[Mammographic evaluation of dense breasts: techniques and limits]. / Exploration des seins denses en mammographie: techniques et limites.

Breast density is a radiological concept based on the proportion of radiopaque glandular tissue relative to radiolucent fatty tissue. Mammographic evaluation of dense breasts is more difficult, related to technical difficulties, with decreased rates for detection and characterization of breast lesions, resulting in reduced sensitivity with increased number of interval cancers at routine follow-up when compared to radiolucent breasts. We will review the definition of dense breasts and their frequency, especially their relationship with the age of patients. We will discuss the current technical problems and the impact of breast density on the efficacy of conventional mammography. We will discuss the value of digital mammography, the role of computer assisted diagnosis (CAD) systems and tomosynthesis in the evaluation of dense breasts.

Leiomyosarcoma of the great saphenous vein.

Peripheral vascular leiomyosarcomas are rare. A case of leiomyosarcoma of the great saphenous vein diagnosed pre-surgically by MRI and fine-needle aspiration is presented. Characteristics of the tumour and imaging features are discussed.

[Local recurrence of ductal carcinoma in situ after conservative breast surgery: mammographic appearance]. / Caractéristiques mammographiques des récidives locales des carcinomes canalaires in-situ après traitement conservateur.

OBJECTIVE: To review the mammographic features of local recurrences of DCIS treated conservatively. MATERIALS AND METHODS: Thirty-five patients treated conservatively for a DCIS have presented subsequently a local recurrence. Three patients had double metachronous and one a bi-focal recurrence. The mammographic appearances of these 39 recurrences were analyzed retrospectively and compared to initial mammograms. RESULTS: Median delay to recurrence was of 47 months (interval 8-240 months). Two-thirds of the recurrent lesions were similar to the initial presentation, of which 90% occurred at the lumpectomy site. In 18/ 35 cases (51%), an intra-ductal component was found at histological diagnosis and among these 11/18 (61%) were strictly intra-ductal. CONCLUSION: Local recurrences of DCIS are proteiform. However, the majority of which, occurring at the lumpectomy site were similar to the primary tumor, raising again the hypothesis of incomplete eradication even when the margins were considered free.

Use of radiology for the pathologist in the management of breast lesions.

Today radiology is an essential step in the pathological analysis of breast biopsies. It is determinant at each stage of the management of non palpable lesions, clusters of microcalcifications and opacities, whether this concerns the needle biopsy or the surgical excision. Firstly, an X-ray is necessary to ensure that the core needle biopsy specimen has been adequately sampled and when samples with microcalcifications are selected by the radiologist, management can be more specific and accurate. In the case of surgical specimens, the X-ray confirms the presence of the radiographic abnormality or the clip indicating the site of the surgical excision which guides sampling. Some radiographic features also provide information on underlying pathologies allowing management to be adapted accordingly. Radiographs are also important to ensure that microscopically detected microcalcifications or lesions exactly correspond to the radiographic abnormality in size and location. The paraffin block can also be X-rayed to select those containing microcalcifications for additional slicing. It is also important to identify the presence of modifications caused by the core needle biopsy (fibrosis, haemorrhage and inflammation) and to carefully recognize displacement of epithelial cells and pseudo-emboli resulting from the needle procedure. Such correlation between radiology and pathology is essential so that appropriate management of the specimen can be adapted and to avoid pitfalls arising from pre-operative procedures.

Stellate images: anatomic and radiologic correlations.

The stellate images are the most well-known and most typical finding in the diagnosis of breast cancer. Its positive predictive value is very high. However, in some cases, the stellate images can correspond to benign lesions. Stellate images require high quality mammograms, precise analysis, and as always in senology, confirmation by clinical examination, ultrasound if necessary, and in the case of palpable lesions, cytology. In this work, we will study malignant and benign stellate images mammographic-pathologic correlation as well as the importance of stellate images in the detection of non-palpable lesions. The typical stellate finding is correlated with the phenomena of fibrosis and elastosis and it is impossible to distinguish benign spicules from malignant spicules on mammography. We will present guidelines in the face of stellate image. Stellate images are for the most part suggestive of malignant lesions, and their discovery should lead to suspicion of cancer until the contrary is proven.

[40 years of progress in breast imaging]. / Quarante ans de progrès en imagerie mammaire.

In the sixties, mammary diagnosis is just clinical, then the low contrast mammography, not very efficient, appears in the seventies. During the eighties, the ultrasound is set up while modern mammography with high contrast allows the non palpable breast lesions diagnosis. In the nineties years the mammography come before the clinical examination within the context of the breast cancer screening program. Some histological correlation are more specific about the ductal carcinoma in situ grading with microcalcifications, while new techniques (MRI, CT) are evaluated. At present the stereotactic large core breast biopsies benefit from the digital prone table, allow a histological diagnosis and avoid surgical excision of some indeterminate images. After the pernicious effects of imaging, we assess the progress according to the cancerous disease results. We also consider the problem of over-diagnosis and over-treatment of ductal carcinoma in situ.

Infected ossified lingual thyroid goitre.

Lingual thyroid is a rare embryologic migration failure. It may undergo goitrous changes and the ensueing complications as well as carcinomatous transformation [1,2]. We describe a case of an infected ossified lingual thyroid goitre with suspicion of carcinomatous transformation.

Contrast-enhanced CT: value for diagnosing local breast cancer recurrence after conservative treatment.

PURPOSE: To assess contrast material-enhanced computed tomography (CT) of breast for diagnosing local recurrence after conservative therapy. MATERIALS AND METHODS: In 111 patients, 118 lesions were evaluated with unenhanced and enhanced CT. Criterion for cancer recurrence was detection of a lesion with an enhancement of 45 HU or more. RESULTS: One group comprised 52 lesions with pathologic diagnoses, obtained within 1 month of CT, of malignancy in 43 and benignancy in nine. Scans were positive in 40 of 43 recurrences and negative in six of nine benign lesions. Seventeen recurrent lesions were nonpalpable, and contrast-enhanced CT results were true-positive in 15 of these. A second group comprised 66 lesions with a mean follow-up of the treated breast of 28 months after CT. In 56 lesions, the scans were negative, with no recurrence in 55; local recurrence was proved with a 14-month delayed surgical biopsy in one. In 10 lesions, scans were positive, with a delayed diagnosis of recurrence 5 and 6 months after CT in two and no evidence of recurrence in eight (false-positive results). The sensitivity of breast CT for both groups was 91% (42 of 46 lesions) with a specificity of 85% (61 of 72 lesions). CONCLUSION: Contrast-enhanced CT is sensitive in the diagnosis of local recurrence of breast cancer, even in nonpalpable lesions, and may be a useful tool in patients with equivocal clinical and/or mammographic findings during follow-up after conservative therapy.

Laryngeal schwannomas.

As laryngeal schwannomas are a threat to breathing, they must be removed. CT and MR provide an accurate pre-operative work-up of these lesions. The clear delineation of the tumoral attachment to the larynx proved to be very useful in the difficult management of our second patient. Our two laryngeal schwannomas exhibited a similar appearance which differed from those of the few other laryngeal nerve sheath tumors reported in the literature The low attenuating outer part correlated with Antoni B areas. The denser enhancing inner part correlated with Antoni A areas containing large vessels. This unusual tumoral appearance, which has been observed in some other peripheral schwannomas, must bring this diagnostic possibility to mind. However, this clearly contrasting distribution of the two components of schwannomas is not the most commonly observed in other locations. More reports are needed to establish whether this special appearance is characteristic of laryngeal location.

[Puncture of bone lesions under tomodensitometric control]. / Ponction des lésions osseuses sous contrôle tomodensitométrique.

Sixty CT-guided fine needle biopsies were performed on 59 patients. Of the 40 lesions in patients with a previous history of cancer, malignancy was confirmed by cytological examination in 27 cases and benignity in three cases. Of the 20 lesions in patients with no previous history of cancer, malignancy was confirmed in nine cases (45%) and benignity in five cases (25%). This precise and safe procedure shows 78% overall accuracy in this series.

Study of three radio-induced malignant fibrohistiocytomas of bone.

Malignant fibrohistiocytoma (MFH) is one of the most frequent malignant tumours of soft tissues [6]. Its classification as a bone tumour, however, is relatively recent [1]. In addition to primary MFH in bone, the entity has been observed to occur as a secondary phenomenon, some cases having complicated pre-existing infarcts of bone [4]. This paper reports three cases of MFH of bone developing as a consequence of previous radiation therapy.