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      Errors and mistakes in breast ultrasound diagnostics Translated title: Błędy i pomyłki w diagnostyce ultrasonograficznej piersi

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          Abstract

          Sonomammography is often the first additional examination performed in the diagnostics of breast diseases. The development of ultrasound imaging techniques, particularly the introduction of high frequency transducers, matrix transducers, harmonic imaging and finally, elastography, influenced the improvement of breast disease diagnostics. Nevertheless, as in each imaging method, there are errors and mistakes resulting from the technical limitations of the method, breast anatomy (fibrous remodeling), insufficient sensitivity and, in particular, specificity. Errors in breast ultrasound diagnostics can be divided into impossible to be avoided and potentially possible to be reduced. In this article the most frequently made errors in ultrasound have been presented, including the ones caused by the presence of artifacts resulting from volumetric averaging in the near and far field, artifacts in cysts or in dilated lactiferous ducts (reverberations, comet tail artifacts, lateral beam artifacts), improper setting of general enhancement or time gain curve or range. Errors dependent on the examiner, resulting in the wrong BIRADS-usg classification, are divided into negative and positive errors. The sources of these errors have been listed. The methods of minimization of the number of errors made have been discussed, including the ones related to the appropriate examination technique, taking into account data from case history and the use of the greatest possible number of additional options such as: harmonic imaging, color and power Doppler and elastography. In the article examples of errors resulting from the technical conditions of the method have been presented, and those dependent on the examiner which are related to the great diversity and variation of ultrasound images of pathological breast lesions.

          Translated abstract

          Sonomammografia jest często pierwszym badaniem dodatkowym wykonywanym w diagnostyce chorób piersi. Rozwój technik obrazowania ultrasonograficznego, a zwłaszcza wprowadzenie głowic o wysokich częstotliwościach, głowic matrycowych, obrazowania harmonicznego, wreszcie elastografii, wpłynął na poprawę diagnostyki chorób piersi. Niemniej, tak jak w przypadku każdej metody obrazowania, zdarzają się błędy i pomyłki, wynikające z technicznych ograniczeń metody, z warunków anatomicznych piersi (przebudowa włóknista), z niedostatecznej czułości, a zwłaszcza swoistości. Błędy w diagnostyce ultrasonograficznej piersi można podzielić na niemożliwe do uniknięcia oraz na potencjalnie możliwe do ograniczenia. W pracy przedstawiono najczęściej popełniane błędy, w tym spowodowane obecnością artefaktów wynikających z uśredniania objętościowego w polu bliskim i dalekim, artefaktów w torbielach lub w poszerzonych przewodach mlekowych (rewerberacje, artefakty ogona komety lub artefakty listka bocznego), niewłaściwym ustawieniem ogólnego wzmocnienia lub krzywej wzmocnienia czy zasięgu. Błędy zależne od badającego, skutkujące przydzieleniem zmiany do niewłaściwej klasyfikacji BIRADS-usg, podzielono na błędnie ujemne i błędnie dodatnie. Wymieniono przyczyny takich wyników. Omówiono sposoby pozwalające zminimalizować liczbę popełnianych błędów, w tym związane z właściwą techniką badania, uwzględniające dane z wywiadu oraz wykorzystanie jak największej liczby dodatkowych opcji, takich jak: obrazowanie harmoniczne, kolorowy dopler i dopler mocy oraz elastografia. W pracy przedstawiono przykłady błędów wynikających z uwarunkowań technicznych metody, zależnych od badającego, które związane są z dużą różnorodnością obrazów ultrasonograficznych zmian patologicznych piersi.

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          Most cited references11

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          Long-term risk of breast cancer in women with fibroadenoma.

          Fibroadenomas are benign breast tumors that are commonly diagnosed in young women and are associated with a slight increase in the risk of breast cancer. These lesions vary considerably in their histologic characteristics. We assessed the correlation between the histologic features of fibroadenomas and the risk of subsequent breast cancer. We conducted a retrospective cohort study of a consecutive series of patients with fibroadenoma diagnosed between 1950 and 1968. Follow-up data were obtained for 1835 patients (90 percent of those eligible). Fibroadenomas with cysts, sclerosing adenosis, epithelial calcifications, or papillary apocrine changes were classified as complex. The rate of subsequent breast cancer among the patients was compared with the rates in two control groups, women listed in the Connecticut Tumor Registry and women chosen from among the patients' sisters-in-law. The risk of invasive breast cancer was 2.17 times higher among the patients with fibroadenoma than among the controls (95 percent confidence interval, 1.5 to 3.2). The relative risk increased to 3.10 among patients with complex fibroadenomas (95 percent confidence interval, 1.9 to 5.1) and remained elevated for decades after diagnosis. Patients with benign proliferative disease in the parenchyma adjacent to the fibroadenoma had a relative risk of 3.88 (95 percent confidence interval, 2.1 to 7.3). Patients with a family history of breast cancer in whom complex fibroadenoma was diagnosed had a relative risk of 3.72, as compared with controls with a family history (95 percent confidence interval, 1.4 to 10). Two thirds of the patients had noncomplex fibroadenomas and no family history of breast cancer and did not have an increased risk. Fibroadenoma is a long-term risk factor for breast cancer. The risk is increased in women with complex fibroadenomas, proliferative disease, or a family history of breast cancer.
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            Invasive breast cancer is a heterogeneous disease in its presentation, pathological classification and clinical course. However, there are more than a dozen variants which are less common but still very well defined by the World Health Organization (WHO) classification. The rarity of many of these neoplasms does not allow large or randomized studies to define the optimal treatment. Many of the descriptions of these cancers are from case reports and small series. Our review brings updated information on 16 epithelial subtypes as classified by the WHO system with a very concise histopathology description and parameters helpful in the clinic. The aim of our review is to provide a tool for breast cancer caregivers which will enable a better understanding of the disease and its optimal approach to therapy. This may also stand as a clinical framework for a future understanding of these rarer breast cancers when gene analysis work is reported.
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              Significant differentiation of focal breast lesions: calculation of strain ratio in breast sonoelastography.

              Initial data suggest that elastography can improve the specificity of ultrasound in differentiating benign and malignant breast lesions. The aim of this study was to compare elastography and B-mode ultrasound to determine whether the calculation of strain ratios (SRs) can further improve the differentiation of focal breast lesions. A total of 227 women with histologically proven focal breast lesions (113 benign, 114 malignant) were included at two German breast centers. The women underwent a standardized ultrasound procedure using a high-end ultrasound system with a 9-MHz broadband linear transducer. B-mode scans and sonoelastograms were analyzed by two experienced readers using the Breast Imaging Reporting and Data System criteria. SRs were calculated from a tumor-adjusted region of interest (mean color pixel density) and a comparable region of interest placed in the lateral fatty tissue. Sensitivity, specificity, and cutoff values were calculated for SRs (receiver-operating characteristic analysis). The women had a mean age of 54 years (range, 19-87 years). The mean lesion diameter was 1.6 +/- 0.9 cm. Sensitivity and specificity were 96% and 56% for B-mode scanning, 81% and 89% for elastography, and 90% and 89% for SRs. An SR cutoff value of 2.45 (area under the curve, 0.949) allowed significant differentiation (P < .001) of malignant (mean, 5.1 +/- 4.2) and benign (mean, 1.6 +/- 1.0) lesions. The quantitative method of SR calculation was superior to subjective interpretation of sonoelastograms and B-mode scans, with a positive predictive value of 89% compared to 68% and 84% for the other two methods. Calculation of SRs contributes to the standardization of sonoelastography with high sensitivity and allows significant differentiation of benign and malignant breast lesions with higher specificity compared to B-mode ultrasound but not elastography. Copyright 2010 AUR. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                J Ultrason
                J Ultrason
                JoU
                Journal of Ultrasonography
                Medical Communications Sp. z o.o.
                2084-8404
                30 September 2012
                September 2012
                : 12
                : 50
                : 286-298
                Affiliations
                [1 ]Zakład Diagnostyki Obrazowej, II Wydział Lekarski, Warszawski Uniwersytet Medyczny, Warszawa, Polska
                [2 ]Zakład Radiodiagnostyki, Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie, Warszawa, Polska
                Author notes
                Adres do korespondencji: Katarzyna Dobruch-Sobczak, Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie, ul. Wawelska 15, 02-034 Warszawa. e-mail: kdsobczak@ 123456gmail.com
                Article
                0014
                10.15557/JoU.2012.0014
                4582529
                a826ab2d-07d4-48dc-a967-659f4b644d45
                2012 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o. All rights reserved.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 July 2012
                : 27 July 2012
                : 09 August 2012
                Categories
                Review

                breast us,breast diseases,diagnostic errors,artifacts
                breast us, breast diseases, diagnostic errors, artifacts

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