Comparison of wire-guided localization (WGL) and radio-guided occult lesion localization (ROLL) in localization of non-palpable breast lesions.

BACKGROUND: The number of patients with non-palpable breast lesions has increased gradually. This is because of the technological development in imaging techniques and the screening programs that lead to early detection of breast lesions. The number of patients with non-palpable breast lesions has increased gradually. This is because of the technological development in imaging techniques and the screening programs that lead to early detection of breast lesions. The aim of marking the non-palpable breast lesions is to achieve accurate lesion localization, to obtain the better cosmetic result with less tissue loss and to provide negative surgical margin. AIM OF THE STUDY: In the current study, we aimed to compare the wire-guided localization (WGL) technique with the radio-guided occult lesion localization (ROLL) technique to assess their accuracy and efficacy in non-palpable breast lesions localization. METHODS: This is a retrospective study conducted at Baheya center for Early Detection and Treatment of Breast Cancer from January 2018 and June2022,where 670 patients with non-palpable breast lesions underwent an excision were enrolled randomly in ROLL group (n = 320) and WGL (n = 350). RESULTS: Both the localization time and the time of operation were significantly decreased with the ROLL in comparison to WGL(P < 0.001). Complete lesion excision with clear margins were reported in 119/135(88.2%) of ROLL group and in 130/159 (81.8%) of WGL group and the difference was significant (P < 0.001). Reoperations (re-lumpectomy or mastectomy) were done as a second procedure on 16(11.8%) of the ROLL patients compared with 29(18.2%) in the WGL patients(P < 0.001). CONCLUSION: This study shows that ROLL is as effective as WGL for non-palpable breast lesions excision. Also, ROLL improve the outcomes by decreasing the duration of surgery, localization time, achieving a higher percentage of clear margin in spite of lower specimen size and scar length.

AI-Based Cancer Detection Model for Contrast-Enhanced Mammography.

BACKGROUND: The recent development of deep neural network models for the analysis of breast images has been a breakthrough in computer-aided diagnostics (CAD). Contrast-enhanced mammography (CEM) is a recent mammography modality providing anatomical and functional imaging of the breast. Despite the clinical benefits it could bring, only a few research studies have been conducted around deep-learning (DL) based CAD for CEM, especially because the access to large databases is still limited. This study presents the development and evaluation of a CEM-CAD for enhancing lesion detection and breast classification. MATERIALS & METHODS: A deep learning enhanced cancer detection model based on a YOLO architecture has been optimized and trained on a large CEM dataset of 1673 patients (7443 images) with biopsy-proven lesions from various hospitals and acquisition systems. The evaluation was conducted using metrics derived from the free receiver operating characteristic (FROC) for the lesion detection and the receiver operating characteristic (ROC) to evaluate the overall breast classification performance. The performances were evaluated for different types of image input and for each patient background parenchymal enhancement (BPE) level. RESULTS: The optimized model achieved an area under the curve (AUROC) of 0.964 for breast classification. Using both low-energy and recombined image as inputs for the DL model shows greater performance than using only the recombined image. For the lesion detection, the model was able to detect 90% of all cancers with a false positive (non-cancer) rate of 0.128 per image. This study demonstrates a high impact of BPE on classification and detection performance. CONCLUSION: The developed CEM CAD outperforms previously published papers and its performance is comparable to radiologist-reported classification and detection capability.

Assessment of macronutrients dietary intake, central adiposity among pre- and postmenopausal Egyptian women with benign and malignant breast tumors.

BACKGROUND: Breast cancer (BC) is the second most frequent cancer in women and the second most common cancer worldwide. Lifestyle factors, like body weight, physical activity and diet, may be accompanying with higher BC risk. AIM: The assessment of macronutrients dietary intake; protein, fat, carbohydrates and their components of amino, fatty acids, and central obesity/adiposity among pre- and postmenopausal Egyptian women with benign and malignant breast tumors. METHODS: The current case control study included 222 women: 85 control, 54 benign and 83 breast cancer patients. Clinical, anthropocentric and biomedical examinations were performed. Dietary history and health attitude were done. RESULTS: The anthropometric parameters including waist circumference (WC) and the body mass index (BMI) of the benign and the women with malignant breast lesions showed the highest values when compared to the control (35.45 ± 15.58 km2 and 101.24 ± 15.01 cm, 31.39 ± 6.77 km2 and 98.85 ± 13.53 cm and 27.51 ± 7.10 km2 and 84.33 ± 13.78 cm). The biochemical parameters revealed high concentration of the total cholesterol (TC) (192.83 ± 41.54 mg/dl), low density lipoprotein-cholesterol (LDL-C) (117.88 ± 35.18 mg/dl) and the median insulin level 13.8 (10.2-24.1) µu/ml in the malignant patients with high significant difference compared to the control. The malignant patients had the highest daily caloric intake (795.84 ± 519.95 K calories) proteins (65.39 ± 28.77 g), total fats (69.09 ± 32.15 g) and carbohydrates (196.70 ± 85.35 g), when compared to the control. Data also revealed the high daily consumption of the different types of the fatty acids with high linoleic/linoleinic ratio among the malignant group (14.284 ± 6.25). Branched chain amino acids (BGAAs), sulphur amino acids (SAAs), conditional amino acids (CAAs) and aromatic amino acids (AAAs) proved to be the highest in this group. Correlation coefficient between the risk factors revealed either positive or negative weak correlation except that between serum LDL-C concentration and the amino acids (isoleucine, valine cysteine, tryptophan and tyrosine) and negative association with the protective polyunsaturated fatty acids. CONCLUSION: Participants with breast cancer had the greatest levels of body fatness and unhealthy feeding habits relative to their high calorie, protein, carbohydrate, and fat intake.

Deformable registration with intensity correction for CESM monitoring response to Neoadjuvant Chemotherapy.

This paper proposes a robust longitudinal registration method for Contrast Enhanced Spectral Mammography in monitoring neoadjuvant chemotherapy. Because breast texture intensity changes with the treatment, a non-rigid registration procedure with local intensity compensations is developed. The approach allows registering the low energy images of the exams acquired before and after the chemotherapy. The measured motion is then applied to the corresponding recombined images. The difference of registered images, called residual, makes vanishing the breast texture that did not changed between the two exams. Consequently, this registered residual allows identifying local density and iodine changes, especially in the lesion area. The method is validated with a synthetic NAC case where ground truths are available. Then the procedure is applied to 51 patients with 208 CESM image pairs acquired before and after the chemotherapy treatment. The proposed registration converged in all 208 cases. The intensity-compensated registration approach is evaluated with different mathematical metrics and through the repositioning of clinical landmarks (RMSE: 5.9 mm) and outperforms state-of-the-art registration techniques.

Swallowing sparing intensity modulated radiotherapy versus standard parotid sparing intensity-modulated radiotherapy for treatment of head and neck cancer: a randomized clinical trial.

BACKGROUND: Dysphagia is a distressing symptom during and after radiotherapy treatment in head and neck cancer (HNC) patients. The objective of this prospective study was to investigate whether swallowing sparing intensity modulated radiotherapy (SW-IMRT) reduces the occurrence of swallowing dysfunction compared to the standard IMRT (ST-IMRT). METHODS: We randomized, planned, and treated patients with HNC who needed whole neck irradiation using the simultaneous integrated boost (SIB) IMRT technique. Doses of 70, 60, and 54 Gy (over 33 daily fractions) were prescribed to the primary tumor, high-risk and low-risk regions, respectively. The postoperative cases received 60 and 54 Gy (over 30 daily fractions) to the high-risk planning target volume (PTV) and low-risk PTV. We contoured organs at risk related to swallowing dysfunction (SWOARs) in all cases. In the ST-IMRT group, parotids only were spared. In the SW-IMRT group, parotids and SWOARs outside the high-risk PTV were spared. Assessment of dysphagia included clinical and instrumental evaluation. RESULTS: One hundred forty-six patients ended their radiotherapy treatment. Dose distribution showed comparable PTV coverage and no difference in parotid glands sparing between the two groups. SWOARs dose reduction with SW-IMRT differs according to tumor location and its overlap with SWOARs. Using different assessment methods, SW-IMRT was associated with a lower occurrence of dysphagia up to one year after treatment. There was no difference between the two groups regarding acute dysphagia (p = 0.262), overall survival (p = 0.811), and disease-free survival (p = 0.876). CONCLUSION: SW-IMRT is significantly better than ST-IMRT regarding a physician-rated and objective assessment of swallowing dysfunction at short- and long-term post-treatment follow-up.

Phyllodes Tumors of the Breast (the Egyptian Experience).

Phyllodes tumors (PT) are rare fibroepithelial lesions, about 0.3-0.5% of all breast tumors. This study is an evaluation of patient characteristics, clinicopathologic features, diagnostic tools, therapeutic options, risk factors for recurrence, and distant metastasis and follow-up findings in patients with PTs. One hundred twenty-seven patients with pathologically proved PTs in the National Cancer Institute, Cairo University, Egypt, from January 2011 to January 2016 were reviewed and analyzed. Sixty patients presented with benign PTs (47.2%), 34 had borderline PTs (26.8%), and 33 had malignant PTs (26%). The mean follow-up period was approximately 36 months; local recurrence occurred in 34 patients, 9 benign cases (14.5%), 11 borderlines (32.4%), and 14 malignant PTs (42.4%). Mastectomy was the most commonly used surgery in recurrent cases (61.4%). Axillary staging was performed in 31 cases (24.4%); only 2 cases showed positive nodal metastasis (6.5%) and were of the malignant subtype. Distant metastasis occurred in 12 patients, 4 with borderline PTs, and 8 with malignant PTs. The most common site for metastasis was the lungs and bones. Adjuvant radiotherapy was applied in 9 patients, 2 in borderline phyllodes, and 7 in malignant phyllodes; post-radiotherapy recurrence occurred in 5 malignant phyllodes patients. Chemotherapy was employed in 10 metastatic patients (4 with borderline and 6 with malignant phyllodes); excision with clear margins is important to reduce the local recurrence. Routine axillary staging should not be done. The adjuvant radiation therapy is still controversial. Local recurrence can develop even after appropriate surgery. Therefore, close follow-up is mandatory.

Added value of contrast-enhanced mammography in assessment of breast asymmetries.

OBJECTIVE: To evaluate the clinical performance of contrast-enhanced spectral mammography (CESM) on asymmetries detected on a mammogram (MG). METHODS: This study was approved by the Scientific Research Review Board of the Radiology Department, and waiver of informed consent was applied for the uses of data of the included cases. The study included 125 female patients,33 (26.4%) who presented for screening and 92 (73.6%) who presented for a diagnostic MG. All had breast asymmetries on MG. Ultrasound examination and CESM using dual-energy acquisitions were performed for all patients. RESULTS: In all, 88/125 (70.4%) females had focal asymmetry (seen in two views and occupying less than a quadrant), 26/125 (20.8%) had global asymmetry (occupying more than one quadrant), 10/125 (8%) had asymmetry (seen in a single view and occupying less than a quadrant), and 1/125 had developing asymmetry (0.8%) (not present in the previous MG). Malignant lesions represented 91 cases, benign lesions represented 30 cases, and 4 cases were high-risk lesions. CESM sensitivity was 100% (v s 97.8 % for sono-mammography), specificity was 55.88% (v s 81.8% for sono-mammography), and the positive- and negative-predictive values were 85.85 and 100% (v s 93.7 and 93% for sono-mammography respectively) . CONCLUSION: In our study, we conclude that focal and global asymmetries with other suspicious mammographic findings were statistically significant for malignancy and CESM played an important role in delineating tumor size and extension. Any non-enhancing asymmetrical density correlated with a benign pathology, if not associated with other suspicious imaging findings. ADVANCES IN KNOWLEDGE:: Our study is the first to explore the added value of CESM to asymmetries detected in screening and diagnostic mammography.