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Patel R, Shames A, Sarkodieh J. Ultrasound features of benign paediatric lumps: radiology-pathology correlation. Clin Radiol 2024; 79:255-262. [PMID: 38320943 DOI: 10.1016/j.crad.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 02/08/2024]
Abstract
Ultrasonography is an appropriate first-line imaging technique for the characterisation of paediatric lumps, given its relative accessibility and absence of radiation exposure. Together with a thorough history and examination, ultrasonography can help to distinguish benign lesions from malignancy. It can also aid further characterisation of benign lesions to inform onward investigation and management. This review features the evaluation of common benign paediatric lumps together with their characteristic sonographic features, following correlation with histopathology results or clinical follow-up.
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Affiliation(s)
- R Patel
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK.
| | - A Shames
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK
| | - J Sarkodieh
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK
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Miao Y, Ren W, Yang F, Li L, Wu L, Dan Shan D, Chen Z, Wang L, Wang Q, Guo L. Diagnostic value of high-frequency ultrasound (HFUS) in evaluation of subcutaneous lesions. Skin Res Technol 2023; 29:e13464. [PMID: 37753674 PMCID: PMC10493336 DOI: 10.1111/srt.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND It is unknown whether high-frequency ultrasound (HFUS) can evaluate invisible subcutaneous lesions. We aimed to investigate the diagnostic value of HFUS in invisible subcutaneous lesions. METHOD Patients with invisible subcutaneous lesions were prospectively recruited from two centres. Before undergoing biopsy or surgery, each lesion was independently evaluated by two clinicians. One provides a clinical diagnosis by only clinical examination and the other provides an integrated diagnosis by combining clinical examination and HFUS information. Diagnoses were classified as correct, wrong, and indeterminate. A total of 391 lesions from 355 patients were enrolled, including 225 epidermoid cysts, 77 lipomas, 25 pilomatrixomas, 21 haemangiomas, 19 dermatofibromas, 11 dermatofibrosarcoma protuberans (DFSP), 7 neurofibromas, and 6 leiomyomas. Using pathological results as the gold standard, diagnostic performance was compared. RESULTS The number of correct diagnoses increased from 185 (47.3%) by clinical examination alone to 316 (80.8%) after the addition of HFUS (P < 0.05). Meanwhile, the indeterminate diagnosis rate decreased from 143 (36.6%) to 10 (2.6%). Using HFUS, the accuracy improved significantly for epidermoid cysts (59.6% vs. 86.7%), lipomas (50.6% vs. 94.8%), pilomatrixomas (0% vs. 48.0%), haemangiomas (23.8% vs. 57.1%), and DFSPs (0% vs. 81.8%) (all p < 0.05). However, HFUS did not significantly improve the diagnostic accuracy of dermatofibromas (15.8% vs. 21.1%, p > 0.999), neurofibromas (42.9% vs. 71.4%, p = 0.625), or leiomyomas (16.7% vs. 100%, p = 0.063). CONCLUSION Combining HFUS and clinical examination can generally improve the diagnostic accuracy and decrease the indeterminacy of invisible subcutaneous lesions, especially epidermoid cysts, lipomas, pilomatrixomas, haemangiomas, and DFSPs. However, for some rare lesions, HFUS cannot provide useful information.
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Affiliation(s)
- Yao Miao
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
- Department of Medical UltrasoundShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Wei‐Wei Ren
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
- Department of Medical UltrasoundShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Fei‐Yue Yang
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
| | - Liang Li
- Department of Dermatological SurgeryShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Ling Wu
- Department of Dermatological SurgeryShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Dan‐ Dan Shan
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
- Department of Medical UltrasoundShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Zi‐Tong Chen
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
- Department of Medical UltrasoundShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Li‐Fan Wang
- Department of UltrasoundZhongshan HospitalFudan UniversityShanghaiChina
| | - Qiao Wang
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
- Department of Medical UltrasoundShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Le‐Hang Guo
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
- Department of Medical UltrasoundShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
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Jin Z, Zhao K, Guo W, Wang D, Deng Y, Chen T. Investigation of Ultrasound Parameters for the Differential Diagnosis of Malignant and Benign Peripheral Nerve Sheath Tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3091-3101. [PMID: 36082840 DOI: 10.1002/jum.16089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/05/2022] [Accepted: 07/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The objectives were to identify the key features of malignant and benign peripheral nerve sheath tumors (PNSTs) and determine a strategy for differentiating them using sonography. METHODS Forty-six malignant peripheral nerve sheath tumors (MPNSTs) and 83 benign peripheral nerve sheath tumors (BPNSTs) confirmed by pathology from April 2010 to July 2021 were included. The general data and grayscale and color Doppler ultrasonic manifestations were compared between the two groups. We used single factor, multifactor, and area under the receiver operating characteristic (ROC) curve analyses to extract significant malignant risk factors and then established a scoring system with these factors. RESULTS The significant variables identified in univariate analysis (P < .05) were maximum diameter, location, shape, boundary, encapsulation, echogenicity, texture pattern, calcification, entering or exiting nerve, and vascularity. Shape, boundary and vascularity were significant risk factors, and a scoring system was established. The area under the ROC curve (0.925) confirmed the usefulness of the scoring system for differentiating MPNSTs and BPNSTs. CONCLUSIONS Ultrasonography is an effective method for differentiating MPNSTs from BPNSTs.
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Affiliation(s)
- Zhenzhen Jin
- Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, China
| | - Kaiping Zhao
- Department of Medical Record Management and Statistics, Beijing Jishuitan Hospital, Beijing, China
| | - Wen Guo
- Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, China
| | - Dandan Wang
- Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, China
| | - Yukun Deng
- Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, China
| | - Tao Chen
- Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, China
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Sechi A, Patrizi A, Vara G, Golfieri R, Neri I. Bei CALME (childhood asymmetry labium majus enlargement): die Ruhe bewahren und nachverfolgen. J Dtsch Dermatol Ges 2021; 19:1276-1282. [PMID: 34541793 DOI: 10.1111/ddg.14528_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Abstract
CALME steht für childhood asymmetry labium majus enlargement und bezeichnet eine physiologische, nichtneoplastische Schwellung des Weichteilgewebes der Labia majora. CALME wird durch die Vergrößerung einer oder mehrerer normaler vulvärer Gewebeanteile verursacht und weist keine äußere Kapsel auf. Vereinzelte Berichte in der Literatur haben das Augenmerk auf diese gutartige Veränderung gelenkt und die Notwendigkeit betont, invasive Eingriffe mit möglichen Dauerfolgen zu vermeiden. Die Ätiopathogenese von CALME ist nach wie vor umstritten, wobei die Hypothese einer hormonell bedingten stromalen Hyperplasie der großen Schamlippen gegenüber der Annahme eines gutartigen neoplastischen Prozesses favorisiert wird. Dieser Artikel zielt darauf ab, einen detaillierten Überblick über die klinischen, histologischen und apparativen Befunde bei CALME zu geben und einen abgestuften Algorithmus zur Herangehensweise und zum Management von genito-inguinalen Geschwülsten bei pädiatrischen Patienten zu erstellen.
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Affiliation(s)
- Andrea Sechi
- IRCCS University Hospital of Bologna St. Orsola-Malpighi Polyclinic Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- IRCCS University Hospital of Bologna St. Orsola-Malpighi Polyclinic Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulio Vara
- Radiology Unit, University Hospital of Bologna St. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, University Hospital of Bologna St. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Iria Neri
- IRCCS University Hospital of Bologna St. Orsola-Malpighi Polyclinic Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Haloot J, Soni NJ, Proud KC. 60-Year-Old Man With Liver Lesions and a Subcutaneous Nodule. Chest 2021; 160:e311-e313. [PMID: 34488974 DOI: 10.1016/j.chest.2020.09.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/20/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Justin Haloot
- Department of Medicine, Long School of Medicine at University of Texas Health San Antonio, San Antonio, TX; Medicine Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Nilam J Soni
- Department of Medicine, Long School of Medicine at University of Texas Health San Antonio, San Antonio, TX; Medicine Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Kevin C Proud
- Department of Medicine, Long School of Medicine at University of Texas Health San Antonio, San Antonio, TX; Medicine Service, South Texas Veterans Health Care System, San Antonio, TX.
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Dou Y, Xuan J, Zhao T, Li X, Wang H, Zhang Y, Wang S. The diagnostic performance of conventional ultrasound and strain elastography in malignant soft tissue tumors. Skeletal Radiol 2021; 50:1677-1686. [PMID: 33532939 DOI: 10.1007/s00256-021-03724-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the diagnostic value of conventional ultrasound (US) and strain elastography (SE) in malignant soft tissue tumors. METHOD A total of 83 soft tissue masses were included prospectively. US and SE imaging were performed at the same time. Two observers assessed the B mode, color Doppler, elastic scores (ES), strain ratio (SR), and SE size to B mode size (EI/B) ratio and compared the consistency of the data between the observers. According to the pathological diagnosis of resection, the cases were divided into malignant and nonmalignant groups. The diagnostic value of conventional US and SE in the prediction of malignant soft tissue tumors was assessed. RESULTS The pathology results divided cases into 36 malignant lesions and 47 nonmalignant lesions. There was no statistically significant difference in gender, location, maximum diameter, echo, tail sign, cystic component, Doppler scores, or SR between the two groups (p > 0.05). However, significant differences between the two groups were found in age, depth, heterogeneity, edge, ES, and EI/B (p < 0.05). The biggest area under the receiver operating characteristics curve (0.934) was the combination model of age, heterogeneity, edge, ES, and EI/B, and the sensitivity and specificity were 0.861 and 0.957, respectively. CONCLUSIONS Conventional US and SE are significant for the diagnosis of malignant soft tissue tumors, and SE can be used as a complementary technique to the characterization of STTs using conventional US.
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Affiliation(s)
- Yanping Dou
- Dalian Medical University, Dalian, China
- Department of Ultrasound, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jianyuan Xuan
- Department of Ultrasound, The Second Hospital, Dalian Medical University, Dalian City, Liaoning province, China
| | - Tengfei Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Dalian Medical University, Dalian, China
- Wound Repair Department, Dalian Ganjingzi District People's Hospital, Dalian, China
| | | | - Hui Wang
- Department of Ultrasound, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Yuhong Zhang
- Department of Ultrasound, The Second Hospital, Dalian Medical University, Dalian City, Liaoning province, China
| | - Shaowu Wang
- Dalian Medical University, Dalian, China.
- Department of Ultrasound, The Second Hospital, Dalian Medical University, Dalian City, Liaoning province, China.
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Sechi A, Patrizi A, Vara G, Golfieri R, Neri I. Keep CALME (childhood asymmetry labium majus enlargement) and follow up. J Dtsch Dermatol Ges 2021; 19:1276-1281. [PMID: 34164912 DOI: 10.1111/ddg.14528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
CALME is the abbreviation of "childhood asymmetry labium majus enlargement" and denotes a physiological, non-neoplastic swelling of labium majus soft tissues. It is caused by the expansion of one or more normal vulvar tissue components and is devoid of a peripheral capsule. A few reports in the literature have raised awareness of this benign condition and stressed the need to avoid invasive procedures with possible permanent sequelae. The etiopathogenesis of CALME is still debated, although the hypothesis of a hormone-driven major labia stromal hyperplasia is favored over the assumption of a benign neoplastic process. This article aims to provide a detailed review of the clinical, histological, and instrumental findings of CALME and provide a step-based algorithm to approach and manage genito-inguinal masses in pediatric patients.
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Affiliation(s)
- Andrea Sechi
- IRCCS University Hospital of Bologna St. Orsola-Malpighi Polyclinic Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- IRCCS University Hospital of Bologna St. Orsola-Malpighi Polyclinic Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulio Vara
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, Bologna, Italia
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, Bologna, Italia
| | - Iria Neri
- IRCCS University Hospital of Bologna St. Orsola-Malpighi Polyclinic Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Wu M, Hu Y, Ren A, Peng X, Ma Q, Mao C, Hang J, Li A. Nomogram Based on Ultrasonography and Clinical Features for Predicting Malignancy in Soft Tissue Tumors. Cancer Manag Res 2021; 13:2143-2152. [PMID: 33688257 PMCID: PMC7936676 DOI: 10.2147/cmar.s296972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/09/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose The objective of this study was to establish a predictive nomogram based on ultrasound (US) and clinical features for patients with soft tissue tumors (STTs). Patients and Methods A total of 260 patients with STTs were enrolled in this retrospective study and were divided into a training cohort (n=200, including 110 malignant and 90 benign masses) and a validation cohort (n=60, including 30 malignant and 30 benign masses). Multivariate analysis was performed by binary logistic regression analysis to determine the significant factors predictive of malignancy. A simple nomogram was established based on these independent risk factors including US and clinical features. The predictive accuracy and discriminative ability of the nomogram were measured by the calibration curve and the concordance index (C-index). Results The nomogram, comprising US features (maximum diameter, margin and vascular density) and clinical features (sex, age, and duration of disease), showed a favorable performance for predicting malignancy, with a sensitivity of 88.2% and a specificity of 78.7%. The calibration curve for malignancy probability in the training cohort showed good agreement between the nomogram predictions and actual observations. The C-indexes of the training cohort and validation cohort for predicting malignancy were 0.89 (95% CI: 0.85–0.94) and 0.83 (95% CI: 0.73–0.94), respectively. Conclusion The nomogram based on US and clinical features could be a simple, intuitive and reliable tool to individually predict malignancy in patients with STTs.
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Affiliation(s)
- Mengjie Wu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Yu Hu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Anjing Ren
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Xiaojing Peng
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Qian Ma
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Cuilian Mao
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Jing Hang
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Ao Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
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Parapatt GK, Oranges T, Paolantonio G, Ravà L, Giancristoforo S, Diociaiuti A, El Hachem M, Rollo M. Color Doppler Evaluation of Arterial Resistive Index in Infantile Hemangioma: A Useful Parameter to Monitor the Response to Oral Propranolol? Front Pediatr 2021; 9:718135. [PMID: 34950614 PMCID: PMC8691212 DOI: 10.3389/fped.2021.718135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Infantile hemangioma (IH) is the most common benign vascular tumor in childhood. In more than 85% of all cases, IHs undergo spontaneous involution, but nearly 10-12% of IHs develop complications and require immediate therapy. Oral propranolol is currently the first-line treatment for IHs. Color Doppler ultrasound is the gold standard in the diagnosis of deep IH, and it is used to evaluate the morphological change and the modification of vascularization that occur during its evolution and treatment. To date, only few data in the literature described the changes of intralesional arterial resistive index (RI) during treatment with propranolol; particularly, some authors have shown an increase of intralesional arterial RI in IHs with clinical regression during treatment with propranolol. The objective of this paper is to evaluate the changes of RI of the intralesional arteries of the IHs during the treatment with oral propranolol. We retrospectively analyzed a total of 64 IHs in 60 patients treated with oral propranolol with a good clinical response. Gray-scale ultrasonography and color Doppler imaging were performed before and during the therapy. The intralesional RIs were measured before and during the treatment. For each lesion, we recorded the RI values, and then we calculated the mean RI value for any single lesion. We compared the mean RI value observed at the baseline with the mean RI value of the last detectable sampling at color Doppler. We also compared between them the mean RI values observed during intermediate ultrasound. The RI values were compared in 44 lesions, with at least two significant samplings of RI. In the 44 lesions compared, we did not find statistically significant variations in the mean RI values between the baseline control and the values recorded at the last post-treatment control. The time trend of mean RI values of the intermediate color Doppler analysis performed between the first pre-treatment control and the last measurable control did not show any statistically significant variation in the trend of mean RI values. Contrarily to what has been described by some authors, in our experience, we have not observed an increase of RI in IHs treated with oral propranolol.
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Affiliation(s)
- George Koshy Parapatt
- Interventional Radiology Unit, Department of Imaging, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Teresa Oranges
- Dermatology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Guglielmo Paolantonio
- Interventional Radiology Unit, Department of Imaging, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Lucilla Ravà
- Unit of Clinical Pathways and Epidemiology, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Simona Giancristoforo
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - May El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Massimo Rollo
- Interventional Radiology Unit, Department of Imaging, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
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De Marchi A, Pozza S, Charrier L, Cannone F, Cavallo F, Linari A, Piana R, Geniò I, Balocco P, Massè A. Small Subcutaneous Soft Tissue Tumors (<5 cm) Can Be Sarcomas and Contrast-Enhanced Ultrasound (CEUS) Is Useful to Identify Potentially Malignant Masses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8868. [PMID: 33260631 PMCID: PMC7730454 DOI: 10.3390/ijerph17238868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022]
Abstract
Subcutaneous masses smaller than 5 cm can be malignant, in contrast with the international guidelines. Ultrasound (US) and magnetic resonance imaging (MRI) are useful to distinguish a potentially malignant mass from the numerous benign soft tissue (ST) lesions. Contrast-enhanced ultrasound (CEUS) was applied in ST tumors, without distinguishing the subcutaneous from the deep lesions. We evaluated CEUS and MRI accuracy in comparison to histology in differentiating malignant from nonmalignant superficial ST masses, 50% smaller than 5 cm. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) with their 95% confidence intervals (CI) were calculated. Of malignant cases, 44.4% measured ≤5 cm. At univariate analysis, no statistically significant differences emerged between benign and malignant tumors in relation with clinical characteristics, except for relationship with the deep fascia (p = 0.048). MRI accuracy: sensitivity 52.8% (CI 37.0, 68.0), specificity 74.1% (CI 55.3, 86.8), PPV 73.1% (CI 53.9, 86.3), and NPV 54.1% (CI 38.4, 69.0). CEUS accuracy: sensitivity 75% (CI 58.9, 86.3), specificity 37% (CI 21.5, 55.8), PPV 61.4% (CI 46.6, 74.3), and NPV 52.6% (CI 31.7, 72.7). CEUS showed a sensitivity higher than MRI, whereas PPV and NPV were comparable. Also, masses measuring less than 5 cm can be malignant and referral criteria for centralization could be revised.
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Affiliation(s)
- Armanda De Marchi
- Department of Imaging, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino, Italy; (A.D.M.); (S.P.); (P.B.)
| | - Simona Pozza
- Department of Imaging, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino, Italy; (A.D.M.); (S.P.); (P.B.)
| | - Lorena Charrier
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5-bis, 10126 Torino, Italy;
| | - Filadelfo Cannone
- Radiology Department, Azienda Sanitaria Provinciale di Siracusa, E. Muscatello Hospital, Contrada Granatello, 96011 Augusta, Italy;
| | - Franco Cavallo
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5-bis, 10126 Torino, Italy;
| | - Alessandra Linari
- Department of Pathology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino, Italy;
| | - Raimondo Piana
- Department of Orthopaedic, Traumatology and Rehabilitation, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino, Italy; (R.P.); (A.M.)
| | - Irene Geniò
- Department of Imaging, Azienda Ospedaliero Universitaria G. Martino, Via Consolare Valeria 1, 98100 Messina, Italy;
| | - Paolo Balocco
- Department of Imaging, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino, Italy; (A.D.M.); (S.P.); (P.B.)
| | - Alessandro Massè
- Department of Orthopaedic, Traumatology and Rehabilitation, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino, Italy; (R.P.); (A.M.)
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11
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Accuracy of ultrasound in the characterization of superficial soft tissue tumors: a prospective study. Skeletal Radiol 2020; 49:883-892. [PMID: 31900511 DOI: 10.1007/s00256-019-03365-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/05/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To prospectively evaluate the accuracy of ultrasound in defining the specific nature of superficial soft tissue masses as well as determining malignancy. MATERIALS AND METHOD Eight hundred twenty-three superficial soft tissue masses were prospectively evaluated with ultrasound by one of five experienced musculoskeletal radiologists. The radiologist at the time of examination provided one to three specific differential diagnoses and the perceived level of confidence with regard to each diagnosis. Clinical and ultrasound diagnoses were compared with the histological diagnosis to determine accuracy. Tumor malignancy was determined by histology or clinical/imaging follow-up. RESULTS Histological correlation was present for 219 (26.6%) of the 823 masses. Compared with histology, the accuracy of clinical and ultrasound examination for determining specific tumor type was 25.6% and 81.2% respectively considering all differential diagnoses provided. Radiologists were "fully confident" with the ultrasound diagnosis in 585 (71.1%) of 823 masses overall. In this setting, when compared with histology, the diagnostic accuracy of ultrasound was 95.5%. When the radiologist was "not fully confident," accuracy was 41.3% for the first differential diagnosis and 60.9% for all differential diagnoses. Diagnostic accuracy improved with increasing radiologist experience. Sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for identifying malignant tumor were 93.3%, 97.9%, 45.2%, and 99.9% respectively. CONCLUSIONS One can be "fully confident" at characterizing over two-thirds of superficial soft tissue masses based on ultrasound appearances and, in this setting, diagnostic accuracy is very high. Ultrasound examination is also highly accurate at discriminating benign from malignant superficial soft tissue masses.
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12
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Miwa T, Otsuji K, Aiba M, Kochi T, Toda K, Nakamura N, Katsumura N, Miyazaki T, Shimizu M. Ultrasonographic findings and diagnosis of omental dedifferentiated liposarcoma: a case report. J Rural Med 2020; 15:68-72. [PMID: 32269642 PMCID: PMC7110100 DOI: 10.2185/jrm.2019-013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/25/2019] [Indexed: 01/19/2023] Open
Abstract
Liposarcoma is one of the most common types of soft tissue sarcomas and can develop at
any site, although omental liposarcoma is extremely rare. Omental liposarcoma has a poor
prognosis because the diagnosis is difficult, until it presents as a large tumor causing
severe noticeable clinical symptoms. A 51-year-old male with lower abdominal pain was
referred to our clinic. Abdominal ultrasonography revealed an ill-defined, solid,
heterogeneous, and hypoechoic tumor deep in the lower abdomen. Generally, liposarcomas are
hyperechoic, though 20% of liposarcomas present as hypoechoic tumors. This variation might
occur depending on the pathological classification. We should consider the possibility of
a dedifferentiated component if ultrasonography reveals typical features of soft tissue
sarcoma with hypoechoic lesion.
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Affiliation(s)
- Takao Miwa
- Department of Gastroenterology, Chuno Kousei Hospital, Japan
| | - Kentaro Otsuji
- Department of Gastroenterology, Chuno Kousei Hospital, Japan
| | - Masashi Aiba
- Department of Gastroenterology, Chuno Kousei Hospital, Japan
| | - Takahiro Kochi
- Department of Gastroenterology, Chuno Kousei Hospital, Japan
| | - Katsuhisa Toda
- Department of Gastroenterology, Chuno Kousei Hospital, Japan
| | | | - Naoki Katsumura
- Department of Gastroenterology, Chuno Kousei Hospital, Japan
| | | | - Masahito Shimizu
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Japan
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13
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Li A, Peng XJ, Ma Q, Dong Y, Mao CL, Hu Y. Diagnostic performance of conventional ultrasound and quantitative and qualitative real-time shear wave elastography in musculoskeletal soft tissue tumors. J Orthop Surg Res 2020; 15:103. [PMID: 32160894 PMCID: PMC7066781 DOI: 10.1186/s13018-020-01620-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 03/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To explore the feasibility to identify malignant musculoskeletal soft tissue tumors using real-time shear wave elastography (rtSWE). METHODS One hundred fifteen musculoskeletal soft tissue tumors in 92 consecutive patients were examined using both conventional ultrasonography (US) and rtSWE. For each patient, the rtSWE parameters including maximum elasticity (Emax), mean elasticity (Emean), minimum elasticity (Emin), standard deviation of the elasticity (Esd), and rtSWE image pattern were obtained. Eighty-one histopathologically confirmed tumors from 73 patients were subjected to analysis. RESULTS The 81 lesions included in the study were histopathologically classified as malignant (n = 21) or benign (n = 60). The statistically significant differences between benign and malignant lesions were found in conventional US characters including size, depth, margin, echogenicity, mass texture, and power Doppler signal. Meanwhile, the significant differences were also found in quantitative rtSWE findings including Emax, Emean, Emin, and Esd values and in qualitative rtSWE parameter named rtSWE image pattern. Multivariate analysis showed that infiltrative margin (OR, 4.470), and size (OR, 1.046) were independent predictors for malignancy in US findings, while Esd value (OR, 9.047) was independent predictors for malignancy in quantitative rtSWE parameters. Areas under the ROC curve (Azs) for US features, Esd value, and rtSWE image pattern were 0.851, 0.795, and 0.792, respectively. CONCLUSIONS Conventional US and quantitative and qualitative rtSWE parameters are useful for malignancy prediction of musculoskeletal soft tissue tumors. rtSWE can be used to supplement conventional US to diagnose musculoskeletal soft tissue tumors.
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Affiliation(s)
- Ao Li
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xiao-Jing Peng
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qian Ma
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ye Dong
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Cui-Lian Mao
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yu Hu
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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14
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Catalano O, Varelli C, Sbordone C, Corvino A, De Rosa D, Vallone G, Wortsman X. A bump: what to do next? Ultrasound imaging of superficial soft-tissue palpable lesions. J Ultrasound 2019; 23:287-300. [PMID: 31786796 DOI: 10.1007/s40477-019-00415-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/01/2019] [Indexed: 02/07/2023] Open
Abstract
Soft-tissue palpable lesions are common in clinical practice, and ultrasound (US) represents the first imaging option in the evaluation of a patient with a soft-tissue swelling. A full and systematic US assessment is necessary, however. This includes grayscale, color- and power-Doppler, spectral-Doppler, and possibly elastography facilities, as well as a trained operator. Several lesions showing characteristic US features can be diagnosed confidently, without any further work-up, and the high spatial resolution of ultrasound in the superficial layers can be a powerful tool to discriminate their etiologies. Second-level options, to be reserved for indeterminate cases or those suspected malignant at initial ultrasound, include magnetic resonance imaging, percutaneous fine-needle aspiration or biopsy, and surgical-excision biopsy. In this article, we discuss the proper US approach for addressing superficial soft-tissue lesions.
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Affiliation(s)
- Orlando Catalano
- Radiology Unit, Istituto Diagnostico Varelli, via Cornelia dei Gracchi 65, 80126, Naples, Italy.
| | - Carlo Varelli
- Radiology Unit, Istituto Diagnostico Varelli, via Cornelia dei Gracchi 65, 80126, Naples, Italy
| | - Carolina Sbordone
- Department of Medicine and Health Science "Vincenzo Tiberio", Molise University, Campobasso, Italy
| | - Antonio Corvino
- Department of Movement and Wellness Sciences, University of Naples Parthenope, Naples, Italy
| | - Dario De Rosa
- Radiology Unit, Istituto Diagnostico Varelli, via Cornelia dei Gracchi 65, 80126, Naples, Italy
| | - Gianfranco Vallone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Ximena Wortsman
- Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues Clinic, University of Chile and Pontifical Catholic University of Chile, Santiago, Chile
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15
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Oh BH, Kim KH, Chung KY. Skin Imaging Using Ultrasound Imaging, Optical Coherence Tomography, Confocal Microscopy, and Two-Photon Microscopy in Cutaneous Oncology. Front Med (Lausanne) 2019; 6:274. [PMID: 31824956 PMCID: PMC6883721 DOI: 10.3389/fmed.2019.00274] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/11/2019] [Indexed: 12/21/2022] Open
Abstract
With the recognition of dermoscopy as a new medical technology and its available fee assessment in Korea comes an increased interest in imaging-based dermatological diagnosis. For the dermatologist, who treats benign tumors and malignant skin cancers, imaging-based evaluations can assist with determining the surgical method and future follow-up plans. The identification of the tumor's location and the existence of blood vessels can guide safe treatment and enable the use of minimal incisions. The recent development of high-resolution microscopy based on laser reflection has enabled observation of the skin at the cellular level. Despite the limitation of a shallow imaging depth, non-invasive light-based histopathologic examinations are being investigated as a rapid and pain-free process that would be appreciated by patients and feature reduced time from consultation to treatment. In the United States, the current procedural terminology billing code was established for reflectance confocal microscopy in 2016 and has been used for the skin cancer diagnosis ever since. In this review, we introduce the basic concepts and images of ultrasound imaging, optical coherence tomography, confocal microscopy, and two-photon microscopy and discuss how they can be utilized in the field of dermatological oncology.
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Affiliation(s)
- Byung Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Ki Hean Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang-si, South Korea
| | - Kee Yang Chung
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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16
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Solivetti FM, Desiderio F, Elia F, Guerrisi A, Cota C, Morrone A. Sonographic appearance of sebaceous cysts. Our experience and a review of the literature. Int J Dermatol 2019; 58:1353-1359. [PMID: 31209860 DOI: 10.1111/ijd.14515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/07/2019] [Accepted: 05/13/2019] [Indexed: 11/26/2022]
Abstract
Sebaceous cysts are benign enveloped nodules resulting from an obstruction of a hair follicle. Although they are very common, differential diagnosis is not obvious and may include many diseases. Ultrasound examination with high frequency probes, in the hands of a skilled operator, is the gold standard for noninvasive evaluation of these diseases. The aim of our study was to describe sonographic patterns found in our experience with high frequency probes. We decided to reevaluate the sonographic appearance of the last 100 patients with sebaceous cysts that were under our observation through conducting a retrospective study. All lesions were examined by a skilled radiologist with an Esaote MyLab 70 XVG ultrasound unit and a dedicated 18 MHz linear probe, sometimes supplemented by 20 MHz. In these skin lesions, we evaluated morphology, size, vascularity, and especially the visibility of skin pores, a characteristic of sebaceous cysts. We found 118 lesions that were mostly located on the trunk. In the majority of cases, the skin lesions had an oval-shaped morphology - 114 (96.6%) - and were hypoechoic in appearance -108 (91.5%). In 60 (50.8%) cases, the skin lesions showed a homogeneous appearance, known as "pseudotestis". The average ultrasound examines with very high frequency probes allowed to evidence skin pores. Our retrospective study on higher frequency probes confirms the data in literature regarding the diagnosis of sebaceous cysts, demonstrating the high incidence and clinical significance of evidence of the so-called epidermal punctum.
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Affiliation(s)
| | - Flora Desiderio
- Radiodiagnostic Service San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Fulvia Elia
- Radiodiagnostic Service San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Antonino Guerrisi
- Radiodiagnostic Service San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Carlo Cota
- Dermatopathology Laboratory San Gallicano, Dermatological Institute IRCCS, Rome, Italy
| | - Aldo Morrone
- Scientific Director San Gallicano Dermatological Institute IRCCS, Rome, Italy
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17
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Zaidi MY, Ethun CG, Liu Y, Poultsides G, Howard JH, Mogal H, Tseng J, Votanopoulos K, Fields RC, Cardona K. The impact of unplanned excisions of truncal/extremity soft tissue sarcomas: A multi‐institutional propensity score analysis from the US Sarcoma Collaborative. J Surg Oncol 2019; 120:332-339. [DOI: 10.1002/jso.25521] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Mohammad Y. Zaidi
- Division of Surgical Oncology, Winship Cancer InstituteEmory University Atlanta Georgia
| | - Cecilia G. Ethun
- Division of Surgical Oncology, Winship Cancer InstituteEmory University Atlanta Georgia
| | - Yuan Liu
- Department of Biostatistics and BioinformaticsEmory University Atlanta Georgia
| | - George Poultsides
- Department of SurgeryStanford University Medical Center Palo Alto California
| | - J. Harrison Howard
- Department of Surgery, Division of Surgical OncologyThe Ohio State University Columbus Ohio
| | - Harveshp Mogal
- Department of SurgeryMedical College of Wisconsin Milwaukee Wisconsin
| | - Jennifer Tseng
- Department of SurgeryUniversity of Chicago Medicine Chicago Illinois
| | | | - Ryan C. Fields
- Department of SurgeryWashington University School of Medicine St. Louis Missouri
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer InstituteEmory University Atlanta Georgia
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18
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Charnock M, Kotnis N, Fernando M, Wilkinson V. Re: an assessment of ultrasound screening for soft tissue lumps from primary care. A reply. Clin Radiol 2019; 74:324. [DOI: 10.1016/j.crad.2019.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
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19
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Charnock M, Kotnis N, Fernando M, Wilkinson V. An assessment of Ultrasound screening for soft tissue lumps referred from primary care. Clin Radiol 2018; 73:1025-1032. [DOI: 10.1016/j.crad.2018.07.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 07/10/2018] [Indexed: 01/30/2023]
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20
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Morii T, Kishino T, Shimamori N, Motohashi M, Ohnishi H, Honya K, Aoyagi T, Tajima T, Ichimura S. Preoperative Ultrasonographic Evaluation for Malignancy of Soft-Tissue Sarcoma: A Retrospective Study. Open Orthop J 2018; 12:75-83. [PMID: 29619120 PMCID: PMC5859456 DOI: 10.2174/1874325001812010075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/14/2018] [Accepted: 02/23/2018] [Indexed: 12/14/2022] Open
Abstract
Background: Ultrasonography is useful for distinguishing between benign and malignant soft-tissue tumors. However, no study has focused on its usefulness in the differential diagnosis between low-grade and high-grade soft-tissue sarcomas. We conducted a retrospective study to determine the usefulness of the parameters of ultrasonograph and to develop a practical scoring system for distinguishing between high-grade and low-grade sarcomas. Methods: Twenty-two cases of low-grade and 43 cases of high-grade malignant soft-tissue sarcoma were enrolled. Ultrasonography parameters including the longest diameter, depth of the tumor, echogenicity, tumor margin, and vascularity defined according to Giovagnorio’s criteria were analyzed as factors to distinguish between the two types of sarcoma. Significant factors were entered into a multivariate model to define the scores for distinction according to the odds ratio. The usefulness of the score was analyzed via receiver operating characteristic analyses. Results: In univariate analysis, tumor margin, echogenicity, and vascularity were significantly different between low- and high-grade sarcomas. In the multivariate regression model, the odds ratio for high-grade vs. low-grade sarcoma was 8.8 for tumor margin, 69 for echogenicity, and 8.3 for vascularity. Scores for the risk factors were defined as follows: 1, ill-defined margin; 2, hypoechoic echogenicity; and 1, type IV in Giovagnorio’s criteria. The sum of each score was confirmed by receiver operating characteristic analysis. The area under the curve was 0.95, with a cut-off score of 3, indicating that the scoring system was useful. Conclusion: The ultrasonography parameters of tumor margin, echogenicity, and vascularity are useful for distinguishing between low- and high-grade sarcomas.
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Affiliation(s)
- Takeshi Morii
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Tomonori Kishino
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Naoko Shimamori
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Mitsue Motohashi
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Hiroaki Ohnishi
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Keita Honya
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka, Tokyo 181-8612, Japan
| | - Takayuki Aoyagi
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Takashi Tajima
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Shoichi Ichimura
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
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21
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Morii T, Kishino T, Shimamori N, Motohashi M, Ohnishi H, Honya K, Aoyagi T, Tajima T, Ichimura S. Preoperative evaluation of intraoperative blood loss during malignant soft tissue tumor resection by ultrasonography. J Orthop Sci 2018; 23:403-407. [PMID: 29366631 DOI: 10.1016/j.jos.2017.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 12/21/2017] [Accepted: 12/24/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Preoperative evaluation of the risk of surgery-related blood loss in malignant soft tissue tumor resection is difficult because of wide variations in histological subtype, malignancy, location, and size. Ultrasonography is useful for the evaluation of blood flow around a soft tissue tumor and has the potential to preoperatively estimate intraoperative blood loss in tumor resection. To date, there has been no report regarding blood loss evaluation using ultrasonography in this field. PATIENTS AND METHODS The usefulness of information obtained by ultrasonography, including tumor size, vessel density in the tumor, and blood flow volume in the vessels, was analyzed for the prediction of intraoperative blood loss in malignant soft tissue tumor resection. RESULTS Vessel density in the tumor and blood flow in the vessels were identified as independent risk factors for blood loss. Using these factors, a new index for the prediction of blood loss was established. Receiver operating characteristic analyses revealed a high area under the curve value (0.80), confirming the accuracy of the index for the prediction of blood loss. CONCLUSION Ultrasonography is a useful modality for predicting intraoperative blood loss in malignant soft tissue tumor surgery.
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Affiliation(s)
- Takeshi Morii
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Tomonori Kishino
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Naoko Shimamori
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Mitsue Motohashi
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hiroaki Ohnishi
- Department of Laboratory Medicine, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Keita Honya
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka, Tokyo, 181-8612, Japan
| | - Takayuki Aoyagi
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Takashi Tajima
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Shoichi Ichimura
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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Rimondi E, Mavrogenis AF, Errani C, Calabrò T, Bazzocchi A, Facchini G, Donatiello S, Spinnato P, Vanel D, Albisinni U, Pelotti P. Biopsy is not necessary for the diagnosis of soft tissue hemangiomas. Radiol Med 2018; 123:538-544. [DOI: 10.1007/s11547-018-0862-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/07/2018] [Indexed: 11/25/2022]
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23
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Tammam TF, Kamhawy GA. Ultrasound-guided regional blockade for lipoma excision: a new approach to an old technique. Acta Anaesthesiol Scand 2017; 61:1325-1333. [PMID: 28832894 DOI: 10.1111/aas.12964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/28/2017] [Accepted: 07/29/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Local anesthesia for lipoma excision can be feasible with anesthetic injection in the fascial plane between the lipoma and the surrounding soft tissues under real-time ultrasonography [ultrasound- guided lipoma plane (ULP) block]. The advantage of targeting a single anesthetic injection plane under ultrasound guidance may allow for technically easier block placement and long-term analgesic effects. METHODS Forty-eight patients were randomly assigned to receive ULP block, group A (n = 24) or traditional block, group B (n = 24). Primary outcome measure was the number of needle passes required to perform the blockade. The level of procedure pain and the time to first request of analgesia were assessed. RESULTS Median (interquartile range) needle passes required to complete the blockade was significantly less in the group A 1(1, 1) in comparison with the group B 3 (2.5, 3); P = 0.0001. Group A required fewer needle redirections 1.5 (1, 2) than group B 2 (2, 2.5); P = 0.001. Group A showed significantly less procedure-related pain 2 (2, 3) when compared with group B 4 (3, 4); P = 0.0001. The time to first rescue analgesic was significantly longer in group A (21.3 ± 4.7 h) in comparison with group B (4.4 ± 1.2 h); P = 0.001. CONCLUSION Ultrasound-guided lipoma plane blockade reduces the number of needle passes required to complete the block and provides less procedure pain and longer pain relief compared with the traditional block in patients undergoing lipoma excision.
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Affiliation(s)
- T. F. Tammam
- Department of Anesthesia and Intensive Care; Faculty of Medicine; Suez Canal University Hospital; Ismailia Egypt
| | - G. A. Kamhawy
- Department of Anesthesia and Intensive Care; Faculty of Medicine; Suez Canal University Hospital; Ismailia Egypt
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24
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Izzetti R, Fantoni G, Gelli F, Faggioni L, Vitali S, Gabriele M, Caramella D. Feasibility of intraoral ultrasonography in the diagnosis of oral soft tissue lesions: a preclinical assessment on an ex vivo specimen. Radiol Med 2017; 123:135-142. [PMID: 28948476 DOI: 10.1007/s11547-017-0817-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 09/14/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The early detection of oral soft tissue lesions is an important prognostic factor, and the possibility of using ultrasonography (US) as a diagnostic tool may improve the diagnosis and characterization of tissue alterations at an early stage. This study aims to evaluate the feasibility of intraoral US by performing a preclinical assessment of an ex vivo specimen in which focal lesions were simulated. MATERIALS AND METHODS Fourteen lesions were simulated on a freshly extracted calf tongue, by introducing in the tongue different materials mimicking the appearance of various focal lesions. The specimen was scanned with a 8 MHz US probe and computed tomography (CT) was performed to compare the two imaging techniques. Later, the specimen was dissected to set a benchmark for size assessment. RESULTS US was able to identify all the simulated lesions within the tongue, resulting in one case more accurate than CT. Statistical analysis demonstrated high correlation between the measurements of the simulated lesions performed on the US images and the real size of the materials introduced in the tongue (p < 0.05). CONCLUSIONS This preclinical study proves that US performs well in the detection and characterization of simulated lesions of the tongue. These findings suggest that US could be effectively used in clinical applications. However, further research is mandatory to assess the reliability of in vivo US in the detection and characterization of tongue lesions as well as of other oral soft tissue alterations.
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Affiliation(s)
- Rossana Izzetti
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Gualtiero Fantoni
- Department of Civil and Industrial Engineering, University of Pisa, Pisa, Italy
| | | | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - Saverio Vitali
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - Mario Gabriele
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Davide Caramella
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
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25
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Taljanovic MS, Gimber LH, Klauser AS, Porrino JA, Chadaz TS, Omar IM. Ultrasound in the Evaluation of Musculoskeletal Soft-Tissue Masses. Semin Roentgenol 2017; 52:241-254. [PMID: 28965544 DOI: 10.1053/j.ro.2017.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Mihra S Taljanovic
- Department of Medical Imaging, Banner University Medical Center Tucson, The University of Arizona, College of Medicine, Tucson, AZ.
| | - Lana H Gimber
- Department of Medical Imaging, Banner University Medical Center Tucson, The University of Arizona, College of Medicine, Tucson, AZ
| | - Andrea S Klauser
- Department of Radiology, Medical University Innsbruck, Section Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Jack A Porrino
- Department of Radiology, University of Washington, Seattle, WA
| | - Tyson S Chadaz
- Department of Medical Imaging, Banner University Medical Center Tucson, The University of Arizona, College of Medicine, Tucson, AZ
| | - Imran M Omar
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Differential diagnosis between benign and malignant soft tissue tumors utilizing ultrasound parameters. J Med Ultrason (2001) 2017. [DOI: 10.1007/s10396-017-0796-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Cranium-Penetrating Mass Detected by Ultrasound Expedited Management of Langerhans Cell Histiocytosis. Pediatr Emerg Care 2017; 33:290-292. [PMID: 28353530 DOI: 10.1097/pec.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 6-year-old boy presented to the pediatric emergency department with a unilateral 5 × 3-cm superficial mass on the postauricular region growing for 1 month. Point-of-care ultrasound was used to evaluate the mass, which revealed a complex cystic mass penetrating the temporal bone. After confirmatory magnetic resonance imaging, the patient was transferred for neurosurgical evaluation, and the tumor was excised. Pathology revealed Langerhans cell histiocytosis.
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Clarke R, Suresh P, Thomas R, Freeman S. Twinkle artefact in the ultrasound diagnosis of superficial epidermoid cysts. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2016; 24:147-153. [PMID: 27867407 DOI: 10.1177/1742271x16658687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/14/2016] [Indexed: 11/17/2022]
Abstract
AIM The aim of the study was to evaluate whether the twinkle artefact is a valuable feature in the sonographic diagnosis of superficial epidermoid cysts. MATERIALS AND METHODS A retrospective search was undertaken of our institution's Radiology Information System and pathology database to identify cases of superficial masses showing the twinkle artefact that proceeded to surgical excision. RESULTS Eighteen superficial masses demonstrating the twinkle artefact were identified that were submitted for pathological analysis. Of these, 17 were confirmed to represent epidermoid cysts and only 1 case had an alternative diagnosis (proliferating trichilemmal cyst). CONCLUSION The presence of the twinkle artefact appears to be a specific and valuable ancillary sonographic feature for the diagnosis of superficial epidermoid cysts.
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Affiliation(s)
| | - Priya Suresh
- Imaging Department, Derriford Hospital, Plymouth UK
| | - Rose Thomas
- Department of Radiology, The Austin Hospital, Melbourne, Australia
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Rimondi E, Benassi MS, Bazzocchi A, Balladelli A, Facchini G, Rossi G, Taieb S, Vanel D. Translational research in diagnosis and management of soft tissue tumours. Cancer Imaging 2016; 16:13. [PMID: 27266712 PMCID: PMC4897899 DOI: 10.1186/s40644-016-0071-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/21/2016] [Indexed: 02/08/2023] Open
Abstract
Finding a soft tissue mass in the superficial regions is a common event in daily clinical practice. Correct management of the diagnostic process is crucial to avoid blunders. Diagnosis is posed by pathology, although both imaging and a better understanding of the cellular and molecular mechanisms play an important a role in the characterization, staging and follow-up of soft tissue masses. Cellular and molecular mechanisms can explain either the development of chemo-resistance and the underlying pre- and post-surgery metastasis formation. These are mandatory to improve prognosis and unveil novel parameters predicting therapeutic response. Imaging mainly involves ultrasound and MR and is fundamental not only in diagnosis but also in the first step of therapy: the biopsy. Novel imaging techniques like Ultrasound Elastosonography, Dynamic Contrast-Enhanced MR imaging (DCE), Diffusion Weighted MR imaging (DWI) and MR Spectroscopy (MRS) are discussed. This paper aims at reviewing and discussing pathological methods and imaging in the diagnosis of soft tissue masses underscoring that the most appropriate treatment depends on advanced molecular and radiological studies.
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Affiliation(s)
- Eugenio Rimondi
- Diagnostic and Interventional Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Serena Benassi
- Laboratory of Experimental Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alba Balladelli
- Laboratory of Experimental Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Rossi
- Interventional Angiographic Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Daniel Vanel
- Research Department, Istituto Ortopedico Rizzoli, Bologna, Italy.
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Low-Flow Vascular Malformation Pitfalls: From Clinical Examination to Practical Imaging Evaluation—Part 1, Lymphatic Malformation Mimickers. AJR Am J Roentgenol 2016; 206:940-51. [DOI: 10.2214/ajr.15.15793] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Hwang EJ, Yoon HS, Cho S, Park HS. The diagnostic value of ultrasonography with 5-15-MHz probes in benign subcutaneous lesions. Int J Dermatol 2015; 54:e469-75. [PMID: 26148060 DOI: 10.1111/ijd.12989] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ultrasonography (US) has recently proved to be useful in diagnostic dermatology. It is convenient to use, completely safe, and provides valuable information. OBJECTIVE This study was performed to compare the diagnostic accuracy of US with that of clinical diagnosis in patients with benign subcutaneous lesions. METHODS We retrospectively examined data for 100 patients with benign subcutaneous lesions who were diagnosed with US and either biopsy or surgery at Seoul National University Boramae Hospital between January 2010 and May 2013. RESULTS Ultrasonography significantly increased the diagnostic yield of benign subcuta-neous lesions (after physical examination [PE], 52.0%; after US, 82.0%; P < 0.005). Rates of sensitivity and specificity for the diagnosis of lipoma were 61.5 and 92.0%, respectively, after PE, and 100 and 100%, respectively, after US. Rates of sensitivity and specificity for the diagnosis of epidermal cysts were 69.4 and 78.4%, respectively, after PE, and 91.8 and 92.2%, respectively, after US. Additionally, rates of sensitivity and specificity for pilomatrixoma were 12.5 and 98.9%, respectively, after PE, and 75.0 and 100%, respectively, after US. Although the accuracy of diagnosis of vascular anomalies and nerve sheath tumors was increased after US, the difference was not significant (vascular anomalies: 40.0% after PE and 80.0% after US; nerve sheath tumors: 28.6% after PE and 42.9% after US). CONCLUSIONS This study suggests that US is a simple and reliable tool that can aid the diagnosis of benign subcutaneous lesions.
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Affiliation(s)
- Eun Jung Hwang
- Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Soyun Cho
- Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Hyun Sun Park
- Department of Dermatology, Seoul National University Boramae Hospital, Seoul, South Korea
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Tanaka R, Inagawa K, Kanomata N, Hata J, Fujimoto W. Photoletter to the editor: Pigmented dermatofibrosarcoma protuberans in a 4-year-old girl and ultrasonographic findings. J Dermatol Case Rep 2015; 9:52-4. [PMID: 26236415 DOI: 10.3315/jdcr.2015.1201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/04/2015] [Indexed: 11/11/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) in children is often clinically misdiagnosed as hemangioma or vascular malformation. Ultrasonography and color Doppler imaging are useful noninvasive tools for the diagnosis of skin tumors and may help distinguish DFSP from other vascular skin lesions in children.
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Affiliation(s)
- Ryo Tanaka
- Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Kiichi Inagawa
- Department of Plastic and Reconstructive Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Naoki Kanomata
- Department of Pathology, Kawasaki Medical School, Kurashiki, Japan
| | - Jiro Hata
- Department of Endoscopy and Ultrasound, Kawasaki Medical School, Kurashiki, Japan
| | - Wataru Fujimoto
- Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
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Affiliation(s)
- Paul DiDomenico
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA.
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
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Oebisu N, Hoshi M, Ieguchi M, Takada J, Iwai T, Ohsawa M, Nakamura H. Contrast-enhanced color Doppler ultrasonography increases diagnostic accuracy for soft tissue tumors. Oncol Rep 2014; 32:1654-60. [PMID: 25109621 DOI: 10.3892/or.2014.3378] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 07/17/2014] [Indexed: 11/06/2022] Open
Abstract
Resolution of ultrasonography (US) has undergone marked development. Additionally, a new-generation contrast medium (Sonazoid) used for US is newly available. Contrast-enhanced US has been widely used for evaluating several types of cancer. In the present study, we evaluated the ability of color Doppler US (CDUS) and Sonazoid to differentiate between benign and malignant soft tissue tumors. A total of 180 patients (87 male, 93 female) were enrolled in the present study. The patient ages ranged from 1 to 91 years (mean 58.1±20.0 years). The maximum size, depth, tumor margins, shape, echogenicity and textural pattern were measured on gray-scale images. CDUS was used to evaluate the intratumoral blood flow with and without Sonazoid. Peak systolic flow velocity (Vp), mean flow velocity (Vm), resistivity index (RI) and pulsatility index (PI) of each detected intratumoral artery were automatically calculated with power Doppler US (PDUS). The present study included 118 benign and 62 malignant tumors. Statistical significances were found in size, depth, tumor margin and textural pattern but not in shape or echogenicity on gray-scale images. Before Sonazoid injection, CDUS findings showed 55% sensitivity, 77% specificity and 69% accuracy, whereas contrast-enhanced CDUS showed 87% sensitivity, 68% specificity and 74% accuracy. There were no statistically significant differences between malignant and benign tumors regarding the mean Vp, Vm, RI and PI values determined on PDUS. In conclusion, contrast-enhanced CDUS proved to be a reliable diagnostic tool for detecting malignant potential in soft tissue tumors.
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Affiliation(s)
- Naoto Oebisu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
| | - Manabu Hoshi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
| | - Makoto Ieguchi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
| | - Jun Takada
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
| | - Tadashi Iwai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
| | - Masahiko Ohsawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Abeno-Ku, Osaka 545‑8585, Japan
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Ultrasound of musculoskeletal soft-tissue tumors superficial to the investing fascia. AJR Am J Roentgenol 2014; 202:W532-40. [PMID: 24848846 DOI: 10.2214/ajr.13.11457] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of our study was to evaluate the diagnostic accuracy of ultrasound in assessing musculoskeletal soft-tissue tumors superficial to the investing fascia. MATERIALS AND METHODS Seven hundred fourteen superficial soft-tissue tumors evaluated with ultrasound by two musculoskeletal radiologists were retrospectively reviewed. In all ultrasound reports, the reporting radiologists provided one, two, or three diagnoses depending on their perceived level of diagnostic certainty. Two hundred forty-seven tumors had subsequent histologic correlation, thus allowing the accuracy of the ultrasound diagnosis to be determined. Images of the lesions with a discordant ultrasound diagnosis and histologic diagnosis were reviewed, and the ultrasound features were further classified as concordant with the known histologic diagnosis, concordant with the known histologic diagnosis with atypical features present, or discordant with the known histologic diagnosis. Four hundred sixty-seven tumors without pathologic confirmation were followed up clinically. RESULTS Overall the accuracy of ultrasound examination for assessing superficial soft-tissue masses was 79.0% when all differential diagnoses were considered and 77.0% when only the first differential diagnosis was considered. The sensitivity and specificity of the first ultrasound diagnosis were 95.2% and 94.3%, respectively, for lipoma; 73.0% and 97.7% for vascular malformation; 80.0% and 95.4% for epidermoid cyst; and 68.8% and 95.2% for nerve sheath tumor. Reduced observer awareness of specific tumor entities tended to contribute to underdiagnosis more than poor specificity of ultrasound findings. Most tumors (236/247, 96%) were benign. The sensitivity and specificity of ultrasound for identifying malignant superficial soft-tissue tumors was 94.1% and 99.7%, respectively. CONCLUSION The diagnostic accuracy of ultrasound in the assessment of superficial musculoskeletal soft-tissue tumors is high and can be improved through increased radiologist awareness of less frequently encountered tumors. Ultrasound is accurate for differentiating benign from malignant superficial soft-tissue tumors.
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Lee YH, Song HT, Suh JS. Use of strain ratio in evaluating superficial soft tissue tumors on ultrasonic elastography. J Med Ultrason (2001) 2014; 41:319-23. [DOI: 10.1007/s10396-014-0528-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
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Matsumoto Y, Takahashi Y, Haraguchi A, Okamoto T, Harimaya K, Matsunobu T, Endo M, Oda Y, Iwamoto Y. Intraosseous hemangioma arising in the clavicle. Skeletal Radiol 2014; 43:89-93. [PMID: 23990112 DOI: 10.1007/s00256-013-1715-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 02/02/2023]
Abstract
Intraosseous hemangioma (IH) is commonly seen in the vertebral column and skull: however, IH occurring in the appendicular skeleton, including the clavicle, is uncommon. We herein report the case of a 69-year-old female presenting with IH of the left clavicle. The findings of preoperative imaging studies, including radiographs, computed tomography (CT), magnetic resonance imaging, fluorine-18-fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)/CT and ultrasonography, are described. In particular, (18)F-FDG PET/CT showed an ill-defined osteolytic lesion with abnormally high FDG uptake. Surgical en bloc resection with preoperative embolization was carried out and a histopathological examination confirmed the presence of an intraosseous cavernous hemangioma in the clavicle.
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Affiliation(s)
- Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan,
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Wagner JM, Lee KS, Rosas H, Kliewer MA. Accuracy of sonographic diagnosis of superficial masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1443-1450. [PMID: 23887955 DOI: 10.7863/ultra.32.8.1443] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
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.
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Affiliation(s)
- Jason M Wagner
- Department of Radiology, University of Wisconsin, Madison, Wisconsin USA.
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Goldberg Y, Lavie O, Mandel R, Auslender R. Imaging of an atypical large perineal cyst diagnosed during pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:721-723. [PMID: 22328275 DOI: 10.1002/uog.11130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2011] [Indexed: 05/31/2023]
Abstract
Perineal cysts are quite frequent, almost 2% of women developing symptoms related to Bartholin or Gartner cysts. In most cases these cysts derive from embryological remnants or ectopic tissue, or form as epithelial inclusion cysts. These structures are usually asymptomatic unless they are complicated by infection. We report the sonographic and magnetic resonance imaging characteristics of a large perineal cyst diagnosed during the first trimester of an uncomplicated pregnancy, followed by conservative management during pregnancy and surgical excision in the puerperium.
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Affiliation(s)
- Y Goldberg
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel.
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Chatzistefanou A, Mantatzis M, Deftereos S, Mintzopoulou P, Prassopoulos P. Peripheral nerve sheath tumors. Benign or malignant? The role of MRI and ultrasonography in a case report. J Neuroimaging 2012; 24:308-10. [PMID: 22913746 DOI: 10.1111/j.1552-6569.2012.00731.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 04/03/2012] [Accepted: 05/06/2012] [Indexed: 11/26/2022] Open
Abstract
A 31-year-old male patient admitted to another hospital for investigation of a localized painful hump in the medial surface of his left leg. The clinical examination revealed a painful palpable lump in the medial surface of left thigh that was initially thought to be a hematoma due to a history of recent trauma. However, an ultrasound was requested to exclude deep venous thrombosis (DVT). The US examination revealed a heterogeneous, fusiform lesion with elongated proximal and distal projections in close proximity to superficial femoral artery and vein and could not definitely exclude the DVT hypothesis. In a second ultrasound examination performed in our department, a neurogenic origin of the lesion was proposed. A consequent MRI examination confirmed the presence of a fusiform tumor in the anatomic path of the saphenous nerve. This was further confirmed intraoperatively, and pathologically was diagnosed as a malignant peripheral nerve sheath tumor (MPNST). In this present study the role of ultrasonography, the correlation between MRI and ultrasonographic findings are discussed and a review of the literature is presented.
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Affiliation(s)
- Alexandros Chatzistefanou
- Department of Radiology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Lin YH, Chiou HJ, Chen WM, Yen CC, Chou YH, Hung GY, Chang CY. Color Doppler ultrasonography evaluation for chemotherapy treatment response of osteogenic sarcoma. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:202-208. [PMID: 22230132 DOI: 10.1016/j.ultrasmedbio.2011.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 11/11/2011] [Accepted: 11/17/2011] [Indexed: 05/31/2023]
Abstract
The aim of this study was to evaluate the vascular parameters of the proximal peripheral arteries of limbs by color Doppler ultrasonography (CDUS) in individuals with osteogenic sarcoma (OGS) after neoadjuvant chemotherapy and their relation to the tumor necrosis rate. We recruited 50 individuals with osteogenic sarcoma who were scheduled for neoadjuvant chemotherapy before elective surgery from 2003 to 2010. Once enrolled, we evaluated these 50 subjects using color Doppler sonography to identify vascular parameters of tumor vessels before and after neoadjuvant therapy. The vascular parameters of the proximal peripheral arteries of limbs (peak systolic velocity [PSV], end-diastolic velocity [EDV], resistive index [RI]) and tumor neovascularity were compared before and after neoadjuvant chemotherapy using CDUS. Before chemotherapy, the PSV, EDV and RI differed significantly between the diseased and contralateral normal limbs (p < 0.001). Among the factors relating to the tumor necrosis rate before chemotherapy, the EDV of the diseased limb (p = 0.047) and tumor neovascularity (p = 0.027) showed significant differences. After chemotherapy, the PSV of the diseased limb (p = 0.022) and the difference in PSV between the diseased and contralateral limbs (p = 0.003) showed significant differences. The vascular parameters of the proximal peripheral arteries of limbs owing to tumor burden differ significantly between the diseased and contralateral normal limbs. For individuals with osteogenic sarcoma who still have a higher difference in PSV between the diseased and contralateral limbs after chemotherapy, another course of chemotherapy after surgery and close follow-up should be considered.
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Affiliation(s)
- Yen-Huai Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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Gavriloaia GV, Gavriloaia MRG, Novac ML. Bioacoustics response of small benign or malignant nodules. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:7695-8. [PMID: 22256121 DOI: 10.1109/iembs.2011.6091896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
One of the most important features of separation between benign or malignant tissues is their smooth or rough shape. This article presents a new method for early diagnosis of thyroid cancer by knowing the resonance frequencies of a certain tissue. Two types of nodules were investigated: spherical and elliptical. Their external surfaces were smooth or rough with different values of spicules. Propagation of sound through the human body was modeled by a classical partial differential equation associated with Neumann or Dirichlet boundary conditions. The assessments of about ten acoustic eigenfrequencies are enough to decide the type of external surfaces: smooth or rough, or whether nodule is benign or malignant. Data obtained by this method refers to the result of investigating 3D bodies smaller than 5 mm, when other medical devices such as ultrasound or CT cannot evaluate their surface shape because of their limited spatial resolution.
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Chiou HJ, Chou YH, Chen WM, Chen W, Wang HK, Chang CY. Soft-tissue tumor differentiation using 3D power Doppler ultrasonography with echo-contrast medium injection. J Chin Med Assoc 2010; 73:628-33. [PMID: 21145510 DOI: 10.1016/s1726-4901(10)70137-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 08/04/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND We aimed to evaluate the ability of 3-dimensional power Doppler ultrasonography to differentiate soft-tissue masses from blood flow and vascularization with contrast medium. METHODS Twenty-five patients (mean age, 44.1 years; range, 12-77 years) with a palpable mass were enrolled in this study. Volume data were acquired using linear and convex 3-dimensional probes and contrast medium injected manually by bolus. Data were stored and traced slice by slice for 12 slices. All patients were scanned by the same senior sonologist. The vascular index (VI), flow index (FI), and vascular-flow index (VFI) were automatically calculated after the tumor was completely traced. All tumors were later confirmed by pathology. RESULTS The study included 8 benign (mean, 36.5 mL; range, 2.4-124 mL) and 17 malignant (mean, 319.4 mL; range, 9.9-1,179.6 mL) tumors. Before contrast medium injection, mean VI, FI and VFI were, respectively, 3.22, 32.26 and 1.07 in benign tumors, and 1.97, 29.33 and 0.67 in malignant tumors. After contrast medium injection, they were, respectively, 20.85, 37.33 and 8.52 in benign tumors, and 40.12, 41.21 and 17.77 in malignant tumors. The mean differences between with and without contrast injection for VI, FI and VFI were, respectively, 17.63, 5.07 and 7.45 in benign tumors, and 38.15, 11.88 and 16.55 in malignant tumors. Tumor volume, VI, FI and VFI were not significantly different between benign and malignant tumors before and after echo-contrast medium injection. However, VI, FI and VFI under self-differentiation (differences between with and without contrast injection) were significantly different between malignant and benign tumors. CONCLUSION Three-dimensional power Doppler ultrasound is a valuable tool for differential diagnosis of soft-tissue tumors, especially with the injection of an echo-contrast medium.
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Affiliation(s)
- Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
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Levi AD, Ross AL, Cuartas E, Qadir R, Temple HT. The Surgical Management of Symptomatic Peripheral Nerve Sheath Tumors. Neurosurgery 2010; 66:833-40. [DOI: 10.1227/01.neu.0000367636.91555.70] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Abstract
OBJECTIVE
To determine the clinical presentation and morbidity of the surgical management of peripheral nerve sheath tumors (PNSTs).
METHODS
We performed a retrospective chart review of surgically treated PNSTs at the University of Miami between 1991 and 2008.
RESULTS
There were a total of 140 cases, including 87 schwannomas, 34 neurofibromas, and 19 malignant peripheral nerve sheath tumors (MPNSTs). The average age of the total study group was 49.0 years; it was significantly lower for patients with neurofibroma. There was a high correlation between neurofibroma tumors and neurofibromatosis-1. Most patients with benign tumors presented with a painful mass, paresthesias, or numbness without significant weakness. Patients who had previously undergone attempted resections and preoperative biopsy had a significantly increased risk (41%) for developing postoperative neurologic deficits when compared with patients who presented with de novo tumors (15%). Intraoperative monitoring appeared to reduce the risk of postoperative motor deficit, particularly in neurofibromas. Most MPNSTs (>80%) were diagnosed at stage IIB or higher and had a combined mortality rate of 31.6% at 78 months. Tumor size was the best predictor of adverse outcome, as all MPNST mortalities occurred in patients with a tumor size of more than 7 cm.
CONCLUSION
PNSTs are a heterogeneous group of lesions. Benign tumors respond well to marginal excision, whereas MPNSTs are aggressive sarcomas that require multimodal management. There was a significantly increased risk of postoperative neurologic deficits in patients who had undergone a previous biopsy, and thus tertiary referral without biopsy is recommended when a PNST is suspected.
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Affiliation(s)
- Allan D. Levi
- Departments of Neurological Surgery and Orthopedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Andrew L. Ross
- University of Miami Miller School of Medicine, Miami, Florida
| | - Esteban Cuartas
- Department of Orthopedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Rabah Qadir
- Department of Orthopedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - H. Thomas Temple
- Department of Orthopedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
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