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McDonald ES, Scheel JR, Lewin AA, Weinstein SP, Dodelzon K, Dogan BE, Fitzpatrick A, Kuzmiak CM, Newell MS, Paulis LV, Pilewskie M, Salkowski LR, Silva HC, Sharpe RE, Specht JM, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Imaging of Invasive Breast Cancer. J Am Coll Radiol 2024; 21:S168-S202. [PMID: 38823943 DOI: 10.1016/j.jacr.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
As the proportion of women diagnosed with invasive breast cancer increases, the role of imaging for staging and surveillance purposes should be determined based on evidence-based guidelines. It is important to understand the indications for extent of disease evaluation and staging, as unnecessary imaging can delay care and even result in adverse outcomes. In asymptomatic patients that received treatment for curative intent, there is no role for imaging to screen for distant recurrence. Routine surveillance with an annual 2-D mammogram and/or tomosynthesis is recommended to detect an in-breast recurrence or a new primary breast cancer in women with a history of breast cancer, and MRI is increasingly used as an additional screening tool in this population, especially in women with dense breasts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Elizabeth S McDonald
- Research Author, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John R Scheel
- Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Alana A Lewin
- Panel Chair, New York University Grossman School of Medicine, New York, New York
| | - Susan P Weinstein
- Panel Vice Chair, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Basak E Dogan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amy Fitzpatrick
- Boston Medical Center, Boston, Massachusetts, Primary care physician
| | | | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; RADS Committee
| | | | - Melissa Pilewskie
- University of Michigan, Ann Arbor, Michigan; Society of Surgical Oncology
| | - Lonie R Salkowski
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - H Colleen Silva
- The University of Texas Medical Branch, Galveston, Texas; American College of Surgeons
| | | | - Jennifer M Specht
- University of Washington, Seattle, Washington; American Society of Clinical Oncology
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California; University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
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2
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Kleiman K, Yalniz C, Woodard S. Ultrafast MR imaging findings of 2 different subtypes in a male patient with bilateral breast cancer. Radiol Case Rep 2024; 19:1366-1370. [PMID: 38288048 PMCID: PMC10823031 DOI: 10.1016/j.radcr.2023.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/08/2023] [Accepted: 12/23/2023] [Indexed: 01/31/2024] Open
Abstract
Bilateral breast cancer in males is an exceedingly rare diagnosis. In this case report, we will discuss the ultrafast sequence findings of a bilateral male breast cancer with different subtypes on his staging dynamic contrast enhanced (DCE) MRI with ultrafast technique. A 94-year-old male presented with bilateral palpable complaints in his breasts. Diagnostic mammography and ultrasound images demonstrated bilateral irregular masses with nipple retraction. Biopsies were performed and the histopathologic examination revealed invasive breast carcinoma of no special type in 1 breast and invasive micropapillary carcinoma in the other breast. Staging MRI with ultrafast sequence showed significant enhancement differences between 2 different subtypes, correlating with the different levels of tumor aggressiveness. Different ultrafast metrics, such as time-to-enhancement and maximum slope, may help to differentiate between several subtypes of breast cancer and serve as prognostic indicators. This case report discusses the application of ultrafast sequence in predicting breast cancer subtypes in a male patient with bilateral disease.
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Affiliation(s)
- Kyle Kleiman
- Edward Via College of Osteopathic Medicine, Carolinas Campus, 350 Howard St, Spartanburg, SC 29303, USA
| | - Ceren Yalniz
- Department of Radiology, The University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA
| | - Stefanie Woodard
- Department of Radiology, The University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249, USA
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Schulze AK, Hoskin TL, Moldoveanu D, Sturz JL, Boughey JC. Tumor Characteristics of Bilateral Breast Cancer Compared with Unilateral Breast Cancer. Ann Surg Oncol 2024; 31:947-956. [PMID: 37906382 DOI: 10.1245/s10434-023-14451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Bilateral breast cancer (BC) has an incidence of 1 to 3 %. This study aimed to describe the clinicopathologic characteristics and management of bilateral BC, estimate disease-free survival (DFS), and compare DFS with unilateral BC. METHODS A retrospective analysis was performed for patients who had bilateral invasive BC or unilateral invasive BC and contralateral ductal carcinoma in situ (DCIS) treated at Mayo Clinic Rochester from 2008 to 2022. A 4:1 matched cohort of patients with unilateral invasive BC was used for comparison. The groups were compared using Wilcoxon rank-sum or chi-square tests. Disease-free survival was analyzed using the Kaplan-Meier method and log-rank test, with Cox proportional hazards regression used for multivariable analysis. RESULTS The study identified 278 cases of bilateral breast cancer (177 cases of bilateral invasive cancer and 101 cases of unilateral invasive cancer with contralateral DCIS), representing 4.1 % of invasive BCs. Biologic subtype was concordant between sides in 79.8 % of the patients. Initial surgery was bilateral mastectomy for 76.6 %, bilateral lumpectomy for 20.5 %, and unilateral mastectomy with unilateral lumpectomy for 2.9 % of the patients. Pathogenic variants in breast cancer predisposition genes were present in 21.7 % of those tested. The patients who had bilateral BC presented with a higher cT category than the patients who had unilateral BC (p = 0.02), and a higher proportion presented with ILC (17.3 % vs 10.9 %; p = 0.004), estrogen receptor-positive (ER+) disease (89.2 % vs 84.2 %; p = 0.04), multicentric/multifocal disease (37.1 % vs 24.3 %; p < 0.001), breast cancer pathogenic variant (21.7 % vs 12.4 %; p = 0.02), and palpable presentation (48.2 % vs 40.8 %; p = 0.03). The patients with bilateral BC showed DFS similar to that for the unilateral BC cohort (p = 0.71). CONCLUSIONS Bilateral BCs most commonly are biologically concordant between sides. Bilateral BC presented more commonly with larger tumors, lobular histology, ER+ status, multicentricity or multifocality, pathogenic variant, and palpable disease. Bilateral BC is not associated with worse DFS than unilateral BC.
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Affiliation(s)
- Amy K Schulze
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Tanya L Hoskin
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Dan Moldoveanu
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jenna L Sturz
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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Ojo AS, Shittu A, Amadife S, Jackson D, Grantham M, Ali A, Sarma R. Synchronous Bilateral Breast Cancer With Discordant Receptor Status: Treating One Patient but Two Diseases. World J Oncol 2023; 14:224-229. [PMID: 37350805 PMCID: PMC10284639 DOI: 10.14740/wjon1603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023] Open
Abstract
The expression of hormone receptors (estrogen and progesterone) and human epidermal growth factor receptor-2 (HER2) has been used for both therapeutic and prognostic purposes in the management of breast cancer. The presence of a discordant receptor status complicates the approach to treatment in patients with synchronous bilateral breast cancer. We describe the case of a 45-year-old female with synchronous bilateral breast cancer with a triple-negative tumor and a contralateral HER2-positive tumor and discussed the impact of this on the approach to therapeutic management.
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Affiliation(s)
- Ademola S. Ojo
- Department of Internal Medicine, Howard University Hospital, Washington, DC, USA
| | - Adedoyin Shittu
- Department of Internal Medicine, Howard University Hospital, Washington, DC, USA
| | - Stacy Amadife
- Department of Internal Medicine, Howard University Hospital, Washington, DC, USA
| | - Devon Jackson
- Department of Pathology, Howard University Hospital, Washington, DC, USA
| | - Mica Grantham
- Department of Pathology, Howard University Hospital, Washington, DC, USA
| | - Ahmed Ali
- Howard University Cancer Center, Washington, DC, USA
| | - Ravi Sarma
- Howard University Cancer Center, Washington, DC, USA
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Clark A, Bishop J. Unknown Case: Painful and Palpable Lumps in Both Breasts. JOURNAL OF BREAST IMAGING 2022; 4:661-663. [PMID: 38417001 DOI: 10.1093/jbi/wbac061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Indexed: 03/01/2024]
Affiliation(s)
- Aurela Clark
- University of Kentucky, Department of Radiology, Lexington, KY, USA
| | - Johnrick Bishop
- University of Kentucky, Department of Radiology, Lexington, KY, USA
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Kwon YG, Park AY. Scoring System to Predict Malignancy for MRI-Detected Lesions in Breast Cancer Patients: Diagnostic Performance and Effect on Second-Look Ultrasonography. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:379-394. [PMID: 36237381 PMCID: PMC9431816 DOI: 10.3348/jksr.2020.81.2.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/17/2019] [Accepted: 07/30/2019] [Indexed: 11/15/2022]
Abstract
Purpose To design a scoring system to predict malignancy of additional MRI-detected lesions in breast cancer patients. Materials and Methods Eighty-six lesions (64 benign and 22 malignant) detected on preoperative MRI of 68 breast cancer patients were retrospectively included. The clinico-radiologic features were correlated with the histopathologic results using the Student's t-test, Fisher's exact test, and logistic regression analysis. The scoring system was designed based on the significant predictive features of malignancy, and its diagnostic performance was compared with that of the Breast Imaging-Reporting and Data System (BI-RADS) category. Results Lesion size ≥ 8 mm (p < 0.001), location in the same quadrant as the primary cancer (p = 0.005), delayed plateau kinetics (p = 0.010), T2 isointense (p = 0.034) and hypointense (p = 0.024) signals, and irregular mass shape (p = 0.028) were associated with malignancy. In comparison with the BI-RADS category, the scoring system based on these features with suspicious non-mass internal enhancement increased the diagnostic performance (area under the receiver operating characteristic curve: 0.918 vs. 0.727) and detected three false-negative cases. With this scoring system, 22 second-look ultrasound examinations (22/66, 33.3%) could have been avoided. Conclusion The scoring system based on the lesion size, location relative to the primary cancer, delayed kinetic features, T2 signal intensity, mass shape, and non-mass internal enhancement can provide a more accurate approach to evaluate MRI-detected lesions in breast cancer patients.
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Affiliation(s)
- Young Geol Kwon
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ah Young Park
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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7
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Debruhl ND, Lee SJ, Mahoney MC, Hanna L, Tuite C, Gatsonis CA, Lehman C. MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer: 2-Year Follow-up. JOURNAL OF BREAST IMAGING 2019; 2:50-55. [PMID: 32055797 DOI: 10.1093/jbi/wbz053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 12/27/2022]
Abstract
Objective The American College of Radiology Imaging Network Trial 6667 showed that MRI can detect cancer in the contralateral breast that is missed by mammography and clinical examination at the time of the initial breast cancer diagnosis, based on 1-year follow-up. This study is a continuation of the trial that evaluates the diagnostic accuracy of MRI for contralateral breast cancer after 2 years of follow-up. Methods In total, 969 women with a diagnosis of unilateral breast cancer and no clinical or imaging abnormalities in the contralateral breast underwent breast MRI. The cancer status of all participants was monitored for 2 years after the initial MRI. Follow-up included documentation of any clinical, imaging, or interventional procedures performed. A study participant was considered positive for cancer if she had a tissue diagnosis of in situ or invasive breast cancer in the contralateral breast within 730 days of her initial MRI. Results Three additional cancers were diagnosed in the study population in the second year of the trial. The diagnostic yield for MRI for the 2-year period was 3% (31/969). After 2 years of follow-up, breast MRI has a sensitivity of 86% and specificity of 88% for detection of contralateral breast cancer. Its negative predictive value was 99%, and its positive predictive value was 22%. These values did not change significantly from the 1-year data. Conclusion A negative contralateral breast MRI has a very high and reliable negative predictive value over 2 years, and, therefore, is helpful in managing and counseling patients during the period of initial diagnosis and early treatment.
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Affiliation(s)
- Nanette D Debruhl
- David Geffen School of Medicine at the University of California, Los Angeles, Department of Radiological Sciences, Los Angeles, CA
| | - Su-Ju Lee
- University of Cincinnati Medical Center, Department of Radiology, Cincinnati, OH
| | - Mary C Mahoney
- University of Cincinnati Medical Center, Department of Radiology, Cincinnati, OH
| | - Lucy Hanna
- Brown University, Center for Statistical Sciences, Department of Biostatistics, Providence, RI
| | | | - Constantine A Gatsonis
- Brown University, Center for Statistical Sciences, Department of Biostatistics, Providence, RI
| | - Constance Lehman
- Massachusetts General Hospital, Division of Breast Imaging, Boston, MA
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Leblond MA, Duchesne N, Provencher L, Hogue JC, Pinault S. Is contralateral breast ultrasound worthwhile in preoperative staging of breast cancer? JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:195-200. [PMID: 30729540 DOI: 10.1002/jcu.22693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/16/2018] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Women with invasive breast cancer are at higher risk of contralateral synchronous cancer. This study aimed at determining if contralateral breast ultrasound (CBUS) examination should be routinely performed in the preoperative evaluation of breast cancer patients. METHODS This is a retrospective study of preoperative CBUS examinations performed between January 2012 and April 2015. The charts of patients presenting for biopsy of a Breast Imaging Reporting and Data System (BIRADS) 5 lesion and who had undergone a concomitant contralateral breast US examination were reviewed. Index tumor, lymph node status, American College of Radiology (ACR) breast density on mammogram, total scanning time, and results of CBUS were recorded. RESULTS Of the 3007 patients who underwent breast biopsies during the study period, 360 patients met the inclusion criteria. Index mass size was 19 ± 10 mm. CBUS examination led to 76 biopsies, of which 12 were positive in 11 patients. Detection rate for mammographically occult contralateral invasive cancers was 3.1% (11/360). Contralateral lesion size was 13 ± 10 mm. Breast density was rated ACR C/D for nine women and ACR B for two. In the ACR C/D subgroup (82%), the contralateral cancer detection rate was 4.1%. Average additional scanning time spent required to perform CBUS examination was 3.1 ± 4.9 min. Patients diagnosed with contralateral invasive breast cancer underwent surgery and/or chemotherapy. The treatment strategy was changed in all 11 patients after the detection of a second primary cancer. CONCLUSION Preoperative CBUS is effective and most beneficial with women presenting ACR C/D breast density. Given its impact on decreasing future morbidity, its routine use should be considered to improve quality healthcare for women diagnosed with breast cancer.
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Affiliation(s)
- Michel-Alexandre Leblond
- Department of Radiology, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
- Department of Radiology, CHU de Québec - Université Laval, Quebec City, QC, Canada
| | - Nathalie Duchesne
- Department of Radiology, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
- Department of Radiology, CHU de Québec - Université Laval, Quebec City, QC, Canada
- Centre des Maladies du Sein du, CHU de Québec - Université Laval, Quebec City, QC, Canada
| | - Louise Provencher
- Department of Surgery, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
- Centre des Maladies du Sein du, CHU de Québec - Université Laval, Quebec City, QC, Canada
- Axe Oncologie, Centre de Recherche du, CHU de Québec - Université Laval, Quebec City, QC, Canada
| | - Jean-Charles Hogue
- Centre des Maladies du Sein du, CHU de Québec - Université Laval, Quebec City, QC, Canada
- Axe Oncologie, Centre de Recherche du, CHU de Québec - Université Laval, Quebec City, QC, Canada
| | - Sylvie Pinault
- Department of Radiology, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
- Department of Radiology, CHU de Québec - Université Laval, Quebec City, QC, Canada
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Sim Y, Tan VKM, Sidek NAB, Chia DKA, Tan BKT, Madhukumar P, Yong WS, Wong CY, Ong KW. Bilateral breast cancers in an Asian population, and a comparison between synchronous and metachronous tumours. ANZ J Surg 2018; 88:982-987. [PMID: 30141242 DOI: 10.1111/ans.14773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/17/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women with unilateral breast cancer have an increased risk of developing bilateral breast cancer (BBC). Patients with metachronous BBC (mBBC) usually have an earlier age of onset, and their prognoses have been shown to be either similar or poorer than those with synchronous BBC (sBBC). Given the differing presentation and characteristics of breast cancers in the Asian population and the West, this study aims to characterize Asian patients with BBC. METHODS All patients who had oncological breast surgery between 2001 and 2010 at the Singapore General Hospital and National Cancer Centre Singapore were reviewed. Patients with BBC were identified and studied. RESULTS A total of 5520 Singaporean women had oncological breast surgery, 155 women (2.8%) had BBC. Of those with BBC, 47.1% (n = 73) were synchronous and 52.9% (n = 82) metachronous (mean interval of 39.4 months), and there was no difference in median age in both groups (54 years of age). Patients with sBBC were more likely to have a positive family history and had asymptomatic contralateral tumours. Although patients with sBBCs were more likely to have ER/PR positive and Her2 negative tumours, they had a lower 5-year overall survival than those with mBBC (P = 0.022). CONCLUSION Our study shows that Asian women with BBC have different characteristics to their Western counterparts. In particular, women with sBBC tended to have a lower 5-year overall survival compared to those with mBBC, despite having seemingly biologically favourable tumours, which suggest that there may be more underlying their tumour biology and genetics.
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Affiliation(s)
- Yirong Sim
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Veronique K M Tan
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Nur A B Sidek
- Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Daryl K A Chia
- Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Benita K T Tan
- Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Preetha Madhukumar
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Wei Sean Yong
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Chow Yin Wong
- Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
| | - Kong Wee Ong
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.,Singhealth Duke-NUS Breast Centre, Singapore General Hospital, Singapore
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Revisión del estado actual de la resonancia magnética en el cáncer de mama. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2018. [DOI: 10.1016/j.gine.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Kovács A, Persson F, Persson M, Andersson MK, Stenman G. Genomic imbalances and MYB fusion in synchronous bilateral adenoid cystic carcinoma and invasive lobular carcinoma of the breast. Mol Clin Oncol 2017; 7:322-326. [PMID: 28894575 PMCID: PMC5582535 DOI: 10.3892/mco.2017.1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/04/2017] [Indexed: 11/07/2022] Open
Abstract
The incidence of synchronous bilateral breast carcinomas (BBCs) has increased with a more frequent use of magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer. A total of 30% of all BBCs occur synchronously. In the present study, we describe a unique case of synchronous BBC in a 59-year-old previously healthy woman with no known family history of breast or ovarian cancer. At the time of diagnosis the patient had an invasive lobular carcinoma (ILC) in the right breast and an adenoid cystic carcinoma (ACC) in the left breast. To the best of our knowledge, this is the first published case of bilateral, simultaneously occurring ACC and ILC of the breast. Genome-wide genomic profiling of the tumors revealed that they had distinctly different genomic imbalances. The ACC had a 5.7 Mb interstitial 6q deletion with a breakpoint located in the 3′-part of MYB, resulting in loss of the last coding exon of MYB and its 3′-UTR. RT-PCR analysis confirmed that the tumor expressed an ACC-specific MYB-NFIB fusion transcript. In contrast, the ILC had no rearrangements of 6q or MYB-NFIB gene fusion but showed instead gain of 1q21.1-qter, loss of 16q11.2-qter, and 22q12.2-q12.3 as the sole genomic imbalances. Notably, concurrent gains of 1q and losses of 16q are characteristic features of ILC. Collectively, our findings indicate that the ACC and ILC had originated independently of each other and that the MYB-NFIB fusion is a specific biomarker for breast ACC.
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Affiliation(s)
- Anikó Kovács
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fredrik Persson
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Oncology, Sahlgrenska University Hospital and Sahlgrenska Cancer Center, Gothenburg, Sweden
| | - Marta Persson
- Department of Pathology and Genetics, Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Mattias K Andersson
- Department of Pathology and Genetics, Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Göran Stenman
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Pathology and Genetics, Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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12
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Breast MRI in the Diagnostic and Preoperative Workup Among Medicare Beneficiaries With Breast Cancer. Med Care 2017; 54:719-24. [PMID: 27111752 DOI: 10.1097/mlr.0000000000000542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We compared the frequency and sequence of breast imaging and biopsy use for the diagnostic and preoperative workup of breast cancer according to breast magnetic resonance imaging (MRI) use among older women. MATERIALS AND METHODS Using SEER-Medicare data from 2004 to 2010, we identified women with and without breast MRI as part of their diagnostic and preoperative breast cancer workup and measured the number and sequence of breast imaging and biopsy events per woman. RESULTS A total of 10,766 (20%) women had an MRI in the diagnostic/preoperative period, 32,178 (60%) had mammogram and ultrasound, and 10,669 (20%) had mammography alone. MRI use increased across study years, tripling from 2005 to 2009 (9%-29%). Women with MRI had higher rates of breast imaging and biopsy compared with those with mammogram and ultrasound or those with mammography alone (5.8 vs. 4.1 vs. 2.8, respectively). There were 4254 unique sequences of breast events; the dominant patterns for women with MRI were an MRI occurring at the end of the care pathway. Among women receiving an MRI postdiagnosis, 26% had a subsequent biopsy compared with 51% receiving a subsequent biopsy in the subgroup without MRI. CONCLUSIONS Older women who receive breast MRI undergo additional breast imaging and biopsy events. There is much variability in the diagnostic/preoperative work-up in older women, demonstrating the opportunity to increase standardization to optimize care for all women.
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13
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França LKL, Bitencourt AGV, Paiva HLS, Silva CB, Pereira NP, Paludo J, Graziano L, Guatelli CS, de Souza JA, Marques EF. Role of magnetic resonance imaging in the planning of breast cancer treatment strategies: comparison with conventional imaging techniques. Radiol Bras 2017; 50:76-81. [PMID: 28428649 PMCID: PMC5396996 DOI: 10.1590/0100-3984.2015.0124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 02/13/2016] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE To assess the role of magnetic resonance imaging (MRI) in the planning of breast cancer treatment strategies. MATERIALS AND METHODS The study included 160 women diagnosed with breast cancer, who underwent breast MRI for preoperative staging. Using Pearson's correlation coefficient (r), we compared the size of the primary tumor, as determined by MRI, by conventional imaging (mammography and ultrasound), and in the pathological examination (gold standard). The identification of lesions not identified in previous examinations was also evaluated, as was its influence on treatment planning. RESULTS The mean age of the patients was 52.2 years (range, 30-81 years), and the most common histological type was invasive ductal carcinoma (in 60.6% of the patients). In terms of the tumor size determined, MRI correlated better with the pathological examination than did mammography (r = 0.872 vs. 0.710) or ultrasound (r = 0.836 vs. 0.704). MRI identified additional lesions in 53 patients (33.1%), including malignant lesions in 20 (12.5%), which led to change in the therapeutic planning in 23 patients (14.4%). CONCLUSION Breast MRI proved to be more accurate than conventional imaging in determining the dimensions of the main tumor and was able to identify lesions not identified by other methods evaluated, which altered the therapeutic planning in a significant proportion of cases.
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Affiliation(s)
| | | | | | - Caroline Baptista Silva
- MD, Resident in Radiology and Diagnostic Imaging, A.C.Camargo
Cancer Center, São Paulo, SP, Brazil
| | - Nara Pacheco Pereira
- MD, Resident in Radiology and Diagnostic Imaging, A.C.Camargo
Cancer Center, São Paulo, SP, Brazil
| | - Jociana Paludo
- MD, Resident in Radiology and Diagnostic Imaging, A.C.Camargo
Cancer Center, São Paulo, SP, Brazil
| | - Luciana Graziano
- MD, Attending Physician, Imaging Department, A.C.Camargo Cancer
Center, São Paulo, SP, Brazil
| | - Camila Souza Guatelli
- MD, Attending Physician, Imaging Department, A.C.Camargo Cancer
Center, São Paulo, SP, Brazil
| | - Juliana Alves de Souza
- MD, Attending Physician, Imaging Department, A.C.Camargo Cancer
Center, São Paulo, SP, Brazil
| | - Elvira Ferreira Marques
- MD, Head of the Department of Breast Imaging, A.C.Camargo Cancer
Center, São Paulo, SP, Brazil
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pCR rates in patients with bilateral breast cancer after neoadjuvant anthracycline-taxane based-chemotherapy - A retrospective pooled analysis of individual patients data of four German neoadjuvant trials. Breast 2017; 32:73-78. [PMID: 28063331 DOI: 10.1016/j.breast.2016.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 12/29/2016] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Patients with bilateral breast cancer (BBC) are usually excluded from participating in clinical trials and little is known about the response and outcome of BBC to neoadjuvant chemotherapy compared to unilateral BC (UBC). METHODS We prospectively captured the information on patients with BBC in our database treated within four neoadjuvant chemotherapy trials and collected retrospectively the rate of pathological complete response (pCR) defined as ypT0 ypN0, ypT0/is ypN0, ypT0 ypNX, clinical and histologic parameters. Synchronous carcinoma in the contralateral breast was considered as the non-indicator lesion. Patients with UBC only treated within the same neoadjuvant trials performed the control group. RESULTS From the 6727 patients treated within 4 German neoadjuvant trials 119 (1.8%) patients have been identified with the diagnosis of BBC. The pCR rate (ypT0 ypN0) was 12.6% in the non-indicator lesion group versus 10.9% the indicator lesion group versus 20.9% for patients with unilateral disease (p = 0.003). There were more advanced tumor stages and positive axillary lymph nodes in the indicator lesion than in the nonindicator lesion or in UBC. In 52.5% the molecular subtype was identical between indicator and non-indicator lesion with more triple negative and HER2 positive BC in the group of UBC. The disease free survival rate (DFS) was 25.8% for patients with UBC versus 39.6% for patients with BBC. CONCLUSION The selection for the indicator lesion was based on tumor size, nodal status and inclusion criteria. Patients with BBC patients had a lower pCR rate and a lower DFS.
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Khalil AI, Bendahhou K, Mestaghanmi H, Saile R, Benider A. [Synchronous bilateral breast cancer: experiences in the Mohammed VI Cancer Treatment Center, CHU Ibn Rochd, Casablanca]. Pan Afr Med J 2016; 25:121. [PMID: 28292084 PMCID: PMC5325485 DOI: 10.11604/pamj.2016.25.121.9967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022] Open
Abstract
Synchronous bilateral breast cancers (SBBC) are characterized by extensive clinical and morphological heterogeneity, with an frequency between 1.5 and 3.2%. Women treated for unilateral breast cancer are at higher risk of developing contralateral breast cancer. Screening and advances in breast imaging have improved detection rates of SBBC. Our study aims to analyze the epidemiological, clinical, histological and therapeutic features of bilateral breast cancer. We conducted a cross-sectional study of patients with breast cancer treated at the Mohammed VI Center over a two year period. Statistical analysis of the results was performed using R. software. 31 patients had SBBC, representing 2.4% of breast cancer cases in our Center. The average age was 47.8 ± 8.4 years, 22.6% of patients used oral contraceptives. A family history of breast cancer was observed in 22.6% of cases. The most common histological type was invasive ductal carcinoma (58.1%), SBR grade II and III were common (38.7%). Hormone receptors were positive for progesterone (38.7%) and for estrogen (41.9%). HER2 was overexpressed in 20.0% of cases. 29.0% of patients received hormonal therapy and 3.2% targeted therapies. Our study showed that bilateral breast cancer represents a small percentage of all breast cancers but have specific clinical features that help to differentiate it from unilateral breast cancer.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Contraceptives, Oral/administration & dosage
- Cross-Sectional Studies
- Female
- Humans
- Middle Aged
- Morocco
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
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Affiliation(s)
- Ahmadaye Ibrahim Khalil
- Laboratoire de Physiopathologie et Génétique Moléculaire, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Maroc
| | | | - Houriya Mestaghanmi
- Laboratoire de Physiopathologie et Génétique Moléculaire, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Maroc
| | - Rachid Saile
- Laboratoire de Biologie et Santé, Unité de Recherche Associée au CNRST-URAC 34, Faculté des Sciences Ben M'Sik, Université Hassan II, Casablanca, Maroc
| | - Abdellatif Benider
- Centre Mohammed VI pour le Traitement des Cancers, CHU Ibn Rochd Casablanca, Maroc
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Bassarova AV, Nesland JM, Sedloev T, Lilleby W, Hristova SL, Trifonov DY, Torlakovic E. Simultaneous Bilateral Breast Carcinomas: A Category with Frequent Coexpression of HER-2 and ER-α, High Ki-67 and bcl-2, and Low p53. Int J Surg Pathol 2016; 13:239-46. [PMID: 16086078 DOI: 10.1177/106689690501300302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate clinicopathological characteristics and immunophenotypes of simultaneous bilateral adenocarcinomas of the breast and their axillary metastases. Immunohistochemical analysis and in situ hybridization were performed using formalin-fixed/paraffin-embedded tissues. In total, 15 primary and 9 metastatic tumors from 8 patients were evaluated. The expression of estrogen receptor-alpha (ER-α), progesterone receptor (PR), Ki 67, p53, bcl-2, and bax were evaluated by immunohistochemistry. Her2 gene amplification was evaluated by chromogenic in situ hybridization (CISH). Four patients were younger that 40 years of age (mean 47 years). Six patients had pleomorphic lobular carcinoma in 1 breast. Four of these had invasive ductal carcinoma in the contralateral breast. One patient had atypical medullary carcinoma in both breasts and 1 patient had atypical medullary carcinoma in 1 breast and pleomorphic lobular carcinoma in the other. The phenotype of the primary tumors and corresponding metastatic tumors was similar for the expression of ER-α (p=0.001), PR (p=0.03), and HER-2 (p=0.018). While strong coexpression of HER-2 and ER-α is exceptional in hereditary breast carcinoma and sporadic breast carcinoma, 6/8 (75%) patients in this study had tumors with strong coexpression of HER-2 and ER-α. P53 protein expression was found in only 2/15 (13%) primary tumors, which is in contrast to BRCA1-related hereditary bilateral breast carcinomas, which often express p53 protein. Most of the patients presented with axillary metastases and had very aggressive course. Characteristically, the tumors showed high levels of expression of ER-α and Her2 amplification, were bcl-2 positive, and had high Ki-67 fraction. However, in patients with atypical medullary carcinoma there was no expression of ER-α or amplification of Her-2.
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Affiliation(s)
- Assia V Bassarova
- Department of Pathology, Alexander University Hospital, Medical University, Sofia, Bulgaria
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17
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Freitas V, Crystal P, Kulkarni SR, Ghai S, Bukhanov K, Escallon J, Scaranelo AM. The value of breast MRI in high-risk patients with newly diagnosed breast cancer to exclude invasive disease in the contralateral prophylactic mastectomy: Is there a role to choose wisely patients for sentinel node biopsy? Cancer Med 2016; 5:1031-6. [PMID: 26992816 PMCID: PMC4924360 DOI: 10.1002/cam4.663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 01/08/2016] [Accepted: 01/15/2016] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to evaluate the presence of clinically and mammographically occult disease using breast MRI in a cohort of cancer patients undergoing contralateral prophylactic mastectomy (CPM) and the utmost indication of axillary assessment (sentinel node biopsy (SLNB)) for this side. A retrospective review of patients with unilateral invasive breast cancer or ductal carcinoma in situ (DCIS) from institutional MRI registry data (2004–2010) was conducted. Characteristics of patients undergoing CPM with breast MRI obtained less than 6 month before surgery were evaluated. A total of 2322 consecutive patients diagnosed with DCIS or stage I to III infiltrating breast cancer underwent preoperative breast MRI. Of these, 1376 patients (59.2%) had contralateral clinical breast exam and mammography without abnormalities; and 116 patients (4.9%) underwent CPM (28 excluded patients had breast MRI more than 6 months before CPM). The mean age of the 88 patients was 49 years (range 28–76 years). Two (2.3%) DCIS identified on surgical pathology specimen were not depicted by MRI and the 5 mm T1N0 invasive cancer (1.1%) was identified on MRI. Preoperative MRI showed 95% accuracy to demonstrate absence of occult disease with negative predicted value (NPV) of 98% (95% CI: 91.64–99.64%). Occult disease was present in 3.4% of CPM. MRI accurately identified the case of invasive cancer in this cohort. The high negative predictive value suggests that MRI can be used to select patients without consideration of SLNB for the contralateral side.
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Affiliation(s)
- Vivianne Freitas
- Department of Medical Imaging, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Pavel Crystal
- Department of Medical Imaging, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Supriya R Kulkarni
- Department of Medical Imaging, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sandeep Ghai
- Department of Medical Imaging, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Karina Bukhanov
- Department of Medical Imaging, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jaime Escallon
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anabel M Scaranelo
- Department of Medical Imaging, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
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18
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Karsten M, Stempel M, Radosa J, Patil S, King TA. Oncotype DX in Bilateral Synchronous Primary Invasive Breast Cancer. Ann Surg Oncol 2015; 23:471-6. [PMID: 26340863 DOI: 10.1245/s10434-015-4841-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Synchronous bilateral breast cancers frequently share the same estrogen receptor (ER) status, yet may differ in other histopathologic features. We sought to examine concordance rates of Oncotype DX recurrence score (RS) testing in women with synchronous bilateral ER-positive breast cancer. METHODS Institutional databases were reviewed to identify patients with synchronous (within 6 months) bilateral primary invasive breast cancer and multiple RSs. RSs were stratified by risk group (RS < 18, low; RS 18-30, intermediate; RS ≥ 31, high) and considered discordant if they reflected different risk groups. RESULTS From 2005-2014, a total of 115 patients presented with synchronous bilateral invasive breast cancer; 43 (37 %) had two RSs available. Median patient age was 60 years (42-84), median tumor size was 1.2 cm (0.5-3.7), and all cases were HER2 negative and node negative. Of 86 RSs, 63 (73 %) were low risk, 20 (23 %) were intermediate risk, and 3 (3 %) were high risk. RSs were concordant in 29 (67 %) patients. Patients with concordant RSs were older (62 years vs. 56 years) and had median levels of progesterone receptor (PR) expression that were higher and more similar-80 and 85 % for bilateral cancers, respectively, compared with 55 and 75 % for bilateral cancers in discordant cases. Discordant RS led to a treatment change in 8/14 (57 %) cases. CONCLUSIONS Among women with synchronous bilateral ER-positive HER2-negative breast cancer, RSs were concordant in 67 % of cases. Concordance rates may be higher in older women or among those with comparable levels of PR expression. These data suggest that testing of both tumors should be considered in patients who are candidates for adjuvant chemotherapy.
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Affiliation(s)
- Maria Karsten
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julia Radosa
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tari A King
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Prognosis of synchronous bilateral breast cancer: a review and meta-analysis of observational studies. Breast Cancer Res Treat 2014; 146:461-75. [DOI: 10.1007/s10549-014-3045-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/23/2014] [Indexed: 12/20/2022]
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20
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Lebris A, Vildé A, Marret H, Body G, Ouldamer L. [Role of imaging procedures in the diagnosis of synchronous bilateral breast cancer]. ACTA ACUST UNITED AC 2013; 42:14-9. [PMID: 24309024 DOI: 10.1016/j.gyobfe.2013.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/12/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the role of imaging procedures in the diagnosis of synchronous bilateral breast cancer (SBBC) PATIENTS AND METHODS: The patient group consisted of consecutive women undergoing managed for SBBC in our institution between January 2006 and July 2012. We defined SBBC as bilateral breast tumors diagnosed simultaneously or up to 3 months after initial diagnosis. Clinical data included comorbidities, BMI (kg/m(2)), preoperative breast imaging modalities used and their findings. RESULTS Of the 2322 patients with newly diagnosed breast cancer treated on the study period, 46 patients with the diagnosis of SBBC were enrolled to the study. A total of 41.3% patients had family history of breast cancer. A total of 56.52% had clinical symptoms. The most frequent situation of diagnosis (32.6%) was the association of a palpable tumor and a contralateral radiologic abnormality. MRI permitted the diagnosis of 19.6% occult contralateral lesions. DISCUSSION AND CONCLUSION Clinical examination and conventional imaging procedures (mammography and sonography) detects the majority (76%) of synchronous contralateral breast cancers. A family history of breast cancer, a multifocal breast tumor or the presence of an invasive lobular carcinoma should be arguments for the realization of a breat MRI to eliminate contralateral malignancy.
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Affiliation(s)
- A Lebris
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
| | - A Vildé
- Département de radiologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France
| | - H Marret
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
| | - G Body
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France
| | - L Ouldamer
- Département de gynécologie, hôpital Bretonneau, centre hospitalier régional universitaire de Tours, 2b, boulevard Tonnelé, 37044 Tours, France; Faculté de médecine François-Rabelais, 37044 Tours, France; Unité Inserm 1069, 37044 Tours, France.
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21
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Brasic N, Wisner DJ, Joe BN. Breast MR Imaging for Extent of Disease Assessment in Patients with Newly Diagnosed Breast Cancer. Magn Reson Imaging Clin N Am 2013; 21:519-32. [DOI: 10.1016/j.mric.2013.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Senkus E, Szade J, Pieczyńska B, Żaczek A, Brożek I, Radecka B, Kowalczyk A, Wełnicka-Jaśkiewicz M, Jassem J. Are bilateral breast cancers different from breast cancers coexisting with ovarian cancer? An immunohistochemical analysis aimed at intrinsic tumor phenotype. Breast 2013; 22:425-30. [PMID: 23642527 DOI: 10.1016/j.breast.2013.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/19/2013] [Accepted: 04/03/2013] [Indexed: 11/24/2022] Open
Abstract
RATIONALE Bilateral breast cancers (BBC) and breast cancers coexisting with ovarian cancer (BOCS) are associated with genetic predisposition more frequently than sporadic cases. We compared the phenotypes of these tumors to better understand their pathomechanisms and aid the guiding of their clinical management. MATERIALS AND METHODS Tumor morphology and expression of ER, PgR, HER2, Ki67, CK5/6, E-cadherin, vimentin and EGFR were assessed in a tissue microarray containing cores from 174 BBC, 23 BOCS and 2 BBC + BOCS. RESULTS BOCS tumors were characterized by higher incidence of EGFR expression, HER2 negativity and lower incidence of intraductal component. HER2-positive phenotypes were marginally more frequent in the BBC group and triple negative tumors - in BOCS. CONCLUSION Breast cancers from BOCS patients are characterized by more aggressive phenotype, most probably related to their more frequent association with BRCA1 mutation.
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Affiliation(s)
- Elżbieta Senkus
- Department of Oncology & Radiotherapy, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland.
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Kim JY, Cho N, Koo HR, Yi A, Kim WH, Lee SH, Chang JM, Han W, Moon HG, Im SA, Noh DY, Moon WK. Unilateral Breast Cancer: Screening of Contralateral Breast by Using Preoperative MR Imaging Reduces Incidence of Metachronous Cancer. Radiology 2013; 267:57-66. [DOI: 10.1148/radiol.12120629] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Sandberg MEC, Hall P, Hartman M, Johansson ALV, Eloranta S, Ploner A, Czene K. Estrogen receptor status in relation to risk of contralateral breast cancer-a population-based cohort study. PLoS One 2012; 7:e46535. [PMID: 23056335 PMCID: PMC3466301 DOI: 10.1371/journal.pone.0046535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 08/31/2012] [Indexed: 02/03/2023] Open
Abstract
Background It is unclear whether estrogen receptor (ER)-status of first primary breast cancer is associated with risk of metachronous (non-simultaneous) contralateral breast cancer (CBC), and to what extent endocrine therapy affects this association. Methods We studied the effect of ER-status of the first cancer on the risk of CBC overall, and for different ER-subtypes of CBC, using a large, population-based cohort. The cohort consisted of all women diagnosed with breast cancer in the Stockholm region 1976–2005; 25715 patients, of whom 940 suffered CBC. The relative risk was analyzed mainly using standardized incidence ratios (SIR). Results Women with breast cancer had a doubled risk of CBC compared to the risk of breast cancer in the general female population (SIR: 2.22 [2.08–2.36]), for women with a previous ER-positive cancer: SIR = 2.30 (95% CI:2.11–2.50) and for women with a previous ER-negative cancer: SIR = 2.17 (95% CI:1.82–2.55). The relative risk of ER-positive and ER-negative CBC was very similar for women with ER-positive first cancer (SIR = 2.02 [95%CI: 1.80–2.27] and SIR = 1.89 [95%CI: 1.46–2.41] respectively) while for patients with ER-negative first cancer the relative risk was significantly different (SIR = 1.27 [95% CI:0.94–1.68] for ER-positive CBC and SIR = 4.96 [95%CI:3.67–6.56] for ER-negative CBC). Patients with ER-positive first cancer who received hormone therapy still had a significantly higher risk of CBC than the risk of breast cancer for the general female population (SIR = 1.74 [95% CI:1.47–2.03]). Conclusion The risk of CBC for a breast cancer patient is increased to about two-fold, compared to the risk of breast cancer in the general female population. This excess risk decreases, but does not disappear, with adjuvant endocrine therapy. Patients with ER-positive first cancers have an increased risk for CBC of both ER subtypes, while patients with ER-negative first cancer have a specifically increased risk of ER-negative CBC.
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Affiliation(s)
- Maria E C Sandberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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25
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Cho N, Kim SM, Park JS, Jang M, Kim SY, Chang JM, Moon WK. Contralateral lesions detected by preoperative MRI in patients with recently diagnosed breast cancer: Application of MR CAD in differentiation of benign and malignant lesions. Eur J Radiol 2012; 81:1520-6. [DOI: 10.1016/j.ejrad.2011.03.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/14/2011] [Accepted: 03/16/2011] [Indexed: 12/20/2022]
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García-Lallana A, Antón I, Saiz-Mendiguren R, Elizalde A, Martínez-Regueira F, Rodríguez-Spiteri N, Pina L. Using magnetic resonance imaging for staging can change the therapeutic management in patients with breast cancer. RADIOLOGIA 2012. [DOI: 10.1016/j.rxeng.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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27
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Kim TH, Kang DK, Jung YS, Kim KS, Yim H. Contralateral enhancing lesions on magnetic resonance imaging in patients with breast cancer: role of second-look sonography and imaging findings of synchronous contralateral cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:903-13. [PMID: 22644687 DOI: 10.7863/jum.2012.31.6.903] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES The purposes of this study were to assess the clinical utility of sonography for evaluation of contralateral suspicious lesions detected on magnetic resonance imaging (MRI) in patients with breast cancer and to compare imaging findings of the index and synchronous contralateral cancers. METHODS We performed breast MRI on 853 consecutive patients with histologically confirmed breast cancer between January 2006 and December 2009. All patients underwent mammography and whole-breast sonography before MRI. We included 126 contralateral enhancing lesions in 98 patients who underwent second-look sonography. Lesions with sonographic correlation were biopsied using sonographic guidance, and lesions without sonographic correlation were biopsied using computed tomographic guidance or followed with imaging modalities. RESULTS Of 126 suspicious lesions, 81 (64%) were correlated on sonography, and 45 (36%) were not. Of 81 correlated lesions, 16 (20%) were malignant, and 65 (80%) were benign. Of 45 lesions that were not correlated on sonography, only 1 (2%) was malignant. Of 17 contralateral cancers, 11 were detected on initial sonography and 5 on second-look sonography. The index and contralateral cancers showed statistically significant differences in the sonographic boundary (P = .003) and posterior echogenicity (P = .013). The contralateral cancers detected on initial or second-look sonography showed significant differences in the echo pattern (P = .001). CONCLUSIONS Magnetic resonance imaging is a reliable tool for detection of occult contralateral breast cancer. With second-look sonography, we can find additional contralateral cancer. When enhancing lesions on MRI are not correlated on sonography, MRI- or computed tomography-guided biopsy or short-term imaging follow-up should be done.
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Affiliation(s)
- Tae Hee Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
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28
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Sandberg MEC, Hartman M, Klevebring D, Eloranta S, Ploner A, Hall P, Czene K. Prognostic implications of estrogen receptor pattern of both tumors in contralateral breast cancer. Breast Cancer Res Treat 2012; 134:793-800. [PMID: 22622811 DOI: 10.1007/s10549-012-2096-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 05/10/2012] [Indexed: 02/07/2023]
Abstract
Estrogen receptor (ER) status is important for breast cancer survival, it is however unclear how prognosis of contralateral breast cancer (CBC) is affected by ER-status of the two tumors. We conducted a large, population-based study of ER-status of both tumors in CBC patients and its influence on prognosis. The cohort consisted of all women diagnosed with CBC in Stockholm, Sweden during 1976-2005, with information on ER-status from medical records (N = 933). Prognosis was modeled as incidence rates of distant metastasis via Poisson regression. The proportion of CBCs with both cancers of the same ER-status was significantly larger than expected by chance. For synchronous (simultaneous) cancers the prognosis was significantly affected by the combined ER-status of both tumors (p = 0.01). Compared to unilateral breast cancer patients the incidence rate ratio (IRR) for patients with double ER-positive tumors was 1.25 (95 % CI: 0.88-1.76), for ER-discordant tumors 2.19 (95 % CI: 1.18-4.08) and for double ER-negative tumors 3.95 (95 % CI: 1.77-8.81). For metachronous (non-simultaneous) cancers, women with double ER-positive tumors had similarly bad prognosis (IRR = 2.95; 95 % CI: 2.39-3.64) as women with double ER-negative tumors (IRR = 2.88; 95 % CI: 1.83-4.52). Both shorter time span between first and second cancer and endocrine therapy for the first cancer further worsened prognosis of women with double ER-positive metachronous CBC. For synchronous CBC patients, ER-pattern of both tumors is an important prognosticator, while among metachronous CBC patients, double ER-positive tumors confer equally bad prognosis as double ER-negative cancers. Our results indicate that this might be due to endocrine therapy resistance.
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Affiliation(s)
- Maria E C Sandberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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29
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García-Lallana A, Antón I, Saiz-Mendiguren R, Elizalde A, Martínez-Regueira F, Rodríguez-Spiteri N, Pina L. [Using magnetic resonance imaging for staging can change the therapeutic management in patients with breast cancer]. RADIOLOGIA 2012; 54:350-6. [PMID: 22534560 DOI: 10.1016/j.rx.2011.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 12/28/2011] [Accepted: 12/31/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare two series of patients with breast cancer, one staged using preoperative MRI and the other staged using conventional techniques, analyzing the changes to treatment, the number of mastectomies, and the number of reinterventions due to involvement of the margins. MATERIAL AND METHODS We reviewed 600 patients divided into 300 patients with preoperative MRI (series 1) and 300 without preoperative MRI (series 2). We recorded the following variables: age, menopausal status, tumor size on pathological examination, multiplicity and bilaterality, surgical treatment and type of treatment, the administration of neoadjuvant chemotherapy, and reintervention for involved margins. We used Student's t-test and the chi-square test to compare the variables between the two series. RESULTS The mean age of patients in the two series was similar (51.5 and 51.8 years, P=0.71). The mean size of the tumor was smaller in series 1 (16.9 mm vs 22.3 mm) (P<.001). More multiple tumors were detected in series 1 (28.7 vs 15.7%) (P<.001). The rate of mastectomies was lower in series 1 (25 vs 48%) (P<.001). Oncoplastic and bilateral surgeries were performed only in series 1. Neoadjuvant chemotherapy was administered more often in series 1 (30.7 vs 9.3%) (P<.001). The difference in the number of reinterventions for involved margins did not reach significance (7.2% in series 1 vs 3.2% in series 2) (P=.095). CONCLUSION When MRI was used for staging, neoadjuvant chemotherapy and oncoplastic surgery were used more often and the mastectomy rate decreased. Despite the increase in conservative surgery in patients staged with MRI, the number of reinterventions for involved margins did not increase, although there was a trend towards significance.
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Affiliation(s)
- A García-Lallana
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, España.
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Shi YX, Xia Q, Peng RJ, Yuan ZY, Wang SS, An X, Cao Y, Tan YT, Jin Y, Cai XY, Sun YL, Teng XY, Liu DG, Jiang WQ. Comparison of clinicopathological characteristics and prognoses between bilateral and unilateral breast cancer. J Cancer Res Clin Oncol 2012; 138:705-14. [DOI: 10.1007/s00432-011-1141-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 12/22/2011] [Indexed: 12/24/2022]
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Wu JM, Beck AH, Pate LL, Witten D, Zhu SX, Montgomery KD, Allison KH, van de Rijn M, West RB. Endogenous versus tumor-specific host response to breast carcinoma: a study of stromal response in synchronous breast primaries and biopsy site changes. Clin Cancer Res 2010; 17:437-46. [PMID: 21098336 DOI: 10.1158/1078-0432.ccr-10-1709] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE We recently described two types of stromal response in breast cancer derived from gene expression studies of tenosynovial giant cell tumors and fibromatosis. The purpose of this study is to elucidate the basis of this stromal response--whether they are elicited by individual tumors or whether they represent an endogenous host reaction produced by the patient. EXPERIMENTAL DESIGN Stromal signatures from patients with synchronous dual primaries were analyzed by immunohistochemistry on a tissue microarray (n = 26 pairs) to evaluate the similarity of stromal responses in different tumors within the same patient. We also characterized the extent to which the stromal signatures were conserved between stromal response to injury compared to the stromal response to carcinoma using gene expression profiling and tissue microarray immunohistochemistry. RESULTS The two stromal response signatures showed divergent associations in synchronous primaries: the DTF fibroblast response is more likely to be similar in a patient with multiple breast primaries (permutation analysis P = 0.0027), whereas CSF1 macrophage response shows no significant concordance in separate tumors within a given patient. The DTF fibroblast signature showed more concordance across normal, cancer, and biopsy site samples from within a patient, than across normal, cancer, and biopsy site samples from a random group of patients, whereas the CSF1 macrophage response did not. CONCLUSIONS The results suggest that the DTF fibroblast response is host-specific, whereas the CSF1 response may be tumor-elicited. Our findings provide further insight into stromal response and may facilitate the development of therapeutic strategies to target particular stromal subtypes.
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Affiliation(s)
- Julie M Wu
- Department of Pathology, Stanford University Medical Center, Stanford, California 94305, USA
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Weinstein S, Rosen M. Breast MR imaging: current indications and advanced imaging techniques. Radiol Clin North Am 2010; 48:1013-42. [PMID: 20868898 DOI: 10.1016/j.rcl.2010.06.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Breast cancer is the most common solid tumor diagnosed in women. In the past decades, great strides have been made in breast cancer screening. While multiple screening trials have shown the benefits of screening mammography, there are limitations to x-ray mammography. Given these inherent limitations, efforts have been made to develop adjunctive imaging techniques, including screening ultrasonography, gamma-specific breast imaging, breast tomosynthesis, dedicated breast computed tomography, and breast magnetic resonance (MR) imaging. This article addresses the current indications and advanced imaging applications of breast MR imaging.
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Affiliation(s)
- Susan Weinstein
- Division of Breast Imaging, Department of Radiology, University of Pennsylvania School of Medicine, 1 Silverstein Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Brem RF, Shahan C, Rapleyea JA, Donnelly CA, Rechtman LR, Kidwell AB, Teal CB, McSwain A, Torrente J. Detection of occult foci of breast cancer using breast-specific gamma imaging in women with one mammographic or clinically suspicious breast lesion. Acad Radiol 2010; 17:735-43. [PMID: 20457416 DOI: 10.1016/j.acra.2010.01.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 01/13/2010] [Accepted: 01/20/2010] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to determine how often breast-specific gamma imaging (BSGI) identifies occult cancerous lesions in women with one suspicious lesion detected on mammography or physical exam. MATERIALS AND METHODS A retrospective review was performed of the records of all patients who underwent BSGI between January 1, 2004, and June 4, 2007. Included in the study were 159 women who had one suspicious breast lesion on physical exam and/or mammography and who underwent BSGI to evaluate for occult lesions in the breast. All patients had one or more foci of cancer proven pathologically. BSGI findings were classified as normal or abnormal on the basis of the presence of focal radiotracer uptake. RESULTS BSGI detected additional suspicious lesions occult to mammography and physical exam in 46 of 159 women (29%). BSGI identified occult cancer in 14 of 40 women (35%) who underwent biopsy or excision because of BSGI findings and in 14 of the 159 (9%) women in this study. In nine women, the occult cancer was present in the same breast as the index lesion (6%), and in five women, the occult cancer was found in the contralateral breast (3%). CONCLUSIONS BSGI is an effective imaging modality in the identification of mammographically and clinically occult cancer in women with one suspicious breast lesion.
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Affiliation(s)
- Rachel F Brem
- Breast Imaging and Interventional Center, Department of Radiology, The George Washington University, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA.
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Bernard JR, Vallow LA, DePeri ER, McNeil RB, Feigel DG, Amar S, Buskirk SJ, Perez EA. In newly diagnosed breast cancer, screening MRI of the contralateral breast detects mammographically occult cancer, even in elderly women: the mayo clinic in Florida experience. Breast J 2010; 16:118-26. [PMID: 20136645 DOI: 10.1111/j.1524-4741.2009.00890.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer is somewhat controversial. The purpose of this study was to evaluate the prevalence of synchronous, occult contralateral breast cancer detected by MRI but not by mammography or clinical breast examination in women with newly diagnosed breast cancer, including those aged 70 years or older at our institution. MRI results for women with newly diagnosed breast cancer who underwent bilateral breast MRI after negative mammography and clinical examination between February 2003 and November 2007 at Mayo Clinic in Florida were reviewed. The prevalence of pathologically confirmed contralateral carcinoma diagnosed solely by MRI was determined and analyzed in the context of age, family history, menopausal status, breast density, and primary-tumor characteristics. Logistic regression was used to explore the association between contralateral carcinoma and potential patient risk factors. A total of 425 women were evaluated, of whom 129 (30%) were aged 70 years or older. A contralateral biopsy was recommended and performed solely on the basis of MRI in 72 of the 425 women (17%). Sixteen of these 72 women (22%) had pathologically confirmed carcinoma, including seven in the older subgroup. The prevalence of clinically and mammographically occult contralateral carcinoma detected by MRI was 3.8% (16/425) overall and 5.4% (7/129) in the group of older women. When potential risk factors for contralateral breast cancer were evaluated, postmenopausal status was the only significant predictor of contralateral cancer detected by MRI (p = 0.016). We concluded that contralateral breast screening with MRI should be considered in postmenopausal women with newly diagnosed breast cancer, even those aged 70 years or older at diagnosis.
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Affiliation(s)
- Johnny Ray Bernard
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida 32224, USA
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Sandberg MEC, Hartman M, Edgren G, Eloranta S, Ploner A, Hall P, Czene K. Diagnostic work-up of contralateral breast cancers has not improved over calendar period. Breast Cancer Res Treat 2010; 122:889-95. [PMID: 20107890 DOI: 10.1007/s10549-010-0748-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 01/13/2010] [Indexed: 11/29/2022]
Abstract
Women who have been treated for breast cancer are typically followed up with regular mammography and palpation, with the aim of detecting recurrences and contralateral breast cancer (CBC). This study aims to investigate if the diagnostic work-up of breast cancer patients has improved over the last 25 years and resulted in earlier diagnoses of CBC. Two population-based cohorts were used; all CBCs in Sweden 1976-2004 (n: 2932), and all CBCs in Stockholm, Sweden, 1976-2005 (n: 626), both cohorts with a maximum of 3 years between the two cancers. Synchronous CBC was defined as two cancers <3 months apart, the remainder was defined as metachronous CBC. We calculated the odds ratio of being diagnosed synchronously, relative to metachronously, using logistic regression, adjusting for whether the second cancer was detected through clinical work-up or not. The odds of synchronous CBC were significantly increased: 1.27 (95% CI, 1.13-1.42) per 5-year period, compared to metachronous, and was not affected by detection mode, but seemed to be explained by adjuvant therapy. The proportion of CBCs detected by clinical work-up did not increase over the study period, and the mean size of the second tumor remained constant. We found an increase in the proportion of synchronous CBCs compared to metachronous, over calendar period, a change that was not associated with clinical work-up, but with adjuvant therapy. This study gives no indications that any improvement in diagnostic work-up of CBC have occurred over the last 25 years.
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Affiliation(s)
- Maria E C Sandberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, 171 77 Stockholm, Sweden.
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Renz DM, Böttcher J, Baltzer PAT, Dietzel M, Vag T, Gajda M, Camara O, Runnebaum IB, Kaiser WA. The contralateral synchronous breast carcinoma: a comparison of histology, localization, and magnetic resonance imaging characteristics with the primary index cancer. Breast Cancer Res Treat 2010; 120:449-59. [DOI: 10.1007/s10549-009-0718-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 12/23/2009] [Indexed: 10/20/2022]
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Weinstein S, Chawla M, Kumar R. Screening of Contralateral Breast in Patients with Breast Cancer: Role of MR Imaging and PET/CT Imaging. PET Clin 2009; 4:343-7. [PMID: 27157303 DOI: 10.1016/j.cpet.2009.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Breast cancer is one of the most common cancers in women. Contralateral breast carcinoma is the most common second malignancy in patients with breast carcinoma. Bilateral breast carcinomas exist in 2 forms: synchronous, in which both tumors occur at the same time, or metachronous, in which they occur at different times. When breast cancer is diagnosed, the contralateral breast should be carefully evaluated for a synchronous tumor. Screening for occult contralateral breast cancer is very important on initial cancer diagnosis. The detection and treatment of a synchronous tumor allows for informed surgical decision making, especially if tissue reconstruction is being considered. If chemotherapy is necessary, the patient would only need treatment once for bilateral synchronous cancers, not twice, as with metachronous cancers.
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Affiliation(s)
- Susan Weinstein
- Department of Radiology, Division of Breast Imaging, University of Pennsylvania Medical Center, 3400 Spruce Street, 1 Silverstein Building, Philadelphia, PA 19104, USA
| | - Madhavi Chawla
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
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Irvine T, Allen DS, Gillett C, Hamed H, Fentiman IS. Prognosis of synchronous bilateral breast cancer. Br J Surg 2009; 96:376-80. [DOI: 10.1002/bjs.6553] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
The prognosis of patients with synchronous bilateral breast cancer (SBBC) is usually based on the tumour with the worst pathological features. There is little evidence in the literature for this assumption, potentially impairing reasoned decisions on optimal adjuvant therapy.
Methods
This was a case–control study in which 68 women with SBBC were matched with 128 women with unilateral breast cancer. Both the GuysRisk prognostic model and the Nottingham Prognostic Index were used to determine the bilateral tumour with the poorer prognosis. Controls were matched for age, menopausal status, date of diagnosis, histological type and grade, and oestrogen receptor and axillary node status.
Results
Both prognostic models indicated the same side tumour with the worst prognosis. Kaplan–Meier survival curves for both disease-free and overall survival showed no significant difference in outcome between the two groups.
Conclusion
Prognosis was determined by the tumour with the worst prognosis, with no additional worsening of outcome incurred from the second tumour.
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Affiliation(s)
- T Irvine
- Hedley Atkins Breast Unit, Guy's Hospital, London, UK
| | - D S Allen
- Hedley Atkins Breast Unit, Guy's Hospital, London, UK
| | - C Gillett
- Hedley Atkins Breast Unit, Guy's Hospital, London, UK
| | - H Hamed
- Hedley Atkins Breast Unit, Guy's Hospital, London, UK
| | - I S Fentiman
- Hedley Atkins Breast Unit, Guy's Hospital, London, UK
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Alm El-Din MA, El-Badawy SA, Taghian AG. Breast cancer after treatment of Hodgkin's lymphoma: general review. Int J Radiat Oncol Biol Phys 2008; 72:1291-7. [PMID: 19028269 DOI: 10.1016/j.ijrobp.2008.07.060] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 07/21/2008] [Accepted: 07/26/2008] [Indexed: 11/25/2022]
Abstract
The improved survival rates among patients with Hodgkin's lymphoma over the past few decades have come with increased incidence of second malignancies. One of the major concerns among female survivors is the significantly elevated risk of breast cancer that appears with extended follow-up. In this review, we include the published literature regarding the risk of breast cancer after irradiation for Hodgkin's lymphoma. We also present the possible long-term surveillance strategies and the optimal time to start screening these women. This could potentially help in early detection of secondary breast cancers and consequently improve outcomes. Furthermore, because of prior radiotherapy, the management of the breast cancer among this unique population has been controversial. We discuss the characteristics of breast cancer that occurs after Hodgkin's lymphoma and also treatment options that could be implemented.
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Affiliation(s)
- Mohamed A Alm El-Din
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Wright FC, Eskicioglu C, Glazier J, Jong R, Causer P, Quan ML. Women with Locally Advanced Breast Cancer are Not at Higher Risk for Contralateral Synchronous Breast Cancer. Breast J 2008; 14:556-61. [DOI: 10.1111/j.1524-4741.2008.00647.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Diagnostic and prognostic utility of molecular markers in synchronous bilateral breast carcinoma. Mod Pathol 2008; 21:1200-7. [PMID: 18469799 DOI: 10.1038/modpathol.2008.35] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Histologic criteria have a limited role in determining whether the synchronous bilateral breast carcinomas represent two primaries or a metastasis to the contralateral breast. We studied the molecular analysis of synchronous bilateral breast carcinoma and whether they are originating from a single or different clone. We examined 17 patients with breast carcinoma, including 12 patients with synchronous bilateral carcinomas and control group of 5 infiltrating ductal carcinomas with regional lymph node metastases. Mutations were quantitatively determined to detect loss of heterozygosity (LOH) and microsatellite size alterations for a broad panel of 15 markers, involving 10 chromosomes using polymerase chain reaction. The carcinomas were classified as de novo or metastasis based on three levels of concordance: (1) marker-affected tumors were considered concordant if 50% or more of the same markers were mutated, (2) same gene copy affected, and (3) temporal sequence of mutation acquisition. In synchronous bilateral breast carcinoma patients, molecular analysis showed discordant mutations in all cases, supporting the diagnosis of de novo bilateral primary breast carcinomas. In patients with lymph node metastases, the primary breast carcinoma and metastases shared the same mutations, revealing a metastatic lesion. In conclusion, the application of molecular technology may play an important role for the differential diagnosis of dual primary carcinomas vs a metastatic breast cancer to contralateral breast. In this study, synchronous bilateral breast cancers represent two independent primaries rather than metastatic events.
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Bu-Ali H, Solh M, Kapur A, Mittal V. Receptor Characteristics of the Second Tumor in Synchronous versus Metachronous Breast Cancer. Am Surg 2008. [DOI: 10.1177/000313480807400806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Presently, there is no consensus on whether synchronous breast cancer has the same disease origin as the primary tumor, or if it is a completely independent second primary. This study explores this concept in both synchronous and metachronous breast cancer looking specifically at their receptor characteristics and level of differentiation. A retrospective chart analysis of 114 patients with synchronous or metachronous breast cancer treated at a single institution between January 1991 and March 2004 was done. Sixty-three per cent of the patients were diagnosed with metachronous breast cancer. Synchronous breast cancer was histologically more aggressive ( P < 0.05) with a significantly higher number of patients having poorly differentiated tumors, a greater number of metastases involving a larger number of organs ( P < 0.05), and lower average survival compared with the metachronous group ( P < 0.005). Both the first and second tumor in both groups were similar in hormone receptor status, histologic subtype, and grade. Synchronous breast cancer is more aggressive and has a poorer outcome than metachronous breast cancer. Concordance in hormone receptor status, grade, and histologic subtype between different tumors within the same patient suggests, but does not completely support, a monoclonal origin. Analysis applied here is crude and more specific methods of analysis such as DNA microarray would be required to infer such a conclusion.
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Affiliation(s)
- Hanadi Bu-Ali
- Department of Surgery, Providence Hospital and Medical Centers, Southfield, Michigan
- Department of Surgery, Breast Health Center, Akron General Medical Center, Akron, Ohio
| | | | - Arthi Kapur
- Department of Surgery, Providence Hospital and Medical Centers, Southfield, Michigan
| | - Vijay Mittal
- Department of Surgery, Providence Hospital and Medical Centers, Southfield, Michigan
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Mann RM, Kuhl CK, Kinkel K, Boetes C. Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol 2008; 18:1307-18. [PMID: 18389253 PMCID: PMC2441490 DOI: 10.1007/s00330-008-0863-7] [Citation(s) in RCA: 499] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 12/10/2007] [Accepted: 01/01/2008] [Indexed: 12/20/2022]
Affiliation(s)
- R. M. Mann
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, P.O. Box 9101 (667), 6500 HB Nijmegen, The Netherlands
| | - C. K. Kuhl
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - K. Kinkel
- Department of Radiology, Clinique des Grangettes, 7, chemin des Grangettes, 1224 Genève, Switzerland
| | - C. Boetes
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, P.O. Box 9101 (667), 6500 HB Nijmegen, The Netherlands
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Bilateral synchronous breast cancer in an Asian population: mammographic and sonographic characteristics, detection methods, and staging. AJR Am J Roentgenol 2008; 190:208-13. [PMID: 18094313 DOI: 10.2214/ajr.07.2714] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was performed to compare the clinical and radiologic findings and pathologic staging between index cancer and contralateral synchronous breast cancers and to determine the roles of mammography and sonography in their detection. CONCLUSION Additional contralateral breast cancers in bilateral synchronous breast cancers are apt to be small and less palpable and to have less suspicious imaging findings and less advanced cancer staging than the index cancer. Bilateral whole-breast sonography with mammography is useful in the early detection of contralateral synchronous breast cancer.
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Marpeau O, Ancel PY, Antoine M, Uzan S, Barranger E. Cancers du sein bilatéraux synchrones : facteurs de risque, diagnostic, histologie, traitement. ACTA ACUST UNITED AC 2008; 36:35-44. [DOI: 10.1016/j.gyobfe.2007.09.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 09/19/2007] [Indexed: 11/16/2022]
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Hartman M, Czene K, Reilly M, Adolfsson J, Bergh J, Adami HO, Dickman PW, Hall P. Incidence and Prognosis of Synchronous and Metachronous Bilateral Breast Cancer. J Clin Oncol 2007; 25:4210-6. [PMID: 17878475 DOI: 10.1200/jco.2006.10.5056] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Because the incidence of breast cancer is increasing and prognosis is improving, a growing number of women are at risk of developing bilateral disease. Little is known, however, about incidence trends and prognostic features of bilateral breast cancer. Patients and Methods Among 123,757 women with a primary breast cancer diagnosed in Sweden from 1970 to 2000, a total of 6,550 developed bilateral breast cancer. We separated synchronous (diagnosed within 3 months after a first breast cancer) and metachronous bilateral cancer, and analyzed incidence and mortality rates of breast cancer using Poisson regression models. Results The incidence of synchronous breast cancer increased by age and by 40% during the 1970s, whereas the incidence of metachronous cancer decreased by age and by approximately 30% since the early 1980s, most likely due to increasing use of adjuvant therapy. Women who developed bilateral cancer within 5 years and at age younger than 50 years were 3.9 times (95% CI, 3.5 to 4.5) more likely to die as a result of breast cancer than women with unilateral cancer. Women with a bilateral cancer diagnosed more than 10 years after the first cancer had a prognosis similar to that of a unilateral breast cancer. Adjuvant chemotherapy of primary cancer is a predictor of poor survival after diagnosis of early metachronous cancers. Conclusion We found profound differences in the incidence trends and prognostic outlook between synchronous and metachronous bilateral breast cancer diagnosed at different ages. Adjuvant chemotherapy therapy has a dual effect on metachronous cancer: it reduces the risk, while at the same time it seems to worsen the prognosis.
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Affiliation(s)
- Mikael Hartman
- Department of Medical Epidemiology and Biostatistics, Stockholm Söder Hospital and Oncologic Center, Clintec, Stockholm, Sweden.
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Abstract
Screening mammography is a powerful tool for reducing breast cancer mortality. Mammography can often detect clinically occult, early-stage breast cancer that is amenable to successful treatment. However, mammography is not a perfect test and has lower sensitivity in young women and in those with dense breasts. Magnetic resonance imaging (MRI) has been shown to depict breast cancers that are occult to other forms of detection, including mammography. This has generated interest in the use of MRI for breast cancer screening. Although preliminary studies in highly selected populations show promise for the potential efficacy of breast cancer screening with MRI, there are many questions that should be addressed before this technique is offered to the general population.
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Affiliation(s)
- Carol H Lee
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
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Pediconi F, Catalano C, Roselli A, Padula S, Altomari F, Moriconi E, Pronio AM, Kirchin MA, Passariello R. Contrast-enhanced MR mammography for evaluation of the contralateral breast in patients with diagnosed unilateral breast cancer or high-risk lesions. Radiology 2007; 243:670-80. [PMID: 17446524 DOI: 10.1148/radiol.2433060838] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate accuracy of gadobenate dimeglumine-enhanced magnetic resonance (MR) mammography for depiction of synchronous contralateral breast cancer in patients with newly diagnosed unilateral breast cancer or high-risk lesions, with histologic analysis or follow-up as reference. MATERIALS AND METHODS The study had ethics committee approval; all patients provided written informed consent. One hundred eighteen consecutive women (mean age, 52 years) with unilateral breast cancer or high-risk lesions and negative findings in the contralateral breast at physical examination, ultrasonography, and conventional mammography underwent gadobenate dimeglumine-enhanced 1.5-T MR mammography. Transverse three-dimensional T1-weighted gradient-echo images were acquired before and at 0, 2, 4, 6, and 8 minutes after gadobenate dimeglumine administration (0.1 mmol per kilogram body weight). Breast Imaging Reporting and Data System (BI-RADS) was used to categorize breast density and the level of suspicion for malignant contralateral breast lesions. Results were compared with histologic findings. Sensitivity, specificity, accuracy, and positive and negative predictive values for contrast-enhanced MR mammography were evaluated. RESULTS Contrast-enhanced MR mammography revealed contralateral lesions in 28 (24%) of 118 patients. Twenty-four lesions were detected in patients with dense breasts (BI-RADS breast density category III or IV). Lesions in eight (29%) of 28 patients were BI-RADS category 4; patients underwent biopsy. Lesions in 20 (71%) patients were BI-RADS category 5; patients underwent surgery. At histologic analysis, 22 lesions were confirmed as malignant; six lesions were fibroadenomas. No false-negative lesions were detected; none of the fibroadenomas were BI-RADS category 5. The sensitivity, specificity, accuracy, and positive and negative predictive values of contrast-enhanced MR mammography for depiction of malignant or high-risk contralateral lesions were 100%, 94%, 95%, 79%, and 100%, respectively. Follow-up findings (12-24 months) confirmed absence of contralateral lesions in 90 of 118 patients with negative contrast-enhanced MR mammographic findings in the contralateral breast. CONCLUSION Contrast-enhanced MR mammography is accurate for detection of synchronous contralateral cancer or high-risk lesions in patients with newly diagnosed breast cancer or high-risk lesions.
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Affiliation(s)
- Federica Pediconi
- Department of Radiological Sciences, University of Rome La Sapienza, Viale Regina Elena, 324, 00161 Rome, Italy.
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Del Frate C, Borghese L, Cedolini C, Bestagno A, Puglisi F, Isola M, Soldano F, Bazzocchi M. Role of pre-surgical breast MRI in the management of invasive breast carcinoma. Breast 2007; 16:469-81. [PMID: 17433681 DOI: 10.1016/j.breast.2007.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Revised: 12/27/2006] [Accepted: 02/06/2007] [Indexed: 12/11/2022] Open
Abstract
The purpose of the study was to assess the role of preoperative breast magnetic resonance imaging (MRI) as a complementary tool to routine imaging methods in the management of women affected by invasive breast carcinoma. Mammograms, sonograms and biopsy results of 121 breasts in 118 women affected by invasive breast carcinoma, who underwent pre-surgical breast MR, were re-examined to identify patients theoretically eligible for conservative surgery instead of radical mastectomy. Surgery effectively performed was evaluated to identify cases for which MRI determined a change in management. The gold standard was the final pathology. Breast MRI determined an overall change in management in 22 out of 121 breasts (18.2%), and in two out of 87 breasts (25.3%) in patients eligible for conservative surgery. In the evaluation of single breasts, MRI resulted in true-positive in 22 out of 29 breasts (75.9%), false-positive in 7 out of 29 breasts (24.1%), leading to over-treatment in women whose treatment was changed from conservative surgery to radical mastectomy. MRI sensitivity in the detection of additional foci not seen on conventional imaging was 57.4%, overall sensitivity 87.4%, sensitivity for invasive cancers 93.1%, while for ductal carcinoma in situ it was 58.8%. In conclusion, breast MRI determines a significant change in the management of patients affected by invasive breast carcinoma, particularly in patients eligible for conservative surgery after standard breast examination.
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Affiliation(s)
- Chiara Del Frate
- Institute of Radiology, University of Udine, P. le Santa Maria della Misericordia, 33100 Udine, Italy.
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Abstract
Mammography is considered the "gold standard" in the evaluation of the breast from an imaging perspective. Multiple studies have demonstrated the benefit of mammography in detecting smaller cancers, leading to identification of early-stage breast cancers, which largely accounts for decreased mortality from breast cancer and the increased rate of breast conservation. Identification of a suspicious lesion on a mammogram prompts further evaluation including additional mammographic views, ultrasound examination, and biopsy. Recently, MRI and positron emission tomography are being offered as adjuncts to the preoperative workup to better stage the patient; however, there is still controversy over the most appropriate use of these modalities.
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Affiliation(s)
- Nora M Hansen
- Lynn Sage Comprehensive Breast Center, Northwestern Memorial Hospital, 675 North St. Clair Street, Galter 13-104, Chicago, IL 60611, USA.
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