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MRgFUS (MR guided Focused Ultrasound) being one of the non-surgical ablation techniques. We have already achieved favorable results in the past clinical study of MRgFUS to local treatment. New twenty one cases of invasive/noninvasive ductal carcinoma of the breast were treated by MRgFUS. Core needle biopsy led to the definitive diagnosis. All the patients were positioned prone in the treatment, using the therapeutic apparatus such as Signa Excite 1.5 T for MRI and ExAblate 2000 version 2.6/4.1 for FUS. Irradiation was not applied to all the 21 cases after MRgFUS. Axillary lymph node metastases were examined by dissection or sentinel lymph node biopsy. Recurrence or abnormal area of residual cancer was treated with Re-MRgFUS or ablated by usual surgery. All the 21 cases were from women patients. Median age is 54 years (range: 34-72). Median diameter of tumor is 15 mm (range: 5-50). As for the numbers of treatment, 17 patients were treated once, and 4 patients twice. Median period of observation is 14 months (range: 3-26). One case of recurrence of pure mucinous carcinoma was experienced. No evidences of recurrence were obtained through MRI for the rest of 20 cases. Skin burns were found in 2 cases. The patient had dimple on the skin immediately above tumor. In conclusion, MRgFUS is a good mean as local control of breast cancer, but the indicated case must be selected strictly. And it needs to observe longer the patients who ware treated by MRgFUS alone.

Among the three modalities, contrast-enhanced three-dimensional MR imaging demonstrated the location and distribution of the lesions most clearly, especially in cases of ductal carcinoma in situ. It has the potential to be a useful diagnostic tool for patients with nipple discharge.

Mammography is considered the most effective method for early detection of breast cancers. However, it is difficult for radiologists to detect microcalcification clusters. Therefore, we have developed a computerized scheme for detecting early-stage microcalcification clusters in mammograms. We first developed a novel filter bank based on the concept of the Hessian matrix for classifying nodular structures and linear structures. The mammogram images were decomposed into several subimages for second difference at scales from 1 to 4 by this filter bank. The subimages for the nodular component (NC) and the subimages for the nodular and linear component (NLC) were then obtained from analysis of the Hessian matrix. Many regions of interest (ROIs) were selected from the mammogram image. In each ROI, eight features were determined from the subimages for NC at scales from 1 to 4 and the subimages for NLC at scales from 1 to 4. The Bayes discriminant function was employed for distinguishing among abnormal ROIs with a microcalcification cluster and two different types of normal ROIs without a microcalcification cluster. We evaluated the detection performance by using 600 mammograms. Our computerized scheme was shown to have the potential to detect microcalcification clusters with a clinically acceptable sensitivity and low false positives.

BACKGROUNDBloody nipple discharge is a significant clue in the detection of ductal carcinoma of the breast. In the past, pathologic diagnoses were obtained exclusively via excision, but recently developed mammoscopic techniques have been found to yield valuable information relating to the diagnosis of intraductal lesions.METHODSMammary duct endoscopy (i.e., mammoscopy) was performed a combined total of 407 times for 295 patients who experienced nipple discharge. Intraductal breast biopsy (IDBB) under mammoscopic observation was performed in 193 intraductal papillomas (from a total of 107 patients) and 30 ductal carcinomas (from a total of 27 patients); IDBB was performed a combined total of 36 times in the 27 patients who had breast carcinoma and yielded 21 diagnostic specimens (58.3%). In addition, the therapeutic value of IDBB was assessed in 70 patients with intraductal papilloma who had undergone more than 3 years of follow‐up; these 70 patients harbored a combined total of 75 intraductal papillomas.RESULTSIDBB correctly identified the presence of carcinoma in 9 of 27 patients (33.3%); 7 other lesions (25.9%) were placed in the suspected carcinoma (i.e., atypical papillary lesion) category, and 5 (18.5%) were identified as intraductal papillomas. Using IDBB, it was difficult to collect diagnostic specimens from patients with breast carcinoma, because of the location and weak tissue cohesiveness of these lesions compared with intraductal papillomas. The 193 intraductal biopsies performed on intraductal papillomas yielded only 20 specimens that were insufficient for diagnosis. IDBB exhibited therapeutic efficacy in 54 of 70 patients with intraductal papilloma (77.6%) who had more than 3 years of clinical follow‐up. Therapeutic results tended to be less favorable for patients who had intraductal lesions in multiple duct lobular units.CONCLUSIONSMammoscopy can contribute not only to the diagnosis of cases of nipple discharge but also to the treatment of intraductal papilloma. Cancer 2004. © 2004 American Cancer Society.