Characterization of Breast Masses With Sonography

OBJECTIVE: To determine whether sonography can be used to categorize some solid breast masses as probably benign so that biopsy can be deferred. METHODS: We prospectively characterized 844 sonographically visible solid breast masses referred for biopsy. Mammographic and sonographic features of the masses were recorded, and all masses were categorized by American College of Radiology Breast Imaging Reporting and Data System classification before biopsy. Of the 844 masses, 148 were categorized as probably benign (Breast Imaging Reporting and Data System category 3). Sonographically guided biopsy (n = 804) or fine-needle aspiration (n = 40) was performed for pathologic correlation. RESULTS: Of the 148 masses that met the sonographic criteria for probably benign masses, there was 1 malignancy, for a negative predictive value of 99.3%. CONCLUSIONS: Follow-up can be an acceptable alternative to biopsy for sonographically probably benign solid masses.     

Gel Pad Application for Automated Breast Sonography

The purpose of this study was to describe the technical aspects of gel pad application for automated breast sonography and to show its effects on pain relief, scan coverage, and image quality. Twenty patients underwent 2 sets of automated breast sonography with and without gel pad application and were then asked to provide feedback on the examination‐related pain. Scan coverage and image quality were compared quantitatively and qualitatively. The degree of pain was significantly decreased after gel pad application (P < .0001). The scan coverage was expanded particularly at the mid‐portion of the breast. Image quality was satisfactory without significant differences between the sets. Gel pad application for automated breast sonography is easy and provides significant pain relief. The scan coverage was expanded, while the image quality was maintained.     

Effect of Clinical Information on Diagnostic Performance in Breast Sonography

Objective. The purpose of this study was to assess whether the clinical information (CI) of patients affects the degree of suspicion for malignancy by radiologists performing breast sonography. Methods. We included 150 breast lesions in 144 patients who underwent breast sonography and sonographically guided core needle biopsy. A pathologic diagnosis was available for all 150 breast lesions: 78 (52%) were malignant, and 72 (48%) were benign. Three radiologists retrospectively reviewed the sonograms of all lesions twice at 8‐week intervals first without any CI for the patients (first review) and then with CI such as patient age, palpability, and personal history of risk factors for breast cancer (second review). The reviewers categorized the final assessment according to the American College of Radiology Breast Imaging Reporting and Data System. We compared diagnostic performance such as sensitivity and specificity and the degree of suspicion for malignancy between the image reviews with and without CI. Results. In the second review, sensitivity was improved in all 3 reviewers (94.0 to 99.2%; P < .05), and specificity was decreased (39.8 to 30.8%; P = .04). There was a significant increase of suspicion for malignancy with the patients' CI (P < .05). Conclusions. Clinical information about a patient's breast cancer history and clinical presentation with a palpable mass can increase the suspicion for malignancy on sonography and the sensitivity of sonographic interpretation.     

Five Cases of Axillary Lymph Node Metastatic Breast Cancer on Contrast‐Enhanced Sonography

This study was performed to determine the importance of contrast‐enhanced sonography for axillary lymph node metastatic breast cancer. Contrast‐enhanced sonographic findings in 5 patients with breast cancer and axillary lymph node metastasis are discussed, and imaging‐pathologic correlations are also presented in 3 cases. In all 5 cases, lymph nodes showed a perfusion defect in the late phase. Rapid arterial enhancement and wash‐out were observed in 2 cases in which we performed second injections. Contrast‐enhanced sonography may be effective for identifying metastatic lesions in lymph nodes, especially in the early stages.     

Three‐Dimensional Sonography of Axillary Lymph Nodes in Patients With Breast Cancer

Sonography is useful in the evaluation of axillary lymph nodes in patients with breast cancer. In this pictorial essay, we review the range of grayscale and Doppler appearances of abnormal axillary lymph nodes on 2‐dimensional and 3‐dimensional imaging.     

Evaluating Lesion Segmentation on Breast Sonography as Related to Lesion Type

Breast sonography currently provides a complementary diagnosis when other modalities are not conclusive. However, lesion segmentation on sonography is still a challenging problem due to the presence of artifacts. To solve these problems, Markov random fields and maximum a posteriori–based methods are used to estimate a distortion field while identifying regions of similar intensity inhomogeneity. In this study, different initialization approaches were exhaustively evaluated using a database of 212 B‐mode breast sonograms and considering the lesion types. Finally, conclusions about the relationship between the segmentation results and lesions types are described.     

女性乳腺小肿块的高频声像图研究

我们用１０ＭＨｚ软探头检查３７例女性乳腺小肿块（肿块的纵横径均＜２０ｍｍ，Ｔ１Ｍ０），均为手术或病理证实。超声诊断以纵、横和斜切等各个切面显示肿块的形状、境界、内部回声、侧方声影、后方回声和纵横比６项指标作综合判断。肿块的捡出率为１００％，最小肿块的直径为３．５ｍｍ×２．６ｍｍ，总符合率为９２％（３４／３７例），良性肿块的符合率为９５％（２１／２２例），恶性肿块的符合率为８２％（９／１１例）和炎性肿块的符合率为１００％（４／４例）。并详细描述了肿块的声像及鉴别点。     

Can Color Doppler Sonography Aid in the Prediction of Malignancy of Thyroid Nodules?

OBJECTIVE: To determine whether color Doppler interrogation of a thyroid nodule can aid in the prediction of malignancy. METHODS: We obtained color Doppler images of thyroid nodules undergoing sonographically guided fine-needle aspiration. The color Doppler appearance of each nodule was graded from 0 for no visible flow through 4 for extensive internal flow. The size, sonographic appearance, results of fine-needle aspiration, and surgical pathologic findings, if available, were recorded for each nodule. RESULTS: There were 254 nodules sampled, of which 32 were malignant (all confirmed at surgery) and 177 were benign. Fourteen (43.8%) of the 32 malignant nodules were color type 4, compared with only 26 (14.7%) of the 177 benign nodules (P = .0004, Fisher exact test). Thirteen (40.1%) of the 32 malignant nodules were solid, as were 18 (10.2%) of the 177 benign nodules (P = .006, Fisher exact test). Among solid nodules, the prevalence of malignancy was greater when the nodule was hypervascular (13 [41.9%] of 31) than when the color type was less than 4 (11 [14.7%] of 77; P = .004, Fisher exact test). CONCLUSIONS: Solid hypervascular thyroid nodules have a high likelihood of malignancy (nearly 42% in our series). The color characteristics of a thyroid nodule, however, cannot be used to exclude malignancy, because 14% of solid nonhypervascular nodules were malignant.     

7532例乳腺超声体检分析

目的 用高频超声对正常女性乳腺健康体检,探讨其在临床及乳腺普查方面的应用价值.方法 对2006年1月-2009年12月间7 532例健康女性乳腺体检声像图进行分析,并对各年龄段的乳腺病变超声结果分布情况进行统计.结果 共检出乳腺病变2 861例(37.98%),正常者4 671例(62.02%).所有受检者中,囊性病变...     

Three‐Dimensional Region‐Based Segmentation for Breast Tumors on Sonography

Because malignant and benign breast tumors show different shapes and sizes on sonography, information about tumor shapes and sizes is important for clinical diagnosis. Since sonograms include noise and tissue texture, accurate clinical diagnosis is highly dependent on clinical experience and expertise. However, manually sketching a 3‐dimensional (3D) breast tumor contour is a time‐consuming and complicated task. Automatic contouring, which provides a contour similar to that of manual sketching of a breast tumor on sonography, may improve diagnostic accuracy. This study presents an efficient method for automatically detecting 3D contours of breast tumors on 3D sonography. The proposed method applies a voxel nearest neighbor filter, a Wiener filter, and an unsharp filter to enhance contrast and reduce noise. After a 3D region‐growing algorithm is used to obtain the contour of the breast tumor, postprocessing of the extracted contour is performed to diminish the shadow region of the tumor. This study evaluated 20 tumor cases comprising 10 benign and 10 malignant cases. The results of computer simulation reveal that the proposed 3D segmentation method provides robust contouring for breast sonograms. This approach consistently obtains contours similar to those obtained by manual contouring of a breast tumor and can reduce the time needed to sketch precise contours.     

乳腺肿块的高频声像图中微钙化的意义

作者对127例乳腺肿块的高频声像图进行回顾性分析，将其中的钙化分为三种类型：（1）微钙化;（2）粗钙化;（3）弧形钙化。71例恶性组中，检出钙化27例，其中微钙化26例，粗钙化1例;56例良性组中，检出钙化9例，微钙化4例，粗钙化4例，弧形钙化1例。两组微钙化率有显著差异。钙化与年龄有关，与肿块大小无关。结果表明：50岁以下妇女组中，微钙化对乳癌诊断的敏感性为35.29％，特异性为94.23％，微钙化对年轻妇女乳癌有很高的诊断价值。