Objectives: Due to the high incidence (50 to 85%) of bone metastasesin advanced breast cancer sternal processes are mostly attributed to aprimary skeletal involvement and not to lymph node metastases, evenin case of medial tumor localisation, positive axillary nodal status andnegative X-ray or scintigraphic findings. The therapeutic consequencesof sternal ultrasound are evaluated.Methods: In 240 patients with histological proven breast cancer andclinical or scintigraphic suspicion of sternal metastases up to 15 sono-graphic examinations were done for primary (differential-) diagnosis,monitoring and follow-up; with additional color-/power Doppler (130patients) and 3D-ultrasound (70 patients).Results: Only 25% of the lesions were primary bone metastases to thesternum, whereas 55% were parasternal lymph node metastases, with/without secondary sternal invasion (overrepresented in patients withmedial tumor localisation) and 3% were both. Ultrasound was superiorto conventional X-ray and scintigraphy. Changes in structure, morphol-ogy and vessel density were early indicators of response to chemo-and/or radiotherapy.Conclusions: Reliable and cost-effective (differential-) diagnosismakes ultrasound a first choice imaging method of sternal metastases inbreast cancer. 3D-ultrasound is a valuable adjunct for coronal views,complete representation of extended tumors and radiotherapy-planning.CT/MRI are especially required in case of retrosternal and extensivemediastinal invasion.

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Computerized classification of solid breast nodules using semi-automated segmentation and boundary characteristics in breastultrasonogramsKim KG, Kim JH, Cho SW, Han H, Moon WK, Seoul NationalUniversity Hospital, Korea; Hallym University Hospital, Korea;Kwangwon National University Hospital, Korea

Objectives: Spiculated and jagged margin shape are known as impor-tant malignant characteristics in breast ultrasonograms. The purpose ofthis study is to develop a method for automated segmentation andclassification of margin characteristics of solid breast nodules in ultra-sonograms.Methods: Boundary characterization was extracted from total 31 breastultrasonograms (17 benign, 14 malignant) containing solid breast nod-ules. The semi-automated segmentation uses mark of random field(MRF) with multiresolution method in breast ultrasonograms. Twobreast special radiologists participated in observer performance studyand were asked to grade the shape with a scale of 3 (1: regular to 3: veryirregular). The computerized scheme analyzed the breast region withina segmented region and quantified the following parameters: shape (jagcount, disperseness, convex hull depth ratio, lobulation count). Corre-lations between the radiologists and the computerized scheme forassessing parameters in corresponding categories were computed.Results: Four shape features (jag count, dispersness, Convex Hull Depth,lobulation count) correlation (� value) were 0.6,0.72,0.62 and 0.41, re-spectively. The disperseness performed best among the four shape fea-tures. Student’s t test results of all shape features were p � 0.001.Conclusions: Radiologists and a computerized scheme correlated bestin dispereness in shape features. These features should be weightedhighly when a computer-aided diagnosis for characterizing breast USmasses is designed and developed.

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Palpable breast lesions: The application of BI-RADS US andreassessment of FNABKwak JY, Kim E-K, Park H-L, CHA General Hospital, College ofMedicine, Pochon CHA University, Korea; Research Institute ofRadiological Science, Yonsei University College of Medicine, Korea

Objectives: To evaluate the application of the ultrasound BI-RADSfinal assessment system and to determine the usefulness of palpationguided fine needle aspiration of palpable breast lesions.Methods: We performed a retrospective review of 160 cases withpalpable lesions of the breast which were undergone the palpation-guided fine needle aspiration, ultrasound and pathologic confirmation.We used the data of ultrasound BI-RADS category on all lesions,analyzed by an expert radiologist about breast imaging, prospectively.Pathologic confirmations included 14-guage automated gun biopsy,11-gauge or 8-gauge vacuum-assisted biopsy, or excision. The positivepredictive values of ultrasound and palpation-guide fine needle aspira-tion were calculated.Results: The positive predictive values of benign, suspicious for ma-lignancy, malignancy and atypical cells on fine needle aspiration were2.8, 77.8, 100 and 37.5, respectively. The positive predictive values ofcategories 1 to 5 on ultrasound were 0, 0, 2, 58.8 and 100, respectively.Conclusions: The application of the ultrasound BI-RADS final assess-ment system about palpable breast lesions was useful. Although posi-tive predictive values of ultrasound and fine needle aspiration, exclud-ing insufficient and atypical results, were acceptable, fine needle aspi-ration is invasive. Therefore, palpation-guided fine needle aspirationcan be eliminated when ultrasound is done meticulously about thepalpable breast lesions.

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Usefulness of preoperative breast MRI in breast cancercompared with breast USLee JE, Shin JH, Choi H-Y, College of Medicine, Ewha WomansUniversity, Korea

Objectives: The purpose of this study was to evaluate the usefulness ofpreoperative breast MRI in breast cancer.Methods: A total of 38 patients with breast cancer underwent surgeryat our institute between October 2004 and June 2005. They wereexamined preoperatively with MRI and US. The maximum diameterand number of the lesions on MRI and US were measured. Thesemeasurements were subsequently compared with pathologic results.The results were divided into equal, overestimated, and underestimatedgroup. Change of therapeutic approach based on MRI was also eval-uated.Results: Breast cancer was correctly evaluated in 30 of 38 (79%)patients at MRI and 21 of 38 (55%) at US; overestimated in three of 38(8%) at MRI and five of 38 (13%) at US; underestimated in five of 38(13%) at MRI and 12 of 38 (32%) at US. Therapeutic approach waschanged in 10 of 38 (26%) patients and all cases were undergonemodified radical mastectomy.Conclusions: In conclusion, preoperative breast MRI in breast cancerpatients was more accurate than breast US. Therefore, breast MRI maybe a useful modality for preoperative evaluation, especially for localstaging of tumor and treatment planning in patients with breast cancer.

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Comparison of accuracy of mammography, ultrasonography andMRI in evaluating residual tumor after neoadjuvantchemotherapy for breast cancerShin JH, Choi H-Y, Lee SW, Baek SY, Kim Y, Lim SM, Lee JK,Ewha Womans University, College of Medicine, Ewha UniversityMokdong Hospital, Seoul, Korea

Objectives: Our study was to determine the relative accuracy ofmammography, ultrasonography, and MRI in evaluating residual tumorafter neoadjuvant chemotherapy for breast cancer as compared with thepathological results.

P162 Ultrasound in Medicine and Biology Volume 32, Number 5S, 2006