Abstract: PURPOSE: The aim of this study was to assess the reliability of the sonographic Breast Imaging Reporting and Data System (BI-RADS) classification in differentiating benign from malignant breast masses. MATERIALS AND METHODS: A total of 292 female patients with breast masses undergoing biopsy between November 2004 and March 2006 in our department were included in this study. All lesions were classified according to the sonographic BI-RADS lexicon. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for the sonographic BI-RADS lexicon and PPV and NPV for each lesion category and each sonographic descriptor were calculated. The chi(2) test and the Fischer exact test were used to evaluate our results. RESULTS: Univariate analysis showed a significant difference between malignant and benign groups with regard to morphology (p<0.001), horizontal-vertical diameter ratio<1 (p<0.002), orientation (p<0.001), noncircumscribed margins (p<0.001), echogenic halo (p<0.001), hypoechoic pattern (p=0.035), shadowing (p<0.001) and surrounding tissue alterations (p=0.001). The cumulative risk for malignancy was 64 and 10 times higher, respectively, in categories 5 and 4 than in category 3. CONCLUSIONS: The sonographic BI-RADS lexicon is an important system for describing and classifying breast lesions.
Abstract: The term locally advanced breast cancer (LABC) encompasses a heterogeneous group
of breast neoplasms; in the last revision of the American Joint Committee on
Cancer (AJCC) staging system, all of stage III disease is considered locally
advanced. LABC constitutes up to 20% of breast cancer in medically underserved
populations in the United States and up to 75% of breast cancers in developing
countries. The prognosis depends on tumor size, extent of lymph node involvement,
and the presence or absence of an inflammatory component. The clinical management
of LABC is complex and should be tailored to the individual patient. However, a
multidisciplinary approach is always recommended combining surgery, radiotherapy
and systemic therapy (chemotherapy and/or hormone therapy). In this paper, we
discuss the possible options in the management of operable (stage IIIA) and
inoperable (stage IIIB-IIIC) LABC.
Abstract: OBJECTIVE: The purpose of this study was to determine the reliability of
sonographic American College of Radiology Breast Imaging Reporting And Data
System (BI-RADS) classification in differentiating benign from malignant breast
masses. METHODS: One hundred seventy-eight breast masses studied by sonography
with a known diagnosis were reviewed. All lesions were classified according to
the sonographic BI-RADS lexicon. Pathologic results were compared with
sonographic features. Sensitivity, specificity, accuracy, and positive predictive
value (PPV) and negative predictive value (NPV) for the sonographic BI-RADS
lexicon were calculated. RESULTS: Twenty-six cases were assigned to class 3, 73
to class 4, and 79 to class 5. Pathologic results revealed 105 malignant and 73
benign lesions. The sonographic BI-RADS lexicon showed 71.3% accuracy, 98.1%
sensitivity, 32.9% specificity, 67.8% PPV, and 92.3% NPV. The NPV for class 3 was
92.3%. The PPVs for classes 4 and 5 were 46.6% and 87.3%. Typical signs of
malignancy were irregular shape, antiparallel orientation, noncircumscribed
margin, echogenic halo, and decreased sound transmission. Typical signs of
benignity were oval shape and circumscribed margin. CONCLUSIONS: The sonographic
BI-RADS lexicon is an important system for describing and classifying breast
lesions.
Abstract: We report a case of synchronous bilateral breast cancer in a patient with
ambiguous external genitalia attributed to a 45,X/46,XY mosaicism. To our
knowledge, this represents the first such case ever to be reported. Mammography,
ultrasonography, computed tomography, and magnetic resonance imaging all showed
bilateral suspicious breast masses with microcalcifications. There were no
radiological findings of muscle invasion or axillary lymphadenopathy. The patient
was successfully treated by bilateral radical modified mastectomy followed by
external irradiation and adjuvant endocrine therapy. Histological examination
revealed a bilateral ductal carcinoma in situ, with a cribriform and papillary
pattern and microfoci of infiltrating ductal carcinoma. The hormonal profile
revealed high levels of follicle-stimulating hormone and luteinizing hormone, and
low levels of testosterone. Testicular sonography revealed small hypoechoic
testicles with bilateral microlithiasis. This case shows that 45,X/46,XY men may
have an increased risk of breast cancer and must be followed up carefully.
Abstract: BACKGROUND: Distant spread from breast cancer is commonly found in bones, lungs,
liver and central nervous system. Metastatic involvement of peritoneum and
retroperitoneum is unusual and unexpected. CASE PRESENTATION: We report the case
of a 67 year-old-woman who presented with gastrointestinal symptoms which
revealed to be the clinical manifestations of peritoneal and retroperitoneal
metastatic spread of an invasive lobular breast cancer diagnosed 15 years before.
CONCLUSION: To the best of our knowledge, the case presented is the third one
reported in literature showing a wide peritoneal and extraperitoneal diffusion of
an invasive lobular breast cancer. The long and complex diagnostic work up which
led us to the diagnosis is illustrated, with particular emphasis on the
multidisciplinary approach, which is mandatory to obtain such a result in these
cases. Awareness of such a condition by clinicians is mandatory in order to make
an early diagnosis and start a prompt and correct therapeutic approach.
Abstract: Although the surgical treatment of breast cancer has become more conservative in
the last decades, some patients still arrive at the first physical examination
with advanced diseases and with large skin infiltration. We report an unusual
case of giant invasive papillary carcinoma of the breast underwent mastectomy and
reconstruction with a bipedicled transverse rectus abdominis myocutaneous (TRAM)
flap.
Abstract: Conservative surgery has become a well-established alternative to mastectomy in
the treatment of breast cancer. However, in case of larger lesions or small-size
breasts, the removal of adequate volumes of breast tissue to achieve tumor-free
margins and reduce the risk of local relapse may compromise the cosmetic outcome,
causing unpleasant results. In order to address this issue, new surgical
techniques, so-called oncoplastic techniques, have been introduced in recent
years to optimize the efficacy of conservative surgery both in terms of local
control and cosmetic results. This article discusses the indications, advantages,
and limitations of these techniques and their results in terms of local
recurrence and overall survival.
Abstract: AIMS: To reassess the relationship between magnetic resonance imaging (MRI)
findings and surgical resection margins in an attempt to address the issue of
appropriate surgical management of phyllodes tumors (PT). METHODS: Three female
patients with a large palpable mass suspicious for phyllodes tumors were studied
by mammography (MX), ultrasound (US) and dynamic MRI and then underwent surgery.
RESULTS: MRI demonstrated a rapidly and markedly enhancing multi-lobulated
lesion. T1-weighted and T2-weighted sequences showed inhomogeneous signal
intensity for the presence of cystic areas with internal septation and
hemorrhage. Some areas of linear enhancement were present around the mass only in
one case. Surgical management was mastectomy in one patient and wide excision in
the other two patients. The margins in one of the latter patients were not clear,
so mastectomy with immediate prosthetic reconstruction was subsequently
performed. Pathological results showed 1 case of benign phylloides tumor, 1 case
of borderline phylloides tumor and 1 case of malignant phylloides tumor.
CONCLUSIONS: MRI enabled complete visualization of the tumor even in the region
close to the chest wall, as well as clear delineation from healthy glandular
tissue and may help to define the appropriate surgical management of phylloides
tumor.
Abstract: Abstract. Radiotherapy was the standard treatment for patients with locally
advanced non-small cell lung cancer until the mid 1990s. Chemotherapy was added
in order to improve outcome, and during the last decade sequential, concurrent or
mixed modalities have been extensively explored and discussed. Goals of
neoadjuvant chemoradiation are resecability and downstaging. Recent published
experiences evidenced that neoadjuvant chemoradiotherapy is feasible if delivered
with low total dose and limited volume; pathological downstaging to stage 0-I
could be a reasonable surrogate end-point for overall and disease free survival
and for distant metastasis.
Abstract: The case of a 41-year-old female patient with axillary lymphadenopathies and
negative clinical and mammographic examinations is discussed. In the suspicion of
a cup syndrome of breast origin, breast sonography was performed. While the
absence of alterations was confirmed, a right parasternal swelling was highly
suggestive of malignancy. On histology, a malignant parasternal nodule was
diagnosed. Breast MRI was performed and an ipsilateral malignant focal lesion was
visualized. Chemotherapy was administered but after a disease-free interval
leptomeningeal and cerebral metastases appeared.
Abstract: The purpose of this study was to reassess the role of MRI in 3 cases of
cystosarcoma phyllodes. Three patients with a palpable large lump were studied
with mammography, ultrasonography and MRI. In the 3 patients mammography showed a
nonspiculate soft-tissue mass while a hypoechoic lobulated mass with cystic areas
was visualized on sonography. Dynamic MRI demonstrated a multi-lobulated lesion
rapidly and markedly enhanced on dynamic studies of contrast-enhanced T1-weighted
imaging. T2WI showed inhomogeneous signal intensity with a hypointense area and
internal septation in the solid portion. MRI enabled complete visualization of
the tumor even in the region close to the chest wall, as well as clear
delineation against the healthy glandular tissue.
Abstract: Axillary lymphadenectomy represents one of the historical hallmarks in the surgical strategy for breast cancer treatment. In recent years the role of axillary dissection is becoming matter for a renewed debate: up to date better therapeutic results together with new biologic acquisitions and progresses in early diagnosis have been influencing current indications and extension of axillary lymphadenectomy; also, cosmetic and financial considerations play a relevant role. This is the background of a large number of studies investigating the possibility of a more limited applications of axillary dissection provided that oncologic results remain unchanged. In this context sentinel node biopsy is one of the most promising lines of research. It can be stated that, as far as early stages are concerned, a trend towards more conservative resection techniques that started with the first quadrantectomies two decades ago, is now involving axillary dissection too. Possibly, in the next future, an elective axillary lymphadenectomy will not be performed any more if the presence of positive nodes will not be preliminarily ascertained. Nevertheless such conservative strategy can not be recommended to date, until the technique of sentinel node biopsy will be optimized and its results confirmed by randomized trials.
