Donna Taylor

MR evaluation of the temporomandibular joint in juvenile rheumatoid arthritis.

Temporomandibular joint (TMJ) disease is uncommon in children but frequently occurs in juvenile rheumatoid arthritis (JRA). Involvement is often asymptomatic; however, it can lead to growth disturbances and facial deformity. Thirty TMJs in 15 children (11 girls and 4 boys aged 3.5–18 years) with JRA were evaluated clinically and by MRI. Plain films were reviewed when available. Magnetic resonance imaging parameters included T1-weighted and in some cases T2-weighted or gradient recall echo sequences. We assessed condylar configuration, glenoid fossa changes, presence of erosions, disk abnormality, range of motion, and presence of joint effusions or pannus. Abnormalities included cortical erosions (n = 19), disk thinning (n = 18), and perforation (n = 2). Reduction of joint movement (n = 20), joint locking (n = 3), and pannus/effusions (n = 5) were also found. Magnetic resonance imaging is a useful technique for the detection of TMJ involvement in JRA. Early detection and therapeutic intervention may lessen or prevent subsequent deformities.

Reducing delay in the diagnosis of pregnancy-associated breast cancer: How imaging can help us

Introduction: The evaluation of breast symptoms during pregnancy or lactation can be challenging but prompt, appropriate assessment of symptoms may lead to earlier cancer detection.

Contrast-enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): Patient preferences and tolerance

Contrast‐enhanced spectral mammography (CESM) may have similar diagnostic performance to Contrast‐enhanced MRI (CEMRI) in the diagnosis and staging of breast cancer. To date, research has focused exclusively on diagnostic performance when comparing these two techniques. Patient experience is also an important factor when comparing and deciding on which of these modalities is preferable. The aim of this study is to compare patient experience of CESM against CEMRI during preoperative breast cancer staging.

Breast Tissue Composition and Immunophenotype and Its Relationship with Mammographic Density in Women at High Risk of Breast Cancer

Aim To investigate the cellular and immunophenotypic basis of mammographic density in women at high risk of breast cancer. Methods Mammograms and targeted breast biopsies were accrued from 24 women at high risk of breast cancer. Mammographic density was classified into Wolfe categories and ranked by increasing density. The histological composition and immunophenotypic profile were quantified from digitized haematoxylin and eosin-stained and immunohistochemically-stained (ERα, ERβ, PgR, HER2, Ki-67, and CD31) slides and correlated to mammographic density. Results Increasing mammographic density was significantly correlated with increased fibrous stroma proportion (rs (22) = 0.5226, p = 0.0088) and significantly inversely associated with adipose tissue proportion (rs (22) = -0.5409, p = 0.0064). Contrary to previous reports, stromal expression of ERα was common (19/20 cases, 95%). There was significantly higher stromal PgR expression in mammographically-dense breasts (p=0.026). Conclusions The proportion of stroma and fat underlies mammographic density in women at high risk of breast cancer. Increased expression of PgR in the stroma of mammographically dense breasts and frequent and unexpected presence of stromal ERα expression raises the possibility that hormone receptor expression in breast stroma may have a role in mediating the effects of exogenous hormonal therapy on mammographic density.

Fibromatosis of the breast: A pictorial review of the imaging and histopathology findings

Fibromatosis of the breast is a rare condition that predominantly affects middle-aged women. It is locally aggressive, and exhibits a high incidence of local recurrence. The clinical presentation and radiological appearance are highly suspicious for carcinoma. Definitive diagnosis is made by diagnostic open biopsy. The aim of this review is to illustrate the main radiological and histopathological characteristics of this rare disease to increase awareness of this entity and discuss the role of magnetic resonance imaging (MRI) in its management.

Predictors of re‐excision in wire‐guided wide local excision for early breast cancer: a Western Australian multi‐centre experience

A significant proportion of breast cancers present as impalpable lesions requiring radiological guidance prior to surgical excision, commonly by hook‐wire placement. Complete lesion excision is an essential part of treatment, and re‐excision may be needed to ensure this and minimize local recurrence. We explore a 1‐year audit of re‐excision of hook‐wire‐guided excisions in two large public breast units in Western Australia and define factors associated with the requirement for re‐excision.

Radioguided localisation of impalpable breast lesions using 99m-Technetium macroaggregated albumin: Lessons learnt during introduction of a new technique to guide preoperative localisation.

Preoperative wire‐guided localisation (WGL) of impalpable breast lesions is widely used but can be technically difficult. Risks include wire migration, inaccurate placement, and inadequate surgical margins. Research shows that radioguided occult lesion localisation (ROLL) is quicker, easier, and can improve surgical and cosmetic outcomes. An audited introduction of ROLL was conducted to validate the technique as a feasible alternative to WGL.

Handling of radioactive seed localisation breast specimens in the histopathology laboratory: the Western Australian experience

Summary Radio-guided occult lesion localisation using iodine-125 seeds (ROLLIS) is a novel method of localisation for impalpable in situ and invasive carcinomas that has been the subject of a recent pilot study and pilot study extension in Western Australia. Robust protocols for radiation safety, specimen labelling, specimen tracking, seed retrieval and seed disposal were developed at two Western Australian laboratories to minimise the risk of seed loss. The processes are safe and effective with no significant radiation exposure to pathologists and with acquisition of all seeds intact and undamaged. The success can be attributed to developing specific seed retrieval techniques, suited to local preferences at each institution, with input from surgeons, radiologists and medical physics personnel. These techniques are now routine and will continue in the randomised control phase of the ROLLIS study.

Radioguided occult lesion localisation using iodine-125 seeds ('ROLLIS') for removal of impalpable breast lesions: First Australian experience

Approximately one‐third of breast cancers are impalpable and require pre‐operative image‐guided localisation. Hook‐wire localisation (HWL) is commonly used but has several disadvantages. Use of a low‐activity radioactive iodine‐125 seed is a promising alternative technique used in the USA and the Netherlands. This pilot study describes the first use of this in Australia.

Radioactive seed localisation to guide removal of impalpable lymph nodes (Radioguided Occult Lesion Localisation using Iodine-125 seeds, “ROLLIS”)

Two patients with cancer requiring removal of specific impalpable lymph nodes for full pathological analysis underwent ultrasound-guided lesion localisation and marking with a low-activity I-125 seed. A gamma probe was used in theatre to localise the signal from the seed and guide excision. Successful removal of the lesions was confirmed with the probe and by specimen radiography. Radioguided Occult Lesion Localisation using I-125 Seeds (“ROLLIS”) provides a method of precisely marking impalpable lesions for surgical excision.