Malignant Solid Masses Research Articles

Computerized analysis of lesions in US images of the breast

Breast sonography is not routinely used to distinguish benign from malignant solid masses because of considerable overlap in their sonographic appearances. The purpose of this study was to investigate the computerized analyses of breast lesions in ultrasonographic (US) images in order to ultimately aid in the task of discriminating between malignant and benign lesions. Features related to lesion margin, shape, homogeneity (texture), and posterior acoustic attenuation pattern in US images of the breast were extracted and calculated. The study database contained 184 digitized US images from 58 patients with 78 lesions. Benign lesions were confirmed at biopsy or cyst aspiration or with image interpretation alone; malignant lesions were confirmed at biopsy. Performance of the various individual features and output from linear discriminant analysis in distinguishing benign from malignant lesions was studied by using receiver operating characteristic (ROC) analysis. At ROC analysis, the feature characterizing the margin yielded Az values (area under the ROC curve) of 0.85 and 0.75 in distinguishing between benign and malignant lesions for the entire database and for an "equivocal" database, respectively. The equivocal database contained lesions that had been proved to be benign or malignant at cyst aspiration or biopsy. Linear discriminant analysis round-robin runs yielded Az values of 0.94 and 0.87 in distinguishing benign from malignant lesions for the entire database and for the equivocal database, respectively. Computerized analysis of US images has the potential to increase the specificity of breast sonography.

THE CURRENT ROLE OF ULTRASONOGRAPHY IN BREAST IMAGING

When properly performed and interpreted, US is an indispensable tool in breast imaging. Despite improvements in equipment, the major roles for US in the breast remain the differentiation of cysts from solid masses and the guidance of interventional procedures. Neither of these are trivial tasks, for they have significantly reduced the number of surgical biopsies performed in the United States. Research studies investigating feature analysis and Doppler show future potential for US to be used to differentiate benign from malignant solid masses.

Usefulness of mammography and sonography in women less than 35 years of age.

Indications, clinical history, mammographic findings, and clinical outcome were reviewed in 1,016 women younger than 35 years who underwent mammography during an 8-year period. The indications for mammography were a palpable mass in 454 (44.7%), findings at routine screening in 237 (23.3%), lumpiness in 29 (14.9%), unilateral nipple discharge in seven (3.5%), localized breast tenderness in six (5.1%), adenopathy in three (1.9%), diffuse tenderness in two (2.9%), bilateral nipple discharge in two (1.5%), and miscellaneous in four (2.2%). In 405 women (39.9%), at least two-thirds of the breast tissue was radiodense; however, in 299 (29.4%) women the breast was predominantly fatty, allowing for excellent mammograms. Six women had carcinomas: Mammographic findings prompted biopsy in one patient, indicated a benign-appearing mass (found to be solid at sonography or aspiration) in three patients with a palpable mass (contributing to delay in biopsy in two), and were negative in two. Sonography was performed in 389 women and was useful in preventing unnecessary biopsy of cysts but was not useful in differentiating benign from malignant solid masses. Younger women with persistent localized breast symptoms should undergo a tailored mammographic examination, but negative findings or findings of a benign lesion should not preclude biopsy of a palpable solid mass.

Real-time breast sonography: application in 300 consecutive patients.

Sonography, disappointing as a primary screening method, has emerged as the single most helpful adjunct to mammography in evaluation of the clinically and/or mammographically abnormal breast. Sonography can reliably diagnose simple cysts presenting as palpable masses or as indeterminate, nonpalpable lesions on mammography. However, differentiation of benign from malignant solid masses cannot be reliably accomplished by sonography. The expense of an automated breast sonographic scanner has deterred many radiologists from the purchase of such a unit. The authors have used both an automated breast scanner and a real-time 10-MHz hand-held unit. This paper describes their experience with the real-time unit, demonstrating both normal and pathologic anatomy. Special emphasis has been placed on the sonographic diagnosis of a simple cyst because this lesion was the cause of one-quarter of all palpable masses and nonpalpable, mammographically dominant masses. Cysts are sharply marginated and anechoic. Posterior enhancement visible in 78 of 80 cysts was not demonstrable on all images in 25% of cysts.