Complex cystic breast masses in ultrasound examination

Complex cystic masses are defined as lesions composed of anechoic (cystic) and echogenic (solid) components, unlike complicated cysts, the echogenic fluid content of which imitates a solid lesion. Complex masses are classified as ACR4 and require histological verification by percutaneous biopsy and/or surgical ablation. The etiology is diverse, and can be benign or high risk (an abscess, hematoma, fat necrosis, fibrocystic mastopathy, a phyllodes tumor, papilloma) as much as malignant (papillary cancer, necrotic cancer, a ductal carcinoma in situ, metastases). The biopsy technique must be adapted to each case and it is often necessary to insert a coil during the procedure. Histopathological correlation is essential to ensure that the samples are representative and concur with the ultrasound appearance, so as not to fail to recognize high risk or malignant lesions requiring appropriate management.     

Role of axillary ultrasound examination in the selection of breast cancer patients for sentinel node biopsy

BACKGROUND: Sentinel node biopsy (SNB) is a time-consuming procedure that can be avoided in presence of axillary metastases. The aim of this study was to assess the accuracy of ultrasound scan (US) in the prediction of axillary nodes status in patients scheduled for SNB. METHODS: Axillary US was performed and when feasible, a core biopsy of suspicious nodes was taken. The nodal status as assessed by US and/or core biopsy was compared with final histology. RESULTS: Of the 132 patients enrolled, 31 (23.5%) had suspicious axillary nodes according to US; 19 (61.3%) were true positive, whereas 12 cases (38.7%) were not. In 14 of 31 suspicious cases an US-guided core-biopsy was taken, which in 11 of 14 cases (78.5%) confirmed the neoplastic involvement. Overall, core biopsy of the nodes correctly predicted the final histology in 13 of 14 cases (92.8%). CONCLUSIONS: The US of axillary nodes, possibly associated with core biopsy, improved the preoperative evaluation of breast cancer patients scheduled for SNB.     

直肠腔内超声术前诊断直肠癌的价值

目的 探讨直肠腔内超声对直肠癌的诊断价值。方法 使用常规直肠腔内超声检查的方法检查直肠的病变情况，并将检查结果与术中所见及术后病理检查结果相比较。结果 除1例直肠癌浸润深度估计过深处，余2例B超检查与手术和术后病理结果一致（符合率92．3％）。结论 直肠腔内超声在分辨肠壁各层结构和了解癌肿润深度，范围等方面有指导意义。     

Utility of axillary ultrasound examination to select breast cancer patients suited for optimal sentinel node biopsy

BACKGROUND: Because sentinel node (SN) biopsy (SNB) is known to produce false-negative results, we examined the usefulness of axillary ultrasound (AUS) in selecting patients suitable for optimal SNB. METHODS: A positive AUS finding (positive AUS) was defined as an echo pattern of a homogeneously hypoechoic SN without an echo-rich center, indicating massive to extensive nodal involvement. The identification of SNs was performed, and complete axillary dissection was carried out. RESULTS: A total of 262 women were enrolled into the study (T1 disease = 94; T2 disease = 145; and T3 disease = 23). The incidence of positive AUS increased with increasing size of breast tumor (P <0.0001). The overall identification and false-negative rates were 88.2% and 10.8%, respectively. However, when limited to AUS-negative patients, SNs were identified in 205 of 208 patients (98.6%), and the false-negative rate was 1.7%. CONCLUSIONS: AUS should be included in the preoperative procedure for the selection of breast cancer patients suitable for SNB.     

Perioperative endocrine status and prognosis in early breast cancer

Although the relationship between breast cancer and hormones has been known for almost two centuries, it is only during the last 16 years that evidence suggesting the hormonal profile of the patient at the time of surgery can affect the outcome, came to light. A series of studies investigated the hypothesis that unopposed estrogen (observed during the follicular phase of the cycle) may adversely affect the overall and/or disease-free survival of women operated on at that time. The findings have been, at times, contradictory. The retrospective nature of the studies, poor recording of last menstrual period, small study size, and the possible effect of the timing of the diagnostic procedures (cytology or core biopsy) on the outcome may be responsible for the conflicting results. Despite this, more sophisticated studies based on pathological or hormonal observations/measurements, confirmed the relation of luteal phase surgery to better outcome. Estrogen-induced increased protease activity activates a cascade of proteolysis and allows the more discohesive tumor cells to gain access to the circulation. Moreover, disseminated cells might be able to proliferate easier because of several estrogen-dependent growth factors. Diminished immune function during the follicular phase, because of natural killer cell activity and mononuclear cell phagocytic activity down-regulation may also be implicated in the dissemination of viable tumor cells. Taken together these findings provide a framework for explaining the observation that luteal phase surgery can lead to an improved outcome. By altering the perioperative hormonal milieu it may be possible to reduce deaths from breast cancer in a simple and nontoxic manner.     

Dual-frequency ultrasound examination of skin and subcutis thickness in breast cancer-related lymphedema

Breast cancer-related lymphedema (BCRL) is a chronic swelling of the arm that sometimes follows breast cancer treatment. Clinically, both skin and subcutis are swollen. Edema is considered to be predominantly subcutaneous and of an even distribution. The purpose of this study was to quantify the degree and uniformity of skin and subcutis swelling around the forearms of women with BCRL. Ten women with BCRL were recruited. Both forearms were examined using 20 MHz ultrasound to visualize the skin and 7 MHz ultrasound to visualize the subcutis. Skin thickness was between the bottom of the entry-echo and the skin-subcutis boundary. Subcutis thickness was measured between the skin-subcutis boundary and the subcutis-muscle boundary. Both average skin thickness (1.97 +/- 1.00 mm) and average subcutis thickness (10.32 +/- 5.63 mm) were greater in the ipsilateral arm than in the contralateral arm (skin 1.12 +/- 0.14 mm, subcutis 5.58 +/- 2.04 mm, p < 0.01, t-test). The degree of increase in skin thickness did not vary around the arm (p > 0.05, ANOVA), while the degree of increase in subcutis thickness did vary (p < 0.05). Skin thickness correlated negatively with subcutis thickness in the contralateral arm, but correlated positively in the ipsilateral arm. The skin and subcutis are thickened in the ipsilateral arm of patients with BCRL. Skin thickness is increased uniformly around the arm and correlates strongly with the degree of swelling, while subcutis swelling varies. The measurement of skin thickness using ultrasound may form a useful clinical tool in the diagnosis of lymphedema and also aid further investigation of therapeutic techniques.     

Significance of ultrasound examination and computed tomography in the diagnosis of pancreatic cancer

The diagnostic sensitivity of USI for localization of a tumor of the pancreatic head was 89.3%, specificity--69.7%, exactness--84.4%. When the tumor was localized in the body-tail these indices were 85.7%, 73.4% and 78.7% respectively. The sensitivity of CT in cases when the localization of the tumor was in the head of the pancreas was 84.9%, specificity--72.2%, exactness--76.5%. When the tumors were localized in the body-tail these indices were 89.5%, 75.4% and 80.9% respectively. An associated analysis of information of the ultrasound and CT concerning the structure of the pancreas made the exactness of the diagnosis of malignization as high as 87.6%, specificity as high as 81.3%, sensitivity as high as 93.7%. The informative value of USI and CT depended on the tumor size, the presence of an inflammatory reaction of the pancreas, the character of a complication, if any, or of their combinations, localization and size of the pathological focus. In the investigation no alterations in the pancreas characteristic only of cancer were found. Thus, a comparison of diagnostic potentials of USI and CT has shown that one method does not exclude, but only supplements the other. CT gives more reliable results in the assessment of the process spread to the surrounding tissues and regional lymph nodes, especially when the tumor is localized in the area of the pancreas tail. USI helps to make more exact assessment of the involvement in the process of the common bile duct, pancreatic duct, and of the visceral vessels by the Doppler examination.     

Perioperative blood transfusion has prognostic significance for breast cancer

The transfusion-induced immune suppression that prolongs kidney graft survival for transplant patients may be detrimental to patients with malignancies. We studied the relationship of blood transfusion to the disease-free survival of 169 patients with operable breast cancer who had undergone mastectomy with axillary dissection at Mount Sinai Hospital between 1964 and 1972. The cumulative 5-year disease-free survival rate for patients who had received transfusions was 51% compared with 65% for patients who had not received blood (p = 0.0210). The two groups of patients were comparable in age, stage, discharge hemoglobin values, proportion of radical mastectomies, and duration of follow-up. Admission hemoglobin values were lower and operative blood loss was higher among patients who had received transfusions, and significant survival differences were noted in relation to operative blood loss: 69% of women with estimated blood loss less than the mean of 370 ml were free of disease at 5 years compared with 50% of women with higher intraoperative losses (p = 0.0279). However, the first year after operation the association of survival with transfusion was highly significant (77% for those who had received transfusions, 94% for those who had not, p = 0.0096), whereas survival rates in relation to operative blood loss differed by only 7% during the same interval (p = 0.1182). These results indicate that perioperative blood transfusion may be a significant prognostic factor for patients undergoing mastectomy for operable breast cancer.     

The role of automated breast ultrasound in the assessment of the local extent of breast cancer

Automated breast ultrasound (ABUS) is a non-invasive advanced ultrasound modality. The degree of extension of the cancer within the breast is very important to choose the appropriate kind of surgery/therapy. In the current work, the aim was to evaluate the role of the ABUS in the assessment of the local extent of the breast cancer before management. This is a prospective analysis that studied 562 female patients with proved breast cancers. Evaluation was in regard of the size, multiplicity, and the stromal invasion (ie, the presence of tumor emboli or tumor masses within the stroma of the breast tissue) around the tumor. Cases were subjected to automated breast ultrasound performed in the axial and coronal planes. ABUS showed high accuracy of assessment of the tumor multiplicity (82.2%) and the stromal involvement (93.5%). There was a statistical significance (P < .001) between the ABUS and the pathology regarding the measurement of the size of the index cancer. In conclusion, ABUS could be used for determination of the intramammary extend of the breast cancer. ABUS provided accurate assessment of the peritumor stromal involvement and multiplicity of the cancer which is required to choose the proper choice of surgery.     

9例妊娠合并乳腺癌患者的围手术期护理

总结9例妊娠合并乳腺癌患者的围手术期护理方法,重点是做好心理护理、孕期胎儿监测、疼痛管理、喂养指导、化疗用药护理及出院指导等。结果9例患者均行剖宫产,其中3例早产儿转儿科治疗,其余6例新生儿出生阿氏评分10分,未出现异常。随访8~78个月,1例患者在乳腺癌术后18个月发现腋窝淋巴结局部复发,再次行腋窝淋巴结清扫术及放疗后,随访5年,未复发,其余患者未发现肿瘤复发。     

Intraoperative ultrasound facilitates surgery for early breast cancer

Background Mammogram-directed wire localization for nonpalpable cancer requires surgeon’s time and coordination and some patient discomfort. Up to half of these nonpalpable lesions can be visualized by ultrasound. Use of intraoperative ultrasound streamlines the process of image-guided surgery. Methods We prospectively visualized 69 nonpalpable breast cancers between January 1998 and July 2001. Ultrasound localization was performed in the operating room immediately before definitive surgery. Breast cancers were localized using either blue dye or a guide wire. Results Ultrasound correctly localized all lesions at surgery. Negative margins for invasive carcinoma were found in 97% (67 of 69) of patients. Re-excisions were performed in only 6% (4 of 69) of patients. Overall negative margins were found in 90% (62 of 69) of patients. Most positive margins (71%) were due to the presence of noncalcified ductal carcinoma in situ. Mastectomy was necessary in 4% of patients, usually due to multifocal invasive carcinoma. Conclusions Increased familiarity with ultrasound has allowed the surgeon to localize breast cancer in the operating room, improving the process of image-guided surgery. Ultrasound localization is accurate, time efficient, technically feasible, and easier for the patient. The re-excision rate is very low and is similar to that for mammographic localization. Intraoperative ultrasound localization should be considered whenever a breast cancer needs image-guided excision.     

多模态超声技术在乳腺癌诊断中的新进展

超声是临床诊断乳腺癌的常规技术之一,但乳腺癌在声像图上表现的多样性,使得临床早期明确诊断和评估预测需要更多的信息,因此多模态超声新技术的联合应用对乳腺癌的诊断尤为重要。笔者概述了近年来多模态超声技术的新进展,包括自动乳腺全容积成像技术,弹性成像和超声造影技术等。这些新技术在临床乳腺癌诊断中发挥重要作用,并在将来有更广阔的应用前景。     

Accuracy of clinical examination, digital mammogram, ultrasound, and MRI in determining postneoadjuvant pathologic tumor response in operable breast cancer patients

Background  

To determine the accuracy, positive predictive value (PPV), and negative predictive value (NPV) of clinical examination and breast imaging techniques in determining pathologic complete response in patients with locally advanced breast cancer after neoadjuvant therapy.     

Axillary ultrasound in invasive breast cancer: experience of our surgeons

Abstract: Preoperative axillary ultrasound (USS) and fine needle aspiration cytology (FNAC) may allow diagnosis of axillary metastases and reduce repeat axillary procedures. This procedure is usually performed by radiologists. The aim of this prospective study was to evaluate the diagnostic accuracy of surgeon performed axillary USS and/or FNAC in determining axillary nodal status preoperatively. Patients with invasive breast cancer from August 2007 to July 2008 were studied prospectively. Patients who had primary hormonal therapy, neo‐adjuvant therapy or distant metastases were excluded. Axillary USS was performed by two consultant breast surgeons trained in ultrasound and biopsy techniques. USS guided FNAC was used to evaluate suspicious nodes. Those with positive cytology (i.e., malignant cells) underwent axillary clearance and the remainder had either sentinel lymph node biopsy or axillary node sample. Axillary USS and FNAC results were compared with final axillary histology. One hundred and twenty eight patients were included with a mean age of 60 years. Nodes were nonpalpable in 96(75%) patients. Forty nine(38.2%) patients had axillary metastases on final histology and 30 of the 49(61%) were identified by preoperative USS guided FNAC. The sensitivity and specificity of this procedure were 61% and 100%, respectively. The positive predictive value and negative predictive value were 100% and 80.6%, respectively. Therefore, 61% of patients with axillary metastases were able to proceed directly to definitive axillary surgery. The use of USS and FNAC to evaluate and sample the axillary nodes in patients with invasive breast cancer can be a useful tool for the breast surgeon.     

Heat fixation of cancer cells ablated with high-intensity-focused ultrasound in patients with breast cancer

BACKGROUND: High-intensity-focused ultrasound (HIFU) is a noninvasive thermal ablation technique. This study reports the use of histological techniques for the pathological assessment of HIFU effects in patients with breast cancer. METHODS: Twenty-three patients with biopsy-proven breast cancer underwent HIFU treatment for primary breast lesion. Mastectomy was performed on all patients after HIFU. By using histological examinations, the surgical specimens were assessed to explore HIFU effects on breast cancer. RESULTS: Coagulation necrosis of targeted tumors was confirmed by microscopy in 23 patients. Tumor cells presented typical characteristics of coagulation necrosis in the peripheral region of the ablated tumor in all patients. However, in 11 of 23 patients, hematoxylin and eosin staining showed normal cellular structure in the central ablated tumor. By using electronic microscopy and nicotinamide adenine dinucleotide-diaphorase stain, those who had normal-appearing cancer cells were not viable. CONCLUSIONS: HIFU can cause the heat fixation of ablated tumor through thermal effect.     

Follow-up examination and survival after treatment of primary breast cancer

Frequent laboratory tests and diagnostic imaging examinations after primary treatment of breast cancer do not improve survival or influence the quality of life. The economic impact should be also taken into consideration. Intensive follow-up should not be recommended as a routine policy based on evidence-based medicine. However, patients usually want to be seen frequently by a physician and undergo diagnostic tests even though free of symptoms. This dilemma for oncologists has not been resolved.