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Resume Devant la survenue d’un serome tardif, chez une patiente porteuse de protheses siliconees texturees ou ayant ete exposee a une prothese texturee auparavant, dans un contexte d’augmentation ou de reconstruction mammaire, le lymphome anaplasique a grandes cellules associe aux implants mammaires devrait etre suspecte. Dans cette deuxieme partie sur le sujet, nous presentons un cas clinique d’un lymphome anaplasique a grandes cellules, survenu chez une patiente de 74 ans, 7 ans apres une mastectomie totale et une reconstruction par prothese siliconee et proposons la demarche diagnostique et l’approche therapeutique de cette entite, en se referant aux donnees de la litterature.

Resume La tomosynthese mammaire, technique d’imagerie en pseudo 3D de la glande mammaire, s’est imposee progressivement ces dix dernieres annees en pratique clinique. Plusieurs etudes ont, en effet, demontre sa superiorite dans la detection du cancer du sein invasif et la reduction du taux de rappel aux depens d’une majoration de l’irradiation si combinee a la mammographie 2D. Sa place dans le depistage est cependant sujette de controverses, en particulier en raison de l’association a une imagerie 2D, qui genere un surcroit d’irradiation. D’ou le recours a la reconstitution d’une image synthetique 2D a partir des donnees de la tomosynthese, consideree comme une alternative prometteuse permettant de s’affranchir de toute irradiation supplementaire. Nous presentons les principales caracteristiques de cette technique, ainsi que sa place future dans la pratique clinique et dans le depistage.

The purpose of this study was to evaluate various combinations of 13 features based on shear wave elasticity (SWE), statistical and spectral backscatter properties of tissues, along with the Breast Imaging Reporting and Data System (BI-RADS), for classification of solid breast lesions at ultrasonography by means of random forests. One hundred and three women with 103 suspicious solid breast lesions (BI-RADS categories 4-5) were enrolled. Before biopsy, additional SWE images and a cine sequence of ultrasound images were obtained. The contours of lesions were delineated, and parametric maps of the homodyned-K distribution were computed on three regions: intra-tumoral, supra-tumoral and infra-tumoral zones. Maximum elasticity and total attenuation coefficient were also extracted. Random forests yielded receiver operating characteristic (ROC) curves for various combinations of features. Adding BI-RADS category improved the classification performance of other features. The best result was an area under the ROC curve of 0.97, with 75.9% specificity at 98% sensitivity.

Lupus mastitis is an uncommon manifestation of systemic lupus erythematosus (SLE) that affects the subcutaneous fat in the breast, much like lupus panniculitis, but additionally involves the mammary gland. We report on two women for whom lupus mastitis was the initial manifestation of SLE and provide a literature review of 34 additional cases reported in the Anglo-Saxon and French literature since 1971, making this the largest review to date. Lupus mastitis (LM) can manifest clinically as subcutaneous masses that may be painful, or may present cutaneous involvement such as thickening and discolouration. The radiologic manifestations of LM are broad and include calcifications, masses and asymmetries. Most often, excluding malignancy requires percutaneous biopsy, with histologic findings that are virtually pathognomonic for SLE. Thus, surgery is avoided and medical management can begin, antimalarial drugs and corticosteroids in most cases.

Magnetic resonance imaging (MRI)-guided breast biopsy is an essential tool of a breast imager; yet, a decade after its introduction, this technique remains challenging and imperfect. This article presents the technique of MRI-guided biopsy, with an emphasis on challenges particular to the technique: technical considerations related to adequate lesion sampling and difficulties in confirming radiologic-pathologic correlation for enhancing lesions. Through clinical vignettes, challenges unique to MRI-guided biopsy are discussed and practical tips are offered. Prebiopsy planning including second-look targeted studies, patient preparation, and equipment is covered. Challenging situations pertaining to breast size, lesion location, or type of enhancement are illustrated, as well as the topic of performing multiple MRI-guided breast biopsies in a single session and biopsies of women with implants. Postbiopsy management is discussed. Success of MRI-guided biopsies requires careful prebiopsy planning, as well as appropriate choice of biopsy device, optimized for the specifics of breast shape and lesion size and location. Special features of biopsy systems (smaller apertures and blunt tips) facilitate the sampling of lesions in challenging locations. Vanishing lesions should undergo short-term follow-up, because malignancy cannot be excluded, as should lesions diagnosed as benign after pathologic analysis when the result is felt to be concordant with imaging features. To this end, radiologic-pathologic correlation is essential. Underestimation rates after MRI-guided breast biopsy are superior to those for vacuum-assisted stereotactic biopsy and ultrasound-guided biopsy. Close follow-up and rebiopsy should be considered when there is imaging-discordant histology. For benign and concordant histology, a first follow-up can be offered at 6 months.

Introduction Surgery is the preferred treatment for recurrent differentiated thyroid carcinoma. However, scar tissue and tissue plane distortion can significantly limit the safety and the precision of the dissection. Careful preoperative planning is key to minimizing perioperative morbidity and positive margins. Case summary We present a case of mixed thyroid carcinoma in a patient with multiple endocrine neoplasia type 1 syndrome. Following the initial surgery, the patient developed two recurrences, resistant to radioactive iodine treatment and had a history of positive margins. A year and a half later, the patient developed a third recurrence that was not palpable. We used a radioactive iodine-125 seed, preoperatively inserted under ultrasonography, to help retrieve the lesion intraoperatively and improve the precision of the dissection. Discussion This is the first case report on the use of radioguidance with an iodine-125 seed to enhance the safety and exactitude of the surgical resection of a locally recurrent thyroid carcinoma. Although radioactive seed localization has been mostly used in breast cancer, this technique demonstrates great potential in becoming a useful adjunct to complex thyroid surgery in selected cases.

Purpose To retrospectively evaluate interobserver variability between breast radiologists when describing abnormal enhancement on breast MR examinations and assigning a BI-RADS category using the Breast Imaging Reporting and Data System (BI-RADS) terminology. Materials and methods Five breast radiologists blinded to patients’ medical history and pathologic results retrospectively and independently reviewed 257 abnormal areas of enhancement on breast MRI performed in 173 women. Each radiologist described the focal enhancement using BI-RADS terminology and assigned a final BI-RADS category. Krippendorff's α coefficient of agreement was used to asses interobserver variability. Results All radiologists agreed on the morphology of enhancement in 183/257 (71%) lesions, yielding a substantial agreement (Krippendorff's α = 0.71). Moderate agreement was obtained for mass descriptors – shape, margins and internal enhancement – (α = 0.55, 0.51 and 0.45 respectively) and NME (non-mass enhancement) descriptors – distribution and internal enhancement – (α = 0.54 and 0.43). Overall substantial agreement was obtained for BI-RADS category assignment (α = 0.71). It was however only moderate (α = 0.38) for NME compared to mass (α = 0.80). Conclusion Our study shows good agreement in describing mass and NME on a breast MR examination but a better agreement in predicting malignancy for mass than NME.