Suspected Breast Cancer Research Articles

Metastases to intramammary lymph nodes in patients with breast cancer: Sonographic findings

To describe the sonographic characteristics of intramammary lymph node metastasis (ILNM) in patients with breast cancer and to assess the value of sonography and sonographically guided fine needle aspiration biopsy (FNAB) in their diagnosis. We retrospectively reviewed the charts and films of 19 women with biopsy-documented ILNM who were seen in our breast diagnostic center between December 1999 and July 2003. The sonographic appearance of the nodes was analyzed and correlated with clinical and mammographic findings and with biopsy results. The ILNMs were clinically and mammographically occult in 7 (37%) of the 19 women. The diameter of the ILNMs was less than 1 cm in 15 (79%) cases. The volume of the central echogenic hilum was less than 50% of the total volume of the node in each of the patients. There was marked decrease in cortical echogenicity of the ILN in all cases. Metastatic involvement was established via sonographically guided FNAB in each of the 19 suspicious intramammary lymph nodes. Sonography and sonographically guided FNAB are valuable methods of assessment for ILNM in patients with known or suspected breast cancer. The most consistent sonographic features associated with ILNM were reduction in the volume of the central echogenic hilum and marked hypoechogenicity of the node's cortex.

Trends in breast cancer screening and diagnosis

Screening mammography is the single most effective method of early breast cancer detection and is recommended on an annual basis beginning at age 40 for women at average risk of breast cancer. In addition to traditional film-screen mammograms, digital mammograms now offer digital enhancement to aid interpretation, which is especially helpful in women with dense breast tissue. Useful emerging adjuncts to mammography include ultrasonography, which is particularly helpful for further assessment of known areas of interest, and magnetic resonance imaging, which shows promise for use in high-risk populations. Image-guided biopsy--directed by ultrasonograpy or stereotactic mammography views--plays a critical role in histologic confirmation of suspected breast cancer.

EC2 AN ECONOMIC EVALUATION OF DASATINIB AS A TREATMENT FOR CHRONIC PHASE CHRONIC MYELOID LEUKAEMIA IN SCOTLAND

EC1 RESOURCE USE AND COST OF DIAGNOSTICWORKUP OF WOMENWITH SUSPECTED BREAST CANCER Lee DW, Stang PE, Goldberg GA, Haberman M GE Healthcare,Waukesha,WI, USA, Independent Consultant, Blue Bell, PA, USA, i3 Innovus, Santa Monica, CA, USA, Thomson Medstat,Washington, DC, USA OBJECTIVES: To estimate resource use and costs associated with a diagnostic workup for suspected breast cancer among female Medicare beneficiaries. METHODS: We used Medicare 5% sample claims data to select non-HMO women 65 who had either a suspicious mammogram (Group A) or signs or symptoms of breast cancer (Group B), but no evidence of active treatment of any prior cancer, in the first 3 quarters of 2004. We then measured their resource use and costs associated with a pre-defined set of relevant breast cancer diagnostic services. RESULTS: Our sample included 45,978 women (19,769 Group A, 26,209 Group B). On average, women presenting for a breast cancer diagnostic workup received 1.4 diagnostic mammograms, 1.0 pathology services, 0.6 radiology services, and 0.5 other breast imaging studies, among other services. The average cost of a diagnostic workup—whether it eventuated in a breast cancer diagnosis or not—was $361, and was nearly identical between groups ($363 Group A vs. $359 Group B), although breast biopsy was a more important determinant of costs for patients in Group A. We estimate that Medicare spends approximately $649 million annually on diagnostic workups for women with suspected breast cancer, and that false positive mammograms result in costs of approximately $250 million. CONCLUSION: Resource use and costs of diagnostic workups for women presenting with suspicion of breast cancer are substantial.

The "Two Week" rule for suspected breast cancer. Improvement in cancer detection rate from 2003-2006 but still too many cancers in the "routine"stream

The "Two Week" rule for suspected breast cancer. Improvement in cancer detection rate from 2003-2006 but still too many cancers in the "routine"stream

Healthcare and support needs of women with suspected breast cancer

This paper is a report of a study to investigate changes in the healthcare and support needs during the diagnostic period, and factors that affect these needs in women with suspected breast cancer. Although the needs of women with breast cancer are well recognized, few studies have examined the needs of women with suspected breast cancer during the diagnostic period. This longitudinal study used an investigator-developed, self-administered questionnaire to collect data from 127 women in Taiwan on three occasions: notification of need for breast biopsy, before biopsy and after diagnosis. The data were collected from November 2004 to April 2005. Participants had high need levels before and after diagnosis, with their top needs in the domains of healthcare services for diagnosis, follow-up and consultation, and information about the disease. They needed disease- and treatment-related information more than emotional support. Need levels were higher (P < 0.01) before diagnosis than after, highest before biopsy, and lowest after diagnosis. Furthermore, needs were higher (P < 0.01) before than after diagnosis for diagnostic services, disease information, and involvement of family and friends. Higher needs were found in married women with more education and no history of benign tumours. Need level did not differ statistically significantly by age, religious status, degree of social support, family history and breast symptoms. Need levels of women with suspected breast cancer vary during the diagnostic period, are highest before breast biopsy, and related to personal characteristics and cultural context. Therefore, during this period, nursing staff should provide patients and families with culturally sensitive, individualized, supportive care.

Investigation of suspected breast cancer

The local extent of breast cancer is often detected only at surgery, but modern imaging may be able to give us this information preoperatively instead

Presumed prevalence analysis on suspected and highly suspected breast cancer lesions in São Paulo using BIRADS criteria.

Breast cancer screening programs are critical for early detection of breast cancer. Early detection is essential for diagnosing, treating and possibly curing breast cancer. Since there are no data on the incidence of breast cancer, nationally or regionally in Brazil, our aim was to assess women by means of mammography, to determine the prevalence of this disease. The study protocol was designed in collaboration between the Department of Diagnostic Imaging (DDI), Institute of Diagnostic Imaging (IDI) and São Paulo Municipal Health Program. A total of 139,945 Brazilian women were assessed by means of mammography between April 2002 and September 2004. Using the American College of Radiology (ACR) criteria (Breast Imaging Reporting and Data System, BIRADS), the prevalence of suspected and highly suspected breast lesions were determined. The prevalence of suspected (BIRADS 4) and highly suspected (BIRADS 5) lesions increased with age, especially after the fourth decade. Accordingly, BIRADS 4 and BIRADS 5 lesions were more prevalent in the fourth, fifth, sixth and seventh decades. The presumed prevalence of suspected and highly suspected breast cancer lesions in the population of São Paulo was 0.6% and it is similar to the prevalence of breast cancer observed in other populations.

Ansiedade no período pré-operatório de cirurgias de mama: estudo comparativo entre pacientes com suspeita de câncer e a serem submetidas a procedimentos cirúrgicos estéticos

Evaluation of anxiety is not part of the routine pre-anesthetic evaluation (APA). Therefore, special situations in which patients might present altered mood will go unnoticed by the anesthesiologist. The objective of this study was to compare, at the moment of the outpatient basis APA, the risk factors, severity, and prevalence of anxiety in patients with suspected breast cancer and those undergoing cosmetic surgery of the breast.After approval by the Ethics Committee, 114 patients, ASA I or II, 14 years or older, were studied at the APA clinic; they were divided in two groups: GMAMA - patients with suspected breast cancer; GPLAST - patients undergoing cosmetic surgery. After signing the informed consent, patients answered the anxiety evaluation test (STAI - State-Trait Anxiety Inventory) before the preanesthetic evaluation. The following parameters were analyzed: socio-demographic data; prior experience with surgical procedures; number and percentage of patients with low, moderate, or high anxiety (STAI I and II); and median of the STAI I and II scores.Both groups were homogenous regarding the socio-demographic data and prior experience with surgical procedures. There was a significant difference in the levels and prevalence of anxiety-state (STAI I). No risk factors for anxiety-state and anxiety-trait were identified.Patients with suspected breast cancer scheduled for nodulectomy or removal of breast tissue for diagnosis, had higher levels and prevalence of anxiety-state than patients undergoing mammaplasty; the levels and prevalence of anxiety-trait were similar in both groups; no risk factors for anxiety-state and anxiety-trait were identified.

Activation of dioxin response element (DRE)-associated genes by benzo(a)pyrene 3,6-quinone and benzo(a)pyrene 1,6-quinone in MCF-10A human mammary epithelial cells

Benzo(a)pyrene (BaP) is a known human carcinogen and a suspected breast cancer complete carcinogen. BaP is metabolized by several metabolic pathways, some having bioactivation and others detoxification properties. BaP-quinones (BPQs) are formed via cytochrome P450 and peroxidase dependent pathways. Previous studies by our laboratory have shown that BPQs have significant growth promoting and anti-apoptotic activities in human MCF-10A mammary epithelial cells examined in vitro. Previous results suggest that BPQs act via redox-cycling and oxidative stress. However, because two specific BPQs (1,6-BPQ and 3,6-BPQ) differed in their ability to produce reactive oxygen species (ROS) and yet both had strong proliferative and EGF receptor activating activity, we utilized mRNA expression arrays and qRT-PCR to determine potential pathways and mechanisms of gene activation. The results of the present studies demonstrated that 1,6-BPQ and 3,6-BPQ activate dioxin response elements (DRE, also known as xenobiotic response elements, XRE) and anti-oxidant response elements (ARE, also known as electrophile response elements, EpRE). 3,6-BPQ had greater DRE activity than 1,6-BPQ, whereas the opposite was true for the activation of ARE. Both 3,6-BPQ and 1,6-BPQ induced oxidative stress-associated genes (HMOX1, GCLC, GCLM, and SLC7A11), phase 2 enzyme genes (NQO1, NQO2, ALDH3A1), PAH metabolizing genes (CYP1B1, EPHX1, AKR1C1), and certain EGF receptor-associated genes (EGFR, IER3, ING1, SQSTM1 and TRIM16). The results of these studies demonstrate that BPQs activate numerous pathways in human mammary epithelial cells associated with increased cell growth and survival that may play important roles in tumor promotion.

The value of 18-FDG-PET for diagnosing and evaluating lymph node metastasis in primary breast cancer

Objective To analyze the result of 18F-2-deoxy-2-fluoro-D-glucose-positron emission tomography (FDG-PET) in suspicious primary breast cancer patients and to evaluate its value for the surgery therapy. Methods Total 36 patients suspected of breast neoplasm were enrolled into the research. The result was compared with the pathology result. The rate of missed diagnosis, the rate of misdiagnosis, the sensitivity and specificity were calculated and analyzed. Results Compared with the pathology results, the misdiagnosis rate, the rate of missed diagnosis, the sensitivity and specificity of FDG-PET for breast cancer were 0%, 36.36%, 63.63% and 100%, respectively. To those who had a neoplasm no more than 2 cm in diameter, the rate of missed diagnosis was as high as 41.67%. To 33 breast cancer patients, the misdiagnosis rate, the rate of missed diagnosis, the sensitivity and specificity for lymph node metastasis were 18.75%, 41.18%, 58.82% and 81.25%, respectively. Conclusion FDG-PET has a perfect specificity and a considerable sensitivity to the primary breast neoplasm and similar to the lymph node metastasis diagnosis. It is an ideal choice for those patients with suspected breast cancer but reluctantly to receive a vulnerarious examination.

Rough neural intelligent approach for image classification: A case of patients with suspected breast cancer

The objective of this paper is to introduce a rough neural intelligent approach for rule generation and image classification. Hybridization of intelligent computing techniques has been applied to see their ability and accuracy to classify breast cancer images into two outcomes: malignant cancer or benign cancer. Algorithms based on fuzzy image processing are first applied to enhance the contrast of the whole original image; to extract the region of interest and to enhance the edges surrounding that region. Then, we extract features characterizing the underlying texture of the regions of interest by using the gray-level co-occurrence matrix. Then, the rough set approach to attribute reduction and rule generation is presented. Finally, rough neural network is designed for discrimination of different regions of interest to test whether they represent malignant cancer or benign cancer. Rough neural network is built from rough neurons, each of which can be viewed as a pair of sub-neurons, corresponding to the lower and upper bounds. To evaluate performance of the presented rough neural approach, we run tests over different mammogram images. The experimental results show that the overall classification accuracy offered by rough neural approach is high compared with other intelligent techniques.

Contrast-enhanced magnetic resonance mammography: does it affect surgical decision-making in patients with breast cancer?

Diagnostic imaging in women with suspected breast cancer should accurately detect and diagnose malignant tumors and facilitate the correct choice of therapy. Contrast-enhanced magnetic resonance mammography (CE-MRM) is potentially the imaging modality of choice for accurate patient management decisions. A total of 164 women with suspected breast cancer based on clinical examination, conventional mammography and/or ultrasound each underwent preoperative bilateral CE-MRM using an axial 3D dynamic T1-weighted gradient-echo sequence and gadobenate dimeglumine as contrast agent. Images were evaluated by two readers in consensus. Histological evaluation of detected lesions was performed on samples from core biopsy or surgery. Determinations were made of the sensitivity, accuracy and positive predictive value of CE-MRM compared to mammography/ultrasound for the detection of malignant lesions and of the impact of CE-MRM for surgical decision-making. Conventional mammography/ultrasound detected 175 lesions in the 164 evaluated patients. CE-MRM revealed 51 additional lesions in 34/164 patients; multifocal and multicentric cancer was detected in 7 and 4 additional patients, respectively, contralateral foci in 21 additional patients and pectoral muscle infiltration in 2 additional patients. CE-MRM also confirmed the absence or benignity of 3 and 1 lesions suspected of malignancy on mammography/ultrasound. The sensitivity and accuracy for malignant lesion detection and identification was 100% and 93.4%, respectively, for CE-MRM compared to 77.3% and 72.1% for mammography/ultrasound, respectively. Patient management was altered for 32/164 (19.5%) patients as a result of CE-MRM. CE-MRM positively impacts patient management decisions and should be performed in all women with suspected breast cancer based on clinical examination, mammography and/or ultrasound.

Rough neural intelligent approach for image classification: A case of patients with suspected breast cancer

The objective of this paper is to introduce a rough neural intelligent approach for rule generation and image classification. Hybridization of intelligent computing techniques has been applied to s...

Evidence-based guidelines and decision support services: a discussion and evaluation in triple assessment of suspected breast cancer

Widespread health service goals to improve consistency and safety in patient care have prompted considerable investment in the development of evidence-based clinical guidelines. Computerised decision support (CDS) systems have been proposed as a means to implement guidelines in practice. This paper discusses the general concept in oncology and presents an evaluation of a CDS system to support triple assessment (TA) in breast cancer care. Balanced-block crossover experiment and questionnaire study. One stop clinic for symptomatic breast patients. Twenty-four practising breast clinicians from United Kingdom National Health Service hospitals. A web-based CDS system. Clinicians made significantly more deviations from guideline recommendations without decision support (60 out of 120 errors without CDS; 16 out of 120 errors with CDS, P<0.001). Ignoring minor deviations, 16 potentially critical errors arose in the no-decision-support arm of the trial compared with just one (P=0.001) when decision support was available. Opinions of participating clinicians towards the CDS tool became more positive after they had used it (P<0.025). The use of decision support capabilities in TA may yield significant measurable benefits for quality and safety of patient care. This is an important option for improving compliance with evidence-based practice guidelines.

Two-week rule: Has prioritisation of breast referrals by general practitioners improved?

A 9-month audit, soon after the introduction of the 2-week rule in the UK in 1999, showed that a significant number of breast cancer patients were referred as non-urgent by their GPs, when the goal is that all suspected breast cancer patients should be seen by a hospital specialist urgently within 2 weeks of referral. The aim of this study was to determine whether GP grading of referrals into urgent and non-urgent had improved. A retrospective review of GP referrals over 8 months, between September 2003 and April 2004, with regard to their urgency, subsequent diagnosis and the use of proformas (standardised referral formats) was carried out. The results were compared to the 1999 audit. Eighty-two of 1178 patients referred by GP had breast cancer, versus 115 of 1176 patients referred in 1999. Sixty-eight per cent (56/82) of breast cancer patients were referred as urgent, compared to 47% (54/115) in 1999 (P=0.005). A proforma was used in 47% (548/1178) of GP referrals while no proforma was used in 1999. Sixty-five of the 82 cancer patients were referred with a proforma and 85% (55/65) were referred as urgent. GP prioritisation of referrals has improved since 1999. With the use of proformas a significant number of patients with cancer were referred urgently.

Dynamic helical CT mammography of breast cancer

The purpose of this study was to determine whether dynamic helical computed tomography (CT)-mammography could assist in selecting the most appropriate surgical method in women with breast cancer. Preoperative contrast-enhanced helical CT scanning of the breast was performed on 133 female patients with suspicion of breast cancer at the same time as clinical, mammographic, and/or ultrasonographic examinations. The patients were scanned in the prone position with a specially designed CT-compatible device. A helical scan was made with rapid intravenous bolus injection (3 ml/s) of 100 ml of iodine contrast material. Three-dimensional maximum intensity projection (MIP) images were reconstructed, and CT findings were correlated with surgical and histopathological findings. Histopathological analysis revealed 84 malignant lesions and seven benign lesions. The sensitivity, specificity, and accuracy levels of the CT scanning were 94.6%, 58.6%, and 78.9%. Helical scanning alone revealed additional contralateral carcinomas in three of four patients and additional ipsilateral carcinomas in three of five patients. However, the technique gave false-positive readings in 24 patients. The preoperative CT-mammogram altered the surgical method in six patients. Dynamic helical CT-mammography in the prone position may be one of the choices of adjunct imaging in patients with suspected breast cancer scheduled for surgery.

Follow my leader

Where as targets exist for the speedy referral of a woman with suspected breast cancer to receive diagnosis and possible therapy, there is no such official guidance for her care after the disease has been treated. Jane Rogersdiscusses the practicalities of nurse-led follow-up clinics for breast cancer patients

Correlation of targeted ultrasound with magnetic resonance imaging abnormalities of the breast

Background Magnetic resonance imaging (MRI) of the breast is highly sensitive for cancer. However, MRI frequently detects additional lesions that mandate further evaluation. The intent of this study was to assess the ability of targeted ultrasound to identify additional lesions detected on MRI in patients undergoing evaluation for breast cancer. Methods Between January 1, 1999, and July 15, 2004, 270 women underwent breast MRI at Grant Medical Center. MRI was obtained in 191 women during evaluation for documented or suspected breast cancer. Fifty-two patients had additional suspicious lesions on MRI, prompting targeted ultrasound; these patients constituted our study population. Results Seventy-five additional suspicious lesions were detected on breast MRI in 52 women. Two women underwent mastectomy without targeted ultrasound. Targeted ultrasound identified 65 of the remaining 73 lesions (89%). Eight lesions (11%) were not visible on targeted ultrasound. Conclusion Targeted ultrasound can be a reliable method to correlate MRI abnormalities in breast cancer patients.

Characterization of breast lesion using double phase Tc-99m Tetrofosmin scintimammography: Comparison of visual and quantitative analyses

To compare the diagnostic performances of visual and quantitative indices of double phase Tc-99m Tetrofosmin scintimammography (TF-SMM) for the detection of breast cancer. Methods Double phase TF-SMM (early, 10 min; delayed, 3 h) were performed after injection of 925 MBq of Tc-99m Tetrofosmin in 75 highly suspected breast cancer patients (malignant: 49, benign: 26). For visual analysis, five scoring method was used. For quantitative analysis, early, delayed lesions to non-lesion ratios (L/Ns) and washout rate (%, WR) were calculated. Receiver operating characteristic curve (ROC) analyses were performed to determine the optimal visual grade, to calculate cut-off values of quantitative indices, and to compare visual and quantitative diagnostic performances. Results When over grade 3 of visual grade was used as cut-off value in the defection of primary breast cancer, the sensitivity and specificity were 75.5 and 80.8%, respectively. The positive and negative predictive values were 88.1 and 63.6%, respectively. The area under curve was 0.824 (95% CI, 0.719–0.902) and standard error (S.E.) was 0.047. The optimal L/N ratios were 3.13 for early and 2.56 for delayed image. When early L/N 3.13 was used as cut-off point, the sensitivity and specificity of TF-SMM were 61.2 and 96.2%, respectively. The positive and negative predictive values were 96.8 and 56.8%, respectively. The AUC was 0.809 (95% CI, 0.702–0.890) and S.E. was 0.049. When delayed L/N 2.56 was used as cut-off value, the sensitivity and specificity were 46.9 and 96.2%, respectively. The positive and negative predictive values were 95.8 and 49%, respectively. The AUC was 0.741 (95% CI, 0.627–0.835) and S.E. was 0.057. No statistical differences between visual assessment and quantitative analysis of early image (difference between area, 0.015; S.E., 0.044; 95% CI, −0.072 to 0.102; p = 0.736) and delayed image (difference between area, 0.083; S.E., 0.054; 95% CI, −0.023 to 0.060; p = 0.189) was noted. However, early L/N was superior to delayed L/N ratio for the detection of breast cancer (difference between area, 0.068; S.E., 0.033; 95% CI, 0.004–0.132; p = 0.038). Conclusion In conclusion, TF-SMM showed a favorable diagnostic accuracy in differentiating benign from malignant breast lesions. The optimal visual interpretation grades for the detection of primary breast cancer of double phase TF-SMM were grade 4 and 5. The optimal quantitative indices for the detection of breast cancer were 3.12 for early L/N and 2.56 for delayed L/N. Visual and quantitative analyses showed similar results. However, early L/N was superior to delayed one for the detection of breast cancer. Therefore, the delayed image should not be routinely performed for the purpose of primary breast cancer detection. These findings deserve further investigation on a larger number of patients to be performed to allow a better validation of the differentiation malignant from benign breast lesions using double phase TF-SMM.

Color-Coded Automated Signal Intensity Curves for Detection and Characterization of Breast Lesions

The objective of this study was to evaluate the value of a color-coded automated signal intensity curve software package for contrast-enhanced magnetic resonance mammography (CE-MRM) in patients with suspected breast cancer. Thirty-six women with suspected breast cancer based on mammographic and sonographic examinations were preoperatively evaluated on CE-MRM. CE-MRM was performed on a 1.5-T magnet using a 2D Flash dynamic T1-weighted sequence. A dosage of 0.1 mmol/kg of Gd-BOPTA was administered at a flow rate of 2 mL/s followed by 10 mL of saline. Images were analyzed with the new software package and separately with a standard display method. Statistical comparison was performed of the confidence for lesion detection and characterization with the 2 methods and of the diagnostic accuracy for characterization compared with histopathologic findings. At pathology, 54 malignant lesions and 14 benign lesions were evaluated. All 68 (100%) lesions were detected with both methods and good correlation with histopathologic specimens was obtained. Confidence for both detection and characterization was significantly (P < or = 0.025) better with the color-coded method, although no difference (P > 0.05) between the methods was noted in terms of the sensitivity, specificity, and overall accuracy for lesion characterization. Excellent agreement between the 2 methods was noted for both the determination of lesion size (kappa = 0.77) and determination of SI/T curves (kappa = 0.85). The novel color-coded signal intensity curve software allows lesions to be visualized as false color maps that correspond to conventional signal intensity time curves. Detection and characterization of breast lesions with this method is quick and easily interpretable.