Minimally invasive breast cancer excision using the breast lesion excision system under ultrasound guidance.

PURPOSE: To assess the feasibility of completely excising small breast cancers using the automated, image-guided, single-pass radiofrequency-based breast lesion excision system (BLES) under ultrasound (US) guidance. METHODS: From February 2018 to July 2019, 22 patients diagnosed with invasive carcinomas ≤ 15 mm at US and mammography were enrolled in this prospective, multi-center, ethics board-approved study. Patients underwent breast MRI to verify lesion size. BLES-based excision and surgery were performed during the same procedure. Histopathology findings from the BLES procedure and surgery were compared, and total excision findings were assessed. RESULTS: Of the 22 patients, ten were excluded due to the lesion being > 15 mm and/or being multifocal at MRI, and one due to scheduling issues. The remaining 11 patients underwent BLES excision. Mean diameter of excised lesions at MRI was 11.8 mm (range 8.0-13.9 mm). BLES revealed ten (90.9%) invasive carcinomas of no special type, and one (9.1%) invasive lobular carcinoma. Histopathological results were identical for the needle biopsy, BLES, and surgical specimens for all lesions. None of the BLES excisions were adequate. Margins were usually compromised on both sides of the specimen, indicating that the excised volume was too small. Margin assessment was good for all BLES specimens. One technical complication occurred (retrieval of an empty BLES basket, specimen retrieved during subsequent surgery). CONCLUSIONS: BLES allows accurate diagnosis of small invasive breast carcinomas. However, BLES cannot be considered as a therapeutic device for small invasive breast carcinomas due to not achieving adequate excision.

Reliability of MRI tumor size measurements for minimal invasive treatment selection in small breast cancers.

INTRODUCTION: Due to the shift towards minimal invasive treatment, accurate tumor size estimation is essential for small breast cancers. The purpose of this study was to determine the reliability of MRI-based tumor size measurements with respect to clinical, histological and radiomics characteristics in small invasive or in situ carcinomas of the breast to select patients for minimal invasive therapy. MATERIALS AND METHODS: All consecutive cases of cT1 invasive breast carcinomas that underwent pre-operative MRI, treated in two hospitals between 2005 and 2016, were identified retrospectively from the Dutch cancer registry and cross-correlated with local databases. Concordance between MRI-based measurements and final pathological size was analyzed. The influence of clinical, histological and radiomics characteristics on the accuracy of MRI size measurements were analyzed. RESULTS: Analysis included 343 cT1 breast carcinomas in 336 patients (mean age, 55 years; range, 25-81 years). Overall correlation of MRI measurements with pathology was moderately strong (ρ = 0.530, P < 0.001), in 42 cases (12.2%) MRI underestimated the size with more than 5 mm. Underestimation occurs more often in grade 2 and grade 3 disease than in low grade invasive cancers. In DCIS the frequency of underestimation is higher than in invasive breast cancer. Unfortunately, none of the patient, imaging or biopsy characteristics appeared predictive for underestimation. CONCLUSION: Size measurements of small breast cancers on breast MRI are within 5 mm of pathological size in 88% of patients. Nevertheless, underestimation cannot be adequately predicted, particularly for grade 2 and grade 3 tumors, which may hinder patient selection for minimal invasive therapy.

Modified core wash cytology (CWC), an asset in the diagnostic work-up of breast lesions.

AIM: A quick and reliable preliminary diagnosis is essential in the management of a same-day breast clinic. In a preclinical study we developed an alternative method of core wash cytology (CWC). This study is an evaluation of this new CWC method introduced into the clinical setting. METHODS: From April 2008 to April 2009, biopsies were taken from lesions in the breast. CWC was obtained from core needle biopsy (CNB) with a modified technique and classified into the categories: malignant, suspicious for malignancy, atypical, benign and inadequate. CWC and CNB diagnoses were correlated with the histopathology of subsequently obtained resection specimens. The sensitivity and specificity were calculated. RESULTS: CWC was obtained from 226 breast lesions. In 167 of these cases subsequent resection of the lesion was performed revealing 149 carcinomas and 18 benign lesions. Of the 149 malignant cases, 136 were considered as either malignant or suspicious for malignancy by CWC, 7 as atypical, 4 as benign and 2 as inadequate. None of the 18 benign lesions were classified as suspicious or malignant on CWC. Eight out of 149 resected carcinomas were not recognized as malignant by histological analysis of the CNB, while 7 of these cases the CWC was considered malignant. The sensitivity and specificity were 97% and 100%, respectively. CONCLUSIONS: In the vast majority of patients the modified CWC technique can provide a quick and reliable diagnosis of malignant breast lesions. Furthermore, combining CWC with CNB histology can improve adequate, preoperative recognition of the malignant character of breast lesions.

Microhemorrhages in the central nervous system: report of a patient with microhemorrhages in brain and spinal cord.

A 53-year-old, woman with microhemorrhages in the brain and spinal cord is described. This patient was initially seen with a reversible oculomotor paresis and hypertension, a year later she developed spinal cord symptoms. T2-weighted magnetic resonance imaging showed characteristic hypointense lesions in the brain and spinal cord consistent with microhemorrhages. Although the occurrence of microhemorrhages in the brain has been described before, the combination of brain and spinal cord microhemorrhages has not been reported yet. The observations in our patient suggest that microvascular changes related to hypertension are a common cause for these microhemorrhages.

[Dental MRI. Phantom study and clinical results]. / Dental-MRT. Phantomstudie und klinische Ergebnisse.

Magnetic resonance imaging (MRI) is used as a diagnostic tool for special indications in oral and maxillofacial surgery. We describe a new MRI technique that presents images in a panoramic view analogous to orthopantomography. This technique is based on three-dimensional T1- and T2-weighted sequences. The familiar panoramic view in MRI provides better orientation and makes diagnosis faster and easier. However, the acquisition time is long (6-12 min per sequence), with a correspondingly high risk of motion artifacts. Moreover, the final workup is also time-consuming. These restrictions could be overcome by progress in hardware and software. There are promising indications for dental MRI.

The value of magnetic resonance imaging in the diagnosis of mandibular osteomyelitis.

Our aim was to evaluate the accuracy of magnetic resonance imaging (MRI) and bone scintigraphy in the diagnosis of mandibular osteomyelitis. Twenty patients with mandibular osteomyelitis were prospectively investigated by conventional radiography, bone scintigrams and MRI. All diagnoses were verified either by surgery or by the clinical course. There was no significant difference between bone scintigraphy and MRI in the detection of osteomyelitis or the assessment of its extent. MRI was significantly better than scintigraphy at detecting the presence and assessing the extent of extraosseous inflammation. We always use MRI to diagnose osteomyelitis. For long-term follow-up of patients with mandibular osteomyelitis, we recommend MRI and bone scintigraphy.

Perfusion CT of the brain: diagnostic approach for early detection of ischemic stroke.

PURPOSE: To determine the value of perfusion computed tomography (CT) in a clinical study of patients with stroke and compare the results with single photon emission CT (SPECT) findings. MATERIALS AND METHODS: Perfusion CT was performed within 6 hours of symptom onset in 32 patients with possible stroke. Cerebral blood volume (CBV), cerebral blood flow (CBF), and time to peak contrast material enhancement were calculated on the basis of the CT results. Cerebral SPECT was also performed in a subgroup of 18 patients. Perfusion CT and SPECT findings were compared in a lesion-by-lesion analysis. Perfusion CT results were compared with follow-up CT and magnetic resonance imaging findings. RESULTS: Areas of reduced CBF were detected with the aid of perfusion CT in 25 of 28 patients with a proved infarct (sensitivity, 89%). The results of the CBF maps corresponded well to SPECT findings in 13 (81%) of 16 patients, but ischemia was located outside the scanning level in the other three patients and was therefore missed. Perfusion CT revealed various changes in CBF, CBV, and time to peak enhancement in ischemic territories. CONCLUSION: Perfusion CT not only allows early detection of cerebral ischemia but also yields valuable information about the extent of perfusion disturbances.