Gabrielle Hurtevent-Labrot

Triple-Negative Breast Cancers: Associations Between Imaging and Pathological Findings for Triple-Negative Tumors Compared With Hormone Receptor-Positive/Human Epidermal Growth Factor Receptor-2-Negative Breast Cancers

BACKGROUND Triple-negative (TN) breast cancers have high malignancy potential and are often characterized by early systemic relapse. Early detection is vital, but there are few comprehensive imaging reports. Here we describe mammography, ultrasound, and magnetic resonance imaging (MRI) findings of TN breast cancers, investigate the specific features of this subtype, and compare the characteristics of TN breast cancers with those of hormone receptor (HR)-positive/human epidermal growth factor receptor (HER)-2-negative breast cancers. MATERIALS AND METHODS From July 2009 to June 2011, mammography and ultrasound findings of 210 patients with pathologically confirmed TN (n = 105) and HR-positive/HER-2-negative breast cancers (n = 105) were retrospectively reviewed from our institutional database. Ultrasound vascularity was notified in 88 cases and elasticity scores were notified in 49 cases overall. Thirty-five patients underwent MRI (22 TN and 13 HR-positive/HER-2-negative). Mammograms, ultrasound, and MRI were reviewed according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon and classification. RESULTS TN breast cancers were more likely to show round, oval, or lobulated masses with indistinct margins on mammography than HR-positive/HER-2-negative breast cancers. On ultrasound, TN tumors were more likely than HR-positive/HER-2-negative breast cancers to show circumscribed or microlobulated margins and no posterior acoustic features or posterior enhancement-positive. On MRI, TN cancers exhibited suspicious aspects more often than HR-positive/HER-2-negative cancers, often with rim enhancement-positiveHER-2 (84.6% of masses were classified BI-RADS 5). CONCLUSION This study is the first to describe findings on mammography, ultrasound, and MRI for TN breast cancers with a matched HR-positive/HER-2-negative control group. Several distinctive morphological features of these aggressive tumors are identified that can be used for earlier diagnosis and treatment, and ultimately to improve outcomes.

Shear-wave elastography quantitative assessment of the male breast: added value to distinguish benign and malignant palpable masses

OBJECTIVE To evaluate the ability of shear-wave elastography (SWE) to distinguish between benign and malignant palpable masses of the adult male breast. METHODS Clinical examination, mammography, B-mode and Doppler ultrasound findings and SWE quantitative parameters were compared in 50 benign lesions (including 40 gynaecomastias) and 15 malignant lesions (invasive ductal carcinomas) from 65 patients who were consecutively addressed for specialized advice at our comprehensive cancer centre. Mean elasticity (El mean), maximum elasticity (El max), El mean of the surrounding fatty tissue and lesion to fat ratio (El ratio) were reported for each patient. RESULTS Malignant masses displayed significantly higher El mean (p < 0.0001), El max (p < 0.0001) and El ratio (p < 0.0001) compared to benign masses without overlap of values between the two groups. By adding SWE to clinical examination, mammography and ultrasound, all the lesions would have been retrospectively correctly diagnosed as benign or malignant. One false positive could have been downstaged, 14/65 undetermined masses could have been correctly reclassified as 4 malignant and 10 benign lesions, for which biopsies could have consequently been avoided. CONCLUSION Evaluation of male breast palpable masses by SWE demonstrates that malignant masses are significantly stiffer lesions and may improve diagnostic management when clinical examination, mammography and conventional ultrasound are doubtful. Advances in knowledge: Quantitative SWE is feasible in male breast and could be of great interest to help classify doubtful lesions after classical clinical and radiological evaluations, probably because of different anatomy and different tumours epidemiology compared with female breast.

Biopsias percutáneas de mama

La necesidad de obtener un diagnostico preoperatorio del cancer de mama (sobre todo antes de la introduccion de la tecnica del ganglio centinela) ha dado lugar a un importante desarrollo de la radiologia intervencionista y ha modificado las condiciones de anuncio del cancer y de su tratamiento. El radiologo es el responsable de la eleccion de la tecnica de biopsia, en funcion del tipo de imagen y de su accesibilidad. La microbiopsia guiada por ecografia es la tecnica mas rapida y la menos costosa, por lo que debe preferirse para el diagnostico de una masa. Las microcalcificaciones se biopsian por macrobiopsia bajo estereotaxia para superar las posibles subestimaciones de la microbiopsia. Aun no existe un consenso sobre las indicaciones de la macrobiopsia bajo ecografia; su interes radica en aumentar el tamano de la muestra para tener un diagnostico anatomopatologico mas fiable. Las biopsias bajo antena de resonancia magnetica estan dirigidas a imagenes no visibles en la radiologia convencional y sobre todo que no tienen traduccion en la ecografia dirigida de segunda intencion. Aunque las indicaciones son cada vez mas numerosas (por el desarrollo, entre otras, de las tecnicas de deteccion en las mujeres portadoras de mutacion), pocos equipos realizan esta tecnica, larga y dificil. Del resultado de la biopsia dependera la continuacion del tratamiento de la paciente: seguimiento simple, vigilancia expectante, exeresis quirurgica de la lesion. El equipo radiologo-patologo debe ser capaz de interpretar las informaciones transmitidas reciprocamente y debe conocer la traduccion radiologica y patologica de las diferentes imagenes detectadas y biopsiadas. La concordancia radiopatologica es esencial para poder validar la conducta practica; en los casos dificiles, se debe hacer en las reuniones multidisciplinarias de concertacion.

Diagnostic et décisions dans le cancer du sein précoce Facteurs de décision en radiologie

1. Un bilan radiologique complet datant de moins de 3 mois est necessaire. 2. Le classement de l’image en categorie BI-RADS doit etre ajuste aux antecedents personnels et familiaux. 3. Le diagnostic histologique doit etre connu en preoperatoire (ganglion sentinelle). 4. La microbiopsie echoguidee est le geste interventionnel le plus simple. 5. La pose d’un clip est souvent necessaire apres biopsie d’une image suspecte de tres petite taille.