Work-up Of Breast Lesions Research Articles

Breast MR with special focus on DW-MRI and DCE-MRI

The use of magnetic resonance imaging (MRI) for the assessment of breast lesions was first described in the 1970s; however, its wide application in clinical routine is relatively recent. The basic principles for diagnosis of a breast lesion rely on the evaluation of signal intensity in T2-weighted sequences, on morphologic assessment and on the evaluation of contrast enhancement behaviour. The quantification of dynamic contrast behaviour by dynamic contrast-enhanced (DCE) MRI and evaluation of the diffusivity of water molecules by means of diffusion-weighted MRI (DW-MRI) have shown promise in the work-up of breast lesions. Therefore, breast MRI has gained a role for all indications that could benefit from its high sensitivity, such as detection of multifocal lesions, detection of contralateral carcinoma and in patients with familial disposition. Breast MRI has been shown to have a role in monitoring of neoadjuvant chemotherapy, for the evaluation of therapeutic results during the course of therapy. Breast MRI can improve the determination of the remaining tumour size at the end of therapy in patients with a minor response. DCE-MRI and DW-MRI have shown potential for improving the early assessment of tumour response to therapy and the assessment of residual tumour after the end of therapy. Breast MRI is important in the postoperative work-up of breast cancers. High sensitivity and specificity have been reported for the diagnosis of recurrence; however, pitfalls such as liponecrosis and changes after radiation therapy have to be carefully considered.

Everything You Always Wanted To Know about Core Wash Cytology in a Same-Day Breast Clinic * but Were Afraid To Ask.

Abstract Background.The histologic core needle biopsy (CNB) diagnosis is gaining importance in the initial diagnostic workup of breast lesions. However, CNB diagnosis requires 24 hours of processing while cytology can allow diagnosis within 1 hour. A quick reliable preliminary diagnosis is essential in the management of the one-day breast clinic.After a successful preclinical study investigating the diagnostic potential of an alternative method of core wash cytology, this method has now been introduced into the clinical setting.1 We hereby present the first data.Materials and methods.From April 2008 to April 2009, ultrasound guided biopsies were obtained from all palpable and non-palpable lesions in the female breast in our institute. Core wash cytology was derived from the CNB with the modified technique and classified in the categories proposed by the 1996 National Cancer Institute-sponsored conference approach: malignant, suspicious for malignancy, atypical, benign and unsatisfactory. The results of the core washes and the CNBs were correlated with the histopathology of subsequently obtained resection specimens. Suspicious for malignancy and malignant was considered as positive. Sensitivity and specificity were calculated.Results.Core wash cytology was obtained from 226 breast lesions. The age of the patients ranged from 21-92 years (median 57,5 years). In 167 of these cases subsequent resection of the lesion was performed in the follow-up. The specimens revealed 149 carcinomas (ductal 111, lobular 24, mucinous 4, tubular1, medullary 1, papillary 1 and 7 intraductal carcinoma grade 2/3). Of the 149 malignant cases 136 were classified as either malignant or suspicious for malignancy on core wash cytology, 7 cases were classified as atypical, 4 as benign and 2 as unsatisfactory. The remaining 18 resected cases were benign (adenosis 4, benign fibrous tumors 9, intracystic papilloma 1, mastitis 1, fat necrosis 2 and 1 mammary duct ectasia). None of the benign lesions were classified as suspicious or malignant on core wash cytology. Eleven lesions were classified as benign, 3 as atypical and 4 as unsatisfactory on core wash cytology. The sensitivity and specificity of the core wash compared to the definite resection diagnosis were 90% and 100%, respectively (95% confidence interval: 86%-95%).Comparing the core wash diagnoses to those on CNBs in the group of 149 resected carcinomas, it was noted that in 8 cases, which were negative on CNB, 5 cases revealed positivity on core wash cytology.Conclusion.The introduced modified technique on core wash cytology can provide a reliable preliminary indication of the likely CNB diagnosis. The modified core wash cytology is a sensitive and quick method for the detection of malignant breast lesions. This information is valuable for same-day patient counselling and management planning.Furthermore, combining core wash cytology with CNB findings can lead to an increase in the number of positive preoperative diagnoses in malignant lesions of the breast.So, don't be reluctant or afraid to implement cytology in the diagnostic work-up of breast lesions.Accepted for publication February 2009 in Cancer Cytopathology Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6017.

Book review

Book review

Localization and biopsy of breast lesions by magnetic resonance imaging guidance.

Contrast-enhanced MRI of the breast has proved to be a valuable tool in the detection and work-up of breast lesions. Most of these lesions are small and not visible by other imaging modalities, such as mammography or US. Thus, only MR-guided preoperative localization techniques or MR-guided percutaneous biopsy can provide a histologic work-up of such lesions. MR-guided preoperative localization seems to be a well-established procedure. However, MR-guided biopsy is still problematic. Although prototypical biopsy systems have been developed, considerable progress is still required. Problems exist with MR-guided biopsy due to severe needle artifacts and tissue shift during the intervention. Thus, needle biopsy currently is not recommended for lesions smaller than 10 mm. This work reviews current techniques for MR-guided preoperative localization and percutaneous biopsy in breast lesions. The diagnostic accuracy achievable with these techniques will be discussed, as well as the potential for new research opportunities and directions. J. Magn. Reson. Imaging 2001;13:903-911.

Technique and interpretation of breast aspiration cytology.

FNA biopsy as a diagnostic modality in breast lesions (palpable and nonpalpable) is a safe, rapid, cost-effective, and accurate method of diagnosis of breast pathology, which is beneficial to the patient, clinician, and cytopathologist. This diagnostic service has become an integral part in the workup of breast lesions in the practice of medicine today.