Diagnosis Of Non-palpable Breast Cancer Research Articles

Magnetic resonance imaging in the diagnosis of nonpalpable breast cancer

Aim. To analyze sensitivity of magnetic resonance imaging (MRI) in the diagnosis of breast cancer when used after mammography and breast ultrasound.Methods. The study included 70 patients with nonpalpable breast lesions who had changes of breast tissue found at previous studies (mammography and breast ultrasound). MRI was performed with the use of Siemens Magnetom Avanto with magnetic field 1.5 Tl.Results. Most frequently nonpalpable lesions were diagnosed in 45 to 60-year old patients (60%), a little rarer - in 39 to 45-year old patients (22.9%), in patients at the age of 61 to 69 - in 10.0% (7 patients). 7.1% patients were over 70. All first detected nonpalpable lesions of breast were biopsied for morphological verification. With the combined use of mammography, sonography, MRI and stereotactic biopsy the diagnosis was made in 100% patients. MRI with contract enhancement showed no relation between sensitivity, specificity and reliability and density of breast tissues.Conclusions. MRI is considered a highly sensitive method of diagnosis and identification of changes found at mammography and breast ultrasound.

Contribution of the High Resolution Ultrasonography in the Diagnosis of Non-Palpable Breast Cancer with Calcification

Contribution of the High Resolution Ultrasonography in the Diagnosis of Non-Palpable Breast Cancer with Calcification

DIAGNOSIS OF NONPALPABLE BREAST CANCER IN PREMENOPAUSAL WOMEN

To analyze the possibilities of standard and additional methods for X-ray mammography (MG) in the comprehensive diagnosis of nonpalpable breast masses and preclinical cancers; to identify the important radiological signs of malignancy as predictors for the application of multislice spiral computed tomography/ magnetic resonance imaging (MSCT/MRI-MG), as well as invasive studies in premenopausal women. The investigation enrolled 423 pre-menopausal patients with nonpalpable breast masses; 129 women were found to have breast cancer. The diagnosis was verified by comprehensive clinical and instrumental examination using standard and additional methods for X-ray mammography, ultra-sonography, MRI, MSCT of the breast and biopsy. Significant radiological signs of malignancy of the lesions were detected and their diagnostic value was identified. The use of additional diagnostic techniques for mammography contributes to the confident visualization of important radiological criteria for malignancy, enhances the informative value of by 5%, and promotes a decline in the number of unjustified biopsies by 11%. Problems in visualizing and categorizing nonpalpable breast masses necessitate additional diagnostic techniques for X-ray mammography. The identification and confident interpretation of important radiological criteria for benign or malignant lesions increase the diagnostic value of X-ray mammography: the sensitivity from 91% to 98%, specificity from 61% to 75%. MSCT-MG and MRI-MG demonstrate even higher efficiency: contrast-enhanced (CE) MSCT–MG (100% sensitivity, 99% specificity) and CE MRI–MG (100% sensitivity, 98% specificity). Sequential radiological and morphological studies improve the quality and efficiency of diagnosis of nonpalpable breast cancer.

Abstract P4-03-07: Contribution of high-resolution ultrasonography in the diagnosis of non-palpable breast cancer with calcification

Abstract Background: In diagnosis of non-palpable calcificated breast cancer (NPCBC), stereo-guided mammotome (ST-MMT) serves as the standard. However, ultrasound resolution has improved dramatically recently. We hypothesized that through ultrasonography, it will become possible to diagnose NPCBC by US guided examination such as fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) with much less invasion than ST-MMT. Method: (Study1) The results of ultrasonic detection ability and US guided examination were studied among the benign lesions of 35 cases and 90 NPCBC patients histologically diagnosed in our facilities from 2010 to 2012. Of the 90 histological types, 74 (82%) were DCIS, and 16 (18%) were invasive carcinoma. (Study 2) The results of 193 progress observation cases from 2008 to 2012 with Birads Category 3 and 4a calcification were examined. Result: (Study1) Using ultrasonography (Toshiba Aprio XG), calcification was detected in 88 of the 90 NPCBC lesions as echogenic foci. Two non-detectable lesions were DCIS of Van Nuys 1 and Van Nuys 2. The results of the FNAC were 80% positive and 20% indeterminate (there were no negative cases). In the 88 cases of possible calcified substance extracted through FNAC, 99% were confirmed under microscopic observation. (Study 2) 163 of 193 cases were able to be followed-up every six months for two to four years. An increase in calcification was observed in nine cases. Five of these cases were diagnosed with DCIS: Four were Van Nuys 1; one was Van Nuys 2. All five cases were of low-grade-malignancy. Conclusion: The diagnostic method using FNAC to visualize calcification using high-resolution ultrasonography is an effective method to reduce the non-efficient, invasive breast cancer detecting method of ST-MMT. The diagnostic method is particularly useful in women of small breast size in Asian countries. The few low-grade DCIS cases included were not detected with ultrasound. However, we believe it is not a diagnostic error. As a result, we stopped using the ST-MMT from 2010. In spite of this, in the MMG screening performed in our facilities from 2010 to 2012, the detection rate of NPCBC without mass on MMG was 0.17 %. This detection rate is excellent in our country. Citation Format: Arai T, Takebe K. Contribution of high-resolution ultrasonography in the diagnosis of non-palpable breast cancer with calcification. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-03-07.

Diagnosis of non-palpable breast cancer

随着乳腺钼靶广泛用于40岁以上女性人群的普查,不能触及肿块的乳腺癌的病例逐渐增多.早期诊断出此类疾病可获得良好的预后.而早期诊断不但依赖于组织病理学,更依赖于在合适的影像学检查定位下获得可靠的组织标本.在诊断不能触及的乳腺病变上,金属丝定位手术活检的金标准已被粗针活检所取代。

Ultrasound (US) diagnosis of nonpalpable breast cancer

Ultrasound (US) is a standard modality to diagnose breast diseases. To elucidate the usefulness of US in the diagnosis of nonpalpable breast cancers, we reviewed the cases that were treated at our institution. Of the 106 cancers that were operated upon at the Tsukuba University Hospital between February 2004 and March 2005, 12 cancers were nonpalpable. We reviewed their US findings, results of US-guided fine needle aspiration cytology (FNAC), core biopsy results, and histological diagnoses. On US, 9 tumors appeared as masses. The US observations were valuable, but a confirmatory diagnosis could not be made. US-guided FNAC was performed in 8 cases; malignancy was suspected in 6 cases. US-guided core biopsy was performed in 9 cases, and it was diagnostic in 7 cases. Nonpalpable breast cancers can be effectively detected by US, and the diagnosis can be confirmed by US-guided FNAC or core biopsy.

Diagnostic assessment of nonpalpable breast cancer-the difference in diagnostic approach for the clinical treatment of breast cancer between the japanese guidelines and the national comprehensive cancer network (USA) guidelines

The detection of non-palpating breast cancer might improve the survival of patients with whole breast cancer because it can be diagnosed at an early stage. Therefore, to standardize the quality of patient care, a published assessment guideline is necessary in a clinical setting. For this purpose, Japan and USA have independent guidelines with different approaches. ''The evidence-based guideline for clinical treatment of breast cancer'' that was published in June 2005 by the Japanese breast cancer society, is the first set of integrated guidelines pertaining to breast cancer in Japan. These guidelines are presented in the research questions (RQ)format. This paper explains 7 RQs(out of 31 RQs)and also discusses the recommendations pertaining to the diagnosis of nonpalpable breast cancer. The National Comprehensive Cancer Network (NCCN; USA)guidelines, which are widely recognized as one of the most reliable guidelines based on published evidences, also contain the diagnostic assessment of asymptomatic patients with a negative physical examination. This paper discusses pros and cons of each of the above mentioned guidelines as well as their clinical application. It is necessary to use both the Japanese and NCCN guidelines while understanding the differences between the two.

Diagnosis of non-palpable breast cancer (image-detected breast cancer)

Diagnosis of non-palpable breast cancer (image-detected breast cancer)

Comparison of Stereotactic Fine Needle Aspiration Cytology and Core Needle Biopsy in 522 Non-Palpable Breast Lesions

To compare the accuracy of stereotactic fine needle aspiration cytologies (S-FNAC) and stereotactic core needle biopsies (S-CNB) in non-palpable breast lesions. Between May 1993 and December 2000, 696 patients with mammographically detected lesions were biopsied both with S-FNAC and S-CNB. S-FNAC was performed with spinal needle 22- or 20-gauge and S-CNB with an automated 14-gauge gun. Of the 696 patients, 522 (75%) underwent breast surgery with postoperative histopathology. In all, 448 of these 522 women (86%) had malignant and 74 (14%) had benign lesions. S-FNAC revealed cancer in 254 (57%) and probable cancer in 48 (11%) (sensitivity 68%, specificity 99.6%) and S-CNB revealed cancer in 388 (87%) and probable cancer in 18 (4%) (sensitivity 90%, specificity 98.8%) of these 448 patients. S-CNB was more accurate than S-FNAC in the diagnosis of non-palpable breast cancer.

Ultrasound-guided lumpectomy of nonpalpable breast cancer versus wire-guided resection: A randomized clinical trial

The wire-guided excision of nonpalpable breast cancer often results in tumor resections with inadequate margins. This prospective, randomized trial was undertaken to investigate whether intraoperative ultrasound (US) guidance enables a better margin clearance than the wire-guided technique in the breast-conserving treatment of nonpalpable breast cancers. Patients with a preoperative histological diagnosis of nonpalpable breast cancer that could be visualized both with US and mammography were included. Patients were randomized to undergo either a wire-guided or a US-guided excision. Adequate margins were defined as >or=1 mm. Of 49 included patients, 23 were assigned to undergo wire-guided excision and 26 to undergo US-guided excision. One patient crossed over to US-guided excision after inadvertent wire displacement. Mean tumor diameter, specimen weight, and operating time were similar in both groups. The excision was adequate in 24 (89%) of 27 US-guided excisions and 12 (55%) of 22 wire-guide excisions (P =.007). US-guided excision seems to be superior to wire-guided excision with respect to margin clearance of mammographically detected and US-visible nonpalpable breast cancers. Patients do not have to undergo the unpleasant wire placement before surgery.

One operation after percutaneous diagnosis of nonpalpable breast cancer: frequency and associated factors.

The purpose of this study was to determine the frequency of and factors associated with performing one therapeutic operation after percutaneous diagnosis of nonpalpable breast cancer. Retrospective review was performed of records of 350 consecutive women who had therapeutic surgery after percutaneous imaging-guided core biopsy diagnosis of nonpalpable breast cancer. Records were reviewed to determine the frequency of performing one operation and associated factors. Statistical analysis was performed. One operation was performed in 283 (80.9%) of 350 women, including 106 (95.5%) of 111 women who had mastectomy and 177 (74.1%) of 239 women who had breast conserving surgery. At bivariate analysis, one operation was significantly more likely in women who had no underestimation (p < 0.001), mastectomy rather than breast conservation (p < 0.001), axillary dissection during the first operation (p < 0.001), percutaneous diagnosis of infiltrating carcinoma (p = 0.001), or mammographic mass (p = 0.006). At multivariate analysis, one operation was significantly more likely if underestimation was absent (odds ratio [OR] = 10.1, 95% confidence interval [CI] = 4.2-24.7) or if mastectomy was performed (OR = 8.7, 95% CI = 3.2-23.5); for women who had breast-conserving surgery, one operation was significantly more likely if underestimation was absent (OR = 11.4, 95% CI = 3.9-33.2) or if a mammographic mass was present (OR = 2.4, 95% CI = 1.3-4.6). One operation was performed in 80.9% of women with percutaneously proven nonpalpable breast cancer, including 74.1% of women who had breast-conserving surgery and 95.5% of women who had mastectomy. Among women who had breast conservation, one operation was significantly more likely if histologic underestimation was absent or if a mammographic mass was present.

The Role of Needle Localization Breast Biopsy for the Diagnosis of Nonpalpable Breast Cancer

The Role of Needle Localization Breast Biopsy for the Diagnosis of Nonpalpable Breast Cancer

Sentinel lymph node biopsy after percutaneous diagnosis of nonpalpable breast cancer.

To determine the technical success rate of sentinel lymph node biopsy in women with nonpalpable infiltrating breast cancer diagnosed by using percutaneous core biopsy and to determine the frequency with which sentinel lymph node biopsy obviated axillary dissection. Retrospective review revealed 33 women who underwent sentinel node biopsy after percutaneous core biopsy diagnosis of nonpalpable infiltrating breast cancer. Sentinel nodes were identified with radioisotope and blue dye; the procedure was technically successful if sentinel nodes were found at surgery. All sentinel nodes were excised. Axillary dissection was performed if tumor was present in sentinel nodes. Sentinel nodes were found at surgery in 30 women (91%). Sentinel nodes were identified with both radioisotope and blue dye in 22 (73%) of these women, with only radioisotope in six (20%), and with only blue dye in two (7%). Sentinel nodes were found in 12 (80%) of 15 women in the first half of the study versus all 18 (100%) women in the second half (P = .08). Sentinel nodes were free of tumor in 23 (77%) of 30 women. In six (86%) of seven women with tumor in sentinel nodes, the sentinel nodes were the only nodes with tumor. Sentinel node biopsy was successful in 30 women (91%) with nonpalpable infiltrating carcinoma diagnosed with percutaneous core biopsy and obviated axillary dissection in 23 women (70%). Using both radioisotope and blue dye may increase the success rate. A learning curve exists, and success improves with experience.

Selective digital enhancement of conventional film mammography

Screening mammography continues to play a key role in the early diagnosis of non-palpable breast cancer. Approximately 5% of patients will have lesions on their mammograms that appear neither clearly benign nor malignant. The proper management of these patients is not well defined. In this study, the mammograms of 64 women who underwent breast biopsy were reviewed. After the initial review, the mammograms were reevaluated using a personal computer driven digital conversion and enhancement system. The majority of indeterminate lesions were assigned a determinate diagnosis by enhancing the areas of abnormality through enlargement, contrast adjustment, and brightness adjustment. The radiologists were able to maintain baseline sensitivity and specificity throughout this process. In contrast, enhancement of lesions initially assigned a diagnosis of characteristically benign or malignant demonstrated no advantage over plain film mammography. These findings suggest a role for the selective use of digital mammography and enhancement techniques.

COMPARATIVE STUDY OF PHYSICAL EXAMINATION AND IMAGING SYSTEMS FOR PREOPERATIVE DIAGNOSIS OF BREAST CANCER

A comparative study of physical examination and imaging systems for preoperative diagnosis of breast cancer was performed on 207 cases treated at our hospital from January 1990 through December 1992. All cases were confirmed by histologic examination. The rate of accurate diagnosis was 90% for physical examination (PE), 86% for mammography (MMG), 84% for ultrasonography (US) and 90% for aspiration cytology. US showed the highest rate of definite malignancy. MMG was useful for the accurate diagnosis of nonpalpable breast cancer and tumors less than 1.0 cm in size. In younger patients, the diagnostic rate of PE was higher and that of MMG was worse. It was also low in noninvasive carcinoma and special types of invasive cancer. All of PE, MMG and US were positive in 80% and negative in 6%. We conclude that MMG is more effective than US, on combination with PE, for detection and screening of breast cancer. Two patients with a nonpalpable cancer of the contralateral breast detected by mammographic microcalcification are presented.

The pattern of diagnosis of a second primary tumor in the breast

One hundred and sixty-seven patients with metachronous bilateral breast cancer were diagnosed at the Northern Israel Oncology Center during the years 1950-1989. The group at high risk to develop a second breast tumor included Jewish women born in Europe whose first tumor was diagnosed when the patient was under the age of 55. The mean time interval between tumors was 88 months. Seventy percent of the patients were diagnosed within nine years of the diagnosis of the first tumor. The characteristics of the 27% of patients with single breast cancers who did not comply with follow-up recommendations were compared to those who did comply. Patients who were under follow-up had smaller tumor and less lymph node involvement. Nevertheless, their survival rate did not differ from those who did not keep their follow-up appointments. This was ascribed to the fact that follow-up procedures for many years used mainly clinical examination and this was not enough to decrease mortality. The diagnosis of non-palpable breast cancer by routine yearly mammography has proved to reduce mortality in patients over the age of 50 with single breast cancers. Therefore, yearly mammography of the contralateral breast in patients with single breast tumors must be done in order to increase the cure rate of contralateral breast cancer. Less patient delay in diagnosis was found before the diagnosis of the second tumor than in patients with a single tumor.

Evaluation of an Improved Dot-immunobinding Assay for Carcinoembryonic Antigen Determination in Nipple Discharge in Early Breast Cancer: Results of a Multicenter Study

We have previously reported carcinoembryonic antigen (CEA) measurement in nipple discharge to be a useful adjunct in the diagnosis of non-palpable breast cancer. We have now developed a "microdot-immunobinding assay" using a specially constructed device to screen efficiently large numbers of patients with nipple discharge for non-palpable breast cancer. The method is as follows: a sample of nipple discharge is placed on a solid phase monoclonal anti-CEA antibody and, if CEA is present in the discharge, it will be detected by a second monoclonal anti-CEA antibody conjugated with alkaline phosphatase. The use of bromochloroindolyl phosphate as a chromogen results in a stable color reaction that can be semiquantitatively analyzed with the naked eye. CEA levels determined by this microdot assay correlated well with those determined using the earlier Elmotec assay. To determine the accuracy of the method, a collaborative study involving 11 institutes in Japan was organized. The CEA levels in nipple discharges from 77 patients undergoing surgery, 44 of whom were diagnosed as having breast cancer, were assayed. The results were that 17 of the 23 patients with palpable breast cancer, and 16 of the 21 patients with non-palpable breast cancer exhibited CEA values > 400 ng/ml, a cut-off value determined in a previous study. The overall accuracy (78%) of this test for diagnosing non-palpable breast cancer was higher than that obtained from ductography or cytology. The system may thus be of use in the screening of early breast cancer.

Evaluation of Dot-immunobinding Assay for Carcinoembryonic Antigen Determination in Nipple Discharge as an Adjunct in the Diagnosis of Early Breast Cancer

We have previously reported carcinoembryonic antigen (CEA) measurement in nipple discharge to be a useful adjunct in the diagnosis of non-palpable breast cancer. As an extension, a dot-immunobinding assay was developed to screen a large number of patients with nipple discharge for non-palpable breast cancer. The principle is as follows. CEA bound to a solid phase monoclonal anti-CEA antibody is detected by a second monoclonal anti-CEA antibody conjugated with horseradish peroxidase. The use of tetramethylbenzidine as a chromogen results in a stable color reaction that can be semiquantitively analyzed by the naked eye. The CEA levels determined by this dot assay correlated well with CEA levels determined using the former Elmotec assay. To determine whether or not the method could also be feasible in the detection of non-palpable breast cancer, a collaborative study from 12 Japanese institutes was organized. The CEA levels in nipple discharges from 155 patients were assayed. Thirteen of 30 patients with palpable breast cancer and 22 of 30 patients with non-palpable breast cancer exhibited CEA values higher than 400 ng/ml, a cut-off value determined using 89 benign controls. The specificity (91%) and sensitivity (73%) of this test were higher than those of mammography or cytology. The incidence of elevated CEA levels in nipple discharge correlated significantly with the incidence of intratumoral antigen expression. Thus, the system could prove useful in screening for early breast cancer.

Carcinoembryonic antigen estimation in nipple discharge as an adjunctive tool in the diagnosis of early breast cancer.

To assess the usefulness of carcinoembryonic antigen (CEA) estimation in nipple discharge for the detection of nonpalpable breast cancer, CEA activity in nipple discharge was measured by enzyme immunoassay using monoclonal antibody. The specificity of the antibody for breast cancer was assessed by an immunohistochemical method. Mean CEA levels in the nipple discharge from 18 patients with benign breast diseases (ten intraductal papilloma; eight fibrocystic disease) was 43 ng/ml (SD, 34 ng/ml), suggesting an upper reference limit of 100 ng/ml. Six of seven nonpalpable breast cancer patients had higher CEA levels than this tentative cutoff value, as did three of five patients with borderline lesions. The incidence of elevated CEA levels in nipple discharge correlated significantly with the incidence of intratumoral antigen expression. These results lead us to conclude that CEA measurement in nipple discharge may be a useful adjunct in the diagnosis of nonpalpable breast cancer.