The Role of PET/CT for Evaluating Breast Cancer

Positron emission tomography combined with computed tomography (PET/CT) has been receiving increasing attention during the recent years for making the diagnosis, for determining the staging and for the follow-up of various malignancies. The PET/CT findings of 58 breast cancer patients (age range: 34-79 years old, mean age: 50 years) were retrospectively compared with the PET or CT scans alone. PET/CT was found to be better than PET or CT alone for detecting small tumors or multiple metastases, for accurately localizing lymph node metastasis and for monitoring the response to chemotherapy in breast cancer patients.

MRI of the Breast for the Detection and Assessment of the Size of Ductal Carcinoma in Situ

OBJECTIVE: The aim of the study was to compare the accuracy of magnetic resonance imaging (MRI) and mammography for the detection and assessment of the size of ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: The preoperative contrast-enhanced MRI and mammography were analyzed in respect of the detection and assessment of the size of DCIS in 72 patients (age range: 30-67 years, mean age: 47 years). The MRI and mammographic measurements were compared with the histopathologic size with using the Pearson's correlation coefficients and the Mann-Whitney u test. We evaluated whether the breast density, the tumor nuclear grade, the presence of comedo necrosis and microinvasion influenced the MRI and mammographic size estimates by using the chi-square test. RESULTS: Of the 72 DCIS lesions, 68 (94%) were detected by MRI and 62 (86%) were detected by mammography. Overall, the Pearson's correlation of the size between MRI and histopathology was 0.786 versus 0.633 between mammography and histopathology (p < 0.001). MRI underestimated the size by more than 1 cm (including false negative examination) in 12 patients (17%), was accurate in 52 patients (72%) and overestimated the size by more than 1 cm in eight patients (11%) whereas mammography underestimated the size in 25 patients (35%), was accurate in 31 patients (43%) and overestimated the size in 16 patients (22%). The MRI, but not the mammography, showed significant correlation for the assessment of the size of tumor in noncomedo DCIS (p < 0.001 vs p = 0.060). The assessment of tumor size by MRI was affected by the nuclear grade (p = 0.008) and the presence of comedo necrosis (p = 0.029), but not by the breast density (p = 0.747) or microinvasion (p = 0.093). CONCLUSION: MRI was more accurate for the detection and assessment of the size of DCIS than mammography.

Evaluation of Mammographic Phantom Images Using JPEG2000 Image Compression

PURPOSE: To determine the usefulness of compression standard JPEG2000 for compression of mammographic images. MATERIALS AND METHODS: Image of a mammographic phantom was compressed using JPEG2000 at ratios of 10:1, 20:1, 30:1, 40:1, 50:1 and 60:1. The sizes of the images were compared, and scores were recorded by counting the numbers of fibers, groups of specks and masses seen in each phantom image. More than four fibers, three groups of specks and three masses and a total score of 10 were considered acceptable. RESULTS: The size of a DICOM image was 17,042 KB, a TIFF image was 8,324 KB, the original JPEG image was 1,506 KB and the most compressed image (50:1) above an acceptable total score of 10 was 43 KB. In each category, the compression image of fiber was acceptable up to compression ratio of 50:1 (score of 5), groups of specks was acceptable up to 60:1 (score of 3) and mass was acceptable up to 50:1 (score of 3.5). The total score, which was acquired by adding up the individual scores of all three categories, for a compression ratio of 50:1 was 12 and was acceptable, but the total score for 60:1 was 8 and was not acceptable. CONCLUSION: The compression standard JPEG2000 is an efficient means for compressing mammographic images at high ratios without compromising diagnostic value.

The Clinicopathologic Characteristics of Breast Carcinoma associated with Nipple Discharge / 한국유방암학회지

PURPOSE: Breast carcinoma presenting with nipple discharge is not uncommon. However, few studies have addressed the clinicopathological characteristics and optimal surgical management of breast carcinoma with nipple discharge. The aims of this study were to determine the clinicopathologic characteristics of breast carcinoma that presents with nipple discharge and the feasibility of breast conservation for these patients. METHODS: We retrospectively reviewed the medical records of the patients with breast carcinoma who presented with nipple discharge and who also underwent curative surgery at Korea Cancer Center Hospital between January 1999 and December 2003. RESULTS: During the study periods, 40 of 1,442 (2.7%) breast cancer patients presented with nipple discharge, and among them, 28 (70%) patients were accompanied by a palpable breast mass. Their median age was 44 yr. Thirty-seven (93%) patients were treated with mastectomy and only 3 (7%) patients were treated with breast conservation. Eleven patients had ductal carcinoma in situ, 17 had stage I disease, 8 had stage II disease and 4 had stage III disease. On the pathologic evaluation, multifocality or multicentricity were found in 7 of 37 (19%) mastectomy specimens, and occult nipple-areola complex (NAC) involvement was found in 3 (8%) cases. In 23 of 37 (62%) mastectomy specimens, we didn't find any evidence of extensive disease (stage III, multicentricity or multifocality or occult NAC involvement) that may preclude breast conservation. Locoregional recurrence was not detected in any of these cases, and 37 of 40 patients are free of disease with a median follow-up of 55 months. CONCLUSION: In this retrospective study, we found that 23 of 37 (62%) women with breast carcinoma associated with nipple discharge and who also underwent mastectomy had no evidence of extensive disease. Thus, we suggest that breast conservation can be done for these patients with performing careful patient selection and appropriate adjuvant therapy.

Imaging and the Clinical-Pathologic Features of Invasive Micropapillary Carcinoma of the Breast

PURPOSE: The purpose of this study was to describe the mammographic and sonographic appearances and the clinical-pathologic features of invasive micropapillary carcinoma. MATERIALS AND METHODS: Between December 1999 and March 2005, among the 3,109 patients who underwent operation for breast cancer, 25 patients proved to have invasive micropaillary carcinoma. Among the 25 patients, we included 22 patients (mean age: 48, range: 26-77 years) who had undergone preoperative mammography and ultrasound. The mammographic and sonographic findings of the lesions were analyzed retrospectively. The pathologic findings were analyzed via the clinical records and pathology reports. RESULTS: Patients manifested with a palpable mass (77%, 17/22), bloody nipple discharge (14%, 3/22) or incidental lesion on the screening mammography (9%, 2/22). On mammography, a mass with an irregular (86%, 12/14) shape and an indistinct (43%, 6/14) or spiculated (43%, 6/14) margin was the most common findings on mammography. On sonography, a hypoechoic (91%, 20/22) mass with irregular shape (73%, 16/22) and an indistinct (32%, 7/22) or microlobulated (32%, 7/22) margin was the most common finding. Pathologically, axillary lymph node metastasis was present in 73% (16/22) of the patients. CONCLUSION: Invasive micropapillary carcinoma appeared an irregular shaped mass with an indistinct margin mass or microcalcifications on mammography and/or sonography. The tumors were frequently associated with axillary lymph node metastasis.

Screening Mammography-Detected Cancers: The Sensitivity of the Computer-aided Detection System as Applied to Full-field Digital Mammography

PURPOSE: We wanted to evaluate the sensitivity of the computer-aided detection (CAD) system for performing full-field digital mammography (FFDM) on the breast cancers that were originally detected by screening mammography. MATERIALS AND METHODS: The CAD system (Image Checker v3.1, R2 Technology, Los Altos, Calif.) together with a full-field digital mammography system (Senographe 2000D, GE Medical Systems, Buc, France) was prospectively applied to the mammograms of 70 mammographically detected breast cancer patients (age range, 37-69; median age, 51 years) who had negative findings on their clinical examinations. The sensitivity of the CAD system, according to histopathologic findings and radiologic primary features (i.e., mass, microcalcifications or mass with microcalcifications) and also the false-positive marking rate were then determined. RESULTS: The CAD system correctly depicted 67 of 70 breast cancer lesions (95.7%). The CAD system marked 29 of 30 breast cancers that presented with microcalcifications only (sensitivity 96.7%) and all 18 breast cancers that presented with mass together with microcalcifications (sensitivity 100%). Twenty of the 22 lesions that appeared as a mass only were marked correctly by the CAD system (sensitivity 90.9%). The CAD system correctly depicted all 22 lesions of ductal carcinoma in situ (sensitivity: 100%), all 13 lesions of invasive ductal carcinoma with ductal carcinoma in situ (sensitivity: 100%) and the 1 lesion of invasive lobular carcinoma (sensitivity: 100%). Thirty one of the 34 lesions of invasive ductal carcinoma were marked correctly by the CAD system (sensitivity: 91.8%). The rate of false-positive marks was 0.21 mass marks per image and 0.16 microcalcification marks per image. The overall rate of false-positive marks was 0.37 per image. CONCLUSION: The CAD system using FFDM is useful for the detection of asymptomatic breast cancers, and it has a high overall tumor detection rate. The false negative cases were found in relatively small invasive ductal carcinoma.

Papillary Lesions of the Breast: Comparison of the US-guided 14-Gauge Automated Gun Method and the 11-Gauge Directional Vacuum-Assisted Biopsy Method

PURPOSE: To compare the outcomes of US-guided 14-gauge automated biopsy and 11-gauge vacuum-assisted biopsy for the papillary lesions of the breast. MATERIALS AND METHODS: We retrospectively reviewed the US-guided core biopsies of 1,723 consecutive breast lesions that were treated from January 2003 to April 2005. Ninety-eight lesions (5.7%) were pathologically reported as papillary lesions. The biopsies were performed with using a 14-gauge automated gun on 65 lesions or with using an 11-gauge vacuum-assisted device on 33 lesions. Thirty-five lesions (54%, 35/65) of 14-gauge automated gun biopsies and 5 lesions (15%, 5/33) of 11-gauge vacuum-assisted biopsies underwent surgery. The histologic findings were compared with the surgical, imaging and follow-up findings. The histologic underestimation rate, the repeat biopsy rate and the false negative rate were compared between the two groups. The repeat biopsy rate was determined by dividing the total number of core biopsies into the number of repeat biopsies. "ADH underestimation" was defined as a lesion yielding atypical ductal hyperplasia on percutaneous biopsy and carcinoma at surgery, and "DCIS underestimation" was defined as a lesion yielding ductal carcinoma in situ on percutaneous biopsy and invasive carcinoma at surgery. RESULTS: The repeat biopsy rate was 42% (27/65) for the 14-gauge automated gun biopsies and 9.1% (3/33) for the 11-gauge vacuum-assisted biopsies. The ADH underestimation rate was 50% (7/14) for the 14-gauge automated gun biopsies and 0% (0/4) for the 11-gauge vacuum-assisted biopsies. The DCIS underestimation was 14% (1/7) for the 14-gauge automated gun biopsies and 0% (0/2) for the 11-gauge vacuum-assisted biopsies. The false negative rate was 0% for these two groups. CONCLUSION: For the papillary lesions of the breast, the outcomes of the US-guided core biopsies performed with the 11-gauge vacuum-assisted device were better than those of the biopsies performed with the 14-gauge automated gun, in terms of underestimation and repeat biopsy.

A case of benign metastasizing leiomyoma in the lung of woman with a history of myomectomy / 대한내과학회지

Benign metastasizing leiomyoma is usually detected years after hysterectomy or myomectomy and characterized by well-circumscribed, singular or, often, multiple nodules. The patient was a 33-year-old woman who presented with cough. She underwent a myomectomy for a large uterine leiomyoma 9 years ago. And now she has recurrent uterine myoma. Multiple nodular lesions in both whole lung fields were incidentally found on a routine chest radiograph. Video-assisted thoracoscopy (VATs) was performed. The resected small nodular lesions composed of extremely well- defferentiated smooth muscle cells with collagen. On immunohistochemical stain, they are positive for smooth muscle markers (desmin and actin). There is no definite evidence of malignancy. Therefore, these multiple nodules are considered as benign metastasizing leiomyoma from a uterine leiomyoma. We report this case with review of literatures.

Aneurysm after Surgical Ligation of Patent Ductus Arteriosus: A Case Report

Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases. A rare complication occurring after its surgical treatment is the development of an aneurysm, and we report the radiologic findings in a case in which this occurred after surgical ligation.

Change of Pulmonary Arterial and Bronchial Diameter During Respiration: HRCT Findings

PURPOSE: To evaluate the changes and normal ranges of the artery-bronchus ratio (ABR) during respiration MATERIALS AND METHODS: We analyzed HRCT of 10 healthy adults. The HRCT findings of ten healthy adults were analysed. CT scanning was performed with 1 mm collimation at 3 mm intervals during full inspiration and full expiration, with a range during inspiration from 2 cm to 4 cm above the carina and from 4 cm above to 2 cm below the right hemidiaphragm. The range during expiration was from 1 cm to 3 cm above the carina and from 4 cm above to 2 cm below the right hemidiaphragm. ABiR (defined as the diameter of pulmonary artery divided by the inner diameter of the bronchus), ABoR (defined as the diameter of pulmonary artery divided by the outer diameter of the bronchus) and BLR (defined as the inner diameter of the bronchus divided by the outer diameter of the bronchus) were measured on the display console. RESULTS: The mean inner diameter of the bronchi was 2.04+/-0.73 mm during inspiration and 1.68+/-0.51 mm during expiration, while the mean diameter of the arteries was 3.95+/-1.03 mm during inspiration and 4.37+/-1.09 mm during expiration. The diameters of the bronchi were thus seen to increase during inspiration, and the diameters of the pulmonary arteries, to decrease. The mean thickness of the bronchial wall was 1.07+/-0.19 mm during inspiration and 1.06+/-0.24mm during expiration; thus, no change in thickness was seen during respiration (p<0.05). Mean ABiR was 2.01+/-0.60 (range 1.15-4.58) during inspiration and 2.59+/-0.74(range 1.16-4.9) during expiration, and in all cases the inner diameter of the bronchus was less than that of the accompanying pulmonary artery. Mean ABoR was 0.91+/-0.19 during inspiration and 1.09+/-0.22 during expiration. while for BLR, the corresponding fingures were 0.46+/-0.06, and 0.44+/-0.09. CONCLUSION: HRCT is a useful tool for evaluating changes in the pulmonary arteries and bronchi during respiration.

Difference of Regional Lung density in Inspiration and Expiration CT

PURPOSE: To evaluate differences in regional density of normal lung, as seen on CT, according to respiration and gravity. MATERIALS AND METHODS: The subjects were 15 healthy volunteers, all non-smokers and without previous pulmonary disease. CT scans were obtained at three selected levels through the apex, middle and basal lung at the aortic arch, carina and just above the diaphragm, respectively at both full inspiration (FVC) and full expiration (RV). Within these regions of interest and at the three scanning levels, lung density was measured in the anterior, lateral, and posterior portions of the peripheral lung field. RESULTS: Attenuation of the anterior portion of the lung was lower than that of the posterior portion(p<0.005); average lung attenuation increase from the anterior to the posterior portion was significantly greater during full expiration than full inspiration (p<0.005), and was significantly greater at the base of the lung than at the apex (p<0.005 on expiration, p=0.006 on inspiration). Lung density during inspiration was lower than during expiration (p<0.005); average lung density increase from full inspiration to full expiration was significantly greater in the posterior portion than in the anterior (p<0.005). In the former, the average increase at the base of the lung was greater than at the apex (p=0.007), but in the latter, the average increase at the apex was greater than at thebase (p<0.005). CONCLUSION: In normal lung, respiration and gravity cause regional density changes, as seen on CT, and result in difference of lung attenuation between dependent and nondependent portions and between the apex, middle and base of the lung, according to inspiration and expiration.

Differentiation of Exudative and Transudative Pleural Effusion: MR Appearances

PURPOSE: The purpose of this study is to determine whether MR images after intravenous administration of Gd-DTPA can differentiate exudative and transudative pleural effusion. MATERIALS AND METHODS: We studied 18 patients with ten exudative and eignt transudative pleural effusions diagnosed clinically and by thoracentesis. We analysed the relationship between T1 value(normalized to fat) and the ratio of effusion/serum protein of pleuraleffusion. We also assessed the contrast enhancement of exudative and transudative pleural effusion on T1 weighted SE images taken at 15 and 30 minutes after administration of Gd-DTPA. RESULTS: The relationship between the effusion/serum protein ratio and T1 value(normalized to fat) was statistically not significant(r=0.27, P=0.381).On precontrast spin-echo T1W1, mean signal intensity of the transudate was 0.18 (+/-0.04) and that of the exudatewas 0.24(+/-0.07), values which were not significant differences(P>0.05). Postcontrast mean signal intensities of transudates at 15 and 30 were 0.20+/- 0.06 and 0.26+/-0.08, respectively, values which were not significantly higherthan that of precontrast mean signal intensity(P<0.05). Postcontrast mean signal intensity values of exudative pleural effusions at 15 and 30 mimutes(0.32+/-0.06 and 0.39+/-0.06, respectively) were, on the other hand, significantly higher than that of precontrast mean signal intensity(P<0.05). CONCLUSION: Postcontrast T1-weighted SE images at 15 and 30 minutes can be helpful in the differentiation of transudative and exudative pleural effusion.