Faculty Bibliography

INTRODUCTION: With the adoption of routine screening mammography, breast cancers are being diagnosed at earlier stages, with DCIS now accouting for 22.5% of all newly diagnosed breast cancers. This has been attributed to both increased breast cancer awareness and improvements in breast imaging techniques. How have these changes, including the increased use of image-guided sampling techniques, influenced the clinical practice of breast surgery? METHODS: The institutional pathology database was queried for all breast surgeries, including breast reconstruction, performed in 1995 and 2005. Cosmetic procedures were excluded. The results were analysed utilizing the Chi-square test. RESULTS: Surgical indications changed during 10-year study period, with an increase in preoperatively diagnosed cancers undergoing definitive surgical management. ADH, and to a lesser extent, ALH, became indications for surgical excision. Fewer surgical biopsies were performed for indeterminate abnormalities on breast imaging, due to the introduction of stereotactic large core biopsy. While the rate of benign breast biopsies remained constant, there was a higher percentage of precancerous and DCIS cases in 2005. The overall rate of mastectomy decreased from 36.8% in 1995 to 14.5% in 2005. With the increase in sentinel node procedures, the rate of ALND dropped from 18.3% to 13.7%. Accompanying the increased recognition of early-stage cancers, the rate of positive ALND also decreased, from 43.3% to 25.0%. CONCLUSIONS: While the rate of benign breast biopsies has remained constant over a recent 10-year period, fewer diagnostic surgical image-guided biopsies were performed in 2005. A greater percentage of patients with breast cancer or preinvasive disease have these diagnoses determined before surgery. More preinvasive and Stage 0 cancers are undergoing surgical management. Earlier stage invasive cancers are being detected, reflected by the lower incidence of axillary nodal metastases

Benign adenomyoepithelioma of the breast is a rare tumor in which the cytologic findings have been described in only a few cases. While benign, the imaging and pathologic features may be mistaken for malignancy. We report the aspiration biopsy findings in four cases of adenomyoepithelioma with radiologic and histologic correlation. Cytopathologists should familiarize themselves with this entity to avoid a misdiagnosis of carcinoma

BACKGROUND: Stereotaxic fine-needle aspiration biopsy (SFNA) of mammographically detected nonpalpable lesions of the breast provides accurate diagnosis and may eliminate many unnecessary excisional biopsies of areas of microcalcification. METHODS: SFNA of microcalcification of indeterminate radiologic significance was performed on 125 patients (1991-1994), yielding 130 specimens (2 sites in 2 patients and bilateral aspirations in 3 patients). Stereotaxic localization was performed, and samples from within the area of microcalcification were obtained using 22-gauge needles. Smears stained with a Giemsa-type stain were prepared and studied by a cytopathologist during the procedure to determine the adequacy of each specimen. RESULTS: Of 130 specimens, 104 (80%) were cytologically benign, 13 (10%) were atypical, 6 (4.6%) were suspicious, and 7 (5.3%) were malignant. All malignant diagnoses were confirmed by subsequent operative biopsy. Follow-up was available in 74 of 104 benign cases (71%): surgical excisions (all benign) in 8 cases and follow-up mammograms at 6 months to 5.8 years in 66 cases (no radiologic change in 64 cases and 2 [1.9%] cases with new radiologic findings [SFNAs of the new radiographic abnormality revealed adenocarcinoma in both]). CONCLUSIONS: SFNA is a reliable and cost-effective method of evaluating indeterminate microcalcification; however, mammographic follow-up is indicated because of the possibility of subsequent and independent cancers

OBJECTIVE: A method for segmenting MR images of the breast was applied to determine fatty and fibroglandular tissue volumes in breasts of women in different age groups. The results were compared with subjective assessments of breast density from X-ray mammograms in the same patients. MATERIALS AND METHODS: Two experienced mammographers assessed the percentage of fat in the breasts of 40 women who were 20-83 years old. MR images were obtained on a 1.0-T scanner equipped with a bilateral receive-only breast coil. Images were acquired using a three-dimensional T1-weighted gradient-echo sequence with a 1.25 x 1.4 x 2.5 mm resolution. On average, breast parenchyma appeared in 30 images in each breast. Image segmentation was based on a semiautomated, two-compartmental (fatty and fibroglandular tissue) model that accounts for partial volume effects. To validate the accuracy of the MR imaging segmentation technique, we performed a phantom study using an identical imaging sequence. RESULTS: The accuracy of the MR imaging segmentation of the phantom was of the order of 2%. In our subjects, fat content was 42.5% +/- 30.3% (mean +/- SD) on mammography versus 66.5% +/- 18% on MR images. Although we found a significant correlation (r = .63) between the two techniques, mammography poorly differentiated breasts containing less than 45% fat. When our analysis included only dense breasts (i.e., those containing less than 75% fat on MR images), the correlation coefficient decreased to .34. The largest discrepancies between mammography and MR imaging occurred in breasts that had 60-80% fat as measured on MR imaging. CONCLUSION: Fatty and fibroglandular tissue can be differentiated on MR images of the breast with high precision and accuracy, therefore allowing assessment of breast density. The conclusions of researchers who used mammographic density patterns should be reassessed

The authors reviewed 316 cases of breast carcinoma diagnosed from January 1, 1986, to December 31, 1989. Clinical data and mammograms were available for all patients. Of the 316 carcinomas, 272 (86.1%) were invasive; 37 (13.6%) of these represented pure invasive lobular carcinoma (ILC). Twenty-five (68.5%) of the 37 patients with ILC and 161 (70.3%) of the 229 patients with invasive ductal carcinoma (IDC) presented with clinically palpable masses. Asymmetric opacities and architectural distortion were the predominant mammographic signs in 21 (57%) of the cases of ILC but only 32 (13.6%) of the cases of IDC. Malignant calcifications were not present in any of the patients with ILC but were present in 110 (47%) of those with IDC. Of the ILC lesions, 29 (85%) [corrected] had the same opacity as that of normal fibroglandular tissue, and the mammographic findings were often subtle and seen initially on one view only. There was no substantial difference in the TNM stage at diagnosis between the two study groups