Do screen-detected lobular and ductal carcinoma present with different mammographic features?
S GARNETT, M WALLIS, and G MORGAN
Br J Radiol 2009;82 20-27
Link to Journal
The CC view is optimum for distinctly visualizing ILC as a spiculate mass, as it appears as a more subtle distortion or asymmetry on the MLO view. ILC is not often isolated from the main glandular density and so optimizing visualization of this area of the breast is key to perception
Main message - Lobular cancers are easily missed on MLO films, but appear as a spiculate mass on the CC
Friday, 19 December 2008
Tuesday, 22 July 2008
Distinct lymph nodal sonographic characteristics in breast cancer patients at high risk for axillary metastases correlate with the final axillary stag
Distinct lymph nodal sonographic characteristics in breast cancer patients at high risk for axillary metastases correlate with the final axillary stage
A MOORE, M HESTER, M-W NAM, Y M BRILL, P McGRATH, H WRIGHT, K, WEISINGER, E ROMOND, and L M SAMAYOA
Br J Radiol 2008;81 630-636
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The purpose of this study was to assess the clinical relevance, limitations and most common findings of axillary ultrasound and subsequent image-guided aspiration cytology in clinically node-negative breast cancer patients who are at high risk for axillary metastasis. Following institutional review board approval and Health Insurance Portability and Accountability Act (HIPAA) compliance, sonographic axillary surveys from 112 patients considered at high risk for axillary metastases were reviewed retrospectively for the following abnormal features: asymmetric cortical thickening/lobulations; loss or compression of the hyperechoic medullary region; absence of fatty hilum; abnormal lymph node shape; hypoechoic cortex; admixture of normal and abnormal appearing nodes; and increased peripheral blood flow. Patients with either normal or abnormal ultrasound exams, but negative cytology, underwent sentinel node mapping. Patients with abnormal ultrasound and positive cytology proceeded to complete axillary dissection. The number of positive nodes, the size of tumour deposits and the histological pattern of metastatic disease on the positive nodes were then correlated and compared with their corresponding sonographic abnormalities. Abnormalities related to the lymph node cortex were indicative of N1a disease. Features such as loss or compression of the hyperechoic medullary region, absence of fatty hilum, abnormal lymph node shape and increased peripheral blood flow were predictors of N2–3 disease.
In conclusion, nodal sonographic characteristics of patients at high risk for metastases are useful predictors of tumour burden in the axilla. When combined with the results from aspiration cytology, these findings could modify the surgical approach to the axilla, eliminating the need for sentinel node mapping in a significant proportion of patients.
A MOORE, M HESTER, M-W NAM, Y M BRILL, P McGRATH, H WRIGHT, K, WEISINGER, E ROMOND, and L M SAMAYOA
Br J Radiol 2008;81 630-636
Link to Journal
The purpose of this study was to assess the clinical relevance, limitations and most common findings of axillary ultrasound and subsequent image-guided aspiration cytology in clinically node-negative breast cancer patients who are at high risk for axillary metastasis. Following institutional review board approval and Health Insurance Portability and Accountability Act (HIPAA) compliance, sonographic axillary surveys from 112 patients considered at high risk for axillary metastases were reviewed retrospectively for the following abnormal features: asymmetric cortical thickening/lobulations; loss or compression of the hyperechoic medullary region; absence of fatty hilum; abnormal lymph node shape; hypoechoic cortex; admixture of normal and abnormal appearing nodes; and increased peripheral blood flow. Patients with either normal or abnormal ultrasound exams, but negative cytology, underwent sentinel node mapping. Patients with abnormal ultrasound and positive cytology proceeded to complete axillary dissection. The number of positive nodes, the size of tumour deposits and the histological pattern of metastatic disease on the positive nodes were then correlated and compared with their corresponding sonographic abnormalities. Abnormalities related to the lymph node cortex were indicative of N1a disease. Features such as loss or compression of the hyperechoic medullary region, absence of fatty hilum, abnormal lymph node shape and increased peripheral blood flow were predictors of N2–3 disease.
In conclusion, nodal sonographic characteristics of patients at high risk for metastases are useful predictors of tumour burden in the axilla. When combined with the results from aspiration cytology, these findings could modify the surgical approach to the axilla, eliminating the need for sentinel node mapping in a significant proportion of patients.
Friday, 16 May 2008
CT-scan-based localization of the internal mammary chain
A novel method for CT-scan-based localization of the internal mammary chain by internal mammary catheterization: an aid in breast cancer radiation therapy planning
A MUNSHI, I MALLICK, A BUDRUKKAR, R JALALI, R BADWE, K A DINSHAW, and R SARIN
Br J Radiol 2008;81 485-489
Link to Journal
The purpose of the study was to evaluate the localization of the internal mammary lymph node chain (IMC) using CT scan data acquired after intraoperative placement of a catheter into the internal mammary vessel (IMV). There appears to be a wide variation in the depth and location of the IMC, as recorded by CT measurements of the catheter in the IMV, demonstrating the need for individual planning. The IMC nodal area is likely to be out of the tangential portals employed in conventional practice.
A MUNSHI, I MALLICK, A BUDRUKKAR, R JALALI, R BADWE, K A DINSHAW, and R SARIN
Br J Radiol 2008;81 485-489
Link to Journal
The purpose of the study was to evaluate the localization of the internal mammary lymph node chain (IMC) using CT scan data acquired after intraoperative placement of a catheter into the internal mammary vessel (IMV). There appears to be a wide variation in the depth and location of the IMC, as recorded by CT measurements of the catheter in the IMV, demonstrating the need for individual planning. The IMC nodal area is likely to be out of the tangential portals employed in conventional practice.
Friday, 25 April 2008
Colorectal breast metastases presenting with atypical imaging features
N R WAKEHAM, K SATCHITHANANDA, W E SVENSSON, N K BARRETT, S COMITIS, N
ZAMAN, G RALLEIGH, D SINNETT, S SHOUSHA, and A K P LIM
Br J Radiol 2008;8
Link to journal
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.
ZAMAN, G RALLEIGH, D SINNETT, S SHOUSHA, and A K P LIM
Br J Radiol 2008;8
Link to journal
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.
Wednesday, 13 February 2008
An investigation into the effects of suboptimal viewing conditions in screen-film mammography
K J ROBSON
Br J Radiol 2008;81 219-231
http://bjr.birjournals.org/cgi/content/abstract/81/963/219?etoc
The ability of an observer to detect objects on a radiograph is influenced by the conditions under which the image is viewed. Therefore, to ensure that as much diagnostically relevant information as possible can be extracted from the image, it is important that satisfactory viewing conditions for the task are established and maintained. Factors that are thought to be important are the luminance of the image, glare and ambient light. Together, these factors lead to the formation of reflection on the image, which may degrade the observer's performance. The purpose of this study was to explore, in a systematic manner, the effect of the factors outlined above on the performance of an observer conducting a threshold contrast–detail diameter test. Each factor was investigated separately with attempts made to minimize the confounding effects of other factors. When examined individually, viewing box luminance, ambient light and glare were found to have little effect on the contrast–detail performance of the observers. Reflection was found to have a significant effect, particularly non-uniform reflection, and the magnitude of the effect was related to the contrast degradation factor and reflection modulation. These quantities, which are derived from basic photometric measurements, may be used to develop a protocol to assess viewing conditions in screen-film mammography.
Br J Radiol 2008;81 219-231
http://bjr.birjournals.org/cgi/content/abstract/81/963/219?etoc
The ability of an observer to detect objects on a radiograph is influenced by the conditions under which the image is viewed. Therefore, to ensure that as much diagnostically relevant information as possible can be extracted from the image, it is important that satisfactory viewing conditions for the task are established and maintained. Factors that are thought to be important are the luminance of the image, glare and ambient light. Together, these factors lead to the formation of reflection on the image, which may degrade the observer's performance. The purpose of this study was to explore, in a systematic manner, the effect of the factors outlined above on the performance of an observer conducting a threshold contrast–detail diameter test. Each factor was investigated separately with attempts made to minimize the confounding effects of other factors. When examined individually, viewing box luminance, ambient light and glare were found to have little effect on the contrast–detail performance of the observers. Reflection was found to have a significant effect, particularly non-uniform reflection, and the magnitude of the effect was related to the contrast degradation factor and reflection modulation. These quantities, which are derived from basic photometric measurements, may be used to develop a protocol to assess viewing conditions in screen-film mammography.
Trends in compressed breast thickness and radiation dose in breast screening mammography
M ROBINSON and C J KOTRE
Br J Radiol 2008;81 214-218
http://bjr.birjournals.org/cgi/content/abstract/81/963/214?etoc
An analysis was performed of the compressed breast thickness recorded in 146 mammographic patient dose surveys each consisting of 50 or more women carried out between 1993 and 2004. The results show a steady and statistically significant increase in compressed breast thickness with time, which is also present when individual independent screening centres and equipment manufacturers are compared. This increase seems most likely to be associated with an increase in the proportion of women in the breast screening age range classified as overweight and obese, which has occurred over the same time period. The associated trends in mean glandular dose per image were calculated for the mammography units used at the time of the surveys, using the most recently published conversion factors. The increase in average radiation dose that might have been expected as a result of the increase in average compressed breast thickness was not actually found in practice, possibly because of advances in equipment design and dose optimization strategies made during the 11-year period. Other implications of an increasing average compressed breast thickness are discussed.
Br J Radiol 2008;81 214-218
http://bjr.birjournals.org/cgi/content/abstract/81/963/214?etoc
An analysis was performed of the compressed breast thickness recorded in 146 mammographic patient dose surveys each consisting of 50 or more women carried out between 1993 and 2004. The results show a steady and statistically significant increase in compressed breast thickness with time, which is also present when individual independent screening centres and equipment manufacturers are compared. This increase seems most likely to be associated with an increase in the proportion of women in the breast screening age range classified as overweight and obese, which has occurred over the same time period. The associated trends in mean glandular dose per image were calculated for the mammography units used at the time of the surveys, using the most recently published conversion factors. The increase in average radiation dose that might have been expected as a result of the increase in average compressed breast thickness was not actually found in practice, possibly because of advances in equipment design and dose optimization strategies made during the 11-year period. Other implications of an increasing average compressed breast thickness are discussed.
Cancer surveillance based on imaging techniques in carriers of BRCA1/2 gene
Cancer surveillance based on imaging techniques in carriers of BRCA1/2 gene mutations: a systematic review
M J BERMEJO-PEREZ, S MARQUEZ-CALDERON, and A LLANOS-MENDEZ
Br J Radiol 2008;81 172-179
http://bjr.birjournals.org/cgi/content/abstract/81/963/172?etoc
We have systematically reviewed the literature focusing on the performance of surveillance programmes and imaging techniques for the early diagnosis of breast and ovarian cancer in women carrying mutations in BRCA1/2 genes. All studies on imaging techniques for the diagnosis of breast cancer indicated that screening MRI had the highest sensitivity (between 77% and 100%). Breast cancer surveillance programmes, including MRI, achieved the highest diagnostic performance (between 83% and 95%) for all women. However, it must be taken into account that biases that may affect the validity of the outcomes were seen in the evaluated studies. Also, MRI is an expensive test with a low positive predictive value and, to date, MRI screening has not been proven to reduce mortality rates in women carrying BRCA1/2 gene mutations. As a result of the scant information and low quality of the papers reviewed, no definitive conclusion could be drawn on the performance of ovarian cancer surveillance in women carrying BRCA1/2 mutations.
M J BERMEJO-PEREZ, S MARQUEZ-CALDERON, and A LLANOS-MENDEZ
Br J Radiol 2008;81 172-179
http://bjr.birjournals.org/cgi/content/abstract/81/963/172?etoc
We have systematically reviewed the literature focusing on the performance of surveillance programmes and imaging techniques for the early diagnosis of breast and ovarian cancer in women carrying mutations in BRCA1/2 genes. All studies on imaging techniques for the diagnosis of breast cancer indicated that screening MRI had the highest sensitivity (between 77% and 100%). Breast cancer surveillance programmes, including MRI, achieved the highest diagnostic performance (between 83% and 95%) for all women. However, it must be taken into account that biases that may affect the validity of the outcomes were seen in the evaluated studies. Also, MRI is an expensive test with a low positive predictive value and, to date, MRI screening has not been proven to reduce mortality rates in women carrying BRCA1/2 gene mutations. As a result of the scant information and low quality of the papers reviewed, no definitive conclusion could be drawn on the performance of ovarian cancer surveillance in women carrying BRCA1/2 mutations.
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