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

The diagnosis and treatment of breast cancer are dependent upon early detection of the disease by physical examination and mammography. Although mammography is a relatively good and cost-effective method of early breast cancer detection, there are some inherent weaknesses associated with this imaging modality that limit its sensitivity and specificity. Contrast-enhanced MRI of the breasts provides the additional capability to answer questions raised or unanswered with conventional imaging methods. This paper reviews contrast-enhanced breast MRI interpretation guidelines and patient preselection criteria for diagnostic problem cases. Technical aspects using a commercially available three-dimensional (3D) spoiled gradient-echo technique are discussed.
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PMID:Contrast-enhanced breast MRI for cancer detection using a commercially available system--a perspective. 955 28

Contrast-enhanced MRI of the breast is probably the most sensitive method to detect breast pathology. It is best used to improve the sensitivity of mammography and sonography in selected patient groups with high breast cancer prevalence, where conventional methods are known to be less sensitive. Despite the high sensitivity of MRI, 5-12 % of invasive carcinomas are not recognized during MRI, because of lack of the typical criteria of carcinoma. MRI is probably inferior to mammography in detecting ductal in-situ carcinoma or very small carcinomas (< 3 mm), because the neo-angiogenesis induced by these small carcinomas is too faint to be detected by contrast-enhanced MRI. These tumours cannot be excluded by a normal MRI examination. MRI is non-specific as the distinction of benign and malignant breast lesions is unreliable. Only in selected cases (fat- or blood-containing lesions) may it improve the specificity of mammography and sonography. Mostly image-guided core biopsy is by far the most specific and least expensive method to establish a definitive diagnosis. For lesions exclusively detected by contrast-enhanced MRI, simple and reliable localisation devices are urgently needed. Presently accepted indications for MRI of the breast are: patients with silicone implants after mastectomy or augmentation mammoplasty (detection of recurrence/prosthesis rupture/silicon leakage); patients whose breasts are difficult to evaluate by combined mammography and sonography, who have had breast conservation therapy (local recurrence), or who have proven carcinoma in one breast (multifocality/-centricity or contralateral breast carcinoma) or proven axillary lymph node metastases from an unknown primary tumor, especially when these are hormone receptor positive; patients with extensive postoperative scarring. In the future, genetically defined high breast cancer risk may become an indication.
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PMID:MRI of the breast: state of the art. 960 56

The differential capacity of iron oxide microspheres and of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) to serve as contrast agents that can map the microcirculation of MCF7 human breast cancer implanted in nude mice has been examined by high resolution MRI. Modulation of signal intensity in T2*-weighted, gradient-echo images after iron oxide administration and the temporal signal enhancement after Gd-DTPA administration were monitored and analyzed at a spatial resolution of 98 x 98 x 500 microm and 195 x 390 x 1,000 microm, respectively. The pathophysiologic features revealed in the contrast-enhanced images were analyzed in reference to those obtained from the corresponding high resolution T2-weighted, spin-echo images and from histologic sections stained with hematoxylin and eosin and with an endothelial cell marker. The results showed that iron oxide microspheres can aid in the characterization of gross histopathologic features and in the assessment of the distribution of the microvasculature, whereas Gd-DTPA estimates the permeability of the microvessels to this agent and determines the cellularity (cell volume fraction) in the vicinity of the vessels.
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PMID:High resolution MRI of MCF7 human breast tumors: complemented use of iron oxide microspheres and Gd-DTPA. 962 79

Since its introduction in 1971 bone scintigraphy has become the classical procedure to confirm or exclude metastatic spread of breast cancer to skeleton. Recent developments in tomographic imaging (CT, MRI) as well as a more critical attitude towards technical diagnostic tests have raised the question about the present role of scintigraphy in staging and follow-up of breast cancer patients. Based upon systematic retrospective analyses bone scintigraphy is recommended for the initial staging of high risk patients (node-positive). In the follow-up of symptom-free patients bone scintigraphy did not prove to be necessary while it should be used in symptomatic patients to confirm and demonstrate the extent of metastatic disease. The bone scan is also useful for treatment control. However, due to similar findings in case of response (flare phenomenon) as well as tumor progression clinical relevance appears to be limited. In future increasing competition with CT and/or MRI will probably occur. Since MRI was proven to be more sensitive as well as specific in direct comparison, all efforts should be made to improve image quality and to reduce costs of skeletal scintigraphy. PET using F-18 fluoride might be an interesting alternative, if it becomes available for reasonable prices.
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PMID:Skeletal scintigraphy in breast cancer management. 964 44

To develop an optimized interpretation strategy of dynamic contrast enhanced breast MRI based on a combination of quantitative and qualitative criteria, the features of 120 histopathologically verified lesions were retrospectively analysed on contrast enhanced dynamically acquired (before and 1, 2, 4 and 7 min following injection of 0.2 mmol kg-1 gadolinium-DOTA) three-dimensional gradient echo images. Quantitative criteria, based on relative signal intensity measurements and qualitative morphological features, including lesion shape, margins and enhancement patterns were analysed in regard to differentiating malignant (n = 70) from benign (n = 50) lesions. Quantitative assessment of enhancement profiles was most accurate when analysis was based on early 1 min measurements. Using a 90% threshold, sensitivity and specificity in detecting breast cancer were 83% and 66%, respectively. When based on qualitative morphological analysis alone, sensitivity and specificity were 83% and 54%. Combined quantitative and qualitative assessment yielded a considerably higher sensitivity, specificity and accuracy of 93%, 74% and 85%, respectively. In conclusion, results from dynamic contrast enhanced breast MRI can be improved by basing the interpretation on both quantitative and qualitative criteria.
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PMID:Improved diagnostic accuracy in dynamic contrast enhanced MRI of the breast by combined quantitative and qualitative analysis. 969 95

Breast conserving therapy (BCT) has turned out to be the standard procedure for the treatment of breast cancer. While the risk of local recurrences was reported as 1-2% or more per year after treatment, follow-up including clinical examination, mammography and even sonography is of priority. This study was performed to assess the efficacy of contrast-enhanced dynamic magnetic resonance tomography (NMR) for the diagnosis of local recurrences after breast conserving therapy, compared to palpation, mammography and ultrasound. In 33 patients local recurrences within the breast were diagnosed after breast conserving surgery. The sensitivity for the diagnosis of local recurrences after BCT was as follows: palpation (51%), mammography (67%), ultrasound (85%) and NMR (91%). All multicentric local recurrences were diagnosed by NMR. Mammography was not able to diagnose 11 local recurrences in radiodense breasts. Here ultrasound was able to diagnose 8 of 11 recurrences, while NMR was able to diagnose 10 of 11 recurrences. Therefore, ultrasound should be included into routine follow-up protocols after BCT to achieve an acceptable sensitivity for the detection of local recurrences. Under defined conditions and indications MRI is the best method to complement mammography and sonography with the highest sensitivity for the diagnosis of local recurrences in the radiodense breast.
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PMID:Magnetic resonance imaging in the diagnosis of local recurrences in breast cancer. 970 76

A 51 year old woman with breast cancer four years ago was studied by bone scintigraphy. At the moment of the study she had bone pain. The bone scintigraphy showed uptake in humerus and femur and no more uptake in other zones of axial skeleton. Then, we made others radiological procedures (X-Ray and MRI) with the aim to make an accurate diagnosis. Then a diagnosis of benign bone tumours; enchondroma was made. It means something obvious but very interesting. In case of doubt we ever have to compare the bone scintigraphy with other diagnostic. examinations.
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PMID:[Nonmetastatic accumulations in bone radionuclide scans in a patient with breast neoplasm]. 981 11

The objective of this study was to assess the value of contrast-enhanced dynamic breast imaging in patients with carcinoma of unknown primary (CUP). Fourteen patients presenting with metastatic disease compatible with breast cancer (axillary lymph node metastasis: n = 6; supraclavicular lymph node metastasis: n = 1; bone metastasis: n = 3; liver metastasis: n = 3; lung metastasis: n = 1), who had no evidence of tumor in X-ray mammograms and ultrasound, underwent bilateral dynamic breast MR imaging. Suspicious lesions were localized preoperatively using a stereotactic device for MR-guided localization procedures. Magnetic resonance imaging revealed suspicious lesions in 9 of 14 patients. Histopathology revealed invasive carcinoma of the breast in 6 of these patients. Two enhancing lesions were fibroadenomas; one proved to be sclerosing adenosis. In 5 patients MR imaging showed no abnormality. Follow-ups performed up to 1 year after initial treatment revealed no breast cancers in these 5 patients. In patients with metastatic disease of unknown primary, MRI of the breast depicts the primary in a considerable number of cases with normal conventional evaluation.
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PMID:MRI of the breast in patients with metastatic disease of unknown primary. 1008 18

Paraneoplastic cerebellar degeneration is a rare complication of cancer and is most frequently associated with lung, ovary, and breast cancers as well as Hodgkins lymphoma. A 74-year-old female with a past history of breast cancer presented with vomiting, ataxia, slurred speech, and dizziness. Her serum chemistry, thyroid and liver function tests, acetylcholine antibodies, serum cortisol, CT, and MRI imaging were all normal. Serum testing for anti-YO antibodies was positive. Further evaluation including CT of the abdomen and pelvis revealed endometrial thickening. Subsequently, an endometrial biopsy showed a poorly differentiated serous adenocarcinoma. Surgical staging was consistent with a stage IIIc serous adenocarcinoma of the uterus. The risk factors, symptoms, signs, differential diagnosis, and clinical and antibody associations of the paraneoplastic cerebellar degeneration syndrome are reviewed. In addition, an efficient approach to the diagnostic evaluation of such patients is proposed.
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PMID:Serous adenocarcinoma of the uterus presenting as paraneoplastic cerebellar degeneration. 1032 56

Previous experimental studies showed that significant changes occur in the electrical properties of breast cancer tissue compared to the surrounding normal tissue. This phenomenon motivated studies on cancer detection using electrical impedance techniques. In the present study, a two-dimensional model of the torso and a numerical method were used to investigate the changes in the potential distribution as a result of a malignant tissue present in the breast. A transverse MRI image of the woman's torso was scanned. Noise reduction and contour-following algorithms were applied to differentiate between eight compartments in the torso. The extracted tissue types were lungs, blood, ribs, bone marrow of the cord, breast fat, skin, skeletal muscle, and heart muscle. Isotropic homogeneous conductivity was assigned to each one of these compartments. The volume conductor problem was solved numerically using the finite volume method to determine the potential distribution developed due to the dipole source. Cases without and with artificially inserted malignant region with realistic sizes were examined to investigate the sensitivity of impedance techniques to detect breast cancer. Significant changes were detected in the potential distribution inside the volume conductor as a result of the realistic size of breast tumors. A linear relation was found between the surface potential in the vicinity of the tumor region and the size of the tumor. For a small malignant area of 0.22 cm2, the surface potential near the tumor region decreased only slightly from a value of 13.81 mV in the normal case to 13.67 mV (0.14 mV change; 1.0%). For a larger malignant area of 5.43 cm2, the potential decrease was more pronounced, 11.29 mV (2.52 mV change; 18.3%), indicating that realistic sizes of breast tumor result in significant changes in the surface potential. Thus, impedance techniques employed in the present study show very good promise in detecting breast cancer.
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PMID:Evaluation of impedance technique for detecting breast carcinoma using a 2-D numerical model of the torso. 1037 83


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