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1.
Am Surg ; 86(8): 1029-1031, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32721172

RESUMO

BACKGROUND: Breast cancer is the most commonly diagnosed noncutaneous malignancy and remains the second leading cause of cancer deaths in women. The Savi Scout (Cianna Medical, Merit Medical Systems, Inc. South Jordan, UT) is a wireless, nonradioactive, wave reflection implant system that enables surgeons to remove targeted breast lesions. Our study aims to be the largest comparison of wire and Savi Scout localization techniques for positive margin, complication, and reoperation rates. METHODS: Single-institution retrospective review of 512 patients that had Savi Scout Surgical Guidance System breast lesion biopsy or wire localized breast biopsy from May 2017 to December 2018. A RedCaps database was created and reviewed for outcomes. RESULTS: For 320 Savi scout patients, margins were positive or less than 1 mm in 18 cases (5.6%). 17 (5.3%) patients required reoperation. Surgical site occurrence was found in 7 (2.1%) patients, and 2 patients required intervention (0.6%). For 175 wire localization patients, margins were positive or less than 1 mm in 24 patients, and all required reoperation (13.7%). A surgical site occurrence was found in 13 (7.4%) patients and 5 patients required intervention (2.8%). DISCUSSION: In our series, the Savi Scout localization system resulted in a lower rate of positive margins, reoperation, and surgical site occurrence. These data suggest that Savi Scout localization is a reasonable replacement to wire localization for breast lesions and might produce superior results.


Assuntos
Neoplasias da Mama/cirurgia , Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Marcadores Fiduciais , Mastectomia Segmentar/métodos , Radar , Cirurgia Assistida por Computador/instrumentação , Adulto , Idoso , Biópsia , Mama/diagnóstico por imagem , Mama/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/patologia , Feminino , Humanos , Margens de Excisão , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Cirurgia Assistida por Computador/métodos
3.
Br J Radiol ; 93(1111): 20191019, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32401540

RESUMO

OBJECTIVE: To establish a radiomics nomogram by integrating clinical risk factors and radiomics features extracted from digital mammography (MG) images for pre-operative prediction of axillary lymph node (ALN) metastasis in breast cancer. METHODS: 216 patients with breast cancer lesions confirmed by surgical excision pathology were divided into the primary cohort (n = 144) and validation cohort (n = 72). Radiomics features were extracted from craniocaudal (CC) view of mammograms, and radiomics features selection were performed using the methods of ANOVA F-value and least absolute shrinkage and selection operator; then a radiomics signature was constructed with the method of support vector machine. Multivariate logistic regression analysis was used to establish a radiomics nomogram based on the combination of radiomics signature and clinical factors. The C-index and calibration curves were derived based on the regression analysis both in the primary and validation cohorts. RESULTS: 95 of 216 patients were confirmed with ALN metastasis by pathology, and 52 cases were diagnosed as ALN metastasis based on MG-reported criteria. The sensitivity, specificity, accuracy and AUC (area under the receiver operating characteristic curve of MG-reported criteria were 42.7%, 90.8%, 24.1% and 0.666 (95% confidence interval: 0.591-0.741]. The radiomics nomogram, comprising progesterone receptor status, molecular subtype and radiomics signature, showed good calibration and better favorite performance for the metastatic ALN detection (AUC 0.883 and 0.863 in the primary and validation cohorts) than each independent clinical features (AUC 0.707 and 0.657 in the primary and validation cohorts) and radiomics signature (AUC 0.876 and 0.862 in the primary and validation cohorts). CONCLUSION: The MG-based radiomics nomogram could be used as a non-invasive and reliable tool in predicting ALN metastasis and may facilitate to assist clinicians for pre-operative decision-making. ADVANCES IN KNOWLEDGE: ALN status remains among the most important breast cancer prognostic factors and is essential for making treatment decisions. However, the value of detecting metastatic ALN by MG is very limited. The studies on pre-operative ALN metastasis prediction using the method of MG-based radiomics in breast cancer are very few. Therefore, we studied whether MG-based radiomics nomogram could be used as a predictive biomarker for the detection of metastatic ALN.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Mamografia/métodos , Análise de Variância , Axila/diagnóstico por imagem , Axila/patologia , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Nomogramas , Estudos Retrospectivos
4.
Cancer Res ; 80(8): 1773-1783, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32295783

RESUMO

Inadequate margins in breast-conserving surgery (BCS) are associated with an increased likelihood of local recurrence of breast cancer. Currently, approximately 20% of BCS patients require repeat surgery due to inadequate margins at the initial operation. Implementation of an accurate, intraoperative margin assessment tool may reduce this re-excision rate. This study determined, for the first time, the diagnostic accuracy of quantitative micro-elastography (QME), an optical coherence tomography (OCT)-based elastography technique that produces images of tissue microscale elasticity, for detecting tumor within 1 mm of the margins of BCS specimens. Simultaneous OCT and QME were performed on the margins of intact, freshly excised specimens from 83 patients undergoing BCS and on dissected specimens from 7 patients undergoing mastectomy. The resulting three-dimensional images (45 × 45 × 1 mm) were coregistered with postoperative histology to determine tissue types present in each scan. Data from 12 BCS patients and the 7 mastectomy patients served to build a set of images for reader training. One hundred and fifty-four subimages (10 × 10 × 1 mm) from the remaining 71 BCS patients were included in a blinded reader study, which resulted in 69.0% sensitivity and 79.0% specificity using OCT images, versus 92.9% sensitivity and 96.4% specificity using elasticity images. The quantitative nature of QME also facilitated development of an automated reader, which resulted in 100.0% sensitivity and 97.7% specificity. These results demonstrate high accuracy of QME for detecting tumor within 1 mm of the margin and the potential for this technique to improve outcomes in BCS. SIGNIFICANCE: An optical imaging technology probes breast tissue elasticity to provide accurate assessment of tumor margin involvement in breast-conserving surgery.


Assuntos
Adenocarcinoma Mucinoso/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Margens de Excisão , Mastectomia Segmentar/métodos , Adenocarcinoma Mucinoso/patologia , Adenocarcinoma Mucinoso/cirurgia , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Técnicas de Imagem por Elasticidade/normas , Feminino , Humanos , Mastectomia Segmentar/normas , Pessoa de Meia-Idade , Reoperação , Tomografia de Coerência Óptica
6.
Am Surg ; 86(2): 90-94, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167041

RESUMO

We aimed to evaluate the surgical margin outcomes and re-excision rates in patients undergoing bracketed seed localization of biopsy-proven breast cancer detected on screening mammogram. After approval by our Institutional Review Board, we retrospectively identified patients who had undergone iodine-125 seed localized lumpectomy at our institution from January 2010 to June 2017 by one of two fellowship-trained breast surgeons. Of those patients, a subset of 25 patients were identified who had undergone bracketed seed localization, defined as two or more seeds used to delineate the radiographic borders of the area of concern. All patients had originally presented with calcifications identified on screening mammogram that were subsequently diagnosed as ductal carcinoma in situ and/or invasive ductal carcinoma by image-guided biopsy performed at our institution. Eight patients had one positive margin on final surgical pathology and required re-excision (32%). One patient was converted to mastectomy. Of the patients requiring re-excision, the average maximum linear extent of calcifications was 3.4 cm (SD 0.97), whereas it was 3.1 cm (SD 1.2) in patients with negative surgical margins (P = 0.5). Bracketing calcifications with radioactive seeds can potentially allow more patients to undergo breast conservation surgery.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Radioisótopos do Iodo/administração & dosagem , Mastectomia Segmentar/métodos , Tratamentos com Preservação do Órgão/métodos , Neoplasias da Mama/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Feminino , Marcadores Fiduciais , Humanos , Biópsia Guiada por Imagem , Mamografia , Margens de Excisão , Reoperação/estatística & dados numéricos , Estudos Retrospectivos
7.
Clin Nucl Med ; 45(5): e232-e235, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32209879

RESUMO

Radiolabeled somatostatin analogs for somatostatin receptor (SSTR)-targeted imaging and peptide receptor radionuclide therapy (PRRT) have demonstrated remarkable success in the management of SSTR-expressing neuroendocrine neoplasms. Primary neuroendocrine breast carcinoma is rare. Heterogeneous SSTR overexpression has also been documented in breast cancer, in both human breast cancer specimens and clinical studies. We report here a case of a 69-year-old woman who had both breast invasive ductal carcinoma and primary large-cell neuroendocrine breast carcinoma (Ki-67 proliferation index of 20%), with disseminated bone and lymph node metastases, demonstrating exceptional tracer uptake on Ga-DOTATOC PET/CT, and remarkably partial remission after Lu-DOTATOC PRRT.


Assuntos
Neoplasias da Mama/radioterapia , Carcinoma Ductal de Mama/radioterapia , Tumores Neuroendócrinos/radioterapia , Octreotida/análogos & derivados , Receptores de Somatostatina/metabolismo , Idoso , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/patologia , Feminino , Humanos , Metástase Linfática , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/metabolismo , Tumores Neuroendócrinos/patologia , Octreotida/uso terapêutico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Resultado do Tratamento
8.
Radiology ; 295(2): 296-303, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32181727

RESUMO

Background The role of preoperative MRI for predicting surgical outcomes in patients diagnosed with ductal carcinoma in situ (DCIS) remains uncertain. Purpose To investigate the associations between preoperative MRI and surgical outcomes in DCIS confirmed by using US-guided core-needle biopsy (CNB) and to evaluate clinical-pathologic variables associated with a benefit from MRI. Materials and Methods Women with DCIS confirmed by using US-guided CNB between January 2012 and December 2016 were included in this retrospective study. Propensity score matching using 18 confounding covariates was used to create matched groups with MRI and without MRI, and surgical outcomes were compared. Clinical-pathologic variables were evaluated to determine women who benefited from MRI. Results A total of 541 women (mean age ± standard deviation, 50 years ± 10) were evaluated. Among 430 women who underwent MRI, 67 additional lesions (16%) were depicted, with 25 (37%) of the 67 additional lesions being malignant. Fifty-seven (13%) of the 430 women had a change in surgical plan because of their MRI findings; the change was appropriate for 31 (54%) women. In matched groups, the MRI group was associated with lower odds of positive resection margin (odds ratio [OR], 0.39; 95% confidence interval [CI]: 0.16, 0.93; P = .03) and repeat surgery (OR, 0.33; 95% CI: 0.12, 0.92; P = .03) compared with the non-MRI group. There was no difference in likelihood of initial mastectomy (OR, 1.2; 95% CI: 0.7, 2.0; P = .59) and overall mastectomy (OR, 0.93; 95% CI: 0.5, 1.6; P = .79). In the MRI group, low nuclear grade (90% [28 of 31] vs 69% [275 of 399]; P = .01), progesterone receptor positivity (81% [25 of 31] vs 61% [244 of 399]; P = .03), and human epidermal growth factor receptor 2 negativity (90% [28 of 31] vs 68% [270 of 399]; P = .01) were associated with a benefit from MRI versus no MRI. Conclusion Preoperative MRI depicted additional malignancy and reduced positive surgical margins and repeat surgery for ductal carcinoma in situ confirmed at US-guided biopsy without a higher mastectomy rate. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Pinker in this issue.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Carcinoma in Situ/diagnóstico por imagem , Carcinoma in Situ/cirurgia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/cirurgia , Imagem por Ressonância Magnética/métodos , Adulto , Biomarcadores Tumorais/análise , Neoplasias da Mama/patologia , Carcinoma in Situ/patologia , Carcinoma Ductal de Mama/patologia , Meios de Contraste , Feminino , Gadolínio DTPA , Humanos , Biópsia Guiada por Imagem , Margens de Excisão , Mastectomia , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Ultrassonografia de Intervenção , Ultrassonografia Mamária
9.
Medicine (Baltimore) ; 99(11): e19506, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176095

RESUMO

RATIONALE: Accessory breast cancer is extremely rare among all cancerous diseases, especially in male patients. There were only few male axillary accessory breast cancer cases that have been reported in scientific literatures so far. Hereby, we would like to discuss a case of male axillary accessory breast cancer found in our hospital. PATIENT CONCERNS: We report a male senile patient suffering from a painful, enlarged, and hardened right axillary mass for more than 20 years. He came for further treatments due to progressive growth of the mass for 11 months with bloody ulceration for more than 1 month. DIAGNOSIS: Pathological examination manifested a grade II infiltrating ductal carcinoma derived from the accessory mammary gland (right axilla), with invasion of local skin. Immunohistochemical examination result: estrogen receptor (++) 90%, progesterone receptor (+++) 100%, human epidermal growth factor receptor-2 (1+), ki67 (20% positive), prostate specific antigen (-), caudal-related homeobox-2 (-), thyroid transcription factor-1 (-), Synaptophysin (+), NapsinA (1), and CK7 (-). INTERVENTIONS: Modified radical mastectomy and axillary lymph nodes clearance were performed on the accessary breast cancer under general anesthesia. Postoperatively, endocrine therapy was provided for the patient, orally-taken Letrozole was recommended for the rest of the patient's life. OUTCOMES: The patient recovered uneventfully and was discharged 3 days after the operation. The patient continued to take Letrozole orally regularly at home and no signs of recurrence were observed. CONCLUSION: Axillary accessory breast cancer in males is extremely rare, with no conspicuous and typical clinical presentations, which leads to inevitable neglect by clinicians. Therefore, there is significant necessity for clinicians to be cautious with this type of disease.


Assuntos
Doença de Alzheimer , Axila , Neoplasias da Mama Masculina/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Metástase Linfática/diagnóstico , Idoso de 80 Anos ou mais , Neoplasias da Mama Masculina/diagnóstico por imagem , Neoplasias da Mama Masculina/patologia , Neoplasias da Mama Masculina/cirurgia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/secundário , Carcinoma Ductal de Mama/cirurgia , Diagnóstico Diferencial , Humanos , Metástase Linfática/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Mastectomia Radical Modificada
10.
J Radiol Case Rep ; 14(2): 21-44, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32184934

RESUMO

A cyst in the breast containing a thick wall, internal septations, or a solid intracystic component is defined as a complex solid and cystic breast mass. These lesions carry a malignant potential between 23-31% and thus require further evaluation with biopsy [1]. We report six cases in which patients were found to have a complex solid and cystic mass, all of which were proven to be malignant breast cancers of varying etiologies. We also review the literature on malignant etiologies of complex solid and cystic breast masses, including their clinical presentation, work-up, histopathologic and immunochemistry findings, treatment, and prognosis.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma in Situ/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Idoso , Biópsia com Agulha de Grande Calibre , Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Ultrassonografia Doppler em Cores , Ultrassonografia Mamária
11.
Br J Radiol ; 93(1109): 20190785, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32101449

RESUMO

OBJECTIVE: To compare standard specimen mammography (SSM) with remote intraoperative specimen mammography (ISM) assessment in breast conserving-surgery (BCS) based on operative times, intraoperative additional excision (IAE) and re-intervention rates. METHODS AND MATERIALS: We retrospectively compared 129 consecutive patients (136 lesions) who had BCS with SSM at our centre between 11/2011 and 02/2013 with 138 consecutive patients (144 lesions) who underwent BCS with ISM between 08/2014 and 02/2015.SSM or ISM were performed to confirm the target lesions within the excised specimen and margin adequacy. The utility of SMM and ISM was evaluated considering pathology as gold-standard, using χ2 or Fisher's exact tests for comparison of categorical variables, and non-parametric Mann-Whitney test for continuous variables. RESULTS: The two groups did not statistically differ for age (p = 0.20), lesion size (p = 0.29) and morphology (p = 0.82) or tumor histology type (p = 0.65). Intraoperative time was significantly longer (p < 0.00001) for SSM (132 ± 43 min) than for ISM (90 ± 42 min). The proportions requiring IAE did not significantly differ between SSM group (39/136 lesions (40%)) and ISM group (52/144 lesions (57%)) (p = 0.19), overall and in stratified analysis by mammographic features. Re-intervention rates were not statistically different between the two groups [SSM:19/136 (14%), ISM:13/144 (9%); p = 0.27]. CONCLUSION: The introduction of ISM in BCS significantly reduced surgical time but did not change IAE and re-intervention rates, highlighting facilitated communication between surgeons and radiologists. ADVANCES IN KNOWLEDGE: Compared to standard mammography imaging, the use of ISM significantly reduced surgical time.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Mamografia/métodos , Mastectomia Segmentar/métodos , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Pessoa de Meia-Idade , Duração da Cirurgia , Consulta Remota/métodos , Reoperação/estatística & dados numéricos , Manejo de Espécimes
12.
Br J Radiol ; 93(1109): 20191039, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32101458

RESUMO

OBJECTIVE: The purpose of this study is to assess the outcomes of symptomatic and asymptomatic solitary dilated ducts detected on mammography, ultrasound, and MRI. METHODS: All cases of isolated solitary dilated ducts between January 1, 2009 and December 31, 2016 in non-lactating females were reviewed. Clinical data, including patient's age, breast cancer history, and pathology results were collected. Imaging was reviewed, and indication for the exam, breast density, maximum diameter of the dilated duct on ultrasound, presence of an intraductal mass, presence of intraductal vascularity, presence of intraductal echogenicity, and subareolar or peripheral location of the dilated duct were recorded. RESULTS: 87 cases of solitary dilated ducts were assessed in this study, of which 3 were malignant, resulting in a positive predictive value of 3.5% (3/87). No malignancy was identified in asymptomatic screening patients. The three malignant cases were seen in patients presenting with a palpable lump (n = 1) or bloody nipple discharge (n = 2). There was a statistically significant association observed between the dilated duct diameter (p = 0.049) and presence of intraductal vascularity (p = 0.0005) with presence of malignancy. CONCLUSION: Rate of malignancy is low in solitary dilated ducts, especially among asymptomatic patients. Patient's presenting with clinical symptoms, larger dilated duct diameters, and/or intraductal vascularity may require additional evaluation including biopsy to exclude malignancy. ADVANCES IN KNOWLEDGE: Clinical and imaging factors can assist in better identifying patients with solitary dilated ducts who should undergo biopsy.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Mamografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Densidade da Mama/fisiologia , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Constrição Patológica , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Papilar/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos
13.
PLoS One ; 15(1): e0228226, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32004334

RESUMO

OBJECTIVE: Exposure to toxic metals such as mercury has been proposed to be a risk factor for the development of breast cancer since some metals can promote genetic mutations and epigenetic changes. We sought to find what toxic metals are present in normal breast tissue and in the tumours of women who had mastectomies for invasive ductal breast carcinoma. MATERIALS AND METHODS: Formalin-fixed paraffin-embedded blocks from mastectomies for breast carcinoma were examined from 50 women aged 34-69 years. Paraffin blocks selected for elemental analysis were from breast tissue not involved by carcinoma and from the carcinoma itself. Seven micrometer-thick sections were stained with autometallography to demonstrate the presence of mercury, and subjected to laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) to confirm the presence of mercury and to detect other toxic metals. RESULTS: Autometallography-detected mercury was seen in intraductal secretions and some luminal epithelial cells of normal breast lobules in 26 (55%) of the 47 samples where lobules were present, and in 10 (23%) of carcinomas from the 44 samples where carcinoma was present. In eight samples ductal carcinoma in situ was present and one of these contained mercury. LA-ICP-MS confirmed the presence of mercury in samples that stained with autometallography, and detected lead, iron, nickel, aluminium, chromium and cadmium in some samples. CONCLUSIONS: Mercury was present in normal breast lobules in more than half of mastectomy samples that contained an invasive carcinoma, and in a smaller proportion of carcinomas and ductal carcinomas in situ. Other toxic metals that may interact synergistically with mercury could be detected in some samples. These findings do not provide direct evidence that toxic metals such as mercury play a role in the pathogenesis of breast cancer, but suggest that future molecular biological investigations on the role of toxic metals in breast cancer are warranted.


Assuntos
Mama/diagnóstico por imagem , Mama/metabolismo , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/metabolismo , Poluentes Ambientais/metabolismo , Mercúrio/metabolismo , Imagem Molecular , Adulto , Idoso , Mama/citologia , Mama/patologia , Carcinoma Ductal de Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade
15.
Radiol Med ; 125(2): 109-116, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31696388

RESUMO

PURPOSE: The purpose of this study is to develop a radiomics model for predicting the Ki-67 proliferation index in patients with invasive ductal breast cancer through magnetic resonance imaging (MRI) preoperatively. MATERIALS AND METHODS: A total of 128 patients who were clinicopathologically diagnosed with invasive ductal breast cancer were recruited. This cohort included 32 negative Ki67 expression (Ki67 proliferation index < 14%) and 96 cases with positive Ki67 expression (Ki67 proliferation index ≥ 14%). All patients had undergone diffusion-weighted imaging (DWI) MRI before surgery on a 3.0T MRI scanner. Radiomics features were extracted from apparent diffusion coefficient (ADC) maps which were obtained by DWI-MRI from patients with invasive ductal breast cancer. 80% of the patients were divided into training set to build radiomics model, and the rest into test set to evaluate its performance. The least absolute shrinkage and selection operator (LASSO) was used to select radiomics features, and then, the logistic regression (LR) model was established using fivefold cross-validation to predict the Ki-67 index. The performance was evaluated by receiver-operating characteristic (ROC) analysis, accuracy, sensitivity and specificity. RESULTS: Quantitative imaging features (n = 1029) were extracted from ADC maps, and 11 features were selected to construct the LR model. Good identification ability was exhibited by the ADC-based radiomics model, with areas under the ROC (AUC) values of 0.75 ± 0.08, accuracy of 0.71 in training set and 0.72, 0.70 in test set. CONCLUSIONS: The ADC-based radiomics model is a feasible predictor for the Ki-67 index in patients with invasive ductal breast cancer. Therefore, we proposed that three-dimensional imaging features from ADC maps could be used as candidate biomarker for preoperative prediction the Ki-67 index noninvasively.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/metabolismo , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/metabolismo , Imagem de Difusão por Ressonância Magnética , Antígeno Ki-67/metabolismo , Biomarcadores Tumorais/metabolismo , Feminino , Humanos , Imageamento Tridimensional , Pessoa de Meia-Idade , Invasividade Neoplásica , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Estudos Retrospectivos , Sensibilidade e Especificidade
16.
Am J Surg Pathol ; 44(2): 182-190, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31609784

RESUMO

Flat epithelial atypia (FEA) is an alteration of terminal duct lobular units by a proliferation of ductal epithelium with low-grade atypia. No consensus exists on whether the diagnosis of FEA in core needle biopsy (CNB) requires excision (EXC). We retrospectively identified all in-house CNBs obtained between January 2012 and July 2018 with FEA. We reviewed all CNB slides and assessed radiologic-pathologic concordance. An upgrade was defined as invasive carcinoma (IC) and/or ductal carcinoma in situ in the EXC. The EXC slides of all upgraded cases were rereviewed. Out of ∼15,700 consecutive CNBs in the study period, 106 CNBs from 106 patients yielded FEA alone or with classic lobular neoplasia (LN). We excluded 52 CNBs (40 patients with prior/concurrent carcinoma and 12 without EXC). After rereview, we reclassified 14 cases (2 marked nuclear atypia, 10 focal atypical ductal hyperplasia, 2 benign). The final FEA study cohort consisted of 40 CNBs from 40 women. The CNB targeted mammographic calcifications in 36 (90%) cases, magnetic resonance imaging nonmass enhancement in 3 (8%), and 1 (2%) sonographic mass. All CNBs were deemed radiologic-pathologic concordant. FEA was present alone in 34 CNBs and with LN in 6. EXC yielded 2 low-grade IC, each spanning <2 mm, identified in tissue sections without biopsy site changes. The remaining 38 cases had no upgrade. Classic LN did not affect the upgrade. The upgrade rate of FEA was 5%; both minute, low-grade "incidental" IC. We conclude that nonsurgical management may be considered in patients without prior/concurrent carcinoma and radiologic-pathologic concordant CNB diagnosis of FEA.


Assuntos
Neoplasias da Mama/patologia , Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Lobular/patologia , Lesões Pré-Cancerosas/patologia , Adulto , Idoso , Biópsia com Agulha de Grande Calibre , Mama/diagnóstico por imagem , Mama/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/terapia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/terapia , Carcinoma Lobular/diagnóstico por imagem , Carcinoma Lobular/terapia , Tratamento Conservador , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Mamografia , Mastectomia , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/terapia , Estudos Retrospectivos , Medição de Risco , Ultrassonografia Mamária
17.
World Neurosurg ; 133: e327-e341, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31520760

RESUMO

BACKGROUND: Medical implications of 3-dimensional (3D) printing technology have evolved and are increasingly used. Surgical spine oncology involves at times complex resection using various surgical approaches and unique spinal reconstruction. As high general complication rates, including hardware failure, are reported, careful preoperative planning and optimized fixation techniques should be performed. 3D printing technology allows the improvement of preoperative planning, practice and exploration of various surgical approaches, and designing customized surgical tools and patient specific implants. OBJECTIVE: To investigate the use of 3D printing technology in complex spine surgeries. METHODS: Between 2015 and 2018, all complex spine oncological cases were evaluated and assessed for the possible benefit of use of 3D printing technology. Following high-quality imaging, a computerized integrated 3D model was created. Based on the planned procedure considering the various surgical steps, a customized 3D model was planned and printed, and in select cases a 3D custom-made implant was designed and printed in various sizes with matching trials. RESULTS: A total of 7 cases were selected for the use of a 3D printing technology. For all, a custom-made model was created. In 3 of these cases, a customized 3D-printed implant was used. Special customized intraoperative instruments were made for 2 cases, and a simulated surgical approach was performed in 5 cases. In 2 cases, pre-bent rods were made based on the model created and were used in surgery later on. CONCLUSIONS: For complex spine oncology cases, the use of 3D printing allowed better preoperative planning, simplified the operative procedure, and enabled improved reconstruction.


Assuntos
Imagem por Ressonância Magnética , Modelos Anatômicos , Impressão Tridimensional , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Transplante Ósseo , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/secundário , Carcinoma Ductal de Mama/cirurgia , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/patologia , Condrossarcoma/cirurgia , Desenho de Equipamento , Feminino , Tumores de Células Gigantes/diagnóstico por imagem , Tumores de Células Gigantes/patologia , Tumores de Células Gigantes/cirurgia , Hemangioma/diagnóstico por imagem , Hemangioma/patologia , Hemangioma/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/patologia , Osteoma Osteoide/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Sarcoma de Ewing/diagnóstico por imagem , Sarcoma de Ewing/secundário , Sarcoma de Ewing/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/secundário , Cirurgia Assistida por Computador/instrumentação , Instrumentos Cirúrgicos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Adulto Jovem
18.
World J Surg Oncol ; 17(1): 208, 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801564

RESUMO

BACKGROUND: Ultrasound, along with ultrasound-guided fine needle aspiration, is currently used for the axillary evaluation of breast cancer patients in order to identify candidates for axillary lymph node dissection. The aim of this study is to evaluate the accuracy of this tool in correctly identifying patients who may or may not benefit from axillary clearance in light of the ACOSOG Z0011 trial recommendations. METHODS: One hundred one patients (65 with positive US-FNA with corresponding axillary lymph node dissection (ALND), and 36 with negative US-FNA with corresponding ALND/sentinel lymph node biopsy) were studied for the number of involved axillary lymph nodes, tumor clinicopathologic features, and axillary radiologic findings. RESULTS: From the positive US-FNA group, 43% of patients had two or fewer positive lymph nodes upon ALND pathologic examination. In the US-FNA negative group, the negative predictive value for detecting axillary disease was 72.7%. With both groups combined, the sensitivity, specificity, PPV, and NPV of US-FNA for selecting patients based on axillary disease burden were 86%, 51.7%, 57%, and 83.3%, respectively. CONCLUSION: Based on Z0011 guidelines, US-FNA is not a reliable tool in triaging patients in need for ALND and leads to overtreatment of 43% patients when positive, while depriving a small but significant percentage of patients from necessary therapy, when negative.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Lobular/patologia , Biópsia Guiada por Imagem/métodos , Linfonodos/patologia , Ultrassonografia/métodos , Axila , Biópsia por Agulha Fina , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Lobular/diagnóstico por imagem , Carcinoma Lobular/cirurgia , Gerenciamento Clínico , Reações Falso-Positivas , Feminino , Seguimentos , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela
19.
Neth J Med ; 77(10): 356-359, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31880271

RESUMO

BACKGROUND: To review the procedural diagnosis of male breast cancer. METHODS: Medline and Google Scholar searches using the terms (male breast cancer) and (diagnosis); and (triple assessment). RESULTS: Most of the search-specific items are incorporated in more comprehensive reviews about male breast cancer in general. Relevant data was extracted in accordance with the aim of this review. RESULTS: Most of the diagnosed cases are advanced stage ductal invasive carcinomas, express hormone receptors in the great majority, and are less likely to over-express HER2-neu. They present usually as a painless retroareolar mass that requires triple assessment. The diagnosis needs a high index of suspicion primarily due to the unawareness of such a cancer in males.


Assuntos
Neoplasias da Mama Masculina/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Neoplasias da Mama Masculina/patologia , Carcinoma Ductal de Mama/patologia , Humanos , Masculino , Mamografia
20.
Eur J Radiol ; 121: 108718, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31711023

RESUMO

PURPOSE: The aim of our study was to evaluate the HER-2 status in breast cancer patients using mammography (MG) radiomics features. METHODS: A total of 306 Chinese female patients with invasive ductal carcinoma of no special type (IDC-NST) enrolled from January 2013 to July 2018 were divided into a training set (n = 244) and a testing set (n = 62). One hundred and eighty-six radiomics features were extracted from digital MG images based on the training set. The least absolute shrinkage and selection operator (LASSO) method was used to select the optimal predictive features for HER-2 status from the training set. Both support vector machine (SVM) and logistic regression models were employed based on the selected features. The area under the receiver operating characteristic (ROC) curves (AUCs) of the training set and testing set were used to evaluate the predictive performance of the models. RESULTS: Compared with the SVM model, the performance of the logistic regression model using a combination of cranial caudal (CC) and mediolateral oblique (MLO) MG views was optimal. In the training set, the sensitivity, specificity, accuracy and area under the curve (AUC) values of the logistic regression model for evaluating HER-2 status based on quantitative radiomics features were 87.29%, 58.73%, 80.00% and 0.846 (95% confidence interval (CI), 0.800-0.887), respectively, and in the testing set, the values were 73.91%, 68.75%, 77.00% and 0.787 (95% CI, 0.673-0.885), respectively. CONCLUSIONS: Radiomics features could be an efficient tool for the preoperative evaluation of HER-2 status in patients with breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/genética , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/genética , Genes erbB-2/genética , Mamografia/métodos , Área Sob a Curva , Mama/diagnóstico por imagem , China , Feminino , Humanos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Curva ROC , Sensibilidade e Especificidade , Máquina de Vetores de Suporte
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