Fine-needle cytology and flow cytometry assessment of reactive and lymphoproliferative processes of the breast.

OBJECTIVE: The breast may be affected by reactive and lymphoproliferative processes such as primary (PBL) or secondary (SBL) lymphoma, reactive intramammary lymph nodes and sclerosing lobulitis; imaging may be not specific and surgical treatment not indicated. We report an experience with fine-needle cytology (FNAC) combined with flow cytometry (FC) and immunocytochemistry (ICC) in the diagnosis of these processes. STUDY DESIGN: Thirty-seven cases comprising intramammary lymph nodes (n = 15), sclerosing lobulitis (n = 2), PBL (n = 11) and SBL (n = 9) are reported. FNAC was used to prepare traditional smears, conventional ICC or FC. Cytological diagnoses were compared to the imaging data, checked by histology or follow-up and statistically evaluated. RESULTS: Imaging was not conclusive in most PBL, SBL, sclerosing lobulitis and some intramammary lymph nodes. FNAC combined with FC and ICC provided a definitive diagnosis of intramammary lymph node, sclerosing lobulitis, PBL and SBL in 18 cases with indication of the specific subtype in 10 cases. Statistical analysis showed 90% sensitivity, 100% specificity, 100% positive predictive value and 89% negative predictive value. CONCLUSIONS: FNAC combined with FC and ICC is a helpful procedure for the diagnosis of reactive and lymphoproliferative processes of the breast. It may prevent unnecessary biopsy and speed up therapeutic procedures.

Preliminary Results of a Simplified Breast MRI Protocol to Characterize Breast Lesions: Comparison with a Full Diagnostic Protocol and a Review of the Current Literature.

RATIONALE AND OBJECTIVES: This study aimed to investigate whether a simplified breast magnetic resonance imaging (MRI) protocol consisting of a localizer, one precontrast sequence, and three time-point postcontrast sequences (at 28 seconds, 84 seconds and 252 seconds after the contrast agent administration) is suitable for the characterization of breast lesions as compared to a full diagnostic protocol (FDP). This study also aimed to review the current literature concerning abbreviated breast MRI protocols and offer an alternative protocol. MATERIALS AND METHODS: Breast magnetic resonance (MR) examinations with detected breast lesions of 98 patients were retrospectively evaluated. Two expert radiologists in consensus reviewed the simplified breast protocol (SBP) first and only thereafter the regular FDP, recording a diagnosis for each detected lesion for both protocols. Receiver operating characteristic curve analysis was performed to determine the diagnostic performance of the SBP compared to the standard FDP. A revision of the previously reported abbreviated breast magnetic resonance protocols was also carried out. RESULTS: A total of 180 lesions were identified; of these, 110 (61%) were malignant and 70 (39%) were benign. Of the 110 malignant lesions, 86 (78%) were invasive ductal carcinoma, 18 (16%) were invasive lobular carcinoma, and 6 (6%) were ductal carcinoma in situ. Areas under the curve for the receiver operating characteristic curves for the SBP vs the FDP were equivalent (0.98 vs 0.99, respectively; P = 0.76). The SBP could be performed in approximately 6 minutes and 58 seconds, compared to 14 minutes and 48 seconds for the FDP. CONCLUSIONS: An SBP protocol including a late postcontrast time point is accurate for the characterization of breast lesions and was comparable to the standard FDP protocol, allowing a potential reduction of the total acquisition and interpretation times.

Mammographic and sonographic features of tubular breast carcinoma.

AIMS AND BACKGROUND: This study aimed to describe the mammographic and sonographic features of tubular carcinoma of the breast. METHODS: A retrospective review of 198 consecutive cases of surgically proven breast cancer revealed ten cases of tubular carcinoma of the breast. Only tumors with a tubular component of at least 75% were included in the study. Mean patient age was 56 +/- 9 years, range 35 to 70 years. RESULTS: The mean size of the tumors was 11 +/- 4 mm. On mammography, all tubular carcinomas appeared as an irregularly shaped mass with a central density in 6/10 cases. Eight tubular carcinomas were described as having spiculated margins. Microcalcifications were present in 4/10 cases. On ultrasound the tumor presented as a hypoechoic mass with irregular margins and posterior acoustic shadowing in 7/10 cases. In three cases the tumor presented as a hypoechoic mass with ill-defined margins and posterior acoustic shadowing. CONCLUSIONS: Although some specific mammographic and sonographic features may suggest the presence of a tubular carcinoma, the final differential diagnosis from other spiculated lesions of the breast should rely on histologic evidence only. Therefore, surgical biopsy should be recommended in all cases of stellate lesions of the breast detected at mammography or ultrasonogram.

Unusual breast lesion mimicking cancer: diabetic mastopathy.

Diabetic mastopathy represents an uncommon tumor-like proliferation of fibrous tissue of the breast that usually occurs in patients who suffered from type 1 diabetes mellitus for a long time. We report an uncommon case of diabetic mastopathy presenting in a type 2 non-insulin dependent diabetes mellitus 61-year-old postmenopausal woman. Physical examination revealed a hard, low movable mass in the upper outer quadrant of the right breast. Mammography and ultrasonography showed typical features of breast cancer. Ultrasound-guided fine-needle aspiration cytology (US-FNAC) was performed showing inflammatory infiltrate, suggesting excisional biopsy. Histological findings demonstrated typical diabetic mastopathy with fibrosis, histiocytic and limphocytic infiltration without evidence of malignancy.

Poly Implant Prothèse (PIP) incidence of rupture: a retrospective MR analysis in 64 patients.

AIM OF THE STUDY: The purpose of this retrospective study was to describe the magnetic resonance imaging (MRI) features of Poly Implant Prothèse (PIP) hydrogel implants in a group of 64 patients and to assess the incidence of rupture, compared to other clinical trials. MATERIAL AND METHODS: In this double-center study, we retrospectively reviewed the data sets of 64 consecutive patients (mean age, 43±9 years, age range, 27-65 years), who underwent breast MRI examinations, between January 2008 and October 2013, with suspected implant rupture on the basis of clinical assessment or after conventional imaging examination (either mammography or ultrasound). All patients had undergone breast operation with bilateral textured cohesive gel PIP implant insertion for aesthetic reasons. The mean time after operation was 8 years (range, 6-14 years). No patients reported history of direct trauma to their implants. RESULTS: At the time of clinical examination, 41 patients were asymptomatic, 16 complained of breast tenderness and 7 had clinical evidence of rupture. Normal findings were observed in 15 patients. In 26 patients there were signs of mild collapse, with associated not significant peri-capsular fluid collections and no evidence of implant rupture; in 23 patients there was suggestion of implant rupture, according to breast MRI leading to an indication for surgery. In particular, 14 patients showed intra-capsular rupture, with associated evidence of the linguine sign in all cases; the keyhole sign and the droplet signs were observed in 6 cases. In 9 patients there was evidence of extra-capsular rupture, with presence of axillary collections (siliconomas) in 7 cases and peri-prosthetic and mediastinal cavity siliconomas, in 5 cases. CONCLUSIONS: The results of this double center retrospective study, confirm the higher incidence (36%) of prosthesis rupture observed with the PIP implants, compared to other breast implants.

Increase of mastectomy rates after preoperative MRI in women with breast cancer is not influenced by patients age.

Preoperative magnetic resonance imaging (MRI) is increasingly used for staging women with breast cancer, including screening for occult ipsilateral or contralateral cancer. If breast-conserving surgery is planned, a MRI examination should be performed in all ages women with suspected breast cancer, especially those exhibiting dense or heterogeneously dense breast parenchyma, for which the sensitivity of both ultrasonography and mammography is low. MRI staging causes more extensive breast surgery in a significative proportion of women by identifying additional cancer. If the ability to find additional occult cancer is the true value of MRI, this is not influenced by patients' ages. For this reason, preoperative MRI should be counseled to all women with breast cancer by clinicians, independently from the age, as the age alone does not preclude additional findings.