Comparison of stereotactic fine needle aspiration biopsy and core needle biopsy in breast lesions

Purpose: The purpose of this study was to evaluate the diagnostic value of two biopsy methods by comparing stereotactic fine needle aspiration biopsy (S-FNAB) with stereotactic core needle biopsy (S-CNB). The biopsies were performed by the same radiologist, in the same breast lesion on the same occasion, in order to establish which method that best can be recommended in different kind of mammographically detected lesions. All lesions that were surgically extirpated after the stereotactic biopsies and had final post-operativ pathological anatomical diagnoses (PAD) were included in this study. Introduction: In Sweden fine needle aspiration biopsy (FNAB) has been successfully used in breast lesions since the 1960th due to both excellent biopsy technique and cytologists. Cytology is not standard procedure in many countries, due to lack of experienced cytologic diagnosticians and incorrect biopsy technique. Thus surgical biopsies have been performed instead of needle biopsies in many places. During the 1970th core needle biopsy (CNB) was developed and the method has later been refined. When we started our study 1993, CNB was not used in breast lesions in Sweden. Biopsy technique: Spinal needles with diameter 0.7 and 0.9 mm were used for S-FNAB and an average of three needle biopsies per lesion were taken. For S-CNB a needle with diameter 2.1 mm and 23 mm throw was used. Three needle biopsies per lesion were taken. Paper I: Between May 1993 and June 1998 pre-operative S-FNAB and S-CNB were performed on a single occasion in 22 breast lesions where post-operative PAD showed invasive lobular cancer (ILC). S-FNAB diagnosed cancer in nine (41 %) and probable cancer in five of the 22 lesions. In three cases S-FNAB showed atypia and in five normal cells without any atypia. S-CNB diagnosed ILC in 20 (91 %) of the 22 patients, a mixture of ILC and invasive ductal cancer (IDC) in one lesion and ductal cancer in situ (DCIS) in the final lesion. In conclusion S-CNB was superior to S-FNAB in lesions where post-operative PAD diagnosed ILC. Paper II: In 72 breast lesions that pre-operatively underwent simultaneous S-FNAB and S-CNB between May 1993 and June 1999 post-operative PAD diagnosed ductal cancer in situ (DCIS). S-FNAB in these 72 lesions diagnosed cancer in 34 cases (47 %) and probable cancer in six lesions, atypia in 12 cases and in 20 tumors the material was benign or unsatisfactory. S-CNB in the same lesions performed on the same occasion diagnosed DCIS in 56 cases (78 %). Another three biopsies showed probable cancer, seven showed atypia and in six lesions only benign material was found. In four of the 72 lesions (6 %) S-FNAB was superior to S-CNB and diagnosed cancer. S-CNB in these four lesions diagnosed two probable cancer, one atypia and one with benign material. In another four cases both methods showed only benign material and in four lesions both methods found atypia. In all of these 12 cases the radiologist had recommeded surgical extirpation due to the suspicious mammographic appearance. Paper III: From May 1993 to December 2000 522 patients underwent surgical extirpation of a breast lesion after simultaneous pre-operative S-FNAB and S-CNB. In 448 of these cases post-operative histopatology diagnosed malignancy and in 74 a benign lesion. S-FNAB pre-operatively diagnosed 254 of the 448 cancers (57 %) and in 48 cases diagnosed probable cancer. S-CNB diagnosed 388 of the cancer cases (87 %) and in 18 probable cancer. S-FNAB was false negative in 96 patients (21 %), while S-CNB was false negative in 22 cases (5 %). In 16 of the 74 benign breast lesions (21 %) PAD diagnosed radial scar, which is considered pre-malignant. Paper IV: Between September 1994 and December 2000 three S-CNBs were taken from every lesion irrespectively of its mammographical appearance. The lesions were divided into three groups depending on their mammographical appearance; microcalcifications only (group I), a mass and microcalcifications (group II) and a mass, a star or distorsion without microcalcifications (group III). Every biopsy was analysed separately. 523 of these breast lesions were extirpated surgically with a post-operative PAD. 454 lesions were malignant (87 %) and 69 were benign. Three S-CNBs diagnosed malignancy in 84 % of all cases in group I. In group II 97 % got a correct pre-operative malignant diagnosis with three S-CNBs, while the correct diagnosis was made in 93 % in group III. These results indicate that three S-CNBs are enough in group II and group III but not sufficient in lesions with microcalcifications only (group I). In spite of the differences concerning diagnostic accuracy the post-operative PAD ratio malignant to benign in the three groups were essentially the same i.e. approximately 85 % malignant lesions. The reason for this is that the interpretation of the mammograms also has to be taken into account when deciding if a surgical extirpation shall be done or not and not only the cytological and histopathological results of the biopsies. Final conclusions: When only the biopsy methods are compared, the pre-operative diagnostic results are generally better with S-CNB than with S-FNAB, especially in lesions diagnosed as ILC and DCIS. S-FNAB in combination with S-CNB can be valuable, since few lesions are pre-operatively diagnostic only with S-FNAB. In clinical routine, the combination of the mammography and the biopsy methods must be evaluated together. A combination of mammography and three S-CNBs gives the best diagnostic outcome in all types of breast lesions

Lesion characterization using spectral mammography

We present a novel method for characterizing mammographic findings using spectral imaging without the use of contrast agent. Within a statistical framework, suspicious findings are analyzed to determine if they are likely to be benign cystic lesions or malignant tissue. To evaluate the method, we have designed a phantom where combinations of different tissue types are realized by decomposition into the material bases aluminum and polyethylene. The results indicate that the lesion size limit for reliable characterization is below 10 mm diameter, when quantum noise is the only considered source of uncertainty. Furthermore, preliminary results using clinical images are encouraging, but allow no conclusions with significance.QC 20120625</p

Correlation of contrast-enhanced ultrasound kinetics with prognostic factors in invasive breast cancer

OBJECTIVES: To correlate contrast-enhanced ultrasound (CEUS) kinetic parameters with traditional and molecular prognostic factors in invasive breast cancer. METHODS: Seventy-five invasive breast cancers were evaluated with contrast harmonic imaging after the injection of a bolus dose of 2.4 ml sulphur hexafluoride microbubble contrast agent. The lognormal function was used for quantitative analysis of kinetic data. These parameters correlated with traditional prognostic factors (tumour size, histological type, tumour grade, axillary lymph node status) and immunohistochemical biomarkers (ER, PR and HER2 status). RESULTS: Statistically significant correlation was found between time-to-peak and tumour grade (P value = 0.023), PR status (P value = 0.042) and axillary node status (P value = 0.025). Wash-out ratio, measured at 21 s was significantly associated with ER status (P value = 0.042) and PR status (P value = 0.026). CONCLUSIONS: Invasive breast carcinomas exhibiting earlier peak enhancement and faster elimination of microbubble contrast agent at CEUS are found to be associated with established predictors of poor prognosis. KEY POINTS: * Contrast-enhanced ultrasound (CEUS) can potentially determine the aggressiveness of invasive breast cancers. * Early peak enhancement and accelerated wash-out at CEUS suggest poor prognosis. * CEUS kinetics are similar to that of DCE-MRI in assessing tumour aggressiveness

Contrast-enhanced ultrasound using real-time contrast harmonic imaging in invasive breast cancer: comparison of enhancement dynamics with three different doses of contrast agent

Background: In the last few years new potential applications have been developed for contrast-enhanced ultrasound (CEUS) and the management of breast diseases, but there is still some debate concerning the optimal dose to evaluate breast lesions, especially as a diagnostic tool. Purpose: To compare different CEUS doses of injected contrast agent in order to establish an optimal dose for the diagnosis of invasive breast cancer. Material and Methods: In Group A we compared the bolus dose of 1.2 mL vs. 2.4 mL and in Group B we compared the bolus dose of 2.4 mL vs. 4.8 mL (26 and 25 invasive carcinomas, respectively). CEUS was performed in real-time contrast harmonic imaging (CHI) using a L9-3 MHz probe. All examinations were recorded in a contrast side/side imaging mode loop for 120 s. Wash-in and wash-out patterns of the contrast agent were analyzed with advanced US quantification software and kinetic curves were used for statistical analysis. Results: In Group B (2.4 mL vs. 4.8 mL), more and stronger correlation was found among kinetic parameters (area under the curve, P< 0.00001; lognormal model parameters, mu, P = 0.0007 and sigma, P< 0.0001; mean transit time, P< 0.0001; model-based wash-out ratios, W-21m, P = 0.0002; W-50m, P = 0.0001; time-to-peak, P = 0.005) as compared to Group A (1.2 mL vs. 2.4 mL). Conclusion: The optimal way to evaluate kinetic features of invasive breast tumors using real-time CEUS is with an injection of contrast agent of either 2.4 mL or 4.8 mL

Automated measurement of volumetric mammographic density:a tool for widespread breast cancer risk assessment

Abstract Introduction: Mammographic density is a strong risk factor for breast cancer and an important determinant of screening sensitivity, but its clinical utility is hampered due to the lack of objective and automated measures. We evaluated the performance of a fully automated volumetric method (Volpara). Methods: A prospective cohort study included 41,102 women attending mammography screening, of whom 206 were diagnosed with breast cancer after a median follow-up of 15.2 months. Percent and absolute dense volumes were estimated from raw digital mammograms. Genotyping was performed in a subset of the cohort (N = 2,122). We examined the agreement by side and view and compared density distributions across different mammography systems. We also studied associations with established density determinants and breast cancer risk. Results: The method showed good agreement by side and view, and distributions of percent and absolute dense volume were similar across mammography systems. Volumetric density was positively associated with nulliparity, age at first birth, hormone use, benign breast disease, and family history of breast cancer, and negatively with age and postmenopausal status. Associations were also observed with rs10995190 in the ZNF365 gene (P &amp;lt; 1.0 × 10−6) and breast cancer risk [HR for the highest vs. lowest quartile, 2.93; 95% confidence interval, 1.73–4.96 and 1.63 (1.10–2.42) for percent and absolute dense volume, respectively]. Conclusions: In a high-throughput setting, Volpara performs well and in accordance with the behavior of established density measures. Impact: Automated measurement of volumetric mammographic density is a promising tool for widespread breast cancer risk assessment. Cancer Epidemiol Biomarkers Prev; 23(9); 1764–72. ©2014 AACR.</jats:p

Effects of percutaneous estradiol–oral progesterone versus oral conjugated equine estrogens–medroxyprogesterone acetate on breast cell proliferation and bcl-2 protein in healthy women

In a prospective, randomized clinical study 77 women were assigned randomly to receive sequential hormone therapy with either conventional oral conjugated equine estrogens (0.625 mg) with the addition on 14 of the 28 days of oral medroxyprogesterone acetate (5 mg) or natural E(2) gel (1.5 mg) with oral micronized P (200 mg) on 14 of the 28 days of each cycle. Because oral conjugated equine estrogens-medroxyprogesterone acetate induced a highly significant increase in breast cell proliferation in contrast to percutaneous E(2)-oral P with a difference between therapies approaching significance, the former therapy has a marked impact on the breast whereas natural percutaneous E(2)-oral micronized P has not