Mogućnosti ultrazvuka visoke rezolucije u prikazu i nadzoru biopsija mamografski suspektnih nakupina mikrokalcifikacija [Role of the high resolution ultrasound in the detection and biopsy guidance of mammographically suspicious microcalcification clusters]

PURPOSE: To determine role of the US in identifying and localizing breast microcalcifications with and without mass, and to evaluate reliability of US guided core biopsy. To evaluate the role of color and power Doppler with spectral vaweform analysis and measurement resistance index in breast lesions with and withouh microcalcifications. ----- MATERIAL AND METHODS: 140 women were examined with US including color, power and spectral vaweform analysis. 70 women had a MMG visible microcalcifications clusters with associated mass and 70 women had microcalcifications only. All underwent core biopsy under US guidance. Clinical, morphological and pathologic findings were retrospectively rewieved. ----- RESULTS: 91% women with microcalcifications and soft tissue mass had positive US examination. 74% women with only microcalcifications cluster had positive US examination. All lesions underwent core biopsy under US guidance. 46% women with microcalcifications and 72% women with microcalcifications and mass have positive color and power Doppler examination. With Color and power Doppler, and with spectral vaweform analysis (SFA) we measured vascular characteristic of lesion. Measurement of resistence index is also done, and with SFA we distinguish vascularizations from artifacts. ----- CONCLUSIONS: US is an accurate method to identify breast lesions with microcalcifications, and also an effective method for tissue-sampling of breast microcalcifications. US guided biopsy can be used as alternative method to stereotactic MMG biopsy. US Color and power Doppler with spectral vaweform analisis (SFA) are sensitive indicator of vascularization inside lesions, but for now have not a significant role in diagnosis of lesions with microcalcification

Comparison of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage [Usporedba višeslojne kompjuterizirane tomografije i duplex Doppler ultrazvuka u otkrivanju aterosklerotskih karotidnih plakova kompliciranih krvarenjem u plak ]

This study compared sensitivity and specificity of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage. Carotid plaques from 50 patients operated for carotid artery stenosis were analyzed. Carotid endarterectomy was performed within one week of diagnostic evaluation. Results of multidetector-row computed tomography and duplex Doppler ultrasonography diagnostic evaluation were compared with results of histological analysis of the same plaque areas. American Heart Association classification of atherosclerotic plaques was applied for histological classification. Median tissue density of carotid plaques complicated with intraplaque hemorrhage was 14.7 Hounsfield units. Median tissue density of noncalcified segments of uncomplicated plaques was 54.3 Hounsfield units (p = 0.00003). The highest tissue density observed for complicated plaques was 31.8 Hounsfield units. Multidetector-row computed tomography detected plaques complicated with hemorrhage with sensitivity of 100% and specificity of 70.4%, with tissue density of 33.8 Hounsfield units as a threshold value. Duplex Doppler ultrasonography plaque analysis based on visual in-line classification showed sensitivity of 21.7% and specificity of 89.6% in detecting plaques complicated with intraplaque hemorrhage. Multidetector-row computed tomography showed a very high level of sensitivity and a moderate level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage. Duplex Doppler ultrasonography plaque analysis based on visual in-line classification showed a low level of sensitivity and a moderate-high level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage

Fine Needle Aspiration Cytology of Chondroid Syringoma

Chondroid syringoma (CS) is a rare, benign, appendageal tumor with diagnostic feature of myxochondroid stroma supporting eccrine and apocrine epithelial structures. The usual presentation is a painless, slowly growing mass, typically located in the head and neck region. It usually affects middle-aged and older male patients. Because of its unremarkable clinical presentation it is often overlooked. It should be included in the differential diagnosis of cutaneous head and neck tumors, especially in middle-aged men. Optimal treatment of CS is total surgical excision. We present a 63 year-old man with a small nodule on the neck with 5 years of duration. The diagnosis was made initially on fine needle aspiration cytology that was performed by ultrasound guidance and confirmed subsequently by histology. FNA cytology may be very useful to determine diagnosis before excision

A retrospective study of ultrasound characteristics and macroscopic findings in confirmed malignant pleural effusion

BACKGROUND: A definitive diagnosis of malignant pleural effusion (MPE) is reached by cytological or histological assessment, but thorough analysis of the ultrasound features of the effusion as well as pleural thickening or nodularity can also be of significant diagnostic help. ----- OBJECTIVE: To assess the relationship of specific ultrasound characteristics and macroscopic features of confirmed malignant pleural effusion, thus increasing the diagnostic potential of thoracic ultrasound. ----- METHODS: The findings of thoracic ultrasonography performed prior to initial thoracentesis in 104 patients with subsequently confirmed malignant pleural effusion were analyzed with regard to the macroscopic features of the pleural effusion. ----- RESULTS: Distribution in terms of frequency of hemorrhagic/sanguinolent (n=64) in relation to nonhemorrhagic transparent/opaque (n=40) MPE, regardless of their ultrasound characteristics, did not yield a statistically significant correlation (p=0.159). Conversely, the frequency distribution of hemorrhagic pleural effusions (n=8) in relation to nonhemorrhagic effusions (n=1), in the group of septated MPE, showed a statistically significant difference (p<0.001). The least number of patients (0.96%) had a complex septated MPE combined with the macroscopic appearance of a serous/transparent nonhemorrhagic effusion, which suggests that this combination is a sporadic occurrence and may have a diagnostic significance for this patient group. ----- CONCLUSION: The incidence of specific combinations of the ultrasound characteristics and macroscopic appearance of MPEs showed different frequency distributions, which may improve the diagnostic value of thoracic ultrasound in this patient population

Possibilities and difficulties in cytological diagnosis of neurinoma

Neurinom ili švanom rijetki je benigni tumor koji potječe od Schwannovih stanica ovojnice živca. To je spororastući, solitarni i inkapsulirani tumor. Može nastati u bilo kojoj dobi, ali najčešće se javlja između 30. i 60. godine života. Na glavi i vratu neurinomi se javljaju u mlađih osoba, u dobi od 20. do 30. godine. Citološka je dijagnoza važna zbog odabira pravilnog liječenja, otkrivanja recidiva ili pojave novog neurinoma na drugome živcu. Citološke punkcije mogu se raditi „naslijepo” ili češće pod kontrolom ultrazvuka. Tijekom sedam godina, od 1. siječnja 2007. do 31. prosinca 2013., punktirano je 14 322 pacijenta na Odjelu za kliničku citologiju i citometriju KB-a Dubrava, a samo u 10 (0,07 %) pacijenata postavljena je citološka dijagnoza neurinoma. Najviše punktiranih neurinoma bilo je u području glave i vrata, u sedam pacijenata od njih 10. Retrospektivno smo analizirali preparate i nalaze i odredili točnost citologije uspoređujući citološku dijagnozu s patohistološkim nalazom. U šest je pacijenata patohistološki potvrđena citološka dijagnoza neurinoma. U četiri pacijenta čija je patohistološka dijagnoza bila neurinom, citološka je dijagnoza glasila mezenhimalni tumor u tri pacijenta, a u četvrtog tumor vretenastih stanica, što su sve bile dijagnoze benignih lezija.Neurinoma (schwannoma) is a rare benign tumor that originates from Schwann cells of the nerve sheath. Neurinoma is a slow-growing, solitary and encapsulated tumor. These neoplasms may occur at any age but are more common between the ages of 30 and 60. Neurinoma of the head and neck occurs in younger people, at the ages of 20 and 30. Cytological diagnosis is important for the accurate treatment, detection of recurrence of the disease and diagnosing a new neurinoma on another nerve. Fine needle aspiration cytology (FNAC) can be done with or without ultrasound guidance. During 7 years - from 1 January 2007 until 31 December 2013, 14 322 FNAC have been done at the Department of Cytology and Cytometry, Dubrava University Hospital and only 10 (0.07%) patients had cytological diagnosis of neurinoma. The most FNAC of neurinoma was done in the head and neck, in 7 patients out of 10. We have analysed retrospectively cytology slides and reports and we determined the accuracy of cytology by comparing cytological diagnoses with pathohistological findings. Cytological diagnosis of neurinoma was accurate in 6 patients according to pathohistological diagnosis. In 4 patients with pathohistological diagnosis of neurinoma cytological diagnoses were mesenchymal tumor in 3 patients and spindle cell tumor in one patient, all of them were benign lesions

Ultrasound diagnostics of infectious diseases of the neck and thoracic organs

Ultrazvuk (UZV) je jedan od najčešće rabljenih modaliteta oslikavanja i navođenja za intervencijske postupke infektivnih bolesti vrata i torakalnih organa. Indikacije za UZV vrata uključuju evaluaciju palpabilnih tvorbi vrata, slučajno pronađenih tvorbi vrata i obradu bolesnika s vrućicom nepoznatog porijekla. UZV toraksa je vrijedna metoda u procjeni aktivnosti bolesti perifernog plućnog parenhima, torakalne stijenke, dijafragme i medijastinuma. Oko 50% bolesnika sa sepsom imaju zahvaćen miokard, što je karakterizirano biventrikularnim uvećanjem, reduciranom kontraktilnošću i dijastoličkom disfunkcijom, što se može utvrditi UZV-om. Ehokardiografija je postala neinvazivna slikovna dijagnostička metoda izbora u bolesnika sa suspektnom endokardijalnom lezijom. Pokazala se korisnom ne samo za prikaz vegetativnih lezija, već i za detekciju komplikacija endokarditisa kao što su perivalvularni apsces i značajna valvularna destrukcija koja vodi do regurgitacije. Ovaj pregledni članak govori o UZV prikazu različitih patoloških stanja vrata, toraksa i srca, naglašavajući sonografske karakteristike udružene s infektivnim bolestima.Ultrasound (US) remains one of the most frequently used and valuable modalities for imaging and guiding interventional procedures in the neck and thoracic infectious diseases. Indications for neck US include evaluation for a palpable neck mass, workup of neck mass discovered incidentally and screening imaging technique in patients with fever of unknown origin. Chest US is a useful tool for assessing disease activity in the peripheral lung parenchyma, chest wall, diaphragm, and mediastinum. About 50% of patients with sepsis show myocardial involvement characterized by biventricular enlargement, reduced contractility and diastolic dysfunction that should be diagnosed by US. Echocardiography has become the noninvasive imaging diagnostic procedure of choice in patients with suspected endocarditic lesions. It has proved useful not only for visualizing vegetative lesions, but also for detecting complications of endocarditis, such as perivalvular abscess and significant valvular destruction leading to regurgitation. This review discusses the US appearances of different pathologies of the neck, thorax and heart, emphasizing sonographic features associated with infectious diseases

Role of the high resolution ultrasound in the detection and biopsy guidance of mammographically suspicious microcalcification clusters

CILJ RADA: Prikazati mogućnost UZV u dijagnostici i nadzoru biopsija lezija dojke koje sadrže mikrokalcifikate. Istražiti ulogu obojenog i power doplera te spektralne frekvencijske analize u dijagnostici lezija dojki koje sadrže mikrokalcifikate. ----- BOLESNICI I METODE: Analizirano je 140 žena. 70 sa mamografski vidljivim mikrokalcifikatima uz mekotkivnu tvorbu i 70 sa mamografski vidljivim mikrokalcifikatima bez tvorbe. Sve lezije su analizirane obojenim i power doplerom, a spektralnom analizom kvantificiran je protok i mjereni indeksi otpora. Kod svih UZV vidljivih lezija učinjene su biopsije širokom iglom pod nadzorom UZV. ----- REZULTATI: Ultrazvukom smo prikazali mikrokalcifikate kod 91% bolesnica s MKC i mekotkivnom lezijom te kod 74% bolesnica samo s MKC, a sve prikazane lezije smo uspješno bioptirali širokom iglom pod kontrolom UZV. Doplerom smo prikazali protok u 46% bolesnica s MKC te u 72% bolesnica kod promjena s MKC i mekotkivnom lezijom. Obojenim i power doplerom uz spektralnu frekvencijsku analizu smo prikazali karakteristike protoka u lezijama, mjerili indekse otpora i razlikovali protoke od artefakata. ----- ZAKLJUČAK: Ultrazvuk se pokazao kao točna metoda za prikaz nakupina mikrokalcifikata i pridruženih lezija. Ultrazvuk je pouzdana i jednostavna metoda za nadzor biopsija širokom iglom i alternativa je kompliciranijoj i skupljoj stereotaksijskoj biopsiji pod kontrolom MMG. Obojeni i power dopler i SFA s kvantifikacijom protoka su dodatne pomoćne metode pregleda ultrazvukom koje za sada imaju ograničenu primjenu.PURPOSE: To determine role of the US in identifying and localizing breast microcalcifications with and without mass, and to evaluate reliability of US guided core biopsy. To evaluate the role of color and power Doppler with spectral vaweform analysis and measurement resistance index in breast lesions with and withouh microcalcifications. ----- MATERIAL AND METHODS: 140 women were examined with US including color, power and spectral vaweform analysis. 70 women had a MMG visible microcalcifications clusters with associated mass and 70 women had microcalcifications only. All underwent core biopsy under US guidance. Clinical, morphological and pathologic findings were retrospectively rewieved. ----- RESULTS: 91% women with microcalcifications and soft tissue mass had positive US examination. 74% women with only microcalcifications cluster had positive US examination. All lesions underwent core biopsy under US guidance. 46% women with microcalcifications and 72% women with microcalcifications and mass have positive color and power Doppler examination. With Color and power Doppler, and with spectral vaweform analysis (SFA) we measured vascular characteristic of lesion. Measurement of resistence index is also done, and with SFA we distinguish vascularizations from artifacts. ----- CONCLUSIONS: US is an accurate method to identify breast lesions with microcalcifications, and also an effective method for tissue-sampling of breast microcalcifications. US guided biopsy can be used as alternative method to stereotactic MMG biopsy. US Color and power Doppler with spectral vaweform analisis (SFA) are sensitive indicator of vascularization inside lesions, but for now have not a significant role in diagnosis of lesions with microcalcification

Role of the high resolution ultrasound in the detection and biopsy guidance of mammographically suspicious microcalcification clusters

CILJ RADA: Prikazati mogućnost UZV u dijagnostici i nadzoru biopsija lezija dojke koje sadrže mikrokalcifikate. Istražiti ulogu obojenog i power doplera te spektralne frekvencijske analize u dijagnostici lezija dojki koje sadrže mikrokalcifikate. ----- BOLESNICI I METODE: Analizirano je 140 žena. 70 sa mamografski vidljivim mikrokalcifikatima uz mekotkivnu tvorbu i 70 sa mamografski vidljivim mikrokalcifikatima bez tvorbe. Sve lezije su analizirane obojenim i power doplerom, a spektralnom analizom kvantificiran je protok i mjereni indeksi otpora. Kod svih UZV vidljivih lezija učinjene su biopsije širokom iglom pod nadzorom UZV. ----- REZULTATI: Ultrazvukom smo prikazali mikrokalcifikate kod 91% bolesnica s MKC i mekotkivnom lezijom te kod 74% bolesnica samo s MKC, a sve prikazane lezije smo uspješno bioptirali širokom iglom pod kontrolom UZV. Doplerom smo prikazali protok u 46% bolesnica s MKC te u 72% bolesnica kod promjena s MKC i mekotkivnom lezijom. Obojenim i power doplerom uz spektralnu frekvencijsku analizu smo prikazali karakteristike protoka u lezijama, mjerili indekse otpora i razlikovali protoke od artefakata. ----- ZAKLJUČAK: Ultrazvuk se pokazao kao točna metoda za prikaz nakupina mikrokalcifikata i pridruženih lezija. Ultrazvuk je pouzdana i jednostavna metoda za nadzor biopsija širokom iglom i alternativa je kompliciranijoj i skupljoj stereotaksijskoj biopsiji pod kontrolom MMG. Obojeni i power dopler i SFA s kvantifikacijom protoka su dodatne pomoćne metode pregleda ultrazvukom koje za sada imaju ograničenu primjenu.PURPOSE: To determine role of the US in identifying and localizing breast microcalcifications with and without mass, and to evaluate reliability of US guided core biopsy. To evaluate the role of color and power Doppler with spectral vaweform analysis and measurement resistance index in breast lesions with and withouh microcalcifications. ----- MATERIAL AND METHODS: 140 women were examined with US including color, power and spectral vaweform analysis. 70 women had a MMG visible microcalcifications clusters with associated mass and 70 women had microcalcifications only. All underwent core biopsy under US guidance. Clinical, morphological and pathologic findings were retrospectively rewieved. ----- RESULTS: 91% women with microcalcifications and soft tissue mass had positive US examination. 74% women with only microcalcifications cluster had positive US examination. All lesions underwent core biopsy under US guidance. 46% women with microcalcifications and 72% women with microcalcifications and mass have positive color and power Doppler examination. With Color and power Doppler, and with spectral vaweform analysis (SFA) we measured vascular characteristic of lesion. Measurement of resistence index is also done, and with SFA we distinguish vascularizations from artifacts. ----- CONCLUSIONS: US is an accurate method to identify breast lesions with microcalcifications, and also an effective method for tissue-sampling of breast microcalcifications. US guided biopsy can be used as alternative method to stereotactic MMG biopsy. US Color and power Doppler with spectral vaweform analisis (SFA) are sensitive indicator of vascularization inside lesions, but for now have not a significant role in diagnosis of lesions with microcalcification

Role of the high resolution ultrasound in the detection and biopsy guidance of mammographically suspicious microcalcification clusters

CILJ RADA: Prikazati mogućnost UZV u dijagnostici i nadzoru biopsija lezija dojke koje sadrže mikrokalcifikate. Istražiti ulogu obojenog i power doplera te spektralne frekvencijske analize u dijagnostici lezija dojki koje sadrže mikrokalcifikate. ----- BOLESNICI I METODE: Analizirano je 140 žena. 70 sa mamografski vidljivim mikrokalcifikatima uz mekotkivnu tvorbu i 70 sa mamografski vidljivim mikrokalcifikatima bez tvorbe. Sve lezije su analizirane obojenim i power doplerom, a spektralnom analizom kvantificiran je protok i mjereni indeksi otpora. Kod svih UZV vidljivih lezija učinjene su biopsije širokom iglom pod nadzorom UZV. ----- REZULTATI: Ultrazvukom smo prikazali mikrokalcifikate kod 91% bolesnica s MKC i mekotkivnom lezijom te kod 74% bolesnica samo s MKC, a sve prikazane lezije smo uspješno bioptirali širokom iglom pod kontrolom UZV. Doplerom smo prikazali protok u 46% bolesnica s MKC te u 72% bolesnica kod promjena s MKC i mekotkivnom lezijom. Obojenim i power doplerom uz spektralnu frekvencijsku analizu smo prikazali karakteristike protoka u lezijama, mjerili indekse otpora i razlikovali protoke od artefakata. ----- ZAKLJUČAK: Ultrazvuk se pokazao kao točna metoda za prikaz nakupina mikrokalcifikata i pridruženih lezija. Ultrazvuk je pouzdana i jednostavna metoda za nadzor biopsija širokom iglom i alternativa je kompliciranijoj i skupljoj stereotaksijskoj biopsiji pod kontrolom MMG. Obojeni i power dopler i SFA s kvantifikacijom protoka su dodatne pomoćne metode pregleda ultrazvukom koje za sada imaju ograničenu primjenu.PURPOSE: To determine role of the US in identifying and localizing breast microcalcifications with and without mass, and to evaluate reliability of US guided core biopsy. To evaluate the role of color and power Doppler with spectral vaweform analysis and measurement resistance index in breast lesions with and withouh microcalcifications. ----- MATERIAL AND METHODS: 140 women were examined with US including color, power and spectral vaweform analysis. 70 women had a MMG visible microcalcifications clusters with associated mass and 70 women had microcalcifications only. All underwent core biopsy under US guidance. Clinical, morphological and pathologic findings were retrospectively rewieved. ----- RESULTS: 91% women with microcalcifications and soft tissue mass had positive US examination. 74% women with only microcalcifications cluster had positive US examination. All lesions underwent core biopsy under US guidance. 46% women with microcalcifications and 72% women with microcalcifications and mass have positive color and power Doppler examination. With Color and power Doppler, and with spectral vaweform analysis (SFA) we measured vascular characteristic of lesion. Measurement of resistence index is also done, and with SFA we distinguish vascularizations from artifacts. ----- CONCLUSIONS: US is an accurate method to identify breast lesions with microcalcifications, and also an effective method for tissue-sampling of breast microcalcifications. US guided biopsy can be used as alternative method to stereotactic MMG biopsy. US Color and power Doppler with spectral vaweform analisis (SFA) are sensitive indicator of vascularization inside lesions, but for now have not a significant role in diagnosis of lesions with microcalcification

Fine needle aspiration cytology of chondroid syringoma [Citologija hondroidnog siringoma]

Chondroid syringoma (CS) is a rare, benign, appendageal tumor with diagnostic feature of myxochondroid stroma supporting eccrine and apocrine epithelial structures. The usual presentation is a painless, slowly growing mass, typically located in the head and neck region. It usually affects middle-aged and older male patients. Because of its unremarkable clinical presentation it is often overlooked. It should be included in the differential diagnosis of cutaneous head and neck tumors, especially in middle-aged men. Optimal treatment of CS is total surgical excision. We present a 63 year-old man with a small nodule on the neck with 5 years of duration. The diagnosis was made initially on fine needle aspiration cytology that was performed by ultrasound guidance and confirmed subsequently by histology. FNA cytology may be very useful to determine diagnosis before excision