Ultrasound examination of the breast. Experience with a high resolution 'real-time'-scanner (author's transl)

A new high resolution real-time ultrasound scanner for diagnosis of the breast is presented. The scanner is designed for the examination of peripheral blood vessels, all superficial soft-tissue organs, such as the thyroid, breast, salivary glands, testes as for well as pediatric examinations. It is a mechanical linear scanner with electronic and mechanical transducer focusing. Its high resolution as such and also the sonographic appearance of benign and malignant breast lesions are demonstrated, general problems of ultrasound examinations of the breast are discussed. The equipment under evaluation is of considerable value in the differentiation of palpable or otherwise localised breast tumors. It is less useful for a general application in the screening for breast cancer.     

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.     

Real-time breast sonography: application in 300 consecutive patients

Sonography, disappointing as a primary screening method, has emerged as the single most helpful adjunct to mammography in evaluation of the clinically and/or mammographically abnormal breast. Sonography can reliably diagnose simple cysts presenting as palpable masses or as indeterminate, nonpalpable lesions on mammography. However, differentiation of benign from malignant solid masses cannot be reliably accomplished by sonography. The expense of an automated breast sonographic scanner has deterred many radiologists from the purchase of such a unit. The authors have used both an automated breast scanner and a real-time 10-MHz hand-held unit. This paper describes their experience with the real-time unit, demonstrating both normal and pathologic anatomy. Special emphasis has been placed on the sonographic diagnosis of a simple cyst because this lesion was the cause of one-quarter of all palpable masses and nonpalpable, mammographically dominant masses. Cysts are sharply marginated and anechoic. Posterior enhancement visible in 78 of 80 cysts was not demonstrable on all images in 25% of cysts.     

乳腺X线摄影与MRI对致密型乳腺内病变的诊断

目的:比较乳腺X线摄影与MRI对致密型乳腺病变的诊断价值.方法:搜集同时行乳腺X线摄影及MRI检查的致密型乳腺患者185例,所有病例均经病理证实,分别分析两种方法的影像学表现,并与病理对照.结果:185例患者中组织病理学为恶性者80例,良性105例.乳腺X线摄影诊断致密型乳腺恶性病变的敏感度、特异度、阳性预测值及阴性预...     

CT scanning of the breast in problem cases

This is a report of the experience with 200 patients who during 1981 to 1984 underwent breast scanning on a conventional body scanner. Pre- and post-contrast scans of the breast were obtained. A postcontrast enhancement of 50 HU and more turned out to be specific for malignant lesions. Radiation dose to the breast was in the same range as with high filtration xeromammography and high resolution film-screen mammography with additional grid. Breast scanning is recommended in cases in which mammography alone is of limited value, including dense fibrocystic breasts in women at high risk, follow-up in breast cancer patients after breast conserving therapy, in patients with silastic implants and in the follow-up of breasts with huge scars due to multiple biopsies.     

Real-time sonography of palpable breast masses

In order to evaluate the clinical usefulness of an electronic real-time linear array scanner in breast diseases, ultrasonography was performed in 148 cases of histologically confirmed palpable breast masses. The real-time images were observed on a television monitor while moving the hand-held transducer probes over the masses. It took only a few minutes to examine and diagnose a palpable mass. Among 45 carcinomas, 39 lesions were correctly diagnosed, four lesions were not detected by ultrasound and two were misdiagnosed as fibroadenomas. On the other hand, ten benign lesions were falsely diagnosed as breast cancers: seven mastopathies (including four sclerosing adenosis), two fibroadenomas and one abscess. The sensitivity and specificity for diagnosing breast cancer were 0.87 and 0.90 respectively. Real-time sonography is a simple, time-saving and useful tool for examining palpable breast masses. However, it should be realised that some breast cancers are difficult to image and differentiate from benign lesions.     

Computed tomography of breast lesions: comparison with x-ray mammography

Thirty-three patients with breast lesions demonstrated by mammography were examined with computed tomography (CT) using a standard whole body scanner. Although the CT images were of good diagnostic quality, the amount of new information gained was limited. The diagnostic accuracy of mammography in the hands of an experienced reader was higher than that with CT. We conclude that, although technically a whole body scanner is capable of producing good images of the breast, the number of patients in whom CT should be used instead of or in addition to mammography is limited. The indication for its use was primarily for patients in whom quality mammograms could not be produced because either the breast was unusually dense or extensive breast disease caused technical difficulties in performing mammograms. Computed tomography was also useful if the interpretation of the mammogram was equivocal, regional lymph node enlargement was questioned, invasion of the chest wall by tumor was suspected, and for planning radiotherapy treatment.     

Analysis of eighty-one cases with breast lesions using automated breast volume scanner and comparison with handheld ultrasound

Objectives

This study aims to evaluate the clinical utility of automated breast volume scanner (ABVS) against handheld ultrasound in detecting and diagnosing breast lesions.

Methods

Eighty-one patients were subjected to both automated breast volume scanner and handheld ultrasound examination in the supine position. The number of lesions detected and the average scanning time (both device-specific and user-specific) for each device were compared. The diagnostic accuracy, sensitivity and specificity were calculated for each method. The maximum diameters of the lesions based on handheld ultrasound and ABVS were compared with the final pathological sizes.

Results

Of the 81 patients, both automated breast volume scanner and handheld ultrasound detected 95 breast lesions. Compared with the pathological diagnosis in 35 lesions, both ABVS and handheld ultrasound exhibited high sensitivity (both 100%) and high specificity (95.0%, and 85.0%, respectively). In addition, ABVS had a higher diagnostic accuracy (97.1%) than handheld ultrasound (91.4%) for breast neoplasms. More importantly, ABVS was capable of displaying the retraction phenomenon in coronal plane. All the invasive ductal carcinomas (12 lesions) presented the retraction phenomenon. In contrast, intraductal carcinomas (3 lesions) and benign lesions did not display such features. Thus, retraction phenomenon had a high specificity (100.0%) and high sensitivity (80.0%) in detecting breast cancer while it also had high accuracy (91.4%) in determining malignant from benign lesions. There was no significant difference in maximum diameters of pathology, 2D and ABVS (p > 0.05), however the correlation coefficient revealed that ABVS had better correlation with pathology (r = 0.616) than 2D (r = 0.468). The user scanning time for the ABVS demonstrated no difference between two examiners (11.7 ± 1.3 min and 12.1 ± 1.4 min; p > 0.05). However, device-specific scanning time was longer for ABVS than handheld ultrasound (11.9 ± 1.4 min vs. 6.8 ± 1.1 min, respectively; p < 0.01).

Conclusions

Automated breast volume scanner provides advantages of high diagnostic accuracy, better lesion size prediction, operator-independence and visualization of the whole breast. It is a promising modality in breast imaging.     

钼靶X线、红外线及B超检查在乳腺肿块诊断中的应用价值

目的：探讨钼靶X线摄影、B超检查和红外线扫描在诊断乳腺肿块性病变中的应用价值，旨在提高对乳腺肿块的检出率和定性诊断准确率。方法：回顾性分析了50例均经三种影像学综合检查的乳腺疾病患者的资料及手术病理对照。结果：钼靶X线检查对乳腺肿块的检出率最高达92％，且定性诊断价值较大；B超检查可明确肿块是囊性还是实质性，并可准确地测出肿块的大小；红外线扫描对鉴别肿块的良恶性有较大的意义。结论：三种影像学检查敏感性各不相同，实用范围各有限制，但综合影像学检查可以取长补短，相互印证，大大提高了乳腺肿块性病变的诊断准确率。     

Dedicated breast CT: radiation dose and image quality evaluation.

PURPOSE: To evaluate the feasibility of breast computed tomography (CT) in terms of radiation dose and image quality. MATERIALS AND METHODS: Validated Monte Carlo simulation techniques were used to estimate the average glandular dose (AGD). The calculated photon fluence at the detector for high-quality abdominal CT (120 kVp, 300 mAs, 5-mm section thickness) was the benchmark for assessing the milliampere seconds and corresponding radiation dose necessary for breast CT. Image noise was measured by using a 10-cm-diameter cylinder imaged with a clinical CT scanner at 10-300 mAs for 80, 100, and 120 kVp. A cadaveric breast was imaged in the coronal plane to approximate the acquisition geometry of a proposed breast CT scanner. RESULTS: The AGD for 80-kVp breast CT was comparable to that for two-view mammography of 5-cm breasts (compressed breast thickness). For thicker breasts, the breast CT dose was about one-third less than that for two-view mammography. The maximum dose at mammography assessed in 1-mm(3) voxels was far higher (20.0 mGy) than that at breast CT (5.4 mGy) for a typical 5-cm 50% glandular breast. CT images of an 8-cm cadaveric breast (AGD, 6.3 mGy) were subjectively superior to digital mammograms (AGD, 10.1 mGy) of the same specimen. CONCLUSION: The potential of high signal-to-noise ratio images with low anatomic noise, which are obtainable at dose levels comparable to those for mammography, suggests that dedicated breast CT should be studied further for its potential in breast cancer screening and diagnosis.     

The study of ultrasonographic diagnosis on breast diseases]

15 sonomammographic findings of 341 histologically proved breast masses were reviewed to improve and objectify the current diagnostic criteria of sonomammography. The author proposed the renewed plan of the diagnostic criteria and the judgement method of benign or malignant breast masses on an electronic linear scanner, offering the author's original diagnostic concept particularly about the shape and the internal echo. This diagnostic approach demonstrated a sensitivity of 93.2%, specificity of 85.9%, and accuracy of 89.7%, which sufficiently showed to raise differential diagnostic capability for breast masses.     

Feasibility study of a breast density measurement within a direct photon-counting mammography scanner system

Purpose

To evaluate the clinical feasibility of breast density measurements by a new application within a direct photon-counting mammography scanner system.

Materials and methods

A retrospective study of consecutive women who underwent mammography using a direct photon-counting mammography scanner system (MicroDose mammography SI; Philips Digital Mammography Sweden AB) was performed at the authors’ institution between September and December 2013. Quantitative volumetric glandularity measurements were performed automatically for each acquired mammographic image using an application (Breast Density Measurement; Philips Digital Mammography Sweden AB). The quantitative volumetric glandularity of each breast was defined as the average values for the mediolateral oblique (MLO) and craniocaudal (CC) mammogram views.

Results

Of the 44 women who underwent bilateral mammogram acquisitions, the breast density measurements were performed successfully in 40 patients (90.9 %). A very good to excellent correlation in the quantitative breast density measurements acquired from the MLO and CC images was obtained in the 40 evaluable patients (R = 0.99).

Conclusion

The calculated volumetric glandularity using this new application should correspond well with the true volumetric density of each breast.     

乳房假体植入后破裂及泄漏的MRI表现

目的：探讨磁共振诊断乳房假体破裂和（或）泄漏的临床价值。方法：对17例隆乳术后患者行MR扫描，对1个体外正常硅胶液硅胶囊袋假体行相同序列MR扫描作为正常参照。对囊袋假体及注射聚丙烯酰胺假体的MR表现进行分类分析。结果：正常硅胶囊袋单腔假体7例12个，其中4例8个囊内为硅胶液；3例4个囊内为生理盐水。生理盐水硅胶囊袋单腔假体破裂2例2个，其中1 个属囊内破裂，MRI示残留塌陷的硅胶囊袋呈长条状长T1、短T2信号；另1个属囊外破裂，MRI示假体内有多条丝状短T2低信号，即“条丝征”，同侧乳房外见假体内容物颗粒。注射聚丙烯酰胺假体10例20个，其中1例2个完整；8例16个完全破裂，表现为多发条块状、结节状长T1、长T2信号，8例中有7例见双侧乳房腺体内及乳房外有注射物颗粒；1例2个内部撕裂，MRI表现为假体内有多发“条丝征”。结论：MR检查可明确乳房假体的类型、位置；明确假体破裂类型及漏出物的分布范围；因此能为临床手术提供准确定位，为随访复查提供客观资料。     

An MRI-compatible semiautomated vacuum-assisted breast biopsy system: initial feasibility study

PURPOSE: To develop an MR-compatible vacuum-assisted core needle breast biopsy system. MATERIALS AND METHODS: A vacuum-assisted breast biopsy system (Mammotome Hand Held; Ethicon Endo-Surgery, USA) was modified for freehand MRI-guided biopsy in an open, interventional 0.5-T scanner (Signa SP; GE, USA). Probes (11 gauge [G]) were fabricated without significant susceptibility artifact. These mate with an electromechanical hand piece and control system that were modified for use within the MRI scanner. A total of 62 breast lesions were simulated in the mammary tissues of six recently lactating sows by injecting between 0.1 and 1.0 mL of an aqueous gel containing dilute gadopentetate dimeglumine (Gd-DTPA) that formed a bright mass on T1-weighted imaging. RESULTS: Mechanical performance was satisfactory. Magnetic susceptibility and radiofrequency (RF) artifacts from the 11-G probe were negligible. T1-weighted fast spin echo (FSE) was used to guide biopsy. Up to eight samples were removed per lesion. Overall, 461 samples were obtained in 493 attempts (94%). Sample weights averaged 54 mg (N = 493) compared to 4.6 mg (N = 24) from 14-G titanium MRI-compatible needles. On average, 59% of the attempted samples yielded target lesion material. CONCLUSION: Preliminary results demonstrate the feasibility of a vacuum-assisted breast biopsy system in the MRI environment. Small 0.1-mL lesions can be biopsied without needle artifacts obscuring the target.     

Coronary calcium scoring with MDCT: the radiation dose to the breast and the effectiveness of bismuth breast shield

OBJECTIVE: The purpose of our study was to determine the breast radiation dose during coronary calcium scoring with multidetector computerized tomography (MDCT). We also evaluated the degree of dose reduction by using a bismuth breast shield when performing coronary calcium scoring with MDCT. MATERIALS AND METHODS: The dose reduction achievable by shielding the adult (35 years or older) female breasts was studied in 25 women who underwent coronary calcium scoring with MDCT. All examinations were performed with a 16-MDCT scanner. To compare the shielded versus unshielded breast dose, the examinations were performed with (right breast) and without (left breast) breast shielding in all patients. With this technique the superficial breast doses were calculated. To determine the average glandular breast radiation dose, we imaged an anthropomorphic dosimetric phantom into which calibrated dosimeters were placed to measure the dose to the breast. The phantom was imaged using the same protocol. Radiation doses to the breasts with and without the breast shielding were measured and compared using the Student's t-test. RESULTS: The mean radiation doses with and without the breast shield were 5.71+/-1.1 mGy versus 9.08+/-1.5 mGy, respectively. The breast shield provided a 37.12% decrease in radiation dose to the breast with shielding. The difference between the dose received by the breasts with and without bismuth shielding was significant, with a p-value of less than 0.001. CONCLUSION: The high radiation during MDCT greatly exceeds the recommended doses and should not be underestimated. Bismuth in plane shielding for coronary calcium scoring with MDCT decreased the radiation dose to the breast. We recommend routine use of breast shields in female patients undergoing calcium scoring with MDCT.     

Female breast radiation exposure during thorax multidetector computed tomography and the effectiveness of bismuth breast shield to reduce breast radiation dose

OBJECTIVE: The purpose of our study was to determine the breast radiation dose when performing routine thoracic multidetector computed tomography (MDCT). We also evaluated dose reduction and the effect on image quality of using a bismuth breast shield when performing thoracic MDCT. MATERIAL AND METHODS: The dose reduction achievable by shielding the adult (18 years or older) female breasts was studied in 50 women who underwent routine thoracic MDCT. All examinations were performed with a 16-MDCT scanner (Sensation Cardiac 16; Siemens Medical Solutions). To compare the shielded/unshielded breast dose, the examination was performed with (right breast) and without (left breast) breast shielding in all patients. With this technique, the superficial breast doses were calculated. To determine the average glandular breast radiation dose, we imaged an anthropomorphic dosimetric phantom into which calibrated dosimeters were placed to measure the dose to breast. The phantom was imaged using the same protocol. Radiation doses to the breasts with and without the breast shielding were measured and compared using the Student t test. RESULTS: In the qualitative evaluation of the MDCT scans, all were considered to be of diagnostic quality. We did not see any differences in quality between the shielded and unshielded lung. The mean radiation doses to the breasts with the shield and to those without the shield were 8.6 +/- 2.33 versus 14.46 +/- 3.94 mGy, respectively. The breast shield enabled a 40.53% decrease in radiation dose to the breast. The difference between the dose received by the breasts with and that received by the breasts without bismuth shielding was significant, with a P value of less than 0.001. CONCLUSIONS: Bismuth in-plane shielding for routine thoracic MDCT decreased radiation dose to the breast without qualitative changes in image quality. The other radiosensitive superficial organs (eg, testes and thyroid gland) specifically must be protected with shielding.     

Breast carcinoma and benign breast lesions. Diaphanography and quantitative evaluation using the computer-controlled image scanner OSIRIS

A total of 110 diaphanograms from women with breast carcinoma and 154 diaphanograms from women with benign breast disorders were quantitatively evaluated using the OSIRIS image scanner. Optical density values in the green and red spectral bands were recorded. The malignant and the benign groups, were statistically evaluated using linear discriminant analysis. Correct classification was obtained in 73.5 per cent of women with breast carcinoma and in 84.6 per cent of women with benign breast disorders. Visual interpretation of the findings alone classified 84.5 per cent of the malignant lesions correctly and 90.8 per cent of the benign lesions correctly. Quantitative evaluation combined with visual interpretation improved the accuracy of classification of breast carcinoma (91.8%), but not of benign breast disorders, which was about the same (83.8%).     

Computed tomographic evaluation of the breast.

Experience with a dedicated breast CT scanner (General Electric CT/M) using a contrast medium enhancement technique indicates that CT is superior to mammography, thermography, or physical examination for diagnosing both benign and malignant mammary disease especially in dense, thick, or fibrocystic breasts. CT is capable of diagnosing totally unsuspected early miniature carcinomas. It can identify and differentiate potential precancerous lesions from benign fibrocystic disease, and is the diagnostic tool of choice for evaluating and following severe fibrocystic disease. CT evaluation also affords definitive diagnostic help in instances where the mammographic, thermographic, and/or physical examinations are inconclusive. It can influence immediate surgical intervention or mitigate against an unnecessary biopsy. The study not only demonstrates morphologic changes in the breast but also accurately depicts an altered iodine pool in mammary tissues.     

乳房假体破裂及注射水凝胶扩散的磁共振成像

目的 :探讨乳房假体破裂及注射聚丙烯酰胺水凝胶扩散的MRI表现及临床意义。方法 :对 18例隆乳术后患者行MR扫描 ,并与术中所见比较。对假体置入及注射聚丙烯酰胺水凝胶的MRI表现进行分类分析。结果 :正常单腔硅凝胶假体 9例 ;单腔硅凝胶假体纤维囊内破裂 13例 ,MRI示假体内有多发条丝状短T2 低信号 ,即“条丝征” ;单腔硅凝胶假体纤维囊外破裂 2例 ,MRI示乳房腺体内长T2 结节状内容物颗粒。正常聚丙烯酰胺水凝胶注射 3例 ,注射聚丙烯酰胺水凝胶扩散 9例 ,MRI示乳腺后间隙以外部位出现结节状长T1、长T2 信号。结论 :MRI可诊断乳房假体有无破裂或注射聚丙烯酰胺水凝胶有无扩散 ,可明确其漏出或扩散的范围 ,因此能为手术提供准确定位 ,为随访提供客观资料。     

Adjunctive diagnostic value of MRI in the breast radial scar

Purpose

We sought to identify breast magnetic resonance imaging (MRI) criteria capable of influencing the differential diagnosis between radial scars related to benign proliferative disease and those associated with breast cancer with a view to proposing breast MRI as a promising and cost-effective modality to be carried out between mammography and surgical biopsy.

Materials and methods

From 1998 to June 2006, we studied 20 patients with a focal architectural distortion on mammography. All patients underwent contrast-enhanced breast MRI with a T1 Philips Gyroscan scanner and the acquisition of T1-weighted fast field echo, echo planar imaging (FFE EPI) axial dynamic sequences with a slice thickness of 3 mm. During postprocessing, subtracted images were assessed for morphological features, pattern of contrast enhancement, time-intensity curve and lesion enhancement rate.

Results

Breast MRI depicted 27 lesions between 7 mm and 30 mm in size. Fifteen of the 27 breast lesions showed benign features, eight showed malignant features and four were classified as suspicious. Pathological examination confirmed the benignity of all 15 lesions showing benign MRI features and revealed the benign nature of the four lesions classified as suspicious.

Conclusions

Evaluation of breast MRI showed that enhancement rate and time-intensity curve were useful only in the differential diagnosis between benign and malignant breast lesions. Our experience confirmed that breast MRI has very high sensitivity and, in particular, a negative predictive value of 100%. Breast MRI could thus be considered a useful diagnostic tool that can guide the choice between follow-up or surgical excision of radial scars.