MRI features of breast cancer immunophenotypes with a focus on luminal estrogen receptor low positive invasive carcinomas.

To compare the magnetic resonance imaging (MRI) features of different immunophenotypes of breast carcinoma of no special type (NST), with special attention to estrogen receptor (ER)-low-positive breast cancer. This retrospective, single-centre, Institutional Review Board (IRB)-approved study included 398 patients with invasive breast carcinoma. Breast carcinomas were classified as ER-low-positive when there was ER staining in 1-10% of tumour cells. Pretreatment MRI was reviewed to assess the tumour imaging features according to the 5th edition of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. Of the 398 cases, 50 (12.6%) were luminal A, 191 (48.0%) were luminal B, 26 (6.5%) were luminal ER-low positive, 64 (16.1%) were HER2-overexpressing, and 67 (16.8%) were triple negative. Correlation analysis between MRI features and tumour immunophenotype showed statistically significant differences in mass shape, margins, internal enhancement and the delayed phase of the kinetic curve. An oval or round shape and rim enhancement were most frequently observed in triple-negative and luminal ER-low-positive tumours. Spiculated margins were most common in luminal A and luminal B tumours. A persistent kinetic curve was more frequent in luminal A tumours, while a washout curve was more common in the triple-negative, HER2-overexpressing and luminal ER-low-positive immunophenotypes. Multinomial regression analysis showed that luminal ER-low-positive tumours had similar results to triple-negative tumours for almost all variables. Luminal ER-low-positive tumours present with similar MRI findings to triple-negative tumours, which suggests that MRI can play a fundamental role in adequate radiopathological correlation and therapeutic planning in these patients.

Advancements of ALK inhibition of non-small cell lung cancer: a literature review.

Background and Objective: The therapeutic landscape for non-small cell lung cancer (NSCLC) has evolved considerably in the last few years. The targeted drugs and molecular diagnostics have been developed together at a fast pace. This narrative review explores the evolution of anaplastic lymphoma kinase (ALK) targeting therapies from discovering the ALK protein, molecular tests, present clinical trial data and future perspectives. Since the body of evidence on lung cancer is growing daily, most oncologists need time to implement data in their daily practice. Methods: We developed a narrative review to provide up-to-date help in the clinical decision-making of ALK-altered NSCLC patients. In 2022, the authors reviewed PubMed's published pivotal randomized Phase 3 trial results. Key Content and Findings: The development of ALK inhibitors was a revolution that is still ongoing; second and third-generation ALK inhibitors provided more than 30 months of progression-free survival (PFS) and impressive "brain-control". Brigatinib provided a survival benefit for patients with baseline brain metastases (HR 0.43, 95% CI: 0.21-0.89), and Lorlatinib demonstrated intracranial response rates of 82%, with 71% of complete intracranial responses. Personalized medicine is the new paradigm, from performing broad genetic panels for diagnosis to individual targeted therapy or combinations of different targeted agents. Conclusions: In the future, performing broad molecular panels should be the standard of care in the front line and after each progression to detect arising resistance mechanisms. Longer PFS will substantially convert a deadly condition into an almost chronic disease in the following decades. Treatment sequencing will be the cornerstone for patient survival, and liquid biopsies may replace tissue biopsies.

Prognostic role of 18F-FDG PET-CT in the prone position in the evaluation of invasive breast carcinoma

Introduction: The objective of this study was to correlate the features of invasive breast carcinoma in 18F-FDG positron emission tomography/computed tomography with histopathological results, findings from other imaging methods, and survival. Methods: This observational single-center study included patients who underwent staging 18F-FDG positron emission tomography/ computed tomography between September 2012 and April 2019; the results were correlated with the findings of other imaging tests and anatomopathological results. Lesions were evaluated for their maximum standardized uptake value on positron emission tomography/computed tomography performed in the prone position. Tumors were classified into three subtypes (luminal, HER2 and triple-negative) based on immunohistochemical analyses. Results: A total of 125 patients with a mean age of 52 years (24­90 years) were analyzed. The primary tumor showed an increased 18F-FDG concentration on positron emission tomography/computed tomography in 122 (97.6%) patients, with a mean maximum standardized uptake value of 7.15 (1.0­32.9 range). The mean maximum standardized uptake value was higher in the triple-negative subtype (11.4; n=24) than in the luminal (6.2; n=89) and HER2 (5.0; n=9) subtypes (p<0.01). Tumors with more aggressive histological and immunohistochemical characteristics showed higher maximum standardized uptake values. Patients with a standardized uptake value greater than 7 in the primary tumor or greater than 6.7 in the axillary lymph nodes had poor overall survival (p=0.03 and p<0.01, respectively). Conclusions: Our study suggests that the maximum standardized uptake value obtained on positron emission tomography/computed tomography in the prone position may correlate with the tumor immunophenotype and overall survival regardless of the treatments performed, and can be used as a prognostic biomarker in invasive breast carcinoma patients

Avaliação do carcinoma mamário invasivo pelo PET-CT com 18F-FDG em decúbito ventral: correlação com achados radiológicos e histológicos / Evaluation of invasive breast carcinoma by PET-CT with 18F-FDG in prone position: correlation with radiological and histological findings

Introdução: A tomografia por emissão de pósitrons (PET/CT) com 18F-FDG vem sendo amplamente utilizada para o diagnóstico, estadiamento e reestadiamento de diversos tumores, fornecendo informações sobre o metabolismo da glicose nos diversos órgãos e tecidos. Para pacientes com câncer de mama, o exame é útil na detecção de metástases à distância, recorrências e avaliação de resposta terapêutica. O PET/CT 18F-FDG com protocolo específico para mamas em decúbito ventral tem alta especificidade para o diagnóstico de carcinomas mamários invasivos (CMI) pois proporciona um melhor delineamento das lesões através da expansão do parênquima mamário e uma melhor ação do 18F-FDG. Objetivo: O objetivo deste trabalho foi avaliar a apresentação CMI nos exames de PET/CT com 18F-FDG em decúbito ventral e correlacionar com resultado histopatológico e achados radiológicos dos demais métodos de imagem. Material e métodos: Estudo observacional e unicêntrico das pacientes em fase de estadiamento, que realizaram o exame no período de setembro de 2012 a abril de 2019, correlacionando os resultados com os achados dos demais exames de imagem e com o resultado anatomopatológico. As lesões foram avaliadas quanto ao seu SUV (standardized uptake value) máximo no PET-CT, sua morfologia de apresentação nos exames e o seu imunofenótipo na análise imunohistoquímica (luminal, HER2 e triplo-negativo). Resultados: Foram analisadas 125 pacientes com idade média de 52 anos (24-90 anos). O tumor primário apresentou aumento da concentração do 18F-FDG no PET-CT em 122 casos (97,6%). A média do valor do SUV máximo dessas lesões foi de 7,15 (1,0-32,9). A média do SUV máximo foi maior nos tumores do imunofenótipo triplo-negativo (11,4; n=24), quando comparado com os tumores luminais (6,2; n=89) e HER2 (5,0; n=9), p<0,01. Das pacientes incluídas no diagnóstico, 64 tinham mamografia realizadas na instituição, sendo o nódulo encontrado em 29 casos (23,3%), distorção arquitetural em 21 casos (16,8%), assimetria/assimetria focal em 12 casos (18,7%) e calcificação em 9 casos (7,2%). 81 pacientes tinham ultrassonografia com o achado de nódulo em 67 casos (53,6%) e distorção arquitetural/outros em 19 casos (15,2%). 101 tinham RM ao diagnóstico, sendo que o tumor primário se apresentou na RM como nódulo em 71 casos (70,3%) e como lesão não nodular em 30 casos (29,7%). Tumores com características histológicas e imuno-histoquímicas mais agressivos apresentaram maior valor de SUVmax. As pacientes que apresentaram SUV até 7 tiveram uma sobrevivência superior a aquelas que apresentaram SUV maior que 7: 85,83 versus 71,35 meses, p = 0,03. Conclusão: O nosso estudo sugere que os valores de SUV máximo obtidos no PET-CT com protocolo dedicado para mamas pode ter correlação com o imunofenótipo do tumor e a sobrevida global, independente dos tratamentos realizados, podendo ser utilizado como um biomarcador prognóstico em pacientes com CMI

Introduction: Positron emission tomography (PET / CT) with 18F-FDG has been widely used for the diagnosis, staging and restaging of various tumors, providing information on glucose metabolism in various organs and tissues. For patients with breast cancer, the test is useful in detecting distant metastases, recurrences and evaluating therapeutic responses. PET / CT 18F-FDG with specific protocol for breasts in prone position has high specificity for the diagnosis of invasive breast carcinomas (IMC) as it provides a better delineation of the lesions through the expansion of the breast parenchyma and a better action of the 18F-FDG. Objective: Evaluate the CMI presentation in PET / CT scans with 18F-FDG in prone position and correlate with histopathological results and radiological findings from other imaging methods. Methodology: Observational and unicentric study of patients in the staging phase, who underwent the examination from September 2012 to April 2019, correlating the results with the findings of the other imaging tests and with the anatomopathological result. The lesions were evaluated for their maximum SUV (standardized uptake value) at PET-CT, their presentation morphology on exams and their immunophenotype in immunohistochemical analysis (luminal, HER2 and triple-negative). Results: 125 patients with a mean age of 52 years (24-90 years) were analyzed. The primary tumor showed an increase in the concentration of 18F-FDG in PET-CT in 122 cases (97.6%). The average maximum SUV value for these injuries was 7.15 (1.0-32.9). The mean of the maximum SUV was higher in the tumors of the triple-negative immunophenotype (11.4; n = 24), when compared to the luminal tumors (6.2; n = 89) and HER2 (5.0; n = 9) , p <0.01. Of the patients included in the diagnosis, 64 had mammography, the nodule being found in 29 cases (23.3%), architectural distortion in 21 cases (16.8%), focal asymmetry / asymmetry in 12 cases (18.7%) and calcification in 9 cases (7.2%). 81 patients had ultrasound with the finding of a nodule in 67 cases (53.6%) and architectural distortion / others in 19 cases (15.2%). 101 had MRI at diagnosis, with the primary tumor presenting at MRI as a nodule in 71 cases (70.3%) and as a non-nodular lesion in 30 cases (29.7%). Tumors with more aggressive histological and immunohistochemical characteristics showed higher SUVmax value. Patients with SUV up to 7 had a better survival than those with SUV greater than 7: 85.83 versus 71.35 months, p = 0.03. Conclusion: Our study suggests that the maximum SUV values obtained in PET-CT with a dedicated breast protocol may be correlated with the tumor immunophenotype and overall survival, regardless of the treatments performed, and can be used as a prognostic biomarker in patients with CMI

Magnetic resonance imaging of the breast: role in the evaluation of ductal carcinoma in situ.

Ductal carcinoma in situ (DCIS) is a precursor mammary lesion whose malignant cells do not extend beyond the basement membrane and presents a risk of progression to malignant disease. Its early detection increased with screening mammography. The objective of this study was to review the literature on the main presentations of DCIS on magnetic resonance imaging (MRI), through searches of the Medline/PubMed, Latin-American and Caribbean Center on Health Sciences Information (Lilacs), and Scientific Electronic Library Online (SciELO) databases. DCIS can occur in its pure form or in conjunction with invasive disease, in the same lesion, in different foci, or in the contralateral breast. MRI has a high sensitivity for the detection of pure DCIS, being able to identify the non-calcified component, and its accuracy increases with the nuclear grade of the lesion. The most common pattern of presentation is non-nodular enhancement; heterogeneous internal structures; a kinetic curve showing washout or plateau enhancement; segmental distribution; and restricted diffusion. MRI plays an important role in the detection of DCIS, especially in the evaluation of its extent, contributing to more reliable surgical excision and reducing local recurrence.

O carcinoma ductal in situ (CDIS) é uma lesão mamária precursora cujas células malignas não ultrapassam a membrana basal e possui risco de evolução para doença maligna. Sua detecção precoce aumentou com a mamografia de rastreamento. O objetivo deste estudo foi realizar uma revisão da literatura sobre as principais apresentações do CDIS na ressonância magnética (RM), utilizando mecanismos de busca na base de dados Medline/PubMed, Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (Lilacs) e Scientific Electronic Library Online (SciELO). O CDIS pode ocorrer de forma pura ou associado a doença invasiva, na mesma lesão, em focos diferentes e na mama contralateral. A RM possui alta sensibilidade para a detecção do CDIS puro, sendo capaz de identificar o componente não calcificado da doença e sua precisão aumenta com o seu grau nuclear. O padrão de apresentação mais comum é o realce não nodular com padrão interno heterogêneo, curva cinética de lavagem rápida (washout) ou platô, de distribuição segmentar e com restrição na difusão. A RM tem importante papel na detecção do CDIS e, principalmente, na avaliação da sua extensão, contribuindo para uma exérese cirúrgica mais confiável e reduzindo as recidivas locais.

Magnetic resonance imaging of the breast: role in the evaluation of ductal carcinoma in situ / Papel da ressonância magnética das mamas na avaliação do carcinoma ductal in situ

Abstract Ductal carcinoma in situ (DCIS) is a precursor mammary lesion whose malignant cells do not extend beyond the basement membrane and presents a risk of progression to malignant disease. Its early detection increased with screening mammography. The objective of this study was to review the literature on the main presentations of DCIS on magnetic resonance imaging (MRI), through searches of the Medline/PubMed, Latin-American and Caribbean Center on Health Sciences Information (Lilacs), and Scientific Electronic Library Online (SciELO) databases. DCIS can occur in its pure form or in conjunction with invasive disease, in the same lesion, in different foci, or in the contralateral breast. MRI has a high sensitivity for the detection of pure DCIS, being able to identify the non-calcified component, and its accuracy increases with the nuclear grade of the lesion. The most common pattern of presentation is non-nodular enhancement; heterogeneous internal structures; a kinetic curve showing washout or plateau enhancement; segmental distribution; and restricted diffusion. MRI plays an important role in the detection of DCIS, especially in the evaluation of its extent, contributing to more reliable surgical excision and reducing local recurrence.

Resumo O carcinoma ductal in situ (CDIS) é uma lesão mamária precursora cujas células malignas não ultrapassam a membrana basal e possui risco de evolução para doença maligna. Sua detecção precoce aumentou com a mamografia de rastreamento. O objetivo deste estudo foi realizar uma revisão da literatura sobre as principais apresentações do CDIS na ressonância magnética (RM), utilizando mecanismos de busca na base de dados Medline/PubMed, Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (Lilacs) e Scientific Electronic Library Online (SciELO). O CDIS pode ocorrer de forma pura ou associado a doença invasiva, na mesma lesão, em focos diferentes e na mama contralateral. A RM possui alta sensibilidade para a detecção do CDIS puro, sendo capaz de identificar o componente não calcificado da doença e sua precisão aumenta com o seu grau nuclear. O padrão de apresentação mais comum é o realce não nodular com padrão interno heterogêneo, curva cinética de lavagem rápida (washout) ou platô, de distribuição segmentar e com restrição na difusão. A RM tem importante papel na detecção do CDIS e, principalmente, na avaliação da sua extensão, contribuindo para uma exérese cirúrgica mais confiável e reduzindo as recidivas locais.