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Multicenter surveillance of women at high genetic breast cancer risk using mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (the high breast cancer risk italian 1 study): final results.

Objectives:To prospectively compare clinical breast examination, mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (MRI) in a multicenter surveillance of high-risk women. Materials and Methods:We enrolled asymptomatic women aged ≥25: BRCA mutation carriers; first-degree relatives of BRCA mutation carriers, and women with strong family history of breast/ovarian cancer, including those with previous personal breast cancer. Results:A total of 18 centers enrolled 501 women and performed 1592 rounds (3.2 rounds/woman). Forty-nine screen-detected and 3 interval cancers were diagnosed: 44 invasive, 8 ductal carcinoma in situ; only 4 pT2 stage; 32 G3 grade. Of 39 patients explored for nodal status, 28 (72%) were negative. Incidence per year-woman resulted 3.3% overall, 2.1% <50, and 5.4% ≥50 years (P < 0.001), 4.3% in women with previous personal breast cancer and 2.5% in those without (P = 0.045). MRI was more sensitive (91%) than clinical breast examination (18%), mammography (50%), ultrasonography (52%), or mammography plus ultrasonography (63%) (P < 0.001). Specificity ranged 96% to 99%, positive predictive value 53% to 71%, positive likelihood ratio 24 to 52 (P not significant). MRI showed significantly better negative predictive value (99.6) and negative likelihood ratio (0.09) than those of the other modalities. At receiver operating characteristic analysis, the area under the curve of MRI (0.97) was significantly higher than that of mammography (0.83) or ultrasonography (0.82) and not significantly increased when MRI was combined with mammography and/or ultrasonography. Of 52 cancers, 16 (31%) were diagnosed only by MRI, 8 of 21 (38%) in women <50, and 8 of 31 (26%) in women ≥50 years of age. Conclusion:MRI largely outperformed mammography, ultrasonography, and their combination for screening high-risk women below and over 50.

Indications for breast magnetic resonance imaging. Consensus document “Attualità in senologia”, Florence 2007

The clinical use of breast magnetic resonance (MR) imaging is increasing, especially for applications requiring paramagnetic contrast-agent injection. This document presents a synthetic list of acceptable indications with potential advantages for women according to evidence from the literature and the expert opinion of the panel that developed this statement. We generally recommend that breast MR imaging be performed in centres with experience in conventional breast imaging [mammography and ultrasonography (US)] and needle-biopsy procedures (under stereotactic or US guidance) as well as in breast MR imaging and second-look US for findings not revealed by conventional imaging performed before MR imaging. In our opinion, there is no evidence in favour of breast MR imaging as a diagnostic tool to characterise equivocal findings at conventional imaging when needle-biopsy procedures can be performed, nor for the study of asymptomatic, non-high-risk women with negative conventional imaging. After a description of technical and methodological requirements, we define the indications and limitations of breast MR imaging for surveillance of high-risk women, local staging before surgery, evaluation of the effect of neoadjuvant chemotherapy, breast previously treated for carcinoma, carcinoma of unknown primary syndrome, nipple discharge and breast implants.RiassuntoLa RM mammaria è in fase di crescente utilizzo clinico, soprattutto per le applicazioni che richiedono la somministrazione di mezzo di contrasto (MdC) paramagnetico. Il presente documento propone una codificazione sintetica delle indicazioni accettabili con potenziale vantaggio per le donne, secondo la valutazione delle evidenze presenti in letteratura e l’opinione del gruppo di esperti estensori del documento. In generale si raccomanda che l’indagine sia eseguita presso centri che siano in grado di combinare l’esperienza senologica relativa all’imaging convenzionale e ai prelievi agobioptici con quella specifica in RM mammaria e che garantiscano l’esecuzione del second look ecografico per i reperti non rilevati all’imaging convenzionale pre-RM. Non si ritiene che vi siano evidenze in favore dell’utilizzo della RM quale approccio diagnostico nella caratterizzazione di reperti equivoci all’imaging convenzionale in tutte le situazioni nelle quali sia praticabile il prelievo agobioptico sotto guida ecografica o stereotassica né in favore dello studio di donne non ad alto rischio asintomatiche e con imaging convenzionale negativo. Sono qui definiti i requisiti tecnici e metodologici di esecuzione dell’indagine e indicazioni e limiti relativi a: sorveglianza delle donne ad alto rischio di tumore mammario; stadiazione locale pretrattamento chirurgico; valutazione dell’effetto della chemioterapia neoadiuvante; mammella trattata per carcinoma; carcinoma unknown primary syndrome; mammella secernente; protesi mammarie.

Ultrasonographic appearance of breast implant complications.

In the last 20 years, we have observed a large diffusion of breast implants used for cosmetic reasons (augmentation mammoplasty) or for reconstructing breast after mastectomy. At the same time, there has been also an increased request for the instrumental evaluation of implants. Clinical examination remains the first approach to symptomatic patients. Mammography is not considered the ideal tool for studying breast implant because of low sensitivity in the detection of implant rupture. According to literature data, the diagnostic accuracy of ultrasonography is debated; in fact, it has a very high sensitivity if it is performed by a skilled radiologist. Currently, magnetic resonance (MR) is considered the gold standard, with a sensitivity higher than 90%. However, in our experience in early complications (acute or subacute bleeding and local infection), ultrasonography represents an useful diagnostic tool both for diagnosis and for interventional procedures such as positioning drain. Interventionist ultrasonography reduces the number of reoperations, allowing a fast problem solution and a reduction of costs. In our experience, ultrasonography may be helpful also for the evaluation of late complications (capsular contractures, intracapsular and extracapsular rupture) that are related to the time elapsed since implant inclusion (more frequent after 8–13 years). The purpose of this study is to evaluate the diagnostic accuracy of ultrasounds and to evaluate if MR is always necessary in the study of breast implants.

Triple negative versus non-triple negative breast cancers in high-risk women: Phenotype features and survival from the HIBCRIT-1 MRI-including screening study

Purpose: To compare phenotype features and survival of triple-negative breast cancers (TNBC) versus non-TNBCs detected during a multimodal annual screening of high-risk women. Experimental Design: Analysis of data from asymptomatic high-risk women diagnosed with invasive breast cancer during the HIBCRIT-1 study with median 9.7-year follow-up. Results: Of 501 enrolled women with BRCA1/2 mutation or strong family history (SFH), 44 were diagnosed with invasive breast cancers: 20 BRCA1 (45%), 9 BRCA2 (21%), 15 SFH (34%). Magnetic resonance imaging (MRI) sensitivity (90%) outperformed that of mammography (43%, P < 0.001) and ultrasonography (61%, P = 0.004). The 44 cases (41 screen-detected; 3 BRCA1-associated interval TNBCs) comprised 14 TNBCs (32%) and 30 non-TNBCs (68%), without significant differences for age at diagnosis, menopausal status, prophylactic oophorectomy, or previous breast cancer. Of 14 TNBC patients, 11 (79%) were BRCA1; of the 20 BRCA1 patients, 11 (55%) had TNBC; and of 15 SFH patients, 14 (93%) had non-TNBCs (P = 0.007). Invasive ductal carcinomas (IDC) were 86% for TNBCs versus 43% for non-TNBCs (P = 0.010), G3 IDCs 71% versus 23% (P = 0.006), size 16 ± 5 mm versus 12 ± 6 mm (P = 0.007). TNBC patients had more frequent ipsilateral mastectomy (79% vs. 43% for non-TNBCs, P = 0.050), contralateral prophylactic mastectomy (43% vs. 10%, P = 0.019), and adjuvant chemotherapy (100% vs. 44%, P < 0.001). The 5-year overall survival was 86% ± 9% for TNBCs versus 93% ± 5% (P = 0.946) for non-TNBCs; 5-year disease-free survival was 77% ± 12% versus 76% ± 8% (P = 0.216). Conclusions: In high-risk women, by combining an MRI-including annual screening with adequate treatment, the usual reported gap in outcome between TNBCs and non-TNBCs could be reduced. Clin Cancer Res; 22(4); 895–904. ©2015 AACR.

Ultrasound-guided fine needle biopsy of the pancreas: smear cytology versus microhistology

Percutaneous fine needle biopsy (FNB), under sonographic guidance, of local pancreatic lesions was studied by comparing the results of smear cytology (SC) with microhistology (MH) in 34 patients in whom both sampling procedures were carried out. MH suffered from a higher number of inadequate samples (retrieval rate: 94.1% SC, 85.3% MH), but reached a superior sensitivity rate as regard to the diagnosis of pancreatic malignancy (91.7% MH, 80.8% SC). Both samples obtained an absolute specificity rate (100%. A 96.3% sensitivity rate was obtained by combination of the two techniques in the absence of complications. Thus, the combined use of SC and MH in pancreatic fine needle biopsy was proven to be a safe and reliable procedure.

Carcinosarcoma of the Breast: An Aggressive Subtype of Metaplastic Cancer. Report of a Rare Case in a Young BRCA-1 Mutated Woman

Carcinosarcoma of the breast (BCS), a subtype of metaplastic breast cancer, is an extremely rare and clinically aggressive tumor containing carcinomatous and nonepithelial components of mesenchymal origin with a clear-cut boundary between them. Metaplastic breast cancers are part of the spectrum of basal-like tumors, and among them, BCS is a peculiar subtype. BCS exhibits different behaviors and has a poor prognosis when compared with more common types of breast cancer. BCS presents a diagnostic and therapeutic challenge owing to the pattern of presentation and to the lack of effective systemic management. We present the case of a 35-year-old woman, BRCA-1 mutation carrier, affected by carcinosarcoma of the right breast. To the best of our knowledge, it is one of the few published cases of BCS in a BRCA-1 mutated woman. We discuss the clinical presentation, the imaging characteristics, and the pathologic findings, and we also present a short review of the literature.

A tool for breast MR images processing and classification

One of the major problems for the womens quality of life in the industrialized countries is the early diagnosis of breast cancer. Contrast-enhanced magnetic resonance of the breast is the most attractive alternative to standard mammography but the manual inspection of images is a long, subjective and error-prone process. To face these problems, we propose a method whose steps are: segmentation, correction of movements and a dynamic study to search and classify the enhancing regions in the images. The proposed method removes noisy background and tissues not interesting for diagnosis, extracts the relevant information and classifies the resulting images by discriminant curves. The developed algorithms has been tuned and tested on 149 exams, supplied by the Imaging Dept. of the Medical Faculty of the University of Pisa. The paper will show the implemented system is innovative and requires minimal user interaction, providing results comparable with clinical direct diagnosis.

Intraductal solitary papilloma: sonographic findings

The aim of the study was to define the ultrasonographic characteristics of intraductal solitary papilloma (ISP) and to discuss the differential diagnoses from other focal lesions of the breast. Sixteen ISP were found among 35 patients with haematic discharging breasts all of whom were submitted to sonography and cytology. The mean age of the patients was 28 years. Three types of lesions were observed: (1) a solid nodule with peripheral hypoechoic areas (56.2%); (2) papillary vegetation within a cystic cavity (25%); (3) periareolar dilated duct, filled with dense material (18.8%). The observed cases demonstrate that sonography was always reliable in detecting the lesion. This result is better than those reported in literature and may be correlated with the low mean age of the patients in our series, which allowed an optimal study with sonography. The three sonographic patterns observed seem to circumscribe the differential diagnoses, thus simplifying the diagnostic process.

Inflammatory aneurysm of the abdominal aorta: role of ultrasonography

During a 5-year period 229 aneurysms of the abdominal aorta were identified by ultrasonography (US) and subsequently submitted to CT. Of these, 41 were seen to be of the inflammatory type on the grounds of the CT scans, confirmed in 29 cases by surgical findings. The patients were 38 men and 3 women, mean age 64.9 years. US, performed using both 3.5 and 5 MHz probes, revealed the inflammatory nature of the aneurysm in 33 of 41 cases (80.5%). In the remaining cases a correct diagnosis could not be determined because of obesity and/or the distal location of the lesion. Regarding the complications associated with the inflammatory nature of the aneurysm (considered only in those cases submitted to surgery) US revealed a good diagnostic accuracy for ureteral involvement (7/7 cases detected, no false positives). Caval involvement was also correctly identified in 6 of 8 cases, although overestimated in 3 of 21. Both of these complications were correctly detected by CT in all cases. Neither US nor CT furnished reliable signs regarding duodenal and colonic involvement (surgically proven in 4 of 29 cases). US proved effective in detecting the inflammatory nature of the aneurysm. If surgery is considered, CT seems mandatory for a correct assessment of the complications.

Indicazioni alla risonanza magnetica mammaria. Documento di consenso "attualità in Senologia", Firenze 2007

The clinical use of breast magnetic resonance (MR) imaging is increasing, especially for applications requiring paramagnetic contrast-agent injection. This document presents a synthetic list of acceptable indications with potential advantages for women according to evidence from the literature and the expert opinion of the panel that developed this statement. We generally recommend that breast MR imaging be performed in centres with experience in conventional breast imaging [mammography and ultrasonography (US)] and needle-biopsy procedures (under stereotactic or US guidance) as well as in breast MR imaging and second-look US for findings not revealed by conventional imaging performed before MR imaging. In our opinion, there is no evidence in favour of breast MR imaging as a diagnostic tool to characterise equivocal findings at conventional imaging when needle-biopsy procedures can be performed, nor for the study of asymptomatic, non-high-risk women with negative conventional imaging. After a description of technical and methodological requirements, we define the indications and limitations of breast MR imaging for surveillance of high-risk women, local staging before surgery, evaluation of the effect of neoadjuvant chemotherapy, breast previously treated for carcinoma, carcinoma of unknown primary syndrome, nipple discharge and breast implants.RiassuntoLa RM mammaria è in fase di crescente utilizzo clinico, soprattutto per le applicazioni che richiedono la somministrazione di mezzo di contrasto (MdC) paramagnetico. Il presente documento propone una codificazione sintetica delle indicazioni accettabili con potenziale vantaggio per le donne, secondo la valutazione delle evidenze presenti in letteratura e l’opinione del gruppo di esperti estensori del documento. In generale si raccomanda che l’indagine sia eseguita presso centri che siano in grado di combinare l’esperienza senologica relativa all’imaging convenzionale e ai prelievi agobioptici con quella specifica in RM mammaria e che garantiscano l’esecuzione del second look ecografico per i reperti non rilevati all’imaging convenzionale pre-RM. Non si ritiene che vi siano evidenze in favore dell’utilizzo della RM quale approccio diagnostico nella caratterizzazione di reperti equivoci all’imaging convenzionale in tutte le situazioni nelle quali sia praticabile il prelievo agobioptico sotto guida ecografica o stereotassica né in favore dello studio di donne non ad alto rischio asintomatiche e con imaging convenzionale negativo. Sono qui definiti i requisiti tecnici e metodologici di esecuzione dell’indagine e indicazioni e limiti relativi a: sorveglianza delle donne ad alto rischio di tumore mammario; stadiazione locale pretrattamento chirurgico; valutazione dell’effetto della chemioterapia neoadiuvante; mammella trattata per carcinoma; carcinoma unknown primary syndrome; mammella secernente; protesi mammarie.