[Value of color-coded duplex sonography in preoperative visualization of lower leg arteries for microsurgical fibula transfer]. / Stellenwert der farbkodierten Duplexsonographie zur präoperativen Darstellung der Unterschenkelarterien bei mikrochirurgischem Fibulatransfer.

BACKGROUND: In patients being considered for a microsurgical fibular transfer, thorough examination of the vascular supply to the lower leg is indisputably necessary. The aim of this study was to evaluate the validity of color-coded duplex sonography (CCDS) in the assessment of the arteries of the lower leg. PATIENTS AND METHODS: In 13 patients needing bony reconstruction of the jaw 22 legs were examined using CCDS. The three arteries of the lower leg were visualized and traced from the ankle to the popliteal fossa. At every arterial segment Doppler sonographic examination was also performed. All 13 patients underwent digital subtraction arteriography (DSA) of the lower extremities, additionally. RESULTS: We were able to visualize and to assess all but one of the arteries using CCDS. In 13 extremities of 9 patients CCDS exhibited a normal vascular supply to the lower leg provided by three regular arteries. DSA confirmed this and the patients underwent fibular transfer. In the other 4 patients a regular vascular situation could not be shown by CCDS because of nonvisualization of arterial segments or pathological findings. Two of these patients received alternative bony transplants. In the remaining two patients angiography exhibited one leg to have a normal three vessel supply, respectively. Fibular transplants could be raised from this leg. In all patients CCDS was able to localize between 3 and 7 perforators branching off the peroneal artery. Their position determined the placement of the skin paddle to be raised with the bone. Further advantages of CCDS were the universal applicability to all patients and the possibility of performing it at our own department. The time required for the examination and the necessity of having adequate technical equipment were the disadvantages. CONCLUSION: In patients being considered for a microsurgical fibular transplantation, we recommend CCDS of the lower leg as a screening tool for the vascular supply of the lower leg. DSA and MRA are predominantly advocated for those patients, in whom CCDS reveals pathological or uncertain findings.

Comparison of full-field digital mammography and film-screen mammography: image quality and lesion detection.

The objective of this study is to compare image quality and lesion detection for full field digital mammography (FFDM) and film-screen mammography (FSM). In 200 women we performed digital mammography of one breast and film-screen mammography of the other breast. Imaging parameters were set automatically. Image quality, visualization of calcifications and masses were rated by three readers independently. Mean glandular dose was calculated for both systems. We found no significant difference in mean glandular dose. Image quality was rated by reader A/B/C as excellent for FFDM in 153/155/167 cases and for FSM in 139/116/114 cases (p<0.03/0.001/0.001). Microcalcifications were detected by FFDM in 103/89/98 and by FSM in 76/76/76 cases (p<0.01/0.06/0.01). Detection of masses did not differ significantly. FFDM provided significantly better visibility of skin and nipple-areola region (p<0.01). FFDM demonstrated improved image quality compared with film-screen mammography. Microcalcification detection was also significantly better with the digital mammography system for two of the three readers.

Microcalcifications of the breast: how does radiologic classification correlate with histology?

PURPOSE: To assess the correlation between the pre-biopsy classification of microcalcifications and the underlying histology. MATERIAL AND METHODS: Using the morphology and distribution patterns according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon, the microcalcifications of 199 lesions in 163 consecutive patients scheduled to undergo 11 G vacuum core biopsy were classified within the BI-RADS categories. The correlation between BI-RADS assessment categories 3, 4, and 5 and the final histological results was statistically evaluated with the chi2 test. The diagnostic indices were calculated. RESULTS: The prospectively classified BI-RADS 3/4/5 findings revealed a malignant histology in 5.9%/17.6%/90.9% of all lesions, respectively. The relationship between BIRADS categories 3, 4, and 5 and histology was statistically highly significant (P<0.0001). The sensitivity, specificity, positive and negative predictive values were 95.7%/21.2%,/37.8%/94.3%, respectively. CONCLUSION: The BI-RADS lexicon describes microcalcifications of the breast and provides diagnostic categories that lead to standardized biopsy recommendations. Nevertheless, how to link description to classification of microcalcifications is still a difficult diagnostic task. The evaluation of microcalcifications as proposed in this article may help to set standards in the clinical routine and in the comparability of scientific data.

[Radiologic-histopathologic correlation of microcalcifications from 11g vacuum biopsy: analysis of 3196 core biopsies]. / Radiologisch-histopathologische Korrelation von Mikrokalzifikationen in 11-G-Vakuumbiopsaten - eine Analyse von insgesamt 3196 Proben.

PURPOSE: To perform a statistical evaluation of microcalcifications (MC) from suspicious breast lesions detected by radiography and histopathology. MATERIALS AND METHODS: Histological and radiological detection of calcifications were compared from 116 biopsies in 96 women. Lesions with identical description of calcifications detected in histopathology and radiography were considered concordant, patients with obvious discrepancies discordant. If histological and radiological groups of calcifications were identical in number but differed in location, the case was considered pseudo-concordant. RESULTS: Histopathology classified 24 of 116 lesions as malignant and 92 as benign. A total of 3196 core biopsies were examined, 851 of these contained groups of calcifications or single calcifications. Both modalities detected 579 calcifications, with 169 exclusively detected by radiography and 103 exclusively by histopathology. In 35 cases (30 %) radiologic and pathologic results were concordant, in 6 cases pseudo-concordant (4 %) and in 75 cases (65 %) discordant. The case-based Kappa coefficient was - 0.09 (- 0.24 to 0.07). The 122 calcifications not detected by histopathology were few or single calcifications at the edge of the core that were probably lost during processing, 18 were possible artefacts. Six cores contained calcium oxalate, 3 contained milk of calcium. In 6 cases malignant disease was found after the first examination, hence the cores were not searched thoroughly for the missing calcifications. In the remaining 14 cases, no calcifications were found despite complete processing of the tissue. In 49 of 103 cases of radiologically undetected microcalcifications, the retrospect analysis showed dense tissue areas that probably contained the calcification. The remaining 54 cases contained calcifications, which were too small to be detected radiologically. SUMMARY: Discordant results from pathological and radiological examinations of biopsies can mainly be explained by calcifications at the edge of the specimen lost during processing, which are therefore not detected in histopathology, and calcifications too small to be visualized radiologically.

[Stereotactic vacuum-assisted breast biopsy--success, histologic accuracy, patient acceptance and optimizing the BI-RADSTM-correlated indication]. / Stereotaktische Vakuumbiopsie mammographisch detektierter Läsionen - Erfolg, histologische Sicherheit, Patientenakzeptanz und BI-RADS trade mark -korrelierte Indikationsoptimierung.

PURPOSE: To evaluate success, histologic accuracy, patient acceptance and BI-RADS TM-correlated malignancy rate of stereotactic vacuum-assisted breast biopsies in order to optimize the indication. MATERIALS AND METHODS: In 132 patients with mammographically detected breast lesions 166 stereotactic vacuum- assisted 11 gauge core biopsies were performed. All lesions were classified according to the BI-RADS TM categories of the ACR. Removal of the lesion was radiographically assessed as complete, representative or not representative. Patient acceptance was evaluated. RESULTS: Of the 166 lesions, 54 (32.5 %) lesions were judged completely removed, 110 (66.3 %) representatively removed and 2 (1.2 %) not representatively removed. Malignancy was found in 38 (22.9 %) lesions. The rate of malignancy increased from 6.3 % (2/32) for BI-RADS TM category 3 to 16.7 % (19/114) for BI-RADS TM category 4 and increased further to 85 % (17/20) for BI-RADS TM category 5 (p < 0.001). The histology of a sufficient vacuum-assisted biopsy was underestimated in 6 (15 %) of the 40 lesions that were subsequently excised surgically. Most patients (98.5 %; 130/132) stated they would undergo a vacuum-assisted biopsy again. CONCLUSION: Vacuum-assisted breast biopsy is accurate, has a justifiable rate of histologic underestimation and is well accepted by patients. Patients with BI-RADS TM category 4 microcalcification benefit the most. Lesions of BI-RADS TM category 3 and BI-RADS TM category 5 should be biopsied only under special circumstances (family risk of breast cancer; assessment of lesions extension).

[Quantitative assessment of therapy related effects after breast conserving therapy with dynamic MRI of the breast]. / Quantitative Erfassung von Gewebsveränderungen der Mamma nach brusterhaltender Therapie mit der dynamischen MR-Mammographie *

PURPOSE: To quantify therapy related effects after breast conservation therapy (BCT) with dynamic MRI of the breast. METHODS: Twenty patients (median age 51 years) with breast conserving tumor excision were included. Contrast enhanced dynamic MRI was performed before and 3, 6 and 12 months after adjuvant radiation therapy (RT) with a total dose of 50.0 to 50.4 Gy. The following sequences were applied: axial fat-suppressed T(2)-weighted; coronal contrast enhanced 3D spoiled gradient-echo (first measurement prior to the administration of 0.16 mmol/kg Gd-DTPA, six repetitive measurements); sagittal T(1)-weighted Flash3D. Enhancement data were obtained using a computer software with automated segmentation of regions of interest (ROIs). After defining ROIs for skin, parenchyma and pectoral muscle of each breast the early enhancement after the first post contrast measurement (E(1)) and the slope of enhancement between the second and last postcontrast measurement (SE(2-L)) were calculated. The edema was quantified by assessing the signal intensities (SI) in the T(2)-weighted images. The thickness of the skin was measured in the sagittal T(1)-weighted images. RESULTS: Three months after RT statistically significant increases between 51 and 179 % of the SI and E(1) quotients were detected for all tissues compared to the examinations prior to RT. Six months after RT the skin still presented a by 102 % significantly higher E(1) quotient, and a by 140 % significantly increased SI quotient. No significant differences for SI and E(1) quotients could be observed 12 months after RT compared to the examinations prior to RT. A significant increase of the SE(2-L) difference for the skin from 0.0225 to 0.0691 and 0.0665 was found 3 and 6 months after RT, respectively. No significant differences between the initial MR examination and the follow-up examinations 3, 6 and 12 months could be detected for the SE(2-L) differences of the parenchyma. CONCLUSION: Early therapy related effects after BCT can be exactly quantified with dynamic MRI using an automated ROI-segmentation and whole breast analysis software. Both edema formation and early enhancement show peaks 3 months after RT, and after 12 months there is no statistically significant difference compared with baseline.