The accuracy of breast ultrasound in the evaluation of clinically benign discrete, symptomatic breast lumps

INTRODUCTION: Recent reports have suggested that breast ultrasound (US) is of value in distinguishing malignant from benign processes. The aim of this study was to establish the accuracy of US in detecting invasive malignancy in clinically benign, discrete, symptomatic breast lumps. METHODS: The US appearances of 205 clinically benign breast masses were documented prospectively and prior to mammography by one radiologist (AJE). The US appearances were then correlated with the fine needle aspiration (FNA), core biopsy and surgical findings and compared with the mammographic findings. RESULTS: The US findings were normal 72 (35%), simple cyst 63 (31%), solid benign 51 (25%), solid indeterminate 15 (7%) and solid malignant four (2%). Ultrasound characterized 13 (93%) of the 14 patients found to have invasive carcinoma as indeterminate or malignant. No patients with normal or simple cyst US findings had invasive malignancy. Ultrasound had significantly better accuracy (97% vs 87%, P < 0.02) sensitivity (93% vs 57%, P < 0.05) and negative predictive value (99% vs 92%, P < 0.002) than mammography in the detection of invasive carcinoma when indeterminate and malignant imaging findings were taken as positive. CONCLUSION: US is a useful adjunct to FNA/core biopsy in confirming the nature of symptomatic, clinically benign breast masses and is superior to mammography in this clinical setting.     

Measurement of two-dimensional blood velocity vectors by the ultrasonic speckle projection technique

A technique has been developed for measuring the two in-plane components of blood velocity using ultrasound. The principle is based on analyzing a time sequence of successive images of the speckle pattern, and forming spatial projections of the resulting three-dimensional data set. The mathematics may be understood in terms of sections through a three-dimensional Fourier transform of the original data. The technique has been tested with data from a computer-controlled scanner using a tissue-mimicking phantom, and with data from a commercial ultrasound scanner using images of flowing blood in a jugular vein. In both cases, velocity vectors with many different orientations were measured, demonstrating the feasibility of the method. A less restrictive real-time implementation is suggested.     

Pediatric pyeloplasty: outcome analysis based on patient age and surgical technique

OBJECTIVES: To analyze our experience with open pyeloplasty, with specific emphasis on procedural outcome on the basis of patient age, surgical technique, complication rate, and complication management. METHODS: All patients from 1974 to 1994 who underwent pyeloplasty at our institution were included in our review. Charts were analyzed for age at presentation, presenting signs and symptoms, type of surgical reconstruction, complications and treatment, and final outcome. RESULTS: From 1974 to 1994, 234 pyeloplasties were performed in 227 patients (108 less than 1 year old, 119 more than 1 year old). The percentage of children less than 1 year old increased throughout: 24% for 1975 to 1980, 37% for 1981 to 1990, and 69% for 1991 to 1994. Presenting signs and symptoms varied according to the age of the child at pyeloplasty. For children less than 1 year old, these were prenatal ultrasound in 86 (79%), urinary tract infection (UTI) in 9 (8%), and abdominal mass in 5 (4.6%). For children more than 1 year old, these were pain in 57 (48%), UTI in 29 (24%), hematuria in 12 (10%), and prenatal ultrasound in 3 (2.5%). Reconstruction was a dismembered pyeloplasty in all cases. The majority of patients in both age groups underwent a nonintubated repair (less than 1 year old, 99 of 114; more than 1 year old, 102 of 120). Postoperative results were evaluated by ultrasound or intravenous urography, with improvement or stable results in 95% of children less than 1 year old and in 96% of children more than 1 year old. Complications included UTI in 18 patients (7.7%), recurrent obstruction in 5 (2.1%), and persistent leak in 4 (1.7%). The complication rate was not related to age. CONCLUSIONS: The nonintubated, dismembered pyeloplasty is an excellent technique for all age groups and has a low complication rate.     

Effects of level and frequency on the detection of decrements and increments in sinusoids

Thresholds for the detection of decrements in level of sinusoidal signals were measured as a function of decrement duration, level (25, 40, 55, and 70 dB SPL) and frequency (250, 1000, and 4000 Hz) in eleven normally hearing subjects. Thresholds for detecting a brief increment in level were also measured. The sinusoids were presented in a background noise intended to mask spectral splatter associated with the decrement or increment. Performance tended to worsen with decreasing frequency, for all decrement durations and for increment detection. Performance also worsened with decreasing level. The results were analyzed using a model consisting of a compressive nonlinearity, a sliding temporal integrator, and a decision device. The analysis indicated that the worsening in performance with decreasing frequency and decreasing level can be attributed partly to increases in the equivalent rectangular duration (ERD) of the temporal integrator, but mainly to changes in the efficiency of the detection process following the temporal integrator; at lower frequencies and levels a larger change is required at the output of the integrator for threshold to be reached. At each frequency, the ERD was relatively invariant with level for levels more than about 20 dB above the absolute threshold.     

Short-term effects of pure anti-oestrogen ICI 182780 treatment on oestrogen receptor, epidermal growth factor receptor and transforming growth factor-alpha protein expression in human breast cancer

Expression of oestrogen receptor (ER), epidermal growth factor receptor (EGFR) and transforming growth factor-alpha (TGF alpha) proteins was assessed by immunocytochemistry on primary breast cancer specimens obtained before and following short-term (7-day) presurgical exposure to pure anti-oestrogen (7 alpha- [9- (4,4,5,5,5-pentafluoropentylsulphinyl) nonyl] estra-1,3,5, (10)-triene-3,17 beta-diol, ICI 182780) treatment and compared with no-treatment controls. Paired needle-core and mastectomy samples were obtained from 21 patients. Effects of ICI 182780 (10(-7)M) on MCF7 breast cancer cell ER, EGFR and TGF alpha expression were also examined over 14 days. ER protein was significantly suppressed by ICI 182780 in vivo (P = 0.009) and comparative analysis of short term ICI 182780 effects in vitro, using ER-positive MCF7 cells, gave largely equivalent results. EGFR and TGF alpha protein levels were unaltered by treatment. ICI 182780 suppresses ER without a concomitant rise in either EGFR or TGF alpha.     

Evaluation of the Green's function for the mixed potential integral equation (MPIE) method in the time domain for layered media

In the use of the time-domain integral equation (TDIE) method for the analysis of layered media, it is important to have the time-domain layered medium Green's function computed for many source-to-field distances /spl rho/ and time instants t. In this paper, a numerical method is used that computes the mixed potential Green's functions G/sub v/(/spl rho/,t) and G/sub A/(/spl rho/,t) for a multilayered medium for many /spl rho/'s and t's simultaneously. The method is applicable to multilayered media and for lossless or lossy dispersive media. Salient features of the method are: 1) the use of complex /spl omega/ so that the surface wave poles are lifted off the real k/sub /spl rho// axis such that pole extractions are not required; 2) the use of half-space extraction so that the integrand for the Sommerfeld integral decays exponentially along the k/sub /spl rho// axis to obtain fast convergence of the integral; and 3) the use of the fast Hankel transform so that the Green's function is calculated for many values of /spl rho/ simultaneously. For a four-layer medium, we illustrate the numerical results by a three-dimensional plot of /spl rho/G/sub v/(/spl rho/,t) versus /spl rho/ and t and demonstrate the space-time evolution of these Green's functions. For a maximum frequency range of 8 GHz, the method requires only a few CPU minutes to compute a table of 100 (points in /spl rho/) /spl times/ 168 (points in t) uniformly spaced values of G/sub v/(/spl rho/,t) on an 867-MHz Pentium PC.