Problem-solving breast MRI: useful or a source of new problems?

PURPOSE:We aimed to evaluate the findings and results from breast magnetic resonance imaging (MRI) examinations performed for problem-solving purposes due to inconclusive conventional imaging findings.METHODS:Imaging findings, biopsy and follow-up results were retrospectively evaluated for breast MRI performed for problem-solving purposes at our department between January 2011 and December 2016 for cases whose mammography, tomosynthesis, or ultrasonography findings were inconclusive. RESULTS:Lesions were identified in 414 of 986 problem-solving MRI examinations, and 13.3% of these lesions were diagnosed as malignant. A total of 124 lesions were additionally found by MRI, and 9.7% of these lesions were diagnosed as malignant. MRI produced false-negative results in four cases. In cases whose conventional imaging methods yielded indefinite results, the sensitivity, specificity, negative and positive predictive values of MRI were found to be 96.3%, 83%, 99.3%, and 46.5%, respectively. For the additional lesions identified, the sensitivity, specificity, negative and positive predictive values of MRI were found to be 91.7%, 69%, 98.7%, and 24%, respectively.CONCLUSION:Breast MRI is a reliable problem-solving method for excluding malignancy that cannot be confirmed by conventional imaging. In such cases, additional findings from MRI may help identify new cancers that cannot be detected with conventional methods. However, it has moderately low specificity which may cause unnecessary biopsies, follow-ups, and anxiety to patients

The Role of Primary Surgery in De Novo Metastatic Breast Carcinoma

Approximately 6-10% of all breast carcinoma is metastatic at diagnosis, termed de novo metastatic breast carcinoma (dnMBC). Systemic therapy remains the first line of treatment in dnMBC, but there is growing evidence that adjuvant locoregional treatment (LRT) of the primary tumor increases progression-free and overall survival (OS). Although selection bias may exist, real-world data from nearly half a million patients show that patients are undergoing primary tumor removal because of the survival benefit. The main question for the advocates for LRT in this patient population is not whether primary surgery is beneficial in dnMBC patients, but rather who is a good candidate for it. Oligometastatic disease (OMD) is a distinct subset of dnMBC that affects a limited number of organs. A better OS can be achieved with LRT in breast cancer patients, especially in those with OMD, bone only, or favorable subtypes. Though there is currently no consensus among breast care specialists on how to treat dnMBC patients, primary surgery for dnMBC should be taken into consideration for a subset of patients following an extensive multidisciplinary discussion. © Copyright 2023 by the Turkish Federation of Breast Diseases Societies / European Journal of Breast Health published by Galenos Publishing House.38. Soran A, Soyder A, Ozbas S, Ozmen V, Karanlik H, Igci A, et al. Breast Health Working Group International (supported by the Turkish Federation of Breast Disease Societies). The role of loco-regional treatment in long-term quality of life in de novo stage IV breast cancer patients: protocol MF07-01Q. Support Care Cancer 2021; 29: 3823-3830. (PMID: 33242163) [Crossref

Activity diagrams of borates: implications on common deposits

Most of the world's borate minerals are found in Neogene deposits and Quaternary lake deposits. Only a few of the borates are common geologically and commercially. A series of equilibrium activity diagrams were calculated for the common as well as some rare borate minerals in the systems of (1) Na2O-B2O3-H2O, (2) CaO-B2O3-H2O +/- CO2, (3) MgO-B2O3-H2O +/- CO2, (4) CaO-Na2O-B2O3-H2O, and (5) CaO-MgO-B2O3-H2O. Stability diagrams constructed with respect to variables of log[a(Mbn+)/(a(H+))(n)] and log[a(Mbn+)/a(Mc(n-1))+(a(H+))] versus both log[aH(2)O] and log[a(B)(OH)(3)] showed that some rare borates are thermodynamically not stable (tertschite, inderborite) at all in these systems. Still some common phases are thermodynamically occurred as metastable phases (tincalconite, meyerhofferite) in some deposits. On the contrary, some thermodynamically stable phases can form kinetically slower than the others and not found as common phases (inyoite). Some common and uncommon minerals such as ulexite, aksaite, and gowerite have small stability fields indicating that they can form at very limited thermodynamic conditions. Some phases such as pandermite, ginorite, ascharite, and suanite being structurally complex phases, form after less complex precursor minerals at the end of diagenesis due to burial and/or increasing temperature. Concentrations of cations and boron, pH, evaporation rate are other controlling variables of diagenetic processes. Through these diagrams, observed paragenetic relations and geochemical conditions can be depicted and expectant paragenetic phases can be predicted in any deposits