Ultrasound characteristics of histologically proven grade 3 invasive ductal breast carcinoma.

High-grade invasive ductal carcinoma (IDC) may paradoxically display features similar to benign breast masses. This study analysed the ultrasound features of histologically proven cases of grade 3 IDC. At North Western BreastScreen Victoria, from 4 February 1993 to 30 September 2002, 181 cases of grade 3 IDC that had ultrasound evaluation were available for retrospective analysis. For each tumour, four features were assessed: margin, attenuation characteristics, echotexture and depth versus width ratio. Eighty-seven per cent of tumours had an aggressive margin with an echogenic rind, microlobulation or angular margins. However, 11% had a well-defined smooth margin. The classic sonographic malignant feature of posterior shadowing was present in only 30%, whereas the tissues posterior to the lesion remained isoechoic in 48% and showed posterior enhancement in 11%. Six per cent of the tumours were isoechoic and difficult to appreciate on ultrasound. The best feature to characterize lesions as malignant was the margin of the lesion. To ensure that malignant lesions are correctly categorized, it is important that interfaces between the tumour and adjacent breast parenchyma are meticulously evaluated in a real-time fashion rather than viewed as a single still image.

Carbon localisation of impalpable breast lesions.

BACKGROUND: Hookwire localisation (HL) is the most widely used technique for excision of impalpable breast lesions. This method has several drawbacks, particularly with logistics. Carbon localisation (CL) is an alternative procedure which is logistically superior to HL, but comparisons of accuracy and costs have not been reported. METHODS: A consecutive case series of all patients from Northwestern BreastScreen undergoing either CL or HL between January 1999 and March 2001. FINDINGS: Of 511 procedures, 219 CLs and 292 HLs were performed. The accuracy of excision did not vary significantly. Where a preoperative diagnosis of malignancy had been made by percutaneous needle biopsy (PNB), the margins were <1mm in 27 of the CL group (18.9%) and 21 of the HL group (29.2%) (P=0.087). Cost analysis was very favourable for CL performed concurrently with PNB since the costs were incremental. INTERPRETATION: At service delivery level, CL is an accurate alternative to HL with better logistics and favourable costs. Nationally, it has the potential to improve the cost effectiveness of breast screening programmes.

Magnetic resonance angiography of renal artery stenosis.

Renal artery stenosis is a common cause of renal impairment which in many cases may be potentially reversible. The diagnosis and follow-up of this condition is commonly carried out using the relatively invasive technique of intra-arterial angiography. Magnetic resonance angiography (MRA) is emerging as a possible alternative technique to conventional angiography. We have studied 60 patients who were referred for investigation of possible renal artery stenosis using both 3-D phase contrast MRA techniques and conventional digital arteriography. Studies were assessed prospectively and conventional angiography was assumed to be the gold standard for the purposes of this study. Calculated sensitivity and specificity results were 84% and 91% respectively, for 3-D phase contrast MRA of the renal arteries. We conclude that 3-D phase contrast MRA is a very promising technique for the noninvasive investigation of renal artery stenosis with high sensitivity and specificity levels acting as a screening test in the future for patients with this potential diagnosis, diminishing the amount of conventional angiograms that are performed.

A comparative study of radionuclide venography and contrast venography in the diagnosis of deep venous thrombosis.

BACKGROUND: The value of the radionuclide blood pool venogram in detecting deep venous thrombosis (DVT) has to date been inadequately evaluated. This is despite its lower complication rate than the gold standard of contrast X-ray venography. AIMS: To compare the relative accuracy and inter observer variability of radionuclide blood pool and X-ray contrast venography as well as evaluate previous literature on radionuclide venography. METHODS: Prospective comparison of radionuclide and contrast venography was performed in 39 patients. Sensitivity and specificity of radionuclide venography were compared to contrast venography and confidence intervals were measured using standard error calculations. A meta-analysis of previous studies was also performed. RESULTS: Significant inter observer variation in reports was present in both radionuclide (37%) and contrast (22%) venograms. Using consensus reports sensitivity of radionuclide venography was 87% compared to contrast venography and specificity was 83%. These results are similar to those obtained in previous studies. Furthermore, sensitivity in specificity in the proximal veins were 90% and 92% respectively which were superior to sensitivity and specificity in the distal veins where it was 74% and 90% respectively. CONCLUSION: The radionuclide venogram appears accurate in the proximal veins and in excluding but not diagnosing distal venous thrombosis.