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Objective: To evaluate the role of preoperative axillary staging with ultrasound (US) and fine needle aspiration cytology (FNAC). Can we avoid intraoperative sentinel lymph node (SLN) examination, with an acceptable revision rate by preoperative staging?, Design: This study is based on the retrospective data of 336 patients that underwent US evaluation of the axilla as part of their staging. A FNAC biopsy was performed when abnormal lymph nodes were visualized. Patients with normal appearing nodes on US or a benign diagnostic biopsy had removal of the SLNs without intraoperative pathological examination. We calculated the sensitivity, specificity and accuracy of US/FNAC in predicting the necessity of an axillary lymphadenectomy. Subsequently we looked at the total cost and the operating time of 3 models. Model A is our study protocol. Model B is a theoretical protocol based on the findings of the Z0011 trial with only clinical preoperative staging and in Model C preoperative staging and intraoperative pathological examination were both theoretically done. sentinel node, staging, ultrasound, preoperative axillary staging, FNAC, axilla RESULTS: The sensitivity, specificity and accuracy are respectively 0.75 (0.66-0.82), 1.00 (0.99-1.00) and 0.92 (0.88-0.94). Only 26 out of 317 (8.2%) patients that successfully underwent staging needed a revision. The total cost of Model A was 1.58% cheaper than Model C and resulted in a decrease in operation time by 9,46%. The benefits compared with Model B were much smaller., Conclusion: Preoperative US/FNAC staging of the axillary lymph nodes can avoid intraoperative examination of the sentinel node with an acceptable revision rate. It saves tissue, reduces operating time and decreases healthcare costs in general., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Idiopathic granulomatous mastitis (IGM) is a rare chronic benign disease of the breast. Histologically, the disease presents as an inflammatory reaction with non-caseating granulomas considered characteristic for IGM. IGM is often confused with breast cancer or mastitis with abcedations, and is treated with surgery which involves mutilation of the breast. Although no consensus exists on the best treatment modality, the use of low-dose oral and topical steroids has proven efficacy.

Diabetic mastopathy is an unusual fibroinflammatory breast lesion that characteristically presents in premenopausal women with long-standing type 1 diabetes mellitus.Patients present with clinically suspicious breast masses or axillary lymph nodes with imaging characteristics indistinguishable from malignancy. Fine needle aspiration is often inadequate and a core biopsy should be performed. Excisional biopsy is not necessary, and annual follow-up is recommended. Recognition of diabetic mastopathy should lead to better care of patients with breast nodules or axillary masses who are diabetic, avoiding surgery for this benign condition.

Objective: To report the imaging findings of a 22-year-old Asian woman with a freely movable retro-areolar nodule in the right breast, first noticed after a holiday in The Philippines., Material and Methods: We preformed clinical examination, mammography and ultrasound with color Doppler imaging. A differential diagnosis of epidermal inclusion cyst, complex cyst, well demarcated carcinoma and echinococcus cyst was proposed. For further differential diagnosis, a MRI of the breasts was performed on a 1.5 superconducting system, with a bilateral breast coil. T2- and T1 weighted images, followed by axial echo-planar diffusion-weighted MRI (DW-MRI) were performed with b values of 0, 500, and 1000 mm2/s (trace images and ADC maps)., Results: The high signal intensity on T2 weighted images confirmed the cystic character of the lesion. The high signal intensity on T1 FS weighted images can be seen in complex cysts and inclusion cysts, but is less likely in an echinococcus cyst. On DW-MRI there is a marked diffusion restriction in the nodule, which can be seen in complex cysts and inclusion cysts. A well demarcated carcinoma is less likely, unless a tumour with a very high cellularity. Because neither carcinoma nor echinococcus cyst could be ruled out, a surgical excision was performed. Pathological examination revealed normal squamous epithelium with stratification and lamellated keratin, consistent with an epidermal inclusion cyst., Conclusion: We argue that in selected cases DW-MRI can be useful to narrow the differential diagnosis and notable differentiate epidermal inclusion cysts from echinococcus cysts.

The purpose of the study is to compare mammography and magnetic resonance (MR) mammography in detection and assessment of extent, of histologically proven ductal carcinoma in situ (DCIS) and to compare MR features of DCIS, with features of invasive carcinoma. Forty histopathologically proven and MR detected pure DCIS lesions were described and compared with 213 enhancing invasive carcinomas. Histopathological examination revealed 49 pure DCIS, MR detected 40 of them (81.6%). There was a good correlation between diameter measured on mammography, MR and histopathology. MR was able to detect additional foci. Ductal enhancement, a focal area or a mass were perceived in respectively 8 (20%), 8 (20%) and 24 (60%) DCIS and in 0, 6 (2.8%) and 207 (97.2%) invasive lesions. Maximal contrast enhancement after 3 minutes was seen in 60.9% of DCIS and before 3 minutes in 61% of invasive masses. Signal intensity increase of more than 100% was seen in 76.9% of DCIS and in 91.1% of invasive carcinomas. DCIS had a wash out in 53.8% and invasive carcinomas in 65.3%. MR was able to detect 81.6% of DCIS. Diameter prediction was good on mammography and MR mammography. The only MR feature exclusively seen in DCIS was ductal enhancement.

We report the imaging findings in an infarcted phyllodes tumor of the breast. A 40-year-old woman presented ten months after surgery for a benign phyllodes tumour with a palpable lump under the scar. We performed clinical examination, mammography, sonography, and MRI. The radiological diagnosis was a postoperative hematoma with granulation tissue. Surgery was performed. Histological diagnosis revealed an infarcted phyllodes tumour. This case illustrates the radiological presentation of a completely infarcted phyllodes tumour. As far as we know, imaging findings of an infarcted phyllodes tumour have not been reported yet.

A case of a primary squamous cell carcinoma of the breast in a patient with synchronous contralateral invasive ductal adenocarcinoma is reported. To our knowledge, no dynamic MR mammography of this pathology is described in the literature. On MR, it presented as a mainly non-enhancing, partially cystic mass with an enhancing irregular peripheral rim. In the differential diagnosis of a mass with unsharp margins and an irregular border of the cystic or the non-enhancing area on MR mammography, a primary squamous cell carcinoma must be included.

Mucoepidermoid carcinoma is a very rare primary tumour of the breast. Until now only 17 cases have been described in the literature. Generally these malignancies have a good prognosis, especially if well differentiated. We report a case of low-grade which recurred as high-grade after 32 months. She also developed a poorly differentiated adenocarcinoma in the other breast 12 years after her initial treatment. At present the patient is well without any sign of disease for 156 months. A literature review of this rare entity is presented.

Only nine cases of primary multifocal leptomeningeal gliomatosis (PMLG) have been reported. We describe the first child with malignant features of PMLG who was diagnosed during life. The differential diagnosis based on imaging findings includes infectious and lymphoproliferative disorders.