Benoît Mesurolle

Breast imaging reporting and data system lexicon for US: interobserver agreement for assessment of breast masses.

PURPOSEnTo retrospectively evaluate the interobserver agreement of radiologists who used the Breast Imaging Reporting and Data System (BI-RADS) lexicon to characterize and categorize ultrasonographic (US) features of breast masses.nnnMATERIALS AND METHODSnNo institutional review board approval or patient consent was required. Five breast radiologists retrospectively independently evaluated 267 breast masses (113 benign and 154 malignant masses in 267 patients) by using the BI-RADS US lexicon. Reviewers were blinded to mammographic images, medical history, and pathologic findings. Interobserver agreement was assessed with the Aickin revised kappa statistic.nnnRESULTSnInterobserver agreement varied from fair for evaluation of mass margins (kappa = 0.36) to moderate for evaluation of lesion boundary (kappa = 0.48), echo pattern (kappa = 0.58), and posterior acoustic features (kappa = 0.47) to substantial for evaluation of mass orientation (kappa = 0.70) and shape (kappa = 0.64). For small (< or =0.7 cm; n = 49) or malignant (n = 154) masses, low concordance was noted for margin descriptors (kappa = 0.30 and 0.28, respectively) and BI-RADS category (kappa = 0.21 and 0.26, respectively). Overall, only fair agreement was obtained for BI-RADS category (kappa = 0.30). Agreement for subdivisions 4a, 4b, and 4c of BI-RADS category 4 was fair (kappa = 0.33), fair (kappa = 0.32), and poor (kappa = 0.17), respectively.nnnCONCLUSIONnReproducibility of US BI-RADS terminology is good except for margin evaluation. A trend toward lower concordance was noted for the evaluation of small masses and malignant lesions. Classification into subdivisions 4a, 4b, and 4c was poorly reproducible.

Sonographic and Mammographic Appearances of Breast Hemangioma

OBJECTIVEnThe purpose of our study was to retrospectively evaluate the clinical, imaging, and pathologic findings of breast hemangiomas in 16 patients.nnnCONCLUSIONnA mass displaying an oval or lobular shape with well-circumscribed or microlobulated margins on mammography and sonography, and in a superficial location, should alert the radiologist to the possible diagnosis of hemangioma. Imaging-guided biopsy appears sufficiently reliable to rule out any malignant or premalignant component and to avoid a surgical excision if doing so is clinically appropriate.

Tissue Harmonic Imaging, Frequency Compound Imaging, and Conventional Imaging Use and Benefit in Breast Sonography

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.

Preoperative Axillary Ultrasound and Fine-needle Aspiration Biopsy in the Diagnosis of Axillary Metastases in Patients with Breast Cancer: Predictors of Accuracy and Future Implications

BackgroundThe utility of axillary lymph node dissection after sentinel lymph node biopsy has been called into question. We sought to determine the sensitivity, specificity, and accuracy of axillary ultrasound and fine-needle aspiration biopsy (FNAB) in the identification of axillary nodal metastasis in early breast cancer patients.MethodsData of patients with stage I and II breast cancer who underwent surgery and staging were reviewed. Axillary ultrasound findings were assessed and lymph node status recorded after axillary dissection. The data were cross-tabulated, and test characteristics were calculated.ResultsOf 235 patients, none demonstrated more than 2 positive sentinel lymph nodes. Ductal carcinoma was present in 68xa0%, estrogen and progesterone receptors were positive in 81 and 64xa0%, respectively, Her-2/neu was positive in 10xa0%, and 36xa0% were axillary node positive. The sensitivity and specificity of ultrasound alone were 55 and 88xa0%, respectively. Predictors of abnormal ultrasound included size of metastasis, estrogen receptor and Her-2 status, tumor grade, and presence of lymphovascular invasion. Addition of FNAB increased the sensitivity and specificity to 69 and 100xa0%. In conjunction with FNAB, the positive and negative predictive values were 100 and 54xa0%, respectively. Ten percent of patients with nodal metastases demonstrated a positive FNAB. Patients with a positive FNAB did not harbor more nodal metastases or a greater proportion of gross extranodal disease compared to patients not subjected to FNAB.ConclusionsAxillary ultrasound with FNAB has an accuracy of >70% in this series. It is easily performed and may avoid unnecessary sentinel lymph node biopsy in a significant number of patients.

Flat Epithelial Atypia of the Breast: Pathological-Radiological Correlation

OBJECTIVEnThis study was undertaken to determine the prevalence of flat epithelial atypia at ultrasound-guided and stereotactically guided needle biopsies, to describe the mammographic and sonographic features of flat epithelial atypia, and to determine the significance of lesions diagnosed as flat epithelial atypia at imaging-guided needle biopsies.nnnMATERIALS AND METHODSnRetrospective review of a database of 1369 consecutive sonographically and stereotactically guided needle biopsies performed during a 12-month period yielded 33 lesions with flat epithelial atypia as the most severe pathologic entity (32 patients). Two radiologists retrospectively reviewed the imaging presentation, by combined consensus, according to the BI-RADS lexicon.nnnRESULTSnTwenty-two of 33 flat epithelial atypia diagnoses (67%) were obtained under stereotactic guidance, and 11 (33%) were obtained under sonographic guidance. Six patients had synchronous breast cancer. Flat epithelial atypia lesions presented mammographically most often as microcalcifications (20/33 [61%]) distributed in a cluster (14/20 [70%]) with amorphous morphology (13/20 [65%]). Sonographically, flat epithelial atypia lesions appeared most often as masses (9/11 [82%]), with an irregular shape (6/9 [67%]), microlobulated margins (5/9 [56%]), and hypoechoic or complex echotexture (7/9 [78%]). Twenty-eight of 33 lesions (85%) were surgically excised, confirming the flat epithelial atypia diagnosis in 11 of the 28 lesions (39%), yielding carcinoma in four (14%) and atypical ductal hyperplasia in six (21%). Columnar cell changes without atypia were diagnosed in four lesions (14%), and lobular carcinoma in situ was diagnosed in three lesions (11%).nnnCONCLUSIONnMammographic and sonographic presentation of flat epithelial atypia is not specific (clustered amorphous microcalcifications and irregular, hypoechoic or complex masses). Given the underestimation rate of malignancy, surgical excision should be considered when imaging-guided biopsy yields flat epithelial atypia.

Volumetric quantification of coronary artery calcifications using dual-slice spiral CT scanner : Improved Reproducibility of measurements with 180° linear interpolation algorithm

Purpose The purpose of this work was to determine the reproducibility of coronary total calcium score (TCS) with dual-slice helical CT and compare three acquisition protocols. Method Fifty patients (59 ± 10 years old) underwent dual-slice helical CT (collimation = 2 × 2.5 mm) and coronary angiography. Two successive scans were performed, resulting in three sets of images: pitch = 1, 360° linear interpolation (LI) (A360); pitch = 1, 180° LI (A180); and pitch = 1.5, 180° LI (B180). TCS values, calculated using a volumetric method with a threshold of 90 HU, were compared, and the interscan variation was determined. Diagnostic performances were compared with receiver operating characteristic curves. Results Protocol A360 provided significantly lower TCS than protocols A180 and B180 (p < 0.0001). No statistical difference was seen between A180 and B180, which provided the lowest interscan variation (40 ± 58%). However, no significant clinical impact of the observed interscan variations was found. Conclusion Reproducibility of TCS with dual-slice helical CT is improved by the 180 LI algorithm. However, dual-slice helical CT is not sufficiently reproducible to allow serial quantification of TCS over time.

Spontaneous Thrombosis of Pseudoaneurysm of the Breast Related to Core Biopsy

WEB This is a Web exclusive article. ore needle biopsy is being used increasingly for the diagnosis of breast masses. It is considered an alternative to surgical biopsy, and the rate of complications is relatively low. The most frequently encountered complication is hematoma [1]. Iatrogenic pseudoaneurysm is a rare complication. We report a case of pseudoaneurysm occurring after 14-gauge core needle biopsy. Spontaneous thrombosis of the pseudoaneurysm occurred over a period of 3 weeks after the biopsy.

Sonography of Postexcision Specimens of Nonpalpable Breast Lesions: Value, Limitations, and Description of a Method

OBJECTIVEnThe objective of our study was to retrospectively review our experience regarding the value of sonography in identifying a nonpalpable mass within a surgically excised specimen and in assessing the surgical margins in cases of malignancy.nnnMATERIALS AND METHODSnOne hundred four lumpectomies were performed in 99 consecutive patients with 131 nonpalpable breast lesions after sonographically guided needle localization. All 104 surgical specimens were scanned on sonography, and 86 specimen radiographs were obtained. Visualization of the lesion on sonography was compared with specimen radiographs and histologic findings. Sonographic margin status was classified as negative (shortest distance between tumor and specimen margin, > 0.2 cm) or positive (shortest distance between tumor and specimen margin, 0.2 cm) and was compared with pathology results.nnnRESULTSnSpecimen sonography showed 95.4% (125/131) of the excised abnormalities; nonfatty background and a lesion size of greater than 0.5 cm contributed significantly to the success of specimen sonography. Four of six lesions missed on sonography were identified on specimen radiography. Among 81 malignant specimens, sonography identified 38 specimens with positive margins and 43 with negative margins. Pathologic examination revealed eight false-positive and 10 false-negative results (21% false-positive rate and 23.2% false-negative rate).nnnCONCLUSIONnSpecimen sonography is an effective procedure for identifying the presence of the lesion within the specimen; however, it is of limited value in cases of small hypoechoic lesions against a fatty background. Assessment of margins is limited by both false-positive and false-negative results.

Surgical Outcome of Biopsy-Proven Lobular Neoplasia: Is There Any Difference Between Lobular Carcinoma In Situ and Atypical Lobular Hyperplasia?

OBJECTIVEnThe aims of our study were to determine the frequency of malignancy after surgical excision of biopsy-proven lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH) lesions, to assess any difference between pure LCIS and pure ALH lesions regarding their radiologic presentation and the malignancy upgrade rate after surgical excision, and to evaluate the outcome of lesions that were not excised surgically but were followed up.nnnMATERIALS AND METHODSnRadiologic and pathologic records of 14,435 imaging-guided needle biopsies of the breast performed between 2004 and 2008 in three different institutions were retrospectively reviewed. A total of 126 patients (0.9%) had biopsy-proven LCIS or ALH, or both, as the highest-risk lesion. Among the 126 patients, 89 (71%) continued to surgery, and 14 were followed up for more than 24 months. The Mantel-Haensel chi-square test was used for statistical analysis.nnnRESULTSnCancer upgrade was documented in 17 of the 43 LCIS (40%), 11 of the 40 ALH (27%), and two of the six combined ALH and LCIS lesions (33%) surgically excised, for a total malignancy upgrade rate of 34% (30/89). Both LCIS and ALH lesions presented mammographically in most cases as microcalcifications (p = 0.078). None of the 14 patients followed up for a mean period of 51 months showed development of malignancy.nnnCONCLUSIONnNo statistically significant difference was found between mammographic presentation and postsurgical outcome of LCIS versus ALH lesions. Surgical excision of these lesions is recommended as long as no evident criteria are provided to differentiate those that might be associated with an underlying malignancy.

Sonographic Appearance of Invasive Ductal Carcinoma of the Breast According to Histologic Grade

OBJECTIVEnThe purpose of this study was to compare the efficacy of the sonographic features in the BI-RADS lexicon for predicting malignancy grade of invasive ductal breast carcinoma in women assigned a BI-RADS category of 4 or 5.nnnMATERIALS AND METHODSnTwo radiologists retrospectively evaluated 299 consecutive cases of grades 1-3 invasive ductal breast carcinoma presenting as a mass in consensus by using the BI-RADS sonographic lexicon. Histologic grade was established on surgical specimens. Effect sizes were calculated via the Goodman and Kruskal tau, an asymmetric measure of strength of nominal association, and results were interpreted in terms of proportional reduction in error.nnnRESULTSnThirty-eight lesions (13%) were grade 1, 153 (51%) were grade 2, and 108 (36%) were grade 3, with the majority of all masses showing an irregular shape (84%) and hypoechoic echotexture (82%). Of the sonographic features examined, malignancy grade was best predicted by posterior acoustics (τ = 0.13, p < 0.001), lesion boundary (τ = 0.05, p < 0.001), and margin (τ = 0.04, p = 0.001). Among grade 3 lesions, there were significantly more lesions with posterior enhancement (53 vs 27.6; adjusted standardized residuals (z(res)) = 7; p < 0.001), abrupt interfaces (68 vs 51.2; z(res) = 4; p < 0.001), and microlobulated margins (12 vs 5.8; z(res) = 3; p = 0.001) than would be expected.nnnCONCLUSIONnMalignancy grade was slightly to moderately predicted by margin, lesion boundary, and acoustic sonographic features. In particular, grade 3 invasive ductal breast carcinomas were more likely than expected to display microlobulated margins, abrupt interfaces, and posterior enhancement.