Michael Suen

High resolution sonographic detection of axillary lymph node metastases in breast cancer.

Axillary lymph node status is crucial in the evaluation of prognosis and in treatment planning of breast cancer. High‐resolution real‐time sonographic scans of the breast and both axillae were performed on 114 patients with breast carcinoma, all of whom had axillary lymph node dissection and histologic assessment. The sensitivity of high‐resolution ultrasonography in the detection of axillary nodal metastases was 84.1%, with a specificity of 97.1%, accuracy of 92.1%, positive predictive value of 94.9%, and negative predictive value 90.7%. Ultrasonography of the axilla provides good information on anatomy and pathology and may have a potential role in the prognostic work‐up of patients who are not surgical candidates.

Sonographic, magnetic resonance imaging, and mammographic assessments of preoperative size of breast cancer.

High resolution sonographic (39 cases), magnetic resonance imaging (32 cases), and mammographic (35 cases) measurements of preoperative size of breast cancer were correlated with the pathologic size in 39 patients with breast carcinoma to determine the most accurate imaging technique for breast cancer size. There were nine T1, 21 T2, four T3, and four T4 tumors. Sonographic and magnetic resonance imaging measurements of tumor size demonstrated correlation coefficients of 0.92 and 0.93, respectively, both of which were superior to that of mammography (0.84). Sonographic tumor size evaluation thus is shown to be equivalent to magnetic resonance imaging in this study. Three of nine (33%), four of seven (57%), and four of eight (50%) T1 tumors would have been overstaged by ultrasonography, magnetic resonance imaging, and mammography, respectively. Three of 21 (14.3%), one of 16 (6.3%), and two of 18 (11.1%) T2 tumors would have been understaged by ultrasonography, magnetic resonance imaging, and mammography, respectively. We therefore found ultrasonography to be of value in the diagnosis and staging of breast cancer.

Sonographic features of benign papillary neoplasms of the breast: review of 22 patients.

The sonographic features of 22 patients with histologically benign intraductal papillomas are presented, with clinical, mammographic, galactographic, and histopathologic correlation. The most common presenting feature in this series is a palpable central breast mass in an elderly woman. Sonography was abnormal in all 22 patients. The typical sonographic features include a well‐defined, smooth‐walled, solid, hypoechoic nodule or a lobulated, smooth‐walled, cystic lesion with solid components. Dilated ducts are a common feature, often with visible solid intraluminal echoes. These findings suggest the diagnosis of an intraductal papilloma. The differential diagnosis includes fibroadenoma and phyllodes tumor (for large solid lesions) and intracystic carcinoma (for complex cystic lesions). Mammograms are frequently normal (36% of patients). When abnormal, the mammographic features are of a smooth‐walled, well‐defined mass or increased retroareolar opacity. Contrary to the reported literature, calcification was seen infrequently. We conclude that ultrasonography is useful in the detection and delineation of intraductal papillomas.

Ultrasonographic demonstration of normal axillary lymph nodes: a learning curve.

High frequency transducers with near field resolution allow visualization of superficial structures in the axilla, such as the lymph nodes, which could not be visualized with older equipment. We have been able to observe normal axillary nodes in 61.5% of 26 women who had histologic correlation of normal lymph nodes at axillary dissection. We studied 663 women with a clinically palpable breast lump using breast and axillary ultrasonography. They were divided into four groups. The first group consisted of all women who had undergone surgery and had histologic correlation of axillary nodes. The second, third, and fourth groups were made up of three consecutive series of 221 women examined. Women from group one were included in groups two, three, and four. A steep learning curve of 7.1 to 41.9 to 64.7% was observed in the detection of normal axillary nodes, suggesting that these appearances can be recognized easily.

Paraffinomas of the breast : mammographic, ultrasonographic and radiographic appearances with clinical and histopathological correlation

Paraffinomas are uncommon lesions occasionally encountered in the breast. The clinical and radiological (mammographic, ultrasound and plain film) features are presented in five patients with breast paraffinomas, one of whom had synchronous infiltrative ductal carcinoma. Histopathological correlation was available in two patients. Women with a history of paraffin injections into the breast may present decades later with hard, nodular breast masses simulating breast cancer. Dense fibrosis particularly in the retroglandular midbreast region causing streaky opacities and bizarre architectural distortion on mammography suggests the diagnosis. Flocculent, amorphous, ring or rounded calcifications may also be present within the breast and axilla. Migration of liquid paraffin through the tissue planes can result in diffuse conglomerate calcification in the chest and abdominal walls.

Genetic imbalances in pT2 breast cancers of southern Chinese women.

While much information has been reported on the genetic alterations in breast cancers of Caucasians, little is known about the Oriental populations where breast cancers currently rank the second most common neoplasm. As a first step toward understanding the underlying genetics changes in this population, we used comparative genomic hybridization (CGH) to the genome-wide analysis of forty pT2 tumors from patients of a racially homogenous population in southern China. A complex pattern of genetic alterations emerged with the commonest chromosomal gains identified on 1q (58%), 8q (55%), 11q13 (25%), 16p (28%), 17q (53%) and 20q (35%), and frequent losses on 8p (38%), 11q (28%), 13q (30%) and 18q (25%). When breast cancers with and without lymph-node metastasis were compared, a higher copy gain of 10p was identified in the node-positive group (P=.036). An overall increase in the average number of genetic aberrations was also identified in the late onset group (>45 years)(P=.042) with a higher incidence of genetic losses noted (P=.035). In particular, losses on 16q were detected in 30% of the late onset patients but none in the early onsets (P=0.049). In this study, we have illustrated the pattern of genetic changes in breast tumors of southern Chinese females. While frequent 1q, 8q, 17q and 20q gains, and common 8p and 13q deletions detected were consistent to those aberrations reported from the Caucasian populations, the difference in genetic changes associated in lymph-node metastasis and age of onset identified should provide the basis for additional investigations into the underlying tumorigenesis in the Oriental population.

Mammographic, sonographic and histopathological correlation of benign axillary masses

Eight cases of benign isolated axillary masses due to tuberculous lymphadenitis (3), chronic inflammation (1), accessory axillary breast tissue (3) and lipoma (1) are presented. The mammographic, sonographic and histopathological features are described, differential diagnoses outlined and usefulness of mammography, ultrasound and ultrasound-guided tissue sampling discussed.