Immersion ultrasonography of excised nonpalpable breast lesion specimens after ultrasound-guided needle localization

Evaluation of rat liver with ARFI elastography: In vivo and ex vivo study

OBJECTIVE

The aim of this study was to compare in vivo vs ex vivo liver stiffness in rats with acoustic radiation force impulse (ARFI) elastography using the histological findings as the gold standard.

METHODS

Eighteen male Wistar rats aged 16-18 months were divided into a control group (n = 6) and obese group (n = 12). Liver stiffness was measured with shear wave velocity (SWV) using the ARFI technique both in vivo and ex vivo. The degree of fibrosis, steatosis and liver inflammation was evaluated in the histological findings. Pearson's correlation coefficient was applied to relate the SWV values to the histological parameters.

RESULTS

The SWV values acquired in the ex vivo study were significantly lower than those obtained in vivo (P < 0.004). A significantly higher correlation value between the degree of liver fibrosis and the ARFI elastography assessment was observed in the ex vivo study (r = 0.706, P < 0.002), than the in vivo study (r = 0.623, P < 0.05).

CONCLUSION

Assessment of liver stiffness using ARFI elastography yielded a significant correlation between SWV and liver fibrosis in both the in vivo and ex vivo experiments. We consider that by minimising the influence of possible sources of artefact we could improve the accuracy of the measurements acquired with ARFI.

Ultrasound-guided preoperative localization of breast lesions: a good choice

PURPOSE

The aim of the study was to verify whether ultrasound (US)-guided preoperative localization of breast lesions is an adequate technique for correct and safe surgical resection and to contribute positively and effectively to this topic in the literature with our results.

METHODS

From June 2016 to November 2016, 155 patients with both benign and malignant breast lesions were selected from our institute to undergo US localization before surgery. The lesions included were: sonographically visible and nonpalpable lesions; palpable lesions for which a surgeon had requested US localization to better evaluate the site and extension; sonographically visible, multifocal breast lesions, both palpable and nonpalpable. US localization was performed using standard linear transducers (Siemens 18 L6, 5.5-8 MHz, 5.6 cm, ACUSON S2000 System, Siemens Medical Solutions). The radiologist used a skin pen to mark the site of the lesion, and the reported lesion's depth and distance from the nipple and pectoral muscle were recorded. The lesions were completely excised by a team of breast surgeons, and the surgical specimens were sent to the Radiology Department for radiological evaluation and to the Pathology Department for histological assessment.

RESULTS

In 155 patients who underwent to preoperative US localization, 188 lesions were found, and the location of each lesion was marked with a skin pen. A total of 181 lesions were confirmed by the final histopathologic exam (96.28%); 132 of them (72.92%) were malignant, and 124 of these (93.93%) showed free margins.

CONCLUSIONS

US-guided preoperative localization of sonographically visible breast lesions is a simple and nontraumatic procedure with high specificity and is a useful tool for obtaining accurate surgical margins.

Role of specimen US for predicting resection margin status in breast conserving therapy

AIM

To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard.

PATIENTS AND METHODS

A total of 132 consecutive patients (age range, 34-87 years; mean, 51 years) underwent breast-conserving surgery for US-detected invasive breast cancer. All surgical specimens underwent US examination. The presence of lesion within the specimen and its distance from the specimen margins were assessed considering a threshold distance between the lesion and specimen margins of 10 mm. US findings were then compared with the pathological ones and specimen US. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) for predicting histological margin status were evaluated, having the histological findings as the reference standard.

RESULTS

The histological examination detected invasive ductal carcinoma in 96/132 (73%) cases, invasive lobular carcinoma in 32/132 (24%), mucinous carcinoma in 4/132 (3%). The pathological margin analysis revealed 96/132 (73%) negative margins and 36 (27%) close/positive margins. US examination detected all 132 breast lesions within the surgical specimens. 110 (83%) negative margins and 22 (17%) positive margins were found on US. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 44%, 94%, 80%, 73% and 82%, respectively, were found for specimen US.

CONCLUSIONS

Specimen US represents a time and cost saving imaging tool for evaluating the presence of US detected-breast lesion within surgical specimen and for predicting the histological margin status.

A prospective pilot study of analysis of surgical margins of breast cancers using high-resolution sonography

To investigate the role of high-resolution specimen sonography (SS) to determine the precise location of the targeted lesion in relation to the six surgical margins; the specimen digital radiography isocenter and the correlation with the rate of re-excision and residual tumour. Freshly excised surgical specimens were scanned by a breast radiologist using a high-frequency linear transducer in a cohort of 25 consecutive women undergoing breast conservation. Sonographic measurements of radial distances from all six margins (superior, inferior, lateral, medial, anterior and posterior) were obtained. Sonographic positive margin status was defined as targeted mass identified <5 mm from the tissue edge. The paired t test was used for statistical comparisons between sonographic and pathological measurements. The median cancer size was 15 mm (range 3.80-42 mm; 95 % CI 9.8-18) on sonography and 16 mm (range 2-60 mm; 95 % CI 15-20) on surgical pathology. SS showed 100 % sensitivity and 59 % specificity in the evaluation of surgical pathology margins. 20 % (5 of 25) patients had positive margins where 60 % were in situ carcinoma. The likelihood of carcinoma at the initial surgical margins was significantly higher in dense breasts (3/6 = 50 % vs 1/17 = 5.8 %; p = 0.04). The deviation of the isocenter of the specimens was found not significant. SS is a valuable tool for identify the cancer within the specimen, and better asses the margins. It is of significant importance in patients with dense breasts where specimen radiography is of limited value.

Presurgical localization of breast abnormalities: an overview and analysis of 202 cases

The purpose of this study was to analyze cases undergoing imaging guided localization prior to surgical excisional biopsy of abnormalities in the breast and to describe the methodology utilized to perform such presurgical localization procedures. Presurgical localization of non palpable breast abnormalities is a simple, safe and effective procedure; it is now used more selectively for this indication due to availability of minimally invasive percutaneous biopsy procedures that can be performed under ultrasound or stereotactic guidance.