A. Van Steen

Idiopathic granulomatous mastitis.

Abstract A case of idiopathic granulomatous mastitis mimicking breast carcinoma clinically and radiographically is reported with mammography, sonography and MR images.

Evaluation of the diagnostic value of a computed radiography system by comparison of digital hard copy images with screen–film mammography: results of a prospective clinical trial

The purpose of the study was to determine prospectively the diagnostic value of a computed radiography (CR) system by comparing mammographic hard copy images with screen–film mammography (SFM). A series of 100 patients, who came for diagnostic investigation, underwent two-view SFM (Lorad M-IV Platinum) and digital mammography with a CR system (AGFA CR system). The images were obtained by double exposure, i.e. same view without removing compression of the corresponding breast. The CR images were processed with dedicated processing for mammography. Six radiologists read sets of SFM and CR images. The primary efficacy parameter was the overall diagnostic value. The secondary efficacy parameters were lesion conspicuity and lesion details (for masses and micro-calcifications), tissue visibility at chest wall and at skin line, axillary details, overall density and sharpness impression and the overall noise impression. These parameters were scored by a 7-point scoring system. “CR non-inferior to SFM” was concluded if the lower confidence interval bound exceeded 80%. The confidence interval for the overall diagnostic value was between 96.4% and 100%. Pooled analysis of the ten features for image quality comparison demonstrated for all but one feature (lesion details of the calcifications) CR non-inferiority to SFM.

Comparison of scrotal scintigraphy and thermography for the diagnosis of varicocele.

Varicocele is the most frequent cause of male subfertility. Several invasive and noninvasive techniques can be used to visualize scrotal phlebectasies. In this study sequential scintigraphy after intravenous injection of 99mTc-albumin was compared with tele-thermography. The normal and pathological images are described. The more obvious the clinical condition, the more lesions were revealed by scintigraphy (29.6% in subfertile men suspected of having variococele; 76.9% in patients with first degree varicocele; and 100% in Grades II and III cases). In 55 cases (of a total of 76 cases explored by radioisotopic techniques), the comparison of the thermographic results with the scintigraphy results suggests that scrotal scintigraphy is less sensitive. However, there are more false positive thermographies expressed as a discordance with clinical examination, which indicates higher specificity of scintigraphy.In conclusion scrotal scintigraphy cannot be considered as the screening procedure of first choice for varicocele, but it can give complementary information, especially when thermographic results are at variance with the clinical examination.

Interval cancers in the beginning years of the breast cancer screening programme in the Belgian province of Limburg

Abstract Objective To assess the occurrence of interval breast cancers among those women who attended the mammography screening programme in the Belgian province of Limburg. Interval cancers are tumours that are being diagnosed before the next scheduled screening round and are related to the sensitivity and the screening interval. Methods Biennial screening is provided to all women aged 50-69. The records of the screening programme were linked to those of the cancer registry. The interval cancer rate, expressed as a proportion of the underlying (expected) breast cancer incidence rate was calculated. The observed interval cancer incidence is the number of interval cancers per 10,000 ‘negative’ screening tests. Results The interval cancer rate in the first year was 25.37% for all cancers (ductal carcinoma in situ included) and 21.7% when the analysis was restricted to invasive tumours. Proportional incidence of interval cancer in the second year after screening was 12.02% for all cancers. Conclusion In conclusion, the interval cancer rates in the Belgian province of Limburg were compatible with the European guidelines. However, increasing the recall rate in our programme and systematically reviewing the interval cancers may improve the quality of the programme even further.

LACTATING ADENOMA IN THE PRESENCE OF GALACTOCELES

BACKGROUND A 22-year-old woman was referred to our department with a painless, fast growing breast mass. She noticed this mass during lactation, after giving birth to her first child. Her gynecologist palpated a large mass in the left breast, two smaller nodules in the left breast, and one small nodule in the right breast. Ultrasonography of the breasts, mammography and MRI were performed, and a tentative diagnosis of phyllodes tumor was proposed. She was subsequently referred to our centre.

16 Mogelijkheden en beperkingen van vroegtijdige diagnostiek van borstkanker

Gezien de frequentie en de mogelijke ernst van de knobbel in de borst is er waarschijnlijk geen treffender voorbeeld van een aandoening waarvoor screeningsprogramma’s meer op hun plaats zijn. De arts krijgt in zijn praktijk regelmatig te maken met klachten over spanning of knobbels in de borst. In dit hoofdstuk worden eerst veelvoorkomende klachten beschreven. Vervolgens wordt ruim aandacht besteed aan screeningsprogramma’s voor borstkanker.

Abstracts of the 4th senologic symposium organized by a. van steen, c. van ongeval, a. similon on may 29-30, 2010 in oostduinkerke

Purpose: To evaluate the place of a yearly ultrasonographical examination in the follow-up after breast cancer surgery and sentinel node biopsy.

Abstract P4-08-09: The Prognostic Importance of “Detection Mode” and “Palpability” in Primary Operable Grade 2 Breast Cancers

Background: Histologic grade 2 breast cancer may benefit most from molecular classification for prognosis. We studied the prognostic value of ‘detection mode’ and ‘palpability’ together with other prognostic variables in a consecutive series of grade 2 lesions. Patients and methods: We used follow-up data from new diagnosed and primary operable grade 2 breast cancers from UH Leuven (January 2000 - May 2005). Endocrine, chemo-and radiotherapy were given when indicated. The first appearing breast cancer related event (BCRE) was calculated as local (local, regional or contra-lateral) or metastatic (metastatic if both appeared together). These prognostic variables were assessed: age at diagnosis (per decade increase), tumor size (per cm increase), screening (yes/no), palpability (yes/no), lobular type (yes/no), chemotherapy (yes/no), endocrine therapy (yes/no), lymph node status (0, 1, 2-4, >4), combined expression of IHC-measured ER (pos = any expression), PgR (pos if any expression) and HER-2 (positive = IHC2/3+ and FISH pos), architectural, nuclear and mitotic score. Univariable and multivariable proportional hazards Cox regression using the Firth9s penalization method to reduce bias in the parameter estimates were used. Results: Of the 1013 patients in the dataset, 14 had missing values (1.4%). With a median follow-up of 80 months, we observed 116 BCRE (11.6%); 43 local and 73 metastatic. In univariable analysis, screen detected cancers showed better (HR 0.63, 95% CI 0.42-0.93) and palpable cancers worse prognosis (HR 1.96, 95% CI 1.13-3.71) than non-screen detected and non-palpable cases respectively. The beneficial univariable effect of screening weakened in the multivariable analysis (HR 0.83, 95% CI 0.52-1.31) as 582/602 (97%) of non-screen detected cancers were palpable vs 227/397 (57%) for screen-detected cancers. If palpable was omitted from the multivariable model the HR of screening decreased to 0.68 (95% CI 0.44-1.03) thereby approximating its univariable result. Conclusion: Overall, palpability is more strongly related to prognosis, but detection method also has an effect even though we do not have enough events to show this with a convincing level of reliability. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-08-09.

Localisation of breast lesions with MR mammography (work-in-progress)

While working with dynamic MR mammography (MRM) the need for an MR-guided localisation technique became obvious, because certain lesions were only detectable with dynamic MRM. We developed a technique to mark small breast lesions with MR guidance. Contrast-enhanced MRI was performed in a second examination, and with the use of markers on the skin a needle was placed next to the lesion. A charcoal mixture was injected around the lesion. We performed this procedure in five patients. Follow-up examinations have shown that the procedure was successful.

Scrotal scintigraphy Vs scrotal thermography: a comparison of scrotal imaging techniques for the diagnosis of varicocele

In otherwise normal and healthy young men the most frequent cause of subfertility is varicocele. As this is also the cause most easy to cure, correct diagnosis of varicocele is extremely important.