Eleni Tousimis

Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer

BACKGROUND Digital infrared thermal imaging (DITI) has resurfaced in this era of modernized computer technology. Its role in the detection of breast cancer is evaluated. METHODS In this prospective clinical trial, 92 patients for whom a breast biopsy was recommended based on prior mammogram or ultrasound underwent DITI. Three scores were generated: an overall risk score in the screening mode, a clinical score based on patient information, and a third assessment by artificial neural network. RESULTS Sixty of 94 biopsies were malignant and 34 were benign. DITI identified 58 of 60 malignancies, with 97% sensitivity, 44% specificity, and 82% negative predictive value depending on the mode used. Compared to an overall risk score of 0, a score of 3 or greater was significantly more likely to be associated with malignancy (30% vs 90%, P < .03). CONCLUSION DITI is a valuable adjunct to mammography and ultrasound, especially in women with dense breast parenchyma.

Clinicopathologic Characteristics of 143 Patients with Synchronous Bilateral Invasive Breast Carcinomas Treated in a Single Institution

Synchronous bilateral invasive breast carcinoma (SBIBC) ranged in incidence from 0.3% to as high as 12%.

The Presentation of Contralateral Axillary Lymph Node Metastases from Breast Carcinoma: A Clinical Management Dilemma

Abstract:  Metastases to the contralateral axillary lymph nodes in breast cancer patients are uncommon. Involvement of the contralateral axilla is a manifestation of systemic disease (stage IV) or a regional metastasis from a new occult primary (T0N1, stage II). The uncertain laterality of the cancer responsible for these metastases complicates overall disease staging and is a management dilemma for clinicians. Seven women who developed contralateral axillary metastases (CAM), but did not have evidence of systemic disease were identified. Patient demographics, histopathologic tumor characteristics, treatment and outcome were examined. The median age was 49 years. A family history of breast cancer was present in six (86%). The initial breast cancers were located in all quadrants. They were generally hormone receptor negative, HER‐2/neu overexpressing and associated with lymphovascular invasion. There was a median interval of 71 months between initial breast cancer diagnosis and CAM presentation. Surgical management of the CAM included simple excision in one (14%) and axillary lymph node dissection in five (71%). Adjuvant treatment consisted of chemotherapy in seven (100%) and hormonal therapy in one (14%). The median follow‐up from the diagnosis of CAM was 35 months and three women were alive without disease, two were alive with disease and two had died of disease. With surgical treatment, there were no axillary recurrences in this series. When patients present with CAM and no evidence of systemic disease or a new primary in the contralateral breast, surgical treatment should be considered for local control and possibly improved relapse‐free survival.

Sentinel Node Positivity Rates With and Without Frozen Section for Breast Cancer

BackgroundSentinel lymph node biopsy (SLNB) is used to detect breast cancer axillary metastases. Some surgeons send the sentinel lymph node (SLN) for intraoperative frozen section (FS) to minimize delayed axillary dissections. There has been concern that FS may discard nodal tissue and thus underdiagnose small metastases. This study examines whether evaluation of SLN by FS increases the false-negative rate of SLNB.MethodsA retrospective analysis of SLNB from 659 patients was conducted to determine the frequency of node positivity among SLNB subjected to both FS and permanent section (PS) versus PS alone. Statistical analysis was performed by the χ2 square test, and a logistic regression model was applied to estimate the effect of final node positivity between the two groups.ResultsFS was performed in 327 patients and PS was performed in all 659 patients. Among patients undergoing both FS and PS (n = 327), the final node positivity rate was 33.0% compared with 19.6% among patients undergoing PS alone (n = 332). After adjustment for patient age, tumor diameter, grade, and hormone receptor status in a multivariate logistic regression model, there remained an increased likelihood of final node positivity for patients undergoing both procedures relative to PS alone (adjusted odds ratio, 2.1; 95% confidence interval, 1.3–3.6; P = .005).ConclusionsThere was a higher rate of SLN positivity in specimens evaluated by both FS and PS. Therefore, evaluating SLN by FS does not underdiagnose small metastases nor produce a higher false-negative rate. Intraoperative FS offers the advantage of less delayed axillary dissections.

Synchronous bilateral invasive breast cancer

Synchronous bilateral invasive breast cancer is a rare event. The etiology of bilateral breast cancer is uncertain, but most evidence supports independent tumors and not metastasis spread from one of the primary tumors. The prognosis of bilateral breast cancer was once thought to be poor, but recent data has suggested a similar survival for bilateral breast cancers as compared to unilateral disease.

Hematoma mimicking local recurrence of breast cancer.

A n 84-year-old woman who underwent breastconserving therapy (BCT) at an outside institution for right breast ductal carcinoma in situ (DCIS) in 2002 presented with right nipple retraction and spontaneous bloody nipple discharge. Her medical history was significant for daily aspirin use. On examination, a palpable 2.5 cm mass in the lower outer quadrant, adherent to the chest wall, was identified (Fig. 1). Mammogram revealed a 2.8 cm Breast Imaging Reporting and Data System (BIRADS) 5 spiculated mass (Fig. 2). Ultrasound demonstrated a 2.9 cm heterogeneously, hypoechoic, slightly lobulated complex cystic mass with enhanced posterior through-transmission (Fig. 3). Fine-needle aspiration of the lesion revealed only blood. For further evaluation of this suspicious mass, a surgical incisional biopsy was performed that showed breast tissue with an organizing blood clot, fibrosis, and radiation change (Fig. 4). Blood was present in a large duct to explain the nipple discharge. There was no evidence of malignancy. An organized hematoma may present as a mass following BCT. It is the result of extravasated blood which diffusely infiltrates the mammary parenchyma forming a focal collection, usually following surgery, radiation, or trauma. On mammogram, hematomas or seromas appear as round or oval masses at the lumpectomy site. Hematomas often resolve slowly and can be replaced by scar tissue forming a spiculated mass. These masses can mimic carcinoma clinically and radiographically. Ultrasound may be useful in a time-dependent fashion. In the early phase, hematomas appear as complex cystic lobular or irregular masses with ill-defined margins. In the late phase, they appear regularly hypoechoic. This case highlights the importance of obtaining adequate tissue for pathologic examination prior to definitive management. In this case, carcinoma was number one in the differential diagnosis following clinical and radiologic examination. Treatment in the event of a recurrent cancer would have been mastectomy. Therefore a thorough examination in this patient resulted in breast salvage.