Hungarian Radiology

[Results of non-operative pathological breast diagnostics - One year experience at the Bács-Kiskun County Teaching Hospital]


AUGUST 10, 2005

Hungarian Radiology - 2005;79(04)

[INTRODUCTION - Non-operative cytological and histopathological assessment of breast lesions are part of the triple (physical, imaging and pathologic) diagnostic approach and allow a more precise planning of surgical procedures. Both methods have advantages and disadvantages; currently, core biopsy is believed to be more efficient in reaching the diagnostic target. PATIENTS AND METHODS - Breast specimens with a histological diagnosis at the Department of Pathology of the Bács-Kiskun County Teaching Hospital were analysed for their preoperative pathology, using the conventional C1-5 and B1-5 diagnostic categories. RESULTS - 295 cytology and 130 core needle biopsy cases were analysed. The rate of non diagnostic (C1 and B1) material was higher for cytology (0.18 versus 0.08 in general; 0.09 versus 0.01 for malignant cases). The rate of cases with an uncertain diagnostic category (C3 and C4 or B3 and B4) was also higher for the cytology specimens (0.24 versus 0.07). False-negative and false-positive cases were rare, but still more frequent among cytology specimens. CONCLUSION - Core needle biopsy performs better than fine needle aspiration cytology in the establishment of a nonoperative diagnosis at our institution. Despite these results, cytology continues to be the first diagnostic choice, because of its relatively low costs.]



Further articles in this publication

Hungarian Radiology

[Ethiopathogenesis of polycystic ovarian syndrome and imaging diagnostics of polycystic ovary]

JAKAB Attila, MOLNÁR Zsuzsanna, TÓTH Zoltán

[Polycystic ovarian syndrome is a heterogenous syndrome with a wide variety of endocrine and metabolic abnormalities and clinical symptoms. It is considered as the most frequent endocrine disorder in women in reproductive age and the most common cause of anovulatory infertility. Key features include menstrual cycle disturbance, hyperandrogenism and obesity. There are many extraovarian aspects to the pathophysiology of polycystic ovarian syndrome, but ovarian dysfunction is central. The underlying unique feature of the ovarian morphology gives the significance of the ultrasound examination. At a recent consensus meeting, a refined definition of the polycystic ovarian syndrome was agreed, encompassing a description of the morphology of the polycystic ovary. The subjective appearance of polycystic ovary should not be substituted for the definition. Further, a woman having polycystic ovary in the absence of menstrual disorder or hyperandrogenism (asymptomatic polycystic ovary) should not be considered as having polycystic ovarian syndrome, until more is known about the situation. Since ultrasound description of polycystic ovary morphology has central role in the diagnosis, and untreated polycystic ovarian syndrome carries long term health risks, the increasing attention to ovarian morphology may offer an effective tool to decrease women`s morbidity. This review outlines the background and feature of ovarian morphology in polycystic ovarian syndrome, and details the current ultrasound definition of polycystic ovary.]

Hungarian Radiology

[Thoughts relating to PET and CT]


Hungarian Radiology

[The glove-finger phenomenon on postero-anterior chest radiograph]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - The glove-finger phenomenon observed on chest plain film is characterized by branching tubular or fingerlike opacities that originate from the hilum and are peripherally directed. This change brings about impaction and inspissation of the mucus and inflammatory debris besides the obstruction of bronchi and of its prestenotic dilatation about. CASE REPORT - A 51 year old male patient presented with coexisting bronchial asthma and microcellular carcinoma of left 2nd pulmonary segment, leading to a tubular type glovefinger phenomenon. The diagnosis was proved by decrease of Tiffeneau’s index, bronchoscopy, bronchocytology and bronchogenic biopsy. CONCLUSION - The glove-finger phenomenon is correctly visible on postero-anterior chest plain film. The dilated and mucus-filled bronchi are not visible on radiography if the sorrounding lung is atelectasic. Because obstructive and nonobstructive bronchogenic diseases can appear with similar presentation, therefore, definitive diagnosis is only possible on the basis of pneumodynamic examinations, bronchoscopy, bronchocytology and biopsy.]

Hungarian Radiology

[Scientific meeting on radiofrequency tumor ablation - Interdisciplinary Forum of the MOTESZ]


Hungarian Radiology

[Congress of the European Society of Pediatric Radiology and Postgraduate Course, Dublin]

KISS Regina Judit

All articles in the issue

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Hungarian Radiology

[Imaging of mesenterial panniculitis - Case report]

KOVÁCS Anita, KISS Ildikó, PALKÓ András

[INTRODUCTION - Mesenterial panniculitis is a rare benign disorder, however it is important to be familiar with, because of the difficulties in differential diagnosis. Authors describe the characteristic imaging signs of the disease based on their two cases. CASE REPORTS - Two male patients (72 and 62 years old) presented with uncertain abdominal pain and weight loss. Acute pancreatitis, chronic gastritis and duodenitis are noted in their case history. The laboratory parameters were normal and the physical examination revealed a palpable epigastrial terime in both patients. Abdominal ultrasound and CT examinations depicted different degree of mesenterial infiltration with lymph node enlargement. Histological analysis of the biopsy sample proved the process to be benign in the first patient. The mass was surgically removed in the second one and histology proved mesenterial panniculitis. CONCLUSION - Mesenterial panniculitis is a benign, chronic non-specific inflammatory disorder. Its appearance may simulate malignant diseases, thus making differential diagnosis is important. Abdominal ultrasound, CT and result of image guided biopsy play an important role in the diagnosis, in case of which conservative therapy and regular follow-up is sufficient.]

Lege Artis Medicinae

[The clinical importance of HER2 expression in breast cancer]

KAHÁN Zsuzsanna

[HER2 (neu/c-erbB-2) is a member of the EGF receptor family. It is activated without binding a specific ligand that leads to malignant transformation and tumor progression. Overexpression of HER2 is detected in approximately one quarter of human breast cancers. Immunohistochemistry and in situ hybridization (FISH) are the most widely used techniques in studying HER2 expression. HER2 positivity indicates worse outcome in node positive breast cancer and increasing number of studies show unfavourable prognosis in node negative cases as well. Recent data indicate that the knowledge of HER2 status may promote therapeutic decision. The generally applied cyclophosphamide- methotrexate-5-fluorouracil (CMF) polychemotherapy seems to provide no benefit in HER2 positive cases in contrast with HER2 negative breast cancer patients. Interestingly, doseintensive doxorubicin based chemotherapy gives better results in HER2 positive than in HER2 negative tumors. Determination of HER2 expression has great importance before therapeutic application of the humanized antibody trastuzumab (Herceptin). HER2 overexpression usually correlates well with estrogen and progesterone receptor negativity and hormone-resistance, therefore hormonal therapy is not justified for these patients. Some experimental and clinical data indicate that in case of simultaneous HER2 and ER positivity tamoxifen worsens treatment results which may be prevented by the coadministration of tamoxifen and trastuzumab. Emerging experimental and clinical data about HER2 has led to a new stage of individual treatment of breast cancer patients. The knowledge of HER2 status promotes antitumor intervention based on molecular characteristics of breast cancers. Therefore, reliable HER2 tests are needed in the everyday practice.]

Hungarian Radiology

[Results of breast cancer screening and clinical mammography at the Kenezy Breast Center, Debrecen between 2002-2003]


[INTRODUCTION - Breast cancer screening has been started in January 1. 2002. in Hungary in the course of the National Health Program. Breast cancer is the main cause of death among women’s malignant tomors, and the aim of the project is to reduce this mortality. The chance of survival is highly increased by the early detection of the disease. Kenezy Breast Center was connected to this project. PATIENTS AND METHODES - Females between 45-65 years without symptoms participated in the project. Paralel to this women with symptoms, sometimes with palplable masses were clinically examined. Screening mammography films were read by two radiologists and the complementary examinations of the breast and the axillary lymph nodes - ultrasonography, guided biopsy (FNAB, core biopsy) - were performed always by the same doctor. Results of the two projects were compared. RESULTS - The incidence of malignant breast cancer was 4‰ in the screening and 1,5% in the clinical group. 46.5% of the malignant breast cancers revealed by the clinical examinations was diagnosed in the group of women between the age of 45 to 65 years. This is the age when most women are involved in the screening program. 7.3% of the tumors was diagnosed in the 40- 44 year age-group and 11.3% among women aging 66-77 years. The rate of malignant tumors smaller than 1.5 cm was 49.1% according to screening records and 36% in the clinical trial. In both groups, tumor size of 1.5 cm proved to be a critical limit regarding to the development of metastases, mainly in the axillary region. Above this size, metastases were more frequent. CONCLUSIONS - Both breast screening program and clinical exams are of great significance. Based on the data obtained during two years, authors found that women below the age of 40 and above the age of 65 should also be involved in the screening program. Detection of breast tumor is possible at an early stage by screening. In the case of small tumors (smaller than 1.5 cm) the development of axillary metastases is less likely than in the case of larger ones. The lack of metastases in the axillary lymph nodes offers better prognosis according to the published scientific data, which reinforces the importance and necessity of the screening programs.]

Clinical Oncology

[Practical use of meta-analyses in predicting disease risk, outcome, and therapy response in breast cancer]


[Breast cancer is globally the most frequent malignant disease in women with increasing incidence. Meta-analyses using data from a large set of patients combining genetic and standard clinicopathological features provide valuable models in predicting disease risk, outcome and therapy response. With the advent of molecular technologies, the amount of available data generated for each tumor and each patient is growing exponentially. The increased data availability allows the development of new innovative systems enabling to discover more effective prognostic and predictive biomarkers. The goal of this review is to summarize meta-analyses that utilize data from countless patients to provide breast cancer risk prediction (Gail-model, Claus-model, BRCApro, IBIS, BOADICEA), and prediction of prognosis and expected therapy response (PREDICT, Magee). In the last part of the review we introduce online analytical tools (KMplot, ROCplot) developed to examine, rank and validate new prognostic and predictive biomarker candidates.]

Clinical Oncology

[Clinical role of multigenic prognostic tests in breast cancer therapy]


[Current clinical practice for breast cancer originates in “evidence based medicine”. In this, each tumor receives a therapy optimal for a given patient population - which might not be optimal for each individual patient. Multigenic tests determining expression of a set of genes can provide additional support in this decision process. Two such tests (MammaPrint and Prosigna) have already received FDA clearance. A number of additional test are commercially available (IHC4, Oncotype DX, EndoPredict, BCI). A common property of these assays is their utility in estrogen receptor positive early breast cancer. The main clinical problem answered by them is the necessity of adjuvant chemotherapy. To date, no reliable algorithm has been identifi ed capable to pinpoint the most effective chemotherapy combination for a given patient. Furthermore, there is no trustworthy test for triple negative breast cancer. The assays utilize different technologies (immunohistochemistry, gene chips, RT-PCR) and a discrepant list of genes - these result in discordance of the predictions for the individual patient. Despite these shortcomings, multigenic tests quickly gained foothold in breast cancer therapy decision process. Their utility is supported by the cost reduction for the health care providers by lowering the number of patients eligible for chemotherapy.]