Magnetic resonance mammography in the evaluation of recurrence at the prior lumpectomy site after conservative surgery and radiotherapy

Problem-solving Breast MRI

Breast MRI has high sensitivity and negative predictive value, making it well suited to problem solving when other imaging modalities or physical examinations yield results that are inconclusive for the presence of breast cancer. Indications for problem-solving MRI include equivocal or uncertain imaging findings at mammography and/or US; suspicious nipple discharge or skin changes suspected to represent an abnormality when conventional imaging results are negative for cancer; lesions categorized as Breast Imaging Reporting and Data System 4, which are not amenable to biopsy; and discordant radiologic-pathologic findings after biopsy. MRI should not precede or replace careful diagnostic workup with mammography and US and should not be used when a biopsy can be safely performed. The role of MRI in characterizing calcifications is controversial, and management of calcifications should depend on their mammographic appearance because ductal carcinoma in situ may not appear enhancing on MR images. In addition, ductal carcinoma in situ detected solely with MRI is not associated with a higher likelihood of an upgrade to invasive cancer compared with ductal carcinoma in situ detected with other modalities. MRI for triage of high-risk lesions is a subject of ongoing investigation, with a possible future role for MRI in decreasing excisional biopsies. The accuracy of MRI is likely to increase with the use of advanced techniques such as deep learning, which will likely expand the indications for problem-solving MRI. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

The Usefulness of Magnetic Resonance Imaging (MRI) for the Detection of Local Recurrence after Mastectomy with Reconstructive Surgery in Breast Cancer Patients

The purpose of this study is to investigate the usefulness of magnetic resonance imaging (MRI) for the detection of local recurrence after nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) with immediate reconstructive surgery for breast cancer. Two hundred and eighty-six NSM or SSM procedures and immediate reconstruction cases between August 2015 and February 2020 were reviewed. The detectability rates of for local recurrence using MRI and ultrasound were assessed, and the characteristics of recurrent and primary cancers were evaluated. The patients with multifocal or multicentric primary cancer and a dense parenchymal pattern showed a higher recurrence rate (p < 0.001). A total of 22 cases showed recurrence, and due to multifocal recurrence, a total of 27 recurrent lesions were identified in the reconstructed breast, of which 12 were symptomatic and 15 were asymptomatic (p < 0.001). With the exception of skin recurrence (n = 6), MRI showed a significantly higher detectability rate (95.2%, 20 of 21) than ultrasound (38.1%, 8 of 21) for the recurrence of cancer in the reconstructed breast (p < 0.001), especially for small-sized (<1 cm) asymptomatic lesions. In addition, the mean recurrence interval of MRI-detected asymptomatic lesions was 21.7 months (SD ± 17.7), which was significantly longer than that of symptomatic recurrence. In conclusion, postoperative MRI can be useful for identifying small-sized (<1 cm) asymptomatic recurrence lesions in reconstructed breast tissue after NSM or SSM, which can be implemented within two years of surgery.

Assessment of Suspected Breast Lesions in Early-Stage Triple-Negative Breast Cancer during Follow-Up after Breast-Conserving Surgery Using Multiparametric MRI

Background

The local recurrence rate of triple-negative breast cancer (TNBC) can be as high as 12%.The standard treatment for early-stage TNBC is breast-conserving surgery (BCS), followed by postoperative radiotherapy with or without chemotherapy. However, detection of the local recurrence of the disease after radiotherapy is a major issue.

Objective

The aim of this study was at investigating the role of dynamic and functional magnetic resonance imaging (MRI) during follow-up after BCS and radiotherapy with/without chemotherapy to differentiate between locoregional recurrence and postoperative fibrosis. Patients and Methods. This prospective study was conducted at the oncology, radiology, and pathology departments, Tanta University. It involved 50 patients with early-stage TNBC who were treated with BCS, followed by radiotherapy with/without chemotherapy. The suspected lesions were evaluated during the follow-up period by sonomammography. All patients were subjected to MRI, including conventional sequences, diffusion-weighted imaging (DWI), and dynamic postcontrast study.

Results

Ten cases were confirmed as recurrent malignant lesions. After contrast administration, they all exhibited irregular T1 hypodense lesions of variable morphology with diffusion restriction and positive enhancement. Eight cases displayed a type III curve, while two showed a type II curve. Histopathological assessment was consistent with the MRI findings in all eight cases. The combination of the data produced by DWI-MRI and dynamic contrast-enhanced (DCE) MRI resulted in 100%sensitivity, 92.5% specificity, 90.9% positive predictive value, 100% negative predictive value, and 98% accuracy.

Conclusion

Combination of DWI-MRI and DCE-MRI could have high diagnostic value for evaluating postoperative changes in patients with TNBC after BCS, followed by radiotherapy with/without chemotherapy. Trial Registrations. No trial to be registered.

Dynamic contrast-enhanced (DCE) imaging: state of the art and applications in whole-body imaging

Dynamic contrast-enhanced (DCE) imaging is a non-invasive technique used for the evaluation of tissue vascularity features through imaging series acquisition after contrast medium administration. Over the years, the study technique and protocols have evolved, seeing a growing application of this method across different imaging modalities for the study of almost all body districts. The main and most consolidated current applications concern MRI imaging for the study of tumors, but an increasing number of studies are evaluating the use of this technique also for inflammatory pathologies and functional studies. Furthermore, the recent advent of artificial intelligence techniques is opening up a vast scenario for the analysis of quantitative information deriving from DCE. The purpose of this article is to provide a comprehensive update on the techniques, protocols, and clinical applications - both established and emerging - of DCE in whole-body imaging.

Imaging surveillance for the detection of ipsilateral local tumor recurrence in patients who underwent oncoplastic breast-conserving surgery with acellular dermal matrix: abbreviated MRI versus conventional mammography and ultrasonography

BACKGROUND

To evaluate the usefulness of surveillance-abbreviated magnetic resonance imaging (AB-MRI) for the detection of ipsilateral local tumor recurrence (LTR) in patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) by comparing its diagnostic performance with that of mammography (MG) and ultrasonography (US).

METHODS

The postoperative MG, US, and AB-MRI findings of the ipsilateral breast and pathological results of 324 patients who underwent oncoplastic BCS using ADM were reviewed. The cancer detection rate (CDR), sensitivity, specificity, positive predictive value (PPV) for biopsy, accuracy, and area under the curve (AUC) for each imaging modality were calculated.

RESULTS

A total of 8 ipsilateral LTRs were diagnosed, and most cancers (87.5%) were stage 0 or 1 (median size of invasive cancer, 1.44 cm; range, 0.7-2 cm). The CDRs of MG, US, MG + US, and AB-MRI were 0.009, 0.012, 0.015, and 0.025 per woman, respectively. Three cancers were detectable on only AB-MRI, and the additional CDR of AB-MRI was 0.010. The sensitivity and specificity of MG, US, MG + US, and AB-MRI were 37.5%, 50%, 62.5%, and 100% and 99.7%, 98.4%, 98.1%, and 97.8%, respectively. The PPVs for biopsy were 75%, 44.4%, 45.5%, and 53.3%, respectively. The AUC was significantly higher for AB-MRI (0.989) than for MG alone (0.686, P = 0.0009), US alone (0.742, P = 0.009), and MG + US (0.803, P = 0.04). A total of 66.7% of cancers visible on only AB-MRI were located at the deep posterior portion of the excision cavity, which might have been missed with MG or MG + US due to masking by the ADM filler.

CONCLUSION

AB-MRI can improve the detection of ipsilateral LTR despite postoperative changes caused by ADM fillers compared to conventional MG and US. Patients who undergo BCS with ADM can be candidates for AB-MRI surveillance considering improved cancer detection and high sensitivity.

Usefulness of postoperative surveillance MR for women after breast-conservation therapy: Focusing on MR features of early and late recurrent breast cancer

Purpose

To investigate the imaging characteristics of early and late recurrent breast cancer and the detectability of mammography, ultrasonography, and breast magnetic resonance imaging (MRI) in patients who underwent breast-conservation therapy (BCT).

Materials and methods

Total of 1312 women with 2026 surveillance breast MRI after BCT between January 2014 and September 2018 were studied. Early recurrence was defined as newly diagnosed breast cancer and/or axillary metastasis within 12 months of surgery. Late recurrence was defined as recurrence after 12months of surgery. We assessed the detectability of recurrent lesions in each postoperative imaging modality and evaluated characteristics of recurrent lesions on postoperative MRI by comparing early and late recurrence groups.

Result

Of the 2026 cases, 103 were confirmed as recurrent breast cancer by biopsy or surgery. Thirty-one cases were early recurrence, and 72 cases were late recurrence. MRI showed significantly higher detectability for recurrent lesions (102 cases, 99%) than mammography (59.4%, p < 0.001) or ultrasound (68.9%, p < 0.001), or both mammography and ultrasound (81.6%, p < 0.001). The recurrent lesions did not have typical malignant morphologic features, but variable features on MRI. However, early recurrent lesions showed fast enhancement in early dynamic phase regardless of the kinetic pattern of delayed dynamic phase; and late recurrence lesions showed early fast enhancement and delayed washout pattern. There were 19 cases which were not detected on mammography or ultrasound but could only be detected with MRI.

Conclusion

Postoperative breast MRI showed significantly higher detectability for recurrent lesions than mammography and ultrasound. Early fast enhancement is the most important feature of recurrent lesions on postoperative breast MRI for both early and late recurrence groups. Due to its high possibility of recurrence, further work-up should be considered regardless of their morphologic features.

Surveillance for second breast cancer events in women with a personal history of breast cancer using breast MRI: a systematic review and meta-analysis

PURPOSE

Women with personal history of breast cancer (PHBC) are currently recommended to receive annual mammography for surveillance of breast cancer recurrence or new primary. However, given issues in accuracy with mammography, there is a need for evolving evidence-based surveillance recommendations with supplemental imaging. In this systematic review, we compiled and compared existing studies that describe the test performance of surveillance breast MRI among women with PHBC.

METHODS

We searched PubMed and EMBASE using MeSH terms for studies (2000-2019) that described the diagnostic characteristics of breast MRI in women with PHBC. Search results were reviewed and included based on PICOTS criteria; quality of included articles was assessed using QUADAS-2. Meta-analysis of single proportions was conducted for diagnostic characteristics of breast MRI, including tests of heterogeneity.

RESULTS

Our review included 11 articles in which unique cohorts were studied, comprised of a total of 8338 women with PHBC and 12,335 breast MRI done for the purpose of surveillance. We predict intervals (PI) for cancer detection rate per 1000 examinations (PI 9-15; I² = 10%), recall rate (PI 5-31%; I² = 97%), sensitivity (PI 58-95%; I² = 47%), specificity (PI 76-97%; I² = 97%), and PPV3 (PI 16-40%; I² = 44%).

CONCLUSIONS

Studies addressing performance of breast MRI are variable and limited in population-based studies. The summary of evidence to date is insufficient to recommend for or against use of breast MRI for surveillance among women with PHBC.

Fat necrosis in the Breast: A systematic review of clinical

Breast fat necrosis (FN) originates from aseptic fat saponification, which is a typical lipid cyst or a spiculated lesion called mammographic presentation which mimics malignancy. In order to avoid biopsy, it would be necessary to identify the spectrum of fat necrosis appearances. A systematic research was conducted in October 2018 by using PubMed, MEDLINE, Embase, Google Scholar databases and Google to search for science literature published after 2004. Therefore, the aim of this systematic review, it is that the FN can provide radiologists, surgeons, and oncologists with better insight and help them manage the condition efficiently.

Problem-Solving MR Imaging for Equivocal Imaging Findings and Indeterminate Clinical Symptoms of the Breast

Breast MR imaging is commonly used for high-risk screening and for assessing the extent of disease in patients with newly diagnosed breast cancer, but its utility for assessing suspicious symptoms and equivocal imaging findings is less widely accepted. The authors review current literature and guidelines regarding the use of breast MR imaging for these indications. Overall, problem-solving breast MR imaging is best reserved for pathologic nipple discharge and sonographically occult architectural distortion with limited biopsy options. Further study is necessary to define the role of problem-solving MR imaging for calcifications, mammographic asymmetries, and surgical scarring.

Magnetic Resonance Imaging after Breast Oncoplastic Surgery: An Update

Breast-oncoplastic surgery, allowing local tumor control and a better cosmetic outcome, is oncologically safe when applied to early-stage breast cancer. Breast cancer recurrence following conservative therapy may occur during the first 5 years after treatment, with a peak incidence after 2 years. Therefore, during the follow-up period, patients undergo a series of ultrasound (US) and mammographic examinations. However, after surgery and radiation therapy, several modifications occur in the treated breast, causing difficulties in image interpretation, especially when local recurrence is suspected. Although not included in routine follow-up, magnetic resonance imaging (MRI) is often used in clinical practice, being considered more sensitive than the conventional imaging examinations in discriminating between postsurgical tissue modifications and tumor recurrence. In this review article, we analyze expected and pathologic breast MRI findings after conservative oncoplastic surgery compared to US and mammographic findings in order to distinguish local recurrence and avoid potential pitfalls in image interpretation.

Comparative diagnostic accuracy of 18F-FDG PET/CT for breast cancer recurrence

In the last decades, in addition to conventional imaging techniques and magnetic resonance imaging (MRI), ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has been shown to be relevant in the detection and management of breast cancer recurrence in doubtful cases in selected groups of patients. While there are no conclusive data indicating that imaging tests, including FDG PET/CT, produce a survival benefit in asymptomatic patients, FDG PET/CT can be useful for identifying the site of relapse when traditional imaging methods are equivocal or conflicting and for identifying or confirming isolated loco-regional relapse or isolated metastatic lesions. The present narrative review deals with the potential role of FDG PET in these clinical settings by comparing its accuracy and impact with conventional imaging modalities such as CT, ultrasound, bone scan, ¹⁸F-sodium fluoride PET/CT (¹⁸F-NaF PET/CT) as well as MRI. Patient-focused perspectives in terms of patients' satisfaction and acceptability are also discussed.

Magnetic resonance imaging: the evolution of breast imaging

INTRODUCTION AND AIMS

To provide an overview of the principle of current breast MRI, the available evidence concerning its indications and optimum use and future potentials.

METHODS AND RESULTS

To date sensitivities of 90-91% have been achieved with a specificity of 72-75%. MRI is the most sensitive method for detecting invasive carcinoma and comparable to mammography concerning detection of DCIS. The achievable specificity, false positive and biopsy rates, however, are much lower than for screening mammography thus do not allow its use for screening of the general population. Indications with proven advantages concern screening of women at high risk and special diagnostic problems that cannot be solved by conventional imaging and percutaneous biopsy: search for primary tumour in CUP syndrome, differentiation of nipple retraction, differentiation of scarring versus recurrence and selected difficult cases. There is no proven benefit for its general use for preoperative staging. One major problem may concern the imperfect interface between imaging and surgery. Further research is also needed for the use of MRI in women at intermediate risk. In women at low risk MRI screening is not recommended. Novel possibilities of MRI concern diffusion weighted imaging as well as MR spectroscopy. Their value for improved lesion differentiation is not yet fully established. Their main potential appears to concern an improved and earlier prediction of response to neoadjuvant therapy. Future developments might address development of more specific contrast agents, replacement of vascular enhancing agents by special MR techniques, testing of sodium MRI or image fusion with other imaging modalities.

DISCUSSION/CONCLUSION

MRI allows new patho-physiological information and thus can complement the information available by conventional methods. Present research should concentrate on improving specificity, improving the interface of imaging and surgery and has to include outcome analyses. Due to issues of specificity the responsible use of MRI should be limited to appropriate indications.

First description of MR mammographic findings in the tumor bed after intraoperative radiotherapy (IORT) of breast cancer

The aim was to investigate changes in the tumor bed on magnetic resonance mammography (MRM) after intraoperative radiotherapy (IORT) and whether they would limit the diagnostic value of posttherapeutic MRM. We retrospectively investigated 36 patients undergoing MRM after IORT (median interval 2.8 years, range 0.4-7.1). Wound cavities with fat necrosis were common after IORT (81%). They were associated with persisting contrast enhancement, i.e., enhancement was mostly seen irrespective of the posttherapeutic interval. It normally presented as rim enhancement and did not cause any diagnostic uncertainty if viewed together with other tissue characteristics. We do not expect a limited diagnostic value of MRM after IORT.

The postconservation breast: part 2, Imaging findings of tumor recurrence and other long-term sequelae

OBJECTIVE

The objectives of this article are to highlight the imaging findings of tumor recurrence and other long-term potential sequelae after breast-conserving surgery and radiation therapy, including increased risk of infection and radiation-induced malignancies. The role of MRI as a problem-solving tool in evaluating the conservatively treated breast will also be discussed.

CONCLUSION

Imaging the treated breast presents challenges because of its limited compressibility and overlapping features of benign posttreatment alterations and tumor recurrence. After lumpectomy and radiation therapy, mammographic findings such as breast edema, skin thickening, fluid collections, architectural distortion, and calcifications have characteristic sequences of evolution toward stability. Changes in the imaging appearance after stability has been achieved--including increasing asymmetry, an enlarging mass, increasing edema or skin thickening, and the development of pleomorphic calcifications within or near the operative bed--should alert the radiologist to possible tumor recurrence. When mammography or sonography is indeterminate, MRI may be useful in excluding recurrence or providing a means for biopsy of a suspicious finding.

[Role of imaging in the diagnostic and therapeutic algorithms of breast cancer]

Early diagnosis and prevention have the most significant effect on overall disease specific outcome; 90% of all breast cancer cases could be cured if diagnosed early and treated accurately. As for all diagnostic methods the most important requirement for diagnostic imaging is to detect breast cancer in its early stage, and to determine accurate tumor staging, in order to select the appropriate therapy. Its role is to monitor the effectiveness of therapy, to follow up patients reliably for early detection of recurrent disease. The spectrum of radiological imaging methods in breast cancer became broader in the past two decades; imaging that provides functional or metabolic data and whole body information such as CT, MRI and PET-CT are now available besides common X-ray and ultrasound mammography. The MRI is getting more and more important for the detection and characterization of breast cancer. Multimodal imaging techniques provide more accurate analysis, which is confirmed by increasing statistics authentically, but none of the imaging methods was specific enough to provide histological diagnosis. However, imaging-guided biopsies enable precise histological or cytological confirmation.

[Breast magnetic resonance imaging: state of the art and clinical applications]

Breast magnetic resonance imaging is a modality that is being progressively integrated into the breast radiologist's daily clinical practice. There is consensus on the minimal technical requirements that a breast MR exam should have in order to attain diagnostic quality. Diagnostic criteria are mainly based on the American College of Radiology's BI-RADS magnetic resonance imaging categories. Breast cancer staging is a main clinical application, but it is not universally accepted. Other applications are: response evaluation in patients treated with chemotherapy, screening in high-risk patients, cancer of unknown origin, assessment of a possible relapse and breast implant evaluation.

MR imaging in the evaluation of equivocal clinical and imaging findings of the breast

Because of its high negative predictive value in excluding breast cancer, magnetic resonance (MR) imaging plays a role in the evaluation of selected clinical and imaging findings of the breast, especially when biopsy is not technically feasible. Case selection is very important in ensuring the efficacy of this use of MR imaging because of potential false-positive and (albeit less likely) false-negative results. This article examines the clinical scenarios and imaging findings in which MR imaging is contributory to patient management after conventional workup with equivocal results.

The impact of partial breast reconstruction using reduction techniques on postoperative cancer surveillance

BACKGROUND

Partial breast reconstruction using reduction techniques has recently increased in popularity. Some fear that combining breast conservation therapy with partial breast reconstruction alters the architecture and will affect patterns of local recurrence and make postoperative cancer surveillance more difficult. The purpose of this series was to evaluate long-term postoperative cancer surveillance.

METHODS

The authors retrospectively reviewed the charts and mammograms of patients (n = 17; average follow-up, 6.3 years) who underwent the oncoplastic reduction technique before 2004. Mammography sensitivity was determined by measuring breast density, qualitative changes, and time until mammographic stabilization was determined. These data were compared with those of a control group from the same time period who underwent breast conservation therapy alone (n = 17; average follow-up, 5.9 years).

RESULTS

Typical mammographic findings, including architectural distortion, cysts, and calcifications, were similar between the two groups. There was no significant difference in breast density scores. The oncoplastic reduction group had longer times to mammographic stabilization (21.2 versus 25.6 months, p = 0.23). There was a trend toward a greater number of postoperative mammograms and ultrasounds in the study group when indexed per follow-up year. The rate of tissue sampling in the study group was significantly higher (53 percent) than that in the control group (18 percent).

CONCLUSIONS

The oncoplastic reduction technique remains safe and effective, without significantly affecting postoperative surveillance. Mammographic findings were similar to those observed in patients with breast conservation therapy alone, and sensitivity was not affected. It takes longer to achieve mammographic stability and more patients in the oncoplastic group will require additional diagnostic testing.

Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group

The use of breast magnetic resonance imaging (MRI) is rapidly increasing. EUSOMA organised a workshop in Milan on 20-21st October 2008 to evaluate the evidence currently available on clinical value and indications for breast MRI. Twenty-three experts from the disciplines involved in breast disease management - including epidemiologists, geneticists, oncologists, radiologists, radiation oncologists, and surgeons - discussed the evidence for the use of this technology in plenary and focused sessions. This paper presents the consensus reached by this working group. General recommendations, technical requirements, methodology, and interpretation were firstly considered. For the following ten indications, an overview of the evidence, a list of recommendations, and a number of research issues were defined: staging before treatment planning; screening of high-risk women; evaluation of response to neoadjuvant chemotherapy; patients with breast augmentation or reconstruction; occult primary breast cancer; breast cancer recurrence; nipple discharge; characterisation of equivocal findings at conventional imaging; inflammatory breast cancer; and male breast. The working group strongly suggests that all breast cancer specialists cooperate for an optimal clinical use of this emerging technology and for future research, focusing on patient outcome as primary end-point.

Treatment of breast cancer through the application of irreversible electroporation using a novel minimally invasive single needle electrode

Irreversible electroporation (IRE) is a therapeutic technology for the ablation of soft tissues using electrodes to deliver intense but short electric pulses across a cell membrane, creating nanopores that lead to cell death. This phenomenon only affects the cell membrane, leaving the extracellular matrix and sensitive structures intact, making it a promising technique for the treatment many types of tumors. In this paper, we present the first in vivo study to achieve tumor regression using a translatable, clinically relevant single needle electrode for treatment administration. Numerical models of the electric field distribution for the protocol used suggest that a 1000 V/cm field threshold is sufficient to treat a tumor, and that the electric field distribution will slightly decrease if the same protocol were used on a tumor deep seated within a human breast. Tumor regression was observed in 5 out of 7 MDA-MB231 human mammary tumors orthotopically implanted in female Nu/Nu mice, with continued growth in controls.

Diagnostic breast MR imaging: current status and future directions

Breast MRI has become an integral component in breast imaging. Indications have become clearer and better defined. Guidelines and recommendations are evolving and many are recognized and published. Future applications are exciting and may possibly improve our ability to diagnose breast cancer, improving the patient's treatment options and ultimately patient outcome.

FDG-PET and other imaging modalities for the evaluation of breast cancer recurrence and metastases: a meta-analysis

Background and purpose

Breast carcinoma is the most common cancer in female patients with a propensity for recurrence and metastases. The accuracy of ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), scintimammography (SMM) and positron emission tomography (PET) in diagnosing the recurrent and/or breast cancer has never been systematically assessed, and present systematic review was aimed at this issue.

Methods

MEDLINE and EMBASE were searched for articles dealt with detection of recurrent and/or metastatic breast cancer by US, CT, MRI, SMM or PET whether interpreted with or without the use of CT. Histopathologic analysis and/or close clinical and imaging follow-up for at least 6 months were used as golden reference. We extracted data to calculate sensitivity, specificity, summary receiver operating characteristic curves and area under the curve and to test for heterogeneity.

Result

In 42 included studies, US and MRI had highest pooled specificity (0.962 and 0.929, respectively); MRI and PET had highest pooled sensitivity (0.9500 and 0.9530, respectively). The AUC of US, CT, MRI, SMM and PET was 0.9251, 0.8596, 0.9718, 0.9386 and 0.9604, respectively. Results of pairwise comparison between each modality demonstrated that AUC of MRI and PET was higher than that of US or CT, p < 0.05. No statistical significance was found between MRI and PET. There was heterogeneity among studies and evidence of publication bias.

Conclusion

In conclusion, MRI seemed to be a more useful supplement to current surveillance techniques to assess patients with suspected recurrent and/or metastatic breast cancer. If MRI shows an indeterminate or benign lesion or MRI was not applicable, FDG-PET could be performed in addition.

The feasibility of irreversible electroporation for the treatment of breast cancer and other heterogeneous systems

Developments in breast cancer therapies show potential for replacing simple and radical mastectomies with less invasive techniques. Localized thermal techniques encounter difficulties, preventing their widespread acceptance as replacements for surgical resection. Irreversible electroporation (IRE) is a non-thermal, minimally invasive focal ablation technique capable of killing tissue using electric pulses to create irrecoverable nano-scale pores in the cell membrane. Its unique mechanism of cell death exhibits benefits over thermal techniques including rapid lesion creation and resolution, preservation of the extracellular matrix and major vasculature, and reduced scarring. This study investigates applying IRE to treat primary breast tumors located within a fatty extracellular matrix despite IREs dependence on the heterogeneous properties of tissue. In vitro experiments were performed on MDA-MB-231 human mammary carcinoma cells to determine a baseline electric field threshold (1000 V/cm) to cause IRE for a given set of pulse parameters. The threshold was incorporated into a three-dimensional numerical model of a heterogeneous system to simulate IRE treatments. Treatment-relevant protocols were found to be capable of treating targeted tissue over a large range of heterogeneous properties without inducing significant thermal damage, making IRE a potential modality for successfully treating breast cancer. Information from this study may be used for the investigation of other heterogeneous tissue applications for IRE.

Mammographic appearance of recurrent breast cancer after breast conservation therapy

RATIONALE AND OBJECTIVES

To compare the mammographic appearance of recurrent breast cancer to the primary tumor in patients treated with breast conservation therapy.

MATERIALS AND METHODS

The charts of women with American Joint Committee on Cancer Stage I or II breast cancer who underwent breast conservation therapy between 1977 and 2001 at our institution were reviewed. A total of 132 patients were diagnosed with local recurrence.

RESULTS

The mammographic appearance of the local recurrence often varied from the appearance of the original breast cancer. This was especially true for women who had mammographically occult primary breast cancer. In these women, the recurrence was detected mammographically 76.9% of the time.

CONCLUSIONS

Given the variable appearance of the local recurrence after breast conservation therapy, any suspicious finding needs to be carefully evaluated regardless of the mammographic appearance of the original tumor.

Diagnostic Breast MR Imaging: Current Status and Future Directions

Breast MRI has become an integral component in breast imaging. Indications have become clearer and better defined. Guidelines and recommendations are evolving and many are recognized and published. Future applications are exciting and may possibly improve our ability to diagnose breast cancer, improving the patient's treatment options and ultimately patient outcome.