Predicting Healthy C5 Spinal Nerve Stumps Eligible for Grafting with MRI, Tinel Test, and Rhomboid Electromyography: A Retrospective Study of 295 Consecutive Brachial Plexus Surgeries.

Background MRI, Tinel test, and rhomboid electromyography (EMG) can be used to predict whether C5 spinal nerve stumps are healthy and eligible for grafting in acute adult brachial plexus injuries, but their comparative diagnostic efficacies have not been evaluated. Purpose To compare diagnostic performances of MRI, Tinel test, and rhomboid EMG in predicting healthy C5 spinal nerve stumps that are eligible for grafting. Materials and Methods This retrospective study included consecutive adult patients with acute brachial plexus injury who underwent microreconstructions between January 2008 and December 2018. Healthy C5 spinal nerve stumps eligible for grafting with preceding normal intradural nerve rootlets were diagnosed by an experienced neuroradiologist using an avulsion severity score system based on fast imaging employing steady-state acquisition or FIESTA neurography, which separates intradural nerve rootlets into normal, partial mild, severe, and complete avulsions. Tinel test and rhomboid EMG results were assessed by an experienced nerve surgeon and neurologist, respectively. The accuracy, sensitivity, and specificity of the three tests were compared using microdissection as the reference standard. P < .05 was considered to indicate a significant difference. Results A total of 251 patients (mean age, 31 years ± 13 [standard deviation]; 217 men) with brachial plexus injuries who had -undergone MRI (n = 251), Tinel test (n = 235), rhomboid EMG (n = 181) and MRI, Tinel test, and EMG (n = 172) were -included. Accuracy, sensitivity, and specificity, respectively, in predicting healthy C5 spinal nerve stumps eligible for grafting were 93% (233 of 251), 84% (58 of 69), and 96% (175 of 182) for MRI; 59% (139 of 235), 56% (37 of 66), and 60% (102 of 169) for Tinel test; and 39% (71 of 181), 85% (43 of 50), and 21% (28 of 131) for rhomboid EMG. MRI (area under the receiver operating characteristic curve [AUC], 0.90; P < .001) -outperformed MRI and Tinel test (AUC, 0.74), Tinel test (AUC, 0.59), and rhomboid EMG (AUC, 0.53). Conclusion MRI performed best in the prediction of healthy graftable C5 spinal nerve stumps in acute adult brachial plexus injuries. © RSNA, 2021 Online supplemental material is available for this article.

Imaging Approaches for Accurate Determination of the Quadriceps Angle.

OBJECTIVES: A retrospective study was conducted using magnetic resonance image (MRI) and a full-length standing scanogram (FLSS) to measure the quadriceps angle (Q-angle) while avoiding soft tissue interference. METHODS: Two steps were retrospectively carried out in two case series. The first step involved using MRI to define the standardized patellar center (PC) and the tibial tubercle (TT) on the frontal plane of the MRI in one group of 60 consecutive patients (from July 2016 to December 2016, 29 men and 31 women, average of 46 years). The next step was transferring the location of the standardized PC and the TT from the MRI to the FLSS in another group of 100 consecutive patients (from April 2009 to March 2014, 50 men and 50 women, average of 36 years). The pelvis and intact femur, knee, and tibia were used to determine the Q-angle on the FLSS. RESULTS: The standardized PC was positioned 42% from the lateral end of femur trans-epicondylar line. The TT was 2 cm distal to the tibial articular surface and 37% from the lateral end of tibial width. The average Q-angle was 9.5° in 100 patients (8.8° in 50 men and 10.1° in 50 women, P = 0.02). The average femoral length was 42.9 cm in 100 patients (44.7 cm in 50 men and 41.1 cm in 50 women, P < 0.001). Women and men had similar pelvic width (27.9 vs 27.8 cm, P = 0.89). CONCLUSION: Using the FLSS may help to accurately determine the Q-angle. Men and women have similar pelvic width. A larger Q-angle in women may be mainly due to the shorter femur.

Value of homodyned K distribution in ultrasound parametric imaging of hepatic steatosis: An animal study.

Ultrasound is the first-line tool for screening hepatic steatosis. Statistical distributions can be used to model the backscattered signals for liver characterization. The Nakagami distribution is the most frequently adopted model; however, the homodyned K (HK) distribution has received attention due to its link to physical meaning and improved parameter estimation through X- and U-statistics (termed "XU"). To assess hepatic steatosis, we proposed HK parametric imaging based on the α parameter (a measure of the number of scatterers per resolution cell) calculated using the XU estimator. Using a commercial system equipped with a 7-MHz linear array transducer, phantom experiments were performed to suggest an appropriate window size for α imaging using the sliding window technique, which was further applied to measuring the livers of rats (n = 66) with hepatic steatosis induced by feeding the rats a methionine- and choline-deficient diet. The relationships between the α parameter, the stage of hepatic steatosis, and histological features were verified by the correlation coefficient r, one-way analysis of variance, and regression analysis. The phantom results showed that the window side length corresponding to five times the pulse length supported a reliable α imaging. The α parameter showed a promising performance for grading hepatic steatosis (p < 0.05; r2 = 0.68). Compared with conventional Nakagami imaging, α parametric imaging provided significant information associated with fat droplet size (p < 0.05; r2 = 0.53), enabling further analysis and evaluation of severe hepatic steatosis.

Varied influence of the femoral or tibial component on quadriceps angles: Verified by imaging studies.

OBJECTIVE: The aim of this study was to evaluate the varied influence of femoral or tibial component on Quadriceps angles (Q-angle) measured with magnetic resonance image (MRI) and full-length standing scanogram (FLSS) techniques. METHODS: Two groups of patients were studied. The first group underwent MRI studies and the second group underwent FLSS studies. Two-step procedures were carried out. Knee MRI in 60 consecutive adult patients simply taken for meniscus or ligament injuries were utilized at the first step. The standardized patellar center (PC) and tibial tubercle (TT) on the frontal plane of MRI were positioned. At the second step, the FLSS in other 100 consecutive young adult patients taken for chronic unilateral lower extremity injuries were used for locating the two landmarks from MRI. The Q-angle was then determined on the anterior superior iliac spine, standardized PC, and TT on the FLSS. RESULTS: For 60 patients, the standardized PC was at the point 42% from the lateral end of the trans-epicondylar line of the femur. The TT was at the point 2 cm distal to the tibial articular surface and 37% from the lateral end of the tibial width. For 100 patients, the Q-angle was an average of 9.5° and 65.2% of the Q-angle was contributed by the upper arm (the femur). Women had a larger Q-angle (10.1° vs. 8.8°, p = 0.02) and a shorter femur (41.1 vs. 44.7 cm, p < 0.001). CONCLUSION: The Q-angle is about 9.5° with 65.2% contributed by the femur. The Q-angle may mainly be influenced by the femoral component. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

Transarterial embolization for postpartum hemorrhage: lessons learned.

BACKGROUND: Although transarterial embolization (TAE) can powerfully control postpartum hemorrhage (PPH), clinical failure of TAE is not uncommon. PURPOSE: To discover whether any parameters could predict timely clinical failure of TAE, then whether a supplementary intervention could be promptly initiated. MATERIAL AND METHODS: We retrospectively analyzed 118 TAE procedures in 113 patients with PPH performed at our institution between January 2012 and May 2015. The patients were divided into the following groups: clinically successful TAE and failed TAE. Successful TAE was defined as obviation of supplementary embolization or surgical intervention for hemostasis. Gestational conditions, angiographic factors, maternal vital signs, and laboratory data were compared between the two groups. RESULTS: In total, 100 (84.8%) TAEs were clinically successful. Multivariate logistic regression analyses revealed independent risk factors of TAE clinical failure, including the requirement for augmented embolic agents, placental retention, and international normalized ratio > 1.3 ( P = 0.009, 0.001, and 0.005, respectively). The post-TAE shock index was significantly associated with TAE failure, using a cut-off value of 0.8. CONCLUSION: The discovered independent risk factors of TAE clinical failure existed before or during the TAE procedure and could not reflect the post-TAE conditions. Although the post-TAE shock index was not an independent factor, it reflected the conditions after TAE and could indicate TAE clinical failure timely.

Diagnostic performance of dual-energy contrast-enhanced subtracted mammography in dense breasts compared to mammography alone: interobserver blind-reading analysis.

PURPOSE: To analyse the accuracy of dual-energy contrast-enhanced spectral mammography in dense breasts in comparison with contrast-enhanced subtracted mammography (CESM) and conventional mammography (Mx). MATERIALS AND METHODS: CESM cases of dense breasts with histological proof were evaluated in the present study. Four radiologists with varying experience in mammography interpretation blindly read Mx first, followed by CESM. The diagnostic profiles, consistency and learning curve were analysed statistically. RESULTS: One hundred lesions (28 benign and 72 breast malignancies) in 89 females were analysed. Use of CESM improved the cancer diagnosis by 21.2 % in sensitivity (71.5 % to 92.7 %), by 16.1 % in specificity (51.8 % to 67.9 %) and by 19.8 % in accuracy (65.9 % to 85.8 %) compared with Mx. The interobserver diagnostic consistency was markedly higher using CESM than using Mx alone (0.6235 vs. 0.3869 using the kappa ratio). The probability of a correct prediction was elevated from 80 % to 90 % after 75 consecutive case readings. CONCLUSION: CESM provided additional information with consistent improvement of the cancer diagnosis in dense breasts compared to Mx alone. The prediction of the diagnosis could be improved by the interpretation of a significant number of cases in the presence of 6 % benign contrast enhancement in this study. KEY POINTS: • DE-CESM improves the cancer diagnosis in dense breasts compared with mammography. • DE-CESM shows greater consistency than mammography alone by interobserver blind reading. • Diagnostic improvement of DE-CESM is independent of the mammographic reading experience.

Comparison of ultrasonographically guided fine-needle aspiration and core needle biopsy in the diagnosis of parotid masses.

BACKGROUND: To retrospectively compare the accuracies of ultrasound-guided fine-needle aspiration (USFNA) and ultrasound-guided core needle biopsy (USCNB) in the diagnosis of parotid masses. METHODS: A total of 171 patients (aged 17-86 years, mean 54 years) with parotid masses (35 malignant and 136 benign lesions) underwent either USFNA (n = 107) or USCNB (n = 64). The diagnostic accuracies for differentiating benign from malignant lesions of both examinations were compared. Surgical histopathology (n = 104) and clinical diagnosis (n = 67) were used to establish the final diagnoses. RESULTS: USCNB had a significantly higher sensitivity (94.1%) than USFNA (55.6%) (p < 0.05) in differentiating benign lesions from malignant conditions. The specificity and overall accuracy of USCNB were higher than those of USFNA (100% and 98.4% versus 93.3% and 86.9%, respectively). USCNB provided more specific diagnosis than USFNA (100% versus 93.3%, p < 0.05). All six patients with lymphomas who underwent USCNB were accurately diagnosed, whereas all four patients with lymphomas who underwent USFNA were not. CONCLUSIONS: USCNB should be preferred to USFNA when a definite diagnosis of a parotid solid mass is needed.

CT-guided hook wire localization of subpleural lung lesions for video-assisted thoracoscopic surgery (VATS).

BACKGROUND/PURPOSE: Histologic diagnosis of suspicious small subpleural lung lesions is difficult and often impossible using existing image-guided needle biopsy techniques including video-assisted thoracoscopic wedge resection. Preoperative lung lesion localization provides a more obvious target to facilitate intraoperative resection. This study reviewed the indications, results and complications of CT-guided hook wire localization for subpleural lung lesions in video-assisted thoracoscopic surgery (VATS). METHODS: Between February 2001 and January 2007, 41 patients (20 males, 21 females; mean age, 52.5 +/- 5.1 years) with 43 subpleural pulmonary lesions underwent preoperative CT-guided double-thorn hook wire localization prior to video-assisted thoracoscopic wedge resection. Nodule diameters ranged from 2 mm to 26 mm (mean, 9.7 +/- 1.6 mm). The distance of the lung lesions from the nearest pleural surfaces ranged from 2 mm to 30 mm (mean, 9.6 +/- 2.0 mm). Patients then received VATS within 5 hours. The efficacy of preoperative localization was evaluated in terms of procedure time, VATS success rate and associated complications of localization. RESULTS: Forty-three wedge resections of the lungs containing 43 subpleural lung lesions as guided or assisted by the inserted hook wires were successfully performed in 41 VATS procedures (41 of 43 procedures, 95.3%). The mean procedure time for preoperative CT-guided hook wire localization was 30.4 +/- 2.8 minutes. Eight patients had asymptomatic minimal pneumothoraces (18.6%); six patients had minimal needle tract parenchymal hemorrhages (13.9%) and one patient (2.3%) had an estimated 100 mL of hemothorax due to a small intercostal artery bleed that was cauterized during operation. The mean procedure time for VATS was 103 +/- 9.7 minutes (range, 44-198 minutes). Pathologic examination revealed seven primary lung cancers, 11 metastases, one hemangioma, 19 definite non-neoplastic pathologies, two nonspecific chronic inflammation, and three metallic foreign bodies. Diagnostic yield was 95%. No major complications related to the preoperative hook wire localization and VATS were noted. CONCLUSION: CT-guided hook wire fixation is useful, helps in precise lesion localization in VATS wedge resection, and has a low rate of minor complications.

Video-assisted thoracoscopic surgery for catamenial hemoptysis: the rationale of preoperative computed tomography-guided hook-wire localization.

Catamenial hemoptysis is a rare disease. Hormone ablation therapy is the treatment of choice with multiple side effects. We report a case of pulmonary endometriosis with deep and changeable focus. Successful treatment was obtained with the combine use of computed tomography-guided hook-wire localization and video-assisted thoracoscopic surgery. Owing to benign and curable in nature, we suggest a more aggressive attitude toward this disease before proceeding to hormone ablation therapy. The role of preoperative localization in the management of such disease was also discussed.

Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies.

BACKGROUND: The results of studies identifying the risk factors for pneumothorax and bleeding in CT-guided coaxial lung needle biopsies were inconsistent and some were even contradictory. All reported series were small with patient populations averaging about 200. STUDY OBJECTIVES: To determine the risk factors for pneumothorax and bleeding after CT-guided coaxial cutting needle biopsy of lung lesions. DESIGN: Retrospective analysis. METHODS: We reviewed 660 biopsy procedures. The risk factors for pneumothorax and bleeding were determined by multivariate analysis of variables related to patient demographics, lung lesions, biopsy procedures, and the individual radiologist. RESULTS: The main complications were pneumothorax (23%; 155 of 660 procedures), chest tube insertion (1%; 9 of 660 procedures), and hemoptysis (4%; 26 of 660 procedures), with no patient mortality. The highest pneumothorax rate correlated with a lesion size of /= 2.1 cm, and the absence of pleural effusion. CONCLUSIONS: The risk factors for highest pneumothorax rate are lesion size /= 2.1 cm, and lung lesions not associated with a pleural effusion.

Primary adenocarcinoma arising in esophageal colon interposition: report of a case.

Colon interposition has become a favored technique for esophageal reconstruction. We report a 79-year-old man with primary adenocarcinoma arising in the interposed colon 30 years after esophageal reconstruction for esophageal cancer. The occurrence of a carcinoma in a colon removed from its natural location and serving a different function suggests this rise in incidence may result from the action of carcinogens on colonic cells over an increasing period.

Uterine artery embolization for symptomatic uterine leiomyoma and adenomyosis.

BACKGROUND AND PURPOSE: Uterine artery embolization (UAE) is increasingly accepted as an alternative treatment for symptomatic uterine leiomyoma and adenomyosis. The purpose of this study was to compare the outcomes of UAE in 3 diagnostic categories--submucosal leiomyoma, intramural leiomyoma, and adenomyosis--to assist in patient selection for this relative new form of therapy. METHODS: The medical records of 43 patients (aged 22 to 54 years) who underwent UAE for symptomatic uterine leiomyoma or adenomyosis were retrospectively reviewed. Magnetic resonance imaging (MRI) was used for categorization of the patients into the 3 diagnostic categories, and also for objective measurement of the uterine and leiomyoma size, and subsequent imaging follow-up. UAE was performed using polyvinyl alcohol particles. Symptom improvement and complications after treatment were evaluated at gynecologist clinics using monthly questionnaires. The group differences in complete symptom resolution, uterine and leiomyoma size reduction, incidence of complications, and subsequent surgeries were analyzed. RESULTS: The mean duration of follow-up was 10.9 months. Complete resolution of symptoms was achieved in 13 out of 16 patients with submucosal leiomyoma (81%), 3 out of 15 patients (20%) with intramural leiomyoma (p = 0.002) and 3 out of 12 patients (25%) with adenomyosis (p = 0.01). The average reduction of leiomyoma size in the submucosal and intramural groups was 56% and 29%, respectively (p = 0.02). None of the patients died. Severe complications occurred in 3 of 43 patients (7%), including permanent amenorrhea in 2 and pelvic actinomycosis in 1 patient. The incidence of complications (p = 0.17) and subsequent surgery (p = 0.67) did not differ significantly among the 3 groups. CONCLUSIONS: UAE is an effective treatment for patients with symptomatic leiomyoma or adenomyosis. In this study, patients with submucosal leiomyoma had the best treatment outcome.

Left internal jugular vein thrombosis due to a lung tumor.

Deep vein thrombosis is a common disease among Caucasians but is rare in Asia. Venous thrombosis may be fatal, for example by a pulmonary embolism and right or left atrial thrombosis. Alternatively, deep vein thrombosis may follow a benign pattern such as femoral and popliteal vein thrombosis. Theories abound regarding the causes of deep vein thrombosis, with the most common theories being long-term stasis and lack of exercise. Internal jugular vein thrombosis is a rare but potentially fatal disease with various causes. In the pre-antibiotics era, this disease was frequently associated with deep neck infection. Recently however, local trauma, central catheterization, and repeated intravenous injections with drugs have become the leading causes of thrombosis. Spontaneous internal jugular vein thrombosis may occur in connection with a neoplasm, termed Trousseau's syndrome. This investigation reports a case of lung cancer associated with internal jugular vein thrombosis.

The use of ultrasonography in preoperative localization of digital glomus tumors.

Small glomus tumors of the digits of the hand are difficult to excise and may be associated with relatively high rates of recurrence. This study was designed to prospectively evaluate the utility of preoperative ultrasound localization of such tumors to facilitate removal and to reduce recurrence rates. During a 5-year period, 34 patients clinically diagnosed with glomus tumors involving their digits were examined with high-resolution ultrasonography (5 to 9 MHz). Color duplex sonography was further applied if flow characteristics were identified. The ultrasound-predicted and actual intraoperative sizes were correlated and analyzed using the paired t test. Patients were followed for 1 to 6 years, and results were documented. Sonography showed a hypoechoic nodule with prominent vascularity between the nail body and the dorsal cortex of the distal phalanx in all subungual tumors. Complete resection was possible in all 35 glomus tumors, with assistance by accurate preoperative ultrasound localization. There was no long-term recurrence among the 29 patients available for evaluation 1 to 6 years postoperatively. Ultrasonography has great advantages in defining the exact location and size of the glomus tumor preoperatively. Prior knowledge of the exact site and size of the glomus tumor facilitates excision and appears to reduce rates of recurrence. The collaboration between hand surgeons and radiologists is useful to successfully treat glomus tumors of the digit.

Factors affecting diagnostic accuracy of CT-guided coaxial cutting needle lung biopsy: retrospective analysis of 631 procedures.

PURPOSE: To analyze variables affecting diagnostic accuracy of computed tomography (CT)-guided percutaneous coaxial cutting needle biopsy of lung lesions. MATERIALS AND METHODS: A retrospective analysis of factors affecting diagnostic accuracy of CT-guided percutaneous coaxial cutting needle lung biopsy was performed in 631 consecutive procedures with confirmed final diagnoses. Benign and malignant needle biopsy results were cross-examined with correct and incorrect final outcomes to determine diagnostic accuracy. Factors affecting diagnostic accuracy were determined by multivariate logistic regression analysis of variables thought to affect diagnostic accuracy. A P value less than 0.05 was interpreted as statistically significant. RESULTS: The overall diagnostic accuracy of CT-guided percutaneous coaxial cutting needle biopsy of lung lesions was 95% (95% CI: 92.7%-96.2%). Sensitivity was 93%, specificity 98%, negative predictive value 6%, positive predictive value 99%, false-positive rate 0.7%, and false-negative rate 15%. The factors affecting diagnostic accuracy were final diagnoses (benign, 86%; malignant, 99%; chi(2) test, P < 0.001) and lesion size (lesions <1.5 cm, 84%; lesions 1.5-5.0 cm, 96%; lesions >5 cm, 93%; chi(2) test, P = 0.06). CONCLUSION: Benign lung lesions, lung lesions smaller than 1.5 cm (which pose technical difficulty), and lung lesions larger than 5 cm (which are associated with a higher necrosis rate) affect diagnostic accuracy of CT-guided percutaneous coaxial cutting needle biopsy of lung lesions.

US-guided catheter drainage of postoperative head and neck fluid collections.

PURPOSE: To analyze results of percutaneous catheter drainage of large fluid collections in the head and neck region noted in the immediate postoperative period. MATERIALS AND METHODS: Thirty-four consecutive patients with 41 large fluid collections in the head and neck detected 7-10 days after oncologic surgery underwent percutaneous catheter drainage. There were 29 men and five women, with a mean age of 52.2 years (95% CI: 47.8-56.7). Each patient had a surgical drain placed in the posterior neck triangle; three patients had low-grade fever and six had diabetes at the time of percutaneous catheter drainage. Conventional management consisting of serial needle aspirations at bedside followed by pressure dressing failed in 15 of 34 patients (44%). Ultrasound-guided drainage was performed and catheters were connected to vacuum balls for continuous suction drainage. RESULTS: The average fluid volume estimated by sonographic measurement was 84 cm(3) (95% CI: 57-112 cm(3)). The fluid content was serosanguinous in 46% (19 of 41), uncoagulated blood in 32% (13 of 41), pus in 15% (six of 41), and saliva in 7% (three of 41). The mean duration of catheter drainage was nine days (95% CI: 7-10 d) and mean fluid drainage was 287 mL (95% CI: 188-387 mL). Ninety-one percent of patients (31 of 34) were successfully treated with initial catheter drainage. Three patients had recurrent fluid collections at the same locations: two were treated with repeated catheter insertions and one required a limited open drainage. No complication related to catheter drainage was noted at 6-month follow-up. CONCLUSION: Percutaneous catheter drainage is effective for large fluid collections in the head and neck region noted in the immediate postoperative period irrespective of contents.

Sonographically guided antegrade common femoral artery access.

OBJECTIVE: To evaluate the feasibility of sonographically guided antegrade common femoral artery puncture and superficial femoral artery access. METHODS: Fifty antegrade common femoral artery punctures and superficial femoral artery access procedures were performed under sonographic guidance alone in 30 consecutive patients (24 male and 6 female; mean age, 55.1 +/- 25.7 years; range, 13-85 years). The indications were (1) insertion of a vascular sheath for balloon angioplasty in 42 attempts (24 patients with lower leg ischemia) and (2) insertion of an angiographic catheter for 1-shot intra-arterial chemoinfusion therapy in 8 attempts (6 patients with distal femoral osteosarcomas). RESULTS: Technical success was achieved in 28 of 30 patients or 48 (96%) of 50 procedures (95% confidence interval, 80.39-98.32). The average procedure time +/- SD (excluding the failures) was 3 +/- 1 minutes (range, 2-6 minutes). In the 2 failures (2 [4%] of 50) in which common femoral artery punctures were accomplished, further superficial femoral artery cannulations were completed under fluoroscopic road map angiographic guidance. A small groin hematoma was noted in 1 patient. No arteriovenous fistula or pseudoaneurysm was encountered. CONCLUSIONS: Sonographically guided antegrade common femoral artery puncture and selective cannulation of the superficial femoral artery are feasible and safe. They may be used as adjunctive modalities in difficult cases of common femoral artery access.

Sonographic evaluation of mammographically detected microcalcifications without a mass prior to stereotactic core needle biopsy.

PURPOSE: The purpose of this prospective study was to evaluate the clinical usefulness of sonographically re-evaluating areas of microcalcification found mammographically before undertaking stereotactic core needle biopsy (SCNB). METHODS: Patients with nonpalpable breast lesions appearing as microcalcifications on mammograms and who had been referred to us for SCNB were re-evaluated sonographically before the procedure. None of the breast lesions had been associated with a density on the mammograms, and the initial sonographic evaluations had been negative. Using the mammograms for correlation, we meticulously re-evaluated the areas of microcalcifications sonographically using a high-frequency linear-array transducer. The sonographic and histopathologic results were then reviewed and correlated. The sonographic findings and visibility of the mammographically detected microcalcifications were analyzed by the 2-tailed Fisher's exact test and the chi-square test. RESULTS: Sixty-six patients, who had 68 cases of microcalcifications, were enrolled. Thirteen of the 66 patients underwent surgery, and 9 of the 13 were found to have breast carcinoma. In the sonographic re-evaluation before SCNB in these 9 patients, an associated soft tissue mass was demonstrated in 5 patients but not in the other 4. Sonographic re-evaluation also revealed abnormalities in 24 of 68 cases (35.3%), in contrast to the negative findings on the initial sonography. Using the chi-square test to identify a trend, we found that the percentage of cases that were sonographically visible was highest for clustered benign microcalcifications and lowest for segmental benign microcalcifications (p < 0.0001). CONCLUSIONS: In breast lesions that appear as microcalcifications without an associated mass on mammograms, pre-SCNB sonographic re-evaluation with a high-frequency transducer can depict microcalcifications, particularly the clustered ones, and can detect small associated masses. Although the absence of a sonographically detectable mass in areas of mammographically detected microcalcifications does not guarantee the absence of cancer, the presence of an associated mass on sonography should warrant close follow-up in the case of negative results to avoid a delay in the diagnosis of breast carcinoma.