OBJECTIVE: To investigate the usefulness of targeted ultrasound (US) in the identification of additional suspicious lesions found by magnetic resonance (MR) imaging in breast cancer patients and the changes in treatment based on the identification of the lesions by the use of targeted US. MATERIALS AND METHODS: One-hundred forty nine patients who underwent breast MR imaging for a preoperative evaluation of breast cancer between January 2002 and July 2004 were included in the study. We searched all cases for any additional lesions that were found initially by MR imaging and investigated the performance of targeted US in identifying the lesions. We also investigated their pathological outcomes and changes in treatment as a result of lesion identification. RESULTS: Of the 149 patients with breast cancer, additional suspicious lesions were detected with MR imaging in 62 patients (42%). Of the 69 additional lesions found in those 62 patients, 26 (38%) were confirmed as cancers by histology. Thirty-eight lesions in 31 patients were examined with targeted US and were histologically revealed as cancers in 18 (47%), high risk lesions in two (5%), benign lesions in 15 (39%), and unidentified lesions in three (8%). The cancer rate was statistically higher in lesions with a US correlate than in lesions without a US correlate (p = 0.028). Of 31 patients, the surgical plan was altered in 27 (87%). The use of targeted US justified a change in treatment for 22 patients (81%) and misled five patients (19%) into having an unnecessary surgical excision. CONCLUSION: Targeted US can play a useful role in the evaluation of additional suspicious lesions detected by MR imaging in breast cancer patients, but is limited in lesions without a US correlate.
Adult ; Aged ; Biopsy ; Breast/pathology ; Breast Diseases/diagnosis/surgery ; Breast Neoplasms/*diagnosis/surgery ; Carcinoma, Ductal, Breast/*diagnosis/surgery ; Carcinoma, Intraductal, Noninfiltrating/*diagnosis/surgery ; Carcinoma, Lobular/*diagnosis/surgery ; Contrast Media/administration & dosage ; Diagnosis, Differential ; False Negative Reactions ; False Positive Reactions ; Female ; Humans ; Image Enhancement/methods ; Imaging, Three-Dimensional/methods ; Magnetic Resonance Imaging/*methods ; Middle Aged ; Predictive Value of Tests ; Sensitivity and Specificity ; Ultrasonography, Mammary/*methods

Antineoplastic Agents, Hormonal ; therapeutic use ; Breast Neoplasms ; classification ; drug therapy ; pathology ; surgery ; Carcinoma in Situ ; drug therapy ; pathology ; surgery ; Carcinoma, Intraductal, Noninfiltrating ; drug therapy ; pathology ; surgery ; Carcinoma, Lobular ; drug therapy ; pathology ; surgery ; Diagnosis, Differential ; Female ; Humans ; Mastectomy ; Precancerous Conditions ; drug therapy ; pathology ; surgery ; Tamoxifen ; therapeutic use

OBJECTIVETo compare the efficacy of methylene blue versus carbon nanopartIcles suspension injection as a tracer for sentinel lymph node detection in breast cancer and the factors associated with the definition of sentinel lymph node biopsy.

METHODSOne hundred and sixteen patients with early breast cancer underwent intraoperative sentinel lymph node biopsy, among them 51 patients accepted injection of methylene blue dye, while 65 patients received carbon nanopartIcles suspension injection. The mapping procedures and SLNB were performed using subareolar or peritumoral injection of methylene blue or carbon nanopartIcles suspension injection at the site of the primary breast cancer, followed by the axi11ary lymph node dissection (ALND). All the SLN and ALN were evaluated pathologically post-operatively.

RESULTSIn the MB group, the false-negative, sensitivity, accuracy, specificity rate of SLNB detection were 88.2%, 13.3%, 86.7%, 84.3%, and 100%, respectively. In the CNP group, the false-negative, sensitivity, accuracy, specificity rate of SLNB detection were 98.5%, 8.7%, 91.3%, 95.4%, and 100%, respectively. The false-negative, sensitivity, specificity rate in the CNP group were trended to be higher than those in the MB group, but the difference of the accuracy and detection rates are significant (P < 0.05).

CONCLUSIONSCompared with methylene blue solution, the carbon nanoparticle injection shows a better stability and operability for the sentinel lymph node detection in breast cancers.

Adult ; Aged ; Axilla ; Breast Neoplasms ; pathology ; surgery ; Carbon ; Carcinoma, Ductal, Breast ; pathology ; surgery ; Carcinoma, Intraductal, Noninfiltrating ; pathology ; surgery ; Carcinoma, Lobular ; pathology ; surgery ; False Negative Reactions ; Female ; Humans ; Injections ; methods ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; diagnosis ; Methylene Blue ; Middle Aged ; Nanoparticles ; Neoplasm Staging ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; methods

Adult ; Breast Neoplasms ; metabolism ; pathology ; secondary ; Carcinoid Tumor ; metabolism ; pathology ; surgery ; Carcinoma, Adenoid Cystic ; pathology ; Carcinoma, Lobular ; metabolism ; pathology ; secondary ; Cervical Intraepithelial Neoplasia ; metabolism ; pathology ; surgery ; Chromogranin A ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Hysterectomy ; Keratins ; metabolism ; Neoplasms, Multiple Primary ; metabolism ; pathology ; surgery ; Ovarian Neoplasms ; metabolism ; pathology ; Sex Cord-Gonadal Stromal Tumors ; metabolism ; pathology ; Synaptophysin ; metabolism ; Uterine Cervical Neoplasms ; metabolism ; pathology ; surgery

OBJECTIVETo study the diagnostic usefulness of immunohistochemical markers in distinguishing between invasive ductal carcinoma and invasive lobular carcinoma of breast.

METHODSTwenty-four cases of grade I invasive ductal carcinoma, 12 cases of classic invasive lobular carcinoma and 14 cases of invasive carcinoma with mixed ductal and lobular features were retrieved from the archival files of Peking University First Hospital during the period from January, 1998 to December, 2001. Immunohistochemical study for E-cadherin, p120 catenin, epithelia membrane protein 1 (EMP1) and DVL1 was performed.

RESULTSThe positivity rates for E-cadherin in grade I invasive ductal carcinoma and classic invasive lobular carcinoma were 83.3% (20/24) and 0, respectively (P < 0.01). The positivity rates for p120 catenin were 100% in both grade 1 invasive ductal carcinoma (membranous staining) and classic invasive lobular carcinoma (cytoplasmic staining). The positivity rates for EMP1 and DVL1 in gradeI invasive ductal carcinoma were 95.8% (23/24) and 54.2% (13/24), respectively; while those in classic invasive lobular carcinoma were 12 and 5 cases, respectively.

CONCLUSIONSE-cadherin and p120 catenin are useful immunomarkers for distinguishing between invasive ductal carcinoma and invasive lobular carcinoma. On the other hand, EMP1 and DVL1 are of limited value in this respect.

Adaptor Proteins, Signal Transducing ; metabolism ; Breast Neoplasms ; metabolism ; pathology ; surgery ; Cadherins ; metabolism ; Carcinoma, Ductal, Breast ; metabolism ; pathology ; surgery ; Carcinoma, Lobular ; metabolism ; pathology ; surgery ; Catenins ; metabolism ; Diagnosis, Differential ; Disease-Free Survival ; Dishevelled Proteins ; Female ; Humans ; Mastectomy ; methods ; Middle Aged ; Neoplasm Proteins ; metabolism ; Phosphoproteins ; metabolism ; Receptors, Cell Surface ; metabolism ; Survival Rate

We report a case of granulocytic sarcoma presented as a recurrent breast tumor in a 42-year-old woman with no history of leukemia. The case was initially diagnosed as malignant lymphoma on a previous biopsy specimen and she refused chemotherapy. At the time of recurrence of the breast tumor, the patient showed full-blown features of leukemia. This case of rare tumor suggests that differential diagnosis should be considered when malignant lymphoma of the breast is detected.
Adult ; Breast Neoplasms/surgery ; Breast Neoplasms/pathology ; Breast Neoplasms/diagnosis+ACo- ; Carcinoma, Lobular/diagnosis ; Case Report ; Cell Nucleus/ultrastructure ; Diagnosis, Differential ; Diagnostic Errors+ACo- ; Female ; Human ; Leukemia, Myelocytic, Acute/pathology ; Leukemia, Myelocytic, Acute/diagnosis+ACo- ; Lymphoma, Large-Cell, Diffuse/diagnosis+ACo- ; Neoplasm Recurrence, Local/pathology

We report a case of granulocytic sarcoma presented as a recurrent breast tumor in a 42-year-old woman with no history of leukemia. The case was initially diagnosed as malignant lymphoma on a previous biopsy specimen and she refused chemotherapy. At the time of recurrence of the breast tumor, the patient showed full-blown features of leukemia. This case of rare tumor suggests that differential diagnosis should be considered when malignant lymphoma of the breast is detected.
Adult ; Breast Neoplasms/surgery ; Breast Neoplasms/pathology ; Breast Neoplasms/diagnosis+ACo- ; Carcinoma, Lobular/diagnosis ; Case Report ; Cell Nucleus/ultrastructure ; Diagnosis, Differential ; Diagnostic Errors+ACo- ; Female ; Human ; Leukemia, Myelocytic, Acute/pathology ; Leukemia, Myelocytic, Acute/diagnosis+ACo- ; Lymphoma, Large-Cell, Diffuse/diagnosis+ACo- ; Neoplasm Recurrence, Local/pathology