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Objective To analyze the MRI data of misdiagnosed and missed diagnosed of breast lesions and their histopathological features.Methods Data from 241 breast lesions within 121 patients were recruited in this study.The data included MRI images,uhrasounds and X-ray images were retrospectively interpreted by two radiologist and each lesion was assessed according to the BI-RADS classification.The pathologic features of miss or error diagnosed lesions on MRI were analyzed.Results In 241 breast lesions (malignance 120,bcnign 121),4 lcsions were miss diagnosed on MRI.Thcy were 2 intraductal papillomatosis and 2 fibroadenoma.All was benign.Twenty three lesions were misdiagnosed on MRI.Sixteen were overestimation,including 3 chronic inflammations,3 sclerosing adenosis,2 fibroadenoma,4 fibrocystic changes with or without atypical ductal hyperplasia (ADH),2 intraductal papilloma,1 infiltration of pectoralis major muscle and 1 axillary lymphnode metastasis.Meanwhile,there were 7 lesions were underestimation.These lesions included 2 invasive ductal carcinomas,1 mucinous adenocarcinoma,2 DCIS and 1 blunt duct adenosis with ADH and focal cancerous,1 inflammatory breast cancer underwent chemotherapy.The sensitivity and specificity and accuracy of breast MRI were 95.83 ％ (115/120),72.73 ％ (88/121),84.23 ％ (203/241),respectively.MRI findings had no difference with respect to mammogram or ultrasound was 75.10 ％ (181/241).Conclusion MRI misdiagnosis and missed often occurs in smaller breast lesions,morphologic and hemodynamic malignant manifestation atypical,especially intraductal lesions.MRI diagnosis should be combined with physical examination,X-ray mammogram and ultrasound to improve diagnostic accuracy and reduce missed diagnosis.
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Objective To review the status and controversy on skin-sparing mastectomy (SSM) for breast cancer. Methods The pertinent literatures about SSM published recently to comprehend its relevant techniques and improvements in comparison with non-skin-sparing mastectomy (NSSM) were analyzed and also the safety of SSM by analyzing the relationships between SSM and ductal carcinoma in situ, restrict nipple-areola complex reservation, and postmastectomy radiotherapy were discussed. Results Skin-sparing mastectomy combined with immediate breast reconstruction is a safe operative modality for T1/T2 tumor without skin adhesion, multicentric tumors, and ductal carcinoma in situ. What is more, it does not defer adjuvant therapy. However, it may be prudent to reserve the nipple-areola complex only for peripherally located T1/T2 tumors and some other less serious invasion degree. Since the effect of SSM and immediate breast reconstruction on postmastectomy radiotherapy is confusing, there are still controversies on whether the patients who have already been operated should take radiotherapy. Conclusion SSM is a safe operative modality for selected patients with breast cancer, and delayed reconstruction may be a good choice for patients who would take postmastectomy radiotherapy.
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Objective To explore surgical approach for internal mammary node biopsy in patients with breast cancer. Methods Modified radical mastectomy and incised intercostal muscles for internal mammary node biopsy was performed on 113 patients. The distance from the internal mammary artery to the lateral sternal border, and the intercostal distance between the two costal cartilage were measured. Anatomical location and maximal diameter of the excised nodes were recorded. Results The internal mammary artery runs through intercostal space along the lateral sternal border. The distance from the internal mammary artery to the lateral sternal border was (10. 9?4. 5) mm, (11.6?2.9) mm, (9.6?3.6) mm and (4.5?3.5) mm in the first, second, third and fourth intercostal space, respectively. The distance between the two costal cartilage was (14. 2?4. 1) mm, (16. 2?4. 2) mm, (13. 9?4. 3) mm and (9.9?3. 6) mm in the first,second, third and fourth intercostal space, respectively. Two hundred and seventy-nine internal mammary nodes were excised from 113 patients. The anatomical location of the internal mammary nodes which embedded in the fatty tissue surrounding internal mammary artery were 41. 2% at the medial side, 51. 6% at the lateral side and 7. 2% in an anterior plane to the internal mammary artery. Metastases in the internal mammary node were detected in 26 patients. The lymph nodes metastasis were detected only in the internal mammary nodes in 5 cases. Conclusion Internal mammary node biopsy via intercostal space is a feasible, minimally traumatic, low-risk procedure.
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Objective To investigate the feasibility of internal mammary sentinel node(SN) biopsy and internal mammary lymph chain excision under thoracoscope. Methods Six small pigs were used for the experiment.The small pigs were intubated using a double lumen endotracheal tube and kept anesthetized with ketamine.Methylene blue(4 ml) was injected subdermally into both of the first pair of breast.The sentinel node biopsy and internal mammary lymph chain dissection was performed thoracoscopically using a harmonic scalpel.Time of the appearance of the first blue-stained node and the dissection procedure were recorded respectively.Results Thoracoscopic internal mammary sentinel node dissection and internal mammary lymph chain excision was performed successfully in all the 6 pigs(12 sides).The time of the appearance of the first blue-stained sentinel node was 5~15 min(mean,8.9 min),the time of thoracoscopic biopsy was 15~50 min(mean,30.4 min),and the time of internal mammary lymph chain excision was 30~56 min on the left side and 22~48 min on the right side(mean,38.2 min),respectively.No bleeding,lung injuries,and other surgical complications occurred. Conclusions Thoracoscopic internal mammary sentinel node dissection and internal mammary lymph chain excision is feasible,easy to perform,and minimally invasive.