Exploring Neoadjuvant Chemotherapy, Predictive Models, Radiomic, and Pathological Markers in Breast Cancer: A Comprehensive Review.

Breast cancer retains its position as the most prevalent form of malignancy among females on a global scale. The careful selection of appropriate treatment for each patient holds paramount importance in effectively managing breast cancer. Neoadjuvant chemotherapy (NACT) plays a pivotal role in the comprehensive treatment of this disease. Administering chemotherapy before surgery, NACT becomes a powerful tool in reducing tumor size, potentially enabling fewer invasive surgical procedures and even rendering initially inoperable tumors amenable to surgery. However, a significant challenge lies in the varying responses exhibited by different patients towards NACT. To address this challenge, researchers have focused on developing prediction models that can identify those who would benefit from NACT and those who would not. Such models have the potential to reduce treatment costs and contribute to a more efficient and accurate management of breast cancer. Therefore, this review has two objectives: first, to identify the most effective radiomic markers correlated with NACT response, and second, to explore whether integrating radiomic markers extracted from radiological images with pathological markers can enhance the predictive accuracy of NACT response. This review will delve into addressing these research questions and also shed light on the emerging research direction of leveraging artificial intelligence techniques for predicting NACT response, thereby shaping the future landscape of breast cancer treatment.

Diffusion tensor imaging parameters in differentiation recurrent breast cancer from post-operative changes in patients with breast-conserving surgery.

AIM OF THE WORK: To investigate mean diffusivity (MD) and fractional anisotropy (FA) measured by diffusion tensor imaging (DTI) as complementary tools to differentiate recurrent breast cancer from post-operative changes in patients with breast-conserving surgery (BCS). PATIENTS AND METHODS: Prospective study was conducted upon 30 patients with BCS that underwent DTI and dynamic contrast MR imaging. DTI was performed using an axial two-dimensional spin-echo echo-planar imaging sequence. The MD and FA of the lesions were calculated by 2 observers. A single pixel seed isotropic region of interest was placed in the solid part of the tumor on the axial color FA map guided by an enhanced part of the tumor. The final diagnosis was done by biopsy for all patients. RESULTS: The pathological examination proved to be recurrent breast cancer (n = 13) and post-operative changes (n = 17). Recurrent breast cancer had significantly lower MD (P = 0.001, 0.001) and higher FA (P = 0.003, 0.02) than in post-operative changes for both observers respectively. At ROC curve analysis of MD, the AUC was 0.86 and 0.85 by both observers. The threshed MD was (0.86, 0.85 × 10-3 mm2/s) used for differentiation between entities revealed sensitivity (76.9%, 92.3%), specificity (82.4%, 64.7%) and accuracy (80%, 76.7%) of both observers respectively. At ROC curve analysis of FA, the AUC was 0.82 and 0.75 by both observers. The threshold FA (0.82, 0.75) was used for differentiation between entities revealed sensitivity (92.3%, 76.9%), specificity (70.6%, 70.6%) and accuracy of (80.0%, 73.3%) of both observers respectively. There was a strong positive correlation of MD (r = 0.86) and FA (r = 0.73) of both observers. Combined analysis of FA and MD used for differentiation between entities had AUC (0.90, 0.88) revealed sensitivity (92.3%, 92.3%), specificity (82.4%, 70.6%) and accuracy of (86.7%, 80.0%) for both observers respectively. CONCLUSIONS: Combined analysis of MD and FA of DTI may play an important role as a non-invasive method for differentiation recurrent breast cancer from post-operative changes in patients with BCS.

The additive role of 1H-magnetic resonance spectroscopic imaging to ensure pathological complete response after neoadjuvant chemotherapy in breast cancer patients.

PURPOSE: To assess the role of 1H-magnetic resonance spectroscopy (1H-MRS) in the confirmation of pathological complete response after neoadjuvant chemotherapy in breast cancer. MATERIAL AND METHODS: Forty-seven cases (53.72 ± 8.53 years) were evaluated using magnetic resonance imaging (MRI) and 1H-MRS with choline (Cho) signal-to-noise ratio (SNR) measured followed by histopathology and ROC analyses. RESULTS: Twelve patients had complete response, and 35 patients had residual disease. Mean age was 53.72 ± 8.53 years. The mean tumour size before neoadjuvant chemotherapy (NAC) was 4.21 ± 0.99 cm and after NAC was 0.9 ± 0.44 cm.Positive total choline signal (tCho) was detected in all cases. The mean Cho SNR before NAC was 9.53 ± 1.7 and after NAC was 2.53 ± 1.3. The Cho SNR cut-off point differentiating between pathologic complete response (pCR) and the non pCR was 1.95. Dynamic MRI showed 83.3% sensitivity, 65.7% specificity, 45.5% positive predictive value, 92.0% negative predictive value, and 70.2% diagnostic accuracy. Combined evaluation done by using the dynamic MRI and 1H-MRS showed 91.5% diagnostic accuracy with 75.0% sensitivity, 97.1% specificity, 75% positive predictive value, and 91.9% negative predictive value. ROC curves of Cho SNR showed statistically significant differences between non pCR and pCR with AUC was 0.955, 82.9% sensitivity, 91.7% specificity, 96.7% positive predictive value, 64.7% negative predictive value, and 85.11% diagnostic accuracy. CONCLUSIONS: 1H-MRS improves the diagnostic accuracy in the prediction of the pCR after NAC.

Breast fibromatosis, an unusual breast disease.

Fibromatosis is a benign tumor that rarely affects the breast and is an unusual site for its occurrence. Whilst the definite etiology of breast fibromatosis is unclear, it may present itself following surgical trauma or silicone implant. Wide local excision with adequate safety margins is considered the standard of care. We review three cases of breast fibromatosis who were presented to and operated in the Oncology center, Mansoura universty (between April 2014 and August 2016). Two of these cases underwent wide local excision and primary closure of the defect whilst the other one was reshaped by mini latismuss dorsi flap.

Polysplenia syndrome: a review of the relationship with viscero-atrial situs and the spectrum of extra-cardiac anomalies.

Polysplenia syndrome is classified as one of the situs ambiguous or heterotaxy syndromes and is classically termed left isomerism or bilateral left-sidedness. However, polysplenia is a controversial and complex entity with no fixed pathognomonic features but rather a broad spectrum of abnormalities. In many published case series, polysplenia was neither associated with viscero-atrial heterotaxy nor with duplication of left-sided structures. The relationship between polysplenia and viscero-atrial situs is not clear. Several recent case reports describe the association of polysplenia with situs inversus totalis or with pancreatic; venous and other anomalies or with several types of malignancy. This article provides the reader with a review of the literature as well as our own experience aiming at better understanding of the polysplenia syndrome, its relationship with viscero-atrial situs and the spectrum of associated extra-cardiac anomalies.