An observational, prospective, open label, multicenter study to evaluate the safety and effectiveness of pegfilgrastim as secondary prophylaxis to decrease the incidence of febrile neutropenia in Korean female patients with breast cancer.

PURPOSE: Pegfilgrastim is a widely used long-acting granulocyte colony-stimulating factor (G-CSF) that prevents febrile neutropenia (FN) in patients with breast cancer receiving chemotherapy. This study aimed to evaluate the incidence of chemotherapy-related FN events and other adverse events (AEs) during chemotherapy in Korean patients with breast cancer treated with pegfilgrastim as secondary prophylactic support. MATERIALS AND METHODS: This was a multicenter, open-label, prospective, observational study. A total of 1255 patients were enrolled from 43 institutions. The incidence of FN was evaluated as the primary endpoint. The secondary endpoints included (1) incidence of bone pain, (2) proportion of patients with a relative dose intensity (RDI) of ≥85%, and (3) proportion of patients with AE. RESULTS: Pegfilgrastim administration reduced FN by 11.8-1.6%. The highest incidence of bone pain was observed at the time point of the 1st day after the administration and mild bone pain was the most common of all bone pain severity. The mean RDI was 98.5 ± 7.3%, and the proportion of the patients with and RDI≥85% was 96.9% (1169/1233). AEs were reported in 52.6% of the patients, and serious drug reactions occurred in only 0.7%. CONCLUSION: The use of pegfilgrastim as secondary prophylaxis was effective and safe for preventing FN in patients with breast cancer who were treated with chemotherapy.

Concurrent laparoscopic highly selective vagotomy with closure of duodenal ulcer perforations show good clinical results as primary repair alone.

OBJECTIVE: To compare clinical and operative results between laparoscopic primary repair (LPR) alone and LPR with highly selective vagotomy (LPR-HSV) in patients with duodenal ulcer perforation. METHODS: Clinical data from patients who underwent either LPR or LPR-HSV by resecting both sides of the neurovascular bundle using an ultrasonic or bipolar electrosurgical device for duodenal ulcer perforations, between 2010 and 2020, were retrospectively collected. Between-group differences in continuous and categorical variables were statistically analysed. RESULTS: Data from 184 patients (mean age, 49.6 years), who underwent either LPR (n = 132) or LPR-HSV (n = 52) were included. The mean operation time was significantly longer in the LPR-HSV group (116.5 ± 39.8 min) than in the LPR group (91.2 ± 33.3 min). Hospital stay was significantly shorter in the LPR-HSV group (8.6 ± 2.6 days) versus the LPR group (11.3 ± 7.1 days). The mean postoperative day of starting soft fluid diet was also significantly shorter in the LPR-HSV group (4.5 ± 1.4 days) than in the LPR group (5.6 ± 4 days). No between-group difference in morbidity rate was observed. The learning curve of the HSV procedure showed a stable procedure time after 10 operations. CONCLUSIONS: LPR with HSV may be a safe and feasible procedure for selective cases who are at high risk for ulcer recurrence.

Guideline No. 440: Management of Monochorionic Twin Pregnancies.

OBJECTIVE: This guideline reviews the evidence-based management of normal and complicated monochorionic twin pregnancies. TARGET POPULATION: Women with monochorionic twin or higher order multiple pregnancies. BENEFITS, HARMS, AND COSTS: Implementation of these recommendations should improve the management of both complicated and uncomplicated monochorionic (and higher order multiple) twin pregnancies. They will help users monitor monochorionic twin pregnancies appropriately and identify and manage monochorionic twin complications optimally in a timely manner, thereby reducing perinatal morbidity and mortality. These recommendations entail more frequent ultrasound monitoring of monochorionic twins compared to dichorionic twins. EVIDENCE: Published literature was retrieved through searches of PubMed and the Cochrane Library using appropriate MeSH headings (Twins, Monozygotic; Ultrasonography, Prenatal; Placenta; Fetofetal Transfusion; Fetal Death; Fetal Growth Retardation). Results were restricted to systematic reviews, randomized controlled clinical trials, and observational studies. There were no date limits, but results were limited to English or French language materials. VALIDATION METHODS: The content and recommendations were drafted and agreed upon by the principal authors. The Board of the SOGC approved the final draft for publication. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE: Maternal-fetal medicine specialists, obstetricians, radiologists, sonographers, family physicians, nurses, midwives, residents, and other health care providers who care for women with monochorionic twin or higher order multiple pregnancies. TWEETABLE ABSTRACT: Canadian (SOGC) guidelines for the diagnosis, ultrasound surveillance and management of monochorionic twin pregnancy complications, including TTTS, TAPS, sFGR (sIUGR), acardiac (TRAP), monoamniotic twins and intrauterine death of one MC twin. SUMMARY STATEMENTS: RECOMMENDATIONS.

Directive clinique no 440 : Prise en charge de la grossesse gémellaire monochoriale.

OBJECTIF: Cette directive clinique passe en revue les données probantes sur la prise en charge de la grossesse gémellaire monochoriale normale et compliquée. POPULATION CIBLE: Les femmes menant une grossesse gémellaire ou multiple de haut rang. BéNéFICES, RISQUES ET COûTS: L'application des recommandations de cette directive devrait améliorer la prise en charge des grossesses gémellaires (ou multiples de haut rang) monochoriales compliquées et non compliquées. Ces recommandations aideront les fournisseurs de soins à surveiller adéquatement les grossesses gémellaires monochoriales ainsi qu'à détecter et prendre en charge rapidement les complications associées de façon optimale afin de réduire les risques de morbidité et mortalité périnatales. Ces recommandations impliquent une surveillance échographique plus fréquente en cas de grossesse monochoriale qu'en cas de grossesse bichoriale. DONNéES PROBANTES: La littérature publiée a été colligée par des recherches dans les bases de données PubMed et Cochrane Library au moyen de termes MeSH pertinents (Twins, Monozygotic; Ultrasonography, Prenatal; Placenta; Fetofetal Transfusion; Fetal Death; Fetal Growth Retardation). Les résultats ont été restreints aux revues systématiques, aux essais cliniques randomisés et aux études observationnelles. Aucune date limite n'a été appliquée, mais les résultats ont été limités aux contenus en anglais ou en français. MéTHODES DE VALIDATION: Les auteurs principaux ont rédigé le contenu et les recommandations et ils se sont entendus sur ces derniers. Le conseil d'administration de la SOGC a approuvé la version définitive aux fins de publication. Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Spécialistes en médecine fœto-maternelle, obstétriciens, radiologues, échographistes, médecins de famille, infirmières, sages-femmes, résidents et autres fournisseurs de soins de santé qui s'occupent de femmes menant une grossesse gémellaire ou multiple de haut rang. RéSUMé POUR TWITTER: Directive canadienne (SOGC) pour le diagnostic, la surveillance échographique et la prise en charge des complications de la grossesse gémellaire monochoriale (p. ex., STT, TAPS, retard de croissance sélectif, cojumeau acardiaque, monoamnionicité et mort d'un jumeau). DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.

Kikuchi-Fujimoto Disease in the Axilla after COVID-19 Vaccination: A Case Report.

BACKGROUND: Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting inflammatory condition of unknown etiology that is characterized by fever and painful lymphadenopathy. KFD commonly involves the posterior cervical region and very rarely occurs in the axilla. CASE PRESENTATION: We report on a case of KFD that presented 3 weeks after receiving the messenger ribonucleic acid-based coronavirus disease 2019 (COVID-19) vaccine. In this case, we suspected the lesions as COVID-19 vaccination-related lymphadenopathy on the initial ultrasonographic examination. CONCLUSION: Through this case report, we highlight that KFD should be considered in the differential diagnosis of patients with axillary lymphadenopathy who have undergone COVID-19 vaccination, as unusual side effects of COVID-19 vaccination have been increasingly reported in the literature owing to the rapid development of various COVID-19 vaccines during the pandemic period. In addition, we emphasize the importance of clinical suspicion in diagnosing KFD due to the fact that axillary involvement of KFD is extremely rare.

Proximity of maxillary molar apexes to the cortical bone surface and the maxillary sinus.

Objectives: This study aimed to analyze the proximity of maxillary molar roots to their overlying cortical bone surfaces and the maxillary sinus. Materials and Methods: Cone-beam computed tomographic images of 151 patients with completely erupted upper molars that had 3 separate roots were studied. The following distances were measured: from the root apex to the cortical plate and maxillary sinus floor, and from the apical 3-mm level of the root to the cortical plate. Differences between groups were analyzed with 1-way analysis of variance and the Scheffé post hoc test, the significance of differences between cone-beam computed tomography views with the paired t-test, and the significance of differences among age groups with linear regression analysis. The significance level was set at p < 0.05. Results: The mesiobuccal and distobuccal root apexes of maxillary second molars were more distant from the buccal cortical plate than the maxillary first molars (p < 0.05). The apical 3-mm level of the mesiobuccal root of the first molar was closer to the buccal cortical bone than the second molar (p < 0.05). In the maxillary first molars, the thickness of the buccal cortical bone decreased in all roots with age (p < 0.05). In all root apexes of both molars, the difference in the vertical level between the maxillary sinus floor and the root apex increased with age (p < 0.05). Conclusions: Awareness of the anatomical profile of maxillary molar apices in relation to the cortical bones and maxillary sinus will be beneficial for apical surgery.

Bi-allelic MYH3 loss-of-function variants cause a lethal form of contractures, pterygia, and spondylocarpotarsal fusion syndrome 1B.

Arthrogryposis is a consequence of reduced fetal movements and arises due to environmental factors or underlying genetic defects, with extensive genetic heterogeneity. In many instances, the genes responsible are involved in neuromuscular function. Missense variants in the gene encoding embryonic myosin heavy chain (MYH3) usually cause distal arthrogryposis. Recently, mono-allelic or bi-allelic MYH3 variants have been associated with contractures, pterygia, and spondylocarpotarsal fusion syndrome 1 (CPSFS1A and CPSFS1B). Here we describe three fetuses presenting in the second trimester with a lethal form of arthrogryposis and pterygia and harbouring bi-allelic variants in MYH3. One proband was compound heterozygous for a missense change and an extended splice site variant, a second proband had a homozygous frameshift variant, and a third proband was homozygous for a nonsense variant. Minigene assays performed on the first fetus showed that the missense and extended splice site variants resulted in aberrant splicing, likely resulting in near complete loss of full-length MYH3 transcript. This study shows that loss of MYH3 is associated with a lethal arthrogryposis phenotype and highlights the utility of minigene assays to assess splicing.

Ectopic cervical thymic squamous cell carcinoma misdiagnosed as thyroid cancer: a case report.

Ectopic thymic neoplasm, particularly ectopic thymic carcinoma, is a rare disease that presents as a neck mass. Here, we present a case of ectopic thymic squamous carcinoma in a 65-year-old man who presented with persistent hoarseness. After fine needle aspiration cytology, the patient underwent total thyroidectomy with lymph node dissection. The final histopathological examination revealed the ectopic thymic squamous carcinoma. The patient was discharged without any postoperative complications. The patient received adjuvant radiation therapy and did not progress during the 1-year follow-up period.

The role of fluorodeoxyglucose-PET/computed tomography as a predictor of breast cancer characteristics and prognosis.

PURPOSE: Fluorodeoxyglucose-PET/computed tomography (FDG-PET/CT) affects the management of patients with breast cancer. Our study aimed to determine the predictive ability of characteristics such as lymph node involvement or subtype and the prognostic value of pretreatment FDG-PET/CT in breast cancer. METHOD: A total of 270 patients who were confirmed with breast cancer histopathologically and underwent pretreatment FDG-PET/CT were enrolled in the study. Nuclear medicine specialists obtained the readings and measured the maximum standardized uptake value (SUVmax) of the images. Tumor and lymph node SUVmax were evaluated according to lymph node metastasis and subtype status. Survival outcomes were analyzed by the Kaplan-Meier method. RESULTS: The lymph node SUVmax and the lymph node/tumor SUVmax ratio were significantly higher in the subgroup of patients with lymph node metastasis than in those without lymph node metastasis. High cutoff lymph node SUVmax value and lymph node/tumor SUVmax ratio were confirmed as significant predictive factors in multivariate analysis. In a comparison of the tumor SUVmax values, the more biological aggressive subtype showed higher tumor SUVmax values. In survival analysis, tumor SUVmax and lymph node SUVmax were significant predisposing factors for disease-free survival in breast cancer. In subgroup analysis, tumor SUVmax was a more significant prognostic factor in patients who had breast cancer with tumor sizes of ≤2 cm. The lymph node SUVmax was more a significant prognostic factor in patients who had breast cancer with lymph node metastasis. CONCLUSION: In this study, we showed that the SUVmax of FDG-PET/CT was a useful predictor of lymph node metastasis and breast cancer prognosis.

The usefulness of red blood cell distribution width and its ratio with platelet count in breast cancer after surgery and adjuvant treatment: a retrospective study.

Background: To date, red blood cell distribution width (RDW) and RDW-to-platelet count ratio (RPR) have been investigated for their association with cancer. This study aimed to investigate the prognostic value of RDW and RPR in breast cancer before and after treatment. Methods: We retrospectively enrolled 395 patients with breast cancer, who were diagnosed between December 2009 and December 2015 and analyzed the association between RDW, RPR, and long-term prognosis. We also compared the RDW and RPR values with the pathologic parameters of breast cancer. The cutoff values for before-treatment RDW, RPR value, after-treatment RDW, and RPR were determined using receiver operating characteristic (ROC) curve analysis by identifying the highest Youden index. Results: In the before-treatment state, no significant disease-free survival (DFS) or overall survival (OS) was found in the RPR and RDW values. However, we found that elevated after-treatment RPR and RDW were significant prognostic factors for DFS, with hazard ratios (HRs) of 2.233 [95% confidence interval (CI): 1.073-4.649; P=0.032] and 2.067 (95% CI: 1.085-3.937; P=0.027). Kaplan-Meier analysis indicated that the after-treatment RPR and RDW groups had poor OS (HR =30.461; 95% CI: 5.138-180.575; P<0.001) compared with the lower after-treatment RPR and RDW groups. In particular, when the RPR and RDW were in the lower group before the treatment and became elevated after the treatment, it showed a remarkably significant result for OS, with HR 132.6 (95% CI: 3.689-4,767.341; P=0.007) and 10.119 (95% CI: 1.853-55.249; P=0.008). Conclusions: Thus, after-treatment RPR and RDW could have prognostic value for breast cancer after surgery and adjuvant treatment.

Schwannoma of the breast presenting as a painful lump: A case report.

RATIONALE: Schwannoma in the breast parenchyma is very unusual. It usually develops on the head, neck, and extensor surfaces of the upper and lower extremities. PATIENT CONCERNS: We report a case of a 60-year-old woman with a palpable and painful mass. Clinically, she experienced neuropathic pain at the mass site. DIAGNOSES: The tumor was a 1 cm, well-circumscribed mass, and revealed schwannoma on core needle biopsy. INTERVENTIONS: The patient underwent wide excision. OUTCOMES: No postoperative complications were observed. A six-month follow-up revealed no recurrence. LESSONS SUBSECTIONS: Although breast schwannoma is a very rare tumor, it is a very important consideration in case of a Breast Imaging-Report and Data System 4A lesion with a painful and palpable mass.

Positive estrogen receptor status is a poor prognostic factor in node-negative breast cancer: An observational study in Asian patients.

ABSTRACT: This study evaluated the outcomes and prognostic factors for breast cancer according to initial lymph node (LN) status. Among patients with LN-negative breast cancer, we also focused on the prognostic value of estrogen receptor (ER) status.Medical records were retrospectively reviewed for 715 patients who underwent curative surgery for breast cancer between January 2005 and December 2015 at a single Korean institution. We evaluated factors that were associated with metastasis-free survival (MFS) according to LN status.Among the 715 patients (age: 28-87 years), 458 patients (64.1%) did not have axillary LN metastasis. Relative to patients without LN metastasis, patients with LN metastasis had larger tumor sizes and higher histological grades. Among patients with no LN metastasis, ER positivity was associated with non-significantly poorer MFS than ER negativity (mean survival: 138.90 months vs. 146.99 months, p = .17), and patients with LN-negative ER-positive disease had MFS rates of 91.7% at 5 years and 74.5% at 10 years. Among patients with LN-negative ER-positive disease, a poor prognosis was significantly associated with larger tumor size (≥2 cm, P = .03) and older age (≥50 years, P = .03).These results indicate that the risk of metastasis increases over time for patients with LN-negative ER-positive breast cancer, and especially for older patients or patients with larger tumors.

Usefulness of 3D-surgical guides in breast conserving surgery after neoadjuvant treatment.

We used 3D printed-breast surgical guides (3DP-BSG) to designate the original tumor area from the pre-treatment magnetic resonance imaging (MRI) during breast-conserving surgery (BCS) in breast cancer patients who received neoadjuvant systemic therapy (NST). Targeting the original tumor area in such patients using conventional localization techniques is difficult. For precise BCS, a method that marks the tumor area found on MRI directly to the breast is needed. In this prospective study, patients were enrolled for BCS after receiving NST. Partial resection was performed using a prone/supine MRI-based 3DP-BSG. Frozen biopsies were analyzed to confirm clear tumor margins. The tumor characteristics, pathologic results, resection margins, and the distance between the tumor and margin were analyzed. Thirty-nine patients were enrolled with 3DP-BSG for BCS. The median nearest distance between the tumor and the resection margin was 3.9 cm (range 1.2-7.8 cm). Frozen sections showed positive margins in 4/39 (10.3%) patients. Three had invasive cancers, and one had carcinoma in situ; all underwent additional resection. Final pathology revealed clear margins. After 3-year surveillance, 3/39 patients had recurrent breast cancer. With 3DP-BSG for BCS in breast cancer patients receiving NST, the original tumor area can be identified and marked directly on the breast, which is useful for surgery. Trial Registration: Clinical Research Information Service (CRIS) Identifier Number: KCT0002272. First registration number and date: No. 1 (27/04/2016).

Is it really post-irradiation morphea or oleoma of the breast?-A case report and literature review.

We report the case of a 65-year-old woman who underwent breast-conserving surgery (BCS) and radiotherapy for breast cancer with hyperpigmentation and skin thickening of the treated breast site 10 years after the surgery. The patient was injected with a liquid foreign body in both breasts 30 years ago. Theses clinical features were considered scleroderma, post-irradiation morphea (PIM), and recurrent breast cancer for differential diagnosis. We performed breast magnetic resonance imaging (MRI), however, the patient had no abnormal findings. Owing to the pain, increased hyperpigmentation, and possibility of cancer recurrence, the patient underwent a simple mastectomy. The final pathologic diagnosis was oleoma with post-radiation fibrosis among drug-induced and toxic scleroderma-like disorders. The patient tolerated surgical therapy without complications. This case report highlight is that difficult to distinguish between PIM and oleoma in patients with a complex history. In this case, the patient had both a history of radiotherapy and a history of foreign body injection, making the clinical diagnosis difficult. PIM and oleoma are non-malignant but can impair a patient's quality of life owing to symptoms and the clinical presentation is similar to that of local recurrence of breast cancer. Thus, arriving at the correct diagnosis typically requires a multidisciplinary approach, including imaging follow-up, skin punch biopsy, or surgery for a definitive diagnosis.

Dynamic changes of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predicts breast cancer prognosis.

BACKGROUND: We aimed to identify whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are more useful predictors after initial intention to treat than at the time of diagnosis. METHODS: We collected the medical data of 533 patients. The results of the peripheral blood sampling before the primary treatments were labeled as initial cohort, and those obtained between 24 and 36 months after initial treatment were defined as the 2nd cohort. Delayed metastasis has been defined as distant metastasis 2 years after treatment, and survival outcome was estimated and compared across groups. RESULTS: Median follow-up duration was 74 months (24-162 months), and 53 patients experienced delayed metastasis. In univariate analysis, metastasis-free survival, patient age at diagnosis, tumor size, axillary lymph node metastasis, HER-2 status, initial NLR and PLR, and 2nd NLR and PLR were found to be significantly associated with delayed metastasis. However, in multivariate analysis, only the 2nd NLR and PLR were found to be significantly associated with delayed metastasis, excluding initial NLR and PLR. Metastasis-free survival was analyzed through the pattern changes of NLR or PLR. The results revealed that patients with continued low NLR and PLR values at pre- and post-treatment (low initial values and 2nd values) showed a significantly better prognosis than those with a change in value or continued high NLR and PLR. CONCLUSIONS: We identified that patients with persistent high NLR and PLR after initial treatment have significant worse prognosis in terms of late metastasis. Therefore, these results suggest that NLR and PLR are more useful in predicting prognosis post-treatment.

Bilateral cervical chondrocutaneous branchial remnants: A case report and a review of the literature.

RATIONALE: Cervical chondrocutaneous branchial remnants are rare, benign, congenital anomalies, frequently seen bilaterally. PATIENT CONCERNS: Here, we report the case of a 4-month-old female infant who presented with bilateral lower neck skin tag since birth. DIAGNOSIS AND INTERVENTIONS: The patient underwent mass excision. The final pathological diagnosis was bilateral cervical chondrocutaneous branchial remnants with hyaline cartilage. OUTCOMES: No complications were observed after excision. One-year follow-up revealed no recurrence. LESSONS: Bilateral chondrocutaneous branchial remnants are rare anomalies. They are often associated with cardiac or genitourinary abnormalities. Therefore, additional preoperative imaging of the abdomen and heart are recommended.

The elements of success in a comprehensive state-wide program to safely reduce the rate of preterm birth.

BACKGROUND: In 2014, a whole-of-population and multi-faceted preterm birth prevention program was introduced in Western Australia with the single aim of safely lowering the rate of preterm birth. The program included new clinical guidelines, print and social media, and a dedicated new clinic. In the first full calendar year the rate of preterm birth fell by 7.6% and the reduction extended from the 28-31 week gestational age group upwards. OBJECTIVE: The objective of this study was to evaluate outcomes in greater depth and to also include the first three years of the program. STUDY DESIGN: This was a prospective population-based cohort study of perinatal outcomes in singleton pregnancies before and after commencement of the program. RESULTS: There was a significant reduction in preterm birth in the tertiary center which extended from 28 weeks gestation onwards and was ongoing. In non-tertiary centers there was an initial reduction, but this was not sustained past the first year. The greatest reduction was observed in pregnancies classified at first attendance as low risk. No benefit was observed in the private sector, but a significant reduction was seen in the remote region of the Kimberley where the program was first launched and vaginal progesterone had been made free-of-charge. CONCLUSION: Preterm birth rates can be safely reduced by a multi-faceted and whole-of-population program but the effectiveness requires continuing effort and will be greatest where the strategies are most targeted.

Comprehensive analyses with radiological and biological markers of breast cancer on contrast-enhanced chest CT: a single center experience using dual-layer spectral detector CT.

OBJECTIVES: To evaluate the predictive value of virtual monoenergetic images (VMIs) by assessing tumor conspicuity on dual-layer spectral detector CT (SDCT) and correlate tumor conspicuity on VMI with prognostic biomarkers in patients with breast cancer. METHODS: Sixty-four patients underwent arterial phase and 90-s delayed phase dual-layer SDCT. A retrospective tumor conspicuity analysis of 14 benign tumors and 65 breast cancers was performed using conventional images (CIs) and VMI at 40 keV (VMI40) on arterial and delayed phase scans (CIART, VMI40ART, CIDE, VMI40DE). Mean Hounsfield units (HU) of tumors were measured on VMI40ART and VMI40DE. A receiver operating characteristic (ROC) curve analysis was performed to compare diagnostic accuracy between image sets. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki67 levels were evaluated using histopathology. Correlations between VMI analyses and histological characteristics of cancers were analyzed. RESULTS: Cancers on VMI40 had a significantly higher conspicuity score and mean HU than benign tumors (p < 0.001). VMI40DE showed the highest conspicuity for cancers (mean, 3.79) and the greatest area under the ROC curve (0.817; 95% confidence interval 0.745-0.889). VMI40DE yielded significantly higher mean HU for cancers than VMI40ART (p < 0.001). The conspicuity score and mean HU on VMI40ART were significantly higher in cancers with ER negativity, PR negativity, and Ki67 positivity (p < 0.05). CONCLUSIONS: VMI40DE may be useful in the diagnosis of breast cancers due to higher tumor conspicuity and better enhancement than VMI40ART. VMI40ART may be beneficial for the prediction of poor breast cancer prognoses. KEY POINTS: • VMI40 improved conspicuity of breast cancer than CI. • VMI40DEyielded higher diagnostic performance of breast cancer than VMI40ART. • VMI40ARThas an additional benefit in terms of prognosis prediction in patients with breast cancers.