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
Thursday, 9 October 2008
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
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.
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.
Monday, 14 April 2008
Surveillance mammography after breast conservation therapy in Hong Kong: Effectiveness and feasibility of risk-adapted approach
T.K. Yau, H. Sze, I.S. Soong, W. Wong, K. Chan, A. Chang, K.Y. Lau and A. Lee
The Breast 17, 2, April 2008, Pages 132-137
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Annual surveillance mammography is commonly recommended after breast conservation therapy (BCT). We retrospectively reviewed its effectiveness on 511 invasive and non-invasive breast cancers treated with BCT between 1994 and 2003. The median follow-up was 5.9 years. The 5-year actuarial ipsilateral breast tumour recurrence (IBTR) rate was 4.5% and contralateral breast cancer (CBC) rate was 2.0% (representing eight times increase in risk). IBTR of 43% and 62% CBC were first detected by surveillance mammography. The IBTR detection rates per 1000 mammograms were 5.2 for patients (n=349) with one or more IBTR risk factors (age
45, positive/close margins or histological grade 3) and 0.6 for patients (n=162) without. No survival difference was observed between different modes of IBTR detection (p=0.342).
In conclusion, a risk-adapted approach of limiting ipsilateral surveillance to patients with IBTR risk is possible but its implementation will be complicated by the continued need of contralateral surveillance.
The Breast 17, 2, April 2008, Pages 132-137
Link to journal
Annual surveillance mammography is commonly recommended after breast conservation therapy (BCT). We retrospectively reviewed its effectiveness on 511 invasive and non-invasive breast cancers treated with BCT between 1994 and 2003. The median follow-up was 5.9 years. The 5-year actuarial ipsilateral breast tumour recurrence (IBTR) rate was 4.5% and contralateral breast cancer (CBC) rate was 2.0% (representing eight times increase in risk). IBTR of 43% and 62% CBC were first detected by surveillance mammography. The IBTR detection rates per 1000 mammograms were 5.2 for patients (n=349) with one or more IBTR risk factors (age
45, positive/close margins or histological grade 3) and 0.6 for patients (n=162) without. No survival difference was observed between different modes of IBTR detection (p=0.342).In conclusion, a risk-adapted approach of limiting ipsilateral surveillance to patients with IBTR risk is possible but its implementation will be complicated by the continued need of contralateral surveillance.
Borderline breast lesions diagnosed at core needle biopsy: Can magnetic resonance mammography rule out associated malignancy? Preliminary results base
Anna Linda, Chiara Zuiani, Massimo Bazzocchi, Alessandro Furlan and Viviana Londero
The Breast 17, 2, April 2008, Pages 125-131
Link to journal
The purpose of this study is to assess whether magnetic resonance mammography (MRM) can exclude associated malignancy in case of diagnosis of borderline breast lesions (B3) at core needle biopsy (CNB). Retrospective analysis of MRM findings of 79 borderline breast lesions (26 benign papillomas, 29 radial sclerosing lesions, 6 atypical ductal hyperplasias, 18 lobular neoplasias) diagnosed at CNB was performed.
Lesions were classified as “non-suspicious” or “suspicious” according to Fischer score. These findings were compared to the results of histological analysis of the excisional specimens. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of MRM in predicting the presence of malignancy were calculated. Out of 24 (30.4%) lesions classified as “suspicious”, 8 (33.3%) proved to be malignant and 16 (66.7%) benign. Among the 55 (69.6%) “non-suspicious” lesions, only 1 (1.8%) was malignant (low-grade ductal carcinoma in situ), while the remaining 54 (98.2%) proved to be benign. MRM sensitivity, specificity, PPV, and NPV were 88.9%, 77.1%, 33.3%, and 98.2%, respectively.
When a borderline lesion is diagnosed on CNB, in case of mild or no enhancement at MRM, follow-up rather than excisional biopsy might be prompted.
The Breast 17, 2, April 2008, Pages 125-131
Link to journal
The purpose of this study is to assess whether magnetic resonance mammography (MRM) can exclude associated malignancy in case of diagnosis of borderline breast lesions (B3) at core needle biopsy (CNB). Retrospective analysis of MRM findings of 79 borderline breast lesions (26 benign papillomas, 29 radial sclerosing lesions, 6 atypical ductal hyperplasias, 18 lobular neoplasias) diagnosed at CNB was performed.
Lesions were classified as “non-suspicious” or “suspicious” according to Fischer score. These findings were compared to the results of histological analysis of the excisional specimens. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of MRM in predicting the presence of malignancy were calculated. Out of 24 (30.4%) lesions classified as “suspicious”, 8 (33.3%) proved to be malignant and 16 (66.7%) benign. Among the 55 (69.6%) “non-suspicious” lesions, only 1 (1.8%) was malignant (low-grade ductal carcinoma in situ), while the remaining 54 (98.2%) proved to be benign. MRM sensitivity, specificity, PPV, and NPV were 88.9%, 77.1%, 33.3%, and 98.2%, respectively.
When a borderline lesion is diagnosed on CNB, in case of mild or no enhancement at MRM, follow-up rather than excisional biopsy might be prompted.
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