High-resolution MR imaging of the breast

Investigation into the use of MRI as a breast imaging tool is ongoing. Several studies have shown that MRI is a very accurate imaging method for the identification of implant failure in the symptomatic patient with augmented breasts. In this clinical setting, MRI may be the study of choice. Imaging techniques, and the MRI appearance of normal and abnormal implants, are described. The use of MRI for the detection of breast cancer is not as straightforward. Preliminary results suggest that this technique can be used as an adjunct to mammography for the detection and diagnosis of breast cancer. However, it is premature to draw firm conclusions regarding the role that MRI should play in the management of women with breast disease because of the wide variability of imaging techniques, protocols, and patient populations in the studies reported to date. In this overview, the current state of MR imaging of the breast is discussed. Technical requirements are described, and potential clinical applications—including the differentiation of benign from malignant lesions, breast cancer staging, detection of recurrence after breast conservation therapy, and detection of cancer in patients presenting with positive axillary lymph nodes with an unknown primary—are reviewed. Many of these potential clinical applications will require an accurate MR-guided biopsy system, and the implementation of such a system as well as its inherent limitations are discussed.     

Breast Cancer Among Men: Raising Awareness for Primary Prevention

The American Cancer Society estimated that in 1993 1,000 new cases of male breast cancer would be diagnosed in the United States and 300 men would die from the disease. The clinical picture of breast cancer among men resembles that seen in women, and the development of the disease among men has been attributed to similar hormonal and genetic causes. The mortality rate from breast cancer is also similar, when corrected for chronological age and stage of the disease at the time of diagnosis and treatment. Guidelines for patient education, health screening, and patient support are presented.     

Updates in the Evaluation and Management of Breast Cancer

Breast cancer is the most commonly diagnosed cancer worldwide. More than 200,000 new cases of invasive breast cancer are diagnosed annually in the United States; approximately 40,000 patients die of the disease. The etiology of most breast cancer cases is unknown, although multiple factors predisposing to the disease have been identified. Apart from increasing age and female sex, these other factors account for only a minority of breast cancer diagnoses. This article provides an overview of the management of noninvasive and invasive breast cancer, which is often complex and varies according to patient factors, disease stage, and breast cancer subtype. Although much progress has been made, continued research endeavors are ongoing; enrollment of eligible patients in prospective clinical trials is an essential way to improve patient outcomes.     

^18F—FDGPET／CT在乳腺疾病中的临床应用价值

目的探讨^18F-FDGPET／CT显像对乳腺良恶性病变的诊断、治疗及疗效观察的临床价值。方法26例乳腺疾病患者进行^18F-FDGPET／CT显像，检查结果与病理对照分析。结果26例患者中乳腺癌20例（其中7例为乳癌术后随访），乳腺良性病变6例；^18F-FDG PET／CT诊断符合率分别为95％（19／20）、100％（6／6），诊断准确率为96．15％。结论^18F-FDG PET／CT对乳腺良恶性病变的鉴别诊断、乳腺癌分期及疗效观察等方面具有更多的优越性。     

Solitary metastatic carcinoma of the spleen.

A care is reported in which an isolated metastatic lesion of the spleen was discovered one year after a modified radical mastectomy for carcinoma of the breast, and seven years following total hysterectomy and bilateral salpingo-oophorectomy for carcinoma of the left ovary. Splenectomy was followed by significant clinical improvement of the patient who remains alive and well four years after operation. Regular physical and roentgen examinations have revealed no evidence of recurrent disease. The factors relating to the occurrence of solitary splenic metastasis are discussed briefly. This case is apparently the fifth reported in the literature.     

Bilateral benign phyllodes tumour in a nulliparous woman: a case report and review of literature

Cystosarcoma Phyllodes is an uncommon disease of the breast with variable clinical behaviour. Its incidence is reported as 1% of all breast tumours. The occurrence of bilateral disease is very rare. In this communication, we present a case of metachronous bilateral benign cystosarcoma phyllodes presenting in a 24year old nulliparous lady. She had right breast mastectomy after two recurrences following local excision. The left breast lesion developed one year after the treatment of the right lesion, again she had to be treated with mastectomy after 2 recurrences. This case unlike most reported cases of bilateral Phyllodes tumour occurred in a nulliparous lady. The problems of diagnosis, clinical behaviour and management are discussed.     

男性副乳腺癌1例并相关文献回顾

男性副乳腺癌在临床上的发病率很低,因为其发病的位置比较隐蔽以及患者的意识不足,常常造成一定程度的误诊。男性副乳腺癌好发部位集中在腋下、腹股沟区域,这和胚胎时期乳腺发育有着紧密的联系,但是其发病原因、发病机制、治疗标准以及预后情况仍处于探索阶段,目前临床诊疗具体参照女性乳腺癌的标准来实施,而且个体化治疗方案也显得参差不齐。鉴于男性副乳腺癌的低发病率、缺乏大量的临床研究以及统一的治疗标准,故笔者报道1例63岁男性副乳腺癌病例(经穿刺腋窝肿块后病理学诊断为副乳腺癌,后行手术治疗)的整体治疗情况,供临床医师参考。     

A clinical oncology perspective on the use of breast MR

MR imaging of the breast detects additional carcinoma in as many as 30% of women thought to have localized disease by clinical examination and mammography. This has led some to advocate its routine use in the preoperative evaluation of breast cancer patients. However, local failure rates in patients selected for breast conservation by conventional methods are less than 5% at 10 years, suggesting that he majority of this disease is controlled with radiotherapy. The potential role of MR in the preoperative evaluation and postoperative follow-up of patients with early-stage breast cancer is discussed.     

动态增强磁共振成像在乳腺癌诊断及疗效监测中的应用进展(英文)

经过20余年的相关研究,MRI现已成为临床公认的用于检出和诊断乳腺疾病的影像检查手段之一。笔者简要阐述了乳腺动态增强(DCE)磁共振成像技术及其临床应用。详细介绍了动态增强中有关药代动力学的测量方法、各种相关参数的定性分析、以及Ktrans和kep等反应药代动力学特征参数的定量分析。笔者不但就当前"是否有必要对每位患者进行动脉输入函数进行测量"等有争议的话题进行了讨论,还在对当前广泛应用的各种动态增强MRI后处理软件进行了较详尽的描述之后,进一步对动态增强MRI在乳腺癌的诊断及疗效监测等方面的临床应用情况进行了详尽的回顾。作者认为:总体来讲,对于乳腺癌的诊断,关键在于关注病灶中最具侵袭性部分的MRI特征。而对于乳腺癌疗效的监测,则应该对整个病灶进行分析。最后,笔者就乳腺MRI对乳腺癌高危人群的筛查以及风险的处理等问题进行了讨论。笔者预测乳腺MRI在女性乳腺疾病尤其是乳腺癌的筛查、诊断、治疗及疗效监测等一系列问题上将继续发挥不可替代的重要作用。     

Social context and outcomes for the ageing breast cancer patient: considerations for clinical practitioners

Current incidence, prevalence and survival rates determine that breast cancer is primarily a disease of older women. This integrative essay provides an extensive review of the literature on (i) the social and psychological factors that influence adjustment to breast cancer and survival from it, (ii) the social and health status of older women, and (iii) the medical treatment of older breast cancer patients. It is concluded that while psychological orientation to the disease, coping strategies and functional continuities of breast cancer patients are important for disease outcome, adjustment to and survival from breast cancer by older women may be compromised by the social context – with respect to marriage and intimate ties, social participation, socio‐economic status, and mental and physical health. The paper concludes with the suggestion that clinical practitioners need to be aware of the both the resources of, and limitations facing the older breast cancer patient, and with the provision of specific recommendations about the clinical management of this population for nurses and other health professionals.     

Imaging of the patient with silicone gel breast implants

There are two reasons for radiologic evaluation of the augmented breast. Because women with implants are at the same risk for breast cancer as other women, imaging is performed to screen for cancer or to work up clinical abnormalities. Additionally, imaging allows assessment of implant integrity. The various methods for imaging implants and breast tissue in the augmented patient are discussed. Imaging findings suggestive of silicone gel implant rupture are presented.     

Inflammatory breast carcinoma

Inflammatory breast carcinoma is a rare and aggressive form of breast cancer. It is rapid in onset and clinically mimics mastitis. We discuss a patient who came to our office with an apparent mastitis that was ultimately determined to be inflammatory breast carcinoma. A review of the typical clinical presentation, diagnostic imaging findings, biochemistry, treatment, and prognosis of the disease follows.     

MR Imaging in the Management of Patients with Breast Cancer

Magnetic resonance (MR) imaging has high sensitivity in detecting and determining the extent of breast cancer and the information provided by this modality has proven valuable in patient management. Investigations defining the strengths of MR imaging, technical advances, and greater standardization of protocols have led to its increased use in patients with breast cancer, both before and following treatment. This article reviews techniques and procedures used in the performance and interpretation of breast MR examinations. Applications of MR imaging in the management of patients with breast cancer are also summarized, including preoperative evaluation of extent of disease, postoperative assessment of residual disease, and the detection of recurrent carcinoma. The use of MR imaging to evaluate patient response to chemotherapy and to assess patients with axillary lymph node metastases with an unknown primary lesion will also be discussed.     

The utility of MRI for the screening and staging of breast cancer

INTRODUCTION & BACKGROUND: Contrast-enhanced magnetic resonance imaging (MRI) of the breast has been recently introduced as a potential clinical tool for the detection, diagnosis, staging and management of breast cancer. In this article, we consider the established and evolving roles of MRI with particular reference to screening in high risk women and staging of the primary tumour. Controversies are discussed in the context of the tumour biology and natural history of breast cancer. METHODS: Articles were identified by searches of PubMed and MEDLINE up to October 2007. RESULTS: Contrast-enhanced MRI is an effective tool for screening women at high risk of breast cancer. However, randomized trials have yet to demonstrate a reduction in mortality. MRI can also facilitate local staging, in particular, the evaluation of ipsilateral multicentric or multifocal lesions and synchronous contralateral disease which may be 'missed' by conventional imaging. However, efficacy with respect to clinically relevant and patient oriented end-points has yet to be addressed in the context of clinical trials. CONCLUSIONS: In women at high risk of breast cancer, screening MRI should be used in conjunction with published guidelines. In women with newly diagnosed breast cancer, the utility of MRI is less clearly defined and should be restricted to selected cases within the multidisciplinary setting.     

Management of breast cancer: past, present, future.

The historical management of breast cancer leading up to the Halsted era is reviewed. Radical mastectomy is examined and evaluated in the light of cancer staging, and different modes of treatment are discussed. The question of what type of surgery and adjuvant therapy is best for each patient is not fully answered and awaits further study and clinical trials. The future promises an immunobiologic approach in the treatment of breast cancer in addition to early operation.     

Overview of breast cancer staging and surgical treatment options

Following diagnosis of breast cancer, patients undergo assessment for local and systemic treatment. Establishing a relationship and communication with the patient is critical to this assessment, as are history-taking, clinical breast examination, review of imaging studies, and interactive discussion with the patient of treatment options and possible breast reconstruction. Some type of surgical therapy is indicated in virtually all women with breast cancer, generally as the first part of a multicomponent treatment plan. The main goal of surgical therapy is to remove the cancer and accurately define the stage of disease. Surgical options broadly consist of breast conservation therapy, generally followed by radiation therapy, or mastectomy. The surgical procedure also includes assessment of regional lymph nodes for metastasis, either by axillary lymph node dissection or by the less-invasive sentinel lymph node biopsy, for the purpose of cancer staging and guiding adjuvant therapy.     

Diabetic mastopathy in an elderly woman misdiagnosed as breast cancer: A case report and review of the literature

BACKGROUNDDiabetic mastopathy is a rare benign disease in clinical practice that mainly occurs in young and middle-aged women with type 1 diabetes. It has also been reported that this disease can be found in patients with type 2 diabetes and other autoimmune diseases, such as Hashimoto''s thyroiditis, as well as in men. The pathogenesis of diabetic mastopathy is not yet clear, and it is easily confused with breast cancer due to their similar clinical manifestations and imaging features. CASE SUMMARYA 69-year-old female patient was admitted because of painless breast masses, with a history of type 2 diabetes. The imaging and physical examination suggested a high risk of breast cancer. Further histopathological analysis showed dense lymphocytes infiltrating around the lobules of the breast, and extensive fibrosis of the surrounding stroma. Finally, diabetic mastopathy was diagnosed.CONCLUSIONThe diagnosis of diabetic mastopathy in elderly patients with painless breast masses is difficult to distinguish from breast cancer, and its imaging manifestations are not specific.     

Detection and evaluation of a palpable breast mass

The discovery of a breast mass, either self-detected or identified by a clinician, is a common, often distressing occurrence for many women. Although most detected breast masses are benign, every woman presenting with a breast mass should be evaluated to exclude or establish a diagnosis of cancer. This article provides a succinct overview of normal breast anatomy and reviews common causes of breast masses. The role of the clinical breast examination is discussed, and an algorithm is provided for optimal utilization of available tools in the diagnostic evaluation of a breast mass. The evaluation should be performed expeditiously and the results communicated promptly to the patient. Regardless of the age of the woman, a clinically suspicious mass must be evaluated even if findings on a mammogram are normal.     

乳腺MRI检查对乳腺癌个体化治疗的作用

乳腺MRI具有极好的软组织分辨率和无射线辐射特点,对乳腺癌诊断和局部分期明显优于X线和超声检查,本文结合临床病例在四个方面重点阐述乳腺MRI检查对乳腺癌个体化治疗的作用.     

Benign breast disease. Diagnosis and treatment.

Breast disease is a common problem found in approximately one of four women from puberty to old age. Of greatest importance to the health care provider is identifying the type of breast disorder and its relative seriousness. Precancerous mastopathy is of major concern, as are other significant forms of benign breast disease, both symptomatic and asymptomatic. Awareness of the many facets of benign breast disease on the part of the health care provider and the patient can heighten sensitivity to subtle changes in breast tissue. Identification of precancerous mastopathy has its greatest impact for early diagnosis of breast cancer. The patient with benign breast disease can be offered reassurance, support and symptomatic treatment for the benign breast disorder by the primary health care provider.