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Heaney RM, Sweeney L, Flanagan F, O'Brien A, Smith C. Ipsilateral microcalcifications after breast-conserving surgery: is it possible to differentiate benign from malignant calcifications? Clin Radiol 2021; 77:216-223. [PMID: 34973807 DOI: 10.1016/j.crad.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
AIM To analyse stereotactic biopsies of microcalcifications in patients with previous ipsilateral breast-conserving surgery (BCS) to identify the positivity rate, assess for an association between the patient's primary cancer or mammographic appearances of the microcalcifications, and the risk of recurrence. MATERIALS AND METHODS Relevant patients from 2018-2020 were identified via a retrospective review of the prospectively maintained radiological procedure database. Clinicopathological features of the patients' primary tumour and new calcifications were obtained from the hospital electronic patient record system and the national integrated medical imaging system. RESULTS Thirty-one percent of recurrences post-ipsilateral BCS presented as isolated microcalcifications on mammography. Fifty-three percent of patients undergoing stereotactic biopsy of ipsilateral calcifications had recurrence. A positive margin status was associated with new or recurrent malignancy. There was no significant correlation between oestrogen-receptor status, sentinel lymph node status, adjuvant radiotherapy or chemotherapy and the risk of recurrence. Calcifications within the tumour bed were more likely to be benign while calcifications within the same quadrant but remote from the tumour bed were more likely malignant. All coarse calcifications were benign while 67% of fine linear/fine linear branching and 89% of fine pleomorphic calcifications were malignant. CONCLUSION Increased time since diagnosis, positive margin status, fine pleomorphic and fine linear calcifications in the same quadrant as the tumour bed were associated with malignancy. Patients with coarse calcifications and calcifications within the tumour bed may avoid stereotactic biopsy and undergo short-interval surveillance.
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Affiliation(s)
- R M Heaney
- Mater Misericordiae University Hospital, Dublin, D07 Y7C6, Ireland.
| | - L Sweeney
- Mater Misericordiae University Hospital, Dublin, D07 Y7C6, Ireland
| | - F Flanagan
- Mater Misericordiae University Hospital, Dublin, D07 Y7C6, Ireland
| | - A O'Brien
- Mater Misericordiae University Hospital, Dublin, D07 Y7C6, Ireland
| | - C Smith
- Mater Misericordiae University Hospital, Dublin, D07 Y7C6, Ireland
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Post IORT seroma complication in breast cancer surgery. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Intraoperative radiotherapy (IORT) has gained popularity over recent years due to its impact on shortening the radiotherapy treatment time for early breast cancer. It has certainly proven effective as an exclusive treatment or when combined with whole breast irradiation (WBIR). Seroma is a common non-life-threatening complication that may delay treatment and impose challenges on radiological diagnostic follow-up.Aim:To review and compare the occurrence of seroma in patients who received exclusive IORT or when combined with WBIR and to outline the diagnostic challenges encountered during radiological follow-up.Materials and methods:Based on strict selection criteria, all eligible patients who received IORT ± WBIR treatment between 2012 and 2019 in a university hospital setting were included. Demographic data, histological diagnosis, tumour size, tumour grade, lymphovascular invasion, nodal status, receptor status, treatment with neoadjuvant hormonal chemotherapy, applicator size, dose used, duration of radiotherapy treatment, timing of seroma development and duration of seroma were documented. Both clinical and radiological follow-up were exercised in all patients.Results:The total number of patients treated with breast conserving surgery (BCS) and IORT was 86. Age ranged between 31 and 75 years with the median age of 51 years. Patients treated exclusively with IORT were 39 (45%) while those who received the IORT as a boost were 47 (55%). Seroma was observed in 39(45%) of both IORT and IORT\WBIR patients. Those included 15(38%) of the exclusive IORT treated patients and 24 (62%) of those treated as a boost. Duration of asymptomatic seroma ranged from 6 months to 6 years. Repeated aspiration was performed in 2 (5%) patients. Postoperative seroma occurred independent of age histological diagnosis, tumour size, tumour grade, lymphovascular invasion, nodal status, receptor status, treatment with neoadjuvant hormonal\chemotherapy, applicator size, dose used or duration of radiotherapy treatment. All reviewed patients have shown increased risk of developing seroma; however, an increased incidence of seroma in the IORT + WBIR treated patients was higher than those who received exclusive IORT treatment.Conclusion:Postoperative seroma is a common non-life-threatening entity that occasionally may lead to delay in the subsequent treatment plan. IORT is a safe modality with many benefits; however, it may increase the risk of seroma formation independent of the clinical parameters. Promoting the expertise in post IORT breast imaging aids in overcoming diagnostic challenges.
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Malagón-López P, Vilà J, Carrasco-López C, García-Senosiain O, Priego D, Julian Ibañez JF, Higueras-Suñe C. Intraoperative Indocyanine Green Angiography for Fat Necrosis Reduction in the Deep Inferior Epigastric Perforator (DIEP) Flap. Aesthet Surg J 2019; 39:NP45-NP54. [PMID: 30358820 DOI: 10.1093/asj/sjy256] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Fat necrosis is a frequent complication (up to 62.5%) of microsurgical breast reconstruction using the deep inferior epigastric perforator (DIEP) flap. This could have important clinical and psychological repercussions, deteriorating the results and increasing reconstruction costs. OBJECTIVES The aim of this study was to demonstrate the intraoperative use of indocyanine green angiography (ICGA) to reduce fat necrosis in DIEP flap. METHODS Sixty-one patients who underwent unilateral DIEP flap procedures for breast reconstruction after oncological mastectomy were included (24 cases with intraoperative use of ICGA during surgery, 37 cases in the control group). The follow-up period was 1 year after surgery. The association between the use of ICGA and the incidence of fat necrosis in the first postoperative year, differences in fat necrosis grade (I-V), differences in fat necrosis requiring reoperation, quality of life, and patient satisfaction were analyzed. RESULTS The incidence of fat necrosis was reduced from 59.5% (control group) to 29% (ICG-group) (P = 0.021) (relative risk = 0.49 [95% CI, 0.25-0.97]). The major difference was in grade II (27% vs 2.7%, P = 0.038). The number of second surgeries for fat necrosis treatment was also reduced (45.9% vs 20.8%, P = 0.046). The ICG group had higher scores on the BREAST-Q. CONCLUSIONS Intraoperative ICGA is a useful technique for reconstructive microsurgery that might improve patient satisfaction and reduce the incidence of fat necrosis by half as well as reduce its grade, especially in small fat necrosis cases; consequently, ICGA could reduce the number of secondary surgeries for treatment of fat necrosis. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Jordi Vilà
- Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | | | - David Priego
- Hospital Germans Trias i Pujol, Barcelona, Spain
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4
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Kim EJ, Kang BJ, Kim SH, Youn IK, Baek JE, Lee HS. Diagnostic Performance of and Breast Tissue Changes at Early Breast MR Imaging Surveillance in Women after Breast Conservation Therapy. Radiology 2017; 284:656-666. [DOI: 10.1148/radiol.2017162123] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Eun Jeong Kim
- From the Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Bong Joo Kang
- From the Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Sung Hun Kim
- From the Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - In Kyung Youn
- From the Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Ji Eun Baek
- From the Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Hyun Sil Lee
- From the Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
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5
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Candelaria RP, Hansakul P, Thompson AM, Le-Petross H, Valero V, Bassett R, Huang ML, Santiago L, Adrada BE. Analysis of stereotactic biopsies performed on suspicious calcifications identified within 24 months after completion of breast conserving surgery and radiation therapy for early breast cancer: Can biopsy be obviated? Am J Surg 2017; 215:693-698. [PMID: 28712671 DOI: 10.1016/j.amjsurg.2017.06.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/23/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To determine the cancer yield of stereotactic biopsy of suspicious calcifications identified within 24 months after breast conservation therapy (BCT). METHODS Retrospective review of stereotactic biopsies performed during 2009-2013 for suspicious calcifications in the ipsilateral breast of patients who completed BCT. RESULTS 94/2773 (3.4%) had stereotactic biopsies for suspicious calcifications in the ipsilateral breast; 7/94 (7.4%) had DCIS (6) or invasive (1) cancer; 5/7 occurred in the same breast quadrant as the primary. All 7 originally had negative surgical margins (≥2 mm); 6 received whole breast irradiation, and 2 received adjuvant chemotherapy + endocrine therapy. Median time to detection was 11 months (range, 6-20 months). There was a strong association between calcification morphology (particularly pleomorphic) and likelihood of malignancy (p = 0.008). CONCLUSIONS Stereotactic biopsy of calcifications identified within 24 months post-BCT has a 7% cancer yield. Tissue biopsy should be performed rather than imaging followup alone when breast calcifications have suspicious morphology.
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Affiliation(s)
- Rosalind P Candelaria
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| | - Palita Hansakul
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| | - Alastair M Thompson
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| | - Huong Le-Petross
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| | - Vicente Valero
- Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| | - Roland Bassett
- Department of Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| | - Monica L Huang
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| | - Beatriz E Adrada
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Rabasco P, Caivano R, Dinardo G, Gioioso M, Lotumolo A, Iannelli G, Villonio A, La Torre G, D'Errico S, Macarini L, Guglielmi G, Cammarota A. Magnetic Resonance Imaging in the Pre-Surgical Staging of Breast Cancer: Our Experience. Cancer Invest 2017; 35:43-50. [PMID: 27901596 DOI: 10.1080/07357907.2016.1251943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the clinical impact of magnetic resonance imaging (MRI) in the detection of multifocal-multicentric breast cancers, already identified by mammography and ultrasound, and analyzed histologically, to evaluate its role in preoperative staging. MATERIALS AND METHODS From January 2012 to February 2014, 188 patients, aged 28 to 74 years, newly diagnosed with breast cancer on conventional imaging (mammography and ultrasound) were enrolled. They underwent preoperative contrast-enhanced 3T MRI. Patients underwent surgery according to international guidelines. Results of all diagnostic procedures were compared. RESULTS Among the 188 patients, 163 (87%) had a unilateral and unifocal tumor at both conventional imaging; MRI diagnosed 22/22 (100%) of multifocal and multicentric tumors, the combination of mammography and ultrasound diagnosed 12/22 (54%), and mammography alone diagnosed 8/22 (36%) multifocal and multicentric tumors. MRI prompted a change in surgical strategy in 10/188 (5%) patients. This change comprised mastectomy instead of conservative surgery (n = 7) and more extensive conservative surgery (n = 3). CONCLUSIONS MRI was confirmed to show higher sensitivity than conventional imaging in detecting multifocal and multicentric breast cancers.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Luca Macarini
- b Department of Radiology , University of Foggia , Foggia , Italy
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Effect of preoperative breast magnetic resonance imaging on surgical decision making and cancer recurrence rates. Invest Radiol 2012; 47:128-35. [PMID: 21934515 DOI: 10.1097/rli.0b013e318230061c] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate breast magnetic resonance imaging (MRI) for cancer staging and surgical planning in patients with known breast cancer, and to evaluate recurrence rates at long-term follow-up. METHODS AND MATERIALS Institutional review board approval and patient consent were obtained. Preoperative MRI with 0.1 mmol/kg gadobenate dimeglumine (MultiHance) was performed in 203/274 women with confirmed breast cancer. The sensitivity, accuracy, and positive predictive value of MRI compared with mammography/ultrasound for malignant lesion detection were calculated, and the effect of MRI on surgical decision making evaluated. The cancer recurrence rate was determined for 172 patients with available 2- to 8-year follow-up data. RESULTS Mammography/ultrasound detected 229 suspicious lesions. Breast MRI detected 159 additional lesions in 48/203 (23.6%) patients; of which 110/110 were correctly classified as malignant and 28/49 as benign, giving sensitivity, accuracy, and positive predictive values for malignant lesion detection of 100% (110/110), 86.8% (138/159), and 84.0% (110/131), respectively. MRI revealed unsuspected multifocal, multicentric, and synchronous contralateral lesions in 7/48, 16/48, and 16/48 patients, respectively, and pectoralis muscle infiltration in 3/38 patients. In 6/48 women, MRI revealed lesions not seen on conventional imaging (n = 5) or discounted suspected multifocal disease (n = 1). Therapy was changed for 50/203 (24.6%) patients: 38 patients underwent more extensive surgery and 12 less extensive surgery. Six (3.5%) recurrences occurred, in all cases at >4 years. CONCLUSION Breast MRI positively affects patient management and is recommended for mapping tumor extent in patients with newly diagnosed cancer. The cancer recurrence rate at long-term follow-up after MRI is low.
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8
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Mammographic findings after intraoperative radiotherapy of the breast. Radiol Res Pract 2012; 2012:758371. [PMID: 22550585 PMCID: PMC3328171 DOI: 10.1155/2012/758371] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 11/04/2011] [Accepted: 11/07/2011] [Indexed: 12/14/2022] Open
Abstract
Intraoperative Radiotherapy (IORT) is a form of accelerated partial breast radiation that has been shown to be equivalent to conventional whole breast external beam radiotherapy (EBRT) in terms of local cancer control. However, questions have been raised about the potential of f IORT to produce breast parenchymal changes that could interfere with mammographic surveillance of cancer recurrence. The purpose of this study was to identify, quantify, and compare the mammographic findings of patients who received IORT and EBRT in a prospective, randomized controlled clinical trial of women with early stage invasive breast cancer undergoing breast conserving therapy between July 2005 and December 2009. Treatment groups were compared with regard to the 1, 2 and 4-year incidence of 6 post-operative mammographic findings: architectural distortion, skin thickening, skin retraction, calcifications, fat necrosis, and mass density. Blinded review of 90 sets of mammograms of 15 IORT and 16 EBRT patients demonstrated a higher incidence of fat necrosis among IORT recipients at years 1, 2, and 4. However, none of the subjects were judged to have suspicious mammogram findings and fat necrosis did not interfere with mammographic interpretation.
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9
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Manifestaciones intratorácicas del cáncer de mama. RADIOLOGIA 2011; 53:7-17. [DOI: 10.1016/j.rx.2010.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 06/22/2010] [Accepted: 07/07/2010] [Indexed: 11/30/2022]
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10
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Intrathoracic manifestations of breast cancer. RADIOLOGIA 2011. [DOI: 10.1016/s2173-5107(11)70001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Sickles EA. The Use of Breast Imaging to Screen Women at High Risk for Cancer. Radiol Clin North Am 2010; 48:859-78. [DOI: 10.1016/j.rcl.2010.06.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Breast MRI After Conservation Therapy: Usual Findings in Routine Follow-Up Examinations. AJR Am J Roentgenol 2010; 195:799-807. [DOI: 10.2214/ajr.10.4305] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol 2010; 7:18-27. [PMID: 20129267 DOI: 10.1016/j.jacr.2009.09.022] [Citation(s) in RCA: 491] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 09/23/2009] [Indexed: 12/19/2022]
Abstract
Screening for breast cancer with mammography has been shown to decrease mortality from breast cancer, and mammography is the mainstay of screening for clinically occult disease. Mammography, however, has well-recognized limitations, and recently, other imaging including ultrasound and magnetic resonance imaging have been used as adjunctive screening tools, mainly for women who may be at increased risk for the development of breast cancer. The Society of Breast Imaging and the Breast Imaging Commission of the ACR are issuing these recommendations to provide guidance to patients and clinicians on the use of imaging to screen for breast cancer. Wherever possible, the recommendations are based on available evidence. Where evidence is lacking, the recommendations are based on consensus opinions of the fellows and executive committee of the Society of Breast Imaging and the members of the Breast Imaging Commission of the ACR.
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Thulkar S, Hari S. Present Role of Mammography/Digital Mammography in Breast Cancer Management. PET Clin 2009; 4:213-25. [DOI: 10.1016/j.cpet.2009.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Séquelles thérapeutiques du sein après traitement conservateur du cancer du sein. ANN CHIR PLAST ESTH 2008; 53:135-52. [DOI: 10.1016/j.anplas.2007.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 10/02/2007] [Indexed: 11/24/2022]
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Gosset J, Guerin N, Toussoun G, Delaporte T, Delay E. [Radiological evaluation after lipomodelling for correction of breast conservative treatment sequelae]. ANN CHIR PLAST ESTH 2007; 53:178-89. [PMID: 18055086 DOI: 10.1016/j.anplas.2007.09.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Accepted: 09/05/2007] [Indexed: 11/19/2022]
Abstract
Breast lipomodelling has been used in our unit since 2002 to correct the sequelae of conservative treatment of cancer. Morphologically, satisfactory results have been recorded and the method is likely to develop considerably. However, the technique has also been questioned because of the possible deleterious radiological impact of injecting fat into the breast. The present work investigated the radiological aspect of conserved breast reconstructed by lipomodelling in a series of 21 patients undergoing ultrasound examination, mammography and MRI, before and after the procedure. Benign-looking microcalcifications were detected on 19% of the mammographies, small (<1cm) oily cysts and complex cysts were visible on respectively 57 and 19% of ultrasound images, whereas 47% of the MRI scans indicated cytosteatonecrotic lesions. Even though multiple events could be observed, their frequency is close to that observed following other conventional breast surgery. Besides, there is clear radiological evidence of benignity. The conclusion of the study is that images obtained after lipomodelling are satisfactory and in no way suggestive of recurrence of breast cancer. Provided that radiologists and experts are aware of this pattern, there is no impact on the radiological follow-up of the patients.
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Affiliation(s)
- J Gosset
- Unité de chirurgie plastique et reconstructrice, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France.
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Pediconi F, Catalano C, Padula S, Roselli A, Moriconi E, Dominelli V, Pronio AM, Kirchin MA, Passariello R. Contrast-enhanced magnetic resonance mammography: does it affect surgical decision-making in patients with breast cancer? Breast Cancer Res Treat 2007; 106:65-74. [PMID: 17203383 DOI: 10.1007/s10549-006-9472-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 11/25/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diagnostic imaging in women with suspected breast cancer should accurately detect and diagnose malignant tumors and facilitate the correct choice of therapy. Contrast-enhanced magnetic resonance mammography (CE-MRM) is potentially the imaging modality of choice for accurate patient management decisions. METHODS A total of 164 women with suspected breast cancer based on clinical examination, conventional mammography and/or ultrasound each underwent preoperative bilateral CE-MRM using an axial 3D dynamic T1-weighted gradient-echo sequence and gadobenate dimeglumine as contrast agent. Images were evaluated by two readers in consensus. Histological evaluation of detected lesions was performed on samples from core biopsy or surgery. Determinations were made of the sensitivity, accuracy and positive predictive value of CE-MRM compared to mammography/ultrasound for the detection of malignant lesions and of the impact of CE-MRM for surgical decision-making. FINDINGS Conventional mammography/ultrasound detected 175 lesions in the 164 evaluated patients. CE-MRM revealed 51 additional lesions in 34/164 patients; multifocal and multicentric cancer was detected in 7 and 4 additional patients, respectively, contralateral foci in 21 additional patients and pectoral muscle infiltration in 2 additional patients. CE-MRM also confirmed the absence or benignity of 3 and 1 lesions suspected of malignancy on mammography/ultrasound. The sensitivity and accuracy for malignant lesion detection and identification was 100% and 93.4%, respectively, for CE-MRM compared to 77.3% and 72.1% for mammography/ultrasound, respectively. Patient management was altered for 32/164 (19.5%) patients as a result of CE-MRM. INTERPRETATION CE-MRM positively impacts patient management decisions and should be performed in all women with suspected breast cancer based on clinical examination, mammography and/or ultrasound.
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Affiliation(s)
- Federica Pediconi
- Department of Radiological Sciences, University of Rome La Sapienza, V.le Regina Elena, 324, Rome, 00161, Italy.
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Della Sala SW, Pellegrini M, Bernardi D, Franzoso F, Valentini M, Di Michele S, Centonze M, Mussari S. Mammographic and ultrasonographic comparison between intraoperative radiotherapy (IORT) and conventional external radiotherapy (RT) in limited-stage breast cancer, conservatively treated. Eur J Radiol 2006; 59:222-30. [PMID: 16616823 DOI: 10.1016/j.ejrad.2006.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2005] [Revised: 02/20/2006] [Accepted: 03/03/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Assess mammographic and echographic modifications in mild cases of breast cancer (suitable for conservative surgery) after intraoperatory radio treatment (IORT) as opposed to conventional post-operative radiotherapy (RT). MATERIALS AND METHODS We report data from 45 patients in each group (IORT and RT). All patients were examined using the same mammographic and ecographic equipment at 6, 12 and 24 months after treatment. We focused on structural alterations, edema and others, and quantified them using pre-established (unbiased) protocols. Both patient examination and subsequent assessment of the results were performed by radiologists with exepertise in breast cancer evaluation. RESULTS At 6 months, IORT patients showed slightly more pronounced structural distortions and oedema than RT patients; these differences became more apparent at 12 months, with the addition of fat necrosis and/or calcifications. These alterations were evident and consistent under both mammographic and ecographic examination, and became even more pronounced at 24 months. At this stage, RT patients showed minimal alterations of the tissue (apart from normal post-surgical scarring), whereas IORT patients showed virtually no improvement over the preceding 12-month period. CONCLUSION We show radiological alterations in post-operative breast cancer are significantly more pronounced in patients treated with IORT as opposed to RT.
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Affiliation(s)
- Sabino Walter Della Sala
- U.O. di Radiodiagnostica, Ospedale Santa Chiara, Dipartimento di Radiodiagnostica, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.
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Yabuuchi H, Kuroiwa T, Kusumoto C, Fukuya T, Ohno S, Hachitanda Y. Incidentally detected lesions on contrast-enhanced MR imaging in candidates for breast-conserving therapy: Correlation between MR findings and histological diagnosis. J Magn Reson Imaging 2006; 23:486-92. [PMID: 16521096 DOI: 10.1002/jmri.20532] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To investigate the correlation between MR findings and the histological diagnosis of incidentally detected lesions in candidates for breast-conserving therapy. MATERIALS AND METHODS MR images of 299 patients with breast cancer were reviewed. Incidentally detected lesions were noted in 59 of 299 (20%) patients, and a histological diagnosis was obtained in 48 of 59 (81%) patients. There were 25 benign and 23 malignant lesions. The number, size, location, morphologic character, and kinetic curve assessment of the MR findings were analyzed. Statistical analyses were performed to determine whether any differences could be observed between benign and malignant lesions. RESULTS Lesions of over 10 mm tended to be malignant (11/16; 69%), whereas those equal or less than 5 mm tended to be benign (12/17; 71%; P < 0.05). Lesions in the same quadrant as the main lesion tended to be malignant (20/27.5; 73%), whereas those in a different quadrant tended to be benign (17.5/20.5; 85%; P < 0.001). Lesions with early peak of enhancement tended to be malignant (20/25; 80%), whereas those with persistent enhancement tended to be benign (20/23; 87%; P < 0.001). CONCLUSION Incidentally detected lesions that are found in a different quadrant from the main lesion, are smaller than 10 mm in diameter, and show persistent enhancement on MR imaging suggest benign lesions. Therefore, patients with such lesions should avoid unnecessary surgical procedures unless lesions are proved to be malignant by cytology or biopsy.
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Affiliation(s)
- Hidetake Yabuuchi
- Department of Radiology, National Kyushu Cancer Center, Fukuoka, Japan.
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Digabel-Chabay C, Allioux C, Labbe-Devilliers C, Meingan P, Ricaud Couprie M. [Architectural distortion and diagnostic difficulties]. ACTA ACUST UNITED AC 2005; 85:2099-106. [PMID: 15692426 DOI: 10.1016/s0221-0363(04)97788-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Identification of architectural distortion requires a good practice of mammography. Prevalence is estimated at 6% of detected abnormalities in screening programs. Under this denomination are gathered focal architectural distortion with predictive positive value (PPV) of 10% and stellate images without central densification, which are more suspicious (PPV 50%). In order to establish a diagnosis, false images must be eliminated by other views. Minimal architectural distortion have to be investigated by other techniques (sonography, MRI percutaneous biopsy) in order to define the best strategy for further management. Stellate images suggestive of radial scars must be surgically removed. The relationships between radial scars and tubular carcinoma are discussed. A particular attention is required for post traumatic or post surgical scars if it exist a high risk of local recurrence or controlateral carcinoma specially after conservative or oncoplastic surgery.
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Affiliation(s)
- C Digabel-Chabay
- Service d'Imagerie Médicale, Centre René-Gauducheau, CRLCC Nantes-Atlantique, boulevard Jacques-Monod, 44807 Saint-Herblain
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Jung JI, Kim HH, Park SH, Song SW, Chung MH, Kim HS, Kim KJ, Ahn MI, Seo SB, Hahn ST. Thoracic manifestations of breast cancer and its therapy. Radiographics 2005; 24:1269-85. [PMID: 15371608 DOI: 10.1148/rg.245035062] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Breast cancer is the second most common cause of cancer-related death in women. In most patients, imaging demonstrates thoracic changes resulting from either treatment, complications of treatment, or tumor recurrence or metastasis. The postsurgical imaging appearance of the chest wall depends on the surgical method used (radical mastectomy, modified radical mastectomy, breast-conserving surgery, breast reconstruction). The most common surgery-related complication is seroma. Radiation therapy frequently causes radiation pneumonitis, which occurs approximately 4-12 weeks after the completion of therapy and is characteristically limited to the field of irradiation. Chemotherapy-related complications include cardiotoxicity, pneumonitis, and infection. Ultrasonography and computed tomography are more sensitive than physical examination for detecting local and regional recurrence. The thorax is a common site of metastasis, which may affect the lymph nodes, bone, lung, pleura, or heart and pericardium. Bone metastasis is usually evaluated with bone scintigraphy and may cause spinal cord compression, a serious complication that requires early diagnosis. Intrapulmonary metastasis may manifest as single or multiple pulmonary nodules, airspace pattern metastasis, lymphangitic metastasis, or endobronchial metastasis. Pleural metastasis usually manifests as pleural effusion, with or without a pleural mass. Familiarity with the spectrum of radiologic findings in breast cancer patients allows accurate image interpretation and correct diagnosis.
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Affiliation(s)
- Jung Im Jung
- Department of Radiology, St Mary's Hospital, College of Medicine, Catholic University of Korea, 62 Yeouido-dong, Youngdungpo-gu, Seoul 150-713, South Korea.
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Sadetzki S, Oberman B, Zipple D, Kaufman B, Rizel S, Novikov I, Papa MZ. Breast Conservation After Neoadjuvant Chemotherapy. Ann Surg Oncol 2005; 12:480-7. [PMID: 15868065 DOI: 10.1245/aso.2005.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 01/19/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tumor downstaging by preoperative neoadjuvant chemotherapy in patients with locally advanced breast tumors allows breast conservation in women who were previously candidates for mastectomy. Nevertheless, lumpectomy success in such cases cannot be fully achieved. The aim of this study was to create a quantitative tool for preoperative evaluation of the success of breast conservation in such patients. METHODS The study population included 100 consecutive patients with stage II and III breast cancer who were designated for lumpectomy and 19 patients who were designated for mastectomy. All patients received neoadjuvant therapy. Breast-conserving surgery was offered in accordance with clinical and esthetic criteria. Demographic details and clinical, imaging, and pathologic information were collected from medical files. A decision protocol for classifying patients to lumpectomy or mastectomy was built by using the Classification and Regression Trees procedure based on preoperative characteristics. RESULTS Three factors were found to be the main predictors for successful breast conservation: absence of diffuse microcalcifications as seen in the pretreatment mammogram, a postchemotherapy tumor size of < 25 mm, and the existence of a circumscribed lesion on mammography. CONCLUSIONS The use of these criteria as a basis for decision on the type of surgery may decrease the performance of unnecessary procedures.
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Affiliation(s)
- Siegal Sadetzki
- The Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
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Doutriaux-Dumoulin I. Imagerie du sein traité. IMAGERIE DE LA FEMME 2005. [DOI: 10.1016/s1776-9817(05)80644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Digabel-Chabay C, Allioux C, Labbe-Devilliers C, Meingan P, Ricaud Couprie M. Distorsions architecturales et difficultés diagnostiques. IMAGERIE DE LA FEMME 2004. [DOI: 10.1016/s1776-9817(04)94790-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Van Zee KJ. Breast imaging: a breast surgeon's perspective. Radiol Clin North Am 2002; 40:517-20. [PMID: 12117190 DOI: 10.1016/s0033-8389(01)00006-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many changes have occurred in the past decade in the imaging of the breast. These improvements have led to more sensitive and specific breast imaging and to the widespread use of minimally invasive biopsy techniques. They have also facilitated a closer working relationship between breast imager and surgeon and have contributed greatly to the surgeon's ability to optimally diagnose and treat breast cancer.
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Affiliation(s)
- Kimberly J Van Zee
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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