Extended field-of-view two-dimensional ultrasonography of the breast: improvement in lesion documentation.
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The purpose of this study was to evaluate the use of extended field-of-view two-dimensional ultrasonographic imaging for improvement in overall breast lesion documentation. Sonographic images of 59 patients with breast lesions or silicone implants were evaluated by three radiologists retrospectively to compare traditional static linear array images alone with images obtained with the addition of an extended field of view to determine if documentation of lesions was improved. The addition of extended field-of-view imaging improved lesion conspicuity by 21% over traditional images. It provided overall improvement in lesion documentation by including a reference point (nipple) or by more completely imaging large masses in 79% and implants in 69%. The larger field of view of this technique is promising as an adjunct to traditional sonography for breast lesion documentation. (+info)
Analysis of normal breast tissue and of solid breast masses using three-dimensional ultrasound mammography.
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OBJECTIVES: To describe the appearance of normal breast tissue and breast masses with three-dimensional ultrasound mammography, and evaluate the contribution of this to the diagnosis of breast masses. MATERIALS AND METHODS: A total of 186 solid hypoechoic breast masses were analyzed with two- and three-dimensional ultrasonography. Three-dimensional planar reformatted sections were reconstructed along planes either orthogonal or parallel to the skin surface. RESULTS: With parallel planar reformatted sections all the masses tended to be round. Margins were clearly demonstrated. In case of carcinomas, circumferential jagging was present in the equatorial planes. In case of fibroadenomas, complete wall continuity of the mass was readily apparent. The hyperechoic bands of fibrous tissue peripheral to the masses appeared either as distinct from the central image (compressive pattern) or converged towards the hypoechoic central core of the mass, producing a stellar pattern (converging pattern). These two patterns were preferentially associated with benign lesions and carcinomas, respectively. Three-dimensional ultrasound mammography had higher specificity, but lower sensitivity, than two-dimensional ultrasound mammography. CONCLUSIONS: Three-dimensional reconstruction, in particular parallel planar reformatted sections, represents a valuable adjunct to the characterization of breast masses using ultrasongraphy. Further studies are necessary to assess the validity of the present findings, particularly with regard to the rarer, more unusual types of carcinoma. (+info)
Women's health issues and nuclear medicine, part II: women and breast cancer.
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OBJECTIVE: This is the second article of a 4-part series on women's health issues and nuclear medicine. This article reviews women and breast cancer. After reading this article the technologist will be able to: (a) discuss breast cancer statistics and potential risk factors for breast cancer; (b) describe the screening tools and diagnostic procedures used for early detection of breast cancer; and (c) explain the role of radionuclide breast tumor imaging in detecting breast cancer. (+info)
Occult breast cancer presenting axillary nodal metastasis: a case report.
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We report a case of a 42-year-old female with occult breast cancer presenting axillary nodal metastasis. She complained of a swelling of the right axillary lymph node, but no breast mass was palpable. Biopsy of the lymph node was performed and histological examination showed a metastatic ductal carcinoma with papillotubular formation. Estrogen receptor of the lymph node was positive. No pathological findings were obtained by mammography and ultrasonography and systemic examinations revealed no extramammary primary lesion. All these data suggested an occult carcinoma of the breast and modified radical mastectomy was performed. Pathological findings of the removed specimen failed to find the primary breast cancer lesion. The patient has been treated with hormonal therapy and she is well without evidence of disease 5 years after surgery. (+info)
Does texture analysis improve breast ultrasound precision?
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OBJECTIVE: To evaluate the possibility of distinguishing between benign and malignant breast tumors using a computer-aided evaluation of echogenicity and echostructure of ultrasound findings at certain focal points. STUDY DESIGN: The ultrasound images from 89 cases of breast tumor were documented under standardized conditions using a linear array machine and 7.5 MHz transducer. In each sonographic image, the maximum area of the 'region of interest' of the tumor was marked and then subjected to consecutive statistical analysis and correlation with the histological findings. For evaluation of tumor status eight parameters of first and second order texture statistics (gray level histogram, Fourier analysis, co-occurrence matrix) were applied. RESULTS: Benign tumors were clearly distinguished from carcinomas in the evaluation of the co-occurrence matrix and the Fourier analysis on the basis of Wilcoxon and Student t-test (P < 0.05) but not in the gray level histogram. Using logistic regression a sensitivity of 73.8% and a specificity of 54.2% were obtained. A statistically significant difference between benign tumors and moderately differentiated together with poorly differentiated carcinomas could be demonstrated. CONCLUSION: This study concludes that texture analysis appears to distinguish between benign and most malignant tumors. A computer texture analyzing system is able to improve the subjective assessment of ultrasound images of the breast but can not replace it. Where the limits of subjective assessment of a given tumor are reached, computerized texture analysis will provide additional information in the differentiation of benign from malignant findings. (+info)
Quantitative vascularity of breast masses by Doppler imaging: regional variations and diagnostic implications.
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Seventy-four biopsy proven breast masses were imaged by color and power Doppler imaging to evaluate vascular pattern of malignant and benign breast masses. The images were analyzed for vascularity. The measurements were made over the entire mass as well as regionally at its core, at its periphery, and in the tissue surrounding it. The surgical specimens were analyzed for microvessel density. The diagnostic performance of Doppler sonographic vascularity indices was evaluated by receiver operating characteristic analysis. The malignant masses were 14 to 54% more vascular than the benign masses. Both types of masses were more vascular by ultrasonography than the tissue surrounding them. Whereas benign masses were 2.2 times more vascular than the surrounding tissue, the malignant masses were 5.0 times more vascular. In a subset of patients the regional vascularity at the core, periphery, and surrounding tissue by Doppler imaging exhibited a strong correlation (R2 > 0.9) with the corresponding histologic microvessel density measurements. Although the malignant masses exhibited a strong gradient in vascularity, core > periphery > surrounding tissue, the benign masses had relatively uniform distribution of vascularity. The area under the receiver operating characteristic curve (A(Z)) for the Doppler indices ranged from 0.56 +/- 0.07 to 0.65 +/- 0.07. A nonlinear analysis including age-specific values of Doppler indices improved the diagnostic performance to A(Z) = 0.85 +/- 0.06. In conclusion, quantitative Doppler imaging when used in combination with a nonlinear rule-based approach has the potential for differentiating between malignant and benign masses. (+info)
The role of enhanced Doppler ultrasound in differentiation of benign vs. malignant scar lesion after breast surgery for malignancy.
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AIM: To evaluate the benefit of echo-contrast-enhanced Doppler sonography in the differentiation of benign vs. malignant breast lesions after surgical removal of a malignant breast mass. METHODS: Thirty-eight patients referred for biopsy of a palpable, suspicious scar lesion 1-15 years (mean 3.3 years) after surgery for breast cancer were examined. During baseline ultrasound examination a subjective scoring system of the vascularity, the number, the regularity of vessels' course and their Doppler parameters were assessed. After injection of an ultrasound contrast agent (Levovist) the same scoring system was applied to the parameters together with enhancement kinetics, enhancement intensity and enhancement pattern. Any increase in the scoring level of two or more characteristics (vascularity, number of vessels, intensity of enhancement in the tumor or regularity score of vessels in the lesion) was defined as suspicious for malignancy. A marked increase of enhancement in the immediate tumor periphery was also regarded as suspicious for malignancy. The sonographic results were assessed prospectively and correlated with the histology of the lesion. RESULTS: Of the 38 patients with a clinically-suspicious scar lesion, there were 28 true scars and 10 malignant scar lesions. All scar lesions showed no or slight vascularity on baseline sonography. After Echocontrast-enhancement a significant increase in tumor vascularity and the number of tumor vessels could be demonstrated in all 10 malignant lesions but in only one of the 28 benign scars. CONCLUSION: Scars pose inherent technical problems for optimal mammography. Sonographic evaluation of the vascularity of the lesion with contrast enhancing agents showed improved diagnostic accuracy in the hands of an experienced examiner. (+info)
Changes in findings of mammography, ultrasonography and contrast-enhanced computed tomography of three histological complete responders with primary breast cancer before and after neoadjuvant chemotherapy: case reports.
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We report the changes in the findings of imaging examinations (mammography, ultrasonography and contrast-enhanced computed tomography) of three patients with primary breast cancer before and after neoadjuvant chemotherapy, who obtained histologically complete responses after the chemotherapy. The neoadjuvant chemotherapy consisted of four cycles of doxorubicin and docetaxel. All patients were clinically judged as partial responders, because of the remaining tumorous lesions in the imaging examinations. However, these tumorous lesions could be related to the chemotherapy-induced fibrosis and tumor necrosis or the remaining fibrocystic changes. In this study, it was considered very difficult to estimate the extent of residual tumors accurately in patients with primary breast cancer after neoadjuvant chemotherapy by any type of imaging examination. (+info)