Clinical implications of architectural distortion visualized by breast ultrasonography.

BACKGROUND: Recently, Architectural distortion (AD) has been detected via ultrasonography (US) even in the absence of a definitive mass; however, the clinical significance of this finding is yet unknown. The purpose of this study is to elucidate the causes of AD, as revealed by US. METHODS: Breast echo was undergone by 931 patients between January and December 2005. The study comprised 45 patients (4.8%) in the age range of 28-76 years (mean 49.8 years) whose images revealed AD despite the absence of mass formation. To investigate the causes of this AD, we retrospectively reviewed the medical records of these patients. RESULTS: In 10 of 45 cases in which US revealed AD, the distortion was attributed to the biopsy procedures. Of these ten patients, seven underwent Mammotome biopsy, two underwent open biopsy; one underwent core-needle biopsy. Seven patients had previous histories of neoadjuvant chemotherapy for breast cancer. Fifteen lesions were benign, and 13 lesions were malignant disease pathologically. CONCLUSIONS: Emphasis on the increasing value of AD detection by US and professional awareness of this fact are of tremendous importance.

Comparison of reading time between screen-film mammography and soft-copied, full-field digital mammography.

PURPOSE: To compare the reading time for full-field digital mammography (FFDM) and screen-film mammography (SFM) using a recommended reading method and to provide data regarding the reading time required to establish the optimal conditions for digital mammography. METHODS: Reading time was measured during image interpretation by two expert radiologists. FFDM images were taken for screening, and readers A and B read images obtained for 79 and 82 patients, respectively. The mammograms read by both readers were similar with regard to patients' backgrounds. Further, 100 SFM mammograms were read to perform comparative analyses. The reading times were compared. RESULT: Reader A recorded mean reading times of 31 and 56 s, respectively, for the SFM and FFDM images with no comparative mammograms, and means of 45 and 62 s for those with comparative mammograms. Reader B recorded mean reading times of 43 and 74 s, respectively, for SFM and FFDM images with no comparative mammograms, and 53 and 66 s for those with comparative mammograms. CONCLUSION: The reading time is prolonged in FFDM performed according to a recommended method. Post-processing is thought to affect the reading time.

Determining the morphological features of breast cancer and predicting the effects of neoadjuvant chemotherapy via diagnostic breast imaging.

BACKGROUND: Neoadjuvant chemotherapy has recently become common therapy for breast cancer. This work studied whether or not the effects of neoadjuvant chemotherapy can be predicted from morphological features of breast cancer in initial diagnostic imaging. MATERIALS AND METHODS: A total of 186 cases who underwent neoadjuvant chemotherapy at this hospital in 2006 were studied. Morphological features were classified into four categories. One is a type of invasive carcinoma that tends to grow along the mammary ducts (type A1), another is a type of expansively growing invasive carcinoma that is relatively well-defined (type A2), a third is a type of irregularly shaped mass that retracts surrounding tissue (type A3), and the fourth is a mixed type. Thus, the effects of neoadjuvant chemotherapy on carcinomas of the four types were compared on the basis of image and pathological findings. Effects of neoadjuvant chemotherapy were classified into three categories of enlarged mass, pCR, and other, with the latter indicating no change or shrinkage. RESULTS: Of the 186 total cases, 72 were classified as type A1, 31 as type A2, 52 as type A3, and 31 as a mixed type. Seven of 31 cases of type A2 (22.6%) were cases of an enlarged mass, revealing a high percentage of such cases. Dividing cases into type A2 and other types and looking at the proportion of cases of an enlarged mass thus indicated a significantly higher tendency. pCR was achieved in 6 of 31 cases with type A2 (19.4%). Here, also, the proportion of type A2 cases was significantly higher. CONCLUSION: Morphological features prior to neoadjuvant chemotherapy can contribute to determining the effects of the therapy. Expansively growing well-defined masses contain lesions at both extremes, tending to enlarge in some instances or instead allowing pCR, so the course of therapy must be carefully followed when performing neoadjuvant chemotherapy.

DCIS showing architectural distortion on the screening mammogram - comparison of mammographic and pathological findings.

BACKGROUND: Patients with mammograms showing architectural distortion often have an invasive carcinoma with noticeable fibrosis, such as scirrhous carcinoma or invasive lobular carcinoma. However, architectural distortion is also seen in some cases of ductal carcinoma in situ (DCIS). METHODS: Of the 316 patients operated on in our hospital from October 2003 to June 2004, 54 were histopathologically diagnosed as having DCIS (excluding cases with microinvasion). Of these 54 patients, 5 exhibited architectural distortion on the preoperative mammogram. The aim of this study was to correlate the radiologic and pathologic features of DCIS showing architectural distortion on the mammogram. RESULTS: The mammograms of the 5 patients revealed clusters of calcifications in the architectural distortion. Sclerosis was seen in the interstitium around the DCIS in 3 cases, and DCIS components were found in Cooper's ligament in 4 cases. In 2 cases, sclerosing adenosis was seen in the background of the DCIS. CONCLUSION: It is generally accepted that architectural distortion in DCIS is due to sclerosing adenosis, but sclerosis in the interstitium around the DCIS and presence of DCIS components in Cooper's ligament proved to be the cause of architectural distortion in the cases described here. Since architectural distortion is also seen in DCIS cases, we think that besides the diagnosis of malignancy, the presence or absence of infiltration should be histopathologically established before surgery.

Indications for stereotactically-guided vacuum-assisted breast biopsy for patients with category 3 microcalcifications.

BACKGROUND: Since microcalcifications classified as category 3 on mammography include not only malignant lesions but also benign lesions, it is difficult to decide whether stereotactic vacuum-assisted breast biopsy (Mammotome(R), MMT) should be performed or the patient should merely be follows. The purpose of this study is to adequately diagnose microcalcifications classified as category 3 and to formulate a correct clinical policy. In addition, we examined the characteristics of the calcifications. METHODS: This study included 51 patients who underwent MMT from July 2003 to October 2004. All the cases were evaluated as category 3, and no abnormal findings were detected on ultrasonography. We classified the pattern of calcifications based on three aspects: 1. density and size, 2. pleomorphic appearance 3. number of calcifications per square centimeter. RESULTS: Of the 51 patients, 14 were histologically diagnosed with ductal carcinoma in situ (DCIS). Heterogeneity in the density and size were observed in 9 of 14 patients (64.3%). The calcifications had a pleomorphic appearance in 6 of 14 patients (42.9%). A large number of calcifications (20/cm(2)) were observed in 8 of 14 patients (57.1%). Better examination characteristics were obtained with heterogeneity in density and size (AUC=0.72 95%C.I: 0.56-0.89) compared with pleomorphic appearance and the number of calcifications per square centimeter. The potential for malignancy was an average of 6 times higher for calcifications with heterogeneity in density and size compared to that for calcifications which were homogeneous in these aspects. CONCLUSION: Attention should be paid to prevent unnecessary mammotome procedures. Heterogeneity in the density and size of calcifications is a reliable criterion for clinical decision-making.

Magnetic resonance mammography has limited ability to estimate pathological complete remission after primary chemotherapy or radiofrequency ablation therapy.

Recently, primary systemic chemotherapy has been used not only for locally advanced breast cancers but also for operable cases for which adjuvant chemotherapy is necessary. Moreover, various kinds of ablation therapies have been tried to treat early breast cancer non-surgically, such as radiofrequency ablation (RFA), interstitial laser surgery, cryosurgery and focused ultrasound surgery (FUS). If pathological complete remission (pCR) can be correctly assessed by magnetic resonance mammography (MRM) or ultrasonography (US), a non surgical approach can be used for treatment. MRM is now widely used to assess the effect of chemotherapy in the neoadjuvant setting. However, the ability of MRM to estimate pCR is not yet sufficient to allow a non-surgical approach to breast cancer. Conversely, ultrasonography (US) might over-diagnose fibrous change as residual invasive cancer. If both MRM and US reveal no abnormal finding, there might be no residual cancer on pathological examination. However, such circumstances are encountered in only 2-3% of cases given the neoadjuvant treatment. Other cases, such as US showing residual disease in spite of pCR on MRM, have some potential for false positivity. Therefore, US-guided needle biopsy, especially vacuum-assisted breast biopsy, might be suitable to judge whether true pCR was achieved in the targeted lesion.

Establishment of seminars to improve the diagnostic accuracy and effectiveness of breast ultrasound.

PURPOSE: To improve the ability of technicians and physicians to find and diagnose breast lesions in breast ultrasound screening. METHODS: Seminars were organized for technicians and physicians engaged in breast ultrasound screening, and tests were carried out to evaluate the usefulness of the seminars. Each seminar lasted 2 days and comprised lectures and group activities. Pretests and post-tests conducted before and after each seminar, respectively, consisted of 100 questions: 50 about animated images, and 50 about static images. The tests required the participant to find lesions in animated images and estimate the probability of malignancy from static images. RESULTS: In the animated image tests, sensitivity was greater after the seminar, although specificity did not change significantly. In the static image tests, sensitivity increased, and a significant increase was also observed in the receiver operating curve analysis for degree of certainty in diagnosing cancer. CONCLUSION: The seminars improved the participants' ability to find and diagnose breast lesions during ultrasound screening.

Diagnostic assessment of nonpalpable breast cancer--the difference in diagnostic approach for the clinical treatment of breast cancer between the Japanese Guidelines and the National Comprehensive Cancer Network(USA)Guidelines.

The detection of non-palpating breast cancer might improve the survival of patients with whole breast cancer because it can be diagnosed at an early stage. Therefore, to standardize the quality of patient care, a published assessment guideline is necessary in a clinical setting. For this purpose, Japan and USA have independent guidelines with different approaches. ''The evidence-based guideline for clinical treatment of breast cancer'' that was published in June 2005 by the Japanese breast cancer society, is the first set of integrated guidelines pertaining to breast cancer in Japan. These guidelines are presented in the research questions (RQ)format. This paper explains 7 RQs(out of 31 RQs)and also discusses the recommendations pertaining to the diagnosis of nonpalpable breast cancer. The National Comprehensive Cancer Network (NCCN; USA)guidelines, which are widely recognized as one of the most reliable guidelines based on published evidences, also contain the diagnostic assessment of asymptomatic patients with a negative physical examination. This paper discusses pros and cons of each of the above mentioned guidelines as well as their clinical application. It is necessary to use both the Japanese and NCCN guidelines while understanding the differences between the two.

Distinct diagnostic criteria for ultrasonographic examination of papillary thyroid carcinoma: a multicenter study.

Recent advances permitting high-resolution ultrasonography have made ultrasonographic examination of nodular thyroid diseases an accessible examination for routine practice. However, diagnostic criteria for ultrasonographic examination of thyroid nodules are not surely established. To identify the optimal strategy for well standardized differential diagnosis of papillary thyroid carcinoma and benign nodules, we evaluated the significance of individual ultrasonographic characteristics of thyroid nodules in a multicenter study. Ten characteristics in ultrasonograms from 53 patients scored by 17 investigators from 15 centers were analyzed by t tests and logistic regression analyses. Between benign and papillary thyroid cancer groups, all characteristics but not size or multiplicity of strong echoes, which suggest calcifications, were significant parameters. Logistic regression analyses showed that border character, shape, and internal echo level are highly significant parameters (p < 0.0005). A multiple logistic regression showed to be the most important predictors of pathologic diagnosis. The diagnostic criterion with border character and internal echo level yielded 93% sensitivity and 92% specificity. In conclusion, univariate and multivariate analyses identified border character, shape, internal echo level, but not strong echoes (calcifications), as important characteristics in differentiating papillary thyroid carcinoma from benign nodules. These results will contribute to standardization of accurate ultrasonographic diagnosis of papillary thyroid carcinoma.

A crescent-shaped sparing proximal to a liver tumor may indicate underlying portal tumor thrombus.

A primary or metastatic liver tumor sometimes blocks portal venous flow and causes a focal sparing in the fatty liver. We herein report a case of segmental sparing due to the portal tumor thrombus extending from the metastatic liver tumor. The present case demonstrates characteristic computer-associated tomographic findings, a distal oval hypodense tumor with proximal "crescent-shaped sparing", which may indicate underlying portal tumor thrombus at the apex of the sparing.