Because of the limited specificity of diagnostic imaging, many breast lesions referred for biopsy turn out to be benign. The objective of this study was to evaluate whether diffusion tensor MRI (DTI) parametric maps can be used to safely avoid biopsy of breast lesions. Individuals referred for breast biopsy based on mammogram (MG), ultrasound (US), and/or contrast enhanced (CE)-MRI were recruited. Scans consisting of T2-weighted and DTI sequences were performed. Multiple DTI-derived parametric color maps were evaluated semi-quantitatively to characterize lesions as "definitely benign," "not definitely benign," or "suspicious." All patients subsequently underwent biopsy. In this moderately-sized prospective study, 21 out of 47 pathologically proven benign lesions were characterized by both readers as "definitely benign," which would have precluded the need for biopsy. Biopsy was recommended for 11 out of 13 cancers that were characterized as "suspicious." In the remaining two cancers and 26 of 47 benign lesions, the scans were characterized as "not definitely benign" and hence required biopsy. The main causes for "not definitely benign" scans were small lesion sizes and noise. The results suggest that in appropriately selected patients, DTI may be used to safely reduce the number of unnecessary breast biopsies.

Background: Scarring and disrupted tissue planes add to already-complex neck anatomy and make localization of nonpalpable pathology difficult in cervical endocrine reoperations. We describe the use of radioactive iodine-125 seed localization (RSL) in 6 patients with metastatic papillary thyroid carcinoma (PTC) and 2 with recurrent hyperparathyroidism. Methods: Eight patients had 2-D ultrasound-guided RSL of the target lesion, 0-3 days preoperatively. Intraoperative gamma probe (Neoprobe) was used to plan incision placement and localize the implanted seed. Recorded operative variables included: number of lymph nodes (LNs) harvested, estimated blood loss (EBL), operative time, length of stay (LOS) and RSL and operative complications. Results: All patients had successful resection of the targeted area and removal of the radioactive seed. There was no seed migration. Two complications occurred in the thyroid group. Conclusion: Radioactive iodine 125 seeds facilitate successful localization of endocrine pathology during reoperative cervical procedures. (C) 2021 Elsevier Inc. All rights reserved.

Identifying the presence of axillary node and internal mammary node metastases in patients with invasive breast cancer is critical for determining prognosis and for deciding on appropriate treatment. Sentinel lymph node biopsy (SLNB) is the definitive method to exclude axillary metastases. Patients with positive SLNB results generally undergo axillary lymph node dissection (ALND). The benefit of preoperative identification of axillary metastases is that it allows the surgeon to proceed directly to ALND and to avoid an unnecessary SLNB and the need for a second surgical procedure involving the axillary nodes. Knowledge of the important anatomic landmarks of the axilla is important in finding and accurately reporting suspicious lymph nodes. The pathologic features of nodal metastases illuminate the imaging appearances of these nodes, as depicted with all modalities. Ultrasonography (US) is the primary imaging modality for evaluating axillary nodes. Morphologic criteria, such as cortical thickening, hilar effacement, and nonhilar cortical blood flow, are more important than size criteria in the identification of metastases. US-guided lymph node sampling, especially with core biopsy, is invaluable in confirming the presence of a metastasis in a suspicious node. Core biopsy has been shown to be equal in safety to fine needle aspiration and has a significantly lower false-negative rate. Magnetic resonance imaging is also useful, with the added benefit of providing a global view of both axillae. Computed tomography and radionuclide imaging play a lesser role in imaging the axilla. Preoperative image-based identification and sampling of abnormal lymph nodes that have a high positive predictive value for metastases is an extremely important component in the management of patients with invasive breast cancer.

PURPOSE:The goal of this study is to develop a computerized method that identifies a specific axillary lymph node (ALN) seen on ultrasound (US) with its most likely corresponding node on breast MRI (BMRI). This goal is an important step in developing a preoperative non-invasive method for staging breast cancer on the basis of multi-modality imaging.METHODS:Twenty patients with newly diagnosed breast cancer were scanned on US and MRI. Two expert breast imaging radiologists independently correlated ALNs seen on US with BMRI, and this correlation was used as the gold standard. To correlate ALNs on US and BMRI, the cortex and hilum of each ALN was segmented using an ellipse fitting algorithm, then the ALN long and short axes and maximum cortical thickness (MCT) were computed. Three ALNs were chosen as candidates from the BMRI datasets for each lymph node seen on US. Finally, the Euclidean distances across all measurements between the US ALN and each of the three BMRI candidates were computed, and the smallest distance was reported as the correlation result.RESULTS:Using the expert radiologists identified correlated BMRI slice as the ground truth, the shortest Euclidean distance successfully identified the same lymph node as the radiologists in 13 out of 16 ALNs (81.25%). In negative ALNs, the standard deviation for long and short axes was relatively large but that of maximum cortical thickness was small. Average maximum cortical thickness and its standard deviation measured in US were very close to those measured in MRI. There were no significant differences among the long axis, short axis, and MCT measurements between US and MRI-T2 weighted sequence (P > 0.05 paired t-test).CONCLUSION:We performed a feasibility study which showed that computerized measurements of ALNs might be used to identify the same ALN on different modalities such as US and BMRI. This type of correlation would be valuable as it would allow the use of combined imaging parameters to be applied to the evaluation of ALNs in patients with breast cancer. It is hoped that the combined multi-modality information would provide a more robust non-invasive method of staging the axilla than is currently available.