Suspicious Breast Lesions Research Articles

Fine-Needle Aspiration Cytology (FNAC) in Breast Cancer: A Reappraisal Based on Retrospective Review of 698 Cases.

Core needle biopsy is replacing fine-needle aspiration cytology (FNAC) as the modality of choice for breast cancer diagnosis. This study was carried out to determine the usefulness of FNAC in breast cancer patients in a tertiary care center in North India. Case files of patients managed in the breast cancer clinic of a single surgical unit between 1993 and 2014 were reviewed. All patients who underwent FNAC at our institute or had their slides reviewed at our institute were included in the study. Patients operated on outside our center and those with FNAC reports which were not available for review were excluded. Data were entered in Microsoft Excel and analyzed with SPSS version 21. True positives and false negatives for FNAC were noted from which sensitivities and positive predictive values (PPVs) were calculated. FNAC was performed in 698 of 1310 patients. Mean age was 48.3years. There were 9 (1.3%) male breast cancer patients. 696 (99.7%) patients had a palpable lump with a mean tumor size of 5.3cm. 54.2% of the patients were clinically node positive. While over 80% of patients were diagnosed on the basis of FNAC before 2000, less than 50% of the patients had an FNAC after 2010. FNAC diagnosed malignancy in 627 patients, while it was inconclusive in 69 and false negative in two patients. No false-positive results were seen. These figures yield an absolute sensitivity of 89.8% and a complete sensitivity of 99.7% for FNAC with a 100% PPV. FNAC is a reliable tool for diagnosing cancer in suspicious breast lesions with a good sensitivity and PPV in hands of an experienced cytopathologist. Surgical treatment may be safely undertaken based on FNAC particularly in early operable breast cancers suitable for breast conservation.

The diagnostic value of digital breast tomosynthesis plus synthesized two-dimensional images in breast disease

Objective To investigate the diagnostic value of digital breast tomosynthesis (DBT) plus synthesized two-dimensional(2D) images (C-view) in benign and malignant breast disease. Methods The prospective study enrolled 93 women with a clinically suspicious breast lesion confirmed by pathology. All patients underwent full-field digital mammography (FFDM) and DBT examinations before surgery or biopsy. Synthesized 2D images (C-view) were reconstructed in DBT. The images in FFDM alone, DBT plus C-view, and DBT plus FFDM were observed, the average glandular dose was recorded and the visibility grade of the disease was evaluated. Pathological analysis was performed on biopsy and surgical specimen to acquire histopathologic type. The average glandular dose among three examinations was compared by analysis of variance, and the visibility grade was compared by Wilcoxon matched-pairs signed-ranks test. The manifestation of breast disease in different examinations was evaluated according to breast imaging reporting and data system (BI-RADS). Taking pathologic results as the gold standard, receiving operating characteristic (ROC) was performed to analyze the diagnostic efficiency of three examinations. Result All lesions in 93 cases were solitary, in which 27 were benign and 66 were malignant. Sixteen cases were pathologically confirmed by biopsy and 77 cases by surgery. For the average glandular dose, there was significant difference among three examinations (P<0.01); it decreased by 50.0%(1.95/3.90) in FFDM alone and DBT plus C-view than DBT plus FFDM. All cases showed the same visibility between DBT plus C-view and DBT plus FFDM, in which 54 cases (58.1%,54/93) showed increased visibility than FFDM (P<0.01). The sensitivity and specificity were both highest in DBT plus C-view (90.9% and 85.2% respectively) to differentiate benign and malignant breast disease. The area of ROC curve in FFDM alone, DBT plus C-view, and DBT plus FFDM were 0.756, 0.880 and 0.862 respectively. Conclusion The combination of synthesized 2D images and DBT can improve both detection of breast lesion and diagnostic efficiency compared with FFDM, without an increase in radiation dose to the breast. Key words: Breast neoplasms; Mammography; Digital breast tomosynthesis

Prediction of malignancy by a radiomic signature from contrast agent-free diffusion MRI in suspicious breast lesions found on screening mammography.

To assess radiomics as a tool to determine how well lesions found suspicious on breast cancer screening X-ray mammography can be categorized into malignant and benign with unenhanced magnetic resonance (MR) mammography with diffusion-weighted imaging and T2 -weighted sequences. From an asymptomatic screening cohort, 50 women with mammographically suspicious findings were examined with contrast-enhanced breast MRI (ceMRI) at 1.5T. Out of this protocol an unenhanced, abbreviated diffusion-weighted imaging protocol (ueMRI) including T2 -weighted, (T2 w), diffusion-weighted imaging (DWI), and DWI with background suppression (DWIBS) sequences and corresponding apparent diffusion coefficient (ADC) maps were extracted. From ueMRI-derived radiomic features, three Lasso-supervised machine-learning classifiers were constructed and compared with the clinical performance of a highly experienced radiologist: 1) univariate mean ADC model, 2) unconstrained radiomic model, 3) constrained radiomic model with mandatory inclusion of mean ADC. The unconstrained and constrained radiomic classifiers consisted of 11 parameters each and achieved differentiation of malignant from benign lesions with a .632 + bootstrap receiver operating characteristics (ROC) area under the curve (AUC) of 84.2%/85.1%, compared to 77.4% for mean ADC and 95.9%/95.9% for the experienced radiologist using ceMRI/ueMRI. In this pilot study we identified two ueMRI radiomics classifiers that performed well in the differentiation of malignant from benign lesions and achieved higher performance than the mean ADC parameter alone. Classification was lower than the almost perfect performance of a highly experienced breast radiologist. The potential of radiomics to provide a training-independent diagnostic decision tool is indicated. A performance reaching the human expert would be highly desirable and based on our results is considered possible when the concept is extended in larger cohorts with further development and validation of the technique. 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:604-616.

3D quantitative breast ultrasound analysis for differentiating fibroadenomas and carcinomas smaller than 1 cm

PurposeIn (3D) ultrasound, accurate discrimination of small solid masses is difficult, resulting in a high frequency of biopsies for benign lesions. In this study, we investigate whether 3D quantitative breast ultrasound (3DQBUS) analysis can be used for improving non-invasive discrimination between benign and malignant lesions. Methods and materials3D US studies of 112 biopsied solid breast lesions (size <1cm), were included (34 fibroadenomas and 78 invasive ductal carcinomas). The lesions were manually delineated and, based on sonographic criteria used by radiologists, 3 regions of interest were defined in 3D for analysis: ROI (ellipsoid covering the inside of the lesion), PER (peritumoural surrounding: 0.5mm around the lesion), and POS (posterior-tumoural acoustic phenomena: region below the lesion with the same size as delineated for the lesion). After automatic gain correction (AGC), the mean and standard deviation of the echo level within the regions were calculated. For the ROI and POS also the residual attenuation coefficient was estimated in decibel per cm [dB/cm].The resulting eight features were used for classification of the lesions by a logistic regression analysis. The classification accuracy was evaluated by leave-one-out cross-validation. Receiver operating characteristic (ROC) curves were constructed to assess the performance of the classification.All lesions were delineated by two readers and results were compared to assess the effect of the manual delineation. ResultsThe area under the ROC curve was 0.86 for both readers. At 100% sensitivity, a specificity of 26% and 50% was achieved for reader 1 and 2, respectively. Inter-reader variability in lesion delineation was marginal and did not affect the accuracy of the technique. The area under the ROC curve of 0.86 was reached for the second reader when the results of the first reader were used as training set yielding a sensitivity of 100% and a specificity of 40%. Consequently, 3DQBUS would have achieved a 40% reduction in biopsies for benign lesions for reader 2, without a decrease in sensitivity. ConclusionThis study shows that 3DQBUS is a promising technique to classify suspicious breast lesions as benign, potentially preventing unnecessary biopsies.

Diffusion-weighted imaging of suspicious (BI-RADS 4) breast lesions: stratification based on histopathology

Objective:To test the use of diffusion-weighted imaging (DWI) in stratifying suspicious breast lesions (BI-RADS 4), correlating them with histopathology. We also investigated the performance of DWI related to the main enhancement patterns (mass and non-mass) and tested its reproducibility.Materials and Methods:Seventy-six patients presented 92 lesions during the sampling period. Two independent examiners reviewed magnetic resonance imaging studies, described the lesions, and determined the apparent diffusion coefficient (ADC) values. Differences among benign, indeterminate- to high-risk, and malignant findings, in terms of the ADCs, were assessed by analysis of variance. Using receiver operating characteristic (ROC) curves, we compared the performance of ADC values in masses and non-mass lesions, and tested the reproducibility of measurements by determining the coefficient of variation and smallest real difference.Results:Among the 92 lesions evaluated, the histopathology showed that 37 were benign, 11 were indeterminate- to high-risk, and 44 were malignant. The mean ADC differed significantly among those histopathological groups, the value obtained for the malignant lesions (1.10 × 10-3 mm2/s) being significantly lower than that obtained for the other groups (p < 0.001). ROC curves demonstrated that DWI performed better when applied to masses than when applied to non-mass lesions (area under the curve, 0.88 vs. 0.67). Reproducibility was good (coefficient of variation, 7.03%; and smallest real difference, ± 0.242 × 10-3 mm2/s).Conclusion:DWI can differentiate between malignant and nonmalignant (benign or indeterminate- to high-risk) lesions, showing better performance for masses. Nevertheless, stratification based on histopathological criteria that are more refined has yet to be achieved.

Value of Radiology Modalities in Diagnosing Benign and Malignant Tumours of Breast: An Observational Study

Breast cancer is the most common malignant tumor among women. The objective of this research is to evaluate the specificity, sensitivity, and accuracy of BSGI, DC, and WE-MRI in the diagnosis of breast benign and malignant breast tumors. 228 female patients have participated in this observational research. The age was ranged from 31-68 years (mean age 42.37± 8.14 years) with suspicious breast lesions according to physical and imaging examination (mammography and/or ultrasonography). Moreover, women, who have suspected local regional recurrence after resection of malignant breast tumor and who were suspected to have tumor residual following chemotherapy or radiotherapy were also included. All patients underwent breast specific gamma imaging, DW-MRI, and DCE-MRI examination, and the results of breast MRI were compared with the histopathological results that were used as the standard diagnostic method. In this research, 111 women were found to have breast lesion. All breast lesions were undergone histopathological analysis using needle biopsy and/or excisional biopsy. Also, the results of the pathological analysis were correlated and confirmed with ultrasonography and mammography. The pathologic analysis confirmed that 76 (68.5%) of 111 lesions were benign breast lesions and 35 (31.5 %) of 111 were malignant breast lesions. The results proved that BSGI had the best results for the detection of breast lesions (sensitivity 96.7%, specificity 93.6 % and accuracy 94.8%) as compared with DCE-MRI (sensitivity 92.3%, specificity 85.6% and accuracy 88.2%) and diffusion weighted imaging (sensitivity 94.1%, specificity 88.5% and accuracy 91.4%). The research stated that BSGI is the most appropriate diagnostic tool for breast lesions.

The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy of breast lesions

ObjectivesTo determine the cost effectiveness of breast biopsy by 9G vacuum-assisted guided by vertical stereotaxy or ultrasonography in comparison with breast biopsy by 14G core-needle biopsy and surgical biopsy. Material and methodsWe analyzed a total of 997 biopsies (181 vacuum-assisted, 626 core, and 190 surgical biopsies). We calculated the total costs (indirect and direct) of the three types of biopsy. We did not calculate intangible costs. We measured the percentage of correct diagnoses obtained with each technique. To identify the most cost-effective option, we calculated the mean ratios for the three types of biopsies. ResultsTotal costs amounted to €225.09 for core biopsy, €638.90 for vacuum-assisted biopsy, and €1780.01 for surgical biopsy. The overall percentage of correct diagnoses was 91.81 per cent for core biopsy, 94.03 per cent for vacuum-assisted biopsy, and 100 per cent for surgical biopsy; however, these differences did not reach statistical significance (P=0.3485). For microcalcifications, the percentage of correct diagnoses was 50 per cent for core biopsy and 96.77 per cent for vacuum-assisted biopsy (P<0.0001). For nodules, there were no significant differences among techniques. The mean cost-effectiveness ratio considering all lesions was 2.45 for core biopsy, 6.79 for vacuum-assisted biopsy, and 17.80 for surgical biopsy. ConclusionCore biopsy was the dominant option for the diagnosis of suspicious breast lesions in general. However, in cases with microcalcifications, the low percentage of correct diagnoses achieved by core biopsy (50 per cent) advises against its use in this context, where vacuum-assisted biopsy would be the technique of choice because it is more cost-effective than surgical biopsy, the other technique indicated for biopsying microcalcifications.

Estudio de costo-efectividad de la biopsia mamaria asistida por vacío versus biopsia con aguja gruesa o arpón

ObjectivesTo determine the cost effectiveness of breast biopsy by 9G vacuum-assisted guided by vertical stereotaxy or ultrasonography in comparison with breast biopsy by 14G core-needle biopsy and surgical biopsy. Material and methodsWe analyzed a total of 997 biopsies (181 vacuum-assisted, 626 core, and 190 surgical biopsies). We calculated the total costs (indirect and direct) of the three types of biopsy. We did not calculate intangible costs. We measured the percentage of correct diagnoses obtained with each technique. To identify the most cost-effective option, we calculated the mean ratios for the three types of biopsies. ResultsTotal costs were €225.09 for core biopsy, €638.90 for vacuum-assisted biopsy, and €1780.01 for surgical biopsy. The overall percentage of correct diagnoses was 91.81% for core biopsy, 94.03% for vacuum-assisted biopsy, and 100% for surgical biopsy; however, these differences did not reach statistical significance (p=0.3485). For microcalcifications, the percentage of correct diagnoses was 50% for core biopsy and 96.77% for vacuum-assisted biopsy (p<0.0001). For nodules, there were no significant differences among techniques. The mean cost-effectiveness ratio considering all lesions was 2.45 for core biopsy, 6.79 for vacuum-assisted biopsy, and 17.80 for surgical biopsy. ConclusionCore biopsy was the dominant option for the diagnosis of suspicious breast lesions in general. However, in cases with microcalcifications, the low percentage of correct diagnoses achieved by core biopsy (50%) advises against its use in this context, where vacuum-assisted biopsy would be the technique of choice because it is more cost-effective than surgical biopsy, the other technique indicated for biopsying microcalcifications.

Whole-lesion apparent diffusion coefficient (ADC) metrics as a marker of breast tumour characterization-comparison between ADC value and ADC entropy.

To prospectively assess the role of whole-lesion apparent diffusion coefficient (ADC) metrics in the characterization of breast tumours by comparing ADC value with ADC entropy. 49 patients with 53 breast lesions underwent phased-array breast coil 1.5-T MRI. Two radiologists experienced in breast MRI, blinded to the final diagnosis, reviewed the ADC maps and placed a volume of interest on all slices including each lesion on the ADC map to obtain whole-lesion mean ADC value and ADC entropy. The mean ADC value and ADC entropy in benign and malignant lesions were compared by the Mann-Whitney U-test. Receiver-operating characteristic analysis was performed to assess the sensitivity and specificity of the two variables in the characterization of the breast lesions. The benign (n = 19) and malignant lesions (n = 34) had mean diameters of 20.8 mm (10.1-31.5 mm) and 26.4 mm (10.5-42.3 mm), respectively. The mean ADC value of the malignant lesions was significantly lower than that of the benign ones (0.87 × 10-3 vs 1.49 × 10-3 mm2 s-1; p < 0.0001). Malignant ADC entropy was higher than benign entropy, without reaching levels of statistical significance (5.4 vs 5.0; p = 0.064). At a mean ADC cut-off value of 1.16 × 10-3 mm2 s-1, the sensitivity and specificity for diagnosing malignancy became optimal (97.1% and 93.7, respectively) with an area under the curve (AUC) of 0.975. With regard to ADC entropy, the sensitivity and specificity at a cut-off of 5.18 were 67.6 and 68.7%, respectively, with an AUC of 0.664. Whole-lesion mean ADC could be a helpful index in the characterization of suspicious breast lesions, with higher sensitivity and specificity than ADC entropy. Advances in knowledge: Two separate parameters of the whole-lesion histogram were compared for their diagnostic accuracy in characterizing breast lesions. Mean ADC was found to be able to characterize breast lesions, whereas entropy proved to be unable to differentiate benign from malignant breast lesions. It is, however, likely that entropy may distinguish these two groups if a larger cohort were used, or the fact that this may be influenced by the molecular subtypes of breast cancers included.

Correlating Tumor Stiffness with Immunohistochemical Subtypes of Breast Cancers: Prognostic Value of Comb-Push Ultrasound Shear Elastography for Differentiating Luminal Subtypes.

PurposeThe purpose of our study is to correlate quantitatively measured tumor stiffness with immunohistochemical (IHC) subtypes of breast cancer. Additionally, the influence of prognostic histologic features (cancer grade, size, lymph node status, and histological type and grade) to the tumor elasticity and IHC profile relationship will be investigated.MethodsUnder an institutional review board (IRB) approved protocol, B-mode ultrasound (US) and comb-push ultrasound shear elastography (CUSE) were performed on 157 female patients with suspicious breast lesions. Out of 157 patients 83 breast cancer patients confirmed by pathology were included in this study. The association between CUSE mean stiffness values and the aforementioned prognostic features of the breast cancer tumors were investigated.ResultsOur results demonstrate that the most statistically significant difference (p = 0.0074) with mean elasticity is tumor size. When considering large tumors (size ≥ 8mm), thus minimizing the statistical significance of tumor size, a significant difference (p< 0.05) with mean elasticity is obtained between luminal A of histological grade I and luminal B (Ki-67 > 20%) subtypes.ConclusionTumor size is an independent factor influencing mean elasticity. The Ki-67 proliferation index and histological grade were dependent factors influencing mean elasticity for the differentiation between luminal subtypes. Future studies on a larger group of patients may broaden the clinical significance of these findings.

Quantification of breast lesion compositions using low-dose spectral mammography: A feasibility study.

The positive predictive power for malignancy can potentially be improved, if the chemical compositions of suspicious breast lesions can be reliably measured in screening mammography. The purpose of this study is to investigate the feasibility of quantifying breast lesion composition, in terms of water and lipid contents, with spectral mammography. Phantom and tissue samples were imaged with a spectral mammography system based on silicon-strip photon-counting detectors. Dual-energy calibration was performed for material decomposition, using plastic water and adipose-equivalent phantoms as the basis materials. The step wedge calibration phantom consisted of 20 calibration configurations, which ranged from 2 to 8 cm in thickness and from 0% to 100% in plastic water density. A nonlinear rational fitting function was used in dual-energy calibration of the imaging system. Breast lesion phantoms, made from various combinations of plastic water and adipose-equivalent disks, were embedded in a breast mammography phantom with a heterogeneous background pattern. Lesion phantoms with water densities ranging from 0% to 100% were placed at different locations of the heterogeneous background phantom. The water density in the lesion phantoms was measured using dual-energy material decomposition. The thickness and density of the background phantom were varied to test the accuracy of the decomposition technique in different configurations. In addition, an in vitro study was also performed using mixtures of lean and fat bovine tissue of 25%, 50%, and 80% lean weight percentages as the background. Lesions were simulated by using breast lesion phantoms, as well as small bovine tissue samples, composed of carefully weighed lean and fat bovine tissues. The water densities in tissue samples were measured using spectral mammography and compared to measurement using chemical decomposition of the tissue. The thickness of measured and known water contents was compared for various lesion configurations. There was a good linear correlation between the measured and the known values. The root-mean-square errors in water thickness measurements were 0.3 and 0.2 mm for the plastic phantom and bovine tissue backgrounds, respectively. The results indicate that spectral mammography can be used to accurately characterize breast lesion composition in terms of their equivalent water and lipid contents.

Applicability and discriminative value of a semiautomatic three-dimensional spherical volume for the assessment of the apparent diffusion coefficient in suspicious breast lesions—feasibility study

IntroductionTo evaluate the feasibility and accuracy of a semiautomatic, three-dimensional volume of interest (3D sphere) for measuring the apparent diffusion coefficient (ADC) in suspicious breast lesions compared to conventional single-slice two-dimensional regions of interest (2D ROIs). MethodThis institutional-review-board-approved study included 56 participants with Breast Imaging Reporting and Data System 4/5 lesion. All received diffusion-weighted imaging magnetic resonance imaging prior to biopsy (b=0–1500 s/mm2). ADC values were measured in the lesions with both methods. Reproducibility and accuracies were compared. ResultsArea under the curve was 0.93 [95% confidence interval (CI) 0.86–0.99] for the 3D sphere and 0.91 (95% CI 0.84–0.98) for the 2D ROIs without significantly differing reproducibility (P=.45). ConclusionA semiautomatic 3D sphere could reliably estimate ADC values in suspicious breast lesions without significant difference compared to conventional 2D ROIs.

Lobular neoplasia diagnosed on breast Core biopsy: frequency of carcinoma on excision and implications for management.

The appropriate follow-up and treatment for patients with a core biopsy diagnosis of lobular neoplasia (atypical lobular hyperplasia or lobular carcinoma in situ) remains controversial. Several studies have attempted to address this issue, with recommendations ranging from close clinical follow-up or surveillance to mandatory surgical excision in all cases. We report the findings at our institution, where virtually every core needle biopsy diagnosis of lobular neoplasia results in follow-up excision. The goal of the study was to identify potential predictors of upgrade to a more significant lesion. We identified 76 patients over a 15-year period with a core biopsy diagnosis of pure lobular neoplasia and no other high-risk lesions. Subsequent surgical excision identified 10 cases (13%) that were upgraded to carcinoma. Upgrade diagnoses included invasive ductal carcinoma (n=1), invasive lobular carcinoma (n=4), ductal carcinoma in situ (n=3), and pleomorphic lobular carcinoma in situ (n=2). All 10 upgraded cases had imaging findings suspicious for malignancy including irregular masses, asymmetric densities, or pleomorphic calcifications. Of the 10 upgraded cases, 7 were diagnosed as lobular carcinoma in situ on core biopsy. The data support a role for radiologic-pathologic correlation in the evaluation of suspicious breast lesions and suggest that the extent of lobular neoplasia in core biopsy specimens may be an indicator of the likelihood of upgrade to carcinoma.

Core needle biopsy for the assessment of unilateral male breast lesions

The importance of preoperative histological diagnosis in the assessment of breast lesions in women is widely established, but in men with breast lesions histological diagnosis is obtained in a limited number of cases. The aim of this study was to report our single-center experience in a large series of 131 CNB performed for suspicious male breast lesions. Our data confirmed that CNB is an effective method in distinguishing between benign and neoplastic lesions in the male breast, thus validating the few published data. CNB should be a routine part of the unilateral male breast swelling diagnostic assessment, being precious tool for the clinicians for surgery planning or avoidance.

Breast-Specific Gamma Imaging in a Breast Cancer Center: Adjunct to Characterization of Suspicious Lesions and Supporting Therapeutic Decisions

Perception and characterization of breast lesions are decisive for radiologists. Structural breast changes are assessed with morphologic imaging modalities, which are also used to guide biopsies of breast lesions. However, the biologic behavior of a breast lesion cannot be estimated reliably with these techniques - and if at all, then only indirectly, for example by evaluation of the margin characteristics. By prospectively introducing Breast-specific gamma imaging (BSGI) in the work-up of suspicious breast lesions, we gained information about metabolic alterations in breast lesions, which were initially detected with conventional modalities. Due to positive correlation between the degree of radiotracer uptake of a breast lesion and its aggressiveness, the diagnostic and therapeutic approach can be influenced.

Improving patient flow and timeliness in the diagnosis and management of breast abnormalities: the impact of a rapid diagnostic unit.

Efforts to streamline the diagnosis and treatment of breast abnormalities are necessary to limit patient anxiety and expedite care. In the present study, we examined the effect of a rapid diagnostic unit (rdu) on wait times to clinical investigations and definitive treatment. A retrospective before-after series, each considering a 1-year period, examined consecutive patients with suspicious breast lesions before and after initiation of the rdu. Patient consultations, clinical investigations, and lesion characteristics were captured from time of patient referral to initiation of definitive treatment. Outcomes included time (days) to clinical investigations, to delivery of diagnosis, and to management. Groups were compared using the Fisher exact test or Student t-test. The non-rdu group included 287 patients with 164 invasive breast carcinomas. The rdu group included 260 patients with 154 invasive carcinomas. The rdu patients had more single visits for biopsy (92% rdu vs. 78% non-rdu, p < 0.0001). The rdu group also had a significantly shorter wait time from initial consultation to delivery of diagnosis (mean: 2.1 days vs. 16.7 days, p = 0.0001) and a greater chance of receiving neoadjuvant chemotherapy (37% vs. 24%, p = 0.0106). Overall time from referral to management remained statistically unchanged (mean: 53 days with the rdu vs. 50 days without the rdu, p = 0.3806). Introduction of a rdu appears to reduce wait times to definitive diagnosis, but not to treatment initiation, suggesting that obstacles to care delivery can occur at several points along the diagnostic trajectory. Multipronged efforts to reduce system-related delays to definitive treatment are needed.

A Case of Choroidal Melanoma Metastatic to the Breast

A 61-year-old woman developed blurred vision in her left eye in December 2006. A clinical diagnosis of choroidal melanoma was made. The patient underwent excision of the left lens, followed by vitrectomy and stereotactic radiotherapy. She remained systemically healthy until 50 months later when, during a CT scan done for staging purposes, a newly visible lump was noted in the lower quadrant of her left breast. Core needle biopsy of the lesion in the left breast was performed, and histologic examination revealed metastasis from the choroidal melanoma. The patient underwent breast-conserving surgery of the left breast. Definitive histological examination showed clear tumor margins in the resected specimen and one sentinel lymph node without evidence of metastatic cells. Twenty-nine months after surgery, a similar nodule was detected in the upper quadrant of the left breast. Core biopsy again showed metastatic melanoma, and similar breast-conserving surgery was performed. Systemic examination, including magnetic resonance imaging of the head and computed tomography of the pelvis, abdomen, and chest, was done regularly and revealed no significant findings. Solitary breast metastases from choroidal melanoma are extremely rare. Nevertheless, clinicians should be aware of this rare form of metastasis when treating patients with suspicious breast lesions and a history of choroidal melanoma. If solitary metastasis is confirmed, then breast-conserving surgery may be recommended.

Independent value of image fusion in unenhanced breast MRI using diffusion-weighted and morphological T2-weighted images for lesion characterization in patients with recently detected BI-RADS 4/5 x-ray mammography findings.

The aim of this study was to evaluate the accuracy and applicability of solitarily reading fused image series of T2-weighted and high-b-value diffusion-weighted sequences for lesion characterization as compared to sequential or combined image analysis of these unenhanced sequences and to contrast- enhanced breast MRI. This IRB-approved study included 50 female participants with suspicious breast lesions detected in screening X-ray mammograms, all of which provided written informed consent. Prior to biopsy, all women underwent MRI including diffusion-weighted imaging (DWIBS, b = 1500s/mm2). Images were analyzed as follows: prospective image fusion of DWIBS and T2-weighted images (FU), side-by-side analysis of DWIBS and T2-weighted series (CO), combination of the first two methods (CO+FU), and full contrast-enhanced diagnostic protocol (FDP). Diagnostic indices, confidence, and image quality of the protocols were compared by two blinded readers. Reading the CO+FU (accuracy 0.92; NPV 96.1%; PPV 87.6%) and the CO series (0.90; 96.1%; 83.7%) provided a diagnostic performance similar to the FDP (0.95; 96.1%; 91.3%; p > 0.05). FU reading alone significantly reduced the diagnostic accuracy (0.82; 93.3%; 73.4%; p = 0.023). MR evaluation of suspicious BI-RADS 4 and 5 lesions detected on mammography by using a non-contrast-enhanced T2-weighted and DWIBS sequence protocol is most accurate if MR images were read using the CO+FU protocol. • Unenhanced breast MRI with additional DWIBS/T2w-image fusion allows reliable lesion characterization. • Abbreviated reading of fused DWIBS/T2w-images alone decreases diagnostic confidence and accuracy. • Reading fused DWIBS/T2w-images as the sole diagnostic method should be avoided.

Touch imprint cytology and stereotactically-guided core needle biopsy of suspicious breast lesions: 15-year follow-up

Touch imprint cytology and stereotactically-guided core needle biopsy of suspicious breast lesions: 15-year follow-up

Análise de Custo-Efetividade do uso do Sistema de Comunicação e Arquivamento de Imagens (PACS) em mamografias digitais

ObjectiveThis study examined the incremental cost-effectiveness ratio (ICER) of the PACS system compared to the screen /film in digital mammograms MethodsA cost-effectiveness analysis was performed comparing the use of PACS to digital mammography films in the early diagnosis of breast cancer screening setting. The outcome was the diagnostic accuracy of suspected malignant lesions, using digital mammograms with the aid of the PACS system or printed images. ResultsAmong 5000 women aged 50 to 69 years the effectiveness of the two technologies studied was the same (70%), the result was favorable to the use of PACS with lower cost to film in R$ 400,000.00. Among 5000 women aged 40 to 49 years, where the diagnostic effectiveness with PACS was 70% and the screen/film system was 55%, the ICER of the first technology in relation to the latter was R $ 544.24/examination for a gain of 1% in effectiveness. ConclusionsThe use of PACS in aid of early diagnosis of suspicious breast lesions appeared advantageous compared to mammography through film, both in women aged 50-69 years and women between 40 and 49 years old. Given the findings suggest the implementation of PACS system in all mammography services to reduce costs and improve early diagnostic accuracy in tracking scenario, including enabling the expansion of the age range for under 50 years old without large increases costs