High Body Mass Index and Thyroid Stimulating Hormone Levels Do Not Affect Thyroid Nodule Selection for Fine-Needle Aspiration Biopsy after Ultrasound Evaluation

BACKGROUND AND OBJECTIVES: This study was to evaluate whether high body mass index (BMI) or thyroid stimulating hormone (TSH) level would affect selecting thyroid nodule for fine-needle aspiration biopsy (FNA) after ultrasound (US) evaluation. MATERIALS AND METHODS: A total of 3155 thyroid nodules (2159 benign and 996 malignant nodules) were included. Four grades of BMI and three levels of TSH were applied for grouping. US features of the thyroid nodules were divided into ‘probably benign’ and ‘suspicious for malignancy’ categories. Patients were grouped according to gender and univariate and multivariate logistic regression analysis were used to find the association between variables and malignancy. RESULTS: TSH levels were significantly higher in the malignant group (p<0.001). The grades of BMI did not show difference between the malignant and benign groups (females, p=0.074 and males, p=0.157). Younger age and ‘suspicious for malignancy’ US category were independent risk factors for malignancy in both genders. In females, a high TSH level (odds ratio=1.010, p<0.001) had significant association with malignancy. Except for younger age (odds ratio=0.998, p<0.001), no variable in nodules with ‘probably benign’ US category was significantly associated with malignancy. CONCLUSION: High TSH levels were more frequent in thyroid malignancy group, but neither high BMI nor high TSH level give additional information for FNA selection after US.

Prevalence of Women with Dense Breasts in Korea: Results from a Nationwide Cross-sectional Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Women with dense breast are known to be at high risk for breast cancer, but their prevalence and number of Korean women are unknown. The current study was to investigate the distribution of mammographic breast density by age of women undergoing screening mammography, and to estimate the prevalence of Korean women with dense breasts, quantitatively. MATERIALS AND METHODS: For obtaining a nationwide representative sample, 6,481 mammograms were collected from 86 screening units participated in the National Cancer Screening Program for breast cancer. Based on the American College of Radiology Breast Imaging Reporting and Data System classification, breast density was evaluated by six breast radiologists, qualitatively. We applied these breast density distributions to age-specific counts of the Korean women population derived to mid-year 2017 to estimate the number of Korean women with dense breasts. RESULTS: Overall, 54.4% (95% confidence interval [CI], 52.9% to 55.8%) of women 40 to 69 years of age had heterogeneously or extremely dense breasts, and this proportion was inversely associated with age. Based on the age distribution of Korean women, we estimated that 6,083,000 women (95% CI, 5,919,600 to 6,245,600) age 40-69 years in Korean have dense breasts. Women aged 40-49 years (n=3,450,000) accounted for 56.7% of this group. CONCLUSION: More than half of Korean women aged 40 and over have dense breasts. To prevent breast cancer effectively and efficiently, it is necessary to develop a new personalized prevention strategy considering her status of breast density.

Practice guideline for the performance of breast ultrasound elastography

Ultrasound (US) elastography is a valuable imaging technique for tissue characterization. Two main types of elastography, strain and shear-wave, are commonly used to image breast tissue. The use of elastography is expected to increase, particularly with the increased use of US for breast screening. Recently, the US elastographic features of breast masses have been incorporated into the 2nd edition of the Breast Imaging Reporting and Data System (BI-RADS) US lexicon as associated findings. This review suggests practical guidelines for breast US elastography in consensus with the Korean Breast Elastography Study Group, which was formed in August 2013 to perform a multicenter prospective study on the use of elastography for US breast screening. This article is focused on the role of elastography in combination with B-mode US for the evaluation of breast masses. Practical tips for adequate data acquisition and the interpretation of elastography results are also presented.

Pleomorphic Adenoma of the Breast: A Diagnosis Using an Ultrasound-Guided Core-Needle Biopsy Case Report

Pleomorphic adenoma is a tumor rarely seen in the breast. To date, only about 70 cases have been reported in the literature. Many reports have used fine-needle aspiration biopsy in the preoperative diagnosis of these lesions. However, pleomorphic adenoma is sometimes mistaken for a malignant tumor because of its cytologic features. In this study, we present a 56-year-old woman with a palpable breast mass. Ultrasound indicated a 15 mm oval-shaped hypoechoic mass with complex echogenicity in the palpable region. Ultrasound-guided core needle biopsy (US-CNB) revealed a pleomorphic adenoma of the breast, which was confirmed through surgical excision. Although pleomorphic adenoma is rarely seen in the breast, results demonstrate the usefulness and accuracy of US-CNB in diagnosing pleomorphic adenoma of the breast.

Phyllodes Tumors and Fibroepithelial Lesions with Cellular Stroma of the Breast and Diagnosed by Sonographically Guided Core Needle Biopsy: A Comparison Between the Results of Excision Biopsy and the Sonographic Findings

PURPOSE: The purpose of this study was to analyze the histologic concordance of sonographically guided core needle biopsy for phyllodes tumors or fibroepithelial lesions with cellular stroma of the breast by comparing this with the outcomes of excision biopsy and to identify any sonographic features that are helpful to predict phyllodes tumors. MATERIALS AND METHODS: We retrospectively reviewed 60 breast masses that were diagnosed as phyllodes tumors (n = 43) or fibroepithelial lesions with cellular stroma (n = 17) on a sonographically guided core needle biopsy. The tumors were all subsequently excised by surgery. The sonographic features were compared between the phyllodes tumors and the non-phyllodes tumors according to the results of excision biopsy. RESULTS: By the results on excision biopsy, there were 48 (80%) phyllodes tumors and 12 (20%) non-phyllodes tumors. Phyllodes tumors were diagnosed at a rate of 90.7% (39/43) for the nodules with phyllodes tumors on the sonographically guided core needle biopsy, and at a rate of 52.9% (9/17) for the nodules with fibroepithelial lesions with cellular stroma on the sonographically guided core needle biopsy. On sonography, heterogeneous internal echotexture (58% vs. 17%, respectively, p = 0.0239), clefts (56% vs. 17%, respectively, p = 0.0331) and horizontal linear striations (71% vs. 33%, respectively, p = 0.0221) were significantly more frequent in the phyllodes tumors than that in the non-phyllodes tumors. CONCLUSION: Identification of a heterogeneous-internal echotexture, clefts and horizontal linear striations on sonography might help differentiate phyllodes tumors from non-phyllodes tumors.

Mammary Fibromatosis: Sonographic Features and Pathologic Correlations

PURPOSE: The purpose of this study was to determine if the sonographic features of mammary fibromatosis had correlation with the pathologic findings. MATERIALS AND METHODS: We identified four cases of fibromatosis of the breast at our institution over a 10-year period. The patients were all women, and they ranged from 25 to 48 years of age (mean, 34.3 years). All four patients complained of palpable breast masses and were subsequently diagnosed with mammary fibromatosis. We retrospectively reviewed their imaging findings. RESULTS: Mammography obtained in one patient revealed architectural distortion. On sonography, all four cases showed spiculated, irregular, hypoechoic masses that could not be differentiated from malignant lesions. After surgical excision and vacuum-assisted biopsy of the masses in four patients, there was no recurrence on clinical or sonographic follow-up over a 13-36 month period. CONCLUSION: Although mammary fibromatosis is a very rare condition, it should be included in the differential diagnosis when an un-calcified, spiculated, irregular and hypoechoic masses are encountered on breast sonography.

Extensive Hemorrhage after Ultrasound-guided Fine Needle Aspiration Biopsy of Thyroid Nodules in a Patient with Long-term Aspirin Therapy / 대한내분비외과학회지

Ultrasound-guided fine needle aspiration biopsy (USFNA) is a very useful procedure for the diagnosis and management of thyroid diseases. It is very safe procedure and complications have been rarely reported. We experienced a case of an extensive hemorrhage after USFNA of the thyroid nodule in a patient undergoing long-term aspirin therapy. We emphasize that it is very important to obtain a patient history carefully before performing a USFNA.

Sonograhphic Features of Adenosis Tumor

PURPOSE: We wanted to evaluate the sonographic features of adenosis tumor of the breast. MATERIALS AND METHODS: We evaluated the sonographic findings of 9 lesions in 9 patients who had a diagnosis of adenosis tumor after excision. The mean age of the patients was 32 years. All the masses were palpable. The sonographic features were interpreted by the ACR-BI-RADS (American College of Radiology Breast Imaging Reporting and Data System). Three of the women underwent mammography. RESULTS: The mean size of the lesion was 2.4 cm, and the shape of the masses was oval (n=9). The orientation was parallel (n=9). The margin was circumscribed (n=7), angular (n=1) and microlobulated (n=1). The lesion boundary was an abrupt interface (n=9). The echo pattern was hypoechoic (n=8) and isoechoic (n=1). Posterior acoustic enhancement was seen in 7 masses, and the other 2 masses showed combined shadowing and enhancement. The final assessment categories were classified into category 3 (n=7) and category 4 (n=2). Mammograms performed in 3 patients revealed a circumscribed mass in 2 patients and negative findings in 1 patient. CONCLUSION: Adenosis tumor of the breast usually shows as an oval, parallel oriented, circumscribed, hypoechoic mass with posterior acoustic enhancement on sonography.

Interested Cases Encountered in the Breast Clinic

Many patients present to the breast clinic with variable symptoms. The degree of palpability is the important symptom for patients and clinicians. Both mammography and ultrasonography play an important role in the diagnosis of breast diseases by indicating the cause of the symptoms and aiding in the selection of treatment for the disease. Sometimes, however, we meet unexpected results. In this paper, we will illustrate the ultrasonographic and mammographic findings of interesting, unusual or perplexing breast cases in order to familiarize ourselves with these breasts through these cases and thereby assist in future diagnosis.

Sonographic Findings of Endometrial Polyps / 대한산부인과학회지

OBJECTIVE: To characterize the sonographic findings of endometrial polyp and to differentiate it from other endometrial lesions. METHODS: Using transvaginal sonography, preoperative sonographic findings of pathologically proven endometrial polyp in 24 patients were retrospectively evaluated for the size, margin, echogenicity, nature (cystic, solid, mixed), and blood flow signal by color Doppler sonography (CDS). The t-test was used to check the statistical significance for Resistive index (RI) between endometrial polyp and other endometrial lesions. RESULTS: Of 110 patients studied for abnormal vaginal bleeding, 24 (21.9%) patients had endometrial polyps, 4 (3.6%) patients had secretory phased endometriums, 4 (3.6%) patients had submucosal myomas, 4 (3.6%) had retained placentaes, 1 (0.9%) had endometrial hyperplasia, 1 (0.9%) had blood clot, 1 (0.9%) had endometrial carcinoma and 71 (64.6%) patients had normal findings. The sonographic findings of endometrial polyp were well defined (24 patients), round (16 patients), hyperechoic (20 patients), and solid mass (21 patients). Using transvaginal CDS, the location of blood flow (9 patients) showed a single feeding artery with a mean RI of 0.60. There were no statistical significant differences between endometrial polyp and other endometrial lesions in arterial waveform (mean RI: 0.6) by transvaginal CDS (p>0.05). CONCLUSION: Endometrial polyp has a characteristic sonographic appearance of a well-defined, hyperechoic round mass by transvaginal sonography. In addition, it contains a single feeding vessel to the vascular stalk with a characteristic color Doppler signal detected by transvaginal CDS. These findings enable us to make differential diagnosis from other endometrial lesions.

Unilateral Breast Edema: Spectrum of Etiologies and Imaging Appearances

Breast edema is defined as a mammographic pattern of skin thickening, increased parenchymal density, and interstitial marking. It can be caused by benign or malignant diseases, as a result of a tumor in the dermal lymphatics of the breast, lymphatic congestion caused by breast, lymphatic drainage obstruction, or by congestive heart failure. Here we describe several conditions, that cause unilateral breast edema with the aim of familiarizing radiologists with these disease entities.

The Usefulness of Additional Bilateral Whole Breast US with Negative Mammographic Results in Asymptomatic Women

PURPOSE: We wanted to evaluate the clinical utility of performing bilateral whole breast US as a subsequent diagnostic method along with mammography in asymptomatic women. MATERIALS AND METHODS: From May 2002 to Dec 2004, we conducted 3998 examinations on 3638 patients with negative findings on the clinical examination and negative mammographic results, and those breast tissues having a BI-RADS category 2, 3, or 4 density were further evaluated by performing bilateral whole breast US. The patients' age distribution ranged from 24 to 66 years (mean age: 43.6 yrs). The abnormalities were compared with core or vacuum assisted core biopsy, operations, and follow up US. For the normal cases, we used the clinical notes and the statistical data from the Korean Central Cancer Registry. RESULTS: For 3998 examinations of 3638 women who were examined with bilateral whole breast US, pathologic confirmations were available for 433 patients and follow-up data were available for 35 patients. The sensitivity, specificity, the positive predictive value and the cancer detection rate of using additional whole breast US were 50, 92.6, 0.6 and 0.5, respectively. The two cancers that were detected only on US were minimal breast cancer. CONCLUSION: Although all the breast cancers that were detected only on US were minimal breast cancers, performing bilateral whole breast US revealed a low cancer detection rate and a high false positive. Therefore, further studies will be needed to investigate the role of US as a screening tool.

Excision of benign breast tumor by an Ultrasound-Guided hand held Mammotome biopsy device / 한국유방암학회지

PURPOSE: The mammotome (MMT) biopsy is a new surgical technique that is a minimally invasive, image guided procedure, and it requires just one small incision and there is no need for multiple insertions in the breast. The aim of this study was to evaluate the efficacy and the safety of the MMT biopsy device for percutaneous removal of breast masses with using ultrasound guidance. METHODS: From Jan. 2003 to Mar. 2005, a total of 1368 US-guided excisional MMT biopsies were performed in 1112 patients at Kangnam Cha Hospital. Those lesions with BI-RADS category 3 and 4a features by USG examination were included in this study. Lesions below 1.0 cm were removed by an 11 G probe, and lesions above 1.0cm were removed by an 8 G probe. Ultrasonographic follow-ups were performed 3-6 months later to assess the residual tissue and scarring. RESULTS: The mean patient age was 36 (range: 14-76) years. The average size of lesion was 1.14 cm (SD = 0.63 cm). Among the patients, 67.3% had nonpalpable lesion and 32.7% had palpable tumor. The majority of the specimens (98.3%) were benign. Most of benign specimens (77.7%) consisted of fibroadenoma and fibrocystic changes, although 23 lesions (1.7%) were malignant. The mean MMT procedure time was 6.2+/-3.9 minutes and the mean number of cores removed was 14.8+/-9.8. No serious bleeding or infection occurred postoperatively. CONCLUSION: This study demonstrates that percutaneous breast biopsy using the MMT system may be feasible and effective method for the diagnostic and therapeutic management of benign breast lesions with minimal morbidity. Complete MMT excision may be safely performed for the lesions those are less than 3 cm in size. A breast surgeon can use MMT instead of open or core needle biopsy for the initial biopsy of breast lesions.

The Radiographic Spectrum of Pulmonary Complications in Major Burn Patient

In recent years, improved antibiotic care and physiologic fluid replacement in cases involving burn wounds have led to a decrease in the rate of fatalaties caused by wound sepsis and shock. There has, however, been an upsurge and relative increase in the frequency (15 -25%) and mortality rate (50 -89 %) of pulmonary complications. Since pulmonary lesions may result from direct injury to the respiratory tract caused by smoke inhalation, from circulatory, metabolic or infectious complications in cases involving cutaneous burns, or may develop during the therapeutic management of these lesions, a wide spectrum of pulmonary abnormalities can occur during the post-burn period. There is considerable overlap between their radiographic appearances, which are often nonspecific. Since the successful management of these patients is based on the early recognition and vig-orous treatment of lesions, familiarity with all facets of these complications, based on a pathophysiology of the injury and on the knowledge of the clinical setting, enables radiologists to make more specific diagnoses.

Bone and Joint changes following Electrical Burn: Plain Radiographic findings

PURPOSE: To evaluate the plain radiographic findings of bone and joint changes following electrical burn. MATERIALS AND METHODS: This study involved 19 patients with 27 bone and joints regions which had sufferedelectrical injury. The most common input and output sites were, respectively, the hand(7/14) and foot (6/10).Three other sites were involved. Four cases involved osteomyelitis, and in four, amputation was performed. Weobserved bone and joint changes, changes following osteomyelitis and changes in the amputation stump. We analyzedthe difference between input and output changes, and when this was interesting, the average time of onset wasassessed. RESULTS: In bone and joint changes following electrical burn, the most frequent radiographic findingwas joint contracture (n=16). Other findings included osteolysis (n=8), articular abnormalites (n=6), periostitis(n=5), fracture (n=5), acro-osteolysis (n=2), and heterotopic bone formation (n=2). In cases involvingosteomyelitis(n=4), aggravation of underlying bone changes was noted. CONCLUSION: In electrical burn, variouschanges were noted in bone and joints, and input injury was more severe than that of output.

Radiologic Findings of Pulmonary Endometriosis

PURPOSE: To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) and pulsed-spraypharmacomechanical thrombolysis (PSPMT) using urokinase for the management of insufficient hemodialysis access. MATERIALS AND METHODS: Between September 1996 and May 1998, 21 insufficient hemodialysis accesses were treated in 16 patients (3 artificial arteriovenous fistulae, AVF ; and 13 arteriovenous graft, AVG). PTA and PSPMT were performed in 6 and 15 and 15 cases, respectively, and success and long-term patency rates were evaluated. RESULTS: The overall success rate of PTA and PSPMT for insufficient hemodialysis access was 76.2%(16/21). The success rates of PTA and PSPMT were 83.3%(5/6) and 73.3%(11/15), respectively. the primary patency rates of PSPMT were 69+/-12.8% at 6 months and 38+/-18.6% at 12 months. One of the two initially successful PTAs had been patent for 7months, and the second PTA was performed at that time due to venous stenosis. The other was patent for 15 months throughout the follow-up period. CONCLUSION: PTA and PSPMT are effective primary methods for the treatment of insufficient hemodialysis access ; success and patency rates were high, and the procedures can be performed repeatedly.