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ABSTRACT: PURPOSE: To evaluate the menstrual cycle and breast composition influence on background parenchymal enhancement of breast magnetic resonance imaging (MRI) and to investigate the optimal time for breast MR examinations. MATERIALS AND METHODS: We evaluated the dynamic contrast-enhanced breast MR images of 238 women who had completed a questionnaire survey about menstrual status. On MRI, the degree of enhancement (DE) of normal parenchyma was measured in the images 2 minutes and 6 minutes after contrast injection. A comparison between premenopausal and postmenopausal women and a separate comparison between dense breasts and fatty breasts were analyzed according to the premenopausal women's menstrual cycle. RESULTS: Premenopausal women showed significantly higher DE than the postmenopausal women (P < 0.001). In premenopausal women, overall DE of fatty breasts and dense breasts was not different. However, fatty breasts showed the highest DE in the 4th week and lowest DE in the 2nd week, while dense breasts showed the highest DE in the 3rd week and the lowest DE in the 4th week of menstrual cycle. CONCLUSION: The influence of menstrual cycle on the enhancement of breast parenchyma is different according to the breast composition. The optimal time for breast MRI could be different for dense and fatty breasts. J. Magn. Reson. Imaging 2013. © 2013 Wiley Periodicals, Inc.
Journal of Magnetic Resonance Imaging 04/2013; · 2.70 Impact Factor
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ABSTRACT: Background
Morphologic and kinetic characteristics of breast lesions are regarded as a major criterion for their differential diagnosis in dynamic magnetic resonance imaging (MRI). However, there have not been well-reported MRI findings of microinvasive ductal carcinoma.PurposeTo evaluate MRI characteristics of microinvasive ductal carcinoma of the breast and to compare MRI findings in patients with microinvasive ductal carcinoma and pure ductal carcinoma in situ (DCIS).Material and Methods
Eighty-one patients with pathologically confirmed microinvasive ductal carcinomas (n = 37) or pure DCIS (n = 44) were included in this study. The MRI findings were analyzed without knowledge of the pathologic and conventional imaging findings. For all the lesions detected on MRI, morphologic and kinetic analyses were performed according to the Breast Imaging Reporting and Data System. For the non-mass lesions, the presence of clustered ring enhancement was also analyzed. Statistical analyses were performed using Student's t test, χ(2) test, and Fisher's exact test.ResultsIn total 35 cases of microinvasive ductal carcinoma and 39 cases of DCIS were detected on MRI. The most common and dominant MRI findings of microinvasive ductal carcinoma and DCIS were non-mass lesions with heterogeneous enhancement. However, the spiculated margin of the mass-type lesion (P = 0.022), the segmental distribution (P = 0.023), and clustered ring enhancement (P = 0.006) of the non-mass-type lesion, and the enhancement kinetics showing strong initial enhancement (P = 0.004) with subsequent wash-out (P = 0.001) were significantly more frequent in microinvasive ductal carcinoma than in DCIS.Conclusion
Non-mass lesions with segmental distribution, heterogeneous enhancement, and strong initial enhancement with a wash-out curve were the dominant MRI findings of microinvasive ductal carcinoma. Compared with DCIS, microinvasive ductal carcinoma showed more suspicious imaging characteristics. For the non-mass lesions, clustered ring enhancement was also a characteristic finding of microinvasion on MRI.
Acta Radiologica 04/2013; · 1.37 Impact Factor
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Eun Sook Ko, Boo-Kyung Han,
Rock Bum Kim,
Eun Young Ko,
Jung Hee Shin,
Sang Yu Nam,
Meeyoung Nam,
Seok Jin Nam,
Jeong Eon Lee,
Won Ho Kil,
Se-Kyung Lee
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ABSTRACT: BACKGROUND: It remains uncertain whether MRI identification of additional foci of disease leads to improved outcome. We undertook a study to evaluate the influence of breast MRI on early and long-term outcome. METHODS: Among 1,271 patients undergone breast cancer surgery between January 2005 and December 2006, 785 patients were attempted for BCS. Operative approach and radiologic findings were compared according to MRI use. We reselected 615 patients with unilateral early-stage breast cancer treated with BCS including RT. We compared the histopathologic characteristics and outcomes according to MRI use. RESULTS: In patients attempted for BCS (n = 785), re-excision rates were not significantly different according to MRI use (P = 1.000). Conversion to mastectomy or bilateral cancer surgery were higher in MRI group (P = 0.002). The IBTR rate was higher in the non-MRI group (P = 0.020). Difference in contralateral cancer rate and total recurrence rates failed to reach statistical significance (P = 0.168, 0.383, respectively). Multivariate study after adjustment showed no difference in recurrence rates and IBTR rates between the two groups (hazard ratios 1.34, 6.37 Ps = 0.385, 0.076). CONCLUSION: Use of MRI in patients with early-stage breast cancer did not result in improvement of a patient's outcome. J. Surg. Oncol © 2013 Wiley Periodicals, Inc.
Journal of Surgical Oncology 03/2013; · 2.10 Impact Factor
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Eun Sook Ko, Boo-Kyung Han,
Rock Bum Kim,
Eun Young Ko,
Jung Hee Shin,
Soo Yeon Hahn,
Seok Jin Nam,
Jeong Eon Lee,
Se Kyung Lee,
Young-Hyuck Im,
Yeon Hee Park
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ABSTRACT: PURPOSE: The purpose of this study was to evaluate the accuracy of breast magnetic resonance imaging (MRI) to predict residual lesion size after neoadjuvant chemotherapy (NAC) and to determine the factors that influence the accuracy of response prediction. METHODS: This study comprised 166 patients who underwent MRI before and after NAC, but before surgery. The longest diameter of the residual cancer was measured using MRI and correlated with pathologic findings. Patients were further divided into subgroups according to various radiologic and histopathologic factors. Pathologic complete response (pCR) was defined as the absence of residual invasive cancer cells. The Pearson correlation was used to correlate tumor size as determined by MRI and pathology, and the Mann-Whitney U test and Kruskal-Wallis test were used to compare MRI-pathologic size discrepancies according to various clinical, histopathologic factors, and MRI findings. RESULTS: Of the 166 women, 40 achieved pCR. The overall sensitivity, specificity, and accuracy for diagnosing invasive residual disease by using MRI were 96, 65, and 89 %, respectively. The Pearson's correlation coefficient between the tumor sizes measured using MRI and pathology was 0.749 (P < 0.001). The size discrepancy was significantly greater in patients with estrogen receptor-positive cancer (P = 0.037), in cancers with low nuclear grade (P = 0.007), and in cancers shown as diffuse non-mass-like enhancement on MRI (P = 0.001). CONCLUSIONS: Size prediction is less accurate in cases with estrogen receptor-positive breast cancer, low nuclear grade, and diffuse non-mass-like enhancement on initial MRI.
Annals of Surgical Oncology 03/2013; · 4.17 Impact Factor
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ABSTRACT: Background:Although ultrasound (US) features of papillary thyroid carcinoma (PTC) are well established, little is known regarding biological behavior according US features. We investigated whether there was a difference in biological behavior between PTCs that did and did not meet malignant US criteria.Patients and Methods:We retrospectively reviewed clinical records and histological and US findings of the index tumors in 488 patients who underwent surgery for PTC. Benign-looking PTC (B-PTC) was defined as showing none of the accepted US criteria for malignancy. Malignant-looking PTCs (M-PTCs) and B-PTCs were compared in terms of patients' age, sex, tumor size, histological subtype, multifocality, lymph node (LN) metastasis, extrathyroidal extension, stage, recurrence, and distant metastasis.Results:B-PTCs accounted for 74 (15%) of all 488 PTCs. Mean tumor size was not significantly different between the groups, with 1.10 cm for M-PTC and 1.11 cm for B-PTC (P = .947). Univariate and multivariate analysis indicated that M-PTC more frequently had LN metastasis, extrathyroidal extension, and a higher stage than B-PTC (all P < .05). The results were significant in tumors ≥1.0 cm, whereas there were no significant differences in tumors <1 cm. As the number of malignant US features increased, multifocality, extrathyroidal extension, LN metastasis, and a higher stage were more likely.Conclusion:PTCs that did not meet malignant US criteria had better prognostic indicators than PTCs that met US criteria. Therefore, US features at the time of diagnosis can serve as a useful tool for predicting biological behavior in PTC.
The Journal of clinical endocrinology and metabolism 03/2013; · 6.50 Impact Factor
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ABSTRACT: To compare the diagnostic performance of new and established full-field digital mammography (FFDM) systems.
During a 15-month period, 1038 asymptomatic women who visited for mammography were prospectively included from two institutions. For women with routine two-view mammograms from established FFDM systems, bilateral mediolateral oblique (MLO) mammograms were repeated using the new FFDM system. One of the four reviewers evaluated two-sets of bilateral MLO mammograms at 4-week intervals by using a five-point score for the probability of malignancy according to a Breast Imaging Reporting and Data System. The lesion type and breast density were determined by the consensus of two readers at each institution. The dichotomized mammographic results correlated with a final pathologic outcome and follow-up data. Receiver operating characteristic (ROC) curves, sensitivity, and specificity were compared in general and according to the lesion type and breast density.
Of the 1038 cases, 193 (18.6%) had cancer. The areas under the ROC curve (AUC), sensitivity, and specificity of the established system were 0.815, 65.3%, and 90.2%, respectively. Those of the new system were 0.839, 68.4%, and 91.7%, respectively. There were no significant differences in the AUCs, sensitivities or the specificities in general between new and established systems (Ps = 0.194, 0.590, 0.322, respectively). We found no significant difference in these parameters according to lesion type or breast density.
The new FFDM system has a comparable diagnostic performance with established systems.
Korean journal of radiology: official journal of the Korean Radiological Society 01/2013; 14(2):164-170. · 1.32 Impact Factor
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ABSTRACT: Background: The cribriform-morular variant of papillary thyroid carcinoma (cmvPTC) is rare. There are few if any studies of the ultrasonographic (US) features of cmvPTC. The aim of this study was to determine the characteristic US and clinical features of the cmvPTC. Methods: A retrospective review of the US and clinical features was performed on 18 surgically confirmed cmvPTCs in five patients who were seen at our institution between January 2000 and December 2010. Results: All patients were female with a mean age of 28 years (range, 19-46 years). Two patients presented with palpable lesions, and the other patients were incidentally detected during screening US. At US, the majority of nodules had well-defined, oval to round shapes, and were hypoechoic and solid without calcifications. However, 6 (33.3%) of 18 nodules did have a cystic change. The size of the lesions varied from 0.3 to 3.0 cm (mean, 1.11 cm). None of the nodules were diagnosed as malignant based on the US criteria, but all except one patient had cytology of their thyroid nodules that were read as malignant, without revealing the subtype of their PTC. Two of the five patients had familial adenomatous polyposis (FAP), and they had bilateral multiple nodules. No metastatic lymph nodes or extrathyroidal extension were identified. To date, none of the patients has had recurrence or metastasis during their mean follow-up of 25 months after thyroidectomy. Conclusion: It appears that most cases of cmvPTC do not have features of malignancy on US and are indolent tumors as far as their clinical and histological features are concerned.
Thyroid: official journal of the American Thyroid Association 08/2012; · 2.60 Impact Factor
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ABSTRACT: The aim of this study was to evaluate whether pleomorphic invasive lobular carcinoma (PILC) is different from classic invasive lobular carcinoma (CILC) in terms of radiologic and clinicopathologic features. We compared the radiologic and clinicopathologic features of 22 surgically confirmed PILCs in 21 patients from 2004 to 2009 and 47 CILCs from 47 consecutive patients. For all cases, we reviewed the imaging findings, medical records and pathological results. PILC had a higher T stage, N stage, nuclear and histologic grade compared to CILC. PILC was more commonly negative for estrogen receptors and positive for HER2 than CILC (all p < 0.05). However, there were no significant differences in age, symptoms, tumor size, extensive intraductal component, lymphovascular invasion, triple negative profile, or multiplicity between the two groups. PILC was not detected on mammography in 1 (4.5%) of 22 cases, whereas CILC was not detected on mammography in 7 (14.9%) of 47 cases and on MRI in 2 (5.0%) of 40 (p = 0.42 and p = 1.000, respectively). MRI identified more frequent multiplicity than mammography for both PILC and CILC (p < 0.001), but was similar to US (p = 0.066). Most lesions showed a spiculated mass or architectural distortion with or without calcifications on mammography and ultrasound. No differences in mass and/or non-mass lesions or kinetics on MRI were observed between the two groups. PILC shows more pathologically aggressive features, but cannot be differentiated from CILC based on imaging findings.
Breast (Edinburgh, Scotland) 08/2012; · 2.09 Impact Factor
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ABSTRACT: Our aim was to determine whether sonographically guided radiofrequency ablation with superficial saline injection can minimize thermal injury of the skin without an influence on therapeutic efficacy.
Institutional Animal Care Committee approval was obtained. Twelve percutaneous radiofrequency ablation procedures were performed in the thighs of 6 rabbits (control, n = 6, right thigh; experimental, n = 6, left thigh). The ablation with local anesthesia was performed in the most superficial area of the thigh muscle. In the experimental group, 1 mL of saline was injected before the ablation at the tissue layer between the skin and ablated muscle. The duration and energy of the ablation were the same in the control and experimental groups. Rabbits were compared for their gross skin state and histopathologic findings after the ablation.
The degree of thermal coagulation of the muscle was similar in both groups at pathologic examination. Grossly, skin redness was mild in the experimental group but moderate in the control group. Of the 6 rabbits, 5 tended to show more frequent histopathologic changes, including an inflammatory reaction, interruption of collagen fibers, injury of the skin adnexa, and fibrosis, in the control group when compared with the experimental group. However, there was no statistically significant difference (all P> .05). One rabbit that underwent ablation at higher energy had a partially dissected epidermis in the control group only.
Sonographically guided radiofrequency ablation with a saline injection superficial to a tumor might prevent skin burns and provide equivalent therapeutic efficacy for ablating superficial lesions.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2012; 31(6):873-8. · 1.25 Impact Factor
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ABSTRACT: Background: The cribriform-morular variant of papillary thyroid carcinoma (cmvPTC) is rare. There are few if any studies of the ultrasonographic (US) features of cmvPTC. The aim of this study was to determine the characteristic US and clinical features of the cmvPTC. Methods: A retrospective review of the US and clinical features was performed on 18 surgically confirmed cmvPTCs in 5 patients who were seen at our institution between January 2000 and December 2010. Results: All patients were female with a mean age of 28 years (range, 19-46 years). Two patients presented with palpable lesions and the other patients were incidentally detected during screening US. At US, the majority of nodules had well-defined, oval to round shapes and were hypoechoic and solid nodule without calcifications. However, 6 (33.3%) of 18 nodules did have cystic change. The size of the lesions varied from 0.3 to 3.0 cm (mean, 1.11 cm). None of the nodules were diagnosed as malignant based on US criteria but all except one patient had cytology of their thyroid nodules that were read as malignant, without revealing the subtype of their PTC. Two of the 5 patients had familial adenomatous polyposis (FAP) and they had bilateral multiple nodules. No metastatic lymph nodes or extrathyroidal extension were identified. To date, none of the patients has had recurrence or metastasis during their mean follow-up of 25 months after thyroidectomy. Conclusion: It appears that most cases of cmvPTC do not have features of malignancy on US and are indolent tumors as far as their clinical and histological features are concerned.
Thyroid: official journal of the American Thyroid Association 05/2012; · 2.60 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the diagnostic contribution of BRAF(V600E) mutation analysis from the fine-needle aspiration (FNA) specimens of calcified thyroid nodules.
From January 2008 to December 2008, 139 patients with 139 calcified thyroid nodules prospectively underwent BRAF(V600E) mutation analysis and ultrasound-guided FNA. At ultrasound, the patterns of calcification were classified into microcalcification, macrocalcification, and rim calcification. The performance of FNA alone then FNA plus BRAF(V600E) mutation analysis for the diagnosis of calcified thyroid nodules was compared on the basis of surgery, repeated FNA, or imaging follow-up for at least 1 year.
Of 139 calcified nodules, 92 (66%) malignancies were detected, which included 91 papillary thyroid carcinomas and one follicular thyroid carcinoma. The malignant rates based on calcification type were 80% (63 of 79) for microcalcifications, 59% (19 of 32) for macrocalcifications, and 36% (10 of 28) for rim calcifications. The BRAF(V600E) mutation was identified in 50% of all nodules and in five (25%) of 20 nodules with indeterminate or nondiagnostic cytology. Adding BRAF(V600E) mutation analysis to FNA compared with FNA alone improved the negative predictive value of 83.9 to 92.2% (p = 0.034) but not the sensitivity, specificity, positive predictive value, and accuracy.
The BRAF(V600E) mutation analysis from FNA specimens for calcified thyroid nodules may be performed for a greater negative predictive value and unveil the malignancy in 25% of indeterminate or nondiagnostic cytology.
American Journal of Roentgenology 04/2012; 198(4):891-5. · 2.78 Impact Factor
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ABSTRACT: The purpose of this study was to correlate the clinicoradiologic and pathologic features of thyroid lymphoma and to identify the most useful diagnostic method for thyroid lymphoma as the first line.
Our study population included 16 patients with a diagnosis of thyroid lymphoma by fine-needle aspiration, core biopsy, or surgery from 1995 to 2010. We retrospectively reviewed imaging and medical records. Sonographic findings were correlated with histopathologic results.
Of the 16 patients, primary lymphomas were found in 13 and secondary in 3. The mean ages of the patients with primary and secondary lymphomas were 60.8 and 42.7 years, respectively. Most patients with primary lymphomas had symptoms of rapid neck swelling or a mass sensation. All primary lymphomas revealed non-Hodgkin B-cell lymphoma, and secondary lymphomas included a B-cell origin in 2 and a T-cell origin in 1. On sonography, 10 (77%) of 13 primary lymphomas showed diffuse heterogeneous hypoechoic parenchyma with intervening echogenic septa-like structures, whereas all secondary lymphomas showed markedly hypoechoic nodules. Markedly hypoechoic parenchyma was correlated with lymphoepithelial lesions and neoplastic cells, whereas the intervening echogenic septa-like structures were consistent with fibrosis on pathologic examination. The exact diagnosis of thyroid lymphoma was possible with core biopsy in all 9 cases (100%) but with fine-needle aspiration in only 3 of 10 (30%), which included 7 under sonographic guidance and 3 under palpation (P = .0030).
Diffuse hypoechoic parenchyma with intervening echogenic septa on sonography under the impression of a primary thyroid lymphoma, particularly in the setting of a rapidly enlarging mass, should prompt core biopsy rather than fine-needle aspiration.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 04/2012; 31(4):589-94. · 1.25 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the frequency and appearance of changes in the breast on sonography in patients after breast cancer surgery including sentinel lymph node localization using methylene blue dye.
Three hundred thirty-seven consecutive patients who underwent breast-conserving surgery in 2006 underwent breast sonography during 2 years after surgery. Sentinel lymph node localization using methylene blue dye was selectively performed. We retrospectively analyzed the unexplained focal lesions not at the lumpectomy site on sonography and investigated whether these findings were associated with sentinel lymph node localization.
Unexplained focal lesions were identified in 36 (14.1%) of 256 patients who had undergone sentinel lymph node localization. The lesions were in the periareolar region (n = 26; outer in 16, upper in 6, inner in 2, and lower in 2) or the retroareolar region (n = 10). The lesion appeared with a fat necrosis-like pattern in the subcutaneous fat layer in 24 (66.7%) or as an irregular mass in the glandular layer in 12 (33.3%). The unexplained focal lesions were pathologically proven benign (n = 10) or were improved or stable during 2 years of imaging follow-up after surgery (n = 26). The unexplained focal lesions in 2 (2.5%) of 81 patients without sentinel lymph node localization were in the nonareolar region, and 1 of these was a recurrence.
After sentinel lymph node localization using methylene blue dye, breast sonography can show unexplained focal lesions in the periareolar and retroareolar regions. Although most of the changes suggest fat necrosis, an irregular parenchymal mass can develop and mimic a recurrence.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2011; 30(12):1711-21. · 1.25 Impact Factor
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ABSTRACT: To determine the role of radiofrequency ablation (RFA) in patients with inoperable symptomatic recurrent thyroid cancers.
Eleven patients with 16 symptomatic recurrent thyroid cancers but ineligible for surgery were prospectively enrolled and underwent ultrasound-guided RFA with local anesthesia in 16 sessions. The mean tumor volume and diameter were 9 ml (range 0.1-34 ml) and 2.9 cm (range 0.7-4.8 cm), respectively. Patients had dysphagia, hoarseness, dyspnea, or a protruding mass due to recurrent tumors. Tumor volume was calculated from follow-up ultrasound, and symptoms were assessed after RFA.
Of 16 sessions, tumor ablation was complete in 6, incomplete in 9, and failed in 1. Incomplete or failed ablation was due to intolerable pain, severe calcified lesion, or tumor encasement of major vessels. Of 15 treated lesions, 13 decreased in volume. Regrowth of treated tumors was observed in 2 lesions. The mean volume reduction was 50.9% (range -9.4 to 96.8%). There were gains for symptom relief for 7 patients (63.6%) with protruding masses (n = 6) and discomfort due to tracheal compression (n = 1). The mean follow-up was 6 months (1-14 months). There were no major complications except a patient with skin burn.
RFA is feasible and safe, and can improve symptoms in the short term.
Annals of Surgical Oncology 02/2011; 18(9):2564-8. · 4.17 Impact Factor
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ABSTRACT: Management of suspicious microcalcifications in very thin breasts is problematic.
To evaluate whether sonographically-guided vacuum-assisted biopsy (USVAB) with digital mammography-guided skin marking (DM) for the diagnosis of breast microcalcifications is comparable to stereotactic-guided vacuum-assisted biopsy (SVAB) in Asian women with thin breasts.
Retrospective review was performed for 263 consecutive suspicious microcalcification lesions in 261 women who underwent USVAB with DM or SVAB using a prone table between January 2004 and December 2007. SVAB was performed for 190 lesions and USVAB for 73 lesions. Biopsy results were correlated with surgical pathology or followed up for at least 12 months. The diagnostic outcomes of SVAB and USVAB to diagnose microcalcifications were compared.
Of 263 lesions, 104 (40%) underwent surgery and 159 (60%) were followed up. SVAB and USVAB groups showed similar final categories or the extent of microcalcifications. US visible lesions were 57 (78%) of 73 at USVAB and 14 (10%) of 140 at SVAB. Of 57 US visible lesions at USVAB, 29 (51%) were not found in initial US but were detectable with the help of DM. Specimen radiographs were negative in 2.1% of lesions at SVAB and in 4.1% at USVAB (p=0.4008). The under-estimation rate and false-negative rate were similar in SVAB and USVAB.
US with DM facilitates US visibility of microcalcifications. USVAB with DM can produce acceptable biopsy results, as can SVAB, to diagnose breast microcalcifications in patients with thin breasts.
Acta Radiologica 02/2011; 52(1):29-34. · 1.37 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2010; 29(12):1833-6. · 1.25 Impact Factor
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ABSTRACT: Hyalinizing trabecular tumors of the thyroid (HTT) is a rare entity. Most behave as benign neoplasms, but their cytological features are challenging and can be similar to those of papillary thyroid carcinoma (PTC). The aim of this study was to compare the ultrasonography (US) readings of HTT with the cytology and frozen section readings.
We retrospectively analyzed the US and cytology features in 10 patients (mean age, 47.5 years, range 26-81; M:F, 1:9) seen between March 2006 and November 2009 who had a histopathological diagnosis of HTT. The US findings were categorized according to the size, shape, margin, echogenicity, echotexture, presence of hypoechoic halo, and microcalcifications. Preoperative fine-needle aspiration cytology, frozen section results, and surgical treatment were reviewed. US features of HTT were compared with those of other tumors including follicular adenomas, follicular variant of PTCs, and conventional PTC.
Out of the 10 patients in our series, 7 underwent total thyroidectomy, and 3 had lobectomy. The sizes of the HTTs ranged from 0.6 to 4.2 cm (mean, 1.77 cm). The most common US features were solid texture (10/10), oval to round shape (10/10), a well-defined aspect (10/10), hypoechoic character (8/10), heterogeneous character (7/10), the presence of a hypoechoic halo (8/10), and no microcalcifications (10/10). The US diagnosis was indeterminate in all but one case and that was read as a benign lesion. As far as the shape and margin US features were concerned, HTT was considered to be most similar to follicular adenomas and follicular variant of PTC, but not to classical PTC. The cytology reading was PTC in 6 of 10 cases, suspicious for PTC in 2, and a HTT versus PTC in 2. The histological diagnosis of frozen sections, when performed, was PTC in three, HTT in three, medullary thyroid carcinoma in two, and deferred in one.
HTT often appears similar to follicular neoplasm on US, but it can be misjudged on cytology as PTC, even in frozen sections. HTT should be included in the list of discordant US-cytology readings of thyroid tumors. This rare tumor might be suspected more often preoperatively by careful attention to cytology in the context of the US reading.
Thyroid: official journal of the American Thyroid Association 12/2010; 21(3):253-9. · 2.60 Impact Factor
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ABSTRACT: Supplemental screening ultrasonography (US) in addition to mammography can help detect early breast cancers in women with dense breasts and other risk factors. It is crucial to understand the imaging features of US-detected cancer to identify them in screening population.
To retrospectively evaluate the US features and final assessments of breast cancers detected by supplemental screening US in comparison with cancers seen on screening mammography.
The study included 80 women (mean age 46 years, range 31–65 years) with 80 breast cancers detected by supplemental screening US. Another 80 women (mean age 52 years, range 33–77 years) with 80 breast cancers seen on screening mammography were included for a control group. US features and final assessments were classified according to the Breast Imaging Reporting and Data System (BI-RADS) without knowledge of the method of detection, or mammographic or histologic findings. Results of the two groups were compared.
Breast cancers detected by supplemental screening US were more frequently found to have the following features: an oval shape (21% [17/80] vs 10% [8/80], P = 0.013), a circumscribed margin (13% [10/80] vs 4% [3/80], P = 0.043), an abrupt interface (79% [63/80] vs 53% [42/80], P < 0.001), and no posterior acoustic (70% [56/80] vs 53% [42/80], P = 0.023) or surrounding tissue (79% [63/80] vs 28% [22/80], P < 0.001) changes. For the final assessment, 93% (74/80) of US-detected cancers and 60% (48/80) of cancers seen on mammography were classified as a category 4, while 3% (2/80) of US-detected cancers and 38% (30/80) of cancers seen on mammography were category 5.
Compared with breast cancers seen on screening mammography, breast cancers detected by supplemental screening US tend to have less malignant US features, although most (95%) of them were classified as category 4 or 5.
Acta Radiologica 11/2010; 51(9):969-76. · 1.37 Impact Factor
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ABSTRACT: The recent American Thyroid Association management guidelines suggest cervical ultrasonography (US) surveillance in patients with differentiated thyroid cancer (DTC). This study was conducted to identify predictive factors that can determine whether subsequent fine needle aspiration guided by ultrasound (US-FNA) is indicated in patients with lesions detected by US after surgery for DTC.
Retrospective analysis at a university-based tertiary hospital.
We reviewed 207 cases of postoperative US-FNA in 180 patients diagnosed with DTC. We examined the relationship between US-FNA histology and clinical factors, imaging abnormalities found by US and with other modalities and pathological staging.
US-FNA recurrence was positive in 56 (27%) cases and negative in 151 (73%) cases. The mean lesion size for FNA was 0·83 cm (range 0·2-2·9 cm). Univariate analysis indicated that tumour recurrence on US-FNA is associated with elevated stimulated thyroglobulin (sTg) levels, with the initial size of the primary tumour, with abnormal US findings, including the ipsilateral site, level III or IV location and extrathyroidal extension, and with other imaging abnormalities. However, multivariate analysis revealed an independent association between recurrence on FNA and suspicious US findings (OR 9·410; 95% CI 3·322-26·654; P<0·001) and elevated serum sTg (OR 5·001; 95% CI 1·067-23·485; P =0·041). Findings on US that were discriminating for recurrent nodules at the thyroidectomy site were abnormalities that were not oval shape or which had an irregular margin. Calcifications or cystic change showed a low sensitivity of 14%.
US-FNA for diagnosis of recurrence after surgery for DTC may be limited to patients with elevated sTg or with lesions that have specific suspicious US findings.
Clinical Endocrinology 11/2010; 74(2):270-5. · 3.17 Impact Factor
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ABSTRACT: The purpose of our study was to provide sonographic findings of cystic nodules, which can mimic malignancies, after fine-needle aspiration (FNA) and to determine the differential points from malignancies.
We retrospectively reviewed the sonographic findings of 33 lesions in 32 patients who had FNA for predominantly cystic nodules or cysts and showed suspicious findings during sonographic follow-up, as well as findings of 47 surgically confirmed papillary thyroid carcinomas (PTCs) in 45 consecutive patients. We evaluated the size, shape, presence of shadowing and a halo, margin, echogenicity, and presence of echogenic dots for each nodule. The final diagnosis of cystic nodules was confirmed by FNA, surgery, or follow-up sonography.
Of the 33 cystic lesions, 31 (94%) were adequate with benign results, and 2 (6%) were inadequate specimens at the initial FNA. There were no malignancies in the cystic nodules at follow-up. The average interval between the initial FNA and suspicious sonographic findings was 26 months (range, 1-92 months). The average size of the suspicious nodules was 0.8 cm (range, 0.3-1.8 cm). Cystic nodules after aspiration were similar to PTCs in their sonographic findings, but the former frequently showed shadowing and a halo (85% versus 21%; P < .0001). With further follow-up, 29 lesions (88%) showed additional decreases in size.
Benign cystic nodules after aspiration can have suspicious malignant features. However, shadowing and a halo associated with malignant features are characteristic findings of cystic nodule shrinkage. Awareness of these findings and correlation with the FNA history can aid in preventing unnecessary FNA.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2010; 29(10):1415-21. · 1.25 Impact Factor
