Is contrast-enhanced mammography (CEM) an alternative to MRI in assessing the response to primary systemic therapy of breast cancer?

PURPOSE: To evaluate the accuracy of contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) in the assessing radiological response to primary systemic therapy (PST). METHOD: Prospective study between February 2021 and October 2022. Women with breast cancer and indication of PST were enrolled. CEM and MRI were performed before and after PST, and the findings, including size and radiological response pattern, were compared with the size of the residual lesion measured in surgical specimens and its Miller-Payne classification (considered the gold standard). Two of four independent radiologists, with 2 years of CEM experience and 10 years of MRI experience, reviewed the images while being blinded to the results of the other technique. The agreement between measurements was evaluated using the Pearson correlation coefficient (r) and Lin's coefficient. RESULTS: Forty-eight women with breast cancer who required PST were enrolled in the study, with a mean age of 57.21 ± 10.14 years. A total of thirty-three participants (68.75 %) completed the study. The correlation between CEM and MRI measurements was high before PST (r: 0.97), and local staging was identical for 45 out of 48 patients. MRI demonstrated better accuracy in predicting residual tumor size than CEM, with Lin's coefficient 0.91 and 0.73, respectively. However, no significant differences were observed in predicting response to therapy. Both methods tended to overestimate the size and degree of response in our study, with mean overestimations of 2.87 mm in CEM and 0.51 mm in MRI. CONCLUSION: CEM was found to be as accurate as MRI in predicting response to PST, indicating its potential as an alternative imaging technique, but further research is necessary.

Predicción del resultado del test Oncotype DX con RM mamaria de 1.5T en tumores con receptores hormonales positivos y HER2 negativo / Prediction of the Oncotype DX test result with 1.5T breast MRI in estrogen receptor-positive HER2-negative tumours

Objetivo Evaluar la relación del resultado del test Oncotype DX en tumores luminales con el valor del coeficiente de difusión aparente (CDA) en la secuencia de difusión en resonancia magnética (RM) mamaria y con otros parámetros radiológicos y anatomopatológicos. Pacientes y método Se revisaron retrospectivamente las RM mamarias de estadificación de las pacientes con cáncer de mama (CM) con receptores de estrógenos (RE) positivos y HER2 negativo a las que se les había solicitado el test Oncotype DX en los últimos cuatro años. Se recogieron los antecedentes familiares y personales, el tamaño y tipo de realce de la lesión, el CDA, el porcentaje de restricción a la difusión y la anatomía patológica. Todo ello se relacionó con el riesgo de recidiva (bajo: < 18, intermedio: 18-30 y alto: > 30) estimado en el test Oncotype DX. Resultados Se incluyeron 70 pacientes. Las lesiones categorizadas como bajo riesgo de recidiva asociaron valores de CDA significativamente más altos que el resto de grupos (p = 0,04) y las clasificadas como alto riesgo menor expresión de receptores de progesterona (RP) (p = 0,038). El valor de CDA clasificó como riesgo bajo o intermedio-alto según Oncotype DX con un área bajo la curva (AUC) de 0,73 (p = 0,001) para todos los tumores y de 0,76 (p < 0,001) en lesiones con RP positivos. Conclusiones Se encontraron valores más altos del CDA en el grupo clasificado como riesgo bajo de recidiva y menor expresión de RP en el grupo de riesgo alto. El CDA podría ser útil en el pronóstico del CM, aunque son necesarios más estudios. (AU)

Objective To assess the relationship of the Oncotype DX test result with the apparent diffusion coefficient (ADC) value in the diffusion sequence in breast magnetic resonance imaging (MRI) and with other radiological and anatomical-pathological parameters. Patients and methods We reviewed the pre-surgical staging breast MRIs of breast cancer (BC) patients with positive oestrogen receptors (ER) and negative HER2, for which the Oncotype DX test had been requested over the last four years. The ADC and the diffusion restriction percentage were obtained. Personal and family background were collected, along with pathological anatomy findings. We determined the association between all these factors and the risk of recurrence (low: < 18, intermediate: 18-30 and high: > 30) estimated by the Oncotype DX test. Results A total of 70 patients were included. Lesions categorized as being at low risk of recurrence according to the Oncotype DX test were associated with significantly higher ADC values than the rest of the groups (p = 0.04), and those classified as high risk were associated with lower progesterone receptor (PR) expression (p = 0.038). The ADC value classified the risk as low or intermediate-high according to the Oncotype DX test with an area under the curve (AUC) of 0.73 (p = 0.001) for all tumours and 0.76 (p < 0.001) in lesions with positive PR. Conclusions Higher ADC values were found in the group classified as being at low risk of tumour recurrence according to Oncotype DX. Lesions with high risk scores expressed lower PR. The ADC value may be useful in the prognosis of breast cancer, although further studies are required. (AU)

Diagnostic performance of PET/computed tomography versus PET/MRI and diffusion-weighted imaging in the N- and M-staging of breast cancer patients.

OBJECTIVE: To provide a systematic review regarding the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) and diffusion-weighted imaging (DWI) compared to 18F-FDG PET/computed tomography (CT) focused on nodal and distant staging in breast cancer patients. METHODS: The PubMed and Embase databases were searched for relevant publications until April 2020. Two independent reviewers searched for eligible articles based on predefined in- and exclusion criteria, assessed quality and extracted data. RESULTS: Eleven eligible studies were selected from 561 publications identified by the search. In seven studies, PET/CT was compared with PET/MRI, and in five, PET/CT with DWI. Significantly higher sensitivity for PET/MRI compared to PET/CT in a lesion-based analysis was reported for all lesions together (77% versus 89%) in one study, osseous metastases (69-99% versus 92-98%) in two studies and hepatic metastases (70-75% versus 80-100%) in one study. Moreover, PET/MRI revealed a significantly higher amount of osseous metastases (90 versus 141) than PET/CT. PET/CT is associated with a statistically higher specificity than PET/MRI in the lesion detection of all lesions together (98% versus 96%) and of osseous metastases (100% versus 95%), both in one study. None of the reviewed studies reported significant differences between PET/CT and DWI for any of the evaluated sites. There is a trend toward higher specificity for PET/CT. CONCLUSION: In general, there is a trend toward higher sensitivity and lower specificity of PET/MRI when compared to PET/CT. Results on the diagnostic performance of DWI are conflicting. Rather than evaluating it separate, it seems to have complementary value when combined with other MR sequences.

REPEATABILITY OF CHOROIDAL THICKNESS MEASUREMENTS ASSESSED WITH SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY IN HEALTHY AND DIABETIC INDIVIDUALS.

PURPOSE: To assess the intrasession repeatability of choroidal thickness measurements obtained using swept-source optical coherence tomography in Type 2 diabetic (T2D) patients and healthy controls. METHODS: This was a single-center, prospective, observational, cross-sectional study with consecutive inclusion of 33 healthy subjects and 43 T2D patients. Subjects underwent three consecutive swept-source optical coherence tomography scans in a single session. After automatic delineation of the choroid, subfoveal choroidal thickness, and thickness at 500-µm intervals up to 2,500 µm nasal and temporal from the fovea were measured using the software caliper by the same operator. Intraclass correlation coefficients (ICCs), coefficients of variation, and test-retest variability were calculated. RESULTS: Mean subfoveal choroidal thickness in healthy subjects and in T2D patients was 229.97 ± 79.9 and 192.67 ± 74.3 µm, respectively (P = 0.013). All intrasession intraclass correlation coefficients were higher than 0.95 and 0.99, respectively. Coefficients of variations were less than 4.4% and 1.8%, respectively. Test-retest variability ranged from 0.76 µm to 11.12 µm and 0.64 µm to 6.29 µm, respectively. No significant differences were found in the intrasession repeatability of any choroidal measurement between healthy subjects and T2D patients. CONCLUSION: Swept-source optical coherence tomography provided excellent intrasession repeatability of choroidal thickness measurements in healthy subjects and T2D patients.

Choroidal thickness measured using swept-source optical coherence tomography is reduced in patients with type 2 diabetes.

OBJECTIVE: To compare choroidal thickness between patients with type 2 diabetes (T2D) and healthy controls measured using swept-source optical coherence tomography (SS-OCT). METHODS: The sample comprised 157 eyes of 94 T2D patients, 48 eyes of which had diabetic macular edema (DME), and 71 normal eyes of 38 healthy patients. Subfoveal (SF) choroidal thickness, and choroidal thickness at 500-µm intervals up to 2500 µm nasal and temporal from the fovea were measured using the SS-OCT. Choroidal thicknesses were compared between groups using Student's t-test. Additionally, Pearson correlations were calculated between diabetes duration, glycosylated hemoglobin (HbA1c) levels, and choroidal thickness. RESULTS: Mean diabetes duration was 16.6±9.5 years, while mean glycosylated hemoglobin was 7.7±1.3%. Overall, the choroid was significantly thinner in T2D patients. Individuals with DME had reduced choroidal thickness in all measurements, except at 2000 and 2500-µm nasal positions, compared to healthy controls. There was a moderate correlation between choroidal thickness and HbA1c levels in DME patients (SF: r = 0.342; p = 0.017). Diabetes duration did not correlate significantly with choroidal thickness. CONCLUSION: SS-OCT measurements revealed that the choroid was significantly thinner in T2D patients, moderate non-proliferative diabetic retinopathy patients, and DME patients than in healthy individuals. Further studies are needed to clarify the effect of diabetes on this layer and the relationship between choroidal thickness and DME.