Jieun Koh

Proper Indication of BRAFV600E Mutation Testing in Fine-Needle Aspirates of Thyroid Nodules

Background The aim of this study was to evaluate the proper indication of adjunctive BRAFV600E mutation analysis at the time of ultrasound-guided fine-needle aspiration in the diagnosis of thyroid nodules. Methods This study included 518 nodules in 479 patients who underwent ultrasound-guided fine-needle aspiration with BRAFV600E mutation. We calculated and compared the diagnostic performances of cytology and cytology with BRAFV600E mutation analysis to detect malignancy among thyroid nodules according to ultrasound features and size. Results Sensitivity, negative predictive value, and accuracy of cytology with BRAFV600E mutation analysis were significantly higher than those of cytology alone in thyroid nodules with suspicious ultrasound features, regardless of size. Diagnostic performances did not show significant differences between cytology and cytology with BRAFV600E mutation analysis in nodules without any suspicious ultrasound features, regardless of size. Conclusion The BRAFV600E mutation analysis was a useful adjunctive diagnostic tool in the diagnosis of thyroid nodules with suspicious ultrasound features regardless of size.

Intrahepatic mass-forming cholangiocarcinoma: prognostic value of preoperative gadoxetic acid-enhanced MRI

AbstractObjectivesTo assess whether gadoxetic acid-enhanced MRI could be used as a prognostic factor for intrahepatic mass-forming cholangiocarcinomas (IMCCs).MethodsForty-one patients with pathologically proven IMCCs who underwent preoperative gadoxetic acid-enhanced MRI were included. The signal intensity of the IMCCs on hepatobiliary phase (HBP) MRI was qualitatively analyzed by two radiologists, and categorized into intermediate or hypointense groups. Analysis of clinicopathological prognostic factors and correlations of imaging and histology were also performed. Survival time and time to recurrence (TTR) were analyzed.ResultsOf the 41 IMCCs, 23 were in the intermediate group and 18 were in the hypointense group on HBP MRI. IMCCs in the intermediate group were associated with shorter survival time (P = 0.048) and TTR (P = 0.002) than the IMCCs of the hypointense group. Only the intermediate group on HBP MRI had a significantly shorter TTR on multivariate analysis (P = 0.012). The IMCCs of the intermediate group showed a tendency for more abundant tumour fibrous stroma than those of the hypointense group (P = 0.027).ConclusionsThe enhancement of IMCCs on HBP gadoxetic acid-enhanced MRI appears to correlate with tumour aggressiveness and outcomes due to the tumour fibrous stromal component. Thus, HBP images could be a useful prognostic factor for IMCCs after surgery.Key points• The enhancement of IMCCs on HBP correlates with the tumour fibrous stroma. • The enhancement of IMCCs on HBP MRI appears to correlate with prognosis. • Gadoxetic acid-enhanced MRI is helpful for predicting prognosis of IMCCs after surgery.

Variability in Interpretation of Ultrasound Elastography and Gray-Scale Ultrasound in Assessing Thyroid Nodules

The aim of this study was to validate inter-observer variability for strain ultrasound elastography (USE) and to compare the diagnostic performance of a combination of gray-scale ultrasound (US) and USE with that of gray-scale US. Three observers from different institutions evaluated gray-scale US images and USE video files of 443 cytopathologically proven benign or malignant thyroid nodules over a 3-mo period. Inter-observer variability did not statistically differ between USE using the Asteria criteria and gray-scale US; however, USE using the Rago criteria had the lowest inter-observer agreement (p < 0.043). For all three observers, sensitivity was increased by adding USE to gray-scale US (81.3%-88.3%, 75.4%-85.4%) compared with gray-scale US (70.4%-80.8%). Specificity was decreased by adding USE to gray-scale US (51.7%-59.1%, 59.1%-73.9%) compared with gray-scale US (69.0%-82.8%). USE and gray-scale US had comparable inter-observer variability. However, on addition of USE to gray-scale US, the additional diagnostic yield was limited compared with that of gray-scale US alone.

Uterine artery embolization (UAE) for diffuse leiomyomatosis of the uterus: clinical and imaging results.

PURPOSE The aim of the current study was to evaluate the efficacy of uterine artery embolization (UAE) in the management of diffuse uterine leiomyomatosis with mid-term follow-up. MATERIALS AND METHODS All patients who underwent UAE between 2008 and 2010 for symptomatic fibroids were analyzed. Among 360 cases, a total of 7 patients with diffuse uterine leiomyomatosis diagnosed based on MRI were included in this retrospective study. Patient ages ranged from 29 to 38 (mean 32.7) years. The median follow-up period was 16 (range; 6-31) months. The embolic agent was non-spherical polyvinyl alcohol particles. All patients underwent follow-up MRI at 3 months after UAE. Uterine volumes were calculated using MRI. Menorrhagia symptom changes were assessed at mid-term follow-up. RESULTS There were no technical failures to catheterize the uterine artery and no adverse events requiring therapy after UAE. Contrast-enhanced MRI showed complete necrosis of the leiomyomatous nodules in 5 patients (71%) 3 months after embolization. Two patients (28%) showed mostly leiomyomatous nodules that were necrotized, some of which were still viable. All 7 patients with menorrhagia had improvement of symptoms at the mid-term follow-up. The initial mean uterine volume was 601.30 ± 533.92 cm(3) and was decreased to a mean of 278.81 ± 202.70 cm(3) at 3 months follow-up, for a mean uterus volume reduction rate of 50.1% (p<0.05). One patient became pregnant 5 months after UAE treatment. CONCLUSION UAE was a highly effective treatment for diffuse uterine leiomyomatosis with mid-term durability and may be a valuable alternative to hysterectomy.

Additional Targeted Biopsy in Clinically Suspected Prostate Cancer: Prospective Randomized Comparison between Contrast-Enhanced Ultrasound and Sonoelastography Guidance

Our aim was to improve the detection of prostate cancer by evaluating whether contrast-enhanced ultrasound (CEUS) or sonoelastography (SE) is more helpful in guiding targeted biopsy (TB) performed before systematic biopsy (SB). A total of 52 patients suspected of having prostate cancer were prospectively included and randomly assigned to either the CEUS or SE group. Different, independent radiologists performed TB and twelve-core SB. Within each group, cancer detection rates based on core number were compared between SB and TB. We evaluated the effect of TB on core-based cancer detection rates between the CEUS and SE groups. Cancer detection was higher in overall TB cores 16.4% (28/171) than SB cores 11.4% (71/624) in both groups. In the SE group, TB cores revealed higher cancer detection than did SB cores from 4.49% (14/312) to 12.86% (9/70) (p = 0.01). Compared with CEUS, SE may improve detection rates when considering additional TB guidance methods.

Additional Magnetic Resonance Imaging–Detected Suspicious Lesions in Known Patients With Breast Cancer: Comparison of Second-Look Digital Tomosynthesis and Ultrasonography

Purpose The aim of the study was to compare the performances of second-look digital breast tomosynthesis (DBT) and ultrasonography (US) for additional magnetic resonance imaging (MRI)–detected suspicious lesions in patients referred for breast cancer. Methods Fifty-five patients (52.5 [9.3] years) with breast cancers newly diagnosed at a referring hospital underwent MRI and afterward DBT and US in our institution. The frequency for detecting additional MRI-detected suspicious lesions on DBT and US and performances of DBT and US were compared. Results Of 37 additional MRI-detected suspicious lesions, 27 were detected on DBT and/or US; 2 were detected on both DBT and US, 1 was detected only on DBT, and 24 were detected only on US. Ultrasonography detected more additional suspicious lesions than DBT (P < 0.0001). Twelve (44.4%) of the 27 lesions were malignant. The sensitivity and negative predictive value of US (100.0% and 100.0%) were significantly higher than those of DBT (16.7% and 83.6%, P < 0.001 and P = 0.001). The specificity of DBT was significantly higher (98.1%) than that of US (78.9%, P = 0.002). Positive predictive values of DBT and US were not significantly different (66.7% vs 52.2%, P = 0.598). The area under the receiver operating characteristic curve of US was significantly higher (0.894) than that of DBT (0.574, P < 0.001). Conclusions Second-look US showed higher performances than DBT for detecting and characterizing suspicious lesions additionally detected on MRI in patients referred for breast cancer.

Intrinsic Subtypes of Breast Cancers Initially Assessed as Probably Benign or of Low Suspicion on Ultrasonography Differ According to Tumor Size: Intrinsic Subtypes and Size of Breast Cancers

To investigate whether the intrinsic subtypes of breast cancers initially assessed as American College of Radiology Breast Imaging and Reporting System (BI‐RADS) category 3 or 4a differ according to tumor size.

Comparison of the Diagnostic Performance of Power Doppler Ultrasound and a New Microvascular Doppler Ultrasound Technique (AngioPLUS) for Differentiating Benign and Malignant Breast Masses

This study was performed to compare the diagnostic performance of power Doppler ultrasound (US) and a new microvascular Doppler US technique (AngioPLUS; SuperSonic Imagine, Aix‐en‐Provence, France) for differentiating benign and malignant breast masses. Power Doppler US and AngioPLUS findings were available in 124 breast masses with confirmed pathologic results (benign, 80 [64.5%]; malignant, 44 [35.5%]). The diagnostic performance of each tool was calculated to distinguish benign from malignant masses using a receiver operating characteristic curve analysis and compared. The area under the curve showed that AngioPLUS was superior to power Doppler US in differentiating benign from malignant breast masses, but the difference was not statistically significant.

New Doppler imaging technique for assessing angiogenesis in breast tumors: correlation with immunohistochemically analyzed microvessels density

Background Microvessel density (MVD) is associated with grade and prognosis in breast tumors. However, conventional color Doppler flow (CDF) imaging has been limited to represent MVD of breast tumors. Purpose To evaluate whether a new Doppler imaging technique (AngioPLUS) can represent MVD of breast tumors. Material and Methods The institutional review board approved this retrospective study, and patients’ informed consent was waived. CDF and AngioPLUS were available in pathologically confirmed 55 breast tumors of 53 women. For each lesion, vascular flow patterns (distribution and amount) of both Doppler images were retrospectively reviewed, and MVD was measured using immunohistochemical analysis of the biopsied tissue sections. MVD was subcategorized as low or high group with reference to the median. The associations between the Doppler features and MVD were evaluated using Fisher’s exact test and Student’s t test. Results Of the 55 masses, 28 (50.9%) were benign and 27 (49.1%) were malignant. Vascular flow distribution and amount of both Doppler imaging were different between the benign and malignant lesions (CDF, P = 0.020 and P = 0.010; AngioPLUS, P = 0.002 and P = 0.005). MVD had no significant relationships with CDF features, but vascular flow distribution on AngioPLUS showed significant differences between the lesions with low and high MVD (P = 0.020); Combined distribution was more frequent in the high MVD lesions than in the low MVD lesions (17/28, 60.7% vs. 6/27, 22.2%). Conclusion Our data confirmed the correlation between a new Doppler imaging technique, AngioPLUS, and MVD. We suggest that AngioPLUS can be used for assessing MVD in breast tumors.

Role of elastography for downgrading BI-RADS category 4a breast lesions according to risk factors:

Background Elastography has been introduced as an additional diagnostic tool to ultrasonography (US) which helps clinicians decide whether or not to perform biopsy on US-detected lesions. Purpose To evaluate the role of strain elastography in downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4a breast lesions according to personal risk factors for breast cancer in asymptomatic women. Material and Methods Strain elastography features of a total of 255 asymptomatic category 4a lesions were classified as soft and not soft (intermediate and hard). Malignancy was confirmed by surgery or biopsy, and benignity was confirmed by surgery or biopsy with no change on US for at least six months. Malignancy rates of lesions with soft and not soft elastography were calculated according to the presence of risk factors. Results Of 255 lesions, 25 (9.8%) were malignant and 230 (90.2%) were benign. Of 195 lesions in average-risk women, the malignancy rate of lesions with soft elastography was 1.5% (1/68), which was significantly lower than the 14.2% (18/127) of lesions with not soft elastography (P = 0.004). Of 60 lesions in increased-risk women, the malignancy rate of lesions with soft elastography was 15.0% (3/20), which was not significantly different from the 7.5% (3/40) of lesions with not soft elastography (P = 0.390). Conclusion In average-risk women, category 4a lesions with soft elastography could be followed up with US because of a low malignancy rate of 1.5%.