1,721,050 research outputs found
Women with personal history of breast cancer are excluded from screening programs. Is it the right choice?
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Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?
No full textIn the last few years, several papers have addressed the introduction of contrast-enhanced MR imaging for screening women at high risk for breast cancer. Taking in consideration five prospective studies, on 3,571 screened women with hereditary predisposition to the disease and 9,652 rounds, we found that 168 patients were diagnosed with breast cancer (155 screen-detected, eight interval, and five cancers excluded from analysis) with a detection rate per year of 1.7%. These cancers were small (49% equal to or less than 10 mm in diameter) but aggressive, 82% being invasive and 49% with histologic grade 3; however, only 19% of these invasive cancers were associated with nodal involvement. The pooled sensitivity was 16% for clinical breast examination, 40% for mammography, 43% for ultrasound, and 81% for MR. The positive predictive value (calculated on the basis of the number of invasive diagnostic procedures due to false positives) was 33%, 47%, 18%, and 53%, respectively. Aim of the present article is to present the historical development of MR imaging of breast tumors that made this application theoretically and technically possible, to explain what strategic problems we face in the presence of a hereditary predisposition to the disease, to review the main results of the published studies, and to outline open problems and future perspectives
MRI screening of women with hereditary predisposition to breast cancer : diagnostic performance and survival analysis
No full textPurpose MRI screening has been shown to allow for an earlier diagnosis of breast cancer in asymptomatic women with proven or suspected mutations in breast cancer susceptibility genes. Major efforts are presently addressed to assess to which extent this improves high-risk women survival. Methods We here discuss the article by Gareth et al (Breast Cancer Res Treat 145(3):663-672, 2014). Results Gareth and colleagues compared MRI sensitivity and specificity and clinical characteristics of breast cancers detected in their study with those reported in six similar prospective cohort screening studies. We here extended this analysis to a total of nine published cohort studies, including the High Breast Cancer Risk Italian Study 1 (HIBCRIT-1) for which we considered the final results published in 2011, instead of those of our interim report (2007) utilized by Gareth et al. Our updated analysis shows that in a total of 392 diagnosed breast cancers, 77 % (95 % confidence interval [CI] 73-81 %) were invasive and 52 % (95 % CI 46-58 %) were invasive grade 3. Only 23 % (95 % CI 18-28 %) of MRI-detected invasive breast cancers had metastatic lymph nodal involvement and 45 % (95 % CI 39-51 %) had a size ≤10 mm. Discussion and Conclusions The capability of MRI to detect invasive breast cancers at early stages could at least partly explain the significantly higher 10-year survival estimated by Gareth et al for asymptomatic highrisk women screened using MRI in the period 1997-2013 (95 %) compared with unscreened high-risk women diagnosed for breast cancer after 1990 and identified as BRCA1/BRCA2 mutation carriers in the years following diagnosis (74 %). It appears however worth noting that the evolution of therapeutic protocols applied to high-risk patients after the discovery of BRCA mutations in 1995-1997 could also have contributed to the observed difference in the survival of these two groups. On the other hand, we agree with Gareth et al that larger datasets are needed to evaluate to which extent improvements in the cancer detection impact on disease-free and overall survival of MRI-screened compared with mammography-alone-screened high-risk women
The Italian Multi Centre Project on Evaluation of MRI and other Imaging Modalities in Early Detection of Mammary Tumours in Subjectat High Genetic Risk
No full textMR spectroscopy of the breast
No full textThis literature review assesses the clinical potential of
proton (1H) magnetic resonance spectroscopy (MRS) of
breast lesions. We here illustrate the basic principles of
spectrum acquisition for volumes of interest, determined
on the basis of dynamic magnetic resonance imaging
(MRI) and of MRS postprocessing. We discuss the criteria
for interpreting the spectrum with particular reference to
the metabolic significance of the peak of total choline
containing compounds at 3.2 ppm, a marker that is
correlated with malignancy. We then summarise the
findings obtained in lesion characterisation (with a possible
gain in specificity with respect to dynamic MRI), the
assessment of the effects of neoadjuvant chemotherapy and
the correlation reported at high-field between the tumour
tissue concentration of choline-containing compounds and
the presence of lymph node metastases. Lastly, we outline
the clinical use of this technique as the final phase of a
complete breast MR examination after intravenous
administration of paramagnetic contrast material for the
dynamic study, with reference t
Structural Aspects of the Binding of Melittin to Phospholipid Bilayers, as a Model for Protein-Lipid Interactions in Membranes
No full textSorveglianza multimodale di donne ad alto rischio genetico di tumore della mammella: studio italiano HIBCRIT
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