Boo-Kyung Han

Outcome of MRI-Guided Breast Biopsy

OBJECTIVE The objective of our study was to investigate the outcome of MRI-guided breast biopsy as a function of the indication for MRI and the MRI features of the lesions. MATERIALS AND METHODS In 154 women (mean age, 51 years) with 172 MRI-detected lesions, MRI-guided vacuum-assisted breast biopsy was attempted. Using the original radiologic report, we evaluated the indication for the original MRI examination and the MRI findings that led to biopsy. We investigated the core and operative histology results and follow-up data. We analyzed the cancer rate as a function of the indication for MRI and the MRI features of the lesions using Fishers exact test. RESULTS In 22 of the 172 lesions (13%), MRI-guided biopsy was deferred due to decreased visualization or nonvisualization of the MRI finding that led to biopsy. Of 150 biopsies in 134 women, core histology revealed 39 malignant (39/150, 26%), 90 benign (90/150, 60%), and 21 high-risk (21/150, 14%) lesions. Through operative histology (n = 13) or follow-up (n = 30), four high-risk lesions were upgraded to malignancy and all deferred lesions except four lost to follow-up were confirmed to be benign. The final number of malignancies was 43 (29%) including 16 in situ and 27 invasive cancers. The probability of malignancy was different in the screening and diagnostic settings (14% vs 36%, respectively; p = 0.05), whereas it was not different according to lesion type (mass, 34%; nonmass, 27%; focus, 19%; p > 0.05) or kinetics (persistent, 23%; plateau, 31%; washout, 29%; p > 0.05). CONCLUSION The cancer rate in our cohort of women who underwent MRI-guided breast biopsy was 29%. It varied according to the indication for the original MRI examination, but not according to the MRI features of the lesions.

Sonographic Findings in the Surgical Bed After Thyroidectomy Comparison of Recurrent Tumors and Nonrecurrent Lesions

The purpose of this study was to assess the sonographic findings of recurrent tumors and nonrecurrent lesions mimicking recurrent tumors in the surgical bed after thyroidectomy for thyroid cancer.

BRAFV600E Mutation Analysis of Thyroid Nodules Needle Aspirates in Relation to Their Ultrasongraphic Classification: A Potential Guide for Selection of Samples for Molecular Analysis

BACKGROUND Proper candidates to improve the effectiveness of molecular testing for thyroid nodules detected on ultrasonography (US) in a clinical setting are not well known. We aimed at evaluating the effective indication and method of BRAF(V600E) mutation analysis of aspiration specimens according to the US features of thyroid nodules in a BRAF(V600E) mutation-prevalent area. METHODS A total of 244 patients with 244 thyroid nodules were prospectively classified as malignant and nonmalignant based on US. Thyroid nodules with any malignant US features including spiculated margin, the presence of microcalcifications or macrocalcifications, marked hypoechogenicity, or a taller-than-wide shape were defined as US-positives and those without these features were defined as US-negatives. All patients underwent US-guided fine-needle aspiration (FNA). The presence of the BRAF(V600E) mutation in FNA specimens was determined by allele-specific polymerase chain reaction (AS-PCR) and direct DNA sequencing. The mutation results were correlated with cytology and either surgical pathology or follow-up. RESULTS Of 244 nodules, 66 were US-positive and 178 were US-negative. The malignancy rate was 92% (61/66) for US-positives and 14% (25/178) for US-negatives. The BRAF(V600E) mutation was identified in 67% (44/66) of US-positives and in 10% (17/178) of US-negatives. The BRAF(V600E) mutation for nodules with indeterminate or nondiagnostic cytology was present in 45% (5/11) of US-positives and in 8% (2/26) of US-negatives (p = 0.0168). A false negative cytology with the mutation was found in only one case of the US-negatives. All nodules with the mutation were surgically confirmed as papillary carcinomas. Adding the genetic analysis to the FNA as compared with the FNA alone improved the sensitivity and accuracy for US-positives, whereas there was no significant improvement for US-negatives. With regard to sensitivity and accuracy, the use of the AS-PCR was better than the use of the direct DNA sequencing for US-positives as compared with US-negatives. CONCLUSION The application of BRAF(V600E) mutation analysis in FNA specimens is more effective for thyroid nodules with malignant US features as compared with nodules without malignant US features. The use of the AS-PCR is more valuable as compared with the direct DNA sequencing to refine the diagnosis in a clinical setting.

Medullary Thyroid Carcinoma: Comparison With Papillary Thyroid Carcinoma and Application of Current Sonographic Criteria

OBJECTIVE The aim of this study was to evaluate whether sonography can diagnose medullary thyroid carcinoma (MTC) as a malignant lesion using widely accepted sonographic criteria and to compare which sonographic findings of MTC are different from findings for papillary thyroid carcinoma (PTC). MATERIALS AND METHODS The study included 42 patients (13 men and 29 women; mean age, 48 years) with 46 MTCs and 51 consecutive patients (10 men and 41 women; mean age, 48 years) with 55 PTCs that were confirmed at surgery. Two radiologists retrospectively determined the sonographic diagnoses according to malignant criteria (a taller-than-wide shape, spiculated margin, marked hypoechogenicity, and microcalcifications or macrocalcifications) and compared the sonographic findings of MTCs and PTCs. RESULTS MTCs were diagnosed as malignant for 72% of cases by sonography, whereas PTCs were 87% malignant (p = 0.0511). Compared with PTCs, MTCs were larger (mean size, 2.3 +/- 1.5 cm vs 1.1 +/- 1.1 cm) (p = 0.001; odds ratio [OR], 3.84; 95% CI, 1.719-8.565), more frequently showed the presence of a cystic change (33% vs 4%) (p = 0.0226; OR, 0.10; 95% CI, 0.014-0.725), and more commonly showed homogeneous echotexture of the solid portion (59% vs 31%) (p = 0.0004; OR, 0.08; 95% CI, 0.019-0.321). MTCs tended to show an oval shape and circumscribed margin, but there was no statistical significance in multivariate analysis. There were no significant differences in echogenicity, presence, and type of calcification for MTCs and PTCs. CONCLUSION Currently accepted sonographic criteria can be applied for a diagnosis of MTCs. MTCs differ from PTCs in size, presence of a cystic change, and echotexture.

Breast Cancer Heterogeneity: MR Imaging Texture Analysis and Survival Outcomes

Purpose To determine the relationship between tumor heterogeneity assessed by means of magnetic resonance (MR) imaging texture analysis and survival outcomes in patients with primary breast cancer. Materials and Methods Between January and August 2010, texture analysis of the entire primary breast tumor in 203 patients was performed with T2-weighted and contrast material-enhanced T1-weighted subtraction MR imaging for preoperative staging. Histogram-based uniformity and entropy were calculated. To dichotomize texture parameters for survival analysis, the 10-fold cross-validation method was used to determine cutoff points in the receiver operating characteristic curve analysis. The Cox proportional hazards model and Kaplan-Meier analysis were used to determine the association of texture parameters and morphologic or volumetric information obtained at MR imaging or clinical-pathologic variables with recurrence-free survival (RFS). Results There were 26 events, including 22 recurrences (10 local-regional and 12 distant) and four deaths, with a mean follow-up time of 56.2 months. In multivariate analysis, a higher N stage (RFS hazard ratio, 11.15 [N3 stage]; P = .002, Bonferroni-adjusted α = .0167), triple-negative subtype (RFS hazard ratio, 16.91; P < .001, Bonferroni-adjusted α = .0167), high risk of T1 entropy (less than the cutoff values [mean, 5.057; range, 5.022-5.167], RFS hazard ratio, 4.55; P = .018), and T2 entropy (equal to or higher than the cutoff values [mean, 6.013; range, 6.004-6.035], RFS hazard ratio = 9.84; P = .001) were associated with worse outcomes. Conclusion Patients with breast cancers that appeared more heterogeneous on T2-weighted images (higher entropy) and those that appeared less heterogeneous on contrast-enhanced T1-weighted subtraction images (lower entropy) exhibited poorer RFS.

Thyroid Lymphoma Correlation of Radiologic and Pathologic Features

The purpose of this study was to correlate the clinicoradiologic and pathologic features of thyroid lymphoma and to identify the most useful diagnostic method for thyroid lymphoma as the first line.

Probably Benign Breast Masses Diagnosed by Sonography: Is There a Difference in the Cancer Rate According to Palpability?

OBJECTIVE The study was designed to assess retrospectively whether there is a difference in the cancer rates between palpable and nonpalpable probably benign breast nodules detected by sonography. We further investigated the clinicopathologic results of sonographically false-negative cases. MATERIALS AND METHODS This study included 352 women who had undergone sonographically guided core biopsies for 374 BI-RADS category 3 masses between March 2004 and February 2005. No masses were diagnosed with definite malignant findings on mammography. The cancer rates of nonpalpable and palpable masses were compared using Fishers exact test. The clinicopathologic results of sonographically false-negative cases were investigated. RESULTS Among the 374 masses, 86 masses (23%) that were lost to follow-up were excluded. Of the 288 masses with follow-up or excision, the cancer rate was 2.4% (7/288). The cancer rate of the nonpalpable masses was 2.1% (4/194) (95% CI, 0.6-5.2%), and the cancer rate of the palpable masses was 3.2% (3/94) (95% CI, 0.6-9.0%), with no statistically significant difference (p = 0.6864). Of the seven cancers, five were diagnosed by a sonographically guided core biopsy and two were diagnosed by surgical excision after a benign biopsy. The seven sonographically false-negative masses in seven patients were identified as three invasive ductal carcinomas, two ductal carcinomas in situ, one mucinous carcinoma, and one papillary carcinoma on the basis of pathology results. CONCLUSION There is no statistically significant difference between the cancer rates of palpable and nonpalpable BI-RADS category 3 masses seen on sonography.

Right ventricular fat infiltration in asymptomatic subjects: observations from ECG-gated 16-slice multidetector CT.

Objective: To analyze the computed tomography (CT) findings of fatty replacement in the right ventricle (RV) of asymptomatic subjects and to correlate the CT findings with electrocardiogram (ECG) abnormalities. Methods: This prospective study included 996 subjects who underwent ECG-gated 16-slice CT for determination of coronary calcium scores. The CT findings were analyzed in terms of location, pattern, and degree of RV fat infiltration, along with the shape and dimension of RV. The RV fat was regarded present when a region showed less than or equal to −30 Hounsfield units as revealed by CT. Results: Computed tomography features suggestive of RV fat were found in 169 subjects (17%; 136 men and 33 women; mean age, 56.3 years). The most frequent location of fat was the basal superior wall (93%); next was the middle superior wall (72%); and then, the RV outflow tract (44%). Subjects with moderate to severe involvement were older than those with mild involvement (P = 0.012). In 3 subjects, the RV wall thickening with fat was more than 5 mm. Angular deformity and undulating appearance of the RV also occurred in 25 (15%) and 20 subjects (12%), respectively. However, these were not patients with ECG findings positive for arrhythmogenic RV dysplasia. Conclusions: Asymptomatic subjects may have fat in RV on CT. However, these subjects show no RV dysfunction or significant ECG-abnormalities consistent with the diagnosis of arrhythmogenic RV dysplasia.

Ultrasonographic detection of occult cancer in patients after surgical therapy for breast cancer.

The purpose of this study was to investigate the efficacy of ultrasonography in detecting an occult malignancy after surgery for breast cancer and to assess the imaging and clinical findings associated with a recurrence.

Cystic Thyroid Nodules After Aspiration Mimicking Malignancy Sonographic Characteristics

Objective. The purpose of our study was to provide sonographic findings of cystic nodules, which can mimic malignancies, after fine‐needle aspiration (FNA) and to determine the differential points from malignancies. Methods. We retrospectively reviewed the sonographic findings of 33 lesions in 32 patients who had FNA for predominantly cystic nodules or cysts and showed suspicious findings during sonographic follow‐up, as well as findings of 47 surgically confirmed papillary thyroid carcinomas (PTCs) in 45 consecutive patients. We evaluated the size, shape, presence of shadowing and a halo, margin, echogenicity, and presence of echogenic dots for each nodule. The final diagnosis of cystic nodules was confirmed by FNA, surgery, or follow‐up sonography. Results. Of the 33 cystic lesions, 31 (94%) were adequate with benign results, and 2 (6%) were inadequate specimens at the initial FNA. There were no malignancies in the cystic nodules at follow‐up. The average interval between the initial FNA and suspicious sonographic findings was 26 months (range, 1–92 months). The average size of the suspicious nodules was 0.8 cm (range, 0.3–1.8 cm). Cystic nodules after aspiration were similar to PTCs in their sonographic findings, but the former frequently showed shadowing and a halo (85% versus 21%; P < .0001). With further follow‐up, 29 lesions (88%) showed additional decreases in size. Conclusions. Benign cystic nodules after aspiration can have suspicious malignant features. However, shadowing and a halo associated with malignant features are characteristic findings of cystic nodule shrinkage. Awareness of these findings and correlation with the FNA history can aid in preventing unnecessary FNA.