Effectiveness of Breast MRI and 18F-FDG PET/CT for the Preoperative Staging of Invasive Lobular Carcinoma versus Ductal Carcinoma / 한국유방암학회지

PURPOSE: We evaluated the utility of magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for the preoperative staging of invasive lobular carcinoma (ILC) of the breast and compared the results with those of invasive ductal carcinoma (IDC). METHODS: The study included pathologically proven 32 ILCs and 73 IDCs. We compared clinical and histopathological characteristics and the diagnostic performances of MRI and 18F-FDG PET/CT for the primary mass, additional ipsilateral and/or contralateral lesion(s), and axillary lymph node metastasis between the ILC and IDC groups. RESULTS: Primary ILCs were greater in size, but demonstrated lower maximum standardized uptake values than IDCs. All primary masses were detected on MRI. The detection rate for ILCs (75.0%) was lower than that for IDCs (83.6%) on 18F-FDG PET/CT, but the difference was not significant. For additional ipsilateral lesion(s), the sensitivities and specificities of MRI were 87.5% and 58.3% for ILC and 100.0% and 66.7% for IDC, respectively; whereas the sensitivities and specificities of 18F-FDG PET/CT were 0% and 91.7% for ILC and 37.5% and 94.7% for IDC, respectively. The sensitivity of 18F-FDG PET/CT for ipsilateral lesion(s) was significantly lower in the ILC group than the IDC group. The sensitivity for ipsilateral lesion(s) was significantly higher with MRI; however, specificity was higher with 18F-FDG PET/CT in both tumor groups. There was no significant difference in the diagnostic performance for additional contralateral lesion(s) or axillary lymph node metastasis on MRI or 18F-FDG PET/CT for ILC versus IDC. CONCLUSION: The MRI and 18F-FDG PET/CT detection rates for the primary cancer do not differ between the ILC and IDC groups. Although 18F-FDG PET/CT demonstrates lower sensitivity for primary and additional ipsilateral lesions, it shows higher specificity for additional ipsilateral lesions, and could play a complementary role in the staging of ILC as well as IDC.

Wernicke's Encephalopathy following Gastrectomy in Patients with Gastric Cancer

Wernicke's encephalopathy is a neurological disorder that is caused by a thiamine deficiency, and characterized by acute confusion, ataxia, a change in the patient's state of mind and abnormal eye movement (op-thalmophlegia and nystag-mus). This encephalopathy can be found in patients with chronic alcoholism, anorexia nervosa, hemodialysis, AIDS and gastroplasty for morbid obesity. The diagnosis of this disease is difficult because not all cases display the typical symptoms. However, this disease can be confirmed not only by the clinical symptoms but also by the brain MRI findings, low thiamine level and clinical response to thiamine replacement therapy. We experienced two cases of Wer-nicke's encephalopathy in patients who underwent a gas-trec-tomy for gastric cancer. However, this condition was not diagnosed until the patients showed neurological symptoms and the typical MRI findings. These patients improved after vitamin B(1) (thiamine) replacement.