The Breast Journal

The Utility of Breast MRI as a Problem-Solving Tool

2011-05-25T01:54:00.000-07:00

The Utility of Breast MRI as a Problem-Solving Tool
Edwin J. Yau, Robert L. Gutierrez, Wendy B. DeMartini, Peter R. Eby, Sue Peacock and Constance D. Lehman
The Breast Journal 17;3:273–280

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Breast magnetic resonance imaging (MRI) is routinely used as a problem-solving tool, but its benefit for this indication remains unclear. The records of 3001 consecutive breast MR examinations between January 1, 2003 and June 6, 2007 were reviewed to identify all those performed for the clinical indication of problem solving. Details of clinical presentation, mammography and ultrasound (US) findings, follow-up recommendations, and pathology outcomes were recorded. Benign versus malignant outcomes were determined by biopsy or 12 months of follow-up imaging and linkage with the regional tumor registry. Problem solving was the clinical indication for 204 of 3001 (7%) of all examinations. Forty-two of 204 examinations (21%) had suspicious or highly suspicious MRI assessments with recommendation for biopsy and 62 of 204 (79%) examinations were assessed as negative, benign, or probably benign. Thirty-six biopsies were performed based on MRI findings and 14 cancers were diagnosed. Biopsy was indicated for 11 of 14 (79%) cancers based on suspicious mammographic or US findings identified prior to MRI. One incidental cancer was detected by MRI alone in a patient at high risk for breast cancer, and two cancers were detected in patients with suspicious nipple discharge and negative mammogram and US. A single false-negative MRI occurred in a patient whose evaluation for a palpable lump prompted biopsy.

Problem-solving breast MRI rarely identifies otherwise occult cancer and can be falsely negative in patients with suspicious findings on mammogram and US. Until the benefits and risks of problem-solving MRI are clarified, it should be used judiciously.

Increase in Mastectomies Performed in Patients in the Community Setting Undergoing MRI

2011-05-25T01:49:00.001-07:00

Increase in Mastectomies Performed in Patients in the Community Setting Undergoing MRI
Ayodele Ayoola, Suganthi Alagarsamy, Jerry Jaboin and Suman Rao
The Breast Journal 17;3:256-259

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This study is designed to determine whether the use of magnetic resonance imaging (MRI) leads to an increased number of unnecessary mastectomies in breast cancer patients in the community setting. This is a retrospective study of the records of 178 patients from the local offices of three community physicians. The medical records of patients over the age of 18 with breast cancer who underwent both MRI and mammogram imaging were reviewed. MRI detected more lesions than mammogram; however, these lesions were not cancerous. The lesions detected by mammogram correlated more with pathologic lesions. Of the 59 patients who underwent mastectomies, 78% had MRI and 22% did not have the imaging. Of the 100 patients who had both MRI and mammogram, 48% underwent lumpectomy and 46% had mastectomy. More patients who had both imaging modalities underwent mastectomies compared to those who had mammogram alone. The addition of MRI evaluation in patients with breast cancer is related to increased unnecessary mastectomies.

Overview of Gynecomastia in the Modern Era and the Leeds Gynaecomastia Investigation Algorithm

2011-05-25T01:46:00.001-07:00

Overview of Gynecomastia in the Modern Era and the Leeds Gynaecomastia Investigation Algorithm
Samir Rahmani, Philip Turton, Abeer Shaaban and Barbara Dall
The Breast Journal 17;3:246-255
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Gynecomastia is a benign enlargement of male breast glandular tissue. At least a third of males are affected at some time during their lifetime. Idiopathic causes exceed other etiologies and relate to an imbalance in the ratio of estrogen to androgen tissue levels or end-organ responsiveness to these hormones. Assessment must include a thorough history and clinical examination, specific blood investigations and usually tissue sampling and/or breast imaging. Management consists of a combination of measures that may include simple reassurance, pharmacological manipulation, medical treatment or surgery. Hormone therapy may help to abort the acute proliferative phase of gynecomastia with a 30% response rate but should not be considered in chronic established cases. Surgical treatment may comprise simple liposuction for a predominant fatty component or direct excision when glandular tissue is predominant. The main aim is to control the patient’s symptoms and to exclude other etiological factors.

Predictors of Invasion and Axillary Lymph Node Metastasis in Patients with a Core Biopsy Diagnosis of Ductal Carcinoma In Situ: An Analysis of 255 Cases

2011-05-25T01:43:00.000-07:00

Predictors of Invasion and Axillary Lymph Node Metastasis in Patients with a Core Biopsy Diagnosis of Ductal Carcinoma In Situ: An Analysis of 255 Cases
Jeong S. Han, Kyle H. Molberg and Venetia Sarode
The Breast Journal 17;3:223–229

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The diagnosis of ductal carcinoma in situ (DCIS) using core biopsy does not ensure the absence of invasion on final excision. We performed a retrospective analysis of 255 patients with DCIS who had subsequent excision. Clinical, radiologic, and pathologic findings were correlated with risk of invasion and sentinel lymph node (SLN) metastasis. Of 255 patients with DCIS, 199 had definitive surgery and 52 (26%) had invasive ductal carcinoma (IDC) on final excision. Extent of abnormal microcalcification on mammography, and presence of a radiologic/palpable mass and solid type of DCIS were significantly associated with invasion on final excision. Sentinel lymph node biopsy was performed in 131 (65.8%) patients of whom 18 (13.4%) had metastasis. Size of IDC and extent of DCIS on final pathology were significantly associated with positive SLN. Micrometastasis and isolated tumor cells comprised majority (71.4%) of the metastases in DCIS. SLN biopsy should be considered in those with high risk DCIS

Imaging of Dermatofibrosarcoma Protuberans of Breast

2010-09-12T19:55:00.001-07:00

Imaging of Dermatofibrosarcoma Protuberans of Breast
Shi-Zuo Liu, Tzu-Lung Ho, Soa-Min Hsu, Hui-Lun Zhan and Chen-Pin Chou
The Breast Journal 2010 16;5:541–543

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Dermatofibrosarcoma protuberans (DFSP) is a rare superficial soft tissue malignancy. We report a 45-year-old woman diagnosed with DFSP involving the breast. Ultrasound of DFSP revealed a heteroechogenetic breast mass, which showed normal adjacent dermis. Mammography disclosed a high-density mass without microcalcification. MRI showed an enhancing lobulated lesion with small area of cystic change and hemorrhage. The patient underwent excision biopsy and pathology revealed DFSP of the breast. DFSP involving the breast is rare and preoperative diagnosis by imaging could be a challenge for clinicians.

A solitary mixed echogenicity and ill-defined soft tissue with no microcalcification located in the subdermal region could indicate the presence of DFSP

Lobular Neoplasia of the Breast

2010-09-12T19:52:00.001-07:00

Lobular Neoplasia of the Breast
Ramachandran Venkitaraman
The Breast Journal 2010 16;5:519–528

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Lobular neoplasia is increasingly being detected, probably due to the widespread screening for breast malignancies. The understanding of lobular neoplasia is undergoing a paradigm shift, from being considered a predictor of recurrence to being considered a pre-invasive lesion, based on molecular studies suggesting a clonal link with invasive lobular cancer.

The management of patients diagnosed to have lobular neoplasia is in evolution, with the increasing need for risk stratification and hence the necessity to identify this entity separately as either lobular carcinoma in-situ and atypical lobular hyperplasia. The indications for wide local excision for patients diagnosed to have lobular neoplasia on biopsy are being defined.

The evidence for preventive strategies like hormonal treatment with Tamoxifen or aromatase inhibitors for high risk patients is increasing, with the results from prospective interventional trials. The role of screening magnetic resonance imaging for surveillance of high risk patients with lobular neoplasia is under evaluation

Imaging Characteristics of Male Breast Disease

2010-09-12T19:50:00.000-07:00

Imaging Characteristics of Male Breast Disease
Zehra Hilal Adibelli, Ozgur Oztekin, Işil Gunhan-Bilgen, Hakan Postaci, Adam Uslu and Enver Ilhan
The Breast Journal 2010 16;5:510–518

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The purpose of the study was to describe the imaging findings of male breast disease. One hundred and sixty-four male patients, who underwent mammography and ultrasonography (US) between January 1999 and December 2008, were retrospectively evaluated. Seventy-five patients (46%) underwent biopsy, and 89 patients (54%) were diagnosed radiologically. The radiologic and pathologic diagnoses in 164 cases of this series were 13 cancers (8%), including one ipsilateral and one contralateral breast cancers, 147 cases of gynecomastia (90%), one fibroadenoma (0.6%), two cases of fibrocystic disease of the breast (1.2%), and one epidermoid inclusion cyst (0.6%).

Three mammographic patterns were adequate to describe all 147 cases of gynecomastia in our series: 53 patients (36%) had nodular gynecomastia, 46 patients (31%) had dendritic gynecomastia, and 48 patients (33%) had diffuse gynecomastia. Gynecomastia was unilateral in 65% of cases (n = 95), and bilateral in 35% of cases (n = 52). On physical examination, two of the malignant lesions had no clinic features of malignancy (15%). On mammography, 11 of 13 malignant masses were demonstrated (85%). A mass with microcalcifications was seen on mammograms in one case (9%). The contours of the masses were irregular in nine cases (82%), well-circumscribed in two cases (18%). The location of the masses was retroareolar in seven cases (64%) and eccentric to the nipple in four cases (36%). The size of the masses varied between 0.5 cm and 5 cm (mean 2.4 cm). Nipple retraction was evident in five cases (45%), and skin thickening in four cases (36%). All of the malignant masses were demonstrated on ultrasound; however, one of them was seen retrospectively after mammography. All of the masses were hypoechoic and solid, the contours were well-defined and smooth in two masses (15%), and irregular in 11 masses (85%), and five masses (39%) had posterior prominent shadowing. Axillary lymphadenopathia was detected in two cases (15%). One patient had a previous contralateral breast cancer, and one had an ipsilateral.

On mammography, breast cancer characteristically exhibits an irregular subareolar mass, nipple retraction, and skin ulceration or thickening, but sometimes breast cancer has a well-circumscribed contour and punctuated microcalcifications. Ultrasonography is essential and useful for further characterization and helpful for demonstrating lymphadenopathies of the axillary region

Computer-assisted Diagnosis in Full-field Digital Mammography—Results in Dependence of Readers Experiences

2010-09-12T19:45:00.001-07:00

Computer-assisted Diagnosis in Full-field Digital Mammography—Results in Dependence of Readers Experiences
Christian Sohns, Besim Angic, Samuel Sossalla, Frank Konietschke and Silvia Obenauer
The Breast Journal 2010 16;5:490–497

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The object of this study was to assess the clinical usefulness of computer-assisted diagnosis (CAD) in the interpretation of early-research, benign and malignant mammograms in dependence on readers’ experience with CAD. CAD was applied on digital mammograms of 303 patients who were divided into three groups: early-research (n = 103), benign (n = 102) and malignant group (n = 98). Mammograms were analyzed by three readers with different experience in evaluating mammograms (medical student, an assistant and an attending physician specifically trained in mammography). All images were presented accidentally with and without the influence of CAD and from different patient groups. The mammograms were classified according to BI-RADS classification.

To evaluate readers’ sensitivity and specificity with and without the application of the CAD system, ROC analysis and the corresponding area under the curve (AUC) were evaluated for each reader. Afterwards significant differences of the accuracy according to readers experience and according to the assistance of the CAD system were calculated.

All readers have an account of accuracy by using CAD in both patient groups. The highest benefit has the student (10% increase of the AUC) followed by the resident (4%) and at least followed by the mammography fellow (3%). There are significant varieties of the accuracy in addiction to the readers’ experience and to the examination method with and without CAD system. Patient group has not a significant influence to the elevation of accuracy by using the CAD. All three readers have nearly the same increase of AUC in the examinations of malignant and early-research group summarized and of the malignant group only. Finally, the increase of accuracy depends on the readers’ experience. For all patient groups CAD-application causes a steeply increase of the ROC curve and consequently a gain of sensitivity

Axillary Ultrasound Assessment in Primary Breast Cancer: An Audit of 653 Cases

2010-09-12T19:41:00.001-07:00

Axillary Ultrasound Assessment in Primary Breast Cancer: An Audit of 653 Cases
Pippa Mills, Ali Sever, Jenny Weeks, David Fish, Sue Jones and Peter Jones
The Breast Journal

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Axillary lymph node status is an important factor in determining the prognosis and treatment in patients with invasive breast cancer. The introduction of the sentinel lymph node biopsy technique in the axilla has significantly reduced the number of patients requiring an axillary clearance procedure. However, a proportion of patients will be found to have axillary metastases after a sentinel node biopsy and will then require a second axillary surgical procedure. A retrospective audit of 653 consecutive patients presenting with invasive breast cancer showed a preoperative diagnosis rate of axillary disease of 23% using axillary ultrasound and fine-needle aspiration (FNA) together. We performed 232 axillary FNAs to diagnose 150 positive axillae. This avoided the need for a second operation in 150 women.

The negative predictive value for axillary metastases using this technique was 79%. Overall accuracy was 84%.

The Utility of Breast MRI in the Management of Breast Cancer

2010-08-18T17:37:00.000-07:00

The Utility of Breast MRI in the Management of Breast Cancer
Paige Teller, Valerie J. Jefford, Sheryl G. A. Gabram, Mary Newell and Grant W. Carlson

The Breast Journal 2010, 16;4:394–403

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Breast magnetic resonance imaging (MRI) is increasingly used in the evaluation of breast cancer. The impact of this modality on patient management at a single institution is evaluated in this paper. A retrospective review was performed for 114 breast cancer patients who had breast MRI as part of their diagnostic evaluation. Clinical information, mammograms, breast ultrasounds and MRI scans were reviewed to determine whether the MRI findings led to a change in patient management. Outcomes as the result of breast MRI were stratified as favorable and unfavorable. Ninety-five patients who had complete clinical, radiologic, and pathologic data were identified. The indications for breast MRI included: high risk screening (n = 3), diagnostic evaluation of disease after neo-adjuvant chemotherapy (n = 24) or prior to re-excision (n = 8), extent of in situ ductal, infiltrating ductal or infiltrating lobular disease histology (DCIS n = 3, IDC n = 24, ILC n = 17), identification of unknown primary (n = 2), assessment of contralateral breast (n = 4), recurrence surveillance (n = 5), and other (n = 5). MRI was concordant with clinical findings and other modalities in 70.5% of cases. MRI altered planned clinical management in 28 of 95 patients (29.5%). Management changes were favorable in 21 patients (75%). Diagnostic evaluation of the breast by MRI alters patient management in 30% of cases depending upon the indications. Alteration in patient management is favorable in 75% of cases.

Evaluation of the breast by MRI alters the clinical management of nearly one-third of patients. Changes are favorable for the majority of these cases. Patients undergoing evaluation for contralateral disease, invasive lobular carcinoma and assessment of chemotherapeutic response may derive a more meaningful benefit from MRI

Flat Epithelial Atypia on Breast Needle Core Biopsy: A Retrospective Study with Clinical-Pathological Correlation

2010-08-18T17:29:00.000-07:00

Flat Epithelial Atypia on Breast Needle Core Biopsy: A Retrospective Study with Clinical-Pathological Correlation
Tsu-Yee Joseph Lee, Rebecca F. MacIntosh, Daniel Rayson and Penny J. Barnes

The Breast Journal 2010, 16;4:377–383

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There are limited data to guide clinical management when flat epithelial atypia (FEA) is identified in breast needle core biopsies (NCBs). Our objectives were to determine the frequency of malignancy in subsequent breast excisions following NCB diagnosis of FEA, and to characterize the pathological and clinical features of associated tumors.

Two hundred and fifty-six breast NCBs from a retrospective search (January 1999–July 2007) were blindly reviewed for FEA/other columnar cell lesions (CCLs). NCBs with co-existing carcinoma were excluded. The study included 211 NCBs: 116 (55%) with CCLs without atypia; 40 (19%) with CCLs with atypical ductal hyperplasia (ADH), 15 (7%) with FEA and 40 (19%) with FEA and ADH; 94 cases had follow-up excisions. Ductal carcinoma in situ and/or invasive carcinoma were present in: 4/26 (15%) excisions with CCLs on NCB, 11/30 (37%) with CCLs + ADH, 1/7 (14%) with FEA alone, and 9/31 (29%) with FEA + ADH. (a) FEA was more frequently seen with ADH, than without ADH in NCBs, (b) FEA and CCLs were more frequently associated with malignancy when with ADH, and (c) tumors excised following NCB diagnosis of FEA+/−ADH had favorable prognostic factors.

A conservative excision is warranted following a NCB diagnosis of FEA and ADH, and may be warranted for FEA alone

Role of Fusion of Prone FDG-PET and Magnetic Resonance Imaging of the Breasts in the Evaluation of Breast Cancer

2010-08-18T17:19:00.000-07:00

Role of Fusion of Prone FDG-PET and Magnetic Resonance Imaging of the Breasts in the Evaluation of Breast Cancer
Linda Moy, Marilyn E. Noz, Gerald Q. Maguire Jr, Amy Melsaether, Abby E. Deans, Antoinette D. Murphy-Walcott and Fabio Ponzo

The Breast Journal 2010, 16;4:369–376

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The purpose of this study is to report further about the statistically significant results from a prospective study, which suggests that fusion of prone F-18 Fluoro-deoxy-glucose (FDG) positron emission tomography (PET) and magnetic resonance (MR) breast scans increases the positive predictive value (PPV) and specificity for patients in whom the MR outcome alone would be nonspecific. Thirty-six women (mean age, 43 years; range, 24–65 years) with 90 lesions detected on MR consented to undergo a FDG-PET scan.

Two blinded readers evaluated the MR and the computer tomography (CT) attenuation-corrected prone FDG-PET scans side-by-side, then after the volumes were superimposed (fused). A semiautomatic, landmark-based program was used to perform nonrigid fusion. Pathology and radiologic follow-up were used as the reference standard. The sensitivity, specificity, PPV, negative predictive value (NPV), and accuracy (with 95% confidence intervals) for MR alone, FDG-PET alone, and fused MR and FDG-PET were calculated.

The median lesion size measured from the MR was 2.5 cm (range, 0.5–10 cm). Histologically, 56 lesions were malignant, and 15 were benign. Nineteen lesions were benign after 20–47 months of clinical and radiologic surveillance. The sensitivity of MR alone was 95%, FDG-PET alone was 57%, and fusion was 83%. The increase in PPV from 77% in MR alone to 98% when fused and the increase in specificity from 53% to 97% were statistically significant (p < 0.05). The false-negative rate on FDG-PET alone was 26.7%, and after fusion this number was reduced to 9%.

FDG-PET and MR fusions were helpful in selecting which lesion to biopsy, especially in women with multiple suspicious MR breast lesions

Disentangling the Roles of Mammographic Screening and HRT in Recent Breast Cancer Incidence Trends in Italy by Analyses Based on Calendar Time and Time Since Screening Activation

2010-08-18T17:15:00.000-07:00

Disentangling the Roles of Mammographic Screening and HRT in Recent Breast Cancer Incidence Trends in Italy by Analyses Based on Calendar Time and Time Since Screening Activation
Emanuele Crocetti, Carlotta Buzzoni, Fabio Falcini, Laura Cortesi, Vincenzo De Lisi, Stefano Ferretti, Rosario Tumino, Antonio Russo and Eugenio Paci

The Breast Journal 2010, 16;4:350–355
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The aim of the study was to evaluate the roles of screening activation and hormone replacement therapy discontinuation on the recent declining breast cancer incidence trends in Italy. We analyzed 41,358 invasive female breast cancers incident during 1991–2004 in six Italian population-based cancer registries.

Overall and age-specific incidence trends were evaluated using Joinpoint analysis. In addition to calendar years, data were analyzed on a years-since-screening-activation basis. Annual percentage change of standardized rates was computed. There were statistically significant increasing trends for women 40–44 and 45–49 years that did not change after screening activation. On the contrary, for women 50–69 years old and for those 70+ years, the increasing trends flattened around 2 years after screening activation. The prevalence of hormone replacement therapy use in Italy is and was rather low.

In conclusion, the recent tendency toward stabilization observed in Italy for female breast cancer incidence rates in women aged 50 years or more follows the introduction of mammographic screening

Follow-up of Probably Benign Lesions (BI-RADS 3 category) in Breast MR Imaging

2010-05-07T18:58:00.001-07:00

Follow-up of Probably Benign Lesions (BI-RADS 3 category) in Breast MR Imaging
Elke Hauth, Lale Umutlu, Sherko Kümmel, Rainer Kimmig, Michael Forsting
The Breast Journal 2010.16;3;:297-304

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The purpose of our study was to determine the frequency of BI-RADS 3 lesions in breast MR imaging in a clinical patient population and their frequency of malignancy in follow-up breast MR imaging.

In 44/698 (6.3%) patients with breast MR imaging, 56 lesions were categorized to BI-RADS 3. These lesions were all not palpable and not detectable at conventional mammography or ultrasound. In follow-up, lesions were score in complete resolved (CRL), partial resolved (PRL), stable lesions (SL), and progressive lesions (PL). Initial signal enhancement of lesions was coded by color intensity (bright for high, medium for medium, dark for low), the postinitial signal enhancement by color hue (blue for increase, green for plateau, red for wash-out). In first follow-up breast MR imaging 23/56 (41%) lesions were PRL, 14/56 (25%) lesions were CRL, 14/56 (25%) lesions remained SL. In one of five PL lesions, histopathology revealed a malignant tumor. In initial breast MR imaging, CRL showed significant fewer high pixels (p = 0.002), medium pixels (p = 0.006) significant more low pixels (p = 0.005) and significant more increase pixels (p = 0.037) than PRL.

In a clinical patient population the frequency of malignancy of BI-RADS 3 lesions in breast MR imaging and their frequency of malignancy are similar to that in conventional mammography.

In initial breast MR imaging, complete resolved lesions showed less suspicious contrast kinetics than other lesions. In follow-up, the increase of lesion size should warrant histopathological diagnosis.

Mammographic Density, Estrogen Receptor Status and Other Breast Cancer Tumor Characteristics

2010-05-07T18:56:00.000-07:00

Mammographic Density, Estrogen Receptor Status and Other Breast Cancer Tumor Characteristics
Jane Ding, Ruth Warren, Anne Girling, Deborah Thompson, Douglas Easton
The Breast Journal 2010. 16;3;:279-289

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Mammographic density was a stronger risk factor for ER positive [OR = 2.94; 95% CI = 1.94–4.43; p < 0.001] than ER negative cancers when comparing breasts with greater than 50% dense region to those with less than 10% density. No other tumor characteristic had a significant correlation with breast density. These results suggest that mammographic percent density may be more strongly related to ER positive than ER negative breast cancer, but otherwise is a risk factor for breast cancer independent of other tumor characteristics

Sensitivity and Specificity of Unilateral Edema on T2w-TSE Sequences in MR-Mammography Considering 974 Histologically Verified Lesions

2010-05-07T18:53:00.001-07:00

Sensitivity and Specificity of Unilateral Edema on T2w-TSE Sequences in MR-Mammography Considering 974 Histologically Verified Lesions
Pascal A. T. Baltzer, Fan Yang, Matthias Dietzel, Aimée Herzog, Anke Simon, Tibor Vag, Mieczyslaw Gajda, Oumar Camara, Werner Alois Kaiser
The Breast Journal 2010. 16;3;:233–239
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Perifocal edema is specifically associated with malignancy and can therefore help to differentiate between benign and malignant breast disease. Furthermore, edema is associated with a higher grading and increased tumor size. These observations may be of prognostic value and should be considered in future investigations

Edema exhibits a clear signal difference to the surrounding tissue. This fact may be useful to quantify the amount of edema in the tissue analyzed.

Further study combining several morphologic and dynamic criteria is needed to fully estimate the full value of edema for MRM

Hydatid Disease of the Breast

2010-03-15T10:45:00.000-07:00

Hydatid Disease of the Breast
Gurkan Ozturk, Mehmet Ozturk, Esref Kabalak
The Breast Journal 2010 16;2:204-5

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Breast involvement can be a part of disseminated hydaditosis or present as primary breast hydatid disease. Isolated breast involvement is reported to be rare, accounting for only 0.27% of the localizations of the cyst and 0.3% of the breast masses. Making a diagnosis of a primary breast hydatid cyst prior to surgery is difficult. There were characteristic ring-shaped structures inside the mass; this was attributed to the difference in the density of the walls and the contents of the daughter cysts inside the fluid-filled hydatid cysts. Such an overpenetrated view might be recommended in endemic areas if fine needle aspiration cytology and/or breast ultrasound results were suggestive of hydatid disease. Complete excision of the cyst is recommended for diagnostic pathological evaluation and treatment.

Imaging Features of Bilateral Lupus Mastitis

2010-03-15T10:24:00.000-07:00

Imaging Features of Bilateral Lupus Mastitis
Yen-Chi Wang, Chen-Pin Chou, Robin B. Levenson, Pin-Pen Hsieh, Jer-Shyung Huang, Huay-Ben Pan
The Breast Journal 2010 16;2:203-4

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Lupus mastitis is a rare disease. Only a few cases with imaging findings have been reported. Women are affected by lupus mastitis more commonly than men, usually between the ages of 20 and 50 years. Lupus mastitis is known as chronic inflammation of the subcutaneous fat of the breast. The main mammographic finding is prominent coarse calcifications because of subcutaneous fat necrosis. Breast ultrasound may demonstrate hyperechoic foci representing calcifications, ill-defined echogenic areas, or breast masses.

In young female SLE patients showing mastalgia and coarse calcifications on mammography, lupus mastitis should be an important differential diagnosis consideration, as it can be managed medically.

An Extensive Breast Hematoma Following Stereotactic 9 Gauge Vacuum Assisted Large-Core Biopsy

2010-03-15T10:21:00.000-07:00

An Extensive Breast Hematoma Following Stereotactic 9 Gauge Vacuum Assisted Large-Core Biopsy
Lee Pheng Yap, Hannah Rouse, Jennifer Cawson
The Breast 2010 16;2:199-200

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Vacuum assisted large-core biopsy is a widely used procedure for performing biopsy of suspicious breast lesions. However, it seems intuitive that the larger incised area of tissue with larger gauge biopsy devices increases hematoma risk. Whereas better tissue samples are obtained, the risk of bleeding is likely to be increased. Our patient had been on warfarin, although blood tests were in normal range before and after the procedure, and she was elderly and obese which are risk factors for wound hematomas.

Large core devices are unnecessary when smaller gauge needle core biopsy can achieve the diagnosis, at lower cost and morbidity. This case was amenable to 14G core biopsy, which is highly sensitive in most cases, and complications may have been avoided. The lesion type and patient risk factors should be considered and the biopsy procedure tailored to the individual case.

True Recurrences and New Primary Tumors Have Different Clinical Features in Invasive Breast Cancer Patients with Ipsilateral Breast Tumor Relapse Afte

2010-03-15T10:19:00.000-07:00

True Recurrences and New Primary Tumors Have Different Clinical Features in Invasive Breast Cancer Patients with Ipsilateral Breast Tumor Relapse After Breast-Conserving Treatment
Takashi Yoshida, Hiroyuki Takei, Masafumi Kurosumi, Jun Ninomiya, Yuko Ishikawa, Yuji Hayashi, Katsunori Tozuka, Hanako Oba, Kaori Kawanowa, Kenichi Inoue, Toshio Tabei
The Breast Journal 2010 16;2:127-133

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Ipsilateral breast tumor relapse (IBTR) after breast-conserving treatment (BCT) may represent two distinct types of lesion, including a true recurrence (TR) or a new primary tumor (NPT). The aim of this study was to ascertain the difference between TRs and NPTs and to show the clinical significance of classifying IBTR into these two types of recurrence.

Patients (n = 2,075) with unilateral invasive breast cancer who underwent BCT between 1987 and 2005 at Saitama Cancer Center were analyzed. IBTR was classified into TR and NPT, which was based on all clinical and pathological features of both a primary tumor and IBTR that can be evaluated. IBTR-free survival and the risk factors were analyzed in order to compare the findings for TR and NPT. In addition, the salvage surgical methods for IBTR and overall survival after IBTR were analyzed. Sixty patients with IBTR were classified into 52 with TR and eight with NPT. IBTR-free survival was significantly shorter in the patients with TR than those with NPT. Young age, tumor size, a positive surgical margin, and omission of radiation therapy (RT) were significant risk factors for TR. Omission of RT was the only significant risk factor for NPT. In 27 patients who underwent a repeat lumpectomy for TR, four had a second IBTR.

The overall survival after IBTR was worse in patients with TR than NPT. TR and NPT show quite different clinical features. Classifying IBTR into TR or NPT can therefore help to select the most appropriate treatment for IBTR

In Newly Diagnosed Breast Cancer, Screening MRI of the Contralateral Breast Detects Mammographically Occult Cancer, Even in Elderly Women: The Mayo Cl

2010-03-15T09:07:00.000-07:00

In Newly Diagnosed Breast Cancer, Screening MRI of the Contralateral Breast Detects Mammographically Occult Cancer, Even in Elderly Women: The Mayo Clinic in Florida Experience
Johnny Ray Bernard Jr, Laura A. Vallow, Elizabeth R. DePeri, Rebecca B. McNeil, Deborah G. Feigel, Surabhi Amar, Steven J. Buskirk, Edith A. Perez
The Breast Journal 2010 16;2:118-126

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The role of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer is somewhat controversial. The purpose of this study was to evaluate the prevalence of synchronous, occult contralateral breast cancer detected by MRI but not by mammography or clinical breast examination in women with newly diagnosed breast cancer, including those aged 70 years or older at our institution.

MRI results for women with newly diagnosed breast cancer who underwent bilateral breast MRI after negative mammography and clinical examination between February 2003 and November 2007 at Mayo Clinic in Florida were reviewed. The prevalence of pathologically confirmed contralateral carcinoma diagnosed solely by MRI was determined and analyzed in the context of age, family history, menopausal status, breast density, and primary-tumor characteristics. Logistic regression was used to explore the association between contralateral carcinoma and potential patient risk factors.

A total of 425 women were evaluated, of whom 129 (30%) were aged 70 years or older. A contralateral biopsy was recommended and performed solely on the basis of MRI in 72 of the 425 women (17%). Sixteen of these 72 women (22%) had pathologically confirmed carcinoma, including seven in the older subgroup. The prevalence of clinically and mammographically occult contralateral carcinoma detected by MRI was 3.8% (16/425) overall and 5.4% (7/129) in the group of older women. When potential risk factors for contralateral breast cancer were evaluated, postmenopausal status was the only significant predictor of contralateral cancer detected by MRI (p = 0.016).

We concluded that contralateral breast screening with MRI should be considered in postmenopausal women with newly diagnosed breast cancer, even those aged 70 years or older at diagnosis

Routine Breast MRI as a Screening Modality for Occult Contralateral Breast Cancer: Where Do We Draw the Line?

2010-03-15T09:04:00.000-07:00

Routine Breast MRI as a Screening Modality for Occult Contralateral Breast Cancer: Where Do We Draw the Line?
Christine Dauphine, Iraj Khalkhali
The Breast Journal 2010 16;2:115-117

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It is clear that there is some benefit to performing MRI in breast cancer patients, looking for contralateral cancers. But at what cost? The results of the analyses by Bernard et al. suggest that selective use is possible. We hope that further studies are undertaken to include minority patients, larger numbers overall, and to continue looking at predictive factors to help determine where MRI would be the most useful

Interstitial Laser Therapy of Breast Fibroadenomas With 6 and 8 Year Follow-Up

2010-03-15T08:55:00.000-07:00

Interstitial Laser Therapy of Breast Fibroadenomas With 6 and 8 Year Follow-Up
K. Dowlatshahi, S. Wadhwani, R. Alvarado, C. Valadez, J. Dieschbourg
The Breast Journal 2010 16;1:73-76

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Fibroadenomas are non-cancerous breast tumors commonly seen in teenagers but also found in women at the time of first mammogram. They have distinct physical findings and imaging features but the definitive diagnosis is made by ultrasound or stereotactic guided needle biopsy.

Treatment options are observation or surgical removal. Recently, removal by ultrasound-guided technique has been reported. Alternatively, the tumor may be ablated within the breast by cold (cryotherapy) or by heat (laser, radiofrequency, focused ultrasound and microwave).

In this paper the laser treatment in two patients, one with bilateral fibroadenomas, with 6 and 8 year follow-up is presented.
The is a minimally invasive image-guided laser treatment of breast fibroadenoma and long term follow-up in two patients; one with single and the other with multiple bilateral tumors. The treatment is an office-based procedure given under local anesthesia with minimal pain and discomfort. It is esthetically superior to lumpectomy

Flat Epithelial Atypia and Atypical Ductal Hyperplasia: Carcinoma Underestimation Rate

2010-03-15T08:49:00.000-07:00

Flat Epithelial Atypia and Atypical Ductal Hyperplasia: Carcinoma Underestimation Rate
Anna Ingegnoli, Cecilia d'Aloia, Antonia Frattaruolo, Lara Pallavera, Eugenia Martella, Girolamo Crisi, Maurizio Zompatori
The Breast Journal 2010 16;1:55-59

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This study was carried out to determine the underestimation rate of carcinoma upon surgical biopsy after a diagnosis of flat epithelial atypia and atypical ductal hyperplasia and 11-gauge vacuum-assisted breast biopsy.

A retrospective review was conducted of 476 vacuum-assisted breast biopsy performed from May 2005 to January 2007 and a total of 70 cases of atypia were identified. Fifty cases (71%) were categorized as pure atypical ductal hyperplasia, 18 (26%) as pure flat epithelial atypia and two (3%) as concomitant flat epithelial atypia and atypical ductal hyperplasia. Each group were compared with the subsequent open surgical specimens. Surgical biopsy was performed in 44 patients with atypical ductal hyperplasia, 15 patients with flat epithelial atypia, and two patients with flat epithelial atypia and atypical ductal hyperplasia. Five cases of atypical ductal hyperplasia were upgraded to ductal carcinoma in situ, three cases of flat epithelial atypia yielded one ductal carcinoma in situ and two cases of invasive ductal carcinoma, and one case of flat epithelial atypia/atypical ductal hyperplasia had invasive ductal carcinoma. The overall rate of malignancy was 16% for atypical ductal hyperplasia (including flat epithelial atypia/atypical ductal hyperplasia patients) and 20% for flat epithelial atypia.

The presence of flat epithelial atypia and atypical ductal hyperplasia at biopsy requires careful consideration, and surgical excision should be suggested.

Breast Cancer Prevention: Patient Decision Making and Risk Communication in the High Risk Setting

2010-03-15T08:27:00.000-07:00

Breast Cancer Prevention: Patient Decision Making and Risk Communication in the High Risk Setting
Elissa M. Ozanne, Eve Wittenberg, Judy E. Garber, Jane C. Weeks
The Breast Journal 2010 16;1:38-47

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The purpose of this study was to investigate prevention decision making among women at high risk for breast cancer, including patient preferences for preventive interventions, patient understanding of disease risk, and patient preferences for risk communication methods, and the corresponding physician understanding of these factors. A prospective interview and survey study was conducted of consecutive new patients seen at a cancer risk and prevention clinic and their physicians.

One hundred and forty-six of 217 eligible patients participated and completed all components of the study (67%), and they were seen by a four physicians. Women's preferences for prevention intervention varied widely across women but were stable across time. Physicians were very often unable to predict their patients' preferences for prevention efforts. Patients overestimated their risk of disease, and physicians overestimated the decrease in perceived risk resulting from counseling

As risk stratification for breast cancer improves, and prevention options become more tolerable, it becomes increasingly important to appropriately counsel women considering such options. This study provides insight into the decision making process of women at high risk for breast cancer and highlights the importance of addressing patient preferences for interventions and risk perception during risk assessment and counseling consultations

Clinical Implications of Subcategorizing BI-RADS 4 Breast Lesions associated with Microcalcification: A Radiology–Pathology Correlation Study

2010-03-15T08:23:00.000-07:00

Clinical Implications of Subcategorizing BI-RADS 4 Breast Lesions associated with Microcalcification: A Radiology–Pathology Correlation Study
Mary Ann Sanders, Lane Roland, Sunati Sahoo
The Breast Journal 2010 16;1:28-31

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Currently radiologists have the option of subcategorizing BI-RADS 4 breast lesions into 4A (low suspicion for malignancy), 4B (intermediate suspicion of malignancy), and 4C (moderate concern, but not classic for malignancy).

To determine the clinical significance of BI-RADS 4 subcategories and the common pathologic changes associated with these mammographic lesions, a retrospective review of 239 consecutive stereotactic-needle core biopsies (SNCB) for microcalcifications was performed. All 239 SNCBs were BI-RADS 4 lesions, and of these, 191 were subcategorized to 4A, 4B or 4C.

Ninety-four of 191 (49%) were 4A, 73 (38%) were 4B, and 24 (13%) were 4C.

Fibrocystic change was the most common finding (66/239; 28%) followed by ductal carcinoma in situ (DCIS) accounting for 23% of cases. This was followed by columnar cell alteration with or without atypia (47/239; 19%), and fibroadenoma (45/239; 19%).

While 70% (17/24) of BI-RADS 4C category lesions were DCIS, only 21% (15/73) of BI-RADS 4B and 10% (10/94) of BI-RADS 4A were DCIS.

Without sub-categorization, carcinoma was diagnosed in 23% (55/239) of all cases with BI-RADS 4. Therefore, subcategorizing BI-RADS 4 lesions is important since it not only benefits the patient and clinician in understanding the level of concern for carcinoma, but will also alert the pathologist

Early Response to Neo-adjuvant Chemotherapy in Carcinoma of the Breast Predicts Both Successful Breast-Conserving Surgery and Decreased Risk of Ipsila

2010-03-15T08:20:00.000-07:00

Early Response to Neo-adjuvant Chemotherapy in Carcinoma of the Breast Predicts Both Successful Breast-Conserving Surgery and Decreased Risk of Ipsilateral Breast Tumor Recurrence
Makoto Ishitobi, Yoshifumi Komoike, Kazuyoshi Motomura, Hiroki Koyama, Hideo Inaji
The Breast Journal 2010 16;1:9-13

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Multivariate analysis showed that the early response was a predictive factor of IBTR-free survival, being independent of other clinicopathological factors. In conclusion, the early response to neo-adjuvant chemotherapy may be a useful predictor of both selection of surgical method and IBTR risk

Sentinel Lymph Node Detection in Breast Cancer Patients by Real-Time Virtual Sonography Constructed With Three-Dimensional Computed Tomography-Lymphog

2010-03-15T08:15:00.000-07:00

Sentinel Lymph Node Detection in Breast Cancer Patients by Real-Time Virtual Sonography Constructed With Three-Dimensional Computed Tomography-Lymphography
Shigeru Yamamoto, Noriko Maeda, Michiko Tamesa, Yukiko Nagashima, Kazuyoshi Suga, Masaaki Oka
The Breast Journal 2010 16;1:4-8

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This is a first attempt at preoperatively identifying SLNs using US guided by the RVS system in breast cancer patients. Although evaluation of SLN metastases was unsatisfactory, this method may be useful for preoperative fine-needle aspiration cytology for diagnosis of SLN metastases

How to Restore Public Trust about Breast Cancer Screening? An Opportunity to Reinforce the Need for Further Advances in Science and Technology and Acc

2010-03-15T08:09:00.000-07:00

How to Restore Public Trust about Breast Cancer Screening? An Opportunity to Reinforce the Need for Further Advances in Science and Technology and Access to Care
Shahla Masood
Editorial
The Breast Journal 2010 16;1:1-3

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A call for rethinking what effectiveness means in response to USPSTF guidelines on mammography screening

Breast Intracystic Papillary Carcinoma: An Update

2010-01-21T11:30:00.000-08:00

Breast Intracystic Papillary Carcinoma: An Update
Julien Calderaro, Marc Espie, Juliette Duclos, Sylvie Giachetti, Delphine Wehrer, Wissam Sandid, Laurence Cahen-Doidy, Marcella Albiter, Anne Janin, Anne de Roquancourt
The Breast Journal Volume 15 Issue 6, Pages 639 - 644

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Intracystic papillary carcinoma (IPC), a breast tumor mainly occuring in the elderly, has long been considered as a variant of ductal carcinoma in situ (DCIS). This is now debated since metastatic cases have been reported.

In this study, surgical pieces of 20 IPCs were reassessed, and markers of myopepithelial layer (p63, CD10 and Smooth Muscle Actin) as well as estrogen receptors (ER) and progesterone receptors (PgR) and C-erb-B2 oncoprotein expression were systematically performed and quantified. In 10 cases, an associated unequivocal invasive component was found. In all 20 cases, no myoepithelial layer was found. Eighteen tumors were ER positive, 14 were PgR positive. Moreover, none of the tumors over-expressed C-erb-B2 oncoprotein. Therefore this study showed that in all cases of IPC there were microscopic features of invasive carcinoma despite good clinical prognostic indicators, and that precise characterization of tumors requires extensive paraffin embedding of surgical pieces

Quantitative Assessment of Radiation-Induced Fibrosis of the Breast with Tissue Compliance Meter, Palpation, and Radiological Imaging: Preliminary Res

2010-01-21T11:28:00.001-08:00

Quantitative Assessment of Radiation-Induced Fibrosis of the Breast with Tissue Compliance Meter, Palpation, and Radiological Imaging: Preliminary Results
A. Gabriella Wernicke, Ruth Rosenblatt, Margarita Rasca, Preeti Parhar, Paul J. Christos, Andrew Fischer, Bhupesh Parashar, Dattatreyudu Nori
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The Breast Journal Volume 15 Issue 6, Pages 579 - 582

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This study is the first to explore the differences in radio-tracer uptake in the axilla in patients following BSGI and comparing the radio-tracer uptake in metasatic nodes versus extravasation of radio-tracer during injection.
The sensitivity of breast specific gamma imaging in detecting primary breast cancers has been shown, but its usefulness in the detection of axillary metastases has not been determined

Oil Cyst Mimicking Intracystic Neoplasm

2009-08-24T19:01:00.000-07:00

Oil Cyst Mimicking Intracystic Neoplasm
Sebnem Orguc, Isıl Basara, Teoman Coskun, Ali Rıza Kandiloglu
The Breast Journal
Volume 15 Issue 5, Pages 542 - 543

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Oil cysts are benign breast masses. Mammographically, oil cysts typically appear as well defined, round or ovoid masses, often with a calcified rim (eggshell calcification).

Sonographically, oil cysts may present in a variety of ways. Most cysts are anechoic or hypoechoic with a variable degree of posterior shadowing or acustic enhancement with a thin capsule. However, oil cysts presenting with mural nodules may rarely mimic intracystic neoplasm and ultrasound cannot characterize the masses as benign.

Mammograms which demonstrate the fatty content are diagnostic.

Calcification of Breast Tissue in the Ehlers–Danlos Syndrome

2009-08-24T18:57:00.000-07:00

Calcification of Breast Tissue in the Ehlers–Danlos Syndrome
Elizabeth Tapley, Peter Beighton
The Breast Journal
Volume 15 Issue 5, Pages 537 - 539

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The practical significance of breast tissue calcification in the EDS lies in the importance of awareness of this association, in the context of routine mammographical screening of carcinoma for the breast

MR Imaging of Tubular Adenoma of Breast Associated with Lactating Change

2009-08-24T18:55:00.000-07:00

MR Imaging of Tubular Adenoma of Breast Associated with Lactating Change
Mariko Goto, Sachiko Yuen, Tsunehiko Nishimura
The Breast Journal
Volume 15 Issue 5, Pages 536 - 537

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Specimen Radiographs Assist in Identifying and Assessing Resection Margins of Occult Breast Carcinomas

2009-08-24T18:52:00.000-07:00

Specimen Radiographs Assist in Identifying and Assessing Resection Margins of Occult Breast Carcinomas
Erik Scott Young, David E. Hogg, Helen Krontiras, Wanda Bernreuter, Marshall Urist, Kirby I. Bland, David C. Chhieng
The Breast Journal
Volume 15 Issue 5, Pages 521 - 523

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For carcinoma specimens with non-grossly identifiable lesions such as microcalcifications, difficulties may be encountered in locating these abnormalities and sampling the margins that are at risk. This is magnified in the case of skin-sparing procedures where the margin is a much greater surface area and is the operation of choice in patients with diffuse microcalcifications and/or multifocal in situ disease. The objective of this study was to determine the efficacy of specimen radiographs of mastectomy in identifying occult carcinoma associated with microcalcifications and assessing the resection margins.

The average number of tissue blocks sampled among randomly selected mastectomy specimens was 15.2 ± 5.4. There was no statistically significant difference in the number of blocks between mastectomy cases with specimen radiographs taken and those without (t-test). Our study suggests that specimen radiographs may assist in identifying occult breast carcinoma associated with microcalcifications and assessing the resection margins without increased sampling

Breast Hamartomas in Adolescent Females

2009-08-24T18:50:00.000-07:00

Breast Hamartomas in Adolescent Females
Henry L. Chang, Melinda F. Lerwill, Allan M. Goldstein
The Breast Journal
Volume 15 Issue 5, Pages 515 - 520
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Breast hamartomas are rare in the adolescent population. The clinical and radiographic features are similar to the more common fibroadenoma, but the pathologic findings are diagnostic. Recurrence can occur if excision is incomplete.

Increased recognition and accurate diagnosis will improve our understanding of the natural history of these lesions

Use of Ultrasound-Guided Percutaneous Vacuum-Assisted Breast Biopsy for Selected Difficult Indications

2009-07-07T12:11:00.000-07:00

Use of Ultrasound-Guided Percutaneous Vacuum-Assisted Breast Biopsy for Selected Difficult Indications
Sylvia H. Heywang-Köbrunner, Anke Heinig, Karin Hellerhoff, Hans Jürgen Holzhausen, Jörg Nährig
The Breast Journal 15;4:348-356

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To assess ultrasound-guided vacuum-assisted biopsy (US-VAB) for selected problem cases and to report experiences with two different biopsy systems. Fifty-one lesions have been biopsied using the Mammotome (n = 24) or the Vacora (n = 27) system.

Main indications: lesion in scarring (n = 5), complex cystic ≥8 mm (n = 7), increase in size (n = 10), architectural distortion (n = 4), uncharacteristic palpable abnormality (2), small size (n = 22), regional microcalcifications (n = 1). Results are verified by surgical excision (n = 10) or follow-up (n = 40). One patient was lost to follow-up. In four of the cases preceding core biopsy was inconclusive. four invasive carcinomas, two ductal carcinoma in situ (DCIS), three papillomas, six fibroadenomas, one adenosis tumor, one hamartoma, 10 complex cysts, 16 benign changes, three fat necroses, two granulomas, three unspecific inflammatory changes are verified.

Surgery confirmed five malignancies, four benign changes, and converted one uncertain diagnosis (architectural distortion) from "inflammatory" to DCIS. Documented removal of all or most of the lesions correctly increased the level of confidence and open surgery could be avoided in 41/51 lesions.

The two systems show different advantages and drawbacks. US-VAB may improve the level of confidence in selected difficult cases. Careful case selection and systematic retrospective correlation of imaging and histology remain crucial

Correlation between Quantified Breast Densities from Digital Mammography and 18F-FDG PET Uptake

2009-07-07T12:06:00.000-07:00

Correlation between Quantified Breast Densities from Digital Mammography and 18F-FDG PET Uptake
Paras Lakhani, Andrew D. A. Maidment, Susan P. Weinstein, Justin W. Kung, Abass Alavi
The Breast Journal 15;4:339-347

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To correlate breast density quantified from digital mammograms with mean and maximum standardized uptake values (SUVs) from positron emission tomography (PET). This was a prospective study that included 56 women with a history of suspicion of breast cancer (mean age 49.2 ± 9.3 years), who underwent 18F-fluoro-2-deoxyglucose (FDG)-PET imaging of their breasts as well as digital mammography. A computer thresholding algorithm was applied to the contralateral nonmalignant breasts to quantitatively estimate the breast density on digital mammograms. The breasts were also classified into one of four Breast Imaging Reporting and Data System categories for density.

Comparisons between SUV and breast density were made using linear regression and the Student's t-test. Linear regression of mean SUV versus average breast density showed a positive relationship with a Pearson's correlation coefficient of R2 = 0.83. The quantified breast densities and mean SUVs were significantly greater for mammographically dense than nondense breasts

The average quantified densities and mean SUVs of the breasts were significantly greater for premenopausal than postmenopausal patients

Menopausal status affects the metabolic activity of normal breast tissue, resulting in higher SUVs in pre- versus postmenopausal patients

A Case of Benign Schwannoma of the Breast: Mammographic, Ultrasonographic and Color Doppler Ultrasonographic Findings

2009-07-07T12:02:00.000-07:00

A Case of Benign Schwannoma of the Breast: Mammographic, Ultrasonographic and Color Doppler Ultrasonographic Findings
Pinar Balci, Yeliz Takes Pekcevik, Sehnaz Caferova, Tulay Canda, Ali Sevinc, Serdar Saydam
The Breast Journal 15;4:417-418

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Most primary tumors of the breast have an epithelial origin. Nonepithelial tumors arising from indigenous structures in the breast are rare. Schwannoma (neurilemoma) is a benign neoplasm of Schwann cell origin. It can be observed anywhere in the body but the breast is a very unusual site for this tumor.

Schwannoma is a slow growing tumor, usually solitary and it appears as a breast lump having clinical and radiologic characteristics suggestive of benign lesions. Its diagnosis is histologic and its treatment is surgical

Primary Leiomyosarcoma of the Breast

2009-07-07T12:01:00.000-07:00

Primary Leiomyosarcoma of the Breast
Bengu Cobanoglu, Muge Sezer, Pervin Karabulut, Sirin Ozer, Ayse Murat
The Breast Journal 15;4:423-425

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Lobulated mass without microcalcification

Barium Sulphate Particles in Breast Mimicking Malignant Type Microcalcification

2009-05-08T14:14:00.000-07:00

Barium Sulphate Particles in Breast Mimicking Malignant Type Microcalcification
Louise Bamford, Tong F. Lioe, Declan M. O'Rourke, Miriam R.E. Buckley
The Breast Journal 2009 15; 3: 305-306

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Because of its radiopaque properties, barium sulphate has long been used impregnated into wound dressings, making it visible on X-ray, a useful identifying tool in cases of misplaced dressing materials. It is most likely that the barium sulphate was introduced into the breast from wound dressing materials at the time of previous abscess drainage. Although various materials have been described mimicking microcalcification on mammogram, as far as we are aware, there are no other reports in the literature identifying barium sulphate as the culprit foreign body material in the breast, mimicking malignant type microcalcification on mammogram.

Foreign body materials within breast can mimic sinister pathology. Such mimics, especially in patients where previous intervention has been performed, presented to the unwary, can prompt extensive further investigation, with resultant significant impact on patient management, patient anxiety, and healthcare resources. We must be aware of this potential pitfall

Unilateral Calcifying Lupus Mastitis in a Male Breast

2009-05-08T14:12:00.000-07:00

Unilateral Calcifying Lupus Mastitis in a Male Breast
Jeroen Crevits, Andreas Van Steen, Chantal Van Ongeval, Guy Marchal
The Breast Journal 2009 15; 3: 307-308

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Lupus mastitis consists of subcutaneous nodules or plaques, with or without epidermal manifestations, usually leaving persistent areas of lipoatrophy. Those which tend to undergo necrosis may be associated with areas of dystrophic calcification. In men without gynecomastia calcifications can only be due to fat necrosis, that may be extensive in case of lipomastia. Differential diagnosis of lupus mastitis includes breast carcinoma, nonHodgkin lymphoma, uncommon breast localizations of connective tissue and systemic diseases. The dystrophic calcifications in our case were easily differentiated from calcifications indicating malignancy. In fact, these mammographic findings could also be due to silicon injections or posttraumatic fat necrosis, but interrogation rejected these hypotheses.

Lupus mastitis is a subset of lupus panniculitis limited to the breast. It is a rare inflammatory reaction of the subcutaneous fat, that may occur in 2–3% of patients with SLE. Lupus mastitis can be suspected in patients with SLE presenting with breast masses involving the subcutaneous fat. However, it is important that any suspicious calcifications and masses should be well examined to exclude malignancy

"Cholesteroloma": A Rare Cause of "Indeterminate" Microcalcifications on Mammography

2009-05-08T14:09:00.000-07:00

"Cholesteroloma": A Rare Cause of "Indeterminate" Microcalcifications on Mammography
Michael A. Seidman, Theresa Scognamiglio, Syed A. Hoda
The Breast Journal 2009 15; 3: 303-304

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"Cholesteroloma" forms when ectatic ducts rupture releasing luminal debris, histiocytes, and cholesterol and/or its precursors into breast stroma. Cholesterol is the principal component of this mass—hence the term "cholesteroloma."

Calcifying Fibrous Pseudotumor of the Breast

2009-05-08T14:04:00.000-07:00

Calcifying Fibrous Pseudotumor of the Breast
Amrit Mangat, Carol Schiller, Patricia Mengoni, Carol Reynolds, Jacqueline S. Jeruss
The Breast Journal 2009 15; 3: 299-301

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Calcifying fibrous pseudotumor (CFP) is classified as a benign fibrous lesion, and is a rare pathologic entity. Previous reports have described CFPs in the extremities, chest wall, pleura, scrotum, mediastinum, neck, and visceral peritoneum. We present the first reported case of a CFP in the breast. CFP should be considered in the differential diagnosis for patients presenting with coarse indeterminate calcifications of the breast

Fiberoptic Ductoscopy-Guided Intraductal Biopsy Improve the Diagnosis of Nipple Discharge

2009-03-30T08:56:00.000-07:00

Fiberoptic Ductoscopy-Guided Intraductal Biopsy Improve the Diagnosis of Nipple Discharge
Hong Ling, Guang-yu Liu, Jin-song Lu, Susan Love, Jia-xin Zhang, Xiao-li Xu, Wei-ping Xu, Kun-wei Shen, Zhen-zhou Shen, Zhi-min Shao
The Breast Journal 15 ( 2): 168 - 175

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Fiberoptic ductoscopy (FDS)-guided intraductal biopsy is a minimally invasive technique developed to obtain pathologic diagnoses for patients with spontaneous nipple discharge.

We performed biopsies of 53 intraductal lesions from March 2006 to April 2007 followed by surgical microdochectomy. FDS-guided intraductal biopsy was shown to be a minimally invasive, safe, and convenient technique with a high ability (90.6%) to get adequate samples. Twenty-seven solitary papillomas, 12 multiple intraductal papilloma, five ductal hyperplasia, three ductal carcinoma in situ, and one invasive ductal carcinoma were diagnosed.

Compared with conventional microdochectomy, FDS-guided intraductal biopsy can significantly increase the detection rate of solitary papilloma (40.7% versus 92.6%, p <>

2009-03-25T21:23:00.000-07:00

Fiberoptic Ductoscopy-Guided Intraductal Biopsy Improve the Diagnosis of Nipple Discharge
Hong Ling, Guang-yu Liu, Jin-song Lu, Susan Love, Jia-xin Zhang, Xiao-li Xu, Wei-ping Xu, Kun-wei Shen, Zhen-zhou Shen, Zhi-min Shao
The Breast Journal, Volume 15 Number 2, 2009 168–175

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Fiberoptic ductoscopy (FDS)-guided intraductal biopsy is a minimally invasive technique developed to obtain pathologic diagnoses for patients with spontaneous nipple discharge.

We performed biopsies of 53 intraductal lesions from March 2006 to April 2007 followed by surgical microdochectomy. FDS-guided intraductal biopsy was shown to be a minimally invasive, safe, and convenient technique with a high ability (90.6%) to get adequate samples. Twenty-seven solitary papillomas, 12 multiple intraductal papilloma, five ductal hyperplasia, three ductal carcinoma in situ, and one invasive ductal carcinoma were diagnosed.

Compared with conventional microdochectomy, FDS-guided intraductal biopsy can significantly increase the detection rate of solitary papilloma (40.7% versus 92.6%, p < 0.05). It should be a routine procedure after intraductal lesion found by screening FDS.

Since it would underestimate all multiple intraductal papilloma and some (50%) cancer, microdochectomy is inevitable if biopsies show atypical ductal hyperplasia

Early Detection of Breast Cancer through Population-Based Mammographic Screening in Asian Women: A Comparison Study between Screen-Detected and Sympto

2009-03-25T21:20:00.000-07:00

Early Detection of Breast Cancer through Population-Based Mammographic Screening in Asian Women: A Comparison Study between Screen-Detected and Symptomatic Breast Cancers
Esther W. L. Chuwa, Allen W. Y. Yeo, Heng Nung Koong, Chow Yin Wong, Wei Sean Yong, Puay Hoon Tan, Juliana T. S. Ho, Jill S. L. Wong, Gay Hui Ho
The Breast Journal, Volume 15 Number 2, 2009 133–139

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Screening mammography has allowed the detection of smaller and hence oncologically more favorable lesions in Asian women. Although no significant survival benefit was demonstrated in our study, a longer period of follow-up is essential before the benefit of mortality reduction, as a result of mammography screening becomes evident in our population

Breast MRI in a Case of "Early Onset" Lactating Adenoma

2009-01-08T07:56:00.000-08:00

Breast MRI in a Case of "Early Onset" Lactating Adenoma
Stefano Magno, Daniela Terribile, Gianluca Franceschini, Cristina Fabbri, Pierfrancesco D'Alba, Federica Chiesa, Alba Di Leone, Melania Costantini, Paolo Belli, Riccardo Masetti
The Breast Journal, Volume 15 Number 1, 2009 105–106

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Care report with images

The Importance of Preoperative Breast MRI for Patients Newly Diagnosed with Breast Cancer

2009-01-08T07:52:00.000-08:00

The Importance of Preoperative Breast MRI for Patients Newly Diagnosed with Breast Cancer
Joseph P. Crowe, Rebecca J. Patrick, Alice Rim
The Breast Journal, Volume 15 Number 1, 2009 52–60

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The findings here of one community hospital's experience (13% upgrade to mastectomy rate) conflict with the COMICE Trial results

2008-12-19T08:12:00.000-08:00

MRI and 1H MRS of The Breast: Presence of a Choline Peak as Malignancy Marker is Related to k21 Value of the Tumor in Patients with Invasive Ductal Carcinoma
Patricia R. Geraghty, Maurice A.A.J. van den Bosch, Daniel M. Spielman, Sandeep Hunjan, Robyn L. Birdwell, Katherine J. Fong, Lara A. Stables, Marowan Zakhour, Robert J. Herfkens, Debra M. Ikeda
The Breast Journal, Volume 14 Number 6, 2008 574–580

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Paper from my Stanford colleague, Deb Ikeda, showing that false -ve scans can occur in invasive ductal carcinoma and that the presence of a choline peak on 1H MRS as malignancy marker is related to the k21 value of the invasive tumor being imaged

2008-12-19T08:06:00.000-08:00

Predictors to Assess Non-Sentinel Lymph Node Status in Breast Cancer Patients with Sentinel Lymph Node Metastasis
Hiromitsu Jinno, Michio Sakata, Sota Asaga, Masahiro Wada, Toshiyuki Shimada, Yuko Kitagawa, Takayuki Suzuki, Tadaki Nakahara, Naoto Kitamura, Atsushi Kubo, Makio Mukai, Tadashi Ikeda, Masaki Kitajima
The Breast Journal, Volume 14 Number 6, 2008 551–555

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Lymphatic invasion of the primary tumor and the number of tumor-involved sentinel lymph nodes (SLN) were significantly correlated with non-SLN metastasis. These 2 factors could be used together to select a sub-group of patients who may not benefit from complete ALND despite a positive SLNB

2008-12-19T07:59:00.000-08:00

Three-Dimensional Imaging Provides Valuable Clinical Data to Aid in Unilateral Tissue Expander-Implant Breast Reconstruction
Oren M. Tepper, Nolan S. Karp, Kevin Small, Jacob Unger, Lauren Rudolph, Ashley Pritchard, Mihye Choi
The Breast Journal, Volume 14 Number 6, 2008 543–550

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3D imaging has great clinical potential during the expansion process. By comparing the unaffected side to the implant size to be inserted, you can predict the relative volume deficiencies and the extent of change required in the contralateral breast

2008-12-19T07:53:00.000-08:00

Comparative Study of Breast Implant Rupture Using Mammography, Sonography, and Magnetic Resonance Imaging: Correlation with Surgical Findings
Giovanni Di Benedetto, Sara Cecchini, Luca Grassetti, Silvia Baldassarre, Gianluca Valeri, Luca Leva, Gian Marco Giuseppetti, Aldo Bertani
The Breast Journal, Volume 14 Number 6, 2008 532–537

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During breast implant evaluation, clinical examination, mammography and ultrasound can be used as the first examination in the follow-up of symptomatic and symptom free patients. MRI is the most sensitive test and it's utility is mainly in the detection of intra-capsular rupture and imaging findings suspicious at mammograms and ultrasound

Potential of Reduction in Total Tumor Volume Measured with 3D-MRI as a Prognostic Factor for Locally-Advanced Breast Cancer Patients Treated with Prim

2008-12-19T07:47:00.000-08:00

Potential of Reduction in Total Tumor Volume Measured with 3D-MRI as a Prognostic Factor for Locally-Advanced Breast Cancer Patients Treated with Primary Chemotherapy
Kenji Akazawa, Yasuhiro Tamaki, Tetsuya Taguchi, Yoshio Tanji, Yasuo Miyoshi, Seung Jim Kim, Kenzo Shimazu, Satsuki Ueda, Tetsu Yanagisawa, Noritsugu Okishiro, Mitsunobu Imazato, Kozuma Yasuyuki, Yoshinobu Sato, Shinichi Tamura, Shinzaburo Noguchi
The Breast Journal, Volume 14 Number 6, 2008 523–531

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Total tumor volume can be a powerful prognostic factor for 'distant recurrence free' survival of breast cancer patients treated with neoadjuvant therapy

Pregnancy-Associated Breast Cancer Patients Can Safely Undergo Lymphatic Mapping

2008-06-10T11:19:00.000-07:00

Pregnancy-Associated Breast Cancer Patients Can Safely Undergo Lymphatic Mapping
Samira Y. Khera, John V. Kiluk, Danielle M. Hasson, Tammi L. Meade, Michael P. Meyers, Elisabeth L. Dupont, Claudia G. Berman, Charles E. Cox
The Breast Journal 14 (3) , 250–254

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As more women put off pregnancy until their 30s and beyond, the possibility of pregnancy-associated breast cancer (PABC) will rise. Treatment options for patients with PABC need to consider possible harm to the fetus. The goal of this study is to review our institution’s experience with sentinel lymph node (SLN) biopsies in patients with PABC. A prospectively accrued breast Institutional Review Board (IRB) approved data base was searched under separate IRB approval for cases of SLN biopsy in patients with PABC. Ten patients were identified between 1994 and 2006 out of 5,563 patients. A chart review was performed on all 10 patients. Ten patients with PABC and an average gestation age of 15.8 weeks underwent SLN biopsy. All patients successfully mapped. Positive SLN were identified in 5/10 patients (50%) while there was no evidence of metastases in 5/10 patients (50%). 9/10 (90%) of patients went on to deliver healthy children without any reported problems. One patient (10%) decided to terminate her pregnancy in the first trimester following surgery prior to the start of chemotherapy.

SLN biopsy can safely be performed in patients with PABC with minimal risk to the fetus. By performing a SLN biopsy, a large proportion of patients with PABC may be spared the risk of a complete axillary lymph node dissection.

Long-Term Outcome of Benign Fibroadenomas Treated by Ultrasound-Guided Percutaneous Excision

2008-06-10T11:13:00.000-07:00

Long-Term Outcome of Benign Fibroadenomas Treated by Ultrasound-Guided Percutaneous Excision
Ian Grady, Heidi Gorsuch, Shelly Wilburn-Bailey
The Breast Journal 14 (3) , 275–278

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Surgical as well as conservative treatment has been described for fibroadenomas. Both have disadvantages. A minimally invasive treatment, ultrasound-guided, vacuum-assisted percutaneous excision has been shown to facilitate the removal of all imaged evidence of benign breast lesions, including fibroadenomas up to 3 cm in diameter. This study is performed to assess the long-term outcome of ultrasound-guided percutaneous excision as a minimally invasive treatment for fibroadenomas. A retrospective review of 69 consecutive fibroadenomas treated with ultrasound-guided percutaneous excision between May, 2001 and December, 2005 was carried out. All these lesions underwent percutaneous excision of all imaged lesion evidence. Clinical and sonographic follow-up was recommended for all patients every 6 months. Initial size, location, and patient age were recorded for each treated lesion. Of 69 lesions treated, 52 were available for follow-up. The median follow-up period was 22 months, with a range of 7 to 59 months. At 6 months, there were no fibroadenoma recurrences. Follow-up sonography demonstrated recurrences in 13 lesions distributed across eight patients. The overall recurrence rate was 15% (8/52) with an actuarial recurrence rate of 33% at 59 months. All of the recurrences were in lesions which were larger than 2 cm in size at initial presentation.

Our data suggest that the mechanism of recurrence is the regrowth of retained lesion fragments too small to be detected by ultrasound—not the incomplete excision of all imaged lesion evidence.

Despite successful percutaneous excision, fibroadenomas do recur. Lesions smaller than 2 cm in size, so treated, do not need additional therapy or surveillance. Fibroadenomas larger than 2 cm are prone to recurrence and require additional treatment.

Impact of Breast MRI on Surgical Treatment, Axillary Approach, and Systemic Therapy for Breast Cancer

2008-06-09T16:52:00.000-07:00

Impact of Breast MRI on Surgical Treatment, Axillary Approach, and Systemic Therapy for Breast Cancer
Claudia S. Mameri, Claudio Kemp, Suzan M. Goldman, Luiz A. Sobral, Sergio Ajzen
The Breast Journal 14 (3) , 236–244

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The purpose of this study is to determine how often breast magnetic resonance imaging (MRI) brings additional information that influences management of patients with breast cancer concerning surgical treatment, axillary lymph node approach, and systemic therapy. From July 2004 to July 2005, 99 patients recently diagnosed with breast cancer in clinical stages 0, I, and II were prospectively evaluated about their therapeutic plans, at first based on usual protocol (physical examination, mammography and ultrasound) and next going through bilateral breast MR. Examinations were carried out at 1.5 T on five sequences of FSPGR 3D for 90 seconds (four post-gadolinium diethylenetriaminepenta acetic acid 0.16 mM/Kg). Parameters analyzed on MRI were extension of primary lesion; detection of multifocality, multicentricity, or contra lateral lesion; muscular or skin involvement; and presence of lymph node involvement. Pathologic confirmation of additional lesions was achieved by core or excisional biopsy. MRI made 69 additional findings in 53 patients. Fifty-one findings were true-positives (51/69 = 73.9%) including 16 larger single lesions; 18 cases of multifocality; 7 cases of multicentricity; 3 cases of contra lateral lesion; 5 cases of lymph node involvement (one of them involved medial thoracic chain); 1 with muscular involvement; 1 with skin involvement. MRI has changed previous management plans in 44.4% of 99 patients. We observed increase in mastectomies (26.8%) on axillary lymph node dissection (25%) and changes on systemic therapy (20.2%), all because of additional MRI true-positive findings.

Breast MRI alters significantly the rate of mastectomy, the approach of axillary chain for staging, and the use of systemic therapy because of its accuracy in evaluating breast cancer local extent.

Breast Calcifications in Ehlers-Danlos Syndrome

2008-04-06T21:06:00.000-07:00

Laxmi Radhakrishnan, Walid D. Salman, Alec J. Howat
The Breast Journal Volume 14 Issue 2 Page 196-197, March/April 2008

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A 52-year-old Caucasian woman with Ehlers–Danlos syndrome (EDS) presented for mammography as part of the NHS Breast Screening Programme. A focus of dense calcifications was seen in the left breast. Core biopsy showed stromal calcification. The patient insisted on removal of the abnormal area. The wide local excision showed stromal calcification identical to that seen in the core biopsy. Clinicians should be aware of EDS patients presenting with breast stromal calcifications and this fact should be taken into account when investigating such lesions.

Computed Tomography-Guided Localization of Breast Lesions

2008-04-06T21:04:00.000-07:00

Salvatore Murgo, Hedwige Wyshoff, Daniel Faverly, Kurt Crener, Louisiane Lenaerts
The Breast Journal Volume 14 Issue 2 Page 169-175, March/April 2008

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Magnetic resonance (MR) imaging and computed tomography (CT) of the breast allow the detection of breast lesions occult on physical examination, mammography and ultrasound. We report our experience to localize such lesions under CT-guidance.

All the lesions were localized with success under CT-guidance. The pathological analysis of the surgical specimens concluded in 11 breast cancers, four lesions of uncertain malignancy potential and 15 benign lesions. The size of these lesions ranged from 4 to 28 mm (mean: 10 mm). No significant complication related to the procedure was observed. Localization under CT guidance is a safe and effective technique to guide the surgical biopsy of breast lesions that can be seen solely on MR or CT.

A Multi-site Validation Trial of Radioactive Seed Localization as an Alternative to Wire Localization

2008-04-06T21:01:00.000-07:00

Jenevieve H. Hughes, Mark C. Mason, Richard J. Gray, Sarah A. McLaughlin, Amy C. Degnim, Jack T. Fulmer, Barbara A. Pockaj, Patricia J. Karstaedt, Michael C. Roarke
The Breast Journal Volume 14 Issue 2 Page 153-157, March/April 2008

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This study aims to validate radioactive seed localization (RSL) as an alternative to wire localization (WL) in the operative excision of nonpalpable breast lesions.

RSL is safe, effective, and compared to WL, reduces the rates of intraoperative re-excision and reoperation for positive margins by 68%. Patient satisfaction is improved with RSL. We strongly favor RSL over WL.

Significance of Intramammary Lymph Nodes in the Staging of Breast Cancer: Correlation with Tumor Characteristics and Outcome

2008-04-06T20:59:00.000-07:00

Aziza Nassar, Cynthia Cohen, George Cotsonis, Grant Carlson
The Breast Journal Volume 14 Issue 2 Page 147-152, March/April 2008

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Patients with stage I breast carcinoma and positive intraMLN metastases have been reported to have a poorer prognosis compared to patients with similar stage and negative intraMLN metastases. However, the presence of intraMLN metastases does not appear to influence the survival of patients with stage II breast carcinoma.

IntraMLN metastasis is a poor prognostic marker but not an independent predictor of poor outcome in patients with breast carcinoma.

Fibroadenoma with Digital Fibroma-Like Inclusions in Neurilemmoma-Like Stromal Component

2008-04-06T20:55:00.000-07:00

Karol Kajo, Katarina Machalekova
The Breast Journal Volume 14 Issue 1 Page 112-113, January/February 2008

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An Unusual Case of Fibromatosis of the Axilla

2008-04-06T20:53:00.000-07:00

Robert H. Caulfield, Atoussa Maleki-Tabrizi, Jeremy Birch, John Davies, Paul Sauven, Venkat Ramakrishnan
The Breast Journal Volume 14 Issue 1 Page 110-112, January/February 2008

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Synchronous Primary Breast Osteosarcoma and Contralateral Benign Cystosarcoma Phylloides: Radiologic and Pathologic Imaging

2008-04-06T20:52:00.000-07:00

Aytug Uner, Banu Ozturk, Mustafa Benekli, Ugur Coskun, Savas Kocak, Ali Osman Kaya, Diclehan Unsal, Selim Erekul, Emel Yaman, Ramazan Yildiz, Suleyman Buyukberber
The Breast Journal Volume 14 Issue 1 Page 109-110, January/February 2008

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Metastatic Breast Cancer Mimicking Benign Fatty Liver Infiltration

2008-04-06T20:50:00.000-07:00

Steve R. Martinez, Rosalie J. Hagge, Scott D. Christensen, John M. Webb
The Breast Journal Volume 14 Issue 1 Page 108-108, January/February 2008

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Desmoid Tumor of the Breast: Radiologic Appearance with a Focus on its Magnetic Resonance Features

2008-04-06T20:49:00.000-07:00

Linda Anna, Londero Viviana, Bazzocchi Massimo, Zuiani Chiara
The Breast Journal Volume 14 Issue 1 Page 106-107, January/February 2008

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Mammographic Screening in Women at Increased Risk of Breast Cancer after Treatment of Hodgkin's Disease

2008-04-06T20:43:00.000-07:00

Ava Kwong, Steven L. Hancock, Joan R. Bloom, Sunita Pal, Robyn L. Birdwell, Carol Mariscal, Debra M. Ikeda
The Breast Journal Volume 14 Issue 1 Page 39-48, January/February 2008

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Treatment regimens for Hodgkin’s disease (HD) that have included radiation to lymph node regions in the thorax have contributed to high rates of long-term disease-free survival. However, incidental radiation exposure of breast tissue in young women has significantly increased the risk of breast cancer compared to expected rates in the general population. After informing patients about risks associated with previous treatment of HD, we studied screening mammograms and call-back rates in women at increased risk for developing breast cancer at a younger age.

Women who have had thoracic nodal irradiation for Hodgkin’s disease have an increased risk of developing secondary breast cancer at an unusually young age. As expected in younger women, high density breast tissue was common on mammography, and the recall and biopsy rates were unusually high. However, early mammographic screening facilitated diagnosis of in situ and early invasive cancer in 3.5% of our subjects.

Commercially Available Titanium Clip Placement

2007-11-18T09:37:00.000-08:00

Commercially Available Titanium Clip Placement Following a Sonographically Guided Core Needle Biopsy of the Breast
Takayoshi Uematsu
The Breast Journal 13 (6), 624–626
Abstract

Large Malignant Phyllodes Tumor With Rapid Growth During Pregnancy

2007-11-18T09:35:00.000-08:00

Large Malignant Phyllodes Tumor With Rapid Growth During Pregnancy: Images of a Case
Scott A. Simpson BA, Jeremiah Redstone MD, Mohamed S. Aziz MD, Stephanie F. Bernik MD
The Breast Journal 13 (6), 620–621
Abstract

Apocrine Carcinoma of the Breast: Clinical, Radiologic, and Pathologic Correlation

2007-11-18T09:29:00.000-08:00

Apocrine Carcinoma of the Breast: Clinical, Radiologic, and Pathologic Correlation
Ethem Unal MD, Aysun Firat MD, Pembegul Gunes MD, Gamze Kilicoglu MD, Ahmet Gulkilik MD, Izzet Titiz MD
The Breast Journal 13 (6), 617–618
Abstract

Small Infiltrating Lobular Carcinomas Mimicking Fibroadenoma on Breast MRI

2007-11-18T08:48:00.000-08:00

Two Cases of Small Infiltrating Lobular Carcinomas Mimicking Fibroadenoma on Breast MRI
Sachiko Yuen, Takayoshi Uematsu, Masako Kasami
The Breast Journal 13 (6), 616–617
Abstract

The most common features of ILC on MRI are an irregular/spiculated inhomogeneous mass with or without enhancing surrounding small foci, multiple small enhancing foci with interconnecting enhancing strands, and architectural distortion; however, the MR appearances of our cases well reflected one of the intrinsic growth patterns of ILC. Although nonenhancing septation is one of the diagnostic features of fibroadenoma, we should notice that ILC can demonstrate nonenhancing septa on MRI.

The Diagnosis and Management of Diabetic Mastopathy

2007-11-18T08:45:00.000-08:00

The Diagnosis and Management of Diabetic Mastopathy
Katie Thorncroft, Leigh Forsyth, Sean Desmond, Riccardo A. Audisio
The Breast Journal 13 (6), 607–613
Abstract

Sclerosing lymphocytic lobulitis is strongly associated with type one diabetes, when it is then known as diabetic mastopathy. This very rare benign condition tends to present in premenopausal women, often with diabetic complications particularly retinopathy. Patients present with clinically suspicious fibrous breast lumps; these are commonly multiple, bilateral, and recurrent. Mammograms show asymmetric densities and no focal mass and ultrasound investigation tends to show ill-defined hypoechoic attenuation with strong posterior acoustic shadowing. Magnetic resonance imaging can be used to further differentiate the lesion from malignancy. However, a core biopsy or excisional biopsy is essential so that a pathologic diagnosis can be made. The constellation of pathologic findings is: lymphocytic lobulitis and ductitis with glandular atrophy, lymphocytic/mononuclear perivascular inflammation which is predominantly B-cell and dense often keloid-like fibrosis, with or without epithelioid-like fibroblasts. A review of the current literature on diabetic mastopathy was carried out as it was noted that there has been no recent review of the literature. Detailed Pubmed and other medical data base searches were carried out and all publications were considered, irrespective of language and date, wherever possible

Cost-Benefit Analysis of a Follow-up Program in Patients with Ca Breast

2007-11-18T08:42:00.000-08:00

Cost-Benefit Analysis of a Follow-up Program in Patients with Breast Cancer: A Randomized Prospective Study
Amparo Oltra, A. Santaballa, B. Munarriz, M. Pastor, J. Montalar
The Breast Journal 13 (6), 571–574
Abstract

Increasing the number of breast cancer patients in follow-up involves increased costs and, with limited health care resources, there is a need to evaluate the cost-benefit to the patient of follow-up regimens. We present a randomized prospective study to evaluate the cost-benefit of intensive follow-up in the early detection of relapses in patients with breast cancer. One hundred and twenty-one patients were randomized to standard clinical follow-up (n = 63) or to an intensive follow-up (n = 58) that included diagnostic laboratory tests and imaging designed to detect early relapse following curative treatment. All patients had annual mammography. The number of scheduled outpatient appointments kept were 359 in the standard clinical follow-up and 355 in the intensive follow-up group. After a median of 3 years of follow-up, there were 28 relapses, 11 in standard clinical follow-up, and 13 in the intensive follow-up group. The overall cost of follow-up was 24,567 euros in the standard clinical follow-up group and 74,171 euros in the intensive follow-up group. Performing complimentary investigations in breast cancer follow-up is associated with higher costs without difference in early detection of relapses

BI-RADS MRI Enhancement Characteristics of Ductal Carcinoma In Situ

2007-11-18T08:39:00.000-08:00

BI-RADS MRI Enhancement Characteristics of Ductal Carcinoma In Situ
Eric L. Rosen, Stacy A. Smith-Foley, Wendy B. DeMartini, Peter R. Eby, Sue Peacock, Constance D. Lehman
The Breast Journal 13 (6), 545–550
Abstract

Although there is overlap in the MRI morphology and enhancement pattern of in situ and invasive breast carcinoma, DCIS more frequently manifests as NMLE than does invasive carcinoma.