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.
Wednesday, 25 May 2011
Increase in Mastectomies Performed in Patients in the Community Setting Undergoing MRI
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
Link to Journal
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.
Ayodele Ayoola, Suganthi Alagarsamy, Jerry Jaboin and Suman Rao
The Breast Journal 17;3:256-259
Link to Journal
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
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.
Samir Rahmani, Philip Turton, Abeer Shaaban and Barbara Dall
The Breast Journal 17;3:246-255
Link to Journal
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
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
Jeong S. Han, Kyle H. Molberg and Venetia Sarode
The Breast Journal 17;3:223–229
Link to Journal
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
Sunday, 12 September 2010
Imaging of Dermatofibrosarcoma Protuberans of Breast
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
Shi-Zuo Liu, Tzu-Lung Ho, Soa-Min Hsu, Hui-Lun Zhan and Chen-Pin Chou
The Breast Journal 2010 16;5:541–543
Link to Journal
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
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
Ramachandran Venkitaraman
The Breast Journal 2010 16;5:519–528
Link to Journal
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
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
Zehra Hilal Adibelli, Ozgur Oztekin, Işil Gunhan-Bilgen, Hakan Postaci, Adam Uslu and Enver Ilhan
The Breast Journal 2010 16;5:510–518
Link to Journal
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
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
Christian Sohns, Besim Angic, Samuel Sossalla, Frank Konietschke and Silvia Obenauer
The Breast Journal 2010 16;5:490–497
Link to Journal
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
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%.
Pippa Mills, Ali Sever, Jenny Weeks, David Fish, Sue Jones and Peter Jones
The Breast Journal
Link to Journal
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%.
Wednesday, 18 August 2010
The Utility of Breast MRI in the Management of Breast Cancer
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
Paige Teller, Valerie J. Jefford, Sheryl G. A. Gabram, Mary Newell and Grant W. Carlson
The Breast Journal 2010, 16;4:394–403
Link to Journal
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
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
Link to Journal
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
Tsu-Yee Joseph Lee, Rebecca F. MacIntosh, Daniel Rayson and Penny J. Barnes
The Breast Journal 2010, 16;4:377–383
Link to Journal
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
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
Link to Journal
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
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
Link to Journal
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
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
Link to Journal
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
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
Link to Journal
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
Friday, 7 May 2010
Follow-up of Probably Benign Lesions (BI-RADS 3 category) in Breast MR Imaging
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
Link to Journal
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.
Elke Hauth, Lale Umutlu, Sherko Kümmel, Rainer Kimmig, Michael Forsting
The Breast Journal 2010.16;3;:297-304
Link to Journal
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
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
Link to Journal
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
Jane Ding, Ruth Warren, Anne Girling, Deborah Thompson, Douglas Easton
The Breast Journal 2010. 16;3;:279-289
Link to Journal
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
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
Link to Journal
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
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
Link to Journal
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
Monday, 15 March 2010
Hydatid Disease of the Breast
Hydatid Disease of the Breast
Gurkan Ozturk, Mehmet Ozturk, Esref Kabalak
The Breast Journal 2010 16;2:204-5
Link to Journal
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.
Gurkan Ozturk, Mehmet Ozturk, Esref Kabalak
The Breast Journal 2010 16;2:204-5
Link to Journal
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
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
Link to Journal
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.
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
Link to Journal
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
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
Link to Journal
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.
Lee Pheng Yap, Hannah Rouse, Jennifer Cawson
The Breast 2010 16;2:199-200
Link to Journal
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
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
Link to Journal
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
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
Link to Journal
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
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