Breast cancer surveillance.

Since several studies have demonstrated the inadequate diagnostic performance of mammography in high risk women, over the past two decades, different breast imaging tests have been evaluated as additional diagnostic methods to mammography, and the most relevant ones are the techniques that do not imply the use of X-rays, considering the young age of these patients and the higher radio-sensitivity. Breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has risen growing interest not only because of the absence of use of X-rays, but also because it provides morpho-functional features, which may depict biological characteristics of breast tissues, including invasive and in situ cancers. Different multicenter non-randomized prospective studies aimed to evaluate breast DCE-MRI as an integral part of surveillance programs, agreed about the evidence that in high risk women screening with DCE-MRI is more effective than either mammography and/or ultrasound. Moreover, this modality leads to the identifications of cancers at a more favorable stage, allowing a real advantage in terms of tumor size and nodal involvement. The medical community is evaluating to suggest DCE-MRI alone as screening modality in high-risk women, as it was reported that in these cases the sensitivity of MRI plus conventional imaging was not significantly higher than that of MRI alone. Breast MRI is now recommended as part of screening program for high risk women by both European and American guidelines.

Mammotome(®) and EnCor (®): comparison of two systems for stereotactic vacuum-assisted core biopsy in the characterisation of suspicious mammographic microcalcifications alone.

PURPOSE: The authors sought to compare the diagnostic performance of the Mammotome(®) and EnCor(®) vacuum-assisted breast biopsy (VABB) systems in the assessment of suspicious mammographic microcalcifications. MATERIALS AND METHODS: Between January 2011 and July 2012, a total of 169 VABB were performed by stereotactic guidance on a prone table. The Mammotome(®) 11G (S1) or EnCor(®) 10G (S2) probes were used randomly. Sampling time and the number of frustules collected were considered; sensitivity, specificity, diagnostic accuracy, positive and negative predictive value (PPV, NPV) of both procedures were evaluated, considering the final histological examination as reference (B1, B3, B5 lesions underwent surgical excision; B2 lesion were considered confirmed after a negative follow-up of at least 1 year). RESULTS: There were no statistically significant differences between the two groups of patients according to the number of procedures (S1 82/169; S2 87/169), average age, BIRADS category (4a, b), and average size of the lesions. The two systems did not differ statistically for correlation with the final histology (S1 k = 0.94 ± 0.06; S2 k = 0.92 ± 0.08) and underestimation of B3 lesions or in situ (S1 4.5%; S2 4.3%). Sensitivity, specificity, PPV, NPV, diagnostic accuracy of S1 and S2 were also not statistically different. The systems differed only in sampling time (S1 80; S2 63 s), but not in total procedure time. CONCLUSIONS: Our study confirms the effectiveness of VABB in the assessment of microcalcifications and highlights the lack of significant differences between the two systems in terms of diagnostic performance.