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Li N, Gong W, Xie Y, Sheng L. Correlation between the CEM imaging characteristics and different molecular subtypes of breast cancer. Breast 2023; 72:103595. [PMID: 37925875 PMCID: PMC10661457 DOI: 10.1016/j.breast.2023.103595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/09/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
PURPOSE To investigate the correlation between the contrast-enhanced mammography (CEM) imaging characteristics and different molecular subtypes of breast cancer (BC). METHODS We retrospectively included 313 eligible female patients who underwent CEM examination and surgery in our hospital from July 2017 to July 2021. Their lesions were confirmed on histopathological examination and immunohistochemical analysis. BC was divided into luminal A, luminal B, HER2-enriched, and triple-negative BC (TNBC) subtypes according to immunohistochemical markers. Nine features were extracted from CEM images, including tumor shape, margins, spiculated mass, lobulated mass, malignant calcification, lesion conspicuity, internal enhancement pattern, multifocal mass, and swollen axillary lymph nodes. Statistical analysis was performed using SPSS 25.0. Univariate analysis and binomial regression were used to analyze the correlation between CEM imaging features and BC molecular subtypes. RESULTS There were 184 (58.8 %) Luminal A, 44 (14.1 %) Luminal B, 47 (15.0 %) HER-2-enriched and 38 (12.1 %) TNBC, respectively. Molecular subtypes were significantly related to the tumor shape, margins, spiculated mass, internal enhancement pattern, malignant calcification and swollen axillary lymph nodes. Spiculated and calcified tumors were associated with Luminal subtypes, especially Luminal B (P < 0.05). Irregular tumor shape and malignant calcification were associated with HER-2-enriched subtype (P < 0.05). Oval or round tumor shape, rim enhancement, and swollen axillary lymph nodes were associated with TNBC (P < 0.05). CONCLUSION CEM imaging features could distinguish BC molecular subtypes. In particular, TNBC showed oval or round tumor shape, rim enhancement, and swollen axillary lymph nodes, providing insights into the diagnosis and prognosis of TNBC.
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Affiliation(s)
- Na Li
- Department of Medical Imaging, Affiliated Hospital of Jining Medical University, Jining, 272000, China.
| | - Weiyun Gong
- Clinic Imaging Center, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, 271000, China
| | - Yuanzhong Xie
- Clinic Imaging Center, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, 271000, China
| | - Lei Sheng
- Clinic Imaging Center, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, 271000, China.
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Lee J, Park NJY, Park HY, Kim WW, Kang B, Keum H, Kim HJ, Kim WH, Chae YS, Lee SJ, Lee IH, Park JY, Jung JH. Oncologic necessity for the complete removal of residual microcalcifications after neoadjuvant chemotherapy for breast cancer. Sci Rep 2022; 12:21535. [PMID: 36513704 PMCID: PMC9748126 DOI: 10.1038/s41598-022-24757-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
The surgical range of breast cancer that shows pathologic complete response (pCR) without change in microcalcifications after neoadjuvant chemotherapy (NAC) is controversial. This study examined whole breast specimens to evaluate the necessity of mastectomy in those cases. The viability of cancer cells around the residual microcalcification was assessed using prospectively collected breast samples to confirm the presence or absence of cancer cells. A total of 144 patients with breast cancer and diffuse microcalcifications were classified into the reduced mass with no change in residual microcalcification (RESMIN, n = 49) and non-RESMIN (n = 95) groups. Five specimens were prospectively evaluated to assess the presence of viable cancer cells around the microcalcification. Tumor responses to NAC were significantly better with high pCR rates in the RESMIN group (p = 0.005 and p = 0.002). The incidence of human epidermal growth factor receptor 2-positive and triple-negative breast cancers was significantly high in the RESMIN group (p = 0.007). Although five (10.2%) patients had locoregional recurrence in the RESMIN group, no local recurrence in the breast was reported. Although pCR was highly estimated, residual cancers, including ductal carcinoma in situ, remained in 80% cases. Therefore, given the weak scientific evidence available currently, complete removal of residual microcalcifications should be considered for oncologic safety.
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Affiliation(s)
- Jeeyeon Lee
- grid.258803.40000 0001 0661 1556Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Nora Jee-Young Park
- grid.258803.40000 0001 0661 1556Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ho Yong Park
- grid.258803.40000 0001 0661 1556Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Wan Wook Kim
- grid.258803.40000 0001 0661 1556Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Byeongju Kang
- grid.258803.40000 0001 0661 1556Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Heejung Keum
- grid.258803.40000 0001 0661 1556Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Hye Jung Kim
- grid.258803.40000 0001 0661 1556Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Won Hwa Kim
- grid.258803.40000 0001 0661 1556Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Yee Soo Chae
- grid.258803.40000 0001 0661 1556Department of Hematology/Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Soo Jung Lee
- grid.258803.40000 0001 0661 1556Department of Hematology/Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - In Hee Lee
- grid.258803.40000 0001 0661 1556Department of Hematology/Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ji-Young Park
- grid.258803.40000 0001 0661 1556Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jin Hyang Jung
- grid.258803.40000 0001 0661 1556Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea ,grid.258803.40000 0001 0661 1556Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
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Dang X, Zhang X, Gao Y, Song H. Assessment of Neoadjuvant Treatment Response Using Automated Breast Ultrasound in Breast Cancer. J Breast Cancer 2022; 25:344-348. [PMID: 35914749 PMCID: PMC9411026 DOI: 10.4048/jbc.2022.25.e32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/20/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
Breast imaging techniques are used to assess the tumor response to neoadjuvant treatment (NAT), which is increasingly one of the preferred therapeutic options and increases the rate of breast conservation for breast cancer. Herein, we report a case in which a woman was diagnosed with invasive ductal carcinoma in the left breast and received NAT before surgery. Automated breast ultrasound (AB US) was regularly performed before and during the NAT to evaluate the tumor response to NAT by measuring diameter changes and volume reductions of the tumor. Images showed that the tumor size was significantly reduced and disappeared after 7 cycles of NAT, except for macrocalcification. Postoperative histopathological examination confirmed that there were no residual tumor cells. We found that AB US overcame the limitations of handheld US, such as operator dependence, poor reproducibility and limited field of view, and can be an alternative modality to assess the tumor response of NAT in the absence of magnetic resonance imaging (MRI) instruments.
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Affiliation(s)
- Xiaozhi Dang
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xin Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Yi Gao
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.
| | - Hongping Song
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
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Lin YH, Yao W, Fei Q, Wang Y. Gastric cancer with calcifications: A case report. World J Clin Cases 2021; 9:8135-8141. [PMID: 34621872 PMCID: PMC8462209 DOI: 10.12998/wjcc.v9.i27.8135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/21/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mucinous gastric carcinoma (MGC) is a rare histological type of gastric carcinoma. Calcifications, seen on imaging and histopathological preparations, and which are infrequent in other types of gastric carcinoma, are characteristic of MGC. We present a patient with MGC with calcifications of the gastric wall and describe the computerized tomography (CT) features of the lesion and changes in the calcifications before and after chemotherapy.
CASE SUMMARY A 61-year-old man was admitted to our hospital in May 2020 because of a large, tender abdominal mass. Abdominal CT showed diffuse, irregular thickening of the gastric walls, with miliary and punctate calcifications. There were metastases to the perigastric and retroperitoneal lymph nodes and also peritoneal seeding. Histological examination of a specimen obtained by endoscopic biopsy showed poorly differentiated calcified signet-ring cell gastric cancer. The patient was clinically staged with T4N+M1 disease. He was treated with docetaxel, cisplatin, and fluorouracil as first-line therapy, irinotecan combined with S-1 as second-line chemotherapy, and programmed cell death protein 1 as third-line therapy. The patient underwent a total of nine cycles of chemotherapy. Follow-up CT scans every 3 mo showed continually increasing calcifications. As of this writing, the patient has survived almost 1 year.
CONCLUSION In this case report, we describe the histopathological and imaging characteristics of a patient with gastric cancer receiving chemotherapy. Multiple punctate calcifications were seen, which gradually increased during chemotherapy. Several possible mechanisms for the calcifications are described, but further research is needed. Future findings may lead to new approaches for the evaluation and treatment of such tumors.
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Affiliation(s)
- Yu-He Lin
- Department of Oncology, China Medical University Affiliated Shengjing Hospital, Shenyang 110022, Liaoning Province, China
| | - Wei Yao
- Department of Surgery, China Medical University Affiliated Shengjing Hospital, Shenyang 110000, Liaoning Province, China
| | - Qian Fei
- Department of Oncology, China Medical University Affiliated Shengjing Hospital, Shenyang 110022, Liaoning Province, China
| | - Ying Wang
- Department of Oncology, China Medical University Affiliated Shengjing Hospital, Shenyang 110022, Liaoning Province, China
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Yim H, Ha T, Kang DK, Park SY, Jung Y, Kim TH. Change in microcalcifications on mammography after neoadjuvant chemotherapy in breast cancer patients: correlation with tumor response grade and comparison with lesion extent. Acta Radiol 2019; 60:131-139. [PMID: 29764199 DOI: 10.1177/0284185118776491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Hyunee Yim
- Department of Pathology, Ajou University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Taeyang Ha
- Department of Radiology, Ajou University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Doo Kyoung Kang
- Department of Radiology, Ajou University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Seong Young Park
- Department of Radiology, Ajou University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Yongsik Jung
- Department of Surgery, Ajou University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Tae Hee Kim
- Department of Radiology, Ajou University School of Medicine, Gyeonggi-do, Republic of Korea
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