Evaluation of pre-therapeutic imaging work-up in the staging of endometrial cancer: Interest in a systematic second opinion in a cancer center.

RATIONALE AND OBJECTIVES: To evaluate the interest of a systematic second opinion in quality assessment and FIGO staging in the pretherapeutic imaging work-up. MATERIALS AND METHODS: A retrospective observational study was conducted on 156 patients who underwent surgery for endometrioid cancer in our institution. 42 % had their initial MRI scans performed in expert centers (University Hospital and Cancer center) and 58 % in non-expert centers. Quality assessment, concordances between initial reports, and second opinions by a junior and a senior ICL radiologist versus histopathological data were analyzed. RESULTS: MRI scans performed in expert centers were more complete and more likely to be rated as higher quality. The overall accuracy of T staging from initial reports vs gold standard was 0.59 (95 % CI, 0.46-0.71) in expert centers and 0.49 (95 % CI, 0.38-0.60) in non-expert centers. The overall accuracy and Kappa of a second opinion for FIGO 2009 staging from expert center and non-expert center examinations were 0.61 (95 % CI, 0.48-0.72) vs 0.50 (95 % CI, 0.39-0.60) and 0.37 vs 0.27 for junior reader and 0.62 (95 % CI, 0.49-0.74) vs 0.48 (95 % CI, 0.37-0.58) and 0.39 vs 0.24 for senior reader, respectively. There was also a significant lower confidence level of the junior radiologist in MRI FIGO staging for non-expert center examinations (p 0.003). CONCLUSION: Accuracy in the FIGO 2009 staging and quality assessment are higher for MR examinations performed from expert centers than in non-expert centers. A systematic second opinion by radiologists in expert centers should be proposed before pre-treatment multidisciplinary consultation.

Feasibility of online non-rigid motion correction for high-resolution supine breast MRI.

PURPOSE: Conventional breast MRI is performed in the prone position with a dedicated coil. This allows high-resolution images without breast motion, but the patient position is inconsistent with that of other breast imaging modalities or interventions. Supine breast MRI may be an interesting alternative, but respiratory motion becomes an issue. Motion correction methods have typically been performed offline, for instance, the corrected images were not directly accessible from the scanner console. In this work, we seek to show the feasibility of a fast, online, motion-corrected reconstruction integrated into the clinical workflow. METHODS: Fully sampled T2 -weighted (T2 w) and accelerated T1 -weighted (T1 w) breast supine MR images were acquired during free-breathing and were reconstructed using a non-rigid motion correction technique (generalized reconstruction by inversion of coupled systems). Online reconstruction was implemented using a dedicated system combining the MR raw data and respiratory signals from an external motion sensor. Reconstruction parameters were optimized on a parallel computing platform, and image quality was assessed by objective metrics and by radiologist scoring. RESULTS: Online reconstruction time was 2 to 2.5 min. The metrics and the scores related to the motion artifacts significantly improved for both T2 w and T1 w sequences. The overall quality of T2 w images was approaching that of the prone images, whereas the quality of T1 w images remained significantly lower. CONCLUSION: The proposed online algorithm allows a noticeable reduction of motion artifacts and an improvement of the diagnostic quality for supine breast imaging with a clinically acceptable reconstruction time. These findings serve as a starting point for further development aimed at improving the quality of T1 w images.

Evaluation of Image Quality of Motion-Corrected Supine Breast MRI.

Breast MRI is the most performant modality for breast cancer diagnosis and could be widespread in the future. The gold standard breast MRI is performed in the prone position, but comfort and correlation with surgery or biopsy positioning can be problematic, while supine MRI could be an interesting alternative. In this work, we evaluated the image quality of T2-weighted supine breast MRI in healthy volunteers after online correction of respiratory motion artifacts compared to standard vendor's reconstruction and to standard prone MRI. T2-weighted images were acquired in the prone and free-breathing supine position in 10 volunteers. Two types of reconstructions were evaluated for supine acquisitions: the standard vendor's reconstruction and an online version of a nonrigid motion correction technique (generalized reconstruction by inversion of coupled system). Image quality criteria, including overall quality, sharpness, uniformity, and different types of artifacts, were assessed and scored by 2 radiologists in a randomized fashion. Interobserver agreement was verified by Weighted Cohen's Kappa calculation and a comparison between the different acquisitions was made by Wilcoxon signed-rank test. Generalized Reconstruction by Inversion of Coupled Systems (GRICS) reconstruction method significantly increased image quality in comparison to the standard reconstruction of supine acquisition. It allows a comparable quality, slightly lower than the gold standard prone MRI in T2-weighted images but it needs to be assessed with more patients and with target lesions before it can be used in clinical practice.

Conversational hypnosis versus standard of care to reduce anxiety in patients undergoing marker placement under radiographic control prior to breast cancer surgery: A randomized, multicenter trial.

Background: Surgery is a cornerstone of breast cancer management. Prior to surgery, a wire marker is placed at the site of the tumor, to enable the surgeon to accurately localize the lesion during later surgery. This procedure can generate considerable anxiety for many patients. We investigated the value of conversational hypnosis (CH) in reducing anxiety in patients undergoing preoperative wire placement under radiographic control. Methods: Randomized, multicentre study in 7 centers in France. Inclusion criteria were patients aged >18 years with an Eastern Cooperative Oncology Group performance status ≤2, scheduled to undergo preoperative wire placement in one or several breast lesions. Patients were randomized in a 1:1 ratio, stratified by center to undergo preoperative wire placement with or without the use of CH by a radiological technician trained in the CH technique. The primary endpoint was the percentage of patients with an anxiety score ≥ 6 on a visual analog scale ranging from 0 (absence of anxiety) to 10 (maximal anxiety). Secondary endpoints were pain score, perceived duration reported by the patient, technician satisfaction with their relationship with the patient, and ease of marker insertion reported by the radiologist. Semi-structured interviews were performed with patients to assess their perception of the marker placement procedure. Results: The trial was prematurely interrupted for futility after a planned interim analysis after accrual of 167 patients, i.e., half the planned sample size. Prior to marker placement, 29.3% (n = 24) of patients in the control group had an anxiety score ≥ 6, versus 42.3% (n = 33) in the CH group (p = 0.08). After marker placement, the change of anxiety score was not significantly different between groups (11.0% (n = 9) versus 14.3% (n = 11), p = 0.615). There was no significant difference in any of the secondary endpoints. In the interviews, patients from both groups frequently spoke of a feeling of trust. Conclusion: This study failed to show a benefit of conversational hypnosis on anxiety in patients undergoing marker placement prior to surgery for breast cancer. The fact that some caregivers had learned this personalized therapeutic communication technique may have had a positive impact on the whole caregiving team. Trial registration: The study was registered with ClinicalTrials.gov (NCT02867644).

Descriptive analysis of recurrences of nasal intestinal-type adenocarcinomas after radiotherapy.

BACKGROUND: Despite adjuvant radiotherapy, rates of recurrences of endoscopically operated nasal intestinal-type adenocarcinomas (ITAC) have not been improved in successive series. To better understand how to improve local control, we aimed to investigate the site of local recurrences of ITACs. METHODS: Retrospective study in a reference center in sinonasal malignancies. For all patients with a local recurrence, radiotherapy plans were retrieved and compared to the delineation of local recurrences. RESULTS: Of 63 patients, 54 underwent adjuvant radiotherapy of which 14 (25.9%) had a local recurrence. Eleven of them had their onset in an optimally irradiated area. Difficulty to dissect the cribriform plate and/or the lateral lamina was reported for 11 patients with local recurrences in the operative reports (p <0.0001). CONCLUSIONS: Most of recurrences arose in an optimally irradiated area. A close cooperation between surgeons and radiotherapists is required to define areas at risk and adapt treatment.

Maximum slope using ultrafast breast DCE-MRI at 1.5 Tesla: a potential tool for predicting breast lesion aggressiveness.

OBJECTIVES: We evaluated the relationship between the maximum slope (MS) based on ultrafast breast DCE-MRI sequences, and the clinical parameters and routine prognostic factors of breast cancer. METHODS: 210 lesions were retrospectively evaluated: 150 malignant (30 each of luminal A invasive carcinoma, luminal B invasive carcinoma, HER2 overexpression (HER2), triple negative (TN), invasive lobular carcinoma (ILC)), and 60 benign. For each lesion, the MS was obtained with an ultrafast sequence and semi-quantitative curves were classified into three types with a conventional DCE sequence. The correlation between MS and age, body mass index (BMI), menopause, and routine prognostic factors were analyzed. RESULTS: A MS cut-off at 6.5%/s could discriminate benign from malignant lesions, with sensitivity and specificity of 84% and 90%, respectively, whereas analysis of semi-quantitative curves showed sensitivity and specificity of 89.3% and 55%, respectively. In multivariate analysis, MS values decreased with BMI increasing (p = 0.035), postmenopausal status (p < 0.001), and positive ER status (p < 0.001) and increased with tumor size (p < 0.001). The MS was significantly lower for the pooled luminal A + ILC group than for the pooled luminal B + HER2 + TN group featuring tumors with poorer prognoses (p < 0.001). With a threshold of 11%/s, the sensitivity and specificity to identify invasive carcinoma subtypes with poorer prognoses were 71% and 68%, respectively. CONCLUSION: The MS allows better tumor characterization and identifies factors of poor prognosis for breast cancer. KEY POINTS: • Maximum slope calculated from ultrafast breast DCE-MRI differentiates benign from malignant breast lesions better than semi-quantitative curves of conventional DCE-MRI. • Maximum slope calculated from ultrafast breast DCE-MRI identifies breast cancers with poor prognoses. • In the case of multiple lesions, the most aggressive may be identified and targeted by measuring the maximum slope.

Synchronous BI-RADS category 3 lesions detected by preoperative breast MRI in patients with breast cancer: may follow-up be adequate?

OBJECTIVE: The purpose of this study was to analyze the rate of malignancy of synchronous Breast Imaging Reporting and Data System (BI-RADS) category 3 lesions identified by preoperative magnetic resonance imaging (MRI) in patients with breast cancer that were followed up rather than biopsied. METHODS: From electronic medical records, we identified 99 patients treated in our institution for whom preoperative breast MRI identified synchronous BI-RADS 3 lesions. Lesion characteristics, rate of second-look ultrasonography (US), rate of collegial decision-making, and rate of biopsies performed during the period of monitoring were analyzed. RESULTS: Second-look US was performed in 96 of 99 patients and did not reveal any lesion. Collegial decision-making for follow-up validation was asked in 32%. The median time to last MRI was 24.4 months (interquartile range [IQR] [19.3; 36.3]). The median follow-up was 39 months (IQR [28; 52]). Two cancers were diagnosed, one at 5 months and one at 26 months of follow-up. The incidence of malignancy of followed up synchronous BI-RADS category 3 lesions was 1.0% (95% CI [0.1%; 7.1%]) at 6 months and 2.2% (95% CI [0.6%; 8.6%]) at 30 months. CONCLUSION: Monitoring could be proposed for synchronous BI-RADS category 3 lesions detected in preoperative breast cancer patients. A continued follow-up beyond 2 years could be of benefit. KEY POINTS: • Follow-up can be proposed for MRI BI-RADS category 3 lesions not detected at second-look ultrasound, possibly after a collegial decision. • Follow-up should be continued annually since cancer may occur beyond 2 years.

Differences in clinical and imaging characteristics between p16-positive non-smokers and p16-positive smokers or p16-negative patients in oropharyngeal carcinoma.

The eighth edition of the TNM classifies oropharyngeal squamous cell carcinomas (OSCCs) depending on p16 status. Some imaging features are reportedly associated more frequently with p16-positive (P16+) OSCC than p16-negative (p16-) OSCC. However, classical risk factors such as tobacco use were not specifically considered when assessing these imaging features. We aimed to evaluate whether P16+ OSCCs have different epidemiological, clinical, prognostic and imaging features depending on smoking status, and to compare P16+ and p16- groups. A retrospective study of data from 85 patients with P16+ OSCC (41 non-smokers, 44 smokers) and 36 with p16- OSCC from 2011 to 2020 was carried out, assessing epidemiological data, clinical aspects of the tumour and presence of adenopathy. Staging was assessed according to the seventh and eighth editions of the TNM. Compared with P16+ OSCC non-smokers, P16+ OSCC smokers had tumours that were less well-defined (36.6% vs 77.8%, p < 0.001), more ulcerated (85.4% vs 44.4%, p < 0.001) and more necrotic (53.7% vs 25%, p = 0.012). There was also less downstaging from N2 or N3 of the seventh edition of the TNM to N1 of the eighth edition for smokers than non-smokers (22.7% vs 43.9%, p = 0.042). Compared with p16- tumours, more P16+ tumours had well-defined contours (55.8% vs 22.2%, p = 0.001), were exophytic (89.6% vs 72.2%, p = 0.023), less necrotic (40.3% vs 80.6%, p < 0.001), less ulcerated (97.2% vs 66.2%, p = 0.006) and involved less muscle tissue (26.0% vs 47.2%, p = 0.027).P16+ OSCCs of smokers show clinical, imaging and prognostic differences with P16+ OSCCs of non-smokers.

Pre-operative axillary ultrasound with fine-needle aspiration cytology performance and predictive factors of false negatives in axillary lymph node involvement in early breast cancer.

PURPOSE: Breast cancer is the most common cancer among females worldwide. Axillary lymph node involvement is an important prognostic factor in pre-operative evaluation. The aim of this study was to evaluate the sensitivity and accuracy of AUS during the initial breast cancer diagnosis and the contribution of ultrasound with guided FNAC (AUS + FNAC) in cases of suspicious node. METHODS: A retrospective study was conducted at the Lorraine Cancer Institute between 1 January and 31 December 2015. It included patients with early breast cancer, all of whom received AUS. If axillary node involvement was suspected, FNAC was performed. Sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND) were performed depending on FNAC results. RESULTS: In total, 292 patients were included. 88 patients (30.1%) had a suspicious lymph node on ultrasound and had FNAC, of whom 53 tested positive for axillary node involvement (60.2%). Among the 35 patients who tested negative with FNAC, 15 had axillary metastatic involvement. Performance of AUS + FNAC was better than that of AUS alone, with sensitivity, specificity, positive predictive and negative predictive values of approximately 44.5%, 100%, 100% and 72.4%, respectively, and accuracy of approximately 77.4%. Luminal A subgroup, axillary involvement of less than two positive nodes or nodal tumor of less than 7 mm are independent factors of false negative rate. CONCLUSIONS: AUS performance would seem to be improved by FNAC, with a false negative rate of approximately 26%. It may be possible to reduce the false negative rate of AUS if its contributing factors are taken into consideration, along with the impact of specific echographic signs as revealed by experienced radiologists.

[Systematic second opinion review of outside imaging in breast cancer diagnosis: An added value]. / Relecture systématique des bilans radiologiques extérieurs de diagnostic du cancer du sein : une valeur ajoutée.

INTRODUCTION: The systematic second opinion review in cancer centers after breast cancer detection is currently under development. The purposes were the evaluation of review's consequences, in particularly of the axillary staging and the evolution of the delays. METHODS: A retrospective study was conducted on patients who consulted a clinician at Cancer Center of Lorraine in Nancy from January 1st, 2016 to December 31th, 2016. We analyzed from their medical charts: the outside exams, the initial therapeutic plan, the second opinion review, the additional exams, the multidisciplinary consultation conclusions, the first treatment, the multidisciplinary consultation after surgery. RESULTS: In all, 251 patients were analyzed. Second opinion review discrepancies were seen in 72.5%. As a result, 43.4% of all patients had new breast-axillary biopsies. New malignancies lesions were identified in 19.9% of patients. Modifications in therapeutic plan were recommended in 19.9% of patients (including patients with and without new malignancies lesions diagnosed). Before a second opinion review, 9.8% of axillary ultrasound lead to a positive fine-needle biopsy. The additional exams identified 9.6% additional lesions. After a positive sentinel lymph node excision biopsy, the multidisciplinary consultation recommended a revision surgery of axillary lymph node dissection for 27% of patients with axillary ultrasound performed in our cancer center, and for 70% of patients without ultrasound (P=0.023). DISCUSSION: The systematic second opinion at cancer center allows the detection of new malignancies lesions and significant modifications in the therapeutic plan. A systematic evaluation of axillary ultrasound in cancer center could be considered.

Preoperative Breast Magnetic Resonance Imaging in Women With Local Ductal Carcinoma in Situ to Optimize Surgical Outcomes: Results From the Randomized Phase III Trial IRCIS.

PURPOSE: We evaluated the addition of breast magnetic resonance imaging (MRI) to standard radiologic evaluation on the re-intervention rate in women with ductal carcinoma in situ (DCIS) undergoing breast-conserving surgery. PATIENTS AND METHODS: Women with biopsy-proven DCIS corresponding to a unifocal microcalcification cluster or a mass less than 30 mm were randomly assigned to undergo MRI or standard evaluation. The primary end point was the re-intervention rate for positive or close margins (< 2 mm) in the 6 months after randomization ( ClinicalTrials.gov identifier: NCT01112254). RESULTS: A total of 360 patients from 10 hospitals in France were included in the study. Of the 352 analyzable patients, 178 were randomly assigned to the MRI arm, and 174 were assigned to the control arm. In the intent-to-treat analysis, 82 of 345 patients with the assessable end point were reoperated for positive or close margins within 6 months, resulting in a re-intervention rate of 20% (35 of 173) in the MRI arm and 27% (47 of 172) in the control arm. The absolute difference of 7% (95% CI, -2% to 16%) corresponded to a relative reduction of 26% (stratified odds ratio, 0.68; 95% CI, 0.41 to 1.1; P = .13). When considering only the per-protocol population with an assessable end point, the difference was 9% (stratified odds ratio, 0.59; 95% CI, 0.35 to 1.0; P = .05). Total mastectomy rates were 18% (31 of 176) in the MRI arm and 17% (30 of 173) in the control arm (stratified P = .93). For 100 lesions seen on MRI, nonmass-like enhancement was more predominant (82%) than mass enhancement (20%). Nevertheless, no specific morphologic and kinetic parameters for DCIS were identified. CONCLUSION: The study did not show sufficient surgical improvement with the use of preoperative MRI to be clinically relevant in DCIS staging. However, this could be reconsidered with the improvement of new MRI sequences and new modalities in magnetic resonance techniques.

Self-compression Technique vs Standard Compression in Mammography: A Randomized Clinical Trial.

Importance: Many women dread undergoing mammography, and some may not attend or reattend breast cancer screening because of the discomfort or pain induced by breast compression. Objective: To evaluate the noninferiority of the self-compression mammography technique for reducing breast thickness compared with standard compression. Design, Setting, and Participants: This prospective, parallel-group, noninferiority randomized clinical trial was conducted from May 7, 2013, to October 26, 2015, at 6 cancer care centers in France. Participants were women aged 50 to 75 years, without a history of recent breast surgical procedure or treatment, and who could perform self-compression. Analyses were performed on intention-to-treat basis from January 27, 2017, to March 30, 2018. Interventions: Patients were randomized 1:1 to the self-compression group or the standard compression group. Main Outcomes and Measures: Primary end point was breast thickness expressed as the mean of 4 views: right and left craniocaudal and right and left mediolateral oblique. The predefined noninferiority margin was a difference of 3 mm, with a 1-sided 95% CI. Secondary end points included compression force, image quality, requirement for additional views, pain, and patient satisfaction and radiographer assessment questionnaires. Results: Among the 549 women randomized, 548 (97.3%) completed the trial. Of these, 275 (48.8%) (mean [SD] age, 61.35 [6.34] years) were randomized to the self-compression arm and 273 (48.5%) (mean [SD] age, 60.84 [6.41] years) to the standard compression arm. The difference in the mean thickness between the 2 arms was lower than the noninferiority margin, with an upper 1-sided 95% CI less than 3 mm (-0.17; 95% CI,-∞ to 1.89 mm; P < .05). Compression force was higher in the self-compression group compared with the standard compression arm for the 4 mammographic views. Pain was statistically significantly lower in the self-compression group (n = 274) compared with the standard compression group (n = 269) (median [interquartile range (IQR)] score, 2 [1-5] vs 3 [1-5]; P = .009). No difference was reported in the image quality scores of the 2 groups or in the number of additional views performed (median [IQR] extra views, 2 [2-2] vs 2 [2-3] extra views; P = .64), whatever the indication, including insufficient image quality (29 [16.8%] vs 27 [15.0%] insufficient quality views; P = .65). No adverse effects or pain were reported by the participants after the self-compression mammography. Conclusions and Relevance: Self-compression does not appear to be inferior to standard compression mammography in achieving minimal breast thickness without increasing pain or compromising image quality; this technique may be an effective option for women who want to be involved in their breast examination. Trial Registration: ClinicalTrials.gov identifier: NCT02866591.

Impact of an abbreviated protocol for breast MRI in diagnostic accuracy.

PURPOSE: We aimed to compare the diagnostic accuracy and interpretation time of an abbreviated protocol relative to the complete protocol of breast magnetic resonance imaging (MRI) with the use of breast imaging reporting and data system (BI-RADS). Between-reader and between-protocol variability for BI-RADS classification and influence of reader expertise on diagnostic accuracies were also evaluated. METHODS: We conducted a retrospective reader study in 90 women who underwent breast MRI: 30 benign examinations (graded as American College of Radiology [ACR] 1 or 2), 30 examinations graded as ACR 3 and 30 examinations requiring a histologic proof (graded as ACR 4 or 5). Two radiologists independently reviewed the protocols. The reference standard was 24 months of imaging follow-up (66.6%, n=60), percutaneous biopsy at the 12th month imaging follow-up (5.5%, n=5), and breast surgery (27.9%, n=25). Analysis was done on a per-breast basis. There were 26 cancers in 168 breasts (15.1%) RESULTS: Interpretation time was higher for the complete protocol (mean difference: 84 s, 95% CI [67;101] for senior and 83 s, 95% CI [70;95] for junior reader; P < 0.001). The reliability of BI-RADS classification between both protocols was very good with intraclass correlation coefficient of 0.89 for junior reader and 0.98 for senior reader; the inter-reader reliability was 0.94 and 0.90 for the complete and abbreviated protocols, respectively. For senior reader, the abbreviated and complete protocols yielded 95.1% and 94.4% specificity and 100% sensitivity. CONCLUSION: Our data provide corroborating evidence that abbreviated protocols decrease interpretation time without compromising sensitivity or specificity. There was a high level of concordance between the abbreviated and complete protocols and between the two readers.

Abbreviated breast magnetic resonance protocol: Value of high-resolution temporal dynamic sequence to improve lesion characterization.

PURPOSE: To evaluate the added value of ULTRAFAST-MR sequence to an abbreviated FAST protocol in comparison with FULL protocol to distinguish benign from malignant lesions in a population of women, regardless of breast MR imaging indication. MATERIALS AND METHODS: From March 10th to September 22th, 2014, we retrospectively included a total of 70 consecutive patients with 106 histologically proven lesions (58 malignant and 48 benign) who underwent breast MR imaging for preoperative breast staging (n=38), high-risk screening (n=7), problem solving (n=18), and nipple discharge (n=4) with 12 time resolved imaging of contrast kinetics (TRICKS) acquisitions during contrast inflow interleaved in a regular high-resolution dynamic MRI protocol (FULL protocol). Two readers scored MR exams as either positive or negative and described significant lesions according to Bi-RADS lexicon with a TRICKS images (ULTRAFAST), an abbreviated protocol (FAST) and all images (FULL protocol). Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for each protocol and compared with McNemar's test. RESULTS: For all readers, the combined FAST-ULTRAFAST protocol significantly improved the reading with a specificity of 83.3% and 70.8% in comparison with FAST protocol or FULL protocol, respectively, without change in sensitivity. By adding ULTRAFAST protocol to FAST protocol, readers 1 and 2 were able to correctly change the diagnosis in 22.9% (11/48) and 10.4% (5/48) of benign lesions, without missing any malignancy, respectively. Both interpretation and image acquisition times for combined FAST-ULTRAFAST protocol and FAST protocol were shorter compared to FULL protocol (p<0.001). CONCLUSION: Compared to FULL protocol, adding ULTRAFAST to FAST protocol improves specificity, mainly in correctly reclassifying benign masses and reducing interpretation and acquisition time, without decreasing sensitivity.

Tumor response assessment by MRI following stereotactic body radiation therapy for hepatocellular carcinoma.

BACKGROUND: To evaluate the MRI features of a tumor response, local control, and predictive factors of local control after stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC). METHODS: Thirty-five consecutive patients with 48 HCCs who were treated by SBRT were included in this retrospective study. All patients provided written informed consent to be treated by SBRT, and prior to inclusion they authorized use of the treatment data for further studies. The assessment was made using MRI, with determination of local and hepatic responses according to Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST) criteria during a two-year follow-up. RESULTS: The local response rate according to mRECIST was higher than with RECIST. A tumor diameter less than 20 mm at baseline was an independent predictive factor for RECIST and mRECIST responses, as was diffusion-weighted signal for RECIST. During follow-up, a tumor diameter of <20 mm (p = 0.034) and absence of a high intensity on T2-weighted (p = 0.006) and diffusion-weighted images (p = 0.039) were associated with a better response according to RECIST. Post-treatment changes include peritumoral ring-like enhanced changes with high intensity on T2-weighted images. CONCLUSIONS: SBRT is a promising technique for the treatment of inoperable HCC. Post-treatment changes on MRI images can resemble tumor progression and as such must be adequately distinguished. The regression of tumorous enhancement is variable over time, although diffusion-weighted and T2-weighted intensities are predictive factors for tumor RECIST responses on subsequent MRIs. They hence provide a way to reliably predict treatment responses.

Comparison of the histopathological results of the radioguided percutaneous microbiopsies and the operative specimens of soft tissue tumors of limbs, trunk and retroperitoneum.

INTRODUCTION: Suspicious lesions of sarcoma require preoperative biopsies. If surgical biopsies remain the gold standard, radioguided percutaneous microbiopsies are gaining an increasing importance. The purpose of this study was to compare histopathological results of percutaneous biopsies of soft tissues, trunk and retroperitoneal tumors with the histopathological results of operative specimens. METHODS: This is a retrospective study including 84 patients treated in our institution. The concordance between the results of the microbiopsy and the operative specimen for the benign-malignant differentiation and the histological type was evaluated. The microbiopsy accuracy was calculated. The sensitivity and the specificity of the microbiopsies compared to the operative specimen were also evaluated for the benign-malignant differentiation. RESULTS: The concordance was 0.92 [0.79-1] for the benign-malignant differentiation, 0.97 [0.92-1] for the histological type. The accuracy of microbiopsies was therefore 96% (sensibility=97.0%; specificity=94.1%) for the benign-malignant detection and 97.8% for the histological type. CONCLUSION: Percutaneous microbiopsies play an important part in the diagnosis of soft tissue tumors of the limbs, trunk and retroperitoneum, in particular as a replacement to more invasive surgical biopsies. This study evidences the increasing importance of the collaboration between radiologist, surgeon and pathologist in the diagnosis of sarcoma.