BILATERAL BREAST CANCER: DIAGNOSIS AND PROGNOSIS.

AIM: To assess bilateral breast cancer patients, initially diagnosed with stage II unilateral breast cancer. MATERIAL AND METHODS: 113 patients with stage 0-II breast cancer diagnosed between 1983 and 2011 were assessed. Of these, 8 patients had bilateral breast cancer: 7 patients with metachronous bilateral breast cancer and 1 patient with synchronous breast cancer. Breast ultrasound, mammography, computed tomography and magnetic resonance imaging were used to diagnose recurrence, loco regional and distant metastasis. RESULTS: Age at diagnosis ranged from 37 to 59 years, with a maximum age incidence in the 4th decade (age between: 31-40 years). The average time interval between the two breast cancers was 8.125 years. The most common histological type was invasive ductal carcinoma. All eight patients with bilateral breast cancer had at least one type of recurrence/metastasis, mostly in the liver, and statistically the pleuropulmonary and liver metastases were the most frequent causes of death. CONCLUSIONS: Patients in the 4th decade diagnosed with unilateral breast cancer are at risk of developing bilateral breast cancer. In metachronous breast cancer, the time interval between the detection of the second breast cancer and death is directly proportional to the time interval between the two breast cancers. TASTASES, DEATH.

PANCREATIC CANCER CT IMAGING: COMPARISON WITH SURGERY.

AIM: To establish the best protocol for pancreatic computer tomography and criteria for staging (mainly for vascular invasion). MATERIAL AND METHODS: Our research included 49 consecutive patients with pancreatic cancer examined at the Iasi "Sf. Spiridon" Hospital between January and December 2014 with a Siemens 16 Emotion CT unit. CT protocol included no enhanced CT and pancreatic phase of the superior abdomen, portal venous phase of the abdomen and pelvis. RESULTS AND DISCUSSION: The study patients were stratified into 5 age groups and the most frequently affected by pancreatic cancer were the patients aged 60 to 79 years. For T staging the extension in the per pancreatic fat tissue, into surrounding organs (5 patients had extension in other organs) and vessels was evaluated. We determined the degree of contact between the tumor and the artery, thrombosis and deformity of the veins and we have found 8 resettable lesions, 28 tumors in stage T3 and 13 pancreatic cancers in stage T4. Thirty-three patients had lymphadenopathies and 31 of them had distant metastases. CONCLUSIONS: Our study proved that computed tomography is a good method of examination for pancreatic cancer when the right imaging protocol is used; during the pancreatic phase the arteries and the tumor are well depicted, liver metastases are best evaluated during the portal venous phase. The best criterion for arterial invasion is tumor contiguity with more than half of vessel circumference, and for vein invasion deformity or thrombosis. Comparison with surgical staging was o good backup for the radiologist and depicted several differences with imaging staging, more often understating than over staging.

CAUSES OF DEATH IN PATIENTS WITH STAGE 0-II BREAST CANCER.

AIM: To analyze the main causes of death in patients with stage 0-II breast cancer who undergo breast conserving surgery or radical mastectomy, and to establish the role of imaging surveillance protocols following breast cancer treatment. MATERIAL AND METHODS: We conducted a retrospective medical record review between January 2005 and December 2012, when breast cancer was the primary cause of death for 113 inpatients. All patients were admitted to the Oncology Clinic of the Iasi Regional Cancer Institute (IRCI), Romania. Patients were stratified by clinical stage 0, I and II, of which 33 (29.2%) patients were managed by breast conservation therapy and 80 (70.8%) underwent radical mastectomy. From the patient medical records all diagnostic imaging studies performed (ultrasound, radiography and computed tomography) were identified and analyzed according to a standard protocol for imaging the postoperative breast. RESULTS: Bone, liver, lung, lymph nodes and local-regional recurrence were the most common sites for metastasis, while the most frequent cause of death were metastases to the liver, pleura, lung and brain. The time interval between recurrence and death ranged from 0-24 years among patients with one type of metastasis, and decreased to 0-3 years since the last recurrence for patients with multiple metastases. CONCLUSIONS: The current imaging protocol for monitoring the postoperative breast could be optimized to improve the prognosis and quality of life in patients with stage 0-II breast cancer.

BREAST INFECTIONS: DIAGNOSIS WITH ULTRASOUND AND MAMMOGRAPHY.

AIM: Evaluation of ultrasonographic and mammographic pattern, etiology and risk factors of breast infections. MATERIAL AND METHODS: Our study included a group of 66 female patients aged 16 to 71 years, examined by ultrasound and mammography in several medical imaging services in Iasi in the interval 2008-2014; ultrasound was performed in all 66 patients and mammography in 22. RESULTS: In our study breast infections occurred mostly during breastfeeding and the most frequent causative agent was Staphylococcus aureus; ultrasound established the correct diagnosis in 63 cases and detected one or more of the following aspects in case of breast infections: edema of the fatty tissue, hypoechoic areas in the breast tissue, dilated ducts, or fluid collections. Mammography was not necessary in puerperal mastitis and was performed only in women over 40 years old; in most cases we had encountered a focal asymmetric density which had low specificity for the diagnosis of mastitis or breast abscess. CONCLUSIONS: Our study proved that ultrasound is a valuable method for the diagnosis of mastitis, especially when an abscess is suspected and established a correct diagnosis in most cases; the abscesses appear as inhomogeneous fluid collections, with poorly defined margins, posterior acoustic enhancement, no Doppler signal inside, sometimes associated with enlarged axillary lymph nodes. Mammography was not helpful for the diagnosis.

Computerized calculation of breast density: our experience from Arcadia Medical Imaging Center.

THE AIM OF THIS STUDY: To implement a spatial fuzzy C-means algorithm for image segmentation and breast tissue density quantification and compare it with BI-RADS breast density classes determined by radiologists. MATERIAL AND METHODS: The analysis was based on 206 mammograms performed in 111 women with various breast abnormalities. Digitized mammographic films were independently double read by radiologists certified in breast diagnosis, followed by consensus with arbitration agreement (radiological ground truth). Reporting was done using the BI-RADS mammography lexicon. Using an algorithm based on a combination of spatial fuzzy C-means clustering and binary thresholding, percent mammographic density was computed in digitized mammograms. The BI-RADS breast density readings were compared with percent breast density measurements determined by computer algorithm. RESULTS: The algorithm was found to match the BI-RADS density classification in 90% of the cases, with an excellent agreement (kappa = 0.88) between the radiological ground truth versus the algorithm breast tissue density estimates. CONCLUSIONS: Our study proposed an algorithm that can be applied both to digitized and digital mammograms, which proved to be effective in breast density estimates. The method can accurately determine the percentage density removing the human observer variability. The proposed method showed an excellent agreement with radiological ground truth.

Multifactorial analysis of local and lymph node recurrences after conservative or radical surgery for stage 0-II breast cancer.

AIM: Multifactorial analysis of local and lymph node recurrences in stage 0-II breast cancer treated by conservative or radical surgery. MATERIAL AND METHODS: In the interval January 1, 2005-July 31, 2013, 477 breast cancer patients were assessed by imaging techniques at the Radiology Clinic of Iasi "Sf. Spiridon" Hospital and Radiology Service of the Iasi Regional Cancer Institute. Of these 229 (48%) patients underwent conservative surgery and 248 (52%) patients radical surgery. RESULTS: Local recurrences were 2.8 times more frequent in conservatively vs. radically treated patients, and lymph node recurrences 2 times more frequent in patients treated conservatively. Breast tumors larger than 3 cm in diameter were at higher risk for local and distant recurrence in lymph nodes. CONCLUSIONS: Assessment in patients with local and lymph nodes recurrences of the relative risk for developing other types of recurrences (bone, pleuro pulmonary, liver, brain metastases) indicated that these are a risk factor for other types of recurrences, influencing the prognosis of patients. Local recurrences showed a higher relative risk for other types of recurrences than nodal recurrences.

Variation in urinary excretion of FDG, yet another uncertainty in quantitative PET.

BACKGROUND: The standardized uptake value (SUV) is the most common estimate of metabolic activity used in clinical positron emission tomography (PET). Several biological and technological factors influence the accurate SUV calculation. PURPOSE: To assess another potential source of variability of the SUV, the variations in urinary excretion of fluorodeoxyglucose (FDG). MATERIAL AND METHODS: Twenty patients with various malignancies scheduled for PET/CT with 18F-FDG were included in the present study. The activity in urine voided immediately before image acquisition was measured and decay corrected. An estimation of FDG content in the urinary bladder was made during imaging, and the two components of urinary FDG were added. The urinary output of FDG, and the quantity of FDG divided by the time to measurements, was estimated. RESULTS: The excretion of FDG in urine was between 5.7% and 15.2% of injected dose (decay corrected), and from 0.06% to 0.3%/min after injection, a five-fold difference in clearance. CONCLUSION: About 10% of injected dose is excreted in urine at 70 min post injection, but the urinary FDG excretion was found to be highly variable, yet another uncertainty affecting the SUV measurements.

Application of artificial neural network for classification of thyroid follicular tumors.

OBJECTIVE: To analyze smears of 197 thyroid follicular tumors (adenoma and carcinoma). STUDY DESIGN: Several types of artificial neural networks (ANN) of various designs were used for diagnosis of thyroid follicular tumors. The typical complex of cytologic features, some nuclear morphometric parameters (area, perimeter, shape factor) and density features of chromatin texture (mean value and SD of gray levels) were defined for each tumor. RESULTS: The ANN was trained by means of cytologic features characteristic for a thyroid follicular adenoma and a follicular carcinoma. At subsequent testing, the correct cytologic diagnosis was established in 93% (25 of 27) of cases. The morphometry increased the accuracy of diagnosis for follicular tumors in up to 97% (75 of 78) of cases. ANN correctly distinguished an adenoma or a carcinoma in 87% (73 of 84) of cases when using color microscopic images of tumors. CONCLUSION: The usage of ANN has raised sensitivity of cytologic diagnosis of follicular tumors to 90%, compared with a usual cytologic method (sensitivity of 56%). The automatic classification of thyroid follicular tumors by means of ANN is prospective.

Lifetime glycaemic exposure predicts reduced coronary vasoreactivity in Type 1 diabetic subjects.

AIMS: Subjects with Type 1 diabetes have impaired coronary vasoreactivity but the independent role of glycaemic control on myocardial perfusion is less clear. We examined the effect of lifetime glycaemic exposure on coronary vasoreactivity in 43 otherwise healthy Type 1 diabetic subjects. METHODS: Myocardial blood flow was calculated basally and during pharmacologically induced hyperaemia in the fasting state and during euglycaemic hyperinsulinaemic clamp (at an insulin infusion rate of 1 mU/kg per min for 60 min) using positron emission tomography and (15)O-water. Glycaemic exposure was estimated as glycosylated haemoglobin A(1c) (HbA(1c)) months. RESULTS: Hyperaemic myocardial blood flow was inversely associated with log HbA(1c) months in the fasting state (r = -0.72, P < 0.01) and during clamp (r = -0.35, P < 0.05). These correlations remained significant after adjustment for lipid values, blood pressures, sex, smoking, body mass index (BMI) and age (r = -0.70, P < 0.05 and r = -0.35, P < 0.05, respectively). No significant correlation was detected between hyperaemic flow and HbA(1c) or plasma glucose values measured immediately preceding the PET study. CONCLUSIONS: The present study demonstrates that the lifetime glycaemic exposure appears to be a better predictor of reduced coronary vasoreactivity than recent glycaemic control in Type 1 diabetic subjects. Reduced coronary vasoreactivity in diabetic subjects with poor glycaemic control and/or long duration of diabetes may represent an early precursor of coronary artery disease.