Melania Costantini

Characterization of Solid Breast Masses Use of the Sonographic Breast Imaging Reporting and Data System Lexicon

Objective. The purpose of this study was to determine the reliability of sonographic American College of Radiology Breast Imaging Reporting And Data System (BI‐RADS) classification in differentiating benign from malignant breast masses. Methods. One hundred seventy‐eight breast masses studied by sonography with a known diagnosis were reviewed. All lesions were classified according to the sonographic BI‐RADS lexicon. Pathologic results were compared with sonographic features. Sensitivity, specificity, accuracy, and positive predictive value (PPV) and negative predictive value (NPV) for the sonographic BI‐RADS lexicon were calculated. Results. Twenty‐six cases were assigned to class 3, 73 to class 4, and 79 to class 5. Pathologic results revealed 105 malignant and 73 benign lesions. The sonographic BI‐RADS lexicon showed 71.3% accuracy, 98.1% sensitivity, 32.9% specificity, 67.8% PPV, and 92.3% NPV. The NPV for class 3 was 92.3%. The PPVs for classes 4 and 5 were 46.6% and 87.3%. Typical signs of malignancy were irregular shape, antiparallel orientation, noncircumscribed margin, echogenic halo, and decreased sound transmission. Typical signs of benignity were oval shape and circumscribed margin. Conclusions. The sonographic BI‐RADS lexicon is an important system for describing and classifying breast lesions.

Achilles tendinitis in psoriasis: clinical and sonographic findings

BACKGROUND Involvement of the Achilles tendon is frequent in psoriatic arthritis, but it is easily missed at clinical examination. OBJECTIVE To seek evidence of Achilles tendon abnormalities by means of sonography in psoriatic patients and to correlate sonographic findings with clinical symptoms (tendon and soft-tissue swelling, pain, and difficulty in walking). METHODS Fifty-nine patients with plaque-type psoriasis (Psoriasis Area and Severity Index score, 3.7-34.7) and 50 healthy, aged-matched volunteers underwent clinical and sonographic evaluation of Achilles tendons and peritendinous structures. RESULTS Eighteen (30.5%) of the 59 patients had clinical symptoms of Achilles tendinitis. Thirty-five (59.3%) of the patients had sonographic abnormalities. Of these, 13 patients had clinically symptomatic abnormalities, and 11 had psoriatic arthritis. Degenerative tendinitis was the most frequent sonographic finding (76.9%) among patients with symptomatic conditions. Five patients with symptoms did not have sonographic alterations. None of the controls had clinical or sonographic changes. CONCLUSIONS In psoriatic patients Achilles tendon abnormalities cannot be excluded even when they are clinically absent.

Magnetic resonance imaging in breast cancer recurrence.

AbstractPurpose. To determine the sensitivity, specificity and accuracy of magnetic resonance imaging (MRI) in detecting breast cancer recurrence. Materials and methods. Forty women conservatively treated for breast cancer underwent MRI and confirmation on histology and cytology of suspected local recurrence. In these patients both clinical and mammographic/ultrasound features of local recurrence were nonspecific or suspicious. All patients were examined at least 1 year after completion of radiation treatment. Dynamic magnetic resonance imaging was performed with a 1.5 T unit using a dedicated bilateral breast coil. Qualitative and quantitative data were obtained. Statistical analysis was also performed with the Student T-test. Results. Breast cancer recurrence was confirmed on histology in 22 patients. MRI identified all the 22 breast recurrent cancers. False-positive contrast enhancement was seen in only two patients. In four patients recurrence was classified as multifocal. In one patient the tumor was detected in the contralateral breast. MRI showed 95% accuracy, 100% sensitivity, 88.8% specificity with 5% false-positives and 100% negative predictive value. Conclusion. Dynamic MRI appears a valuable technique for differentiation of post-treatment changes from recurrent carcinoma and for guiding the histological confirmation. Its high negative predictive value may have an impact on follow-up of treated breast.

Sonographic diagnosis of distal biceps tendon rupture: a prospective study of 25 cases.

To describe the sonographic findings of distal biceps tendon ruptures and to assess the accuracy of the technique.

DIFFUSION-WEIGHTED IMAGING IN BREAST LESION EVALUATION

PurposeThe purpose of this study was to investigate the ability of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) in the detection and characterisation of breast lesions.Materials and methodsFrom September 2005 to September 2007, 86 patients with breast lesions who underwent magnetic resonance imaging (MRI) in our department were included in our study. MRI was performed with a 1.5-T unit using a standard protocol including DWI sequence. For each breast lesion, the ADC value was calculated and compared with that of normal breast tissue and to the definitive pathological diagnosis. Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis.ResultsA total of 126 breast lesions were detected. Pathology results revealed 100 malignant and 26 benign lesions. Mean diameter of lesions was 26.02 mm (range 4–90 mm), including 52 lesions ≤15 mm in size. Mean ADC value of normal glandular tissue was 1.55×10−3 mm2/s. Mean ADC value of malignant lesions was 0.97×10−3 mm2/s. Mean ADC value for benign lesions was 1.66×10−3 mm2/s. Benign lesions showed ADC values significantly higher than malignant lesions (p<0.0001).ConclusionsDWI provides reliable information to support MRI diagnosis of breast masses. ADC value appears a promising adjunctive parameter in distinguishing malignant from benign breast lesions.RiassuntoObiettivoLo scopo di questo lavoro è stato quello di valutare l’utilità dell’imaging di diffusione nella caratterizzazione delle lesioni mammarie.Materiali e metodiSono stati inclusi nel nostro studio 86 pazienti con lesione sospetta della mammella inviate all’esecuzione di risonanza magnetica (RM) mammaria presso il nostro Dipartimento da settembre 2005 a settembre 2007. La RM è stata eseguita con apparecchio da 1,5 T; il protocollo di studio includeva una sequenza di diffusione (DWI). Per ogni paziente è stato calcolato il valore del coefficiente di diffusione apparente (ADC) delle lesioni individuate e del parenchima ghiandolare controlaterale. Il valore ADC relativo alle lesioni è stato poi confrontato con la diagnosi patologica definitiva. I test di Mann-Whitney U e Kruskal-Wallis sono stati utilizzati per l’analisi statistica.RisultatiSono state identificate 126 lesioni. L’esame istopatologico ha rivelato la presenza di 100 lesioni maligne e 26 lesioni benigne. Il diametro medio delle lesioni è stato di 26,02 mm (range: 4–90 mm), di cui 52 con diametro ≤15 mm. L’ADC medio del tessuto ghiandolare normale è stato di 1,55×10−3 mm2/s. L’ADC medio delle lesioni maligne è stato di 0,97×10−3 mm2/s. L’ADC medio delle lesioni benigne è stato di 1,66×10−3 mm2/s. Le lesioni benigne hanno mostrato valori di ADC significativamente più alti rispetto alle lesioni maligne (p<0,0001).ConclusioniLa DWI fornisce utili informazioni alla diagnosi di lesioni mammarie in RM. Il valore di ADC sembra un parametro aggiuntivo promettente nella distinzione tra lesioni maligne e benigne della mammella.

Role of color Doppler sonography in the assessment of musculoskeletal soft tissue masses.

Fifty‐six patients with soft tissue masses of the limbs (36 benign, 20 malignant) prospectively underwent sonography (color Doppler and pulsed Doppler examinations) to assess the role of Doppler interrogation in differentiating benign from malignant lesions. Sonography showed 60% sensitivity, 55% specificity, 71% negative predictive value, 42% positive predictive value, and 57% accuracy. Color Doppler evaluation showed 85% sensitivity, 88% specificity, 91% negative predictive value, 80% positive predictive value, and 87% accuracy. Diastolic and venous velocities and pulsatility index values were not statistically significant. Mean systolic velocity was 0.27 m/s in benign lesions and 0.55 m/s in malignant lesions. By combining sonographic and Doppler data, a correct diagnosis was obtained in 51 of 56 patients (90% sensitivity, 91% specificity, 85% positive predictive value, 94% negative predictive value, 91% accuracy). Color Doppler and pulsed Doppler evaluations represent a useful adjunct to sonography and should be routinely included in the evaluation of musculoskeletal soft tissue masses by ultrasonography.

Diffusion-weighted Imaging in Evaluating the Response to Neoadjuvant Breast Cancer Treatment

Abstract:  The aim of this study was to investigate the role of diffusion imaging in the evaluation of response to neoadjuvant breast cancer treatment by correlating apparent diffusion coefficient (ADC) value changes with pathological response. From June 2007 to June 2009, all consecutive patients with histopathologically confirmed breast cancer undergoing neoadjuvant chemotherapy were enrolled. All patients underwent magnetic resonance imaging (MRI) (including diffusion sequence) before and after neoadjuvant treatment. The ADC values obtained using two different methods of region of interest (ROI) placement before and after treatment were compared with MRI response (assessed using RECIST 1.1 criteria) and pathological response (assessed using Mandard’s classification).

Magnetic Resonance Imaging Features in Triple-Negative Breast Cancer: Comparison With Luminal and HER2-Overexpressing Tumors

BACKGROUND It has been ascertained that triple-negative (TN) breast cancer is characterized by an aggressive clinical course and a poor prognosis. The purpose of our study was to compare the magnetic resonance imaging (MRI) features of the 3 major different breast cancer subtypes (TN, luminal, and human epidermal growth factor receptor 2 [HER2]-overexpressing) and to suggest the criteria that might predict TN phenotype. MATERIALS AND METHODS From October 2007 to April 2011, we studied 77 patients with histologically confirmed TN breast cancer who underwent breast MRI. We randomly included 148 patients with non-TN breast cancer (110 luminal and 38 HER-overexpressing) as a control group. We evaluated the clinicopathologic data, the MRI morphologic and kinetic features, the signal intensity on T2-weighted images, and the apparent diffusion coefficient (ADC). RESULTS Our results confirmed that TN tumors are more aggressive, are usually diagnosed at a younger age compared with the other study groups, and show benign morphologic features with MRI. Backward stepwise logistic regression identified some parameters as independent predictors of TN-type lesions: age, size, shape, presence of edema, and infiltrative characteristics. The receiver operating characteristic (ROC) curve, built with 4 of 5 these factors as criteria to predict TN status, showed a 0.664 area under the curve (AUC) value (sensitivity 58.4%, specificity 73.2%). The inclusion of the fifth criterion showed a 0.699 AUC value (sensitivity, 49.4%; specificity, 89.4%). CONCLUSION We identified the clinicoradiologic parameters that are independent predictors of TN breast lesions, which might be helpful for earlier prediction of the TN status of a breast lesion.

Solid breast mass characterisation: use of the sonographic BI-RADS classification

PurposeThe aim of this study was to assess the reliability of the sonographic Breast Imaging Reporting and Data System (BI-RADS) classification in differentiating benign from malignant breast masses.Materials and methodsA total of 292 female patients with breast masses undergoing biopsy between November 2004 and March 2006 in our department were included in this study. All lesions were classified according to the sonographic BI-RADS lexicon. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for the sonographic BI-RADS lexicon and PPV and NPV for each lesion category and each sonographic descriptor were calculated. The χ2 test and the Fischer exact test were used to evaluate our results.ResultsUnivariate analysis showed a significant difference between malignant and benign groups with regard to morphology (p<0.001), horizontal-vertical diameter ratio<1 (p<0.002), orientation (p<0.001), noncircumscribed margins (p<0.001), echogenic halo (p<0.001), hypoechoic pattern (p=0.035), shadowing (p<0.001) and surrounding tissue alterations (p=0.001). The cumulative risk for malignancy was 64 and 10 times higher, respectively, in categories 5 and 4 than in category 3.ConclusionsThe sonographic BI-RADS lexicon is an important system for describing and classifying breast lesions.RiassuntoObiettivoValutare l’attendibilità della classificazione BI-RADS nella caratterizzazione ecografica delle lesioni solide della mammella.Materiali e metodiSono state studiate 292 pazienti con nodulo mammario sottoposto a biopsia nel nostro Dipartimento dal novembre 2004 al marzo 2006. Ogni lesione è stata studiata ecograficamente e classificata secondo i criteri BI-RADS. Sono stati calcolati specificità, sensibilità, accuratezza, valore predittivo positivo e negativo (VPP e VPN) del sistema BI-RADS, VPP e VPN per ogni classe e per ogni descrittore ecografico. Sono stati adottati il test del χ2 e il test esatto di Fischer per valutare la significatività dei nostri risultati.RisultatiDall’analisi univariata sono emerse differenze statisticamente significative tra il gruppo lesioni maligne e quello lesioni benigne rispetto alle seguenti variabili: forma (p<0,001), rapporto dei diametri inferiori a 1 (p<0,002), orientamento (p<0,001), margini non circoscritti (p<0,001), alone iperecogeno (p<0,001), ipoecogenecità (p=0,035), sbarramento (p<0,001), presenza di alterazioni del parenchima circostante (p=0,001). Dall’analisi multivariata è risultato che il rischio di avere una lesione maligna è in classe V e IV, rispettivamente 64 e 10 volte maggiore rispetto alla classe III.ConclusioniIl nostro studio conferma che la classificazione ecografica BI-RADS costituisce un accurato sistema per la descrizione e il management delle lesioni mammarie.

DWI in breast MRI: role of ADC value to determine diagnosis between recurrent tumor and surgical scar in operated patients.

INTRODUCTION Purpose of our study is to evaluate the role of the apparent diffusion coefficient (ADC) in the diagnosis of recurrent tumor on the scar in patients operated for breast cancer. Assess, therefore, the weight of diagnostic diffusion echo-planar sequence, in association with the morphological and dynamic sequences in the diagnosis of tumor recurrence versus surgical scar. MATERIALS AND METHODS From September 2007 to March 2009, 72 patients operated for breast cancer with suspected recurrence on the scar were consecutively subjected to magnetic resonance imaging (MRI), including use of a diffusion sequence. All patients with pathological enhancement in the scar were then subjected to histological typing. MRI was considered negative in the absence of areas of suspicious enhancement. In all cases it was measured the ADC value in the scar area or in the area with pathological enhancement. The ADC values were compared with MRI findings and histological results obtained. RESULTS 26 cases were positive/doubtful at MRI and then subjected to histological typing: of these recurrences were 20 and benign were 6. 46 cases were judged negative at MRI and therefore not sent to cyto-histology. The average ADC value of recurrences was statistically lower of scarring (p<0.001). CONCLUSIONS ADC value can be a specific parameter in differential diagnosis between recurrence and scar. The diffusion sequence, in association with the morphological and dynamic sequences, can be considered a promising tool for the surgical indication in suspected recurrence of breast cancer.