A pilot study to evaluate assisted freehand ultrasound elasticity imaging in the sizing of early breast cancer: a comparison of B-mode and AFUSON elasticity ultrasound with histopathology measurements.

OBJECTIVE: This pilot study investigates the role of assisted-freehand ultrasound (AFUSON) elasticity imaging of the breast in assessing the contour, size and area of 23 early breast cancers by making comparison of AFUSON with the equivalent B-mode ultrasound images and gold standard histopathology slides. METHODS: The B-mode, AFUSON and digitised histopathology slides of three early breast cancers were compared for contour, size and area with histopathology scans. AFUSON features that corresponded to areas of known malignant change on the histopathology slides were regarded as diagnostic. These diagnostic criteria were then applied to the B-mode and AFUSON elasticity images of all 23 breast cancers in the pilot study without having the availability of the histopathology scans for reference. Corresponding diameters were measured and the results were compared with the equivalent measurements on the scans of the histology slides. The results were tabulated in histogram form. Diagnostic confidence levels were evaluated. RESULTS: Size dimension accuracy increased from 66% using B-mode alone to 82% using combined B-mode and AFUSON elasticity images. Tumour area accuracy was also increased. A small number of cases had a striking visual similarity of shape on AFUSON elasticity scans and histopathology slides. CONCLUSION: In spite of the shortfalls in this study, AFUSON elasticity imaging was capable of acquiring some high-quality images that showed strong correlation between AFUSON elasticity and scans of histology slides. Further studies will be carried out to refine the technique and determine if it has a role in the diagnosis and management of breast cancer.

Stereotactic core biopsy of an impalpable screen-detected breast lesion using acupuncture-analgesia.

Chinese acupuncture-analgesia is used for pain management during various surgical procedures. Over the past 40 years this approach has been introduced in many countries and has been particularly helpful in the investigation and treatment of patients who are unable to tolerate conventional analgesia. We report here the case of a woman with a 17-year history of myalgic encephalitis who underwent a stereotactic core biopsy of the breast under acupuncture-analgesia. A planning session was needed to assess the patient's existing condition and her response to acupuncture. During this session, a range of frequencies for electrical stimulation of the acupuncture needles using electro-acupuncture apparatus was determined. We describe the combined acupuncture and biopsy procedures and the patient's impressions and outcomes are recorded.

Fusion of contrast-enhanced breast MR and mammographic imaging data.

Increasing use is being made of Gd-DTPA contrast-enhanced MRI (CE-MRI) for breast cancer assessment since it provides three-dimensional (3D) functional information via pharmacokinetic interaction between contrast agent and tumour vascularity, and because it is applicable to women of all ages as well as patients with post-operative scarring. CE-MRI is complementary to conventional X-ray mammography, since it is a relatively low-resolution functional counterpart of a comparatively high-resolution 2D structural representation. However, despite the additional information provided by MRI, mammography is still an extremely important diagnostic imaging modality, particularly for several common conditions such as ductal carcinoma in situ (DCIS) where it has been shown that there is a strong correlation between microcalcification clusters and malignancy. Pathological indicators such as calcifications and fine spiculations are not visible in CE-MRI and therefore there is clinical and diagnostic value in fusing the high-resolution structural information available from mammography with the functional data acquired from MRI. This article is a clinical overview of the results of a technique to transform the coordinates of regions of interest (ROIs) from the 2D mammograms to the spatial reference frame of the contrast-enhanced MRI volume. An evaluation of the fusion framework is demonstrated with a series of clinical cases and a total of 14 patient examples.

The changing pattern of chronic lung disease of prematurity.

Thirty four infants with chronic lung disease of prematurity were reviewed and divided into two groups on the appearance of the chest radiograph. Type 1 disease (n = 19) was defined as homogeneous or patchy ill defined opacification in the lungs without coarse reticulation, and type 2 disease (n = 11) had the classical appearance of bronchopulmonary dysplasia. Four patients could not be classified. We conclude that type 1 disease represents typical chronic lung disease of premature infants, and type 2 is usually complicated by pulmonary interstitial emphysema. As no infant with type 1 disease died, its histopathological basis is unknown.

Diffraction patterns in the shadows of disks and obstacles.

We compare the Fresnel diffraction pattern of a thin circular disk with that of a square obstacle, specifically evaluating the on-axis field strength. Photographs of the diffraction patterns reveal some curious features for the square obstacle. Second, the precise electric and magnetic fields behind a conducting circular disk are evaluated without invoking the Fresnel approximation and contrasted with the rigorous electromagnetic result for a metal sphere. The calculations show that the two cases differ only slightly in the Fresnel region.

Diffraction from a circular aperture: on-axis field strength.

A useful, analytical result for the on-axis field strength from a uniformly illuminated circular aperture is derived. Also, new calculations for circular apertures with tapered illuminations are presented.

The demonstration of true hermaphroditism by computed tomography.

Intersex states are rare but if unsuspected may cause diagnostic confusion. We describe one such patient with true hermaphroditism which was misdiagnosed on computed tomography (CT). Laparotomy revealed a female genital tract and histology confirmed the presence of ovatestes, despite a male phenotype.

Small bowel masses due to gallstones: report of two cases.

Two patients are described with solitary small bowel masses due to gallstones. Radiographs showed evidence of choledocho-duodenal fistula formation. Even when a study with contrast medium is intended primarily for the examination of the small intestine, a solitary intraluminal mass should direct attention to the duodenal loop where evidence of a fistula should be sought.