Repeated surgeries in invasive lobular breast cancer with preoperative MRI: Role of additional carcinoma in situ and background parenchymal enhancement.

OBJECTIVES: Analysing the influence of additional carcinoma in situ (CIS) and background parenchymal enhancement (BPE) in preoperative MRI on repeated surgeries in patients with invasive lobular carcinoma (ILC) of the breast. METHODS: Retrospective analysis of 106 patients (mean age 58.6±9.9years) with 108 ILC. Preoperative tumour size as assessed by MRI, mammography and sonography was recorded and compared to histopathology. In contrast-enhanced MRI, the degree of BPE was categorised by two readers. The influence of additionally detected CIS and BPE on the rate of repeated surgeries was analysed. RESULTS: Additional CIS was present in 45.4% of the cases (49/108). The degree of BPE was minimal or mild in 80% of the cases and moderate or marked in 20% of the cases. In 17 cases (15.7%) at least one repeated surgery was performed. In n=15 of these cases, repeated surgery was performed after BCT (n=9 re-excisions, n=6 conversions to mastectomy), in n=2 cases after initial mastectomy. The initial surgical procedure (p=0.008) and additional CIS (p=0.046) significantly influenced the rate of repeated surgeries, while tumour size, patient age and BPE did not (p=ns). CONCLUSIONS: Additional CIS was associated with a higher rate of repeated surgeries, whereas BPE had no influence.

Background parenchymal enhancement in breast MRI before and after neoadjuvant chemotherapy: correlation with tumour response.

OBJECTIVES: To correlate the decrease in background parenchymal enhancement (BPE) and tumour response measured with MRI in breast cancer patients treated with neoadjuvant chemotherapy (NAC). METHODS: One hundred and forty-six MRI examinations of 73 patients with 80 biopsy-proven breast cancers who underwent breast MRI before and after NAC were retrospectively analysed. All images were reviewed by two blinded readers, who classified BPE into categories (BEC; 1 = minimal, 2 = mild, 3 = moderate, 4 = marked) before and after NAC. Histopathological and morphological tumour responses were analysed and compared. RESULTS: The distribution of BEC 1/2/3/4 was 25/46/18/11 % before and 78/20/2/0 % after NAC. On average, BPE decreased by 0.87 BEC. Cohen's kappa showed substantial agreement (k = 0.73-0.77) before and moderate agreement (k = 0.43-0.60) after NAC and moderate agreement (k = 0.62-0.60) concerning the change in BEC. Correlating the change in BPE with tumour response, the average decrease in BEC was 1.3 in cases of complete remission, 0.83 in cases with partial response, 0.85 in cases with stable disease and 0.40 in cases with progressive disease. Correlation analysis showed a significant correlation between the decrease in BEC and tumour response (r = -0.24, p = 0.03). CONCLUSIONS: BPE decreased by, on average, 0.87 BEC following NAC for breast cancer. The degree of BPE reduction seemed to correlate with tumour response. KEY POINTS: • BPE decreases by an average of 0.87 categories under neoadjuvant chemotherapy. • The reduction of BPE following neoadjuvant chemotherapy correlates with the tumour response. • The classification of the BPE shows good agreement among trained readers.

MR imaging-guided vacuum-assisted breast biopsy: reduction of false-negative biopsies by short-term control MRI 24-48 h after biopsy.

AIM: To evaluate whether another contrast-enhanced (CE) magnetic resonance imaging (MRI) examination 24-48 h after MRI-guided vacuum-assisted breast biopsy (MRI-VAB) can reduce the rate of false-negative cases. MATERIALS AND METHODS: The study included 252 patients who underwent MRI-VAB for the clarification of 299 lesions. The success of MRI-VAB was assessed at interventional MRI and another CE MRI 24-48 h after the intervention. In cases of successful MRI-VAB (complete or partial lesion removal) and benign histological results, follow-up breast MRI was performed. In cases of unsuccessful biopsy (unchanged lesion), tissue sampling was repeated. False-negative cases were calculated to assess the diagnostic value of MRI follow-up within 2 days after intervention. RESULTS: Ninety-eight malignant (32.8%) and 201 (67.2%) benign lesions were diagnosed using MRI-VAB. At immediate unenhanced control MRI, all lesions were assessed as successfully biopsied. In 18 benign cases (6%), CE MRI after 24-48 h showed an unsuccessful intervention. Further tissue sampling revealed another 13 cancers in these patients. This results in a false-negative rate of 11.7%. Follow-up MRI of the benign lesions presented no further malignancy. CONCLUSIONS: MRI-VAB with immediate unenhanced control offers a success rate of 94%. The rate of false-negative biopsies (11.7%) could be reduced to zero by using short-term follow-up MRI. Therefore, a further CE breast MRI 24-48 h after benign MRI-VAB to eliminate missed cancers is recommended.

Management of breast lesions detectable only on MRI.

UNLABELLED: Breast MR imaging has become established as the most sensitive imaging method for diagnosing breast cancer. As a result of the increasing examination volume and improved image quality, the number of breast lesions detected only on MRI and requiring further clarification has risen in recent years. According to the S3-guideline "Diagnosis, Therapy, and Follow-Up of Breast Cancer" as revised in July 2012, institutions performing breast MRI should provide the option of an MRI-guided intervention for clarification. This review describes the indications, methods and results of MRI-guided interventions for the clarification of breast lesions only visible on MRI. Recent guidelines and study results are also addressed and alternative methods and pitfalls are presented. KEY POINTS: ▶ Up to 57 % of lesions originally visible only on MRI can be sonographically correlated and biopsied. ▶ MRI-guided intervention is necessary for the clarification of BI-RADS® 4 and 5 lesions detectable only on MRI ▶ MRI-guided vacuum-assisted breast biopsy should be preferentially used ▶ MRI-guided localization and surgical excision should be used if MRI-guided vacuum-assisted biopsy is not possible ▶ If BI-RADS® 4 and 5 findings visible only on MRI are not detectable on interventional MRI, a follow-up MRI should be performed within six months.

Imaging the activity of nitrate reductase by means of a scanning electrochemical microscope.

Scanning electrochemical microscopy (SECM) was used to characterize immobilized nitrate reductase (NaR) from Pseudonomonas stutzeri (E.C. 1.7.99.4). Nitrate reductase with membrane fragment was embedded in a polyurethane hydrogel in a capillary and solubilized NaR without membrane fragment was covalently coupled to a diaminoethyl-cellulose-carbamitate film on glass. After systematic studies of possible mediators, SECM feedback imaging of both forms of immobilized NaR was accomplished with methylviologen as redox mediator.

Seminal sperm antibodies exhibit an unstable spontaneous course and an increased incidence of leucocytospermia.

The prognostic significance of seminal sperm antibodies for male fertility is difficult to define. Among other factors, spontaneous remissions and transient induction through genito-urinary infections may change their significance for male fertility considerably. We therefore investigated their spontaneous course over time and their association with leucocytospermia. For the investigation of possible relationships between the mixed antiglobulin reaction (MAR) test results for IgA and IgG sperm antibodies and leucocytospermia, 138 patients with > or = 1 million leucocytes/ml ejaculate were compared with 1051 patients with < 1 million leucocytes/ml ejaculate (WHO normal range). In a second part of the study the spontaneous course of MAR IgG and IgA test results was investigated in 58 of the 1189 patients who had three or more MAR tests and a leucocyte concentration of < 1 million/ml ejaculate. The mean interval between the first and second MAR test was 4.1 (SD +/- 4.2) and between the second and third MAR test 6.0 (SD +/- 6.7) months. In total, 64% of patients with an MAR IgG test result > 40% showed a stable spontaneous course. Patients with lower MAR IgG test results and the majority of all MAR IgA-positive patients were found to have an undulating course of MAR test results. There was a higher incidence of leucocytes > or = 1 million/ml ejaculate in patients with higher MAR results (p < 0.05 for IgG, p < 0.001 for IgA).(ABSTRACT TRUNCATED AT 250 WORDS)

Internal quality control of semen analysis.

OBJECTIVE: To test a scheme for quality control of semen analysis. DESIGN: The reproducibility of assessment of sperm concentration, motility, and morphology was obtained for the same sample measured by different technicians (between or intertechnician variation) and for different samples assessed by each technician with time (within or intratechnician variation). SETTING: Andrology Laboratory. PATIENTS: Semen samples were analyzed from all patients attending the clinic. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Within technician and between technician coefficients of variation for concentration, motility, and morphology. RESULTS: When 100 sperm were routinely assessed, both intratechnician variation, as assessed from the precision of duplicate measurements, and intertechnician variation revealed hyperbolic curves with increasing variation at low percentages (less than 20) of motile or morphological forms. When these low values were excluded, mean intratechnician variations were 5.0%, 8.4%, and 2.8% for concentration, motility, and morphology, respectively, and mean intertechnician variations were, respectively, 6.1%, 5.6%, and 5.6%. Similar mean intertechnician variation for morphology was obtained for repeated assessment of prestained (7.3%) or presmeared (5.9%) slides. The use of cryopreserved semen to monitor longitudinal changes in the technicians' assessments revealed variations of 8.1% to 12% in concentration and 9.7% to 14% in motility. Computing the monthly means for sperm concentration, motility, and morphology over a 4.5-year period revealed a marked reduction in percentage of normal morphological forms, unrelated to the sperm count or mean age of the men attending the clinic. This was shown to be a result of a shift in the assessment by technicians. CONCLUSIONS: Quality control is necessary and possible in an andrology clinic.