Diagnostic accuracy of sonography and combined sonographic assessment and sonographically guided cytology in nonpalpable solid breast lesions

Extramedullary Relapse of B Cell Acute Lymphoblastic Leukemia in Bilateral Breasts Treated with Whole Breast Radiotherapy

Isolated extramedullary relapse of acute lymphoblastic leukemia (ALL) in the breast is extremely rare. We herein report a case of a 38-year-old female with B cell ALL, who had isolated extramedullary relapse initially in the left breast and subsequently in the right breast, 3 and 4 years, respectively, after hematopoietic allogenic stem cell transplantation. She was successfully salvaged with bilateral whole breast radiotherapy, 24 Gy/12 fractions/2.5 weeks. This brief report highlights the importance of awareness of extramedullary leukemic relapse in the breast as one of the differential diagnoses of breast masses in the context of ALL. Since these tumors are extremely radioresponsive, radiation therapy is a safe and effective treatment option for isolated extramedullary relapse of ALL in the breast.

Ultrasound Detection of Microcalcifications in Surgical Breast Specimens

The objective was to evaluate a commercial image processing technique (MicroPure, Canon Medical Systems, Tustin, CA, USA) for detection of microcalcifications in breast surgical specimens. Twenty women scheduled for surgical excision of an area with breast calcifications were enrolled, their surgical specimens underwent grayscale ultrasound (US) and MicroPure examination using an Aplio XG scanner (Canon). Four independent and blinded readers analyzed 54 US and 54 MicroPure digital clips to determine the number of calcifications and scored image quality and artifacts on a 10-point scale. All readers saw significantly more microcalcifications with MicroPure than with US, 14.0 ± 12.0 versus 3.0 ± 3.2 (p <0.0001). Three readers preferred MicroPure image quality over that of US (p <0.009) and vice versa for one reader (p = 0.003). Three readers saw fewer Cooper's ligament artifacts with MicroPure than with US (p <0.0001); one reader saw no significance difference between them (p = 0.58). In conclusion MicroPure identified more breast microcalcifications than grayscale US in ex vivo surgical breast specimens.

An unusual presentation of locally recurrent breast cancer: a case report

Recurrent breast carcinoma is usually detected by imaging studies and biopsy. We present a case with unusual clinical presentation and discuss the diagnosis and treatment. While core needle biopsy and fine-needle aspiration are important in the diagnosis of early-stage breast cancer, physical examination and close follow-up are important in the absence of a diagnosis.

Ultrasound (US) diagnosis of nonpalpable breast cancer

BACKGROUND

Ultrasound (US) is a standard modality to diagnose breast diseases. To elucidate the usefulness of US in the diagnosis of nonpalpable breast cancers, we reviewed the cases that were treated at our institution.

METHODS

Of the 106 cancers that were operated upon at the Tsukuba University Hospital between February 2004 and March 2005, 12 cancers were nonpalpable. We reviewed their US findings, results of US-guided fine needle aspiration cytology (FNAC), core biopsy results, and histological diagnoses.

RESULTS

On US, 9 tumors appeared as masses. The US observations were valuable, but a confirmatory diagnosis could not be made. US-guided FNAC was performed in 8 cases; malignancy was suspected in 6 cases. US-guided core biopsy was performed in 9 cases, and it was diagnostic in 7 cases.

CONCLUSIONS

Nonpalpable breast cancers can be effectively detected by US, and the diagnosis can be confirmed by US-guided FNAC or core biopsy.

Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis

PURPOSE

To assess the value of ultrasonography (US) and US-guided fine-needle aspiration biopsy (FNAB) in the detection and diagnosis of recurrent cancer in breasts reconstructed with autogenous myocutaneous flaps after mastectomy for primary breast cancer and to describe the US appearances of recurrence in the reconstructed breast.

MATERIALS AND METHODS

Between July 1994 and March 2001, US of the reconstructed breast was performed in 20 women with autogenous myocutaneous flap reconstruction. US findings were correlated with clinical and mammographic findings. US-guided FNAB of 25 (64%) of the 39 recurrent cancers depicted at US was performed.

RESULTS

Twenty-one (54%) of the 39 recurrent cancers depicted at US were clinically occult. Mammography performed in 12 of the 20 patients with reconstructed breasts depicted 14 (56%) of the 25 recurrent cancers that were detected at US in these patients. US-guided FNAB helped to establish a definitive diagnosis of recurrent breast carcinoma in 24 (96%) of the 25 tumor specimens sampled.

CONCLUSION

US and US-guided FNAB are valuable for the assessment of both palpable and clinically occult recurrent breast cancers in autogenous myocutaneous flap breast reconstructions.

Acute lymphoblastic leukemia relapse in the breast diagnosed with gray-scale and color Doppler sonography

Extramedullary relapses of acute lymphoblastic leukemia (ALL) in children and young adults are rare and in most cases are localized in the central nervous system, testes, or both. We describe a rare case of extramedullary relapse of ALL in the breast of a 17-year-old girl. The patient, who had been diagnosed with ALL 1 year before and had been in complete remission for 5 months, was admitted to the hospital for investigation of a mass in her left breast. On clinical examination, she had a large, palpable, nontender mass in her left breast. Mammography revealed a very dense mass. On gray-scale and power Doppler sonography, the appearance of the mass was consistent with malignancy. Histopathologic examination of a surgical biopsy specimen permitted accurate diagnosis of ALL.

Sonographic evaluation of mammographically detected microcalcifications without a mass prior to stereotactic core needle biopsy

PURPOSE

The purpose of this prospective study was to evaluate the clinical usefulness of sonographically re-evaluating areas of microcalcification found mammographically before undertaking stereotactic core needle biopsy (SCNB).

METHODS

Patients with nonpalpable breast lesions appearing as microcalcifications on mammograms and who had been referred to us for SCNB were re-evaluated sonographically before the procedure. None of the breast lesions had been associated with a density on the mammograms, and the initial sonographic evaluations had been negative. Using the mammograms for correlation, we meticulously re-evaluated the areas of microcalcifications sonographically using a high-frequency linear-array transducer. The sonographic and histopathologic results were then reviewed and correlated. The sonographic findings and visibility of the mammographically detected microcalcifications were analyzed by the 2-tailed Fisher's exact test and the chi-square test.

RESULTS

Sixty-six patients, who had 68 cases of microcalcifications, were enrolled. Thirteen of the 66 patients underwent surgery, and 9 of the 13 were found to have breast carcinoma. In the sonographic re-evaluation before SCNB in these 9 patients, an associated soft tissue mass was demonstrated in 5 patients but not in the other 4. Sonographic re-evaluation also revealed abnormalities in 24 of 68 cases (35.3%), in contrast to the negative findings on the initial sonography. Using the chi-square test to identify a trend, we found that the percentage of cases that were sonographically visible was highest for clustered benign microcalcifications and lowest for segmental benign microcalcifications (p < 0.0001).

CONCLUSIONS

In breast lesions that appear as microcalcifications without an associated mass on mammograms, pre-SCNB sonographic re-evaluation with a high-frequency transducer can depict microcalcifications, particularly the clustered ones, and can detect small associated masses. Although the absence of a sonographically detectable mass in areas of mammographically detected microcalcifications does not guarantee the absence of cancer, the presence of an associated mass on sonography should warrant close follow-up in the case of negative results to avoid a delay in the diagnosis of breast carcinoma.

Fine needle aspiration cytology versus percutaneous biopsy of nonpalpable breast lesions

Fine needle aspiration (FNA) and core biopsy (CB) are efficient alternatives to surgical biopsy: FNA provides a sampling of cells and is very cost effective. The main limits are insufficient sampling rate and the impossibility to diagnose invasion. CB allows architectural description and the diagnosis of specific benign and malignant lesions, but is more expensive and time-consuming.

Critical clinicopathologic analysis of 23 cases of fine-needle breast sampling initially recorded as false-positive. The 44-year experience of the Institut Curie

BACKGROUND

Because false-positive cytologic diagnoses in breast tumors are rare, few cases have been reported, although their consequences may be highly detrimental to the patient. The authors report the Institut Curie's experience, by using a multidisciplinary approach.

METHODS

Of 9334 benign breast tumors examined preoperatively for cytologic diagnosis by fine-needle sampling (FNS), the 23 (0.25%) FNS cases considered to be false-positive were retrospectively reviewed and analyzed.

RESULTS

Tumors were situated close to the nipple in 7 cases and away from the nipple in 16 cases. Tumor stage was T0 for 1 case, T1 for 18 cases, and T2 for 4 cases. Radiologically, six tumors were classified as malignant, seven as indeterminate or suspicious, and nine as benign. Three of six tumors studied by flow cytometry were DNA aneuploid. Based on a multidisciplinary clinicopathologic review, 20 FNS cases were finally classified as false-positive, and the remaining 3 tumors with malignant FNS and subsequent benign histology were classified as true-positive, because local and/or metastatic progression was observed in the short term.

CONCLUSIONS

The authors' review suggests two categories of false-positive cases: the first in which cytologic benign patterns are overdiagnosed, and the second in which atypical morphologic criteria were present. Nevertheless, as shown by the malignant course in three cases, patients with malignant preoperative FNS and corresponding benign histology always require close clinical follow-up. Finally, surgical overtreatment rate could be decreased if all radiologically benign tumors with positive/suspicious FNS were subject to intraoperative frozen section examination.