Diffusion-weighted magnetic resonance imaging in cervical lymphadenopathy: report of three cases of patients with Bartonella henselae infection mimicking malignant disease

Diffusion-weighted MR imaging is a potential technique for differentiation between benign and malignant lymph nodes. However, lympadenopathy caused by Bartonella henselae infection showes low ADC values in diffusion weighted MRI as typically seen in malignant disease.

[MRI for malignant pancreatic tumors]

In recent years continuous advancements in software and hardware technology of modern MRI systems have contributed to substantial progress in the field of pancreatic tumor imaging. Despite technical advances in abdominal MRI, multislice CT still remains the preferential diagnostic tool for pancreatic lesions. In the majority of cases the essential clinical questions can thereby be answered with a high degree of accuracy. However, in dilemma cases state-of-the-art MR imaging can provide relevant information for the diagnosis allowing an optimal therapeutic concept. This report gives an overview on possible applications for MRI in the diagnostic evaluation of malignant pancreatic tumors.

Counseling and care: A Breast Cancer Awareness Training to improve participation and adherence to screening recommendations in women with a family history of breast cancer

1530

Background: BRCA1 or BRCA2 mutation carriers are at an increased lifetime risk to develop breast and ovarian cancer. In a substantial number of families with affected members the known susceptibility genes cannot be identified. According to the recommendations of the German Consortium for Hereditary Breast and Ovarian Cancer, women with a hereditary predisposition for breast cancer should participate at an intensified surveillance program (ISP) including genetic counseling, risk estimation, BSE, CBE, BreastUS, MX, and MRI. Nonadherence might be influenced by cancer worryness, anxiety, health beliefs, and a lack of information about screening benefits.The aim of this investigation was to evaluate the impact of an indivualized Breast Cancer Awareness Training to improve the participation and adherence towards an ISP. Methods: Since 2005, an at-risk sample of 46 non-participating women (mean age 29 y; range 19–43 y) got an intensive breast cancer awareness training, including structured BSE, specific information about regular follow-up, screening advice, and radiological diagnostic procedures. To establish invidualized counseling and training particular needs (e.g., reasons for non-adherence, health beliefs and behaviours), risk perception, anxiety, and sociodemographic factors were evaluated by interviews and self-report questionnaires. The control group consisted of 38 participants of the ISP. Results: Breast cancer worry, anxiety, and lack of information about the benefits of screening programs were the main reasons for non-adherence. Within 3 months after the base counseling participation rates in MX (>30J), BUS, MRI, and CBE reached 98%. The numbers remain consistent in a 2-year follow up. 80% of participants practice BSE monthly, and 46% reported changes in lifestyle regarding nutrition, obesity, and health beliefs. Conclusions: Our approach emphasizes importance of self confidence and awareness for participation at the ISP for women at high breast cancer risk. Individualized counseling, BSE, re-evaluation, and reinforcement sessions are correlated with changes in health beliefs and behaviours for enhancing participation and adherence in women with a family history of breast cancer.

No significant financial relationships to disclose.

Concentrations of plasminogen activator inhibitor type1 (PAI-I) and urokinase-type plasminogen aktivator (uPA) in primary breast cancer (BC) tissue and corresponding axillary lymph node metastasis

Abstract #2046

Background: Components of the plasminogen activator system play a key role in tumor invasion and metastasis. Tumor tissue levels of urokinase-type plasminogen activator (uPA) and its inhibitor PAI-1 showed a strong prognostic impact in node-negative and node-positive primary BC. uPA/PAI-1 were the first novel prognostic factors in primary BC reaching the highest level of evidence for their clinical utility and they have recently been recommended by ASCO for clinical decision making.
 Material and Methods: For the first time, correlations between uPA and PAI-1 concentrations in 73 primary tumor tissues and corresponding axillary lymphnodes (ALN) in node-negative (pN0) and node-positive (pN+) BC (1991-98) and their prognostic impact on disease-free (DFS) and overall survival (OS) were evaluated.
 Results: Median follow-up was 56 months. Overall, PAI-I (p=0,014) and uPA concentrations (p<0,001) were significantly higher in tumour tissue than in the corresponding ALN. There was no significant difference of PAI-1 in primary tumor tissue between pN0 and pN+ disease. In involved ALN (pN+), concentrations of PAI-1 but not of uPA, were significantly higher than in pN0 (p<0.001). Moreover, patients with higher PAI-1 concentrations in the corresponding ALN than in their primary tumor had a significantly shorter DFS (p<0,001) and OS (p=0.005).
 Discussion: Our clinical findings support the basic research data implicating uPA and PAI-1 as key proteolytic factors in metastasis-asociated processes such as adhesion, angiogenesis, invasion, proliferation and migration. For the first time, we are able to demonstrate that particularly PAI-1 seems to be involved in tumor metastasis in primary breast cancer with its concentrations being higher in involved ALN than in the primary tumor. Besides uPA/PAI-1 being validated and clinically useful prognostic factors, interference with the uPA/PAI-1 system thus promises to be an interesting therapeutic concept in BC.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2046.

[Whole-body MRI in children with langerhans cell histiocytosis for the evaluation of the skeletal system]

PURPOSE

The usefulness of whole-body MRI (WB-MRI) for the detection of skeletal lesions in patients with Langerhans cell histiocytosis should be documented on the basis of case presentations.

MATERIALS AND METHODS

In six patients with histologically proven Langerhans cell histiocytosis, 14 WB-MRI examinations were performed to evaluate the skeletal system within disease staging (6 primary, 8 follow-up examinations). The examinations were performed on a 1.5 Tesla, 32-channel whole-body scanner. The examination protocol consisted of T 1-weighted and STIR sequences in coronal and sagittal orientation. For comparison, radiographs of the initial skeletal lesions and those that were additionally detected on WB-MRI were available.

RESULTS

In 4 patients no additional skeletal lesions were found on WB-MRI besides the initial lesion leading to the diagnosis of unifocal single system disease. In 2 patients WB-MRI was able to identify additional skeletal lesions. In a 5 S year-old boy with the primary lesion located in the cervical spine, a second lesion was detected in the lumbar spine on the initial scan and in the skull and proximal femur during follow-up examination. In a 12 year-old girl with a primary lesion of the thoracic spine, WB-MRI diagnosed additional lesions in the pelvic bone and the tibia. In both patients the diagnosis of multifocal skeletal involvement led to chemotherapy. During follow-up examination, the healing response under therapy could be demonstrated. Comparison with conventional imaging showed that especially lesions located in the spine or the pelvis were not detectable on radiographs even when knowing the MR results.

CONCLUSION

The extent of skeletal involvement in Langerhans cell histiocytosis has crucial impact on therapy and prognosis. Whole-body MRI has been reported to be an established method for the evaluation of disseminated skeletal disease with distinct advantages over conventional radiography and bone scintigraphy. Our results suggest that WB-MRI should also be the imaging modality of choice for the assessment of skeletal involvement in children with Langerhans cell histiocytosis.