Abstract Background: Stage II-III TNBC retains a poor outcome despite high chemosensitivity. Patients (pts) with pCR after neoadjuvant chemotherapy have a good prognosis whereas non-responding pts have a 25-40% risk of distant relapse at 5 years. pCR is thus a major goal in TNBC. We previously reported that TNLABC benefit the most of dose dense dose intense cyclophosphamide (C)-epirubicin (E) (S.Giacchetti; BJC, 2014) Aim: To confirm these results prospectively and analyze the predictive factors of response to high dose chemotherapy in TNBC. Patients and methods: From january 2009 to april 2015 non inflammatory TNLABC received high dose C (1200 mg/m2 d1 qw 2) with E (75 mg/m2/ d1 qw2) for 6 cycles. The pts had a breast biopsy with frozen tissue. We performed molecular studies: qRT-PCR for AR, FOXA1, PI3K and FASAY technic for p53 mutation.The percentage of stromal Tumor-infiltrating lymphocytes (TILs) was also evaluated by two independent pathologists and assessed as a continuous variable. A18F-FDG PET/CT was performed initially and after 2 courses of chemotherapy and the metabolic answer assessed as a variation of the tumor uptake (ΔSUVmax). We report here the pathological complete response (pCR) (absence of infiltrative carcinomas in the breast and in the lymph nodes) and the factors associated with pCR. Results: The characteristics of the 74 pts are listed in table 1. The median age is 48 years old, 48 pts (65.8%) are premenopausal and 79% did not have any family history of breast cancers. TIL was divided in 3 groups < 10 % (26 pts, 40 %); 10-50 % (30 pts, 46 %) > 50% (9 pts, 14 %). Pathological response was assessed in 66 pts, one pt progressed during chemotherapy and 6 pts did not undergo surgery yet. 28 pts were in pCR (42.4 %). With a median follow up of 25 months, 13 pts (17.8 %) progressed and 8 (11%) died. Table 1: Patients characteristics and pCR according to tumor features and metabolic responseCharacteristicsNumber of pts (%)N of pts evaluated for pCRpCR (%)OR [IC 95%]p-valueTumor size T2363519 (54)10.04T337319 (29)0.34 [0.12 ; 0.96]Nodal status N0363315 (46)10.62N1/N2/N3 24/11/33313 (39)0.78 [0.29 ; 2.07]Histological grade: 2660 (0) 0.04*3676028 (47)TILs <10 %26 (40)2510 (40)10.02610-50 %30 (46)267 (27)0.55 [0.17 ; 1.80]≥ 509 (14)9 7 (78)5.25 [0.90 ; 30.62]P53 Mutated54 (89)5121 (41)10.43WT7 (12)53 (60)2.14 [0.33; 13.96]AR Negative43 (83)4318 (42)10.46Positive 9 (17)95 (56)1.74 [0.41 ; 7.38]FOXA1 Negative40 (77)4015 (38)10.08Positive 12 (23)128 (60) 3.33 [0.86 ; 12.99]Molecular Apocrine8 (17)85 (63)10.19TN38 (83)3814 (37)0.35 [0.07 ; 1.69]PI3K Non mutated44 (88)4419 (43)10.75Mutated6 (12)63 (50)1.31 [0.24 ; 7.26]SUVmax at 2 courses0.0001< 70 %27 (53)221 (5)1≥ 70 %24 (47)2318 (78)79.2 [8.48 ; 739.82]* Measured with a Fisher Test Tumor size, tumor grade, percentage of TILs, the change in 18F-fluorodeoxyglucose tumor uptake (ΔSUVmax) were significantly associated with pCR at univariate analysis. Only one factor remained significant at multivariate analysis, the ΔSUVmax, OR: 0.04 [0.007- 0.27], p = 0.0008. Conclusion: In this prospective phase III trial we confirm the efficacy of a dose dense EC in TNBC. The metabolic response evaluated with 18 F-FDG PET/CT is a strong and reliable predictor of pCR and could allow an early change of treatment for the non responders. A clinical trial is planned to test this strategy. Citation Format: Giacchetti S, De Roquancourt A, Groheux D, Piron P, Lehmann-che J, Cuvier C, Resche-rigon M, Albiter M, Roche B, Frank S, Hamy A-S, Teixeira L, Marty M, Lalloum M, Espié M. Prediction of pathological response (pCR) to neoadjuvant dose dense and intense cyclophosphamide and anthracycline in a prospective series of triple negative locally advanced breast cancers (TNLABC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-08.

The nodal status in breast cancer is a major prognostic factor in terms of survival. It also plays a role in the therapeutic decision-making process. Therefore, the evaluation of lymph node involvement in breast cancer is imperative in establishing a personalized treatment scheme. The sentinel lymph node procedure has proved successful for small breast tumors (T1-T2), limiting axillary lymphadenectomy and its side effects without changing overall survival. Even so, a substantial number of women must undergo axillary lymphadenectomy during a second surgery when the analysis of the sentinel node discloses major nodal involvement. Imaging can improve patient selection, especially those who appear eligible for immediate axillary lymphadenectomy. Ultrasound is able to depict morphological abnormalities in the lymph nodes such as cortical thickening, peripheral vascularization, hilar infiltration and loss of the kidney-shaped appearance of a normal node. When ultrasound is negative, the risk of massive nodal involvement is limited, thus allowing the oncologist to take an approach with the sentinel lymph node procedure. Magnetic resonance imaging (MRI) can also be useful in detecting pathological lymph nodes, particularly with diffusion-weighted MRI sequence.

Le statut ganglionnaire est un facteur pronostique majeur dans le cancer du sein en termes de survie. Il intervient également dans la décision thérapeutique. L’évaluation ganglionnaire est donc primordiale. La technique du ganglion sentinelle a pris le pas sur le curage pour les petites tumeurs (T1-T2) limitant les effets secondaires du curage sans modifier la survie. En revanche, un nombre non négligeable de femmes doivent subir un curage dans un second temps lorsque l’atteinte ganglionnaire est importante sur le ganglion sentinelle. L’imagerie pourrait améliorer la sélection des patientes, notamment celles devant bénéficier d’un curage d’emblée. L’échographie est en effet capable de détecter les atteintes ganglionnaires importantes devant des anomalies morphologiques telles que l’épaississement cortical, la vascularisation périphérique, l’infiltration hilaire et la perte de l’aspect réniforme du ganglion. Lorsque l’échographie est négative, le risque d’atteinte massive est limité, permettant la technique du ganglion sentinelle. L’IRM est également performante, notamment grâce à la séquence de diffusion pour détecter les adénopathies.

Background: Triple-negative (TN) breast cancers exhibit major initial responses to neoadjuvant chemotherapy, but generally have a poor outcome. Because of the lack of validated drug targets, chemotherapy remains an important therapeutic tool in these cancers.Methods: We report the survival of two consecutive series of 267 locally advanced breast cancers (LABC) treated with two different neoadjuvant regimens, either a dose-dense and dose-intense cyclophosphamide-anthracycline (AC) association (historically called SIM) or a conventional sequential association of cyclophosphamide and anthracycline, followed by taxanes (EC-T). We compared pathological responses and survival rates of these two groups and studied their association with tumours features.Results: Although the two regimens showed equivalent pathological complete response (pCR) in the whole population (16 and 12%), the SIM regimen yielded a non-statistically higher pCR rate than EC-T (48% vs 24%, P = 0.087) in TN tumours. In the SIM protocol, DFS was statistically higher for TN than for non-TN patients (P = 0.019), although we showed that the TN status was associated with an increased initial risk of recurrence in both regimens. This effect gradually decreased and after 2 years, TN was associated with a significantly decreased likelihood of relapse in SIM-treated LABC (hazard ratio (HR) = 0.25 (95% CI: 0.07-0.86), P = 0.028).Conclusions: AC dose intensification treatment is associated with a very favourable long-term survival rate in TN breast cancers. These observations call for a prospective assessment of such dose-intense AC-based regimens in locally advanced TN tumours.

Le terme lésions de second look en IRM mammaire indique qu’il s’agit de lésions détectées en IRM non vues initialement en mammographie et en échographie. Les objectifs de notre étude étaient d’analyser le déplacement des cibles entre l’IRM et échographie de second look, de rechercher des critères morphologiques BiRads discriminants pour prédire le caractère bénin ou malin pour mieux poser les indications d’échographie de second look et de biopsie, et d’analyser de la concordance des critères morphologiques entre l’échographie et l’IRM. Il s’agit d’une étude rétrospective, monocentrique, ayant inclus des patientes pour lesquelles une anomalie mammaire (masse ou rehaussement sans masse) a été découverte en IRM et non vue par un bilan initial incluant mammographie et échographie. Pour être incluses, ces lésions devaient toutes être retrouvées par une échographie de second look et biopsiées. Une description précise des caractéristiques de ces lésions en IRM et en échographie ainsi que de leur localisation a été faite selon les critères BiRads. Cent patientes consécutives (soit 108 lésions) ont été incluses entre janvier 2008 et janvier 2010. Elles ont toutes été suivies pendant au moins deux ans. Quatre-vingt-deux sur 108 lésions biopsiées (76 %) étaient bénignes et 26/108 lésions (24 %) étaient malignes. L’étude confirme que le passage du procubitus en IRM au décubitus de l’échographie déplace la tumeur dans l’axe antéro-postérieur principalement ; les déplacements dans les autres directions ne sont pas significatifs. L’étude montre que les facteurs de risque ne sont pas des critères fiables pour poser une indication d’échographie de second look. Elle a montré également que des contours circonscrits et une courbe de rehaussement progressive (type I) pour les masses en IRM présentent la plus forte valeur prédictive négative > 0,85. En échographie, la forme ronde ou ovale, les contours circonscrits et l’orientation parallèle à la peau étaient en faveur de la bénignité avec des VPN > 0,85. Pour les masses, l’étude montre que la concordance d’interprétation des critères morphologiques bénins versus suspectes entre l’IRM et l’échographie est très faible pour la forme (Kappa = 0,09) et faible pour les contours (Kappa = 0,23). De plus, l’IRM surestime la taille des cibles par rapport à l’échographie (t-test de Student, p = 0,0001). L’examen de second look est indispensable après une IRM même en cas de lésion classée ACR 3 qui peut présenter un aspect suspect en échographie. Les indications de biopsies avec mise en place d’un clip doivent être larges pour contrôler le site de biopsie en IRM. Seul ce contrôle permet de stopper sans risque les investigations en cas de résultats bénin de la biopsie.

The term "second look" lesions in MRI refers to lesions detected by MRI that were not initially seen on mammography or ultrasound. The objectives of our study were to analyse the displacement of targets between MRI and ultrasound; to define discriminating BIRADS morphological criteria to predict benign or malignant character and better establish the indications of second look ultrasound and biopsy; and to analyse the agreement between ultrasound and MRI in terms of morphological criteria. A retrospective and monocentric review was performed of the records of consecutive patients with breast abnormalities (mass or non-mass) initially detected by MRI that were not initially seen on mammography or ultrasound. All patients with abnormalities found during the performance of second look ultrasound and biopsied were included in the study. All lesions were documented using the BIRADS lexicon for MRI and ultrasound. Of 100 included patients, 108 lesions were detected by MRI, found via second look ultrasound and biopsied between January 2008 and 2010. All of the included patients were followed-up for a variable period, from 2 to 5 years. Eighty-two upon 108 biopsied lesions (76%) were benign and 26/108 lesions (24%) were malignant. This study confirmed the switch from procubitus to decubitus essentially displaces the tumour in the antero-posterior direction. It showed that the risk factors were not reliable criteria for establishing an indication for second look ultrasound. This study also showed that circumscribed contours and a progressive enhancement curve (type I) for masses on MRI had the strongest negative predictive value of greater than 0.85. In ultrasound, the round or oval shape, circumscribed contours and the parallel orientation to the skin favoured benignity with a NPV of greater than 0.85. For masses, the study showed that the agreement in interpretation of the benign versus suspicious morphological criteria between the MRI and the ultrasound was very weak for the shape (Kappa=0.09) and weak for the contours (Kappa=0.23). Finally, the MRI overestimated the size of the targets compared to ultrasound (Student t-test, p=0.0001). The performance of second look ultrasound has to be performed after the detection of an abdnormality on MRI even for lesion classified BIRADS 3. The biopsy indications must be wide with insertion of a clip and a control MRI. Only this control allows to stop the investigation if the biopsied lesion is benign.

Microcirculation imaging in breast cancer involves studying tissue enhancement after contrast injection, which is used to calculate perfusion and permeability. The magnitude of enhancement reflects blood and interstitial volumes. This technique has benefitted from advances in MRI, which allow large volumes to be acquired with a good compromise between temporal and spatial resolution. Software has also advanced enabling microcirculation maps to be calculated and heterogeneity to be analyzed. If permeability is increased and interstitial volume is reduced, the microcirculation imaging suggests a suspicious aggressive lesion and can be used for early assessment of neoadjuvant therapies by demonstrating restoration of normal functional indices, which precede morphological changes.

Abstract Background: Inflammatory breast carcinomas have poor prognosis even in the absence of evident synchronous metastases. 18F-FDG PET/CT is not recommended in initial staging but could improve the sensibility of synchronous metastases detection and the management of the patients. Objective: To assess factors associated with synchronous metastases in inflammatory breast carcinomas when evaluated by 18F-FDG PET/CT. Methods: Since 2006, initial staging of locally advanced breast carcinomas in our center consisted of 18F-FDG PET/CT in addition to standard laboratory and radiological tests. We reviewed data of patients with inflammatory breast carcinomas treated from 2006 to 2013 who had an initial evaluable18F-FDG PET/CT. Fisher's exact test and logistic model were used to assess factors associated with synchronous metastases. Overall survival was estimated with the method of Kaplan-Meier. Results: Among 353 locally advanced breast carcinomas seen at the breast disease unit, hospital Saint Louis from 04/2006 to 04/2013, we identified 40 inflammatory breast carcinomas. Initial 18F-FDG PET/CT was available for review in 32 inflammatory breast carcinomas. Median age was 57 years (range 38-78), 39% had pre-menopausal status (n = 12), clinical node involvement was found in 87.5% (n = 28). Histological features on biopsy were: ductal invasive carcinoma 91% (n = 29), SBR grade III 72% (n = 23), negative hormonal receptor 75% (n = 24), positive HER2 37.5% (n = 12), triple negative 44% (n = 14). Synchronous metastases were found in 41% of inflammatory breast carcinomas (n = 13), bone (n = 7), liver (n = 6) and mediastinum (n = 4). Synchronous metastases seemed more common in HER2 positive than in HER2 negative inflammatory breast carcinomas (58% vs 30%, p = 0.15). In multivariate analysis, no factor was associated with synchronous metastases. All patients with inflammatory breast carcinomas received neoadjuvant chemotherapy with sequential anthracycline and taxane (16 patients), dose-dense anthracycline and alkylating agent (8 patients), taxane with or without bevacizumab (7 patients) and anthracycline in 1 patient. Trastuzumab was given in all HER2 positive inflammatory breast carcinomas. Clinical response to neoadjuvant chemotherapy was complete in 16.5% (n = 5), partial in 67% (n = 20), stable or progressive in 16.5% (n = 5) and missing for 1 patient. One patient died before response assessment. Thirty patients (94%) underwent radical mastectomy with axillary node dissection. Pathologic complete response in breast and nodes was found in 27.5% (n = 8). Axillary node invasion was found in 45% (n = 13). All positive hormonal receptors patients received endocrine therapy after surgery. With a median follow-up of 33 months, 10 patients died. Median overall survival was 38.8 months (95%CI: 30.3-NA) with no difference between HER2 positive and HER2 negative patients. Conclusion: Synchronous metastases are common in inflammatory breast carcinomas especially in case of HER2 positive tumors. Complete initial staging with 18F-FDG PET/CT could be useful to detect synchronous metastases mainly in bone and liver and thus allowed to adapt further treatment. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-12-13.

Abstract Background: Use of hormone replacement therapy (HRT) has been associated with an increased risk of breast cancer. Few studies focus on correlation between HRT and in situ breast cancer A large cohort study, the Million Women Study (Reeves GK et al. Lancet Oncol. 2006) have shown that the use of HRT has been associated with an increased incidence of in situ breast cancer (RR = 1, 55, IC=1, 4–1,72, p = 0,03). Purpose: We investigated the association between HRT use and duration and in situ breast cancer incidence from a data base of infraclinic breast lesions. Materials & Methods: From 2007 to 2011, 2708 patients (pts) with a non palpable breast lesion were referred to our breast disease unit for exploration (Saint Louis Hospital, Paris). Radiological abnormalities were screened by mammography and/or breast ultrasound, and/or MRI. Out of 2708 pts, 1668 had a biopsy. All biopsies were seen by an anatomopathologist dedicated to breast. Here, we focus on the 1017 postmenopausal women (61%). Results: Biopsies revaled invasive breast cancers in 222 pts (22%), in situ breast cancers in 164 pts (16%) [10 lobular in situ carcinoma and 154 ductal in situ carcinoma], high risk breast lesions in 103 pts (10%) and benign breast lesions in 528 patients (52%). Characteristics of the 164 patients with in situ breast cancer: median age 62 [IQR: 57 to 68], at least one pregnancy (mean number of pregnancies per woman, 1.6) 75,6%, family history of breast cancer:30,2%. Among these 164 patients, 42.6 % had used an oral contraceptive and 53% of them a HRT, with a mean duration of use of 7 years. The HRT use was not significantly associated with in situ breast cancer (p = 0.66) as well as the duration of HRT. Discussion: In this study of postmenopausal women, HRT use, whatever is the duration, was not associated with in situ breast cancer. Although a lack of statistical power may be invoked to explain these results, these findings suggest that the type of the HRT could be important to explain the difference between our study and the Million Women Study. In our study, the HRT used is in the majority of the pts, percutaneous oestrogens and natural progesterone as it is the most commun HRT used in France (Fournier A, Int J Cancer. 2005) during this period of time. Use and type of HRT are different in USA where conjugated estrogens and medroxy progestogerone acetate were commonly used. Conclusion: We therefore encourage further studies to better appreciate the links between type of HRTs and in situ breast cancer. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-13-03.

The analytical performance of immunochromatographic assay (ICA) is usually determined by the biological activity of antibody and gold nanoparticle conjugates (AuNP probes). However, conventional probes are constructed using the nondirectional coupling method that can cause the improper orientation of antibodies with the poor accessibility of antigen-binding sites. To address these issues, we report a site-specific directional coupling strategy to enhance the bioactivity of AuNP probes through the specific covalent binding of the aldehyde group in the Fc domain of antibodies with the hydrazide group modified on the surface of AuNPs. Through this design, the antibodies can be erected on the AuNP surface to fully expose the Fab domain and achieve the maximized functional availability. Leveraging these AuNP probes as ICA labels, we demonstrate an improved detection of the hepatitis B surface antigen with less used amount of labeled antibody (0.2 mg/pmol AuNPs), shorter reaction time (10 min), better antibody bioactivity, and higher detection sensitivity (2 ng/mL) compared with the carbodiimide method. Overall, this work provides great promise for the design and the construction of high-performance probes to enhance the detection performance of ICA sensors.

L’IRM mammaire ne doit pas être utilisée pour le diagnostic différentiel entre un cancer du sein inflammatoire (CSI) et une mastite aiguë (MA) avant traitement. Lorsque les symptômes de mastite persistent après dix à 15 jours de traitement médical bien conduit, une IRM peut être réalisée en complément de l’échographie, de la mammographie et des prélèvements histologiques pour éliminer un CSI. Concernant le bilan d’extension, l’IRM serait utile pour rechercher une lésion controlatérale, la TEP-TDM pour connaître l’extension métastatique à distance et dans certains centres pour savoir l’extension ganglionnaire locorégionale initiale qui guide les champs d’irradiation (l’atteinte ganglionnaire pouvant être négativée après chimiothérapie néoadjuvante). L’IRM et la TEP-TDM seraient intéressantes pour dépister précocement les patientes répondant mal à la chimiothérapie néoadjuvante afin de la modifier rapidement.

Breast MRI should not be used for differential diagnosis between inflammatory breast cancer and acute mastitis (AM) prior to treatment. When mastitis symptoms persist after 10 to 15 days of well-managed medical treatment, MRI may be performed in addition to an ultrasound examination, a mammogram and to taking histological samples, in order to eliminate inflammatory breast cancer (IBC). For staging, MRI would seem to be useful in looking for a contralateral lesion, PET-CT for finding information about remote metastases and in certain centres, for information about the initial extension to local/regional lymph nodes, which would guide the fields of irradiation (since patients can become lymph node negative after neoadjuvant chemotherapy). MRI and PET-CT seems to be useful for early detection of patients responding poorly to neoadjuvant chemotherapy so that the latter may be rapidly modified.

To determine the malignancy rate of nonpalpable breast lesions, categorised according to the Breast Imaging Reporting and Data System (BI-RADS) classification in the setting of a Breast Care Unit.

OBJECTIVES:To determine the malignancy rate of nonpalpable breast lesions, categorised according to the Breast Imaging Reporting and Data System (BI-RADS) classification in the setting of a Breast Care Unit. METHODS:All nonpalpable breast lesions from consecutive patients referred to a dedicated Breast Care Unit were prospectively reviewed and classified into 5 BI-RADS assessment categories (0, 2, 3, 4, and 5). RESULTS:A total of 2708 lesions were diagnosed by mammography (71.6%), ultrasound (8.7%), mammography and ultrasound (19.5%), or MRI (0.2%). The distribution of the lesions by BI-RADS category was: 152 in category 0 (5.6%), 56 in category 2 (2.1%), 742 in category 3 (27.4%), 1523 in category 4 (56.2%) and 235 in category 5 (8.7%). Histology revealed 570 malignant lesions (32.9%), 152 high-risk lesions (8.8%), and 1010 benign lesions (58.3%). Malignancy was detected in 17 (2.3%) category 3 lesions, 364 (23.9%) category 4 lesions and 185 (78.7%) category 5 lesions. Median follow-up was 36.9 months. CONCLUSION:This pragmatic study reflects the assessment and management of breast impalpable abnormalities referred for care to a specialized Breast Unit. Multidisciplinary evaluation with BI-RADS classification accurately predicts malignancy, and reflects the quality of management. This assessment should be encouraged in community practice appraisal.

To assess the value of whole body CTA, as a complement to head CTA, in the management of brain-dead patients as potential organ donors. Materials and Methods. A total of 27 consecutive brain-dead patients admitted in a center authorized in the harvesting of organs between October 2006 and January 2008 were included. The imaging protocol used was the protocol recommended by the French Society of Neuroradiology, with additional arterial phase helical acquisition of the chest, abdomen and pelvis, and parenchymal phase helical acquisition of the abdomen and pelvis. The imaging findings were then correlated to the surgical reports after organ harvesting.CTA readily demonstrates tissue lesions, a contraindication to harvesting (14 cases, including one false positive), and anatomical variants of the vascular system (7 arterial variants and 3 venous variants) and liver (8 patients).CTA, the gold standard paraclinical examination for brain death assessment, allows, in a single examination, the identification of contraindications to organ harvesting that may modify the surgical approach and even avoid unnecessary mobilisation of the transplant team. It may also provide valuable preoperative evaluation by detecting anatomical variants of the liver and kidneys.

Purpose. To assess the value of whole body CTA, as a complement to head CTA, in the management of brain-dead patients as potential organ donors.Materials and Methods. A total of 27 consecutive brain-dead patients admitted in a center authorized in the harvesting of organs between October 2006 and January 2008 were included. The imaging protocol used was the protocol recommended by the French Society of Neuro-radiology, with additional arterial phase helical acquisition of the chest, abdomen and pelvis, and parenchymal phase helical acquisition of the abdomen and pelvis. The imaging findings were then correlated to the surgical reports after organ harvesting.Results. CTA readily demonstrates tissue lesions, a contraindication to harvesting (14 cases, including one false positive),and anatomical variants of the vascular system (7 arterial variants and 3 venous variants) and liver (8 patients).Conclusion. CTA, the gold standard paraclinical examination for brain death assessment, allows, in a single examination, the identification of contraindications to organ harvesting that may modify the surgical approach and even avoid unnecessary mobilisation of the transplant team. It may also provide valuable preoperative evaluation by detecting anatomical variants of the liver and kidneys.

Diffusion-weighted imaging is helpful to further characterize lesions that remain indeterminate after morphological and dynamic MR evaluation. Suspicious lesions are hyperintense on diffusion-weighted images with corresponding low ADC values, indicating restricted diffusion and hypercellularity. Benign lesions and tumors responding to treatment usually have no diffusion restriction. ADC maps are useful for T2W hyperintense lesions that could mask the presence of restricted diffusion. Image fusion is sometimes needed to accurately localize enhancing lesions on ADC maps. For indeterminate lesions, a hypocellular appearance suggests a lower ACR category whereas the presence of restricted diffusion suggests a higher category.

To examine factors associated with one step surgery in case of non-palpable breast cancer.Clinical data of 152 consecutively diagnosed patients with breast cancer were analyzed retrospectively. Preoperative diagnostic findings were divided in subgroups: mammographically visible mass/microcalcifications/sonographically visible mass/sonographically visible architectural distortion. Correlation between tumor-size, radiologic tumor morphology, quality of localization and number of operation was evulated. For localization exact wire position was defined less than 3 mm apart from the lesion.One hundred and thirty-six patients attempted breast conservation and underwent preoperative tumor localization. Fourteen of 16 patients had mastectomy without preoperative localization. Average tumor size was 12 mm for one-operation, and 17 mm for re-operation. Significant correlation (p < 0.001) was found between one operation and masses visible in mammograms (55/62 (89%) patients) or sonography (53/64 (83%) patients). Significant correlation was found (p < 0.001) between more re-operation and microcalcifications in mammograms (33/89 (37% patients). In 123/138 (89%) cases wire position was central, in 15/138 (11%) cases distance was maximally 10 mm. No significant correlation was found between number of operation and wire position. Re-operation was required in 38 cases.Mammographically or sonographically visible mass, small size of tumors, preoperative percutaneous biopsy and exact preoperative localization are important for a single step procedure for definite surgical treatment, that we found in 74% of the patients.