ABSTRACT
Patients with neurofibromatosis type I and breast cancer represent a subset of people who may be considered at high risk for secondary cancers after conventional whole breast radiation therapy and breast conservation surgery. A case of a 49-year-old woman with neurofibromatosis type I is presented. She was diagnosed with a 1.1-cm right breast infiltrating ductal carcinoma. Clinical, diagnostic imaging, and pathologic features are discussed. Her initial treatment plan of breast conserving therapy was thwarted when her sentinel node biopsy was positive for micrometastatic disease in 1/14 lymph nodes. She elected to have a bilateral simple mastectomy. This case addresses the rare dilemma of offering breast conservation therapy as a viable option for patients with neurofibromatosis type I. Current data on radiation-induced secondary cancers such as sarcoma after treatment for breast and other cancers are reviewed.
Subject(s)
Breast Neoplasms/complications , Breast Neoplasms/therapy , Carcinoma, Ductal, Breast/complications , Carcinoma, Ductal, Breast/therapy , Neoplasms, Second Primary , Neurofibromatosis 1/complications , Biopsy, Needle , Breast Neoplasms/diagnosis , Carcinoma, Ductal, Breast/diagnosis , Female , Genetic Predisposition to Disease , Humans , Mammography , Mastectomy , Mastectomy, Segmental , Middle Aged , Neoplasms, Radiation-Induced/etiology , Radiotherapy, Adjuvant/adverse effects , Sentinel Lymph Node BiopsyABSTRACT
OBJECTIVE: Our objective was the implementation and evaluation of a novel enhancement technique for improved interpretation of high-resolution digitized mammograms from computer monitors. MATERIALS AND METHODS: A wavelet algorithm was designed to attenuate the image spectral characteristics responsible for the long-range image correlation that often interferes with digital display. The algorithm was evaluated with a localization response operating characteristic (LROC) experiment with 500 negative, benign, and cancer cases with masses and calcification clusters. Three observers reviewed the original and wavelet-enhanced images on a 5-Mpixel monitor using a custom-made workstation user interface. RESULTS: Performance indexes were estimated for four different case combinations, each observer, and each interpretation mode. Wavelet enhancement improved the performance of all observers in all case combinations. Detection accuracy ranged from 0.678 to 0.827 for the unprocessed original data and 0.709-0.871 for the enhanced cases. Localization accuracy ranged from 0.547 to 0.785 for the original images and 0.568-0.847 for the enhanced cases, yielding increases of 5-15%. The difference between enhanced and original performances was statistically significant at the 0.10 level and in a few combinations at the 0.05 level. CONCLUSION: Soft-copy digitized mammography could replace standard film mammography under appropriate display parameters and conditions. The optimization of the soft-copy quality is expected to require more advanced processing techniques than standard gray-scale adjustments. Wavelet-based algorithms, such as the one proposed here, offer better soft-copy quality than the originals and a better starting point for additional manual gray-scale adjustments or automated postprocessing.
