Ultrasonography of Superficial Soft-Tissue Masses: Society of Radiologists in Ultrasound Consensus Conference Statement.

The Society of Radiologists in Ultrasound convened a panel of specialists from radiology, orthopedic surgery, and pathology to arrive at a consensus regarding the management of superficial soft-tissue masses imaged with US. The recommendations in this statement are based on analysis of current literature and common practice strategies. This statement reviews and illustrates the US features of common superficial soft-tissue lesions that may manifest as a soft-tissue mass and suggests guidelines for subsequent management.

Utility of Longitudinal Measurement of the Liver With Ultrasound in Comparison to Computed Tomography Liver Volume in Assessing Hepatomegaly.

ABSTRACT: The purpose of the study is to retrospectively compare the longitudinal measurement of the liver on ultrasound (US) with liver volume as measured on computed tomography (CT). This institutional review board-approved retrospective study with prospective image analysis included adult patients with US examinations of the liver and CT examinations of the abdomen performed within 2 weeks of each other from January 1, 2010, to April 30, 2016. We recorded the dome-to-tip longitudinal length measurement of the right lobe of the liver on the US study. The liver volume was calculated using manual 3-dimensional segmentation of the CT data set. Additional linear liver measurements and qualitative assessments were retrospectively made on the US and CT images. Hepatomegaly was defined as a liver volume 2000 mL or greater. The sample had 302 patients including 140 males and 162 females. Liver length measured on US had a moderate positive correlation with liver volume measured on CT, with a Pearson correlation coefficient of 0.7078. The optimum cutoff of liver length (US) was found to be 17 cm by Youden index, with a sensitivity of 76.0% and specificity of 73.4% for hepatomegaly. Additional linear measurements and qualitative assessments of the liver did not significantly improve the diagnosis of hepatomegaly. In conclusion, liver length measured with US has only a moderate correlation with liver volume. Commonly used US liver length maximum values of 16 to 18 cm produce a significant number of false-negatives and false-positives for the diagnosis of hepatomegaly.

Ultrasonography of Cervical Lymph Nodes.

Ultrasonography is an excellent method for imaging evaluation of cervical lymph nodes. This article provides an image-rich review of the sonographic manifestations of diseases involving the cervical lymph nodes, with an emphasis on the expected anatomic distribution of diseases.

Scrotal Ultrasound.

Ultrasound is the imaging modality of choice to evaluate the scrotum because of its high resolution, Doppler capabilities, availability, and lack of ionizing radiation. Acute urologic emergencies diagnosed with ultrasound include testicular torsion, testicular rupture, and Fournier gangrene. The radiologist's knowledge of sonographic features of vascular, infectious, traumatic, and benign and malignant processes that occur in the scrotum coupled with the patient's presenting symptoms, age, and physical examination allows for the correct diagnosis of a wide spectrum of scrotal pathology.

Ultrasound of Soft Tissue Masses and Fluid Collections.

Soft tissue masses and fluid collections are frequently encountered in sonographic practice, either as principal indication for diagnostic examination or as an incidental finding during an examination performed for other indications. Sonography is a good first-line imaging modality for evaluation of superficial masses and fluid collections, but requires meticulous attention to technique to avoid diagnostic pitfalls. Although many superficial masses are diagnosed with ultrasound, there are several potential diagnostic challenges, including differentiating hematomas from sarcomas. This article provides an image-rich review of the sonographic features of common soft tissue masses, with emphasis on practical tips to accurately recognize important pathology.

Ultrasound-Guided Fine-Needle Aspiration With Optional Core Needle Biopsy of Head and Neck Lymph Nodes and Masses: Comparison of Diagnostic Performance in Treated Squamous Cell Cancer Versus All Other Lesions.

OBJECTIVES: To evaluate the diagnostic performance of ultrasound (US)-guided fine-needle aspiration with optional core needle biopsy of head and neck lymph nodes and masses, with attention to differences between biopsy of treated squamous cell carcinoma (SCC) and biopsy of other lesions. METHODS: Institutional Review Board approval was obtained, and the need for consent was waived for this retrospective study. All 861 US-guided biopsies of head and neck lymph nodes and masses performed between March 1, 2012, and May 16, 2016, were reviewed. RESULTS: Of the 861 biopsies, 53 targeted SCC with residual masses after treatment. The biopsy procedures yielded benign or malignant pathologic results in 71.7% (38 of 53) of treated SCC and 90.7% (733 of 808) of all other lesions (P < .001). A reference standard based on subsequent pathologic results or clinical and imaging follow-up was established in 68.4% of procedures. In cases with benign or malignant biopsy results and a subsequent reference standard, the sensitivity values for malignancy were 87.5% (95% confidence interval, 64.0%-96.5%) in treated SCC and 98.3% (95% confidence interval, 96.0%-99.3%) in all other cases (P = .047), and the specificity values were 63.6% (95% confidence interval, 35.4%-84.8%) in treated SCC and 99.5% (95% confidence interval, 97.3%-99.9%) in all other cases (P < .001). There were no major complications related to the biopsy procedures. CONCLUSIONS: Excluding treated SCC, US-guided fine-needle aspiration with optional core needle biopsy of head and neck lymph nodes and masses has excellent diagnostic performance. Needle biopsy of head and neck SCC with a residual mass after therapy has a high rate of nondiagnostic samples, suboptimal sensitivity, and poor specificity.

Fine-needle aspiration with selective use of core needle biopsy of major salivary gland tumors.

OBJECTIVES: Preferential use of fine-needle aspiration (FNA) versus core needle biopsy (CNB) for distinguishing benign from malignant major salivary gland tumors is highly debated. The main disadvantage of FNA is lower sensitivity, whereas arguments against CNB include use of a larger bore needle and greater risk of complications. The aim of this study is to evaluate our experience performing ultrasound-guided (UG) FNA with selective use of CNB based on preliminary cytopathology, and to determine whether our preoperative diagnostic approach is more sensitive and specific than FNA alone-and at least as sensitive and specific as CNB alone. STUDY DESIGN: Retrospective review of UG needle biopsy sampling of lesions arising in or around parotid and submandibular glands. METHODS: Ultrasounds of 141 needle biopsies were identified. Patient/lesion/needle biopsy characteristics, preliminary cytopathology, final pathology, imaging studies, and subsequent clinical course and treatment were documented. RESULTS: Needle biopsies performed according to our protocol provided results that guided clinical decision making in 125 of 135 cases, 92.6% (95% confidence interval [CI], 86.8%-96.4%) of the time. Using 41 cases that had histologic verification, sensitivity was 100% (95% CI, 79.6%-100%), and specificity was 92.3% (95% CI, 75.9%-97.9%) for detecting malignancy. We definitively characterized 120 lesions as benign (84) or malignant (36). CONCLUSION: Preoperative needle biopsy diagnoses allowed clinical management to progress 92.6% of the time. The protocol of FNA with selective use of CNB may potentially reduce patient exposure to risks associated with CNB without the tradeoff of lower sensitivity seen with FNA. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2522-2527, 2017.

Ultrasound-Guided Needle Biopsy of Neck Lymph Nodes in Patients With Suspected Lung Cancer: Are the Specimens Sufficient for Complete Pathologic Evaluation to Guide Patient Management?

BACKGROUND: The purpose of this study is to determine the ability of ultrasound guided needle biopsy of a neck lymph node to provide adequate tissue for complete pathologic evaluation of suspected metastatic lung cancer, including molecular testing for epidermal growth factor receptor gene mutations by pyrosequencing and anaplastic lymphoma kinase gene rearrangement by fluorescence in situ hybridization. METHODS: Institutional review board approval was obtained and the requirement for informed consent was waived. All ultrasound guided neck biopsies performed July 1, 2011, to June 30, 2015, were retrospectively reviewed, and all biopsies performed for suspected lung cancer metastatic to supraclavicular and cervical lymph nodes were included. RESULTS: Forty patients with suspected lung cancer underwent ultrasound-guided needle biopsy of an abnormal appearing neck lymph node identified on preprocedure computed tomography or positron emission tomography/computed tomography. Thirty-seven patients were subsequently diagnosed with lung cancer and 3 were diagnosed with lymphoma. A definitive pathologic diagnosis was rendered in 95% of neck node biopsies (38/40; 95% confidence interval, 84%-99%). Of the 36 specimens diagnostic for lung cancer, 16 were considered for further molecular testing and the specimen was adequate for molecular testing in 15 (94%; 73%-100%) cases. Therefore, the neck node biopsy specimens were adequate for complete pathologic workup in 93% (37/40; 81%-98%). No complications related to the biopsies were observed. CONCLUSIONS: In patients presenting with suspected lung cancer and suspicious neck lymph nodes, ultrasound-guided needle biopsy frequently provides adequate tissue for complete pathologic evaluation and eliminates the need for more invasive procedures.

Ultrasound Versus Computed Tomographic Guidance for Percutaneous Biopsy of Chest Lesions.

OBJECTIVES: To compare ultrasound (US) versus computed tomography (CT) for primary guidance during needle biopsy of chest lesions. METHODS: Institutional Review Board approval was obtained for this Health Insurance Portability and Accountability Act-compliant retrospective study, and the need for informed consent was waived. All US- and CT-guided chest biopsy procedures performed between January 1, 2012, and October 15, 2014, at our institution were reviewed, and all procedures targeting peripheral intrathoracic and chest wall lesions were included. Axillary lesions, lung lesions without peripheral pleural contact, and mediastinal lesions without a transcutaneous US window were excluded. Radiologic, pathologic, and clinical records were reviewed. RESULTS: Fifty-five procedures with primary US guidance (23 lung, 6 pleural, 2 mediastinal, and 24 chest wall) and 130 CT procedures (88 lung, 10 pleural, 7 mediastinal, and 25 chest wall) were performed. Diagnostic samples were obtained in 98% (54 of 55) of US procedures and 87% (113 of 130) of CT procedures (P = .02). Pneumothorax requiring treatment occurred in 2% (1 of 55) of US procedures and 5% (7 of 130) of CT procedures (P = .25). Computed tomographic localization was used in 29% (16 of 55) of US procedures. Nevertheless, the average patient radiation dose was significantly less in US procedures (182 mGy-cm) versus CT procedures (718 mGy-cm; P< .01). The average procedure time was 40 minutes for US and 38 minutes for CT (P = .39). The average lesion size was 4.5 cm for US and 4.9 cm for CT (P = .14). CONCLUSIONS: During biopsy of peripheral intrathoracic lesions and chest wall lesions, primary US guidance resulted in a higher likelihood of a diagnostic sample and a decreased patient radiation dose compared with CT guidance.

Ultrasound-Guided Transcutaneous Needle Biopsy of the Base of the Tongue and Floor of the Mouth From a Submental Approach.

Limited data exist regarding the feasibility of ultrasound-guided transcutaneous biopsy of the base of the tongue and floor of the mouth. This retrospective study reviewed 8 cases with lesions in the base of the tongue or floor of the mouth that were biopsied by fine-needle aspiration. Core biopsy was also needed in 1 case. All biopsies were technically successful, and all yielded squamous cell carcinoma. One biopsy yielded a false-positive result, as subsequent resection yielded high-grade dysplasia with no invasion. The other biopsy results were considered true-positive based on subsequent pathologic examinations (2 cases) or clinical/imaging follow-up (5 cases). There were no significant complications associated with the biopsies.

Accuracy of sonographic diagnosis of superficial masses.

OBJECTIVES: The purpose of this study was to retrospectively review the diagnostic accuracy of sonography in the evaluation of superficial masses with surgical and histologic findings as the reference standard. METHODS: Institutional Review Board approval was obtained, informed consent was waived, and Health Insurance Portability and Accountability Act compliance was maintained. Seventy-two superficial masses in 62 patients were examined sonographically by a single radiologist (reader 1) and subsequently underwent surgical therapy. Three radiologists experienced in sonography, blinded to the original interpretation and surgical findings, retrospectively and independently reviewed the sonographic images and assigned the cases to 1 of 14 diagnostic categories. For all lesions, the rendered diagnosis was compared with the reference standard to determine concordance. For the specific diagnosis of lipoma, sensitivity, specificity, and accuracy were assessed for all readers individually and collectively. RESULTS: Surgery and histolopathologic analysis yielded 39 lipomas, 6 hernias, 4 foreign bodies, 4 hemangiomas, and 19 other nonlipomatous lesions, including 1 malignancy. The rendered diagnosis was concordant with the reference standard in 93% of cases for reader 1 and in 89% of cases for all readers. The sensitivity, specificity, and accuracy for the diagnosis of lipoma were 92%, 100%, and 96% for reader 1 and 96%, 97%, and 96% for all readers. CONCLUSIONS: Sonography has high accuracy in the evaluation of superficial masses, particularly lipomas.

CT-guided lung biopsies: pleural blood patching reduces the rate of chest tube placement for postbiopsy pneumothorax.

OBJECTIVE: The objective of our study was to determine whether pleural blood patching reduces the need for chest tube placement and hospital admission for pneumothorax complicating CT-guided percutaneous lung biopsy. MATERIALS AND METHODS: We reviewed 463 CT-guided lung biopsies performed between August 2006 and March 2010 to determine whether intervention for pneumothorax was required and patient outcome. Intervention was categorized as simple aspiration, aspiration and intrapleural blood patching, or chest tube placement and hospital admission. The technique for pleural blood patching consisted of complete pneumothorax aspiration, immediate placement of up to 15 mL of peripheral autologous blood into the pleural space, and positioning the patient in the ipsilateral decubitus position for 1 hour after the procedure. RESULTS: Intervention for pneumothorax was necessary in 45 of 463 patients (9.7%) and 19 of 463 patients (4.1%) required chest tube placement. Pleural blood patching as a method to treat a postbiopsy pneumothorax and avoid further intervention was associated with a significantly higher success rate than simple aspiration: 19 of 22 (86.4%) vs seven of 15 (46.7%) (odds ratio = 7.2, p = 0.03), respectively. CONCLUSION: Aspiration with intrapleural blood patching is superior to simple aspiration to treat pneumothorax associated with CT-guided lung biopsy. Pleural blood patching reduces the need for chest tube placement and hospital admission in this patient population.

Carbonic anhydrase inhibitors. The X-ray crystal structure of human isoform II in adduct with an adamantyl analogue of acetazolamide resides in a less utilized binding pocket than most hydrophobic inhibitors.

We investigated the inhibitory activity of several 1,3,4-thiadiazole-sulfonamides against all catalytically active CA (EC 4.2.1.1), CA I-XV. The tail derivatizing the 5-position in the 1,3,4-thiadiazole-2-sulfonamide scaffold was observed to be critical as an inhibitory determinant of these compounds. The high resolution X-ray crystal structure of hCA II in complex with 5-(1-adamantylcarboxamido)-1,3,4-thiadiazole-2-sulfonamide, showed the adamantyl moiety of the inhibitor residing in a less utilized binding pocket than that of most hydrophobic inhibitors, lined by the amino acid residues Ile91, Val121 and Phe131. This binding site may explain the diverse inhibition profiles of 5-carboxamide- and sufonamide-derivatized 1,3,4-thiadiazole-2-sulfonamides and offers a hot spot for designing isoform selective inhibitors, considering that residues 91 and 131 are highly variable among the 13 catalytically active isoforms.