Microcalcifications and Peritumoral Edema Predict Survival Outcome in Luminal Breast Cancer Treated with Neoadjuvant Chemotherapy.

Background Little is known regarding findings at imaging associated with survival in patients with luminal breast cancer treated with neoadjuvant chemotherapy (NAC). Purpose To determine the relationship between imaging (MRI, US, and mammography) and clinical-pathologic variables in predicting distant metastasis-free survival (DMFS) and overall survival (OS) in patients with luminal breast cancer treated with NAC. Materials and Methods In this retrospective study, consecutive women with luminal breast cancer who underwent NAC followed by surgery were identified from the breast cancer registries of two hospitals. Women from one hospital between January 2003 and July 2015 were classified into the development cohort, and women from the other hospital between January 2007 and July 2015 were classified into the validation cohort. MRI scans, US scans, and mammograms before and after NAC (hereafter, referred to as pre- and post-NAC, respectively) and clinical-pathologic data were reviewed. Peritumoral edema was defined as the water-like high signal intensity surrounding the tumor on T2-weighted MRI scans. The prediction model was developed in the development cohort by using Cox regression and then tested in the validation cohort. Results The development cohort consisted of 318 women (68 distant metastases, 54 deaths) and the validation cohort consisted of 165 women (37 distant metastases, 14 deaths) (median age, 46 years in both cohorts). Post-NAC MRI peritumoral edema, age younger than 40 years, clinical N2 or N3, and lymphovascular invasion were associated with worse DMFS (all, P < .05). Pre-NAC mammographic microcalcifications, post-NAC MRI peritumoral edema, age older than 60 years, and clinical T3 or T4 were associated with worse OS (all, P < .05). The prediction model showed good discrimination ability (C index, 0.67-0.75 for DMFS and 0.70-0.77 for OS) and stratified prognosis into low-risk and high-risk groups (10-year DMFS rates, 79% vs 21%, respectively; and 10-year OS rates, 95%-96% vs 63%-67%, respectively) in the validation cohort. Conclusion MRI features and clinical-pathologic variables were identified that were associated with prolonged survival of patients with luminal breast cancer treated with neoadjuvant chemotherapy. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Kataoka in this issue.

External validation and modification of nomogram for predicting positive resection margins before breast conserving surgery.

PURPOSE: A positive resection margin after breast conserving surgery (BCS) is the most important risk factor for tumor recurrence. In 2012, Seoul National University Hospital (SNUH) breast surgery team developed a nomogram for predicting positive resection margins before BCS to provide individual surgical plans that could reduce local recurrence without increasing re-excision rates. The purpose of this study was to validate this nomogram using an external cohort and to test if addition of surgeon-related factor could improve its use as a predictive model. METHODS: A total of 419 patients with breast cancer who underwent BCS from January to December 2018 were retrospectively reviewed. Using the SNUH BCS nomogram, risk score for positive resection margins was calculated for 343 patients. The predictive accuracy of the nomogram was assessed, and multivariable logistic regression analyses were performed to evaluate the nomogram's predictive variables. RESULTS: The positive resection margin rate of the current external validation cohort was 13.5% (46 out of 343), compared to 14.6% (151 out of 1034) of the original study. The discrimination power of the SNUH BCS nomogram as measure by area under the receiver operating characteristics curve (AUC) was 0.656 [95% confidence interval (CI) 0.576-0.735]. This result is lower than expected value of 0.823 [95% CI 0.785-0.862], the AUC of the original study. Multivariable logistic regression analysis showed that, among the five nomogram variables, presence of tumor size discrepancy greater than 0.5 cm between MRI and ultrasonography (OR 2.445, p = 0.019) and presence of ductal carcinoma in situ on needle biopsy (OR 2.066, p = 0.048) were significantly associated with positive resection margins. Finally, the nomogram score was re-calculated by adding each surgeon's resection margin positive rate as odds ratio and the AUC was increased to 0.733. CONCLUSIONS: Validation of the SNUH BCS nomogram was not successful in the current study as much as its original publication. However, we could improve its predictive power by including surgeon-related factor. Before applying a published nomogram as a preoperative predictive model, we suggest each institution to validate the model and adjust it with surgeon-related factor. Addition of new factors to currently available nomograms holds promise for improving its applicability for breast cancer patients at the actual clinical level.

Benign Breast Papilloma without Atypia: Outcomes of Surgical Excision versus US-guided Directional Vacuum-assisted Removal or US Follow-up.

Background Recent studies suggest that US-guided directional vacuum-assisted removal (DVAR) is a satisfactory alternative to surgery for benign papilloma of the breast and recommend discretionary diagnostic US follow-up without intervention. Purpose To compare the outcomes of benign papilloma without atypia diagnosed with core needle biopsy (CNB) in patients who underwent US-guided DVAR, US follow-up without intervention, or surgery. Materials and Methods This retrospective review included consecutive patients with benign papilloma without atypia diagnosed with US-guided CNB between January 2005 and September 2015. Five hundred female patients who underwent surgical excision (n = 206), US-guided DVAR (n = 233), or more than 2 years of US follow-up without intervention (n = 61) were included. The clinical and radiologic findings and cancer upgrade rate were compared among the three groups. Propensity score matching was performed for comparison of the upgrade rate in the surgery and US-guided DVAR groups. Results The mean patient age (±standard deviation) was 46.4 years ± 9.6. The upgrade rate to malignancy was 1.8% (nine of 500 patients; 95% confidence interval [CI]: 0.9%, 3.4%) in the total study population, 1.9% (four of 206 patients; 95% CI: 0.8%, 4.9%) after surgery, 2.1% (five of 233 patients; 95% CI: 0.9%, 4.9%) after US-guided DVAR, and 0% (0 of 61 patients; 95% CI: 0.0%, 5.9%) after US follow-up without intervention (P = .80); after propensity-score matching, the upgrade rate was 1.9% in the surgery group (three of 151 patients; 95% CI: 0.6%, 5.6%) and 3.3% in the US-guided DVAR group (five of 151 patients; 95% CI: 1.4%, 7.5%; P = .48). The recurrence rate after US-guided DVAR was 3.6% (six of 166 patients) during 24-65 months of follow-up; all recurrences were confirmed as benign at subsequent surgery. Fifty-nine of the 61 lesions in the group with US follow-up without intervention (97%) remained stable in size with no growth during a mean follow-up of 43.3 months (range, 25-130 months). Conclusion Low rates of upgrade, recurrence, and growth after US-guided directional vacuum-assisted removal and US follow-up without intervention suggest that benign papilloma without atypia can be managed more conservatively rather than undergoing surgical excision. © RSNA, 2019 Online supplemental material is available for this article.

Comparison of the Diagnostic Performance of Synthetic Versus Acquired High b-Value (1500 s/mm2 ) Diffusion-Weighted MRI in Women With Breast Cancers.

BACKGROUND: Acquired high b-value (>1000 s/mm2 ) diffusion-weighted imaging (DWI) has its strength in lesion detection. However, it is not easily used, due to a lower signal-to-noise ratio, eddy current distortions, and prolonged acquisition times. Synthetic DWI does not have these disadvantages because it is based on indirect acquisition, calculated in a voxel-wise manner. PURPOSE: To compare the diagnostic performance of synthetic and acquired high b-value (1500 s/mm2 ) DWI in women with breast cancer. STUDY TYPE: Retrospective. POPULATION: A total of 108 patients (median age 49 years [range 32-77]) with 133 breast cancers. FIELD STRENGTH/SEQUENCE: 3T, echo-planar imaging. ASSESSMENT: Three radiologists independently reviewed image sets of both synthetic (S-b1500) and acquired (A-b1500) high b-value DWI. Malignancy confidence of the lesion was scored using a 6-point Likert-type scale. STATISTICAL TEST: Jack-knife alternative free-response receiver-operating characteristic 1 (JAFROC1) analysis was used. Sensitivity and positive predictive value (PPV) were compared using generalized estimating equations. An independent t-test was used to compare the confidence. An intraclass correlation coefficient was calculated to compare interobserver agreement. RESULTS: The JAFROC1 figures of merit values were 0.816 and 0.808 in S-b1500 and A-b1500, respectively, with no statistically significant difference (P = 0.637). Sensitivity was higher in synthetic than in A-b1500 for readers 2 (P = 0.015) and 3 (P = 0.037). Although sensitivity was higher in S-b1500 than in A-b1500 for reader 1, the difference was not significant (P = 0.487). The PPV of S-b1500 was not significantly different from that of A-b1500 (P = 0.397). The malignancy confidence of true-positive tumors was higher in S-b1500 than in A-b1500 (P = 0.013). Interobserver agreement was good for both sequences. DATA CONCLUSIONS: The synthetic high b-value DWI may improve the diagnostic sensitivity for breast cancer detection without affecting PPV compared with acquired high b-value DWI. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:857-863.

Perception of indoor air quality (IAQ) by workers in underground shopping centers in relation to sick-building syndrome (SBS) and store type: a cross-sectional study in Korea.

BACKGROUND: We examined the indoor air quality (IAQ) perceptions of workers and their relationships with the symptoms of sick-building syndrome (SBS) and store types in underground shopping centers. METHODS: In 2017, 314 store workers in nine underground shopping centers in Seoul, Korea, were assessed. The all participants' stores were partially opened onto a passage. Using questionnaires, they were asked about their demographics, job characteristics, 16 SBS symptoms, and seven IAQ perceptions. The SBS symptoms were categorized as skin, eye irritation, respiratory, or general. An IAQ perception score was calculated by adding the number of positive responses to each type of IAQ and categorized into three levels. RESULTS: The prevalence of SBS symptom groups in the previous month was 43.6% for skin symptoms, 62.4% for eye irritation symptoms, 65.6% for respiratory symptoms, and 64.7% for general symptoms. Participants who perceived IAQ were more likely to have SBS symptoms (odds ratio: 1.81-7.84). The type of store employing the workers was associated with several IAQ perceptions. Subjects who worked in clothing and fashion-accessory stores were more likely to have high IAQ perception scores than those who worked in food services. CONCLUSIONS: About half of the store workers in underground shopping centers had experienced SBS symptom groups in the previous month. The SBS symptom groups were associated with almost all IAQ perceptions. Because IAQ perception was associated with store type, studies of IAQ in working areas might need to improve store workers' health in underground shopping centers.

Predictors of Invasive Breast Cancer in Patients With Ductal Carcinoma In Situ in Ultrasound-Guided Core Needle Biopsy.

OBJECTIVES: To determine predictors of invasiveness of lesions with US-guided biopsy-confirmed ductal carcinoma in situ (DCIS), focusing on US features, including shear wave elastography (SWE). METHODS: From January 2015 to September 2016, a total of 80 lesions with US-guided biopsy-confirmed DCIS were detected in patients who underwent preoperative mammography, B-mode US, and SWE. Data were retrospectively reviewed from clinical records, pathologic reports, and imaging assessments. Imaging data included mammographic findings, B-mode US findings based on the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS), and the mean and maximum elasticity values on SWE. The final BI-RADS assessment, including the degree of elasticity of the mass, was evaluated. Continuous variables were examined by an independent t test, and categorical variables were examined by the Fisher exact test. The independent factors for predicting a histologic upgrade were evaluated by a multivariate logistic regression analysis. RESULTS: Among the 80 lesions, 27 (33.8%) showed an invasive component after surgical excision. None of the BI-RADS US descriptors, which include shape, orientation, margin, and echogenicity, showed a significant correlation with the rate of a histologic upgrade to invasive cancer. However, the BI-RADS assessment category (P = .015) and nuclear grade (P = .005) were significantly correlated with invasiveness of the mass. The maximum stiffness value was lower in the pure DCIS group (119.04 vs 85.33 kPa; P = .041). CONCLUSIONS: The BI-RADS category based on US findings, maximum stiffness value on SWE, and nuclear grade of DCIS are predictive of invasive components in DCIS.

Usefulness of preoperative breast magnetic resonance imaging with a dedicated axillary sequence for the detection of axillary lymph node metastasis in patients with early ductal breast cancer.

OBJECTIVE: Axillary staging of primary breast cancer is important; however, axillary staging using advanced magnetic resonance imaging (MRI) techniques is very difficult to use. Therefore, we want to evaluate the diagnostic performance of preoperative MRI with a dedicated axillary sequence for axillary lymph node (ALN) metastasis in patients with early ductal breast cancer and determine potential predictors of axillary nodal positivity. MATERIALS AND METHODS: We retrospectively reviewed the MRI findings for 74 consecutive patients diagnosed with invasive breast cancer. The diagnostic performances of axial images alone and axial + reconstructed coronal images for the detection of ALN metastasis were evaluated. The clinicopathological and MRI features of the primary breast cancer lesions were determined. RESULTS: The sensitivity (52.9% vs. 47.1%), specificity (89.5% vs. 71.9%), positive predictive value (60% vs. 33.3%), and negative predictive value (86.4% vs. 82%) for the preoperative detection of ALN metastasis were higher for axial + coronal images than for axial images. In addition, the area under the receiver operating characteristic curve value was higher for axial + coronal images than for axial images (0.595 vs. 0.712, p = 0.043). Peritumoral high signal intensity on T2-weighted images (p = 0.015) of the primary tumor was significantly associated with ALN metastasis. CONCLUSION: Our findings suggest that preoperative axial + reconstructed coronal MR images exhibit good diagnostic performance for ALN metastasis in patients with early ductal breast cancer. In addition, peritumoral high signal intensity on T2-weighted images of the primary tumor can be used as a predictor of ALN metastasis in these patients.

Reliability of Computer-Assisted Breast Density Estimation: Comparison of Interactive Thresholding, Semiautomated, and Fully Automated Methods.

OBJECTIVE: The purpose of this study was to investigate the reliability of computer-assisted methods of estimating breast density. MATERIALS AND METHODS: Craniocaudal mammograms of 100 healthy subjects were collected from a screening mammography database. Three expert readers independently assessed mammographic breast density twice in a 1-month period using interactive thresholding and semiautomated methods. In addition, fully automated breast density estimation software was used to generate objective breast density estimates. The reliability of the computer-assisted breast density estimation was assessed in terms of concordance correlation coefficients, limits of agreement, systematic difference, and reader variability. RESULTS: Statistically significant systematic bias (paired t test, p < 0.01) and variability (4.75-10.91) were found within and between readers for both the interactive thresholding and the semiautomated methods. Using the semiautomated method significantly reduced the within-reader bias of one reader (p < 0.02) and the between-reader variability of all three readers (p < 0.05). The breast density estimates obtained with the fully automated method had excellent agreement with those of the reference standard (concordance correlation coefficient, 0.93) without a significant systematic difference. CONCLUSION: Reader-dependent variability and systematic bias exist in breast density estimates obtained with the interactive thresholding method, but they may be reduced in part by use of the semiautomated method. Assessing reader performance may be necessary for more reliable breast density estimation, especially for surveillance of breast density over time. The fully automated method has the potential to provide reliable breast density estimates nearly free from reader-dependent systematic bias and reader variability.

Does adding diffuse optical tomography to sonography improve differentiation between benign and malignant breast lesions? Observer performance study.

OBJECTIVES: The purpose of this study was to investigate the added value of diffuse optical tomographic categories combined with conventional sonography for differentiating between benign and malignant breast lesions. METHODS: In this retrospective database review, we included 145 breast lesions (116 benign and 29 malignant) from 145 women (mean age, 46 years; range, 16-86 years). Five radiologists independently reviewed sonograms with and without a diffuse optical tomographic category. Each lesion was scored on a scale of 0% to 100% for suspicion of malignancy and rated according to the American College of Radiology Breast Imaging Reporting and Data System classification. Diagnostic performance was analyzed by comparing area under receiver operating characteristic curve values. Reader agreement was assessed by intraclass correlation coefficients. RESULTS: In the multireader multicase receiver operating characteristic analysis, adding a diffuse optical tomographic category to sonography improved the diagnostic accuracy of sonography (mean areas under the curve, 0.923 for sonography alone and 0.969 for sonography with diffuse optical tomography; P = .039). The interobserver correlation was also improved (0.798 for sonography alone and 0.904 for sonography with diffuse optical tomography). The specificity increased for 4 reviewers from a mean of 19.5% to 45.8% (P < .001 for reviewers 1-4; P = .238 for reviewer 5) with no significant change in the sensitivity. When the diffuse optical tomographic category was applied strictly, the specificity increased for all reviewers from a mean of 19.5% to 68.3% (P < .001 for all reviewers) with no significant change in the sensitivity. CONCLUSIONS: The addition of diffuse optical tomographic categories to sonography may improve diagnostic performance and markedly decrease false-positive biopsy recommendations.

Reproducibility of Apparent Diffusion Coefficient Measurements in Malignant Breast Masses.

This study aimed to evaluate the reproducibility of apparent diffusion coefficient (ADC) measurements in malignant breast masses, and to determine the influence of mammographic parenchymal density on this reproducibility. Sixty-six patients with magnetic resonance findings of the mass were included. Two breast radiologists measured the ADC of the malignant breast mass and the same area on the contralateral normal breast in each patient twice. The effects of mammographic parenchymal density, histology, and lesion size on reproducibility were also assessed. There was no significant difference in the mean ADC between repeated measurements in malignant breast masses and normal breast tissue. The overall reproducibility of ADC measurements was good in both. The 95% limits of agreement for repeated ADCs were approximately 30.2%-33.4% of the mean. ADC measurements in malignant breast masses were highly reproducible irrespective of mass size, histologic subtype, or coexistence of microcalcifications; however, the measurements tended to be less reproducible in malignant breast masses with extremely dense parenchymal backgrounds. ADC measurements in malignant breast masses are highly reproducible; however, mammographic parenchymal density can potentially influence this reproducibility.

Clinical and radiologic features of neuroendocrine breast carcinomas.

Neuroendocrine breast carcinoma is a rare and distinct type of breast carcinoma, with morphologic features similar to those of pulmonary and gastrointestinal tract neuroendocrine tumors. More than 50% of cells express neuroendocrine markers. We documented the clinical and radiologic features of 11 patients with histologically confirmed neuroendocrine breast carcinomas. Clinical manifestations included nipple discharge (6 patients) and palpable masses (5 patients). Lesions were mainly oval or irregular on mammography (n = 8), sonography (n = 11), and magnetic resonance imaging (n = 9). Understanding the clinical and radiologic features of neuroendocrine breast carcinoma will facilitate the differential diagnosis.

Health-Related Quality of Life of Post-Stroke Patients in a Public Hospital.

This study aimed to identify the correlation between influencing factors of activities of daily living (ADLs), mental health, and health-related quality of life (HRQoL) among post-stroke patients who enrolled in a transitional care service in a public hospital. This cross-sectional study involved 67 stroke patients who were enrolled in a transitional care service and visited the outpatient clinic at a public hospital in Seoul between March and December 2022. Their general characteristics, ADLs, mental health, and HRQoL were assessed. The data were analyzed using independent samples t-tests, analysis of variance, and Pearson correlation analysis, and the influencing factors were analyzed using regression analysis. HRQoL showed a statistically significant difference between patients living in different types of arrangements (t = 2.50, p = 0.015), and patients scores on the modified Rankin Scale (t = 7.08, p < 0.001). HRQoL was also significantly correlated with ADLs and mental health in stroke patients (r = -0.59, p < 0.001; r = -0.41, p < 0.001, respectively). Meanwhile, stroke severity (ß = -0.30, p = 0.002), living arrangements (ß = -0.30, p = 0.009) and ADLs (ß = -0.45, p < 0.001) were found to influence HRQoL (F = 6.87, p < 0.001, R2 = 0.47). Reduced dependence for ADLs, improvements in symptoms consequent to stroke, and support related to living arrangements contributed to improved HRQoL and interventions for post-stroke patients in the transitional care service of a public hospital.

Concordance of HER2 status between core needle biopsy and surgical resection specimens of breast cancer: an analysis focusing on the HER2-low status.

BACKGROUND: Human epidermal growth factor receptor 2 (HER2)-low status has recently gained attention because of the potential therapeutic benefits of antibody-drug conjugates (ADCs) in breast cancer patients. We aimed to investigate the concordance of HER2 status between core needle biopsy (CNB) and subsequent surgical resection specimens focusing on the HER2-low status. METHODS: This retrospective study was conducted in 1,387 patients with invasive breast cancer whose HER2 status was evaluated in both CNB and surgical resection specimens. The discordance rates between CNB and surgical resection specimens and the clinicopathological features associated with HER2 status discordance were analyzed. RESULTS: The overall concordance rates of HER2 status between CNB and surgical resection specimens were 99.0% (κ = 0.925) for two-group classification (negative vs. positive) and 78.5% (κ = 0.587) for three-group classification (zero vs. low vs. positive). The largest discordance occurred in CNB-HER2-zero cases with 42.8% of them reclassified as HER2-low in surgical resection. HER2 discordance was associated with lower histologic grade, tumor multiplicity, and luminal A subtype. In multivariate analysis, tumor multiplicity and estrogen receptor (ER) positivity were independent predictive factors for HER2-zero to low conversion. CONCLUSIONS: Incorporation of HER2-low category in HER2 status interpretation reduces the concordance rate between CNB and surgical resection specimens. Tumor multiplicity and ER positivity are predictive factors for conversion from HER2-zero to HER2-low status. Therefore, HER2 status should be re-evaluated in resection specimens when considering ADCs in tumors exhibiting multiplicity and ER positivity.

Background Breast Parenchymal Signal During Menstrual Cycle on Diffusion-Weighted MRI: A Prospective Study in Healthy Premenopausal Women.

OBJECTIVE: To prospectively investigate the influence of the menstrual cycle on the background parenchymal signal (BPS) and apparent diffusion coefficient (ADC) of the breast on diffusion-weighted MRI (DW-MRI) in healthy premenopausal women. MATERIALS AND METHODS: Seven healthy premenopausal women (median age, 37 years; range, 33-49 years) with regular menstrual cycles participated in this study. DW-MRI was performed during each of the four phases of the menstrual cycle (four examinations in total). Three radiologists independently assessed the BPS visual grade on images with b-values of 800 sec/mm² (b800), 1200 sec/mm² (b1200), and a synthetic 1500 sec/mm² (sb1500). Additionally, one radiologist conducted a quantitative analysis to measure the BPS volume (%) and ADC values of the BPS (ADCBPS) and fibroglandular tissue (ADCFGT). Changes in the visual grade, BPS volume (%), ADCBPS, and ADCFGT during the menstrual cycle were descriptively analyzed. RESULTS: The visual grade of BPS in seven women varied from mild to marked on b800 and from minimal to moderate on b1200 and sb1500. As the b-value increased, the visual grade of BPS decreased. On b800 and sb1500, two of the seven volunteers showed the highest visual grade in the early follicular phase (EFP). On b1200, three of the seven volunteers showed the highest visual grades in EFP. The BPS volume (%) on b800 and b1200 showed the highest value in three of the six volunteers with dense breasts in EFP. Three of the seven volunteers showed the lowest ADCBPS in the EFP. Four of the seven volunteers showed the highest ADCBPS in the early luteal phase (ELP) and the lowest ADCFGT in the late follicular phase (LFP). CONCLUSION: Most volunteers did not exhibit specific BPS patterns during their menstrual cycles. However, the highest BPS and lowest ADCBPS were more frequently observed in EFP than in the other menstrual cycle phases, whereas the highest ADCBPS was more common in ELP. The lowest ADCFGT was more frequent in LFP.

Automated Versus Handheld Breast Ultrasound for Evaluating Axillary Lymph Nodes in Patients With Breast Cancer.

OBJECTIVE: Automated breast ultrasound (ABUS) is a relevant imaging technique for early breast cancer diagnosis and is increasingly being used as a supplementary tool for mammography. This study compared the performance of ABUS and handheld ultrasound (HHUS) in detecting and characterizing the axillary lymph nodes (LNs) in patients with breast cancer. MATERIALS AND METHODS: We retrospectively reviewed the medical records of women with recently diagnosed early breast cancer (≤ T2) who underwent both ABUS and HHUS examinations for axilla (September 2017-May 2018). ABUS and HHUS findings were compared using pathological outcomes as reference standards. Diagnostic performance in predicting any axillary LN metastasis and heavy nodal-burden metastases (i.e., ≥ 3 LNs) was evaluated. The ABUS-HHUS agreement for visibility and US findings was calculated. RESULTS: The study included 377 women (53.1 ± 11.1 years). Among 385 breast cancers in 377 patients, 101 had axillary LN metastases and 30 had heavy nodal burden metastases. ABUS identified benign-looking or suspicious axillary LNs (average, 1.4 ± 0.8) in 246 axillae (63.9%, 246/385). According to the per-breast analysis, the sensitivity, specificity, positive and negative predictive values, and accuracy of ABUS in predicting axillary LN metastases were 43.6% (44/101), 95.1% (270/284), 75.9% (44/58), 82.6% (270/327), and 81.6% (314/385), respectively. The corresponding results for HHUS were 41.6% (42/101), 95.1% (270/284), 75.0% (42/56), 82.1% (270/329), and 81.0% (312/385), respectively, which were not significantly different from those of ABUS (P ≥ 0.53). The performance results for heavy nodal-burden metastases were 70.0% (21/30), 89.6% (318/355), 36.2% (21/58), 97.3% (318/327), and 88.1% (339/385), respectively, for ABUS and 66.7% (20/30), 89.9% (319/355), 35.7% (20/56), 97.0% (319/329), and 88.1% (339/385), respectively, for HHUS, also not showing significant difference (P ≥ 0.57). The ABUS-HHUS agreement was 95.9% (236/246; Cohen's kappa = 0.883). CONCLUSION: Although ABUS showed limited sensitivity in diagnosing axillary LN metastasis in early breast cancer, it was still useful as the performance was comparable to that of HHUS.

Comparison of sonography with sonographically guided fine-needle aspiration biopsy and core-needle biopsy for initial axillary staging of breast cancer.

OBJECTIVES: The purpose of this study was to determine the roles of sonography and sonographically guided fine-needle aspiration biopsy and core-needle biopsy for initial axillary staging of breast cancer. METHODS: Of 220 patients with breast cancer who underwent preoperative or prechemotherapy sonography for axillary staging, 52 patients who underwent sonographically guided fine-needle aspiration biopsy and core-needle biopsy for cortical thickening or a compressed hilum of lymph nodes on sonography were prospectively enrolled. Sonography and fine-needle aspiration biopsy/core-needle biopsy findings were compared with final pathologic results from sentinel lymph node biopsy or axillary lymph node dissection. RESULTS: Forty-eight patients met the final study criteria; we excluded 4 who had received primary systemic chemotherapy and showed negative fine-needle aspiration biopsy/core-needle biopsy results and negative final postoperative pathologic results. The positive predictive value of axillary sonography was 54%. The sensitivity and specificity of fine-needle aspiration biopsy were 73% and 100%, respectively, and those of core-needle biopsy were 77% and 100%. Results did not differ significantly between sonographically guided core-needle biopsy and fine-needle aspiration biopsy. The complication rates of fine-needle aspiration biopsy and core-needle biopsy were both 4%, and fine-needle aspiration biopsy and core-needle biopsy cost $180 and $350, respectively. CONCLUSIONS: Both sonographically guided fine-needle aspiration biopsy and core-needle biopsy were useful for axillary staging of breast cancer with high sensitivity. However, fine-needle aspiration biopsy is recommended based on the advantages of low cost and minimal invasiveness.

Effect of Household Type on the Prevalence of Climacteric Syndrome among Middle-Aged Men.

Research on climacteric syndrome among middle-aged men remains scant compared to the research among women. Research is also lacking on climacteric syndrome among older adults living alone, particularly men, who are more vulnerable than females living alone. This cross-sectional study investigated whether the prevalence of climacteric syndrome is associated with the type of household middle-aged men live in and identified the determinants of climacteric syndrome based on the household type. Six hundred middle-aged men living in multi-person households and six hundred living alone were surveyed about general characteristics, diet-related factors, and climacteric syndrome. Data were analyzed using Pearson's chi-squared test, Fisher's exact test, and logistic regression. The risk of climacteric syndrome in single-person households was found to be 1.6 times higher than that among multi-person households (p = 0.006). In multi-person households, income and breakfast frequency predicted climacteric syndrome (p < 0.05), while age, breakfast frequency, dinner frequency, and weekly eating out frequency predicted climacteric syndrome in single-person households (p < 0.05). Thus, dietary factors are more closely linked to the prevalence of climacteric syndrome in single-person households than in multi-person households. This highlights the need for climacteric syndrome interventions for middle-aged men, whose health concerns may persist into older adulthood.

Development and External Validation of a Machine Learning Model to Predict Pathological Complete Response After Neoadjuvant Chemotherapy in Breast Cancer.

PURPOSE: Several predictive models have been developed to predict the pathological complete response (pCR) after neoadjuvant chemotherapy (NAC); however, few are broadly applicable owing to radiologic complexity and institution-specific clinical variables, and none have been externally validated. This study aimed to develop and externally validate a machine learning model that predicts pCR after NAC in patients with breast cancer using routinely collected clinical and demographic variables. METHODS: The electronic medical records of patients with advanced breast cancer who underwent NAC before surgical resection between January 2017 and December 2020 were reviewed. Patient data from Seoul National University Bundang Hospital were divided into training and internal validation cohorts. Five machine learning techniques, including gradient boosting machine (GBM), support vector machine, random forest, decision tree, and neural network, were used to build predictive models, and the area under the receiver operating characteristic curve (AUC) was compared to select the best model. Finally, the model was validated using an independent cohort from Seoul National University Hospital. RESULTS: A total of 1,003 patients were included in the study: 287, 71, and 645 in the training, internal validation, and external validation cohorts, respectively. Overall, 36.3% of the patients achieved pCR. Among the five machine learning models, the GBM showed the highest AUC for pCR prediction (AUC, 0.903; 95% confidence interval [CI], 0.833-0.972). External validation confirmed an AUC of 0.833 (95% CI, 0.800-0.865). CONCLUSION: Commonly available clinical and demographic variables were used to develop a machine learning model for predicting pCR following NAC. External validation of the model demonstrated good discrimination power, indicating that routinely collected variables were sufficient to build a good prediction model.

Distinguishing benign from malignant masses at breast US: combined US elastography and color doppler US--influence on radiologist accuracy.

PURPOSE: To investigate the effect of the combined use of ultrasonographic (US) elastography and color Doppler US on the accuracy of radiologists in distinguishing benign from malignant nonpalpable breast masses and in making the decision for biopsy recommendations at B-mode US. MATERIALS AND METHODS: This prospective study was conducted with institutional review board approval; written informed consent was obtained. A cohort of 367 biopsy-proved cases in 319 women (age range, 22-78 years; mean age, 48.6 years) with B-mode US, US elastographic, and Doppler US images was included. Five blinded readers independently scored the likelihood of malignancy for four data sets (ie, B-mode US alone, B-mode US and elastography, B-mode US and Doppler US, and B-mode US, US elastography, and Doppler US). The area under the receiver operating characteristic curve (A(z)) values, sensitivities, and specificities of each data set were compared. RESULTS: The A(z) of B-mode US, US elastography, and Doppler US (average, 0.844; range, 0.797-0.876) was greater than that of B-mode US alone (average, 0.771; range, 0.738-0.798) for all readers (P = .001 for readers 1, 2, and 3; P < .001 for reader 4; P = .002 for reader 5). When both elastography and Doppler scores were negative, leading to strict downgrading, the specificity increased for all readers from an average of 25.3% (75.4 of 298; range, 6.4%-40.9%) to 34.0% (101.2 of 298; range, 26.5%-48.7%) (P < .001 for readers 1, 2, 4, and 5; P = .016 for reader 3) without a significant change in sensitivity. CONCLUSION: Combined use of US elastography and color Doppler US increases both the accuracy in distinguishing benign from malignant masses and the specificity in decision-making for biopsy recommendation at B-mode US.

Differentiating benign from malignant thyroid nodules: comparison of 2- and 3- dimensional sonography.

OBJECTIVES: To compare the diagnostic performance of radiologists and to determine interobserver and intraobserver variability with regard to differentiation of benign and malignant thyroid nodules using prospectively obtained 2-dimensional (2D) and 3-dimensional (3D) sonograms. METHODS: This study had Institutional Review Board approval, and the requirement for patient informed consent was waived. Conventional 2D and 3D sonograms were obtained from 82 patients (age range, 20-77 years; mean age, 51 years) with 91 thyroid nodules (15 cancers, 13 indeterminate, and 63 benign lesions) before diagnostic fine-needle aspiration. Three radiologists reviewed stored 2D and 3D images for internal content, shape, margin, echogenicity, echo texture, and the presence of calcification and estimated the level of suspicion as to the probability of malignancy according to known sonographic criteria. The diagnostic performance of 2D images was compared with that of 3D images. RESULTS: For all readers, interpretation using 3D images was more sensitive and specific than that using 2D images for diagnosis of malignant thyroid nodules, with the exception of specificity for reader 1. However, differences were not statistically significant (P > .05). Area under the receiver operating characteristic curve values were 0.83 for 2D images and 0.92 for 3D images for reader 1; 0.78 for 2D images and 0.89 for 3D images for reader 2; and 0.89 for 2D images and 0.93 for 3D images for reader 3. Interobserver agreement between the 3 radiologists for differentiation of benign and malignant thyroid nodules was better for 3D images (κ = 0.49) than for 2D images (κ = 0.15). Intraobserver variability for nodule descriptions and assessments using 3D and 2D images was fair to moderate. CONCLUSION: The performance of radiologists and interobserver and intraobserver agreement for characterization of thyroid nodules were better when 3D sonograms were used than when 2D sonograms were used.