Official Proceedings - AIUM

American Institute of Ultrasound in Medicine Proceedings J Ultrasound Med 32(suppl):S1–S134, 20131538313 Case Presentations of “Cloudy Ascites” Associated WithFemale Pelvic MalignanciesRaydeen Busse, 1,2 Gail Hoshiko-Reed, 2 Chrystie Fujimoto 1,2 *1Obstetrics, Gynecology, and Women’s Health, University ofHawaii, Honolulu, Hawaii USA; 2 Hawaii Pacific Health, Honolulu,Hawaii USAObjectives—There is no effective early detection available forovarian cancer screening; therefore, vague symptoms of early satiety, abdominaldiscomfort, and abdominal bloating commonly result in pelvic ultrasoundimaging. Ascites in the gynecologic patient is easily identifiedusing high-resolution transvaginal pelvic ultrasound imaging even whenpresent in trace amounts. Although the presence of cul-de-sac free fluid inpatients of childbearing age is a routine finding due to ovulation and themenstrual cycle, the presence in postmenopausal women regardless ofamount warrants further investigation. We present 3 cases of echogenicpelvic fluid or “cloudy ascites” found in perimenopausal and postmenopausalwomen in whom pelvic malignancies were diagnosed.Methods—Transvaginal ultrasound that is performed in ourunit classifies and subjectively quantifies free pelvic fluid in all patients.We noted 3 cases in which the presence of free pelvic fluid in perimenopausaland postmenopausal women changed in character and quantityover a short period of time. There were no ovarian masses. Thepresence and change of the pelvic fluid was solely what led to the subsequentoperative diagnoses of 3 different pelvic malignancies in our 3 cases.Results—The presence of clear or anechoic cul-de-sac freefluid was present in each of the 3 cases, and short-term follow-up was recommended.In each case, the ascites changed from anechoic to complexon ultrasound imaging or increased in subjective amount. No ovarian abnormalitieswere seen in any of the 3 cases. Further evaluation was initiated,and subsequent operative pathology revealed a mucinous adenocarcinomaof the appendix, metastatic breast cancer after 15 years of remission, anda fallopian tube carcinoma.Conclusions—In perimenopausal, specifically, postmenopausalwomen, our premise is that ascites or pelvic free fluid should always beclassified as to its echogenicity and amount. If the fluid appears to representan exudate or contain echoes, some type of inflammatory processcould be present, or the fluid could represent malignant ascites. Althoughcomplex or cloudy ascites is not pathognomonic for malignancy, it certainlyis a cause for further evaluation.1538648 Predicting Prognostic Factors of Breast Cancer Using ShearWave ElastographyWoo Jung Choi,* Hak Hee Kim, Joo Hee Cha, Hee JungShin, Hyunji Kim, Min Ji Hong, Eun Suk Cha, Hyeon SookKim, Sung Hun Kim Radiology, Asan Medical Center, Seoul,KoreaObjectives—To investigate the correlation between histologicfactors, including immunohistochemical factors, of breast cancer relatedto the prognosis of tumors using shear wave elastography (SWE).Methods—One hundred twenty-two pathologically provenbreast cancers from 116 women (age range, 27–77 years; mean age, 48.1years) were included in this study. For each lesion, B-mode ultrasoundand SWE images were obtained. Of the SWE features, the mean elasticityvalue, maximum elasticity value, and SWE ratio were extracted. TheSWE ratio was calculated as the ratio of the stiffest portion of the lesionto the similar region of interest in fat tissue. Histologic findings frompathologic reports were used for comparison, namely, nuclear and histologicgrade, nodal status, vascular invasion, invasive size, and immunohistochemicalfactors such as estrogen receptor (ER), progesteronereceptor (PR), Her-2 (c-erb B2), Her-1 (epidermal growth factor receptor),CK5/6, p53, and Ki-67. The Mann-Whitney U test and Kruskal-Wallistest were used to compare the SWE values in the groups of histologicparameters. Subtypes based on the immunohistochemical profile werecompared with SWE values using the Kruskal-Wallis test.S99Results—The negative group of ER (P = .004), negative groupof PR (P = .016), positive group of p53 (P = .024), and positive group ofKi-67 (P = .008) showed statistically significant positive associations witha high SWE ratio. A high nuclear grade (P = .014), high histologic grade(P = .015), and large invasive size (P = .010) was associated with a significanthigh SWE ratio. The mean elasticity value and maximum elasticityvalue showed less statistical significance with the histologic factors.The Kruskal-Wallis analysis showed that the SWE ratio was significantlydifferent across the subtypes based on the immunohistochemical profile(P = .013).Conclusions—The SWE ratio may provide useful informationfor predicting prognostic factors of breast cancer.1538793 Understanding How Ultrasound Technology Promotes StudentAttention During Instruction of the Physical ExamCaridad Hernandez, 1 * Christine Bellew, 1 Alfredo Tirado, 1,2Andrew Payer, 1 Manette Monroe, 1 Juan Cendan 1 1 MedicalEducation, University of Central Florida College of Medicine,Orlando, Florida USA; 2 Emergency Medicine, Florida Hospital,Orlando, Florida USAObjectives—The use of point-of-care ultrasonography (US) isincreasing in medical practice. Accompanying this is an interest in incorporatingUS education in undergraduate medical education. Here we explorethe role of US technology as part of an instructional strategy toenhance students’ motivation to learn to perform the neck/thyroid exam.Methods—We used a qualitative research design usingprompted text responses. Second-year students in the physical diagnosiscourse participated. All students received traditional instruction onthe physical exam of the neck/thyroid with the addition of a student-runUS exam of the neck. Students worked in small groups with a facultyinstructor and a standardized patient. Following the sessions, they submittedresponses to 5 items aimed at assessing 4 categories of motivationalvariables: attention, relevance, confidence, and satisfaction. Datawere analyzed using a grounded theory approach. Two authors reviewedthe responses, devised a coding framework, and generatedthemes. NVivo, a qualitative data analysis platform, was used to evaluatethe data.Results—Sixty-five students completed the prompted-responseitems. We report analysis of students’ responses to the item, “Using USworked to maintain my attention by.” Four major themes emerged: (1)engagement—the session was “fun,” “engaging,” “extremely interesting,”and “interactive”; (2) active learning—being actively involved in identifyingstructures and getting to handle the probes was key to maintainingtheir attention; (3) clinical application of anatomy—application of theirknowledge of anatomy and anticipated applicability maintained their attention;(4) hands-on learning—actually doing the US themselves helpedthem learn the procedure/anatomic structures and relationships as opposedto looking at still images obtained by others.Conclusions—Incorporating the use of US with the physicalexam of the neck/thyroid helps maintain students’ attention because it promoteslearner engagement and provides clinical contextualization ofanatomy. Another theme that emerged was that hands-on real-time capturingof images by the students themselves improved their understandingof relevant anatomy.1538852 Value of Qualitative Sonoelastographic Evaluations in theDiagnosis of Solid Breast MassesHasan Yerli, 1 * Tugbahan Yilmaz, 2 Banu Ural 2 1 Radiology,2General Surgery, Baskent University Zubeyde Hanim, Practiceand Research Center, Izmir, TurkeyObjectives—To determine whether the use of a qualitative elasticityscoring method by sonoelastography (SE) is useful to differentiatebetween benign and malignant breast masses.Methods—One hundred seventy lesions in 145 consecutive pa-