The effect of COVID-19 pandemic on breast imaging: a clinical observations

6NOV-DEC6032

The value of preoperative contrast-enhanced breast magnetic resonance imaging on surgical planning in breast cancer patients

Amaç: Meme kanserli olgularda, hastalığın evresinin doğru saptanması ve geri ye tümör dokusunun bırakılmaması uygun tedavi planlamasında belirleyici rol oynamaktadır. Meme manyetik rezonans görüntüleme (MRG), meme kanserli olgularda preoperatif cerrahi planlamasında kullanımı artan bir modalitedir. Bu çalışmanın amacı, prospektif olarak, meme kanserli kadınlarda, cerrahi önce si elde edilen meme MRG’nin cerrahi tedavi planlamaya katkısını araştırmaktır. Hastalar ve Yöntem: Çalışmaya 30 hasta dahil edildi. Lezyonlar Breast Imaging Reporting and Data System (BI-RADS) sınıflamasına göre 6 kategoride tanım landı. Veriler meme MRG incelemesi sonucu cerrahi planlamada yapılan değişik lik açısından analiz edildi. Bulgular: Hastaların primer tümör boyutları ile meme MRG ve histopatolojik değerlendirme ile ölçümlerinin yüksek düzeyde korelas yon gösterdiği saptandı (r:0.796, p:0.00). Meme MRG ile 11 hastada (%36) 14 ek lezyon saptandı. İki hasta hariç tüm olgularda histopatolojik değerlendirme so nuçlarının MRG bulguları ile uyumluluk gösterdiği görüldü. Tüm hasta grubunda meme MRG bulgularının cerrahi değişikliğe neden olduğu hasta oranı %17 idi. Mastektomi planlanan 16 olgunun 1’ine (%6.5) senkron kontrlateral meme kan seri nedeniyle ek meme koruyucu cerrahi (MKC) yapıldı. MKC planlanan olgula rın 4’ünde (%28) cerrahi plan mastektomi olarak değiştirildi. Hastaların 1’inde primer kanserin sınırları ve uzanımları, meme MRG ile daha net ortaya kondu ve MKC’den vazgeçilerek mastektomi uygulandı. Sonuç: Meme MRG bulgularının MKC planlanan hastalarda cerrahi planı de ğiştirebileceği klinik ve mamografik olarak saptanmış olup; preoperatif kont rastlı meme MRG’nin klinik ve mamografik saptanamayan okült invaziv ve no ninvaziv meme kanserlerinin yakalanmasında, tümör evrelemesinde, cerrahi planlamada rol oynadığı düşünülmektedir.Objective: Accurate detection of tumor stage and no recurrent tumor af ter surgery play a determinant role in surgical planning in breast cancer patients. Breast magnetic resonance imaging (MRI) is being increasingly used in preoperative planning for breast cancer. The aim of this study is to evaluate the incremental value of preoperative breast MRI to surgical plan ning in women with diagnosis of breast cancer. Patients and methods: Thirty patients were enrolled in this study. Lesions were categorized according to the Breast Imaging Reporting and Data System (BI-RADS) classification. The data were analyzed according to the benefits and detriments of MRI findings and changes in surgical planning made according to MRI results. Results: There was a high correlation between primary tumor size and breast MRI– histopathologic measurements (r:0.796, p:0.00). Fourteen additional lesions were detected in 11 patients (%36) with MRI. MRI findings were concordant with histopathologic results except in 2 patients. In 17% of total patient group, the surgical approach changed according to breast MRI findings. An additional breast- conserving surgery (BCS) was applied in 1 of 16 (%6.5) patients with synchroneus contrlateral breast cancer whom were planned to undergo mastectomy. In 4 patients (28%) with BCS decision, the surgical ap proach was changed to mastectomy. In one patient, the border and extansion of the primary cancer was detected more clearly by MRI and the decision of BCS was changed to mastectomy. Conclusion: We found that MRI findings accurately guided the CBS planning. Preoperative contrast-enhanced breast MRI plays an important role in detec tion, staging and surgical planning in invasive and noninvasive cancers

Radiologic findings of screen-detected cancers in an organized population-based screening mammography program in Turkey

PURPOSE:Bahçeşehir Breast Cancer Screening Program is a population based organized screening program in Turkey, where asymptomatic women aged 40–69 years are screened biannually. In this prospective study, we aimed to determine the mammographic findings of screen-detected cancers and discuss the efficacy of breast cancer screening in a developing country.METHODS:A total of 6912 women were screened in three rounds. The radiologic findings were grouped as mass, focal asymmetry, calcification, and architectural distortion. Masses were classified according to shape, border, and density. Calcifications were grouped according to morphology and distribution. Cancers were grouped according to the clinical stage.RESULTS:Seventy cancers were detected with an incidence of 4.8/1000. Two cancers were detected in other centers and three were not visualized mammographically. Mammographic presentations of the remaining 65 cancers were mass (47.7%, n=31), calcification (30.8%, n=20), focal asymmetry (16.9%, n=11), architectural distortion (3.1%, n=2), and skin thickening (1.5%, n=1). The numbers of stage 0, 1, 2, 3, and 4 cancers were 13 (20.0%), 34 (52.3%), 14 (21.5%), 3 (4.6%), and 1 (1.5%), respectively. The numbers of interval and missed cancers were 5 (7.4%) and 7 (10.3%), respectively.CONCLUSION:A high incidence of early breast cancer has been detected. The incidence of missed and interval cancers did not show major differences from western screening trials. We believe that this study will pioneer implementation of efficient population-based mammographic screenings in developing countries

Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study

PURPOSEThe clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions.METHODSThis retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson’s chi-squared test, the Fisher–Freeman–Halton test, and Fisher’s exact test were used for the statistical analyses.RESULTSThe overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes.CONCLUSIONADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision

Bi-Rads Outcome Assessment of Mammography Screening; Medical Audit of a Breast Imaging Center

Aim: To audit our mammography screening practice according to the American College of Radiology (ACR) recommendations in the years 2017 and 2018. Method: We documented and analyzed our breast imaging data collected between March 14th, 2017 and December 31st, 2018 and performed a medical audit related to our mammography screening practice. The results were evaluated according to ACR BI-RADS recommendations and performance benchmarks. Results: The total number of mammographic screening patients who had no personal history of breast cancer was 2413 in 2017 and 2018. Our PPV1, PPV2 and PPV3 values were 5.6%, 30.8%, 52.9% accordingly. The recall rate was 11%. Outcomes for cancer detection rate, minimal cancer rate, early-stage cancer rate and lymph node negativity were 0.74%, 50%, 77% and 64% respectively. Conclusion: The mammographic screening outcomes are in accordance with ACR performance benchmarks. Despite a desired high early cancer detection rate, axillary lymph node negativity was found to be below the desired range of 75%. Medical auditing is important for a breast imaging unit to monitor the effectiveness of screening and diagnostic procedures and presents as an effective feedback tool to improve the practice

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