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Scoring of tumor-infiltrating lymphocytes (TILs) in breast cancer specimens has gained increasing attention, as TILs have prognostic and predictive value in HER2+ and triple-negative breast cancer. We evaluated the intra- and interrater variability when scoring TILs by visual inspection of hematoxylin and eosin-stained tissue sections. We further addressed whether immunohistochemical staining of these sections for immune cell surface markers CD45, CD3, CD4, and CD8 and combination with nanoString nCounter® gene expression analysis could refine TIL scoring. Formalin-fixed paraffin-embedded and fresh-frozen core needle biopsies of 12 female and treatment-naive breast cancer patients were included. Scoring of TILs was performed twice by three independent pathologists with a washout period of 3 days. Increasing intra- and interrater variability was observed with higher TIL numbers. The highest reproducibility was observed on tissue sections stained for CD3 and CD8. The latter TIL scores correlated well with the TIL scores obtained through nanoString nCounter® gene expression analysis. Gene expression analysis also revealed 104 and 62 genes that are positively and negatively related to both TIL scores. In conclusion, integration of immunohistochemistry and gene expression analysis is a valuable strategy to refine TIL scoring in breast tumors.

A "butterfly" vertebra is a rare congenital anomaly, presenting as a sagittal cleft in the vertebral body. In the literature it has been described as an isolated finding, but it can also be associated with various syndromes, such as Alagille, Jarcho-Levin, Crouzon and Pfeiffer syndrome. We present a case of a 35-year old man with chronic low back pain. The diagnosis of a butterfly vertebra of S1 with disc space narrowing of L5-S1 was made. Usually the abnormality occurs at the thoracolumbar spine and we are not aware of a description of a sacral butterfly vertebra. Although a butterfly vertebra is usually asymptomatic, it could lead to discal herniation or chronic back pain due to alteration in spinal biomechanics.

OBJECTIVE: To evaluate the preoperative detection of axillary metastasis combining ultrasound (US)-guided fine needle aspiration cytology (FNAC) and liquid-based cytology (Surepath(®)) to reduce sentinel node procedures. METHODS: In total, 148 patients with clinically negative lymph nodes and no preoperative therapy were included. All patients underwent preoperative ultrasound of the axilla with FNAC if suspicious lymph nodes were found. Complete axillary lymph node dissection was performed at primary surgery when FNAC was positive. All other patients underwent a sentinel node procedure. RESULTS: US-guided FNAC of the axilla revealed metastasis in 34 (23.0%) of the 148 patients. These 34 patients were 53.1% of all patients (n = 64) with proven axillary lymph node involvement. In 66 patients (44.6%), both ultrasound and histopathology were negative. Overall sensitivity of US-guided FNAC was 50.0%, specificity 100%, positive predictive value 100% and negative predictive value 70.2%. InT1 tumours, all patients referred for sentinel node procedure were node-negative. The correlation between malignant FNAC and histopathology was 100%. US-guided liquid-based FNAC in patients with no clinically positive lymph nodes reduced the necessity for a sentinel node procedure by 23.0%. CONCLUSIONS: We advocate that US-guided fine needle aspiration (FNA) combined with liquid-based cytology of axillary lymph nodes should be included in the preoperative staging of breast cancer.

Purpose/Introduction: An accurate assessment of the Tumor Blood Flow (TBF) can become crucial for breast cancer management. Earlier studies have demonstrated the feasibility of quantifying perfusion parameters in human breast tumors using a deconvolution analysis of DCE-MRI. However, the TBF values were on average higher than the literature PET values. Earlier in myocardium, it has been shown that a prebolus method will allow the use of high concentrations of contrast agent for tissue analysis, in combination with a lower concentration bolus to maintain the linearity of AIF signal intensity. The aim of the present study was to evaluate the use of the prebolus technique in a small cohort of breast tumors. Subjects and Methods: In vivo perfusion measurements were performed in 23 women with breast tumors on a 1.5 T scanner. The routine MR mammography protocol was applied first. At the slice where tumor enhances maximally, the prebolus protocol was applied 10 minutes later. 1ml of Gd- DTPA solution at 2ml/s was injected at the beginning of a dynamic axial single slice inversion-prepared (IR prepared) TFE acquisition (800 dynamics with a temporal resolution of 0.3s). At the 400th dynamic, a high dose of either 10ml (8 patients, 5 malignant and 3 benign) or 20ml (15 patients, 11 malignant and 4 benign) of contrast agent was injected at 2ml/s and a further 400 dynamics were acquired. ROIs were placed manually over the aorta and the region within the breast lesion with highest enhancement. From the prebolus curve, AIFs were reconstructed by time-shifting and adding the prebolus response curve until the relevant high dose equivalent was reached. The RE time course from the tumor ROI was then deconvolved to generate the parametric maps. Results: Whether the TBF calculation was performed with or without prebolus AIF estimation, the median TBF was higher in malignant tumors compared to the benign ones (p

Introduction: In breast tumors, a prebolus first pass perfusion method was recently proposed for improved perfusion quantification. This method enables simultaneous accomplishment of an unsaturated AIF curve with the initial prebolus and a tissue curve with adequate SNR with the subsequent high dose. However, an important concern in the prebolus technique in breast tumors remains the selection of a suitable contrast dose protocol. In this study we investigated the effect of dose reduction in the context of prebolus DCE MRI. Materials & Methods: In vivo perfusion measurements were performed in 23 women with breast tumors on a 1.5 T scanner. The routine MR mammography protocol was applied first. In the slice where the tumor enhanced maximally, 10 minutes later prebolus protocol was applied. 1ml of Gd-DTPA solution at 2ml/s was injected at the beginning of a dynamic axial single slice inversion-prepared (IR prepared) TFE acquisition (800 dynamics at a temporal resolution of 0.3s). At the 400th dynamic, a high dose of either 10ml (8 patients, 5 malignant and 3 benign) or 20ml (15 patients, 11 malignant and 4 benign) of contrast agent was injected at 2ml/s and a further 400 dynamics were acquired. ROIs were placed manually over the central part of the aorta and the breast lesion with highest enhancement. From the prebolus curve, AIFs were reconstructed by time-shifting and adding the prebolus response curve until the relevant high dose equivalent is reached. The RE time course from the tumor ROI was then deconvolved. Finally, parametric values were calculated from the impulse response function. Results: Comparison of the tumor RE curves with 10ml and 20ml in two separate patients with same histopathological diagnosis shows a less noisy time intensity curve with the 20ml bolus. The median values of TBF are presented separately for the malignant and benign tumors for both injection protocols, indicating that the median TBF for both malignant and benign tumors are in a matching range. On the other hand, the 1-10 ml protocol achieves a significant difference in the median TBF between benign and malignant tumors (P

A "butterfly" vertebra is a rare congenital anomaly, presenting as a sagittal cleft in the vertebral body. In the literature it has been described as an isolated finding, but it can also be associated with various syndromes, such as Alagille, Jarcho-Levin, Crouzon and Pfeiffer syndrome. We present a case of a 35-year old man with chronic low back pain. The diagnosis of a butterfly vertebra of S1 with disc space narrowing of L5-S1 was made. Usually the abnormality occurs at the thoracolumbar spine and we are not aware of a description of a sacral butterfly vertebra. Although a butterfly vertebra is usually asymptomatic, it could lead to discal herniation or chronic back pain due to alteration in spinal biomechanics.

We present a case of a 16-year-old boy with a painful swelling in the popliteal fossa, slight fever, articular and muscle pain of 3 weeks duration. Plain radiography and MR examination were performed in order to characterize the lesion. Additionally to the poorly defined mass, 2 satellite nodules were shown. Subsequent biopsy revealed a granulomatous process and 2 satellite lymphadenopathies highly suggestive of cat-scratch disease. This case shows that the differential diagnosis of a soft tissue mass of the knee should not only include tumoral processes or pseudotumoral lesions, but also granulomas from infectious or non-infectious origin. Knowledge of the patients contact with cats and the detection of skin scratches is usually the clue to the correct diagnosis.