[Value of Thermal Tomography in Early Diagnosis of Breast Cancer in Animal Models].

Objective To obtain ultrasound and thermal tomography images of breast cancer during its growth and to assess the value of thermal tomography in detecting breast cancer. Methods Breast cancer models were established with NOD/SCID mice and SD rats. These animal models were examined by thermal tomography,plain ultrasound,and contrast-enhanced ultrasound. Tumor tissues were stained with CD34 to explore the relationship between tumor heat production and vascular pathology. Results Thermal tomography detected breast cancer 2-4 days earlier than ultrasound. The expression of CD34 in tumor tissues was increased,along with thickened,increased,and irregular blood vessels. Conclusion Thermal tomography can detect early breast cancer and is a promising tool for screening breast cancer.

[Comparison of Elasticity Imaging and Virtual Touch TM Tissue Imaging and Quantification in the Diagnosis of Thyroid Nodules].

Objective To compare the values of elasticity imaging(EI)and Virtual Touch TM tissue imaging and quantification(VTIQ)in diagnosing thyroid nodules and explore the factors influencing the accuracy of these two techniques.Methods Totally 62 patients who were planned to receive surgery for thyroid nodules underwent conventional ultrasound,EI,and VTIQ examinations.EI patterns were scored according to the degree and distribution of strain,the strain of nodule and surrounding normal reference tissue were measured,and then strain index was calculated.Shear wave velocity in nodules were obtained under VTIQ mode.Results The nodules were malignant in 40 patients and benign in 22 patients.When the strain score of 3 was regarded as malignant,the diagnostic sensitivity,specificity,and accuracy of EI in detecting thyroid nodules were 90.00%,31.82%,and 69.32%,respectively.Receiver operating characteristic curve results showed that the area under curves of EI-SI and VTIQ methods for diagnosing thyroid nodules was 77.8%(95%CI:0.64-0.91)(P=0.000)and 74.3%(95%CI:0.62-0.87)(P=0.002),respectively.Thyroid nodules' characteristics location(P=0.04)and size(P=0.02)were correlated with the diagnostic accuracy of EI.The accuracy of SI and VTIQ were not affected by thyroid nodules' characteristics(P>0.05).Conclusions The diagnostic accuracy of EI for thyroid nodules is related to nodules' characteristics.EI combined with semi-quantitative SI and quantitative VTIQ can effectively improve the diagnostic capability for thyroid nodules.

[Molecular Mechanisms of Breast Nodule Stiffness].

The texture of breast nodules has always the focus of clinical palpation,and the stiffness of breast nodules has been a hot research topic of ultrasound elastography. Both texture and stiffness are based on the principle that malignant tissue is stiffer than benign tissues,but the underlying mechanisms of breast nodule stiffness is not yet confirmed. Breast nodule stiffness is affected by both substance and mesenchyme,and the latter is an important factor. Collagen,as the major composition of the extra cell matrix,plays an important role in breast nodule stiffness. This review summarizes the molecular mechanisms of intracellular and extracellular changes in the formation of breast nodules.

Values of ultrasound features and MMP-9 of papillary thyroid carcinoma in predicting cervical lymph node metastases.

Preoperative assessment of the cervical lymph node status is important in therapeutic schedule and further evaluations of prognosis for papillary thyroid carcinoma (PTC) patients. Our aim was to investigate the diagnostic values of conventional ultrasound (US), contrast-enhanced ultrasound (CEUS) features and the expression of MMP-9 of PTC in predicting the cervical lymph node metastases (LNM). In total, 156 patients with PTC confirmed by surgical pathology were included. Seventy-one patients had cervical LNM, while 85 patients had no LNM. The patients had cervical LNM (39.51 ± 13.29 years) were younger than those had no LNM (44.15 ± 10.94 years) (P = 0.02). Multivariate logistic regression results showed that tumor size ≥0.95 cm (OR = 13.47), ill-defined margin (OR = 4.31), internal heterogeneous low-enhancement (OR = 5.19) and ECE (OR = 25.25) were predictive for the presence of cervical LNM. The detection rate of ECE for the PTC with LNM by CEUS (81.48%, 44/54) was higher than by US (46.30%, 25/54). There was significant difference in MMP-9 intensity between PTC with and without cervical LNM (P = 0.000), and intense reactions (+++) were mainly found in the PTCs with LNM (80.95%, 17/21). In conclusion, the combination of conventional US, CEUS features and MMP-9 expression may serve as an effective tool for predicting the cervical LNM of PTC.

Percutaneous Removal of Benign Breast Lesions with an Ultrasound-guided Vacuum-assisted System: Influence Factors in the Hematoma Formation.

Objective To explore the influence factors in hematoma formation after removing benign breast lesions with an ultrasound-guided vacuum-assisted system.Methods A total of 232 females with 312 benign breast masses received excisional biopsy with ultrasound- guided vacuum-assisted system. The pathology of patients, Results of hematoma development and outcome, influence factors for hematoma occurrence (nodule size, nodule location, number of nodule, breast shape, menstrual period, efficacy time of bandage, and application of hemostatic agents during the procedure) were recorded.Results Pathologic examination revealed fibroadenomas in 138 lesions, fibroadenosis in 127 lesions, intraductal papillomas in 39 lesions, inflammatory change in 4 lesions, retention cyst of the breast in 3 lesions, and benign phyllodes tumor in 1 lesion. Thirty hematomas were observed in patients (9.6%). Finally, 97.0% hematomas were absorbed completely within 6 months follow-up. The incidence rates of hematoma were increased by 24.7%, 10.0%, 63.2%, 13.9% in the nodule diameter larger or equal to 25 mm group, removal of larger or equal to two nodules once time from one patient group, menstrual period group, and larger and loose breast group, respectively (all P<0.05). However, the incidences were decreased by 60.6% in the bandage performed for 12-24 hours or beyond 24 hours group (P<0.05). The multiple logistic regression models revealed that nodule size (χ2=15.227, P<0.001), number of nodule (χ2=7.767, P=0.005), menstrual period (χ2=24.530, P<0.001), and breast shape (χ2=9.559, P=0.002) were independent risk factors associated with hematoma occurrence, but efficacy time of bandage was a protective factor associated with hematoma occurrence.Conclusion The occurrence of hematoma after the minimally invasive operation was associated with nodule size, number of nodule, menstrual period, breast shape, and efficacy time of bandage.

[Construction of Nude Mouse Model of Triple Negative Breast Cancer and Value of Thermal Tomography].

OBJECTIVE: To explore the early detection of breast cancer by ultrasonic imaging and thermal tomography of luciferase or green fluorescent protein (GFP)-labeled MDA-MB-231 breast cancer cell line-xenografts in nude mice. METHODS: Fluorescence-tagged lentiviral vectors were transfected into the triple-negative breast cancer cell line MDA-MB-231. These cells were implanted either subcutaneously under the right breast pad or intravenously into the tail vein of nude BALB/C mice. Thermal tomography and ultrasound imaging were used to detect tumor formation and to monitor tumor growth and metastasis in vivo. RESULTS: Triple negative breast cancer cell line-xenografts were used to successfully construct an orthotopic nude mice model of breast cancer metastasis in the peritoneum. Thermal tomography and ultrasound imaging were used together to detect small tumors. Thermal tomography imaging detected small tumors earlier than ultrasound imaging. CONCLUSIONS: Thermal tomography can be used to monitor changes in tumor growth and detect abnormal tissue. Therefore, it can serve as a convenient,rapid,sensitive, and reliable technique for early screening of human breast cancer.

Performance of Ultrasonic Shear Wave Elastography in Assessing Benign and Malignant Breast Lesions.

OBJECTIVE: To determine the best shear wave elastography (SWE) quantitative parameters including the maximum elasticity (Emax), mean elasticity(Emean), minimum elasticity, standard deviation and ratio of Emean (Eratio) in assessing benign and malignant breast lesions. METHODS: Totally 302 breast lesions underwent conventional ultrasound and SWE. Each lesion was classified according to ultrasound Breast Imaging Reporting and Data System (BI-RADS). The receiver operating characteristic(ROC) curves were used to determine the cut-off values of SWE quantitative parameters and to suggest breast lesions as benign or malignant. The sensitivity,specificity and the Youden index (sum of sensitivity and specificity minus 1) of SWE quantitative parameters were compared,and then the sensitivity,specificity and the Youden index of the combinations of each SWE parameters in assessing breast lesions were compared. RESULTS: The sensitivity,specificity and the Youden index of the Emax were 0.87,0.97 and 0.84,which were higher than other SWE parameters (all P<0.01). The sensitivity, specificity and the Youden index of Emax combined with ultrasound BI-RADS were 0.86,0.97 and 0.83, which were higher than other combinations (all P<0.01). CONCLUSIONS: Compared with other parameters, Emax has the best performance in assessing breast lesions. It can be used as an important quantitative indicator for the evaluation of benign and malignant breast lesions.

A set of shear wave elastography quantitative parameters combined with ultrasound BI-RADS to assess benign and malignant breast lesions.

The goal of this study was to determine whether a combination of shear wave elastography (SWE) quantitative parameters could improve the accuracy of ultrasonography in the differentiation of benign and malignant breast lesions. Two hundred seventy-nine breast lesions in 251 women were evaluated with ultrasonography and SWE; pathologic results of all lesions were available. Each lesion was classified according to the Breast Imaging Reporting and Data System (BI-RADS) for ultrasound. SWE quantitative parameters, including maximum elastic value (Emax), mean elastic value (E mean), standard deviation (SD) and ratio of E mean of the lesion to E mean of the surrounding parenchyma (E ratio), were recorded. A receiver operating characteristic curve was used to determine their cutoff values. When any of the four parameters was equal to or higher than the cutoff value, the set of SWE parameters was counted as positive. When both BI-RADS and the set were positive, lesions were evaluated as positive for malignancy. We compared the performance of this combination with use of BI-RADS, Emax, E mean, SD or E ratio alone and also with the combination of BI-RADS and Emax for benign/malignant differentiation. The combination of Emax, E mean, SD, or E ratio with BI-RADS had a sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Youden index of 0.967, 0.912, 0.908, 0.969, 0.938 and 0.879, respectively. The accuracy was the highest (p < 0.01) without loss of sensitivity. Combining a set of SWE quantitative parameters (E max, E mean, SD and E ratio) could improve the accuracy of ultrasonography in differentiation of benign from malignant breast lesions, without loss of sensitivity.

[The value of ultrasound in diagnosis of IgG4-related sialadenitis].

PURPOSE: To study the ultrasonic manifestation of IgG4-related sialadenitis, and improve sonographers' understanding of this disease. METHODS: Based on the clinical serological test and histopathologic diagnosis, the features were evaluated by sonography in 25 cases of IgG4-related sialadenitis, including the shape and border of the gland, internal echo texture, presence and distribution of vascularity, duct dilatation, presence/absence of calculi and submandibular lymph nodes. The changes on ultrasonography in 14 patients with IgG4-related sialadenitis before and after steroid treatment were evaluated. RESULTS: There were 20 men and 5 women ranging between 42-89 years old with an average age of 64.5 years old. The sites of involvement were submandibular gland (20 cases) and parotid gland (5 cases). Of the 10 patients with diffuse involvement, the lesions showed bilateral symmetrical distribution in 9 patients and unilateral involvement in 1 patient with multiple hypoechoic lesions against a heterogeneous background. The ducts were dilated in 3 patients, and had calculus in 2 patients. Doppler sonography in all patients with diffuse involvement of the gland showed prominent intraglandular vessels. Of the 15 patients with focal involvement, 14 patients showed unilateral involvement and only one showed bilateral involvement of the submandibular gland with hypoechoic heterogeneous. The vessels showed a radial pattern within the lesions. There were definite submandibular lymph nodes involvement by IgG4-related disease in 4 of the 8 patients. After steroid treatment, the prominent sonographic feature of IgG4-related sialadenitis gradually receded. CONCLUSIONS: Sonologist must be aware of sonographic appearances in patients with IgG4-related sialadenitis, which can help correct diagnosis and treatment.

[The value of age-adjusted D-dimer cut-off value in diagnosing deep vein thrombosis in elderly patients].

OBJECTIVE: To validate the value of age-adjusted D-dimer combined with clinical probability to confirm or exclude deep vein thrombosis (DVT) in elderly patients. METHOD: Elderly patients ( ≥ 65 years) suspected with DVT were evaluated by Wells score and D-dimer test. All patients underwent ultrasonography examination except for patients with Wells score < 2 and negative D-dimer test results. Conventional cut-off value is 500 µg/L, while age-adjusted cut-off value is set as patient's age×10 µg/L. We compared the sensitivity and specificity using the 2 cut-off values in confirming or excluding the diagnoses of DVT. RESULTS: The study population consisted of 624 patients [mean age(76.4 ± 19.3) years], DVT was confirmed in 192 (30.8%) patients. Using Wells score model, 326 patients (52.2%) were scored as unlikely DVT and DVT was confirmed by ultrasonography in 44 patients (13.5%), and 298 patients as likely DVT patients and DVT was confirmed in 148 patients (55.0%). The sensitivity, specificity, positive predictive value, and negative predictive value by conventional and age-adjusted D-dimer cut-off value for diagnosing DVT in low-risk patients evaluated by Wells score model were 95.5%, 40.4%, 20.0%, 98.3% and 95.5%, 61.0%, 27.6%, 87.1%, respectively, and which were 89.9%, 67.3%, 73.1%, 87.1% and 89.2%, 89.3%, 89.2%, 89.3%, respectively, in high-risk patients evaluated by Wells score model. Thus, specificity increased about 20% using age-adjusted D-dimer cut-off value compared with conventional D-dimer cut-off value. CONCLUSION: The age-adjusted D-dimer cut-off value combined with clinical probability evaluation could increase diagnosing specificity of DVT in elderly patients.

Study of quantitative elastography with supersonic shear imaging in the diagnosis of breast tumours.

PURPOSE: This study was undertaken to evaluate the value of quantitative elastography in the diagnosis of breast tumours. MATERIALS AND METHODS: Conventional ultrasound (US) and quantitative elastography were performed in 108 women with 114 breast lesions by two experienced radiologists, and pathological results were available in all cases. For each lesion, the maximum, mean, and minimum (min) elasticity and elasticity ratio between lesions and surrounding tissue were measured. The Breast Imaging Reporting and Data System (BI-RADS) categories were assessed with conventional US in all lesions. RESULTS: Malignant lesions exhibited significantly higher maximum and mean elasticity (111.57 ± 69.29 kPa and 54.49 ± 33.70 kPa) than did benign lesions (59.00 ± 45.3 kPa and 36.64 ± 26.18 kPa) (p<0.01). For maximum elasticity versus BI-RADS, performance results were sensitivity 60.9 % vs. 78.3%, specificity 85.3% vs. 98.5%, positive predictive value (PPV) 73.7% vs. 97.3 %, negative predictive value (NPV) 76.3% vs. 87.0 % and accuracy 75.4% vs. 90.3%. BI-RADS had significantly better accuracy than maximum elasticity (p<0.01). Maximum and mean elasticity of invasive ductal carcinoma (IDC) were significantly higher than those of fibroadenoma (p<0.01), whereas the difference was not statistically significant with fibroadenosis, papilloma and inflammation (p>0.01). Maximum and mean elasticity and elasticity ratio of BI-RADS 5 were all significantly higher than those of BI-RADS 3 (p<0.01). Reliability for maximum and mean elasticity were almost perfect [intraclass correlation coefficients (ICC)=0.87 and 0.79]. CONCLUSIONS: Shear-wave elastography gives quantitative elasticity information that could potentially help in breast-lesion characterisation, although it cannot replace conventional BI-RADS in the differentiation of breast lesions.

Comparison of automated breast volume scanning to hand-held ultrasound and mammography.

PURPOSE: Our aim was to investigate the diagnostic potential of automated breast volume scanning (ABVS) and compare it with manual ultrasound (US) and mammography. PATIENTS AND METHODS: One hundred and fifty-five patients with a total of 165 breast lesions had mammograms, manual US and an ABVS. Multiplanar reconstructions in coronal, transverse and sagittal views were reconstructed from the automated data set. After biopsy or surgery, all lesions were confirmed histologically. Data were evaluated according to the Breast Imaging Reporting and Data System (BI-RADS) classification. Detection rate, diagnostic accuracy, sensitivity, specificity and positive (PPV) and negative (NPV) predictive value of each method were analysed. RESULTS: Detection rate, diagnostic accuracy and mammography sensitivity were significantly lower than those of each US method (p<0.05). There were no significant differences between manual US and ABVS. When combining ABVS, US and mammography, diagnostic accuracy, sensitivity and specificity reached 96.4%, 97.1% and 95.2%, respectively. A spiculated and stellate margin in the coronal plane has a high specificity in diagnosing malignant lesions. CONCLUSIONS: ABVS can provide additional information in the differential diagnosis of a lesion. It has significantly higher sensitivity than mammography, but it is similar to manual US and cannot be preferred to a manual US examination.

Percutaneous excisional biopsy of clinically benign breast lesions with vacuum-assisted system: comparison of three devices.

PURPOSE: The aim of this study was to compare three devices in percutaneous excisional biopsy of clinically benign breast lesions in terms of complete excision rate, duration of procedure and complications. MATERIALS AND METHODS: In a retrospective study from March 2005 to May 2009, 983 lesions underwent ultrasound-guided excisional biopsy with three vacuum-assisted systems, respectively. The lesions were category 3 lesions as determined by ultrasound imaging according to Breast Imaging Reporting and Data System (BI-RADS) (n=951) or had been confirmed as benign by a previous core needle biopsy (n=32). The completely excision rate, duration of procedure and complications (hematoma, pain and ecchymosis) were recorded. RESULTS: 99.7% (980/983) lesions were demonstrated to be benign by pathology after percutaneous excisional biopsy. The overall complete excision rate was 94.8% (932/983). In lesions whose largest diameter equal to or larger than 1.5cm, the complete excision rates of EnCor(®) group (97.8%, 348/356) and Mammotome(®) group (97.2%, 139/143) were significantly higher than that of Vacora(®) group (91.9%, 445/484) (P<0.05). The EnCor(®) group (6.6±6.5min) had a significant less duration than Mammotome(®) (10.6±9.3min) and Vacora(®) group (25.6±23.3min) (P<0.05). Hematoma occurred more in EnCor(®) group and Mammotome(®) group than in Vacora(®) group (P<0.05). CONCLUSIONS: All these three vacuum-assisted systems are highly successful for excisional biopsy of benign breast lesions.

Breast lesions with imaging-histologic discordance during 16-gauge core needle biopsy system: would vacuum-assisted removal get significantly more definitive histologic diagnosis than vacuum-assisted biopsy?

The aim of this study was to determine the role of vacuum-assisted biopsy (VAB) in patients with ultrasound imaging-histologic discordance during 16-gauge core needle biopsy (CNB) and to compare VAB with vacuum-assisted removal (VAR) in diagnostic accuracy in patients with ultrasound imaging-histologic discordance. From January 2006 to October 2008, a consecutive biopsy was performed on 1532 lesions with ultrasound-guided 16-gauge CNB. Sixty two lesions were considered to be ultrasound imaging-histologic discordant. Among the 62 lesions, 55 lesions underwent subsequent VAB or VAR, which made up our study population. Among the 55 cases, 22 underwent subsequent US-guided VAR, and the other 33 lesions underwent subsequent US-guided VAB. All malignant lesions at VAB and VAR got subsequent surgery, and all benign lesions at VAR or VAB were followed up for at least 1 year. Five lesions of the VAR group were diagnosed as having carcinoma (5/22, 22.7% of pathologic changing rate). Seven lesions of the VAB group were diagnosed as having carcinoma (7/33, 21.2% of pathologic changing rate). Subsequent surgery further demonstrated the diagnosis of VAB for all the lesions with pathologic change. There was no significant difference in pathologic changing rate between these two groups (p < 0.05). A US-guided VAB was a valuable alternative to VAR or surgery excision to obtain definitive diagnosis in patients with breast lesions showing imaging-histologic discordance during 16-gauge CNB.

Sonographically guided percutaneous excision of clinically benign breast masses.

PURPOSE: To report our experience with a vacuum-assisted biopsy device system in percutaneous excision of clinically benign breast masses under sonographic guidance. METHODS: Percutaneous removal of 79 masses in 58 patients was performed with a vacuum-assisted biopsy device under sonographic guidance from April 2008 to September 2008. The lesions were category 3 lesions on sonogram, according to Breast Imaging Reporting and Data System (n = 74), or had been confirmed as benign by a previous core needle biopsy (n = 5). RESULTS: All procedures were technically successful. Confirmed as benign were 98.7% (78/79) lesions on pathology after resection, and 93.7% (74/79) lesions were excised completely as demonstrated by follow-up sonographic examination. The duration of the procedure ranged from 2 to 19 minutes (mean ± SD, 9.6 ± 9.3). CONCLUSIONS: Percutaneous excision using a vacuum-assisted biopsy device is an alternative to surgical excision of benign breast masses.

Breast lesions with ultrasound imaging-histologic discordance at 16-gauge core needle biopsy: can re-biopsy with 10-gauge vacuum-assisted system get definitive diagnosis?

The aim of this study was to evaluate if re-biopsy with 10-gauge vacuum-assisted biopsy (VAB) could get definitive diagnosis for breast lesions with ultrasound (US) imaging-histologic discordance at 16-gauge core needle biopsy (CNB). From January 2007 to June 2008, a consecutive biopsy was performed on 1069 lesions with US-guided 16-gauge CNB. A total of 28 lesions were considered to be US imaging-histologic discordant and all of them underwent subsequent 10-gauge VAB. All malignant lesions located at VAB were treated with subsequent surgery and all benign lesions at VAB were followed up for at least 1 year. Six of the 28 lesions (21.4%) had pathologic upgrade after VAB. In them, one case upgraded from adenosis to ductal carcinoma in situ (DCIS); one case upgraded from adenosis to infiltrating ductal carcinoma (IDC); one case upgraded from atypical ductal hyperplasia to IDC; two cases upgraded from intraductal papilloma to DCIS; and one case upgraded from sclerosing adenosis to invasive lobular carcinoma (ILC). The subsequent surgery further demonstrated the diagnosis of VAB for all the lesions with histologic upgrade. Re-biopsy could improve diagnostic accuracy in patients with breast lesions showing imaging-histologic discordance during CNB, and 10-gauge VAB was a valuable method to deal with re-biopsy.

[Clinical value of contrast-enhanced ultrasound in the diagnosis of Budd-Chiari syndrome with inferior vena cava obstruction].

OBJECTIVE: To explore the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis of Budd-Chiari syndrome with inferior vena cava (IVC) obstruction. METHOD: A total of 38 patients with Budd-Chiari syndrome with IVC obstruction were examined by CEUS before and after vascular interventional management, and the results were compared with angiographic findings. RESULTS: The location and degree of IVC obstruction were clearly showed on CEUS. Enhancement was found in the occlusion site, and blood flow was narrowed at the stenosis site. The arrival time was earlier after treatment in the IVC obstruction, and it was positively correlated with the pressure of IVC( P< 0.05). CONCLUSION: The location and type of the occlusion and stenosis in IVC can be accurately determined by CEUS. Therefore, CEUS can provide useful information for the selection of surgical procedures and post-operative effectiveness.

[Study on diagnostic accuracy of ultrasound-guided core needle breast biopsy].

OBJECTIVE: to evaluate the diagnostic accuracy of ultrasound-guided core needle biopsy of breast tumors. METHODS: six hundred and sixty-seven cases of core needle biopsy of breast encountered during the period from January, 2004 to June, 2007 were retrieved from the archival file and retrospectively reviewed. The core needle biopsy diagnoses were correlated with the histologic findings of the subsequent surgical excision specimens. The discrepancies were further analyzed. RESULTS: three hundred and eighty-two patients had core needle biopsy diagnosis followed by local excision, breast conservation surgery or mastectomy. Two hundred and eighty-one cases were confirmed to have malignancy in the surgical specimens. Review of the corresponding core needle biopsies showed 4 false-negative cases, no false-positive cases, 28 cases with underestimation and 2 cases with overestimation. The false-negative rate was 1.4% (4/281). The rate of underestimation for ductal carcinoma-in-situ was 6/11. The diagnostic accuracy of core needle biopsy was 94.7% (266/281). CONCLUSION: in order to improve the diagnostic accuracy of core needle biopsy of breast tumors, recognition of the limitation of the procedure, application of immunohistochemistry and awareness of potentially rare entities are important.

An evaluation of a 10-gauge vacuum-assisted system for ultrasound-guided excision of clinically benign breast lesions.

The aim of this study was to evaluate a 10-gauge vacuum-assisted system for the excision of clinically benign breast lesions. The minimal excision of 245 lesions in 162 patients was performed with VACORA vacuum-assisted system under the guidance of ultrasound between July 2007 and April 2008. The lesions were category 3 lesions as determined by ultrasound imaging according to Breast Imaging Reporting and Data System (BI-RADS) (n=208) or had been confirmed as benign by a previous core-needle biopsy (n=37). As many as 244 lesions were demonstrated to be benign and one case was demonstrated to be malignant by pathology after resection. In the 244 benign lesions, 220 lesions were excised completely as demonstrated by the follow-up ultrasound examination. The malignant lesion was managed with surgical excision. The 10-gauge vacuum-assisted system is highly successful for the excision of benign breast lesions; it is an alternative tool for minimal treatment of benign breast lesions.

Undetermined focal liver lesions on gray-scale ultrasound in patients with fatty liver: characterization with contrast-enhanced ultrasound.

BACKGROUND AND AIM: The purpose of this study was to assess the clinical value and potential impact of contrast-enhanced ultrasound (CEUS) in the characterization of undetermined focal liver lesions (FLLs) in patients with fatty liver. METHODS: Fifty-two patients (34 men, 18 women) with fatty liver with 67 FLLs (size range, 1-8.6 cm; mean, 4.1 +/- 3.1 cm) undetermined at baseline ultrasound (US) underwent contrast-enhanced US. CEUS examinations were analyzed by two experienced sonologists blinded to the final diagnosis. Readers evaluated by consensus the baseline echogenicity, the dynamic enhancement pattern in comparison with peripheral liver parenchyma. The final diagnosis was based on consensus interpreting of all examinations by another two expert observers with access to histological data. The characterization accuracy, sensitivity, and specificity of CEUS in characterizing the lesion as benign or malignant, and as the correct pathologic type, were analyzed. RESULTS: After CEUS, two hemangiomas, three inflammatory pseudotumors, and one hepatocellular carcinoma were misdiagnosed. The overall characterization accuracy, sensitivity and specificity of CEUS were 91% (61/67), 91.7% (11/12), and 90.9% (50/55), respectively. Forty-three benign lesions were diagnosed as the correct pathologic type. The portal venous phase and late phase were important in the characterization of the lesions. The characterization accuracy had no relationship with the size of FLLs. CONCLUSION: CEUS can improve the characterization of undetermined FLLs arising from fatty liver.