Diffusion-weighted magnetic resonance imaging in focal breast lesions: analysis of 78 cases with pathological correlation

Purpose

This study assessed the usefulness of magnetic resonance diffusion-weighted imaging (DWI) in distinguishing between benign and malignant breast lesions.

Materials and methods

Gadolinium-enhanced magnetic resonance imaging (MRI) and DWI with determination of the apparent diffusion coefficient (ADC) were performed on 78 women, each with a focal breast lesion at least 7 mm in diameter, which was studied by cytology or histology.

Results

Final diagnoses were obtained by cytology in 29 cases and histology in 49 (11 percutaneous biopsies and 38 surgical specimens). There were 43 benign lesions (13 fibrocystic disease, eight fibroadenoma, seven adenosis, five normal breast tissue, four inflammatory lesions, three intramammary lymph nodes, two scleroelastosis and one fat necrosis) and 35 malignant lesions (30 invasive ductal carcinoma, two invasive lobular carcinoma, one ductal carcinoma in situ, one carcinomatous mastitis and one metastasis from neuroendocrine carcinoma). The mean ADC values were 1.677±0.151 for benign lesions and 1.298±0.129 for malignant lesions (p<0.001). With an ADC cutoff value of 1.48, DWI had 88.6% sensitivity [confidence interval (CI) 78.1%?C99.1%] and 95.3% specificity (CI 88.9%?C100%), with 31 true positives, four false negatives (three invasive ductal carcinoma and one carcinomatous mastitis), 41 true negatives and two false positives (one fat necrosis and one fibroadenoma). With the cutoff value set at 1.52, DWI sensitivity (35 true positive, no false negative) was 100% and specificity was 86% (CI 75.7%?C96.3%) due to 37 true negatives and six false positives (an additional two fibroadenoma and two fibrocystic disease compared with those recorded with the cutoff set at 1.48). The overall accuracy of DWI considering both cutoff values (72 correct evaluations out of 78 cases) was 92.3% (CI 86.4%?C98.2%).

Conclusions

DWI is a reliable tool for characterising focal breast lesions.     

Ultrasonography in lesions of the rotator cuff and biceps tendon

Ultrasonography (US) of the shoulder joint was performed in 88 patients, 15 of whom were referred for surgery. US was made with a real-time linear-array scanner, provided with a transducer of 7.5 MHz. Subsequently, all patients underwent single-contrast arthrography of the shoulder. When compared with the arthrographic findings, diagnosis by US showed 21 true positive, 3 false positive, 57 true negative and 7 false negative cases of a full-thickness tear of the rotator cuff. Small tears (2 cm or less in diameter) may be the most difficult to assess. US readily revealed biceps tendinitis and rupture of the biceps tendon, as well as fluid collection in the bursae above the rotator cuff tendons.     

Scintimammography in conjunction with ultrasonography for local breast cancer recurrence in post-mastectomy breast

The aim of this study was to compare the usefulness of (99)Tc(m)-methoxy-isobutyl-isonitrile (MIBI) scintimammography and ultrasonography, alone and in combination, for the detection of chest wall recurrence in the post-mastectomy breast. A total of 41 consecutive post-mastectomy patients (mean age 46.6 years; median age 45 years) with clinical suspicion of breast cancer recurrence were evaluated. For scintimammography all patients received a 740-900 MBq iv injection of (99)Tc(m)-MIBI; planar images were taken 5-10 min post-injection followed by supine single photon emission CT. Breast ultrasonography was performed in each patient using a 7.5 MHz transducer. Both MIBI uptake and ultrasound findings were documented using standard protocols. All patients had fine needle aspiration cytology biopsy (FNAC), core biopsy or excision biopsy for final tissue diagnosis. Of the 41 patients, 24 had true positive signs of local breast cancer recurrence upon ultrasonography, 10 were diagnosed as true negatives, a sensitivity of 86%, specificity 77%, positive predictive value (PPV) 89%, negative predictive value (NPV) 71% and accuracy 83% (p = 0.001). By comparison, scintimammography findings were found to be true positive in 25 patients and true negative in 12 patients - sensitivity 89%, specificity 92%, PPV 96%, NPV 80% and accuracy 90% (p = 0.001). Using a combination of these two modalities, the combined sensitivity was 100%, specificity 77%, PPV 90%, NPV 100% and accuracy 93%. The high NPV of the two studies in combination implies a potential use of this approach to exclude recurrent disease in patients with a low initial index of suspicion and/or when histology is indeterminate.     

Diagnostic potential of targeted electrical impedance scanning in classifying suspicious breast lesions.

RATIONALE AND OBJECTIVE: To evaluate the potential of targeted electrical impedance scanning (EIS) for classifying suspicious breast lesions. METHODS: EIS was performed in full knowledge of mammographic findings and findings of clinical breast examination. One hundred seventeen patients with a total of 129 breast lesions were examined with EIS before breast biopsy (surgical excision or vacuum core biopsy). Diagnostic indexes of targeted EIS were calculated depending on major lesion characteristics. Capacitance and conductivity of all positive spots (S) and the surrounding normal breast tissue (NBT) were quantified using ROI measurements. The ratio S/NBT was calculated to compare true positive (n = 44) and false positive (n = 18) spots. RESULTS: With respect to histology, of the 129 lesions 71 were malignant and 58 lesions were benign. Overall sensitivity of targeted EIS was 62%, specificity 69%, PPV 71%, and NPV 60%. Sensitivity of EIS varied depending on the tumor size, which was between 48% (> 20 mm) and 71% (11-20 mm). Highest specificity (86%) was observed for large lesions (> 20 mm); however, the NPV was only 35% for lesions of that size. NPV was higher for nonpalpable lesions (74%) and clusters of microcalcifications (85.7%) compared with palpable lesions (39%) and solid lesions (44%). There was no statistical difference of S/NBT ratio neither for conductivity nor capacitance of true and false positive spots. Compared with true positive spots a trend of a higher conductivity ratio at 100 Hz and 200 Hz was seen for false positive spots. CONCLUSION: EIS showed mediocre overall diagnostic accuracy for classifying suspicious breast lesions. Quantitative analysis of positive EIS findings did not help to differentiate between false and true positive spots.     

Diagnostic accuracy of radionuclide imaging using 131I nor-cholesterol or meta-iodobenzylguanidine in patients with hypersecreting or non-hypersecreting adrenal tumours

The aim of this retrospective study was to evaluate the diagnostic accuracy of nor-cholesterol and meta-iodobenzylguanidine radionuclide imaging in two separate groups of patients with adrenal tumours to characterize lesions as adenoma or pheochromocytoma. We studied 75 patients (22 male and 53 female, mean age 47 +/- 15 years) with hypersecreting (n = 32) or non-hypersecreting (n = 43) unilateral adrenal tumours detected by computerized tomography or magnetic resonance scans. 131I nor-cholesterol adrenal scintigraphy was performed in 41 patients. Meta-[131I]iodobenzylguanidine (131I-MIBG) imaging was acquired in the other 34 patients. Pathology examinations (n = 58) or computerized tomography follow-up studies (n = 17) were obtained. Adrenal lesions were represented by 44 adenomas, four cysts, one myelolipoma, one pseudotumour, one ganglioneuroma, 16 pheochromocytomas, three carcinomas, four metastases and one sarcoma. Radionuclide studies were qualitatively evaluated and the corresponding results were classified as true positive, true negative, false positive and false negative. Diagnostic sensitivity, specificity and accuracy as well as positive and negative predictive values were calculated. The diagnostic values of nor-cholesterol scintigraphy in identifying adrenal adenomas were sensitivity 100%, specificity 71%, accuracy 95%, positive predictive value 94% and negative predictive value 100%; of note, two false positive cases were observed represented by a pheochromocytoma and a myelolipoma. The diagnostic values of MIBG scintigraphy in recognizing pheochromocytoma were sensitivity 100%, specificity 95%, accuracy 97%, positive predictive value 94% and negative predictive value 100%; only one false positive case occurred consisting of a carcinoma. It is concluded that, in the large majority of cases, adrenal scintigraphy using nor-cholesterol or MIBG is able to characterize specific lesions such as adenoma and pheochromocytoma, respectively. These findings show relevant clinical impact, particularly in patients with non-hypersecreting adrenal lasions. Radiotracer selection depends on clinical patient history and department availability; since benign adenomas are the most common cause of non-hypersecreting tumours, nor-cholesterol should be the first choice followed by MIBG if nor-cholesterol shows normal images. However, rare as well as unusual findings may be observed; nor-cholesterol uptake may occasionally be also found in non-adenoma tumours such as myelolipoma and pheochromocytoma. Similarly, MIBG accumulation may occur not only in lesions arising from medullary chromaffin tissue, but also rarely in cortical adrenal carcinoma.     

18F-FDG符合线路显像对食管癌术后复发转移的诊断价值

目的 探讨^18F-脱氧葡萄糖（FDG）符合线路显像对食管癌术后复发转移的诊断价值。方法 对29例临床怀疑复发转移的食管鳞状细胞癌术后患者行^18F-FDG符合线路显像，计算其诊断复发转移灶的灵敏度、特异性和准确性，并与CT诊断结果比较。结果 29例患者中符合线路显像真阳性19例，真阴性6例，假阳性、假阴性各2例，其诊断食管癌术后复发转移的灵敏度、特异性和准确性分别为90．5％（19／21例）、75．0％（6／8例）和86．2％（25／29例）；而CT诊断的灵敏度、特异性和准确性分别为71．4％（15／21例）、87．5％（7／8例）和75．9％（22／29例）。在符合线路显像与CT检查均阳性的13例患者中，CT检出病灶20个；而符合线路显像检出27个，比CT多检出的病灶包括食管癌复发，锁骨上、纵隔和肺门淋巴结及骨转移。结论 ^18F-FDG符合线路显像对食管癌术后复发转移的诊断具有较高的临床价值，尤其在临床疑有复发转移而常规影像学检查阴性时有重要意义。     

Common occurrence of benign liver lesions in patients with newly diagnosed breast cancer investigated by MRI for suspected liver metastases.

The purpose of this study was to determine the prevalence of benign liver lesions in patients with breast cancer who are referred to magnetic resonance (MR) imaging for suspected breast cancer metastases at initial presentation. The original MR imaging reports of consecutive patients with breast cancer were reviewed; these patients had undergone MR imaging at our institution to investigate for suspected breast cancer liver metastases, at initial presentation between April 1993 and May 1998. Determination of the presence of benign and malignant liver lesions in each patient was made, as well as their relative frequencies. Diagnostic accuracy of MR imaging was evaluated by correlation with histologic specimens (5 patients) and imaging follow-up (27 patients). Thirty-four patients with newly diagnosed breast carcinoma were evaluated with MR imaging. A total of 11 (32%) of these patients had benign lesions only. Of 21 (62%) total patients who had malignant liver lesions, 19 had breast cancer metastases (2 had coexistent benign lesions), 1 had metastatic carcinoid, and 1 had hepatocellular carcinoma. No liver lesions were detected in two patients (6%). In one patient with biopsy-proven subcentimeter breast metastases, no focal lesions were shown on MR imaging. No other diagnostic errors in classification of liver lesions by MR imaging occurred, as shown by clinical correlation and imaging follow-up in all patients. True positive detection of malignant liver lesion was 20/21, true negative was 13/13, false positive was 0/13, and false negative was 1/21, for a sensitivity of 95% and a specificity of 100% for the detection of malignant liver lesions. Benign liver lesions are common in breast cancer patients suspected clinically of having liver metastases. Benign lesions alone were observed in one-third of our patients. The high diagnostic accuracy of MR imaging in the evaluation of hepatic lesions underscores the value of this technique for baseline investigation of breast cancer patients with clinically suspected liver metastases, particularly patients in whom treatment approaches are dramatically affected by the presence of liver metastases. J. Magn. Reson. Imaging 1999;10:165-169.     

Diagnostic accuracy of breast sonography. Comparison among three different techniques]

Mechanical arc scanning is widely used for breast sonography in Japan. The authors have used three different kinds of devices over the past seven years. The diagnostic accuracy was compared among three groups of patients with pathologically confirmed breast masses. In group A, 309 cases (77 carcinomas) were evaluated with a 10 MHz contact compound scanner, and the sensitivity, specificity and accuracy rates were 77.9%, 97.8% and 92.9%, respectively. In group B, 306 cases (56 carcinomas) were evaluated with a 5 or 7.5 MHz mechanical arc scanner, and the sensitivity, specificity and accuracy rates were 89.3%, 84.8% and 85.6%, respectively. In group C, 296 cases (71 carcinomas) were evaluated with a 7.5 MHz real time scanner, and the sensitivity, specificity and accuracy rates were 95.8%, 92.4% and 93.2%, respectively. In cases with T1 breast cancer, the methods had sensitivities of 60.0%, 85.7% and 94.5%, respectively. The sensitivity of the real-time scanner was not significantly different from that of the mechanical arc scanner. In conclusion, the hand-held real-time scanner with high-frequency transducer is a simple, useful device with high diagnostic accuracy for breast examination and can be used as a substitute for the mechanical arc scanner.     

Ultrasound-guided core needle biopsy of non-palpable breast lesions: a prospective analysis in 204 cases

Purpose: To assess the diagnostic value of ultrasound (US)-guided 14 G core needle breast biopsy in non-palpable suspicious breast lesions.

Material and Methods: From August 1997 to April 2001, 198 patients with 204 suspicious non-palpable breast lesions underwent US-guided large core needle biopsy. Biopsies were performed with a free-hand technique using US equipment with a 7.5 MHz linear-array transducer; a minimum of three cores were obtained from each lesion. Pathological findings in US-guided core biopsy were correlated to findings in subsequent surgery or long-term (more than 2 years) imaging follow-up.

Results: Among the 204 non-palpable breast lesions for which histopathological findings were obtained by US-guided core biopsy, 118 were malignant (114 carcinoma, 2 metastasis, 1 lymphoma, and 1 malignant phyllodes tumor) and 86 were benign (4 carcinoma and 82 benign lesions confirmed at surgery or after at least 2 years of follow-up). Sensitivity, specificity, positive predictive value, and negative predictive value for diagnosis of malignancy in our series were 97%, 100%, 100%, and 95%, respectively. Diagnostic yield with 1, 2, 3, and 4 specimens per lesion was 73.5%, 88%, 94%, and 97.5%, respectively.

Conclusion: US-guided core needle biopsy is a sensitive percutaneous biopsy method for diagnosing non-palpable breast lesions. To achieve a high diagnostic yield, a minimum number of three cores per lesion is advisable.     

Differentiation of benign and malignant breast lesions: A comparison between automatically generated breast volume scans and handheld ultrasound examinations

Objective

To assess the diagnostic value of automated breast volume scanning (ABVS) or conventional handheld ultrasonography (HHUS) for the differentiation of benign and malignant breast lesions.

Materials and methods

The study prospectively evaluated 239 lesions in 213 women who were scheduled for open biopsy. The patients underwent ABVS and conventional HHUS. The sensitivity, specificity, accuracy, false positive rate, false negative rate, and positive and negative predictive values for HHUS and ABVS images were calculated using histopathological examination as the gold standard. Additionally, diagnostic accuracy was further evaluated according to the size of the masses.

Results

Among the 239 breast lesions studied, pathology revealed 85 (35.6%) malignant lesions and 154 (64.4%) benign lesions. ABVS was similar to HHUS in terms of sensitivity (95.3% vs. 90.6%), specificity (80.5% vs. 82.5%), accuracy (85.8% vs. 85.3%), positive predictive value (73.0% vs. 74.0%), and negative predictive value (93.3% vs. 94.1%). The area under the receiver operating characteristic (ROC) curve, which is used to estimate the accuracy of the methods, demonstrated only minor differences between HHUS and ABVS (0.928 and 0.948, respectively).

Conclusions

The diagnostic accuracy of HHUS and ABVS in differentiating benign from malignant breast lesions is almost identical. However, ABVS can offer new diagnostic information. ABVS may help to distinguish between real lesions and inhomogeneous areas, find small lesions, and demonstrate the presence of intraductal lesions. This technique is feasible for clinical applications and is a promising new technique in breast imaging.     

Cervical ultrasound combined with parathyroid hormone assay prior to parathyroid exploration

The purpose of this study was to analyse ultrasound (US) findings and US-guided fine needle aspirations (FNAs) for parathyroid hormone (PTH) in pre-operative evaluation prior to parathyroid exploration. Thirteen patients with primary hyperparathyroidism (pHTP) underwent cervical US combined with FNAs. Fourteen suspected lesions were aspirated and the patients were operated on. The US examinations were performed with a real-time scanner using a 7.5-MHz transducer and the direct contact method. The aspiration method was modified according to Doppman et al. (1983), the main differences being that US instead of CT-guidance was used and an immunoradiometric assay was performed for the direct quantitative determination of intact PTH instead of a mid-region specific radioimmunoassay. The freehand technique was employed, using needles with an outer diameter of 0.55–0.6 mm, and the aspirated material (1–2 drops of blood) was dissolved in 1 ml saline. Ice was used to freeze the sample immediately.Normal serum PTH (s-PTH) varies from 10 to 55 ng/l, while the s-PTH of these 13 patients varied from 86 to 188 ngl/. The values for PTH in the suspect parathyroid lesions varied from 6 to 78,400 ng/l. Of the 14 lesions aspirated, there were 11 true positive, two true negative, and one false negative findings. The diagnostic accuracy of this method was 93%, its sensitivity 92% and its specificity 100%.US combined with FNA for PTH assay is the primary imaging method of choice prior to parathyroid re-exploration, prior to more invasive imaging methods, prior to sclerotherapy and before primary parathyroid exploration in selected problem cases.     

CT对急性阑尾炎的诊断价值

目的 评价CT扫描对急性阑尾炎的诊断价值：方法对临床怀疑急性阑尾炎患者48例均做CT平扫，层厚10mm、间距10mm，扫描范围从腰3椎体至耻骨联合。CT诊断急性阑尾炎的标准包括阑尾增粗横径超过6mm，阑尾结石伴阑尾周围炎性改变；CT诊断结果与手术病理结果进行对照。结果CT检查发现29例真阳性，15例真阴性，3例假阴性和1例假阳性。CT诊断急性阑尾炎的敏感性为90％，特异性为96％，准确性为9l％，阳性预测值93％，阴眭预测值为83％。15例无阑尾炎患者、CT发现其他病变11例（73％）。结论CT对急性阑尾炎诊断具有高度的敏感性、特异性和准确性。对真阴性患者可发现其他各种病变。     

Gadobenate dimeglumine as a contrast agent for dynamic breast magnetic resonance imaging: effect of higher initial enhancement thresholds on diagnostic performance

RATIONALE AND OBJECTIVE: Gadobenate dimeglumine (Gd-BOPTA), a high-relaxivity contrast agent, has been recently proposed for dynamic MR imaging of the breast. The objective of this study was to optimize the diagnostic performance of Gd-BOPTA-enhanced dynamic breast MR imaging by using adjusted initial enhancement thresholds. METHODS: Thirty-four patients with 36 breast lesions (malignant/benign = 28/8) underwent dynamic breast MRI with 0.1 mmol/kg Gd-BOPTA and 120-second time resolution. A score system based on shape (round/oval/lobular = 0; linear/dendritic/stellate = 1), margins (defined = 0; undefined = 1), pattern (homogeneous = 0; inhomogeneous = 1; rim = 2), kinetics (continuous = 0; plateau = 1; washout = 2), and initial enhancement was used. Initial enhancement was determined with standard (<50% = 0; 50%-100% = 1; >100% = 2) and adjusted (<100% = 0; 100%-240% = 1; >240% = 2) thresholds. Scores of 0 to 3 indicated benign lesions and scores of 4 to 8 malignant lesions. Diagnostic performance was assessed in terms of sensitivity, specificity, positive and negative predictive values, and overall accuracy. RESULTS: The initial enhancement was >100% for 26 malignant and 7 benign lesions and >240% for 16 and 1 lesions, respectively. The overall score was 5.89 +/- 1.34 with standard thresholds and 5.50 +/- 1.53 with adjusted thresholds (P = 0.003) for cancers, 4.00 +/- 1.93 and 3.25 +/- 1.75 (P = 0.028) for benign lesions, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy was 96%, 13%, 79%, 50%, and 78%, respectively, with standard thresholds and 96%, 75%, 93%, 86%, and 92%, respectively, with adjusted thresholds. A ductal carcinoma in situ was false negative whereas a fat necrosis and a papilloma were false positive with both thresholds. Three fibroadenomas, 1 adenosis, and 1 fibrosis were false positive with standard thresholds but true negatives with adjusted thresholds. CONCLUSIONS: Lesion characterization with Gd-BOPTA requires higher thresholds for initial enhancement than those used with conventional Gd-chelates, leading to improved specificity, predictive values, and accuracy.     

Differential diagnosis of solitary pulmonary nodules based on 99mTc-EDDA/HYNIC-TOC scintigraphy: the effect of tumour size on the optimal method of image assessment

Purpose The aim of the study was to determine an optimal method for the evaluation of scintigrams obtained with ^99mTc-EDDA/HYNIC-TOC for the purpose of differential diagnosis of solitary pulmonary nodules (SPNs) and to assess the diagnostic value of the method. Methods Eighty-five patients (48 males and 37 females, mean age 57 years, range 34–78 years) were enrolled in the study. Patients underwent ^99mTc-EDDA/HYNIC-TOC scintigraphy for the purpose of differential diagnosis of SPNs (size between 1 and 4 cm). Images of all patients were evaluated visually in a prospective manner. Results Positive scintigraphic results were found in 37 out of 40 (93%) patients with malignant SPNs including 34 out of 35 (97%) patients with primary lung carcinoma. Two remaining false negative cases turned out to be metastatic lesions of malignant melanoma and leiomyosarcoma. Among 45 benign tumours, negative results were obtained in 31 cases (69%) and positive results in 14. The accuracy of the method was 80%. Analysis of the results of the visual assessment of scintigrams revealed a significantly higher frequency of false positive results among larger nodules (diameter at least 1.4 cm). Uptake of the tracer in those nodules was therefore assessed semi-quantitatively (using the tumour-to-background ratio), in expectation of an improvement in the low specificity of the visual method. The semi-quantitative assessment reduced the total number of false positive results in a subgroup of larger nodules from 13 to six, while preserving the high sensitivity of the method. Conclusion The combination of visual analysis (for lesions smaller than 1.4 cm in diameter) and semi-quantitative assessment (for larger lesions) provided a high sensitivity of the method and significantly improved its specificity (84%) and accuracy (88%) in comparison with visual analysis (p<0.05).     

Role of axillary lymph node ultrasound and large core biopsy in the preoperative assessment of patients selected for sentinel node biopsy

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy of axillary lymph node sonography, if necessary in combination with US-guided large core biopsy, in the preoperative evaluation of breast cancer patients scheduled for quadrantectomy and sentinel lymph node excision. MATERIALS AND METHODS: From July 2001 to December 2002, we evaluated 117 breast cancer patients with ultrasound and, where indicated, FNAB. Breast lesions had diameters between 4 and 26 mm (mean diameter 11 mm). Fifteen (13%) of the 117 patients were excluded from the series as they did not fulfil the criteria for preliminary sonography of the axilla: in 9 patients fewer than 4 nodes were detected and in 6 patients the breast lesions were intraoperatively found to be benign. Eleven patients (10.7 %) with sonographically suspicious axillary nodes were sampled by US-guided core biopsy using a 14 or 16 Gauge Tru-Cut needle. RESULTS: The ultrasound study aims to evaluate the dimensions and morphology of the breast lesion as well as detect and assess at least 4 axillary nodes. These were evaluated for hilar and cortical thickening and ratio between the sinus diameter and the total longitudinal diameter. Lymph nodes with hilar diameters equal to or greater than 50% of the longitudinal diameter were considered normal. Of the 102 patients evaluated, 77 (75.7%) had normal axillary nodes according to the US criteria adopted. Negativity was confirmed by histology in 56 cases (72.7%, true negative); 21 (27.3%, false negative) were found to be positive, in contrast with the sonographic appearance. The false negative cases were due to lymph node micrometastasis which probably did not cause morphologic alterations perceptible at ultrasound. The remaining 25 patients (24.5%) had axillary lymph nodes classified as suspicious. In 13 cases of (52%, true positive) there was agreement with histology, whereas in 12 cases (48%, false positive) the US suspicion was not confirmed at surgery. The most important sonographic alteration was the gradual reduction in hilar echogenicity (seen in 100% metastatic nodes); conversely, hilar denting or irregularities, as well as dimensional criteria, proved to be poorly specific. CONCLUSIONS: The sonographic assessment of axillary and internal mammary chain nodes, possibly in addition to core biopsy, improves the preoperative evaluation of breast cancer patients scheduled for conservative surgery of the breast (quadrantectomy) and the axilla (sentinel node biopsy). US findings suspicious for metastatic involvement of axillary lymph nodes should be considered as an exclusion criterion for sentinel node biopsy. A more widespread use of axillary node biopsy and an accurate sonographic evaluation of the excised lymph node increase the specificity of the procedure, allowing a better correlation between sonographic findings and definitive histology.     

Impact of PET/CT in comparison with same day contrast enhanced CT in breast cancer management

PURPOSE: To evaluate the impact of F-18 fluorodeoxyglucose (FDG) positron emission tomography with fused computerized tomography (PET/CT) in comparison with same day contrast enhanced CT (CE-CT) in breast cancer management. METHOD: Seventy studies in 49 breast cancer patients, 17 for initial and 53 for restaging disease were included. All patients underwent PET/CT for diagnostic purposes followed by CE-CT scans of selected body regions. PET/CT was started approximately 90 minutes following IV injection of 10-15 mCi of F-18 FDG on a GE Discovery PET/CT system. Oral contrast was given before F-18 FDG injection. The CE-CT was performed according to departmental protocol. RESULTS: Out of a total of 257 lesions, 210 were concordant between PET/CT and CE-CT. There were 47 discordant lesions, which were verified by either biopsy (35) or follow-up (12 PET positive CE-CT negative lesions). PET/CT correctly identified 25 true positive (TP). CE-CT identified 2 TP lesions missed by PET/CT which were false negatives (FNs): one liver metastasis with necrosis, which was nonavid to FDG uptake because of necrosis and a second one missed on abdominal metastatic node, which did not change staging or treatment. PET/CT incorrectly identified 2 false positive lesions while CE-CT incorrectly identified 18 false positive. TP recurrence of the disease was found by PET/CT in 44% (15/34 pts), whereas 56% (19/34 pts) were free of disease. The CE-CT described progression of the disease in 1 true negative PET/CT study and no progression in 2 TP PET/CT studies. The sensitivity, specificity, accuracy, positive productive value, and negative productive value for PET/CT were 97.8%, 93.5%, 97.3%, 99.1%, 85% and for CE-CT were 87.6%, 42%, 82.1%, 91.6%, 31.7%. CONCLUSION: In this study, PET/CT played a more important role than CE-CT scans alone and provided an impact on the management of breast cancer patients.     

高频超声与X线钼靶对早期乳腺癌的诊断价值

目的 分析比较高频超声、X线钼靶单独及两者联合应用对早期乳腺癌的诊断价值.方法 体检发现乳腺包块、怀疑乳腺肿瘤的258例患者,行高频超声、X线钼靶的单独检查和联合检查,并行手术治疗.对照分析手术病理与影像学表现.结果 258例患者,手术病理证实早期乳腺恶性肿瘤135例,良性乳腺肿瘤123例.对于诊断早期乳腺癌,联合检查的敏感性优于单独的高频超声检查或X线钼靶检查(P<0.05),准确性优于X线钼靶检查(P<0.05),特异性、阳性预测值、阴性预测值、假阳性、假阴性等指标3组间均无显著差异(P均>0.05).对于早期乳腺癌患者,高频超声和X线钼靶相比,检出的钙化灶较少(18.3% vs 36.5%,P<0.01),能够发现更多的乳腺癌腋窝淋巴结转移(69.0% vs 33.3%,P<0.01).结论 高频超声与X线钼靶的单独和联合检查对于早期乳腺恶性肿瘤均为可靠的影像学诊断方法,联合应用诊断早期乳腺癌具有较高的敏感性和准确性.     

Imaging investigation of pancreatic cystic lesions and proposal for therapeutic guidelines

AIM:To propose a diagnostic algorithm for preoperatively predicting the need for surgical intervention.METHODS:The study included 56 patients(27 men and 29 women) with a final diagnosis of cystic pancreatic lesions.The following materials were used:ultrasonic equipment with 3.5 and 7 MHz linear,convex and biopsical transducers.Multidetector computed tomography(MDCT) investigations were performed using a 16-slice scanner.Images were obtained following the oral administration of 200 mL water and 100 mL intravenous iopamidol(300 mg/mL) administered by pump injector at a rate of 3 mL/s(40 and 60 s post-injection,respectively) using 0.5 mm detectors,reconstructed at 1 mm(pancreatic phase) or 2 mm(portal venous phase) increments.The table feed was 10 mm per rotation.Images were acquired in the pancreatic and portal venous phases of contrast enhancement.The "Chiba" needles 18,20,22,23 G and an automatic aspiration system were used in conjunction with the followingmethods of guiding the interventional procedures:(1) "free-hand" biopsy and puncture method under ultrasound(US) or computed tomography(CT) control;(2) guiding method using biopsical transducer.RESULTS:All 56 patients in this study underwent at least two cuts imaging survey methods,such as US,CT or magnetic resonance imaging(MRI).The most common preoperative diagnostic examination was US scan-56 patients(100%).MDCT studies were conducted in 49(87.50%) and MRI in 13(23.21%).More than half of patients surveyed(37) underwent some type of interventional procedure:25-fine-needle aspiration and 29-fine needle aspiration biopsy(FNAB),as part of the examination.Thirty-four patients of all 56 patients underwent surgery because of histological evidence of malignancy after the FNAB for cystic lesions of the pancreas.Distal pancreatectomy with splenectomy was the most common operative approach in 13 patients,followed by Whipple resection in 11 and distal pancreatectomy without splenectomy in 7.Three patients were treated with total pancreatectomy due to the presence of a multifocal mucinous neoplasm.Comparing the diagnostic results of US examination with those of MDCT examination and histological verification true positive results were found in 31 patients,true negative in 11 patients,false positive in 5 and false negative in 9 patients.Accordingly we estimated the power of the diagnostic imaging methods for cystic lesions of the pancreas.A specificity of 68.75%,sensitivity of 79.48%,accuracy of 75.00%,positive predictive value of 86.11% and negative predictive value of 55% were obtained.The power increased after applying invasive procedures with immunohistochemical analysis of CEA and P-53(Fig.4).In 15 patients with cytological feature of malignant tumour cells,the tumour markers were positive.In our opinion the higher the percentage of reacting cells the higher the percent of malignancy.In patients with clear symptoms and/or clear imaging features of malignant or premalignant cystic neoplasm,the need for surgery was confirmed by histological verification in 34(60.71%) of cases.CONCLUSION:By using the proposed algorithm,cystic mucinous tumors of the pancreas were detected and proper operative interventions would have been rendered with fewer diagnostic examinations.     

Magnetic resonance imaging versus arthroscopy for the investigation of the osteochondral humeral defect in anterior shoulder instability

A double-blind prospective study was done with 15 patients with anterior shoulder instability to determine the diagnostic efficacy of magnetic resonance (MR) imaging versus arthroscopy in the evaluation of chondral or osteochondral lesions of the humeral head. MR produced 6 true positives, 5 true negatives and 4 false negatives, and its accuracy and sensitivity were 60% and 87%, respectively, whereas arthroscopy gave 8 true positives, 5 true negatives and 2 false negatives, with a sensitivity of 80% and an accuracy of 87%. All lesions diagnosed with either method were regarded as positive by definition, with the result that the specificity was always 100%. The differences in diagnosis sprang from the false negatives. The 40% discrepancy between the two methods was probbly due to our distinction in MR between intra- and extraarticular osteochondral lesions. In the first group (the 4 MR false negatives), there were three instances of firstdegree intra-articular lesion and one diagnostic error (third-degree lesion). In the second (the 2 arthroscopy false negatives), the lesions were of the extra-articular type. It is thus advisable to employ both of these methods to ensure the correct diagnosis of a Hill-Sachs lesion, and hence the correct choice of treatment.     

MRI动态增强扫描在乳腺良恶性病变中的诊断价值

目的:评价MRI动态增强扫描在乳腺良恶性病变中的诊断价值。方法:回顾性分析58例经病理证实的乳腺病变的MRI动态增强扫描强化形态及时间-信号强度曲线图表现。结果:良性病变共22例(纤维腺瘤8例,导管内乳头状瘤5例,乳腺囊肿5例,导管囊状扩张伴慢性炎症1例,囊性乳腺病3例);恶性病变共36例(浸润性导管癌28例,浸润性小叶癌3例,导管原位癌2例,浸润性乳头状癌2例,髓样癌1例)。恶性病变多表现为边缘毛刺、分叶征或边缘模糊,环状强化或不规则强化。良性病变多表现为边缘光滑整齐的均匀强化,其中5例囊肿无强化。其中形态学阳性预测值为89.47%,阴性预测值为90.00%,准确率为89.66%。强化表现阳性预测值为89.74%,阴性预测值为94.74%,准确率为91.38%。时间-信号强度曲线图:22例良性病变,13例(59.09%)表现为Ⅰ型,8例(36.36%)表现为Ⅱ型,1例(4.55%)表现为Ⅲ型;36例恶性病变,1例(2.78%)表现为Ⅰ型,9例(25.00%)表现为Ⅱ型,26例(72.22%)表现为Ⅲ型,阳性预测值为79.55%,阴性预测值为92.86%,准确率为82.76%。结论:乳腺MRI动态增强的形态学表现与时间-信号强度曲线图相结合,在良恶性病变的诊断与鉴别诊断中具有较高的价值。