Susan E. Rowling

Strategy for Repeat Biopsy of Patients with Prostatic Intraepithelial Neoplasia Detected by Prostate Needle Biopsy

PURPOSE We evaluated the strategy for repeat biopsy of patients with prostatic intraepithelial neoplasia without concurrent carcinoma detected on prostate needle biopsy. MATERIALS AND METHODS Of 1,275 consecutive patients undergoing prostate needle biopsy 61 were identified with prostatic intraepithelial neoplasia but without concurrent prostate carcinoma. Of the 61 patients 53 had undergone repeat biopsy. The medical records, transrectal ultrasound, and operative and pathological reports of these patients were reviewed. RESULTS Repeat biopsy was done in 53 patients with prostatic intraepithelial neoplasia, yielding carcinoma in 15, prostatic intraepithelial neoplasia without carcinoma in 8 and benign tissue in 30. The yield of carcinoma from repeat biopsy of a prostatic intraepithelial neoplasia site was 8.3% (7 of 84 sites). A total of 18 sites of carcinoma was detected by repeat biopsy of a previous random biopsy site (8), a prostatic intraepithelial neoplasia site only (5), a transrectal ultrasound nodule (3), a palpable nodule and prostatic intraepithelial neoplasia site (1), and a transrectal ultrasound nodule and prostatic intraepithelial neoplasia site (1). Carcinoma was as frequently detected by repeat biopsy of a prostatic intraepithelial neoplasia site (6 patients) as by random repeat biopsy (6 patients). CONCLUSIONS Repeat prostate needle biopsy of patients with prostatic intraepithelial neoplasia should include random repeat biopsy and repeat biopsy of transrectal ultrasound abnormalities as well as previous sites of prostatic intraepithelial neoplasia.

Quantitative Vascularity of Breast Masses by Doppler Imaging: Regional Variations and Diagnostic Implications

Seventy‐four biopsy proven breast masses were imaged by color and power Doppler imaging to evaluate vascular pattern of malignant and benign breast masses. The images were analyzed for vascularity. The measurements were made over the entire mass as well as regionally at its core, at its periphery, and in the tissue surrounding it. The surgical specimens were analyzed for microvessel density. The diagnostic performance of Doppler sonographic vascularity indices was evaluated by receiver operating characteristic analysis. The malignant masses were 14 to 54% more vascular than the benign masses. Both types of masses were more vascular by ultrasonography than the tissue surrounding them. Whereas benign masses were 2.2 times more vascular than the surrounding tissue, the malignant masses were 5.0 times more vascular. In a subset of patients the regional vascularity at the core, periphery, and surrounding tissue by Doppler imaging exhibited a strong correlation (R2 > 0.9) with the corresponding histologic microvessel density measurements. Although the malignant masses exhibited a strong gradient in vascularity, core > periphery > surrounding tissue, the benign masses had relatively uniform distribution of vascularity. The area under the receiver operating characteristic curve (A(Z)) for the Doppler indices ranged from 0.56 +/‐ 0.07 to 0.65 +/‐ 0.07. A nonlinear analysis including age‐specific values of Doppler indices improved the diagnostic performance to A(Z) = 0.85 +/‐ 0.06. In conclusion, quantitative Doppler imaging when used in combination with a nonlinear rule‐based approach has the potential for differentiating between malignant and benign masses.

Intratesticular vasculitis simulating a testicular neoplasm.

Gray scale and color Doppler sonography play an important role in the evaluation of patients with acute scrotal pain. The primary differential diagnosis includes epididymoorchitis versus testicular torsion. In the clinical setting of acute trauma, testicular disruption or intrascrotal hematoma are also considered. 1 Intratesticular hematoma in the absence of trauma is extremely rare. We present a case of nontraumatic acute scrotal pain occurring in a young patient with surgically proved spontaneous intra testicular hemorrhage resulting from isolated testicular vasculitis. The preoperative sonographic appearance did not support the diagnosis of testicular torsion or epididymoorchitis but mimicked testicular neoplasm.

Does Use of a PACS Increase the Number of Images Per Study? A Case Study in Ultrasound

The purpose of this study was to determine if the use of a picture archiving and communications system (PACS) in ultrasonography increased the number of images acquired per examination. The hypothesis that such an increase does occur was based on anecdotal information; this study sought to test the hypothesis. A random sample of all ultrasound examination types was drawn from the period 1998 through 1999. The ultrasound PACS in use (ACCESS; Kodak Health Information Systems, Dallas, TX) records the number of grayscale and color images saved as part of each study. Each examination in the sample was checked in the ultrasound PACS database,.and the number of grayscale and color images was recorded. The comparison film-based sample was drawn from the period 1994 through 1995. The number of examinations of each type selected was based on the overall statistics of the section; that is, the sample was designed to represent the approximate frequency with which the various examination types are done. For film-based image counts, the jackets were retrieved, and the number of grayscale and color images were counted. The number of images obtained per examination (for most examinations) in ultrasound increased with PACS use. This was more evident with some examination types (eg, pelvis). This result, however, has to be examined for possible systematic biases because ultrasound practice has changed over the time since the authors stopped using film routinely. The use of PACS in ultrasonography was not associated with an increase in the number of images per examination based solely on the use of PACS, with the exception of neonatal head studies. Increases in the number of images per study was otherwise associated with examinations for which changes in protocols resulted in the increased image counts.

Does use of a PACS increase the number of images per study? A case study in ultrasound

The purpose of this study was to determine if the use of a PACS in ultrasound increased the number of images acquired per examination. The hypothesis that such an increase does occur was based on anecdotal information; this study sought to test the hypothesis. There was no significant difference in the total number of images per study for film and PACS.

Experience report: a multivendor ultrasounds mini-PACs--engineering and clinical issues

The authors have been operating an ultrasound miniPACS for approximately two years. In the last six months, the system was more than doubled in size with inclusion of a teleradiology component and connection to PACS hardware from other vendors. This paper presents the engineering, operational, and clinical challenges posed by this integration and the logistical and systems approaches to meeting those challenges.