Downstream imaging following abnormal molecular breast imaging, lessons learned and suggestions for success.

OBJECTIVES: Molecular breast imaging (MBI) is a supplemental screening modality that assists in detection of breast cancer. Objectives were to investigate how abnormal MBI findings were further evaluated on subsequent imaging studies and assess outcomes. METHODS: Retrospective single-institution review included patients who underwent supplemental screening MBI between October 2018 and October 2021, utilizing 300 MBq (8 mCi) 99mTc-sestamibi as radiotracer. Patients with abnormal MBI were assessed for subsequent imaging, biopsies, or surgeries performed. Outcome metrics included recall rate, cancer detection rate, and positive predictive values for recall (PPV1) and biopsy (PPV3); 95% confidence intervals calculated via Wilson score interval. All tests were two-sided; p < 0.05 considered statistically significant. RESULTS: Total of 716 MBI exams performed, 93 of which were read as abnormal with ultimate detection of 11 malignancies. Recall rate was 13.0%, cancer detection rate was 15.4/1000 (invasive: 11.2/1000), PPV1 was 11.8%, and PPV3 was 27.5%. Of 11 malignancies, 7 (63.6%) were not visible on concurrent or most recent mammogram. Initial subsequent imaging study detected a correlate for mass uptake in 20/22 (90.9%) cases compared to 42/70 (60.0%) for nonmass uptake (p < 0.007), with correlates for nonmass uptake seen on ultrasound or mammogram in only 5/19 (26.3%). MRI was utilized in 63 (8.8%) cases overall. CONCLUSION: Screening MBI afforded a high cancer detection rate, yet lower detection of nonmass uptake on subsequent ultrasound/mammography resulted in increased usage of MRI compared to prior reports. As utilization of MBI increases, more reported experiences are needed to establish best practices and understand effects of implementation.

Successful Lumpectomy in a Patient With Multicentric Breast Cancer.

When there is extensive breast cancer, patients typically undergo mastectomy. However, lumpectomy may still be performed for patients who are motivated to avoid a mastectomy and understand the risk for positive margins requiring second surgery in unique cases. This report details the surgical management and clinical reasoning behind lumpectomy for a multicentric breast cancer spanning 5 cm. The lumpectomy was a success with negative margins on final pathology.

A Case of Male Breast Cancer Patient with CHEK2*1100delC Mutation.

Male breast cancer (MBC) is a rare disease that accounts for less than one percent of all breast cancers. The association between BRCA1 and BRCA2 mutations and MBC has been well-established; recent data suggest that CHEK2 1100delC heterozygosity is also associated with an increased risk of MBC. Herein, we present the case of a 47-year-old male who was initially diagnosed with bilateral symmetric gynecomastia on a diagnostic mammogram performed for right breast palpable lump. Sixteen months after his diagnosis of gynecomastia, he presented with enlarging right breast palpable lumps and underwent a diagnostic mammogram and breast ultrasound. Ultrasound-guided biopsies were performed on the right breast mass and axillary lymphadenopathy. Pathology revealed right breast invasive ductal carcinoma (IDC) and right axillary metastatic lymphadenopathy. Subsequent genetic testing found CHEK2*1100delC mutation. This case report focuses on the presentation, diagnosis, and management of breast cancer, as well as long-term cancer screening in the setting of CHEK2 mutation in a relatively young male patient.

Hematoma Mimicking Breast Cancer on CT Scan and Breast Ultrasound.

There are many benign breast lesions that mimic breast cancer on breast imaging. Postlumpectomy scar, hematoma, fat necrosis, diabetic mastopathy, and granulomatous mastitis are examples of benign breast lesions that have suspicious breast imaging findings. Mammogram and breast ultrasound are the imaging studies to evaluate breast findings. CT scan is not used to evaluate breast findings because it delivers high radiation dose to the breast, and breast tissue is often confused as breast masses on CT scan. The following case demonstrates an incidentally detected breast mass on CT scan performed to assess for pulmonary embolism. The CT scan and subsequent breast ultrasound both demonstrated suspicious breast imaging findings. Final pathology from ultrasound-guided biopsy revealed hematoma. This benign finding was concordant with the patient's medical history of cirrhosis with low platelet count and medication history of warfarin.

Immediate dilation of a tight or stenotic cervix by intra-procedural administration of hyoscine butylbromide: A clinical trial.

BACKGROUND: Cervical dilation is indicated prior to performing various gynecological procedures. However, gynecologists are at times confronted with a stenotic or tight cervix, resistant to dilation. This can be problematic particularly when cervical ripening has not been attempted hours before the start of the procedure. OBJECTIVE: The objective of this study is to investigate the efficacy of administration of hyoscine butylbromide for cervical dilation for immediate dilation of the tight or stenotic cervix. MATERIALS AND METHODS: In this clinical trial study, a population of 40 women, aged 20-70 yr with stenotic cervix, evidenced by resistance to pass dilator #2 through their cervical canal were compared. Cervical patency was assessed 10 min following intra-cervical canal instillation of hyoscine butylbromide. RESULTS: Cervical width of 57.5% of patients became wider, as evidenced by passage of the number 4 Hegar dilator through the cervical canal without resistance. Independent T-tests did not reveal any statistically significant difference between the two groups based on their age. Fisher Exact test revealed a statistically significant difference between the two groups based on the prior route of delivery, with a more statistically significant response in patients who had vaginal deliveries. CONCLUSION: Intra-cervical canal instillation of hyoscine butylbromide is effective in immediate dilation of the tight or stenotic cervix during intra-uterine procedures.

Cervical Priming by Misoprostol before Diagnostic Dilatation and Curettage: A Randomized Clinical Trial.

BACKGROUND: Difficulty in cervical dilatation is a hard situation during the procedure of diagnostic dilatation and curettage in some cases. This study was performed to evaluate the effect of vaginal misoprostol for cervical priming before diagnostic dilatation and curettage. METHODS: In this study 56 women were selected as the candidates for dilatation and curettage. The study was double blind and was performed for two parallel groups. One misoprostol tablet (200 µg) was administered in posterior fornix of vagina 2-4 hr before operation in 28 patients whereas in other 28 patients, placebo (VitB6) was used. Then, the two groups were compared according to the patency of the cervix measured by No. 5 Hegar dilators and the duration of dilatation and curettage procedure as well. Chi-square test, t-test, and Mann-Whitney U test were used for comparing two groups, and a p-value less than 0.05 was considered as statistically significant. RESULTS: Before the procedure of dilatation and curettage, the patency of the cervix was measured by passing Hegar dilator number 5 through the cervical canal in fifteen (53.6%) patients in the misoprostol group and 8 patients (28.6%) in the placebo group (p=0.05) which their difference was statistically significant. The effect of misoprostol was not significant in nulliparous women and postmenopausal period either. CONCLUSION: Vaginal misoprostol is a useful drug for ripening and dilating the cervix. It also facilitates the procedure of dilatation and curettage in premenopausal and multiparous women. Misoprostol was less effective in nulliparous women and in postmenopausal period.

Outcome of subsequent pregnancies in familial molar pregnancy.

Familial recurrent molar pregnancy is an exceedingly rare condition, in which complete hydatidiform moles are mostly diploid but biparental in origin and the outcome of subsequent pregnancies is likely to be a hydatidiform mole or other type of reproductive loss. We previously reported a case of familial molar pregnancy (family K) comprising five affected members (four sisters and one of their cousins) each with at least one hydatidiform mole (HM). In addition to the molar pregnancies, these patients have a total of three miscarriages and 8 normal pregnancies leading to healthy children; but the youngest member of this family has given birth to a boy with Down syndrome. Our second family (case S) includes two sisters with diploid biparental complete moles. They have a total of six molar pregnancies with no living child. Recently the younger sister had a partial molar pregnancy with apparently normal XX fetus accompanying diffuse molar changes of the placenta that led to preeclampsia and preterm delivery. Overall, these families have had 26 pregnancies including 12 molar pregnancies (complete or partial) and three abortions. We concluded that these families are predisposed to various genetic mutations, chromosomal abnormalities and clinical manifestations, which affect their offspring. Further studies of patients are needed to determine any relationship between a history of familial molar pregnancy and trisomy or other chromosomal abnormalities in offspring and genetic mutations in the products of conception to complete the puzzle and manage familial molar pregnancy.