Change in microcalcifications on mammography after neoadjuvant chemotherapy in breast cancer patients: correlation with tumor response grade and comparison with lesion extent.

BACKGROUND: After neoadjuvant chemotherapy (NAC), persistent microcalcifications are often observed in spite of a decrease in the primary tumor size. PURPOSE: To analyze the changes in microcalcifications after NAC and to evaluate the accuracy of residual microcalcifications in predicting the extent of residual cancer. MATERIAL AND METHODS: Eighty patients who received NAC and underwent both mammography and magnetic resonance imaging (MRI) before and after the completion of NAC were included. The location of microcalcifications was classified into two types: inside the mass and outside the mass. RESULTS: The extent of the residual calcifications was larger than the pathologic residual lesion in 14 (74%) of 19 patients with complete response (CR) on MRI, but the discrepancy was <1 cm in eight (42%) patients. The median value of the discrepancy was significantly higher in patients showing CR with outside calcifications compared to CR with inside calcifications (2.0 cm vs. 0.7 cm, P = 0.008). After NAC, the decrease of calcifications was more frequently observed in cancers showing CR on MRI or Miller-Payne grade 5 and the increase of calcifications more frequently occurred in cancers showing progress disease on MRI or Miller-Payne grade 1 ( P < 0.001 and P = 0.044). CONCLUSION: The change in microcalcifications after NAC was correlated with the tumor response to NAC. The discrepancy was highest in the group showing CR on MRI with outside calcifications. In tumors with inside calcifications, the discrepancy was relatively low within an acceptable range.

Clinical application of whole-genome sequencing of solid tumors for precision oncology.

Genomic alterations in tumors play a pivotal role in determining their clinical trajectory and responsiveness to treatment. Targeted panel sequencing (TPS) has served as a key clinical tool over the past decade, but advancements in sequencing costs and bioinformatics have now made whole-genome sequencing (WGS) a feasible single-assay approach for almost all cancer genomes in clinical settings. This paper reports on the findings of a prospective, single-center study exploring the real-world clinical utility of WGS (tumor and matched normal tissues) and has two primary objectives: (1) assessing actionability for therapeutic options and (2) providing clarity for clinical questions. Of the 120 patients with various solid cancers who were enrolled, 95 (79%) successfully received genomic reports within a median of 11 working days from sampling to reporting. Analysis of these 95 WGS reports revealed that 72% (68/95) yielded clinically relevant insights, with 69% (55/79) pertaining to therapeutic actionability and 81% (13/16) pertaining to clinical clarity. These benefits include the selection of informed therapeutics and/or active clinical trials based on the identification of driver mutations, tumor mutational burden (TMB) and mutational signatures, pathogenic germline variants that warrant genetic counseling, and information helpful for inferring cancer origin. Our findings highlight the potential of WGS as a comprehensive tool in precision oncology and suggests that it should be integrated into routine clinical practice to provide a complete image of the genomic landscape to enable tailored cancer management.

Effect of papillary muscle and trabeculae on left ventricular function analysis via computed tomography: A cross-sectional study.

Deciding whether to include or exclude the papillary muscles and trabeculae to blood pool is essential, because quantifications of left ventricular (LV) functional parameters and myocardial mass are significantly affected. As a result, such inclusion or exclusion might produce different indices for diagnosis and therapy. Using cardiac computed tomography (CT), we obtained standard values of the portion of papillary muscle and trabeculae in normal adults, and to find out how the inclusion or exclusion of papillary muscle and trabeculae affect LV functional parameters depending on the patient group. Excluding the papillary muscles from the LV mass results in easier automated contour detection using CT. The percentage portions of papillary muscle and trabeculae to LV end-diastolic volume (EDV) and LV mass (LVM) were 11.9 ±â€…5.6% and 20.2 ±â€…4.3%, respectively, significantly affecting disease diagnosis. Imaging should be consistent at follow-up and include or exclude the papillary muscles and trabeculae to avoid introducing significant differences between measurements.

The diagnostic performance and clinical value of deep learning-based nodule detection system concerning influence of location of pulmonary nodule.

BACKGROUND: The deep learning-based nodule detection (DLD) system improves nodule detection performance of observers on chest radiographs (CXRs). However, its performance in different pulmonary nodule (PN) locations remains unknown. METHODS: We divided the CXR intrathoracic region into non-danger zone (NDZ) and danger zone (DZ). The DZ included the lung apices, paramediastinal areas, and retrodiaphragmatic areas, where nodules could be missed. We used a dataset of 300 CXRs (100 normal and 200 abnormal images with 216 PNs [107 NDZ and 109 DZ nodules]). Eight observers (two thoracic radiologists [TRs], two non-thoracic radiologists [NTRs], and four radiology residents [RRs]) interpreted each radiograph with and without the DLD system. The metric of lesion localization fraction (LLF; the number of correctly localized lesions divided by the total number of true lesions) was used to evaluate the diagnostic performance according to the nodule location. RESULTS: The DLD system demonstrated a lower LLF for the detection of DZ nodules (64.2) than that of NDZ nodules (83.2, p = 0.008). For DZ nodule detection, the LLF of the DLD system (64.2) was lower than that of TRs (81.7, p < 0.001), which was comparable to that of NTRs (56.4, p = 0.531) and RRs (56.7, p = 0.459). Nonetheless, the LLF of RRs significantly improved from 56.7 to 65.6 using the DLD system (p = 0.021) for DZ nodule detection. CONCLUSION: The performance of the DLD system was lower in the detection of DZ nodules compared to that of NDZ nodules. Nonetheless, RR performance in detecting DZ nodules improved upon using the DLD system. CRITICAL RELEVANCE STATEMENT: Despite the deep learning-based nodule detection system's limitations in detecting danger zone nodules, it proves beneficial for less-experienced observers by providing valuable assistance in identifying these nodules, thereby advancing nodule detection in clinical practice. KEY POINTS: • The deep learning-based nodule detection (DLD) system can improve the diagnostic performance of observers in nodule detection. • The DLD system shows poor diagnostic performance in detecting danger zone nodules. • For less-experienced observers, the DLD system is helpful in detecting danger zone nodules.

Clinical utility of early postoperative cardiac multidetector computed tomography after coronary artery bypass grafting.

We evaluated the clinical utility of early postoperative cardiac computed tomography (CT) for evaluating left ventricular (LV) function and predicting prognosis in patients who had undergone coronary artery bypass grafting (CABG). Of the 205 patients who underwent CABG from March 2011 to December 2014, 136 underwent early postoperative cardiac CT (within 30 days after CABG) and were enrolled as the study population. The baseline and postoperative follow-up echocardiographic findings, major adverse cardiac events (MACE), and death were recorded for a follow-up period (mean, 5.9 ± 1.1 years). Functional cardiac CT parameters were compared to echocardiographic measurements. The associations between cardiac CT findings and functional recovery and prognosis were evaluated by logistic regression analyses. The LVEF measured via cardiac CT was significantly higher (56.2 ± 11.5% vs. 61.9 ± 12.9%; p = 0.0002) compared to those via early postoperative echocardiography, but the wall motion score index (WMSI) was not significantly different (1.23 ± 0.33 vs. 1.21 ± 0.28, p = 0.5041) between the two methods. During the follow-up period, 17 patients (12.5%) died and 40 (29.4%) developed MACE. Both the LVEF and WMSI measured with early postoperative echocardiography (p = 0.0202 and odds ratio [OR] = 5.0171, p = 0.0039, respectively), and cardiac CT (OR = 0.9625, p = 0.0091 and OR = 14.3605, p = 0.0001, respectively) predicted MACE OR = 0.9630, but only the WMSI, measured using cardiac CT, predicted all-cause death (OR = 10.6017, p = 0.0035). In CABG patients, LVEF and the WMSI measured with early postoperative cardiac CT were comparable with echocardiography and predicted the development of MACE and all-cause death.

The feasibility of synthetic MRI in breast cancer patients: comparison of T2 relaxation time with multiecho spin echo T2 mapping method.

OBJECTIVE:: To compare the T2 relaxation times acquired with synthetic MRI to those of multi-echo spin-echo sequences and to evaluate the usefulness of synthetic MRI in the clinical setting. METHODS:: From January 2017 to May 2017, we included 51 patients with newly diagnosed breast cancer, who underwent additional synthetic MRI and multiecho spin echo (MESE) T2 mapping sequences. Synthetic MRI technique uses a multiecho and multidelay acquisition method for the simultaneous quantification of physical properties such as T1 and T2 relaxation times and proton density image map. A radiologist with 9 years of experience in breast imaging drew region of interests manually along the tumor margins on two consecutive axial sections including the center of tumor mass and in the fat tissue of contralateral breast on both synthetic T2 map and MESE T2 map images. RESULTS:: The mean T2 relaxation time of the cancer was 84.75 ms (± 15.54) by synthetic MRI and 90.35 ms (± 19.22) by MESE T2 mapping. The mean T2 relaxation time of the fat was 129.22 ms (± 9.53) and 102.11 ms (± 13.9), respectively. Bland-Altman analysis showed mean difference of 8.4 ms for the breast cancer and a larger mean difference of 27.8 ms for the fat tissue. Spearman's correlation test showed that there was significant positive correlation between synthetic MRI and MESE sequences for the cancer (r = 0.713, p < 0.001) and for the fat (r = 0.551, p < 0.001). The positive estrogen receptor and low histologic grade were associated with little differences between two methods (p = 0.02 and = 0.043, respectively). CONCLUSION:: T2 relaxation times of breast cancer acquired with synthetic MRI showed positive correlation with those of MESE T2 mapping. Synthetic MRI could be useful for the evaluation of tissue characteristics by simultaneous acquisition of several quantitative physical properties. ADVANCES IN KNOWLEDGE:: Synthetic MRI is useful for the evaluation of T2 relaxation times of the breast cancers.

Dependency on Smartphone Use and Its Association with Anxiety in Korea.

OBJECTIVE: South Korea has the highest rate of smartphone ownership worldwide, which is a potential concern given that smartphone dependency may have deleterious effects on health. We investigated the relationship between smartphone dependency and anxiety. METHODS: Participants included 1,236 smartphone-using students (725 men and 511 women) from six universities in Suwon, South Korea. Participants completed measures of smartphone use, smartphone dependency, anxiety, and general characteristics (i.e., demographic, health-related, and socioeconomic characteristics). To measure smartphone dependency and anxiety, we used questionnaires of Yang's test developed from Young's Internet Addiction Test and Zung's Self-Rating Anxiety Scale. We used multiple logistic regression to determine the association between smartphone dependency and anxiety after adjusting for relevant factors. RESULTS: On a scale from 25 to 100, with higher scores on the smartphone dependency test indicating greater dependency, women were significantly more dependent on smartphones than were men (mean smartphone dependency score: 50.7 vs. 56.0 for men and women, respectively, p<0.001). However, the amount of time spent using smartphones and the purpose of smartphone use affected smartphone dependency in both men and women. Particularly, when daily use time increased, smartphone dependency showed an increasing trend. Compared with times of use <2 hours vs. ≥6 hours, men scored 46.2 and 56.0 on the smartphone dependency test, while women scored 48.0 and 60.4, respectively (p<0.001). Finally, for both men and women, increases in smartphone dependency were associated with increased anxiety scores. With each one-point increase in smartphone dependency score, the risk of abnormal anxiety in men and women increased by 10.1% and 9.2%, respectively (p<0.001). CONCLUSION: Among this group of university students in South Korea, smartphone dependency appeared to be associated with increased anxiety. Standards for smartphone use might help prevent deleterious health effects.