Midline omphalovesical anomalies in children: Contribution of ultrasound imaging

Based on reports of 9 surgically proven cases, the authors stress the contribution of high-resolution sonography in the work-up of omphalovesical midline anomalies in children. Sonography (US) proved useful, especially in disorders of urachal patency (cystic mass and sinus type of the malformation). In the cystic-type mass (3 cases), a midabdominal echogenic cystic mass was demonstrated. The echogenic content resulted from infectious complication. In the sinus type, an echogenic, thickened, tubular omphalovesical tract (8–15 mm) was visualized. This tubular configuration results from the normal omphalovesical anatomy, as can be demonstrated by high-resolution US. With infection, the fascia surrounding the urachal remnants seems to limit the infection. Differential diagnosis should include vesical duplications anomalies, dystrophic calcifications of the umbilical arteries remnants, and, in case of a solid mass, urachal carcinoma. Ultrasound should be part of the work-up of any suspected urachal or other midline anomaly.     

Furosemide diminishes 18F-fluoroethylcholine uptake in prostate cancer in vivo

Purpose

¹⁸F-Fluoroethylcholine (¹⁸F-FECh) is excreted via the urinary system with high activity accumulation in the urinary bladder. Furosemide and oral hydration can be administered concomitantly to reduce urinary activity to provide better detectability of retroperitoneal and pelvic lesions. Currently it is unknown if there is any effect of furosemide on ¹⁸F-FECh uptake in organs, tissues and tumour lesions and the extent to which image quality along the urinary tract may be improved by furosemide.

Methods

We retrospectively analysed 217 ¹⁸F-FECh PET/CT examinations from 213 patients with known prostate cancer (PCa), performed either with oral hydration (109) or furosemide 20 mg together with oral hydration (108). Maximum ¹⁸F-FECh uptake in different organs, tissues, lymph nodes and osseous metastases was quantified in terms of standardized uptake value (SUV) in a volume of interest and compared between the two groups. To characterize the impact of furosemide on lesion detectability a three-point rating scale was used to assess the presence of focal activity spots in the ureters and of perivesicular artefacts.

Results

Patient characteristics and distribution of tumour lesions were well balanced between the two groups. Overall, SUVmax values from normal organs were increased after furosemide compared to the values in patients scanned without furosemide. Significant changes were observed in the salivary glands, liver, spleen, pancreas, kidneys, gluteus muscle and perirenal fat. SUVmax values were significantly decreased after furosemide in lymph node metastases (SUVmax 4.81?±?2.68 vs. 6.48?±?4.22, p?=?0.0006), but not in osseous metastases. Evaluation of image quality along the urinary tract revealed significantly better depiction of the perivesicular space and significantly less focal tracer accumulation in the ureters in patients receiving furosemide, but the number of detected lymph nodes was not significantly different.

Conclusion

Furosemide administration reduced choline uptake in tumour lesions, especially significant in pelvic lymph node metastases. Although furosemide administration improved image quality, optimal image quality may also be obtained by adequate hydration without the risk of diminishing choline uptake in PCa lesions. Therefore a controlled hydration protocol seems more appropriate than administration of furosemide.     

Cross-sectional imaging of idiopathic solitary renal vein varix: Report of two cases

Two cases of solitary renal vein varices are reported which presented as incidental findings on abdominal computed tomography (CT) and were initially thought to represent retroperitoneal lymph nodes. Contrast-enhanced CT, magnetic resonance imaging (MRI), and Doppler ultrasound (US), all demonstrated the vascular nature of these masses suggesting the correct diagnosis. When a rounded soft tissue density mass is seen on noncontrast-enhanced CT either in or contiguous to the renal hilum, a renal vein varix must be excluded. Doppler US, MRI, or dynamic contrast-enhanced CT should be done to exclude a renal varix as the cause.     

Radiological evaluation of palpable breast masses during pregnancy and lactation

Objective

To evaluate the role of different imaging modalities in the diagnosis of palpable breast masses during pregnancy and lactation.

Materials and methods

Forty eight patients with palpable breast masses during pregnancy and lactation were evaluated by Ultrasound. When Ultrasound revealed a benign lesion as cyst no further diagnostic evaluation was necessary. On the other hand, when Ultrasound demonstrated a suspicious lesion, mammography, MRI and or biopsy was performed.

Results

Ultrasound showed a well defined lesion with the criteria of benignity categorized as BI-RADS 2 in 25 cases, 20 cases as BI-RADS 3, 2 cases as BI-RADS 4 and one as BI-RADS 5. One of the 2 cases classified as BI-RADS 4 was completely obscured on mammography. According to Goettinger score, MRI categorized 4 lesions in lactating patients as 1 intermediate and 3 suspicious. Tru-cut biopsy and US guided aspiration established the pathological diagnosis in 23 cases.

Conclusion

The majority of pregnancy-associated breast masses are benign; still, a thorough evaluation of any lesion is required, in order to rule out malignancy. US constitutes the most appropriate radiologic method for evaluating breast disorders in women during pregnancy and lactation. US has a greater sensitivity than mammography in this issue. MRI is not recommended during pregnancy and shows limitation in the lactating period. MRI breast should be used for undetermined cases and for staging malignancy. When the imaging results are suspicious and for grading malignancy, biopsy should be performed to obtain a pathologic diagnosis.     

Contrast-enhanced ultrasound (CEUS) facilitated US in detecting lateral neck lymph node metastasis of thyroid cancer patients: diagnosis value and enhancement patterns of malignant lymph nodes

Objectives

To examine the value of CEUS as a non-invasive tool in detecting lateral neck metastasis (LNM) and the enhancement patterns of malignant lymph nodes (LN) for thyroid cancer patients.

Methods

Eighty-two consecutive patients, who underwent both preoperative non-enhanced US and CEUS examinations, were retrospectively reviewed. All patients underwent lateral neck dissection (LND). Enhancement patterns of 102 collected LNs matching to CEUS findings were analyzed.

Results

CEUS detected LNM in 53 of 65 patients, showing a higher sensitivity and accuracy than that of conventional US (p?=?0.109 and p?=?0.154, respectively). Thirteen patients’ surgical procedures were altered by CEUS findings, including nine true positive and four false positive cases. Five patients’ surgical procedures were altered by conventional US findings, including two true positive and three false positive cases. Heterogeneous enhancement, perfusion defects, microcalcification, and centripetal/hybrid enhancement were all specific criteria for malignant LNs in univariate analysis. In multivariate analysis, only heterogeneous enhancement and centripetal/hybrid enhancement were significantly related to LN metastasis (p?=?0.000 and p?=?0.037, respectively).

Conclusions

CEUS may be a potential tool to facilitate conventional US in detecting LNM. Heterogeneous enhancement and centripetal/hybrid enhancement are useful criteria to distinguish between malignant and benign LNs.

Key Points

? CEUS findings facilitated conventional US in detecting LNM. ? Heterogeneous, centripetal/hybrid enhancement, microcalcification and perfusion defects were specific criteria of malignant LNs. ? Heterogeneous and centripetal/hybrid enhancement were significantly related to LN metastasis in multivariate analysis.     

Effectiveness of MR Urography in the Evaluation of Kidney which Failed to Opacify during Excretory Urography: Comparison with Ultrasonography

Objective

The purpose of this study was to compare the effectiveness of MR urography (MRU) with that of ultrasonography (US) in the evaluation of urinary tract when this failed to opacify during excretory urography (EXU).

Materials and Methods

Twelve urinary tracts in 11 patients were studied. In each case, during EXU, the urinary system failed to opacify within one hour of the injection of contrast media, and US revealed dilatation of the pelvocalyceal system. Patients underwent MRU, using a HASTE sequence with the breath-hold technique; multi-slice acquisition was then performed, and the images were reconstructed using maximal intensity projection. Each set of images was evaluated by three radiologists to determine the presence, level, and cause of urinary tract obstruction.

Results

Obstruction was present in all twelve cases, and in all of these, MRU accurately demonstrated its level. In this respect, however, US was successful in only ten. The cause of obstruction was determined by MRU in eight cases, but by US in only six. In all of these six, MRU also successfully demonstrated the cause.

Conclusion

MRU is an effective modality for evaluation of the urinary tract when this fails to opacify during EXU, and appears to be superior to US in demonstrating the level and cause of obstruction.     

Evaluation of 11C-choline PET/CT for primary diagnosis and staging of urothelial carcinoma of the upper urinary tract: a pilot study

Purpose

We conducted a pilot study to prospectively evaluate the efficacy of PET/CT with ¹¹C-choline (choline PET/CT) for primary diagnosis and staging of urothelial carcinoma of the upper urinary tract (UUT-UC).

Methods

Enrolled in this study were 16 patients (9 men, 7 women; age range 51 – 83 years, mean?±?SD 69?±?10.8 years) with suspected UUT-UC. The patients were examined by choline PET/CT, and 13 underwent laparoscopic nephroureterectomy and partial cystectomy. Lymphadenectomy and chemotherapy were also performed as necessary in some of the patients. Of the 16 patients, 12 were confirmed to have UUT-UC (7 renal pelvis carcinoma and 5 ureteral carcinoma), 1 had malignant lymphoma (ureter), 1 had IgG4-related disease (ureter), and 2 had other benign diseases (ureter).

Results

Of the 16 study patients, 13 showed definite choline uptake in urothelial lesions, and of these, 11 had UUT-UC, 1 had malignant lymphoma, and 1 had IgG4-related disease. Three patients without choline uptake comprised one with UUT-UC and two with benign diseases. Of the 12 patients with UUT-UC, 3 had distant metastases, 2 had metastases only in the regional lymph nodes, and 7 had no metastases. Distant metastases and metastases in the regional lymph nodes showed definite choline uptake. The outcome in patients with UUT-UC, which was evaluated 592 – 1,530 days after surgery, corresponded to the patient classification based on the presence or absence of metastases and locoregional or distant metastases. Choline uptake determined as SUVmax 10 min after administration was significantly higher than at 20 min in metastatic tumours of UUT-UC (p?Conclusion This study suggests that choline PET/CT is a promising tool for the primary diagnosis and staging of UUT-UC.     

18F-fluorodeoxyglucose positron emission tomography combined with whole-body computed tomographic angiography in critically ill patients with suspected severe sepsis with no definite diagnosis

Purpose

Timely identification of septic foci is critical in patients with severe sepsis or septic shock of unknown origin. This prospective pilot study aimed to assess ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET), combined with whole-body computed tomographic angiography (CTA), in patients with suspected severe sepsis and for whom the prior diagnostic workup had been inconclusive.

Methods

Patients hospitalized in an intensive care unit with a suspected severe sepsis but no definite diagnosis after 48 h of extensive investigations were prospectively included and referred for a whole body FDG-PET/CTA. Results from FDG-PET/CTA were assessed according to the final diagnosis obtained after follow-up and additional diagnostic workup.

Results

Seventeen patients were prospectively included, all on mechanical ventilation and 14 under vasopressor drugs. The FDG-PET/CTA exam 1) was responsible for only one desaturation and one hypotension, both quickly reversible under treatment; 2) led to suspect 16 infectious sites among which 13 (81 %) could be confirmed by further diagnostic procedures; and 3) triggered beneficial changes in the medical management of 12 of the 17 study patients (71 %). The FDG-PET/CTA images showed a single or predominant infectious focus in two cases where CTA was negative and in three cases where CTA exhibited multiple possible foci.

Conclusion

Whole-body FDG-PET/CTA appears to be feasible, relatively safe, and provides reliable and useful information, when prospectively planned in patients with suspected severe sepsis and for whom prior diagnostic workup had been inconclusive. The FDG-PET images are particularly helpful when CTA exhibits no or multiple possible sites.     

Real-time contrast-enhanced ultrasound-guided biopsy of focal hepatic lesions not localised on B-mode ultrasound

Objective

To prospectively evaluate the technical feasibility of percutaneous real-time contrast-enhanced ultrasound (CEUS) guided biopsy of focal hepatic lesions that are not confidently localised on B-mode US.

Methods

The study included 44 patients (mean age, 61.3 years) whose biopsy target could not be confidently localised on B-mode US performed by two independent radiologists. Biopsy was attempted under the guidance of both CEUS and B-mode US simultaneously displayed on a single monitor. Final diagnosis was established based on the pathological examination of the biopsy specimen as well as on clinical and radiological follow-up.

Results

The size and depth of the target lesions were 18.0?±?9.0 mm (mean ± SD) and 41.8?±?17.2 mm respectively. Five patients with negative or indistinct CEUS findings did not undergo biopsy, while 39 patients completed the biopsy. In 38 of the 39 patients, the biopsy result was concordant with the final diagnosis. In the remaining one patient, the biopsy failed to prove metastasis. As there were six cases of technical failure, the technical success rate was 86% (38/44). The sensitivity in diagnosing malignancy was 88% (30/34).

Conclusion

Real-time CEUS-guided biopsy is technically feasible for hepatic focal lesions that are not confidently localised on B-mode US.     

The diagnostic efficiency of ultrasound guided imaging algorithm in evaluation of patients with hematuria

Purpose

To assess the efficiency of the following imaging algorithm, including intravenous urography (IVU) or computed tomography urography (CTU) based on ultrasonographic (US) selection, in the radiological management of hematuria.

Materials and methods

One hundred and forty-one patients with hematuria were prospectively evaluated. Group 1 included 106 cases with normal or nearly normal US result and then they were examined with IVU. Group 2 was composed of the remaining 35 cases which had any urinary tract abnormality, and they were directed to CTU. Radiological results were compared with clinical diagnosis.

Results

Ultrasonography and IVU results of 97 cases were congruent in group 1. Eight simple cysts were detected with US and 1 non-obstructing ureter stone was detected with IVU in remaining 9 patients. The only discordant case in clinical comparison was found to have urinary bladder cancer on conventional cystoscopy. Ultrasonography and CTU results were congruent in 30 cases. Additional lesions were detected with CTU (3 ureter stones, 1 ureter TCC, 1 advanced RCC) in remaining 5 patients. Ultrasonography + CTU combination results were all concordant with clinical diagnosis. Except 1 case, radio-clinical agreement was achieved.

Conclusion

Cross-sectional imaging modalities are preferred in evaluation of hematuria. CTU is the method of choice; however the limitations preclude using CTU as first line or screening test. Ultrasonography is now being accepted as a first line imaging modality with the increased sensitivity in mass detection compared to IVU. The US guided imaging algorithm can be used effectively in radiological approach to hematuria.     

Congenital cystic lung disease: prenatal ultrasound and postnatal multidetector computer tomography evaluation. Correlation with surgical and pathological data

Purpose

The aim of this study was to evaluate the diagnostic accuracy of postnatal multidetector computed tomography (MDCT) compared with prenatal ultrasound (US), surgical findings, and histology, in 33 patients with congenital cystic lung disease.

Methods

Thirty-three patients, 17 males and 16 females, were evaluated by MDCT. Twenty-seven of these patients underwent prenatal US between week 18 and 22, and between week 32 and 35 of gestation. Lung lobectomy, segmentectomy, atypical resection, lesion resection were performed in 31 patients and surgical specimens were analysed.

Results

Prenatal US and MDCT correctly diagnosed 76.9 and 94 % of the lesions, respectively. Disagreement occurred in six lesions with prenatal US and in two lesions with MDCT. No statistically significant differences were observed between the two techniques (P = 0.122).

Conclusions

As most surgeons consider the surgical resection of these lesions mandatory, our study underscores the essential role of imaging, in particular CT, in providing invaluable preoperative information on congenital cystic lung diseases recognised in uterus.     

Magnetic resonance imaging in fetal anomalies: What does it add to 3D and 4D US?

Objective

The objective of our study is to evaluate the contribution of adding MRI findings to sonographic data when assessing fetal anomalies and to determine how this addition may affect the management of pregnancy.

Study design

We prospectively examined 26 fetuses who had sonographically suspected congenital anomalies over a period of 1 year. 2D/3D and 4D ultrasound, Doppler and magnetic resonant imaging was done for all patients. MRI was done within 1 week following US examination. The maternal age range was 18-39 years. The gestational age range was 15-38 weeks (mean age = 29 weeks). Ultrasound and magnetic resonance findings were compared together.

Results

We reported different types of congenital anomalies including eight cases of isolated central nervous system anomalies, four abdominal, five musculoskeletal anomalies, seven cases of renal anomalies and two cases of Meckel Gruber syndrome. MRI and sonography showed concordant findings in 18 cases. MRI changed the diagnosis in five cases and provided additional information in three cases. Ultrasound was superior to magnetic resonance imaging in three cases.

Conclusion

Our results showed that fetal MR imaging can be used as a complementary modality to US in diagnosing fetal abnormality in which US findings are inconclusive or equivocal.     

The Role of Prostatic Arterial Embolization in Patients with Benign Prostatic Hyperplasia: A Systematic Review

Purpose

This study was designed to summarize the evidence on clinical outcomes and complications of prostatic arterial embolization (PAE) in patients with benign prostatic hyperplasia (BPH).

Methods

We searched Medline and Embase for PAE trials of patients with BPH upto November 2013. Two reviewers independently checked the inclusion and exclusion criteria and performed data extraction of study characteristics, quantitative and qualitative outcomes, and complications.

Results

The search yielded 562 studies, of which 9 articles with 706 patients were included. In these 9 articles, there was a possible overlap of data and the quality of 8 studies was assessed as poor. All patients had moderate-to-severe, lower urinary tract symptoms (LUTS). The mean age ranged from 63.4–74.1 years. After embolization, a decrease of the prostate volume (PV) and post void residual (PVR) was seen mainly in the first month with a further decrease up to 12 months, increasing afterwards. The prostate specific antigen (PSA) decreased up to 3 months after PAE, increasing afterwards. The peak urinary flow (Qmax) increased mainly the first month and decreased after 30 months. The international prostate symptom score (IPSS) and quality of life-related symptoms (QOL) improved mainly during the first month, with a further improvement up to 30 months. No deterioration of the international index of erectile function (IIEF) was seen after PAE. The PAE procedure seems safe.

Conclusions

Although the number of studies was small, qualitatively poor, and with overlap of patients, the initial clinical outcomes as reported up to 12 months seem positive and the procedure seems safe.     

Role of 3-dimensional ultrasonography and virtual cystoscopy in detection of bladder lesions in patients with hematuria

Objective

To study the accuracy of three-dimensional (3D) sonography and sonographic cystoscopy in diagnosing bladder tumors in patients with hematuria in comparison with two-dimensional (2D) sonography.

Patients and methods

Twenty-seven patients with hematuria underwent a trans-abdominal US for kidney and bladder. Patients with hematuria and free upper urinary tract at ultrasound underwent a 3D US and conventional cystoscopy (CS). The results of 3D US were compared with those of conventional cystoscopy.

Results

Conventional cystoscopy revealed 22 tumors in 15 patients, while 12 patients showed no bladder tumors. Overall, 3D US gave a correct diagnosis in 21 of 22 lesions (95.5%) in the 15 patients and effectively diagnosed all the 12 negative cases as being negative. Three dimensional sonography had a sensitivity of 95.5%, specificity of 100%, positive predictive value of 100% and negative predictive value of 92.3% in comparison to 81.8%, 66.7%, 81.8% and 66.7% respectively by 2D US.

Conclusion

3D US was more sensitive than 2D US in diagnosing bladder tumors in patients with hematuria.     

Diagnosis by imaging in renal and urinary tract malformations. Comparison of echography and traditional radiological studies

The diagnostic sensitivity of Ultrasound (US) was studied in 142 children with suspected kidney and urinary tract malformations. According to the clinical tests performed the patients underwent excretory urography (EU) and/or voiding cystouretrography (VCU); the results were compared to US findings. In the 75 patients with malformations, US proved to be extremely sensitive in abdominal renal ectopies, in "horseshoe" kidney, and in congenital obstructions of the ureteropelvic and vesico-ureteral junctions. US showed a higher sensitivity than EU in identifying multicystic kidney and in most cases of hypodysplasia. On the other hand, VCU was more accurate in vesico-ureteral reflux studies; US should thus be used in the follow-up of the patients undergoing medical therapy. EU must however be considered as the most important tool in the evaluation of early renal injuries and their possible development.     

Circumferential perirenal urinoma mimicking nephromegaly on urography

Four cases of circumferential perirenal urinoma in patients with cancer are described. Intravenous urography showed evidence of apparent renal enlargement. In 1 case, opacification of extravasated urine was dense enough to be seen on the urogram, and the diagnosis was confirmed by computed tomography (CT). In the other cases, sonography followed by CT diagnosed urinoma, after tumor invasion had been suggested because of the pseudonephromegaly. Ureteral obstruction was demonstrated in all cases, due to retroperitoneal adenopathy in 1 case and to pelvic tumor in the other 3. Sonography or CT is required for the diagnosis of circumferential perirenal urinoma mimicking nephromegaly urographically.     

Safety of ventilation/perfusion single photon emission computed tomography for pulmonary embolism diagnosis

Purpose

The aim of this management outcome study was to assess the safety of ventilation/perfusion single photon emission computed tomography (V/Q SPECT) for the diagnosis of pulmonary embolism (PE) using for interpretation the criteria proposed in the European Association of Nuclear Medicine (EANM) guidelines for V/Q scintigraphy.

Methods

A total of 393 patients with clinically suspected PE referred to the Nuclear Medicine Department of Brest University Hospital from April 2011 to March 2013, with either a high clinical probability or a low or intermediate clinical probability but positive D-dimer, were retrospectively analysed. V/Q SPECT were interpreted by the attending nuclear medicine physician using a diagnostic cut-off of one segmental or two subsegmental mismatches. The final diagnostic conclusion was established by the physician responsible for patient care, based on clinical symptoms, laboratory test, V/Q SPECT and other imaging procedures performed. Patients in whom PE was deemed absent were not treated with anticoagulants and were followed up for 3 months.

Results

Of the 393 patients, the prevalence of PE was 28 %. V/Q SPECT was positive for PE in 110 patients (28 %) and negative in 283 patients (72 %). Of the 110 patients with a positive V/Q SPECT, 78 (71 %) had at least one additional imaging test (computed tomography pulmonary angiography or ultrasound) and the diagnosis of PE was eventually excluded in one patient. Of the 283 patients with a negative V/Q SPECT, 74 (26 %) patients had another test. The diagnosis of PE was finally retained in one patient and excluded in 282 patients. The 3-month thromboembolic risk in the patients not treated with anticoagulants was 1/262: 0.38 % (95 % confidence interval 0.07–2.13).

Conclusion

A diagnostic management including V/Q SPECT interpreted with a diagnostic cut-off of “one segmental or two subsegmental mismatches” appears safe to exclude PE.     

Diagnostic Performance of Ultrasound for Macroscopic Hematuria in the Era of Multidetector Computed Tomography Urography

Purpose

The objective of this study was to evaluate the diagnostic performance of ultrasound for detecting urinary tract neoplasm in the setting of macroscopic hematuria by using multidetector computed tomography urography (MDCTU) and cystoscopy as the reference standard.

Methods

This retrospective study was approved by our institutional review board. Patients with macroscopic hematuria who were investigated with an abdominal or renal ultrasound, an MDCTU, and a cystoscopy between January 2007 and December 2009, were eligible (95 patients). Exclusion criteria were time interval >12 months between index and reference tests or the absence of histopathologic proof of malignancy. Ultrasound results of the remaining 86 patients were collected and compared with the reference standard test, which was the combination of MDCTU for the assessment of upper urinary tract and cystoscopy for assessment of the lower urinary tract. The final diagnosis of neoplasm was based on pathologic findings.

Results

Urinary tract neoplasm was diagnosed in 20% of the patients (17/86). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of ultrasound for detecting urinary tract neoplasms were 35.3% (6/17), 89.9% (62/69), 46.2% (6/13), 84.9% (62/73), 3.48 (95% confidence interval, 1.34-9.02), and 0.72 (95% confidence interval, 0.5-1.3), respectively.

Conclusion

Sensitivity of ultrasound for the evaluation of macroscopic hematuria in the era of MDCTU is lower than expected. Results of our study suggest that patients with macroscopic hematuria should undergo MDCTU as first-line imaging modality, with little added benefit from ultrasound.     

The association of aorto-iliac aneurysms with ureteral obstruction

Aorto-iliac aneurysms may entrap the ureters in perianeurysmal fibrosis, causing medial ureteral deviation and/or obstruction. The latter has been described only in male patients; a further 5 cases due to iliac and 3 to aortic aneurysm are reported. The radiologic picture resembles retroperitoneal fibrosis; the correct diagnosis may be suggested when ureteral tethering or narrowing lies near arterial calcification. Sonography is usually the most appropriate investigation to confirm the diagnosis. When sonography shows an aortic aneurysm, the kidneys should be scanned to rule out hydronephrosis. Similarly, films of the kidneys should be obtained when an abdominal aneurysm is demonstrated by aortography.     

Value of FNAC in abnormal axillary lymph nodes with non specific mammograms

Objective

This study aimed to evaluate the role of fine-needle aspiration cytology (FNAC) in the diagnosis of abnormal axillary lymph nodes identified in patients with nonspecific mammographic findings.