Differentiation of Benign and Malignant Breast Masses: Comparison of Ultrasonography with Power Doppler Imaging and 99mTc-Scintimammography

PURPOSE: The objective of our study was to compare the value of differential diagnosis of ultrasonography with power Doppler imaging(PDI) and 99mTc-MIBI scintimammography in the evaluation of breast lesions. MATERIALS AND METHODS: Fifty-five breast lesions in 48 patients underwent both 99mTc-MIBI scintimammography and sonography with PDI. Lesions were classified as benign or malignant on the basis of the absence or presence of a focus of increased activity at scintimammography, and the shape, border, echogenicity and amount of flow at sonography. The accuracy of the two modalities according to tumor size was compared. RESULTS: Pathologic diagnosis showed that among the 55 lesions, 40 were malignant and 15 were benign. In the detection of breast cancer, sensitivities and specificities were 97.5%(39/40) and 66.7%(10/15) for ultrasonography with PDI and 72.5%(29/40) and 86.7%(13/15) for scintimammography. For 32 lesions smaller than 2 cm, sensitivities and specificities were 94.7%(18/19) and 61.5%(8/13) for ultrasonography with PDI and 57.9%(11/19) and 84.6%(11/13) for scintimammography. For 23 lesions 2 cm or larger, these parameters were 100%(21/21) and 100%(2/2) for ultrasonography with PDI and 85.7%(18/21) and 100%(2/2) for scintimammography. CONCLUSION: In the diagnosis of breast cancer, ultrasonography with PDI was less specific than 99mTc-MIBI scintimammography. Ultrasonography with PDI was, however, more sensitive than 99mTc-MIBI scintimammography, particularly for lesions smaller than 2 cm.

Results of Radioiodine Treatment for Distant Metastases of Differentiated Thyroid Carcinoma / 대한핵의학회잡지

PURPOSE: To evaluate the effectiveness of radioiodine treatment for metastatic thyroid carcinoma, we reviewed results of radioactive iodine treatment in patients with functional lung or bone metastases. MATERIALS ANF METHODS: Of 760 patients who were treated for differentiated thyroid cancer between 1984 and 1998, we detected pulmonary metastases and bone metastases in 76 patients (10.0%) and 20 patients (2.6%), respectively. Among them, we could evaluate the effectiveness of I-131 therapy in 53 patients with lung metastases and 15 patients with bone metastases. RESULTS:Of 53 patients who received I-131 therapy with a mean cumulative dose of 26.2 GBq (1.1-84.4 GBq) for pulmonary metastases, metastatic lung lesions completely resolved in 19 patients (35.8%) and improved in 22 patients (41.5%). In 13 of 19 patients with complete remission of pulmonary metastases, the total accumulated dose of I-131 was less than 18.5 GBq. We found 43 sites of metastatic bone lesions in 15 patients with bone metastases. Of 29 lesions which received I-131 therapy, metastatic lesions improved in 14 sites (48.3%), but did not change or progress in 15 sites (51.7%) despite the I-131 therapy. Three lesions were completely cured with a combination treatment of surgery(+/- external radiotherapy) and I-131 therapy, and the other 11 lesions improved. CONCLUSION: Radioactive iodine treatment gives favorable results for pulmonary metastases. However, for bone metastases, there might be a need to use combination therapy including I-131 and surgery or external irradiation.

Pred ictive Efficacy of Radioisotope Voiding Cystography for Renal Outcome / 대한핵의학회잡지

PURPOSE: As vesicoureteral reflux (VUR) could lead to renal functional deterioration when combined with urinary tract infection, we need to decide whether operative anti-reflux treatment should be performed at the time of diagnosis of VUR. Predictive value of radioisotope voiding cystography (RIVCG) for renal outcome was tested. MATERIALS AND METHODS: In 35 children (18 males, 17 females), radiologic voiding cystourethrography (VCU), RIVCG and DMSA scan were performed. Change in renal function was evaluated using the follow-up DMSA scan, ultrasonography, and clinical information. Discriminant analysis was performed using individual or integrated variables such as reflux amount and extent at each phase of voiding on RIVCG, in addition to age, gender and cortical defect on DMSA scan at the time of diagnosis. Discriminant function was composed and its performance was examined. RESULTS: Reflux extent at the filling phase and reflux amount and extent at postvoiding phase had a significant prognostic value. Total reflux amount was a composite variable to predict prognosis. Discriminant function composed of reflux extent at the filling phase and reflux amount and extent at postvoiding phase showed better positive predictive value and specificity than conventional reflux grading. CONCLUSION: RIVCG could predict renal outcome by disclosing characteristic reflux pattern during various voiding phases.