Background Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has always been a problem solver in troublesome breast lesions. Despite its many advantages, the encountered low specificity results in unnecessary biopsies. Diffusion-weighted MRI (DW-MRI) is a well-established technique that helps in characterizing breast lesions according to their water diffusivity. So this work aimed to assess the diagnostic performance of DW-MRI in troublesome breast lesions and see if it can replace DCE-MRI study. Results In our prospective study, we included 86 patients with mammography and/or ultrasound-detected 90 probably benign or probably malignant (BIRADS 3 or 4) breast lesions. Among the studied cases, 49/90 lesions were benign, and 41/90 were malignant. Combined analysis of morphological and kinetic findings in DCE-MRI had achieved the highest sensitivity of 95.1%. DW-MRI alone was less sensitive (73.2%) yet more specific (83.7%) than DCE-MRI (77.6%). Diagnostic accuracy of DCE-MRI was higher (85.6%) as compared to DW-MRI which was (78.9%). Conclusion DCE-MRI is the cornerstone in the workup of troublesome breast lesions. DW-MRI should not be used as supplementary tool unless contrast administration is contraindicated. Combining both DCE-MRI and DW-MRI is the ultimate technique for better lesion evaluation.

Objectives Since being declared a global pandemic, the SARS-CoV-2 virus had a significant impact on the entire globe. The pandemic has placed a heavy burden on healthcare systems worldwide, and cancer patients are particularly prone. Despite the fact that initial international reports suggest delays in breast cancer (BC) diagnosis and screening programs, the Egyptian context requires additional research on this topic. To examine whether COVID-19 has changed the pattern of disease presentation before and after the pandemic, focusing on the tumor, node, and metastasis (TNM) staging of the disease at the initial presentation Methods This single-center, retrospective study of female BC patients initially diagnosed at Baheya Foundation was conducted during the following time frames: from Jan 2019 to Jan 2020 (Pre COVID-19 cohort) and from Mar 2020 to Mar 2021 (post–COVID-19 cohort). We compared the two cohorts in terms of clinical characteristics, tumor characteristics, and the number of days from presentation to treatment. Our primary endpoint was the difference in the TNM stage of BC at the initial presentation. Results This analysis included 710 BC patients, 350 from the pre-COVID cohort and 360 from the post-COVID group. We detected a 27.9% increase in late-stage BC (stages III-IV) in the post-pandemic cohort compared to the pre-pandemic (60.1% vs. 47%, p < 0.001). The time from diagnosis to commencement of treatment was significantly longer (28.34 ± 18.845 vs 36.04 ± 23.641 days, p < 0.001) in the post-COVID cohort (mean difference = 7.702, 95% CI 4.54–10.85, p < 0.001). A higher percentage of patients in the post-pandemic cohort received systemic neoadjuvant therapy ( p-value for Exact’s test for all treatment options = 0.001). Conclusions The number of patients requiring systemic neoadjuvant chemotherapy increased dramatically in the post-pandemic group with advanced stages of BC at presentation. This study highlights the need for proper management of cancer patients during any future pandemic.

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Background Axillary lymph node metastasis is considered one of the main prognostic factors clinically used for the evaluation of breast cancer patient. Also, an accurate diagnosis of axillary lymph node metastasis has a significant effect on the tumor staging and treatment planning. Ultrasonography is a noninvasive, available imaging modality that is capable of giving a real-time evaluation of axillary lymph nodes in breast cancer cases. On the other hand, multi-detector-row computed tomography is increasingly preferred by clinicians to preoperatively evaluate regional lymph node status in many cancers. The aim of this study was to compare the diagnostic performance of computed tomography against ultrasound in detecting axillary lymph node status in breast cancer patients. Results One hundred and fifty breast cancer patients were included in this prospective study. According to the final pathological results, 79/150 (52.7%) lymph nodes were metastatic, while 71/150 (47.3%) lymph nodes were benign with no evidence of metastases. Ultrasound examination has achieved a sensitivity of 76.4% and a specificity of 60.8% with overall diagnostic accuracy of 68.7%. Computed tomography (CT) examination has achieved a much higher sensitivity of 98.6%, a much lower specificity of 35.4%, and overall diagnostic accuracy of 65.3%. In our study, CT examination was superior on ultrasound in the determination of the level of lymph node affection, and this may be attributed to the dependency of ultrasound examination on the operator’s experience. Conclusions CT is not routinely used in the assessment of nodal stage. However, if used in proper clinical setting, it may increase our confidence in excluding nodal metastasis owing to its high sensitivity. Despite its low specificity, it may act as road map for the surgeon, providing the ability to assess all groups of lymph nodes as well as the number of the suspicious lymph nodes.