The new method, the old problem - role of contrast-enhanced spectral mammography in the diagnosis of breast cancer among Polish women.

PURPOSE: The aim of the study was to evaluate spectral mammography (CESM) in diagnosing breast cancer, which is based on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). MATERIAL AND METHODS: The study included a group of 547 women who underwent spectral mammography and histopathological verification of the lesion, previously seen in mammography and/or ultrasound. In the group of 547 women, 593 focal lesions were diagnosed. All CESM examinations were carried-out with a digital mammography device dedicated to performing dual-energy CESM acquisitions. An intravenous injection of 1.5 ml/kg of body mass of non-ionic contrast agent was performed. RESULTS: The analysis includes 593 breast lesions, in this group cancer was detected in 327 (55.14%) lesions, and in 256 (43.17%) cases benign lesions were confirmed by histopathological examination and at least 12 months of observation. The method shows differentiation of benign and malignant lesions in the breast: sensitivity of 97.86%, specificity of 59.4%, PPV - 74.76%, NPV - 95.76%. CONCLUSIONS: Spectral mammography could be an ideal method to detect breast cancer. Thanks to the high NPV (95.76%), it facilitates the exclusion of cancer in situations where pathological contrast enhancement is not observed. The unsatisfactory specificity of the study (59.4%) would not make it safe to avoid a core needle biopsy of lesions that undergo contrast enhancement.

Primary neuroendocrine carcinoma of the breast - a report of four cases.

Breast neuroendocrine tumours are rare, accounting for up to 5% of all breasts tumours and approximately 1% of all neuroendocrine tumours. In most cases, breast neuroendocrine tumours are histologically and moderately well differentiated. Neuroendocrine breast tumours lack characteristic imaging patterns. The histopathological assessment of these tumours is difficult, and in most cases the correct diagnosis is made after proper examination of the postsurgical specimen.

[The treatment of clinically silent breast lesions]. / Sposób postepowania w niemych klinicznie zmianach w piersiach.

Analysis of a diagnostic procedure leading to the clinical diagnosis and treatment of nonpalpable lesions in breast was presented in the paper. 668 women with breast lesions were treated in our department between 1995 and 2001. Nonpalpable lesions were detected in 68 women. The following diagnostic-treatment algorithm was used: case history and physical examination, radiological examination, hooked wire localisation under mammography or USG, breast surgical biopsy, intra-operative histological examination, further procedures according to morphological changes found in patients. Mammography was performed in 68 patients. Stereotactic needle biopsy under mammography was done in 61 patients (DXRBL-18-9 needle was used). The lesions were localized under USG in 7 patients. Surgical biopsy and X-Ray examination of the removed specimen was performed in 68 patients. Intra-operative histological examination revealed benign lesions in 54 women whereas malignant lesions were found in 14 women. Post-operative complications were present in 8 patients. Nonpalpable breast lesions require individual, planned diagnostic treatment. Stereotactic needle biopsy not only allows definitive surgical removal of malignant lesions within margins of normal breast tissue but also gives a good cosmetic effect. Complex diagnostics together with standardized procedure ensure the highest rate of correct diagnosis and lower the risk of diagnostic failures.