G. Mac Grogan

Radiological features of triple-negative breast cancers (73 cases)

OBJECTIVESnTriple-negative breast cancers generally occur in young women and they have the potential to be aggressive. It is important for this subtype of tumour to be detected early. We studied the appearance of 73 tumours on mammography, sonography and MRI in order to determine what specific features they showed on imaging.nnnPATIENTS AND METHODSnFrom July 2009 to December 2010, we retrospectively reviewed mammogram and sonogram images of 73 triple-negative cancers. Colour Doppler had been used to depict vascularisation in 34 cases and elastography score calculated in 17 cases. Sixteen patients had undergone MRI. The radiological description of these different modalities draws on the BI-RADS lexicon and categorisation.nnnRESULTSnOn mammography, triple-negative cancers often presented as a round mass (59.3%) or an oval or lobulated mass (65%), with circumscribed (15%), microlobulated (12.5%), indistinct (55%) or occasionally spiculated margins (15%). On sonography, the vast majority of these cancers appeared as masses (92.8%) with occasional posterior acoustic attenuation (22.6%). MRI showed more suspicious images than the standard examinations, notably rim-enhancement (eight out of 12 masses).nnnCONCLUSIONn. Radiological images appear as lobulated masses more readily, while on sonography posterior enhancement is shown more often than attenuation, and MRI finds rim-enhancement.

Correlation between imaging and molecular classification of breast cancers.

The histological type of tumour according to the WHO: ductal, lobular, rare forms, is correlated with specific aspects of the imaging based on each type. This morphological classification was improved by knowledge of the molecular anomalies of breast cancers, resulting in the definition of cancer sub-groups with distinct prognoses and different responses to treatment: luminal A, luminal B, HER2 positive, basal-like, triple-negative. Studies are beginning to deal with the appearance of each sub-type in the imaging. It is now important for the radiologist to be familiar with them.

Les prélèvements mammaires en stéréotaxie : macrobiopsies avec aspiration et biopsies chirurgicales stéréotaxiques

Resume Des techniques recentes de prelevements mammaires assistes par la stereotaxie sont utiles pour le diagnostic des images mammaires infracliniques depistees et permettent d’eviter un grand nombre de biopsies chirurgicales classiques. Les modalites techniques des macrobiopsies avec aspiration et des biopsies chirurgicales stereotaxiques sont decrites, ainsi que leurs avantages, leur fiabilite pour etablir le diagnostic histologique ou la confirmation diagnostique pretherapeutique, et les complications, limites, et inconvenients de ces methodes. Leur place dans la prise en charge des anomalies mammaires infracliniques est discutee en fonction de la classification Breast Imaging Reporting and Data System (BI-RADS) de l’ American College of Radiology .Stereotactically-guided procedures for diagnosis of breast lesions can avoid a lot of surgical biopsies. Stereotactic guidance is used for vacuum-assisted core biopsies and for stereotactic breast biopsies. Technical details of the procedures are described, and the benefits and the limits of these methods are discussed. Indications for breast sampling are proposed according to the Breast Imaging Reporting and Data System (BI-RADS) assessment categories.

Correlation between imaging and prognostic factors: Molecular classification of breast cancers

The new molecular classification of breast cancers defines cancer sub-groups with a distinct prognosis and response to treatment. Studies on the literature deal with the imaging of each tumour sub-type. The radiologist should be familiar with them in order to adapt the care of an aggressive sub-type. In view of the current knowledge, the following have been significantly more often observed: mammographical spiculated mass with echogenic halo in luminal A sub-type; architectural distortion in luminal B sub-type; an irregular mass with indistinct margin comprising microcalcifications, with an abrupt interface in the sonography, or non-sonographic mass in the HER2 sub-type; a very hypoechogenic, lobulated mass with indistinct or microlobulated margin, with an abrupt interface, sometimes pseudo-benign, in the triple-negative sub-type.