Analysis of background parenchymal enhancement (BPE) on contrast enhanced spectral mammography compared with magnetic resonance imaging.

OBJECTIVES: With the growing number of new breast cancer cases in women, new methods of imaging arise. Contrast enhanced spectral mammography (CESM) and magnetic resonance imaging (MRI) are comparable methods regarding sensitivity. The aim of this study is to check if analysis of background parenchymal enhancement on CESM can improve its usefulness. MATERIAL AND METHODS: A total of 64 patients with breast lesions found previously on ultrasound or mammography underwent MRI and CESM within less than one month. On MRI the contrast enhancement kinetics and visual BPE were evaluated. On CESM the enhancement of lesions was noted as well as a quantitative level of BPH. The gathered data was analysed in terms of patterns and relations. RESULTS: A total of 66 lesions were identified both on MRI and CESM, including 11 (17%) benign and 55 (83%) malignant lesions. Among malignant lesions 13 (20%) were assessed as intraductal and 42 (64%) as infiltrating carcinomas. The study showed correlation between the level of enhancement on CESM and the type of kinetic curve on MRI and lesion enhance-ment on CESM as well as confirmed the fact that the BPE is a destimulant in both methods of imaging. CONCLUSIONS: Evaluation of BPE level on CESM can help reading radiologists to define a lesion as malignant with higher probability than based only on the qualitative lesion enhancement level.

Intensity and Pattern of Enhancement on CESM: Prognostic Significance and its Relation to Expression of Podoplanin in Tumor Stroma - A Preliminary Report.

BACKGROUND/AIM: It is possible that the degree of enhancement on contrast-enhanced spectral mammography (CESM), a new diagnostic method, might provide prognostic information for breast cancer patients. Therefore, in a group of 82 breast cancer patients, we analyzed the prognostic significance of degree and pattern of enhancement on CESM as well as its relation to: (a) breast cancer immunophenotype (based on ER/PR/HER2 status) (b) podoplanin expression in cancer stroma (lymphatic vessel density plus podoplanin-positivity of cancer-associated fibroblasts), and (c) other histological parameters. MATERIALS AND METHODS: For each tumor the intensity of enhancement on CESM was qualitatively assessed as strong or weak/medium, while the pattern - as homogenous and heterogenous. RESULTS: Herein we report, for the first time, that strong and heterogenous enhancement on CESM was related to unfavorable disease-free survival of breast cancer patients (p=0.005). Moreover, the strong enhancement was more frequent in large and node-positive tumors (pT>1, pN>0) (p=0.002), as well as in carcinomas with podoplanin-sparse stroma (p=0.008). CONCLUSION: Intensity and pattern of enhancement on CESM might provide (together with the results of other diagnostic imaging methods) not only the confirmation of presence or absence of tumor, but also prognostic information.

Comparison between breast MRI and contrast-enhanced spectral mammography.

BACKGROUND: The main goal of this study was to compare contrast-enhanced spectral mammography (CESM) and breast magnetic resonance imaging (MRI) with histopathological results and to compare the sensitivity, accuracy, and positive and negative predictive values for both imaging modalities. MATERIAL/METHODS: After ethics approval, CESM and MRI examinations were performed in 102 patients who had suspicious lesions described in conventional mammography. All visible lesions were evaluated independently by 2 experienced radiologists using BI-RADS classifications (scale 1-5). Dimensions of lesions measured with each modality were compared to postoperative histopathology results. RESULTS: There were 102 patients entered into CESM/MRI studies and 118 lesions were identified by the combination of CESM and breast MRI. Histopathology confirmed that 81 of 118 lesions were malignant and 37 were benign. Of the 81 malignant lesions, 72 were invasive cancers and 9 were in situ cancers. Sensitivity was 100% with CESM and 93% with breast MRI. Accuracy was 79% with CESM and 73% with breast MRI. ROC curve areas based on BI-RADS were 0.83 for CESM and 0.84 for breast MRI. Lesion size estimates on CESM and breast MRI were similar, both slightly larger than those from histopathology. CONCLUSIONS: Our results indicate that CESM has the potential to be a valuable diagnostic method that enables accurate detection of malignant breast lesions, has high negative predictive value, and a false-positive rate similar to that of breast MRI.

Perfusion CT is a valuable diagnostic method for prostate cancer: a prospective study of 94 patients.

PURPOSE: The aim of this study is to assess the usefulness of perfusion computer tomography (pCT) in prostate cancer (PCa) diagnostics. MATERIALS AND METHODS: 94 patients with biopsy-proven PCa were enrolled in the study. Dynamic pCT of the prostate gland was performed for 50 seconds after an intravenous injection of contrast medium. Blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface area product (PS) were computed in the suspected PCa area and in normal prostatic tissue. RESULTS: PCa was visible in pCT in 90 of the 94 examined patients as a focal peripheral CT enhancement. When PCa was located in the peripheral zone (PZ), it was visible on perfusion maps, mostly showing an early peak followed by wash-out. The average values of all perfusion parameters were higher for tumour than for normal prostate tissue (p < 0.000). BV and BF were dependent on tumour grade expressed by the Gleason score (GS). All PCa cases were divided into groups, according to histological grade, as low (GS ≤ 6), medium (GS = 7), and high (GS > 7). In high-grade PCa, the mean BF value was significantly higher (p = 0.001) than the mean value of BF low- and medium-grade PCa (p = 0.011). Similar results were obtained regarding the mean values of BV; the more aggressive the cancer grade, the higher the mean BV value (p = 0.04). CONCLUSION: CT quantitative perfusion imaging allows PCa to be distinguished from normal prostate tissue. The highest values for BF and BV were observed in the most aggressive PCa grade.

Contrast-enhanced spectral mammography: comparison with conventional mammography and histopathology in 152 women.

OBJECTIVE: The goal of the study was to compare conventional mammography (MG) and contrast-enhanced spectral mammography (CESM) in preoperative women. MATERIALS AND METHODS: The study was approved by the local Ethics Committee and all participants provided informed consent. The study included 152 consecutive patients with 173 breast lesions diagnosed on MG or CESM. All MG examinations and consults were conducted in one oncology centre. Non-ionic contrast agent, at a total dose of 1.5 mL/kg body weight, was injected intravenous. Subsequently, CESM exams were performed with a mammography device, allowing dual-energy acquisitions. The entire procedure was done within the oncology centre. Images from low and high energy exposures were processed together and the combination provided an "iodine" image which outlined contrast up-take in the breast. RESULTS: MG detected 157 lesions in 150 patients, including 92 infiltrating cancers, 12 non-infiltrating cancers, and 53 benign lesions. CESM detected 149 lesions in 128 patients, including 101 infiltrating cancers, 13 non-infiltrating cancers, and 35 benign lesions. CESM sensitivity was 100% (vs. 91% for MG), specificity was 41% (vs. 15% for MG), area under the receiver operating characteristic curve was 0.86 (vs. 0.67 for MG), and accuracy was 80% (vs. 65% for MG) for the diagnosis of breast cancer. Both MG and CESM overestimated lesion sizes compared to histopathology (p < 0.001). CONCLUSION: CESM may provide higher sensitivity for breast cancer detection and greater diagnostic accuracy than conventional mammography.

Nephrectomy or nephron-sparing surgery - how to decide?

AIM OF THE STUDY: Radical nephrectomy in the treatment of renal cell carcinoma (RCC) remains the gold standard, but nephron-sparing surgery (NSS) is still increasing in importance. The main goal of this study was to compare the diagnostic accuracy of ultrasound and multi-detector computed tomography in RCC staging and its influence on deciding about further patient treatment. MATERIAL AND METHODS: 87 patients (age range 27-90 years; median 61.5) underwent ultrasound (US) scan and contrast-enhanced computed tomography (CE-CT) of the abdomen and pelvis. 28 patients were qualified for NSS. The remaining group of patients underwent nephrectomy. RESULTS: NSS was performed more frequently among patients with lesions in the lower pole of the kidney and there was no infiltration to the calyx and renal pelvis. Radical nephrectomy (RN) was pursued in cases with lesions in the central or upper pole. Lesion diameter in patients qualified for NSS was smaller than in patients qualified for radical nephrectomy. CONCLUSIONS: Determining the relationship between tumour and adjacent structures is not a simple matter. According to our study, 50% of CT results differ from histopathology assessment. Tumour diameter determined in CT examination is larger than in ultrasound and histopathological measurements while US scanning tends to underestimate tumour size in relation to histopathological assessment.

Comparison between intensity modulated radiotherapy (IMRT) and 3D tangential beams technique used in patients with early-stage breast cancer who received breast-conserving therapy.

BACKGROUND: The most often found complications in patients with breast cancer who received radiotherapy are cardiac and pulmonary function disorders and development of second malignancies. AIM: To compare the intensity modulated radiotherapy with the 3D tangential beams technique in respect of dose distribution in target volume and critical organs they generate in patients with early-stage breast cancer who received breast-conserving therapy. MATERIALS AND METHODS: A dosimetric analysis was performed to assess the three radiotherapy techniques used in each of 10 consecutive patients with early-stage breast cancer treated with breast-conserving therapy. Radiotherapy was planned with the use of all the three techniques: 3D tangential beams with electron boost, IMRT with electron boost, and intensity modulated radiotherapy with simultaneous integrated boost. RESULTS: The use of the IMRT techniques enables more homogenous dose distribution in target volume. The range of mean and median dose to the heart and lung was lower with the IMRT techniques in comparison to the 3D tangential beams technique. The range of mean dose to the heart amounted to 0.3-3.5 Gy for the IMRT techniques and 0.4-4.3 for the tangential beams technique. The median dose to the lung on the irradiated side amounted to 4.9-5 Gy for the IMRT techniques and 5.6 Gy for the 3D tangential beams technique. CONCLUSION: The application of the IMRT techniques in radiotherapy patients with early-stage breast cancer allows to obtain more homogenous dose distribution in target volume, while permitting to reduce the dose to critical organs.

Primary soft tissue giant cell tumour of the neck. Cytological and histological characteristics of the tumour and differential diagnosis.

Giant cell tumour of soft part is a very rare neoplasm. The majority of these tumours are located superficially (in subcutaneous tissue) and occur in the proximal parts of the extremities. The deep-situated giant cell tumours of the neck are extremely rare. That is why we report a case of primary giant cell tumour of soft part localized in the trapezius muscle of a 19-year-old woman. We present both cytological and histological picture of the neoplasm. The cytological image of the smear is so representative that the proper diagnosis can be settled basing on the fine-needle aspiration cytology.

[Solitary fibrous tumor of the pleura (SFTP) hidden in the pleural effusion]. / Umiejscowiony wlóknisty guz oplucnej (SFTP) ukryty w wysieku oplucnowym.

UNLABELLED: The patient with a non-malignant type of solitary fibrous tumor of the pleura (SFTP) has been presented as an example; this tumor manifested itself in long-lasting pleural effusion. The tumor, submerged in the liquid, with the diameter of 16 cm, was invisible in standard and computer X-rays of the chest. The tumor was found and removed during the thoracotomy. The patient has been alive for 9 years, without symptoms of the disease since the operation was performed. CONCLUSIONS: 1. The source of one-sided exudation can be a non-malignant SFTP. 2. Tumor submerged in the liquid can be invisible on standard and computer pictures of the chest.

Clinical significance of biological differences between cavitated and solid form of squamous cell lung cancer.

Recently, Kolodziejski et al. [Kolodziejski LS, Dyczek S, Duda K, Goralczyk KJ, Wysocki MW, Lobaziewicz W. Cavitated tumor as a clinical subentity in squamous cell lung cancer patients. Neoplasma 2003;50:66--73] have shown, that patients with cavitated form of squamous cell lung cancer (c-SqCLC) treated by surgery had shorter survival than patients with solid form (s-SqCLC) despite having similar stage, histological features and causes of deaths. Therefore, we decided to check if tumour biological features are responsible for the difference in patients' response. The aim of the study was to assess tumour proliferation rate (MIB-1 labelling index, MIB-1 LI), tumour proliferation pattern and expression of epidermal growth factor receptor (EGFR labelling index, EGFR LI) in solid and cavitated SqCLCs. A total of 81 patients with SqCLC were analysed; 18 c-qCLC (with cavity identified at X-ray examination) and 63 s-SqCLC. Expression of Ki-67 protein (MIB-1 LI) and proliferation pattern based on this staining and EGFR LI was visualized in formalin-fixed paraffin-embedded sections, using immunohistochemistry. s-SqCLC showed faster proliferation than c-SqCLC. Mean MIB-1 LI for the first group was higher-39.2% (range, 12.7--65.6) than for the second group--26.1% (range, 7.1--45.6) (P=0.000). In c-SqCLC subgroup, eight tumours with intermediate type of proliferation, six with random and four with mixed pattern were identified. However, in the s-SqCLC there were 18 with intermediate, 22 with random and 22 with mixed type of proliferation. The difference between architecture of proliferation and histological grade was seen (P=0.040). Mean EGFR LI did not differ between c-SqCLC (31.1%) and s-SqCLC (29.3%); however, median value was non-significantly lower for c-SqCLC (14.0%) than in s-SqCLC (21.0%). Univariate Kaplan-Meier analysis revealed that patients with s-SqCLC and a lower pTNM, faster tumour proliferation (MIB-1 LI>39%) and 13%

[Resection of the renal vein leiomyosarcoma with preservation of the kidney]. / Wyciecie miesaka gladkokomórkowego zyly nerkowej z zaoszcz dzeniem nerki.

We present a case of 75 years old woman who successfully underwent resection of the right renal vein leiomyosarcoma (LMS-VR) with preservation of the kidney. It is the first reported case in Polish and fifth in world literature. The patient is alive without recurrence 24 months after operation. The surgical resection of LMS-VR with the preservation of the kidney should always be considered when the tumour does not infiltrate the renal hilus.

Prognostic significance of epidermal growth factor receptor in surgically treated squamous cell lung cancer patients.

Epidermal growth factor receptor (EGFR) is one of signalling pathways activated during premalignant proliferative changes in the airway epithelium. However there is no agreement about prognostic significance of EGFR expression in non-small cell lung cancer (NSCLC). Facts mentioned above prompted us to study EGFR expression in the group of 78 surgically treated squamous cell lung cancer (SqCLC) patients. The EGFR expression was visualized in formalin-fixed, paraffin-embedded sections, using immunohistochemistry. Three methods of assessment of EGFR expression were applied: percentage of cells with membranous EGFR expression--EGFR labellig index (EGFR LI), percentage of fields with membranous EGFR staining (PS%) and staining intensity (absent, weak or strong) in the whole specimen (SI). Mean EGFR LI and PS% values were 30.4 +/- 3.5% and 51.6 +/- 3.9%, respectively. Patients with higher EGFR expression (EGFR LI, PS%, SI) were significantly younger than those with low EGFR expression. EGFR LI was higher in pT3 tumours than in pT1+pT2 tumours, moreover, EGFR expression (EGFR LI, PS%, SI) was significantly higher in G1+G2 tumours than in G3 tumours. There were significant correlations between parameters used for assessment of EGFR expression. PS% < or = 50 indicated shorter disease-specific survival than PS% > 50. However, patients with tumours with both very low and very high EGFR LI (13% > or = EGFR LI > 80%) showed significantly shorter survival than those with medium EGFR LI (13% < GFR LI < or = 80%). Additionally, pTNM and pN significantly influenced patients' survival. In multivariate analysis, EGFR LI and pTNM were independent prognostic parameters influencing disease-specific survival of patients.