Sonographic Staging Research Articles

Correlation of preoperative sonographic staging and postoperative histopathologic staging in patients with invasive breast cancer.

To assess the accuracy of preoperative sonographic staging in patients with primary invasive breast cancer. We retrospectively analyzed a prospectively kept service database of patients with newly diagnosed, unifocal, cT1-3, invasive breast cancer. All patients were diagnosed at a single center institution between January 2013 and December 2021. Clinical T stage was assessed preoperatively by ultrasound and correlated with the definite postoperative pathologic T stage. Demographics, clinical and pathological characteristics were collected. Factors influencing accuracy, over- and underdiagnosis of sonographic staging were analyzed with multivariable regression analysis. A total of 2478 patients were included in the analysis. Median patients' age was 65years. 1577 patients (63.6%) had clinical T1 stage, 864 (34.9%) T2 and 37 (1.5%) T3 stage. The overall accuracy of sonography and histology was 76.5% (n = 1896), overestimation was observed in 9.1% (n = 225) of all cases, while underestimation occurred in 14.4% (n = 357) of all cases. Accuracy increased when clinical tumor stage cT was higher (OR 1.23; 95% CI 1.10-1.38, p ≤ 0.001). The highest accuracy was seen for patients with T2 stage (82.8%). The accuracy was lower in Luminal B tumors compared to Luminal A tumors (OR 0.71; 95% CI 0.59-0.87, p ≤ 0.001). We could not find any association between sonographic accuracy in HER2 positive patients, and demographic characteristics, or tumor-related factors. Our unicentric study showed a high accuracy of sonography in predicting T stage, especially for tumors with clinical T2 stage. Tumor stage and biological tumor factors do affect the accuracy of sonographic staging.

Addendum to consensus opinion from International Deep Endometriosis Analysis (IDEA) group: sonographic evaluation of the parametrium.

Preoperative sonographic staging in patients with suspected parametrial endometriosis is essential to plan surgical intervention and anticipate the need for a multidisciplinary approach, and thus optimize surgical outcome. The results of a recent meta-analysis suggest that there is a need to define more accurately the ultrasonographic criteria for parametrial involvement in endometriosis. This addendum to the International Deep Endometriosis Analysis (IDEA) consensus highlights the sonographic characteristics of the parametrium and identifies ultrasound techniques to diagnose deep endometriosis in this area. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Update on Ultrasound Diagnostic Criteria and New Ultrasound Severity and Activity Scorings of Hidradenitis Suppurativa: Modified SOS-HS and US-HSA.

Hidradenitis suppurativa (HS) is a devasting autoimmune cutaneous disease that affects the hair follicles and can clinically present palpable nodules, abscesses, and tunnels (fistulas), usually in the intertriginous regions. It has been widely reported that color Doppler ultrasound can detect subclinical abnormalities and stage the severity of the disease more accurately. Nevertheless, the ultrasound diagnostic criteria were reported with 15 MHz 10 years ago, and now it is possible to detect early anatomical abnormalities in HS using 70 MHz. Thus, an update of the ultrasonographic diagnostic criteria is needed. The most widely used sonographic staging of severity of HS (SOS-HS) includes the number of affected regions, besides counting the number of key lesions like pseudocysts, fluid collections, and tunnels; however, the total number of affected regions may fit better in an activity scoring. Furthermore, a high number of tunnels or communicated tunnels can complicate the management and may indicate an even more urgent treatment, which should be considered in the severity classification. To date, no hidradenitis scoring of activity has been reported in the literature, making it difficult to track the degree of inflammation under treatment objectively. Therefore, two new scorings are proposed. The first is an updated sonographic scoring of severity called modified SOS-HS (mSOS-HS), and the second is an activity ultrasound scoring of HS called US-HSA. Both staging systems can provide better anatomical information for discriminating the categories and, therefore, selecting more appropriate treatments and supporting research and clinical trials by giving more objective anatomical tools in real-world settings.

Non-surgical treatment of hidradenitis suppurativa: the role of cryotherapy.

Hidradenitis suppurativa is a chronic and recurrent inflammatory disease with a great impact on a patient's quality of life, due to the painful involvement of very sensitive areas, such as the groin, mammary area, and genitals, with malodourous discharge. Multiple treatment options are available; however, no single treatment is effective for all patients, and usually, a combination of medical therapy with various surgical and physical procedures is provided. Cryotherapy is not a routine technique to treat HS, although usually available in the majority of medical clinics, and is cheaper than laser and surgical treatments. The aim of this study was to evaluate the effectiveness of cryotherapy on persistent HS nodules, to reduce the burden of local disease. Retrospective observational study in all patients treated with liquid nitrogen cryotherapy for persistent nodules of hidradenitis suppurativa in the last 2 years, with at least 6 months of follow-up after the procedure. Disease severity was assessed with Hurley staging and sonographic staging according to SOS-HS (18 MHz probe, Esaote-MyLab™). The results were scored with a 0-3 points scale, as complete remission (3), partial response (2 to 1), or no response (0), after one session of treatment. Local cleansing and antiseptic treatment after the procedure was the same as previously performed in each patient, not to influence recovery. In total, 23 patients were included, with a total of 71 persistent nodules treated with a single cryotherapy session. The treatment has been effective in 63 out of 71 nodules treated (88.7%), and the patients attested that they recommend the treatment, the discomfort during recovery was minimal, and the management was not different from daily routine. Persistence was considered as having a failure rate (11.3% overall) and occurred in 7.5% of the nodules of the axillary region, 18.2% on the groin, and 11.2% for nodules of the gluteal region. Cryotherapy is a simple and effective procedure for the treatment of persistent nodules of HS not responding to medical therapy, and it is a valid alternative to local surgery or laser ablation.

Preoperative Sonographic Prediction of Limited Axillary Disease in Patients with Primary Breast Cancer Meeting the Z0011 Criteria: an Alternative to Sentinel Node Biopsy?

PurposeTo assess the accuracy of preoperative sonographic staging for prediction of limited axillary disease (LAD, one or two metastatic lymph nodes) and to identify factors associated with high prediction–pathology concordance in patients with early-stage breast cancer meeting the Z0011 criteria.Materials and MethodsPatients treated between January 2015 and January 2020 were included in this retrospective, multicentric analysis of prospectively acquired service databases. The accuracy of LAD prediction was assessed separately for patients with one and two suspicious lymph nodes on preoperative sonography. Test validity outcomes for LAD prediction were calculated for both groups, and a multivariate model was used to identify factors associated with high accuracy of LAD prediction.ResultsOf 2059 enrolled patients, 1513 underwent sentinel node biopsy, 436 primary and 110 secondary axillary dissection. For LAD prediction in patients with one suspicious lymph node on preoperative ultrasound, sensitivity was 92% (95% CI 87–95%), negative predictive value (NPV) was 92% (95% CI 87–95%), and the false-negative rate (FNR) was 8% (95% CI 5–13%). For patients with two preoperatively suspicious nodes, the sensitivity, NPV, and FNR were 89% (95% CI 84–93%), 73% (62–83%), and 11% (95% CI 7–16%), respectively. On multivariate analysis, the number of suspicious lymph nodes was associated inversely with correct LAD prediction ([OR 0.01 (95% CI 0.01–0.93), p ≤ 0.01].ConclusionsSonographic axillary staging in patients with one metastatic lymph node predicted by preoperative ultrasound showed high accuracy and a false-negative rate comparable to sentinel node biopsy for prediction of limited axillary disease.

Abstract P1-01-14: Axillary assessment by Systemic Axillary Sonography (SAS) for axillary disease treated with neoadjuvant chemotherapy

Abstract Objective. For patients with breast cancer related lymph node metastases, neoadjuvant chemotherapy (NAC) can de-escalate axillary surgery. A radiologic marker (RM) is commonly placed at the time of the initial biopsy to ensure removal of that node at final surgery, but the utility of this marker is largely debated. Systematic Axillary Sonography (SAS) consists of a thorough sonographic axillary staging before and after NAC with possible post NAC node biopsy and has been previously suggested as an alternative. The primary aim of this study was to assess the effectiveness of SAS in axillary evaluation after NAC. The secondary aim was to compare the effectiveness of SAS to RM. Methods. A retrospective analysis of prospectively collected data from 95 patients from 2010 to 2020 at University of Miami Hospital and Jackson Memorial Hospital. Study inclusion criteria were positive axillary lymph node (LN) biopsy, NAC, performance of SAS and axillary surgery. Results. 89 patients were analyzable. The median age was 49±12. All patients had clinical axillary exam and axillary US with positive LN biopsy. 62 patients had additional breast MRI before treatment. All patients had clinical axillary exam and axillary US after chemotherapy. 58 patients had post-treatment MRI and 49 repeated axillary LN biopsy. Pre-treatment clinical exam of the axilla had a sensitivity of 73%. When MRI was added the sensitivity rose to 95%. Since axillary US and positive axillary node biopsy were a prerequisite, the sensitivity of pre-NAC US cannot be assessed. After chemotherapy, all patient underwent axillary examination and US assessment. Repeated axillary clinical exam had low sensitivity of 31% and high specificity of 85%. Repeat MRI exam showed low sensitivity and specificity of 53% and 49% respectively. Post-NAC US without subsequent LN biopsy had a sensitivity of 55% with specificity of 67%. The addition of repeat axillary LN biopsy increased the sensitivity of SAS to 100%. 59 patients in our group had RM placed during pre-NAC axillary LN biopsy. 24 underwent axillary dissection without sentinel lymph node biopsy (SLNB) and 35 patients had a SLNB. The RM was retrieved in 32/35 patients. The “clipped” node was also sentinel node in 66% (12/35). The final pathology revealed benign results in all “clipped” non-sentinel nodes. 18% (6/33) of patients with “clipped” node were diagnosed with axillary metastases in “non-clipped” lymph nodes. Conclusion. SAS is a cheap, quick and reliable method facilitating pre and post-treatment assessment and restaging of the axilla after NAC. Post-NAC biopsy, when indicated, better defines eligibility for axillary surgery decreasing morbidity and cost. In this study, placement of a RM was of no significant benefit. Patient characteristicsRaceTumor gradeWhite, non-hispanic19Gr 13White-hispanic46Gr 240Black, non-hispanic18Gr 346Asian3Receptor statusUnknown3HR+/HER2-42Age49+/-12HR+/HER2+19BMI29+/-5.7HR-/HER2+7Menopausal statusHR-/HER2-21Premenopausal49Tumor sizePostmenopausal40T19T238T328T414LN statusN158N221N310 Citation Format: Siarhei Melnikau, Christina Layton, Tolga Ozmen, Megan Allen, Eli Avisar. Axillary assessment by Systemic Axillary Sonography (SAS) for axillary disease treated with neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-01-14.

The Effect of CT-Guided Artificial Pneumothorax plus Thoracoscopy and Central Venous Catheterization on the Drainage Effect of Pediatric Empyema and Pulmonary Function.

The aim of the study is to investigate the effect of CT-guided artificial pneumothorax combined with a thoracoscopic and central venous catheter on empyema drainage effect and pulmonary function in children. A total of 82 pediatric patients with empyema admitted to our hospital from January 2020 to December 2021 were retrospectively analyzed. The control group was treated with artificial pneumothorax combined with thoracoscopy. The study group was treated with a CT-guided and central venous catheter. The operation time, intraoperative bleeding, surgical field exposure, WBC, C-reactive protein, and pulmonary function were compared between the two groups. The size of effusion and sonographic staging were compared between the two groups. All children underwent spirometry and a maximal incremental cardiopulmonary exercise test. The operation indicators (operation time, intraoperative blood loss, etc.) and adverse reactions were compared between the two groups. The differences in the operation time, intraoperative blood loss, postoperative hospital stay, postoperative drainage volume, and surgical field exposure between the two groups had a statistical significance (P < 0.05); the differences in the body temperature, total peripheral white blood cell count, C-reactive protein, size of effusion, and sonographic staging between the two groups had no statistical significance (P > 0.05); before operation, the differences in the expression levels of FVC (%), FEV1 (%), FEV1/FVC, and MVV (%) and indicators of cardiopulmonary function including VE/VO2, breathing reserve(%), VD/VT(%), and VO2/work between the two groups had no statistical significance, but at 6 months after operation, FVC (%), FEV1 (%), FEV1/FVC, and MVV (%) in the study group were significantly higher than those in the control group (P < 0.05) and VE/VO2 and VD/VT(%) in the study group were obviously lower than those in the control group (P < 0.05); the incidence rate of chest pain, pulmonary edema, and skin infection in the study group was lower than that in the control group (P < 0.05). CT-guided artificial pneumothorax combined with thoracoscopic and central venous catheter drainage of empyema in children is more thorough, with less bleeding, less trauma, rapid recovery of pulmonary function, and is worthy of clinical promotion.

Sonographic Evaluation of Hidradenitis Suppurativa with Smartphone-Linked Portable Ultrasound

Background: Clinical staging systems for hidradenitis suppurativa (HS) have poor interrater reliability and may underestimate disease activity. Sonographic staging systems may overcome these challenges, but conventional ultrasound (US) machines are expensive and bulky. Portable (p)US may facilitate the integration of sonography into routine practice. Objectives: To assess the ability of a novel smartphone-linked pUS device to identify key sonographic lesions of HS. Methods: The charts of 16 patients with HS who were assessed with pUS at the outpatient Dermatology and Wound Care Clinics of a university hospital center were retrospectively reviewed. Clinical and sonographic images of the affected areas were examined. The main outcome measures were the number of patients with identifiable sonographic lesions and the number of patients with subclinical lesions detected by pUS. Results: All 3 key sonographic lesions of HS were identifiable with pUS. Sonographic lesions were identified in 10 patients (62.5%). Subclinical lesions were identified in 2 patients (12.5%); in both cases, this affected management decisions. Conclusions: We demonstrate the ability of pUS to identify the key sonographic lesions of HS. pUS is a simple and affordable way to integrate HSUS into clinical and research settings, with clear potential benefits to patients.

Clinical and Power-Doppler ultrasound features related with persistence of fistulous tracts under treatment with adalimumab in hidradenitis suppurativa: 4 years of follow-up.

Fistulous tracts are the hallmark lesions of hidradenitis suppurativa (HS) and respond poorly to the currently available medical treatments. To evaluate the clinical and ultrasound features related with both healing and persistence of fistulous tracts in patients under treatment with adalimumab, a retrospective analysis of power-Doppler ultrasound (PD-US) images with fistulas in HS patients was performed. The clinical and sonographic staging of HS, body areas involved, and anatomic characteristics of the fistulous tracts were registered and graded. Chi-square test, univariate/multivariate Cox-regression analysis with clustered error, and Kaplan-Meier analysis were computed to analyze data. In total, 151 fistulous tracts from 33 HS patients were included. Age, BMI, length, thickness, subcutaneous pattern, high intensity of PD-US signal, and a high grade of fibrosis/edema were all related to a lower possibility of healing and a high risk of longer persistence at binomial Cox-regressions. Whereas, multivariate regressions showed that high fibrosis, was the variable with the highest risk of poor response and longer survival. Survival-analysis showed that fistulas with high fibrosis or PD-US signal have longer survival time than those with absent/low fibrosis or signal. Limitations include the impossibility to detect with ultrasound lesions less than 0.1 mm and smaller sample size. In conclusion, an accurate assessment of fibrosis may be crucial to define better when a surgical approach-besides the medical treatment-could be required. PD-US may assess the decrease of vascularization in HS lesions and consequently the reduction of inflammation due to immunomodulatory therapies.

Cesarean scar pregnancy: a therapeutic dilemma.

Cesarean scar pregnancy: a therapeutic dilemma.

P10.05: Integrated Enzian classification: a new proposal for sonographic pelvic endometriosis staging – feasibility and interobserver reproducibility

P10.05: Integrated Enzian classification: a new proposal for sonographic pelvic endometriosis staging – feasibility and interobserver reproducibility

Abstract P3-01-17: Evaluation of “Systematic sonographic axillary staging” on clinically node positive breast cancer patients becoming clinically node negative after neoadjuvant chemotherapy

Abstract Purpose Accumulating evidence supports usage of sentinel lymph node biopsy (SLNB) for clinically node positive (cN+) breast cancer (BC) patients, who become clinically node negative (ycN-) after neoadjuvant chemotherapy (NAC). How to reassess the axilla after NAC is a challenging issue. In our institution, Systematic Sonographic Axillary Staging (SSAS) is currently being tested in this group of patients. The aim of this study is to analyze the early results of this approach. Method During initial presentation, systematic sonographic axillary staging is done preferentially by the surgeon. Needle biopsy is then performed of suspicious node(s). At completion of NAC, the axilla is again systematically staged sonographically, taking into account the pre-treatment disease locations. Any residual morphologically suspicious node undergoes a repeat needle biopsy. According to the evidence of residual disease, the patient is either scheduled for axillary dissection (AD) or for SLNB. We analyzed early results of SSAS on patients, who converted ycN (-) after NAC. Strictly adherence to SSAS protocol was the only inclusion criteria. Results A total of 25 patients were included. On repeat axillary USG after NAC, 11 patients had normal appearing and 14 patients had suspicious appearing lymph nodes (LNs). 14 patients underwent repeat biopsy; 9 patients had benign and 5 patients had malign pathology results. 20 patients underwent SLNB. Among 20 patients, 12 patients had negative SLNB and 8 patients had positive SLNB (4 patients had benign appearing LNs on repeat USG and 4 patients had benign biopsy results). 13 patients underwent AD (8 patients after positive SLNB and 5 patients directly after positive US-guided biopsy result). Among 8 patients with positive SLNB, 4 patients had macrometastatic disease (&amp;gt;2mm) on SLNB. In 3 of these 8 patients, no additional disease was found on AD, while 1 patient had only isolated tumor cell and 1 patient had only micrometastasis (Table 1). Table 1. Size of the axillary involvement among patients with positive SLNB Sentinel Lymph Node BiopsyAxillary DissectionPatient #LN* (+) / Total LNs removedSize of involvement (mm)LN* (+) / Total LNs removedSize of involvement (mm)11/611/50.122/42.50/5-31/363/19141/210/3-51/11.50/21-62/21.53/32.573/357/10384/447/133* LN = lymph node Conclusion Systematic sonographic axillary staging is a reliable approach to cN (+) patients, who become ycN0 after NAC. This observation should be tested in a larger study. Citation Format: Ozmen T, Lazaro M, Vinyard A, Avisar E. Evaluation of “Systematic sonographic axillary staging” on clinically node positive breast cancer patients becoming clinically node negative after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-17.

Color Doppler ultrasound assessment of morphology and types of fistulous tracts in hidradenitis suppurativa (HS)

Fistulous tracts in hidradenitis suppurativa (HS) are key signs of severity and their clinical evaluation alone may be limited for assessing their presence and morphology. There is also a need to determine the factors that allow reversibility of the anatomic changes in HS. We sought to categorize fistulous tracts in HS. A retrospective study of color Doppler ultrasound images of cases with positive clinical and sonographic criteria of HS with fistulous tracts was performed. The sonographic staging of HS, location, and anatomic characteristics of the tracts were registered and graded. Statistical analysis for correlating variables was performed using bivariate and multivariate studies. In all, 52 patients presenting 96 fistulous tracts met the criteria. Morphology was defined and a sonographic classification into 3 types of fistulae was developed. Type 3 concentrated 71% of the cases presenting communicating tracts, and type 2, 29%. Types 2 and 3 represented 63% of patients with multiple fistulous tracts. Fistulous tracts types 2 and 3 were significantly correlated with age 35years or older and groin location. Ultrasound cannot detect lesions less than 0.1mm. Fistulous tracts in HS can be categorized using ultrasound, which may support earlier and more precise management.

A novel sonographic scoring system for antenatal risk assessment of obstetric complications in suspected morbidly adherent placenta.

The purpose of this study was to evaluate a novel sonographic scoring system for risk assessment of complications in patients suspected of having morbidly adherent placenta. This retrospective study evaluated the association between maternal complications and a grayscale sonographic scoring system for adherent placenta before surgery. Criteria for adherent placenta included uteroplacental and uterobladder demarcation lines and the presence of lacunae. Placentas were classified into 4 stages: stage 0, normal placentation; stage 1, low probability of adherence; stage 2, moderate possibility of adherence; and stage 3, high suspicion of adherence. Placental adherence as assessed by a surgical team, estimated blood loss, and postoperative hospitalization days were determined for each group, as well as the rates of the need for packed blood cells, cryoprecipitate units, and hysterectomy. One hundred nine women were included in the study. Twenty-six (23.8%) women were given a score of stage 0, 22 (20.2%) stage 1, 28 (25.7%) stage 2, and 33 (30.3%) stage 3. Linear regression analysis demonstrated that the sonographic staging was the only variable significantly associated with the number of packed cells or cryoprecipitate units transfused (P< .001) and a clinical diagnosis of adherent placenta (P< .001). In addition, both sonographic staging and a history of cesarean delivery were significantly associated with hysterectomy (P = .01; P = .03, respectively), treatment with any blood products (P< .001; P= .01), and the duration of postoperative hospitalization (P< .001; P = .006). A scoring system based on simple grayscale parameters may be effective for antenatal risk assessment of maternal complications in cases of suspected morbidly adherent placenta.

Is axillary sonographic staging less accurate in invasive lobular breast cancer than in ductal breast cancer?

The purpose of this study was to determine whether axillary sonography is less accurate in invasive lobular breast cancer than in ductal breast cancer. Patients with invasive breast cancer were retrospectively identified from histologic records from 2010 to 2012. Staging axillary sonograms from 96 patients with primary breast cancer in each of 2 subgroups, invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC), were reviewed. Preoperative sonographically guided 14-gauge core biopsy was performed on morphologically abnormal lymph nodes. Thirty-one of 96 patients (32%) in each subgroup were node positive on final postoperative histopathologic analysis. Axillary staging sensitivity was 17 of 31 patients (54%) in the IDC subgroup and 15 of 31(48%) in the ILC subgroup. Further analysis of the data showed no statistically significant differences between these subgroups. We found that there was no statistically significant difference in the accuracy of axillary sonographic staging between ILC and IDC.

Mediastinoscopy in the era of endobronchial ultrasound: when should it be performed?

Accurate mediastinal lymph node staging is critical for patients with non-small cell lung cancer (NSCLC). Although cervical mediastinoscopy has been regarded as the method of choice for mediastinal staging in NSCLC, emergence of minimally invasive sonography, for example endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound fine needle aspiration (EUS-FNA), has led to questions about the routine use of mediastinoscopy. EBUS-TBNA has access to all the mediastinal lymph nodes accessible by mediastinoscopy but also extends to the N1 nodes. EUS-FNA enables access to paraesophageal (station 8) and pulmonary ligament (station 9) lymph nodes, which are not accessible by either mediastinoscopy or EBUS-TBNA. On the basis of current evidence, sonographic staging is the recommended choice for patients with high pretest probability of lymph node metastatic involvement; all negative results should, however, be verified by mediastinoscopy, especially in centers with low expertise. For patients with low pretest probability, mediastinoscopy may be omitted.

Changes of parotid and submandibular glands caused by radiotherapy—an ultrasound evaluation

Radiotherapy may alter the normal morphology of salivary glands located in the radiation field. These changes could be evaluated safely by sonography; however, there have been few studies in this regard. This study is aimed at evaluating the sonographic changes of the parotid and submandibular glands in patients undergoing radiotherapy for head and neck malignancies. 20 patients (16 males and 4 females) with head and neck malignancies who had been referred for radiotherapy to the Qaem Hospital in Mashhad, Iran, entered the study. Length, height, depth, echotexture, echogenicity and margins of parotid and submandibular glands were evaluated in three stages (I, before radiotherapy; II, 2 weeks after radiotherapy; and III, 6-7 weeks after radiotherapy) using sonography. Peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) were also evaluated by Doppler sonography. Significant differences in length, height and depth (p = 0.000, p = 0.000, and p = 0.39, respectively) and also echotexture, echogenicity and gland margins (p = 0.000) were observed before and after radiotherapy. Doppler sonography results showed no significant differences regarding PSV, EDV and RI between sonographic stages. Echotexture and echogenicity were the only independent parameters that showed significant differences in sonographic stages I and II (p = 0.000). Length in stage I and II (p = 0.000) and echogenicity in stage III (p = 0.038) were the only parameters that showed significant differences between the two glands. Radiotherapy may change the echotexture, echogenicity and margins of the salivary glands from homogenic to heterogenic, hyperechoic to hypoechoic and regular to irregular, respectively, and may reduce their size.

Preoperative sonographic axillary staging in breast cancer: correlation with sentinel node sampling

Axillary ultrasound staging with core biopsy (CB) or fine needle aspiration (FNA) in primary breast cancer is well established. Negative patients will have a sentinel lymph node biopsy (SLNB). This study compares the initial ultrasound finding versus final axillary histology in patients undergoing SLNB.

Application of Endoscopic Sonography in Preoperative Staging of Rectal Cancer

The aim of this study was to evaluate our experience with the application of endoscopic sonography in preoperative staging of rectal cancer. Between April 2004 and May 2010, 192 patients with rectal cancer first underwent endoscopic sonography and then underwent surgery at our hospital. None of the patients in this study received neoadjuvant therapy. The endoscopic sonographic staging results were compared with those of postoperative pathologic staging. The accuracy of overall T staging was 86.5%, and for T1, T2, T3, and T4, the accuracy rates were 86.7%, 94.0%, 86.2%, and 65.5%, respectively. The accuracy of T staging for ulcerated lesions was significantly lower than that for nonulcerated lesions (P = .013). The accuracy of T staging between nontraversable stenotic lesions and traversable lesions was also significantly different (P = .002). The accuracy of N staging was 77.8%, and the specificity and sensitivity were 85.6% and 74.2%, respectively. Endoscopic sonography is safe and effective for preoperative staging of rectal cancer and should be a routine examination before surgery. As for ulcerated and nontraversable stenotic lesions, however, the results of endoscopic sonographic staging could be doubtful. Moreover, the accuracy of endoscopic sonographic N staging still needs modification by further research.

Pathologic Continuum of Acute Appendicitis

Appendicitis is one of the most common causes of the acute abdomen often requiring emergent surgery. Delayed diagnosis leads to the progression of uncomplicated appendicitis to complicated (gangrenous, perforated) appendicitis, often changing clinical management. Computed tomography and ultrasound are imaging modalities of choice to preoperatively diagnose appendicitis. Recent concerns of radiation exposure and cost have renewed interest in using ultrasound as an initial, diagnostic study. A sonographic pictorial and histopathologic review of the continuum of appendicitis is presented. A comprehensive sonographic examination of the appendix should investigate the size (maximal diameter), the echogenic submucosal layer integrity, the mural color Doppler signature, the presence of a fecalith, and the periappendiceal changes. Features of an uncomplicated appendicitis include size greater than 6 to 7 mm, hyperemia on color Doppler, mural thickening, and an intact echogenic submucosal layer. Gangrenous appendicitis is characterized by loss of the echogenic submucosal layer with absent color Doppler flow. Loculated pericecal fluid, prominent pericecal fat, and circumferential loss of the submucosal layer are suggestive of perforation. Sonographic staging can triage management of appendicitis by directing urgent laparoscopic appendectomy for uncomplicated appendicitis, open appendectomy for complicated appendicitis, and conservative management (antibiotics with percutaneous drainage) for perforated appendicitis with abscess formation.