ObjectiveTo evaluate suspicious amorphous calcifications diagnosed on full-field digital mammography (FFDM) and establish correlations with histopathology findings.Materials and MethodsThis was a retrospective study of 78 suspicious amorphous calcifications (all classified as BI-RADS® 4) detected on FFDM. Vacuum-assisted breast biopsy (VABB) was performed. The histopathological classification of VABB core samples was as follows: pB2 (benign); pB3 (uncertain malignant potential); pB4 (suspicion of malignancy); and pB5 (malignant). Treatment was recommended for pB5 lesions. To rule out malignancy, surgical excision was recommended for pB3 and pB4 lesions. Patients not submitted to surgery were followed for at least 6 months.ResultsAmong the 78 amorphous calcifications evaluated, the histopathological analysis indicated that 8 (10.3%) were malignant/suspicious (6 classified as pB5 and 2 classified as pB4) and 36 (46.2%) were benign (classified as pB2). The remaining 34 lesions (43.6%) were classified as pB3: 33.3% were precursor lesions (atypical ductal hyperplasia, lobular neoplasia, or flat epithelial atypia) and 10.3% were high-risk lesions. For the pB3 lesions, the underestimation rate was zero.ConclusionThe diagnosis of precursor lesions (excluding atypical ductal hyperplasia, which can be pB4 depending on the severity and extent of the lesion) should not necessarily be considered indicative of underestimation of malignancy. Suspicious amorphous calcifications correlated more often with precursor lesions than with malignant lesions, at a ratio of 3:1.

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Background Breast magnetic resonance imaging (MRI) has high sensitivity in detecting invasive neoplasms. Controversy remains about its impact on the preoperative staging of breast cancer surgery. This study evaluated survival and surgical outcomes of preoperative MRI in conservative breast cancer surgery. Methods A phase III, randomized, open-label, single-center trial including female breast cancer participants, stage 0–III disease, and eligible for breast-conserving surgery. We compared the role of including MRI in preoperative evaluation versus radiologic exam routine with mammography and ultrasound in breast cancer conservative candidates. The primary outcome was local relapse-free survival (LRFS), and secondary outcomes were overall survival (OS), mastectomy rate, and reoperation rate. Results 524 were randomized to preoperative MRI group (n = 257) or control group (n = 267). The survival analysis showed a 5.9-years LRFS of 99.2% in MRI group versus 98.9% in control group (HR = 0.72; 95% CI 0.12—4.28; p = 0.7) and an OS of 95.3% in the MRI group versus 96.3% in the control group (HR = 1.37 95% CI 0.59–3.19; p = 0.8). Surgical management changed in 21 ipsilateral breasts in the MRI group; 21 (8.3%) had mastectomies versus one in the control group. No difference was found in reoperation rates, 22 (8.7%) in the MRI group versus 23 (8.7%) in the control group (RR = 1.002; 95% CI 0.57–1.75; p = 0.85). Conclusion Preoperative MRI increased the mastectomy rates by 8%. The use of preoperative MRI did not influence local relapse-free survival, overall survival, or reoperation rates.

Background: Radiotherapy (RT) forms a vital component of treatment for breast cancer, contributing to the increasing number of survivors worldwide. It is known from historical cohorts that breast RT increased the risk of developing heart disease 10 years or more following treatment. It is less certain whether the lower cardiac radiation doses received during modern RT still increase cardiac risk. Cardiovascular Magnetic Resonance (CMR) imaging has the potential to provide early surrogate markers of radiation-induced heart disease that may help predict which women will be at increased risk in the future. Methods: This is a prospective longitudinal imaging study to evaluate CMR findings in a cohort of women receiving adjuvant RT for early breast cancer at the Oxford Cancer Centre. The patients undergo CMR imaging (with gadolinium enhancement and adenosine stress), Doppler echocardiography, blood testing (including BNP and troponin), ECG and clinical examination prior to RT, within 72 hours of completing RT, and at 3 months, 6 months and 5 years following RT. The results of these investigations will be related to cardiac radiation exposure estimated using 3D-dosimetric data obtained by analysis of CT-based RT planning. Recruitment and Provisional Results: As of May 2011, 30 women have been recruited. The women had a mean age of 57.1 years (range = 42.0 to 63.9). All women had left-sided cancer and none received adjuvant cytotoxic chemotherapy. The mean whole heart dose was 1.47 Gray (range = 0.65 to 4.20), the mean left ventricle dose was 2.03 (range = 0.88 to 6.99) and the mean left coronary artery dose was 7.55 Gray (range = 1.50 to 24.59). Preliminary analysis of the first 10 participants showed that all had a normal left ventricular ejection fraction at baseline (mean 76%, range 60–82%) and immediately following RT (mean reduction 3%, p=0.18). None had myocardial oedema as detected by T2-STIR imaging or fibrosis and scarring as demonstrated by late gadolinium enhancement (LGE). Conclusion and Future Plans: Preliminary results suggest that the relatively low heart doses received by the women undergoing modern CT-planned left breast RT at the Oxford Cancer Centre do not result in any cardiovascular abnormality detectable by CMR imaging. Further and updated results will be available for the San Antonio Breast Cancer Symposium. Recruitment will continue until at least 20 women have completed baseline scans and follow-up scans up to 6 months. At this stage a full analysis will be performed including a wider range of CMR endpoints including: - Overall LV systolic function (EF and volumes) - Regional wall motion analysis - T2-weighted imaging (oedema) - T1 and T2 mapping (quantitative T1 and T2 relaxation times) - Tagged myocardial strain analysis - Stress perfusion defects (endothelial/microcapillary damage) - Late gadolinium (LGE) imaging (fibrosis/scarring) Depending on the results of this analysis, recruitment may be expanded to include women with either lower cardiac risk (e.g. with right-sided breast cancer) or higher cardiac risk (e.g. receiving anthracycline chemotherapy). Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-13-06.

Esta tese também é dedicada à vida. À vida das mães, e por consequências às famílias, importante instituição que une e enriquece valores. Que possamos juntos contribuir para que menos crianças fiquem órfãs de suas mães e menos mães percam suas filhas para o câncer de mama. AGRADECIMENTOS Ao meu orientador, Nestor de Barros, por sua sabedoria em valorizar o importante da vida e transmitir tranquilidade nos momentos difíceis. Aos amigos de tantos anos de convívio, Vera Lúcia Nunes Aguillar, Aron Belfer, Vivian Schivartche, Ana Luisa F. Hanke e Andréa G. Freitas, bem como às técnicas da mamografia, que comigo trabalharam na URP no período de 2006 e 2007 e indiretamente participaram deste trabalho, deixando suas ações e emoções registradas nos laudos mamográficos e das biópsias de fragmento assistidas à vácuo. Aos médicos solicitantes dos exames mamográficos e das biópsias realizadas, pela confiança e retorno dos seguimentos de suas pacientes. À Dra. Filomena M. Carvalho, pelo respaldo científico e excelência diagnóstica, com sugestões oportunas.