Muscle mass loss in breast cancer patients of reproductive age (≤ 45 years) undergoing neoadjuvant chemotherapy.

PURPOSE: Loss of muscle mass is associated with negative clinical outcome in breast cancer (BC) patients. Therefore, the aim of the study is to evaluate if there is pectoralis muscle area (PMA) depletion, reflecting loss of muscle mass, in breast cancer patients of reproductive age (≤ 45 years) undergoing neoadjuvant chemotherapy (NAC) and to correlate PMA with clinical and histopathological data. MATERIAL AND METHODS: This monocentric study, approved by our institutional review board, enrolled a total of 52 consecutive patients (mean age 37 ± 4.96 years) with histologically proven primary breast cancer between January 2019 and September 2021, treated with NAC and in whom tumor response and PMA were assessed with breast MRI. Two radiologists calculated PMA before and after NAC independently and blindly on axial 3D FLASH pre-contrast T1-weighted images. Wilcoxon-Mann-Whitney U test compared median values and percentage changes of pectoralis muscle area at the beginning and at the end of NAC (158 ± 25.5 days). Multivariate regression analysis on ΔPMA (difference between PMA pre-NAC and PMA post-NAC) was done according to clinical and histopathological data. Inter-reader and intra-reader agreement was estimated with K statistics. RESULTS: Pre-NAC PMA mean value was larger than post-NAC PMA mean value (9.6 ± 2.6 cm2 vs. 8.7 ± 2.2 cm2, p < 0.001, delta value 1.41). According to the RECIST criteria, no significant differences between complete and partial response were found. Multivariate regression analysis did not show any significant relationships between ΔPMA and age, time between MRI examinations, estrogen and progesterone receptor status, human epidermal growth factor receptor 2 status, Ki-67 expression, lymph node involvement, RECIST criteria, histological type, and different regimes of NAC. Inter-reader (k = 0.74) and intra-reader agreement (0.67 and 0.73) in PMA assessment was good. CONCLUSIONS: PMA variation in BC young patients, directly estimated on breast MRI, could be a potential tool to monitor body composition during NAC with potential implications in improving outcome.

The value of coronal view as a stand-alone assessment in women undergoing automated breast ultrasound.

BACKGROUND: Aim of the study was to evaluate the value of automated breast ultrasound (AUS) in women with dense breast, in terms of reading times, diagnostic performance and interobserver agreement. The assessment of coronal images alone versus the complete multiplanar (MPR) views was evaluated. METHODS: Between August and October 2017, consecutive patients with dense breast that were referred to our Institute, for post-mammography ultrasound assessment, pre-operative assessment or follow-up of known benign lesions, were invited to undergo an additional study with AUS. Three radiologists, (5, 15 and 25 years of experience in breast imaging), reviewed the exams twice: first assessing reconstructed coronal images alone, second the complete MPR views. Reading times, diagnostic performance and interobserver agreement were assessed. RESULTS: One hundred eighty-eight women were included, for a total of 67 breast lesions, 25 (37%) malignant and 42 (63%) benign. Compared to MPR, coronal view was associated with: lower reading times, respectively, for the three readers: 83 ± 37, 84 ± 43 and 76 ± 30 versus 163 ± 109, 131 ± 57, 151 ± 42 s (p < 0.035); lower sensitivity: 44.8%, 62.1%, 55.2% versus 69.0% (p = 0.059), 65.5% (p = 0.063), 72.4% (p = 0.076), respectively; better specificity: 94.1%, 93.7%, 94.2% versus 89.5% (p = 0.093), 87.4% (p = 0.002), 91.6% (p = 0.383), respectively. Agreement between the most and the least experienced reader was fair to moderate for categorical variables and significant for continuous ones. CONCLUSION: The coronal view allows significantly lower reading times, a valuable feature in the screening setting, but its diagnostic performance makes the complete multiplanar assessment mandatory.

Muscle mass loss after neoadjuvant chemotherapy in breast cancer: estimation on breast magnetic resonance imaging using pectoralis muscle area.

OBJECTIVES: The loss of skeletal muscle mass is widely considered a predictor of poor survival and toxicity in breast cancer patients. The aim of this study is to evaluate if there is pectoralis muscle area (PMA) variation, reflecting loss of skeletal muscle mass, on consecutive MRI examinations after neoadjuvant chemotherapy. METHODS: The retrospective study protocol was approved by our institutional review board. A total of n = 110 consecutive patients (mean age 56 ± 11 years) who were treated with neoadjuvant chemotherapy (NAC) for histologically proven primary breast cancer between January 2017 and January 2019 and in whom tumor response was checked with standard breast MRI were included. Two radiologists calculated the pectoralis muscle cross-sectional area before and after NAC. RESULTS: Time between the MRI examinations, before starting NAC and after completing NAC, was 166.8 ± 50 days. PMA calculated pre-NAC (8.14 cm2) was larger than PMA calculated post-NAC (7.03 cm2) (p < 0.001). According to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria, there were no significant differences between responders (complete or partial response) and non-responders (p = 0.362). The multivariate regression analysis did not show any significant relationships between ΔPMA and age, time between MRI exams, estrogen and progesterone receptor status, human epidermal growth factor receptor status (HER-2), Ki-67 expression, lymph node status, RECIST criteria, histological type, average lesion size, molecular categories, and grade. Inter-reader (k = 0.72) and intra-reader agreement (0.69 and 0.71) in PMA assessment were good. CONCLUSIONS: Pectoralis muscle mass varies in breast cancer patients undergoing NAC and this difference can be estimated directly on standard breast MRI. KEY POINTS: • Pectoralis muscle area variation reflects loss of skeletal muscle mass. • Pectoralis muscle area on MRI is reduced after NAC. • Pectoralis muscle mass loss seems independent from other variables.

Comparison between execution and reading time of 3D ABUS versus HHUS.

BACKGROUND: Breast density is an independent risk factor for breast cancer. Mammography is supplemented with handheld ultrasound (HHUS) to increase sensitivity. Automatic breast ultrasound (ABUS) is an alternative to HHUS. Our study wanted to assess the difference in execution and reading time between ABUS and HHUS. METHODS AND MATERIALS: N = 221 women were evaluated consecutively between January 2019 and June 2019 (average age 53 years; range 24-89). The execution and reading time of ABUS and HHUS was calculated with an available stopwatch. Time started for both procedures when the patient was ready on the examination table to be examined to the end of image acquisition and interpretation. RESULTS: No patients interrupted the exam due to pain or discomfort. N = 221 women underwent ABUS and HHUS; N = 11 patients refused to undergo both procedures due to time constraints and refused ABUS; therefore, 210 patients were enrolled with both ABUS and HHUS available. The average time to perform and read the exam was 5 min for HHUS (DS ± 1.5) with a maximum time of 11 min and a minimum of 2 min. The average time with ABUS was 17 min (DS ± 3.8, with a maximum time of 31 min and a minimum time of 9 min). The ABUS technique took longer to be performed in all patients, with an average difference of 11 min (range 3-23 min) per patient, P < 0,001. Separating ABUS execution from reading time we highlighted as ABUS execution is more time-consuming respect HHUS. In addition, we can underline that time required by radiologists is longer for ABUS even only considering the interpretation time of the exam. CONCLUSION: A significant difference was observed in the execution and reading time of the two exams, where the HHUS method was more rapid and tolerated.

Influence of Breast Density on Patient's Compliance during Ultrasound Examination: Conventional Handheld Breast Ultrasound Compared to Automated Breast Ultrasound.

BACKGROUND: Our aim was to study the influence of breast density on patient's compliance during conventional handheld breast ultrasound (US) or automated breast US (ABUS), which could be used as adjunct screening modalities. METHODS: Between January 2019 and June 2019, 221 patients (mean age: 53; age range: 24-89 years) underwent both US and ABUS. All participants had independently interpreted US and ABUS regarding patient compliance. The diagnostic experience with US or ABUS was described with a modified testing morbidity index (TMI). The scale ranged from 0 (worst possible experience) to 5 (acceptable experience). Standard statistics was used to compare the data of US and data of ABUS. Breast density was recorded with the Breast Imaging Reporting and Data System (BI-RADS) score. RESULTS: The mean TMI score was 4.6 ± 0.5 for US and 4.3 ± 0.8 for ABUS. The overall difference between patients' experience on US and ABUS was statistically significant with P < 0.0001. The difference between patients' experience on US and ABUS in women with BI-RADS C and D for breast density was statistically significant with P < 0.02 in favor of US (4.7 ± 0.4) versus 4.5 ± 0.6 for ABUS. Patients' experience with breast density B was better for US (4.7 ± 0.4) versus 4.3 ± 0.6 for ABUS with P < 0.01. Pain or discomfort occurred during testing, especially in patients >40 years. CONCLUSION: Patient age (>40 years) is a significant predictor of decreased compliance to ABUS. Compliance of ABUS resulted lower that of US independently for breast density.

Is 9-G DBT-Guided Vacuum-Assisted Breast Biopsy Sufficient to Completely Remove T1 Breast Cancers (below 20 mm)? Analysis of 146 Patients with Histology as Reference Standard.

Objectives: Vacuum-assisted breast biopsy (VABB) is a safe procedure comparable to surgical biopsy for the characterization of distortions, microcalcifications, and mass lesions. Vacuum-assisted excision of T1 breast tumors could be on potential management in alternative to surgery. The primary objective of this work was to assess the therapeutic success of the stereotaxic vacuum breast biopsy in small breast cancer (T1N0M0) lesions excision. Methods: From our electronic database, all the vacuum breast biopsies performed from January 1, 2015, to December 1, 2019, have been retrospectively reevaluated. N = 2,200 cases were identified and n = 145 ensured "mammographic complete removal" at the end of vacuum-assisted excision treatment and were considered for analysis. Surgical gold standard was used. Results: N = 143 procedures were successfully completed with complete removal of mammographic calcifications. The mean size of the lesions completely excised with VABB was 8.9 ± 3.6 mm (range, 3-23 mm). Lesions below 10 mm were n = 118 and lesion with diameter >10 mm were n = 28. N = 3/146 cases (4.4%), relapses were observed in follow-up (at 12-24 up to a maximum of 60 months): the mean size of relapsed lesions completely excised was 3.6 ± 2.1 mm (range, 2-6 mm). No relapse before 12 months were observed. The mean size of the lesions in these patients with relapse at the time of the first VABB procedures was 13 ± 6.5 mm (range, 7-12 mm). N = 117/118 (99%) lesions excised using VABB without relapse after 1 year of follow-up had a diameter below 10 mm. Conclusions: Vacuum breast biopsy could safely remove small breast cancers (T1N0M0) with few relapses.

A Prospective Comparative Evaluation of Handheld Ultrasound Examination (HHUS) or Automated Ultrasound Examination (ABVS) in Women with Dense Breast.

Mammography is the gold standard examination for breast cancer screening. In women with high breast density, mammography has reduced sensitivity. In these women, an additional screening option is often recommended. This study prospectively compared ABVS and HHUS in women with mammography-negative examinations and dense breasts. Materials and methods: N = 222 women were evaluated prospectively and consecutively between January 2019 and June 2019 (average age 53 years; range 39−89). McNemar's test and ROC analysis were used with standard statistical software. We included in the study both symptomatic and asymptomatic women with dense breasts. Women included underwent both HHUS and ABVS after mammography with independent reading. Results: N = 33/222 (15%) women resulted in having breast cancer. Both ABVS and HHUS identified more cancers than standard mammography, and both HHUS and ABVS had false-positive examinations: n = 13 for HHUS and n = 12 for ABVS. We found that HHUS had better accuracy than ABVS. The AUC of the ROC was 0.788 (95% CI 0.687−0.890) for ABVS and 0.930 (95% CI 0.868−0.993) for HHUS. This difference was statistically significant (p < 0.05). Conclusions: HHUS was more accurate in breast cancer detection than ABVS. Multicentric studies must confirm these data for supplemental imaging in women with dense breasts.

Myeloma Spine and Bone Damage Score (MSBDS) on Whole-Body Computed Tomography (WBCT): Multiple Reader Agreement in a Multicenter Reliability Study.

Objective: To assess the reliability of the myeloma spine and bone damage score (MSBDS) across multiple readers with different levels of expertise and from different institutions. Methods: A reliability exercise, including 104 data sets of static images and complete CT examinations of patients affected by multiple myeloma (MM), was performed. A complementary imaging atlas provided detailed examples of the MSBDS scores, including low-risk and high-risk lesions. A total of 15 readers testing the MSBDS were evaluated. ICC estimates and their 95% confidence intervals were calculated based on mean rating (k = 15), absolute agreement, a two-way random-effects model and Cronbach's alpha. Results: Overall, the ICC correlation coefficient was 0.87 (95% confidence interval: 0.79-0.92), and the Cronbach's alpha was 0.93 (95% confidence interval: 0.94-0.97). Global inter- and intra-observer agreement among the 15 readers with scores below or equal to 6 points and scores above 6 points were 0.81 (95% C.I.: 0.72-0.86) and 0.94 (95% C.I.:0.91-0.98), respectively. Conclusion: We present a consensus-based semiquantitative scoring systems for CT in MM with a complementary CT imaging atlas including detailed examples of relevant scoring techniques. We found substantial agreement among readers with different levels of experience, thereby supporting the role of the MSBDS for possible large-scale applications. Significance and Innovations • Based on previous work and definitions of the MSBDS, we present real-life reliability data for quantitative bone damage assessment in multiple myeloma (MM) patients on CT. • In this study, reliability for the MSBDS, which was tested on 15 readers with different levels of expertise and from different institutions, was shown to be moderate to excellent. • The complementary CT imaging atlas is expected to enhance unified interpretations of the MSBDS between different professionals dealing with MM patients in their routine clinical practice.