Tarja Rissanen

Breast Sonography in Localizing the Cause of Nipple Discharge Comparison With Galactography in 52 Patients

The purpose of this study was to evaluate breast sonography in localizing abnormalities in the discharging duct in patients with spontaneous nipple discharge.

B-mode, power Doppler and contrast-enhanced power Doppler ultrasonography in the diagnosis of breast tumors.

PURPOSE To investigate the role of B-mode and unenhanced and enhanced power Doppler ultrasonography (US) in differentiating solid breast lesions, and to find out whether morphologically different tumors differ in terms of vascularity. MATERIAL AND METHODS Sixty-five lesions, indeterminate or suggestive of malignancy after mammography were prospectively examined with B-mode and unenhanced and enhanced power Doppler US. The lesions were classified as benign, indeterminate or malignant at B-mode, and as benign or malignant at power Doppler US. The results were compared to the histologic diagnoses. Vascularity was analyzed also quantitatively to find out whether threshold values for differential diagnostics could be set. RESULTS The sensitivity, specificity, and overall accuracy of the morphologic evaluation were 100%, 10%, and 57%, respectively. Rounded lesions were more vascular than spiculated lesions, but vascular assessment was only helpful when it supported a benign morphology. In quantitative analysis, due to the overlap between the benign and malignant lesions, no threshold values could be set. CONCLUSION Morphologic criteria were useful in characterizing malignant lesions, but the large proportion of indeterminate findings decreased the specificity of US. Neither unenhanced, nor enhanced power Doppler US was able to improve diagnostic accuracy.

Ultrasonographically guided wire localization of nonpalpable breast lesions

The results of 102 preoperative ultrasonographically guided wire localizations of nonpalpable breast lesions were reviewed. Ultrasonography was used because of nonvisualization during mammography (16 cases), a difficult location of the lesion (3 cases), vasovagal syncope during mammographic guidance (two cases), or the radiologists preference (81 cases). All localizations were successful. Removal was confirmed by specimen mammography or ultrasonography or both in 85 cases and by macroscopic examination in 10 cases. In seven cases specimen radiography was not performed. One syncope and one wire insertion into the pectoralis fascia occurred. Ultrasonographically guided wire localization is accurate and well tolerated in aiding surgical biopsy of breast lesions.

Contribution of Ultrasonography and Fine-Needle Aspiration Cytology to the Differential Diagnosis of Palpable Solid Breast Lesions

Purpose: To define the role of ultrasonography (US) and fine-needle aspiration biopsy (FNAB) relative to mammography in differentiating between benign and malignant palpable solid breast lesions, and to assess the contribution of FNAB cytology to the delay between referral and the definitive diagnosis of breast cancer. Material and Methods: We retrospectively reviewed the mammograms and US images of 84 palpable breast lesions, 63 of them also blindly. The lesions were classified as benign, indeterminate or malignant by both modalities. The results were compared with histologic diagnoses. The cytologic reports of 57 lesions were reviewed and compared to the final diagnoses. The delay from referral until diagnosis was calculated for each case. Results: Eighty-one of the 84 lesions (96%) were visible as a local abnormality at US. Fifty-two of the 53 cancers were seen as a tumor (n=51) or an architectural distortion (n=1). In the blinded analysis, the sensitivity of FNAB cytology was 92%, specificity 83%, and overall accuracy 88%. There were no false-negative malignancies in the three modalities combined. The delay until the date of the final diagnosis was shorter in the group with a cytologic diagnosis positive for malignancy. Conclusion: Malignancy is unlikely if the US, mammographic and cytologic findings of a palpable breast lesion are all benign. Active and critical use of these three modalities could cut down the number of surgical biopsies of benign breast lesions and provide prompt surgical treatment for malignant lesions.

Mammography and Ultrasound in the Diagnosis of Contralateral Breast Cancer

Forty-nine (5%) of 956 women referred for follow-up imaging after breast cancer treatment had a malignancy in both breasts. The mammograms and ultrasonograms or US reports, and histologic slides or pathologic reports of 31 of these patients were reviewed. Mammography was more sensitive than clinical examination or US in detecting contralateral breast cancer, the sensitivity of mammography being 81%. Thirty-nine percent of the contralateral cancers were nonpalpable, and all were first detected at mammography. No cancers were depicted by US alone. US provided complementary information about palpable masses in 50% of the cases in which the mammographic finding was difficult to interpret. The mammographic appearance and the difficulties in detecting a contralateral cancer were similar to those known to be characteristic for first primaries. Distinguishing a new primary from a metastasis from the first breast cancer was not always possible by means of mammography or US.

Ultrasound-guided fine needle aspiration biopsy in the diagnosis of breast cancer recurrence after mastectomy

Purpose: to define the accuracy and clinical impact of fine needle aspiration biopsy (FNAB) in diagnosing recurrent breast cancer after mastectomy. Material and Methods: the results of ultrasonography (US) and US-guided FNAB of 175 lesions located at the mastectomy site or in the ipsilateral axilla were reviewed. the final diagnosis was recurrent cancer in 77 cases and benign lesion in 98 cases, as verified by histological examination (n=77) or follow-up (n=98). Results: FNAB yielded a representative aspirate in 92.6% of cases. the sensitivity, specificity and overall accuracy of FNAB cytology were 96.1%, 89.8% and 92.6% respectively. US and FNAB cytology were complementary methods in recurrent cancer diagnosis. the cytologic examination increased the specificity of US. the only recurrent tumor which appeared benign both sonographically and cytologically was removed because of a suspicious finding at palpation. FNAB cytologic diagnosis was found to have a clinical impact in 92.2% of the recurrent cases. Conclusion: US-guided FNAB provided an accurate adjunct to clinical examination and mammography for diagnosing and excluding breast cancer recurrence after mastectomy.

Radiography of the Male Breast in Gynecomastia

In order to investigate the role of imaging methods in the evaluation of the male breast we reviewed the mammograms and ultrasonograms (US) performed in 40 men with breast enlargement or pain. The patients, whose breasts were examined by either mammography (n = 7) or US (n = 1) or both (n = 32), ranged in age from 14 to 83 years. The final diagnoses were gynecomastia in 35 patients, lipomas in one, abscess or sequelae to abscess in 2, and normal in 2. In gynecomastia the subareolar density was of varying shape and size or showed a diffuse pattern of heterogeneous density occupying the whole breast on mammography, and a retromammillar hypoechoic focus, a diffuse heterogeneous area, or a combination of these was observed at US. Eleven breasts and one axillary lymph node were examined by US-guided fine-needle aspiration biopsy (FNAB), which was diagnostic in all cases. Mammography is recommended for the evaluation of the male breast if the differential diagnosis between gynecomastia and fatty enlargement is not clinically evident, and in all cases of unilateral breast symptoms. US is a complementary method to mammography and is also useful to provide guidance for FNAB.