Response of bilateral breasts to the endogenous hormonal fluctuation in a menstrual cycle evaluated using 3D MRI

Relationship Between Breast Ultrasound Background Echotexture and Magnetic Resonance Imaging Background Parenchymal Enhancement and the Effect of Hormonal Status Thereon

We studied the relationship between breast ultrasound background echotexture (BET) and magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and whether this relationship varied with hormonal status and amount of fibroglandular tissue (FGT) on MRI. Two hundred eighty-three Korean women (52.1 years; range = 27-79 years) with newly diagnosed primary breast cancer who underwent preoperative breast ultrasound and MRI were retrospectively studied. Background echotexture, BPE, and FGT were classified into 4 categories, and age, menopausal status, menstrual cycle regularity, and menstrual cycle stage at MRI were recorded. Background echotexture and BPE relationship was assessed overall, and in menopausal, FGT, menstrual cycle regularity, and menstrual cycle stage subgroups. Background echotexture and BPE correlated in women overall, and menopausal, FGT, and menstrual cycle subgroups and those in the first half of the cycle (all P < 0.001). Background echotexture reflects BPE, regardless of menopausal status, menstrual cycle regularity, and FGT and may be a biomarker of breast cancer risk.

Divergent Impact of Breast Cancer Laterality on Clinicopathological, Angiogenic, and Hemostatic Profiles: A Potential Role of Tumor Localization in Future Outcomes

To date, lateral differences of invasive breast cancer (IBrC) with respect to the angiogenic and hemostatic profiles were never studied. Here, we aimed to determine the relationship of tumor laterality with various clinical and pathological parameters including angiogenic and hemostatic profiles. A total of 92 women that were initially non-metastatic and treated by surgery were included in this single-center prospective study. Patients were grouped according to tumor localization. A four-year follow-up was accomplished in all patients with a 15.22% recurrence rate. An immunoassay of selected angiogenic and hemostatic parameters, as well as immunohistochemistry of estrogen and progesterone receptors, human epidermal growth factor receptor 2 (HER2), and Ki67, was comparatively performed in groups with right- and left-sided IBrC. The same analysis was carried out in a subgroup of patients with luminal A molecular subtype of cancer. Patients with right-sided tumors free of nodal involvement had a significantly longer overall survival compared to their left-sided counterparts (p = 0.0491). Additionally, right-sided tumors had a higher predisposition to be a luminal-A subtype of IBrC (p = 0.0016). Furthermore, 10% of left-sided tumors exhibited an overexpression of HER2, while only 2% patients suffering right-sided tumors displayed a positive score (p = 0.0357). Our findings revealed a significantly higher concentration of vascular endothelial growth factor (VEGF)-A (p = 0.0136), lower anti-angiogenic ratios (sVEGFR1/VEGF-A (p = 0.0208) and sVEGFR2/VEGF-A (p = 0.0068)), and elevated plasminogen activator inhibitor type 1 (PAI-1) (p = 0.0229) in patients with breast cancer localized in the left breast, regardless of the molecular subtype of IBrC. Our study showed that left-sided breast tumors without lymph node metastases demonstrate worse overall survival. Laterality of IBrC is associated with pro-angiogenic and pro-thrombotic conditions. We propose to consider laterality as a prognostic factor of IBrC.

Ethnic and age differences in right-left breast asymmetry in a large population-based screening population

OBJECTIVE

Exposure to sex hormones is important in the pathogenesis of breast cancer and inability to tolerate such exposure may be reflected in increased asymmetrical growth of the breasts. This study aims to characterize, for the first time, asymmetry in breast volume (BV) and radiodense volume (DV) in a large ethnically diverse population.

METHODS

Automated measurements from digital raw mammographic images of 54,591 cancer-free participants (aged 47-73) in a UK breast screening programme were used to calculate absolute (cm³) and relative asymmetry in BV and DV. Logistic regression models were fitted to assess asymmetry associations with age and ethnicity.

RESULTS

BV and DV absolute asymmetry were positively correlated with the corresponding volumetric dimension (BV or DV). BV absolute asymmetry increased, whilst DV absolute asymmetry decreased, with increasing age (P-for-linear-trend <0.001 for both). Relative to Whites, Blacks had statistically significantly higher, and Chinese lower, BV and DV absolute asymmetries. However, after adjustment for the corresponding underlying volumetric dimension the age and ethnic differences were greatly attenuated. Median relative (fluctuating) BV and DV asymmetry were 2.34 and 3.28% respectively.

CONCLUSION

After adjusting for the relevant volumetric dimension (BV or DV), age and ethnic differences in absolute breast asymmetry were largely resolved.

ADVANCES IN KNOWLEDGE

Previous small studies have reported breast asymmetry-breast cancer associations. Automated measurements of asymmetry allow the conduct of large-scale studies to further investigate these associations.

Quantitative Measurements of Breast Density Using Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis

Breast density, a measure of dense fibroglandular tissue relative to non-dense fatty tissue, is confirmed as an independent risk factor of breast cancer. Although there has been an increasing interest in the quantitative assessment of breast density, no research has investigated the optimal technical approach of breast MRI in this aspect. Therefore, we performed a systematic review and meta-analysis to analyze the current studies on quantitative assessment of breast density using MRI and to determine the most appropriate technical/operational protocol. Databases (PubMed, EMBASE, ScienceDirect, and Web of Science) were searched systematically for eligible studies. Single arm meta-analysis was conducted to determine quantitative values of MRI in breast density assessments. Combined means with their 95% confidence interval (CI) were calculated using a fixed-effect model. In addition, subgroup meta-analyses were performed with stratification by breast density segmentation/measurement method. Furthermore, alternative groupings based on statistical similarities were identified via a cluster analysis employing study means and standard deviations in a Nearest Neighbor/Single Linkage. A total of 38 studies matched the inclusion criteria for this systematic review. Twenty-one of these studies were judged to be eligible for meta-analysis. The results indicated, generally, high levels of heterogeneity between study means within groups and high levels of heterogeneity between study variances within groups. The studies in two main clusters identified by the cluster analysis were also subjected to meta-analyses. The review confirmed high levels of heterogeneity within the breast density studies, considered to be due mainly to the applications of MR breast-imaging protocols and the use of breast density segmentation/measurement methods. Further research should be performed to determine the most appropriate protocol and method for quantifying breast density using MRI.

Menstrual Cycle-Related Fluctuations in Breast Volume Measured Using Three-Dimensional Imaging: Implications for Volumetric Evaluation in Breast Augmentation

BACKGROUND

Breast volume is a key parameter of breast measurement in breast augmentation. However, the correlation between menstrual cycle phases and variation in breast volume has not been well studied.

METHODS

Young female patients with regular menstrual cycles underwent eight three-dimensional imaging scans during a single menstrual cycle from November 2017 to January 2018. Breast volumetric difference at each timepoint and basic breast volume were measured for each subject. Preovulatory phase and postovulatory phase values were compared using an unpaired t test. A Pearson's linear correlated analysis was performed to identify the correlation between the basic breast volume and maximum range of breast volumetric difference during the menstrual cycle.

RESULTS

Thirteen patients (26 breasts) met the inclusion criteria. During the menstrual cycle, the breast volumetric difference showed first a rising trend followed by a fall. A significant difference in the breast volumetric difference between the preovulatory phase and postovulatory phase (- 19.6 ± 2.1 ml pre-ovulation vs. - 6.9 ± 3.3 ml post-ovulation, p = 0.002) was noted. There was a positive linear association between breast volume and maximum range of breast volumetric difference when a Pearson correlation was used (r = 0.45, p = 0.021).

CONCLUSIONS

The breast volume fluctuates during the menstrual cycle, and there is a significant difference between the preovulatory phase and postovulatory phase for breast volumetric change. The influence of the menstrual cycle on breast volume should be taken into consideration by plastic surgeons performing breast augmentation.

LEVEL OF EVIDENCE IV

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Imaging and Clinical Features of an Unusual Unilateral Breast Enlargement Diagnosed as Fibrocystic Change: A Case Report

Patient: Female, 38

Final Diagnosis: Fibrocystic change

Symptoms: Breast swelling

Medication: —

Clinical Procedure: Breast biopsy

Specialty: Radiology

Near Field Breast Tumor Detection Using Ultra-Narrow Band Probe with Machine Learning Techniques

In this work, we propose a near-field microwave sensing modality that uses a single probe combined with a classification algorithm to help in detecting the presence of tumors in the human female breast. The concept employs a near-field resonant probe with an ultra-narrow frequency response. The resonant probe is highly sensitive to the changes in the electromagnetic properties of the breast tissues such that the presence of the tumor is gauged by determining the changes in the magnitude and phase response of the sensor's reflection coefficient. A key feature of our proposed detection concept is the simultaneous sensing of tissue property changes to the two female breasts since the right and left healthy breasts are morphologically and materially identical. Once the probe response is recorded for both breasts, the Principle Component Analysis (PCA) method is employed to emphasize the difference in the probe responses. For validation of the concept, tumors embedded in a realistic breast phantoms were simulated. To provide additional confidence in the detection modality introduced here, experimental results of three different sizes of metallic spheres, mimicking tumors, inserted inside chicken and beef meat were detected using an electrically-small probe operating at 200 MHz. The results obtained from the numerical tests and experiments strongly suggest that the detection modality presented here might lead to an inexpensive and portable early and regular screening for breast tumor.

Comprehensive analysis of haemostatic profile depending on clinicopathological determinants in breast cancer patients

Thrombosis is one of the leading causes of mortality in cancer patients. The aim of the study was to evaluate the concentrations and activities of selected haemostatic parameters in the plasma of patients diagnosed with breast cancer (BrCa) and to make an attempt at finding associations with their levels and selected clinicopathological factors; clinical classification, histological grading, and molecular subtype of BrCa. The study involved 145 Caucasian ethnicity women. Eighty-five women aged 45-66 with primary BrCa without distant metastases (M0). Inclusion criteria were as follows: histopathological examination confirming the diagnosis of primary BrCa, without previous radiotherapy and chemotherapy. The control group consisted of 60, post-menopausal women, aged 45-68. Haemostatic profile expressed by concentrations and activities of tissue factor (TF) and its inhibitor (TFPI) as well as concentrations of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) were measured applying immunoassay techniques. A significantly higher concentration of PAI-1 was noted in patients with BrCa localized in the left breast. We observed significantly lower activity of TFPI and significantly higher concentration of PAI-1 in the group of patients with invasive ductal carcinoma as compared with invasive lobular carcinoma. A significantly higher concentration of t-PA in patients with pT2 BrCa in relation to pT1 cases was noted. Based on comprehensive analysis of haemostatic profile depending on clinicopathological features, we suggest that haemostatic parameters play crucial roles in invasion and metastases of malignant tumours.