Will MRI screening deliver the expected survival advantage in BRCA 1 carriers?

Will MRI screening deliver the expected survival advantage in BRCA 1 carriers?
L.J. Hamilton, A.J. Evans, E.J. Cornford, E.A. Rakha, I.O. Ellis, W.D. Foulkes
Clinical Radiology (2009) 64, 1045-1047

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Magnetic resonance imaging (MRI) screening for breast cancer has greater sensitivity than conventional mammographic screening.1,2 Digital mammography gives maximum sensitivity in younger women with denser breasts.3 Combining MRI with digital mammography is likely to give maximum sensitivity. This additional sensitivity offered by MRI has the potential to identify breast cancer at an earlier stage, when the tumours are smaller in size and are not associated with metastases to regional lymph nodes

It is of vital importance that actual mortality data on a cohort of MRI-screened BRCA1 carriers without prior breast cancer are published to en- able an informed decision on the benefits of MRI screening in this group. Until such mortality data are available, the predicted benefits must remain just that - predictions. We urge caution until such time as prospective survival data are available

Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience

Ultrasound-guided vacuum-assisted excision of breast papillomas: review of 6-years experience
A.J. Maxwell
Clinical Radiology (2009) 64, 801-806

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The findings suggests that vacuum-assisted removal is a satisfactory alternative to surgery for the majority of patients, but that particular attention should be paid to ensuring complete lesion removal in view of the relatively high recurrence rate in this series

The Royal College of Radiologists Breast Group breast imaging classification

The Royal College of Radiologists Breast Group breast imaging classification
A.J. Maxwell, N.T. Ridley, G. Rubin, M.G. Wallis, F.J. Gilbert, M.J. Michell

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Standardisation of the classification of breast imaging reports will improve communication between the referrer and the radiologist and avoid ambiguity, which may otherwise lead to mismanagement of patients. Following wide consultation, the Royal College of Radiologists Breast Group has produced a scoring system for the classification of breast imaging. This will facilitate audit and the development of nationally agreed standards for the investigation of women with breast disease.

This five-point system is as follows:

1. normal
2. benign findings
3. indeterminate/probably benign findings
4. findings suspicious of malignancy
5. findings highly suspicious of malignancy

It is recommended that this be used in the reporting of all breast imaging examinations in the UK

NB (Ed) : There are no definitions or lexicon associated with this classification, which renders it less than it could have been, and allows significant variability in reporting, particularly category 2 and 3 findings. These are important differences with the BIRADS classification which will hinder the comparison of data between the US/Europe and the UK

Mammographically non-calcified ductal carcinoma in situ: sonographic features with pathological correlation in 35 patients

Mammographically non-calcified ductal carcinoma in situ: sonographic features with pathological correlation in 35 patients
B. Mesurolle, M. El-Khoury, K. Khetani, N. Abdullah, L. Joseph, E. Kao
Clinical Radiology 64( 6) 2009: 628-636

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Ultrasonographically detected radiographically non-calcified DCIS commonly displays an irregular shape, microlobulated margins, and complex echotexture, giving a “pseudomicrocystic” appearance. Microlobulated margins and “pseudomicrocystic” echotexture seem to be associated with a cancerization of the lobules

Risk–benefit analysis of preoperative breast MRI in patients with primary breast cancer

Risk–benefit analysis of preoperative breast MRI in patients with primary breast cancer
K.C. Siegmann, A. Baur, U. Vogel, B. Kraemer, M. Hahn, C.D. Claussen
Clinical Radiology 2009 64(4): 403-413

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119 patients undergoing pre-operative MRI of the breasts. The findings changed management in 48 patients (40.3%). The change in clinical management and patient benefit were independent of BD and TT (p > 0.05).
The percentage of additional biopsies of benign lesions was 10.1%

NB No difference in outcome between tumour types (rather unexpected)

Patient satisfaction and efficacy of vacuum-assisted excision biopsy of fibroadenomas

Patient satisfaction and efficacy of vacuum-assisted excision biopsy of fibroadenomas
P. Thurley, A. Evans, L. Hamilton, J. James, R. Wilson
Clinical Radiology (2009) 64; 4:381-385

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VAB excision is well-tolerated, safe, and popular with a high initial success rate for fibroadenomas. Bruising and pain are common the week after the procedure