An exploratory clinical trial of preoperative non-invasive localization before breast-conserving surgery using augmented reality technology.

PURPOSE: This single-center, randomized, prospective, exploratory clinical trial was conducted to assess the clinical efficacy of an augmented reality (AR)-based breast cancer localization imaging solution for patients with breast cancer. METHODS: This clinical trial enrolled 20 women who were diagnosed with invasive breast cancer between the ages of 19 and 80, had a single lesion with a diameter ≥ 5 mm but ≤ 30 mm, had no metastases to other organs, and had not received prior chemotherapy. All patients underwent mammography, ultrasound, computed tomography, and magnetic resonance imaging for preoperative assessment. Patients were randomly assigned to ultrasound-guided skin marking localization (USL) and AR-based localization (ARL) groups (n = 10 in each group). Statistical comparisons between USL and ARL groups were made based on demographics, radiologic features, pathological outcomes, and surgical outcomes using chi-square and Student t-tests. RESULTS: Two surgeons performed breast-conserving surgery on 20 patients. Histopathologic evaluation of all patients confirmed negative margins. Two independent pathologists evaluated the marginal distances, and there were no intergroup differences in the readers' estimates (R1, 6.20 ± 4.37 vs. 5.04 ± 3.47, P = 0.519; R2, 5.10 ± 4.31 vs. 4.10 ± 2.38, P = 0.970) or the readers' average values (5.65 ± 4.19 vs. 4.57 ± 2.84, P = 0.509). In comparing the tumor plane area ratio, there was no statistically significant difference between the two groups in terms of either reader's mean values (R1, 15.90 ± 9.52 vs. 19.38 ± 14.05, P = 0.525; R2, 15.32 ± 9.48 vs. 20.83 ± 12.85, P = 0.290) or the overall mean values of two readers combined (15.56 ± 9.11 vs. 20.09 ± 13.38, P = 0.388). Convenience, safety, satisfaction, and reusability were all superior in the AR localization group (P < 0.001) based on the two surgeons' responses. CONCLUSION: AR localization is an acceptable alternative to ultrasound-guided skin marking with no significant differences in surgical outcomes.

Breast Cancer after Radiation Therapy in a Patient with Li-Fraumeni Syndrome: A Case Report.

Li-Fraumeni syndrome (LFS) is an inherited autosomal-dominant tumor-predisposition disorder caused by germline mutations in the TP53 tumor suppressor gene. Since patients with LFS are likely to develop therapy-related cancers, radiation therapy should be avoided if breast cancer is found in these individuals. Herein, we present a case of secondary breast cancer in an LFS patient after radiation and chemotherapy for the first diagnosed breast sarcoma.

Bladder Cancer Metastasis to the Breast in a Male Patient: Imaging Findings on Mammography and Ultrasonography.

Male breast cancer is rare, accounting for approximately 1% of breast cancers. Metastasis from extra-mammary malignancy to the breast in men is extremely rare. The most common primary tumors that metastasize to the breast in male are prostate, lung, stomach, colorectal cancer, melanoma, and sarcoma. To our knowledge, only a few cases of bladder cancer presenting with metastasis to the male breast have been reported, and metastasis with infiltration rather than mass is extremely rare. We report imaging findings on mammography and ultrasonography in a 59-year-old male with bladder cancer metastatic to the breast.

Metabolic changes in breast cancer on dual-time-point 18F-FDG PET/CT imaging according to primary tumor uptake and background parenchymal enhancement.

OBJECTIVE: This study was aimed at investigating metabolic changes in breast cancer on dual-time-point 18F-FDG PET/CT imaging (DTPI) according to primary tumor uptake and determining whether this technique is affected by background parenchymal enhancement (BPE). METHODS: A total of 189 patients with newly diagnosed breast cancer who underwent DTPI examination were retrospectively evaluated. DTPI was performed using a standard FDG/PET protocol followed by delayed image acquisition at 120 min after injection. Patients were divided into two groups according to primary tumor uptake as breast cancer with low maximum standard uptake value (SUVmax) (< 2.5) and high SUVmax (≥ 2.5). The maximal SUV of the primary breast tumor (T-SUVmax), contralateral breast parenchyma uptake (B-SUVmax) according to different BPE grades, tumor to background ratio (T/B-SUVmax), and their percentage changes between early and delayed images (retention index, RI) were calculated. RESULTS: For primary tumor uptake, tumors with high SUV had a significant increase in mean T-SUVmax between early and delayed images (8.17 vs. 9.16, P < 0.001), and %RI T-SUVmax was 10.52%. Conversely, mean T-SUVmax did not change between early and delayed images for tumors with low SUV (1.96 vs. 1.94, P = 0.610), and %RI T-SUVmax was - 1.41%. The mean %RI B-SUVmax was - 12.43% for minimal BPE, - 14.19% for mild BPE, - 19.49% for moderate BPE, and - 21.25% for marked BPE grade, indicating that higher BPE grades undergo better washouts on delayed imaging (ß = - 3.220, P < 0.001 for trend). The %RI T/B-SUVmax of both breast cancer groups with low SUV and high SUV was 18.86% and 32.47%, respectively. CONCLUSIONS: Breast cancer with low SUV undergoes no significant change in SUV on DTPI; however, washing of background parenchymal activity was evident over time, resulting in significantly increased tumor contrast in delayed images, which leads to increased sensitivity. Breast parenchymal washout was more significant with increased BPE level. Therefore, DTPI is expected to be more useful for evaluating breast lesions in regions with marked BPE on MRI.

Digital Breast Tomosynthesis as a Breast Cancer Screening Tool for Women with Gynecologic Cancer.

Purpose: The purpose of our study was to evaluate digital breast tomosynthesis as a breast cancer screening modality for women with gynecologic cancer. Materials and Methods: This retrospective study included patients with underlying gynecologic malignancies who underwent screening digital breast tomosynthesis for breast cancer. The cancer detection rate, recall rate, sensitivity, specificity, and positive predictive value (PPV) were calculated. PPV1 was defined as the percentage of all positive screening exams that have a tissue diagnosis of cancer within a year. PPV2 was defined as the percentage of all diagnostic exams (and Breast Imaging Reporting and Data System category 4, 5 from screening setting) with a recommendation for tissue diagnosis that have cancer within a year. PPV3 was defined as the percentage of all known biopsies actually performed that resulted in a tissue diagnosis of cancer within the year. For each case of screen-detected cancer, we analyzed the age, type of underlying gynecologic malignancy, breast density, imaging features, final Breast Imaging Reporting and Data System assessment, histologic type, T and N stages, molecular subtype, and Ki-67 index. Results: Among 508 patients, 7 with breast cancer were identified after a positive result. The cancer detection rate was 13.8 per 1000 screening exams, and the recall rate was 17.9%. The sensitivity was 100%, and the specificity was 83.2%. The false negative rate was 0 per 1000 exams. The PPV1, PPV2, and PPV3 were 7.7, 31.8, and 31.8, respectively. Conclusion: Digital breast tomosynthesis may be a promising breast cancer screening modality for women with gynecologic cancer, based on the high cancer detection rate, high sensitivity, high PPV, and high detection rate of early-stage cancer observed in our study.

Dystrophic Calcifications in the Breast from Secondary Hyperparathyroidism.

BACKGROUND: Soft tissue calcification is common in patients with secondary hyperparathyroidism who have received long-term treatment with hemodialysis. However, calcifications in the breast parenchyma are not common. We report a case of a woman with dystrophic breast calcifications from secondary hyperparathyroidism. CASE REPORT: A 65-year-old woman presented with a palpable mass in her right breast which she had discovered 1 month ago. She had a medical history of end-stage renal disease. Mammography and ultrasound revealed large dystrophic calcifications in both breasts. Core needle biopsy was performed for calcifications in the right breast, and the pathologic diagnosis was dystrophic calcification in the stroma from secondary hyperparathyroidism. CONCLUSION: Reviewing our case will contribute to a fast and correct diagnosis in patients with dystrophic breast calcifications and lab results indicating secondary hyperparathyroidism, and will help discriminate these benign lesions from malignancies.

Visualization of Breast Microcalcifications on Digital Breast Tomosynthesis and 2-Dimensional Digital Mammography Using Specimens.

PURPOSE: The purpose of this study is to compare the visibility of microcalcifications of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) using breast specimens. MATERIALS AND METHODS: Thirty-one specimens' DBT and FFDM were retrospectively reviewed by four readers. RESULTS: The image quality of microcalcifications of DBT was rated as superior or equivalent in 71.0% by reader 1, 67.8% by reader 2, 64.5% by reader 3, and 80.6% by reader 4. The Fleiss kappa statistic for agreement among readers was 0.31. CONCLUSIONS: We suggest that image quality of DBT appears to be comparable with or better than FFDM in terms of revealing microcalcifications.

Shear-Wave Elastography for the Differential Diagnosis of Breast Papillary Lesions.

OBJECTIVE: To evaluate the diagnostic performance of shear-wave elastography (SWE) for the differential diagnosis of breast papillary lesions. METHODS: This study was an institutional review board-approved retrospective study, with a waiver of informed consent. A total of 79 breast papillary lesions in 71 consecutive women underwent ultrasound and SWE prior to biopsy. Ultrasound features and quantitative SWE parameters were recorded for each lesion. All lesions were surgically excised or excised using an ultrasound-guided vacuum-assisted method. The diagnostic performances of the quantitative SWE parameters were compared using the area under the receiver operating characteristic curve (AUC). RESULTS: Of the 79 lesions, six (7.6%) were malignant and 12 (15.2%) were atypical. Orientation, margin, and the final BI-RADS ultrasound assessments were significantly different for the papillary lesions (p < 0.05). All qualitative SWE parameters were significantly different (p < 0.05). The AUC values for SWE parameters of benign and atypical or malignant papillary lesions ranged from 0.707 to 0.757 (sensitivity, 44.4-94.4%; specificity, 42.6-88.5%). The maximum elasticity and the mean elasticity showed the highest AUC (0.757) to differentiate papillary lesions. CONCLUSION: SWE provides additional information for the differential diagnosis of breast papillary lesions. Quantitative SWE features were helpful to differentiate breast papillary lesions.

Can preoperative 3-T MRI predict nipple-areolar complex involvement in patients with breast cancer?

PURPOSE: To evaluate the diagnostic performances of preoperative 3-T breast MRI for predicting nipple-areolar complex (NAC) involvement. MATERIALS AND METHODS: We analyzed the predictors of NAC involvement in breast cancer, with diagnostic performances. RESULTS: Among the 403 patients, 43 cases were surgically confirmed for NAC involvement. For predicting NAC involvement, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 60.5%, 87.5%, 36.6%, 94.9%, and 84.6%, respectively. Continuity to NAC, unilateral enhancement of NAC and thickening of NAC were significant magnetic resonance findings predictive of NAC involvement. CONCLUSIONS: Preoperative 3-T breast MRI is a useful method to predict NAC involvement in breast cancer patients.

Digital breast tomosynthesis and breast ultrasound: Additional roles in dense breasts with category 0 at conventional digital mammography.

PURPOSE: To compare the diagnostic performances of digital breast tomosynthesis (DBT) and ultrasound for the dense breasts with category 0 at conventional digital mammography. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and informed consent was waived. Among the 1103 patients who underwent screening digital mammography at our institution, 769 (69.7%) patients had dense breasts. Of the 769 patients, 229 (29.8%) lesions were categorized as 0. DBT, breast ultrasound and digital mammography were performed in 108 (47.2%) patients. BI-RADS final assessments for DBT and ultrasound were recorded. Categories 1-3 were clinically considered as benign, and categories 4 and 5 were clinically considered as malignant. The diagnostic performances of breast ultrasound and DBT were correlated with final pathologic reports or follow-up images. RESULTS: Among 108 lesions, 17 (15.7%) were malignant and 91 (84.3%) were benign. Sensitivity was 100% for both ultrasound (17/17) and DBT (17/17) and negative predictive value was also 100% for both ultrasound (49/49) and DBT (74/74). Specificity and positive predictive value for ultrasound were 53.9% (49/91) and 28.8% (17/59), respectively. Specificity and positive predictive value for DBT were 81.3% (74/91) and 50% (17/34), respectively. DBT showed higher diagnostic accuracy than that of breast ultrasound (DBT: 84.3%, 91/108; ultrasound: 61.1%, 66/108; p<0.001). The benign biopsy rate of DBT (50%, 17/34) was lower than that of ultrasound (71.2%, 42/59). CONCLUSION: DBT showed better diagnostic performance than breast ultrasound for dense breasts with category 0. DBT may reduce the benign biopsy rate and short term follow-up.

Role of shear-wave elastography (SWE) in complex cystic and solid breast lesions in comparison with conventional ultrasound.

OBJECTIVE: To evaluate the additional role of shear-wave elastography (SWE) in differential diagnosis of complex cystic and solid breast lesions. MATERIALS AND METHODS: From January 2013 to November 2013, 140 complex cystic and solid breast lesions from 139 consecutive patients were performed ultrasound and SWE prior to biopsy. BI-RADS ultrasound final assessment and SWE parameters were recorded for each lesion. Histopathologic diagnosis was used as the reference standard. RESULTS: Among the 140 lesions, 30 lesions (21.4%) were malignant. The mean maximum elasticity (Emax) of malignant lesions (184.3 kPa) was significantly higher than that of benign lesions (45.5 kPa) (P<0.001). Homogeneity of elasticity and color pattern were significantly different from malignancy and benign lesions (P<0.05). Emax with cutoff value at 108.5 kPa showed Az value of 0.968 (95% CI, 0.932-0.985) with sensitivity of 86.7% and specificity of 97.3%. Using this cutoff value, false-positive rate was 2.7% and false-negative rate was 13.3%. By applying an Emax value of 108.5 kPa or less as a criterion for downgrading BI-RADS category 4a lesions to category 3 lesions, 103/123 (83.7%) lesions could be downgraded to category 3 lesions. CONCLUSION: Additional use of SWE could reduce unnecessary benign biopsies in complex cystic and solid breast lesions.

Computer-aided detection system for masses in automated whole breast ultrasonography: development and evaluation of the effectiveness.

PURPOSE: The aim of this study was to evaluate the performance of a proposed computer-aided detection (CAD) system in automated breast ultrasonography (ABUS). METHODS: Eighty-nine two-dimensional images (20 cysts, 42 benign lesions, and 27 malignant lesions) were obtained from 47 patients who underwent ABUS (ACUSON S2000). After boundary detection and removal, we detected mass candidates by using the proposed adjusted Otsu's threshold; the threshold was adaptive to the variations of pixel intensities in an image. Then, the detected candidates were segmented. Features of the segmented objects were extracted and used for training/testing in the classification. In our study, a support vector machine classifier was adopted. Eighteen features were used to determine whether the candidates were true lesions or not. A five-fold cross validation was repeated 20 times for the performance evaluation. The sensitivity and the false positive rate per image were calculated, and the classification accuracy was evaluated for each feature. RESULTS: In the classification step, the sensitivity of the proposed CAD system was 82.67% (SD, 0.02%). The false positive rate was 0.26 per image. In the detection/segmentation step, the sensitivities for benign and malignant mass detection were 90.47% (38/42) and 92.59% (25/27), respectively. In the five-fold cross-validation, the standard deviation of pixel intensities for the mass candidates was the most frequently selected feature, followed by the vertical position of the centroids. In the univariate analysis, each feature had 50% or higher accuracy. CONCLUSION: The proposed CAD system can be used for lesion detection in ABUS and may be useful in improving the screening efficiency.

Nodular fasciitis of the breast: two cases with a review of imaging findings.

Nodular fasciitis of the breast is a rare, benign, proliferative disease characterized by sudden onset and rapid growth. It can clinically and radiologically mimic breast cancer. We present imaging findings from two cases of nodular fasciitis that initially manifested as palpable masses. Sonographically, they appeared as irregular, not-circumscribed hypoechoic nodules. The diagnosis of nodular fasciitis was made by US-guided core needle biopsies. US-guided vacuum-assisted excision was subsequently performed in the first case, while the second resolved via spontaneous regression.

Effect of Gd-EOB-DTPA on hepatic fat quantification using high-speed T2-corrected multi-echo acquisition in (1)H MR spectroscopy.

PURPOSE: To determine whether gadolinium ethoxybenzyldiethylenetriaminepentaacetic acid (Gd-EOB-DTPA) administration affects hepatic fat quantification by magnetic resonance spectroscopy (MRS) using the fast breath-hold high-speed T2-corrected multiecho (HISTO) technique. MATERIALS AND METHODS: Seventy-six patients underwent Gd-EOB-DTPA-enhanced liver MR and 15sec breath-hold HISTO MRS (4 times), twice before and twice after Gd-EOB-DTPA administration. Two consecutive MRSs were performed immediately before the dynamic study. Post-contrast MRS was performed twice continuously, approximately 15min after contrast injection, prior to obtaining 20-min hepatobiliary phase images. We used paired t-test and intraclass correlation coefficient (ICC) to evaluate the variability of the mean fat fraction (FF) on pre-contrast MRS and post-contrast MRS and the effect of the contrast agent on the mean FF. RESULTS: The mean FFs were not significantly different between pre-contrast MRS and post-contrast MRS (6.50%±6.54 versus 6.70%±6.61, P=0.15). The ICC of FF calculation between pre- and post-contrast MRS was 0.984. The ICCs for the FF magnitude between pre- and post-contrast MRS were 0.452, 0.771, and 0.995 for FF <5%, FF 5-10%, and FF ≥10%, respectively. CONCLUSION: Gd-EOB-DTPA does not appear to influence hepatic fat quantification, especially for patients with hepatic steatosis.

Double inversion recovery MR imaging of the breast: efficacy in detection of breast cancer.

PURPOSE: To investigate the efficacy of the double inversion recovery sequence (DIR) in breast cancer detection. MATERIALS AND METHODS: Fifty-six patients with biopsy-proven breast cancers underwent preoperative breast MRI, including sagittal DIR and contrast-enhanced T1-weighted images (CE-T1WI). Twenty-four of the 56 patients additionally underwent sagittal T1WI and T2WI. The signal intensities of the lesion (L) and ipsilateral normal breast tissue (N) were measured. The lesion-to-normal ratio (LNR) was defined as LNR = 100(L-N)/N. We compared LNRs among the four sequences, and then assessed the differences of LNRs between CE-T1WI and DIR in each pathologic subgroup (IDC and non-IDC group). Multiple regression analysis was performed to identify predictors of the signal-to-noise ratios (SNR) of the normal tissue or lesion and LNRs. RESULTS: The mean LNR did not differ significantly between DIR (58.65 ± 71.55) and CE-T1WI (59.78 ±31.04), nor did the LNRs between DIR and CE-T1WI in the two subgroups. The LNRs of DIR did not differ significantly between the two subgroups (P = 0.247). The SNR of lesions in DIR was correlated with the intraductal component percentage (r(2) = 0.485, P = 0.037). CONCLUSION: DIR and CE-T1WI showed similar tumor detection efficacy, and DIR could complement dynamic MRI for detecting breast cancer without a contrast agent.

Dose reduction in automatic optimization parameter of full field digital mammography: breast phantom study.

PURPOSE: We evaluated the impact of three automatic optimization of parameters (AOP) modes of digital mammography on the dose and image quality. METHODS: Computerized Imaging Reference Systems phantoms were used. A total of 12 phantoms with different thickness and glandularity were imaged. We analyzed the average glandular dose (AGD) and entrance surface exposure (ESE) of 12 phantoms imaged by digital mammography in three modes of AOP; namely standard mode (STD), contrast mode (CNT), and dose mode (DOSE). Moreover, exposure factors including kVp, mAs, and target/filter combination were evaluated. To evaluate the quality of the obtained digital image, two radiologists independently counted the objects of the phantoms. RESULTS: According to the AOP modes, the score of masses and specks was sorted as CNT>STD=DOSE. There was no difference in the score of fiber among the three modes. The score of image preference was sorted as CNT>STD>DOSE. The AGD, ESE, and mAs were sorted as CNT>STD>DOSE. The kVp was sorted as CNT=STD>DOSE. The score of all test objects in the phantom image was on a downtrend with increasing breast thickness. The score of masses was different among the three groups; 20-21%>30%>50% glandularity. The score of specks was sorted as 20-21%=30%>50% glandularity. The score of fibers was sorted as 30%>20-21%=50% glandularity. The score of image preference was not different among the three glandularity groups. The AGD, ESE, kVp, and mAs were correlated with breast thickness, but not correlated with glandularity. CONCLUSION: The DOSE mode offers significant improvement (19.1-50%) in dose over the other two modes over a range of breast thickness and breast glandularity with acceptable image quality. Owning knowledge of the three AOP modes may reduce unnecessary radiation exposure by utilizing the proper mode according to its purpose.

Correlation of nasal obstruction with nasal cross-sectional area measured by computed tomography in patients with nasal septal deviation.

OBJECTIVES: The objective of the present study was to investigate the relationship between the subjective sensation of nasal obstruction and the corresponding cross-sectional area for nasal airflow in patients with a deviated septum. METHODS: Seventy-one patients with a diagnosis of unilateral nasal obstruction due to a deviated nasal septum were evaluated by preoperative computed tomography. Anterior anatomic characteristics (the internal nasal valve angle and the cross-sectional areas at the external nasal valve, the head of the inferior turbinate, and the head of the middle turbinate) and posterior anatomic factors (the cross-sectional areas at the openings of the frontal sinus, maxillary sinus, and end of the nasal septum) were examined. Associations between the computed tomography measurements and the subjective severity of nasal obstruction were analyzed with a visual analog scale (VAS). RESULTS: Anterior and posterior anatomic characteristics were associated with the subjective severity of nasal obstruction. Anterior anatomic factors were related to the VAS scores of patients with anterior septal deviation, and posterior anatomic factors were related to the VAS scores of patients with posterior septal deviation. CONCLUSIONS: This study indicated that the anterior and posterior parts of the nasal cavity are both related to nasal obstruction. In some patients, the posterior part of the nasal cavity was more important than other locations in causing nasal obstruction.

Automated ultrasound of the breast for diagnosis: interobserver agreement on lesion detection and characterization.

OBJECTIVE: The purpose of this study was to prospectively evaluate interobserver agreement on lesion detection and characterization in the review of automated ultrasound images of the breast by five radiologists. SUBJECTS AND METHODS: From August to October 2009, bilateral whole-breast ultrasound examinations were performed with an automated technique and with a handheld device for 55 women consecutively scheduled to undergo diagnostic ultrasound. Three-dimensional volume data from automated ultrasound were reviewed by five radiologists, who were unaware of the results of ultrasound with a handheld device and mammography and of the clinical information. If a lesion was detected with automated ultrasound, clock-face position, distance from the nipple, largest diameter, and BI-RADS final assessment category were evaluated. If the lesion was a mass, shape, orientation, margin, echogenicity, and posterior feature were analyzed. Intraclass correlation coefficients and kappa statistics were used for statistical analysis. RESULTS: At least two observers identified 145 lesions with automated ultrasound. Among 725 possible detections, 587 (81%) detections were made. Individual investigators detected between 74% (107/145) and 88% (127/145) of the lesions. The rate of detection of lesions larger than 1.2 cm was 92%. Most lesions detected only with handheld ultrasound (11/12, 92%) or automated ultrasound (34/36, 94%) were cysts or probably benign masses. All intraclass correlation coefficients for lesion location and size exceeded 0.75, indicating high reliability. Substantial agreement was found for mass shape (κ = 0.71), orientation (κ = 0.72), margin (κ = 0.61), and BI-RADS final assessment category (κ = 0.63). CONCLUSION: Detection of lesions larger than 1.2 cm in greatest diameter was reliable. High reliability was obtained for reporting lesion size and location. Substantial agreement was obtained for description of key feature and final assessment category.

Nasal skin thickness measured using computed tomography and its effect on tip surgery outcomes.

OBJECTIVE: Skin thickness can be a major factor affecting rhinoplasty outcomes. However, few studies have examined the impact of nasal skin thickness on rhinoplasty aesthetic results. The aim of this study is to determine the effect of nasal skin thickness on the tip surgery outcome objectively. STUDY DESIGN: Case series with chart review. SETTING: Academic tertiary care medical center. SUBJECTS AND METHODS: The study involved 77 patients who were evaluated using preoperative computed tomography scans and underwent rhinoplasty including tip surgery. Surgical outcomes were classified as excellent, good, or poor. Nasal skin thickness was measured at nasion, rhinion, nasal tip, and columella using computed tomography scans and was analyzed according to surgical outcomes. RESULTS: The mean nasal skin thickness was 3.3 mm for nasion, 2.4 mm for rhinion, 2.9 mm for nasal tip, and 2.3 mm for columella. Postoperative outcomes were classified as excellent in 45, good in 17, and poor in 15 patients. The excellent outcome group had the thinnest nasal tip and columella nasal skin (2.8 mm and 2.2 mm), whereas the poor outcome group had the thickest skin in these regions (3.4 mm and 2.6 mm) (P < .0001 and P = 0.01, respectively). CONCLUSION: Nasal skin is thickest over the nasofrontal angle, thins over the rhinion, is thick again in the nasal tip, and thins out over the columella. Thick skin at the nasal tip and columella was associated with poor surgical outcomes. Regional skin thickness appears to be an important prognostic factor for tip surgery success.

Ultrasound features of suture granulomas in the thyroid bed after thyroidectomy for papillary thyroid carcinoma with an emphasis on their differentiation from locally recurrent thyroid carcinomas.

The purpose of our study was to evaluate the ultrasound features of suture granulomas at the thyroid bed after thyroidectomy for papillary thyroid carcinoma with an emphasis on their differentiation from locally recurrent thyroid carcinomas. We enrolled 14 suture granulomas in 10 patients and 20 locally recurrent carcinomas in 18 patients after thyroidectomy, confirmed by surgery (15 out of 20 recurrent carcinomas), or ultrasound-guided fine needle aspiration cytology (14 suture granulomas and 5 recurrent carcinomas). The ultrasound findings, including presence of internal echogenic foci suggesting calcification or suture material, were compared between the two groups. In the cases with internal echogenic foci, the size, number, distribution pattern, and the presence of a paired appearance were also evaluated. In result, most of the suture granulomas were irregular (n=13) and heterogeneous (n=9) (p<0.05). The incidence of internal echogenic foci was higher in suture granulomas (n=12) than in recurrent carcinomas (n=7) (p<0.05). The internal echogenic foci in all suture granulomas were clustered centrally or paracentrally, unlike those in recurrent carcinomas (p<0.05). Most of the echogenic foci in suture granulomas were larger than 1 mm in diameter (p<0.05) and had a paired appearance (p<0.05). Shape, heterogeneity, and the presence of central or paracentral internal echogenic foci are helpful criteria for differentiating suture granulomas from locally recurrent tumors in the thyroid bed.