Dynamic contrast-enhanced breast magnetic resonance imaging findings that affect the magnetic resonance-directed ultrasound correlation of non-mass enhancement lesions: a single-center retrospective study.

OBJECTIVE: Our single-center retrospective study aimed to evaluate the relationship between magnetic resonance (MR)-directed ultrasound (MDUS) detectability and MRI findings of non-mass enhancement (NME) lesions, regarding the morphologic and enhancement features, the distance from the skin and nipple, and the presence of concomitant landmarks. METHODS: A total of 350 MRI-detected NME lesions that were determined between January 2015 and May 2019 and subsequently underwent MDUS were analyzed. The MRI findings, biopsy results, and follow-up outcomes of lesions were recorded. The correlation between the MRI findings of the lesions and MDUS detectability was analyzed. RESULTS: 114 (32.6%) of the 350 lesions had a counterpart in the MDUS. Respectively, 66 (37.9%), 38 (43.2%) and 59 (38.3%) of the lesions detected in MDUS were larger than 20 mm in size, with a distance of less than 20 mm to the nipple and 15 mm to the skin. The lesion size and lesion distance to the nipple and skin were significantly associated with a ultrasound correlate (p < 0.05). The MDUS detection rate was significantly higher in NME lesions with MR findings including diffuse distribution (p < 0.001), clustered-ring enhancement pattern (p < 0.001), washout kinetic curve (p = 0.006), and MR-BIRADS category 5 (p < 0.001). Multivariate logistic regression showed that only the clustered-ring enhancement pattern was significantly associated with an MDUS correlation (p < 0.001). CONCLUSION: Statistically significant correlations were found between the size, distance to the nipple and skin, distribution pattern, enhancement pattern and kinetic curve of the NME lesions on MRI and ultrasound detectability. ADVANCES IN KNOWLEDGE: We found that clustered-ring enhancement patterns were significantly more frequent in MR-directed ultrasound detectable lesions.

The effect of chemotherapy type and timing among the other factors on patency of totally implantable vascular access devices in colorectal carcinoma.

PURPOSE: Catheter-related complications are observed in infusion of chemotherapy, and these were encountered with targeted therapies. Our principle is to study non-mechanical effects of type and initiation time of chemotherapy among the other factors on patency of totally implantable vascular access devices (TIVAD) inserted in patients with colorectal carcinoma. METHODS: This is a one-center retrospective cohort study. We analyzed TIVAD related complications in 624 patients with colorectal carcinoma. The patients were categorized by chemotherapy type (non-target-directed chemotherapy agents (Group A), bevacizumab (Group B), and cetuximab (Group C)). Additionally, we divided the patients into groups by the time interval between TIVAD insertion and chemotherapy initiation. According to our study, a 3-day period was optimal. Therefore, we named the groups as within 3 days and beyond 3 days, and called this process 3 days cut-off. Age, gender, jugular-subclavian access, platelet count, INR, the types of chemotherapy, and the initiation time of chemotherapy were investigated by survival tests. We compared chemotherapy type groups both one-by-one and combined into one group. RESULTS: The TIVADs were removed due to the complications in 11 patients of Group A, 6 patients of Group B, and 3 patients of Group C. Only chemotherapy type was significant (p = 0.011) in Cox regression test. A clear difference (p = 0.010) was detected between the catheter patency of Group A and combination of Groups B and C, because of skin necrosis and thrombosis. Within 3 days of their first chemotherapy day, an important difference between Group A and Group C (p = 0.013) was observed in the TIVAD patency. The same observation was made between Group A and Group B (p = 0.007). Beyond this period, no major difference was detected (p = 0.341). CONCLUSION: A major effect on catheter patency was detected by using the target-directed chemotherapy agent within 3 days, which should be considered in target-directed chemotherapy.

Comparison of the Magnetic Resonance Imaging Findings of Paget's Disease of the Breast and Malignant Tumor Invasion of the Nipple-Areola Complex.

OBJECTIVE: We aimed to investigate the distinction between Paget's disease of the breast (PDB) and malignant tumor invasion of nipple-areolar complex (MTION) with Magnetic resonance imaging (MRI) findings without the need for skin punch biopsy. MATERIALS AND METHODS: MRI findings of 16 patients with pathologically proven PDB and 11 patients with pathologically proven MTION were reviewed retrospectively. MRI images were assessed for nipple morphological changes; areolar-periareolar skin changes; thickness, classification, and kinetic characteristics of the nipple-areolar complex (NAC) enhancement; morphological pattern, size, and pathological diagnosis of concomitant malignant lesions; kinetic characteristics of the concomitant malignant lesions enhancement; continuity of enhancement between the nipple and closest concomitant malignant lesion; similarity of enhancement kinetics of the NAC and concomitant malignant lesions; and nipple-to-malignant lesion distance in both patient groups. RESULTS: Areolar-periareolar skin thickening was statistically different between the patient groups. Enhancement kinetic pattern was classified as persistent in four patients with MTION and plateau in seven patients with PDB. Moreover, NAC enhancement kinetic characteristics were statistically different between the groups. Invasive ductal carcinoma was detected in three patients with PDB and five patients with MTION. A statistically significant difference in malignant lesion pathological types was detected between the patient groups. CONCLUSION: The significant MRI findings in patients with MTION diagnosed as invasive ductal carcinoma were areolar-periareolar skin thickening and asymmetric NAC enhancement with persistent kinetics pattern. In patients diagnosed with ductal carcinoma in situ, a plateau pattern of asymmetric NAC enhancement without any areolar-periareolar skin changes on MRI may indicate PDB.

Can preoperative axillary ultrasound and biopsy of suspicious lymph nodes be an alternative to sentinel lymph node biopsy in clinical node negative early breast cancer?

AIM: The aim of this study was to assess the efficacy of preoperative axillary ultrasonography (AUS) and preoperative axillary fine-needle aspiration biopsy (FNAB) from suspicious lymph nodes in clinically node-negative breast cancer to compare with radiologically positive and sentinel lymph node biopsy (SLNB) positive involvement. METHOD: Clinically node-negative early-stage breast cancer patients were included in the study. These patients underwent preoperative AUS examination, suspicious lymph nodes were evaluated with FNAB. AUS-FNAB results were compared with those of SLNB or axillary dissection. RESULTS: Of 181 patients undergoing AUS, 32 were reported to have axillary metastasis, 25 suspicious, and 124 benign nodes. The suspicious group underwent FNAB examination and metastasis was found in 9 of them. The sensitivity of AUS-FNAB was found to be 64.06%, specificity 100%, positive predictive value 100%, and negative predictive value (NPV) 83.5%. The false negativity rate (FN) of this method was 16,4%. Lymphovascular invasion and tumour size were found statistically significant factors for false negativity. CONCLUSION: It was concluded that axillary AUS-FNAB with its high NPV, low FN rate, may be a clinical alternative to SLNB for early-stage breast cancer patients.

The MRI characteristics of non-mass enhancement lesions of the breast: associations with malignancy.

OBJECTIVE:: The American College of Radiology updated the terms used for expressing the imaging characteristics of non-mass enhancement (NME) lesions in the fifth edition of the breast imaging-reporting data system (BI-RADS) lexicon. Both the distribution and internal enhancement descriptors were revised for NME lesions. Our aim was to determine the MRI characteristics of NME lesions and to investigate their association with malignancy. METHODS:: The MRI results of 129 NME lesions were retrospectively evaluated. The medical files, biopsy results and follow-up findings of lesions were recorded. Patients who had benign biopsy and those who had stable or regressed lesions during follow-up were classified as benign. All MRI results had been obtained with a 1.5 Tesla Signa HDx MR system (GE Healthcare). RESULTS:: Segmental and diffuse distribution along with clustered-ring internal enhancement were significantly associated with malignancy, while linear distribution and homogeneous enhancement pattern were associated with benignancy. Additionally, the plateau type (Type II) curve was significantly more frequent in malignant lesions. There was no association between the presence of cystic structures and the benign/malignant nature of the lesion. However, multivariate logistic regression showed that only segmental distribution and diffusion restriction were associated with malignancy. CONCLUSION:: In the current study, segmental distribution, clustered-ring enhancement, Type II dynamic curve and the presence of diffusion restriction were found to be associated with malignancy. There is a requirement for multicenter studies which include higher numbers of patients in order to better evaluate lesions with rarer characteristics for distribution and enhancement pattern. ADVANCES IN KNOWLEDGE:: Our aim in this study was to investigate the MRI characteristics of NME lesions. We have reported the MRI findings of NME lesions and have found that segmental distribution and clustered-ring enhancement patterns are significantly more frequent in malignant lesions.

Radiologic Findings of a Rare Subtype of Invasive Breast Cancer with Poor Prognosis: Metaplastic Carcinoma of the Breast.

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the mammographic, sonographic and MRI findings of metaplastic breast carcinoma. METHODS: In this retrospective review study, we analyzed the medical files of 9600 patients who were treated for invasive breast cancers. Clinical information, histopathologic and radiologic findings of 65 patients were included in this study. All existing radiologic images and medical reports were reviewed retrospectively. Thirty-three patients had MG, 58 patients had US and 7 patients had MRI imaging results. RESULTS: Mammographically, the most frequent presentations of MPBC were round shape, microlobulated margin and high density masses. Calcifications with or without masses were not a frequent finding. The most common sonographic findings were round shape, partially indistinct angular margin, hypoechoic and heterogeneous echo patterns and no posterior feature masses. All lesions were presented as masses rather than non-mass enhancements on magnetic resonance imaging. Features of masses had more malignant feature on MRI than other modalities in all 7 patients. CONCLUSION: Metaplastic breast carcinoma is one of the rarest poorly differentiated invasive breast carcinomas. Interestingly, these aggressive tumors demonstrate benign or moderately malign features on imaging methods. This appearance of MPBC can cause it to be misdiagnosed as a benign breast lesion especially in young women. MPBC should be kept in mind in the differential diagnosis of large palpable breast masses. Therefore, follow-up at short intervals and/or multimodality imaging studies which include breast MRI are important for the diagnosis of MPBC.

Is there any relationship between adc values of diffusion-weighted imaging and the histopathological prognostic factors of invasive ductal carcinoma?

OBJECTIVE: MRI is being used increasingly as a modality that can provide important information about breast cancer. Diffusion-weighted imaging (DWI) is an imaging technique from which apparent diffusion coefficient (ADC) values can be calculated in addition to obtaining important structural information which cannot be obtained from other imaging studies. We did not find any significant relationships between ADC values and prognostic factors, but did provide some explanations for conflicting results in the literature. METHODS: The ADC results of 61 females with invasive ductal carcinomas were evaluated. DWI was performed and ADC values were calculated from the area in which restriction of diffusion was the highest in ADC mapping. B value was 500 and region of interest (ROI) was designated between 49 and 100 mm2. Calculations were performed automatically by the device. Tissue samples were obtained for prognostic factor evaluation. The relationships between ADC and prognostic factors were investigated. Comparisons between groups were made with one-way ANOVA and Kruskal Wallis test. Pairwise comparisons were made with Dunn's test. Analyses of categorical variables were made with Chi-square test. RESULTS: We found a weak negative correlation between ADC and Ki-67 values (r = -0.279; p = 0.029). When we compared ADC values in regard to tumour type, we found no significant differences for tumour grade, Ki-67 positivity, estrogen receptor positivity, progesterone receptor positivity, C-erb B2, lymphovascular invasion and ductal carcinoma in situ or lobular carcinoma in situ component. On a side note, we found that mean ADC values decreased as tumour grade increased; however, this was not statistically significant. CONCLUSION: The literature contains studies that report conflicting results which may be caused by differences in B values, ROI area and magnetic field strength. Multicentre studies and systematic reviews of these findings may produce crucial data for the use of DWI in breast cancer. Advances in knowledge: To determine if any significant relationship exists between DWI findings and prognostic factors of breast cancer.

Acute necrotizing encephalopathy secondary to diphtheria, tetanus toxoid and whole-cell pertussis vaccination: diffusion-weighted imaging and proton MR spectroscopy findings.

We present a previously healthy 6-month-old boy who was admitted to our hospital with lethargy, hypotonia and focal clonic seizures 6 days following diptheria, tetanus toxoid and whole-cell pertussis vaccination. A diagnosis of acute necrotising encephalopathy was made with the aid of MRI, including diffusion-weighted imaging and proton MR spectroscopy.