Mondor’s Disease

A Mondor’s disease is a rare, benign and self-limiting condition. It is due to thrombophlebitis of the superficial veins of the breast and chest wall. It usually occurs in middle-aged women who present with a palpable cordlike structure, often painful in the acute phase. The aetiology is unknown, and may be related to trauma, surgery, infection or tight clothing. The finding of a superficial vessel seen as a linear opacity on mammography and a tubular structure on ultrasound is typical. An intra-luminal thrombus may be seen on ultrasound, and there may be absent flow on Doppler imaging. Conservative treatment is usually instituted, although surgery may be indicated in certain circumstances

Spectrum of breast asymmetries: a pictorial essay

Introduction: Asymmetric breast tissue is a relatively common mammographic finding and is usually benign. It might be due to a normal variation, postoperative changes or hormone replacement therapy. However, an asymmetric area may indicate a developing mass or an underlying cancer. Method: We collected random cases of asymmetric breast densities on mammography, and present examples of the four types according to the recent ACR BIRADs classification. The four types are global asymmetry (previously known as asymmetric breast tissue), asymmetry (previously known as density seen on one projection), focal asymmetry (previously known as focal asymmetric density) and a developing asymmetry (replacing architectural distortion). The final diagnoses are given, confirmed on further investigations such as biopsy and FNAC or supplementary imaging. Conclusion: Accurate interpretation of breast asymmetry found on a mammogram may needs additional imaging studies such as supplementary views, ultrasonography or magnetic resonance imaging. Radiologist should be aware of this condition and further assessment should be carried out in a logical work flow for optimum patient care

False positive detection rate of R2-CAD in evaluation of breast lesions at Full-Field-Digital Mammogram (FFDM)

Introduction: Interpretation of mammogram is a challenging task and the performance level of readers is known to vary widely between general radiologist and breast imaging experts. R2-CAD is a software-based system to identify regions of the mammogram with suspicious features and to draw the reader’s attention to these areas and decide whether they are genuinely abnormal. It has been available for several years with FDA Approval and was recently brought to our centre with the use of FFDM. Method: This is a retrospective study of cases from January 2008 until May 2008. We collected all 191 cases of mammogram with R2-CAD highlighted lesion during this period. The images were traced and reviewed. The CAD-prompt lesion was documented and correlation with supplementary imaging, FNAC or biopsy was done to conclude the CAD-prompt lesion. Result: R2-CAD highlighted calcification in 41 patients (21.5%), lump in 122 patients (63.9%) and both calcification and lump in 28 patients (14.7%). The R2-CAD detected malignant lesions in 13 patients (6.8%), benign lesions in 67 patients (35.1%) and normal breast tissue (false positive) in 111 patients (58.1%) Conclusion: R2-CAD has a high false positive rate and low detection rate for malignant lesions. As such, it should be used as an aid not the first line mammographic interpretation

Melioidosis presenting as orbital and parotid abscesses with intracranial extension

We report a fatal case of melioidosis in a diabetic patient presenting with orbital and parotid abscesses associated with intracranial subdural empyema. The likelihood of infections due to Pseudomonas pseudomallei is increased in patients with reduced immune status in endemic regions of the world. The risk to travellers to South East Asia in this era of global travel is also emphasized

A survey on physical factors and compressed breast thickness in voluntary mammography screening using FFDM system in Malaysia: preliminary results

This paper aims at presenting preliminary results of a survey on physical factors, namely tube potential (kV), tube current exposure time product (mAs) and compressed breast thickness (CBT) during voluntary mammography screening using Full-Field Digital Mammography (FFDM) System in Malaysia. Retrospective data were collected from 1128 FFDM images of 282 women from three major ethnic groups (Malay, Chinese and Indian) who underwent voluntary screening mammography at Breast Centre, International Islamic University Malaysia from January to March 2008. Results from the present study were then compared with results from the previous study on Screen-Film Mammography System (SFM) according to the ethnic group for both Cranio-caudal (CC) and Mediol-Lateral (MLO) views. We found that the mean kV for CC view for the three ethnic groups are Malay (28), Chinese (28) and Indian (28), and for MLO view are Malay (29), Chinese (28) and Indian (29). These values are higher than the kV for SFM which were Malay (26), Chinese (27) and Indian (26) for CC and Malay (26), Chinese (27) and Indian (26) for CC and MLO views respectively. The mean mAs for CC and MLO views for FFDM were lower compared to SFM systems. These values were Malay (104), Chinese (108) and Indian (91) for CC views and Malay (106), Chinese (105), and Indian (94) for MLO views for the FFDM system. The values for SFM system are for CC and MLO views were Malay (120), Chinese (106) and Indian (126), and Malay (166), Chinese (132), Indian (183) respectively. The median CBT for CC and MLO views increased by 27% and 7% respectively on the FFDM compared to the SFM system. In conclusion, the FFDM operates with higher kV, lower mAs, and higher CBT when compared with SFM system. Median CBT on CC and MLO view with FFDM system are 27% and 7% higher respectively compared to the SFM. We are currently collecting data on mean glandular dose with FFDM systems to assess how the change in local mammography practice influences this value. This will allow comparison with related data from other parts of the world

Influence of support group intervention on quality of life of Malaysian breast cancer survivors

Given that breast cancer is the most prevalent form of cancer affecting Malaysian women and its low survival rate, this study investigates the possible influence of support group intervention on quality of life (QOL). It also examines the interrelationships between QOL subdomains as research has shown the influence of emotional expression on psychological and physical wellbeing. Rasch analysis was implemented to examine perception of QOL and the comparability of the Functional Assessment of Cancer Therapy General and Breast Cancer scales (FACT-G and FACT-B) of the Functional Assessment of Chronic Illness Therapy inventory. Results indicated that perception of QOL may be influenced by factors other than support group intervention. The FACT-G and FACT-B scales were comparable in the measurement of QOL for breast cancer, and the interrelationships between the QOL subdomains were supported. The findings of this study accentuate the importance of focusing support group interventions on improvement of emotional well-being to maintain patients’ QOL despite the cancer

Causal links in QOL sub-domains accentuate greater support for physical and emotional well-being of breast cancer survivors

Group psychotherapy or support group (SG) interventions have been reported to improve the quality of life (QOL) of cancer patients. For an improved life of Malaysian breast cancer survivors, facilities for SG interventions have been set up both in the urban and rural areas of the country. However, the impact of support group participation on QOL of these patients, and factors that may influence it have remained elusive. This study, examines the impact of SG participation on the QOL of Malaysian breast cancer survivors using the Functional Assessment of Chronic Illness Therapy (FACIT) questionnaire. Multiple comparisons using the Tukey HSD show that the QOL measure for rural SG participants are significantly lower (F(2,55) = 14.570; p < 0.01) than for urban SG participants. Analysis of the interrelationships between the QOL sub-domains indicated that functional wellbeing (FWB) fully mediates the effects of physical wellbeing (PWB) and emotional wellbeing (EWB) on social wellbeing (SWB). In addition, PWB was relatively more influential than EWB in determining patients’ FWB and SWB while PWB, EWB and FWB collectively explained about 25% of the variability in SWB. Findings of this study thus indicate that measurement of QOL is relative to patients’ location i.e., urban or rural, which in turn reflects the patients’ education and financial background

The College of Radiology Mammogram Subsidy Programme at IIUM Breast Centre, Kuantan : an audit (2004 -2008)

INTRODUCTION & OBJECTIVE The IIUM Breast Centre is an accredited mammogram provider under the College of Radiology Subsidised Mammography Programme (CMP) from 2004. We wish to present an audit of the results on 1344 Malaysian women who had mammogram under the programme at the Centre from 2004 - 2008. METHODS All women who came for mammogram under the CMP Programme were included in this 5-year review. Social and demographic data were analyzed and mammogram studies were reported based on BIRADS categories. Breast Ultrasound was performed on subjects with dense breasts and whenever mammogram findings were abnormal. Lesion sampling was performed on indeterminate or suspicious lesions, based on mammographic and sonographic features and lesion vascularity on Colour Flow Imaging (CFI). Probably benign BIRADS 3 lesions were monitored by short term ultrasound surveillance. Results of sampling were classified into normal, benign breast disease and breast cancer. RESULTS A total of 1344 subjects had breast imaging under the programme, with preference given to women with a family history of breast cancer. Chinese women were the largest racial group participating in the programme (59%). A family history of breast cancer was present in 9.5% of subjects. Most subjects (55.2%) had normal findings (BIRADS 1); 28.6% had benign findings (BIRADS 2); while 3.7% were in BIRADS 4 & 5 categories. Breast Ultrasound was done in 52% of women, and lesion sampling in 44 patients (3.2%). Sampling techniques used were FNAC (47%) and core biopsy (43%), and 5 women had image-guided hook-wire localization prior to excision. Pathology results showed benign breast disease in 47.6% and breast cancer in 45.3%. The cancer detection rate in this group is 19/1344 (1.4%). CONCLUSION Mammography offers the best chance of detecting early breast cancer. Subsidised mammography programmes are available in the country in the absence of national level population screening. This audit of 1344 women who participated in the College of Radiology Subsidised Mammography Programme showed that mammography supplemented with ultrasound prior to lesion sampling yielded a positive sampling rate of 45.3% and a cancer detection rate of 1.4%