No abstract

Preoperative axillary ultrasound-guided biopsy is a useful step in the process of axillary staging. Approximately 50 % of women with axillary involvement can be identified preoperatively. Still, one in four women with an ultrasound-guided biopsy-"proven" negative axilla has a positive SNB.

BackgroundWe aimed to develop a multivariable model for prediction of underestimated invasiveness in women with ductal carcinoma in situ at stereotactic large core needle biopsy, that can be used to select patients for sentinel node biopsy at primary surgery.MethodsFrom the literature, we selected potential preoperative predictors of underestimated invasive breast cancer. Data of patients with nonpalpable breast lesions who were diagnosed with ductal carcinoma in situ at stereotactic large core needle biopsy, drawn from the prospective COBRA (Core Biopsy after RAdiological localization) and COBRA2000 cohort studies, were used to fit the multivariable model and assess its overall performance, discrimination, and calibration.Results348 women with large core needle biopsy-proven ductal carcinoma in situ were available for analysis. In 100 (28.7%) patients invasive carcinoma was found at subsequent surgery. Nine predictors were included in the model. In the multivariable analysis, the predictors with the strongest association were lesion size (OR 1.12 per cm, 95% CI 0.98-1.28), number of cores retrieved at biopsy (OR per core 0.87, 95% CI 0.75-1.01), presence of lobular cancerization (OR 5.29, 95% CI 1.25-26.77), and microinvasion (OR 3.75, 95% CI 1.42-9.87). The overall performance of the multivariable model was poor with an explained variation of 9% (Nagelkerke’s R 2), mediocre discrimination with area under the receiver operating characteristic curve of 0.66 (95% confidence interval 0.58-0.73), and fairly good calibration.ConclusionThe evaluation of our multivariable prediction model in a large, clinically representative study population proves that routine clinical and pathological variables are not suitable to select patients with large core needle biopsy-proven ductal carcinoma in situ for sentinel node biopsy during primary surgery.

Purpose: To determine lipid composition of excised healthy and metastatic sentinel lymph nodes of breast cancer patients, as lipids are a potential discriminatory marker for malignancy. Materials and Methods:Ten breast cancer patients undergoing surgical nodal staging were included. Results: In all, 6/32 (19%) of the excised nodes contained metastases. The ratios of the lipid resonances 5.4-5.2, 4.3-4.1, 2.8, 2.3-2.0, 1.6-1.3, 0.9 ppm between metastatic vs. benign were 0.3, 1.2, 0.2, 0.2, 1.2, and 0.9, respectively. Only the ratios of signals from unsaturated fatty acids to the total lipid signal differed significantly.Conclusion: Metastatic axillary lymph nodes contained fewer unsaturated fatty acids than benign nodes. 7T 1 H-MRS may be useful for detecting axillary breast cancer metastases.

Adrenal abscess is an uncommon finding in neonates and young infants. It may have a fatal outcome if inadequately treated. This case report describes the successful diagnosis and treatment of a left-sided adrenal abscess in a 5-week-old girl. Abdominal US and antigranulocyte antibody-scintigraphy showed an encapsulated suprarenal mass with debris suspicious for an adrenal abscess. Treatment is generally surgical. In this case, however, we performed US-guided percutaneous drainage combined with intravenous antibiotic treatment. The child recovered fully.

ObjectiveTo compare the Heel Enthesitis MRI Scoring model (HEMRIS) with clinical and PET/CT outcomes in patients with cutaneous psoriasis (Pso), psoriatic arthritis (PsA) or ankylosing spondylitis (AS).MethodsThis prospective, observational study included 38 patients with Pso, PsA and AS. Patients were included regardless of presence or absence of clinical heel enthesitis. MRI-scans of both ankles and a whole-body 18F-FDG PET/CT were acquired. MRIs were assessed for enthesitis by two independent and blinded observers according to the HEMRIS. A physician, blinded for imaging results, performed clinical evaluations of enthesitis at the Achilles tendon and plantar fascia.ResultsIn total, 146 entheses were scored according to the HEMRIS and clinically assessed for enthesitis (6 entheses were clinically affected). In Achilles tendons with clinical enthesitis, the HEMRIS structural damage score was significantly higher, compared to Achilles tendons without clinical enthesitis (respective median scores 1.0 and 0.5; p=0.04). In clinically unaffected entheses, HEMRIS abnormalities occurred in 44/70 (63%) of Achilles tendons and in 23/70 (33%) of plantar fascia. At the Achilles tendon, local metabolic activity measured on PET/CT was weakly associated with the structural (rs=0.25, p=0.03) and total HEMRIS (rs=0.26, p=0.03).ConclusionThis study revealed a high prevalence of subclinical HEMRIS abnormalities and discrepancy between HEMRIS and clinical and PET/CT findings. This may suggest that the HEMRIS is a sensitive method for detection of inflammatory and structural disease of enthesitis at the Achilles tendon and plantar fascia, although the clinical significance of these MRI findings remains to be determined in longitudinal studies.

Background: Based on the unique physical properties of collagen, dualenergy computed tomography (DECT) is able to detect pathological changes in fibrous structures. This has been demonstrated for the Achilles tendon (1) and traumatic disc injury in elderly patients (2). Objectives: The purpose of this study was to assess the diagnostic potential of DECT collagen imaging for the detection of intervertebral disc involvement in patients with axial spondyloarthritis (axSpA) in correlation with osseous lesions in MRI. Methods: Sixteen patients with suspicion of or known axSpA and back pain were included. All patients underwent a 1.5-Tesla-MRI including T1 and STIR sequences and an ultra-low-dose DECT of the spine using two sequential helical acquisitions. DECT images were reconstructed in 120 kV-equivalent standard CT images and collagen maps with 1.0 mm slice thickness in sagittal reconstructions. MRI and CT images (D1 to S1) were scored for transdiscal ankylosis, Andersson lesions, syndesmophytes, spondylitis anterior and fatty corner lesions (when applicable) as well as for degenerative findings. DECT images were scored for a loss of collagen density affecting the nucleus pulposus or the anulus fibrosus. Sensitivity (SE) and specificity (SP) values were calculated. All analyses were performed on the level of the disco vertebral units. Results: Twelve male and four female patients with a mean age of 46.6 ± 11.6 years were included. Eleven were finally diagnosed with axSpA, 3 with degenerative spine disease and 2 with diffuse idiopathic skeletal hyperostosis (DISH). MRI detected 73 lesions in 274 discovertebral units (61 SpA related, 12 degenerative; 26 affecting the disc and 35 affecting the vertebral corner) and CT 68, whereas DECT identified pathologically decreased collagen content in 60 discs (35 in the nucleus and 25 in the anulus). DECT showed high diagnostic accuracy when compared to SpArelated and degenerative changes (MRI and CT combined; SE: 67%; SP 99.5%) and for SpA-lesions only (SE 72%; SP 94.2%), however, was less susceptible for degeneration (SE 60%; SP 81.9%). When comparing disc lesions in SpA as detected by MRI (transdiscal ankylosis and Andersson lesions) with nucleus-pulposus changes in DECT, it showed an SE of 88.5% and an SP of 95.1%. However, the diagnostic accuracy was inferior when comparing anterior spondylitis and fatty corner lesions in MRI with anulus fibrosus changes in DECT (SE 51.4% and SP 97%), although the SE was markedly higher for active inflammatory corner lesion (92.3%) than for fatty marrow lesions (23.3%). The mean radiation exposure was 8.1 ± 3.4 mSv. Conclusion: DECT is able to demonstrate soft-tissue involvement of the disc, especially for transdiscal ankylosis, Andersson lesions and active anterior spondylitis. This can be achieved with considerably low radiation exposure. While measuring the collagen density, it provides additional information to conventional CT and MR images. Thus, it has high potential to develop into a useful tool to further enhance our understanding o...