Characterization and guided-procedures of breast suspicious microcalcifications: can MicroPure ultrasound do it?

Objective

To assess the diagnostic value of high-frequency (MicroPure) ultrasound in evaluating suspicious microcalcifications and to determine its capability in biopsy guidance.

Subjects and methods

Sixty-two cases with suspicious microcalcifications detected on mammographic examination had been re-evaluated by MicroPure US. The studied cases underwent true cut tissue/surgical excision biopsy. Histopathology revealed 25 benign and 37 malignant lesions and was considered the gold standard of reference.

Results

Malignant microcalcifications were easier to be visible at MicroPure US, as they were detected in 86.5% (n = 32/39) compared to only 68% (n = 17/25) of the benign lesions. US depicted more breast masses associated with malignant microcalcifications in 78% (n = 29/37) than those associated with benign ones seen in 36% (n = 9/25).Visibility of suspicious microcalcifications at US was aided by preliminary mammogram. Given known mammography location of these microcalcifications had made their visualization accessible by MicroPure US in 79% (n = 49) of the cases.

Conclusion

MicroPure ultrasound cannot discriminate benign from malignant breast microcalcifications. MicroPure can be useful in detecting clustered microcalcifications that are not accessible by B-mode ultrasound; provided knowledge of their mammographic location and thus can provide better guidance for pre-surgical wire localization and ultrasound-guided biopsies.     

Waldenstr?m's macroglobulinaemia of the breast detected by colour Doppler ultrasound.

Waldenstr?m's macroglobulinaemia (lymphoplasmacytoid lymphoma) is a low grade B cell non-Hodgkin's lymphoma. The majority of patients present with advanced disease. Lymphoma of the breast is rare and usually arises as part of a disseminated disease process. A case of disseminated Waldenstr?m's macroglobulinaemia is reported in which the breast was involved. The findings using standard mammographic and ultrasound techniques were non-specific and only when colour Doppler examination was performed could an abnormality be detected.     

Interval growth of probably benign breast lesions on follow-up ultrasound: how can these be managed?

Objectives  

To investigate the malignancy rate in probably benign lesions with interval growth on follow-up ultrasound (US) and the cut-off values for predicting malignancy.     

Real-time ultrasound elastography: Does it improve B-mode ultrasound characterization of solid breast lesions?

Introduction

Elastography is a non-invasive medical imaging technique that detects tumors based on their stiffness (elasticity). Strain images display the relative stiffness of lesions compared with the stiffness of surrounding tissue as cancerous tumors tend to be many times stiffer than the normal tissue, which “gives” under compression. An image in which different degrees of stiffness show as different shades of light and dark is called an elastogram.

Purpose

To prospectively evaluate the sensitivity and specificity of the real-time sonoelastography as compared with B-mode US for distinguishing between benign and malignant solid breast masses. The density of the glandular breast tissue was taken in consideration in addition to the Breast Imaging Reporting and Data System (BI-RADS) categories of the lesions, with biopsy results as the reference standard.

Methods

A total of 216 candidate solid lesions (123 benign and 93 malignant) in 188 patients were examined with 2-dimensional ultrasonography, elastosonography and mammography (for 147 patients). The lesions were classified according to the density of the glandular breast tissue into low density group (D1) and a high density group (D2) and were categorized with the BIRADS score. Elastographic images were assigned an elasticity score of 1 to 5 (1–3, benign; 4 and 5, malignant) according to the Multi-Center Team of Study and the strain ratios of the lesions were measured. Concordance between the imaging findings and histopathologic results was documented. Statistical analysis was performed and sensitivity, specificity and positive and negative predictive values for both elastography and conventional sonography were calculated.

Results

Elastography showed less sensitivity but higher specificity than conventional sonography in the differentiation of benign from malignant solid lesions: B-mode sonography had sensitivity of 85.1%, specificity of 93.9%, a positive predictive value of 92.5% and a negative predictive value of 87.8%, compared with the sensitivity of 80.1%, specificity of 97.1%, a positive predictive value of 96.8% and a negative predictive value of 82.1% for elastography. Elastography was superior to B-mode US in diagnosing solid lesions in the low density group (D1) (96.6% vs. 92.4% specificity) and less in the dense glandular tissue (97.8% vs. 95.9% specificity).

Conclusions

Real-time sonoelastography is an useful technique for the characterization of benign and malignant solid lesions as it increases the diagnostic specificity comparable to B-mode ultrasound, particularly in both ACR 1 and 2, thus reducing the false-positive rate.     

Comparison between different imaging techniques in the evaluation of malignant breast lesions: can 3D ultrasound be useful?

Purpose

This study was done to assess the feasibility of three-dimensional ultrasonography (3D-US) for volume calculation of solid breast lesions.

Materials and methods

The volumes of 36 malignant lesions were measured using conventional 2D-US, 3D-US and magnetic resonance imaging (MRI) and compared with that obtained with histology (standard of reference). With 2D Ultrasouns, volume was estimated by measuring three diameters and calculating volume with the mathematical formula for spheres. With 3D-US, stored images were retrieved and boundaries of masses were manually outlined; volume calculation was performed with VOCAL software. For MRI, volume measurements were obtained with special software for 3D reconstructions, after each lesion had been manually outlined. Histology measured the three main diameters and the volume was estimated using the mathematical formula for spheres. Interclass correlation coefficient (ICC) and Bland–Altman plots were used to assess agreement between the volumes measured.

Results

ICC indicated that a good level of concordance was identified between 3D-US and histology (0.79). According to the Bland–Altman analysis, limits of agreement of mean differences of the volumes measured with the three imaging modalities were comparable with histology: ?2÷1.5 cm³ for 3D-US; ?2.3÷1.3 cm³ for 2D-US and ?2.2÷1.6 cm³ for MRI.

Conclusions

3D-US is a reliable method for the volumetric assessment of breast lesions. 3D-US is able to provide valuable information for the preoperative evaluation of lesions.     

Consultant breast radiographers: Where are we now?: An evaluation of the current role of the consultant breast radiographer

IntroductionThe aim of this study is to:

• •Evaluate the current role of the consultant breast radiographer.
• •Compare current practice with the four key components for consultant practice.
• •Gauge the support of radiologist colleagues.
• •Determine the other professional commitments involved with the role.

This study could be the precursor for a macro study of all consultant radiographer practice in other specialities.MethodologyMethodology used was a comparative ethnographic study. Questionnaires to the 24 consultant breast radiographers currently in post, and consultant breast radiologists, who work with them, were conducted.Data collection was a qualitative thematic approach.ConclusionConsultant breast radiographers provide high quality care to patients through excellent clinical practice, leadership and good communication.However, this study shows hospital Trusts emphasis for non medical consultants is for clinical practice first. Some radiologists are still a barrier to progression for consultant breast radiographers, and radiologists have a big influence in recruitment decisions.Consultant breast radiographer posts are well established, their numbers are increasing through recognition of the role and of their abilities and performance. Consultant breast radiographers state that becoming a consultant is the major achievement of their career, proving the Society of Radiographers' vision of the four-tier career structure has been well received by the radiography profession.     

Plain radiographic diagnosis of mobile esophageal polyp – Now you see me,now you don't

Esophageal fibrovascular polyps are rare benign tumors usually arising from proximal 1/3rd of the esophagus. Clinically they are asymptomatic or present with varying degree of digestive and respiratory symptoms depending upon their structure. The diagnosis usually requires multimodality approach including invasive endoscopy. We report a case of mobile cervical esophageal polyp where plain radiography alone was diagnostic; further workup included barium studies, computed tomography and therapeutic endoscopy.     

DEGRO practical guidelines: radiotherapy of breast cancer I

Background and purpose

The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft für Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012.

Methods

A comprehensive survey of the literature concerning radiotherapy following breast conserving therapy (BCT) was performed using the search terms “breast cancer”, “radiotherapy”, and “breast conserving therapy”. Data from lately published meta-analyses, recent randomized trials, and guidelines of international breast cancer societies, yielding new aspects compared to 2007, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the DKG (Deutsche Krebsgesellschaft), this paper addresses indications, target definition, dosage, and technique of radiotherapy of the breast after conservative surgery for invasive breast cancer.

Results

Among numerous reports on the effect of radiotherapy during BCT published since the last recommendations, the recent EBCTCG report builds the largest meta-analysis so far available. In a 15 year follow-up on 10,801 patients, whole breast irradiation (WBI) halves the average annual rate of disease recurrence (RR 0.52, 0.48–0.56) and reduces the annual breast cancer death rate by about one sixth (RR 0.82, 0.75–0.90), with a similar proportional, but different absolute benefit in prognostic subgroups (EBCTCG 2011). Furthermore, there is growing evidence that risk-adapted dose augmentation strategies to the tumor bed as well as the implementation of high precision RT techniques (e.g., intraoperative radiotherapy) contribute substantially to a further reduction of local relapse rates. A main focus of ongoing research lies in partial breast irradiation strategies as well as WBI hypofractionation schedules. The potential of both in replacing normofractionated WBI has not yet been finally clarified.

Conclusion

After breast conserving surgery, no subgroup even in low risk patients has yet been identified for whom radiotherapy can be safely omitted without compromising local control and, hence, cancer-specific survival. In most patients, this translates into an overall survival benefit.     

Preoperative assessment of stenosis of the epiaortic vessels: can colour-Doppler ultrasound really supplant angiography?

PURPOSE: To evaluate the diagnostic role of digital angiography compared with colour-Doppler US in the study of epiaortic vessel stenoses and the degree of morbidity associated with angiography. MATERIALS AND METHODS: Out of 2,000 angiographic examinations of the epiaortic vessels performed for the concurrent presence of clinical findings of cerebrovascular insufficiency and colour-Doppler US findings of carotid-vertebral stenosis, a randomized sample of 200 patients was evaluated. The retrospective review of medical records provided the surgical data of the stenosis which were subsequently compared with the angiography and colour-Doppler US findings, and with the clinical and laboratory data to identify the possible complications of angiography. RESULTS: Diagnostic agreement was 75%. Colour-Doppler US underestimated stenosis in 16.5% and overestimated stenosis in 8% of cases. In 18% of cases there was a diagnostic gain of angiography (vascular lesions associated with main lesion), which also provided clinically important incidental findings (intracranial aneurysms, meningiomas) in 6.5% of patients. No relevant complications resulting from the angiographic procedure were recorded. CONCLUSIONS: Angiography allowed a more accurate evaluation of the degree of stenosis compared with colour-Doppler ultrasound. Moreover, it allowed diagnosis of important associated conditions that may affect therapeutic planning. In our series, we recorded no important complications related to angiography. Therefore, angiography remains the standard of reference in the preoperative evaluation of patients with clinically diagnosed cerebral ischaemia. Though fairly reliable as a first-line investigation, Colour-Doppler US is not sufficiently exhaustive as a pre-operative evaluation tool.     

Influence of additional breast ultrasound on cancer detection in a cohort study for quality assurance in breast diagnosis—analysis of 102,577 diagnostic procedures

Purpose  

To determine the value of a breast ultrasound (US) examination in addition to mammography in cases of American College of Radiology (ACR) tissue pattern III and IV in symptomatic women and women at risk.     

Chest ultrasound in the assessment of patients in ICU: How can it help?

Background: Different imaging techniques can be used for assessment of chest problems in ICU patients, however ultrasound is a good diagnostic tool giving more information and at the same time without exposure to radiation and without risk of critical patient transfer.Aim of the work: The aim of this work was to study the role of thoracic ultrasound in assessment of ICU patients.Materials and methods: The study was carried out on 30 patients admitted to the ICU.B and M modes chest ultrasound was done for all patients using EsaoteMyLab?Alpha with eHD Technology.Results: The study included 19 males and 11 females with mean age of 42.6 ± 21.4 years. In this study ultrasound was able to diagnose Pneumothorax: 3 cases (10%). Pleural effusion: 20 cases (66.6%). Alveolar interstitial syndrome: 7 cases (23.3%). Lung consolidation: 20 cases (66.6%). Pulmonary infarcts: 1 case (3.3%). Neoplastic disease: 1 case (3.3%). Chest wall pathology: 1 case (3.3%).Conclusion: Ultrasound examination of the chest is a non- invasive, and promising bed side tool for examination of ICU patients.     

Predictive model for contrast-enhanced ultrasound of the breast: Is it feasible in malignant risk assessment of breast imaging reporting and data system 4 lesions?

AIM: To build and evaluate predictive models for contrast-enhanced ultrasound (CEUS) of the breast to distinguish between benign and malignant lesions. METHODS: A total of 235 breast imaging reporting and data system (BI-RADS) 4 solid breast lesions were imaged via CEUS before core needle biopsy or surgical resection. CEUS results were analyzed on 10 enhancing patterns to evaluate diagnostic performance of three benign and three malignant CEUS models, with pathological results used as the gold standard. A logistic regression model was developed basing on the CEUS results, and then evaluated with receiver operating curve (ROC). RESULTS: Except in cases of enhanced homogeneity, the rest of the 9 enhancement appearances were statistically significant (P < 0.05). These 9 enhancement patterns were selected in the final step of the logistic regression analysis, with diagnostic sensitivity and specificity of 84.4% and 82.7%, respectively, and the area under the ROC curve of 0.911. Diagnostic sensitivity, specificity, and accuracy of the malignant vs benign CEUS models were 84.38%, 87.77%, 86.38% and 86.46%, 81.29% and 83.40%, respectively. CONCLUSION: The breast CEUS models can predict risk of malignant breast lesions more accurately, decrease false-positive biopsy, and provide accurate BI-RADS classification.     

Digital breast tomosynthesis within a symptomatic “one-stop breast clinic” for characterization of subtle findings

Objective:

The aim of the study was to evaluate the diagnostic accuracy of combination of full-field digital mammography [two dimension (2D)] and digital breast tomosynthesis [DBT, three dimension (3D)] by comparing the combination with 2D imaging in a symptomatic setting.

Methods:

A retrospective analysis was conducted involving 103 patients who attended symptomatic breast clinics between March 2012 and September 2012. All had subtle signs on 2D images or ultrasound. Mammographic score distribution was compared between 2D imaging and 2D + 3D imaging, followed by comparison with the gold-standard histopathology. Receiver operative characteristic curves and area under curve (AUC) were calculated for 2D imaging and the combination imaging (2D + 3D). SPSS^® v. 21 (IBM Corp., New York, NY; formerly SPSS Inc., Chicago, IL) was used for data analysis with p < 0.05 as statistically significant.

Results:

M3 lesions were reduced from 91 (85.8%) to 18 (16.9%) with the combination imaging. The mean AUC ± 95% confidence interval for 2D images alone was 0.721 (0.662–0.905) and for combined 2D and 3D images was 0.901 (0.765–1.00). The difference in AUCs between the two modalities was 0.180.

Conclusion:

DBT (3D imaging) increases diagnostic accuracy in a symptomatic breast clinic setting and reduces the number of M3 mammograms, when used as an adjuvant to 2D images. Therefore, DBT has the potential to increase workflow efficiency in a symptomatic setting by reducing benign biopsies.

Advances in knowledge:

DBT reduces the number of M3 mammograms when used in the symptomatic breast setting and has the potential to reduce benign biopsies.     

High-intensity focused ultrasound ablation of liver tumours: can radiological assessment predict the histological response?

Cancer therapies usually depend on cross-sectional imaging for the assessment of treatment response. This study was designed to evaluate the ability of MRI to predict zones of necrosis following the use of high-intensity focused ultrasound (HIFU) to treat liver metastases. Patients with liver metastases, who had been scheduled for elective surgical resection of their tumours, were recruited to this non-randomized Phase II study. In each case, a proportion of an index liver tumour target was ablated. The response to HIFU was assessed after 12 days using contrast-enhanced MRI and compared directly with histological analysis at the time of surgery. Eight patients were treated, of whom six were subsequently assessed with both MRI and histology. There were no major complications. MRI predicted complete ablation in three cases. In each case, histological analysis confirmed complete ablation. In one case, the region of ablation observed on MRI appeared smaller than predicted at the time of HIFU, but histology revealed complete ablation of the target region. The predominant characteristic of HIFU-ablated tissue was coagulative necrosis but heat fixation was evident in some areas. Heat-fixed cells appeared normal under haematoxylin and eosin staining, indicating that this is unreliable as an indicator of HIFU-induced cell death. This study demonstrates that HIFU is capable of achieving selective ablation of pre-defined regions of liver tumour targets, and that MRI evidence of complete ablation of the target region can be taken to infer histological success.     

What are the characteristics of breast cancers misclassified as benign by quantitative ultrasound shear wave elastography?

Objectives

Shear wave elastography (SWE) is a promising adjunct to greyscale ultrasound in differentiating benign from malignant breast masses. The purpose of this study was to characterise breast cancers which are not stiff on quantitative SWE, to elucidate potential sources of error in clinical application of SWE to evaluation of breast masses.

Methods

Three hundred and two consecutive patients examined by SWE who underwent immediate surgery for breast cancer were included. Characteristics of 280 lesions with suspicious SWE values (mean stiffness >50 kPa) were compared with 22 lesions with benign SWE values (<50 kPa). Statistical significance of the differences was assessed using non-parametric goodness-of-fit tests.

Results

Pure ductal carcinoma in situ (DCIS) masses were more often soft on SWE than masses representing invasive breast cancer. Invasive cancers that were soft were more frequently: histological grade 1, tubular subtype, ≤10 mm invasive size and detected at screening mammography. No significant differences were found with respect to the presence of invasive lobular cancer, vascular invasion, hormone and HER-2 receptor status. Lymph node positivity was less common in soft cancers.

Conclusion

Malignant breast masses classified as benign by quantitative SWE tend to have better prognostic features than those correctly classified as malignant.

Key points:

? Over 90?% of cancers assessable with ultrasound have a mean stiffness >50 kPa. ? ‘Soft’ invasive cancers are frequently small (≤10 mm), low grade and screen-detected. ? Pure DCIS masses are more often soft than invasive cancers (>40?%). ? Large symptomatic masses are better evaluated with SWE than small clinically occult lesions. ? When assessing small lesions, ‘softness’ should not raise the threshold for biopsy.     

Evaluation and optimization of radioprotective activity of Coronopus didymus Linn. in γ-irradiated mice

Purpose:?To evaluate and optimize the radioprotective ability of the most potent fraction of an aqueous extract of Coronopus didymus in whole body γ-irradiated Swiss albino mice and to evaluate the antioxidant status and lipid peroxidation of the livers of the surviving mice. To correlate the free radical scavenging studies with in vivo radioprotection ability.

Materials and methods:?Swiss albino mice were treated with either vehicle or the different doses of extract/fraction suspension by an i.p. route, 30 min before exposure to 10 Gy γ-irradiation and the animals were monitored twice daily for any signs of radiation toxicity and mortality. Radiation dose response (7 – 11 Gy), optimization of route, time of drug administration and evaluation of dose response factor (DRF) at the best dose of the fraction was studied. Endogenous antioxidant status and lipid peroxidation of the livers of the mice surviving on the 31st day was evaluated by using spectrophotometric methods.

Results:?The most active free radical scavenging fraction (CDF1) as assessed by competition kinetic studies using pulse radiolysis showed maximum in vivo radioprotection of 70% at a dose of 400 mg/kg body weight (bw) compared to corresponding 10 Gy irradiated control. Optimum radioprotection was observed upon i.p. administration, 30 min prior to 10 Gy irradiation and DRF at a dose of 400 mg/kg bw for 30 day survival was found to be 1.07. The levels of endogenous antioxidant enzymes and lipid peroxidation in the CDF1 treated surviving mice were found to reverse back to their normal levels.

Conclusions:?The optimum dose, time and route of drug administration for maximum radioprotection by CDF1 were determined. The reversal of the levels of endogenous antioxidant enzymes and lipid peroxidation indicates reduced oxidative stress in CDF1 treated surviving mice.