Background
Axillary lymph node metastasis is considered one of the main prognostic factors clinically used for the evaluation of breast cancer patient. Also, an accurate diagnosis of axillary lymph ...node metastasis has a significant effect on the tumor staging and treatment planning. Ultrasonography is a noninvasive, available imaging modality that is capable of giving a real-time evaluation of axillary lymph nodes in breast cancer cases. On the other hand, multi-detector-row computed tomography is increasingly preferred by clinicians to preoperatively evaluate regional lymph node status in many cancers. The aim of this study was to compare the diagnostic performance of computed tomography against ultrasound in detecting axillary lymph node status in breast cancer patients.
Results
One hundred and fifty breast cancer patients were included in this prospective study. According to the final pathological results, 79/150 (52.7%) lymph nodes were metastatic, while 71/150 (47.3%) lymph nodes were benign with no evidence of metastases. Ultrasound examination has achieved a sensitivity of 76.4% and a specificity of 60.8% with overall diagnostic accuracy of 68.7%. Computed tomography (CT) examination has achieved a much higher sensitivity of 98.6%, a much lower specificity of 35.4%, and overall diagnostic accuracy of 65.3%. In our study, CT examination was superior on ultrasound in the determination of the level of lymph node affection, and this may be attributed to the dependency of ultrasound examination on the operator’s experience.
Conclusions
CT is not routinely used in the assessment of nodal stage. However, if used in proper clinical setting, it may increase our confidence in excluding nodal metastasis owing to its high sensitivity. Despite its low specificity, it may act as road map for the surgeon, providing the ability to assess all groups of lymph nodes as well as the number of the suspicious lymph nodes.
Background
Nipple discharge is one of the commonest encountered complaints in the field of breast imaging. Excluding malignancy as a cause of pathological nipple discharge is of utmost importance. ...Our aim in this study was to assess the role of contrast-enhanced spectral mammography (CESM) in the diagnostic workup of patients with pathological nipple discharge (PND).
Results
In the current prospective study, 59/140 lesions were benign and 81/140 lesions were malignant. Analysis of CESM had achieved a higher sensitivity of 97.5% and a similar specificity of 54.2% as compared to sono-mammography, which achieved a sensitivity of 92.6% and specificity of 54.2%. The diagnostic accuracy of CESM was higher (79.3%) than sono-mammography (76.3%). CESM performed better than sono-mammography in the assessment of disease extent, as it was able to detect multifocality, multicentricity, and diffuse abnormalities, which were found in 24.1%, 43.0% and 8.9% of cases, respectively, as compared to 20.5%, 37.2%, and 3.8% of cases by sono-mammography.
Conclusion
CESM can be a valuable diagnostic imaging tool in the detection of malignancy associated with PND if sono-mammographic findings are equivocal. Its greater impact is on the delineation of disease extent, which will alter the treatment strategy.
Background
Risk factors are traits or behaviors that have an influence on the development of breast cancer (BC). Awareness of the prevalent risk factors can guide in developing prevention ...interventions.
Purpose
To evaluate the correlation between the breast density, body mass index, and the risk of breast cancer development in relation to the menopausal status in a native African-Arab population.
Material and methods
The study included 30,443 screened females who were classified into cancer and non-cancer groups and each group was further sub-classified into pre- and postmenopausal groups. The breast density (BD) was reported and subjectively classified according to the 2013 ACR BI-RADS breast density classification. The weight and height were measured, and the body mass index (BMI) was calculated and classified according to the WHO BMI classification.
Results
A statistically significant difference was calculated between the mean BMI in the cancer and non-cancer groups (p: .027) as well as between the pre- and postmenopausal groups (p < .001). A positive statistically insignificant correlation was calculated between the breast density and the risk of breast cancer in the premenopausal group (OR: 1.062, p: .919) and a negative highly significant correlation was calculated in the postmenopausal group (OR: 0.234, p < .001).
Conclusion
BMI and BD are inversely associated with each other. The current studied population presented unique ethnic characteristics, where a decreased BD and an increased BMI were found to be independent risk factors for developing breast cancer.
Background
During multi-detector computed tomography (MDCT) of the chest, incidental breast lesions (IBLs) are occasionally encountered. Mammography remains the gold standard for the early detection ...of breast cancer. However, limitations exist in patients with dense breasts. Contrast spectral mammography (CESM) is widely available compared to MRI; it increases the sensitivity for breast cancer detection without decreasing the specificity.
Results
The study is a prospective study that included 113 female breast cancer patients for CT staging. One hundred and six of the patients had unilateral carcinoma and 7 of them had bilateral cancer with a total of 120 breasts evaluated. The CT findings were correlated with CESM findings regarding the multiplicity and bilaterality of the disease. The sensitivity, specificity, PPV, NPV, and accuracy of the CT in the detection of multiplicity were 97.44%, 100%, 100%, 95.45%, and 98.33%, respectively, and the sensitivity, specificity, PPV, NPV, and accuracy of the CT in the detection of bilateral disease were 68.18%, 97.96%, 88.24%, 93.20%, and 92.50%, respectively.
Conclusions
Breast cancer patients for MDCT chest as a part of their metastatic workup can omit the further need for CESM.
Background
Axillary nodal status is crucial for the management of cases with recently diagnosed breast cancer; usually addressed via axillary ultrasonography (US) along with tissue sampling in case ...of suspicion. Axillary nodal dissection and sentinel biopsy may be done, but are rather invasive, carrying a potential complication risk, which raises the need for non-invasive, reliable, pre-operative axillary imaging. We aimed at evaluating the performance of diffusion-weighted imaging (DWI) regarding preoperative axillary evaluation, using functional information derived from diffusion capacity differences between benign and malignant tissue. We included 77 axillary nodes from 77 patients (age range 20–78 years, mean 50 ± 12.6 SD) in our prospective study, presenting with variable clinical breast complaints, all scoring BIRADS 4/5 on sonomammography (SM). They underwent axillary evaluation by both US and DW-MRI where US classified nodes into benign, indeterminate, or malignant by evaluating nodal size, shape, cortical thickness, and hilar fat. Qualitative DWI classified them into either restricted or not and a cut-off apparent diffusion coefficient (ADC) value was calculated to differentiate benign and malignant nodal involvement. Results for each modality were correlated to those of final histopathology, which served as the standard of reference.
Results
The calculated sensitivity, specificity, accuracy, PPV, and NPV for US was 100%, 36.6%, 75.3%, 71.2%, and 100%, respectively. Statistical indices for qualitative DWI were 76.6%, 63.3%, 76.6%, 63.3%, and 71.4%, respectively (
P
value < 0.001). The calculated cut off value for ADC between infiltrated and non-infiltrated nodes was 0.95 × 10
−3
mm
2
/s concluding statistical indices of 76.6%, 63.3%, 76.6%, 63.3%, and 71.4%, respectively (
P
value < 0.001).
Conclusion
Combining DW-MRI to conventional US improves diagnostic specificity and overall accuracy of preoperative axillary evaluation of patients with recently discovered breast cancer.
Background
Breast cancer is one of the leading causes of female morbidity and mortality. Management options vary between lesions of BIRADS categories 3 and 4. Therefore, reliable differentiation ...would improve outcome. Although sonomammography and contrast-enhanced breast magnetic resonance imaging (CE-MRI) remain the cornerstone for assessment of breast disease, additional, non-invasive techniques can be used to increase the efficiency of evaluation such as shear wave elastography (SWE) and diffusion-weighted magnetic resonance imaging (DW-MRI). This prospective study included 66 breast lesions that were categorized as BIRADS 3 or 4 by ultrasound ± mammography. All lesions were evaluated by SWE, CE-MRI and DW-MRI. For SWE, lesions were evaluated by both qualitative and quantitative methods. For CE-MRI, both morphological and kinematic evaluations were done and for DW-MRI, both qualitative and quantitative assessments were studied. Results of all imaging modalities were correlated to histopathology.
Results
Thirty-seven out of the examined 66 lesions (56.06%) were categorised as BIRADS 3, out of which 1 (2.7%) turned out to be malignant on histopathology and 36 (97.29%) were proved benign. Twenty-nine (43.93%) were categorized as BIRADS 4, out of which 2 (6.89%) turned out to be benign on pathology and 27 (93.1%) were proved malignant. Morphological and kinematic evaluations of CE-MRI showed 92.59% and 92.86%sensitivity, 94.74% and 84.21% specificity, 92.59 and 81.25%PPV, 94.74 and 94.12% NPV, and 93.85% and 87.88% accuracy respectively. Color-coded scoring of SWE showed indices of 89.29%, 68.42%, 67.57%, 89.66%, and 77.27% respectively. The calculated cut-off value for
E
max differentiating benign from malignant was 65.15 kpa, resulting in indices of 96.43%, 57.89%, 95.65%, 62.79%, and 74.24% respectively. For
E
ratio, the calculated cut-off value was 4.55, resulting in indices of 71.43%, 68.42%, 76.47%, 62.50% and 69.70% respectively. For qualitative evaluation of DW-MRI, indices were 78.57%, 65.79%, 62.86%, 80.65%, and 71.21% respectively. For ADC, the calculated cut-off value was 1.25 × 10
3
mm
2
/s, which resulted in indices of 75.00%, 84.21%, 82.05%, 77.78%, and 80.30% respectively.
Conclusion
CE-MRI showed the best diagnostic performance indices. While, SWE and DW-MRI present variable diagnostic performance, both techniques can be used as an adjunct to other imaging modalities to aid the clinical decision and increase its diagnostic confidence.
Background
Accurate staging and proper management of axillary lymph nodes (ALNs) in breast cancer patients are important for treatment. Surgical management of the axilla has evolved greatly in the ...last 20 years. Sentinel lymph node biopsy (SLNB), which was first investigated in the early 1990s, has replaced routine axillary lymph node dissection. This study evaluates the capability of using an ultrasound (US) as an alternative tool for the frozen section in the assessment of the ex vivo sentinel lymph node biopsy in countries with limited resources.
Results
The study is a prospective study that included 216 female patients with early breast cancer and negative axillary lymph nodes. All excised lymph nodes were examined by the intraoperative US and frozen section examinations. All the results were correlated with the final histopathological results. The number of negative nodes by US, frozen, and paraffin section examination was 58.30%, 69.40%, and 69.40%, respectively. The number of positive nodes by the US, frozen, and paraffin section examinations was 41.70%, 30.60%, and 30.60% respectively. The sensitivity, specificity, PPV, NPV, and accuracy of US in the detection of positive lymph nodes were 95.45%, 82%, 70%, 97.62%, and 86.11%, respectively, and the sensitivity, specificity, PPV, NPV, and accuracy of frozen examination in the detection of positive lymph nodes were 90.91%, 96%, 90.91%, 96%, and 94.44%, respectively.
Conclusion
Intraoperative US is a good negative test in the assessment of ex vivo SLNB, but it is not a good positive test, so it cannot replace the intraoperative frozen section in the assessment of SLNs.
Background
Mammography is the most accepted, accurate, and effective modality in screening of breast cancer, yet its sensitivity is affected by the density of the breast tissue. Alternative methods ...for screening are the sonography and MRI but both had their limitations. A new option named ABUS (automated breast ultrasound system) is now proposed to overcome the breast US limitation as it is time-consuming and operator-dependent and to overcome the costly time-consuming MRI. The objectives of the study are to evaluate the accuracy of ABUS in the detection of different breast lesions as a substitution for mammography. This prospective study included 25 women outreached for digital mammography or handheld ultrasound examination at the period between January 2017 and February 2018. Women have no specific age group.
Results
Significant improvement in the detection of breast lesions by ABUS use with mammogram especially in dense breasts (ACR class C and D)
Conclusion
ABUS is a promising competitor to mammogram in screening of breast lesions
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