Chen-Pin Chou

The Adjunctive Digital Breast Tomosynthesis in Diagnosis of Breast Cancer

Purpose. To compare the diagnostic performance of digital breast tomosynthesis (DBT) and digital mammography (DM) for breast cancers. Materials and Methods. Fifty-seven female patients with pathologically proved breast cancer were enrolled. Three readers gave a subjective assessment superiority of the index lesions (mass, focal asymmetry, architectural distortion, or calcifications) and a forced BIRADS score, based on DM reading alone and with additional DBT information. The relevance between BIRADS category and index lesions of breast cancer was compared by chi-square test. Result. A total of 59 breast cancers were reviewed, including 17 (28.8%) mass lesions, 12 (20.3%) focal asymmetry/density, 6 (10.2%) architecture distortion, 23 (39.0%) calcifications, and 1 (1.7%) intracystic tumor. Combo DBT was perceived to be more informative in 58.8% mass lesions, 83.3% density, 94.4% architecture distortion, and only 11.6% calcifications. As to the forced BIRADS score, 84.4% BIRADS 0 on DM was upgraded to BIRADS 4 or 5 on DBT, whereas only 27.3% BIRADS 4A on DM was upgraded on DBT, as BIRADS 4A lesions were mostly calcifications. A significant P value (<0.001) between the BIRADS category and index lesions was noted. Conclusion. Adjunctive DBT gives exquisite information for mass lesion, focal asymmetry, and/or architecture distortion to improve the diagnostic performance in mammography.

Clinical evaluation of contrast-enhanced digital mammography and contrast enhanced tomosynthesis—Comparison to contrast-enhanced breast MRI

PURPOSE To compare the diagnostic accuracy of contrast-enhanced digital mammography (CEDM) and contrast-enhanced tomosynthesis (CET) to dynamic contrast enhanced breast MRI (DCE-MRI) using a multireader-multicase study. METHODS Institutional review board approval and informed consents were obtained. Total 185 patients (mean age 51.3) with BI-RADS 4 or 5 lesions were evaluated before biopsy with mammography, tomosynthesis, CEDM, CET and DCE-MRI. Mediolateral-oblique and cranio-caudal views of the target breast CEDM and CET were acquired at 2 and 4 min after contrast agent injection. A mediolateral-oblique view of the non-target breast was taken at 6 min. Each lesion was scored with forced BI-RADS categories by three readers. Each reader interpreted lesions in the following order: mammography, tomosynthesis, CEDM, CET, and DCE-MRI during a single reading session. RESULTS Histology showed 81 cancers and 144 benign lesions in the study. Of the 81 malignant lesions, 44% (36/81) were invasive and 56% (45/81) were non-invasive. Areas under the ROC curve, averaged for the 3 readers, were as follows: 0.897 for DCE-MRI, 0.892 for CET, 0.878 for CEDM, 0.784 for tomosynthesis and 0.740 for mammography. Significant differences in AUC were found between the group of contrast enhanced modalities (CEDM, CET, DCE-MRI) and the unenhanced modalities (all p<0.05). No significant differences were found in AUC between DCE-MRI, CET and CEDM (all p>0.05). CONCLUSION CET and CEDM may be considered as an alternative modality to MRI for following up women with abnormal mammography. All three contrast modalities were superior in accuracy to conventional digital mammography with or without tomosynthesis.

Imaging of Dermatofibrosarcoma Protuberans of Breast

Abstract:  Dermatofibrosarcoma protuberans (DFSP) is a rare superficial soft tissue malignancy. We report a 45‐year‐old woman diagnosed with DFSP involving the breast. Ultrasound of DFSP revealed a heteroechogenetic breast mass, which showed normal adjacent dermis. Mammography disclosed a high‐density mass without microcalcification. MRI showed an enhancing lobulated lesion with small area of cystic change and hemorrhage. The patient underwent excision biopsy and pathology revealed DFSP of the breast. DFSP involving the breast is rare and preoperative diagnosis by imaging could be a challenge for clinicians. A solitary mixed echogenicity and ill‐defined soft tissue with no microcalcification located in the subdermal region could indicate the presence of DFSP.

The outcome of a quality-controlled mammography screening program: Experience from a population-based study in Taiwan

Background: A greater policy of emphasis on the early detection and treatment of breast cancer is prevalent among developed countries. To raise the screening performance with a potentially decreased mortality rate, it is crucial to evaluate and analyze the screening outcome after implementation. We report the clinical outcome of an 8‐year nationwide mammography screening in Taiwan to help share our statistical information on breast screening worldwide, especially in Asia. Methods: Taiwan has provided nationwide, free, biennial mammographic screening since 2004. A total of 2,392,789 consecutive screening mammography examinations were performed during this study period for women aged 50–69 years (2006–2009) and 45–69 years (from December 2009 onwards). The screening covers 33.2% of the target population in the most recent 2 years. The workload of every screening radiologist, the overall recall rate, positive predictive value (PPV1), cancer detection rate (CDR), cancer incidence rate (CIR) from the screening, 1‐year interval cancer, sensitivity, and specificity of the screening mammography are calculated, and compared with the American College of Radiology (ACR) recommendation level and/or those of other screening mammographic series. Results: The CDRs (%) and CIRs (%) increased from 3.94–4.08 and 4.80–5.04 to 4.71–5.04 and 5.71 after 2009, implying a high occurrence of breast cancer in the younger age group of 45–49 years. The recall rates (9.3–10.0%) in this review are within the ACR recommendation range (<10%) and the PPV1 has also reached the ACR recommended level (>5%) in the most recent 2 years. The improvement of the screening performance may be attributed to our peer auditing review and education program. The sensitivity of our screening mammography is slightly lower than that of the ACR recommended level (>85%), which is still comparable to the results of the Vermont area in the USA. Although the workload (screenees/screeners) for every radiologist each year has increased from 150 in 2004 to 1360 in 2012, it does not seem to worsen the quality outcome of this screening program. Conclusion: From the outcome review of this national mammography screening, there is still room to ameliorate our performance through comprehensive and continued education, to improve the competence of cancer detection and decrease false negative (FN) cases.

Percutaneous retrieval of dislodged central venous port catheter: experience of 25 patients in a single institute:

Background: For a dislodged port catheter, percutaneous retrieval by using a loop snare or a basket is the standard technique, with high success. However, once a loop snare fails, the likelihood of success with other tools is considered low. Purpose: To report our experience of percutaneous retrieval of dislodged port catheters and to emphasize the usefulness of grasping forceps. Material and Methods: During a 6-year period, a total of 25 dislodged port catheters were retrieved in our institute. The interval between port catheter implantation and dislodged catheter retrieval was 3–85 months (mean 23 months). The time of delayed retrieval ranged from 3 to 604 days (mean 58 days). A loop snare or grasping forceps were used via either the femoral or jugular route. Results: The prevalence of port catheter dislodgement was 0.4% in our institute. All dislodged port catheters were successfully removed, including four patients with delayed retrieval of more than 90 days. A loop snare was used in 20 patients, with technical success in 18. Grasping forceps were used in seven patients, all with success (including the two patients who failed by initial use of a loop snare). No procedure-related complications were encountered, except transient arrhythmia in four patients requiring no medication. Conclusion: Although the prevalence of port catheter dislodgement is low, percutaneous attempts at retrieval should be performed in all patients, even in chronic settings. A loop snare is the instrument of choice for retrieval. Grasping forceps can be used as an auxiliary instrument, especially in patients where a loop snare fails.

Assessment of blood flow in hepatocellular carcinoma: Correlations of computed tomography perfusion imaging and circulating angiogenic factors

Hepatocellular carcinoma (HCC) is a highly vascular tumor through the process of angiogenesis. To evaluate more non-invasive techniques for assessment of blood flow (BF) in HCC, this study examined the relationships between BF of HCC measured by computer tomography (CT) perfusion imaging and four circulating angiogenic factors in HCC patients. Interleukin 6 (IL-6), interleukin 8 (IL-8), vascular endothelial growth factor (VEGF), and platelet derived growth factor (PDGF) in plasma were measured using Bio-Plex multiplex immunoassay in 21 HCC patients and eight healthy controls. Circulating IL-6, IL-8 and VEGF showed higher concentrations in HCC patients than in controls (p < 0.05), and predicted HCC occurrence better than chance (p < 0.01). Twenty-one patients with HCC received 21-phase liver imaging using a 64-slice CT. Total BF, arterial BF, portal BF, arterial fraction (arterial BF/total BF) of the HCC and surrounding liver parenchyma, and HCC-parenchyma ratio were measured using a dual-vessel model. After analyzing the correlations between BF in HCC and four circulating angiogenic factors, we found that the HCC-parenchyma ratio of arterial BF showed a significantly positive correlation with the level of circulating IL-8 (p < 0.05). This circulating biomarker, IL-8, provides a non-invasive tool for assessment of BF in HCC.

Antegrade Retrieval of Ureteral Stents Through an 8-French Percutaneous Nephrostomy Route

OBJECTIVE The purpose of this study was to describe the technique of antegrade retrieval of ureteral stents under fluoroscopic guidance through an 8-French nephrostomy. MATERIALS AND METHODS During an 8-year period, we retrieved 26 ureteral stents from 24 patients who were not candidates for retrograde removal or had other conditions precluding use of a retrograde approach. A loop snare or grasping forceps was used to retrieve a ureteral stent in the renal pelvis or calyx or upper ureter through an 8-French vascular sheath with a safety wire in place. A snare catheter advanced into the bladder for retrieval of the bladder end was used in patients in whom retrieval with both a loop snare and a grasping forceps failed. RESULTS All 26 ureteral stents were successfully retrieved by the antegrade approach. Ten stents were retrieved with a snare alone and nine with a forceps alone. Five stents were retrieved successfully with a forceps after initial failures with snare catheters. Two stents were retrieved with snare catheters advanced into the bladder. The major complication of nephrostomy wound infection occurred in a patient with a urinary tract infection who underwent a one-stage procedure. All minor complications, including pelvic perforation in one patient and blood clot in the renal pelvis in four patients, resolved spontaneously without adverse sequelae. CONCLUSION Antegrade percutaneous retrieval of a ureteral stent through an 8-French nephrostomy is safe and effective and has a high degree of technical success. It can be used as a routine interventional practice in radiology.

Differentiation between pelvic abscesses and pelvic tumors with diffusion-weighted MR imaging: a preliminary study

PURPOSE Use diffusion-weighted magnetic resonance imaging (MRI) in differentiating pelvic abscess from pelvic cystic tumor. MATERIALS AND METHODS Patients with pelvic abscess (n=23) or pelvic cystic tumor (n=15) who underwent diffusion-weighted MRI were reviewed. RESULTS Pelvic abscesses showed hyperintensity on diffusion-weighted MRI and hypointensity on apparent diffusion coefficient (ADC) map. The mean ADC values of fluid in pelvic abscess and pelvic tumors were 0.73 ± 0.15 × 10(-3) and 2.27 ± 0.45 × 10(-3) mm(2)/s, respectively. Pelvic abscesses had significantly lower ADC values than pelvic cystic tumors (P<.001). CONCLUSION Diffusion-weighted MRI provides a noncontrast method for interpreting pelvic cystic lesions.

Evaluation of the Effects of Chitosan Hemostasis Dressings on Hemorrhage Caused by Breast Biopsy.

Background: Female breast tissue has a rich vascular supply and carries a high risk of excessive bleeding during large-core needle biopsy. It is crucial to shorten bleeding time and reduce hematoma size after the procedure. Currently, more efficient hemostatic dressings are becoming available. Material and Methods: The bleeding time and hematoma size after breast biopsy with use of either Instant Clot Pad (ICP) dressings or cotton gauze were compared. Results: ICP could attract a vast number of red blood cells and formed blood clots in about 30 s (in vitro blood clotting test). In clinical breast biopsy examinations, the average bleeding time with ICP was significantly reduced to about 2.9 min as compared to 6.4 min with cotton gauze (p < 0.005). The average hematoma size was also reduced with the use of ICP (0.89 cm3) as compared to cotton gauze (1.28 cm3). In patients with benign breast disease, ICP significantly reduced hematoma size. Conclusion: ICP used after breast biopsy could shorten the bleeding time in all patients, and significantly reduce the hematoma size in patients with benign compared to those with malignant breast disease.

Imaging Features of Bilateral Lupus Mastitis

whereas the staining was negative for vimentin, a fetoprotein, c-erbB-2, estrogen, and progesterone receptor. The differential diagnosis of breast cancer with choriocarcinomatous features should be made with metastases of choriocarcinoma to the breast. Our patient did not have a history of uterine or ovarian tumor. These patients have to be under the control with short intervals because of poor prognosis of this variant of breast cancer.