Value of Ultrasonographic Features for Assessing Malignant Potential of Complex Cystic Breast Lesions.

OBJECTIVES: To assess the value of ultrasonography (US) features for determining the malignant potential of complex cystic lesions. METHODS: Seventy-nine complex cystic lesions were reviewed retrospectively. They were classified into four types according to US features in type I, the masses have a thick outer wall, thick internal septa, or both; in type II, the masses are an intracystic type with one or more discrete solid mural lesions within a cyst; in type III, the masses contain mixed cystic and solid components and are at least 50% cystic portion in a mass; in type IV, there are predominantly (at least 50%) solid masses with eccentric or central cystic foci. Positive predictive values were calculated for all types. RESULTS: The frequency of malignancy was higher among type III and IV lesions than among the other two types. Lesions with a diameter greater than or equal to 20 mm, margins not circumscribed, resistance index greater than or equal to 0.7, and axillary abnormal nodes had a high probability of malignancy. CONCLUSIONS: US is an important adjunct to evaluate the malignant potential of complex cystic lesions.

[Ultrasound-guided assistant infusion technique for percutaneous radiofrequency ablation of liver cancer].

OBJECTIVE: To assess the value of an infusion-based separation technique to assist in ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) of liver cancers abutting the liver edge. METHODS: Twenty-four cases of malignant liver tumors abutting the hepatic edge were treated with US-guided puncture accompanied by the assistant infusion technique. The US-guided puncture was made with a 22-G needle through the hepatic tissue and into the abdominal cavity near the target tumor. Infusion of a saline solution was used to separate the liver from any surrounding structures so that percutaneous RFA could be safely performed. Complications, including gastrointestinal injury, hemorrhage and death, were recorded. Technical efficacy and safety were evaluated. RESULTS: Among the 24 patients, the target tumors were adjacent to the right kidney (n=6), colon (n=6), stomach (n=5), pericardium (n=4), and gall bladder (n=3). Twenty-three patients received a successful radical percutaneous RFA with assistant infusion. The assistant infusion volumes ranged from 80-390 ml and created spaces ranging from 0.8-2.5 cm between the liver and surrounding structures. Five of the cases with tumors adjacent to the stomach or colon received the largest volume infusions. The infusion failed to create a separation space in only one case, due to the presence of an adhesion; as a result, this patient was treated with palliative RFA. The mean hospital stay for all 24 patients was four days after surgery. No severe complications or deaths occurred. At 1-month follow-up, computed tomography images showed that 22 cases had complete ablation, yielding a technical success rate of 95.7% (22/23). No needle track implantation was observed. CONCLUSION: Assistant infusion for percutaneous radiofrequency ablation creates a protective space between the liver and surrounding structures in patients with liver tumors abutting the liver edge. This safe and effective assistant technique broadens the range of patients available for percutaneous RFA treatment.

Ultrasound findings of papillary thyroid microcarcinoma: a review of 113 consecutive cases with histopathologic correlation.

Papillary thyroid microcarcinoma (PTMC) is a malignant thyroid tumor of less than 1 cm in size. Ultrasound (US) is the preferred imaging modality for PTMC. This study retrospectively evaluated the US results from 113 consecutive cases of PTMC with 127 nodules and correlated the results with the histopathologic findings. The results showed none of the PTMC nodules had a cystic element. Half of the PTMC nodules had a well-defined boundary and the remaining half had an ill-defined boundary. A percent (6.3%) of the nodules had a halo sign. Microcalcification was present in approximately half of the PTMC nodules. The cancerous tissue with a papillary structure was hypoechogenic and the amount of fibrous stroma determined whether the nodule echogenicity was heterogeneous or homogeneous. Heterogeneous echogenicity was associated with a fibrous stroma proportion of >20%. Only PTMC nodules with predominantly follicular structures containing a large proportion of colloid demonstrated isoechogenicity. Well-defined boundaries on US were associated with well-defined histologic margins, with or without the presence of an intact fibrous pseudo-capsule. A halo sign with a well-defined boundary detected by US was associated with the presence of an intact fibrous pseudo-capsule. Half of the PTMC nodules with ill-defined boundaries exhibited infiltration into the surrounding thyroid tissue, while the remaining half of the PTMC nodules with ill-defined boundaries on US presented irregular nodule margins by histology, rather than nodule infiltration. Psammoma bodies detected at a frequency ≥5 per ×200 microscopic field of view were detectable on US as microcalcifications.

Improvement in T-staging of rectal carcinoma: using a novel endorectal ultrasonography technique with sterile coupling gel filling the rectum.

Our purpose was to study the accuracy of using endorectal ultrasonography (ERUS) with sterile coupling gels filling the rectum in the preoperative T-staging of rectal carcinoma. A total of 189 patients with confirmed rectal carcinoma were recruited. All underwent ERUS and surgery within the week following sonography. EURS was performed by introducing sterile coupling gel into the rectum. Two radiologists looked at the images at the same time and agreed upon staging. Rectal carcinoma was staged from Tis to T4. The accuracy of T-staging by ERUS was 89.95%. The sensitivity, specificity, PPV and NPV for ERUS at different stages were calculated. For early stage (Tis and T1), these values were 93.62%, 97.89%, 93.62% and 97.89%, respectively. ERUS filling with sterile coupling gel in the rectum overcomes the pressure effect from a water bath and the restriction caused by tumor stenosis, thus, greatly improving the accuracy of T-staging. The examination is real-time, safe and inexpensive.

[Percutaneous radiofrequency ablation with artificial hydrothorax for liver cancer in the hepatic dome].

OBJECTIVE: To assess the value of application of percutaneous radiofrequency ablation (RFA) with artificial hydrothorax for liver cancer in the hepatic dome. METHODS: Thirty-two patients with 43 lesions of hepatic malignant tumors in the hepatic dome underwent ultrasound-guided percutaneous radiofrequency ablation (RFA) with artificial hydrothorax. Artificial hydrothorax was created by infusion of saline via an intrathoracically placed 14-G central venous catheter, which was ultrasound-guided percutaneously inserted before RFA, separating the right lung from the hepatic dome. The adverse reaction and therapeutic efficacy were also analyzed. RESULTS: In the 32 patients with 43 lesions in the hepatic dome (4 tumors in segment IV 21 tumors in segment VII and 18 tumors in segment VIII), 18 lesions of 14 patients were not observed by ultrasound before the operation. Thirty-two patients received the ultrasound-guided placement of intrathoracical catheter, and (1606.3 ± 485.9) ml (1000 - 2500 ml) saline solution was infused successfully. After obtaining an image of the whole tumor, 31 patients received percutaneous RFA therapy on schedule, and 22 patients received percutaneous transdiaphragmatic RFA therapy. One patient with 2 lesions gave up the treatment, because one of his tumors was not detectable by ultrasound. Diaphragmatic muscle hemorrhage was seen in two patients, subcutaneous edema in two patients, and pneumothorax in one patient. All the complications were cured, and no serious complications or related death occurred. 1-month follow-up with contrast-enhanced CT/MRI images showed that 29 patients had complete ablation, and the effective rate of this technique was 93.5% (29/31). CONCLUSIONS: Artificial hydrothorax helps us not only to visualize the whole tumor in the hepatic dome, but also offers a transdiaphragmatic route for therapy. Ultrasound-guided percutaneous RFA with artificial hydrothorax is a feasible, safe, and effective technique for treating liver cancer in the hepatic dome and worthy of being promoted.

[Prospective evaluation of ultrasonography, multi-slice spiral CT, endoscopic ultrasonography, and magnetic resonance imaging in assessment of TNM staging and assessment of resectability in pancreatic carcinoma].

OBJECTIVE: To evaluate prospectively the efficacy and clinical significance of ultrasonography (US), multi-slice spiral CT (MSCT), magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS) in assessment of the TNM staging and resectability of pancreatic carcinoma. METHODS: Consecutive 68 patients with pancreatic carcinoma underwent US, MSCT, MRI, and EUS to assess their efficacies in assessment of the size of carcinoma, lymph node metastasis, and distant metastasis. The results of theses imaging techniques were compared with the surgical and pathological findings. RESULTS: EUS was the most precise technique in evaluating the T staging of pancreatic carcinoma with the coefficients of regression of maximum and minimum radii of 1.025 (P=0.043) and 0.987 (P<0.0001). In the assessment of lymph node metastasis, EUS had the highest sensitivity (75.0%), accuracy (87.5%), and negative predictive values (91.7%). Univariate logistic regression showed that EUS was significantly correlated with the surgical findings (OR: 33.00, 95%CI: 7.18-151.77 P<0.0001). Multivariate logistic regression analysis confirmed that EUS had an independent predictive value (OR: 34.50, 95%CI: 6.54-182.09, P<0.0001). MSCT had the highest sensibility (88.9%) in the assessment of distant metastasis and had the highest accuracy (61.8%) in preoperative TNM staging of pancreatic carcinoma. All 4 imaging techniques were correlated with surgical findings in assessment of the resectability. Multivariate logistic regression analysis confirmed that none of the imaging techniques had independent predictive value. CONCLUSION: MSCT is the best method in preoperative TNM staging of pancreatic carcinoma. EUS is the best methods in the assessment of tumor size and lymph node metastasis. Preoperative assessment of pancreatic carcinoma needs combination of at least two kinds of imaging techniques.

[Comparision of sonographic findings and pathological features in ovarian thecoma].

OBJECTIVE: To compare the sonographic findings with pathological features of ovarian thecoma, and to analyze the relationship between them. METHODS: The sonograms of 45 ovarian thecoma cases were reviewed retrospectively and categorized into three subtypes as sound attenuation pattern, homogeneous hypoechoic pattern and solid and cystic mixed pattern. The pathological findings were classified as theca cell-predominant, fibroblast-predominant and mixed thecoma according to the cellular composition of the tumors. Hyaline degeneration and luteinization of the tumors were recorded. The pathologic findings of each subtype based on sonography were compared. RESULTS: Of the 45 patients, there were 34 (75.6%) solid ovarian lesions, 15 (33.3%) of those showed a sound-attenuation pattern with an anterior hypoechoic zone and posterior acoustic attenuation in sonography, the other 19 (42.2%) cases had homogeneous hypoechoic pattern with no posterior acoustic attenuation, and the remaining 11 (24.4%) cases presented as a solid and cystic mixed pattern. There were no significant differences in pathological cellular composition among the three sonographic subtypes. Five solid tumors containing hyaline degeneration and one with luteinization were found to have posterior acoustic attenuation. The solid and cystic mixed thecomas showed cystic degeneration and hemorrhage. CONCLUSION: Solid ovarian thecomas usually have typical sonographic features, which may be associated with degeneration but not with cellular composition within the tumor.

[Prospective comparison of ultrasonography, helical computed tomography, magnetic resonance imaging, and endoscopic ultrasonography in assessing locoregional invasion of primary pancreatic carcinoma].

OBJECTIVE: To evaluate prospectively the efficacy and clinical significance of ultrasonography (US), helical computed tomography (HCT), endoscopic ultrasonography (EUS) and magnetic resonance imaging (MRI) in assessing locoregional invasion to the surrounding tissue or organs of primary pancreatic carcinoma. METHODS: Sixty-eight consecutive patients with pancreatic carcinoma underwent US, HCT, EUS and MRI examinations before surgical exploration. All imaging results in terms of tumor size and locoregional invasion were assessed separately by two diagnostic radiologists and compared with the surgical and pathological findings. RESULTS: Among the HCT, US, EUS and MRI examinations, EUS had the highest accuracy in assessing tumor size with a regression coefficient for the maximal and minimal diameter of 1.0250 (P = 0.0426) and 0.9873 (P < 0.0001), respectively. In the assessment of locoregional invasion to the surrounding tissue or organs, EUS also had the highest accuracy (75.8%) and sensitivity (80.0%), but MRI had the highest positive predicting value (97.4%). None of these four imaging techniques was significantly correlated with the surgical findings when analyzed by univariate logistic regression. CONCLUSION: Endoscopic ultrasonography may be the most useful imaging technique in assessing tumor size, but for assessing loco-regional invasion of primary pancreatic carcinoma, combination of more than one imaging techniques may be necessary.

[Sonographic evaluation of the special thyroid carcinoma].

OBJECTIVE: To analyze the cases of thyroid carcinoma with special sonographic features, so as to increase the accuracy of sonographic diagnosis for thyroid carcinoma. METHODS: The sonographic characteristics of 9 patients with special sonographic appearance were analyzed. According to the sonographic features, they were divided into two kinds: 8 cases suffered from thyroid diffuse malignant lesions, and one case showed cystic lesion sticking out of the thyroid. The sonographic appearance of gray scale and color Doppler characteristics of the lesions were recorded. RESULT: In the first kind of lesions, the dimensional ultrasound appearance of gray scale had an apparent feature, however, its color Doppler characteristics had no apparent feature, and all of the 8 cases were diagnosed correctly by ultrasound. In the second kind of lesion, the sonographic appearance of gray scale and color Doppler had no special features, so the case was diagnosed as benign disease wrongly by ultrasound. CONCLUSION: The first kind of lesions has apparent sonographic features, sonographic diagnosis can serve as the first choice. However, the second kind of lesion had no apparent sonographic feature.

[Prospective evaluation of the clinical significance of ultrasonography, helical computed tomography, magnetic resonance imaging and endoscopic ultrasonography in the assessment of vascular invasion and lymph node metastasis of pancreatic carcinoma].

OBJECTIVE: To evaluate prospectively the efficacy of ultrasonography (US), helical computed tomography (HCT), endoscopic ultrasonography (EUS) and magnetic resonance imaging (MRI) in the assessment of vascular invasion and lymph node metastasis in pancreatic carcinoma. METHODS: Consecutive 68 patients with pancreatic carcinoma were studied. Results of each imaging techniques regarding vascular invasion and lymph node metastasis were compared with the surgical and pathological findings. RESULTS: (1) US findings were confirmed moderately in accordance with surgical and pathological results in the evaluation of inferior cava vein, splenic artery and vein invasion of pancreatic carcinoma. HCT findings of evaluating superior mesenteric vein, portal vein, splenic vein were confirmed greatly in accordance with surgical and pathological results. The results of evaluating superior mesenteric artery, inferior cava vein, splenic artery, common hepatic artery, proper hepatic artery, celiac trunk, abdominal aorta were confirmed moderately in accordance with surgical and pathological results. MRI findings of evaluating superior mesenteric artery and vein, portal artery and vein were moderately in accordance with surgical and pathological results. EUS findings of evaluating splenic vein were confirmed greatly in accordance with surgical and pathological results, and moderately in accordance with surgical and pathological results in the evaluation of superior mesenteric vein. (2) EUS had the highest sensitivity (75.0%), accuracy (87.5%), and negative predictive values (91.7%) in the evaluation of lymph node metastasis. The sensitivity of HCT and MRI were 37.5% and 35.3%, which were significantly lower than that of EUS. The sensitivity of US was 18.7%, which was the lowest of all. In addition, the multivariate logistic regression analysis confirmed that EUS had an independent predictive value (OR: 34.50, 95%CI: 6.54 - 182.09). CONCLUSION: Helical CT should be considered the most precise technique to evaluate vascular invasion. EUS had an independent predictive value with respect to tumor metastasis to regional lymph nodes.

[Diagnostic value of ultrasonography in thyroid lesions].

OBJECTIVE: To analyse ultrasonographic mapping of the thyroid lesions, so as to summarize ultrasonographic characteristics, and improve the accuracy rate of preoperative diagnosis for thyroid lesions. METHODS: The clinical data were analyzed for 1700 patients with different thyroid lesions who were treated between January 2002 and December 2005. The appearance of gray scale and colour Doppler sonography for the lesions was prospectively studied, the different blood flow index was determined. All patients underwent surgery and had histopathologic diagnosis at Cancer Hospital, Chinese Academy of Medical Sciences. The criterion of diagnosis for benign lesions were (1) multinodular; (2) the presence of peripheral halo; (3) regular and defined margins, intranodular uniform echogenicity; (4) macrocalcification; (5) the degree of blood flow was I or IV grade, the distribution of blood flow was I type; (6) the blood resistance index was over 0. 6, the blood peak value speed was below 12 cm/s. The criterion of diagnosis for malignant lesions were (1) single nodular; (2) irregular and partly defined margins; (3) intranodular irregular hypoechogenicity; (4) microcalcification; (5) the degree of blood flow was II or III grade, the distribution of blood flow was II type; (6) the presence of metastatic lymph node in region; (7) the blood resistance index was below 0. 6, the blood peak value speed was over 12 cm/s. RESULTS: Of all cases, 1284 cases were benign and 416 cases malignant. The accuracy rate of gray scale sonography for benign and malignant thyroid lesions was respectively 80. 0% and 75.0%. The accuracy rate of ultrasound diagnosis for benign and malignant thyroid lesions was respectively 86.0% and 82.0%, total accuracy rate for thyroid lesion was 85.0%. CONCLUSIONS: Gray scale sonography was very important to distinguishing between benign and malignant lesions of thyroid tumor, the accuracy rate was greatly improved with colour Doppler sonography, but the determination of blood flow index is no help to differentiating between benign and malignant lesions of thyroid tumor. The accurate rate of ultrasound for the diagnosis of thyroid lesions is high, it is the first choice measure in preoperative diagnosis for thyroid lesions.

[Value of high-resolution ultrasonography in differential diagnosis of cervical cystic lesions].

OBJECTIVE: To analyze ultrasonographic features of the different kinds of cervical cystic lesions, and propose differential diagnostic standard for these lesions based on the evidence of high resolution ultrasonography. METHODS: The clinical data of 107 patients with different kinds of cervical cystic lesions were analyzed. The role of gray scale and colour Doppler sonography for such lesions was prospectively studied. RESULTS: The rate of accuracy for benign cervical cystic lesions was 91.1% (92/101), however, it was only 16.7% (1/6) for malignant cervical cystic lesions. CONCLUSION: High-resolution ultrasonography is effective and simple in differential diagnosis of different kinds of cervical cystic lesions, especially for benign ones.