Combined use of US elastography and color Doppler US increases both the accuracy in distinguishing benign from malignant masses and the specificity in decision-making for biopsy recommendation at B-mode US.

Objective. The purpose of this study was to evaluate the diagnostic potential of the sonoelastographic strain index for differentiation of nonpalpable breast masses. Methods. Ninety-nine nonpalpable breast masses (79 benign and 20 malignant) in 94 women (mean age, 45 years; range, 21-68 years) who had been scheduled for a sonographically guided core biopsy were examined with B-mode sonography and sonoelastography. Radiologists who had performed the biopsies analyzed the B-mode sonograms and provided American College of Radiology Breast Imaging Reporting and Data System categories. The strain index (fat to lesion strain ratio) was calculated by dividing the strain value of the subcutaneous fat by that of the mass. The histologic result from the sonographically guided core biopsy was used as a reference standard. The diagnostic performance of the strain index and that of B-mode sonography were compared by receiver operating characteristic (ROC) curve analysis. Results. The mean strain index values ± SD were 6.57 ± 6.62 (range, 1.29-28.69) in malignant masses and 2.63 ± 4.57 (range, 0.54-38.76) in benign masses (P = .019). The area under the ROC curve values were 0.835 (95% confidence interval [CI], 0.747-0.902) for B-mode sonography and 0.879 (95% CI, 0.798-0.936) for the strain index (P = .490). The sensitivity, specificity, positive predictive value, and negative predictive value were 95% (19 of 20), 75% (59 of 79), 48% (19 of 39), and 98% (59 of 60), respectively, when a best cutoff point of 2.24 was used. Conclusions. The strain index based on the fat to lesion strain ratio has diagnostic performance comparable with that of B-mode sonography for differentiation of benign and malignant breast masses.

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Before and after neoadjuvant chemotherapy for breast cancer, the ΔD(max) of MRI correlated moderately with the ΔSUV on PET. For prediction of the pCR, MRI proved to be a more specific modality than PET.

An aliasing artifact that appears as a blue-green-red pattern in a breast mass as depicted on US-elastography is suggestive of a possible cystic breast lesion.

PurposePrimary systemic therapy (PST) downstages up to 40% of initial documented axillary lymph node (ALN) metastases in breast cancer. The current surgical treatment after PST consists of breast tumor resection and axillary lymph node dissection (ALND). This strategy, however, does not eliminate unnecessary ALND in patients with complete remission of axillary metastases. The aim of this study was to examine the accuracy of sentinel lymph node biopsy (SLNB) after PST among patients with documented ALN metastasis at presentation and to identify the rate of pathologic complete-remission (CR) with ALN after PST.MethodsWe analyzed 66 patients with ALN metastasis that was pathologically proven preoperatively who underwent SLNB and concomitant ALND after PST. Axillary ultrasound (AUS) was used to evaluate the clinical response of initially documented ALN metastasis after PST. Intraoperative lymphatic mapping was performed using blue dye with or without radioisotope.ResultsAfter PST, 34.8% of patients had clinical CR of ALN on AUS and 28.8% patients had pathologic CR of ALN. The overall success rate of SLNB after PST was 87.9%, and the sentinel lymph node identification rate in patients with clinical CR was 95.7%. In patients with successful lymphatic mapping, 70.7% of patients had residual axillary metastases. The overall accuracy and false-negative rate were 87.9% and 17.1% in all patients: 95.5% and 10.0% in patients with clinical CR of ALN, and 83.3% and 19.4% in patients with residual axillary disease after PST.ConclusionOur findings suggest that SLNB may be feasible in patients with initial documented ALN metastasis who have clinical CR for metastatic ALN after PST. Further investigation in a prospective setting should be performed to confirm our results.

The performance of radiologists and interobserver and intraobserver agreement for characterization of thyroid nodules were better when 3D sonograms were used than when 2D sonograms were used.

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