Prediction of the presence of invasive disease from the measurement of extent of malignant microcalcification on mammography and DCIS

Prediction of the presence of invasive disease from the measurement of extent of malignant microcalcification on mammography and ductal carcinoma in situ grade at core biopsy
E.A.M. O'Flynn, J.C. Morel, J. Gonzalez, N. Dutt, D. Evans, R. Wasan, M.J. Michell
Clinical Radiology 64, Issue 2, February 2009, Pages 178-183

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Risk of invasion associated positively with -

increased cluster size

Cluster size DCIS (mm)	Total cases	Invasive cases	Non-invasive cases
<11	136	27 (20%)	109 (81%)
11–30	131	40 (31%)	91 (69%)
31–60	95	33 (35%)	62 (65%)
>60	40	18 (45%)	22 (55%)
Total	402	118 (29%)	284 (71%)

Increasing DCIS Grade

DCIS grade	All cases	Invasive cases	Non-invasive cases
Low	31	4 (13%)	27 (87%)
Intermediate	103	26 (25%)	77 (75%)
High	239	86 (36%)	153 (64%)
Unclassified	3	1 (33%)	2 (67%)
Unknown	26	1 (4%)	25 (96%)
Total	402	118 (29%)	284 (71%)

Allows risk of invasion to be objectively estimated pre-operatively, and therefore an informed decision made about whether SLNB should be performed at the same time as definitive surgery

Does computer-aided detection have a role in the arbitration of discordant double-reading opinions in a breast-screening programme?

Does computer-aided detection have a role in the arbitration of discordant double-reading opinions in a breast-screening programme?
J.J. James, E.J. Cornford
Clinical Radiology (2009) 64, 46 - 51

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The main effect of CAD acting as an arbitrator of discordant double-reading opinions is to increase
the recall rate, significantly above what is found when arbitration is performed by an independent third reader. Using CAD as an arbitrator may be an option to deal with discordant double-reading opinions when no other method of consensus or arbitration is available

Dual time point FDG-PET/CT imaging… Potential tool for diagnosis of breast cancer

Dual time point FDG-PET/CT imaging… Potential tool for diagnosis of breast cancer
A.A. Zytoon, K. Murakami, M.R. El-Kholy, E. El-Shorbagy
Clinical Radiology (2008) 63, 1213e1227

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This is an interesting Egyptian study showing that dual time point FDG-PET/CT improves the discrimination between non-invasive and invasive cancers, and provided superior sensitivity for the detection of small cancers and cancers in dense breast.

PET/CT in breast cancer is becoming increasingly used in the western world, and new indications are regularly being found. This may be one of them if validated in another study

The mammographic correlations of a new immunohistochemical classification of invasive breast cancer

The mammographic correlations of a new immunohistochemical classification of invasive breast cancer
Clinical Radiology, 2008, 63; 11: 1228-1235

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The mammographic features of breast cancer show significant correlation with molecular classes of invasive breast cancer identified by protein expression IHC analysis. The biological reasons for the findings and implications of these regarding imaging protocols require further study and may provide mechanisms for improvement of detection of these lesions

Radiological appearances of papillary breast lesions

Radiological appearances of papillary breast lesions
M.J. Brookes and A.G. Bourke
Clinical Radiology 2008 63; 11:1265-1273

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The commonest mammographic appearance of a papillary tumour is as a soft-tissue mass, with calcification present in less than half of cases. When calcification is present the pattern is variable, but clusters of pleomorphic calcification can occur, sometimes resembling the mammographic appearance of invasive ductal carcinoma. Ultrasonography of papillary lesions typically shows a solid, oval, intraductal mass, often associated with duct dilatation. A cystic component is also commonly seen, and lesions may appear hypervascular on colour Doppler ultrasound. Magnetic resonance imaging (MRI) has a high sensitivity, but low specificity for detecting papillary tumours, and is useful in establishing the extent and distribution of lesions in patients with multiple papillomatosis. Despite a benign histology on core biopsy, an argument exists for complete surgical excision of all papillary tumours, as a significant proportion of papillomas will contain foci of atypia or overt malignant change

Dual time point FDG-PET/CT imaging… Potential tool for diagnosis of breast cancer

Dual time point FDG-PET/CT imaging… Potential tool for diagnosis of breast cancer
A.A. Zytoon, K. Murakami, M.R. El-Kholy and E. El-Shorbagy
Clinical Radiology 2008 63,11: 1213-1227

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Dual time point FDG-PET/CT improves the discrimination between non-invasive and invasive cancers, and provided superior sensitivity for the detection of small cancers and cancers in dense breast

Ultrasound diagnosis of fibroadenoma — is biopsy always necessary?

G.E.C. Smith and P. Burrows
followed by commentary by Barbara Dall
Clinical Radiology Volume 63, Issue 5, May 2008, Pages 511-515

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The majority of patients in the 25 years and under age group have benign breast pathology, most commonly fibroadenoma. Modern ultrasound is a reliable technique to diagnose fibroadenoma in the hands of experienced breast radiologists. Therefore, in this age group, it is proposed that a palpable lump that has the ultrasound characteristics entirely consistent with a fibroadenoma need not be biopsied unless there is overriding clinical concern. The patients should be reassured, discharged, and advised to return for further evaluation only if they detect a change in the palpable abnormality

A project is also being co-ordinated by Robin Wilson, surveying the data from UK breast screening centres. May be presented at the RCRBG annual meeting this November

Experience with ultrasonographically guided vacuum-assisted resection of benign breast tumors

N. Tagaya, A. Nakagawa, Y. Ishikawa, T. Oyama and K. Kubota
Clinical Radiology 63, Issue 4, April 2008, Pages 396-400

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Aim - To evaluate the feasibility and safety of vacuum-assisted resection of benign breast tumours using an 8 G handheld device.

Materials and Methods - Over a 2-year period, 22 patients with 26 breast tumours diagnosed as benign using aspiration biopsy cytology were enrolled. The mean patient age was 38 years, and the mean maximal diameter of the tumour was 13 mm. A handheld Aloka SSD 6500 ultrasonography device with a linear-type 7.5 MHz transducer was inserted into the posterior aspect of the tumour with the patient under local anaesthesia, and the tumour was resected under ultrasonographic guidance.

Results - This method was employed successfully in all patients, and the mean operation time was 33 min. Post-procedure complications included subcutaneous bleeding in 12 cases and haematoma in one. The pathological diagnoses were fibroadenoma in 16 cases, mastopathy in six, and tubular adenoma and pseudoangiomatous stromal hyperplasia in two cases each, respectively. Follow-up ultrasonography revealed residual tumours in four cases (15.4%).

Conclusions - Although this method is feasible and safe without severe complications, it is necessary to select appropriate patients, and to obtain informed consent regarding the possibility of recurrence or residual tumour.