Tag Archives: breast cancer

The Role of Sonoelastography in the Differential Diagnosis of Breast Lesions

Gheonea Ioana1, Popescu Camelia2, Bondari A.1

1 Radiology and Imaging Department, University of Medicine and Pharmacy Craiova
2 ENT Department, Emergency Hospital Craiova

Background: Tissue elasticity imaging technology is expected to be a new modality for breast diagnosis, based on hardness as a tissue characteristic that is affected by tissue disease such as cancer.
Aim: To assess the value of sonoelastography in the differential diagnosis of breast lesions.
Patients and method: We included in this prospective study 59 patients diagnosed with breast lesions between January 2009 and January 2010. All the patients were examined in the supine position and the B mode ultrasound image was displayed alongside the elastography strain image. An EUS Hitachi EUB 8500 ultrasound system with an embedded elastography module (Hitachi Medical Systems Europe Holding AG, Zug, Switzerland) and a 6.5-MHz linear probe was used to obtain the B mode and elastography strain images. The elastography strain images were scored according to the Tsukuba elasticity score.
Results: For assessment of sonoelastography role in differential diagnosis of breast lesions, we performed ROC analysis, and we obtained a sensitivity of 89.7%, and a specificity of 92.9% (area under the ROC curve = 0.924, 95% CI = 0.822–0.977 and p = 0.0001).
Conclusions: Elastography is a fast, simple method which can complement the conventional US. Elastography is promising, and with future improvements in the technology, this imaging modality will become an invaluable tool for the diagnosis of breast diseases in the clinical setting.

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Multidisciplinary Approach of Breast Cancer. Case Reports

Podeanu Daniela1, Stolnicu Simona2, Georgescu R3, Treaba Andrada1, Șincu Nina-Ioana4, Copotoiu C5, Brînzaniuc Klara6

1 Department of Radiology and Medical Imaging, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Surgery Clinic III, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Clinic of Infectious Diseases I, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
5 Surgery Clinic I, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
6 Department of Anatomy, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Breast cancer is still the world’s most common cancer in women. Multidisciplinary approach represents the gold standard in diagnosis.
Case presentation: In order to emphasize the importance of this issue, we present three of our cases. In these cases of invasive carcinoma, in women ranged from 42 to 54 years, the diagnosis tools were clinical examination, mammography, ultrasound and histopathology. Minimal invasive breast biopsy and preoperative localisation procedures, under ultrasound and stereotactic guidance contributed to preoperative planning.
Conclusions: Interdisciplinary approach in diagnosis provides optimal management of breast cancer.

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Does the Result of Completion Axillary Lymph Node Dissection Influence the Recommendation for Adjuvant Treatment in Sentinel Lymph Node Positive Patients?

Sávolt Á1, Mátrai Z1, Tóth L1, Polgár C2, Musonda P3, Szabó É4, Horváth Z5, Kásler M6, Péley G7

1 Department of General and Thoracic Surgical Oncology, National Institute of Oncology, Budapest, Hungary
2 Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary
3 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
4 Department of Diagnostic Radiology , National Institute of Oncology, Budapest, Hungary
5 Department of Medical Oncology, National Institute of Oncology, Budapest, Hungary
6 National Institute of Oncology, Budapest, Hungary
7 Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, UK

Aims: The Hungarian National Institute of Oncology has just closed a single-centre randomized clinical study. The OTOASOR (Optimal Treatment of the Axilla – Surgery or Radiotherapy) trial compares completion axillary lymph node dissection (ALND) to regional nodal irradiation (RNI) in patients with sentinel lymph node-positive (SLN+) primary invasive breast cancer. In the investigational treatment arm patients received 50 Gy RNI instead of completion ALND. In these patients we had information only about the SLN status, but the further axillary nodal involvement remained unknown. The aim of this study was to investigate whether the result of completion ALND influenced the recommendation for adjuvant treatment in SLN+ breast cancer patients.
Patients and methods: Patients with SLN+ primary breast cancer were randomized for completion ALND (arm A-standard treatment) or RNI (arm B-investigational treatment). Adjuvant systemic treatments was given according to the standard institutional protocol and patients were followed according to the actual institutional guidelines.
Results: Between August 2002 and June 2009, 474 SLN+ patients were randomized to completion ALND (arm A-standard treatment, 244 patients) or RNI (arm B-investigational treatment, 230 patients). There were no significant differences in terms of major prognostic factors between the two arms. Two-hundred and fourty-two patients (99.6%) on arm A and 229 patients (99.6%) on arm B received adjuvant systemic treatments including chemotherapy and/or endocrine treatment (p=NS). One-hundred and ninety-four patients (79.5%) received adjuvant chemotherapy on arm A and 159 patients (69.1%) on arm B (p=0.031). Two-hundred and four patients (83.6%) received adjuvant endocrine treatment on arm A and 196 patients (85.2%) on arm B (p=NS). Six patients (2.5%) received adjuvant trastuzumab treatment on arm A and 13 patients (5.7%) on arm B (p=NS).
Conclusions: The result of completion ALND after positive SLNB appears to have no major impact on the administration of adjuvant systemic therapy.

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Retrospective Analysis of Breast Cancer Patient Data for Identification of Candidates for BRCA Mutation Detection

Dénes L1, Stolnicu Simona2, Pap Zsuzsanna1, Bődi Zsuzsanna3, Fail Ágnes3, Pávai Z1

1 Department of Anatomy and Embryology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pathology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Student, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Breast cancer is the leading type of cancer affecting women, with an increasing trend of mortality, and a lifetime risk of more than 10%. There are cases of inherited predisposition, which is mostly caused by mutations of the tumor suppressor genes BRCA1 and BRCA2. The objective of this retrospective study is to identify presumptive candidates for BRCA1 mutation carriers using available clinical, histopathological and immunohistochemical data.
Material and method: We processed the available recorded data of 1334 patients diagnosed with breast cancer between the years 2005 and 2010 from the archives of the Pathology Department of the Clinical County Hospital Tg.-Mures. We considered age under 45, histopathological characterization and available immunohistochemical information.
Results: The main selection criteria (age below or equal to 45 years) excluded the majority from further analysis, while 188 cases (12.35%) remained. After performing distribution into histopathological type groups, we looked at the immunohistochemical data. We obtained 19 ER-/PR- negative cases without Her2/neu information, and only 12 cases could be proven to be triple negative, and thus to be considered as primary candidates for BRCA mutation screening.
Conclusions: We identified a very small number of presumptive BRCA mutation carrier candidates. This is due mostly to the fact that the information available comprised macroscopic and classical histopathological data. Immunohistochemical characterization is not widespread, but this shortcoming will be circumvented by prospective reprocessing of the archived biological materials, in order to characterize the BRCA mutation patterns of our population.

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Clinical Efficiency of Diffusion Weighted Imaging with Background Body Signal Suppression in Magnetic Resonance Mammography — Choosing a Qualitative or a Quantitative Approach

Nechifor-Boila IA1, Buruian M1, Frandeș-Podeanu Daniela1, Charlot Matilde2, Borda Angela3

1 Department of Radiology and Medical Imaging, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Department of Radiology and Medical Imaging, Lyon Sud Hospital Center, Pierre-Bénite, France
3 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objectives: Diffusion Weighted Imaging with Background Body Signal Suppression (DWIBS) is a new and promising imaging technique designed to improve diagnostic performance of Dynamic Contrast-Enhanced-Magnetic Resonance Mammography (DCE-MRM). The aim of our study was to assess the diagnostic efficiency of both qualitative and quantitative DWIBS in a retrospective cohort study.
Methods: We performed a registry-based study at the Department of Radiology, Lyon Sud Hospital. All consecutive MRM examinations from 02.2010 to 02.2011 were reviewed. DWIBS was interpreted blindly, both qualitatively (lesion characteristics and signal) and quantitatively (Apparent Diffusion Coefficient – ADC). The ADC cut-off value was determined using Receiver Operating Characteristics (ROC) curve analysis. Clinical efficiency indicators were calculated using either the pathological examination or the disease status after a minimum of 6 months follow-up as gold standard.
Results: The lot consisted of 78 women, with a mean age of 50.3±14 years and a total of 112 breast lesions. Qualitative DWIBS found 73 suspicious and 39 non-suspicious lesions, while the gold standard (pathological diagnosis/follow-up) reported 56 benign and 56 malignant ones. The sensitivity and specificity values for qualitative DWIBS were 84% and 53.37%, respectively. ROC curve analysis revealed the best performance for quantitative DWIBS at an ADC of 1.1×10-3 mm2/s, resulting in a sensitivity of 71.4% and a specificity of 76.8%.
Conclusion: DWIBS is a new and improved diffusion technique with a dual and efficient interpretation system applicable in clinical settings. Moreover, its use as a complement to DCE-MRM offers large potential for improving MRM efficiency in breast cancer diagnosis.

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Magnetic Resonance Mammography: Actual Trends and Perspectives

Nechifor-Boila IA1, Buruian M1, Borda Angela2

1 Department of Radiology and Medical Imaging, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Magnetic Resonance Mammography (MRM) is a new radiologic examination with wide perspectives in breast cancer diagnosis. We performed a systematic review of the literature, in order to obtain a clear view on the actual role of MRM, together with an accurate evaluation of its performance in clinical settings.
Material and methods: We conducted a thorough PubMed search, both directly and through MeSH (Medical Subject Headings), using specific keywords. We then applied the following filters: articles published only between 1999 and 2011 and written in English or French. Priority was given to reviews and clinic trials according to previously set criteria.
Results: We evaluated the clinical efficiency of MRM using sensitivity, specificity and predictive values (positive and negative). Sensitivity varied between 81 and 98%, while specificity had a much wider dispersion (65–93%), thus supporting the statement that MRM is a sensitive but not a specific examination. Diffusion MRM was comparable to standard MRM, while spectroscopy showed a low sensitivity and a high specificity.
Conclusions: MRM is a complex investigation, with well documented recommendations and good sensitivity. Diagnostic specificity remains an important issue, but with improvement perspectives from new techniques like diffusion and spectroscopy.

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