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This article presents comments on various studies related to breast cancer. It includes "Effect of Screening and Adjuvant Therapy on Mortality From Breast Cancer," "Image Quality and Breast Dose of 24 Screen-Film Combinations for Mammography" and "The Accuracy of Ultrasound, Stereotactic and Clinical Core Biopsies in the Diagnosis of Breast Cancer, With an Analysis of False-Negative Cases."

Abstract: Over the last decade a significant amount of research has been conducted into the durability of thermal barrier coatings (TBCs) focusing mainly on issues of oxidation, erosion and foreign object damage (FOD). However, as the performance and durability of TBCs has improved the temperatures at which they operate has increased. This increase in temperature has resulted in another lifing issue for EB PVD TBCs, namely that of CMAS attack. Calcium–magnesium–alumino-silicate (CMAS) attack occurs when atmospheric dust that has deposited on the surface of turbine blades melts and wicks into the columns of the TBC. This occurs at temperatures above 1240–1260°C and results in the degradation of the columnar microstructure of the TBCs. Due to the fact that TBCs operate in a temperature gradient CMAS only infiltrates part of the coating before solidifying. There are a number of issues associated with CMAS attack, both chemical and mechanical. From a chemical point of view CMAS attack of electron beam (EB) physical vapour deposited (PVD) TBCs can be considered as a form of corrosion; when there is a lot of excess CMAS on the surface of a coated component Yttria diffuses out of the TBC into the molten CMAS resulting in a t′ to monoclinic phase transformation in the yttria stabilised zirconia (YSZ), CMAS attack also results in localised melting and subsequent re-precipitation of the coating resulting in a loss of the defined columnar microstructure. While from a mechanical point of view the CMAS, once re-solidified, reduces the strain compliance of the EB PVD and can result in spallation of the TBC on cooling. Furthermore, current studies have indicated that small amount of CMAS infiltration significantly increases the erosion rate of EB PVD TBCs. This paper covers various aspects of CMAS attack of EB PVD TBCs, specifically looking at minimum levels of CMAS required to initiate damage, as well as investigating it from an erosion–corrosion perspective. [Copyright &y& Elsevier]

The article discusses studies on diagnostic imaging for breast cancer. A study stressed that excision of lobular neoplasia (LN) is unnecessary if careful radiographic-pathologic correlation is performed and strict histologic criteria are adhered when making the diagnosis. A research highlighted the outcomes among breast imaging-reporting and data system (BI-RADS)-5 lesion patients who were treated in a community practice in the U.S. from 1998 to 2002. Another study evaluated the efficiency of core biopsy for BI-RADS-5 breast lesions.

The article presents abstracts on medical topics which include patters of patient referral to surgeons for treatment of breast cancer, reduction mammaplasty and sensitivity of the nipple-areola complex and malignant phyllodes tumor of the female breast.

Background.--Women with invasive breast cancer who are treated with breast-conserving surgery and radiotherapy face a cumulative risk of local disease recurrence of approximately 10% at 10 years. To the authors' knowledge, the role of mammographic density as a risk factor for the development of local recurrence has not been thoroughly evaluated to date. Methods.--Medical records were reviewed for 335 patients who underwent breast-conserving surgery for invasive breast cancer and for whom a pretreatment mammogram was available. Information was recorded concerning mammographic density as well as tumor features, patient characteristics, and adjuvant treatments received. Patients were categorized for mammographic density based on the Wolfe classification as either low (<25% density), intermediate (25-50% density), or high (>50% density). A multivariate survival analysis was conducted using the Cox proportional hazards model with local disease recurrence as the primary endpoint. Results.--Patients in the high mammographic density group experienced a much greater risk of local disease recurrence compared with women with the least dense breasts (10-year actuarial risks: 21% vs 5%; hazards ratio [HR], 5.7 [95% confidence interval, 1.6-20; P =.006]). The difference in the rates of disease recurrence at 10 years was pronounced for women who did not receive radiotherapy (40% vs 0% for patients with >50% density and <25% density, respectively; P < .0001 ). Conclusions.--Mammographic breast density is an important risk factor for local breast cancer recurrence among women not receiving breast irradiation. Mammographic density should be taken into consideration when stratifying patients for clinical trials of partial breast radiotherapy. If confirmed, mammographic density might be used to help determine which patients might benefit from radiotherapy. [ABSTRACT FROM AUTHOR]

Purpose.--To determine the diagnostic indexes of lymph node ultrasonography (US) of the axillary and supraclavicular regions for detecting lymph node recurrence (LNR) after breast cancer surgery and assess the effect of lymph node evaluation on prognosis during bilateral breast US. Materials and Methods.--Institutional review board approved this retrospective study and waived informed consent. Between January 2003 and December 2004, 3982 lymph node US examinations, including bilateral axillary and supraclavicular areas, were performed in 1817 women (mean age, 49.9 years; range, 22-86 years) after breast cancer surgery, nine of whom had palpable lesions. Final diagnosis was based on cytopathologic results, clinical follow-up, and imaging studies for at least 12 months after breast US. Diagnostic indexes of US for detecting LNR were assessed. The frequency of distant metastases between patients with ipsilateral LNR and those without was compared. Three-year mortality rates of patients with ipsilateral LNR only and those with distant metastases were evaluated. Results.--Of 1817 patients, 54 had suspicious LNR at US (28 at first, 20 at second, five at third, and one at fourth US examination). Thirty-nine of 1817 patients (2.1%), including nine with palpable lesions, had LNR, 11 of whom had ipsilateral LNR only. At first lymph node US. LNR was detected in 17 patients; at second, in 10; at third, in two; and at fourth, in one. Nine had false-negative results. The respective sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of lymph node US for detecting LNR per woman was 76.9% (30 of 39), 98.7% (1754 of 1778), 98.2% (1784 of 1817), 55.6% (30 of 54), and 99.5% (1754 of 1763); those of first lymph node US were 85.0% (17 of 20), 99.4% (1786 of 1797), 99.2% (1803 of 1817), 60.7% (17 of 28), and 99.8% (1786 of 1789); and those of total US examinations were 78.0% (32 of 41), 99.4% (3917 of 3941), 99.2% (3949 of 3982), 57.1% (32 of 56), and 99.8% (3917 of 3926). Distant metastases were found more frequently in patients with ipsilateral LNR (62%) than in those without (2.3%) (P < .0001). The 3-year mortality rate of patients with ipsilateral LNR only was significantly lower than that in patients with distant metastases (P = .03). Conclusion.--Ipsilateral LNR is a predictor of distant metastasis, and lymph node evaluation during breast US is useful for early detection of LNR in asymptomatic patients. [ABSTRACT FROM AUTHOR]

Objective.--The objective of our study was to report the results of classification of sonographic findings according to BI-RADS and to calculate the positive predictive value (PPV) for each BI-RADS assessment category. Subjects and Methods.--We prospectively classified 4,668 breast sonograms according to BI-RADS final assessment category. Suspicious sonographic findings were divided into major and minor suspicious findings. Category 1 was normal and category 2 was a benign finding such as cyst or nodule with uniform and intense hyperechogenicity. A nodule neither category 2 nor category 4 or 5 was defined as category 3. A nodule with one or more suspicious findings, not category 5, was defined as category 4. A nodule with two or more major suspicious findings was defined as category 5. Results.--Of the 4,668 cases, 321 cases failed to undergo follow-up of at least 1 year. The PPV was 0.1% in category 1 (3/2, 191), 0% in category 2 (0/773), 0.8% in category 3 (6/737), 31.1% in category 4 (161/519), and 96.9% in category 5 (123/127). In palpable lesions (n = 751), the PPV was 2.2% in category 1 (2/93), 0.9% in category 3 (2/ 217), 54% in category 4 (107/198), and 98% in category 5 (98/100). In nonpalpable lesions (n = 3,596), the PPV was 0.05% in category 1 (1/2,098), 0.8% in category 3 (4/520), 16.8% in category 4 (54/321), and 92.6% in category 5 (25/27). Conclusion.--As with mammography, placing sonographic lesions into BI-RADS categories is useful for predicting the presence of malignancy. [ABSTRACT FROM AUTHOR]

In this study, the investigators compared whole-body MRI to FDGPET- CT in 33 women with breast cancer and suspicion of recurrent and/or metastatic disease. Recurrent and/or metastatic disease was identified in 20 of the 33 patients. Although PET-CT detected more lymph node metastases, MRI found more distant metastases. MRI was slightly more sensitive than PET-CT (93% and 91%, respectively), whereas PET-CT was more specific than MRI (90% vs 86%, respectively). This article provides information about the type of imaging test that should be performed when recurrent and/or metastatic disease is suspected, and although histopathologic confirmation was available for only a few findings, the authors may have provided some answers. In some cases, the answer depends on the location of the metastatic lesions. For example, PET-CT detected more lymph node metastases than MRI did, especially in the axillary and mediastinal regions. MRI, on the other hand, revealed more metastases involving bone and the liver than PET-CT did. In the future, additional answers may come from a firmer understanding of tumor biology. For example, it may be reasonable to image women with a history of low-grade invasive lobular carcinoma according to one sequence and those with a history of high-grade invasive ductal carcinoma in a different manner. The Schmidt and colleagues study is a start, but additional studies are needed with larger numbers of patients and state-of-the-art imaging. [ABSTRACT FROM AUTHOR]

The article focuses on a study on differentiating benign from malignant solid breast masses with ultrasonographic (US) strain imaging with biopsy results as the reference standard. It references a study by E. S. Burnside et al. published in a 2007 issue of "Radiology." The study suggests that US strain imaging can facilitate improved classification of benign and malignant breast masses, although interobserver variability and image quality influence observer performance.

The article discusses research being done on whether short cessation of hormone replacement therapy (HRT) changes mamographic density. It references a study by K. Weaver et al published in a 2008 issue of "Maturitas." HRT is said to increase breast density, thus decreasing the sensitivity of cancer screening by mammography. The study compared density values of mammography before and after the cessation of HRT using Wilcoxon signed-rank test for categorical variables, and changes in breast pain and tenderness during mammography were also recorded.