Brigitte Wilczek

Adding 3D automated breast ultrasound to mammography screening in women with heterogeneously and extremely dense breasts: Report from a hospital-based, high-volume, single-center breast cancer screening program.

PURPOSE The aim of this study was to evaluate the impact of the 3D automated breast ultrasound (3D ABUS) when added to full field digital screening mammography (FFDSM), on breast cancer detection and recall rates in asymptomatic women with dense breasts examined in a high-volume breast cancer screening mammography center. METHODS AND MATERIAL 1668 asymptomatic women, age 40-74 years, with heterogeneously dense parenchyma (ACR3) or extremely dense breast (ACR4) were included in the study. FFDSM was performed using standard craniocaudal (CC) and mediolateral oblique (MLO) views followed by anteroposterior (AP); lateral (LAT) and medial (MED) acquisitions of 3D ABUS in both breasts. All mammograms were double read by two dedicated breast radiologists. The 3D ABUS was read by the first radiologist immediately after reading the mammograms. The second reader looked at the 3D ABUS only if there was a need for consensus discussion because of unclear or abnormal mammograms or 3D ABUS. RESULTS The combined FFDSM and 3D ABUS generated a total of 6.6 cancers per 1000 women screened (95% CI: 3.0, 10.2; p<0.001) compared with 4.2 cancers per 1000 women screened (95% CI) for FFDSM alone. The difference in yield was an additional 2.4 detected cancers per 1000 women screened (95% CI: 0.6, 4.8; p<0.001). The corresponding recall rate per 1000 women screened was 13.8 (95% CI: 9.0, 19.8) for FFDSM alone and 22.8 for combined FFDSM and ABUS (95% CI: 16.2, 30.0), yielding a difference of an additional 9.0 recalls per 1000 women screened (95% CI: 3.0, 15.0; p=0.004). CONCLUSION The addition of 3D ABUS to FFDSM in women with ACR3 or ACR4 breast density significantly improved invasive breast cancer detection rate with an acceptable recall increase.

Feasibility study on the treatment of small breast carcinoma using percutaneous US-guided preferential radiofrequency ablation (PRFA)

The purpose of this study was to determine the safety and efficacy of percutaneous ultrasound (US) guided preferential radiofrequency ablation (PRFA) of unifocal human invasive breast carcinoma with largest radiological diameters of up to 16 mm. Thirty-three patients were enrolled in a study to be treated prior to scheduled partial mastectomy. A needle-shaped treatment electrode, successively developed in two different sizes, was placed into the center of the lesions using ultrasound guidance. A temperature of 85 degrees C was maintained for 10 min. The analysis of the resected specimen was performed using conventional histopathological methods with the aim to determine the size of the lesion as well as the potential viability of tumor cells. Of the 33 patients enrolled 31 were treated. In 26 (84%) patients a complete ablation of the tumor was achieved. Ultrasound guided preferential radiofrequency ablation of small breast carcinoma is feasible and patient friendly. The success rate depends on accurate preoperative diagnostic imaging as well as an exact position of the needle electrode.

Bolus Compared with Continuous Infusion of Microbubble Contrast Agent Using Real-Time Contrast Harmonic Imaging Ultrasound in Breast Tumors

Background: Contrast-enhanced ultrasound (CEUS) has gained interest because of its ability to gather vascular information in various organs. There is still a matter of debate concerning its value in breast lesions. The method of choice on how to administer the contrast agent varies depending on the organ to be studied. Infusion of microbubbles is used in echocardiography, while bolus administration is the preferred technique for abdominal organs. Purpose: To compare—in equal doses—bolus versus continuous infusion of microbubbles, using real-time contrast harmonic imaging in breast tumors. Material and Methods: A total of 29 female patients (mean age 54 years) with either clear malignant or benign findings in the breast or axilla were included. Contrast harmonic imaging (CHI US) was performed with a Philips iU22 using an L9-3 MHz linear probe, especially designed for this purpose. A low mechanical index (0.06–0.07) was used to avoid massive destruction of the microbubbles. A dose of 2.4 ml of Sono Vue was first infused intravenously over 1 min with an infusion pump. After 10 min, the same dose was injected as a bolus over 2 s, followed by a flush of 10 ml of saline solution. Contrast uptakes by the tumors were recorded 2 min from the moment of injection, with both methods for each patient. Results: Bolus administration of contrast agent provided a sharply demarcated enhancement and wash-out pattern for all lesions. The continuous infusion of the same contrast agent failed to show any wash-in/wash-out or time-to-peak/peak intensity phenomena in all cases. Conclusion: CEUS using real-time harmonic imaging in order to evaluate breast tumors should be performed with bolus administration of contrast agent in order to achieve better intensity/time curve outcomes.

Differentiation between benign and malignant breast tumors using kinetic features of real-time harmonic contrast-enhanced ultrasound

Background Contrast-enhanced ultrasound (CEUS) has gained interest because of its ability to gather vascular information in diverse organs. There is still a subject of debate concerning its value in breast lesions, especially as a differential diagnostic tool. Purpose To investigate whether kinetic parameters of CEUS can differentiate between malignant and benign breast lesions. Material and Methods We evaluated 75 malignant and 21 benign lesions in the breast or axilla. Contrast harmonic imaging (CHI) US was performed after the injection of a bolus dose of 2.4 mL of Sono Vue® (Bracco, Milano, Italy). The following parameters were calculated for kinetic analysis: initial slope, time to peak enhancement, wash-out ratios W21 and W50 (relative decrease in signal intensity from the peak enhancement to 21 s and 50 s, respectively). Results A significant difference was found between the benign and malignant lesions in time-to-peak (P value <0.05) and wash-out ratios W21 (P value <0.001) and W50 (P value <0.001). The mean time-to-peak was 9.3 s for malignant and 14.6 s for benign lesions. The mean signal drop from peak to signal intensity measured at 50 s was 85% for malignant and 66% for benign lesions. There was no difference in absolute values of peak signal intensity and initial slope. The most significant difference between standardized benign and malignant wash-out curves was found at 21 s but statistical significance was reached in the range of 14–50 s. Conclusion Real-time CEUS can evolve into a new non-invasive option for differentiate malignant from benign breast lesions.

Prognostic Significance of Pathological Chest Radiography in Transplant Patients Affected by Cytomegalovirus and/or Pneumocystis Carinii

Purpose: In order to evaluate the prognostic significance of chest film findings in connection with cytomegalovirus (CMV) and/or pneumocystis carinii infection (PC), a retrospective review was made of the pulmonary charts of 274 recipients of kidney and/or pancreatic grafts transplanted between April 1987 and December 1990. Material, Methods and Results: Positive laboratory findings for CMV and/or PC were seen in 92 patients. In 77 patients only CMV was found, 13 patients had both CMV and PC, and 2 patients had only PC. In 57 patients a chest examination was performed. The films were reviewed by 2 radiologists independently. In 32 patients normal chest film findings were seen, while 25 patients demonstrated pathological changes. Of the patients with pathological changes 3 had only pleuritis while the remaining 22 demonstrated parenchymal infiltrations. No deaths occurred among patients infected with CMV and/or PC, when the chest film findings were normal or pleuritis only was seen, but there were 9 deaths in the group of patients with parenchymal infiltrations. Of the patients who died, 2 had only CMV, 5 had both CMV and PC, and 2 had only PC. The overall mortality, regardless of radiological findings, did not exceed 3% in patients with CMV only, but increased to 38% in patients with both CMV and PC. In patients with parenchymal infiltrations the corresponding mortality figures were increased to 18% and 56%, respectively. Conclusion: We conclude that a radiologically verified pneumonia related to the infectious agent influences the prognosis, and that CMV pneumonia has a better prognosis than PC pneumonia.

Adjunctive Diagnostic Value of Targeted Electrical Impedance Imaging to Conventional Methods in the Evaluation of Breast Lesions

Purpose: To determine the diagnostic accuracy of targeted electrical impedance imaging in characterizing breast lesions, and to evaluate whether lesion size, depth and histopathology affect the diagnosis. Material and Methods: A total of 137 women with 145 lesions (79 malignant and 66 benign) found by palpation or mammography were prospectively enrolled in this study. The patients were examined by means of clinical breast examination, mammography, ultrasonography, and electrical impedance imaging with TransScan TS2000. A level of suspicion (LOS) post-processing algorithm (v2.67) was used for TS2000 lesion assessment. Imaging findings were correlated with cytologic (n = 54) and histologic diagnoses (n = 91). Patients with benign lesions were followed up for a mean of 36 months. Results: TS2000 showed a high sensitivity (86%) which did not differ significantly from that of mammography (87%) and ultrasonography (US) (75%). The specificity of TS2000 (49%) was significantly lower compared to mammography (97%, P<0.0001) and US (100%, P<0.0001). The additive use of TS2000 to mammography and US yielded no significant increase in sensitivity (97%), but the decrease in specificity was significant (46%, P<0.0001). Diagnostic effectiveness of TS2000 (Az = 0.68), as measured by the area under the ROC curve, was significantly lower than for mammography (Az = 0.93, P<0.0001) and for US (Az = 0.91, P<0.0001). When using TS2000 in addition to mammography and US (Az = 0.86), a significant impairment was found (P = 0.0003). Conclusion: The role of targeted electrical impedance imaging as an adjunct to mammography and ultrasonography in the diagnosis of breast lesions is not justified by the result of this study.

Contrast-enhanced ultrasound using real-time contrast harmonic imaging in invasive breast cancer: comparison of enhancement dynamics with three different doses of contrast agent

Background In the last few years new potential applications have been developed for contrast-enhanced ultrasound (CEUS) and the management of breast diseases, but there is still some debate concerning the optimal dose to evaluate breast lesions, especially as a diagnostic tool. Purpose To compare different CEUS doses of injected contrast agent in order to establish an optimal dose for the diagnosis of invasive breast cancer. Material and Methods In Group A we compared the bolus dose of 1.2 mL vs. 2.4 mL and in Group B we compared the bolus dose of 2.4 mL vs. 4.8 mL (26 and 25 invasive carcinomas, respectively). CEUS was performed in real-time contrast harmonic imaging (CHI) using a L9-3 MHz probe. All examinations were recorded in a contrast side/side imaging mode loop for 120 s. Wash-in and wash-out patterns of the contrast agent were analyzed with advanced US quantification software and kinetic curves were used for statistical analysis. Results In Group B (2.4 mL vs. 4.8 mL), more and stronger correlation was found among kinetic parameters (area under the curve, P < 0.00001; lognormal model parameters, μ, P = 0.0007 and σ, P < 0.0001; mean transit time, P < 0.0001; model-based wash-out ratios, W21m, P = 0.0002; W50m, P = 0.0001; time-to-peak, P = 0.005) as compared to Group A (1.2 mL vs. 2.4 mL). Conclusion The optimal way to evaluate kinetic features of invasive breast tumors using real-time CEUS is with an injection of contrast agent of either 2.4 mL or 4.8 mL.

Solitary intraductal papilloma of the male breast: diagnostic value of galactography.

The Breast Journal, Volume 9, Number 4, 2003 330–331 Address correspondence and reprint requests to: Botond K. Szabo, MD, Department of Diagnostic Radiology, Huddinge University Hospital, SE-141 86, Huddinge, Sweden, or email: Botond.Szabo@cfss.ki.se. Blackwell Publishing Ltd. July/August 2003 94 Original Article Papilloma of the Male Breast sz bo et al. Solitary Intraductal Papilloma of the Male Breast: Diagnostic Value of Galactography

A comparison of 99Tcm-MDP and 99Tcm-MIBI in the detection of breast cancer

In this study, we made an intra-individual comparison of the uptake of 99Tcm-MDP and 99Tcm-MIBI in breast cancer. Twenty women with large breast masses (one dimension ⩾3 cm on mammography) underwent SPET in the supine position with both agents. All transverse sections demonstrating tumour activity were added together and the net (total) tumour uptake in a region of interest was compared to that of surrounding tissue activity (background). We also evaluated maximum tumour uptake versus background activity. Tumour uptake was observed in all examinations. In constrast to MIBI, eight MDP examinations showed increased uptake in normal breast parenchyma in addition to tumour uptake. There was no significant difference in net tumour uptake between the two tracers and non-parenchymal (indifferent) background activity, but the maximum tumour activity of MIBI was significantly higher than that of MDP. In the eight MDP examinations with parenchymal activity, mammograms were required to identify tumour uptake correctly. In conclusion, MDP may provide similar images to MIBI in post-menopausal women not receiving hormone replacement therapy. For other patients, MIBI gives better tumour depiction.

Sentinel node scintigraphy in breast cancer using a dual tracer technique.

AimIn order to depict the anatomy and improve the localization, sentinel node scintigraphy in breast cancer was combined with intravenous administration of pertechnetate. As this may reduce the detectability of weak ‘hot spots’, the number of lymph nodes detected at scintigraphy and at surgery in one group of patients was compared with that obtained in another group that had not received pertechnetate. Patients and methodsThe number of ‘hot spots’ at frontal and lateral views in 47 female patients at scintigraphy performed 2–3 h after subcutaneous injection of radiocolloid together with 25 MBq pertechnetate i.v. was compared in retrospect with that of 41 female patients who had not received pertechnetate. The number of lymph nodes detected at surgery using a hand-held gamma probe together with blue dye in the two groups was also compared. The washout kinetics of pertechnetate was studied in 10 patients. ResultsThere was no difference in the number of detected lymph nodes at any comparison. The kinetics study revealed a decreasing activity with time after correction for physical decay. ConclusionAdministration of a 25 MBq pertechnetate i.v. in order to improve the anatomical localization at sentinel node scintigraphy in breast cancer does not reduce the detectability of radioactive lymph nodes.