CT for Preoperative Prediction of Axillary Lymph-Node Status in Patients with Breast Cancer

BACKGROUND: The clinical staging may serve to guide initial therapy based on all available preoperative data, such as history, physical and laboratory examinations, and biopsy material. Computed tomography is one of the most attractive methods of evaluating the clinical state of patients with breast cancer. In cases where the lymph nodes are enlarged, CT of the chest can accurately detect the level of axillary lymph nodes involvement. CT may also simultaneously play a role in evaluating the mediastinum and the supraclavicular areas for adenopathy, primary tumors and lung metastases. The aim of this study was to determine the appropriate size criteria for metastatic axillary lymph nodes on CT and to evaluate the validity of using CT to detect axillary lymph-node metastases due to breast cancer. METHODS: CT examination of the chest was performed before axillary lymph node dissection in 98 patients with breast cancer. We measured the sizes of the lymph nodes according to the short-axis diameters seen on CT. We estimated the sensitivity, the specificity, the ROC curve, and the predictability of CT based on lymph-node sizes. RESULTS: The diagnostic criterion for node metastases was 5 mm. At the 5 mm point, the accuracy of CT for axillary metastases was 70% with a sensitivity of 89%, a specificity of 60%, a negative predictive value of 90%, and a positive predictive value of 56%. CONCLUSIONS: In conclusion, CT is not an accurate assessment in the diagnosis of axillary lymph-nodemetastases due to breast cancer. However, CT data can be interpreted with sufficient sensitivity and negative predictability for CT to serve as a screening test.

The Usefulness of Color Doppler Ultrasonography In the Evaluation of Breast Mass

PURPOSE: To evaluate the usefulness of color Doppler ultrasonography in the differential diagnosis of breast masses. MATERIALS AND METHODS: We prospectively evaluated to pathologically proven breast lesions. Forty-three were benign (39 fibroadenomas, two papillomas and two lipoma) and 27 were malignant (25 infiltrating ductal cardinomas, one mucinous carinoma and one atypical medullary caricinoma). In 32 cases, we categorized color signal from 0 to III, according to the degree of vascularity, and analysed peak systolic velocity (PSV) and resistive index (RI). RESULTS: Color signals of malignant lesions tended to be high grade (II, III), whereas those of benign lesions tended to be low (0, I), and the difference was statistically significant (P<0.005). In the analysis of spectral waveform , correlation between RI, PSV and malignancy was statistically significant (P<0.02). RI above 0.7 and PSV above 10 were the highest recorded values for sensitivity and specificity. CONCLUSION: Color Doppler ultrasound is a useful modality to distinguish benign from malignant breast masses. Malignancy is suggested when the color signal is grade II or III, the resistive index is higher than 0.7, and peak systolic velocity is higher than 10cm/sec.

A Case of Endoscopically Diagnosed Gastric Cancer with Metastasis to Thyroid and Breast / 대한소화기내시경학회지

Metastatic malignant tumors involving the thyroid gland are not as unusual as was once believed. They may in fact be more common than primary cancer of the thyroid, especially if careful screening is performed at autopsy. The origins of primary neoplasms that metasta size to the thyoid are myriad, but reports obviously indicate predminantly cancers of the kidney, breast, and lung and malignant melanoma. Occasienally, metastatic lesions from several gastrointestinal neoplasms such as colo-retal and esophageal carcinoma are seen, but metastasis from gastric cancer is very rare. We have seen one case of thyroid cancer metastasized from the stomach cancer. It simultaneously spread to the breast also and confirmed with gastrofiberscopic biopsy, fine needle aspiration cytology of the thyroid and excisonal biopsy of the breast. We report this case with reriew of literature.