D-galactose-based signal-enhanced color Doppler sonography of breast tumors and tumorlike lesions.

RATIONALE AND OBJECTIVES: This study sought to evaluate prospectively the diagnostic potential of unenhanced and enhanced color Doppler and power Doppler for the differentiation of tumors and tumorlike lesions of the breast. METHODS: Ninety-two patients with 110 tumors or tumorlike lesions of the breast were investigated by unenhanced and enhanced color and power Doppler ultrasound. The sonomorphologic aspects of vascularization were analyzed. In addition, maximal systolic frequency shift, resistance, and pulsatility indices were determined. RESULTS: In 15 (24%) of 63 primary carcinomas, 15 (68%) of 22 fibroadenomas, and all (100%) of 14 postoperative lesions, the sonomorphologic analysis for the differential diagnosis of breast tumors was improved after contrast enhancement in color Doppler mode. In comparing unenhanced color Doppler to power Doppler, the latter was found to be slightly superior (sensitivity, 60% vs. 67%; specificity, 39% vs. 45%, respectively); after enhancement, both modes were equivalent (sensitivity, 100% vs. 100%; specificity, 95% vs. 95%, respectively). Signal enhancement resulted in a significant improvement in sensitivity and specificity (P < 0.01). Typical signs of malignancy were irregular vessel calibers, serpiginous courses, penetration of the tumor's margin, and irregular reticular vascularization. The quantitative parameters proved not to be helpful for the differential diagnosis of breast tumors. CONCLUSIONS: By improved analysis of the vascularization pattern, d-galactose-enhanced color Doppler sonography was found to provide more reliable differential diagnostic information than unenhanced Doppler ultrasound in tumors and tumorlike lesions of the breast.

[Can the high-resolution 13-MHz ultrasonography facilitate the preoperative localization and marking of microcalcification clusters?]. / Kann die hochauflösende 13-MHz-Sonographie die präoperative Lokalisation und Markierung von Mikroverkalkungsgruppen erleichtern?

PURPOSE: The value of 13 MHz ultrasound regarding the preoperative localisation in combination with mammography were investigated into. MATERIAL AND METHOD: Out of 112 mammaographically detected calcifications, 30 (30 patients) were clusters of microcalcifications. Out of these, 23 were classified as suspicious of malignancy and were preoperatively localised with a 7.5 and 13 MHz probe. Upon marking the skin, a fine needle was inserted, and after due correction blue dye or coal solution was instilled. RESULTS: Following mammographically shown position, 23 clusters of microcalcifications could be localised using the 13 MHz probe. A localisation with the 7.5 MHz probe was impossible in all cases. A single correction of the needle's site was necessary with 35% (8/23) of patients. The maximum distance of the needle's tip in case of misposition measured 11 mm. CONCLUSION: Giving a known mammographic position and a sonographic perceptibility of clusters of microcalcifications in a maximal depth of penetration of 2 cm, 13 MHz high resolution ultrasound examination in combination with mammography prove to be a valuable means in facilitating the preoperative localisation.

[Color-coded signal-enhanced duplex ultrasonography of space-occupying intramammary processes]. / Farbkodierte signalverstärkte Duplexsonographie raumfordernder intramammärer Prozesse.

PURPOSE: Prospective comparison of plain and signal-enhanced frequency and amplitude-modulated colour Doppler ultrasound of intramammary tumours to evaluate new criteria for diagnostic analysis. METHODS: Frequency and amplitude-modulated colour Doppler examination with qualitative and quantitative analysis of 80 potentially malignant intramammary lesions were performed before and after application of d-galactose. RESULTS: Signal-enhanced sonography revealed a typical vessel morphology of primary and recurrent breast cancer facilitating differential diagnosis. In 18 (frequency modulated US) or 16 (amplitude modulated US) of 51 carcinomas, the typical malignant vascularisation structure was sufficiently visible only after application of the signal enhancing agent. In 50% of the fibroadenomas, Doppler analysis of the vessels was possible only after application of d-galactose. CONCLUSION: The application of d-galactose provides additional criteria for the differential diagnosis of breast lesions due to improved visualisation of the vascularisation structure.

[Fibromatosis of the breast]. / Fibromatose der Brust.

Fibromatosis of the breast is a rare benign mesenchymal transformation of the connective tissue, the origin of which is probably situated in the fascia of the pectoral muscle and the Cooper's ligaments. In the clinical and radiological examination, it is difficult to differentiate between a mammary carcinoma or other malignant tumours of the breast. Only histological examination can lead to the final diagnosis. Large-scale excision of these tumours, which have a tendency to relapse, is the therapy of choice. The diagnostic problems are shown in a case of a 26-year old patient.

[Disseminated lymphangioleiomyomatosis]. / Disseminierte Lymphangioleiomyomatose.

Clinical and histological findings of generalised lymphangioleiomyomatosis are demonstrated. A 40-year old woman died within a few weeks because of massive pulmonary involvement. Tumour mass in the area of the left ovary together with enlarged lymph nodes suggested a metastasising ovarian cancer.

[Ultrasound examination of the female breast: comparison of 7.5 and 13 MHz]. / Ultraschalluntersuchung der weiblichen Brust: Vergleich von 7.5 und 13 MHz.

PURPOSE: We investigated whether the high resolution ultrasound (13 MHz-scanner) shows smaller lesions and better differentiation than the 7.5 MHz-scanner. METHOD: Prospectively, sonography was performed on forty-seven patients with a 7.5 MHz-scanner as well as with a 13 MHz-scanner in identical slices. RESULTS: Obviously we could obtain more exact diagnoses by using the high resolution scanner. In two patients additional satellite of the primary tumor could be found. In four patients, unclear sonographic findings could be identified as cysts. A disadvantage in the usage of the 13 MHz-scanner is that mastopathy and benign lesions are more difficult to diagnose. With the high resolution more details could be seen although the inhomogeneity as well as the irregularity of the margins are seen more clearly and, therefore, the physician has to reestimate his point of view. To optimize the quality of the pictures made by high resolution ultrasound, it is necessary to regulate the system, which sometimes is quite difficult. CONCLUSION: The recognition of smallest lesions and the reliable presentation of cysts indicates that the 13 MHz-scanner is a good additive diagnostic parameter to the 7.5 MHz-scanner. Therefore, this method may become important for diagnosing multicentrity within carcinomas.

Is there a correlation in breast carcinomas between tumor size and number of tumor vessels detected by gadolinium-enhanced magnetic resonance mammography?

Tumor vessels are known as a sign of malignancy in breast tumors. Is there a correlation between tumor size and the number of vessels in cases of breast tumor examined by dynamic gadolinium (Gd)-enhanced MR imaging? Eighteen patients (mean age, 46 +/- 7 years) underwent dynamic Gd-enhanced MR imaging of the breast by three-dimensional gradient echo sequence using thin-layer technique (2.5 mm) at 1.5T. The dynamic study included one precontrast and four postcontrast sequences (every 90 seconds) in coronal slices. Postprocessing by subtraction method and reconstruction in both transverse and sagittal planes were performed. All carcinomas showed rapid Gd enhancement. Tumor size (0.5 to 31.5 cm3; mean, 6.3 +/- 3.7 cm3) and number of vessels (1 to 10; mean, 3 +/- 2.1) were detected in summation of all three directions. A significant correlation was found between number of vessels and tumor size (r = 0.787, p < or = 0.01). Breast tumor size significantly correlated with the number of vessels detected by Gd-enhanced MR mammography. The introduced method is a further important step in differentiating a carcinoma from a benign lesion.

[Surgical technique of subcutaneous/skin preserving tumor-adapted mastectomy]. / Operative Technik der subkutanen/hautsparenden tumoradaptierten Mastektomie.

Subcutaneous mastectomy as a procedure to prevent breast cancer has been abandoned because of the insufficient resection of breast tissue and the high rate of complications. Including the recent experiences in reconstructive breast surgery the subcutaneous mastectomy allows a degree of tissue resection comparable to total mastectomy with a lower rate of complications. Surgical technique, our own results and new indications for subcutaneous mastectomy are presented.

[Ultrasound detection of breast cancer with normal mammogram]. / Sonographischer Nachweis des Mammakarzinoms bei unauffälliger Mammographie.

In eleven patients with breast cancer the diagnosis was made by using ultrasound as the only method. In none of the patients could mammography show the malignoma. Although six of the patients underwent additional tube X-ray investigation, no radiological criteria of malignancy were found on the mammograms. In ten patients a lump of the breast was palpable and/or retraction of the skin was visible. In one woman, neither the clinical investigation nor the mammography could reveal the tumor. The ultrasound of the breast is a indispensable and useful method for diagnosing breast cancer.

Peripheral washout sign on contrast-enhanced MR images of the breast.

PURPOSE: To assess the value of the peripheral washout sign on delayed contrast material-enhanced magnetic resonance (MR) images in differentiation of benign from malignant breast masses. MATERIALS AND METHODS: In 49 women with 79 breast lesions (55 malignant and 24 benign), dynamic contrast-enhanced MR imaging was performed every 90 seconds during the first 7 minutes and repeated at 10, 20, 30, 40, 50, and 60 minutes after injection of contrast material. Qualitative analysis of the images was performed to evaluate the presence of the peripheral washout sign (a hypointense zone in the periphery of the lesion relative to the center). Quantitative analysis of the images was performed by measuring the signal intensity of the periphery and center of the lesions. RESULTS: The peripheral washout sign was seen in 28 (51%) of the 55 carcinomas on delayed contrast-enhanced MR images (> 10 minutes). Quantitative analysis demonstrated different enhancement profiles of the periphery and center of these lesions. The periphery showed early increase and decrease of enhancement, while the center showed gradual increase and persistent enhancement. The peripheral washout sign was not seen in any of the benign lesions. Specificity was 100% and sensitivity was 51% for diagnosis of breast carcinoma. CONCLUSION: Peripheral washout may be a reliable sign of malignancy on delayed contrast-enhanced MR images of the breast.

[Optimal use of MRI mammography from the economic viewpoint]. / Der optimale Einsatz der MR-Mammographie (MRM) unter wirtschaftlichen Gesichtspunkten.

With the introduction of the contrast agent gadolinum DTPA there were hopes that "MRM" would prove to be the investigatory technique that would largely solve the problems of breast diagnostics. However, after the early years of acceptance, the new method of investigation became a subject of controversy. Nonetheless, MRM today occupies a recognized place in diagnostics for certain indications. It is still true, however, that reliable use of this procedure requires a great deal of experience, since there is a relatively large area of overlap between benign and malignant tumors. Further, the costs are significantly higher than those for conventional methods of investigation. New studies that have been conducted at the Charité, Campus Virchow Medical Center in Berlin, suggest that, if one takes the relevant indications into account, MRM can be economic and contribute significantly to cost reduction. Application of a newly developed software package has shown that the good discrimination in a suspect area resulting from contrast agent enhancement makes possible a reliable differentiation between malignant and benign tissue changes. A further result was that, when certain boundary conditions are satisfied, a contrast agent bolus of 0.1 mmol/kg BW is sufficient, making a double dose (0.2 mmol/kg BW) unnecessary.

Magnetic Resonance Female Breast Imaging (MRFBI) - Evaluation of the Changes in Signal Intensity over Time Pre- and Post-administration of 0.2 mmol/kg Gd-DTPA.

PURPOSE: We are looking for a threshold value to discriminate between benign and malign breast lesions in MRI of female breast after administration of 0.2 mmol Gadolinum-DTPA/kg bw. MATERIALS AND METHODS: Double coil breast MRI (1.5 Tesla) were performed in 65 patients with an suspicious lesion for malignancy in an anteriorly examination. 57 patients could be evaluated in our study design. Histopathological 35 patients had an invasive carcinoma, 3 patients had an in-situ-carcinoma and in 27 patients benign changes were found. RESULTS: For different carcinoma diameters we found a different increase of signal intensity (SI): small carcinoma (< 10 mm) had an maximum increase of SI of 102 %, medium sized (10 to 20 mm) 222 % and carcinomas over 20 mm showed an increase of 271 %. We did not find a significant difference between SI in benign and malign lesions. The sensitivity was 94.6 % the specificity 65 %. CONCLUSION: A threshold value to distinguish between malign and benign in MRI could not be defined. With the double normal Gd-DTPA dose we do not have better specificity and sensitivity than for normal dose (0.1 mmol/kg bw) is described.

Boeck sarcoidosis of the breast: mammographic, ultrasound, and MR findings.

The rare case of sarcoidosis of the breast is presented. The mammographic, ultrasound, and MR appearances are described.