Seok Seon Kang

Sonographic Findings in the Surgical Bed After Thyroidectomy Comparison of Recurrent Tumors and Nonrecurrent Lesions

The purpose of this study was to assess the sonographic findings of recurrent tumors and nonrecurrent lesions mimicking recurrent tumors in the surgical bed after thyroidectomy for thyroid cancer.

BRAFV600E Mutation Analysis of Thyroid Nodules Needle Aspirates in Relation to Their Ultrasongraphic Classification: A Potential Guide for Selection of Samples for Molecular Analysis

BACKGROUND Proper candidates to improve the effectiveness of molecular testing for thyroid nodules detected on ultrasonography (US) in a clinical setting are not well known. We aimed at evaluating the effective indication and method of BRAF(V600E) mutation analysis of aspiration specimens according to the US features of thyroid nodules in a BRAF(V600E) mutation-prevalent area. METHODS A total of 244 patients with 244 thyroid nodules were prospectively classified as malignant and nonmalignant based on US. Thyroid nodules with any malignant US features including spiculated margin, the presence of microcalcifications or macrocalcifications, marked hypoechogenicity, or a taller-than-wide shape were defined as US-positives and those without these features were defined as US-negatives. All patients underwent US-guided fine-needle aspiration (FNA). The presence of the BRAF(V600E) mutation in FNA specimens was determined by allele-specific polymerase chain reaction (AS-PCR) and direct DNA sequencing. The mutation results were correlated with cytology and either surgical pathology or follow-up. RESULTS Of 244 nodules, 66 were US-positive and 178 were US-negative. The malignancy rate was 92% (61/66) for US-positives and 14% (25/178) for US-negatives. The BRAF(V600E) mutation was identified in 67% (44/66) of US-positives and in 10% (17/178) of US-negatives. The BRAF(V600E) mutation for nodules with indeterminate or nondiagnostic cytology was present in 45% (5/11) of US-positives and in 8% (2/26) of US-negatives (p = 0.0168). A false negative cytology with the mutation was found in only one case of the US-negatives. All nodules with the mutation were surgically confirmed as papillary carcinomas. Adding the genetic analysis to the FNA as compared with the FNA alone improved the sensitivity and accuracy for US-positives, whereas there was no significant improvement for US-negatives. With regard to sensitivity and accuracy, the use of the AS-PCR was better than the use of the direct DNA sequencing for US-positives as compared with US-negatives. CONCLUSION The application of BRAF(V600E) mutation analysis in FNA specimens is more effective for thyroid nodules with malignant US features as compared with nodules without malignant US features. The use of the AS-PCR is more valuable as compared with the direct DNA sequencing to refine the diagnosis in a clinical setting.

High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer.

To determine ultrasound (US) features that most accurately predict the presence of axillary lymph node metastasis, we retrospectively analysed the results of preoperative US breast examinations of axillary lymph nodes in 425 consecutive patients who subsequently underwent surgery for invasive breast cancer. We compared the US findings with pathologic results for axillary lymph node metastasis. US features included length of the longest (L) and shortest (S) axes, L/S ratio, cortical thickness, presence of hilum and shape. The results of multivariate logistic regression analysis revealed that cortical thickness greater than 3mm was the most accurate indicator, with 4.14 times increased risk of the presence of an axillary lymph node metastasis as compared to cortical thickness less than 3mm. The absence of a hilum showed the highest specificity for axillary lymph node metastasis (94.6%), but low sensitivity.

Sonography of thyroid nodules with peripheral calcifications.

This study was designed to assess the role of sonography (US) in the differentiation of benign from malignant thyroid nodules with peripheral calcifications.

Breast MRI for Evaluating Patients with Metastatic Axillary Lymph Node and Initially Negative Mammography and Sonography

Objective We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging. Materials and Methods From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients. Results MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign. Conclusion Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.

Cystic Thyroid Nodules After Aspiration Mimicking Malignancy Sonographic Characteristics

Objective. The purpose of our study was to provide sonographic findings of cystic nodules, which can mimic malignancies, after fine‐needle aspiration (FNA) and to determine the differential points from malignancies. Methods. We retrospectively reviewed the sonographic findings of 33 lesions in 32 patients who had FNA for predominantly cystic nodules or cysts and showed suspicious findings during sonographic follow‐up, as well as findings of 47 surgically confirmed papillary thyroid carcinomas (PTCs) in 45 consecutive patients. We evaluated the size, shape, presence of shadowing and a halo, margin, echogenicity, and presence of echogenic dots for each nodule. The final diagnosis of cystic nodules was confirmed by FNA, surgery, or follow‐up sonography. Results. Of the 33 cystic lesions, 31 (94%) were adequate with benign results, and 2 (6%) were inadequate specimens at the initial FNA. There were no malignancies in the cystic nodules at follow‐up. The average interval between the initial FNA and suspicious sonographic findings was 26 months (range, 1–92 months). The average size of the suspicious nodules was 0.8 cm (range, 0.3–1.8 cm). Cystic nodules after aspiration were similar to PTCs in their sonographic findings, but the former frequently showed shadowing and a halo (85% versus 21%; P < .0001). With further follow‐up, 29 lesions (88%) showed additional decreases in size. Conclusions. Benign cystic nodules after aspiration can have suspicious malignant features. However, shadowing and a halo associated with malignant features are characteristic findings of cystic nodule shrinkage. Awareness of these findings and correlation with the FNA history can aid in preventing unnecessary FNA.

Sonography of Axillary Masses What Should Be Considered Other Than the Lymph Nodes

Objective. The purpose of this study was to review the sonographic findings of various axillary masses other than lymph nodes in correlation with other imaging and pathologic findings. Methods. From a sonographic database, we collected interesting cases of axillary masses with pathologic or other imaging corroboration from the last 10 years. Results. Images of various soft tissue masses were reviewed. They included masses associated with accessory breasts (fibroadenomas, hamartomas, fat necrosis, and cancer arising from axillary breasts), other soft tissue masses (lipomas, schwannomas, hemangiomas, fibromatosis, epidermoid cysts, and malignant fibrous histiocytomas), and complications presenting as masses after axillary lymph node dissection (seromas, hematomas, suture granulomas, pseudoaneurysms, and lymphangiectasia). Conclusions. Awareness of the characteristic sonographic findings of various disease entities that cause axillary masses will help in the correct diagnosis of axillary masses.

Papillary Thyroid Carcinoma With BRAFV600E Mutation: Sonographic Prediction

OBJECTIVE The purpose of this article is to assess the clinical and sonographic findings that can predict the presence of the BRAF(V600E) mutation of a papillary thyroid carcinoma. MATERIALS AND METHODS The study included 135 consecutive patients with surgically confirmed papillary thyroid carcinoma. All patients underwent ultrasound and ultrasound-guided fine-needle aspiration. The BRAF(V600E) mutation was determined using allelespecific polymerase chain reaction and direct DNA sequencing from fine-needle aspiration samples. We retrospectively compared the clinical and ultrasound findings of nodules with and without the mutation, including size, margin, shape, calcifications, echogenicity, and ultrasound diagnosis. RESULTS Of 135 patients, results were positive for the mutation for 106 patients (79%) and negative for 29 (21%). Among the patients with the BRAF(V600E) mutation, the ratio of men to women was 1:5.2 (p = 0.156), and the mean age was 47 years (range, 26-73 years; p = 0.326). The mean tumor size was 0.9 cm (range, 0.3-4.0 cm; p = 0.099). On ultrasound, papillary thyroid carcinomas with the BRAF(V600E) mutation tended to show a taller-than-wide shape, but this finding was not statistically significant (p = 0.055). The BRAF(V600E) mutation was not associated with the presence of calcifications (54% vs 71%; p = 0.032), although it was not an independent predictor. There were no significant differences in tumor echogenicity, tumor margin, and ultrasound diagnosis between the two groups. CONCLUSION Papillary thyroid carcinoma with the BRAF(V600E) mutation tends to be taller than wide and is not associated with the presence of calcifications on ultrasound. However, these findings are not specific enough to predict the presence or absence of the BRAF(V600E) mutation of a papillary thyroid carcinoma.

Application of Sonographic BI-RADS to Synchronous Breast Nodules Detected in Patients with Breast Cancer

OBJECTIVE The purpose of this study was to evaluate the applicability of the current BI-RADS for sonography to the assessment of synchronous breast nodules other than the primary malignant tumor in patients with breast cancer. MATERIALS AND METHODS One hundred eighty-nine synchronous nodules in 147 breast cancer patients were surgically excised after localization, and 412 synchronous nodules in 191 patients were observed or biopsied or excised without localization. Among a total of 601 synchronous nodules, 372 nodules were ipsilateral and 229 were contralateral to a primary malignant tumor. Two radiologists retrospectively reviewed sonograms of these nodules and determined the sonographic BI-RADS category without clinical information or pathologic results. For each nodule, the preoperative BI-RADS category and pathologic or follow-up results were compared. RESULTS Four hundred eighty-two nodules were classified category 3; 112 nodules, category 4; and seven nodules, category 5. Fifty-five (11.4%) of the category 3 nodules and 57 (47.9%) of the category 4 and 5 nodules were confirmed malignant. Thirty-six (21.2%) of 170 category 3 synchronous nodules in the same quadrant as the primary tumor were confirmed malignant, as were 12 (9.8%) of 122 nodules in a different quadrant and eight (4.2%) of 190 nodules in the contralateral breast. CONCLUSION For assessment of synchronous nodules in breast cancer patients, application of conventional screening sonographic BI-RADS categories may not account for possible increased risk of malignancy in synchronous nodules, especially those in the same quadrant of the breast as the index malignant tumor.

Background parenchymal enhancement on breast MRI: influence of menstrual cycle and breast composition.

To evaluate the menstrual cycle and breast composition influence on background parenchymal enhancement of breast magnetic resonance imaging (MRI) and to investigate the optimal time for breast MR examinations.