Primary Extranodal Follicular T-Cell Lymphoma and Ductal Breast Carcinoma Diagnosed by a Magnetic Resonance Imaging-Guided Vacuum-Assisted Biopsy: A Case Report.

BACKGROUND Extranodal non-Hodgkin lymphomas (NHL) are low-grade B-cell lymphomas and the breast is not a common site for this condition. This case report describes a 62-year-old woman with a primary NHL and ductal carcinoma in situ (DCIS) of the left breast diagnosed by a magnetic resonance imaging (MRI)-guided vacuum-assisted breast biopsy. The simultaneous diagnosis of breast cancer and NHL is rare, with few cases described in the literature. Primary breast lymphomas account only for 0.04% to 0.5% of breast malignancies. CASE REPORT In November 2016, a 62-year-old woman was treated for a peripheral T-cell lymphoma (follicular helper T-cell phenotype) of the left upper central breast; later she underwent periodic breast imaging follow-ups. In October 2018, MRI revealed a focal 33-mm non-mass contrast enhancement (according to the Breast Imaging Reporting and Data System -MRI lexicon of the American College of Radiology) in the lower external quadrant of the left breast. Neither mammography nor ultrasonography demonstrated any suspicious features. The multidisciplinary medical team performed an MRI-guided vacuum-assisted breast biopsy and the histological analysis confirmed the diagnosis of a DCIS. Subsequently, she underwent surgery resulting in eradication of the disease and has had regular follow-ups, including mammography, ultrasonography, and MRI. CONCLUSIONS This is a rare case of both a primary NHL of the breast and DCIS, which was detected only by MRI. It highlights the role of an MRI-guided vacuum-assisted breast biopsy, which allows an accurate and economic diagnosis in case of suspicious findings on MRI. We recommend the use of MRI in follow-ups for patients with previous breast lymphomas (high-risk patients).

Breast Magnetic Resonance Spectroscopy at 3 T in Biopsy-Proven Breast Cancers: Does Choline Peak Correlate With Prognostic Factors?

OBJECTIVES: The role of functional techniques, such as magnetic resonance spectroscopy (H-MRS), as noninvasive tools to increase breast MR imaging reliability has been widely investigated during the last 2 decades. Considering the growing interest in tumor biology and its influence on functional parameters, the aim of this study was to investigate the relationship between H-MRS parameters and breast cancer biomarkers and to evaluate whether the results of H-MRS at 3 T can correlate with established breast cancer prognostic factors in our clinical experience. MATERIALS AND METHODS: One hundred two patients with biopsy-proven breast cancer underwent 3 T breast MR imaging. Single-voxel H-MRS was performed after the T1-weighted sequence, using a PRESS water-suppressed sequence (BREASE). Data were collected from a single rectangular volume of interest that encompassed the lesion. Magnetic resonance images and spectra of 102 Breast Imaging Reporting and Data System 6 lesions were prospectively evaluated by 2 radiologists in consensus. H-MRS results were considered positive if the choline peak signal-to-noise ratio was 2 or higher. H-MRS findings were then compared with morphological features and to histological findings, such as lesion size, nuclear grade, Ki-67, hormone receptor status, and Her2 expression. RESULTS: Elevated levels of total choline were detectable in 68/102 cases (66.67%) and undetectable in 34/102 (33.33%). A statistically significant association between the presence of choline peak and higher tumor grading (P < 0.0001), greater Ki-67 value (P < 0.0001), and larger lesion size (P < 0.0001) was found. No statistically significant associations were observed between choline peak and the luminal subgroups, even if higher levels of choline were more frequent in nonluminal A lesions. CONCLUSIONS: Our study confirms that 3 T breast H-MRS can be a valid additional tool to obtain further information about breast cancer biology and to predict tumor aggressiveness, because the detection of elevated levels of total choline in the spectrum is associated with a biologically aggressive breast cancer phenotype (large dimensions, grade 3, high values of Ki-67). Our results need to be validated in standardized larger-scale studies.

Changes in total choline concentration in the breast of healthy fertile young women in relation to menstrual cycle or use of oral contraceptives: a 3-T 1H-MRS study.

BACKGROUND: To evaluate changes in total choline (tCho) absolute concentration ([tCho]) in the breast of healthy fertile women in relation to menstrual cycle (MC) or use of oral contraceptives (OC). METHODS: After institutional review board approval, we prospectively evaluated 40 healthy fertile volunteers: 20 with physiological MC, aged 28 ± 3 years (mean ± standard deviation; nOC group); 20 using OC, aged 26 ± 3 years (OC group). Hormonal assays and water-suppressed single-voxel 3-T proton magnetic resonance spectroscopy (1H-MRS) were performed on MC days 7, 14, and 21 in the nOC group and only on MC day 14 in the OC group. [tCho] was measured versus an external phantom. Mann-Whitney U test and Spearman coefficient were used; data are given as median and interquartile interval. RESULTS: All spectra had good quality. In the nOC group, [tCho] (mM) did not change significantly during MC: 0.8 (0.3-2.4) on day 7, 0.9 (0.4-1.2) on day 14, and 0.4 (0.2-0.8) on day 21 (p = 0.963). In the OC group, [tCho] was 0.7 (0.2-1.7) mM. The between-groups difference was not significant on all days (p ≥ 0.411). All hormones except prolactin changed during MC (p ≤ 0.024). In the OC group, [tCho] showed a borderline correlation with estradiol (r = 0.458, p = 0.056), but no correlation with other hormones (p ≥ 0.128). In the nOC group, [tCho] negatively correlated with prolactin (r = -0.587, p = 0.006) on day 7; positive correlation was found with estradiol on day 14 (r = 0.679, p = 0.001). CONCLUSIONS: A tCho peak can be detected in the normal mammary gland using 3-T 1H-MRS. The [tCho] in healthy volunteers was 0.4-0.9 mM, constant over the MC and independent of OC use.

Microcalcification morphological descriptors and parenchyma fractal dimension hierarchically interact in breast cancer: A diagnostic perspective.

INTRODUCTION: Herein, we propose a Systems Biology approach aimed at identifying quantitative morphological parameters useful in discriminating benign from malignant breast microcalcifications at digital mammography. MATERIALS AND METHODS: The study includes 31 patients in which microcalcifications had been detected during XR mammography and were further confirmed by stereotactic (XR-guided) biopsies. Patients were classified according to the BIRADS (Breast Imaging-Reporting and Data System), along with their parenchyma fractal dimension and biopsy size. A geometrical-topological characterization of microcalcifications was obtained as well. RESULTS: The 'size of biopsy' was the parameter endowed with the highest discriminant power between malignant and benign lesions thus confirming the reliability of surgeon judgment. The quantitative shape evaluation of both lesions and parenchyma allowed for a promising prediction of the BIRADS score. The area of lesions and parenchyma fractal dimension show a complex distribution for malignant breast calcifications that are consistent with their qualitative morphological pattern. Fractal dimension analysis enables the user to obtain reliable results as proved by its efficiency in the prediction of the morphology of breast cancer. CONCLUSION: By reconstructing a phase-space distribution of biophysical parameters, different patterns of aggregation are recognized corresponding to different calcium deposition patterns, while the combination of tissue and microcalcification morphological descriptors provide a statistically significant prediction of tumour grade. CLINICAL RELEVANCE: The development of an automated morphology evaluation system can help during clinical evaluation while also sketching mechanistic hypotheses of microcalcification generation.

Errors in imaging of emergencies in pregnancy.

There is evidence that emergencies in pregnancy are subject to mismanagement; however, the percentage of error in the diagnosis of emergencies in pregnancies has not been studied in-depth. The purpose of this article is to review the most common emergencies in pregnancies, focusing the attention on errors in images. The topics covered are divided into gynecological and nongynecological, and for each pathology, the possible errors in the diagnostic pathway, the possible technical errors in the execution of the examination, and in the end, the possible errors in interpretation of the images have been dealt with. These last two entities are often connected, in the fact that a substandard examination can stem interpretation errors, but the systemization of the error is a valid approach in helping to learn from these errors, reducing the possibility that the same error can represent itself.

Effect of preoperative breast magnetic resonance imaging on surgical decision making and cancer recurrence rates.

PURPOSE: To evaluate breast magnetic resonance imaging (MRI) for cancer staging and surgical planning in patients with known breast cancer, and to evaluate recurrence rates at long-term follow-up. METHODS AND MATERIALS: Institutional review board approval and patient consent were obtained. Preoperative MRI with 0.1 mmol/kg gadobenate dimeglumine (MultiHance) was performed in 203/274 women with confirmed breast cancer. The sensitivity, accuracy, and positive predictive value of MRI compared with mammography/ultrasound for malignant lesion detection were calculated, and the effect of MRI on surgical decision making evaluated. The cancer recurrence rate was determined for 172 patients with available 2- to 8-year follow-up data. RESULTS: Mammography/ultrasound detected 229 suspicious lesions. Breast MRI detected 159 additional lesions in 48/203 (23.6%) patients; of which 110/110 were correctly classified as malignant and 28/49 as benign, giving sensitivity, accuracy, and positive predictive values for malignant lesion detection of 100% (110/110), 86.8% (138/159), and 84.0% (110/131), respectively. MRI revealed unsuspected multifocal, multicentric, and synchronous contralateral lesions in 7/48, 16/48, and 16/48 patients, respectively, and pectoralis muscle infiltration in 3/38 patients. In 6/48 women, MRI revealed lesions not seen on conventional imaging (n = 5) or discounted suspected multifocal disease (n = 1). Therapy was changed for 50/203 (24.6%) patients: 38 patients underwent more extensive surgery and 12 less extensive surgery. Six (3.5%) recurrences occurred, in all cases at >4 years. CONCLUSION: Breast MRI positively affects patient management and is recommended for mapping tumor extent in patients with newly diagnosed cancer. The cancer recurrence rate at long-term follow-up after MRI is low.