Darrell N. Smith

The Utility of Ultrasonographically Guided Large-Core Needle Biopsy Results From 500 Consecutive Breast Biopsies

Five hundred ultrasonographically guided large‐core needle breast biopsies of solid masses were performed in 446 women. Histopathologic results were correlated with imaging findings. Ultrasonographically guided large‐core needle biopsy resulted in diagnosis of malignancy (n = 124) or severe atypical ductal hyperplasia (n = 4) in 128 lesions (26%). In the remaining 372 lesions (74%), ultrasonographically guided large‐core needle biopsy yielded benign pathologic results. Follow‐up of more than 1 year (n = 225), results of surgical excision (n = 50), or both were obtainable in 275 (74%) of the benign lesions. No malignancies were discovered at surgical excision or during follow‐up of this group of benign lesions. There were no complications related to large‐core needle biopsy that required additional treatment. Ultrasonographically guided large‐core needle biopsy is a safe and accurate method for evaluating breast lesions that require tissue sampling.

Sonographic Evaluation of Clinically Palpable Breast Cancers Invisible on Mammography

Abstract: The purpose of this study was to determine the utility of sonography in the evaluation of palpable breast cancers invisible on mammography. A retrospective review of the pathology departments database was used to identify patients with palpable breast cancers. Consecutive patients that had excision between January 1992 and September 1997 were included. Mammograms and breast ultrasounds were reviewed retrospectively and correlated with pathologic and surgical findings. During the study period 298 women presented with a palpable breast cancer for imaging at our institution. Of these, 38 cancers (12.8%) were not seen on mammography. In 32 patients where no mammographic abnormality was found, ultrasound was able to detect a mass corresponding to the area of clinical concern. Histologic tumor types included 30 invasive ductal carcinomas, 5 ductal carcinomas in situ, and 3 invasive lobular carcinomas. Mammographic density was mild with scattered fibroglandular densities in 2 (5%), heterogeneously dense in 12 (32%), and extremely dense in 24 (63%). Thirty‐one masses (97%) were hypoechoic and 1 (3%) was echogenic. Lesion margins were irregular in 23 (72%), lobulated in 5 (16%), and well‐circumscribed in 4 (12%). In this group of patients the combination of mammography and ultrasound of the mass demonstrated 99% of the palpable cancers. In patients presenting with a breast mass on physical examination in whom mammography fails to demonstrate an abnormality, supplemental ultrasound is helpful in most instances to further characterize the lesion.

Lactating Adenoma: Sonographic Features

Abstract: The lactating adenoma is a benign breast lesion occurring as a palpable mass in pregnant or lactating patients. The ultrasound characteristics of 15 lactating adenomas in 15 patients were reviewed retrospectively. Most of the lactating adenomas in this series (10 of 15) had one or more typically benign features such as circumscribed borders, smooth lobulations, or an echogenic pseudocapsule. The remaining five, however, had features typically associated with malignancy, including irregular, angulated, or ill‐defined margins, or posterior acoustic shadowing.

Feasibility of MR Imaging–Guided Breast Lumpectomy for Malignant Tumors in a 0.5-T Open-Configuration MR Imaging System

RATIONALE AND OBJECTIVES The authors performed this study to develop the technology for and evaluate the utility of a 0.5-T vertical open-configuration magnetic resonance (MR) imaging system for imaging-guided breast lumpectomy of malignant tumors. MATERIALS AND METHODS Twenty women with breast cancer underwent MR imaging-guided lumpectomy in a 0.5-T vertical open-configuration MR system. During lumpectomy, pre- and postresection images were acquired with and without contrast material. Images were used both for tumor localization and to monitor resection. If residual enhancement was observed, additional resection was performed in an effort to secure negative pathologic margins. RESULTS The procedure evolved over time with technology innovations and improvements. Specifically, instruments were acquired that were compatible with MR imaging breast procedures, the echo time with the Dixon technique was modified to optimize image quality, contrast material injection was timed for maximum lesion enhancement, breath-hold image acquisition was instituted, and the biopsy cavity was filled with saline and the incision closed before image acquisition. CONCLUSION All breast lesions were identified despite limited spatial resolution and fat-suppression techniques. The evolved techniques facilitated intraoperative margin evaluation and prompted additional surgical margin resection in five patients, sparing four from an additional surgical procedure. Intraoperative MR imaging has the potential to improve the complete pathologic excision of invasive breast cancer.

Mammographic and Sonographic Features of Angiolipoma of the Breast

Abstract: The mammographic and sonographic appearance of angiolipomas of the breast is presented. This rare benign variant of lipoma usually presents as a painless breast mass. The imaging characteristics of angiolipomas of the breast are variable, overlapping with both other benign breast neoplasms and with malignancies. The most common mammographic appearance of angiolipomas of the breast in this series was an oval or round, isodense, circumscribed mass. The most common sonographic features were oval shape, circumscribed borders, and iso‐ to slight hyperechogenicity. These imaging features are nonspecific and biopsy is required for definitive diagnosis.

Imaging features of nonmyxomatous primary neoplasms of the heart and pericardium

We present the imaging findings in 13 patients with nonmyxomatous primary neoplasms of the heart and pericardium. Ten patients had abnormal chest films. While echocardiography was useful for determining origin of the tumor, CT (computed tomography) and MRI (magnetic resonance imaging) were better at delineating extent of disease. The radiographic appearance of these rare neoplasms of the heart and pericardium is varied. Cross-sectional imaging plays a crucial role in the surgical planning and management of these patients.

Spindle Cell Lipoma of the Breast A Case Report

A case of spindle cell lipoma of the breast found on mammography in a 53-year-old woman is presented. This rare type of tumor has been previously reported on only after its presentation as a palpable mass. Radiographically it appears as a well-circumscribed mass. Ultrasonographically it appears as a homogeneously hyperechoic nodule. Histologically these lesions are composed of spindle cells intermingled with adipocytes.

Mediastinal large cell lymphoma: prognostic significance of CT findings at presentation and after treatment.

Objective: Primary mediastinal large cell lymphoma is a distinctive subtype of non-Hodgkin’s lymphoma. Computed tomography (CT) has become an integral part of the evaluation of these patients at presentation and after completion of therapy. The purpose of this study is to identify CT features that predict increased risk of relapse. Methods: A retrospective study of patients with primary mediastinal large cell lymphoma who underwent CT scans of the thorax. Results: Tumor volume greater than 100 ml after completion of therapy was a statistically significant predictor of increased risk of relapse (p = 0.02, Fisher exact test). Other measurements (obtained at presentation and after completion of treatment) were not statistically significant in predicting relapse. Conclusion: CT plays an important role in predicting outcome in primary mediastinal large cell lymphoma. Large residual tumor volume after completion of treatment predicts an increased risk of relapse.

Image-guided core breast biopsy of ductal carcinoma in situ presenting as a non-calcified abnormality

OBJECTIVE Ductal carcinoma in situ (DCIS) typically presents as calcifications which are detected mammographically. Our aim was to evaluate the less common presentations of ductal carcinoma in situ diagnosed by image-guided core biopsy and correlate with histopathologic diagnoses. METHODS AND MATERIAL Imaging and histopathologic findings were retrospectively reviewed in 11 patients with ductal carcinoma in situ diagnosed at core biopsy that presented as noncalcified radiographic abnormalities. RESULTS Mammography showed non-calcified, circumscribed nodules, ill-defined nodules and architectural distortion. In two patients, no mammographic abnormality was detected. Sonography showed circumscribed, round or oval, solid masses; irregular, heterogeneous masses; and a tubular structure. Histopathologic diagnoses included multiple architectural subtypes and ranged from low to high nuclear grade. CONCLUSION Although image-guided core biopsy diagnosis of ductal carcinoma is typically made when sampling calcifications, DCIS can be diagnosed following biopsy of non-calcified masses or distortion. There is no correlation between histopathologic subtype and radiologic appearance.

Negative pressure fixation device to reduce motion artifacts on contrast-enhanced MRI of the breast: A clinical feasibility study

To investigate the effect of a negative pressure fixation device on misregistration artifacts in contrast‐enhanced (CE) MR subtraction images.