Detected, yet not Diagnosed - Breast Cancer Screening with MRI Mammography in High-Risk Women.

BACKGROUND: MRI has been demonstrated to be the most sensitive imaging method for detecting breast cancer in women at high risk, allowing depiction of cancers that are occult on mammography, ultrasound and clinical breast examination. This high sensitivity is tempered by imperfect specificity due to overlap in the features of benign and malignant lesions. CASE: We present the case of a young BRCA2 mutation carrier whose breast cancer could have been diagnosed 2 years earlier; this is a rare case of a false-negative finding in MRI. DISCUSSION: We discuss morphological, physiological and psychological reasons for underestimation of MRI sets, especially in young women. CONCLUSION: We conclude that double reading in MR screening for breast cancer in high-risk women, as conducted for mammography screening, could be considered.

Does a supplementary preoperative breast MRI in patients with invasive lobular breast cancer change primary and secondary surgical interventions?

BACKGROUND: We evaluated whether a supplementary preoperative breast MRI in patients with invasive lobular breast cancer (ILC) has changed number and methods of primary and number of secondary surgical interventions. MATERIALS AND METHODS: This was a retrospective controlled single-center analysis of 178 ILC patients. The 2 study groups consisted of 92 patients with breast MRI (MRI group) and of 86 patients without breast MRI (non-MRI group). We investigated the primary and final surgical procedures and factors that influenced the number of secondary surgical interventions. RESULTS: A total of 40 primary mastectomies (38%) have been performed in the MRI group, compared with 27 (30%) in the non-MRI group (P = .119).There have been more bilateral surgical interventions in the MRI group (14 vs 3 patients; P = .002). The 2 groups did not differ with respect to secondary surgery rates (P = .429). The MRI and non-MRI group were significantly different with respect to age and breast density (P = .003 and P = .002). Yet, both variables seemed not to influence secondary surgery rates (P = .516 and P = .788, respectively). CONCLUSIONS: The implementation of preoperative breast MRI tended to result in more primary mastectomies and bilateral surgeries and did not seem to decrease the secondary surgery rate.

Persistent left superior vena cava with absent right superior vena cava: morphological CT features and clinical implications.

Here we report a rare case of the persisting left superior vena cava with simultaneous absence of the right superior vena cava. This central venous variation has been identified during a routine chest CT scan as follow-up after colonic cancer in an asymptomatic patient with no previous history of heart diseases. Morphological features of this variation are illustrated on axial CT images and 3D image reconstructions. This anomaly occurs in 0.1% of the general population. In presence with the right superior vena cava it is the most common anatomical variation in the central venous system with a reported occurrence of 0.2-8%. Such condition can be associated with additional congenital cardiovascular malformations and heart diseases or rhythm abnormalities. Diagnosis can be difficult and is often achieved incidentally since hemodynamics in these patients can be normal and clinical symptoms are mostly absent. Important clinical implications include difficulties in central venous access or cardiac pacemaker placement as well as management consequences in cardiothoracic surgery. In conclusion clinicians should be aware of this anomaly and their clinical relevance to avoid possible complications.