Sonographically guided needle biopsy of nonpalpable breast lesions.

This article describes the techniques of sonographically guided fine-needle aspiration (FNA) and core-needle biopsy (CNB) of nonpalpable breast lesions. Virtually any nonpalpable breast lesion that is clearly demonstrated on sonograms can be sampled with a needle under ultrasound guidance. Advantages of ultrasound-guided FNA include its pinpoint accuracy, the excellent tolerance by patients, and the ability to aspirate or inject fluid or air. Advantages of ultrasound-guided CNB include a near 100% tissue recovery rate even in fibrous masses, the ability to assess the invasiveness of a cancer, and the fact that tissue cores are readily interpreted by any pathologist. In institutions in which an expert cytopathologist is available, FNA is often used as a first-line biopsy technique, with CNB being reserved for situations in which FNA cannot provide a definitive answer to the question asked. In most institutions, however, CNB has become the standard for percutaneous needle biopsy of breast masses, and sonography has replaced stereotaxy as the standard guidance technique for nonpalpable masses.     

Ultrasonographically guided wire localization of nonpalpable breast lesions.

The results of 102 preoperative ultrasonographically guided wire localizations of nonpalpable breast lesions were reviewed. Ultrasonography was used because of nonvisualization during mammography (16 cases), a difficult location of the lesion (3 cases), vasovagal syncope during mammographic guidance (two cases), or the radiologist's preference (81 cases). All localizations were successful. Removal was confirmed by specimen mammography or ultrasonography or both in 85 cases and by macroscopic examination in 10 cases. In seven cases specimen radiography was not performed. One syncope and one wire insertion into the pectoralis fascia occurred. Ultrasonographically guided wire localization is accurate and well tolerated in aiding surgical biopsy of breast lesions.     

Focal fibrosis of the breast diagnosed by a sonographically guided core biopsy of nonpalpable lesions: imaging findings and clinical relevance.

OBJECTIVE: The purpose of this study was to evaluate the frequency of focal fibrosis of the breast diagnosed by a sonographically guided core biopsy of nonpalpable lesions, to characterize imaging features, and to evaluate their clinical relevance. METHODS: In a retrospective review of 724 lesions that underwent sonographically guided core biopsy of nonpalpable breast lesions, 62 cases had a diagnosis of focal fibrosis. Two radiologists analyzed the sonographic and mammographic findings according to the Breast Imaging Reporting and Data System. The results were compared with histologic findings at surgery or imaging findings during surveillance. RESULTS: The incidence of focal fibrosis was 8.6% (62/724). Sonographic films were available in 56 cases, so 56 cases were reviewed for their sonographic findings. Among the mammograms reviewed, 64.7% (33/51) had negative findings. Among the sonograms reviewed, the most common features were oval shape (32/56, 57.1%), parallel orientation (36/56, 64.3%), microlobulated margin (24/56, 42.9%), abrupt interface (50/56, 89.3%), isoechoic pattern (42/56, 75.0%), and a lack of posterior acoustic features (45/56, 80.4%). The Breast Imaging Reporting and Data System final assessment was category 3 in 27 (48.2%) and category 4 in 29 (51.8%). Most of the category 4 lesions were category 4A (26/29, 89.7%). Surgical excision (n = 7) and follow-up for at least 1 year (n = 49) showed no malignancy. CONCLUSIONS: Focal fibrosis was found in 8.6% by a sonographically guided core biopsy of nonpalpable breast lesions. Most of the lesions were categorized as probably benign (category 3) or having a low suggestion of malignancy (category 4A). Focal fibrosis diagnosed at core biopsy can be managed with a 6-month follow-up protocol.     

X线三维立体定位术诊断临床检查阴性乳腺病变

目的 探讨乳腺X线三维立体定位术在临床检查阴性乳腺病变中的诊断价值.方法 64例患者因乳腺X线摄影检查发现可疑病变而接受立体定位术.利用乳腺三维立体导丝定位术和三维立体定位穿刺术对乳腺不能扪及的病变进行术前定位和旋切活检,术后行病理学检查.结果 64例患者中,62例定位满意,2例定位偏离,定位满意度96.88%.其中恶性病变10例,7例为导管原位癌(DCIS),良性病变54例.结论 乳腺三维立体定位技术可发现和诊断临床检查阴性的乳腺病变,有助于提高乳腺DCIS的检出率.     

Intramuscular myxoma: sonographic appearance and sonographically guided needle biopsy.

The sonographic appearances of four intramuscular myxomas were reviewed. These tumors appeared as well-defined, ovoid masses surrounded by normal muscle. The echogenicity was decreased in all cases, and the presence of small fluid-filled clefts and cystic areas was noted in three of the four lesions. Color Doppler examination was performed in two cases and was negative. Sonographically guided fine-needle aspiration biopsy yielded a thick myxoid substance. Large-core cutting needle biopsy allowed establishment of the diagnosis in one of the two cases in which it was performed. The differential diagnosis of a well-demarcated intramuscular mass with multiple fluid-filled clefts or cystic areas should include intramuscular myxoma.     

Myopericytoma of the neck: sonographic appearance and sonographically guided needle biopsy

We report the imaging and pathologic findings of a case of myopericytoma of the neck in a 70-year-old woman, which was diagnosed by ultrasound-guided core-needle biopsy. The mass demonstrated homogeneous intense enhancement on contrast-enhanced CT and was markedly hypervascular on power Doppler sonography. The histopathological findings of the core biopsy were consistent with myopericytoma.     

Tuberculosis of the parotid gland: sonographic manifestations and sonographically guided aspiration.

OBJECTIVE: Involvement of the parotid gland by tuberculosis (TB) is rare. If treated properly, the prognosis of TB of the parotid gland is good. In this retrospective study, we report our experience with sonography and sonographically guided aspiration in the diagnosis of parotid TB. METHODS: Over 12 years, 9 adults (mean age, 48 years) with parotid gland TB had been examined with high-resolution sonography and color Doppler sonography for their clinical problems of swelling on the mandibular angle. Sonographically guided fine-needle aspiration was done for cytologic study, stains for acid-fast bacilli, and cultures for mycobacterium. RESULTS: The sonographic patterns were classified as chiefly the parenchymal type (4 patients) and chiefly the periparotid type (5 patients). The parenchymal type appeared as a diffusely enlarged, comparatively hypoechoic gland (compared with the contralateral asymptomatic gland), with or without focal intraparotid nearly anechoic zones, which might have a cavity or cavities within it. The periparotid type appeared as hypoechoic nodules located in the peripheral zone of the hyperechoic parotid gland, consistent with enlarged periglandular lymph nodes. The diagnosis of parotid TB was made in 8 of 9 patients on the basis of sonographically guided aspiration for acid-fast bacilli stains, cytologic study, and cultures for mycobacterium. CONCLUSIONS: Sonographic examination contributes substantially in the diagnosis of parotid TB infection. In the presence of diffuse parotid echo pattern changes with periparotid lymphadenopathy, and with or without focal hypoechoic zones, TB infection should be differentiated. Sonographically guided fine-needle aspiration may provide further diagnostic information by means of stains, cultures, and cytologic study.     

Evaluation of solid breast lesions with power Doppler sonography.

PURPOSE: We compared the abilities of power and conventional color Doppler sonography to depict the vascularity of solid breast lesions and evaluated the usefulness of power Doppler sonography in differentiating between benign and malignant breast lesions. METHODS: One hundred two solid breast lesions (59 benign and 43 malignant lesions) were studied with power and color Doppler sonography. Power and color Doppler sonograms were retrospectively compared for the depiction of blood flow signals. Power Doppler images were also reviewed for the amount of Doppler signals, pattern of vascularity, and morphology of vessels. The sensitivity, specificity, and accuracy of the 2 techniques were calculated. RESULTS: Compared with color Doppler sonography, power Doppler sonography depicted flow superiorly in 61 cases (60%) and equally in 41 cases (40%). On power Doppler sonography, the incidence of marked blood flow in malignant lesions (65%) was higher than that in benign lesions (39%). The pattern of vascularity was predominantly central (86%) and/or penetrating (65%) more often in malignant lesions than in benign lesions (51% and 34%, respectively). Branching (56%) and disordered vessels (42%) were seen more often in malignant lesions than in benign lesions (22% and 8%, respectively). The sensitivity, specificity, and accuracy in diagnosing malignancy were 64%, 76%, and 71%, respectively, for power Doppler sonography and 77%, 76%, and 76% for color Doppler sonography. CONCLUSIONS: Power Doppler sonography was more sensitive than color Doppler sonography in the detection of flow in solid breast lesions. Although power Doppler sonography was not more effective in diagnosing malignant lesions, central and penetrating vascularity patterns and branching and disordered vessels seem to be helpful findings in predicting malignancy.     

脂肪组织声像图改变在乳腺良恶性病变中的诊断价值

目的 探讨脂肪组织声像图改变在乳腺良恶性病变中的诊断价值.方法 回顾性分析92例患者共114个乳腺病灶边缘皮下脂肪组织的声像图特点,所有病灶均经手术后病理证实.以病理结果为金标准构建ROC曲线,评价皮下脂肪组织改变在乳腺良恶性病变中的诊断价值.结果 61例良性病灶及53例恶性病灶的ROC曲线下面积为0.862,(P=0.000).皮下脂肪组织声像图改变达Ⅲ级及以上者提示为恶性病变,以Ⅲ级为诊断乳腺恶性病变的指标,其灵敏度为73.6％,特异度为93.4％.恶性病灶的脂肪组织声像图可表现为内部纤维组织增多,脂肪回声增高,浑浊、模糊,呈“毛玻璃样”改变.脂肪改变的范围在乳腺良恶性病变中差异有统计学意义(P=0.000).结论 皮下脂肪组织声像图改变对乳腺良恶性病变的鉴别有诊断价值.     

术中超声引导切除触诊阴性乳腺肿块

目的探讨术中超声引导切除触诊阴性乳腺肿块的应用价值。方法对78例女性患者的92个临床触诊阴性的乳腺病灶行超声引导下肿块切除术,并对切下的组织进行超声检查以证实肿块被完整切除。结果92个触诊阴性肿块在超声定位下均被一次性切除,定位准确率达100%。其中病理证实纤维囊性乳腺病24个,纤维腺瘤59个,不典型增生4个,恶性肿瘤5个(导管原位癌1个,浸润性导管癌4个)。结论术中超声引导触诊阴性乳腺肿块切除准确可行,可帮助选择最佳切口,提高手术效率,使病灶边缘的组织切除量更加合理,还可明显减少患者的焦虑。     

Diagnostic sonography of the female breast

The female breast can be easily examined by sonography due to its anatomical site. Today water-coupling methods or real-time scanners with high transducer frequency are the procedures of choice. The sonographic picture of the normal breast is described and a discussion presented of the criteria on which the differential diagnosis between cystic and solid lesions is based. The domain of sonography is the demonstration of cystic lesions as from a diameter of 3 mm. Solid lesions must be bigger to become demonstrable by sonography. Sonography is at present incapable of replacing mammography as a screening method for the early detection of breast cancer for several reasons. Primarily one has to spend at least half an hour for an exact examination of both breasts. A more serious disadvantage, however, is the fact that the majority of breast cancers demonstrated by sonography is far beyond the early stages. It was, moreover, observed that the sonographic appearance of the tumour was dependent on the cellular content of the tumour as well as the connective tissue density. Tumours with a high cellular content are more easily penetrable by ultrasonic waves and might, therefore, be misinterpreted as being a benign lesion. On comparing mammography and sonography it is interesting to note that tumours in a dense breast are more easily detectable by sonography, whilst tumours in a breast rich in fatty tissue are more easily demonstrated by mammography.     

Image-directed fine needle aspiration biopsy in nonpalpable breast lesions

Fine needle aspiration biopsy of nonpalpable breast lesions may be performed with imaging guidance. The technique has a potential role, but is underused because of a relative paucity of specialty-trained, enthusiastic breast cytopathologists. This article discusses the strengths and limitations of the technique in the context of the various imaging modalities, and in comparison with needles used for histologic sampling.     

彩超对肺实性占位性病变的应用价值

目的:通过对肺周及肺内实性病灶的彩色信号和多普勒频谱分析,比较良恶性病变的不同表现,探讨彩超在鉴别肺实性病变良恶性方面的价值和方法。资料和方法:1997年3月～2000年12月,经X线或CT定位,B超及彩超共观察肺实性病变107例,其中彩超观察满意的101例为本文研究对象,包括良性38例,恶性63例。有95例经病理证实,包括手术病理17例,穿刺病理68例,支气管镜检8例,痰检2例;另6例炎性病变抗炎治疗后CT证实病灶消失。结果:良性和恶性病变的血流检出率分别为82%和59%,有显著性差异。良性病变动脉峰值流速39.4±28.0cm?s,阻力指数0.71±0.32;恶性病变分别为20.5±20.0cm?s,0.36±0.31。结论:彩超能很好显示肺实性病变内血流状况,对鉴别良恶性病变有重要的参考价值。     

Comparison of ultrasound elastography, mammography, and sonography in the diagnosis of solid breast lesions.

OBJECTIVE: The purpose of this study was to evaluate the value of ultrasound elastography (UE) in differentiating benign versus malignant lesions in the breast and compare it with conventional sonography and mammography. METHODS: From September 2004 to May 2005, 296 solid lesions from 232 consecutive patients were diagnosed as benign or malignant by mammography and sonography and further analyzed with UE. The diagnostic results were compared with histopathologic findings. The sensitivity, specificity, accuracy, positive and negative predictive values, and false-positive and -negative rates were calculated for each modality and the combination of UE and sonography. RESULTS: Of 296 lesions, 87 were histologically malignant, and 209 were benign. Ultrasound elastography was the most specific (95.7%) and had the lowest false-positive rate (4.3%) of the 3 modalities. The accuracy (88.2%) and positive predictive value (87.1%) of UE were higher than those of sonography (72.6% and 52.5%, respectively). The sensitivity values, negative predictive values, and false negative rates of the 3 modalities had no differences. A combination of UE and sonography had the best sensitivity (89.7%) and accuracy (93.9%) and the lowest false-negative rate (9.2%). The specificity (95.7%) and positive predictive value (89.7%) of the combination were better, and the false-positive rate (4.3%) of the combination was lower than those of mammography and sonography. CONCLUSIONS: In a clinical trial with Chinese women, UE was superior to sonography and equal or superior to mammography in differentiating benign and malignant lesions in the breast. A combination of UE and sonography had the best results in detecting cancer and potentially could reduce unnecessary biopsy. Ultrasound elastography is a promising technique for evaluating breast lesions.     

Application of estrogen receptor immunocytochemical assay to aspirates from mammographically guided fine needle biopsy of nonpalpable breast lesions.

The importance of hormone receptors in the management and prognosis of breast cancer is well established, but difficult to apply to the growing numbers of very small breast cancers being detected. To assess the feasibility of applying estrogen receptor immunocytochemical assay (ER-ICA) to cytologic specimens, we prospectively studied 100 patients who had fine needle aspiration biopsy (FNAB) of mammographically detected nonpalpable breast lesions. All 100 patients also had surgical excision of these nonpalpable lesions immediately after cytologic aspiration. Twenty malignancies were ultimately diagnosed by histology; 17 of them had been cytologically diagnosed. Using specific monoclonal antibody for estrogen receptor, we applied ER-ICA to cytologic preparation of 15 malignant neoplasms with sufficient cellular material available for the assay. Positive immunostaining was demonstrated in nine cases. No ER expression was seen in six cases. Immunocytochemical assay was also done on frozen tissue of the corresponding surgically removed tumors, with 86.6% concordance between the two results. This study is the first to demonstrate that ER-ICA can be effective in assessing hormone receptor content of mammographically directed cytologic aspirates.     

Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis.

OBJECTIVE: To determine the accuracy of transvaginal sonography (TVS) for the diagnosis of deep pelvic endometriosis. METHODS: In a prospective study, 142 women with clinical signs of endometriosis underwent TVS followed by surgical and histopathological investigations. The presence and extent of endometriosis involving the uterosacral ligaments, vagina, rectovaginal septum, intestines, bladder and ovaries shown by TVS were compared with surgical and histological findings. The sensitivity, specificity, predictive values and accuracy of TVS for predicting deep pelvic endometriosis were assessed. RESULTS: Ovarian and deep pelvic endometriosis were found by surgery and histology in respectively 83 (58.5%) and 79 (55.6%) of the 142 patients. The sensitivity, specificity, and positive and negative predictive values of TVS for the diagnosis of deep pelvic endometriosis were 78.5%, 95.2%, 95.4% and 77.9%, respectively. The sensitivity and specificity of TVS for endometriotic involvement of the uterosacral ligaments, vagina, rectovaginal septum and intestines were 70.6% and 95.9%, 29.4% and 100%, 28.6% and 99.3%, and 87.2% and 96.8%, respectively. The sensitivity and specificity of TVS for bladder involvement were 71.4% and 100%, respectively. CONCLUSION: TVS accurately diagnoses intestinal and bladder endometriosis, but is less accurate for uterosacral, vaginal and rectovaginal septum involvement.