Breast sonoelastography: Now and in the future.

PURPOSE: The purpose of this study was to identify practice trends and opinions concerning breast sonoelastography in two different health care systems, one in Europe (France) and the other in North America (Province of Québec/Canada). MATERIALS AND METHODS: We distributed an 11-item online survey among French and Canadian breast radiologists. The survey comprised of four sections: (i) personal practice characteristics, (ii) breast sonoelastography usage in daily practice and evaluation of its usefulness, (iii) limitations and roles of sonoelastogrpahy in their clinical practice, and (iv) types of elastographic technique and interpretation. RESULTS: We found that sonoelastography of the breast appears unpopular among Canadian radiologists, and poorly credible among French radiologists, who perceive it as an unreliable technique. To date, its real impact in clinical practice remains uncertain. CONCLUSION: Continued learning and awareness of the indications, advantages and limitations of breast sonoelastography may motivate breast radiologists to adopt its use.

Enhancement of breast cancer on pre-treatment dynamic contrast-enhanced MRI using computer-aided detection is associated with response to neo-adjuvant chemotherapy.

PURPOSE: To evaluate whether enhancement of breast cancer on pre-treatment dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as evaluated semi-quantitatively using computer-aided detection (CAD) is associated with response to neo-adjuvant chemotherapy. MATERIALS AND METHODS: A total of 84 women, (mean age, 51±10 [SD] years; range: 30-73 years) with 84 breast cancers who underwent MRI before neo-adjuvant chemotherapy were included in this retrospective study. The proportion of each type of signal intensity-time curve (SITC) (type 1: persistent; type 2: plateau; Type 3: washout) within the tumor volume was quantified semi-automatically using a CAD system (Aegis®, Sentinelle medical, Toronto, Canada) and was compared to histological features of the tumors and to pathological response to neo-adjuvant chemotherapy. RESULTS: Pathological complete response was obtained in 29 patients (35%). Proportion of SITC type 1 was greater in non-responders (P=0.019) while proportion of SITC type 3 was greater in responders (P=0.04). Sensitivity, specificity, and accuracy of proportion of SITC type 1 for the identification of incomplete response on pathology were 42% (95% CI: 29%-56%), 90% (95% CI: 73%-98%), and 59% (95% CI: 48%-70%), respectively. CONCLUSION: Proportion of SITC type 1 (persistent) in breast cancers on pre-treatment MRI as semi-automatically quantified using a CAD system is associated with absence of pathological complete response to neo-adjuvant chemotherapy with good specificity.

Stereoscopic digital mammogram: Usefulness in daily practice.

OBJECTIVES: To assess the benefit of stereoscopic digital mammography in daily practice. METHODS: Stereoscopic digital (SD) mammography allows a fused 3D view of mammogram. A 4-degree cranio-caudal (CC) angle view matched with a regular CC view allows generating a stereoscopic view. Three breast radiologists reviewed retrospectively 1110 stereoscopic digital mammograms (1075 women) performed between November 2011 and February 2013 with the following sequence: each evaluated firstly conventional mammogram alone, and then integrated SD mammograms. The benefit was quoted in 3-grade scale: 0 for no benefit, 1 moderate and 2 excellent. The concordance between radiologists was evaluated by the W Randall coefficient. Subgroup analysis according to the BI-RADS classification, breast density and type of abnormalities were performed by calculating odds-ratio. RESULTS: The readers had the same opinion regarding the value of stereoscopic digital mammograms in 87% of cases (962/1110). Benefit was null, moderate and excellent in 8, 52 and 26% respectively. The concordance of radiologists was excellent with a W coefficient above 0.89. CONCLUSIONS: SD mammogram improved interpretation of abnormal mammograms. This potentially interesting and promising complementary tool might be beneficial in daily breast imaging practice.

Ultrasound features of retroareolar breast carcinoma.

PURPOSE: The goal of this study was to report the ultrasound features of retroareolar breast carcinoma (RABC). MATERIALS AND METHODS: The ultrasound examinations of the breast of 53 women with RABC were reviewed. They had a mean age of 67.2 years±13.4 (standard deviation [SD]) (range: 46-85 years). RABC were defined as carcinomas located less than 2cm from the nipple on mammogram. RESULTS: Among the 53 RABC, 42 (42/53; 79%) were invasive ductal carcinomas, 6 (6/53; 11%) were invasive lobular carcinomas, 4 (4/53; 8%) were ductal carcinomas in situ and 1 (1/53; 2%) was intracystic papillary carcinoma. The mean size of RABCs was 22.5mm±8.2 (SD) (range: 7.2-54.8mm). RABCs presented as a mass (53/53; 100%) with an irregular shape (44/53; 83%), a non-parallel orientation (37/53; 70%), non-circumscribed margins (50/53; 94%), a hypoechoic echotexture (46/53; 87%,) posterior attenuation (45/53; 85%) and increased vascularity (37/53; 70%) on Doppler ultrasound. CONCLUSION: On ultrasound, RABC have a presentation similar to that of breast carcinoma in other locations.

Values of pathological analysis of lost tissue fragments in the vacuum canister during a vacuum-assisted stereotactic biopsy of the breast.

OBJECTIVE: Determine values of pathological analysis of the canister content during a vacuum-assisted breast biopsy (VABB). METHODS: Approval was obtained from the ethical committee. Prospective radiological and pathological analyses of the canister content collected during 231 VABBs performed on 231 patients were carried out. χ(2) test was used to determine predictors on canister pathology. RESULTS: The canister pathology was reported separately in 212 cases. It showed only blood in 78/212 (37%) cases and benign (including high-risk lesions) and malignant results in, respectively, 113/212 (53%) and 21/212 (10%) cases. Respective specimen analysis was benign, including high-risk lesions in 162/212 cases (76%) and malignant in 50/212 (24%) cases. Microcalcifications were documented on canister X-ray in 70/231 (30%) cases. There was significant association between the canister and the specimen pathology (p<0.0001). In none of the cases was microcalcifications seen exclusively in the canister content or pathological upgrading found in the canister content compared with the specimen. CONCLUSION: Small tissue fragments and microcalcifications may be lost in the canister during a VABB. Nevertheless, our results did not show any significant value for systematic analysis of the canister content. ADVANCES IN KNOWLEDGE: There is no added diagnostic value to retrieval and analysis of tissue lost in the canister during a VABB.

Mammographically non-calcified ductal carcinoma in situ: sonographic features with pathological correlation in 35 patients.

AIM: To present the sonographic findings of mammographically non-calcified ductal carcinoma in situ (DCIS) with histopathologic correlation. MATERIALS AND METHODS: The mammographic and ultrasonographic presentations of 47 radiographically non-calcified DCIS lesions in 35 patients were retrospectively analysed. Histological characteristics (architectural appearance, nuclear grade, percent of involved lobules, and presence of necrosis) were reviewed. RESULTS: Seventeen lesions were not mammographically visible (17/47, 36%). Ultrasonographically, these lesions showed an irregular shape (28/47, 60%), microlobulated margins (34/47, 72%) and abrupt interfaces (42/47, 90%). Only 11% (5/47) displayed posterior shadowing. The echotexture of these lesions was most frequently complex (29/47, 62%); therefore, they were divided into two types: type I (24 cases), which were predominantly solid with cystic components, and type II (five cases), which were predominantly cystic with a solid intra-cystic component. A trend to have greater than 50% DCIS cells in cancerous lobules was observed in masses displaying type I echotexture (difference=36%, 95% confidence interval 10.6-62.5) and microlobulated margins (difference=32%, 95% confidence interval 5.1-58.7). CONCLUSION: Ultrasonographically detected radiographically non-calcified DCIS commonly displays an irregular shape, microlobulated margins, and complex echotexture, giving a "pseudomicrocystic" appearance. Microlobulated margins and "pseudomicrocystic" echotexture seem to be associated with a cancerization of the lobules.

Leiomyosarcoma of the great saphenous vein.

Peripheral vascular leiomyosarcomas are rare. A case of leiomyosarcoma of the great saphenous vein diagnosed pre-surgically by MRI and fine-needle aspiration is presented. Characteristics of the tumour and imaging features are discussed.

Sonographic target sign and rim enhancement on magnetic resonance imaging in metastatic melanoma to the breast.

We report a target sign on ultrasound and peripheral rim enhancement on gadolinium (Gd)-enhanced MRI images in metastasis to the breast from melanoma. These classic signs, as reported in the liver (ultrasound target sign) and in primary breast cancers (Gd rim enhancement), are probably also of value in cases of metastatic lesions to the breast.

[Local recurrence of ductal carcinoma in situ after conservative breast surgery: mammographic appearance]. / Caractéristiques mammographiques des récidives locales des carcinomes canalaires in-situ après traitement conservateur.

OBJECTIVE: To review the mammographic features of local recurrences of DCIS treated conservatively. MATERIALS AND METHODS: Thirty-five patients treated conservatively for a DCIS have presented subsequently a local recurrence. Three patients had double metachronous and one a bi-focal recurrence. The mammographic appearances of these 39 recurrences were analyzed retrospectively and compared to initial mammograms. RESULTS: Median delay to recurrence was of 47 months (interval 8-240 months). Two-thirds of the recurrent lesions were similar to the initial presentation, of which 90% occurred at the lumpectomy site. In 18/ 35 cases (51%), an intra-ductal component was found at histological diagnosis and among these 11/18 (61%) were strictly intra-ductal. CONCLUSION: Local recurrences of DCIS are proteiform. However, the majority of which, occurring at the lumpectomy site were similar to the primary tumor, raising again the hypothesis of incomplete eradication even when the margins were considered free.

[Local recurrence and metastatic dissemination of renal cell carcinoma: clinical and imaging characteristics]. / Récidives et disséminations métastatiques du cancer du rein: particularités cliniques et implications en imagerie.

The goal of this pictorial essay is to review the typical and less typical appearances of recurrent and metastatic renal cell carcinoma. Spiral computed tomography is the method of choice to evaluate the postsurgical nephrectomy site and usual sites of metastases.

[Invasive infra centimetric breast lobular carcinoma: ultrasonographic features]. / Cancers lobulaires invasifs infracentimétriques: aspects échographiques.

PURPOSE: To evaluate the ability of breast ultrasound to detect and analyze small (less than 1 cm in size) invasive lobular carcinomas. MATERIAL: and methods. A retrospective analysis of 93 small invasive carcinomas measuring less than 10 mm in size diagnosed between 1998 and 2000 in our institution was performed. In this group, 15 invasive lobular carcinomas were identified in 12 patients. All mammograms and ultrasound examinations were reviewed. RESULTS: Twelve cases of less than 10 mm invasive lobular carcinomas were diagnosed. Two lesions in one patient and one in an other patient were not detected at ultrasound and mammogram (multifocal carcinomas). All invasive lobular carcinomas were found as hypoechogenic masses with ill-defined margins and posterior shadowing. Four lesions showed evidence of microlobulations, 6 lesions an hyperechogenic halo and only one showed a vertical axis. The sensitivity of ultrasound in this group was recorded as 80% (12/15). CONCLUSION: The study confirms a high sensitivity of ultrasound examination in detection and characterization of small infiltrative lobular carcinoma.

[Pheochromocytomas and CT: can size predict malignancy?]. / Phéochromocytomes et tomodensitométrie: la taille est-elle un élément prédictif de malignité?

OBJECTIVES: The purpose of this study was to determine clinical and imaging findings associated with malignancy in pheochromocytomas. MATERIAL: and methods. A multicentric retrospective CT study including 50 lesions (23 benign and 27 malignant histologically proven pheochromocytomas) was conducted. The diagnosis of malignancy was based on histological criteria (capsular rupture, local invasion), on synchronous metastases or on the occurrence of locoregional recurrences or metastases during the outcome. The analysis was based on clinical data (age, sex, secretion of the lesion and hypertension) and on radiological criteria (largest diameter of the tumor, side, homogeneity, regularity and sharpness of contours). RESULTS: A statistical difference was found between the median largest diameter, the regularity and sharpness of contours benign and malignant lesions (p<0.0001); other clinical and radiological criteria being non significantly different. A largest diameter greater than 45 mm enabled to suggest malignancy with a sensitivity of 100% and a specificity of 69%. CONCLUSION: A diameter larger than 50mm, presence of a locoregional invasion and of metastases are strong arguments favouring.

[CT guided adrenal biopsies: remaining indications?]. / Biopsies surrénaliennes: existe t-il encore des indications?

The need for adrenal gland biopsy has much decreased since CT and MR criteria have been introduced for further characterization of adrenal lesions. Several diagnostic criteria have been described for characterization of benign versus malignant adrenal lesions based on density measurements and contrast wash-out. Adrenal biopsy may be indicated for lesions that remain indeterminate in nature after CT and MRI. Such lesions include those with a percentage of wash-out near the 50% threshold or lesions that have increased in size at follow-up imaging in spite of their benign appearance based on density measurement at prior CT evaluation. The location of the adrenal glands has an impact on the technical difficulties during biopsy and the types of complications. Ipsilateral lateral decubitus seems the more logical approach and can be used for right or left adrenal lesions; this approach is generally well tolerated by patients. Biochemical evaluation should be performed prior to biopsy in order to exclude pheochromocytoma. The overall accuracy of adrenal biopsy, considering both positive predictive value and negative predictive value, compared to the gold standard is between 80 and 95% with a complication rate of about 10%.

[Miliary induced by intravesical BCG immunotherapy for carcinoma of the bladder: CT Findings]. / Miliaire pulmonaire secondaire à une immunothérapie intravésicale par le Bacille de Calmette-Guérin: aspect TDM.

The authors describe the case of a patient presenting miliary involvement of the lung due to mycobacterium bovis after intravesical BCG administration. After initial transurethral resection, the patient was treated with immunotherapy by intravesical instillation of BCG and received 9 treatments without any problem. After the 10th treatment, the patient presented with cough and signs of urinary infection. At admission the chest radiograph showed a miliary pattern, better seen at high resolution CT, and using helical technique with the maximum intensity projection (MIP) reconstructions. MIP demonstrated to better advantage the well defined contours of the nodules, distributed evenly and randomly in the whole lung. After anti-TB treatment, the patient had regained full activity with persistence of the miliary pattern but a decreased number and size of nodules and calcification in some of them. This case illustrates a rare complication of intravesical immunotherapy, and points out the superiority of Sliding Thin Slab MIP (STS-MIP) compared with standard HRCT which allows a better detection of extent and follow-up of a military pattern, notably in moderate forms, by improvement of the anatomical resolution.