Daniel Rotten

Ultrasonographically guided fine needle aspiration cytology and core-needle biopsy in the diagnosis of breast tumors

The present study was designed to assess the performance of fine needle aspiration cytology (FNAC) and core-needle biopsy (CNB) of breast lesions when these procedures are performed under sonographic guidance. The results obtained in 1142 FNAC procedures and 180 CNB procedures were analysed. The study took place in a University Hospital and a private practice clinic. The patients eligible for this study were a series of women, in whom at least one hypoechoic, limited mass was found at breast ultrasonography. Cystic masses were excluded from the study. Each individual mass was investigated using either FNAC or CNB under sonographic guidance. Accuracy characteristics to suspect or diagnose malignant and pre-malignant breast lesions, such as sensitivity and specificity, were calculated. The cytological results were classified into four categories according to standard criteria: benign; atypical and/or suspicious for cancer (hyperplasia with atypia); malignant; and unsatisfactory for diagnosis specimen. Tissue specimens were classified according to the W.H.O. The 1142 lesions submitted to FNAC included 66 invasive carcinomas, 4 intraductal carcinomas, and 4 atypical hyperplasias. FNAC led to 6 false-negative examinations, equally distributed between small (volume < or = 1 cm3), and larger lesions, and 1 false-positive examination. There were 12.9% (147/1142) inadequate smears. Only 3 inadequate samples were obtained in the presence of a discrete pathologic lesion (3/363, or 0.1%). All 3 corresponded to invasive carcinomas. The majority of inadequate samples (144/147, or 98.0%) were obtained in the normal/dystrophic group. Overall, the sensitivity is 92.1%, and the specificity is 84.8%. The 180 lesions submitted to CNB included 31 invasive carcinoma, 5 intraductal carcinomas, and 17 atypical hyperplasias. CNB, in this series, had an accuracy rate of 100%. In conclusion, US guidance increases the accuracy of breast tissue sampling procedures. This is of particular importance as the number of suspicious images to be investigated steadily increases, as the result of mass screening.

Mass screening for breast cancer with sonomammography: a prospective study

A prospective study was performed to assess the reliability of sonographic mammography in mass screening for breast lesions and diagnosis of small, presumably early, breast cancers. 1350 women underwent a sonomammographic examination of the breasts. Sonomammographic images were described in terms of their elementary constituents. Final diagnosis was obtained through cytological, and, when indicated, histological analysis. This ultimately led to the diagnosis of 13 breast cancers. Statistical analysis of the elementary sonomammographic image data using a logistic regression found two criteria to be highly associated with cancer. These were: (1) jagged aspect of the margins extending to the anterior or posterior walls; (2) major axis of the lesion not parallel to the skin surface. When combined, these two criteria have a 100% sensitivity and 99.6% specificity. The conclusions of the present study were validated for the screening of young women and may be applied to the screening of small lesions. However, these conclusions should be restricted to tumors 5 mm or more in diameter and of the common histological type, i.e. the infiltrating ductal carcinomas. Within these limitations, sonographic mammography can be considered a reliable technique for mass screening for breast cancer.

Visualization of fetal lips and palate using a surface‐rendered oropalatal (SROP) view in fetuses with normal palate or orofacial cleft lip with or without cleft palate

In the presence of an orofacial cleft detected at routine midtrimester antenatal screening, precise characterization of the malformation is necessary, as this will affect the medical work-up and help in informing the parents1. The best method with which to analyze the palate is still under debate. Evaluation is usually based on multiplanar or tomographic reconstructions obtained with three-dimensional (3D) ultrasonography. Analysis of the posterior palate is impeded by artifacts due to acoustic shadowing by the anterior bony structures of the maxilla2. Various specific views have been advocated to overcome this difficulty, such as the ‘reverse face’ view, the intraoral ‘en face’ view, the ‘flipped face’ view, ‘angled insonation’, the ‘axial underside’ view and the ‘oblique face’ view (reviewed by To3). However, none has received general agreement. Our group has shown that the use of all three traditional orthogonal planes is necessary to examine thoroughly the different landmarks, in order to differentiate the involvement of the lip, alveolus and posterior hard palate. Lip analysis necessitates visualization of the coronal planes, and, in the case of bilateral clefts, the midsagittal plane. The palate (alveolus, maxilla, secondary palate) is best analyzed using coronal and axial planes4,5. However, 3D multiplanar reconstructions are impeded by certain drawbacks: to convey the information necessitates multiple scans; they focus on the bony defect of the palate; and they are difficult to interpret, in particular by lay people, in contrast with the more readily understood surface-rendered views6. To overcome these flaws, we have developed a surface-rendered representation, corresponding to the submental intraoral photograph of the neonatal palate that is used by orofacial surgeons to visualize clefts7,8 : the surface-rendered oropalatal (SROP) sonographic view. The SROP sonographic view is oriented in an oblique direction, transoral and directed upwards, from cephalad to caudal. Image reconstruction utilizes the surface rendering mode, which combines representation of the

Prenatal diagnosis of cleft lip/palate: The surface rendered oro-palatal (SROP) view of the fetal lips and palate, a tool to improve information-sharing within the orofacial team and with the parents

The ultrasonographic surface rendered oro-palatal (SROP) view is a 3D reconstructed view of the fetal perioral region, which combines ultrasound insonation in a trans oral, upward directed axial direction and the surface rendered mode. It allows the simultaneous visualization on a single scan of the superior lip, alveolar ridge and secondary palate. It corresponds prenatally to the submental intra oral photography of the palate of neonates. The aim of the study was to demonstrate the benefice of using the SROP view in the management of cleft lip with or without cleft palate, uni- or bi-lateral, diagnosed prenatally (22-28 gestational weeks). The SROP view allowed the representation on a single view of the characteristics of the defect useful to the different members of the orofacial team to exactly evaluate the difformity and to plan the ulterior therapeutic steps (e.g. side, extension of the cleft to the secondary palate, tooth organization). Also, being easier to read by lay people thanks to the use of a surface rendered representation rather than the usual multiplanar reconstructions in the three traditional orthogonal planes, the SROP view makes it easier to bring exact information to the parents about the malformation and its consequences.