Showing papers on "Breast lumps published in 2002"

Sonographic appearances of galactoceles

Abstract: Purpose The aim of this study was to investigate and summarize the sonographic appearances of galactoceles. Methods We retrospectively reviewed the sonograms and clinical records of 10 patients with galactoceles who had been examined over a 5-year period to evaluate breast lumps that had occurred during lactation or the puerperium. Results Sonograms from all patients showed well-defined lesions with thin, echogenic walls. The internal appearances of the lesions included homogeneous contents with medium-level echoes in 6 patients and heterogeneous contents with fluid clefts and anechoic rims in 4 patients. Focal echogenic areas with distal shadowing were seen in 2 patients. Most of the lesions showed some distal acoustic enhancement, depending on the internal contents. The diagnosis of a galactocele was established by needle aspiration in 9 patients and by excision biopsy in 1 patient. Needle aspiration alone was therapeutic in 8 patients. Conclusions Galactoceles can have a wide range of sonographic appearances and can mimic other lesions of the breast, both benign and malignant. The clues to the diagnosis are recent childbirth and lactation and the presence of a well-defined lesion with some distal acoustic enhancement. Needle aspiration of the lesion is both a diagnostic tool and an effective treatment in most patients with galactoceles. © 2002 John Wiley & Sons, Inc. J Clin Ultrasound 30:18–22, 2002.

EDITORIALS Routinely Teaching Breast Self-Examination is Dead. What Does This Mean?

Abstract: Physical examination of the breast is not a single test. Among clinicians (where it is termed “clinical breast examination” or CBE), it has various degrees of accuracy, depending on the clinician and his or her technique (1). Among women (where it is termed “breast self-exam” or BSE), it is sometimes an accurate test, but often it is not (2,3). In either case, physical examination of the breast is a difficult examination to learn to do well, especially when searching for the subtle changes that can signal early breast cancer (2,4–9). Physical examination of the breast is a skill taught to the fingers; it is sometimes confused with the knowledge of the clinical significance of a lump in the breast. One can have little skill at detecting slight asymmetrical thickening in the breast yet understand that, should a breast lump be detected in the usual course of bathing or dressing (i.e., without a systematic search plan), it is potentially serious and should be clinically evaluated. One of the striking changes in the presentation of breast cancer in the United States over the past 25 years is the reduction in the size of lumps discovered by women themselves. Large breast lumps are much less common now than before. Although it is not clear that the practice of BSE has improved during this time, it is clear that women have a greater appreciation (call it “awareness”) now than they did before about the importance of a lump of any size. It may be that having this knowledge rather than having BSE skill has reduced the size of detected breast lumps. Whether this reduction in the size of women-detected breast lumps has contributed to the recent reduction in breast cancer mortality is uncertain (10).

Increased incidence of benign breast disease in female renal transplant patients receiving cyclosporin.

Abstract: Background: Unlike other cancers, breast cancer does not occur at increased frequency in renal transplant patients but fibroadenomata may be more common as a result of exposure to cyclosporin. In order to determine the incidence of benign breast disease in renal transplant patients at Monash Medical Centre, current female patients were studied. Methods: The study was divided into two parts: (i) a retrospective review of those who presented with clinically detectable breast lumps; and (ii) mammographic screening of current female transplant patients who had been transplanted for more than 1 year. Results: In the retrospective study there were 11 patients with 16 breast lumps among a total of 85 patients. All were confirmed by biopsy. The mean age at diagnosis of breast lumps was 41.5 years (range 25–70 years). The mean time to presentation was 3.5 years after transplantation. Nine out of 11 patients had benign breast disease including fibroadenoma (six patients), fibrocystic disease (two patients) and intraductal papillomatosis (one patient). Two patients had breast cancer. Five of the patients with fibroadenoma had multiple lumps and a recurrent course. All patients with fibroadenomata had received cyclosporin. In the second part, 54 patients were further screened. The mean duration of transplantation was 6.4 years (range 1.25–18.5 years). Eighty-seven per cent of the patients had received cyclosporin, and 80% had a negative (normal) study. Seven of 54 had abnormalities including cysts and calcification, of whom two patients had fibroadenomata. Four patients had ‘dense mammograms’, all of whom received cyclosporin as a part of their immunosuppression. No breast cancer was detected during the study. Conclusion: The incidence of benign breast disease in the female transplant patients studied was far greater then the general population. The increase in fibroadenomata, in particular, may relate to the use of cyclosporin.

Improved breast cytology results with near patient FNA diagnosis.

Abstract: OBJECTIVE: To examine the impact of a cytopathologist using near patient fine needle aspiration diagnosis (NPFD) for breast diagnosis. STUDY DESIGN: The cytology results of all palpable solid breast lesions undergoing fine needle aspiration (FNA) during a two-year period were prospectively audited and categorized as definitely benign or malignant (definite), probably benign, indeterminate or suspicious (indefinite) or unsatisfactory. The final diagnosis (benign or malignant) was determined from a review of patients' charts and a survey of patients' family physicians. Aspirates were performed by surgical staff and reported either later (non-NPFD) or by NPFD. RESULTS: Of 720 FNAs, 230 were by NPFD and 490 by non-NPFD. NPFD was associated with a significantly greater proportion of definite reports (91.9% versus 82.4%). NPFD of discrete breast lumps was associated with higher specificity (89.1% versus 67.5%) and a lower unsatisfactory rate (9.4% versus 19.6%) than non-NPFD. NPFD did not improve the unsatisfactory rate of FNAs from diffuse breast thickenings. CONCLUSION: FNA by a dedicated specialist and immediate reporting should be an integral part of a breast diagnostic service.

Bleeding after excision of breast lumps

Abstract: Bleeding complications after excision of lumps in the breast are common and may be related to the prescription of heparin for prophylaxis of thrombo-embolism. Between I June 1997 and I January 2000, 206 lumps of the breast were removed in 186 patients. All patients received a low molecular weight heparin as a prophylaxis for deep venous thrombosis. The number of bleeding complications was 23 (11%). Patients operated on the day of admission had more bleeding complications than those who were operated on the day after admission (19/145 (13%) compared with 4/61 (7%)). The difference was not significant (p = 0.26). Smoking and use of antihypertensive medication were registered more often in patients without bleeding complications. Lumpectomy of the breast is an operation with a lot of bleeding complications. This might be related to the timing of deep venous thrombosis prophylaxis.

Correlation of fine needle aspiration cytology and its histopathology in diagnosis of breast lumps.

Abstract: This study was carried out to evaluate the accuracy of FNAC and the role of FNAC in palpable breast lumps for the early surgical management in out patient and inpatient basis. The study was carried out in Dhaka Medical College during the period of January-December, 2000. FNAC was performed on 310 patients presented with palpable breast lumps. Histopathology was available for 122 cases. Of them, cytologically diagnosed benign cases were 106, histologically 105 cases were proved so. There was false negative diagnosis in one case. All 14 cases diagnosed as malignant cytologically proved as such histologically. Two cases reported as suspicious for malignancy one of which were proved malignant histologically. False positive diagnosis was made in one case. FNAC of breast lump was found to be associated with increased diagnostic yields. It can be carried out safely as a preoperative diagnostic method in-patients with breast lumps mostly in out-patient department.

Cytological breast fine needle aspirate images analysis with a genetic fuzzy finite state machine

Abstract: A system based on a fuzzy finite state machine (FFSM) has been developed for evaluating cytological features derived directly from a digital scan of breast fine needle aspirate (FNA) slides. The system uses computer vision techniques to analyse cell nuclei in order to extract determinate features and to try to find, by means of genetic algorithms (GA), the ideal FFSM that is able to classify them. This application to breast cancer diagnosis uses the characteristics of individual cells to discriminate benign from malignant breast lumps. In our system, we try to find a texture measurement that can be included in the feature set in order to improve the classifier performance: a complexity measurement of the structural pattern is used to discriminate between benign and malign cells. With this measure and the technique described, we have observed that not only is the absolute complexity of the image relevant, but also the way in which the complexity is distributed at different scales.

Cytological analysis and immunocytochemical expression of Ki67 and Bcl-2 in breast proliferative lesions.

Abstract: Fine needle aspiration cytology (FNAC) is considered a reliable method for the diagnosis of breast diseases However, in some cases, cytological diagnosis may be difficult because of the presence of certain cytological parameters, which suggest a proliferative/indeterminate epithelial lesion, ie a cytological "gray zone" In this retrospective study we considered 37 cases with an uncertain cytological diagnosis and compared the cytological parameters with the histological diagnosis Furthermore, each case was evaluated with cellular markers such as Ki67 and bcl-2, in order to be able to differentiate the benign from the malignant proliferative breast lumps Our study showed a correlation between Ki67 expression and malignancy (p<0001), whereas, no association was observed with decreased or increased bcl-2 activity Therefore, in our opinion, immunocytochemical Ki67 expression may be helpful in the differentiation of cytologically suspicious/indeterminate breast lesions

Estudo Prospectivo das Características Sonográficas no Diagnóstico de Nódulos Sólidos da Mama

Abstract: Purpose: to evaluate, in a prospective way, the importance of ultrasound features of solid breast lesions in the differentiation between benign and malignant lumps. Methods: one hundred and forty-two patients with solid breast lesions, from the Department of Gynecology and Obstetrics of the Federal University of Goias (Brazil), were included in the trial. All ultrasound examinations were performed by a training doctor, always supervised by an experienced professional. The characteristics of the lesions studied were: shape, retrotumoral echoes, internal echoes, oriented diameter, halo of bright echoes and Cooper ligaments. Each of the ultrasound features was compared to the results of the histological examination. Results: among the 142 patients included in the trial, 90 (63%) had their lesions excised, and 77 (86%) had pathologic diagnoses of benign tumors and 13 (14%) of malignant tumors. The following characteristics were statistically significant in the diagnosis of the breast cancer (c2): masses with retrotumoral shadowing (p=0.0001), irregular shape (p=0.0007), heterogeneous internal echoes (p=0.0015) and vertically oriented - taller than wide (p<0.0001). The presence of halo of bright echoes anterior to the lump and the presence of wider Cooper ligaments were not related to the correct diagnosis of malignancy in this trial. Conclusion: ultrasound is a diagnostic method that can help physicians between the differentiation of benign and malignant breast lumps. The presence of retrotumoral shadowing, irregular shape, heterogeneous internal echoes and vertical orientation - lesions taller than wide - were related to the pathologic diagnosis of breast malignancies.

Fine needle aspiration biopsy (FNAB) of breast lumps: comparison study between pre- and post-operative histological diagnosis.

Abstract: Fine-needle aspiration biopsy is recommended as first and most important step in the management of breast cancer. A retrospective study was realized on 420 patients that underwent fine-needle aspiration (FNAB) in comparison to 140 patients that underwent surgical management. The results of FNAB showed that 81% of the cases were benign with an accuracy of 93%, a specificity of 97% and a sensitivity of 92% compared to operative findings. The accuracy of FNAB depends on the expertise and experience of the cyto pathologist as well as the technical skills of the physician performing the biopsy. FNAB is showing to be a highly effective procedure which can obviate unnecessary surgery in breast suspected lumps, save time and money and patient anxiety. It is the effective method for distinguishing benign from malign breast lesions.

Tactile mapping for breast cancer diagnosis

Abstract: This paper presents the development of a prototype tactile mapping device (TMD) system comprised mainly of a tactile sensor array probe, a 3D camera and a force/torque sensor, which can provide the means to produce tactile maps of the breast lumps during a breast palpation. Focusing on the key tactile topology features from breast palpation such as spatial location, size and shape of the detected lesion, and the force levels used to demonstrate the palpable abnormalities, these maps can record the results of clinical breast examination with a set of pressure distribution profiles and force sensor measurements due to detected lesion. The vision based knowledge, neural networks and tactile sensing technology are integrated for the investigation of soft tissue interaction with tactile/force sensor, where the hard inclusion (breast cancer) can be characterized through the neural network learning capability, instead of using a simplified complex biomechanics model with many heuristic assumptions. These maps will serve as an objective documentation of palpable lesions for future comparative examinations. Preliminary results of simulated experiments of the TMD prototype have validated our hypothesis and provided solid promising data showing the feasibility of the TMD in real clinical applications.

Tactile imaging of palpable breast cancer

Abstract: This paper presents the development of a prototype Tactile Mapping Device (TMD) system comprised mainly of a tactile sensor array probe (TSAP), a 3-D camera, and a force/torque sensor, which can provide the means to produce tactile maps of the breast lumps during a breast palpation. Focusing on the key tactile topology features for breast palpation such as spatial location, size/shape of the detected lesion, and the force levels used to demonstrate the palpable abnormalities, these maps can record the results of clinical breast examination with a set of pressure distribution profiles and force sensor measurements due to detected lesion. By combining the knowledge of vision based, neural networks and tactile sensing technology; the TMD is integrated for the investigation of soft tissue interaction with tactile/force sensor, where the hard inclusion (breast cancer) can be characterized through neural network learning capability, instead of using simplified complex biomechanics model with many heuristic assumptions. These maps will serve as an objective documentation of palpable lesions for future comparative examinations. Preliminary results of simulated experiments and limited pre-clinical evaluations of the TMD prototype have tested this hypothesis and provided solid promising data showing the feasibility of the TMD in real clinical applications.© (2002) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Male Breast Sonography: An Upward Trend

Abstract: Breast cancer is the most common cancer among women in the United States. But it is not only limited to women, and because men face questionable breast masses too, the importance of ultrasound keeps growing. A painless breast lump is always a concern to anyone—man or woman. As breast lumps in men become more common, breast ultrasound assumes an increasingly important function in differentiating benign from malignant lumps and guiding large-core needle biopsies.