Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases?

Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases?
C. Simmons, N. Miller, W. Geddie, D. Gianfelice, M. Oldfield, G. Dranitsaris, and M. J. Clemons

Ann Oncol 2009 20: 1499-1504

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This prospective study demonstrates the presence of substantial discordance in receptor status between primary tumor and metastases, which led to altered management in 20% of cases. Tissue confirmation should be considered in patients with clinical or radiological suspicion of metastatic recurrence

Follow-up may not be beneficial after treatment of grade 1 breast cancer

Follow-up may not be beneficial after treatment of grade 1 breast cancer

M. Kontos, D. Allen, D. T. Trafalis, G. Jones, H. Garmo, L. Holmberg, H. Hamed
British Journal of Surgery 2009; 96: 999 – 1004

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Identification of women treated for breast cancer who have a low risk of locoregional recurrence or contralateral breast cancer, and who can be discharged safely from follow-up, would lower costs without compromising prognosis. This study investigated the risk of locoregional recurrence and contralateral breast cancer in women treated for grade 1 breast cancer

Some 1143 women who had surgery for breast cancer were followed, and the rate of locoregional recurrence or contralateral breast cancer was determined. The risk was compared to the tumour grade

At a mean follow-up of 9·1 years, 10-year estimates of the cumulative risk of locoregional recurrence or contralateral breast cancer for grade 1, 2 and 3 breast cancer were 0·03 (95 per cent confidence interval (c.i.) 0·01 to 0·08), 0·12 (0·09 to 0·15) and 0·16 (0·13 to 0·20) respectively. Grade 1 tumours had a risk of locoregional recurrence or contralateral breast cancer of 285 (95 per cent c.i. 93 to 670) per 100 000 person-years

Women treated for grade 1 breast cancer could be discharged from follow-up after completion of the primary treatment, without compromising their quality of care

The clinical value of bilateral breast MR imaging: is it worth performing on patients showing suspicious microcalcifications on mammography?

The clinical value of bilateral breast MR imaging: is it worth performing on patients showing suspicious microcalcifications on mammography?
Ayano Akita, Akihiro Tanimoto, Hiromitsu Jinno, Kaori Kameyama, Sachio Kuribayashi
Eur Radiol (2009) 19: 2089–2096

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The purpose of this study was to evaluate the clinical value of bilateral breast magnetic resonance (MR) imaging (MRI) in patients showing suspicious microcalcifications on mammography and negative ultrasound findings. Fifty patients underwent MRI before stereotactic vacuum-assisted breast biopsy (SVAB). MR findings were classified into five types for interpretation, and types 4 and 5 were considered malignant. SVAB revealed 13 carcinomas and 37 benign lesions. Malignant lesions were more frequently found in cases of positive MRI diagnoses than in negative MRI diagnoses (P  < 0.001). Mammography had a sensitivity of 100%, a specificity of 24% and an accuracy of 44%, whereas mammography plus MRI had a sensitivity of 85%, a specificity of 100% and an accuracy of 96%. In the evaluation of mammographically detected microcalcifications, bilateral breast MRI is of good diagnostic value and may alter the indications for SVAB

Feasibility of MRI-guided large-core-needle biopsy of suspiscious breast lesions at 3 T

Feasibility of MRI-guided large-core-needle biopsy of suspiscious breast lesions at 3 T
Nicky H. G. M. Peters, Carla Meeuwis, Chris J. G. Bakker, Willem P. Th. M. Mali, Arancha M. Fernandez-Gallardo, Richard Hillegersberg, Marguerite E. I. Schipper, Maurice A. A. J. Bosch
Eur Radiol (2009) 19: 1639–1644

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The feasibility of large-core-needle magnetic resonance imaging (MRI)-guided breast biopsy at 3 T was assessed. Thirty-one suspicious breast lesions shown only by MRI were detected in 30 patients. Biopsy procedures were performed in a closed-bore 3-T clinical MR system on a dedicated phased-array breast coil with a commercially available add-on stereotactic biopsy device. Tissue sampling was technically successful in 29/31 (94%) lesions. Median lesion size (n  = 29) was 9 mm. Histopathological analysis showed 19 benign lesions (66%) and one inconclusive biopsy result (3%). At follow-up of these lesions, 15 lesions showed no malignancy, no information was available in three patients and two lesions turned out to be malignant (one lesion at surgical excision 1 month after biopsy and one lesion at a second biopsy because of a more malignant enhancement curve at 12-months follow-up MRI). Nine biopsy results showed a malignant lesion (31%) which were all surgically removed. No complications occurred.

MRI-guided biopsy at 3 T is a safe and effective method for breast biopsy in lesions that are occult on mammography and ultrasound. Follow-up MRI at 6 months after the biopsy should be performed in case of a benign biopsy result

Technical aspects of breast MRI—do they affect outcomes?

Technical aspects of breast MRI—do they affect outcomes?
Ruth Warren, Stefano Ciatto, Petra Macaskill, Richard Black, Nehmat Houssami
Eur Radiol (2009) 19: 1629–1638

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In a systematic review of breast MRI for assessing ipsilateral breast cancer to detect additional lesions, technical details were extracted from publications to assess their effect on diagnostic performance. Where technical parameters were complete, we examined their effect on summary ROC models, and the TP:FP ratio and PPV, using random-effects logistic regression. A total of 2,801 breasts in 19 publications underwent statistical analysis for year of study, slice thickness, and repetitions after contrast-medium injection. None were associated with TP/FP ratio. Summary ROC analysis provided weak evidence (P  = 0.09) of an association between diagnostic performance and time period, however no trend over time. Tesla strength was reported in 2,801 cases. Other key information was omitted including whether both breasts were examined for 1683 (60%), position of the patient in 1,375 (49%), and imaging planes used in 688 (25%). Contrast agent and dose were reported for 2,646 (95%) breasts. Reporting technique was inconsistently reported. Single radiology reports were found in 1,637 (58%) cases, double in 347 (12.4%), and in 960 (34%) knowledge of mammography or ultrasound findings was not stated. Slice thickness, number of sequences after contrast medium, and year of study did not show significant performance differences. Other technical information was deficient. There is an urgent need to improve the quality of reporting of breast MRI studies

Real-time US elastography in the differentiation of suspicious microcalcifications on mammography

Real-time US elastography in the differentiation of suspicious microcalcifications on mammography
Nariya Cho, Woo Kyung Moon, Jeong-Seon Park
Eur Radiol (2009) 19: 1621–1628

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When a cutoff point between elasticity scores of 1 and 2 was used, US elastography showed 97% (34/35) sensitivity, 62% (26/42) specificity, 68% (34/50) PPV, and 96% (26/27) NPV with an Az value of 0.852 (0.753–0.923, 95% confidence interval) in the differentiation of benign and malignant microcalcifications. Our results suggest that US elastography has the potential to differentiate benign and malignant lesions associated with microcalcifications detected at screening mammography

Diffusion-weighted imaging (DWI) in MR mammography (MRM): clinical comparison of echo planar imaging (EPI) and half-Fourier single-shot turbo spin ech

Diffusion-weighted imaging (DWI) in MR mammography (MRM): clinical comparison of echo planar imaging (EPI) and half-Fourier single-shot turbo spin echo (HASTE) diffusion techniques
P. A. T. Baltzer, D. M. Renz, K.-H. Herrmann, M. Dietzel, I. Krumbein, M. Gajda, O. Camara, J. R. Reichenbach, W. A. Kaiser
Eur Radiol (2009) 19: 1612–1620

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The sensitivity and specificity of routine diagnostics (97.4% and 85.7%) were superior to EPI-DWI (87.2% and 82.9%) and HASTE-DWI (76.9% and 88.6%). Selecting only nonmass lesions, DWI did not prove to be of diagnostic value. Lesion demarcation by DWI was significantly lower compared with that by CE-T1w, with EPI-DWI showing the better performance (p  < 0.001). No significant differences were found for size measurements between CE-T1w and DWI. Although clearly inferior compared with CE-T1w imaging, both DWI techniques are applicable for lesion assessment and size measurements