Assessment of breast cancer size: sonographic and pathologic correlation

PURPOSE

Accurate presurgical assessment of tumor size in breast cancer is important for choosing appropriate treatment. We retrospectively compared presurgical sonographic measurements of tumor size with postsurgical measurements of size and other variables.

METHODS

In 174 cases, tumor size was measured by sonography before surgery, and those measurements were compared with values obtained by histopathologic examination of the specimens. The histologic type and grade, the number of lesions, and the presence of an extensive intraductal component also were considered in the intramodal correlations of tumor size.

RESULTS

Sonographic measurements of tumor size correlated well with size measured after surgery (r = 0.72; 95% confidence interval, 0.64-0.78). The correlation was higher for lesions of 20 mm or less in their longest diameter than for larger lesions. The intramodal size correlation was lower for tumors with an extensive intraductal component than for tumors without an extensive intraductal component. The sonographic versus pathologic correlation of tumor size was less accurate when several lesions were present.

CONCLUSIONS

Sonography is useful for presurgical assessment of tumor size in patients with breast cancer, especially for single lesions of 20 mm or less and without an extensive intraductal component.

Mediastinal lymphadenopathy in cryptogenic fibrosing alveolitis: the effect of steroid therapy on the prevalence of nodal enlargement

PURPOSE

To determine the prevalence of enlarged mediastinal lymph nodes in cryptogenic fibrosing alveolitis (CFA) and to assess whether this frequency was related to steroid administration.

MATERIAL AND METHODS

Retrospective review of chest radiographs and high-resolution computed tomography (CT) of 54 patients with proven cryptogenic fibrosing alveolitis (CFA). Twenty-two of the 54 patients received oral steroids up to 2 months before the time of high-resolution CT examination (group 1); the remaining 32 patients had not taken steroids for at least 6 months before study entry (group 2). The prevalence, distribution, and size of enlarged mediastinal lymph nodes was determined in all groups. The diagnosis of CFA was histologically established in 44 patients. In 10 patients the diagnosis of CFA was based on clinical and high-resolution CT findings.

RESULTS

Mediastinal lymphadenopathy was present in 26 of 54 patients with CFA. The prevalence of enlarged nodes was 14% (three of 22) in patients who had received oral steroids up to 2 months before the time of CT examination, and 71% (23 of 32) in patients that had not taken steroids for at least 6 months before study entry.

CONCLUSION

We conclude that patients with CFA on steroid therapy had a significantly lower prevalence of mediastinal adenopathy (P < 0.001) than patients who had not taken steroids.

Metastatic breast carcinoma in axillary lymph nodes: in vitro US detection

PURPOSE

To establish the ultrasonographic (US) characteristics of benign versus metastatic lymph nodes.

MATERIALS AND METHODS

One hundred fifty-eight axillary lymph nodes in 40 patients (age range, 31-73 years) surgically treated for breast cancer have been studied in vitro with a 7.5-MHz US probe in a water bath. The long-to-short axis ratio and the hilar and cortical characteristics were evaluated; the US findings were correlated with the histopathologic findings. To estimate the long-to-short axis ratio, all lymph nodes were measured.

RESULTS

Of the 158 lymph nodes, 45 showed histopathologic evidence of metastasis; 38 of the 45 revealed US signs of malignancy. The signs that caused malignancy to be suspected were a long-to-short axis ratio of less than 1.5, absence of a hilus, and disruption of the cortical zone. The most specific sign for the diagnosis of metastasis was absence of the hilus. The increase in the long-to-short axis ratio was the finding that caused the most false-negative interpretations. Signs of malignancy were more accurate in lymph nodes 10 mm or larger than they were in lymph nodes smaller than 10 mm.

CONCLUSION

Findings of in vitro US studies of axillary adenopathy provide the basis for the evaluation of lymph node metastasis in vivo before surgery, especially in those lymph nodes 10 mm or larger.

Imaging findings of sternal abnormalities

Radiographic findings in the sternal abnormalities are often nonspecific, showing appearances from a localized benign lesion to an aggressive lesion as seen with infections and malignant neoplasms. A specific diagnosis of sternal abnormalities can be suggested on the basis of CT and MR characteristics. Familiarity with the presentation and variable appearance of sternal abnormalities may aid the radiologist is suggesting a specific diagnosis. We present among others characteristic radiographic findings of hemangioma, chondrosarcoma, hydatid disease, and SAPHO syndrome. In those cases in which findings are not specific, cross-sectional imaging modalities may help the clinician in their management.

Increased density of the azygos lobe on frontal chest radiographs simulating disease: CT findings in seven patients

OBJECTIVE

Our objectives were to show that an opaque azygos lobe on the anteroposterior chest radiograph can be a normal finding and to investigate the causes of the increased density.

MATERIALS AND METHODS

We prospectively examined 53 patients seen during a 3-year period in whom an azygos lobe was detected on chest radiographs. The size of the lobe was determined by the location of the trigone on chest radiographs. The trigone is the triangular area that marks the upper portion of the azygos fissure. If the trigone was located on the lateral aspect of the pulmonary apex, the azygos lobe was classified as type A (nine patients); if the trigone was situated at the midpoint of the cupula of the apex, the lobe was considered type B (20 patients); if the trigone was located on the medial face of the apex, the lobe was considered type C (24 patients). An opaque azygos lobe was defined as an increase of density suggestive of a pulmonary or mediastinal process. The findings on chest radiographs were compared with those on CT scans, which were obtained in all patients.

RESULTS

Radiographs showed abnormally opaque azygos lobes in seven patients. Three cases were type B and the opaque lobe had a triangular aspect, suggesting pulmonary disease. Four cases were type C and the opacity had a convex aspect, suggesting a mediastinal mass. In all cases, CT scans showed a shallow azygos lobe and increased depth of the soft tissues of the mediastinum in front of the azygos lobe. This appearance was caused by tortuosity of the supraortic vessels in six cases and by a shadow from a normal thymus in one case. No pathologic process was discovered in any of the patients.

CONCLUSION

We believe an opaque azygos lobe can be a normal finding, usually resulting from overlapping tortuous supraortic vessels.

Imaging of the azygos lobe: normal anatomy and variations

We describe the normal appearance of the azygos lobe on plain radiography and CT. Several findings are presented that, to our knowledge, have not been previously reported, such as the inferior prolongation of the fissure, the apparent intrapulmonary path of the right brachiocephalic vein and superior vena cava seen on the anteroposterior chest radiograph, and the visible fissure on the lateral chest radiograph.

[Usefulness of CT scan in the diagnosis of pulmonary aspergilloma]

Early diagnosis and precise anatomical localization of aspergillomas are essential for an effective treatment of their complications. We have evaluated the usefulness of thorax CT scan in the fulfillment of these objectives. Nine consecutive patients were studied with a presumable diagnosis of pulmonary aspergilloma. A thorax CT scan was performed in all patients (sections every 5 to 10 mm) in lying position and with lateral mobilizations. This technique allowed to rule out as fibrotic lesions some of the images previously attributed to mycetomas by conventional X-ray. On the other hand it helped to identify small size aspergillomas, to precise their localization and to demonstrate the possible communication between the main cavity and bronchial tree. In three patients who died in the period immediately following the study an excellent correlation between CT scan and underlying pathological lesions was observed.

Pulmonary nodule simulated on the lateral chest radiograph by branches of the aortic arch

A prospective study of 500 lateral radiographs of the chest showed a nodular opacity superimposed on the trachea above the aortic arch in 15 patients (3%). Because no abnormalities were identified on the posteroanterior radiograph or on CT scans, we assume that this pseudonodule is produced by branches of the aorta. In all cases, CT showed that the left subclavian artery or the innominate artery-right subclavian complex protruded into the lung.

Cystic schwannoma mimicking adrenal tumor

The CT and ultrasound findings in a case of cystic schwannoma mimicking a left adrenal tumor are reported. The differential diagnosis of cystic lesions arising in the adrenal region is discussed.

Calcification in the portal and collateral veins wall: CT findings

We report an uncommon case of calcification of the portal and collateral vein wall, in a patient with thrombosis of the portal vein secondary to cirrhosis, demonstrated by computed tomography.