Breast cancer is the most common malignancy in women and early detection is important for its successful treatment. The aim of this study was to investigate the sensitivity and specificity of three methods for early detection of breast cancer: breast magnetic resonance imaging (MRI), digital mammography, and breast tomosynthesis in comparison to histopathology, as well as to investigate the intraindividual variability between these modalities. We included 57 breast lesions, each detected by three diagnostic modalities: digital mammography, breast MRI, and breast tomosynthesis, and subsequently confirmed by histopathology. Breast Imaging-Reporting and Data System (BI-RADS) was used for characterizing the lesions. One experienced radiologist interpreted all three diagnostic modalities. Twenty-nine of the breast lesions were malignant while 28 were benign. The sensitivity for digital mammography, breast MRI, and breast tomosynthesis, was 72.4%, 93.1%, and 100%, respectively; while the specificity was 46.4%, 60.7%, and 75%, respectively. Receiver operating characteristics (ROC) curve analysis showed an overall diagnostic advantage of breast tomosynthesis over both breast MRI and digital mammography. The difference in performance between breast tomosynthesis and digital mammography was significant (p <0.001), while the difference between breast tomosynthesis and breast MRI was not significant (p=0.20).

Diffusion-weighted imaging (DWI) has not been well explored in differentiation of malignant from benign breast lesions. The aims of this study were to examine the role of apparent diffusion coefficient (ADC) values in differentiation of malignant from benign tumors and distinguishing histological subtypes of malignant lesions, and to determine correlations between ADC values and breast tumors structure. This cohort-study included 174 female patients who underwent contrast-enhanced breast MR examination on a 3T scanner and were divided into two groups: patient group (114 patients with proven tumors) and control group (60 healthy patients). One-hundred-thirty-nine lesions (67 malignant and 72 benign) were detected and pathohistologically analyzed. Differences between variables were tested using chi-square test; correlations were determined using Pearson's correlation test. For determination of cut off values for diagnostic potential, Receiver Operating Characteristic curves were constructed. Statistical significance was set at p < 0.05. Mean ADC values were significantly lower in malignant compared to benign lesions (0.68 × 10 −3 mm 2 /s vs. 1.12 × 10 −3 mm 2 /s, p < 0.001). The cut off value of ADC for benign lesions was 0.792 × 10 −3 mm 2 /s (sensitivity 98.6%, specificity 65.7%), and for malignant 0.993 × 10 −3 mm 2 /s (98.5, 80.6%). There were no significant correlations between malignant lesion subtypes and ADC values. DWI is a clinically useful tool for differentiation of malignant from benign lesions based on mean ADC values. The cut off value for benign lesions was higher than reported recently, due to high amount of fibrosis in included benign lesions. Finally, ADC values might have implications in determination of the biological nature of the malignant lesions.

Large-format histology is a laboratory method that is based on embedding and processing continuous tisssue slices representing the entire cross section of the organ under study.Unlike the standard histological technique, large-format histology enables analysis of the lesion while preserving the surrounding tissue of the entire section surface. Due to this, large-format histology has found its use in diagnostic routine, especially in breast carcinomas. Key morphological prognostic parameters, such as tumour size, tumour extent, tumour multifocality, resection margins, presence and distribution of in situ carcinoma, and response to neoadjuvant therapy are more precisely determined on large sections.Intratumoural and intertumoural heterogeneity are also more easily detected and interpreted, with possibility to perform additional immunohistochemical and molecular analysis on tissue that has been processed for large sections. Large-format histology has found its place in modern breast pathology, especially in multidisciplinary diagnostics and therapy teams where correlation of the findings of multimodality preoperative radiology and those in large-format histological sections enable better therapy planning for each individual patients. ApstraktHistološka tehnika velikog formata je laboratorijska procedura koja omogućava vizualizaciju i patohistološku analizu čitavog preseka organa koji se ispituje. Za razliku od standardne histološke tehnike, histološka tehnika velikog formata omogućava analizu lezije dok je okolno tkivo čitave resekcione površine očuvano. Zahvaljujući ovome, histološka tehnika velikog formata našla je mesto u svakodnevnom rutinskom radu u patologiji, naročito u dijagnostici karcinoma dojke. Ključni prognostički parametri, kao što su veličina tumora, ekstenzija tumora, tumorska multifokalnost, status resekcionih margina, prisustvo i distribucija in situ karcinoma, kao i odgovor na neoadjuvantnu terapiju se mogu preciznije odrediti na velikm rezovima. Intratumorska i intertumorska heterogenost se takođe lakše uočavaju i tumače, uz održanu mogućnost izvođenja dodatnih imunohistohemijskih i molekularnih analiza na tkivu koje je preparirano za velike rezove. Histološka tehnika velikog formata pronašla je svoje mesto u savremenoj patologiji karcinoma dojke, naročito u radu multidisciplinarnih dijagnostičkih i terapijskih timova gde patološko-radiološka 4 korelacija imidžing metoda i velikih rezova omogućava bolje planiranje terapije za svakog pacijenta individualno.