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1.
JAMA ; 323(8): 746-756, 2020 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-32207768

RESUMO

Importance: Improved screening methods for women with dense breasts are needed because of their increased risk of breast cancer and of failed early diagnosis by screening mammography. Objective: To compare the screening performance of abbreviated breast magnetic resonance imaging (MRI) and digital breast tomosynthesis (DBT) in women with dense breasts. Design, Setting, and Participants: Cross-sectional study with longitudinal follow-up at 48 academic, community hospital, and private practice sites in the United States and Germany, conducted between December 2016 and November 2017 among average-risk women aged 40 to 75 years with heterogeneously dense or extremely dense breasts undergoing routine screening. Follow-up ascertainment of cancer diagnoses was complete through September 12, 2019. Exposures: All women underwent screening by both DBT and abbreviated breast MRI, performed in randomized order and read independently to avoid interpretation bias. Main Outcomes and Measures: The primary end point was the invasive cancer detection rate. Secondary outcomes included sensitivity, specificity, additional imaging recommendation rate, and positive predictive value (PPV) of biopsy, using invasive cancer and ductal carcinoma in situ (DCIS) to define a positive reference standard. All outcomes are reported at the participant level. Pathology of core or surgical biopsy was the reference standard for cancer detection rate and PPV; interval cancers reported until the next annual screen were included in the reference standard for sensitivity and specificity. Results: Among 1516 enrolled women, 1444 (median age, 54 [range, 40-75] years) completed both examinations and were included in the analysis. The reference standard was positive for invasive cancer with or without DCIS in 17 women and for DCIS alone in another 6. No interval cancers were observed during follow-up. Abbreviated breast MRI detected all 17 women with invasive cancer and 5 of 6 women with DCIS. Digital breast tomosynthesis detected 7 of 17 women with invasive cancer and 2 of 6 women with DCIS. The invasive cancer detection rate was 11.8 (95% CI, 7.4-18.8) per 1000 women for abbreviated breast MRI vs 4.8 (95% CI, 2.4-10.0) per 1000 women for DBT, a difference of 7 (95% CI, 2.2-11.6) per 1000 women (exact McNemar P = .002). For detection of invasive cancer and DCIS, sensitivity was 95.7% (95% CI, 79.0%-99.2%) with abbreviated breast MRI vs 39.1% (95% CI, 22.2%-59.2%) with DBT (P = .001) and specificity was 86.7% (95% CI, 84.8%-88.4%) vs 97.4% (95% CI, 96.5%-98.1%), respectively (P < .001). The additional imaging recommendation rate was 7.5% (95% CI, 6.2%-9.0%) with abbreviated breast MRI vs 10.1% (95% CI, 8.7%-11.8%) with DBT (P = .02) and the PPV was 19.6% (95% CI, 13.2%-28.2%) vs 31.0% (95% CI, 17.0%-49.7%), respectively (P = .15). Conclusions and Relevance: Among women with dense breasts undergoing screening, abbreviated breast MRI, compared with DBT, was associated with a significantly higher rate of invasive breast cancer detection. Further research is needed to better understand the relationship between screening methods and clinical outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT02933489.


Assuntos
Densidade da Mama , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Mamografia/métodos , Adulto , Idoso , Biópsia , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética/efeitos adversos , Mamografia/efeitos adversos , Pessoa de Meia-Idade , Invasividade Neoplásica , Valor Preditivo dos Testes , Padrões de Referência , Sensibilidade e Especificidade
2.
Am Surg ; 86(2): 90-94, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167041

RESUMO

We aimed to evaluate the surgical margin outcomes and re-excision rates in patients undergoing bracketed seed localization of biopsy-proven breast cancer detected on screening mammogram. After approval by our Institutional Review Board, we retrospectively identified patients who had undergone iodine-125 seed localized lumpectomy at our institution from January 2010 to June 2017 by one of two fellowship-trained breast surgeons. Of those patients, a subset of 25 patients were identified who had undergone bracketed seed localization, defined as two or more seeds used to delineate the radiographic borders of the area of concern. All patients had originally presented with calcifications identified on screening mammogram that were subsequently diagnosed as ductal carcinoma in situ and/or invasive ductal carcinoma by image-guided biopsy performed at our institution. Eight patients had one positive margin on final surgical pathology and required re-excision (32%). One patient was converted to mastectomy. Of the patients requiring re-excision, the average maximum linear extent of calcifications was 3.4 cm (SD 0.97), whereas it was 3.1 cm (SD 1.2) in patients with negative surgical margins (P = 0.5). Bracketing calcifications with radioactive seeds can potentially allow more patients to undergo breast conservation surgery.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Radioisótopos do Iodo/administração & dosagem , Mastectomia Segmentar/métodos , Tratamentos com Preservação do Órgão/métodos , Neoplasias da Mama/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Feminino , Marcadores Fiduciais , Humanos , Biópsia Guiada por Imagem , Mamografia , Margens de Excisão , Reoperação/estatística & dados numéricos , Estudos Retrospectivos
3.
JAMA ; 323(8): 746-756, 2020 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-32096852

RESUMO

Importance: Improved screening methods for women with dense breasts are needed because of their increased risk of breast cancer and of failed early diagnosis by screening mammography. Objective: To compare the screening performance of abbreviated breast magnetic resonance imaging (MRI) and digital breast tomosynthesis (DBT) in women with dense breasts. Design, Setting, and Participants: Cross-sectional study with longitudinal follow-up at 48 academic, community hospital, and private practice sites in the United States and Germany, conducted between December 2016 and November 2017 among average-risk women aged 40 to 75 years with heterogeneously dense or extremely dense breasts undergoing routine screening. Follow-up ascertainment of cancer diagnoses was complete through September 12, 2019. Exposures: All women underwent screening by both DBT and abbreviated breast MRI, performed in randomized order and read independently to avoid interpretation bias. Main Outcomes and Measures: The primary end point was the invasive cancer detection rate. Secondary outcomes included sensitivity, specificity, additional imaging recommendation rate, and positive predictive value (PPV) of biopsy, using invasive cancer and ductal carcinoma in situ (DCIS) to define a positive reference standard. All outcomes are reported at the participant level. Pathology of core or surgical biopsy was the reference standard for cancer detection rate and PPV; interval cancers reported until the next annual screen were included in the reference standard for sensitivity and specificity. Results: Among 1516 enrolled women, 1444 (median age, 54 [range, 40-75] years) completed both examinations and were included in the analysis. The reference standard was positive for invasive cancer with or without DCIS in 17 women and for DCIS alone in another 6. No interval cancers were observed during follow-up. Abbreviated breast MRI detected all 17 women with invasive cancer and 5 of 6 women with DCIS. Digital breast tomosynthesis detected 7 of 17 women with invasive cancer and 2 of 6 women with DCIS. The invasive cancer detection rate was 11.8 (95% CI, 7.4-18.8) per 1000 women for abbreviated breast MRI vs 4.8 (95% CI, 2.4-10.0) per 1000 women for DBT, a difference of 7 (95% CI, 2.2-11.6) per 1000 women (exact McNemar P = .002). For detection of invasive cancer and DCIS, sensitivity was 95.7% (95% CI, 79.0%-99.2%) with abbreviated breast MRI vs 39.1% (95% CI, 22.2%-59.2%) with DBT (P = .001) and specificity was 86.7% (95% CI, 84.8%-88.4%) vs 97.4% (95% CI, 96.5%-98.1%), respectively (P < .001). The additional imaging recommendation rate was 7.5% (95% CI, 6.2%-9.0%) with abbreviated breast MRI vs 10.1% (95% CI, 8.7%-11.8%) with DBT (P = .02) and the PPV was 19.6% (95% CI, 13.2%-28.2%) vs 31.0% (95% CI, 17.0%-49.7%), respectively (P = .15). Conclusions and Relevance: Among women with dense breasts undergoing screening, abbreviated breast MRI, compared with DBT, was associated with a significantly higher rate of invasive breast cancer detection. Further research is needed to better understand the relationship between screening methods and clinical outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT02933489.


Assuntos
Densidade da Mama , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Imagem por Ressonância Magnética , Mamografia , Invasividade Neoplásica/diagnóstico por imagem , Adulto , Idoso , Mama/diagnóstico por imagem , Estudos Transversais , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética/métodos , Mamografia/métodos , Pessoa de Meia-Idade , Sensibilidade e Especificidade
4.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(1): 42-48, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-31950788

RESUMO

Objective: To explore the value of a radiomics approach based on MRI texture analysis (TA) in identifying intraductal carcinoma of the prostate gland (IDCP). Methods: MRI images of 56 patients with pathological proven prostate cancer were analyzed retrospectively, including 31 patients with pure prostate adenocarcinoma and 25 patients with IDCP component in the prostate adenocarcinoma lesions. After imaging features of lesions were analyzed, then enhanced arterial and venous phase images were imported into Omni-Kinetics software for the extraction the TA features of region of interests' lesion according to the T2-weighted imaging. In order to set up a regression prediction model which based on texture parameters and morphological features. Furthermore, the comparison of diagnostic accuracy of each TA regression models were assessed by operating characteristic curves (ROC). Results: Among the imaging features of peripheral lesions, the incidence of surgical capsule invasion, prostatic capsule involvement, and seminal vesicle invasion in patients with IDCP was higher than that in patients with adenocarcinoma alone ( P<0.05). Among the imaging features of transitional zone lesions, patients with adenocarcinoma containing IDCP had a higher incience of imaging features as benign prostatic hyperplasia, extracapsular invasion of the prostate, seminal vesicles invasion, and vascular nerve bundles than that in pure adenocarcinoma group ( P<0.05). In order to differential diagnosis of simple adenocarcinoma and adenocarcinoma containing IDCP, 4 arterial phase texture features were used to build the regression model in the peripheral zone group, and the area under the curve ( AUC) of the TA model and combined model with or without seminal vesicles invasion were 0.890 and 0.938, respectively. In the transitional zone group, 2 arterial phase texture features and 2 venous phase features were used in TA regression model, and the AUC of texture model and the combined model with or without vascular nerve bundles were 0.844 and 0.901, respectively. Conclusion: The incidence of adenocarcinoma with IDCP is higher in high-grade invasive prostate cancer. It is wonderful that when compared with T2WI, enhanced sequential texture analysis is more valuable when using the radiomics approach based on MRI texture analysis in identifying IDCP in prostate cancer.


Assuntos
Carcinoma Intraductal não Infiltrante , Imagem por Ressonância Magnética , Neoplasias da Próstata , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/normas , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Estudos Retrospectivos
5.
Eur Radiol ; 30(1): 514-522, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31375867

RESUMO

OBJECTIVES: To analyze the utility of metabolic imaging, and specifically of dedicated breast positron emission tomography (dbPET) to differentiate between indolent and potentially aggressive ductal carcinoma in situ (DCIS). METHODS: After institutional review board approval, we retrospectively reviewed the cases of pure DCIS who underwent dbPET before biopsy and surgery in Lucus Augusti Universitary Hospital (Lugo, Spain) and in Fudan Cancer Institute (Shanghai, China) between January 2016 and May 2018. Grade 1 and "non-comedo" grade 2 DCIS were considered low-risk disease, while intermediate-grade with necrosis or grade 3 cases were included in the high-risk group. DbPET sensitivity and specificity to differentiate between indolent and potentially aggressive DCIS were determined along with their respective 95% confidence intervals. RESULTS: We enrolled 139 surgery-confirmed pure DCIS cases. Fifty were high-risk neoplasms and 89 low-risk DCIS. Only seven low-risk lesions were positive at dbPET and five of potentially aggressive neoplasms did not show FDG uptake, all included into the field of view (FOV). Sensitivity and specificity of dbPET to differentiate between indolent and potentially aggressive DCIS were 90% (95% CI, 77-96%) and 92% (95% CI, 84-97%), respectively. CONCLUSION: Metabolic imaging could help to identify the subgroup of indolent lesions from those potentially aggressive ones that may be managed by active surveillance. KEY POINTS: • Low- and high-grade DCIS likely arise from two distinct evolutionary paths and when low-grade lesions progress to invasive cancer, the tumor is frequently low grade and well differentiated. • Ongoing clinical trials evaluate whether patients with low-risk DCIS could be safely managed by an active surveillance approach, with avoidance of unnecessary treatments and without impact on ipsilateral invasive breast cancer free survival time. • Dedicated breast PET may differentiate harmless from potentially hazardous DCIS, supporting active surveillance for the management of those women with low-grade DCIS, decreasing the rate of the upgrade to invasive carcinoma at surgical excision.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Sobremedicalização/prevenção & controle , Tomografia por Emissão de Pósitrons/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , China , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Espanha
6.
Cancer Metastasis Rev ; 38(3): 445-454, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31605250

RESUMO

Cells grown in three dimensions (3D) within natural extracellular matrices or synthetic scaffolds more closely recapitulate the phenotype of those cells within tissues in regard to normal developmental and pathobiological processes. This includes degradation of the surrounding stroma as the cells migrate and invade through the matrices. As 3D cultures of tumor cells predict efficacy of, and resistance to, a wide variety of cancer therapies, we employed tissue-engineering approaches to establish 3D pathomimetic avatars of human breast cancer cells alone and in the context of both their cellular and pathochemical microenvironments. We have shown that we can localize and quantify key parameters of malignant progression by live-cell imaging of the 3D avatars over time (4D). One surrogate for changes in malignant progression is matrix degradation, which can be localized and quantified by our live-cell proteolysis assay. This assay is predictive of changes in spatio-temporal and dynamic interactions among the co-cultured cells and changes in viability, proliferation, and malignant phenotype. Furthermore, our live-cell proteolysis assay measures the effect of small-molecule inhibitors of proteases and kinases, neutralizing or blocking antibodies to cytokines and photodynamic therapy on malignant progression. We suggest that 3D/4D pathomimetic avatars in combination with our live-cell proteolysis assays will be a useful preclinical screening platform for cancer therapies. Our ultimate goal is to develop 3D/4D avatars from an individual patient's cancer in which we can screen "personalized medicine" therapies using changes in proteolytic activity to quantify therapeutic efficacy.


Assuntos
Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/metabolismo , Carcinoma Intraductal não Infiltrante/patologia , Animais , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Técnicas de Cultura de Células/métodos , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Feminino , Humanos , Microscopia Confocal , Imagem Óptica/métodos , Proteólise , Microambiente Tumoral
7.
Int J Radiat Oncol Biol Phys ; 105(3): 471-472, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31540590
8.
Pathology ; 51(6): 563-569, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472981

RESUMO

Ductal carcinoma in situ is a non-invasive form of breast cancer. Its incidence is increasing due to widespread use of mammographic screening. It presents several diagnostic and management challenges in part due to its relatively indolent behaviour. Most series analysing biomarkers in these lesions are small (<100 patients) and large clinical trials have not been frequent. Herein, we review the recent progress made in understanding the biology of this entity and the tools available for prognostication.


Assuntos
Neoplasias da Mama/patologia , Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Detecção Precoce de Câncer , Feminino , Humanos , Mamografia
9.
Acta Clin Croat ; 58(1): 13-22, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363320

RESUMO

The aim of this study was to evaluate the quantitative sonoelastographic values recorded on shear-wave sonoelastography (SWE) of high-risk breast lesions and ductal carcinoma in situ (DCIS). We retrospectively analyzed histopathologic and SWE data (quantitative maximum, minimum and mean stiffness, lesion-to-fat ratio (E-ratio), lesion size) of 228 women referred to our Department for core needle breast biopsy during a four-year period. Among 230 lesions, histopathologic findings showed 34 high-risk breast lesions and 29 DCIS, which were compared with 167 ductal invasive carcinomas. High-risk lesions had lower values of all sonoelastographic features than ductal in situ and invasive carcinoma, however, only E-ratio showed a statistically significant difference in comparison to DCIS (3.7 vs. 6, p<0.001). All sonoelastographic features showed significant difference between in situ and invasive carcinoma. There was a significant correlation between lesion size and stiffness (r=0.36; p<0.001). Stiffness measured by SWE is an effective predictor of the histopathologic severity of sonographically detectable breast lesions. Elasticity values of high-risk lesions are significantly lower than those of malignant lesions. Furthermore, we showed that along with the sonographic appearance, which in most cases shows typical microcalcifications, DCIS had significantly different elasticity parameters than invasive carcinoma.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Ultrassonografia Mamária/métodos , Adulto , Idoso , Neoplasias da Mama/patologia , Calcinose/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos
10.
Breast Cancer Res Treat ; 178(1): 221-230, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31368035

RESUMO

BACKGROUND: A better understanding underlying radiation (RT) response after breast-conserving surgery (BCS) is needed to mitigate over-treatment of DCIS. The hazard ratio (HR) measures the effect of RT but assumes the effect is constant over time. We examined the hazard function adjusted for adherence to surveillance mammography to examine variations in LR risk and the effect of RT over time. METHODS: Crude hazard estimates for the development of LR in a population cohort of DCIS treated by BCS ± RT were computed. Multivariable extended Cox models and hazard plots were used to examine the association between receipt of RT and risk of each outcome adjusted for baseline covariates and adherence to mammography. RESULTS: Population cohort includes 3262 women treated by BCS; 1635 received RT. Median follow-up was 13 years. LR developed in 364 women treated by BCS alone and 274 treated with RT. LR risk peaked at 2 years, declined until year 7, and then remained steady. The peak hazard of LR was associated with adverse features of DCIS. Early LR risk was attenuated in patients treated with RT but late annual risks of LR and invasive LR were similar among the two treatment groups. On multivariate analysis, RT was associated with a reduction in early LR risk (HR = 0.52, 95% CI 0.43-0.63, p < 0.0001) but did not reduce the risk of late LR (HR = 0.89, 95% CI: 0.67, 1.19, p = 0.44) (interaction, p = 0.002). CONCLUSIONS: The effect of RT is not uniform over time and greatest in the first 7 years after BCS for DCIS, which can guide future research to understand mechanisms underlying RT response and optimize future management of DCIS.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/terapia , Mastectomia Segmentar/métodos , Feminino , Humanos , Mamografia , Cooperação do Paciente , Vigilância da População , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
11.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466977

RESUMO

This case describes a 69-year-old woman, who presented with rapidly progressive cerebellar symptoms and unintentional weight loss. Full neurological assessment excluded space-occupying lesions, vascular accidents and infection. Surprisingly, a chest, abdomen and pelvis CT showed a left hemipelvis mass, which was subsequently biopsied. A high-grade serous carcinoma of tubo-ovarian origin was found, diagnosing paraneoplastic cerebellar degeneration (PCD) secondary to this. The exact mechanism is not known, but is thought to be immune-mediated. In cases of PCD, after cancer treatment, the neurological disability stabilises to a severe level and will unfortunately be lifelong. Our patient continues to make great progress with intensive rehabilitation for her ongoing balance issues. Early recognition of PCD can lead to a prompt diagnosis of the underlying malignancy and hence subsequent management. This can at least limit the extent of the neurological disability of the disease and increase the survival rate from cancer.


Assuntos
Doenças Cerebelares/reabilitação , Neoplasias das Tubas Uterinas/complicações , Neoplasias Ovarianas/complicações , Degeneração Paraneoplásica Cerebelar/etiologia , Idoso , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Carcinoma , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Doenças Cerebelares/diagnóstico , Doenças Cerebelares/etiologia , Doenças Cerebelares/patologia , Cerebelo/diagnóstico por imagem , Cerebelo/patologia , Neoplasias das Tubas Uterinas/diagnóstico por imagem , Neoplasias das Tubas Uterinas/patologia , Neoplasias das Tubas Uterinas/terapia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Mamografia , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Degeneração Paraneoplásica Cerebelar/diagnóstico , Resultado do Tratamento
12.
Breast ; 47: 93-101, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31362135

RESUMO

OBJECTIVES: The aim of this retrospective study is to compare surgical margins, reoperation rates and local recurrences after breast conserving surgery (BCS) using radioguided occult lesion localization (ROLL) or radioactive seed localization (RSL). MATERIALS AND METHODS: We reviewed 744 consecutive patients with impalpable primary invasive breast cancer who underwent BCS at Helsinki University Hospital between 2010 and 2012. ROLL was used in our unit until October 31st, 2011; from November 1st we changed localization method to RSL. RESULTS: 318 patients underwent ROLL and 426 RSL. Patients in the RSL group had more often multifocal (p = 0.013) tumours. No statistically significant differences were found regarding tumour size, specimen weight, histology or grade of tumours or lymph node status. 42 (5.6%) patients were reoperated because of insufficient margins, 13 (4.1%) in the ROLL group and 29 (6.8%) in the RSL group. The reoperation rate was not different between the groups either in the univariable analysis (p = 0.112) or in the multivariable binary logistic regression analysis (p = 0.204). Risk factors for reoperations were multifocality of the tumour (p < 0.001), extensive intraductal component (p < 0.001), larger tumour size (p = 0.011), and smaller specimen weight (p = 0.014). The median follow-up time in the ROLL group was 81 (8-94) months and 64 (3-73) months in the RSL group. The five-year local recurrence-free survival (LRFS) estimates for ROLL and RSL groups were 98.0% and 99.4%, respectively (log-rank test, p = 0.323). CONCLUSION: Reoperation rates and LRFS were comparable for ROLL and RSL in patients with impalpable breast cancer treated with BCS.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Margens de Excisão , Mastectomia Segmentar/métodos , Recidiva Local de Neoplasia/patologia , Ultrassonografia Mamária/métodos , Adulto , Idoso , Biópsia com Agulha de Grande Calibre/métodos , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/mortalidade , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/mortalidade , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Finlândia , Hospitais Universitários , Humanos , Mastectomia Segmentar/efeitos adversos , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Palpação , Prognóstico , Cintilografia/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
13.
Breast J ; 25(4): 604-611, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31206889

RESUMO

The purpose is to determine whether an abbreviated MRI protocol (ABMR) is ready to be used for breast cancer screening in an academic practice setting. Two hundred and fifty nine breast MRIs from 1/1/2012 to 6/30/2012 were retrospectively reviewed using ABMR (MIP, Pre-contrastT1, single dynamic post-contrastT1, and subtraction). Five breast radiologists (4-28 year-expr) participated in this reader study performed in two phases: Phase1 - radiologist's privy to clinical history but not to comparison imaging. Phase2 - radiologists provided comparison imaging. For phase1, studies were reviewed using three steps: (a) MIP only (positive/negative/intermediate); (b) ABMR (recall/no recall) and (c) With T2 (for changes in recommendations). Radiologist also recorded total time for interpretation. In Phase2 the MRIs coded as "recall" were re-reviewed with available comparison studies, noting changes in final recommendation. The abnormal interpretation rates (AIRs) were calculated for phase1 and phase2 results with comparison to the original full protocol. Of the 259 patients (avg. age-52 years; range 26-78), there were seven cancers (three invasive, three DCIS and one breast lymphoma). Acquisition time for ABMR was 3 minutes, ABMR + T2-8 minutes, and original full protocol 16 minutes. Average MIP was positive or indeterminate in 86% (6/7) and negative in 14% (1/7) cancers. The average AIR for MIP only was 20.8% (sens-77.1%; spec-80.8%. The AIR w/o comparisons was 25.6% (sens-91.4%; spec- 76.2%); however the average AIR decreased in phase 2 with comparisons to 13.7% (sens-91.4%; spec-88.5%). The AIR of the original full protocol read was 16.2% (sens-100%; spec-85.7%). Addition of T2 changed assessment in only 3% (1.2%-6.5%). Avg. read time for ABMR including T2 was 2.5 minutes (1.6-4.0 minutes). ABMR is reliable for breast cancer screening, with acceptable interpretation time and acceptable AIR.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Centros Médicos Acadêmicos , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/prevenção & controle , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/prevenção & controle , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Radiologistas , Sensibilidade e Especificidade , Fatores de Tempo
14.
Ann Surg Oncol ; 26(11): 3472-3477, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31147991

RESUMO

BACKGROUND: Mammographic breast density (MBD) is an independent risk factor for breast cancer. Information regarding the relationship of MBD and breast cancer biology in women with ductal carcinoma in situ (DCIS) is currently lacking. This study aimed to examine the clinicopathologic characteristics of DCIS in women stratified by MBD. METHODS: A retrospective review was performed to identify women with pure DCIS who underwent preoperative mammography between 2010 and 2018. Clinicopathologic and demographic data were collected. For the purpose of analysis, MBD was categorized as "non-dense" (Breast Imaging-Reporting and Data System [BI-RADS] density categories A and B) or "dense" (BI-RADS C and D) according to its identification in radiology reports. RESULTS: Of 3227 patients with a breast cancer diagnosis enrolled in the institutional Breast Cancer Database during the study period, 658 (20%) had pure DCIS. Of these 658 patients, 42% had non-dense breasts, and 58% had dense breasts. Most lesions were non-palpable (92%) and detected by mammography (84%). Patients with dense breasts were more likely to be younger at the time of diagnosis (p < 0.001), premenopausal (p < 0.001), and Asian (p = 0.018), and to have higher-grade disease (p = 0.006; Table 2). Family history, BRCA status, parity, mammogram frequency, palpability, method of presentation, lesion size, hormone receptor status, comedo histology, and recurrence did not differ significantly between the two groups (Table 1). The median follow-up period was 7.1 years. CONCLUSION: Women with pure DCIS and higher MBD are more likely to be younger at the time of diagnosis, premenopausal, and Asian, and to present with higher-grade disease. Further research on the relationship of age, MBD, and tumor biology in DCIS is warranted.


Assuntos
Densidade da Mama , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Mamografia/métodos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Ultrassonografia Mamária/métodos
15.
Diagn Interv Radiol ; 25(4): 265-269, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31124788

RESUMO

PURPOSE: We aimed to evaluate the detectability of contrast enhancing lesions, initially demonstrated in standard prone dynamic contrast-enhanced MRI (DCE-MRI), in a supplementary supine breast MRI examination performed following the standard prone DCE-MRI examination and to show the correlation of spatial displacement of the lesions with breast size and density. METHODS: Forty-two patients with 45 lesions were prospectively evaluated. Supine breast MRI was acquired with a 6-channel body coil following a standard DCE-MRI in prone position after repositioning the patient. No additional contrast media was administered. Images were evaluated by two radiologists in consensus for the visibility of the lesions. Lesion localization relative to the sternal midline, chest wall and nipple was measured in both prone and supine positions. Correlations between lesion displacement and breast size or breast density were analyzed. RESULTS: Of 45 lesions, 23 (52.3%) were masses, 22 (47.7%) were nonmass enhancements (NME). Forty-four lesions (97.8%) could be detected on supine images. One linear NME of 33 mm in length could not be seen on supine images. Twenty (46.5%) of the detected lesions in supine position were equal to or smaller than 10 mm (11 NME [55%] and 9 masses [45%]). Lesion displacement relative to the chest wall increased with increasing breast size (P < 0.001). CONCLUSION: An abbreviated supine sequence following a standard prone DCE-MRI with single contrast media administration is an effective method for defining the lesion location in supine position.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mama/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Imagem por Ressonância Magnética/métodos , Adulto , Mama/anormalidades , Mama/patologia , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Feminino , Humanos , Hipertrofia/diagnóstico por imagem , Hipertrofia/patologia , Imagem Tridimensional , Imagem por Ressonância Magnética/estatística & dados numéricos , Pessoa de Meia-Idade , Decúbito Ventral/fisiologia , Estudos Prospectivos , Radiologistas , Decúbito Dorsal/fisiologia , Parede Torácica/diagnóstico por imagem
17.
Breast J ; 25(4): 585-589, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31087380

RESUMO

PURPOSE: To compare sensitivities and specificities of ductography to noninvasive imaging studies in determining the cause of nipple discharge and assess the value of ductography on the basis of pathologic results. METHODS: In this retrospective review of women with nipple discharge who underwent ductography between January 1, 2005 and October 30, 2015, at our institution, we compared ductography with noninvasive imaging results (mammography, ultrasound, MRI) to determine its relative diagnostic sensitivity, specificity, and relative accuracy. Diagnosis was defined from pathology results, clinical notes, and minimum of 1-year follow-up monitoring. The primary endpoints include accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. The analyses were carried out in different configurations to compare results by the following pathologic categories: cancer, high-risk lesion, intraductal papilloma (IP) without atypia, and benign pathology and/or normal imaging results. RESULTS: In patients with breast cancer, ductography and noninvasive breast imaging had similar sensitivities. In patients with a high-risk lesion, ductography was significantly more sensitive than noninvasive imaging modalities. In patients with intraductal papilloma without atypia, ductography was more sensitive than noninvasive imaging, but the difference was of only borderline significance. For women with benign pathology and/or normal imaging, noninvasive imaging showed a significantly higher specificity than ductography. CONCLUSION: In the absence of standard diagnostic algorithm for patients presenting with nipple discharge, the clinician has numerous options to choose a diagnostic approach that will yield the most accurate information with the least disruption to the patient. Our results indicate the value of ductography compared to value of noninvasive imaging modalities when cancer is suspected and when high risk lesion is suspected. While we show the sensitivity of ductography is similar to noninvasive imaging modalities in the setting of cancer, the sensitivity of ductography is statistically valuable for diagnosing high-risk lesions. Our hope is that this study will emphasize more research and more understanding in clinical utility and management of high-risk lesions, leading to patient-focused algorithm for diagnosing the etiology of abnormal nipple discharge.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Mamografia/métodos , Derrame Papilar/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Papiloma Intraductal/diagnóstico por imagem , Papiloma Intraductal/patologia , Lesões Pré-Cancerosas/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia Mamária , Adulto Jovem
19.
Breast J ; 25(4): 612-618, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31087467

RESUMO

BACKGROUND: There is a tendency to avoid nipple-sparing mastectomy (NSM) when a tumor-nipple distance (TND) is <2 cm due to the risk of occult nipple involvement. The purpose of the study was to determine whether the patients who undergo NSM with immediate reconstruction are oncologically safe when TND is <2 cm. METHODS: Patients who underwent NSM followed by immediate reconstruction for breast cancer were retrospectively analyzed. Patients who are negative for nipple-base in either frozen-section or paraffin histopathology were included. MRI was used to obtain TNDs to compare local-recurrence-free and disease-free survival in group I (TND <2 cm) and group II (TND ≥2 cm). Disease-free survival rates were determined to assess the outcome. RESULTS: Of the 214 cases with malignancy on MRI, 21 cases diagnosed with pure ductal carcinoma in situ were excluded. Among the 193 NSM cases diagnosed with invasive cancer, TND was <2.0 cm in 59 (30.56%) cases and ≥2.0 cm in 134 (69.43%) cases. No significant differences were found between groups in regards to ER, PR, HER2-neu status, and nodal involvement (P = 0.34, P = 0.41, P = 0.54, and P = 0.12 respectively). In a median follow-up time of 62 months (range; 13-114), patients in group I had four local recurrences, whereas group II was found to have five local and three distant metastases. No significant differences were observed between groups concerning disease-free survival (10-year DFS 93.2% vs 96.3%; P = 0.368 respectively). CONCLUSIONS: Patients who have invasive cancer diagnosis with a TND <2 cm are eligible to undergo therapeutic NSM with immediate reconstruction.


Assuntos
Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Mastectomia/métodos , Mamilos/cirurgia , Adulto , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/mortalidade , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/mortalidade , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/mortalidade , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Mamoplastia , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Mamilos/anatomia & histologia , Tratamentos com Preservação do Órgão , Complicações Pós-Operatórias/etiologia , Mastectomia Profilática/métodos , Taxa de Sobrevida
20.
Breast J ; 25(3): 393-400, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30945398

RESUMO

Benign papillary and sclerosing lesions of the breast (intraductal papillomas, complex sclerosing lesions, radial scars) are considered high-risk lesions due to the potential for upgrade to carcinoma on subsequent surgical excision. Optimal clinical management of such lesions remains unclear due to variable reported upgrade rates. Apocrine metaplasia is a common finding in breast tissue and its role in MRI enhancing lesions is increasingly being recognized. The purpose of this study was to investigate the MRI features of papillary and sclerosing lesions of the breast, evaluate the clinical management and upgrade rate of such lesions, and examine the contribution of apocrine metaplasia to the imaging findings. A 13-year retrospective review of MRI-guided biopsies identified 70 MRI-detected and -biopsied papillary and sclerosing lesions. Sixteen lesions without atypia underwent surgical excision; only one case (6%) was upgraded to pleomorphic lobular carcinoma in situ. The majority (64%) of biopsies contained apocrine metaplasia either within or adjacent to the targeted lesion. We found that half of MRI-detected lesions had T2 hyperintense foci (2-5 mm) or masses (>5 mm) adjacent to the lesion. Histologic correlation showed apocrine cysts were likely responsible for this imaging finding in 56% of these cases.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Mamárias/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Feminino , Seguimentos , Humanos , Biópsia Guiada por Imagem , Imagem por Ressonância Magnética , Glândulas Mamárias Humanas/diagnóstico por imagem , Glândulas Mamárias Humanas/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Esclerose
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