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Quantitative microstructural sonography differs from conventional sonography in several ways. The frequency as well as the amplitude of echoes is recorded and assessed using spectral analysis techniques. The effects of diffraction of the ultrasound beam are calibrated, as are the transfer characteristics of the system. Studies of patients with alcoholic liver disease revealed significantly increased attenuation, heterogeneity of scatterers, and local scattering strength in those with severe disease; in contrast, patients with mild cirrhosis exhibited decreased local scattering strength compared to normal individuals. Using retrospective three-parameter discriminant analysis, 23 out of 24 patients were successfully categorized, suggesting that the parameters used were capable of measuring microstructural changes associated with these disease states. Parameters varied widely among 6 types of hepatic tumors, suggesting that this method may offer promise in distinguishing tumors from normal cases and alcoholic liver disease as well as from each other. Further applications and evaluation of this method appear justified.

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The distinction between primary lung adenocarcinoma and metastatic breast carcinoma in patients with a history of breast cancer is difficult by frozen section (FS) analysis. Our experience with 129 FSs from 121 patients with a pulmonary nodule and a history of breast cancer was reviewed. The pretest odds ratio of primary pulmonary carcinoma/metastatic breast carcinoma was 2.6. The incidence of 12 histopathologic features was assessed in a "training set" composed of 20 FSs, 10 with primary lung adenocarcinoma and 10 with metastatic breast cancer. A differential diagnosis model composed of significant pathologic features that favor the diagnosis of primary lung adenocarcinoma (acini, lepidic growth, nuclear pseudoinclusions, and scar) or metastatic breast carcinoma (comedonecrosis, solid nests, trabecular architecture, and cribriform growth) was identified. The external validity of this model was successfully tested by challenging 19 pathologists and trainees with a test set of 20 unknown FSs, supporting the clinical applicability of the diagnostic model.

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