The diagnosis and management of diabetic mastopathy.

Sclerosing lymphocytic lobulitis is strongly associated with type one diabetes, when it is then known as diabetic mastopathy. This very rare benign condition tends to present in premenopausal women, often with diabetic complications particularly retinopathy. Patients present with clinically suspicious fibrous breast lumps; these are commonly multiple, bilateral, and recurrent. Mammograms show asymmetric densities and no focal mass and ultrasound investigation tends to show ill-defined hypoechoic attenuation with strong posterior acoustic shadowing. Magnetic resonance imaging can be used to further differentiate the lesion from malignancy. However, a core biopsy or excisional biopsy is essential so that a pathologic diagnosis can be made. The constellation of pathologic findings is: lymphocytic lobulitis and ductitis with glandular atrophy, lymphocytic/mononuclear perivascular inflammation which is predominantly B-cell and dense often keloid-like fibrosis, with or without epithelioid-like fibroblasts. A review of the current literature on diabetic mastopathy was carried out as it was noted that there has been no recent review of the literature. Detailed Pubmed and other medical data base searches were carried out and all publications were considered, irrespective of language and date, wherever possible.

Radioguided occult lesion localisation (ROLL) is available in the UK for impalpable breast lesions.

INTRODUCTION: To test the feasibility and reliability of ROLL in a district general hospital (DGH) dealing with screening detected breast lesions. PATIENTS AND METHODS: [(99m) Tc]-labelled colloidal human serum albumin was injected in the core of the breast lesion under ultrasound or stereotactic guidance 2-4 h prior to surgery. At operation, the radioactivity is localised using a gamma-probe. This allows optimal placement of the skin incision and subsequent WLE of the abnormal area. RESULTS: ROLL was utilised on 36 patients (median age, 61 years; range, 43-75 years); of these, 33 B5 lesions had a therapeutic one-step procedure (lumpectomy and axillary dissection) and 3 B4 patients had the lesion excised for diagnostic purposes. Localisation lasted a median of 8 min (range, 5-15 min), ROLL-guided wide tumour excision lasted 20 min (range, 15-30 min), and median postoperative hospital stay was 2 days (range, 1-3 days). Median cancer diameter was 12 mm (range, 6-40 mm). Margins were clear in 29 patients, while 7 patients with DCIS had involved margins. Median minimal clearance was 5 mm (range, < 1-10 mm). Patients had either excellent (24/36) or good (12/36) cosmetic results. CONCLUSIONS: ROLL successfully localised all lesions; this technique can be implemented in any DGH with a Nuclear Medicine Department. The learning curve is short, cost effectiveness is proven, and cosmetic results are highly rewarding. ROLL could rapidly become the standard localisation technique in the UK.