Global evidence for joint effects of multiple natural and anthropogenic drivers on soil nitrogen cycling.

Global soil nitrogen (N) cycling remains poorly understood due to its complex driving mechanisms. Here, we present a comprehensive analysis of global soil δ15N, a stable isotopic signature indicative of the N input-output balance, using a machine-learning approach on 10,676 observations from 2670 sites. Our findings reveal prevalent joint effects of climatic conditions, plant N-use strategies, soil properties, and other natural and anthropogenic forcings on global soil δ15N. The joint effects of multiple drivers govern the latitudinal distribution of soil δ15N, with more rapid N cycling at lower latitudes than at higher latitudes. In contrast to previous climate-focused models, our data-driven model more accurately simulates spatial changes in global soil δ15N, highlighting the need to consider the joint effects of multiple drivers to estimate the Earth's N budget. These insights contribute to the reconciliation of discordances among empirical, theoretical, and modeling studies on soil N cycling, as well as sustainable N management.

A predictive model using MRI and clinicopathologic features for breast cancer recurrence in young women treated with upfront surgery.

OBJECTIVES: To identify preoperative breast MR imaging and clinicopathological variables related to recurrence and develop a risk prediction model for recurrence in young women with breast cancer treated with upfront surgery. METHODS: This retrospective study analyzed 438 consecutive women with breast cancer aged 35 years or younger between January 2007 and December 2016. Breast MR images before surgery were independently reviewed by breast radiologists blinded to patient outcomes. The clinicopathological data including patient demographics, clinical features, and tumor characteristics were reviewed. Univariate and multivariate logistic regression analyses were used to identify the independent factors associated with recurrence. The risk prediction model for recurrence was developed, and the discrimination and calibration abilities were assessed. RESULTS: Of 438 patients, 95 (21.7%) developed recurrence after a median follow-up of 65 months. Tumor size at MR imaging (HR = 1.158, p = 0.006), multifocal or multicentric disease (HR = 1.676, p = 0.017), and peritumoral edema on T2WI (HR = 2.166, p = 0.001) were identified as independent predictors of recurrence, while adjuvant endocrine therapy (HR = 0.624, p = 0.035) was inversely associated with recurrence. The prediction model showed good discrimination ability in predicting 5-year recurrence (C index, 0.707 in the development cohort; 0.686 in the validation cohort) and overall recurrence (C index, 0.699 in the development cohort; 0.678 in the validation cohort). The calibration plot demonstrated an excellent correlation (concordance correlation coefficient, 0.903). CONCLUSION: A prediction model based on breast MR imaging and clinicopathological features showed good discrimination to predict recurrence in young women with breast cancer treated with upfront surgery, which could contribute to individualized risk stratification. CLINICAL RELEVANCE STATEMENT: Our prediction model, incorporating preoperative breast MR imaging and clinicopathological features, predicts recurrence in young women with breast cancer undergoing upfront surgery, facilitating personalized risk stratification and informing tailored management strategies. KEY POINTS: Younger women with breast cancer have worse outcomes than those diagnosed at more typical ages. The described prediction model showed good discrimination performance in predicting 5-year and overall recurrence. Incorporating better risk stratification tools in this population may help improve outcomes.

Use of a commercial artificial intelligence-based mammography analysis software for improving breast ultrasound interpretations.

OBJECTIVES: To evaluate the use of a commercial artificial intelligence (AI)-based mammography analysis software for improving the interpretations of breast ultrasound (US)-detected lesions. METHODS: A retrospective analysis was performed on 1109 breasts that underwent both mammography and US-guided breast biopsy. The AI software processed mammograms and provided an AI score ranging from 0 to 100 for each breast, indicating the likelihood of malignancy. The performance of the AI score in differentiating mammograms with benign outcomes from those revealing cancers following US-guided breast biopsy was evaluated. In addition, prediction models for benign outcomes were constructed based on clinical and imaging characteristics with and without AI scores, using logistic regression analysis. RESULTS: The AI software had an area under the receiver operating characteristics curve (AUROC) of 0.79 (95% CI, 0.79-0.82) in differentiating between benign and cancer cases. The prediction models that did not include AI scores (non-AI model), only used AI scores (AI-only model), and included AI scores (integrated model) had AUROCs of 0.79 (95% CI, 0.75-0.83), 0.78 (95% CI, 0.74-0.82), and 0.85 (95% CI, 0.81-0.88) in the development cohort, and 0.75 (95% CI, 0.68-0.81), 0.82 (95% CI, 0.76-0.88), and 0.84 (95% CI, 0.79-0.90) in the validation cohort, respectively. The integrated model outperformed the non-AI model in the development and validation cohorts (p < 0.001 for both). CONCLUSION: The commercial AI-based mammography analysis software could be a valuable adjunct to clinical decision-making for managing US-detected breast lesions. CLINICAL RELEVANCE STATEMENT: The commercial AI-based mammography analysis software could potentially reduce unnecessary biopsies and improve patient outcomes. KEY POINTS: • Breast US has high rates of false-positive interpretations. • A commercial AI-based mammography analysis software could distinguish mammograms having benign outcomes from those revealing cancers after US-guided breast biopsy. • A commercial AI-based mammography analysis software may improve interpretations for breast US-detected lesions.

High-resolution diffusion-weighted MRI plus mammography for detecting clinically occult breast cancers in women with dense breasts.

PURPOSE: To compare the performance of mammography, high-resolution DW-MRI, DCE-MRI, and their combinations in detecting clinically occult breast cancer in women with dense breasts. METHOD: 544 breasts from 281 consecutive asymptomatic women with dense breasts were retrospectively identified. They underwent breast MRI for preoperative evaluation of breast cancers (n = 214) or as supplemental screening (n = 67) including DCE-MRI and DW-MRI (b values, 0 and 1000 sec/mm2; in-plane resolution, 1.1 × 1.1 mm2 and 1.3 × 1.3 mm2; section thickness, 3 mm), in addition to mammography. Three readers independently reviewed each examination on a per-breast basis. Histopathology and at least two year of imaging follow-up served as the gold standard. The sensitivities and specificities of different imaging modalities were compared using McNemar test. RESULTS: 230 of 544 breasts (42 %) had malignant lesions. The sensitivity of DW-MRI was higher than that of mammography (77.0 % vs 57.9 %; adjusted p < 0.001), but lower than that of DCE-MRI (84.8 %; adjusted p = 0.014). The specificity of DW-MRI was comparable to those of mammography (98.1 % vs 99.1 %; adjusted p > 0.999) and DCE-MRI (97.1 %; adjusted p > 0.999). DW-MRI plus mammography had a comparable sensitivity and specificity to those of DCE-MRI plus mammography (88.6 % vs 90.9 % and 97.1 % vs 96.2 %; adjusted p > 0.999 for both). CONCLUSIONS: High-resolution DW-MRI had a sensitivity higher than mammography and lower than DCE-MRI. Nevertheless, DW-MRI plus mammography showed a comparable sensitivity and specificity to DCE-MRI plus mammography for detecting clinically occult cancers in women with dense breasts.

Unenhanced Breast MRI With Diffusion-Weighted Imaging for Breast Cancer Detection: Effects of Training on Performance and Agreement of Subspecialty Radiologists.

OBJECTIVE: To investigate whether reader training improves the performance and agreement of radiologists in interpreting unenhanced breast magnetic resonance imaging (MRI) scans using diffusion-weighted imaging (DWI). MATERIALS AND METHODS: A study of 96 breasts (35 cancers, 24 benign, and 37 negative) in 48 asymptomatic women was performed between June 2019 and October 2020. High-resolution DWI with b-values of 0, 800, and 1200 sec/mm² was performed using a 3.0-T system. Sixteen breast radiologists independently reviewed the DWI, apparent diffusion coefficient maps, and T1-weighted MRI scans and recorded the Breast Imaging Reporting and Data System (BI-RADS) category for each breast. After a 2-h training session and a 5-month washout period, they re-evaluated the BI-RADS categories. A BI-RADS category of 4 (lesions with at least two suspicious criteria) or 5 (more than two suspicious criteria) was considered positive. The per-breast diagnostic performance of each reader was compared between the first and second reviews. Inter-reader agreement was evaluated using a multi-rater κ analysis and intraclass correlation coefficient (ICC). RESULTS: Before training, the mean sensitivity, specificity, and accuracy of the 16 readers were 70.7% (95% confidence interval [CI]: 59.4-79.9), 90.8% (95% CI: 85.6-94.2), and 83.5% (95% CI: 78.6-87.4), respectively. After training, significant improvements in specificity (95.2%; 95% CI: 90.8-97.5; P = 0.001) and accuracy (85.9%; 95% CI: 80.9-89.8; P = 0.01) were observed, but no difference in sensitivity (69.8%; 95% CI: 58.1-79.4; P = 0.58) was observed. Regarding inter-reader agreement, the κ values were 0.57 (95% CI: 0.52-0.63) before training and 0.68 (95% CI: 0.62-0.74) after training, with a difference of 0.11 (95% CI: 0.02-0.18; P = 0.01). The ICC was 0.73 (95% CI: 0.69-0.74) before training and 0.79 (95% CI: 0.76-0.80) after training (P = 0.002). CONCLUSION: Brief reader training improved the performance and agreement of interpretations by breast radiologists using unenhanced MRI with DWI.

Prediction of the MammaPrint Risk Group Using MRI Features in Women With Estrogen Receptor-Positive, HER2-Negative, and 1 to 3 Node-Positive Invasive Breast Cancer.

BACKGROUND: MammaPrint assigns chemotherapeutic benefits to patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative, and 1 to 3 node-positive invasive breast cancer. However, its cost and time-consuming nature limit its use in certain clinical settings. We aimed to develop and validate the prediction models for the low MammaPrint risk group using clinicopathologic and MRI features. PATIENTS AND METHODS: Overall, 352 women with ER-positive, HER2-negative, and 1 to 3 node-positive invasive breast cancer were retrospectively reviewed and assigned to development (n = 235) and validation sets (n = 117). Univariate and multivariate analyses identified features associated with the low MammaPrint risk group. The area under the receiver operating characteristic curves (AUROCs) of models based on clinicopathologic, MRI, and combined features were evaluated. RESULTS: Development set multivariate analysis showed that clinicopathologic features including low histologic grade (odds ratio [OR], 5.29; P = .02), progesterone receptor-positivity (OR, 3.23; P = .01), and low Ki-67 (OR, 6.05; P < .001) and MRI features, including peritumoral edema absence (OR, 2.24; P = .04) and a high proportion of persistent components (OR, 1.15; P = .004) were significantly associated with the low MammaPrint risk group. The AUROCs of models based on clinicopathologic, MRI, and combined features were 0.77, 0.64, and 0.80 in the development and 0.66, 0.60, and 0.70 in the validation sets, respectively. CONCLUSION: The combined model incorporating clinicopathologic and MRI features showed potential in predicting the low MammaPrint risk group, and may support decision-making in clinical settings with limited access to MammaPrint.

Assessing internal mammary lymph node metastasis by breast magnetic resonance imaging in breast cancer.

The internal mammary lymph nodes (IMLNs) are a main pathway of metastasis in breast cancer, and breast magnetic resonance imaging (MRI) plays an important role in staging that disease. We investigated the MRI parameters that can predict metastatic IMLNs and evaluated their diagnostic performance by comparing the breast MRI findings for metastatic and benign IMLNs. From January 2016 to December 2020, 474 cases of enlarged IMLNs on breast MRI were identified. By cytopathology or integrated positron emission tomography/computed tomography (PET/CT), 168 IMLNs were confirmed as metastatic, and 81 were confirmed as benign. Breast MRIs were reviewed by 2 radiologists, and various parameters (node axes, fatty hilum, necrosis, margin characteristics, restricted diffusion, and involved levels; primary tumor location and skin involvement) were assessed. Independent t-tests, receiver operating characteristic (ROC) curve analyses, chi-square tests, and Fisher exact tests were performed to compare and evaluate the diagnostic accuracy of the imaging findings. Significant differences in the breast MRI findings for the short and long axes, fatty hilum, necrosis, margin characteristics, diffusion restriction, and tumor location were observed between benign and metastatic IMLNs. Compared with the long axis and the ratio of the axes, the short axis had the best diagnostic value (higher area under the ROC curve) for predicting metastatic IMLNs. In conclusion, breast MRI parameters such as short axis, presence of fatty hilum, necrosis, margin characteristics, and diffusion restriction can be used to evaluate and differentiate benign from metastatic IMLNs, offering valuable insights to improve diagnosis and treatment planning in breast cancer.

Improving mammography interpretation for both novice and experienced readers: a comparative study of two commercial artificial intelligence software.

OBJECTIVES: To evaluate the improvement of mammography interpretation for novice and experienced radiologists assisted by two commercial AI software. METHODS: We compared the performance of two AI software (AI-1 and AI-2) in two experienced and two novice readers for 200 mammographic examinations (80 cancer cases). Two reading sessions were conducted within 4 weeks. The readers rated the likelihood of malignancy (range, 1-7) and the percentage probability of malignancy (range, 0-100%), with and without AI assistance. Differences in AUROC, sensitivity, and specificity were analyzed. RESULTS: Mean AUROC increased in both novice (0.86 to 0.90 with AI-1 [p = 0.005]; 0.91 with AI-2 [p < 0.001]) and experienced readers (0.87 to 0.92 with AI-1 [p < 0.001]; 0.90 with AI-2 [p = 0.004]). Sensitivities increased from 81.3 to 88.8% with AI-1 (p = 0.027) and to 91.3% with AI-2 (p = 0.005) in novice readers, and from 81.9 to 90.6% with AI-1 (p = 0.001) and to 87.5% with AI-2 (p = 0.016) in experienced readers. Specificity did not decrease significantly in both novice (p > 0.999, both) and experienced readers (p > 0.999 with AI-1 and 0.282 with AI-2). There was no significant difference in the performance change depending on the type of AI software (p > 0.999). CONCLUSION: Commercial AI software improved the diagnostic performance of both novice and experienced readers. The type of AI software used did not significantly impact performance changes. Further validation with a larger number of cases and readers is needed. CLINICAL RELEVANCE STATEMENT: Commercial AI software effectively aided mammography interpretation irrespective of the experience level of human readers. KEY POINTS: • Mammography interpretation remains challenging and is subject to a wide range of interobserver variability. • In this multi-reader study, two commercial AI software improved the sensitivity of mammography interpretation by both novice and experienced readers. The type of AI software used did not significantly impact performance changes. • Commercial AI software may effectively support mammography interpretation irrespective of the experience level of human readers.

Patterns of δ15N in forest soils and tree foliage and rings between climate zones in relation to atmospheric nitrogen deposition: A review.

The stable nitrogen (N) isotope ratio (δ15N) of forest samples (soils, tree foliage, and tree rings) has been used as a powerful indicator to explore the responses of forest N cycling to atmospheric N deposition. This review investigated the patterns of δ15N in forest samples between climate zones in relation to N deposition. Forest samples exhibited distinctive δ15N patterns between climate zones due to differences in site conditions (i.e., N availability and retention capacity) and the atmospheric N deposition characteristics (i.e., N deposition rate, N species, and δ15N of deposited N). For example, the δ15N of soil and foliage was higher for tropical forests than for other forests by >1.2 ‰ and 4 ‰, respectively due to the site conditions favoring N losses coupled with relatively low N deposition for tropical forests. This was further supported by the unchanged or increased δ15N of tree rings in tropical forests, which contrasts with other climate zones that exhibited a decreased wood δ15N since the 1920s. Subtropical forests under a high deposition of reduced N (NHy) had a lower δ15N by 2-5 ‰ in the organic layer compared with the other forests, reflecting high retention of 15N-depleted NHy deposition. At severely polluted sites in East Asia, the decreased δ15N in wood also reflected the consistent deposition of 15N-depleted NHy. Though our data analysis represents only a subset of global forest sites where atmospheric N deposition is of interest, the results suggest that the direction and magnitude of the changes in the δ15N of forest samples are related to both atmospheric N and site conditions particularly for tropical vs. subtropical forests. Site-specific information on the atmospheric N deposition characteristics would allow more accurate assessment of the variations in the δ15N of forest samples in relation to N deposition.

Correlation of shear-wave elastography parameters with the molecular subtype and axillary lymph node status in breast cancer.

PURPOSE: To examine correlations between shear-wave elastography (SWE) parameters with molecular subtype and axillary lymph node (LN) status of breast cancer. METHODS: We retrospectively analyzed 545 consecutive women (mean age, 52.7 ± 10.7 years; range, 26-83) with breast cancer who underwent preoperative breast ultrasound with SWE between December 2019 and January 2021. SWE parameters (Emax, Emean, and Eratio) and the histopathologic information from surgical specimens including histologic type, histologic grade, size of invasive cancer, hormone receptor and HER2 status, Ki-67 proliferation index, and axillary LN status were analyzed. The relationships between SWE parameters and histopathologic findings were analyzed using an independent sample t-test, one-way ANOVA test with Tukey's post hoc test, and logistic regression analyses. RESULTS: Higher stiffness values of SWE were associated with larger lesion size (>20 mm) on ultrasound, high histologic grade, larger invasive cancer size (>20 mm), high Ki-67, and axillary LN metastasis. Emax and Emean were the lowest in the luminal A-like subtype, and all three parameters were the highest in the triple-negative subtype. Lower value of Emax was independently associated with the luminal A-like subtype (P = 0.04). Higher value of Emean was independently associated with axillary LN metastasis for tumors ≤ 20 mm (P = 0.03). CONCLUSION: Increases in the tumor stiffness values on SWE were significantly associated with aggressive histopathologic features of breast cancer. Lower stiffness values were associated with the luminal A-like subtype, and tumors with higher stiffness values were associated with axillary LN metastasis in small breast cancers.

Pseudoangiomatous Stromal Hyperplasia of the Breast in a Female Adolescent Presenting as Bilateral Gigantomastia.

Pseudoangiomatous stromal hyperplasia (PASH) is a rare idiopathic proliferative mesenchymal breast disease related to hormonal imbalance, and thus extremely rare in children and adolescents. In addition, PASH manifests as a bilateral gigantomastia in some cases with no established cause or treatment. Here, we report a case of a rapidly developed PASH presenting with bilateral gigantomastia in a 14-year-old premenarchial female patient. Considering the patient's age and emotions and the need for nipple-areolar complex repositioning, we performed reduction mammoplasty rather than total mastectomy despite the possibility of recurrence. Although some masses could not be completely removed, no complications, such as infection, wound dehiscence, or hematoma occurred postoperatively. The patient was stable during the 18-month follow-up period, although an evidence of recurrent and residual disease was noted upon ultrasonography.

[Mammography-Guided Interventional Procedure]. / ìœ ë°©ì´¬ì˜ìˆ ìœ ë„í•˜ 중재 ì‹œìˆ .

Mammography has been the standard screening method for breast cancer. In women with suspicious calcifications and architectural distortion identified on mammography or digital breast tomosynthesis only without detected on breast US, stereotactic biopsy and mammography-guided preoperative localization is one of the method for pathologic diagnosis. This review aims to describe the indication, contraindication, technique of stereotactic biopsy, clip placement after stereotactic biopsy, and digital breast tomosynthesis-guided stereotactic biopsy. In addition, this article reviews mammography-guided preoperative localization using a wire or non-wire device.

Effects of Preoperative Breast MRI on Breast Cancer Survival Outcomes in Women Aged 35 Years and Younger.

Background The impact of preoperative breast MRI on the long-term outcomes in patients with breast cancer who are 35 years and younger has not been established. Purpose To evaluate the impact of preoperative breast MRI on recurrence-free survival (RFS) and overall survival (OS) in women with breast cancer who are 35 years and younger by using propensity score matching. Materials and Methods A total of 708 women who were 35 years and younger (mean age, 32 years ± 3 [SD]) and diagnosed with breast cancer from 2007 to 2016 were retrospectively identified. Patients who underwent preoperative MRI (MRI group) were matched with those who did not (no MRI group) according to 23 patient and tumor characteristics. RFS and OS were compared using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to estimate the hazard ratios (HRs). Results Of 708 women, 125 patient pairs were matched. In the MRI group versus the no MRI group, the mean follow-up time was 82 months ± 32 versus 106 months ± 42, and the rates of total recurrence and death were 22% (104 of 478 patients) versus 29% (66 of 230 patients) and 5% (25 of 478 patients) versus 12% (28 of 230 patients), respectively. The time to recurrence was 44 months ± 33 in the MRI group and 56 months ± 42 in the no MRI group. After propensity score matching, the MRI and no MRI groups did not show significant differences in total recurrence (HR, 1.0; P = .99), local-regional recurrence (HR, 1.3; P = .42), contralateral breast recurrence (HR, 0.7; P = .39), or distant recurrence (HR, 0.9; P = .79). The MRI group showed a tendency toward better OS, but this was not statistically significant (HR, 0.47; P = .07). In the entire unmatched cohort, MRI was not an independent significant factor for predicting RFS or OS. Conclusion Preoperative breast MRI was not a significant prognostic factor for recurrence-free survival in women 35 years and younger with breast cancer. A tendency toward better overall survival was observed in the MRI group, but this was not significant. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Kim and Moy in this issue.

Outcomes and imaging features of microinvasive carcinoma and ductal carcinoma in situ: Matched cohort study.

INTRODUCTION: The purpose of this study is to investigate the differences in clinical outcomes between microinvasive carcinoma (mIC) and ductal carcinoma in situ (DCIS) and compare the imaging features of both using mammography, US and MRI. MATERIALS AND METHODS: This retrospective study was approved by our institutional review board. Between January 2011 and December 2013, 516 women with mIC or DCIS confirmed by surgery were included. Patients were matched with propensity score matching to compare recurrence-free survival (RFS). RFS was compared using a Cox proportional hazards model. Imaging features were also compared between the two groups. RESULTS: Among 516 women, 219 mIC and 297 DCIS tumors were identified. After matching, 132 women were allocated to each group. The mean follow-up duration was 80.2 months. In the matched cohort, no statistically significant association was observed between the DCIS and mIC groups in terms of total recurrence (hazard ratio [HR]: 1.7; 95% confidence interval [CI]: 0.8-4.0; P = 0.19), local-regional recurrence (HR: 3.4; 95% CI: 0.9-12.3, P = 0.07), or contralateral recurrence (HR: 0.9; 95% CI: 0.3-2.8, P = 0.89). Non-mass lesions at US (P = 0.004), moderate or marked background parenchymal enhancement (P = 0.04), and higher peak enhancement (P = 0.02) at MRI were more commonly seen in the mIC group than in the DCIS group. CONCLUSION: Microinvasive carcinomas are distinct from DCIS in terms of imaging features, but no statistically significant association in recurrence survival.

Assessment of sources variability of riverine particulate organic matter with land use and rainfall changes using a three-indicator (δ13C, δ15N, and C/N) Bayesian mixing model.

In intensive agricultural watersheds, riverine particulate organic matter (POM) may be transported from many sources such as rice paddies, crop uplands, forests, and livestock farming areas during rainy seasons. However, the impacts of land-use and rainfall changes on the POM sources are not well understood. In this study, changes in the sources of riverine POM were investigated in an agricultural area of Korea between 2014 and 2020/21. During this period, land-use and rainfall patterns changed dramatically. The δ13C, δ15N, and C/N of the POM sources as well as those of riverine POM were analyzed, and a stable isotope analysis in R (SIAR) model was utilized for source apportionment. There were differences in δ13C, δ15N, and C/N among the sources. For example, manure had higher δ13C (-22.6 ± 3.3‰) and δ15N (+10.6 ± 5.9‰) than soils (from -28.0 ± 0.8‰ to -25.1 ± 1.2‰ for δ13C and +3.6 ± 1.7‰ to +9.8 ± 1.4‰ for δ15N). For soils, the δ13C and δ15N were higher for upland soils, while C/N was greater for forest soils than for others. For riverine POM, the δ15N marginally changed; however, the δ13C and C/N increased from -26.1 ± 0.9‰ to -20.8 ± 5.3‰ and from +7.7 ± 1.7 to +18.8 ± 8.3 between 2014 and 2020/21, respectively. The SIAR model showed that the contributions of paddy (from 41.0% to 14.9%) and upland fields (from 48.1% to 23.7%) to riverine POM decreased between the periods due to decreased paddy area and the implementation of best management practice on upland fields, respectively. However, the contribution of forests (from 3.5% to 28.0%) and manure (from 7.4% to 33.5%) increased probably due to improper management of forest clear-cutting sites and livestock manure storage sites. The contributions of agricultural soils to riverine POM decreased in drier years. Our study suggests that land management rather than land-use area is critical in riverine POM management, particularly in wetter years.

The Accuracy of Mammography, Ultrasound, and Magnetic Resonance Imaging For the Measurement of Invasive Breast Cancer With Extensive Intraductal Components.

BACKGROUND: The precise preoperative evaluation of radiologic tumor size with extensive intraductal component (EIC) is important. This study compared the accuracy of mammography, ultrasound (US), and magnetic resonance imaging (MRI) to measure invasive breast cancer with EIC. METHODS: Between 2007 and 2012, we collected data from 6816 patients who underwent surgery for invasive breast cancer at our institution. We reviewed the postoperative surgical reports of the tumors, in which the invasive tumor size and EIC were measured separately. Finally, we included 370 women who underwent preoperative mammography, US, and MRI. Each modality was retrospectively reviewed to measure the size of invasive breast cancer with EIC. The reference standard was surgical pathologic size and the accuracies of the image were evaluated. RESULTS: Spearman's correlation coefficient for the size of invasive cancer with EIC was good between MRI (r = 0.741) and pathology, and moderate between mammography (r = 0.661) or US (r = 0.514) and pathology. Both mass and nonmass lesions showed good correlations (intraclass correlation coefficient [ICC] = 0.672 and 0.612, respectively) in MRI. Furthermore, the subgroup of tumors without microcalcifications showed a higher correlation with MRI (ICC = 0.796) than with mammography (ICC = 0.620). However, the subgroup with microcalcifications showed a good correlation with mammography (ICC = 0.702) compared to MRI (ICC = 0.680) and US (ICC = 0.532). CONCLUSION: The lesion on mammography, US, and MRI reflected preoperative size of invasive cancer with EIC. MRI shows a higher correlation than mammography and US. However, cancer with calcifications of mammography shows a more accurate size than MRI or US.

[Patterns in the Use and Perception of Digital Breast Tomosynthesis: A Survey of Korean Breast Radiologists]. / 디지털 ìœ ë°© í† ëª¨ì‹ í Œì‹œìŠ¤ì— 대한 국내 사용 현황과 인식에 관한 설문조사 연구.

Purpose: To evaluate the pattern of use and the perception of digital breast tomosynthesis (DBT) among Korean breast radiologists. Materials and Methods: From March 22 to 29, 2021, an online survey comprising 27 questions was sent to members of the Korean Society of Breast Imaging. Questions related to practice characteristics, utilization and perception of DBT, and research interests. Results were analyzed based on factors using logistic regression. Results: Overall, 120 of 257 members responded to the survey (response rate, 46.7%), 67 (55.8%) of whom reported using DBT. The overall satisfaction with DBT was 3.31 (1-5 scale). The most-cited DBT advantages were decreased recall rate (55.8%), increased lesion conspicuity (48.3%), and increased cancer detection (45.8%). The most-cited DBT disadvantages were extra cost for patients (46.7%), insufficient calcification characterization (43.3%), insufficient improvement in diagnostic performance (39.2%), and radiation dose (35.8%). Radiologists reported increased storage requirements and interpretation time for barriers to implementing DBT. Conclusion: Further improvement of DBT techniques reflecting feedback from the user's perspective will help increase the acceptance of DBT in Korea.

Tablet-based cognitive behavioral intervention to improve arthritis associated fatigue: A pilot study.

This pilot study evaluated the effect of the tablet-based cognitive behavioral intervention ("Tab-CBI") on daily steps, fatigue, and self-efficacy. Tab-CBI combined simple walking and a cognitive behavioral approach. An experimental pretest-posttest repeated measures design was used with 24 older adults. RM-ANOVA results showed a significant group difference (Tab-CBI vs. Comparison), F (1, 22) = 2.25, p =0.048 and time difference (baseline vs. week 4 vs. week 6), F (2, 44) =5.04, p =0.01 in daily steps. There was no significant group difference, F (1, 22) = 2.99, p =0.09, but significant time difference existed, F (2, 44) =2.65, p =0.04 in the PROMIS Fatigue scores. In the PROMIS Self-efficacy scores, no significant group difference, F (1, 22) = 0.02, p =0.90) was found, but significant time difference existed, F (2, 44) =3.27, p = 0.04. The findings provide preliminary evidence for the positive impact of Tab-CBI, but should be interpreted cautiously.

Features of breast cancer initially assessed as probably benign on ultrasound: A retrospective study.

We evaluated the features of breast cancers initially assessed as probably benign at ultrasound (US). Of the 7098 patients who underwent breast cancer surgery at our institution between 2014 and 2016, 179 lesions in 178 patients who had both a prior US with Breast Imaging Reporting and Data System (BI-RADS) category 3 assessment and a recent US with a diagnosis of breast cancer were enrolled. Prior and recent US findings and category were retrospectively reassessed in line with the BI-RADS Atlas and analyzed. Of the 179 BI-RADS 3 lesions, 105 (59%) were retrospectively reassessed to category 4 and 74 (41%) retained category 3. Noncircumscribed margin, irregular shape, posterior enhancement, and nonparallel orientation were more frequently observed in the reassessment category 4 group than in the reassessment category 3 group (94% vs 43%, 81% vs 19%, 16% vs 4%, 14% vs 0%, respectively). The recent US revealed that 150 of the 179 lesions (84%) had > 20% size increase, and 121 (68%) showed morphologic changes. Margin was the most frequently observed morphologic feature to change (41%, 73/179). Care should be taken to look for subtle but suspicious US features and changes in mass, especially of margin, for early diagnosis of breast cancer.

A Comparative Analysis of Patient Satisfaction and Cosmetic Outcomes after Breast Reconstruction through BREAST-Q and the Judgment of Medical Panels: Does it Reflect Well in Terms of Aesthetics in Korean Patients?

Background Currently, the BREAST-Q can effectively measure patient's satisfaction on the quality of life from the patient's perspective in relation to different type of breast reconstruction. However, evaluation of patient satisfaction and cosmetic outcomes in breast reconstruction may have potential to led bias. Methods To maximize the benefits of using BREAST-Q to evaluate clinical outcome, we performed comparative study focused on the correlation between postoperative BREAST-Q and cosmetic outcomes assessed by medical professionals. For the current analysis, we used three postoperative BREAST-Q scales (satisfaction with breast, psychosocial well-being, and sexual well-being). The Ten-Point Scale by Visser et al was applied to provide reproducible grading of the postoperative cosmetic outcomes of the breast. The system includes six subscales that measured overall aesthetic outcome, volume, shape, symmetry, scarring, and nipple-areolar complex. The photographic assessments were made by five medical professionals who were shown photographs on a computer screen in a random order. Obtained data were stored in Excel and evaluated by Spearman's correlations using SPSS Statistics. Results We enrolled 92 women in this study, 10 did not respond to all scales of postoperative BREAST-Q, the remaining 82 women had undergone breast reconstruction. The correlation between BREAST-Q score and aesthetic score measured by Ten-Point Scale for the three BREAST-Q scales all show positive values in Spearman's correlation coefficient. Conclusion A significant correlation without any bias observed was found between the patient's satisfaction measured by BREAST-Q after breast reconstruction and the medical expert's aesthetic evaluation.