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Wiacek A, Oluyemi E, Myers K, Ambinder E, Bell MAL. Coherence Metrics for Reader-Independent Differentiation of Cystic From Solid Breast Masses in Ultrasound Images. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:256-268. [PMID: 36333154 PMCID: PMC9712258 DOI: 10.1016/j.ultrasmedbio.2022.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 06/16/2023]
Abstract
Traditional breast ultrasound imaging is a low-cost, real-time and portable method to assist with breast cancer screening and diagnosis, with particular benefits for patients with dense breast tissue. We previously demonstrated that incorporating coherence-based beamforming additionally improves the distinction of fluid-filled from solid breast masses, based on qualitative image interpretation by board-certified radiologists. However, variable sensitivity (range: 0.71-1.00 when detecting fluid-filled masses) was achieved by the individual radiologist readers. Therefore, we propose two objective coherence metrics, lag-one coherence (LOC) and coherence length (CL), to quantitatively determine the content of breast masses without requiring reader assessment. Data acquired from 31 breast masses were analyzed. Ideal separation (i.e., 1.00 sensitivity and specificity) was achieved between fluid-filled and solid breast masses based on the mean or median LOC value within each mass. When separated based on mean and median CL values, the sensitivity/specificity decreased to 1.00/0.95 and 0.92/0.89, respectively. The greatest sensitivity and specificity were achieved in dense, rather than non-dense, breast tissue. These results support the introduction of an objective, reader-independent method for automated diagnoses of cystic breast masses.
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Affiliation(s)
- Alycen Wiacek
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Eniola Oluyemi
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Kelly Myers
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Emily Ambinder
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Muyinatu A Lediju Bell
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
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2
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Fujioka T, Mori M, Yashima Y, Yamaga E, Oyama J, Yokoyama K, Kubota K, Oda G, Nakagawa T, Onishi I, Tateishi U. A useful case of ultrasound-guided axillary lymph node aspiration in a breast cancer patient with improved needle visibility. Radiol Case Rep 2021; 16:3295-3299. [PMID: 34484534 PMCID: PMC8403720 DOI: 10.1016/j.radcr.2021.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 12/02/2022] Open
Abstract
Ultrasound-guided, lymph node, fine-needle aspiration cytology is important in diagnosing axillary lymph node metastasis in breast cancer. However, poor needle visibility can render the procedure difficult. We describe a case in which state-of-the-art enhancement techniques using matrix linear probes can provide better needle visibility and improve the certainty and efficiency of the examination.
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Affiliation(s)
- Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku Tokyo, 113-8519 Japan
| | - Mio Mori
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku Tokyo, 113-8519 Japan
| | - Yuka Yashima
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku Tokyo, 113-8519 Japan
| | - Emi Yamaga
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku Tokyo, 113-8519 Japan
| | - Jun Oyama
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku Tokyo, 113-8519 Japan
| | - Kota Yokoyama
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku Tokyo, 113-8519 Japan
| | - Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, 343-8555 Japan
| | - Goshi Oda
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku Tokyo, 113-8519 Japan
| | - Tsuyoshi Nakagawa
- Department of Surgery, Breast Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku Tokyo, 113-8519 Japan
| | - Iichiroh Onishi
- Department of Diagnostic Pathology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku Tokyo, 113-8519 Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku Tokyo, 113-8519 Japan
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Wiacek A, Oluyemi E, Myers K, Mullen L, Bell MAL. Coherence-Based Beamforming Increases the Diagnostic Certainty of Distinguishing Fluid from Solid Masses in Breast Ultrasound Exams. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1380-1394. [PMID: 32122720 DOI: 10.1016/j.ultrasmedbio.2020.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 05/23/2023]
Abstract
Ultrasound is often used as a supplement for mammography to detect breast cancer. However, one known limitation is the high false-positive rates associated with breast ultrasound. We investigated the use of coherence-based beamforming (which directly displays spatial coherence) as a supplement to standard ultrasound B-mode images in 25 patients recommended for biopsy (26 masses in total), with the eventual goal of decreasing false-positive rates. Because of the coherent signal present within solid masses, coherence-based beamforming methods allow solid and fluid-filled masses to appear significantly different (p < 0.001). When presented to five board-certified radiologists, the inclusion of robust short-lag spatial coherence (R-SLSC) images in the diagnostic pipeline reduced the uncertainty of fluid-filled mass contents from 47.5% to 15.8% and reduced the percentage of fluid-filled masses unnecessarily recommended for biopsy from 43.3% to 13.3%. These results are promising for the potential introduction of R-SLSC (and related coherence-based beamforming methods) into the breast clinic to improve diagnostic certainty and reduce the number of unnecessary biopsies.
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Affiliation(s)
- Alycen Wiacek
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Eniola Oluyemi
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Kelly Myers
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Lisa Mullen
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Muyinatu A Lediju Bell
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Department of Computer Science, John Hopkins University, Baltimore, Maryland, USA
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Lee C, Zhou C, Hyde B, Song P, Hangiandreou N. Techniques for Improving Ultrasound Visualization of Biopsy Markers in Axillary Lymph Nodes. J Clin Imaging Sci 2020; 10:21. [PMID: 32363083 PMCID: PMC7193150 DOI: 10.25259/jcis_9_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/03/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: Biopsy markers are often placed into biopsy-proven metastatic axillary lymph nodes to ensure later accurate node excision. Ultrasound is the preferred imaging modality in the axilla. However, sonographic identification of biopsy markers after neoadjuvant therapy can be challenging. This is due to poor conspicuity relative to surrounding parenchymal interfaces, treatment-related alteration of malignant morphology during neoadjuvant chemotherapy, or extrusion of the marker from the target. To the authors’ knowledge, the literature provides no recommendations for ultrasound scanning parameters that improve the detection of biopsy markers. The purpose of this manuscript is 3-fold: (1) To determine scanning parameters that improve sonographic conspicuity of biopsy markers in a phantom and cadaver model; (2) to implement these scanning parameters in the clinical setting; and (3) to provide strategies that might increase the likelihood of successful ultrasound detection of biopsy markers in breast imaging practices. Materials and Methods: An ex vivo study was performed using a phantom designed to simulate the heterogeneity of normal mammary or axillary soft tissues. A selection of available biopsy markers was deployed into this phantom and ultrasound (GE LOGIQ E9) was performed. Scanning parameters were adjusted to optimize marker conspicuity. For the cadaver study, the biopsy markers were deployed using ultrasound guidance into axillary lymph nodes of a female cadaver. Adjustments in transducer frequency, dynamic range, cross-beam (spatial compound imaging), beam steering, speckle reduction imaging, harmonic imaging, colorization, and speed of sound were evaluated. Settings that improved marker detection were used clinically for a year. Results: Sonographic scanning settings that improved biopsy marker conspicuity included increasing transducer frequency, decreasing dynamic range, setting cross-beam to medium hybrid, turning on beam steering, and setting speckle reduction imaging in the mid-range. There was no appreciable improvement with harmonic imaging, colorization, or speed of sound. Conclusion: On a currently available clinical ultrasound scanning system, ultrasound scanning parameters can be adjusted to improve the conspicuity of biopsy markers. Overall, optimization requires a balance between techniques that clinically increase contrast (dynamic range, harmonic imaging, and steering) and those that minimize graininess (spatial compound imaging, speckle reduction imaging, and steering). Additional scanning and procedural strategies have been provided to improve the confidence of sonographic detection of biopsy markers closely associated with the intended target.
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Affiliation(s)
- Christine Lee
- Department of Radiology, Division of Breast Imaging and Intervention, Mayo Clinic, Rochester, China
| | - Chenyun Zhou
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Brenda Hyde
- Consulting Radiologists Ltd., Edina, MN, China
| | - Pengfei Song
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL
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Sonographic visibility of cannulas using convex ultrasound transducers. BIOMED ENG-BIOMED TE 2019; 64:691-698. [DOI: 10.1515/bmt-2018-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/30/2019] [Indexed: 11/15/2022]
Abstract
Abstract
The key for safe ultrasound (US)-guided punctures is a good visibility of the cannula. When using convex transducers for deep punctures, the incident angle between US beam and cannula varies along the cannula leading to a complex visibility pattern. Here, we present a method to systematically investigate the visibility throughout the US image. For this, different objective criteria were defined and applied to measurement series with varying puncture angles and depths of the cannula. It is shown that the visibility not only depends on the puncture angle but also on the location of the cannula in the US image when using convex transducers. In some image regions, an unexpected good visibility was observed even for steep puncture angles. The systematic evaluation of the cannula visibility is of fundamental interest to sensitise physicians to the handling of convex transducers and to evaluate new techniques for further improvement.
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van de Berg NJ, Sánchez-Margallo JA, van Dijke AP, Langø T, van den Dobbelsteen JJ. A Methodical Quantification of Needle Visibility and Echogenicity in Ultrasound Images. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:998-1009. [PMID: 30655111 DOI: 10.1016/j.ultrasmedbio.2018.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/31/2018] [Accepted: 10/04/2018] [Indexed: 06/09/2023]
Abstract
During ultrasound-guided percutaneous interventions, needle localization can be a challenge. To increase needle visibility, enhancements of both the imaging methods and the needle surface properties have been investigated. However, a methodical approach to compare potential solutions is currently unavailable. The work described here involves automated image acquisition, analysis and reporting techniques to collect large amounts of data efficiently, delineate relevant factors and communicate effects. Data processing included filtering, line fitting and image intensity analysis steps. Foreground and background image samples were used to compute a contrast-to-noise ratio or a signal ratio. The approach was evaluated in a comparative study of commercially available and custom-made needles. Varied parameters included needle material, diameter and surface roughness. The shafts with kerfed patterns and the trocar and chiba tips performed best. The approach enabled an intuitive polar depiction of needle visibility in ultrasound images for a large range of insertion angles.
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Affiliation(s)
- Nick J van de Berg
- Department of BioMechanical Engineering Delft University of Technology, Delft, The Netherlands.
| | - Juan A Sánchez-Margallo
- Medical Technology, SINTEF, Norway; Computer Systems and Telematics, University of Extremadura, Extremadura, Spain
| | - Arjan P van Dijke
- Department of BioMechanical Engineering Delft University of Technology, Delft, The Netherlands
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Soliman LM, Farag E. The search for the holy grail for regional anesthesia continues. Minerva Anestesiol 2018; 85:7-9. [PMID: 30328338 DOI: 10.23736/s0375-9393.18.13263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Loran M Soliman
- Department of General Anesthesia, Anesthesia Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ehab Farag
- Department of General Anesthesia, Anesthesia Institute, Cleveland Clinic, Cleveland, OH, USA - .,Outcomes Research, Anesthesia Institute, Cleveland Clinic, Cleveland, OH, USA
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Ferre R, Pare M, Mesurolle B. Ultrasound features of retroareolar breast carcinoma. Diagn Interv Imaging 2017; 98:409-413. [DOI: 10.1016/j.diii.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
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9
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Cassano E, Trentin C. Integrated Breast Biopsy for Best Radiological Diagnosis of Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Retroareolar Carcinomas in Breast Ultrasound: Pearls and Pitfalls. Cancers (Basel) 2016; 9:cancers9010001. [PMID: 28042819 PMCID: PMC5295772 DOI: 10.3390/cancers9010001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/26/2016] [Accepted: 12/26/2016] [Indexed: 11/17/2022] Open
Abstract
Breast Ultrasound (US) is an important tool for both screening and diagnostic examinations. Although breast US has benefitted from significant recent technical improvements, its use for the retroareolar region is known to be more challenging than for other locations. The retroareolar location was defined by Giess et al. in 1998 as the region where any lesion is situated at less than two cm from the nipple and/or involves the nipple-areolar complex on mammogram. Understanding of the complex anatomy and physiology of the nipple-areolar region is important to avoid misinterpretation and misdiagnosis. The ability for the breast imager to manage difficulties related to the retroareolar area is paramount by adjusting settings (compounding, frequency, Doppler) and utilizing specific manoeuvers. Cases illustrating difficulties encountered in diagnosis of retroareolar carcinomas are presented.
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Tang SJ, Vilmann AS, Saftoiu A, Wang W, Streba C, Fink PP, Griswold M, Wu R, Dietrich CF, Jenssen C, Hocke M, Kantowski M, Pohl J, Fockens P, Annema JT, van der Heijden EH, Havre RF, Pham KDC, Kunda R, Deprez PH, Mariana J, Vazquez-Sequeiros E, Larghi A, Buscarini E, Fusaroli P, Lahav M, Puri R, Garg PK, Sharma M, Maluf-Filho F, Sahai A, Brugge WR, Lee LS, Aslanian HR, Wang AY, Shami VM, Markowitz A, Siddiqui AA, Mishra G, Scheiman JM, Isenberg G, Siddiqui UD, Shah RJ, Buxbaum J, Watson RR, Willingham FF, Bhutani MS, Levy MJ, Harris C, Wallace MB, Nolsøe CP, Lorentzen T, Bang N, Sørensen SM, Gilja OH, D’Onofrio M, Piscaglia F, Gritzmann N, Radzina M, Sparchez ZA, Sidhu PS, Freeman S, McCowan TC, de Araujo CR, Patel A, del Ali MA, Campbell G, Chen E, Vilmann P. EUS Needle Identification Comparison and Evaluation study (with videos). Gastrointest Endosc 2016; 84:424-433.e2. [PMID: 26873530 PMCID: PMC5570521 DOI: 10.1016/j.gie.2016.01.068] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/29/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS EUS-guided FNA or biopsy sampling is widely practiced. Optimal sonographic visualization of the needle is critical for image-guided interventions. Of the several commercially available needles, bench-top testing and direct comparison of these needles have not been done to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development. METHODS Descriptive bench-top testing and comparison of 8 commonly used EUS-FNA needles (all size 22 gauge): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition (Cook Medical); ClearView (Conmed); EZ Shot 2 (Olympus); and BNX (Beacon Endoscopic), and 2 new prototype needles, SonoCoat (Medi-Globe), coated by echogenic polymers made by Encapson. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in GI US examination who were unfamiliar with EUS needle devices. RESULTS There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, 1 prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (P < .01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%-75% worse, P < .001). CONCLUSIONS All FNA needles have their inherent and different echogenicities, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity.
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Affiliation(s)
- Shou-jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Adrian Saftoiu
- Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology Craiova, Craiova, Romania
| | - Wanmei Wang
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Costin Streba
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology Craiova, Craiova, Romania
| | | | - Michael Griswold
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ruonan Wu
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | | | | | | | - Jürgen Pohl
- Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | | | | | | | | | | | | | - Jinga Mariana
- University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | | | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Gurgaon, India
| | | | - Malay Sharma
- Jaswant Rai Speciality Hospital, Uttar Pradersh, India
| | | | - Anand Sahai
- Centre Hospitalier de l’Universite de Montreal, Canada
| | | | - Linda S. Lee
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Andrew Y. Wang
- University of Virginia Health System, Division of Gastroenterology and Hepatology, Charlottesville, Virginia, USA
| | - Vanessa M. Shami
- University of Virginia Health System, Division of Gastroenterology and Hepatology, Charlottesville, Virginia, USA
| | | | - Ali A. Siddiqui
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Girish Mishra
- Wake Forest University Hospital, Winston-Salem, North Carolina, USA
| | | | | | | | - Raj J. Shah
- University of Colorado Hospital, Denver, Colorado, USA
| | - James Buxbaum
- University of Southern California Keck School of Medicine, California, USA
| | | | | | | | | | | | | | | | - Torben Lorentzen
- Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Niels Bang
- Aarhus University Hospital, Aarhus, Denmark
| | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | | | - Maija Radzina
- Paula Stradina Clinical University Hospital, Riga, Latvia
| | - Zeno Adrian Sparchez
- 3rd Medical Department, University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | | | | | | | | | - Akash Patel
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Garth Campbell
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Edward Chen
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Peter Vilmann
- Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
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Ranga U, Kalra N, Saxena AK, Bhatia A, Sandhu MS, Duseja AK, Chawla YK, Khandelwal N. Focal hepatic lesions characterisation by different sonographic techniques: a prospective analysis. J Ultrasound 2016; 19:15-23. [PMID: 26941878 PMCID: PMC4762844 DOI: 10.1007/s40477-015-0172-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 06/06/2015] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Ultrasound is usually the first diagnostic investigation for the assessment of liver lesions. Apart from conventional sonography (CS), new grey-scale sonographic techniques have been developed which have increased the application of ultrasound in liver imaging. The present study was undertaken to compare image quality of CS, real-time compound sonography (RTCS), tissue harmonic sonography (THS) and tissue harmonic compound sonography (THCS) in focal liver lesions. MATERIALS AND METHODS 100 patients with focal hepatic lesions were enroled. Lesions were divided into solid and cystic group. Solid lesions were evaluated for lesion conspicuity and elimination of artefacts. For cystic lesions, lesion conspicuity, posterior acoustic enhancement and internal echoes within the lesion were evaluated. Grading was done using 3-5-point scales. Overall image quality was assessed depending on the total points. RESULTS 78 solid and 22 cystic liver lesions were included. THCS showed superior results for lesion conspicuity, elimination of artefacts and overall image quality in solid lesions. RTCS showed similar results as THCS for lesion conspicuity and overall image quality in solid lesions. THS gave better results in cystic lesions for all imaging parameters. Results of THCS though slightly inferior, showed no significant difference from THS, in cystic lesions. CS was found to have least diagnostic value in characterisation. CONCLUSIONS For evaluation of focal hepatic lesions, a combination of compound and harmonic sonography, i.e. THCS, is the preferred sonographic technique.
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Affiliation(s)
- Upasana Ranga
- />Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Naveen Kalra
- />Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Akshay K. Saxena
- />Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Anmol Bhatia
- />Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Manavjit S. Sandhu
- />Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Ajay K. Duseja
- />Departments of Hepatology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Yogesh K. Chawla
- />Departments of Hepatology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
| | - Niranjan Khandelwal
- />Departments of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012 India
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Anvari A, Forsberg F, Samir AE. A Primer on the Physical Principles of Tissue Harmonic Imaging. Radiographics 2015; 35:1955-64. [DOI: 10.1148/rg.2015140338] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Use of color Doppler ultrasound during ultrasound-guided breast interventional procedures. AJR Am J Roentgenol 2014; 203:W747. [PMID: 25415745 DOI: 10.2214/ajr.14.13189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Reusz G, Sarkany P, Gal J, Csomos A. Needle-related ultrasound artifacts and their importance in anaesthetic practice. Br J Anaesth 2014; 112:794-802. [DOI: 10.1093/bja/aet585] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Bozzato A, Loika A, Hornung J, Koch M, Zenk J, Uter W, Iro H. Comparison of conventional B-scan, tissue harmonic imaging, compound imaging and tissue harmonic compound imaging in neck lesion characterisation. Eur Arch Otorhinolaryngol 2010; 267:1593-8. [DOI: 10.1007/s00405-010-1255-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 04/09/2010] [Indexed: 10/19/2022]
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Abstract
The use of ultrasonography in dense breast remains a controversial topic. It is acknowledged that ultrasound as an adjunct to mammography increases the detection rate of breast cancers. However, the main limitation of US, in addition to its operator dependent nature, is its low specificity, leading to a high rate of false positive results. Several techniques can be used to improve the performance of US and cost/effectiveness ratio, such as Doppler imaging, harmonic imaging, spatial and frequency compound imaging, all of which are routinely available, and elastosonography, contrast US and 3D US which are still in development.
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Affiliation(s)
- I Leconte
- Département d'imagerie médicale, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Bruxelles.
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Schueller G, Schueller-Weidekamm C, Helbich TH. Accuracy of ultrasound-guided, large-core needle breast biopsy. Eur Radiol 2008; 18:1761-73. [PMID: 18414872 DOI: 10.1007/s00330-008-0955-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Revised: 01/31/2008] [Accepted: 02/23/2008] [Indexed: 11/30/2022]
Abstract
Ultrasound-guided, large-core needle biopsy (US-LCNB) of suspicious breast lesions is acknowledged as less invasive and less expensive and less time consuming than surgical biopsy, and provides a histologic diagnosis with a comparable high degree. US-LCNB has been proven to help reduce the number of unnecessary surgeries for benign disease. Its limitations, however, are false-negative results and underestimation of disease. Thus, the demand for breast teams is to carefully adhere to the principles of triple assessment and imaging-histologic correlation, and follow-up of lesions with a specific benign histology after biopsy. Also, the acceptance of guidelines and rigorous quality controls help to reliably minimize the delay in the diagnosis of breast cancer in patients with false-negative biopsies. This paper aims to summarize the equipment and methods as well as the benefits and limitations of US-LCNB. Also, guidelines of quality assessment are suggested. Finally, recent developments which may help to overcome the limitations of US-LCNB will be discussed, i.e., directional vacuum-assisted biopsy (VAB), three-dimensional (3D) US-guided biopsy, as well as the use of tissue harmonic imaging (THI) and compound imaging (CI) during biopsy.
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Affiliation(s)
- G Schueller
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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De Felice C, Savelli S, Angeletti M, Ballesio L, Manganaro L, Meggiorini M, Porfiri L. Diagnostic utility of combined ultrasonography and mammography in the evaluation of women with mammographically dense breasts. J Ultrasound 2007; 10:143-51. [PMID: 23396266 PMCID: PMC3478707 DOI: 10.1016/j.jus.2007.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess the diagnostic utility and additional cost of combined breast ultrasonography and mammography in the evaluation of asymptomatic women with mammographically dense breasts. MATERIALS AND METHODS Of 5108 asymptomatic women, who underwent mammography, 1754 had dense breasts (BI-RADS 3 or 4) and negative mammographic outcome. They were divided in 4 subgroups according to their age (<40 yrs; 40-49 yrs; 50-59 yrs; >59 yrs). Breast ultrasonography was performed immediately after mammography. Lesions detected at ultrasonography were examined cytologically/histologically. Mammograms from women, who were diagnosed carcinoma at ultrasonography, were reviewed by an external radiologist. Costs per diagnosed carcinoma and per examined woman were calculated on the basis of current regional charges. RESULTS Mammographies (5108) were performed, 67 cancers were detected (cancer detection rate 13.1‰): mammography identified 55 carcinomas and ultrasonography performed in women with dense breasts identified 12 cancers (17.9% of all cancers detected, overall cancer detection rate 6.8‰). Ultrasonography identified a benign condition in 1567 out of 1754 women (89.3%) (in 925 absence of focal lesions; 438 simple cysts; 56 ductal ectasia; 148 benign solid lesions); 97 complex cysts, 52 lesions that could not be differentiated as liquid or solid lesions, and 38 solid lesions suspicious for malignancy in the remaining 187 out of 1754 patients (10.7%). Cytology/histology confirmed carcinoma in 12 women (overall biopsy rate 26.2‰, benign biopsy rate 19.4‰). The additional costs were: € 6,123.45 per detected cancer, € 41.89 per examined woman. CONCLUSION Breast ultrasonography immediately after mammography in women with dense breasts is useful to avoid diagnostic delays and inconvenient medico-legal implications even though this procedure involves increased costs.
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Affiliation(s)
- C. De Felice
- Department of Gynaecological Sciences, University of Rome La Sapienza, Rome, Italy
| | - S. Savelli
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - M. Angeletti
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - L. Ballesio
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - L. Manganaro
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - M.L. Meggiorini
- Department of Gynaecological Sciences, University of Rome La Sapienza, Rome, Italy
| | - L.M. Porfiri
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
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Mesurolle B, Helou T, El-Khoury M, Edwardes M, Sutton EJ, Kao E. Tissue harmonic imaging, frequency compound imaging, and conventional imaging: use and benefit in breast sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1041-51. [PMID: 17646366 DOI: 10.7863/jum.2007.26.8.1041] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate different sonographic settings (tissue harmonic, frequency compounding, and conventional imaging) and to determine which setting optimizes breast lesion detection and lesion characterization. METHODS Four hundred thirteen consecutive breast lesions (249 benign and 164 malignant) were evaluated by sonography using 4 different modes (conventional imaging at 14 MHz, tissue harmonic imaging at 14 MHz [THI], and frequency compound imaging at 10 MHz [CI10] and 14 MHz [CI14]). The images were reviewed by consensus by 2 breast radiologists. For each image, the lesion was graded for conspicuity, mass margin assessment, echo texture assessment, overall image quality, and posterior acoustic features. RESULTS For lesion conspicuity, THI and CI14 were better than conventional imaging (P < .01) and CI10 (P < .01) particularly against a fatty background (P < .01 for THI versus conventional for a fatty background versus P = .13 for a dense background). Frequency compound imaging at 10 MHz performed the best in echo texture assessment (P < .01), as well as overall image quality (P < .01). For margin assessment, CI10 performed better for deep and large (> or =1.5-cm) lesions, whereas CI14 performed better for small (<1.5-cm) and superficial lesions. Finally, THI and CI14 increased posterior shadowing (P < .01) and posterior enhancement (P < .01). CONCLUSIONS The standard breast examination incorporates 2 distinct processes, lesion detection and lesion characterization. With respect to detection, THI is useful, especially in fatty breasts. With respect to characterization, compound imaging improves lesion echo texture assessment. No single setting in isolation can provide the necessary optimized information for both of these tasks. As such, a combination approach is best.
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Affiliation(s)
- Benoît Mesurolle
- Department of Radiology, McGill University Health Center, Montreal General Hospital, Montreal, QC, Canada.
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