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Hungarian Radiology

DECEMBER 27, 2010

[Lesions resembling radial scar of the breast - Is preoperative biopsy of the radial scar needed?]

SEBŐ Éva, SARKADI László, KOVÁCS Ilona, TÓTH Dezső, BÁGYI Péter

[INTRODUCTION - The radial sclerosing lesion is one of the most common benign breast lesions. It can mimic malignant tumours on mammogram in many cases. In one third of the cases invasive tumour or in situ carcinoma occur in radial sclerosing lesion, therefore surgical excision is mandatory. The aim of our work is to diagnose the malignant cases with preoperative biopsy (FNAB, core biopsy) when radial scar morphology lesion is detected in order to avoid two-step surgical procedure. PATIENTS AND METHODS - Forty-five patients were examined with the same method. In all cases of radial sclerosing morphology lesions a mammography, complementary radiograms, ultrasonography (US) and synchronous US guided FNAB and core biopsy were performed. Postoperative pathological findings were compared to the results of preoperative biopsies. RESULTS - In 6 of 45 cases (13%) malignant tumours mimicked radial scar in morphology. All of them were diagnosed preoperatively with core biopsy (B5). The FNAB was nondiagnostic (C1) in 2 patients, suspicious for malignancy (C4) in 2 patients and was positive in 2 cases (C5). Radial scars or complex sclerosing lesions were diagnosed in 39 patients preoperatively. In 28 cases (72%), malignancy was not detected with postoperative pathological examination. In 8 cases (20%) DCIS and, in 3 cases (8%), malignant tumours were found associated to radial scar. Neither FNAB nor core biopsy gave false positive results in the non-malignant group. In the patients with DCIS associated to radial scar, core biopsy proved malignancy in 5 cases and FNAB in only 1 case. In 3 cases of invasive malignant tumour associated with radial scar core biopsy was positive in 1 patient, while FNAB was negative or non-diagnostic in all of them. CONCLUSION - According to the latest publications vacuum- assisted large-core needle biopsy (VLNB) performed with 11G needle (12) is the safest procedure to justify or exclude malignancy in the radial scar. Observation would be enough in the non-malignant cases and this procedure has therapeutic potential as well. In case where these methods are not available, as in Hungary, all radial scar cases require surgical excision. Therefore, preoperative core biopsy is recommended in order to avoid a two-step surgical procedure.]

Hungarian Radiology

JUNE 20, 2006

[Atypical breast cyst: problems of differential diagnosis]

PAPP László, KOVÁCS Zsolt, SZABÓ Éva, MINIK Károly, ANTALFI Bálint, BENDE Sándor

[INTRODUCTION - Cystic breast masses detected by ultrasound can be devided into several groups upon their morphology. One of them is the group of progressive atypical cysts. CASE REPORT - A young female patient presented multiple palpable nodules in the central part and in the upper-medial quadrant of the left breast. Ultrasound examination showed cystic lesions of middle size and with smooth walls. The cytological results of two consecutive punctures of the cyst was C2, consistent with acute inflammatory hemorrhagic cystic content. The patient was followed up by ultrasound, which 4-6 months later demonstrated considerable progression in size and morphological changes of the cysts. The presence of intracystic nodules and the pericystic solid lesions made the use of MRI examination justified but it couldn’t exclude the possibility of multicentric malignancy. The breast team decided the excision of the cystic lesions, at first. The biopsy revealed multiple intraductal and intracystic papilloma surrounded by normal breast tissue. CONCLUSION - Considering the problems of differential diagnosis which raised the suspicion of similar morphological histological entities (intracystic papillar carcinoma, adenoid cystic carcinoma, DCIS) surgery was justified. According to the authors’s suggestion, despite of the frightening morphological, radiological and clinical status, the less radical surgery should be performed.]

Hungarian Radiology

MAY 15, 2010

[Breast malignancies: review of the year 2008/2009 radiological diagnostics and therapy news - Onco Update, 2010]

FORRAI Gábor

[Systematic review of the recent articles of the years 2008/2009 about breast tumours’ radiological diagnostics and guided therapy, the actual place of the imaging and interventional methods are presented.]