BILATERAL BREAST CANCER: DIAGNOSIS AND PROGNOSIS.

AIM: To assess bilateral breast cancer patients, initially diagnosed with stage II unilateral breast cancer. MATERIAL AND METHODS: 113 patients with stage 0-II breast cancer diagnosed between 1983 and 2011 were assessed. Of these, 8 patients had bilateral breast cancer: 7 patients with metachronous bilateral breast cancer and 1 patient with synchronous breast cancer. Breast ultrasound, mammography, computed tomography and magnetic resonance imaging were used to diagnose recurrence, loco regional and distant metastasis. RESULTS: Age at diagnosis ranged from 37 to 59 years, with a maximum age incidence in the 4th decade (age between: 31-40 years). The average time interval between the two breast cancers was 8.125 years. The most common histological type was invasive ductal carcinoma. All eight patients with bilateral breast cancer had at least one type of recurrence/metastasis, mostly in the liver, and statistically the pleuropulmonary and liver metastases were the most frequent causes of death. CONCLUSIONS: Patients in the 4th decade diagnosed with unilateral breast cancer are at risk of developing bilateral breast cancer. In metachronous breast cancer, the time interval between the detection of the second breast cancer and death is directly proportional to the time interval between the two breast cancers. TASTASES, DEATH.

PANCREATIC CANCER CT IMAGING: COMPARISON WITH SURGERY.

AIM: To establish the best protocol for pancreatic computer tomography and criteria for staging (mainly for vascular invasion). MATERIAL AND METHODS: Our research included 49 consecutive patients with pancreatic cancer examined at the Iasi "Sf. Spiridon" Hospital between January and December 2014 with a Siemens 16 Emotion CT unit. CT protocol included no enhanced CT and pancreatic phase of the superior abdomen, portal venous phase of the abdomen and pelvis. RESULTS AND DISCUSSION: The study patients were stratified into 5 age groups and the most frequently affected by pancreatic cancer were the patients aged 60 to 79 years. For T staging the extension in the per pancreatic fat tissue, into surrounding organs (5 patients had extension in other organs) and vessels was evaluated. We determined the degree of contact between the tumor and the artery, thrombosis and deformity of the veins and we have found 8 resettable lesions, 28 tumors in stage T3 and 13 pancreatic cancers in stage T4. Thirty-three patients had lymphadenopathies and 31 of them had distant metastases. CONCLUSIONS: Our study proved that computed tomography is a good method of examination for pancreatic cancer when the right imaging protocol is used; during the pancreatic phase the arteries and the tumor are well depicted, liver metastases are best evaluated during the portal venous phase. The best criterion for arterial invasion is tumor contiguity with more than half of vessel circumference, and for vein invasion deformity or thrombosis. Comparison with surgical staging was o good backup for the radiologist and depicted several differences with imaging staging, more often understating than over staging.

BREAST INFECTIONS: DIAGNOSIS WITH ULTRASOUND AND MAMMOGRAPHY.

AIM: Evaluation of ultrasonographic and mammographic pattern, etiology and risk factors of breast infections. MATERIAL AND METHODS: Our study included a group of 66 female patients aged 16 to 71 years, examined by ultrasound and mammography in several medical imaging services in Iasi in the interval 2008-2014; ultrasound was performed in all 66 patients and mammography in 22. RESULTS: In our study breast infections occurred mostly during breastfeeding and the most frequent causative agent was Staphylococcus aureus; ultrasound established the correct diagnosis in 63 cases and detected one or more of the following aspects in case of breast infections: edema of the fatty tissue, hypoechoic areas in the breast tissue, dilated ducts, or fluid collections. Mammography was not necessary in puerperal mastitis and was performed only in women over 40 years old; in most cases we had encountered a focal asymmetric density which had low specificity for the diagnosis of mastitis or breast abscess. CONCLUSIONS: Our study proved that ultrasound is a valuable method for the diagnosis of mastitis, especially when an abscess is suspected and established a correct diagnosis in most cases; the abscesses appear as inhomogeneous fluid collections, with poorly defined margins, posterior acoustic enhancement, no Doppler signal inside, sometimes associated with enlarged axillary lymph nodes. Mammography was not helpful for the diagnosis.

Computerized calculation of breast density: our experience from Arcadia Medical Imaging Center.

THE AIM OF THIS STUDY: To implement a spatial fuzzy C-means algorithm for image segmentation and breast tissue density quantification and compare it with BI-RADS breast density classes determined by radiologists. MATERIAL AND METHODS: The analysis was based on 206 mammograms performed in 111 women with various breast abnormalities. Digitized mammographic films were independently double read by radiologists certified in breast diagnosis, followed by consensus with arbitration agreement (radiological ground truth). Reporting was done using the BI-RADS mammography lexicon. Using an algorithm based on a combination of spatial fuzzy C-means clustering and binary thresholding, percent mammographic density was computed in digitized mammograms. The BI-RADS breast density readings were compared with percent breast density measurements determined by computer algorithm. RESULTS: The algorithm was found to match the BI-RADS density classification in 90% of the cases, with an excellent agreement (kappa = 0.88) between the radiological ground truth versus the algorithm breast tissue density estimates. CONCLUSIONS: Our study proposed an algorithm that can be applied both to digitized and digital mammograms, which proved to be effective in breast density estimates. The method can accurately determine the percentage density removing the human observer variability. The proposed method showed an excellent agreement with radiological ground truth.