A Comparative Study between the Preoperative Diagnostic Tumor Size and the Postoperative Pathologic Tumor Size in Patients with Breast Tumors / 한국유방암학회지

PURPOSE: This comparative study analyzed the relationship between the preoperative diagnostic tumor size and the postoperative pathologic tumor size for breast cancer patients and benign breast tumor patients. METHODS: We analyzed the clinicopathological information of 191 breast cancer patients and 187 benign breast tumor patients by conducting a retrospective chart review. The preoperative diagnostic tumor sizes were measured using physical examination, mammography and sonography in the benign breast tumor patients and they were additionally measured by computerized tomography and magnetic resonance imaging in the breast cancer patients. Body mass index (BMI) was defined as the ratio of the body weight in kilograms to the square of height in meters. RESULTS: The tumor sizes measured by mammography (r=0.66) and physical examination (r=0.87) were highly correlated to the pathologic tumor size in the breast cancer patients and benign the breast tumor patients, respectively. Physical examination and magnetic resonance imaging had a tendency to overestimate the tumor size and sonography underestimated the pathologic tumor size in the breast cancer patients. The correlation coefficient for the physical examination was increased when the patient age was less than 50 years and the BMI was less than 25. Multiple regression analysis revealed that assessing the tumor size according to physical examination, mammography and sonography were effective for determining estimation of pathologic tumor size in the benign breast tumor patients, but assessing the tumor size by physical examination and sonography was not effective for determining the tumor size in breast cancer patients. CONCLUSION: Mammography and physical examination can be useful to estimate the pathologic tumor size in breast cancer patients and benign breast tumor patients, respectively. Physical examination can be useful to estimate the size when a breast tumor is palpable, the age of a patient is less than 50, and the BMI is less than 25.

Ultrasonographic Findings of the Ulnar Nerves in Cubital Tunnel Syndrome

PURPOSE: To determine useful diagnostic criteria of cubital tunnel syndrome (CTS), using ultrasonographic ulnar nerve cross-sectional areas (UNCSA) measurements. MATERIALS AND METHODS: The CTS group included 28 patients confirmed with nerve conduction study and the control group included 17 healthy adults. Ulnar nerve cross-sectional areas (UNCSA) were measured at the distal 1/3 upper arm level and in the cubital tunnel (CTN). US findings of CTS were ulnar nerve dislocation (n = 2), ulnar nerve subluxation (n = 5), ganglion (n = 1), sever elbow joint osteoarthritis (n = 1) and elbow joint valgus deformity after fracture (n = 1). UNCSA, the ratio of UNCSA in CTN to distal 1/3 upper arm level (CH ratio), and the difference of UNCSA between CTN and distal 1/3 upper arm level (CH difference) were evaluated to obtain the optimal diagnostic cutoff value of CTS, using ROC curve. RESULTS: The mean UNCSA in CTN was 0.168 cm2 in the CTS and 0.067 cm2 in the control. The CTS could be diagnosed when UNCSA, the CH ratio and the CH difference are larger than 0.096 cm2, 1.371 and 0.036 cm2 respectively. The ROC curve area was largest and the sensitivity, specificity was respectively 82.4%, 95.8%, when the CH difference was used as cutoff value. CONCLUSIONS: Ultrasound is useful for the detection of CTS pathogenic lesions in CTN. The highest diagnostic accuracy was acquired when the CH difference is larger than 0.036 cm2.

Does Ultrasound-Guided Directional Vacuum-Assisted Removal Help Eliminate Abnormal Nipple Discharge in Patients with Benign Intraductal Single Mass?

OBJECTIVE: To evaluate whether the removal of an intraductal mass using an ultrasound (US)-guided directional vacuum-assisted device can eliminate symptoms in patients presenting with abnormal nipple discharge. MATERIALS AND METHODS: Between March 2004 and October 2006, 36 patients who presented with abnormal nipple discharge, underwent US-guided, 11-gauge vacuum-assisted biopsy for a benign intraductal single mass on US. The ability of the procedure to eliminate nipple discharge was evaluated by physical examination during follow-up US. Lesion characteristics, biopsy variables, and histologic features were analyzed to identify factors affecting symptom resolution. RESULTS: Of the 36 lesions, 25 (69%) were intraductal papillomas, 10 (28%) were fibrocystic changes, and one (3%) was a fibroadenoma. The nipple discharge disappeared in 69% (25 of 36) of the women at a mean follow-up time of 25 months (range 12-42 month). There was no difference in the lesion characteristics, biopsy variables, and the histologic features between groups that eliminated the symptom compared those with persistent nipple discharge. CONCLUSION: US-guided directional vacuum-assisted removal of an intraductal mass appears to eliminate nipple discharge in only 69% of patients and thus, it should not be considered as an alternative to surgical excision.

The Usefulness of Stress Perfusion MR using Steady State Free Precession Sequence for Depiction of Significant Coronary Artery Stenosis

PURPOSE: To evaluate the technical performance of stress myocardial perfusion magnetic resonance (MR) imaging using saturation-recovery steady-state free precession (SR- SSFP) and to assess the diagnostic accuracy of this examination for depiction of significant coronary artery stenosis. MATERIALS AND METHODS: 167 patients underwent stress myocardial perfusion MR imaging at rest and adenosine-induced stress by using a 1.5-T cardiac MR imaging unit. The first-pass MR perfusion was performed using SR-SSFP sequence. Coronary angiography was performed in 113 patients. Image analysis was performed to compare the diagnostic accuracy of MR imaging with that of coronary angiography. RESULTS: During the MR examination, minor side effects of adenosine-induced stress occurred, most commonly chest discomfort (29%), followed by dyspnea (4%), and facial flushing (0.8%). The overall sensitivity of MR imaging for depicting at least one coronary artery with significant stenosis was 91%. The sensitivities of MR imaging for depiction of stenoses were as follows: 80% for single-vessel stenosis, 81% for double-vessel stenosis, and 100% for triple-vessel stenosis.. The specificity of MR imaging for identification of patients with significant coronary artery stenosis was 78%. CONCLUSION: Stress myocardial magnetic resonance (MR) perfusion imaging using SR-SSFP sequence is safe and useful for the detection of significant coronary artery disease.

The Usefulness of Stress Perfusion MR using Steady State Free Precession Sequence for Depiction of Significant Coronary Artery Stenosis

PURPOSE: To evaluate the technical performance of stress myocardial perfusion magnetic resonance (MR) imaging using saturation-recovery steady-state free precession (SR- SSFP) and to assess the diagnostic accuracy of this examination for depiction of significant coronary artery stenosis. MATERIALS AND METHODS: 167 patients underwent stress myocardial perfusion MR imaging at rest and adenosine-induced stress by using a 1.5-T cardiac MR imaging unit. The first-pass MR perfusion was performed using SR-SSFP sequence. Coronary angiography was performed in 113 patients. Image analysis was performed to compare the diagnostic accuracy of MR imaging with that of coronary angiography. RESULTS: During the MR examination, minor side effects of adenosine-induced stress occurred, most commonly chest discomfort (29%), followed by dyspnea (4%), and facial flushing (0.8%). The overall sensitivity of MR imaging for depicting at least one coronary artery with significant stenosis was 91%. The sensitivities of MR imaging for depiction of stenoses were as follows: 80% for single-vessel stenosis, 81% for double-vessel stenosis, and 100% for triple-vessel stenosis.. The specificity of MR imaging for identification of patients with significant coronary artery stenosis was 78%. CONCLUSION: Stress myocardial magnetic resonance (MR) perfusion imaging using SR-SSFP sequence is safe and useful for the detection of significant coronary artery disease.