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
Friday, 19 December 2008
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
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
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
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
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
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
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
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
Tuesday, 10 June 2008
Pregnancy-Associated Breast Cancer Patients Can Safely Undergo Lymphatic Mapping
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.
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
Link to Journal
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
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.
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.
Monday, 9 June 2008
Impact of Breast MRI on Surgical Treatment, Axillary Approach, and Systemic Therapy for Breast Cancer
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.
Claudia S. Mameri, Claudio Kemp, Suzan M. Goldman, Luiz A. Sobral, Sergio Ajzen
The Breast Journal 14 (3) , 236–244
Link to Journal
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.
Sunday, 6 April 2008
Breast Calcifications in Ehlers-Danlos Syndrome
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.
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
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.
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
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.
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
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.
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
Karol Kajo, Katarina Machalekova
The Breast Journal Volume 14 Issue 1 Page 112-113, January/February 2008
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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
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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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
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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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
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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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
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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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
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.
The Breast Journal Volume 14 Issue 1 Page 39-48, January/February 2008
Link to Journal
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.
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