Identifying an early treatment window for predicting breast cancer response to neoadjuvant chemotherapy using immunohistopathology and hemoglobin parameters.

BACKGROUND: Breast cancer pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) varies with tumor subtype. The purpose of this study was to identify an early treatment window for predicting pCR based on tumor subtype, pretreatment total hemoglobin (tHb) level, and early changes in tHb following NAC. METHODS: Twenty-two patients (mean age 56 years, range 34-74 years) were assessed using a near-infrared imager coupled with an Ultrasound system prior to treatment, 7 days after the first treatment, at the end of each of the first three cycles, and before their definitive surgery. Pathologic responses were dichotomized by the Miller-Payne system. Tumor vascularity was assessed from tHb; vascularity changes during NAC were assessed from a percentage tHb normalized to the pretreatment level (%tHb). After training the logistic prediction models using the previous study data, we assessed the early treatment window for predicting pathological response according to their tumor subtype (human epidermal growth factor receptor 2 (HER2), estrogen receptor (ER), triple-negative (TN)) based on tHb, and %tHb measured at different cycles and evaluated by the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS: In the new study cohort, maximum pretreatment tHb and %tHb changes after cycles 1, 2, and 3 were significantly higher in responder Miller-Payne 4-5 tumors (n = 13) than non-or partial responder Miller-Payne 1-3 tumors (n = 9). However, no significance was found at day 7. The AUC of the predictive power of pretreatment tHb in the cohort was 0.75, which was similar to the performance of the HER2 subtype as a single predictor (AUC of 0.78). A greater predictive power of pretreatment tHb was found within each subtype, with AUCs of 0.88, 0.69, and 0.72, in the HER2, ER, and TN subtypes, respectively. Using pretreatment tHb and cycle 1 %tHb, AUC reached 0.96, 0.91, and 0.90 in HER2, ER, and TN subtypes, respectively, and 0.95 regardless of subtype. Additional cycle 2 %tHb measurements moderately improved prediction for the HER2 subtype but did not improve prediction for the ER and TN subtypes. CONCLUSIONS: By combining tumor subtypes with tHb, we predicted the pCR of breast cancer to NAC before treatment. Prediction accuracy can be significantly improved by incorporating cycle 1 and 2 %tHb for the HER2 subtype and cycle 1 %tHb for the ER and TN subtypes. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02092636 . Registered in March 2014.

Assessment of Functional Differences in Malignant and Benign Breast Lesions and Improvement of Diagnostic Accuracy by Using US-guided Diffuse Optical Tomography in Conjunction with Conventional US.

Purpose To investigate ultrasonography (US)-guided diffuse optical tomography to distinguish the functional differences of hemoglobin concentrations in a wide range of malignant and benign breast lesions and to improve breast cancer diagnosis in conjunction with conventional US. Materials and Methods The study protocol was approved by the institutional review boards and was HIPAA compliant. Written informed consent was obtained from all patients. Patients (288 women; mean age, 50 years; range, 17-94 years) who underwent US-guided biopsy were imaged with a handheld US and optical probe. The US-imaged lesion was used to guide reconstruction of light absorption maps at four wavelengths, and total hemoglobin (tHb), oxygenated hemoglobin (oxyHb), and deoxygenated hemoglobin (deoxyHb) were computed from the absorption maps. A threshold (80 µmol/L) was chosen on the basis of this study population. Two radiologists retrospectively evaluated US images on the basis of the US Breast Imaging Reporting and Data System lexicon, and a lesion was considered malignant when a score of 4C or 5 was given or a lesion had tHb greater than 80 µmol/L. A two-sample t test was used to calculate significance between groups, and Spearman ρ was computed between hemoglobin parameters and tumor pathologic grades. Results Three tumors were Tis, 37 were T1, 19 were T2-T4 carcinomas, and 233 were benign lesions. The mean maximum tHb, oxyHb, and deoxyHb of Tis-T1 and T2-T4 groups were 89.3 µmol/L ± 20.2 (standard deviation), 65.0 µmol/L ± 20.8, and 33.5 µmol/L ± 11.3, respectively, and 84.7 µmol/L ± 32.8, 57.1 µmol/L ± 19.8, and 34.7 µmol/L ± 18.9, respectively. The corresponding values of benign lesions were 54.1 µmol/L ± 23.5, 38.0 µmol/L ± 17.4, and 25.2 µmol/L ± 13.8, respectively. The mean maximum tHb, oxyHb, and deoxyHb were significantly higher in the malignant groups than the benign group (P <.001, <.001, and .041, respectively). For malignant lesions, the mean maximum tHb moderately correlated with tumor histologic grade and nuclear grade (ρ = 0.283 and 0.315, respectively). The mean maximum oxyHb moderately correlated with tumor nuclear grade (ρ = 0.267). When radiologists' US diagnosis and the tHb were used together, the sensitivity, specificity, positive predictive value, and negative predictive value were 96.6%-100%, 77.3%-83.3%, 52.7%-59.4%, and 99.0%-100%, respectively, for the combined malignant group. Conclusion The tHb and oxyHb correlate with breast cancer pathologic grade and can be used as an adjunct to US to improve sensitivity and negative predictive value in breast cancer diagnosis. (©) RSNA, 2016 Online supplemental material is available for this article.

Ultrasound-Guided Diffuse Optical Tomography for Predicting and Monitoring Neoadjuvant Chemotherapy of Breast Cancers: Recent Progress.

In this manuscript, we review the current progress of utilizing ultrasound-guided diffuse optical tomography (US-guided DOT) for predicting and monitoring neoadjuvant chemotherapy (NAC) outcomes of breast cancer patients. We also report the recent advance on optical tomography systems toward portable and robust clinical use at multiple clinical sites. The first patient who has been closely monitored before NAC, at day 2, day 8, end of first three cycles of NAC, and before surgery is given as an example to demonstrate the potential of US-guided DOT technique.

Maximizing Mentorship Throughout Your Breast Imaging Career.

Unlike many other subspecialties in radiology, breast radiologists practice in a patient-facing and interdisciplinary environment where team building, communication, and leadership skills are critical. Although breast radiologists can improve these skills over time, strong mentorship can accelerate this process, leading to a more successful and satisfying career. In addition to providing advice, insight, feedback, and encouragement to mentees, mentors help advance the field of breast radiology by contributing to the development of the next generation of leaders. During the mentorship process, mentors continue to hone their listening, problem-solving, and networking skills, which in turn creates a more supportive and nurturing work environment for the entire breast care team. This article reviews important mentorship skills that are essential for all breast radiologists. Although some of the principles apply to all mentoring relationships, ensuring that every breast radiologist has the skills to be both an effective mentor and mentee is key to the future of the profession.

Mentorship Interest in Breast Imaging: Survey Results From the Society of Breast Imaging.

OBJECTIVE: This study assessed mentorship interest within the breast radiologist community to guide development of a mentorship program through the Society of Breast Imaging (SBI). METHODS: A 19-question survey developed by the SBI mentorship committee was distributed electronically to its members March 16, 2021, to May 7, 2021, to gauge interest in forming a society-sponsored mentorship program. Responses were analyzed, with subgroups compared using chi-square analysis. RESULTS: There was an 18% response rate (598/3277), and 65% (381/588) professed interest in an SBI-sponsored mentorship. Respondents were evenly distributed between academic (241/586, 41%) and private practice (242/586, 41%). Most were breast imaging fellowship-trained (355/593, 60%) and identified as female (420/596, 70%). For practice years, 50% (293/586) were late career (11+ years) with the remainder early-mid career (201/586, 34%) or trainees (92/586, 16%). For mentorship content areas, work/life balance was the most popular choice (275/395, 70%) followed by leadership (234/395, 59%). Most respondents were not currently mentors (279/377, 74%) or mentees (284/337, 84%). Those interested in a mentorship relationship were statistically younger (<45 years old, 234/381, 61% vs 31/207, 15%, P < 0.00001), female (289/381, 76% vs 123/207, 59%, P = 0.00003), academics (189/381, 50% vs 48/207, 23%, P < 0.00001), identified as a racial/ethnic minority (138/381, 64% vs 121/297, 15%, P < 0.00001), and fellowship-trained (262/381, 69% vs 88/207, 43%, P < 0.00001). CONCLUSION: There is demand, especially among the society's young and minority members, for an SBI-sponsored mentorship program. Work/life balance and leadership were the most popular choices for guidance.

Penetration of Günther Tulip filter struts through an introducer sheath: case report and safety concerns.

The authors present a patient who had a Günther-Tulip inferior vena cava filter placed under fluoroscopic guidance. The filter struts were seen to penetrate through the introducer sheath at deployment. This was believed to be secondary to a kink in the sheath at the site of venous entry and was due to the patient's nuchal obesity as well as his inability to turn his head to the opposite side. The introducer sheath was then placed through a long reinforced metal sheath through which the filter was then placed without complication.

Technical challenges in TIPS creation via the right subclavian vein.

This report describes a 64-year-old man with Laennec cirrhosis requiring a transjugular intrahepatic portosystemic shunt (TIPS) to alleviate ascites before surgical mesh repair of a large symptomatic umbilical hernia. During the procedure, both internal jugular veins and the right external jugular vein were found to be occluded. The right subclavian vein was accessed and a TIPS was successfully created. Some of the technical challenges encountered in performing the procedure from the right subclavian vein are described.

Coregistered photoacoustic and ultrasound imaging and classification of ovarian cancer: ex vivo and in vivo studies.

Most ovarian cancers are diagnosed at advanced stages due to the lack of efficacious screening techniques. Photoacoustic tomography (PAT) has a potential to image tumor angiogenesis and detect early neovascular changes of the ovary. We have developed a coregistered PAT and ultrasound (US) prototype system for real-time assessment of ovarian masses. Features extracted from PAT and US angular beams, envelopes, and images were input to a logistic classifier and a support vector machine (SVM) classifier to diagnose ovaries as benign or malignant. A total of 25 excised ovaries of 15 patients were studied and the logistic and SVM classifiers achieved sensitivities of 70.4 and 87.7%, and specificities of 95.6 and 97.9%, respectively. Furthermore, the ovaries of two patients were noninvasively imaged using the PAT/US system before surgical excision. By using five significant features and the logistic classifier, 12 out of 14 images (86% sensitivity) from a malignant ovarian mass and all 17 images (100% specificity) from a benign mass were accurately classified; the SVM correctly classified 10 out of 14 malignant images (71% sensitivity) and all 17 benign images (100% specificity). These initial results demonstrate the clinical potential of the PAT/US technique for ovarian cancer diagnosis.

Colloid transport of plutonium in the far-field of the Mayak Production Association, Russia.

Sorption of actinides, particularly plutonium, onto submicrometer-sized colloids increases their mobility, but these plutonium colloids are difficult to detect in the far-field. We identified actinides on colloids in the groundwater from the Mayak Production Association, Urals, Russia; at the source, the plutonium activity is approximately 1000 becquerels per liter. Plutonium activities are still 0.16 becquerels per liter at a distance of 3 kilometers, where 70 to 90 mole percent of the plutonium is sorbed onto colloids, confirming that colloids are responsible for the long-distance transport of plutonium. Nano-secondary ion mass spectrometry elemental maps reveal that amorphous iron oxide colloids adsorb Pu(IV) hydroxides or carbonates along with uranium carbonates.

The radiology assistant: a contrarian's view.

Recent and rapid increases in the utilization of diagnostic imaging have not been matched by concomitant additions to the supply of radiologists and radiology technologists. One proposal to alleviate an expected worsening of this emerging workforce crisis is to create a new job category, the radiology assistant (RA), encompassing a roster of enhanced capabilities that would allow the radiologists to divest themselves of some of their non-interpretative duties with respect to the performance of imaging tests. Through the collaborative efforts of the American College of Radiology and the American Society of Radiology Technologists a nationally recognized, baccalaureate-level curriculum has been designed for the training of RAs. A centerpiece of the curriculum is instruction in fluoroscopy. However, examinations of the GI tract by fluoroscopy are rapidly declining in frequency, raising doubt about the enhanced value an RA would bring to a radiology practice in the near future and worries about encroachment on the range of radiologists' responsibilities over the long term.