The Value of Ultrasonographic Detection for Metastatic Axillary Lymph Nodes in Breast Cancer

PURPOSE: We evaluated the significance and accuracy of sonographic detection of metastatic axillary lymph nodes (LNs) in breast cancer. MATERIALS AND METHODS: We retrospectively reviewed the sonographic findings and postoperative results of axillary LNs in 47 patients with breast cancer. The sonographic criteria for metastatic LNs were defined as the loss of the echogenic hilum and any uneven cortical thickness of over 3 mm. We analyzed the correlation between the preoperative sonographic findings and the postoperative results of the LNs. RESULTS: Out of 47 patients, 22 patients showed 43 sonographic metastatic LNs. Among these 22 patients, 18 patients had 183 histopathologically proven metastatic LNs. The pathological examination of the remaining 25 patients revealed metastatic LNs in 6 patients. The overall sensitivity, specificity and accuracy of ultrasonography for detecting metastatic axillary LNs in breast cancer were 75%, 82.6% and 78.7%, respectively. As the number of metastatic LNs detected on sonography increased, the number of histologically proven metastatic LNs increased. CONCLUSION: Ultrasonographic evaluation of axillary LNs in breast cancer can provide relatively accurate information about the presence or absence of metastasis. Therefore, it is useful to decide the initial staging and treatment planning of patients with breast cancer.

Ultrasonographic Findings of Metaplastic Squamous Breast Carcinoma and the Pathologic Correlation

PURPOSE: We investigated the ultrasonographic (US) appearance of metaplastic squamous breast carcinoma with the pathologic correlation. MATERIALS AND METHODS: During an 8-year period, the US appearances of 10 patients with metaplastic squamous breast carcinoma were retrospectively analyzed on the basis of the Breast Imaging and Reporting Data System (BI-RADS) - US lexicon. These 10 patients included 9 patients having invasive adenocarcinomas of the breast with more than 30% squamous metaplasia, and one patient had pure primary squamous cell carcinoma. We correlated the US findings with the pathologic findings. RESULTS: On US, the majority of the tumors showed oval shapes (70%), indistinct margins (50%), parallel orientation (80%), echogenic halos (60%), complex echogenicity with solid and cystic components (60%), and posterior enhancement (70%). The findings of calcifications (20%) and metastatic axillary lymph nodes (10%) were rare. On pathologic examination, half of the tumors showed infiltrative microscopic margins. All six cases showing complex echogenicity with solid and cystic components on US were pathologically related to the cystic or necrotic portion, and three of these cases had hemorrhage. CONCLUSION:On US, metaplastic squamous breast carcinoma mainly manifested as oval, complex, echoic masses with indistinct margins and posterior enhancement that was pathologically related to the cystic or necrotic portions.

MR Imaging with Fluid Attenuated Inve rsion Recovery Sequence of Childhood Adrenoleukodystrophy: Comparisonwith T2 Weighted Spin Echo Imaging

PURPOSE: The purpose of this study was to evaluate the usefulness of FLAIR(Fluid Attenuated InversionRecovery) MR imaging in childhood adrenoleukodystrophy by comparing with those of T2-weighted FSE imaging, and tocorrelate MRI finidings with clinical manifestations. MATERIALS AND METHODS: Axial FLAIR images(TR/TE/TI=10004/123/2200) and T2-weighted FSE images(TR/TE=4000/104) of brain in six male patients(age range :6-17 years, mean age : 10.2 years) with biochemically confirmed adrenoleukodystrophy were compared visually by tworadiologists for detection, conspicuity, and the extent of lesion. Quantitatively, we compared lesion/CSFcontrast, lesion/CSF contrast to noise ratio(CNR), lesion/white matter(WM) contrast, and lesion/WM CNR betweenFLAIR and T2 weighted image. We correlated MR findings with clinical manifestations of neurologic symptoms andevaluated whether MRI could detect white matter lesions in neurologically asymptomatic patients. RESULTS: Visualdetection of lesions was better with FLAIR images in 2 of the 6 cases and it was equal in the remainders. Visualconspicuity and detection of the extent of lesion were superior on FLAIR images than T2-weighted images in all 6cases. In the quantitative assessment of lesions, FLAIR was superior to T2-weighted image for lesion/CSF contrastand lesion/CSF CNR, but was inferior to T2 weighted image for lesion/WM contrast and lesion/WM CNR. In one case,FLAIR images distinguished the portion of encephalomalacic change from lesions. MR findings ofadrenoleukodystrophy were correlated with clinical manifestations in symptomatic 4 cases, and also detected whitematter lesions in asymptomatic 2 cases. CONCLUSION: MR imaging with FLAIR sequence provided images that wereequal or superior to T2-weighted images in the evaluation of childhood adrenoleukodystrophy. MRI findings werewell correlated with clinical manifestations and could detect white matter lesions in neurologically asymptomaticadrenoleukodystrophy patients.

The Usefulness of CT and MR Virtual Colonoscopy in the Evaluation of Experimental Polyp Models

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of CT and MR virtual colonoscopy using an experimental model of colonic polyposis. MATERIALS AND METHODS: Eleven pig colons ranging from 15 to 20cm in length were cleansed and a total of 99 variable sized polyps ranging from 3 to 15mm in diameter were created. The polyps were divided into three groups according to size: <5mm(n=23), 5-9mm(n=44), and ?10mm(n=32) in diameter. Each specimen was scanned using spiral CT and MRI. Each CT and MR virtual colonoscopy was independently evaluated by two radiologists blinded to the location, size and numbers of polyps, but aware that polyps were present. Interobserver agreement regarding the detection rate of the polyps during the two types of virtual colonoscopy was measured and the diagnostic accuracy of CT and MR virtual colonoscopy was compared. Results: In both CT and MR virtual colonoscopy, the detection rates determined by the two radiologists coincided in all three groups(p<0.05). The detection rates of polyps less than 5mm, between 5 and 9mm, and 10mm or larger in diameter were 74%(17/23), 89%(39/44), and 100%(32/32), respectively, in CT colonoscopy, and 61%(14/23), 89%(39/44), and 100%(32/32), respectively in MR colonoscopy. In polyps 5mm or larger, the results of the two types of virtual colonscopy coincided but in those less than 5mm in diameter, the results of MR virtual colonoscopy were slightly inferior to those of CT colonoscopy. Conclusion: Both CT and MR virtual colonoscopy provide high detection rates of colonic polyps 5mm or larger in diameter and these techniques can therefore be used to diagnose colonic mass lesions.

The Usefulness of CT and MR Virtual Colonoscopy in the Evaluation of Experimental Polyp Models

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of CT and MR virtual colonoscopy using an experimental model of colonic polyposis. MATERIALS AND METHODS: Eleven pig colons ranging from 15 to 20cm in length were cleansed and a total of 99 variable sized polyps ranging from 3 to 15mm in diameter were created. The polyps were divided into three groups according to size: <5mm(n=23), 5-9mm(n=44), and ?10mm(n=32) in diameter. Each specimen was scanned using spiral CT and MRI. Each CT and MR virtual colonoscopy was independently evaluated by two radiologists blinded to the location, size and numbers of polyps, but aware that polyps were present. Interobserver agreement regarding the detection rate of the polyps during the two types of virtual colonoscopy was measured and the diagnostic accuracy of CT and MR virtual colonoscopy was compared. Results: In both CT and MR virtual colonoscopy, the detection rates determined by the two radiologists coincided in all three groups(p<0.05). The detection rates of polyps less than 5mm, between 5 and 9mm, and 10mm or larger in diameter were 74%(17/23), 89%(39/44), and 100%(32/32), respectively, in CT colonoscopy, and 61%(14/23), 89%(39/44), and 100%(32/32), respectively in MR colonoscopy. In polyps 5mm or larger, the results of the two types of virtual colonscopy coincided but in those less than 5mm in diameter, the results of MR virtual colonoscopy were slightly inferior to those of CT colonoscopy. Conclusion: Both CT and MR virtual colonoscopy provide high detection rates of colonic polyps 5mm or larger in diameter and these techniques can therefore be used to diagnose colonic mass lesions.