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Wang M, Du S, Gao S, Zhao R, Liu S, Jiang W, Peng C, Chai R, Zhang L. MRI-based tumor shrinkage patterns after early neoadjuvant therapy in breast cancer: correlation with molecular subtypes and pathological response after therapy. Breast Cancer Res 2024; 26:26. [PMID: 38347619 PMCID: PMC10863121 DOI: 10.1186/s13058-024-01781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/09/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND MRI-based tumor shrinkage patterns (TSP) after neoadjuvant therapy (NAT) have been associated with pathological response. However, the understanding of TSP after early NAT remains limited. We aimed to analyze the relationship between TSP after early NAT and pathological response after therapy in different molecular subtypes. METHODS We prospectively enrolled participants with invasive ductal breast cancers who received NAT and performed pretreatment DCE-MRI from September 2020 to August 2022. Early-stage MRIs were performed after the first (1st-MRI) and/or second (2nd-MRI) cycle of NAT. Tumor shrinkage patterns were categorized into four groups: concentric shrinkage, diffuse decrease (DD), decrease of intensity only (DIO), and stable disease (SD). Logistic regression analysis was performed to identify independent variables associated with pathologic complete response (pCR), and stratified analysis according to tumor hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) disease subtype. RESULTS 344 participants (mean age: 50 years, 113/345 [33%] pCR) with 345 tumors (1 bilateral) had evaluable 1st-MRI or 2nd-MRI to comprise the primary analysis cohort, of which 244 participants with 245 tumors had evaluable 1st-MRI (82/245 [33%] pCR) and 206 participants with 207 tumors had evaluable 2nd-MRI (69/207 [33%] pCR) to comprise the 1st- and 2nd-timepoint subgroup analysis cohorts, respectively. In the primary analysis, multivariate analysis showed that early DD pattern (OR = 12.08; 95% CI 3.34-43.75; p < 0.001) predicted pCR independently of the change in tumor size (OR = 1.37; 95% CI 0.94-2.01; p = 0.106) in HR+/HER2- subtype, and the change in tumor size was a strong pCR predictor in HER2+ (OR = 1.61; 95% CI 1.22-2.13; p = 0.001) and triple-negative breast cancer (TNBC, OR = 1.61; 95% CI 1.22-2.11; p = 0.001). Compared with the change in tumor size, the SD pattern achieved a higher negative predictive value in HER2+ and TNBC. The statistical significance of complete 1st-timepoint subgroup analysis was consistent with the primary analysis. CONCLUSION The diffuse decrease pattern in HR+/HER2- subtype and stable disease in HER2+ and TNBC after early NAT could serve as additional straightforward and comprehensible indicators of treatment response. TRIAL REGISTRATION Trial registration at https://www.chictr.org.cn/ . REGISTRATION NUMBER ChiCTR2000038578, registered September 24, 2020.
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Affiliation(s)
- Mengfan Wang
- Department of Radiology, The First Hospital of China Medical University, Nanjing North Street 155, Shenyang, 110001, Liaoning Province, China
| | - Siyao Du
- Department of Radiology, The First Hospital of China Medical University, Nanjing North Street 155, Shenyang, 110001, Liaoning Province, China
| | - Si Gao
- Department of Radiology, The First Hospital of China Medical University, Nanjing North Street 155, Shenyang, 110001, Liaoning Province, China
| | - Ruimeng Zhao
- Department of Radiology, The First Hospital of China Medical University, Nanjing North Street 155, Shenyang, 110001, Liaoning Province, China
| | - Shasha Liu
- Department of Radiology, The First Hospital of China Medical University, Nanjing North Street 155, Shenyang, 110001, Liaoning Province, China
| | - Wenhong Jiang
- Department of Radiology, The First Hospital of China Medical University, Nanjing North Street 155, Shenyang, 110001, Liaoning Province, China
| | - Can Peng
- Department of Radiology, The First Hospital of China Medical University, Nanjing North Street 155, Shenyang, 110001, Liaoning Province, China
| | - Ruimei Chai
- Department of Radiology, The First Hospital of China Medical University, Nanjing North Street 155, Shenyang, 110001, Liaoning Province, China
| | - Lina Zhang
- Department of Radiology, The First Hospital of China Medical University, Nanjing North Street 155, Shenyang, 110001, Liaoning Province, China.
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Chen Z, Huang M, Lyu J, Qi X, He F, Li X. Machine learning for predicting breast-conserving surgery candidates after neoadjuvant chemotherapy based on DCE-MRI. Front Oncol 2023; 13:1174843. [PMID: 37621690 PMCID: PMC10446166 DOI: 10.3389/fonc.2023.1174843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
Purpose This study aimed to investigate a machine learning method for predicting breast-conserving surgery (BCS) candidates, from patients who received neoadjuvant chemotherapy (NAC) by using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) obtained before and after NAC. Materials and methods This retrospective study included 75 patients who underwent NAC and breast surgery. First, 3,390 features were comprehensively extracted from pre- and post-NAC DCE-MRIs. Then patients were then divided into two groups: type 1, patients with pathologic complete response (pCR) and single lesion shrinkage; type 2, major residual lesion with satellite foci, multifocal residual, stable disease (SD), and progressive disease (PD). The logistic regression (LR) was used to build prediction models to identify the two groups. Prediction performance was assessed using the area under the curve (AUC), accuracy, sensitivity, and specificity. Results Radiomics features were significantly related to breast cancer shrinkage after NAC. The combination model achieved an AUC of 0.82, and the pre-NAC model was 0.64, the post-NAC model was 0.70, and the pre-post-NAC model was 0.80. In the combination model, 15 features, including nine wavelet-based features, four Laplacian-of-Gauss (LoG) features, and two original features, were filtered. Among these selected were four features from pre-NAC DCE-MRI, six were from post-NAC DCE-MRI, and five were from pre-post-NAC features. Conclusion The model combined with pre- and post-NAC DCE-MRI can effectively predict candidates to undergo BCS and provide AI-based decision support for clinicians with ensured safety. High-order (LoG- and wavelet-based) features play an important role in our machine learning model. The features from pre-post-NAC DCE-MRI had better predictive performance.
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Affiliation(s)
| | | | | | | | | | - Xiang Li
- Department of Radiology, the Second Hospital of Dalian Medical University, Dalian, China
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Zheng CH, Xu K, Shan WP, Zhang YK, Su ZD, Gao XJ, Wang YJ, Qi JY, Ding XY, Wang CP, Wang YS. Meta-Analysis of Shrinkage Mode After Neoadjuvant Chemotherapy for Breast Cancers: Association With Hormonal Receptor. Front Oncol 2022; 11:617167. [PMID: 35444932 PMCID: PMC9014257 DOI: 10.3389/fonc.2021.617167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Patients with concentric shrinkage mode after neoadjuvant chemotherapy (NAC) is considered to be ideal candidates for breast conserving treatment (BCT). While, what proportion of patients would represent CSM have not been well defined. This study was conducted to pool the rates of concentric shrinkage mode (CSM) in patients undergoing NAC, determine the impact of hormonal receptor on the shrinkage mode after NAC and estimate the rates of the CSM in various subgroups. Methods We conducted a systematic review following the guidelines for Meta-Analyses and Systematic reviews for the PRISMA guidelines. We systematically searched the literature about shrinkage mode after NAC from PubMed, Web of Science, Embase, The Cochrane Library, CNKI, Wanfang database published from January 2002 to June 2020 on breast cancer shrinkage mode after NAC and carefully screened the literature by using eligibility criteria: (1) patients with primary breast cancer treated with NAC; (2) publications with available data of shrinkage mode measured by magnetic resonance imaging (MRI), or data of pathology and hormonal receptor. The association between shrinkage mode and hormonal receptor was estimated using Stata 15.1 software. Results This analysis included a total of 2434 tumors from 23 papers. The included studies were heterogeneous (I2 = 89.4%, P<0.01). Random effects model was used to estimate the overall rates of CSM: 56.6% [95%CI (50.5%, 62.7%)]. According to the analysis of hormonal receptor, 10 of the paper was included for HR+ (hormone receptor positive) type analysis and the rate of CSM for HR+ type was 45.7% [95%CI (36.4%, 55.0%)]; 9 of the paper was used for HR- type (hormone receptor negative) analysis and the incidence of HR-CSM is 63.1% [95%CI (50.0%, 76.1%)]; with HR+ type as the control, the OR of the HR- CSM rate is 2.32 (1.32, 4.08) folds of HR+ type. From subgroup analyses, the CSM% of luminal A, luminal B, Her2+, and triple negative were 29.7% (16.5%, 42.8%); 47.2% (19.1%, 75.3%); 59.0% (39.7%, 78.3%); 66.2% (52.8%, 79.6%), respectively. Conclusions Breast cancer patients undergoing NAC did not get an ideal odds ratio of CSM. The incidence of CSM in breast cancer after NAC is associated with hormonal receptor. Patients with triple-negative breast cancers have the highest rates of CSM after NAC. More care should be taken to select patients with the luminal subtypes for BCT throughout NAC.
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Affiliation(s)
- Chun-Hui Zheng
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.,Department of Breast Surgery, Weifang People's Hospital, Weifang, China
| | - Kai Xu
- Department of Preventive Medicine, Weifang Medical University, Weifang, China.,Department of Radiology and Environmental Medicine, China Institute for Radiation Protection, Taiyuan, China
| | - Wen-Ping Shan
- Department of Preventive Medicine, Weifang Medical University, Weifang, China
| | - Ya-Kun Zhang
- Department of Anesthesiology, Weifang People's Hospital, Weifang, China
| | - Zhi-De Su
- Department of Pharmacy, Weifang People's Hospital, Weifang, China
| | - Xiang-Jin Gao
- Department of Preventive Medicine, Weifang Medical University, Weifang, China
| | - Yu-Jue Wang
- School of Dentistry, University of California Los Angeles, Los Angeles, CA, United States
| | - Jian-Yu Qi
- Department of Preventive Medicine, Weifang Medical University, Weifang, China
| | - Xiao-Yan Ding
- Department of Laboratory Medicine, Key Laboratory of Clinical Laboratory Diagnostics in Universities of Shandong, Weifang Medical University, Weifang, China
| | - Chun-Ping Wang
- Department of Preventive Medicine, Weifang Medical University, Weifang, China
| | - Yong-Sheng Wang
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Abstract
The incidence of breast cancer in younger women is rising. Although early-onset breast cancer is highly associated with biologically aggressive tumors such as triple-negative and human epidermal growth factor 2 (HER2)-positive cancers, the more recent increase is disproportionately driven by an increase in the incidence of luminal cancer. In particular, the increase in de novo stage IV disease and the inherent age-based poorer survival rate among younger women with even early-stage luminal cancers suggest underlying distinct biologic characteristics that are not well understood. Further contributing to the higher number of early-onset breast cancers is pregnancy-associated breast cancer (PABC), which is attributed to persistent increases in maternal age over time. Although guidelines for screening of patients who carry a BRCA1 or BRCA2 gene mutation are well established, this population comprises only a fraction of those with early-onset breast cancer. A lack of screening in most young patients precludes timely diagnosis, underscoring the importance of early education and awareness. The disproportionate disease burden in young women of certain racial and ethnic groups, which is further exacerbated by socioeconomic disparity in health care, results in worse outcomes. An invited commentary by Monticciolo is available online. ©RSNA, 2022.
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Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Naziya Samreen
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Samantha L Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
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Li L, Zhang Q, Qian C, Lin H. Impact of Preoperative Magnetic Resonance Imaging on Surgical Outcomes in Women with Invasive Breast Cancer: A Systematic Review and Meta-Analysis. Int J Clin Pract 2022; 2022:6440952. [PMID: 36081810 PMCID: PMC9436630 DOI: 10.1155/2022/6440952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Currently, whether magnetic resonance imaging (MRI) should be routinely applied to patients with breast cancer before surgery remains controversial. A pooled analysis of the association between preoperative MRI and surgical outcomes in female patients with newly diagnosed invasive breast cancer was conducted to provide evidence-based medicine for clinical practice. METHODS Three independent researchers searched the following databases: PubMed, Medline, Embase, Ovid, Cochrane Library, and Web of Science from inception to April 2022. Literature was included and excluded according to Cochrane's principles. The basic information from eligible documents was extracted. Systematic evaluation and meta-analysis were performed, and the odds ratio (OR) was analyzed by the random-effect model. The quality of the literature was assessed using the modified Jadad scale and the Newcastle-Ottawa (NOS) mean scale. RESULTS A total of 19 studies were included, including 4 randomized controlled trials and 15 observational comparative studies. Among them, most studies were not limited to a specific pathological type, with the exception of 3 that were limited to invasive lobular carcinoma. The results showed that preoperative MRI examination would significantly reduce the reoperation rate (OR = 0.77, P=0.02) and increase the mastectomy rate (OR = 1.36, P=0.001). In comparison, preoperative MRI did not significantly affect the rate of secondary mastectomy (OR = 0.77, P=0.02), the rate of positive margin (OR = 1.08, P=0.66), the rate of mastectomy (OR = 1.00, P < 0.05), and reoperations (OR = 0.65, P=0.19) in the subgroup analysis of patients with invasive lobular carcinoma. CONCLUSION Available evidence suggests that preoperative MRI examination increases the rate of mastectomy and reduces the rate of reoperations. The results indicate that preoperative MRI examination has the potential to benefit patients with breast cancer, but more high-quality studies are needed for confirmation.
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Affiliation(s)
- Li Li
- Department of Medical Imaging, Haikou Maternal and Child Health Hospital, Haikou 570203, China
| | - Qinghong Zhang
- Department of Breast Surgery, Haikou Maternal and Child Health Hospital, Haikou 570203, China
| | - Chunrui Qian
- Department of Radiology, Haikou Hospital of Traditional Chinese Medicine, Haikou 570216, China
| | - Huien Lin
- Department of Medical Imaging, Haikou Maternal and Child Health Hospital, Haikou 570203, China
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Steinhof-Radwańska K, Grażyńska A, Lorek A, Gisterek I, Barczyk-Gutowska A, Bobola A, Okas K, Lelek Z, Morawska I, Potoczny J, Niemiec P, Szyluk K. Contrast-Enhanced Spectral Mammography Assessment of Patients Treated with Neoadjuvant Chemotherapy for Breast Cancer. Curr Oncol 2021; 28:3448-3462. [PMID: 34590596 PMCID: PMC8482113 DOI: 10.3390/curroncol28050298] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Evaluating the tumor response to neoadjuvant chemotherapy is key to planning further therapy of breast cancer. Our study aimed to evaluate the effectiveness of low-energy and subtraction contrast-enhanced spectral mammography (CESM) images in the detection of complete response (CR) for neoadjuvant chemotherapy (NAC) in breast cancer. Methods: A total of 63 female patients were qualified for our retrospective analysis. Low-energy and subtraction CESM images just before the beginning of NAC and as a follow-up examination 2 weeks before the end of chemotherapy were compared with one another and assessed for compliance with the postoperative histopathological examination (HP). The response to preoperative chemotherapy was evaluated based on the RECIST 1.1 criteria (Response Evaluation Criteria in Solid Tumors). Results: Low-energy images tend to overestimate residual lesions (6.28 mm) and subtraction images tend to underestimate them (2.75 mm). The sensitivity of low-energy images in forecasting CR amounted to 33.33%, while the specificity was 92.86%. In the case of subtraction CESM, the sensitivity amounted to 85.71% and the specificity to 71.42%. Conclusions: CESM is characterized by high sensitivity in the assessment of CR after NAC. The use of only morphological assessment is insufficient. CESM correlates well with the size of residual lesions on histopathological examination but tends to underestimate the dimensions.
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Affiliation(s)
- Katarzyna Steinhof-Radwańska
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland;
- Correspondence: ; Tel.: +48-32-358-1350
| | - Anna Grażyńska
- Students’ Scientific Society, Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (A.G.); (K.O.); (Z.L.); (I.M.); (J.P.)
| | - Andrzej Lorek
- Department of Oncological Surgery, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland;
| | - Iwona Gisterek
- Department of Oncology and Radiotherapy, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (I.G.); (A.B.)
| | - Anna Barczyk-Gutowska
- Department of Radiology and Nuclear Medicine, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland;
| | - Agnieszka Bobola
- Department of Oncology and Radiotherapy, Prof. Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (I.G.); (A.B.)
| | - Karolina Okas
- Students’ Scientific Society, Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (A.G.); (K.O.); (Z.L.); (I.M.); (J.P.)
| | - Zuzanna Lelek
- Students’ Scientific Society, Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (A.G.); (K.O.); (Z.L.); (I.M.); (J.P.)
| | - Irmina Morawska
- Students’ Scientific Society, Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (A.G.); (K.O.); (Z.L.); (I.M.); (J.P.)
| | - Jakub Potoczny
- Students’ Scientific Society, Department of Radiology and Nuclear Medicine, Medical University of Silesia, Medyków 18, 40-514 Katowice, Poland; (A.G.); (K.O.); (Z.L.); (I.M.); (J.P.)
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland;
| | - Karol Szyluk
- 1st Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62, 41-940 Piekary Śląskie, Poland;
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Reis J, Thomas O, Lahooti M, Lyngra M, Schandiz H, Boavida J, Gjesdal KI, Sauer T, Geisler J, Geitung JT. Correlation between MRI morphological response patterns and histopathological tumor regression after neoadjuvant endocrine therapy in locally advanced breast cancer: a randomized phase II trial. Breast Cancer Res Treat 2021; 189:711-723. [PMID: 34357493 PMCID: PMC8505284 DOI: 10.1007/s10549-021-06343-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE To correlate MRI morphological response patterns with histopathological tumor regression grading system based on tumor cellularity in locally advanced breast cancer (LABC)-treated neoadjuvant with third-generation aromatase inhibitors. METHODS Fifty postmenopausal patients with ER-positive/HER-2-negative LABC treated with neoadjuvant letrozole and exemestane given sequentially in an intra-patient cross-over regimen for at least 4 months with MRI response monitoring at baseline as well as after at least 2 and 4 months on treatment. The MRI morphological response pattern was classified into 6 categories: 0/complete imaging response; I/concentric shrinkage; II/fragmentation; III/diffuse; IV/stable; and V/progressive. Histopathological tumor regression was assessed based on the recommendations from The Royal College of Pathologists regarding tumor cellularity. RESULTS Following 2 and 4 months with therapy, the most common MRI pattern was pattern II (24/50 and 21/50, respectively). After 4 months on therapy, the most common histopathological tumor regression grade was grade 3 (21/50). After 4 months an increasing correlation is observed between MRI patterns and histopathology. The overall correlation, between the largest tumor diameter obtained from MRI and histopathology, was moderate and positive (r = 0.50, P-value = 2e-04). Among them, the correlation was highest in type IV (r = 0.53). CONCLUSION The type II MRI pattern "fragmentation" was more frequent in the histopathological responder group; and types I and IV in the non-responder group. Type II pattern showed the best endocrine responsiveness and a relatively moderate correlation between sizes obtained from MRI and histology, whereas type IV pattern indicated endocrine resistance but the strongest correlation between MRI and histology.
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Affiliation(s)
- Joana Reis
- Department of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus AHUS, University of Oslo, Postboks 1000, 1478, Lørenskog, Norway. .,Translational Cancer Research Group, Akershus University Hospital (AHUS), Postboks 1000, 1478, Lørenskog, Norway.
| | - Owen Thomas
- grid.411279.80000 0000 9637 455XHealth Services Research Department, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Maryam Lahooti
- grid.411279.80000 0000 9637 455XDepartment of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Marianne Lyngra
- grid.411279.80000 0000 9637 455XDepartment of Pathology, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Hossein Schandiz
- grid.411279.80000 0000 9637 455XDepartment of Pathology, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Joao Boavida
- grid.411279.80000 0000 9637 455XDepartment of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Kjell-Inge Gjesdal
- grid.411279.80000 0000 9637 455XDepartment of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway ,Sunnmøre MR-Clinic, Agrinorbygget, Langelansveg 15, 6010 Ålesund, Norway
| | - Torill Sauer
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Campus AHUS, University of Oslo, Postboks 1000, 1478 Lørenskog, Norway ,grid.411279.80000 0000 9637 455XTranslational Cancer Research Group, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway ,grid.411279.80000 0000 9637 455XDepartment of Pathology, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Jürgen Geisler
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Campus AHUS, University of Oslo, Postboks 1000, 1478 Lørenskog, Norway ,grid.411279.80000 0000 9637 455XTranslational Cancer Research Group, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway ,grid.411279.80000 0000 9637 455XDepartment of Oncology, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway
| | - Jonn Terje Geitung
- grid.411279.80000 0000 9637 455XDepartment of Diagnostic Imaging and Intervention, Akershus University Hospital (AHUS), Postboks 1000, 1478 Lørenskog, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Campus AHUS, University of Oslo, Postboks 1000, 1478 Lørenskog, Norway
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