Screening with magnetic resonance imaging, mammography and ultrasound in women at average and intermediate risk of breast cancer

Background

The addition of MRI to mammography and ultrasound for breast cancer screening has been shown to improve screening sensitivity for high risk women, but there is little data to date for women at average or intermediate risk.

Methods

Two thousand nine hundred and ninety-five women, aged 40 to 65 years with no previous history of breast cancer were enrolled in a screening program, which consisted of two rounds of MRI, ultrasound and mammography, one year apart. Three hundred and fifty-six women had a CHEK2 mutation, 370 women had a first-degree relative with breast cancer (and no CHEK2 mutation) and 2269 women had neither risk factor. Subjects were followed for breast cancer for three years from the second screening examination.

Results

Twenty-seven invasive epithelial cancers, one angiosarcoma and six cases of DCIS were identified over the four-year period. Of the 27 invasive cancers, 20 were screen-detected, 2 were interval cancers, and five cancers were identified in the second or third follow-up year (i.e., after the end of the screening period). For invasive cancer, the sensitivity of MRI was 86%, the sensitivity of ultrasound was 59% and the sensitivity of mammography was 50%. The number of biopsies incurred by MRI (n = 156) was greater than the number incurred by mammography (n = 35) or ultrasound (n = 57). Of the 19 invasive cancers detected by MRI, 17 (89%) were also detected by ultrasound or mammography.

Conclusions

In terms of sensitivity, MRI is slightly better than the combination of mammography and ultrasound for screening of women at average or intermediate risk of breast cancer. However, because of additional costs incurred by MRI screening, and the small gain in sensitivity, MRI screening is probably not warranted outside of high-risk populations.

[Clinical and radiological evaluation of malignant metaplasia of benign primary bone tumors on the material of University Orthopaedic Department of Szczecin between 2002-2007]

The study presents clinical and diagnostic problems in patients with malignant bone metaplasia. Material is composed of 13 patients treated surgically between april 2002 and august 2007. In three cases tumors were localised in tibia, in 5 patients around distal femur, in 2 in pelvis, in 2 in humerus and in 1 in lumbar spine. None of the patients has had recurrence by february 2006 r, 12 patients have been free of the disease so far. However, one individual diagnosed with giant cell tumor metaplasia to osteosarcoma did not accept proposed therapy. The authors have particularly emphasized thorough clinical and radiological evaluation and the need of team work before surgical procedure.

[Pharmacogenetics of the local thrombolysis in patients with deep vein thrombosis]

Thrombophilia, the state of increased tendency for blood clotting, is considered the disorder of a complex etiology, caused by both environmental and genetic factors. As gene variants predisposing to thrombophilia and influencing the increased risk of vein thrombosis might influence response to local thrombolysis, the aim of the work was to characterize the pharmacogenetic conditions for local streptokinase treatment in patients with a deep vein thrombosis (DVT) of lower extremities based on the following polymorphism analyses: G1691A polymorphism of factor V (FV), G20210A polymorphism of prothrombin (PT), A4250G (Thr312Ala) polymorphism of fibrinogen-alpha (FGA), G(-455)A polymorphism of fibrinogen-beta (FGB), 4G/5G polymorphism of plasminogen activator inhibitor type 1(PAI-1) and insertion/deletion (I/D) polymorphism of tissue plasminogen activator (t-PA). The study included 40 DVT patients who underwent a local thrombolytic treatment within 14-day period from diagnosis. Full recanalization was achieved in 20 subjects (50%) [group R(+)], whereas incomplete or total lack of recanalization was identified in the remaining 20 patients [group R(-)]. No major complications of thrombolytic treatment occurred in the studied group. In the case of prothrombin gene all individuals carried homozygous wild type genotype (GG). Prevalence of the genotypes and alleles of the remaining five polymorphisms did not differ significantly between the groups R(+) and R(-). Neither sex nor age, smoking or time period from diagnosis to introduction of the thrombolytic treatment significantly influenced treatment efficacy. The results of the study suggest that a local thrombolysis with streptokinase introduced within two week period from the diagnosis is a safe and efficient method of treatment for deep vein thrombosis of lower extremities. However, size of the group is insufficient to clearly determine the association between investigated polymorphisms and efficacy of local treatment with streptokinase.

[Evaluation of the value of color doppler ultrasound investigations in diagnosis of the most frequently occurring diseases of the scrotal pouch]

The objective of the work was to estimate the value of ultrasound investigation with the use of colour Doppler imaging in diagnosing diseases of intrascrothy structures. Epidemiology of pathological testis epididymitis and seminal cord as well as histomorphology of tumours in testes were discussed. Technique of radiological imaging of this area and rules of colour Doppler ultrasonography were presented. Investigations were performed, with apparatus Acuson 128 XP-10 using colour Doppler, in presentation B and B-colour. The accomplished evaluation covered the localization, size, echostructure and blood supply, vascularization of the studied changes, and in defined cases (mainly inflammations, and malignant neoplasms), coefficient of RI flow resistance was determined. Ultrasound examinations with the implementation of colour Doppler were carried out in 306 patients, aged from 15 to 75 years, who were divided into two groups. Group I--control comprised 70 patients, group II--236 patients, in whom the clinical examination revealed various pathological changes within scrota. In patients of group I no changes in the intrascrotal structures were observed in the clinical examinations however, ultrasound study detected small varicoceles in 8 patients, and in 2 tiny cysts in epididymis. In group II by ultrasound the following were diagnosed: 50 inflammations, 15 testotorsion, 45 hydroceleus, 36 tumours, 20 traumas and 70 cases of varicocele. On the basis of the performed investigations it has been disclosed that colour Doppler USG examination is very useful in diagnosis of diseases, namely the so-called "acute scrotum"--trauma, torsion, inflammation of testis and epididymitis. It is also useful in differentiating inflammatory, neoplastic changes of testes and epididymidis, relying on the complex estimation of their echostructures, blood supply vascularization as well as the character of vascular flow. Differentiating only on the basis of spectrum of the flow and the value of resistance indicator is not sufficient. Doppler technique is of essential significance in preoperative diagnosis, concerning the varicocele and monitoring of the postoperative period allowing for the estimation of the therapeutic effectiveness (Fig. 1, 2, 3, 4).