Staging primary breast cancer. Are there tumour pathological features that correlate with a false-negative axillary ultrasound?

Staging primary breast cancer. Are there tumour pathological features that correlate with a false-negative axillary ultrasound?
S. Johnson, S. Brown, G. Portera, J. Steela, K. Paisleya, R. Watkinsa and C. Holgate
Clinical Radiology 2011 66;6:497-499

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Of 155 women with normal ultrasounds, 45 (29%) were node positive at axillary surgery. Breast tumour size was significantly different with the average size smaller in the true-negative group: 21 versus 30 mm (p < 0.02). The histological type varied significantly between the groups, with more lobular carcinomas in the false-negative group [6/110 (5%) versus 6/45 (13%), p < 0.001]. The false-negative group was also more likely to show lymphovascular invasion in the breast [6/110 (5%) versus 14/45 (31%), p < 0.001]. There was no significant difference in tumour grade or ER status.

The present study has found significant differences in tumour characteristics between women with true-negative and false-negative axillary staging ultrasound in terms of size, primary tumour histological type and presence of lymphovascular invasion. In particular, axillary ultrasound in primary lobular carcinoma may be less accurate and a negative result is more likely to be spurious than with primary ductal carcinomas.

Significance of internal mammary lymph nodes in patients after mastectomy with tissue-expander reconstruction: a case–control study

Significance of internal mammary lymph nodes in patients after mastectomy with tissue-expander reconstruction: a case–control study
R. Kaewlai, S.R. Digumarthy, B.L. Smith, A.D. Corben, W.G. Austen Jr., J.-A.O. Shepard, A. Sharma
Clinical Radiology 65 (2010) 453–459
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IMNs are common on imaging after mastectomy and tissue-expander placement. The IMNs decreased or remained stable on follow-up imaging and may represent reactive nodes

Ultrasound of the axilla: where to look for the sentinel lymph node

Ultrasound of the axilla: where to look for the sentinel lymph node
P. Britton, P. Moyle, J.R. Benson, A. Goud, R. Sinnatamby, S. Barter, M. Gaskarth, E. Provenzano, M. Wallis
Clinical Radiology 2010 65:373–376

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Of 121 patients who underwent axillary ultrasound and CB no malignancy was identified in 73, all of whom subsequently underwent SLNB. Histological evidence of CB in the SLN was identified in 47 (64%) patients. The position of all the lymph nodes identified on ultrasound and the 47 patients whose SLNs were identified were drawn on composite diagrams of the axilla.

Of the 36 nodes identified as sentinel whose position relative to other nodes could be determined, 29 (81%) represented the lowest node identified in the axilla, four (11%) were the second lowest, and three (8%) were the third lowest node. None of the four patients whose CB was from the fourth lowest node had the CB site identified at subsequent SLNB

Ultrasound of the axilla should be carried out in a systematic fashion focusing on level I nodes paying particular attention to the lowest one or two lymph nodes

Image-guided breast biopsy: state-of-the-art

Image-guided breast biopsy: state-of-the-art
E.A.M. O'Flynn, A.R.M. Wilson, M.J. Michell
Clin Rad 65;4:259-270

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Review of breast biopsy by the King's team

Criteria for the safe avoidance of needle sampling in young women with solid breast masses

Criteria for the safe avoidance of needle sampling in young women with solid breast masses
A.J. Maxwell, J.M. Pearson
Clinical Radiology 2010 65;3:218-222

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Nine women with breast cancer, seven with phyllodes, and six with papillomas were found.

No delayed diagnoses in those who had ultrasound would have been made if the following criteria had been applied to avoid needle sampling:

• age less than 25 years
• no known risk factors for breast malignancy
• mass not rapidly enlarging
• smooth discrete mobile mass on clinical examination, or lesion impalpable
• well-defined homogeneously isoechoic or mildly hypoechoic solid mass
• less than 3 cm in greatest dimension
• ovoid shape, aligned parallel to the skin surface
• smooth or gently lobulated contour (two or three lobulations only; no microlobulation
• thin echogenic pseudocapsule
• no calcification
• no acoustic shadowing

Needle sampling could have been safely avoided in approximately two-thirds of the women reviewed below the age of 25 with a solid breast mass

Screening for breast cancer post reduction mammoplasty

Screening for breast cancer post reduction mammoplasty
T.M. Muir, J. Tresham, L. Fritschi, E. Wylie
Clinical Radiology 2010 65;3:198-205

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Postoperative breast changes following reduction mammoplasty do not significantly hinder analysis of the screening mammogram

Lesion size is a major determinant of the mammographic features of ductal carcinoma in situ: findings from the Sloane project

Lesion size is a major determinant of the mammographic features of ductal carcinoma in situ: findings from the Sloane project
A. Evans, K. Clements, A. Maxwell, H. Bishop, A. Hanby, G. Lawrence, S.E. Pinder
Clinical Radiology 2010 65;3:181-184

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Lesion size has a strong influence on the radiological features of calcific DCIS; small, high-grade lesions often show no casting calcifications, whereas casting calcifications are seen in nearly half of large, low-grade lesions. As small clusters of punctate or granular calcifications may represent high-grade DCIS, an aggressive clinical approach to the diagnosis of such lesions is recommended as the adequate treatment of high-grade DCIS will prevent the occurrence of potentially life-threatening high-grade invasive disease