Breast Nodules Research Articles

Diagnostic performance of contrast-enhanced ultrasound and enhanced magnetic resonance for breast nodules.

In the current study, we sought to evaluate the diagnostic efficacies of conventional ultrasound (US), contrast-enhanced US (CEUS), combined US and CEUS and magnetic resonance imaging (MRI) in detecting focal solid breast lesions. Totally 117 patients with 120 BI-RADS category 4A-5 breast lesions were evaluated by conventional US and CEUS, and MRI, respectively. SonoVue was used as contrast agent in CEUS and injected as an intravenous bolus; nodule scan was performed 4 minutes after bolus injection. A specific sonographic quantification software was used to obtain color-coded maps of perfusion parameters for the investigated lesion, namely the time-intensity curve. The pattern of contrast enhancement and related indexes regarding the time-intensity curve were used to describe the lesions, comparatively with pathological results. Histopathologic examination revealed 46 benign and 74 malignant lesions. Sensitivity, specificity, and accuracy of US in detecting malignant breast lesions were 90.14%, 95.92%, and 92.52%, respectively. Meanwhile, CE-MRI showed sensitivity, specificity, and accuracy of 88.73%, 95.92%, and 91.67%, respectively. The area under the ROC curve for combined US and CEUS in discriminating benign from malignant breast lesions was 0.936, while that of MRI was 0.923, with no significant difference between them, as well as among groups. The time-intensity curve of malignant hypervascular fibroadenoma and papillary lesions mostly showed a fast-in/fast-out pattern, with no good correlation between them (kappa<0.20). In conclusion, the combined use of conventional US and CEUS displays good agreement with MRI in differentiating benign from malignant breast lesions.

Diagnostic value of contrast-enhanced ultrasound in breast precancerous lesions

Objective To evaluate the diagnostic value of contrast-enhanced ultrasound in breast precancerous lesions. Methods Retrospectively analyzed the contrast-enhanced ultrasound model and angiographic predictive model of 465 cases of the A prospective multicenter study of breast nodules contrast-enhanced ultrasound that led the Sichuan Provincial People′s Hospital from January 2016 to April 2017, which included 69 cases of breast precancerous lesions and 396 other types benign lesions, and the sensitivity, specificity and accuracy of the diagnosis of breast precancerous lesions were calculated. Results The sensitivity of ultrasound predictive model for the diagnosis of precancerous lesions was 60.9% and AUC was 0.681. Precancerous lesions mainly showed non-concentricity, increased homogeneity, and increased lesions; other types of benign lesions mainly showed non-centripetal, high uniformity enhancement and lesion size unchanged. Conclusions Contrast-enhanced ultrasound shows a potential value in the differential diagnosis of precancerous lesions and other types of benign lesions, that can help clinicians to take early intervention measures for breast precancerous lesions, but there are still many problems to be solved. Key words: Contrast-enhanced ultrasound; Breast neoplasms; Breast precancerous lesions; Predictive model

Thyroid nodules coexisting with either cystic or solid breast nodules: a new clue for this association between nodules coming from ultrasonography.

Thyroid and breast nodules (BNs) are common, their prevalence varying based mainly on the population (including age, residence in area of different iodine availability) studied and methods used. The coincidence of thyroid and breast diseases remains controversial and the majority of the studies evaluate the association between breast cancer and thyroid disorders. Here we describe our experience of such association in a non-oncological series. Between the years 2000 and 2005, 3,372 patients from outpatient clinics were referred for thyroid ultrasonography (US) at our University Hospital; concurrent breast US in the 1,896 women revealed the presence of BNs in 127. The 127 women were divided into two groups, based on the cystic or solid nature of the BN(s). In 84/127 (66.1%) the single or multiple BN was/were cystic (group 1), while in the remaining 43 (33.9%) the single or multiple BN was/were solid [group 2; 19/43 had one thyroid nodule (TN) and the remaining 24/43 had ≥2 TNs]. When BN were cystic the coexisting TN(s) was/were more likely to be concordant in localization (i.e., right/right or left/left localization) whereas, when the BN were solid, the coexisting thyroid nodule/nodules was/were more likely to be discordant. In women with cystic BNs (CBNs), TNs were more frequently multiple (64% of cases), whereas in cases with solid BNs (SBNs), the frequency of single and multiple TNs was approximately the same. In patients with TNs/CBNs, TNs tend to be subcentimetric and localized in the inferior pole of either thyroid lobe. In patients with TNs/SBNs, TNs tend to be larger and localized in the middle of either thyroid lobe. In women with BNs associated with TNs, there are interesting differences concerning TNs when patients are stratified based on the cystic or solid nature of the BN.

Biopsy: CT-guided fine needle aspiration is best? radiologist perspective

Availability of computed tomography (CT) and advances in lung screening techniques allowed the identification of growing number of pulmonary nodules. The ability to differentiate between benign and malignant lesions is a challenge. Cytological or tissue sampling of suspected nodules by percutaneous guided imaging, has increasingly been placed as an effective and safe alternative. Analysed cases of fine needle aspiration biopsy (FNAB) and core biopsy performed at the Intervention Center of our institution. As well, review of literature to compare indications, limitations and complications of techniques. FNAB is often used in a number of situations. Thyroid, breast nodules, and suspicious lymph nodes are examples. Percutaneous CT-guided FNAB is widely accepted as an accurate and safe procedure for pulmonary nodules. Core biopsy has gained space, with higher accuracy, low false negative indices, high positivity and similar complication. Interventionist practice is the first option in the diagnostic approach of suspected pulmonary nodules. Both strategies have a minimal morbi-mortality rate if compared to conventional surgical biopsy.

Fluorescence-guided surgery for cancer patients: a proof of concept study on human xenografts in mice and spontaneous tumors in pets.

Surgery is often the first treatment option for patients with cancer. Patient survival essentially depends on the completeness of tumor resection. This is a major challenge, particularly in cases of peritoneal carcinomatosis, where tumors are widely disseminated in the large peritoneal cavity. Any development to help surgeons visualize these residual cells would improve the completeness of the surgery. For non-disseminated tumors, imaging could be used to ensure that the tumor margins and the draining lymph nodes are free of tumor deposits.Near-infrared fluorescence imaging has been shown to be one of the most convenient imaging modalities. Our aim was to evaluate the efficacy of a near-infrared fluorescent probe targeting the αvβ3 integrins (Angiostamp™) for intraoperative detection of tumors using the Fluobeam® device.We determined whether different human tumor nodules from various origins could be detected in xenograft mouse models using both cancer cell lines and patient-derived tumor cells. We found that xenografts could be imaged by fluorescent staining irrespective of their integrin expression levels. This suggests imaging of the associated angiogenesis of the tumor and a broader potential utilization of Angiostamp™. We therefore performed a veterinary clinical trial in cats and dogs with local tumors or with spontaneous disseminated peritoneal carcinomatosis. Our results demonstrate that the probe can specifically visualize both breast and ovarian nodules, and suggest that Angiostamp™ is a powerful fluorescent contrast agent that could be used in both human and veterinary clinical trials for intraoperative detection of tumors.

A deep learning framework for supporting the classification of breast lesions in ultrasound images

In this research, we exploited the deep learning framework to differentiate the distinctive types of lesions and nodules in breast acquired with ultrasound imaging.A biopsy-proven benchmarking dataset was built from 5151 patients cases containing a total of 7408 ultrasound breast images, representative of semi-automatically segmented lesions associated with masses. The dataset comprised 4254 benign and 3154 malignant lesions. The developed method includes histogram equalization, image cropping and margin augmentation. The GoogLeNet convolutionary neural network was trained to the database to differentiate benign and malignant tumors.The networks were trained on the data with augmentation and the data without augmentation. Both of them showed an area under the curve of over 0.9. The networks showed an accuracy of about 0.9 (90%), a sensitivity of 0.86 and a specificity of 0.96.Although target regions of interest (ROIs) were selected by radiologists, meaning that radiologists still have to point out the location of the ROI, the classification of malignant lesions showed promising results. If this method is used by radiologists in clinical situations it can classify malignant lesions in a short time and support the diagnosis of radiologists in discriminating malignant lesions. Therefore, the proposed method can work in tandem with human radiologists to improve performance, which is a fundamental purpose of computer-aided diagnosis.

The anticancer activity of (e)-1-(4’-aminophenyl)-3-phenylprop-2-en-1-on against DMBA-induced mammary cancer in Sprague Dawley rat through the regulation of microRNA-21 expression

Background: The new anticancer is urgently needed due to the high resistance and recurrence of breast cancer. Previous study reported that a new chalcone derivative, (e)-1-(4’-aminophenyl)-3-phenylprop-2-en-1-on, has a potential cytotoxicity against T47D breast cancer cell line. In this study we investigated the anticancer activity of (e)-1-(4’-aminophenyl)-3-phenylprop-2-en-1-on against DMBA-induced mammary cancer in Sprague Dawley rat and its effect on microRNA-21 expression.Methods: Twenty four female rats were divided into 6 groups. The first group, G1 received corn oil. The groups 2 to 6 (G2, G3, T1, T2, and T3) were induced by DMBA (dissolved in corn oil) 20 mg/kgBW for 5 weeks. After breast nodule observed, G2 received vehicle and G3 received tamoxifen. Whereas, T1, T2, T3 received (e)-1-(4’-aminophenyl)-3-phenylprop-2-en-1-on with different doses, ie. 5, 15, and 45 mg/kgBW/day for 21 days, respectively. Tumor size was measured every weeks for 21 days and on day 22, plasma and breast tissues were collected to examine the miR-21 expression by qRT-PCR and histopathological feature, respectively.Result: The result showed that significantly decreased tumor growth (p&lt;0.05) and better histopathological malignant grading in G3, T1, T2, T3 were observed. Moreover, significantly reduced miR-21 relative expression (p&lt;0.05) in G3, T1 and T2 were also observed. Conclusion: (e)-1-(4’-aminophenyl)-3-phenylprop-2-en-1-on has potential anticancer activity on DMBA-induced mammary cancer in Sprague Dawley rat through its activity on miR-21 expression. Hence, (e)-1-(4’-aminophenyl)-3-phenylprop-2-en-1-on might be a new anticancer candidate in the future.

Kindlin-2 could influence breast nodule elasticity and improve lymph node metastasis in invasive breast cancer

This study investigated the relationship between quantitative parameters of shear wave elastography (SWE, maximum elasticity [Emax], minimum elasticity [Emin], mean elasticity [Emean]), collagen intensity and Kindlin-2 expression in benign and malignant breast nodules, and if Kindlin-2 expression is related with lymph node metastasis. A total of 102 breast nodules from 102 patients were included in our study who underwent ultrasound elastography before surgery or core needle biopsy. There was a significant difference between benign and malignant breast nodules in Emax, Emean, collagen intensity and Kindlin-2 expression, but it had no difference in Emin. Collagen intensity and Kindlin-2 expression both correlated positively with Emax, but not with Emean. Among 38 malignant breast nodules, the average Emax of the metastasis group was higher than that of the non-metastasis group, but it had no statistical significance. Compared with the non-metastasis group, Kindlin-2 expression was considerably higher in the metastasis group. However, there was no difference in collagen intensity between the metastasis group and the non-metastasis group. In conclusion, Kindlin-2 and collagen might contribute to breast nodule elasticity through molecular mechanisms. In breast cancer, overexpression of Kindlin-2 might be a risk factor for lymph node metastasis.

Nilai Diagnostik USG Gray Scale, Color Doppler, dan Strain Elastografi dalam Menentukan Keganasan Tumor Payudara

The study’s aim is to analize the diagnostic values of Gray Scale ultrasound, Color Doppler and strain Elastography determining malignancy of breast tumor. The research was conducted at the Radiology Division of Wahidin Sudirohusodo and Hasanuddin University hospital in Makassar from February to March 2018 by using the diagnostic value. There were 51 research samples who had the clinical symptom of breast nodule. The examination of ultrasound gray scale, color doppler and strain elastography was performed to assess the breast nodules and determine malignancy and benign based on the classification of each examination. The results were based on USG breast and the three were compared. The comparative standard used was histopathological examinations as a gold and the data were analized using the Chi-Square test.The research results indicated that based on the histopatology examination from 51 samples, 18 samples (35,3%) had malignant tumor, and 33 samples (64,7%) had benign tumor. The gray scale revealed sensitivity of 94,4% and spesifisity of 81,8%, whereas usg color doppler based on vascular distribution revealed the sensitivity of 77,8% and the spesificity 93,9%, based on vascular amount of sensitivity 72,2% and spesificity 93,9% and resistance index sensitivity 89,4% and spesificity 87,5% with cut off value for malignant tumor ≥0,495 in 17 samples (81%), whereas benign has a resistance value index &lt;0,495 in 28 samples (93,3%). As for the strain elastography based on Tsukuba scores, sensitivity was 94,4%, spesificity was 81,8%and based on strain ratio sensitivity was 94,4%, spesificity was 90,9% with cut off value for malignant tumor of ≥2,63, whereas benign tumor of &lt;2,63. The highest sensitivity and spesificity were found in the examination of strain elastography based on strain ratio ,which were 94,4% dan 90,9% with the value of Area Under Curve of 0,906 with the cut-off point of 2,63.

Conventional US combined with acoustic radiation force impulse (ARFI) elastography forprediction of triple-negative breast cancer and the risk of lymphatic metastasis.

To evaluate the combination of conventional ultrasound (US) and acoustic radiation force impulse (ARFI) elastography in predicting triple-negative breast cancer and the likelihood of lymphatic metastasis. A total of 178 women presenting from May 2013 to September 2015 with pathologically proven triple-negative (n = 60) or hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer (n = 118) were reviewed. Conventional US and ARFI imaging including Virtual touch tissue image (VTI) and Virtual Touch tissue Quantification (VTQ), were performed for each breast nodule. Parameters collected included patient age, lymph node involvement, histological grade, tumor subtype, appearance on conventional US, shear wave velocity (SWV) value, VTI score and the boundary on VTI. The ARFI findings were compared with the pathological findings. Younger age (P < 0.001), higher histological grade (P < 0.001), lymphatic metastasis (P < 0.001), more nodes involved (P = 0.001), larger tumor size (P = 0.008), regular shape (P = 0.032), high VTI score (P = 0.006), unclear VTI boundary (P = 0.033), SWV ≥3.51 m/s (P = 0.015) were significantly associated with triple-negative breast cancer. High VTI score (P = 0.004) and a high SWV ≥4.15 m/s (P = 0.002) were significantly associated with lymphatic metastasis. Conventional US combined with ARFI may be used to predict triple-negative breast cancer. Those cancers with higher SWV and the high VTI score have a higher likelihood of lymphatic metastasis.

Breast and pleuropulmonary metastasis of multirecurrent scalp dermatofibrosarcoma protuberans: a case report

BackgroundDermatofibrosarcoma protuberans is a rare tumor, representing about 0.1% of skin malignant tumors. It is characterized by local aggressiveness with significant potential for recurrence. Although metastasis is rare, it does occur. We report a case of a Burkinabe woman with dermatofibrosarcoma protuberans.Case presentationA 27-year-old Burkinabe woman consulted our institution for a recurrent scalp nodule that had been evolving for 13 years. At clinical examination, she was in good condition with a dry cough. An atrophic scarring alopecic plaque of 15-cm diameter in the right parietal region of the scalp, topped by an erythematous firm nodule measuring 3 × 2 × 2 cm, was noted, as well as a mobile nodule located in the axillary tail of the right breast. Cerebral computed tomodensitometry had not objectified the reach of the vault or the brain. A thoracic scan revealed four intrathoracic tissue masses straight to pleural touch. There were no evolutionary lesions in the abdominopelvic region. Histopathologic examination of the biopsy of the scalp nodule showed a proliferation of fibrous background, with fusiform cells carrying a storiform appearance. These cells had dark, elongated nuclei and showed some mitosis without atypia. The cells expressed CD34 intensely and diffusely. The test results were negative for PS100 and smooth muscle actin. The breast nodule showed the same profile as the scalp nodule.ConclusionsWe concluded on the diagnosis of scalp dermatofibrosarcoma protuberans with breast metastasis and probable pleuropulmonary metastasis.

Bilateral Axillo‐Breast Approach Robotic Thyroidectomy (BABA RT) Does Not Interfere with Breast Image Follow‐Up

Bilateral axillo-breast approach robotic thyroidectomy (BABA RT) is frequently performed and has excellent cosmetic results. However, there has been concern that subcutaneous tunneling in construction of the operation field might interfere with subsequent breast imaging. In this study, we evaluated whether BABA RT interferes with breast imaging by evaluating serial perioperative results of mammography and ultrasonography. We selected female patients who underwent BABA RT between 2008 and 2012, and who also had mammography or ultrasonography pre- and postoperatively, and compared the results of pre- and postoperative imaging. The results of mammography and ultrasonography were reported according to the Breast Imaging Reporting and Data System (BIRADS). A total of 175 nodules from 108 female patients were analyzed. The mean age of the patients was 42.9±9.7years, and the median follow-up period was 34.1months. Ninety-four patients (87.0%) underwent total thyroidectomy, and 101 patients (93.5%) had malignant thyroid disease. After BABA RT, mammography and ultrasonography were performed an average of 2.9±2.0 times and 3.3±2.0 times per person, respectively. Six patients required breast intervention according to mammography or ultrasonography after BABA RT, and all procedures were successfully conducted. BABA RT did not cause diagnostic difficulties such as poor sonic window in subsequent breast imaging studies. Routine breast imaging studies for breast nodule follow-up could be performed without difficulties resulting from BABA RT.

Primary non-Hodgkin's lymphoma of the breast. A case report

Abstract Background Primary breast lymphomas, a rare subtype of non-Hodgkin's lymphoma, represent 0.04–0.5% of all breast cancers, 0.38–0.7% of all lymphomas, and 1.7–2.2% of extranodal lymphomas. The treatment choice is based on chemotherapy containing anthracycline and rituximab. Surgery is limited to being less invasive and only for diagnostic purposes. Radiotherapy has an important role as consolidation therapy, particularly in patients with negative nodes. Clinical case A 70 year old woman with a breast nodule in the left upper outer quadrant, with slow growth, expansive, painless, and accompanied by skin changes, malaise, weight loss, fatigue, chill, and sweating. There was tissue replacement by the mammary gland tumour, skin changes due to invasion, and a 5 cm axillary lymphadenopathy. The mammography showed skin thickening and a dense pattern of 80% of breast tissue replacement, and the lymphadenopathy with loss of radiolucent centre and soft tissue invasion. The biopsy confirmed a diffuse high grade large cell lymphoma. She received an rituximab (R-CHOP) chemotherapy scheme and radiotherapy with tangential and supraclavicular and axillary fields. After completing the chemotherapy, the patient is on follow-up, and at 15 months she is alive without disease activity. Conclusions Primary lymphoma of the breast is a rare entity. Multimodal treatment with combined chemo-radiotherapy is the cornerstone. Surgery is reserved only for diagnostic purposes.

Evaluation of the Efficacy of Clinical Breast Examination Gloves in the Diagnosis of Breast Lumps.

Recent studies have questioned the efficacy of mammography in reducing breast cancer-related mortality. Additionally, the efficacies of commercially available gloves marketed as aiding the detection of breast lumps have not been independently verified. To evaluate the efficacy of clinical breast examination gloves in the detection of breast lumps. During the period from October 2011 to June 2012, patients were submitted to clinical examination with and without gloves. This prospective study involved 202 patients who underwent conventional clinical breast examination (test 1) or clinical breast examination with Sensifemme® gloves (test 2). All patients underwent subsequent bilateral ultrasonography (test 3) to confirm the findings of the physical examinations. The Chi-square test was used to compare values, while the kappa concordance index was used to determine the concordance between the diagnostic tests. The mean age of the patients was 43 years; 298 breast lumps were detected. In the clinical examination group (test 1), sensitivity was 54%, specificity was 78%, and accuracy was 57%. These rates for clinical breast examinations with gloves (test 2) were 68%, 58%, and 66%, respectively. The glove increased the diagnosis of breast nodules by 14%; the rate of false-positives was also higher (42% for test 2 compared to 22% for test 1). The accuracy of the glove was found to be superior to clinical examination after 100 patients had been examined. The kappa indices for test 1 vs. test 3 and for test 2 vs. test 3 were 0.15 and 0.16, respectively. Clinical examination using the glove was more effective than clinical examination with bare hands for the diagnosis of breast lumps, as it increased the sensitivity and accuracy of lump detection. However, this was at the expense of a higher false-positive rate, which can lead to further tests, unnecessary biopsies, and patient anxiety. The concordance of clinical examination results (whether performed with or without the glove) with those of ultrasonography is weak. Moreover, the glove has a steep learning curve that may discourage its use in certain circumstances.

Differential Diagnosis of Breast Category 3 and 4 Nodules Through BI-RADS Classification in Conjunction with Shear Wave Elastography

Ultrasound (US) has become one of the important imaging methods for differentiating benign from malignant breast lesions. In 2013, the American College of Radiology published the fifth edition of the Breast Imaging-Reporting and Data System (BI-RADS). BI-RADS is a guide with recommendations for the standardization of breast imaging (US, mammography and magnetic resonance imaging) reports and for the auditing of centers employing such methods. Its objective is to standardize the nomenclature used in the reports. However, current US examinations are neither adequately sensitive nor sufficiently specific enough. The average Young's modulus was measured through shear wave elastography (SWE) to evaluate the diagnostic value of the BI-RADS classification in conjunction with SWE in differentiating BI-RADS 3 and 4 nodules. A total of 100 consecutive women with 126 breast lesions, including 65 benign and 61 malignant lesions, were included. The average Young's modulus of breast nodules and peri-nodule tissue (Emean1 and Emean2) was also determined through SWE. A receiver operating characteristic curve was drawn on the basis of pathologic results. The highest cut-off values were C1 and C2. At Emean1 > C1 or Emean2 > C2, BI-RADS 3 was increased to 4a and BI-RADS 4a was increased to 4b. At Emean1 ≤ C1 and Emean2 ≤ C2, BI-RADS 4b was decreased to 4a. Other BI-RADS classifications remained unchanged. BI-RADS 3 and 4a were considered benign. BI-RADS 4b and 4c were malignant. The area under the curve, sensitivity and specificity of the BI-RADS classification in conjunction with SWE were 0.952, 93.4% and 95.4%, respectively. The area under the curve, sensitivity and specificity of the original BI-RADS classification were 0.883, 82.0% and 87.7%, respectively. Differences were statistically significant (p = 0.028, Z-test). The diagnostic sensitivity and specificity were increased effectively. As a new method, BI-RADS classification in conjunction with SWE that combines the average Young's modulus yields a high value in terms of the differential diagnosis of breast nodules.

1386P - Breast cancer fast-track programme - Evolution and guidelines to prioritize patient referral

In our country there are a breast cancer (BC) Screening (45-70) but actually some patients are diagnosted out of it so Breast cancer fast-track program (BCFP) has proved to be an effective system to efficiently assess symptomatic women to prompt diagnose. The aim of this study is to develop a clinical prediction rule in order to better identify BC to reduce time interval between patient referral by the primary care (PC) physician to the specialist, diagnosis of BC, and start treatment. From 2009 to 2015 we analyzed retrospectively all proposals sent from PC with suspected BC to the oncology coordinator at the Clinico-Malvarrosa Health Department in Valencia. We studied the different variables for which patients were referred to BCFP and analyzed if any of them could be related to increased chance of developing BC. Variables recorded include the presence/absence of lump, inflammation, pain, ulceration, skin change, nipple changes and secretion of the nipple, nodularity and family history. To investigate a grade of association we performed a Pearson Chi Square test using STATA program. 810 patients were considered for the study. 156 were diagnosed with BC (19, 3%). The mean of age was 65, 6 years ( 27- 94). 55 patients were between 45 and 70 years and 34 out of them were going regularly screening. 78, 2%, were diagnosed with localized stage. Above the patients diagnosed with BC, mean of time till specialist assessment was 16,8 days (Standard Deviation, SD 10,9); 11,5 days (SD 13,7) were needed for histopathological diagnosis, and first treatment was administered after 26,5 days (SD 18,2). Among the evaluated variables four were identified to be highly associated with BC: fixed chest lesion [Odds ratio, OR 12,7: IC 95% 7,8-20,7], lump lesion in women older than 50 years [OR 8.9: IC 95% 6,1-13,2], > 3 cm breast nodule [OR 8,2: IC 95% 5,3-12,8] and nipple secretion and retraction [OR 2,1: IC 95% 1,3-3,1]. The results show that the implementation of BCFP has managed to increase cooperation between the different healthcare professionals involved in BC leading to a faster diagnosis of BC. We have identified four variables that are significantly associated with BC, aiming to decrease the evaluation time by the specialist and start earlier the treatment.

Low-Grade Malignant Proliferating Tricholemmal Tumor Associated With Occult Ductal Carcinoma In Situ of the Breast.

Malignant proliferating tricholemmal tumor (MPTT) is a rare adnexal neoplasm most commonly located on the scalp. We a 62-year-old woman who presented to her local physician with a palpable but not visible nodule of the left breast, initially diagnosed as squamous cell carcinoma. Histopathological evaluation of the reexcision specimen incidentally revealed ductal carcinoma in situ. On referral to our institution, the skin biopsy specimen was reviewed and interpreted as a low-grade MPTT. This patient and 2 previously reported cases of MPTT involving breast skin highlight presentation of a rare tumor at an unusual site and the potential for misdiagnosis as squamous cell carcinoma. Reexcision provided the unexpected benefit for our patient of early diagnosis of ductal carcinoma in situ not revealed by imaging.

Pseudo-tumeurs mammaires révélant une maladie de Horton

IntroductionGiant cell arteritis most commonly involves the external carotid branches. Although they are less typical, extra-cephalic forms have also been reported. Case reportWe report the case of a 59-year-old female patient who developed bilateral, painful breast nodules with fever and altered general status since two months. Two weeks later, she presented frontal headache and scalp tenderness. A colour duplex ultrasound of the temporal artery showed a halo sign. The results of a breast needle biopsy were inconclusive but the temporal artery biopsy confirmed the diagnosis of giant cell arteritis. The disease course was rapidly favourable after institution of corticosteroids. IntroductionBreast involvement is rare but could be the first sign of giant cell arteritis. The internal mammary artery, which is a branch of the subclavian artery, can be affected and responsible for breast nodules.

Quantitative indicators of diagnosis research on BI-RADS 3~5 classification in the 2013 edition of BI-RADS

Objective To explore the value of BI-RADS scoring system based on the sonographic features in the breast nodules. Methods In order to build a Logistic regression model, regression was made to analyse 401 patients ' sonographic features of breast nodules. A scoring system was developed based on the results of regression's filter and the weight of each factor, used to score and classify the other 243 patients. It's diagnostic value was evaluated through comparing all types of theoretic risk ranges of BI-RADS. Results Age, morphology, orientation, margin, echo pattern and microcalcifications in a mass were selected in the final step of the logistic regression analysis. By means of scoring system, the scores corresponding to BI-RADS 3, 4a, 4b, 4c, 5 classes are 6, 7-8, 9-15, 16-22 and ≥23 respectively. Case study comprehensive score of BI-RADS 3-5 classification's positive predictive values were 0, 4.17%, 21.43%, 84.85%, 100%, and the area under the ROC curve scoring system was 0.947. Conclusions The scoring system can objectively score and classify breast nodules, and therefore provide an effective reference for clinical evaluation of benign and malignant breast. Key words: Ultrasonography; Beast diseases; Breast Imaging Reporting and Data System; Score

PO-38 - Young women with breast cancer and inferior vena cava thrombosis. Which is the best therapeutic option? And for how long?

Thromboembolic disease (TED) is frequent, and, thromboembolic events are the second cause of death in active cancer patients Today we have knowledge of a lot of risk and predictor factors of thrombosis in cancer, although some mechanisms underlying this increased thromboembolic risk, still remains unclear. Knowing that cancer is today curable, we want to remark that not only old people but also young should be investigated about their personal burden of thromboembolic disease to improve prognosis, and at the same time remark the need to establish different therapeutic strategies in each stage of the disease to prevent or treat TED. We present the case of a young 28 old, female, with breast nodule and axillaries lymphadenopathies, highly suspicious of breast cancer. She has an acute Inferior Vena Cava Thrombosis in her Scan Tomography with a 40% occlusion clinically asymptomatic. Personal history: 2008 splenectomy by a refractory autoimmune hemolytic anemia Directed Coombs Positive (DC) to corticosteroids, 2010 hypothyroidism, 2011 anti lupus antibodies(LA) during traditional pre surgical coagulation test, that persist along time. Family history positive for breast cancer, mother and grandmother and negative for thromboembolic disease In this scenario we decide to put her in low molecular weight heparin 1mg/kg bid a day until we have the oncology diagnosis and then re evaluate our therapeutic anticoagulant decision. After breast cancer diagnosis with the axillaries biopsy she continued with LMWH at full doses to perform the surgery and complete treatment. The diagnosis after surgery was high grade intraductal carcinoma N1 Pos of 21. She performs chemotherapy with cyclophosphamide, doxorubicin and taxol and then radiotherapy. She has been controlled with doppler ultrasonography every three months, at month six shows vena cava recanalization. When she finished radiotherapy we stop HBPM one day and reevaluated for LA that persist positive. At this time we decided to change treatment to antivitamin K until today. The patient, two years later continues in cancer remission with LA and DC positive without hemolytic symptoms and also without new thromboembolic events. The careful evaluation of the personal risk factors for thromboembolic disease in young and old patients with active cancer not only are good to prevent but also probably make us more aggressive at the time to treat in the first stage of cancer and the TED.