Tubulolobular carcinoma of the breast: clinical, mammographic and sonographic findings

PURPOSE: To determine and quantitate radiologic characteristics of tubulolobular carcinoma of the breast and to report clinical and pathologic findings. MATERIALS AND METHODS: A retrospective review of records of 2872 women who received a diagnosis of breast carcinoma between January 1988 and January 2006 revealed 26 histopathologically proven tubulolobular carcinoma of the breast. Analysis included history; findings at physical examination, mammography, and sonography (US) at the time of diagnosis and in postoperative follow-up, and histopathological results. RESULTS: At physical examination, palpable mass was present in 85% (n=22) of the patients. The mammographic findings were mass in 17 (65%), asymmetric focal density in 2 (8%), architectural distortion in 2 (8%) and negative mammograms in 5 (19%) of the 26 patients. US depicted 25 masses in 24 patients, all of which were hypoechoic, with spiculated (n=13) or microlobulated (n=12) margins. The cancer was clinically occult in 12% (n=3), mammographically occult in 19% (n=5), and radiologically occult in 4% (n=1) of the patients. Histologically, the mean size of the tumor was 1.7cm and 18 (69%) patients were node negative. CONCLUSION: Tubulolobular carcinoma of the breast usually manifests clinically as a firm, immobile mass and mammographically as a spiculated or ill-defined, irregular, isodense mass without microcalcifications. Common findings on sonography include a homogeneously hypoechoic, spiculated or microlobulated mass with posterior acoustic shadowing or normal acoustic transmission. Tubulolobular carcinoma should be included in the differential diagnosis for breast masses with these imaging features.     

Visibility of mammographically occult breast cancer on diffusion-weighted MRI versus ultrasound

PurposeTo investigate the visibility of mammographically occult breast cancers on diffusion-weighted MRI (DWI) versus ultrasound.Materials and methodsMammographically occult breast cancers (n = 60) initially detected on contrast-enhanced MRI that underwent pre-biopsy targeted ultrasound were retrospectively evaluated for visibility on DWI and ultrasound.ResultsMore cancers were visible on DWI than ultrasound (78% vs. 63%; p = 0.049), with 32 (53%) visible on both and 7 (12%) not visible on either. Visibility differences were more significant in larger lesions (92% vs. 68%, p = 0.006).ConclusionDWI may detect more mammographically occult cancers than ultrasound, warranting further investigation as an alternative supplemental screening technique.     

Impact of margin status on outcomes following accelerated partial breast irradiation using single-lumen balloon-based brachytherapy

PurposeTo examine the impact of margin status on clinical outcomes for patients enrolled in the American Society of Breast Surgeons (ASBrS) MammoSite^® Registry Trial.Methods and MaterialsOne thousand four hundred forty-nine cases of early-stage breast cancer underwent breast-conserving therapy with a single-lumen balloon-based applicator used to deliver adjuvant accelerated partial breast irradiation (34 Gy in 10, bid fractions). One thousand two hundred fifty-five cases (87%) had invasive breast cancer (median size = 10 mm) and 194 cases (13%) had ductal carcinoma in situ (DCIS; median size = 8 mm).ResultsPatients were stratified by margin status into negative (n = 1326), close (<2mm; n = 110), and positive (n = 13) margins. One hundred twenty-three cases (8.5%) had close or positive margins. Overall, no statistical difference in the 6-year rate of ipsilateral breast tumor recurrence (IBTR) was noted for close margins compared with that of margin-negative patients (8.7% vs. 4.1%, p = 0.10) or for positive margins compared with that of margin-negative patients (14.3% vs. 4.1%, p = 0.41). In patients with DCIS, there was a statistically significant increase in IBTR with close margins (17.6% vs. 4.2%, p = 0.004) and when close and positive margins were pooled (15.7% vs. 4.2%, p = 0.01 with a nonsignificant reduction in disease-free survival for DCIS patients with close margins (82.4% vs. 90.8%, p = 0.12). The increase in IBTR for close and close/positive patients was secondary to statistically significant increases in elsewhere failures rather than true recurrences/marginal misses.ConclusionNonsignificant increases in the rates of IBTR were noted with close and positive margins for invasive cancer with further data required to validate these findings.     

Use and perception of breast protective equipment by female contact football players

ObjectivesFemale contact football players sustain contact breast injuries that can negatively affect their sporting performance. This study investigated what female contact football players wear on their breasts during training and competition, and their perceptions on the protection provided by these garments against contact breast injury.DesignA custom-designed survey about breast injuries and prevention strategies was distributed via an online link to coaches and team staff of contact football teams throughout Australia. The fit and features of breast support and/or protection that players wore during training and competition were also directly assessed.Methods207 female Australian Football League (AFL), Rugby League, Rugby Union (XVs) and Rugby 7 s players completed the survey. The breast support of 112 of these players was also assessed.ResultsOnly 17% (n = 35) of players reported using breast protective equipment, of which 66% (n = 23) perceived it provided protection against contact breast injuries. Reasons reported for not using protective equipment included not knowing it existed (n = 79, 53%), it was too uncomfortable/hot (n = 50, 24%) and that it did not fit or was restrictive (n = 33, 22%). Although most players (n = 97, 87%) reported to wear a sports bra, 52% (n = 58) wore an ill-fitted bra and only 31% (n = 63) perceived it provided any protection against contact breast injuries.ConclusionsBreast protective equipment is not commonly worn by female contact football players reportedly due to a lack of awareness of its existence, discomfort or poor fit. Although most female contact football players usually wore a sports bra, most players perceived these bras did not provide breast protection.     

Contrast-enhanced multiphasic CT and MRI findings of adenosquamous carcinoma of the pancreas

ObjectiveThe objective was to retrospectively study computed tomography (CT) and magnetic resonance imaging (MRI) findings of adenosquamous carcinoma of the pancreas (PASC).Materials and MethodsTwelve patients (six women and six men; mean age, 61.3 years; range, 47–78 years) who presented with PASC as documented by pathologic examination underwent CT (n= 10) or both CT and MRI (n= 2) examination. Two radiologists evaluated the images and determined the location, size, margin, internal attenuation or signal intensity, contrast enhancement, and pattern for each tumor. Additionally, the presence of poorly enhanced areas, upstream main pancreatic duct (MPD) dilatation, pancreatic atrophy, and peripancreatic tissue metastasis were evaluated. Images were cross-referenced to surgical and pathologic findings.ResultsMasses were distributed throughout the pancreas (head, n= 6; body, n= 1; and tail, n= 5). The tumor size ranged from 2.4 to 5.5 cm with an average size of 3.7 cm. Eight (66.7%) masses were ill defined, and seven (58.3%) were partially exophytic. Twelve (100%) masses showed heterogeneous and poorly enhanced areas. The lesions showed weak (n= 5), moderate (n= 5), or intense (n= 2) progressive enhancement. The diameter of MPD in six patients ranged from 3.0 to 5.0 mm with an average of 3.7 mm. Pancreatic atrophy was not found. In 10 patients (83.3%), masses invaded the peripancreatic tissues. Two patients had metastatic liver disease at presentation.ConclusionPASC typically presented as an ill-defined, hypovascular mass with a poorly enhanced area, exophytic tendency, and peripancreatic tissue invasion. Lack of pancreatic atrophy and mild MPD dilatation were also distinct from common duct pancreatic adenocarcinoma.     

Improving muscular endurance with the MVe Fitness Chair™ in breast cancer survivors: A feasibility and efficacy study

ObjectivesTo assess the feasibility and efficacy of delivering Pilates exercises for resistance training to breast cancer survivors using the MVe Fitness Chair?.DesignPilot randomized controlled trial.MethodsTwenty-six female breast cancer survivors were randomized to use the MVe Fitness Chair? (n = 8), traditional resistance training (n = 8), or a control group (no exercise) (CO) (n = 10). The MVe Fitness Chair? and traditional resistance training groups completed 8 weeks of exercise. Muscular endurance was assessed pre and post-test for comparisons within and between groups using push ups, curl ups, and the Dynamic Muscular Endurance Test Battery for Cancer Patients of Various Ages.ResultsFeasibility of the MVe Fitness Chair? was good, evidenced by over 80% adherence for both exercise groups and positive narrative feedback. Significant improvements in muscular endurance were observed in the MVe Fitness Chair? (p < 0.002) and traditional resistance training groups (p < 0.001), but there were no differences in improvement between the MVe Fitness Chair? and traditional resistance training groups (p < 0.711) indicating that Pilates and traditional resistance training may be equally effective at improving muscular endurance in this population.ConclusionsThe MVe Fitness Chair? is feasible for use in breast cancer survivors. It appears to promote similar improvements in muscular endurance when compared to traditional resistance training, but has several advantages over traditional resistance training, including cost, logistics, enjoyment, and ease of learning.     

Repeated surgeries in invasive lobular breast cancer with preoperative MRI: Role of additional carcinoma in situ and background parenchymal enhancement

ObjectivesAnalysing the influence of additional carcinoma in situ (CIS) and background parenchymal enhancement (BPE) in preoperative MRI on repeated surgeries in patients with invasive lobular carcinoma (ILC) of the breast.MethodsRetrospective analysis of 106 patients (mean age 58.6 ± 9.9 years) with 108 ILC. Preoperative tumour size as assessed by MRI, mammography and sonography was recorded and compared to histopathology. In contrast-enhanced MRI, the degree of BPE was categorised by two readers. The influence of additionally detected CIS and BPE on the rate of repeated surgeries was analysed.ResultsAdditional CIS was present in 45.4% of the cases (49/108). The degree of BPE was minimal or mild in 80% of the cases and moderate or marked in 20% of the cases. In 17 cases (15.7%) at least one repeated surgery was performed. In n = 15 of these cases, repeated surgery was performed after BCT (n = 9 re-excisions, n = 6 conversions to mastectomy), in n = 2 cases after initial mastectomy. The initial surgical procedure (p = 0.008) and additional CIS (p = 0.046) significantly influenced the rate of repeated surgeries, while tumour size, patient age and BPE did not (p = ns).ConclusionsAdditional CIS was associated with a higher rate of repeated surgeries, whereas BPE had no influence.     

Dual-modal computer-assisted evaluation of axillary lymph node metastasis in breast cancer patients on both real-time elastography and B-mode ultrasound

PurposeTo propose a computer-assisted method for quantifying the hardness of an axillary lymph node on real-time elastography (RTE) and its morphology on B-mode ultrasound; and to combine the dual-modal features for differentiation of metastatic and benign axillary lymph nodes in breast cancer patients.Materials and methodsA total of 161 axillary lymph nodes (benign, n = 69; metastatic, n = 92) from 158 patients with breast cancer were examined with both B-mode ultrasound and RTE. With computer assistance, five morphological features describing the hilum, size, shape, and echogenic uniformity of a lymph node were extracted from B-mode, and three hardness features were extracted from RTE. Single-modal and dual-modal features were used to classify benign and metastatic nodes with two computerized classification approaches, i.e., a scoring approach and a support vector machine (SVM) approach. The computerized approaches were also compared with a visual evaluation approach.ResultsAll features exhibited significant differences between benign and metastatic nodes (p < 0.001), with the highest area under the receiver operating characteristic curve (AUC) of 0.803 and the highest accuracy (ACC) of 75.2% for a single feature. The SVM on dual-modal features achieved the largest AUC (0.895) and ACC (85.7%) among all methods, exceeding the scoring (AUC = 0.881; ACC = 83.6%) and the visual evaluation methods (AUC = 0.830; ACC = 84.5%). With the leave-one-out cross validation, the SVM on dual-modal features still obtained an ACC as high as 84.5%.ConclusionDual-modal features can be extracted from RTE and B-mode ultrasound with computer assistance, which are valuable for discrimination between benign and metastatic lymph nodes. The SVM on dual-modal features outperforms the scoring and visual evaluation methods, as well as all methods using single-modal features. The computer-assisted dual-modal evaluation of lymph nodes could be potentially used in daily clinical practice for assessing axillary metastasis in breast cancer patients.     

Outcomes of radioembolization for unresectable hepatocellular carcinoma in patients with marginal functional hepatic reserve

PurposeTo evaluate the outcomes of radioembolization (RE) as a therapy for unresectable hepatocellular carcinoma (HCC) in patients with marginal functional hepatic reserve.MethodsA retrospective review of 471 patients (1/2010–7/2015) treated with RE (Therasphere, BTG, UK) was performed. A total of 36 patients (mean age: 66.1 ± 9.3, male: 86.1%) underwent therapy for HCC with a MELD ≥ 15 (median: 16, range: 15–22). Baseline demographics of the study cohort were as follows: etiology (HCV: 26, 72.2%), cirrhosis (n = 32, 88.9%), ECOG 0 (n = 16, 44.4%), Child-Pugh class (A = 15, B = 19, C = 2), unilobar distribution (n = 27, 75%), AFP > 200 (n = 11, 30.6%), portal vein thrombosis (PVT, n = 7, 19.4%), metastasis (n = 3, 8.3%). Outcomes analyzed included CTCAEv4.03 laboratory toxicities (120-day), imaging response (mRECIST), progression-free survival (PFS), and overall survival (OS).ResultsA total of 42 treatments were performed with mean dose of 2.02 ± 1.23 GBq. The cumulative grade 3/4 toxicity was 28% overall and 21% for bilirubin at 120-days. The objective response and disease control rates were 48.3% (14/29) and 69% (20/29) respectively. The median (95% CI) PFS was 5.9 (4.4–7.7) months. Ten (27.8%) patients received additional locoregional therapy at a median (IQR) of 138 (102–243) days post RE. The mean (95% CI) OS was 21.9 (14.8–29.0) months. The absence of PVT was associated with improved OS (p = 0.005) Disease control at 90-days was also associated with an OS benefit (p = 0.037).ConclusionsPatients with unresectable HCC and marginal functional hepatic reserve treated with RE had favorable objective response and disease control rates, both predictive of overall survival.     

Impact of fibroglandular tissue and background parenchymal enhancement on diffusion weighted imaging of breast lesions

PurposeTo evaluate the influence of the amount of fibroglandular breast tissue (FGT) and background-parenchymal enhancement (BPE) on lesion detection, quantitative analysis of normal breast tissue and of breast lesions on DWI.Materials and methodsIRB approved this retrospective study on focal findings at contrast-enhanced (CE) breast MR and DWI performed during July–December 2011. Patients with cysts, previous irradiation, silicone implants and current chemotherapy were excluded. DWI with fat suppression was acquired before dynamic acquisition (b factors: 0.1000 s/mm²) using 1.5 and 3 T scanners. Using correlation with dynamic and T2 images, ROIs were drawn free-hand within the borders of any visible lesion and in contralateral normal breast. Fisher's exact test to evaluate visibility and Wilcoxon-rank-sum test for comparison of ADC values were used. The amount of FGT and BPE was visually assessed by concurrent MRI. Analysis was stratified by menopausal status.Results25/127 (20%) lesions were excluded for technical reasons. 65/102 (64%) lesions were visible on DWI (median diameter: 1.85 cm). Mass lesions (M) were more visible (43/60 = 72%) than non-mass enhancement (NME) (22/42 = 52%) and malignant lesions were more visible (55/72 = 76%) than benign (10/30 = 33%). BPE and FGT did not influence visibility of M (p = 0.35 and p = 0.57 respectively) as well as of NME (p = 0.54 and p = 0.10). BPE and FGT did not influence visibility of malignant (p = 0.96 and p = 1.0) and benign lesions (p = 1.0 and p = 0.10). Results were confirmed adjusting for menopausal status. The ADC value of normal breast tissue was not influenced by BPE, while it was lower in predominantly fatty breasts compared to dense ones (p = 0.002).ConclusionsFGT affects the quantitative evaluation of ADC in normal breast tissue whereas BPE does not. Furthermore, both BPE and FGT do not influence visibility of benign or malignant findings, including both mass lesions and non-mass enhancement, on DWI.     

Imaging features of automated breast volume scanner: Correlation with molecular subtypes of breast cancer

ObjectivesTo investigate the correlation between the imaging features obtained by an automated breast volume scanner (ABVS) and molecular subtypes of breast cancer.MethodsWe examined 303 malignant breast tumours by ABVS for specific imaging features and by immunohistochemical analysis to determine the molecular subtype. ABVS imaging features, including retraction phenomenon, shape, margins, echogenicity, post-acoustic features, echogenic halo, and calcifications were analysed by univariate and multivariate logistic regression analyses to determine the significant predictive factors of the molecular subtypes.ResultsBy univariate logistic regression analysis, the predictive factors of the Luminal-A subtype (n = 128) were retraction phenomenon (odds ratio [OR] = 10.188), post-acoustic shadowing (OR = 5.112), and echogenic halo (OR = 3.263, P < 0.001). The predictive factors of the Human-epidermal-growth-factor-receptor-2-amplified subtype (n = 39) were calcifications (OR = 6.210), absence of retraction phenomenon (OR = 4.375), non-mass lesions (OR = 4.286, P < 0.001), absence of echogenic halo (OR = 3.851, P = 0.035), and post-acoustic enhancement (OR = 3.641, P = 0.008). The predictors for the Triple-Negative subtype (n = 47) were absence of retraction phenomenon (OR = 5.884), post-acoustic enhancement (OR = 5.255, P < 0.001), absence of echogenic halo (OR = 4.138, P = 0.002), and absence of calcifications (OR = 3.363, P = 0.001). Predictors for the Luminal-B subtype (n = 89) had a relatively lower association (OR ≤ 2.328). By multivariate logistic regression analysis, retraction phenomenon was the strongest independent predictor for the Luminal-A subtype (OR = 9.063, P<0.001) when present and for the Triple-Negative subtype (OR = 4.875, P<0.001) when absent.ConclusionsABVS imaging features, especially retraction phenomenon, have a strong correlation with the molecular subtypes, expanding the scope of ultrasound in identifying breast cancer subtypes with confidence.     

Small nodules (1–2 cm) in liver cirrhosis: Characterization with contrast-enhanced ultrasound

ObjectiveTo determine the diagnostic efficacy of arterial phase contrast-enhanced ultrasound (CEUS) for characterizing small hepatic nodules (1–2 cm) in patients with high-risk for hepatocellular carcinoma (HCC).Materials and methodsOver 12 months, CEUS was performed in 59 patients at high-risk for HCC with small hepatic nodules (1–2 cm; mean, 1.5 cm). Based only on arterial phase (<45 s) vascular intensity and pattern, lesions were prospectively diagnosed as HCC if there was hypervascularity without known features of hemangioma. The diagnosis of HCC was made regardless of the presence or absence of washout. Verification of diagnosis was made by liver transplantation (n = 13), biopsy (n = 12), resection (n = 3) or clinical and imaging follow-up for at least 12 months (n = 31).ResultsAt of the time of CEUS, the 59 nodules were diagnosed as HCC in 26 and benign lesions in 33, including 20 regenerative/dysplastic nodules (RN/DN), 11 hemangiomas, and 2 focal fat sparing. All 26 nodules with arterial phase hypervascularity without hemangioma-like features were HCC. However, CEUS misdiagnosed HCC as RN/DN in 4 cases with arterial iso- (n = 3) or hypovascularity (n = 1). CEUS correctly diagnosed all 11 hemangiomas. The sensitivity, specificity, and accuracy of CEUS for diagnosing HCC were 86.7, 100, and 93.2%.ConclusionsArterial phase vascular intensity and pattern of CEUS are highly accurate for the diagnosis of small (1–2 cm) HCC and hemangioma in liver cirrhosis. On CEUS, arterial phase hypervascularity without a hemangioma-pattern alone may be sufficient for diagnosis of small HCC. Infrequent iso/hypovascular HCC may erroneously suggest RN/DN necessitating biopsy or close follow-up.     

Simultaneous whole-body 18F-FDG PET-MRI in primary staging of breast cancer: A pilot study

PurposeAccurate initial staging in breast carcinoma is important for treatment planning and for establishing the likely prognosis. The purpose of this study was to assess the utility of whole body simultaneous ¹⁸F-FDG PET-MRI in initial staging of breast carcinoma.Methods36 patients with histologically confirmed invasive ductal carcinoma underwent simultaneous whole body ¹⁸F-FDG PET-MRI on integrated 3 T PET-MR scanner (Siemens Biograph mMR) for primary staging. Primary lesion, nodes and metastases were evaluated on PET, MRI and PET-MRI for lesion count and diagnostic confidence (DC). Kappa co relation analysis was done to assess agreement between the satellite, nodal and metastatic lesions detected by PET and MRI. Histopathology, clinical/imaging follow-up served as the reference standard.Results36 patients with 37 histopathologically proven index breast cancer were retrospectively studied. Of 36 patients, 25 patients underwent surgery and 11 patients received systemic therapy. All index cancers were seen on PET and MR. Fused PET-MRI showed highest diagnostic confidence score of 5 as compared to PET (median 4; range 3–5) and MRI (median 4; range 4–5) alone. 2/36 (5.5%) patients were detected to have unsuspected contralateral synchronous cancer. 47 satellite lesions were detected on DCE MRI of which 23 were FDG avid with multifocality and multicentricity in 21 (58%) patients. Kappa co relation analysis revealed fair agreement for satellite lesion detection by the two modalities (κ = 0.303; P = 0.003).The study showed a sensitivity of 60% and 93.3% on PET and MRI respectively for detection of axillary lymph nodes with a specificity of 91% for both and a false negative rate of 6.7% on MRI and 40% on PET. Kappa co relation analysis between PET and MRI for all the lymph nodes detected revealed fair agreement by the two modalities (κ = 0.337; P = 0.000). Combined PET-MRI increased diagnostic confidence for nodal involvement (median DC 5, range 4–5; P < 0.05).Distant metastases were found in 8/36 (22%) patients at the time of diagnosis with a total of 91 metastatic lesions on PET (DC ≥ 4) and 105 on MRI (DC ≥ 4), the difference being statistically significant (P = 0.001) while Kappa co relation analysis showed significant agreement between the two modalities (κ = 0.667; P = 0.000). Overall PET-MRI led to a change in management in 12 (33.3%) patients.ConclusionIn this pilot study, simultaneous ¹⁸F-FDG PET-MR, has been found to be useful in whole-body initial staging of breast cancer patients.     

Analysis of brain and spinal cord lesions to occult brain damage in seropositive and seronegative neuromyelitis optica

ObjectivesAccording to aquaporin-4 antibody (AQP4-Ab), neuromyelitis optica (NMO) can be divided into seropositive and seronegative subgroups. The purpose of this study was to a) compare the distribution of spinal cord and brain magnetic resonance imaging (MRI) lesions between seropositive and seronegative NMO patients; b) explore occult brain damage in seropositive and seronegative NMO patients; and c) explore the contribution of visible lesions to occult grey and white matter damage in seropositive and seronegative NMO patients.Materials and methodsTwenty-two AQP4-Ab seropositive and 14 seronegative NMO patients and 30 healthy controls were included in the study. Two neuroradiologists independently measured the brain lesion volume (BLV) and the length of spinal cord lesion (LSCL) and recorded the region of brain lesions. The normal-appearing grey matter volume (NAGM-GMV) and white matter fractional anisotropy (NAWM-FA) were calculated for each subject to evaluate occult brain damage.ResultsThe seropositive patients displayed more extensive damage in the spinal cord than the seronegative patients, and the seronegative group had a higher proportion of patients with brainstem lesions (28.57%) than the seropositive group (4.55%, P = 0.064). Both NMO subgroups exhibited reduced NAGM-GMV and NAWM-FA compared with the healthy controls. NAGM-GMV was negatively correlated with LSCL in the seropositive group (r_s = −0.444, P = 0.044) and with BLV in the seronegative group (r_s = −0.768, P = 0.002). NAWM-FA was also negatively correlated with BLV in the seropositive group (r_s = −0.682, P < 0.001).ConclusionOur findings suggest that the occult brain damage in these two NMO subgroups may be due to different mechanisms, which need to be further clarified.     

Factors associated with one step surgery in case of non-palpable breast cancer

PurposeTo examine factors associated with one step surgery in case of non-palpable breast cancer.Materials and methodsClinical data of 152 consecutively diagnosed patients with breast cancer were analyzed retrospectively. Preoperative diagnostic findings were divided in subgroups: mammographically visible mass/microcalcifications/sonographically visible mass/sonographically visible architectural distortion. Correlation between tumor-size, radiologic tumor morphology, quality of localization and number of operation was evulated. For localization exact wire position was defined less than 3 mm apart from the lesion.ResultsOne hundred and thirty-six patients attempted breast conservation and underwent preoperative tumor localization. Fourteen of 16 patients had mastectomy without preoperative localization. Average tumor size was 12 mm for one-operation, and 17 mm for re-operation. Significant correlation (p < 0.001) was found between one operation and masses visible in mammograms (55/62 (89%) patients) or sonography (53/64 (83%) patients). Significant correlation was found (p < 0.001) between more re-operation and microcalcifications in mammograms (33/89 (37% patients). In 123/138 (89%) cases wire position was central, in 15/138 (11%) cases distance was maximally 10 mm. No significant correlation was found between number of operation and wire position. Re-operation was required in 38 cases.ConclusionMammographically or sonographically visible mass, small size of tumors, preoperative percutaneous biopsy and exact preoperative localization are important for a single step procedure for definite surgical treatment, that we found in 74% of the patients.     

Preoperative breast MR Imaging in patients with primary breast cancer has the potential to decrease the rate of repeated surgeries

PurposeThe impact of preoperative MRI on re-excisions and mastectomy rate is discussed controversially in the literature. Aim of this study was to evaluate the effect of preoperative breast MRI on the surgical procedure and rate of repeated surgeries.Material and methodsA total of 991 consecutive patients in the years 2009 and 2010 with 1036 primary breast cancers were retrospectively analyzed. Sixty percent (599 patients with 626 cancers) received preoperative breast MRI. Planned surgical procedures before and after MRI and numbers of repeated surgeries in patients with (MR+ ) and without preoperative MRI (MR−) were compared.ResultsThe result of preoperative MRI changed the surgical procedure in 25% (157/626) of the cases. In 81% (127/157), MRI was beneficial for the patients, as otherwise occult carcinomas were removed (n = 122) or further biopsy could be prevented (n = 5). Mastectomy rates did not differ between MR+ and MR- group (39% vs. 39%). On multiple regression analysis, the MR+ group had a lower chance for repeated surgery (p < 0.05).ConclusionPreoperative MRI could lower the chance for repeated surgery in patients with primary breast cancer. The rate of mastectomy did not differ between patients undergoing preoperative MRI and those who did not.     

Long-term outcomes with high-dose-rate brachytherapy for the management of base of tongue cancer

PurposeTo report the long-term results of a prospective, nonrandomized clinical trial using high-dose-rate (HDR) brachytherapy (BT) for the management of base of the tongue (BOT) tumors.Methods and MaterialsBetween January 1992 and June 2011, 60 patients (mean age, 57 years; range, 36–78 years) with T1–T4 and N0-3 carcinoma of BOT were treated. Fifty-six patients (93%) had advanced (Stage III-IV) disease. HDR BT boost (mean dose, 17 Gy; range, 12–30 Gy) was delivered after 50–70 Gy (mean 62 Gy) locoregional external beam irradiation. Seventeen patients (28%) received radiochemotherapy (RCT) with cisplatin.ResultsThe 5-year actuarial rate of local tumor control, locoregional tumor control, overall survival (OS), and cancer-specific survival (CSS) was 57%, 50%, 47%, and 61%, respectively. OS was significantly better in patients (n = 17) receiving RCT (69% vs. 39%; p = 0.005). Delayed soft-tissue ulceration occurred in seven patients (12%). Only one patient (<2%) developed osteoradionecrosis. In univariate analysis, the tumor size (T1–T2–T3 vs. T4) was found to have a significant effect on CSS (p = 0.043), whereas the nodal status (N0 vs. N+) affected locoregional tumor control (p = 0.042), OS (p = 0.002), and CSS (p = 0.015). Low histologic grade (1–2) was associated with better CSS (p = 0.020), whereas RCT significantly improved OS (p = 0.012).ConclusionsExternal beam irradiation combined with interstitial HDR BT boost results in good local tumor control with an acceptable rate of late side effects in patients with BOT carcinoma. RCT improves OS. Our results are similar to those reported with traditional low-dose-rate BT implants.     

Direct lymphangiography as treatment option of lymphatic leakage: Indications,outcomes and role in patient's management

BackgroundTo evaluate the effectiveness of lymphography as a minimally invasive treatment option of lymphatic leakage in terms of local control and to investigate which parameters influence the success rate.MethodThis retrospective study protocol was approved by the ethic committee. Patient history, imaging data, therapeutic options and follow-up were recorded and retrospectively analyzed. Between June 1998 and February 2013, 71 patients (m:w = 42:29, mean age, 52.4; range 42–75 years) with lymphatic leakage in form of lymphatic fistulas (n = 37), lymphocele (n = 11), chylothorax (n = 13) and chylous ascites (n = 10) underwent lymphography. Sixty-four patients (90.1%) underwent successful lymphography while lymphography failed in 7 cases. Therapeutic success was evaluated and correlated to the volume of lymphatic leakage and to the volume of the applied iodized oil.ResultSigns of leakage or contrast extravasation were directly detected in 64 patients. Of 64 patients, 45 patients (70.3%) were treated and cured after lymphography. Based on the lymphography findings, 19 patients (29.7%) underwent surgical intervention with a completely occlusion of lymphatic leakage. The lymphatic leak could be completely occluded in 96.8% of patients when the lymphatic drainage volume was less than 200 mL/day (n = 33). Even when lymphatic drainage was higher than 200 mL/day (n = 31), therapeutic lymphography was still successful in 58.1% of the patients.ConclusionLymphography is an effective, minimally invasive method in the detection and treatment of lymphatic leakage. The volume of lymphatic drainage per day is a significant predictor of the therapeutic success rate.