Adenoid cystic carcinoma: A case of rare breast cancer

Adenoid cystic carcinoma is a rare form of breast cancer accounting for 0.1%-1.0% of all mammary malignancies. It is characterized by an indolent clinical course and favorable prognosis, contrary to other breast cancers. Diagnostic mammogram and breast ultrasound play a pivotal role in the early detection and diagnosis of breast adenoid cystic carcinoma. Treatment may consist of lumpectomy and radiation therapy vs mastectomy alone. Even though rare, late disease recurrence and metastasis has been reported in the literature thus long-term surveillance is of utmost importance for these patients. We will review the literature and discuss the case of a 52-year-old female who presented with a palpable lump of the right breast, which was pathologically proven to be adenoid cystic carcinoma of the breast.     

Mammography screening for breast cancer: Four years of nationwide screening in Finland

Biennial breast cancer screening with two-view screen-film mammography started on a nationwide basis in Finland in January 1987. Women have been invited by birth year cohort to attend a free-of-charge examination. The program has progressively expanded to include two or three new birth year cohorts yearly of women between 50 and 59 years of age. Participation has averaged 89% and the breast cancer detection rate has ranged from 3.8 to 3.3 per thousand compared with an expected annual incidence of breast cancer in this age group of 1.6 per thousand. The positive predictive value has increased from 33% to 53%. Results to date, collected by the radiologists responsible for each screening centre, indicate an acceptable sensitivity and specificity for the program. Specificity is much better than that which had generally been considered possible or practical. Double reading of all films, intensive training in both mammography and mammography screening, and careful evaluation of ongoing results by the radiologists involved are all believed to be important factors leading to a high sensitivity and specificity of mammography screening. Correspondence to: M. Pamilo     

The role of self-evaluation and education of radiographers involved in a breast cancer screening program at Clinical Hospital Center Rijeka

IntroductionEarly breast cancer detection can be achieved by enforcing the quality of mammography screening program. Hence, proper breast positioning is necessary. Systematic education of radiographers on mammographic positioning is a prerequisite for obtaining high-quality mammograms. The aim of this study is to demonstrate the importance of self-evaluation and education of radiographers involved in a breast cancer screening program.MethodsThe First School of Mammographic Positioning was organized in 2018 at Clinical Hospital Center (CHC) Rijeka and 24 radiographers included in the screening program attended. Four months after the School, an analysis and comparison of randomly selected mammograms was performed. Retrospective analysis was performed, and two sets of collected data were gathered from the period before and after the education. The quality criteria for evaluation were set and the mammograms were independently analyzed by two radiographers with experience in mammography. The chi-square test was used to perform statistical analysis.ResultsResults showed a statistically significant difference in the quality of mammograms before and after training for all criteria (p < 0.05).ConclusionSelf-evaluation and education of radiographers at the CHC Rijeka have led to a significant progress in image quality.Implications for practiceResults of this work imply that there is a strong need to formalize breast imaging education and the need to implement systematic education at the national level in Croatia.     

Tomosynthesis as a screening tool for breast cancer: A systematic review

BackgroundMammography is an important screening tool for reducing breast cancer mortality. Digital breast tomosynthesis (DBT) can potentially be integrated with mammography to aid in cancer detection.MethodUsing the PRISMA guidelines, a systematic review of current literature was conducted to identify issues relating to the use of tomosynthesis as a screening tool together with mammography.FindingsUsing tomosynthesis with digital mammography (DM) increases breast cancer detection, reduces recall rates and increases the positive predictive value of those cases recalled. Invasive cancer detection is significantly improved in tomosynthesis compared to mammography, and has improved success for women with heterogeneous or extremely dense breasts.ConclusionTomosynthesis reduces some limitations of mammography at the time of screening that until recently were most often addressed by ultrasound at later work-up. Tomosynthesis can potentially be adopted alongside mammography as a screening tool.     

Predictive value of mammography in early detection of breast cancer: Analysis of histological findings in breast biopsies indicatedonly by mammography

From 1985 to 1989 breast biopsies were performed in 1835 patients with suspicious mammographic findings. Inasive cancers were diagnosed in 274 patients in-situ cancers in 186. The predictive value of mammography (0.33) was correlated with the age of patient, and compared with data in the literature. The prevalence of benign and malignant lesions was correlated with the mammographic features. We suggest that the predictive value of mammography, and the ration of noninvasive to invasive cancers detected would be optimal criteria for quality control of Offprint requests to: I.Schreer     

乳腺癌筛查的现状及进展

乳腺癌是严重威胁女性健康的主要疾病之一,近年来乳腺癌发病率逐年升高.乳腺癌筛查的方法 包括临床乳腺检查、乳腺X 线摄影、乳腺超声及乳腺磁共振成像等,各种方法 的检出效能不一.目前,国外已有较系统的乳腺癌筛查方法.我国女性乳腺特点及乳腺癌发病特点与西方国家不同,因此不能照搬国外模式.我国目前还没有筛查乳腺癌的指南,也没有系统的关于乳腺癌筛查的评价指标.     

A rare case of metastatic small cell carcinoma of breast from mixed types of cervical carcinoma

Metastatic small cell carcinoma to the breast from the uterine cervix is an extremely rare case. We report a case of a 58-year-old postmenopausal woman who presented with postmenopausal bleeding. Further investigations confirmed the diagnosis of mixed types of squamous and small cell cervical carcinoma. She underwent chemoradiotherapy and brachytherapy. A few months later, she presented with a palpable left breast lump three months after the diagnosis. Diagnosis of metastatic small cell carcinoma of the breast was confirmed by biopsy. Due to its rarity, we report on this case along with its relevant literature review.     

Breast imaging findings in women with BRCA1- and BRCA2-associated breast carcinoma

AIM: To document the breast imaging findings of women with BRCA1 and BRCA2-associated breast carcinoma. MATERIALS AND METHODS: Family history clinic records identified 18 BRCA1 and 10 BRCA2 cases who collectively were diagnosed with 27 invasive breast carcinomas and four ductal carcinoma in situ (DCIS) lesions. All underwent pre-operative imaging (29 mammogram and 22 ultrasound examinations). All invasive BRCA-associated breast carcinoma cases were compared with age-matched cases of sporadic breast carcinoma. RESULTS: Within the BRCA cases the age range was 26-62 years, mean 36 years. Two mammograms were normal and 27 (93%) abnormal. The most common mammographic features were defined mass (63%) and microcalcifications (37%). Thirty-four percent of women had a dense mammographic pattern, 59% mixed and 7% fatty. Ultrasound was performed in 22 patients and in 21 (95%) indicated a mass. This was classified as benign in 24%, indeterminate in 29% and malignant in 48%. Mammograms of BRCA1-associated carcinomas more frequently showed a defined mass compared with BRCA2-associated carcinomas, 72 versus 36% (73% control group) whilst mammograms of BRCA2-associated carcinomas more frequently showed microcalcification, 73 versus 12% (8% control group; p < 0.001). Thirty-six percent of the BRCA2-associated carcinomas were pure DCIS while none of the BRCA1 associated carcinomas were pure DCIS (p = 0.004). Of those patients undergoing regular mammographic screening, 100% of BRCA2-associated carcinomas were detected compared with 75% of BRCA1-associated carcinomas. CONCLUSION: These data suggest that the imaging findings of BRCA1 and BRCA2-associated carcinomas differ from each other and from age-matched cases of sporadic breast carcinoma.     

Magnetic resonance imaging of breast vascularity in medial versus lateral breast cancer

Objective

Breasts with malignant tumors can demonstrate a general increased vascularity compared to the contralateral breast and a prominent blood vessel adjacent to the tumor on magnetic resonance imaging (MRI). The aim of the study was to further characterize these alterations in blood supply by location of the tumor within the breast using MRI.

Materials and methods

The study group included 105 patients who underwent breast MRI for suspicion of a malignancy over a 2-year period. Fifty-one had pathologically verified malignant tumors (study group), 11 had pathologically verified benign lesions (control), and 43 had negative scans (control). The malignant lesions were distinguished by location, medial or lateral, within the breast. Origin of the vascular supply and vessel diameter was recorded in a blinded manner. When available, MRI scans performed 2 years after treatment were reviewed as well.

Results

Of the 24 medial malignant tumors, 21 (87%) had a predominantly medial vascular supply and 3 (13%), a predominantly lateral supply; of the 23 lateral tumors, 11 (48%) had a predominantly medial vascular supply and 8 (35%), a predominantly lateral supply (p = 0.03). In 4 cases, no dominant vessel was noted. Maximum vessel diameter was 3.6 ± 1.1 mm in the patients with malignancy and 2.6 ± 0.8 mm in the controls (p < 0.0005). General increased vascularity was demonstrated in 91% of the medial tumor subgroup and 83% of the lateral tumor subgroup, as opposed to 36-37% in the control groups (p < 0.0005). Follow-up MRI, performed in 8 patients in the malignant-tumor group after treatment, revealed a considerable decrease in the prominent vessels, to a size close to that of the controls.

Conclusion

Breasts with malignant tumors are characterized by an altered general vascular supply, a prominent feeding vessel, and increased regional vascularity. Both the presence and location of the tumor affect the vascular supply. The vascular change apparently diminishes after treatment, although this finding requires further investigation in a larger sample.     

Congestive heart failure as a rare cause of unilateral breast edema: A case report & review of the literature

Reported cases encountered difficulty in differentiating between inflammatory carcinoma and breast edema caused by congestive heart failure especially if the breast edema is unilateral. Our presented case is an elderly woman with unilateral breast edema due to congestive heart failure that was initially suspected to have breast cancer based on clinical findings. However imaging studies showed breast edema pattern with no definite underlying mass. This edema was resolved with standard treatment of heart failure. Congestive heart failure may be a possible cause of unilateral breast edema especially in a patient with background of congestive heart failure.     

乳腺癌Bcl-2蛋白的表达及临床意义

目的 探讨B细胞淋巴瘤/白血病-2(B cell lymphoma/leukemia-2,Bcl-2)在乳腺癌组织中表达的临床意义.方法 2000年1月-2004年12月就诊的乳腺癌133例,用免疫组织化学法检测Bcl-2蛋白的表达,分析其表达与临床病理特征及预后的关系.结果 Bcl-2在乳腺癌中的表达率为57.9％(...     

高频X线钼靶摄影对乳腺病变的诊断价值

目的探讨乳腺钼靶摄影在乳腺癌诊断中的应用价值。方法回顾性分析经手术、病理证实,资料较完整的46例乳腺癌的钼靶X线表现。结果46例乳腺癌X线表现直接显示肿块35例,占76．09％;钙化24例,占52．17％;局限性致密及结构紊乱5例,占10．87％;大导管相6例,占13．04％;乳头内陷8例,占17．39％;异常血管7例,占15．23％。结论乳腺钼靶摄影在乳腺癌的诊断中具有很较高的应用价值。     

Outcome of breast lesions detected at screening ultrasonography

Objective

To assess the final outcome of breast lesions detected during screening ultrasonography (US) and categorized by BI-RADS final assessment.

Materials and methods

During a 1-year period, 3817 consecutive asymptomatic women with negative findings at both clinical breast examinations and mammography underwent bilateral whole breast US and BI-RADS categories were provided for US-detected breast lesions. The reference standard was a combination of histology and US follow-up (≥12 months), and the final outcomes of 1192 US-detected lesions were analyzed.

Results

Of 904 category 2 lesions, 890 remained stable for 12–60 months. Biopsies of 14 lesions revealed no malignancies (NPV = 100%). Of 247 category 3 lesions, 232 remained stable for 12–60 months. Biopsies of 15 lesions revealed 2 malignancies, which were diagnosed within 6 months of the index examination and were node negative (NPV = 99.2%). Of 41 category 4 lesions, biopsies of 38 lesions revealed 5 malignancies (PPV = 12.2%), and 3 remained stable for 37–51 months. No US-detected lesion was classified as category 5.

Conclusion

The rates of malignancy for US-detected BI-RADS categories 2, 3, and 4 lesions were 0%, 0.8%, and 12.2%, respectively. The final assessment of US BI-RADS categorization showed it to be an appropriate predictor of malignancy for screening US-detected breast lesions.     

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

PURPOSE: To examine factors associated with one step surgery in case of non-palpable breast cancer. MATERIALS AND METHODS: Clinical 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 3mm apart from the lesion. RESULTS: One 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 12mm for one-operation, and 17mm 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 10mm. No significant correlation was found between number of operation and wire position. Re-operation was required in 38 cases. CONCLUSION: Mammographically 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.     

Myositis ossificans of the breast - A rare case report with radiologic-pathologic correlation

Myositis ossificans is a pathologic process of ossification in soft tissues. The breast is an exceptionally rare location for myositis ossificans with less than 5 cases documented in the English literature. We present a case of a 66-year-old woman with myositis ossificans of the left breast and no known initiating trauma. The significance of the progression of clinical and radiological findings are discussed in detail. This case shows the importance of radiology for identifying unique pathology as well as close radiological follow up.     

A comparative study of pain experienced during successive mammography examinations in patients with a family history of breast cancer and those who have had breast cancer surgery

IntroductionTo measure mammography-related pain in two groups of women undergoing regular surveillance as a baseline for future care.MethodsFollowing ethical approval, two hundred and forty two women aged 32–84 years (mean 54), were invited by written invitation to participate in the study. Two hundred women accepted the invitation, 100 women had a family history (FH) of breast cancer, 100 had undergone conservative surgery (FU) for breast cancer and were currently asymptomatic. A validated pain scale was used to score the participants' perceived pain before compression based on memory, immediately after compression and one week later. A series of baseline parameters were also captured including compression force, breast size/density, menstrual history and any adverse events following mammography to allow the investigation of relationships.ResultsThere was a strong correlation (r = 0.79, p < 0.001) between previous pain scores and current pain scores, no significant correlations were found between breast size, breast density or total compression force and pain. Pain scores reduced between previous and current examinations and there was consistency in overall pain scores, despite variations in the compression forces applied.ConclusionPhysical side effects from mammography can develop and extend beyond the examination period. Patients' prior experience of pain was the only significant predictor of current pain in this study.Implications for practiceData on past mammography experiences are essential to improve future pain outcomes. Post-mammography aftercare should be a routine feature of the examination.     

A useful case of ultrasound-guided axillary lymph node aspiration in a breast cancer patient with improved needle visibility

Ultrasound-guided, lymph node, fine-needle aspiration cytology is important in diagnosing axillary lymph node metastasis in breast cancer. However, poor needle visibility can render the procedure difficult. We describe a case in which state-of-the-art enhancement techniques using matrix linear probes can provide better needle visibility and improve the certainty and efficiency of the examination.     

计算机定位活检与摄影对早期乳腺癌诊断的比较研究

目的评价并比较计算机定位活检与摄影对早期乳腺癌诊断的价值。方法2001年11月至2002年9月乳腺数字化摄影2850例,其中直径≤2.0 cm病灶156处(148例患者)。随机对68处行计算机定位活检,以手术病理结果和随访结果为金标准,比较计算机活检法与摄影法对早期乳腺癌诊断的一致性。结果活检明显优于摄影(P<0.05)。结论计算机活检法对早期乳癌诊断有很大实用价值。     

Metastases to the breast from small-cell lung cancer: MR findings. A case report

We report a case of blood-borne metastatic breast disease of small-cell lung cancer in a 44-year-old patient with no previous history of malignancy. The possibilities of MR in the early detection of breast metastases and their appearance on MR images are discussed.
Metastases to the breast should be considered when MR mammography of the breast reveals multiple, bilateral, well-defined lesions with ring enhancement and wash-out pattern.     

Elevated G2 chromosomal radiosensitivity in Irish breast cancer patients: a comparison with other studies

Previous studies have shown that a significant proportion of breast cancer patients exhibit elevated G2 chromosomal radiosensitivity in contrast to controls (approximately 40%). In this study, the G2 assay was applied to a small number of Irish breast cancer patients who were recorded as sporadic cases and they were compared with a control group to compare and contrast with the previous documented studies. Lymphocyte cultures were set up on whole blood samples and stimulated with phytohaemagglutinin. The cultures were irradiated 74?h later with 0.5?Gy gamma-radiation and cells were arrested in metaphase by treating the cultures with colcemid. The chromosomes were harvested and the aberrations scored per 100 metaphases to assign a G2 score. The assay was first carried out on four donor controls to estimate intra-individual variation and then ten controls for inter-individual variation to measure assay reproducibility. The G2 assay was then applied to 27 breast cancer patients. Good intrinsic assay reproducibility was observed in the coefficient of variation (CV) data in three out of four controls. Intra-individual variation was similar in three out of four of the donors (4.6?–?5.1%) with one donor showing a higher CV compared with the others (22.9%). Inter-individual variation was calculated at 30.5% for all controls. No significant difference was observed between intra- and inter-individual variation using the variance ratio F-test. A G2 radiosensitivity cut-off of 110 aberrations/100 metaphases was calculated from the controls, and from this 70.4% of breast cancer patients and 7.7% of controls were calculated as G2 radiosensitive. This proportion of G2-sensitive breast cancer patients is the highest recorded in studies to date. It is thought that the G2 radiosensitivity assay is a biomarker of breast cancer predisposition genes of low penetrance, suggesting the presence of these genes in the Irish breast cancer patients used in this study who were recorded as sporadic cases. A larger number of Irish patients would be required to consolidate these findings and be representative of the Irish breast cancer population.