3083

Mucocele-like tumors of the breast: Radiologic findings andpathologic resultsHwang SH, Oh KK, Park JS, Kim E-K, Yonsei University, YongdongSeverance Hospital, Korea; National Health Insurance Corporation,Ilsan Hospital, Korea; Yonsei University, Severance Hospital, Korea

Objectives: To determine the radiologic features of mucocele-liketumor (MLT) of the breast. These radiologic findings were correlated tothe pathologic results.Methods: Eight patients with MLT of the breast were identified from1997 through 2004. The age of the patients ranged from 35 to 48 years(mean age, 41 years). Seven patients had undergone mammography.Seven had also undergone sonography. Four patients were taken thebreast MRI. The lesions of all eight patients were surgically excised.We retrospectively analyzed the radiologic findings and correlated thepathologic results.Results: Five patients had the clustered microcalcification as mammo-graphic finding. On sonography, five lesions were showed as oval orlobular masses. Four of them had hypoechoic masses with mixedinternal echo pattern. The masses of four patients revealed high signalon T2WI and early peripheral enhancement pattern in MRI. Patholog-ical results showed that the association with malignancy was very high(n � 4).Conclusions: The possibility of association with malignancy was veryhigh. On mammography the MLT had the intermediate clustered mi-crocalcification. On sonography the MLT showed the oval or lobularshaped mass with mixed internal echo pattern. The breast MRI revealedthe mass with high signal intensity on T2WI and the early peripheralrim enhancement.

3084

Differentiation of benign and malignant cystic breast lesionsaccording to sonographic findingsChang Y-W, Kwon KH, Choi DL, Goo DE, Kim DH, Lee HK,Soonchunhyang University Hospital, Korea; Chosun UniversityHospital, Korea; Soonchunhyang University Hospital, Bucheon,Korea

The purpose of this essay are to illustrate the cystic lesions of the breastaccording to subdivide the types of ultrasonographic findings correlatedwith pathology. We try to evaluate the characteristic features of cysticmasses of benign versus malignant and to determine appropriate man-agement according to the ultrasonographic findings. Breast cystic le-sions were categorized as simple cysts, complicated cysts, clusteredcysts, cysts with thin septa, cystic masses with thick wall/septa ornodules and complex solid and cystic masses. Simple cyst, clusteredcysts, cyst with thin septa and complicated cysts were all benign in ourstudy and recommended follow-up. Symptomatic complicated cystsshould be managed by aspiration cytology o treatment under clinicalgrounds. Cystic masses with thick wall/septa or nodules and complexsolid and cystic masses should be biopsied even if these masses areround, or oval shaped and have well-circumscribed margins.

3085

Analysis of imaging study for breast papilloma: Comparisonbetween breast ultrasound and galactographyAn JK, Choi YS, Woo JJ, Kim HS, Kim SH, Park SW, Han CY, EuljiHospital, Eulji University, School of Medicine, Korea

Objectives: To illustrate the advantage and disadvantage of breastultrasound for the evaluation of papilloma in comparison with galac-tography.

Methods: We retrospectively reviewed the sonographic and galacto-graphic findings of fifteen patients with pathologically proven papillo-mas, which were confirmed by ultrasound-guided core biopsy (n � 2)or by surgical excision (n � 13). Clinical symptoms, location andnumber of the lesions, cause of discordance of sonographic and galac-tographic findings were analyzed.Results: The patients were all women, mean age of 47 years (range, 34to 63). Twelve patients had nipple discharge, two with no clinicalsymptoms and one with palpable mass. Both sonography and galac-tography were performed for all 12 patients with nipple discharge. Oneof the 12 galactography failed due to inverted nipple and one showednegative finding from peripherally located lesions, which were detectedon sonography. Eight cases showed centrally located papillomas inconcord with sonographic findings and two cases with positive galac-tography showed more lesions on sonography. Among two cases withmultiple papillomas, one showed bilateral multiple lesions and theother revealed different quadrant masses.Conclusions: Breast ultrasound had advantage in detection of multiplepapillomas, peripherally located lesions, asymptomatic papillomas andgalactographically inaccessible lesions.

3086

Diagnostic value of breast duct sonography and ductoscopy—ananalysis of 86 casesGrunwald S, Ohlinger R, Schulz K, Bobermien K, Schwesinger G,Schimming A, Heyer H, Frese H, Institute of Gynecology andObstetrics, Germany; Institute of Pathology, Germany; Institute forDiagnostic Radiology and Neuroradiology, Germany

Objectives: Benign conditions are the most frequent cause of nippledischarge, but malignant and precancerous lesions, such as ductalpapilloma and papillomatosis, need to be ruled out. This study aims toevaluate the value of ductoscopy.Methods: Between 1999 and May 2005, 86 ductoscopies were com-pleted in 71 patients with uni- or bilateral nipple discharge afterexcluding extramammary etiologies. Nipple discharge had been presentin 76 breasts. Preoperative noninvasive and minimal-invasive testswere compared with ductoscopy and open biopsy results. In 71 ducto-scopies, histological results were available for comparison. Histologicassessment revealed 13 benign lesions, 44 papillomas, five precursorlesions, six DCIS and three invasive carcinomas.Results: Breast duct endoscopy was successfully completed in all 86cases, galactography in only 18 cases. Only mammography and ductsonography reached statistical significance with respect to detectingabnormal tissue. All techniques except MRI reached satisfactory sen-sitivities and specificities. Only duct sonography and ductoscopy hadsensitivity values greater than 60%.Conclusions: Sonography and ductoscopy are similarly sensitive andspecific for detecting intraductal lesions. A more precise assessment ofductoscopy will require further studies. In order to increase the detec-tion rate of in-situ carcinomas, endoscopic techniques for obtainingintraductal biopsies should be improved and be used more frequently.

3087

Evaluation of nipple discharge with US in correlation withgalactographyLee JY, Ko EY, Moon G, Lee KS, Lee Y, Hallym University SacredHeart Hospital, Korea

Objectives: To assess the better diagnostic approach to the lesionscausing nipple discharge with ultrasound (US) in correlation withgalactography.Methods: We reviewed images of 33 patients with abnormal nippledischarge who underwent both galactography and US. Thirteen US

P204 Ultrasound in Medicine and Biology Volume 32, Number 5S, 2006

were performed before galactography and 30 US were done aftergalactography with informations of galactographic findings. Ten pa-tients received US twice before and after galactography on the sameday. Three readers diagnosed lesions with galactogram only, and withgalactogram and US together. They gave points to the latter diagnosisin comparison with the former diagnosis (�1: worse, 0: equal, 1: better,2: detection of additional lesion). Paired US exams of 10 patientsbefore and after galactography were graded according to three pointsscale (0: failure in lesion detection, 1: lesion detected but not well-characterized, 2: lesion detected and well-characterized) without infor-mation of their sequences. Scores of US before and after galactographywere compared.Results: Diagnosis with galactography and US together was moreaccurate than galactography only (p � .05). US immediately aftergalactography demonstrated lesions better than US just before galac-tography (p � .05).Conclusions: We recommend combination of galactography and USimmediately after galactography in evaluation of lesions with abnormalnipple discharge.

3088

The value of several methods in differential diagnosis of benignand malignant breast tumorsChu H, Renmin Hospital of Wuhan University, China

Objectives: To provide more accurate parameters in the early diagno-sis of breast cancer.Methods: One hundred sixty-eight breast tumors proved by patholog-ical diagnosis through biopsy and/or operation were studied by 2Dultrasound, color Doppler flow imaging, contrast enhanced color Dopp-ler ultrasound and mammography at the same time.Results: (1) There was significant difference between benign andmalignant tumors regarding the appearance of the tumor, including theshape, edge, membrane, internal and rear echo, the longitudinal-trans-verse axis ratio, the existence of calcification and enlarged axillarylymph nodes (p � 0.001). (2) There was significant difference in bloodflow signal density of benign and malignant tumors between pre- andpost contrast medium injection (p � 0.001). (3) The hemodynamicparameters peak systolic velocity and resistance index were signifi-cantly higher in breast malignant tumors than that in benign tumors. (4)After contrast medium was injected, the opacity interval time of benignand malignant groups were 268 � 84 s and 141 � 32 s, respectively,and there was significant difference between two groups (p � 0.001).Conclusions: Initial judgement can be obtained by traditional ultra-sound to breast benign and malignant tumors. Ultrasound contrastmedium can enhance detection rate of breast tumors blood flow, reflectthe blood supply of tumors more accurately and help the differentialdiagnosis of benign and malignant tumors.

3089

Comparison of internal composition of benign and malignantbreast tumors using three-dimensional power DopplerChang Y-C, Huang C-S, Lee H-T, Wang Y-T, Liu H-M, NationalTaiwan University Hospital and National Taiwan University Collegeof Medicine, Taiwan

Objectives: to evaluate whether the 3D gray and power Doppler (PD)color shell histogram reflect the differences of internal compositionbetween benign and malignant breast lesions.Methods: Ninety-three patients with pathologically proved breast le-sions, including 59 benign and 43 malignant masses, were examinedwith 3D PD ultrasound and analyzed using VOCAL shell histogram.Results: There were significant differences between benign and ma-lignant in standard deviation (28.88 � 4.40 versus 27.71 � 7.31, p �

0.036), skewness (0.79 � 0.30 versus 0.70 � 0.49, p � 0.010) andkurtosis (3.66 � 0.75 versus 3.74 � 1.42, p � 0.018) but no differenceof the mean gray (73.42 � 19.19 versus 78.45 � 21.40, p � 0.549) ofgray level VOCAL histogram. Comparison between malignant andbenign breast lesions, there were significant differences in vasculariza-tion index (VI) (0.90 � 1.11 versus 2.23 � 4.58, p � 0.019) andvascularization-flow index (VFI) (0.30 � 0.61 versus 0.59 � 0.97, p �0.037) while there was no significant differences in flow index (FI)(21.41 � 16.24 versus 26.61 � 17.84, p � 0.256).Conclusions: Malignant breast lesions had more widely distributed,heterogeneous gray levels with peak value at lower gray level andlower kurtosis. They also had characteristic lower VI and VFI valuethan benign lesions. 3D PD breast ultrasound has great potential forquantitative analysis of internal composition and vasculature of breastlesions.

3092

Can ultrasound predict the status of biological markers in breastcancer?Kim SH, Seo BK, Je BK, Kim BK, Kim SJ, Cho KR, Cha SH,Lee KY, Korea University Ansan Hospital, Korea; Korea UniversityAnam Hospital, Korea

Objectives: Estrogen (ER) receptor, progesterone (PR) receptor, HER-2/neu, p53 and Ki-67 are the biological markers to predict response totreatment and prognosis in breast cancers. The objective of the studywas to determine whether ultrasound could predict status of biologicalmarkers in breast cancers.Methods: From January 2003 to September 2005, 149 patients whounderwent breast cancer surgery and performed preoperative ultra-sound were included in this study. Total number of the cancers was160. Two radiologists evaluated breast background echoes and char-acteristics of the masses according to the BI-RADS-Ultrasound. Forassessment of the biological markers, immunohistochemistry was used.The Fischer exact test was used for statistical analysis.Results: Calcifications associated with masses were more frequent incancers (55%) with HER-2/neu overexpression than those (27%) with-out HER-2/neu overexpression and this was significant (p � 0.05).Ki-67 was correlated with background echoes (p � 0.05) and hetero-geneous background was more frequent in cancers with high level ofKi-67. However, there was no correlation of ultrasonographic findingswith status of ER receptor, PR receptor and p53 (p � 0.05).Conclusions: In conclusion, most ultrasonographic findings could notpredict the status of biological markers, although calcifications aremore frequent in cancers with HER-2/neu overexpression and hetero-geneous background is more common in cancers with high level ofKi-67.

3093

Ultrasound in detection of residual breast carcinoma beforereexcisional surgeryKim SJ, Cha JH, Cho N, Moon WK, Konkuk University Hospital,Korea; Seoul National University Hospital, Korea

Objectives: To evaluate the value of ultrasound(US) and power Dop-pler(PD) imaging in the examination of residual breast cancer beforere-excision. MRI or mammographic diagnosis of residual disease inpatients with positive margins is hampered by postsurgical changesparticularly within 1 month after excision.Methods: One hundred thirty patients, status post-lumpectomy andwith close or positive margins, underwent US of breast using a 12–13MHz transducer and power map equipment for evaluation of residualdisease before re-excision. Time interval between lumpectomy and US

Abstracts P205