Nonpalpable, probably benign breast lesions: follow-up strategies after initial detection on mammography.
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Biopsy↗
Biomedical subjects
D D Adler
Publications and source records attributed to D D Adler.
Sonographic features of breast hamartomas.
The sonographic features of ten breast hamartomas are reported. Four masses were clinically palpable. The mammographic appearance was characteristic of hamartomas in five cases. In the remaining five lesions, because the radiographic appearance was not pathognomonic, surgical excision was required for pathologic confirmation of the diagnosis. A wide spectrum of sonographic appearances was identified, the most frequent was that of a moderate to well-circumscribed, solid, hypoechoic mass with posterior acoustic shadowing. Two isoechoic hamartomas were very difficult to visualize on sonography. We conclude that ultrasound has a minimal role in the diagnosis of breast hamartomas, in view of their wide sonographic variability.
Adipose Tissue↗
Breast hamartomas: variable mammographic appearance.
The mammograms of 17 women with pathologically proved breast hamartomas were reviewed. Abnormal masses were detected on 12. Nine women had masses with benign features. Two of these had findings considered classic for hamartoma. In three cases, the appearance of the mass was suggestive of carcinoma. The breasts were very dense in four of five women without detectable mass. The findings suggest that the classic mammographic appearance of breast hamartomas is less common than previously reported, which may be explained by earlier detection of small hamartomas.
Adult↗
Breast microcalcifications after lumpectomy and radiation therapy.
Ten of 152 (7%) consecutive breast cancer patients who underwent excisional biopsy and radiation therapy developed suspect microcalcifications at the biopsy site. All ten patients underwent reexcision. Seventeen other patients developed scattered, coarse, benign macrocalcifications that have remained stable as determined with mammographic follow-up. Of the ten patients who underwent reexcision, six had clusters of calcifications that were benign, and four had malignant calcifications. The morphologic appearance of the microcalcifications was similar in both malignant and benign disease, although the malignant calcifications tended to appear earlier than the benign ones. Three of the four patients with recurrent carcinoma had had calcifications in the original cancer. The mammographic features of the microcalcifications were not specific enough to distinguish recurrent malignancy from benign disease. Unless calcifications that occur in the breast after lumpectomy and radiation therapy have an unequivocally benign appearance (ie, scattered, round, homogeneous-appearing macrocalcifications), they should be viewed with suspicion and subjected to excisional biopsy.
Adult↗
Paraffin tissue block radiography: adjunct to breast specimen radiography.
Radiography of specimens is an essential step in confirming excision of nonpalpable breast lesions. On occasion, however, the pathologist may not identify the lesion histologically. The authors report five cases in which suspicious microcalcifications were included in the excised tissue but were not identified by the pathologist. In all five, paraffin tissue block radiography enabled identification of the specific blocks containing the microcalcifications. The correct tissue blocks were then sectioned again, and the microcalcifications were identified histopathologically. In one case, the initial diagnosis of intraductal hyperplasia was changed to intraductal carcinoma with focal invasion. When the pathologist cannot identify the calcifications on initial histopathologic sections, this technique may assist in identification of the mammographic abnormality.
Biopsy↗
Ultrasound of benign breast conditions.
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Breast↗
Lesion detectability in ultrasonic computed tomography of symptomatic breast patients.
From 95 subjects imaged with both speed of sound and attenuation ultrasonic computed tomography (UCT), analyses were performed on 40 cases for which unequivocal clinical diagnoses were available for correlation. This paper describes the UCT image characteristics and addresses the hypothesis that carcinomas and other lesions can be detected and localized by means of simple visual criteria or lesion characteristics that are quantitative relative to those of other breast tissues in the same patient. The most useful within-patient criterion was selection of the solid mass with the highest speed of sound in either breast (12 of 12 carcinomas). Architectural asymmetry between breasts in the three types of images was a significant contributing factor in visual image interpretation in seven of the eight cancer patients in whom there were comparable images of both breasts. Solid masses were discriminated by attenuation coefficient and pulse echo criteria. Our results did not substantiate the hypothesis that the average speed of sound throughout the cancer containing breast would be higher than in the contralateral breast. These results are better than might be expected from pulse echo imaging alone on this population. However, clinical implementation probably should be deferred until the technique is made more convenient and less expensive, or more accurate with a greater promise for diagnosis of minimal cancers.
Breast↗
Breast cancer: evaluating mammography in early diagnosis.
The high incidence of breast cancer among American women has made early diagnosis the focus of large scale research efforts. X-ray mammography plays a key role in achieving the goal of early diagnosis inasmuch as mammography is currently the best proven imaging modality for the diagnosis of breast cancer. Data demonstrating the efficacy and safety of mammography are summarized and radiographic features of breast cancer are outlined. Newer, more invasive methods used in conjunction with mammography are also discussed. It is hoped that the emphasis on practical considerations will enhance the understanding of the primary physician caring for women in order to increase the current under-utilization of mammography.
Breast Neoplasms↗
Accessory breast tissue in the axilla: mammographic appearance.
Mammographic features of normal accessory axillary breast tissue were analyzed in 13 women, 54% of whom had positive findings on physical examination. Radiographically the accessory tissue resembled the remaining normal glandular tissue but was separate from it. The mean radiographic dimension of the accessory tissue, which was best seen on oblique or exaggerated craniocaudal views, was 3.9 cm. In most cases the accessory tissue was either bilateral or confined to the right side. When found on mammography, accessory axillary breast tissue should be recognized as a normal developmental variant rather than considered a pathologic lesion, although carcinoma can develop in the accessory tissue. A specific, radiography-aided diagnosis of accessory axillary breast tissue can eliminate unnecessary biopsy.
Adult↗
Two-view specimen radiography in surgical biopsy of nonpalpable breast masses.
Nonpalpable, low-density, noncalcified lesions sometimes can be difficult to see on an initial specimen radiograph. In 57 consecutive wire localizations, 37 patients had obvious microcalcifications and did not require a second specimen radiograph. Twenty-six patients had nonpalpable, noncalcified lesions, and a second specimen radiograph was obtained in 24 of these. In four of these cases the initial specimen radiograph failed to show the suspected lesion, and a second specimen radiograph orthogonal to the original plane of orientation of the specimen showed the lesion to be contained within the biopsied material. Although it is seldom necessary to use this technique, it may obviate a second biopsy specimen as well as reduce operative time. We found that a second orthogonal specimen radiograph provided important information in 7% of cases.
Aged↗
Ultrasound evaluation of uncommon renal transplant complications.
Twenty-five patients who had undergone renal transplants developed uncommon complications that were detected and followed serially with sonography. Two patients developed renal calculi, which produced hydronephrosis in both instances. Other uncommon causes of postoperative hydronephrosis occurred in 5 cases; the causes included ureteral necrosis, ureteral stricture, and a renocutaneous fistula. Eight cases of renal infarction, manifesting 3 different sonographic appearances, were encountered. The presence and disappearance of postoperative gas in the collecting system were documented in 3 patients. The other unusual abnormalities detected involving the transplanted kidney include tuberculosis, pyonephrosis, 3 solitary cysts, a corpus lutem cyst simulating a perinephric fluid collection, and massive urinary ascites.
Adolescent↗
MRI of the spleen: normal appearance and findings in sickle-cell anemia.
The MRI appearance and characteristics of the normal and diseased spleen were prospectively evaluated using spin-echo imaging with a superconducting magnet operating at 0.35 T. Sixty normal patients and 13 patients with sickle-cell anemia involving the spleen were studied. The normal spleen was isointense or slightly more intense than liver at a repetition time of 0.5 sec. At a longer repetition time (TR 2.0 sec), the normal spleen was usually more intense than liver, becoming markedly hyperintense compared to liver on relatively T2-weighted images (TR 2.0 sec, TE 56 msec). All patients with sickle-cell anemia showed abnormally diminished signal intensity of the spleen.
Adolescent↗
Splenic trauma in the pediatric patient: the integrated roles of ultrasound and computed tomography.
Seven children who sustained splenic trauma were scanned by ultrasound and computed tomography (CT) or ultrasound and nuclear liver/spleen scan. All patients were managed conservatively and did not need abdominal surgery. On the initial sonogram, the majority of children had multiple areas of both increased and decreased echogenicity. Hematomas were followed to resolution in five of seven children and were usually multiple and hypoechoic prior to complete disappearance. On contrast-enhanced CT scans, areas of splenic hemorrhage appeared as low attenuation. Our small patient population demonstrates that, following an initial CT scan, sonography is helpful for sequential splenic imaging to show when the appearance of the spleen returns to normal. When correlated with the clinical information, such data are helpful to the clinician in determining when a child who has sustained splenic trauma may resume normal activity.
Adolescent↗
Hepatic cavernous hemangioma: magnetic resonance imaging. Work in progress.
Using a 0.35-T superconducting magnet and spin echo imaging, we prospectively evaluated 11 patients who had proved hepatic cavernous hemangioma. Magnetic resonance (MR) identified more lesions than either contrast-enhanced CT, or ultrasonography. The MR appearance was consistent; hemangiomas were homogeneous and generally isointense at short TR and TE intervals but were hyperintense at long TR intervals and greatly hyperintense at long TR and long TE intervals. However, the MR appearance of hemangioma was not specific; 2/14 other focal hepatic masses had similar features. The calculated relaxation times (T1, T2) were not useful in lesion characterization, although the intensity ratio of hemangioma to normal liver at the TR = 2.0 sec TE = 56 msec pulse sequence was useful in diagnosis since hemangiomas always had a ratio greater than 1.4.
Adult↗
Ultrasonic computed tomography of the breast. Improvement of image quality by use of cross-correlation time-of-flight and phase-insensitive attenuation measurements.
The authors present two methods of reducing refraction artifacts in ultrasonic computed tomography of the breast. Measuring the time of flight of sonic pulses by cross-correlation instead of leading-edge detection significantly reduces distortion and improves resolution in speed-of-sound images. Phase-insensitive reception of pulse energy across a large aperture array is shown to be superior to a conventional single-element transducer for attenuation imaging.
Breast Diseases↗
Computed tomography of liver infarction.
Liver infarcts are relatively rare and uncommonly are diagnosed before autopsy. The CT appearance of hepatic infarction was studied in five patients. In four of these, well-defined, wedge-shaped, low-attenuation zones extending to the liver surface were seen on contrast-enhanced scans. The infarcts involved the right lobe of the liver in all patients, and the left lobe as well in two. Associated splenic infarcts were present in three patients and renal infarcts in two. While the clinical and laboratory findings in hepatic infarction can be completely mimicked by hepatic abscess, the different CT appearance of these lesions should permit noninvasive distinction in most patients.
Adult↗
Case report 220. Osseous sarcoidosis of left 5th digit in a young child with systemic sarcoidosis.
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Bone Diseases↗
Radiographic findings of scleroderma in childhood.
The radiographs of 12 children with the American Rheumatism Association criteria for scleroderma were analyzed and compared to the adult presentation. Childhood and adult manifestations of the disease differ. Although some similarities exist, tuft resorption and soft-tissue calcifications in the fingers are more common in childhood. In contrast, small bowel involvement, hand contractures, and erosive arthropathy are less frequent. In particular, inflammatory joint destruction was not identified in this small pediatric group.
Adolescent↗