Long-term outcome of 9G MRI-guided vacuum-assisted breast biopsy: results of 293 single-center procedures and underestimation rate of high-risk lesions over 12 years.

PURPOSE: Breast magnetic resonance imaging (MRI) can detect some malignant lesions that are not visible on mammography (MX) or ultrasound (US). If a targeted, second-look fails, MRI-guided breast biopsy is the only available tool to obtain a tissue sample and pathological proof of these "MRI-only lesions". The aim of this study is to report the performance and underestimation rate of 9G MRI-guided vacuum-assisted breast biopsy (VABB) over 12 years at a single center. MATERIAL AND METHODS: All 9G MRI-VABB procedures performed from January 2010 to December 2021 were retrospectively reviewed. Two MRI scanners (1.5 T and 3 T) were used with the same image resolution and contrast media. All suspicious lesions detected only by breast MRI underwent biopsy. Reference standard was histological diagnosis or at least 1-year negative follow-up. All malignant and atypical lesions underwent surgery, which was used as the reference standard. RESULTS: A total of 293 biopsies were retrospectively reviewed. Histopathological VABB results revealed 142/293 (48.4%) benign lesions, 77/293 (26.2%) high-risk lesions, and 74/293 (25.2%) malignant lesions. No significant complications were observed. Surgical pathology results allowed for the reclassification of n = 7/48 B3b lesions: n = 4 were ductal carcinoma in situ, while n = 3 presented invasive features at surgical histology (2 IDC; 1 ILC). B3b underestimation occurred overall in 14.6% of B3 cases. Breast follow-up was achieved for all benign VABB results, and only one false-negative case was observed. CONCLUSION: Our results confirm that 1.5 T and 3 T MRI-guided VABB is an accurate and safe procedure for histopathologic final diagnosis of MRI-only lesions. Critical issues remain the potential high-risk underestimation rate of B3b VABB results and management of follow-up of benign lesions.

The value of coronal view as a stand-alone assessment in women undergoing automated breast ultrasound.

BACKGROUND: Aim of the study was to evaluate the value of automated breast ultrasound (AUS) in women with dense breast, in terms of reading times, diagnostic performance and interobserver agreement. The assessment of coronal images alone versus the complete multiplanar (MPR) views was evaluated. METHODS: Between August and October 2017, consecutive patients with dense breast that were referred to our Institute, for post-mammography ultrasound assessment, pre-operative assessment or follow-up of known benign lesions, were invited to undergo an additional study with AUS. Three radiologists, (5, 15 and 25 years of experience in breast imaging), reviewed the exams twice: first assessing reconstructed coronal images alone, second the complete MPR views. Reading times, diagnostic performance and interobserver agreement were assessed. RESULTS: One hundred eighty-eight women were included, for a total of 67 breast lesions, 25 (37%) malignant and 42 (63%) benign. Compared to MPR, coronal view was associated with: lower reading times, respectively, for the three readers: 83 ± 37, 84 ± 43 and 76 ± 30 versus 163 ± 109, 131 ± 57, 151 ± 42 s (p < 0.035); lower sensitivity: 44.8%, 62.1%, 55.2% versus 69.0% (p = 0.059), 65.5% (p = 0.063), 72.4% (p = 0.076), respectively; better specificity: 94.1%, 93.7%, 94.2% versus 89.5% (p = 0.093), 87.4% (p = 0.002), 91.6% (p = 0.383), respectively. Agreement between the most and the least experienced reader was fair to moderate for categorical variables and significant for continuous ones. CONCLUSION: The coronal view allows significantly lower reading times, a valuable feature in the screening setting, but its diagnostic performance makes the complete multiplanar assessment mandatory.

A very rare case of mycobacterium gordonae infection of the breast.

Mastitis is a common disease in women with both infectious and noninfectious causes. Most cases occur during lactation and are caused by Staphylococcus aureus and Streptococcus species; parasites and Mycobacteria have rarely been reported to cause breast infections (Mandell, Douglas, and Bennett's principles and practice of infectious diseases (9th edn);2019, Am J Respir Crit Care Med. 2007;175:367). Nontuberculous mycobacteria (NTM) which are also referred to as atypical mycobacteria, mycobacteria other than tuberculosis (MOTT), or environmental mycobacteria are a large group of Mycobacteria which are becoming increasingly common cause of infection all over the world (Arch Dermatol. 2006;142:1287). NTM can cause infection diseases especially in immunocompromised patients, such as HIV-positive hosts, most commonly in the lungs, skin and soft tissue, lymph nodes or rarely spread with multiorgan dissemination (Arch Plast Surg. 2014;41:759). Mycobacterium gordonae (M. gordonae) is a slow-growing atypical mycobacterium that is considered the least pathogenic NTM. The organism is ubiquitous, and mostly isolated from soil and water. Despite its nonvirulent nature, clinically significant infections have been reported also in some immunocompetent patients (J Formosan Med Assoc. 2020, Clin Infect Dis. 1992;1229). We report the first documented case of breast infection in a young immunocompetent woman sustained by Mycobacterium Gordonae.

Freehand 3T MR-guided vacuum-assisted breast biopsy (VAB): a five-year experience.

Background Magnetic resonance (MR) permits the detection of some malignant lesions that cannot be identified with mammography or ultrasonography. The characterization of these MR-only detectable lesions often requires a biopsy. Purpose To evaluate the technique, the feasibility and the accuracy of freehand 3T MR-guided VAB for the characterization of suspicious, MR-only detectable lesions and to compare VAB results with surgical pathology and follow-up imaging results. Material and Methods During 2010-2015, 118 women who were referred for MR-guided VAB were retrospectively reviewed. All BI-RADS MR 4 and 5 lesions and some BI-RADS MR 3 lesions (according to clinical context and patient anxiety) were scheduled to undergo biopsy. Results A total of 123 suspicious lesions were retrospectively selected. Technical failures occurred in only two cases (1.6%) due to the location of the lesions. Histopathological results revealed 59 benign lesions (48%), 27 high-risk lesions (22%), and 35 malignant lesions (28.4%). Surgical pathology results led to the reclassification of eight B3 lesions: one proved to be a ductal carcinoma in situ, while seven presented with invasive features. B3 underestimation also occurred in 29% of the cases. MR follow-up was achieved for all the benign lesions and no false-negative cases were observed. No complications, 3T-related artefacts, or difficulties were observed. Conclusion Freehand 3T MR-guided VAB was found to be a valid, safe, fast, and inexpensive alternative to surgical histology.

Magnetic resonance imaging of breast cancer: does the time interval between biopsy and MRI influence MRI-pathology discordance in lesion sizing?

Background Breast magnetic resonance imaging (MRI) is more accurate than ultrasound and mammography in estimating local extension of both invasive breast cancer and ductal carcinoma in situ (DCIS) and it is part of a breast cancer patient's preoperative management. Purpose To verify if time interval between breast biopsy and preoperative MRI, lesion margins, and biopsy technique can influence tumor sizing on MRI. Material and Methods By a database search, we retrospectively identified all women with a newly diagnosed, biopsy-proven, primary breast cancer who underwent MRI before surgery. The time interval between biopsy and MRI, the type of biopsy procedure, and various pathological features of tumors were collected. We defined the concordance between MRI and pathology measurements as a difference of <5 mm in lesion sizing. Results One hundred and sixty-six women (mean age, 51.4 ± 10.4 years) were included. The time interval between biopsy and MRI showed only a weak correlation with the absolute MRI-pathology difference (r = 0.236). Stratifying the whole cohort of patients using a cutoff value of 30 days, we found that the MRI-pathology discordance was significantly higher in patients with a biopsy-MRI time interval >30 days ( P < 0.05). By means of multivariate analysis, we found that DCIS subtype and the presence of poorly defined margins on MRI are the only two factors independently and strongly associated with MRI-pathology discordance in lesion sizing. Conclusion Size, histology, and margins of tumors may affect the accuracy of MRI measurements. The type of biopsy procedure and the time interval between biopsy and preoperative MRI are not independently associated to MRI-pathology discordance.

Lung hyperaeration assessment by computed tomography: correction of reconstruction-induced bias.

BACKGROUND: Computed tomography (CT) reconstruction parameters, such as slice thickness and convolution kernel, significantly affect the quantification of hyperaerated parenchyma (VHYPER%). The aim of this study was to investigate the mathematical relation between VHYPER% calculated at different reconstruction settings, in mechanically ventilated and spontaneously breathing patients with different lung pathology. METHODS: In this retrospective observational study, CT scans of patients of the intensive care unit and emergency department were collected from two CT scanners and analysed with different kernel-thickness combinations (reconstructions): 1.25 mm soft kernel, 5 mm soft kernel, 5 mm sharp kernel in the first scanner; 2.5 mm slice thickness with a smooth (B41s) and a sharp (B70s) kernel on the second scanner. A quantitative analysis was performed with Maluna® to assess lung aeration compartments as percent of total lung volume. CT variables calculated with different reconstructions were compared in pairs, and their mathematical relationship was analysed by using quadratic and power functions. RESULTS: 43 subjects were included in the present analysis. Image reconstruction parameters influenced all the quantitative CT-derived variables. The most relevant changes occurred in the hyperaerated and normally aerated volume compartments. The application of a power correction formula led to a significant reduction in the bias between VHYPER% estimations (p < 0.001 in all cases). The bias in VHYPER% assessment did not differ between lung pathology nor ventilation mode groups (p > 0.15 in all cases). CONCLUSIONS: Hyperaerated percent volume at different reconstruction settings can be described by a fixed mathematical relationship, independent of lung pathology, ventilation mode, and type of CT scanner.

Magnetic resonance imaging of breast cancer: factors affecting the accuracy of preoperative lesion sizing.

BACKGROUND: Accurate preoperative sizing of breast cancer with imaging modalities has a great importance in the surgical planning. PURPOSE: To assess the influence of tumor size and histology on the accuracy of measurement of cancer local extension by magnetic resonance imaging (MRI). MATERIAL AND METHODS: One hundred and eighty-six patients with primary breast cancer, for a total of 221 lesions, were included in this retrospective study. Tumors were divided into five histological groups: invasive ductal carcinoma (IDC), IDC with extensive intraductal component (EIC), invasive lobular carcinoma (ILC), ductal carcinoma in situ (DCIS), and "other histology" (mucinous, papillary, medullary, tubular, and apocrine breast cancer). Microscopic measurement of the largest diameter of tumors at pathology was chosen as reference standard and compared with MRI measurement. Concordance was defined as a difference ≤ 5 mm between MRI and pathology. RESULTS: The mean size of tumors at pathology was 24.8 ± 19.4 mm, while at MRI it was 29.7 ± 20 mm (P < 0.05), with a significant overestimation of MRI. MRI-pathology concordance was found in 98/221 cases (44.3%), while MRI overestimated the size of 81/221 tumors (36.7%). The extent of overestimation was significantly different among the five histological groups (P < 0.05). At multivariate analysis, DCIS histology was the factor more significantly associated with MRI-pathology discordance (P = 0.0005), while the influence of tumor dimension at pathology was less significant (P = 0.0073). CONCLUSION: DCIS histology is strongly associated with discordance between MRI and pathology sizing of breast cancer. Lesion size can also influence the accuracy of MRI measurements, but to a lesser extent.

Seronegative spondyloarthropathies: what radiologists should know.

Inflammatory involvement of the spine and sacroiliac joints is the most peculiar feature of seronegative spondyloarthropathies (SpA), which include ankylosing spondylitis, psoriatic arthritis, reactive arthritis (Reiter's syndrome), enteropathic spondylitis (related to inflammatory bowel diseases) and undifferentiated spondyloarthropathies. SAPHO syndrome may also be considered a SpA, but there is no clear agreement in this respect. Imaging, along with clinical and laboratory evaluation, is an important tool to reach a correct diagnosis and to provide a precise grading of disease progression, influencing both clinical management and therapy. Conventional radiography, which is often the first-step imaging modality in SpA, does not allow an early diagnosis. Computed tomography (CT) demonstrates with a very high spatial resolution the tiny structural alterations of cortical and spongy bone before they become evident on plain film radiographs. Magnetic resonance imaging (MRI) is the only modality that provides demonstration of bone marrow oedema, which reflects vasodilatation and inflammatory hyperaemia. The primary aim of this review article was to examine the involvement of the spine and sacroiliac joints in SpA using a multimodal radiological approach (radiography, CT, MRI), providing a practical guide for the differential diagnosis of these conditions.

Complete pathological response of hormone receptor positive invasive breast cancer in a patient with multiple myeloma treated with ixazomib.

Multiple myeloma is a hematological cancer characterized by relapse after treatment and poor prognosis. Ixazomib, a second-generation protease inhibitor, is one of the most recently available treatments for relapsed or refractory multiple myeloma, while it has also shown good potential as antitumoral agent in preclinical solid tumor models such as breast cancer cell lines. Here we report the case of a 68-year-old female with multiple myeloma and an incidental cT1b (9 mm) hormone receptor positive breast cancer lesion that showed a complete pathological response to a three-month combination therapy with Ixazomib, bendamustine and dexamethasone and no signs of disease relapse during the later follow-up. This is the first case report describing such clinical outcome in breast cancer following Ixazomib, bendamustine and dexamethasone combination therapy. To investigate the potential antitumoral activity of Ixazomib in breast cancer, we performed in vitro experiments using two hormone receptor positive breast cancer cell lines. We assessed the synergism between Ixazomib and bendamustine and the antiproliferative effect of Ixazomib. We found no synergistic interaction between the two drugs, while Ixazomib alone showed an antiproliferative effect against tumoral cells, suggesting that this drug has been responsible for tumor regression in our case.

Freehand 1.5T MR-Guided Vacuum-Assisted Breast Biopsy (MR-VABB): Contribution of Radiomics to the Differentiation of Benign and Malignant Lesions.

Radiomics and artificial intelligence have been increasingly applied in breast MRI. However, the advantages of using radiomics to evaluate lesions amenable to MR-guided vacuum-assisted breast biopsy (MR-VABB) are unclear. This study includes patients scheduled for MR-VABB, corresponding to subjects with MRI-only visible lesions, i.e., with a negative second-look ultrasound. The first acquisition of the multiphase dynamic contrast-enhanced MRI (DCE-MRI) sequence was selected for image segmentation and radiomics analysis. A total of 80 patients with a mean age of 55.8 years ± 11.8 (SD) were included. The dataset was then split into a training set (50 patients) and a validation set (30 patients). Twenty out of the 30 patients with a positive histology for cancer were in the training set, while the remaining 10 patients with a positive histology were included in the test set. Logistic regression on the training set provided seven features with significant p values (<0.05): (1) 'AverageIntensity', (2) 'Autocorrelation', (3) 'Contrast', (4) 'Compactness', (5) 'StandardDeviation', (6) 'MeanAbsoluteDeviation' and (7) 'InterquartileRange'. AUC values of 0.86 (95% C.I. 0.73-0.94) for the training set and 0.73 (95% C.I. 0.54-0.87) for the test set were obtained for the radiomics model. Radiological evaluation of the same lesions scheduled for MR-VABB had AUC values of 0.42 (95% C.I. 0.28-0.57) for the training set and 0.4 (0.23-0.59) for the test set. In this study, a radiomics logistic regression model applied to DCE-MRI images increased the diagnostic accuracy of standard radiological evaluation of MRI suspicious findings in women scheduled for MR-VABB. Confirming this performance in large multicentric trials would imply that using radiomics in the assessment of patients scheduled for MR-VABB has the potential to reduce the number of biopsies, in suspicious breast lesions where MR-VABB is required, with clear advantages for patients and healthcare resources.

Is 9-G DBT-Guided Vacuum-Assisted Breast Biopsy Sufficient to Completely Remove T1 Breast Cancers (below 20 mm)? Analysis of 146 Patients with Histology as Reference Standard.

Objectives: Vacuum-assisted breast biopsy (VABB) is a safe procedure comparable to surgical biopsy for the characterization of distortions, microcalcifications, and mass lesions. Vacuum-assisted excision of T1 breast tumors could be on potential management in alternative to surgery. The primary objective of this work was to assess the therapeutic success of the stereotaxic vacuum breast biopsy in small breast cancer (T1N0M0) lesions excision. Methods: From our electronic database, all the vacuum breast biopsies performed from January 1, 2015, to December 1, 2019, have been retrospectively reevaluated. N = 2,200 cases were identified and n = 145 ensured "mammographic complete removal" at the end of vacuum-assisted excision treatment and were considered for analysis. Surgical gold standard was used. Results: N = 143 procedures were successfully completed with complete removal of mammographic calcifications. The mean size of the lesions completely excised with VABB was 8.9 ± 3.6 mm (range, 3-23 mm). Lesions below 10 mm were n = 118 and lesion with diameter >10 mm were n = 28. N = 3/146 cases (4.4%), relapses were observed in follow-up (at 12-24 up to a maximum of 60 months): the mean size of relapsed lesions completely excised was 3.6 ± 2.1 mm (range, 2-6 mm). No relapse before 12 months were observed. The mean size of the lesions in these patients with relapse at the time of the first VABB procedures was 13 ± 6.5 mm (range, 7-12 mm). N = 117/118 (99%) lesions excised using VABB without relapse after 1 year of follow-up had a diameter below 10 mm. Conclusions: Vacuum breast biopsy could safely remove small breast cancers (T1N0M0) with few relapses.

A Prospective Comparative Evaluation of Handheld Ultrasound Examination (HHUS) or Automated Ultrasound Examination (ABVS) in Women with Dense Breast.

Mammography is the gold standard examination for breast cancer screening. In women with high breast density, mammography has reduced sensitivity. In these women, an additional screening option is often recommended. This study prospectively compared ABVS and HHUS in women with mammography-negative examinations and dense breasts. Materials and methods: N = 222 women were evaluated prospectively and consecutively between January 2019 and June 2019 (average age 53 years; range 39−89). McNemar's test and ROC analysis were used with standard statistical software. We included in the study both symptomatic and asymptomatic women with dense breasts. Women included underwent both HHUS and ABVS after mammography with independent reading. Results: N = 33/222 (15%) women resulted in having breast cancer. Both ABVS and HHUS identified more cancers than standard mammography, and both HHUS and ABVS had false-positive examinations: n = 13 for HHUS and n = 12 for ABVS. We found that HHUS had better accuracy than ABVS. The AUC of the ROC was 0.788 (95% CI 0.687−0.890) for ABVS and 0.930 (95% CI 0.868−0.993) for HHUS. This difference was statistically significant (p < 0.05). Conclusions: HHUS was more accurate in breast cancer detection than ABVS. Multicentric studies must confirm these data for supplemental imaging in women with dense breasts.

Plasma Cell-Free DNA Integrity Assessed by Automated Electrophoresis Predicts the Achievement of Pathologic Complete Response to Neoadjuvant Chemotherapy in Patients With Breast Cancer.

PURPOSE: The study of plasma cell-free DNA integrity (cfDI) has shown potential for providing useful information in neoplastic patients. The aim of this study is to estimate the accuracy of an electrophoresis-based method for cfDI evaluation in the assessment of pathologic complete response (pCR) in patients with breast cancer (BC) undergoing neoadjuvant chemotherapy (NACT). PATIENTS AND METHODS: Fifty-one patients with BC undergoing anthracycline-/taxane-based NACT were recruited. Plasma samples were collected from each patient at diagnosis (t0), after anthracycline administration (t1), and after NACT completion (t2). The concentration of differently sized cell-free DNA fragments was assessed by automated electrophoresis. cfDI, expressed as cfDI index, was calculated as the ratio of 321-1,000 bp sized fragment concentration to 150-220 bp sized fragment concentration assessed at t2. cfDI index was then used to build an exploratory classifier for BC response to NACT, directly comparing its sensitivity and specificity with magnetic resonance imaging (MRI), through bootstrapped logistic regression. RESULTS: cfDI index was assessed on 38 plasma samples collected from as many patients at t2, maintaining a 30/70 ratio between pCR and non-pCR patients. cfDI index showed an area under the receiver operating characteristic curve in predicting the achievement of pCR of 81.6, with a cutoff above 2.71 showing sensitivity = 81.8 and specificity = 81.5. The combination of cfDI index and MRI showed, in case of concordance, an area under the receiver operating characteristic curve of 92.6 with a predictive value of complete response of 87.5 and a predictive value of absence of complete response of 94.7. CONCLUSION: cfDI index measured after NACT completion shows great potential in the assessment of pCR in patients with BC. The evaluation of its use in combination with MRI is strongly warranted in prospective studies.

The Margins' Challenge: Risk Factors of Residual Disease After Breast Conserving Surgery in Early-stage Breast Cancer.

BACKGROUND/AIM: Clinicopathological features of patients undergoing margin enlargement after lumpectomy for early breast cancer with positive/close excision margins were analyzed in order to define whether a re-operative procedure could have been avoided. Furthermore, a standardized protocol of specimen orientation was adopted in order to optimize both the widening procedure as well as the oncologic outcome. PATIENTS AND METHODS: A retrospective analysis was performed including pre-, peri-, and post-operative parameters, and a predictive score by means of a multivariate model was developed using all clinically and statistically significant variables associated with residual disease (RD). RESULTS: RD was significantly related to positive tumor margins, hormone receptor negative, HER2-positive, and tumors with high Ki67 proliferation index (p<0.001); the corresponding contribution to the prognostic score was as follows: close margins, 3 points; hormone receptor positive disease, 2 points; low Ki67, 2 points; HER2 negativity, 1 point. In 102 patients with a score >3, only 2 patients (2.0%) had RD, while in 81 patients with a score ≤3, 55 patients (67.9%) had RD (p<0.001). CONCLUSION: This predictive model might aid in clinical-decision making of patients with positive margins who actually require a widening procedure after intraoperative and/or definitive histology.

Myeloma Spine and Bone Damage Score (MSBDS) on Whole-Body Computed Tomography (WBCT): Multiple Reader Agreement in a Multicenter Reliability Study.

Objective: To assess the reliability of the myeloma spine and bone damage score (MSBDS) across multiple readers with different levels of expertise and from different institutions. Methods: A reliability exercise, including 104 data sets of static images and complete CT examinations of patients affected by multiple myeloma (MM), was performed. A complementary imaging atlas provided detailed examples of the MSBDS scores, including low-risk and high-risk lesions. A total of 15 readers testing the MSBDS were evaluated. ICC estimates and their 95% confidence intervals were calculated based on mean rating (k = 15), absolute agreement, a two-way random-effects model and Cronbach's alpha. Results: Overall, the ICC correlation coefficient was 0.87 (95% confidence interval: 0.79-0.92), and the Cronbach's alpha was 0.93 (95% confidence interval: 0.94-0.97). Global inter- and intra-observer agreement among the 15 readers with scores below or equal to 6 points and scores above 6 points were 0.81 (95% C.I.: 0.72-0.86) and 0.94 (95% C.I.:0.91-0.98), respectively. Conclusion: We present a consensus-based semiquantitative scoring systems for CT in MM with a complementary CT imaging atlas including detailed examples of relevant scoring techniques. We found substantial agreement among readers with different levels of experience, thereby supporting the role of the MSBDS for possible large-scale applications. Significance and Innovations • Based on previous work and definitions of the MSBDS, we present real-life reliability data for quantitative bone damage assessment in multiple myeloma (MM) patients on CT. • In this study, reliability for the MSBDS, which was tested on 15 readers with different levels of expertise and from different institutions, was shown to be moderate to excellent. • The complementary CT imaging atlas is expected to enhance unified interpretations of the MSBDS between different professionals dealing with MM patients in their routine clinical practice.

Prosthetic breast implant rupture: imaging--pictorial essay.

In recent years, requests for breast implant surgery have occurred for several reasons. First, the number of diagnosed breast cancer cases has increased, and the number of reconstructive surgeries consequently has multiplied. Second, the number of patients who constantly try to achieve a better physical shape, corresponding in Western countries to the common image of prosperous and tonic breasts, has proliferated. These circumstances have led to an increasingly frequent need for more accurate and sophisticated imaging methods to study prosthetic breast implants and their integrity. Diagnostic imaging for the study of patients with suspected breast implant ruptures uses different techniques of radiologic investigation such as mammography and ultrasonography, even if the current gold standard is magnetic resonance imaging (MRI). This study aimed to draw attention to the main MRI signs capable of highlighting contractures or ruptures of the implants that are not always clinically detectable and thus to provide plastic surgeons with an adequate instrument for discerning any possible alterations in prosthetic implants. Furthermore, it was necessary to stress the importance of teamwork. In fact, proper cooperation and coordination between radiologists and dedicated plastic surgeons are fundamental for the proper management of patients and the complications they may experience.

Axillary adenopathy after COVID-19 vaccine in patients undergoing breast ultrasound.

After COVID-19 vaccination, a spectrum of axillary lymphadenopathy were observed in patients undergoing routine breast ultrasound. Malignancy remains the most serious differential in cases of unilateral axillary adenopathy. Knowledge of axillary ultrasound findings after COVID-19 vaccination is essential to prevent unnecessary biopsy or change in therapy in oncological patients. From March to May 2021, 10 female patients underwent breast ultrasound in our Department for the evaluation of axillary lumps. All the patients received their first or second dose of COVID-19 vaccine 20-30 days before the exam in the same extremity of the ultrasound evaluation where lymphadenopathy was found. Five patients had a personal history of previous breast cancer, and the radiologist decided to perform a core biopsy (the histology was negative for malignancy). The other five patients with no personal history of cancer underwent ultrasound and returned after a short-term follow-up. Regression of the enlarged lymph nodes was found.

Circulating Tumor DNA Using Tagged Targeted Deep Sequencing to Assess Minimal Residual Disease in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy.

In breast cancer patients undergoing neoadjuvant chemotherapy before surgery, there is an unmet need for noninvasive predictive biomarkers of response. The analysis of circulating tumor DNA (ctDNA) in particular has been the object of several reports, but few of them have studied the applicability of tagged targeted deep sequencing (tTDS) to clinical practice and its performance compared with droplet digital PCR (ddPCR). Here, we present the first results from an ongoing study involving a prospectively accrued, monocentric cohort of patients affected by invasive breast cancer, undergoing neoadjuvant chemotherapy followed by surgery with curative intent as per clinical practice. A pretreatment tumor biopsy and plasma samples were collected before and during treatment, after surgery, and every six months henceforth or until relapse, whichever came first. Pretreatment biopsies were sequenced with a 409-gene massive parallel sequencing (MPS) panel, allowing the identification of target mutations and their research in plasma by tTDS and ddPCR as a complementary approach. Using tTDS, we demonstrated the presence of at least one deleterious mutation in all the relapsed cases we studied (n = 4), with an average lead time of six months before clinical relapse. The association with ddPCR was suboptimal, and only one relapsed patient could be identified with such method. tTDS shows potential as an early noninvasive method for the detection of MRD in BC patients.

Tumor-to-nipple Distance Should Not Preclude Nipple-sparing Mastectomy in Breast Cancer Patients. Personal Experience and Literature Review.

BACKGROUND/AIM: A retrospective study was performed in 246 breast cancer patients to define whether tumor-to-nipple distance (TND) assessment by breast MRI may select patients eligible to nipple-sparing mastectomy (NSM) as compared to permanent section assessment of retroareolar margin. PATIENTS AND METHODS: Pre- and post-operative parameters including imaging data, histology of the primary tumor, biologic prognostic factors, and adjuvant regimens were retrieved; patients with close/positive retroareolar margins underwent nipple or NAC excision. The primary endpoint was loco-regional recurrence (LRR). RESULTS: Patients with TND ≤2 cm had a significantly higher rate of invasive ductal carcinoma (p<0.003) and excision margins less than 2 mm (p<0.000). Eleven retroareolar specimens were positive at definitive pathology; final re-excision specimen examination showed residual disease in seven patients (63.6%). At a median follow-up of 31 to 33 months, no NAC recurrence did occur; disease-free survival was more than 96%, and LRR was homogeneously distributed among TND subgroups. CONCLUSION: Therapeutic NSM is a safe procedure independently of TND assessed at preoperative breast MRI. Permanent section assessment of retroareolar tissue is more accurate and cost-effective than frozen section. Furthermore, delayed nipple and/or NAC excision did not impair local disease control.