Triple-negative breast cancer: correlation between imaging and pathological findings

Triple-negative breast cancer: correlation between imaging and pathological findings
Eun Sook Ko, Byung Hee Lee, Hyun-A Kim, Woo-Chul Noh, Min Suk Kim & Sang-Ah Lee
European Radiology 2010; 20;5:1111-1117

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Results: 
Triple-negative breast cancers showed a high histological grade. On mammography, triple-negative breast cancers usually presented with a mass (43/87, 49%) or with focal asymmetry (19/87, 22%), and were less associated with calcifications. On ultrasound, the cancers were less frequently seen as non-mass lesions (12/87, 14%), more likely to have circumscribed margins (43/75, 57%), were markedly hypoechoic (36/75, 57%) and less likely to show posterior shadowing (4/75, 5%). Among the three types of breast cancers, ER-negative/PR-negative/HER2-positive breast cancers most commonly had associated calcifications (52/65, 79%) on mammography and were depicted as non-mass lesions (21/65, 32%) on ultrasound

Conclusion: 
Our results suggest that the imaging findings might be useful in diagnosing triple-negative breast cancer

Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study

Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study
Jung Min Chang, Woo Kyung Moon, Nariya Cho, Wonshik Han, Dong-Young Noh, In-Ae Park & Eun-Jung Jung
European Radiology 2010; 20;5:1093-1100

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Results:
Of the 114 patients, 87 eventually underwent surgery: among the 100 supposed benign papillomas, surgical excision revealed fibrocystic change or no residual lesion in nine cases, intraductal papilloma in 74, atypical papilloma in 13, papillary ductal carcinoma in situ (DCIS) in three and one invasive papillary carcinoma. The upgrade rate for an atypical papilloma or papilloma with adjacent foci of atypical ductal hyperplasia (ADH) and malignancy was 13% (95% CI = 7.1–21.2%) and 4% (95% CI = 1.1–9.9%), respectively. The mean lesion size (P = 0.041) was significantly larger when lesions were upgraded to malignancy. Other features were not significantly associated with pathological underestimation (P >  0.05).

Conclusion: 
Surgical excision should be considered for benign intraductal papillomas above 1.5 cm in size

Influence of additional breast ultrasound on cancer detection in a cohort study for quality assurance in breast diagnosis—analysis of 102,577 diagnostic procedures

Influence of additional breast ultrasound on cancer detection in a cohort study for quality assurance in breast diagnosis—analysis of 102,577 diagnostic procedures
Fritz K. W. Schaefer, A. Waldmann, A. Katalinic, C. Wefelnberg, M. Heller, W. Jonat & I. Schreer
European Radiology 2010; 20;5:1085-1092

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Results:
In total, 62,006 additional USs were performed, in which 116 mammographically and clinically occult breast cancers were diagnosed (detection rate: 1.9/1,000 examinations), while mammography alone (40,551 examinations) revealed 903 cancers (22.3/1,000). Of all 1,019 breast cancer findings, 12.8% were detected because of the combination of mammography and US. In the group with ACR III/IV, 15.9% of cancers were found by supplemental US compared with mammography alone.

Conclusion:
The addition of US to mammography vs. mammography alone resulted in a significant (P  < 0.01) increase in breast cancer detection rate

US-guided diffused optical tomography: a promising functional imaging technique in breast lesions

US-guided diffused optical tomography: a promising functional imaging technique in breast lesions
Shan-Shan You, Yu-Xin Jiang, Qing-Li Zhu, Ji-Bin Liu, Jing Zhang, Qing Dai, He Liu & Qiang Sun
Eur Radiol 2010 20;2:293-302

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Results:  There were 96 benign lesions and 118 malignant lesions. The total haemoglobin concentration (THC) of all 214 lesions was calculated from DOT. The average THC in benign lesions was 125.5 ± 83.4 µmol/L, and in malignant lesions 222.2 ± 87.2 µmol/L. The THC of malignant lesions was significantly higher than that of benign lesions (p < 0.05). 

When a THC of 140 µmol/L was used as the cutoff value for differentiating breast cancer from benign lesions, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of DOT were 83.9%, 66.7%, 76.2%, 75.6% and 77.1%, respectively. 

Our study demonstrated that THC was significantly higher in malignant lesions than in benign lesions.
 
Conclusion:  US-guided diffused optical tomography, a noninvasive functional imaging technique, has potential utility in differentiating breast cancer from benign lesions

Analysis of false-negative results after US-guided 14-gauge core needle breast biopsy

Analysis of false-negative results after US-guided 14-gauge core needle breast biopsy
Ji Hyun Youk, Eun-Kyung Kim, Min Jung Kim, Jin Young Kwak & Eun Ju Son
Eur Radiol (2010) 20: 782–789

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Most false negatives were found immediately and imaging-histological discordance was the most important clue. Careful correlation of clinical, radiological and histological results as well as appropriate follow-up is essential

High Risk Screening - adding US to Mammography - ACRIN Results

Combined Screening With Ultrasound and Mammography vs Mammography Alone in Women at Elevated Risk of Breast Cancer
Wendie A. Berg; Jeffrey D. Blume; Jean B. Cormack; Ellen B. Mendelson; Daniel Lehrer; Marcela Bohm-Velez; Etta D. Pisano; Roberta A. Jong; W. Phil Evans; Marilyn J. Morton; Mary C. Mahoney; Linda Hovanessian Larsen; Richard G. Barr; Dione M. Farria; Helga S. Marques; Karan Boparai; for the ACRIN 6666 Investigators
JAMA 2008;299 2151-2163

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Adding a single screening ultrasound to mammography will yield an additional 1.1 to 7.2 cancers per 1000 high-risk women, but it will also substantially increase the number of false positives.

Results of the ACRIN 6666 trial, whose results were presented at RSNA 2007. As expected ultrasound is good at picking up additional cancers, not visualized on mammography, BUT at a significant cost of false positivies and unnecessary biopsies.

Prevention of futile sentinel node procedures in breast cancer: Ultrasonography of the axilla and fine-needle aspiration cytology are obligatory

Prevention of futile sentinel node procedures in breast cancer: Ultrasonography of the axilla and fine-needle aspiration cytology are obligatory
F. Gilissen, R. Oostenbroek, R. Storm, P. Westenend and P. Plaisier
European Journal of Surgical Oncology (EJSO 34, Issue 5, May 2008, Pages 497-500

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By preoperative US and FNA of the axilla in patients with breast cancer, half of the axillary metastases can be detected prior to surgery. In more than a quarter of breast cancer patients, a futile SNP can be prevented.

Therefore, preoperative US of the axilla plus FNA are obligatory in patients with breast carcinoma.