Morton H. Leonard

Laser optoacoustic imaging system for detection of breast cancer

We designed, fabricated and tested the laser optoacoustic imaging system for breast cancer detection (LOIS-64), which fuses optical and acoustic imaging techniques in one modality by utilizing pulsed optical illumination and ultrawide-band ultrasonic detection of resulting optoacoustic (OA) signals. The system was designed to image a single breast slice in craniocaudal or mediolateral projection with an arc-shaped array of 64 ultrawide-band acoustic transducers. The system resolution on breast phantoms was at least 0.5 mm. The single-channel sensitivity of 1.66 mVPa was estimated to be sufficient for single-pulse imaging of 6 to 11 mm tumors through the whole imaging slice of the breast. The implemented signal processing using the wavelet transform allowed significant reduction of the low-frequency (LF) acoustic noise, allowed localization of the optoacoustic signals from tumors, and enhanced the contrast and sharpened the boundaries of the optoacoustic images of the tumors. During the preliminary clinical studies on 27 patients, the LOIS-64 was able to visualize 18 out of 20 malignant lesions suspected from mammography and ultrasound images and confirmed by the biopsy performed after the optoacoustic tomography (OAT) procedure.

Detection and noninvasive diagnostics of breast cancer with two-color laser optoacoustic imaging system

We have designed, fabricated and tested a new laser optoacoustic imaging system (LOIS-64/16) for quantitative optoacoustic tomography of breast cancer. The system was designed to create a single slice of an optoacoustic image of the breast with 64 ultrawide band acoustic transducers. Other 16 transducers on the back of the acoustic probe were used to reconstruct the light distribution inside the breast. The system resolution was at least 0.5 mm for high-aspect-ratio objects. Maximum system sensitivity was 4.8 mV/Pa and the RMS noise of 3.1 mV, which allowed imaging of small (less than 1 cm) tumors at depths over 3 cm. The directivity of the optoacoustic transducers used in LOIS-64/16 assured that the signal detection was better than 70% of the maximum for about 75% of the imaging slice and reduced quickly for signals coming from out of the imaging slice. Implemented signal processing allowed significant reduction of the low-frequency acoustic noise and localizing the small OA signals. The system was able to differentiate phantoms mimicking tumors and malformations visualized in clinics based on the contrast and morphology of their images obtained at 1064 nm and 757 nm.

Comparison of breast tissue measurements using magnetic resonance imaging, digital mammography and a mathematical algorithm

Women with mostly mammographically dense fibroglandular tissue (breast density, BD) have a four- to six-fold increased risk for breast cancer compared to women with little BD. BD is most frequently estimated from two-dimensional (2D) views of mammograms by a histogram segmentation approach (HSM) and more recently by a mathematical algorithm consisting of mammographic imaging parameters (MATH). Two non-invasive clinical magnetic resonance imaging (MRI) protocols: 3D gradient-echo (3DGRE) and short tau inversion recovery (STIR) were modified for 3D volumetric reconstruction of the breast for measuring fatty and fibroglandular tissue volumes by a Gaussian-distribution curve-fitting algorithm. Replicate breast exams (N = 2 to 7 replicates in six women) by 3DGRE and STIR were highly reproducible for all tissue-volume estimates (coefficients of variation <5%). Reliability studies compared measurements from four methods, 3DGRE, STIR, HSM, and MATH (N = 95 women) by linear regression and intra-class correlation (ICC) analyses. Rsqr, regression slopes, and ICC, respectively, were (1) 0.76-0.86, 0.8-1.1, and 0.87-0.92 for %-gland tissue, (2) 0.72-0.82, 0.64-0.96, and 0.77-0.91, for glandular volume, (3) 0.87-0.98, 0.94-1.07, and 0.89-0.99, for fat volume, and (4) 0.89-0.98, 0.94-1.00, and 0.89-0.98, for total breast volume. For all values estimated, the correlation was stronger for comparisons between the two MRI than between each MRI versus mammography, and between each MRI versus MATH data than between each MRI versus HSM data. All ICC values were >0.75 indicating that all four methods were reliable for measuring BD and that the mathematical algorithm and the two complimentary non-invasive MRI protocols could objectively and reliably estimate different types of breast tissues.

Computing mammographic density from a multiple regression model constructed with image-acquisition parameters from a full-field digital mammographic unit.

Breast density (the percentage of fibroglandular tissue in the breast) has been suggested to be a useful surrogate marker for breast cancer risk. It is conventionally measured using screen-film mammographic images by a labor-intensive histogram segmentation method (HSM). We have adapted and modified the HSM for measuring breast density from raw digital mammograms acquired by full-field digital mammography. Multiple regression model analyses showed that many of the instrument parameters for acquiring the screening mammograms (e.g. breast compression thickness, radiological thickness, radiation dose, compression force, etc) and image pixel intensity statistics of the imaged breasts were strong predictors of the observed threshold values (model R(2) = 0.93) and %-density (R(2) = 0.84). The intra-class correlation coefficient of the %-density for duplicate images was estimated to be 0.80, using the regression model-derived threshold values, and 0.94 if estimated directly from the parameter estimates of the %-density prediction regression model. Therefore, with additional research, these mathematical models could be used to compute breast density objectively, automatically bypassing the HSM step, and could greatly facilitate breast cancer research studies.

Bilateral Extensive Ductitis Obliterans Manifested by Bloody Nipple Discharge in a Patient with Long-Term Diabetes Mellitus

Abstract:  Ductitis obliterans or mastitis obliterans is a rare late manifestation of mammary ductal ectasia. We describe a long‐term diabetic patient who presented with bilateral bloody nipple discharge and poorly defined nodularities around the nipple of both breasts. The ductography showed multiple segments of irregular ductal narrowing and intraluminal filling defects in both breasts. The bilateral resection of the sub‐areolar portion of the breast showed exuberant fibrous obliteration of the large‐ and medium‐sized ducts by granulation tissue associated with few histiocytes. Ductal dilatation and intraductal accumulation of histiocytes was also present. This represents a late and florid form of mammary ductal ectasia. Differential diagnostic considerations including fibrocystic changes, diabetic sclerosing lymphocytic lobulitis, idiopathic granulomatous lobular mastitis, and periductal mastitis (Zuska disease) are discussed. Accurate diagnosis can help avoid or limit radical surgeries in this group of patients.

Intraductal papilloma of the breast in association with preoncogenic gene of breast cancer

We reported a case of an African American woman who went to the hospital with palpable right breast lump with bloody nipple discharge at University of Texas Medical Branch at Galveston. The modalities of breast imagings included mammography and ultrasonography. The method used for viral identification was Linear Array HPV genotyping test. Intraductal papilloma revealed as high density tubular or rounded lobular masses with partially circumscribed, obscured margins and clustered punctate microcalcifications on mammograms. Ultrasound showed as intraductal masses with dilated ducts. The core biopsy demonstrated duct filled with papillary lesion and post excision revealed intraductal papilloma. HPV DNA types 16, 33, 58 and 71 were detected after use of Linear Array HPV genotyping test.

Benign Asymmetry of the Femur

To the Editor:— A positive Galeazzis sign may indicate a femoropelvic pathology. Frequently, however, it is only an indication of a benign asymmetry of the femur which requires no treatment. Galeazzi in 1930 1 described shortening of the thigh as indicative of a femoropelvic pathology (Fig 1). He suggested that this sign might result from a defective acetabulum with subluxation, congenital dislocation of the hip, coxa vara, rudimentary development of the head, shaft, or neck of the femur, absence of a portion of the shaft of the femur, etc. A positive Galeazzis sign, however, may simply indicate that one thigh is somewhat shorter than the other. This latter condition—benign asymmetry of the femur—will correct itself. In the seven-year period from 1956 through 1963, we have seen 52 infants with a positive Galeazzis sign. Forty of these patients had significant pathology of congenital dysplasia, dislocation, subluxation, etc, and 12 had

Atypical papillary lesions after core needle biopsy and subsequent breast carcinoma

Abstract Background: Papillary lesions of the breast cause diagnostic problem because papillary structures are found in benign and malignant processes. Core needle biopsy is important to make an initial diagnosis, but it still has potential pitfalls. Comparison between core needle biopsy and excisional biopsy can predict the possibility of malignant change in atypical papillary lesions. Objective: Evaluate the concordance between core needle biopsy and excisional results in atypical papillary lesions of the breast. Materials and methods: The pathology database of University of Texas Medical Branch at Galveston, USA was searched for patients with atypical papillary lesions at core needle biopsy who subsequently underwent surgical excision. Pathology reports from the excisional biopsies was also examined to assign each case to one of three categories, downgrade to benign papilloma, no change (remained atypical papillary lesion), and upgrade to carcinoma. The mammograms and ultrasounds were reviewed for each case. They characterized the lesions according to multiple imaging criteria. Results: Twenty-four patients with atypical papillomas at core biopsy subsequently underwent surgical excision. The lesions were downgraded to benign papilloma in 25%, remained atypical papillary lesion in 33%, and upgraded to carcinoma in 42%. On mammographic presentations (n = 23), masses were in 61%, architectural distortion in 4.3%, mass with calcifications in 9%, mass with architectural distortion and calcifications in 4.3%, calcifications alone in 17.4%, and architectural distortion and calcifications in 4.3%. On ultrasound findings (n = 21), solid masses were in 90%, intracystic masses in 10%, peripheral in locations in 81%, and subareolar in location in 19%. Conclusion: Due to the high upgrade rate of atypical papillary lesions to carcinoma (42%), excision of all atypical papillary lesions with wide excision margin is recommended for cases with pathologic diagnosis of atypical papillary lesion on core-needle biopsy.

Gastrointestinal Series in Patients With Gallstones-Reply

We do not oppose the performance of both an oral cholecystogram and an upper GI series in patients regarding whom differentiation between diseases involving the two systems is difficult. We would never suggest that a patient with classic peptic ulcer symptoms and gallstones not have a GI series. We did not conclude that a GI series is unnecessary in patients with gallstones. What we did was examine the films of 100 patients defined in a particular way and demonstrate a potentially important abnormality by upper GI series in only four of them. In our patients, the GI series had a relatively low yield of identifying abnormalities in patients with gallstones in the absence of GI bleeding or suspicion of GI cancer.