Prediction of solid and micropapillary components in lung invasive adenocarcinoma: radiomics analysis from high-spatial-resolution CT data with 1024 matrix.

PURPOSE: To predict solid and micropapillary components in lung invasive adenocarcinoma using radiomic analyses based on high-spatial-resolution CT (HSR-CT). MATERIALS AND METHODS: For this retrospective study, 64 patients with lung invasive adenocarcinoma were enrolled. All patients were scanned by HSR-CT with 1024 matrix. A pathologist evaluated subtypes (lepidic, acinar, solid, micropapillary, or others). Total 61 radiomic features in the CT images were calculated using our modified texture analysis software, then filtered and minimized by least absolute shrinkage and selection operator (LASSO) regression to select optimal radiomic features for predicting solid and micropapillary components in lung invasive adenocarcinoma. Final data were obtained by repeating tenfold cross-validation 10 times. Two independent radiologists visually predicted solid or micropapillary components on each image of the 64 nodules with and without using the radiomics results. The quantitative values were analyzed with logistic regression models. The receiver operating characteristic curves were generated to predict of solid and micropapillary components. P values < 0.05 were considered significant. RESULTS: Two features (Coefficient Variation and Entropy) were independent indicators associated with solid and micropapillary components (odds ratio, 30.5 and 11.4; 95% confidence interval, 5.1-180.5 and 1.9-66.6; and P = 0.0002 and 0.0071, respectively). The area under the curve for predicting solid and micropapillary components was 0.902 (95% confidence interval, 0.802 to 0.962). The radiomics results significantly improved the accuracy and specificity of the prediction of the two radiologists. CONCLUSION: Two texture features (Coefficient Variation and Entropy) were significant indicators to predict solid and micropapillary components in lung invasive adenocarcinoma.

Swim-up method is superior to density gradient centrifugation for preserving sperm DNA integrity during sperm processing.

Purpose: This study aimed to evaluate the effects of swim-up and density gradient centrifugation methods on sperm DNA fragmentation. Methods: Nineteen normozoospermic patient samples with ≥100 × 106 motile sperms were included in this study. Sperm DNA fragmentation, progressive motility, and progressive motile sperm number were measured before and after the swim-up method or density gradient centrifugation. Results: Sperm DNA fragmentation was not statistically different between swim-up-(14.4 ± 2.1%, p = 0.32) and density gradient centrifugation-processed (25.0 ± 3.0%, p = 0.20) and unprocessed semen samples (19.2 ± 1.9%). Sperm DNA fragmentation was significantly lower in swim-up-than in density gradient centrifugation-processed samples (p < 0.05). Sperm progressive motility was significantly higher (p < 0.05) in swim-up-(92.9 ± 1.0%) and density gradient centrifugation-processed (81.3 ± 2.0%) samples, with the former being higher, than in unprocessed semen samples (53.1 ± 3.7%). The recovery rate of progressive motile sperms was significantly lower in swim-up-(9.7 ± 1.4%) than in density gradient centrifugation-processed samples (17.2 ± 1.8%, p < 0.05). Conclusions: The swim-up method is superior to density gradient centrifugation, evidenced by less sperm DNA fragmentation and higher sperm progressive motility. The recovery rate of progressive motile sperms was better after density gradient centrifugation than after swim-up.

Effect of blastocyst shrinkage on assisted reproductive outcomes: a retrospective cohort study describing a new morphological evaluation of blastocyst pre-vitrification and post-warming.

BACKGROUND: The failure of frozen-thawed blastocysts to re-expand adequately within a few hours after warming has been reported to have a negative impact on assisted reproductive technology (ART) outcomes. However, the extent to which this failure truly affects ART outcomes has not yet been presented in a manner that is easily understandable to medical practitioners and patients. This study aimed to assess the effects of blastocyst shrinkage on ART outcomes and determine a more effective morphological evaluation approach for use in clinical settings. METHODS: This retrospective observational cohort study of frozen-thawed blastocyst transfer cycles was conducted from April 2017 to March 2022. Overall, 1,331 cycles were eligible for inclusion, of which 999 were good-quality blastocysts (GQB) and 332 were non-good-quality blastocysts (non-GQB). All frozen-thawed blastocyst transfer cycles performed during the specified study period were included in the study. Exclusion criteria were established to mitigate potential sources of bias as these cycles could impact implantations. We calculated rates and age-adjusted odds ratios of implantation, clinical pregnancy, ongoing pregnancy, and live birth of the re-expansion group, which showed sufficient expansion, and shrinkage group, which showed insufficient expansion. We also calculated the implantation, clinical pregnancy, ongoing pregnancy, and live birth rates of the re-expansion and shrinkage groups for each morphological scoring system parameter. RESULTS: A reduced ART outcome was observed with use of blastocysts with shrinkage after vitrification/warming. The age-adjusted odds ratios for implantation, clinical pregnancy, ongoing pregnancy, and live birth were lower in the shrinkage group than in the re-expansion group. CONCLUSIONS: This study examined the adverse effect of blastocyst shrinkage after warming and recovery culturing on reproductive outcomes in a clinically useful manner by retrospectively examining a substantial number of frozen-thawed embryo transfer cycles. The study findings can possibly reduce concerns regarding over- or under-estimation of blastocyst implantation by allowing providers and patients to refer to the data.

Spindle Cell Carcinoma of the Breast: Investigation of Magnetic Resonance Imaging Features of 26 Cases.

OBJECTIVE: The aim of the study was to retrospectively investigate the fat-saturated T2-weighted sequences (FST2WI) and 3-dimensional dynamic contrast-enhanced sequence (DCE) of magnetic resonance imaging (MRI) findings of breast spindle cell carcinoma (SpCC). METHODS: Twenty-six women with surgically confirmed breast SpCC, who underwent breast MRI in 2 institutions, were enrolled in this study (mean age, 54 years; range, 27-81 years). Two breast radiologists determined the MRI findings by consensus after independent interpretations. Each MRI finding was analyzed. RESULTS: Most lesions of SpCC showed a solitary mass (92.2%). Most masses were round/oval (76.0%), had an irregular margin (88.0%), rim enhancement (72.0%), washout kinetic analysis (96.0%), hyperintensity on FST2WI (84%), hyperintensity on FST2WI and fast enhancing component on DCE (56%), and hypointense rim on FST2WI (72.0%). CONCLUSIONS: Most breast SpCC showed a solitary mass, round/oval shape, irregular margin, rim enhancement, washout kinetics, and intratumoral hyperintensity on FST2WI; a hypointense rim on FST2WI; and hyperintensity on FST2WI and fast enhancing component on DCE.

Prediction of pathological complete response after neoadjuvant chemotherapy in breast cancer: comparison of diagnostic performances of dedicated breast PET, whole-body PET, and dynamic contrast-enhanced MRI.

PURPOSE: To compare the diagnostic performance of ring-type dedicated breast PET (dbPET), whole-body PET (WBPET), and DCE-MRI for predicting pathological complete response (pCR) after neoadjuvant chemotherapy (NAC). METHODS: This prospective study included 29 women with histologically proven breast cancer on needle biopsy between July 2016 and July 2019 (age: mean 55 years; range 35-78). Patients underwent WBPET followed by ring-type dbPET and DCE-MRI pre- and post-NAC for preoperative evaluation. pCR was defined as an invasive tumor that disappeared in the breast. Standardized uptake values corrected for lean body mass (SULpeak) were calculated for dbPET and WBPET scans. Maximum tumor length was measured in DCE-MRI images. Reduction rates were calculated for quantitative evaluation. Two radiologists independently evaluated the qualitative findings. Reduction rates and qualitative findings were compared between the pCR (n = 7) and non-pCR (n = 22) groups for each modality. Differences in quantitative and qualitative data between the two groups were analyzed statistically. RESULTS: Significant differences were observed in the reduction rates of dbPET and DCE-MRI (P = 0.01 and 0.03, respectively) between the two groups. Univariate and multiple logistic regression analyses revealed that SULpeak reduction rates in WBPET and dbPET (P = 0.02 and P = 0.01, respectively) and in dbPET (odds ratio, 16.00; 95% CI 1.57-162.10; P = 0.01) were significant indicators associated with pCR, respectively. No between-group differences were observed in qualitative findings in the three modalities. CONCLUSION: SULpeak reduction rate of dbPET > 82% was an independent indicator associated with pCR after NAC in breast cancer.

Effect of Computer-aided Detection System Use on the Duration of MRI-guided Biopsy of the Breast.

BACKGROUND/AIM: Magnetic resonance imaging (MRI)-guided breast biopsy is a complex and time-consuming procedure. This study aimed to clarify the factors that affect the duration of the procedure. PATIENTS AND METHODS: Twenty-eight examinations performed at our institute for 27 lesions detected solely on MRI were analyzed. The correlations between the clinicopathological factors and duration of the procedure were estimated. RESULTS: The needle guidance method was the only factor that significantly affected the duration of the MRI-guided vacuum-assisted breast biopsy (VAB) (p=0.012). The use of a computer-aided detection (CAD) system with grid breast compression plates had significantly shorter durations (62±12 min) than the manual calculation of coordinates with pillar-type compression plates (76±13 min). CONCLUSION: This preliminary study showed that the use of a CAD system might shorten the duration of MRI-guided VAB.

Radiogenomics of magnetic resonance imaging and a new multi-gene classifier for predicting recurrence prognosis in estrogen receptor-positive breast cancer: A preliminary study.

To examine the correlation of qualitative and quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) results with 95-gene classifier or Curebest 95-gene classifier Breast (95GC) results for recurrence prediction in estrogen receptor-positive breast cancer (ERPBC).This retrospective study included 78 ERPBC patients (age range, 24-74 years) classified into high- (n = 33) and low- (n = 45) risk groups for recurrence based on 95GC and who underwent DCE-MRI between July 2006 and November 2012. For qualitative evaluation, mass shape, margin, and internal enhancement based on BI-RADS MRI lexicon and multiplicity were determined by consensus interpretation by 2 breast radiologists. For quantitative evaluation, mass size, volume ratios of the DCE-MRI kinetics, and both the kurtosis and the skewness of the intensity histogram for the whole mass in the initial and delayed phases were determined. Differences between the 2 risk-groups were analyzed using univariate logistic regression analyses and multiple logistic regression analyses. Receiver-operating characteristic curve cut-off values were used to define the groups.As for the qualitative findings, the difference between the 2 groups was not significant. For the quantitative data, the volume ratio of "medium" in the initial phase differed significantly between the 2 groups (P = .049). The volume ratio of "medium" (P = .006) and of "slow-persistent" (P = .005), and the delayed phase kurtosis (P = .012) in the univariate logistic regression analyses, and in the multiple logistic regression, volume ratio of "medium" >38.9% and delayed phase kurtosis >3.31 were identified as significant high-risk indicators (odds ratio, 5.83 and 3.55; 95% confidence interval, 1.58 to 21.42 and 1.24 to 10.15; P = .008 and P = .018, respectively).A high volume ratio of "medium" in the initial phase and/or high kurtosis in the delayed phase for quantitative evaluation could predict high ERPBC recurrence risk based on 95GC.

The balance between Foxp3 and Ror-γt expression in peripheral blood is altered by tocilizumab and abatacept in patients with rheumatoid arthritis.

BACKGROUND: The balance between Th17 cells and regulatory T (Treg) cells has been shown to play an important role in the development of rheumatoid arthritis (RA). Recent studies have shown that treatment with abatacept (ABT) or tocilizumab (TCZ) affects Th17 and Treg cell populations. Although not unanimously accepted, several reports have shown that Treg cells are decreased by ABT and increased by TCZ, and that Th17 cells are decreased by TCZ. To further investigate the effects of ABT and TCZ on the skewing of T cell populations, we analyzed the expression of master regulators genes of helper T cell lineages following ABT/TCZ treatment of RA patients. METHODS: Ten patients treated with ABT and 10 patients treated with TCZ were enrolled. Total RNA was extracted from peripheral blood cells at baseline, and after 12 and 24 weeks of therapy. The expression levels of T-bet, GATA3, Foxp3 and Ror-γt were semi-quantified using real-time PCR. The relative expression levels were expressed as the ratios of two genes (T-bet/GATA3, Foxp3/GATA3, Foxp3/T-bet, Foxp3/Ror-γt, Ror-γt/T-bet, Ror-γt/GATA3), and the changes in these ratios with treatment were determined. RESULTS: The Foxp3/Ror-γt ratio was decreased after ABT therapy (0.67 ± 0.16 at 24 weeks, P = 0.0034) but was increased after TCZ therapy (2.00 ± 1.03 at 24 weeks, P = 0.0013). In addition, the Ror-γt/GATA3 ratio was decreased after TCZ therapy (0.78 ± 0.37 at 24 weeks, P = 0.0008). Except for these ratios, no significant skewing in the expression of these factors was detected. No significant relationship between clinical response to the treatment and change in the ratios of these factors was determined. CONCLUSION: Treatment with TCZ or ABT differently affected the balance between Foxp3 and Ror-γt expression in the peripheral blood of patients with RA.

Effectiveness of Certolizumab Pegol in Treating Rheumatoid Arthritis Patients with Persistent Inflamed Residual Mono- or Oligosynovitis Resistant to Prior TNF-α Inhibitors.

We report four cases of successful treatment with certolizumab pegol (CZP) of rheumatoid arthritis (RA) patients with persistent inflamed residual mono- or oligosynovitis resistant to prior TNF-α inhibitors. Although the patients were in a moderate disease activity, a low activity, or a remission of RA, they sustained inflammatory mono-/oligoarthritis even after treatment with prior TNF inhibitors. They were then all treated with CZP and observed in a serial ultrasonography. In all cases, the positive power Doppler signals in the joint have disappeared promptly and all of the patients were able to retain remission in the long term. The treatment of CZP to the refractory mono-/oligoarthritis of inflammatory synovitis in RA patients has not been previously described. The cases suggest that it may be associated with the feature of CZP, possible effective penetration into the site of inflammation.

Evaluation of suspicious nipple discharge by magnetic resonance mammography based on breast imaging reporting and data system magnetic resonance imaging descriptors.

PURPOSE: To evaluate the findings of magnetic resonance mammography for suspicious nipple discharge based on breast imaging-reporting and data system magnetic resonance imaging (MRI) descriptors and establish any correlations with the histopathologic diagnoses. METHODS: Forty-seven patients with suspicious nipple discharge underwent MRI using a 1.5-T system. Images were evaluated for a signal of abnormal discharge, related abnormal enhancement according to the breast imaging-reporting and data system MRI descriptors, and the presence of clustered ring enhancement and were compared with the histopathologic diagnoses established in 39 lesions. RESULTS: The most common finding in patients with suspicious nipple discharge was non-masslike enhancement. Seventeen malignant and 22 benign lesions were detected. The most frequent findings in the malignant lesions were "segmental" (59%), "heterogeneous" (57%), and plateau pattern (40%). Clustered ring enhancement was found in 60% of the enhanced malignant lesions (P = 0.002). The combination of segmental distribution and clustered ring enhancement showed a significant association with malignant lesions (P = 0.004). CONCLUSIONS: Magnetic resonance imaging provides clinically useful information in patients with suspicious nipple discharge.

Preliminary result of accelerated partial breast irradiation after breast-conserving surgery.

PURPOSE: To investigate the feasibility of accelerated partial breast irradiation (APBI) for Japanese patients, we started high-dose-rate interstitial brachytherapy (HDR-ISBT) as monotherapy after breast-conserving surgery (BCS). METHODS: We implanted 45 Tis-2 breast cancer patients at National Hospital Organization Osaka National Hospital between June 2002 and June 2006. Our eligibility criteria were broader than the ones used previously in western countries. We included margin-positive cases and younger patients (median age: 44; range: 26-68) to adapt the criteria for Japanese women. Total prescribed doses were 36-42 Gy in six to seven fractions, and the volumes encompassed by 100% prescribed dose (V100) were 38.5-315.1 cc. Fifteen patients received chemotherapy. RESULTS: Treatment could be completed for all patients. Two local failures (4%) and two distant metastases were observed, while one patient died of liver metastasis. Seven wound complications, four with and three without infection, and two rib fractures occurred. The significant risk factors for wound complications were non-administration of prophylactic antibiotics during ISBT (P < 0.01), open cavity implant (P < 0.05), large V100 (P < 0.01), V150 (P < 0.05), and V200 (P < 0.05). CONCLUSION: APBI after BCS for Japanese women with relatively small breasts was well tolerated, but special care should be taken with treatment technique.

Quantitative evaluation of acute mucosal reaction to interstitial brachytherapy using color histograms.

PURPOSE: Color histograms of tongue photographs were used to make a quantitative evaluation of acute mucosal reaction to high-dose-rate fractionated interstitial brachytherapy. METHODS AND MATERIALS: Six patients with oral cavity cancer were analyzed with two methods (color histogram and vinyl plate). Using a photograph of the tongue, we calculated the histogram of each pixel of 1mm(2) of the tongue surface. The results were compared with the physician's inspection and the radiation dose. RESULTS: The histogram showed a difference between the reactive area (erythema and pseudomembranous mucositis [PM]) and the nonreactive area. The relationship between inspection and the histogram showed a good correlation, although the histogram tended to change earlier than the subjective judgment. The peak time was 12-13 days after delivery of the final fraction of brachytherapy. The minimum dose required to cause PM was 3.3-3.6Gy per fraction (total: 29.7-32.4Gy). CONCLUSIONS: Our new method of using color histograms for quantitative evaluation is helpful in the analysis of the relationship between mucosal reaction and radiation dose. The minimum dose causing PM was considered to be about 30Gy per nine fractions.

[Visualization of pancreaticobiliary reflux in patients with elevated amylase activity in bile with dynamic secretin-stimulated MR cholangiopancreatography].

Seven patients who had elevated amylase activity in the bile at cholecystectomy and seven normal volunteers were prospectively examined by secretin-stimulated dynamic MRCP. Thirty-five consecutive MR cholangiopancreatograms were acquired at intervals of approximately 10 sec after secretin injection; the acquisition time was 4 sec per image. In all normal volunteers, no apparent signal intensity (SI) changes were noted in the intra- and extrahepatic ducts. Of the 7 patients, the extrahepatic duct showed a sequential SI increase from downstream to upstream in 6; its caliber increased subsequent to pancreatic fluid secretion in 5; and duodenal filling grade tended to be lower in the patients (p < 0.01). These findings were thought to be suggestive of pancreaticobiliary reflux.