Evaluation of solid breast lesions with power Doppler: value of penetrating vessels as a predictor of malignancy.

INTRODUCTION: This study aimed to evaluate the vascular pattern of solid breast lesions using power Doppler ultrasonography (PDUS) and assess whether the presence of intratumoural penetrating vessels can predict breast cancer malignancy. METHODS: Greyscale ultrasonography (US) and PDUS were prospectively performed on 91 women in Malaysia with histopathologically proven breast lesions. The diagnostic accuracy of greyscale US, PDUS, and both greyscale US and PDUS was calculated and compared. RESULTS: The 91 women had 102 breast lesions (55 benign, 47 malignant). Of the 47 malignant lesions, 36 demonstrated intratumoural penetrating vessels. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of greyscale US findings in diagnosing malignancy were 100.0%, 71.4%, 74.1% and 100.0%, respectively. The presence of calcification in the breast lesion and the margin, shape and posterior acoustic features of the lesion were significant parameters in predicting malignancy (p < 0.01). The sensitivity, specificity, PPV and NPV of the presence of intratumoural penetrating vessels in predicting malignancy were 76.5%, 80.0%, 76.5% and 80.0%, respectively. When both greyscale US and PDUS were used, there was a significant correlation in predicting malignancy (p < 0.05). The specificity and PPV values of the combined greyscale US and PDUS method (89.0% and 85.7%, respectively) were higher than those of greyscale US or PDUS alone. CONCLUSION: Flow patterns revealed by PDUS can be useful for differentiating benign and malignant breast lesions. The visualisation of penetrating vessels in solid breast lesions can be used to complement greyscale US findings in predicting malignancy.

Synchronous unilateral infiltrating ductal and lobular breast carcinoma.

The incidence of synchronous bilateral infiltrating breast cancer has been reported to be 2%. However, synchronous unilateral infiltrating ductal carcinoma and infiltrating lobular carcinoma (ILC) are very rarely reported. We present a woman with palpable ILC who was later found to have synchronous well-circumscribed ductal carcinoma on further imaging. We also discuss the use of diagnostic approaches such as ultrasonography, mammography and histopathology. This case highlights the importance of careful assessment of concurrent lesions in the breast in the presence of an existing carcinoma.

Radiological analysis of the ethmoid roof in the Malaysian population.

OBJECTIVE: To ascertain the prevalence of the lateral lamella of the cribriform plate height according to Keros classification in the Malaysian population, and to find if there is any difference between the major ethnic groups in Malaysia (Malay, Chinese, Indian). METHODS: Retrospective analysis of 150 CT scan studies of the paranasal sinuses. RESULTS: The mean height of the lateral lamella of the cribriform plate (LLCP) in 300 sides was 2.64mm. Keros type I was seen in 240 sides (80%), while, Keros type II was seen in 60 sides (20%). There was no significant difference in the distribution of Keros classification among the major ethnic groups of Malaysia (Malay, Chinese, Indian). Keros type I was seen in 103 sides in males and 137 sides in females. Significant difference was observed in type II between the male and female (47 sides in males and 13 sides in female; p-value <0.001). When comparing the difference in the height of the LLCP in the same individual, asymmetry was observed in 139 patients. The LLCP height was higher on the left side in 71 patients and higher on the right in 68. CONCLUSION: The understanding of the anatomy of the ethmoid roof with its possible variation is crucial to give the surgeon the optimal information about the possible risk that one can face during the surgery.