Preoperative Breast MRI: Current Evidence and Patient Selection.

Breast MRI is the most sensitive imaging modality for the assessment of newly diagnosed breast cancer extent and can detect additional mammographically and clinically occult breast cancers in the ipsilateral and contralateral breasts. Nonetheless, appropriate use of breast MRI in the setting of newly diagnosed breast cancer remains debated. Though highly sensitive, MRI is less specific and may result in false positives and overestimation of disease when MRI findings are not biopsied prior to surgical excision. Furthermore, improved anatomic depiction of breast cancer on MRI has not consistently translated to improved clinical outcomes, such as lower rates of re-excision or breast cancer recurrence, though there is a paucity of well-designed studies examining these issues. In addition, current treatment paradigms have been developed in the absence of this more accurate depiction of disease span, which likely has limited the value of MRI. These issues have led to inconsistent and variable utilization of preoperative MRI across practice settings and providers. In this review, we discuss the history of breast MRI and its current use and recommendations with a focus on the preoperative setting. We review the evidence surrounding the use of preoperative MRI in the evaluation of breast malignancies and discuss the data on breast MRI in the setting of specific patient factors often used to determine breast MRI eligibility, such as age, index tumor phenotype, and breast density. Finally, we review the impact of breast MRI on surgical outcomes (re-excision and mastectomy rates) and long-term breast recurrence and survival outcomes.

Tigecycline in the management of osteomyelitis: a case series from the bone and joint infection (BAJIO) database.

Tigecycline is approved for cutaneous infections, intra-abdominal infections, and community-acquired pneumonia. However, pharmacokinetic data suggest therapeutic concentrations in additional sites, such as bone, despite exiguous clinical data supporting such use. Thus, the objective of this study was to analyze patients with osteomyelitis treated with tigecycline to ascertain its utility in this malady. Our database of osteomyelitis patients was surveyed for instances treated with tigecycline. Cases were evaluated in terms of adverse events and clinical success. Nineteen patients received tigecycline for osteomyelitis. Thirteen met criteria for evaluation of the primary endpoint of clinical success. The most common dose employed was 50 mg twice daily. Adverse events, however, were not statistically more likely with 100 mg administered once daily. Eleven patients (85%) achieved clinical success. Thus, congruent with pharmacokinetic data, tigecycline appeared efficacious for osteomyelitis in the majority of patients who received it. Adverse events were not correlated with dosing strategy.