Dometi i ograničenja e-learninga u prevenciji karcinoma

Based on the data of the IARC, throughout the world app. 1 115 000 new breast cancer cases are registrated. In Europe breast cancer is the most common cancer in female population (app. 350 000 new cases and 130 000 deaths each year). The permanent education of all healthcare providers in breast cancer prevention remains an important issue in a breast cancer prevention. There are numerious aspects of distance learning in breast cancer prevention: from basic lectures concerning cancer to postgraduate studies in medical oncology, including different models of distance learning and e-learning. In this paper we focused on Web Based Training (WBT) and open platforms for e-learning in this field of education. Apart from the education of the healthcare providers involved in breast cancer prevention, we also focused on different solutions applied in e-learning for the education of healthy female population in different age groups. Few countries in the Balkans have policies for early detection of breast cancer. The development of policies for breast cancer prevention should be regarded as a high priority issue.Prema podacima IARC-a, u svijetu je zabilježeno oko 1,115,000 novih slučajeva karcinoma dojke. U Europi, karcinom dojke je najčešći oblik karcinoma među ženama (svake godine bilježi se oko 350,000 novih slučajeva, a 130,000 slučajeva godišnje završava smrću). Kontinuirana edukacija medicinskog osoblja i osoba zaposlenim u zdravstvenim ustanovama važan je čimbenik u kontekstu prevencije karcinoma dojke. Postoji više aspekata učenja na daljinu kada govorimo o sprečavanju karcinoma dojke, od osnovnih predavanja o karcinomu do poslijediplomskih studija onkologije, koji uključuju različite modele učenja na daljinu i učenja putem interneta. Ovaj rad bavi se učenjem uz pomoć interaktivnih web sadržaja (WBT - Web Based Training) i otvorenim platformama za učenje putem Interneta s ciljem stjecanja znanja iz ovog područja. Osim edukacijom medicinskog osoblja i osoba zaposlenih u zdravstvenim ustanovama, rad se također bavi različitim rješenjima za učenje putem Interneta koja su usmjerena na edukaciju zdrave ženske populacije različitih dobnih skupina. Nekoliko zemalja na Balkanu razvilo je programe ranog otkrivanja karcinoma dojke. Razvoju ovakvih programa za prevenciju karcinoma dojke trebalo bi dodijeliti visoki prioritet

Importance of microcalcifications in mammographic differentiation of the invasive ductal breast cancer and of the ductal carcinoma in situ

Introduction: Microcalcifications represent a significant and reliable sign of the presence of the malignant breast lesion. Aim: The aim of the paper is to radiologically evaluate the type and distribution of suspicious microcalcifications, in patients with invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). Material and Methods: Retrospective analysis includes the evaluation of the type and distribution of suspicious microcalcifications, in patients with histologically verified malignant lesions: invasive ductal carcinoma (N1=40 pts.) and ductal carcinoma in situ (N2=40 pts.). Standardised mediolateral oblique and cranicaudal views were selected for the evaluation of the images, taken on the full-field digital mammograph (FFDM 'Selenia', Institute of Oncology and Radiology of Serbia, Belgrade), on the dedicated workstation of the mammography unit, with the aid of the software for lesion evaluation. Results: Eight patients with invasive ductal carcinoma (20%) had no suspicious microcalcifications, as opposed to the patients with ductal in situ carcinoma, where all patients had suspicious microcalcifications (p<0.05). In the subgroup of patients with invasive ductal carcinoma, the most frequent type of microcalcifications included the fine pleomorphic calcifications (75%). In patients with ductal carcinoma in situ, amorphous (57.5%) and linear/ branching microcalcifications were more frequent than other types (55%). Conclusion: The results of this study show that the amorphous microcalcifications segmental distribution usually detected in the subgroup with DCIS, which coincides with published results. With acceptable sensitivity and specificity, amorphous microcalcifications and linear distribution segment represents a specific mammographic findings in the detection of DCIS

Breast Magnetic Resonance Imaging: Morphologic and Kinetic Parameters in the Evaluation of Breast Carcinoma Response to Neoadjuvant Chemotherapy

Uloga hemioterapijskih protokola primenjenih u neoadjuvantnoj terapiji karcinoma dojke (NACT), podrazumeva indukovanje regresije tumora pre primene hirurškog modaliteta lečenja, kao i sterilizaciju mikrometastatskih fokusa. Praćenje odgovora omogućava ranu procenu efikasnosti NACT. Postizanje patološkog kompletnog odgovora (pCR) nakon primenjene NACT, u korelaciji je sa produženim ukupnim preživljavanjem (OS). Savremeni pristup u izboru specifične onkološke terapije podrazumeva maksimalni efekat u postizanju pCR. Postoji potreba standardizovanja primene senzitivne i specifične radiološke metode za ranu procenu odgovora tumora na NACT, već nakon primene drugog terapijskog ciklusa, kako bi se identifikovale ispitanice kod kojih postoji rani tumorski odgovor. Praćenje odgovora na NACT, moguće je na osnovu praćenja predefinisanih morfološko – dinamskih parametara magnetne rezonanciju dojki (MRI), kao što je promena najveće dimenzije tumora, promena volumena izračunatog na osnovu matematičkog modela, koji uzima u obzir tri dimenzije tumora, procenu tipa tumorske regresije i procenu dinamskih svojstava lezije. Cilj 1. Procena tačnosti postupaka merenja veličine tumora prikazanog MRI – RECIST, volumetrijska metoda, a u odnosu na patohistološku veličinu tumora i odgovor. 2. Procena promene morfologije tumora – tip tumorske regresije (dendritični ili koncentrični tip) u proceni tumorskog odgovora na NACT. 3. Procena dinamskih karakteristika tumora kao parametra neoangiogeneze...The role of neoadjuvant chemotherapy (NACT) in breast cancer treatment is to induce tumor regression before surgery, including the sterilization of micro metastatic foci. Evaluation of tumor response to treatment provides the early assessment of NACT efficacy. Pathological complete response (pCR) upon the completion of NACT correlates with the prolongation of the overall survival (OS). The up-to-date therapeutic approach in breast cancer treatment aims at maximizing the effect of pCR achievement. There is however the need to standardize the highly sensitive and specific imaging method for early assessment of tumor response to NACT – upon the completion of the 2nd cycle of NACT, so that the histologic responders could be identified. The assessment of tumor response to NACT is achieved through the selection and analysis of the predefined morphologic and dynamic parameters – endpoints evaluated with the dynamic contrast enhanced breast MRI that include: the change of the largest tumor size, the change of the tumor volume defined with the mathematical model taking into account the three tumor dimensions, tumor shrinkage pattern and dynamic features of the lesion. Aim 1. Assessment of the tumor size and volume measurement accuracy with MRI, taking into account the measuring tools: RECIST and volume, in relation to the pathological tumor size and response. 2. Assessment of the change of morphologic tumor features – shrinkage pattern (dendritic vs. concentric) as the measure of tumor response to NACT. 3. Assessment of dynamic tumor features as the endpoint reflecting tumor neoangiogenesis..

MRI in the evaluation of breast cancer patient response to neoadjuvant chemotherapy: predictive factors for breast conservative surgery

PURPOSEWe aimed to prospectively assess the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the evaluation of predictive factors for breast conservative surgery during neoadjuvant chemotherapy.MATERIALS AND METHODSSixty-six patients were evaluated before the first treatment cycle, after the second cycle, and upon the completion of neoadjuvant chemotherapy according to largest tumor diameter, tumor volume, postcontrast enhancement, and tumor regression pattern. The patients were divided into responders (pathologic complete and near complete response) and nonresponders. Each subgroup was re-evaluated according to morphokinetic criteria for identification of candidates for breast conservative surgery.RESULTSIn responders (n=27), the lesion size upon the completion of neoadjuvant chemotherapy was significantly smaller compared to nonresponders (1.5±0.6 vs. 3.2±0.9 cm; P < 0.001), as was the volume (1.2 vs. 11.0 cm3; P < 0.001). The measured lesion size did not differ from the histologic size (1.5±0.6 vs. 1.2±0.6 cm; P = 0.09) and had a high correlation (r=0.93). In responders, the following parameters were significantly different before and after neoadjuvant chemotherapy: size (3.6±1.4 to 1.5±0.6 cm; P < 0.001), volume (17.6 to 1.2 cm3; P < 0.001), predominant concentric regression, plateau and continuous time-intensity curves (P < 0.001). DCE-MRI has the sensitivity of 87% and the accuracy of 77% to identify candidates for breast conservative surgery.CONCLUSIONSelected morphokinetic DCE-MRI parameters may contribute to the multidisciplinary decision when considering the selection of candidates for breast conservative surgery

Breast dynamic contrast enhanced MRI: fibrocystic changes presenting as a non-mass enhancement mimicking malignancy

We aimed to analyse the morphokinetic features of breast fibrocystic changes (nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia) presenting as a non-mass enhancement (NME)in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) examination. Forty-six patients with histologically proven fibrocystic changes (FCCs) were retrospectively reviewed, according to Breast Imaging Reporting and Data System (BI-RADS) lexicon. Prior to DCE-MRI examination, a unilateral breast lesion suspicious of malignancy was detected clinically, on mammography or breast ultrasonography. The predominant features of FCCs presenting as NME in DCE-MRI examination were: unilateral regional or diffuse distribution (in 35 patients or 76.1%), heterogeneous or clumped internal pattern of enhancement (in 36 patients or 78.3%), plateau time-intensity curve (in 25 patients or 54.3%), moderate or fast wash-in (in 31 patients or 67.4%).Nonproliferative lesions were found in 11 patients (24%), proliferative lesions without atypia in 29 patients (63%) and lesions with atypia in six patients (13%), without statistically significant difference of morphokinetic features, except of the association of clustered microcysts with proliferative dysplasia without atypia. FCCs presenting as NME in DCE-MRI examination have several morphokinetic features suspicious of malignancy, therefore requiring biopsy (BI-RADS 4). Nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia predominantly share the same predefined DCE-MRI morphokinetic features.Radiology and Oncology (2017), 51(2): 130-13

Posterior breast cancer: Mammographic and ultrasonographic features

Background/Aim. Posterior breast cancers are located in the prepectoral region of the breast. Owing to this distinctive anatomical localization, physical examination and mammographic or ultrasonographic evaluation can be difficult. The purpose of the study was to assess possibilities of diagnostic mammography and breast ultrasonography in detection and differentiation of posterior breast cancers. Methods. The study included 40 women with palpable, histopathological confirmed posterior breast cancer. Mammographic and ultrasonographic features were defined according to Breast Imaging Reporting and Data System (BI-RADS) lexicon. Results. Based on standard two-view mammography 87.5%, of the cases were classified as BI-RADS 4 and 5 categories, while after additional mammographic views all the cases were defined as BIRADS 4 and 5 categories. Among 96 mammographic descriptors, the most frequent were: spiculated mass (24.0%), architectural distortion (16.7%), clustered microcalcifications (12.6%) and focal asymmetric density (12.6%). The differentiation of the spiculated mass was significantly associated with the possibility to visualize the lesion at two-view mammography (p = 0.009), without the association with lesion diameter (p = 0.083) or histopathological type (p = 0.055). Mammographic signs of invasive lobular carcinoma were significantly different from other histopathological types (architectural distortion, p = 0.003; focal asymmetric density, p = 0.019; association of four or five subtle signs of malignancy, p = 0.006). All cancers were detectable by ultrasonography. Mass lesions were found in 82.0% of the cases. Among 153 ultrasonographic descriptors, the most frequent were: irregular mass (15.7%), lobulated mass (7.2%), abnormal color Doppler signals (20.3%), posterior acoustic attenuation (18.3%). Ultrasonographic BI-RADS 4 and 5 categories were defined in 72.5% of the cases, without a significant difference among various histopathological types (p = 0.109). Conclusion. Standard two-view mammography followed by additional mammographic projections is an effective way to demonstrate the spiculated mass and to classify the prepectoral lesion as category BI-RADS 4 or 5. Additional ultrasonography can overcome the mimicry of invasive lobular breast carcinoma at mammography