Modern radiology in the differential diagnosis of breast diseases accompanied by calcium micromasses

The study was undertaken to enhance the efficiency of diagnosis of breast cancer shown up as calcium micromasses since breast diseases appear as clusters of 50-600-um calciferous inclusions that are not inclined to the formation of conglomerates without a visible node on a X-ray film, may be a manifestation of both sclerosing adenosis and nonpalpable cancer. Of the examined 4500 females aged 15 to 83 years, breast calcium masses were detected in 207. Of them, 39 females were found to have clustered calcium micromasses without a node on a X-ray film; in them cancer and sclerosing adenosis were diagnosed in 28 (71.8%) and 11 (28.2%) females, respectively. Examination was made by using clinical, mammographic, and sonographic studies. Intervention radiology and pathomorphological studies were studied. This has yielded a number of signs that are characteristic of malignant and benign diseases attended by clusters of calcium micromasses in a restricted area without a visible node on X-ray films that assist in making a correct preoperative conclusion with a greater probability in 80%.     

Cytology of abnormal nipple discharge: a cyto-histological correlation

Spontaneous or expressible nipple discharge may occur in palpable and nonpalpable breast lesions. The aim of the study was to evaluate the sensitivity and specificity of nipple discharge cytology in palpable and nonpalpable breast lesions. One hundred and seventy-four nipple discharge specimens were reviewed, of which 82 had corresponding surgical pathology, including 34 palpable breast lesions and 48 nonpalpable breast lesions. There was good correlation between nipple discharge cytology and concomitant fine needle aspiration (FNA) cytology. Nipple discharge cytology is as specific as concomitant FNA cytology but is slightly less sensitive in detecting papillomas or malignant lesions. The sensitivity and specificity of the nonpalpable and palpable breast lesions were similar. Nipple discharge cytology is very helpful in detecting an underlying breast lesion even if the case has no palpable mass in the breast.     

Cytochemical classification of nonpalpable breast carcinoma

A stereotaxic needle biopsy technique makes it possible to obtain diagnostic cytologic material from nonpalpable breast lesions down to sizes of 2 to 3 mm in diameter. Considering the high correlation between the type of DNA distribution pattern and patient survival demonstrated in palpable breast carcinomas, cytophotometric DNA measurements were performed on smear preparations from nonpalpable tumors. In a series of 30 consecutive nonpalpable breast carcinomas, the same types of DNA profiles as shown in palpable tumors were found. This indicates that malignancy grading of breast carcinomas by cytochemical means can be performed on stereotaxic needle biopsy material and that an improved prognostic evaluation may be expected by the use of the methods described. This should result in a better therapeutic approach to patients with nonpalpable breast tumors.     

A place of outpatient screening in the formation of a current organizational scheme for better radical detection of breast cancer

The authors consider it necessary to revise the current views of breast cancer in women. In their opinion, excessive consideration of mammography as an independent section of radiation diagnosis does not contribute to better detection of breast cancer. The principle of including mammography into the general traditional section of current radiation diagnosis should be regarded as of paramount importance. Mammography should be widely introduced into the general polyclinic network of the practical health care system of the Russian Federation. The so-called mammological dispensaries (centers) that have been or being set up should more clearly define their functions mainly to rendering an organizational and methodological assistance in the diagnosis of breast cancer at a routine outpatient level, to make its specified diagnosis, and to define the tactics of rendering a medical care of detected breast pathology in the polyclinic. The authors consider that the wide introduction of screening for breast cancer into the practice of polyclincs is one of the basic ways of improving of its detection.     

乳腺内不可触及病灶的定位活检应用价值

目的:探讨乳腺内不可触及病灶(NPBL)的定位活检技术及其在乳腺癌早期诊断中的临床应用价值。方法:对彩超发现的4459个和钼靶发现的25个NPBL分别行麦默通旋切和钩丝定位活检,确定病灶的病理类型。结果:4459个NPBL中3196个病灶为乳腺腺病或伴纤维腺瘤样结节(71.7%),1198个为纤维腺瘤(26.9%),11个为分叶状肿瘤(0.2%),17个为导管内乳头状瘤(0.4%),9个为乳腺导管原位癌,5个为导管原位癌伴微浸润,23个为浸润性癌(恶性占0.8%)。25个钼靶发现的NPBL中乳腺腺病13例(52%),导管原位癌7例,导管原位癌伴微浸润2例,浸润性癌3例(恶性占48%)。结论:超声引导下麦默通和钼靶引导下钩丝定位切除可以对NPBL做出定性诊断,具备创伤小、手术时间短和定位精准等特点,对提高乳腺癌的早期诊断率、降低死亡率具有一定的临床应用价值。     

Stereotactic radiofrequency ablation: A minimally invasive technique for nonpalpable breast cancer in postmenopausal patients

Background: The purpose of this study was to determine the feasibility of radiofrequency ablation (RFA) of nonpalpable breast cancer in postmenopausal women, and report on long-term follow-up with clinical examination and mammography. Methods: Since November 2000, we have performed RFA on stereotactically localized nonpalpable breast cancers (only mammographic densities) in women older than 65 years with other serious health problems. Results: The first patient had the procedure done in the office with sedation and local anesthesia. The radiofrequency probe was inserted by stereotactic localization, and the RFA proceeded for 20 min at 75 °C. Two weeks later, the lesion was not seen mammographically, but by palpation there was induration at the ablation site. Six weeks later, open excision of the area confirmed a prominent ablation site with no remaining viable tumor cells. The second patient had the same procedure, and has been followed without open biopsy. The third patient had DCIS and the probe arrays were not able to penetrate the lesion. The fourth and fifth patients had light sedation with an intercostal nerve block to eliminate discomfort and this approach was found to be a very effective office procedure. The last two patients’ ablation sites were injected with depo-medrol and they were placed on anti-inflammatory therapy to decrease the palpable induration caused by fat necrosis. Conclusion: We found RFA feasible for definitive therapy for nonpalpable breast cancer. If our results are confirmed by larger clinical trials, RFA would eliminate open surgery and decrease the morbidity associated with lumpectomy and radiation.     

Preliminary experience in sentinel node and occult lesion localization (SNOLL) technique—One center study

Aim

The aim of this study was to present one center experience in applying the SNOLL technique to patients with suspected occult breast lesions.

Background

In the last years, the widespread use of mammographic screening programs resulted in an increasing number of women with nonpalpable suspicious breast lesions requiring further examination. The new method called sentinel node and occult lesion localization (SNOLL) enables the intraoperative detection of nonpalpable breast tumors and sentinel node biopsy in one surgical procedure.

Materials and methods

46 patients with suspected malignant lesions or diagnosed non-palpable breast cancer were subjected to a pre-operative SNOLL procedure. The day before the surgery, they were administered two radiotracers: one to localize the tumor and the other to localize the sentinel node. During the surgery, the breast tumor and the sentinel node, which in most cases had been examined intraoperatively, were detected with a handheld gamma probe and resected under its control.

Results

All 46 (100%) patients had their occult breast lesions resected. Histopathologic examination revealed cancer in 40 patients: in situ in 2 cases, invasive in 38 cases. All these patients had their sentinel nodes examined. In one case only, the sentinel node could not be located with a gamma probe. Intraoperative tests showed the sentinel node to be metastatic in 5 patients, who were then given a simultaneous axillary lymphadenectomy. In addition, the final histopathologic examination revealed metastasis to the sentinel node in one patient, who had to be reoperated.

Conclusion

SNOLL is a modern technique that enables a precise intraoperative localization of non-palpable suspected malignant breast lesions in combination with a sentinel node biopsy. Extended application of intraoperative management leads to significant decrease in the number of reoperations performed in patients with early bread cancer.     

Cytophotometrical and biochemical characterization of nonpalpable, mammographically detected mammary adenocarcinomas

Fifty nonpalpable, mammographically detected, invasive breast carcinomas were analysed with respect to DNA distribution pattern, steroid receptor content, and histopathological criteria. No significant histomorphological differences were found as compared to palpable breast carcinomas. In contrast, DNA distributions of palpable and nonpalpable tumors differed. Ninety percent of these relatively small breast carcinomas were found to exhibit nuclear DNA amounts within the diploid and tetraploid regions of normal breast epithelium. In earlier findings in palpable breast carcinomas, 55% are of the diploid-tetraploid type. The mean cellular content of the estrogen receptor was 1.0 fmole/microgram DNA in this group of mammographically detected carcinomas, which is significantly higher than in routinely detected, ie, larger, breast carcinomas. It is suggested that, despite the histomorphological findings, nonpalpable, mammographically detected breast carcinomas are dominated by biologically highly differentiated, slowly proliferating carcinomas with a favourable prognosis.     

彩色多普勒超声对临床触诊阴性乳腺癌的诊断价值

目的:探讨超声对临床触诊阴性乳腺癌的诊断价值。方法:回顾性分析135个临床触诊阴性乳腺肿块(恶性33个,良性102个)超声直接和间接征象图特征,并与病理结果对照分析,计算超声诊断触诊阴性乳腺肿块灵敏性、特异性、阳性预测值、阴性预测值及准确性。结果:直接征象中微钙化、Ⅱ～Ⅲ级血流、穿支血管、阻力指数RI≥0.7和间接征象中浅筋膜的改变、腋窝淋巴结肿大具有较高诊断价值,良恶性组比较差异有统计学意义(P均<0.01)。超声诊断临床触诊阴性乳腺癌的灵敏性81.82%、特异性93.14%、阳性预测值79.41%、阴性预测值94.06%、准确性90.37%。结论:超声对临床触诊阴性乳腺癌的早期诊断具有重要价值。     

High-throughput molecular analysis from leftover of fine needle aspiration cytology of mammographically detected breast cancer

We investigated whether residual material from diagnostic smears of fine needle aspirations (FNAs) of mammographically detected breast lesions can be successfully used to extract RNA for reliable gene expression analysis. Twenty-eight patients underwent FNA of breast lesions under ultrasonographic guidance. After smearing slides for cytology, residual cells were rinsed with TRIzol to recover RNA. RNA yield ranged from 0.78 to 88.40 μg per sample. FNA leftovers from 23 nonpalpable breast cancers were selected for gene expression profiling using oligonucleotide microarrays. Clusters generated by global expression profiles partitioned samples in well-distinguished subgroups that overlapped with clusters obtained using "biologic scores" (cytohistologic variables) and differed from clusters based on "technical scores" (RNA/complementary RNA/microarray quality). Microarray profiling used to measure the grade of differentiation and estrogen receptor and ERBB2/HER2 status reflected the results obtained by histology and immunohistochemistry. Given that proliferative status in the FNA material is not always assessable, we designed and performed on FNA leftover a multiprobe genomic signature for proliferation genes that strongly correlated with the Ki67 index examined on histologic material. These findings show that cells residual to cytologic smears of FNA are suitable for obtaining high-quality RNA for high-throughput analysis even when taken from small nonpalpable breast lesions.     

The role of contrast enchanced axillary ultrasonography in early breast cancer patients

The most important prognostic factor for the patients with breast cancer are metastases to axillary lymph nodes (ALNs). Preoperative ultrasound (US) combined with fine needle aspiration biopsy (US-FNAB) has been proved to be the most reliable method to detect nonpalpable axillary metastases in patients with breast cancer. Our study was aimed to examine the value of US contrast agent (CA) SonoVue in the US examination of the axilla for the detection of axillary lymph node (ALN) metastases in breast cancer patients. Therefore, two studies were performed. The first study included 27/70 patients with breast cancer who had an indeterminate result of the standard US examination of the axilla (L/T < 1.2 or MCT > 3 mm or predominantly non-hilar vessel signal) and underwent US examination with CA. In the second study, 26 breast cancer patients underwent standard axillary US examination performed independently by two skilled operators. The patients with indeterminate or malignant ALN underwent US- guided fine needle aspiration biopsy (US-FNAB). For macrometastases, the sensitivity, specificity, NPV and PPV of US-FNAB were 91%, 93%, 100% and 100%, respectively. The reproducibility of the standard US examination (the second study) was 85% (22/26 patients), and for the metastases larger than 5 mm, it was 100%. Moreover, our second study proved that the same results as with CA can be achieved by two skilled operators performing a standard US examination. The sensitivity of both operators was 92%. In the case of metastases larger than 5 mm, the reproducibility was 100%. Micrometastases remain a problem also in the hands of very experienced operators even if using CA.     

Diagnosis of hemorrhagic diseases; evaluation of procedures. I

Careful and complete history and physical examination are essential in the diagnosis of diseases characterized by hemorrhage and are more reliable than laboratory tests for the prediction of the tendency to bleed at the time of surgical operation. Specific questions should be asked about bleeding from various anatomical sites, allergic manifestations, diet, and exposure to poisons and chemical substances. Because hemorrhagic diseases may be hereditary, it is necessary to obtain a family history. If there is a personal or family history of abnormal bleeding, the examiner should obtain exact details about the events immediately preceding the bleeding episodes, the character and duration of the hemorrhage and the response to therapy. The history is particularly important in the case of patients who are to have operation. Failure to obtain a history of past bleeding episodes may be catastrophic. In patients with bleeding tendencies who require operation, the history is valuable in predicting the severity of the bleeding. Physical examination including examination of retina, breast and pelvic organs will often detect evidence of lesions that are helpful in the diagnosis of the primary diseases of which the hemorrhage is a manifestation. The location, distribution, character and number of hemorrhagic lesions are of value in diagnosis and in prognosis.     

DIAGNOSIS OF HEMORRHAGIC DISEASES—Evaluation of Procedures

Careful and complete history and physical examination are essential in the diagnosis of diseases characterized by hemorrhage and are more reliable than laboratory tests for the prediction of the tendency to bleed at the time of surgical operation. Specific questions should be asked about bleeding from various anatomical sites, allergic manifestations, diet, and exposure to poisons and chemical substances. Because hemorrhagic diseases may be hereditary, it is necessary to obtain a family history. If there is a personal or family history of abnormal bleeding, the examiner should obtain exact details about the events immediately preceding the bleeding episodes, the character and duration of the hemorrhage and the response to therapy.The history is particularly important in the case of patients who are to have operation. Failure to obtain a history of past bleeding episodes may be catastrophic. In patients with bleeding tendencies who require operation, the history is valuable in predicting the severity of the bleeding.Physical examination including examination of retina, breast and pelvic organs will often detect evidence of lesions that are helpful in the diagnosis of the primary diseases of which the hemorrhage is a manifestation. The location, distribution, character and number of hemorrhagic lesions are of value in diagnosis and in prognosis.     

人体心功能状态综合评价的实验研究

本文介绍了系统地检查和评阶人体心功能的方法。本方法是以多个无创性心功能指标、动态的功能性负荷刺激和数学分析判断方法,对心功能作综合性评价。前先进行安静状态下的检查与评定,排除明显的心脏疾病,并初步评价心功能。其次进行运动负荷的检查与评定,发现早期心脏疾病,挑选优良的泵血功能者。笫三步进行下身负压或低氧运动双负荷的检查与评定,达到对心脏疾病挖潜和选拔调节功能优良者。最后,为了人体心功能的择优,采用运动(或者低氧运动)和下身负压二种检查的联合评价。本方法能显露人体心功能状态的储备和调节能力的优劣,达到发现早期疾病、提高诊断率,择优选拔人体心功能的目的。     

Is SNOLL a good localization technique in early breast cancer treatment? A single center’s experience

AimThe aim of this study was to evaluate the method and present one center’s experience in applying the SNOLL technique to patients with non-palpable suspicious breast lesions.Materials and methods371 patients with suspected malignant lesions or diagnosed non-palpable breast cancer were subjected to a preoperative SNOLL procedure. The day before the surgery, they were administered two radiotracers to localize the tumor in the breast and the sentinel node. The following day, with the help of a handheld gamma probe the breast conserving surgery was performed.ResultsAll 371 patients (100%) had their suspected occult breast lesions resected. Histo-pathological examination revealed cancer in 339 patients all these patients had their sentinel nodes examined. The intraoperative tests showed the sentinel node to be metastatic in 35 patients, who were then given a simultaneous axillary lymphadenectomy. Another 7 patients were diagnosed with positive lymph nodes in the final pathology and had to undergo a second operation. Reoperations compelled by positive surgical margins were performed in 26 cases.ConclusionsSNOLL as a good technique of intraoperative localization, enables to remove a nonpalpable breast cancer together with sentinel lymph node in a single surgical procedure. It seems to be a optional method to be used in patients treated with breast conserving therapy.     

Histopathological study of breast cancer and normal breast tissue after magnetic resonance-guided cryotherapy ablation

BACKGROUND: Cryotherapy ablation is a minimally invasive procedure being investigated as an alternative to conventional surgery. There are few reports in breast cancer. AIM: Evaluate the histopathology of tumoral and normal breast tissue after cryotherapy. METHODS: Eleven patients with clinically <2.0cm and ultrasound visible tumors were studied. Invasive carcinoma was documented by preoperative mammography, magnetic resonance imaging and biopsies. Cryotherapy needles were inserted in the tumor under magnetic resonance guidance and deep freezed with a CRYO-HIT TM System-3. Lumpectomy was performed within 4-5 weeks following cryoablation and submitted for pathological examination including immunostaining of keratins. RESULTS: The tumoral response after cryoablation was variable. In 4 cases there was no viable invasive carcinoma left and focal DCIS only in 2. In 6 cases, residual invasive carcinoma of various size was present with DCIS inside or outside the cryozone. One case could not be evaluated because the cryozone was adjacent to the tumor due to technical problems. Histologically, the normal breast parenchyma of the cryozone showed dense fibrosis, fat necrosis, xanthogranulomatous reaction, endovascular fibrosis and haemorrhages in all cases. The positive immunostaining of keratins revealed remnants of cytoskeleton of carcinomatous cells in the necrotic areas without any viable tumoral cells on routine stains. Skin ulceration and/or necrosis were observed in five patients. CONCLUSIONS: Cryotherapy allows tumor destruction of variable extent in breast carcinomas <2.0cm in diameter. Immunostaining of keratins is useful to identify cytoskeleton remnants of tumor cells in devitalized areas.     

Targeting HMGB1: An available Therapeutic Strategy for Breast Cancer Therapy

HMGB1 is a member of highly conserved high mobility group protein superfamily with intracellular and extracellular distribution. Abnormal HMGB1 levels are frequently manifested in various malignant diseases, including breast cancer. Numerous studies have revealed the clinical value of HMGB1 in the diagnosis and therapy of breast cancer. However, the dual function of pro- and anti-tumor makes HMGB1 in cancer progression requires more profound understanding. This review summarizes the functions and mechanisms of HMGB1 on regulating breast cancer, including autophagy, immunogenic cell death, and interaction with the tumor microenvironment. These functions determine the strategies for the development of chemotherapy, radiotherapy, immunotherapy and combination therapies by targeting HMGB1 in breast cancer. Defining the mechanisms of HMGB1 on regulating breast cancer development and progression will facilitate the application of HMGB1 as a therapeutic target for breast cancer.     

Mitochondria and Familial Predisposition to Breast Cancer

Mitochondrial genome and functional alterations are related to various diseases including cancer. In all cases, the role of these organelles is associated with defects in oxidative energy metabolism and control of tumor-induced oxidative stress. The present study examines the involvement of mitochondrial DNA in cancer and in particular in breast cancer. Furthermore, since mitochondrial DNA is maternally inherited, hereditary breast cancer has been focused on.     

Précautions,pièges et artéfacts en TEP/TDM du thorax

PET/CT with ¹⁸F-FDG is a test widely used in the evaluation of chest diseases as diverse as oncology indications and in particular the evaluation of pulmonary nodules, mediastinal disorders of the chest wall, breast lesions or even heart diseases including those of infectious valves. Despite the many precautions taken to the successful completion of the examination, a caution of the interpretation of the exam is required, given the pitfalls and artifacts inherent to the technique, respiratory and cardiac movements, the misrepresentation lesions (false positives of false negatives) or altered by the treatment. Their knowledge can minimize their impact on the interpretations and avoid the use of supplements investigations, sometimes invasive, or worse, administering a noxious or inappropriate treatment. The purpose of this paper is to describe the pitfalls and artifacts of PET/CT with ¹⁸F-FDG commonly found in the thoracic region but also to expose the various precautions that can help the conduct of the exam, the interpretation and even the optimal patient management.