Sensitivity of mammography and ultrasonography on detecting abnormal findings of ductal carcinoma in situ.

OBJECTIVE: To analyze the mammographic and ultrasonographic findings of ductal carcinoma in situ (DCIS) and determine the sensitivity in Thai women. MATERIAL AND METHOD: Mammograms and bilateral whole-breast ultrasonograms of 37 proven cases of DCIS were reviewed. The former was assessed for microcalcifications and soft tissue densities while the latter was evaluated for masses and thickened ducts. Ultrasonography was used to spot the areas to visualize soft tissue densities in mammogram. RESULTS: Mammography detected 22 cases of DCIS having pure microcalcifications, eight cases with mixed microcalcifications and soft tissue densities, six cases with pure abnormal soft tissue densities and one case showing negative finding. The ultrasonography detected 13 cases showing masses, seven cases as showing thickened ducts and 17 cases as negative findings. CONCLUSION: Microcalcifications are characteristic findings in mammogram accounting for 81% of DCIS in the present study. Ultrasonography shows abnormalities including mass and thickened duct lesions in 54% of DCIS. The combined modalities can give the detection of abnormalities in 97% of DCIS.

Does color Doppler ultrasound vascularity predict the response to neoadjuvant chemotherapy in breast cancer?

OBJECTIVES: To assess the proportions of response to neoadjuvant chemotherapy of breast cancer according to color Doppler ultrasound vascularity patterns. MATERIAL AND METHOD: Prospective evaluation using gray scale and color Doppler ultrasound for number of vessels and feeding appearances of tumors as well as the changes in tumor sizes at before and after chemotherapy in 69 breast cancer patients. RESULTS: The overall response rate in 70 breast cancers was 20%. Twenty-nine lesions (41%) showed hypervascularity and 41 lesions (59%) revealed hypovascularity. There were 5 vascularity patterns and each pattern had the proportion of responders as follows; 33.3% for hypovascularity with single-vessel feeding into the tumor, 25% for hypovascularity with single-vessel feeding at periphery of the tumor, 25% for no vascular feeding to the tumor, 16.7% for hypervascularity with vascular feeding at the periphery of the tumor and 13% for hypervascularity with vascular feeding into the tumor. The highest percentage of responsive group was the pattern of hypovascularity with single-vessel feeding into the tumor (33.3%). CONCLUSION: There is a trend that tumor vascularity and patterns of vascular feeding by color Doppler ultrasound can predict the responsiveness of breast cancer to neoadjuvant chemotherapy.

Abnormal findings in breast imaging: a hospital-based survey in 4264 Thai women.

OBJECTIVE: To evaluate the distributions of common and significant imaging findings from breast imagings at King Chulalongkorn Memorial Hospitals. MATERIAL AND METHOD: Data was collected from every mammography performed from November 1, 2001 to October 31, 2002. The reports were analyzed and imaging findings were recorded. The ACR BI-RADS category was applied to all cases. RESULTS: There were 4264 patients and all of them were female. The age range was between 19-90 years and average age was 50.1 years. The most common positive findings were cysts (39.22%), followed by focal lesions (14.76%), mass (8.69%), architectural distortion (7.83%), calcification (7.36%) and thick ducts (3.76%). According to ACR BI-RADS, most of the studies were in category 2 (42.59%), followed by category 1 (38.67%), category 3 (12.08%) category 5 (3.45%), category 4 (3.12%) and category 0 (0.09%). CONCLUSION: Breast imaging is the standard screening tool for breast cancer and can reveal different kinds of findings. Knowing the distribution of these findings helps both the radiologists to understand the scope of their work and the institution to audit their practice.

Pattern of local-regional recurrence in patient with early breast cancer after mastectomy: an analysis of 357 cases at King Chulalongkorn Memorial Hospital.

A retrospective review was performed on 357 patients with early stage I-IIIA operable breast cancer who were treated with mastectomy and referred to the clinic at the Division of Radiation Therapy, Department of Radiology, King Chulalongkorn Memorial Hospital between Jan 1991 and Dec 2001. Patients characteristics, treatment modalities and pattern of local and regional failure were evaluated. The median and mean age in the present study were 49 and 50.2 years, respectively. Stage I, II and IIIA were 10.9%, 79.6% and 9.5%, respectively. One hundred and ninety-seven patients (55.2%) received postoperative radiation therapy (RT). Adjuvant chemotherapy was given in 247 patients (69.2%) while 122 patients (34.2%) received adjuvant hormonal therapy. Sixty one patients (17.1%) received both adjuvant chemotherapy and hormonal therapy. However, 12.6% (45/357) did not receive any adjuvant treatment. Median follow up time was 42.6 months (range 6-136 months). Ipsilateral supraclavicular node and chest wall were the most common sites of local-regional recurrence. The chest wall recurrence rate was 10.4% (37/357), which was 16.9% (27/160) in the non postoperative radiation (No RT) group and 5.1% (10/197) in the postoperative radiation (RT) group. For ispilateral supraclavicular node, the recurrence rate was 10.6% (38/357), which was 15.6% (25/160) and 6.6% (13/197) for non RT and RT groups, respectively. The incidence of ipsilateral axilla, ipsilateral internal mammary node and ipsilateral infraclavicular node recurrence rate were 4.2%, 3.6% and 0.8%, respectively. Overall, chest wall and ipsilateral supraclavicular node were the most common sites of local-regional recurrence in early stage operable breast cancer who underwent mastectomy Postoperative adjuvant radiation therapy decreased the risk of local-regional recurrence.

Estrogen and progesterone receptors status in Thai female breast cancer patients: an analysis of 399 cases at King Chulalongkorn Memorial Hospital.

A retrospective review was performed on 576 patients who have been diagnosed breast cancer and referred to Division of Radiation Therapy, Department of Radiology, King Chulalongkorn Memorial Hospital between January 1995-September 2001. There were three hundred ninety nine cases of invasive breast cancer that available for estrogen (ER) and/or progesterone (PR) receptor status. The mean and median age in our study were 49.6 year and 49.0 year respectively. About 60.9 per cent of the patients were pre and peri-menopause and 37.8 per cent were post-menopause. Most of the histological cell type were invasive ductal carcinoma which comprised of 92.7 per cent. Histologic grading were nearly equal for moderately and poorly differentiated grade: 43.66 per cent and 40.66 per cent. The results of our study showed 53.4 per cent of 399 patients had ER positive and 42.1 per cent of 380 patients had PR positive. The proportion of ER+PR+, ER+PR-, ER-PR+, and ER-PR- were 36.31 per cent, 15.53 per cent, 5.79 per cent and 42.37 per cent respectively. Older age and post-menopause women had higher ER+. While patients with increase tumor size, poorly differentiated grading, increase positivity of axillary lymph nodes and higher stage have more chance of ER negative and PR negative.