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Bo J, Sun M, Wei C, Wei L, Fu B, Shi B, Fang X, Dong J. MRI combined with clinical features to differentiate ovarian thecoma-fibroma with cystic degeneration from ovary adenofibroma. Br J Radiol 2024; 97:1057-1065. [PMID: 38402483 DOI: 10.1093/bjr/tqae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/11/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVE To explore the value of magnetic resonance imaging (MRI) and clinical features in identifying ovarian thecoma-fibroma (OTF) with cystic degeneration and ovary adenofibroma (OAF). METHODS A total of 40 patients with OTF (OTF group) and 28 patients with OAF (OAF group) were included in this retrospective study. Univariable and multivariable analyses were performed on clinical features and MRI between the two groups, and the receiver operating characteristic (ROC) curve was plotted to estimate the optimal threshold and predictive performance. RESULTS The OTF group had smaller cyst degeneration degree (P < .001), fewer black sponge sign (20% vs. 53.6%, P = .004), lower minimum apparent diffusion coefficient value (ADCmin) (0.986 (0.152) vs. 1.255 (0.370), P < .001), higher age (57.4 ± 14.2 vs. 44.1 ± 15.9, P = .001) and more postmenopausal women (72.5% vs. 28.6%, P < .001) than OAF. The area under the curve of MRI, clinical features and MRI combined with clinical features was 0.870, 0.841, and 0.954, respectively, and MRI combined with clinical features was significantly higher than the other two (P < .05). CONCLUSION The cyst degeneration degree, black sponge sign, ADCmin, age and menopause were independent factors in identifying OTF with cystic degeneration and OAF. The combination of MRI and clinical features has a good effect on the identification of the two. ADVANCES IN KNOWLEDGE This is the first time to distinguish OTF with cystic degeneration from OAF by combining MRI and clinical features. It shows the diagnostic performance of MRI, clinical features, and combination of the two. This will facilitate the discriminability and awareness of these two diseases among radiologists and gynaecologists.
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Affiliation(s)
- Juan Bo
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, China
| | - Mingjie Sun
- Faculty of Graduate Studies, Wannan Medical College, Wuhu, Anhui 241002, China
| | - Chao Wei
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
| | - Longyu Wei
- Faculty of Graduate Studies, Bengbu Medical College, Bengbu, Anhui 233030, China
| | - Baoyue Fu
- Faculty of Graduate Studies, Bengbu Medical College, Bengbu, Anhui 233030, China
| | - Bin Shi
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
| | - Xin Fang
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
| | - Jiangning Dong
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, China
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
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Gerhardt F, Blank V, Prasse G, Wiegand J, Rademacher S, von Laffert M, Karlas T. Contrast-enhanced ultrasound characteristics for the diagnosis of biliary adenofibroma. Ultraschall Med 2024; 45:84-86. [PMID: 38081210 DOI: 10.1055/a-2209-5837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Florian Gerhardt
- Division of Hepatology, University Hospital Leipzig, Leipzig, Germany
| | - Valentin Blank
- Division of Gastroenterology, University Hospital Halle, Halle, Germany
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
| | - Gordian Prasse
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Wiegand
- Division of Hepatology, University Hospital Leipzig, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Leipzig, Leipzig, Germany
| | | | - Thomas Karlas
- Division of Gastroenterology, University Hospital Leipzig, Leipzig, Germany
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Kanemaru N, Nakai Y, Watadani T, Nakao T, Hinata M, Nakazawa A, Akamatsu N, Ushiku T, Hasegawa K, Abe O. Multimodal imaging findings of intrahepatic cholangiocarcinoma arising from a biliary adenofibroma: a case report with radiological-pathological correlation. Abdom Radiol (NY) 2023; 48:2469-2476. [PMID: 37074475 PMCID: PMC10333138 DOI: 10.1007/s00261-023-03908-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Biliary adenofibroma is a solid microcystic epithelial neoplasm in the liver, comprising microcystic and tubuloacinar glandular tissues lined by a non-mucin secreting biliary epithelium and supported by a fibrous stroma. It is an extremely rare benign tumor with potential for malignant transformation. Herein, we report the case of a 64-year-old woman diagnosed with intrahepatic cholangiocarcinoma arising from biliary adenofibroma. METHODS Imaging studies revealed a tumor of 50 mm diameter, consisting of two components in S1 of the liver. The ventral portion of the tumor showed an ill-defined mass with early peripheral and gradual centripetal enhancement invading to the middle hepatic vein on computed tomography (CT), diffusion restriction on magnetic resonance images, and high fluorine-18-2-deoxy-D-glucose (FDG) uptake on positron emission tomography, like conventional intrahepatic cholangiocarcinoma. The dorsal portion showed a well-defined and low-attenuated mass with heterogeneous early enhancement and partial wash-out on CT, marked hyperintensity on heavily T2-weighted images, and low FDG uptake. The patient subsequently underwent extended left hepatectomy. RESULTS Pathologically, the former was diagnosed as cholangiocarcinoma and the latter as biliary adenofibroma. We discuss the radiological-pathological correlation of the tumor with a literature review. CONCLUSION Preoperative diagnosis of biliary adenofibroma is extremely challenging; however, clinically, it is crucial not to miss the presence of malignant findings.
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Affiliation(s)
- Noriko Kanemaru
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yudai Nakai
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Takeyuki Watadani
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takahiro Nakao
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Munetoshi Hinata
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akiko Nakazawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nobuhisa Akamatsu
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tetsuo Ushiku
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kiyoshi Hasegawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Hao J, Zhang C, Cao Q, Zou J, Wang C. Pulmonary Adenofibroma: Report of a Case with Multiple Masses. Ann Clin Lab Sci 2016; 46:691-695. [PMID: 27993885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We are reporting one case of multiple pulmonary adenofibromas in a 57-year-old non-smoking female. Ten well-circumscribed masses were identified in both lungs. The masses are characterized by gland-like structures lined by a single layer of simple cuboidal or columnar epithelium. The stroma is abundant and demonstrates compact spindle-cells. The epithelial component is generally positive for CK7, TTF-1, Napsin A. The stromal component displays expression of vimentin, desmin, SMA, h-CALD, ER, PR, Bcl-2, and is negative for CD34, CD117, CD99. We are postulating that the possible histogenesis of these lesions is via proliferation of mesenchymal component of the peribronchial wall, which entraps the epithelium as it expands. Hitherto, this is the first case with multiple lesions reported. Currently, the patient is 11 months post-surgery and doing well.
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Affiliation(s)
- Junmei Hao
- Department of Pathology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong Province, China
| | - Cuiping Zhang
- Department of Pathology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong Province, China
| | - Qinghua Cao
- Department of Pathology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong Province, China
| | - Jiarui Zou
- Department of Pathology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong Province, China
| | - Chaofu Wang
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kato H, Hatano Y, Makino H, Furui T, Morishige KI, Matsuo M. Clear cell carcinoma of the ovary: comparison of MR findings of histological subtypes. Abdom Radiol (NY) 2016; 41:2476-2483. [PMID: 27167231 DOI: 10.1007/s00261-016-0777-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To retrospectively compare the MR findings of histological subtypes of clear cell carcinomas (CCCs) of the ovary. MATERIALS AND METHODS This single-center retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. Between April 2005 and August 2015, we found 51 consecutive patients with histopathologically proven CCCs. Among them, 44 CCCs in 37 patients who underwent preoperative MR imaging were included. CCCs were pathologically divided into three subgroups: (1) four clear cell adenofibroma-associated CCCs, (2) 21 endometriosis-associated CCCs, and (3) 19 indeterminate CCCs. The statistical tests were used to compare the frequency of qualitative assessments and value of quantitative measurements among the histological subtypes. RESULTS On T2-weighted images, hypointense areas within solid components were more frequently observed in clear cell adenofibroma-associated CCCs [3/4 (75%)] than in the remaining CCCs [1/40 (3%)] (p < 0.01), and the signal intensity ratios (SIRs) of solid components were significantly lower in clear cell adenofibroma-associated CCCs (0.27 ± 0.13) than in the remaining CCCs (0.61 ± 0.18) (p < 0.01). On T1-weighted images, hyperintensities of cystic components were more frequently observed in the endometriosis-associated CCCs [17/21 (81%)] than in the remaining CCCs [5/20 (25%)] (p < 0.01), and the SIRs of cystic components were significantly higher in endometriosis-associated CCCs (2.99 ± 1.51) than in the remaining CCCs (1.82 ± 1.10) (p < 0.01). CONCLUSION MR features may help differentiate between adenofibroma-associated and endometriosis-associated CCC.
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Affiliation(s)
- Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Yuichiro Hatano
- Department of Pathology, Gifu University School of Medicine, Gifu, Japan
| | - Hiroshi Makino
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu, Japan
| | - Tatsuro Furui
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu, Japan
| | - Ken-Ichirou Morishige
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
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Shi H, Chen X, Lv B, Zhang X. Concurrent tamoxifen-related Müllerian adenofibromas in uterus and ovary. Int J Clin Exp Pathol 2015; 8:15381-15385. [PMID: 26823898 PMCID: PMC4713684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/25/2015] [Indexed: 06/05/2023]
Abstract
Tamoxifen is a widely used in anti-oestrogen treatment of breast cancer. Previous reports showed that tamoxifen is associated with proliferative endometrial lesions. We herein reported an unusual case of concurrent hyperplastic lesions in the uterine cavity and right ovary in a 45-year-old woman with tamoxifen therapy. Regular vaginal ultrasonography showed the progressive endometrial thickening and right ovary enlargement during the period of drug use. Both lesions in the uterine cavity and right ovary showed characteristics resembling that of Müllerian adenofibroma. There were also foci of endometriosis in her bilateral ovarian surfaces. We suggest that women taking tamoxifen with a known history of endometriosis should be followed with transvaginal ultrasonography periodically.
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Affiliation(s)
- Haiyan Shi
- Department of Pathology, The Affiliated Women's Hospital, School of Medicine, Zhejiang University Hangzhou 310003, PR China
| | - Xiaoduan Chen
- Department of Pathology, The Affiliated Women's Hospital, School of Medicine, Zhejiang University Hangzhou 310003, PR China
| | - Bingjian Lv
- Department of Pathology, The Affiliated Women's Hospital, School of Medicine, Zhejiang University Hangzhou 310003, PR China
| | - Xiaofei Zhang
- Department of Pathology, The Affiliated Women's Hospital, School of Medicine, Zhejiang University Hangzhou 310003, PR China
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Affiliation(s)
- Ty K Subhawong
- Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
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Belotserkovtseva LD, Klimova NV, Samatova TB, Agapova NA. [Capacities of digital mammography in screening]. Vestn Rentgenol Radiol 2008:33-36. [PMID: 21337748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of the study was to estimate the capacities of digital mammography in screening in women followed up by a mammologist in the Surgut Clinical Perinatal Center. The results of analog and digital mammography were compared using a Senographe DS in 1772 subjects who had been followed up by a mammologist in the Surgut Clinical Perinatal Center for 3-7 years. Females in whom mammography was first made as a basic study on a digital mammography were identified in an individual group of 887 subjects. Analysis of the capacities of analog and digital mammography indicated many advantages of the latter.
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Konishi Y, Sato H, Fujimoto T, Tanaka H, Takahashi O, Tanaka T. Adenofibroma of the endometrium protruding into the vaginal cavity: findings on transvaginal ultrasonography, MRI and CT. J Obstet Gynaecol Res 2006; 32:623-7. [PMID: 17100829 DOI: 10.1111/j.1447-0756.2006.00467.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adenofibroma is a rare benign biphasic neoplasm that is classified into the mixed epithelial and mesenchymal tumor group. We report the case of a 42-year-old woman with adenofibroma of the endometrium protruding into the vagina. Transvaginal ultrasonography revealed the tumor as an intravaginal mass containing multiple cystic components. Magnetic resonance imaging (MRI) showed a heterogeneous high-intensity mass filling the vaginal cavity on T2-weighted imaging, with a low-contrast enhanced septum identified within the mass on gadolinium-enhanced, T1-weighted imaging. Contrast-enhanced computed tomography (CT) showed a heterogeneous low-attenuating multicystic mass filling the vaginal cavity. Although preoperative diagnosis of this rare tumor is very difficult, the combination of MRI, CT, and ultrasonography offers a useful diagnostic tool.
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Affiliation(s)
- Yoshitomo Konishi
- Division of Obstetrics and Gynecology, Department of Reproductive and Developmental Medicine, Akita University School of Medicine, Akita, Japan.
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Abstract
Adenofibroma is an extremely rare benign biphasic neoplasm that is classified into the mixed epithelial and mesenchymal tumor group. It typically affects the endometrium, but may occur in the cervix or in an extrauterine location. Preoperative diagnosis of this tumor is usually difficult. We describe the case of a 55-year-old woman with papillary cervical adenofibroma, which appeared as a cervical mass containing multiple cystic components on transvaginal ultrasound. This lesion appears to be clinically and histologically benign but must be differentiated from malignant lesions of the uterus, particularly from adenosarcoma, which can be suggestive of adenofibroma. Accurate diagnosis of these benign tumors permits appropriate counseling of patients.
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Affiliation(s)
- A Haberal
- SSK Maternity and Health Teaching Hospital, Gynecology, Ankara, Turkey
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Affiliation(s)
- Michael Patlas
- Department of Radiology, Hamilton General Hospital, Hamilton, ON, Canada L8L 2X2
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Chaudhary H, Raghvendran M, Dubey D, Srivastava A, Mandhani A, Kapoor R, Kumar A. Correlation of radiological and clinical features of metanephric neoplasms in adults. Indian J Cancer 2004; 41:37-40. [PMID: 15105578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The main objective was to determine the clinical and radiological features of metanephric neoplasms. The tumors were diagnosed on histopathological examination. The clinical data and imaging features were retrospectively analyzed. Between 1998 and 2003, 3 patients underwent radical nephrectomy for renal masses turning out as metanephric neoplasms on histopathology. Two of these tumors were metanephric adenoma (MA) and one was metanephric adenofibroma (MAF). Clinical and radiological features were reviewed. All patients were adult females who presented with flank pain. Tumor was detected on screening ultrasound as a hyperechoic lesion. In all cases CT showed a hyper-attenuating exophytic lesion with cystic areas that enhanced with IV contrast. Based on combination of clinical and imaging features it may be possible to prospectively identify metanephric neoplasms and thus avoid unnecessary radical nephrectomy in favor of conservative surgery.
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Affiliation(s)
- H Chaudhary
- Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Abstract
We report the fine-needle aspiration (FNA) cytology findings of endometrioid adenofibroma arising in the ovary of a 60-year-old woman who presented with vaginal bleeding. Imaging studies revealed a large pelvic mass, which was sampled by computed tomography-guided FNA and core biopsy. The FNA yielded cellular smears composed of bland endometrioid cells and fragments of ovarian-type stroma. The core biopsy showed a biphasic process comprising bland endometrioid glands in a spindle-cell stroma. Immunohistochemical studies performed on the core showed the stroma to be CD10-negative and smooth muscle actin-positive. Subsequent resection of the tumor confirmed the diagnosis and revealed an adenocarcinoma arising in the tumor that was not sampled by FNA. To our knowledge, the cytologic features of ovarian endometrioid adenofibroma have not been previously described.
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Affiliation(s)
- Keith E Volmar
- Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Idotta R, Scopelliti P, Polimeni C, Lirosi MF. Serous papillary cystic ovarian borderline tumor: case report. CLIN EXP OBSTET GYN 2003; 29:293-6. [PMID: 12635749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
A case of a 30-year-old patient with a serous papillary borderline tumor of the right ovary who underwent a simple mono-lateral salpingo-oophorectomy is presented. Conservative surgery allowed a subsequent pregnancy with spontaneous delivery 27 months later.
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Affiliation(s)
- R Idotta
- Gynecologic Department 2, Casa di cura Villa Autora, Reggio Calabria, Italy
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Affiliation(s)
- Oguz Akin
- School of Medicine, Baskent University, 06490 Ankara, Turkey
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Valentin L, Hagen B, Tingulstad S, Eik-Nes S. Comparison of 'pattern recognition' and logistic regression models for discrimination between benign and malignant pelvic masses: a prospective cross validation. Ultrasound Obstet Gynecol 2001; 18:357-365. [PMID: 11778996 DOI: 10.1046/j.0960-7692.2001.00500.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To test prospectively the diagnostic performance of two logistic regression models for calculation of individual risk of malignancy in adnexal tumors (the 'Tailor model' and the 'Timmerman model'), and to compare them to that of 'pattern recognition' (subjective evaluation of the gray-scale ultrasound image and color Doppler ultrasound examination). DESIGN Consecutive women with a pelvic mass judged clinically to be of adnexal origin underwent preoperative ultrasound examination including color and spectral Doppler examination. The same examination techniques and definitions as those used in the studies in which the logistic regression models had been created were used. The Tailor model was tested in 133 women (35 of whom hada malignancy) and the Timmerman model in 82 women (29 of whom had a malignancy). A subset of 79 women (28 of whom had a malignancy) was used to compare the performance of the Tailor model and the Timmerman model by calculating and comparing the areas under the receiver operating characteristics curves of the two models. Sensitivity and specificity with regard to malignancy were calculated for all three methods. RESULTS Pattern recognition performed better than the two logistic regression models (sensitivity around 85%, specificity around 90%). Using a risk of malignancy of > 50% to indicate malignancy (as suggested in the original publications), the sensitivity of the Tailor model was 69% and the specificity 88% (n = 133). The corresponding values for the Timmerman model were 62% and 79% (n = 82). The receiver operating characteristics curves showed the two logistic regression models to have similar diagnostic properties (area under the curve, 0.87 vs. 0.84; P = 0.25; n = 79). The diagnostic performance of the mathematical models was much poorer in this study than in those in which the models had been created. CONCLUSION The poor diagnostic performance of the mathematical models can probably be explained by subtle differences in definitions and examination technique and by differences between the original tumor populations and the study population. For mathematical models to be generally useful, they probably need to be created on the basis of a very large number of tumors, and the variables in the model must be unequivocally defined and the examination technique meticulously standardized.
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Affiliation(s)
- L Valentin
- Department of Obstetrics and Gynecology, Lund University, University Hospital, Malmö, Sweden.
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Abstract
We report a rare case and description of a benign pediatric renal mass. To our knowledge, this tumor has never been described in urologic published reports. It is possible that the identification of this renal tumor could spare a child the toxic adjuvant chemotherapy that would be administered if confused with histologically similar tumors such as clear cell sarcoma of the kidney.
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Affiliation(s)
- M A Palese
- Department of Surgery, Division of Urology, University of Maryland Medical System, Baltimore, Maryland, USA
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Alcázar JL, Errasti T, Mínguez JA, Galán MJ, García-Manero M, Ceamanos C. Sonographic features of ovarian cystadenofibromas: spectrum of findings. J Ultrasound Med 2001; 20:915-919. [PMID: 11503928 DOI: 10.7863/jum.2001.20.8.915] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To describe the sonographic characteristics of ovarian cystadenofibromas. METHODS We conducted a retrospective study of 23 ovarian tumors histopathologically confirmed as ovarian cystadenofibromas that were preoperatively evaluated by transvaginal color Doppler sonography. RESULTS In all cases the mass was predominantly cystic. Septations appeared in 30.4% of the tumors. Papillary projections or solid nodules appeared in 56.5% of the cases. The most frequent appearance was a unilocular complex cystic mass. In 47.8% of the tumors, vascularization was detected, having a typical pattern of peripheral vascularization with scattered vessels of high blood flow impedance. CONCLUSIONS We have described the sonographic spectrum of findings of ovarian cystadenofibromas. The most frequent appearance was a unilocular cystic mass with gross papillary projections or solid nodules. In almost half of the tumors, vascularization could be detected.
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Affiliation(s)
- J L Alcázar
- Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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Rose PG, Faulhaber P, Miraldi F, Abdul-Karim FW. Positive emission tomography for evaluating a complete clinical response in patients with ovarian or peritoneal carcinoma: correlation with second-look laparotomy. Gynecol Oncol 2001; 82:17-21. [PMID: 11426956 DOI: 10.1006/gyno.2001.6246] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Positive emission tomography (PET) provides a novel means of imaging malignancies. The following study was undertaken to evaluate the predictive value of PET in determining a pathologic complete response in patients with advanced ovarian or peritoneal carcinoma who had a complete clinical response following primary chemotherapy. METHODS Twenty-two patients with advanced-stage ovarian (N = 17) or peritoneal (N = 5) carcinoma who had achieved complete clinical and radiologic remission and normal CA-125 level after six cycles of chemotherapy and who had consented to a second look laparotomy procedure were studied. All patients received platinum based therapy and all but one patient, treated elsewhere, received paclitaxel in combination with platinum. Following IV administration of 20 mCi [(18)F]fluorodeoxyglucose (FDG), the entire abdomen and pelvis were scanned. Various technical modifications including bladder activity dilution, intravenous hydration with diuretic therapy, and mechanical bowel preparations, were used to reduce background activity. Second-look laparotomy findings were classified as negative, macroscopically positive if a biopsy of a suspicious area was histologically positive, or microscopically positive if only a nonsuspicious area was histologically positive. The effect of patient preparation prior to PET imaging was evaluated. RESULTS Persistent disease was found in 13 of the 22 patients (59%). Only one of nine sites with macroscopic and none of four with microscopic disease were accurately predicted. The sensitivity was only 10% and the specificity 42%. Intravenous hydration, diuretic therapy, and bowel preparation did not improve the results. CONCLUSIONS These results suggest that despite technical modifications the sensitivity of PET before second-look laparotomy for small-volume persistent disease is low.
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Affiliation(s)
- P G Rose
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Cleveland, Ohio, 44106, USA
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20
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Abstract
Nephrogenic adenofibroma is a benign renal tumor in children and young adults described by Hennigar and Beckwith in 1992. Seven cases have been described, and we report the first case in an 11-month-old child, in good health, revealed by a macroscopic hematuria. Nephrogenic adenofibroma is an unusual tumor, which was difficult to distinguish from nephroblastoma and mesoblastic nephroma. Beckwith makes a distinction between this principal differential diagnosis in child renal tumors based upon morphologic and immunohistochemical patterns. In our observation, the diagnosis remained difficult and needed several reviews of our case. Beckwith proposed the final diagnosis: nephrogenic adenofibroma with stromal predominance. The prognosis is excellent and no treatment is indicated. A FISH analysis of the tumor cells found a trisomy 11. Trisomy 11 has been reported in mesoblastic nephroma as the most frequent chromosomal abnormality. This finding in tumor cells provides an argument for excluding the diagnosis of nephroblastoma but can not clarify the difference between nephrogenic adenofibroma and mesoblastic nephroma.
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Affiliation(s)
- E Guzman
- Laboratoire d'Anatomie Pathologique, H spital Pasteur, CHU Nice, France.
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21
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Hermans J, Bodart F, François D, Merlo P, Fauconnier JP, Schmitz A, Gérard R, de Ruyver D, Eeckhoudt L. [++Scintimammography: a new imaging technique for diagnosis and follow-up of breast cancer]. Bull Cancer 2000; 87:334-40. [PMID: 10827352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
99m Tc MiBi has emerged as a new imaging technique for primary breast carcinomas. The aim of this study was to analyze the diagnostic performance and the additional information provided by scintimammography (SMN). Two hundred and forty consecutive women referred to surgery for abnormalities breast or suspicious breast cancer were scanned before surgery. Sensitivity and specificity were respectively 92% and 53%. PPV: 77.5% and PVN: 79.3%. All false negative scans occurred in cancers 1 cm. SMN detected multiple foci of uptake in the same breast in 13%, that were all confirmed to be multifocal disease and histology. Controlateral focal uptake was also detected; at this time 5/27 are confirmed to be bilateral breast neoplasms; 22 patients are in follow-up. SMN is reliable in the diagnosis of breast cancer and also with difficult cases of mammography. Moreover, SMN provides additional qualitative information in 19.6% of breast carcinomas, such as chest wall infiltration, multifocal or bilateral breast cancer.
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Affiliation(s)
- J Hermans
- Centre hospitalier Jolimont-Lobbes, 159, rue Ferrer, 7100 La Louvière, Belgique
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22
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Abstract
PURPOSE To describe the sonographic features of paraovarian cystadenomas. MATERIALS AND METHODS We searched the computerized pathology and radiology databases for cases of histopathologically proved paraovarian cystadenomas from January 1993 through December 1996 in which preoperative sonography had also been performed. Fourteen paraovarian cystadenomas or cystadenofibromas were identified in 14 patients aged 20-57 years. Sonographic and pathologic findings were correlated. RESULTS Three of the masses appeared as simple cysts sonographically. Of the remaining 11 masses, nine had solid nodular areas within the cyst; three had septations; and four had a thick wall, an irregular wall, or both at sonography. At sonography, four masses were thought to arise outside the ovary, four were erroneously thought to arise in the ovary, and the location was uncertain in six. CONCLUSION Paraovarian cystadenomas are cystic masses that usually contain one or more small solid nodules and occasionally contain septations.
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Affiliation(s)
- C D Korbin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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23
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Christensen B, Hoffmann J, Metz KA, Schindler AE. [Differential diagnosis of cystic adnexa processes. A comparison of the value of sonography, puncture cytology and color and biochemical biopsy analysis with histology]. Zentralbl Gynakol 1997; 119:66-74. [PMID: 9139500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The histological diagnoses of 109 cystic adnexal masses were compared with the results of ultrasound examination, color, cytology and biochemical analyses of cystic fluid. In cases with suspicious results by ultrasound examination most of the malignant tumors but only a small number of benign cystic masses were found. Macroscopic and cytologic examinations gave no further informations. By biochemical analyses functional cysts could be detected with 86% of sensitivity and 100% of specificity by a combination of estradiol, progesterone and Ca 12-5. Endometrioma and malignant tumors could be separated from other adnexal masses (specificity 95%, sensitivity 100%) with a combination of Tag 72-4 and CASA.
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Affiliation(s)
- B Christensen
- Zentrum für Frauenheilkunde, Universitätsklinikum-GHS Essen
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24
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Abulafia O, Sherer D. Longstanding ovarian serous cystadenofibroma sonographically mimicking a urachal cyst. Acta Obstet Gynecol Scand 1996; 75:685-7. [PMID: 8822669 DOI: 10.3109/00016349609054701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- O Abulafia
- Department of Obstetrics and Gynecology, Marshall University, Huntington, West Virginia, USA
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25
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Huang KT, Chen CA, Cheng WF, Wu CC, Jou HJ, Hsieh CY, Lin GJ, Hsieh FJ. Sonographic characteristics of adenofibroma of the endometrium following tamoxifen therapy for breast cancer: two case reports. Ultrasound Obstet Gynecol 1996; 7:363-366. [PMID: 8774105 DOI: 10.1046/j.1469-0705.1996.07050363.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Adenofibroma of the endometrium is thought to be a rare benign variant of the mixed mesodermal tumor, and its preoperative diagnosis is difficult. We describe the sonographic characteristics of two cases of adenofibroma of the endometrium. In both cases the patient was receiving prolonged tamoxifen therapy following surgery for breast cancer. Sonographically, this rare disease is observed as an intracavitary mass containing multiple small cysts with low-resistance intratumor blood flow. The unique sonographic findings make the preoperative diagnosis possible.
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Affiliation(s)
- K T Huang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan
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26
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Comerci SC, Levin TL, Ruzal-Shapiro C, Berdon WE, Beckwith JB, Hibshoosh H, Hurlet-Jensen A, Sitarz AL. Benign adenomatous kidney neoplasms in children with polycythemia: imaging findings. Radiology 1996; 198:265-8. [PMID: 8539391 DOI: 10.1148/radiology.198.1.8539391] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE To correlate pathologic, computed tomographic (CT), and ultrasound (US) characteristics of nephrogenic adenofibromas and embryonal adenomas (uncommon pediatric renal tumors) in children. MATERIALS AND METHODS Medical records and imaging and pathologic findings were reviewed in three children (aged 6 1/2, 7, and 11 years) with adenomatous renal tumors and polycythemia. Specimens were reviewed at the National Wilms Tumor Study Pathology Center (Loma Linda, Calif). RESULTS All tumors were smaller than 3 cm in greatest dimension. They were hyperechoic on US scans and had high attenuation on unenhanced CT scans. Two patients underwent nephrectomy for initial diagnosis of Wilms tumor. The third underwent local excision. At pathologic examination, embryonal-appearing adenomatous epithelial cells were found to form tubules and papillae with abundant psammomatous calcifications. Two masses were classified as embryonal adenomas and one as nephrogenic adenofibroma. CONCLUSION Increased attenuation on CT scans and increased echogenicity on US scans of renal adenomatous tumors are distinctive findings that may reflect the presence of tubulopapillary structures and psammomatous calcifications.
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Affiliation(s)
- S C Comerci
- Department of Radiology, Columbia Presbyterian Medical Center, Babies' and Children's Hospital of New York, New York, NY 10032, USA
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27
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Mascaretti G, Carta G, Renzi E, Peluzzi C, Bonitatibus A, Di Francesco CL, Patacchiola F, Moscarini M. [Transvaginal ultrasonography and nuclear magnetic resonance. Comparison of techniques in the evaluation of ovarian lesions]. Minerva Ginecol 1994; 46:591-5. [PMID: 7854561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A total of 53 patients were included in this study, aged between 21 and 72 years old and hospitalised with the diagnosis of ovarian tumour. All patients underwent a clinical examination, ultrasonography and NMR prior to surgery. The findings of ultrasonography and NMR were correlated with histological results in order to evaluate the value of these methods in the differential diagnosis of benign and malignant ovarian tumours. Histological tests revealed 46 benign tumours, 3 borderline cases and 4 malignant growths. Transvaginal ultrasonography revealed precisely 47 out of 53 ovarian tumours, and NMR 49 out of 53. The main limitation of both techniques was the tendency to overestimate ovarian lesions (specificity: ultrasonography 89%, NMR 93%). As far as concerns the identification of malignant lesions NMR does not appear to offer significant advantages in comparison to ultrasonography (sensitivity 85% ultrasonography = NMR).
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MESH Headings
- Adenocarcinoma, Papillary/diagnosis
- Adenocarcinoma, Papillary/diagnostic imaging
- Adenocarcinoma, Papillary/pathology
- Adenofibroma/diagnosis
- Adenofibroma/diagnostic imaging
- Adenofibroma/pathology
- Adult
- Aged
- Cystadenocarcinoma/diagnosis
- Cystadenocarcinoma/diagnostic imaging
- Cystadenocarcinoma/pathology
- Cystadenoma, Mucinous/diagnosis
- Cystadenoma, Mucinous/diagnostic imaging
- Cystadenoma, Mucinous/pathology
- Cystadenoma, Serous/diagnosis
- Cystadenoma, Serous/diagnostic imaging
- Cystadenoma, Serous/pathology
- Diagnosis, Differential
- Female
- Fibroma/diagnosis
- Fibroma/diagnostic imaging
- Fibroma/pathology
- Humans
- Magnetic Resonance Imaging
- Middle Aged
- Ovarian Cysts/diagnosis
- Ovarian Cysts/diagnostic imaging
- Ovarian Cysts/pathology
- Ovarian Neoplasms/diagnosis
- Ovarian Neoplasms/diagnostic imaging
- Ovarian Neoplasms/pathology
- Teratoma/diagnosis
- Teratoma/diagnostic imaging
- Teratoma/pathology
- Ultrasonography
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Affiliation(s)
- G Mascaretti
- Dipartimento di Discipline Chirurgiche, Università degli Studi de L'Aquila
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28
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Salem S, White LM, Lai J. Doppler sonography of adnexal masses: the predictive value of the pulsatility index in benign and malignant disease. AJR Am J Roentgenol 1994; 163:1147-50. [PMID: 7976891 DOI: 10.2214/ajr.163.5.7976891] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether pulsed Doppler sonography can be used to distinguish between benign and malignant adnexal masses on the basis of pulsatility index. SUBJECTS AND METHODS In an 18-month period, all patients in whom an adnexal mass was detected at sonography had further evaluation of the mass by color and pulsed Doppler sonography. Ninety-nine patients with 102 masses that were surgically removed were included in the study. The pulsatility indexes were calculated from the reproducible spectral waveforms generated from flow centrally or peripherally within or immediately adjacent to the mass. Each lesion was categorized on the basis of its gray scale morphologic features as typically benign or indeterminate/malignant in appearance. RESULTS Of the 102 adnexal masses, 89 were benign and 13 were malignant. In seven of the 89 benign lesions, no flow could be detected, and these were excluded from analysis. Of the remaining 82 benign lesions, 65 showed pulsatility indexes consistently equal to or greater than 1.0, and 17 showed pulsatility indexes of less than 1.0. Ten of the 13 malignant lesions had pulsatility indexes consistently less than 1.0, and three primary malignant tumors had their lowest pulsatility indexes ranging between 1.1 and 1.8. Sixty-five of the 68 masses with pulsatility indexes equal to or greater than 1.0 were benign, for a positive predictive value of 96% for benign disease. Ten of the 27 masses with pulsatility indexes of less than 1.0 were malignant, for a positive predictive value of 37% for malignant disease. Forty-five masses were detected in perimenopausal and postmenopausal patients. In this group, the pulsatility index had a positive predictive value of 88% for benign disease and 47% for malignant disease. In this study, 45 of 49 masses that had a typically benign sonographic appearance had pulsatility indexes equal to or greater than 1.0. All 49 masses had benign histology. In the remaining 46 masses with an indeterminate/malignant sonographic appearance, 20 of 23 with pulsatility indexes equal to or greater than 1.0 were benign, and 10 of 23 with pulsatility indexes of less than 1.0 were malignant. CONCLUSION Our results show a high positive predictive value of high-impedance flow in benign adnexal disease and a predominance of low-impedance flow in malignant adnexal disease. However, the pulsatility indexes showed considerable overlap between benign and malignant lesions, indicating that Doppler sonography has severe limitations in the differentiation of benign from malignant adnexal disease on the basis of low-impedance flow (pulsatility index < 1.0).
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Affiliation(s)
- S Salem
- Department of Radiological Sciences, Mount Sinai Hospital, Toronto, Ontario, Canada
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29
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Abstract
This article illustrates the different appearances of benign ovarian and paraovarian masses at endovaginal sonography. A retrospective study was performed of the records for 118 patients with 140 surgically proved benign adnexal masses, including dermoid cysts (n = 27), endometriomas (n = 40), epithelial inclusion cysts (n = 14), serous cystadenomas (n = 11), mucinous cystadenomas (n = 14), fibromas (n = 11), cystadenofibromas (n = 12), paratubal cysts (n = 5), hydrosalpinges (n = 3), and tubo-ovarian abscesses (n = 3). Preoperative diagnosis was made in 96% of the dermoid cysts on the basis of a hyperechoic attenuating component or multiple small horizontal interfaces and in 100% of uncomplicated fibromas on the basis of a hypoechoic attenuating mass. There was an overlap among the endovaginal sonographic appearances of the other condition.
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Affiliation(s)
- M Atri
- Department of Diagnostic Radiology, Montreal General Hospital, Quebec, Canada
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30
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31
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Runkel S, Wischnik A, Teubner J, Kaven E, Gaa J, Melchert F. Oxygenation of mammary tumors as evaluated by ultrasound-guided computerized-pO2-histography. Adv Exp Med Biol 1994; 345:451-8. [PMID: 8079743 DOI: 10.1007/978-1-4615-2468-7_60] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The average pO2 in breast carcinomas in situ is significantly lower than that in the normal breast tissue. The mean pO2 value for benign breast tumors is significantly higher than that of the breast cancers but lies significantly lower than the corresponding normal breast. No significant differences are found in the mean pO2 values when comparing cancers of different stages and histology. A decrease in the mean pO2 value is measured from the periphery to the center of the breast tumors investigated. The average pO2 values for pre- and postmenopausal patients differ significantly. The described method provides a reliable assessment of tissue pO2 in situ with a minimum of discomfort. Due to extensive inter tumor heterogeneity, prediction of pO2 values for tumors of same stage and same histology is not possible, so that measurement of individual tumor is mandatory for determining therapy response.
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Affiliation(s)
- S Runkel
- Department of Obstetrics and Gynecology, University of Heidelberg, Mannheim, Germany
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32
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Cosgrove DO, Kedar RP, Bamber JC, al-Murrani B, Davey JB, Fisher C, McKinna JA, Svensson WE, Tohno E, Vagios E. Breast diseases: color Doppler US in differential diagnosis. Radiology 1993; 189:99-104. [PMID: 8372225 DOI: 10.1148/radiology.189.1.8372225] [Citation(s) in RCA: 195] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To subjectively and semiquantitatively evaluate color Doppler signals on images of breast lesions. MATERIALS AND METHODS A 5-MHz ultrasound (US) system was used to examine 210 new breast lesions. Signals were evaluated subjectively with an analog scale. A semiquantitative scoring system involved analysis of the average number of vessels per square centimeter and average density of color pixels. RESULTS Vessels were detected in 57 of 58 cancers (mean, 0.11 vessels per square centimeter, occupying 1.76% of the scan area). Color Doppler scores had no correlation with conventional prognostic indicators such as lymph node status or survival. Fewer vessels per square centimeter (mean, 0.06) occupying a smaller area (mean, 0.41%) were detected in the five fibroadenomas (n = 36) that showed color Doppler signals. Most cases (99 of 104 [96%]) of benign breast changes had no color Doppler signals. CONCLUSION Color Doppler signals in a lesion otherwise thought to be benign should prompt a biopsy, while the absence of signals in an indeterminate lesion is reassuring.
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33
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Abstract
The value of whole body positron emission tomography using F-18 2-deoxy-2-fluoro-d-glucose in primary work-up and follow-up was prospectively evaluated in 37 patients with primary or metastatic breast cancer. From 20 primary breast masses 15 from 16 malignant and 4 from 4 benign lesions confirmed by biopsy, were detected. In 3 out of 21 patients in correlation to morphologic imaging, respectively biopsy, no metastatic disease was not identified. Generally speaking, whole body positron emission tomography appears to be a suitable diagnostic staging tool in breast cancer.
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Affiliation(s)
- E U Nitzsche
- Department of Radiological Science, UCLA School of Medicine
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34
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Leonardi M, Pedretti G, Caprioli E, Bellicini G. [The value of ultrasonography in benign breast diseases]. Minerva Ginecol 1993; 45:113-6. [PMID: 8332275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In recent years breast scans have been widely used for the precise diagnosis of breast cancer. However, the value of this diagnostic tool is debatable in comparison to mammography in women of a childbearing age who often present a dense youthful breast. The role of clinical examination as a screening process is also examined. In the light of these findings the Authors evaluated the role played by ultrasonography in breast cancer, and in particular benign breast tumours, in a group of outpatients attending the clinic. The technique used was relatively simple: the scan in the department used for gynecological and obstetrical ultrasonography was fitted with a 5 MHz probe and was used to perform all the scans. In addition, a Kiteco space maintainer was used for ultrasonography of soft tissue. Scans were performed at a distance of 0.5 cm. The Authors examined 107 patients with benign breast tumours using ultrasonography. They evaluated the morphology, dimensions, edges and internal echo-structure of pathological formations and adjacent areas. The value of breast ultrasonography emerges from an analysis of the results both in the study of the glandular structure and in the differentiation between cystic and solid type lesions which are not always diagnosed during clinical examination. A total of 59 fibroadenoma, 44 cysts, 2 lipoma and 2 phylloids were diagnosed. Fibroadenomas had smooth edges in 98.4% of cases and were lobulate in 1.6%. In 100% of cases the fibroadenomas diagnosed presented fine internal homogeneous echoes with a lower echogenicity than that of surrounding glandular tissue.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Leonardi
- Divisione di Ginecologia e Ostetricia, USSL 36, Iseo, BS
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35
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Marquet KL, Funk A, Fendel H, Handt S. [The echo-dense edge and hyper-reflective spikes: sensitive criteria for malignant processes in breast ultrasound]. Geburtshilfe Frauenheilkd 1993; 53:20-3. [PMID: 8382650 DOI: 10.1055/s-2007-1023631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
At the Department of Gynaecology of the RWTH-Aachen, 110 patients with palpatory and/or mammographic suspect findings were sonographically examined. By using a high resolution 10 MHz-probe with a freely mobile transducer, a new method of differential diagnostic criteria was established, pertaining to the edge of the tumour. The high echogenetic halo and the hyperdense spikes proved to be most important differential diagnostic tools in assessing sonographically suspect tumours.
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36
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Patton ML, Haith LR, Goldman WT. An improved technique for needle localized biopsy of occult lesions of the breast. Surg Gynecol Obstet 1993; 176:25-9. [PMID: 8381241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The current retrospective study reports the results of the 98 outpatient procedures using a modified version of needle localized excisional biopsies of occult lesions of the breast at a community hospital. Intraoperative fluoroscopy is used to direct a second needle placement along the dissection tract to localize more accurately the intraglandular lesion. The medical records of 88 patients who underwent this procedure between 1989 and 1991 were reviewed. A detailed description of the procedure used as well as clinical data from roentgenographic, histologic and operative reports are given. Benign histologic findings were reported in 80.6 percent of the instances, with fibrocystic disease accounting for most (66 of 79) of the benign diagnoses. Primary malignancy was found in 18 biopsies, with noninfiltrating ductal carcinoma being the most prevalent (n = 8). Infiltrating ductal carcinoma was found six times, infiltrating lobular carcinoma was found three times and a combination of noninfiltrating ductal and noninfiltrating lobular carcinoma was found once. Metastasis to axillary lymph nodes was found twice. One lesion of the breast was large cell lymphoma. Mass lesions accounted for 46 of the 98 lesions and calcifications accounted for the remaining 52. Thirteen of the 18 primary lesions that proved to be malignant presented as calcifications, whereas five presented as a mass. Infiltrating carcinoma, however, was more likely to be associated with mass lesions than with calcifications--all five malignant mass lesions were infiltrating, whereas of the 13 lesions with calcifications, four were infiltrating. Failure to confirm the removal of the lesion roentgenographically occurred once, but there were no other complications to this technique. Additionally, a circumareolar incision was used in 64.7 percent of the procedures and 76.5 percent of the procedures were done using local anesthesia and intravenous sedation. We conclude that the technique introduced herein is a simple, highly reliable means to localize accurately nonpalpable lesions of the breast using a combination of fluoroscopy and needle localization that allows a better cosmetic result.
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MESH Headings
- Adenofibroma/diagnostic imaging
- Adenofibroma/pathology
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Needle/methods
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Carcinoma/diagnostic imaging
- Carcinoma/pathology
- Carcinoma/secondary
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/secondary
- Female
- Fibrocystic Breast Disease/diagnostic imaging
- Fibrocystic Breast Disease/pathology
- Fluoroscopy
- Humans
- Lymphatic Metastasis
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Retrospective Studies
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Affiliation(s)
- M L Patton
- Department of Surgery, Crozer Chester Medical Center, Upland, Pennsylvania 19013-3995
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37
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Image interpretation session: 1992. Pott disease (tuberculous spondylitis), with alcoholic cirrhosis and an incidental fibroadenoma of the left breast. Radiographics 1993; 13:172-4. [PMID: 8426920 DOI: 10.1148/radiographics.13.1.8426920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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38
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39
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Jokich PM, Monticciolo DL, Adler YT. Breast ultrasonography. Radiol Clin North Am 1992; 30:993-1009. [PMID: 1518941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ultrasound of the breast has a role both as the primary and as an ancillary modality in the work-up of breast abnormalities. Its main role is to differentiate cystic from solid abnormalities and to thereby guide further work-up and intervention. Only the diagnosis of a simple cyst will obviate the need for further evaluation or therapy. Doppler ultrasonography of breast lesions may give further information in the future, although this is currently not employed in clinical practice. Various types of ultrasound examinations may yield useful information in the patient with breast cancer or in women with breast prostheses.
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Affiliation(s)
- P M Jokich
- Department of Radiology, Rush Medical College, Chicago, Illinois
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40
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Skaane P. [Ultrasonic examination of the breast]. Tidsskr Nor Laegeforen 1992; 112:2367-9. [PMID: 1412239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Ultrasonography can be a valuable adjunct to mammography in the evaluation of breast pathology. Breast sonography can differentiate a cyst from a tumour. Fibroadenomas and carcinomas can often present characteristic ultrasonic features but, as a rule, ultrasonography does not give a confident diagnosis of benign or malignant tumour. Ultrasound-guided needle biopsies and preoperative localization of non-palpable lesions can be performed. Breast sonography should be regarded as an adjunct to mammography. The practical role of ultrasonography in a breast-imaging centre will depend on the quality of the triple diagnostics.
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Affiliation(s)
- P Skaane
- Røntgenavdelingen, Ullevål sykehus, Oslo
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41
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Abstract
The authors describe mammographic and pathologic evidence of the growth of a fibroadenoma in an 82-year-old obese woman, 44 years after menopause, who had never been treated with hormone therapy. The patient's obesity is hypothesized as the causal factor for increased estrogen levels leading to growth of the fibroadenoma.
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Affiliation(s)
- R C Swisher
- Iris Cantor Center for Breast Imaging, Department of Radiological Sciences, University of California Los Angeles 90024
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42
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Abstract
From July 1, 1989, through June 30, 1991, 1,218 preoperative wire-localization breast biopsies were performed at one institution. In this group, 254 (21%) of the abnormalities were fibroadenomas, 26 of which had enlarged or developed in the interval between routine or short-interval follow-up mammography. This interval growth was noted in 21 premenopausal women and in five who were postmenopausal and receiving oral estrogen supplementation.
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Affiliation(s)
- J E Meyer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
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43
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Abstract
Fifteen patients are described who attended out Breast Screening Programme, and were found to have sclerosed fibroadenomas, the imaging of which raised the possibility of carcinoma. In six of these a reflective zone between a mass lesion and distal acoustic shadowing might have been used to infer the benign diagnosis.
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Affiliation(s)
- P B Guyer
- Southampton and Salisbury Breast Screening Unit, Royal South Hants Hospital
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44
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Symonds DA, Copeland BE, Drane A, Kaplan GN, Graham RR. Pathologic correlation in mammographically directed breast biopsies. Arch Pathol Lab Med 1992; 116:28-32. [PMID: 1734830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In a series of 1137 diagnostic breast biopsy specimens in a 2-year period, nearly half (n = 534) underwent specimen mammography. Calcifications were found in 48% of the specimen mammograms. In a quarter of the cases, calcification was a marker either for carcinoma or a significant precursor lesion. Moreover, in the majority of these malignancies, calcifications were markers of preinvasive carcinoma. In another quarter of cases, some form of proliferative ductal hyperplasia accounted for calcifications, and in the remainder, cysts and miscellaneous other conditions accounted for calcifications. The yield of malignancy was much lower in noncalcified specimens (12%). A nodular or asymmetric density proved to be a fibroadenoma in 30% of cases. However, the majority of cases had less well-defined changes, probably representing some form of lobular fibrosis. We found submission of a duplicate specimen mammogram with the breast biopsy specimen to pathology to be a significant adjunct to correlation. The abnormal area is marked on the mammogram by the radiologist for the pathologist. This is particularly helpful for localizing noncalcified stromal abnormalities. Calcifications are most easily and reliably isolated by serial slicing and performing another radiograph of the slices.
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Affiliation(s)
- D A Symonds
- Department of Laboratory Medicine, Union Memorial Hospital, Baltimore, MD 21218
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45
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Schild R, Fendel H. [Doppler ultrasound differentiation of benign and malignant breast tumors]. Geburtshilfe Frauenheilkd 1991; 51:969-72. [PMID: 1665464 DOI: 10.1055/s-2008-1026246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Before surgery we studied the blood flow in and around 59 breast tumours (35 malignant and 24 benign) and investigated a correlation with the histology. The most decisive factors were the maximum end-diastolic frequency B (probability greater than magnitude of z = 0.0009) and the mean frequency F mean (probability greater than magnitude of z = 0.0017). The maximum systolic frequency A, the resistance index Ri, the diastolic angle W and the pulsatility index Pi showed less significant differences between malignant and benign histological types. In a retrospective survey, we tried to confirm the definitive histology by our Doppler results. In this, we failed in 17.14%--of malignant cases and in 33.33% in the cases of benign tumours.
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46
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Hachiya J, Seki T, Okada M, Nitatori T, Korenaga T, Furuya Y. MR imaging of the breast with Gd-DTPA enhancement: comparison with mammography and ultrasonography. Radiat Med 1991; 9:232-40. [PMID: 1668410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The accuracy of MR imaging with Gd-DTPA enhancement was compared with mammography and ultrasonography in 52 patients with clinically palpable benign and malignant breast masses (36 carcinomas, 2 malignant phyllodes tumors, 7 fibroadenomas, 7 cysts). On dynamic MR imaging, carcinomas and fibroadenomas were discriminated by their different dynamic enhancement profiles. In carcinomas, signal intensity increased rapidly, reaching a peak or plateau within 2 min after the injection of contrast medium. In fibroadenomas, signal intensity showed a much slower continuous increase without ceasing until about 8 min after injection. Malignant phyllodes tumors showed a dynamic enhancement profile identical to that of benign fibroadenomas. MR imaging correctly identified 84% of malignant tumors, 86% of fibroadenomas, and 100% of cysts, and was substantially more accurate in tissue characterization than mammography. The results of ultrasonography were highly similar to those of MR imaging. However, no single modality was infallible, and the three modalities were complementary rather than competitive. Considering the high cost and long examination time of MR imaging, mammography supplemented by ultrasonography seems to be the method of choice in the diagnosis of breast lesions. Nevertheless, MR imaging can add important information when the results of mammography and ultrasonography are insufficient or contradictory.
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Affiliation(s)
- J Hachiya
- Department of Radiology, Kyorin University School of Medicine, Tokyo, Japan
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47
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Edmonds PD, Mortensen CL, Hill JR, Holland SK, Jensen JF, Schattner P, Valdes AD. Ultrasound tissue characterization of breast biopsy specimens. Ultrason Imaging 1991; 13:162-85. [PMID: 1650048 DOI: 10.1177/016173469101300204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Results of measurements of ultrasound speed and absorption coefficients in the range 3 to 8 MHz in breast tissues at 37 C are reported and analyzed in attempts to identify a set of ultrasound parameters capable of discriminating normal, benign, and malignant tissues. We analyzed 118 tissue regions, comprising 47 normal, 55 benign, and 16 malignant by straight-line fitting of frequency dependence of attenuation. Data for ten additional regions, for a total of 128, became available and were added to the cohort when we subsequently fitted quadratic curves. Sound speed consistently emerged as the variable with greatest discriminating power, particularly for separating normal from benign and malignant tissue. Great difficulty was encountered in discriminating benign from malignant, even when the jackknife technique was used. More success was found with classification and regression trees (CART), although results were sensitive to assigned misclassification costs. Best results from straight-line fits were obtained when discriminating malignant from combined normal/benign data after randomly assigning 75 percent of the data to the learning set and 25 percent to the test set. Then, 23 out of 25 normal/benign and 4 out of 4 malignant cases in the test set were correctly classified. With quadratic fitting, best results were obtained in the three-class case--the false positive rate for malignancy was reduced to zero in the learning (0/31) and test (0/10) sets. Nevertheless, the false negative rate increased to 13 out of 31 (42 percent) in the learning set, while attaining zero (0/4) in the test set.
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Affiliation(s)
- P D Edmonds
- Bioengineering Research, SRI International Menlo Park, CA 94025
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48
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Mendelson EB. Ultrasound secures place in breast Ca management. Diagn Imaging (San Franc) 1991; 13:121-9, 157. [PMID: 10149716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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49
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Latteri M, Cipolla C, Amato C, Bottino A, Graceffa G, Cassano T, Salanitro L, Bajardi G, Tomasino RM, Nuara R. [Importance of early diagnosis in the improvement of prognosis in breast carcinoma: non-palpable lesions. Preliminary results]. MINERVA CHIR 1990; 45:1439-45. [PMID: 1965017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There are still marked differences in the current indications for breast screening proposed by the various international school of oncology. Epidemiological data to the effect that breast screening in asymptomatic women aged over 50 reduces the death rate due to breast cancer now appears to be widely accepted, but an analogous finding for women aged between 40-49 has not yet been confirmed. Following a brief analysis of the most important breast screening programmes carried out to date, the Authors report the preliminary results regarding the identification and biopsy of non-palpable breast lesions during the course of a screening programme in 1986 by the Dept. of Cancer Surgery. Of a total of 1128 breast scans in asymptomatic patients aged between 40 and 73, 24 suspect (1.9%) non-palpable lesions were found of which 5 (20.8%) proved to be carcinomas.
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50
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Senofsky GM, Davies RJ, Olson L, Skully P, Olshen R. The predictive value of needle localization mammographically assisted biopsy of the breast. Surg Gynecol Obstet 1990; 171:361-5. [PMID: 2237718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study was done to review critically the experience at the University of California at San Diego in needle localization mammographic biopsy of the breast with regard to use and accuracy in identifying early carcinoma of the breast. Ninety-seven patients underwent needle localization mammographic biopsy of the breast between 1985 and 1987. Indications for this procedure included the presence of microcalcifications or a mass shown on mammographic examination, or both, in conjunction with physical examination which did not define a discrete abnormality in the area. Mammographic, demographic, pathologic, hormone receptor data and staging information were recorded and processed on the MicroVax II computer (Digital Equipment Corporation). Twenty-four per cent of lesions with needle localization mammographic assisted biopsy proved to be malignant. Sixteen lesions were diagnosed as an infiltrating ductal carcinoma and ten of these had an accompanying intraductal carcinoma. Over-all, intraductal carcinoma was present in 16 of the 23 specimens diagnosed as malignant. At biopsy, the margins were clear in 17 of 23, and vascular invasion was present in only one patient with an infiltrating lobular carcinoma. Five were tumor in situ, 12 were stage 1 and five were stage 2 (staging information was not available in one instance). Hormone receptor data were available in 17 of 23 specimens. Estrogen receptors were positive in 13 and progesterone receptors were positive in six. The smallest preinvasive malignant lesion was 4 millimeters, as seen on the mammogram, and the smallest free-standing invasive lesion was 8 millimeters. Preinvasive lesions (intraductal) presented as microcalcifications in 80 per cent. Invasive lesions presented as either a mass (n = 9) or as a mass and microcalcifications (n = 5) in 81 per cent. All five lesions presenting as both a mass and microcalcifications on mammogram proved to be malignant. Multifocal lesions on mammographic examination which proved to be malignant were multifocal pathologically in only 50 per cent. Needle localization mammographic biopsy is useful in detecting early carcinoma of the breast. Biopsy should be done on lesions presenting on mammogram as both a mass and microcalcifications and not observed. Focality of lesions on mammogram does not correlate with focality on biopsy and may be misleading as criteria for operative planning.
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Affiliation(s)
- G M Senofsky
- Department of Surgery, University of California, San Diego Medical Center
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