Benign Lesions with Posterior Acoustic Shadowing on Ultrasound: The Pathologic Correlation

A breast lesion with posterior acoustic shadowing is often encountered on sonography and this finding is generally accepted as a sign of malignancy. Although its detection is important for differentiating a malignant breast mass from a benign breast mass, posterior acoustic shadowing is the result of attenuation of the sound beam by a desmoplastic host response to breast cancer rather than the posterior acoustic shadowing being due to the tumor itself. Therefore, many breast conditions that contain fibrous elements also can induce some degree of acoustic shadowing. In this article, we present various benign breast lesions that display posterior acoustic shadowing and we discuss the radiologic findings along with the pathologic correlation.

Unilateral Breast Edema: Spectrum of Etiologies and Imaging Appearances

Breast edema is defined as a mammographic pattern of skin thickening, increased parenchymal density, and interstitial marking. It can be caused by benign or malignant diseases, as a result of a tumor in the dermal lymphatics of the breast, lymphatic congestion caused by breast, lymphatic drainage obstruction, or by congestive heart failure. Here we describe several conditions, that cause unilateral breast edema with the aim of familiarizing radiologists with these disease entities.

The Usefulness of Ultrasound-Guided Core Needle Biopsy for Non-Palpable Breast Lesion

PURPOSE: To determine the usefulness of ultrasound-guided core biopsy for the diagnosis of non-palpable beast lesions. MATERIALS AND METHODS: Between April 1996 and December 2000, 932 lesions in 901 patients were the object of ultrasound-guided core biopsy. Of these, 440 non-palpable lesions ranging in size from 0.3 to 3.0 (average, 0.9)cm, and found in 428 patients (all women aged, on average, 43.9 years), were included in this study. The pathologic results of core biopsy were compared with the available surgical data, and clinical and radiologic follow-up data were also reviewed. A 16-gauge needle was used in 197 lesions, and a 14-gauge neadle in the other 243. RESULTS: At core biopsy, 53 lesions were diagnosed as invasive carcinoma, and 45 of these were excised. Forthfour were confirmed as invasive carcinoma, and in one case there was no residual tumor. Seven lesions, diagnosed as ductal carcinoma in situ at core biopsy, were surgically removed, and the final diagnosis was ductal carcinoma in four cases and invasive carcinoma in two. Two of four cases initially diagnosed as atypical ductal hyperplasia were finally diagnosed as invasive carcinoma after surgery. Six lesions diagnosed at core biopsy asbenign were later found to be malignant (false-negative rate, 8.3%). Radiologic imaging suggested that all six lesions-for two of which, a 14-gauge needle was used, and for four, a 16-gauge needle-were malignant. The false-negative rate was 5.1% and 12%, respectively, whithout statistical significance (p=0.26). CONCLUSION: Ultrasound-guided core needle biopsy for non-palpable breast lesions is useful and can replace surgical excision. To avoid false-negative assessment, however, strict radiologic-histopathologic correlation is required.

Changes in Diagnostic Methods of Non-palpable Breast Lesions: Analysis for 5 Years

PURPOSE: To describe the changes in diagnostic methods and reassess the role of core biopsy compared with needle localization biopsy (NLB) in the evaluation of non-palpable breast lesions. MATERIALS AND METHODS: We retrospectively analyzed 930 non-palpable breast lesions which underwent either core biopsy or NLB between January 1996 and December 2000. NLB involved 511 lesions in 482 patients, and core biopsy, 419 lesions in 365 patients. For a given lesion, NLB was guided by either mammography (n=213) or ultrasonography (US) (n=298), but only US was used to guide a core biopsy. Over the five-year period, we calculated the total number of biopsies per year relating to non-palpable breast lesions, also determining the mammographic findings in cases involving NLB and the percentage of malignancies seen at histopathology. RESULTS: The total number of biopsies increased with time: 1996: n=91, 1997: n=118, 1998: n=144, 1999: n=245, 2000: n=332. The implementation of core biopsy, however, led to a decrease in the proportion of NLB (1996: 97.8%, 1997: 84.7%, 1998: 75.7%, 1999: 47.8%, 2000: 28.9%). Among nonpalpable lesions which underwent mammography-guided NLB, 46.5% (20/43) were a mass or density in 1996, while in 2000 the proportion was 5.7% (2/35). During this period, however, the finding of calcification without a mass increased from 48.8% in 1996 to 94.3% in 2000. The proportion of cases in which NLB demonstrated malignancy increased from 13.5% in 1996 to 49% in 2000; where US-guided NLB was used, the increase was remarkable: from 15.2% in 1996 to 65.6% in 2000. CONCLUSION: In the evaluation of non-palpable breast lesions, the appropriate use of core biopsy can decrease the need for a more invasive method such as NLB. Furthermore, because most benign lesions diagnosed by core biopsy do not also undergo NLB, the use of the latter increases the yield of malignancies.

A case of breast sparganosis

A 29-year-old Korean woman visited the Department of Surgery in MizMedi Hospital with a palpable itching mass on the right breast that had existed for the past 7 months. She had no history to eat either frogs or snakes, but had the history of drinking impure water. Sonography revealed a serpiginous hypoechoic tubular structure associated with partial fat necrosis in breast parenchymal layer and subcutaneous fat layer. It also revealed oval cystic lesions. At operation, an ivory white opaque ribbon-like worm that measured 16.5 cm in length and 0.5 cm in width was extracted. Anti-sparganum specific serum IgG level in the patient's serum (absorbance = 0.71), measured by ELISA, was found to be significantly higher than those of normal controls (cut off point = 0.21). Sonography and ELISA appear to be helpful to diagnose sparganosis. Breast sparganosis is rarely found throughout the world.

Brachial Artery Approach for Outpatient Arteriography

PURPOSE: To evaluate the diagnostic usefulness of brachial approach arteriography for outpatients, withparticular regard to safety and image quality. MATERIALS AND METHODS: The angiographic findings and follow-upmedical records of 131 brachial approach arteriographies in 121 outpatients were retrospectively analysed. 5 Fpigtail catheters were used in 125 cases, and 5-F OCU-A catheters were used in three cases of renal arteriography,and three of upper extremity arteriography without catheter. RESULTS: Except for three cases of brachial arterypuncture failure, all procedures were performed successfully. One hundred and fifteen of 119 lower extremityarteriographies were visualized down to the level of the tibioperoneal artery. The non-visualized cases were threein which there was multiple obstruction at the distal common iliac artery and one with insufficient contrastamount due to renal failure. In four cases there were complications : two involved arterial thrombosis, one was anintramuscular hematoma, and one an A-V fistula. CONCLUSION: For outpatients, brachial approach arteriography canreplace the femoral approach. Its image quality is excellent, there are time-cost benefits, and the rate ofcomplications is relatively low.