[Diagnostic value of strain ratio measurement in the differentiation of malignant and benign breast lesions]. / Diagnostische Aussagekraft der Strain-Ratio-Messung zur Unterscheidung zwischen malignen und benignen Brusttumoren.

PURPOSE: The aim of this study was to evaluate the strain ratio measurement of breast lesions, to calculate the diagnostic value and to provide practically oriented recommendations concerning execution. MATERIALS AND METHODS: 117 breast lesions in 98 patients were included in the study. All lesions were examined by B-mode ultrasound and elastography using strain ratio measurement. The preinterventional findings of the different methods were compared to the final histopathological results. The sensitivity, specificity, positive and negative predictive value and the diagnostic accuracy were calculated for each method. RESULTS: There was a significant difference between the strain ratio of malignant (mean 6.50; sd 3.03; 95 %-CI 5.68 - 7.33) and benign (mean 1.79; sd 3.83; 95 %-CI 0.92 - 2.75) lesions. The strain ratio showed a sensitivity of 92.6 % (95 %-CI 82.1 - 97.9) and a specificity of 95.2 % (95 %-CI 86.7 - 99.0). The positive and negative predictive values were 94.3 % and 93.7 %. B-mode ultrasound achieved a sensitivity of 94.4 % (95 %-CI 84.6 - 98.8) and a specificity of 87.3 % (95 %-CI 76.5 - 94.3). The positive and negative predictive values were 86.4 % and 94.8 %. CONCLUSION: Strain ratio measurement of breast lesions is a standardized fast method for analyzing the stiffness inside the examined areas. Used as an additional tool to B-mode ultrasound, it helps to increase the specificity of the examination.

Time-domain optical mammography SoftScan: initial results.

RATIONALE AND OBJECTIVES: Near-infrared (NIR) technology appears promising as a noninvasive technique for breast cancer screening and diagnosis. The technology capitalizes on the relative transparency of human tissue in this spectral range and its sensitivity to the main components of the breast: water, lipid, and hemoglobin. In this study, the authors report quantitative measurements of these components and the functional contrast between healthy and diseased tissue. MATERIALS AND METHODS: A four-wavelength time domain optical imaging system was used to perform noninvasive NIR measurements in the breast of 49 women both pre- and postmenopausal, ages 24-80. Algorithms based on a diffusive model of light transport provided absolute bulk and local values of breast constituent concentrations. RESULTS: Important variations in the functional and structural NIR properties of the breast were observed. Demographics trend were noticed in accordance with breast physiology. In the 23 cases imaged with suspicious masses, the optical images were consistent with the mammographic findings. Substantial contrast between masses and adjacent tissue is observed. Moreover, consistent differences between malign and benign cases are found with optical imaging. CONCLUSION: The results of this pilot study illustrate the sensitivity of optical techniques to the composition of the breast. In addition, preliminary data suggest that benign and malignant tumors can potentially be noninvasively differentiated with optical imaging. Moreover, statistically significant discrimination based on deoxy-hemoglobin content between malign and benign cases was found with optical imaging (P = .0184, one-tailed t test).

D-galactose-based signal-enhanced color Doppler sonography of breast tumors and tumorlike lesions.

RATIONALE AND OBJECTIVES: This study sought to evaluate prospectively the diagnostic potential of unenhanced and enhanced color Doppler and power Doppler for the differentiation of tumors and tumorlike lesions of the breast. METHODS: Ninety-two patients with 110 tumors or tumorlike lesions of the breast were investigated by unenhanced and enhanced color and power Doppler ultrasound. The sonomorphologic aspects of vascularization were analyzed. In addition, maximal systolic frequency shift, resistance, and pulsatility indices were determined. RESULTS: In 15 (24%) of 63 primary carcinomas, 15 (68%) of 22 fibroadenomas, and all (100%) of 14 postoperative lesions, the sonomorphologic analysis for the differential diagnosis of breast tumors was improved after contrast enhancement in color Doppler mode. In comparing unenhanced color Doppler to power Doppler, the latter was found to be slightly superior (sensitivity, 60% vs. 67%; specificity, 39% vs. 45%, respectively); after enhancement, both modes were equivalent (sensitivity, 100% vs. 100%; specificity, 95% vs. 95%, respectively). Signal enhancement resulted in a significant improvement in sensitivity and specificity (P < 0.01). Typical signs of malignancy were irregular vessel calibers, serpiginous courses, penetration of the tumor's margin, and irregular reticular vascularization. The quantitative parameters proved not to be helpful for the differential diagnosis of breast tumors. CONCLUSIONS: By improved analysis of the vascularization pattern, d-galactose-enhanced color Doppler sonography was found to provide more reliable differential diagnostic information than unenhanced Doppler ultrasound in tumors and tumorlike lesions of the breast.

Different transendothelial migration behaviour pattern of blood monocytes derived from patients with benign and malignant diseases of the breast.

BACKGROUND: In this study we compared the expression of selected monocyte surface antigens with the potential to transmigrate through an endothelial layer before and after surgery from breast cancer patients (CA) and patients with benign disease of the breast (BE). MATERIALS AND METHODS: Transmigration capacity of mononuclear cells was determined after isolation by Ficoll density gradient, layered over human umbilical vein endothelial cells and cultured in a two chamber plate added with fMLP as a chemotactic stimulus. We determined monocyte phenotye (HLA-DR, FcgRI/CD64, CR1/CD11b and LFA-1/CD11a) and the phagocytosis of E. coli by flow cytometry. RESULTS: Before surgery blood monocytes had an equal expression of the measured surface antigens, but were different in regard to their interaction with endothelial cells. Monocytes derived from CA had a higher transmigration potency than those of BE. Moreover, the migration through the endothelial cell layer created different populations of monocytes. Surgical stress modified transmigrated monocytes of BE into the direction of monocytes from CA. Phagocytic capacity of peripheral blood monocytes from CA was significantly diminished and was further reduced after surgery when measured in transmigrated cells. CONCLUSION: Our study shows that monocytes from CA and BE can be discriminated in regard to their interaction with endothelial cells.

A new elastographic method for estimation and imaging of lateral displacements, lateral strains, corrected axial strains and Poisson's ratios in tissues.

A major disadvantage of the current practice of elastography is that only the axial component of the strain is estimated. The lateral and elevational components are basically disregarded, yet they corrupt the axial strain estimation by inducing decorrelation noise. In this paper, we describe a new weighted interpolation method operating between neighboring RF A-lines for high precision tracking of the lateral displacement. Due to this high lateral-tracking precision, quality lateral elastograms are generated that display the lateral component of the strain tensor. These precision lateral-displacement estimates allow a fine correction for the lateral decorrelation that corrupts the axial estimation. Finally, by dividing the lateral elastogram by the axial elastogram, we are able to produce a new image that displays the distribution of Poisson's ratios in the tissue. Results are presented from finite-element simulations and phantoms as well as in vitro and in vivo experiments.

Expression and intracellular localization of FKHRL1 in mammary gland neoplasms.

FKHRL1 (FOXO3a), a member of the Forkhead family of genes, has been considered to be involved in the development of breast tumors; however, the in vivo expression and activation status of FKHRL1 in breast tumors still remains unclear. We immunohistochemically demonstrated the expression and intracellular localization of FKHRL1 in human breast tumors by the novel anti-FKHRL1 antibody which is available for formalin-fixed paraffin-embedded specimens. In a total of 51 cases of benign tumors, FKHRL1 was diffusely expressed in all cases, and its intracellular localization was revealed to be cytoplasmic (inactive form) in 94% of cases of intraductal papillomas (16/17) and 91% cases of fibroadenomas (31/34), with a similar pattern to normal glandular epithelium. In invasive ductal carcinomas, 83% of the cases (93/112) diffusely expressed FKHRL1; however, unlike benign tumors, 71% of the cases (66/93) showed the nuclear-targeted, active form of FKHRL1. Moreover, activated FKHRL1 was predominantly observed in scirrhous (29/36, 81% of the cases) and papillotubular (30/38, 79% of the cases) subtypes, compared to the solid-tubular subtype (7/19, 37% of the cases). Furthermore, the cases with nuclear-targeted FKHRL1 showed a tendency to have lymph nodal metastasis with statistical significance (P < 0.0001). Thus, the activation of FKHRL1 seems to be recognized as one of the specific features of invasive ductal carcinoma of the breast.

Fine needle aspiration cytologic diagnosis of axillary accessory breast tissue, including its physiologic changes and pathologic lesions.

Sixty-nine cases of axillary accessory breast tissue, including its physiologic changes and pathologic lesions, were diagnosed by fine needle aspiration cytology. The age of the patients ranged from 13 to 40 years, with a median of 25, and all were female. The cases presented with swellings in the left axilla in 16 cases, right axilla in 30 cases and both axillae in 23 cases. The common clinical diagnoses included accessory breast tissue (23.2%), lipomatous lesion (17.4%), lymphadenopathy (18.8%) and swellings not otherwise specified (30.4%). In 8.8% cases two of the possibilities were considered. The cytodiagnoses included axillary accessory breast tissue (47 cases), axillary breast tissue with pregnancy or lactational changes (15), cystic disease (4) and fibroadenoma (3). One of the cystic disease cases showed granulomatous inflammation. Although no case of carcinoma in axillary breast tissue was diagnosed during the study period, there were two cases of malignancy in axillary swellings (diagnosed as metastatic carcinoma) when no primary was detected in the breasts.

Significance of resistive index in color Doppler ultrasonogram: differentiation between benign and malignant breast masses.

The objective of this article is to evaluate the significance of resistive index in differentiation between benign and malignant breast lesions on duplex ultrasonographic examination. Resistive indices obtained in 106 breast lesions of 104 patients were included. Sixty-four were benign (mean age: 32.4 +/- 11.1 years), and 42 were malignant lesions (mean age: 47.8 +/- 11.4 years). The resistive index was classified as follows: below 0.49, from 0.5 to 0.59, 0.6 to 0.69, 0.7 to 0.79, and above 0.8. We analyzed and defined the optimal threshold value of RI between benign and malignant lesions. The mean values of the RI of benign and malignant lesions were 0.62 +/- 0.095 (range 0.44-0.86) and 0.74 +/- 0.097 (range, 0.50-0.92), respectively. The resistive index exceeded 0.7 in 80% of malignant lesions. The difference of the RI between malignant and benign lesions was statistically significant when the threshold value was 0.7 (P < 0.001). A resistive index over 0.7 may suggest malignant lesions. Due to the considerable overlap of the range of the RI, it may not be diagnostic in any single patient; however, it may be helpful in conjunct with gray-scale image.

[Estimation of vascular blood flow velocity in the breast neoplasms]. / Otsenka skorosti krovotoka v sosudakh molochnoi zhelezy pri ee opukholiakh.

Based on examinations of 133 females having the normal breast, benign and malignant tumors, the potentialities of color Doppler mapping of breast vessels are shown. Cancers showed an increased vascularity in the peritumor areas and high flow velocity (Vmax' Vmean) in the surrounding tumor vessels. These criteria are not related to the size of a malignant tumor.

[Effects of light deprivation on carcinogenesis induced by N-nitrosomethylurea in female rats]. / Vliianie svetovoi deprivatsii na kantserogenez, indutsirovannyi N-nitrozometilmochevinoi, u samok krys.

One month-old female rats were blinded by surgery and received single intravenous injections of 50 mg/kg body weight of N-nitrosomethylurea (NMU) two weeks later. Simultaneously, normal animals were injected an identical dose of NMU. The frequency of NMU-induced neoplasms in blind rats was 33% vs. 75% in control (P < 0.05), with neoplastic development latency being longer as compared with controls. The frequency of mammary gland adenocarcinoma, leukemia and adenoma of the pituitary and thyroid gland in blind rats was significantly lower while mammary gland fibroadenoma was more frequent than in intact animals. Carcinogen-treated blind animals survived much longer (448 +/- 21 days) than normal controls (284 +/- 22 days) (P < 0.001). The frequency of spontaneous neoplasms in blind and normal rats was identical. The inhibitory effect on carcinogenesis seems to be due to enhanced functional activity of the pineal gland in blind animals.

Axial-shear strain distributions in an elliptical inclusion model: experimental validation and in vivo examples with implications to breast tumor classification.

Recently, we reported on the axial-shear strain fill-in of the interior of loosely bonded stiff elliptical inclusions in a soft background at non-normal orientations, and the lack of fill-in in firmly bonded inclusions at any orientation. In this paper, we report on the experimental validation of the simulation studies using tissue-mimicking gelatin-based phantoms. We also show a few confirmatory examples of the existence of these phenomena in benign vs. malignant breast lesions in vivo. Phantom experiments showed that axial-shear strain zones caused by firmly bonded elliptical inclusions occurred only outside of the inclusion, as predicted by the simulation. By contrast, the axial-shear strain zones filled in the interior of loosely bonded elliptical inclusions at non-normal orientations. The axial-shear strain elastograms obtained from the in vivo cases appeared to be in general agreement with our experimental results. The results reported in this paper may have important clinical implications. Specifically, axial-shear strain fill-in inside an inclusion may be a unique signature of stiff, loosely bonded, ellipsoidal or elongated inclusions at non-normal orientations. Thus, it may be useful as a marker of benignity of benign breast lesions (e.g., fibroadenomas) that are generally stiff, elongated and loosely bonded to the host tissues.

Correlación y características de microcalcificaciones: en pacientes clase III, IV, V con resultados histológicos / Micro calcification correlation and characteristics: in parients class III, IV, V with histological results

Analizar las características de las microcalcificaciones en un grupo de pacientes clasificados como clase III, IV y V; y correlacionarlos con los resultados histológicos. Entre mayo 2004 y mayo 2009 se biopsiaron 165 pacientes bajo guía estereotáxica de las cuales 7 fueron clase III, 142 clase IV y 16 clase V. Se analizaron: por número, área, forma y distribución para establecer la clase mastológica y se correlacionaron con la histología. La clase mastológica predominante fue clase IV 142 pacientes (86,06 por ciento), clase V 16 pacientes (9,70 por ciento) y clase III 7 pacientes (4,24 por ciento), las características morfológicas predominantes fueron las microcalcificaciones amorfas (43,03 por ciento), el resultado histopatológico de las microcalcificaciones amorfas agrupadas se relacionan en mayor porcentaje con lesiones benignas 58,9 por ciento, mientras que las microcalcificaciones granulares segmentarias se relacionan predominantemente con lesiones proliferativas malignas 85,61 por ciento y 80 por ciento respectivamente, el fibroadenoma mamario fue el más frecuente con 20 casos (22,47 por ciento), de las lesiones proliferativas típicas la adenosis esclerosante fue predominante en 40 casos (59,70 por ciento), de lesiones proliferativas atípicas, la atipia epitelial plana tuvo mayor incidencia 7 (58,33 por ciento) y la patología maligna el carcinoma intraductal con 27 casos (50,94 por ciento). Existe correlación entre la morfología y distribución de las microcalcificaciones con respecto al resultado de anatomía patológica, microcalcificaciones amorfas agrupadas se relacionan con patología benigna, mientras que microcalcificaciones granulares segmentarias y amorfas segmentarias se correlacionan con patología proliferativa y maligna.

Analyzing the characteristics of micro calcifications biopsy under stereotactic guidance in group of patients classified class III, IV, V, correlate with histological results. In service imaging and intervention of unit Mastology, Barcelona period May 2004-May 2009 biopsied 206 patients were guided by stereotaxic micro calcifications which 7 were class III 142 class IV 16 class V. Analyzed number, area, shape, and distribution to establish the class mastologic and correlated with histological. 181 patients with diagnosis of microcalcifications, which are considered suspect classification BIRADS. The class was predominant s IV 142 patients (86.06 percent), followed by class V 16 patients (9.70 percent) class III and 7 patients (4.24 percent), the predominant morphological feature were clustered amorphous micro calcifications (43.03 percent), with regard to histopathologic results are clustered amorphous microcalcifications associated with greater percentage benign lesions 58.9 percent, while the segmental granular and amorphous microcalcifications relate predominantly segmental proliferative and malignant lesions and 80 percent 85.61 percent respectively, of the lesions found fibroadenoma was the most frequent with 20 cases (22.47 percent), proliferative lesions typical of sclerosing adenosis was predominant 40 cases (59.70 percent) atypical proliferative lesions, flat epithelial atypia had higher incidence 7 (58.33 percent) malignant pathology the intraductal carcinoma 27 cases (50.94 percent). Correlation between morphology distributions of micro calcifications on the outcome pathologic clustered amorphous micro calcifications associated with benign disease, while segmental granular amorphous micro calcifications correlated with segmental proliferative and malignant.

Gigantomastia associada a fibroadenomas / Gigantomastia associated the Fibroadenomas

Gigantomastia é uma anomalia que causacomplicações sérias e nem todas as macromastias são sintomáticas. Dessa forma, uma avaliação apropriadada paciente, bem como um atendimento multidisciplinar faz-se necessário.A intervenção cirúrgica é conseqüentemente o método de escolha nesta patologia, sendo uma excelenteterapêutica na gigantomastia. O tamoxifeno pode ser um adjuvante útil e pode permitir resultados estáveis quandocombinado com a mamoplastia redutora .

Gigantomastia is a pathology that can cause serious complications but at some cases there are no symptoms. An adequate evaluation of the patient and a multidisciplinary attendance is necessary. The surgery intervention is the method of choice in this pathology, being an excellent therapeutic. TheTamoxifeno can be a good adjuvant producing stable results when combined with the cosmetic surgery .