Jae Jeong Choi

Diffusion-weighted imaging of breast cancer: correlation of the apparent diffusion coefficient value with prognostic factors.

To evaluate the role of diffusion‐weighted imaging (DWI) in the detection of breast cancers, and to correlate the apparent diffusion coefficient (ADC) value with prognostic factors.

Role of Sonographic Elastography in the Differential Diagnosis of Axillary Lymph Nodes in Breast Cancer

The purpose of this study was to evaluate the diagnostic utility of sonographic elastography in differentiating reactive and metastatic axillary lymph nodes in breast cancer.

Role and Clinical Usefulness of Elastography in Small Breast Masses

RATIONALE AND OBJECTIVES The aim of this study was to evaluate and compare the diagnostic performance of elastography, B-mode ultrasound (US), and a combination of elastography and B-mode US for the differentiation of small breast masses. MATERIALS AND METHODS A total of 315 breast masses < 1 cm (267 benign, 48 malignant) in 278 patients were examined with B-mode US and elastography. Histopathologic results were used as a reference standard. Two radiologists retrospectively evaluated the B-mode images according to the American College of Radiology Breast Imaging Reporting and Data System and elastographic images according to the elasticity scoring classification system proposed by Itoh et al and the strain ratio. B-mode US and elastography were combined according to the cutoff value. The diagnostic performance of B-mode US, elastography, and the combination of the two modalities was compared using receiver-operating characteristic curve analysis. RESULTS The mean elasticity score for malignant masses (3.02 ± 1.33) was significantly higher than that for benign masses (1.72 ± 0.78) (P < .001). Areas under the receiver-operating characteristic curves were 0.616 for B-mode US, 0.784 for elasticity score, 0.668 for strain ratio, 0.727 for the combination of B-mode US and elasticity score, and 0.701 for the combination of B-mode US, elasticity score, and strain ratio. The sensitivity, specificity, positive predictive value, and negative predictive value were 93.8%, 51.7%, 25.9%, and 97.9%, respectively, when elasticity score and B-mode US were combined as follows: downgrade of B-mode US assessment category in cases with elasticity scores of 1, no change in cases with scores of 2 or 3, and upgrade in cases with scores of 4 or 5. CONCLUSION Elasticity score alone showed the best diagnostic performance, but a combination of B-mode US and elasticity score may have predictive value for the differentiation of benign and malignant lesions <1 cm.

Clinical significance of incidental finding of focal activity in the breast at 18F-FDG PET/CT.

OBJECTIVE The purpose of this study was to determine the clinical significance of the incidental finding of hypermetabolic foci in the breast at (18)F-FDG PET/CT in patients with malignant disease other than breast cancer or during a screening examination. MATERIALS AND METHODS The files of 13,897 women who underwent FDG PET/CT from November 2004 to October 2009 were retrospectively reviewed. Forty-eight patients with incidental breast uptake had undergone either tissue confirmation or clinical follow-up with additional sonographic imaging. The following four variables were evaluated: age, maximum standard uptake value (SUV(max)) of breast uptake at FDG PET, findings in the CT portion of PET/CT, and sonographic findings. Malignancy rates were calculated for each variable. RESULTS Malignancy was diagnosed in 18 (37.5%) patients and a benign condition in 30 (62.5%) patients. Statistically significant differences in malignancy rate were found between the groups with SUV(max) less than 2 (24.2%) and the group with SUV(max) of 2 or greater (66.7%) and between the group with lesions in a BI-RADS ultrasound category lower than 4 (10.7%) and the group with lesions in category 4 or higher (75.0%) (p < 0.05). There was no significant difference in malignancy rates between the groups younger than 45 years (11.1%) and 45 years and older (53.3%) or between the group with lesions in a BI-RADS category lower than 4 (30.2%) and that with lesions in category 4 or higher (100%) on the CT portion of PET/CT. CONCLUSION Incidental hypermetabolic foci in the breast may represent malignancy in as many as 37.5% of cases. The SUV(max) and sonographic findings can be useful for differentiating benign from malignant lesions.

Diagnostic value of breast MRI for predicting metastatic axillary lymph nodes in breast cancer patients: diffusion-weighted MRI and conventional MRI.

PURPOSES To evaluate the diagnostic value of diffusion-weighted MRI (DWI) and combination of conventional MRI and DWI to predict metastatic axillary lymph nodes in breast cancer. MATERIALS AND METHODS Two hundred fifty-two breast cancer patients with 253 axillae were included. The morphological parameters on axial T2-weighted images without fat saturation and apparent diffusion coefficient (ADC) values were retrospectively analyzed. An independent t-test/chi-square test and receiver operating characteristics (ROC) curve analysis were used. RESULTS On conventional MRI, short and long axis length, maximal cortical thickness, relative T2 value, loss of fatty hilum (p<0.001 for each), and eccentric cortical thickening (p<0.003) were statistically significantly different between the metastatic and nonmetastatic groups. The short axis to long axis ratio was not a statistically significant parameter. The ADC value was significantly different between the 2 groups, with an AUC that was higher than that of conventional MR parameters (AUC, 0.815; threshold, ≤0.986×10-3 mm(2)/sec; sensitivity, 75.8%; specificity, 83.9%). Using the adopted thresholds for each parameter, a total number of findings suggesting malignancy of 4 or higher was determined as the threshold, with high specificity (90.1%). CONCLUSION Using conventional MRI and DWI, we can evaluate the axilla in breast cancer with high specificity.

Clinical and imaging characteristics of Polyimplant Prosthesis hydrogel breast implants.

Objective: To describe the clinical and imaging characteristics of Polyimplant Prosthesis (PIP) hydrogel breast implants. Methods: Seven patients with surgically confirmed 8 ruptured and 6 normal PIP hydrogel implants were enrolled in our study. We reviewed retrospectively the medical records and breast ultrasonographic and magnetic resonance imaging (MRI) findings of the patients. Results: Breast asymmetry was the most common clinical feature of PIP hydrogel implant rupture. The main radiologic finding of ruptured implants was a significant fluid collection around the implant. All 4 intracapsular ruptures showed no significant collapse of the implants despite a large accumulation of fluid surrounding the ruptured implants on ultrasonography and MRI. Three extracapsular ruptures showed variable collapse of the implants, partial collapse in 1 implant and total collapse in 2 implants. One extracapsular rupture showed enlargement of the implant. Ultrasonography and MRI revealed hydrogel extension to the muscles and chest wall in all 4 extracapsular ruptures and extensive inflammation and fibrosis in 3 extracapsular ruptures. Conclusions: Polyimplant Prosthesis hydrogel implant rupture can be clinically silent. Knowledge of clinical and radiologic findings of the ruptured implants will be helpful in its diagnosis.

Metastases to the breast from extramammary malignancies−sonographic features.

To evaluate the clinical and sonographic (US) features of metastatic tumors from extramammary malignancies to the breast.

Gel Pad Application for Automated Breast Sonography

The purpose of this study was to describe the technical aspects of gel pad application for automated breast sonography and to show its effects on pain relief, scan coverage, and image quality. Twenty patients underwent 2 sets of automated breast sonography with and without gel pad application and were then asked to provide feedback on the examination‐related pain. Scan coverage and image quality were compared quantitatively and qualitatively. The degree of pain was significantly decreased after gel pad application (P < .0001). The scan coverage was expanded particularly at the mid‐portion of the breast. Image quality was satisfactory without significant differences between the sets. Gel pad application for automated breast sonography is easy and provides significant pain relief. The scan coverage was expanded, while the image quality was maintained.

F-18 FDG PET/CT demonstration of thymoma followed by development of lung cancer.

It is well-known that thymoma can be associated with diverse extrathymic malignancies. The authors present a case of a 72-year-old man with myasthenia gravis in which F-18 FDG PET/CT demonstrated high FDG uptake in both an anterior mediastinal mass and a lung nodule. The FDG uptake in the lung nodule was significantly higher than that of the thymic lesion, which might suggest the possibility of a second development of lung cancer in this thymoma patient. Surgical resection was done for the 2 tumors, and histologic examination revealed anterior mediastinal thymoma and primary adenocarcinoma of the lung. This case demonstrates the potential usefulness of PET/CT in detecting and assessing the second extrathymic malignancy in a patient with thymoma.

Band-Like Interposing Fat along Large Vessels: Ultrasonographic Pseudolesions of the Breast

Objective The aim of this study is to evaluate the clinical characteristics and ultrasonographic findings of band-like interposing fat as well as to identify additional approaches for its diagnosis. Materials and Methods This study included 26 confirmed cases of band-like interposing fat from June 2008 to June 2010. A retrospective analysis was performed to evaluate the clinical characteristics and ultrasonographic findings in these cases. Five radiologists analyzed the ultrasonographic findings, which correlated with the mammographic and MRI findings when available, according to Breast Imaging Reporting and Data System classification. Results None of the 26 patients had any symptoms. In 92.3% of the patients, the lesion was located in the upper outer quadrant of the breast. The mean distance of the lesion from the nipple was 2.4 ± 0.7 cm (1.1-4.5). The mean depth of the lesion from the skin was 1.3 ± 0.3 cm (0.8-2.1). The mean maximal length of the lesion was 0.8 ± 0.4 cm (0.3-1.8). The following were the most frequent ultrasonographic findings of lesions: irregular shape, not parallel orientation, indistinct margins, abrupt interface, hypoechogenicity, no posterior feature, no calcification, and presence of vascularity. The most frequent BI-RADS category was 4a. There were no suspicious findings on the mammography or MRI. Conclusion Ultrasonographic findings may lead to misclassification of band-like interposing fat as a malignancy. A better understanding of the clinical and ultrasonographic characteristics of band-like interposing fat would facilitate its differentiation from a true mass.