Relea A, Alonso J A, González M, Zornoza C, Bahamonde S, Viñuela B E, Encinas M B
Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, Palencia, España.
Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, Palencia, España.
Radiologia (Engl Ed). 2018 Sep-Oct;60(5):413-423. doi: 10.1016/j.rx.2018.04.004. Epub 2018 Jun 12.
To determine whether the twinkling artifact on Doppler ultrasound imaging corresponds to microcalcifications previously seen on mammograms and to evaluate the usefulness of this finding in the ultrasound management of suspicious microcalcifications.
We used ultrasonography to prospectively examine 46 consecutive patients with groups of microcalcifications suspicious for malignancy identified at mammography, searching for the presence of the twinkling artifact to identify the microcalcifications. Once we identified the microcalcifications, we obtained core-needle biopsy specimens with 11G needles and then used X-rays to check the specimens for the presence of microcalcifications. We analyzed the percentage of detection and obtainment of microcalcifications by core-needle biopsy with this technique and the radiopathologic correlation. Microcalcifications that were not detected by ultrasound or discordant lesions were biopsied by stereotaxy at another center. We also used ultrasound guidance for preoperative marking with clips, usually orienting them radially.
We identified and biopsied 41 of the 46 lesions under ultrasound guidance, including 24 of 25 carcinomas (17 in situ). B-mode ultrasound was sufficient for biopsying the microcalcifications in 14 patients, although the presence of the twinkling artifact increased the number of microcalcifications detected and thus enabled more accurate preoperative marking. Thanks to the twinkling sign, we were able to identify 27 additional groups of microcalcifications (89% vs. 30%; p < 0.05). All the surgical specimens had margins free of disease.
The twinkling artifact is useful for microcalcifications in ultrasound examinations, enabling a significant increase in the yield of ultrasound-guided biopsies and better preoperative marking of groups of microcalcifications.
确定多普勒超声成像中的闪烁伪像是否与先前在乳腺钼靶检查中发现的微钙化相对应，并评估这一发现对可疑微钙化超声管理的有用性。
我们对46例在乳腺钼靶检查中发现有可疑恶性微钙化群的连续患者进行了超声前瞻性检查，寻找闪烁伪像以识别微钙化。一旦识别出微钙化，我们用11G针获取粗针活检标本，然后用X射线检查标本中是否存在微钙化。我们分析了用该技术通过粗针活检检测和获取微钙化的百分比以及放射病理相关性。超声未检测到的微钙化或不一致的病变在另一个中心通过立体定位活检。我们还使用超声引导用夹子进行术前标记，通常将它们径向定位。
我们在超声引导下对46个病变中的41个进行了识别和活检，包括25个癌中的24个（17个原位癌）。14例患者仅用B超就足以对微钙化进行活检，尽管闪烁伪像的存在增加了检测到的微钙化数量，从而使术前标记更准确。由于闪烁征，我们能够识别另外27组微钙化（89%对30%；p<0.05）。所有手术标本切缘均无病变。
闪烁伪像在超声检查中对微钙化很有用，能显著提高超声引导活检的成功率，并能更好地对微钙化群进行术前标记。
