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BACKGROUND: The use of preoperative magnetic resonance imaging (MRI) for early-stage breast cancer (ESBC) is increasing, but its utility in detecting additional malignancy is unclear and delays surgical management (Jatoi and Benson in Future Oncol 9:347-353, 2013. https://doi.org/10.2217/fon.12.186 , Bleicher et al. J Am Coll Surg 209:180-187, 2009. https://doi.org/10.1016/j.jamcollsurg.2009.04.010 , Borowsky et al. J Surg Res 280:114-122, 2022. https://doi.org/10.1016/j.jss.2022.06.066 ). The present study sought to identify ESBC patients most likely to benefit from preoperative MRI by assessing the positive predictive values (PPVs) of ipsilateral and contralateral biopsies. METHODS: A retrospective cohort study included patients with cTis-T2N0-N1 breast cancer from two institutions during 2016-2021. A "positive" biopsy result was defined as additional cancer (PositiveCancer) or cancer with histology often excised (PositiveSurg). The PPV of MRI biopsies was calculated with respect to age, family history, breast density, and histology. Uni- and multivariate logistic regression determined whether combinations of age younger than 50 years, dense breasts, family history, and pure ductal carcinoma in situ (DCIS) histology led to higher biopsy yield. RESULTS: Of the included patients, 447 received preoperative MRI and 131 underwent 149 MRI-guided biopsies (96 ipsilateral, 53 contralateral [18 bilateral]). PositiveCancer for ipsilateral biopsy was 54.2%, and PositiveCancer for contralateral biopsy was 17.0%. PositiveSurg for ipsilateral biopsy was 62.5%, and PositiveSurg for contralateral biopsy was 24.5%. Among the contralateral MRI biopsies, patients younger than 50 years were less likely to have PositiveSurg (odds ratio, 0.02; 95% confidence interval, 0.00-0.84; p = 0.041). The combinations of age, density, family history, and histology did not lead to a higher biopsy yield. CONCLUSION: Historically accepted factors for recommending preoperative MRI did not appear to confer a higher MRI biopsy yield. To prevent delays to surgical management, MRI should be carefully selected for individual patients most likely to benefit from additional imaging.
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Neoplasias da Mama , Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Mamografia , Estudos Retrospectivos , Biópsia , Imageamento por Ressonância Magnética/métodos , Biópsia Guiada por ImagemRESUMO
INTRODUCTION: The rate of mastectomy in lumpectomy-eligible patients with unilateral breast cancer is increasing. We sought to investigate the association between magnetic resonance imaging (MRI) and surgical management of patients with early-stage breast cancer by comparing the rate of mastectomy as first surgery in patients with and without preoperative MRI. METHODS: A bi-institutional retrospective study included patients diagnosed between 2016 and 2020. Lumpectomy-eligible patients with in situ and invasive cancer were included. Those receiving preoperative therapy, MRI before diagnosis, or with known bilateral cancer were excluded. The risk factors for bilateral and multicentric disease were accounted for. Fisher's exact and chi-square tests compared categorical variables, Wilcoxon two-sample test analyzed continuous variables, and multivariate analyses were performed with Poisson regression. RESULTS: Four hundred twenty-eight participants met inclusion criteria. Patients who received MRI were younger (58 versus 67 y; P < 0.001) and had denser breasts (group 3 or 4; 61% versus 25%; P < 0.001). Mastectomy rate was twice as high in patients undergoing MRI (32% versus 15%, rate ratio 2.16; P < 0.001), which remained significant in multivariate analysis (rate ratio 2.0; P < 0.001). Contralateral mastectomy (12% versus 4%; P = 0.466) and reexcision (13% versus 12%; P = 0.519) rates were similar. Time to surgery was greater in those receiving MRI alone and MRI biopsy (34 [no MRI] versus 45 [MRI] versus 62 [MRI biopsy]; P < 0.001 for both). CONCLUSIONS: MRI receipt is associated with a doubled rate of mastectomy in lumpectomy-eligible patients. Future work is needed to standardize patient selection for MRI to those with the highest likelihood of having additional undiagnosed disease.
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Neoplasias da Mama , Mastectomia , Humanos , Feminino , Mastectomia/métodos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Mastectomia Segmentar , Estudos Retrospectivos , Imageamento por Ressonância Magnética/métodos , Cuidados Pré-OperatóriosRESUMO
BACKGROUND: Health care reform in the United States has generated a paradigm shift in the practice of radiology aimed at increasing the degree of patient-centered care. We conducted a study to quantify the amount of time breast imaging radiologists spend on value-added activities at an academic comprehensive cancer center located in Miami, Florida, and accredited by the American College of Radiology as a Breast Imaging Center of Excellence. METHODS: A prospective, observational study was conducted during a period of 20 consecutive workdays. Three participating breast imaging radiologists maintained a real-time log of each activity performed. A generalized linear model was used to perform a 1-way analysis of variance. An alpha level of .05 was used to determine statistical significance. RESULTS: The average daily time dedicated to these activities was 92.1 minutes (range, 56.4-132.2). The amount of time significantly differed among breast imaging radiologists and correlated with their assigned daily role (P < .001 for both) but was independent of their years of experience. The daily role that required the most time was the interpretation of diagnostic imaging studies, which is when most interactions with patients, their relatives, and referring physicians occurred. The specific activity that required the most time was preparing for and participating in tumor boards. CONCLUSIONS: Our findings suggest that the breast imaging radiologists who participated in this study dedicated a significant amount of their time to value-added activities to help improve patients' experience across the continuity of their care. We propose that similar studies be conducted at other institutions to better assess the magnitude of this finding across different breast imaging care settings.
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Mama/diagnóstico por imagem , Institutos de Câncer/estatística & dados numéricos , Diagnóstico por Imagem/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Radiologistas/estatística & dados numéricos , Feminino , Humanos , Estudos Prospectivos , Estados UnidosRESUMO
BACKGROUND: The objective of this study was to demonstrate that computer-extracted image phenotypes (CEIPs) of biopsy-proven breast cancer on magnetic resonance imaging (MRI) can accurately predict pathologic stage. METHODS: The authors used a data set of deidentified breast MRIs organized by the National Cancer Institute in The Cancer Imaging Archive. In total, 91 biopsy-proven breast cancers were analyzed from patients who had information available on pathologic stage (stage I, n = 22; stage II, n = 58; stage III, n = 11) and surgically verified lymph node status (negative lymph nodes, n = 46; ≥ 1 positive lymph node, n = 44; no lymph nodes examined, n = 1). Tumors were characterized according to 1) radiologist-measured size and 2) CEIP. Then, models were built that combined 2 CEIPs to predict tumor pathologic stage and lymph node involvement, and the models were evaluated in a leave-1-out, cross-validation analysis with the area under the receiver operating characteristic curve (AUC) as the value of interest. RESULTS: Tumor size was the most powerful predictor of pathologic stage, but CEIPs that captured biologic behavior also emerged as predictive (eg, stage I and II vs stage III demonstrated an AUC of 0.83). No size measure was successful in the prediction of positive lymph nodes, but adding a CEIP that described tumor "homogeneity" significantly improved discrimination (AUC = 0.62; P = .003) compared with chance. CONCLUSIONS: The current results indicate that MRI phenotypes have promise for predicting breast cancer pathologic stage and lymph node status. Cancer 2016;122:748-757. © 2015 American Cancer Society.
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Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Lobular/patologia , Processamento de Imagem Assistida por Computador/métodos , Linfonodos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fenótipo , Prognóstico , Curva ROCRESUMO
Purpose To investigate relationships between computer-extracted breast magnetic resonance (MR) imaging phenotypes with multigene assays of MammaPrint, Oncotype DX, and PAM50 to assess the role of radiomics in evaluating the risk of breast cancer recurrence. Materials and Methods Analysis was conducted on an institutional review board-approved retrospective data set of 84 deidentified, multi-institutional breast MR examinations from the National Cancer Institute Cancer Imaging Archive, along with clinical, histopathologic, and genomic data from The Cancer Genome Atlas. The data set of biopsy-proven invasive breast cancers included 74 (88%) ductal, eight (10%) lobular, and two (2%) mixed cancers. Of these, 73 (87%) were estrogen receptor positive, 67 (80%) were progesterone receptor positive, and 19 (23%) were human epidermal growth factor receptor 2 positive. For each case, computerized radiomics of the MR images yielded computer-extracted tumor phenotypes of size, shape, margin morphology, enhancement texture, and kinetic assessment. Regression and receiver operating characteristic analysis were conducted to assess the predictive ability of the MR radiomics features relative to the multigene assay classifications. Results Multiple linear regression analyses demonstrated significant associations (R2 = 0.25-0.32, r = 0.5-0.56, P < .0001) between radiomics signatures and multigene assay recurrence scores. Important radiomics features included tumor size and enhancement texture, which indicated tumor heterogeneity. Use of radiomics in the task of distinguishing between good and poor prognosis yielded area under the receiver operating characteristic curve values of 0.88 (standard error, 0.05), 0.76 (standard error, 0.06), 0.68 (standard error, 0.08), and 0.55 (standard error, 0.09) for MammaPrint, Oncotype DX, PAM50 risk of relapse based on subtype, and PAM50 risk of relapse based on subtype and proliferation, respectively, with all but the latter showing statistical difference from chance. Conclusion Quantitative breast MR imaging radiomics shows promise for image-based phenotyping in assessing the risk of breast cancer recurrence. © RSNA, 2016 Online supplemental material is available for this article.
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Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Genômica/métodos , Imageamento por Ressonância Magnética/métodos , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Feminino , Expressão Gênica , Humanos , Aumento da Imagem , Interpretação de Imagem Assistida por Computador , Pessoa de Meia-Idade , Fenótipo , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de RiscoRESUMO
To determine whether mammographic or sonographic features can predict the Oncotype DX™ recurrence scores (RS) in patients with TI-II, hormone receptor (HR) positive, HER2/neu negative and node negative breast cancers. Institutional board review was obtained and informed consent was waived for this retrospective study. Seventy-eight patients with stage I-II invasive breast cancer that was HR positive, HER2 negative, and lymph node negative for whom mammographic and or sonographic imaging and Oncotype DX™ assay scores were available were included in the study Four breast dedicated radiologists blinded to the RS retrospectively described the lesions according to BI-RADS lexicon descriptors. Multivariable logistic regression was used to test for significant independent predictors of low (<18) versus intermediate to high range (≥18). Two imaging features reached statistical significance in predicting low from intermediate or high risk RS: pleomorphic microcalcifications within a mass (P = 0.017); OR 8.37, 95 % CI (1.47-47.79) on mammography and posterior acoustic enhancement in a mass on ultrasound (P = 0.048); OR 4.35, 95 % CI (1.01-18.73) on multivariable logistic regression. A mass with pleomorphic microcalcifications on mammography or the presence of posterior acoustic enhancement on ultrasound may predict an intermediate to high RS as determined by the Oncotype DX(TM) assay in patients with stage I-II HR positive, HER2 negative, and lymph node negative invasive breast cancer.
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Neoplasias da Mama/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Adulto , Idoso , Axila , Neoplasias da Mama/patologia , Feminino , Perfilação da Expressão Gênica/métodos , Humanos , Linfonodos/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/genética , Radiografia , Receptor ErbB-2/biossíntese , Receptores de Estrogênio/biossíntese , Receptores de Progesterona/biossíntese , Estudos Retrospectivos , Ultrassonografia , Adulto JovemRESUMO
While there are varying opinions on what age to begin and at what interval to perform breast cancer screening, screening mammography is recommended for all women irrespective of disability. Unfortunately, women with disabilities are more likely to present with later-stage disease and higher mortality owing to the barriers for more widespread screening in this population. Women with disabilities may experience challenges accessing breast imaging services, and imaging centers may have suboptimal facilities and staff who are inexperienced in caring for this population. Efforts to increase accessibility by employing universal design to increase ease of access and provide training to improve the patient experience will go far to improve outcomes for patients with disabilities. To date, there exists no comprehensive guidance on how to improve breast cancer screening programs for women with disabilities. The purpose of this paper is to review barriers to screening faced by patients with disabilities, describe strategies to overcome these barriers, and provide guidance for radiologists and referring providers in selecting the best exam for the individual patient.
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Neoplasias da Mama , Pessoas com Deficiência , Humanos , Feminino , Neoplasias da Mama/diagnóstico , Mamografia , Detecção Precoce de Câncer/métodos , Avaliação de Resultados da Assistência ao PacienteRESUMO
More than 25 million Americans have limited English-language proficiency (LEP) according to the U.S. Census Bureau. This population experiences challenges accessing health care and is least likely to receive preventive health care, including screening mammogram. In a setting where the breast radiologist does not speak the language of their patient, using certified medical interpreter services is fundamental. Medical interpreter use is associated with improved clinical care and patient satisfaction and can potentially increase adherence to screening mammograms and follow-up in patients with LEP. Title VI of the Civil Rights Act requires interpreter services for patients with LEP who are receiving federal financial assistance. Failure to provide interpretative services when necessary is considered discriminatory and illegal. The use of untrained medical interpreters, including ad hoc interpreters (eg, family, friends, or untrained staff), is associated with more medical errors, violation of confidentiality, and poor health outcomes. Types of medical interpretation services available to address language barriers include in-person interpretation, telephone and video remote interpretation, and qualified bilingual staff. Proper training and certification of medical interpreters is essential to prevent misinterpretations and ensure patient safety. When using an interpreter service, speak to and maintain eye contact with the patient, address the patient directly and seat the interpreter next to or slightly behind the patient, use visual aids whenever possible, and have the patient repeat the information to verify comprehension. Breast radiologists can address disparities in breast cancer screening and treatment by promoting effective communication.
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Neoplasias da Mama , Barreiras de Comunicação , Mamografia , Tradução , Humanos , Feminino , Neoplasias da Mama/diagnóstico por imagem , Acessibilidade aos Serviços de Saúde , Estados Unidos , Proficiência Limitada em InglêsRESUMO
Hispanic/Latino people represent 19% of the U.S. population, and this proportion is expected to increase to 26% by 2050. Hispanic/Latino people comprise a diverse ethnic group that includes individuals from all races, religions, languages, cultural identities, and nationalities. Barriers to health care that have created significant disparities in this community include language, low socioeconomic status, and inability to afford health insurance. Health coverage for Hispanic/Latino people has been a longstanding problem in the U.S., stopping many of these patients from seeking preventive care such as screening mammography. Breast cancer is the most common cancer among Hispanic/Latino women in the U.S. and the leading cause of cancer death in this group. Five-year breast cancer survival in Hispanic/Latino women is slightly lower than that in non-Hispanic White women. Some of the factors that account for the ethnic disparities in breast cancer include lower levels of adherence to screening mammography of Hispanic/Latino women as a consequence of inadequate insurance coverage, language barriers, lack of transportation, being unable to leave work, and lack of childcare. By promoting a culturally sensitive clinical environment, breast radiologists can increase patient engagement, utilization of preventive services, treatment adherence rates, and overall health status.
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Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/diagnóstico , Mamografia , Hispânico ou Latino , Assistência à Saúde Culturalmente Competente , Detecção Precoce de CâncerRESUMO
Acinetobacter baumannii is an important opportunistic pathogen that causes serious health-related infections, especially in intensive care units. The present study aimed to investigate the antimicrobial activity of Riparin-B (Rip-B) alone and in association with norfloxacin against multidrug-resistant clinical isolates of A. baumannii. For this, the minimum inhibitory concentrations were determined by the microdilution method. For the evaluation of resistance-modulating activity, MIC values for antibiotics were determined in the presence or absence of subinhibitory concentrations of Rip-B or chlorpromazine (CPZ). The AdeABC-AdeRS efflux system genes from these isolates were detected by PCR. Docking studies were also carried out to evaluate the interaction of Riparin-B and the AdeABC-AdeRS efflux system. The study was conducted from 2017 to 2019. The results showed that Rip-B showed weak intrinsic activity against the strains tested. On the other hand, Rip-B was able to modulate norfloxacin's response against A. baumannii strains that express efflux pump-mediated resistance. Docking studies provided projections of the interaction between Rip-B and EtBr with the AdeB protein, suggesting that Rip-B acts by competitive inhibition with the drug. Results found by in vitro and in silico assays suggest that Rip-B, in combination with norfloxacin, has the potential to treat infections caused by multidrug-resistant A. baumanni with efflux pump resistance.
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A woman in her mid 40s presented for breast imaging after 1 week of painful and enlarged right axillary lymphadenopathy. She denied history of fever, weight loss, night sweats fatigue, cat scratch or other trauma. She received the second dose of Pfizer COVID-19 vaccine 3 months previously on the contralateral arm. A mammogram demonstrated a single, asymmetric, large and dense right axillary lymph node. Ultrasound confirmed a 2.5 cm lymph node with cortical thickening of 0.6 cm. Ultrasound-guided core biopsy showed necrotising lymphadenitis with associated aggregates of histiocytes and plasmacytoid dendritic cells. Potential causes of necrotising adenitis including Bartonella, tuberculosis, Epstein-Barr Virus, herpes simplex virus, systemic lupus erythematosus and lymphoma were excluded. In the absence of any identifiable infectious or autoimmune causes, and given the temporal relatedness with vaccine administration, it was determined that the Kikuchi-Fujimoto-like necrotising lymphadenitis was likely secondary to the COVID-19 vaccine. To date, there has been no casual association made between the COVID-19 vaccine and KFD necrotising lymphadenitis.
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Vacinas contra COVID-19 , COVID-19 , Infecções por Vírus Epstein-Barr , Linfadenite Histiocítica Necrosante , Linfadenite , Linfadenopatia , Feminino , Humanos , COVID-19/complicações , Vacinas contra COVID-19/efeitos adversos , Infecções por Vírus Epstein-Barr/complicações , Herpesvirus Humano 4 , Linfadenite Histiocítica Necrosante/etiologia , Linfadenite Histiocítica Necrosante/complicações , Biópsia Guiada por Imagem/efeitos adversos , Linfadenopatia/etiologiaRESUMO
The presence of mammographically evident hyperdense foci within axillary lymph nodes elicits concern for calcium deposits, which in turn have a wide differential diagnosis including both benign and malignant entities. Tissue sampling, most commonly by way of image-guided core needle biopsy, is needed in many cases when a definite etiology cannot be clinically established. In this case series we present history, imaging findings, and pathology results (or long term follow-up stability as biopsy surrogate) of several women with body tattoos who at mammography were noted to have a characteristic pattern of "bubbly" pseudo-calcifications within axillary lymph nodes, and absence of other mammographic, sonographic and clinical abnormalities.
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Neoplasias da Mama , Calcinose , Tatuagem , Feminino , Humanos , Tatuagem/efeitos adversos , Biópsia por Agulha/métodos , Neoplasias da Mama/patologia , Axila/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Calcinose/etiologia , Calcinose/patologia , Biópsia , Algoritmos , Biópsia de Linfonodo Sentinela/métodosRESUMO
OBJECTIVE: To compare readers' performances when detecting architectural distortion (AD) on digital breast tomosynthesis (DBT). To determine the risk of malignancy of DBT with synthetic mammogram (SM)-detected AD and evaluate imaging features that are associated with malignancy risk. METHODS: This IRB-approved retrospective review included all cases of DBT-detected AD that were recommended for biopsy from October 2013 to July 2019. Cases were reviewed by three breast radiologists and the overall agreement between radiologists was calculated. Medical records were reviewed for pathological outcomes and imaging findings. Statistical analyses used were Cohen's kappa and its 95% confidence interval, and one-way analysis of variance. RESULTS: A total of 172 lesions were included. The overall agreement for the presence of AD in our study was fair (0.253). The majority (20/36, 55.5%) of the malignant ADs were associated with asymmetries (13/36, 36.1%), calcifications (4/36, 11.1%), or both (3/36, 8.3%), compared to nonmalignant ADs (40/136, 31.0%; P = 0.038). The positive predictive value (PPV) of DBT with SM-detected AD for malignancy was 21.8% (36/165), 18.8% (18/96) for DBT-detected AD, and 26.0% (18/69) for SM-detected AD, although the difference was not statistically significant (P = 0.258). A breast MRI correlate was identified for all malignant AD lesions (17/17, 100.0%; P = 0.004). CONCLUSION: The detection of AD remains a challenging task for radiologists, with moderate-to-fair interobserver agreement. With a PPV for malignancy of 21.8%, percutaneous biopsy and subsequent pathology-imaging correlation are necessary for AD to exclude the possibility of malignancy.
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Image-guided core-needle breast and axillary biopsy (CNB) is the standard-of-care procedure for the diagnosis of breast cancer. Although the risks of CNB are low, the most common complications include bleeding and hematoma formation. Post-procedural bleeding is of particular concern in patients taking antithrombotic therapy, but there is currently no widely established standard protocol in the United States to guide antithrombotic therapy management. In the face of an increasing number of patients taking antithrombotic therapy and with the advent of novel classes of anticoagulants, the American College of Radiology guidelines recommend that radiologists consider cessation of antithrombotic therapy prior to CNB on a case-by-case basis. Lack of consensus results in disparate approaches to patients on antithrombotic therapy undergoing CNB. There is further heterogeneity in recommendations for cessation of antithrombotic therapy based on the modality used for image-guided biopsy, target location, number of simultaneous biopsies, and type of antithrombotic agent. A review of the available data demonstrates the safety of continuing antithrombotic therapy during CNB while highlighting additional procedural and target lesion factors that may increase the risk of bleeding. Risk stratification of patients undergoing breast interventional procedures is proposed to guide both pre-procedural decision-making and post-procedural management. Radiologists should be aware of antithrombotic agent pharmacokinetics and strategies to minimize post-procedural bleeding to safely manage patients.
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The diagnosis via core needle biopsy of concurrent ductal carcinoma in situ and lobular carcinoma in situ within an enlarging previously biopsied benign fibroadenoma in women in their 40s is rare. Several case reports have described the occurrence of malignant changes within fibroadenomas, usually as an incidental finding following excision, and few reports have documented the transition of a fibroadenoma to malignancy. The current case report emphasises the importance of re-biopsying enlarging fibroadenomas, even with otherwise maintained benign appearing features on imaging, in women in their 40s, in order to exclude the possibility of malignancy.
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Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Lobular/patologia , Fibroadenoma/patologia , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/terapia , Carcinoma Lobular/diagnóstico por imagem , Carcinoma Lobular/terapia , Feminino , Humanos , Mamografia , Pessoa de Meia-IdadeRESUMO
In 2016, the World Health Organization added Breast Implant-Associated Anaplastic Large Cell lymphoma as a provisionally recognized lymphoma to the family of existing Anaplastic Large Cell lymphomas. Current estimates of the lifetime risk of the disease in women with textured breast implants range from 1:1,000 to 1:30,000. The mean interval from implant placement to diagnosis is 10.7 ± 4.6 years and the most common clinical symptom at presentation is breast swelling. A high level of clinical suspicion is recommended in patients presenting with breast symptoms and/or peri-implant fluid collection occurring more than 1 year after breast implant placement. Ultrasound is the imaging modality of choice, with a high sensitivity for peri-implant fluid and a high specificity for peri-implant mass. When ultrasound is inconclusive, breast MRI is indicated. As of today, all confirmed cases have tested positive for CD30 immunohistochemistry and the disease has shown to have an excellent prognosis when it is diagnosed earlier (localized disease), and when complete surgery, consisting of explantation, capsulectomy, and removal of any associated capsule mass, is performed. This overview summarizes the available epidemiological and clinical data of Breast Implant-Associated Anaplastic Large Cell lymphoma, with an emphasis on imaging features.
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Implantes de Mama , Neoplasias da Mama/etiologia , Linfoma Anaplásico de Células Grandes/diagnóstico , Linfoma Anaplásico de Células Grandes/etiologia , Imageamento por Ressonância Magnética/estatística & dados numéricos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Feminino , Humanos , Imuno-Histoquímica , Linfoma Anaplásico de Células Grandes/fisiopatologia , UltrassonografiaRESUMO
PURPOSE: The purpose of this study was to investigate if human-extracted MRI tumor phenotypes of breast cancer could predict receptor status and tumor molecular subtype using MRIs from The Cancer Genome Atlas project. MATERIALS AND METHODS: Our retrospective interpretation study utilized the analysis of HIPAA-compliant breast MRI data from The Cancer Imaging Archive. One hundred and seven preoperative breast MRIs of biopsy proven invasive breast cancers were analyzed by 3 fellowship-trained breast-imaging radiologists. Each study was scored according to the Breast Imaging Reporting and Data System lexicon for mass and nonmass features. The Spearman rank correlation was used for association analysis of continuous variables; the Kruskal-Wallis test was used for associating continuous outcomes with categorical variables. The Fisher-exact test was used to assess correlations between categorical image-derived features and receptor status. Prediction of estrogen receptor (ER), progesterone receptor, human epidermal growth factor receptor, and molecular subtype were performed using random forest classifiers. RESULTS: ER+ tumors were associated with the absence of rim enhancement (P = 0.019, odds ratio [OR] 5.5), heterogeneous internal enhancement (P = 0.02, OR 6.5), peritumoral edema (P = 0.0001, OR 10.0), and axillary adenopathy (P = 0.04, OR 4.4). ER+ tumors were smaller than ER- tumors (23.7 mm vs 29.2 mm, P = 0.02, OR 8.2). All of these variables except the lack of axillary adenopathy were also associated with progesterone receptor+ status. Luminal A tumors (nâ¯=â¯57) were smaller compared to nonLuminal A (21.8 mm vs 27.5 mm, P = 0.035, OR 7.3) and lacked peritumoral edema (P = 0.001, OR 6.8). Basal like tumors were associated with heterogeneous internal enhancement (P = 0.05, OR 10.1), rim enhancement (P = 0.05, OR6.9), and perituomral edema (P = 0.0001, OR 13.8). CONCLUSIONS: Human extracted MRI tumor phenotypes may be able to differentiate those tumors with a more favorable clinical prognosis from their more aggressive counterparts.
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Neoplasias da Mama/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/genética , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Fenótipo , Prognóstico , Receptores de Estrogênio/genética , Receptores de Progesterona/genéticaRESUMO
BACKGROUND: Imaging features derived from MRI scans can be used for not only breast cancer detection and measuring disease extent, but can also determine gene expression and patient outcomes. The relationships between imaging features, gene/protein expression, and response to therapy hold potential to guide personalized medicine. We aim to characterize the relationship between radiologist-annotated tumor phenotypic features (based on MRI) and the underlying biological processes (based on proteomic profiling) in the tumor. METHODS: Multiple-response regression of the image-derived, radiologist-scored features with reverse-phase protein array expression levels generated association coefficients for each combination of image-feature and protein in the RPPA dataset. Significantly-associated proteins for features were analyzed with Ingenuity Pathway Analysis software. Hierarchical clustering of the results of the pathway analysis determined which features were most strongly correlated with pathway activity and cellular functions. RESULTS: Each of the twenty-nine imaging features was found to have a set of significantly correlated molecules, associated biological functions, and pathways. CONCLUSIONS: We interrogated the pathway alterations represented by the protein expression associated with each imaging feature. Our study demonstrates the relationships between biological processes (via proteomic measurements) and MRI features within breast tumors.
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OBJECTIVE: To assess the results of an initial round of supplemental screening with hand-held bilateral breast ultrasound following a negative screening mammogram in asymptomatic women with dense breast tissue who are not at high risk for breast cancer. MATERIALS AND METHODS: A retrospective, Health Insurance Portability and Accountability Act compliant, Institutional Research Board approved study was performed at a single academic tertiary breast center. Informed consent was waived. A systematic review of the breast imaging center database was conducted to identify and retrieve data for all asymptomatic women, who were found to have heterogeneously dense or extremely dense breast tissue on screening bilateral mammograms performed from July 1, 2010 through June 30, 2012 and who received a mammographic final assessment American College of Radiology's (ACR) Breast Imaging Reporting and Data System (BI-RADS) category 1 or BI-RADS category 2. Hand-held screening ultrasound was performed initially by a technologist followed by a radiologist. Chi-square and t-test were used and statistical significance was considered at P < 0.05. RESULTS: A total of 1210 women were identified. Of these, 394 underwent the offered supplemental screening ultrasound. BI-RADS category 1 or 2 was assigned to 323 women (81.9%). BI-RADS category 3 was assigned to 50 women (12.9%). A total of 26 biopsies/aspirations were recommended and performed in 26 women (6.6%). The most common finding for which biopsy was recommended was a solid mass (88.5%) with an average size of 0.9 cm (0.5-1.7 cm). Most frequent pathology result was fibroadenoma (60.8%). No carcinoma was found. CONCLUSION: Our data support the reported occurrence of a relatively high number of false positives at supplemental screening with breast ultrasound following a negative screening mammogram in asymptomatic women with dense breast tissue, who are not at a high risk of developing breast cancer, and suggests that caution is necessary in establishing wide implementation of this type of supplemental screening for all women with dense breast tissue without considering other risk factors for breast cancer.