Electropotential measurements as a new diagnostic modality for breast cancer.

BACKGROUND: Proliferative changes in breast epithelium are an intrinsic aspect in the development of breast cancer, and result in regions of epithelial electrical depolarisation within the breast parenchyma, which can extend to the skin surface. Diagnostic information might be obtained from a non-imaging and non-invasive test based on skin-surface electropotentials. METHODS: In 661 women, scheduled for open biopsy at eight European centres, we studied whether measurements of breast electrical activity with surface sensors could distinguish benign from malignant breast disease. A depolarisation index was developed. RESULTS: We found a highly significant trend of progressive electrical changes according to the proliferative characteristics of the biopsied tissue. Discriminatory information was obtained in both premenopausal and postmenopausal women, and the index was not related to age. The best test performances were for women with palpable lesions. The median index was 0.398 for non-proliferative benign lesions, 0.531 for proliferative benign lesions, and 0.644 for cancer (ductal carcinoma-in-situ and invasive). A specificity of 55% was obtained at 90% sensitivity for women with palpable lesions when a discriminant based on age and the depolarisation index was used. INTERPRETATION: This new modality may have diagnostic value, especially in reducing the number of unnecessary diagnostic tests among women with inconclusive findings on physical examination. Understanding and control of the biological variability of these electrical phenomena will be important in the improvement of this test. Studies in populations with a lower cancer prevalence are needed to assess further the diagnostic value of this approach.

Senology-the urgent need for a specialty.

Expert physicians from many European and Latin American countries are engaged in a systematic effort to persuade influential colleagues and government officials to recognize senology as a well-defined scientific discipline and establish it as an independent specialty. The task is complex, as the establishment of a new specialty always is. Senology is not a superfluous specialty; it is similar in characteristics and indications to many other single organ-targeted specialties such as cardiology, hematology, nephrology, neurology, and others. The quest for its recognition may be a long effort that will require vigor, intelligence, firmness, persistence, and the establishment of a dialogue between interested physicians and government representatives, leaving personal interests aside. To take the care of patients with breast diseases to its optimal stage, it will be imperative to create specialized breast centers governed by principles of unity of place and action. Gathering under the same roof all specialists skilled and interested in the diagnosis and management of benign and malignant diseases of the breast and all the diagnostic and therapeutic equipment to deliver care to these patients will bring us much closer to our goal.

Electropotential evaluation as a new technique for diagnosing breast lesions.

A new approach, termed the Biofield test, may have the potential to augment the process of diagnosing breast cancer. This technique is based on the analysis of skin surface electrical potentials measured by an array of specially designed sensors which are placed on the breasts. Measurements are recorded noninvasively and then analyzed using pattern recognition algorithms to produce an immediate and objective assessment of breast tissue in vivo. Initial clinical trials suggests that the test can achieve a sensitivity of approximately 90% and a specificity of 40-50%, which indicates that the test might be useful for excluding cancer when it is, in fact, absent. Although research to date has focused on the differential diagnosis of suspicious breast lesions, future applications could include breast cancer screening, close surveillance and diagnosis of recurrent cancers in breasts previously treated with conservative therapy, and monitoring the effectiveness of breast cancer therapies. Improvements and new applications are expected to occur as additional research and validation in actual clinical settings is performed.

Amyloidosis-related cauda equina compression in long-term hemodialysis patients. Three case reports.

STUDY DESIGN: These case reports illustrate the neurologic manifestations due to beta 2 microglobulin amyloid deposition at the lumbar spine level in long-term hemodialysis patients. OBJECTIVE: Radiologic investigations suggested the amyloid origin of extradural soft tissue deposition, which was confirmed by histologic examination after surgical excision. SUMMARY OF BACKGROUND DATA: Although cervical myelopathy is a recently recognized complication of long-term dialysis-related beta 2 microglobulin amyloidosis, neurologic manifestations due to amyloid deposition at the lumbar spine level have rarely been reported. METHODS: Three case reports of cauda equina compression in long-term hemodialysis patients are presented. Follow-up radiography, computed tomography, and magnetic resonance imaging were performed and patients underwent surgical decompression of the thecal sac. RESULTS: In two patients, the compression resulted from the development of a destructive spondylarthropathy, and from the infiltration of extradural spaces and ligaments by an abnormal soft tissue. The third patient had lumbar spinal stenosis due to multiple disc protrusion and to hypertrophy of facet joints and ligamentum flavum. Multilevel laminectomies enabled excision of an abnormal fibrous tissue responsible for the thecal sac compression. Histologic examination of the excised fibrous tissues disclosed amyloid deposits in intervertebral discs, apophysial joints, and ligaments. CONCLUSIONS: In long-term hemodialysis patients, cauda equina compression may develop as the consequence of beta 2 microglobulin amyloid deposition in lumbar intervertebral discs, facet joints, and ligaments. Magnetic resonance imaging is well suited to show the extent of the compression and supports the argument for the amyloid origin of extradural soft tissue.

Herault breast screening programme: results after 30 months of a mobile French schedule.

Breast screening in the Herault Department (France) has been carried out since July 1990. As with other French programmes, it is a population-based screen, whose main features are related to its organization in that: (a) it is performed by a specific unit (the 'Institut Montpelliérain d'Imagerie Medico-Biologique'); and (b) the group of women targeted is those aged 40-70 years. The two-view mammography is performed every 2 years in mobile units. This paper presents the results after 30 months: 26,026 participants were screened from a target population of 52,617 women, giving a participation rate of 49%. The recall rate and the biopsy rate observed were 7% and 1.5%, respectively. The predictive positive value was 8.4% for a positive test while it was 35% for the biopsy; the values increased with age. 137 cancers were observed giving a detection rate of 5.3%, of which 82% were in situ. Small (< or = to 10 mm) tumours represented 41.5%, and 71.5% of the cancers were node negative. The surgical treatment was conservative for 66% of them.

Isolated clustered microcalcifications: diagnostic value of mammography--series of 400 cases with surgical verification.

PURPOSE: To determine the diagnostic value of mammographic criteria in cases of isolated clustered microcalcifications. MATERIALS AND METHODS: Four hundred mammographic studies of isolated clustered microcalcifications for which surgical verification was available were reviewed. A descriptive statistical study was performed to evaluate the distribution of each criterion relative to histopathologic results, followed by a multivariate study to determine statistically significant criteria. Seven breast specialists gave a consensus opinion on the need for surgery. RESULTS: There were 302 benign lesions and 98 cancers. The most useful criteria were vermicular form, linear/branching shape, and irregular size of microcalcification. The number of biopsies recommended with use of these three criteria was 177 instead of the 172 recommended by the experts. CONCLUSION: Use of these three preoperative criteria permits correct diagnosis of most such malignancies (90% in our series vs 67% diagnosed by the experts).

[Cauda equina syndrome disclosing adenocarcinoma of the ethmoid]. / Syndrome de la queuè de cheval révélateur d'un adénocarcinome de l'ethmoïde.

Cauda equina metastases have been exceptionally described in sinusal neoplasms. MRI with gadolinium injection show up the primitive lesion and its neurologic extension. We report a case of cauda equina syndrome in which, only MRI, had show up intradural metastases and localised the ethmoïd sinus carcinoma.

Sensitivity of magnetic resonance imaging of the wrist in very early rheumatoid arthritis.

The aim of this study was to evaluate magnetic resonance images (MRI) of soft tissue abnormalities in the wrist of RA patients in the early stage of the disease. We performed magnetic resonance imaging of the wrist in 15 patients with early rheumatoid arthritis according to ACR criteria, of less than 10 months duration (mean duration 4.8 months). None of the patients had carpal bone erosions on standard radiography. MRI demonstrated abnormality of the soft tissue in 13 of the 15 cases. On coronal MRI, the sites of involvement of the synovitis were the recess of the distal ulnar (9 pts.), the distal radioulnar joint (4 pts.) and the radiocarpal joint (7 pts.). On axial MRI, tendon sheath effusion of the digital flexor was present in 3 patients. Carpal bone lacunae were present in only 4 patients. Disease activity was not associated with the extent of the synovitis on wrist MRI. Our study suggests that MRI is a sensitive method for the detection of synovitis in early RA.

[Histological typing of the breast by multifocal biopsies]. / Le typage histologique du sein par biopsies multifocales.

The current concept of high risk mastopathy was revolutionised by the work of Dupont and Page (1985), who demonstrated the importance of proliferative mastopathies in the assessment of the risk, particularly when they are associated with epidemiological factors. Based on these data, the Montpellier breast pathology study and research group (GERPAMM) developed on original method designed to define the precise histological profile of women considered to be at risk of breast cancer, despite the absence of any focal mammographic signs. This typing, consisting of a rigorous surgical protocol strictly complying with Page's histological definitions, was performed in women presenting a certain risk defined by clinical, cytological and radiological criteria (density and disseminated microcalcifications). This paper presents a preliminary review of 6 years' experience in 162 cases. The preliminary results confirm than many cases of atypical hyperplasia are not associated with a focal mammographic abnormality. However, in the absence of focal signs, certain types of disseminated microcalcifications with a morphological appearance suggestive of an intraductal origin, are significantly associated with high-risk histological signs. Histological typing is therefore useful to predict the cancer risk, to dedramatise cases without significant hyperplasia and to propose an adapted and justified approach to cases with a high histological risk.

[Mass screening for breast cancer in Herault county. First results in women between 40 and 70 years old]. / Dépistage de masse du cancer du sein dans l'Hérault. Premiers résultats chez la femme entre 40 et 70 ans.

A large scale mammography breast cancer screening has begun in Herault county on the first of july 1990. The aim of the project was to determine the impact of two-view mammography upon the size of the tumor and later upon mortality from breast cancer. The women aged 40-70 at entry were invited by mail to the first round of mobile breast screening. Between the start and the 8th of march 1991, 5098 (64%) attended the first round. The cancer detection rate was 5.9/1000, the positive detection rate was 7.75%, the benign malignant surgical biopsy ratio was 1:0.7 and the percentage of surgical biopsies positives for malignancy was 42.6%. Two months after this study, the screening specificity was 96.7% and the sensibility was 92.7%. The rate of tumor size less or equal to 1 cm was 72% (for 30 malignancies) and the rate of mastectomies was 43.3%. These friendly results were compared to those of others breast cancers screenings.

[Proposal for a radiologic classification of disorders of the pelvi-rectal angle based on measurement of the posterior rectal inclination. Value of dynamic digitalized rectography]. / Proposition d'une classification radiologique des troubles de la statique pelvirectale basée sur la mesure de l'inclinaison rectale postérieure. Intérêt de la rectographie dynamique numérisée.

The difficulties for evaluation of the perineal descent have always been linked to the choice of references and mostly with the incertitude of the measurement of length on the radiographic film. This present study was carried out to evaluate the perineal descent on the choice of an angular measurement: the posterior rectal inclination. The dynamic digitalized rectography was used to investigate the pelvic floor status of 134 women: 115 patients complaining of idiopathic constipation, and 19 healthy volunteers. Results have shown 3 populations with an increasing graduation of perineal impairment and led to propose a radiologic classification of pelvic floor impairment: stage I, or solid perineum, stage II, or descending perineum and stage III or descended perineum. This study has brought up that the first sign of a pelvic floor abnormality may be increased descent during straining, only later followed by perineal descent at rest. The relationship linking abnormal perineal descent and excessive opening of the ano-rectal angle suggested logically that fecal incontinence may be the end complication of the Descending Perineum Syndrom.

[Thyroid nodules and non-functional goiters. Diagnostic contribution of nuclear resonance imaging]. / Nodules thyroïdiens et goitres non fonctionnels. Apport diagnostique de l'imagerie par résonance magnétique.

The finding of a "cold" thyroid nodular or goiter raises the problem of its potential malignancy, usually resulting in systematic surgery. Ultrasonography and computerized tomography provide accurate information concerning the size, structure and connections of these abnormalities, but they have very little to say about their histological nature. We evaluated the contribution of magnetic resonance imaging (MRI) to the histological diagnosis by attempting tissue characterization before surgery in 97 patients with nonfunctional thyroid nodule or goiter. Comparisons with the pathological study of operative specimens showed a very small percentage (1.05 percent) of false negative results in terms of malignancy, and this was due to reliable arguments for benignity which we were able to collect from MRI signal intensity and structural analysis. Without these criteria, a decisive answer would have been very difficult, as shown by the significant rate of false positive results (14.73 percent) and a specificity of only 81.8 percent if every lesion interpreted as doubtful is considered malignant. Attention is drawn to the difficulties encountered in characterizing lesion with intracystic vegetations and in distinguishing between thyroiditis and lymphoma. The possibility of obtaining frontal and sagittal sections increases the usefulness of MRI. The operator's experience is essential in interpreting the signals and deciding on the therapeutic approach.