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1.
Medicine (Baltimore) ; 98(40): e17481, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577783

RESUMO

Axillary lymph node metastasis (ALNM) is commonly the earliest detectable clinical manifestation of breast cancer when distant metastasis emerges. This study aimed to explore the influencing factors of ALNM and develop models that can predict its occurrence preoperatively.Cases of sonographically visible clinical stage T1-2N0M0 breast cancers treated with breast and axillary surgery at West China Hospital were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed to evaluate associations between ALNM and variables. Decision tree analyses were performed to construct predictive models using the C5.0 packages.Of the 1671 tumors, 541 (32.9%) showed axillary lymph node positivity on final surgical histopathologic analysis. In multivariate logistic regression analysis, tumor size (P < .001), infiltration of subcutaneous adipose tissue (P < .001), infiltration of the interstitial adipose tissue (P = .031), and tumor quadrant locations (P < .001) were significantly correlated with ALNM. Furthermore, the accuracy in the decision tree model was 69.52%, and the false-negative rate (FNR) was 74.18%. By using the error-cost matrix algorithm, the FNR significantly decreased to 14.75%, particularly for nodes 5, 8, and 13 (FNR: 11.4%, 9.09%, and 14.29% in the training set and 18.1%,14.71%, and 20% in the test set, respectively).In summary, our study demonstrated that tumor lesion boundary, tumor size, and tumor quadrant locations were the most important factors affecting ALNM in cT1-2N0M0 stage breast cancer. The decision tree built using these variables reached a slightly higher FNR than sentinel lymph node dissection in predicting ALNM in some selected patients.


Assuntos
Neoplasias da Mama/patologia , Metástase Linfática/patologia , Adulto , Axila , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , China , Árvores de Decisões , Feminino , Humanos , Modelos Logísticos , Excisão de Linfonodo , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco
2.
Medicine (Baltimore) ; 98(37): e17082, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517829

RESUMO

To compare the accuracy of breast lesion size measurement of cone-beam breast-CT (CBBCT), digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM).Patients scheduled for mastectomy due to at least 1 malignant breast lesion were included. Mastectomy specimens were examined by CBBCT, DBT, FFDM, and histopathology.A total of 94 lesions (40 patients) were included. Histopathological analyses revealed 47 malignant, 6 high-risk, and 41 benign lesions. Mean histopathological lesion size was 20.8 mm (range 2-100). Mean absolute size deviation from histopathology was largest for FFDM (5.3 ±â€Š6.7 mm) and smallest for CBBCT 50 mA, high-resolution mode (4.3 ±â€Š6.7 mm). Differences between imaging modalities did not reach statistical significance (P = .85).All imaging methods tend to overestimate breast lesion size compared to histopathological gold standard. No significant differences were found regarding size measurements, although in tendency CBBCT showed better lesion detection and cT classification over FFDM.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Tomografia Computadorizada de Feixe Cônico , Mamografia , Idoso , Mama/diagnóstico por imagem , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/cirurgia , Humanos , Interpretação de Imagem Assistida por Computador , Mamografia/métodos , Mastectomia , Estudos Prospectivos , Estudos Retrospectivos , Carga Tumoral
3.
Isr Med Assoc J ; 21(9): 612-614, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542907

RESUMO

BACKGROUND: Young women concerned about a breast cancer diagnosis will visit breast care centers and request breast cancer screening, including imaging studies, on their initial visit. OBJECTIVES: To explore the role of breast examination and breast ultrasound in self-referred asymptomatic women under the age of 40 years. METHODS: We identified 3524 women under the age of 40 at our medical clinic from 1 January 2010 until 1 June 2014. Of this group, 164 women with above average breast cancer risk were excluded and 233 were excluded because of breast complaints. Of 3127 women, 220 underwent breast ultrasound following the initial visit to the clinic and formed the study group. RESULTS: Of 220 women evaluated with ultrasound, 68 had prior positive clinical findings. Of this group 8 women had no sonographic findings, and in the remaining 60, a total of 30 simple cysts, 15 fibroadenomas, and 15 suspicious solid masses were identified. One infiltrating ductal carcinoma and one ductal carcinoma in situ were found in a biopsy. The remaining 152 of the 220 total women who underwent breast ultrasound without showing prior physical findings did not require follow-up. CONCLUSIONS: In the absence of clinical findings during physical breast examination, the addition of breast ultrasonography does not provide additional information to supplement the physical examination in self-referred women under age 40 who do not have any major risk factors for developing breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Mamografia/estatística & dados numéricos , Ultrassonografia Mamária/estatística & dados numéricos , Adulto , Mama/diagnóstico por imagem , Feminino , Humanos , Israel/epidemiologia , Exame Físico/estatística & dados numéricos , Risco , Adulto Jovem
4.
Br J Radiol ; 92(1103): 20190098, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31538515

RESUMO

OBJECTIVE: To determine incidence of internal mammary nodes (IMN) at baseline CT of locally advanced breast cancer (LABC) and ascertain prognostic implication. METHODS AND MATERIALS: Retrospective review of all LABC patients from 1 January 2012 through 31 December 2014 was performed after approval from institutional review board. CTs of 182 patients enrolled were reviewed by two radiologists independently, and IMNs were documented based on size, location and relation with location of breast primary. 3-year follow-up was analysed and incidence of metastases was calculated as overall incidence, incidence in patients with and without discernible IMN at baseline imaging. Results are presented as numbers and percentages. Differences in metastases of two groups were compared using χ2 test. 95% CI was calculated and p < 0.05 was considered significant. RESULTS: 77 of 182 had identifiable IMN (42.3% incidence). Majority of identifiable nodes were on ipsilateral side of primary (incidence 90.90%) with higher incidence in patients with upper-outer quadrant tumours (55.9%). Majority were seen in second intercostal space (44.4%). 36 (19.7%) developed distant metastases within 3 years of therapy. Of these, 21 (27.3%) had IMN as compared with 15 (14.3 %) without IMN on baseline imaging. Patients with identifiable IMN on baseline CT had significantly higher incidence of distant metastases (p = 0.0321). CONCLUSION: Significant number LABC patients have identifiable IMN on baseline imaging with patients showing IMN on baseline CT showing significantly higher rate of metastatic disease following therapy. ADVANCES IN KNOWLEDGE: Many LABC patients have identifiable IMNs on baseline imaging which show higher incidence of subsequent metastatic disease.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/terapia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Metástase Linfática , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
5.
Zhonghua Yi Xue Za Zhi ; 99(31): 2440-2444, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31434424

RESUMO

Objective: To explore the correlation between dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), magnetic resonance diffusion-weighted imaging (DWI) images of breast cancer and human epidermal growth factor receptor-2 (Her-2) expression. Methods: A retrospective analysis of 84 patients with breast cancer confirmed by biopsy from January 2012 to December 2016 in Zhejiang University Lishui Hospital was conducted. The data of DCE-MRI, DWI scanning were collected before surgery and Her-2 was detected by immunohistochemistry (IHC). Then, all the patients were divided into Her-2 positive group and Her-2 negative group according to Her-2 expression. There were 44 cases in the Her-2 positive group and 40 cases in the Her-2 negative group. The differences in the characteristics of the lesion morphology, time-signal intensity curve (TIC), early enhancement rate and apparent diffusion coefficient (ADC) were compared, and their correlation with Her-2 expression was analyzed. Results: Of the 84 lesions, 12 were orthotopic ductal carcinoma, 6 were lobular carcinoma, and 66 were invasive ductal carcinoma. There were significant differences in lesion morphology (P=0.012) and TIC curve morphology (P=0.038) between Her-2 positive group and negative group. At the same time, the early enhancement rate (P=0.012) and ADC value (P=0.038) of Her-2 positive group were significantly higher than those of negative group. Except morphology of segmental lesions and TIC curve morphology, other characteristic parameters were correlated to Her-2 (all P<0.05). The correlation coefficients between early enhancement rate, ADC value and Her-2 expression were as high as 0.758 and 0.809 (all P<0.05). Conclusions: The morphology of breast cancer lesions, time-signal intensity curve, early enhancement rate and ADC value are all correlated with Her-2 expression.The early enhancement rate and ADC value are significantly positively correlated with Her-2 expression.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Receptor ErbB-2 , Estudos Retrospectivos
6.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(4): 684-690, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31441272

RESUMO

Thermoacoustic imaging (TAI) is a new non-invasive, non-ionization and nondestructive modality capable of high microwave contrast and high ultrasound resolution, and it has attracted extensive attention in recent years. This review introduces the technical principle, imaging system and imaging characteristics of TAI, and then introduces the application of TAI for breast cancer detection as an example. This review introduces the advantages of TAI in solving corresponding clinical problems in view of its high resolution and high contrast. In addition, it also explains the roles of TAI in medical diagnosis and treatment. Finally, the potential applications of TAI in medical diagnosis is introduced from many aspects and multiple perspectives. The future development of TAI in the challenges of current medical diagnosis is also prospected.


Assuntos
Acústica , Neoplasias da Mama/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Humanos , Micro-Ondas
7.
Medicine (Baltimore) ; 98(35): e16648, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464900

RESUMO

RATIONALE: Primary granulocytic sarcoma of the breast is a rare and poor-prognosis malignancy. Clinicians do not have sufficient knowledge of this disease and often misdirect it as other soft tissue sarcomas or inflammation. PATIENT CONCERNS: A 42-year-old female presented with a self-discovered asymptomatic growing and palpable right breast mass that had been present for 4 months. DIAGNOSES: The patient was diagnosed as primary myeloid sarcoma. INTERVENTIONS: The patient received modified radical mastectomy in the right breast and sentinel lymph node biopsy. Pathological diagnosis is primary granulocytic sarcoma. Then the patient accepted acute myeloid leukemia-induction chemotherapy. OUTCOMES: The follow-up of this patient has no evidence of disease progression or spread during 1 year. LESSONS: Granulocytic sarcoma in the breast tissue is rare. But it still should be considered in the differential diagnosis of any tumor in the breast. The present study discusses comprehensively the clinical and pathological characteristics to improve the understanding of myeloid sarcoma.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia , Sarcoma Mieloide/diagnóstico por imagem , Sarcoma Mieloide/terapia , Adulto , Citarabina/uso terapêutico , Diagnóstico Diferencial , Feminino , Mepesuccinato de Omacetaxina/uso terapêutico , Humanos , Quimioterapia de Indução , Mastectomia Radical Modificada , Biópsia de Linfonodo Sentinela , Resultado do Tratamento
8.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(4): 290-293, 2019 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-31460724

RESUMO

In this paper, the focus of technical review of the registration application data of digital Breast Tomosynthesis Mammography System was sorted out, so as to provide reference for researchers and manufacturers in China when applying for registration and preparation of such products.


Assuntos
Mamografia , Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , China , Humanos , Mamografia/instrumentação , Mamografia/normas , Intensificação de Imagem Radiográfica/normas , Fatores de Risco
9.
J Surg Oncol ; 120(6): 897-902, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31441070

RESUMO

A patient-specific 3-dimensional printed model (3DPM) of a woman with breast cancer was created. Mastectomy was favored as BCS would necessitate significant breast size alteration due to the extent of disease. After review of the 3D printed model, the patient and surgeon agreed on breast-conserving surgery. Use of patient-specific 3DPM in the setting of breast cancer may aid patient decision making and surgical planning, leading to enhanced surgical and oncological outcomes.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia Segmentar/métodos , Impressão Tridimensional/instrumentação , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico
10.
Br J Radiol ; 92(1103): 20190177, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31365279

RESUMO

OBJECTIVE: In the UK RCR 5-point breast imaging system (UKS), radiologists grade mammograms from 1 to 5 according to suspicion for malignancy, however unlike BI-RADS, no lexicon of descriptors is published. The aim of this study was to determine whether strict categorisation of microcalcifications (MCC) according to BI-RADS was a better predictor of malignancy than the UKS and whether these descriptors could be used within the UKS. METHODS: A retrospective review of 241 cases, with MCC on mammography, who underwent biopsy was performed. Morphology, distribution, extent, UKS score, BI-RADS category and pathology were recorded. The positive predictive value (PPV) of each classification system for malignancy was calculated. RESULTS: 28.6% were diagnosed with DCIS/IDC. The PPV for malignancy using the UKS was 18.9%, 69.4%, 100% for M3-5 respectively (p < 0.001) and using ΒI-RADS morphology was amorphous: 7.1%, coarse heterogeneous: 33.3%, fine pleomorphic: 48.1% and fine linear/fine linear branching: 85.2% (p < 0.001). The PPV based on distribution was grouped: 14.2%, regional: 32.3%, diffuse: 33.3% and linear/segmental: 77.8% (p < 0.001). Combining all cases of benign-appearing, amorphous and grouped coarse heterogenous and grouped fine pleomorphic MCC gave a PPV of 12.8%. Combining regional, linear or segmental coarse heterogenous and fine pleomorphic and all fine linear/branching MCC resulted in a PPV of 83.3% for malignancy. CONCLUSION: Combining morphology and distribution of MCC is accurate in malignancy prediction. Use of BI-RADS descriptors could help standardise reporting within the UKS and an algorithm using these within the UKS is proposed. Better prediction would enable more appropriate counselling and help to identify discrepancies. ADVANCES IN KNOWLEDGE: No guidance exists on scoring of suspicious MCC in the UK breast imaging system. Use of BI-RADS morphologic/distribution descriptors can aid malignancy prediction. Findings other than morphology of MCC are important in malignancy prediction. An algorithm for use by the UK radiologist when evaluating MCC is provided.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Calcinose/patologia , Carcinoma Ductal de Mama/patologia , Detecção Precoce de Câncer , Feminino , Humanos , Mamografia/métodos , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Estudos Retrospectivos
11.
Br J Radiol ; 92(1103): 20190345, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31453718

RESUMO

OBJECTIVE: To compare image quality and breast density of two reconstruction methods, the widely-used filtered-back projection (FBP) reconstruction and the iterative heuristic Bayesian inference reconstruction (Bayesian inference reconstruction plus the method of total variation applied, HBI). METHODS: Thirty-two clinical DBT data sets with malignant and benign findings, n = 27 and 17, respectively, were reconstructed using FBP and HBI. Three experienced radiologists evaluated the images independently using a 5-point visual grading scale and classified breast density according to the American College of Radiology Breast Imaging-Reporting And Data System Atlas, fifth edition. Image quality metrics included lesion conspicuity, clarity of lesion borders and spicules, noise level, artifacts surrounding the lesion, visibility of parenchyma and breast density. RESULTS: For masses, the image quality of HBI reconstructions was superior to that of FBP in terms of conspicuity,clarity of lesion borders and spicules (p < 0.01). HBI and FBP were not significantly different in calcification conspicuity. Overall, HBI reduced noise and supressed artifacts surrounding the lesions better (p < 0.01). The visibility of fibroglandular parenchyma increased using the HBI method (p < 0.01). On average, five cases per radiologist were downgraded from BI-RADS breast density category C/D to A/B. CONCLUSION: HBI significantly improves lesion visibility compared to FBP. HBI-visibility of breast parenchyma increased, leading to a lower breast density rating. Applying the HBIR algorithm should improve the diagnostic performance of DBT and decrease the need for additional imaging in patients with dense breasts. ADVANCES IN KNOWLEDGE: Iterative heuristic Bayesian inference (HBI) image reconstruction substantially improves the image quality of breast tomosynthesis leading to a better visibility of breast carcinomas and reduction of the perceived breast density compared to the widely-used filtered-back projection (FPB) reconstruction. Applying HBI should improve the accuracy of breast tomosynthesis and reduce the number of unnecessary breast biopsies. It may also reduce the radiation dose for the patients, which is especially important in the screening context.


Assuntos
Densidade da Mama/fisiologia , Neoplasias da Mama/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Artefatos , Teorema de Bayes , Neoplasias da Mama/patologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/normas , Mamografia/métodos , Mamografia/normas , Pessoa de Meia-Idade , Estudos Retrospectivos , Carga Tumoral
12.
Clin Nucl Med ; 44(8): e479-e483, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274628

RESUMO

F-FDG PET/CT imaging is an important diagnostic tool for accurate staging and assessment of response to neoadjuvant chemotherapy (NACT) in patients with locally advanced breast carcinoma (LABC). However, F-FDG being non-specific marker, it also accumulates in inflammatory conditions, leading to false positive results. Angiogenesis, an essential characteristic for tumor development, intrusion and metastasis can be imaged using Ga-labeled RGD tripeptide. We here depict a series of clinically staged LABC patients who underwent both Ga-DOTA-RGD2 and F-FDG PET/CT imaging for staging and illustrate the similarities and significant differences between the two tracers.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Glicólise , Neovascularização Patológica/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias da Mama/irrigação sanguínea , Neoplasias da Mama/metabolismo , Feminino , Fluordesoxiglucose F18 , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias
13.
Clin Nucl Med ; 44(8): e492-e494, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274632

RESUMO

We present a 53-year-old woman who had shortness of breath and atypical chest pain and underwent Tc-sestamibi myocardial perfusion imaging to detect coronary artery disease. The raw data in cine format showed an incidental focus close to the heart, and SPECT/CT fused images revealed a focus of intense uptake in the left breast. The subsequent histopathologic findings and F-FDG PET/CT imaging confirmed the diagnosis as primary breast lymphoma. After 3 cycles of chemotherapy, previously visualized abnormal uptake in the left breast disappeared on the follow-up PET/CT.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Achados Incidentais , Linfoma/diagnóstico por imagem , Imagem de Perfusão do Miocárdio , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tecnécio Tc 99m Sestamibi , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade
14.
Medicine (Baltimore) ; 98(30): e16528, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348268

RESUMO

BACKGROUND: Early diagnosis and treatment of breast cancer are important to prevent fatal tumor progression. Axillary lymph node (ALN) status is the most significant prognostic factor for diagnosing overall survival in breast cancer patients. Axillary lymph node dissection (ALND) is regarded as the reference standard for determining ALN status. However, ALND is an invasive therapy with high morbidity and complications such as lymphedema, seroma and nerve injury. Comparatively, magnetic resonance imaging (MRI) and ultrasound are noninvasive and non-radiative techniques that are common imaging methods to diagnose breast cancer lymph node metastasis. Many studies have investigated the diagnostic value of MRI combined with ultrasound for breast cancer ALN metastasis, but the evidence has been insufficient to apply these modalities when diagnosing new patients. METHODS: We will search electronic databases including PubMed, EMbase, The Cochrane Library, Chinese Biomedical Database, WangFang Database, and China National Knowledge Infrastructure. The language of studies is limited in English or Chinese. The final search includes articles published in June, 2018. Stata 14.0 software will be used for all statistical analyses, and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) will be utilized to evaluate the quality of the included studies. Meta-regression and subgroup analyses will be performed to explore heterogeneity, which will be derived from the different countries of origin of the included studies. Deeks' funnel plot asymmetry test will be demonstrated the inexistence of publication bias. RESULT: This study will provide a rational synthesis of current evidences for magnetic resonance imaging combined with ultrasound for breast cancer. CONCLUSION: The conclusion of this study will provide evidence for the diagnostic value of MRI combined with ultrasound for lymph node metastasis in breast cancer. REGISTRATION: PROS-PERO CRD42019134474.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Detecção Precoce de Câncer/estatística & dados numéricos , Metástase Linfática/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Axila , Neoplasias da Mama/patologia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Metanálise como Assunto , Valor Preditivo dos Testes , Análise de Regressão , Projetos de Pesquisa , Ultrassonografia/métodos
15.
Cancer Imaging ; 19(1): 46, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269987

RESUMO

BACKGROUND: Mammography (MG) is highly sensitive for detecting microcalcifications, but has low specificity. This study investigates whether establishing a preoperative nomogram including ultrasonographic findings can help predict the likelihood of malignancy in patients with mammographic microcalcification. METHODS: Between May 2012 and January 2017, 475 patients with suspicious microcalcifications detected on MG underwent ultrasonography (US). The χ2 test was used to screen risk factors among the variables. Then, a multivariate logistic regression analysis was performed to identify independent predictors of malignant microcalcifications. A mammographic nomogram (M nomogram) and mammographic-ultrasonographic nomogram (M-U nomogram) were established based on multivariate logistic regression models. The discriminatory ability and clinical utility of both nomograms were compared by the receiver operating characteristics curve and decision curve analysis. The calibration ability was evaluated using a calibration curve. RESULTS: Among the cases, 68.2% (324/475) were pathologically diagnosed as breast cancer and 31.8% (151/475) were benign lesions. Based on multivariate logistic regression analysis, age, clinical manifestation, morphology and distribution of microcalcifications on MG and lesions associated with microcalcifications on US were confirmed as independent predictors of malignant microcalcifications. In terms of discrimination ability, the C-index of the M-U nomogram was significantly higher than that of the M nomogram (0.917 vs 0.897, p = 0.006). The bias-corrected curve was close to the ideal line in the calibration curve. Decision curve analysis suggested that the M-U nomogram was superior to M nomogram. CONCLUSIONS: Combining mammographic parameters with ultrasonographic findings in a nomogram provided better performance than an M nomogram alone, especially for dense breasts, which suggests the value of ultrasonographic finding for individualized prediction of malignancy in patients with microcalcifications.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Mamografia/métodos , Ultrassonografia/métodos , Adulto , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Calcinose/complicações , Calcinose/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Nomogramas , Período Pré-Operatório , Sensibilidade e Especificidade
16.
Cancer Imaging ; 19(1): 48, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307537

RESUMO

BACKGROUND: Imaging techniques can provide information about the tumor non-invasively and have been shown to provide information about the underlying genetic makeup. Correlating image-based phenotypes (radiomics) with genomic analyses is an emerging area of research commonly referred to as "radiogenomics" or "imaging-genomics". The purpose of this study was to assess the potential for using an automated, quantitative radiomics platform on magnetic resonance (MR) breast imaging for inferring underlying activity of clinically relevant gene pathways derived from RNA sequencing of invasive breast cancers prior to therapy. METHODS: We performed quantitative radiomic analysis on 47 invasive breast cancers based on dynamic contrast enhanced 3 Tesla MR images acquired before surgery and obtained gene expression data by performing total RNA sequencing on corresponding fresh frozen tissue samples. We used gene set enrichment analysis to identify significant associations between the 186 gene pathways and the 38 image-based features that have previously been validated. RESULTS: All radiomic size features were positively associated with multiple replication and proliferation pathways and were negatively associated with the apoptosis pathway. Gene pathways related to immune system regulation and extracellular signaling had the highest number of significant radiomic feature associations, with an average of 18.9 and 16 features per pathway, respectively. Tumors with upregulation of immune signaling pathways such as T-cell receptor signaling and chemokine signaling as well as extracellular signaling pathways such as cell adhesion molecule and cytokine-cytokine interactions were smaller, more spherical, and had a more heterogeneous texture upon contrast enhancement. Tumors with higher expression levels of JAK/STAT and VEGF pathways had more intratumor heterogeneity in image enhancement texture. Other pathways with robust associations to image-based features include metabolic and catabolic pathways. CONCLUSIONS: We provide further evidence that MR imaging of breast tumors can infer underlying gene expression by using RNA sequencing. Size and shape features were appropriately correlated with proliferative and apoptotic pathways. Given the high number of radiomic feature associations with immune pathways, our results raise the possibility of using MR imaging to distinguish tumors that are more immunologically active, although further studies are necessary to confirm this observation.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Perfilação da Expressão Gênica/métodos , Genômica/métodos , Imagem por Ressonância Magnética/métodos , Idoso , Apoptose , Neoplasias da Mama/genética , Feminino , Humanos , Fenótipo
17.
Medicine (Baltimore) ; 98(27): e16306, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277170

RESUMO

This study investigated the effect of sex hormones on F-fluorodeoxyglucose (FDG) uptake in normal breast tissue.The retrospective study included 249 premenopausal women (median age, 45 years) who were diagnosed with unilateral breast cancer and underwent FDG positron emission tomography/computed tomography and hormone tests. The volume of interest was within the contralateral normal breast and the standardized uptake values (SUVs) were measured. The correlations of sex hormones (including estrogen, progesterone, testosterone, follicle-stimulating hormone [FSH] and luteinizing hormone [LH]) with the SUVs of the normal breast were analyzed.There was a weak negative correlation between age and breast FDG uptake (P = .012, Spearman coefficient = -.16 for the maximum standardized uptake values [SUVmax]), especially in the luteal phase group (P = .005, Spearman coefficient = -.27 for SUVmax). The SUVs of normal breast tissue were increased when progesterone levels were higher (P = .043, Spearman coefficient = .13 for SUVmax). In the irregular menstrual cycle group, FDG uptake in the breast decreased as FSH (P = .027, Spearman coefficient = -.42 for SUVmax) and LH (P = .048, Spearman coefficient = -.44 for SUVmax) increased.Glucose metabolism of normal breast tissue decreases with age, and progesterone weakly affects breast FDG uptake. Gonadotropins may affect breast FDG uptake in premenopausal women with irregular menstrual cycles.


Assuntos
Mama/metabolismo , Estradiol/sangue , Fluordesoxiglucose F18/farmacocinética , Hormônio Foliculoestimulante/sangue , Hormônio Luteinizante/sangue , Progesterona/sangue , Testosterona/sangue , Adulto , Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/farmacocinética , Valores de Referência , Estudos Retrospectivos
18.
Br J Radiol ; 92(1100): 20180978, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31291125

RESUMO

OBJECTIVES: To assess the value of computed diffusion-weighted imaging (cDWI) and voxelwise computed diffusion-weighted imaging (vcDWI) in breast cancer. METHODS: This retrospective study involved 130 patients (age range, 25-70 years; mean age ± standard deviation, 48.6 ± 10.5 years) with 130 malignant lesions, who underwent MRI examinations, including a DWI sequence, prior to needle biopsy or surgery. cDWIs with higher b-values of 1500, 2000, 2500, 3000, 3500, and 4000 s/mm2, and vcDWI were generated from measured (m) DWI with two lower b-values of 0/600, 0/800, or 0/1000 s/mm2. The signal-to-noise ratio (SNR) and contrast ratio (CR) of all image sets were computed and compared among different DWIs by two experienced radiologists independently. To better compare the CR with the SNR, the CR value was multiplied by 100 (CR100). RESULTS: The CR of vcDWI, and cDWIs, except for cDWI1000, differed significantly from that of measured diffusion-weighted imaging (mDWI) (cDWI1000: CR = 0.4904, p = 0.394; cDWI1500: CR = 0.5503, p = 0.006; cDWI2000: CR = 0.5889, p < 0.001; cDWI2500: CR = 0.6109, p < 0.001; cDWI3000: mean = 0.6214, p < 0.001; cDWI3500: CR = 0.6245, p < 0.001; cDWI4000: CR = 0.6228, p < 0.001). The vcDWI provided the highest CR, while the CRs of all cDWI image sets improved with increased b-values. The SNR of neither cDWI1000 nor vcDWI differed significantly from that of mDWI, but the mean SNRs of the remaining cDWIs were significantly lower than that of mDWI. The SNRs of cDWIs declined with increasing b-values, and the initial decrease at low b-values was steeper than the gradual attenuation at higher b-values; the CR100 rose gradually, and the two converged on the b-value interval of 1500-2000 s/mm2 . CONCLUSIONS: The highest CR was achieved with vcDWI; this could be a promising approach easier detection of breast cancer. ADVANCES IN KNOWLEDGE: This study comprehensively compared and evaluated the value of the emerging post-processing DWI techniques (including a set of cDWIs and vcDWI) in breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Interpretação de Imagem Assistida por Computador/métodos , Adulto , Idoso , Mama/diagnóstico por imagem , Estudos de Avaliação como Assunto , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Razão Sinal-Ruído
19.
Can Assoc Radiol J ; 70(3): 282-291, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31300313

RESUMO

PURPOSE: Our purpose was twofold. First, we sought to determine whether 2 orthogonal oriented views of excised breast cancer specimens could improve surgical margin assessment compared to a single unoriented view. Second, we sought to determine whether 3D tomosynthesis could improve surgical margin assessment compared to 2D mammography alone. MATERIALS AND METHODS: Forty-one consecutive specimens were prospectively imaged using 4 protocols: single view unoriented 2D image acquired on a specimen unit (1VSU), 2 orthogonal oriented 2D images acquired on the specimen unit (2VSU), 2 orthogonal oriented 2D images acquired on a mammogram unit (2V2DMU), and 2 orthogonal oriented 3D images acquired on the mammogram unit (2V3DMU). Three breast imagers randomly assessed surgical margin of the 41 specimens with each protocol. Surgical margin per histopathology was considered the gold standard. RESULTS: The average area under the curve (AUC) was 0.60 for 1VSU, 0.66 for 2VSU, 0.68 for 2V2DMU, and 0.60 for 2V3DMU. Comparing AUCs for 2VSU vs 1VSU by reader showed improved diagnostic accuracy using 2VSU; however, this difference was only statistically significant for reader 3 (0.73 vs 0.63, P = .0455). Comparing AUCs for 2V3DMU vs 2V2DMU by reader showed mixed results, with reader 1 demonstrating increased accuracy (0.72 vs 0.68, P = .5984), while readers 2 and 3 demonstrated decreased accuracy (0.50 vs 0.62, P = .1089 and 0.58 vs 0.75, P = .0269). CONCLUSIONS: 2VSU showed improved accuracy in surgical margin prediction compared to 1VSU, although this was not statistically significant for all readers. 3D tomosynthesis did not improve surgical margin assessment.


Assuntos
Neoplasias da Mama/cirurgia , Imagem Tridimensional/métodos , Mamografia/métodos , Margens de Excisão , Mastectomia Segmentar , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
20.
Expert Opin Drug Saf ; 18(9): 817-827, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31305174

RESUMO

Introduction: Preoperative systemic therapy (PST) including neoadjuvant chemotherapy (NAC) in breast cancer (BC) is used nowadays on a large scale especially in aggressive BC subtypes. The use of NAC in BC may be associated with some safety issues and hazards including possible increased rate of locoregional recurrence, inadequate staging with subsequent over or under-treatment, and surgical complications. Areas covered: This review article aims to discuss these concerns and to clarify the adequate steps and procedures needed to increase safety and alleviate the possible drawbacks of NAC. The author will discuss the adequate and meticulous technical procedures needed to stage and localize the breast tumor, detect any affected axillary lymph node, improve the accuracy and safety of doing sentinel lymph node biopsy (SLNB) after NAC, estimate the tumor response to NAC to determine the extent of surgery, and enhance the precise documentation of pCR. Expert opinion: The use of breast MRI, image-detectable clips in the tumor bed, dual technique during SLNB, and target axillary dissection are among the required steps to maintain safety. In the future, ongoing prospective trials will allow us to select patients who can safely avoid breast and/or axillary surgery after systemic therapy.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Terapia Neoadjuvante/métodos , Antineoplásicos/efeitos adversos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Terapia Neoadjuvante/efeitos adversos , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Seleção de Pacientes , Biópsia de Linfonodo Sentinela/métodos
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