Intraoperative ultrasound localization of nonpalpable breast cancers: A valuable aid during breast-conserving surgery

Objective

To evaluate the usefulness of intra-operative ultrasonography (US) for localization of nonpalpable breast cancer that could be visualized with preoperative US.

Patients and methods

We prospectively assessed 57 nonpalpable sonographically detected and biopsy-proved breast cancers in 57 patients. US localization of breast cancers was performed in the OR by the radiologist immediately before definitive surgery using either injection of blue dye or placement of a guide wire after marking of the skin overlying the lesion with a marking pen. Tumor identification, the correlation with tumor diameter on preoperative US, analysis of resection margins, and the need to perform surgical re-excision were analyzed.

Results

US correctly localized all lesions at surgery. Re-excision due to positive resection margins was necessary in four patients (7%) including three patients with ductal carcinoma-in situ (DCIS) and one patient with invasive disease at the surgical margin. Mastectomy was necessary in one patient (1.7%) due to multifocal invasive carcinoma. Thus, the re-excision rate was 8.7% (5 of 57).

Conclusion

US in the operating room is an attractive alternative guiding tool of localizing nonpalpable breast cancers that have been seen on preoperative US improving the process of image-guided surgery.     

The value of dynamic MRI in the evaluation of the breast following conservative surgery and radiotherapy

Objective

To assess the value of dynamic contrast-enhanced magnetic resonance mammography (DCE-MRM) in breast cancer patients treated by conservation breast surgery and radiotherapy.

Materials and methods

This prospective study were performed on 20 consecutive female patients, from January 2008 till January 2010 at Zagazig university hospitals. All cases had undergone breast conservative therapy (BCT) at least 9–12 months since the end of radiation therapy up to 5 years. All cases were suspected for either recurrence or post-operative complications by clinical examination in conjunction with mammography or/and US. DCE-MRM was performed at 1.5 T. The findings were correlated with the histopathology in all cases.

Results

We found that DCE-MRM accurately revealed the presence or absence, location, and extent of recurrent tumor more accurately than mammography or US. US had high sensitivity and specificity (85.7% and 76.8%) compared to mammography (71.4% and 38.4%, respectively). Seven recurrent cases were found, two of them were multifocal. False-positive contrast enhancement was seen in only one patient pathologically proved as granuloma. MRI showed 95% accuracy, 100% sensitivity, 92.3% specificity with 83% positive predictive value and 100% negative predictive value.

Conclusion

The conventional imaging was insufficient to detect the recurrent lesions after BCT, so DCE-MRI should be the imaging modality of choice in detection of the tumoral recurrence, and differentiating it from other complications. One limitation of the DCE-MRM is the persistent false-positive enhancement due to granulation tissue.     

The diagnostic value of PET/CT in recurrence and distant metastasis in breast cancer patients and impact on disease free survival

Aim of work

To detect the diagnostic value of PET/CT in breast cancer patients. We compared the performance of PET/CT with that of conventional imaging in detection of recurrence and distant metastasis and evaluated the impact PET/CT results have on disease free survival.

Materials and methods

We retrospectively studied 50 patients with breast cancer with clinical suspicion of recurrent or metastatic lesion and who underwent PET/CT and conventional imaging procedures. The imaging results were retrospectively compared with histopathology and clinical follow-up as a reference standard.

Results

PET/CT detected distant metastases with a sensitivity of 97% and a specificity of 93%. In contrast, the sensitivity and specificity of combined conventional imaging procedures were 75% and 73%, respectively, disease-free survival was significantly shorter in the 34 M1-PET/CT patients than in the 14 M0-PET/CT patients (log-rank P = 0.002) also PET/CT detected recurrence in 1 patient with equivocal mammographic findings.

Conclusion

In breast cancer, PET/CT is superior to conventional imaging procedures for detection of recurrence, distant metastases and PET/CT can be used to improve prediction of the clinical outcome of breast cancer patients.     

Value of mammography and combined grey scale ultrasound and ultrasound elastography in the differentiation of solid breast lesions

Aim of the work

The aim of this work was to evaluate the value of ultrasound elastography (UE) in differentiating benign versus malignant solid breast lesions discovered in mammography and compare it with grey scale ultrasound (US) and mammography.

Methods

From May 2011 to May 2013, 114 solid lesions from 100 consecutive patients discovered during mammography were categorized into benign or malignant by mammography and US and further analyzed with UE. The diagnostic results of the cases were compared with histopathologic findings.

Results

Of 114 lesions, 33 were histologically malignant, and 81 were benign. UE was the most specific (95.1%) of the 3 modalities. The accuracy (81.7%) of UE was equal to mammography and was higher than those of US (82.5% and 71.9%, respectively). A combination of UE and US had the best sensitivity (90.9%) and accuracy (93.8%).

Conclusions

Ultrasound elastography is useful for breast lesion characterization and is an easier and cheaper method and more specific than mammography or US alone, but it is operator dependent. When combined with US, detection accuracy can be greatly improved and the combination potentially could reduce unnecessary biopsy.     

Ultrasonographic criteria for fine needle aspiration of nonpalpable thyroid nodules 1–2 cm in diameter

Purpose

To investigate the ultrasonographic (US) characteristics for nonpalpable thyroid nodules 1–2 cm in diameter and to evaluate the guideline for fine needle aspiration (FNA) in terms of US findings.

Materials and methods

Between June 2005 and November 2006, FNA was performed in 919 thyroid nodules by radiologists. Of these nodules, 51 malignant nodules and 72 benign nodules were finally included. All 123 nodules were analyzed by 3 radiologists if there were the following US characteristics: marked hypoechogenecity, hypoechogenecity, isoechogenecity, hyperechogenecity, microcalcification, coarse calcification, rim calcification, spiculated margin, taller-than-wide shape, irregular shape, hypoechoic rim and honeycomb appearance. The maximum diameters of nodules and thickness of hypoechoic rim were measured. US characteristics relevant as predictors were identified using a Chi-square or Fisher's exact test and odds ratio. We compared the diagnostic efficacy of 3 US criteria for FNA indication.

Results

Microcalcification, taller-than-wide shape, marked hypoechogenecity, hypoechogenecity, coarse calcification, irregular shape and spiculated margin were significant characteristics of malignant nodules. Isoechogenecity, hypoechoic rim and honeycomb appearance was significant characteristics of benign nodules. Rim or arc calcification, hyperechogenecity and thickness of hypoechoic rim were insignificant. Among 3 US criteria for FNA indication, NFI showed the highest diagnostic efficacy, 98.0% in sensitivity, 75.0% in specificity and 150.0 in odds ratio.

Conclusion

As for nonpalpable thyroid nodules 1–2 cm in diameter, US characteristics are useful for differentiating between malignant and benign nodules. Malignant US characteristics and honeycombing appearance have significant value in selecting nodules for biopsy and reducing the frequency of the FNA procedure.     

The performance of computer-aided detection when analyzing prior mammograms of newly detected breast cancers with special focus on the time interval from initial imaging to detection

Purpose

The clinical role of CAD systems to detect breast cancer, which have not been on cancer containing mammograms not detected by the radiologist was proven retrospectively.

Methods

All patients from 1992 to 2005 with a histologically verified malignant breast lesion and a mammogram at our department, were analyzed in retrospect focussing on the time of detection of the malignant lesion. All prior mammograms were analyzed by CAD (CADx, USA). The resulting CAD printout was matched with the cancer containing images yielding to the radiological diagnosis of breast cancer. CAD performance, sensitivity as well as the association of CAD and radiological features were analyzed.

Results

278 mammograms fulfilled the inclusion criteria. 111 cases showed a retrospectively visible lesion (71 masses, 23 single microcalcification clusters, 16 masses with microcalcifications, in one case two microcalcification clusters). 54/87 masses and 34/41 microcalcifications were detected by CAD.Detection rates varied from 9/20 (ACR 1) to 5/7 (ACR 4) (45% vs. 71%). The detection of microcalcifications was not influenced by breast tissue density.

Conclusion

CAD might be useful in an earlier detection of subtle breast cancer cases, which might remain otherwise undetected.     

Combined sonoelastographic scoring and strain ratio in evaluation of breast masses

Aim of the work

To detect the diagnostic performance of the combined use of sonoelastographic scoring and strain ratio in differentiation of benign and malignant breast masses with the histopathology is the standard reference.

Patients and methods

One hundred and seventy-two women with 190 breast masses were enrolled in this prospective study. Conventional US (B-mode and color Doppler US) and sonoelastography (elasticity score “ES” and calculation of strain ratio “SR”) were performed. B-mode images were classified according to the Breast Imaging Recording and Data System. The hardness was determined with 5-point scoring method and SRs of the lesions were calculated. Receiver operating characteristic (ROC) curves were performed and the cutoff point for differentiation of benign and malignant masses was detected.

Results

There was a significant difference (P = 0.02) in the mean SRs between benign and malignant breast masses. The area under the curve (AUC) for combination of ES and SR (0.964) was higher than for ES alone (0.852) and B-mode US (0.823). A cutoff value of 3.6 for the SR allowed the best differentiation of benign and malignant breast lesions.

Conclusion

The combined use of elasticity score and strain ratio of sonoelastography increased the diagnostic performance in distinguishing benign from malignant breast masses.     

Real-time MRI navigated US: Role in diagnosis and guided biopsy of incidental breast lesions and axillary lymph nodes detected on breast MRI but not on second look US

Objectives

To prospectively evaluate the accuracy of real-time ultrasound combined with supine-MRI using volume navigation technique (RtMR-US) in diagnosis and biopsy of incidental breast lesions (ILSM) and axillary lymph nodes (LNSM) suspicious of malignancy on contrast enhanced magnetic resonance imaging (CE-MRI).

Materials and methods

Five hundred and seventy-seven women were examined using breast CE-MRI. Those with incidental breast lesions not identified after second-look ultrasound (US) were recruited for RtMR-US. Biopsy was performed in ILSM. Breast lesions were categorized with BI-RADS system and Fisher’ exact test. Axillary lymph nodes morphology was described. To assess efficacy of RtMR-US, diagnostic accuracy, sensitivity, specificity, detection rate and Kappa index of conventional-US and RtMR-US were calculated.

Results

Forty-three lesions were detected on CE-MRI before navigation. Eighteen were carcinomas and 25 ILSM. Of these, 21 underwent a RtMR-US. Detection rate on RtMR-US (90.7%) was higher than on conventional-US (43%) (p < 0.001). Agreement between both techniques was low (k = 0.138). Twenty ILSM and 2 LNSM were biopsied. Sixty-five percent were benign (100% of BI-RADS3 and 56% of BI-RADS4-5). Diagnostic performance of RtMR-US identifying malignant nodules for overall lesions and for the subgroup of ILSM was respectively: sensitivity 96.3% and 100%, specificity 18.8% and 30.7%, positive predictive value 66.7% and 43.7%, negative predictive value 75% and 100%. In addition RtMR-US enabled biopsy of 2 metastatic lymph nodes.

Conclusions

Real time-US with supine-MRI using a volume navigation technique increases the detection of ILSM. RtMR-US may be used to detect occult breast carcinomas and to assess cancer extension, preventing unnecessary MRI-guided biopsies and sentinel lymph node biopsies. Incidental lesions BI-RADS 3 non-detected on conventional-US are probably benign.     

Magnetic resonance spectroscopy in recurrent breast masses following conservative surgery and radiation therapy

Purpose

The purpose of our study was to assess the value of functional magnetic resonance spectroscopy (1H MRS) in evaluating patients with recurrent cancer breast after breast conservative therapy (BCT) and radiation therapy by the presence of the choline-containing compounds (Cho) as a marker of malignancy.

Patients and methods

Twenty-six patients were included in the study all the patients were subjected to previous BCT and associated radiation therapy. All of them were suspected to have tumor recurrence by clinical examinations, periodic mammographic examination and or ultrasonography. All the patients were submitted to dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) followed by magnetic resonance spectroscopy (MRS) at 1.5 T MRI machine.

Results

Local recurrence was confirmed by histopathology in 19 patients, MRS detected 18 patients with sensitivity of 94.7%, false positive was seen in one patient in whom histopathology revealed inflammatory mastitis (specificity 85.7%). One patient was false negative diagnosed by histopathology as ductal carcinoma in situ (DCIS) with negative predictive value of 85.7% and overall accuracy of 92.3%.

Conclusion

In our study breast MRS using choline (Cho) integral was accurate in evaluating patients with recurrent breast masses after BCT and radiation therapy. It reaches a high level of diagnostic performance.     

Sonoelastography versus dynamic magnetic resonance imaging in evaluating BI-RADS III and IV breast masses

Background

Several clinical studies showed that sonoelastography was useful for the differentiation of benign and malignant breast lesions. Contrast-enhanced MRI has emerged as a promising tool in the detection, diagnosis, and staging of breast cancer.

Aim of work

To study the role of sonoelastography versus dynamic MRI in evaluating BI-RADS III, IV breast masses and detect which modality is of better sensitivity and specificity trying to guide the patient either to follow-up the lesion or proceed to lesion excision.

Subjects and methods

The study included 50 Egyptian patients (age ranged from 32 to 58 years) who presented by breast masses and categorized as BI-RADS III, IV by mammography and ultrasound. Sonoelastography and dynamic MRI were done for all the patients.

Results

Differentiation between BI-RADS III and IV by US elastography had 84% sensitivity and 84% specificity and by MRI had 88% sensitivity and 80% specificity.

Conclusion

Regarding the sonoelastography, it is an easy and cheap modality. The elasticity score is an important parameter for lesion characterization. Combination of morphologic and dynamic MRI studies is very important for the breast lesion evaluation. MRI is more sensitive but less specific than sonoelastography. Finally if we find any suspicious character elicited by either sonoelastography or MRI (BI-RADS IV), lesion excision is recommended.     

A computerized global MR image feature analysis scheme to assist diagnosis of breast cancer: a preliminary assessment

Objectives

To develop a new computer-aided detection scheme to compute a global kinetic image feature from the dynamic contrast enhanced breast magnetic resonance imaging (DCE-MRI) and test the feasibility of using the computerized results for assisting classification between the DCE-MRI examinations associated with malignant and benign tumors.

Materials and Methods

The scheme registers sequential images acquired from each DCE-MRI examination, segments breast areas on all images, searches for a fraction of voxels that have higher contrast enhancement values and computes an average contrast enhancement value of selected voxels. Combination of the maximum contrast enhancement values computed from two post-contrast series in one of two breasts is applied to predict the likelihood of the examination being positive for breast cancer. The scheme performance was evaluated when applying to a retrospectively collected database including 80 malignant and 50 benign cases.

Results

In each of 91% of malignant cases and 66% of benign cases, the average contrast enhancement value computed from the top 0.43% of voxels is higher in the breast depicted suspicious lesions as compared to another negative (lesion-free) breast. In classifying between malignant and benign cases, using the computed image feature achieved an area under a receiver operating characteristic curve of 0.839 with 95% confidence interval of [0.762, 0.898].

Conclusions

We demonstrated that the global contrast enhancement feature of DCE-MRI can be relatively easily and robustly computed without accurate breast tumor detection and segmentation. This global feature provides supplementary information and a higher discriminatory power in assisting diagnosis of breast cancer.     

Identification of occult breast lesions detected by magnetic resonance imaging with targeted ultrasound: A prospective study

Objective

To verify the capacity of targeted ultrasound (US) to identify additional lesions detected on breast magnetic resonance imaging (MRI), but occult to initial mammography, US and clinical examinations.

Methods

This prospective study included 68 additional relevant breast lesions identified on MRI of 49 patients. As an inclusion criterion, breast US and mammography were required and performed up to six months before MRI. These lesions were then subjected to targeted “second-look” US up to 2 weeks after MRI, performed by one or two radiologists with expertise on breast imaging. Lesions were evaluated according to the established Breast Imaging Report and Data System (BI-RADS) lexicon.

Results

Targeted US identified 46/68 (67.6%) lesions revealed by MRI. No significant associations were observed between US identification and the type of lesion, dimensions, morphological characteristics and enhancement pattern according to MRI findings. Targeted US identified 100% of BI-RADS category 5 lesions, 90% of category 4 lesions, and just over 50% of category 3 lesions (p < 0.05). There was significant agreement (p < 0.001) between MRI and US BI-RADS classification for all three categories.

Conclusion

Targeted US can identify a large proportion of the lesions detected by breast MRI, especially those at high risk of malignancy, when performed by a professional with experience in both breast US and MRI.     

Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis

PURPOSE: To assess the value of ultrasonography (US) and US-guided fine-needle aspiration biopsy (FNAB) in the detection and diagnosis of recurrent cancer in breasts reconstructed with autogenous myocutaneous flaps after mastectomy for primary breast cancer and to describe the US appearances of recurrence in the reconstructed breast. MATERIALS AND METHODS: Between July 1994 and March 2001, US of the reconstructed breast was performed in 20 women with autogenous myocutaneous flap reconstruction. US findings were correlated with clinical and mammographic findings. US-guided FNAB of 25 (64%) of the 39 recurrent cancers depicted at US was performed. RESULTS: Twenty-one (54%) of the 39 recurrent cancers depicted at US were clinically occult. Mammography performed in 12 of the 20 patients with reconstructed breasts depicted 14 (56%) of the 25 recurrent cancers that were detected at US in these patients. US-guided FNAB helped to establish a definitive diagnosis of recurrent breast carcinoma in 24 (96%) of the 25 tumor specimens sampled. CONCLUSION: US and US-guided FNAB are valuable for the assessment of both palpable and clinically occult recurrent breast cancers in autogenous myocutaneous flap breast reconstructions.     

Evaluation of tumor extent in breast cancer patients using real-time MR navigated ultrasound: Preliminary study

Objectives

To evaluate the accuracy of real-time MR navigated ultrasound (MRnav US) for tumor extent measurements in breast cancer and to investigate variables influencing the accuracy of MRnav US in comparison with US alone.

Methods

Fifty-three patients with 60 malignancies underwent preoperative breast MRI and US with or without MRI navigation. Maximum lesion sizes based on MRnav US and US alone were measured, and their relationship with the pathology was analyzed considering the differences in the clinicopathologic variables of the patients.

Results

Among 60 breast cancers, mean lesion size at initial breast US without MRI navigation and at MRI-navigated US was 19 mm and 24 mm, respectively, compared with 28 mm on the histopathology. Overall, the tumor size estimated with MRnav US was more strongly correlated with the histologic tumor size than with US alone. Accurate measurements by MRnav US were significantly more frequent in the lesions that were presented as a mass type on MRI. In addition, the accurate measurement of mass extent was improved with MRnav US in patients who had non-mass type lesions on MRI and who had undergone neoadjuvant systemic chemotherapy when compared with US alone.

Conclusion

MRnav US was more accurate for tumor extent estimation than US alone, and specific clinicopathologic variables can affect the accuracy of MRnav US.     

Assessment of breast lesions using BI-RADS US lexicon in mammographically dense breasts (ACR categories 3 and 4) with histopathological correlation

Purpose

To assess the role of ultrasonography in detection, and categorization of breast lesions in patients with mammographically dense breasts with the use of the BI-RADS US lexicon.

Patients and methods

This study included 60 female patients (age range from 20 to 80 years, mean 38.3 ± 11.9) complaining of mastalgia, breast lump or nipple discharge with mammographically dense breast tissue. Breast ultrasound was performed to all patients with a 12-MHz linear-array transducer. Sonographic findings of the breast lesions were described and categorized according to the BI-RADS US assessment categories. Biopsy procedures were performed for the sonographically detected breast lesions with histopathological examination of the biopsied tissue.

Results

The main complaint was palpable breast mass encountered in 25 patients, 12 of mastalgia, 4 of nipple discharge, 12 patients were on screening and 7 on follow up. 36 patients were categorized as ACR 3 and 24 ACR 4 regarding the density of their breasts in mammography. Mammography revealed no abnormalities in 31 patients and abnormal in 29 patients, the commonest mammographic finding was breast mass, detected in 19 patients. Ultrasound detected breast lesions in 56 (93.3%) out of 60 patients. BI-RADS US category 2 was the most common category representing 36.7%. Ultrasonography had a diagnostic reliability for differentiating between benign and malignant breast lesions (p = 0.869) in mammographically dense breasts while mammography was diagnostically unreliable (p = 0.045).

Conclusion

Ultrasound is a mandatory adjunct to mammography in detection and characterization of breast lesions in mammographically dense breasts.     

Contralateral lesions detected by preoperative MRI in patients with recently diagnosed breast cancer: application of MR CAD in differentiation of benign and malignant lesions

Objectives

To retrospectively investigate the added value of kinetic features measured by computer-aided diagnosis (CAD) for differentiating benign and malignant contralateral breast lesions detected by preoperative MRI in breast cancer patients.

Methods

This study was approved by our institutional review board, and the requirement for informed consent was waived. Fifty-two breast MR images and their CAD kinetic features were obtained for 52 consecutive breast cancer patients with contralateral breast lesions detected by preoperative MRI and confirmed by excision (23 cancers and 29 benign lesions). Three experienced radiologists independently reviewed the MR images without CAD information and assessed probabilities of malignancy. Four weeks later, these probabilities were reanalyzed using stored CAD data. Diagnostic performances and detection rates of delayed washout components were compared between interpretations without and with CAD for each reader.

Results

Use of MR CAD increased detection of washout component by 2.4- to 3.7-fold than visual assessment for enhancing contralateral lesions, which increased sensitivity (91% vs. 87% in reader 1; 96% vs. 74% in reader 2; 91% vs. 70% in reader 3) and decreased specificity, but statistical significance was only found for decreased specificity in one reader (52% vs. 28%, P = 0.039), and overall performance (areas under ROC curves 0.672 vs. 0.616 in reader 1; 0.624 vs. 0.603 in reader 2; 0.706 vs. 0.590 in reader 3) remained unimproved.

Conclusion

Addition of MR CAD increased sensitivity and decreased specificity than radiologist's assessment alone for differentiating benign and malignant contralateral lesions in breast cancer patients and overall performance remained unimproved.     

Incremental value of real-time ultrasound elastography in differentiating breast masses

Aim of the work

To evaluate the value of real-time ultrasound elastography (RTE) in differentiating benign from malignant breast masses.

Materials and methods

This study included, whether palpable or non-palpable, 145 sonographically proven breast masses in 121 patients, imaged by conventional B-mode US, color-flow Doppler US and RTE with histopathological analysis considered as the golden standard reference.

Results

Lesions were differentiated into benign and malignant by conventional B-mode US (79; 45.5% and 66; 54.5%, respectively), RTE (80; 55.2% and 65; 44.8% respectively), and histopathology (82; 56.6% and 63; 43.4%, respectively). The mean difference in the mass size was significant between B-mode US and RTE in malignant masses (P = 0.002), while not significant among benign masses (P = 0.153). The B-mode US depicted sensitivity of 92.06%, specificity of 90.24%, PPV of 87.88%, NPV of 93.67% and accuracy of 91.03%, while the RTE showed sensitivity of 98.41%, specificity of 96.34%, PPV of 95.38%, NPV of 98.75% and accuracy of 97.24%.

Conclusion

Combined use of RTE can complement conventional B-mode US with improving its diagnostic performance in differentiating breast lesions with subsequent reduction in the rate of unnecessary biopsies in benign lesions.     

Differentiating benign from malignant solid breast lesions: Combined utility of conventional ultrasound and contrast-enhanced ultrasound in comparison with magnetic resonance imaging

Objective

To prospectively evaluate the diagnostic efficacy of conventional ultrasound (US), contrast-enhanced US (CEUS), the combined use of two modalities, and magnetic resonance imaging (MRI) in the differentiation of focal solid breast lesions.

Materials and methods

61 patients with BI-RADS category 3–5 breast lesions detected at conventional US underwent CEUS and MRI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of conventional US, CEUS, combination of two modalities and MRI for discrimination between benign and malignant breast lesions.

Results

Tissue specimens of 61 breast lesions were obtained either from surgical resection (n = 46) or from needle biopsy (n = 15). Histopathologic diagnosis revealed 28 benign and 33 malignant lesions. The diagnostic performance of conventional US and CEUS in differentiating benign from malignant breast lesions showed no significant difference (P = 0.741). The combination of two modalities significantly improved the diagnostic accuracy compared with either conventional US or CEUS alone (P = 0.031 and P = 0.012, respectively). The area under the ROC curve (A_z) value for the combined use of two modalities for discrimination between benign and malignant breast lesions was 0.94, and that for MRI was 0.91, whereas no statistical difference was found between them (P = 0.296).

Conclusion

The combined use of conventional US and CEUS has a better diagnostic performance than either method alone and displays good agreement with MRI in the differentiation capability for benign and malignant breast lesions.     

Postoperative restaging: PET/CT impact on diagnosis and management

Purpose

The goal of this study was to assess the value of combined PET/CT in the restaging of suspected recurrent cancer and its impact on further management planning of the patients.

Patients and methods

Fourty-two patients with suspected recurrence due to new clinical, biochemical and radiologic findings were prospectively evaluated. PET/CT results were compared with PET and CT data. A final diagnosis of recurrence was confirmed by biopsy or by further clinical and radiologic work-up.

Results

Thirty nine out of 42 patients had recurrence and or distant metastases in 108 malignant sites. For the site-based analysis PET/CT showed 100% sensitivity, 80% specificity, 98% PPV, 100% NPV and 98% accuracy compared with 100%, 50%, 94%, 100% and 95%, respectively, for PET, and 87%, 50%, 94%, 28% and 83%, respectively, for CT. For the patient-based analysis, PET/CT showed 100% sensitivity, 75% specificity, 97% PPV, 100% NPV and 98% accuracy compared with 100%, 50%, 92%, 100% and 93%, respectively for PET and 86%, 75%, 97%, 38% and 86%, respectively for CT. PET/CT results changed the management of 90% of patients.

Conclusion

PET/CT provides accurate restaging of suspected recurrent cancer with a significant clinical impact on further management planning.     

Effect of adding screening ultrasonography to screening mammography on patient recall and cancer detection rates: A retrospective study in Japan

Purpose

To determine whether adding screening ultrasonography to screening mammography can reduce patient recall rates and increase cancer detection rates.

Materials and methods

We analyzed the results of mammography and ultrasonography breast screenings performed at the Total Health Evaluation Center Tsukuba, Japan, between April 2011 and March 2012. We also reviewed the modalities and results of diagnostic examinations from women with mammographic abnormalities who visited the Tsukuba Medical Center Hospital for further testing.

Results

Of 11,753 women screened, cancer was diagnosed in 10 (0.22%) of the 4529 participants who underwent mammography alone, 23 (0.37%) of the 6250 participants who underwent ultrasonography alone, and 5 (0.51%) of the 974 participants who underwent mammography and ultrasonography. The recall rate due to mammographic abnormalities was 4.9% for women screened only with mammography and 2.6% for those screened with both modalities. The cancer detection rate was 0.22% for women screened only with mammography (positive predictive value, 4.5%) and 0.31% for those screened with both modalities (positive predictive value, 12.0%).Of the 211 lesions presenting as mammographic abnormalities investigated further, diagnostic ultrasonography found no abnormalities in 63 (29.9%) and benign findings in 69 (33.7%). The rest 36.4% needed mammography, cytological or histological examinations or follow-up in addition to diagnostic ultrasonography.

Conclusions

It is possible to reduce the recall rate in screening mammography by combining mammography and ultrasonography for breast screening.