The role of tomosynthesis in breast cancer staging in 75 patients.

OBJECTIVES: Compare tomosynthesis to mammography, ultrasound, MRI, and histology for the detection and staging of BI-RADS 4-5 anomalies, as a function of breast composition, lesion location, size, and histology. PATIENTS AND METHODS: Seventy-five patients underwent mammography, tomosynthesis, ultrasound, and MRI. The diagnostic accuracy of the different examinations was compared. RESULTS: The sensitivities for detection were as follows: 92.5% with MRI, 79% for ultrasound, 75% for tomosynthesis, and 59.5% for mammography. Tomosynthesis improves the sensitivity of mammography (P=0.00013), but not the specificity. The detection of multifocality and multicentricity was improved, but not significantly. Tomosynthesis identified more lesions than mammography in 10% of cases and improved lesion staging irrespective of the density, but was still inferior to MRI. The detection of ductal neoplasia was superior with tomosynthesis than with mammography (P=0.016), but this was not the case with lobular cancer. The visualization of masses was improved with tomosynthesis (P=0.00012), but not microcalcifications. Tomosynthesis was capable of differentiating lesions of all sizes, but the smaller lesions were easier to see. Lesion sizes measured with tomosynthesis, excluding the spicules, concurred with histological dimensions. Spicules lead to an overestimation of the size. CONCLUSION: In our series, tomosynthesis found more lesions than mammography in 10% of patients, resulting in an adaption of the surgical plan.

Shear wave elastography contribution in ultrasound diagnosis management of breast lesions.

PURPOSE: To determine the diagnosis performance of shear wave elastography in the differentiation of benign and malignant breast lesions and the factors influencing the elasticity values. To suggest an appropriate management of breast lesions using the ultrasound-elastography combination. PATIENTS AND METHODS: Monocentric retrospective study of 167 breast lesions classified by conventional ultrasound as BI-RADS category 3 or higher that underwent an elastography study and histological analysis. RESULTS: The analysis of qualitative parameters, according to the classification established in this study, allows us to obtain a sensitivity of 91.1% and a specificity of 92.3%. These values are very close to or better than the quantitative parameters Emax and Emean. Different Emax thresholds values were established based on the long axis of the lesion and its palpable character, which appeared to be significant factors influencing elasticity. The management of breast lesions by combining ultrasound and elastography, as proposed here, allows us to keep the sensitivity of an ultrasound (96%), while doubling its specificity (86.2% versus 43.1%). CONCLUSION: With the complementary nature of their performance, the combination of conventional ultrasound and shear wave elastography can improve the management of breast lesions. The qualitative classification proposed appears to be relevant assistance in lesion characterization.

[Evaluation of stereotactic core biopsies of the breast with the 10-gauge Vacora® biopsy device: a review of 541 procedures]. / Évaluation des macrobiopsies mammaires stéréotaxiques par système Vacora® 10-gauge (541 procédures).

PURPOSE: To evaluate stereotactic core biopsies of the breast with the 10-gauge Vacora(®) biopsy device. PATIENTS AND METHODS: Retrospective study of 541 procedures in 502 patients performed between 2007 and 2009. RESULTS: The procedure failed in 2% of cases, non-complicated hematomas occurred in 5% of cases and unsightly scars in two cases. A clip was deployed in 70% of cases, successfully in 99% of cases. The procedure was well tolerated in 88% of cases. Core biopsies confirmed a benign lesion in 55% of cases, borderline lesions in 19% of cases and malignant lesions in 26% of cases with complementary surgery performed in 40% of cases. For surgical lesions, sensitivity, specificity, PPV and NPV were 89%, 100%, 100% and 84% respectively. Atypical ductal dysplasia was under-estimated in 8% of cases while DCIS was under-estimated in 14% of cases. After review of the mammograms, 3% of Bi-Rads 4 lesions were reclassified as Bi-Rads 3 lesions, all benign at core biopsy. Half of these results were from screening mammography programs. CONCLUSION: Results with the 10-gauge Vacora(®) biopsy device are similar to reports from the literature, mainly using the Mammotome system, with regards to tolerability and reliability for a lesser cost.

Neoadjuvant endocrine therapy in breast cancer.

The clinical benefits of endocrine therapy for patients with hormonosensitive breast cancer are well established. For many years, five years' treatment with tamoxifen was the gold standard of adjuvant treatment. The recent development of new endocrine agents provides physicians with the opportunity to take a more effective therapeutic approach. Nevertheless, the success of neoadjuvant endocrine therapy is much more recent and less frequently reported in the literature. This article reviews the studies published on neoadjuvant endocrine treatment (tamoxifen and aromatase inhibitors). According to the literature, neoadjuvant endocrine therapy seems to be effective and well tolerated. The newer generation of aromatase inhibitors (letrozole, anastrozole, exemestane) appear to result in better overall response rates and more conservative surgery than tamoxifen. Patients with an ER Allred score of 6 and over are most likely to respond and gain clinical benefit. The optimal duration of neoadjuvant therapy has not yet been investigated in detail. These preliminary results are interesting and should be confirmed by further studies.

EXCEL gradebooks: an EXCELlent strategy for saving teacher time.

Time ultimately is the most precious commodity across professions. In the teaching profession, educators put in pre-class development time, class contact time, and post-class grading and grade calculation time (as well as other administrative time). End-of-term grade calculation can be a massive, time-wasting headache. If teachers develop electronic spreadsheets that track attendance and use formulas to do the final calculations automatically as data is entered into the spreadsheets, then teachers can nearly eliminate end-of-term number crunching and use that time for other endeavors.

Effect of appliance reactivation after decay of initial activation on osteoclasts, tooth movement, and root resorption.

Clinical orthodontists frequently reactivate appliances following decay. Studies of tooth movement and tissue responses following reactivations indicate that linear tooth movement and rapid recruitment of osteoclasts can be achieved if reactivation is timed to coincide with the latter part of the bone remodeling cycle initiated by the first activation. Both can be delayed if reactivations are timed for the early part of the previous cycle. The objective of this study was to examine tooth movement, root resorption, and osteoclast recruitment following appliance reactivation after the first activation had decayed. Bilateral orthodontic appliances were activated with 40 cN in 144 rats to mesially tip the maxillary molars. After 16 days, rats were randomized into two groups of 72. In group 1, appliances were reactivated in precisely the same manner as the first activation. In group 2, appliances were sham-reactivated. Rats were sacrificed at 1, 3, 5, 7, 10, and 14 days. Orthodontic movement was measured cephalometrically; changes in osteoclasts and root resorption were assessed at both compression and tension sites histomorphometrically; tartrate-resistant acid phosphatase (TRAP) was measured in alveolar bone and serum biochemically. Orthodontic tooth movement was linear in group 1, but osteoclasts required 3 to 5 days to appear. There were no group- or time-related differences in root resorption. Bone TRAP levels were elevated in both groups but dropped significantly (p<0.01) in group 2 at day 7. Appliance reactivations that followed decay of the first activation produced efficient tooth movement without increased risk of root resorption, but these changes were not accompanied by rapid osteoclast recruitment at compression sites. Timing appliance reactivations for the latter portion of the previous bone remodeling cycle could have significant clinical advantages because the delay period seen in tooth movement following a single activation or short-term reactivation can be avoided.

[Metastatic epiduritis with invasiveness of the left renal vein]. / Epidurite métastatique avec envahissement de la veine rénale gauche.

We report a case of epidural metastasis with left renal vein invasion. This nonsymptomatic venous involvement was detected by ultrasonography and confirmed at CT and MR imaging. Such an unusual cause of renal vein tumor thrombus occurred through a lumbar vein which represents one of its usual collateral branches.

[Postmenopausal hydrometra. Influence of tamoxifen]. / L'hydromètre post-ménopausique. Influence du tamoxifène.

Vaginal ultrasonography of the uterus using a high frequency endocavitary probe was performed in 300 postmenopausal women: 150 receiving no replacement nor suppressive hormone therapy and 150 receiving adjuvant anti-estrogen treatment in the form of tamoxifen because of breast cancer. Evidence was found of hydrometra in 84 cases (28%): 10 in the group taking no hormone therapy (6.6%) as compared with 74 in the group exposed to tamoxifen (49.3%). The difference was statistically significant (p < 0.01). In addition, mean thickness of the endometrium was estimated at 6 mm (range: 2-40) in the first group versus 12 mm (range: 3-60) in the second (p < 0.001). It emerged from this comparative ultrasound study that the incidence of postmenopausal hydrometra was influenced by taking tamoxifen. Fluid secretion appearances seen one out of two in treated patients reflect the paradoxical proestrogenic type action of tamoxifen on the uterine mucosa.

[In situ breast carcinoma developing in a fibroadenoma. Apropos of 4 case reports]. / Carcinomes mammaires in situ développés dans un fibro-adénome. A propos de 4 observations.

There were 4 cases of fibro-adenoma which, when examined histologically, showed a lobular or canalicular carcinoma in situ. These are reported. The results as compared with those in the literature suggest to the authors that fibro-adenoma should be removed.