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Batohi B, Fang C, Michell MJ, Morel J, Shah C, Wijesuriya S, Peacock C, Rahim R, Wasan R, Goligher J, Satchithananda K. An audit of mammographic screen detected lesions of uncertain malignant potential (B3) diagnosed on initial image guided needle biopsy: how has our practice changed over 10 years? Clin Radiol 2019; 74:653.e19-653.e25. [PMID: 31078275 DOI: 10.1016/j.crad.2019.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/03/2019] [Indexed: 11/25/2022]
Abstract
AIM To review all cases of B3 lesion diagnosed at initial image-guided needle biopsy over two 5-year cohorts to identify upgrade rates to malignancy and the effect of changing guidance on the management of such lesions. MATERIALS AND METHODS Data was collected retrospectively. Mammographic features, biopsy type and management were recorded for each lesion. Upgrade rates for each B3 histological category were quantified. Statistical analysis was performed using SPSS. RESULTS There were 224 cases in 2005-2010 and 240 cases in 2010-2015. Mammographically 211 lesions were microcalcifications, 182 masses, 65 distortions and six asymmetric densities with no difference in the mammographic features in the two cohorts. Two hundred and eight 14 G core biopsies and 256 initial vacuum-assisted biopsies were performed. There was a statistically significant reduction in benign surgical biopsies and an increase in second-line vacuum biopsy/excision in the latter cohort, with no significant change in the upgrade rate. There was an overall 6% upgrade to invasive malignancy and 13% upgrade to ductal carcinoma in situ (DCIS). The upgrade rates for the following histological categories were atypical intraductal epithelial proliferation (AIDEP) 33.2% (21/63); classical (not pleomorphic) in situ lobular neoplasia (ISLN) 18.2% (6/33); flat epithelial hyperplasia (FEA) 21.7% (20/92); papilloma with atypia 53.8% (7/13), without atypia 12.1% (8/66); and radial scar/complex sclerosing lesion with atypia 16.7% (2/12), and without atypia 7.9% (6/76). CONCLUSION Upgrade rates remain high for some histological categories even with first-line use of vacuum biopsy. Management of borderline lesions should be considered carefully in a multidisciplinary meeting. In many cases, the need for diagnostic surgical excision has been replaced by image-guided vacuum sampling.
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Affiliation(s)
- B Batohi
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
| | - C Fang
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - M J Michell
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - J Morel
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - C Shah
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - S Wijesuriya
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - C Peacock
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - R Rahim
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - R Wasan
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - J Goligher
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - K Satchithananda
- Department of Breast Radiology and National Breast Screening Training Centre, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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Lowes S, Leaver A, Cox K, Satchithananda K, Cosgrove D, Lim A. Evolving imaging techniques for staging axillary lymph nodes in breast cancer. Clin Radiol 2018; 73:396-409. [DOI: 10.1016/j.crad.2018.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/02/2018] [Indexed: 12/18/2022]
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Lim AKP, Satchithananda K, Dick EA, Abraham S, Cosgrove DO. Microflow imaging: New Doppler technology to detect low-grade inflammation in patients with arthritis. Eur Radiol 2017; 28:1046-1053. [PMID: 29022101 PMCID: PMC5811585 DOI: 10.1007/s00330-017-5016-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 06/04/2017] [Accepted: 08/02/2017] [Indexed: 11/28/2022]
Abstract
Aim To assess the efficacy of microvascular imaging in detecting low-grade inflammation in arthritis compared with Power Doppler ultrasound (PDUS). Method and materials Patients presenting for ultrasound with arthralgia were assessed with grey-scale, PDUS and Superb Microvascular Imaging (SMI). Videoclips were stored for analysis at a later date. Three musculoskeletal radiologists scored grey-scale changes, signal on PDUS and/or SMI within these joints. If a signal was detected on both PDUS and SMI, the readers graded the conspicuity of vascular signal from the two Doppler techniques using a visual analogue scale. Results Eighty-three patients were recruited with 134 small joints assessed. Eighty-nine of these demonstrated vascular flow with both PD and SMI, whilst in five no flow was detected. In 40 joints, vascularity was detected with SMI but not with PDUS (p = 0.007). Out of the 89 joints with vascularity on both SMI and PDUS, 23 were rated as being equal; while SMI scored moderately or markedly better in 45 cases (p <0.001). Conclusion SMI is a new Doppler technique that increases conspicuity of Doppler vascularity in symptomatic joints when compared to PDUS. This allows detection of low grade inflammation not visualised with Power Doppler in patients with arthritis. Key Points • SMI detects vascularity with improved resolution and sensitivity compared to Power Doppler. • SMI can detect low-grade inflammation not seen with Power Doppler. • Earlier detection of active inflammation could have significant impact on treatment paradigms. Electronic supplementary material The online version of this article (doi:10.1007/s00330-017-5016-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A K P Lim
- Department of Imaging, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK. .,Department of Experimental Medicine and Therapeutics, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0HS, UK. .,Digestive Diseases, Department of Surgery and Cancer, Imperial College London, QEQM, St. Mary's Hospital, Praed Street W2, London, UK.
| | - K Satchithananda
- Department of Imaging, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - E A Dick
- Department of Imaging, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - S Abraham
- Digestive Diseases, Department of Surgery and Cancer, Imperial College London, QEQM, St. Mary's Hospital, Praed Street W2, London, UK.,Department of Rheumatology and Medicine, NIHR/Wellcome Clinical Research Facility, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 OHS, UK
| | - D O Cosgrove
- Department of Imaging, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
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Satchithananda K, Sellars MEK, Ryan SM, Sidhu PS. Microbubble Ultrasound Contrast Agents in the Visualization of Peripheral Vasculature in 'Doppler Rescue': A Review. Ultrasound 2016. [DOI: 10.1179/174227104x5043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Microbubble ultrasound contrast agents were developed for use in the macrovascular circulation as an adjunct to a colour Doppler ultrasound examination — 'Doppler-rescue'. Although technical developments and the unique behavior of microbubble contrast in the liver have eclipsed the original perceived use, there remains an important role for microbubble contrast in the peripheral vasculature. This review details the applications of microbubble contrast agents in 'Doppler-rescue', with illustrations of important disease processes suitable for examination with microbubble contrast in order to reduce further radiological investigations.
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Wasan R, Morel J, Iqbal A, Evans D, Goligher J, Peacock C, Rahim R, Satchithananda K, Michell M. Digital breast tomosynthesis improves the accuracy of the diagnosis of circumscribed lesions because of increase of margin visibility. Breast Cancer Res 2014. [PMCID: PMC4243136 DOI: 10.1186/bcr3701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
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Parsons TM, Satchithananda K, Berbe R, Siddiqui IA, Robinson E, Hart AJ. [MRI investigations in patients with problems due to metal-on-metal implants]. Orthopade 2014; 42:629-36. [PMID: 23912305 DOI: 10.1007/s00132-012-2036-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Until recently, metal-on-metal (MoM) hip implants were commonly used for joint replacement and resurfacings. Their use has rapidly declined following reports of Frühversagen and soft tissue disease caused by the release of metal debris from the prosthesis. Detection of these soft tissue lesions has proven difficult using conventional imaging techniques and blood metal ion tests. Current guidelines recommend the use of imaging modalities including metal artefact reduction sequence (MARS) magnetic resonance imaging (MRI), computed tomography and ultrasound but provide little indication which is best. MARS significantly reduces the susceptibility artefact induced by the presence of metal objects, thereby producing diagnostic quality images that can be shared with other physicians and compared over time. The clinical interpretation of MRI findings of solid pseudotumours and severe muscle atrophy is straightforward: revision is usually recommended. However, the most common MRI findings are of a cystic pseudotumour and minor muscle wasting. In these cases decision-making is difficult and we currently use multi-disciplinary and multi-colleague based meetings to make decisions regarding patient management. This article presents a comparison of imaging modalities and an update on the interpretation of MARS MRI for the investigation of patients with MoM hip implants.The English full-text version of this article is available at Springer Link (under "Supplemental").
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Siddiqui I, Sabah S, Satchithananda K, Lim A, Henckel J, Skinner J, Hart A. Cross-sectional imaging of the metal-on-metal hip prosthesis: The London ultrasound protocol. Clin Radiol 2013; 68:e472-8. [DOI: 10.1016/j.crad.2013.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 01/29/2013] [Accepted: 02/07/2013] [Indexed: 11/26/2022]
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Hughes EK, Nassar L, Lim A, Barrett N, Comitis S, Cunningham D, Flais S, Gupta A, Ralleigh G, Stewart V, Svensson W, Williamson R, Zaman N, Satchithananda K. Automated breast volume scanner: an initial experience. Breast Cancer Res 2011; 13 Suppl 1:O1-6, P1-47. [PMID: 22151232 PMCID: PMC3238232 DOI: 10.1186/bcr2947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lee B, Lim A, Krell J, Satchithananda K, Lewis JS, Stebbing J, Meric-Bernstam F. Re-evaluating the efficacy of axillary ultrasound in the detection of nodal metastasis and its impact on clinical practice. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4 Background: Recent reports have indicated a lack of overall survival benefit for axillary node dissection versus sentinel lymph node biopsy in early breast cancer. To study this further, we wished to assess the accuracy and effectiveness of ultrasound guided fine needle aspiration (FNA) cytology in detecting lymph node involvement in breast cancer patients, in order to refine and evaluate our current clinical pathways as newly diagnosed invasive breast cancer patients routinely undergo pre-surgical axillary ultrasound. Methods: An FNA was taken from nodes of consecutive patients, which appeared abnormal on ultrasonography based on size, morphology, fatty hilum and cortical thickness measurements. Ultrasound and FNA cytological findings were correlated with histology following axillary node dissection. Of 260 cases, 123 (47.3%) had metastatic nodal involvement. Of these cases, only 66 (53.7%) were reported as positive on US findings. Results: The overall positive predictive value (PPV) of ultrasound for detecting metastatic nodal involvement measured 0.82, and the negative predictive value (NPV) was 0.60. The sensitivity was 0.54, specificity measured 0.85 and the accuracy was 0.68. The ultrasound morphological nodal features with the greatest correlation with malignancy were absence of a fatty hilum (p=0.003) and an increased cortical thickness (p=0.03). Cases with a metastatic nodal burden density of a least 20% were also more likely to be detected as abnormal on axillary ultrasound. (p=0.009). Conclusions: Axillary ultrasound has a low NPV and negative sonographic results do not exclude node metastases with sufficient sensitivity in most cases, to justify its routine clinical use. [Table: see text]
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Affiliation(s)
- B. Lee
- Imperial College NHS Trust Hospitals, Department of Medical Oncology, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Radiology, London, United Kingdom; Department of Oncology, Cancer Research UK Laboratories, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial College NHS Trust Hospitals, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Surgery, London, United Kingdom; Imperial College, London, United Kingdom; University of Texas
| | - A. Lim
- Imperial College NHS Trust Hospitals, Department of Medical Oncology, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Radiology, London, United Kingdom; Department of Oncology, Cancer Research UK Laboratories, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial College NHS Trust Hospitals, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Surgery, London, United Kingdom; Imperial College, London, United Kingdom; University of Texas
| | - J. Krell
- Imperial College NHS Trust Hospitals, Department of Medical Oncology, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Radiology, London, United Kingdom; Department of Oncology, Cancer Research UK Laboratories, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial College NHS Trust Hospitals, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Surgery, London, United Kingdom; Imperial College, London, United Kingdom; University of Texas
| | - K. Satchithananda
- Imperial College NHS Trust Hospitals, Department of Medical Oncology, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Radiology, London, United Kingdom; Department of Oncology, Cancer Research UK Laboratories, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial College NHS Trust Hospitals, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Surgery, London, United Kingdom; Imperial College, London, United Kingdom; University of Texas
| | - J. S. Lewis
- Imperial College NHS Trust Hospitals, Department of Medical Oncology, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Radiology, London, United Kingdom; Department of Oncology, Cancer Research UK Laboratories, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial College NHS Trust Hospitals, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Surgery, London, United Kingdom; Imperial College, London, United Kingdom; University of Texas
| | - J. Stebbing
- Imperial College NHS Trust Hospitals, Department of Medical Oncology, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Radiology, London, United Kingdom; Department of Oncology, Cancer Research UK Laboratories, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial College NHS Trust Hospitals, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Surgery, London, United Kingdom; Imperial College, London, United Kingdom; University of Texas
| | - F. Meric-Bernstam
- Imperial College NHS Trust Hospitals, Department of Medical Oncology, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Radiology, London, United Kingdom; Department of Oncology, Cancer Research UK Laboratories, Imperial College Healthcare NHS Trust, London, United Kingdom; Imperial College NHS Trust Hospitals, London, United Kingdom; Imperial College NHS Trust Hospitals, Department of Surgery, London, United Kingdom; Imperial College, London, United Kingdom; University of Texas
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Sorelli PG, Cosgrove DO, Svensson WE, Zaman N, Satchithananda K, Barrett NK, Lim AKP. Can contrast-enhanced sonography distinguish benign from malignant breast masses? J Clin Ultrasound 2010; 38:177-181. [PMID: 20146214 DOI: 10.1002/jcu.20671] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND We investigated whether microvascular enhancement on contrast-enhanced sonographic (CEUS) imaging can aid in distinguishing between benign and malignant lesions and correlated these findings with histopathological findings. METHOD Fifteen patients with a palpable breast mass were recruited. Following informed consent, 4.8 mL of the microbubble contrast agent SonoVue was injected intravenously. Digital video clips of lesion enhancement were obtained and reviewed by a consultant radiologist who scored each lesion on the following characteristics: homogeneous versus heterogeneous enhancement, the presence or absence of focal defects, well- versus ill-defined margins and vascular morphology score (VMS). RESULT Histologically there were 7 malignant and 8 benign lesions. The calculated sensitivity for CEUS in the diagnosis of malignancy was 100%, with a 37.5% specificity. There was no statistically significant difference in overall mean VMS between the malignant and benign lesions. CONCLUSION The results of our study have not shown any additional benefit in the use of CEUS over conventional triple assessment. The positive trend seen in the higher mean VMS for the malignant tumors needs further investigation with a larger cohort of patients.
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Affiliation(s)
- P G Sorelli
- Department of Surgery, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, United Kingdom
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Meades RT, Svensson WE, Frank JW, Gada V, Ralleigh G, Satchithananda K, Barrett N, Nijran KS. Carcinoma of the breast wire localisation post nuclear medicine sentinel lymph node imaging. Are radiologists receiving a significant dose? Eur Radiol 2009; 20:529-32. [PMID: 19763580 DOI: 10.1007/s00330-009-1594-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 07/28/2009] [Accepted: 08/06/2009] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the radiation dose received by the radiologist when performing wire localisation for axillary radio-isotope sentinel node imaging-guided biopsy in patients with impalpable breast cancers treated with breast-preserving excision. When wire placement follows radio-isotope sentinel node imaging (RSNI) the radiologist is exposed to a radiation risk that has never been previously assessed. METHODS Radiation doses to radiologists performing ultrasound-guided localisation following nuclear medicine sentinel node imaging were measured for procedures on the day of surgery (20 MBq) and also on the day before surgery (40 MBq). These measurements were compared with theoretically calculated doses. RESULTS Twelve patients showed comparable results between measurements and estimated doses. The mean measured dose was 1.8 muSv (estimated 1.8 muSv) for same-day and 4.8 muSv (estimated 3.4 muSv) for next-day surgery cases. At worst, radiologists who perform 36 wire localisations per year immediately following RSNI receive a radiation dose of 0.17 mSv. CONCLUSIONS This study highlights the need to inform radiologists of the relative risk when performing pre-surgical localisation after RSNI. This risk should be justified locally in accordance with the total dose received by the localising radiologist. Particular consideration should be given to pregnant staff and the possibility of performing wire localisations before radio-isotope injection.
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Affiliation(s)
- R T Meades
- Imperial College Healthcare NHS Trust, London, UK
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Wakeham NR, Satchithananda K, Svensson WE, Barrett NK, Comitis S, Zaman N, Ralleigh G, Sinnett D, Shousha S, Lim AKP. Colorectal breast metastases presenting with atypical imaging features. Br J Radiol 2008; 81:e149-53. [PMID: 18440938 DOI: 10.1259/bjr/62391254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast metastases from non-breast primaries are rare in female patients and exceedingly rare in male patients, with only a handful of cases described. Lymphoma, metastatic melanoma and bronchial carcinoma are the primary sites for the majority of breast metastases. Breast metastases from colorectal carcinoma have been described previously in only a small number of cases in the literature. Here, we report a further two patients with biopsy-proven colorectal carcinoma metastases to both breasts, who demonstrate contrasting unusual and atypical imaging features that have not been reported previously. In one case, the imaging appearances mimic a multifocal primary breast carcinoma. Metastatic disease in the breast is a marker for disseminated metastatic spread, with a correspondingly poor prognosis. Therefore, we review the imaging features that differentiate metastatic breast disease from multifocal breast primaries, which are important to recognize because the management options for these patients differ greatly.
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Affiliation(s)
- N R Wakeham
- Department of Radiology, West of London Breast Screening Service, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
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Wakeham NR, Satchithananda K, Barrett NK. Audit of wide bore needle biopsies graded B3: does the final pathology justify the increasing rate of benign biopsy? Breast Cancer Res 2006. [PMCID: PMC3332662 DOI: 10.1186/bcr1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Acute appendicitis presenting with scrotal symptoms is a rare event, occurring when a patent processus vaginalis persists. We present a case where ultrasound demonstrated an inflamed appendix and a scrotal abscess, allowing the correct surgical management in a difficult clinical situation. In a child presenting with scrotal signs and vague lower abdominal symptoms, an ultrasound assessment of the right iliac fossa should always be performed.
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Affiliation(s)
- K Satchithananda
- Department of Diagnostic Radiology, Kings College Hospital, Denmark Hill, London, UK
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