Kai-Hsiung Ko

Non-mass-like breast lesions at ultrasonography: Feature analysis and BI-RADS assessment ☆

OBJECTIVE To analyze the features of non-mass-like (NML) breast lesions on ultrasound (US) and determine their corresponding malignancy rate and to stratify these lesion patterns according to US BI-RADS categories. MATERIALS AND METHODS One hundred sixty-four consecutive lesions were retrospectively classified into four types according to the US features, the corresponding positive predictive values (PPVs) were obtained. Clinical, imaging, and histopathological findings were reviewed. RESULTS Among the 164 lesions, 39 (24%) were classified as type Ia, 14 (8%) as type Ib, 39 (24%) as type IIa, 19 (12%) as type IIb, 19 (12%) as type III, and 34 (21%) as type IV. The PPVs for malignancy were 21% for type Ia, 79% for type Ib, 10% for type IIa, 58% for type IIb, 16% for type III, and 21% for type IV. All NML lesions were classified as BI-RADS category 4a (type IIa), 4b (type Ia, III and IV) and 4c (type Ib and IIb) according to their PPVs. There was a significantly higher frequency of malignancy among lesions of type Ib and type IIb compared with the other types (P<0.01 for each). Lesions with associated calcifications, presence of abnormal axillary nodes, or a mammographic finding of suspected malignancy had a higher probability of malignancy (P<0.05 for each). CONCLUSION US is useful in clarifying the indication for biopsy of NML lesions. The types of US classifications used in our study establish reliable references for the NML patterns when stratified according to the BI-RADS categories.

Features on MDCT that predict surgery in patients with adhesive-related small bowel obstruction.

Purpose The purpose of this study was to determine the contribution of multidetector-row computed tomography (MDCT) in the management of adhesion-related small bowel obstruction (SBO) and to identify its predictive value for surgery. Methods We conducted a retrospective review of 151 patients over a 5-year period with the diagnosis of SBO caused by adhesion. These patients were divided into two groups: surgery (n =  63) and observation group (n =  88). Two radiologists blinded to the outcome of the patients evaluated MDCT images retrospectively, recording the bowel diameter, bowel wall thickness, degree of obstruction, air-fluid level, mesenteric fatty stranding, transitional zone, intraperitoneal fluid, close loop, whirl sign, and faeces sign. Statistical analyses were performed using univariate and multivariable analyses. Results Multivariable analysis showed that MDCT demonstrated presence of intraperitoneal fluid (Odds ratio, OR, 4.38), high-grade or complete obstruction (OR, 3.19) and mesenteric fatty stranding (OR, 2.81), and absence of faeces sign (OR, 2.11) were the most significant predictors. When all of the four criteria were used in combination, high sensitivity of 98.4% and specificity of 90.9% were achieved for the prediction for surgery. Conclusion MDCT is useful to evaluate adhesion-related SBO and to predict accurately patients who require surgery. Use of the four MDCT features in combination is highly suggestive of the need for early surgical intervention.

Underestimation of invasive lesions in patients with ductal carcinoma in situ of the breast diagnosed by ultrasound-guided biopsy: A comparison between patients with and without HER2/neu overexpression☆

PURPOSE To determine the rate of underestimation of ductal carcinoma in situ (DCIS) diagnosed at imaging-guided biopsy and to analyze its association with HER2/neu oncogene, an important biomarker in assessing the tumour aggressiveness and guiding hormone therapy for breast cancer. METHODS We retrospectively reviewed 162 patients with DCIS diagnosed by imaging-guided core needle biopsy between January 2008 and March 2013. All of these patients received surgical excision, and in 25, the diagnosis was upgraded to invasive breast cancer. In this study, we examined the ultrasound, mammographic features and histopathological results for each patient, and compared these parameters between those with and without HER2/neu overexpression. RESULTS Of the 162 DCIS lesions, 110 (67.9%) overexpressed HER2/neu. Nineteen patients with HER2/neu overexpressing DCIS (n=19/110, 17.3%) were upgraded after surgery to a diagnosis of invasive breast cancer. In this group, the upgrade rate was highest in patients with a dilated mammary duct pattern (42.1%, n=8/19, p=0.02) and the presence of abnormal axillary nodes (40.0%, n=12/30, p<0.01) at ultrasound and was significantly associated with comedo tumour type on pathology. CONCLUSIONS Biopsy may underestimate the invasive component in DCIS patients. Sonographic findings of dilated mammary ducts and presence of abnormal axillary lymph nodes may help predicting the invasive components and possibly driving more targeted biopsy procedures.

Predictive value of 18F-FDG PET and CT morphologic features for recurrence in pathological stage IA non-small cell lung cancer.

AbstractPatients with pathological stage IA non-small cell lung cancer (NSCLC) may relapse despite complete surgical resection without lymphovascular invasion. A method of selecting a high-risk group for adjuvant therapy is necessary. The aim of this study was to assess the predictive value of 18F-fluorodeoxyglucose (FDG) uptake and the morphologic features of computed tomography (CT) for recurrence in pathological stage IA NSCLC.One hundred forty-five patients with pathological stage IA NSCLC who underwent pretreatment with FDG positron emission tomography and CT evaluations were retrospectively enrolled. The associations among tumor recurrence and patient characteristics, maximal standard uptake value (SUVmax) of primary tumors, and CT imaging features were investigated using univariate and multivariate analyses. A receiver operating characteristic (ROC) curve analysis was performed to quantify the predictive value of these factors.Tumor recurrence developed in 21 (14.5%) of the 145 patients, and the 5-year recurrence-free survival rate was 77%. The univariate analysis demonstrated that SUVmax, the grade of histological differentiation, tumor size, and the presence of bronchovascular bundle thickening were significant predictive factors (P < 0.05). A higher SUVmax (≥2.5) (P = 0.021), a lower ground-glass opacity ratio (⩽17%) (P = 0.014), and the presence of bronchovascular bundle thickening (P = 0.003) were independent predictive factors of tumor recurrence in the multivariate analysis. The use of this predictive model yielded a greater area under the ROC curve (0.877), which suggests good discrimination.The combined evaluation of FDG uptake and CT morphologic features may be helpful in the prediction of recurrence in patients with pathological stage IA NSCLC and in the stratification of a high-risk group for postoperative adjuvant therapy or prospective clinical trials.

Breast Nonmass Enhancement Detected with MRI: Uility and Lesion Characterization with Second-Look Ultrasonography.

The purpose of this study was to verify the utility of second‐look ultrasonography (US) in evaluating nonmass enhancement (NME) lesions detected on breast magnetic resonance imaging (MRI) by analysing its correlation and imaging features. From July 2008 to June 2012, 102 consecutive MRI‐detected NME lesions were subsequently evaluated with US. Lesions were evaluated according to the established Breast Imaging Reporting and Data System (BI‐RADS) lexicon. The correlation between MRI‐detected NME lesion characteristics, lesion size, histopathological findings and features at second‐look US were analysed. Second‐look US identified 44/102 (43%) of the NME lesions revealed by MRI. A US correlate was seen in 34/45 (76%) malignant lesions compared with 10/57 (18%) benign lesions (p < 0.0001). The likelihood of malignancy was significantly higher for NME lesions with a US correlate than lesions without: 34/44 (77%) versus 11/58 (19%) (p < 0.0001). The malignancy of the 44 (43%) MRI‐detected NME lesions with a US correlate was significantly associated with US lesion margins and BI‐RADS categories (p = 0.001 and 0.002 respectively). Second‐look US of MRI‐detected NME lesions is useful for decision‐making as part of the diagnostic workup. Familiarity with the US features associated with malignancy improves the utility of US in the workup of these NME abnormalities.

Differentiation of Malignant and Benign Incidental Breast Lesions Detected by Chest Multidetector-Row Computed Tomography: Added Value of Quantitative Enhancement Analysis

To retrospectively determine the association between breast lesion morphology and malignancy and to determine the optimal value of lesion enhancement (HU, Hounsfield units) to improve the diagnostic accuracy of breast cancer in patients with incidental breast lesions (IBLs). A total of 97 patients with 102 IBLs detected from July 2009 to December 2012 were enrolled in this study. Two radiologists analyzed CT images for the presence of malignancy based on the morphology of the lesions alone and in combination with an enhancement value (HU) analysis. There were 36 malignant and 66 benign IBLs. When the morphology and enhancement values were combined, the sensitivity, specificity, and accuracy were 92%, 97%, and 95%, respectively, for reader 1 and 89%, 94%, and 92%, respectively, for reader 2. The addition of HU values led to correct changes in the diagnosis; specifically, the accuracy of the diagnosis of reader 1 and reader 2 improved by 6.9% and 11.8%, respectively. The addition of the enhancement value (HU) to the CT morphology improved the diagnostic accuracy in the differentiation of malignant from benign IBLs by using the region of interest (ROI) to measure the HU within the most suspicious part of the lesion.

SUVmax and Tumor Size Predict Surgical Outcome of Synchronous Multiple Primary Lung Cancers

AbstractTo assess surgical outcomes in synchronous multiple primary lung cancer (SMPLC) and correlations with clinicopathological features and prognostic/predictive factors.We retrospectively reviewed patients diagnosed with early-stage nonsmall cell lung cancer (NSCLC) between January 2006 and June 2012. In total, 564 patients with resectable NSCLC underwent a preoperative positron emission tomography-computed tomography scan followed by anatomic resection. We reviewed the clinical features of 35 SMPLC patients. Surgical outcomes, prognosis, and tumor imaging features were evaluated (median follow-up = 44 months).In total, 35 eligible SMPLC patients (6.21%) were identified (11 men [31%], 24 women [69%], mean age = 65 years]). The tumors were bilateral in 17 patients (49%) and in different lobes of the ipsilateral lung in 18 patients (51%). Most patients (26/35, 74%) had 2 primary tumors, and 26% (9/35) had more than 2 tumors (6 with 3 tumors; 3 with 4 tumors). The median size of the most advanced tumor was 3.0 cm (range 0.9–54). The median standard uptake value (SUV) of the largest tumor was 3.1 (range 1.0–13.3). The patients were treated as follows: 30 lobectomies, 2 sublobar resections, 2 sequential bilateral lobectomies, and 1 bi-lobectomy. Twenty-four patients (69%) received adjuvant therapy. The overall cumulative 5-year survival was 91.5% (median overall survival = 45.5 months). Patients with a reference tumor ⩽ 3 cm and SUV ⩽ 3.1 had an expected 5-year survival of 100%. Patients with a reference tumor > 3 cm and SUV > 3.1 had an expected 5-year survival rate of 53.3%.SMPLC patients can benefit from aggressive surgery. The size and SUVmax of the reference tumor may predict postoperative outcomes.

Mediastinal hemangioma presenting with a characteristic feature on dynamic computed tomography images

Hemangiomas are uncommon benign tumors of the mediastinum. The definite diagnosis is sometimes difficult to make because of usually nonspecific features on single-phase contrast-enhanced computed tomography (CT) images. We described a 60-year-old woman suffering from a neck mass with progressive enlargement. On the dynamic CT study, the tumor showed peripheral nodular enhancement on early phase images and progressive centripetal fill-in on delayed phase images. Hemangioma was preoperatively diagnosed on the basis of this characteristic CT appearance.

Midgut volvulus as a delayed consequence of posttraumatic mesenteric pseudocyst

Complicated midgut volvulus is a surgical emergency with high mortality rate if not treated promptly. Most of midgut volvulus in adults is a silent form of congenital midgut malrotation, but it also can be acquired from other medical conditions, such as adhesion bands, tumors, and mesenteric cysts. Posttraumatic mesenteric pseudocysts are rare entities, and the diagnosis tends to be delayed. In reviewing the medical literature, midgut volvulus as a delayed consequence of posttraumatic hemorrhagic mesenteric pseudocyst has never been reported before. Here, we report a 50-year-old female patient who had experienced blunt abdominal injury 3 months earlier and midgut volvulus that resulted from a delayed posttraumatic hemorrhagic pseudocyst. The patient was successfully treated with surgical intervention.

The role of the ground-glass opacity ratio in resected lung adenocarcinoma

OBJECTIVES The goal of this study was to investigate the role of the ground-glass opacity (GGO) ratio in lung adenocarcinoma in predicting surgical outcomes. METHODS Patients who underwent surgical resection for pulmonary adenocarcinoma between January 2004 and December 2013 were reviewed. The clinical data, imaging characteristics of nodules, surgical approaches and outcomes were analysed with a mean follow-up of 87 months. RESULTS Of 789 enrolled patients, 267 cases were categorized as having a GGO ratio ≥0.75; 522 cases were categorized as having a GGO ratio <0.75. The gender, tumour differentiation, epidermal growth factor receptor mutation, smoking habits, lymphovascular space invasion, tumour size, maximum standard uptake value and carcinoembryonic antigen levels were significantly different in the 2 groups. In the group with a GGO ratio ≥0.75, 63.3% of the patients underwent sublobar resection (18.8% with a GGO ratio < 0.75, P <0.001). These patients had fewer relapses (2.2% for GGO ratio ≥0.75, 26.8% for GGO ratio <0.75, P < 0.001) and a better 5-year survival rate (95.5% for GGO ratio ≥0.75, 77.4% for GGO ratio <0.75, P < 0.001). None of the patients with a GGO ratio ≥0.75 had lymph node involvement. The multivariable Cox regression analysis revealed that a GGO ratio <0.75 was an independent factor for postoperative relapse with a hazard ratio of 3.96. CONCLUSIONS A GGO ratio ≥0.75 provided a favourable prognostic prediction in patients with resected lung adenocarcinoma. Sublobar resection and lymph node sampling revealed a fair outcome regardless of tumour size. However, anatomical resection is still the standard approach for patients with tumours with a GGO ratio <0.75, size >2 cm.