Objectives: Several types of small metal breast tissue markers (markers) are used during imageguided biopsy procedures. The aim of this study was to compare the visibility of the four types of markers currently used in our institutes on ultrasound images.
　Materials and Methods: This was a single-center retrospective study involving female patients who had a marker inserted by mammography-guided biopsy from April 2016 to November 2021 and subsequently underwent ultrasound examination for clinical diagnosis during the period covered. The visibility of each marker was scored on a four-point scale by four technologists and the mean visibility scores were compared using the Steel-Dwass test.
　Results and Discussion: The study included 101 cases (age range: 31 to 79 years, median: 50 years). The mean marker visibility scores were 2.5 points (34 cases) for the cork type, 1.5 points (14cases) for the hourglass type, 0.8 points (36 cases) for the ribbon type and 2.8 points (17 cases) for the spring type. There was significantly higher visibility for the spring and cork types than for the hourglass and ribbon types (p<0.05). In heterogeneous mammary tissue, it is often difficult to distinguish between markers and in vivo structures. Therefore, it was found that the delineation of structures that are clearly different from in vivo structures, such as anechoic or acoustic shadows, is an important factor in improving the visibility of the marker.
　Conclusion: The visibility of markers implanted in the breast after biopsy for the spring and cork types than was superior to that of the hourglass and ribbon types. The presence of anechoic areas and acoustic shadows affected the marker visibility results.

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Non-invasive ductal carcinoma（DCIS） with apocrine differentiation is a rare disease. Herein we report three cases of the disease. Case 1：A woman in her 60s was found to have microcalcifications and focal asymmetric density（FAD） in her right breast on mammography（MG）. Since ultrasonography（US） showed a hypoechoic area in the AC area in her right breast, we suspected DCIS, but core needle biopsy（CNB） was not sufficient to determine whether it was benign or malignant, so a wait-and-see approach was taken. As US after six months showed no change, additional CNB and surgery were conducted before a diagnosis of DCIS with apocrine differentiation was made. Case 2：A woman in her 80s was found to have FAD and grouped microcalcifications in her right breast and a mass and pleomorphic calcifications in her left breast on MG. US showed a hypoechoic area in the CDE area in the right breast and a hypoechoic mass in the left breast. CNB and surgery were conducted before the same diagnosis as the first case was made for the right breast lesion and invasive ductal carcinoma was diagnosed for the left breast mass. Case 3：A woman in her 50s was found to have a mass in her left breast by her previous doctor. At the first US and eight-month US, we suspected DCIS, but a total of three vacuum assisted biopsies and additional CNB did not provide sufficient information to determine whether it was benign or malignant. Based on the previous results, we inferred breast cancer and performed a probe lumpectomy, which led to the same diagnosis as the first case. Although preoperative histopathological diagnosis was difficult in all cases, multimodality evaluation helped us to consistently confirm malignancy.

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　Ultrasonic systems deteriorate slowly. The Research group to Examine Quality Control Phantom of the Japan Association of Breast and Thyroid Sonology developed a phantom for the purpose of objective quality control of body surface ultrasound images, and completed the Ultrasonic Quality Control Phantom for Daily Inspection（US-4B）in November 2021. Although it is a simple tool for judging the management of image degradation over time, it is very important to be familiar with the correct use, method, and system of evaluation.
　The purpose of use of the quality control phantom and precautions for its use are described, and the actual quality control method studied by the research group is reported.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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