Invasive Ductal Carcinoma vs. Invasive Lobular Carcinoma: Mammographic Findings

PURPOSE: The purpose of this study is to evaluate mammographic findings of invasive ductal carcinoma(IDC) and invasive lobular carcinoma(ILC)and to find differential points between the two. MATERIALS AND METHODS: 239 patients, who underwent mammography prior to surgery and were proved to have IDC(224 patients) or ILC(15 patients)pathologically, were analized retrospectively. On mammogram, presence of mass and micro calcification were analized. When there was a mass on mammogram, lesion opacity was classified into high, equal, or low opacity andborder of the mass was classified into spiculated, poorly marginated, and well-marginated. When there was nodefinite mass, mammographic findings were classified into asymmetric opacity and no mass. RESULTS: Masses were observed in 168 patients(75%) of IDC and 12 patients(80%) of ILC. Border of the masses were spiculated(n=50,22.3%), poorly marginated(n=112, 50%), or well-marginated(n=6, 2.7%) in patients with IDC. Spiculated and poorly marginated borders were observed in 8 patients(53.3%) and 4 patients(26.7%) respectively, in patients with ILC. Microcalcifications were seen in 88 patients(39.3%) of IDC and 2 patients(13.3%) of ILC. Equal or low opacities ofthe lesions were observed in 29 patients(17.3%) of IDC and 5 patients(33.3%) of ILC. CONCLUSION: Although equalor low opacities were observed more frequently in ILC and microcalcifications were noted more frequently in IDC,it was difficult to differentiate the two diseases based on mammographic findings.

Clustered Microcalcifications without Mass on Mammography: Benignancy vs. Malignancy

PURPOSE: The purpose of this study is to evaluate the accuracy of differentiation between benign and malignant clustered microcalcifications without mass on mammogram. MATERIAL AND METHODS: Fourty six mammogramsof 44 patients showing clustered microcalcifications without mass were interpreted blindly by five independent observers majoring in breast imaging from different institutions. Twenty two were malignant (10 infiltratingductal carcinomas, 12 intraductal carcinomas) and 24 were benign (all fibrocystic disease). The observers judgebenignancy or malignancy of microcalcifications. The authors assess the accuracy of differential diagnosis of clustered microcalcifications. RESULT: Of 24 cases proved benign microcalcifications, five radiologists correctly interpreted 20 on average as benign and of malignant 22 cases, 16 on average were correctly interpreted asmalignant. The diagnostic accuracy of malignant microcalcifications was 71.8% on average(63.6%-81.8%) and the diagnostic accuracy for benign microcalcifications was 83% on average(71% - 92%). It was 9 among total 46 cases that were misinterpreted by more than three radiologists. Among these 9 cases, malignant microcalcifications thathad been misinterpreted as benign were seven, benign microcalcifications misinterpreted as malignant were two. CONCLUSION: The diagnostic accuracy of clustered malignant microcalcifications(71.8%) without mass on mammogramwas lower than that of benign microcalcifications(83.3%). So, in case of suspected malignant microcalcification onmammogram, it is preferable that along with magnification view, histopathologic confirmation by core biopsy mustbe obtained.

The Usefulness of CT-guided Fine-needle Aspiration of Lymph Nodes in Uterine Cervical Carcinoma

PURPOSE: The purpose of this study was to evaluate the usefulness of CT-guided percutaneous needle aspiration(PCNA) of paraaortic and pelvic lymph nodes in patients with uterine cervical carcinoma. MATERIALS AND METHODS: CT-guided PCNA was performed in 18 patients with treated cervical carcinoma. initial clinical stages were CIS in one, lb in three, lib in ten, and IIIb in four cases. We used 20 gauge Westcott needles for aspiration. Mean depth from skin to lymph nodes was 10.0cm in paraaortic group (n=13) and was 7.9cm in pelvic group (n=5). The size of lymph nodes ranged 1.0-3.0cm (mean :1.8) and 1.5-5.0cm (mean :2.6cm), respectively. RESULTS: All cases with paraaortic lymph node enlargement were proved to be metastatic lymphadenopathy. In five cases with pelvic lymph node enlargement, three were proved to be malignancy and two were negative. Among 16 cases with metastatic lymphadenopathy, eight patients were treated with chemotherapy, five with radiation therapy, and three with chemotherapy and radiotherapy. In two cases with negative results lymph nodes were disappeared or unchanged on follow up CT scans. No complications were encountered during CT-guided PCNA procedure. CONCLUSION: CT-guided PCNA of paraaortic and pelvic lymph nodes is a useful method in determining metastasis from cervical carcinoma and in planning further treatment.

Self-expandable Metallic Stents for Palliative Treatment of Malignant Esophagogastric Strictures: Experiences in 103 Patients

PURPOSE: To evaluate the effects and complications of self-expandable metallic stent for the treatment of malignant esophagogastric strictures. MATERIALS AND METHODS: From September 1991 to March 1995, 110 stents were placed under fluoroscopic guidance in 103 patients. Of the 103 patients, there were 73 patients with esophageal cancer, 14 patients with gastric cancer, 12 patients with recurrence after surgery, three patients with esophageal compression by metastatic mediastinal lymphadenopathy, and one patient with esophageal invasion by lung cancer. Seventeen patients had esophagorespiratory fistulas. Under fluoroscopic guidance, 113 self-expandable metallic stents (99 Song stents, 14 Strecker stents) were placed in 103 patients. RESULTS: After stent placement, 68 (66%) of the patients could ingest solid food, 26 (25.2%) could ingest soft food, whereas three (2.9%) were not able to have food. Esophagorespiratory fistulas were occluded immediately after stent insertion. All stents were placed without any technical failures or procedural morbidity or mortality. Complications included restenosis in 13, gastroesophageal reflux in 11, stent tube migration in eight, massive bleeding in four, delayed esophageal perforation in one, stent obstruction by food impaction in one patient. CONCLUSION: Self-expandable metallic stent seems to be relatively safe and effective procedure in the palliative treatment of malignant esophagogastric stricture.