Ultrasonic automatic classification algorithm in the diagnosis of breast masses / 中华超声影像学杂志

Objective:To explore the clinical effectiveness of an automatic computer-aided diagnosis(CAD) method in benign and malignant breast masses discrimination.Methods:The ultrasound images of 539 patients from the Second Hospital of Harbin Medical University and the Second Hospital of Hebei Medical University between 2012 to 2019 were analyzed retrospectively. According to the fifth Breast Imaging Reporting and Data System (BI-RADS), four breast radiologists first sent the case into a BI-RADS category with the original ultrasound image. Then with the CAD result, radiologists gave a category again. Pathology results and clinical data were not available to the radiologists during the diagnosis process. The histological and follow-up results were used as the gold standard. The accuracy of CAD automatic classification, radiologists′ diagnosis before and after CAD application were compared using the ROC curves. The accuracy, sensitivity and specificity of the diagnosis were also calculated.Results:The classification algorithm has a good performance in benign and malignant breast masses discrimination.When the cutoff value was 0.495, the accuracy, sensitivity and specificity were 0.878, 0.868 and 0.886 respectively. When the cutoff value was 0.203, the sensitivity and specificity was 0.981 and 0.337 respectively. With the CAD method, the radiologists improved their diagnostic performance. The total area under the ROC curve for the four radiologists increased from 0.775 to 0.871( P<0.001). The total sensitivity increased from 0.786 to 0.842, and the specificity increased from 0.681 to 0.813. Conclusions:The automatic classification algorithm in this study provides quantitative reference for doctors′ diagnosis. It has the potential to improve junior radiologists′ diagnostic performance in differentiating benign and malignant breast masses.

Value of ultrasonic S-Detect technique in diagnosis of breast masses / 南方医科大学学报

OBJECTIVE@#To evaluate the value of ultrasound S-Detect in the diagnosis of breast masses.@*METHODS@#A total of 85 breast masses in 62 female patients were diagnosed by S-Detect technique and conventional ultrasound. The diagnostic efficacy of conventional ultrasound and S-Detect technique was analyzed and compared with postoperative pathological results as the gold standard.@*RESULTS@#When operated by junior physicians, the diagnostic efficacy of conventional ultrasound was significantly lower than that of S-Detect technique (P < 0.05), but this difference was not observed in moderately experienced and senior physicians (P>0.05). S-Detect technique was positively correlated with the diagnostic results of senior physicians (r=0.97). Using S-Detect technique, the diagnostic efficacy did not differ significantly between the long axis section and its vertical section (P>0.05). Routine ultrasound showed a better diagnostic efficacy than S-Detect for breast masses with a diameter below 20 mm (P < 0.05), but for larger breast masses, its diagnostic efficacy was significantly lower than that of SDetect (P < 0.05).@*CONCLUSION@#S-Detect can be used in differential diagnosis of benign and malignant breast masses, and its diagnostic efficiency can be comparable with that of BI-RADS classification for moderately experienced and senior physicians, but its diagnostic efficacy can be low for breast masses less than 20 mm in diameter.

Ultrasound evaluation of biopsy proven malignant breast mass

Background: Breast cancer is the most common malignancy in female worldwide. Ultrasound (US) is a safe and easily available modality for evaluation of breasts in females of all age groups. It can detect characteristic features of breast malignancy with high degree of accuracy. This study was undertaken with the aims to evaluate the ultrasonographic features of malignant breast mass, to identify the most commonly encountered gray scale ultrasound findings and to study the role of Doppler ultrasound in those cases.Methods: The study was conducted in Dr B. Borooah Cancer Institute, Guwahati from January 2018 to January 2019. Gray scale ultrasound including Doppler study was done in all the female patients coming with palpable breast lump or with nipple discharge and images were archived. The archived images of a total number of 108 patients with biopsy report positive for malignancy were retrospectively studied and the ultrasound findings were evaluated.Results: Most common gray scale ultrasound features for malignant breast masses were hypoechoic mass, taller than wide, irregular shape, having spiculated margins, neither posterior acoustic enhancement nor shadowing, presence of intralesional microcalcifications and surrounding echogenic halo. Hypervascularity, noticeable difference in waveform pattern between central and peripheral vessels, high resistance flow pattern with absent or reversal of diastolic flow were the common Doppler findings.Conclusions: Combination of Doppler with gray scale ultrasound has emerged as a very important technique in diagnosing malignant breast mass with high accuracy.

Significance of age in the ultrasound interpretation of BI-RADS 3 and 4A breast lumps / 医学研究生学报

ObjectiveBoth BI-RADS 3 and 4A breast lumps have certain effects on the clinician's decision of proper treatment. The purpose of this study was to compare the ultrasonic BI-RADS classification and pathological results of breast lumps in patients of different ages, and explore the significance of age in ultrasound interpretation of BI-RADS 3 and 4A breast lumps.MethodsWe selected 728 patients with breast lumps treated in our hospital from Jun. 2014 to Dec. 2017 as research objects. According to different ages, the patients were divided into juvenile group (7-17 years old) , young group (18-40 years old), middle-aged group (41-65 years old) and aged group (> 65 years). Comparison was made between ultrasound results and pathological results and among the incidences of breast malignant masses of BI-RADS 3 and 4A grade of different ages to analyze possible factors that might affect the benign and malignant breast lumps of BI-RADS 3 and 4A.ResultsA total number of 728 patients was included in this study. Compared with pathological results, the rate of malignant breast tumors in BI-RADS 3 and 4A gradually increased with age. As to BI-RADS 3 breast lumps, the malignant rate of BI-RADS 3(6.54%) in aged group was higher than those of juvenile group(0.00%), young group (0%), middle-aged group (0.95%) and the differences were of statistical significance (P<0.05). As to BI-RADS 4A breast lumps, the malignant rate of juvenile group(0%) was lower than those of young group (2.06%), middle-aged group(6.54%) and aged group(25.39%), and the malignant rate in the elderly group was higher than those of the other groups(P<0.05). Logistic results showed age (OR=1.21,95%CI:1.07~1.36) and weight (OR=3.87,95%CI:1.24~12.81) were risk factors for breast cancer.ConclusionAge plays an important role in the ultrasound interpretation of BI-RADS 3 and 4A breast lumps. For young people, clinical assessment of BI-RADS 4A breast lumps by ultrasound can be properly degraded. While for elderly people, clinical assessment of BI-RADS 3 and 4Abreast lumps can be properly upgraded.

Fibroadenolipoma of breast – A rare case report

Fibroadenolipoma is a solid, rare benign tumor. It is a circumscribed lesion composed of fat and other breast tissues which may be normal or which may show various changes. The reported incidence of breast hamartomas is 0.7% of all benign breast tumors in females [1]. Clinical findings resemble fibroadenoma and if there is a palpable mass, the patients may receive an immediate diagnosis. Ductal hyperplasia, apocrine metaplasia, calcification and adenosis may occur within the hamartoma, with rarer instances of lobular or ductal intraepithelial neoplasms.

Evaluation of breast mass and applicability of histopathology and sonomamography for accurate diagnosis of malignant masses

Breast or mammary gland is a modified sweat gland. The mammary gland is a superficial organ. Breast carcinoma is the most common cancer in women all over India and accounts for 25% to 31% of all cancers in women in Indian cities. With the increased incidence of breast cancers every breast lump needs to be evaluated so as to assure the patient of its nature. The study was based on 50 patients who were referred to the Department of Radiodiagnosis and Imaging for evaluation of breast lesions. A detailed breast specific history was taken including menstrual history, history of mastalgia, lactational history, past and family history of any breast problem. Results showed that, highest incidence of breast lesions was found in the age group of 20-29 years containing (36%) of all cases. The second peak was seen in the age group of 40-49 years containing (18%) of all cases. Left sided lesions were slightly more common. While it was observed that of the 50 cases referred ultrasound correctly diagnosed 42% cases as malignant as compared to 18 % diagnosed as malignant by histopathology. The findings of the study potray that Ultrasound (US) should be used as the initial examination in patients and shall also be used as adjuvant to mammography in older patients.

Comparative Study Between Mammotome and Conventional Resection in the Diagnosis and Treatment of Breast Mass / 中国微创外科杂志

Objective To compare the advantages and disadvantages between the Mammotome ( MMT ) and conventional resection operation in the diagnosis and treatment of breast tumors . Methods A total of 288 patients during the period from February to July of 2014 were divided into MMT group ( 137 cases ) and control group ( 151 cases ) according to patient ’ s willingness .The surgical and post-operative results , postoperative complications and burden of disease were compared between the two groups . Results As compared to the control group, the MMT group had shorter operation time [(28.3 ±9.1) min vs.(37.5 ±14.2) min, t =-6.472, P=0.000], larger amount of tissue cut [(29.2 ±8.1) g vs.(16.5 ±7.9) g, t=13.462, P=0.000], lower visual analogue scales at one day after surgery [(4.2 ±3.6) points vs.(4.9 ±1.5) points, t=-2.189, P=0.029], lower incidence of postoperative breast shape change [10.2% (14/137) vs.55.0% (83/151), χ2 =64.392, P =0.000], and higher patient satisfaction scores [(7.2 ±1.8) points vs.(5.3 ±2.9) points, t=6.601, P=0.000], but more intraoperative bleeding [(22.3 ± 4.3) ml vs.(12.6 ±5.9) ml, t=15.807, P=0.000], higher incidence of postoperative breast hematoma [9.5% (13/137) vs. 2.6%(4/151),χ2 =6.050, P=0.014], and higher total costs [(5.12 ±1.97) ×103 yuan vs.(3.18 ±2.01) ×103 yuan, t=8.258, P=0.000]. Conclusion The MMT operation has advantages of short time , more cut tissue volume, mild postoperative pain, good postoperative breast shape , and high patient satisfaction , but disadvantages of easy development of hematoma and high total costs.

Ultrasound elasticity imaging correction and biopsy diagnosis value in BI-RADS 4 breast mass / 中国肿瘤临床

Objective:To compare the diagnostic value of strain ratio correction in ultrasound elasticity imaging and ultrasound-guided percutaneous biopsy for the diagnosis of breast imaging reporting and data system (BI-RADS) 4 breast mass. Methods:From January 2014 to June 2016 in the Affiliated Hospital of Chengde Medical College, 120 patients with breast tumor resection and preoperative BI-RADS4 of all the masses were included in this study. The diagnostic value of contrast ultrasound elastography strain ratio correction and biopsy in ultrasound-guided percutaneous biopsy was evaluated with pathology as the gold standard. Results:In the 120 cases of grade BI-RADS4 mass by ultrasound elastography after correction, 46 cases were graded BI-RADS4 without changing;59 cases were downgraded to BI-RADS3, and 15 cases were upgraded to BI-RADS5. The pathology, ultrasonic elastography strain ratio correction, biopsy diagnostic sensitivity, specificity, and accuracy were 90.7%, 81.8%, 85.5%, 88.8%, 98.5%, and 95.0%, respectively. A significant difference was found between ultrasonic elastography strain ratio correction and ultrasound-guided biopsy for the diagnosis of breast malignant mass (P0.05). Conclusion:Ultrasound-guided puncture biopsy is highly valuable in qualitative diagnosis of BI-RADS4 breast mass. After the pathological diagnosis, ultrasound elastography strain ratio has certain clinical value in BI-RADS4 guided biopsy and correction of mass classification.

Evaluation of breast isodense masses using mammography / 实用放射学杂志

Objective To explore the characteristic manifestations of breast malignant isodense masses using mammography. Methods 121 breast isodense masses with pathological confirmations were collected.Compared indicators with pathological findings were the tumor size,shape,edge,structure changes around the mass,axillary lymph nodes,skin changes,nipple changes,suspi-cious malignant calcification.χ2 test and Logistic regression analysis were used to evaluate the diagnostic values of each indicator.Re-sults In the 121 isodense masses,73 were benign,48 were malignant tumors.According to χ2 test analysis,factors impacted the nature of mass including:tumor morphology (χ2 =14.376,P =0.002),tumor edge (χ2 = 21.555,P =0.000),structure twisted surrounding the mass (χ2 =26.939,P =0.000),axillary lymph nodes (χ2 =1 6.285,P =0.000),skin thickening (χ2 =4.698,P =0.030).According to multivariate binary Logistic regression analysis,risk factors of the Logistic regression model included:edge infiltrating of mass (P =0.014),structure twisted surrounding the mass (P =0.003),axillary lymph nodes (P =0.026).Conclusion The characteristic manifestations of breast malignant isodense masses include edge infiltrating,structure twisted surrounding the mass,axillary lymph nodes.These manifestations are of great significance in differential diagnosis of breast isodense masses.

The curative effect of mammotome minimally invasive biopsy system in the treatment of benign breast mass / 中国基层医药

Objective To compare the curative effect of ultrasound guided mammotome minimally invasive biopsy system and open operation in the treatment of benign breast mass .Methods 60 benign breast mass patients with total 115 phymas were selected as treatment group , and were given the mammotome minimally invasive biopsy treatment .60 benign breast mass patients with total 105 phymas who were given traditional open operation at the same time,were selected as control group .The treatment effect and satisfaction condition of patients in the two groups were compared.Results The phymas of patients in two groups were all removed by operation .The operation time,blood loss,healing time and scar size after operation in the treatment group were all shorter than those in the control group (t=2.41,3.87,2.44,9.84,P<0.05 or P<0.01).The incidence rate of postoperative complication in the treatment group (6.66%) was significantly lower than that in the control group (20.00%)(χ2 =4.62,P<0.05).The postop-erative satisfaction of patients in the treatment group (95.00%) was significantly higher than that in the control group (20.00%)(χ2 =5.26,P<0.05).Conclusion Compared with open operation ,ultrasound guided mammotome min-imally invasive biopsy system in the treatment of benign breast mass has advantages of shorter operative time ,smaller operative trauma ,shorter postoperative healing time ,less operative complication ,higher satisfaction of patients .

Health education instruction of MAMMOTOME system under the guidance of ultrasound in minimally invasion treatment of breast tumor in outpatient / 中国医学装备

Objective:To Provide health education instruction for Benign Breast Mass patient with implement MAMMOTOME system in outpatient service of minimally invasive surgery patients’ psychological problems.Methods: Using self-made questionnaire form compare with before and after health education instruction.Results: The patients’ knowledge understanding is rise from 17.84% to 95.02%. Concern by 90.87% to 24.90% levels of satisfaction from 84.23% to 99.17%.Conclusion: The patients with lump in breast have psychological problems and deep pressure obviously. To provide the best care and health education instruction for the patients in preoperative may reduce anxiety and worry, improve the understanding of disease, Cooperate with the doctor. Make good relationship with patient. Increase patients’ satisfaction, Reduced complications.

Band-Like Interposing Fat along Large Vessels: Ultrasonographic Pseudolesions of the Breast

OBJECTIVE: The aim of this study is to evaluate the clinical characteristics and ultrasonographic findings of band-like interposing fat as well as to identify additional approaches for its diagnosis. MATERIALS AND METHODS: This study included 26 confirmed cases of band-like interposing fat from June 2008 to June 2010. A retrospective analysis was performed to evaluate the clinical characteristics and ultrasonographic findings in these cases. Five radiologists analyzed the ultrasonographic findings, which correlated with the mammographic and MRI findings when available, according to Breast Imaging Reporting and Data System classification. RESULTS: None of the 26 patients had any symptoms. In 92.3% of the patients, the lesion was located in the upper outer quadrant of the breast. The mean distance of the lesion from the nipple was 2.4 +/- 0.7 cm (1.1-4.5). The mean depth of the lesion from the skin was 1.3 +/- 0.3 cm (0.8-2.1). The mean maximal length of the lesion was 0.8 +/- 0.4 cm (0.3-1.8). The following were the most frequent ultrasonographic findings of lesions: irregular shape, not parallel orientation, indistinct margins, abrupt interface, hypoechogenicity, no posterior feature, no calcification, and presence of vascularity. The most frequent BI-RADS category was 4a. There were no suspicious findings on the mammography or MRI. CONCLUSION: Ultrasonographic findings may lead to misclassification of band-like interposing fat as a malignancy. A better understanding of the clinical and ultrasonographic characteristics of band-like interposing fat would facilitate its differentiation from a true mass.

Comparison of Diagnostic Performance of US Elastography and Conventional B-mode US in Differentiation of Breast Lesions

PURPOSE: The purpose of this study was to compare the diagnostic performance of ultrasound (US) elastography and conventional B-mode US for discrimination between benign and malignant breast lesions. MATERIALS AND METHODS: During a 13-month period, 277 women with 335 sonographically visible breast lesions who were scheduled to undergo biopsy were examined with US elastography. Elastographic findings were classified as benign or malignant based on the area ratio, with 1.00 as the threshold. Findings on conventional B-mode US were classified according to the BI-RADS category, as follows: lesions of BI-RADS categories 2 and 3 were considered benign, while those in categories 4 and 5 were considered malignant. Statistical analysis included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and ROC curve analysis for comparison of the diagnostic performance of US elastography and conventional B-mode US. RESULTS: Of the 335 breast lesions, 85 (25.4%) showed malignancy on pathology. Findings on B-mode US showed malignancy in 264 (78.8%) and elastographic findings showed malignancy in 102 (30.4%). The sensitivity, specificity, PPV, NPV, and accuracy of B-mode US and elastography were 98.8%, 28.0%, 31.8%, 98.6%, and 79.4% and 69.4%, 81.2%, 57.8%, 88.8%, and 79.4%, respectively. Elastography showed significantly higher specificity and PPV and lower sensitivity and NPV, compared with B-mode US (p < 0.001). The area under the ROC curve (AUC value) was 0.761 for elastography, and 0.634 for B-mode US (p < 0.001). CONCLUSIONS: US elastography can improve specificity and PPV of B-mode US, but with significant sacrifice of sensitivity and NPV. Therefore, US elastography may complement B-mode US for differentiation of breast masses.

Successfully treated Mycobacterium abscessus mastitis: A rare cause of breast masses.

Rapidly growing mycobacteria are pathogens responsible for cutaneous or subcutaneous infections especially occurring after injection, trauma or surgery. We describe a patient with Mycobacterium abscessus mastitis that presented as a mass lesion and haemorrhagical discharge. It was initially diagnosed and treated as fibrocystic disease and non-specific abscess. Full recovery was obtained with combination therapy of clarithromycin, linezolid and amikacin without surgical debridement followed by several abscess aspirations. Atypical mycobacteria should be considered in diagnosis of chronic breast lesions in endemic areas. This is the first reported case of mastitis due to M. abscessus in Turkey.

Optical Imaging of the Breast

As the increased prevalence of breast cancer and the advances in breast evaluation awareness have resulted in an increased number of breast examinations and benign breast biopsies, several investigations have been performed to improve the diagnostic accuracy for breast lesions. Optical imaging of the breast that uses near-infrared light to assess the optical properties of breast tissue is a novel non-invasive imaging technique to characterize breast lesions in clinical practice. This review provides a summary of the current state of optical breast imaging and it describes the basic concepts of optical imaging, the potential clinical applications for breast cancer imaging and its potential incorporation with other imaging modalities.

Percutaneous Excision of a Benign Breast Mass Using Ultrasound-guided, Vacuum-assisted Core Biopsy: A Review of 197 Cases with Long Term Follow-up

PURPOSE: To assess long term results of excising benign masses using ultrasound (US)-guided, vacuum-assisted core biopsy (Mammotome). MATERIALS AND METHODS: We enrolled 163 patients (197 masses) receiving USguided excision using vacuum-assisted core biopsy and follow-up sonography in this retrospective study. The masses were category 3 as determined by ultrasound imaging according to the Breast Imaging Reporting and Data System (BI-RADS) (n=145) or pathologically confirmed as benign masses by a previous core-needle biopsy although category 4a and 4b (n = 52). Pathology, the presence of hematoma and residual tissue, as well as scar formation were assessed. RESULTS: We diagnosed 190 (96.5%) benign masses, 4 (2.0%) malignant masses, and 3 (1.5%) high-risk lesions. Most (176 masses, 91.2%) were excised completely as demonstrated by the follow-up ultrasound examination. Scar changes were minimal (68.7%) or moderate (31.3%), with regression in 53%. CONCLUSION: US-guided excision using vacuum-assisted core biopsy is effective for the removal of benign breast masses. The majority of scars are minimal, with good cosmetic effect. However, subsequent excision should be done for malignant masses or phyllodes tumor because radiologic absence does not guarantee complete removal.

Ultrasound-guided mammotome excision biopsy for benign breast lesions

OBJECTIVE: A 15-month review of all mammotome excision breast biopsies in the Medical City to evaluate our experience in excising benign breast lesions using this technique by taking into consideration the complications encountered and patient satisfaction regarding the procedure and the postoperative result.METHODS: The study included all patients seen by two breast surgeons of the Medical City Breast Clinic from May 2007 to July 2008 with both palpable breast masses visible on ultrasound with a Breast Imaging Reporting a Data System (BIRADS) classification of 2-4. Women with lesions at high risk for malignancy were excluded from the study. Patient demographics were noted, lesions were classified according to BIRADS classification and data regarding the procedure, compilations incurred and patient satisfaction ratings were obtained.RESULTS: One hundred nineteen patients with ages ranging from 17 to 72 years old underwent ultrasound guided mammotome excision at the TMC-Breast Clinic removing a total of 167 lesions. Majority (82%) of patients were premenopausal whereas 22 (18%) were postmenopausal. Ecchymosis (73%) was the most frequent complication during the procedure due to hematoma formation, pain and a skin nick that require suturing. Of the 25 patients who had a previous open biopsy, 23 (92%) preferred mammotome excision over open breast biopsy.CONCLUSION: Ultrasound-guided mammotome excision is a safe and well-tolerated alternative to open excision biopsy for benign lesions of the breast.

Influence of psychological intervention on the mental state of patients before Mammotome minimal-ly invasive biopsy system for excision of benign breast lump / 中国实用护理杂志

ObjectiveTo study the influence of psychological intervention on anxiety and de-pression of patients before Mammotome minimally invasive biopsy system in resection of benign breast lump. Methods120 patients with breast lumps were divided into the experimental group and the control group with 60 cases in each group. The psychological intervention was used in the experimental group be-fore the surgery, including psychological cognition, psychological guidance and support, family support, etc,and the routine nursing care was given to the control group. SDS and SAS were used to evaluate the psy-chological state of the two groups before surgery using χ2 test. ResultsThe anxiety and depression score in the experimental group was significantly lower than that of the control group. ConclusionsThe psy-chological intervention before Mammotome minimally invasive biopsy system in resection of benign breast lump can effectively ameliorate the anxiety and depression of patients.

Color Doppler ultrasound in the assessment of the breast mass / 中国基层医药

Objective The aim of the study was to determine the diagnostic value of color Doppler ultrasound in the assessment of the breast mass.Methods The results of ultrasonograph of the breast mass were retrospectively observed in 79 operation and pathological proven breast mass parients,in which 47 patients had proven malignant breast mass and 32 patients had proven benign malignant breast mass.Results Color Doppler ultrasound had a sensitivity of 100%for diagnosing breast mass,accuracy of 93.7%(30/32)and 91.4%(43/47)for diagnosing malignant and benign mass.Conclusion Color Doppler ultrasound has high diagnostie value in distinguishing malignant from benign mass.

Usefulness of Core Needle Biopsy Compared with Fine Needle Aspiration Cytology for Palpable Breast Masses

PURPOSE: Fine needle aspiration cytology (FNAC) is an established, highly accurate method for diagnosing breast lesions. However, core needle biopsy (CNB) is being increasingly used in this setting. The purpose of this study was to evaluate the accuracy of both methods and to assess which is more proper as an initial diagnostic method for palpable breast masses. METHODS: The authors performed 403 FNACs and 226 CNBs in palpable breast masses between January 2002 and December 2002. The cytologic diagnoses were classified into three groups: malignant, suspicious or benign, and the histologic diagnoses were classified into three groups: malignant, atypical or benign. Histological conformation was obtained in 123 aspirated cases and 69 biopsied cases, either by open biopsy or mastectomy. RESULTS: FNAC and CNB did equally well for the specificity (98.4% vs 100%), the false positive rate (1.6% vs 0%), and the positive predictive value (97.4% vs 100%) for malignancy. However, statistical differences are found for the sensitivity (63.8% vs 92.5%; P=0.000), the false negative rate (36.2% vs 7.5%; P=0.000), and the diagnostic accuracy (81.8% vs 92.4%; P=0.006). CONCLUSION: For palpable breast masses, CNB has a higher sensitivity, diagnostic accuracy and lower false negative rate than FNAC. Our study suggests that CNB is a useful initial diagnostic tool for assessing a breast mass before establishing a treatment strategy.