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Query: UMLS:C0006142 (breast cancer)
 160,383 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two patients developed a persistent illness characterized clinically and electrophysiologically by asymmetric involvement of spinal roots, of cranial and peripheral nerves. In the first case the disease was not discovered clinically but only after autopsy. The primary neoplasm remained undetected at autopsy. There was profound infiltration of the leptomeninges by tumor cells with features of metastatic adenocarcinoma. In the second patient onset of neurological symptoms occurred 16 years after surgery for breast cancer, which may be reasonably considered the primary malignancy-CSF cytology was positive only in the second patient in whom Gd-DTPA MRI supported the diagnosis. Our cases demonstrate that diagnosis in leptomeningeal carcinomatosis may be a challenging clinical problem.
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PMID:Leptomeningeal carcinomatosis presenting as progressive multineuritis: clinical, pathologic, and MRI study. 879 51

Because of the high tendency of breast cancer to develop metastatic deposits in the skeleton, space-occupying processes in the sternal region are mostly attributed to osseous metastases and not to parasternal lymph node involvement, even in case of solitary lesions, primary tumor localizations in the inner quadrants, positive axillary nodes and negative X-ray or bone scan findings. The sonographic examinations of 115 patients with breast cancer and clinical and/or scintigraphic suspicion of sternal metastasis, however, revealed the typical bone metastases of the sternum with a small soft tissue tumors in only 27.8 %, whereas 59.1 % of the cases showed parasternal recurrences; 5.2 % had both. Non-tumorous changes were seen in 6.1 %, equivocal results in 1.7 %. Solitary osseous metastasis of the sternum was rare; multiple skeletal lesions were found in the majority of this group in contrast to the patients in the parasternal relapse group, which moreover showed strong overrepresentation of the primary tumor localization in the inner quadrants. X-rays of the chest or the sternum were often false-negative and not reliable, the bone scans positive only in cases of secondary sternal invasion or skeletal metastases. Concerning reliability and cost, sonography was the imaging method of first choice for diagnosis, therapy planning and follow-up for space-occupying processes in the sternal region, with CT or MRI as adjuncts in cases of extended tumors invading the mediastinum.
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PMID:[Metastasis to the sternum or parasternal recurrence of breast carcinoma? Value of sonography]. 882 Mar 68

Investigation into the use of MRI as a breast imaging tool is ongoing. Several studies have shown that MRI is a very accurate imaging method for the identification of implant failure in the symptomatic patient with augmented breasts. In this clinical setting. MRI may be the study of choice. Imaging techniques, and the MRI appearance of normal and abnormal implants, are described. The use of MRI for the detection of breast cancer is not as straightforward. Preliminary results suggest that this technique can be used as an adjunct to mammography for the detection and diagnosis of breast cancer. However, it is premature to draw firm conclusions regarding the role that MRI should play in the management of women with breast disease because of the wide variability of imaging techniques, protocols, and patient populations in the studies reported to date. In this overview, the current state of MR imaging of the breast is discussed. Technical requirements are described, and potential clinical applications- including the differentiation of benign from malignant lesions, breast cancer staging, detection of recurrence after breast conservation therapy, and detection of cancer in patients presenting with positive axillary lymph nodes with an unknown primary-are reviewed. Many of these potential clinical applications will require an accurate MR-guided biopsy system, and the implementation of such a system as well as its inherent limitations are discussed.
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PMID:High-resolution MR imaging of the breast. 889 12

The MA11 human breast-cancer cell line was established with cells isolated from a bone-marrow sample using immunomagnetic beads conjugated to the anti-MUC1 antibody BM-2. The cell line showed a selective preference for metastasising to the brain in athymic nude mice. Following injection of MA11 cells into the left ventricle of the heart, brain metastases developed in 87% (20/23) animals, with a mean latency until development of neurological symptoms of 65 days. Necropsy and histological examination revealed tumour nodules of varying sizes throughout the brain, invading both grey and white matter of both hemispheres, and with extensive involvement of the cerebellum. MRI spin-echo images indicated brain lesions in some animals that were subsequently confirmed by histology. Three mice showed small tumour nodules (1-2 mm) in the lung, and 2 had solitary lesions (< 1 mm) within the spinal cord. Metastases were not detected in bone, liver, adrenal gland, kidney, spleen or heart. The human MUC1 mucin, as determined by a europium-based immunoradiometric assay, was detected in the serum of 9/11 animals that showed histological evidence of brain metastases. The mucin could not be found in mouse serum samples taken before day 46. The concentration range of MUC1 observed was from <1 to >50 U/ml, and did not appear to correlate with the size or number of tumours as determined from histological sections. This new model provides an opportunity to study the mechanisms of clinically relevant organ-selective metastases and may be of use in evaluating novel treatment for brain metastases in breast cancer.
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PMID:Brain metastasis model in athymic nude mice using a novel MUC1-secreting human breast-cancer cell line, MA11. 893 53

Implementation of MR imaging of the breast as an extension of the existing imaging modalities in the diagnosis of breast cancer was evaluated in a university cancer center, MR imaging of the breast was performed in 54 patients, in whom the MR results were compared with the triple test (the combination of clinical examination, mammographic evaluation, and cytology) and the final histological diagnosis. MR imaging of the breast depicted 30 of the 33 malignancies (sensitivity, 91%). In two of the malignancies, the carcinoma was clinically and mammographically occult. For the three patients with a false-negative MRI diagnosis, the conventional mammography showed suspicions clustered microcalcifications as a sign of in situ carcinoma. For seven patients, MR imaging of the breast incorrectly suggested the presence of a malignant lesion (specificity, 67%). To improve MR specificity, we perform MR-guided ultrasonographic fine-needle aspiration biopsy (FNAB). Although MR imaging of the breast is a highly sensitive examination, conventional x-ray mammography remains the most efficient imaging modality in the diagnosis of breast cancer. In our patient population, MR imaging of the breast had additional value for women with mammographically dense breast tissue and especially for patients with clinical evidence of breast carcinoma that could not be detected with conventional diagnostic methods.
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PMID:MR lesion detection in a breast cancer population. 895 27

The purpose of this study was to determine observer variability in the interpretation of contrast enhanced breast MRI and to evaluate its effect on the detection and differentiation of breast cancer. 57 women underwent breast MRI using spin echo and dynamic spoiled gradient-recalled sequences. Images were independently reviewed by three radiologists, two experienced and one newly trained in breast MRI interpretation. One of the experienced readers reviewed all examinations twice. Interpretation was based on lesion conspicuity, signal intensity, contour and enhancement pattern. Contrast uptake was assessed using region of interest (ROI) analysis of the dynamic images and calculation of a maximum enhancement index. Sensitivity and specificity in the diagnosis of malignancy irrespective of disease extent, and in the diagnosis of multifocal malignancy were estimated. 113 lesions were reported. Kappa coefficient estimations showed only a moderate agreement between the two experienced readers in rating morphological characteristics; the agreement between the newly trained reader and the experienced readers was even worse. Moreover, there was significant interobserver and intraobserver variation in the enhancement index measurements. Weighted kappa values indicated good agreement between the experienced readers in lesion and overall interpretation, excellent intraobserver agreement, but substantial disagreement between the newly trained reader and both experienced readers. All readers showed good sensitivity in cancer detection, but specificity was substantially lower. There is significant observer variability and a substantial learning curve in the interpretation of breast MRI, and variability in the ROI analysis of dynamic data. Further efforts to improve the reliability of ROI analysis and image interpretation are needed to help MRI realise its full potential in the clinical management of breast cancer.
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PMID:Observer variability in the interpretation of contrast enhanced MRI of the breast. 895 17

Radioimmunoscintigraphy (RIS) with Tc-99m labeled 170H.82, an intact murine monoclonal antibody (MAb) was performed in 27 patients with suspected primary, recurrent, or metastatic breast cancer. For radioimmunoimaging the authors used a double-headed, high-resolution gamma camera. The lesions detected by RIS were evaluated by histopathology, and for metastatic disease by CT, MRI, and bone scan. If the evaluation was made lesion by lesion, RIS with Tc-99m MAb 170H.82 showed 23 true-positive results, 3 false-negative results, 9 true-negative results, 3 false-positive results for primary and recurrent disease; sensitivity was 88% and specificity was 75%. In patients with distant metastases, detection rate was 67% (12 true-positive results and 6 false-negative results). All patients had normal baseline values for human anti-mouse antibodies (HAMA) and 6 weeks after RIS with 2 mg MAb, only 2 of 23 patients had developed a HAMA response (9%). No adverse effects were observed. The authors' clinical experience shows that RIS with MAb 170H.82 is a valuable additional method for detecting breast cancer, especially in patients with uncertain primaries or scar tissue after breast conserving treatment in which differential diagnosis is very difficult.
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PMID:Radioimmunoscintigraphy with Tc-99m labeled monoclonal antibody 170H.82 in suspected primary, recurrent, or metastatic breast cancer. 899 70

Thirty-nine patients with brain metastasis from breast cancer who were treated in our hospital between 1978 and 1992 and followed up until November 1995 were reviewed. The initial diagnosis of brain metastasis and follow-up were made by MRI and/or CT. Extracranial metastases were found in 90% of the patients and were the cause of death in 89%. Treatments included surgery alone in 2 patients (group S) surgery plus postoperative radiotherapy in 8 (group SR), radiotherapy alone in 28 (group R) and conservative therapy in 1 (group C). Radiotherapy of up to 40Gy to the whole brain was carried out, but was performed in only 75% of patients in group R. The overall median survival was 5.4 months with a 1-year survival rate of 23% and a two-year rate of 10%. In patients treated with over 40Gy, the survival time for radiotherapy alone was 5.1 months, with a 1-year survival rate of 9.5%; relief of specific neurologic symptoms was noted in 80%. The longest survival was noted in a patient with a single brain metastasis, who, to date, has survived for five years and two months following 60Gy of irradiation. Patients with the following clinical conditions should have a good prognosis: (1) no further metastases in other sites, or well controlled if existing, (2) no symptoms of NF (neurological function: RTOG) or slight, and improved NF by treatment, (3) surgical candidate, (4) good response to initial treatment on CT or MRI. Despite a bad prognosis in general, brain metastasis from breast cancer can be treated affirmatively, if these clinical conditions are fulfilled.
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PMID:[Treatment results of brain metastasis from breast cancer: course of the disease and radiation therapy]. 903 61

Scintimammography using Tc-99m sestamibi and contrast enhanced MRI were performed in order to determine the accuracy of both methods in the diagnostic work up of patients with suspicious or indeterminate preliminary diagnosis. 25 controls and 56 patients (14 with suspicious and 42 with indeterminate preliminary diagnoses), in whom physical examination and/or mammography warranted breast biopsy, underwent prone planar scintimammography. Sestamibi uptake was scored visually and measured using the ROI technique to enable semiquantitative evaluation. The patient group additionally underwent plain and contrast enhanced MRI. Visually determined signal increase following application of Gd-DTPA was compared with scintigraphic findings and final histopathologic results. Sensitivity and specificity of semiquantitative scintimammography for diagnosing breast cancer was 88% and 87%, respectively. Based on ROC analysis a target/non target ratio R > 1.3 was shown to be the optimal threshold for separating benign from suspicious scintigraphic diagnoses. MRI reading provided a slightly higher sensitivity (91%), but a considerable lower specificity (52%) due to contrast enhancement of different benign lesions. In the clinically important patient subpopulation with indeterminate results from previous diagnostic procedures, sensitivity of scintimammography fell to 79%, while specificity remained at 87%. MRI revealed a higher sensitivity of 89% and a lower specificity of 52%. Our data indicate that semiquantitative scintimammography using Tc-99m sestamibi provides a comparable sensitivity to contrast enhanced MRI in the assessment of breast cancer. The latter does not reduce the number of biopsies yielding benign results due to the high number of false positive diagnoses. Therefore, scintimammography seems to be the preferable tool in the diagnostic work-up of patients with indeterminate mammographic diagnoses.
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PMID:Evaluation of mammographic breast lesions with Tc-99m sestamibi scintimammography and contrast enhanced MRI. 905 Jan 97

Thirty-two patients were examined in order to evaluate the role of high-resolution MRI in the treatment planning of breast cancer. A 1.5T Signa imager (GE Medical Systems) was used with dedicated receive-only breast coil. The pulse sequence based on RARE was used with the fat-suppression technique. After examining both breasts with larger FOV (30 cm), the affected breast alone was examined with smaller FOV (18 cm) and larger matrix (512 x 384) with Gd enhancement. Breast cancer showed more prominent and earlier enhancement compared with normal breast tissue. Linear or spotty continuous enhancement from the main tumor was considered to be suggestive of intraductal spread. Of 32 patients, 20 showed linear or spotty enhancement around the main tumor on MRI, and 15 of these 20 had intraductal spread. On the other hand, 12 out of 32 patients were considered to have little intraductal spread on MRI, and these findings corresponded to the pathological findings. Sensitivity, specificity and accuracy of detecting intraductal spread were 88%, 75% and 78%, respectively. In order to evaluate the extent of intraductal spread, further study using more precise correlation with pathology is necessary. High-resolution MRI was also considered to be useful for evaluating the presence of multifocal or multicentric focies or muscle invasion.
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PMID:[The use of high resolution MR imaging for pre-treatment evaluation of breast cancer: detection of intraductal spread]. 912 74


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