Diagnostic performance of shear wave elastography of the breast according to scanning orientation.

OBJECTIVES: To evaluate the influence of the scanning orientation on diagnostic performance measured by the mean elasticity, maximum elasticity, and fat-to-lesion elasticity ratio on ultrasound-based shear wave elastography in differentiating breast cancers from benign lesions. METHODS: In this study, a total of 260 breast masses from 235 consecutive patients were observed from March 2012 to November 2012. For each lesion, the mean elasticity value, maximum elasticity value, and fat-to-lesion ratio were measured along two orthogonal directions, and all values were compared with pathologic results. RESULTS: There were 59 malignant and 201 benign lesions. Malignant masses showed higher mean elasticity, maximum elasticity, and fat-to-lesion ratio values than benign lesions (P < .0001). The areas under the receiver operating characteristic curves were as follows: average mean elasticity on both views, 0.870; mean elasticity on the transverse view, 0.866; maximum elasticity on both views, 0.865; maximum elasticity on the transverse view, 0.864; mean elasticity on the longitudinal view, 0.849; fat-to-lesion ratio on both views, 0.849; maximum elasticity on the longitudinal view, 0.845; fat-to-lesion ratio on the transverse view, 0.841; and fat-to-lesion ratio on the longitudinal view, 0.814. Intraclass correlation coefficients for agreement between the scanning directions were as follows: mean elasticity, 0.852; maximum elasticity, 0.842; fat-to-lesion ratio, 0.746, for masses; and mean elasticity, 0.392, for anterior mammary fat. CONCLUSIONS: Mean elasticity, maximum elasticity, and fat-to-lesion elasticity ratio values were helpful in differentiating benign and malignant breast masses. The scanning orientation did not significantly affect the diagnostic performance of shear wave elastography for breast masses.

Clinical and imaging characteristics of papillary neoplasms of the breast associated with malignancy: a retrospective cohort study.

Papillary neoplasms of the breast comprise a broad range of pathologies ranging from papillomas to papillary carcinomas and have been associated with breast cancers. In this study, we evaluated the clinical, mammographic and sonographic features of papillary breast neoplasms from benign papillary breast lesions to malignancy-associated papillary lesions. A total of 194 lesions in 179 patients were analyzed, including 117 benign papillomas, 24 atypical papillomas, 41 benign papillomas with malignancies and 12 papillary carcinomas found between January 2003 and August 2011 in our institution. Statistically significant clinical factors included patient age (p = 0.001), lesion multiplicity (p = 0.009) and peripheral location (p = 0.003). Among these factors, the odds ratio for malignancy was 8.9 for bilateral multiple lesions. Visibility (p = 0.001) and density (p = 0.039) were significant factors for malignancy in mammograms, and echo patterns (p = 0.006), boundary (p = 0.001) and vascularity (p = 0.005) were significant features on ultrasound that differentiated malignancies from benign lesions. Overall, when papillary breast lesions are located bilaterally and peripherally in older patients, they are correlated with breast cancers. Additionally, for papillary breast lesions that appear highly dense on mammograms and/or exhibit positive vascularity on ultrasound, the probability of malignancy is relatively high.

A new assessment of patellar instability using coronal magnetic resonance images of the patella superimposed on the femur and its clinical utility.

OBJECTIVE: This study aimed to evaluate the clinical utility of a new assessment for patellar subluxation using magnetic resonance (MR) images of the patella superimposed on the femur and to determine its correlation with the tibial tuberosity-trochlear groove (TT-TG) distance. MATERIALS AND METHODS: This retrospective study included 81 men and 44 women who underwent MR imaging at our institution. There were 19 cases of patellar dislocation. The control group consisted of 116 patients. An assessment of the distance of subluxation was carried out using coronal superimposed MR images. The results were correlated with the TT-TG distance calculated using the axial combined MR images. The sensitivity and specificity of various distances of subluxation were evaluated as diagnostic thresholds for patellar dislocation, where the clinical diagnosis was used as the standard of reference. RESULTS: The use of the distance of subluxation on coronal superimposed MR images showed discrete difference between patellar dislocation and controls. The mean distance of subluxation was approximately 3 times larger for patients with patellar dislocation compared with controls (P < 0.001). Likewise, the mean TT-TG distance was approximately 50% greater for patients with patellar dislocation compared with controls (P < 0.001). However, there was no correlation between the distance of subluxation and the TT-TG distance. The best diagnostic discrimination was achieved at the 7-mm threshold of subluxation. CONCLUSIONS: The use of the distance of subluxation on coronal superimposed MR images can be a useful method to evaluate patellar dislocation. The best diagnostic discrimination was achieved at a threshold of 7 mm.

Diagnosis of pseudoangiomatous stromal hyperplasia of the breast: ultrasonography findings and different biopsy methods.

PURPOSE: Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a rare, benign condition that can be mistaken as a fibroadenoma on an ultrasound examination or as a low-grade angiosarcoma on a histological examination. The objective of this study was to evaluate the ultrasound features and to present biopsy methods to correctly identify PASH. PATIENTS AND METHODS: We retrospectively reviewed the data of 55 women who were diagnosed with PASH of the breast. Ultrasound features were evaluated according to the Breast Imaging Reporting and Data System (BI-RADS; American College of Radiology). The diagnostic ability of different biopsy methods such as core needle biopsy, vacuum-assisted biopsy and excisional biopsy were analyzed with the final histopathological results of surgical specimens. RESULTS: PASH presented as a circumscribed solid mass, with hypoechoic texture with or without heterogeneity, and a parallel orientation. The features of small, internal cysts or vascular channels and no calcifications can be used to differentiate the lesions from fibroadenomas. A core needle biopsy misdiagnosed PASH in 13 cases out of 28 cases and vacuum-assisted biopsy correctly identified PASH in all 3 cases. CONCLUSION: Ultrasound features of PASH should be noted when performing a biopsy. For inconclusive cases of PASH, an excisional biopsy followed by an initial core biopsy should be performed.

Endoscopy-assisted breast-conserving surgery for early breast cancer.

PURPOSE: Breast-conserving surgery is now accepted as one of the standard therapeutic options for stages I and II breast cancers. Although breast-conserving surgery can help retain a good breast shape, a long marked scar would be a disadvantage. Endoscopic surgery can be performed via a small and remote incision that becomes inconspicuous after surgery. To improve the cosmetic outcome, endoscopic breast-conserving surgery, which can be performed through minimal axillary and periareolar semicircular incisions, was undertaken. METHODS AND MATERIALS: From October 2002 to October 2004, 20 breast cancer patients whose tumor sizes were less than 3 cm and who were clinically node negative without invasion to the skin and pectoralis major muscle underwent endoscopic breast-conserving surgery. First, endoscopic dye-guided sentinel node biopsy was done through a low transverse axillary incision lateral to the pectoralis major muscle. The subpectoral pocket was gently created by Vein Harvest under the view of endoscopic monitor. We made the periareolar semicircular incision to create the skin flap and to resect the tumor-containing quadrant by using Visiport and PowerStar scissors. Frozen-section biopsies were done to rule out tumor invasion to the resection margin. Patient characteristics, tumor characteristics, operation time, and amount of bleedings were all evaluated. RESULTS: The mean age of patients was 45 (range: 25-64). The mean tumor size was 2.2 cm (range: 0.2-4.0 cm). The average operation time of the early 9 cases, except the 3 cases that underwent axillary-node dissection, was 178 minutes, and that of the later 8 cases was 130 minutes (P<0.001). The mean amount of operative bleeding was 184+/-130 ml. There were no major complications. CONCLUSION: Endoscopic breast-conserving surgery is a new technique that can minimize the long operation scar of classic breast-conserving surgery. In properly selected cases, our results showed the maximized cosmetic satisfaction of the breast cancer patients and a shortened operation time after the learning period, promising it could be an alternative to the classic breast-conserving surgery.

Value of contrast-enhanced power Doppler sonography using a microbubble echo-enhancing agent in evaluation of small breast lesions.

PURPOSE: The purpose of this study was to prospectively evaluate the usefulness of contrast-enhanced power Doppler sonography (PDUS) using a microbubble echo-enhancing agent in differentiating between malignant and benign small breast lesions. PATIENTS AND METHODS: Between July 1, 2000, and September 30, 2001, we performed gray-scale sonographic examination of patients in whom diagnostic sonography or screening mammography had revealed solid breast lesions measuring less than 2 cm in the largest dimension. The patients were then examined on PDUS before and after injection of a microbubble contrast agent. The sonographic findings for all 3 techniques, as well as the morphologic features of the Doppler signals for each patient before and after injection of the contrast agent on PDUS, were independently assessed. Each lesion was classified as "benign" or "malignant" on the basis of specific criteria for sonographic interpretation. A hemodynamic study was performed in which time-transit profiles of the Doppler signals on contrast-enhanced PDUS were generated using a computer-assisted program, and the results for each patient were compared with the findings of a histopathologic examination of surgical specimens. RESULTS: Thirty-six patients (35 women and 1 man) with a mean age of 43.5 years (range, 18-69 years) were evaluated. The tumors ranged from 4 to 19 mm in the largest dimension. Histopathologic examination revealed that 19 tumors were benign and 17 were malignant. For morphologic diagnosis of the malignant lesions, the sensitivity of gray-scale sonography was 100%, compared with 29% for PDUS without contrast enhancement. The specificity of gray-scale sonography was 47%, compared with 74% for PDUS without contrast enhancement. Contrast-enhanced PDUS had a sensitivity of 71% and a specificity of 58%. The diagnostic accuracy was 72% for gray-scale sonography, 53% for PDUS without contrast enhancement, and 64% for contrast-enhanced PDUS. The time-transit profiles of the hemodynamic study did not reveal a statistically significant difference in the accuracy rates of contrast-enhanced PDUS between benign and malignant breast lesions. CONCLUSIONS: Compared with PDUS without contrast enhancement, contrast-enhanced PDUS provides better visualization of the morphology of vascular Doppler signals that is characteristic of malignancy and therefore has a higher sensitivity and diagnostic accuracy, albeit a lower specificity. In differentiating between benign and malignant small breast lesions, contrast-enhanced PDUS can be helpful when used with gray-scale sonography and PDUS without contrast enhancement.