deoxyHb and blood concentration images for each breast were calculated. For the five biopsy proven benign lesions, ultrasound/mammography diagnoses were suspicious for malignancy (four cases) and highly suspicious for malignancy (one case). Four lesions showed less than 1.0 V maximum deoxyHb and less than 1.5 V maximum blood concentration levels on average and spatial image correlation showed no correlated masses in both deoxyHb and blood concentration images. For the four biopsy proven malignant lesions, ultrasound/mammography diagnoses were highly suspicious for malignancy. Maximum deoxyHb and blood concentration changes were greater than 2.9 V on average except one lesion which showed smaller deoxyHb signal (maximum 0.85 V) but the deoxyHb mass and blood concentration mass were highly correlated.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Apocrine Glands/diagnostic imaging
- Apocrine Glands/pathology
- Biomarkers, Tumor/blood
- Biopsy
- Breast Diseases/blood
- Breast Diseases/diagnostic imaging
- Breast Diseases/pathology
- Breast Neoplasms/blood
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/blood
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Diagnosis, Differential
- Female
- Fibroadenoma/blood
- Fibroadenoma/diagnostic imaging
- Fibroadenoma/pathology
- Hemoglobins/metabolism
- Humans
- Hyperplasia
- Image Processing, Computer-Assisted
- Metaplasia
- Middle Aged
- Oxyhemoglobins/metabolism
- Spectroscopy, Near-Infrared
- Ultrasonography, Mammary
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Affiliation(s)
- Q Zhu
- University of Connecticut, Department of Electrical and Computer Engineering, Storrs 06269, USA.
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Zonderland HM, Coerkamp EG, Hermans J, van de Vijver MJ, van Voorthuisen AE. Diagnosis of breast cancer: contribution of US as an adjunct to mammography. Radiology 1999; 213:413-22. [PMID: 10551221 DOI: 10.1148/radiology.213.2.r99nv05413] [Citation(s) in RCA: 230] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the value of ultrasonography (US) as an adjunct to mammography for the diagnosis of breast cancer. MATERIALS AND METHODS In a 2-year prospective study, 4,811 mammograms were classified according to level of suspicion of malignancy. Targeted US was performed to analyze (a) circumscribed lesions, possibly cysts; (b) palpable lesions visible at mammography; (c) palpable lesions not visible at mammography; and (d) nonpalpable lesions visible at mammography. After US was performed in 1,103 cases (23%), cases were reclassified for level of suspicion. RESULTS In 338 cases, breast cancer was diagnosed. The sensitivity of mammography for all 4,811 cases was 83%; the specificity was 97%. After US, the combined sensitivity increased to 91%, with a specificity of 98%. The increase was significant (P < .001). The increase in sensitivity was highest among women younger than 50 years. The positive predictive value for mammography was high (72%), which reflects a high threshold for biopsy; this may have augmented the yield of US. CONCLUSION The use of US as an adjunct to mammography resulted in an increase in diagnostic accuracy. Its contribution to the diagnosis of breast cancer in this study was 7.4%.
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Affiliation(s)
- H M Zonderland
- Department of Radiology, Leiden University Medical Center, The Netherlands
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Abstract
The incidence of breast cancer in US women remains disturbingly high, and unfortunately primary care physicians still frequently encounter patients in whom the disease is suspected or, even worse, confirmed. Fortunately, however, the body of knowledge surrounding the disease has grown dramatically during the past decade, and major advances have been made in the understanding of breast cancer risk, prevention, diagnosis, and treatment. Controversies persist, particularly those concerning the screening of younger women, but consensus now exists regarding many clinical issues relevant to primary care practice. Although multidisciplinary subspecialty expertise must be made available to all women with known or suspected breast cancer, the primary care physician has an important role to play when dealing with patients with this condition. The following article focuses on what primary care practitioners need to know to expertly contribute to the diagnosis, counseling, and initial treatment of women with this disease.
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Affiliation(s)
- K Ford
- Beth Israel Deaconess Medical Center Boston, Massachusetts, USA
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41
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Blohmer JU, Schmalisch G, Kürten A, Chaoui R, Lichtenegger W. Relevance of sonographic criteria for differential diagnosis of mammary tumours. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s0929-8266(97)00035-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
BACKGROUND Decision making in favor of conservative breast surgery is dependent upon the accuracy of preoperative evaluation of tumor stage, of which imaging modalities occupy a pivotal role. Systematic studies correlating the relative accuracy of various evaluating strategies are few, but remain vital means of making the optimal selection of diagnosis and subsequent treatment option. In this study, we evaluated the relative efficacy of: (1) palpation (P), (2) ultrasonography (US), and (3) bilateral mammography (MG) of the breast and axilla. METHODS In a prospective study, 109 female patients undergoing a modified radical mastectomy were subjected to a preoperative diagnostic assessment protocol involving palpation, ultrasonography, and bilateral mammography of the breast and axilla. Subsequently the preoperative findings were correlated to the postoperative histopathological reports. Cancer-specific criteria evaluated were tumor size, location, histologic type, histoarchitecture, and calcification, as well as status of regional nodes. Patient-specific criteria included age, size, and density of the breast and presence of associated benign breast disease. Percentage sensitivity, specificity, and positive and negative predictive values were determined for MG, US, and P as well as MG + P and US + P. RESULTS In assessment of the primary tumor, P, MG, and US showed an overall sensitivity of 88%, 92%, and 90%, respectively; MG + P and US + P had a sensitivity of 99% each. In nodal assessment, P, MG, and US showed an overall sensitivity of 88%, 69%, and 77%, respectively; MG + P and US + P had a sensitivity of 90% and 94%, respectively. Mammography understaged the tumor, whereas US and P overstaged tumors as well as nodes. US was particularly better than MG in younger women, smaller breast size, denser breast consistency, with or without associated benign breast disease, and cystic or necrotic tumors with invasive ductal histology. In addition, US was comparable to MG in most of the other criteria as well. Disadvantages of US over MG were its complete inability to detect microcalcification and certain intraductal cancers. CONCLUSION We conclude that: (1) the combination of US and P provides equivalent preoperative efficacy as MG, (2) the combination is more cost-effective preoperative assessment for subsequent selection of therapeutic modality, and (3) in certain well-defined circumstances discussed by us, mammography is most useful and should be considered as the imaging modality of choice.
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Affiliation(s)
- R Y Chandawarkar
- Cancer Immunology Program, Fordham University, Bronx, New York, USA
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Carson PL, Moskalik AP, Govil A, Roubidoux MA, Fowlkes JB, Normolle D, Adler DD, Rubin JM, Helvie M. The 3D and 2D color flow display of breast masses. ULTRASOUND IN MEDICINE & BIOLOGY 1997; 23:837-849. [PMID: 9300987 DOI: 10.1016/s0301-5629(97)00073-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A prospective study was performed in 24 women with breast masses on mammography going on to surgical biopsy. 2D and 3D power mode and frequency shift color flow Doppler scanning and display were compared. Vessels were displayed as rotatable color volumes in 3D, superimposed on gray-scale slices. The latter were stepped sequentially through the imaged volume. Radiologists rated the masses in each display (3D, 2D and videotapes) on a scale of 1 to 5 (5 = most suspicious) for each of six conventional gray-scale and six new vascular criteria. Thirteen masses proved to be benign and 11 were malignant. 3D provided a stronger subjective appreciation of vascular morphology and allowed somewhat better ultrasound discrimination of malignant masses than did the 2D images or videotapes (specificities of 85%, 79% and 71%, respectively, at a sensitivity of 90%). Only in 3D did the vascularity measures display a trend towards significance in this small study.
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Affiliation(s)
- P L Carson
- Department of Radiology, University of Michigan Medical Center, Ann Arbor 48109, USA.
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