Ayşegül Özdemir

Differential diagnosis of solid breast lesions: contribution of Doppler studies to mammography and gray scale imaging.

To assess the role of Doppler sonography when used in conjunction with mammography and gray scale sonography in differentiating solid breast lesions and to find out whether lesion size is a limiting factor for Doppler evaluation.

Contrast-Enhanced Power Doppler Sonography in Breast Lesions Effect on Differential Diagnosis After Mammography and Gray Scale Sonography

Objective. To evaluate the efficacy of contrast‐enhanced power Doppler sonography in the differential diagnosis of breast lesions after a mammography–gray scale sonography combination. Methods. Sixty‐eight patients with 69 breast masses underwent power Doppler sonography before and after intravenous injection of a contrast agent. The lesions were diagnosed as “highly suggestive of malignancy” (category 5; n = 32), “suspicious” (category 4; n = 21), and “probably benign” (category 3; n = 16) by mammography and gray scale sonography, modeled on the American College of Radiology Breast Imaging Reporting and Data System classification. Power Doppler findings did not affect patient treatment. The authors subjectively evaluated the estimated area of vascularity, degree of enhancement following contrast agent administration, morphologic features, and distribution of vessels within the lesions. Results. The final diagnoses were malignant in 28 lesions and benign in 41. Significant enhancement after contrast agent injection was detected in both the malignant and benign groups. Only 2 criteria, estimated area of vascularity and degree of enhancement following contrast agent administration, proved to be significant diagnostic determinants for contrast‐enhanced power Doppler sonography (P < .001; interobserver agreements, 74.4 and 77.8, respectively). Contrast‐enhanced power Doppler sonography provided a higher specificity, positive predictive value, and negative predictive value than power Doppler sonography but a lower sensitivity and negative predictive value than mammography–gray scale sonography. Only in the category 4 lesions could the combination of mammography–gray scale sonography and contrast‐enhanced power Doppler sonography accomplish a higher specificity (71%) and positive predictive value (70%) than mammography–gray scale sonography (39% and 53%, respectively). Conclusions. Power Doppler and contrast‐enhanced power Doppler sonography cannot be recommended as confirmatory tests in Breast Imaging Reporting and Data System category 3 and category 5 lesions. Although contrast‐enhanced power Doppler sonography may help reduce unnecessary biopsies in Breast Imaging Reporting and Data System category 4 lesions, recommendation of its use has many drawbacks, such as imperfectly established criteria, lack of absolute certainty, and high cost.

The effectiveness of training for breast cancer and breast self-examination in women aged 40 and over.

Background. Training on breast health is required to increase awareness of early detection of breast cancer, especially in countries with limited resources.Methods. Of the 784 invited women, 462 participated in the study (58.9%). The training included both theoretical and breast self-examination (BSE) training between preeducation and posteducation tests. Following the theoretical presentation, breast examination training was performed using a breast simulator. The competency of the participants on breast examination was assessed by an evaluation guide.Results. All breast cancer symptoms were stated at significantly higher rates compared to those before education (P<.05). The most commonly stated risk factor in both preeducation and posteducation tests was “no breast-feeding,” with ratios of 15.2% and 56.3%, respectively. Early detection modalities for breast cancer were also stated more often in the posteducation test compared to the preeducation (P<.05). In the preeducation test, only 4.3% to 18.7% of the participants women could state most of the BSE steps. After BSE training, 85% to 92% of the participants were competent in BSE steps.Conclusions. Theoretical education on breast cancer and BSE training in low-educated women, even illiterate, is highly effective.

Interdigitating dendritic cell tumor with breast and cervical lymph-node involvement: a case report and review of the literature

Interdigitating dendritic cell tumor (IDCT) is an extremely rare malignancy. It occurs primarily in lymph nodes, but extranodal involvement has also been reported. A 38-year-old woman with IDCT with breast and cervical lymph-node involvement is reported in this paper. To our knowledge, this is the first case of IDCT originating from the breast. In the breast and lymph node, the tumor displayed diffuse sheets, fascicles and storiform growth pattern. It was composed of oval to spindle cells with pale to eosinophilic cytoplasm, ill-defined cell outlines, oval nuclei with vesicular chromatin and prominent eosinophilic nucleoli. Mitotic activity was three per ten high-power fields. The neoplastic cells were intermingled with small mature lymphocytes and plasma cells. Immunohistochemical studies showed that the tumor cells were strongly and diffusely positive for vimentin, CD68, S-100 protein, CD45/leukocyte common antigen and fascin and focally positive for lysozyme, alpha-1 antitrypsin and CD4. Ki-67 labeling index was 10%. The patient was treated with combined therapeutic approaches, including surgery, radiotherapy and chemotherapy. IDCT has the potential for an aggressive clinical course. However, 32 months after the initial diagnosis, the patient is still alive and being followed with a stable tumor burden.

Spontaneous thrombosis of a vein of Galen aneurysmal malformation: possible effects of contrast media

Abstract. A 5-year-old boy with macrocephaly and mental retardation was referred for radiologic evaluation. After cranial CT and MR imaging, the diagnosis of mural type vein of Galen aneurysmal malformation was established by angiography. Two weeks later, preembolization angiography revealed complete thrombosis of the malformation. Although it is a very rare event, vein of Galen aneurysmal malformation may spontaneously thrombose following diagnostic angiography. Possible effects of contrast media on thrombosis were discussed.

TL-201 scintigraphy, mammography and ultrasonography in the evaluation of palpable and nonpalpable breast lesions: a correlative study☆

PURPOSE To determine the feasibility of Tl-201 as a tumor localizing agent in palpable and nonpalpable breast lesions, in comparison with mammography and ultrasonography (US), and to evaluate the contribution of these modalities to each other in obviating biopsy. MATERIALS AND METHODS Seventy-two palpable and nonpalpable breast lesions were prospectively classified as benign, indeterminate, or malignant according to the sonographic and mammographic criteria and were further analyzed with Tl-201 scanning. These classifications were compared with biopsy results. The sensitivity, specificity, accuracy, false positive and false negative rates (FPR, FNR), negative and positive predictive values (npv, ppv) were calculated for each individual modality and combination of modalities to evaluate the contribution of these three techniques to each other. RESULTS Of 72 lesions 52 were histologically malignant and 20 were benign. Overall, mammography was the most sensitive (92%) and Tl-201 was the most specific (75%) of the three modalities. Mammography + Tl combination was the most specific (90%) and accurate (97%) of dual combinations. In mammographically or sonographically indeterminate cases, Tl-201 was much more specific (75% versus 37% for mammography and US) and more accurate (82% versus 36% for mammography and 54% for US) than the other two modalities, and mammography + Tl combination was significantly superior to other dual combinations (87% specific and 91% accurate). Use of Tl-201 scanning as an adjunct to mammography + US combination increased the specificity, ppv, and accuracy rates overall, particularly in mammographically or sonographically indeterminate cases. CONCLUSIONS In mammographically and sonographically indeterminate breast lesions thallium scanning may be offered as a third step of investigation to obviate biopsy.

Comparison of indium-111 octreotide and thallium-201 scintigraphy in patients mammographically suspected of having breast cancer: preliminary results

Indium-111 octreotide and thallium-201 scintigraphic studies were compared in 21 patients (16 with palpable and five with non-palpable lesions) suspected of having breast malignancies on the basis of mammography. Early (15 min) and late (3 h)201Tl (111 MBq) and 4-h and 24-h111In-octreotide (111–148 MBq) static planar anterior images (matrix 256×256) were obtained on separate days. Images were evaluated both visually and quantitatively. Biopsy was performed following the imaging studies. Histopathology revealed 17 breast carcinomas (15 cases of invasive ductal carcinoma, one mucinous adenocarcinoma and one intraductal carcinoma) and four benign breast lesions (two fibroadenomas, one abscess and one case of fat necrosis). The means histopathologcial tumour size (mean largest diameter) was 3.38±1.9 cm.111In-octreotide detected 16 of the 17 breast cancers (94%) while201Tl detected 13 of them (76%). Both111In-octreotide and201Tl missed one nonpalpable carcinoma showing only an isolated cluster of microcalcifications on mammography. The smallest tumour size detected by both agents 1.5×1.5 cm. Of the four benign lesions, only the breast abscess revealed both201Tl and111In-octreotide uptake.111In-octreotide scan also showed tracer uptake in five of the six patients with histologically proven axillary metastases, while four of these six patients showed201Tl uptake. The tumour/background (T/B) ratios of late111In-octreotide and201Tl images were 1.71±0.38 and 1.46±0.30 respectively (P=0.039). In this preliminary study,111In-octreotide yielded more favourable results than201Tl in the detection of breast carcinomas. However, the diagnostic efficacy of111In-octreotide imaging needs to be investigated in larger patient series.

Breast varices: imaging findings of an unusual presentation of collateral pathways in superior vena caval syndrome

Imaging findings are presented of an unusual pathway of collateral circulation consisting of bilateral and diffuse dilated breast veins from a patient with long standing superior vena caval syndrome. The main importance of this case is the extent of the collateral development through the breast veins, serving as the major pathway of collateral circulation. Identification of this unusual collateral development, which resembles breast varices, was performed with contrast-enhanced chest CT scans, digital subtraction venography, color Doppler ultrasonography, and mammographic studies. Collateral development was secondary to a long segment idiopathic venous occlusion involving bilateral subclavian and brachiocephalic veins as well as vena cava superior. We conclude that dilated breast veins when detected on any imaging modality should raise the suspicion of central venous obstruction.

Behaviors Toward Methods of Breast Cancer Early Detection in Women Over 40 Years in a Rural Region of Ankara, Turkey

Background. In this study, we aimed to determine behaviors of women over 40 years toward methods of breast cancer early detection in a rural region of Ankara, Turkey. Methods. Of the 1277 women aged over 40 years, 910 (71.3%) participated in the study. Results. Not performing breast self-examination was 3.1 times more frequent in those aged 60 years and older (95% confidence interval [CI], 1.8–5.2), 2.1 times more frequent in those who could only read and write (95% CI, 1.5–2.9), and 2.5 times more frequent in housewives (95% CI, 1.5–4.3). The likelihood of clinical breast exam was 1.8 times less in women aged 60 years old and older compared with younger women. Primary school graduates had a 1.9 times (95% CI, 1.3–2.9) greater chance of not having had a mammography compared with those that been at least primary school graduates. Conclusions. For women to change their behavior and adopt early methods of diagnosing breast cancer, it is necessary to reach priority target groups during the training provided by primary care institutions.

Topluma Dayalı Mamografi Taramasına Katılımı Etkileyen Faktörler

Objectives: This study aims to investigate the demographic or risk factors affecting participation in a population-based breast screening with mammography program in a rural area of Turkey. Patients and Methods: This definitive epidemiological study was carried out between December 2002 and August 2003, in a town of Ankara. Of the 784 women, 710 were interviewed and 462 (58.9%) of them participated in the screening. A questionnaire was used for collecting data. Results: The mean age of the women was 50.7aplusmn;10.0 years. Fifty four percent of the single, widowed or divorced women (p=0.001), 62.5% of those aged 60 years or older (palt;0.001), and 42.8% of the illiterate or literate women (palt;0.001) did not participate the screening. Women, who were elder had a 1.1-fold greater risk of nonparticipation in mammography screening than younger ones (95% confidence interval, 1.04-1.09), and those who were postmenopausal had 1.5-fold greater risk than those who were premenopausal (95% confidence interval, 1.04-2.22). Conclusion: Age, marital, educational and menopausal statuses seem to be effective on participation in the population-based study. Screening programs should be planned considering these factors. Amac: Bu calismanin amaci Turkiyea#39;nin kirsal bir alaninda topluma dayali mamografi taramasina katilimi etkileyen demografik ve risk faktorlerini incelemektir. Hastalar ve Yontemler: Tanimlayici epidemiyolojik calisma olarak tasarlanan arastirmanin veri toplanmasi Aralik 2002 ve Agustos 2003 tarihleri arasinda Ankaraa#39;nin bir ilcesinde yapildi. Toplam 784 kadindan 710a#39;u ile gorusuldu ve 462a#39;si (%58.9) taramaya katildi. Veri toplamak icin anket formu kullanildi. Bulgular: Kadinlarin ortalama yasi 50.7aplusmn;10.0 yildi. Bekar dul veya bosanmis olanlarin %54a#39;unun (p=0.0001), 60 yas ve uzerindekilerin %62.5a#39;inin (palt;0.001) ve okuma yazma bilmeyen veya okur yazar olanlarin %42.8a#39;inin (palt;0.001) taramaya katilmadigi saptandi. Yasli kadinlarin genclere gore mamografi taramasina katilmama riskinin 1.1 kat (1.04-1.09; %95 guven araligi) ve menopoz sonrasi donemde olanlarin menopoz oncesi donemde olanlara gore 1.5 kat (1.04-2.22; %95 guven araligi) daha fazla oldugu belirlendi. Sonuc: Topluma dayali meme kanseri taramasina katilimi etkileyen faktorler yas, medeni durum, egitim durumu ve menopozda olup olmamadir. Tarama planlanirken katilimi az olabilecek gruplarin katilimini artiracak uygulamalarin gelistirilmesi onerilmektedir.