43 research outputs found
Characterisation of indeterminate focal breast lesions on grey-scale ultrasound: role of ultrasound elastography.
PURPOSE: This study was undertaken to evaluate the role of ultrasound (US)
elastography in characterising focal breast lesions classified as indeterminate
on B-mode US.
MATERIALS AND METHODS: Eighty-four focal breast lesions, 64 benign and 20
malignant (mean diameter, 15.1 mm), detected but not characterised on B-mode US
in 72 women, Breast Imaging Reporting and Data System (BI-RADS) US category 3
(n=56) or category 4 (n=28), were studied with US elastography and classified in
consensus by two radiologists according to a five-point colour scale.
Sensitivity, specificity and positive and negative predictive values (PPV and
NPV) of US elastography compared with conventional US were calculated in relation
to microhistology (n=67) and cytology (n=17), which were used as the reference
standard.
RESULTS: A total of 65/84 (77.4%) lesions were correctly classified as benign or
malignant using US elastography, whereas the remaining 19/84 (22.6%) were
incorrectly assessed. There were no statistically significant differences between
US elastography and B-mode US with regard to sensitivity (70% vs. 68.4%),
specificity (79.6% vs. 78.5%), PPV (51.8% vs. 48.1%) and NPV 89% vs. 89.5%
(p>0.5). By contrast, a statistically significant difference was noted in the
evaluation of BI-RADS 3 lesions, in which US elastography had 50% sensitivity,
86% specificity, 30% PPV and 93.5% NPV compared with BI-RADS 4 lesions (78.6%,
57.1%, 64.7% and 72.7%) (p<0.5).
CONCLUSIONS: The high NPV of US elastography may help reduce the use of biopsy in
BI-RADS 3 lesions, but its low PPV in BI-RADS 4 lesions does not allow avoidance
of biopsy on the basis of the US elastographic score alone in this group of
lesions
Usefulness of SonoVue in the identification of sentinel nodes in patients with breast cancer
Purpose
Preoperative lymphoscintigraphy, introduced accordingly to sentinel lymph node biopsy (SLNB), is considered the gold standard for accurate axillary lymph node staging for breast cancer [4-9].
The technique, for the low radiation doses used (average absorbed doses of 0.5-1 mGy), is considered the almost devoid of carcinogenic potential.
However lymphoscintigraphy has limitations such as the need of specialized medical and technician personnel and having to follow the strict and precise protectionist rules.
Lymphatic imaging after intraparenchymal microbubble injection has been reported in animal models, and only few papers report human use.
The aim of our study was to investigate the dynamics of intradermal injection of
microbubbles as they travel to draining SLNs and to identify and localize SLNs before surgery in patients with breast cancer.
Methods and Materials
14 consecutive consenting women (mean age 61 years, range 39-70), with primary breast cancer were subjected to periareolar intradermal injection of of 0.5 ml of SonoVue (Bracco Imaging, Milan, Italy), of the upper outer quadrant for the identification of the sentinel lymph node. A IU 22 scanner (Philips Ultrasound,Bothell,WA,USA), with a 3-9 MHz linear transducer
and Pulse-inversion harmonic imaging tool were used to image the progression of CEUS (contrast enhancement ultra sound). After introduction of the contrast agent the patients were monitored ultrasonographically
for 120 minutes, performing a dermal massage.
Results In all patients were identified lymphatic pathways that were followed only for few centimeters from the injection site of microbubbles.
In no patient was identified the sentinel node. Conclusion
The echo scintigraphy with SonoVue in our experience does not seem to be a
reproducible method for the study of the sentinel lymph node.
The few studies in the literature seem to confirm the reduced reliability of the method that needs to be improved
Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study
Objectives: To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. Methods: The MIPA observational study enrolled women aged 18–80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. Results: A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. Conclusions: Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. Key Points: • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups
Preoperative breast MRI positively impacts surgical outcomes of needle biopsy–diagnosed pure DCIS: a patient-matched analysis from the MIPA study
Objectives: To investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS). Methods: The MIPA observational study database (7245 patients) was searched for patients aged 18–80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs). Results: Of 1005 women with pure unilateral DCIS at CNB/VAB (507 MRI group, 498 noMRI group), 309 remained in each group after matching. First-line mastectomy rate in the MRI group was 20.1% (62/309 patients, OR 2.03) compared to 11.0% in the noMRI group (34/309 patients, p = 0.003). The reoperation rate was 10.0% in the MRI group (31/309, OR for reoperation 0.40) and 22.0% in the noMRI group (68/309, p < 0.001), with a 2.53 OR of avoiding reoperation in the MRI group. The overall mastectomy rate was 23.3% in the MRI group (72/309, OR 1.40) and 17.8% in the noMRI group (55/309, p = 0.111). Conclusions: Compared to those going directly to surgery, patients with pure DCIS at CNB/VAB who underwent preoperative MRI had a higher OR for first-line mastectomy but a substantially lower OR for reoperation. Clinical relevance statement: When confounding factors behind MRI referral are accounted for in the comparison of patients with CNB/VAB-diagnosed pure unilateral DCIS, preoperative MRI yields a reduction of reoperations that is more than twice as high as the increase in overall mastectomies. Key Points: • Confounding factors cause imbalance when investigating the influence of preoperative MRI on surgical outcomes of pure DCIS. • When patient matching is applied to women with pure unilateral DCIS, reoperation rates are significantly reduced in women who underwent preoperative MRI. • The reduction of reoperations brought about by preoperative MRI is more than double the increase in overall mastectomies
UtilitĂ del SonoVue nella identificazione del linfonodo sentinella in pazienti affette da carcinoma mammario
Scopo: UtilitĂ del SonoVue nella identificazione e localizzazione del linfonodo sentinella in pazienti affette da carcinoma mammario.
Materiali e metodi: 14 donne (età media, 61 anni; range, 39-70), affette da carcinoma mammario, sono state sottoposte ad iniezione intradermica periareolare al QSE, di 2,4 ml di SonoVue, per l' identificazione del linfonodo sentinella. Gold Standard è stata considerata la linfoscintigrafia con macroaggregati di albumina. Dopo introduzione del m.d.c. Le pazienti sono state monitorate ecograficamente per 120 minuti eseguendo un massaggio dermico.
Risultati: In nessuna paziente si è identificato il linfonodo sentinella. In tutte le pazienti sono state identificate le vie linfatiche che si sono seguite solo per qualche centimetro dal punto di inoculo delle microbolle.
Conclusioni: In nessuna paziente si è identificato il linfonodo sentinella. In tutte le pazienti sono state identificate le vie linfatiche che si sono seguite solo per qualche centimetro dal punto di inoculo delle microbolle
High-frequency ultrasound in the study of male breast palpable masses
Purpose. To evaluate the role of high frequency colour-
Doppler ultrasound in the study of diffuse or local breast
nodules in males, and compare these results with those
of mammography.
Materials and methods. We studied 105 men aged
between 12 and 82 years (mean age 42.3 years) with a
palpable breast mass with or without pain. All patients
underwent clinical and ultrasound examination. Seventyeight
also underwent mammography, whereas 27 did not
because of young age (under 25 years) (n=10), no clinical
or sonographic suspicion of a malignant mass
(n=16), and ulcerated neoplastic lesion (n=1). The final
diagnosis derived from surgery in six patients and from
three-year follow-up for 99 patients.
Results. Eighty-nine patients had gynecomastia (85%),
nine had adipomastia (8%), one had fibrolipoma (1%),
five had carcinoma (5%) (invasive ductal carcinoma in
four and bifocal ductal carcinoma and lobular carcinoma
in one patient) and one had liposarcoma (1%). The
clinical examination detected a bilateral (n=66) or unilateral
(n=39) breast mass. Ultrasonography provided the
correct diagnosis of diffuse nodular pathology in all
cases and orientated diagnosis towards malignancy (6
cases) or benignity (1 case) of the lesions. No additional
information was obtained from mammography, as
compared to high-frequency ultrasonography. The integration
of colour-Doppler in the examination was of
little use as it demonstrated extensive vascularisation of
most (5 cases) of the malignant lesions.
Conclusions. Our results indicate that ultrasound allows
the detection and characterization of palpable breast
masses as well as correct local staging of neoplasms
by identifying the degree of infiltration of the surrounding
tissues