[Breast cancer].

Neoadjuvant chemotherapy (NAC) represents a new approach based on sound theoretical, pharmacokinetic, and experimental principles. The purpose of NAC is to improve control of the primary site by downstaging and to improve control of micrometastatic disease. NAC has been standard therapy in the management of locally advanced breast cancer. Patients with earlier stage breast cancer may also benefit from treatment with NAC. Recently some investigators have mentioned that NAC can be used instead of adjuvant chemotherapy and would be most appropriate for patients who wish to preserve their breast but who have tumors too large for breast conserving surgery. In this article, we reviewed the present status of NAC (indication, clinical response, pathologic response, survival, possibility of breast conservation, prognostic/predictive factors, neoadjuvant endocrine therapy) and discussed several unanswered questions on NAC (survival benefit, optimal number of treatment cycles, optimal regimens) and future direction. Combined modality therapy including NAC appears to provide excellent local control, the possibility of breast conservation, and, probably, an increased survival rate, at least for some subsets of patients. Furthermore, through sequential sampling, NAC provides indeed the opportunity to identify molecular mechanisms associated with pathologic response and to study the possibility to guide the choice for induction treatment and patient populations submitted to neoadjuvant chemotherapy.

Dynamic multislice helical CT of maxillomandibular lesions: distinction of ameloblastomas from other cystic lesions.

PURPOSE: To evaluate the clinical usefulness of dynamic multislice helical CT in differentiating ameloblastoma from other cystic lesions in cases of maxillomandibular cystic lesions. MATERIALS AND METHODS: The study included 32 patients with maxillomandibular cystic lesions (ameloblastoma [n=6], myxofibroma [n=1], odontogenic keratocyst [n=3], dentigerous cyst [n=11], radicular cyst [n=11], and paradental cyst [n=2]). Dynamic study was performed before and 30 sec, and 90 sec after intravenous contrast medium administration. CT density values and percentage of density increase were calculated at 30 and 90 sec. RESULTS: In five cases of ameloblastoma, a rapidly enhancing area was detected within the cystic lesions at 30 sec, while no apparent rapid enhancement was seen in the other cystic lesions. Three cysts showed gradual enhancement in the marginal area at 90 sec. Comparing ameloblastoma and other kinds of cysts, we found significant differences in the percentage of density increase at 30 sec (p<0.01) and 90 sec (p<0.05). CONCLUSION: Dynamic multislice helical CT is useful in the diagnosis of cystic lesions of the maxillomandibular region, especially in the detection of neovascularities in ameloblastoma.

[Diagnosis of breast cancer extent using dynamic multidetector-row CT: correlation between MPR imaging and pathological cross-sections].

PURPOSE: To evaluate the clinical usefulness of dynamic multidetector-row CT (dynamic MD-CT) for the detection of intraductal extension of breast cancer. MATERIALS AND METHODS: Dynamic MD-CT was performed in 31 patients with breast masses (26 invasive ductal carcinomas, 4 non-invasive ductal carcinomas and one benign lesion). We grouped the cases into four categories according to the degree of intraductal extension of the main tumor: IDS1: intraductal component less than 1 cm, IDS2: intraductal component 1 cm to 2 cm, IDS3: intraductal component 2 cm to 3 cm, IDS4: intraductal component more than 3 cm. To achieve complete CT-pathologic correlation, we retrospectively reconstructed MPR in the same plane as the histological cross-section. RESULTS: Thirty breast carcinomas (100%) showed strong enhancement in both the first and second phases of contrast enhanced dynamic MD-CT. The sensitivity and specificity of dynamic MD-CT for the detection of the intraductal component were 80.0% (12/15) and 100% (15/15). The accuracy of detection for the four tumor categories was 100% (15/15) for IDS1, 25% (1/4) for IDS2, 42.9% (3/7) for IDS3, and 100% (4/4) for IDS4. CONCLUSION: Dynamic MD-CT of the breast was found to be effective for the detection of intraductal extension of breast carcinoma and thought to be useful in the preoperative assessment of indications of breast-conserving surgery.

Power Doppler sonography of breast masses: correlation of Doppler spectral parameters with tumor angiogenesis and histologic growth pattern.

The purpose of this study was to examine the relationship between spectral analysis on power Doppler sonography and microvessel density. Power Doppler sonography was performed in 71 patients with breast masses (36 invasive carcinomas and 35 benign lesions). Microvessel density was measured in surgical specimens from all breast carcinomas using anti-factor VIII-related antibody. Invasive carcinomas were divided into two groups according to their growth pattern (solid type, scirrhous type). The pulsatility index and resistive index were high in malignant tumors compared with those in benign lesions (P < 0.001). The maximum velocity had weak statistical significance (P < 0.05). Although the correlation of maximum velocity with microvessel density was strong in solid tumors (P < 0.001), the maximum intensity in scirrhous tumors had no correlation with microvessel density. In conclusion, solid tumors showed a tendency toward correlation of maximum velocity with microvessel density. High maximum velocity with high microvessel density suggests breast carcinoma and could be predictive of a poor prognosis in invasive breast carcinoma.

[Power Doppler US in breast masses: correlation of spectral analysis findings with pathological features].

The purpose of this study was to clarify the usefulness of power Doppler imaging for the diagnosis of breast masses. Materials were histologically confirmed breast masses: 24 benign lesions, 4 non-invasive carcinomas, and 54 invasive carcinomas. In invasive breast carcinoma, pathological examination was used to classify the degree of intratumor fibrous stroma (IFS) into three groups. The relationships between IFS and Doppler spectral parameters (Vmax, Vmin, PI, RI) were evaluated retrospectively. High PI and low Vmin values were well correlated with IFS grade. Carcinomas with low IFS grades had higher Vmax values than benign lesions.

[Comparative study of 201Tl and 99mTc-MIBI in breast tumor].

A comparative study of 201Tl and 99mTc-MIBI was performed in 39 breast tumors. 201Tl scintigraphy was carried out in 24 breast tumors and 99mTc-MIBI scintigraphy in 15. The sensitivity of 201Tl for malignant tumors was 100% (22/22), but specificity was 0% (0/2). On 99mTc-MIBI scintigraphy, the sensitivity for the malignant tumors was 83.3% (10/12) and specificity was 100% (3/3). 99Tc-MIBI might be more useful for the diagnosis of breast tumors, because the tumor/background ratio of 99mTc-MIBI was significantly higher than that of 201Tl. In addition, 201Tl scintigraphy and 99mTc-MIBI scintigraphy showed the same degree of accuracy (93.3%) in diagnosis of lymph node reached. Moreover, when either US and 201Tl or 99mTc-MIBI scintigraphy was positive for lymph node metastasis, accuracy of detection of lymph node metastasis became 94.4%. A combined study of US and scintigraphy might improve the accuracy for diagnosis of lymph node metastasis.