Management of lesions of uncertain malignant potential on breast core needle histology: an alternative to surgery in selected cases
S.L. Tennant, A. Evans, L.J. Hamilton, J. James, A.H.S. Lee, Z. Hodi, I.O. Ellis, E.A. Rakha, A.R.M. Wilson
The Breast 17 (2008) 546–549
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Something we all aspire to do - not overtreat borderline lesions which could possibly be followed, after adequate Vacuum Assisted Biopsy. This is a sensible way to go, with adequate multidiscipinary discussion of the case, and close follow up
Friday, 19 December 2008
Management of lesions of uncertain malignant potential on breast core needle histology: Vacuum-assisted excision as an alternative to surgical excisio
Management of lesions of uncertain malignant potential on breast core needle histology: Vacuum-assisted excision as an alternative to surgical excision (EDITORIAL)
The Breast 17 (2008) 543–544
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Editorial comment on the Nottingham paper
The Breast 17 (2008) 543–544
Link to Journal
Editorial comment on the Nottingham paper
Thursday, 9 October 2008
Evaluation of breast lesions with contrast-enhanced ultrasound using the microvascular imaging technique: Initial observations
Evaluation of breast lesions with contrast-enhanced ultrasound using the microvascular imaging technique: Initial observations
He Liu, Yu-Xin Jiang, Ji-Bin Liu, Qing-Li Zhu, Qiang Sun
The Breast 17 (2008) 532 - 539
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The aim of the paper was to evaluate the usefulness of contrast-enhanced ultrasound using the microvascular imaging technique in the diagnosis of breast lesions. Conventional and contrast-enhanced ultrasound using the microvascular imaging technique were performed after administration of SonoVue. The peripheral enhancement pattern was suggestive of malignancy, with a sensitivity of 39.5%, specificity of 98.3%, PPV of 94.4%, NPV of 69.4%, and accuracy of 73.8%. Homogeneous, regional, and heterogeneous enhancement patterns did not show meaningful diagnostic information
He Liu, Yu-Xin Jiang, Ji-Bin Liu, Qing-Li Zhu, Qiang Sun
The Breast 17 (2008) 532 - 539
Link to Journal
The aim of the paper was to evaluate the usefulness of contrast-enhanced ultrasound using the microvascular imaging technique in the diagnosis of breast lesions. Conventional and contrast-enhanced ultrasound using the microvascular imaging technique were performed after administration of SonoVue. The peripheral enhancement pattern was suggestive of malignancy, with a sensitivity of 39.5%, specificity of 98.3%, PPV of 94.4%, NPV of 69.4%, and accuracy of 73.8%. Homogeneous, regional, and heterogeneous enhancement patterns did not show meaningful diagnostic information
Breast screening: Axillary lymph node status of interval cancers by interval year
Breast screening: Axillary lymph node status of interval cancers by interval year
Lauro Bucchi, Donella Puliti, Alessandra Ravaioli, Laura Cortesi, Vincenzo De Lisi, Fabio Falcini, Stefano Ferretti, Alfonso Frigerio, Lucia Mangone, Marco Petrella, Chiara Petrucci, Priscilla Sassoli de Bianchi, Adele Traina, Rosario Tumino, Roberto Zanetti, Manuel Zorzi, Eugenio Paci
The Breast 17 (2008) 477 - 483
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We can confirm the hypothesis that there exists a relationship between the time since last negative screen and the biological aggressiveness of interval-surfacing cancers. The second interval year, but not the first, was associated with an excess risk of lymph node metastases that was independent from tumour size and grade. The results of this study improve the understanding of the screening process, particularly the interplay between mammography sensitivity and the natural history of breast cancer.
Lauro Bucchi, Donella Puliti, Alessandra Ravaioli, Laura Cortesi, Vincenzo De Lisi, Fabio Falcini, Stefano Ferretti, Alfonso Frigerio, Lucia Mangone, Marco Petrella, Chiara Petrucci, Priscilla Sassoli de Bianchi, Adele Traina, Rosario Tumino, Roberto Zanetti, Manuel Zorzi, Eugenio Paci
The Breast 17 (2008) 477 - 483
Link to journal
We can confirm the hypothesis that there exists a relationship between the time since last negative screen and the biological aggressiveness of interval-surfacing cancers. The second interval year, but not the first, was associated with an excess risk of lymph node metastases that was independent from tumour size and grade. The results of this study improve the understanding of the screening process, particularly the interplay between mammography sensitivity and the natural history of breast cancer.
Monday, 2 June 2008
Can mammographic findings help discriminate between atypical ductal hyperplasia and ductal carcinoma in situ after needle core biopsy?
Jenny K. Hoang, Prue Hill and Jennifer N. Cawson
The Breast 17, Issue 3, June 2008, Pages 282-288
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In a screening population of women, the mammographic characteristics for 68 cases of atypical ductal hyperplasia (ADH) diagnosed by needle core biopsy (NCB) were reviewed to seek mammographic findings which differentiate between ductal carcinoma in situ (DCIS) and ADH. A blinded analysis by two radiologists was performed for 48 cases with microcalcification. The mammographic findings were correlated with the surgical histological results of benign non-atypical, ADH and carcinoma (DCIS or invasive) to identify features which were associated with a higher or lower odds ratio (OR) for malignancy. Underestimates for malignancy occurred in 14 of 29 cases with granular calcification form (OR 7.9, 95% confidence interval (CI) 1.5–41) and 6 of 8 cases with segmental/linear branching distribution (OR 9.0, 95%CI 1.6–52). No malignancy was found at surgical excision in 16 cases with fine, rounded calcification.
In conclusion, detailed assessment of calcification distribution and form gave helpful predictors for malignancy. Lesions with fine rounded calcification were always benign.
The Breast 17, Issue 3, June 2008, Pages 282-288
Link to Journal
In a screening population of women, the mammographic characteristics for 68 cases of atypical ductal hyperplasia (ADH) diagnosed by needle core biopsy (NCB) were reviewed to seek mammographic findings which differentiate between ductal carcinoma in situ (DCIS) and ADH. A blinded analysis by two radiologists was performed for 48 cases with microcalcification. The mammographic findings were correlated with the surgical histological results of benign non-atypical, ADH and carcinoma (DCIS or invasive) to identify features which were associated with a higher or lower odds ratio (OR) for malignancy. Underestimates for malignancy occurred in 14 of 29 cases with granular calcification form (OR 7.9, 95% confidence interval (CI) 1.5–41) and 6 of 8 cases with segmental/linear branching distribution (OR 9.0, 95%CI 1.6–52). No malignancy was found at surgical excision in 16 cases with fine, rounded calcification.
In conclusion, detailed assessment of calcification distribution and form gave helpful predictors for malignancy. Lesions with fine rounded calcification were always benign.
Is surgical excision necessary in benign papillary lesions initially diagnosed at core biopsy?
Won-Ho Kil, Eun Yoon Cho, Jung Han Kim, Seok-Jin Nam and Jung-Hyun Yang
The Breast 17, Issue 3, June 2008, Pages 258-262
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Debate continues regarding the use of surgical excision in benign papillary lesions initially diagnosed at core biopsy. The objective of this study is to propose management guidelines for benign papillary breast lesions initially diagnosed at core biopsy. Between January 2003 and January 2006, 76 lesions were identified as benign papillary lesions at initial core needle biopsy (n=68) or vacuum biopsy (n=8). After surgical excision, six of the 68 benign papillary lesions initially diagnosed at core needle biopsy were confirmed as malignant papillary neoplasms, giving a false-negative rate of core needle biopsy of 8.8%. Three of the eight atypical papillomas initially diagnosed at core needle biopsy were confirmed as papillary cancer in final pathology, giving a false-negative rate of 37.5%. In the analysis of the difference between benign papillary lesions and atypia or malignant papillary lesions, malignant papillary lesions were located more peripherally (p=0.005) than benign lesions and were larger (>1.5 cm, p=0.017).
It is concluded that atypical papillomas at initial core biopsy or large, clinically peripherally located papillomas (>1.5 cm) need additional surgical excision.
The Breast 17, Issue 3, June 2008, Pages 258-262
Link to Journal
Debate continues regarding the use of surgical excision in benign papillary lesions initially diagnosed at core biopsy. The objective of this study is to propose management guidelines for benign papillary breast lesions initially diagnosed at core biopsy. Between January 2003 and January 2006, 76 lesions were identified as benign papillary lesions at initial core needle biopsy (n=68) or vacuum biopsy (n=8). After surgical excision, six of the 68 benign papillary lesions initially diagnosed at core needle biopsy were confirmed as malignant papillary neoplasms, giving a false-negative rate of core needle biopsy of 8.8%. Three of the eight atypical papillomas initially diagnosed at core needle biopsy were confirmed as papillary cancer in final pathology, giving a false-negative rate of 37.5%. In the analysis of the difference between benign papillary lesions and atypia or malignant papillary lesions, malignant papillary lesions were located more peripherally (p=0.005) than benign lesions and were larger (>1.5 cm, p=0.017).
It is concluded that atypical papillomas at initial core biopsy or large, clinically peripherally located papillomas (>1.5 cm) need additional surgical excision.
Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography—A clinical approach
S.M. Tan, H.S. Teh, J.F. Kent Mancer and W.T. Poh
The Breast 17, Issue 3, June 2008, Pages 252-257
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Ultrasound elastography using the extended combined auto-correlation method of tissue elasticity allows for real-time strain image visualisation using a free-hand probe with concurrent conventional B mode imaging. Four hundred and fifteen consecutive women with 550 breast lesions confirmed on B mode ultrasound were assessed with elastography using the elasticity score. There were 119 malignant and 431 benign lesions. The elastography sensitivity was 78.0%, specificity was 98.5% and overall accuracy was 93.8%. The median score for malignancy was 5 and that for benign lesions was 2.
There was good correlation with B mode BIRADS category. 98.6% of lesions with an elasticity score of 2 or below (95%CI=96.8–99.4) were benign. BIRADS 3 lesions with an elasticity score of 2 or below may be re-classified as BIRADS 2 lesions. We found that 15.3% of BIRADS 2 and 3 lesions with an elasticity score of 3 were malignant. Real-time ultrasound elastography is user-friendly with a high accuracy rate, thereby improving B mode ultrasound assessment.
The Breast 17, Issue 3, June 2008, Pages 252-257
Link to article
Ultrasound elastography using the extended combined auto-correlation method of tissue elasticity allows for real-time strain image visualisation using a free-hand probe with concurrent conventional B mode imaging. Four hundred and fifteen consecutive women with 550 breast lesions confirmed on B mode ultrasound were assessed with elastography using the elasticity score. There were 119 malignant and 431 benign lesions. The elastography sensitivity was 78.0%, specificity was 98.5% and overall accuracy was 93.8%. The median score for malignancy was 5 and that for benign lesions was 2.
There was good correlation with B mode BIRADS category. 98.6% of lesions with an elasticity score of 2 or below (95%CI=96.8–99.4) were benign. BIRADS 3 lesions with an elasticity score of 2 or below may be re-classified as BIRADS 2 lesions. We found that 15.3% of BIRADS 2 and 3 lesions with an elasticity score of 3 were malignant. Real-time ultrasound elastography is user-friendly with a high accuracy rate, thereby improving B mode ultrasound assessment.
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