Age-related ultrasonic properties of breast tissue in vivo.

The aim of the current work was to quantify the ultrasonic properties of the whole breast in vivo as a function of age. Forty-four women were scanned using a computerized ultrasonic scanner developed in our laboratory. Raster scans in two orthogonal views, mediolateral and craniocaudal, were obtained using the ultrasonic through-transmission method. By combining the information from the two views, we estimated two acoustic properties: speed of sound and attenuation coefficient. On the basis of the results, both the attenuation coefficient and the speed of sound follow a three-phase age-related pattern. During the first phase, which corresponds to ages 20 to 35 y, both properties decrease with time and then remain roughly unchanged until about 55 y. During the third phase corresponding to ages >55 y, values decrease again with time. The mean speed of sound decreases from 1504 ± 35 m/s at <30 y to 1452 ± 9 m/s at >60 y (p < 0.01), and the attenuation coefficient decreases from 1.27 ± 0.32 to 0.96 ± 0.13 dB/cm/MHz (p < 0.03), respectively. In conclusion, both the ultrasonic speed of sound and the attenuation coefficient of breast tissue are age related. Both parameters decrease during life, markedly during the first and third phases. These changes may be attributed to anatomic and physiologic changes associated with reproductivity and menopause.

Feasibility study of contrast-enhanced automated acoustic mammography.

The feasibility of implementing image subtraction in through-transmission breast sonography was examined. Acoustic mammograms of women with suspicious findings were obtained using through-transmission imaging. Precontrast images were initially acquired. Then a perflutren liquid microsphere contrast agent solution was injected intravenously, and new sets of images were acquired. Precontrast-postcontrast subtraction images depicting the resulting changes were then obtained and visually compared with other imaging modalities. The ability to detect changes stemming from contrast agent injection in the through-transmission mode was verified. The comparability with x-ray mammography and magnetic resonance imaging was shown. Finally, the ability to compare images obtained before and several months after surgery was confirmed.

Classification of breast cancer precursors through exhaled breath.

Certain benign breast diseases are considered to be precursors of invasive breast cancer. Currently available techniques for diagnosing benign breast conditions lack accuracy. The purpose of this study was to deliver a proof-of-concept for a novel method that is based on breath testing to identify breast cancer precursors. Within this context, the authors explored the possibility of using exhaled alveolar breath to identify and distinguish between benign breast conditions, malignant lesions, and healthy states, using a small-scale, case-controlled, cross-sectional clinical trial. Breath samples were collected from 36 volunteers and were analyzed using a tailor-made nanoscale artificial NOSE (NA-NOSE). The NA-NOSE signals were analyzed using two independent methods: (i) principal component analysis, ANOVA and Student's t-test and (ii) support vector machine analysis to detect statistically significant differences between the sub-populations. The NA-NOSE could distinguish between all studied test populations. Breath testing with a NA-NOSE holds future potential as a cost-effective, fast, and reliable diagnostic test for breast cancer risk factors and precursors, with possible future potential as screening method.

Investigation of acoustic changes resulting from contrast enhancement in through-transmission ultrasonic imaging.

Through-transmitted ultrasonic waves can be used for computed projection imaging of the breast. The goal of this research was to analyze the acoustic properties changes associated with the propagation of ultrasonic waves through media before and after ultrasound contrast agent (UCA) injection and to study the feasibility of a new imaging method combining projection imaging and UCA. Two transmission techniques were examined: Gaussian pulses and pulse inversion. In the latter, three different double inverted pulses were studied: double Gaussian, double square and double sine. A computerized automatic ultrasonic scanning system was used for imaging. To simulate blood vessels, a phantom, consisting of a latex tube through which saline was circulated, was assembled. The phantom was placed within the scanner and sets of acoustic projection images were acquired. Then, a suspension of the UCA Definitely was added to the saline and a new set of images was obtained. The pre and postcontrast images were quantitatively compared in terms of amplitude and time-of-flight (TOF). In addition, nonlinearity was evaluated by comparing the relative alteration of the positive and negative parts of the signal. Statistically significant (p < 0.001) changes in the projection images resulting from the UCA injection were observed in wave amplitude (22% +/- 13%), TOF (7.9 ns +/- 6.3 ns) and nonlinear properties (35% +/- 32% and 56% +/- 17% for Gausian pulses and pulse inversion, respectively). One in vivo study of a female breast is also presented and its preliminary outcomes discussed. Together, these results indicate the technical feasibility of the suggested method and its potential to detect breast tumors.

Unexpected foci of 18F-FDG uptake in the breast detected by PET/CT: incidence and clinical significance.

PURPOSE: The aim of this study was to evaluate the frequency and clinical significance of unexpected focal (18)F-fluorodeoxyglucose (FDG) uptake localized by PET/CT within the breast. METHODS: The files of 4,038 consecutive female cancer patients referred for FDG PET/CT over a period of 74 months were retrospectively reviewed. Patients with breast cancer were excluded from the study. The incidence of focal sites of increased FDG uptake localized by PET/CT to the breast was determined. The intensity of uptake was measured using the lean body mass maximum standard uptake value (LBM SUV(max)), and the presence and patterns of morphologic changes on CT were assessed. The etiology and clinical significance of findings were confirmed histologically or with imaging and clinical follow-up. RESULTS: Unexpected FDG foci in the breast were identified in 33 of 4,038 patients (0.82%). Follow-up data were available for 30 patients. Malignancy was diagnosed in 17 patients (histology 12, clinical 5) and excluded in 13 patients (histology 9, clinical 4). There was a borderline statistically significant difference in FDG uptake (LBM SUV(max)) between malignant (3.13 +/- 2.25) and benign (1.85 +/- 1.18) lesions (p = 0.05). Focal lesions were seen on CT in 23 patients (malignant 11, benign 12), and CT was negative in 7 patients (malignant 6, benign 1). CONCLUSION: Although rare, incidental focal abnormal FDG uptake in the breast may represent malignant lesions in up to 57% of patients. Breast incidentalomas on PET/CT warrant further assessment including tissue sampling to define the etiology of these unexpected FDG-avid foci.

Electrical impedance scanning as a new breast cancer risk stratification tool for young women.

BACKGROUND: Electrical impedance scanning (EIS) measures changes in breast tissue associated with breast cancer (Br-Ca) development. The T-Scan(tm2000 (ED is designed to use EIS to identify women ages 30-39 with elevated risk of breast cancer (i.e., T-Scan+ women). AIM: To estimate the relative probability of breast cancer in a T-Scan+ woman compared to a randomly selected young woman. METHODS: A prospective, two-cohort trial was conducted in pre-menopausal women. The Specificity (S(p))-Cohort evaluated T-Scan specificity in 1,751 asymptomatic women ages 30-39. The Sensitivity)S(n))-Cohort evaluated T-Scan sensitivity in 390 women ages 45-30 scheduled for biopsy. Specificity, sensitivity, and conservative estimate of disease prevalence were used to calculate relative probability. RESULTS: In the S(p)-Cohort, 93 of 1,751 women were T-Scan+ (S(p) = 94.7%; 95% CI: 93.7-95.7%). In the S(n)-Cohort, 23 of 87 biopsy-proven cancers were T-Scan+ (S(n) = 26.4%; 95% CI: 17.4-35.4%). Given S(p) = 94.7%, S(n) = 26.4% and prevalence of 1.5 cancers/1,000 women (ages 30-39), the relative probability of a T-Scan+ woman having Br-Ca is 4.95: (95% CI: 3.16-7.14). CONCLUSION: EIS can identify a subset of young women with a relative probability of breast cancer almost five times greater than in the population of young women at-large. T-Scan+ women have a sufficiently high risk of Br-Ca to warrant further surveillance or imaging.

Prospective study of electrical impedance scanning for identifying young women at risk for breast cancer.

BACKGROUND: One way to improve the cost-benefit ratio for breast cancer screening in younger women is to identify those at high-risk of breast cancer and manage them in an optimal manner. The purpose of this study is to evaluate the sensitivity and specificity of Electrical Impedance Scanning (EIS) for identifying young women who are at risk for having breast cancer and should be followed with directed imaging technologies. METHODS: A prospective, observational, two-arm, multi-site clinical trial was performed on women aged 30-45 years. The 'Sensitivity Arm' included Clinical Breast Examinations (CBE) and EIS (T-Scan 2000ED) on 189 women prior to scheduled breast biopsy. The 'Specificity Arm' included 1361 asymptomatic women visiting clinics for routine annual well-woman examination. Sensitivity and specificity were determined. Relative probability for a woman with a positive EIS examination was computed and compared with other approaches commonly used to define 'high-risk' in this population. RESULTS: Fifty of 189 women in the Sensitivity arm had verified cancers, 19 of whom had positive EIS examination resulting in sensitivity of 38% (19/50). Of the 1361 women in the Specificity arm, 67 had positive EIS examination resulting in a specificity of 95% (1294/1361). The relative probability of a woman with a positive EIS examination was 7.68, which compares favorably with other established risk identifiers (e.g. two first-degree relatives with breast cancer or atypical ductal hyperplasia). CONCLUSION: EIS may have an important role as a screening tool for identifying young women that should be followed more closely with advanced imaging technologies for early detection of breast cancer.

Electrical impedance scanning for the early detection of breast cancer in young women: preliminary results of a multicenter prospective clinical trial.

PURPOSE: To evaluate the feasibility and patient satisfaction with electrical impedance scanning (EIS) for early detection of breast cancer in young women. METHODS: Women undergoing screening clinical breast examination, imaging, or biopsy were eligible for EIS examination with T-Scan 2000ED (Mirabel Medical Systems, Austin, TX). Multiple logistic regression analysis evaluated the association between clinical variables and EIS performance. Patients completed a screening EIS satisfaction questionnaire (1 = least satisfied to 5 = most satisfied). RESULTS: Twenty-nine cancers were identified among 1,103 women. Sixty-six percent (19 of 29) of cancers were nonpalpable and 55% (16 of 29) were in women age < or = 50 years. EIS sensitivity and specificity in women younger than 40 years was 50% and 90%, respectively. Exogenous estrogen use (P < .001) and menopausal status (P = .007) correlated significantly with EIS performance. False-positive rates were increased in postmenopausal women and those taking exogenous hormones. No correlation was evident between EIS performance and family history, prior breast cancer, breast density, or palpability. EIS-positive women younger than age 40 were 4.5 times more likely to have breast carcinoma than were women randomly selected from the general population. Patients were highly satisfied with the comfort, speed, and reporting of EIS screening (mean score, 4.8). CONCLUSION: EIS seems promising for early detection of breast cancer, and identification of young women at increased risk for having the disease at time of screening. Positive EIS-associated breast cancer risk compares favorably with relative risks of conditions commonly used to justify early breast cancer screening. Patients are satisfied with a screening paradigm involving breast EIS.

Giant cell arteritis complicated by spinal cord infarction: a therapeutic dilemma.

Spinal cord involvement is uncommon in giant cell arteritis (GCA) and spinal cord infarction is extremely rare. We describe an 80-year-old man with active GCA who developed sudden paraplegia and dissociated sensory loss while receiving steroid treatment. Magnetic resonance imaging showed high signal abnormality consistent with spinal cord infarction in the anterior spinal artery territory at the level of D10. The case illustrates the elusive nature of GCA and the diagnostic and therapeutic dilemmas faced by the physician caring for these patients.