Contrast-enhanced mammography predicts pathological response after neoadjuvant chemotherapy in locally advanced breast cancer.

Introduction: Recently, contrast-enhanced mammography (CEM) has emerged as a reliable alternative to breast magnetic resonance imaging (MRI) for the assessment of pathological response in breast cancer patients. Our study sought to determine the diagnostic accuracy of CEM to predict pathological complete response (pCR) in patients who received neoadjuvant chemotherapy (NACT). Methods: We retrieved the medical records of patients who underwent NACT at our institution. Using post-surgery pCR, morphological evidence and CEM enhancement tumours were classified as follows: 1) radiologic complete response (rCR); 2) functional radiological complete response (frCR); and 3) non-complete response. Initially, we used multivariate analyses adjusted by clinical variables and frCR or rCR to determine which variables affected pathological response. Then, CEM diagnostic accuracy to discriminate pCR was assessed using receiver operating characteristic curves in univariate and multivariate models including either frCR or rCR. Results: A total of 48 patients were included in our study. Most patients (68.7%) were hormone receptor (HR)+ and 41.6% (20) of the patients achieved pCR. Using univariate logistic regression analyses we found that HR status, HER2 status, rCR and frCR had a significant impact on CEM diagnostic accuracy. Exploratory analyses found that CEM sensitivity was higher for HR- tumours. Multivariate logistic regression analyses found 60% sensitivity, 92.9% specificity and 79.2% accuracy in a model that included clinical variables and rCR. Conclusion: CEM is a reliable alternative to high-cost, time-consuming breast MRI that predicts pCR in patients undergoing NACT; CEM diagnostic accuracy was higher among patients who harboured HR- tumours.

Screen-detected breast cancer is associated with better prognosis and survival compared to self-detected/symptomatic cases in a Chilean cohort of female patients.

PURPOSE: The implementation of national breast cancer (BC) screening programs in Latin America has been rather inconsistent. Instead, most countries have opted for "opportunistic" mammogram screenings on the population at risk. Our study assessed and compared epidemiological, clinical factors, and survival rates associated with BC detected by screening (SDBC) or self-detected/symptomatic (non-SDBC) in Chilean female patients. METHODS: Registry-based cohort study that included non-metastatic BC (stage I/II/III) patients diagnosed between 1993 and 2020, from a public hospital (PH) and a private university cancer center (PC). Epidemiological and clinical data were obtained from medical records. RESULTS: A total of 4559 patients were included. Most patients (55%; n = 2507) came from PH and were diagnosed by signs/symptoms (non-SDBC; n = 3132, 68.6%); these patients displayed poorer overall (OS) and invasive disease-free survival (iDFS) compared to SDBC. Importantly, the proportion of stage I and "luminal" BC (HR + /HER2 -) were significantly higher in SDBC vs. non-SDBC. Finally, using a stage/subset-stratified age/insurance-adjusted model, we found that non-SDBC cases are at a higher risk of death (HR:1.75; p < 0.001). In contrast, patients with PC health insurance have a lower risk of death (HR: 0.60; p < 0.001). CONCLUSION: We confirm previous studies that report better prognosis/survival on SDBC patients. This is probably due to a higher proportion of stage I and luminal-A cases versus non-SDBC. In turn, the survival benefit observed in patients with PC health insurance might be attributed to a larger proportion of SDBC. Our data support the implementation of a systematic BC screening program in Chile to improve patient prognosis and survival rates.

Survival rates of advanced estrogen-receptor positive breast cancer. Analysis of 211 cases

ABSTRACT Background: About 80% of breast cancer (BC) cases express estrogen receptor (ER), which has been correlated with good prognosis and response to estrogen deprivation Aim: To characterize ER positive advanced BC (ABC) patients treated at our institution assessing the impact of clinical pre-sentation (stage IV, de novo disease at diagnosis versus systemic recurrence) and BC subtype on survival rates. Material and Methods: We evaluated 211 ER+ advanced BC (ABC) patients, treated between 1997 and 2017. Results: The median overall survival (OS) was 37 months. Median OS for the period 1997/2006 and 2007/2017 were 33 and 42 months, respectively (p = 0.47). Luminal A, ABC stage IV disease at diagnosis displayed better OS rates than Luminal B stage IV tumors (100 and 32 months respectively, p < 0.01). Conclusions: Clinical presentation (stage IV vs. systemic recurrence) and tumor subtype are key determinants of OS in ABC.

Antecedentes: Casi el 80% de los casos de cáncer de mama (CM) son positivos para receptores de estrógenos (RE+). Éstos se caracterizan por una mejor sobrevida y respuesta a terapia endocrina. Objetivo: Caracterizar a pacientes con CM avanzado (CMA), RE+, y determinar sobrevida según presentación clínica y subtipos. Material y Métodos: Analizamos en nuestra base de datos los antecedentes de 211 pacientes con CMA RE+, tratados en nuestra institución en el período 1997-2017. Se evaluó el impacto de la presentación clínica (estadio IV al diagnóstico, enfermedad de novo, versus recurrencia sistémica) y subtipo de CM, en los niveles de sobrevida. Resultados: La mediana de sobrevida global (SG) fue de 37 meses. La mediana de SG para el período 1997/2006 y 2007/2017 fue de 33 y 42 meses; respectivamente (p = 0,47). Pacientes con CMA, estadio IV, Luminal A al momento del diagnóstico mostraron mejores tasas de SG frente al estadio IV del Luminal B (100 y 32 meses respectivamente (p < 0,01). Conclusiones: La presentación clínica (estadio IV, de novo, versus recurrencia sistémica) y subtipo son determinantes clave de la SG en CMA.

Mammography correlates to better survival rates in breast cancer patients: a 20-year experience in a University health institution.

Breast cancer (BC) is the most common malignancy in women. We retrieved medical records from >2,000 Chilean BC patients over the 1997-2018 period. The objective was to assess changes in clinical presentation or prognosis of our patients throughout these 20 years of practice. Although most variables did not display significant variations, we observed a progressive increase in stage IV BC over this period. Our data showed that tumour stage III/IV or HER2-enriched subtype tumours were associated with poorer prognosis. In contrast, we found that patients diagnosed by mammography had better overall survival. We speculate that better screenings and more sensitive imaging could explain the unexpected rise in stage IV cases. Our results support mammography screenings as an effective measure to reduce BC-related mortality.

Survival rates of advanced estrogen-receptor positive breast cancer. Analysis of 211 cases.

BACKGROUND: About 80% of breast cancer (BC) cases express estrogen receptor (ER), which has been correlated with good prognosis and response to estrogen deprivation Aim: To characterize ER positive advanced BC (ABC) patients treated at our institution assessing the impact of clinical pre-sentation (stage IV, de novo disease at diagnosis versus systemic recurrence) and BC subtype on survival rates. MATERIAL AND METHODS: We evaluated 211 ER+ advanced BC (ABC) patients, treated between 1997 and 2017. RESULTS: The median overall survival (OS) was 37 months. Median OS for the period 1997/2006 and 2007/2017 were 33 and 42 months, respectively (p = 0.47). Luminal A, ABC stage IV disease at diagnosis displayed better OS rates than Luminal B stage IV tumors (100 and 32 months respectively, p < 0.01). CONCLUSIONS: Clinical presentation (stage IV vs. systemic recurrence) and tumor subtype are key determinants of OS in ABC.

Breast lesions with atypia in percutaneous biopsies, managed with surgery in the last 10 years.

INTRODUCTION: The optimal management of breast lesions with atypia (BLA), detected in percutaneous biopsies after screening mammograms, is a controversial issue. The aim of this paper is to compare histological diagnosis by percutaneous biopsy with the results of the surgical biopsy of these lesions and to analyse the changes to clinical approach this would imply. METHOD: A retrospective study was carried out on patients operated on between June 2007 and June 2017 with a diagnosis of BLA. One hundred and forty-seven patients were identified with a pre-operative diagnosis of flat epithelial atypia (FEA), atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, lobular carcinoma in situ and other atypia. RESULTS: The average age at diagnosis of BLAs was 52 ± 9.4 years. Radiologically, the lesions presented as microcalcifications in 79%, nodules in 15.6% and other lesions 5.4%. 73.5% of these were biopsied by means of digital stereotaxis. All of the patients analysed underwent a partial mastectomy. Changes in a biologically high-risk lesion were observed in 26.5% of the surgical specimens, of which 75.5% corresponded with ADH and FEA. In the percutaneous biopsies consistent with ADH (40.1%), ductal carcinoma was discovered in 6.8% (5.1% in situ and 1.7% invasive), which implied specific, multi-disciplinary management. Of the FEAs, 84.8% required a second treatment (surgery and/or hormone therapy ± radiotherapy, depending on whether it concerned FEA 59.6%, ADH 21.2% or ductal carcinoma in situ 3.8%). CONCLUSION: These data show the clinical relevance in the diagnosis of ADH and FEA in percutaneous biopsies. For the diagnosis of FEA in particular, the associated risk of biologically high-risk lesions and ductal carcinoma is made evident.

The Neutrophil to Lymphocyte Ratio Predicts the Response to Neoadjuvant Chemotherapy in Luminal B Breast Cancer.

Objective: Tumor response to neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients is a predictor for overall survival. The aim of our study was to determine a relationship between the neutrophil to lymphocyte ratio (NLR) prior to NAC, BC subtypes and the probability of a pathologic complete response (pCR). Materials and Methods: Medical records were collected retrospectively from Centro de Cancer at Red Salud UC-Christus. Clinical data collected included peripheral blood cell counts, BC subtype at diagnosis and the pathology report of surgery after chemotherapy. Results: A total of 88 patients were analyzed. Approximately, a 25% had a pCR, and displayed a significant correlation between BC subtype and pCR (p= 0.0138 Chi2); this was more frequent in epidermal growth factor receptor type 2 (HER2) enriched subtype patients (54%). Luminal B BC patients with a pCR had significantly lower NLR levels (t test, p= 0.0181). Conclusions: HER2-enriched tumors had a higher probability of pCR. In Luminal B tumors, NLR had a statistically significant relationship with the probability of pCR. In this subtype, NLR could be a useful biomarker to predict tumor response to NAC. Further studies including other clinical parameters for systemic inflammation such as platelet counts, intratumoral NLR or body mass index could help identify patients that would get the most benefit from NAC.

Características clínicas y pronóstico de pacientes con cáncer de mama HER2 positivo avanzado, en la era antes y después de terapias anti-HER2 / Survival of patients with advanced HER2+ breast cancer. Analysis of a cancer center database

Background: HER2+ breast cancer (BC) subtype overexpresses the Human Epidermal growth factor Receptor type-2 (HER2) and is characterized by its aggressiveness and its high sensitivity to monoclonal antibody-based HER2-targeted therapies. Aim: To assess the prognosis and evaluate the impact of novel anti-HER2 therapies on advanced HER2+ BC patients treated at our institution over the last decades. Material and Methods: Analysis of the patient database at a cancer center of a university hospital. Information about the subtype of cancer was obtained in 2,149 of 2,724 patients in the database. Eighteen percent of the latter were HER2+. We analyzed data of 83 of these patients with advanced disease. Results: Median overall survival (OS) was 24 months. For patients treated between 1997-2006 median OS was 17 months and for those treated in the period 2007-2017 median OS was 32 months (p = 0.09). Conclusions: A non-significant trend towards better survival in the last decade was observed. HER2+ BC overall survival has improved in our center. This can be probably attributed to the use of novel more effective anti-HER2 therapies.

[Contrast-enhanced spectral mammography. Experience in 465 examinations]. / Rendimiento de la mamografía espectral de energía dual con contraste en la detección de cáncer de mama: experiencia en un centro de referencia.

BACKGROUND: Contrast-enhanced spectral mammography or "contrast mammography" has a better cost effectiveness than breast magnetic resonance for confirmation of suspicious lesions detected on breast screening programs. AIM: To report the experience of a single center in Santiago. MATERIAL AND METHODS: All patients referred for contrast mammography between July 2015 and October 2017 were studied. We recorded the patient risk factors for breast cancer. In 85 patients with suspicious lesions, biopsy results were available. RESULTS: We analyzed 465 contrast mammographies. The most common clinical indications were suspicion of cancer and previous inconclusive studies. Mass type lesions were detected in 33% of the studies. Non-mass-type lesions were observed in 10% of cases and findings compatible with papillomatosis in 2%. Fifty five percent of the studies had no visible lesions. In the 85 patients with a pathological study of the biopsy, the sensitivity of the contrast mammography was 100%, with a diagnostic accuracy of 85%, positive and negative predictive values of 82 and 100% respectively. CONCLUSIONS: Contrast mammography can be of great use for the assessment of patients with an altered conventional mammography, before indicating a magnetic resonance imaging or a percutaneous biopsy.

Rendimiento de la mamografía espectral de energía dual con contraste en la detección de cáncer de mama: experiencia en un centro de referencia / Contrast-enhanced spectral mammography: experience in 465 examinations

Background: Contrast-enhanced spectral mammography or "contrast mammography" has a better cost effectiveness than breast magnetic resonance for confirmation of suspicious lesions detected on breast screening programs. Aim: To report the experience of a single center in Santiago. Material and Methods: All patients referred for contrast mammography between July 2015 and October 2017 were studied. We recorded the patient risk factors for breast cancer. In 85 patients with suspicious lesions, biopsy results were available. Results: We analyzed 465 contrast mammographies. The most common clinical indications were suspicion of cancer and previous inconclusive studies. Mass type lesions were detected in 33% of the studies. Non-mass-type lesions were observed in 10% of cases and findings compatible with papillomatosis in 2%. Fifty five percent of the studies had no visible lesions. In the 85 patients with a pathological study of the biopsy, the sensitivity of the contrast mammography was 100%, with a diagnostic accuracy of 85%, positive and negative predictive values of 82 and 100% respectively. Conclusions: Contrast mammography can be of great use for the assessment of patients with an altered conventional mammography, before indicating a magnetic resonance imaging or a percutaneous biopsy.

[Survival of patients with advanced HER2+ breast cancer. Analysis of a cancer center database]. / Características clínicas y pronóstico de pacientes con cáncer de mama HER2 positivo avanzado, en la era antes y después de terapias anti-HER2.

BACKGROUND: HER2+ breast cancer (BC) subtype overexpresses the Human Epidermal growth factor Receptor type-2 (HER2) and is characterized by its aggressiveness and its high sensitivity to monoclonal antibody-based HER2-targeted therapies. AIM: To assess the prognosis and evaluate the impact of novel anti-HER2 therapies on advanced HER2+ BC patients treated at our institution over the last decades. MATERIAL AND METHODS: Analysis of the patient database at a cancer center of a university hospital. Information about the subtype of cancer was obtained in 2,149 of 2,724 patients in the database. Eighteen percent of the latter were HER2+. We analyzed data of 83 of these patients with advanced disease. RESULTS: Median overall survival (OS) was 24 months. For patients treated between 1997-2006 median OS was 17 months and for those treated in the period 2007-2017 median OS was 32 months (p = 0.09). CONCLUSIONS: A non-significant trend towards better survival in the last decade was observed. HER2+ BC overall survival has improved in our center. This can be probably attributed to the use of novel more effective anti-HER2 therapies.

Tumor de células granulares de la mama. Presentación de un caso / Granular cell tumor of the breast. Case presentation

El tumor de células granulares (TCG) es una neoplasia muy infrecuente y usualmente benigna, que afecta preferentemente a la lengua.En sólo un 6% por ciento de los casos publicados ha sido primario de la mama. Desde el punto de vista clínico e imagenológico, se plantea el diagnóstico diferencial con un carcinoma mamario invasor. Por ende, el examen anatomopatológico de muestras por punción o quirúrgicas, es crucial para establecer el diagnóstico e intentar subclasificarlo para predecir su conducta biológica. Se presenta el caso de una mujer chilena de 54 años con un TCG de la mama izquierda:(AU)

Granular cell tumor (GCT) is an uncommon and usually benign neoplasm that mostly occurs on the tongue. In only 6 percent of all published cases, GCT has been primary of the breast. From a clinical and radiological point of view, a differential diagnosis with an invasive breast carcinomais considered. Therefore, the anatomopathological examination of core biopsie or surgical samples is crucial to establish a diagnosis and tryto subclassify it in order to predict its biological behavior. We present the case of a 54-year-old chilean woman with a GCT in her left breast.(AU)

Immunoglobulin G4 -related Sclerosing Mastitis: AIRP Best Cases in Radiologic-Pathologic Correlation.

Editor's Note.-RadioGraphics continues to publish radiologic-pathologic case material selected from the American Institute for Radiologic Pathology (AIRP) "best case" presentations. The AIRP conducts a 4-week Radiologic Pathology Correlation Course, which is offered five times per year. On the penultimate day of the course, the best case presentation is held at the American Film Institute Silver Theater and Cultural Center in Silver Spring, Md. The AIRP faculty identifies the best cases, from each organ system, brought by the resident attendees. One or more of the best cases from each of the five courses are then solicited for publication in RadioGraphics. These cases emphasize the importance of radiologic-pathologic correlation in the imaging evaluation and diagnosis of diseases encountered at the institute and its predecessor, the Armed Forces Institute of Pathology (AFIP).

Clinico-Pathologic Subtypes of Breast Cancer Primary Tumors Are Related to Prognosis after Recurrence

Background: Pathological factors, based mainly on immunohistochemistry (IHC) and histological differentiation, are mostly used to differentiate breast cancer (BC) subtypes. Our present aim was to describe the characteristics and survival of a relapsing BC patient cohort based on clinico-pathologic subtypes determined for the primary tumors. Methods: We used a clinico- pathological definition of BC subtypes based on histological grade (HG), estrogen receptor (ER), progesterone receptor (PgR),and epidermal growth factor receptor type 2 (HER2) expression assessed by IHC. We determined variables associated with loco-regional recurrence (LRR), second primaries (SP), systemic recurrence (SR) and post-recurrence survival (PRS). Results: Out of 1,702 patients, 240 (14%) had an event defined as recurrence. Those with recurrent disease were significantly younger than those without,and were initially diagnosed at more advanced stages, with larger tumors, greater lymph nodal involvement and higher HG. With a median follow up of 61 months (1-250), 4.6% of patients without recurrence and 56.6% of patients with an event defined as recurrence had died. The median PRS for the LRR group was 77 months; 75 months for those who developed a SP and 22 months for patients with an SR (p <0.0001). In SR cases, the median PRS was shorter for ER- tumors than for ER+ tumors (15 vs. 26 months, respectively; p = 0.0019, HR 0.44; CI: 0.25-0.44). Conclusions: Subtype, defined through classic histopathologic parameters determined for primary tumors, was found to eb related to type of recurrence and also to prognosis after relapse.

Breast cancer and pregnancy: a comparative analysis of a Chilean cohort.

INTRODUCTION: Recent reports show that pregnancy-associated breast cancer (PABC) survival is similar to that of non-pregnant young patients. We evaluate the characteristics and prognosis of PABC patients treated in our cancer centre. PATIENTS AND METHODS: We identified patients with invasive PABC who were treated between 1999 and May 2013 and compared their characteristics with a no PABC cohort of similar age. RESULTS: The prevalence of PABC was 1% (n = 17). The median age was 35 years (range: 29- 42 years). The initial tumour was suspected clinically in 93% of the cases. Total mastectomy rates were higher in women with PABC (78.6% versus 40.5%, p = 0.02), and more tumours in the PABC group were triple negative, epidermal growth factor type 2 (HER2)-positive, and at advanced stages; however, these differences were not statistically significant. While estimated overall survival at ten years was higher in the non-PABC group (75.5% versus 80.5%, p = 0.043), disease-specific survival (DSS) rate at ten years was not statistically different between groups (83.9% for PABC and 75.5% for unrelated pregnancy BC, p = 0.37). CONCLUSIONS: PABC is a rare event. In our cohort, it tended to be more aggressive. Compared with a similar age cohort, the DSS was not worse.

Enhancement of visual perception with use of dynamic cues.

UNLABELLED: Institutional review board approval and signed informed consent were not needed, as medical images included in public databases were used in this study. The purpose of this study was to improve the detection of microcalcifications on mammograms and lung nodules on chest radiographs by using the dynamic cues algorithm and the motion and flickering sensitivity of the human visual system (HVS). Different sets of mammograms from the Mammographic Image Analysis Society database and chest radiographs from the Japanese Society of Radiological Technology database were presented statically, as is standard, and in a video sequence generated with the dynamic cues algorithm. Nine observers were asked to rate the presence of abnormalities with a five-point scale (1, definitely not present; 5, definitely present). The data were analyzed with receiver operating characteristic (ROC) techniques and the Dorfman-Berbaum-Metz method. The video sequence generated with the dynamic cues algorithm increased the rate of detection of microcalcifications by 10.2% (P = .002) compared with that obtained with the standard static method, as measured by the area under the ROC curve. Similar results were obtained for lung nodules, with an increase of 12.3% (P = .0054). The increase in the rate of correct detection did not come just from the image contrast change produced by the algorithm but also from the fact that image frames generated with the dynamic cues algorithm were put together in a video sequence so that the motion sensitivity of the HVS could be used to facilitate the detection of low-contrast objects. SUPPLEMENTAL MATERIAL: http://radiology.rsnajnls.org/cgi/content/full/250/2/551/DC1.