Analysis of Local Recurrence Risk in Ductal Carcinoma In Situ and External Validation of the Memorial Sloan Kettering Cancer Center Nomogram.

BACKGROUND: Adjuvant radiotherapy and hormonotherapy after breast-conserving surgery (BCS) in ductal carcinoma in situ (DCIS) have been shown to reduce the risk of local recurrence. To predict the risk of ipsilateral breast tumor relapse (IBTR) after BCS, the Memorial Sloan Kettering Cancer Center (MSKCC) developed a nomogram to analyze local recurrence (LR) risk in our cohort and to assess its external validation. METHODS: A historical cohort study using data from 296 patients treated for DCIS at the Hospital Clínic of Barcelona was carried out. Patients who had had a mastectomy were excluded from the analysis. RESULTS: The mean age was 58 years (42-75), and the median follow-up time was 10.64 years. The overall local relapse rate was 13.04% (27 patients) during the study period. Actuarial 5- and 10-year IBTR rates were 5.8 and 12.9%, respectively. The external validation of the MSKCC nomogram was performed using a multivariate logistic regression analysis on a total of 207 patients, which did not reach statistical significance in the studied population for predicting LR (p = 0.10). The expression of estrogen receptors was significantly associated with a decreased risk of LR (OR: 0.25; p = 0.004). CONCLUSIONS: In our series, the LR rate was 13.4%, which was in accordance with the published series. The MSKCC nomogram did not accurately predict the IBTR in this Spanish cohort of patients treated for DCIS (p = 0.10).

Quantitative ultrasound image analysis of axillary lymph nodes to differentiate malignancy from reactive benign changes due to COVID-19 vaccination.

PURPOSE: The aim of this study is to assess the potential of quantitative image analysis and machine learning techniques to differentiate between malignant lymph nodes and benign lymph nodes affected by reactive changes due to COVID-19 vaccination. METHOD: In this institutional review board-approved retrospective study, we improved our previously published artificial intelligence model, by retraining it with newly collected images and testing its performance on images containing benign lymph nodes affected by COVID-19 vaccination. All the images were acquired and selected by specialized breast-imaging radiologists and the nature of each node (benign or malignant) was assessed through a strict clinical protocol using ultrasound-guided biopsies. RESULTS: A total of 180 new images from 154 different patients were recruited: 71 images (10 cases and 61 controls) were used to retrain the old model and 109 images (36 cases and 73 controls) were used to evaluate its performance. The achieved accuracy of the proposed method was 92.7% with 77.8% sensitivity and 100% specificity at the optimal cut-off point. In comparison, the visual node inspection made by radiologists from ultrasound images reached 69.7% accuracy with 41.7% sensitivity and 83.6% specificity. CONCLUSIONS: The results obtained in this study show the potential of the proposed techniques to differentiate between malignant lymph nodes and benign nodes affected by reactive changes due to COVID-19 vaccination. These techniques could be useful to non-invasively diagnose lymph node status in patients with suspicious reactive nodes, although larger multicenter studies are needed to confirm and validate the results.

Magnetic Resonance Imaging Assessment of Radial Scars/complex Sclerosing Lesions of the Breast.

PURPOSE: To describe the magnetic resonance characteristics of radial scars/complex sclerosing lesions (RS/CSL) of the breast using the current BI-RADS lexicon. To investigate the value of diffusion weighted imaging to predict malignancy. PATIENTS AND METHODS: From 2010 to 2017, we have found 25 women with architectural distortion at mammography who underwent surgical resection with a final hystopathologic report of RS/CSL. For the description of MRI findings, we adhered to BI-RADS classification (5th edition). RESULTS: The final pathological diagnosis was: "pure" RS/CSL in 7 cases (28%), RS/CSL with associated high risk lesions in 12 (48%) and 6 cases (24%) were associated with malignancy. Magnetic resonance findings: four of 25 negative or focus. Five of 25 mass enhancement: irregular, non circumscribed spiculated mass with heterogeneous or rim enhancement and most with type II curves. Sixteen of 25 non mass enhancement: focal or linear distribution and heterogeneous internal enhancement most with type I curves. Six of 25 had cancer associated with the complex sclerosing lesion. All six showed non-mass enhancement. Two cases with invasive breast carcinoma had ADC values under 1.15 x10-3 mm/s while most of the rest had the values above. CONCLUSION: Most RS/CSL showed enhancement at MR. The predominant pattern was a non-mass, focal, heterogeneous internal enhancement with type 1 curves. All cases with associated cancer showed non mass enhancement. Invasive breast cancers had ADC values < 1.15 10-3 s/mm2.

Ultrasound Findings of Breast Adenomas.

OBJECTIVES: Breast adenomas are rare benign tumors. The aim of this study was to describe the ultrasound findings of breast adenomas, including less common worrisome features that can mimic malignancy. METHODS: From November 2014 to November 2019, we performed 1605 core needle biopsies guided by ultrasound in our department. In all, 229 corresponded to fibroadenomas and 12 to breast adenomas. RESULTS: Breast adenomas represented 0.75% of all core needle biopsies; 50% (6 of 12) were tubular adenomas; 17% (2 of 12) were ductal adenomas; and 33% (4 of 12) were lactating adenomas. Tubular and lactating adenomas occurred in young women and ductal adenomas in postmenopausal women. Lactating adenomas occurred in pregnant or breastfeeding women and were larger than the other adenomas. Ultrasound showed a mass with an oval shape, a parallel orientation, circumscribed margins, and hypoechoic and homogeneous patterns in most cases. However, up to one-third of them presented with suspicious findings. CONCLUSIONS: Breast adenomas are rare benign entities with no specific clinical and radiologic features. Sometimes, they appear as suspicious tumors on radiologic modalities, requiring a histopathologic assessment to rule out malignancy. Radiologists need to be familiar with this entity to determine concordance between imaging and the final pathologic analysis.

Biopsia de microcalcificaciones de mama bajo guía estereotáxica. Factores que influyen en los resultados / Stereotactically-guided biopsy of breast microcalcifications. Factors influencing the results

Objetivo. Valorar la eficacia diagnóstica de la biopsia de microcalcificaciones bajo guía estereotáxica con dispositivo de vacío, relacionándose con la presencia o no de microcalcificaciones en los cilindros, el tamaño de la lesión y el número de cilindros extraídos. Material y métodos. Se revisaron retrospectivamente 173 biopsias en mesa prona guiadas por estereotaxia con aguja de vacío 9 G, de enero de 2008 a julio de 2012, con correlación histológica de las cirugías o seguimiento con mamografía. Se calcularon los falsos negativos, las infravaloraciones y la sensibilidad. Los resultados se relacionaron con el número de cilindros obtenidos, la presencia de microcalcificaciones y el tamaño de la lesión. Resultados. Se realizaron 173 biopsias en 169 pacientes, excluyéndose 7 biopsias por carecer de seguimiento o de diagnóstico histológico definitivo; finalmente se evaluaron 166 biopsias. Se intervinieron 104 casos (40 benignas, una de alto riesgo, 63 malignas) y se hizo seguimiento mamográfico en 62. En 140 casos (84,3%) se obtuvieron microcalcificaciones, en 14 (8,4%) estaban ausentes y en 12 (7,2%) se hallaron en escaso número (< 3). Hubo 7 falsos negativos (8,6%), en 5 de los cuales no se obtuvieron microcalcificaciones, con un diámetro de las lesiones de 5-13 mm, extrayéndose entre 7-24 cilindros, y 13 infravaloraciones (7,8%), con un diámetro de 5-25 mm, obteniéndose 7-20 cilindros. La sensibilidad del método fue de un 91,4%. La presencia o ausencia de microcalcificaciones y el número de cilindros fueron estadísticamente significativos en relación con los falsos negativos. Conclusión. En la biopsia de microcalcificaciones bajo guía estereotáxica con aguja de vacío es esencial obtener microcalcificaciones en los cilindros. Su ausencia aumenta la tasa de falsos negativos de forma significativa (AU)

Objective. To assess the diagnostic accuracy of vacuum-assisted stereotactically-guided biopsy of breast microcalcifications related to the presence and number of microcalcifications in the specimens, lesion size, and the number of specimens obtained. Material and methods. We retrospectively reviewed the results of 173 biopsies of microcalcifications obtained from January 2008 to July 2012 under stereotactic guidance with a vacuum-assisted biopsy system with a 9-gauge probe. We correlated the results with surgery or long-term mammographic follow-up. The false negative rate, underestimation rate and sensitivity were calculated. We correlated these findings with the number of specimens obtained, the presence of microcalcifications and lesion size. Results. There were 173 biopsies of microcalcifications in 169 patients. Seven biopsies were excluded due to the lack of long-term follow-up or final histologic diagnosis. A total of 104 patients underwent surgery (the results showed benign lesions in 40 patients, a high-risk lesion in one patient and malignancy in 63 patients). Microcalcifications were obtained in 140 specimens (84.3%), were absent in 14 (8.4%) and were scarce (< 3) in 12 specimens (7.2%). There were 7 false negative results (8.6%), of which 5 biopsy specimens showed no microcalcifications. The average lesion diameter was 5-13 mm and 7-24 specimens were obtained. In 13 there was underestimation (7.8%), lesion diameter was 5-25 mm and 7-20 specimens were retrieved. Sensitivity was 91.4%. The presence of microcalcifications in the specimens and their number were statistically significant factors influencing the results. Conclusion. An adequate number of microcalcifications in the specimens from stereotactic vacumm-assisted biopsy is paramount. The absence of microcalcifications will significantly increase the rate of false negatives (AU)

Cáncer de mama asociado al embarazo: estudio analítico observacional / Pregnancy-Associated Breast Cancer: An analytical observational study

Fundamento y objetivo: El cáncer de mama asociado al embarazo se define como aquel que aparece durante la gestación o durante el primer año posparto. Pacientes y método: Estudio retrospectivo analítico observacional en el que se comparan 56 cánceres de mama y embarazo (CME) diagnosticados entre 1976-2008 con 73 pacientes con cáncer de mama no asociado al embarazo (CMNE). Se analizan los diversos datos demográficos, los factores pronósticos, el tratamiento y la supervivencia en ambos grupos. Resultados: La prevalencia de CME en nuestro centro es 8,13/10.000 embarazos. La mayor frecuencia (62%) apareció durante el puerperio. Los estadios son mayores en el CME respecto al CMNE, siendo el 31,3% avanzados en el CME frente al 13,3% en el CMNE (p < 0,05). En cuanto a factores pronósticos, el 27,3% de CME eran grado tumoral iii frente al 15,8% del CMNE. En el grupo CME el 33,3% tenían receptores para estrógeno negativos, el 48,7% receptores para progesterona negativos y el 34,5% eran Her2Neu positivo frente al 22,2, 24,1 y 31%, respectivamente, en CMNE. En el 52,8% de CME aparecieron ganglios afectados frente al 33,8% del CMNE (p < 0,05). En el grupo CME la supervivencia global y libre de enfermedad a 5 años fue del 63,7 y del 74,2%, respectivamente. Conclusiones: El peor pronóstico que se observa en el grupo CME es debido posiblemente a la presencia de factores de pronóstico adversos: metástasis ganglionares, receptores hormonales negativos y grado tumoral tipo iii, así como al diagnóstico tardío, con un porcentaje mayor de cánceres avanzados (AU)

Background and objective: Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy and up to one year postpartum. Patients and method: A retrospective, analytical, observational study comparing 56 cases of breast cancer and pregnancy (PABC) diagnosed 1976-2008 with 73 patients with breast cancer not associated with pregnancy (non-PABC) was performed. Demographic data, prognostic factors, treatment and survival were reviewed and compared. Results: The prevalence of PABC in our center is 8.3/10,000. The highest frequency (62%) appeared during the postpartum period. The stages are higher in PABC, being 31.3% advanced (EIII and EIV) in PABC versus 13.3% in non-PABC (P < .05). Regarding prognostic factors, 27.3% in PABC had a tumoral grade 3 versus 15.8% of non-PABC. Among women with PABC, 33.3% had negative estrogen receptors, 48.7% negative progesterone receptors and 34.5% positive Her2Neu compared with 22.2, 24.1 and 31%, respectively of non-PABC patients. Finally, positive lymph nodes were found in 52.8% of PABC, versus 33.8% non-PABC (P < .05). Overall and disease-free survival rate at 5 years for PABC was 63.7 and 74.2%, respectively. Conclusions: The poorer survival observed is possibly due to the presence of adverse prognostic features such as lymph node metastases, negative hormone receptors, tumoral grade III, as well as a delay in diagnosis with a higher rate of advanced stages (AU)

[Pregnancy-Associated Breast Cancer: An analytical observational study]. / Cáncer de mama asociado al embarazo: estudio analítico observacional.

BACKGROUND AND OBJECTIVE: Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy and up to one year postpartum. PATIENTS AND METHOD: A retrospective, analytical, observational study comparing 56 cases of breast cancer and pregnancy (PABC) diagnosed 1976-2008 with 73 patients with breast cancer not associated with pregnancy (non-PABC) was performed. Demographic data, prognostic factors, treatment and survival were reviewed and compared. RESULTS: The prevalence of PABC in our center is 8.3/10,000. The highest frequency (62%) appeared during the postpartum period. The stages are higher in PABC, being 31.3% advanced (EIII and EIV) in PABC versus 13.3% in non-PABC (P < .05). Regarding prognostic factors, 27.3% in PABC had a tumoral grade 3 versus 15.8% of non-PABC. Among women with PABC, 33.3% had negative estrogen receptors, 48.7% negative progesterone receptors and 34.5% positive Her2Neu compared with 22.2, 24.1 and 31%, respectively of non-PABC patients. Finally, positive lymph nodes were found in 52.8% of PABC, versus 33.8% non-PABC (P < .05). Overall and disease-free survival rate at 5 years for PABC was 63.7 and 74.2%, respectively. CONCLUSIONS: The poorer survival observed is possibly due to the presence of adverse prognostic features such as lymph node metastases, negative hormone receptors, tumoral grade iii, as well as a delay in diagnosis with a higher rate of advanced stages.

Role of elastography in the assessment of breast lesions: preliminary results.

OBJECTIVES: The purposes of this study were to evaluate the diagnostic utility of elastography in differentiating benign from malignant breast lesions and compare it with conventional sonography. METHODS: A total of 124 breast lesions (59 malignant and 65 benign) were examined with B-mode sonography and subsequently with elastography. Conventional sonographic findings were classified according to the American College of Radiology Breast Imaging Reporting and Data System for sonography, and elastographic images were assigned an elasticity score of 1 to 5 (1-3, benign; 4 and 5, malignant) according to the Ueno classification. Cytologic diagnoses obtained from fine-needle aspiration and histopathologic results from a core-needle biopsy or surgical biopsy were used as reference standards. Statistical analysis included sensitivity, specificity, and positive and negative predictive values for both elastography and conventional sonography. RESULTS: B-mode sonography had sensitivity of 96.6% (95% confidence interval, 93.3%-99.9%), specificity of 76.9% (69.2%-84.6%), a positive predictive value of 79.2% (72.1%-86.2%), and a negative predictive value of 96.2% (92.4%-99.9%), compared with sensitivity of 69.5% (60.5%-78.5%), specificity of 83.1% (76.3%-89.8%), a positive predictive value of 78.9% (70.6%-87.1%), and a negative predictive value of 75.0% (67.4%-82.6%) for elastography. Elastography showed less sensitivity but higher specificity than conventional sonography. CONCLUSIONS: Our results show that elastography may be useful as a complementary technique in addition to conventional sonography in the characterization of breast lesions because it increases the diagnostic specificity, thus reducing the false-positive rate.

Carcinoma micropapilar infiltrante de la mama en un varón. A propósito de un caso / Invasive micropapillary carcinoma of the male breast. A case report

Introducción: El carcinoma micropapilar infiltrante de la glándula mamaria representa una variante histológica con una alta incidencia de metástasis ganglionares y un alto índice de recidivas locorregionales, que se ha descrito de forma muy ocasional en la mama masculina. Caso clínico: Se presenta un caso de un varón de 75 años con un carcinoma micropapilar infiltrante de la mama derecha de 2 cm y con metástasis en uno de 11 ganglios axilares. Los receptores hormonales fueron positivos y el c-erbB 2 determinado inmunohistoquímicamente fue negativo. La evolución a los 17 meses del diagnóstico fue satisfactoria. Conclusión: El carcinoma micropapilar infiltrante también puede presentarse en la mama masculina con las mismas características clínicas y morfológicas que en la mama femenina

Introduction: Invasive micropapillary carcinoma of the breast is a histological subtype of carcinoma with a high incidence of lymph node metastasis and frequent recurrences that has only been described occasionally in the male breast. Clinico-pathological report: A case of a 75 year old male with a 2 cm invasive micropapillary carcinoma and metastasis in one out of 11 axillary lymph nodes is presented. Hormone receptors were positive and c-erbB 2 detected immunohistochemically was negative. The follow-up was successful after 17 months of diagnosis. Conclusion: Invasive micropapillary carcinoma can also occur in the male breast with the same clinic and morphologic characteristics than in the female breast (AU)

Tumor estromal del tracto gastrointestinal que simula un tumor maligno del ovario en el estudio ecográfico transvaginal / Gastrointestinal stromal tumor simulating a malignant ovarian tumor in transvaginal

Presentamos un caso de tumor de origen no ginecológico que simula un tumor maligno de ovario, descubierto en el transcurso de una revisión ginecológica mediante ecografía ginecológica transvaginal con power Doppler. El resultado de la anatomía patológica revela que setrata de un tumor estromal gastrointestinal de bajo riesgo (TEGI). Este tipo de tumores tiene un buen pronóstico y evolución si cuando son detectados son menores de 5 cm. El tratamiento de este tipo de tumor es quirúrgico

A case of non-gynecologic tumor mimicking a malignant ovarian neoplasm by transvaginal power Dopler ultrasonographic study is presented. The hystopathologic study revealed a gastrointestinal estromal tumor of low grade. These tumor have a good prognosis wen are detected under 5 cm of size. The treatment of choice is surgery

[Retroperitoneal paraganglioma]. / Paraganglioma retroperitoneal.

OBJECTIVES: To report the radiological findings of retroperitoneal paragangliomas. METHODS: A patient who presents with colic pain and undergoes intravenous urography and CT scan. RESULTS: KUB x-ray revealed an increase of radiodensity on the left flank. The urography showed a partially obstructive urinary lithiasis in the proximal third of the left ureter with a mass effect laterally displacing pelvis and ureter. The study was completed with an i.v. contrast abdominal CT scan which showed a left para-aortic solid mass under the kidney with heterogeneous contrast uptake. CONCLUSIONS: The correlation of symptoms and catecholamine levels is the best way to guide the etiological diagnosis after CT scan.

Diagnostic value of hysterosalpingography in the detection of intrauterine abnormalities: a comparison with hysteroscopy.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic accuracy of hysterosalpingography (HSG) in comparison with hysteroscopy in the detection of intrauterine abnormality in infertile patients. MATERIALS AND METHODS: Seventy-eight patients being investigated for infertility and undergoing HSG and hysteroscopy were studied retrospectively. Radiologic findings on HSG, including single or multiple filling defects and uterine wall irregularities, were evaluated and compared with hysteroscopic findings, which were considered the reference standard. RESULTS: HSG showed a sensitivity of 81.2% compared with that of hysteroscopy and a specificity of 80.4%, with a positive predictive value of 63.4% and a negative predictive value of 83.7%. HSG also had a false-negative rate of 90% and a false-positive rate of 21.8%. Overall agreement between the two procedures was 73%. CONCLUSION: HSG is still a useful screening test for the evaluation of the uterine cavity in the study of primary or secondary infertility. In addition, HSG provides information concerning the assessment of tubal morphology and patency. We believe that these two procedures are complementary in the evaluation of the uterine cavity.

Depósitos áuricos en ganglios axilares simulando microcalcificaciones / Calcific deposits in axillary lymph nodes mimicking microcalcifications

El carcinoma de mama se manifiesta frecuentemente como microcalcificaciones distribuidas siguiendo patrones cálcicos característicos.La presencia de microcalcificaciones en los ganglios axilares es un hallazgo infrecuente, y excepcionalmente secundaria a la afectación metastásica de los mismos por un carcinoma mamario. Presentamos el caso de una paciente con antecedentes de artritis reumatoide con microcalcificaciones en ganglios axilares observadas en una mamografía de control, describiendo los hallazgos radiológicos, el diagnóstico diferencial, y realizando una revisión de la bibliografía (AU)

Alteraciones tubáricas y peritoneales diagnosticadas por histerosalpingografía / Tubal and peritoneal alterations diagnosed by hysterosalpingography

En el estudio de las causas de infertilidad, los factores tubáricos y peritoneales representan el 25-40 por ciento de los casos. La histerosalpingografía (HSG) es el método diagnóstico principal en el estudio de la morfología y permeabilidad tubárica, aunque presenta una menor sensibilidad en la valoración de las adherencias pélvicas. El propósito de este trabajo es describir las manifestaciones radiológicas más frecuentes de las principales patologías tubáricas y peritoneales observadas mediante histerosalpingografía. Hemos revisado las histerosalpingografías practicadas en nuestro centro desde enero de 1998 hasta diciembre de 1999 en pacientes en estudio de infertilidad, seleccionando las imágenes más representativas de las distintas entidades patológicas (AU)