Luis Pina

Breast MRI: EUSOBI recommendations for women's information.

AbstractThis paper summarizes information about breast MRI to be provided to women and referring physicians. After listing contraindications, procedure details are described, stressing the need for correct scheduling and not moving during the examination. The structured report including BI-RADS® categories and further actions after a breast MRI examination are discussed. Breast MRI is a very sensitive modality, significantly improving screening in high-risk women. It also has a role in clinical diagnosis, problem solving, and staging, impacting on patient management. However, it is not a perfect test, and occasionally breast cancers can be missed. Therefore, clinical and other imaging findings (from mammography/ultrasound) should also be considered. Conversely, MRI may detect lesions not visible on other imaging modalities turning out to be benign (false positives). These risks should be discussed with women before a breast MRI is requested/performed. Because breast MRI drawbacks depend upon the indication for the examination, basic information for the most important breast MRI indications is presented. Seventeen notes and five frequently asked questions formulated for use as direct communication to women are provided. The text was reviewed by Europa Donna–The European Breast Cancer Coalition to ensure that it can be easily understood by women undergoing MRI.Key Points• Information on breast MRI concerns advantages/disadvantages and preparation to the examination • Claustrophobia, implantable devices, allergic predisposition, and renal function should be checked • Before menopause, scheduling on day 7–14 of the cycle is preferred • During the examination, it is highly important that the patient keeps still • Availability of prior examinations improves accuracy of breast MRI interpretation

Pregnancy associated breast cancer

BACKGROUND Breast carcinoma during pregnancy put the health of the mother in conflict with that of the foetus. The aim is to give optimal treatment to the mother to maximise the chances of survival, whilst minimising the risk of harm of the foetus. We report the epidemiology, pathology, clinical picture, therapeutic management and foetal outcome of pregnant women with breast cancer treated in our institution. PATIENTS AND METHODS Twenty-two pregnant breast cancer patients were treated in our hospital from January 1996 to October 2006. Parents were surveyed by mail or telephone regarding outcomes of children exposed to chemotherapy in uterus. RESULTS The treatment of breast cancer pregnancy should conform as closely as possible to standardised protocols for patients without concomitant pregnancy. Most of the patients underwent surgery during pregnancy In four cases diagnosed during the first trimester chemotherapy was initiated during the 10th week when organogenesis period was finished. None of the children exposed to chemotherapy during this trimester presented congenital malformations. All 11 cases diagnosed during second and third trimester were treated with Doxorrubicin, Fluoracil and Cyclophosphamide and four cases were treated with taxanes. No congenital malformations were detected. CONCLUSION Breast cancer can be treated with FAC chemotherapy during the second and third trimesters without significant complications for the children exposed to chemotherapy in uterus. We report four cases treated with taxanes after the first trimester and no congenital anomalies were observed.

Myofibroblastoma of male breast: report of three cases and review of the literature

Abstract. We report three cases of male breast myofibroblastoma. This uncommon benign tumor arises from breast mesenchyma and is more frequently seen in adult men. Mammographic findings consist of a well-delimited, round to oval dense mass, variable in size but usually 1–4 cm in diameter. No microcalcifications were observed. Ultrasonography confirms the solid nature of the lesion, showing a well-circumscribed, homogeneous, hypoechoic mass, compressible with pressure. Although FNA cytology may support the diagnosis, surgical biopsy should be performed. Tumorectomy is the treatment of choice. To our knowledge, no more than 40 cases of breast myofibroblastoma have been reported. This is the first report in the literature which emphasizes the mammographic and ultrasonographic features of this tumor.

Nonpalpable, well-defined, probably benign breast nodule: management by fine-needle aspiration biopsy and long-interval follow-up mammography

Abstract The management of nonpalpable, well-defined breast nodules by short-interval, 6-month follow-up mammography is widely accepted. We have, however, been managing these type of lesions with fine-needle aspiration biopsy (FNAB), guided by sonography or stereotaxic approach, in order to reduce the number of follow-up mammograms. We recommended surgical biopsy only in cases with malignant or suspicious cytology. Patients with benign cytology or inadequate sample were included in a 12-month-interval mammography surveillance program. In the series we present, two carcinomas were diagnosed among 145 lesions (1.38 %). Both had shown malignancy in FNAB. Another two cases, suspicious of malignancy in FNAB, finally resulted benign in histology. The remaining 141 nodules, monitored for at least 2 years, or surgically removed at the patients request, have not shown signs of malignancy, regardless of a diagnosis of either benign or inadequate sample in FNAB. Sensitivity and negative predictive value of FNAB have therefore been 100 % in this series. No notable differences were observed between stereotaxic and sonographic guidance, except the percentage of inadequate samples (20.3 % by sonography; 25.9 % by stereotaxic sampling). We conclude that stereotaxic or sonographic FNAB is a very accurate diagnostic method in lesions of this type, allowing long-interval surveillance of the nodules with nonsuspicious cytological results.

Early breast cancer treated with conservative surgery, adjuvant chemotherapy, and delayed accelerated partial breast irradiation with high-dose-rate brachytherapy

PURPOSE To evaluate the feasibility and intermediate-term results of conservative surgery, adjuvant chemotherapy, and delayed accelerated partial breast irradiation (APBI) with high-dose-rate brachytherapy. METHODS AND MATERIALS Between 2000 and 2007, a total of 26 patients with a median age of 54 years were treated with conservative surgery followed by adjuvant chemotherapy and exclusive high-dose-rate brachytherapy. Inclusion criteria followed the Radiation Therapy Oncology Group 95-17 trial guidelines. The tumor bed was marked at the time of surgery (n = 2) or before brachytherapy (n = 24). The brachytherapy procedure was performed at a median of 22 weeks after surgery. A median of 14 brachytherapy catheters were placed in three to four parallel planes. A dose of 34.0 Gy in 10 b.i.d. fractions given over 5 consecutive days was prescribed to the clinical target volume (CTV90). RESULTS After a median followup of 53 months (range, 6.8-81), Radiation Therapy Oncology Group Grade 1-2 events and Grade 3 events were observed in 10 (38.4%) patients and 3 (11.5%) patients, respectively. No Grade 4-5 events were observed. Patients rated their cosmetic result as excellent (37.5%), good (50.0%), fair (8%), or poor (4%) based on the Wazers Criteria. The 6-year actuarial local, elsewhere in the breast, and distant control rates were 100%, 96.2%, and 96.2%, respectively. Six-year disease-free survival and overall survival were 92.3% and 96.2%, respectively. CONCLUSIONS Patients undergoing surgery and adjuvant chemotherapy can still be candidates for APBI. Optimal visualization of the internal lumpectomy scar before implantation is mandatory. Cosmetic results may be slightly worse due to the interaction between chemotherapy and APBI, and technical refinements may be needed in this group of patients.

Calcified filariasis of the breast: report of four cases

Abstract. Circumscribed to endemic areas throughout tropical countries, filariasis is a rare and unknown disease in Europe. We report four cases of calcified filariasis involving the breast, supporting the diagnosis on the typical mammographic appearance of the calcified worms and the past history of filarial infection. Few reports have been published in the radiology literature about this infrequent manifestation of the parasitation. The purpose of this article is to show the mammographic characteristics of this disease that soon will be seen frequently in developed countries due to the increasing population from the endemic areas.

Ultrasound-guided core-needle biopsy of breast lesions

ObjectiveTo review the role of ultrasound-guided core-needle biopsy (CNB) in the management of breast lesions.MethodsReview of the most relevant literature on this topic.ResultsThis technique shows a high sensitivity value of about 97.5% and it offers many advantages over other imaging techniques to guide a biopsy: non-ionising radiation, low cost, full control of the needle in real time, accessibility in difficult locations, multidirectional punctures and excellent comfort for patients and radiologists. All of these advantages have made this technique the most widespread used to perform a biopsy for a suspicious breast lesion. The most important limitation is the failure to perform a biopsy for lesions that are not seen on ultrasound. An adequate radiological–pathological correlation is necessary to minimise the false-negative results.ConclusionUltrasound-guided CNB has proven to be a reliable technique for performing a biopsy for breast lesions that can be clearly seen on ultrasound.

Carcinoma adenoide quístico de mama

Objetivo Revisar los hallazgos radiologicos del carcinoma adenoide quistico (CAQ), asi como su presentacion clinica. Material y metodo Realizamos un estudio retrospectivo desde enero de 1990 hasta julio de 2004, en el que se encontraron 5 casos de CAQ de mama, todos ellos en mujeres, entre 4.036 lesiones malignas diagnosticadas (0,12%). Se revisaron los estudios mamograficos disponibles (5 casos), ecograficos (4 casos) y de resonancia magnetica (un caso). Asimismo se reviso la presentacion clinica de los casos y la evolucion de las pacientes. Resultados Tres casos fueron palpables. Los hallazgos mamograficos consistieron en tres nodulos irregulares y mal delimitados, un nodulo redondeado bien delimitado y una densidad asimetrica. En ningun caso se apreciaron microcalcificaciones. En tres casos la ecografia mostro la presencia de nodulos polilobulados y mal delimitados, mientras que otra de las lesiones aparecio como un nodulo redondeado y bien delimitado con pequenos quistes en su interior. Esta lesion presento una intensa vascularizacion en el estudio doppler. El unico caso en que se realizo resonancia magnetica mostro un nodulo redondeado con captacion heterogenea de contraste, margenes bien definidos y curva de captacion altamente sospechosa de malignidad. El tratamiento aplicado en todos los casos fue la tumorectomia asociada a radioterapia. Cuatro de las pacientes se encuentran asintomaticas hasta el momento (seguimiento medio de 64 meses) y una de ellas presento metastasis pulmonares y hepaticas 12 anos despues del diagnostico de CAQ. Conclusion El CAQ es una tumoracion infrecuente de mama cuya apariencia radiologica es variada, aunque predominan lesiones de moderada o alta sospecha. Destacamos la ausencia de microcalcificaciones en estos tumores. Generalmente su pronostico es bueno, aunque existe la posibilidad de desarrollar metastasis a distancia.

Técnicas de biopsia para el diagnóstico de lesiones mamarias no palpables

Facing a non-palpable mammary lesion requiring a diagnostic biopsy, consideration must be given to the most suitable guiding method for obtaining the latter. Three methods are employed at present: stereotaxy (basically in cases of microcalcifications), echography (above all in the nodules), and magnetic resonance (for lesions not made visible through the previous systems). The next step is to select the most suitable biopsy technique. The most classical and reliable technique is the surgical biopsy with prior marking using a metallic harpoon, but, besides its high cost, it has the drawback of being an aggressive technique for the diagnosis of a benign pathology. Numerous systems of puncture have been developed as alternatives. Puncture with a fine needle is technically simple to carry out and can provide good results in the mammary nodules, but the existence of positive and negative false results has progressively limited its use. As an alternative, the systems of biopsy with a broad needle have made it possible to obtain multiple cylinders with a high diagnostic reliability, above all in the case of mammary nodules. However, their use in microcalcifications continues to show negative false results. The arrival of systems of vacuum-assisted biopsy has made it possible to obtain cylinders of greater quality, above all in cases of microcalcifications. Finally, the systems of percutaneous resection biopsy by means of cannulas with a diameter of 22 mm make it possible to completely extract lesions of a size below that of the cannula, with a reliability similar to that of the surgical biopsy.

Stereotactic‐Guided Excisional Biopsy: A New Technique for Very Thin Breasts

Abstract:  Stereotactic biopsies are widely used for the diagnosis of breast lesions. Most biopsy devices require breast thickness of at least 25–30 mm with compression. We describe an alternative technique in order to perform excisional stereotactic‐guided biopsies for very thin breasts using the prone stereotactic table. In the outpatient setting and with local anesthesia, this procedure can be performed by a radiologist, a surgeon, and a nurse. After conventional stereotactic localization, a fine needle is placed at the site of the lesion. Once the point is marked with a skin marker, a 25G × 16 mm needle is introduced. Then, a couple of stereotactic views are taken to confirm the correct position of the needle. Later, the surgeon excises the lesion guided by the needle. Additional radiographs of the specimen and the remaining breast tissue are obtained to ensure the accuracy of the procedure.