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Matthews S, Kyi M, Nasimudeen A, Marusic A, Johns CS, Page J. Targeted Lung Health Check: breast related incidental findings-imaging appearances and lessons learned. Br J Radiol 2024; 97:371-376. [PMID: 38268227 PMCID: PMC11027243 DOI: 10.1093/bjr/tqad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/24/2023] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE The introduction of Targeted Lung Health Checks (TLHC) to screen for lung cancer has highlighted that incidental findings are common and require management strategies. This study analyses retrospectively, incidentally detected breast lesions reported as part of the TLHC referred to the Breast Cancer clinicians. METHODS All participants with incidental breast nodules referred to the Breast Cancer team in the first year of screening were reviewed. RESULTS Fifty-two participants (48 female; 92.3%) were referred to the Breast Multidisciplinary Team Meeting for assessment of 43 breast nodules, 8 breast asymmetry/dense breasts, and 2 likely breast related metastatic disease. One participant declined breast team referral. For the 42 breast nodules investigated, the final diagnoses were 5 breast carcinomas, 10 normal breast tissue, and 27 benign nodules. One male patient was diagnosed with breast carcinoma. The 29 breast nodules classified as smooth and well defined were all benign. No malignancy was demonstrated in the group with asymmetric or dense breast tissue. Metastatic breast carcinoma was confirmed in two participants. Twenty-six out of thirty-seven (54%) females had prior breast screening mammograms precluding further investigation. CONCLUSION Incidental breast nodules are common on THLC scans. Smooth, sharply defined breast nodules are likely to be benign but low-dose CT is poor at accurately assessing breast nodules. Agreed breast referral pathways prior to starting the Lung Cancer Screening programme are recommended. Access to screening mammograms can reduce referrals to the Breast clinic. ADVANCES IN KNOWLEDGE Lessons learned from TLHC pilot studies can be useful to sites commencing national TLHC programme.
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Affiliation(s)
- Suzanne Matthews
- Main Radiology Department, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, United Kingdom
- NHS Doncaster CCG, Doncaster DN4 5HZ, United Kingdom
| | - Moe Kyi
- NHS Doncaster CCG, Doncaster DN4 5HZ, United Kingdom
- Doncaster and Bassetlaw Hospitals NHS Trust, Doncaster DN2 5LT, United Kingdom
| | - Abdul Nasimudeen
- NHS Doncaster CCG, Doncaster DN4 5HZ, United Kingdom
- Doncaster and Bassetlaw Hospitals NHS Trust, Doncaster DN2 5LT, United Kingdom
| | - Ante Marusic
- Telemedicine Clinic, Reading RG1 3EU, United Kingdom
| | - Christopher S Johns
- Main Radiology Department, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, United Kingdom
| | - Jason Page
- Doncaster and Bassetlaw Hospitals NHS Trust, Doncaster DN2 5LT, United Kingdom
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Park J, Kim C, Cha YK, Chung MJ. Missed and Detected Incidental Breast Cancers on Contrast Enhanced Chest CT: Detection Rates and CT Features. Diagnostics (Basel) 2023; 13:diagnostics13091522. [PMID: 37174913 PMCID: PMC10177537 DOI: 10.3390/diagnostics13091522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
This study investigated the rate at which radiologists miss or detect incidental breast cancers on chest CT and to compare the CT features between the two groups. This retrospective study evaluated chest CT examinations and medical records of patients who registered with the diagnosis code of "breast cancer" between January 2016 and December 2020, and who had undergone contrast enhanced chest CT 3-18 months before registration, during which they were unaware of any breast lesions. This study found that out of 84 patients, incidental breast cancer lesions were missed in 54 (64.3%) and detected in 30 (53.7%). The initial treatment was delayed in the missed breast lesions group (p = 0.004). Breast lesions of smaller sizes (<9.0 mm, p = 0.01), or with lower enhancement ratios (<1.4, p = 0.009), were more likely to be missed. When three radiologists re-read the CTs with more attention to breast area, they detected breast cancers with higher accuracies (90.1%, 87.9%, and 81.3%). In summary, this study revealed that radiologists miss 64.3% of incidental breast cancers on chest CT, especially those of sub-centimeter sizes and weak enhancements.
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Affiliation(s)
- Jiyeon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Chohee Kim
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Yoon Ki Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Myung Jin Chung
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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Kuo CFJ, Chen HY, Barman J, Ko KH, Hsu HH. Complete, Fully Automatic Detection and Classification of Benign and Malignant Breast Tumors Based on CT Images Using Artificial Intelligent and Image Processing. J Clin Med 2023; 12:1582. [PMID: 36836118 PMCID: PMC9960342 DOI: 10.3390/jcm12041582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 02/19/2023] Open
Abstract
Breast cancer is the most common type of cancer in women, and early detection is important to significantly reduce its mortality rate. This study introduces a detection and diagnosis system that automatically detects and classifies breast tumors in CT scan images. First, the contours of the chest wall are extracted from computed chest tomography images, and two-dimensional image characteristics and three-dimensional image features, together with the application of active contours without edge and geodesic active contours methods, are used to detect, locate, and circle the tumor. Then, the computer-assisted diagnostic system extracts features, quantifying and classifying benign and malignant breast tumors using a greedy algorithm and a support vector machine. The study used 174 breast tumors for experiment and training and performed cross-validation 10 times (k-fold cross-validation) to evaluate performance of the system. The accuracy, sensitivity, specificity, and positive and negative predictive values of the system were 99.43%, 98.82%, 100%, 100%, and 98.89% respectively. This system supports the rapid extraction and classification of breast tumors as either benign or malignant, helping physicians to improve clinical diagnosis.
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Affiliation(s)
- Chung-Feng Jeffrey Kuo
- Department of Materials Science and Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | - Hsuan-Yu Chen
- Department of Materials Science and Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | - Jagadish Barman
- Department of Materials Science and Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | - Kai-Hsiung Ko
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
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4
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Iodinated Contrast Enhancement of Breast Cancer on Prone Multidetector Computed Tomography-Preliminary Findings. J Comput Assist Tomogr 2023; 47:45-49. [PMID: 36219728 DOI: 10.1097/rct.0000000000001385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Contrast-enhanced breast imaging has gained increasing importance in the diagnosis and management of breast cancer. The aim of this study was to assess breast cancer enhancement after contrast administration on prone multidetector computed tomography (MDCT). MATERIALS AND METHODS This retrospective, unicentric, institutional review board-approved study included patients with newly diagnosed breast cancer who were submitted to contrast-enhanced MDCT in prone position, with image acquisition before and after nonionic iodinated contrast administration. RESULTS Sixty breast cancer patients aged between 31 and 74 years (mean, 49 years) were included. Most patients (n = 50, 83.3%) had no special type invasive breast carcinoma and luminal subtype (n = 45, 75%). All index breast tumors were identified on prone MDCT. Forty-three cases (70.5%) presented as mass, 13 (21.3%) as nonmass enhancement and 4 (6.6%) as both mass and nonmass enhancement. Mean tumor density was 37.8 HU and 87.9 HU on precontrast and postcontrast images, respectively. Mean contrast enhancement was 50.2 HU (range, 20-109 HU). There were no statistically significant differences in tumor enhancement according to histological type, molecular subtype, nuclear grade, tumor size, or imaging presentation. CONCLUSIONS Our results show that breast cancer usually can be identified and have significant contrast enhancement on prone MDCT images. This method could be used as an alternative when other contrast-enhanced breast imaging methods are not available.
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Lapointe M, Kerbaul F, Meckert F, Cognard N, Mathelin C, Lodi M. [Breast cancer and organ transplantation: Systematic review and meta-analysis]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:60-72. [PMID: 36375787 DOI: 10.1016/j.gofs.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Our main objective was to investigate donor-transmitted epithelial cancers of all origins in comparison with breast cancers, with analysis of the carcinological outcome of recipients. Our secondary objective was to define medical check-up to be performed before any organ procurement from a donor with a history of breast cancer. METHODOLOGY We performed a systematic review of the literature up to June 1st 2022 by including all original articles (including clinical cases) reporting cases of epithelial cancer transmitted from donor to recipient, followed by a meta-analysis of epidemiological and survival data. RESULTS In total, we included 52 articles (31 clinical cases and 21 cohort studies), representing 91,388 donors, 236,142 recipients, and 2591 cases of transmitted cancer. The risk of transmitted cancer was significantly higher with a history of breast cancer compared with a history of other cancer (RR=9.48 P=0.0025). In clinical cases, the pre-donation check-up was specified in only 33.3% of publications. The time between transplantation and cancer occurrence was longer in cases of breast cancer transmission compared to other epithelial cancers: 1435.8 days versus 297.6 (P<0.001). CONCLUSION Organ donation from a person previously treated for breast cancer or having a risk of occult breast cancer is possible in some situations but requires an adapted pre-donation assessment, the respect of good practice guidelines and an expert opinion in complex situations.
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Affiliation(s)
- M Lapointe
- CHRU, 1, avenue Molière, 67200 Strasbourg, France
| | - F Kerbaul
- Direction prélèvement et greffe organes et tissus, direction générale médicale et scientifique, agence de la biomédecine, 93212 La Plaine cedex, France
| | - F Meckert
- Direction prélèvement et greffe organes et tissus, direction générale médicale et scientifique, agence de la biomédecine, 93212 La Plaine cedex, France
| | - N Cognard
- CHRU, 1, avenue Molière, 67200 Strasbourg, France
| | - C Mathelin
- CHRU, 1, avenue Molière, 67200 Strasbourg, France; Institut de cancérologie Strasbourg Europe (ICANS), 17, avenue Albert-Calmette, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS, UMR7104 Inserm U964, université de Strasbourg, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France.
| | - M Lodi
- CHRU, 1, avenue Molière, 67200 Strasbourg, France; Institut de cancérologie Strasbourg Europe (ICANS), 17, avenue Albert-Calmette, 67200 Strasbourg cedex, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS, UMR7104 Inserm U964, université de Strasbourg, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
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Angelico G, Broggi G, Spadola S, Mulè A, Magro G. PET/CT-Detected myofibroblastoma of the breast with bizarre cells: A potential diagnostic pitfall of malignancy. Breast J 2021; 27:726-730. [PMID: 34196064 PMCID: PMC8518039 DOI: 10.1111/tbj.14269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022]
Abstract
Myofibroblastoma (MFB) is a rare benign mesenchymal tumor usually occurring in the breast parenchyma. This tumor can present as a palpable nodule or can be incidentally detected as a nonpalpable mass on routine screening mammogram. We first report a rare case of histologically proven MFB of the breast revealed by fluoro‐deoxyglucose uptake on PET‐CT examination in a patient with a lung nodule. Tumor exhibited an unusual morphology, being predominantly composed of polygonal, epithelioid, and deciduoid‐like cells set in a myxoid stroma. The most striking feature was the multifocal presence of atypical/bizarre, mono/bi‐nucleated cells that, in addition to diffuse myxoid stromal changes, were a concern of malignancy, especially on core biopsy. The final diagnosis of MFB was achieved on surgically resected specimen and, similarly to other benign soft tissue tumors (especially leiomyoma and schwannoma/neurofibroma), the term “bizarre cell MFB of the breast” is proposed to emphasize the degenerative/reactive nature of the atypia.
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Affiliation(s)
- Giuseppe Angelico
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Gineco-patologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Broggi
- Department of Medical, Surgical Sciences and Advanced Technologies and Biotechnological Sciences, G.F. Ingrassia, Anatomic Pathology, University of Catania, Catania, Italy
| | - Saveria Spadola
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Gineco-patologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonino Mulè
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Gineco-patologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Magro
- Department of Medical, Surgical Sciences and Advanced Technologies and Biotechnological Sciences, G.F. Ingrassia, Anatomic Pathology, University of Catania, Catania, Italy
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Abstract
Computed tomography (CT) and magnetic resonance (MR) imaging may demonstrate a wide variety of incidental findings in the breast, including primary breast carcinoma, the second most common cancer in women. It important to recognize the spectrum of pathologic conditions in order to properly assess the need for further workup. Some findings may be diagnosed as benign on the basis of CT/ MR imaging and clinical history alone, whereas others will require evaluation with dedicated breast imaging and possibly biopsy. This article serves to guide radiologists' management of the wide spectrum of incidental breast findings encountered on cross-sectional imaging.
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Zhang J, Zhou L, Dionigi G, Zhang D, Zhao L, Liang N, Xue G, Sun H. Association Between the Presence of Female-Specific Tumors and Aggressive Clinicopathological Features in Papillary Thyroid Cancer: A Retrospective Analysis of 9,822 Cases. Front Oncol 2021; 11:611471. [PMID: 33791205 PMCID: PMC8006326 DOI: 10.3389/fonc.2021.611471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/25/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To investigate the association between the presence of female-specific tumors and aggressive clinicopathological features in papillary thyroid cancer (PTC). Methods This study retrospectively analyzed 9,822 female cases between June 2008 and December 2017. Odds ratios and corresponding 95% confidence intervals were calculated. Findings were stratified by age and body mass index (BMI) in different models. Results 1443/9822 (14.7%) patients with PTC had a female-specific tumor. Presence of a benign breast mass was an independent risk factor for a primary PTC lesion > 1 cm in diameter (adjusted OR = 1.446, 95% CI 1.136–1.840, P = 0.003), but a protective factor against extrathyroidal extension of PTC (adjusted OR = 0.650, 95%CI 0.500–0.845, P = 0.001). Presence of a benign uterine mass was an independent risk factor for multifocal PTC (adjusted OR = 1.305, 95%CI 1.113–1.531, P = 0.001). Analyses stratified by age and BMI revealed the presence of a benign breast mass was an independent risk factor for a primary PTC lesion > 1 cm in diameter in patients aged <36 years (adjusted OR = 1.711, 95% CI 1.063–2.754, P = 0.027), and a protective factor against extrathyroidal extension of PTC in patients aged ≥36 - <42 years (OR adjusted = 0.533, 95% CI 0.302–0.941, P = 0.030) or with a BMI ≥ 23.4 kg/m2 (BMI ≥ 23.4 to < 25.7 kg/m2, adjusted OR = 0.441, 95% CI 0.246–0.792, P = 0.006; BMI ≥25.7 kg/m2, adjusted OR = 0.558, 95% CI 0.315–0.998, P2 = 0.045). Presence of a benign uterine mass was an independent risk factor for multifocal PTC in patients aged ≥49 years (adjusted OR = 1.397, 95% CI 1.088–1.793, P = 0.009) or with a BMI <21.5 kg/m2 (OR adjusted = 1.745, 95% CI 1.214–2.509, P = 0.003). Conclusion The presence of a benign breast mass was an independent risk factor for a primary PTC lesion > 1 cm in diameter and a protective factor against extrathyroidal extension of PTC, while the presence of a benign uterine mass was an independent risk factor for multifocal PTC. Data from this study may help surgeons propose more personalized treatment plans when encountering patients with PTC and female-specific benign tumors.
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Affiliation(s)
- Jiao Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun, China
| | - Le Zhou
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun, China
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Daqi Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun, China
| | - Lina Zhao
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun, China
| | - Nan Liang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun, China
| | - Gaofeng Xue
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun, China
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun, China
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9
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Margolies LR, Salvatore M, Tam K, Yip R, Bertolini A, Henschke CI, Yankelevitz DF. Breast mass assessment on chest CT: Axial, sagittal, coronal or maximal intensity projection? Clin Imaging 2020; 63:60-64. [PMID: 32146335 DOI: 10.1016/j.clinimag.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The goal of this work is to determine the optimal projection to detect breast masses on Chest CT. METHODS Institutional Review Board (HIPPA compliant) approval was obtained with a waiver of consent. 10 image pairs of Chest CT images containing breast masses were selected for review by 10 chest radiologists: the pairs consisted of axial, sagittal, coronal and axial MIP images (MIP images) with each projection compared to a MIP and with one another. For each pair, the image where the mass was most conspicuous was recorded. RESULTS MIPs were preferred to any cross sectional projection 82% of the time; sagittal (63%) or coronal (63%) images were preferred to the axial projection. When sagittal and coronal images were compared there was no preference. CONCLUSIONS MIP images should be obtained and reviewed for breast pathology; sagittal or coronal projections may provide additional information.
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Affiliation(s)
- Laurie R Margolies
- Department of Diagnostic, Molecular and Interventional Radiology, New York, NY, United States of America.
| | - Mary Salvatore
- Department of Diagnostic, Molecular and Interventional Radiology, New York, NY, United States of America
| | - Kathleen Tam
- Department of Diagnostic, Molecular and Interventional Radiology, New York, NY, United States of America
| | - Rowena Yip
- Department of Diagnostic, Molecular and Interventional Radiology, New York, NY, United States of America
| | - Alexandra Bertolini
- Department of Diagnostic, Molecular and Interventional Radiology, New York, NY, United States of America
| | - Claudia I Henschke
- Department of Diagnostic, Molecular and Interventional Radiology, New York, NY, United States of America
| | - David F Yankelevitz
- Department of Diagnostic, Molecular and Interventional Radiology, New York, NY, United States of America
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10
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Margolies LR, Salvatore M, Yip R, Tam K, Bertolini A, Henschke C, Yankelevitz D. The chest radiologist's role in invasive breast cancer detection. Clin Imaging 2018; 50:13-19. [DOI: 10.1016/j.clinimag.2017.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 10/25/2017] [Accepted: 12/05/2017] [Indexed: 11/12/2022]
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Change of paradigm in treating elderly with breast cancer: are we undertreating elderly patients? Ir J Med Sci 2018; 188:379-388. [DOI: 10.1007/s11845-018-1851-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/13/2018] [Indexed: 12/16/2022]
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12
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O'Sullivan JW, Muntinga T, Grigg S, Ioannidis JPA. Prevalence and outcomes of incidental imaging findings: umbrella review. BMJ 2018; 361:k2387. [PMID: 29914908 PMCID: PMC6283350 DOI: 10.1136/bmj.k2387] [Citation(s) in RCA: 166] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide an overview of the evidence on prevalence and outcomes of incidental imaging findings. DESIGN Umbrella review of systematic reviews. DATA SOURCES Searches of MEDLINE, EMBASE up to August 2017; screening of references in included papers. ELIGIBILITY CRITERIA Criteria included systematic reviews and meta-analyses of observational studies that gave a prevalence of incidental abnormalities ("incidentalomas"). An incidental imaging finding was defined as an imaging abnormality in a healthy, asymptomatic patient or an imaging abnormality in a symptomatic patient, where the abnormality was not apparently related to the patient's symptoms. Primary studies that measured the prevalence of incidentalomas in patients with a history of malignancy were also considered in sensitivity analyses. RESULTS 20 systematic reviews (240 primary studies) were identified from 7098 references from the database search. Fifteen systematic reviews provided data to quantify the prevalence of incidentalomas, whereas 18 provided data to quantify the outcomes of incidentalomas (13 provided both). The prevalence of incidentalomas varied substantially between imaging tests; it was less than 5% for chest computed tomography for incidental pulmonary embolism in patients with and without cancer and whole body positron emission tomography (PET) or PET/computed tomography (for patients with and without cancer). Conversely, incidentalomas occurred in more than a third of images in cardiac magnetic resonance imaging (MRI), chest computed tomography (for incidentalomas of thorax, abdomen, spine, or heart), and computed tomography colonoscopy (for extra-colonic incidentalomas). Intermediate rates occurred with MRI of the spine (22%) and brain (22%). The rate of malignancy in incidentalomas varied substantially between organs; the prevalence of malignancy was less than 5% in incidentalomas of the brain, parotid, and adrenal gland. Extra-colonic, prostatic, and colonic incidentalomas were malignant between 10% and 20% of the time, whereas renal, thyroid, and ovarian incidentalomas were malignant around a quarter of the time. Breast incidentalomas had the highest percentage of malignancy (42%, 95% confidence interval 31% to 54%). Many assessments had high between-study heterogeneity (15 of 20 meta-analyses with I2 >50%). CONCLUSIONS There is large variability across different imaging techniques both in the prevalence of incidentalomas and in the prevalence of malignancy for specific organs. This umbrella review will aid clinicians and patients weigh up the pros and cons of requesting imaging scans and will help with management decisions after an incidentaloma diagnosis. Our results can underpin the creation of guidelines to assist these decisions. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42017075679.
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Affiliation(s)
- Jack W O'Sullivan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Tim Muntinga
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Sam Grigg
- University of Melbourne, Victoria, Australia
| | - John P A Ioannidis
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
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13
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Zhang Y, Shi X, Lu Y. Breast panniculitis with liquefactive fat necrosis: A case report. Exp Ther Med 2018; 15:5523-5527. [PMID: 29904432 DOI: 10.3892/etm.2018.6095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/01/2018] [Indexed: 11/06/2022] Open
Abstract
Panniculitis is a group of heterogeneous disorders characterized by inflammation of the subcutaneous adipose tissue. Panniculitis of breast tissue as the initial manifestation has rarely been reported and is often misdiagnosed. Breast panniculitis may cause substantial morbidity and early diagnosis and treatment are important for the prognosis of the disease. The present study has reported a case of panniculitis with inflammation of the mammary glands as the initial presentation and provided a detailed description of ultrasonography, X-ray, computed tomography, magnetic resonance imaging and other imaging features of breast panniculitis. The treatment and follow-up were also described. Following treatment with systemic corticosteroids combined with methotrexate and thalidomide for 2 months, the breast appeared to be normal without scar formation. The present case report provides a good reference for the future diagnosis and treatment of breast panniculitis.
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Affiliation(s)
- Yongfeng Zhang
- Department of Rheumatology and Immunology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Xuhua Shi
- Department of Rheumatology and Immunology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yuewu Lu
- Department of Rheumatology and Immunology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
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14
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Pencharz D, Nathan M, Wagner TL. Evidence-based management of incidental focal uptake of fluorodeoxyglucose on PET-CT. Br J Radiol 2018; 91:20170774. [PMID: 29243502 DOI: 10.1259/bjr.20170774] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Focal incidental uptake, with or without CT abnormalities, is a common finding on fluorodeoxyglucose PET/CT and evidence-based management for this type of uptake is lacking. This article reviews the evidence on focal incidental uptake including the incidence of malignancy, differential diagnosis and imaging criteria which can be used to further characterize it. The article focusses on PET rather than CT criteria. The strength of the evidence base is highly variable ranging from systematic reviews and meta-analyses to a virtual absence of evidence. Caution needs to be used when using standardized uptake values (SUVs) reported in other studies due to interpatient and institution observed variation in SUVs. There is sufficient evidence to permit specific suggestions on how to interpret the foci and recommend further management in the: pituitary (investigate when SUVmax >4.1), thyroid (investigate all), breast (investigate all), lung parenchyma (if focus of fluorodeoxyglucose without a CT nodule, no further investigations), colon (investigate all foci with SUVmax >5.9, urgently if SUVmax >11.4), adrenals (criteria depend on if patient has cancer) and prostate gland (investigate in males aged >50 years or >40 years if peripheral uptake or patient has other risk factors). There is some evidence to guide further management for the parotid gland, naso-orophaynx, oesophagus, pancreas, uterus and ovaries. There is insufficient evidence to guide management for the liver, spleen, kidneys, gallbladder, testis and bone, for these organs patient characteristics and other guidelines will likely be of more use in determining further management.
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Affiliation(s)
- Deborah Pencharz
- 1 Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust , Brighton, East Sussex , UK
| | - Malavika Nathan
- 2 Department of Nuclear Medicine, Royal Free Hospital NHS Foundation Trust , London , UK
| | - Thomas L Wagner
- 2 Department of Nuclear Medicine, Royal Free Hospital NHS Foundation Trust , London , UK
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15
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Jung HK, Kuzmiak CM, Kim KW, Choi NM, Kim HJ, Langman EL, Yoon S, Steen D, Zeng D, Gao F. Potential Use of American College of Radiology BI-RADS Mammography Atlas for Reporting and Assessing Lesions Detected on Dedicated Breast CT Imaging: Preliminary Study. Acad Radiol 2017; 24:1395-1401. [PMID: 28728854 DOI: 10.1016/j.acra.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/11/2017] [Accepted: 06/08/2017] [Indexed: 01/20/2023]
Abstract
RATIONALE AND OBJECTIVES Dedicated breast computed tomography (DBCT) is an emerging and promising modality for breast lesions. The objective of this study was to evaluate the potential use of applying the BI-RADS Mammography Atlas 5th Edition for reporting and assessing breast lesions on DBCT. Currently, no atlas exists for DBCT. MATERIALS AND METHODS Four radiologists trained in breast imaging were recruited in this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study. The enrolled radiologists, who were blinded to mammographic and histopathologic findings, individually reviewed 30 randomized DBCT cases that contained marked lesions. Thirty-four lesions were included in this study: 24 (70.6%) masses, 7 (20.6%) calcifications, and 3 (8.8%) architectural distortions. Eight (23.5%) lesions were malignant and 26 (76.5%) were benign. The reader was asked to specify according to the BI-RADS Mammography Atlas for each marked DBCT lesion: primary findings, features, breast density, and final assessment. We calculated readers' diagnostic performances for differentiating between benign and malignant lesions and interobserver variability for reporting and assessing lesions using a generalized estimating equation and the Fleiss kappa (κ) statistic. RESULTS The estimated overall sensitivity of the readers was 0.969, and the specificity was 0.529. There were no significant differences in the sensitivity and the specificity between lesion types. For reporting the presence of a primary finding, the overall substantial agreement (κ = 0.70) was seen. In assigning the breast density and the final assessment, the overall agreement was moderate (κ = 0.53) and fair (κ = 0.30). CONCLUSION The use of the BI-RADS Mammography Atlas 5th Edition for DBCT showed high performance and good agreement among readers.
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Affiliation(s)
- Hae Kyoung Jung
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Cherie M Kuzmiak
- Department of Radiology, School of Medicine, University of North Carolina, CB #7510, Physicians' Office Building, Rm #118, 170 Manning Drive, Chapel Hill, NC 27599.
| | - Keum Won Kim
- Department of Radiology, Konyang University Hospital, College of Medicine, Daejeon, Republic of Korea
| | - Na Mi Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hye Jeong Kim
- Department of Radiology, Kyungpook University Hospital, College of Medicine, Busan, Republic of Korea
| | - Eun Lee Langman
- Department of Radiology, School of Medicine, University of North Carolina, CB #7510, Physicians' Office Building, Rm #118, 170 Manning Drive, Chapel Hill, NC 27599
| | - Sora Yoon
- Department of Radiology, School of Medicine, Duke University, Durham, North Carolina
| | - Doreen Steen
- Department of Radiology, School of Medicine, University of North Carolina, CB #7510, Physicians' Office Building, Rm #118, 170 Manning Drive, Chapel Hill, NC 27599
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Fei Gao
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
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Gossner J. Intramammary Findings on CT of the Chest - a Review of Normal Anatomy and Possible Findings. Pol J Radiol 2016; 81:415-421. [PMID: 28058068 PMCID: PMC5181571 DOI: 10.12659/pjr.896312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/31/2016] [Indexed: 01/10/2023] Open
Abstract
Computed tomography (CT) is a frequently performed examination in women of all ages. In all thoracic CT examinations of the chest at least parts of the breasts are included. Therefore incidental breast pathology may be observed. It has been suggested that one out of 250 women undergoing chest CT will show a malignant incidental breast lesion. Given the high number of performed chest CT examinations, this contributes to a significant number of malignancies. In this review, after a brief discussion of the value of computed tomography in breast imaging, normal and pathologic findings are discussed to create awareness of this potential “black box” on chest CT.
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Affiliation(s)
- Johannes Gossner
- Department of Clinical Radiology, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany
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17
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Bignotti B, Succio G, Nosenzo F, Perinetti M, Gristina L, Barbagallo S, Secondini L, Calabrese M, Tagliafico A. Breast findings incidentally detected on body MRI. SPRINGERPLUS 2016; 5:781. [PMID: 27386267 PMCID: PMC4912526 DOI: 10.1186/s40064-016-2343-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 12/21/2022]
Abstract
Objectives To evaluate breast findings incidentally detected on body MRI. Methods A retrospective review of the institutional database identified 1752 body MRI performed between January 2015 and September 2015. MRI of women with breast tissue visible in the field-of-view were reviewed for breast findings. Breast findings were classified with the breast imaging reporting and data system (BI-RADS) lexicon. The standard statistic, costs of additional work-up, and the clinical relevance were used to describe breast findings, and we calculated 95 % exact confidence intervals (CIs). Results 440 body MRI of 440 women (mean age: 57 ± 20 years) included breast tissue in the field-of-view. A total of 41 breast findings were identified in 41 patients. Breast findings were classified BI-RADS 2 N = 25, BI-RADS 3 N = 13, BI-RADS 4 N = 3. A total of 3.6 % [95 % CI 1.6 %, 5.6 %] women with breast tissue visible on MRI had a recommendation for further imaging work-up for a breast finding. The 18.7 % (3 of 16) of these patients had a clinically important finding (breast cancer). Further imaging evaluation increased costs of €108.3 per patient with a breast finding. Conclusions Clinically important breast findings could be detected on body MRI in up to 0.7 % (3 of 440) of women.
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Affiliation(s)
- Bianca Bignotti
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Giulia Succio
- Department of Diagnostic Senology, IRCCS Azienda Ospedaliera Universitaria San Martino IST-Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Francesca Nosenzo
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Michela Perinetti
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Licia Gristina
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Stella Barbagallo
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Lucia Secondini
- Department of Health Sciences (DISSAL), University of Genova, Via A. Pastore 1, 16132 Genoa, Italy
| | - Massimo Calabrese
- Department of Diagnostic Senology, IRCCS Azienda Ospedaliera Universitaria San Martino IST-Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Alberto Tagliafico
- Institute of Anatomy, Department of Experimental Medicine, University of Genova, Via Leon Battista Alberti, 2, 16132 Genoa, Italy
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18
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Schramm D, Jasaabuu C, Bach AG, Tennstedt O, Spielmann RP, Surov A. Costs associated with evaluation of incidental breast lesions identified on computed tomography. Br J Radiol 2015; 89:20140847. [PMID: 26648250 DOI: 10.1259/bjr.20140847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The purpose of this study was to calculate the costs associated with the evaluation of breast incidentalomas (BI) identified on CT. METHODS All CT scans of the thorax performed at the radiological department of the University Hospital of the Martin-Luther-University Halle-Wittenberg between the years 2006 and 2014 were reanalysed retrospectively. 111 patients with BI were identified. The radiological and clinical reports of these cases were examined, and the costs of all further diagnostic procedures performed to clarify the detected BI were calculated. RESULTS In 31 (27.9%) of the 111 patients, BI were not further investigated. Of the remaining 80 (72.1%) cases of BI, primary breast carcinoma was diagnosed in 10 (12.5%) cases, breast involvement by lymphoma in 7 (8.8%) cases, intramammary metastases in 19 (23.7%) cases and different benign findings in 44 (55.0%) cases. The total costs associated with clarification of BI in our institution (n = 53) amounted to €14,045.71. The costs per BI were €265.01 and per newly identified breast cancer €1560.63. CONCLUSION Breast lesions incidentally detected on CT should be categorized as major incidental findings because of the high frequency of malignancy. The radiologist should carefully evaluate the breast on CT images and all identified BI should be clarified. The clarification of BI is associated with a low economic burden in comparison with screening programmes for primary breast cancer. ADVANCES IN KNOWLEDGE The radiologist should carefully evaluate the breast on CT and all identified BI should be clarified. The evaluation of BI is associated with a low economic burden.
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Affiliation(s)
- Dominik Schramm
- 1 Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Cholpan Jasaabuu
- 1 Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Andreas G Bach
- 1 Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Oliver Tennstedt
- 2 Department of Controlling, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Rolf P Spielmann
- 1 Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Alexey Surov
- 1 Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Poyraz N, Emlik GD, Keskin S, Kalkan H. Incidental Breast Lesions Detected on Computed Thorax Tomography. THE JOURNAL OF BREAST HEALTH 2015; 11:163-167. [PMID: 28331715 DOI: 10.5152/tjbh.2015.2656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/02/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although mammography is the primary imaging method of the breast, incidental benign and malignant breast lesions are increasingly being detected on computed tomographies (CTs) performed to detect different pathologies. Therefore, the detection and accurate identification of these lesions is important. In this study, we aimed to evaluate the frequency, morphological features, and results of incidental breast lesions on CTs performed for the detection of extramammarian pathologies. MATERIALS AND METHODS Incidental breast lesions on CTs performed in our department between 2011 and 2013 were evaluated. Patients who had previously diagnosed breast lesions were excluded from the study. The inclusion criteria were histopathologic diagnose and being followed-up for at least 2 years. RESULTS The study population consisted of 33 women whose mean age was 55±1.38 (37-78) years. Of the 33 women, 12 (36%) had malignant and 21 (64%) had benign or normal findings. The most common malignant lesion was invasive ductal carcinoma, and the most common benign lesion was fibroadenoma. Ill-defined contour and lymphadenopathy in malignant lesions and well-defined contour in benign lesions were the most important CT findings. CONCLUSION Breast must be carefully evaluated if it is included in the scans. An accurate report of breast lesions gives an opportunity for early diagnosis and treatment.
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Affiliation(s)
- Necdet Poyraz
- Department of Radiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Ganime Dilek Emlik
- Department of Radiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Suat Keskin
- Department of Radiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Havva Kalkan
- Department of Radiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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20
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Rotaru N, Punga J, Codreanu I, Gavrilasenco I, Manea D, Cujba N. Nonsuppurative Nodular Panniculitis of the Breast. Clin Breast Cancer 2015; 15:e219-21. [PMID: 25851541 DOI: 10.1016/j.clbc.2015.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/23/2015] [Accepted: 02/26/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Natalia Rotaru
- Department of Radiology, Medpark International Hospital, State University of Medicine and Pharmacy "Nicolae Testemiţanu", Chişinau, Republic of Moldova.
| | - Janna Punga
- Department of Breast Oncology, Institute of Oncology, Chişinau, Republic of Moldova
| | - Ion Codreanu
- Department of Radiology, Medpark International Hospital, State University of Medicine and Pharmacy "Nicolae Testemiţanu", Chişinau, Republic of Moldova
| | - Igor Gavrilasenco
- Department of Radiology, Institute of Oncology, Chişinau, Republic of Moldova
| | - Diana Manea
- Department of Medicine, Medpark International Hospital, Chişinau, Republic of Moldova
| | - Natalia Cujba
- Department of Radiology, Medpark International Hospital, State University of Medicine and Pharmacy "Nicolae Testemiţanu", Chişinau, Republic of Moldova
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21
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Yuan WH, Li AFY, Hsu HC, Chou YH. Isolated panniculitis with vasculitis of the male breast suspicious for malignancy on CT and ultrasound: a case report and literature review. SPRINGERPLUS 2014; 3:642. [PMID: 25392810 PMCID: PMC4227985 DOI: 10.1186/2193-1801-3-642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Abstract
Introduction We report a case of a 54-year-old male patient with a hard, painful nodule within his right breast which was misdiagnosed preoperatively as breast cancer. Case description Preoperative work-up included physical examination, non-contrast chest computed tomography (CT), sonography, and sono-guided breast biopsy. Isolated breast panniculitis with vasculitis (BPWV), a rare disease, was diagnosed by histopathologic examination of tissue obtained from excisional biopsy. Discussion and Evaluation Subcutaneous panniculitis with or without vasculitis, a condition of nonsuppurative inflammatory process involving the subcutaneous fat layer of skin, is related to different causes. A palpable benign male breast lesion resembling a malignancy includes gynecomastia, panniculitis with or without vasculitis, fat necrosis, ruptured epidermal cyst, pseudoangiomatous stromal hyperplasia, subareolar abscess, intraductal papilloma, hematoma, and atypical fibroadenoma. To make an accurate preoperative diagnosis of a male breast mass, a physician has to carefully analyze various imaging findings. The cases of BPWV may present as an isolated breast lesion or as a component of a systemic disease. The diagnosis of the reported patient was compatible with an isolated BPWV because panniculitis and/or vasculitis were not present at other sites or organs at the time of diagnosis or during follow-up. Conclusions Excisional biopsy and clinical data can provide the correct diagnosis and determined the appropriate treatment strategy of a male BPWV.
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Affiliation(s)
- Wei-Hsin Yuan
- Division of Radiology, Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan ; Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, ShiPai Road, 11217 Taipei City, Beitou District Taiwan ; School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Anna Fen-Yau Li
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan ; School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hui-Chen Hsu
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, ShiPai Road, 11217 Taipei City, Beitou District Taiwan ; Division of Medical Imaging for Health Management, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, ShiPai Road, 11217 Taipei City, Beitou District Taiwan ; School of Medicine, National Yang Ming University, Taipei, Taiwan
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