Objective: To evaluate diagnostic performance of diffusion weighted imaging (DWI) in evaluating ovarian masses with suspicious features on magnetic resonance imaging (MRI). Patients and methods: Pelvic MRI and DWI assessed 235 complex and solid ovarian masses of suspicious MRI features. On DWI, scanning acquired by b values: 0, 500, 1000 and 1500. Analysis considered signal intensity (SI) at b1000 and the mean ADC values for the solid components of the masses. Results: Included masses proved benign in 75(32%), borderline (low potential malignancy) in 55(23.4%) and malignant in 105(44.6%). Restricted diffusion was observed in all of the invasive malignancy (57.1%, n = 105/184). Benign and borderline tumors with high DWI SI presented 15.2% and 27.7% respectively (P < 0.05). The mean ADC value was 1.2 + 0.34 · 10 À3 mm 2 /s, 1.1 + 0.06 · 10 À3 mm 2 /s, and 0.83 + 0.15 · 10 À3 mm 2 /s for benign, borderline and malignant masses respectively. The ADC values of malignant masses and benign masses with fibrous components showed no significant difference (P = 0.333). Significant difference was detected in those with fatty tissue (P = 0.002). Conclusion: DWI supported by conventional MRI data can confirm or exclude malignancy in suspicious ovarian masses. The combined analysis of quantitative and qualitative criteria and knowledge of the sequence pitfalls are required.

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Staging the axilla post-NACT (neo-adjuvant chemotherapy) by sentinel lymph node biopsy (SLNB) may allow patients to avoid undergoing axillary lymph node dissection (ALND) 1 ; however, its optimum usage is still questionable. Three prospective clinical trials (ACOSOG Z1071, SENTINA, and SN FNAC) evaluated the accuracy of SLNB post-NACT described identification rates (IR) ranging from 87.6%-92.9%. Overall, false-negative rates (FNRs) were higher than 10%, and all those trials did not achieve their primary end point.Reduction of the FNR (12.6%-9.8%) could be achieved in those patients with a normal axillary ultrasound (US) after NACT and three or more removed SLNs. [2][3][4] Methylene blue (MB) 1% is used for SLNB in node-negative (-ve) early breast cancer with IR and FNR comparable to other blue dyes or radioactive isotopes at a very low cost 5The natural concept that the best LN to evaluate response to NACT is the pathologic proven LN before starting NACT has been previously emphasized. Marking +ve LNs pre-NACT and then removing them together with SLNB post-NACT was described as targeted axillary dissection (TAD). Applying a marker clip for +ve LNs under US guidance and then marking these LNs post-NACT with radioactive I 125 seeds achieved IR of 96.7%, concordance among clipped LNs and SLNs reached 91%. 6 Caudle et al, 2016, used similar technique with IR of clipped nodes of 97.6%. The marked LN was recognized as SLN in 77% of cases. 7 Donker et al, 2015, used only radioactive I 125 seed for marking +ve ALNs pre-NACT with IR of 97%. 8 Tattooing of biopsied ALNs using sterile black carbon suspension (Spot TM ) was tried as a technique for TAD. Spot TM is FDA-approved carbon-based marker for presurgical colonic tattooing and remains in the site for months. An equivalent to Spot TM is also available, BlackEye ink. Choy et al, 2015, used suspended carbon particles (Spot TM ) to mark +ve ALNs in 28 cases. Overall, IR was 96.4%. 9 Park et al, in 2018, used Charcotrace TM for 20 cases pre-NACT, IR was 100% during surgery. Concordance among tattooed LNs and SLNs was described to be 75%. 10

Objective: To evaluate the clinical performance of contrast-enhanced spectral mammography (CESM) on asymmetries detected on a mammogram (MG). Methods: This study was approved by the Scientific Research Review Board of the Radiology Department, and waiver of informed consent was applied for the uses of data of the included cases. The study included 125 female patients,33 (26.4%) who presented for screening and 92 (73.6%) who presented for a diagnostic MG. All had breast asymmetries on MG. Ultrasound examination and CESM using dual-energy acquisitions were performed for all patients. Results: In all, 88/125 (70.4%) females had focal asymmetry (seen in two views and occupying less than a quadrant), 26/125 (20.8%) had global asymmetry (occupying more than one quadrant), 10/125 (8%) had asymmetry (seen in a single view and occupying less than a quadrant), and 1/125 had developing asymmetry (0.8%) (not present in the previous MG). Malignant lesions represented 91 cases, benign lesions represented 30 cases, and 4 cases were high-risk lesions. CESM sensitivity was 100% (v s 97.8 % for sono-mammography), specificity was 55.88% (v s 81.8% for sono-mammography), and the positive- and negative-predictive values were 85.85 and 100% (v s 93.7 and 93% for sono-mammography respectively) . Conclusion: In our study, we conclude that focal and global asymmetries with other suspicious mammographic findings were statistically significant for malignancy and CESM played an important role in delineating tumor size and extension. Any non-enhancing asymmetrical density correlated with a benign pathology, if not associated with other suspicious imaging findings. Advances in knowledge:  Our study is the first to explore the added value of CESM to asymmetries detected in screening and diagnostic mammography.

Background: The gold standard for axillary staging in node-negative early-stage breast cancer is sentinel lymph node biopsy (SLNB). Axillary lymph node dissection (ALND), SLNB, and axillary radiotherapy have all been associated with axillary problems, but at a smaller incidence with SLNB alone than with ALND. The Z0011 trial demonstrated that there is no benefit from axillary dissection in the context of positive SLN. Aim: Compare locoregional recurrence, disease free survival (DFS), and overall survival (OS) between SLNB and observation in patients with early stage clinically node negative breast cancer by palpation and preoperative ultrasonography. Methodology: Candidates for Breast Conservative Surgery include 60 patients with clinically and radiologically node-negative early breast cancer, randomized to one of two groups: Study group (group A): 30 patients underwent BCS with no further axillary surgery. Control group (group B): 30 patients underwent BCS and SLNB. Follow up was done to detect the two years locoregional recurrence, DFS and OS. Results: After a two-year follow-up, there was no discernible difference between the two arms in terms of axillary, local, or metastatic recurrence. Regarding post-operative arm edema, both arms significantly differ from one another. Conclusion: Omission of axillary surgery in T1 and some cases of T2 N0 breast cancer patients appears safe and applicable without affecting locoregional recurrence and axillary/nodal recurrence. Longer term follow-up is needed