M. Asad-Syed

Radiofrequency Ablation as a Substitute for Surgery in Elderly Patients with Nonresected Breast Cancer: Pilot Study with Long-term Outcomes

PURPOSE To determine the efficacy and tolerance of ultrasonography (US)-guided percutaneous radiofrequency (RF) ablation with endocrine therapy in elderly patients with breast cancer who decline or are not candidates for surgery. MATERIALS AND METHODS Internal ethics committee approval was obtained, and patients gave informed written consent. Women older than 70 years with breast carcinoma, who had undergone neoadjuvant endocrine therapy within the past 6 months, underwent US-guided RF ablation while under local anesthesia and sedation. Only tumors measuring 3 cm or smaller and situated at least 1 cm from the skin, nipple, and chest wall were selected. Multitine electrodes were used. Endocrine therapy was continued for a total of 5 years, and breast irradiation was not performed. Clinical follow-up included US, mammography, and dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging every 2 months for 6 months and then every 6 months until 5 years. Primary end points were RF ablation efficacy at 1 year on the basis of DCE MR imaging follow-up and procedural tolerance. The secondary end point was delayed local efficacy at the end of endocrine therapy (5 years) on the basis of DCE MR imaging follow-up. RESULTS Twenty-one women were treated from December 2004 to April 2010 (median age, 79 years; age range, 70-88 years). Efficacy was demonstrated at 1 year, with only one patient presenting with a local relapse. No general complications were noted. Skin burn occurred in four patients, with spontaneous healing after a maximum of 2 months. Ten patients were followed up for 5 years, with three additional patients presenting with cancer recurrence outside the ablation zone at 30, 48, and 60 months-including two with lobular carcinoma. Four patients died during the full follow-up, two of breast cancer-related causes and two of unrelated causes. CONCLUSION RF ablation in elderly patients with nonresected breast cancer is well tolerated and efficient at 1-year follow-up. The technique is not recommended for lobular carcinoma.

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.

Imaging benign inflammatory syndromes

Benign mastitis is a rare disease and its management is difficult. The diagnostic challenge is to distinguish it from carcinomatous mastitis. We make a distinction between acute mastitis secondary to an infection, to inflammation around a benign structure or to superficial thrombophlebitis, and chronic, principally plasma cell and idiopathic granulomatous mastitis. Imaging is often non-specific but we need to know and look for certain ultrasound, mammogram or magnetic resonance imaging (MRI) signs to give a pointer as early as possible towards a benign aetiology. A biopsy should be undertaken systematically where there is the slightest diagnostic doubt, to avoid failing to recognise a carcinomatous mastitis.

The inflammatory breast: management, decision-making algorithms, therapeutic principles.

Inflammatory syndrome is one of the rare emergency breast situations. Its etiology is benign, infectious in most cases. The clinical examination is often self-evident and suggests the diagnosis. But alone it is insufficient, and diagnostic tests are necessary to guide therapy. As essential as it is, mammographys limitations reinforce the benefit of ultrasonography, which in all cases reveals an abscess and has greater sensitivity for detecting a malignant tumor. If the etiology is benign, clinical signs will disappear with medical treatment, with no need for further investigation. While it is legitimate to initiate a trial treatment, it must not delay oncologic management, because of the severity of inflammatory cancer.

Le lymphome malin non-hodgkinien est une cause d'hypodensité péri-portale intra-hépatique au scanner

The authors report two cases of non-Hodgkin lymphoma in non immunodeficient subjects characterized by periportal low attenuation at CT. Both patients showed gallbladder wall thickening. The different causes of periportal abnormalities are presented and discussed.

Diagnostic du cancer du sein après 74 ans : information donnée par les structures de gestion du dépistage organisé à la sortie de la tranche d’âge concernée

Breast cancer among older women is a major and increasing public health issue. No clear recommendation has been established in France after 74 years, the age limit for state-organised screening program. A survey was performed among all regional agencies in charge of the breast screening to analyse which information is delivered to women reaching the age of 75 years. A postal survey sent to 91 French organised cancer screening agencies. Among the 89 agencies that answered, only 22 deliver a systematic written information. Twelve suggest that mammographic screening should be continued, and five mention clinical examination. Twenty agencies dispatch the screening to general practitioners or gynaecologists. Two information letters insist on the ongoing risk of breast cancer. Most of the written information is given with the last mammography report. No impact study has ever been performed. In our study, only 25% of the screening agencies give systematic information to women. The modalities and the substance of this information are heterogeneous. A better information seems to be a key-point for earlier clinical breast cancer diagnosis among older women, for whom there is little direct evidence of the benefit of systematic mammographic screening.

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.

Modalités de diagnostic du cancer du sein chez la femme âgée : une absence d’acquis, une réflexion nécessaire…

Aucune donnee n’est a notre connaissance disponible concernant les modalites diagnostiques du cancer du sein apres l’age limite du depistage organise, 74 ans en France. Pourtant 20 % des patientes sont agees de 75 ans au moins au diagnostic, une proportion qui va fortement augmenter dans les annees a venir.

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.